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Children
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Amniotic Fluid Anomalies: From Prenatal Management to Neonatal Outcomes
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Amniotic Fluid Anomalies: From Prenatal Management to Neonatal Outcomes

A special issue of Children (ISSN 2227-9067). This special issue belongs to the section "Pediatric Neonatology".

Deadline for manuscript submissions: closed (30 March 2024) | Viewed by 13930

Special Issue Editors

Dr. Viola Seravalli

E-Mail Website
Guest Editor
Department of Health Science, Division of Pediatrics, Obstetrics and Gynecology, Careggi Hospital, University of Florence, Florence, Italy
Interests: fetal ultrasounds; prenatal diagnosis; intrauterine growth restriction; preterm birth; multiple gestation; obstetrics
Dr. Mariarosaria Di Tommaso

E-Mail Website
Guest Editor
Department of Health Science, Division of Pediatrics, Obstetrics and Gynecology Careggi Hospital, University of Florence, Florence, Italy
Interests: reproductive medicine; obstetric delivery; fetal medicine; preterm birth；preeclampsia; obstetrics

Special Issue Information

Dear Colleagues,

Abnormal amniotic fluid volume (AFV) is the consequence of a wide range of different obstetric and foetal conditions, leading to an excess (polyhydramnios) or a defect (oligohydramnios) of amniotic fluid. The perinatal outcomes depend on the underlying etiology, the gestational age at which the amniotic fluid anomaly is first detected, and the presence of foetal anomalies. Studies have yielded conflicting results on the association between isolated oligohydramnios or idiopathic polyhydramnios and adverse perinatal outcomes, and the most effective treatments of pregnancy complications, particularly in terms of gestation, is still a controversial topic. Although there is not enough evidence to support induction of labour in isolated AFV anomalies, this is still offered in many practices.

The aim of this Special Issue is to collect original research, systematic reviews, or expert opinions on all aspects of this topic. In particular, contributions on the pathophysiology, management, and perinatal outcomes of isolated oligohydramnios and idiopathic mild polyhydramnios will be welcomed. We also encourage papers focused on new techniques for the management and treatment of neonates at risk of pulmonary hypoplasia secondary to severe oligohydramnios.

Our work will be based on an interdisciplinary approach to disseminate advanced knowledge and evidence with the aim to improve maternal, foetal, and neonatal health.

We look forward to receiving your contributions.

Dr. Viola Seravalli
Dr. Mariarosaria Di Tommaso
Guest Editors

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Keywords

  • amniotic fluid
  • oligohydramnios
  • polyhydramnios
  • meconium aspiration syndrome
  • pulmonary hypoplasia

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Published Papers (3 papers)

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Research

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11 pages, 1448 KiB  
Article
Intra-Amniotic Inflammation or Infection: Suspected and Confirmed Diagnosis of “Triple I” at Term
by Sara Consonni, Elettra Salmoiraghi, Isadora Vaglio Tessitore, Armando Pintucci, Valentina Vitale, Patrizia Calzi, Francesca Moltrasio and Anna Locatelli
Children 2023, 10(7), 1110; https://doi.org/10.3390/children10071110 - 26 Jun 2023
Cited by 1 | Viewed by 1603
Abstract
Chorioamnionitis (CA) at term of pregnancy can have an infectious and/or inflammatory origin and is associated with adverse outcomes. Triple I (intrauterine inflammation, infection, or both, TI) has been proposed to reduce the overdiagnosis of infection and neonatal overtreatment. The aim of this [...] Read more.
Chorioamnionitis (CA) at term of pregnancy can have an infectious and/or inflammatory origin and is associated with adverse outcomes. Triple I (intrauterine inflammation, infection, or both, TI) has been proposed to reduce the overdiagnosis of infection and neonatal overtreatment. The aim of this study is to identify clinical and histological variables that could predict adverse outcomes when TI is suspected and/or confirmed. This retrospective cohort study included 404 pregnancies (gestational age ≥ 37 weeks) that were divided into 5 all-inclusive and mutually exclusive groups. TI was defined according to the NICHD definition of 2015, and it could be confirmed (TI+) or not confirmed (TI−) via histological examination. Signs of infection/inflammation that did not conform to the definition of TI were classified as “clinical suspicion” and could be supported (CS+) or not supported (CS−) by histology. Cases of histological chorioamnionitis (HCA) without clinical manifestation represented a fifth group. Whole placental involvement (WPLI) was defined as a histological inflammation involving the maternal and fetal sides. There were 113 TI+, 30 TI−, 186 CS+, 35 CS−, and 40 isolated HCA cases. WPLI was diagnosed in 133 cases (39.2%). Composite neonatal outcome (CNO) occurred in 114 cases (28.2%) while composite maternal outcome (CMO) occurred in 192 cases (47.5%). Compared with CS+, TI+ was more predictive of CNO (p = 0.001), CMO (p < 0.001), and WPLI (p = 0.005). WPLI was related both to CNO (p < 0.001) and to CMO (p = 0.046). TI+ and WPLI showed similar sensitivity but different specificity in predicting CNO. At logistic regression, CNO was independently predicted by TI+ (OR 2.21; p = 0.001) and by WPLI (OR 2.23; p = 0.001). Compared with CS, TI is a better predictor of CNO and can be useful for the identification of newborns at risk. Full article
(This article belongs to the Special Issue Amniotic Fluid Anomalies: From Prenatal Management to Neonatal Outcomes)
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Review

