Peripartum outcomes of high-risk pregnancies complicated by oligo- and polyhydramnios: a prospective longitudinal study

Maternal and perinatal outcomes of oligohydramnios in late term and post term pregnancies at public hospitals in Ethiopia: a cross-sectional study

BACKGROUND

The prevalence of oligohydramnios ranges from 12 to 14% after 41 weeks to as high as 30% in post term pregnancies. Oligohydramnios poses a dilemma in the choice of mode of labor and delivery in a setup where there is lack of continuous electronic fetal monitoring during labor. The condition also puts the mother at risks of operative interventions and cesarean delivery. We aimed to asses the maternal and perinatal outcomes in pregnancies with oligohydramnios in late term and post term pregnancy in this study.

METHODS

A cross-sectional study was conducted among mothers with diagnosis of oligohydramnios after 40+ 6 weeks of gestation at four hospitals at four public hospitals in Addis Ababa, Ethiopia from May 1, 2021 to September 30, 2021. Data were collected using structured questionnaire. Logistic regression were performed to assess factors associated with the adverse maternal and perinatal outcomes.

RESULTS

From a total of 142 mothers with oligohydramnios in late term and post tem pregnancies, 40.8% delivered through cesarean section. Spontaneous labor and elective cesarean section were more likely to occurr in parous women (AOR 2.5, 95% CI 1.06-6.04, p = 0.04), but with less likely in those with secondary level education (AOR 0.13, 95% CI 0.02-0.74, p = 0.02). There was no statistically significant difference in adverse outcomes between those who had induction of labor and those who had either spontaneous labor or had elective cesarean section.

CONCLUSIONS

The adverse maternal and perinatal outcomes in late term and post term pregnancies with oligohydramnios may not be different among different modes of delivery. Induction of labor can be safe in these particular group of women with intermittent auscultation with fetoscope in a setup where continuous electronic fetal monitoring is not readily available.

Term Idiopathic Polyhydramnios, and Labor Complications

Background and Aim: Polyhydramnios is associated with an increased risk of various adverse pregnancy outcomes, yet complications during labor have not been sufficiently studied. We assessed the labor and perinatal outcomes of idiopathic polyhydramnios during term labor. Methods: Retrospective cohort study at a tertiary medical center between 2010 and 2014. Women with idiopathic polyhydramnios defined as an amniotic fluid index (AFI) greater than 24 cm or a deep vertical pocket (DVP) > 8 cm (cases) were compared with women with a normal AFI (5-24 cm) (controls). Statistics: Descriptive, means ± SDs, medians + IQR. Comparisons: chi-square, Fisher's exact test, Mann-Whitney Test, multivariate logistic models. Results: During the study period 11,065 women had ultrasound evaluation completed by a sonographer within two weeks of delivery. After excluding pregnancies complicated by diabetes (pre-gestational or gestational), fetal anomalies, IUFD, multifetal pregnancies, elective cesarean deliveries (CD) or missing data, we included 750 cases and 7000 controls. The degree of polyhydramnios was mild in 559 (75.0%) cases (AFI 24-30 cm or DVP 8-12 cm), moderate in 137 (18.0%) cases (30-35 cm or DVP 12-15 cm) and severe in 54 (7.0%) cases (AFI >35 cm or DVP > 15 cm). Idiopathic polyhydramnios was associated with a higher rate of CD 9.3% vs. 6.2%, p = 0.004; a higher rate of macrosomia 22.8% vs. 7.0%, p < 0.0001; and a higher rate of neonatal respiratory complications 2.0% vs. 0.8%, p = 0.0001. A multivariate regression analysis demonstrated an independent relation between polyhydramnios and higher rates of CD, aOR 1.62 (CI 1.20-2.19 p = 0.002) and composite adverse neonatal outcome aOR 1.28 (CI 1.01-1.63 p = 0.043). Severity of polyhydramnios was significantly associated with higher rates of macrosomia and CD (p for trend <0.01 in both). Conclusions: The term idiopathic polyhydramnios is independently associated with macrosomia, CD and neonatal complications. The severity of polyhydramnios is also associated with macrosomia and CD.

