ISOLATED HYDRAMNIOS AT TERM GESTATION AND THE OCCURRENCE OF PERIPARTUM COMPLICATIONS

Objective: To determine if hydramnios at term gestation is an independ ent risk factor for poor pregnancy outcome and perinatal death. Study design: The study population consisted of 60 702 patients with singlet on gestation who delivered at term (>37 weeks). Patients were classifi ed into two groups according to the presence or the absence of hydramn ios. Hydramnios was diagnosed in the presence of an amniotic fluid ind ex greater than 25 cm or of a maximum vertical pocket of amniotic flui d of at least 8 cm or by subjective assessment. Logistic regression an alysis was used to evaluate the unique contribution of hydramnios to f etal death and to perinatal and maternal morbidity. Results: The preva lence of hydramnios was 1211/60 702 (2%). Patients with hydramnios had a higher incidence of complications than those with a normal amount o f amniotic fluid: cesarean section (22.8 vs. 8.5%, P<0.01), antepartum death (0.6 vs. 0.2%, P<0.005), postpartum death (2.8 vs. 0.4%, P<0.01 ), abruptio placenta (0.9 vs. 0.3%, P<0.001), fetal distress (6.1 vs. 3.65%, P<0.0015), meconium-stained amniotic fluid (17.8 vs. 15%, P<0.0 01), low Apgar score at 5 min (2.95 vs. 1%, P<0.01), malpresentation ( 6.8 vs. 2.9%, P<0.01), clinical chorioamnionitis (0.3 vs. 0.1%, P<0.05 ), prolapse of cord (2.2 vs. 0.3%, P<0.01), and large-for-gestational- age infant (LGA) (23.8 vs. 8.1%, P<0.01). When adjusted for confoundin g variables, the presence of hydramnios remained strongly associated w ith perinatal mortality (odds ratio 5.5 (95% CI 3.2-9.3)) and neonatal and maternal morbidity (odds ratios 2.1 (CI 1.1-3.7) and 2.3 (CI 1.9- 2.7), respectively). Conclusions: (1) Hydramnios at term is an indepen dent risk factor for perinatal death; (2) Fetal surveillance is warran ted in patients with hydramnios even in the absence of other known ris k factors for adverse pregnancy outcome. (C) 1998 Elsevier Science Ire land Ltd.