Acute recurrent polyhydramnios - management with indomethacin
The fetus develops inside of a sac that is surrounded by a membrane called the amnion. The sac contains amniotic fluid, which surrounds the developing fetus and protects the fetus from injuries. Polyhydramnios is a condition that occurs when there is too much amniotic fluid. Acute polyhydramnios is rare. The exact cause is unknown, but it may result from an increase in the amount of urine produced by the fetus. It is estimated to occur in only 1 out of every 12,000 pregnancies. In the majority of cases, the fetus dies and the mother is severely ill. At the present time, treatment for this condition is to remove the excess amniotic fluid using amniocentesis. This procedure involves inserting a long, thin needle into the mother's abdomen and into the sac containing the developing fetus. The needle is used to draw fluid, in some cases up to several liters, out of the sac. This procedure is not ideal because it can damage the placenta and fetus, cause premature labor, preterm delivery, or fetal death. An alternative method of treatment is to use non-steroidal anti-inflammatory drugs, such as indomethacin. This drug has been shown to reduce the amount of amniotic fluid, but the potentially hazardous effects of this drug have limited its use. This article describes the case report of a 28-year-old woman who had three pregnancies complicated by polyhydramnios, which developed between weeks 26 and 29 of pregnancy. Amniocentesis was used to remove the excess fluid in the first two pregnancies. In both cases, the fetus was delivered prematurely at week 29, and weighed approximately 3 pounds. During the third pregnancy, the woman was treated with indomethacin starting at week 26 of pregnancy. By week 35, the mother developed symptoms of heartburn and gastric pain. Treatment with indomethacin was stopped, and the amount of amniotic fluid began to increase causing abdominal pain. Amniocentesis was performed to remove the excess fluid. At week 36, a normal labor began and the woman gave birth to a healthy five and a half pound baby. It is concluded that indomethacin may be useful for treating severe cases of acute polyhydramnios, as an alternative to repeated amniocentesis. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: British Journal of Obstetrics and Gynecology
Maternal cigarette smoking, regular use of multivitamin/mineral supplements, and risk of fetal death
Maternal smoking has been linked to many pregnancy complications that include intrauterine growth retardation and new-born death. Data from the 1988 National Maternal and Infant Health Survey that sampled 12,465 singleton pregnancies reveal smoking increased the risk of fetal death. Regular supplement consumption before or after pregnancy recognition did not affect the risk of fetal death, and the number of fetal deaths among women who used supplements and smoked were reduced compared to those who smoked about the same number of cigarettes but did not use supplements.
Publication Name: American Journal of Epidemiology
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