POLYHYDRAMNIOS IS AN INDEPENDENT RISK FACTOR FOR PERINATAL-MORTALITY AND INTRAPARTUM MORBIDITY IN PRETERM DELIVERY

Objective: To investigate the clinical significance of polyhydramnios as a predictor of perinatal death and intrapartum morbidity in patient s with preterm delivery. Study design: The study population consisted of 4211 patients with singleton gestation, intact membranes and preter m delivery (< 37 weeks). Two groups were identified and compared accor ding to the sonographic assessment of the amniotic fluid volume: incre ased and normal amniotic fluid. Analyses were conducted for the entire cohort as well as for the cohort excluding from each group all cases with congenital malformations. Logistic regression was used to assess the unique contribution of polyhydramnios to mortality and morbidity i n the presence of other known risk factors. Results: The prevalence of polyhydramnios among women who delivered preterm was 5% (210/4211) in cluding and 3.7% (142/3818) excluding the cases of congenital malforma tions, respectively. Polyhydramnios was associated with a higher rate of diabetes, large for gestational age neonates, fetal malpresentation at delivery, previous perinatal death and with a lower Apgar score at 1 and 5 min. Polyhydramnios was an independent predictor of perinatal mortality and intrapartum morbidity. When adjusted for well recognize d risk factors for perinatal mortality and intrapartum morbidity (e.g. diabetes, severe pregnancy induced hypertension, multiparity, congeni tal malformation, previous perinatal death, low gestational age at del ivery), the presence of polyhydramnios significantly increased the rat e of perinatal mortality (odds ratio (OR) 5.8; 95% confidence interval (CI) 3.68-9.11) and of intrapartum morbidity (OR 2.8; 95% CI 1.94-4.0 3). Conclusion: In the setting of preterm delivery, polyhydramnios is an independent risk factor for perinatal mortality and intrapartum com plications even in the absence of congenital malformation and other co nditions traditionally associated with increased perinatal mortality a nd morbidity.