Polyhydramnios 24. Causes of polyhydramnios during pregnancy, symptoms, risks, prognosis and possible treatment. Treatment of polyhydramnios during pregnancy

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What is polyhydramnios during pregnancy?

Throughout the period pregnancy the fetus is in amniotic fluid ah (amniotic fluid) in the uterine cavity. The importance of amniotic fluid for the development of the fetus and its safety in the womb is enormous.

Amniotic fluid protects the fetus from mechanical impact from the outside (shocks and shocks), gives the fetus the opportunity to move freely, take part in the metabolism of the fetus, protect the umbilical cord from squeezing.

AT different dates pregnancy, the amount of amniotic fluid is different: for example, in a period of 10 weeks - the volume of water is 30 ml, at 14 weeks - already 100 ml, and at 37-38 weeks the volume of amniotic fluid reaches 1-1.5 liters.

Polyhydramnios is a pathological condition, a complication of pregnancy with an excess of the normal volume of amniotic fluid. Polyhydramnios can develop both in the early stages of pregnancy and in its later period. This complication occurs in about 25% of pregnant women.

Amniotic fluid is in a state of constant movement and systematic renewal.

Causes of polyhydramnios

The causes of polyhydramnios are currently not fully understood and not exactly established.
The risk group for the occurrence of polyhydramnios includes women in the presence of the following situations:

diabetes mellitus in a pregnant woman;

infectious diseases (rubella, toxoplasmosis, cytomegalovirus infection, herpetic infection); these diseases can have mild symptoms, so they are sometimes difficult to diagnose;

bacterial infections suffered by a woman before conception or during pregnancy;

diseases of cardio-vascular system;

kidney disease;

multiple pregnancy (identical twins); often there is polyhydramnios of one fetus and oligohydramnios of another;

large fruit;

placental tumor or other pathology of the placenta;

fetal anemia;

Rh-conflict pregnancy (in the mother Rh negative factor blood, and the father and fetus are Rh-positive);

violations of the excretory function in the fetus;

pathology of the fetus: genetic abnormalities, malformations of the central nervous system, heart, kidney, gastrointestinal tract.

Women in this group develop polyhydramnios more often than women who do not have these risk factors, but may not develop.

In the third trimester, the cause of polyhydramnios may be a violation of the swallowing function of the fetus. During this period, the child daily absorbs up to 4 liters of amniotic fluid, then excreting them in the urine. Swallowing disorders may be associated with fetal abnormalities (cleft palate or upper lip), fetal hydrocephalus, disorders of the formation and development of the cardiovascular system, nervous system, gastrointestinal tract.

In 30% of developed polyhydramnios during pregnancy, it is not possible to establish the cause of this complication.

Forms, types and degrees of polyhydramnios

There are 2 forms of polyhydramnios - acute and chronic.

Acute polyhydramnios - a sharp increase in the volume of amniotic fluid occurs and rapidly increases. Within a few days (and sometimes even several hours), the size of the abdomen increases sharply, pain in the lumbar region and in the groin region. This type of polyhydramnios is typical for early pregnancy.

Chronic polyhydramnios - the amount of amniotic fluid exceeds the norm, but their volume increases gradually; the woman's condition is usually stable.

There are several types of polyhydramnios:

Relative polyhydramnios is not dangerous, but only if the doctor is sure that the pregnant woman does not have any infections. Most often, this type of polyhydramnios develops with a large fetus.

Borderline polyhydramnios (also called a tendency to polyhydramnios) - the volume of amniotic fluid is at the borderline between normal and elevated values.

Idiopathic polyhydramnios - its cause remains unclear.

Moderate polyhydramnios - characterized by a slight deviation from the normal amount of amniotic fluid and a gradual increase in symptoms. Often, external manifestations of moderate polyhydramnios are completely absent.

Severe polyhydramnios - the belly of a pregnant woman is rapidly increasing in size, the woman feels the active movements of the fetus, as well as pain in the lower back and perineum.

There are 3 degrees of severity of polyhydramnios:

Mild degree - the volume of amniotic fluid reaches 3 liters;

Moderate degree - the volume of amniotic fluid is 3-5 liters;

Severe degree - the volume of amniotic fluid is more than 5 liters.

