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What is Polyhydramnios? How does it affect pregnancy ?

Polyhydramnios which is also known as hydramnios or polyhydramnion is a condition of pregnancy in which the woman has extra amniotic fluid filled in the amniotic sac. It is observed in about one percent of pregnancies. This is a problem that is manifested when AFI-Amniotic fluid index is above 24 centimetres (Amniotic fluid is a fluid that surrounds the baby to protect from hurt or blow. It also aids against infection and development of lungs). The fluid rises gradually. It should be about a liter in the uterus at 38 weeks. The amniotic fluid minimizes to about 800ml by end of 40 weeks as amniotic fluid is swallowed by the baby which is later expelled in its urine. The volume of the fluid is thus controlled. But in case of a disturbance, the volume rises rapidly. It could be about 3 litres in the case of polyhydroaminosis which is 3 times the normal value that should be around the baby.

Polyhydramnios are of two types:
• Chronic polyhydramnios: This type is where extra amniotic fluid fills in the uterus gradually.
• Acute polyhydramnios: This type is where extra amniotic fluid fills in rapidly in the uterus.

Oligohydramnios is another condition but it is opposite of polyhraminos ie., this condition is where there is a deficiency of amniotic fluid in the uterus.

Causes of Polyhydramnios

• Intrauterine infection
• Rh-isoimmunisation
• Chorioangioma of the placenta
• Multiple gestation pregnancy
• Twin-to-twin transfusion syndrome
• Cardiac problems
• Kidney problems
• Maternal diabetes mellitus
• Fetal hyperglycemia
• Polyuria

Study reveals that prenatal death or structural malformations occur in women with severe Polyhydramnios. But then there were cases that showed a perfect healthy baby even in the case of Polyhydramnios.

Symptoms of Polyhydramnios

• Large Tummy
• Feeling taut
• Swollen legs
• Skin is stretched
• Constipation
• Heartburn
• Shiny skin
• Stretch marks
• Uncomfortable and breathless
• Indigestion
• Varicose veins

The abnormalities arise when fetus swallows in some of the amniotic fluid in the womb.

Some of the abnormalities associated with Polyhydramnios are:
• Bochdalek’s hernia
• Fetal renal disorders: Antenatal Bartter syndrome
• Neurological abnormalities: Anencephaly
• Skeletal dysplasia
• Dwarfism

Gastrointestinal abnormalities
• Esophageal atresia
• Duodenal atresia
• Facial cleft
• Neck masses
• Tracheoesophageal fistula
• Diaphragmatic hernias
• Annular pancreas (leading to obstruction)

Chromosomal abnormalities
• Down syndrome
• Edwards syndrome

When it comes to the birth, what happens?

Labor shall be normal but in case of a baby with more than normal weight, birth shall be early. If the water breaks even before the labor, Ambulance will have to be called upon. Any contractions prior to 37 weeks should be informed to the doctor.

In labor, careful monitoring is done and this is for the following reasons:
• Excess amniotic fluid in the uterus makes it hard for the baby to position its head down to the pelvis. In case of water break, umbilical cord pulls down to vagina. This means the cord is in front of the baby’s head. Then a C-section has to be performed as a case of emergency.
• Placenta goes away from the uterus in the early stages in the case of shrinkage of uterus which happens due to the release of amniotic fluid.
• There are chances of heavy bleeding after birth of the baby which may need third stage care.
• In the case of diabetes or a big baby, the baby is made to move down steadily by pushing through the pelvis. This way the baby does not get stuck.

If there is a problem your position is set such that it frees the baby to come out.
• In case of late delivery with worsening symptoms, labor may be induced.

A C-section may also be performed if
• There are twins in the womb
• Baby lies transverse to uterus
• Baby doesn’t stabilize into a position

Read the next part of this article (What is Polyhydramnios? (part 2 ..))

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