Acute recurrent polyhydramnios and amniotic prolactin

A 25 year-old patient in her third pregnancy presented with acute polyhydramnios at 24 weeks' gestation, which was the same time as in the two previous pregnancies. In both she had preterm premature rupture of membranes, preterm delivery and neonatal deaths. In the third pregnancy, amnioreductions combined with medical treatment resulted in the birth by Caesarean section of a normally formed live male at 31 weeks of pregnancy. Acute recurrent polyhydramnios is an extremely rare condition of unknown aetiology. We hypothesized that amniotic prolactin plays a role in this pathology. It was measured serially in amniotic fluid and high levels were found.     

The Association of Ring Chromosome 13 and Duodenal Obstruction

The antenatal diagnosis of ring chromosome 13 was made in a fetus at 30 weeks gestation. The pregnancy had progressed normally until this time, when polyhydramnios was suspected, and sonography demonstrated polyhydramnios, a growth delay of 4 weeks, and a double bubble sign, indicating duodenal obstruction or atresia. Cordocentesis was performed, and the karyotype was remarkable for a ring chromosome 13 in all fetal cells examined. Ring chromosome 13 is a rare chromosomal abnormality, usually associated with intrauterine growth delay and neural, cardiac, and renal malformations, but generally not associated with duodenal obstruction.     

Hypercalcemic crisis in third trimenon: evaluating the optimal treatment strategy

Hypercalcemia due to primary hyperparathyroidism during pregnancy is a rare condition and associated with increased morbidity and mortality for the mother and the unborn child. Whereas parathyroidectomy is favored during the second trimester, no clear recommendations exist for its management during the third trimenon. We here report the case of a 26-year-old woman in the 29th week of her first pregnancy, who was admitted to our clinic with hypertension, intra-uterine growth retardation and polyhydramnios. Severe hypercalcemia due to primary hyperparathyroidism was diagnosed (total calcium 3.34?mmol/l; PTH 216?pg/ml), but no enlarged parathyroid gland could be localized by ultrasound. Treatment with calcitonin and cinacalcet could not control hypercalcemia. Therefore explorative surgery was performed and a single parathyroid adenoma was resected, resulting in normalization of serum calcium levels. The surgical procedure was tolerated well by the mother and fetus. Hypercalcemia-induced hypertension and polyhydramnios ameliorated before C-section was performed two weeks later and unrelated to the intervention. This case report underlines the importance of early diagnosis and treatment of primary hyperparathyroidism during pregnancy. If diagnosed in the third trimenon, an interdisciplinary approach is crucial. If medical treatment fails to sufficiently control hypercalcemia, surgical parathyroid exploration should be considered even in cases of unsuccessful localization of adenomatous parathyroid glands.     

Pregnancy outcomes in severe polyhydramnios: no increase in risk in patients needing amnioreduction for maternal pain or respiratory distress

Introduction: Polyhydramnios is a common complication of fetal malformations and has been described to have high risk of pregnancy complications such as prematurity and placental abruption. In a subgroup of women severe polyhydramnios may lead to maternal dyspnea or untreatable pain, and amnioreduction is the procedure indicated to relieve those symptoms. There is a lack of information concerning the increase in the risk for the pregnancy when the procedure is indicated. Therefore, this study sought to evaluate the risk of complications in pregnancies with severe polyhydramnios that needed amnioreduction in relation to the basal risk for the pregnancy of having polyhydramnios without the need for the procedure.

Materials and methods: Patients with singleton pregnancies and severe polyhydramnios followed in our fetal medicine center were evaluated retrospectively. Pregnancy complications (prematurity rate, fetal death, premature rupture of membranes, placental abruption and chorioamnionitis) were studied in the group of patients needing the procedure and their risk was compared to the risk of having a pregnancy with severe polyhydramnios but with no need for the procedure.

Results: One hundred and thirty-five patients were evaluated. Forty-four patients (32.6%) needed amnioreduction. There was no increase in the risk of having complications when the procedure was needed OR?=?1.4 (CI 0.46–1.26).

Conclusion: Amnioreduction performed to relieve maternal symptoms did not statistically increase the risk of pregnancy complications with severe polyhydramnios in single pregnancies.     

Trisomy 18: the value of late prenatal diagnosis

Diagnosis of trisomy 18 was made in 2 fetuses late in pregnancy. Both pregnancies were complicated by polyhydramnios coexisting with fetal growth retardation. The significance of these findings, and the advantages and limitations of late prenatal diagnosis of fetal chromosomal abnormality are discussed.     

