Polyhydramnios, also known as hydramnios, means the excessive accumulation of amniotic fluid, which occurs in about 1 to 2% of pregnancies. Amniotic fluid is the fluid that surrounds the fetus during pregnancy. This complication is mild in most cases and is caused by the gradual accumulation of amniotic fluid in the second half of pregnancy. It may cause shortness of breath, premature birth, or similar symptoms if it is severe.
If you have this disease, you should see a doctor to prevent its complications. Treatment of this complication depends on its severity. If it is mild, it may go away on its own. But severe Polyhydramnios will probably require more careful monitoring.
What is Polyhydramnios?
Polyhydramnios is an excessive accumulation of amniotic fluid, the protective fluid that surrounds the unborn baby in the womb during pregnancy. Amniotic fluid around the baby protects against injury if the abdomen is traumatized or crushed. This fluid also protects your baby from infection and helps the baby’s lungs grow.
The fluid around the baby gradually increases to around one liter by 38 weeks. This amount is reduced to about 800 ml in 40 weeks. The baby swallows amniotic fluid regularly and then excretes it as urine. In this way, the unborn baby controls the amniotic fluid volume around it. When this balance is upset, the amniotic fluid volume can increase rapidly. In severe hydramnios cases, there may be as much as three liters of fluid or three times the normal amount around the baby.
Polyhydramnios can be a single disease with no congenital defects or other diseases. But it is more common in cases where the unborn baby has certain congenital anomalies or has a heart or lung disease. Polyhydramnios is also associated with various genetic disorders, including Down syndrome and Edward syndrome, but only if the child has duodenal atresia or other gastrointestinal obstruction. Hydramnios is also sometimes referred to as a condition known as intrauterine growth restriction (IUGR).
Symptoms
The amniotic fluid volume gradually increases, so it may not have significant symptoms. Symptoms that may occur include:
- Constipation
- Breathlessness
- Heartburn
- Swollen ankles and feet
- Fetal malposition, such as breech presentation
- Feeling tightness or huge in the belly
- Heartburn
- Decreased urine production
Some of these symptoms can be a common problem in pregnant women and may not be caused by polyhydramnios. Consult your obstetrician if you have these symptoms and are concerned.
Causes
Accumulation of excess fluid around the fetus can be due to the mother, baby, or placenta’s health problem. Determining the cause is often difficult, especially if it is mild.
Diabetes
If the mother already has diabetes or gestational diabetes, she is prone to hydramnios. It is unclear why more amniotic fluid is produced if the mother has diabetes. The baby may produce more urine because it receives more sugar through the placenta.
Twin-to-twin transfusion syndrome (TTTS)
Twin pregnancies can develop in several ways. The most common is the formation of two embryos in two different water sacs and the formation of only one common placenta for both fetuses. When a placenta of shared blood vessels feeds both fetuses during a twin pregnancy, they may have an imbalance in food and oxygen intake, causing one fetus to grow less than the other; it is called twin blood transfusion or TTTS.
Twin-to-twin transfusion syndrome between twins is one of the most common complications between identical twins who feed on a shared placenta. Getting more blood produces too much urine, which leads to the overproduction of amniotic fluid.
Chromosomal or genetic conditions
Sometimes a child may not pass fluids properly through the gastrointestinal tract or through their kidneys. This means the baby will be unable to swallow and excrete amniotic fluid normally, disrupting the fluid level. This problem can be associated with a chromosomal disorder such as Down syndrome. If there is a concern that polyhydramnios is related to the baby’s development, the doctor may recommend an amniocentesis test for more information.
A complication with the baby
A rare condition called a hydrops fetal scan causes fluid in the baby’s lungs and abdomen, causing amniotic fluid to build up around the fetus. Maternal infections, such as slapstick syndrome or toxoplasmosis, can cause fetal hydrops. Another infrequent cause is the mother’s rhesus status mismatch with the child’s rhesus status. This is very rare due to prenatal screening and the health care a doctor provides.
What problems can polyhydramnios cause?
Increased amniotic fluid may increase the risk of these problems during pregnancy:
- Premature birth: Birth before 37 weeks of pregnancy
- Premature rupture of the membranes (PROM): When the amniotic sac ruptures after 37 weeks of pregnancy but before labor begins
- Placental abruption: When the placenta separates completely or partially from the uterine wall before birth
- Stillbirth: When a baby dies in the womb after 20 weeks of pregnancy
- Postpartum hemorrhage: Severe bleeding after birth
- Fetal malposition: When the baby’s head is not down, it may be necessary to give birth by cesarean section.
- Umbilical cord prolapse: The umbilical cord falls into the vagina before the baby.
