gynecology and obstetrics
Polyhydramnios
Treatment of Polyhydramnios
Delivery at about 39 weeks Possibly manual withdrawal of amniotic fluid (amnioreduction) Recommendations for prenatal monitoring depend on the severity of polyhydramnios, based on AFI: AFI ≥ 30 cm (which increases risk of fetal death): Prenatal monitoring should begin as early as 32 weeks or whenever it is diagnosed thereafter; it should include nonstress testing at least once a week. However, such monitoring has not been proved to decrease the fetal death rate. AFI ≥ 24 to < 30 cm: Prenatal monitoring with nonstress testing is recommended ( Treament reference ). All degrees of polyhydramnios: Ultrasonography should be done every 4 weeks to check for macrosomia and to evaluate fetal anatomy. Delivery at about 39 weeks should be planned. Mode of delivery should be based on the usual obstetrical indications (eg, presenting part). Reducing amniotic fluid volume (eg, by amnioreduction) or reducing its production should be considered only if preterm labor occurs or if polyhydramnios causes severe maternal symptoms; however, there is no evidence that this approach improves outcomes. Also, there is no consensus on how much fluid to remove and how rapidly it should be removed, although removal of about 1 L over 20 minutes has been suggested. Disorders that could be contributing to polyhydramnios (eg, maternal diabetes) should be controlled. 1.Society for Maternal-Fetal Medicine (SMFM); Dashe JS, Pressman, EK, Hibbard JU: SMFM Consult Series #46: Evaluation and management of polyhydramnios.Am J Obstet Gynecol219 (4):B2–B8, 2018. doi: 10.1016/j.ajog.2018.07.016 Epub 2018 Jul 23. 