Polyhydramnios 24. Polyhydramnios - causes and signs, treatment and prevention. Factors due to the pathology of pregnancy

Update: October 2018

Amniotic fluid plays a huge role in the development of the unborn child and the course of childbirth. Not only the condition of the future baby, but also the mother depends on their quantity and quality.

Polyhydramnios, as an obstetric pathology, is not uncommon, but few pregnant women attach particular importance to this complication, although it, like all other deviations from the physiological course of pregnancy, needs, if not treatment, then careful monitoring.

The consequences of polyhydramnios are very serious and can become sad, up to the loss of an unborn child.

What is amniotic fluid for?

Everyone knows that life on Earth first originated in water, and then appeared on land. Man is no exception, and his embryo goes through the initial period of its existence in the aquatic environment, that is, in amniotic fluid Oh.

The embryo develops in the fetal bladder (another name is amnion), which is filled with a biologically active medium - amniotic fluid, in other words, amniotic fluid. Amniotic fluid is of great importance, because it depends on their quantitative and qualitative composition whether the existence of the embryo and the course of childbirth will be comfortable. Amniotic fluid performs many different functions.

provides nutrition to the fetus, due to the nutrients contained in it, which are swallowed by the future person, and in the early stages they are absorbed by the skin.
provides optimal, and, most importantly, constant temperature conditions (about 37 degrees).
maintains pressure inside the fetal bladder, prevents squeezing of the umbilical cord and parts of the fetus.
amniotic fluid protects the future person from mechanical influences from the outside (for example, blows to the stomach) and protects the fetus from external noise effects.
amniotic fluid contains immunoglobulins - antibodies that prevent infection of the embryo, and the waters themselves are protected from the external environment and various infections due to the impermeability of the fetal bladder.
amniotic fluid allows freedom of movement of the fetus in the uterus, especially in early dates.

Polyhydramnios: what does it mean?

Polyhydramnios is a pathological condition that occurs during the period of gestation, when an excessive amount of amniotic fluid accumulates. For example, at the 36th week of pregnancy, that is, at the end of the gestation period, the amount of amniotic fluid reaches 600 ml - 1.5 liters, then with this pathology the volume of amniotic fluid exceeds the agreed norm (1500 - 2000 ml).

The amount of amniotic fluid is directly related to the gestational age, and as it increases, the volume of water also increases (see). For example, at 10 weeks the amount of water is insignificant and is only 30 ml, and by 14 weeks the volume of amniotic fluid reaches 100 ml, and so on. The incidence of polyhydramnios is 0.3% - 1% of all registered pregnancies.

What is polyhydramnios

In its course, polyhydramnios can be both acute and chronic. In prognostic terms, acute polyhydramnios is unfavorable chronic and is characterized by a rapid increase in symptoms over several days and even hours. As a rule, the described pathology is observed at short stages of pregnancy, which requires its immediate termination. If polyhydramnios is chronic, then the volume of water increases gradually and the symptoms are smoothed out. Most often, chronic polyhydramnios is diagnosed in the last stages of pregnancy.

There are three degrees of severity of chronic polyhydramnios:

mild degree, when the amount of amniotic fluid does not exceed 3000 ml
moderate degree- the amount of water is in the range of 3000 - 5000 ml
severe - if amniotic fluid exceeds 5 liters (more common at the end of pregnancy).

There is another gradation of polyhydramnios:

relative polyhydramnios- does not pose a danger and is set according to the ratio of the amount of water and the size of the fruit;
tendency to polyhydramnios or borderline polyhydramnios- the amount of amniotic fluid corresponds to the upper limit of normal;
idiopathic polyhydramnios- the prerequisite for its occurrence is not known;
moderate polyhydramnios during pregnancy - in this case, there are no external manifestations, and the volume of water only slightly “rolls over”;
pronounced polyhydramnios- has the characteristic signs of the described pathology, the stomach grows rapidly.

Why polyhydramnios occurs

To date, the causes of polyhydramnios in pregnant women have not been studied enough. All factors that determine the development of this pathology are divided into 4 groups:

maternal factors

Factors Caused by Pregnancy Complications

Complications of this pregnancy can also cause an excess of amniotic fluid. These include:

(damage to blood vessels, in particular the placenta)
(cm. )
pathology of the placenta (chorioangioma and others)

fruit factors

various fetal anomalies(infection of the esophagus, chromosomal diseases, pathology of the urinary system, brain, fetal immobility, etc.)
multiple pregnancy, and more often one of the fetuses develops polyhydramnios, and the other oligohydramnios due to the development of feto-fetal transfusion syndrome

Idiopathic polyhydramnios occurs without a cause

The mechanism of development of polyhydramnios is a violation of the exchange of amniotic fluid. This exchange consists in the excretion and consumption of amniotic fluid. If in the short term of pregnancy the amnion only secretes fluid, then in the later stages, the replacement of amniotic fluid occurs through the amniotic area of the placenta. And any pathology of it leads to a change in the volume of water. The amount of amniotic secretion also increases due to the urine that the fetus secretes, and its absorption is carried out through the lungs and digestive tract of the child.

