Chronic Polyhydramnios Research Articles

Chronic Polyhydramnios: A Medical Entity Which Could Be a Model of Muscle Development in Decreased Mechanical Loading Condition.

Polyhydramnios is a condition related to an excessive accumulation of amniotic fluid in the third trimester of pregnancy and it can be acute and chronic depending on the duration. Published data suggest that during muscle development, in the stage of late histochemical differentiation decreased mechanical loading cause decreased expression of myosin heavy chain (MHC) type 1 leading to slow-to-fast transition. In the case of chronic polyhydramnios, histochemical muscle differentiation could be affected as a consequence of permanent decreased physical loading. Most affected would be muscles which are the most active i.e., spine extensor muscles and muscles of legs. Long-lasting decreased mechanical loading on muscle should cause decreased expression of MHC type 1 leading to slow-to-fast transition, decreased number of muscle fiber type I especially in extensor muscles of spine and legs. Additionally, because MHC type 1 is present in all skeletal muscles it could lead to various degrees of hypotrophy depending on constituting a percentage of MHC type 1 in affected muscles. These changes in the case of preexisting muscle disorders have the potential to deteriorate the muscle condition additionally. Given these facts, idiopathic chronic polyhydramnios is a rare opportunity to study the influence of reduced physical loading on muscle development in the human fetus. Also, it could be a medical entity to examine the influence of micro- and hypogravity conditions on the development of the fetal muscular system during the last trimester of gestation.

Pathogenetic role of vitamin D deficiency and immune-inflammatory disorders in development of fetal distress in pregnant women with chronic hydramnion

The role of vitamin D deficiency and immune-inflammatory disorders in the mechanisms of development of fetal distress in pregnant women with chronic polyhydramnios remains unexplored. Objective: to evaluate the role of vitamin D deficiency and associated immune inflammatory disorders in the development of fetal distress in pregnant women with chronic polyhydramnios. Materials and methods. Surveyed 30 women with a physiological course of pregnancy and 90 pregnant women with chronic polyhydramnios. In the serum, the level of the metabolite of vitamin D – 25(OH)D and the cytokines IL-10 and IL-6 were determined by enzyme immunoassay using standard kits. Statistical processing of the obtained results was performed using standard methods using the «MS Excel» and «Statistica SPSS 10.0 for Windows» application package. The results of the research. In pregnant women with chronic polyhydramnios, there is a significant decrease of the metabolite of vitamin D – 25(OH)D level by 21 % in the serum, a decrease of the level of the anti-inflammatory cytokine IL-10 by 26.4 % and an increase of the concentration of pro-inflammatory IL-6 by 17 % compared to women with physiological course of pregnancy. The occurrence of fetal distress against the background of chronic polyhydramnios is accompanied by a intensification of vitamin D deficiency and immune-inflammatory disorders: levels 25(OH)D and IL-10, respectively, by 18.5 % and 17.5 % less, and IL-6 by 13.3 %, than in women with chronic polyhydramnios without fetal distress. The expressiveness of immune disorders in the organism of pregnant women with chronic polyhydramnios is determined by the level of vitamin D in the organism. Thus, in women with a deficiency of 25(OH)D in the serum, a significant decrease in the IL-10 concentration by 47.8 % and a significant increase in the IL-6 level by 34.6 % were recorded in comparison with the indicators in women with vitamin D deficiency. Conclusions. Vitamin D deficiency and associated immune-inflammatory disorders play an important role in the development of fetal distress in pregnant women with chronic polyhydramnios.

Pathogenetic role of vitamin D deficiency and immune-inflammatory disorders in development of fetal distress in pregnant women with chronic hydramnion

The role of vitamin D deficiency and immune-inflammatory disorders in the mechanisms of fetal distress development in pregnant women with chronic polyhydramnios remains unstudied. Objective: to evaluate the role of vitamin D deficiency and associated immune inflammatory disorders in the development of fetal distress in pregnant women with chronic polyhydramnios. Materials and methods. In total, 30 women with a physiological course of pregnancy and 90 pregnant women with chronic polyhydramnios were examined. The serum levels of vitamin D metabolite (25 (OH)D) and cytokines IL-10 and IL-6 were determined by enzyme immunoassay using standard kits. Statistical processing of the obtained results was performed using standard methods with MS Excel and Statistica SPSS 10.0 for Windows application package. Results. In pregnant women with chronic polyhydramnios, there is a significant decrease in the serum level of vitamin D metabolite 25 (OH)D by 21 % and anti-inflammatory cytokine IL-10 by 26.4 %, and an increase in the concentration of pro-inflammatory IL-6 by 17 % compared to women with physiological course of pregnancy. The occurrence of fetal distress in chronic polyhydramnios is accompanied by worsening of vitamin D deficiency and immune-inflammatory disorders: the levels of 25 (OH)D and IL-10 are 18.5 % and 17.5 % decreased, respectively, and IL-6 is 13.3 % increased than in women with chronic polyhydramnios without fetal distress. The intensity of immune disorders in pregnant women with chronic polyhydramnios is determined by the level of vitamin D in the organism. Thus, in women with 25 (OH)D deficiency, a significant decrease in serum IL-10 concentration by 47.8 % and a significant increase in IL-6 by 34.6 % were recorded in comparison with these indicators in women with vitamin D deficiency. Conclusions. Vitamin D deficiency and associated immune-inflammatory disorders play an important role in the development of fetal distress in pregnant women with chronic polyhydramnios.

