Materiały źródłowe

• #1

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3964358/

  Polyhydramnios is defined as a pathological increase of amniotic fluid volume in pregnancy and is associated with increased perinatal morbidity and mortality. […] To prevent the above complications, there are two methods of prenatal treatment: amnioreduction and pharmacological treatment with non-steroidal anti-inflammatory drugs (NSAIDs). […] Treatment consists of reducing the volume of amniotic fluid to improve maternal well-being and prolong the pregnancy. The following methods are used to reduce amniotic fluid volumes: amnioreduction (therapeutic amniocentesis) and pharmacological treatment. […] To date, this method has not been evaluated in randomized or controlled studies, but it offers a clear clinical benefit if done after careful diagnostic evaluation. […] Prostaglandin synthetase inhibitors stimulate fetal secretion of arginine vasopressin, resulting in vasopressin-induced antidiuresis.

• #2 Polyhydramnios – Augusta HealthSearchClose SearchSearch IconSearch IconClose Search IconMobile Menu IconMobile Menu Close IconInstagramFacebookTwitterYoutube

  https://www.augustahealth.com/disease/polyhydramnios/

  Polyhydramnios (pol-e-hi-DRAM-nee-os) is the buildup of increased amniotic fluid — the fluid that surrounds the baby in the uterus during pregnancy. Polyhydramnios happens in about 1% to 2% of pregnancies. […] If you learn that you have polyhydramnios, your health care team carefully tracks your pregnancy to help prevent health problems. Treatment depends on how serious the condition is. Mild polyhydramnios may go away on its own. Severe polyhydramnios may need to be watched more closely by your care team. […] Mild polyhydramnios rarely needs treatment. It may go away on its own. […] Otherwise, treatment for an underlying cause — such as diabetes — may help clear up polyhydramnios. […] You may need treatment in the hospital if you have severe polyhydramnios with symptoms such as shortness of breath, stomach pain or contractions. Polyhydramnios treatment may include:

• #3 Polyhydramnios – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK562140/

  Polyhydramnios is a pathological condition characterized by an excess of amniotic fluid associated with increased rates of maternal and neonatal morbidity and mortality. This condition develops when the mechanisms regulating amniotic fluid volume are disrupted, most commonly due to excess fetal urine production, impaired swallowing, or gastrointestinal obstruction. The diagnosis is made through ultrasonography when the single deepest vertical pocket of fluid is at least 8 cm or the amniotic fluid index is at least 24 cm. Polyhydramnios can be classified as mild, moderate, or severe based on these parameters. […] Antenatal treatment for mild polyhydramnios is rarely required. However, when polyhydramnios is severe, fetal pathology is often present, warranting a more comprehensive evaluation and antepartum fetal surveillance. Patients with severe polyhydramnios may experience symptoms such as dyspnea and edema, for which amnioreduction can provide relief.

• #4 The Fetal Medicine Foundation

  https://fetalmedicine.org/education/fetal-abnormalities/amniotic-fluid/polyhydramnios

  Polyhydramnios […] Prevalence: […] 1 in 100 pregnancies. […] Ultrasound diagnosis: […] The vertical measurement of the deepest pocket of amniotic fluid free of fetal parts is used to classify polyhydramnios into mild (8-11 cm), moderate (12-15 cm) and severe (≥16 cm). […] In most cases, polyhydramnios develops late in the second or in the third trimester of pregnancy. Acute polyhydramnios at 16-22 weeks is mainly seen in association with twin-to-twin transfusion syndrome. […] Associated abnormalities: […] There are essentially two major causes of polyhydramnios: […] – Reduced fetal swallowing: due to brain abnormalities (e.g anencephaly, Dandy-Walker malformation), facial tumors, gastrointestinal obstruction (e.g. esophageal or duodenal atresia, small bowel obstruction), compressive pulmonary disorders (e.g. pleural effusions, diaphragmatic hernia, CPAM, CHAOS), narrow thoracic cage due to skeletal dysplasias), and fetal akinesia deformation sequence (due to neuromuscular impairment of fetal swallowing).

