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PubMed1992

Maternal smoking and the risk of polyhydramnios.

BACKGROUND: Washington State birth certificates were used to conduct a population-based case-control study to assess the possible association of maternal smoking with polyhydramnios. METHODS: All singleton births complicated by polyhydramnios (n = 557) were identified from the vital records for the years 1984 to 1987. For comparison, 1671 records were randomly selected for the same years from singleton births uncomplicated by polyhydramnios. RESULTS: Women who reportedly smoked prenatally were found to be at increased risk for polyhydramnios (relative risk [RR] = 1.7, 95% confidence interval [CI] = 1.5-2.1, adjusted for marital status, maternal age, and parity). When women with conditions known to be associated with polyhydramnios were excluded, the risk for those who smoked prenatally remained elevated (RR = 1.8, 95% CI = 1.1-2.3). CONCLUSION: Overdistention of the uterus from polyhydramnios may cause a variety of pregnancy complications. The observed association of smoking with polyhydramnios may be a further indication for public health interventions aimed at preventing smoking during pregnancy.

Adult↗
PubMed1990

Quantifiable polyhydramnios: diagnosis and management.

Little has been written regarding the ultrasonographic quantification of polyhydramnios or its subsequent management. Therefore, we designed this study to define polyhydramnios using the amniotic fluid index of greater than 2 SDs above the mean for late second- to third-trimester pregnancies, or 24 cm or greater. One hundred twelve nondiabetic women referred to Women's Hospital, Los Angeles County/University of Southern California Medical Center with the descriptive diagnosis of polyhydramnios made by experienced ultrasonographers were included in the study. There was poor correlation between these descriptions and fetal outcome. Twenty-six were qualitatively described as having severe, 29 as moderate, and 57 as mild polyhydramnios. Forty-nine of the 112 patients met our definition of significant polyhydramnios by having an amniotic fluid index of 24 cm or more. This particular definition allowed the inclusion of all fetuses with serious structural defects and/or death. Seven patients had an amniotic fluid index less than 24 cm, but with the traditional quantitative definition of one pocket of 8 cm or more; none of these patients had poor fetal outcome. These data appear to suggest that the use of descriptive definitions of polyhydramnios or a single fluid pocket of 8 cm or greater should be discarded in favor of using an amniotic fluid index of 24 cm or more. Once the diagnosis of polyhydramnios is made, the patient should have a detailed sonographic evaluation, be offered cytogenetic studies, and have antepartum surveillance.

Congenital Abnormalities↗
PubMed1996

[Ultrasonographic diagnosis of polyhydramnios and its association with congenital malformations].

We carried out a prospective study at the Hospital de Gineco-Obstetricia del Instituto Mexicano del Seguro Social, in León, Guanajuato in order to evaluate the association between polyhydramnios and fetal congenital anomalies. 200 women were included, 100 with polyhydramnios and 100 with normal amniotic fluid (control group). The diagnosis of polyhydramnios was made with ultrasound scanning using maximum vertical pocket technique and amniotic fluid index. The patients with polyhydramnios had an average maximum vertical pocket of 9.3 centimeters and amniotic fluid index of 27.0 centimeters. In patients with polyhydramnios 24 cases of congenital malformations were found, and none in patients with normal amniotic fluid (P < 0.01). The most common fetal anomalies were: esophageal atresia (25%), anencephaly (21%) and ductus arteriosus (21%). There were six perinatal deaths in the group of patients with polyhydramnios, five of them had congenital abnormalities, on the other hand in the control group there were no perinatal deaths (P < 0.01). Owing to the signifficative association between polyhydramnios and congenital anomalies, we suggest to reinforce the ultrasound evaluation in order to detect these abnormalities and to offer an early treatment and therefore a better prognosis to the fetus.

Adult↗
PubMed1996

The underlying cause of polyhydramnios determines prematurity.