Signs of polyhydramnios

The manifestations of polyhydramnios can be different, they are associated with the pressure of the enlarged uterus on neighboring organs.

Many of the symptoms inherent in this complication of pregnancy can be regarded by women as normal and acceptable signs of the pregnancy itself, and not its pathology.

Symptoms of polyhydramnios may include:

feeling of heaviness, discomfort and frequent pain in the abdomen;

constant feeling of weakness;

shortness of breath at the most minimal physical activity(occurs due to the high standing of the diaphragm);

increased heart rate (often sudden);

severe swelling of the lower extremities, anterior abdominal wall, labia;

the abdomen in girth at the level of the navel exceeds 100-120 cm;
often a woman feels a distinct “squishing” or “gurgling” in her stomach;

the appearance of a large number of rough stretch marks;

excessive enlargement of the uterus that does not correspond to the gestational age;

decrease in the daily amount of urine;

increased anxiety of the fetus;

difficulty listening to the fetal heartbeat.

The rapid increase in symptoms can even lead to uterine rupture.
Symptoms in chronic polyhydramnios are not pronounced, increase gradually, and the woman has time to adapt to these changes. Diagnosis of chronic polyhydramnios can be difficult.

Diagnosis of polyhydramnios

When establishing the diagnosis of polyhydramnios, the following are taken into account:

woman's complaints

medical examination and examination data;

vaginal examination data;

ultrasound scan data.

Complaints of a pregnant woman with polyhydramnios are reduced to general malaise, shortness of breath, a feeling of heaviness in the abdomen, pain in the lower back and perineum.

Medical examination and examination reveal pallor of the skin and a decrease in the subcutaneous fat layer on the abdomen of the pregnant woman; often the venous network is clearly visible on the abdomen. The circumference of the abdomen does not correspond to the gestational age (exceeds it). When probing, the uterus is sharply enlarged, it has a spherical shape, its tension is felt. The fetal heartbeat is poorly heard, and the fetus itself easily changes its position during palpation (palpation). Separate parts of the fetus can be felt with great difficulty.

Vaginal examination reveals a shortened cervix with a slightly open internal os, through which a strained fetal bladder can be identified.

Ultrasound scanning allows the doctor to clarify the gestational age, determine the estimated fetal weight and amniotic fluid volume, and also, using special calculations, determine the so-called amniotic fluid index (AFI)

AFI - amniotic fluid index

Some researchers consider 6-24 cm to be normal indicators of IAI, others - 8.1-18 cm. With polyhydramnios, these figures increase.

There is also a table of normal IAI values for each week of pregnancy. With this table, the doctor can compare the data obtained from the ultrasound scan.

Consequences of polyhydramnios

The earlier polyhydramnios occurs, the more fluid accumulates in the uterine cavity, and the higher the risk of complications.

The consequences of pronounced polyhydramnios are quite serious:

premature termination of pregnancy (miscarriage or premature birth) occurs in 28% of pregnant women with polyhydramnios;

indomitable vomiting develops in 36% of women;

increased blood pressure in a pregnant woman;

incorrect position of the fetus - in 6.5% of women with polyhydramnios;

cord entanglement with excessive fetal activity;

development of placental insufficiency (30% of pregnant women), and even fetal death;

fetal hypoxia in the early stages causes a delay in the development of the fetus, in the later stages it affects the nervous system of the child, reduces its immunity;

malformations of the gastrointestinal tract and central nervous system can also be the result of polyhydramnios;

if polyhydramnios developed after an infection, infection of the fetus may also occur;

bleeding in women with acute polyhydramnios occurs in 41% of cases, and in chronic - in 6% of cases;

late gestosis affects up to 20% of pregnant women with polyhydramnios;

premature discharge of amniotic fluid;

premature detachment of the placenta;

weakness labor activity due to excessive distension of the uterus;

prolapse of the umbilical cord or parts of the fetus (legs, handles) during childbirth.

Moderate polyhydramnios, although it affects the fetus, it gives more chances for gestation to the term of birth and independent childbirth. The consequences are rarely severe.

Childbirth with polyhydramnios

With a mild and moderate degree of polyhydramnios, they try to continue the pregnancy until the physiological term of its completion.

If severe respiratory or circulatory disorders occur, early delivery is indicated.

