Severe polyhydramnios and a large fetus or relative polyhydramnios before childbirth is a pathology or feature of pregnancy. What are the dangers of polyhydramnios during pregnancy and its treatment? What are the dangers of polyhydramnios in a pregnant woman?
Pathology of amniotic fluid, the most common of which is polyhydramnios, is an urgent, not yet sufficiently studied problem in obstetrics. What does polyhydramnios mean and is it dangerous during pregnancy?
It is a condition characterized by the presence of excess fluid in the amniotic cavity. This is considered to be a volume of more than 1.5 liters by the end of full-term pregnancy, and in accordance with multiple foreign monographs - more than 2 liters. The frequency of this pathology among all births ranges from 0.3 to 1.2%. Typically, clinical symptoms appear when the volume of fluid is more than 3 liters.
The role of amniotic fluid and its source
The amniotic environment plays a huge role in ensuring the normal growth and development of the fetus both during a physiological pregnancy and in conditions unfavorable for it - complications of pregnancy or illness of the mother. Amniotic water provides the growing fetus with the necessary free space, mechanical and noise protection, participates in maintaining its temperature balance, gas exchange, nutrition and removal of metabolic products, in the formation of immunity and hormonal state.
In addition, in the last weeks of pregnancy and during childbirth, amniotic fluid is involved in preparing the birth canal for the passage of the fetus, protects the umbilical cord from compression and prevents disruption of blood flow in it.
Source of formation amniotic fluid in early pregnancy is not well understood. It is assumed that it is formed as a result of “sweating” (transudation) of maternal plasma through the chorionic and amniotic membranes or fetal plasma through its permeable skin.
The process of maintaining a balance between products has been studied somewhat more amniotic fluid and their resorption (reabsorption) in the second trimester. The main source is the fetus itself - its alveolar fluid, which is secreted by the lungs up to 400 ml per day, and urine, daily amount which by the end of pregnancy is already from 400 ml to 1.2 liters.
The decrease in fluid occurs partly due to a decrease in its production by the lungs as a result of their preparation for external respiration, swallowing it (at the 18th week - 200 ml) and further resorption through the epithelium of the lungs into the lymphatic vessels due to the difference in osmotic pressure between the fetal plasma and alveolar fluid . The intensity of liquid ingestion gradually increases to a volume of 500 ml at 40 weeks.
A decrease in fluid production by the alveoli of the lungs also occurs under the influence of the release of certain hormones and biologically active substances by the fetus, for example, vasopressin and catecholamines. In addition, its excess is partially removed due to the difference in osmotic pressure in the plasma of the mother and child.
What are the dangers of polyhydramnios?
It poses a danger both to the fetus, the pregnancy itself, and to the mother. Often in the early stages it is accompanied by early toxicosis in the form of “vomiting of pregnancy” (in 36%), possible spontaneous abortions, fetal malnutrition and chronic hypoxia, delay intrauterine development.
Polyhydramnios on later also contributes to intrauterine growth retardation. As a result of its excessive mobility, it is possible to become entangled in the umbilical cord, develop chronic asphyxia, and form an abnormal position in the uterine cavity (about 6%) in the form of a breech or transverse position. Premature termination of pregnancy or premature pregnancy may occur, which threatens not only the death of the fetus, but also massive bleeding.
Polyhydramnios on latest dates pregnancy and during childbirth can lead to late (in 5-20%), early or premature rupture of water with prolapse of the umbilical cord, arms or legs of the fetus. Prolonged labor as a result of weakness cannot be ruled out. ancestral forces and absence of contractions due to decreased contractility of the uterus or its atony, absence of pushing due to overstretching of the abdominal wall muscles. Facial or breech presentation and fetal hypoxia, premature placental abruption and other complications often occur.
Possible consequences for the child, in addition to asphyxia and death (the incidence of stillbirth with polyhydramnios is on average 10%), is intrauterine infection with septic complications, some delay in physical development, decreased immune defense, tendency to respiratory diseases.
IN postpartum period A woman's recovery is longer. The danger is posed by purulent and septic complications due to protracted labor and the need to provide obstetric care or surgical interventions, and the possibility of re-bleeding.
Reasons for the development of pathology
Disturbances in the processes described above can lead to excess amniotic fluid. Polyhydramnios can occur mainly in cases of:
- Intrauterine infection and development of amniotic fluid infection syndrome. This reason is the most common. Moreover, the main percentage falls on infections that are sexually transmitted (chlamydia, ureaplasma, herpes simplex virus, etc.). Pathogens can also be mycoplasma, respiratory viral infections, infections in inflammatory diseases of the genitourinary system (colpitis, adnexitis, pyelonephritis, cystitis, etc.).
