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Perinatal outcome in pregnancy with polyhydramnios in comparison with

normal pregnancy in department of obstetrics at Shiraz University of Medical
Sciences

Article  in  Journal of Maternal-Fetal and Neonatal Medicine · May 2017

DOI: 10.1080/14767058.2017.1325864

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 The Journal of Maternal-Fetal & Neonatal Medicine

ISSN: 1476-7058 (Print) 1476-4954 (Online) Journal homepage: http://www.tandfonline.com/loi/ijmf20

Perinatal outcome in pregnancy with

polyhydramnios in comparison with normal
pregnancy in department of obstetrics at Shiraz
University of Medical Sciences

Nasrin Asadi, Azadeh Khalili, Zahra Zarei, Arsalan Azimi, Maryam Kasraeian,
Leila Foroughinia, Alireza Salehi, Hamid Reza Ravanbod, Sarah Davoodi &
Homeira Vafaei

To cite this article: Nasrin Asadi, Azadeh Khalili, Zahra Zarei, Arsalan Azimi, Maryam Kasraeian,
Leila Foroughinia, Alireza Salehi, Hamid Reza Ravanbod, Sarah Davoodi & Homeira Vafaei (2017):
Perinatal outcome in pregnancy with polyhydramnios in comparison with normal pregnancy in
department of obstetrics at Shiraz University of Medical Sciences, The Journal of Maternal-Fetal &
Neonatal Medicine, DOI: 10.1080/14767058.2017.1325864

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THE JOURNAL OF MATERNAL-FETAL & NEONATAL MEDICINE, 2017
https://doi.org/10.1080/14767058.2017.1325864

ORIGINAL ARTICLE

Perinatal outcome in pregnancy with polyhydramnios in comparison with

normal pregnancy in department of obstetrics at Shiraz University of
Medical Sciences
Nasrin Asadia, Azadeh Khalilib, Zahra Zareic, Arsalan Azimic, Maryam Kasraeiana
, Leila Foroughiniaa†,
Alireza Salehid, Hamid Reza Ravanbodc‡, Sarah Davoodib and Homeira Vafaeia
a
Department of Obstetrics & Gynecology, Maternal-fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran;
b
Department of Obstetrics & Gynecology, Shiraz University of Medical Sciences, Shiraz, Iran; cShiraz University of Medical Sciences,
Shiraz, Iran; dResearch Center for Traditional Medicine and History of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran

ABSTRACT ARTICLE HISTORY

Objective: Polyhydramnios can lead to maternal and fetal complication during pregnancy, so Received 27 November 2016
diagnosis and management can decrease some perinatal complications. Revised 25 April 2017
Study design: One hundred and fourteen singleton pregnancies were diagnosed with idiopathic Accepted 28 April 2017
polyhydramnios in the department of obstetrics at Shiraz University of Medical Sciences between
January 2000 and January 2011 and were compared with 114 normal pregnancies for their peri- KEYWORDS
natal outcome. Variables include birth weight, admission to neonatal intensive care unit (NICU), Amniotic fluid index;
meconium staining, respiratory distress, fetal death, neonatal death, low 1-min and 5-min APGAR idiopathic polyhydramnios;
score, primary cesarean section (C/S), preterm delivery (<37 weeks), postpartum bleeding, and perinatal outcome
placental abruption.
Results: Low birth weight (<2500 g), macrosoma (>4000 g), NICU admission, fetal distress, fetal
death, lower 1-min and 5-min APGAR score, preterm delivery, and neonatal death were higher in
the case group. However, meconium staining and malpresentation were equal between the two
groups. Except for prematurity and 1-min and 5-min APGAR scores, there were no significant dif-
ferences in other maternal or fetal outcomes considering the severity of polyhydramnios.
Conclusion: Idiopathic polyhydramnios should be considered as a high-risk pregnancy that war-
rants close surveillance. More studies should be done to detect the best time and interval of
fetal surveillance in these patients. Chromosomal and torch studies can determine the definite
cause of polyhydramnios.

