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Perinatal Outcomes of Idiopathic Polyhydramnios with Normal http:// ijp.mums.ac.ir Systematic Review (Pages: 9349-9362) Perinatal Outcomes of Idiopathic Polyhydramnios with Normal Ultrasound: A Systematic Review and Meta-Analysis Samiyeh Kazemi1, Farin Soleimani2, Sara Kazemi3, Anoshirvan Kazemnejad4, Zahra Kiani1, 5 1 *Farzaneh Pazandeh , Nasrin Azimi 1PhD Student of Reproductive Health, Student Research Committee, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2Associate Professor/MD, Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran. 3MSc Student of Health Education, Department of Health Education & Health Promotion, Faculty of Medical Science, Tarbiat Modares University (TMU),Tehran, Iran. 4Professor of Biostatistics, Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran. 5Assistant Professor, Midwifery and Reproductive Health Research Center, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Abstract Background: Incidence of polyhydramnios in various studies has been reported from 0.2 to 3.9%. Approximately, 50-60% of cases are idiopathic with no known etiology. We aimed to investigate perinatal outcomes of idiopathic polyhydramnios with a normal ultrasound. Materials and Methods: In this study, Persian and English databases including Barakatkns, SID, Magiran, Medline, Science Direct, Scopus, Cochran, Embase, and ProQuest were searched for articles published from 1950 to August 2018. The search procedure was conducted with keywords related to "idiopathic polyhydramnios", "perinatal outcomes", "normal ultrasound", and their equivalents in "Mesh" and PICO. In meta-analysis, first we quantified heterogeneity by using I2 statistics and tested using the Cochran’s Q test. Even when a low heterogeneity was detected, a fixed-effects model was applied, and for more than 75% of heterogeneity, random-effects model was used. The Forest Plot chart was drawn up and the relative risk (RR) estimate for each study (ES), the pooled estimate of "RR" by combining all the studies and its 95% CI, and the P-value associated with it, were indicated. Results: In this study, 13 articles involving 325,426 pregnant women were included for the Meta- analysis. The RR and 95% CI of Caesarian Section (C.S), 1.61(1.25-2.07), macrosomia, 1.84(1.40- 2.42), preterm delivery, 2.45(1.29-4.64), NICU admission, 2.90(1.77-4.74), Apgar score min 5 <7, 2.79(1.18-6.57), fetal distress, 1.69(1.02-2.80), and large for gestational age (LGA), 2.27(1.38-3.72), were determined. We found a higher RR of perinatal outcomes including NICU admission, Apgar score min 5<7, preterm delivery, and LGA. RR other perinatal outcomes such as macrosomia, fetal distress, and C.S. were lower. Conclusion: Idiopathic Polyhydramnios was significantly associated with adverse perinatal outcomes. Intensive intrapartum monitoring and further attention in the postpartum are warranted. Key Words: Idiopathic-polyhydramnios, Meta-analysis, Normal ultrasound, Perinatal outcome. *Please cite this article as: Kazemi S, Soleimani F, Kazemi S, Kazemnejad A, Kiani Z, Pazandeh F, et al. Perinatal Outcomes of Idiopathic-Polyhydramnios with Normal Ultrasound: A Systematic Review and Meta- Analysis. Int J Pediatr 2019; 7(5): 9349-62. DOI: 10.22038/ijp.2018.36148.3155 *Corresponding Author: Farzaneh Pazandeh, Assistant Professor, Midwifery and Reproductive Health Research Center, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Email: [email protected] Received date: Jun.26, 2018; Accepted date: Jan 22, 2019 Int J Pediatr, Vol.7, N.5, Serial No.65, May. 2019 9349 Perinatal Outcomes of Idiopathic Polyhydramnios with Normal Ultrasound 1- INTRODUCTION hydramnios without ultrasonographically identifiable fetal anomalies or placental Polyhydramnios is present in tumors, the absence of preexisting or approximately 2% of pregnancies. The overall incidence of polyhydramnios gestational diabetes, no fetal infections, no evidence of fetal/maternal hemorrhage or irrespective of etiology ranges in various isoimmunization, and no fetal studies from 0.2 to 3.9% (1, 2). Approximately, 50-60% of cases are chromosomal abnormalities (5-7). Idiopathic polyhydramnios is a matter of idiopathic with no known etiology (3). The debate in obstetric practice, as perinatal amniotic fluid index (AFI) technique defines hydramnios as an amniotic fluid outcomes idiopathic polyhydramnios is conflicting in literature. The aim of this index (AFI) of ≥ 24 cm or ≥ 25 cm, which systematic review and meta-analysis was respectively is ≥ 95, and ≥ 97.5% in normal singleton pregnancies. Also, the to investigate the perinatal outcomes of idiopathic polyhydramnios