Skip to main content
  1. Right Decisions
  2. GGC - Clinical Guidelines
  3. Maternity
  4. Back
  5. Ultrasound
  6. Amniotic Fluid Volume Assessment (500)
RDS newsletter for February now available

Right Decision Service newsletter: February 2025

Welcome to the February 2025 update from the RDS team

1.     Next release of RDS

 

A new release of RDS is planned (subject to outcomes of current testing) for week beginning 24th February. This will deliver:

 

  • Fixes to mitigate the recurring glitches with the RDS admin area and the occasional brief user interface outages which have arisen following implementation of the new distributed technology infrastructure in December 2024.

 

  • Capability to embed content from Google calendar, Google Maps, Daily Motion, Twitter feeds, Microsoft Stream into RDS pages.

 

  • Capability to include simple multiplication in RDS calculators.

 

The release will also incorporate a number of small fixes, including:

  • Exporting of form within Medicines Sick Day Guidance in polypharmacy toolkit
  • Links to redundant content appearing in search in some RDS toolkits
  • Inclusion of accordion headers alongside accordion text in search result snippets.
  • Feedback form on mobile app.
  • Internal links on mobile app version of benzo tapering tool

 

We will let you know when the date and time for the new release are confirmed.

 

2.     New RDS developments

There is now the capability to publish toolkits on the web with left hand side navigation rather than tiles on the homepage. To use this feature, turn on the “Toggle navigation panel” option at the top of the Page settings menu at toolkit homepage level – see below. Please note that publication to downloadable mobile app for this type of navigation is still under development.

The Benzodiazepine tapering tool (https://rightdecisions.scot.nhs.uk/benzotapering) is now available as part of the RDS toolkit for the national benzodiazepine prescribing guidance developed by the Scottish Government Effective Prescribing team. The tool uses this national guidance developed with a wide-ranging multidisciplinary group. This should be used in combination with professional judgement and an understanding of the needs of the individual patient.

3.     Archiving and version control and new RDS Search and Browse interface

Due to the intensive work Tactuum has had to undertake on the new technology infrastructure has pushed back the delivery dates again and some new requirements have come out of the recent user acceptance testing. It now looks likely to be an April release for the search and browse interface. The archiving and version control functionality may be released earlier. We’ll keep you posted.

4.     Statistics

At the end of January, Olivia completed the generation of the latest set of usage statistics for all RDS toolkits. If you would like a copy of the stats for your toolkit, please contact Olivia.graham@nhs.scot .

 

5.     Review of content past its review date

We have now generated reports of all RDS toolkit content that has exceeded its review date by 6 months or more. We will be in touch later this month with toolkit owners and editors to agree the plan for updating or withdrawing out of date content.

 

6.     Toolkits in development

Some important toolkits in development by the RDS team include:

  • National CVD prevention pathways – due for release end of March 2025.
  • National respiratory pathways, optimal cancer diagnostic pathways and cancer prehabilitation pathways from the Centre for Sustainable Delivery. We will shortly start work on the national cancer referral pathways, first version due for release via RDS around end of June 2025.
  • HIS Quality of Care Review toolkit – currently in final stages of quality assurance.

 

The RDS team and other information scientists in HIS have also been producing evidence summaries for the Scottish Government Realistic Medicine team, to inform development of national guidance around Procedures of Limited Clinical Value. This guidance will in due course be translated into an RDS toolkit.

 

7. Training sessions for new editors (also serve as refresher sessions for existing editors) will take place on the following dates:

  • Friday 28th February 12-1 pm
  • Tuesday 11th March 4-5 pm

 

To book a place, please contact Olivia.graham@nhs.scot, providing your name, organisation, job role, and level of experience with RDS editing (none, a little, moderate, extensive.)

 

To invite colleagues to sign up to receive this newsletter, please signpost them to the registration form  - also available in End-user and Provider sections of the RDS Learning and Support area.   If you have any questions about the content of this newsletter, please contact his.decisionsupport@nhs.scot  If you would prefer not to receive future newsletters, please email Olivia.graham@nhs.scot and ask to be removed from the circulation list.

With kind regards

 

Right Decision Service team

Healthcare Improvement Scotland

 

 

Amniotic Fluid Volume Assessment (500)

Please report any inaccuracies or issues with this guideline using our online form

Amniotic fluid volume is an important parameter in the assessment of fetal well being. Oligohydramnios and polyhydramnios are rare. When extremes of amniotic fluid volume are reported this is likely to lead to further investigations and a cascade of interventions.

When assessment of liquor volume is requested the following method of evaluation should be employed

  • Global subjective assessment of amniotic fluid volume as a guide.
  • Formal objective assessment of amniotic fluid by the measurement of a single vertical pool. This must be at least 1cm wide and contain no cord loops.
  • Determine whether normal, oligohydramnios or polyhydramnios as described below. DVP appears to perform better in the assessment of amniotic fluid volume during fetal surveillance since the use of amniotic fluid index increases the rate of diagnosis of olighydramnios and induction of labour without any improvement in perinatal outcome.

NORMAL

Deepest pool between 2 to 8 cms.

OLIGOHYDRAMNIOS

Deepest pool <2cms.

If present the likely underlying diagnosis will be IUGR, PROM/PPROM or renal pathology.

Check fetal kidneys and bladder.

ANHYDRAMNIOS

No liquor.

Likely causes as for oligohydramnios.

POLYHYDRAMNIOS

Global increase in AFV. Deepest pool greater than 8cms.

Assess

  1. Fetal biometry (HC, AC, FL)
    Skeletal dysplasias often associated with polyhydramnios
  2. Fetal anatomy
    Exclude gross fetal abnormality as per department protocol (esp thoracic/neck masses and Congenital Diaphragmatic Hernia CDH)

Look for the fetal stomach

  • The presence of >1 bubble suggests upper gastrointestinal atresia
  • Double bubble suggests duodenal atresia
  • > 2 bubbles jejunal atresia more likely
  • Absent stomach raises possibility of oesophageal atresia
    (90% will have distal fistula and the stomach will be visible)

The stomach may be in the fetal chest secondary to CDH. Check cardiac axis/chest contents

Document on Scan Report: Stomach, Kidneys, Bladder, Nose & Lips and diaphragm seen.

If no clinic appointment within a week refer to Day Care for review.

Editorial Information

Last reviewed: 23/01/2023

Next review date: 31/01/2028

Author(s): Donna Maria Bean.

Version: 2

Approved By: Obstetrics Clinical Governance Group

Document Id: 500

References

Nabhan AF, Abdelmoula YA. Amniotic fluid index versus single deepest vertical pocket as a screening test for preventing adverse pregnancy outcome. Cochrane Database of Systematic Reviews 2008, Issue 3.

Harman CR. Amniotic Fluid abnormalities. Seminars in Perinatology 32:288-294

Magann EF, Morton ML, Nolan TE, Martin JJN, Whitworth NS and Morrison JC. Comparative efficacy of two sonographic measurements for detection of aberrations in the amniotic fluid volume and the effect of amniotic fluid volume on pregnancy outcome. Obstetrics and Gynaecology. 83:959-962