BACKGROUND AND PURPOSE:

• Pagan et al. (Ultrasound in Obstetrics & Gynecology, 2022) analyzed pregnancy outcomes in singleton pregnancies with idiopathic polyhydramnios

METHODS:

• Systematic review and meta-analysis
• Study Inclusion criteria
  • Prospective and retrospective studies
  • Presence of a control group (normal amniotic fluid volume)
  • Singleton pregnancies
  • Idiopathic polyhydramnios: Identified using sonographic amniotic fluid volume assessment
• Study design
  • Polyhydramnios definition: Four-quadrant AFI with polyhydramnios ≥24 cm or single deepest pocket (SDP) ≥8 cm | AFI >25 cm also included (commonly used definition)
  • Idiopathic polyhydramnios: No etiology identified on ultrasound
  • Effect estimates expressed as odds ratio (OR) and its corresponding 95% CI
  • Data pooled using random effects model
• Primary outcome
  • Intrauterine fetal demise
• Secondary outcomes
  • NICU admission
  • Macrosomia: ≥4000 g birthweight
  • 5 minute APGAR score <7
  • Neonatal death
  • Low birthweight
  • Malpresentation
  • Cesarean delivery

RESULTS:

• 12 studies
  • Idiopathic polyhydramnios patients: 2392 | Controls: 160,135
• Pregnancies complicated by idiopathic polyhydramnios had higher odds of
  • Neonatal death: OR 8.68 (95% CI, 2.91 to 25.87)
  • Intrauterine fetal demise: OR 7.64 (95% CI, 2.50 to 23.38)
  • NICU admission: OR 1.94 (95% CI, 1.45 to 2.59)
  • 5-minute APGAR score <7: OR 2.21 (95% CI, 1.34 to 3.62)
  • Macrosomia: OR 2.93 (95% CI, 2.39 to 3.59)
  • Malpresentation: OR 2.73 (95% CI, 2.06 to 3.61)
  • Cesarean delivery: OR 2.31 (95% CI, 1.79 to 2.99)

CONCLUSION:

• Pregnancies with idiopathic polyhydramnios are associated with increased odds of adverse pregnancy outcomes, particularly neonatal death and intrauterine fetal demise
• Antenatal fetal surveillance may be a consideration for pregnancies with idiopathic polyhydramnios
• The authors state

Currently, there is insufficient data on the threshold of the AFV (mild, moderate or severe) at which antenatal testing should be initiated

Future investigations are needed to determine an AFV threshold above which antenatal testing would be helpful

Learn More – Primary Sources:

Idiopathic polyhydramnios and pregnancy outcomes: systematic review and meta-analysis

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