Abstract
Background: The US (including Doppler & 4D) is a simple method for early detection of amniotic fluid abnormalities to evaluate the fetal wellbeing and congenital lethal and non lethal anomalies. Our results demonstrate that there are different etiologies causing amniotic fluid abnormalities. Aim of work: The ultrasonographic early diagnosis and follow up of amniotic fluid abnormalities for evaluation the fetal wellbeing, fetal growth and early warning signs of fetal distress to determine the suitable time for delivery. Patient and methods: This study was performed between November 2019 and July 2020 at Obied Hospital-KSA. The study was carried on 80 cases presented with amniotic fluid abnormalities. Results: Out of 3220 pregnant females attending the outpatient clinic of the Gynecology and Obstetrics Department in ObH, 80 (2.48%) females with amniotic fluid abnormalities were selected. The maternal age ranged from 19 to 40 years. The true gestational age ranged from 13 to 40 weeks. The results show that there were significant positive correlations between amniotic fluid abnormality and fetal congenital anomalies, fetal growth disturbance & fetal wellbeing. In our study, the incidence of congenital anomalies was 44 cases out of 80 (55%). Lethal anomalies was seen in 20 cases (45.45% of congenital anomalies), non lethal in 24 cases (54.54%). Our results demonstrate that there are different etiologies causing Amniotic fluid abnormalities. Conclusion: Despite 45% of idiopathic etiology, we concluded that congenital anomalies should be carefully searched on whenever amniotic fluid abnormalities were detected. Full anomaly scan and close antenatal follow up are recommended.
Highlights
Amniotic fluid measurement is mandatory as the amniotic fluid abnormalities occur in about 7 percent of pregnancies. 1Oligohydramnios is considered a feature of chronic hypoxemia.Abnormalities associated with polyhydramnios involving the skeletal, gastrointestinal & central nervous system can occur. 2Fetal causes of oligohydramnios include fetal urinary tract anomalies, such as renal agenesis, polycystic kidneys, or any urinary obstructive lesion
In the less than average amniotic fluid group we found the following etiologies, idiopathic (75%), congenital abnormalities and others (25%)
In this study we classified etiologies of polyhydramnios into, fetal congenital anomalies (52.64 %), idiopathic (47.36%). we had found the malformations associated with the polyhydramnios as follows: GIT, MSK, neck, face, heart, hydrops fetalis and CNS anomalies
Summary
Amniotic fluid measurement is mandatory as the amniotic fluid abnormalities occur in about 7 percent of pregnancies. 1. Group A: oligohydramnios & anhydramnios: diagnosed when the LVP is below 2 and the AFI is below 5 Group C: polyhydramnios: the LVP is above 8 and the AFI is above or equal to 25 cm Follow up the patients by the same technique of examination: Every time the fetal biometry is reevaluated [to follow up the growth pattern and if small for date, IUGR, macrosomia were detected], fetal biophysical profile, AFV is reassessed for volume changes, turbidity, follow up of the maturity and the placental grading. Fetal outcome: The accuracy of diagnosis of congenital anomalies for completed pregnancies, was documented by post natal clinical examination done by a neonatologist to detect any congenital anomalies, to manage the survived babies, determine if they need any assisted ventilation, and determine if lung hypoplasia is present or not.
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