Introduction prematurity of neonates, increased rate of cesarean

Polyhydramnios in term means excessive amniotic fluid
volume. In definition, it is a condition where amniotic
fluid volume is equal to or more than 2000 ml, which is
usually detected in the third trimester [1]. Using ultra-
sound, polyhydramnios is defined as amniotic fluid
index (AFI) above 95th percentile for the gestational
age. It has three subtypes: mild (AFI 25–30 cm), moder-
ate (AFI 30.1–35 cm) and severe (AFI >35 cm) [2].
The prevalence of polyhydramnios is 0.2% to 1.6%.
There is reported increase rate of both maternal and
perinatal morbidities due to polyhydramnios. Common
complications in polyhydramnios include pregnancy-
induced hypertension (PIH), maternal respiratory
difficulties, increased risk of preterm labor and
section (C/S), and a high prevalence of fetal mortality
and morbidity [1].
The risk factors for polyhydramnios include diverse
maternal and fetal conditions, such as gestational dia-
betes mellitus, placental abnormalities, isoimmuniza-
tion, multiple gestation, congenital anomalies, and
chromosomal aberrations. The diagnosis of “idiopathic
polyhydramnios” is made when there is absence of
any risk factors [3]. Between all the pregnancies com-
plicated by polyhydramnios, almost 2/3 of cases are in
this category [4].
There is controversy in literature regarding the associ-
ation between idiopathic polyhydramnios and perinatal
outcome. There are some studies cited that idiopathic
polyhydramnios plays a role in perinatal outcome.

CONTACT Maryam Kasraeian Maryamkasraeian@gmail.com Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences,
Shiraz, Iran

Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
†Box Hill Hospital, Victoria, Australia
‡CSU PHD in Doctor of Health Science, MD Australia
ß 2017 Informa UK Limited, trading as Taylor & Francis Group
2 N. ASADI ET AL.

Although there are many conflicting reports, still there
is no guideline how to approach these patients during
pregnancy.
The purpose of this study is to provide a better
view on the possible association between idiopathic
polyhydramnios and adverse perinatal outcomes. The
outcome of pregnancies was compared according to
the severity of polyhydramnios as well.
Materials and methods
A cross-sectional retrospective comparative study that
includes all the women who were admitted with idio-
pathic polyhydramnios to two referral hospitals (Hazrat
Zainab and Hafez) in the period between January 2000
and January 2011 was compared to others with
uncomplicated pregnancy. The study protocol and
research ethics were approved by the Institutional
Review Board (IRB) of the Shiraz University of Medical
Sciences and related Ethics Committee before initiat-
ing the study.
The data were collected from patient’s record so
informed consent was not taken. However, the
patients’ information and individual characteristics
were not disclosed.
Idiopathic polyhydramnios was defined as an
amniotic fluid index (AFI) more than 24 cm without
any defined cause. The exclusion criteria included
any history of gestational diabetes mellitus, abnormal
placentation, isoimmunization, multiple gestation,
chromosomal aberrations, and any fetal anomalies
after birth.
Accordingly, 114 cases of idiopathic polyhydramnios
were considered as the case group and 114 normal
pregnancies were the control. In control group, the
women with normal amniotic fluid who delivered at
the same period were enrolled in the study as simple
random sampling. The numbers of patients included in
both groups were equal in each year. These two
groups were compared considering some fetal and
maternal variables including postpartum hemorrhage,
placental abruption, birth weight, NICU admission,
meconium staining, respiratory distress, fetal death,
neonatal death, low 1-min and 5-min APGAR score,
primary cesarean section (C/S), and preterm delivery.
The formula used to detect the sample size was
N ¼ 2(a/2)p(1-p)d
With a ¼ 0.05 and b ¼ 0.20.
Statistical methods
All data analyses were conducted using Statistical
Package for the Social Sciences version 19 (SPSS Inc.,
Chicago, IL), and the descriptive variables included
mean and standard deviations. Independent sample
t-test for quantitative variables and chi-square for
qualitative variables were used. Also analysis of covari-
ance (ANCOVA) was performed for detection of inde-
pendent effect. A two-tailed p-value less than .05 was
considered as the level of statistical significance.
Results
Common indication for primary cesarean section in
this group was fetal distress (34%, 15 out of 44) and
common cause of primary cesarean section in control
group was the presence of meconium (50%, 5 out of
10). There was no difference in baseline clinical charac-
teristics between idiopathic polyhydramnios group
and the control group (Table 1).
The mean of gestational age at time of delivery was
lower in the case group compared to the control
groups (p-value ¼ .001). The chances of abruption and
primary cesarean section were higher in polyhydram-
nios group (p-value ¼ .029, 95% CI: 1.79–2.35)
(Table 2). The total number of C/S in case group was
85 (74.56%), 44 of them (51.8%) were primary C/S and
41 (48.2%) were secondary.
Indication for primary C/S including breech 6
(13.7%), abruption 6 (13.7%), non-reactive NST (no
beat-to-beat variability) and OCT positive 15 (34.0%),
active phase arrest 5 (11.4%), cord prolapse 2 (4.5%),

