Cause Of Polyhydramnios Research Articles

Polyhydramnios associated with rare genetic syndromes: two case reports

BackgroundWe present two genetic causes of polyhydramnios that were challenging to diagnose due to their rarity and complexity. In view of the severe implications, we wish to highlight these rare genetic conditions when obstetricians consider differential diagnoses of polyhydramnios in the third trimester.Case presentationPatient 1 is a 34-year-old Asian woman who was diagnosed with polyhydramnios at 28 weeks’ gestation. First trimester testing, fetal anomaly scan, and intrauterine infection screen were normal. Subsequent antenatal ultrasound scans revealed macroglossia, raising the suspicion for Beckwith–Wiedemann syndrome. Chromosomal microarray analysis revealed a female profile with no pathological copy number variants. The patient underwent amnioreduction twice in the pregnancy. The patient presented in preterm labor at 34 weeks’ gestation but elected for an emergency caesarean section. Postnatally, the baby was noted to have a bell-shaped thorax, coat hanger ribs, hypotonia, abdominal distension, and facial dysmorphisms suggestive of Kagami–Ogata syndrome. Patient 2 is a 30-year-old Asian woman who was diagnosed with polyhydramnios at 30 weeks’ gestation. She had a high-risk first trimester screen but declined invasive testing; non-invasive prenatal testing was low risk. Ultrasound examination revealed a macrosomic fetus with grade 1 echogenic bowels but no other abnormalities. Intrauterine infection screen was negative, and there was no sonographic evidence of fetal anemia. She had spontaneous rupture of membranes at 37 + 3 weeks but subsequently delivered by caesarean section in view of pathological cardiotocography. The baby was noted to have inspiratory stridor, hypotonia, low-set ears, and bilateral toe polysyndactyly. Further genetic testing revealed a female profile with a pathogenic variant of the GLI3 gene, confirming a diagnosis of Greig cephalopolysyndactyly syndrome.ConclusionThese cases illustrate the importance of considering rare genetic causes of polyhydramnios in the differential diagnosis, particularly when fetal anomalies are not apparent at the 20-week structural scan. We would like to raise awareness for these rare conditions, as a high index of suspicion enables appropriate counseling, prenatal testing, and timely referral to pediatricians and geneticists. Early identification and diagnosis allow planning of perinatal care and birth in a tertiary center managed by a multidisciplinary team.

Bartter[StQuote]s syndrome as a forgotten cause of polyhydramnios

Bartter[StQuote]s syndrome as a forgotten cause of polyhydramnios

Cardiac Adaptation and Preferential Streaming in Fetuses with Multiple Nuchal Cords.

The echocardiographic monitoring of a fetus with multiple nuchal cords around the fetal neck is important as it may result in cardiac remodeling and preferential streaming, thus affecting the condition of the fetus. The main aim of our study was to assess whether the collision of the umbilical cord around the fetal neck can lead to discrepancies in the size of the pulmonary artery and the aorta in the three-vessel view and to an increase in the size of the heart, which may result from the compression of the carotid arteries caused by the umbilical cord wrapping around the fetal neck. A total number of 854 patients were included in this study and divided into three groups. Group A (control group) included 716 fetuses (84%) without the umbilical cord around the fetal neck. Group B (study group B) included 102 fetuses (12%) with one coil of the umbilical cord around the fetal neck. Group C (study group C) included 32 fetuses (4%) with two coils of the umbilical cord around the fetal neck. The range of the gestational age of the patients considered for this study was 27-40.2 weeks based on the ultrasound biometry and was not statistically different between the analyzed groups A, B and C (p > 0.05). The Pa/Ao index was calculated by dividing the value of the width of the pulmonary artery (in mm) to the width of the aorta (in mm) measured in the ultrasound three-vessel view. We found that fetuses that the fetuses with one and two coils of the umbilical cord around the neck showed significantly higher values of the width of the pulmonary trunk with the unchanged value of the aorta width. Therefore, we also observed significantly higher values of the ratio of the pulmonary trunk to the aorta for the fetuses wrapped with the umbilical cord around the neck compared with the control group without the umbilical cord around the neck (. Moreover, in the fetuses with one and two coils of the umbilical cord around the fetal neck, an increased amount of amniotic fluid was observed, whereas larger dimensions of CTAR in the fetuses with two coils of the umbilical cord around the neck were present (p < 0.05). The wrapping of the fetus with the umbilical cord around the fetal neck may induce the redistribution of blood flow, leading to fetal heart enlargement and disproportion and may be the cause of polyhydramnios.

