Dashe Jodi S, Pressman Eva K, Hibbard Judith U
Society for Maternal-Fetal Medicine, 409 12 St. SW, Washington, DC 20024, USA.
Am J Obstet Gynecol. 2018 Oct;219(4):B2-B8. doi: 10.1016/j.ajog.2018.07.016. Epub 2018 Jul 23.
Polyhydramnios, or hydramnios, is an abnormal increase in the volume of amniotic fluid. Identification of polyhydramnios should prompt a search for an underlying etiology. Although most cases of mild polyhydramnios are idiopathic, the 2 most common pathologic causes are maternal diabetes mellitus and fetal anomalies, some of which are associated with genetic syndromes. Other causes of polyhydramnios include congenital infection and alloimmunization. The purpose of this document is to provide guidance on the evaluation and management of polyhydramnios. The following are Society for Maternal-Fetal Medicine recommendations: (1) we suggest that polyhydramnios in singleton pregnancies be defined as either a deepest vertical pocket of ≥8 cm or an amniotic fluid index of ≥24 cm (GRADE 2C); (2) we recommend that amnioreduction be considered only for the indication of severe maternal discomfort, dyspnea, or both in the setting of severe polyhydramnios (GRADE 1C); (3) we recommend that indomethacin should not be used for the sole purpose of decreasing amniotic fluid in the setting of polyhydramnios (GRADE 1B); (4) we suggest that antenatal fetal surveillance is not required for the sole indication of mild idiopathic polyhydramnios (GRADE 2C); (5) we recommend that labor should be allowed to occur spontaneously at term for women with mild idiopathic polyhydramnios; that induction, if planned, should not occur at <39 weeks of gestation in the absence of other indications; and that mode of delivery should be determined based on usual obstetric indications (GRADE 1C); and (6) we recommend that women with severe polyhydramnios deliver at a tertiary center due to the significant possibility that fetal anomalies may be present (GRADE 1C).
羊水过多是指羊水体积异常增加。识别出羊水过多后，应查找潜在病因。虽然大多数轻度羊水过多病例是特发性的，但最常见的两个病理原因是母体糖尿病和胎儿畸形，其中一些与遗传综合征有关。羊水过多的其他原因包括先天性感染和同种免疫。本文档的目的是为羊水过多的评估和管理提供指导。以下是母胎医学协会的建议：（1）我们建议单胎妊娠的羊水过多定义为最大垂直深度≥8cm或羊水指数≥24cm（2C级）；（2）我们建议仅在严重羊水过多导致严重母体不适、呼吸困难或两者兼有的情况下考虑羊膜腔穿刺放液（1C级）；（3）我们建议吲哚美辛不应仅用于减少羊水过多情况下的羊水（1B级）；（4）我们建议轻度特发性羊水过多这一单一指征不需要进行产前胎儿监测（2C级）；（5）我们建议轻度特发性羊水过多的女性足月时应顺其自然分娩；如果计划引产，在没有其他指征的情况下，不应在妊娠<39周时进行；分娩方式应根据常规产科指征确定（1C级）；以及（6）我们建议严重羊水过多的女性在三级中心分娩，因为胎儿可能存在畸形的可能性很大（1C级）。