• #5 Polyhydramnios – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/polyhydramnios/symptoms-causes/syc-20368493

  In polyhydramnios, increased levels of amniotic fluid accumulates in the uterus during pregnancy. […] Severe cases may require treatment. […] Treatment depends on how serious the condition is. Mild polyhydramnios may go away on its own. Severe polyhydramnios may need to be watched more closely by your care team. […] Greater health problems usually are linked with severe polyhydramnios.

• #6 Polyhydramnios – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK562140/

  The management of polyhydramnios depends on its severity and underlying cause. Mild idiopathic polyhydramnios rarely require treatment, whereas those with severe disease are more likely to experience uterine irritability, abdominal pain, or dyspnea that could benefit from treatment. […] For symptomatic patients with severe polyhydramnios, amnioreduction can be considered. Amnioreduction is an ultrasound-guided procedure that removes amniotic fluid through a large transabdominal needle, typically a 15-cm 20-gauge needle. […] In twin gestations complicated by twin-twin transfusion syndrome, amnioreduction was historically the mainstay of treatment. However, most experts now believe that selective fetoscopic laser photocoagulation (SFLP) is a superior treatment for patients with more severe diseases; SFLP treats the root cause of twin-twin transfusion syndrome and appears to be associated with superior outcomes in some studies.

• #7 Polyhydramnios – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/polyhydramnios/diagnosis-treatment/drc-20368494

  Mild polyhydramnios rarely needs treatment. It may go away on its own. […] Otherwise, treatment for an underlying cause such as diabetes may help clear up polyhydramnios. […] You may need treatment in the hospital if you have severe polyhydramnios with symptoms such as shortness of breath, stomach pain or contractions. Polyhydramnios treatment may include: […] Your health care team may use amniocentesis to drain the extra amniotic fluid from your uterus. This procedure carries a small risk of health problems. These include preterm labor, placental abruption and premature rupture of the membranes. […] Your health care professional may prescribe medicine taken by mouth called indomethacin (Indocin). It’s used for 48 hours to help decrease contractions and reduce amniotic fluid volume.

• #8 Polyhydramnios: Causes, Symptoms, Complications & Treatment

  https://my.clevelandclinic.org/health/diseases/17852-polyhydramnios

  Polyhydramnios means theres too much amniotic fluid in your uterus during pregnancy. A mild case of polyhydramnios may not cause any symptoms or problems, but more severe forms may require treatment. […] Treatment may be needed if you have severe polyhydramnios. In some cases that means treating the underlying condition (like diabetes) causing polyhydramnios. Other treatment options include: […] Draining excess amniotic fluid. […] Inducing labor before your due date, usually between 37 and 39 weeks of pregnancy. […] Polyhydramnios is generally not treated if its a mild case or if youre at the end of your pregnancy. Your provider may schedule additional appointments to monitor your condition. In most cases, monitoring your pregnancy closely is the best plan. […] Polyhydramnios is a complication of pregnancy that typically doesnt require treatment. Your provider will watch you closely and may recommend an induction. If youve been diagnosed with having too much amniotic fluid, its OK to be concerned. Talk to your pregnancy care provider about your concerns and ask any questions you have about the condition. Your provider is there to support you and make sure you and your baby are healthy. Most people with polyhydramnios have healthy babies without complications.

• #9 Polyhydramnios – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/polyhydramnios/diagnosis-treatment/drc-20368494

  After treatment, your health care team likely will want to check your amniotic fluid level about every 1 to 3 weeks. […] If you have mild to moderate polyhydramnios, your care team probably will plan to have you deliver your baby at 39 or 40 weeks. If you have severe polyhydramnios, your team likely will talk about the right timing of delivery. The goal is to lower the chances of health problems for you and your baby.