The preterm delivery rate in polyhydramnios is higher than in the normal population. We conducted this study to determine if different aetiologies for polyhydramnios have different frequencies of preterm delivery. Three hundred and forty women with a singleton pregnancy and polyhydramnios were included in the study group. A delivery was considered premature if it occurred before 37 weeks' gestation. Preterm deliveries occurred in 14.1 per cent of patients with unexplained polyhydramnios, 27.7 per cent of patients with insulin-dependent diabetes mellitus (IDDM), and in 36 per cent of pregnancies with congenital malformations. The prevalence of preterm delivery was significantly greater for the subgroups with IDDM (P = 0.02) and congenital malformations (P = 0.001), when compared with patients with idiopathic polyhydramnios. The prevalence of preterm delivery in patients with gestational diabetes mellitus was no greater than for the population at large. The underlying cause of polyhydramnios is a major factor in determining when delivery will occur.

Congenital Abnormalities↗
PubMed2006

Cervical length assessment in women with idiopathic polyhydramnios.

OBJECTIVE: The aims of the study were to determine cervical length among patients with polyhydramnios and to assess the relationship between the severity of polyhydramnios, cervical length and gestational age at delivery. PATIENTS AND METHODS: A prospective study was designed including 92 consecutive singleton pregnancies with polyhydramnios between 24 and 40 weeks' gestation. Cervical length was measured using transvaginal sonography. Polyhydramnios was defined when amniotic fluid index (AFI) was equal to or greater than 20 cm. A single sonologist performed all the examinations of the cervical length and the AFI. RESULTS: The median cervical length and AFI were 37.5 (range, 7-52) mm and 28.8 (range, 20-43) cm, respectively. A significant gradual shortening of the cervical length was observed with advancing gestational age (P=0.027). No significant association was found between AFI and cervical length (P=0.24). A cut-off of 15 mm (n=5) was associated with a significantly lower gestational age at delivery (30+/-2.6 weeks vs. 37.2+/-4.2 weeks, respectively, P<0.001). CONCLUSIONS: Women with polyhydramnios have a gradual shortening of cervical length with advancing gestational age. However, this finding is not related to the severity of polyhydramnios.

Cervix Uteri↗
PubMed1991

Study of 156 cases of polyhydramnios and congenital malformations in a series of 118,265 consecutive births.

Polyhydramnios associated with congenital anomalies was studied over nine years in 118,265 consecutive pregnancies. The prevalence of this association was 1.32% (156 cases). A case-control study allowed the examination of genetic and environmental factors for the origin of polyhydramnios associated with congenital malformations. Diagnosis of polyhydramnios associated with congenital malformations was performed prenatally in 41% of the cases; 16% of the infants were stillborn. Fifty-five percent of the cases had more than one malformation, 13.4% of them had a chromosomal aberration, and 32% had multiple malformations that do not constitute a syndrome. There was an increase of consanguinity in the parents of our patients. The incidence of polyhydramnios and congenital anomalies in first-degree relatives was 3.8%, and first-degree relatives had more malformations than the controls had (8.3% vs 3.2%). Our study demonstrated the low capacity of a general prenatal screening program because the diagnosis of malformations associated with polyhydramnios was made in only 41% of the cases and only six of 21 chromosomal abnormalities were diagnosed prenatally. We recommend the use of fetal chromosome analysis and careful ultrasonographic examination in every pregnancy complicated by polyhydramnios.

Chromosome Aberrations↗
PubMed1995

Is polyhydramnios in an ultrasonographically normal fetus an indication for genetic evaluation?

