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Transient Polyhydramnios during Pregnancy Complicated with Gestational Diabetes Mellitus: Case Report and Systematic Review. Diagnostics (Basel) 2022; 12:diagnostics12061340. [PMID: 35741150 PMCID: PMC9221944 DOI: 10.3390/diagnostics12061340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 05/25/2022] [Accepted: 05/25/2022] [Indexed: 01/27/2023] Open
Abstract
Polyhydramnios is an obstetrical condition defined as a pathological increase in the amniotic fluid and is associated with a high risk of maternal-fetal complications. Common causes of polyhydramnios include fetal anatomical and genetic abnormalities, gestational diabetes mellitus, and fetal viral infections. We present the case of a 30-year-old Caucasian woman with transient polyhydramnios associated with gestational diabetes mellitus and obstetric complications. The diagnosis was based on the ultrasound assessment of amniotic fluid volume during a common examination at 26 weeks. Two weeks prior, the patient had been diagnosed with gestational diabetes mellitus. After 4 days, the patient was examined, and the amniotic fluid index returned to normal values. At 38 weeks, the patient presented to the emergency room due to lack of fetal active movement. Ultrasound revealed polyhydramnios, the patient was admitted for severe fetal bradycardia, and fetal extraction through emergency cesarian section was performed. Six weeks after birth, the patient underwent an oral glucose tolerance test with normal values, confirming gestational diabetes mellitus. We performed a systematic review of the literature on polyhydramnios, from January 2016 to April 2022, to analyze all recent published cases and identify the most common etiological causes and important aspects related to maternal-fetal outcomes.
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2
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Simonyi A, Eros FR, Hajdu J, Beke A. Effectiveness of fetal ultrasound diagnostics in cardiac malformations and association with polyhydramnios and oligohydramnios. Quant Imaging Med Surg 2021; 11:2994-3004. [PMID: 34249629 DOI: 10.21037/qims-20-823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 03/17/2021] [Indexed: 11/06/2022]
Abstract
Background Examine the effectiveness of prenatal ultrasound diagnostics in the detection of cardiovascular malformations, and their association with polyhydramnios and oligohydramnios. Methods We examined the fetal ultrasonography and postnatal clinical/fetopathological data of 372 newborns/fetuses over a 7-year period in a tertiary centre. Fetal echocardiography was performed in cases of suspected US findings between 18-32 weeks. During the ultrasound the amniotic fluid amount was measured and the amniotic fluid index (AFI) or largest amniotic fluid pocket was determined. Results Prenatal ultrasonographic results and postnatal/fetopathological diagnosis were fully congruent in 236/372 cases (63.4%), and in 66/372 cases of cardiovascular anomalies (17.7%) the discovery was partial, while in 70/372 cases no fetal cardiovascular anomalies were diagnosed during pregnancy (18.8%) (false negative). Cardiovascular malformations were isolated in 255 cases, in 172 of which (67.5%) the results of prenatal ultrasonography and postnatal diagnostics were fully congruent. In 43 cases (16.9%) the prenatal discovery was partial, and in 40 cases (15.7%) there was no prenatal recognition of the malformation. Cardiovascular abnormalities were found as a part of multiple malformations in 76 cases. In 41 fetuses the cardiovascular malformation was associated with chromosomal abnormalities. Cardiovascular malformations were significantly associated with polyhydramnios. Although in some of the cardiovascular malformations the association rate with polyhydramnios was high (AVSD, double outlet right ventricle, tetralogy of Fallot), we found a moderate association rate (19.7%). The association with oligohydramnios was 8.57%. Conclusions Echocardiography plays an important role in the prenatal diagnostics. In cases of polyhydramnios and oligohydramnios, fetal echocardiography should be performed.
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Affiliation(s)
- Atene Simonyi
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
| | - Fanni Rebeka Eros
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
| | - Julia Hajdu
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary.,Gottsegen György Hungarian Institute of Cardiology, Budapest, Hungary
| | - Artur Beke
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
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3
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Sagi-Dain L, Singer A, Falik-Zaccai T, Peleg A, Bar-Shira A, Feingold-Zadok M, Ben Shachar S, Maya I. The effect of polyhydramnios degree on chromosomal microarray results: a retrospective cohort analysis of 742 singleton pregnancies. Arch Gynecol Obstet 2021; 304:649-656. [PMID: 33591382 DOI: 10.1007/s00404-021-05995-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 02/02/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To analyze the risk for clinically significant microarray aberrations in pregnancies with polyhydramnios. METHODS Data from all chromosomal microarray analyses (CMA) performed due to polyhydramnios between January 2013 and December 2019 were retrospectively obtained from the Ministry of Health Database. The rate of clinically significant (pathogenic and likely pathogenic) CMA findings in isolated and non-isolated polyhydramnios cohorts was compared to a local control group of 5541 fetuses with normal ultrasound, in which 78 (1.4%) abnormal results were demonstrated. Subgroup analyses were performed by the degree of polyhydramnios, week of diagnosis, maternal age, and the presence of additional sonographic anomalies. RESULTS In the isolated polyhydramnios cohort, 19/623 (3.1%) clinically significant CMA aberrations were noted, a significantly higher rate compared to the control population. However, the risk for abnormal CMA results in the 158 cases with mild polyhydramnios (AFI 25-29.9, or maximal vertical pocket 8-11.9 cm) did not significantly differ from pregnancies with normal ultrasound. Of 119 cases of non-isolated polyhydramnios (most frequently associated with cardiovascular (26.1%) and brain (15.1%) anomalies), 8 (6.7%) abnormal CMA findings were noted, mainly karyotype-detectable. CONCLUSION Mild polyhydramnios was not associated with an increased rate of clinically significant microarray results, compared to pregnancies with normal ultrasound. An extensive anatomical sonographic survey should be performed in pregnancies with polyhydramnios, with consideration of fetal echocardiography.
