Polyhydramnios and Oligohydramnios Treatment & Management

Updated: Sep 20, 2017
  • Author: Brian S Carter, MD, FAAP; Chief Editor: Dharmendra J Nimavat, MD, FAAP  more...
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Treatment

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.

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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.

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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.

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