Polyhydramnios is
a medical condition in which an excess of amniotic fluid is present in
the amniotic sac. It is seen in about 1% of pregnancies. It is
typically diagnosed when amniotic fluid index (AFI) is greater than
24 cm.
Polyhydramnios condition may be of two types:
i)
Chronic
polyhydramnios where excess
amniotic fluid accumulates gradually
ii)
Acute
polyhydramnios where excess
amniotic fluid collects rapidly.
Causes of polyhydramnios may be
single or may be multiple and in many cases cause of polyhydramnios may be not
known. Some important causes of polyhydramnios are maternal cardiac problems, renal
problems, maternal diabetes mellitus, and some viral infection and foetal cause
are congenital foetal malformation (tracheao esophageal fistula, anencephaly,
open spina bifida, facial cleft and neck masses), twin baby syndrome, Rh blood
group incompatibility and chorioangioma of placenta, etc.
In majority of cases the accumulation of amniotic fluid is
gradual and the patient is not very much inconvenienced. The patient may suffer
from dyspnoea, palpitation, edema of leg, varicosities in the legs or vulva and
haemorrhoids.
Investigation by sonography in which AFI is more than
24cm. on the basis of AFI polyhydramnios may be of mild, moderate and severe. If
AFI is upto 29cm it is categorised as mild and in between 29 to 35cm it is
moderate. When AFI is more than 35cm it is severe type of polyhydramnios. In case
of severe polyhydramnios the chance of foetal malformation is more and
perinatal mortality rate is high. Radiography is not commonly performed these
days.
Polyhydramnios can cause maternal and foetal complication.
Maternal complications may be eclampsia, malpresentation, premature rupture of
membrane, pre-term labour, accidental haemorrhage, cord prolapse, uterine
inertia.
The death of foetus is mostly due to prematurity and
congenital abnormality.
Management of polyhydramnios depend on the severity of it. In
minor degree amnios usually require no treatment except extra bed rest for few
days. In case of severe case of polyhydramnios if there is no foetal abnormality
and pregnancy is less than 37 weeks amnio reduction is done.
