Determination of amniotic fluid volume in twin pregnancies: Ultrasonographic evaluation versus operator estimation

Objective: We sought to determine the accuracy of amniotic fluid volume estimation (visually) in diamniotic twin pregnancy versus ultrasonography techniques. Study Design: In this prospective study the volume of each sac in 23 sets of diamniotic twin pregnancies was subjectively and objectively estimated by a second-year obstetric resident, nurse sonographer, maternal-fetal medicine fellow, and maternal-fetal medicine staff. The actual volume was confirmed by amniocentesis and a dye-dilution technique. Results: There was no difference in the total number of correct estimates of volume by level of operator experience (P = .98), ultrasonography technique (P = .87), or combined subjective versus objective correct estimates (P = .87). Identification of low volume was not different among the four evaluators (P = .48), but the percentage of correct estimates was poor (7%-29%). The 2-diameter pocket was a better predictor of oligohydramnios (57%) than the amniotic fluid index or the largest vertical pocket (12.5%; P = .002). Conclusion: The extremes of volume (low or high) are poorly identified by the subjective or objective assessment of volume. (Am J Obstet Gynecol 2000;182:1606-9.)