Polyhydramnios during pregnancy is a serious pathology that requires treatment. Polyhydramnios during pregnancy - basic information about the disease and methods of its treatment

The article describes the signs of polyhydramnios in expectant mothers. Find out why polyhydramnios is dangerous for the fetus and how to treat it.

All future mothers dream that everything is in order with their child. And, of course, they worry when a doctor discovers an ailment during pregnancy. Immediately they begin to get very worried because of ignorance of the situation.

What to do if you have polyhydramnios? First of all, calm down and follow all the doctor's instructions. Next, we will study in detail all the questions on this diagnosis.

How to determine polyhydramnios during pregnancy?

At different stages of the ongoing pregnancy, the volume of amniotic water is different
After all, the fetus grows, and with it the amount of fluid that it needs to obtain nutrients and for normal development increases.
In addition, two pregnant women cannot have the same amount of amniotic fluid. But there are allowable limits for the volume of fluid at different periods of pregnancy.
If a woman is found to have a deficiency or excess of amniotic fluid, then a diagnosis is made: oligohydramnios or polyhydramnios

Diagnosis - polyhydramnios can be put by a gynecologist if there are complaints from the patient and on the basis of measurements of the volume of the abdomen, which are carried out at each appointment.

It is possible to accurately determine polyhydramnios in a future woman in labor during an ultrasound examination. Where is it installed amniotic index. As mentioned above, it should not exceed allowable limits:

at 16-17 weeks: 72-221 mm
at 21-23 weeks: 88-239 mm
at 33 weeks: 76-279 mm

IMPORTANT: If your polyhydramnios index is equal to the upper acceptable value, then do not neglect the suggestion of your obstetrician - go to the hospital for examination. This is required for the safety of your baby.

Signs of polyhydramnios during pregnancy

This pathology can occur in chronic,acute form. If this - chronic form, then polyhydramnios responds well to medical treatment.

Symptoms may not be present at all. moderate course of the disease, or the following symptoms And external changes:

stretch marks on the abdomen, the large size of the uterus and the volume of the tummy of a pregnant woman can reach 115-120 centimeters
abdominal pain, discomfort
frequent or persistent ailments, feelings of weakness
swelling of the legs
increased heart rate, unpleasant gurgling in the abdominal part
dyspnea

acute form polyhydramnios can develop very rapidly. Sometimes its manifestation disappears in just a few hours.
With such a course of the disease, a woman needs to be urgently hospitalized
You may have to do an abortion, otherwise the fetus will be born with a number of serious diseases, even his death is not ruled out

Moderate polyhydramnios during pregnancy

This type of pathology does not pose a great danger to the baby and the future woman in labor, in contrast to the pronounced, acute polyhydramnios. Still, it doesn't hurt to see your doctor. If this is not done, the consequences may be different:

intrauterine freezing
baby developmental anomalies
prolongation of pregnancy
premature birth

This pathology occurs for the following reasons:

Increased blood sugar in the expectant mother
Various fetal diseases (diseases of the gastrointestinal tract, central nervous system)
Differences in the blood types of the baby and mom
Preeclampsia
Diseases of a pregnant woman (heart, kidneys), infections
Genetics
Problems in the functioning of the placenta
Multiple pregnancy, large baby

As a rule, moderate polyhydramnios is found in the later stages. In the early stages, there is idiotic polyhydramnios, which occurs without any reason and also passes with time.

In the presence of such an ailment, the patient should go to the gynecologist on time and follow his instructions.

In the last weeks, the amount of amniotic fluid should be 1-1.5 liters, depending on the size of the baby. If there are more amniotic waters, then this is polyhydramnios
To avoid premature birth, disruption of the functioning of blood circulation in the placenta, premature detachment of it, bleeding, it is necessary to hospitalize the expectant mother
Ensure control over her condition and the condition of the fetus, carry out the necessary drug treatment

Why is polyhydramnios dangerous during pregnancy?

In the worst case, if the polyhydramnios of the future woman in labor is not controlled by a specialist doctor, the following consequences can await you:

due to a strong stretching of the walls of the uterus, a violation of the birth process occurs, detachment of the placenta ahead of time
it happens that a large amount of amniotic fluid causes labor before the due time
since the child has a lot of space, he may take the wrong position, as needed during childbirth
38.4% of pregnant women have bleeding
in 20% of cases, late gestosis occurs
24.3% of women in labor have miscarriages
36% have prolonged, uncontrollable vomiting
for a child, polyhydramnios is dangerous because he develops various pathologies of the gastrointestinal tract and nervous system

Polyhydramnios. Dangerous Consequences

What to do with polyhydramnios during pregnancy?

