17852 Polyhydramnios

Overview

Polyhydramnios is a condition where there is too much amniotic fluid in the sac that surrounds a developing baby during pregnancy. Amniotic fluid cushions the baby and helps it grow. When there is too much fluid, it can cause discomfort for the mother and, in rare cases, problems for the baby.

It is not very common. About 1 to 2 percent of pregnancies have polyhydramnios.

It affects pregnant women, usually in the later part of pregnancy. It can happen in any pregnancy, but some women have a higher risk, such as those with diabetes or carrying twins.

Symptoms

Common symptoms

• Often there are no symptoms at all — it is found during an ultrasound.
• The belly may look or feel larger than expected for the stage of pregnancy.
• Mild discomfort, shortness of breath, or swelling in the legs and feet.

Symptoms in children

• Not applicable — this condition develops during pregnancy and does not affect children after birth unless they have an underlying condition.

Symptoms in older adults

• Not applicable — polyhydramnios is a condition of pregnancy and does not affect older adults.

Causes

Main causes

• The exact cause is often unknown.
• Gestational diabetes or poorly controlled diabetes that was present before pregnancy.
• Problems with the baby's ability to swallow or absorb fluid.
• Twin-to-twin transfusion syndrome, which can happen when twins share a placenta.

Risk factors

• Being pregnant with twins or more babies.
• Diabetes that is not well controlled.
• Having had polyhydramnios in a previous pregnancy.
• Certain birth defects in the baby that affect swallowing.

When to see a doctor

See a doctor urgently if:

• If you have any emergency symptoms listed above, call your local emergency number immediately.
• If you have regular contractions or a decrease in your baby's movements, go to the hospital right away.

Book a routine appointment if:

• Attend all your prenatal appointments.
• If you notice a sudden increase in your belly size or strong discomfort, contact your midwife or doctor.

Diagnosis

Polyhydramnios is usually found during an ultrasound scan. The doctor measures the deepest pocket of amniotic fluid to see if it is above normal.

Tests that may be done

• Ultrasound to measure the amniotic fluid level.
• Glucose test to check for diabetes.
• Detailed ultrasound to look at the baby's swallowing, urine, and overall development.
• Nonstress test or biophysical profile to check on the baby's wellbeing.

What to expect at your appointment

If your doctor finds polyhydramnios, they will monitor you more often. You may have repeat ultrasounds and checkups. They will also look for a cause and plan the safest delivery for you and your baby.

Treatment

Treatment depends on how severe the condition is and whether a cause is found. Most mild cases only need monitoring. Severe cases may need to reduce the extra fluid or treat the underlying cause.

Self-care at home

• Rest when you feel short of breath.
• Stay hydrated, but only drink as much fluid as advised by your doctor.
• Avoid heavy lifting or intense exercise.
• Keep a close watch on your baby's movements and tell your doctor if they change.

Medical treatments

Your doctor may recommend extra rest or frequent monitoring. In some cases, a procedure to remove some amniotic fluid (called amnioreduction) is used. There are also medicines that can help reduce the amount of amniotic fluid, but these are only used under the close care of your specialist.

When is surgery considered?

Surgery is rarely needed for polyhydramnios itself. Amnioreduction can be done to remove extra fluid. A very small number of babies may need surgery after birth to fix an underlying problem that caused the polyhydramnios.

Living with this condition

You may need to take extra rest and reduce activity. Your doctor will tell you how often to come for checkups. Many women continue normal daily activities while being monitored.

Lifestyle tips

• Take naps when needed.
• Sleep on your side to improve blood flow.
• Report any leaking fluid or contractions right away.
• Talk to your doctor before taking any over-the-counter medicine.

Diet and exercise

Eat a balanced diet and stay moderately active if your doctor agrees. Some women find that resting helps relieve shortness of breath. Ask your doctor what exercise is safe for you.

Mental health and emotional wellbeing

It can be worrying to hear that there is extra fluid around your baby. Fear and anxiety are common. It is important to ask your doctor questions and share your feelings with someone you trust.

Prevention

You cannot always prevent polyhydramnios. However, if you have diabetes, keeping your blood sugar well controlled before and during pregnancy may lower the risk.

Vaccines

There is no vaccine that prevents polyhydramnios.

Screening programmes

Polyhydramnios is usually detected during a routine prenatal ultrasound scan. There is no separate screening test for it.

Complications

If left untreated

• Preterm labor or early delivery.
• Your water breaking early.
• Placental abruption, when the placenta separates from the womb.
• Umbilical cord prolapse, when the cord slips through the cervix before the baby.

Long-term outlook

Most women with polyhydramnios have a healthy pregnancy and a healthy baby. With careful monitoring and the right treatment when needed, the risks are usually low. Your healthcare team will make a plan to keep both you and your baby safe.

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