2019 Articles

Polyhydramnios among women in a cluster-randomized trial of ultrasound during prenatal care within five low and low-middle income countries: a secondary analysis of the first look study

Bauserman, Melissa; Nathan, Robert; Lokangaka, Adrien; McClure, Elizabeth M.; Moore, Janet; Ishoso, Daniel; Tshefu, Antoinette; Figueroa, Lester; Garces, Ana; Harrison, Margo S.; Wallace, Dennis; Saleem, Sarah; Mirza, Waseem; Krebs, Nancy; Hambidge, Michael; Carlo, Waldemar; Chomba, Elwyn; Miodovnik, Menachem; Koso-Thomas, Marion; Liechty, Edward A.; Esamai, Fabian; Swanson, Jonathan; Swanson, David; Goldenberg, Robert L.; Bose, Carl

Background
In many low and low-middle income countries, the incidence of polyhydramnios is unknown, in part because ultrasound technology is not routinely used. Our objective was to report the incidence of polyhydramnios in five low and low-middle income countries, to determine maternal characteristics associated with polyhydramnios, and report pregnancy and neonatal outcomes.


Methods
We performed a secondary analysis of the First Look Study, a multi-national, cluster-randomized trial of ultrasound during prenatal care. We evaluated all women enrolled from Guatemala, Pakistan, Zambia, Kenya and the Democratic Republic of Congo (DRC) who received an examination by prenatal ultrasound. We used pairwise site comparisons with Tukey-Kramer adjustment and multivariable logistic models with general estimating equations to control for cluster-level effects. The diagnosis of polyhydramnios was confrimed by an U.S. based radiologist in a majority of cases (62%).


Results
We identified 305/18,640 (1.6%) cases of polyhydramnios. 229 (75%) cases were from the DRC, with an incidence of 10%. A higher percentage of women with polyhydramnios experienced obstructed labor (7% vs 4%) and fetal malposition (4% vs 2%). Neonatal death was more common when polyhydramnios was present (OR 2.43; CI 1.15, 5.13).


Conclusions
Polyhydramnios occured in these low and low-middle income countries at a rate similar to high-income contries except in the DRC where the incidence was 10%. Polyhydramnios was associated with obstructed labor, fetal malposition, and neonatal death.


Trial registration

NCT01990625

, November 21, 2013.