- Diabetes mellitus (average 12%).
- Incompatibility of mother and fetus according to the Rh factor and the development of hemolytic disease.
- Much less often, polyhydramnios occurs during pregnancy with twins, when feto-fetal blood transfusion syndrome may develop, with fetal developmental anomalies, especially abnormalities of the digestive organs or nervous system, with hereditary diseases, blood diseases, and placental pathologies.
The share of pathologies with unknown causes accounts for more than 60%. How to determine polyhydramnios?
Signs of polyhydramnios during pregnancy
Depending on the nature of the course, this pathology is distinguished as:
- Acute, which usually occurs in short-term pregnant women - in the second trimester (ranging from 16 to 20 weeks).
- Chronic, usually developing in the third trimester.
Acute polyhydramnios
Compared to chronic, it is characterized by a particularly unfavorable course. Its symptoms increase very quickly - over several days or even several hours. A pregnant woman complains of a rapid increase in the volume of the abdomen, severe heaviness in its lower parts and in the perineal area, sometimes severe pain in the lumbar region and perineum, and increased blood pressure. On general examination, the anterior wall of the abdomen is swollen and smooth with stretch marks, and the uterus is tense. When auscultating the fetus, heart sounds are muffled and difficult to hear.
The death of the fetus or its birth with malformations is quite likely. Due to acute placental insufficiency and premature placental abruption, spontaneous abortion, life-threatening intrauterine bleeding (in 41%), uterine rupture or the threat of uterine rupture are possible.
Chronic polyhydramnios
Chronic polyhydramnios in the third trimester of pregnancy is characterized by a gradual increase in the volume of amniotic fluid and slow development. The prognosis largely depends on the severity of the pathology and the rate of increase in fluid volume. Sometimes, with a very slow increase in its quantity, it is quite difficult to recognize the pathology without instrumental examination.
In the chronic course, the symptoms of polyhydramnios during pregnancy are less pronounced than in the acute course. There is no pain syndrome or the degree of pain intensity is insignificant. The diagnosis is made on the basis of subjective complaints, general examination and instrumental examination.
A woman may complain about:
- excessive fetal activity;
- shortness of breath even with slight physical exertion;
- moderate heaviness and sometimes pain in the abdomen;
- heartburn and belching, especially after eating even a small amount of food;
- attacks of palpitations and weakness;
- persistent swelling of the legs;
- formation of stretch marks on the skin of the abdomen;
A general examination reveals:
- Increased density and upon palpation.
- Fluctuation in the abdomen (fluctuations in fluid).
- Excessive activity of the fetus, as well as its excessive mobility and unstable position during palpation.
- Difficulty in identifying small fetal parts.
- Muffled or muffled fetal heartbeat.
- Inconsistency (exceeding) of the measurement results of the abdominal circumference and the distance from the womb to the fundus of the uterus (height of the fundus of the uterus) for the given stage of pregnancy.
- Swelling of the legs and varicose veins.
- During vaginal examination during labor, a tense amniotic sac is revealed, regardless of the presence or absence of contractions.
The severity of the pathology and its diagnosis
Depending on the volume of amniotic fluid, it is customary to distinguish three degrees of severity of the pathology:
- I degree - 3,000 ml;
- II degree - from 3,000 to 5,000 ml;
- III degree - more than 5,000 ml.
Ultrasound examination is of particular importance for diagnostic purposes. With its help, from 16 weeks, the index of polyhydramnios during pregnancy is calculated, which is called the amniotic fluid index (AFI).
The method consists of mentally dividing the abdomen into 4 zones using two mutually perpendicular lines that intersect in the navel area. Then, during ultrasound examination, the largest vertical pocket of fluid is selected in each zone and measured. The sum of the results obtained is the numerical value of the AFI, expressed in millimeters.
From the 16th week of pregnancy, its average value gradually increases and becomes maximum by the 27th week - 156 mm (the lower limit of normal is 85 mm, the upper limit is 245 mm), after which the average value decreases every week. For example, at 32 weeks the average AFI value is 144 mm (76-269 mm), at 33 weeks - 143 mm (74-274 mm), and at 35 weeks - 140 mm (70-279 mm).