Idiopathic Polyhydramnios and Pregnancy Outcome: Systematic Review and Meta-analysis

ABSTRACT Amniotic fluid volume (AFV) is examined via ultrasound often several times in pregnancy and can be an indicator of the overall health of a fetus. However, disorders of amniotic fluid can arise without complications for the fetus; excess of amniotic fluid without any accompanying fetal conditions is referred to as idiopathic polyhydramnios. Previous research has shown conflicting results with regard to outcomes related to idiopathic polyhydramnios, with some finding it increases adverse outcomes and others reporting an increase in adverse outcomes only in moderate or severe cases. This study is a systematic review and meta-analysis meant to assess the relationship between idiopathic polyhydramnios and perinatal outcomes for singleton pregnancies. Eligibility criteria included studies that had a control group with normal AFV and defined polyhydramnios as an amniotic fluid index of 24 cm or greater or a single deepest pocket of 8 cm or greater. Similar methods of defining polyhydramnios were considered as long as they were evidence-based. Studies with known causes of polyhydramnios were excluded to ensure cases analyzed for this study were idiopathic. The primary outcome was intrauterine fetal demise, with secondary outcomes of neonatal death, neonatal intensive care unit (NICU) admission, macrosomia, 5-minute Apgar score, malpresentation, and cesarean delivery. Final review and analysis included 12 articles, with a total of 2392 patients with idiopathic polyhydramnios and 160,135 patients with normal AFV. Risk of bias was determined to be low for these studies, although the comparability was not well-defined. Analysis for the primary outcome included 8 of the 12 studies and showed that the risk of intrauterine fetal demise was increased in those with idiopathic polyhydramnios (odds ratio [OR], 7.64; 95% confidence interval [CI], 2.50–23.38). Secondary outcome analysis for neonatal death showed that individuals with polyhydramnios were 8.68 times more likely to experience neonatal death than controls (95% CI, 2.91–25.87). Examining other secondary outcomes, the association between NICU admission and idiopathic polyhydramnios showed that patients with polyhydramnios were more likely to be admitted to the NICU (OR, 1.94; 95% CI, 1.45–2.59). When assessing 5-minute Apgar scores, results showed that individuals with polyhydramnios were more likely to have an Apgar score of less than 7 (OR, 2.21; 95% CI, 1.34–3.62). In addition, rates of cesarean delivery were significantly higher with idiopathic polyhydramnios (OR, 2.31; 95% CI, 1.79–2.99), as was macrosomia (OR, 2.93; 95% CI, 2.39–3.59). Malpresentation was also higher in the polyhydramnios group than in the control group (OR, 2.73; 95% CI, 2.06–3.61). The authors of this meta-analysis conclude that in pregnancies with idiopathic polyhydramnios, there is an elevated risk of both intrauterine fetal demise and neonatal death. In addition, all other negative pregnancy outcomes analyzed were more common in pregnancies affected by idiopathic polyhydramnios. One limitation of this review is the heterogeneity inherent in analyzing many studies with different sample characteristics and different analysis methods. Although efforts were made to reduce bias, there is some inherent bias that cannot be accounted for completely. Further research is needed to fully characterize the clinical implications of the increased risk for adverse pregnancy outcomes shown here. This study also showed an increased risk based on the current clinical threshold for polyhydramnios, but more data are needed on accurate AFV thresholds and the clinical implications stemming from various thresholds.