• #10 Polyhydramnios | Saint Luke’s Health System

  https://www.saintlukeskc.org/health-library/polyhydramnios

  Polyhydramnios often doesn’t go away on its own. Your healthcare provider will do regular ultrasounds to watch your amniotic fluid level. Regular prenatal care is also done to check your baby’s health. In many cases, no treatment is needed. If your provider decides that treatment is needed, it may include: […] Medicines. These help reduce the amount of fluid being made. They are rarely used beyond 32 weeks. […] Amnioreduction. This drains excess fluid from the uterus. It is done during amniocentesis. […] Induction of labor. This may be done if the pregnancy is at term or beyond. Your healthcare provider will tell you more, if needed. […] Your healthcare provider can tell you more about the cause of your high amniotic fluid level. They can also talk with you about any needed treatments.

• #11 Polyhydramnios (too much amniotic fluid)

  https://www.nhs.uk/conditions/polyhydramnios/

  Polyhydramnios (too much amniotic fluid) usually does not need any treatment. You may have extra check-ups for the rest of your pregnancy and during labour and birth. […] If the polyhydramnios is caused by a condition such as gestational diabetes, you’ll be treated for the condition. […] If you have severe polyhydramnios, you may have some of the amniotic fluid drained from your womb using a thin needle. You may need this treatment more than once. You’ll be monitored afterwards to check your fluid levels.

• #12 Polyhydramnios | March of Dimes

  https://www.marchofdimes.org/find-support/topics/planning-baby/polyhydramnios

  Polyhydramnios happens when there is too much amniotic fluid around your baby during pregnancy. […] How is polyhydramnios treated? […] When an ultrasound shows you have too much amniotic fluid, your provider does a more detailed ultrasound to check for birth defects and twin-to-twin transfusion syndrome. […] Your provider also may recommend a blood test for diabetes and an amniocentesis. Amniocentesis is a test that takes some amniotic fluid from around the baby to check for problems, like birth defects and genetic conditions in your baby. […] In many cases, slight polyhydramnios goes away by itself. Other times, it may go away when the problem causing it is fixed. For example, if your babys heart rate is causing the problem, sometimes your provider can give you medicine to fix it.

• #13 Polyhydramnios (Causes, Symptoms, and Treatment)

  https://patient.info/doctor/polyhydramnios

  Polyhydramnios treatment and management […] Management is undertaken in secondary care. There are no guidelines or large studies to guide management decisions. […] The first step is to identify if there is an underlying cause. […] Identified causes are treated as appropriate. Fetal hydrops anaemia is treated with intravascular transfusion. If gestational diabetes is diagnosed, tight glycaemic control should be maintained. This may involve dietary manipulation, oral medication or insulin. […] Mild polyhydramnios can be simply monitored and treated conservatively. […] Preterm labour is common due to overdistension of the uterus, and measures should be taken to minimise this complication. This includes regular antenatal checks and inspection of the uterus. Serial ultrasound scans should be carried out to monitor the AFI and fetal growth.

• #14 What Is Polyhydramnios? Causes, Symptoms, and More

  https://www.webmd.com/baby/what-to-know-about-polyhydramnios

  Polyhydramnios makes the womb larger than normal. It can affect your pregnancy. […] If you have severe polyhydramnios, you may have early labor, breathing problems, or abdominal pain. In such cases, you may need immediate treatment and even hospitalization. […] Polyhydramnios treatment includes: […] Your doctor will drain the excess amniotic fluid from your womb. They may use amniocentesis to remove the fluid. However, the drainage procedure has some risk of complications such as early labor, detachment of the placenta, and rupture of the amniotic sac. […] Your doctor may prescribe oral medicines such as indomethacin (Indocin). It helps reduce your babys urine production and amniotic fluid levels. However, it must be taken before 31 weeks of pregnancy. […] After polyhydramnios treatment, your doctor will continue to monitor your amniotic fluid level every few weeks. Understand that most expectant mothers with polyhydramnios have mildly increased amniotic fluid levels and will not need these kinds of treatments.

