400 " SDO400004 University of Khartoum
Facultyof Medicine
Postgraduate Medical Studies Board
Risk Factors Outcome Associated With Polyhydramnios in Sudanese Women
By
DR. Onima IbraWm Musa Hassan
M-BBS. (University of Ukrainia)
Athesis submitted in prtial fulfillment for the requirement of
Clinical MD degree in Obstetrics & Gynaecology
October 2002
Supervisor
Prof Abdel Salarn Gerais
M.B.B.S. (Khartoum) F.R.C.O.G(UK) MD(Khartournl 11 k
QW04 Contents
Acknowledgement ...... i
English abstract ...... iii
Arabic abstract ...... v
CHAPTER ONE
Introduction &Literaturereview ...... 1
O bjectives ...... 3 1
CHAPTER TWO
Materials and Methods ...... 52
CHAPTER THREE
R e sults ...... 3 5
Figures Tables ...... 40
CHAPTER FOUR
Discussion ...... 53
Conclusion ...... 57
Recommendations ...... 59
References ...... 61
Appendix ...... 66 LIST OF TABLES
Page Table (1) Percentage distribution of patients according to past 43 History of personal risk factors. Table 2) Percentage distribution of patients according to past 43 obstetrical risk factors. Table 3) Percentage distribution of patients according to Rhesus 43 factor. Table 4) Percentage distribution of patients according to 45 different risk factors. Table (5) Percentage distribution of patients according to crrent 46 complication. Table 6) Percentage distribution of patients according to 46 different antenatal provided anagement. Table 7) Percentage distribution of patients according to 48 indications for induction of labour. Table (8) Percentage distribution of patients according to 48 indications for eergency aesarean section. Table 9) 'Percentage distribution of patients according to 48 indication for elective aesarean section. Table(I 0) Percentage distribution of status of outcome. 4 8 Table( 1 Percentage distribution of outcome according to 50 different apparent malforination. Table(] 2 Percentage distribution of newborns according to types 5 1 of special management provided. Table(] 3) Deepest p91 of Amniotic fluid volume by U\S. 52 Chi- square test. LIST OF FIGURES
Page Figure (1) Distribution of patients according to age group. 40 Figure 2) Distribution of patients according to parity. 40 Figure 3) Distribution of patients according to past obstetrical 4 history of stillbirths. Figure 4) Distribution of patients according to past obstetrical 41 history of neonatal deaths. Figure (5) Distribution of patients according to past obstetrical 42 history of abortion. Figure 6) Distribution of patients according to gestational ages 42 at diagnosis in weeks. Figure 7) Distribution of patients according to Deepest pool of 44 amniotic fluid volume by ultrasound. Figure (8) Distribution of patients according to presence of' 45 associated risk factors. Figure 9) Distribution of patients according o gestational age at 47 delivery in weeks. Figure( I 0) Distribution of patients according to mode of 47 delivery. Figure(] 1) Distribution of patients according to teir sex. 49 Figure(] 2) Distribution of outcome according to weight. 4 9 Figure(] 3 Distribution of otcome according to presence of 50 apparent malfonnation. Figure(14) Distribution of newborns according to special 5 1 management provided. Acknowledgement
No thesis is brought to fruition without the auther receiving
Considerable help and encouragement. Therefore I wish to
Acknowledge my debts to my supervisor professor Abdel Salam
Grais or his continuous help and guidence, and I wish to thank
him for his suggestions, criticism and valuable advice throughout the period of this study.
I wish to express my appreciation 'and indebtedness to
Dr. Sayda El Dirdery for her advice, support and encouragement.
Special thanks to Dr. Osman Ortashi and Dr. Abdel Raheem
Ebeid in Fetomatemal unit of Soba university hospital fr heir support and encouragement to select this topic and to proceed on
I must take this opportunity to express my appreciation and thanks to Dr. Firial Omer and Dr.Amira Mochtar for their help.
Thanks also extended to Mr. Mohamed Ibrahim, who carried out the statistical anaslysis. Also I wish to thank Miss. Amel
Ibrahim for her great appreciated effort in typing this thesis. lam very much grateful to myfriends and colleagues for their
support and help. Thank to every body whom I did not mention.
Finally, I'm very grateful to my parents, sister and brothers for their help and support during the course of the study. Abstract
Objectives:
To detect the associated risk factors, the role of ultrasound in
the antenatal diagnosis ad fetal outcome in cases of
polyhydramnios. Setting:
Soba University Hospital.
Subject
100 patients of confirmed polyhydramnios who had been
followed in the fetornaternal unit in Soba University Hospital fforn
1/4/2001 to 16/2002.
Results
Polyhydramnios increased with advanced maternal age,
(42%) of the patients were grandmultiparae. Twenty percent them had bad obstetrical history. Most of the patients 78%) were
diagnosed after the gestational age of 28 weeks.
Seventy nine percent of the patients had mild polyhydramnios, (15%) had modrate polyhydramnios and (6%) ol the cases polyhydramnios were severe. thirty nine percent of the patients had associated risk factors in the current pregnancy, These risk factors were as follows.- diabetes in 16%), Rhesus
iso-immunization complicated with hydrops fetalis in 4, congenital malformation in (15%) and 4 had multiple pregnancy.
Sixty five percent of the cases had no complication and did not need any tretament, those with complications were managed by different methods such as control of diabetes, Amnioreduction and Indomethacin therapy.
Thirty eight percent of the patients delivered preterm, 44%) delivered by caeserean section, most of them were emergency caeserean section.
Twenty five percent of the neoborns weighted more than Og.
Fifteen percent of them had apparent congenital malformation,
43% of the them needed different types of special management.
Perinatal mortality was found to be ( 92%).
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