Table 1. Demographic data of idiopathic polyhydramnios group and control group.

Variable Polyhydramnios N (114) Normal group N (114) p-Value OR (95%CI)
Age (Mean ± SD) 28.37 ± 6.63 26.81 ± 5.61 .056 —
Gravid (Mean; median) 2.54; 2 2.29; 2 .157 —
Live (Mean; median) 1.08; 1 1.26; 1 .705 —
Abort (Mean; median) 0.27; 0 0.21; 0 .301 —
Death (Mean; median) 0.21; 0 0.09; 0 .807 —
G.A (Mean ± SD) 36.12 ± 3.36 38.64 ± 1.05 .001 —
GA categorical Number (percent)
GA <36 58 (49.1%) 3 (2.6%) .001 35.72 (10.79–119.10)
GA >37 58 (50.9%) 111 (97.4%)
Sex Number (percent)
Male 60 (52.6%) 69 (60.5%) .229 0.725 (0.43–1.23)
Female 54 (47.4%) 45 (39.5%)
 THE JOURNAL OF MATERNAL-FETAL & NEONATAL MEDICINE 3

Table 2: Comparison of outcome of pregnancy between polyhydramnios group and control group.
Variablea Polyhydramnios group Number (Percent) Control group Number (Percent) p-Value CI
Malpresentation
Yes 6 (5.3%) 2 (1.8%) .28 3.11 (95% CI: 0.62–15.75)
No 108 (94.7%) 112 (98.2%)
Primary section
Yes 44 (38.6%) 10 (8.8%) .001 6.54 (95% CI: 3.09–13.85)
No 70 (61.4%) 104 (91.2%)
Birth weight (categorical)
LBW (<2500g) 40 (35.1%) 4 (3.5%) .001 —
NL (2500–4000g) 67 (58.8%) 108 (94.7%)
Macrosomia (>4000g) 7 (6.1%) 2 (1.8%)
Neonatal ICU care unit
Yes 44 (38.6%) 6 (5.3%) .001 11.32 (95% CI: 4.58–27.95)
No 70(61.4%) 108 (94.7%)
Meconium staining
Yes 10 (8.8%) 8 (7%) .807 1.27 (95% CI: 0.48–3.35)
No 104 (91.2%) 106 (93%)
Respiratory distress
Yes 37 (32.5%) 1 (0.9%) .001 54.3 (95% CI: 7.3–404.2)
No 77 (67.5%) 113 (99.1%)
Fetal death
Yes 7 (6.1%) 0(0%) .014 2.06 (95% CI: 1.8–2.4)
No 107 (93.9%) 114 (100%)
Neonatal death
Yes 24 (21.1%) 0 (0%) .001 2.27 (95% CI: 1.94–2.65)
No 90 (78.9%) 114 (100%)
Postpartum hemorrhage
Yes 4 (3.5%) 0 (0%) .122 2.04 (95% CI: 1.78–2.33)
No 110 (96.5%) 114 (100%)
Placental Abruption
Yes 6 (5.3%) 0 (0%) .029 2.06 (95% CI: 1.79–2.35)
No 108 (94.7%) 114 (100%)
APGAR 1(Mean ± SD) 6.6 ± (2.8) 8.7 ± (0.74) .001
APGAR 1 (categories)
<7 41 (36%) 5 (4.4%) .001 12.4 (95% CI: 4.6–32.4)
7–10 73 (64%) 109 (95.6%)
APGAR 5 (Mean ± SD) 7.7 ± (3.1) 9.8 ± (0.52) .001 —
APGAR 5 (categories)
<7 24 (21.1%) 0 (0%) .001 2.27 (95% CI: 1.94–2.65)
7–10 90 (78.9%) 114 (100%)
AFI (categories)
Mild (24–30) 96 (84.2%) — — —
Moderate (31–35) 5 (4.4%) —
Severe (36<) 13 (11.4%) —
Birth weight (Mean ± SD) 3130.96 (±3930.1) 3195.35 (±411.4) .862