Childbirth with polyhydramnios is often premature. The fetal bladder bursts suddenly, which entails a copious outpouring of amniotic fluid. It is such an abundant outpouring of water that can lead to prolapse of the legs, fetal handle or umbilical cord and be an indication for caesarean section. Early outpouring of amniotic fluid leads to a weakening of labor activity; contractions may be completely absent.

Excessive stretching of the uterus can lead to premature detachment of the placenta or to heavy bleeding in the postpartum period. And the incorrect position of the fetus (transverse or gluteal), which it can take with polyhydramnios, can also serve as an indication for operative delivery by caesarean section.
To avoid serious consequences in childbirth during the outpouring of amniotic fluid, an early puncture of the fetal bladder is carried out. As a result of such manipulation, the amniotic fluid pours out in a thin stream, the uterus gradually contracts, and the contractions intensify.
Nevertheless, in most cases with polyhydramnios, delivery is carried out by caesarean section.

Polyhydramnios treatment

Treatment usually includes broad-spectrum antibiotics (except tetracycline), B vitamins, diuretics, drugs that improve blood microcirculation and uteroplacental blood flow.

Polyhydramnios, detected at an early stage of development, is effectively treated without consequences for the mother and fetus.

In the case of acute severe polyhydramnios, they often resort to amniotomy (opening the fetal bladder) and draining excess amniotic fluid. In extreme cases, with a threat to the life of the mother, they resort to termination of pregnancy.

Prevention of polyhydramnios

Throughout the entire period of pregnancy, a woman should visit a doctor in a timely manner, inform the doctor about any changes in her condition and well-being, and carry out all the prescribed examinations. Of great importance healthy lifestyle woman's life, proper diet, hiking on fresh air and work and rest schedule.

The fetus is surrounded by amniotic fluid, the volume of which changes throughout pregnancy (the longer the gestational age, the more amniotic fluid becomes).

Polyhydramnios is such a pathology of the amniotic fluid, in which there is an excess of it, and even an excess. So, by the end of pregnancy (37-38 weeks), the amount of water should not exceed 1.5 liters.

The reasons

The reasons that lead to polyhydramnios are not well understood. Conventionally, they can be divided into several groups:

maternal reasons

First of all, this group includes chronic diseases of women.

Diabetes mellitus in 25% of cases causes polyhydramnios during the gestation period. This also includes chronic diseases of the cardiovascular and urinary systems (glomerulonephritis and pyelonephritis, hypertension, heart defects).

An important role in the development of polyhydramnios is played by chronic or acute infections. Especially those that are included in the group of TORCH infections (rubella, herpes, cytomegalovirus, toxoplasmosis).

In addition, diseases of the genital area (uterine fibroids, endometriosis, chronic inflammatory processes of the uterus and appendages) serve as the reason for the increase in the volume of amniotic fluid.

Causes due to fetal pathology

First of all, these are congenital anomalies of development and chromosomal diseases (anencephaly, pathology of the spinal cord and urinary system, neoplastic processes, and others).

Polyhydramnios also develops with multiple pregnancy or large fetuses.

Factors due to the pathology of pregnancy

This group includes: various pathologies of the placenta (tumors children's place), preeclampsia (damage to the walls of blood vessels and an increase in their permeability), a decrease in hemoglobin, Rh-conflict pregnancy.

Idiopathic polyhydramnios also occurs, the cause of which could not be established.

Diagnostics

Diagnosis of polyhydramnios includes a physical examination and additional research methods:

Physical examination

When measuring the circumference of the abdomen and the height of the fundus of the uterus, their significant sizes are determined, exceeding the indicators characteristic of this period of pregnancy. This is especially noticeable with regular monitoring of a pregnant woman. Palpation of the uterus reveals its tension and excessive mobility of the embryo.

Table: standing height of the uterine fundus and abdominal circumference by week of pregnancy

When listening to the fetal heartbeat, muffled or muffled heart sounds are determined.

In the case of a vaginal examination of a woman in childbirth, a tense fetal bladder can be detected even outside the contraction.

Instrumental examination

The "gold standard" for determining the amount of amniotic fluid is the calculation of the amniotic fluid index (AFI) during ultrasound.

