Polyhydramnios in term gestation: An independent risk factor for perinatal death

OBJECTIVE: The excessive perinatal morbidity and mortality observed in patients with polyhydramnios has been attributed 10 its association with congenit.il anomalies and preterm birth. The purpose of this study was to determine if polyhydramnios is an independenl risk factor for poor pregnancy outcome after adjusting for the effect of congenital anomalies in term gestation. STUDY DESIGN: The study population consisted of 60,702 patients with singleton gestation who delivered at term (>37 weeks). Patients were classified into two groups according to the presence (11 = 1,211) or absence of polyhydramnios (n = 5'.).491). Polyhydramnios was diagnosed b\ using any of the following criteria: an arnniotic fluid index >25 cm, a maximum vertical pocket >8 cm or bv subjective assessment. Statistical analysis was conducted with univariate techniques and multiple logistic regression to adjust for confounding variables. RESULTS: The prevalence of poKhvdramnios was 2%. Patient,-, with polyhydramnios had a higher incidence of complications than patients with normal amniotic fluid: cesarean section ( 11.9% vs 8.4%; p < 0.01 ). antepart im death {0.6% vs. 0.2%, p < 0.05), postpartum death (2.S% vs. 0.4%, p < 0.01), abruption (0.9% vs. 0.3%, p < 0.01). fetal distress (6.1% vs. 3.6%. p < 0.01), mcconium-stained amniotic fluid (17.8% vs. lf>%. p < 0.01), low apgar score at 5 minutes (2.9% vs. 1%, p < 0.01), malpresentation (6> vs. 2.9%, p < 0.01), chorioamnionitis (0.3% vs. 0.1, p < 0.05), prolapse of cord (2.2% vs. 0.3%, p < 0.01), LGA (23.8% vs. 8.1 %, p < 0.01). When adjusted for risk factors for perinatal mortality and intrapartum morbidity (i.e , congenital anomalies, previous perinatal death, I.BW, PIU. diabetes, malpresentation). (he presence of polyhydramnios remained strongly associated with perinatal mortality. CONCLUSION: 1 ) Polyhydramnios at term is an independent risk factor for perinatal death; 2) fetal surveillance is warranted in patients with polyhydramnios even in the absence of other known risk factors for adveise pregnancy outcome.