Polyhydramnios

Overview

Polyhydramnios is a condition that occurs during pregnancy where there is an excessive accumulation of amniotic fluid surrounding the baby in the uterus. It happens in about 1 to 2 percent of pregnancies and can be mild or severe. Mild cases may not cause any symptoms, while severe cases can lead to shortness of breath, swelling in the lower extremities and abdominal wall, uterine discomfort or contractions, and fetal malposition. The cause of polyhydramnios is not always clear, but it can be associated with factors such as maternal diabetes, twin-twin transfusion, fetal anemia, blood incompatibilities, or infection during pregnancy. If left untreated, polyhydramnios can lead to complications such as premature birth, premature rupture of membranes, placental abruption, umbilical cord prolapse, C-section delivery, stillbirth, and heavy bleeding after delivery.

Understanding the disease

Symptoms

Symptoms of polyhydramnios may include:

• 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
• Itchiness, especially after a warm bath or shower
• Numbness, tingling, burning, or weakness in hands, feet, arms, or legs
• A feeling of fullness soon after eating and bloating or pain in the left upper abdomen due to an enlarged spleen
• Unusual bleeding, such as a nosebleed or bleeding gums
• Painful swelling of one joint, often the big toe
• Shortness of breath and difficulty breathing when lying down It is important to consult with a healthcare provider if you experience any of these symptoms during pregnancy.

Assessment and Diagnosis

Triage

You should see a doctor if polyhydramnios is suspected, especially if you experience symptoms such as shortness of breath, swelling in the lower extremities and abdominal wall, uterine discomfort or contractions, fetal malposition, or if your uterus is excessively enlarged and your health care provider has trouble feeling the baby. It is important to consult with a health care provider who is knowledgeable about polyhydramnios and can provide appropriate monitoring and treatment.

Diagnosis

Polyhydramnios can be diagnosed through a fetal ultrasound, which uses high-frequency sound waves to produce images of the baby. If the initial ultrasound shows evidence of polyhydramnios, a more detailed ultrasound may be performed to estimate the amniotic fluid volume (AFV) or to measure the Amniotic Fluid Index (AFI). An AFV value of 8 centimeters or more or an AFI of 25 centimeters or more indicates polyhydramnios. Your healthcare provider will also use a detailed ultrasound to diagnose or rule out birth defects and other complications.

Management and Treatment

Complications

Potential complications of polyhydramnios include premature birth, premature rupture of membranes, placental abruption, umbilical cord prolapse, C-section delivery, stillbirth, and heavy bleeding due to lack of uterine muscle tone after delivery. Polyhydramnios is associated with these complications, especially when it occurs early in pregnancy or with a significant amount of excess amniotic fluid.

Treatment

Treatment for polyhydramnios depends on the severity of the condition. Mild cases may resolve on their own, while severe cases may require closer monitoring. Your health care provider will carefully monitor your pregnancy to help prevent complications. In cases where polyhydramnios is caused by maternal diabetes or another treatable condition, addressing the underlying issue may help resolve the excess amniotic fluid. Treatment options may include:

1. Bed rest: In some cases, limited bed rest may be recommended to slow down amniotic fluid production.
2. Medications: Specific medications may be prescribed if polyhydramnios is caused by an underlying condition, such as maternal diabetes.
3. Amnioreduction: Severe polyhydramnios may require amnioreduction, a procedure to remove excess amniotic fluid through a needle inserted into the uterus.
4. Close monitoring: In cases where the cause of polyhydramnios isn't clear or the condition is mild, your health care provider may opt for close monitoring to ensure the pregnancy progresses safely. It is essential to consult with your health care provider to determine the most appropriate treatment plan based on your specific circumstances and the severity of your polyhydramnios.

Preparing for medical consultation

To prepare for an appointment for polyhydramnios, you should:

1. Write down any symptoms you're experiencing, including when they first started and how they've changed over time.
2. Write down key personal information, including any other medical conditions for which you're being treated.
3. Make a list of all medications, vitamins, or supplements that you're taking.
4. Ask a friend or family member to accompany you, if possible, to your appointment.
5. Write down questions to ask your doctor.
6. Be aware of any pre-appointment restrictions.
7. Bring a list of your medications, vitamins, and supplements.
8. Bring a list of your key medical information, including other conditions.
9. Bring a list of key personal information, including any recent changes or stressors in your life.
10. Don't hesitate to ask other questions during your appointment. Remember to provide your healthcare provider with as much information as possible to ensure the best possible care for you and your baby.