Polyhydramnios 24. Polyhydramnios during pregnancy is a serious pathology that requires treatment. Factors due to complications of pregnancy
Polyhydramnios is a pathological condition that is expressed in the form of excessive accumulation of amniotic fluid in the uterus during pregnancy.
The volume of amniotic or amniotic fluid changes during pregnancy, for example, at the tenth week, their amount should not be higher than 30 ml, at the fourteenth - 100 ml, and in the last trimester, the volume of amniotic fluid varies between 1000-1500 ml. In case of exceeding these norms for the amount of amniotic fluid, polyhydramnios occurs during pregnancy.
In medical practice, there is acute and chronic polyhydramnios, it all depends on the severity. For example, with a mild degree of polyhydramnios, the excess of fluid in the uterus is insignificant, but if the volume of water is significantly higher than the norm, we are talking about severe polyhydramnios.
Pregnant women with a diagnosis of polyhydramnios are recommended to be under continuous medical supervision in order to prevent the development of serious complications. If, with this diagnosis, the woman was not found to have circulatory and respiratory disorders, specialists try to preserve the pregnancy until the last until the natural process of delivery, otherwise it is resolved prematurely, since it poses a threat to the woman's life.
Treatment of this pathology is carried out taking into account the severity of the condition of the expectant mother. If such an anomaly in a pregnant woman is not very pronounced, then it can disappear on its own and without the intervention of doctors.
In the treatment of severe and acute polyhydramnios, an amniotomy (or opening of the fetal bladder) is often prescribed to drain excess amniotic fluid.
Symptoms of polyhydramnios.
Symptoms of the manifestation of such a pregnancy pathology can be very different, due, first of all, to the pressure of the enlarged uterus on nearby organs. For example, in case of acute polyhydramnios, the cases of which are quite rare, and which are found mainly in the early stages of bearing a child, there is a rapid increase in the volume of amniotic fluid, heaviness in the abdomen appears and a rapid increase in its size. At the same time, the expectant mother may experience pain in the lower back and perineum of an acute nature, edema of the lower extremities, vulva and abdominal wall, shortness of breath or difficulty breathing, and decreased urination. In addition, the pregnant woman has an increase in blood pressure, and, among other things, it is difficult to listen to the fetal heartbeat and feel it with her fingers.
Chronic polyhydramnios in most cases manifests itself in the third trimester of pregnancy. I must say that the symptoms in this case are less pronounced than in the acute degree of polyhydramnios: the size of the abdomens increase gradually, allowing the woman to adapt to them. However, it is worth noting that in this variant there are various diseases of the mother during pregnancy. These include diabetes mellitus, bacterial or infectious diseases, renal and cardiovascular diseases suffered by the future mother.
Causes of polyhydramnios.
It often happens that the causes of polyhydramnios remain unclear. But the most common causes of this condition are:
- congenital abnormalities in the development of the fetus, affecting the development of the gastrointestinal tract, kidney or heart, the central nervous system of the child;
- deviations in the child of a chromosomal nature;
- pregnancy with identical twins, during which one fetus has polyhydramnios, and the other has oligohydramnios;
- diabetes mellitus, pyelonephritis, metabolic and fluid disorders in the body;
- diseases of the cardiovascular system;
- fetal anemia;
- Rh-conflict between the blood of the mother and the child (the mother's Rh factor is negative, and the father's is positive);
infections (rubella, cytomegalovirus); - bacterial or infectious diseases suffered by a pregnant woman before conception or during pregnancy;
- swelling of the placenta.
- urinary tract infections;
- incorrect position of the fetus in the uterine cavity, which requires a cesarean section;
- increased blood pressure;
- abnormal growth of the fetus;
- premature rupture of the fetal bladder with the outflow of amniotic fluid;
- prolapse of the umbilical cord;
- premature birth;
- premature exfoliation of the placenta;
- stillborn children;
- high risk of postpartum hemorrhage against the background of weak uterine contractility.
