Pregnancy in women does not always proceed smoothly, without complications and pathologies. One of the pathological conditions is polyhydramnios. So experts call the excess of permissible norms of amniotic fluid. What should a future mother know about such norms? How is polyhydramnios determined? What threatens such a pathology?
About the role of amniotic fluid
Without this valuable fluid, the proper development of the baby in the womb is impossible. It is the amniotic fluid that protects it from any mechanical influences, provides complete freedom of movement, and participates in metabolism. They also protect the umbilical cord from the slightest squeezing.
It is worth noting that the amniotic fluid is always in motion, systematically updated.
As for the norms of this fluid, they depend on the duration of pregnancy. Naturally, the larger it is, the higher the amount of amniotic fluid. For example, at 10 weeks their volume is only 30 ml, at 100 ml, at 37-38 weeks - up to one and a half liters. If this indicator is exceeded by the end of bearing the baby, then experts state that the woman has polyhydramnios.
About signs of pathology
How do they know that the amount of amniotic fluid exceeds the norm? You can suspect trouble for a number of symptoms. Here they are:
- A feeling of heaviness in the abdomen that does not go away.
- Prolonged malaise, constant weakness in the body.
- Shortness of breath due to high standing of the diaphragm.
- Sudden increase in heart rate.
- Regular and extensive lower limbs.
- The volume of the abdomen at the level of the navel reaches 100 or 120 centimeters.
- Covering the skin of the abdomen with coarse stretch marks.
- Regular and distinct inside the abdomen, which doctors call fluctuation.
About the danger of polyhydramnios
There are two forms of this pathology. More dangerous - acute. It is characterized by the fact that the amount of amniotic fluid increases sharply and rapidly. The process can take place literally within a few days or even hours. The expectant mother has a sharp increase in the size of the abdomen. At the same time, discomfort and lightness are felt all the time, in the groin area, in the lower abdomen. A future mother with acute polyhydramnios feels tension in the walls of the uterus, and swelling of the anterior abdominal wall is also possible, which can be seen visually.
The second form of polyhydramnios is chronic. It differs from the previous one by a gradual increase in the amount of water. But chronic pathology can lead to many real complications for the development of the baby. Here they are:
- Premature spontaneous abortion. According to statistics, this happens in 28% of all expectant mothers with such a pathology.
- Abundant uncontrollable vomiting - threatens with dehydration and fetal hypoxia. This phenomenon is observed in a third of all women with polyhydramnios.
- Fetal presentation is diagnosed in 6% of all pregnant women with this diagnosis.
- Fetoplacental insufficiency with the occurrence of chronic hypoxia of the fetus (sometimes it dies).
- Complex malformations of the central nervous system of the unborn child, pathology of the gastrointestinal tract.
- Profuse bleeding. In the acute form of the pathology, they are observed in 41% of pregnant women, in the chronic form - in 6%.
- Dangerous late gestosis. They threaten 5-20% of patients with polyhydramnios.
- If it turns out that the cause of such polyhydramnios was an infectious process, then intrauterine infection of the fetus is possible.
- Prolapse of the handle, leg, umbilical cord of the fetus during childbirth.
Polyhydramnios is a real indication for a caesarean section, because as a result of this pathology, the child takes the wrong position - it can be pelvic, transverse, oblique.
Due to the strong and sharp overstretching of the walls of the uterus, a woman may have a weakening of labor, premature aging, and sometimes placental abruption. Bleeding and other complications may occur after childbirth.
Causes of polyhydramnios during pregnancy
Diabetes mellitus, kidney disease, some infectious and cardiovascular diseases can contribute to the occurrence of pathology in a pregnant woman. Rhesus conflict in mother and unborn child is another reason for polyhydramnios.
Pathology develops as a result of too large a fetus and with malformations of its development.
In this article:
Pregnancy is undoubtedly the happiest period in a woman's life, but even he 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 amniotic fluid changes throughout pregnancy, so it is important to monitor their amount in each trimester.
Polyhydramnios is the appearance of an excess amount of amniotic fluid, significantly exceeding the norm. The diagnosis of polyhydramnios can put a woman at a variety of stages of pregnancy. These complications occur in 1 in 100 pregnancies.