Biochemical markers and effectivity of the preventive therapy of the fetal distress and preterm delivery in pregnant women with polyhydramnios

Polyhydramnios in pregnant women are one of the most frequent pathologies in obstetrics, which is caused by an increase in the use of ultrasound screening of pregnant women and ranges from 1–3 to 8%. The aim of the study was to evaluate changes in blood biochemical parameters, biophysical profile of the fetus and the health status of newborns in pregnant women with polyhydramnios during the prophylactic therapy of this pathology and to estimate the frequency of polyhydramnios occurrence under the influence of preventive therapy in pregnant women at risk of polyhydramnios. We examined 120 pregnant women at gestational age from 20 to 38 weeks between the ages of 20 and 39 years: 1 group consisted of 30 healthy pregnant women, 2 group — 90 pregnant women with chronic polyhydramnios, which was divided into two subgroups: 40 pregnant women without fetal distress in 1 subgroup and 50 pregnant women with fetal distress in 2 subgroups. 1 subgroup of pregnant women received prophylactic Magnerot, Tivortin, Larnamine, Lymphomyosot and vitamin D3. The 2nd subgroup of pregnant women received traditional treatment according to the clinical protocol of the Ministry of Health of Ukraine №900 dated December 27, 2006, №782 dated December 29, 2005. Prenatal diagnosis was carried out by the method of enzyme-linked immunosorbent assay: the metabolite level of vitamin D-25 OH(D) was determined, anti-inflammatory cytokines IL–10, IL–6, vascular endothelial growth factor VEGF, malonic aldehyde, carbonyl groups of proteins, superoxide dismutase, serum protein content. Conducted ultrasound examination of the fetus and dopplerometry of uterine-placental vessels, cardiotocography of the fetus, evaluated the biophysical profile of the fetus. The significance of the difference between the compared groups was determined using Student's t test. In pregnant women with chronic polyhydramnios, a decrease in endogenous glutathione antioxidant reserves, a decrease in the activity of the superoxide dismutase antioxidant enzyme, an increase in the activity of the pro-oxidant enzyme xanthine oxidase and the presence of cytokine imbalance have been found. It is shown that among all biochemical changes in the body of pregnant women with chronic polyhydramnios, vitamin D deficiency, inflammation and disturbance of angiogenesis play the most important role in the development of fetal distress. Pregnant women at high risk of polyhydramnios who received the proposed preventive therapy for fetal distress, improved fetoplacental blood flow, decreased the percentage of placental dysfunction by 1.8 times, fetal distress — by 1.5 times, premature birth — by 2 times, decreased asphyxia in newborns 1.7 times, the rate of perinatal morbidity in newborns decreased 1.9 times, compared with the group of pregnant women receiving traditional therapy. Thus, the positive effect of preventive therapy of pathology of pregnant women with polyhydramnios was confirmed clinically and biochemically.

Fetal malformations associated with chronic polyhydramnios in singleton pregnancies

Forty-one congenital malformations were found in 28 newborns in a group of 197 cases of chronic polyhydramnios in singleton pregnancies. Of these, a total of 61% ( 17 28 ) was antenatally diagnosed ultrasonically. Nine newborns (4.5%) had malformations of the central nervous system (CNS), 9 (4.5%) cardiovascular malformations, 8 (4.1%) musculoskeletal anomalies, 7 (3.6%) malformations of the urinary and reproductive system, 4 (2%) respiratory system anomalies and 3 (1.6%) anomalies of the gastrointestinal system. Chromosomal abnormalities were found in three cases. As the association of polyhydramnios with fetal congenital anomalies is quite high (14.2% in our series), it is imperative to make a major effort to antenatally detect as many cases as possible. This means that in the case of hydramnios the following are required: ultrasound examination by an expert, echo ultrasonography when no other abnormalities are detected, and maybe even a chromosomal analysis.

Administration of prostaglandin inhibitors to the mother; the potential risk to the fetus and neonate with duct-dependent circulation

Two infants were delivered by urgent Caesarean section at 34 weeks because of fetal distress. One rapidly developed severe cardiac failure and the other marked cyanosis. Their mothers had been prescribed indomethacin and mefenamic acid (Ponstan) to treat premature onset of labour and chronic polyhydramnios, respectively. Both infants had duct-dependent circulations, their cross-sectional echocardiography showing only a small (1-2 mm diameter) patent ductus arteriosus. The early onset and severity of their symptoms suggested that the maternal intake of prostaglandin inhibitors may have deleteriously led to early closure of their ducts, essential in duct-dependent circulations. Although such occurrences are rare, fetal cross-sectional echocardiography should be performed prior to administration of prostaglandin inhibitors during pregnancy.

