Twin with hydramnios: treating premature labor at source.

Six twin pregnancies complicated by hydramnios and premature labor were prospectively studied to determine whether indomethacin reduces amniotic fluid. Requirements for study entry included a gestational age less than 32 completed weeks and an amniotic fluid greater than 10 cm in one or both sacs. The amniotic fluid was measured using real-time ultrasonography before, during, and after treatment. Indomethacin treatment was initiated as a 100 mg rectal suppository and maintained thereafter by 50 mg orally every 6 hours. Treatment was discontinued after 32 completed weeks' gestation, if the patient was asymptomatic and the amniotic fluid was "normal" (less than 8 cm) or after the onset of oligohydramnios in one or both sacs (less than 2 cm). The interval from initiation of treatment to delivery ranged from 12 to 101 days. A coincidental reduction in amniotic fluid was observed in all seven treatment cycles. The time interval to obtain "normal" fluid ranged from 4 to 20 days (mean, 12.5 days). There were no perinatal complications attributable to indomethacin treatment. These data suggest that in selected pregnancies complicated by hydramnios, indomethacin may be of value not only in prolonging gestation but also in amniotic fluid reduction.