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Polyhydramnios is associated with multiple maternal and fetal abnormalities. Although the risks of persistent polyhydramnios are well described, the clinical implications of polyhydramnios that resolves prior to delivery are not. Thirty-four non-diabetic patients with resolving polyhydramnios were studied. An amniotic acid index of >or= 20 was used to define polyhydramnios. Antepartum and postpartum outcomes were compared with those patients with persistent polyhydramnios, and a control group of 102 singleton term deliveries. Patients with resolving polyhydramnios did not have a significant increase in congenital anomalies. An 8% incidence of congenital anomalies was noted in patients with persistent polyhydramnios; this was significant compared with controls (p < 0.05). Idiopathic resolving polyhydramnios was associated with a higher mean birth weight (p < 0.05) than controls, with significantly more babies weighing more than 4200 g. An increase in placental thrombus formation was noted in patients with idiopathic resolving and persistent polyhydramnios compared to the control group (p < 0.01). The etiology of this is unclear. Obstetricians should be aware of the risk of macrosomia and the possibility of placental disease in these fetuses.

Twin to twin transfusion, complicated by acute polyhydramnios in a monozygous twin pregnancy, is a difficult clinical problem. A precipitous course usually results in termination of the pregnancy within a few days and often is associated with a high perinatal mortality rate. Two cases are presented that were treated with repeated amniocenteses for the relief of extreme abdominal discomfort and to prevent imminent premature labor. The amount of amniotic fluid removed each time varied from 300 cc to 1200 cc, which was enough to relieve symptoms but not enough to induce uncontrolled uterine activity. A total of 3500 cc and 4750 cc of amniotic fluid were removed from the first and the second patient, respectively. The procedure was found to be safe and resulted in prolonging the pregnancies by 14 and 11 days, respectively. This management, with the addition of tocolysis and close fetal surveillance can offer some hope in an otherwise hopeless situation.

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