Polyhydramnios consequences. What threatens polyhydramnios at different stages of pregnancy, treatment of pathology

An increase in the volume of amniotic fluid above the normal level is quite rare, according to various estimates, in 1-2% of pregnant women. Polyhydramnios during pregnancy and its consequences is the topic of many studies. Until now, it is not clear exactly what mechanisms trigger the process of water accumulation, but the factors that significantly increase the likelihood of polyhydramnios are already well known.

What is polyhydramnios in pregnant women

Polyhydramnios is considered an obstetric pathology, a complication of pregnancy. Another name for polyhydramnios is polyhydramnios. This Greek word fully reflects the essence of this disorder: a large (poly-) accumulation of water (-hydra-) in the amniotic or fetal bladder (-amnion).

Amniotic fluid by the end of an uncomplicated pregnancy has a volume of not more than 1.5 liters. They accumulate gradually, simultaneously with the growth of the uterus. They are not just a liquid in which the fetus is temporarily located, but also perform important functions: they participate in metabolism, help maintain optimal pressure and temperature, and protect against infections. Amniotic fluid contains nutrients, hormones, salts, antibodies. In the early stages of pregnancy, it is absorbed through the skin of the fetus, in the later stages, the child begins to swallow it. By the end of pregnancy, he drinks and excretes up to 800 ml per day.

The waste products of the baby also enter the amniotic fluid, so they are constantly updated. The liquid is completely replaced by a purified one every 3 days. Naturally, polyhydramnios cannot but affect the functioning of this well-established mechanism, therefore, during pregnancy, the water level is repeatedly monitored.

The norms of amniotic fluid at different periods were determined:

Deviation from these norms upwards is considered polyhydramnios. Usually this pathology occurs in the 2-3 trimester, but sometimes it can be diagnosed at an earlier date.

Reasons for the development of the disorder

Polyhydramnios is formed during pregnancy under the influence of 2 multidirectional reasons: increased production of amniotic fluid and reduced absorption. Water is produced by the amniotic membrane, which covers the inside of the placenta. The lungs and gastrointestinal tract of the child are involved in the absorption of water, the reverse absorption is carried out by the same amniotic membrane. In half of pregnant women with polyhydramnios in the placenta, the causes of this disorder can be found: multiple foci with poor blood circulation, hemorrhages, non-functional areas, lack of villi penetrated by blood vessels.

Polyhydramnios in the third trimester is exacerbated if the fetus has impaired absorptive activity, that is, it swallows amniotic fluid less often or less than nature intended. Such violations are quite frequent, they make up one in five cases of polyhydramnios. The cause may be obstruction of the gastrointestinal tract in a child, defects in the nervous and cardiovascular systems, chromosomal abnormalities, brain damage, anemia.

Up to half of cases of polyhydramnios are idiopathic, that is, their cause cannot be established not only during pregnancy, but also after childbirth.

In order to diagnose polyhydramnios in time and manage to reduce its consequences for the child, you need to pay attention to the symptoms of polyhydramnios during pregnancy:

Preeclampsia, accompanied by severe nausea, profuse vomiting, is the most common symptom of polyhydramnios. The combination of gestosis and polyhydramnios is usually accompanied by swelling of the legs and abdomen, an increase in pressure.
Squishing amniotic fluid when moving, changing posture may be a sign of its excess volume.
The size of the uterus is ahead of the average for this period. Closer to childbirth, the circumference of the abdomen can reach 1.2 m.
Due to the strong increase in the uterus, pressure on the organs increases. How to recognize polyhydramnios, given that all women have signs of this condition towards the end of pregnancy: frequent urination and digestive problems are normal; shortness of breath, heart failure, pain in the abdomen, perineum, lower back can be caused by polyhydramnios.
Signs of pressure of an excessively large uterus on the inferior vena cava are periodic dizziness, weakness, dark spots before the eyes. The symptoms are aggravated when the woman lies on her back.
The growth of the abdomen exceeds the elastic capabilities of the skin, so multiple stretch marks appear on it - the best creams for stretch marks.
The fetus may show increased motor activity in an unusually large amniotic sac. A symptom of polyhydramnios can be repeated changes in the position of the child in the later stages. What is fraught with increased space for a child? First, the risk of breech presentation, and hence, caesarean section, is increasing. Secondly, the likelihood of intrauterine hypoxia in a baby is higher due to the entanglement of his umbilical cord.

The above symptoms are indirect. The diagnosis is made only on the basis of ultrasound data. During the study, either the volume of water is calculated by measuring the transverse and longitudinal size of the uterus, or the OPV index is determined.

