Is resolving polyhydramnios a benign clinical entity?

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SPO Abstracts

J a n u a r y 1995 A m J O b s t e t Gynecol

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IS OLIGOHYDRAMNIOS IN POSTDATES GESTATION A FUNCTION OF FETAL WEIGIIT? Y. Bernhard. I. Bar-Havax, Z. Weiner ~, M.Y. Divon. Dept. OB/GYN, Albert Einstein College of Medicine, Bronx, NY. OBJEC'TIVE: To assess the influence of fetal weight on the development of oligohydrnnmios and subsequent fetal distress in postdates gestation (gestetional age (GA) >" 41 weeks). STUDY DESIGN: From 1/1/92-7/1/94, 814 consecutivo postdates gestation were prospectively evaluated. Sonographically determined enmiotic fluid indices (AFI) were obtained on all patients. Olignhydrnnmioswas defined as an AFi < 5cm. Birthwcight (BW'), gender and mode of delivery were recorded for each patient. Student's t-test and chi-sqanre were used for statistical analysis. RESULTS: TABLE I INFLUENCE O F BW ON AFI GA (weeks) AFI (cm) BW (~m) BW <2500gm AFI (cm) (mean + SD) (mean 4- SD) (mesa -t- SD) < 5 (n=103) 41.5 :[: 0.4 3.4 4- 1.I 3449 4- 445 4 neonates > 5 (n=711) 41.5 -I- 0.5 10.7 + 4.2 3665 4- 487 6 neonates p value NS < .0001 < .001 .002 7/19 (36.8%) fetuses with a BW <2800gin (5th%ile for BW) had oligohydramnios, compared with 96/795 (12. 1%) fetuses > 2800gins, p < .0001. Gender was not associated with an increased incidence of olignhydraranios. TABLE II INCIDENCE OF C/S FOR FETAL DISTRESS BY BW IN PATIENTS W I T H OLIGOHYDRAMNIOS Group I Group II Group H I <250egm 2500-40008m >,10088m C/S 4/4 (100%)* 8186 (9.3%) 1/13 (7.7%) *pffiO.006 compared with group II and pffiO.05 compared with group III. Using < 2800gm provided a sensitivity of 46%, specificity of 99 % and allowed prediction of 6/7 fetuseswith olignhydramnios undergoing C/S for fetal distress. No postdates fetus with olignhydramnios and a BW >4100gm (95th%ile for BW) required a C/S for fetal distress. CONCLUSIONS: I) Oligohydramnlos in postdates gestation is associated with a significantly lower BW. 2) The likelihood of C/S for fetal distress in postdates gestation with oligohydramoios depends on fetal weight.

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IS RESOLVING POLYHYI)RAI~[NIOS A BENIGN CLINICAL ENTITY? Y. Barah~rd, 1. Bar-Hava=, Z. Weiner', M.Y. Divon. Dept. OB/GYN, Albert Einstein College of Medicine, Bronx, NY. OBJECTIVE: To assess the clinical significance of resolving polyhydrnmnios. STUDY DESIGN: From 1/1/92-7/1/94 a sonographically measured anmiotic fluid index (AFI) was prospectively obtained in 3677 consecutive third trimaster pragmmcias. Polyhydrsmnios was defined as an AFI >24cm. A computer search of all 3677 newborn charts was performed to identify infants born with structural or chromosomal anomalies. RESULTS: Polyhydramnios was detected in 84/3677 women (2.3%). 17 women had only one exam, and were excluded from further study; the remaining 67 study patients had between 2-7 serial sonograms. 24/67 (35.8%) wore associated with 8estational diabetes mellitos (GDM) and two with pregnstational diabetes. TABLE ! INCIDENCE O F COMPLICATIONS IN PATIENTS W I T H POLYHYI)RAaMNIOS Structural/Chromosomal Anomalies GDM ResolvlngPolyhydramnios(26/67=38.8%) 10/26 (38.5%) 4/26(15.4%) Persistent Polyhydramnios(41/67=61.2%) 2/31 (4.9%) 20/41 (48.8%) p value (by Fisher exact tost) 0.005 0.03 Two of the patients with resolving polyhydramniss had newborns with a chromosomal ancuploidy, ie, trisomy 21 and trisomy 18. 9/10 structural anomalies involved only the renal system. 20/67 (29.8%) women had fluctuating polyhydramnios (AFIs fluctuating above and below 24cm with each exam). 14 of these 20 women (70%) had GDM or prcgnstatioenl diabetes; none of their newborns had a structural or chromosomal anomaly. CONCLUSIONS: I) Resolving polyhydramnios is not s benign clinical entity, but is associated with an increased incidence of chromosomal ancoploidy and structural anomalies compared with pcralstont polyhydramnios. Thus patients with resolving polyhydramnios warrant a targeted ultrasound. 2) Persistent polyhydramnios is more frequently associated with GDM than resolving polyhydramnios. 3) Fluctuating polyhydramnios is associated with GDM, but not chromosomal and structural anomalies.