The Significance of Recurrent Polyhydramnios

Summary: A study of 30 women who had polyhydramnios in more than 1 pregnancy revealed that 8 of the 36 resultant pregnancies (22.2%) were associated with diabetes mellitus, 14 (37.8%) with fetal macrosomia, and the perinatal mortality rate was 16.2% (6 of 37). The incidence of major fetal malformations or abnormalities was 18.9% (7 of 37); 4 of the 6 deaths resulted from malformations (anencephalus (2), hydrocephalus (1), nonimmune hydrops (1)), and the other 2 deaths were from hyaline membrane disease associated with prematurity. Recurrent polyhydramnios occurred in 1 in 1,720 pregnancies. The onset was acute in 3, subacute in 2 and chronic in 31, the perinatal deaths in these categories being 2, 1 and 3 respectively. The risk of recurrent polyhydramnios is the risk of fetal malformation and premature delivery. The latter may be preventable by prompt therapy with indomethacin, and serial amniocentesis if this therapy fails.     

Outcome of children born out of pregnancies complicated by unexplained polyhydramnios

Our aim was to assess the long-term outcomes of infants born out of a pregnancy complicated by unexplained polyhydramnios. We retrospectively analysed a cohort of 173 singleton pregnancies with polyhydramnios. There were 24 singletons with unexplained polyhydramnios, defined as polyhydramnios where prenatal testing was negative. Infants were examined by a paediatrician at a median age of 12 months (range 12-64 months). Of the 24 infants, 19 (79%) had a normal outcome. West syndrome, polyuria and pulmonary stenosis were diagnosed in three children during follow up, while there were two perinatal deaths. Paediatric follow up of children born out of pregnancies complicated by unexplained polyhydramnios should be carried out systematically.     

Perinatal Outcome in Idiopathic Polyhydramnios

Objectives

To study perinatal outcome in idiopathic polyhydramnios.

Methods

Case–control study was conducted in 500 pregnant women with idiopathic polyhydramnios (study group) and 500 normal pregnant women (control group) attending the outpatient department of SHKM Medical College, Haryana. Perinatal outcomes were recorded in both the groups.

Results

Out of 500 cases with idiopathic polyhydramnios, maximum cases were diagnosed between 28 and 36 weeks of pregnancy (84.6 %), and maximum presented with mild polyhydramnios (82 %). In the study and control groups, there were no statistically significant differences in preeclampsia and gestational hypertension (p = 0.445 and p = 0.230). In the study and control groups, 74.6 and 79.6 % women, respectively, had normal vaginal delivery (p = 0.250). The study group recorded much higher number of preterm deliveries than the control group (54 %) (p = 0.000). In the study group, 51.8 % women had maternal complications, while in the control group, 13.6 % women had obstetrical complications. The study group recorded higher perinatal mortality (10.4 %) than the control group.

Conclusions

Idiopathic polyhydramnios is associated with higher perinatal morbidity and mortality than normal pregnancy.     

The Timing of Delivery in Diabetic Pregnancy: A 10-Year Review

The approach of term in the pregnancy of a diabetic woman is a time of anxiety for patient and physician alike. The impact of a conservative approach to the timing of delivery is outlined in this review of the clinical course and outcome of 276 pregnancies of diabetic women, delivered at the National Maternity Hospital, Dublin between 1981 and 1990. The mean gestation at delivery was 39 weeks, 229 patients (83%) delivered at or beyond 38 weeks and 112 patients (41%) delivered at or beyond 40 weeks. The overall induction of labour rate was 27% and the elective Caesarean section rate was 19%. Sixty seven percent of patients achieved a normal delivery, the forceps rate was 5%, and 28% of patients were delivered by Caesarean section. There were 16 perinatal deaths in the series, with 7 due to lethal malformations. There were 5 deaths of normally formed infants occurring at or beyond 38 weeks' gestation. All of these 5 deaths had been preceded by clinically apparent polyhydramnios or macrosomia and recognized poor control. This study stresses the value of strict diabetic control in the management of diabetic pregnancy and highlights the significance of polyhydramnios and macrosomia as indicators of risk approaching term in diabetic pregnancy.     

Substance abuse and polyhydramnios

OBJECTIVE: Maternal drug use is known to have fetal central nervous system depressive effects as manifested by decreased biophysical profile scores. Drug effects on the amniotic fluid index (AFI), one variable of the biophysical profile, are not well documented. Our objective was to determine the effects of maternal drug use on the AFI. STUDY DESIGN: Over an 18-month period from July 1997 to December 1998, consecutive cases of women with toxicology-proven drug use during pregnancy were identified. AFI values and the rate of polyhydramnios in substance users were compared with those observed at our institution in more than 6400 patients undergoing ultrasound testing during the same period as the cases. RESULTS: Sixty-three toxicology-positive cases were identified. Although there was no significant difference between mean AFI values, the incidence of polyhydramnios (AFI >24 cm) was significantly higher in substance users (28.6%) than in control patients (3.9%) (P <.005). CONCLUSION: Maternal substance abuse is associated with a significantly higher incidence of polyhydramnios and should be considered a possible etiologic factor in women with apparent idiopathic polyhydramnios.     

