Maternal and Fetal Outcomes in Pregnant Women With Polyhydramnios Treated Based on Maternal and Fetal Distress and Preterm Delivery

Polyhydramnios is a medical condition describing an excess of amniotic fluid in the amniotic sac which can be seen in 1%-2% of women. The overall prevalence of this condition is reported on 750 pregnancies. Patients suffered from polyhydramnios often referred to hospitals complaining about discomfort in the abdomen and respiratory distress. Abnormal magnitude of the uterus (compared to gestational age) along with difficulty touching embryonic organs and problems associated with fetus auscultation can be observed on physical examination. A definitive diagnosis is ultimately possible through ultrasound and by measuring the ammonic fluid index. Amniotic fluid index (AFI) more than 25 cm is considered as polyhydramnios, accordingly (1). Polyhydramnios may be associated with fetal and maternal complications such as respiratory distress, thromboembolism, preterm labor, atonic uterus, anemia, caesarean section, premature fetus, umbilical cord prolapse caused by the rupture of the membranes and fetal distress (2-4). Common treatment methods of polyhydramnios pregnancies include examination of maternal risk factors (diabetes, viral hepatitis, syphilis and other torch infections and addiction) and examination of fetal risk factors (hydrops fetalis, esophageal atresia, gastroschisis, anencephaly, diaphragmatic hernia, placental chorioangioma, severe anemia, heart problems and chromosomal abnormalities). In mild cases, simple control and follow-ups, continuous ultrasound and conservative treatment methods Abstract Objectives: Polyhydramnios is a condition that could be along with significant maternal, fetal and neonatal consequences. One of the most important complications of this condition is preterm labor and delivery of preterm neonates. Although in mild cases expectant conservative management is effective, in more severe cases, medications (such as indomethacin) and amnioreduction could be considered. Each one of these methods could be accompanied with complications. This study aims to examine the results of management of patients with polyhydramnios according to the fetal and maternal distress and preterm labor criteria. Materials and Methods: In this descriptive-analytic setting, 26 pregnant mothers with polyhydramnios (amniotic fluid index [AFI] more than 30) were managed according to the fetal and maternal distress and preterm labor criteria. In cases under 32 gestational weeks, indomethacin was used with an initial dose of 25 mg every 6 hours and a maximum dose of 2-3 mg/kg that was tapered when the AFI diminished. In refractory cases, the flowchart of fetal and maternal distress and preterm labor was employed. In pregnancies aged over 32 weeks, in case of maternal distress amnioreduction was performed, and in asymptomatic patients, cervical length, funneling, color Doppler and placental thickness were evaluated and in normal cases controlling was carried every 1-2 weeks and abnormal cases amnioreduction was carried out. Results: The mean age of studies patients was 28.12 ± 7.22 years and the mean pregnancy age was 232.23 ± 23.57 days. On this basis, there were 8 patients under 32 gestational weeks, in which indomethacin was administered and a response to treatment was seen in the week 1. All cases have increased amniotic fluid again in week 2. In 2 cases, re-administration was done. All patients including those aged over 32 weeks and those who reached 32 weeks by using indomethacin were managed according to the suggested algorithm. Symptoms indicating maternal distress was present in 3 patients (11.5%), 2 of them were treated with amnioreduction and the other one did not give consent and pregnancy termination was carried out at the age of 29 gestational weeks due to cord prolapse. In 2 cases with amnioreduction, the pregnancy reached to term. The mean cervical length was 32.38 ± 2.38 mm and dilatation or funneling was not present. Decreased placental thickness, placental malfunction and abnormal placental circulation were not detected. Except for the one mentioned case, all pregnancies were terminated over 34 gestational weeks, and besides a case with prolapse, no other maternal, fetal or neonatal complication was observed. Conclusion: The effect of indomethacin was temporary and this medication could be used safely. The beginning of delivery is suddenly in these patients and is not predictable by cervical changes. The placenta was normal in all cases in the current study. In case of maternal distress, amnioreduction was along with good outcome. Color Doppler evaluation and placental thickness were not accompanied with good results.