• #15 Treatment & Monitoring of Polyhydramnios: | Know Polyhydramnios

  https://polyhydramnios.org/learn-more-about-polyhydramnios/treatment-and-management-of-polyhydramnios/

  There is no treatment for Polyhydramnios, but there are ways to manage the condition. […] Monitoring and management methods include management of the underlying condition (when possible), fetal surveillance, reducing fluid, and creating an effective care plan. […] Certain underlying conditions that are known to cause Polyhydramnios can be managed effectively and may reduce the level of fluid when done correctly. […] Amnioreduction is considered safe to use in extreme circumstances. […] Amnioreduction is done for the purpose of providing maternal relief from the symptoms of severe Polyhydramnios, and to help reduce the risk of preterm birth. […] Amnioreduction is not a long-term treatment. The effects of amnioreduction only last a few weeks at the most because it does not treat the underlying condition causing the Polyhydramnios. It is only used to provide relief to symptomatic mothers and to attempt to prolong the pregnancy.

• #16 Polyhydramnios in Pregnancy – Miracle Babies

  https://www.miraclebabies.org.au/Polyhydramnios-in-Pregnancy

  Polyhydramnios is the condition of having an excessive accumulation of amniotic fluid that surrounds the baby in the uterus. […] Mild cases of polyhydramnios rarely require treatment and may go away on their own. Even cases that cause discomfort can usually be managed without intervention. […] If you experience preterm labour, shortness of breath or abdominal pain, you may need treatment potentially in the hospital. […] Treatment may include drainage of excess amniotic fluid. Your health care provider may use amniocentesis to drain excess amniotic fluid from your uterus. This procedure carries a small risk of complications, including preterm labour, placental abruption and premature rupture of the membranes. […] Your health care provider may prescribe the oral medication indomethacin (Indocin) to help reduce fetal urine production and amniotic fluid volume. Indomethacin isn’t recommended beyond 31 weeks of pregnancy. Due to the risk of fetal heart problems, your baby’s heart may need to be monitored with a fetal echocardiogram and Doppler ultrasound. Other side effects may include nausea, vomiting, acid reflux and inflammation of the lining of the stomach (gastritis).

• #17 Polyhydramnios

  https://www.mymlc.com/health-information/diseases-and-conditions/p/polyhydramnios2/?section=Causes

  Polyhydramnios (pol-e-hi-DRAM-nee-os) is the excessive accumulation of amniotic fluid — the fluid that surrounds the baby in the uterus during pregnancy. Polyhydramnios occurs in about 1 to 2 percent of pregnancies. […] If you’re diagnosed with polyhydramnios, your health care provider will carefully monitor your pregnancy to help prevent complications. Treatment depends on the severity of the condition. Mild polyhydramnios may go away on its own. Severe polyhydramnios may require closer monitoring. […] In other cases, treatment for an underlying condition — such as diabetes — may help resolve polyhydramnios. […] If you experience preterm labor, shortness of breath or abdominal pain, you may need treatment — potentially in the hospital. Treatment may include: […] Drainage of excess amniotic fluid. Your health care provider may use amniocentesis to drain excess amniotic fluid from your uterus. This procedure carries a small risk of complications, including preterm labor, placental abruption and premature rupture of the membranes.

• #17 Polyhydramnios

  https://www.mymlc.com/health-information/diseases-and-conditions/p/polyhydramnios2/?section=Causes

  Medication. Your health care provider may prescribe the oral medication indomethacin (Indocin) to help reduce fetal urine production and amniotic fluid volume. Indomethacin isn’t recommended beyond 31 weeks of pregnancy. […] After treatment, your doctor will still want to monitor your amniotic fluid level approximately every one to three weeks. […] If you have mild to moderate polyhydramnios, you’ll likely be able to carry your baby to term, delivering at 39 or 40 weeks. If you have severe polyhydramnios, your health care provider will discuss the appropriate timing of delivery, to avoid complications for you and your baby. […] Polyhydramnios can be a worrisome finding during pregnancy. Work with your pregnancy care provider to ensure that you and your baby receive the best possible care.