AFI values at the upper limit of normal or slightly above it mean moderate or relative polyhydramnios, in which there is no threat to the fetus. This indicator is the most significant in terms of characterizing its functional state and development. Constant monitoring of AFI helps prevent the development of pathological complications in the fetus.
Ultrasound is also used to determine the state of the placental structure and the timeliness of its maturation. In addition, by conducting cardiotocography, the general condition of the fetus is checked, and additional studies are prescribed to identify defects and anomalies of fetal development. How to treat a diagnosed pathology?
Treatment of polyhydramnios
When a diagnosis is made, the woman must be hospitalized in the department of pathology of pregnant women in order to clarify the diagnosis, identify the cause of the pathology and draw up a treatment plan. Treatment tactics depend on the period of development of the pathological condition, the cause and the degree of its severity. The presence of abnormalities of fetal development is an indication for termination of pregnancy.
In case of chronic polyhydramnios I and II degrees, which develop in the third trimester, treatment is usually carried out on an outpatient basis, aimed at maintaining pregnancy and physiological delivery. In case of an unexpressed acute form and stage III of the disease after 28 weeks of pregnancy, treatment is necessary before the onset of symptoms of fetal maturity (efficacy is about 71%). An acute form of pathology that has developed before the specified period is an indication for termination of pregnancy.
Treatment includes regular diet with limited intake table salt, spices, spicy and pickled foods, extractive dishes. From medicines diuretics with potassium and magnesium preparations, antiviral, antibacterial drugs and antibiotics (mandatory) of a wide spectrum of action are prescribed, as well as agents that help improve microcirculation (Curantil, Actovegin) and vitamin complexes.
In acute forms of pathology or the presence of a very large volume of fluid, a repeat is sometimes indicated. An increase in the clinical picture of an increase in the volume of amniotic fluid during therapy is an indication for early delivery.
The feasibility of using traditional medicine
Treatment of polyhydramnios folk remedies they are not recognized by official medicine because they contain unrefined components that can cause adverse reactions in the mother and, especially, in the fetus. In addition, they do not have a selective effect and a sufficient degree of effectiveness, which contributes to the loss of time necessary for treatment. It is only possible to use products that have a diuretic effect and vitamin supplements of plant origin, and only on the recommendation of a doctor.
Prevention of the condition
How to avoid polyhydramnios? Prevention consists of additional examination of a woman planning a pregnancy in order to identify and treat chronic infection and diabetes.
In the antenatal clinic, pregnant women with RH-negative blood, diabetes mellitus, a history of fetal development anomalies, pathology of the amniotic fluid and chronic inflammatory diseases of the genital organs are identified as a risk group.
The value of amniotic fluid for a baby is invaluable. They are the ones who do protective function, ensure a normal supply of the baby with all the necessary substances and serve as protection for the umbilical cord even from the slightest pressure. But the volume of fluid in the amniotic cavity has clear norms. Exceeding these indicators is a pathological condition, so it is important for the expectant mother to know why polyhydramnios is dangerous during pregnancy and how to behave in cases where this disorder occurs.
The first signs of polyhydramnios that a pregnant girl can appreciate
Standard indicators for the amount of amniotic fluid change significantly by different dates. If at the tenth week of embryo development there should be only 30 ml of fluid, then already at the fourteenth week their volume reaches 100 ml. And in the last weeks of pregnancy, the fetus should be surrounded by at least 1-1.5 liters of fluid.
Excessive amniotic fluid requires the intervention of a specialist, but it is important for a woman to know how to determine the possible development of pathology.
This condition is easily diagnosed using ultrasound. But an ultrasound examination is carried out only 4 times if the baby is developing correctly and the woman is in normal health, so the expectant mother needs to inform the doctor if the following symptoms appear:
- a feeling of heaviness in the abdominal cavity and possible pain;
- difficulty breathing, which is a consequence of increased pressure on the diaphragm during polyhydramnios;
- swelling in the legs;
- frequent weakness and feeling of fatigue;
- attacks of sudden increase in heart rate;
- a sharp increase in abdominal volume and the appearance of severe stretch marks;
- feeling of gurgling in the stomach.
All this should be the reason for an urgent visit to the doctor who is managing the pregnancy, since in this case it is necessary to immediately carry out specialized treatment.
What can cause polyhydramnios during pregnancy?
