Approach Considerations

In women with polyhydramnios or oligohydramnios, note the following:

Consider hospitalizing and thoroughly evaluating the mother in cases diagnosed after 26-33 weeks' gestation.
If the fetus does not have an anomaly, delivery should be performed if the biophysical profile is nonreassuring.
The instillation of isotonic sodium chloride solution in the second trimester may be of benefit in some patients. Use transabdominal amnioinfusion to instill 400-600 mL, which may improve visualization for ultrasonography and increase the amniotic fluid volume.
In cases associated with postmaturity, review the pregnancy dating. If the gestation is truly longer than term, deliver the fetus by means of either induction or cesarean delivery.
If meconium is present during labor, administer amnioinfusion therapy to reduce the potential for fetal distress and prenatal aspiration.

Transfer these pregnant women to a tertiary center when they have a high likelihood of maternal illness, preterm delivery, or infant problems that may require the resources of a tertiary care facility.

Medical Care

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.

Polyhydramnios

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 amniotic fluid index (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.

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.

Oligohydramnios

Maternal bed rest and hydration promote the production of amniotic fluid by increasing the maternal intravascular space. Bed rest may also help when pregnancy-induced hypertension (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 (1500-2500 mL/day) is associated with a 20-30% improvement in AFI and a reduction in cesarean delivery.^[18] Further studies are necessary to determine if a corresponding improvement in fetal and neonatal well-being can be substantiated with such "forced hydration" therapy.

Consultations

A specialist in maternal-fetal medicine should be consulted when significant polyhydramnios or oligohydramnios 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, pediatric infectious disease specialist, or other genetics specialists as required to care for the infant.

Medication

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Author

Brian S Carter, MD, FAAP Professor of Pediatrics, University of Missouri-Kansas City School of Medicine; Attending Physician, Division of Neonatology, Children's Mercy Hospital and Clinics; Faculty, Children's Mercy Bioethics Center

Brian S Carter, MD, FAAP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Hospice and Palliative Medicine, American Academy of Pediatrics, American Pediatric Society, American Society for Bioethics and Humanities, American Society of Law, Medicine & Ethics, Society for Pediatric Research, National Hospice and Palliative Care Organization

Disclosure: Nothing to disclose.

Coauthor(s)

Roland L Boyd, DO Neonatologist, Section of Neonatology, Neonatal Services, Ltd

Roland L Boyd, DO is a member of the following medical societies: American Academy of Osteopathy, American Academy of Pediatrics, American College of Osteopathic Pediatricians

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

David A Clark, MD Professor and Martha Lepow Chairman of Pediatrics, Professor of Obstetrics and Gynecology, Albany Medical College; Director, Children's Hospital at Albany Medical Center

David A Clark, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American College of Nutrition, American Forestry Association, American Pediatric Society, Capital District Pediatric Society, Christian Medical and Dental Associations, European Society for Paediatric Research, Eastern Society for Pediatric Research, Floyd W Denny Pediatric Alumni Society, Medical Society of the State of New York, New York Academy of Sciences, Society for Pediatric Research

Disclosure: Nothing to disclose.

Chief Editor

Dharmendra J Nimavat, MD, FAAP Associate Professor of Clinical Pediatrics, Department of Pediatrics, Division of Neonatology, Southern Illinois University School of Medicine; Staff Neonatologist, Clinical Director, NICU Regional Perinatal Center, HSHS St John's Children's Hospital

Dharmendra J Nimavat, MD, FAAP is a member of the following medical societies: American Academy of Pediatrics, American Association of Physicians of Indian Origin

Disclosure: Nothing to disclose.

Additional Contributors

Ted Rosenkrantz, MD Professor, Departments of Pediatrics and Obstetrics/Gynecology, Division of Neonatal-Perinatal Medicine, University of Connecticut School of Medicine

Ted Rosenkrantz, MD is a member of the following medical societies: American Academy of Pediatrics, American Pediatric Society, Eastern Society for Pediatric Research, American Medical Association, Connecticut State Medical Society, Society for Pediatric Research

Disclosure: Nothing to disclose.