Diagnostics of polyhydramnios.
Diagnosis of this pathological condition during pregnancy is carried out on the basis of the woman's complaints. To make a diagnosis, an ultrasound examination of the fetus is prescribed, in which the amount of amniotic fluid is determined and the "amniotic index" is calculated. If the resulting indicator exceeds the norm, polyhydramnios is placed.
In addition, the doctor may order additional tests:
- An amniocentesis procedure, in which samples of amniotic fluid are taken for analysis, which contain fetal waste products.
- Analysis of glucose uptake, which is a screening test for the definition of gestational diabetes (that occurs during the gestation of a baby). The woman is given syrup to drink, and after half an hour, blood is taken for analysis to determine the glucose level. If the blood sugar level exceeds the permissible limits, an additional glucose assimilation test is performed, which reveals the presence or absence of gestational diabetes.
- A biochemical analysis of the blood serum of a pregnant woman, which determines the levels of substances associated with certain birth defects.
- Karyotyping or analysis of the quality and quantity of chromosomes for all 23 pairs of chromosomes. For analysis, samples of amniotic fluid or placenta are used, which are taken during amniocentesis or chorionic biopsy.
The effectiveness of treatment directly depends on the establishment and elimination of the cause of the development of polyhydramnios, for which the specialist prescribes some examinations:
- Fetal ultrasound and Doppler ultrasound (with its help, the vessels, fetus, uterus and umbilical cord are examined), in which the state of the uterus and fetus is established, as well as the blood flow in the placenta.
- CTG (cardiotocography) of the fetus, in order to assess the general condition.
- A blood test for intrauterine infection.
- Blood test and smear for sexually transmitted infections (chlamydia, mycoplasma, ureaplasma).
- In the presence of a negative Rh factor, a woman in a position must have a blood test for antibodies.
How to alleviate the condition with polyhydramnios on your own?
If you have shortness of breath, you should rest more, avoid going up the floor without an elevator, do all your household chores slowly.
With heartburn against the background of pressure from the uterus on the stomach:
- you should eat in small portions as often as possible;
- do not overeat at night and eat right before bedtime;
- you need to give up foods and drinks that provoke it (fatty foods, carbonated drinks, etc.);
- Place pillows under your back before going to bed (to form a reclining position);
- take antacids as directed by a doctor.
The effect of polyhydramnios on the condition of a pregnant woman.
- Feelings of pain and discomfort.
- Complication of the labor process: weakness of contractions, early placental abruption, excessive bleeding against the background of excessive stretching of the uterus.
- Complications during the recovery period.
- The emergence of various defects and pathologies in the development of the fetus.
- Perinatal death.
- Fetal asphyxia against the background of weakening of labor, which negatively affects the general condition of the baby and his central nervous system.
Polyhydramnios during pregnancy is a rather serious phenomenon, even in the case of a mild degree of pathology, because it indicates the presence of irregularities during pregnancy, certain diseases that can seriously harm the health of a woman and a child. Therefore, it is important to take preventive measures to prevent the development of this phenomenon. These include, first of all, various examinations that will help to timely identify the factors contributing to the development of polyhydramnios. It is also recommended to adhere to a certain diet, consume a certain amount of liquid, and be more often in the fresh air while walking. And most importantly, strictly follow the recommendations of the doctor leading the pregnancy, take all the vitamins and prescribed medications, and also undergo the prescribed procedures. Identified polyhydramnios at the initial stage of development can be easily, quickly and effectively treated without harm to the health of the mother and fetus.
In this article:
Pregnancy is undoubtedly the happiest period in a woman's life, but even it can sometimes be overshadowed by all sorts of troubles and pathologies. One of these pathological conditions during pregnancy is polyhydramnios, which must be treated.
The composition of the amniotic fluid changes throughout pregnancy, so it is important to monitor the amount in each trimester.