Polyhydramnios is diagnosed with an increase in IAI and the size of the largest pocket of amniotic fluid 8 cm or more. However, ultrasound should be performed in dynamics (repeatedly).

Norms of the amniotic fluid index by week

16 weeks - 73-201mm (average 121mm);
17 weeks - 77-211mm (average 127mm);
18 weeks - 80-220mm (average 133mm);
19 weeks - 83-230mm (average 137mm);
20 weeks - 86-230mm (average 141mm);
21 weeks - 88-233mm (average 143mm);
22 weeks - 89-235mm (average 145mm);
23 weeks - 90-237mm (average 146mm);
24 weeks - 90-238mm (average 147mm);
25 weeks - 89-240mm (average 147mm);
26 weeks - 89-242mm (average 147mm);
27 weeks - 85-245mm (average 156mm);
28 weeks - 86-249mm (average 146mm);
29 weeks - 84-254mm (average 145mm);
30 weeks - 82-258mm (average 145mm);
31 weeks - 79-263mm (average 144mm);
32 weeks - 77-269mm (average 144mm);
33 weeks - 74-274mm (average 143mm);
34 weeks - 72-278mm (average 142mm);
35 weeks - 70-279mm (average 140mm);
36 weeks - 68-279mm (average 138mm);
37 weeks - 66-275mm (average 135mm);
38 weeks - 65-269mm (average 132mm);
39 weeks - 64-255mm (average 127mm);
40 weeks - 63-240mm (average 123mm);
41 weeks - 63-216mm (average 116mm);
42 weeks - 63-192mm (average 110mm).

Laboratory tests

From laboratory methods studies are additionally assigned

blood for Rh factor and antibodies,
blood for sugar (to exclude gestational diabetes),
PCR for detection of pathogens of TORCH infections.

Cardiotocography (CTG) and Doppler

In order to assess the condition of the fetus, cardiotocography (instrumental listening to the fetal heartbeat) and dopplerometry (study of blood flow in the fetal, umbilical and uterine vessels) are performed.

Polyhydramnios treatment

Treatment of excess amniotic fluid is aimed at eliminating the cause that caused it. If hyperglycemia (high blood sugar) is detected, treatment is aimed at normalizing its level. In case of detection of Rh-sensitization of the pregnant woman, appropriate therapy is carried out (treatment or prevention of hemolytic disease of the fetus).

If intrauterine malformations are found in the fetus, which led to the development of polyhydramnios and are incompatible with the life of the child, the pregnancy is terminated for medical reasons.

A moderate degree of polyhydramnios detected in the third trimet is an indication for its further prolongation during the treatment of placental insufficiency (improvement of uteroplacental blood flow).

With moderate polyhydramnios are assigned:

tocolytics (expanding uterine vessels and reducing the tone of the uterus): partusisten, ginipral;
antispasmodics: papaverine, no-shpa, magnesia;
antiplatelet agents (improve the rheology or "fluidity" of the blood): trental, chimes;
vitamins ( vitamin C, group B, tocopherol as an antioxidant);
actovegin (improves the absorption of glucose and oxygen).

When an intrauterine infection is detected, etiotropic therapy is prescribed (drugs that are detrimental to infectious agents): antibiotics of the macrolide group (erythromycin, josamycin), antiviral or anti-candidiasis agents.

If acute polyhydramnios or severe chronic polyhydramnios is diagnosed after 28 weeks of pregnancy, treatment is carried out until signs of fetal lung maturation appear (in this case, glucocorticoids, surfactant are prescribed), followed by early delivery.

The indication for termination of pregnancy is a gestational age of less than 28 weeks and acute polyhydramnios.

In some cases, therapeutic amniocentesis is possible, although its effectiveness is rather low.

In childbirth, an early opening of the fetal bladder and careful (under the control of the hand) slow discharge of them is shown to prevent prolapse of the umbilical cord loops. The end of the second and third stage of labor is carried out under intravenous administration of uterotonics (oxytocin).

The course of childbirth and the effect of polyhydramnios on the fetus

Polyhydramnios has an adverse effect on the course of pregnancy and childbirth.

Often there is a premature outflow of water, which causes premature birth or termination of pregnancy in later dates.

Also, polyhydramnios aggravates the course of preeclampsia or serves as a starting point in its development.

