Causes of polyhydramnios
In most cases, the exact cause of the condition is difficult to identify. Polyhydramnios during pregnancy can be caused by several factors.
Maternal reasons:
- heart disease, kidney disease;
- diabetes. The disease causes fetal hyperglycemia and, as a result, polyuria (fetal urine is the main source of amniotic fluid);
- multiple pregnancy;
- inflammatory diseases of the pelvic organs;
- hemolytic anemia.
Causes of polyhydramnios due to fetal pathologies:
- inability to swallow amniotic fluid due to gastrointestinal malformations (esophageal and duodenal atresia);
- malformations of the central nervous system (hydrocephalus, anencephaly, meningocele);
- tracheoesophageal fistula;
- diaphragmatic hernia, for example, Bochdalek's hernia, in which the pleuro-peritoneal membranes are not developed and the stomach prolapses into the chest cavity. Because of this defect, the fetus is not able to swallow a sufficient amount of amniotic fluid;
- fetal kidney disorders leading to increased urine production, such as in antenatal Bartter's syndrome;
- chromosomal abnormalities such as Down syndrome and Edwards syndrome;
- skeletal dysplasia (dwarfism);
- sacrococcal teratoma.
Diet
In the second trimester, there is a risk of developing gestational diabetes , which is associated with polyhydramnios. Therefore, a mandatory condition is to limit simple carbohydrates - candies, waffles, sweet pastries, halva, cookies, condensed milk, etc. There is no point in restricting fluid intake, since it does not affect the amount of amniotic fluid.
The consumption of table salt should be limited, which will reduce water retention in the body, therefore internal swelling, swelling of the anterior abdominal wall and legs will be significantly reduced. They recommend a diet excluding canned food, salty, spicy foods, sausages and smoked meats, and extractive dishes. The diet should include protein (meat, fish, cottage cheese), fruits, berries, vegetables, vegetable juices, as well as complex carbohydrates in the form of whole grain bread, whole cereals, bran bread, and legumes.
Symptoms of polyhydramnios
Clinical signs:
- abdominal enlargement;
- uterine size advances gestational age;
- shiny skin with stretch marks;
- dyspnea;
- swelling.
Symptoms are more pronounced in acute polyhydramnios: the abdomen quickly enlarges, a nagging pain appears in the lower abdomen and perineum, and shortness of breath increases. Chronic polyhydramnios during pregnancy is not so pronounced, since amniotic fluid accumulates gradually. A pregnant woman may feel well, so hydramnios is often diagnosed during a routine ultrasound. Mobility, abnormal position, and weak heart rhythm (dull heartbeat) of the fetus are noted. Ultrasound helps to identify extensive hypoechoic zones and assess the volume of amniotic fluid. Polyhydramnios during late pregnancy is manifested by a discrepancy between the size of the uterus and the gestational age.
Also, to make a diagnosis, the content of prolactin in the amniotic fluid is determined. With polyhydramnios, its content is reduced (relative to the norm for a certain period of pregnancy).
List of sources
- Sidorenko V.N., Bugrov V.Yu., Kletsky S.K., Sakharov I.V. A modern view on the etiopathogenesis of oligohydramnios and polyhydramnios and ways to solve them for polyhydramnios of an infectious nature/Medical news. - 2021. - No. 4. — P. 53-57.
- Ishchenko A.I., Demenina N.K. // Women's health. - 2014. - No. 6. - pp. 26-28.
- Kulavsky E.V. Features of the course of pregnancy and childbirth with polyhydramnios. Abstract for the academic degree of Candidate of Medical Sciences. Ufa 2004, 26 p.
- Zubkova M.V. Clinical and genetic characteristics of oligohydramnios and polyhydramnios: Abstract of thesis. dis. ...cand. honey. Sci. - M., 2007. - 21 p.
- Pustotina O.A., Bubnova N.I., Ezhova L.S. Clinical and morphological characteristics of the fetoplacental complex in polyhydramnios and oligohydramnios of infectious origin / Obstetrics and Gynecology. - 2007. - No. 3. — P.42-46.
Consequences of polyhydramnios
The prognosis for the fetus is unfavorable. Perinatal mortality is about 50%. The main causes of death are prematurity and developmental defects. The consequences of polyhydramnios for a child are intrauterine hypoxia, umbilical cord strangulation, development of neonatal pneumopathy, malnutrition (underweight), hyperglycemia.
Polyhydramnios significantly increases the risk of complications during childbirth:
- incorrect presentation of the fetus;
- premature contractions;
- premature rupture of membranes;
- umbilical cord prolapse;
- placental abruption.
The risks are usually proportional to the volume of accumulated amniotic fluid. The consequences of polyhydramnios for a woman are hypertension, respiratory failure, postpartum hemorrhage.
Pathogenesis
The main role in the development of polyhydramnios is played by the placenta and fetal membranes. With this pathology, involutive changes in the placenta and amnion are detected. In the fetal membranes, the number of microvilli and their increased branching increases, which is accompanied by an increase in the thickness of the embryonic membrane. With this pathology, on the one hand, the secreting activity of the amnion , and on the other hand, destructive changes occur in it, which lead to tissue necrosis. Necrosis affects the development of the fetus and causes various developmental pathologies. The chorion veins also undergo changes - they narrow, and sometimes they are completely overgrown in the chorion villi. With polyhydramnios, fluid transport inward increases through the membranes and through expanded intercellular channels in the epithelium. And due to the thickening of the membranes, the reabsorption of water is partially blocked, which helps to increase their quantity.