Polyhydramnios is the appearance of an excess amount of amniotic fluid that is significantly higher than the norm. A woman can be diagnosed with polyhydramnios at various stages of pregnancy. These complications occur in 1 in 100 pregnancies.
During the normal course of pregnancy, the required amount of amniotic fluid is formed for the development of the fetus, approximately 1000-1500 ml. The amniotic fluid is 97% water, which contains proteins, calcium, chlorine and sodium salts. Thus, the baby receives oxygen, essential nutrients and reliable protection from the external environment. Also, the embryo can calmly move and swim in the mother's abdomen, make movements with its limbs.
The amniotic fluid is the environment in which the fetus develops. The water temperature is 37 degrees.
Amniotic fluid properties:
- Amniotic fluid protects the embryo from shock and shock. In addition, noise coming from the outside world is also muted.
- The amniotic fluid protects the umbilical cord from being squeezed between the wall of the uterus and the fetus.
- The amniotic fluid can help relieve pain during labor.
- They facilitate the opening of the cervix during childbirth.
- The bubble, in which the fetus and amniotic fluid are located, creates an airtight shell into which nothing can enter from the outside.
- Amniotic fluid contains immunoglobulins.
The amount of amniotic fluid changes every week. Therefore, there are norms for each trimester of pregnancy. At the very beginning of pregnancy, the amount of amniotic fluid is approximately 30 ml. At 23 weeks, the amount of amniotic fluid is about 600-700 ml. By 30, 32, 33 and 34 weeks, this figure is approximately 600-900 ml. By week 36, the amount of water increases to 1000. At 37 and 38 weeks of pregnancy, the amount of amniotic fluid becomes maximum. At 39 weeks and closer to the birth itself, there is a decrease in amniotic fluid to 800 ml.
In the presence of some predisposing factors, the amount of water may decrease or increase. When amniotic fluid is less than normal, then this condition is called oligohydramnios. Low water is also a pathology and affects the development of the fetus and the condition of the pregnant woman.
Causes of polyhydramnios
Although the causes of polyhydramnios have not yet been fully understood, there are some factors that contribute to the onset of this pathology.
Polyhydramnios during pregnancy can occur due to the following reasons:
- fetal developmental pathology;
- infectious diseases of a pregnant woman;
- bacterial infection;
- diseases of the cardiovascular system;
- Rh-conflict between mother and fetus;
- metabolic disease;
- diabetes;
- pyelonephritis;
- multiple pregnancy;
- large fruits.
Types of polyhydramnios
This condition in a pregnant woman can proceed in different ways: in an acute form or a chronic form. There may be pronounced or moderate polyhydramnios.
The acute form is characterized by a violation of the general condition of the pregnant woman and the fetus. Such births, as a rule, end in miscarriage, stillbirth, or such a child will have developmental defects. Polyhydramnios appears in an acute form, usually starting from the 16th to the 24th week. Sometimes the amount of amniotic fluid can increase even over a period of several hours. In this case, immediate medical attention is required, in view of the dangerous condition.
Moderate polyhydramnios during pregnancy is characterized by a gradual increase in symptoms and signs. Moderate polyhydramnios can lead to the birth of a child with developmental abnormalities. This is due to the constant lack of oxygen. Very often, moderate polyhydramnios occurs in a chronic asymptomatic form, and therefore can go unnoticed for a long time.
Signs of polyhydramnios
Sometimes a pregnant woman herself may suspect that she has polyhydramnios, by the presence of some signs characteristic of this condition.
- The belly of a pregnant woman with an excess amount of amniotic fluid reaches more than 100 cm in circumference. It has a slightly rounded shape. There is a feeling of heaviness in the abdomen and back. The uterus increases in size and begins to squeeze the internal adjacent organs. Therefore, as a result, the pregnant woman often has shortness of breath and other ailments.
- Lower limbs may swell. In some cases, early rupture of amniotic fluid may even occur.
- A fluctuation appears: a gurgling in the stomach is quite clearly audible in a pregnant woman. There is pain in the perineum.