Management of polyhydramnios pregnancy without risk factors: a case report

Introduction: Polyhydramnios is a condition in which the amount of amniotic fluid increases more than 2 litres. The causes of polyhydramnios are multifactorial, and most are idiopathic. Here we report challenging management of polyhydramnios case without apparent risk factors.&#x0D; Case: A 30-year-old woman G2P1001, 27-28 weeks of gestational age referred due to our tertiary health care center due to polyhydramnios. The patient chief complaint was progressively enlarged abdomen since a month ago. Her previous pregnancy, medical history and family history were unremarkable. The obstetric examination reflects the size of uterus equivalent to 36 weeks of gestational age. The fetomaternal ultrasound reveals a life, single fetus with normal heart rate and fetal movement, estimated fetal weight about 1057 grams, placenta corpus posterior grade I, Maximum Vertical Pocket 22.83 cm, no major congenital abnormalities were visible and bladder appears filled. Laboratory tests revealed blood glucose levels 90 mg/dl, Hb-A1c 5.2%, Ureum 27.30 mg/dl, Creatinine 3.39 mg/dl, and numerous leukocytes on urine sediment. Amnioreduction and fetal pulmonary maturation were conducted by Dexamethason protocol. Amnioreduction yield 1500 ml of clear, yellowish amniotic fluid. Regarding abnormality in renal function, diagnosis of Acute on Chronic Kidney Disease (ACKD were established by Internal medicine department, and the patients were given a series of ceftriaxone injection. The patient was planned for indomethacin therapy; however, Indomethacin was not available in Bali.&#x0D; Conclusion: Careful search for causes both from the maternal factor and fetal abnormalities can help to determine the prognosis of pregnancy. Ideally, amnioreduction, coupled with indomethacin therapy, are needed to reduce amniotic fluid, and serial monitoring of the amniotic fluid volume is required to prevent preterm labor.

POLYHYDRAMNIOS

Background: Polyhydramnios is a condition characterized by excessiveamniotic fluid around the baby. The most widespread causes of severe Polyhydramnios are fetalanomalies often linked with a primary genetic anomaly. However, gestational diabetes, multiplepregnancies and idiopathic factors are commonly related with milder cases. So, we designedthis study to see the association of polyhydramnios and perinatal outcome. Objectives: Tocompare the Perinatal outcomes in patients with explained and unexplained Polyhydramnios.Study Design: Cohort study. Setting: Obstetrics &amp; Gynaecology Department and Diabetesclinic of Postgraduate Medical Institute, Lahore General Hospital. Period: 6 months From Jan2014 to June 2014. Material &amp; Methods: 300 females were included through Non probabilitypurposive sampling. Informed consent and Demographic history was recorded. The patientswere divided into two groups. Those having congenital anomalies and diabetes mellitusdetermined by ultrasonography and laboratory investigations were included in Group ‘I’ andpatients with no detectable cause of polyhydramnios were included in Group ‘II’. All the data wasrecorded in well-defined proforma. Data was entered and analyzed through SPSS 20. Relativerisk was calculated to see any association between perinatal outcomes in both study groups.RR &gt; 1 was considered as statistically significant. Results: The mean age of the patients wasnoted as 29.37±5.37 years. The mean gestational age was noted as 34.82±2.09 weeks. In thisstudy, Macrosomia was observed in 60 (20%) cases whereas Malpresentation was observedin 51 (17%) cases. Malpresentation was observed in 51 patients out of which 14 (27.5%) werefrom explained Polyhydramnios and 37 (72.5%) were from unexplained Polyhydramnios group.Statistically there is significant difference between the study groups i.e. RR=3.181. Macrosomiawas observed in 60 patients out of which 18 (30%) were from explained Polyhydramnios groupand 42 (70%) were from unexplained Polyhydramnios group. Statistically there is significantdifference between the study groups i.e. RR=2.852. Conclusion: It was concluded throughresults of this study that unexplained Polyhydramnios has more risk of developing adverseperinatal outcome.

