Intrapartum hydramnios at term and perinatal outcome

The objective of this study was to compare the intrapartum outcome among laboring patients with hydramnios (amniotic fluid index > or = 24.0 cm) versus those with adequate fluid (amniotic fluid index > 5.0 and < 24.0 cm). Prospectively, during a 2-year period, 341 patients in early labor underwent four-quadrant measurement of amniotic fluid volume. Forty-two patients had intrapartum oligohydramnios (amniotic fluid index < or = 5.0 cm) and were excluded from further analysis. The study compares the outcome between 277 subjects with adequate fluid and 22 with hydramnios. The intrapartum amniotic fluid index, birth weight, incidence of macrosomia (birth weight > or = 4000 gm), shoulder dystocia, cesarean section for fetal distress or cephalopelvic disproportion, Apgar score, and neonatal malformations were noted in each of the 299 subjects. Umbilical arterial blood gas was analyzed in 189 patients. In this study, 22 women with hydramnios had a significantly higher risk of delivering a macrosomic fetus than the 277 patients with a normal index (36.3% vs 13.7%; p = 0.01). There was no significant difference in the incidence of shoulder dystocia, cesarean section for cephalopelvic disproportion, or fetal distress, Apgar scores < 7 at 1 and 5 minutes, fetal acidosis, or neonatal anomalies. We conclude that hydramnios during the intrapartum period in patients at term is significantly associated with delivery of a macrosomic fetus, but not with delivery of a compromised neonate.