Therefore, any pathology of the fetus associated with the gastrointestinal tract
urinary system
lungs, leads to a violation of the exchange of water.

The clinical picture of polyhydramnios

Manifestations of polyhydramnios are associated with both the severity and the course of the disease.

Acute polyhydramnios

As it was written earlier, acute polyhydramnios is more severe and the clinical picture is pronounced. Acute polyhydramnios often occurs in the second trimester, around 16-20 weeks. Symptoms develop within hours. The woman notes a sharp increase in the abdomen, pain and heaviness in the lower abdomen and in the perineum, severe shortness of breath, and so on.

Chronic polyhydramnios

The clinical picture of chronic polyhydramnios is more blurred. Since the accumulation of water occurs gradually, the manifestations of this pathology do not occur immediately. In some pregnant women, there are no signs of polyhydramnios at all, and an excess amount of water is detected by chance, during the next ultrasound examination. Chronic polyhydramnios usually occurs between 30 and 33 weeks of gestation. Its features are primarily:

discrepancy between the size of the abdomen and the gestational age, that is, the values of the height of the fundus of the uterus and the circumference of the abdomen are more than normal.
the doctor listens to the muffled fetal heartbeat, which is associated with an excess of amniotic fluid, which makes it difficult to auscultate. The pregnant woman herself may notice too active movements and mobility of the fetus, which on palpation is detected as an incorrect position of the baby ( breech presentation, transverse or oblique position).
women may complain about:
- shortness of breath even after minor physical exertion (the uterus "supports" the diaphragm)
- heartburn
- sudden tachycardia
- bouts of weakness
- characteristic and persistent swelling of the legs
- pain or heaviness in the lower abdomen
- due to an increase in the abdomen, multiple pregnancy stretch marks (stretch marks) appear on the abdominal wall.

During examination and palpation of the abdomen, the doctor notes its tension, fetal mobility and high presenting part.

Diagnostics

A doctor may suspect polyhydramnios based on examination data (abdominal size, incorrect position / presentation of the fetus, dull heartbeat) and the presence of complaints.

ultrasound

To confirm the diagnosis, an ultrasound scan is mandatory, with the help of which the amniotic fluid index (abbreviated AFI) is calculated. The AAI calculation method is the summed value of all "pockets", that is, places free from small parts of the fetus and umbilical cord in the four quadrants of the uterine cavity.
The amniotic fluid index is the gold standard for diagnosing amniotic fluid pathology.
The AFI data changes daily (water is changed every 3 hours).
The calculated IAI is compared with physiological parameters for this period gestation (there is a special table).

Gestational age	Amniotic fluid index, cm
Gestational age	5th percentile	50 percentile	95th percentile
14 weeks	2,8	5,0	8,6
16 weeks	3,6	5,8	9,6
18 weeks	4,6	6,8	11,1
20 weeks	5,5	8,0	12,9
22 weeks	6,3	9,3	14,9
24 weeks	7,0	10,7	16,9
26 weeks	7,5	12,0	18,7
28 weeks	7,6	13,0	19,9
30 weeks	7,5	13,6	20,6
32 weeks	7,1	13,6	20,4
34 weeks	6,4	12,9	19,4
36 weeks	5,6	11,8	17,9
38 weeks	4,7	10,3	15,9
40 weeks	3,7	8,6	13,9

In addition to the examination and ultrasound, the woman is assigned the following tests

blood for sugar (exclusion/confirmation of diabetes mellitus);
vaginal smear for microflora;
polymerase chain reaction (blood or vaginal swabs) for TORCH infections;
clinical blood and urine tests;
blood for antibodies (if the woman's blood is negative);
cardiotocography, dopplerometry to monitor the condition of the fetus.

If a pregnant woman is being treated in a hospital, then her stomach is measured daily, the fetal heartbeat is heard and its position is determined.

Treatment

How to treat polyhydramnios during pregnancy depends on the cause that caused it. All women with this pathology, especially those with moderate and severe degrees, are subject to hospitalization in the department of pathology of pregnant women.

