Labor and Delivery
When it comes time for labor and delivery with Polyhydramnios its completely normal for anxiety to be at an all time high. After all, the risk factors are very scary, and there is no universal standard for delivery with polyhydramnios at this time. We poured through the research and guidelines available from resources such as OBGYN Project, SFMF, ACOG, NIH, and Royal Cornwall Hospitals. Then we complied the following guidelines to help moms safely navigate the end of their pregnanies.
Table of Contents
Late Fetal Demise
There is an increased risk of late fetal demise with Polyhydramnios. Because of this, it is recommended to deliver at term and not go beyond 39+6 weeks.¹
Since the original publication of this page, the ACOG has released new guidelines recommending spontaneous delivery on or before 40+6 weeks for pregnancies complicated by mild, uncomplicated Polyhydramnios.
Failure to progress is the number one reason for unplanned c-sections with Polyhydramnios, and it happens in 35-55% of deliveries. Studies also show that it doesn’t matter if labor happens spontaneously or by artificial induction, failure to progress happens equally in both situations.²
Polyhydramnios babies have a higher rate of NICU admittance than the normal population, regardless of the severity of the amniotic fluid level. This is usually due to breathing or feeding problems.³
Commonly Missed Anomalies
Esophageal atresia and tracheoesophageal fistula are among the most commonly missed anomalies in babies born from pregnancies complicated by Polyhydramnios. Therefore, it is recommended that a small feeding tube be passed from the nose to the stomach before the first feeding to exclude esophageal atresia.
Finding a cause after Delivery
The risk of finding an underlying cause after delivery is 9% during the neonatal period and as high as 28% up to one year later. Due to this risk, pediatric support should be available following delivery for every Polyhydramnios baby, regardless if there is an antenatal diagnosis of an underlying condition or not.¹
Notes about Rupture of Membranes
Risks with ROM
A rapid decline in the amount of amniotic fluid greatly increases the risks of placental abruption and umbilical cord prolapse. To help reduce these risks, a controlled Artificial Rupture Of Membranes (AROM) is recommended.
Patient education on what to do in case of spontaneous membrane rupture is vital to reduce the risk of umbilical cord prolapse.
If your water breaks while you are away from your birthing center, immediately get into a knee-chest position (images) and call emergency services.
In very severe cases of Polyhydramnios, an amnioreduction in early labor may be beneficial to reduce the risk of placental abruption.
AROM should ONLY be done once the baby is fully engaged in the birth canal to reduce the risk of the umbilical cord slipping into the birth canal first.
Controlled AROM should be done by an experienced obstetrician using a small needle to allow for a slow leak of the fluid. Keeping the patient on her back while the fluid drains may also be helpful to avoid cord prolapse.
Mild/Moderate Idiopathic Polyhydramnios with no other fetal or maternal complications
- Allow for spontaneous labor between 40+0 and 40+6 weeks
- Deliver in a perinatal center
Mild/Moderate Polyhydramnios with fetal, maternal, or other obstetric complications
- The timing of delivery should be determined by the appropriate recommendation for the complicating condition (see ACOG delivery timing recommendations)
- Delivery should occur at either a perinatal or tertiary center, depending on the needs of the complicating condition.
Severe Idiopathic Polyhydramnios
- Recommended delivery between 38 + 0 and 38+ 6 weeks
- Deliver at a tertiary center
Severe Polyhydramnios with known fetal anomalies, early onset of Severe Polyhydramnios, or Polyhydramnios accompanied by fetal growth restriction
- Recommended delivery at 37 weeks
- Delivery at a tertiary center
Unstable lie after 37 weeks
- Indication for 38-39 week elective c-section in order to prevent umbilical cord prolapse
- If a vaginal delivery is desired, ECV may be attempted with immediate induction by controlled rupture of membranes to follow
Labor and Delivery Guidelines
- Labor & Delivery method should be individualized and based on normal obstetric indications
- Foley bulb induction (or other similar balloon inductions) should never be used in Polyhydramnios due to the increased risk of umbilical cord prolapse.
- Determine fetal position upon admission
- If malpresentation is found, an external cephalic version may be possible if there are no contraindications
- Perform controlled AROM only after the head has engaged (see notes on ROM above)
- Continuous fetal monitoring and frequent position checks of the baby are recommended
- Uterotonics should be available in the delivery room in case postpartum hemorrhage occurs
- Monitor mother closely for signs of maternal hemorrhage, pulmonary embolism, and amniotic fluid embolism
- Pediatric support should be made available to every baby after delivery
- Consider passing a small feeding tube before the baby’s first feeding to rule out EA or TEF
¹Pilliod, Rachel A et al. “The risk of fetal death in nonanomalous pregnancies affected by polyhydramnios.” American journal of obstetrics and gynecology vol. 213,3 (2015): 410.e1-6. doi:10.1016/j.ajog.2015.05.022
³Khan, Sarwat, and Jennifer Donnelly. “Outcome of pregnancy in women diagnosed with idiopathic polyhydramnios.” The Australian & New Zealand journal of obstetrics & gynaecology vol. 57,1 (2017): 57-62. doi:10.1111/ajo.12578
Polyhydramnios Statistics – Polyhydramnios is a rare condition that complicates about 1% of all pregnancies. This page breaks down all of the known statistics surrounding it.