meconium 4 (9%), CPD 1 (2.3%) and placenta previa
1 (2.3%), and failed induction 4 (9%).
Comparison of pregnancy outcome between the
two groups is represented in Table 2. Low birth weight
(<2500 g), macrosomia (>4000 g), NICU admission,
fetal distress, fetal death, lower 1-min and 5-min
APGAR score, preterm delivery, and neonatal death
were higher in the case group (p < .05). However,
meconium staining and malpresentation were equal in
the two groups (p > .05).
The average and standard deviation of AFI were
27.26 ± 5.3 cm in the case group. Between these cases,
84.2% (96 cases) were categorized as mild polyhy-
dramnios, 4.4% (5 cases) as moderate polyhydramnios,
and 11.4% (13 cases) as severe polyhydramnios. With
regard to outcome of pregnancy according to the
severity of polyhydramnios, 36.46% of the fetuses with
mild polyhydramnios, 40.00% of the moderate, and
23.07% of the severe group had a low birth weight.
The average of birth weight was 2903.59 g (±942.00) in
mild group, 2360.00 g (±383.10) in moderate group,
and 2091.54 g (±724.38) in severe group (p ¼ .007).
Analysis of covariance was done for detection of inde-
pendent effect of birth weight when GA is in the
model. After adjustment for GA, BW was not statistic-
ally significant for this group (p ¼ .196).
There were no significant statistical differences in
fetal and maternal adverse outcomes including LBW,
macrosomia, NICU admission, meconium staining, fetal
distress, fetal death, neonatal death, postpartum hem-
orrhage, abruption, primary cesarean section, and mal-
presentation between mild, moderate, and severe
polyhydramnios. These results are shown in Figure 1.
The prevalence of first-minute APGAR score of
lesser than 7 was 31.25% in mild group, 60% in mod-
erate group, and 61.5% in severe group with a
4 N. ASADI ET AL.
Figure 1. Maternal and perinatal adverse outcomes between mild, moderate and severe polyhydramnios.
p-value ¼.024. Regarding APGAR score in 5 min,
15.62% of neonates of mild group, 60% of moderate
group, and 46.154% of severe group had value less
than 7 with a p-value ¼ .005.
Premature birth was 42.7% in mild, 100% in moder-
ate, and 76% in severe group with a p-value ¼ .006. The
rate of both first- and five-minute APGAR score of less
than 7 in premature birth were statistically significant in
moderate and severe group with p values < .05.
After adjustment for prematurity, primary C/S
(p-value ¼ .000), low birth weight (p-values ¼ .000),
macrosomia (p-values ¼ .000), NICU admission (p-values
¼ .000), respiratory distress (p-values ¼ .000), neonatal
death (p-values ¼ .005), and low 1-min (p-values ¼ .031)
and 5-min (p-values ¼ .005) APGAR score were signifi-
cant in term idiopathic polyhydramnios compared
with control group.
Due to lack of fetal death evaluation, we evaluated
neonatal records. The final causes of neonatal death
were not detected but 83.4% of them (20 out of 24)
were 36 weeks, so prematurity, low APGAR, RDS, and
IUGR were the main causes.
Mean 1-min APGAR was 3.65 ± 1.75 (minimum ¼ 1
and maximum ¼ 7) and 5-min APGAR was 4.65 ± 2.80
(minimum ¼ 0 and maximum ¼ 8) in gestational age
36 weeks in neonatal death.
Four out of 24 of neonatal death (16.6%) were-
37 weeks. One of them was born with low APGAR
and IUGR, and another one was born with low APGAR
and meconium. Two of them were born with low
APGAR and respiratory distress.
Mean 1-min APGAR was 3.75 ± 2.06 (minimum ¼ 2
and maximum ¼ 6) and 5-min APGAR was 5.25 ± 2.22
(minimum ¼ 3 and maximum ¼ 8) in gestational age
37 weeks in neonatal death.
In addition, there was no statistical difference
between the term idiopathic polyhydramnios and con-
trol group for dead fetuses (p-values ¼ .343).
Discussion
During the last trimester, the fetus urinates around
30% of its body weight and swallows around 20 to
25% of amniotic fluid each day. The lung also secretes
about 10% to amniotic fluid. Any minor inconsistency
through the production and swallowing process may
lead to polyhydramnios [3].
The exact etiology of idiopathic polyhydramnios has
not been clearly identified. However, studies have
revealed that concentration of a number of
compounds (i.e. aldosterone, hCG, prolactin, HPL, b2-
microglobulin) is increased in both maternal serum
and amniotic fluid of hydramnic patients [5]. In a study
which was performed by Zhu et al., they reported an
increase in aquaporin 8 and aquaporin 9 expressions
in the fetal membrane of these cases [6].
Polyhydramnios is categorized into three groups:
mild, moderate and severe. The more severe the poly-
hydramnios, the more likely to identify the etiology of
the disease. Pri-Paz et al. reported that higher AFI was
found to be associated with a higher rate of prenatally
detected congenital anomalies [2].

