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Whittington JR, Chauhan SP, Wendel MP, Ghahremani TL, Pagan ME, Carter MM, Magann EF. Historical Assessment, Practical Management, and Future Recommendations for Abnormal Amniotic Fluid Volumes. J Clin Med 2024; 13:4702. [PMID: 39200844 PMCID: PMC11355879 DOI: 10.3390/jcm13164702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Revised: 08/07/2024] [Accepted: 08/08/2024] [Indexed: 09/02/2024] Open
Abstract
Objective: The purpose of this review is to examine the evidence that defines normal and abnormal amniotic fluid volumes (AFVs) and current recommendations on the management of abnormalities of AFV. Methods: The studies establishing normal actual AFVs and the ultrasound estimates used to identify normal and abnormal AFVs were evaluated. Recommendations from national and international organizations were reviewed for guidance on the definitions and management of abnormal AFVs. Results: A timeline of the development of the thresholds that define abnormal AFVs was created. Recommendations from 13 national and international guidelines were identified, but the definitions and management recommendations for abnormal AFVs varied considerably between groups. An algorithm for the management of oligohydramnios and polyhydramnios was developed. Knowledge gaps and the structure of future studies were examined. Conclusions: Assessment of AFV is performed multiple times per day in antenatal clinics and hospitals. Current recommendations on defining and managing abnormal AFVs differ between national and international organizations. We have proposed algorithms to assist in the management of abnormal AFVs until further studies can be undertaken.
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Affiliation(s)
- Julie R. Whittington
- Department of Obstetrics and Gynecology, Navy Medicine Readiness and Training Command Portsmouth, Portsmouth, VA 23708, USA; (J.R.W.)
| | - Suneet P. Chauhan
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX 77030, USA
| | - Michael P. Wendel
- Department of Obstetrics & Gynecology, University of Arkansas for Medical Sciences, 4301 W. Markham St. Slot 518, Little Rock, AR 72205, USA
| | - Taylor L. Ghahremani
- Department of Obstetrics & Gynecology, University of Arkansas for Medical Sciences, 4301 W. Markham St. Slot 518, Little Rock, AR 72205, USA
| | - Megan E. Pagan
- Department of Obstetrics and Gynecology, Darnall Army Medical Center, Fort Hood, TX 76500, USA
| | - Meagen M. Carter
- Department of Obstetrics and Gynecology, Navy Medicine Readiness and Training Command Portsmouth, Portsmouth, VA 23708, USA; (J.R.W.)
| | - Everett F. Magann
- Department of Obstetrics & Gynecology, University of Arkansas for Medical Sciences, 4301 W. Markham St. Slot 518, Little Rock, AR 72205, USA
- Department of Obstetrics and Gynecology, Virginia Tech Carillion, Roanoke, VA 24016, USA
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Jiang Z, Ye X, Cao D, Xiang Y, Li Z. Association of Placental Tissue Metabolite Levels with Gestational Diabetes Mellitus: a Metabolomics Study. Reprod Sci 2024; 31:569-578. [PMID: 37794198 DOI: 10.1007/s43032-023-01353-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 09/09/2023] [Indexed: 10/06/2023]
Abstract
The purpose of the study is to investigate the metabolic characteristics of placental tissue in patients diagnosed with gestational diabetes mellitus (GDM). Ultra-performance liquid chromatography-mass spectrometry (UPLC-MS/MS) was employed to qualitatively and quantitatively analyze the metabolites in placental tissues obtained from 25 healthy pregnant women and 25 pregnant women diagnosed with GDM. Multilevel statistical methods are applied to process intricate metabolomics data. Meanwhile, we applied machine learning techniques to identify biomarkers that could potentially predict the risk of long-term complications in patients with GDM as well as their offspring. We identified 1902 annotated metabolites, out of which 212 metabolites exhibited significant differences in GDM placentas. In addition, the study identifies a set of risk biomarkers that effectively predict the likelihood of long-term complications in both pregnant women with GDM and their offspring. The accuracy of this panel was measured by the area under the receiver operating characteristic curve (ROC), which was found to be 0.992 and 0.960 in the training and validation sets, respectively. This study enhances our understanding of GDM pathogenesis through metabolomics. Furthermore, the panel of risk markers identified could prove to be a valuable tool in predicting potential long-term complications for both GDM patients and their offspring.