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Affiliation(s)
- Lena Sagi-Dain
- Genetics Institute, Carmel Medical Center, Affiliated to the Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| | - Amihood Singer
- Community Genetics, Public Health Services, Ministry of Health, Jerusalem, Israel
| | - Tzipora Falik-Zaccai
- Institute of Human Genetics, Galilee Medical Center, Nahariya, Israel.,The Azrieli Faculty of Medicine, Bar-Ilan, Safed, Israel
| | - Amir Peleg
- Genetics Institute, Carmel Medical Center, Affiliated to the Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Anat Bar-Shira
- The Genetic Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | - Shay Ben Shachar
- The Genetic Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Idit Maya
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Recanati Genetics Institute, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
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4
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Wang Y, Zhu C, Du L, Li Q, Lin MF, Férec C, Cooper DN, Chen JM, Zhou Y. Compound Heterozygosity for Novel Truncating Variants in the LMOD3 Gene as the Cause of Polyhydramnios in Two Successive Fetuses. Front Genet 2019; 10:835. [PMID: 31572445 PMCID: PMC6753228 DOI: 10.3389/fgene.2019.00835] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 08/13/2019] [Indexed: 01/03/2023] Open
Abstract
Polyhydramnios is sometimes associated with genetic defects. However, establishing an accurate diagnosis and pinpointing the precise genetic cause of polyhydramnios in any given case represents a major challenge because it is known to occur in association with over 200 different conditions. Whole exome sequencing (WES) is now a routine part of the clinical workup, particularly with diseases characterized by atypical manifestations and significant genetic heterogeneity. Here we describe the identification, by means of WES, of novel compound heterozygous truncating variants in the LMOD3 gene [i.e., c.1412delA (p.Lys471Serfs*18) and c.1283dupC (p.Gly429Trpfs*35)] in a Chinese family with two successive fetuses affected with polyhydramnios, thereby potentiating the prenatal diagnosis of nemaline myopathy (NM) in the proband. LMOD3 encodes leiomodin-3, which is localized to the pointed ends of thin filaments and acts as a catalyst of actin nucleation in skeletal and cardiac muscle. This is the first study to describe the prenatal and postnatal manifestations of LMOD3-related NM in the Chinese population. Of all the currently reported NM-causing LMOD3 nonsense and frameshifting variants, c.1412delA generates the shortest truncation at the C-terminal end of the protein, underscoring the critical role of the WH2 domain in LMOD3 structure and function. Survey of the prenatal phenotypes of all known LMOD3-related severe NM cases served to identify fetal edema as a novel presenting feature that may provide an early clue to facilitate prenatal diagnosis of the disease.
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Affiliation(s)
- Ye Wang
- Fetal Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Caixia Zhu
- Fetal Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Liu Du
- Department of Ultrasonic Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Qiaoer Li
- Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-Sen University, Jiangmen, China
| | - Mei-Fang Lin
- Department of Ultrasonic Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Claude Férec
- EFS, Univ Brest, Inserm, UMR 1078, GGB, Brest, France.,CHU Brest, Service de Génétique, Brest, France
| | - David N Cooper
- Institute of Medical Genetics, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Jian-Min Chen
- EFS, Univ Brest, Inserm, UMR 1078, GGB, Brest, France
| | - Yi Zhou
- Fetal Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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5
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Bauserman M, Nathan R, Lokangaka A, McClure EM, Moore J, Ishoso D, Tshefu A, Figueroa L, Garces A, Harrison MS, Wallace D, Saleem S, Mirza W, Krebs N, Hambidge M, Carlo W, Chomba E, Miodovnik M, Koso-Thomas M, Liechty EA, Esamai F, Swanson J, Swanson D, Goldenberg RL, Bose C. Polyhydramnios among women in a cluster-randomized trial of ultrasound during prenatal care within five low and low-middle income countries: a secondary analysis of the first look study. BMC Pregnancy Childbirth 2019; 19:258. [PMID: 31331296 PMCID: PMC6647057 DOI: 10.1186/s12884-019-2412-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 07/15/2019] [Indexed: 01/13/2023] Open
Abstract
Background In many low and low-middle income countries, the incidence of polyhydramnios is unknown, in part because ultrasound technology is not routinely used. Our objective was to report the incidence of polyhydramnios in five low and low-middle income countries, to determine maternal characteristics associated with polyhydramnios, and report pregnancy and neonatal outcomes. Methods We performed a secondary analysis of the First Look Study, a multi-national, cluster-randomized trial of ultrasound during prenatal care. We evaluated all women enrolled from Guatemala, Pakistan, Zambia, Kenya and the Democratic Republic of Congo (DRC) who received an examination by prenatal ultrasound. We used pairwise site comparisons with Tukey-Kramer adjustment and multivariable logistic models with general estimating equations to control for cluster-level effects. The diagnosis of polyhydramnios was confrimed by an U.S. based radiologist in a majority of cases (62%). Results We identified 305/18,640 (1.6%) cases of polyhydramnios. 229 (75%) cases were from the DRC, with an incidence of 10%. A higher percentage of women with polyhydramnios experienced obstructed labor (7% vs 4%) and fetal malposition (4% vs 2%). Neonatal death was more common when polyhydramnios was present (OR 2.43; CI 1.15, 5.13). Conclusions Polyhydramnios occured in these low and low-middle income countries at a rate similar to high-income contries except in the DRC where the incidence was 10%. Polyhydramnios was associated with obstructed labor, fetal malposition, and neonatal death. Trial registration NCT01990625, November 21, 2013.
