The fluid surrounding the baby in the womb during pregnancy is called amniotic fluid. It plays a crucial role in the child’s normal growth and development. However, when there is an excess of amniotic fluid in the womb, it is termed ‘polyhydramnios’ in medical parlance.
This condition typically arises in the latter half of pregnancy, though it can occasionally manifest earlier, around 16 weeks. Diagnosis often occurs during routine pregnancy check-ups. A slight increase in amniotic fluid usually poses no issue.
While polyhydramnios itself isn’t usually serious, it may necessitate additional check-ups and a hospital delivery. Following diagnosis, doctors can monitor the situation and provide treatment as needed.
This article provides detailed information about polyhydramnios.
Reason
The cause of excess amniotic fluid during pregnancy is not always known, but certain factors are believed to contribute:
Maternal Health Factors:
- Twin or multiple pregnancy.
- Pre-existing diabetes in the mother or development of gestational diabetes, particularly if it is uncontrolled.
- Pregnancy infection.
Child Health Factors:
Polyhydramnios can also result from complications related to the baby’s growth and development. Typically, the baby regulates amniotic fluid levels by swallowing it and excreting it as urine. If the baby encounters difficulty swallowing, amniotic fluid levels may rise, leading to polyhydramnios. For instance:
- Gut atresia, a blockage in the baby’s digestive tract.
- Swallowing problems stemming from central nervous system or chromosomal abnormalities.
- Complications related to the baby’s blood group or Rh factor.
- Twin-to-twin transfusion syndrome, occurring when twins share the same womb.
- Congenital heart disease.
- Infant infection.
Symptoms
A slight increase in amniotic fluid may not yield noticeable symptoms. However, excessive amniotic fluid may manifest with the following symptoms:
- Abdominal pain or tightness
- Shortness of breath
- Heartburn
- Constipation
- Increased urinary frequency
- Swelling of the legs, feet, and vulva (external genitalia)
Excessive amniotic fluid enlarges the uterus, exerting pressure on adjacent organs such as the stomach, lungs, bladder, and rectum. These symptoms primarily result from this increased pressure.
It’s important to note that each of these symptoms can also occur in a normal pregnancy. Therefore, if you experience these symptoms, it’s advisable to consult a doctor.
Your doctor may suspect polyhydramnios based on three main symptoms:
- An unusually large belly relative to your stage of pregnancy
- Inability to detect your baby’s heartbeat
- Difficulty determining your baby’s position in the womb
Ways to Diagnose Polyhydramnios
Amniotic Fluid Index (AFI):
A routine ultrasound scan can assess the amount of amniotic fluid in the womb, known as the amniotic fluid index or AFI. The normal range for AFI in pregnancy is 5 cm to 25 cm. If the amniotic fluid measures less than 5 cm, it is termed ‘oligohydramnios,’ while a measurement exceeding 25 cm indicates ‘polyhydramnios.’ This test is typically conducted after 24 weeks of pregnancy.
Other Tests:
If polyhydramnios is suspected based on symptoms and ultrasound findings, further diagnostic tests may be recommended by the doctor to ascertain the cause:
- Blood tests: These tests are conducted to identify any infectious diseases associated with polyhydramnios.
- Glucose challenge test: This test is performed to determine if gestational diabetes is present.
- Amniocentesis: A sample of amniotic fluid is extracted from the uterus for analysis. Amniotic fluid contains various cells and chemicals from the fetus, allowing for assessment of genetic abnormalities.
- Non-stress test: This test involves using a special device to monitor the baby’s movement and heart rate, aiming to detect any abnormalities in fetal heart rate.
- Doppler ultrasound: A detailed ultrasound examination is conducted to evaluate the baby’s circulation and ensure it is normal.
Treatment
A slight increase in amniotic fluid typically resolves on its own and may not necessitate treatment. However, if polyhydramnios is linked to an underlying condition, such as diabetes, treatment may be necessary. Hospital treatment may be warranted if excess fluid leads to symptoms like shortness of breath or abdominal pain.
Doctors may employ the following methods to manage polyhydramnios:
- Amniocentesis: Excess amniotic fluid can be drained from the womb through a procedure known as amniocentesis. However, this intervention carries certain risks, including premature birth, premature rupture of membranes, and premature separation of the placenta.
- Medications: In some cases, doctors may prescribe oral medication such as indomethacin for a limited period, typically up to 48 hours. This medication helps reduce uterine contractions and amniotic fluid volume. It’s crucial to follow the doctor’s instructions and be aware of potential side effects.
What to Do?
- Stay calm and avoid excessive anxiety as polyhydramnios is typically manageable.
- Prioritize rest, considering taking maternity leave early if you’re working.
- Discuss delivery plans with your doctor beforehand, including what to do if your water breaks prematurely or if labor begins unexpectedly.
- Stay vigilant for any new symptoms, excessive abdominal enlargement, or discomfort, and promptly consult your doctor if any arise.
- Seek support from other mothers who have experienced polyhydramnios for additional insights and advice.
Additionally, mentally prepare for potential scenarios:
- Expect additional check-ups and ultrasound scans to monitor your baby’s condition.
- Be prepared for further tests to identify the cause of polyhydramnios, such as diabetes or blood glucose level testing, amniocentesis, or amniotic fluid extraction.
- If a cause is identified, be ready to undergo appropriate treatment, such as diabetes management if maternal diabetes is detected.
- Understand that in cases of excessive amniotic fluid, your doctor may opt for interventions like fluid removal through a needle or other treatments.
Delivery Plan
If you have polyhydramnios, a hospital delivery will likely be recommended to ensure immediate access to any necessary treatment during labor.
Typically, you’ll be encouraged to wait for labor to progress naturally, unless there are concerns for you or your baby’s health. In such cases, labor may be induced or a cesarean section may be performed.
It’s common for more fluid to pass after the water breaks in polyhydramnios compared to a normal delivery. This is normal and not cause for alarm, but your baby’s heart rate will be closely monitored during this time.
After delivery, your baby may undergo special tests, such as inserting a thin tube through the throat to assess the stomach or digestive tract for any issues. These tests are routine and aim to ensure your baby’s well-being.
FAQ
Polyhydramnios cannot be prevented. However, managing factors such as diabetes can reduce the risk. For instance, controlling blood glucose levels in pre-existing or gestational diabetes may lower the likelihood of polyhydramnios.
Yes, the majority of cases of polyhydramnios do not pose significant problems, and healthy births are achievable.
Polyhydramnios slightly increases the likelihood of a cesarean section, but it's not always necessary. A cesarean section may be recommended only if a vaginal delivery is deemed too risky by the doctor.
The volume of amniotic fluid varies throughout pregnancy. At 10 weeks gestation, it's approximately 10-20 milliliters. This volume gradually increases as the baby grows, reaching its peak of about 800-1000 milliliters around 36-37 weeks. It then gradually decreases after 37 weeks.
Approximately one in 100 pregnant individuals may experience polyhydramnios.