Polyhydramnios is a condition characterized by an increase in the amount of amniotic fluid in the amnion. Pathology manifests itself at different stages of embryogenesis, accompanied by deterioration of general well-being, fluctuation, swelling and severe toxicosis. It is possible to diagnose polyhydramnios during pregnancy on the basis of objective examination and ultrasound data. Treatment of pathology involves hospitalization in the obstetric department, where antibiotics, drugs that improve blood flow in the placenta, vitamins are prescribed. Taking into account the severity of the patient’s condition, wait-and-see tactics or emergency delivery can be used.
Polyhydramnios is an obstetric anomaly accompanied by a gradual or rapid deviation of the level of AF from normal indicators in the direction of increase. Another name for this pathological condition is polyhydramnion. Normally, the volume of AF depends on the gestation period: at 10 weeks – 30 ml, after 21 days – 100 ml, at 18 weeks – 400 ml, closer to childbirth – 800-1500 ml. Polyhydramnios is diagnosed in about 1% of patients at different stages of gestation, most often the pathology occurs in the 2-3 trimester. The danger of polyhydramnios during pregnancy is to provoke multiple negative consequences for the woman and the child. In 36% of all cases, this condition causes severe toxicosis at any stage of embryogenesis and contributes to a significant deterioration of the patient’s condition.
A third of cases of polyhydramnios end in spontaneous abortions. The fetal membranes cannot withstand the increased pressure of AF and are damaged, which is accompanied by stillbirth. Polyhydramnios during pregnancy is fraught with an incorrect location of the fetus in the uterus due to the presence of a large space for its movements. Such a violation manifests itself in about 6-7% of cases. The danger of polyhydramnios during pregnancy also lies in the fact that in every second case it provokes the development of postpartum bleeding, premature outpouring of amniotic fluid, placental abruption.
The pathogenesis of polyhydramnios may consist of two opposite mechanisms: a violation of the secretory activity of the villi of the fetal membranes and a pathological increase in the volume of AF due to a disorder of absorption. Normally, the absorption of amniotic fluid is carried out through the lungs and intestines of the baby, as well as directly by the amniotic membrane itself. Polyhydramnios during pregnancy can also develop in case of impaired swallowing activity of the fetus. At the same time, a normal volume of AF is released, but the water does not have time to go through the absorption cycle (normally amniotic fluid is updated every 3 hours, and the child swallows up to 4 liters per day).
It has not been possible to finally find out the causes of polyhydramnios so far. Doctors believe that the risk of developing obstetric pathology increases significantly if a woman has metabolic disorders, in particular, diabetes mellitus. Polyhydramnios during pregnancy often occurs due to diseases of the kidneys, cardiovascular system. The probability of polyhydramnion increases against the background of Rh conflict. Another common cause of polyhydramnios during pregnancy is infection, and in this case there is a threat of intrauterine infection of the fetus. The greatest danger is the causative agents of rubella and herpes, toxoplasma and cytomegalovirus.
Polyhydramnios during pregnancy can be provoked by disorders in the development of the fetus. According to statistics, obstetric abnormality is more often diagnosed if there are abnormalities associated with chromosomal mutations. Polyhydramnios during pregnancy often occurs in the presence of malformations of the kidneys, intestines, lungs, central nervous system, heart. The risk group for the formation of this pathology includes women who, after conception, have suffered viral and bacterial infections, including influenza, SARS. A certain role in the development of polyhydramnios during pregnancy is played by the impact of negative factors: smoking, drug and alcohol use, work at harmful enterprises, insufficient intake of nutrients.
Classification and symptoms
Depending on the rate of increase in the volume of amniotic fluid in obstetrics , there are two types of this condition:
- Chronic polyhydramnios is the most favorable variant of the course of pathology, in which there is a high probability of delivering the fetus before the expected date of delivery. In this case, polyhydramnios develops gradually during pregnancy, is accompanied by minor clinical manifestations and responds well to conservative treatment.
- Acute polyhydramnios is a severe form characterized by a rapid increase in the volume of AF (in just a few hours). More often, this pathology develops at 16-18 weeks of gestation, leading to a serious condition of the mother and baby. This form causes spontaneous abortion in late terms, severe congenital anomalies, stillbirth and provokes serious complications on the part of the patient.
The severity of polyhydramnios during pregnancy is determined by the amount of amniotic fluid: light – AF volume up to 3 liters, moderate – from 3 to 5 liters, severe – over 5 liters.