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Affiliation(s)
- Melissa Bauserman
- Department of Pediatrics, University of North Carolina School of Medicine, 101 Manning Drive, CB 7596, Chapel Hill, NC, 27599-7596, USA.
| | - Robert Nathan
- Department of Radiology, Harborview Medical Center, University of Washington Medical Center, Seattle, WA, USA
| | - Adrien Lokangaka
- Kinshasa School of Public Health, Kinshasa, DRC, Republic of the Congo
| | | | | | - Daniel Ishoso
- Kinshasa School of Public Health, Kinshasa, DRC, Republic of the Congo
| | - Antoinette Tshefu
- Kinshasa School of Public Health, Kinshasa, DRC, Republic of the Congo
| | - Lester Figueroa
- Fundación para la Alimentación y Nutrición de Centro América y Panamá (FANCAP), Guatemala City, Guatemala
| | - Ana Garces
- Fundación para la Alimentación y Nutrición de Centro América y Panamá (FANCAP), Guatemala City, Guatemala
| | - Margo S Harrison
- Department of Obstetrics and Gynecology, University of Colorado, Denver, CO, USA
| | | | - Sarah Saleem
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Waseem Mirza
- Department of Pediatric Radiology, Aga Khan University, Karachi, Pakistan
| | - Nancy Krebs
- Department of Pediatrics, University of Colorado, Denver, CO, USA
| | - Michael Hambidge
- Department of Pediatrics, University of Colorado, Denver, CO, USA
| | - Waldemar Carlo
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Elwyn Chomba
- Department of Pediatrics, University of Zambia, Lusaka, Zambia
| | - Menachem Miodovnik
- Perinatology and Pregnancy Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD, USA
| | - Marion Koso-Thomas
- Perinatology and Pregnancy Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD, USA
| | - Edward A Liechty
- Department of Pediatrics, Indiana University, Indianapolis, IN, USA
| | | | - Jonathan Swanson
- Department of Radiology, Seattle Children's Hospital, University of Washington Medical Center, Seattle, WA, USA
| | - David Swanson
- Department of Radiology, University of Washington Medical Center, Seattle, WA, USA
| | - Robert L Goldenberg
- Department of Obstetrics/Gynecology, Columbia University, New York City, NY, USA
| | - Carl Bose
- Department of Pediatrics, University of North Carolina School of Medicine, 101 Manning Drive, CB 7596, Chapel Hill, NC, 27599-7596, USA
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Crimmins S, Mo C, Nassar Y, Kopelman JN, Turan OM. Polyhydramnios or Excessive Fetal Growth Are Markers for Abnormal Perinatal Outcome in Euglycemic Pregnancies. Am J Perinatol 2018; 35:140-145. [PMID: 28838004 PMCID: PMC6124657 DOI: 10.1055/s-0037-1606186] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE This study aims to investigate the perinatal outcome of fetuses with polyhydramnios and/or accelerated growth among women with a normal oral glucose challenge test (oGCT). METHODS Singleton, nonanomalous pregnancies with an oGCT(< 130 mg/dL) at 24 to 28 weeks, who subsequently demonstrate polyhydramnios (amniotic fluid index > 24 cm or maximum vertical pocket > 8 cm) and/or accelerated growth (abdominal circumference > 95th percentile) on two-third trimester examinations were studied. Maternal demographics, delivery, and neonatal information were recorded. Cases were compared with a reference group (normal oGCT with neither abnormal third-trimester growth nor polyhydramnios). RESULTS A total of 282 pregnancies were in the study group, and 663 were in the reference group. Deliveries in the study group were at a higher risk for birth weight (BW)% > 90%, standard deviation, and postpartum hemorrhage when compared with the reference group (adjusted odds ratio: 2.3-5.6). Pregnancies complicated by both polyhydramnios and accelerated fetal growth were significantly more likely to result in a BW% > 90% (odds ratio [OR]: 18.5; 95% confidence interval [CI]: 8.9-38.6) and PPH (OR: 4.2; 95% CI: 2.4-7.6). CONCLUSION Pregnancies with normal oGCT that develop polyhydramnios and accelerated growth are at higher risk for maternal and neonatal complications. Isolated polyhydramnios without accelerated growth increases the risk for delivery complications but not neonatal morbidity.