Pregnancy outcome in patients undergoing long-term hemodialysis.

Three uremic patients receiving hemodialysis for more than 5 years became pregnant and proceeded to the third trimester. A variety of complications were noted, including threatened abortion, vanished twin, preterm premature rupture of membranes, polyhydramnios, intra-uterine fetal death, intra-uterine growth retardation, premature labor and hypertension. Two of these 3 mothers gave birth to healthy babies under the management of the high-risk pregnancy team.     

Idiopathic polyhydramnios at term and pregnancy outcomes: a multicenter observational study

Aim: To assess pregnancy outcomes in pregnancies with idiopathic polyhydramnios at term.

Methods: We conducted a retrospective cohort study of 106 225 term pregnancies from 37 hospitals in China. Maternal and fetal outcomes in pregnancies with idiopathic polyhydramnios were compared with pregnancies with normal amniotic fluid. The primary outcome was intra-uterine fetal death (IUFD).

Results: In all, 307 out of 106?225 (0.3%) had idiopathic polyhydramnios at term, 276 of which were mild and 31 of which were moderate-severe. Compared to term pregnancies with normal amniotic fluid, pregnancies idiopathic polyhydramnios was associated with over 24-fold higher risk for IUFD (adjusted odds ratio [aOR] 24.4, 95% confidence interval (CI) 7.3–82.0), macrosomia (aOR 2.8, 95%CI 2.0–3.8), malpresentation (aOR 2.5, 95%CI 1.7–3.7), cesarean delivery (aOR 2.5, 95%CI 1.7–3.7) and low APGAR scores at 5?min (aOR 4.3, 95%CI 2.4–7.8), which increased with severity of idiopathic polyhydramnios.

Conclusion: Term pregnancies with idiopathic polyhydramnios, especially moderate–severe ones are at a significantly increased rate for adverse pregnancy outcome. Increased antepartum surveillance of fetal well-being and timed delivery are warranted.     

Prenatal diagnosis of 2q32 deletion syndrome characterized by multiple segmental deletions and complex chromosomal rearrangement involving chromosomes 2, 5 and 7

This is the first case of 2q32 microdeletion syndrome diagnosed prenatally and followed throughout the pregnancy. The pregnancy was complicated by fetal club feet, ventriculomegaly, intrauterine growth retardation and polyhydramnios. This is a unique and highly complicated prenatal diagnosis case of a de novo complex chromosomal rearrangement involving chromosomes 2, 5 and 7 with 15 breaks and multiple interstitial 2q deletions, resulting in the 2q32 microdeletion syndrome. The delineation of the karyotype in this case and origin of the pathology required the use of multiple genetic technologies including conventional cytogenetics, fluorescence in situ hybridization, single-nucleotide polymorphism array and array comparative genomic hybridization.     

Amniotic fluid concentrations of collagenase-1 and collagenase-3 are increased in polyhydramnios

OBJECTIVE: Polyhydramnios places increased tension on the fetal membranes and should conceptually be associated with an increased need for tissue remodeling to prevent premature rupture of membranes (PROM). Herein we use polyhydramnios as a model to study the association of the collagenase class of matrix metalloproteinases (MMPs) with tissue remodeling during pregnancy. METHODS: Amniotic fluids were collected by transabdominal amniocentesis from women with polyhydramnios and from women with normal amniotic fluid volume at second trimester, third trimester and at term. Fluids were assayed for MMP-1 and MMP-13 (collagenase-1 and 3) using ELISA. The concentrations in polyhydramnios were compared with subjects undergoing amniocentesis with normal amniotic fluid volume. Statistical comparisons were made using Scheffe's method for correction in multiple means comparison. P of <0.05 was considered statistically significant. RESULTS: MMP-1 and MMP-13 are present in the amniotic fluid at all stages of pregnancy. The concentrations of these MMPs were significantly elevated in the polyhydramnios samples independent of gestational age. CONCLUSION: Polyhydramnios is associated with increased amniotic fluid concentrations of MMP-1 and MMP-13 suggesting their role in tissue remodeling.     

How to manage an accelerated embryo cohort in IVF

The case of a successful pregnancy is reported here, following intracytoplasmic sperm injection which resulted in a cohort of embryos showing accelerated cleavage kinetics. Pregnancy was not achieved with fresh embryos transferred at the 4-cell stage but was achieved with cryopreserved accelerated embryos. After an ovarian stimulation cycle, 20 mature oocytes were observed. Early cleavage was observed in 19 of these, 26 h post-injection, and 17 were beyond the 4-cell stage 42 h after injection. No pregnancy was obtained after the transfer of two fresh embryos at the 4-cell stage without fragments. Following the transfer of two frozen accelerated embryos, a twin pregnancy was obtained, which resulted in the delivery of two healthy babies. This case report demonstrates that classical scoring systems may need to be adapted to reflect the cleavage kinetics of the whole embryo cohort.     

