Table 12

Impact of amniotic fluid assessment for polyhydramnios on stillbirth and perinatal mortality


Location and Type of Study


Stillbirths/Perinatal Outcomes

Reviews and meta-analyses

Magann et al. 2007 [107]

USA, China

Systematic review. 7 studies included. N = 3 studies of idiopathic polyhydramnios, N = 4 studies of polyhydramnios that adjusted for congenital anomalies.

Assessed the association of idiopathic polyhydramnios on perinatal outcomes.

PMR: 2-fold to 5-fold increase in risk in polyhydramnios vs. normal AFI groups, respectively.

Observational studies

Mazor et al. 1996 [112]


Cohort study. Singleton pregnancies (N = 4211) with intact membranes and pre-term delivery (< 37 wks).

Compared the effect in the group with increased amniotic fluid volume (exposed) vs. normal amniotic fluid volume (unexposed) by sonographic assessment.

PMR: OR = 5.8 (95% CI: 3.68–9.11).

Intrapartum morbidity: OR = 2.8 (95% CI: 1.94–4.03).

Polyhydramnios was an independent predictor of perinatal mortality and intrapartum morbidity.

Dashe et al. 2002 [113]


Retrospective cohort study. N = 672 singleton pregnancies with hydramnios categorised as mild, moderate, or severe based on greatest amniotic fluid index of 25.0-29.9 cm, 30.0-34.9 cm, or 35.0 cm or more, respectively.

To characterise the prevalence and ultrasound detection of fetal anomalies in pregnancies with hydramnios, and to estimate anomaly and aneuploidy risks when no sonographic abnormality is noted.

77 (11%) of neonates had one or more anomalies.

Fetal death rate: 4%; 60%; of these had anomalies.

Erez et al. 2005 [114]


Retrospective logistic regression analysis. N = 192 SGA neonates with polyhydramnios, N = 5,515 SGA neonates with normal amniotic fluid, N = 3,714 appropriate for gestational age (AGA) neonates with polyhydramnios, N = 83,763 AGA.

Assessed the impact of combined SGA and polyhydramnios on perinatal mortality.

PMR: OR = 20.55 (95% CI: 12.6–33.4) comparing SGA+polyhydramnios to AGA fetuses with normal AFI

Shoham et al. 2001 [182]


Matched case-control study. N = 368 women with gestational diabetes mellitus (N = 194 with polyhydramnios, AFI>25 cm; N = 184 women with normal AFI) under strict metabolic control enrolled from 1995–1996.

To determine whether gestational diabetes (GDM) complicated with hydramnios is associated with higher rates of perinatal morbidity and mortality than those with normal amniotic fluid (AFI).

No significant differences in rates of antepartum fetal death.

Haws et al. BMC Pregnancy and Childbirth 2009 9(Suppl 1):S5   doi:10.1186/1471-2393-9-S1-S5

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