Diagnosis
If the obstetrician suspects Polyhydramnios, he or she will use ways to investigate further. In the first stage, the doctor uses ultrasound for diagnosis. In this experiment, high-frequency sound waves produce a child’s images on a monitor. Suppose the initial ultrasound shows evidence of hydramnios. In that case, the healthcare provider may perform a more accurate ultrasound that measures the volume of amniotic fluid (AFV) by measuring the largest and deepest part of the fluid around the baby. The amount of AFV 8 cm or more indicates Polyhydramnios.
If Polyhydramnios is diagnosed, the ob-gyn will perform additional tests. The test is based on risk factors, infections, and previous assessments of the child. Additional tests include:
- Blood tests: It is done to diagnose infectious diseases.
- Amniocentesis: A procedure in which a sample of amniotic fluid containing fetal cells and various chemicals produced by the baby is taken out of the uterus for testing.
- Nonstress test: This test looks at how the baby’s heartbeat reacts when the baby moves.
Treatment
Mild cases of hydramnios rarely require treatment and may resolve on their own. Complete examinations are performed at prenatal appointments. Dr. Arjang Naim, MD, and his team make prenatal appointments so pregnant mothers can be checked in time for maternal and fetal health. Treatment may be needed if you experience shortness of breath, premature labor, or abdominal pain. Treatment includes the following:
- Medication: Oral indomethacin is prescribed to help reduce fetal urine production and amniotic fluid volume. Indomethacin is not recommended beyond 31 weeks of gestation. Because of the risk of heart problems, it may cause to the fetus. Other side effects of the drug may include nausea, vomiting, acid reflux, and gastric mucosa inflammation.
- Drainage of excess amniotic fluid: Amniocentesis is used to drain excess amniotic fluid from the uterus.
After treatment, your doctor will check your amniotic fluid level approximately every one to three weeks.
What are the best ways to cope with polyhydramnios?
If you notice that your amniotic fluid volume is high, you should take a series of precautions, including:
- If you have shortness of breath, do your work slowly, get enough rest and inform those around you if you need help.
- You may have heartburn because the uterus pushes the stomach up. Therefore, eat small and regular amounts, do not lie down directly after eating and do not eat right before bed, and avoid eating and drinking things that worsen your heartburn.
- You may be anxious, so try relaxing techniques, attend pregnancy yoga classes, find enjoyable distractions, and connect with mothers who have experienced this type of pregnancy.
Labor and giving birth
It is usually recommended that you give birth in a hospital. Any equipment or treatment is readily available to you or your baby. If it does not pose a risk to you or your baby, you can have a normal delivery, which may require induction of labor or cesarean section.
During childbirth, a lot of fluid is released from the body. This is normal and not a cause for concern. The baby’s heart rate may also need to be closely monitored during delivery. After delivery, the baby is thoroughly examined to confirm its health and may have tests performed.
Is polyhydramnios common?
Approximately 1 in 100 women have excess amniotic fluid, accumulating gradually in the second half of pregnancy. In a small number of women, fluid accumulates rapidly, leading to premature labor.
If the doctor has told you that you have polyhydramnios, try not to worry because, usually, polyhydramnios is not a sign of something serious. So get enough rest if you work; you may need to start your maternity leave earlier; talk to your doctor or midwife about your birth plan, including what to do if your waters break or you give birth earlier than expected.
Additional questions
- What is the amniotic fluid made of?
In the early weeks of pregnancy, amniotic fluid is mostly water from the body. After about 20 weeks of pregnancy, the baby’s urine is mostly liquid. Amniotic fluid also contains nutrients, hormones, and antibodies.
- What are the symptoms of Edwards syndrome?
- Low birth weight
- Small head and jaw
- An unusual-looking face and head
- Unusual hands and feet
- Problems with feeding, breathing, seeing, and hearing
- How many cm is severe polyhydramnios?
- Mild polyhydramnios is characterized by a value of 8–11 cm
- Moderate polyhydramnios by a value between 12–15 cm
- Severe polyhydramnios by values above 16 cm 86
- Does polyhydramnios mean big baby?
Too much amniotic fluid may indicate that the fetus is larger than average.
- What is Slapped cheek syndrome?
Slapped cheek syndrome is caused by a virus called parvovirus B19. It is found in droplets coughed and sneezed by people with the infection. This virus spreads in a similar way to colds and flu.
References
https://www.mayoclinic.org/diseases-conditions/polyhydramnios/diagnosis-treatment/drc-20368494
https://www.healthline.com/health/pregnancy/too-much-amniotic-fluid#what-happens-next
https://www.dartmouth-hitchcock.org/obstetrics/polyhydramnios.html
https://www.babycenter.com.my/a551936/polyhydramnios
https://americanpregnancy.org/pregnancy-complications/polyhydramnios-high-amniotic-fluid-25711
https://www.marchofdimes.org/complications/polyhydramnios.aspx