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Affiliation(s)
- Zhifa Jiang
- Department of Obstetrics and Gynecology, Huizhou First Maternal and Child Health Care Hospital, Guangdong, Huizhou, China
- Guangdong Medical University, Guangdong, Zhanjiang, China
| | - Xiangyun Ye
- Guangdong Medical University, Guangdong, Zhanjiang, China
| | - Dandan Cao
- Guangdong Medical University, Guangdong, Zhanjiang, China
| | - Yuting Xiang
- Department of Obstetrics and Gynecology, Affiliated Dongguan Hospital, Southern Medical University of Major Diseases in Obstetrics and Gynecology, Dongguan, China
| | - Zhongjun Li
- Guangdong Medical University, Guangdong, Zhanjiang, China.
- Department of Obstetrics and Gynecology, Affiliated Dongguan Hospital, Southern Medical University of Major Diseases in Obstetrics and Gynecology, Dongguan, China.
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Soni S, Paidas Teefey C, Gebb JS, Khalek N, Neary K, Miller K, Moldenhauer JS. Amnioreduction vs expectant management in pregnancies with moderate to severe polyhydramnios. Am J Obstet Gynecol MFM 2023; 5:101192. [PMID: 37858792 DOI: 10.1016/j.ajogmf.2023.101192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/20/2023] [Accepted: 10/09/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND The rate of polyhydramnios is higher in pregnancies complicated by congenital anomalies. These pregnancies have higher rates of peripartum complications. Amnioreduction is offered to relieve maternal symptoms such as dyspnea, abdominal and respiratory discomfort, and other issues like satiety. OBJECTIVE This study aimed to report the rates of amnioreduction and its associated complications in pregnancies with moderate to severe polyhydramnios secondary to fetal anomalies. We also sought to determine if amnioreduction provided additional benefits, including prolongation of pregnancy and a decrease in the rates of peripartum morbidities associated with moderate to severe polyhydramnios. STUDY DESIGN This was a retrospective review of anomalous singleton pregnancies with moderate to severe polyhydramnios that were evaluated and delivered at a single center between 2013 and 2021. Peripartum outcomes were compared between pregnancies that underwent amnioreduction and those that were expectantly managed. Mann-Whitney U tests were used to compare continuous variables and Fisher's exact tests were used for categorical variables. A multiple regression model was created to understand the effects of amnioreduction on gestational age at delivery. RESULTS A total of 218 singleton pregnancies met the inclusion criteria of moderate to severe polyhydramnios in the study period. Of those, 110 patients (50.5%) underwent amnioreduction and 108 patients (49.5%) opted for expectant management. A total of 147 procedures were performed at a median gestational age of 32.5 weeks and a median of 1900 mL of amniotic fluid was removed per procedure. Complications occurred in 10.9% (n=16) of procedures, including preterm delivery within 48 hours in 5.4% cases (n=8). The median amniotic fluid index was higher in the amnioreduction group than in the expectant group (38.9 cm vs 35.5 cm; P<.0001). Patients who underwent amnioreduction had an earlier median gestational age at delivery (36.3 weeks vs 37.0 weeks; P=.048), however, the rates of spontaneous preterm delivery were similar. A higher percentage of women in the amnioreduction group had vaginal delivery (49.4% vs 30.5%; P=.01) and lower rates of uterine atony (2.4% vs 13.7%; P=.006). In the multiple linear regression analysis, the gestational age at delivery positively correlated with gestational age at amnioreduction after controlling for amniotic fluid volume (P<.0001; 95% confidence interval, 0.34-0.71). In addition, the patients in the amnioreduction group were twice as likely to have a vaginal delivery (P=.02). CONCLUSION Amnioreduction in the setting of moderate-severe polyhydramnios has a reasonably low rate of complications but does not provide any benefits in terms of prolonging the pregnancy. The procedure may increase the likelihood of vaginal delivery and lower the rates of uterine atony.