In our study, among 114 patients with idiopathic
polyhydramnios, 84.2% were categorized as mild, 4.4%
as moderate, and 11.4% as severe polyhydramnios.
The outcome of pregnancies was compared according
to the severity of polyhydramnios. Except for 1-min
and 5-min APGAR score and prematurity, there were
no significant differences in any maternal or fetal out-
comes between these three groups .The incidence of
low 1-min and 5-min APGAR score was less in mild
group compared to moderate and severe groups.
Indeed, the sample size of moderate and severe was
low in comparison with mild hydramnios (18 versus
96).
In the large cohort study of 253 women with idio-
pathic polyhydramnios, Pri-Paz et al. showed that
moderate-to-severe degree of polyhydramnios
(AFI ¼30 cm) was not associated with a risk of adverse
pregnancy outcome when compared to pregnancies
with mild polyhydramnios (AFI <30 cm) [2].
Adverse perinatal outcomes were compared
between idiopathic polyhydramnios and control group.
The chance of prematurity in case group was 18 times
more than for control group, which is similar to a
recent study by Pri-Paz et al. and Taskin et al. [2,7].
Although this reveals a strong association between
hydramnios and premature birth that accompanied
with many adverse outcomes, idiopathic polyhydram-
nios per se is an important factor for many adverse
fetal outcomes.
After adjustment for premature birth, the results
showed that polyhydramnios is an independent risk
factor for some adverse maternal and fetal outcomes,
including primary C/S, low birth weight, macrosomia,
NICU admission, respiratory distress, neonatal death,
and low 1-min and 5-min APGAR score. Our assess-
ment showed that there are significant correlations
between hydramnios at term and all these outcomes.
These results indicate that the adverse outcomes are
not due to prematurity alone. This was confirmed by
the study of Maymon et al. about peripartum compli-
cations in isolated gestational hydramnios [5].
Prematurity and polyhydramnios are both consid-
ered as etiology for placental abruption; however, in
this study, abruption was only seen in the women
with hydramnios who develop preterm delivery, but
not in term group of hydramnios. Therefore, prematur-
ity may be considered as an important factor for the
development of abruption [5]. In this study, abruption
is not correlated with amniotomy because all of them
came with vaginal bleeding before amniotomy.
Post-partum hemorrhage was seen in 3.5% of case
group and none of them control group. Identification
of patients with PPH risk factors is not useful clinically
THE JOURNAL OF MATERNAL-FETAL & NEONATAL MEDICINE 5
because a small proportion of them develop hemor-
rhage and most of patients which experienced bleed-
ing did not have any risk factors. So there is not any
measure to prevent PPH in these patients; however,
polyhydramnios is one of the main PPH risk factors [8].
Primary cesarean section was another variable
which was evaluated in this study. In idiopathic poly-
hydramnios, C/S was 4.4 times more prevalent com-
pared with the control group. This finding is
consistent with previous studies about increased rates
of primary C/S in pregnancies with idiopathic polyhy-
dramnios; [3,5,9,10] however, other studies did not
report this association [7,11].
One- and five-minute APGAR score of lesser than 7
were 8.1 and 21.1 times more in case group compared
with control group, respectively. This indicates a correl-
ation between idiopathic polyhydramnios and low
APGAR score of first and fifth minute. This result was
similar to other studies for first-minute low APGAR
score, but is in contrast with them for the fifth-minute
APGAR score [3,5,9,12,13].
Respiratory distress was seen 37-fold more preva-
lent in idiopathic polyhydramnios compared with con-
trol groups and showed significant correlation
between respiratory distress and idiopathic polyhy-
dramnios which was similar with two previous studies
[5,9].
The rate of NICU admission was seen 7.3-fold in
hydramnios group compared with control group. This
result was in contrast with conclusions by Panting
et al.; however, they are similar to the findings of
Chen et al. [3,9].
The rate of neonatal low birth weight in this study
was 10-fold more in hydramnios group, which was in
contrast with what Panting et al. had found [3], but
was similar to the findings of other studies [9,12].
Indeed, prematurity is an important cause of LBW, but
another pathology is described in case of polyhydram-
nios. A possible explanation is that increased amniotic
fluid pressure not only impairs placental circulation
but also inversely affects the serum PH and PaO2 of
the fetus [14,15].
Most previous studies have found an increased rate
of macrosomia in pregnancies with idiopathic polyhy-
dramnios [3,5,9,11,13]; however, this was not found in
the study by Taskin et al. [9]. Our study revealed a cor-
relation between idiopathic polyhydramnios and large
for gestational age despite of exclusion of those hav-
ing gestational diabetes, using GCT and OGTT. The
