Polyhydramnios and Oligohydramnios Treatment & Management
- Author: Brian S Carter, MD, FAAP; Chief Editor: Ted Rosenkrantz, MD more...
The first step is identifying the etiology of the abnormal volume of amniotic fluid. Medical care includes the use of steroids to enhance fetal lung maturity if preterm delivery is anticipated.
- Patients with polyhydramnios tend to have a higher incidence of preterm labor secondary to overdistention of the uterus.
- Schedule weekly or twice weekly perinatal visits and cervical examinations.
- Place patients on bed rest to decrease the likelihood of preterm labor.
- Perform serial ultrasonography to determine the AFI and document fetal growth.
- In cases of polyhydramnios associated with fetal hydrops secondary to fetal anemia, the direct intravascular transfusion of erythrocytes (or infusion into the fetal abdomen) may improve the fetal hematocrit and fetal congestive heart failure, thereby allowing prolongation of the pregnancy and improving survival.
- Maternal bed rest and hydration promote the production of amniotic fluid by increasing the maternal intravascular space. Bed rest may also help when PIH is present, allowing prolongation of the pregnancy.
- Studies show that oral hydration, by having the women drink 2 liters of water, increases the AFI by 30%.
- In singleton pregnancies where oligohydramnios is present without maternal and fetal complications, evidence exists that either oral or intravenous maternal hydration (1500-2500ml/day) is associated with a 20-30% improvement in AFI and a reduction in cesarean delivery. Further studies are necessary to determine if a corresponding improvement in fetal and neonatal wellbeing can be substantiated with such "forced hydration" therapy.
See the list below:
- A specialist in maternal-fetal medicine should be consulted when significant oligohydramnios or polyhydramnios is present, especially when the condition is unexplained, involves hydrops fetalis, or is associated with congenital malformations.
- Genetic counseling may be helpful in cases in which congenital anomalies are identified.
- Consult a neonatologist, pediatric surgeon, pediatric cardiologist, pediatric nephrologist, or other genetics specialists as required to care for the infant.
See the list below:
- In cases of polyhydramnios in which maternal diabetes is suspected, perform a glucose tolerance test. If the test results are positive, treat the mother with an American Diabetes Association (ADA) diet. Insulin is rarely needed.
Chamberlain PF, Manning FA, Morrison I, et al. Ultrasound evaluation of amniotic fluid volume. II. The relationship of increased amniotic fluid volume to perinatal outcome. Am J Obstet Gynecol. 1984 Oct 1. 150(3):250-4. [Medline].
Rosenberg VA, Buhimschi IA, Dulay AT, Abdel-Razeq SS, Oliver EA, Duzyj CM, et al. Modulation of Amniotic Fluid Activin-A and Inhibin-A in Women With Preterm Premature Rupture of the Membranes and Infection-Induced Preterm Birth. Am J Reprod Immunol. 2011 Oct 13. [Medline].
Ben-Chetrit A, Hochner-Celnikier D, Ron M, Yagel S. Hydramnios in the third trimester of pregnancy: a change in the distribution of accompanying fetal anomalies as a result of early ultrasonographic prenatal diagnosis. Am J Obstet Gynecol. 1990 May. 162(5):1344-5. [Medline].
Pri-Paz S, Khalek N, Fuchs KM, Simpson LL. Maximal Amniotic Fluid Index as a Prognostic Factor in Pregnancies Complicated by Polyhydramnios. Ultrasound Obstet Gynecol. 2011 Sep 5. [Medline].
Magann EF, Haas DM, Hill JB, Chauhan SP, Watson EM, Learman LA. Oligohydramnios, Small for Gestational Age and Pregnancy Outcomes: An Analysis Using Precise Measures. Gynecol Obstet Invest. 2011 Oct 26. [Medline].
Kollmann M, Voetsch J, Koidl C, et al. Etiology and perinatal outcome of polyhydramnios. Ultraschall Med. 2014 Aug. 35(4):350-6. [Medline].
Abdel-Fattah SA, Carroll SG, Kyle PM, Soothill PW. Amnioreduction: how much to drain?. Fetal Diagn Ther. 1999 Sep-Oct. 14(5):279-82. [Medline].
