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27 week pregnant. AFI is 3.7. How to treat this and what precaution should be taken?

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My daughter pregnancy week is 27 and her AFI is 3.7. Around 15 days back it was more that 5. How we can treat this? What precautions? We are too much worried in this regard. Any specific rest is required? She is in job and have lot of sitting work, travelling by car around 50 kms to and from every day. This is her first child / pregnancy. XXXXXX
Posted Mon, 13 Aug 2012 in Early Pregnancy Signs and Symptoms
 
 
Answered by Dr. Sourav Ganguly 1 hour later
Hello XXXXXX,
Thanks for writing in.
Your daughter needs admission to a tertiary level hospital and needs total bed rest. The bed rest has to be in the right lateral position.
She also needs to take plenty of fluids. Everyday, she should keep a tab on the fetal kicks. If she is experiencing fewer kicks than normal, she needs to tell her physician immediately.
She needs to be monitored with weekly ultrasounds to make sure that the baby is doing well.
A more drastic treatment such as amnio-infusion or an early delivery by induction of labor would be needed if the child’s condition is deteriorating or amniotic fluid volume doesn’t increase after expectant management.
Please consult a gynecologist as soon as possible to detect the cause and about the next steps ahead.
Hope I have answered your query. If you have any further questions I will be happy to help
Wish your daughter a speedy recovery.
Regards,
Dr Sourav Ganguly
Above answer was peer-reviewed by
 
Follow-up: 27 week pregnant. AFI is 3.7. How to treat this and what precaution should be taken? 44 hours later
Dear Dr. Ganguly,

I was expecting a reply from Gyaenocologist. Any ways.

Two latest Ultrasound reports are uploaded. Some input in my earlier query may be wrong.

Kindly advise based on two US reports uploaded today. What precautions are to be taken - sitting postures - at home / office, bed rest any, upto what time she may continue to keep going to office, any medications pl.

With best regards,

XXXXXX
 
 
Answered by Dr. Sourav Ganguly 3 hours later
Hi,

Thanks for writing back.

I believe that my earlier reply was not very convincing. As a general physician, I have been associated with many gynecology patients, so let me try today to provide you with a useful answer.

I have seen your both USG report. The earlier report (16.06.12) showed AFI value of 5.1(which is below normal but we can only call it oligohydramnios, if AFI value below 5) and in the later report (21.07.12) the AFI value is 12, so that is in the normal range. Others parameters of fetus are also within normal limit.

That means previously she had less liquor but presently it is adequate.

At this point of time, she with her baby, is fine but please follows some basic suggestions

1.     The bed rest has to be in the right lateral position.

2.     She also needs to take plenty of fluids.

3.     Every day, she should keep a count on the fetal kicks. If she is experiencing fewer kicks than normal, she needs to tell her obstetrician immediately.

4.     She needs to be monitored with monthly ultrasounds to see the AFI and condition of the baby.

5.     Avoid driving car or a long distance journey until the term of her pregnancy.

Please consult a gynecologist as soon as possible to detect the cause and about the next steps ahead.

Hope I have answered your query. If you have any further questions, I will be happy to help.

If you do not have any clarifications, you can close the discussion, rate the answer, and write a review for me.

Wish your daughter a speedy recovery.

Regards,
Dr Sourav Ganguly
Above answer was peer-reviewed by
 
Follow-up: 27 week pregnant. AFI is 3.7. How to treat this and what precaution should be taken? 2 hours later
Dear Dr. Saheb,

Thanks a lot. She is under treatment of a gyanecologist at Ghazibad (Dr. XXXXXXX XXXXXXX MD in Gyanecology). She has prescribed her ARG-9 XXXXXXX + some other medicines like Fe / Ca etc.

In earlier report (16.6.2012), AFI was not given and maximal aminiotic fluid pocket depth was mentioned as 51mm i.e. 5.1 cm. Is it AFI? No AFI is given in earlier report. In recent report, AFI is 12cms (the largest pocket measuring 3.9 cms).

Is this is a reduction in level from 5.1 cm to 3.9 cm as doctor seeing her has not given any comment on her old report and shows concern only this time.

Is she has to go for bed rest or while she is sleeping, she has to take right lateral position. Next sonography will be done tomorrow or on 2.8.2012.

I am sorry for hurting you by saying that reply was expected from a gyanecologist.

As a family history, me, my elder daughter and this daughter suffers Thalesmia Minor. Does this has impact in AFI as elder daughter XXXXXXX suffers with low AFI, steriods were given for foetus lungs development, cesarian pre mature delivery by around 4 weeks. Is AFI also is heredeory? In 1983, 1985 my wife has never gone for USG and both were normal deliveries (last one was with foreceps).

Is medication also prescribed on this forum?

With best regards,
XXXXXX
 
 
Answered by Dr. Sourav Ganguly 4 hours later
Hi,

Thanks for writing back.

To determine the AFI, doctors may use a four-quadrant technique, when the deepest, unobstructed, vertical length of each pocket of fluid is measured in each quadrant and then added up to the others, or the so called "Single Deepest Pocket" technique

So in your first report maximal amniotic fluid pocket depth of 5.1 cm is not mean AFI is 5.1 but as you can assume if all quadrant deepest pocket is equal then AFI in this cases was around 20 which was normal and majority of the cases all four quadrant deepest pocket are not equal so we don’t use single pocket depth, we always use AFI and your first case I am not sure why they used that but your second USG it is definitely within normal limit but assuming first report was true then there is reduction of maximal amniotic fluid pocket depth but still it is within normal range.

Thalassemia disease does not predispose towards oligohydramnios (reduced amniotic fluid volume).

Yes, in this forum I cannot prescribe you medications. But I can tell that what your doctor prescribed is perfectly correct. You please follow it.

Hope I have answered your query. If you have any further questions, I will be happy to help.
If you do not have any clarifications, you can close the discussion, rate the answer, and write a review for me.

Wish your daughter a speedy recovery.

Regards,
Dr Sourav Ganguly
Above answer was peer-reviewed by
 
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