exact etiology of this association is not well known;
however, mild degrees of glucose intolerance might
be the cause of excessive fetal growth in this popula-
tion. Further investigations are needed to display any
6 N. ASADI ET AL.
relation between degree of glucose intolerance and
fetal birth weight in these patients. In this study, we
found that the rate of LBW associated with idiopathic
polyhydramnios was higher than LGA (10 versus 3.3
times, respectively).
The rate of fetal death was 6-fold in the case group,
with increased rate of antepartum deaths which is
same finding in other studies [5,9]. The rate of neo-
natal death in case group was 21-fold more than the
control group. This result shows an increased risk of
neonatal mortality and morbidity in pregnancies with
idiopathic polyhydramnios. In comparison with previ-
ous studies, we have had a higher mortality rate than
what was found by Panting et al., but in accordance
with the findings of Chen et al. or Maymon et al.
[3,5,9].
According to this study, idiopathic polyhydramnios
has an increased risk of preterm delivery, low birth
weight, macrosomia, lower 1-min and 5-min APGAR
score, abruption, admission to NICU, fetal respiratory
distress, primary C/S, and antepartum death. Therefore,
patients with polyhydramnios should be observed and
followed carefully.
There are some limitations for this study which are
as follows: retrospective nature of which entails a pro-
spective study to confirm the results. Second, the fol-
low-up of neonates up to childhood was not
performed because of absence of their phone number
or address and it may obscure some of the upcoming
consequences. For example, Dorleijn et al. reported
that in 28.4% of neonates with idiopathic polyhydram-
nios, abnormalities were detected during the first year
of life which emphasize an importance of follow-up
for these neonates [10]. Third, as the current study has
been made in a referral center so we did not know
accurate onset of polyhydramnios and we collected all
cases during 11 years, thus only 18 out of 114 cases
had moderate and severe polyhydramnios.
The fourth factor is that in this review measurement
of AFI was performed by different examiners, which
increases the bias. Finally, we could not perform any
interventional procedure for patients with severe poly-
hydramnios because they refer to our hospital when
they were complicated and interventional procedure
was not possible. The sample size in this study was
quite large in comparison with previous studies and
the study power of 0.9 is adequate.
In this study, we concluded that idiopathic poly-
hydramnios should be considered as an important
finding, which can lead to maternal and perinatal mor-
tality and morbidity. Therefore, in spite of some other
studies [3,11], we believe that these mothers need
more frequent antenatal care and fetal surveillance.
Further well-designed prospective studies are needed
to investigate such testings and to determine the opti-
mal mode of antenatal testings and timing of delivery.
Conclusions
Idiopathic polyhydramnios should be considered as a
high-risk pregnancy that warrants close surveillance.
More studies should be done to detect the best time
and interval of fetal surveillance in these patients.
Chromosomal and torch studies can determine the
definite cause of polyhydramnios.
Acknowledgements
This project is supported by Shiraz University of Medical
Sciences (SUMS) and grant code is EC-P-90–4013. This study
is based on the thesis of Zahra Zarei Dr., one of authors of
this article for receiving degree as specialist in obstetrics and
gynecology.
Disclosure statement
No potential conflict of interest was reported by the authors.
Funding
This project is supported by Shiraz University of Medical
Sciences (SUMS) and grant code is EC-P-90–4013. This study
is based on the thesis of Zahra Zarei Dr., one of authors of
this article for receiving degree as specialist in obstetrics and
gynecology.
References
[1] Cardwell MS. Polyhydramnios: a review. Obstet
Gynecol Surv. 1987;42:612–617.
[2] Pri-Paz S, Khalek N, Fuchs KM, et al. Maximal amniotic
fluid index as a prognostic factor in pregnancies com-
plicated by polyhydramnios. Ultrasound Obstet
Gynecol. 2012;39:648–653
[3] Panting-Kemp A, Nguyen T, Chang E, et al. Idiopathic
polyhydramnios and perinatal outcome. Am J Obstet
Gynecol. 1999;181:1079–1082.
[4] Hill LM, Breckle R, Thomas ML, et al. Polyhydramnios:
ultrasonically detected prevalence and neonatal out-
come. Obstet Gynecol. 1987;69:21–25.
[5] Maymon E, Ghezzi F, Shoham-Vardi I, et al. Isolated
hydramnios at term gestation and the occurrence of
peripartum complications. Eur J Obstet Gynecol
Reprod Biol. 1998;77:157–161.
[6] Zhu X, Jiang S, Hu Y, et al. The expression of aqua-
porin 8 and aquaporin 9 in fetal membranes and pla-
centa in term pregnancies complicated by idiopathic
polyhydramnios. Early Hum Dev. 2010;86:657–663.
[7] Taskin S, Pabuccu EG, Kanmaz AG, et al. Perinatal out-
comes of idiopathic polyhydramnios. Interv Med Appl
Sci. 2013;5:21–25.