There are currently no clearly identified reasons for the appearance of polyhydramnios. But there are risk groups that more often than others suffer from an increase in the amount of amniotic fluid. Most often this pathology appears in the following cases:
- infectious diseases of any localization;
- chronic diseases of female organs;
- diabetes mellitus and other chronic diseases;
- during gestation of a multiple pregnancy, oligohydramnios may be observed in one fetus and polyhydramnios in the other;
- renal failure;
- Rhesus conflict between mother and fetus.
- bearing a large fetus;
- defects in the development of the baby.
These reasons can provoke an increase in the amount of amniotic fluid, which must be treated after a detailed examination of the pregnant woman. Modern medicine can help carry a pregnancy to term in most of these cases, but the condition requires serious attention from doctors.
What are the dangers of this condition?
Every expectant mother needs to know that this pathology is quite dangerous for her and the baby. The amount of amniotic fluid increases sharply. This process takes from several hours to several days. This provokes difficulty in the circulation of fluid around the baby and complicates the normal excretion of its waste products and the supply of all important substances and oxygen.
The consequences of this condition may be as follows:
- frequent vomiting occurs, causing uterine tone;
- in a quarter of cases premature birth occurs;
- there is abnormal positioning of the fetus, which can cause traumatic birth;
- in some cases, damage to the fetal nervous system is observed;
- fetoplacental insufficiency, leading to impaired fetal development and even death;
- in the presence of an infectious disease, there is a risk of intrauterine infection of the fetus;
- in the later stages there is a possibility of late gestosis, which is dangerous due to intoxication of mother and baby;
- the risk of bleeding, which may lead to the need for emergency delivery and seriously threaten the life of the fetus and the pregnant woman;
- overstrain of the uterus, leading to a decrease in labor;
- in rare cases, it becomes necessary to terminate the pregnancy.
Obviously, excess amniotic fluid has serious consequences, so at times quite serious therapy is carried out in order to maintain the pregnancy and enable the woman to cope with the birth process.
But often in such cases, the birth of a baby naturally carries great dangers, so a caesarean section is performed - that’s enough effective way saving the baby and mother with polyhydramnios.
How is the disorder diagnosed?
Only a doctor can determine polyhydramnios during pregnancy after a series of procedures. Ultrasound examination is the most effective. But even after the doctor saw the threat of polyhydramnios in the ultrasound images, another group of diagnostic procedures is carried out. The main ones are:
- blood test for infectious diseases;
- blood test for the presence of antibodies that indicate Rh conflict;
- diagnosis of the presence of protein in urine;
- analysis of vaginal flora using a smear;
- electrocardiogram;
- Dopplerometry.
If necessary, additional procedures are carried out to accurately establish a diagnosis and develop a treatment program. It is individual for each pregnant woman, so you should not listen to the recommendations of women who have encountered this problem, you need to go to a specialist.
In most cases, polyhydramnios is treated in a hospital setting using a large group of drugs.
The main goal of treatment is to prevent premature birth and ensure normal functioning of the fetus.
How to deal with polyhydramnios in pregnant women
There is practically no way to prevent the occurrence of this pathology. It is important for a woman to follow the doctor’s recommendations regarding nutrition and lifestyle, and also closely monitor her general condition. At the slightest disturbance, and even more so when swelling appears, you should consult a doctor.
Treatment is carried out until the severe stage of polyhydramnios, that is, until there are no disturbances in the breathing and circulation of the fetus from an increase in the volume of amniotic fluid. In such cases, a large set of procedures is used:
- the mother is prescribed a multivitamin complex, taking into account individual characteristics health conditions;
- medications are prescribed to normalize the condition of the placenta;
- drugs are used to restore uteroplacental blood flow, which ensures normal life support for the fetus;
- amniocentesis procedure for slow artificial removal of fluid - allows you to reduce the amount of amniotic fluid by 200 ml;
- antibacterial drugs are prescribed;
- Diuretic medications and herbal decoctions are used.
All this is done to help the body remove excess fluid and ensure normal renewal of amniotic fluid. This becomes the key to a successful pregnancy and prevents the baby from developing chronic diseases.
The purpose of these procedures is to help the body remove excess fluid and ensure normal renewal of amniotic fluid. This becomes the key to a successful pregnancy and prevents the baby from developing chronic diseases.
But during polyhydramnios, the condition of a pregnant woman can change very dramatically, so daily medical monitoring is carried out, which consists of weighing the expectant mother, as well as cardiotocography of the fetus.