• #18 Polyhydramnios (Causes, Symptoms, and Treatment)

  https://patient.info/doctor/polyhydramnios

  Amnioreduction (drainage of amniotic fluid under ultrasound guidance) is also used in cases where indometacin is contra-indicated, in severe polyhydramnios, or in patients who are symptomatic. It is more commonly used in twin-to-twin transfusion syndrome. There are few studies but those that exist suggest it is safe and effective, although serial procedures may be required. […] Polyhydramnios associated with twin-to-twin syndrome may also benefit from laser ablation of the connecting placental vessels.

• #19 Polyhydramnios – Gynecology and Obstetrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/gynecology-and-obstetrics/antenatal-complications/polyhydramnios

  Polyhydramnios is excessive amniotic fluid; it is associated with maternal and fetal complications. […] Management is by treating maternal disorders contributing to polyhydramnios. If symptoms are severe or if painful preterm contractions occur, treatment may also include manual reduction of amniotic fluid volume. […] Treatment of Polyhydramnios includes delivery at about 39 weeks and possibly manual withdrawal of amniotic fluid (amnioreduction). […] Reducing amniotic fluid volume (eg, by amnioreduction) or reducing its production should be considered only if polyhydramnios causes severe maternal discomfort. […] There is no consensus on how much fluid to remove and how rapidly it should be removed, although removal of approximately 1 L over 20 minutes has been suggested.

• #20 Polyhydramnios (Causes, Symptoms, and Treatment)

  https://patient.info/doctor/polyhydramnios

  Induction of labour should be considered if fetal distress develops. Induction by artificial rupture of the membranes (ARM) should be controlled, performed by an obstetrician and with consent to proceed to lower-segment caesarean section if required. […] Corticosteroids should be given to the mother antenatally if preterm delivery is imminent or considered. This helps to improve lung maturity. […] Prostaglandin synthetase inhibitors, particularly indometacin, may be used. This acts at least partly by reducing renal blood flow and reducing fetal urination. It is used usually for a maximum of 48 hours and regimes vary. It is not used in twin-to-twin syndrome or after 32 weeks, as adverse effects outweigh benefits in these cases. The main risk is fetal ductus arteriosus constriction and the risk increases with gestation.

• #21 Polyhydramnios

  https://johnsonmemorial.org/jmh-health/disease-conditions/con-20339036

  Your health care professional may prescribe medicine taken by mouth called indomethacin (Indocin). It’s used for 48 hours to help decrease contractions and reduce amniotic fluid volume. […] After treatment, your health care team likely will want to check your amniotic fluid level about every 1 to 3 weeks. […] If you have mild to moderate polyhydramnios, your care team probably will plan to have you deliver your baby at 39 or 40 weeks. If you have severe polyhydramnios, your team likely will talk about the right timing of delivery. The goal is to lower the chances of health problems for you and your baby.

• #22 Polyhydramnios – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK562140/

  Indomethacin is a prostaglandin synthetase inhibitor that decreases fetal urine output and amniotic fluid volume, in addition to reducing uterine irritability in preterm patients. However, indomethacin is associated with adverse fetal and neonatal outcomes, such as periventricular leukomalacia, severe intraventricular hemorrhage, and necrotizing enterocolitis, when administered after 32 weeks of gestation. […] The delivery timing depends on the severity of polyhydramnios and the presence and severity of any underlying conditions or complications, such as congenital anomalies, preterm prelabor rupture of membranes, and placental abruption. Patients with underlying pathology should be treated according to recommendations specific to the pathology, and those with severe polyhydramnios should be delivered at a tertiary facility due to significant potential increases in maternal and neonatal morbidity and mortality.

