Amount of polyhydramnios attributable to diabetes may be less than previously reported

AIM To evaluate the frequency and the quantity of polyhydramnios attributable to diabetes in pregnancy.METHODS The charts of patients with a four-quadrant amniotic fluid index(AFI) ≥ 20 cm and either a diagnosis of diabetes or a diabetes screening test during the index pregnancy were retrospectively reviewed. AFI was stratified into 5 categories and the frequency of diabetes was evaluated for each group. The frequency of polyhydramnios attributable to diabetes was compared to the frequency of polyhydramnios in the setting of fetal anomalies or no known cause. RESULTS One thousand five hundred and forty-five patients were included in the study. Eight point five percent(n = 131) had diabetes and no other cause for polyhydramnios. Eleven point two percent(173) had antenatally diagnosed anomalies. For all categories of AFI except the largest(> 40.9 cm) the most common cause of polyhydramnios was idiopathic. In patients with diabetes the AFI was most likely to be between 26 cm and 35.9 cm.CONCLUSION The rate of polyhydramnios in this study is 8.5%. Patients with diabetes most commonly have mild polyhydramnios between 26 and 35.9 cm of fluid on a four-quadrant AFI.

Chinese Herbal Medicine in Treatment of Polyhydramnios:a Meta-analysis and Systematic Review

Objective To compare the efficacy of Chinese herbal medicine （therapy A） or Chinese herbal medicine plus indomethacin （therapy B） with that of indomethacin alone （therapy C） in treating polyhydramnios. Methods Literatures published up to April 2012 were retrieved from PubMed, Embase and Cochrane library, Chinese National Knowledge Infrastructure （CNKI）, Chinese Scientific and Technological Periodical Database （VIP）, Wangfang, and Traditional Chinese Medicine online. Two researchers collected data independently. The assessment of methodological quality was based on Cochrane handbook and the materials were analyzed with software RevMan 5.1.2. The outcome measure index was relative risk or difference of mean value （95% confidence interval）. The following outcomes were evaluated： （1） general clinical improvement rate; （2） maximum vertical pocket depth; （3） amniotic fluid index （AH） value; （4） rate of fetal ductus arteriosus constriction; （5） incidence of adverse events. Results Based on the search strategy, 5 trails involving 1017 patients were finally included. Compared with therapy C, therapy A decreased the rate of fetal ductus arteriosus constriction （P〈0.01）. Therapy B was more effective than therapy C in general clinical improvement and decrease of AH for polyhydramnios （P〈 0.01 ）. No serious adverse events were reported in therapy A and therapy B. Conclusions Compared with therapy C, therapy A and therapy B may appear to be more effective for polyhydramnios. However, the exact effect needs to be confirmed with well-designed large-scale clinical trials.

An Unusual Case of BSND Gene–Related (Type IV) Bartter Syndrome Presenting as Antenatal Bartter Syndrome:A Case Report and Review of Literature

Bartter syndrome is a group of autosomal recessive renal tubular disorders;it has two types of presentation:antenatal and classic.The antenatal type presents as severe unexplained polyhydramnios in the second trimester.This is due to fetal urinary losses of sodium,chloride,and potassium,leading to fetal polyuria.The classic type presents in the late neonatal or infancy stage,with dehydration,dyselectrolytemia,failure to thrive,and nephrocalcinosis.Antenatal scans are normal in such cases.Type I and II Bartter syndrome presents in the antenatal period,whereas type IV has a classic presentation.We describe an unusual case of type IVa Bartter syndrome presenting in the antenatal period,with severe polyhydramnios.The initial diagnosis was made based on amniotic fluid chloride levels and later confirmed by performing a genetic test.Genetic testing is important for confirming diagnosis and prognostication regarding the condition.