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POLYHYDRAMNIOS
Polyhydramnios (pol-e-hi-DRAM-nee-os) is the excessive accumulation of amniotic fluid - the fluid that surrounds the baby in the uterus during pregnancy. Polyhydramnios occurs in about 1 to 2 percent of pregnancies.
Most cases of polyhydramnios are mild and result from a gradual buildup of amniotic fluid during the second half of pregnancy. Severe polyhydramnios may cause shortness of breath, preterm labor, or other signs and symptoms.
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
Causes
Some of the known causes of polyhydramnios include:
A birth defect that affects the baby's gastrointestinal tract or central nervous system
Maternal diabetes
Twin-twin transfusion - a possible complication of identical twin pregnancies in which one twin receives too much blood and the other too little
A lack of red blood cells in the baby (fetal anemia)
Blood incompatibilities between mother and baby
Infection during pregnancy
Often, however, the cause of polyhydramnios isn't clear.
Complications
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
Stillbirth
Heavy bleeding due to lack of uterine muscle tone after delivery
Diagnosis
If your health care provider suspects polyhydramnios, he or she will do a fetal ultrasound. This test uses high-frequency sound waves to produce images of your baby on a monitor.
If the initial ultrasound shows evidence of polyhydramnios, your health care provider may do a more detailed ultrasound. He or she will estimate the amniotic fluid volume (AFV) by measuring the single largest, deepest pocket of fluid around your baby. An AFV value of 8 centimeters or more suggests polyhydramnios.
Blood tests
Amniocentesis
Nonstress test
Treatment
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.
In other cases, treatment for an underlying condition - such as diabetes - may help resolve polyhydramnios.
If you experience 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. This procedure carries a small risk of complications, including preterm labor, placental abruption and premature rupture of the membranes.
Medication. 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. Due to the risk of fetal heart problems, your baby's heart may need to be monitored with a fetal echocardiogram and Doppler ultrasound. Other side effects may include nausea, vomiting, acid reflux and inflammation of the lining of the stomach (gastritis).
After treatment, your doctor will still want to monitor your amniotic fluid level approximately every one to three weeks.
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.
Polyhydramnios can be a worrisome finding during pregnancy. Work with your pregnancy care provider to ensure that you and your baby receive the best possible care.
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