In childbirth, due to overstretching of the uterus, weakness of the labor force often occurs, early or prenatal outflow of water, hypotonic bleeding in the afterbirth and early postpartum periods.

Premature abruption of the placenta is also possible, both during pregnancy and in childbirth.

The postpartum period is characterized by subinvolution (slow contraction of the uterus).

Polyhydramnios causes incorrect positions and presentation of the fetus due to its increased motor activity, extensor insertion of the fetal head during childbirth.

Also, childbirth can be complicated by prolapse of the loop of the umbilical cord and small parts of the child. The increased activity of the fetus in the overstretched uterus contributes to the entanglement of the umbilical cord, which can lead to impaired fetoplacental blood flow, intrauterine fetal hypoxia, and even death in childbirth.

The effect of polyhydramnios on the fetus

Excess amniotic fluid can lead to the following consequences for the fetus:

fetal death during pregnancy or childbirth (intrauterine hypoxia, abortion, strangulation by the umbilical cord);
development of pneumopathy (non-infectious lung diseases) due to aspiration syndrome or intrauterine infection;
low birth weight of the fetus (hypotrophy) due to intrauterine growth retardation of the fetus;
large size of the fetus (4 or more kg) as a result of hyperglycemia.

Some research on pregnancy

Polyhydramnios during late pregnancy - what is dangerous, causes and consequences for the child

The increase in amniotic fluid depends on the gestational age. Its relative volume increases by 45% from gestation, by 25% from . Starting from, amniotic fluid increases by 10% per week, and from 33 its growth stops.

If delivery did not occur on, then there is a weekly decrease in the volume of water by 8%.

If production exceeds resorption, then polyhydramnios develops. For each week of gestation, its own amount of water is determined. Polyhydramnios during pregnancy is considered to be an excess of more than 1500 ml by the end of pregnancy. Abroad, the number 2000 ml is accepted.

An increase in the volume of fluid is reflected in the position of the child (still the fetus). Even in the last stages of pregnancy, his unstable position remains. A large room for movement leads to a change in presentation from head to breech or transverse. This poses a risk during childbirth.

Polyhydramnios during pregnancy may be evidence of various pathologies of the fetus, which are not always amenable to correction or subsequent treatment.

Polyhydramnios during late pregnancy: causes

In 60% of cases, it is not possible to establish why polyhydramnios developed. Amniotic fluid is constantly in a state of exchange. It is absorbed by the amniotic membrane, swallowed by the fetus. So there is a decrease in its volume. The secretion of new portions occurs directly from the placenta, due to the urine of the fetus and lung fluid. A complete exchange cycle takes 3 hours.

The defeat of one of the links of the exchange leads to polyhydramnios. The causes of polyhydramnios may be:

maternal diseases: diabetes mellitus, infections, inflammatory diseases;
multiple pregnancy with feto-fetal blood transfusion syndrome;
congenital malformations: acardia-acephaly, malformations of the nervous or urinary system, digestive tract, lungs, heart, skeleton;
hereditary diseases and chromosomal abnormalities: Down syndrome, trisomy 13.18 chromosomes;
neoplastic processes (congenital tumors);
blood diseases,
intrauterine infections;
hemolytic disease of the fetus;
non-immune dropsy of the fetus;
pathology of the placenta: chorionangioma, placenta surrounded by a roller.

Polyhydramnios that occurs during pregnancy with twins can be called physiological if it is not associated with other pathological conditions. Two fruits release the amount of liquid required for each, so the total volume will be increased.

Symptoms and clinical signs of polyhydramnios

You can suspect polyhydramnios with rapid weight gain. With the obligatory measurement of the volume of the abdomen and the height of the fundus of the uterus during a visit to the doctor, there is an advance in terms of pregnancy.

In, and weeks of pregnancy, mandatory screening studies are carried out using ultrasound, during which amniotic fluid is measured. A change in their number requires further examination and treatment.

If an infection is detected, antibiotic treatment is given. To improve placental blood flow, Trental, Curantil, and magnesium preparations are prescribed.

With polyhydramnios in combination with malformations, symptoms of genetic abnormalities, a consultation with a geneticist is necessary. If the expressed amount of fluid is not combined with other abnormalities and intrauterine infection, then it is possible to remove part of the water during amniocentesis.