In the normal course of pregnancy, the necessary amount of amniotic fluid is formed for the development of the fetus, approximately 1000-1500 ml. The amniotic fluid consists of 97% water, which contains proteins, calcium, chlorine and sodium salts. Thus, the baby receives oxygen, necessary nutrients and reliable protection from the external environment. Also, the embryo can calmly move and swim in the mother's abdomen, make movements with the limbs.
Amniotic fluid is the environment in which the fetus develops. The water temperature is 37 degrees.
Properties of amniotic fluid:
- The amniotic fluid protects the embryo from impact and shock. In addition, the noise coming from the outside world is also muffled.
- Amniotic fluid protects the umbilical cord from being squeezed between the wall of the uterus and the fetus.
- Amniotic fluid helps reduce pain during labor.
- They help open 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, for each trimester of pregnancy, there are rules. 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 already 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. Oligohydramnios 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 are not yet fully understood, there are some factors that contribute to the occurrence of this pathology.
Polyhydramnios during pregnancy can occur due to such reasons:
- pathology of fetal development;
- infectious diseases of a pregnant woman;
- bacterial infection;
- diseases of the cardiovascular system;
- Rhesus conflict between mother and fetus;
- metabolic disease;
- diabetes;
- pyelonephritis;
- multiple pregnancy;
- large fruit.
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 severe or moderate polyhydramnios.
The acute form is characterized by a violation of the general condition of the pregnant woman and the fetus. Such childbirth, as a rule, ends 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 within a few 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 anomalies. 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 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 a circumference of more than 100 cm. 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 neighboring organs. Therefore, as a consequence, a 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: in a pregnant woman, gurgling in the abdomen is quite clearly audible. There are pains in the perineum.
- A large number of stretch marks appear on the abdomen.
- The pregnant woman's pulse quickens. The fetal heartbeat is weakly audible.
- Since there is more free space, the fetus takes the wrong 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 activity.
Polyhydramnios is also dangerous because the child can wrap around the umbilical cord. Hypoxia may develop, the fetus will receive less oxygen. Even if the birth takes place on time, the fetus may have 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 polyhydramnios appears in a woman, 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 the 16th week. The cause of this condition is often the Rh-conflict of the mother and 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. You can hear the rolling of water in the stomach. The uterus increases in size and becomes edematous.
You can determine moderate polyhydramnios at a scheduled ultrasound examination or at an examination. Moderate polyhydramnios is characterized by early labor and placental abruption.
A pregnant woman with moderate polyhydramnios should be constantly under the supervision of specialists, as it sometimes happens that this diagnosis is erroneous or is temporary.
In the absence of a serious pathology, the doctor tries to keep the pregnancy and that the birth takes place naturally without artificial intervention. Conservative treatment is prescribed: vitamins, hypothiazide. If necessary, antibiotic therapy is carried out.
Polyhydramnios at the end of pregnancy
Polyhydramnios at the end of pregnancy is approximately 0.6% of all other pathologies. Its appearance may 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 activity.
Therefore, such a diagnosis is an indicator for carrying out. Treatment of such polyhydramnios is carried out depending on the cause.
Diagnosis of polyhydramnios
You can diagnose polyhydramnios at an examination by a gynecologist at an appointment in 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. Doplerometry is also prescribed. Thus, it is possible to identify a more accurate amount of amniotic fluid, check the blood flow in the umbilical cord and placenta.
A thorough examination of the fetus allows you to identify 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 is normal in a certain trimester of pregnancy.
If the diagnosis is confirmed, then the woman is sent for an additional examination of the fetus.
Consequences
With polyhydramnios, the following consequences are possible:
- or termination of pregnancy;
- fetal death or developmental defects;
- if an infection becomes the cause of polyhydramnios, then there is a possibility of infection of the fetus;
- prolapse of the umbilical cord or handle (leg) of the fetus during childbirth;
- the presenting part of the fetus does not fall during childbirth or is not fixed;
- malposition.
- bleeding;
- various gestoses.
Treatment
The main treatment for the diagnosis of polyhydramnios is aimed at eliminating the cause that caused this pathology. First, the expectant mother passes all the necessary tests confirming the presence of polyhydramnios: fetal cardiotocography, ultrasound examination, blood test for the Rh factor, dopplerography and others.
