eMedicine Specialties > Pediatrics: Cardiac Disease and Critical Care Medicine > Neonatology

Polyhydramnios and Oligohydramnios: Follow-up

Author: Roland L Boyd, DO, FAAP, FACOP, Neonatologist, Section of Neonatology, Neonatal Services Limited
Coauthor(s): Brian S Carter, MD, FAAP, Professor of Pediatrics, Department of Pediatrics, Division of Neonatology, Vanderbilt University School of Medicine; Co-director, Pediatric Advance Comfort Team, Vanderbilt Children's Hospital
Contributor Information and Disclosures

Updated: Feb 14, 2008

Follow-up

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.

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.

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.

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%.7
    • 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.

Miscellaneous

Medicolegal Pitfalls

  • Failure to perform ultrasonography in a pregnancy complicated by either polyhydramnios or oligohydramnios to investigate associated or contributory fetal anomalies
  • The underlying anomalies may determine the outcome of the fetus, as well as the treatment and outcome of the neonate. As appropriate, specialists should be consulted, and the patient should be transferred in a timely fashion to optimize the outcome of the pregnancy and to reduce the risk of perinatal mortality.
 


More on Polyhydramnios and Oligohydramnios

Overview: Polyhydramnios and Oligohydramnios
Differential Diagnoses & Workup: Polyhydramnios and Oligohydramnios
Treatment & Medication: Polyhydramnios and Oligohydramnios
Follow-up: Polyhydramnios and Oligohydramnios
References
[ CLOSE WINDOW ]

References

  1. 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. Oct 1 1984;150(3):250-4. [Medline].

  2. 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. May 1990;162(5):1344-5. [Medline].

  3. Abdel-Fattah SA, Carroll SG, Kyle PM, Soothill PW. Amnioreduction: how much to drain?. Fetal Diagn Ther. Sep-Oct 1999;14(5):279-82. [Medline].

  4. Cabrol D, Jannet D, Pannier E. Treatment of symptomatic polyhydramnios with indomethacin. Eur J Obstet Gynecol Reprod Biol. May 1996;66(1):11-5. [Medline].

  5. Kramer WB, Van den Veyver IB, Kirshon B. Treatment of polyhydramnios with indomethacin. Clin Perinatol. Sep 1994;21(3):615-30. [Medline].

  6. Mamopoulos M, Assimakopoulos E, Reece EA, et al. Maternal indomethacin therapy in the treatment of polyhydramnios. Am J Obstet Gynecol. May 1990;162(5):1225-9. [Medline].

  7. Desmedt EJ, Henry OA, Beischer NA. Polyhydramnios and associated maternal and fetal complications in singleton pregnancies. Br J Obstet Gynaecol. Dec 1990;97(12):1115-22. [Medline].

  8. Biggio JR Jr, Wenstrom KD, Dubard MB, Cliver SP. Hydramnios prediction of adverse perinatal outcome. Obstet Gynecol. Nov 1999;94(5 Pt 1):773-7. [Medline].

  9. Brace RA, Resnik R. Dynamics and disorders of amniotic fluid. In: Creasy RK, Resnik R, eds. Maternal-Fetal Medicine. 4th ed. 1999:632-43.

  10. Fanaroff AA, Martin RJ. Diseases of the fetus and infant. In: Neonatal-Perinatal Medicine. 6th ed. 1997:315-9.

  11. Harrison MR, Golbus MS, Filly RA. Prenatal diagnosis and treatment. In: The Unborn Patient. 2nd ed. 1990:139-49.

  12. Hill LM, Breckle R, Thomas ML, Fries JK. Polyhydramnios: ultrasonically detected prevalence and neonatal outcome. Obstet Gynecol. Jan 1987;69(1):21-5. [Medline].

  13. Jones KL. Oligohydramnios sequence. In: Smith's Recognizable Patterns of Human Malformation. 5th ed. 1997.

  14. 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. Feb 1999;3(1):48-61. [Medline].

  15. Macri CJ, Schrimmer DB, Leung A, et al. Prophylactic amnioinfusion improves outcome of pregnancy complicated by thick meconium and oligohydramnios. Am J Obstet Gynecol. Jul 1992;167(1):117-21. [Medline].

  16. Morales WJ, Talley T. Premature rupture of membranes at <25 weeks: a management dilemma. Am J Obstet Gynecol. Feb 1993;168(2):503-7. [Medline].

  17. Phelan JP, Ahn MO, Smith CV, et al. Amniotic fluid index measurements during pregnancy. J Reprod Med. Aug 1987;32(8):601-4. [Medline].

  18. Pitt C, Sanchez-Ramos L, Kaunitz AM, Gaudier F. Prophylactic amnioinfusion for intrapartum oligohydramnios: a meta- analysis of randomized controlled trials. Obstet Gynecol. Nov 2000;96(5 Pt 2):861-6. [Medline].

  19. 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. Sep 1993;10(5):369-73. [Medline].

  20. Schumacher B, Moise KJ Jr. Fetal transfusion for red blood cell alloimmunization in pregnancy. Obstet Gynecol. Jul 1996;88(1):137-50. [Medline].

  21. Vergani P, Ghidini A, Locatelli A, et al. Risk factors for pulmonary hypoplasia in second-trimester premature rupture of membranes. Am J Obstet Gynecol. May 1994;170(5 Pt 1):1359-64. [Medline].

  22. 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. May 2000;90(1):67-71. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

polyhydramnios, oligohydramnios, too much amniotic fluid, too little amniotic fluid, oligoamnios, oligamnios, fetal lung development, membrane rupture, fetal urine, fetal swallowing, Potter syndrome, premature rupture of the membranes, PROM, abruptio placenta, malpresentation, cesarean delivery, postpartum hemorrhage, pulmonary hypoplasia, meconium staining of the amniotic fluid, fetal heart conduction abnormalities, umbilical cord compression, poor tolerance of labor, lower Apgar scores, fetal acidosis, intrauterine growth restriction, IUGR, multiple gestations, neonatal macrosomia, fetal hydrops, neonatal hydrops, ascites, pleural effusion, pericardial effusion, GI tract obstruction, duodenal atresia, tracheoesophageal fistula, Potter syndrome, multicystic-dysplastic kidney, enlarged urinary bladder, prune-belly syndrome

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Roland L Boyd, DO, FAAP, FACOP, Neonatologist, Section of Neonatology, Neonatal Services Limited
Roland L Boyd, DO, FAAP, FACOP 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.

Coauthor(s)

Brian S Carter, MD, FAAP, Professor of Pediatrics, Department of Pediatrics, Division of Neonatology, Vanderbilt University School of Medicine; Co-director, Pediatric Advance Comfort Team, Vanderbilt Children's Hospital
Brian S Carter, MD, FAAP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, National Hospice and Palliative Care Organization, and National Perinatal Association
Disclosure: Nothing to disclose.

Medical Editor

Ted Rosenkrantz, MD, Head, Division of Neonatal-Perinatal Medicine, Professor, Departments of Pediatrics and Obstetrics/Gynecology, 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.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine.com, Inc
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

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.

CME Editor

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, Head, Division of Neonatal-Perinatal Medicine, Professor, Departments of Pediatrics and Obstetrics/Gynecology, 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.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.