The OPV index is considered a more accurate way to diagnose polyhydramnios, it is calculated in cm or mm. For each gestational age, there are norms with which this value is compared:

week of pregnancy	Average index value, cm	Index limit, cm
16	12,1	20,1
18	13,3	22
20	14,1	23
22	14,5	23,5
24	14,7	23,8
26	14,7	24,2
28	14,6	24,9
30	14,5	25,8
32	14,4	26,9
34	14,2	27,4
36	13,8	27,9
38	13,2	26,9
40	12,3	24

How to determine the excess of amniotic fluid according to the results of ultrasound: if the index is close to the average value, but does not exceed the limit, the amount of water is normal, no treatment is required. If the index is greater than the maximum permissible value, polyhydramnios is diagnosed.

What forms of polyhydramnios occur during pregnancy

According to the rate of fluid accumulation, polyhydramnios is divided into 2 forms: acute and chronic.

Acute

The acute form is characterized by the rapid arrival of amniotic fluid. The volume of the abdomen grows literally before our eyes: in a few hours, a maximum of a couple of days. More often it develops in the middle of pregnancy and has a sharply negative effect on the mother and baby. Severe polyhydramnios (more than 5 liters) usually proceeds in an acute form, is almost not treatable, and often requires emergency delivery.

Chronic

Chronic polyhydramnios occurs gradually. Excess water is either detected throughout pregnancy, or gradually increases in the third trimester. The treatment of this form is more often successful, the prognosis is favorable: most pregnant women carry the baby to the PDR. Mild (up to 3 l) and moderate polyhydramnios (up to 5 l) usually has a chronic form, is asymptomatic or has implicit, erased signs.

What is the danger of polyhydramnios for a baby

Having received this diagnosis, a woman inevitably begins to wonder what polyhydramnios threatens her and her baby. The most common consequence of this complication is the deterioration of the fetus. A child may feel oxygen starvation, receive less nutrients, which affects its intrauterine development and growth. If polyhydramnios is caused by an infection, the baby can become infected in utero. Such an infection threatens a baby with disruption of the organs, increases the risk of death in the first week of life. A child can be born with inflammation of the lungs, intestines, meninges.

Also, polyhydramnios disrupts the process of childbirth. Placental abruption and heavy bleeding during childbirth are especially dangerous, the risk of premature birth is high. Acute polyhydramnios in the later stages can provoke rupture of the membranes and fetal death.

To understand why polyhydramnios is dangerous, you should refer to the statistics:

the threat of interruption is present in 69% of pregnant women with polyhydramnios;
a third of pregnancies end in miscarriage, early birth;
preeclampsia begins in 50%, it often wears a severe form and leads to a serious deterioration in the well-being of the expectant mother;
Fetal malnutrition is diagnosed in 53% of cases;
caesarean section is required by 49% of women;
in 7% of pregnant women, the fetus is located incorrectly;
a third of childbirth takes place with various complications;
with infectious polyhydramnios, 61% of children are born with signs of intrauterine infection;
in half of the cases, placental abruption occurs during pregnancy, and bleeding occurs during childbirth.

Treatment of the problem

The main task of the doctor when detecting polyhydramnios is to identify its cause. For this, a pregnant woman is prescribed a series of studies to detect infection, diabetes, antibodies, identify possible malformations, chromosomal pathologies.

Based on the data obtained, it is determined how to treat each specific case. Possible options:

There is no specific medical treatment for polyhydramnios. If a pathology is identified that could lead to its appearance, appropriate therapy is carried out: the infection is eliminated, blood sugar is corrected, and pressure is normalized.
If insufficient blood circulation in the placenta is detected, drugs that thin the blood, dilate blood vessels, vitamins and antioxidants are prescribed. Correct nutrition - a pregnant woman with polyhydramnios is shown a physiologically complete diet.
With excessive excretion of urine by the kidneys of the fetus up to 35 weeks, the drug Indomethacin may be prescribed.
The volume of water and the condition of the child are constantly monitored. If polyhydramnios is mild to moderate and the fetus is receiving adequate nutrition, the woman may be treated as an outpatient. The probability of having a healthy baby at term is quite high.
If acute polyhydramnios is diagnosed, there are violations of the fetus, the pregnant woman is urgently hospitalized. If the gestational age is long, the fetus is sufficiently formed, there are no contraindications for natural childbirth, the woman is stimulated to give birth - the fetal bladder is opened. Due to the high risk of detachment, prolapse of the umbilical cord, the amniotomy is carried out through a needle, the water is removed slowly.
If the child is incorrectly located in the uterus, a planned caesarean section is prescribed, with a high risk of fetal death, an emergency operation is performed.

