Role of indomethacin in polyhydramnios

Abstract

Objective: To observe the role of indomethacin in polyhydramnios.Method: This was a prospective, longitudinal and analytical study conducted in Kathmandu University Hospital, Dhulikhel from 1st July 2011 to 1st of December 2012. There were 32 patients included in the study. Indomethacin was administered orally at the dose of 25 mg three times a day for 1 week. The patients were admitted for observation of clinical symptoms, fundal height, fetal status and amniotic fluid index measurement. After the delivery, baby was investigated for any abnormality of fetal circulation.Results: There were total of 2700 deliveries in 1 year. Among them 46 cases were of polyhydramnios. The frequency was 1.7%. Among the 46 cases, 32 (69.6%) were idiopathic who were included whereas 8 (17.4%) were of diabetes mellitus, 4 (8.7%) were Rh isoimmunisation, and 2 (4.3%) were fetal anomalies. The mean age group was 24.5+/ -4.2 years. There were total 10 (31.3%) patients presented at 29 weeks of gestation whereas only 5 (15.7%) patients at 32 weeks of gestation. Regarding the gravid index, 17 (53.1%) patients were primigravida. There was statistically significant reduction in amniotic fluid volume following 1 week administration of indomethacin. Conclusion:Though there are many modes of treatment for polyhydramnios, the 1 week therapy with indomethacin is equally beneficial.

The Role of Indomethacin in Isolated Polyhydramnios

“…Mean gestational age at presentation in our study was 30.78±1.56 weeks similar to study by Abhyankar et al and Carmona F et al 16,17 In our study there was a significant decrease in amniotic fluid when given in patients with Idiopathic Polyhydramnios similar to study conducted by Abhyankar et al, Abou-GhannamG et al and Block Abraham Dana et al 16,18,19 Pregnancy was prolonged by an average of 5.5±1.89 weeks and average duration of therapy was 22.5±6.38 days. These findings were similar to study conducted by Shrestha A et al and Abhyankar et al 11,16 Kirshon et al and Mamopoulos et al reported that reduction in amniotic fluid was not detrimental to the fetus and on discontinuation amniotic fluid returned to normal. 20,21 But in our study one patient who continued taking Indomethacin, at home, without any follow up and surveillance returned with severe oligohydramnios.…”

“…8,9 The reported incidence of polyhydramnios varies between 0.4 and 3.3%. 4,10 In our study incidence observed was 1.47% which is similar to the study conducted by Shrestha A et al 11 In our study Idiopathic Polyhydramnios accounted for 70% of the cases which was similar to a study conducted by Pri-Paz et al and Sandlin AT et al 4,12 Wiegand SL et al reported that most of the cases (78%) belonged to mild polyhydramnios and about 21% of cases were moderate to severe polyhydramnios. 13 But in our study as 18 cases of Idiopathic Polyhydramnios with symptoms were included, 6 cases (33.33%) belonged to mild and 12 cases (66.66%) belonged to moderate to severe polyhydramnios.…”

“…The mean gestational age at delivery in our study was 36.28±1.41 weeks similar to study by Abhyankar et al 16 In our study 17 (94%) had a good perinatal outcome similar to study conducted by Shrestha A et al and Abhyankar et al 11,16 Prostaglandins are important to maintain the patency of the ductus arteriosus during fetal life. Indomethacin therefore has a potential to cause ductal constriction.…”