Comparing Pregnancy, Childbirth, and Neonatal Outcome in Women with Idiopathic Polyhydramnios with Those of Healthy Pregnant Women

Amani Ghazi Jasim and Vian Hussam Almensy

Abstract

Idiopathic polyhydramnios is a common high-risk obstetric condition associated with increased maternal and perinatal morbidity. This study aimed to compare pregnancy, childbirth, and neonatal outcomes in women with idiopathic polyhydramnios versus healthy pregnant women with normal amniotic fluid volume. This prospective case-control study was conducted at the Maternity and Pediatrics Teaching Hospital in Al-Diwaniyah, Iraq, between 1 February and 1 December 2024. Thirty singleton pregnancies with idiopathic polyhydramnios (amniotic fluid index >25 cm) and 30 matched controls with normal amniotic fluid volume (5–24 cm) were enrolled. Detailed clinical history, physical examination, and transvaginal ultrasound assessment of cervical length were performed. The primary obstetric outcome was the cesarean section rate. Neonatal outcomes included Apgar score at 5 minutes, respiratory distress, and neonatal intensive care unit (NICU) admission. Multivariable logistic and linear regression models adjusted for gestational age and cervical length were used. Gestational age at delivery was significantly lower in the polyhydramnios group (34.63 ± 0.93 vs. 37.63 ± 1.03 weeks, p < 0.001), and cervical length was shorter (3.03 ± 0.54 vs. 3.58 ± 0.20 cm, p < 0.001). The cesarean section rate was significantly higher in the polyhydramnios group (66.7% vs. 36.7%, p = 0.020). Neonates in the polyhydramnios group had lower Apgar scores at 5 minutes (6.75 ± 1.02 vs. 7.50 ± 0.61, p = 0.007), higher respiratory distress (13.3% vs. 0%, p = 0.040), and higher NICU admission rates (63.3% vs. 23.3%, p < 0.001). Multivariable analysis confirmed idiopathic polyhydramnios as an independent predictor of cesarean delivery (adjusted odds ratio 13.72, 95% CI 2.46–76.38, p = 0.003) and lower Apgar score (β = –0.66, p = 0.021). Idiopathic polyhydramnios is independently associated with increased risks of cesarean delivery and adverse neonatal outcomes. Intensified antenatal surveillance and timely intervention are warranted in these pregnancies.