Treatment of polyhydramnios with folk remedies is not only absolutely ineffective, but also deadly for the baby. Any medicinal plants have a toxic effect on the body, and with polyhydramnios, each additional negative factor can lead to termination of pregnancy.

If indicated, amnioreduction is performed. This is an operation that consists in removing excess amniotic fluid through a needle. Up to 7 liters can be removed at a time; during pregnancy, amnioreduction can be performed repeatedly.

A woman is given local anesthesia, a needle is inserted through the abdominal wall into the fetal bladder, the depth and angle of insertion is controlled using ultrasound. The needle is connected to a tube, amniotic fluid is removed through it.

This method of treatment has a rather high risk of complications: infection of the puncture site, placental abruption, trauma to the fetus with a needle is possible. There are even cases of death of a baby for unknown reasons. Therefore, amnioreduction should be carried out only by a qualified specialist and only according to strict indications, which include a short gestational age and a high risk of death of the child.

Prevention of polyhydramnios during pregnancy

Prevention of polyhydramnios begins even before pregnancy. At the planning stage, it is necessary to undergo an examination to identify risk factors, treat detected infections, and eliminate inflammatory processes in the genitourinary system.

During pregnancy, it is important to detect any violations in time, for this you need to register up to 12 weeks and undergo all recommended examinations. The sooner polyhydramnios is diagnosed, the higher the chance of having a healthy baby. Recommendations for pregnant women - a minimum of toxins and stress, the elimination of overwork, maximum fresh air, proper nutrition, regular, but not excessive physical activity.

Polyhydramnios is a pathological condition, which is expressed in the form of excessive accumulation of amniotic fluid in the uterus during pregnancy.

The volume of amniotic fluid or amniotic fluid during pregnancy changes, for example, in the tenth week their amount should not exceed 30 ml, in the fourteenth - 100 ml, and in the last trimester the volume of amniotic fluid varies within 1000-1500 ml. If these norms are exceeded in terms of the amount of amniotic fluid, polyhydramnios occurs during pregnancy.

In medical practice, acute and chronic polyhydramnios occur, it all depends on the severity. For example, with a mild degree of polyhydramnios, the excess fluid in the uterus is insignificant, but if the volume of water is significantly higher than normal, we are talking about severe polyhydramnios.

Pregnant women diagnosed with polyhydramnios are recommended to be under continuous medical supervision in order to prevent the development of serious complications. If, with this diagnosis, a woman did not have circulatory and respiratory disorders, specialists until the last try to keep the pregnancy 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 amniotic sac) is often prescribed to drain excess amniotic fluid.

Symptoms of polyhydramnios.
Symptoms of the manifestation of such a pathology of pregnancy can be very different, due primarily to the pressure of the enlarged uterus on nearby organs. For example, in acute polyhydramnios, the cases of which are quite rare, and which occur mainly in the early stages of bearing a child, there is a rapid increase in the volume of amniotic fluid, heaviness appears in the abdomen and its rapid increase in size. At the same time, the expectant mother may experience pain in the lower back and perineum of an acute nature, swelling of the lower extremities, vulva and abdominal wall, shortness of breath or difficulty breathing, decreased urination. In addition, a pregnant woman has an increase in blood pressure, and, in addition, it is difficult to listen to the fetal heartbeat and feel it with your 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 with an acute degree of polyhydramnios: the size of the abdomen increases gradually, allowing the woman to adapt to them. However, it is worth noting that in this option there are various diseases of the mother during pregnancy. These include diabetes mellitus, bacterial or infectious diseases transferred by the expectant mother, kidney and cardiovascular diseases.

Causes of polyhydramnios.
It often happens that the causes of polyhydramnios remain unclear. But the most common causes of this condition are:

congenital pathologies in the development of the fetus that affect the development of the gastrointestinal tract, kidney or heart, the central nervous system of the child;
deviations in a child of a chromosomal nature;
pregnancy with identical twins, during which one fetus has polyhydramnios and the other has oligohydramnios;
diabetes mellitus, pyelonephritis, metabolic disorders and body fluids;
diseases of the cardiovascular system;
fetal anemia;
Rh-conflict of the blood of the mother and child (the mother has a negative Rh factor, and the father has a positive one);
infections (rubella, cytomegalovirus);
bacterial or infectious diseases suffered by a pregnant woman before conception or during pregnancy;
placental tumor.

Complications of polyhydramnios:

urinary tract infections;
incorrect position of the fetus in the uterine cavity, which requires a caesarean section;
increased blood pressure;
pathological 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.

The earlier polyhydramnios develops, the higher the level of fluid accumulated in the uterus, and the higher the likelihood of complications.

Diagnosis 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 obtained indicator exceeds the norm, polyhydramnios is put.

