Acute Recurrent Polyhydramnios: A Combination of Amniocenteses and NSAID May Be Curative Rather than Palliative

Abstract

Acute recurrent polyhydramnios is a rare occurrence characterized by a poor fetal outcome. This is a case report describing a 34-year-old woman presenting with acute recurrent polyhydramnios. Treatment with non-steroidal anti-inflammatory drugs (NSAID) and therapeutic amniocenteses was initiated immediately and resulted in a decreased amniotic fluid production from 30 weeks’ gestation. Even after the discontinuation of NSAID treatment, the amniotic fluid production normalized, and the woman delivered a healthy boy at 39 weeks 2 days’ gestation. Amniotic prolactin was measured at three occasions using an enzyme-linked immunosorbent assay. As in normal pregnancies, amniotic prolactin levels decreased by 80% from highest to lowest value in this case of resolving acute recurrent polyhydramnios.

Relationship between the amniotic fluid prolactin level at early second trimester and pregnancy outcome

“…De Santis et al put forward hypothesis of acute recurrence of polyhydramnios may be linked to the dysfunctional chorionic receptors for prolactin. Previous study assessed AF prolactin levels three times during the pregnancy, study revealed no change with advancing gestational age (27). No change was determined in this study, however intervals that the samples were obtained too short to detect decreasing concentrations with advancing gestational age.…”

Polyhydramnios: Causes, Diagnosis and Therapy

“…However, there is no consensus regarding the volume of aspirated amniotic fluid, the speed of aspiration and the use of tocolytics or antibiotics. The intervention is usually concluded when ultrasound examination shows an AFI of 15 to 20 cm or if intra-amniotic pressure drops to < 20 mmHg [53,66]. In some cases, the intervention had to be terminated due to maternal discomfort or premature placental abruption.…”