- A large number of stretch marks appear on the abdomen.
- The pulse of the pregnant woman quickens. The fetal heartbeat is weakly audible.
- As more free space appears, the fetus takes up an incorrect position in the uterus (pelvic, oblique). This is directly reflected in the childbirth itself: the stretched uterus contracts incorrectly and childbirth with polyhydramnios will be characterized by weak labor.
Polyhydramnios is also dangerous because the child can be entwined with the umbilical cord. Hypoxia may develop, the fetus will receive less oxygen. Even if the delivery takes place on time, the fetus may have an intrauterine pathology, such a child may be born with a violation of the development of internal organs or systems.
It should be remembered that the earlier a woman has polyhydramnios, the more amniotic fluid accumulates and the risk of complications increases.
Moderate polyhydramnios
The diagnosis of moderate polyhydramnios is made when the amount of amniotic fluid is approximately 1.5 or 2 liters. And although such a diagnosis is made even in the first trimester of pregnancy, it is possible to seriously talk about the presence of pathology only starting after 16 weeks. The reason for this condition is often the Rh-conflict between the mother and the fetus or the presence of infections.
A woman with moderate polyhydramnios feels tension in the abdomen. It becomes more elastic. When you feel the fetus, you will notice that it often changes its position. Rolling water is heard in the abdomen. The uterus grows in size and becomes edematous.
You can determine moderate polyhydramnios on a routine ultrasound examination or examination. For moderate polyhydramnios, early childbirth and placental abruption are characteristic.
A pregnant woman with moderate polyhydramnios should be constantly monitored by specialists, as sometimes it happens that this diagnosis is erroneous or temporary.
In the absence of a serious pathology, the doctor tries to preserve the pregnancy and so that the birth takes place naturally without artificial intervention. Conservative treatment is prescribed: vitamins, hypothiazide. If necessary, antibiotic therapy is performed.
Polyhydramnios at the end of pregnancy
Polyhydramnios at the end of pregnancy accounts for approximately 0.6% of all other pathologies. Its appearance can be caused by late toxicosis. This threatens with serious complications during childbirth:
- prolapse of the umbilical cord;
- oxygen starvation of the fetus;
- weakness of labor.
Therefore, such a diagnosis is an indicator for carrying out. Treatment of such polyhydramnios is carried out depending on the cause.
Diagnostics of polyhydramnios
You can diagnose polyhydramnios by examining a gynecologist at an appointment with a antenatal clinic. To do this, the doctor examines the pregnant woman for the presence of relevant signs. The most reliable method for diagnosing polyhydramnios is an ultrasound examination. Dopplerometry is also prescribed. Thus, you can identify a more accurate amount of amniotic fluid, check the blood flow in the umbilical cord and placenta.
Thorough examination of the fetus reveals possible anomalies in its development.
Polyhydramnios can be diagnosed using the "amniotic index". There is a special table that allows you to determine the amount of amniotic fluid in the norm in a certain trimester of pregnancy.
If the diagnosis is confirmed, then the woman is sent for additional examination of the fetus.
Effects
With polyhydramnios, the following consequences are possible:
- or termination of pregnancy;
- fetal death or developmental defects;
- if the cause of polyhydramnios is an infection, then there is a possibility of infection of the fetus;
- prolapse of the umbilical cord or hand (leg) of the fetus during childbirth;
- the presenting part of the fetus does not descend during childbirth or is not fixed;
- malposition.
- bleeding;
- various gestosis.
Treatment
The main treatment for the diagnosis of polyhydramnios is aimed at eliminating the cause that caused this pathology. First, the expectant mother takes all the necessary tests to confirm the presence of polyhydramnios: fetal cardiotocography, ultrasound examination, blood test for Rh factor, Doppler ultrasonography and others.
As a rule, complex treatment is carried out. In the case of moderate or unexpressed pathology of the pregnant woman, drug therapy is prescribed. Depending on the woman's condition, treatment can take place in a hospital or at home (outpatient). This condition does not require termination of pregnancy or delivery.
