myhealthfirs.com

POLYHYDRAMNIOS : definition ,type, clinical feature, complication, management

pratiksha.jagtap30.2017@gmail.com

POLYHYDRAMNIOS

 

DEFINITION :
Anatomical definition :
” Polyhydramnions is defined as a state where liquor amnii exceed 2000 ml “\
Clinical Definition :
” The excessive accumulation of liquor amnii causing discomfort to the patient and when an imaging help is needed to substantiate the clinical diagnosis of the lie and presentation of the fetus  “
When the amniotic fluid index is more than 24 cm ( more than 95th centile for gestational age ) and the deepest vertical pocket (DVP) is more than 8 cm.
INCIDENCE :
  • The incidence varies from 1 to 2% cases
  • It is more common in multiparae than in primigravidae
  • While minor degree of hydramnios are fairly common , hydramnios sufficient to produce clinical symptoms probably occurs in 1 in 1000 pregnancy

ETIOLOGY OR RISK FACTOR :

There are several potential causes or etiologies that can lead to polyhydramnios:
  • Maternal Diabetes :
  1. Women with pre-existing diabetes or gestational diabetes have an increased risk of polyhydramnios due to elevated fetal urine production.
  • Fetal Anomalies :
  1. Certain fetal abnormalities, such as gastrointestinal or central nervous system defects, can impair the swallowing or absorption of amniotic fluid, leading to its accumulation.
  • Twin-to-Twin Transfusion Syndrome (TTTS) :
  1.  In pregnancies with monochorionic twins (twins sharing one placenta), TTTS can occur where one twin receives too much blood flow and produces excessive urine, leading to polyhydramnios in the recipient twin.
  • Fetal Anemia :
  1. Conditions such as Rh incompatibility or fetal hemolytic disease can lead to fetal anemia, which in turn can result in increased blood flow to the placenta and increased amniotic fluid production.
  • Fetal Infections :
  1. Certain infections like cytomegalovirus (CMV) or parvovirus can affect fetal swallowing mechanisms or cause abnormal fetal development, contributing to polyhydramnios.
  • Placental Abnormalities :
  1. Any condition affecting placental function, such as placental chorioangioma (a benign tumor of the placenta), can disturb the regulation of amniotic fluid levels.
  • Idiopathic :
  1. In some cases, polyhydramnios occurs without an identifiable cause (idiopathic polyhydramnios).
  2. It may be associated with maternal factors like obesity or be a result of increased fetal urination for unknown reasons.
  • Medications :
  1.  Certain medications, particularly those that increase fetal urine production (diuretics) or relax the uterus (tocolytics), can contribute to polyhydramnios

TYPES OF POLYHYDRAMNIOS 

Polyhydramnios, characterized by an excessive accumulation of amniotic fluid during pregnancy, can be classified into two main types based on its onset and duration:
  • Acute Polyhydramnios :
  1. This type of polyhydramnios develops suddenly and is often associated with conditions that rapidly increase fetal urine production, such as twin-to-twin transfusion syndrome (TTTS) or fetal anomalies like diaphragmatic hernia.
  2. Acute polyhydramnios may require urgent management to stabilize maternal and fetal conditions.
  • Chronic Polyhydramnios :
  1. Chronic polyhydramnios develops gradually over time and is more commonly associated with conditions that chronically increase fetal urine production or impair fetal swallowing over an extended period.
  2. Causes may include maternal diabetes, fetal genetic syndromes affecting the central nervous system, or structural anomalies that affect fetal swallowing or gastrointestinal function.
In addition to these types, polyhydramnios can also be categorized based on severity:
  • Mild Polyhydramnios :
  1. Amniotic fluid volume is slightly above normal but not significantly affecting pregnancy outcomes.
  • Moderate Polyhydramnios :
  1. Amniotic fluid volume is moderately increased, which may require monitoring and potential interventions depending on the underlying cause and maternal-fetal status.
  • Severe Polyhydramnios :
  1. Amniotic fluid volume is markedly increased, posing greater risks to both the mother (such as preterm labor or placental abruption) and the fetus (such as intrauterine growth restriction or malpresentation)
The classification of polyhydramnios helps in determining appropriate management strategies, which may include close monitoring with ultrasound, fetal testing, maternal evaluation for associated conditions like diabetes, and sometimes therapeutic interventions such as amnioreduction to alleviate symptoms and reduce risks.
SIGN AND SYMPTOMS :
the common signs and symptoms:
  • Maternal Symptoms :
  1. Abdominal Distension : One of the most noticeable signs is a rapid increase in the size of the abdomen beyond what is expected for the gestational age.
  2. Shortness of Breath :Compression of the diaphragm by the enlarged uterus due to excessive amniotic fluid can lead to difficulty breathing.
  3. Edema : Edema in the lower extremities may occur due to increased pressure on veins and lymphatic vessels.
  4. Discomfort : Increased abdominal pressure can cause discomfort, especially in the later stages of pregnancy.
  • Fetal Symptoms :
  1. Excessive Fetal Movement : Fetal movements may be more pronounced due to the increased space within the uterus.
  2. Malpresentation : Polyhydramnios can increase the risk of abnormal fetal presentation, such as breech presentation.
  3. Preterm Labor :The increased uterine distension can irritate the uterus and lead to premature contractions and possibly preterm labor.
  4. Fetal Distress : Severe polyhydramnios may compress the umbilical cord, reducing blood flow to the fetus and resulting in signs of fetal distress during monitoring.