SMFM Consult Series #46: Evaluation and management of polyhydramnios

Polyhydramnios, or hydramnios, is an abnormal increase in the volume of amniotic fluid. Identification of polyhydramnios should prompt a search for an underlying etiology. Although most cases of mild polyhydramnios are idiopathic, the 2 most common pathologic causes are maternal diabetes mellitus and fetal anomalies, some of which are associated with genetic syndromes. Other causes of polyhydramnios include congenital infection and alloimmunization. The purpose of this document is to provide guidance on the evaluation and management of polyhydramnios. The following are Society for Maternal-Fetal Medicine recommendations: (1) we suggest that polyhydramnios in singleton pregnancies be defined as either a deepest vertical pocket of ≥8 cm or an amniotic fluid index of ≥24 cm (GRADE 2C); (2) we recommend that amnioreduction be considered only for the indication of severe maternal discomfort, dyspnea, or both in the setting of severe polyhydramnios (GRADE 1C); (3) we recommend that indomethacin should not be used for the sole purpose of decreasing amniotic fluid in the setting of polyhydramnios (GRADE 1B); (4) we suggest that antenatal fetal surveillance is not required for the sole indication of mild idiopathic polyhydramnios (GRADE 2C); (5) we recommend that labor should be allowed to occur spontaneously at term for women with mild idiopathic polyhydramnios; that induction, if planned, should not occur at <39 weeks of gestation in the absence of other indications; and that mode of delivery should be determined based onusual obstetric indications (GRADE 1C); and (6) we recommend that women with severe polyhydramnios deliver at a tertiary center due to the significant possibility that fetal anomalies may be present (GRADE 1C).

Perinatal outcome in pregnancy with polyhydramnios in comparison with normal pregnancy in department of obstetrics at Shiraz University of Medical Sciences

Objective: Polyhydramnios can lead to maternal and fetal complication during pregnancy, so diagnosis and management can decrease some perinatal complications.Study design: One hundred and fourteen singleton pregnancies were diagnosed with idiopathic polyhydramnios in the department of obstetrics at Shiraz University of Medical Sciences between January 2000 and January 2011 and were compared with 114 normal pregnancies for their perinatal outcome. Variables include birth weight, admission to neonatal intensive care unit (NICU), meconium staining, respiratory distress, fetal death, neonatal death, low 1-min and 5-min APGAR score, primary cesarean section (C/S), preterm delivery (<37 weeks), postpartum bleeding, and placental abruption.Results: Low birth weight (<2500 g), macrosoma (>4000 g), NICU admission, fetal distress, fetal death, lower 1-min and 5-min APGAR score, preterm delivery, and neonatal death were higher in the case group. However, meconium staining and malpresentation were equal between the two groups. Except for prematurity and 1-min and 5-min APGAR scores, there were no significant differences in other maternal or fetal outcomes considering the severity of polyhydramnios.Conclusion: Idiopathic polyhydramnios should be considered as a high-risk pregnancy that warrants close surveillance. More studies should be done to detect the best time and interval of fetal surveillance in these patients. Chromosomal and torch studies can determine the definite cause of polyhydramnios.

Amount of polyhydramnios attributable to diabetes may be less than previously reported.

AIMTo evaluate the frequency and the quantity of polyhydramnios attributable to diabetes in pregnancy.METHODSThe charts of patients with a four-quadrant amniotic fluid index (AFI) ≥ 20 cm and either a diagnosis of diabetes or a diabetes screening test during the index pregnancy were retrospectively reviewed. AFI was stratified into 5 categories and the frequency of diabetes was evaluated for each group. The frequency of polyhydramnios attributable to diabetes was compared to the frequency of polyhydramnios in the setting of fetal anomalies or no known cause.RESULTSOne thousand five hundred and forty-five patients were included in the study. Eight point five percent (n = 131) had diabetes and no other cause for polyhydramnios. Eleven point two percent (173) had antenatally diagnosed anomalies. For all categories of AFI except the largest (> 40.9 cm) the most common cause of polyhydramnios was idiopathic. In patients with diabetes the AFI was most likely to be between 26 cm and 35.9 cm.CONCLUSIONThe rate of polyhydramnios in this study is 8.5%. Patients with diabetes most commonly have mild polyhydramnios between 26 and 35.9 cm of fluid on a four-quadrant AFI.