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Affiliation(s)
- Sarah Crimmins
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, Maryland
| | - Cecilia Mo
- George Washington University School of Medicine, Washington, District of Columbia
| | - Yomna Nassar
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jerome N. Kopelman
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, Maryland
| | - Ozhan M. Turan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, Maryland
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7
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Frank Wolf M, Peleg D, Stahl-Rosenzweig T, Kurzweil Y, Yogev Y. Isolated polyhydramnios in the third trimester: is a gestational diabetes evaluation of value? . Gynecol Endocrinol 2017; 33:849-852. [PMID: 28488900 DOI: 10.1080/09513590.2017.1323857] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
We evaluated implications of testing for gestational diabetes mellitus (GDM) in pregnancies complicated by third trimester isolated polyhydramnios with previous negative diabetes screening test. In this retrospective cohort study of 104 pregnant women with polyhydramnios between 2005 and 2013, all had normal first trimester fasting glucose and normal glucose challenge test (GCT < 140 mg/dL). Late onset GDM was diagnosed in five women (4.8%) with isolated polyhydramnios, one abnormal value in the oral glucose tolerance test (OGTT) was identified in four additional women (3.8%). No significant differences were found in risk factors for GDM, mean second trimester GCT (117.5 vs. 107.2 mg/dL, p = 0.38) or fasting glucose values (82 vs. 86 mg/dL, p = 0.29) between women in the polyhydramnios group with and without late GDM diagnosis. Moreover, no significant difference was found in relation to the mode of delivery or birth weight between the studied groups (3437 ± 611 vs. 3331 ± 515 g, p = 0.63). Diagnosis of third trimester polyhydramnios was not associated with increased risk for GDM or neonatal complications.
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Affiliation(s)
- Maya Frank Wolf
- a Department of Obstetrics & Gynecology , Galilee Medical Center, Ziv Medical Center, Faculty of Medicine in Galilee, Bar-Ilan University , Zefat , Israel
| | - David Peleg
- b Department of Obstetrics and Gynecology , Ziv Medical Center, Faculty of Medicine in Galilee, Bar-Ilan University , Zefat , Israel
| | - Talia Stahl-Rosenzweig
- c Department of Obstetrics and Gynecology , Baruch Padeh Medical Center , Poriya , Israel
| | - Yaffa Kurzweil
- d Department of Obstetrics and Gynecology , Assaf Harofeh Medical Center , Zerifin , Israel
| | - Yariv Yogev
- e Helen Schneider Hospital for Women, Rabin Medical Center , Petach Tikva , Israel , and
- f Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel
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8
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Abstract
A retrospective matched case control study was conducted to examine the incidence of caesarean delivery (CD) among women admitted with polyhydramnios with and without a trial of labour compared to women with normal amniotic fluid index (AFI). Singleton pregnancies diagnosed with polyhydramnios upon admission to labour between 2003 and 2013 were included. A control group (normal AFI) matched at a ratio of 1:1 was randomly selected. Primary outcome was the incidence of CD. A total of 588 women were included. The overall incidence of CD was significantly higher among women with polyhydramnios (31.3%) compared to the controls (18.7%), (p < .001). The incidences of both non-labouring caesarean and intrapartum operative deliveries were significantly higher among women with polyhydramnios compared to the controls (p = .007 and p = .01, respectively). On a multiple logistic regression model, polyhydramnios was found to be an independent risk factor for delivery by a caesarean (p = .0015; OR 2.0; 95%CI 1.30-2.90).
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Affiliation(s)
- Abeer Suleiman
- a Department of Obstetrics and Gynecology , Emek Medical Center , Afula , Israel
| | - Raed Salim
- a Department of Obstetrics and Gynecology , Emek Medical Center , Afula , Israel.,b Rappaport Faculty of Medicine , Technion , Haifa , Israel
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9
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Luo QQ, Zou L, Gao H, Zheng YF, Zhao Y, Zhang WY. Idiopathic polyhydramnios at term and pregnancy outcomes: a multicenter observational study. J Matern Fetal Neonatal Med 2016; 30:1755-1759. [PMID: 27625160 DOI: 10.1080/14767058.2016.1224835] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Qing-Qing Luo
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China, and
| | - Li Zou
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China, and
| | - Hui Gao
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China, and
| | - Yan-Fang Zheng
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China, and
| | - Yin Zhao
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China, and
| | - Wei-Yuan Zhang
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
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10
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Allaf B, Dreux S, Schmitz T, Czerkiewicz I, Le Vaillant C, Benachi A, Houfflin-Debarge V, Maréchaud M, Oury JF, Muller F. Amniotic fluid biochemistry in isolated polyhydramnios: a series of 464 cases. Prenat Diagn 2015; 35:1331-5. [DOI: 10.1002/pd.4700] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 09/22/2015] [Accepted: 09/24/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Bichr Allaf
- Biochimie-Hormonologie; Hôpital Robert Debré, APHP; Paris France
| | - Sophie Dreux
- Biochimie-Hormonologie; Hôpital Robert Debré, APHP; Paris France
| | - Thomas Schmitz
- Gynécologie-Obstétrique; Hôpital Robert Debré, APHP; Paris France
| | | | | | - Alexandra Benachi
- Gynécologie-Obstétrique et Médecine de la Reproduction, Hôpital Antoine Béclère, AP-HP; Université Paris Sud; Clamart France
| | | | | | | | - Françoise Muller
- Biochimie-Hormonologie; Hôpital Robert Debré, APHP; Paris France
- Université Versailles Saint Quentin en Yvelines; Versailles France
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11
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Nayak SS, Shukla A, Kodandapani S, Adiga PK, Girisha KM. What does fetal autopsy unmask in oligohydramnios? J Matern Fetal Neonatal Med 2015; 29:2347-51. [PMID: 26381033 DOI: 10.3109/14767058.2015.1085021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE We aimed to determine the value of autopsy in fetuses with antenatally diagnosed oligohydramnios. PATIENTS AND METHODS We evaluated all fetal losses over a period of 6.5 years. Those with oligohydramnios on antenatal scan were critically analyzed. Oligohydramnios was defined as amniotic fluid index of less than five objectively or as an obvious lack of liquor at subjective assessment. A detailed postmortem examination was carried out in all the fetuses after obtaining an informed consent. RESULTS Fetal autopsy was conducted in 255 cases. Fifty-five (21.5%) fetuses were diagnosed to have oligohydramnios on antenatal ultrasonography. On analysis of antenatal causes of oligohydramnios, maternal/placental factors were noted in 18%, ultrasound findings known to affect amniotic fluid in 27% while cause remained unidentified in 54.5% of cases. On autopsy, fetal malformations were noted in 61.8% cases, intrauterine growth retardation in 21.8% fetuses and no obvious malformations in 16.3% fetuses. Renal anomalies were noted in 40% cases and non-renal malformations in 21.8% cases. CONCLUSION The postmortem examination helped us to identify the cause of fetal loss in 46 (83.6%) fetuses with antenatal oligohydramnios. A working diagnosis could not have been established without autopsy in 19 (34.5%) cases.