and to evaluate single deepest pocket (SDP) is ≥ 8; or the whether it is associated with adverse examiner’s subjective assessment of having an increased amount of amniotic events. fluid volume (1). Idiopathic- 2- MATERIALS AND METHODS polyhydramnios is defined as disorders that are not associated with factors such as This systematic review and Meta- maternal diabetes, isoimmunization, fetal Analyses was performed according to the infection (Cytomegalovirus [CMV], or Preferred Reporting Items for Systematic toxoplasmosis), placental tumors, multiple Reviews (PRISMA) checklist (14). gestations, or fetus related anomalies in singleton pregnancies (e.g., central 2-1. Inclusion and Exclusion Criteria nervous system or gastrointestinal 2-1-1.Types of participants anomalies, aneuploidy, other structural This systematic review considered studies anomalies, and hydrops) that can result in that focused on women with singleton polyhydramnios (1, 4-7). pregnancy, women with idiopathic Polyhydramnios has previously been polyhydramnios and normal sonography in associated with an increased risk of a hospital, or as part of the team of number of perinatal morbidity and participants in the interventions in a mortality, such as preterm birth, simulated hospital environment. aneuploidy, cesarean section, fetal 2-1-2. Types of interventions anomalies, and perinatal and postnatal mortality (4-12). Pregnancy complicated We focused primarily on perinatal, and by polyhydramnios can present diagnostic childbirth outcomes in singleton pregnancy and therapeutic dilemmas for obstetricians. women. So we evaluated the effect of Many clinicians have viewed idiopathic hydramnios on perinatal polyhydramnios as a prognostic factor of outcome in uncomplicated pregnancies increased risk of pregnancy complications between 37 weeks, 0 days and 41 weeks, and have recommended an extensive 6 days of gestation. evaluation of these pregnancies (9, 10, 13). 2-1-3. Types of studies In contrast to earlier reports, the correlation of idiopathic hydramnios with This systematic review considered adverse perinatal and childbirth outcomes observational studies designs including has been less consistent in more recent cross-sectional, studies, descriptive investigations. In the present review, studies, before and after studies, idiopathic hydramnios is defined as prospective and retrospective cohort Int J Pediatr, Vol.7, N.5, Serial No.65, May. 2019 9350 Kazemi et al. studies, and case-control studies, related to using key words and index terms, a the perinatal outcome for inclusion. systematic search was taken through ‘OR’ and ‘AND’, including those shown in 2-1-4. Types of outcomes (Table.1), ‘PICO Key words’ below and This systematic review considered studies Search keywords in PubMed database that included the following outcomes: (1) (Box.1). Databases including Barakatkns, perinatal outcomes, (2) neonatal outcomes, SID, Magiran, Medline (via PubMed), (3) peripartum outcomes. Science Direct, Scopus, Cochran, Embase, ProQuest, and also Google Scholar were 2-2. Search Strategy searched for the relevant articles. The first step was to use the words Observational studies (cross-sectional, contained in the review title to do a case-control, descriptive, cohort studies) in scoping of the titles and abstracts in the the English and Persian language from related literature in different electronic 1950 to the end of August 2018 were databases. The relevant key words included for this research. Clinical trials, according to population, intervention, letters to the editor, review studies, and comparison, outcome (PICO) were then studies in other languages were excluded identified from the medical subject from the study. headings (Mesh) function in PubMed. By Table-1: PICO key words (P=population, I=intervention, C=context, O=outcome) P I C O Singleton pregnancy Effect of idiopathic hydramnios on Perinatal outcomes Pregnancy women perinatal outcome. Women with idiopathic Childbirth Neonatal outcomes polyhydramnios Peripartum outcomes Box -1. Search keywords in PubMed database. A full electronic search strategy for PubMed was applied using: Idiopathic- polyhydramnios [tiab] OR Polyhydramnios [tiab] OR Hydramnios [tiab] OR Hydramnios idiopathic [tiab] AND Pregnancy [tiab] OR Childbirth outcome [tiab] OR Birth outcome [tiab] OR Perinatal outcome [tiab]. relevant keywords. In the third stage 2-3. Study Selection articles, information, and statistical After an initial review of retrieved articles analyses were extracted. Disagreement and removing duplicate and irrelevant among the researchers was resolved by ones,
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