Clinical and morphological characteristics of the fetoplacental complex in hydramnios and oligohydramnios

Objective: to reveal the mechanisms responsible for the abnormal volume of amniotic fluid in infectious fetoplacental complex (FPC) lesion on the basis of the results of a placental morphological study and the cytological characteristics of amniotic fluid. Setting: Research Center of Obstetrics, Gynecology, and Perinatology, Russian Agency for Medical Technologies, Moscow Design: a prospective study. Subjects and materials: 215 women with term singleton pregnancy, including 25 apparently healthy women, 190 women at high infectious risk (34 with oligohydramnios, 44 with hydramnios, and 112 with a normal volume of amniotic fluid), their neonatal infants and placentas; 69 amniotic fluid samples taken by amniocentesis during cesarean section. Methods: clinicoanamnestic, functional, microbiological, cytological, morphological, statistical studies. Resalts: the abnormal volume of amniotic fluid in women at a high infectious risk has been ascertained to develop in the presence of complicated pregnancy; it is attended by complicated labor in every three females: 72% of children (2.4 times more than in the normal volume of amniotic fluid) are born with the clinical manifestations of intrauterine infection (TUI), with intrauterine growth retardation and other complications. Hydramnios and oligohydramnios of infectious genesis occur with pronounced placental morphological changes: circulatory and dystrophic disorders promoting impaired blood supply to IUI are prevalent in oligohydramnios while hydramnios is characterized by the inflammatory and dystrophic changes that prevent fluid absorption from the amniotic space. Dystrophic changes in the placental structures are especially unfavorable: they are accompanied by circulatory disorders in a third of cases, as evidenced by Doppler study, and chronic hypoxia and fetal growth retardation in 59% of cases. Desquamation of dystrophically changed amniocytes results in amniotic fluid cytosis and IUI shown in 46% of children. With suppurative inflammation, the count of polymorphonuclear leukocytes drastically increases in the fetal integuments and the microflora appears, which is followed by the development of neonatal aspiration pneumonia. Conclusion: hydramnios and oligohydramnios of infectious genesis develops in the presence of pronounced placental morphofunctional changes and significantly increase a risk for neonatal complications, including the manifestation of IUI.