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Polyhydramnios and fetal intrauterine growth restriction: ominous combination
G K Sickler1, D A Nyberg, R Sohaey
1Center for Perinatal Disease, Swedish Hospital Medical Center, Seattle, Washington, USA.
Insights
The combination of polyhydramnios and intrauterine growth restriction in fetuses is a serious condition. Most affected infants have major anomalies or chromosomal abnormalities, necessitating genetic evaluation.
Area of Science:
- Perinatology
- Medical Genetics
- Prenatal Diagnosis
Background:
- Polyhydramnios and intrauterine growth restriction (IUGR) are common prenatal findings.
- The combined significance of these conditions requires further investigation.
Purpose of the Study:
- To evaluate the prognostic significance of concurrent polyhydramnios and intrauterine growth restriction.
- To determine the incidence of anomalies and mortality in affected fetuses.
Main Methods:
- Retrospective review of 39 fetuses diagnosed with polyhydramnios and IUGR via prenatal sonography over 6 years.
- Polyhydramnios defined as amniotic fluid index (AFI) ≥ 24; IUGR defined as estimated fetal weight < 10th percentile.
- Postnatal evaluation for major anomalies and chromosomal abnormalities.
Main Results:
- 92% of fetuses had major anomalies; 67% of those without prenatal sonographic anomalies had postnatal anomalies.
- Chromosomal abnormalities were found in 38% of cases (including trisomy 18 and 13).
- The overall mortality rate was 59%.
Conclusions:
- The combination of polyhydramnios and IUGR is an ominous sign with a high rate of fetal anomalies and mortality.
- Genetic analysis and thorough fetal assessment are crucial for fetuses diagnosed with both conditions.
- Even in the absence of other sonographic findings, significant anomalies are common.
Abstract:
The purpose of this study was to evaluate the significance of polyhydramnios combined with intrauterine growth restriction. During a 6 year period, 39 fetuses were identified by prenatal sonography as having both polyhydramnios and intrauterine growth restriction. Polyhydramnios was defined as a four-quadrant amniotic fluid index of 24 or greater (mean 30.5, range 24 to 40). Intrauterine growth restriction was defined as estimated fetal weight less than the tenth percentile (Hadlock standards). The mean birth weight was 2213 g. Major anomalies were present postnatally in 92% (36 of 39) of fetuses. Among nine fetuses without sonographically detectable anomalies prenatally, six (67%) proved to have one or more anomalies at birth. Chromosome abnormalities were present in 38% (15 cases) including 10 fetuses with trisomy 18 and one with trisomy 13. The overall mortality rate was 59%. The combination of polyhydramnios and intrauterine growth restriction is ominous. The majority of fetuses have major anomalies or chromosome abnormalities, or both, even when other sonographic abnormalities are absent. Chromosome analysis and detailed fetal evaluation should be offered when polyhydramnios and intrauterine growth restriction are identified prenatally.