Acute and Subacute Polyhydramnios in Singleton Pregnancies

Over a 10-year period when 51,022 singleton infants were delivered, 19 pregnancies (1 in 2,685) were complicated by acute polyhydramnios 17 (1 in 3,000) by subacute polyhydramnios and 501 (1 in 102) by chronic polyhydramnios. The incidence of major congenital malformations in singleton pregnancies associated with acute polyhydramnios was 63% and the perinatal mortality rate was 74%. When subacute polyhydramnios occurred in singleton pregnancies, the incidence of major congenital malformations was 65%, similar to acute polyhydramnios, but the perinatal mortality rate was only 35%. The comparable figures for chronic polyhydramnios in singleton pregnancies were a major malformation incidence of 14% and perinatal mortality rate of 10%. The type of onset of polyhydramnios, acute, subacute or chronic is therefore the most important indicator of prognosis. In patients with gross polyhydramnios, acute renal failure must be specifically excluded.

Theoretical effects of amniotic fluid volume changes on surfactant concentration measurements

A baseline model for consideration of the theoretical effects of amniotic fluid volume changes on surfactant concentration measurements has been constructed. The baseline data include: a polynomial equation that best fits experimental data comparing amniotic fluid lecithin concentration measurements to gestational age, inflow of 0.450 L of surfactant-poor fluid into the amniotic fluid per day, outflow of 0.450 L of surfactant-rich fluid per day, and volume of 1.0 L of amniotic fluid between 30 to 31 and 38 to 39 weeks' gestation. With this model the incremental amounts of lecithin necessary to achieve the concentration levels derived from the polynomial equation have been calculated. The quantity of lecithin needed was calculated at intervals of 0.1 day for 56 days. Polyhydramnios and oligohydramnios were then allowed to develop hypothetically by modifying the inflow or outflow of fluid while keeping the quantity of lecithin added exactly the same as was determined from the baseline data. Chronic polyhydramnios or oligohydramnios had minimal effects on the concentration measurements. The effects of acute polyhydramnios (or oligohydramnios) were greater when the change in volume was due to an increased (or decreased) volume of inflow as compared to a decreased (or increased) volume of outflow.

The Clinical Significance of Endometrial Prolactin

Prolactin (PRL) is produced not only by the anterior pituitary gland but also by human endometrium. That decidual stromal cells secrete PRL from day 22 of the menstrual cycle is demonstrated by: 1) nett accumulation of PRL during in vitro culture; 2) PRL accumulation is prevented by inhibitors of protein synthesis; and 3) identification of PRL mRNA within endometrial decidua. Endometrial PRL is biologically and immunologically equipotent with pituitary PRL and its amino acid sequence is very similar. In human pregnancy, decidual PRL binds to receptors on the fetal chorion and amnion and thereby passes into amniotic fluid in high concentration. Three putative functions of uterine PRL are suggested from current studies: a) a PRL receptor defect is present in the chorion laeve of patients with pregnancies complicated by chronic polyhydramnios and this deficiency in chorionic receptors for endometrial PRL may result in the development of excessive amniotic fluid; b) decidual PRL may modulate prostaglandin synthesis not only within the endometrium prior to menstruation, but also within the chorion and amnion to allow labour to proceed in a timely manner; and c) amniotic fluid PRL may pass into the fetal tracheo-bronchial system to promote surfactant production. Unlike pituitary PRL with distant target organs, decidual PRL appears to have paracrine or cybernetic functions in the human uterus, placental membranes and the fetus.

Chronic idiopathic polyhydramnios: evidence for a defect in the chorion laeve receptor for lactogenic hormones.

Binding of human GH (hGH) to the lactogenic receptor of human chorion laeve has been compared in membrane preparations from normal pregnancies and those complicated by chronic idiopathic polyhydramnios. Specific binding of [125I]hGH was significantly lower (mean +/- SE, 1.64 +/- 0.28%; n = 5) in chronic idiopathic polyhydramnios than in normal pregnancies (2.93 +/- 0.4%; n = 16). Scatchard analysis data were consistent with a reduced lactogenic hormone receptor concentration being the explanation for this reduced hGH binding. By contrast, the specific binding of [125I]insulin to its receptor was unchanged when chorion laeve from hydramniotic pregnancies (7.29 +/- 1.98%; n = 4) was compared with that from normal pregnancies (8.63 +/- 1.35%; n = 7). We conclude that a lactogenic hormone receptor defect exists in the chorion laeve of pregnancies complicated by chronic idiopathic polyhydramnios. Such impaired binding for PRL may explain the development of excessive amniotic fluid volumes, which is characteristic of this complication of pregnancy.

The ultrasonic aspects of polyhydramnios.

SUMMARYIn a consecutive series of 250 patients with polyhydramnios, there were 242 patients with chronic and 8 with acute polyhydramnios. The incidence of fetal abnormality in association with chronic polyhydramnios was 18.4% (49 patients); 64% of these abnormalities had features recognisable by ultrasonography but only 28% could have been positively diagnosed by plain radiography. Acute polyhydramnios was associated with uniovular twins, and 2 of the 10 infants were malformed. This study demonstrated that ultrasonography has a greater diagnostic role than radiography in the patient who presents with polyhydramnios.