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Management of idiopathic severe polyhydramnios

Management of idiopathic severe polyhydramnios
Severe polyhydramnios is defined as amniotic fluid index ≥35 cm or single deepest pocket ≥16 cm. Severe symptoms can be defined as significantly interfering with the patient's ability to conduct the normal activities of daily life. Amnioreduction relieves symptoms immediately, but amniotic fluid may reaccumulate within a few days to weeks. Intervention to reduce amniotic fluid is not indicated in asymptomatic patients or patients with mild shortness of breath, abdominal discomfort, and/or uterine irritability that is reasonably tolerable.
GA: gestational age.
* Uterine irritability is treated in the same way as preterm labor:
  • For GA <32 weeks: Administer indomethacin for 48 hours for tocolysis and its amniotic fluid-reducing effects.
  • For GA 32 to <34 weeks: Administer nifedipine or a beta-sympathomimetic for up to 48 hours for tocolysis.
  • For GA ≥34 weeks: No tocolysis.
¶ Administer a course of betamethasone per standard guidelines, and
  • For GA <32 weeks: Administer indomethacin for 48 hours for tocolysis and its amniotic fluid-reducing effects.
  • For GA 32 to <34 weeks: Administer nifedipine or a beta-sympathomimetic for up to 48 hours for tocolysis.
  • For GA ≥34 weeks: No tocolysis.
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