Polyhydramnios is a condition when the amount of amniotic fluid during pregnancy is excessive.Although generally not cause serious problems, the condition requires regular monitoring from a doctor.
Amniotic fluid is the fluid that surrounds the fetus. Its functions include protecting the fetus from pressure outside the uterus, providing room for bone growth, and maintaining a warm temperature for the fetus.
Polyhydramnios is a condition that is rarely experienced by pregnant women. Usually, this condition occurs during the third trimester. However, polyhydramnios can also occur as early as the second trimester of pregnancy.
Under normal conditions, the volume of amniotic fluid will increase slowly from the beginning of pregnancy until it reaches its maximum amount (about 800 ml-1 liter) at 34 to 36 weeks. After that, the amniotic fluid will decrease slowly as the time of delivery approaches.
Amniotic fluid volume remains stable because the fetus swallows and excretes it as urine. Meanwhile, in polyhydramnios, the balance of amniotic fluid in the uterus is disturbed. Amniotic fluid balance disorders can occur due to a number of factors, namely:
- Birth defects in the fetus that affect the ability to swallow amniotic fluid, such as abnormalities in the digestive tract or the fetal central nervous system, and impaired muscle control of the fetus
- Anemia in the fetus
- Diabetes in the mother, both gestational diabetes and diabetes that existed before pregnancy
- Infections to the fetus during pregnancy, such as toxoplasma or rubella
- Accumulation of fluid in one part of the fetal bodyhydrops fetalis)
- Problems with the placenta
- Disorders of the baby's heart rate
- Twin to twin transfusion syndrome (TTTS) which causes one fetus to receive too much blood from the placenta so that the fluid excreted by the fetus through urine increases and increases the volume of amniotic fluid
- Abnormal chromosomal or genetic conditions, such as Down syndrome, Edward's syndrome, achondroplasia, and Beckwith Wiedemann syndrome
- Blood incompatibility between mother and fetus
Symptoms of Polyhydramnios
Polyhydramnios that is mild and develops gradually may not cause any significant symptoms. However, in some cases, the volume of amniotic fluid can increase very quickly to more than 2 liters.
Meanwhile, severe polyhydramnios can cause the uterus to stretch excessively so that it presses on the surrounding organs. Complaints that usually arise include:
- Mother gains more weight than expected
- Difficulty breathing or shortness of breath
- Digestive disorders, such as constipation
- Tension or contraction of the uterus
- Decreased urination
- Swelling in the lower legs and pubic which can be accompanied by varicose veins
- Difficult to feel fetal movement
- Sstretch marks on the skin
When to go to the doctor
Consult a gynecologist if you experience complaints as mentioned above. Most of the above symptoms are commonly felt by pregnant women, especially in the third trimester or near the time of delivery. However, in women with polyhydramnios, symptoms can be very bothersome or occur early.
If you have been diagnosed with polyhydramnios and experience new symptoms or worsening of previous symptoms, see a doctor immediately. With early treatment, complications that can arise from polyhydramnios can be prevented.
Seek immediate medical attention if:
- Rupture of membranes occurs early
- Bleeding from the vagina for more than 24 hours
- Visual disturbances, such as blurred vision
Diagnosis of polyhydramnios
To diagnose polyhydramnios, the doctor will ask questions related to the symptoms experienced and the drugs that are being used by the mother. After that, the doctor will perform a physical examination.
Polyhydramnios can generally be detected through routine pregnancy tests, such as measuring the height of the uterus. Doctors will suspect polyhydramnios if the size of the uterus is larger than the normal size for gestational age. Polyhydramnios can also be suspected if the doctor has difficulty detecting the position or heartbeat of the fetus.
The investigation needed to confirm polyhydramnios is an ultrasound examination. Through a pregnancy ultrasound, the doctor can find out the approximate amount of amniotic fluid. In addition, the severity of polyhydramnios can also be known through the value amniotic fluid index (AFI) on ultrasound. Here is the explanation:
- Mild polyhydramnios, if the AFI value is 24 cm–29.9 cm
- Moderate polyhydramnios, if the AFI value is 30cm–34.9cm
- Severe polyhydramnios, if the AFI value is more than 35cm
Ultrasound can also be done to see the size of the fetus's body, the condition of the kidneys and urinary tract of the fetus, as well as blood flow to the fetus' kidneys and placenta. This test can help your doctor identify the cause of polyhydramnios.
If the diagnosis of polyhydramnios has been established, the doctor will perform several follow-up examinations to determine the cause of polyhydramnios and monitor the condition of the fetus. Here are some checks that can be done:
- Amniocentesis or the procedure of taking amniotic fluid containing fetal cells, to detect chromosomal abnormalities that can cause abnormalities in the fetal organs and trigger polyhydramnios
- Blood tests, to check for possible infections or diabetes that are known to cause polyhydramnios
- Nonstress test, to check changes in the fetal heart rate when the fetus moves
- Biophysical profile test, to check breathing, muscle condition, and fetal movement using ultrasound
Mild polyhydramnios will generally go away on its own without special treatment. Patients will usually be advised to rest as much as possible and undergo more routine pregnancy control.
If polyhydramnios occurs due to health problems for the fetus or mother, these disorders need to be addressed first so that the polyhydramnios can also improve. This can be done on an outpatient basis.
Treatments that can be given to patients include changes in diet and medication if the patient is known to have diabetes, as well as giving antibiotics to patients suffering from toxoplasmosis.
Meanwhile, severe polyhydramnios that causes shortness of breath, abdominal pain, or premature labor, needs to be treated in a hospital. Treatment steps include:
Administration of indomethacin
Indomethacin can be used to reduce fetal urine production and amniotic fluid volume. However, this drug can not be given after the 31st week of pregnancy because of the risk of causing heart problems.
The condition of the fetal heart also needs to be monitored while taking this drug. In addition, side effects in pregnant women after taking indomethacin, such as nausea, vomiting, and stomach ulcers also need to be monitored.
If needed, the doctor can remove excess amniotic fluid through amniocentesis. However, this procedure carries the risk of causing complications, such as placental abruption, premature rupture of membranes, or premature delivery.
Laser ablation can be performed to treat polyhydramnios caused by multiple pregnancies with transfusion syndrome (TTTS).. This procedure is used to partially close the placental blood vessels that supply excessive blood to one of the fetuses.
After the patient is treated, the doctor will continue to monitor the amount of amniotic fluid every 1-3 weeks. Although polyhydramnios can cause disquieting symptoms, patients are generally able to give birth to healthy children.
In mild or moderate polyhydramnios, labor can still be carried out normally and when fetal growth is complete. However, in severe polyhydramnios, labor may need to be expedited to avoid the risk of complications to the mother and fetus, such as fetal distress.
An earlier delivery can be done by induction method or by caesarean section. This procedure is also recommended if the patient with polyhydramnios has had contractions before the 37th week of pregnancy or has an early rupture of the membranes.
Complications of Polyhydramnios
Complications of pregnancy and childbirth that can arise due to polyhydromnios, in the form of:
- Premature birth
- Baby grow too big
- premature rupture of membranes
- Placental abruption
- The umbilical cord that comes out before the baby during delivery
- Fetal death in the womb (stillbirth)
- Post partum haemorrhage
Prevention of Polyhydramnios
Polyhydramnios is difficult to prevent. However, there are several things that can be done to reduce the risk of this condition, namely:
- Do not smoke
- Eat a nutritious diet, which includes fruit, vegetables, low-fat dairy products, lean meats, and nuts
- Take prenatal vitamins, such as folic acid, as directed by your doctor
- Controlling existing conditions or diseases, such as diabetes