The principal cause of hydramnios in diabetic pregnancies is usually poor glycemic control, although fetal gastrointestinal anomalies (e.g., esophageal atresia) need to be excluded. In practice, polyhydramnios is usually diagnosed when any single vertical pocket of amniotic fluid is deeper than 8 cm (equivalent to the 97th percentile) or when the sum of four pockets, one from each quadrant of the uterus (amniotic fluid index), exceeds approximately 24 cm (95th percentile Moore and Cayle, 1990 ). The precise clinical definition varies, encompassing the recording of more than 2000 mL of amniotic fluid at delivery and various measures of amniotic fluid pocket depths as observed on ultrasonography. Polyhydramnios is defined as excess amniotic fluid. Moore, in Avery's Diseases of the Newborn (Ninth Edition), 2012 Polyhydramnios Polyhydramnios in itself may create obstetric problems such as premature labour, postpartum haemorrhage and PROM resulting in prolapsed cord. Idiopathic polyhydramnios 12 does not seem to be less associated with adverse perinatal outcomes than polyhydramnios in which one of the above fetal or maternal conditions has been identified. However, in approximately two-thirds of pregnancies with polyhydramnios, no specific cause can be established. Also, lesions of the umbilical cord and placenta have been associated with polyhydramnios. Other abnormal maternal and fetal conditions associated with polyhydramnios are maternal diabetes mellitus, macrosomia, multiple pregnancy and non-immune fetal hydrops. Nearly one in five pregnancies with chronic polyhydramnios has been associated with fetal anomalies. The aetiology of polyhydramnios is diverse and includes fetal congenital anomalies, notably neural tube defects and neuromuscular defects preventing adequate swallowing, on the one hand, and gastrointestinal obstruction resulting in fluid congestion on the other. Chronic polyhydramnios which develops gradually over weeks or months is more common than acute polyhydramnios. Its incidence has been reported to range from 0.4% to 3.3%. Polyhydramnios is defined as a deepest fluid pocket of more than 8 cm or an amniotic fluid index of at least 25 cm or more. Juriy W Wladimiroff, Sturla H Eik-Nes, in Ultrasound in Obstetrics and Gynaecology, 2009 Polyhydramnios
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