Journal of Ultrasound in Medicine, Vol 16, Issue 9 609-614, Copyright © 1997 by American Institute of Ultrasound in Medicine
Polyhydramnios and fetal intrauterine growth restriction: ominous combination
G. K. Sickler, D. A. Nyberg, R. Sohaey and D. A. Luthy
Center for Perinatal Disease, Swedish Hospital Medical Center, Seattle, Washington, USA.
The purpose of this study was to evaluate the significance of
polyhydramnios combined with intrauterine growth restriction. During a 6
year period, 39 fetuses were identified by prenatal sonography as having
both polyhydramnios and intrauterine growth restriction. Polyhydramnios was
defined as a four-quadrant amniotic fluid index of 24 or greater (mean
30.5, range 24 to 40). Intrauterine growth restriction was defined as
estimated fetal weight less than the tenth percentile (Hadlock standards).
The mean birth weight was 2213 g. Major anomalies were present postnatally
in 92% (36 of 39) of fetuses. Among nine fetuses without sonographically
detectable anomalies prenatally, six (67%) proved to have one or more
anomalies at birth. Chromosome abnormalities were present in 38% (15 cases)
including 10 fetuses with trisomy 18 and one with trisomy 13. The overall
mortality rate was 59%. The combination of polyhydramnios and intrauterine
growth restriction is ominous. The majority of fetuses have major anomalies
or chromosome abnormalities, or both, even when other sonographic
abnormalities are absent. Chromosome analysis and detailed fetal evaluation
should be offered when polyhydramnios and intrauterine growth restriction
are identified prenatally.