As a rule, complex treatment is carried out. In case of moderate or unexpressed pathology, the pregnant woman is prescribed drug therapy. Depending on the condition of the woman, 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, 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 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 carried out using a thin catheter. Measures are taken to prevent prolapse of the umbilical cord or limbs of the fetus.
Medicines to stimulate labor should be used no earlier than 2 hours after the outflow of amniotic fluid.
In the early stages, when it is impossible to carry out delivery, amniotic fluid is released. Amniotic fluid helps the baby move through 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 for up to 28 weeks, an abortion is performed.
childbirth
If polyhydramnios does not affect the condition of a pregnant woman or her fetus, then in this case, 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 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 remedy, a caesarean section is performed.
The postpartum period may 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 an Rhesus 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.
To prevent polyhydramnios, the expectant mother should take vitamin complexes or medications prescribed by a doctor.
It is necessary to undergo all examinations and analyzes on time, as they will help to identify a pathology or deviation in the development of the fetus even 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 condition of the baby depends.
Useful video
Polyhydramnios in pregnant women in obstetric practice is not so common. Such a pathology needs special attention and treatment, because it can pose a serious danger to both the woman and the child. About why the amount of amniotic fluid increases, and what to do if this happens, we will tell in this material.
What it is?
The amniotic fluid, limited by the walls of the amnion (fetal bladder), is an ideal nutrient medium for the growth and development of the baby before it is born. They protect the baby from injury, acting as a reliable shock absorber. They take the waste products of the baby and remove them, nourish the child and protect his delicate skin.
If for some reason the amount of amniotic fluid increases relative to the norm, we are talking about polyhydramnios - dangerous condition, which can lead to sad consequences. Waters can arrive gradually, then the excess will be smooth, or they can increase in volume rapidly.
In medical language, the problem is called "polyhydromonion". Such a pathology is recorded in approximately 1-2% of the total number of pregnancies. The amount of water during a healthy pregnancy comes gradually, and by -16 weeks it can already be determined and measured using an ultrasound machine.
Since they cannot be drained and the volume measured, a special indicator is used to determine the amount of amniotic fluid - the amniotic fluid index (AFI). In a normal pregnancy, not burdened by pathologies, it looks like this:
Norms of the amniotic fluid index (IAF) - table:
Obstetric period, (week) | IAI (normal limits), mm | Obstetric term (week) | IAI (normal limits), mm |
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Exceeding the upper threshold of norms for a certain period is the basis for judging that a woman has polyhydramnios. Most often, the problem becomes apparent in the 2nd and 3rd trimesters of pregnancy.
Classification
Polyhydramnios is conditionally divided into moderate and pronounced. If the amount of water exceeds the upper limit of normal values by no more than 10%, we are talking about a moderate degree. But for assessing polyhydramnios during pregnancy, it is not so much the exact amount of excess water that matters, but the speed with which they arrive.
The amniotic fluid index, determined in dynamics, allows you to set this speed. If the increase is slow, then we are talking about chronic polyhydramnios. With this pathology, the prognosis is most favorable, in most cases pregnancy manages to be conveyed to the due date and give birth to a completely normal baby.
If the waters arrive very quickly, their number increases rapidly, literally within a few hours or days, then such polyhydramnios is considered acute. This is a severe pathology.
If it develops at an early stage (14-16 weeks of pregnancy), it usually leads to termination of pregnancy, because amniotic membranes simply cannot withstand the pressure of large amounts of water. If the gap does not occur, the risks of congenital anomalies in the development of the child increase. Acute polyhydramnios can also occur in the later stages, and then the risk of losing a child will also be significant.
In addition, polyhydramnios can be mild (with a slight excess), moderate (with an approximate amount of amniotic fluid of 3-5 liters) and severe (if the amount of water exceeds 5 liters).
In each case, the forecasts are purely individual: it is very difficult to predict how the mother and baby will behave, what the state of the amnion and placenta will be.
Causes
Even with the current level of development of medicine and science, it has not yet been possible to find out the true causes of polyhydramnios. But for many years of observation and practice, obstetrician-gynecologists have reason to say that polyhydramnios is a very controversial pathology.
On the one hand, the secretory ability of the villi of the amniotic membrane is disturbed due to excess fluid. On the other hand, excess fluid begins to accumulate due to the fact that the fetal membranes begin to absorb fluid worse.