If gestational diabetes mellitus is detected, the treatment of polyhydramnios consists in correcting blood glucose, and if immunological Rh incompatibility is detected, appropriate therapy is carried out (treatment or prevention of hemolytic disease of the unborn child).
However, in most cases, the cause of polyhydramnios remains unidentified, then therapy is aimed at normalizing uteroplacental blood flow:
- antiplatelet agents: chimes, trental
- tocolytics: ginipral, partusisten
- antispasmodics: nosh-pa
- shows the introduction of vitamins ( vitamin C, vitamin E, B vitamins)
- there is evidence of the advisability of prescribing indomethacin tablets for polyhydramnios.

Regardless of whether an infection is detected during the examination or not, a woman must be prescribed antibiotic therapy, while using broad-spectrum drugs from the macrolide group (erythromycin, josamycin, and others).
In the case of severe polyhydramnios, amniocentesis is performed by puncturing the abdominal wall, inserting a needle into the uterine cavity and taking a certain amount of water.

Complications

Why is polyhydramnios dangerous during pregnancy? - a similar question interests every woman with this pathology.

Firstly, polyhydramnios, especially acute, is dangerous by abortion, which is carried out artificially for medical reasons up to 28 weeks.
In addition, polyhydramnios often causes preterm labor (a uterus overstretched by water and a tense fetal bladder cause opening of the uterine os and uterine contractions), prenatal outflow of water, bleeding in the first 2 hours after childbirth and in the afterbirth period (due to impaired uterine contractility) .
Also, polyhydramnios, especially in childbirth, can cause premature detachment of the placenta, and this is an indication for an emergency caesarean section. During the outpouring of water, small parts of the baby or a loop of the umbilical cord may fall out, which also means an emergency and surgery.
Due to the high motor activity of the fetus, its incorrect position / presentation and entanglement with the umbilical cord are often observed.
With polyhydramnios, the uteroplacental blood supply is disturbed, which leads to intrauterine hypoxia and fetal growth retardation.
Gestosis with polyhydramnios is much more common than in other cases, as well as arterial hypertension and incessant vomiting.

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases should be carried out under the supervision of a specialist. All drugs have contraindications. Expert advice is required!

What is polyhydramnios during pregnancy?

Throughout the period pregnancy The fetus is in the amniotic fluid (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 stages of 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, kidneys, 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) observed 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).

Also, polyhydramnios develops with multiple pregnancies or large fetal sizes.

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 (ascorbic acid, 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

Around the baby in the womb is a constant amniotic fluid, which is vital for its safety and development. These waters are the protection of the fetus from mechanical shocks, infections, temperature changes, they are important for the formation of the processes of respiration and digestion, as well as for the development of the bones and muscles of the baby. What is polyhydramnios? This is when too much amniotic fluid accumulates in the uterus, this diagnosis occurs in 1% of all pregnancies.

Types of polyhydramnios

Relative - not dangerous if the doctor is sure that the pregnant woman does not have any infection. It is most common in women who are expecting a large child.

Idiopathic - polyhydramnios, the cause of which has remained unclear.

Moderate - the size of the vertical pocket is 8-18 cm.

Pronounced - the size of the vertical pocket is above 18cm, and more than 24cm.

Borderline, a tendency to polyhydramnios - when the level is at the borderline between the norm and the elevated level. Observation is required.

Acute - when the amount of water increases at a high speed. Quite dangerous for the life of the fetus, if no action is taken by the doctors.

Chronic - the amount of fluid is above normal, but stable.

Causes of polyhydramnios during pregnancy

Experts say that it is possible to find out the causes of polyhydramnios only in 2 cases out of 3. It turns out that one third of pregnant women with this diagnosis have idiopathic polyhydramnios (for no apparent reason). Why does a woman have this problem?

out of control diabetes at a woman.
Multiple pregnancy. In most cases, it happens that one child receives more blood and nutrients than another, which leads to complications.
Anomalies in the development of the fetus. In this case, it can be difficult for the baby to swallow and process the amniotic fluid. This occurs due to cleft lip or palate, hydrocephalus, problems with the gastrointestinal tract, nervous system or heart.
Fetal anemia.
Cardiovascular disease in pregnancy.
Incompatibility of blood of mother and child.
Problems in the work of the placenta.

Signs and Diagnosis

If we are talking about a mild form, then usually a woman does not feel any suspicious abnormalities.

