POLYHYDRAMNIOS
-excessive accumulation of amniotic fluid
Amniotic fluid volume is increasing more
>2000 ml then this condition is termed to
be hydramnios.
By Ultrasonography we can measure
AFI and SDP
Normal AFI value: 5-25cm
Normal SDP value: 2-8cm
TYPES ON BASIS OF DEGREE:
1. Mild Hydramnios
AFI: between 25-30cm (common)
2. Moderate Hydramnios
AFI: between 30-35cm
3. Severe Hydramnios
AFI: more than 35cm
TYPES ON BASIS OF ONSET:
1. Acute (Rare)
Sudden, takes few days to begin
2. Chronic (Common)
Gradual, takes few weeks to
begin (because the amniotic fluid
is rising slowly)
ETIOLOGY:
1. IDIOPATHIC (most common) (it
means it is completely unknown)
2. FETAL FACTOR – congenital
defects
a. Anencephaly
b. Cleft lip and cleft palate
c. Esophageal or duodenal
atresia
d. Open spina bifida
e. Rhesus isoimmunization
(hydrops fetalis)
f. Fetal infections
3. MATERNAL FACTORS
a. Multiple pregnancy (appears
in monozygotic twins where
there is one rare complication
appears that is TTTS means
twin-twin transmission
syndrome)
b. Cardiac or renal disease (to
compensate the oxygen
demand for the fetus there is
hyperplasia)
c. Diabetes (blood glucose level
is high, so what happened
these high glucose levels
enter in the fetal circulation
there is hyperglycemia in fetus
and this hyperglycemia may
cause polyuria and so more
urine again may contribute in
large amount of amniotic fluid)
4. PLACENTA
Chorioangioma of the
placenta (where the
benign tumor is formed in
the placental tissue,
benign tissues means
there is hypoplasia of
blood vessels and when it
takes place then what
happen again there is a
more translation of fluid
across the membrane and
will enter in the amniotic
sac)
SIGNS AND SYMPTOMS:
 Abdomen girth (it is increasing
more and more in comparison to
the normal pregnancy because
the fluid volume is more)
So when the girth is increasing
more along with that what
happened the
 Fundal height is more than the
weeks of gestation (suppose the
week of gestation is 24 but in here
we measure 28 to 30 cm)
and may cause
 Dyspnea (because the height
goes up and that will display
diaphragm up and that may cause
difficulty in breathing and will
again cause
 Palpitation (the blood vessels are
compressed)
Compressed vessels may cause
 Edema and varicosities in the
legs, hemorrhoids
 Skin tense, shine and large
striae
 Unstable lie, malpresentation,
Fetal parts not defined
 FHS not auscultate by
stethoscope
DIAGNOSIS
 Ultrasonography
 Helpful determine lie, 3. Acute Intolerance
presentation, congenital defects of 4. Risk for bleeding
the fetus 5. Ineffective coping
 Blood test 6. Risk for premature labor
-high level of sugar (Diabetes, 7. Fatigue
ABO and Rh grouping) Additional
 Amniocentesis NURSING INTERVENTION
Elevated level of alpha fetoprotein 1. Encourage the patient to maintain
in open neural tube defects bed rest.
COMPLICATIONS 2. Advise the patient to avoid
 Premature rupture of the straining on defecation.
membranes 3. Monitor the patient for signs and
 Preterm labor symptoms of premature labor.
 Accidental hemorrhage 4. Prepare the woman for
 Cord prolapse amniocentesis and possible labor
induction as appropriate.
 Uterine inertia
 Postpartum hemorrhage and
shock
 Fetal death due to prematurity
and congenital birth defects
MANAGEMENT
 Minor degrees: no treatment.
 Bed rest, diuretics, water and
salt restriction
 Hospitalization
 Indomethacin therapy
-impairs lung liquid
production/enhances absorption.
 Amniocentesis
To relieve maternal distress and
to test for fetal lung maturity.
Additional:
 Early detection and control in
case of Diabetes
 Rhesus isoimmunization
preventable
 Congenital abnormalities can
be terminated in early
pregnancy
Mild Polyhydramnios
 Bed rest and limit the activities
Severe Polyhydramnios
 Admit in a hospital
 Collect blood test for ABO, Rh
grouping, targeted USG
 Amnioreduction
NURSING DIAGNOSIS
1. Risk for Maternal and Fetal Injury
related to Polyhydramnios
2. Acute Pain