Hydramnios - Causes, Symptoms, Diagnosed, Treatment., and Complications

Introduction:

Amniotic fluid plays a key role in pregnancy and fetal development. Amniotic fluid is a watery fluid present inside a casing called the amniotic membrane, and this fluid surrounds the baby throughout pregnancy to provide a cozy temperature and protection by giving a cushion effect. The amounts of amniotic fluid may vary, but usually, women contain about 500 to 1000 ml of amniotic fluid. Amniotic fluid is important for the development of many fetal organs, including the kidneys, lungs, and gastrointestinal tract. Beginning in the second trimester, the baby will begin tasting and swallowing the amniotic fluid from the uterus and even take practice breathing to start preparing the baby's lungs for the outside world. Too much or too little amniotic fluid can cause pregnancy complications and developmental abnormalities.

What Is Hydramnios?

Hydramnios, also called polyhydramnios, is a pregnancy condition in which there is the presence of excess amniotic fluid around the fetus. It occurs in about one percent of all pregnancies. The build-up of extra amniotic fluid slowly starts in the second half of pregnancy. Most cases of hydramnios are mild because of a temporary shift in amniotic fluid production. This slight excess of amniotic fluid usually does not require any treatment and gets corrected on its own. Severe cases of fluid accumulation are rare; it could signal a problem with the baby, such as a gastrointestinal defect, central nervous system, or the inability to swallow. But constant high levels of amniotic fluid can put the pregnancy at risk for premature labor, premature rupture of the membranes, breech presentation, placental abruption, or umbilical cord prolapse.

What Is the Cause of Hydramnios?

Amniotic fluid comes from the baby's kidneys, and it reaches into the uterus from the baby's urine. The absorption of the fluid happens when the baby swallows it and by breathing motions. The amniotic fluid amount will increase until the 36th week of pregnancy, after which there is a slow reduction. If the baby produces too much urine or does not swallow properly, amniotic fluid builds up. Other factors that are connected with hydramnios include the following:

• Birth defects affect the swallowing ability of the fetus (which helps regulate amniotic fluid levels).

• Uncontrolled maternal diabetes (increased blood glucose levels can cause increased urination in the baby).

• Infection in the fetus.

• Abnormal fetal heart rate.

• In the presence of blood incompatibilities between the baby and mom (like Rh and Kell diseases).

• Problem with the placenta.

• A problem in the fetus's stomach.

• Anemia in the baby.

• Twin-to-twin transfusion syndrome.

What Are the Symptoms of Hydramnios?

It is common that most women with mild hydramnios do not experience any symptoms at all. But in severe cases, the following signs can be experienced:

• Difficulty in feeling the movement of the fetus due to the extra amniotic fluid cushioning the uterus.
• Difficulty in breathing and abdominal discomfort since the uterus presses on the lungs and other organs.
• Urinating less often.
• A sensation of tightness in the abdomen.
• Indigestion, constipation, uterine contraction, breathlessness, and swelling in the leg, ankle, hip, or foot.

How Is Hydramnios Diagnosed?

Hydramnios is generally diagnosed using ultrasound. This usually occurs during a routine appointment or if the doctor investigates other symptoms. The doctor may specifically test for this condition if the uterus becomes unexpectedly large very soon or if the mother has trouble feeling the baby.

The doctor will check the pockets of the fluid with the help of soundwaves to find out the total amount. Ultrasounds help rule out the cause of hydramnios, particularly hydramnios occurring because of a birth defect.

What Is the Treatment for Hydramnios?

The main aim of treatment is to keep pregnant for as long as it is safe. Treatment may also make you more comfortable. The treatment for hydramnios depends on the severity of the condition. If the condition is mild, then no specific treatment might be needed. But in more severe cases, the doctor will determine the best treatment strategy based on the particular pregnancy. If the cause of hydramnios is known and treatable, like gestational diabetes, then treatment is provided to manage the condition.

• Closely Watching the Amount of Amniotic Fluid - The healthcare provider will monitor the amniotic fluid level during every visit.
• Medicine - There are medicines available to reduce the output of baby urine; therefore, it limits the amniotic fluid amount. The medicine is called Indomethacin and is not recommended after the first 31 weeks of the pregnancy.
• Removal of Excess Fluid - Removal of excess amniotic fluid from the uterus is called amnioreduction by amniocentesis. It is done by using a large needle, as with amniocentesis. The needle is inserted through the uterus into the amniotic sac. The procedure may be performed more than once throughout the pregnancy.
• Early Delivery - If the condition is too risky for the mother and the baby, only then is early pregnancy recommended. This will differ very much from one pregnancy to the next. Generally, the goal of treatment is to get the patient as close to the term (39 to 40 weeks) as possible.
• Fetal Echocardiogram - This is used to monitor the development of the baby’s heart because of the greater risk of an abnormality.

What Is the Complication of Hydramnios?

Mild hydramnios often do not cause any problems. The extra amniotic fluid that appears during the second trimester of pregnancy returns to normal on its own. Hydramnios may also occur in pregnancies with more than one baby (twins, triplets, or more).

Too much amniotic fluid can cause the uterus to become too large, which can lead to preterm labor, or the amniotic fluid sac may break too early, leading to early pregnancy and other complications. Also, the enlarged uterus due to the accumulation of amniotic fluid puts pressure on other organs leading to pregnancy complications, especially if the condition happens early into the pregnancy. The complications from a severe form of the condition include

• Early labor.
• The baby grows quickly and becomes large while in the uterus.
• Wrong position of the baby in the womb (fetal malposition).
• Too much bleeding after giving birth.
• Too much bleeding after giving birth.
• Detachment of the placenta from the uterus(placental abruption) before delivery.
• The umbilical cord falls out before the baby's birth (umbilical cord prolapse).
• Stillbirth.

Conclusion:

Hydramnios occur due to excess accumulation of the amniotic fluid in the uterus. It is not a common condition. Mild hydramnios can occur during pregnancy which will get corrected on its own, but a severe one can put both the mother and the baby at risk. This condition is identified during routine prenatal checkups, so it is important to have regular checkups.