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Follow-up needed for polyhydramnios births

Obstetrics and gynaecology

Obstetrics and gynaecology

Polyhydramnios is a complication of pregnancy associated with a range of fetal and maternal pathologies. In cases where a cause is not identifiable the risk of pre-term delivery because of premature labour is significant, even when amniotic fluid reduction is performed. A study in the BJOG suggests that, even in apparently uncomplicated cases, polyhydramnios is significantly associated with developmental anomalies and other neonatal pathologies.

Polyhydramnios, the presence of excessive liquor or amniotic fluid surrounding the fetus during pregnancy, is diagnosed using objective ultrasonic signs.

Its causes include fetal aneuploidy, maternal diabetes, excessive fetal urine production and reduced removal of fluid from the sac by fetal ingestion caused by oesophageal atresia. Investigation usually identifies a cause, but a significant minority of cases remain unexplained.

A study, from France, investigated whether unexplained polyhydramnios has implications for the health of the child after birth.

Polyhydramnios was identified in 173 cases from a population of more than 12,000 pregnancies. The study examined 24 unexplained cases of polyhydramnios in singleton pregnancies. It analysed factors including the age and parity of the mother, gestational age at delivery, mode of delivery, birthweight and neonatal outcome. The median follow-up was 12 months.

Of the 24 cases of unexplained polyhydramnios, 17 continued to have a normal course through pregnancy, although most needed amniotic fluid reduction. These all resulted in babies who showed no abnormalities when examined in the year after birth.

In the remaining seven cases, one child died in utero and was later found to have a variety of congenital malformations. Four were delivered either pre-term or with signs of hypoxia; one child subsequently died because of prematurity and periventricular leucomalacia. Two children who had a normal course through pregnancy were identified as having an anomaly (polyuric syndrome and pulmonary stenosis respectively) after birth.

The authors conclude that, in addition to excluding oesophageal atresia at birth, paediatricians should offer surveillance even when the outcome at birth is apparently normal.

Touboul C, Boileau P, Picone O et al. Outcome of children born out of pregnancies complicated by unexplained polyhydramnios. BJOG 2007;114:489-492

Reviewer

Dr Chris Barclay
GP, Sheffield

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