Common Cares

Polyhydramnios

Introduction:

The joys of motherhood are but untold, for it is a feeling that wants you to give more. It has been truly said that the best experience a woman undergoes, is that of giving birth. Though undergoing severe pain and discomfort, a mother finds great delight, when the sound of a healthy baby rings in her ears. From the time she is told of the pregnancy, till the time the baby is delivered she is constantly surrounded with thoughts of what she would do for the baby- the dreams, the ambitions and the joy. But more important for any mother to be, is being aware of the fact that her health directly affects that of the baby. There are many conditions that are known to affect the development of the baby and create complications during pregnancy. Therefore pregnancy needs to be monitored carefully so that any complication can be assessed at an early stage and precautions taken. One such condition is polyhydramnios.

Amniotic Fluid

When the baby is developing it needs some cushioning and support, so that it can be protected against trauma or infection. To serve this purpose a fluid called amniotic fluid surrounds the developing fetus in the amniotic sac, which is located in the uterus. It serves the important function of providing a cushioning effect that protects the baby from trauma (if you should fall down, for example) and the umbilical cord from being compressed, thereby reducing the baby's oxygen supply. It protects the baby from infection and serves as a backup source for essential nutrients for the baby. It also helps the baby to move and to breathe and supports the development of such vital organs in the baby like the digestive, musculoskeletal, and respiratory systems. When this fluid fills the sac, the baby swallows it and excretes it through urine. The same fluid is cycled by the baby.

Polyhydraminos

“Ploy” means excess and “hydramnios” means amniotic fluid. The fetus plays an important role in keeping just the right amount of fluid in the amniotic sac. Excessive production of amniotic fluid in the amniotic sac is called polyhydramnios. In this condition, there may be excess secretion of the fluid , or the baby is unable to recycle the fluid because of gastric or intestinal obstruction or failure to develop.In some conditions like neural tube defects of the baby wher the brain is open to outside and its fluid collects in the amniotic sac , resulting in the polyhydramnios. But the most common cause is the excess secretion of the fluid due to diabetes.

Diabetes and polyhydramnios

If a pregnant lady has been told that she has excess of amniotic fluid she need not be alarmed because it usually is not a serious condition and most of the women diagnosed with the condition deliver healthy babies. But in certain cases the condition could indicate the presence of diabetes in the mother. If the patient is diagnosed with diabetes and has not been managing it properly then it could lead to excessive levels of amniotic fluids during pregnancy. Almost 10% of those diagnosed with polyhydramnios are diabetic. It is usually detected in the third trimester. To confirm the cause the patient is give glucose tests. These cases are usually mild and can be resolved through proper glucose control. The doctor usually recommends regular nonstress tests and ultrasounds, so that the progress of the baby can be closely watched. Bed rest is also suggested as a preventive measure for membrane ruptures.

Symptoms

The presence of excessive amniotic fluid is suspected when:

• The uterus grows more rapidly than it should and the patient cannot feel the movements of the baby.
• They may experience unusual abdominal discomfort due to the extra pressure.
• Too many fluctuations in weight.
• Frequent and increased back pain.
• Extreme swelling on feet and ankles.

In case these symptoms are seen the doctor performs an ultrasound and gives a score on the amniotic fluid index (AFI). This is determined by measuring across the largest pockets of amniotic fluid in four different sections of the uterus and adding them together. The normal range for the third trimester is 5-25 cm anything more than 25 cm is considered to be high.

Other causes

Macrosomia or multiple gestations

Polyhydramnios may also result due to Macrosomia or multiple gestations. If the baby is too huge or the lady is carrying twins or multiples then she is at a high risk of developing this condition. It is very common in cases of twins when the fluid transfusion occurs from one twin to the other. In this case the donor twin may suffer from too little amniotic fluid, while the recipient twin is creating too much.

Fetal abnormalities

In some very rare cases the baby may have certain abnormalities or medical problems that may cause the baby to stop swallowing the fluid while the kidneys continue to excrete the fluid already swallowed. This may include any condition like pyloric stenosis, cleft lip or palate, or some kind of blockage in the gastrointestinal tract that makes it difficult for the baby to swallow.

Neurological Problems

The baby may sometimes have certain neurological problems such as neural tube defects or hydrocephaly. These make it difficult for the baby to swallow. Doctors generally perform a high-resolution ultrasound in order to check for fetal malformations and possibly an amniocentesis to test for a genetic defect.

Complications

Polyhydramnios is a condition that can put both the mother and the baby to a number of risks, which may result in severe complications. These include:

1. Preterm labor, therefore the patient needs to be monitored regularly.
2. There is an increased risk of placental abruption (a condition in which the placenta detaches too early) due to the large gush of fluid leaving the uterus when labor starts. Umbilical cord prolapse may occur when the cord falls through the cervical opening where it may be compressed during delivery. Both these problems may cut off the baby's oxygen supply and may require an emergency cesarean section.
3. The patient is also put at a higher risk for postpartum hemorrhage because the uterus may not be able to contract, as it needs to after labor.

It is therefore exigent that the medical team looks out for these conditions during labor.

Treatment

The problem of polyhydramnios resolves by itself in most of the cases. More so if it is a very mild case. If the fluid is very excessive or causing great discomfort, then the doctor may resort to the removal of some of the fluid so that the pressure can be reduced. The procedure known as therapeutic amniocentesis requires the insertion of a needle through the uterus into the amniotic sac to draw out the fluid. Some of the patients may be required to take this treatment on a weekly basis. In certain cases, the doctor may prescribe a prostaglandin inhibitor like Indomethacin, which has been shown to reduce the baby's urine output.