Polyhydramnios is when there is an overproduction of amniotic fluid. Much more often polyhydramnios occurs in twin pregnancies, women suffering from diabetes or in the course of a severe form of serological conflict. What are the causes and symptoms of polyhydramnios? How is the treatment going?

Polyhydramnios(too much amniotic fluid) is associated with the possibility of a number of complications, especially in the perinatal period. Examples include umbilical cord prolapse or incorrect insertion of the fetal head. The most characteristic symptom of polyhydramnios is the abdominal size being inadequately large in relation to the gestational age. Excessive fetal movement makes it difficult to hear your pulse.

What is amniotic fluid?

Amniotic fluid (amniotic fluid) is made from a mixture of the mother's body fluids and the developing fetus. It contains amniotic cell elements, proteins, fats and active enzymes. It has been estimated that complete amniotic fluid replacement occurs within two hours. The very mechanism of the formation of the fluid is not fully known. It is important that the optimal pH for the absorption is kept, in the range of 8.4-8.9. The amount of amniotic fluid varies with the gestational age. The largest volume is at 30-36 t.c. and then it gradually decreases, reaching the volume of 800 ml in the perinatal period. Fetal water is essential for the proper development of the fetus. They guarantee the optimal environment for the maturity of the respiratory system. They perfectly absorb the fetus against external stimuli and ensure freedom of movement. In addition, they are involved in the transport and exchange of nutrients.

When is amniotic fluid volume pathological?

The physiological volume of fluid is considered to be less than 2000 ml in the third trimester of pregnancy. Any greater value is referred to as polyhydramnios. It is associated with a disturbed absorption and production of amniotic fluid. In many cases, polyhydramnios is not an isolated condition but coexists with fetal malformations. Most often these are abnormalities related to the digestive system, e.g. esophageal atresia. Other factors influencing the increase in the volume of amniotic fluid on the part of the fetus include defects in other systems, e.g. genitourinary system, and on the maternal side, metabolic diseases such as diabetes.Polyhydramnios is also seen in severe serological conflict, when the mother's body reacts to foreign antigens circulating in the bloodstream.

Symptoms of polyhydramnios

The increasing volume of amniotic fluid is primarily associated with the feeling of shortness of breath and discomfort in the abdominal cavity. In addition, there is excessive contractile activity in the uterus as the muscle begins to stretch in response to polyhydramnios. All of this can lead to preterm labor, preceded by a rupture of the membranes. Polyhydramnios carries the risk of many pathologies of the perinatal period: prolapse of the umbilical cord or small parts of the fetus.

The physical examination shows that the uterine muscle is tense, and the pregnant belly itself is excessively arched and spherical, while palpating a positive symptom of bubbling, which is an indicator of the presence of fluid in the abdominal cavity. The fetus is more mobile, which is indirectly related to the difficulties in listening to the fetal heartbeat.

Diagnostics of polyhydramnios

The basic examination that allows to detect any abnormalities related to the volume of amniotic fluid is ultrasonography. Ultrasound examination should be performed according to strictly defined rules. In order to accurately estimate the volume of amniotic fluid, the uterus must be divided into four quadrants and within each quadrant there are places devoid of the umbilical cord and small parts of the fetus. They are the so-called fluid pockets, and the final value is the sum of all four of them. An experienced obstetrician does not always use the above-mentioned algorithm, and often after the first application of the head, he is able to determine whether the volume of amniotic fluid is correct. Accurate, objective assessment in the form of determining the AIF value is helpful in monitoring the discussed pathology.

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Polyhydramnios therapy

Treatment of excessive amniotic fluid depends on the cause of the increased production of amniotic fluid. Unfortunately, in many cases, the causative agent cannot be identified, and therefore treatment is difficult. The available form of treatment - amnioreduction, is much more often used. It is a procedure that eliminates not the source of polyhydramnios, but ailments related to polyhydramnios. The feeling of shortness of breath, abdominal pain or significant uterine muscle tension are just some of the indications for the amnioreduction procedure. It is a procedure that involves puncturing the abdominal wall of a pregnant woman under ultrasound guidance (up tolocation of the fetus and placenta) with a puncture needle and decompression of excess amniotic fluid. The amniocentesis procedure is associated with a short-term improvement in the patient's clinical condition and the resolution of unpleasant ailments, although in many cases a repeated increase in the volume of amniotic fluid is observed.

The prognosis for pregnancies complicated by polyhydramnios is actually determined by the cause of the increased amniotic fluid. Some causative factors can be eliminated. Unfortunately, due to the excessive stretching of the uterine muscle, we often deal with premature birth. On the other hand, rapid contraction of the uterus after delivery carries the risk of major bleeding, which is an immediate life-threatening condition. In addition to possible maternal complications, the percentage of perinatal mortality increases in the presence of polyhydramnios.

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Pregnancy