Association and Correlation Between Amniotic Fluid Index and Glucose Concentration

Purpose: To study the association and correlation between the amniotic fluid index, random glucose concentration, and serum glucose concentration after avoiding oral intake of sugar in a pregnant female with polyhydramnios.

Methods: The research was performed on pregnant women with polyhydramnios (n=104 ) after 28 weeks. USG was performed using a SAMSUNG HS 70A (Samsung Electronics Pvt. Ltd., Seoul, South Korea) and a GE Voluson P8 (GE Healthcare, Little Chalfont, UK). We measured amniotic fluid index and took a blood sample for hemoglobin (Hb)A1C, fasting blood glucose, post-prandial and random blood glucose, and also performed a glucose tolerance test in pregnant women.

Results: This is a prospective study, all 104 patients that were recruited in this study were pregnant females with polyhydramnios mainly from the urban and rural zone with different age groups (between 21 and 37 years). In our study, we observed that after avoiding oral intake of sugar in pregnant females with polyhydramnios, it was concluded that the amnionic fluid index lies towards the lower side. Polyhydramnios is more common in the urban zone and among older pregnant females. Out of 104 pregnant females with polyhydramnios, 82 were diagnosed with gestational diabetes after 28 weeks.

Conclusion: In this study, we have concluded that the earliest and most sensitive predictor for gestational diabetes is a rise in the amniotic fluid index which could have been prevented by avoiding oral intake of sugar. Early prediction of gestational diabetes can be made by amniotic fluid index even before glucose concentration. We observed that by reducing oral intake of sugar, the amniotic fluid index drops down in pregnant females

Transient Polyhydramnios during Pregnancy Complicated with Gestational Diabetes Mellitus: Case Report and Systematic Review

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.

<p>What is the Impact of Abnormal Amniotic Fluid Volumes on Perinatal Outcomes in Normal Compared with At-Risk Pregnancies?</p>

Objective

Assessing amniotic fluid volume is an integral part of obstetric practice. Data are sparse on at-risk pregnancy and amniotic fluid volumes. The aim of our study was to determine if there is a difference in perinatal outcomes based on complications of pregnancy and amniotic fluid volumes. We hypothesized that at-risk pregnancies with abnormal amniotic fluid volumes would have worse perinatal outcomes than normal pregnancies with abnormal amniotic fluid volumes.

Study Design

This retrospective cohort study evaluated both normal and at-risk singleton pregnancies with intact membranes on admission for delivery. Amniotic fluid volumes were estimated using both the amniotic fluid index (AFI) and single deepest pocket (SDP) techniques. All sonograms were performed by trained ultrasound technicians or obstetrician/gynecologists. We placed 3365 women into 6 separate groups (at-risk versus normal, then further stratified by oligohydramnios by SDP, normal fluid, or polyhydramnios by AFI).

Results

At-risk pregnancies with normal fluid and at-risk pregnancies with polyhydramnios have significantly increased risk of neonatal intensive care unit (NICU) admission [OR 2.06 (95% CI 1.63,2.60), OR 2.74 (95% CI 1.54, 4.87)]. Birthweight is significantly higher in at-risk and normal pregnancies with polyhydramnios than those with normal pregnancies and normal fluid (p<0.0001). Birthweight is significantly lower in at-risk pregnancies with oligohydramnios (p<0.0001). There were no significant differences in need for amnioinfusion in labor, variables or lates influencing delivery, meconium staining, or umbilical artery pH <7.1.

Conclusion

Our study attempted to further define risk of adverse pregnancy outcomes by defining the pregnancy as normal or at-risk and amniotic fluid volumes. Contrary to our hypothesis, we did not find an increased risk of many of the adverse perinatal outcomes we studied amongst at-risk pregnancies with abnormal fluid. There was an increased risk of NICU admission associated with polyhydramnios in normal and at-risk pregnancies.

