Amniotic fluid volume and onset of labor in physiological pregnancy

We measure, by means of ultrasound, the amniotic fluid volume (expressed as maximal vertical pocket or MVP) in 646 normal pregnancies at the 39th gestational week. Our aim is to evaluate the possible correlation between MVP and onset of the labor. In a 2-week follow-up, the onset of the labor is considered the "event" variable in a time-dependent statistical analysis. Univariate analysis (Kaplan-Meier algorithm) describes a different trend in predicting the onset of labor when a stratification of MVP < 50 and > or = 50 mm was performed (chi2 = 7.91 p < 0.0049 with 1 df, Breslow-Gehan test). The first category was comprised of 496 fetuses with a median (min-max) MVP of 39 mm (25-49), the second category of 150 fetuses with a MVP of 57 mm (50-100). The results suggest that lower levels of MVP are associated to a higher percentage of the onset of labor. Furthermore, in our measurement, performed at the 39th gestational week, the correlation with the events is higher within the 40th gestational week. In fact, at 7 days from the amniotic fluid measurement, the onset of labor and the subsequent delivery is observed in 80.65 and 73.00% of the cases when they are stratified according to MVP < 50 and > or = 50 mm. At the end of the follow-up, instead, the percentage of "events" is similar, 88.10 and 86.67%, respectively. Adjustment for covariates (Cox analysis), as well as maternal age, neonatal weight, and obstetrics history, show an odds ratio (95% C.I.) of 2.08 (1.61-2.69) for MVP, using the above cutoff level. In physiological pregnancy, lower levels of amniotic fluid at term correlated to a higher probability of the onset of labor.