Polyhydramnios - Causes, Symptoms, Diagnosis and Treatment

Introduction

The term "polyhydramnios" refers to an excessive buildup of amniotic fluid. A greater probability of unfavorable pregnancy outcomes is connected with this clinical condition. The generation and resorption of amniotic fluid are in a dynamic equilibrium under physiological conditions. Fetal urine and fetal lung liquid production both affect fluid levels. Fetal swallowing, intramembranous absorption, and intravascular absorption are ways whereby amniotic fluid is reabsorbed. The proportional importance of each of these systems fluctuates during pregnancy. A disturbed balance can cause polyhydramnios that can be brought on by impaired swallowing ability or excessive urination.

What Is Polyhydramnios?

Polyhydramnios is a pregnancy disorder characterized by an excess of amniotic fluid. The liquid that covers the developing fetus in the uterus is called amniotic fluid. The amniotic fluid significantly influences the development and growth of the fetus.

Even though this illness typically manifests in the second part of pregnancy, it can start as early as 16 weeks. Typically, mild polyhydramnios has no problems. Mild polyhydramnios could disappear by themselves. Closer monitoring may be necessary for severe polyhydramnios.

How Frequent Are Polyhydramnios?

Polyhydramnios is an uncommon condition that affects around 1 % of pregnancies.

What Are the Causes of Polyhydramnios?

Some of the recognized causes of polyhydramnios are as follows:

• A birth abnormality that impacts the baby's central nervous system or gastrointestinal tract.

• Diabetes in mothers (increased blood glucose level).

• Twin-twin transfusion, a potential issue with identical twin pregnancies where one twin receives much more blood whereas the other gets insufficient blood, can cause a deficit of red blood cells in the fetus (fetal anemia).

• Blood compatibility issues between the mother and the child.

• Infection during pregnancy.

• Abnormalities in the fetal heart rate.

However, the cause of polyhydramnios is only sometimes apparent.

What Are the Symptoms of Polyhydramnios?

Due to the moderate nature of the illness, some individuals do not exhibit any symptoms. However, in the case of a more severe form of polyhydramnios, patients may experience the following symptoms:

• Stomach cramps, contractions, or a feeling of tightness.

• Respiration difficulty.

• Heartburn.

• Having trouble pooping (constipation).

• Frequent urination.

• Swelling in your legs, foot, and vulva (external genitals).

The lungs, stomach, rectum, and bladder are neighboring organs put under strain while the uterus grows larger. This increased pressure is most likely the source of the symptoms.

How Is Polyhydramnios Diagnosed?

Fetal ultrasounds will be performed if the healthcare professional predicts polyhydramnios. High-frequency sound waves are used in this test to create images of a baby on a monitor.

The healthcare provider might do a more thorough ultrasound if the initial ultrasound reveals signs of polyhydramnios. The largest and deepest fluid pocket surrounding a child will be measured to determine the amniotic fluid volume (AFV). When the AFV is 8 cm or higher, polyhydramnios is likely.

The largest pocket at four distinct locations in the uterus can be used as a substitute for measuring amniotic fluid. The amniotic fluid index is the total of these measurements (AFI). When the AFI is 25 centimeters or greater, polyhydramnios is evident. A doctor will also use a thorough ultrasound to identify or rule out birth abnormalities and other issues.

If diagnosed with polyhydramnios, additional tests are required. Testing is conducted based on the risk factors, previous exposure to infections, and prior assessments of the unborn babies.

Additional tests include the following:

• Amniocentesis: A sample of the amniotic fluid containing fetal cells and numerous substances produced by the infant is taken from the uterus during an amniocentesis surgery and tested. A karyotype analysis may be performed to examine the baby's chromosomes for abnormalities.

• Non-Stress Test: This test measures the baby's heart rate changes in response to movement. Patients will wear a unique device to monitor the baby's heart rate on their abdomen throughout the exam. Patients could be instructed to eat or drink anything to get the baby moving. A buzzer-like gadget is used to wake infants and get them moving.

• Biophysical Profile: This examination makes use of ultrasound to give patients more details about their unborn child's respiration, tone, and movement, as well as the amount of amniotic fluid that is present in the uterus. A nonstress test could be added to it.

How Is Polyhydramnios Treated?

Mild polyhydramnios cases rarely need treatment and sometimes go away on their own. Even uncomfortable situations can typically be handled without assistance.

In some situations, managing an underlying illness, like diabetes, may aid in the recovery from polyhydramnios. Preterm labor, breathlessness, or stomach pain may require medical attention, possibly in a hospital. Treatment options include:

• Excess Amniotic Fluid Drainage: A doctor may use amniocentesis to remove extra amniotic fluid from your uterus. Preterm labor, placental abruption, and premature membrane rupture are the minor risks of this surgery.

• Medication: To help decrease fetal urine output and amniotic fluid volume, the oral drug Indomethacin (Indocin) is advised. The use of Indomethacin is not advised after 31 weeks of pregnancy. The baby's heart may need to be checked with fetal echocardiography and Doppler ultrasound due to the possibility of fetal cardiac issues.

• Labor Induction: Bringing on labor earlier than expected, usually between 37 and 39 weeks of pregnancy.

What Are the Complications?

Some complications of polyhydramnios are as follows:

• Premature birth.

• Premature membrane rupture, or when your water breaks before it should.

• Placental abruption (separation of the placenta from the uterus wall before delivery).

• Umbilical cord prolapse (umbilical cord enters the vagina before the baby).

• C-section birth or delivery.

• Stillbirth.

• Profuse bleeding after delivery due to decreased uterine muscle strength.

The risk of problems increases with the onset of polyhydramnios earlier in the pregnancy and the amount of extra amniotic fluid present.

Can Polyhydramnios Be Prevented?

Polyhydramnios cannot be prevented, unfortunately. Managing blood sugar levels is one precaution if patients have gestational diabetes or had diabetes before becoming pregnant.

Conclusion

Polyhydramnios is a pregnancy condition that usually does not require treatment. The majority of women with polyhydramnios have healthy babies without any issues. The doctor will closely examine the pregnancy if polyhydramnios is found to be present in order to assist in avoiding difficulties. The severity of the condition will determine how it is treated. Mild polyhydramnios could disappear by themselves. Closer monitoring may be necessary for severe polyhydramnios.