Ultrasound and Doppler sonography are performed every 5-7 days. This approach allows doctors to comprehensively assess the condition of the mother and baby and, if necessary, carry out an emergency birth. Doctors also speed up delivery if the condition does not improve during treatment, but, on the contrary, worsens.
A pregnant woman should remember that it is necessary to inform the doctor about any observed deviations from the normal state. Ignoring this problem will not lead to anything good, and without the intervention of doctors the condition will not improve.
Specialists can now save 90% of pregnancies with polyhydramnios, so it is important to provide timely assistance to the expectant mother. In many ways, the success of treatment depends on how attentively the woman herself treats her condition.
Pregnancy is a wonderful time, but a woman must be vigilant to protect not only her health, but also her unborn baby from pathologies. In fact, there are plenty of potential dangers when carrying a fetus; remember at least polyhydramnios as a serious pathological process.
So, polyhydramnios is an excessive accumulation of amniotic fluid in the uterine cavity. It’s worth clarifying right away that this problem is discovered on the third ultrasound, when the doctor reports that the volume of amniotic fluid exceeds the prescribed norm of 1-1.5 liters. This problem should not be ignored, since it prevents the fetus from staying in the womb and its timely birth. Before starting treatment for polyhydramnios during pregnancy, it is necessary to understand what is the cause of this pathology?
With polyhydramnios, the baby feels an excess of fluid surrounding him, which can lead to serious consequences for his health.
There are several reasons for polyhydramnios, but only a doctor can determine what exactly led to this pathology.
There are several reasons for this pathological process, but doctors present the most frequently diagnosed among them:
- multiple pregnancy;
- the presence of chronic diseases in the female body;
- exacerbation of infectious diseases;
- Rhesus conflict;
- large fruit;
- pathologies at the intrauterine level.
The problem is obvious, but the question arises: how to treat it correctly so as not to harm the baby or provoke complications with his health at birth?
Symptoms of the disease
Polyhydramnios during pregnancy can occur in acute and chronic forms. If in the first case the disease progresses spontaneously and can become the main reason for hospitalization; then the symptoms of chronic polyhydramnios are mild, but getting rid of them is very problematic.
A woman may not be aware of the presence of such a serious problem in the body, but increased swelling of not only the extremities should prompt her to worrying thoughts. In most cases, this pathological condition is clearly noticeable, and the expectant mother compares herself to a filled “barrel of water.”
Signs of polyhydramnios are heaviness in the abdomen, general weakness, shortness of breath, and others. Among the main symptoms of polyhydramnios are the following:
- heaviness in the stomach;
- discrepancy between the size of the uterus and the ultrasound examination;
- gurgling and rumbling in the stomach;
- frequent shortness of breath;
- increased heart rate;
- decline in performance;
- general malaise.
Of course, such signs can also signal another disease in the pregnant woman, but it still won’t hurt to undergo a detailed diagnosis.
Detailed diagnostics
If the leading gynecologist suspects moderate polyhydramnios during pregnancy, treatment of the patient should begin with a detailed diagnosis that will determine the problem and its causes, and also help select the most adequate treatment regimen for a specific clinical picture.
A thorough examination for suspected polyhydramnios includes a detailed blood and urine test, ultrasound and some other studies. The study of pathology should begin with the following laboratory tests:
- general blood test;
- blood test for glucose;
- blood test to exclude (confirm) Rh conflict;
- general urinalysis;
- smear to study the vaginal microflora.
Additional results may be required:
- Ultrasound of the pelvic organs;
- Dopplerometry;
When reliable information is received, after carefully studying it, the doctor recommends undergoing a course of conservative treatment, which demonstrates its effectiveness in all trimesters of pregnancy. positive result, a beneficial effect on the vital functions of the fetus.
Formal treatment for polyhydramnios
Most likely, a woman diagnosed with Polyhydramnios will have to undergo medical treatment. When diagnosing polyhydramnios, the doctor suggests that the woman be kept in bed, and then undergo hospitalization. complex treatment under strict medical supervision. First of all, the expectant mother needs to perform daily fetal cardiotography, measure blood pressure and monitor weight to avoid excessive weight gain. In addition, once a week, an ultrasound scan of the pelvic organs and Doppler sonography are required, which determines the vital signs of the fetus.
These are prerequisites for successful treatment. Even if a pregnant woman refuses to go to the hospital for preservation, she is also under medical supervision, regularly attends antenatal clinics, takes the required tests in a timely manner, and undergoes an examination.