In addition, the doctor may prescribe additional studies:

The procedure of amniocentesis, in which samples of amniotic fluid are taken for analysis, containing fetal cells, the products of its vital activity.
A glucose uptake test, which is a screening test for gestational diabetes (which occurs during pregnancy). The woman is given syrup to drink, and half an hour later, blood is taken for analysis to determine the level of glucose. If the blood sugar level exceeds acceptable limits, an additional glucose uptake test is performed, which reveals the presence or absence of gestational diabetes.
Biochemical analysis of a pregnant woman's blood serum, 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.

Treatment of polyhydramnios in pregnant women.
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:

Ultrasound of the fetus and dopplerography (with its help, vessels, the fetus, uterus and umbilical cord are examined), in which the condition of the uterus and fetus, as well as blood flow in the placenta, is established.
CTG (cardiotocography) of the fetus, in order to assess the general condition.
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 position must take a blood test for antibodies.

Taking into account the causes and severity of this pathology, appropriate treatment is prescribed. So in the case of unexpressed polyhydramnios and polyhydramnios of moderate severity, treatment with medications is used, both in outpatient (mild) and inpatient conditions (with polyhydramnios of moderate severity). In this case, the pregnancy is maintained until its natural physiological completion (delivery) with continuous treatment. Usually, women are prescribed antibiotics (except tetracycline), diuretics (diuretics), vitamins (hypothiazid, B vitamins), immunomodulatory therapy. Also at 24-38 weeks of pregnancy, a woman is prescribed Indomethacin. If the measures taken do not bring a positive result, and polyhydramnios continues to develop, turning into a severe degree, while there are all signs of intrauterine suffering of the fetus, in most cases, pregnancy is resolved ahead of schedule. With weakness of labor activity, appropriate treatment is also applied (drugs are used no earlier than two hours after the outflow of amniotic fluid).

How to alleviate the condition with polyhydramnios on your own?
With shortness of breath, you should rest more, avoid climbing to the floor without an elevator, do all household chores slowly.

With heartburn against the background of uterine pressure on the stomach:

should eat small meals as often as possible;
do not eat at night and eat immediately before bedtime;
you need to give up foods and drinks that provoke it (fatty foods, carbonated drinks, etc.);
put pillows under your back before going to bed (to form a reclining position);
Take antacids as directed by your doctor.

If new symptoms occur or the condition worsens, call your doctor right away.

Influence of polyhydramnios on the condition of a pregnant woman.

Feelings of pain and discomfort.
Complication of the process of childbirth: weakness of contractions, early detachment of the placenta, excessive bleeding against the background of excessive stretching of the uterus.
Complications during the recovery period.

The effect of polyhydramnios on the fetus.

The occurrence of various defects and pathologies in the development of the fetus.
perinatal death.
Asphyxia of the fetus against the background of a weakening of labor activity, which negatively affects the general condition of the baby and its central nervous system.

Prevention.
Polyhydramnios during pregnancy is a rather serious phenomenon, even in the case of a mild degree of pathology, because it indicates the presence of disorders 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, first of all, include various surveys that will help to timely identify factors contributing to the development of polyhydramnios. It is also recommended to adhere to a certain diet, consume a certain amount of fluid, and often be in the fresh air, taking walks. And most importantly, strictly follow the recommendations of the doctor leading the pregnancy, take all the vitamins and prescribed drugs, and also undergo the prescribed procedures. Revealed polyhydramnios at the initial stage of development is simply, quickly and effectively treated without harm to the health of the mother and fetus.

These signs familiar to pregnant women may indicate a dangerous pathology -.

The entire period of its stay in the womb, the baby swims in the amniotic fluid. These waters are its source of nutrition and protection from various mechanical damage and infections.

During pregnancy, amniotic fluid is renewed, and at the same time, their quantity changes, which may indicate pathologies in the process of bearing a child.

The volume of water should be equal to 30 ml. This figure will increase to 100 ml. And at 37 - up to 1-1.5 liters. If the water turns out to be from 1.5-2 liters, then doctors talk about polyhydramnios.

REASONS FOR THE POLYGODOM

The course of this disease can be acute and chronic. In the first case, there is a lot of water so quickly that the child either dies in the womb, because placental insufficiency or premature detachment of the placenta occurs, or is born with significant malformations.

If a woman has chronic polyhydramnios, then the amount of water increases gradually and the doctor monitors the course of pregnancy.

In almost 30% of cases, doctors cannot determine the cause of polyhydramnios, but experts identify the main factors that can cause such complications.