Diuretics (diuretics), vitamins and antibiotics are prescribed. Antibiotics are necessary to fight microorganisms, since the main cause of polyhydramnios often lies in the infectious process. Also, starting from 24 weeks and up to 38 weeks, indomethacin is prescribed.
If the prescribed treatment does not help or polyhydramnios takes a severe form, then the doctor prescribes early delivery. They use medications that help to artificially induce labor.
During artificial delivery, it is necessary to carefully open the membranes, and gradually release the amniotic fluid so as not to cause fetal asphyxia. This procedure is performed using a thin catheter. Measures are taken to prevent the umbilical cord or fetal extremities from falling out.
Medicines to stimulate labor should be used no earlier than 2 hours after the outpouring of amniotic fluid.
In the early stages, when it is impossible to carry out delivery, amniotic fluid is released. The amniotic fluid helps the child move along the birth canal, regardless of the artificial or natural opening of the fetal bladder. But this should be done carefully so that the umbilical cord does not fall out.
If the fetus has malformations that are incompatible with life, then an abortion is carried out for up to 28 weeks.
Childbirth
If polyhydramnios does not affect the condition of a pregnant woman or her fetus, then childbirth is carried out naturally. Mandatory procedure in this case: artificial opening of the fetal bladder. In this case, the volume of the uterus decreases, and this helps to make the contractions more productive. Often such childbirth is delayed, and then there is a need for rhodostimulation. Rhodostimulation is carried out by the introduction of labor-accelerating drugs. And already as the most extreme measure, a cesarean section is performed.
The postpartum period can be complicated by bleeding due to poor uterine contractility. Therefore, the woman is prescribed the introduction of reducing drugs, such as oxytocin and methylergometrine.
Prevention of polyhydramnios
Since polyhydramnios is a pathology, this condition can be avoided if precautions are taken.
It is very important to immediately exclude the presence of Rh-conflict. During pregnancy, a woman should move as much as possible. It is necessary to calculate the amount of fluid taken. It also does not hurt to adjust the diet a little.
For the prevention of polyhydramnios, the expectant mother should take vitamin complexes or medications prescribed by a doctor.
It is necessary to pass all examinations and analyzes on time, as they will help to identify pathology or abnormalities in the development of the fetus at the earliest stages.
In this case, you can avoid serious consequences during childbirth and in the postpartum period. It is important to remember that regular examinations by an obstetrician-gynecologist are not just a formality, but a vital necessity, on which the baby's condition depends.
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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 is added by 10% per week, and from 33 its growth stops.
If delivery did not occur, then a weekly decrease in water volume by 8% is observed.
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 is 2000 ml.
The increase in fluid volume affects the position of the baby (still a fetus). Even in the last stages of pregnancy, its unstable position remains. Large space for movement leads to a change in presentation from head to pelvic or transverse. This is dangerous during childbirth.
Polyhydramnios during pregnancy may be evidence of various fetal pathologies that are not always amenable to correction or subsequent treatment.
Polyhydramnios in late pregnancy: causes
In 60% of cases, it is not possible to establish why polyhydramnios has developed. The amniotic fluid is constantly in a state of exchange. It is absorbed by the amniotic membrane and is swallowed by the fetus. This is how its volume decreases. The secretion of new portions occurs directly from the placenta, due to fetal urine and lung fluid. The complete exchange cycle takes 3 hours.
The defeat of one of the links of exchange leads to polyhydramnios. The reasons for polyhydramnios can be:
- maternal diseases: diabetes mellitus, infections, inflammatory diseases;
- multiple pregnancy with fetal blood transfusion syndrome;
- congenital malformations: acardia-acephaly, defects of the nervous or urinary system, digestive tract, lungs, heart, skeleton;
- hereditary diseases and chromosomal abnormalities: Down's 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, which occurs during pregnancy with twins, can be called physiological if it is not associated with other pathological conditions. The two fruits secrete the amount of liquid required for each, so the total volume will be increased.
