From the Guidelines
Management of polyhydramnios depends on its severity, which is classified as mild, moderate, or severe based on the amniotic fluid index (AFI) or maximum vertical pocket (MVP), and the most recent guidelines from 2024 recommend individualized approaches to management. For mild polyhydramnios (AFI 24-29.9 cm or MVP 8-11 cm), expectant management with regular monitoring is typically sufficient, with serial ultrasounds every 3-4 weeks to assess fluid levels and fetal growth, as suggested by 1. For moderate polyhydramnios (AFI 30-34.9 cm or MVP 12-15 cm), closer surveillance is warranted with ultrasounds every 2-3 weeks, and consideration of maternal-fetal medicine consultation and detailed anatomical survey to rule out fetal anomalies, as recommended by 1. For severe polyhydramnios (AFI ≥35 cm or MVP >15 cm), aggressive management may be necessary, including more frequent monitoring (weekly ultrasounds), consideration of amnioreduction if maternal symptoms are significant (respiratory distress, severe discomfort), and possible indomethacin therapy (25 mg orally three times daily for 48-72 hours, maximum 5-7 days due to risk of premature ductal closure) to reduce fetal urine production, as indicated by 1. All severity levels require evaluation for underlying causes such as gestational diabetes, fetal anomalies, or infections. Some key points to consider in management include:
- The Quintero staging of twin-twin transfusion syndrome, which can help guide management decisions, as outlined in 1
- The importance of regular monitoring and surveillance, as recommended by 1 and 1
- The potential benefits and risks of amnioreduction and indomethacin therapy, as discussed in 1 and 1
- The need for individualized approaches to management, taking into account the specific severity of polyhydramnios and the presence of any underlying conditions, as recommended by 1 and 1. Antenatal testing with non-stress tests or biophysical profiles should be initiated at 32-34 weeks regardless of severity, as polyhydramnios increases risks of cord prolapse, placental abruption, and preterm labor, as suggested by 1.