![]() Idiopathic polyhydramnios has also been associated with an increased risk of neonatal intensive care unit admission. As noted previously, there is an increased rate of structural abnormalities or genetic syndromes in the neonate following a gestation complicated by polyhydramnios. Planning for care of the neonate is necessary in cases of polyhydramnios. Some investigators report a higher frequency of nonreassuring fetal heart rate tracings and postpartum hemorrhage. An increased risk of operative vaginal delivery in the presence of polyhydramnios has also been reported. Rates of caesarean delivery for women with pregnancies complicated by idiopathic polyhydramnios range from 35% to 55%. Studies have also demonstrated that women with pregnancies complicated by idiopathic polyhydramnios are significantly more likely to undergo a cesarean delivery for failure to progress. Rates of dysfunctional labor are increased in the presence of polyhydramnios. External version for nonvertex fetal presentation may be considered if there are no contraindications to this procedure. Clinical or sonographic determination of the fetal presenting part should be performed upon presentation in labor. Rates of fetal nonvertex presentation are reported to increase as severity of polyhydramnios increases. If an induction is planned, it should not occur at < 39 weeks’ gestation in the absence of other indications. Labor should be allowed to occur spontaneously at term and the mode of delivery should be determined based on usual obstetric indications. Regarding timing of delivery, there are no data to suggest that induction of labor or PTB are associated with an improved outcome in the setting of mild idiopathic polyhydramnios. The role and frequency of follow-up ultrasonography is unclear, but the imaging may be warranted in cases where there is concern for progression of polyhydramnios or to evaluate fetal growth. Although antepartum surveillance is often performed in this setting, there are no data to suggest that such assessment decreases perinatal mortality. The most recent guidance from the American College of Obstetricians and Gynecologists on antepartum fetal surveillance does not specifically address isolated polyhydramnios or list it as an indication for surveillance. Mild polyhydramnios accounts for approximately 65% to 70% of cases, moderate polyhydramnios for 20%, and severe polyhydramnios for 4000 g in approximately 15% to 30% of cases. The degree of polyhydramnios is frequently categorized as mild, moderate, or severe, based on an AFI of 24.0 to 29.9 cm, 30.0 to 34.9 cm, and ≥ 35 cm, or a DVP of 8 to 11 cm, 12 to 15 cm, or ≥ 16 cm, respectively. Idiopathic polyhydramnios is usually detected in the third trimester, at a mean gestational age of 31 to 36 weeks across various series. Polyhydramnios is most often identified in the third trimester. When AFI is used, the threshold is generally considered to be 24 cm or 25 cm, depending on whether a 95th or 97th percentile is selected. When the single DVP is used, polyhydramnios is defined as a measurement ≥ 8.0 cm. Q| How is amniotic fluid volume assessed?Īfter 20 weeks’ gestation, amniotic fluid volume is assessed by usingĮither the deepest vertical pocket (DVP) or the amniotic fluid index (AFI). ![]() This summary of SMFM Consult Series #46 reviews major considerations in evaluation and management of polyhydramnios (Table 1). Idiopathic polyhydramnios accounts for approximately 60% to 70% of cases of polyhydramnios in published series and is identified in nearly 1% of pregnancies. When no etiology for the excess amniotic fluid is identified, polyhydramnios is termed “idiopathic,” or unexplained. ![]() The two most common pathologic causes of polyhydramnios are maternal diabetes mellitus and fetal anomalies. Identification of polyhydramnios should prompt a search for an underlying etiology. Polyhydramnios, or hydramnios, is an abnormal increase in the volume of amniotic fluid.
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