As for drug therapy, it includes taking medications from several pharmacological groups at once, each of which has a positive effect on the fetus and a targeted effect on the problem.
- Antibacterial therapy in the presence of infectious diseases, as an option - a course of Rovamycin or Erythromycin.
- Diuretics for removing excess amniotic fluid (Furasemide).
- Drugs that improve the quality of the placenta and prevent its premature aging.
- Drugs to enhance placental blood flow.
- Vitamin therapy (vitamins C, B and E).
Treatment of polyhydramnios is aimed at removing excess fluid from the body using diuretics. As a rule, one course of treatment is enough to stabilize the condition of a pregnant woman and prevent premature birth. If a woman is in interesting position“does not trust official medicine, then you can always turn to real help traditional treatment. Its main goal is to remove excess fluid from the body, and for this you need to take diuretic decoctions. As you know, rose hips, hawthorn, chamomile and other herbs that do not interfere with the normal course of pregnancy have a mild diuretic effect.
It is very important to coordinate any treatment with a doctor so as not to harm the baby’s health. With the right approach, the problem can be solved within a week.
Consequences of polyhydramnios
Many women simply do not understand how dangerous polyhydramnios is during pregnancy.
Timely diagnosis and treatment of polyhydramnios will help avoid many complications and preserve the baby’s health. Its occurrence in a pregnant body can lead to the following pathologies:
- incorrect presentation of the fetus;
- indications for caesarean section;
- early placental abruption;
- acute fetal hypoxia;
- weak labor activity;
- umbilical cord prolapse during childbirth;
- development of late gestosis;
- vomiting in a woman and dehydration;
- swelling of the newborn's brain upon birth.
It is now clear that treatment of polyhydramnios is a prerequisite for the birth of a healthy and strong baby, otherwise problems with his health after birth simply cannot be avoided.
Update: October 2018
Amniotic fluid plays a huge role in the development of the unborn child and the course of labor. Not only the condition of the unborn baby, but also the mother, depends on their quantity and quality.
Polyhydramnios, as an obstetric pathology, is common, but few pregnant women attach particular importance to this complication, although it, like all other deviations from the physiological course of pregnancy, requires, if not treatment, then careful monitoring.
The consequences of polyhydramnios are very serious and can become tragic, including the loss of an unborn child.
What is amniotic fluid needed for?
Everyone knows that life on Earth first originated in water, and then appeared on land. Man is no exception, and his embryo goes through the initial period of its existence in aquatic environment, that is, in the amniotic fluid.
The embryo develops in the fetal bladder (another name is amnion), which is filled with a biologically active medium - amniotic fluid, otherwise known as amniotic fluid. Amniotic fluid is of great importance, because it is from its quantitative and quality composition depends on whether the existence of the embryo and the course of labor will be comfortable. Amniotic fluid has many different functions.
- provides nutrition to the fetus due to the contained in it nutrients, which are swallowed by the future person, and in the early stages they are absorbed by the skin.
- provides optimal and, most importantly, constant temperature conditions (about 37 degrees).
- maintains pressure inside the fetal bladder, prevents compression of the umbilical cord and parts of the fetus.
- amniotic fluid protects the future person from mechanical influences from the outside (for example, blows to the stomach) and protects the fetus from external noise effects.
- amniotic fluid contains immunoglobulins - antibodies that prevent infection of the embryo, and the water itself is protected from the external environment and various infections due to the impermeability of the fetal bladder.
- amniotic fluid provides freedom of movement of the fetus in the uterus, especially in the early stages.
Polyhydramnios: what does it mean?
Polyhydramnios is a pathological condition that occurs during gestation, when an excessive amount of amniotic fluid accumulates. For example, at the 36th week of pregnancy, that is, at the end of the gestation period, the amount of amniotic fluid reaches 600 ml - 1.5 liters, then with this pathology the volume of amniotic fluid exceeds the agreed norm (1500 - 2000 ml).
The amount of amniotic fluid is directly related to the gestational age and as it increases, the volume of water also increases (see). For example, at 10 weeks the amount of water is insignificant and amounts to only 30 ml, and by 14 weeks the volume of amniotic fluid already reaches 100 ml, and so on. The incidence of polyhydramnios is 0.3% - 1% of all recorded pregnancies.
What is polyhydramnios like?
