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Oligohydramnios: should it be considered a risk factor for developmental dysplasia of the hip?
Dimitrios Manoukian1, Andreas Rehm
1Department of Paediatric Orthopaedics, Addenbrookes Hospital, Cambridge, UK.
Insights
Oligohydramnios, or reduced amniotic fluid, is a significant independent risk factor for developmental dysplasia of the hip (DDH). This finding highlights the importance of monitoring amniotic fluid levels during pregnancy for early DDH detection.
Area of Science:
- Orthopedics
- Neonatal care
- Prenatal diagnostics
Background:
- Developmental dysplasia of the hip (DDH) is associated with several risk factors, including breech presentation, family history, firstborn status, and female sex.
- The role of oligohydramnios (reduced amniotic fluid) as a DDH risk factor is debated due to inconsistent definitions and prior studies.
- Previous research has questioned the significance of torticollis, multiple gestation, delivery mode, and prematurity as DDH risk factors.
Purpose of the Study:
- To investigate the association between oligohydramnios and developmental dysplasia of the hip (DDH).
- To evaluate whether oligohydramnios should be considered an independent risk factor for DDH.
- To clarify the definition and clinical significance of oligohydramnios in relation to DDH.
Main Methods:
- Retrospective analysis of live births between 2001 and 2014 at a single institution.
- Identification of pregnancies with reduced amniotic fluid (oligohydramnios) and collection of data on DDH, breech presentation, female sex, and family history.
- Statistical analysis, including odds ratios and regression analysis, to assess risk factors and control for confounding variables.
Main Results:
- Oligohydramnios was found in 16% of DDH cases, with an odds ratio (OR) of 3.9 (95% CI: 2.1-7.3) for DDH.
- Breech presentation (OR = 10.6) and female sex (OR = 19.1) were also significant risk factors for DDH.
- Regression analysis confirmed oligohydramnios as an independent risk factor for DDH, with all examined factors showing statistical significance (P < 0.05).
Conclusions:
- Reduced amniotic fluid/oligohydramnios is an independent risk factor for developmental dysplasia of the hip (DDH).
- The diagnosis of oligohydramnios during antenatal scans warrants consideration as a significant risk factor for DDH.
- Future studies on DDH should incorporate oligohydramnios as a key variable for risk assessment and management.
Abstract:
Breech, family history, first born and female sex are the main risk factors described for developmental dysplasia of the hip (DDH). Foot abnormalities and oligohydramnios have also been listed. Recent studies have discredited torticollis, multiple gestation pregnancy, mode of delivery and prematurity as risk factors. Definition of oligohydramnios in the literature is inconsistent. Our aim was to investigate the term oligohydramnios and evaluate whether it should be considered a risk factor for DDH. All live births in our institution between 2001 and 2014 were included. We identified all pregnancies classed as reduced amniotic fluid (AF) or oligohydramnios over that period. Data on DDH, breech presentation, female sex and positive family history were collected. The significance level was set to 5%. We identified 73 990 live births, 3408 pregnancies were classed as reduced AF or oligohydramnios. The incidence of DDH (Graf type IIb and higher) was 1: 1000 (75 babies, 18 bilateral). Oligohydramnios/reduced AF was found in 12 (16%) DDH babies. Breech presentation was found in 24 (32%), positive family history in 19 (25%) and female sex in 71 (94.7%). Oligohydramnios was found to be associated with a higher odds ratio (OR) for DDH [OR = 3.9, 95% confidence interval (CI): 2.1-7.3] as were breech presentation (OR = 10.6, 95% CI: 6.5-17.1) and female sex (OR = 19.1, 95% CI: 7-52.4). All examined risk factors showed statistical significance (P < 0.05). A regression analysis was performed to control for interactions and confounding factors and confirmed the findings. On the basis of our findings the diagnosis of reduced AF/oligohydramnios in consecutive antenatal sonographic scans should be regarded as an independent risk factor for DDH and be considered in any future studies regarding DDH. Level of evidence: Level IV: Case series.
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