A survey of perinatologists: amniotic fluid index or deepest vertical pocket?

INTRODUCTION: A 2009 Cochrane review found that amniotic fluid index use increases the rates of oligohydramnios and labor induction in singletons without improvement of perinatal outcomes when compared with the use of the deepest vertical pocket. We sought to determine the use of either amniotic fluid index or deepest vertical pocket among Society of Maternal-Fetal Medicine members.

METHODS: Registered Society of Maternal-Fetal Medicine members were contacted by mail from September 2012 and February 2013 and asked to participate in a web-based survey addressing the use of amniotic fluid index and deepest vertical pocket.

RESULTS: Two hundred twelve members participated (9.9%). Deepest vertical pocket was considered the most accurate method of evaluating amniotic fluid in the second trimester regardless of years since fellowship (10 years or less 61.8% compared with 10 years or greater 68.9%, P=.18) or practice type (academic 35.5% compared with nonacademic 47.1%, P=.36). Amniotic fluid index was considered the most accurate method of evaluating fluid in the third trimester regardless of years since fellowship (10 years or less 60.3% compared with greater than 10 years 53.9%, P=.59) or practice type (academic 62.7% compared with nonacademic 73.9%, P=.50). Most respondents thought antepartum interventions were more common when fluid is documented as low by amniotic fluid index (). One hundred eleven respondents (52.3%) replied oligohydramnios is overdiagnosed when using amniotic fluid index compared with deepest vertical pocket. Of 72 using amniotic fluid index, 50% replied they were unsure the Cochrane review merited a practice change, 41.7% replied that it is hard to change from using amniotic fluid index, and 30.6% thought more data favoring deepest vertical pocket are needed.(Figure is included in full-text article.)

CONCLUSION: : Variations in evaluating amniotic fluid persist, suggesting the need for consensus in the diagnosis and management of low amniotic fluid in singleton gestations.