Symptoms and clinical signs of polyhydramnios
You can suspect you have polyhydramnios with rapid weight gain. With the mandatory 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 of indicators in terms of pregnancy.
At, and weeks of pregnancy, mandatory screening studies are performed using ultrasound, during which the 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, magnesium preparations are prescribed.
With polyhydramnios in combination with developmental defects, symptoms of genetic abnormalities, a geneticist's consultation is necessary. If a pronounced amount of fluid is not combined with other abnormalities and intrauterine infection, then part of the water can be removed during amniocentesis.
It is suggested to terminate a pregnancy for medical reasons in case of acute polyhydramnios, which appeared before and is combined with severe defects.
A woman who has been diagnosed with a pathology of amniotic fluid should listen to the doctor's recommendations, if necessary, do not avoid hospitalization, because this condition can be life threatening for the fetus.
How to avoid polyhydramnios?
It is impossible to influence the volume of amniotic fluid by limiting fluid intake: their balance is offline.
Those who have a pregnancy with existing diabetes mellitus should carefully monitor their glucose levels, be monitored by an endocrinologist and adjust the insulin dose 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 become the cause of the disease in the fetus.
If you have, 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 unnecessary load on the pancreas, you need to remove from the menu an excess of simple carbohydrates - sweet and starchy foods. This will be a kind of diet to reduce the risk of developing hyperglycemia.
To endure 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 pregnancy will be easy, and childbirth will give a healthy baby.
Amniotic fluid is one of the guarantors of the normal development and life of a child in the womb. It is protection from external influences, it is a comfortable environment for freedom of movement of the embryo, it is one of the participants in metabolism, it is part of the mechanism of protecting the umbilical cord from being squeezed. The rate of amniotic fluid at each period is different, but if by 37-38 weeks it exceeds the limit of 1.5 liters, polyhydramnios is diagnosed.
Causes of the disease
The exact causes of polyhydramnios have not yet been identified. But there are categories of women most susceptible to this disease. This does not mean that it will necessarily occur, but the risk is still high in the following group of pregnant women:
- women with kidney disease
- women with diabetes
- women with diseases of the cardiovascular system
- pregnant women with infectious diseases
- pregnant women with Rh-conflict mom and baby
- pregnant twins (multiple pregnancies)
- pregnant women with large fetuses
And also the reasons for polyhydramnios can be:
- fetal malformations
- reduced excretory function of the fetus
- impaired swallowing function in the fetus
And yet, in 30% of cases, doctors are powerless in finding the true cause of polyhydramnios.
Symptoms of the disease
Symptoms depend on the type of polyhydramnios.
With acute polyhydramnios(which is rare), the pregnant woman feels severe pain in the perineum and lower back. In this case, a woman's blood pressure may increase. The amount of water increases rapidly, so the expectant mother feels both heaviness in the abdomen and discomfort, and notices a rapid increase in the size of the abdomen.
With chronic polyhydramnios the symptoms are not so noticeable: the stomach increases gradually, and the woman adapts to some ailments, not attaching great importance to them. But polyhydramnios is a sign of pathology in the female body, it requires compulsory treatment.
Signs of the disease
And yet, let's highlight several signs of polyhydramnios, which almost always indicate the presence of a disease:
- Swelling of the feet
- Weakness and malaise
- Dyspnea
- Reinforced covering of the abdomen with stretch marks
- Pain and heaviness in the abdomen
- Rapid pulse
- Distinct gurgling in the abdominal cavity
Disease types
Allocate acute and chronic polyhydramnios.
Acute form of the disease is characterized by a sharp increase in amniotic fluid, and it is really dangerous. This form of polyhydramnios can develop within a few hours or days. If the volume of the abdomen has increased greatly, this indicates the development of an acute form of polyhydramnios.