The waters are renewed every three hours. To replace the previous portion of the liquid, which is almost completely absorbed by the amniotic membrane, as well as the lungs and intestines of the child, a new portion is produced. If the old one has not yet been completely absorbed, then this causes an increase in the amount of liquid. This, in short, is the mechanism for the development of pathology. There is still heated scientific debate about what are the reasons that trigger this mechanism.
Most often, polyhydramnios develops in women suffering from the following pathologies:
- diabetes mellitus and gestational diabetes (this cause accounts for almost 30% of all cases of polyhydramnios);
- infectious diseases, including chronic and sexually transmitted diseases (the most common infection with herpes viruses, rubella pathogens, toxoplasmosis and cytomegalovirus infection);
- inflammatory diseases of the reproductive system;
- chronic and acute diseases of the heart and blood vessels;
- chronic or acute diseases of the kidneys and urinary system;
- anemia of various origins.
The reason for the development of polyhydramnios can be some features of the pregnancy itself:
- preeclampsia;
- multiple pregnancy;
- immunological incompatibility of the mother and fetus (usually due to the difference in Rh factors).
Some developmental pathologies of the baby itself can also lead to polydramnios:
- congenital malformations (most often anomalies in the development of the brain and spine - anencephaly, hydrocephalus, microcephaly, etc., as well as malformations of the stomach, intestines - artesia of various parts of the digestive tract);
- genetic chromosomal abnormalities (Down's syndrome, Patau's syndrome, etc.).
Some pathologies of the placenta also affect the likelihood of polyhydramnios, in particular chorionangioma.
At risk for the development of polyhydramnios are women who have chronic diseases who have been ill with them at an early stage of gestation, including SARS and influenza, as well as women who are in disadvantaged social conditions - poor nutrition, lack of essential vitamins and minerals have an impact. Often, polyhydramnios is accompanied by pregnancy in women who abuse alcohol, drugs and smoking.
The risk group includes women who have a high risk of giving birth to a child with chromosomal abnormalities (those who become pregnant after 35 years of age, have disabled children with chromosomal ailments, have relatives with genetic pathologies, have several miscarriages in a row in anamnesis).
Among all identified cases of polyhydramnios in pregnant women about 20% is accounted for by polydramnios caused by fetal abnormalities.
All of the above factors can cause the accumulation of amniotic fluid. If a woman has infections or inflammatory diseases of the reproductive organs, the amnion may produce amniotic fluid components too actively, and their excretion will be slow.
If the baby has a malformation of the esophagus, he will swallow water less actively or will not swallow it at all, which will also lead to an overflow of the amniotic bladder.
Symptoms and signs
The severity of symptoms in polyhydramnios depends on the type of pathology. If chronic polyhydramnios is observed, then the woman's body adapts to the gradual accumulation of amniotic fluid, compensatory mechanisms begin to work.
As a result, the expectant mother there is no clear clinical picture, the symptoms "smooth out", sometimes occur almost imperceptibly. It is usually discovered by the middle of the second trimester, not earlier.
Acute polyhydramnios occurs much less frequently, and a woman's complaints appear almost immediately. She complains of a deterioration in her condition, of pain and a feeling of "bursting" in her stomach.
For the most part, in an acute form, the pathology develops in the period from 14 to 24 weeks of pregnancy, more often up to 20 weeks. With such a violation, in almost 95% of cases, the most terrible suspicions are confirmed - chromosomal abnormalities of the fetus, while in chronic polyhydramnios, defects and anomalies are not always present.
It is almost impossible for a future mother to determine chronic polyhydramnios on her own. Symptoms characteristic of polyhydramnios are more pronounced in acute disorders. But sometimes in a calmer form, they can also be present with a gradually developing pathology.
With polyhydramnios:
- the fetus moves too actively;
- a woman often feels heaviness and fullness in her stomach;
- there is severe pain in the abdomen (with acute polyhydramnios);
- a woman has severe shortness of breath even after minor physical exertion;
- the expectant mother has all the signs of premature birth or spontaneous abortion if the problem is detected in the last months of pregnancy.
In the third trimester, the most striking and characteristic sign of polyhydramnios is late toxicosis. Unlike the early one, it becomes rampant - sometimes with polyhydramnios, the frequency of vomiting in a pregnant woman reaches several episodes per hour.