• #23 Polyhydramnios in Pregnancy: Too Much Amniotic Fluid in the Third Trimester | Know Polyhydramnios

  https://polyhydramnios.org/learn-more-about-polyhydramnios/polyhydramnios-in-pregnancy/

  In cases of very severe amniotic fluid levels, amnioreduction can be used to temporarily reduce fluid levels in order to prolong a pregnancy at risk of preterm delivery. […] Indomethacin is a medication usually given to stop preterm labor during the second trimester. One of the effects of indomethacin is to reduce amniotic fluid levels. Even though it does temporarily reduce fluid levels, the SMFM does NOT RECOMMEND the use of indomethacin for the sole purpose of reducing fluid due to the risks of heart complications to the unborn baby. […] Lowering fluid levels can sometimes help to reduce the risks of Polyhydramnios, especially during labor and delivery. […] However, reducing amniotic fluid does not take away what caused it to be high in the first place. […] Cases caused by certain underlying diseases, such as diabetes or fetal heart problems, require effective management of the underlying disease and close monitoring of both mother and baby.

• #23 Polyhydramnios in Pregnancy: Too Much Amniotic Fluid in the Third Trimester | Know Polyhydramnios

  https://polyhydramnios.org/learn-more-about-polyhydramnios/polyhydramnios-in-pregnancy/

  Polyhydramnios is a pregnancy complication involving too much amniotic fluid that requires careful monitoring during the third trimester. […] Treatment for Polyhydramnios depends on the cause and the severity of each individual case. It usually involves the effective management of known conditions. […] Mild, idiopathic cases may not require any special treatment, but should still be monitored for potential changes. Fetal surveillance is recommended every other week until 37 weeks, then weekly until delivery. […] Moderate/severe idiopathic cases need closer monitoring of both mother and baby. Fetal surveillance is recommended weekly either until Polyhydramnios resolves or until delivery. […] Polyhydramnios complicated by other high-risk factors such as the early onset of severe Polyhydramnios, Polyhydramnios complicated by IUGR, or Polyhydramnios accompanied by known fetal anomalies should be considered very concerning. These cases require twice-weekly fetal surveillance, referral to genetics and a maternal-fetal medicine specialist, and possible interventions like amnioreduction.

• #24 Treatment & Monitoring of Polyhydramnios: | Know Polyhydramnios

  https://polyhydramnios.org/learn-more-about-polyhydramnios/treatment-and-management-of-polyhydramnios/

  The most commonly used prostaglandin inhibitor is calledIndomethacinand its primary medical use is to delay preterm labor for up to 48 hours so that other interventions, such as steroid injections, can be administered. […] Although indomethacin does reduce the amount of amniotic fluid surrounding a baby, the Society for Maternal-Fetal Medicine recommends that indomethacin NOT be used for the sole purpose of reducing amniotic fluid in the setting of Polyhydramnios.

• #25

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3964358/

  However, prostaglandin synthetase inhibitors have not been approved for this indication in pregnancy in Germany. […] Sulindac is a non-steroidal anti-inflammatory drug; use of sulindac can also lead to a reduction of amniotic fluid volume. […] As fetal urine production constitutes the main source of amniotic fluid and changes in urine production can significantly change the dynamics of amniotic fluid volumes, the effect of intra-amniotic administration of arginine vasopressin was investigated. […] Another potential therapy is based on mRNA expression in chorion and amnion cells of aquaporin (AQP) 1, 8 und 9 in amniotic fluid, which is increased in polyhydramnios.

• #26 Mayo Clinic Health Library – Polyhydramnios | Swiss Medical Network

  https://www.swissmedical.net/en/healtcare-library/con-20339036

  Drainage of extra amniotic fluid. Your health care team may use amniocentesis to drain the extra amniotic fluid from your uterus. […] Medicine. Your health care professional may prescribe medicine taken by mouth called indomethacin (Indocin). It’s used for 48 hours to help decrease contractions and reduce amniotic fluid volume. […] After treatment, your health care team likely will want to check your amniotic fluid level about every 1 to 3 weeks. […] If you have mild to moderate polyhydramnios, your care team probably will plan to have you deliver your baby at 39 or 40 weeks. If you have severe polyhydramnios, your team likely will talk about the right timing of delivery. The goal is to lower the chances of health problems for you and your baby.

