Causes of polyhydramnios during pregnancy, symptoms,risks, prognosis and possible treatment

Update: October 2018

Amniotic fluid plays a huge role in the development of the future
child and childbirth. Depends on their quantity and quality.
only the state of the future baby, but also the mother.

Polygonology, like obstetric pathology, is not uncommon, but
few pregnant women give this complication a special
value, although it, like all other deviations from the physiological
during the course of pregnancy, it needs, if not treatment, so
careful observation.

The consequences of polyhydramnios are very serious and can become sad,
until the loss of the unborn child.

What is amniotic fluid for?

Everyone knows that life on Earth was first born in water, and
then it appeared on land. Man is no exception and
its embryo passes the initial period of its existence in water
environment, that is, in the amniotic fluid.

An embryo develops in the fetal bladder (also known as amnion),
which is filled with biologically active medium – amniotic
liquid, in a different way amniotic fluid. Amniotic fluid have
great value, because it is from their quantitative and
quality composition depends on whether it will be comfortable existence
embryo and childbirth. Amniotic fluid will do a lot of
different functions.

  • provides nutrition to the fetus, due to contained in it
    nutrients ingested by the future
    man, and in the early stages they are absorbed by the skin.
  • provides optimum, and, the main thing, constant temperature
    mode (about 37 degrees).
  • maintains pressure inside the membranes, warns
    overstretching the umbilical cord and parts of the fetus.
  • amniotic fluid protects the future person from mechanical
    external influences (for example, blows to the stomach) and protects the fetus from
    external noise effects.
  • amniotic fluid contains immunoglobulins – antibodies,
    preventing infection of the embryo, and the waters themselves are protected from
    the external environment and various infections due to the impermeability of the fetal
    the bubble.
  • amniotic fluid provides freedom of movement of the fetus
    in the uterus, especially in the early stages.

Polygonum: what does this mean?

The pathology is called a pathological condition, which
occurs during gestation when it accumulates
excessive amount of amniotic fluid. For example, at week 36
pregnancy, that is, at the end of the term of carrying a child
amniotic fluid reaches 600 ml – 1.5 liters, then at this
pathology, the amount of amniotic fluid exceeds the stipulated rate (1500
– 2000 ml).

The amount of amniotic fluid is directly related to the period of gestation.
and as it increases, the volume of water increases (see the calculator
calculating gestation by week). For example, at 10 weeks
the amount of water is insignificant and is only 30 ml, and by 14
week the volume of amniotic fluid reaches already 100 ml, and so
Further. The frequency of occurrence of polyhydramnios is 0.3% – 1% of all
recorded pregnancies.

How is the water

According to its course, polyhydramnios can be both acute and chronic.
In forecasting terms, acute polyhydramide unfavorable
chronic and characterized by rapid, in a few days and even
hours of increasing symptoms. Generally described pathology
observed on short periods of pregnancy, which requires immediate
its interruptions. If the polyhydramnios is chronic, then the volume of water
increases gradually and the symptoms more smooth. More often
diagnosed with chronic polyhydramnios in the last terms
of pregnancy.

There are three severity of chronic polyhydramnios:

  • mild degree when the amount of amniotic fluid is not
    more than 3000 ml
  • moderate degree – the amount of water is within
    3000 – 5000 ml
  • severe degree – if the amniotic fluid exceeds 5 liters
    (more common at the end of pregnancy).

There is another gradation of polyhydramnios:

  • relative water flow is not dangerous and
    set by the ratio of the amount of water and the size of the fetus;
  • the trend towards polyhydramnios or the boundary polyhydramnios – quantity
    amniotic fluid corresponds to the upper limit of normal;
  • idiopathic polyhydramnios – a prerequisite for its occurrence
    known;
  • moderate polyhydramnios during pregnancy – in this case, external
    manifestations are absent, and the volume of water only slightly “rolls over”;
  • pronounced polyhydramnios – has the characteristic features described
    pathology, the belly grows fast.

Why does polyhydramnios arise

To date, the causes of polyhydramide in pregnant women studied
not enough. All the factors that determine the development of this
pathologies are divided into 4 groups:

Maternal factors

  • Diabetes mellitus, it is he who is guilty of a quarter percent of a case
    in the occurrence of excess amniotic fluid.