If the case is severe, then there is shortness of breath, swelling in the lower abdomen and rare trips to the toilet in a small way.

Polyhydramnios is usually diagnosed after an ultrasound. It can be prescribed unscheduled if the gynecologist suddenly noticed some signs - high blood pressure, a urinary tract infection suddenly appeared, the stomach became larger than normal and edema appeared.

Treatment Methods

If polyhydramnios is acute, then an amniotomy will be prescribed to remove excess water. If it is chronic, then it will be better to prolong the pregnancy until the due date and prescribe complex therapy.

Is it possible to recover at home folk remedies? I strongly recommend that you follow the doctor's instructions and do not use any herbal remedies or homeopathy. There are a number of drugs that are used depending on the cause of polyhydramnios, we will talk about them in detail below. BUT folk remedies leave for the treatment of colds.

What does an obstetrician-gynecologist usually prescribe?

Actovegin, Curantil. These funds are prescribed to everyone in a row, with the slightest deviation from the norm. To use them or not for prevention is the decision of every woman. Here are interesting data on each of the drugs: Curantil and Actovegin.
Antibacterial drugs (Amoxiclav, Ampicillin, Wilprafen, Rovamycin, Cefazolin). Some of them are prohibited during pregnancy, but their use is possible if the benefit exceeds possible risk. In most cases, polyhydramnios reveals the infection that led to it. It is necessary to take tests and determine which antibiotic these bacteria have an increased sensitivity to. This method is an order of magnitude more effective than just drinking a randomly selected drug for prevention.
Wobenzym. The drug of animal and vegetable origin. It is used in complex therapy with antibacterial drugs.
Diuretics (Canephron, Hypothiazid).
Indomethacin. Decongestant and anti-inflammatory drug. Helps to normalize fluid levels.
Vitamins.

Future mothers can face the problem of increasing the amount of amniotic fluid at any time, however, polyhydramnios during late pregnancy causes the greatest concern among doctors. Do you know why?

It turns out that at this time, pathology can provoke, at best, premature birth, and at worst, bleeding during labor, or even endanger the health and life of the baby. And after all, it can be prevented and independently identified, the main thing is to know how.

The amniotic fluid surrounds the baby in the womb. It performs several functions at once: it protects, provides freedom of movement, takes part in metabolic processes, and is also responsible for the development of basic skills in the fetus (swallowing, motor). They say that it smells like milk, and this explains how a newborn baby finds the breast so quickly.

Nature intended that this fluid be regularly updated. That is why its volume is different for different periods:

at 10 weeks it is about 10 ml;
at 14 - 100 ml;
at 21 - 22 - 400 ml;
at 30 - 32 - 700 ml;
at 37 - 38 - up to 1500 ml (this is the maximum);
in 39 - 40 - about 800 ml.

This is ideal. And if the volume significantly exceeds the norm, they put polyhydramnios. As a rule, doctors are alarmed by a significant excess - by 1.5 - 2 times. The most interesting thing is that modern medicine distinguishes between several types of polyhydramnios, sometimes making a borderline diagnosis, which sounds like a "tendency to polyhydramnios." In other words, there is no pathology yet, but the risk of its development has been identified.

How to suspect and detect

To answer this question, it should be recalled that there are two stages of polyhydramnios: acute and chronic. Moreover, the signs in both cases are the same, the difference is only in the speed of their manifestation.

In the first case, the amount of amniotic fluid increases sharply and quickly, literally in a day, or even a few hours. Changes are visible to the naked eye, as the woman's tummy also grows. The situation is aggravated by the appearance pain in the perineum, lower back, swelling of the abdominal wall, and finally, a sharp increase in pressure, due to which the fetal heartbeat is poorly heard.

But in the later stages, you should not worry about this: acute polyhydramnios is most often diagnosed in the first trimester, which cannot be said about chronic. It is from him that expectant mothers in demolition suffer. How is it characterized?

Slow and gradual increase in the volume of water.
As a result, a gradual increase in the size of the abdomen, which a woman may not even pay attention to.
Less commonly - swelling in the lower extremities, nausea, abdominal pain.

You may also experience:

weakness;
worsening condition;
feeling of heaviness in the abdomen;
shortness of breath.

At this time, you can often hear gurgling in the stomach. He himself, with polyhydramnios, reaches a volume of 100 - 120 cm. A lot of stretch marks appear on it.

If you suspect these symptoms in yourself, you should not postpone going to the doctor. Simply because the condition is dangerous not only for the mother, but also for the child. But first things first.