In the later stages, swelling of the anterior abdominal wall also becomes noticeable. Half of patients with polyhydramnios have fluctuation. This term denotes a characteristic sound accompaniment - the “squishing” of amniotic fluid in different situations, for example, when changing the position of the body.
The uterus, which is much larger in polyhydramnios, presses on the diaphragm, which causes difficulty in breathing, problems with cardiac activity may begin to be felt - tachycardia is most often recorded in women.
Another characteristic external sign of polyhydramnios is the formation of extensive and rough stretch marks on the skin of the abdomen.
Danger and Consequences
Polyhydramnios is dangerous as an abortion. The amniotic membranes that surround the baby along with the waters are elastic and durable, but not to such an extent that they can withstand too much liquid.
The most tragic scenario is the rupture of the fetal membrane and the death of the baby. Spontaneous termination ends approximately every third pregnancy with polyhydramnios.
Distended amniotic sac and large amount of fluid inside it create a large space for the movement of the child, and he actively uses this. Because of this, cord entanglement, breech or transverse presentation is quite often detected, which will require a special approach to delivery. Most often, a child is born by caesarean section.
In childbirth, polyhydramnios threatens to turn into massive bleeding. Medical statistics report that fairly heavy postpartum bleeding occurs in about half of pregnant women with a confirmed diagnosis of polyhydramnios.
In 7-8% of women, premature outflow of water is observed, which threatens with a long anhydrous period and the onset of hypoxia or infection of the baby. Premature placental abruption occurs in 5% of pregnant women with polyhydramnios.
The pathological condition in every fifth expectant mother at a later date causes nausea and vomiting, an increase in blood pressure. In 6% of cases, a child has intrauterine growth retardation.
Diagnostics
The first suspicions of possible polyhydramnios usually arise from an obstetrician-gynecologist. When examining a pregnant woman at each scheduled visit, the height of the uterine fundus (VVDM) is measured. In a future mother with polyhydramnios, this size, which normally corresponds to the term (at 18 weeks - 18 cm, at 38 weeks - 38 cm), is significantly exceeded. The circumference of the abdomen is also enlarged.
"Manual" gynecological examination shows that the uterus has a tight elastic consistency, its walls are "stretched", the manipulations of the doctor when trying to probe parts of the body of the fetus cause "gurgling" and "squishing", and it is quite difficult to probe the baby, because in the large space of the enlarged uterus it is easier for him to hide from such an examination.
Quite often, the baby is located in the uterine cavity in a pelvic or transverse presentation, while the presenting part of his body is quite high above the entrance to the small pelvis. The heart tone of the baby, which any obstetrician at the reception can easily listen to, is heard unintelligibly, deafly. It is normal to listen to the baby's heart with a large amount of fluid surrounding it.
If a woman has other symptoms of polyhydramnios, the problem becomes clear to an experienced doctor almost immediately. But in order to make such a diagnosis, he must be sure of the correctness of his assumptions. Therefore, the woman receives a referral to the ultrasound diagnostics room.
The somnologist examines the amount of amniotic fluid. This is done in a very interesting way. The doctor visually divides the stomach into four equal sectors. In each of them using an ultrasonic sensor, the amount of amniotic fluid is measured, free from loops of the umbilical cord and body parts of the crumbs. The amount of liquid is measured by the depth of these "pockets".
Then all four results are added up, and the same amniotic fluid index is obtained, which is the main criterion for the norm or pathology. Border excess - a tendency to polyhydramnios. This condition is also studied in detail and carefully monitored.
If the IAF exceeds the norm, then the doctor carefully examines the baby on an ultrasound scan, trying to detect possible signs of genetic pathologies, malformations of internal organs. Then the state of the placenta and uteroplacental blood flow is subject to a detailed study. For this, ultrasound is used, popularly called “ultrasound with Doppler”.
A lot of information can be given by screening studies of the first and second trimester. If they did not show an increased risk of having a baby with chromosomal abnormalities, then doctors will consider other reasons for the development of polyhydramnios. In some cases, the expectant mother may be recommended to donate blood for hormones, in particular, for the concentration of prolactin. An increase in amniotic fluid is often accompanied by a drop in the level of this hormone.
