POLYHYDRAMNIOS OLIGOHYDRAMNIOS CARE
Category: Child Health
Abstract : Medical Care: The first step is identifying the etiology of the abnormal volume
of amniotic fluid. Medical care includes use of steroids to enhance fetal lung
maturity if preterm delivery is anticipated. • Polyhydramnios o
Patients with polyhydramnios tend to have a higher incidence of preterm labor
secondary to overdistention of the uterus. o Schedule weekly or twice we
Medical Care: The first step is identifying the etiology of the abnormal volume
of amniotic fluid. Medical care includes use of steroids to enhance fetal lung
maturity if preterm delivery is anticipated.
• Polyhydramnios
o
Patients with polyhydramnios tend to have a higher incidence of preterm labor
secondary to overdistention of the uterus.
o Schedule weekly or twice weekly
perinatal visits and cervical examinations.
o Place patients on bed rest to
decrease the likelihood of preterm labor.
o Perform serial ultrasonography to
determine the AFI and document fetal growth.
o In some cases of
polyhydramnios associated with fetal hydrops, the direct intravascular
transfusion of erythrocytes may increase the fetal survival rate.
•
Oligohydramnios
o Maternal bed rest and hydration promote the production of
amniotic fluid by increasing the maternal intravascular space.
o 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
may be helpful in significant oligohydramnios or polyhydramnios, 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 genetics
other specialist 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.
Most
cases of polyhydramnios respond in the first week of treatment with
indomethacin. The approach appears to be highly effective (90-100% in some
studies), provided that the cause is not hydrocephalus or a neuromuscular
disorder that alter fetal swallowing.
Drug Category: Prostaglandin
inhibitors -- When administered to pregnant women with polyhydramnios, these
drugs can reduce fetal urinary flow, decreasing the volume of amniotic
fluid.
Further Inpatient Care:
• Polyhydramnios: See recommendations
for oligohydramnios below.
• Oligohydramnios
o Consider hospitalizing
and thoroughly evaluating the mother in cases diagnosed after 26-33 weeks'
gestation.
o If the fetus does not have an anomaly, delivery should be
performed if the biophysical profile is nonreassuring.
o 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.
o 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.
o If meconium is present during labor,
administer amnioinfusion therapy to reduce the potential for fetal distress and
prenatal aspiration.
Transfer:
• Transfer 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
o 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.
o
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
o The primary complications are those
related to fetal distress before or during labor.
o The risk of fetal
infection is increased in the presence of prolonged rupture of the
membranes.
Prognosis:
• Polyhydramnios
o If the condition is not
associated with any other findings, the prognosis is usually good.
o
According Desmedt et al, the PMR in polyhydramnios associated with a fetal or
placental malformation was 61%.
o 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.
o Studies
show that, as the severity of polyhydramnios increases, so does the likelihood
of determining the etiology.
o 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
o In renal agenesis,
the mortality rate is 100%.
o Milder forms of renal dysplasia or obstructive
uropathy can be associated with mild-to-severe forms of pulmonary hypoplasia and
long-term renal failure.
o 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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