Amniotic fluid biochemistry in isolated polyhydramnios: a series of 464 cases. (3rd November 2015)

• Record Type: Journal Article
• Authors: Allaf, Bichr; Dreux, Sophie; Schmitz, Thomas; Czerkiewicz, Isabelle; Le Vaillant, Claudine; Benachi, Alexandra; Houfflin‐Debarge, Véronique; Maréchaud, Martine; Oury, Jean‐François; Muller, Françoise
• Is Part Of: Prenatal diagnosis. Volume 35:Number 13(2015:Dec.)
• Page Start: 1331
• Page End: 1335
• Publication Date: 2015-11-03
• Subjects: Prenatal diagnosis -- Periodicals; Fetus -- Diseases -- Diagnosis -- Periodicals; Electronic journals; 618.32075
• DOI: 10.1002/pd.4700
• Languages: English
• ISSNs: 0197-3851

Abstract

Abstract: Objective: To report amniotic fluid biochemistry in a large series of 464 cases of isolated polyhydramnios in order to analyze both the outcome and the benefit of amniotic fluid biochemistry. Methods: This retrospective cohort (2008–2012) included polyhydramnios cases for which amniotic fluid samples were sent to our laboratory for biochemical analysis (total protein, alpha‐fetoprotein and gamma‐glutamyl transpeptidase) so as to investigate the etiology. A Bartter index and an esophageal atresia index were defined. Final diagnoses were compared between groups to determine the association between these indices and the frequency and type of adverse outcomes. Results: Among 464 cases of polyhydramnios considered isolated at ultrasound examination, severe fetal diseases were diagnosed in 136 (29.3%): 46 (9.9%) chromosomal anomalies, 28 (6%) Bartter syndrome, 23 (4.95%) other genetic syndromes, 22 (4.75%) swallowing disorders and 17 (3.7%) uro‐nephrological disorders. Amniotic fluid biochemistry identified esophageal atresia with 66.6% (10/15) sensitivity and 100% specificity and Bartter syndrome with 85.7% (24/28) sensitivity and 84.2% specificity. Conclusion: Isolated polyhydramnios is associated with a high risk of severe fetal diseases. Molecular cytogenetics and amniotic fluid biochemistry are helpful tools. © 2015 John Wiley & Sons, Ltd. Abstract : What's already known about this topic? When evident causes of polyhydramnios have been discounted, polyhydramnios is considered to be idiopathic. However, severe fetal diseases can be observed and are difficult to diagnose. What does this study add? Based on a series of idiopathic polyhydramnios we observed a 29.3% frequency of severe fetal diseases. Amniotic fluid biochemistry including total protein, AFP and GGTP allowed the diagnosis of Bartter syndrome or esophageal atresia. In addition, molecular cytogenetics gave an additional diagnosis of submicroscopic abnormalities.