Mandatory appointment unscheduled delivery of general clinical blood and urine tests, and a swab is taken from the vagina to identify possible infections that could be the root cause of the problem with the amniotic fluid.
If a woman and her baby have different Rh factors, then if polyhydramnios is suspected, the expectant mother will also go to donate blood for antibodies. When an increase in the amount of water is associated with the immune rejection of the fetus by the mother's body, which occurs during the Rhesus conflict, the antibody titer also shows an increase.
Invasive diagnostic methods, in particular amniocentesis or cordocentesis, are rarely prescribed for suspected polyhydramnios.
If there is such a need, you should not refuse the procedure. It will allow you to find out with great accuracy whether the crumbs have hereditary or chromosomal pathologies.
An alternative to unsafe and controversial invasive diagnostics is a non-invasive DNA test, in which fetal blood cells are isolated from a mother’s venous blood sample in a genetic laboratory, and their DNA is used to make a conclusion about the child’s health. Such an analysis is expensive - several tens of thousands of rubles, and therefore not available to everyone.
Treatment
Confirmed polyhydramnios requires doctors to be more attentive to the expectant mother. She is prescribed to go to the reception more often - depending on the degree of polyhydramnios - up to 1 time per week.
Starting from the 28th week of pregnancy, she will have a weekly CTG, based on the results of which it will be possible to monitor the baby's well-being, his heart rhythms, and a possible state of hypoxia.
It is customary to treat polyhydramnios in a hospital. The expectant mother is ordered to observe complete rest so that her actions and physical activity do not provoke premature birth or outpouring of water.
She is strictly forbidden to be nervous, worry, sort things out with the household. If necessary, the doctor prescribes light sedatives on a natural basis, which will help the pregnant woman cope with excitement and worries.
The ban is also imposed on sex, because the contractions of the uterine muscles that accompany an orgasm can provoke a rupture of the amnion.
It is impossible to cure polyhydramnios, but you can support a woman and her baby with medication. That's what doctors do. Treatment is based on the treatment of the underlying disease that caused the increase in water.
If these are inflammatory processes of the mother's reproductive organs, then the course of treatment is chosen by the gynecologist, if the cause is heart disease, then the main therapy is the cardiologist. In diabetes or gestational diabetes, the decision to prescribe certain drugs is made by an endocrinologist.
If malformations are detected in a child, a woman is offered to terminate the pregnancy for medical reasons. If she refuses to do so, the doctors will do everything possible to keep the baby alive and the mother healthy. With pathologies of the placenta, a course of drugs that improve placental blood flow and multivitamins is prescribed.
If the true reasons for the increase in amniotic fluid remain unknown, then the standard scheme for providing medical care for polyhydramnios is applied - antibiotic treatment. The goal of this therapy is avoid the development of intrauterine infection.
Among antibacterial drugs, most often expectant mothers are prescribed "Cefotaxime", "Vilprafen" and "Ceftriaxone". Antibiotics of the tetracycline group are not prescribed during pregnancy.
At the same time, it is recommended to take "Kurantila" and "Actovegin" to improve uteroplacental blood flow, multivitamin complexes are also prescribed. To remove excess fluid from the body, diuretics, drugs with a diuretic effect, are included in the standard treatment regimen.
If the dynamics are positive, then the pregnancy will be maintained until 37-38 weeks. The expectant mother will need to come to the hospital earlier to meet the 37th week under the round-the-clock supervision of specialists who are ready to deliver her at any time if the baby's condition worsens.
On which method of childbirth to stop, doctors decide during the last weeks of pregnancy. It is not recommended to give birth naturally, because a plentiful outflow of water under the pressure of their mass can literally wash small parts of the fetal body out of the uterus. In addition, there is a high probability of developing weakness of tribal forces. If natural childbirth is allowed, then the bubble is opened artificially.
90% of women with polyhydramnios give birth by elective caesarean section. So the risks in childbirth associated with a large amount of amniotic fluid can be minimized.
If a woman enters the hospital with an acute stage of polyhydramnios, she is recommended to terminate the pregnancy. When this happens in the third trimester, especially with a large fetus, it is not advisable to keep the pregnancy, because the baby is already viable.
A timely caesarean section will save the lives of both the woman and her child.