Causes of polyhydramnios:

too large fetus or multiple pregnancy;
transferred infections, ARVI, acute respiratory infections;
chronic kidney and cardiovascular diseases;
intrauterine infections of the mother, for example, chlamydia, mycoplasmosis, etc.
fetal malformations;
Rhesus conflict in mother and child.

To accurately diagnose, a pregnant woman will have an ultrasound scan. In addition, the gynecologist can also conduct a vaginal examination, which will help determine the tension of the fetal bladder.

WHAT IS POLYHYDRAULIC

Polyhydramnios can provoke serious complications, and if it is not cured in time, you can earn placental insufficiency, preeclampsia, chronic hypoxia of the baby, and even cause premature birth.

A large amount of fluid allows the baby to swim and somersault in the womb, instead of getting into the correct position before birth. Such freedom can turn into an umbilical cord around the neck for a little one, as well as before going out into the world.

Threats with polyhydramnios:

urinary tract infections;
incorrect position of the fetus in the uterine cavity, which requires a caesarean section;
increased blood pressure;
premature;
pathological growth of the fetus;
premature rupture of the fetal bladder with the outflow of amniotic fluid;
prolapse of the umbilical cord;
stillborn children;
high risk of postpartum hemorrhage against the background of weak uterine contractility;
in a baby, polyhydramnios can cause malformations in the development of the central nervous system and the gastrointestinal tract.

TREATMENT OF POLYGONY

As soon as the fact of polyhydramnios is proven, the pregnant woman will be prescribed treatment. Usually these are drugs that improve microcirculation, uteroplacental blood flow and metabolic processes.

Future mothers are constantly monitored by doctors. Antibiotic therapy is carried out so as not to lead to fetal hypoxia.

Treatment is prescribed based on the disease or the reasons for which it arose. Although, practice shows that in more than half of the cases, the causes of polyhydramnios cannot be established.

In the article we discuss polyhydramnios during pregnancy - varieties, causes, symptoms and consequences. You will learn why polyhydramnios is dangerous for mother and child, how to determine polyhydramnios by the amniotic fluid index, what is included in its treatment regimen and how to prevent its occurrence.

With polyhydramnios, the amount of amniotic fluid exceeds the norm

What is polyhydramnios during pregnancy? This is an excess accumulation of amniotic fluid in the uterus. Amniotic fluid surrounds the baby and is very important for its development. Amniotic fluid protects the fetus from external influences and infections, ensures normal metabolism and freedom of movement, maintains temperature balance, and prevents squeezing of the umbilical cord.

When the fluid balance is disturbed, and its amount exceeds the norm, polyhydramnios occurs.. Polyhydramnios in pregnant women is diagnosed in 1% of cases.

There are several types of pathology:

according to the flow rate - chronic and acute polyhydramnios during pregnancy;
by the amount of amniotic fluid - borderline, moderate and severe polyhydramnios during pregnancy.

In chronic polyhydramnios, the amount of amniotic fluid increases gradually, and the symptoms of the pathology are less pronounced. In acute polyhydramnios, the amount of amniotic fluid increases in a few days or even hours. The size of the abdomen increases dramatically, there are pains in the lumbar region and groin. Such a pathology threatens to rupture the uterus and requires artificial termination of pregnancy.

Most often, acute polyhydramnios occurs in the early stages, and chronic polyhydramnios occurs during late pregnancy.

Borderline polyhydramnios or a tendency to polyhydramnios during pregnancy is diagnosed when the amount of amniotic fluid corresponds to the upper limit of the norm, but does not go beyond its value. Moderate polyhydramnios during pregnancy is determined if there are slight deviations from normal indicators, while there are no external manifestations. Severe polyhydramnios is accompanied by obvious symptoms - the stomach is growing rapidly, the woman feels the baby move.

What is the danger of polyhydramnios during pregnancy

Polyhydramnios causes complications throughout pregnancy and childbirth. It is especially dangerous if, in the last stages of gestation, polyhydramnios is diagnosed during pregnancy - the consequences for the child and mother can be deplorable.

What threatens polyhydramnios during pregnancy for a woman:

severe dehydration due to continuous vomiting;
oblique, transverse or pelvic presentation of the fetus;
heavy bleeding during childbearing and after childbirth;
premature detachment of the placenta;
development of late gestosis;
spontaneous miscarriage or premature birth;
weak labor activity due to overstretching of the uterus;
prolapse of the umbilical cord, limbs of the fetus during childbirth.

What is the danger of polyhydramnios during pregnancy for a child:

reduced immunity;
malformations of the gastrointestinal tract and central nervous system;
fetoplacental insufficiency;
prematurity;
infection;
fetal death.

Causes of polyhydramnios during pregnancy

Doctors still do not know exactly why there is polyhydramnios during pregnancy. However, they identify a risk group in which pathology occurs most often.

