Depending on the pregnant woman, polyhydramnios can take different forms. Medical treatment is not always necessary.
What is polyhydramnios?
Polyhydramnios (also called hydramnios or polyhydramnios) is when a pregnant woman has a higher than average amount of amniotic fluid. The medical definition of polyhydramnios is based on the so-called amniotic fluid index (AFI) – if this index exceeds a value of 20 cm in a pregnant woman, then according to the medical definition there is an above-average amount of amniotic fluid. Another indicator of polyhydramnios is an amniotic fluid volume of more than 2 liters at the time of delivery. Polyhydramnios are often accompanied by an increased abdominal girth of the pregnant woman and consistent fluid movements in the uterus (womb). The heart sounds of the unborn child may be attenuated. Polyhydramnios occur in approximately 1 – 3% of all pregnancies.
Causes
Possible causes of polyhydramnios can be found in both the fetus and the expectant mother. Among the possible causes of increased amniotic fluid on the part of the mother is, for example, the presence of diabetes mellitus (also known as diabetes): in the fetus, the mother’s sugar disease can lead to what is known as polyuria, or increased production of urine. As a result, polyhydramnios develops. Diseases such as syphilis in a pregnant woman can also promote polyhydramnios. In the unborn child, heart defects or various infections, for example, can cause polyhydramnios to occur. Malformations of the gastrointestinal tract, developmental disorders of the cerebrum, disorders of bone formation, chromosomal anomalies or a present cleft lip and palate in the fetus also occasionally lead to an increased amount of amniotic fluid in the uterus. Finally, polyhydramnios may also be favored if an embryo does not absorb amniotic fluid or absorbs too little through drinking.
Symptoms, complaints, and signs
In a so-called polyhydramnios, the amount of amniotic fluid in the amnion is greater than two liters. In approximately three percent of all pregnancies, this condition can occur before the completion of the 37th week of pregnancy. Complications can arise for both the mother and the child. Polyhydramnios is characterized by persistent pain in the lower abdomen, severe abdominal tenderness, contractions, pulling in the lower abdomen, shortness of breath and dizziness. Various pregnancy symptoms such as indigestion, constipation, heartburn, swollen legs, varicose veins or stretch marks increase. Since polyhydramnios can be caused by different disorders, other symptoms are also possible, but they are indicative of the underlying disorder in each case. There is also a weakening of the fetal heart sounds. If these symptoms occur in the 37th week of pregnancy, there are many indications of polyhydramnios. To avoid complications in the mother and child, emergency treatment should be initiated immediately. Complications may include placental abruption, premature rupture of the membranes, umbilical cord prolapse, or an unusual delivery position of the baby. Furthermore, the mother may develop high blood pressure as a result of the increased amount of amniotic fluid. There is also an increased risk of urinary tract infections. There is a risk of premature birth for the child. If necessary, the birth must be induced by cesarean section as early as the 37th week of pregnancy. The birth weight of the child may be reduced. In extreme cases, infant death occurs.
Diagnosis and course
Polyhydramnios are usually diagnosed with the help of sonography (an imaging procedure based on ultrasound). Using the images of an expectant mother’s abdomen obtained in this way, the amount of amniotic fluid can be determined, for example, according to the criteria of AFI. For this purpose, the abdomen shown is first divided into four quadrants (quarters). The largest amniotic fluid depots of the individual quadrants are then summed up and can thus provide information about the presence of a polyhydramnios. If a polyhydramnios does not regress on its own or is not treated appropriately, various complications can arise during the course of pregnancy.For example, polyhydramnios can cause the amniotic sac to rupture prematurely. Polyhydramnios can also lead to a prolapse of the umbilical cord on the part of the expectant mother or a rupture of the placenta. Last but not least, increased amniotic fluid occasionally interferes with a suitable fetal position.
Complications
Polyhydramnios may be manifested by a variety of symptoms. However, symptoms and complications vary widely among most women, so a general prediction usually cannot be made. The abdominal girth of those affected increases considerably and there is a lot of tight skin around the abdomen. The patient’s ability to cope with stress also decreases significantly due to polyhydramnios, and breathing difficulties and, among other things, shortness of breath occur. Furthermore, it is not uncommon for those affected to suffer from heartburn or abdominal pain. Polyhydramnios also leads to constipation and general digestive problems or stomach pain. The patient’s quality of life is considerably reduced by this disease. Due to the swollen legs, patients sometimes suffer from restricted mobility and not infrequently also have varicose veins. Polyhydramnios does not have to be treated in every case. In most cases, the symptoms disappear again on their own, so that there are no particular complications. Only rarely are surgical interventions necessary. However, the life of the mother and the child is not endangered.
Treatment and therapy
Polyhydramnios do not always require medical treatment; increased amniotic fluid can also regress on its own in various cases. If the amniotic fluid does not regress on its own, so-called amniocentesis is performed in various cases of pronounced polyhydramnios. In this procedure, a hollow needle is inserted into the amniotic sac; in further treatment steps, excess amniotic fluid can then be drained. Alternatively, polyhydramnios can also be treated with drugs, which usually have an inhibitory effect on the production of amniotic fluid. Whether a polyhydramnios requires treatment and which therapeutic measures are used if necessary depends, among other things, on factors such as the severity of a polyhydramnios and the state of health of the embryo and expectant mother. If a polyhydramnios is based on diseases of the mother, a possible correction of an amniotic fluid excess is often accompanied by therapeutic measures that target the underlying disease at hand.
Prevention
Because in many cases the causes of polyhydramnios cannot be clearly diagnosed, appropriate prevention is hardly possible. If an expectant mother has known metabolic diseases of her own, such as diabetes mellitus, consistent treatment of the underlying disease can reduce the risk of polyhydramnios; suitable action steps can be requested here from the attending physician, for example.
Follow-up
In most cases of polyhydramnios, only a few and also only limited aftercare measures are available to the affected person. For this reason, a physician must be consulted early in the course of this disease to prevent further complications or discomfort that can limit the quality of life of the affected person. However, it is not always possible to treat the disease, although it is not always necessary. In many cases, the symptoms may resolve on their own, although permanent monitoring by a doctor is still very important in order to detect complications and other complaints at an early stage. The child should also be monitored regularly after the successful birth to ensure that the child develops normally. In most cases, there will be no further complications or complaints. Should a miscarriage occur, those affected are dependent on intensive psychological support. The support of one’s own family in particular has a very positive effect on the further course of the disease. Further aftercare measures are usually not available to those affected by polyhydramnios.
You can do it yourself
If the abdominal girth is unnaturally large during pregnancy, a doctor should be consulted. If polyhydramnios is present, the woman should not exercise and should watch carefully for unusual symptoms. Treatment is necessary only if there is acute danger to the baby. Therefore, no further action needs to be taken initially. However, if pain or other discomfort develops, medical advice is needed. Affected women can better withstand a possible puncture of the abdomen by avoiding heavy foods before the procedure. After the procedure, they should take it easy for a few days. The amniotic sac needs to recover to avoid complications during delivery. Affected women can relieve discomfort after a procedure by drinking soothing teas, getting a professional massage and, most importantly, getting plenty of rest. If the discomfort does not subside as a result, the gynecologist must prescribe a suitable medication and perform another ultrasound examination. In most cases, however, a polyhydramnios progresses without major complications. In many cases, the excess amniotic fluid does not need to be treated.