Usefulness of fetal autopsy in the diagnosis of blomstrand chondrodysplasia: a report of three cases

Blomstrand osteochondrodysplasia (BOCD) is a rare autosomal recessive sclerosing skeletal dysplasia characterized by accelerated chondrocyte differentiation. In this article, we discuss three cases where lethal skeletal dysplasia was suspected and Blomstrand dysplasia was diagnosed by autopsy. Antenatal ultrasound findings include increased nuchal translucency, tetramicromelia and polyhydramnios. Radiological hallmark is advanced skeletal maturation and bone sclerosis. Histology of long bones revealed narrow cartilagenous cap and changes in the physeal growth zone which showed severe hypoplasia and disorganization of proliferative phase and hypertrophic phase. Homozygous and compound heterozygous mutations in PTHR1 gene have been implicated in the pathogenesis of this chondrodysplasia.     

Management of a triplet pregnancy with two anencephalic fetuses and polyhydramnios

The occurrence of a triplet pregnancy discordant for anencephaly is rare and its management presents a clinical dilemma. We report what appears to be the first case of a triplet pregnancy with two anencephalic fetuses complicated by premature contractions and severe polyhydramnios. Its management, which results a healthy newborn weighing 1385 g is discussed.     

妊娠合并糖尿病患者胎儿宫内安全监测

妊娠合并糖尿病增加了母儿疾病的发生风险,如妊娠期高血压疾病、羊水过多、巨大胎儿、肩难产、胎儿畸形、胎儿生长受限、胎儿窘迫和胎死宫内、新生儿低血糖、新生儿高胆红素血症以及新生儿远期并发症.对妊娠合并糖尿病患者规范化、专业化及多学科合作的血糖管理,有助于降低母婴并发症发生的风险,合理的宫内监测有助于及早发现胎儿的异常,进而...     

Amniodrenaje repetido para el tratamiento de un polihidramnios grave

The polyhydramnios, with an incidence of 1/200 pregnancies, defined as the increase in the amount of amniotic fluid, is associated with an increase in perinatal pathology. It is due to disruption of the equilibrium that exists between the production and removal of the fluid. It is diagnosed by ultrasound and is determined by semi-quantitative methods. During pregnancy can be An aetiological study may be made during pregnancy. The treatment is aimed at reducing the risk of complications due to uterine overdistensión, mainly pre-term birth, and appropriate care of the newborn. We report a case of severe polyhydramnios treated by repeated amniodrainage, produced by a pseudo-hypoaldosteronism, a rare cause, and difficult to diagnose by routine prenatal study     

Maternal and fetal factors related to abnormal amniotic fluid.

OBJECTIVE: The objective of this study was to identify maternal and infant characteristics related to alteration of amniotic fluid volume at birth. STUDY DESIGN: A series of 27,145 consecutive malformed newborn infants from the Spanish Collaborative Study of Congenital Malformations (ECEMC) was analyzed. From this total, 3.01% were found to have oligohydramnios and 3.69% were found to have polyhydramnios. RESULTS: As expected, renal/urinary tract and lung defects were associated with oligohydramnios, whereas esophageal and intestinal atresias, neural tube defects, and other central nervous system malformations were associated with polyhydramnios. In addition, other defects such as cardiovascular anomalies, hydrocephaly, and microcephaly were also related to abnormalities of amniotic fluid volume. After excluding the defects whose association to oligo- or polyhydramnios is well recognized, we compared the frequency of different variables among them and with infants with a normal volume of amniotic fluid. In comparison with infants with normal amniotic fluid volume, the groups with oligo- and polyhydramnios had lower birth weight, shorter gestational age and umbilical cord, higher parental ages, and a greater frequency of spontaneous abortions. The differences were more marked for weight in newborn infants with oligohydramnios, and for gestational age, umbilical cord length, number of previous pregnancies, and spontaneous abortions in polyhydramnios cases. Placental weight was lower in oligohydramnios cases than in infants with normal amniotic fluid, and higher in polyhydramnios cases. Parental consanguinity and twinning were more frequent in polyhydramnios. Maternal morbidity was higher in both groups with abnormal amniotic fluid volume, especially for acute diseases such as hypertension, diabetes mellitus, and gestational diabetes. Chromosomal aberrations were more frequent in the oligo- and polyhydramnios groups than in cases with a normal volume of amniotic fluid, which supports the suggestion of performing prenatal cytogenetic analysis in any pregnancy complicated by an abnormal volume of amniotic fluid. CONCLUSION: The fact that all of these results are similar in the control group of healthy infants suggests that at least some of the variables associated with abnormal amniotic volume could be considered as causal factors altering the production of fluid.