Hydramnios is a condition when there is too much amniotic fluid around the baby during pregnancy. It is also called polyhydramnios. It is very uncommon which occurs roughly in 1 to 2% of all pregnancies.
Causes
Finding a specific cause for hydramnios is not easy and nearly in 50% of cases, cause cannot be identified. Certain conditions that can cause are –
- Diabetes in mother
- Digestive problems that block fluid
- Problems with swallowing which may be because of central nervous system problems or chromosome issues
- Twin-to-twin transfusion syndrome, in this identical twins share a placenta
- Heart failure
- Infection
- Chorioangioma
- Genetic defects
- Fetal anemia
Symptoms
Hydramnios is the pressure placed on the belly and internal organs by the amniotic sac that is the first symptom. Other include the following –
- The fast growth of the uterus
- Stomach discomfort
- Shortness of breath
- Constipation
- Heartburn
- Rapid weight gain
- Abdominal and feet swelling
- Reduction in urine
- fatigue
- Labor pains (contractions)
Risks
There are few hydramnios risks –
Difficulty giving birth
It might be tricky for the fetus to enter the pelvis during labor, drawing the umbilical cord out before the baby. This is known as a cord prolapse and might have to undergo a c-section.
Placental abruption
When the placenta tears away from the uterine wall during labor which can cause hemorrhages.
Rupture of the amniotic sac
The amniotic sab can rip, making the water break before the due date. This could result in premature birth.
Fetus malpresentation
If the baby’s feet are facing the cervix in this condition, instead of the usual head-down position, might need a c-section.
Bleeding after delivery
Might undergo severe bleeding after giving birth due to injuries to the placenta and uterus.
Stillbirth
Hydramnios increases the risk of stillbirth which is the death of the fetus in the uterus.
Diagnosis
If the doctor suspects the possibility of hydramnios, there are several means by which diagnosis can be done such as –
Fetal ultrasonography
An ultrasound is the most effective technique to check for hydramnios. If there is any evidence, more comprehensive ultrasound techniques can be employed which can measure the amniotic fluid in four of the deepest uterine cavities. The doctor will calculate the amniotic fluid index which is usually between 12 to 24 cm in the 34th week of pregnancy. A value above 25 cm means there are hydramnios.
Glucose challenge
This test checks if developed diabetes during pregnancy. If the blood sugar is higher than normal after periodic measurements, gestational diabetes is diagnosed. The presence of this can further confirm hydramnios.
Karyotyping
This is employed to test for genetic abnormalities in the fetus. The doctor will obtain the fetal cells by taking some of the amniotic fluid or a piece of the placenta. Congenital defects are a stronger marker for hydramnios.
Amniocentesis
This is one of the earliest methods of testing where amniotic fluid is extracted from the uterus via an injection. The fluid can then be tested for infections and other problems.
Test to monitor diagnosed hydramnios –
- Specialized ultrasonography
- Non-stress test
- Biophysical test
Treatment
The goal of the treatment is to keep the pregnancy safe as long as possible. It will depend on symptoms, pregnancy, and general health. It will also depend on the severity of the condition but in most cases, hydramnios is moderate which often resolves itself over time. It includes –
- Closely watching the amount of amniotic fluid and doctor will check at every visit.
- Medicine can reduce how much urine the baby makes and can lower the amount of fluid.
- Removing some of the amniotic fluid by inserting a needle through the uterus and into the amniotic sac. This is called amnioreduction with amniocentesis.
- Deliver the baby if it is risky.
- Treat the diabetes of the mother.
Management
- Avoid physical activity
- Control heartburn
- Reduce anxiety
Conclusion
Hydramnios during pregnancies almost always go through early labor, so early hospitalization is the best bet. If at home the water breaks, consult the doctor as early as possible.
References –