• #27 The Fetal Medicine Foundation

  https://fetalmedicine.org/education/fetal-abnormalities/amniotic-fluid/polyhydramnios

  – Increased fetal urination: maternal diabetes mellitus and maternal uremia (increased glucose and urea cause osmotic diuresis), hyperdynamic fetal circulation due to fetal anemia (e.g. red blood cell isoimmunization or congenital infection), fetal and placental tumors (e.g. sacrococcygeal teratoma, placental chorioangioma), or twin-to-twin transfusion syndrome. […] Investigations: […] Detailed ultrasound examination. […] Glucose tolerance test if there is associated macrosomia. […] TORCH test if there are fetal features suggestive of infection. […] Follow up: […] Ultrasound scans every 1-3 weeks to monitor fetal condition, amniotic fluid volume and cervical length. […] Prenatal therapy: […] Maternal diabetes mellitus: good glycemic control. […] Defects resulting in reduced fetal swallowing or severe idiopathic polyhydramnios: serial amniodrainages if there is cervical shortening. However, the procedure itself may precipitate premature labor. An alternative and effective method of treatment is maternal administration of indomethacin; however, this drug may cause fetal ductal constriction, and close monitoring by serial fetal echocardiographic studies is necessary.

• #28 Polyhydramnios and Oligohydramnios Treatment & Management: Approach Considerations, Medical Care, Consultations

  https://emedicine.medscape.com/article/975821-treatment

  Consider hospitalizing and thoroughly evaluating the mother in cases diagnosed after 26-33 weeks’ gestation. […] 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 the amniotic fluid volume. […] If meconium is present during labor, administer amnioinfusion therapy to reduce the potential for fetal distress and prenatal aspiration. […] Patients with polyhydramnios tend to have a higher incidence of preterm labor secondary to overdistention of the uterus. […] 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.

• #29 Polyhydramnios | Altru Health System

  https://www.altru.org/health-library/conditions/polyhydramnios

  Your health care team may use amniocentesis to drain the extra amniotic fluid from your uterus. This procedure carries a small risk of health problems. […] Your health care professional may prescribe medicine taken by mouth called indomethacin (Indocin). It’s used for 48 hours to help decrease contractions and reduce amniotic fluid volume. […] After treatment, your health care team likely will want to check your amniotic fluid level about every 1 to 3 weeks. […] If you have mild to moderate polyhydramnios, your care team probably will plan to have you deliver your baby at 39 or 40 weeks. If you have severe polyhydramnios, your team likely will talk about the right timing of delivery. The goal is to lower the chances of health problems for you and your baby.

• #30 The Fetal Medicine Foundation

  https://fetalmedicine.org/education/fetal-abnormalities/amniotic-fluid/polyhydramnios

  Delivery: […] Standard obstetric care and delivery in most cases. […] Severe polyhydramnios: controlled induction and membrane rupture at 38 weeks gestation to avoid risk of umbilical cord prolapse. […] Prognosis: […] This depends on the cause of polyhydramnios and the gestational age at delivery.

• #31 Management of Symptomatic Polyhydramnios

  https://exxcellence.org/list-of-pearls/management-of-symptomatic-polyhydramnios/?categoryName=&searchTerms=&featured=False

  Polyhydramnios is an excessive amount of amniotic fluid relative to gestational age. […] For moderate to severe polyhydramnios, antenatal testing should be considered at 32-34 weeks gestation along with serial ultrasound evaluation to monitor amniotic fluid levels and fetal growth. […] In cases of severe or symptomatic polyhydramnios, amnioreduction may be performed. […] Delivery is recommended no later than 39-40 weeks. Severe and symptomatic situations require balancing the risks of early delivery against the risks of the interventions. Polyhydramnios is not itself an indication for cesarean delivery.