Risk factors associated with preterm birth: a retrospective study in Mukalla Maternity and Childhood Hospital, Hadhramout Coast/Yemen

Preterm birth (PTB) is a major determinant of neonatal mortality, morbidity and childhood disability. It has long-term adverse consequences for health. The causes of preterm delivery (PTD) are multifactorial. This study was conducted to determine the most common risk factors for PTB at Mukalla Maternity and Childhood (MCH) Hospital, Yemen. A retrospective case-control study was conducted. It involved the records of 100 women with live PTD as cases and 400 women with live term delivery as controls at Mukalla MCH Hospital in 2018. All the data were analysed using the Statistical Package for the Social Sciences (version 24). The statistical relationship between independent variables and PTB was studied by the Chi-square test in bivariate analysis and logistic regression in multivariate analysis. The strength of association was confirmed by using odds ratios (ORs) with a 95% confidence interval (CI). Risk factors with statistically significant association with premature birth were a family history of PTD (adjusted OR [AOR] 2.353; CI 1.3-4.258, p-value 0.005), pre-eclampsia (AOR 4.120; CI 1.818-9.340, p-value 0.001), parity (AOR 2.139; CI 1.249-3.662, p-value 0.006), premature rupture of membranes (AOR 4.161; CI 2.323-7.456, p-value 0.000) and abnormal amniotic fluid volume (AOR 4.534; CI 1.364-15.071, p-value 0.014). An early recognition of preterm risk factors will help medical staff and healthcare workers to identify women with a high-risk pregnancy.

Comparison of automated vs. manual measurement to estimate fetal weight in isolated polyhydramnios

Objective To understand the impact of the measurement method to predict actual birthweight in pregnancies complicated with isolated polyhydramnios in the third trimester. Methods A prospective study was conducted with 60 pregnant women between the 37th and 40th weeks of gestation. Routine biometric measurements were obtained by two-dimensional (2D) ultrasonography. When a satisfactory image was obtained, the image was frozen to get two measurements. First, calipers were placed to get the manual measurement. Then automated measurement was captured by the ultrasonography machine in the same image. The fetal weight was estimated by using the Hadlock II formula. Results The mean difference was found to be 0.03, -0.77, -0.02 and 0.17 for biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC) and femur length (FL), respectively. Pearson's correlation coefficient between automated and manual estimated fetal weights (EFWs) and the actual birthweight was 0.919 and 0.796, respectively. The mean difference between actual and manual EFW measurement values was 46.16 ± 363.81 g (range between -745 g and 685 g) (P = 0.330). Also, the mean difference between actual and automated EFW measurement values was found to be 31.98 ± 218.65 g (range between -378 g and 742 g) (P = 0.262). The Bland-Altman test results have shown that, 666 g lower or 759 g higher values were obtained when the measurement was performed manually. On the other hand, EFW results were 396 g lower or 460 g higher than the actual birthweight with automated measurement tools. Conclusion The accuracy rate of fetal weight estimation with ultrasonography is high for both automated and manual measurements. Automated tools have a higher success to predict the EFW.

Delivery mode and perinatal outcomes after diagnosis of oligohydramnios at term in China

Objective: The purpose of this study is to assess the incidence of oligohydramnios at term and evaluate whether the mode of delivery in patients with oligohydramnios influences perinatal outcomes in China.Methods: A cross-sectional survey of all deliveries in 39 hospitals in China from 1 January 2011-31 December 2011 was evaluated for the mode of delivery and perinatal outcomes in women with oligohydramnios compared to those without known oligohydramnios after excluding preterm births, polyhydramnios, and oligohydramnios secondary to premature rupture of membranes.Results: Oligohydramnios complicated 3954 (4.4%) of the 89,050 pregnancies, analyzed. Pregnancy cases with oligohydramnios compared those without known oligohydramnios had a significantly higher incidence of preexisting or gestational diabetes mellitus, fetal growth restriction, nonreassuring fetal heart tracings, obesity and malpresentation (p<.001). The cesarean delivery (CD) rate was significantly higher in pregnancies with identified oligohydramnios compared to those without (84.4 versus 54.7%; p<.001). Furthermore, in 2/3 of these CD in pregnancies with oligohydramnios, the identification of oligohydramnios was the only indication for the CD. In pregnancies with oligohydramnios, vaginal delivery did not significantly increase the risks of adverse outcomes compared to vaginal delivery without oligohydramnios, except postpartum complication.Conclusion: CD is not indicated in term pregnancies with isolated oligohydramnios. Vaginal delivery of oligohydramnios is not associated with increased perinatal mortality.