How is polyhydramnios treated?
Treatment of polyhydramnios is carried out when there is a threat of premature birth or acute respiratory failure in a pregnant woman. To eliminate polyhydramnios, multiple amniocentesis is used - a puncture in the amniotic membrane and collection of amniotic fluid. If the condition is caused by fetal polyuria, the pregnant woman is prescribed a short course of indomethacin. If diabetes mellitus is detected in the mother, hypoglycemic therapy is selected to correct blood glucose levels. If an inflammatory disease is suspected, antibacterial drugs are prescribed. If the cause of the pathology has not been established, normalization of the uteroplacental blood flow is carried out. Antiplatelet agents, vitamins, and antispasmodics are usually prescribed. Read more about the treatment of hydramnios on our website Dobrobut.com.
Related services: Consultation with a gynecologist during pregnancy
Treatment and prognosis
Therefore, it is important to identify this disease as early as possible and apply timely measures. Treatment depends on the cause of polyhydramnios: for infection, it can be antibacterial drugs, and for extragenital pathology, treatment of the underlying disease. In any case, a pregnant woman with polyhydramnios should receive increased attention, because she is at risk of developing complications. She is required to undergo additional ultrasound diagnostics; a CTG (cardiotocography) is performed on the baby to monitor his heartbeat and movements. Even with such a diagnosis, you can give birth to a completely healthy child if you follow the doctor’s recommendations and are attentive to your health.
Photos from our own practice:
Ultrasound. Pregnancy 32 weeks. Polyhydramnios. A single water pocket of 10.9 cm is a sign of moderate polyhydramnios.
Pregnancy 30 weeks. Polyhydramnios. A single water pocket of 9.3 cm is a sign of moderate polyhydramnios.
Ultrasound 4D. Pregnancy 33 weeks. Polyhydramnios due to infection (CMV). Photos of the fetal face are best obtained in conditions of polyhydramnios, however, in the case of polluted, “turbid” waters, interference from the suspended matter contained in the water is visible and the “portrait of the fetus” seems unclear
Chorioangioma of the placenta is one of the causes of polyhydramnios.
Congenital malformations of the fetus, congenital heart defect of the fetus, polyhydramnios and pregnancy 4d
Complications
Everyone who has been diagnosed with this pathology is interested in the dangers of polyhydramnios for pregnant women. An acute form of pathology, as already noted, can provoke termination of pregnancy. Until the 28th week of gestation, termination is carried out for medical reasons. With polyhydramnios, labor may occur prematurely because the uterus is greatly distended. Complications may include prenatal rupture of water, bleeding in the first two hours after birth and in the afterbirth period.
Polyhydramnios often causes placental abruption to occur too early. In such cases, doctors may resort to abdominal delivery. During the release of amniotic fluid, small parts of the baby or umbilical cord loops may fall out, then surgery will be urgently needed.
With polyhydramnios, the fetus is often too active, which can cause it to become entangled in the umbilical cord or become incorrectly positioned. This may also be the reason for the inability to give birth naturally. There is also a risk of suffocation for the baby. Polyhydramnios causes disruption of blood flow in the uterus and placenta, therefore intrauterine hypoxia (lack of oxygen) is possible, and developmental delays in the child are also likely. With polyhydramnios, pregnant women may develop gestosis, uncontrollable vomiting and a persistent increase in blood pressure.
Diagnostics
Polyhydramnios is suspected upon examination based on the indicators described above. Be sure to tell your doctor about all the symptoms that bother you. To confirm polyhydramnios, ultrasound diagnostics are done. The amniotic fluid index is calculated. This is the gold standard for diagnosing the pathology in question. The data of this index is measured every day.
Other diagnostic methods:
- vaginal smear to determine microflora
- blood sugar test to look for possible diabetes
- clinical blood and urine tests
- PCR for torch infections
- blood test for antibela in case of negative rhesus in a pregnant woman
- Dopplerometry (monitoring the baby’s condition)
- cardiotocography
When treating a patient in a specialized medical institution, every day they measure her abdominal circumference, listen to the fetal heartbeat and look at its position.
Medicines
Photo: yaprelest.ru
For polyhydramnios, the following groups of medications can be prescribed:
- anti-inflammatory drugs - prescribed in the presence of an inflammatory process in a woman’s body. The mechanism of action of the drugs is aimed at suppressing the activity of inflammatory mediators, which can be produced under the influence of various exo- and endogenous damaging factors;
- antibacterial agents - used to treat infectious diseases of bacterial etiology. The choice of a specific drug is made depending on the sensitivity of the pathogen that was the source of the development of the infectious disease. Of course, only those antibacterial agents that do not have a teratogenic effect should be prescribed;
- medicines that help improve microcirculation. Representatives of this group of drugs normalize capillary permeability and also improve metabolic processes in the walls of blood vessels;
- vitamin and mineral complexes, the purpose of which helps to saturate a woman’s body with all the necessary vitamins and minerals, thereby enhancing the body’s protective properties.