OBJECTIVE: Our purpose was to determine the frequency of fetal chromosomal anomalies in pregnancies complicated by polyhydramnios. STUDY DESIGN: Between Jan. 1, 1992, and July 31, 1993, an amniotic fluid index was measured prospectively in 2730 third-trimester pregnant women. Polyhydramnios was defined as an amniotic fluid index > or = 24 cm. A computer search identified all infants born with structural or chromosomal anomalies. RESULTS: Polyhydramnios was detected in 49 of 2730 women (1.7%). The incidence of chromosomal anomalies was two in 49 (4.1%) compared with three in 2681 (0.12%) among women with normal fluid (p < 0.05). Six of the 49 newborns had structural anomalies (12.2%), whereas 48 of 2681 (1.8%) structural anomalies occurred in the control group (p < 0.05). Among study patients both fetuses with chromosomal anomalies were growth retarded; four of the six structural anomalies were associated with an amniotic fluid index > 30 cm. CONCLUSIONS: (1) Polyhydramnios is associated with an increased incidence of congenital fetal anomalies. (2) Growth-retarded fetuses with polyhydramnios warrant genetic evaluation. (3) A genetic study is not absolutely indicated for patients with polyhydramnios and a sonographically normal fetus.

Amniocentesis↗
PubMed1999

Idiopathic polyhydramnios and perinatal outcome.

OBJECTIVE: The aim of this study was to determine whether there is any association between idiopathic polyhydramnios and adverse perinatal outcome. STUDY DESIGN: One hundred fifty-one consecutive women with singleton pregnancies complicated by idiopathic polyhydramnios (amniotic fluid index >24 cm) who were delivered at our institution during an 18-month period (December 1996-May 1998) were studied. Outcome measures studied included preterm delivery (<37 weeks' gestation), low birth weight (<2500 g), macrosomia (>4000 g), malpresentation at delivery, rate of cesarean delivery, Apgar score at 5 minutes <7, admission to the neonatal intensive care unit, and perinatal death. These findings were compared by means of the chi(2) test with those of 302 matched control subjects with normal amniotic fluid volume (<24 cm). RESULTS: Among pregnancies complicated by idiopathic polyhydramnios we did not observe any increases in preterm deliveries, low birth weight, low Apgar scores at 5 minutes, neonatal intensive care unit admissions, or perinatal mortality rate. However, idiopathic polyhydramnios was associated with significantly higher rates of malpresentation, macrosomia, and primary cesarean delivery. CONCLUSION: In contrast to previous reports that polyhydramnios related to specific causes (congenital anomalies, diabetes mellitus, isoimmunization) is associated with adverse perinatal outcomes, such as prematurity, low birth weight, and perinatal death, idiopathic polyhydramnios is not associated with higher rates of these traditional measures of poor outcome.

Apgar Score↗
PubMed2004

Amniotic fluid concentrations of collagenase-1 and collagenase-3 are increased in polyhydramnios.

OBJECTIVE: Polyhydramnios places increased tension on the fetal membranes and should conceptually be associated with an increased need for tissue remodeling to prevent premature rupture of membranes (PROM). Herein we use polyhydramnios as a model to study the association of the collagenase class of matrix metalloproteinases (MMPs) with tissue remodeling during pregnancy. METHODS: Amniotic fluids were collected by transabdominal amniocentesis from women with polyhydramnios and from women with normal amniotic fluid volume at second trimester, third trimester and at term. Fluids were assayed for MMP-1 and MMP-13 (collagenase-1 and 3) using ELISA. The concentrations in polyhydramnios were compared with subjects undergoing amniocentesis with normal amniotic fluid volume. Statistical comparisons were made using Scheffe's method for correction in multiple means comparison. P of <0.05 was considered statistically significant. RESULTS: MMP-1 and MMP-13 are present in the amniotic fluid at all stages of pregnancy. The concentrations of these MMPs were significantly elevated in the polyhydramnios samples independent of gestational age. CONCLUSION: Polyhydramnios is associated with increased amniotic fluid concentrations of MMP-1 and MMP-13 suggesting their role in tissue remodeling.

Adult↗
PubMed1998

Prevalence of polyhydramnios in the third trimester in a population screened by first and second trimester ultrasonography.