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IS POLYHYDRAMNIOS ASSOCIATED W I T H AN INCREASED UMBILICAL ARTERY SYSTOLIC-DIASTOLIC RATIO IN THIRDTRIMESTER GESTATIONS? Y Barnherd. I Bar-I-lava ~, Z Weiner~, CE Henderson, MY Divon. Dept. OB/GYN, Albert Einstein College of Medicine, Bronx, NY. OBJECTIVE: To determine if polyhydrnnmios is associated with increased systolic-diastolic ratios (S/D) of umbilical artery (UA) Doppler wavcforms in third-trimaster fetuses and to assess its clinical significance. STUDY DESIGN: From 1/1/92-7/1/94 an anmiotic fluid index (AFI) was measured prospectively in 3677 third trimester woman. Of these a control group of 1148 uncomplicated pregnancies of 30 weeks' gestation or greater with a normal AFI was identified. Polyhydramoios was defined as an AFI >24cm. The 95th %lie for an S/D was determined as a function of gastational age (GA). A computer search of ell newborn charts during the study period was performed to identify all infants born with structural or chromosomal anomalies. Chisquare and Fisher exact tests were utilized. RESULTS: All 65 woman with an AFI >24cm had an S/D measured at the same visit. 16/65 (24.6%) women had gestational diabetes; none of their newborns had a struetural or chromosomal abnormality. An elevated S/D >95th% for GA was measured in 8/65 (12.3%) of patients with polyhydramnios, significantly more than in women with normal fluid 57/1148 (5%), p =0.03. TABLE I INCIDENCE O F ANOMALIES Polyhydramnlos Polyhydramnios Normal S/D Elevated S/D p Va~u¢ Chromosomal Anomalies 0/54 (0%) 2/8 (25%)* 0.022 Structural Anomalies 1/54 (1.8%) 5/8 (62.5%) 0.0006 *Trisomy 21, trisomy 18 The incidence of chromosomal and structural anomalies among 8852 deliveries during the study period was 0.14% and 2.3 %, respectively. CONCLUSIONS: 1) Polyhydramnles is associated with an increased incidence of an elevated S/D. 2) A significantly increased incidence of both chromosomal ananploidy and structural anomalies occurs in patients with polyhydrsmnios and an elevated S/D, compared with patients having polyhydramnios alone.

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CHRONIC ABRUPTION OUGOHYDRAMNIO8 SEQUENCE (CAO8) A COMPLICATION OF ABRUPTIO PLACENTAE J, BlicM, II. G i d n ' , T. Strong, Phoenix Perinatal Associates snd Good Samaritan Regional Medical Center, Phoenix, Arizona. OBJECTIVE: Oligohydrsmnioa in the absence of ruptured membranes is infrequently associated with sbruptio placentae. Chronic abruption otigohydramnios sequence is defined and the clinical significance presented. STUDY DF.81GN: A retrospective review of patients presenting to Good Samaritan Regional Medical Center in Phoenix, Arizona was performed from January 1, 1990 to June 30, 1994 (4½ years). All patients with s diagnosis of abnJptio placentae were reviewed and all patients with oligohydramnios and/or premature ruptured membranes were selected. CAOS is defined by patients presenting with clinically significsnt vaginal bleeding in the absence of placenta previs or other identifiable source of bleeding. Amniotic fluid volume was initially documented as normal. Oligohydrsmnios (AFI < 5) eventually developed without evidence of ruptured membranes. RESULTS: Twenty-four patients with CAOS were identified. Fourteen (68%) had first evidence of abruption < 20 weeks gestationsl age. A clot was identified between the chorion and the uterus in 18/24 (7§%). The mean gsstational age at first bleed is 19.4 _+ 5.5 weeks with the mean gestetionel age at delivery 28.1 + 4 . 8 weeks. Prsterm premature ruptured membranes eventually occurred in 15/24 (63%). The PMR was 292/10OO. Coagulopsthy (8%) and IUGR (8%) were infrequent. CONCLUSION: Abrdptio placentae occurs in approximately 1% of pregnancies. If delivery does not occur, chronic sbruption can result. These pregnancies can develop CAOS, which may affect management (usa of tocolytics, steroids, maternal transport, etc.). CAOS is s new entity with significant clinical implications, including s mean geetational age at delivery of 28 weeks,