Idiopathic Recurrent Polyhydramnios: A Rare Case Report

Polyhydramnios occurs in 1-2% of pregnancies and may be idiopathic in more than half of the cases. The diagnosis of idiopathic polyhydramnios can be made only in the absence of maternal diabetes, fetal anomalies, aneuploidies, multiple gestation, Rh incompatibility, placental tumours and non-immune hydrops. Rarely, idiopathic polyhydramnios may be recurrent in future pregnancies and sometimes neonatal examination may reveal cause of polyhydramnios. Preterm delivery and associated fetal anomalies are the main concerns with recurrent polyhydramnios. Very few cases of recurrent idiopathic polyhydramnios have been reported in literature with a maximum number of four pregnancies being affected consecutively. We report here a case of idiopathic polyhydramnios which recurred consecutively in three pregnancies with a good neonatal outcome.

Prenatal Diagnosis and Pregnancy Outcome Analysis of Polyhydramnios

ABSTRACTThe aim of the study was to investigate the etiology and pregnancy outcomes in mothers with polyhydramnios through prenatal diagnosis and pregnancy outcome analysis of pregnant women with polyhydramnios. One hundred and thirty women were enrolled. Fifty pregnant women with polyhydramnios were categorized as the case group, and 80 pregnant women with normal amniotic fluid were categorized as the control group. The causes of polyhydramnios and the pregnancy outcomes were analyzed. Two cases had chromosomal abnormalities, seven had severe α-thalassemia, 15 had fetal anomalies, four had maternal-fetal diseases and 22 had unexplained idiopathic polyhydramnios. Significantly, higher occurrences of cesarean section, preterm birth, fetal anomaly, fetal distress, fetal macrosomia and female fetuses occurred in patients with polyhydramnios than in patients without polyhydramnios. Polyhydramnios is associated with a higher occurrence of adverse perinatal outcomes. Intensive monitoring of the maternal-fetal condition and prenatal diagnosis is important in patients with polyhydramnios.

Polyhydramnios and Adverse Perinatal Outcome

Polyhydramnios complicates 1% to 3% of all pregnancies, and approximately 50% to 60% of cases are idiopathic. Although many fetal and maternal causes of polyhydramnios are known, idiopathic polyhydramnios is defined as that with no identifiable etiology. Amniotic fluid is commonly assessed using the amniotic fluid index (AFI), with polyhydramnios defined as an AFI of 24 cm or greater or 25 cm or greater, which is in the 95th or 97.5th percentile in normal singleton pregnancies. Polyhydramnios is subdivided into mild (24–30), moderate (30.1–35), and severe (AFI > 35). This retrospective cohort study was performed to reevaluate the cutoff point for polyhydramnios and identify a specific value associated with an increased risk for adverse outcomes. All patients enrolled had a sonographic assessment during pregnancy, and all had a singleton fetus at 20 weeks’ gestation or later with an AFI of greater than 10 cm. The patients were stratified into 5 groups according to the AFI: 10 to 19, 20 to 23, 24 to 27, 28 to 31, and 32 or greater. The group with AFI of less than 20 cm was the comparison group. Pregnancy characteristics, complications, and perinatal outcomes were compared among the groups. A total of 14,813 deliveries were enrolled: 9974 (67.3%) had 10 to 19, 2771 (18.7%) had 20 to 23, 1315 (8.8%) had 24 to 27, 494 (3.3%) had 28 to 31, and 260 (1.7%) had AFI of 32 or greater. Preterm labor, placental abruption, cesarean delivery, and malpresentation were more prevalent in a linear fashion as the AFI increased, with the highest prevalence in the group with AFI of 32 or greater. A nonlinear but significant difference between the groups was observed for prior cesarean delivery, gestational diabetes mellitus, postterm pregnancies, and macrosomia. With these complications, the prevalence increased as AFI increased up to an AFI of 31, with a relative decrease in the group with AFI of 32 or greater. A significantly increased rate of perinatal mortality was noted as AFI increased. The rate of low Apgar scores at 1 and 5 minutes was significantly higher and fetal pH tended to be lower in the groups with increased AFI. An Apgar score of less than 7 at 1 and 5 minutes showed a linear association with increased AFI. Three multiple logistic regression models using preterm labor, Apgar of less than 5 at 7 minutes, and perinatal mortality were constructed. All models exhibited a linear increase in the risk for adverse perinatal outcome with increasing AFI. The main finding of the study is the increased adverse perinatal outcome as AFI rises in a dose-response manner from AFI of greater than 20. The widely accepted cutoff for polyhydramnios is AFI of greater than 24, with established associations between polyhydramnios and adverse perinatal outcomes. A diagnosis of polyhydramnios requires additional evaluation to detect fetal anatomic or chromosomal anomalies or maternal conditions such as diabetes. The accepted definition of polyhydramnios as AFI of greater than 24 should be further reevaluated.