AIMS: To determine the prevalence of polyhydramnios in a routine antenatal population, in which first and second trimester ultrasound screening for fetal abnormality had been performed and to examine the outcome in these pregnancies. METHODS: A retrospective analytical survey of all obstetric ultrasound examinations performed in a university teaching hospital over a thirty-six month period. Polyhydramnios was defined as either the measurement of a single deepest pool of liquor > 8 cm (AFV) or according to the amniotic fluid index, the sum of a four quadrant measurement > 24 cm (AFI). Using the stated definitions, polyhydramnios was diagnosed in 37 women, 16 of whom had a raised AFI. The main outcomes of interest included the mode of onset of labour and mode of delivery (rates of spontaneous and induced labour, cesarean section deliveries), birth weight, presence or absence of fetal anomalies, and the perinatal outcome. RESULTS: The prevalence of polyhydramnios in this study is lower (0.15% AFI > 24 cm and 0.36% AFV > 8 cm) than in previous studies. The association between polyhydramnios, maternal diabetes mellitus (10.8%), fetal abnormalities (5.4%) and fetal macrosomia (10.8%) was also lower than in past reports. There was a better overall fetal outcome compared with previous studies and no perinatal deaths were seen. CONCLUSIONS: In this study, the prevalence of polyhydramnios in the third trimester was lower than in previous studies, as well as being associated with a better prognosis. This may have been the result of a combination of several factors. These include the introduction of multi-level ultrasound screening for fetal abnormality, and the improved care of diabetic women, and mothers with rhesus iso-immunisation.

Amniotic Fluid↗
PubMed2005

Perinatal outcomes of polyhydramnios without associated congenital fetal anomalies after the gestational age of 20 weeks.

BACKGROUND: Polyhydramnios carries a high rate of complications during pregnancy and adverse perinatal outcomes. We could find no studies of this condition in a large Asian population. The aim of this investigation was to evaluate the risks of adverse perinatal outcomes in a large study population with polyhydramnios without associated fetal anomalies after the gestational age of 20 weeks in Taiwan. METHODS: We retrospectively reviewed the computerized records of women who had babies without associated fetal anomalies after the gestational age of 20 weeks at Chang Gung Memorial Hospital from July 1990 to December 2001. Possible confounding factors that could affect the occurrence of polyhydramnios were analyzed. We then investigated the relative risks of these events to adverse perinatal outcome by adjusting the variants. RESULTS: Significantly higher incidences of preeclampsia, placental abruption, placenta accreta, past history of fetal death or preterm delivery, multiple pregnancy, bodyweight gain > or = 20kg during pregnancy and primiparity were noted in patients with polyhydramnios than in patients without this condition. The presence of polyhydramnios significantly increased the rate of preterm delivery, low birth weight or very low birth weight, low one- and five-minute Apgar scores, fetal death, large for gestational age babies, meconium-stained amniotic fluid, Cesarean section, fetal distress in labor, NICU transfer and neonatal death. CONCLUSIONS: Polyhydramnios carried a higher incidence of adverse perinatal outcomes, such as low Apgar scores, fetal death, fetal distress in labor, NICU transfer and neonatal death, despite exclusion of congenital anomalies from the study population. Detailed antepartum fetal well-being surveillance, intensive intrapartum monitoring and further attention postpartum are warranted in patients with this condition.

Apgar Score↗
PubMed1995

[Polyhydramnios and its relationship with congenital malformations: ultrasonographic diagnosis].

We analyzed the occurrence of polyhydramnios during pregnancy and to indicate the association with congenital abnormalities of the product and maternal alterations. A retrospective descriptive and transversal study was performed which included 6087 pregnant patients who were submitted to ultrasonographic studies from January 1, 1991 to December 31, 1993. The final sample consisted of 72 patients with criteria of polyhydramnios and who had a complete, clinical history, specific data concerning the reproductive history and maternal risk factors associated with polyhydramnios and fetal malformations was compiled. The occurrence of polyhydramnios during pregnancy was 1.1% and the association with congenital malformations was 13.8%, being the majority neural tube defects. The maternal alterations were related in 13.7% to polyhydramnios, being primary cause gestational diabetes. Anencephalia presented a significant statistics (p < 0.05). The occurrence of polyhydramnios is low in obstetric patients. Neural tube defects such as anencephalia are the primary fetal defects. Gestational diabetes and multiple gestations are the more significant maternal alterations.