In its course, polyhydramnios can be both acute and chronic. In terms of prognosis, acute polyhydramnios is unfavorable compared to chronic polyhydramnios and is characterized by a rapid increase in symptoms over several days and even hours. As a rule, the described pathology is observed at short stages of pregnancy, which requires its immediate termination. If polyhydramnios is chronic, then the volume of water increases gradually and the symptoms are more smoothed out. Chronic polyhydramnios is most often diagnosed in the last stages of pregnancy.
There are three degrees of severity of chronic polyhydramnios:
- mild degree, when the amount of amniotic fluid does not exceed 3000 ml
- moderate degree– the amount of water is in the range of 3000 – 5000 ml
- severe degree - if amniotic fluid exceeds 5 liters (more common at the end of pregnancy).
There is another gradation of polyhydramnios:
- relative polyhydramnios– does not pose a danger and is set according to the ratio of the amount of water and the size of the fruit;
- tendency towards polyhydramnios or borderline polyhydramnios– the amount of amniotic fluid corresponds to the upper limit of normal;
- idiopathic polyhydramnios– the prerequisite for its occurrence is unknown;
- moderate polyhydramnios during pregnancy - in this case, there are no external manifestations, and the volume of water only slightly “off scale”;
- severe polyhydramnios– has characteristic features described pathology, the stomach grows quickly.
Why does polyhydramnios occur?
To date, the causes of polyhydramnios in pregnant women have not been studied enough. All factors that determine the development of this pathology are divided into 4 groups:
Maternal factors
Factors associated with pregnancy complications
Complications of this pregnancy can also be caused by an excess of amniotic fluid. These include:
- (vascular damage, in particular the placenta)
- (cm. )
- pathology of the placenta (chorioangioma and others)
Fruit factors
- various fetal developmental anomalies(esophageal fusion, chromosomal diseases, pathology of the urinary system, brain, fetal immobility, etc.)
- multiple pregnancy, and more often one of the fetuses develops polyhydramnios, and the other develops oligohydramnios due to the development of feto-fetal transfusion syndrome
Idiopathic polyhydramnios occurs without a reason
The mechanism for the development of polyhydramnios is a violation of the exchange of amniotic fluid. This exchange consists of the secretion and consumption of amniotic fluid. If at short stages of pregnancy the amnion only secretes fluid, then in later stages the replacement of amniotic fluid occurs through the amniotic area of the placenta. And any pathology leads to a change in the volume of water. The amount of amniotic secretion also increases due to the urine that the fetus secretes, and its absorption is carried out through the lungs and digestive tract of the child.
- Therefore, any fetal pathology associated with the gastrointestinal tract
- urinary system
- lungs, leads to disruption of water metabolism.
Clinical picture of polyhydramnios
Manifestations of polyhydramnios are associated with both the severity and course of the disease.
Acute polyhydramnios
As was written earlier, acute polyhydramnios is more severe and clinical picture clearly expressed. Acute polyhydramnios most often occurs in the second trimester, around 16–20 weeks. Symptoms increase in a matter of hours. The woman notes a sharp increase in the abdomen, pain and heaviness in the lower abdomen and perineum, severe shortness of breath, etc.
Chronic polyhydramnios
The clinical picture of chronic polyhydramnios is more blurred. Since the accumulation of water occurs gradually, the manifestations of this pathology do not appear immediately. In some pregnant women, there are no signs of polyhydramnios at all, and an excess amount of water is discovered by chance during the next ultrasound examination. Chronic polyhydramnios usually occurs between 30 and 33 weeks of gestation. Its signs, first of all, are:
- discrepancy between the size of the abdomen and the gestational age, that is, the height of the uterine fundus and abdominal circumference are greater than normal.
- the doctor listens to the muffled heartbeat of the fetus, which is associated with excess amniotic fluid, which makes auscultation difficult. The pregnant woman herself may notice too active movements and mobility of the fetus, which upon palpation is detected as an incorrect position of the baby ( breech presentation, transverse or oblique position).
- women may complain about:
- shortness of breath even after minor physical activity(the uterus “props” the diaphragm)
- heartburn
- sudden tachycardia
- attacks of weakness
- persistent swelling of the legs is also characteristic
- pain or heaviness in the lower abdomen
- Due to the enlargement of the abdomen, multiple pregnancy stretch marks (striae) appear on the abdominal wall.
During examination and palpation of the abdomen, the doctor notes its tension, fetal mobility and high-standing presenting part.
Diagnostics
The doctor may suspect polyhydramnios based on examination data (size of the abdomen, incorrect position/presentation of the fetus, dull heartbeat) and the presence of complaints.