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Affiliation(s)
- Shelly Soni
- Richard D. Wood Jr Center for Fetal Diagnosis & Treatment, Department of General, Thoracic & Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA (Drs Soni, Paidas Teefey, Gebb, Khalek, Neary, Miller, and Moldenhauer); Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (Drs Soni, Paidas Teefey, Gebb, Khalek, and Moldenhauer).
| | - Christina Paidas Teefey
- Richard D. Wood Jr Center for Fetal Diagnosis & Treatment, Department of General, Thoracic & Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA (Drs Soni, Paidas Teefey, Gebb, Khalek, Neary, Miller, and Moldenhauer); Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (Drs Soni, Paidas Teefey, Gebb, Khalek, and Moldenhauer)
| | - Juliana S Gebb
- Richard D. Wood Jr Center for Fetal Diagnosis & Treatment, Department of General, Thoracic & Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA (Drs Soni, Paidas Teefey, Gebb, Khalek, Neary, Miller, and Moldenhauer); Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (Drs Soni, Paidas Teefey, Gebb, Khalek, and Moldenhauer)
| | - Nahla Khalek
- Richard D. Wood Jr Center for Fetal Diagnosis & Treatment, Department of General, Thoracic & Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA (Drs Soni, Paidas Teefey, Gebb, Khalek, Neary, Miller, and Moldenhauer); Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (Drs Soni, Paidas Teefey, Gebb, Khalek, and Moldenhauer)
| | - Kayla Neary
- Richard D. Wood Jr Center for Fetal Diagnosis & Treatment, Department of General, Thoracic & Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA (Drs Soni, Paidas Teefey, Gebb, Khalek, Neary, Miller, and Moldenhauer)
| | - Kendra Miller
- Richard D. Wood Jr Center for Fetal Diagnosis & Treatment, Department of General, Thoracic & Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA (Drs Soni, Paidas Teefey, Gebb, Khalek, Neary, Miller, and Moldenhauer)
| | - Julie S Moldenhauer
- Richard D. Wood Jr Center for Fetal Diagnosis & Treatment, Department of General, Thoracic & Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA (Drs Soni, Paidas Teefey, Gebb, Khalek, Neary, Miller, and Moldenhauer); Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (Drs Soni, Paidas Teefey, Gebb, Khalek, and Moldenhauer)
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Whittington JR, Ghahremani T, Friski A, Hamilton A, Magann EF. Window to the Womb: Amniotic Fluid and Postnatal Outcomes. Int J Womens Health 2023; 15:117-124. [PMID: 36756186 PMCID: PMC9900144 DOI: 10.2147/ijwh.s378020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 01/18/2023] [Indexed: 02/04/2023] Open
Abstract
Amniotic fluid volumes are tightly regulated, and amniotic fluid derangement can indicate maternal complications or fetal abnormalities. Ultrasound estimate of amniotic fluid provides a tool to evaluate the maternal-fetal-placental interface in real-time. Oligohydramnios and polyhydramnios are associated with adverse maternal and neonatal outcomes. Oligohydramnios is associated with adverse maternal and neonatal outcomes including cesarean delivery, operative vaginal delivery, induction of labor, postpartum hemorrhage, small for gestational age neonate, intrauterine demise, neonatal death, NICU admission, and APGAR less than 7 at. 5 minutes of life Polyhydramnios is associated with adverse outcomes including cesarean delivery, induction of labor, placental abruption, shoulder dystocia, cord prolapse, postpartum hemorrhage, intrauterine fetal demise, NICU admission, neonatal death, APGAR less than 7 at 5 minutes of life, large for gestational age neonate, and respiratory distress syndrome. Therefore, Amniotic fluid should be evaluated when maternal or fetal well-being is in question.
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Affiliation(s)
- Julie R Whittington
- Women’s Health Department, Naval Medical Readiness and Training Center Portsmouth, Portsmouth, VA, USA,Correspondence: Julie R Whittington, Women’s Health Department, Naval Readiness and Training Command Portsmouth, 620 John Paul Jones Circle, Portsmouth, VA, 23321, USA, Tel +1-979-848-9665, Email
| | - Taylor Ghahremani
- Department of OB/GYN, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Andrew Friski
- Women’s Health Department, Naval Medical Readiness and Training Center Portsmouth, Portsmouth, VA, USA
| | - Andrew Hamilton
- Women’s Health Department, Naval Medical Readiness and Training Center Portsmouth, Portsmouth, VA, USA
| | - Everett F Magann
- Women’s Health Department, Naval Medical Readiness and Training Center Portsmouth, Portsmouth, VA, USA
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