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Affiliation(s)
| | | | - Sreelakshmi Kodandapani
- b Department of Obstetrics and Gynecology , Kasturba Medical College, Manipal University , Manipal , Karnataka , India
| | - Prashanth K Adiga
- b Department of Obstetrics and Gynecology , Kasturba Medical College, Manipal University , Manipal , Karnataka , India
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12
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Aminotic Fluid Index and its Correlation with Fetal Growth and Perinatal Outcome. JOURNAL OF FETAL MEDICINE 2015. [DOI: 10.1007/s40556-015-0049-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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13
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Cho GJ, Hong HR, Kim SW, Hong SC, Oh MJ, Kim HJ. Decreased umbilical orexin-A level is associated with idiopathic polyhydramnios. Acta Obstet Gynecol Scand 2015; 94:295-300. [DOI: 10.1111/aogs.12559] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 12/08/2014] [Indexed: 11/26/2022]
Affiliation(s)
- Geum Joon Cho
- Department of Obstetrics and Gynecology; College of Medicine; Korea University; Seoul Korea
| | - Hye-Ri Hong
- Department of Obstetrics and Gynecology; School of Medicine; Kyung Hee University; Seoul Korea
| | - Suhng Wook Kim
- Department of Biomedical Science; College of Health Sciences; Korea University; Seoul Korea
| | - Soon Cheol Hong
- Department of Obstetrics and Gynecology; College of Medicine; Korea University; Seoul Korea
| | - Min-Jeong Oh
- Department of Obstetrics and Gynecology; College of Medicine; Korea University; Seoul Korea
| | - Hai Joon Kim
- Department of Obstetrics and Gynecology; College of Medicine; Korea University; Seoul Korea
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Dickinson JE, Tjioe YY, Jude E, Kirk D, Franke M, Nathan E. Amnioreduction in the management of polyhydramnios complicating singleton pregnancies. Am J Obstet Gynecol 2014; 211:434.e1-7. [PMID: 24881825 DOI: 10.1016/j.ajog.2014.05.036] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Revised: 04/13/2014] [Accepted: 05/24/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the contribution of amnioreduction to the management of singleton pregnancies that are complicated by symptomatic polyhydramnios. STUDY DESIGN Retrospective review of all singleton pregnancies that received at least 1 amnioreduction for polyhydramnios from 2000-2012 at a single obstetric unit that provides a statewide service. The indications, procedural techniques, and pregnancy outcomes were evaluated. RESULTS One hundred thirty-eight women with polyhydramnios (maximal vertical pocket [MVP], ≥8 cm) had 271 amnioreduction procedures during the study period. The median gestation at the first drain was 31.4 weeks (interquartile range, 28.4-34 weeks) and a median of 1 procedure (interquartile range, 1-2 procedures) was performed per pregnancy. Sixty-three women (45.6%) required >1 amnioreduction. The median volume removed per pregnancy was 2100 mL (interquartile range, 1500-4260 mL). The median duration from the first amnioreduction until delivery was 26 days (interquartile range, 15-52.5 days). There was no significant association between gestation at delivery and the volume per procedure or total volume that was removed. Earlier gestation at first drain was associated positively with earlier gestations at delivery. In 4.1% of amnioreduction procedures (11/271 procedures), there was an unplanned preterm birth within 48 hours. The median gestation at delivery was 36.4 weeks (interquartile range, 34-38 weeks). The final diagnoses were gastrointestinal malformations (21%), idiopathic polyhydramnios (20.3%), chromosomal anomaly (15.2%), syndromic condition (13.7%), and neurologic condition (8%). CONCLUSION Amnioreduction has a useful role in the management of polyhydramnios in singleton pregnancies. Complications are uncommon, and delivery typically occurs near term.