Choice of scheduled cesarean delivery versus trial of labor for advanced maternal age primiparous women

OBJECTIVE

We aimed to evaluate perinatal outcomes of advanced maternal age (AMA) primiparous women seeking scheduled cesarean delivery (CD) versus a trial of labor (TOL).

MATERIALS AND METHODS

This was a retrospective cohort study of primiparous women ≥40 years of age carrying a single fetus, who delivered at a tertiary, university-affiliated medical center (2007-2014). We compared perinatal outcomes of women who chose a scheduled CD with those who chose TOL. Subsequently, we compared women who had successful TOL (sTOL) with those who had a failed TOL (fTOL).

RESULTS

Out of 62 102 deliveries during the study period, inclusion criteria were met by 374 women. Of them, 83 (22.2%) women had a scheduled CD, and 291 (77.8%) had TOL. Of the TOL group, 118 women (40.5%) had fTOL and 173 (59.5%) had sTOL. Women in the fTOL had higher rates of 1-min Apgar score <7, neonatal asphyxia and adverse neonatal composite outcome compared with women in the sTOL group (p < .05). After adjusting for potential confounders, compared with sTOL, fTOL was not associated with adverse neonatal composite outcome. Compared with scheduled CD, fTOL was associated with an increased risk for adverse neonatal composite outcome (aOR 2.65, 95% CI 1.13-6.19, p = .03).

CONCLUSION

AMA primiparous women attempting TOL have comparable outcome to those seeking scheduled CD, however, women with fTOL have higher rates of adverse neonatal outcome.

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]

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.

Are Major Depression and Generalized Anxiety Disorder Associated With Oligohydramnios in Pregnant Women? A Case-Control Study

PURPOSE

This study examined the prevalence of major depression and generalized anxiety disorder (GAD) in pregnant women with and without a diagnosis of oligohydramnios.

DESIGN AND METHODS

The study sample included 53 pregnant women with a diagnosis of oligohydramnios and 80 healthy pregnant women subjects. Major depression and GAD were diagnosed with the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (SCID-I).

FINDINGS

Pregnant women with oligohydramnios had higher scores of depressive and anxiety symptom, and a higher prevalence rate of major depression (24.5% vs. 6.2%) and GAD (30.2% vs. 3.2%).

PRACTICE IMPLICATIONS

The results of the present study suggest that oligohydramnios appears to be associated with both major depression and GAD in pregnant women.

Outcomes From Polyhydramnios With Normal Ultrasound

OBJECTIVE

To investigate the short- and long-term outcomes of children from pregnancies complicated with polyhydramnios, defined as amniotic fluid index (AFI) >24 cm, and with a normal detailed ultrasound examination.

METHODS

This retrospective cohort study examined 134 children aged 4 to 9 years with polyhydramnios and normal detailed ultrasound examination during pregnancy compared with 268 controls with normal AFI and normal detailed ultrasound examination matched for maternal age, year of delivery, gestational week at delivery, and presence or absence of diabetes. The primary outcome was the rate of malformations diagnosed postnatally. Additional outcomes were obstetrics outcomes, genetic syndromes, and neurodevelopment.

RESULTS

Polyhydramnios was associated with increased risk for cesarean delivery (CD) and birth weight >90th percentile. This elevation in CD was attributed to increased rate of elective CD due to suspected macrosomia. Polyhydramnios was associated with increased risk for congenital malformations (n = 25 [19%] compared with 27 [10%], respectively; P = .016) without a statistically significant increase in the rate of major malformations (11 [8%] vs. 10 [4%]; P = .057). Genetic syndromes were more prevalent in the polyhydramnios group (5 [3.7%] vs. 2 [0.75%]; P = .043), as were neurologic disorders and developmental delay (9.7% vs. 3%; P = .004).

CONCLUSIONS

Despite a normal detailed ultrasound examination, polyhydramnios is associated with increased rate of fetal malformations, genetic syndromes, neurologic disorders, and developmental delay, which may be diagnosed only after birth.