    Important periods of fetal development

  • Infections take second place, both chronic and
    acute, in particular, TORCH infections (cytomegalovirus, rubella,
    toxoplasmosis, herpes).
  • Renal and cardiac pathologies – followed by chronic
    pathology of the kidneys and cardiovascular system (pyelonephritis,
    glomerulonephritis, heart defects, arterial hypertension and
    other).
  • Gynecologic pathologies – also “contribute to” and
    diseases of the reproductive system (inflammation of the uterus, inflammation
    appendages, uterine tumors, infertility, endometriosis).

Factors due to pregnancy complications

Complications of this pregnancy can also cause
overabundance of amniotic fluid. These include:

  • preeclampsia (vascular damage, in particular the placenta)
  • rhesus conflict
  • low hemoglobin (see iron preparations for anemia)
  • pathology of the placenta (chorionangioma and others)

Fruit factors

  • various anomalies of fetal development (esophageal fouling,
    chromosomal diseases, urinary system pathology,
    brain, fetal mobility, etc.)
  • multiple pregnancy, more often in one of the fruits
    polyhydramnios develops, while another has low water due to the development
    feto-fetal transfusion syndrome
  • large fruit

Idiopathic polyhydramnios occurs without cause

The mechanism for the development of polyhydramnios is in violation of the exchange
amniotic fluid. This exchange is the allocation and
consumption of amniotic fluid. If on short periods of pregnancy
the amnion only secretes the fluid, then at a later date the replacement
amniotic fluid occurs through the amniotic area of ​​the placenta. AND
any pathology leads to a change in the volume of water. Also
the amount of amniotic secretion increases due to urine,
which the fetus secretes, and its absorption through the lungs
and the child’s digestive tract.

  • Therefore, any pathology of the fetus associated with gastrointestinal
    tract
  • urinary system
  • lungs, leads to disruption of water exchange.

Clinical picture of polyhydramnios

Manifestations of polyhydramnios are associated with both the degree of manifestation and
and over the course of the disease.

Sharp water

As it was written earlier, acute polyhydramnios flows heavier and
the clinical picture is clearly marked. Sharp water чаще возникает
in the second trimester, in the region of 16 – 20 weeks. Symptoms are rising for
hours A woman notes a sharp increase in abdomen, pain and
heaviness in the lower abdomen and in the perineum, severe shortness of breath and
other

Chronic Polyhydramnios

The clinical picture of chronic polyhydramnios is more erased. So
as the accumulation of water occurs gradually, the manifestations of this
pathology does not occur immediately. Some pregnant women have signs
polyhydramnios are absent altogether, and excess water
detected by chance during the next ultrasound
research. Chronic Polyhydramnios обычно возникает на 30 – 33
weeks of gestation. Its signs, first of all, are:

  • discrepancy between the size of the abdomen during pregnancy, that is
    values ​​of the height of standing of the bottom of the uterus and abdominal circumference more
    norms.
  • the doctor listens to the deaf heartbeat of the fetus, which is associated with
    excess amniotic fluid impeding auscultation. Herself
    pregnant woman may notice too active movements and mobility
    a fetus that when palpation is detected as an abnormal position
    baby (pelvic presentation, lateral or oblique position).
  • women may complain about:
    • shortness of breath even after slight exertion (uterus
      �”Props” the diaphragm)
    • heartburn
    • sudden tachycardia
    • bouts of weakness
    • persistent swelling of the legs
    • abdominal pain or heaviness
    • by increasing the abdomen on the abdominal wall appear
      multiple stretch marks of pregnancy (striae).

During the examination and palpation of the abdomen the doctor marks him
tension, mobility of the fetus and high standing presenting
part.

Diagnostics

The doctor may be suspicious on the basis of inspection data
(size of the abdomen, abnormal position / presentation of the fetus, deaf
palpitations) and complaints.