COMPLICATION :

Maternal complication :
  1. Pre – eclampsia
  2. Malpresentation
  3. Premature rupture of membrane
  4. Preterm labor
  5. Accidental hemorrhage
  6. Early rupture of membrane
  7. Cord prolapse
  8. Uterine inertia
  9. Increased operative delivery due to malpresentation
  10. Retained placenta
  11. Shock
  12. Subinvolution
  13. Increased puerperal morbidity

Fetal complication :

  1. Death mostly due to prematurity
  2. low birth weight

MANAGEMENT :

  1. Monitoring and Evaluation :
  • Ultrasound Monitoring : Regular ultrasound examinations are essential to measure amniotic fluid volume (AFV) and assess fetal growth and well-being.
  • Fetal Surveillance : Non-stress tests (NSTs), biophysical profiles (BPPs), or Doppler studies may be performed to monitor fetal heart rate, movements, and amniotic fluid levels.
  1. Identifying and Treating Underlying Causes :
  • Maternal Diabetes Management : If polyhydramnios is due to diabetes, optimizing blood glucose levels through diet, exercise, insulin, or other medications is crucial.
  • Fetal Anomaly Evaluation :Detailed fetal ultrasound and possibly genetic testing may be performed to evaluate for structural abnormalities or genetic conditions contributing to polyhydramnios.
  1. Symptomatic Management :
  • Amnioreduction :In cases of severe polyhydramnios causing significant maternal discomfort, respiratory compromise, or increasing risk of preterm labor, therapeutic removal of excess amniotic fluid (amnioreduction) may be performed. This is typically done using ultrasound guidance to reduce the risk of complications.
  • Bed Rest :In some cases, maternal bed rest may be recommended to reduce the risk of preterm labor and manage discomfort.
  1. Addressing Complications and Risks :
  • Preterm Labor Management :Antenatal corticosteroids may be administered to enhance fetal lung maturity if preterm delivery is anticipated.
  • Monitoring for Fetal Distress :Close monitoring of fetal heart rate patterns and response to interventions is important to detect signs of fetal distress early
  1. Multidisciplinary Approach :
  • Consultation with Specialists :Depending on the underlying cause, consultations with maternal-fetal medicine specialists, neonatologists, genetic counselors, and other specialists may be necessary for comprehensive management.
  1. Patient Education and Support :
  • Education :Providing information to the patient and family about the condition, its potential causes, management strategies, and signs of complications is essential.
  • Supportive Care : Offering emotional support and addressing concerns related to the pregnancy and its management.
Regular prenatal visits are critical to monitor the progress of polyhydramnios and adjust management strategies as needed based on ongoing assessments. The goal of management is to optimize outcomes for both the mother and the fetus while addressing any underlying conditions contributing to the excess amniotic fluid accumulation.
Exit mobile version