Termination of pregnancy for medical reasons is offered for acute polyhydramnios, which appeared before and is combined with severe defects.

A woman who has been diagnosed with amniotic fluid pathology should listen to the doctor's recommendations, if necessary, not avoid hospitalization, because. this condition can threaten the life of the fetus.

How to avoid polyhydramnios?

It is impossible to influence the volume of amniotic fluid by restricting fluid intake: their balance is offline.

Those who have become pregnant with existing diabetes mellitus should carefully monitor their glucose levels, be observed by an endocrinologist and adjust insulin doses in a timely manner.

Pregnancy planning involves a complete examination of the spouses. If a woman has foci of chronic infection, it is necessary to achieve a stable remission so that they do not cause illness in the fetus.

If at, then the introduction of anti-D immunoglobulin helps to avoid conflict with the child's blood and the development of hemolytic disease of the fetus.

Nutrition for polyhydramnios during pregnancy

Must be balanced. In order not to create an excessive load on the pancreas, you need to remove from the menu an excess of simple carbohydrates - sweet and flour. This will be a kind of diet to reduce the risk of developing hyperglycemia.

To bear a child and avoid the consequences of polyhydramnios, you need to consciously approach its planning. Three months before conception, you can start the examination and undergo treatment, if necessary. Then the pregnancy will be easy, and childbirth will give a healthy baby.

The pathology of amniotic fluid, the most common of which is polyhydramnios, is an urgent, yet insufficiently studied problem in obstetrics. What does polyhydramnios mean and why is it dangerous during pregnancy?

It is a condition characterized by the presence of excess fluid in the amniotic cavity. This is considered to be a volume of more than 1.5 liters by the end of a full-term pregnancy, and in accordance with multiple foreign monographs - more than 2 liters. The frequency of this pathology among all births ranges from 0.3 to 1.2%. Usually, clinical symptoms appear when the volume of fluid is more than 3 liters.

The role of amniotic fluid and their source

The amniotic environment plays a huge role in ensuring normal growth and development of the fetus both during a physiologically proceeding pregnancy, and in conditions unfavorable for it - complications of pregnancy or mother's disease. Amniotic waters provide the growing fetus with the necessary free space, mechanical and noise protection, participate in maintaining its temperature balance, in gas exchange, nutrition and removal of metabolic products, in the formation of immunity and hormonal state.

In addition, on recent weeks Pregnancy and during childbirth, amniotic fluid is involved in the preparation of the birth canal for the passage of the fetus, protects the umbilical cord from compression and prevents blood flow disturbance in it.

Source of amniotic fluid formation on early dates pregnancy is not well understood. It is assumed that it is formed as a result of "wetting" (transudation) of the mother's plasma through the chorionic and amniotic membranes or the fetal plasma through its permeable skin.

The process of maintaining a balance between the production of amniotic fluid and their resorption (reversal absorption) in the second trimester has been studied somewhat more. The main source is the fetus itself - its alveolar fluid, which is secreted by the lungs up to 400 ml during the day, and urine, the daily amount of which by the end of pregnancy is already from 400 ml to 1.2 liters.

The decrease in fluid occurs in part due to a decrease in its production by the lungs as a result of their preparation for external respiration, swallowing it (at the 18th week - 200 ml) and further resorption through the epithelium of the lungs into the lymphatic vessels due to the difference in osmotic pressure between the fetal plasma and alveolar fluid . The intensity of fluid swallowing gradually increases to a volume of 500 ml at 40 weeks.

A decrease in fluid production by the alveoli of the lungs also occurs under the influence of the release of certain hormones and biologically active substances by the fetus, for example, vasopressin and catecholamines. In addition, its excess is partially removed due to the difference in osmotic pressure in the plasma of the mother and child.

What threatens polyhydramnios?

It poses a danger both to the fetus, the pregnancy itself, and to the mother. Often in the early stages it is accompanied by early toxicosis in the form of "vomiting of pregnant women" (in 36%), spontaneous abortions, malnutrition of the fetus and chronic hypoxia, intrauterine growth retardation are possible.

