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Risk Factors Outcome Associated with Polyhydramnios in Sudanese Women

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Risk Factors Outcome Associated with Polyhydramnios in Sudanese Women 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%). iv ?-..R Wt? ?11.i515 R rtA,- V)2;U VotAUL U110, ULL:-- WI alb LJ 4:rA a_.41 :JJL4-1 tl . - OL .fy Y/1h J! ry - - I/th l pul ;.:,L,) Lp_,Jl js jj -a 01A j-u ;LLUJI cVL;Ll ZAL- :.jVULI oU <Al J.,r 'PL.JI .:,Lj JL _J.Jjl J_a LS JAJI iAj Xv.; Of L-ft- 2IjJJ o^ c,UL, r1i" c c.v-l ), c-;ts cNUW A %ri) c Al J;L-jl 'L- --Jl at..-Al ;.,L,)l 61A jr r#,.d fJJI j<J ;AjL ze (%YA) Y'rLZA1. J;LjI ;.)Ij :;Lsr %Yi) )fl L) ciur-WL. (%ro) JJ-1 sALi C-Ap L) A L) <-Jl XI)i J;L-jl -jA UP v LS !S'i -Aijji (% o) (% j LA _rA -' :, (% T) l LPL-JI izLj :,VL L4L-4 vi Introduction literature review Introduction: Amniotic fluid plays a major role in fetal growth and development. Increased amount of amniotic fluid volume can interfere directly with fetal development, and it can be an indirect sign of an underlying disorder, Sonographic evaluation of the amniotic fluid canthus, aid in the diagnosis of fetal structural anomalies and fetal compromise and can help in guiding pregnancy management decisions. Definition: It is a condition in which there is an excess of liquor amnii surrounding the unborn infant. In normal case the actual quantity of fluid varies but up to two litres is considered to b normal and above it constitutes hydramnios. Hydramnlos is defined by some authors as amniotic fluid volume above the normal range for gestional age. For practical clinical purposes it may be considered as. Single pool > 8cm Aminotic fluid index > 0th centile Incidence: Polyhydramnios occurs in 05-2% of all pregnancies (21. From study done in Paris 1980, about hydramnios and fetal malformations, the incidence of hydrarnnios was o.29 out of 17.528 pregnancies (3) While in study done in witzerland in 1993 about the prevalence and etiology of hydramnios, the incidence was 1.08 % out of 17.750 pregnancies (4) Polyhydramnios can be idiopathic (- 60% ), associated with maternal diabetes 20%), associated with congenital fetal anomaly (-20%). Even in the absence of an identifiable cause >60%), polyhydramnios is associatedwith an increased rate of aesarean section, anteparturn fetal death 06% vs 02%), Postpartum death (2.8% vs 04%), abruption 09% vs 03%), malpresentation 68% vs 29%), cord prolapse 2.2% vs:0.3%), and large for gestational age infant 24% vs 8%) 2). Polyhydramnios occurs more often in multipara than in primigravada (5) Physiology: Amniotic fluid surrounds and protects the fetus in the amniotic cavity. It provides a cushion against the constricting confines of the gravid uterus, allowing the fetus room for movement and growth and protecting it from external trauma. The space around the fetus is necessary for the normal development and maturation of fetal lungs. It also promotes normal development of limbs by permitting periodic extension, thus preventing joint contractures. The fluid bathing the fetus helps maintain the fetal body temperature and plays a part in the homeostasis of fluid and electrolytes. The mechanisms of amniotic fluid production and consumption, and the composition and volume of. amniotic fluid,
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