Polyhydramnios is a condition which affects the uterus of a pregnant woman. In this condition, excessive amniotic fluid (the liquid that surrounds the baby in the womb) accumulates in the uterus. When this happens, the uterus becomes larger than normal.
Amniotic fluid has a significant role in the baby’s growth. Typically, amniotic fluid is swallowed by the baby in utero and then urinated out. This stabilizes the amount of fluid in the uterus.This process maintains a dynamic balance between the production and absorption of amniotic fluid.
When this happens, the uterus becomes larger than normal.
When a disruption affects the balance, complications can arise for the woman and fetus.
This condition affects roughly 1 percent of pregnancies.Most cases of polyhydramnios are mild and result from a gradual buildup of amniotic fluid during the second half of pregnancy.
Role of Amniotic Fluid –
Amniotic fluid fills the sac surrounding your developing baby and plays several important roles:
• It cushions your baby to protect them from trauma (if you take a tumble, for instance).
• It helps maintain a constant temperature in the womb.
• It prevents the umbilical cord from becoming compressed, which would reduce your baby’s oxygen supply.
• It helps the digestive and respiratory systems develop as your baby swallows and excretes it and “inhales” and “exhales” it from their lungs.
• It allows your baby to move around so their muscles and bones develop properly.
• It protects against infection.
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
• Uterine discomfort or contractions
• Swelling in the lower extremities and abdominal wall
• Fetal malposition, such as breech presentation
• Sensation of tightness in stomach
• Difficulty with bowel movements (constipation)
• Producing less urine
• Enlargement of vulva
Polyhydramnios can develop for several reasons, such as:
• the fetus having difficulty swallowing the amniotic fluid
• multiple pregnancies, which are those with two or more fetuses in the womb
• congenital malformations, such as a blockage of the fetus’s gastrointestinal or urinary tract, or an abnormal development of the brain and spinal cord
• maternal diabetes, which refer to as gestational diabetes
• problems affecting the fetus’s genetic makeup, lungs, or nervous system
• the fetus producing an increased amount of urine
• anemia, or a lack of red blood cells, in the fetus
• an infection in the fetus
Polyhydramnios may increase the risk of these problems during pregnancy:
• Premature rupture of the membranes (PROM) – When the amniotic sac breaks after 37 weeks of pregnancy but before labor starts
• Premature birth – Birth before 37 weeks of pregnancy
• Fetal malposition – When a baby is not in a head-down position and may need to be born by cesarean section
• Placental abruption – When the placenta partially or completely peels away from the wall of the uterus before birth
• Stillbirth – When a baby dies in the womb after 20 weeks of pregnancy
• Postpartum hemorrhage – Severe bleeding after birth
Polyhydramnios is diagnosed by ultrasound, but not usually at the routine 20-week screening ultrasound. That’s because signs and symptoms of the condition tend not to develop until later in the pregnancy.
After 20 weeks’ gestation, amniotic fluid volume is assessed by using
either the deepest vertical pocket (DVP) or the amniotic fluid index (AFI).
The degree of polyhydramnios is frequently categorized as mild, moderate, or severe, based on an AFI of 24.0 to 29.9 cm, 30.0 to 34.9 cm, and ≥ 35 cm, or a DVP of 8 to 11 cm, 12 to 15 cm, or ≥ 16 cm, respectively.
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.
Treatment may include:
• Drainage of excess amniotic fluid.
Your doctor use amniocentesis to drain excess amniotic fluid from your uterus. This procedure carries a small risk of complications, including preterm labor, placental abruption and premature rupture of the membranes.
Your health care provider may prescribe the oral medication indomethacin (Indocin) to help reduce fetal urine production and amniotic fluid volume. Indomethacin isn’t recommended beyond 31 weeks of pregnancy.
After treatment, your doctor will still want to monitor your amniotic fluid level approximately every one to three weeks.
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