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

Polyhydramnios and Oligohydramnios: Treatment & Medication

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

Treatment

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%.

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.

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.

Medication

Most cases of polyhydramnios respond in the first week of treatment with indomethacin.4,5,6 The approach appears to be highly effective (90-100% in some studies), provided that the cause is not hydrocephalus or a neuromuscular disorder that alters fetal swallowing.

Prostaglandin inhibitors

When administered to pregnant women with polyhydramnios, these drugs can reduce fetal urinary flow, decreasing the volume of amniotic fluid.


Indomethacin (Indocin)

Rapidly absorbed; metabolism occurs in liver by demethylation, deacetylation, and glucuronide conjugation; inhibits prostaglandin synthesis.

Coadministration with aspirin increases risk of serious NSAID-related adverse effects; probenecid may increase concentrations and, possibly, toxicity of NSAIDs; may decrease effect of hydralazine, captopril, and beta-blockers; may decrease diuretic effects of furosemide and thiazides; monitor PT closely (instruct patients to watch for signs of bleeding); may increase risk of methotrexate toxicity; may increase phenytoin levels when administered concurrently

Documented hypersensitivity; GI bleeding; renal insufficiency

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Can cause fetal renal and CNS complications; associated with premature closure of the fetal ductus arteriosus when administered near term; acute renal insufficiency, hyperkalemia, hyponatremia, interstitial nephritis, and renal papillary necrosis may occur; increases risk of acute renal failure in patients with preexisting renal disease or compromised renal perfusion; reversible leukopenia may occur (discontinue if persistent leukopenia, granulocytopenia, or thrombocytopenia present).
Periventricular leukomalacia has been reported in infants whose mothers have received indomethacin as a tocolytic.

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
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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].

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Further Reading

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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

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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.

 
 
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