After childbirth, doctors pay special attention to the baby. Mortality among these newborns is more than twice as high as among other groups of children. On the very first day, blood is taken from the baby for infections, to determine the group and Rh factor (in case of conflict), and also carry out the necessary therapy, if necessary.
Folk remedies
Polyhydramnios is not treated with folk remedies. There is no such weed and root that could affect the internal processes in the amniotic membrane. The only reasonable treatment regimen is classical drug therapy.
However, in some cases, a woman may turn to traditional medicine prescriptions, but only to replace the symptomatic pill with an alternative method. For example, diuretic drugs with a small chronic polyhydramnios can, with the permission of a doctor, be replaced with cranberry juice or parsley decoction, which also have a diuretic effect.
With an increase in pressure, the expectant mother can drink carrot juice or weak chamomile tea in small quantities. With diabetes, she will have to adhere to a strict diet. However, all these methods do not cancel traditional medical treatment, including antibiotics.
It is impossible to refuse to undergo therapy, because no folk remedies can affect the Rh conflict or congenital malformations of the baby, and even more so, TORCH infections and diseases of the cardiovascular system are not treated with plantain and nettle.
Forecasts and prevention
If polyhydramnios is detected at an early stage, and it is not acute, not associated with genetic defects and fetal abnormalities, then the prognosis is quite favorable. Timely treatment helps to eliminate the complication completely.
Acute polyhydramnios has unfavorable prognosis, especially in the early stages - most of these babies die in utero. Death is not excluded in acute polyhydramnios at a later date.
There are no specific preventive measures. However, it is possible to minimize the possibility of a pathological increase in amniotic fluid if you plan to conceive a child in advance.
A woman needs to be examined in advance by a cardiologist, endocrinologist and nephrologist, visit a female doctor to rule out diseases of the reproductive system.
Before conception, you need to take a blood test for infections, including sexually transmitted infections, urine for bacterial culture, blood and urine for sugar. If pathologies are found, you should be treated before you conceive a son or daughter. If there are risks of genetic pathologies, it is advisable to visit a geneticist in advance and consult with him.
Women in order to avoid the development of polyhydramnios should register as early as possible in the antenatal clinic and not refuse to undergo mandatory screening tests in the first and second trimesters.
Regular testing, adherence to the principles of proper nutrition, prevention of large weight gain and the development of preeclampsia - these are the main tasks facing the expectant mother. If she has bad habits, for example, smoking, and she did not stop doing it at the stage of planning a child, then she should say goodbye to a cigarette as soon as possible, because, according to doctors, the likelihood of polyhydramnios in a smoking pregnant woman is three times higher than in women leading a healthy lifestyle.
To prevent an increase in the amount of amniotic fluid, a woman "in position" you need to observe the sleep and rest regimen, rest enough, do not overload yourself with excessive physical exertion, do not be nervous, monitor your drinking regime (there should be enough moisture, but it should not be too much), and also walk more in the fresh air on foot.
Around the baby in the womb is a constant amniotic fluid, which is vital for its safety and development. These waters are the protection of the fetus from mechanical shocks, infections, temperature changes, they are important for the formation of the processes of respiration and digestion, as well as for the development of the bones and muscles of the baby. What is polyhydramnios? This is when too much amniotic fluid accumulates in the uterus, this diagnosis occurs in 1% of all pregnancies.
Types of polyhydramnios
Relative - not dangerous if the doctor is sure that the pregnant woman does not have any infection. It is most common in women who are expecting a large child.
Idiopathic - polyhydramnios, the cause of which has remained unclear.
Moderate - the size of the vertical pocket is 8-18 cm.
Pronounced - the size of the vertical pocket is above 18cm, and more than 24cm.
Borderline, a tendency to polyhydramnios - when the level is at the borderline between the norm and the elevated level. Observation is required.
Acute - when the amount of water increases at a high speed. Quite dangerous for the life of the fetus, if no action is taken by the doctors.
Chronic - the amount of fluid is above normal, but stable.
Causes of polyhydramnios during pregnancy
Experts say that it is possible to find out the causes of polyhydramnios only in 2 cases out of 3. It turns out that one third of pregnant women with this diagnosis have idiopathic polyhydramnios (for no apparent reason). Why does a woman have this problem?
- Uncontrolled diabetes mellitus in a woman.
- Multiple pregnancy. In most cases, it happens that one child receives more blood and nutrients than another, which leads to complications.
