EP06.48: A decade's data of treating polyhydramnios

Polyhydramnios is a recognised cause of preterm birth and obstetric complications. The etiology is wide-ranging and sometimes unexplained. Different management strategies have been utilised with no international consensus. Our objective was to describe the management and outcomes of pregnancies complicated by polyhydramnios. A retrospective 10-year cohort (January 2014-December 2023) of all pregnancies with a diagnosis of polyhydramnios in a tertiary fetal medicine centre. Of 234 women diagnosed with polyhydramnios 53 (29.4%) had an antenatal diagnosis of gastrointestinal obstruction, 24 (10.2%) had a cardiac diagnosis, 11 (4.7%) had a congenital diaphragmatic hernia, 79 (33.8%) had miscellaneous structural anomalies and the remaining 67 (28.6%) were unexplained. 20 (8.5%) had a diagnosis of a genetic disorder. Of the treated women (n = 110), 69 (62.7%) had indomethacin and 41 (37.3%) had only amnioreductions. Of the indomethacin-treated, 29 (42.0%) went on to have amnioreductions (mean 1.7 (0.85) amnioreductions, range 1-4). Of those treated only by amnioreduction alone, five women (12.5%) had repeat procedures and four (10.0%) had three reductions. The mean gestation of developing polyhydramnios was 26.9 (±3.1, 20-31) in the indomethacin-treated group, 27.1(±2.3, 22-30) in those who needed drainage and indomethacin, and 30.6 (24-35 ± 2.2) in the women who had amniodrainage only. We had one case of ductal constriction at 34 weeks, baby was diagnosed with BRAF mutation for cranio faciocutaneous syndrome postnatally. In those not exposed to indomethacin (n = 165), there were 117 live births (70.9%) and 12 (7.4%) intrauterine demises (IUDs), 17 (10.4%) neonatal deaths, four (2.5%) terminations and 16 outcomes were unknown (9.8%). In the group treated with indomethacin (n = 69), there were 49 (10.0%) live births, nine (13.0%) IUDs, one termination (1.4%), eight (11.6%) neonatal deaths and three unknown (4.3%). Indomethacin treatment in polyhydramnios is associated with a high chance of needing subsequent amniodrainage but it may reduce the number of amniodrainages needed.