Pediatric Polyhydramnios and Oligohydramnios Treatment & Management

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

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 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.
  • Oligohydramnios
    • 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.[7]
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Consultations

  • 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.
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Diet

  • 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.
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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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