POLYHYDRAMNIOS

Prepared by:
Cuyuca, Vincent Gabriel
Natividad, Charmaine Joy
Sy, Krystelle Anne
What is POLYHYDRAMNIOS?
What is POLYHYDRAMNIOS?
• Polyhydramnios, or hydramnios, refers to an excessive
amount of amniotic fluid around the fetus in the
uterus.
• The fetus's kidneys produce the amniotic fluid, which
flows into the womb via the fetus's urine.
• The fetus then swallows the fluid and reabsorbs it with
its breathing motions. This act of swallowing helps
balance the amount of amniotic fluid in the womb.
• This process maintains a dynamic balance between
the production and absorption of amniotic fluid.
When a disruption affects the balance, complications
can arise for the woman and fetus
Prevalence Statistics
 Prevalence Statistics
• Polyhydramnios is the term used to describe an excess accumulation of
amniotic fluid. This clinical condition is associated with a high risk of
poor pregnancy outcomes. The reported prevalence of polyhydramnios
ranges from 0.2 to 1.6 % of all pregnancies.
• Under physiological conditions there is a dynamic equilibrium between
the production and resorption of amniotic fluid. Fluid levels are
influenced by fetal urination and fetal lung liquid production. Amniotic
fluid is reabsorbed by fetal swallowing and intramembranous and
intravascular absorption. The relative attribution of each of these
mechanisms varies over the course of the pregnancy. A disturbed
equilibrium can be the result of compromised swallowing function or
increased urination and can lead to polyhydramnios.
• A fetus close to term will produce between 500–1200 ml urine and
swallow between 210–760 ml of amniotic fluid per day. Even small
changes in this equilibrium can result in significant changes in amniotic
fluid volumes.
 Prevalence Statistics
• An underlying disease is only found in 17 % of cases in mild
polyhydramnios. In contrast, an underlying disease is detected in
91 % of cases in moderate to severe polyhydramnios . The
literature lists the following potential etiologies.
• fetal malformations and genetic anomalies (8–45 %)
• maternal diabetes mellitus (5–26 %)
• multiple pregnancies (8–10 %)
• fetal anemia (1–11 %)
• other causes, e.g. viral infections, Bartter syndrome,
neuromuscular disorders, maternal hypercalcemia. Viral
infections which can lead to polyhydramnios include parvovirus
B19, rubella, and cytomegalovirus. Other infections, e.g.
toxoplasmosis and syphilis, can also cause polyhydramnios.
Anatomy and Physiology
Anatomy and Physiology
Pathophysiology
Pathophysiology
The amount of amniotic fluid volume present at any one time reflects a
balance between the production and removal of the amniotic fluid. The
factors affecting this are:

Amniotic fluid production

 Fetal urine production
 Secretions from the respiratory tract
 Oral secretions
Amniotic fluid removal
 Fetal swallowing
 A.

POLYHYDRAMNIOS
Too much amniotic fluid in the amniotic
space.

↓ Swallowing ↑ Urination

Developmental delays in the Major causes are:

Gastrointestinal System:
• Maternal DM
• TE Fistula
• Hyperglycemic baby
• Esophageal Fistula

• Duodenal Atresia

• Esophageal Atresia

Neuromuscular Disorder:

• Myotonic Dystrophy
Assessment
Signs and Symptoms
•Difficulty breathing
•Swelling in the lower extremities
•Swelling of the vulva
•Decreased urine production
•Constipation
•Heartburn
•Feeling huge or tightness in the belly
 Diagnostic Findings
If your health care provider suspects polyhydramnios,
he or she will do a fetal ultrasound. This test uses
high-frequency sound waves to produce images of
your baby on a monitor.
If the initial ultrasound shows evidence of
polyhydramnios, your health care provider may do a
more detailed ultrasound. He or she will estimate the
amniotic fluid volume (AFV) by measuring the single
largest, deepest pocket of fluid around your baby. An
AFV value of 8 centimeters or more suggests
polyhydramnios.
 Diagnostic Findings
Additional tests may include:

Blood tests. Blood tests for infectious diseases

associated with polyhydramnios may be offered.