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Affiliation(s)
- Jan Elizabeth Dickinson
- School of Women's and Infants' Health, The University of Western Australia, Perth, WA, Australia; Women and Infants Research Foundation, Perth, WA, Australia
| | - Yan Yan Tjioe
- School of Women's and Infants' Health, The University of Western Australia, Perth, WA, Australia
| | - Emily Jude
- School of Women's and Infants' Health, The University of Western Australia, Perth, WA, Australia
| | - Daniel Kirk
- School of Women's and Infants' Health, The University of Western Australia, Perth, WA, Australia
| | - Malcolm Franke
- School of Women's and Infants' Health, The University of Western Australia, Perth, WA, Australia
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15
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Harlev A, Sheiner E, Friger M, Hershkovitz R. Polyhydramnios and adverse perinatal outcome – what is the actual cutoff? J Matern Fetal Neonatal Med 2013; 27:1199-203. [DOI: 10.3109/14767058.2013.853736] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Tashfeen K, Hamdi IM. Polyhydramnios as a predictor of adverse pregnancy outcomes. Sultan Qaboos Univ Med J 2013; 13:57-62. [PMID: 23573383 DOI: 10.12816/0003196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Revised: 09/12/2012] [Accepted: 12/22/2012] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES This study aimed to ascertain the frequency of polyhydramnios in singleton pregnancies, to determine the associated risk factors, and assess the adverse maternal and perinatal outcomes. METHODS A retrospective cohort study of all singleton pregnancies complicated with polyhydramnios after 28 weeks of gestation was carried out in Nizwa Hospital's Obstetrics & Gynecology Department, Oman, from January 2002 to December 2007. Of 25,979 pregnant women reviewed, 477 were found to have polyhydramnios. The control group consisted of 900 pregnant women. Cases of polyhydramnios were diagnosed as mild, moderate, or severe based on their highest amniotic fluid index. Cases were compared with controls in terms of demographic data; prevalence of diabetes, macrosomia, or Caesarean deliveries; frequency of fetal anomalies, and perinatal mortality rate. RESULTS Polyhydramnios was diagnosed in 1.8% of pregnancies. It was mild in 382 (80%), moderate in 84 (17.6%), and severe in 12 (2.4%). A total of 72 (15.3 %) cases of polyhydramnios were complicated by diabetes (gestational or established diabetes mellitus) as compared to 10% of the control group and 39 (8.1%) neonates had congenital anomalies. Polyhydramnios was associated with advanced maternal age; 58 (12.2%) of subjects were over 40 years old. The perinatal mortality rate with polyhydramnios was 42 per 1,000 births compared to 14 per 1000 births in the control group. CONCLUSION These data demonstrate that polyhydramnios is associated with an increased risk of adverse perinatal outcomes, and there is a significant positive relation with maternal age, diabetes, fetal anomalies, and fetal macrosomia.
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Affiliation(s)
- Kaukab Tashfeen
- Department of Obstetrics & Gynecology, Nizwa Hospital, Nizwa, Oman
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17
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Pri-Paz S, Khalek N, Fuchs KM, Simpson LL. Maximal amniotic fluid index as a prognostic factor in pregnancies complicated by polyhydramnios. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2012; 39:648-653. [PMID: 21898637 DOI: 10.1002/uog.10093] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES Polyhydramnios is present in approximately 2% of pregnancies and has been associated with a variety of adverse pregnancy outcomes. Our aim was to evaluate the association between the maximal amniotic fluid index (AFI) and the frequency of specific adverse outcomes. METHODS This was a retrospective chart review of 524 singleton pregnancies diagnosed with polyhydramnios and delivered in a single tertiary referral center between 2003 and 2008. Polyhydramnios was defined as either AFI ≥ 25 cm or a maximum vertical pocket (MVP) ≥ 8 cm even in the presence of AFI < 25 cm. The cohort was stratified into four groups based on the maximal AFI noted during the pregnancy: < 25 cm but with MVP ≥ 8 cm; 25-29.9 cm; 30-34.9 cm; and ≥ 35 cm. Data were collected to determine the frequency of the following adverse pregnancy outcomes: prenatally diagnosed congenital anomalies, fetal aneuploidy, preterm delivery, Cesarean delivery, low birth weight, 5-min Apgar score < 7 and perinatal mortality. RESULTS Higher AFI was associated with a statistically significant increase in the frequency of adverse pregnancy outcomes. The most severe form of polyhydramnios, as based on the maximal AFI (≥ 35 cm; n = 67), was associated with the highest rates of prenatally diagnosed congenital anomalies (79%), preterm delivery (46%), small-for-gestational-age neonate (16%), aneuploidy (13%) and perinatal mortality (27%). No significant association between degree of polyhydramnios and adverse outcome was demonstrated in cases of idiopathic polyhydramnios (n = 253). CONCLUSIONS There is an association between the frequencies of a variety of adverse pregnancy outcomes and the severity of polyhydramnios as reflected by the maximal AFI.
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Affiliation(s)
- S Pri-Paz
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, New York 10032, USA.
