The Effect of Indomethacin Therapy on Reducing the Amniotic Fluid Index (AFI) in Moderate to Severe Polyhydramnios

Document Type : Original Article

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Abstract

Introduction: Severe and intermediate polyhydramnios may cause various maternal and fetal complications. Indometacin therapy in moderate to severe polyhydramnios is recommended in some studies but, there no such study has been done in Iran. This study was done in order to investigate the effect of indomethacin in decreasing AFI and on enhancing duration of pregnancy.
 
Materials and Methods: This randomized clinical trial was carried out in the year 2006 at Hamadan Fatemieh Hospital on 40 women who were 22 to 30 weeks pregnant, suffering from moderate to sever polyhydramnios (diagnosed by sonographic examination). Patients divided randomly into two groups. Twenty patients (case group) were treated with 1/5mg/kg/day of indomethacin for two weeks and the control group were just observed and hospitalized only in case of respiratory distress or abdominal pain occurrence. patients in the case group were assessed for drug complications, then after intervention to evaluate the AFI, they were checked by sonography in the second and forth week. Both groups followed up to delivery time and neonates examined for PDA. Individual data, pregnancy duration, Apgar score, and complications were collected in the questionnaire and analyzed by SPSS software, using the descriptive statistics, frequency distribution tables and statistical tests. Statistical significance was p<0.05.
 
Results: The mean duration of pregnancy in case and control group was 38±1.33 and 34±2.93 weeks respectively, with the statistically significant difference (p=0.0001). After 4 weeks of treatment, AFI decreased from 24.2±3.54 cm to 17.15±2.36 cm. The neonates' APGAR scores were much higher for case group in comparison with controls. Indomethacin had no maternal or fetal complications.
 
Conclusion: This study showed that, the success rate in case group was 100%. The mean duration of pregnancy was longer in case group, AFI decreased and neonates’ APGAR was better than the control group.

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References

1. Cunningham FG, Leveno KJ, Bloom SL et al. Williams Obstetrics. Twenty-second editions,
New York: McGraw-Hill; 2005. 527-533.
2. Bennett V, Brown L. Myles textbook for midwives. 12th ed. 1993, Churchill-Livingstone,
London: Disorders of the amniotic fluid; P: 331-334.
3. Achiron R, Lipitz S, Kidron D, Hegesh J, Rotestein Z. In utero congestive heart failure due to
maternal indomethacin treatment for polyhydramnios and premature labor in a fetus with
antenatal closure of the foramen ovale. Prenat Diagn 1996; 16(7): 652-6.
4. Cabrol D, Jannet D, Panneir E. Treatment of symptomatic polyhydramnios with indomethacin.
Eur J obstet Gynecol Repro Bil 1996; 66(1): 11-15.
5. Kramer WB, Van den Veyver IB, Krishon B. Treatment of polyhydramnios with indomethacin.
Clin Prinatol 1994; 21(3): 615-30.
6. Kirshon B, Mari G, Moise KJ Jr. Indomethacin therapy in the treatment of symptomatic
polyhdramnios. Obstet Gynecol 1990; 75: 202.
7. Abhyankar S, Salvi VS. Indomethacin therapy in polyhdramnios. J Postgrad Med 2000 Jul-Sep;
46(3): 179-8
8. Carbrol D, Jannet D, Pannier E. Treatment of polyhydramnios with indomethacin. Eur J Obstet
Gynecol Reprod Biol 1996 May; 66(1): 11-5.
9. Carmona F, Martinez-Roman S, Mortera C, Puerto B, Cararoch V, Iglesias X. Efficacy and
safety of indomethacin therapy for polyhydramnios. Eur J Obstet Gynecol Reprod Biol 1993;
52: 175-180.
10. Vigil - de Garcia PE , Campos -Rivera P, Lasso -de La Vega J. Pregnancy complicated with
symptomatic polyhydramnios: treatment with indemethacin. Gynecol Obstet Med 1997 Jan;
65:21-6
11. Sawdy RJ, Lye S, Fisk NM, Rennet PR. A double –blind randomized study of fetal side effects
during and after the short-term maternal administration of indomethacin, sulindac, and
nimesulide for the treatment of preterm labor. Am J Obstet Gynecol; 2003. 188(4): 1046-51.
12. Sandruck JC, Grobman WA, Gerber SE. The effect of short-term indomethacin therapy on
amniotic fluid volume. Am J Obstet Gynecol 2005; 192(5): 1443-5.
13. Kriplani A, Abbi M, Banerjee N, Roy KK, Takkar D. Indomethacin therapy in the treatment of
polyhydramnios due to placental chorioangioma. J Obstet Gynecol Res 2001; 27(5): 245-8.
14. Hill LM, Lazebnik N, Many A. Effect of indomethacin on individual amniotic fluid indices in
multiple gestations. J Ultrasound Med 1996; 15(5): 395-9. 

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