POLYHYDRAMNIOS

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 Definition:An amount of amniotic fluid more
than 2000 ml.

Incidence:About 1:200.

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 Aetiology
Increased production or decreased
consumption of amniotic fluid will result in
polyhydramnios.

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 Aetiology>POLYHYDRAMNIOS
>Foetal causes:
a.Congenital anomalies:
b. Uniovular twins:
c. Increased placental mass:
>Maternal causes:
a. Diabetes mellitus
b. Pregnancy induced hypertension
c. Severe generalised oedema

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 Foetal causes>Congenital anomalies:
a. Anencephaly:
1.transudation of the cerebro-spinal fluid
from the exposed meninges.
2. absence of swallowing of the liquor.
3. foetal polyuria resulting from lack of
antidiuretic hormone or irritation of the
exposed centres.
b. Atresia of the oesophagus or duodenum
enables the foetus to swallow the liquor.
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 Foetal causes>Uniovular twins:
Due to interconnecting vascularity in the
placenta, one foetus obtains more circulation
so that its heart and kidneys hypertrophy
leading to increased urine production. So one
amniotic sac only is affected.

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 Foetal causes> Increased placental mass

a. Oedema of the placenta due to:

1.hydrops foetalis resulting from Rh-
inompatibility, severe anaemia,
haemoglobinopathies particularly a-thalassaemia
major and cytomegalovirus infection.
2.true knot of the cord causes obstruction of
venous return with placental congestion.
3. foetal liver cirrhosis as in syphilis.
b. Chorio-angioma and large placenta.

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Maternal causes>Diabetes mellitus
Diabetes mellitus due to:

a. increased osmotic pressure of the liquor

amnii due to its high sugar content,

b. foetal polyuria resulting from

hyperglycaemia.

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 Maternal causes>Pregnancy induced
hypertension

Pregnancy induced hypertension:

Due to oedema of the placenta.

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 Maternal causes>Severe generalised
oedema

Severe generalised oedema:

Cardiac, hepatic or renal.

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 Clinical Varieties
Acute hydramnios:
a.Very rare,
b. rapid accumulation of liquor,
c. occurs before 20 weeks,
d.the commonest cause is uniovular twins but foetal
anomalies
Chronic hydramnios
a.More common,
b. accumulation of liquor is gradual,
c.it occurs in late pregnancy,
d.the condition may end by preterm labour.

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 Clinical Picture
a.Abdominal discomfort and pain in acute
hydramnios.

b.Pressure symptoms: dyspnoea, palpitation,

indigestion, haemorrhoids, oedema and
varicosities of the lower limbs.

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 Clinical Picture
Signs
a.General examination:may reveal pregnancy-induced
hypertension.
b.Abdominal examination:
Inspection: overdistended abdomen.
Palpation:
1.The fundal level is higher than gestational age.
2.The uterus is tense cystic.
3.The foetal parts are felt with difficulty by dipping.
4.Fluid thrill can be elicited.
5.Malpresentation and nonegagement are common.

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 Differential Diagnosis
a. Causes of oversized pregnant uterus.
b.Ovarian cyst with pregnancy.
c.Ascites.

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 Management>Acute hydramnios
Termination of pregnancy by high artificial rupture of
membranes. This allows gradual escape of liquor thus
shock and separation of the placenta are avoided.

Shock results from rapid accumulation of blood in the

splanchnic area after sudden drop of intrauterine
pressure.

Separation of the placenta occurs due to sudden drop

of intrauterine pressure and shrinkage of the placental
site following this. Drew Smythe catheter is used for
rupture of hind water in such conditions.

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Management>Chronic hydramnios
During pregnancy:
a.Termination of pregnancy by high artificial rupture of
membranes if the foetus is dead or malformed.
b. Expectant treatment if the foetus is healthy.
> rest,
>sedative,
>salt restriction,
> treatment of the underlying cause as diabetes and
toxoplasmosis.
> Termination of pregnancy if the condition is not
improved or get worse.

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Management>Chronic hydramnios
During pregnancy:
Repeated amniocentesis may be indicated in
premature foetus with marked pressure
symptoms. 1.5-2 litres can be aspirated in a
rate not exceeding 500 ml/hour under
sonographic control. However, the amniotic
fluid is rapidly reaccumulating and there is risk
of premature labour, injury to the foetus or
umbilical cord vessels.

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Management>Chronic hydramnios
During labour:
a. Malpresentation, cord presentation and / or
cord prolapse should be detected and the labour
is managed according to the condition.
b. When the cervix is half dilated Drew Smythe
catheter is passed to rupture the hind water. This
will initiate uterine contractions which can be
enhanced by oxytocins.
c. Active management of third stage is carried
out to guard against postpartum haemorrhage.
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 Complications>Maternal
During pregnancy:
a.Abortion.
b.Preterm labour.
c.Pregnancy-induced hypertension.
d.Pressure symptoms.
e.Malpresentation.

During labour:
a.Premature rupture of membranes.
b.Cord prolapse.
c. Abruptio placentae.
d. Shock.
e. Postpartum haemorrhage.
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 Complications>Foetal
a. Prematurity.
b. Asphyxia due to cord prolapse or placental
separation.

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