Polyhydramnios in the later stages also contributes to the delay in intrauterine development of the fetus. As a result of its excessive mobility, entanglement with the umbilical cord, the development of chronic asphyxia, the formation of an incorrect position in the uterine cavity (about 6%) in the form of a breech presentation or a transverse position are possible. Premature termination of pregnancy may occur, premature, which threatens not only the death of the fetus, but also massive bleeding.

Polyhydramnios in the last stages of pregnancy and during childbirth can lead to late (in 5-20%), early or premature outflow of water with prolapse of the umbilical cord, handle or leg of the fetus. Also, protracted labor is not excluded as a result of the development of weakness of the generic forces and the absence of contractions due to a decrease in the contractility of the uterus or its atony, the absence of attempts due to overstretching of the muscles of the abdominal wall. Often there are facial or breech presentation and fetal hypoxia, premature detachment of the placenta and other complications.

Possible consequences for the child, in addition to asphyxia and death (the stillbirth rate with polyhydramnios is an average of 10%), is intrauterine infection with septic complications, some delay in physical development, decreased immune defenses, susceptibility to respiratory diseases.

In the postpartum period, the recovery of a woman is longer. The danger is purulent and septic complications due to protracted labor and the need to provide obstetric benefits or surgical interventions, the possibility of re-bleeding.

Reasons for the development of pathology

Violations of the above processes can lead to an excess of amniotic fluid. Polyhydramnios can occur mainly in the following cases:

Intrauterine infection and the development of amniotic fluid infection syndrome. This reason is the most common. Moreover, the main percentage falls on infections that are sexually transmitted (chlamydia, ureaplasma, herpes simplex virus, etc.). The causative agents can also be mycoplasma, respiratory viral infections, infection with inflammatory diseases of the genitourinary system (colpitis, adnexitis, pyelonephritis, cystitis, etc.).
Diabetes mellitus (average 12%).
Incompatibility of mother and fetus according to the Rh factor and the development of hemolytic disease.
Much less often, polyhydramnios occurs during pregnancy with twins, when feto-fetal hemotransfusion syndrome can develop, with abnormalities in the development of the fetus, especially abnormalities in the development of the digestive organs or the nervous system, with hereditary diseases, blood diseases, placental pathology.

The share of pathology with unexplained causes accounts for more than 60%. How to define polyhydramnios?

Signs of polyhydramnios during pregnancy

Depending on the nature of the course, this pathology is distinguished as:

Acute, which usually occurs in pregnant women with short terms - in the second trimester (ranging from 16 to 20 weeks).
Chronic, developing, as a rule, in the third trimester.

Acute polyhydramnios

Compared with chronic, it is characterized by a particularly unfavorable course. Its symptoms increase very quickly - within a few days or even a few hours. The pregnant woman complains of a rapid increase in the volume of the abdomen, severe heaviness in its lower sections and in the perineum, sometimes severe pain in the lumbar region and in the perineum, increased blood pressure. On general examination, the anterior wall of the abdomen was swollen and smooth with stretch marks, and the uterus was tense. On auscultation of the fetus, heart sounds are muffled and difficult to hear.

The death of the fetus or its birth with malformations is quite likely. Due to acute fetoplacental insufficiency and premature detachment of the placenta, spontaneous abortion, life-threatening intrauterine bleeding (in 41%), uterine rupture or the threat of rupture are possible.

Chronic polyhydramnios

Chronic polyhydramnios in the third trimester of pregnancy is characterized by a gradual increase in the volume of amniotic fluid and slow development. The prognosis largely depends on the severity of the pathology and the rate of increase in fluid volume. Sometimes, with a very slow increase in its number, it is quite difficult to recognize a pathology without an instrumental examination.

In the chronic course, the symptoms of polyhydramnios during pregnancy are less pronounced than in the acute course. There is no pain syndrome or the degree of pain intensity is insignificant. The diagnosis is made on the basis of subjective complaints, general examination and instrumental examination.

A woman may complain about:

excessive activity of the fetus;
shortness of breath even with slight physical exertion;
moderate heaviness, and sometimes pain in the abdomen;
heartburn and belching, especially after taking even a small amount of food;
palpitations and weakness;
persistent swelling of the legs;
the formation of stretch marks on the skin of the abdomen;

General examination reveals:

Increased density and its palpation.
Fluctuation in the abdomen (fluid fluctuations).
Excessive activity of the fetus, as well as its excessive mobility and unstable position on palpation.
Difficulty in identifying small fetal parts.
Muted or muffled fetal heartbeat.
Discrepancy (excess) of the results of measurements of the circumference of the abdomen and the distance from the womb to the bottom of the uterus (height of the state of the bottom of the uterus) this deadline pregnancy.
Swelling of the legs and varicose veins.
On vaginal examination during childbirth - a tense fetal bladder, regardless of the presence or absence of contractions.