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13 pages, 3163 KiB  
Review
Maternal Outcomes Following Active vs. Expectant Management of Previable Preterm Pre-Labor Rupture of Membranes: A Meta-Analysis
by Megan A. Sylvester, Gabrielle Mintz and Giovanni Sisti
Children 2023, 10(8), 1347; https://doi.org/10.3390/children10081347 - 4 Aug 2023
Cited by 1 | Viewed by 2355
Abstract
The diagnosis of previable preterm pre-labor rupture of membranes (PROM) is known to be associated with poor outcomes for both the mother and the fetus. Following previable preterm PROM, patients are generally offered either active management through the termination of the pregnancy or [...] Read more.
The diagnosis of previable preterm pre-labor rupture of membranes (PROM) is known to be associated with poor outcomes for both the mother and the fetus. Following previable preterm PROM, patients are generally offered either active management through the termination of the pregnancy or expectant management to increase the chances of fetal survival. It is difficult to counsel patients because there is a lack of data directly comparing maternal outcomes following active vs. expectant management. Using the data in the current literature, the goal of the present meta-analysis was to determine if there were any differences in terms of maternal risks when active versus elective management was chosen. PubMed, Google Scholar, EMBASE, and Scopus were searched. We found four studies accounting for a total of 506 patients. The risk ratio (RR) of chorioamnionitis in active vs. expectant management was 0.30 (with a 95% confidence interval, CI, of 0.09–1.02). The heterogeneity of the study results was 81% (I2). A sub–analysis of two included studies revealed an RR of postpartum hemorrhage in active vs. expectant management of 0.75 (95% CI 0.27–2.07) and an RR of maternal sepsis of 0.23 (95% CI 0.04–1.28). The heterogeneity of the study results for this sub-analysis was 68% (I2) for postpartum hemorrhage and 0% (I2) for maternal sepsis. Overall, there was no statistically significant difference in the risk of chorioamnionitis, postpartum hemorrhage, or maternal sepsis when active management was chosen over expectant management in previable preterm PROM at <24 weeks. The scarcity and the high heterogeneity of the available data likely contributed to the lack of statistical significance and calls for further work directly comparing maternal outcomes following active vs. expectant management. Full article
(This article belongs to the Special Issue Amniotic Fluid Anomalies: From Prenatal Management to Neonatal Outcomes)
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15 pages, 1605 KiB  
Review
Amniotic Fluid Disorders: From Prenatal Management to Neonatal Outcomes
by Mor Huri, Mariarosaria Di Tommaso and Viola Seravalli
Children 2023, 10(3), 561; https://doi.org/10.3390/children10030561 - 16 Mar 2023
Cited by 7 | Viewed by 9047
Abstract
Amniotic fluid volume assessment has become standard in the surveillance of fetal well-being, especially in high-risk pregnancies. Amniotic fluid disorders are a frequent and important topic in fetal and perinatal medicine. However, although important advances have been achieved, many important and challenging questions [...] Read more.
Amniotic fluid volume assessment has become standard in the surveillance of fetal well-being, especially in high-risk pregnancies. Amniotic fluid disorders are a frequent and important topic in fetal and perinatal medicine. However, although important advances have been achieved, many important and challenging questions remain unanswered to date. An abnormally low amniotic fluid volume, referred to as oligohydramnios, has been traditionally considered a possible indicator of placental insufficiency or fetal compromise and is associated with an increased rate of obstetric interventions. An excess of amniotic fluid, referred to as polyhydramnios, may be secondary to fetal or maternal conditions and has been associated with a variety of adverse pregnancy outcomes, especially when it is severe. The ultrasonographic detection of an amniotic fluid disorder should prompt a proper workup to identify the underlying etiology. Data on the association of isolated oligohydramnios or idiopathic polyhydramnios with adverse obstetric and perinatal outcomes are conflicting. While the management of secondary oligohydramnios is usually guided by the underlying condition, the management of isolated oligohydramnios is poorly defined. Similarly, the management of idiopathic and secondary polyhydramnios is not yet standardized. There is an urgent need for randomized clinical trials to provide stronger recommendations on the management of these two common conditions. Full article
(This article belongs to the Special Issue Amniotic Fluid Anomalies: From Prenatal Management to Neonatal Outcomes)
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