Pediatric Polyhydramnios and Oligohydramnios Follow-up

  • Author: Brian S Carter, MD, FAAP; Chief Editor: Ted Rosenkrantz, MD   more...
 
Updated: Feb 24, 2012
 

Further Inpatient Care

  • Polyhydramnios: See recommendations for oligohydramnios below.
  • Oligohydramnios
    • 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 volume of the amniotic fluid.
    • In cases associated with postmaturity, review 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.
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Transfer

  • Transfer to a tertiary center is indicated when the pregnant woman has 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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Complications

  • Polyhydramnios
    • Risks and complications of amnioinfusion include amniotic fluid embolism, maternal respiratory distress, increased maternal uterine tone, and transient fetal respiratory distress. An increase in the risk of maternal or fetal infection is not substantiated.
    • Risks of amniocentesis include fetal loss (1-2%). Other complications are placental abruption, preterm labor, fetal-maternal hemorrhage, maternal Rh sensitization, and fetal pneumothorax. The risk of fetal infection is slightly increased.
  • Oligohydramnios
    • The primary complications are those related to fetal distress before or during labor.
    • The risk of fetal infection is increased in the presence of prolonged rupture of the membranes.
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Prognosis

  • Polyhydramnios
    • If the condition is not associated with any other findings, the prognosis is usually good.
    • According Desmedt et al, the PMR in polyhydramnios associated with a fetal or placental malformation was 61%.[11]
    • As mentioned in Background and Mortality/Morbidity 20% of infants with polyhydramnios have some anomaly; in these cases, the prognosis depends on the severity of the anomaly.
    • Studies show that, as the severity of polyhydramnios increases, the likelihood of determining the etiology increases.
    • In cases of mild polyhydramnios, the likelihood of finding a significant problem is only about 16.5%; this should be communicated to the parents.
  • Oligohydramnios
    • In renal agenesis, the mortality rate is 100%.
    • Milder forms of renal dysplasia or obstructive uropathy can be associated with mild-to-severe degree of pulmonary hypoplasia and long-term renal failure.
    • In cases of pulmonary hypoplasia, the effectiveness of many treatments such as the administration of surfactant, high frequency ventilation, and nitric oxide has not been established. The prognosis in these cases is related to the volume of amniotic fluid and the gestational age at which oligohydramnios develops.
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Contributor Information and Disclosures
Author

Brian S Carter, MD, FAAP  Professor of Pediatrics (Neonatology), Vanderbilt University School of Medicine; Director, Neonatal Follow-up Program, Monroe Carell Jr Children's Hospital at Vanderbilt

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 Society for Bioethics and Humanities, American Society of Law, Medicine & Ethics, National Hospice and Palliative Care Organization, Society for Pediatric Research, and Southern Society for Pediatric Research

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, and American College of Osteopathic Pediatricians

Disclosure: Nothing to disclose.

Specialty Editor Board

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 Medical Association, American Pediatric Society, Connecticut State Medical Society, Eastern Society for Pediatric Research, and Society for Pediatric Research

Disclosure: Nothing to disclose.

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  Chairman, Professor, Department of Pediatrics, Albany Medical College

David A Clark, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Pediatric Society, Christian Medical & Dental Society, Medical Society of the State of New York, New York Academy of Sciences, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Carol L Wagner, MD  Professor of Pediatrics, Medical University of South Carolina

Carol L Wagner, MD is a member of the following medical societies: American Academy of Pediatrics, American Chemical Society, American Medical Women's Association, American Public Health Association, American Society for Bone and Mineral Research, American Society for Clinical Nutrition, Massachusetts Medical Society, National Perinatal Association, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Chief Editor

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 Medical Association, American Pediatric Society, Connecticut State Medical Society, Eastern Society for Pediatric Research, and Society for Pediatric Research

Disclosure: Nothing to disclose.

References

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