Adolescent↗
PubMed1995

Polyhydramnios and hypercalcemia associated with congenital mesoblastic nephroma: case report and a new appraisal.

BACKGROUND: Polyhydramnios and hypercalcemia are known complications of congenital mesoblastic nephroma. Hypercalcemia has been shown to cause polyuria. Polyuria is believed to be the probable cause for the polyhydramnios, but the exact mechanism remains unknown. To our knowledge, this is the first reported case of a relationship between hypercalcemia and polyhydramnios. CASE: A 26-year-old primigravida was diagnosed with congenital mesoblastic nephroma and polyhydramnios at 36 weeks' gestation. Neonatal hypercalcemia was detected immediately after delivery at 40 weeks' gestation. After removal of the nephroma, the calcium level normalized. CONCLUSION: Hypercalcemia may be the mechanism underlying polyhydramnios in cases of congenital mesoblastic nephroma. Calcium levels should be monitored after delivery, and prompt surgical removal of the tumor should be performed.

Adult↗
PubMed2006

Steady-state levels of aquaporin 1 mRNA expression are increased in idiopathic polyhydramnios.

OBJECTIVE: Polyhydramnios is a condition associated with significant perinatal morbidity. While the exact pathophysiology of this condition is unknown in the absence of obvious anatomic or organic etiologies, impaired intramembranous water transport has been shown. Previous studies from our laboratory have shown that the water channel aquaporin 1 (AQP1) is expressed in human fetal membranes from term pregnancies with normal amniotic fluid (AF) volume. Therefore, we hypothesized that in pregnancies with idiopathic polyhydramnios, AQP1 expression might be reduced in fetal membranes from pregnancies with this AF volume disorder. STUDY DESIGN: Placentas were collected from women at term (37-40 weeks) who presented with either polyhydramnios (amniotic fluid index [AFI] >24.0 cm) or normal AF volume (AFI 5.0-23.9 cm). Immediately after delivery, the membranes (amnion and chorion) directly overlying the placenta and the free-floating reflected membranes were sampled (total of 4 samples from each placenta). RNA was isolated from each sample and expression was quantified using real-time reverse transcriptase polymerase chain reaction (PCR) and relative quantification of gene expression. RESULTS: Relative to pregnancies with normal AF volume, there was an increase in expression of the water channel AQP1 in all regions of the fetal membranes. The greatest increase (33-fold) was seen in the reflected amnion. CONCLUSION: AQP1 expression is increased in polyhydramnios. This finding suggests that alterations in AQP1 expression may be a compensatory response to and not a cause of idiopathic polyhydramnios. We speculate that therapies focused on regulating AQP1 expression may be useful for treating this condition.

Aquaporin 1↗
PubMed1998

Myotonic dystrophy is a significant cause of idiopathic polyhydramnios.

OBJECTIVE: Myotonic dystrophy, the most common form of muscular dystrophy seen in pregnant women, may be a significant cause of middle trimester polyhydramnios. Our purpose was to determine the prevalence of myotonic dystrophy in women with idiopathic polyhydramnios and to characterize the ultrasonographic findings associated with cases. STUDY DESIGN: We examined the cases of 67 patients who were delivered of infants at the University of Utah between 1992 and 1996 with a diagnosis of idiopathic polyhydramnios (amniotic fluid index >25). Women with diabetes mellitus, hydrops, or fetal anomalies known to cause polyhydramnios were excluded from the study. Amniotic fluid samples or cord blood samples were obtained from 41 patients, and polymerase chain reaction amplification and Southern blot analysis were performed to detect the presence of the myotonic dystrophy mutation. Ultrasonographic findings, prenatal course, and neonatal outcomes were reviewed in all cases. RESULTS: Four of the 41 patients tested had the myotonic dystrophy mutation, yielding a prevalence in our population of 9.7%. Three of the 4 patients reported a family history of myotonic dystrophy. Ultrasonographic findings associated with a positive result included abnormal posturing of extremities (3/4) and unilateral clubbed foot (3/4). No other structural or growth abnormalities were seen. Two of the patients were delivered before term, 1 at 26 weeks and 1 at 32 weeks. Three of the 4 infants were severely affected, necessitating admission to the intensive care unit, and 1 died on day 11 after birth. One infant, whose myotonic dystrophy mutation consisted of between 800 and 900 triplet repeats, did not require admission to the intensive care unit. CONCLUSION: Myotonic dystrophy may be seen as idiopathic polyhydramnios and should be considered as part of the differential diagnosis in these cases. Women with a familial history of myotonic dystrophy or ultrasonographic evidence of hypotonia, including positional abnormalities of the extremities, should be offered deoxyribonucleic acid testing for the myotonic dystrophy mutation.