Polyhydramnios during pregnancy can manifest itself in different ways, the clinical picture depends on the severity and rate of progression of the pathology. The most characteristic sign of obstetric abnormality is late toxicosis, accompanied not only by intense bouts of nausea, but also severe vomiting. A woman suffering from polyhydramnios during pregnancy has swelling of the anterior abdominal wall, there may also be an accumulation of fluid in the subcutaneous adipose tissue of the lower extremities. Almost every patient has a fluctuation – “squelching” of the amniotic fluid, which increases with movement.
Polyhydramnios during pregnancy is always accompanied by a significant deterioration in the general condition of a woman. Due to the pressure of the uterine fundus on the diaphragm, shortness of breath is noted, sometimes the work of the heart is disrupted, tachycardia is detected. With polyhydramnios, a pregnant woman is worried about abdominal pain, lower back and groin area, increased fatigue. Against the background of strong tissue overgrowth, multiple rough stretch marks appear on the anterior abdominal wall. On the part of the fetus, polyhydramnios during pregnancy is usually accompanied by signs of hypoxia, pelvic presentation and umbilical cord entanglement are also possible due to sufficient space for motor activity.
An obstetrician-gynecologist can suspect polyhydramnios during pregnancy already on the basis of an objective examination and complaints of the patient. In addition to the deterioration of the general condition of a woman, a characteristic feature is an increase in the standing of the uterine floor, which does not correspond to the gestation period. Also, polyhydramnios during pregnancy is evidenced by a significant increase in the circumference of the abdomen, indicators sometimes exceed 100-120 cm. Palpation can determine the pathological position of the fetus in the uterine cavity – oblique, transverse or pelvic. If polyhydramnios is suspected during pregnancy, a woman is prescribed laboratory diagnostics: general blood and urine tests, a smear from the genital tract for microflora in order to detect infections.
If polyhydramnios during pregnancy is caused by rhesus conflict, a study is shown to determine the amount of antibodies. The diagnosis is finally established after ultrasound. During the procedure, it is possible to measure the amount of AF, as well as to assess the functionality of the placenta and the well-being of the fetus. In rare cases, amniocentesis is performed. Polyhydramnios during pregnancy requires careful monitoring of the baby. For this purpose, CTG and uteroplacental Dopplerography are performed, allowing to assess the degree of hypoxia, heart function, motor activity, blood flow level in the umbilical cord vessels and determine further medical tactics.
Treatment of polyhydramnios
Polyhydramnios during pregnancy requires hospitalization in an obstetric hospital and careful monitoring of the condition of the woman and fetus. Complete rest is prescribed, it is important to exclude stressful factors and physical exertion. The medical treatment of polyhydramnios during pregnancy depends on the cause of this condition. Therapy of the underlying disease, which contributed to the development of a pathological increase in the volume of AF, is necessarily carried out. If the etiology of polyhydramnios during pregnancy is not established, the classical scheme is used – antibacterial therapy in order to prevent the introduction of intrauterine infection.
Conservative treatment of polyhydramnios during pregnancy also involves the use of drugs to improve uteroplacental blood flow, vitamin complexes, diuretic drugs. In the case of acute polyhydramnios during pregnancy and a significant deterioration of the patient’s condition, associated with a threat to her life, depending on the period of embryogenesis, an interruption or premature delivery by caesarean section is indicated. If the conservative approach gives positive dynamics, pregnancy management is continued until 37-38 weeks.
Delivery in the case of polyhydramnios during pregnancy is carried out by planned Caesarean section. It is important to prevent spontaneous opening of the fetal bladder. Due to the large volume of amniotic fluid, its rapid outpouring can lead to the loss of small parts of the fetus, as well as the weakness of labor. If a decision is made to carry out natural childbirth against the background of polyhydramnios during pregnancy, an amniotomy is required. This additionally stimulates contractions.
Prognosis and prevention
In general, the prognosis for polyhydramnios is favorable. Early diagnosis and treatment make it possible to prolong gestation until the expected date of delivery and preserve the health of the baby. However, this condition is often complicated by birth and postpartum bleeding, intrauterine hypoxia, premature placental abruption. Acute polyhydramnios during pregnancy in most cases leads to fetal death. To prevent the development of obstetric abnormalities, conception should be planned, infection foci treated in a timely manner and be consulted by an obstetrician-gynecologist. Prevention of lack of water during pregnancy also consists in moderate physical activity and proper nutrition. A woman during the gestation period should avoid stress and bad habits, stay in the fresh air a lot.