• #32 Too Much Amniotic Fluid: Should I Be Concerned About Polyhydramnios?

  https://www.healthline.com/health/pregnancy/too-much-amniotic-fluid

  Polyhydramnios is a condition where a woman simply has too much amniotic fluid during her pregnancy. […] If your doctor suspects polyhydramnios, the very first thing they’ll do is order additional testing to ensure that there’s nothing wrong with your baby. Mild to moderate polyhydramnios may need no additional treatment other than monitoring. […] Only in very rare, severe cases is treatment considered. This includes medication and draining the excess amniotic fluid. […] You can expect more frequent monitoring and testing, and many doctors will discuss a cesarean delivery if they feel the baby is too large, or breech or vaginal birth is too risky.

• #33 Polyhydramnios | Texas Children’s

  https://www.texaschildrens.org/content/conditions/polyhydramnios

  Polyhydramnios is a condition in which there is too much amniotic fluid during pregnancy, the fluid that surrounds the developing fetus. Excess amniotic fluid can put both mother and baby at risk of complications. […] Treatment will depend on the severity and cause of the amniotic fluid buildup. Treatment may include: […] Amnioreduction, a procedure used in severe cases to withdraw amniotic fluid, reducing the risk of preterm labor (similar to an amniocentesis). […] Delivery and postnatal care should be carefully planned and coordinated with a team of maternal-fetal medicine specialists, neonatologists, and pediatric specialists experienced in working together to treat pregnancies involving rare amniotic fluid conditions, and any associated birth defects, ensuring the best possible care beginning at birth. […] Treatment needs at birth vary for each baby depending on the severity and underlying cause of the excess amniotic fluid and the presence of any associated birth defects or genetic conditions.

• #34 Polyhydramnios and Oligohydramnios Treatment & Management: Approach Considerations, Medical Care, Consultations

  https://emedicine.medscape.com/article/975821-treatment

  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 diet. Insulin is rarely needed. […] Studies show that oral hydration, by having the women drink 2 liters of water, increases the AFI by 30%. […] Maternal hydration therapy improves the quantity of amniotic fluid and the pregnancy outcome in third-trimester isolated oligohydramnios: a controlled randomized institutional trial. […] Treatment of symptomatic polyhydramnios with indomethacin. […] Treatment of polyhydramnios with indomethacin. […] Maternal indomethacin therapy in the treatment of polyhydramnios.

• #35 Polyhydramnios – Causes – Management – Prognosis – TeachMeObGyn

  https://teachmeobgyn.com/pregnancy/fetal-abnormality/polyhydramnios/

  Polyhydramnios refers to an abnormally large level of amniotic fluid during pregnancy. […] It is defined by an amniotic fluid index that is above the 95th centile for gestational age. […] In this article, we shall look at the causes, clinical assessment and management of polyhydramnios. […] No medical intervention is required in the majority of women with polyhydramnios. […] If the maternal symptoms are severe (e.g breathlessness), an aminoreduction can be considered. It is associated with infection and placental abruption (due to a sudden decrease in intrauterine pressure), and is therefore not performed routinely. […] Indomethacin can be used to enhance water retention, and thus reduces fetal urine output. It is associated with premature closure of the ductus arteriosus and therefore should not be used beyond 32 weeks. […] In cases of idiopathic polyhydramnios, the baby must be examined before its first feed by a paediatrician. A nasogastric tube should be passed to ensure there is not a tracheoesophageal fistula or oesophageal atresia.

• #36

  https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=acd3785

  Having too much of this fluid is called polyhydramnios. It means that there’s more fluid around your baby than there should be. […] In most cases, treatment is not needed. Sometimes the problem gets better over time. […] If it is causing problems for you or your baby, you may need treatment. The type of treatment you get depends on how much amniotic fluid you have. It also depends on how far along you are in your pregnancy and what your symptoms are. […] In rare cases, your doctor may use a needle to remove extra fluid from the amniotic sac. Or you may be given medicine. […] Depending on your health and the health of your baby, your doctor or midwife may recommend having your baby early. […] Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse advice line if you are having problems.

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