This group includes women who are diagnosed with the following:

diabetes;
kidney disease;
infectious diseases - rubella, herpes, toxoplasmosis, cytomegalovirus;
cardiovascular diseases;
multiple pregnancy;
Rhesus conflict;
placenta pathology.

Sometimes in the last stages, the baby's swallowing or excretory function is disturbed, which causes polyhydramnios in pregnant women. Also, polyhydramnios occurs if the child is too large or has malformations.

Symptoms of polyhydramnios during pregnancy

With polyhydramnios, there are a number of symptoms and signs that can tell a woman that something is wrong in her body.

What are the symptoms of polyhydramnios during pregnancy:

chronic weakness and malaise;
pain and heaviness in the abdomen;
shortness of breath due to the high standing of the diaphragm;
swelling of the lower extremities;
rapid heart rate;
abdominal volume 100-120 cm or more;
a large number of rough stretch marks;
gurgling sound inside the abdomen.

Signs of polyhydramnios during late pregnancy:

constant tension of the uterus;
excessively high fetal activity;
reduction in urine production.

The sooner you detect these signs, the more effective the treatment will be.

Some women are interested in how to determine polyhydramnios during pregnancy on their own. The answer to this question is unambiguous - no way. You don't diagnose yourself. You can only pay attention to external signs, for example, too rough stretch marks, and consult a doctor for an accurate diagnosis.

How to determine polyhydramnios in pregnant women

Polyhydramnios can only be detected by ultrasound.

To diagnose polyhydramnios, a woman is given an ultrasound examination, during which the amniotic index is calculated - the volume of amniotic fluid. In addition to ultrasound, the gynecologist measures the circumference of the abdomen and the height of the fundus of the uterus to find out if they exceed normal values. The doctor also performs palpation of the uterus and reveals its tension and high mobility of the embryo.

amniotic fluid index table

To determine the exact amount of amniotic fluid, the uterine cavity is divided into four squares, the largest area between the uterine wall and the fetus is measured in each of them, the indicators are summed up and the amniotic fluid index (AFI) is obtained.

IAI is compared with a table of the norm of the amount of amniotic fluid, which indicates indicators for different stages of pregnancy. According to this table, polyhydramnios during pregnancy occurs when the index goes beyond the limits of probable fluctuations. If you are at the 37th week of pregnancy, and the indicator is at the upper limits of the norm, that is, you have borderline polyhydramnios in the last stages of pregnancy, do not refuse hospitalization. You'd better be under medical supervision.

Pregnancy period, weeks	Average normal indicator, mm	Probable fluctuations, mm
16	121	73-201
17	127	77-211
18	133	80-220
19	137	83-225
20	141	86-230
21	143	88-233
22	145	89-235
23	146	90-237
24	147	90-238
25	147	89-240
26	147	89-242
27	156	85-245
28	146	86-249
29	145	84-254
30	145	82-258
31	144	79-263
32	144	77-269
33	143	74-274
34	142	72-278
35	140	70-279
36	138	68-279
37	135	66-275
38	132	65-269
39	127	64-255
40	123	63-240
41	116	63-216
42	110	63-192

How to treat polyhydramnios during pregnancy

The first thing to do when the first signs of polyhydramnios appear is to forget about self-treatment. Do not use over-the-counter or traditional medicines without the approval of your doctor. They can be dangerous in your condition and make you feel even worse. With symptoms of acute polyhydramnios, immediately call an ambulance. It's about your child's life.

Before treating polyhydramnios during pregnancy, determine its degree:

with a mild degree of polyhydramnios, therapy is not needed; the doctor prescribes more frequent examinations of the pregnant woman in order to monitor her condition;
in moderate and severe cases, hospitalization is required.

Since the development of polyhydramnios provokes chronic oxygen starvation of the fetus, it is necessary to quickly establish the cause of the pathology and cure it.

You will be given additional tests:

general analysis of blood and urine;
blood sugar test;
blood test for Rh conflict;
smear on flora;
dopplerometry;
cardiotocography;
Fetal ultrasound.

In some cases, the doctor performs an abdominal amniocentesis. During this procedure, a sample of amniotic fluid is taken from the uterus, the cells of the fetus and waste products are examined to assess the state of his health.

Having found out the cause of polyhydramnios, the specialist will prescribe the appropriate treatment.

