POLYHYDRAMNIOS

Asheber Gaym M.D.

January 2009
 Outline
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 Define polyhydramnios
 List etiologies of polyhydramnios
 Discuss the diagnosis of polyhydramnios
 Outline complications of polyhydramnios
 Discuss management of polyhydramnios

Asheber Gaym,2009
 Definitions

 Polyhydramnios refers to an amniotic fluid volume

in excess of two liters.
 Acute polyhydramnios is a sudden and rapid
increase in amniotic fluid volume
 Chronic polyhydramnios on the other hand is a
gradually developing increase in amniotic fluid
volume
 Polyhydramnios is associated with maternal and
perinatal complications and thus requires diagnosis
of possible causes and their management
Asheber Gaym,2009
 Etiologies of Polyhydramnios
Maternal
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•Idiopathic – majority no cause
identified except the
polyhydramnios
•Diabetes mellitus
•RH Isoimmunization
•Syphillis infections
Asheber Gaym,2009
Fetal
•Congenital anomalies-
anencephaly; gastroschissis;
tracheo esophageal fistula;
intestinal atresia
•Multiple pregnancy with twin to
twin transfusion syndrome
 Diagnosis of Polyhydramnios

History Physical exam Sonography

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•Sudden increase in
abdominal girth
•Respiratory difficulty
•Abdominal discomfort
•Decreased perception
of fetal movement
•Abdomen felt to be
larger than previous
deliveries for the same
gestational age
•Increased fundal height
compared to gestational
age
•Difficult to palpate fetal
parts
•Difficult to auscultate
fetal heart tones
•Tense uterus
•Positive fluid thrill
•Maximum vertical
pocket > 8 cms
•Amniotic fluid index
for gestational age –
compare with
nomogram for
gestational age
•General assessment of
amniotic fluid

Asheber Gaym,2009
 Complications of Polyhydramnios
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 Premature rupture of the membranes

 Preterm labor
 Respiratory distress
 Abruptio placentae in cases of sudden rupture
 Cord prolapse
 Malpresentations
 Difficulty in following fetal heart tones
 Higher risk of post partum hemmorhage

Asheber Gaym,2009
 Management of Polyhydramnios

 Make all clinical and sonographic evaluations to

identify any possible etiology and manage
accordingly
 In idiopathic polyhydramnios:
 Therapeutic amniocentesis- in acute respiratory distress
( performed intermittently to relieve over distension)
 Medical management – with prostaglandin synthetase
inhibitors such as indomethacin in cases of chronic
polyhydramnios

Asheber Gaym,2009