A clinical study of fetomaternal outcome in pregnancy with polyhydramnios

Abstract

Background: Amniotic fluid not only provides protection to the fetus from traumatic forces, cord compression, and microbial pathogens, but also plays an integral role in the normal development of the fetal musculoskeletal, pulmonary, and gastrointestinal systems. Polyhydramnios, defined as an excessive amount of amniotic fluid, complicates approximately 0.4-3.3% of all pregnancies. Fetal conditions that are associated with polyhydramnios include major congenital anomalies and both the immunologic and non-immunologic forms of hydrops foetalis. Maternal medical conditions are also known to be associated with polyhydramnios and subsequently alter perinatal outcome. So by diagnosing these cases as early as possible, these maternal complications can be prevented and advise proper prenatal counseling in relevant cases. Methods: This study was conducted in obstetrics and gynaecology department at a tertiary care hospital, over the period of from September 2015 to September 2016. Prospective observational study. Results: Polyhydramnios is commoner in primigravida. Causative factor are mainly idiopathic after which the most important is fetal defects. Diabetes is also associated finding with polyhydramnios in 8.3% cases. The occurrence of fetal congenital abnormality was directly proportional to the gestational age of pregnancy. Incidence of congenital abnormality was found to be 1.25 %. Congenital heart disease and cleft lip and cleft palate (3%) were the commonest congenital abnormality associated with polyhydramnios followed by anencephaly and spina bifida (3.3%). Conclusions: In our study Idiopathic polyhydramnios was found to be the most common cause of polyhydramnios. A careful study must be done for detection of etiological factors in all cases of polyhydramnios, careful screening, prenatal and antenatal counseling will help to improve the foetal outcome as well as to prevent the maternal complication.

Polyhydramnios; Fetomaternal Outcome of Polyhydramnios; A Clinical Study in a Tertiary Care Institute

“…14 Anencephaly was the topmost anomaly in a study done at India. 9 Cleft lip and palate was responsible for 4.6% of congenital anomalies in our study whereas 5% of them was present in an International study. 9 Polyhydramnios was seen most commonly in women in age range 31 -40 years, followed by 21 -30 years age group according to our research.…”

“…13 Similarly Akram H et al noticed 51% cases of 31 -40 years age 15 .49% of our cases were multigravidas, whereas 59.9% were multigraviads in another study. 9 Likewise 57% were multigravidas in study by Chaurasia S et al 14…”

Clinical Profile and Maternal Outcome in Patients with Polyhydramnios

“…In our study we found mild hydramnios in 95% patients and only 5% had moderate to severe hydramnios. Desmedt et al (8) found in their 10 year study in 537 patients with polyhydramnios that 5.9% patients had preexisting diabetes and 3% had gestational diabetes.in another study by Rajgire AA et al (9) about 58.1% cases of polyhydramnios had associated maternal condition of which maximum cases had preeclampsia (16.6%) and anaemia (16.6%) followed by gestational diabetes mellitus (8.3%) followed by Rh isoimmunization (6.6%). Gita Guin et al (10) found in their study that diabetes mellitus was found in 20% of cases,PIH in 17.7%,twin pregnancy in 6.6% and Rh incompatibility in 4.4% .In our study there were associated factors like anemia in 27%, diabetes mellitus in 8%,multiple pregnancy in 6% and Rh negative in 6%of cases.…”

“…We found an incidence of 27% anemia, 22% malpresentations, 16% preterm labour, 15% pregnancy induced hypertension,10% intrauterine deaths, 6% PROM, 3% placenta previa, 1% abruption and 1% antepartum eclampsia in our patients. Rajgire AA et al (9) found in their study that about 31.4% of cases of polyhydramnios had complications like malpresentation (6.6%), preterm labour (5%), premature rupture of membrane (s5%), eclampsia( 5%), placenta previa (3.3%), and 3.3% patients developed postpartum haemorrhage. Least common were cord prolapse and placental abruption (1.6%) Gita Guin et al (10) found that the incidence of malpresentation was 13.3%, cord prolapse (11.1%) and PPH (4.4%) In their study, Sudha Chourasia et al (11) found that the common complications were preterm labour (16.3%) followed by PROM (3.7%) abruption placentae (2.9%) and PPH (2.9%) In our study 53% of patients were managed conservatively.…”

Polyhydramnios;

“…8 The perinatal outcome of polyhydramnios can be affected by certain complications like malpresentations, preterm labor, premature rupture of membranes, accidental haemmorhage, cord prolapse, uterine inertia, retained placenta, and postpartum haemmorhage. 9 Therapeutic amniocentesis is a method to deal with symptomatic polyhydramnios for the relief of respiratory distress. 10 Prostaglandin synthetase inhibitors like indomethacin and sulindac have been used in management of polyhydramnios as they reduce amniotic fluid volume by decreasing fetal urine output and enhancing resorption of lung fluid.…”