Anemia of Prematurity - Portal Neonatal

Prognosis:
• Polyhydramnios
o If the condition is not associated with any other findings, the prognosis is usually good.
o According Desmedt et al, the PMR in polyhydramnios associated with a fetal or
placental malformation was 61%.
o As mentioned in Background and Mortality/Morbidity 20% of infants with
polyhydramnios have some anomaly; in these cases, the prognosis depends on the
severity of the anomaly.
o Studies show that, as the severity of polyhydramnios increases, so does the likelihood
of determining the etiology.
o In cases of mild polyhydramnios, the likelihood of finding a significant problem is only
about 16.5%; this should be communicated to the parents.
• Oligohydramnios
o In renal agenesis, the mortality rate is 100%.
o Milder forms of renal dysplasia or obstructive uropathy can be associated with mild-tosevere
forms of pulmonary hypoplasia and long-term renal failure.
o In cases of pulmonary hypoplasia, the effectiveness of many treatments such as the
administration of surfactant, high frequency ventilation, and nitric oxide has not been
established. The prognosis in these cases is related to the volume of amniotic fluid and
the gestational age at which oligohydramnios develops.
MISCELLANEOUS Section 8 of 9
Medical/Legal Pitfalls:
• Failure to perform ultrasonography in a pregnancy complicated by either polyhydramnios or
oligohydramnios to rule associated or contributory fetal anomalies
• The underlying anomalies may determine the outcome of the fetus, as well as the treatment
and outcome of the neonate. As appropriate, specialists should be consulted and the patient
should be transferred in a timely fashion to optimize the outcome of the pregnancy and to
reduce the risk of perinatal mortality.
BIBLIOGRAPHY Section 9 of 9
• Abdel-Fattah SA, Carroll SG, Kyle PM, Soothill PW: Amnioreduction: how much to drain?
Fetal Diagn Ther 1999 Sep-Oct; 14(5): 279-82[Medline].
• Ben-Chetritn A: Hydramnios in the third trimester of pregnancy: a change in the distribution
of accompanying fetal anomalies as a result of early ultrasonographic prenatal diagnosis.
• Biggio JR Jr, Wenstrom KD, Dubard MB, Cliver SP: Hydramnios prediction of adverse
perinatal outcome. Obstet Gynecol 1999 Nov; 94(5 Pt 1): 773-7[Medline].
• Brace RA, Resnik R: Dynamics and Disorders of Amniotic Fluid. In: Creasy RK and Resnik
R, eds. Maternal-Fetal Medicine. 4th ed 1999; 632-643.
• Cabrol D, Jannet D, Pannier E: Treatment of symptomatic polyhydramnios with
indomethacin. Eur J Obstet Gynecol Reprod Biol 1996 May; 66(1): 11-5[Medline].
• Chamberlain PF, Manning FA, Morrison I, et al: Ultrasound evaluation of amniotic fluid
volume. II. The relationship of increased amniotic fluid volume to perinatal outcome. Am J
Obstet Gynecol 1984 Oct 1; 150(3): 250-4[Medline].
• Desmedt EJ, Henry OA, Beischer NA: Polyhydramnios and associated maternal and fetal
complications in singleton pregnancies. Br J Obstet Gynaecol 1990 Dec; 97(12): 1115-
22[Medline].