1. Influence of polyhydramnios on perinatal outcomes.
WOGS MEETING - 16TH March 2012
Dr. Mugdha Wakodkar, Trust SHO
Dr. Shweta Joshi, ST6
Mrs. Kalpana Upadhyay, Consultant O&G
WREXHAM MAELOR HOSPITAL (BCUHB North Wales)

2. Introduction
Polyhydramnios - excess amniotic fluid for given gestation in pregnancy
It complicates % of all pregnancies
Prognosis depends on cause - good prognosis in idiopathic type

3. Causes Fetal Maternal Placental Idiopathic 55%
Tracheoesophageal fistula, oesophageal atresia, duodenal atresia, diaphragmatic hernia
Maternal Diabetes 25%
Chorioangioma (rare)
Lethal skeletal dysplasia
Twin Pregnancy (mostly monochorionic with TTTS)
Open neural tube defects
TORCH and Parvovirus infection
Fetal macrosomia, fetal anaemia – Rh disease

4. Physiology of Amniotic Fluid
Amniotic fluid after 20 weeks largely consists of fetal urine
Volume depends on urine production, fetal swallowing and absorption
Amniotic fluid -
250 ml at 16 wks
1000 ml at 34 wks
declines to 800 ml at term

5. Diagnosis - ultrasonography
Subjective assessment – by experienced trained sonographer OR
Single deepest vertical pool – > 8cm is polyhydramnios
Amniotic fluid index - varies with gestational age
An AFI < 5 cm - oligohydramnios
An AFI > 25 cm – polyhydramnios
AFI > 95th centile for the gestational age
Obstetric ultrasound- Trish Chudleigh and Basky Thilanganathan,
Progress in Obstetrics and Gynaecology –John Studd , Vol 18

6. Reference range AFI used at WMH

7. Standard Currently no standard guideline in RCOG / NICE
Literature search
Little evidence on diagnosis and management of polyhydramnios
No large studies done on the optimum management

8. Aim of study Study demographics Assessing outcome- maternal and fetal
To look into what investigations were done
To propose a guideline

9. Methods Retrospective study Jan 2010 to August 2010
Cases identified by using help of ultrasonography department
Identified all scan reports
With term “polyhydramnios” on growth scan
Looked into 48 cases

10. Gravidity
( n =18 )
( n =30 )

11. Family h/o Diabetes
( n =8)
( n = 40)

12. Anomaly scan
4% (n=2)
96% (n=46)

13. AFI

14. Deepest vertical pool
6 out of 48 had deepest vertical pool used as criteria for polyhydramnios
Between 7 and 8

15. GTT
(*n=8)
(n=40)
*6 of 8 cases already diagnosed with IDDM, 2 of 8 diagnosed near term

16. GTT positive (**n=6) (n=34)
**these 6 positive results were newly diagnosed with GDM

17. TORCH and Parvo testing

18. TORCH and Parvovirus results
Positive results were only for IgG antibiodies and none for IgM antibodies.

19. Gestation at delivery

20. Onset of labour

21. Reasons for IOL SROM- 3 Medical reasons-3 DM- 10 Polyhydramnios-4
Postdates-9

22. Mode of delivery

23. Baby weight

24. Neonatal outcomes 42 had no problems identified
6 had some problems – incidental abnormality, nothing to account for polyhydramnios

25. Summary
Out of 48 cases, 6 were diagnosed to have pre existing diabetes, 6 new cases were diagnosed- 25% cases had identifiable cause
75% cases had idiopathic cause for polyhydramnios
No obvious fetal abnormality to account for polyhydramnios
None of the cases were positive for TORCH or Parvovirus IgM antibody
IOL in 4 cases due to polyhydramnios – none of them had cord prolapse or complications seen with polyhydramnios.
Concern regarding the diagnostic criteria – Are we over diagnosing polyhydramnios?

26. Suggestions/Recommendations
Formulation of departmental guideline on specific ultrasonographic diagnostic criteria for diagnosis of polyhyramnios
What tests should be offered?
Is there a role for TORCH+Parvo?
Is there a role of GTT?
IOL individualised and to be discussed with senior staff if being done for polyhydramnios

27. Limitation of the study
Looked into small number of cases
Non availability of national guidelines/standards

28. Acknowledgement
Audit department at Wrexham Maelor Hospital post graduate center
Radiology department at Wrexham Maelor Hospital

29. Thank You