The Severity of Polyhydramnios, Estimated Fetal Weight and Preterm Delivery Are Independent Risk Factors for the Presenceof Congenital Malformation s

Abstract

Objective: To evaluate maternal and fetal factors associated with congenital malformations in patients with polyhydramnios. Study Design: The study group consisted of 275 singleton pregnancies with an amniotic fluid index (AFI) >25.0 cm. An equal number of controls were matched for maternal age, gravidity, parity and gestational age. The proportion of cases and controls with malformations was compared. Polyhydramnios cases were categorized into three groups by severity: mild (AFI 25–30 cm), moderate (AFI: 30.1–35.0 cm) and severe (AFI >35.1 cm). Among cases, logistic regression analysis was utilized to estimate the risk for fetal congenital malformations in relation to severity of polyhydramnios, estimated fetal weight, maternal diabetic status and gestational age at delivery. Results: Congenital malformations were detected in 40 of 275 cases (14.5%) with polyhydramnios and in 9 cases (3.3%) of the control group (p < 0.01). The relative risks of congenital malformations increased with the severity of polyhydramnios: 3.2 (95% CI 1.5–6.8), 5.7 (95% CI 2.4–13.3) and 13.1 (95% CI 5.8–29.5) for mild, moderate and severe polyhydramnios, respectively. Congenital malformations among polyhydramnios cases were present in 54.5% of small-for-gestational age fetuses, in contrast to 12.7% for average-for-gestational age fetuses and 10.8% for large-for-gestational age fetuses (p < 0.001). Maternal diabetic status did not significantly affect the fetal anomaly rate once polyhydramnios was detected. Premature newborns in the polyhydramnios group had a higher malformation rate (24%) than did term newborns (11.3%) (p < 0.02). In the study group, multiple logistic analysis confirmed the significance of severe polyhydramnios, small-for-gestational age status and preterm delivery as independent contributors to the malformation risk. Conclusions: Polyhydramnios (AFI >35 cm), small-for-gestational age fetus and preterm delivery are independent risk factors for congenital malformations.

A clinical study of fetomaternal outcome in pregnancy with polyhydramnios

“…Anisa Fawad conducted a study where total number of cases of polyhydramnios was 70 and found congenital abnormality as anencephaly in maximum number of cases, duodenal atersia, oesophageal atresia and gastroschisis two each. 10,13 Present study subjects presented in 20-27 weeks of gestation were 3.3%, 28-36 weeks 6.6% and 37 -42 weeks 90% comparable tostudy done by Akram H, Nasir A, Rana T on increasing severity of polyhydramnios -a risk factor for congenital malformation conducted in Lady Willingdon hospital, Lahore presented with the result of subjects in 20-27 weeks of gestation were 10 (16.6%), in 28-36 weeks of gestation were 28 (46.6%) and in 37-42 weeks of gestation were 28 (46.6%) and in 37-42 weeks of gestation were 22 (36.6%). 15 In present study the probable aetiological factor for polyhydramnios was idiopathic in 65.1%, fetal congenital abnormality in 26.6% and gestational diabetes mellitus in 8.3%.…”

“…It is observed that with increasing severity of polyhydramnios, percentage of anomalous foetusincreases. 10 Perinatal morbidity and mortality are significantly increased when polyhydramnios is present at delivery. Fetal conditions that are associated with polyhydramnios include major congenital anomalies (open neural tube defects, upper gastrointestinal tract obstruction or malformation etc.)…”

Correlation between Maternal Characteristics during Early Pregnancy, Fetal Growth Rate and Newborn Weight in Healthy Pregnancies

“…Currently, a growing amount of evidence has demonstrated a relationship between IUGR and macrosomic fetuses with short- and long-term complications [6,11,12,13,14]. The link between long-term cardiovascular and metabolic diseases has been studied and has shown a higher rate of hypertension, diabetes mellitus and cardiovascular risk in infants and adults who had extremely abnormal FG [1,2,19].…”

“…Traditionally, most of attention has been given to fetuses located at the far sides of EFW curves because those cases account for most of the perinatal morbidity [6,10,11,12,13,14,15,16,17,18]…”

Short-Term Outcome for Term and Near-Term Singleton Infants with Intrapartum Polyhydramnios

“…Polyhydramnios, defined as AFI greater than 24 cm, has been related to maternal diabetes [1][2][3] and has been involved in preterm labor [2,4] , congenital malformations [1][2][3][5][6][7] and macrosomia [1][2][3]8] . The term 'idiopathic hydramnios' is used to describe pregnancies where polyhydramnios is present, but without any ultrasono-graphically identifiable fetal anomalies or maternal diseases.…”