Congenital Abnormalities↗
PubMed1983

Polyhydramnios associated with fetal limb abnormalities.

Four cases of fetal dwarfism and one case of extremity shortening with limb reduction abnormalities associated with polyhydramnios are presented. In one case, the diagnosis of camptomelic dwarfism associated with polyhydramnios was missed on sonography because no extremity measurements were obtained. Severe fetal limb anomalities were prospectively diagnosed in two patients with polyhydramnios by sonographic measurement of fetal limb lengths. The development of polyhydramnios was observed in two additional cases of fetal dwarfism. These five cases are presented to emphasize the clinical significance of recognizing the relationship between polyhydramnios and fetal dwarfism.

Arm↗
PubMed1994

Polyhydramnios: ultrasonic detection of fetal and maternal conditions.

Estimation of amniotic fluid volume is an important part of routine obstetric sonography. A relationship between polyhydramnios and poor perinatal outcome has been reported. This study correlates the severity of polyhydramnios with perinatal morbidity and mortality. Among 67 cases of polyhydramnios detected in singleton pregnancies, 8 were associated with maternal conditions including noninsulin-dependent diabetes (5 cases), insulin-dependent diabetes (1 case) and gestational diabetes (2 cases). Forty-four were associated with fetal conditions, including fetal anomalies (31 cases), fetal chromosomal disorders (10 cases) and fetal functional disorders (3 cases). Fifteen of the 67 cases had no apparent underlying fetal or maternal cause. Perinatal death occurred in 19 cases (28%) and was associated with fetal anomalies (12 cases), chromosome disorders (6 cases) and a functional fetal abnormality (1 case). Severe polyhydramnios with amniotic pocket dimensions > or = 120 mm (91%) or with a need for amniocentesis (91%) were associated with fetal abnormalities in most cases. The rate of perinatal death was not increased, indicating that severe polyhydramnios does not always result in lethal abnormalities.

Female↗
PubMed1997

Polyhydramnios and fetal intrauterine growth restriction: ominous combination.

The purpose of this study was to evaluate the significance of polyhydramnios combined with intrauterine growth restriction. During a 6 year period, 39 fetuses were identified by prenatal sonography as having both polyhydramnios and intrauterine growth restriction. Polyhydramnios was defined as a four-quadrant amniotic fluid index of 24 or greater (mean 30.5, range 24 to 40). Intrauterine growth restriction was defined as estimated fetal weight less than the tenth percentile (Hadlock standards). The mean birth weight was 2213 g. Major anomalies were present postnatally in 92% (36 of 39) of fetuses. Among nine fetuses without sonographically detectable anomalies prenatally, six (67%) proved to have one or more anomalies at birth. Chromosome abnormalities were present in 38% (15 cases) including 10 fetuses with trisomy 18 and one with trisomy 13. The overall mortality rate was 59%. The combination of polyhydramnios and intrauterine growth restriction is ominous. The majority of fetuses have major anomalies or chromosome abnormalities, or both, even when other sonographic abnormalities are absent. Chromosome analysis and detailed fetal evaluation should be offered when polyhydramnios and intrauterine growth restriction are identified prenatally.

Abnormalities, Multiple↗