Association of isolated polyhydramnios at or beyond 34 weeks of gestation and pregnancy outcome

OBJECTIVE

To evaluate pregnancy outcome among women with isolated polyhydramnios at admission for labor at or beyond 34 weeks of gestation.

METHODS

Retrospective cohort study at a tertiary medical center between 2007 and 2012. Isolated polyhydramnios was defined as amniotic fluid index (AFI) greater than 25 cm at admission in the absence of gestational or pregestational diabetes mellitus or fetal structural or chromosomal anomalies. Women with isolated polyhydramnios were compared with women with a normal AFI (5-25 cm).

RESULTS

Overall, 31,376 women were eligible for analysis, of whom 215 (0.7%) had isolated polyhydramnios and 31,161 normal AFI. Women with isolated polyhydramnios had higher rates of labor induction (7.9% compared with 4.8%, P=.04) and cesarean delivery (12.1% compared with 5.1%, P<.001). They also had higher rates of placental abruption (0.9% compared with 0.2%, P=.02), abnormal or intermediate fetal heart rate (FHR) tracings (7.0% compared with 3.2%, P=.002), and prolonged first stage of delivery (6.0% compared with 1.4%, P<.001). Isolated polyhydramnios was also associated with higher rates of shoulder dystocia (1.9% compared with 0.3%, P<.001) and respiratory distress syndrome (0.5% compared with 0.03%, P=.001). On a multiple logistic regression model, isolated polyhydramnios was an independent risk factor for labor induction (adjusted odds ratio [OR] 1.7, 95% confidence interval [CI] 1.01-2.8), cesarean delivery (adjusted OR 2.6, 95% CI 1.7-4.0), prolonged first stage of delivery (adjusted OR 3.6, 95% CI 1.97-6.7), abnormal or intermediate FHR tracings (adjusted OR 2.6, 95% CI 1.6-4.5), placental abruption (adjusted OR 8.4, 95% CI 2.00-35.4), shoulder dystocia (adjusted OR 3.4, 95% CI 1.2-9.7), and respiratory distress syndrome (adjusted OR 38.9, 95% CI 4.6-332.6). Mild isolated polyhydramnios (AFI 25.1-30.0) was independently associated with cesarean delivery, prolonged first stage of delivery, placental abruption, abnormal or intermediate FHR tracings, and shoulder dystocia.

CONCLUSION

Isolated polyhydramnios at admission for labor at or beyond 34 weeks of gestation is associated with adverse obstetric and neonatal outcomes.

Polyhydramnios: Causes, Diagnosis and Therapy

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

Amniotic fluid as a vital sign for fetal wellbeing

Introduction: Amniotic fluid, once thought to merely provide protection and room for necessary movement and growth for the fetus, is now understood to be a highly complex and dynamic system that is studied as a data point to interpret fetal wellbeing. Methods: Assessment of amniotic fluid volume is now routine when performing a sonographic evaluation of fetal status and is an important consideration in the assessment and management of perinatal morbidity and mortality.1,2 In this review, we will cover the dynamics that affect amniotic fluid volume, review methods for measurement and quantification of volume, review definitions for normative data as related to neonatal outcomes, and provide evidence based guidance on the workup and management options for oligoydramnios and polyhydramnios in singleton and twin pregnancies. Conclusions: When abnormalities of fluid exist, appropriate workup to uncover the underlying etiology should be initiated as adverse fetal outcomes are sometimes associated with these variations from normalcy.

A prospective clinical study of feto-maternal outcome in pregnancies with abnormal liquor volume

AIMS AND OBJECTIVE(S): Evaluating feto-maternal outcome in pregnancies with abnormal liquor volume.

MATERIAL AND METHOD(S)

200 pregnant subjects between 20 and 42 weeks of gestation, who were clinically suspected to have an abnormal amniotic fluid volume (oligohydramnios or polyhydramnios) were subjected to ultrasonographic (USG) assessment of amniotic fluid index. The subjects were closely monitored through pregnancy, labour and puerperium.

