Maternal Hydramnios Research Articles

Idiopathic Infantile Arterial Calcification: The Spectrum of Clinical Presentations

Idiopathic infantile arterial calcification (IIAC) is a rare disorder characterized by extensive calcification of medium and large arteries. We report the case of a 32-week-old infant with hydrops fetalis and heart failure who died at 4 days of age. At autopsy the infant was found to have cardiomegaly, myocardial infarctions and multifocal calcifications of the aorta and arteries in the lungs, heart, thyroid, spleen, and testis. Calcification extended from the internal elastic lamina into the intima and media and was associated with a giant-cell reaction and smooth muscle proliferation. A search of the English language medical literature identified 161 IIAC case reports. Of these, 48% of cases presented in utero or at birth with hydrops fetalis, maternal hydramnios, heart failure, or respiratory distress and 52% present later, at a median age of 3 months, with sudden onset of fever, vomiting, irritability, or respiratory distress in a previously healthy infant. Significantly, 19 of 22 IIAC survivors presented at less than 2 weeks of age, and 15 survivors were treated with diphosphonates.

Medical risk factors in perinatal mortality in Kuwait: a case-controlled study from Al-jahra district

This study is the first of its kind in Kuwait. It evaluates various risk factors associated with perinatal mortality (PNM) in the Al-Jahra district hospital during the period January 1995-December 1997. Risks associated with PNM were age above 30, parity above 8, history of abortion or perinatal death, lack of antenatal care, presence of chronic maternal disease, hydramnios, antepartum haemorrhage, breech presentation and low Apgar scores. The effect of the appropriate preventative programmes involving highlighting women at risk of perinatal mortality and probable intervention are discussed.

Ten years' experience in the management of cervical teratomas

Five patients with cervical teratoma were seen between 1982 and 1992 in the Maternity and Children's Hospital, Riyadh, Saudi Arabia. All presented with a cervical mass at birth. Their weights ranged between 2.6 and 3.5 kg (average 3.1 kg); all were full-term babies, three girls and two boys. Three cases were diagnosed antenatally; three had a history of maternal hydramnios; three presented with severe respiratory distress at birth and needed endotracheal intubation. All patients underwent surgical treatment except one who died before surgical intervention because of severe respiratory distress. Surgery included complete resection of the tumor. The postoperative courses were uneventful. The histopathology of the tumor showed tissue from all three germ layers. Over 3-11 years of follow-up, none of the patients showed signs of recurrence. Postoperative thyroid function tests and serum alpha-fetoprotein showed no abnormalities. We conclude that antenatal diagnosis help to reduce the morbidity and mortality due to upper airway obstruction. Surgery is safe and represents the only way of treating this tumor.

Duodenal atresia and stenosis: reassessment of treatment and outcome based on antenatal diagnosis, pathologic variance, and long-term follow-up.

Duodenal atresia and stenosis was observed in 103 infants and children from 1972 to 1991. There were 59 girls and 44 boys. Atresia was noted in 79 instances and stenosis in 24. Maternal hydramnios was detected in 33 cases, 46 babies were premature, and 31 had Down's syndrome. Fifty-four infants had significant associated anomalies including 35 with cardiac defects. Diagnosis was achieved by prenatal ultrasound examination in 14 cases, observation of a double-bubble sign on abdominal radiograph in 73, and contrast studies in 30 infants including 24 with stenosis. At operation annular pancreas was noted in 37 cases, malrotation in 37 cases, anterior portal vein in 4, and a second web in 3. Surgical treatment included duodenoduodenostomy in 85, duodenotomy and web excision in 8, and duodenojejunostomy in 10. Operative survival was 95%. Deaths were related to complex cardiac defects. Despite antenatal diagnosis, prompt intervention, and apparent early surgical success (95% survival), late deaths (5%) and late complications including motility disorders, megaduodenum, gastroesophageal reflux, duodenal-gastric reflux, gastritis, peptic ulcer disease, blind loop syndrome, and biliary-pancreatic conditions may be observed months to years after management during the neonatal period. Modifications in surgical technique including early tapering duodenoplasty may be useful, and close long-term follow-up is an essential component of patient care.

Perinatal outcome of forty-nine pregnancies complicated by acardiac twinning

Acardiac twinning affects 1 in 100 monozygotic twin pregnancies and 1 in 35,000 pregnancies overall. The presence of an acadiac twin requires the normal (or "pump") twin to provide circulation for itself, as well as the acardiac sibling. In many cases the acardiac twin is almost equal in size to the normal twin. The principal perinatal problems associated with acardiac twinning are pump-twin congestive heart failure, maternal hydramnios, and preterm delivery. We reviewed the perinatal courses of 49 acardiac twin pregnancies to identify factors prognostic of favorable outcome. The overall perinatal mortality was 55%, primarily associated with prematurity. Mean (± SD) gestational age at delivery was 29 ± 7.3 weeks, with a mean (±SD) normal twin weight of 1378 ± 1047 gm. The acardiac weight averaged 651 ± 571 gm. However, the occurrence of hydramnios, the occurrence of preterm labor, and perinatal outcome were strongly related to the ratio of the acardiac and pump-twin's weight. The mean overall ratio of the twin weights was 52% ± 42%. However, the mean weight ratio for patients delivered before 34 weeks was 60% versus 29% (p < 0.04). Preterm delivery was strongly associated with the development of hydramnios and congestive heart failure in the pump twin (p < 0.01). If the twin-weight ratio was above 70% (25% of cases), the incidence of preterm delivery was 90%; hydramnios, 40%; and pump-twin congestive heart failure, 30% compared with 75%, 30%, and 10%, respectively, when the ratio was less (p < 0.05). Regression of the weight of the acardiac twin against its longest dimension (L) resulted in this equation for prediction of acardiac weight: Weight (grams) = 1.2 L2 − 1.7L; r = 0.79, p < 0.01. These data suggest that estimation of the relative weights in acardiac twins provides prognostic information regarding outcome. Poor outcome occurs with congestive heart failure and hydramnios in the normal twin. Use of the above data may assist in counseling patients and determining optimal management.

