Polyhydramnios

Objectives

Understand what is Polyhydramnios

The causes of Polyhydramnios

Appreciate the implications of

Polyhydramnios

Learn about the Management of

Polyhydramnios

What is Polyhydramnios

What is Polyhydramnios?

Poly
A lot

Hydramnios
Amniotic fluid

Purpose
Protection of fetus
Allows development of lung and limbs

What is normal ?

What is normal?

Gradual build up of amniotic fluid

800 1000mls at 36-37 weeks

In 0.15% more than that

Most cases are mild

Causes

Causes

Idiopathic 50%

Maternal

Fetal

Placental

Maternal Causes

Maternal Causes

Diabetes
Osmotic diuresis with glucosuria

Infection
Parvovirus 19, CMV, Toxoplasmosis, Rubella, Syphilis

Associated with fetal macrosomia

Infection

Autoimmunisation abnormal Antibodies

Leading to fetal hydrops

Fetal Causes

Fetal Causes
Fetal swallowing reduces amniotic fluid
Absence of swallowing makes fluid build up
Myotonic dystrophies
Neuromuscular diseases
Skeletal dysplasias

Blockage of GI tract of fetus

Duodenal atresia/stenosis
Oesophageal atresia
Gastroschisis
Diaphragmatic Hernia

Twin to twin transfusion syndrome

Fetal trisomies 21, 18 and 13

Placental Causes

Placental Causes

Placental abruption
Usually as acute presentation
But easy differentiation

Chorioangioma
Rare
Benign lesion of placental
Excess capillary formation in absence of villous
differentiation

Presentation

Mild

Severe

Presentation

Mild
Has often no symptoms
Can appear as large for dates

Severe

Discomfort / Pain
Definite appearance of large for dates
Premature labour
PROM

Diagnosis

Diagnosis

Examination

Investigations

Diagnosis

Examination
Increased Symphyseal Fundal Height
Difficult to palpate fetal parts
Often suspected at routine antenatal exam when
SFH is increased

Investigations

Diagnosis

Ultrasound
AFI amniotic fluid index
At ultrasound divide the uterus in 4 quadrants and
measure largest pool of liquor then multiply by 4
Or measure the pool in each quadrant
Normal AFI 8-18cm
AFI > 24 cm or
Single largest pool of liquor > 8cm

Amniotic fluid of > 2000 mls

Normal Amniotic Fluid

Moderate Polyhydramnios

Single Pocket of Liquor

AFI Measurement

Finding a Cause

Finding a Cause

Laboratory tests:
Random glucose
Glucose tolerance test
TORCH screen
Check for Toxoplasmosis, Rubella, CMV, Syphilis and
Parvovirus 19

Ultrasound
To look for fetal abnormalities

Implications

Implications

Antenatally
Discomfort
Preterm labour
Premature Rupture of the Membranes or PROM

Intrapartum
Malpresentation
Cord prolapse
Obstructed labour

Management

Mild
Observation

Treat underlying cause if possible:

Tight glycaemic control in diabetes

Antenatal Management

The mainstay of treatment are:

Close observation antenatally
regular checks
biophysical profiling

Preterm labour
Antenatal steroids to help maturation of fetal
lungs

Antenatal intervention

Amnioreduction
Drain 400 600mls of amniotic fluid
Useful at time of delivery to avoid
malpresentations and cord prolapse

Indomethacin
In case of no GI tract anomaly

Amnioreduction

Ultrasound of
Amniocentesis

Amnioreduction in
Polyhydramnios

Procedure of
Amniocentesis

Management of TTTS

Management of TTTS

Antenatal intervention

Risks of reduction amniocentesis:

Chorioamnionitis
Damage of placental vessel with haemorrhage

Risks of indomethacin
Only use until 35 weeks due to risk of premature
closure of the Ductus Arteriosus

Plan delivery
Induction of labour / expediting delivery
Controlled ARM
Being prepared for section at the time of ARM
Higher incidence of caesarean section

Prognosis
Only 16% of pregnancies with
polyhydramnios have or develop an
associated problem
Poor prognosis is associated with fetal or
placental malformation mortality rate is
60%
20% of infants with polyhydramnios have an
anomaly
The more severe the polyhydramnios, the
greater the chance to find an underlying
cause