Amniotic fluid distribution in predicting perinatal outcome in patients with ruptured membranes

To determine if amniotic fluid distribution predicts perinatal outcome in women with spontaneously ruptured membranes.

Patients presenting for labor and delivery with spontaneously ruptured membranes had amniotic fluid indices determined upon admission. Those with greater than 50% of their amniotic fluid in the upper quadrants were placed in the upper-greater group and those with greater than 50% in the lower quadrants were placed in the lower-greater group. The groups were compared with respect to meconium staining, 1- or 5-minute Apgar scores below 7, persistent variable or late decelerations, umbilical arterial or venous pH below 7.20, cesarean for non-reassuring fetal heart rate monitoring, and neonatal intensive care unit admissions.

One hundred women were studied, 60 in the upper-greater group and 40 in the lower-greater group. Significant differences between upper-greater and lower-greater distributions were noted in meconium staining (28.3% compared with 0%, P < .001), 1-minute Apgar score below 7 (16.7% compared with 2.5%, P < .027), variable decelerations (63.3% compared with 25.0%, P < .001), late decelerations (23.3% compared with 0%, P < .001), and cesarean for non-reassuring fetal heart tracing (11.6% compared with 0%, P < .025). The negative predictive values for all of the variables studied were in the range 92.5-100%, with the exception of variable decelerations (75%).

Amniotic fluid distribution predicts perinatal outcome in patients with ruptured membranes. This test's high negative predictive value indicates its potential as a valuable screening tool. These results may provide additional guidance in defining the intrapartum management of patients presenting with ruptured membranes.