The severity of the pathology and its diagnosis

Depending on the volume of amniotic fluid, it is customary to distinguish three degrees of severity of the pathology:

I degree - 3,000 ml;
II degree - from 3,000 to 5,000 ml;
III degree - more than 5,000 ml.

Of particular importance is the diagnostic value of ultrasound. With its help, from 16 weeks, the index of polyhydramnios during pregnancy, which is called the amniotic fluid index (AFI), is calculated.

The method consists in mentally dividing the abdomen into 4 zones by means of two mutually perpendicular lines that intersect at the navel. Then, during ultrasound examination, the largest vertical pocket with liquid is selected in each zone and measured. The sum of the results obtained is the numerical value of the IAF, expressed in millimeters.

From the 16th week of pregnancy, its average value gradually increases and becomes maximum by the 27th week - 156 mm (the lower limit of the norm is 85 mm, the upper one is 245 mm), after which the average value decreases every week. For example, at week 32, the average IAI is 144 mm (76-269 mm), at week 33 - 143 mm (74-274 mm), and at 35 weeks - 140 mm (70-279 mm).

IAI values at the upper limit of the norm or slightly above it mean moderate or relative polyhydramnios, in which there is no threat to the fetus. This indicator is the most significant in terms of characterizing its functional state and development. Constant monitoring of IAI helps prevent the development of pathological complications in the fetus.

With the help of ultrasound, the state of the placental structure and the timeliness of its maturation are also determined. In addition, by conducting cardiotocography, the general condition of the fetus is checked, additional studies are prescribed to identify defects and anomalies in fetal development. How to treat a diagnosed pathology?

Polyhydramnios treatment

When establishing a diagnosis, it is necessary to hospitalize a woman in the department of pathology of pregnant women in order to clarify the diagnosis, identify the cause of the pathology and draw up a treatment plan. The tactics of treatment depends on the period of development of the pathological condition, the cause and the degree of its severity. The presence of anomalies of fetal development is an indication for termination of pregnancy.

In chronic polyhydramnios I and II degrees, which develop in the third trimester, usually on an outpatient basis, treatment is carried out aimed at maintaining pregnancy and physiological delivery. With an unexpressed acute form and III degree of the disease after 28 weeks of pregnancy, treatment is necessary before the onset of symptoms of fetal maturity (efficiency is about 71%). The acute form of the pathology, which developed before the specified period, is an indication for termination of pregnancy.

Treatment includes a normal diet with limited intake of salt, spices, spicy and pickled foods, extractive dishes. Of the drugs, diuretics with potassium and magnesium preparations, antiviral, antibacterial drugs and antibiotics (mandatory) of a wide spectrum of action, as well as agents that improve microcirculation (Curantil, Actovegin) and vitamin complexes are prescribed.

In the acute form of pathology or the presence of a very large volume of fluid, a repeated one is sometimes indicated. The increase in the clinical picture of an increase in the volume of amniotic fluid against the background of ongoing therapy is an indication for early delivery.

The feasibility of using traditional medicine

Polyhydramnios treatment folk remedies it is not recognized by official medicine, since they contain unpurified components that can cause adverse reactions in the mother and, especially, in the fetus. In addition, they do not have a selective effect and a sufficient degree of effectiveness, which contributes to the loss of time required for treatment. It is only possible to use drugs that have a diuretic effect and vitamin supplements of plant origin, and only on the recommendation of a doctor.

Condition prevention

How to avoid polyhydramnios? Prevention consists in an additional examination of a woman planning a pregnancy in order to identify and treat chronic infections and diabetes.

In the antenatal clinic, pregnant women with the presence of RH-negative blood, diabetes, the presence in the anamnesis of abnormalities in the development of the fetus, pathology of the amniotic medium and chronic inflammatory diseases of the genital organs are allocated to the risk group.