Does Polyhydramnios Predict Adverse Perinatal Outcome in Congenital Diaphragmatic Hernia? [10P

Abstract

INTRODUCTION: To examine polyhydramnios as a predictor of adverse perinatal outcomes in prenatally diagnosed congenital diaphragmatic hernia (CDH). METHODS: A retrospective cohort study of CDH cases evaluated between 11/2008 and 6/2016. Perinatal outcomes including preterm birth and mode of delivery were compared between CDH cases with polyhydramnios (amniotic fluid index greater than 25 cm) and those with normal amniotic fluid index. Additional data compared between groups were fetal anatomic characteristics, intrauterine fetal demise (IUFD), gestational age at delivery, preterm birth, length of hospital stay, and neonatal death. Cases that resulted in termination were excluded. Chi square and Fischer's exact tests were used to compare proportions. RESULTS: 192 cases were identified, and 56 of these (29.2%) had polyhydramnios. No significant associations were observed in fetal anatomic characteristics between the polyhydramnios and normal amniotic fluid groups. Similarly, there were no differences in gestational age at delivery, preterm birth, vaginal delivery, or neonatal or infant death between these groups. However, cases with polyhydramnios demonstrated a trend toward a higher risk of IUFD (33.3% vs. 66.7%, p = 0.06), and were more likely to have a prolonged neonatal length of hospital stay (37 days versus 22 days, p= 0.03) compared to cases with normal amniotic fluid. CONCLUSION: Comparing CDH cases with polyhydramnios to those with normal amniotic fluid, similar rates of fetal anatomic characteristics, preterm birth, vaginal delivery, and neonatal or infant death were observed. There was a trend toward a higher risk of IUFD in the polyhydramnios group, suggesting that these cases may merit closer antepartum surveillance.