The universal treatment of polyhydramnios during pregnancy includes several areas that gradually reduce the amount of amniotic fluid:

therapy of the underlying disease;
relief of painful symptoms - pain is effectively relieved by antispasmodics, such as No-shpa or Magnesia with polyhydramnios of pregnant women;
vitamin therapy - it is mandatory to take vitamin C, E and B vitamins;
improvement of uteroplacental circulation and metabolism - tocolytics Ginipral and Partusisten dilate the uterine vessels, reduce the tone of the uterus; antiplatelet agents Curantil and Trental normalize the “fluidity” of blood;
diuretic drugs - for example, furosemide;
therapeutic and diagnostic amniocentesis - in severe polyhydramnios, up to 200 ml of amniotic fluid is slowly removed from the uterus;
strict diet - well fights thirst and excess fluid in the body.

Regardless of whether an infection has been identified, a course of anti-inflammatory drugs and antibiotics is prescribed for polyhydramnios of pregnancy. In the case of urogenital infections, Vilprafen is often used for polyhydramnios in pregnant women. A stronger antibiotic is Ceftriaxone for polyhydramnios. It is useful not only in the treatment of infections of the genitourinary system, but also in infections of the skin, digestive and respiratory tract.

In the process of treatment, the woman is under the constant supervision of a doctor. Every day, weight and blood pressure are measured, cardiotocography of the fetus is performed. Doppler ultrasound is done every 5-7 days. If the child's condition stabilizes, the pregnancy is maintained until 37-38 weeks. If there is no improvement or the amount of amniotic fluid increases, an emergency delivery is performed.

Nutrition for polyhydramnios in pregnant women

The basic rules of the diet for polyhydramnios of pregnant women:

eat foods that contain animal and vegetable protein;
exclude dairy products and fatty meat, fish from the diet;
increase the amount of fruits and vegetables on the menu;
drink plenty of water and freshly squeezed juice.

Prevention

Since the causes and consequences of polyhydramnios during pregnancy have not yet been clearly established, doctors have not developed specific preventive measures.

Plan your pregnancy. Before conceiving a child, go through examinations, get tested for hidden sexual infections, cure caries, tonsillitis and other foci of chronic infection.
Get registered in time during pregnancy and do not miss scheduled gynecological examinations up to 39-41 weeks.
Stick to proper nutrition and daily routine, avoid places with large crowds of people and other sources of infection.

The best prevention of polyhydramnios during pregnancy is regular ultrasound. Only an ultrasound examination will reveal the complication in time at an early stage, and after treatment you will be able to endure and give birth to a healthy child.

For more information about amniotic fluid, see the video:

What to remember

What does polyhydramnios mean during pregnancy - an excess of amniotic fluid that surrounds the baby in the amniotic sac.
The diagnosis of polyhydramnios is made if the amniotic fluid index is greater than the upper limit of the probable fluctuations in the norm.
Symptoms of polyhydramnios are weakness and shortness of breath, swelling of the lower extremities, an increase in the volume of the abdomen, the appearance of rough stretch marks, gurgling sounds.
The causes of polyhydramnios are chronic and infectious diseases of a woman, fetal malformations, Rh conflict, multiple pregnancy.
Polyhydramnios can cause miscarriage or premature birth, complications during labor, malformations of the child, his death.
Treatment includes therapy for the underlying disease, vitamin therapy, normalization of uteroplacental blood flow, and antibiotics.

The amount of amniotic fluid changes throughout the gestational period. Indicators should be within normal limits. Otherwise, we are talking about a pathology that adversely affects the health of the mother and her baby. Fortunately, the excess of the amniotic fluid index, although dangerous, is observed in only 1% of pregnant women and can be successfully treated.

Polyhydramnios and the norm of amniotic fluid.

Before childbirth, the amount of amniotic fluid is 800 ml (as well as at 35 weeks of gestation). At the 10th week of pregnancy, its volume is only 30 ml, by 14 weeks it grows to 100 ml, and by 20 weeks - up to 400 ml. At 30 weeks of pregnancy, the amount of amniotic fluid is 700 ml, and by 38 weeks it reaches its maximum value - from 1 to 1.5 liters. If there is too much amniotic fluid in the uterus, then we are talking about polyhydramnios.

According to the degree of severity, relative (mild) polyhydramnios is distinguished, which is diagnosed if the volume of the amniotic fluid is very slightly higher than normal, as well as moderate polyhydramnios, which is detected if there are slight deviations from acceptable indicators. With a significant excess of the normal amount of amniotic fluid, we are talking about a severe form of pathology.

Moderate polyhydramnios during pregnancy is not considered a serious threat to the health of the mother and child. In this case, the volume of amniotic fluid increases slowly, and the woman does not feel any pronounced unpleasant symptoms. Additionally, there is tension in the uterine and abdominal walls. Moderate polyhydramnios during pregnancy threatens with unpleasant consequences for the mother and her baby, however, the chances that the birth will go well are quite high.