УЗAND

  • Для подтверждения диагноза обязательно проводится УЗAND, с
    which is used to calculate the amniotic fluid index
    (сокращенно ANDАЖ). Способ расчета ANDАЖ представляет собой
    the summed up value of all the “pockets”, that is, the places free from
    small parts of the fetus and umbilical cord in the four quadrants of the cavity
    uterus.
  • ANDндекс амниотической жидкости является золотым стандартом при
    establishing the pathology of amniotic fluid.
  • Данные ANDАЖ изменяются ежедневно (воды заменяются каждые 3
    hours)
  • Вычисленный ANDАЖ сравнивают с физиологическими показателями для
    this period of gestation (there is a special table).
Gestational age ANDндекс амниотической жидкости, см
5 percentiles 50 percentiles 95 percentiles
14 weeks 2.8 5.0 8.6
16 weeks 3.6 5.8 9.6
18 weeks 4.6 6.8 11.1
20 weeks 5.5 8.0 12.9
22 weeks 6.3 9.3 14.9
24 weeks 7.0 10.7 16.9
26 weeks 7.5 12.0 18.7
28 weeks 7,6 13.0 19.9
30 weeks 7.5 13.6 20.6
32 weeks 7.1 13.6 20.4
34 weeks 6.4 12.9 19.4
36 weeks 5.6 11.8 17.9
38 weeks 4.7 10.3 15.9
40 weeks 3.7 8.6 13.9

Кроме осмотра и УЗAND женщине назначаются следующие анализы

  • blood for sugar (exclusion / confirmation of sugar
    diabetes);
  • vaginal smear on microflora;
  • polymerase chain reaction (blood or vaginal smears) on
    TORCH infection;
  • clinical blood and urine tests;
  • blood for antibodies (if rhesus blood has women
    negative);
  • cardiotocography, dopplerometry for condition monitoring
    fetus.

If a pregnant woman is treated in a hospital, then she is daily
make a measurement of the abdomen, listen to the heartbeat of the fetus and
determine its position.

Treatment

How to treat high water during pregnancy depends on the reason
his caller. Все women с данной патологией, особенно со
moderate and severe, are hospitalized in
department of pathology of pregnant women.

  • In the case of gestational diabetes mellitus treatment
    polyhydramnios is the correction of blood glucose, and when identifying
    immunological rhesus incompatibility carry out the corresponding
    therapy (treatment or prevention of future hemolytic disease
    child).
  • However, in most cases the cause of polyhydramide remains
    unidentified, then therapy is aimed at normalizing
    uteroplacental blood flow:

    • antiplatelet agents: chimes, trental
    • tocolytics: ginipral, partusisten
    • antispasmodics: papaverine, load-pa
    • shown the introduction of vitamins (ascorbic acid, vitamin E,
      vitamins of group B)
    • actovegin
    • there is evidence of the advisability of appointment in high flow
      indomethacin tablets.
  • Regardless of whether the infection was detected during examination or
    No, the woman must be prescribed antibiotic therapy, while
    uses a wide range of drugs from the group of macrolides
    (эритромицин, джозамицин и other).
  • Amniocentesis is performed in case of severe polyhydramnios.
    by puncturing the abdominal wall, inserting a needle into the uterine cavity and
    a certain amount of water intake.

Complications

What is dangerous polyhydramnios during pregnancy? – a similar question
interested in every woman with this pathology.

  • Firstly, high water availability, especially acute, is a dangerous interruption.
    беременности, которое в сроке до 28 weeks проводят искусственно по
    medical indications.
  • In addition, polyhydramnios often cause premature
    childbirth (overstretched uterus and tense fetal bladder
    cause uterine opening and uterine contraction), prenatal
    rupture of water, bleeding in the first 2 hours after birth and
    subsequent period (due to impaired contractility
    uterus).
  • Also многоводие, особенно в родах, может вызвать
    premature detachment of the placenta, and this serves as an indication for
    emergency caesarean section. During the outbreak of water is possible
    loss of small parts of the baby or the umbilical cord loop, which is also
    means an emergency situation and an operation.
  • ANDз-за высокой двигательной активности плода нередко наблюдаются
    his wrong position / presentation and cord entanglement.
  • With polyhydramnios, uteroplacental blood supply is impaired,
    что ведет к внутриутробной гипоксии и задержке развития fetus.
  • Gestosis with polyhydramnios are much more common than in others.
    cases, as well as hypertension and uncontrollable vomiting.

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