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18
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Leibovitch L, Schushan-Eisen I, Kuint J, Weissmann-Brenner A, Maayan-Metzger A. Short-term outcome for term and near-term singleton infants with intrapartum polyhydramnios. Neonatology 2012; 101:61-7. [PMID: 21912184 DOI: 10.1159/000329621] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Accepted: 05/25/2011] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate rates of early short-term neonatal complications among term and near-term newborn infants with polyhydramnios. METHODS Retrospective data were collected on 788 term infants with prenatal diagnosis of polyhydramnios and 1,576 matched controls, including information on maternal condition and on infant perinatal complications. RESULTS The total rate of major congenital malformations among infants born to mothers with polyhydramnios was 2.3% compared to 0.13% for those with normal amniotic fluid index (p < 0.001). Infants in the study group were more likely to be born to diabetic mothers, were heavier and large for gestational age and were more likely to be delivered by cesarean section. Infants with polyhydramnios, but no major congenital malformations, are at increased risk for minor congenital malformations (4.2%) as well as for postnatal complications, such as respiratory distress (5.7%), cardiovascular manifestations (mainly delayed closure of the ductus arteriosus; 3.1%) and hypoglycemia (7%) compared to controls. Multivariate logistic regression revealed that polyhydramnios was associated only with postnatal respiratory distress and hypoglycemia. The severity of polyhydramnios was not associated with an increased rate of neonatal complications. CONCLUSION Although infants with polyhydramnios, but no major congenital malformations, were found to have increased rates of respiratory distress and hypoglycemia, these clinical manifestations were mild and had little effect on the babies' well-being and length of hospital stay.
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Affiliation(s)
- Leah Leibovitch
- Department of Neonatology, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
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19
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Ogawa M, Sato A, Mori K, Nagao D, Kamada K, Sato M, Terada Y. Clinical significance of amniotic fluid glucose concentration in polyhydramnios. J Matern Fetal Neonatal Med 2011; 25:1073-6. [PMID: 21916813 DOI: 10.3109/14767058.2011.622003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To evaluate whether amniotic fluid glucose concentration can predict poor neonatal outcome in cases with polyhydramnios as an overall assessment. METHODS In this retrospective study, we have reviewed 42 consecutive pregnant women with singleton gestations complicated with polyhydramnios who gave birth at one tertiary care center between January 2003 and September 2010. Perinatal clinical findings were reviewed, and the neonatal outcome, such as livebirth or stillbirth and early neonatal death, was compared. A p value less than 0.05 was considered to be significant. RESULTS Thirteen of 42 neonates had a poor outcome, including stillbirth or early neonatal death. Multiple logistic regression analysis showed that amniotic fluid glucose (p = 0.042) was significant factor influencing poor neonatal prognosis [odds ratio 0.66; 95% confidence interval 0.44-0.98]. Receiver operating characteristics curve and sensitivity and specificity curve showed that the optimal cut-off value of amniotic fluid glucose concentration for predicting poor neonatal outcome was 17 mg/dl. CONCLUSIONS Amniotic glucose concentration less than 17 mg/dl and the presence of congenital heart anomaly were better predictors for a poor postnatal outcome in cases with polyhydramnios.
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Affiliation(s)
- Masaki Ogawa
- Perinatal Care Center, Akita University Hospital, Hondo, Akita, Japan.
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20
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Association of Maternal Medical Conditions and Unfavorable Birth Outcomes: Findings from the 1996–2003 Mississippi Linked Birth and Death Data. Matern Child Health J 2009; 15:910-20. [DOI: 10.1007/s10995-009-0516-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Dorleijn DMJ, Cohen-Overbeek TE, Groenendaal F, Bruinse HW, Stoutenbeek P. Idiopathic polyhydramnios and postnatal findings. J Matern Fetal Neonatal Med 2009; 22:315-20. [PMID: 19085623 DOI: 10.1080/14767050802531870] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Our objective was to investigate the outcome of neonates with idiopathic polyhydramnios in the first year after birth. METHODS All patients diagnosed in the Erasmus Medical Centre Rotterdam and the University Medical Centre Utrecht between January 2000 and April 2005 with idiopathic polyhydramnios were studied. The outcome variables included mode of delivery, pre-term delivery, birth weight, macrosomia, large-for-gestational-age (weight > p90), neonatal or infant mortality and infant morbidity at 1 year after delivery. These were related to antenatal findings, including the onset of polyhydramnios and ultrasonographic evidence of macrosomia (estimated fetal weight > p90). RESULTS Polyhydramnios was diagnosed at a mean gestational age (+/- s.d.) of 31.0 +/- 4.9 weeks. The mean gestational age at birth (+/- s.d.) was 37.9 +/- 3.7 weeks. Macrosomia at birth was present in 25.3% (22/88). Sixty-three of 88 infants were in good health 1 year after birth; 20 infants had an abnormality and 5 children had died. Macrosomia and detection of polyhydramnios in the third trimester was associated significantly with a good outcome. CONCLUSION In neonates with idiopathic polyhydramnios, abnormalities were detected during the first year of life in 28.4%. Detection of polyhydramnios in the second trimester and low or normal birth weight are risk factors for associated abnormalities.
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Affiliation(s)
- Desirée M J Dorleijn
- Division of Perinatology and Gynecology, University Medical Centre Utrecht, Utrecht 3508 AB, The Netherlands
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Johnson JM, Chauhan SP, Ennen CS, Niederhauser A, Magann EF. A comparison of 3 criteria of oligohydramnios in identifying peripartum complications: a secondary analysis. Am J Obstet Gynecol 2007; 197:207.e1-7; discussion 207.e7-8. [PMID: 17689653 DOI: 10.1016/j.ajog.2007.04.048] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2006] [Revised: 03/19/2007] [Accepted: 04/26/2007] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The objective of the study was to ascertain the diagnostic accuracy of 3 criteria of oligohydramnios in identifying 4 peripartum complications. STUDY DESIGN The 3 definitions of oligohydramnios were amniotic fluid index (AFI) 5.0 cm or less and AFI <5% for gestational age (GA) using nomograms by Moore and Cayle or Magann et al. Likelihood ratio (LR) and guidelines by the Evidence-Based Medicine Working Group were used in the secondary analysis of previously published reports. AFI obtained during antepartum and intrapartum periods were analyzed separately. RESULTS The 95% confidence intervals for the prevalence of oligohydramnios using the 3 criteria are significantly different in the antepartum or intrapartum analysis. The LR was <6 for ante- and intrapartum AFI to identify cesarean delivery for nonreassuring fetal heart rate tracing, Apgar score 3 or less at 5 minutes, umbilical arterial pH <7.00, and newborns' weight 5% or less for GA. CONCLUSION The 3 criteria for determining the adequacy of amniotic fluid are not fungible, and they are not useful diagnostic tests for identifying peripartum complications because LR is <10.