Etiology and perinatal outcome of polyhydramnios.

To determine causes of polyhydramnios and the respective perinatal outcome. We retrospectively analyzed cases with polyhydramnios at the Medical University Graz, Austria from 2003 - 2011. Inclusion criteria were single deepest pocket ≥ 8 cm, amniotic fluid index ≥ 25 cm, each of the latter parameters > 95th percentile or subjective impression. Etiologies, including TORCH infection, diabetes and congenital malformations, as well as perinatal outcome were evaluated. Out of 860 singleton pregnancies with polyhydramnios, 2.9 % had positive TORCH serology, 8.5 % had congenital anomalies, 19.8 % had maternal diabetes, and 68.8 % were idiopathic. The most common fetal anomalies were cardiac defects (32.9 %). Elective caesarean sections were more common in the groups with malformations and maternal diabetes. Low birth weight combined with severe polyhydramnios or maternal diabetes was associated with malformations. Diagnosis of polyhydramnios should prompt glucose-tolerance testing, detailed sonography including fetal echocardiography, and TORCH serology. Especially pregnancies with polyhydramnios and small fetuses as well as those with maternal diabetes should be carefully evaluated for malformations.

Polyhydramnios: Causes, Diagnosis and Therapy.

Polyhydramnios is defined as a pathological increase of amniotic fluid volume in pregnancy and is associated with increased perinatal morbidity and mortality. Common causes of polyhydramnios include gestational diabetes, fetal anomalies with disturbed fetal swallowing of amniotic fluid, fetal infections and other, rarer causes. The diagnosis is obtained by ultrasound. The prognosis of polyhydramnios depends on its cause and severity. Typical symptoms of polyhydramnios include maternal dyspnea, preterm labor, premature rupture of membranes (PPROM), abnormal fetal presentation, cord prolapse and postpartum hemorrhage. Due to its common etiology with gestational diabetes, polyhydramnios is often associated with fetal macrosomia. To prevent the above complications, there are two methods of prenatal treatment: amnioreduction and pharmacological treatment with non-steroidal anti-inflammatory drugs (NSAIDs). However, prenatal administration of NSAIDs to reduce amniotic fluid volumes has not been approved in Germany. In addition to conventional management, experimental therapies which would alter fetal diuresis are being considered.

Influence of polyhydramnios on perinatal outcomes

AimTo assess feto-maternal outcome of pregnancies with polyhydramnios.BackgroundThe incidence of polyhydramnious is around 1% of all pregnancies. Prognosis depends on the cause of polyhydramnios. Currently no guidelines are available to...

The importance of low blood urea nitrogen levels in pregnant patients undergoing hemodialysis to optimize birth weight and gestational age

Most published reports indicate that intensified hemodialysis results in better pregnancy outcomes. Here we studied clinical characteristics and the outcomes of 28 pregnant women receiving hemodialysis. We found an association between maternal blood data and birth weight, and gestational age and outcomes. There were 18 surviving infants who were followed up for one year. In the others there were 4 spontaneous abortions, 1 stillbirth, 3 neonatal deaths and 2 deaths after birth. Analysis of blood chemistry for 20 pregnancies from 12 weeks of gestation until delivery showed that the average hemoglobin level was significantly higher in the group that successfully delivered than in the unsuccessful group. There were significant negative relationships between the blood urea nitrogen (BUN) level and the birth weight or gestational age in the latter cohort. A birth weight equal to or greater than 1500 g or a gestational age equal to or exceeding 32 weeks corresponded to BUN levels of 48-49 mg/dl or less. Whether the low BUN is the direct cause of the improved outcome remains to be examined.