Chronic form of polyhydramnios differs in the moderate nature of the growth of amniotic fluid (amniotic fluid). The signs of this form of the disease are not so obvious, therefore, it is often problematic to diagnose the disease. Pregnant women consider some discomfort to be the norm, but it would be worth mentioning the ailments to the doctor so that the treatment is timely.
Why is polyhydramnios dangerous during pregnancy?
For Mom
For the female body, polyhydramnios is fraught with:
- severe toxicosis
- dehydration
- bleeding
- late gestosis
For baby
The disease can lead to:
- breech / transverse presentation of the child
- development of placental insufficiency (the child does not receive enough oxygen and nutrients from the mother's placenta)
- stunting of a child
- damage to the nervous system
- decreased fetal immunity
The main danger of polyhydramnios is spontaneous premature termination of pregnancy. Unfortunately, statistics show a large number of such outcomes.
Diagnosis of the disease
Necessary tests and examinations
The study of the uterus allows you to diagnose polyhydramnios: an enlarged uterus, elastic and tense, speaks of the disease. Feeling, the doctor notes its rounded or barrel-shaped shape.
Also, with polyhydramnios, the fetus is highly mobile - it constantly changes its position.
With the help of ultrasound, the diagnosis is confirmed, CTG is necessarily performed in order to assess the condition of the child.
A blood test is also performed to detect intrauterine infection.
Treatment and prevention of polyhydramnios during pregnancy
With mild polyhydramnios drug treatment is prescribed, which is performed on an outpatient basis.
With polyhydramnios of moderate severity the pregnant woman is hospitalized, in the hospital she is under medical supervision, takes certain devices (antibiotics, vitamins, diuretics). As a rule, in this case, pregnancy is brought to its logical conclusion - labor is not stimulated.
With a severe degree of polyhydramnios the doctor decides on an emergency delivery, since the health and life of the mother and child is under serious threat. If the term still does not allow to induce labor, the pregnant woman is prescribed the release of amniotic fluid (a procedure that requires great care).
Treatment is prescribed by a doctor based on the results of the examination, determining the form of the course of the disease
Preventive measures that can significantly reduce the risk of polyhydramnios are simple, in general, things:
- strict adherence to all doctor's prescriptions, timely passage of all examinations
- outdoor hiking
- correct diet and fluid intake
- going to the doctor if you have any suspicious symptoms
Features of the management of pregnancy and childbirth with polyhydramnios
If the doctor has identified polyhydramnios in a pregnant woman, she will be assigned additional studies to exclude fetal malformations. You will have to go to the doctor more often, as well as on an ultrasound scan, as well as more often you will need to take certain tests.
Inpatient treatment is often required, it is not uncommon for a pregnant woman to be in the hospital until the very birth. But these are all reasonable precautions, because the pathology is by no means harmless.
Complications in childbirth with polyhydramnios, unfortunately, are also not so rare. The recovery period can also last longer. In 22% of cases in pregnant women with polyhydramnios, labor is weak. Massive bleeding is another threat caused by this pathology.
But do not tune in to the worst - doctors will do everything possible to minimize the risks. A disciplined pregnant woman, aiming at the most positive outcome, has a high chance of getting it.
The main thing is not to avoid doctors, do not neglect their recommendations, be patient and act wisely.
Instead of a conclusion
So, polyhydramnios is a serious pathology of pregnancy. 5 theses about this disease:
1. There are two types of polyhydramnios: acute and chronic. The first is the most dangerous complication, in most cases it ends with emergency delivery.
2. Doctors have not identified the true causes of polyhydramnios, but there are women who are most susceptible to this disease.
3. Even some discomfort (pain in the lower back, in the perineum), weakness, shortness of breath and rapid pulse should be the reason for an extraordinary visit to the doctor.
4. Mild polyhydramnios is treated on an outpatient basis, moderately severe - inpatiently, acute polyhydramnios requires drastic measures (childbirth, release of amniotic fluid).
