Polyhydramnios and fetal intrauterine growth restriction: ominous combination

The purpose of this study was to evaluate the significance of polyhydramnios combined with intrauterine growth restriction. During a 6 year period, 39 fetuses were identified by prenatal sonography as having both polyhydramnios and intrauterine growth restriction. Polyhydramnios was defined as a four‐quadrant amniotic fluid index of 24 or greater (mean 30.5, range 24 to 40). Intrauterine growth restriction was defined as estimated fetal weight less than the tenth percentile (Hadlock standards). The mean birth weight was 2213 g. Major anomalies were present postnatally in 92% (36 of 39) of fetuses. Among nine fetuses without sonographically detectable anomalies prenatally, six (67%) proved to have one or more anomalies at birth. Chromosome abnormalities were present in 38% (15 cases) including 10 fetuses with trisomy 18 and one with trisomy 13. The overall mortality rate was 59%. The combination of polyhydramnios and intrauterine growth restriction is ominous. The majority of fetuses have major anomalies or chromosome abnormalities, or both, even when other sonographic abnormalities are absent. Chromosome analysis and detailed fetal evaluation should be offered when polyhydramnios and intrauterine growth restriction are identified prenatally.