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Diagnosis of polyhydramnios in early gestation: indication for prenatal diagnosis?
S K Hendricks1, L Conway, K Wang
1Department of Obstetrics and Gynecology, University of Washington Medical Center, Seattle 98195.
Insights
Early diagnosis of polyhydramnios (excess amniotic fluid) before 26 weeks gestation reveals a strong link with congenital anomalies, particularly in severe cases. Chromosomal analysis is likely unnecessary if no other ultrasound findings are present.
Area of Science:
- Maternal-Fetal Medicine
- Prenatal Diagnosis
- Genetics
Background:
- Idiopathic polyhydramnios has been linked to trisomies 18 and 21, suggesting a need for chromosomal analysis.
- The natural history and fetal outcomes of polyhydramnios diagnosed early in gestation require further delineation.
Purpose of the Study:
- To investigate the association between early-onset polyhydramnios (before 26 weeks gestation) and congenital abnormalities.
- To evaluate the resolution rates and fetal outcomes based on polyhydramnios severity and presence of anomalies.
- To assess the utility of amniocentesis in cases of early idiopathic polyhydramnios without other ultrasound findings.
Main Methods:
- Retrospective analysis of 138 pregnancies with polyhydramnios diagnosed before 26 weeks gestation.
- Classification of polyhydramnios into severe, moderate, and mild categories.
- Correlation of polyhydramnios severity with congenital abnormalities, twin-to-twin transfusion, chromosomal abnormalities, and pregnancy outcomes.
Main Results:
- Severe polyhydramnios (86%) and moderate polyhydramnios (72%) were highly associated with congenital anomalies.
- Mild polyhydramnios showed a lower association with anomalies (17%), with a high resolution rate (91%) when anomalies were absent.
- No cases of severe polyhydramnios or moderate polyhydramnios with anomalies resolved; chromosomal abnormalities were only found with additional sonographic findings.
Conclusions:
- Early diagnosis of polyhydramnios, especially when severe or moderate, is strongly associated with congenital anomalies.
- The presence of other ultrasound findings is crucial for guiding further investigation like amniocentesis.
- Routine amniocentesis for idiopathic polyhydramnios diagnosed early without other sonographic abnormalities is likely not beneficial.
Abstract:
Previously published reports have indicated that idiopathic polyhydramnios may be associated with trisomies 18 and 21 and that chromosomal analysis is indicated. Furthermore, the natural history and fetal outcome of polyhydramnios diagnosed in early gestation have not been well delineated. We identified 138 pregnancies with polyhydramnios prior to 26 weeks' gestation. Of 131 complete cases, 21 were diagnosed as severe, 18 as moderate, and 92 as mild polyhydramnios. Congenital abnormalities were noted in 18 of 21 severe cases (86 per cent). Two of the remaining three cases were twin-to-twin transfusion. Thirteen of 18 cases with moderate polyhydramnios (72 per cent) were associated with anomalies; six of the remaining cases were twin-to-twin transfusion. Sixteen of 92 cases of mild polyhydramnios (17 per cent) were associated with congenital abnormalities. In 69 of 76 cases of mild hydramnios not associated with anomalies (91 per cent), the hydramnios resolved prior to delivery. Only 2 of 16 (13 per cent) associated with anomalies resolved. In 4 of 5 cases (80 per cent) with moderate hydramnios and no anomalies, the amniotic fluid volume was normal on subsequent ultrasound. No case of moderate polyhydramnios associated with anomalies or maternal conditions nor any case of severe polyhydramnios resolved. There were seven cases of chromosomal abnormalities in this series; all were associated with sonographic findings in addition to the presence of polyhydramnios. On the basis of these data, we doubt the benefit of amniocentesis following the early diagnosis of idiopathic polyhydramnios in the absence of other ultrasound findings.