Polyhydramnios refers to an excessive amount of amniotic fluid around the fetus in the uterus. The fetus’s kidneys produce the amniotic fluid, which flows into the womb via the fetus’s urine.
The fetus then swallows the fluid and reabsorbs it with its breathing motions. This act of swallowing helps balance the amount of amniotic fluid in the womb.
This process maintains a dynamic balance between the production and absorption of amniotic fluid. When a disruption affects the balance, complications can arise for the woman and fetus.
Polyhydramnios access in about 1to 2% of pregnancies. Most cases of polyhydramnios are mild and result from a gradual build-up of amniotic fluid during the second half of pregnancy. Severe polyhydramnios may cause shortness of breath, preterm labor, or other signs and symptoms.
Polyhydramnios symptoms result from pressure being exerted within the uterus and on nearby organs.
Mild polyhydramnios may cause few – if any – signs or symptoms. Severe polyhydramnios may cause –
• Shortness of breath or the inability to breathe
• Swelling in the lower extremities and abdominal wall
• Uterine discomfort or contractions
• Fetal malposition, such as breech presentation
• Sensation of tightness in the stomach
• Enlargement of the vulva
• Producing less urine
For most women, the cause of their polyhydramnios condition remains a mystery. Women with mild cases most likely have symptoms due to the increasing amount of fluid in their uterus. Moderate to severe polyhydramnios could be caused by the following –
• Birth defect affecting the baby’s ability to swallow
• High blood glucose levels (mother has diabetes either before or after becoming pregnant)
• Differing blood types (mother has Rh-negative, the baby has Rh-positive)
• Carrying identical twins with transfusion syndrome
• Problem in the baby’s stomach
• Issues with the placenta
• Too much fluid in the baby
• Baby develops an infection
• Complications with the heart rate of the baby
Polyhydramnios is associated with –
• Premature birth
• Premature rupture of membranes – when your water breaks early
• Placental abruption – when the placenta peels away from the inner wall of the uterus before delivery
• Umbilical cord prolapse – when the umbilical cord drops into the vagina ahead of the baby
• C-section delivery
• Heavy bleeding due to lack of uterine muscle tone after delivery
A doctor will measure your stomach and determine if your uterus is too large. Typically, that means you are measuring two or more weeks ahead of your expected due date.
In addition, polyhydramnios can be diagnosed if the doctor has difficulty locating the heartbeat of the baby or feeling for the baby.
Ultimately an ultrasound will be done to determine the amount of amniotic fluid.
Doctors can also test the woman for issues that can cause polyhydramnios. These tests may include –
• Blood tests to check for maternal diabetes or infection
• A procedure called amniocentesis, in which a doctor collects a sample of amniotic fluid from the womb and sends it to a lab for genetic dialysis.
Mild cases of polyhydramnios rarely require treatment and may go away on their own. Even cases that cause discomfort can usually be managed without intervention.
If the patient experiences preterm labor, shortness of breath, or abdominal pain, you may need treatment- potentially in the hospital. Treatment may include –
• Drainage of excess amniotic fluid
Your health care provider may use amniocentesis to drain excess amniotic fluid from your uterus.
Your doctor may prescribe the oral medication indomethacin tohelp reduce fetal urine production and amniotic fluid volume. This medicine is not recommended beyond 31 weeks of pregnancy. Due to the risk of fetal heart problems, your baby’s heart may need to be monitored with a fetal echocardiogram and Doppler ultrasound.
If you have mild to moderate polyhydramnios, you’ll likely be able to carry your baby to term, delivering at 39 or 40 weeks. If you have severe polyhydramnios, your health care provider will discuss the appropriate timing of delivery, to avoid complications for you and your baby.
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