OC283: Clinical use of fetal urine production rate for differentiation of the causes of polyhydramnios

OC283: Clinical use of fetal urine production rate for differentiation of the causes of polyhydramnios

Polyhydramnios: Etiology, Diagnosis, and Treatment

After completing this article, readers should be able to: 1. Understand the various causes of polyhydramnios. 2. Describe the pathways of amniotic fluid production and removal. 3. Appreciate the reason for preterm delivery following the diagnosis of polyhydramnios. 4. Recognize the treatment methods for polyhydramnios. 5. Explain the importance of sudden changes in fundal size during pregnancy. Polyhydramnios, sometimes referred to as hydramnios, is a relatively uncommon complication affecting pregnancy that refers to the presence of an excessive amount of amniotic fluid relative to gestational age. Onset may be gradual or sudden, based on the cause. Gradual onset may be largely asymptomatic. In this situation, the diagnosis is suspected when fundal height exceeds that expected for gestational age. In contrast, sudden onset of polyhydramnios often is symptomatic, characterized by contractions and significant abdominal discomfort. Polyhydramnios has potential serious consequences, primarily related to the cause, but also due to the increased risk of adverse pregnancy outcome, such as preterm labor (PTL) or preterm premature rupture of the membranes (PPROM). The exact incidence of polyhydramnios is unknown because mild, asymptomatic cases may be discovered only at the time of delivery and are underreported. Several series have suggested that the incidence may range up to 1.6% in a low-risk population. Most cases are mild and often not associated with any significant sequelae. Approximately 35% of cases could be classified as moderate or severe, requiring further diagnostic or therapeutic measures. Prior to the routine use of diagnostic ultrasonography, the incidence of polyhydramnios seemed much lower. Today, though, ultrasonography studies may reveal an abnormal increase in amniotic fluid volume earlier in pregnancy, resulting in more cases being reported. Intuitively, it seems that earlier diagnosis via ultrasonography could improve outcome, but that has not yet been proven conclusively. The clinical suspicion of abnormally large fundal size remains critical to the diagnosis …

Procedure-related complications of rapid amniodrainage in the treatment of polyhydramnios.

To investigate the procedure-related complications of rapid amniodrainage in the treatment of polyhydramnios. We followed prospectively all patients with polyhydramnios treated with rapid amniodrainage under continuous ultrasound guidance using a vacuum wound-drainage system from 1995 to 2002 in the fetal medicine unit of a university teaching hospital. We recorded: maternal age, type of pregnancy (singleton/twin), cause of polyhydramnios, gestational age at amniocentesis, volume of amniotic fluid drained, duration of the procedure, other intrauterine procedures in addition to the amniodrainage, and procedure-related complications including placental abruption, premature rupture of membranes (PROM), chorioamnionitis, fetal bradycardia and preterm delivery within 48 h of amniodrainage. Seventy-four consecutive women had 134 rapid amniodrainage procedures during the study period. Four procedures were excluded because the women were already in labor at the time of amniodrainage and they delivered within 48 h of the procedure. The final database therefore consisted of 70 patients with 130 procedures. Sixty-two percent (80/130) of the procedures were performed for the treatment of twin-twin transfusion syndrome (TTTS). There were altogether four procedure-related complications (3.1%; 95% CI, 1.0-8.0%). Three of them occurred in the TTTS group (3/80 procedures, 3.8%; 95% CI, 1.0-11.0%): one case each of placental abruption, PROM and fetal bradycardia. One PROM occurred in the non-TTTS group (1/50 procedures, 2.0%; 95% CI, 0-11.0%). In both cases of PROM the women presented in labor. Rapid amniodrainage using a vacuum wound-drainage system is safe and efficient to treat severe polyhydramnios, with a 3.1% complication rate.

Successful management of fetal cervical teratoma using the EXIT procedure

Fetal cervical teratoma is a cause of polyhydramnios, premature labor, and newborn airway obstruction. Formation of a multispecialty team and use of the EXIT procedure is essential for survival of the neonate. Without a team, there is little hope for fetal survival; mortality will be 80–100%. Early diagnosis and planning are essential. Cervical teratomas can contribute to pulmonary insufficiency and chondromalacia because of a mass effect in utero and underdevelopment of the fetal lungs. J. Matern.-Fetal Med. 1999;8:295–297. © 1999 Wiley-Liss, Inc.