Amniocentesis. Amniocentesis is a procedure in
which a sample of amniotic fluid — which contains
fetal cells and various chemicals produced by the
baby — is removed from the uterus for testing. Testing
may include a karyotype analysis, used to screen the
baby's chromosomes for abnormalities.
Management
 Management
Treatment may includes the following:

Drainage of excess amniotic fluid. Your health care provider may use amniocentesis to
drain excess amniotic fluid from your uterus. This procedure carries a small risk of
complications, including preterm labor, placental abruption and premature rupture of the
membranes.

Medication. Your health care provider may prescribe the oral medication indomethacin
(Indocin) to help reduce fetal urine production and amniotic fluid volume. Indomethacin
isn't recommended beyond 31 weeks of pregnancy. Due to the risk of fetal heart
problems, your baby's heart may need to be monitored with a fetal echocardiogram and
Doppler ultrasound. Other side effects may include nausea, vomiting, acid reflux and
inflammation of the lining of the stomach (gastritis).
Nursing Process
 Assessment
After 20 weeks of gestation, amniotic fluid volume is assessed by using either the
DVP or AFI. In multiple gestations, the DVP is used. These semiquantitative measures
are preferred over subjective assessment because of their reproducibility, and in the
setting of amniotic fluid abnormalities, a numerical estimate permits serial assessment
over time and facilitates communication among providers. To measure the DVP, the
ultrasound transducer is held perpendicular to the floor while scanning in the sagittal
plane (parallel to the long axis of the patient’s body), and the largest vertical pocket of
amniotic fluid is measured. To calculate the AFI, the uterus is divided into 4 equally
sized quadrants and the depth of the single deepest fluid pocket in each quadrant is
measured; the sum of these measurements is the AFI. To be included in either the DVP
or AFI, each measured amniotic fluid pocket must be at least 1 cm wide.
 Diagnosis
• Fluid volume excess related to decrease urine output and retention of
sodium and water
• Ineffective breathing pattern related to pressure on the diaphragm
• Impaired physical mobility related to edema and discomfort from the
enlarged uterus
• Anxiety related to fetal outcome
• Risk for injury at delivery related to prolonged over distension of uterus
 Planning
At the end of the nursing care,

• Mother's vital signs will decrease and will be back to its normal
parameters
• Fluid in the amniotic space decrease
• Mother will be relive from difficulty of breathing
• Mother's intake and output will be monitored strictly
• Mother's abdominal pain will be lessen
 Implementation
• Discuss the causative factors of excess fluid volume
• Monitor Intake and output every 4 hours
• Weigh patient daily and pare to previous weighs
• Auscultate breath sounds every 2 hours and pm for the presence of
crackles and monitor for frothy sputum production.
• Follow low sodium diet or fluid restriction.
• Encourage or provide oral care every 2 hours
• Monitor for distended neck veins and ascites
• Facilitate effective breathing by:
a. Positioning the patient in a Fowler’s bed and propped up position to increase the
vital capacity of lungs to inhale more air.
b. Administering oxygen (8-10 L/min)
• Providing comfort and rest.
• Maintaining intake and output chart
 Evaluation
After nursing care and intervention, assess the fetus and the mother’s health

condition including the fluid volume if it decreases or if it increase more. When the

mother improves in her condition, assist her in changing position and sitting on the

bed and assist her for early ambulation.

References

Fischer, R., (2008). “Amniotic Fluid: Physiology and Assessment”.

https://www.glowm.com/section_view/heading/Amniotic%20Fluid:%20Physiology%20and%20Assessme
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Hamza, A. et al, Solomayer, G., (2010). “Polyhydramnios: Causes, Diagnosis and Therapy”.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3964358/
Mayo Clinic, (2020).”Polyhydramnios”.
https://www.mayoclinic.org/diseases-conditions/polyhydramnios/symptoms-causes/syc-20368493
Nwadike, V., (2018). “What are the risk of having too much amniotic fluid?”.
https://www.medicalnewstoday.com/articles/323232.php
Patni, S., (2014). “Polyhydramnios in singleton pregnancies: perinatal outcomes and management”.
https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/tog.12113
Savita, M., (2017). “Polyhydramnios”. https://www.slideshare.net/MnSavita/polyhydramnios-76251160
 
https://www.slideshare.net/MnSavita/polyhydramnios-76251160
https://www.academia.edu/9054889/polyhydromnis_and_oligo
https://www.mayoclinic.org/diseases-conditions/polyhydramnios/diagnosis-treatment/drc-20368494