- Anomalies in the development of the fetus. In this case, it can be difficult for the baby to swallow and process the amniotic fluid. This occurs due to cleft lip or palate, hydrocephalus, problems with the gastrointestinal tract, nervous system or heart.
- Fetal anemia.
- Cardiovascular disease in pregnancy.
- Incompatibility of blood of mother and child.
- Problems in the work of the placenta.
Signs and Diagnosis
If we are talking about a mild form, then usually a woman does not feel any suspicious abnormalities.
If the case is severe, then there is shortness of breath, swelling in the lower abdomen and rare trips to the toilet in a small way.
Polyhydramnios is usually diagnosed after an ultrasound. It can be prescribed unscheduled if the gynecologist suddenly noticed some signs - high blood pressure, a urinary tract infection suddenly appeared, the stomach became larger than normal and edema appeared.
Treatment Methods
If polyhydramnios is acute, then an amniotomy will be prescribed to remove excess water. If it is chronic, then it will be better to prolong the pregnancy until the due date and prescribe complex therapy.
Is it possible to recover at home folk remedies? I strongly recommend that you follow the doctor's instructions and do not use any herbal remedies or homeopathy. There are a number of drugs that are used depending on the cause of polyhydramnios, we will discuss them in detail below. And leave folk remedies for the treatment of colds.
What does an obstetrician-gynecologist usually prescribe?
- Actovegin, Curantil. These funds are prescribed to everyone in a row, with the slightest deviation from the norm. To use them or not for prevention is the decision of every woman. Here are interesting data on each of the drugs: Curantil and Actovegin.
- Antibacterial drugs (Amoxiclav, Ampicillin, Wilprafen, Rovamycin, Cefazolin). Some of them are prohibited during pregnancy, but their use is possible if the benefit outweighs the possible risk. In most cases, polyhydramnios reveals the infection that led to it. It is necessary to take tests and determine which antibiotic these bacteria have an increased sensitivity to. This method is an order of magnitude more effective than just drinking a randomly selected drug for prevention.
- Wobenzym. The drug of animal and vegetable origin. It is used in complex therapy with antibacterial drugs.
- Diuretics (Canephron, Hypothiazid).
- Indomethacin. Decongestant and anti-inflammatory drug. Helps to normalize fluid levels.
- Vitamins.
Amniotic fluid is the first living environment of every person. The well-being of a woman and the development of the fetus, the features of labor activity depend on their number and composition.
The volume of amniotic fluid increases every week as the baby grows. In some women, the amount of water does not correspond to the norm.
Both polyhydramnios and oligohydramnios during pregnancy can bring various unpleasant surprises to the expectant mother, so such a deviation cannot be ignored.
Polyhydramnios during pregnancy: what does it mean
Polyhydramnios during pregnancy is an excess of the volume of amniotic fluid in the amniotic sac. The role of amniotic fluid in the development of the child is enormous: maintaining the body in space, ensuring freedom of movement, a source of nutrients, protection from damage and infections. But their number should always correspond to the norm.
During an ultrasound examination, the doctor determines the amniotic fluid index (AFI) - an indicator of the amount of amniotic fluid, and compares it with the table.
When determining the IAI, the sonologist visually divides the cavity of the amniotic sac into 4 equal parts and in each determines the space that is filled with water and does not contain parts of the baby's body (vertical pocket). If the largest pocket has a depth of 2 cm or less, oligohydramnios is diagnosed; if the depth is more than 8 cm, polyhydramnios is diagnosed.
Gynecologists distinguish different forms of polyhydramnios:
1
Relative polyhydramnios- a slight deviation from the norm at this time, usually associated with the bearing of a large fetus, and in the absence of other pathologies, it can be safe for the woman and the fetus. 
2 border state, or a tendency to polyhydramnios during pregnancy - a case when the amount of water reaches the upper limit of the norm, and it is possible that in the future their excess may appear.
Due to polyhydramnios, a woman may not develop labor activity, so in the last weeks she should be under the supervision of doctors, and if necessary, she is done.
Polyhydramnios during pregnancy: treatment
How to treat polyhydramnios during pregnancy depends on the cause of the disorder. If amniotic fluids accumulate due to a woman's illness, appropriate therapy is needed.