There are acute and chronic forms of pathology. In the first case, the volume of amniotic fluid increases very rapidly (within hours or days). At the same time, the woman complains of an increase in the volume of the abdomen, pain in the inguinal and lumbar regions. In the chronic form of pathology, there is a tendency to a gradual increase in symptoms.

Polyhydramnios: causes and signs.

For the successful treatment of polyhydramnios, it is necessary to find out the reasons that provoked it. In 30% of cases, this is not possible. There are women who are at risk for the occurrence of polyhydramnios during pregnancy.

Most often, this pathology appears due to the following reasons:

Polyhydramnios in late pregnancy sometimes means that the baby swallows too much amniotic fluid, as a result of which it is not updated in time. The success of its treatment, as well as the normal course of pregnancy and childbirth, largely depends on the timely diagnosis of pathology.

The following signs indirectly indicate the excess of the amount of amniotic fluid:

feeling of heaviness and discomfort in the abdomen;
often occurring weakness, which is constantly observed by the end of gestation;
severe shortness of breath;
sudden increase in heart rate;
the appearance of edema;
excessive increase in the size of the abdomen;
the appearance of a large number of noticeable stretch marks;
fluctuation (gurgling in the stomach);
excess of the normal size of the reproductive organ.

Diagnosis of polyhydramnios.

For the timely diagnosis of pathology, doctors use the amniotic fluid index, which is calculated in two ways: objectively (by ultrasound) or subjectively. In the latter case, an examination is carried out using a transverse scan and a thorough examination. If a large amount of fluid is visualized between the fetus and the anterior abdominal wall, then this indicates polyhydramnios.

A more significant deviation from normal values is detected by ultrasound diagnostics. To do this, the uterine cavity is conditionally divided into four identical squares. In each of the areas, the maximum pocket is determined, then the indicators are calculated and summarized among themselves. The results obtained are compared with the data of a special table.

In the last stages of gestation, an excess of the amniotic fluid index is very dangerous. It is accompanied by tension of the reproductive organ, deviation of its parameters from acceptable values, excessive activity of the fetus. During a gynecological examination, an increase in the height of the uterine fundus is revealed. If pathological symptoms are detected, treatment should be started as soon as possible.

Consequences of polyhydramnios.

What threatens polyhydramnios during pregnancy? Amniotic fluid is a source of nutrition for the fetus, as well as a natural habitat that protects it from external negative factors. With an increase in the volume of amniotic fluid, there is a threat to the health of the mother and her child.

If polyhydramnios during pregnancy is not treated, the following complications may occur:

miscarriage or premature birth;
incorrect presentation of the fetus, which can adversely affect the process of natural childbirth or become an indication for caesarean section;
uterine bleeding;
pathologies of childbirth, for example, weak labor activity, premature detachment of the placenta;
polyhydramnios in the last stages of pregnancy is fraught with the development of preeclampsia.

Exceeding the amniotic fluid index for the baby is no less dangerous than for his mother. It can provoke various deviations, lead to disruption of the life support processes of the fetus, up to its intrauterine death. Polyhydramnios complicates the process of childbirth, preventing the normal birth of a child. Sometimes it causes weak labor activity, which is one of the causes of asphyxia.

How to treat polyhydramnios during pregnancy?

Treatment of polyhydramnios is complex. To determine the therapeutic tactics, they are trying to find out the reasons that served as an impetus for the development of the disease. For this purpose, various examinations are carried out, for example, fetal CTG, ultrasound, Dopplerography. To exclude or confirm the infectious nature of the pathology, a vaginal smear is examined for flora. In order to diagnose diabetes, a blood glucose test is performed.

With moderate or mild polyhydramnios, drug therapy is usually carried out. For this, diuretics, vitamin-mineral complexes, as well as medicines aimed at normalizing the functioning of the placenta are used. Antibiotics are prescribed if abnormalities are due to infection. In severe pathology, amniotic fluid is partially removed by inserting a thin catheter into the amniotic cavity.

Delivery is carried out very carefully. In the initial period of childbirth, lateral amniotomy (puncture of the fetal bladder) is used and measures are taken to prevent prolapse of the umbilical cord and fetal arms. Due to amniotomy, the volume of the uterus decreases, and contractions become more productive. If the birth of the baby is delayed, then drugs are used to stimulate labor. In extreme cases, a caesarean section is performed.

Polyhydramnios detected in a woman during pregnancy is dangerous not only for her, but also for her baby. However, there is no need to panic ahead of time. If the pathology is treated in a timely manner, then adverse effects can be reduced to zero. Depending on the severity of the disease, the expectant mother may be prescribed inpatient or outpatient treatment.