Why does

Modern medicine can name the main reasons for the development of polyhydramnios, but not all. In about 30% of cases, it is not possible to understand why this happened. Most often, the situation occurs when the woman herself is no different large sizes(she is small and fragile), and the child she bears is a hero.

But there are other factors, including:

(leads to the development of pathology in 95% of cases);
diabetes mellitus (it is the cause in every third case);
intrauterine infection;
diseases of the cardiovascular system;
placental disorders;
kidney disease;
preeclampsia and the same nausea in the later stages;
multiple pregnancy;
infectious diseases transferred in an interesting position;
malformations of the fetus (problems with the central nervous system, decreased excretory function, problems with swallowing).

Few people know that almost before childbirth, the child absorbs up to 4 liters of fluid per day, and so every day. But you should not worry about this, because it is updated every three hours.

What is dangerous

The consequences of the development of polyhydramnios can be deplorable if no action is taken. First of all, the condition is dangerous for the crumbs themselves, who are now becoming more active and at risk of “earning” an entanglement with the umbilical cord.

What else is dangerous condition?

The development of late gestosis, if they were not. This happens, for example, if the amount of amniotic fluid increases at 32-33 weeks.
Premature birth due to early outflow of water.
Placental insufficiency, which can provoke chronic fetal hypoxia and, as a result, a threat to its normal development.
Complications in childbirth.

It has been proven that polyhydramnios prevents the child from taking the correct position immediately before delivery. As a result, they make a diagnosis of "previa", with which they are sent to, of course, if the situation does not change.

Other possible consequences:

Weakness of labor activity, which is due to excessive stretching of the uterus. Under such conditions, the placenta may exfoliate even ahead of time, which will lead to the development of bleeding.
Prolapse of the umbilical cord at the time of delivery or the handle, the legs of the child, which, on the one hand, will increase the risk of developing injuries in him, and on the other hand, will complicate the work of doctors, prolong the process. At the same time, asphyxia sometimes occurs, which in the future may affect mental development. At risk are women who were diagnosed with polyhydramnios at 36-37 weeks.

But the worst thing is that polyhydramnios at any time, including at 38-39 weeks, can cause the appearance of intrauterine pathologies that, at a minimum, threaten the health of the child, and at most, his life.

Diagnostics

Detect polyhydramnios during additional ultrasound, where the doctor sets the amniotic index, that is, the volume of fluid.

There are rules for different terms. So:

at 16 - 18 weeks, the indicator should be in the range of 73 - 220 ml;
at 22 - 26 weeks - 89 - 238 ml;
at 32 - 34 weeks - 77 - 278 ml.

Polyhydramnios is an insidious pathology, so if at 34-35 weeks, when the mother feels great, she is given the upper limit of the norm and hospitalization is recommended, she must agree. This pathology must be constantly monitored in order to prevent the terrible! Remember this!

Sometimes the diagnosis of Polyhydramnios is preceded by the diagnosis of Moderate Polyhydramnios. What does it mean? The presence of a problem and its slow, rather than abrupt development. That is, the amount of water is increasing, although not as fast as it could, but there is time to correct the condition.

When the pathology is revealed, it's time to find its causes, because the treatment depends on them. Therefore, the mother is prescribed:

To confirm the diagnosis, cardiotocography may be prescribed.

Prevention and treatment

Ideally, therapy is prescribed, depending on the identified cause of the pathology. So:

with Rhesus conflict, immunoglobulins are administered;
intrauterine infection - prescribe antibiotics that are allowed for women in an interesting position;
diabetes mellitus - diet and additional therapy to correct sugar levels.

True, due to a third of the unidentified causes of pathologies, the question of how to treat polyhydramnios in each specific case is sometimes not even raised, because there is a “universal scheme” to get rid of the problem for sure.

What does it mean? What expectant mother assign all at once:

antibiotic therapy with broad-spectrum drugs;
diet
diuretics;
preparations containing magnesium.

To maintain immunity, improve the general condition of the mother and fetus, vitamin complexes containing vitamins B, C, E are also prescribed.

In extreme cases, at 33-34 weeks, an amniotomy can be done in the chronic course of the pathology. This is a procedure in which the bubble is opened to pour out part of the waters. Thus, doctors can protect themselves and the pregnant woman from a rupture, in which the waters leave rapidly, taking the umbilical cord or limbs of the baby with them and endangering his life and health.

In the later stages, at 36 - 41 weeks, they may decide to stimulate labor.

You can prevent all these problems by planning a pregnancy (this is an examination before conception), regularly undergoing examinations, listening to the doctor's recommendations.