OBSERVATION(S)

Ultrasonically, abnormal liquor volume was confirmed in 90-93% clinically suspected patients. Post term pregnancy (38.5%), PROM (30%) and prolonged pregnancy (23.5%) were associated with oligohydramnios. Fetal congenital anomalies (31.1%), diabetes mellitus (20%), PIH (17.7%), twin pregnancy (6.6%) and Rh incompatibility (4.4%) were associated with polyhydramnios. The incidence of labour induction, fetal labour intolerance, CS for fetal distress and 1 min Apgar of <7 was high in oligohydramnios subjects. Premature labour complicated 40% of polyhydramnios pregnancies. The overall incidence of congenital anomalies (14%) and perinatal mortality (20%) in subjects with abnormal liquor volume was significantly higher (P < 0.001) than in women with normal liquor volume (0.3, 2.3% respectively).

CONCLUSION(S)

A good clinical examination can pick up most subjects of abnormal liquor volume. Abnormal liquor volumes are associated with increased maternal morbidity and adverse perinatal outcome.

Short-term outcome for term and near-term singleton infants with intrapartum polyhydramnios

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.

The role of amniotic fluid assessment in indicated preterm delivery

Measuring amniotic fluid pockets with ultrasound is an efficient and reasonably reliable method of evaluating amniotic fluid volume and categorizing relative risk of perinatal morbidity. The most commonly used ultrasound criteria for oligohydramnios, SDP <2 cm and AFI <5 cm, assign approximately 2%-3% and 4%-5% of late preterm pregnancies into the "low amniotic fluid" category. The AFI offers somewhat greater sensitivity and greater precision but has less specificity for predicting perinatal morbidity than does the SDP. Thus, before 34 weeks, use of the AFI <5 cm as a criterion for intensive fetal monitoring, but not as sole criteria for delivery, is recommended. In pregnancies beyond 34 weeks, use of either AFI or SDP to diagnose oligohydramnios can be expected to reliably identify fetuses at risk for compromised perinatal outcome especially if replicate measurements are confirmatory. In such cases, care must be taken to identify comorbid conditions that, together with oligohydramnios, may place the fetus at significant risk. In such cases, delivery is the recommended intervention.

Use of near-infrared spectroscopic analysis of second trimester amniotic fluid to assess preterm births

This pilot study investigated the possibility that metabolomic differences exist in second trimester of women delivering at term (≥37 weeks, n = 216) and preterm (≤35 weeks, n = 11). For this retrospective study, biobanked AF samples underwent near-infrared (NIR) spectral analysis using wavelengths from 700 to 1050 nm. Spectral data was compressed then optimized by multilinear regression to create a calibration model. The resultant model was able to classify term and preterm births based on differing AF metabolomic profiles with a sensitivity and specificity of 100%. When groups were classified using a prematurity index (PI), there was a statistical difference (P < 0.001) between the predicted preterm group (PI 0.77 ± 0.08) and the term group (PI 1.00 ± 0.02). In conclusion, the 2nd trimester AF samples showed distinct differences in metabolomic profiles between patients delivering preterm as compared to those at term in functional groups related to proteins, carbohydrates, fats, polyols, and water.

The role of amniotic fluid assessment in evaluating fetal well-being

Owing to the frequent use of bedside ultrasound, much is known about the regulation of and normative values for amniotic fluid volume and the mechanisms by which this fluid is regulated. The management protocols for conditions with extremes of amniotic fluid volume have become more exact, resulting in interventions more likely to improve outcome. Much is still unclear; there are no tools to measure amniotic fluid volume with precision, and measurement of fetal urinary output is cumbersome and error-prone.

Postnatal management of congenital bilateral renal hypodysplasia

Renal hypodysplasia (RHD) is a congenital disorder, characterized by an abnormally developed kidney. Mutations in genes such as PAX2, HNF1-beta, TCF2, EYA1, that encode factors critical in early renal development, are being found. RHD is the leading cause of chronic renal failure in childhood, with or without associated urologic abnormalities such as vesicoureteric reflux and urinary tract obstruction. Antenatal detection has improved understanding of this disorder, resulting in enhanced outcomes through earlier intervention, including peritoneal dialysis. Management requires a multidisciplinary team approach that commences prior to the birth of the child.