Disease relevance of Polyhydramnios

• Hypocalciuria and hypomagnesemia are specific clinical features of Gitelman syndrome, while HPS/aBS is a life-threatening disorder of the newborn with polyhydramnios, premature delivery, hyposthenuria, and nephrocalcinosis [1].
• However, the clinical feature in the patient lacking the characteristic symptoms of IBS such as polyhydramnios, premature labor, or severe salt loss in neonatal period contrasts with that of the typical BSND patients described so far in the literature [2].
• A case of severe craniosynostosis-radial aplasia (Baller-Gerold) syndrome is described in a newborn male, following a pregnancy complicated by polyhydramnios and intrauterine growth retardation [3].
• Hydrops fetalis, with or without oligo- or polyhydramnios, is associated with very high fetal mortality [4].
• Latent myotonic dystrophy: the cause of hydramnios and an increase in serum creatine kinase concentration [5].

High impact information on Polyhydramnios

• Raised alpha-fetoprotein concentrations were found at 29 and 30 weeks' gestation in the amniotic fluid and maternal serum of a woman who presented in her seventh pregnancy with apparent polyhydramnios [6].
• Fetal abnormalities including chylous ascites, polyhydramnios, claw hands, and hammer toes were identified in an infant who had a missense mutation R106P and a 52bp deletion in the gene for a peroxisomal beta-oxidation enzyme, D-3-hydroxyacyl-CoA dehydratase/D-3-hydroxyacyl-CoA dehydrogenase, D-bifunctional protein [7].
• Fumarase deficiency: two siblings with enlarged cerebral ventricles and polyhydramnios in utero [8].
• Letter: Polyhydramnios and neonatal renal failure--a possible association with maternal acetaminophen ingestion [9].
• Transgenic aquaporin 1 knockout mice provide a unique animal of polyhydramnios [10].

Chemical compound and disease context of Polyhydramnios

• Before delivery without indomethacin, the polyhydramnios reformed [11].
• Maternal lithium therapy and polyhydramnios [12].
• Infusions of comparable volumes of vehicle or lower concentrations of angiotensin 1 [48 micrograms/(kg.day)] did not cause gross polyhydramnios [13].
• Treatment of polyhydramnios with prostaglandin synthetase inhibitor (indomethacin) [11].
• Elevated fetal plasma lactate produces polyhydramnios in the sheep [14].

Biological context of Polyhydramnios

• We report the case of a manic-depressive gravida on lithium therapy who developed polyhydramnios in her last trimester [12].
• Doppler assessment of the renal blood flow velocity waveform during indomethacin therapy for preterm labor and polyhydramnios [15].
• The ultrasound triad of fetal hydramnios, abnormal hand posturing, and any other anomaly predicts autosomal trisomy [16].
• The diagnosis was based on the recurrence of hydramnios and nonimmune hydrops in a fetus with normal chromosomes, normal amniotic fluid alpha-fetoprotein, normal fetal echocardiography, and lack of evidence of a lysosomal storage disease [17].
• Gestational age at delivery and accordingly birth weight were significantly lower in patients with hydramnios compared to those with a normal AFI (34.9 +/- 2.1 vs. 39.1 +/- 1.2, p < 0.001; 2,508 +/- 399 vs. 2,995 +/- 420, p < 0.001, respectively) [18].

Anatomical context of Polyhydramnios

• In ovine fetuses, intravascular infusion of sodium lactate elevates fetal plasma and amniotic lactate levels and produces polyhydramnios [19].
• We speculate that idiopathic polyhydramnios may be associated with a deficiency of aquaporin 1 channels in human fetal membranes [10].
• The following pathophysiological mechanism for explaining polyhydramnios in recipient twins is proposed: chronic overload in recipient twins causes enhanced release of ANF from the fetal heart [20].
• In utero congestive heart failure due to maternal indomethacin treatment for polyhydramnios and premature labour in a fetus with antenatal closure of the foramen ovale [21].
• A 26-year-old, para 1 woman was referred for genetic counselling at 36 weeks' gestation with the sonographic findings of intrauterine growth retardation (IUGR), polyhydramnios, ventricular septal defect, and an enlarged cisterna magna [22].

Gene context of Polyhydramnios

• B: in polyhydramnios, elevated AF placental hormones were found, while PRL was very low [23].
• We propose that a chorionic PRL receptor deficiency underlies the various clinical forms of chronic polyhydramnios [24].
• Here, we studied binding of the potent lactogen, human GH, to this receptor in 18 normal pregnant women, in 12 patients whose pregnancies were complicated by chronic polyhydramnios and in 13 with chronic oligohydramnios [24].
• CONCLUSION: These data suggest that amniotic fluid concentrations of human brain natriuretic peptide and endothelin-1 were highest in the twins with polyhydramnios and lowest in the twins with oligohydramnios, which suggests the importance of these hormones in the regulation of amniotic fluid volume [25].
• OBJECTIVE: To investigate atrial natriuretic peptide (ANP) levels in fetuses with cardiac defects and to evaluate the relationships between plasma ANP levels and the presence of polyhydramnios [26].

Analytical, diagnostic and therapeutic context of Polyhydramnios

• CONCLUSION: Large-volume therapeutic amniocentesis can be used to treat hydramnios, with a 1.5% complication rate [27].
• A case of twin reversed arterial perfusion (TRAP) sequence (acardiac twin) complicated by hydramnios was managed by maternal administration of indomethacin [28].
• With rapid intravenous infusion of very large volumes of isotonic saline solutions into the fetus, the fluid could stay within the fetal body, thereby creating hydrops fetalis, be transferred into the amniotic fluid through the fetal kidneys, thereby creating polyhydramnios, or be transferred across the placenta into the maternal circulation [29].
• Continuous-wave Doppler ultrasound was used to assess blood flow velocities and determine the pulsatility index of the uterine arteries in ten pregnant women at 23-33 weeks' gestation during indomethacin therapy for preterm labor or polyhydramnios [30].
• CONCLUSION: Because antenatal diagnosis is possible, we suggest that there should be a high index of suspicion for idiopathic arterial calcification when there is sonographic hyperechogenicity of vessel walls, evidence of polyhydramnios, cardiomyopathy, or a family history of idiopathic arterial calcification [31].

References