How to determine and what forms there are
The volume of amniotic fluid is assessed by ultrasound in two ways: the amniotic fluid index is measured by summing the depth of the pockets in the four sections of the uterus, or the depth of the largest free pocket is determined. Exceeding the established values indicates polyhydramnios. According to the degree, they distinguish between moderate, which occurs most often and often proceeds favorably, and severe, requiring active monitoring. According to the speed of development, they distinguish between chronic, which increases gradually, and acute, in which water accumulates over several days - this is a rare but serious situation.
- Amniotic fluid index by ultrasound
- Measuring the largest pocket
- Moderate polyhydramnios is the most common option
- Severe polyhydramnios
- Chronic - develops gradually
- Acute - grows over several days
Reasons
In approximately half of cases, the cause cannot be determined, and such idiopathic polyhydramnios is usually mild. Among the known causes, the first place is taken by maternal diabetes, including gestational diabetes: high glucose levels increase urination in the fetus. This is followed by developmental defects that prevent the child from swallowing water, for example, in case of obstruction of the esophagus or gastrointestinal tract, as well as abnormalities of the nervous system. Intrauterine infections, Rh conflict, multiple pregnancy with feto-fetal syndrome and a large fetus are important.
- Idiopathic polyhydramnios without an established cause
- Diabetes mellitus and gestational diabetes
- Malformations of the gastrointestinal tract in the fetus
- Anomalies of the fetal nervous system
- Intrauterine infections
- Rh conflict and hemolytic disease
- Multiple pregnancy
Symptoms
With moderate polyhydramnios, a woman may not notice anything, and it is detected during a routine ultrasound. As the volume increases, the abdomen increases faster than expected, a feeling of heaviness and fullness, shortness of breath, heartburn, swelling of the legs, and lower back pain appear. The uterus becomes tense, parts of the fetus are less palpable, and movements are felt as sweeping and unclear, because the baby moves freely in a large volume of fluid. In acute polyhydramnios, symptoms increase rapidly and require urgent treatment.
- Belly larger than expected
- Heaviness and distension in the abdomen
- Shortness of breath and difficulty breathing while lying down
- Heartburn and swelling of the legs
- Tense uterus
- Fuzzy sweeping movements
What examinations are needed
First of all, an ultrasound is repeated and excess fluid is confirmed, while simultaneously performing an expert assessment of the fetal anatomy to exclude malformations. A test for carbohydrate metabolism disorders is required, since gestational diabetes is a common and correctable cause. An examination for infections is prescribed, the blood type and Rh factor are determined, and in case of Rh-negative blood, the presence of antibodies is assessed. The child’s condition is monitored using Doppler and CTG. In some cases, genetic consultation and invasive diagnostics are discussed.
- Ultrasound with measurement of amniotic fluid index
- Expert ultrasound of fetal anatomy
- Glucose test and gestational diabetes
- Examination for intrauterine infections
- Blood type, Rh factor and antibodies
- Doppler and CTG
- Consultation with a geneticist according to indications
Observation and treatment
With moderate polyhydramnios without an identified cause, observation with ultrasound monitoring and the child’s condition is usually sufficient. If gestational diabetes is found, the key role is played by normalizing glucose levels with diet and, if necessary, treatment: often this already reduces the amount of water. In case of infection, appropriate therapy is carried out. Severe polyhydramnios with shortness of breath and the threat of premature birth are treated in a hospital, where amnioreduction can be performed - removal of part of the water. Childbirth with polyhydramnios is carried out carefully, since there is a higher risk of umbilical cord prolapse and bleeding.
- Observation and control ultrasound
- Normalization of glucose levels in diabetes
- Treatment of identified infection
- Hospitalization for severe forms
- Amnioreduction according to indications
- Prevention of respiratory distress when early labor is threatened
- Giving birth in a facility with emergency care capabilities