Patrelli TS, Gizzo S, Cosmi E, Carpano MG, Di Gangi S, Pedrazzi G, et al. Maternal hydration therapy improves the quantity of amniotic fluid and the pregnancy outcome in third-trimester isolated oligohydramnios: a controlled randomized institutional trial. J Ultrasound Med. 2012 Feb. 31(2):239-44. [Medline].
Cabrol D, Jannet D, Pannier E. Treatment of symptomatic polyhydramnios with indomethacin. Eur J Obstet Gynecol Reprod Biol. 1996 May. 66(1):11-5. [Medline].
Kramer WB, Van den Veyver IB, Kirshon B. Treatment of polyhydramnios with indomethacin. Clin Perinatol. 1994 Sep. 21(3):615-30. [Medline].
Mamopoulos M, Assimakopoulos E, Reece EA, et al. Maternal indomethacin therapy in the treatment of polyhydramnios. Am J Obstet Gynecol. 1990 May. 162(5):1225-9. [Medline].
Desmedt EJ, Henry OA, Beischer NA. Polyhydramnios and associated maternal and fetal complications in singleton pregnancies. Br J Obstet Gynaecol. 1990 Dec. 97(12):1115-22. [Medline].
Biggio JR Jr, Wenstrom KD, Dubard MB, Cliver SP. Hydramnios prediction of adverse perinatal outcome. Obstet Gynecol. 1999 Nov. 94(5 Pt 1):773-7. [Medline].
Brace RA, Resnik R. Dynamics and disorders of amniotic fluid. Creasy RK, Resnik R, eds. Maternal-Fetal Medicine. 4th ed. 1999. 632-43.
Fanaroff AA, Martin RJ. Diseases of the fetus and infant. Neonatal-Perinatal Medicine. 6th ed. 1997. 315-9.
Harrison MR, Golbus MS, Filly RA. Prenatal diagnosis and treatment. The Unborn Patient. 2nd ed. 1990. 139-49.
Hill LM, Breckle R, Thomas ML, Fries JK. Polyhydramnios: ultrasonically detected prevalence and neonatal outcome. Obstet Gynecol. 1987 Jan. 69(1):21-5. [Medline].
Jones KL. Oligohydramnios sequence. Smith's Recognizable Patterns of Human Malformation. 5th ed. 1997.
Kilpatrick SE. Histologic prognostication in soft tissue sarcomas: grading versus subtyping or both? A comprehensive review of the literature with proposed practical guidelines. Ann Diagn Pathol. 1999 Feb. 3(1):48-61. [Medline].
Macri CJ, Schrimmer DB, Leung A, et al. Prophylactic amnioinfusion improves outcome of pregnancy complicated by thick meconium and oligohydramnios. Am J Obstet Gynecol. 1992 Jul. 167(1):117-21. [Medline].
Morales WJ, Talley T. Premature rupture of membranes at 11111Am J Obstet Gynecol</i>. 1993 Feb. 168(2):503-7. [Medline].
Phelan JP, Ahn MO, Smith CV, et al. Amniotic fluid index measurements during pregnancy. J Reprod Med. 1987 Aug. 32(8):601-4. [Medline].
Pitt C, Sanchez-Ramos L, Kaunitz AM, Gaudier F. Prophylactic amnioinfusion for intrapartum oligohydramnios: a meta- analysis of randomized controlled trials. Obstet Gynecol. 2000 Nov. 96(5 Pt 2):861-6. [Medline].
Rib DM, Sherer DM, Woods JR Jr. Maternal and neonatal outcome associated with prolonged premature rupture of membranes below 26 weeks' gestation. Am J Perinatol. 1993 Sep. 10(5):369-73. [Medline].
Schumacher B, Moise KJ Jr. Fetal transfusion for red blood cell alloimmunization in pregnancy. Obstet Gynecol. 1996 Jul. 88(1):137-50. [Medline].
Vergani P, Ghidini A, Locatelli A, et al. Risk factors for pulmonary hypoplasia in second-trimester premature rupture of membranes. Am J Obstet Gynecol. 1994 May. 170(5 Pt 1):1359-64. [Medline].
Xiao ZH, Andre P, Lacaze-Masmonteil T, et al. Outcome of premature infants delivered after prolonged premature rupture of membranes before 25 weeks of gestation. Eur J Obstet Gynecol Reprod Biol. 2000 May. 90(1):67-71. [Medline].