Ultrasound
- To confirm the diagnosis, an ultrasound is required, with the help of which the amniotic fluid index (abbreviated as AFI) is calculated. The method for calculating the AFI is the summed value of all “pockets,” that is, places free from small parts of the fetus and umbilical cord in the four quadrants of the uterine cavity.
- The amniotic fluid index is the gold standard for determining the pathology of amniotic fluid.
- IAF data changes daily (water is replaced every 3 hours).
- The calculated IAF is compared with physiological indicators for a given gestational age (there is a special table).
| Gestational age | Amniotic fluid index, cm | ||
| 5th percentile | 50th percentile | 95th percentile | |
| 14 weeks | 2,8 | 5,0 | 8,6 |
| 16 weeks | 3,6 | 5,8 | 9,6 |
| 18 weeks | 4,6 | 6,8 | 11,1 |
| 20 weeks | 5,5 | 8,0 | 12,9 |
| 22 weeks | 6,3 | 9,3 | 14,9 |
| 24 weeks | 7,0 | 10,7 | 16,9 |
| 26 weeks | 7,5 | 12,0 | 18,7 |
| 28 weeks | 7,6 | 13,0 | 19,9 |
| 30 weeks | 7,5 | 13,6 | 20,6 |
| 32 weeks | 7,1 | 13,6 | 20,4 |
| 34 weeks | 6,4 | 12,9 | 19,4 |
| 36 weeks | 5,6 | 11,8 | 17,9 |
| 38 weeks | 4,7 | 10,3 | 15,9 |
| 40 weeks | 3,7 | 8,6 | 13,9 |
In addition to examination and ultrasound, the woman is prescribed the following tests:
- blood test for sugar (exclusion/confirmation of diabetes mellitus);
- vaginal smear for microflora;
- polymerase chain reaction (blood or vaginal swabs) for TORCH infections;
- clinical blood and urine tests;
- blood for antibodies (if the woman’s Rh blood is negative);
- cardiotocography, Doppler monitoring to monitor the condition of the fetus.
If a pregnant woman is being treated in a hospital, then her abdomen is measured daily, the fetal heartbeat is listened to and its position is determined.
Treatment
How to treat polyhydramnios during pregnancy depends on the cause that caused it. All women with this pathology, especially those with moderate and severe degrees, are subject to hospitalization in the department of pathology of pregnant women.
- If gestational diabetes mellitus is detected, treatment of polyhydramnios consists of correcting blood glucose, and if immunological Rh incompatibility is detected, appropriate therapy is carried out (treatment or prevention of hemolytic disease of the unborn child).
- However, in most cases, the cause of polyhydramnios remains unknown, then therapy is aimed at normalizing uteroplacental blood flow:
- antiplatelet agents: chimes, trental
- tocolytics: ginipral, partusisten
- antispasmodics: , nosh-pa
- administration of vitamins is indicated (ascorbic acid, vitamin E, B vitamins)
- There is data on the advisability of prescribing indomethacin tablets for polyhydramnios.
- Regardless of whether an infection is detected during examination or not, the woman must be prescribed antibiotic therapy, using broad-spectrum drugs from the macrolide group (erythromycin, josamycin and others).
- In case of severe polyhydramnios, amniocentesis is performed by puncturing the abdominal wall, inserting a needle into the uterine cavity and withdrawing a certain amount of water.
Complications
Why is polyhydramnios dangerous during pregnancy? - a similar question interests every woman with this pathology.
- Firstly, polyhydramnios, especially acute, is dangerous due to termination of pregnancy, which is carried out artificially for medical reasons before 28 weeks.
- In addition, polyhydramnios often causes premature birth (the uterus overstretched by water and a tense amniotic sac cause opening of the uterine pharynx and uterine contractions), prenatal rupture of water, bleeding in the first 2 hours after birth and in the subsequent period (due to impaired contractility of the uterus) .
- Also, polyhydramnios, especially during childbirth, can cause premature placental abruption, and this is an indication for an emergency cesarean section. During the rupture of water, small parts of the baby or the umbilical cord loop may fall out, which also means an emergency situation and surgery.
- Due to high motor activity The fetus is often observed to have abnormal position/presentation and entanglement with the umbilical cord.
- With polyhydramnios, the uteroplacental blood supply is disrupted, which leads to intrauterine hypoxia and delayed fetal development.
- Gestosis with polyhydramnios occurs much more often than in other cases, as well as arterial hypertension and uncontrollable vomiting.