[8] Giannella L, Mfuta K, Pedroni D, et al. Delays in the
delivery room of a primary maternity unit: a retro-
spective analysis of obstetric outcomes. J Matern Fetal
Neonatal Med. 2013;26:593.
[9] Chen KC, Liou JD, Hung TH, et al. Perinatal outcomes
of polyhydramnios without associated congenital fetal
anomalies after the gestational age of 20 weeks.
Chang Gung Med J. 2005;28:222–228.
[10] Dorleijn DM, Cohen-Overbeek TE, Groenendaal F,
et al. Idiopathic polyhydramnios and postnatal find-
ings. J Matern Fetal Neonatal Med. 2009;22:315–320.
[11] Smith CV, Plambeck RD, Rayburn WF, et al. Relation of
mild idiopathic polyhydramnios to perinatal outcome.
Obstet Gynecol. 1992;79:387–389.
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[12] Mathew M, Saquib S, Rizvi SG. Polyhydramnios. Risk
factors and outcome. Saudi Med J. 2008;29:256–260.
[13] Mazor M, Ghezzi F, Maymon E, et al.
Polyhydramnios is an independent risk factor for
perinatal mortality and intrapartum morbidity in
preterm delivery. Eur J Obstet Gynecol Reprod Biol.
1996;70:41–47.
[14] Fisk NM, Vaughan J, Talbert D. Impaired fetal blood
gas status in polyhydramnios and its relation to
raised amniotic pressure. Fetal Diagn Ther. 1994;9:
7–13.
[15] Fisk NM, Tannirandorn Y, Nicolini U, et al. Amniotic
pressure in disorders of amniotic fluid volume. Obstet
Gynecol. 1990;76:210–214.