5. The earlier polyhydramnios is detected, the easier it is to control and treat it.
The causes of polyhydramnios during pregnancy are diverse.
1. Diseases of the mother.
Diabetes mellitus must be mentioned among the most common causes. It was believed that it occurs because there is a lot of sugar in the amniotic fluid, or because the fetus has too much urine, but research has not confirmed this. Polyhydramnios in diabetes mellitus develops due to the fact that microcirculation in the vessels of the placenta is impaired. Of all cases of polyhydramnios, a third develops in women with diabetes mellitus.
In addition, polyhydramnios can be in women suffering from cardiovascular diseases, kidney disease.
2. Diseases of the fetus. Polyhydramnios often accompanies congenital malformations, for example, esophageal atresia or malformations of the central nervous system. Often these abnormalities are incompatible with the life of the fetus. They are diagnosed with an ultrasound examination. Another important cause is hemolytic disease of the fetus and newborn. With Rh-conflict, polyhydramnios occurs with a frequency of up to 95%.
3. Twins. Monoamniotic twins often cause polyhydramnios, because in almost 100% of cases there is a discharge of blood through an additional vessel (shunt) of the placenta from one fetus to another. At the same time, polyhydramnios develops, since this fetus secretes more urine, and a difference in weight between the twins is formed. Often this is acute polyhydramnios in the early stages of pregnancy (16-20 weeks).
4. Infections. The role of intrauterine infection with such STDs as chlamydia, ureaplasma and some others has been proven. Please note that we are talking about an infection of the uterine cavity, these infections are found in smears much more often than they cause such a problem.
5. Dysfunction of the membranes themselves with excessive secretion of amniotic fluid. This is the rarest reason, if all of the above are excluded. Based on the foregoing, in each specific case, the answer to the question of why polyhydramnios does not lie on the surface, and requires an in-depth examination.
Polyhydramnios, symptoms
The signs of polyhydramnios are not always obvious, only acute polyhydramnios has obvious symptoms. If it develops slowly, gradually, the woman manages to adapt to it and feels good. The tendency to polyhydramnios can appear very early, as early as 16 weeks, and is often noted for the first time on an ultrasound examination. Often this early polyhydramnios is associated with twins.However, gynecologists know how to determine polyhydramnios without this examination.
The fundus of the uterus is more than 3 cm higher than it should be with the current gestational age, the uterus seems unusual to the touch (fluctuation, or swelling during examination, as if water was poured into a bag), parts of the fetus are poorly felt, it is too mobile, and the heartbeat is heard from labor.
With acute polyhydramnios, a woman is worried about a feeling of pressure on the perineum, abdominal pain due to the rapid stretching of the uterus, she herself notices that the abdomen is tense and grows too quickly. Shortness of breath and palpitations may be disturbing, many have edema.
Moderate, slowly developing polyhydramnios does not cause much discomfort.
Quite often, a woman hears on an ultrasound the term polyhydramnios with suspension. What does this mean, and is it worth worrying about? In fact, suspension in amniotic fluid is not always a pathology. In most cases, this is a desquamated epithelium of the fetus and a high content of protein substances, and does not say anything terrible. Only when this suspension is in large flakes and is combined with other symptoms, there can be a suspicion of its meconium nature, which happens during fetal hypoxia (distress) and requires some kind of action. If the doctor after the ultrasound did not call you an ambulance, but let you go home calmly, there is nothing to worry about, everything is not so scary.
Why is polyhydramnios dangerous?
Why is polyhydramnios dangerous during pregnancy? What threatens mother and child?First of all, polyhydramnios is a threat to the child. His small world in which he lives is disrupted, and this can cause him to lack nutrients and oxygen. Acute polyhydramnios can cause premature placental abruption and death of the child. The baby can get tangled in his own umbilical cord, due to the fact that he is too free, the formation of an incorrect presentation is possible (the most dangerous is the oblique and transverse position of the fetus). This is what is bad about polyhydramnios, and if such a diagnosis is made, treatment is vital.