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Magann EF, Doherty DA, Ennen CS, Chauhan SP, Shields D, Gjesdal SM, Morrison JC. The ultrasound estimation of amniotic fluid volume in diamniotic twin pregnancies and prediction of peripartum outcomes. Am J Obstet Gynecol 2007; 196:570.e1-6; discussion 570.e6-8. [PMID: 17547899 DOI: 10.1016/j.ajog.2007.01.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2006] [Revised: 12/28/2006] [Accepted: 01/24/2007] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine ultrasonic estimations of amniotic fluid in diamniotic twins across gestation using the single deepest pocket (SDP) technique and correlate volumes to intrapartum and neonatal outcomes. STUDY DESIGN Prospective observational study using diamniotic dichorionic and diamniotic monochorionic pregnancies. Intrapartum and neonatal outcomes were evaluated. RESULTS Between April 2004 and April 2006, 299 women were recruited. There was no significant relationship between SDP and gestational age. Statistically significant differences by SDP groups (for low, normal, and high volumes) include preterm delivery (P = .043; 56, 62, and 86%), abnormal labor tracing (P = .013; 5, 8, and 27%), fetal labor intolerance (P = .026; 6, 9, and 27%), Apgar scores at 5 minutes (P = .028; 17, 10, and 27%) and any neonatal complications (P = .002; 28, 21, and 55%). CONCLUSION The SDP is constant between 17 and 37 weeks. Fetal labor intolerance and adverse neonatal outcomes are greater in a twin with hydramnios.
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Affiliation(s)
- Everett F Magann
- Department of Obstetrics and Gynecology, Naval Medical Center Portsmouth, Portsmouth, VA, USA
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Lapaire O, Holzgreve W, Zanetti-Daellenbach R, Refecca ME, Irene H, Sevgi T. Polyhydramnios: An Update. ACTA ACUST UNITED AC 2007. [DOI: 10.5005/jp-journals-10009-1086] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract
Maternal, fetal or placental pathologies may result in an excessive amount of amniotic fluid (AF) volume. Therefore, the surveillance of the AF volume, predominantly by ultrasound, has become an important instrument for the assessment of fetal well-being. An excessive accumulation of amniotic fluid, as a consequence of a disturbed balance between production, fetal resorption and secretion, is defined as polyhydramnios. Its degree correlates significantly with fetal morbidity and mortality. Therefore, polyhydramnios is an important clinical pattern in perinatal medicine. Approximately 20 percent of the fetuses with severe polyhydramnios show a congenital anomaly, whereas 50 percent of all cases are considered to be idiopathic, mostly with mild patterns. Furthermore, the likelihood of aneuploidy varies from 0.4 to 10 percent. Early detection, provides a correct diagnosis and allows a individual therapy. A referral to a tertiary center is advised in case of severe polyhydramnios and unknown etiology.
In this review, current diagnostic as well as therapeutical aspects are discussed.
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Porter H, Lookinland S, Belfort MA. Evaluation of a new real-time blood continuous glucose monitoring system in pregnant women without gestational diabetes. A pilot study. J Perinat Neonatal Nurs 2004; 18:93-102. [PMID: 15214248 DOI: 10.1097/00005237-200404000-00004] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The incidence of gestational diabetes mellitus (GDM) has reached epidemic proportions in the United States, affecting 200,000 pregnant women annually. Controversies exist regarding whether the glucose levels used to diagnose GDM in pregnancy should be lowered since similar fetal complications are seen in women with GDM as well as in nondiabetic women. Although GDM has been extensively studied, the effects of the earlier stage of glucose intolerance are not well understood. The objectives of this descriptive, comparative, correlational pilot study include assessment of real-time blood glucose concentrations in women (20) with idiopathic macrosomia and/or polyhydramnios but with a normal baseline glucose screening test. This group was compared to pregnant women (20) without idiopathic macrosomia and/or polyhydromnios as confirmed by normal ultrasounds (controls). All subjects had a normal screeing test and/or a 3-hour Glucose Tolerance Test earlier in the pregnancy and wore a continuous glucose monitoring system for 72 hours. No adverse maternal complications were seen. Neonatal complications included macrosomia, shoulder dystocia, and hyperbilirubinemia. There was no significant association between real-time blood glucose levels and adverse maternal or fetal/neonatal complications. There is little evidence available regarding real-time physiologic glycemic levels in pregnant women. The findings of our pilot study provide baseline data for the design of a larger study to compare blood glucose levels and complications in euglycemic women and compare to women with those impaired glucose tolerance.
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Affiliation(s)
- Heidi Porter
- Utah Valley Regional Medical Center, Provo, Utah, USA
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