Does fetal gut obstruction cause hydramnios and growth retardation?

In order to study the effects of impaired fetal intestinal absorption of amniotic fluid, two series of neonates (551 from Liverpool and 172 from Rome) with different types of congenital gut obstruction were divided into two groups and compared. Group A consisted of patients with complete obstruction at or above the proximal jejunum (within 15 cm of the ligament of Treitz). Patients of group B had either incomplete obstruction at group A level or either incomplete or complete obstruction at a lower level. Maternal hydramnios and fetal growth retardation rates were found to be significantly higher in group A than in group B. Maternal hydramnios was associated with an increased prematurity rate (P less than .001). Fetal growth retardation was not related to the presence of additional anomalies. In group A growth retardation was more frequent in babies born after 37 weeks of gestation (P less than .05). No differences were found between the Liverpool and Rome series of patients. These findings suggest that fetal gut function not only contributes to the control of amniotic fluid volume but also, in the final stages of pregnancy, to normal fetal growth. Maternal hydramnios may be the cause of premature delivery of fetuses with upper gut obstructions.

Cervical mass in a fetus associated with maternal hydramnios: A. R. Kagan and R. J. Steckel. Am J Roentgenol 140:507–509, (March), 1983

Cervical mass in a fetus associated with maternal hydramnios: A. R. Kagan and R. J. Steckel. Am J Roentgenol 140:507–509, (March), 1983

Hydrops fetalis: sonographic evaluation and clinical implications.

A systematic sonographic evaluation of hydropic fetus is presented, based on 21 cases and a literature review. The clinical implications of fetal ascites with or without anasarca, maternal hydramnios, maternal oligohydramnios, or an abnormally thick placenta are discussed as they relate to fetal outcome. It is concluded that sonography could play a major role in determining the optimal approach to perinatal management of the fetus in hydrops fetalis, and thus contribute to a reduction in the perinatal mortality and morbidity associated with this disorder.

Chorioangioma of the placenta. A cause of cardiomegaly and heart failure in the newborn.

Transient candiomegaly and congestive heart failure associated with a clinical picture of hydrops fetalis were seen in 2 newborn infants.In both instances the placenta harbored large hemangiomas (chorioangiomas), which have been described as functioning large arteriovenous fistulae.It is almost certain that cardiomegaly under these circumstances is caused by systemic hypotension, increased vascular volume, and high output failure known to accompany other systemic arteriovenous shunts in the neonate, such as large cutaneous hemangiomas, hemangio-endotheliomas of the liver and arteriovenous aneurysm of the vein of Galen.Because of their location, chorioangiomas are associated with a more complex clinical syndrome, which frequently includes hydramnios.Chorioangiomas should be included in the differential diagnosis of neonatal cardiomegaly and maternal hydramnios.

Congenital cystic malformation of the lung and its relation to hydramnios.

SummaryThe clinical histories and postmortem findings of two infants with congenital cystic adenomatoid malformation of the lung (CCAML) are reported. One, liveborn though hydropic, died within one hour; the other was stillborn, but not hydropic. In both cases there had been maternal hydramnios. The association of hydramnios with this condition is probably due to impaired absorption of amniotic fluid by both the cystic tumour and the remaining lung tissue which is displaced and compressed.

Adenomatoid hamartoma of the lung in a neonate.

A case of adenomatoid hamartoma in a premature male infant is described and the recent literature is reviewed. The present case demonstrates the frequently associated features of maternal hydramnios of late onset, and premature delivery with foetal respiratory difficulty and anasarca.

The amniotic fluid in anencephaly: Preliminary report

With increasing frequency, characteristics of the amniotic fluid are being used to predict fetal condition in utero. In the present report, spectrophotometric changes previously considered specific for Rh immunization are described in maternal hydramnios with fetal anencephaly.

Preterm delivery for sensitized Rh-negative mothers.

Planned early delivery for selected, sensitized, Rh-negative patients to avoid fetal death or the delivery of severely anemic and hydropic infants resulted in the salvage of 59 of 73 Rh-positive infants. By previous and present experience maternal antibody titers have proved to be inadequate in predicting the severity of fetal involvement in utero. The selection of patients for early delivery was made primarily from obstetric history unless maternal hydramnios or cessation of fetal activity intervened. While this prognostic mechanism was adequate in most instances, there is obvious need for a means of accurately predicting the status of the individual fetus to prevent perinatal mortality from prematurity as well as from far-advanced hemolytic disease.

Maternal hydramnios and congenital anomalies of the central nervous system: Prindle, Ingalls, and Kirkwood: p. 555

Maternal hydramnios and congenital anomalies of the central nervous system: Prindle, Ingalls, and Kirkwood: p. 555

Maternal hydramnios and congenital anomalies of the central nervous system.

THE association of hydramnios with congenital anomalies, long recognized, was confirmed once again by a previous investigation into antecedent (prenatal) factors influencing tracheoesophageal fistula; hydramnios was present in 20 of the 107 cases.1 The meaning of this association was obscure, and clarification is now sought reversing the approach by studying the results of 145 pregnancies complicated by hydramnios. These pregnancies terminated in the delivery of 68 defective infants, including 45 with anencephalus, 8 with spina bifida, 6 with hydrocephalus and 4 with mongolism.The Group StudiedThe patients studied were for the most part residents of Boston; some came from . . .