Polyhydramnios or hydramnios is the excess of amniotic fluid
in the uterus that the baby is in. Polyhydramnios is observed in approximately
1-2% of all pregnancies.
The diagnosis is made by monitoring the amniotic fluid on
ultrasound. The amniotic fluid index (ASI) method is diagnosed as
polyhydramnios if the total of 4 quadrants is greater than 250 mm or the
deepest vertical pocket measurement is greater than 80 mm.
Normally the amniotic fluid volume is 200 ml at 16 weeks,
1000 ml at 28 weeks, 900 ml at 36 weeks and 800 ml at 40 weeks.
In cases where the water is too much, there is excessive
growth and tension in the mother's abdomen. For this reason, the mother may
have difficulty breathing and feel discomfort in her abdomen.
Reasons:
About 50% of polyhydramnios cases are idiopathic, meaning no
cause can be identified. Especially in mild polyhydramnios cases, this rate is
higher, whereas in the majority of severe polyhydramnios cases, an etiological
cause can be detected.
Conditions
that can cause polyhydramnios:
- Diabetes in the mother (pregestational or gestational
diabetes)
- Anomalies that prevent the fetus from swallowing
(esophageal atresia)
- Digestive system anomalies, esophageal atresia (no
esophagus)
- Central nervous system anomalies, anencephaly,
- Respiratory tract anomalies
- Diaphragmatic hernia (may compress the esophagus)
- Congenital heart diseases
- Presence of hydrops fetalis in the fetus (Immune or
non-immune)
- Rh immunization (blood incompatibility)
- Fetus-related infections (congenital infections)
- Twin pregnancy (twin to twin transfusion syndrome)
- Chromosomal anomalies
- Skeleton anomalies
- Thoracic anomalies
- Myotonic dystrophy etc. congenital muscle diseases
- High hatching cardiac failure
- Chorioangioma in the placenta
- Fetal anemia
- Sacrococcygeal teratoma
- Pseudohipoaldosteronism
- Fetal batter syndrome (hyperprostaglandin E syndrome)
- Fetal nephrogenic diabetes insipitus
The first step in a pregnancy with polyhydramniosis is a careful
ultrasonographic anomaly screening. The presence of an anomaly or brain anomaly
in the fetus in the chest or in the abdomen should be investigated. The second
step is to investigate the causes of the mother. Blood sugar monitoring is done
to investigate the presence of diabetes in the mother.
Risks and
complications related to polyhydramnios:
The potential risk in the presence of polyhydramniosis is
preterm pain due to overvoltage, opening of the water sac. If the water drains
suddenly, there may be cord sagging or placenta separation (detachment).
Polyhydramnios can cause preterm labor. The risk of infant mortality (perinatal
mortality rate) in Polihdramnios varies between 10% and 30%. In addition, in
the case of polyhydramnios, the risk of cesarean increased due to the reverse
of the baby, such as breech posture. In the case of excessive polyhiramnios,
conditions related to the pressure of the uterus, which have grown too
excessively, such as shortness of breath in the mother, excessive edema in the
legs, ureteral compression, may occur. The risk of postpartum uterine atony
increases.
Treatment:
Although it is not applied very frequently, in some cases,
excessive fluid can be drawn with an injector (amnio-drainage, amniocentesis)
and reduced.
Amniotic fluid amount may decrease with the drug called
indomethacin, but it is inconvenient to use this drug after 32 weeks. It can
cause early closure of the ductus venous in fetuses older than 32 weeks.
Amniocentesis
(Amnio-drainage):
Amnio-drainage is the removal of some of the amniotion fluid
from the mother's womb with the help of an injector. It is similar to the
amniocentesis process. However, more fluid is taken in the amnio-drainage
process. The amnio-drainage process carries some risks: it can cause the loss
of pregnancy (death of the baby) at a rate of 2-3 per thousand, causing the
onset of birth. Chorioamnionitis (inflammation of the membranes in the uterus)
can cause premature rupture of membranes or other risks. In polyhydramnios
cases, a lot of amniodraining can be done serially. It is not a procedure
applied in every polyhydramnios patient.
ADDITIONAL
INFORMATION:
- There are studies reporting that IUGR and polhidramnios are
more common in infants of high altitude.
- The biggest factor in the amniotic fluid of the fetus is
the urination of the fetus. Urination of the fetus, swallowing amniotic fluid,
transudation from the skin, fluid produced from fetal lungs are other factors
contributing to the amniotic fluid cycle.
-UMBILICAL CORD AROUND BABY’S NECK
-LOW AMNIOTIC FLUID IN PREGNANCY
-HIGH AMNIOTIC FLUID IN PREGNANCY
-PREMATURE MEMBRANE RUPTURE
-FETAL DISTRESS