To accurately establish polyhydramnios, the doctor gives direction to:

ultrasound diagnostics
cardiotocography to establish the condition of the baby
dopplerography for the study of the uterus, the development of the child
blood tests, lab smear test

Upon confirmation of the diagnosis, the specialist doctor will prescribe an individual treatment for the patient.

How to treat polyhydramnios during pregnancy?

The pathology will be treated by a gynecologist. The most commonly prescribed medications are:

Curantil, Actovegin - preventive pills
antibacterial drugs: Ampicillin, Vilprafen, Cefazolin, (some of these drugs cannot be used while in an interesting position, but they are used to treat irreversible consequences)
diuretics facilities
Wobenzym, as a complex medicine with antibiotics
Indomethacin (as decongestant means)
vitamin drugs

Treatment of polyhydramnios in pregnant women. What drugs to drink?

How to determine the tendency to polyhydramnios during pregnancy?

The tendency to polyhydramnios is determined on ultrasound by the IAI coefficient (amniotic fluid index). If it is equal to the upper limit of the volume of amniotic fluid, then this is a tendency to the pathology of polyhydramnios.

If it is detected, the specialist doctor constantly monitors the patient. See the table below for the lower and upper limits of the IAI at various periods of embryonic development.

IAI table at various stages of pregnancy development

Polyhydramnios in multiple pregnancy

Multiple pregnancy itself is more difficult than normal. If the expectant mother has polyhydramnios, then she is determined for stationary observation.

After all, this pathology means that in the body of a woman there are some processes that do not correspond to the norm. Depending on the source of the disease, your attending obstetrician will prescribe the appropriate treatment.

What to do with multiple pregnancy during pregnancy: tips and reviews

With an increased volume of amniotic fluid, even moderate, it is imperative to be observed by specialists.

Video: polyhydramnios, pregnancy

When it comes to treatment, a pregnant woman is usually unenthusiastic about the prospect. Many of us prefer to do without any medication during the period of bearing a child. But, unfortunately, this is not always possible. If a woman has developed, then she can no longer do without the help of doctors.

Why polyhydramnios during pregnancy should be treated?

Amniotic fluid surrounds the baby throughout the entire period of intrauterine development. It not only serves as a habitat for the unborn baby, but also provides him with freedom of movement, protects him from possible mechanical damage from the outside, and generally keeps the small organism normal. Scientists say that they smell almost like mother's milk: that's why a newly born angel, while still completely helpless, accurately determines the location of her mother's breast.

Throughout pregnancy, the amount of amniotic fluid is constantly changing. At first, they rapidly increase in volume, then, on the contrary, the liquid becomes less and less in relation to the child. But there is always a norm that doctors are guided by when examining a pregnant woman.

Polyhydramnios is also a deviation from this particular norm. The latter is not so common, but is fraught with many dangers. The baby, who is in a large amount of amniotic fluid, is more active in the later stages, when his movements should already be constrained by a decrease in the surrounding space. There is nothing good in this, because, freely tumbling, the baby can wrap itself around the umbilical cord, and more than once.

A fetal bladder overflowing with water runs the risk of bursting prematurely, which is fraught with the onset of labor activity ahead of time. Childbirth during polyhydramnios pregnancy is difficult, labor activity is weak, the uterus can stretch excessively, which causes severe bleeding during childbirth. There is a risk of development, and the development of fetoplacental insufficiency, the postpartum period also proceeds with complications.

The baby also suffers: complications during childbirth prevent an easy birth, in particular, there is a risk of asphyxia in the baby, depression of its central nervous system and gastrointestinal tract. Even during fetal development, polyhydramnios can cause the development of certain pathologies, doctors say.

How is polyhydramnios treated during pregnancy?

The causes of polyhydramnios during pregnancy have not yet been studied well enough, but among the probable causes, doctors distinguish Rh-conflict, nephritis, diseases of the cardiovascular system, intrauterine infections and others.

Before starting the treatment of polyhydramnios during pregnancy, which is carried out mainly in a hospital, the doctor must establish the reason why it developed. To do this, a pregnant woman is sent for a series of examinations (ultrasound with, CTG, a blood test and a smear for infections, with a Rh conflict - on).

Actually, further tactics will depend on the reason. With a Rh conflict between mother and child, it may be necessary to administer immunoglobulin, and intrauterine infections are treated. However, it should be recognized that in almost a third of cases the causes of the pathology remain unexplained. Therefore, over the years, a “universal” treatment regimen for polyhydramnios during pregnancy has already been developed. Usually, the complex of mandatory prescriptions for polyhydramnios includes multivitamins (vitamins of groups B, E and C are required), a magnesium preparation, a broad-spectrum antibiotic, and dietary nutrition.

In general, the treatment of polyhydramnios pregnancy is aimed directly at reducing the amount of amniotic fluid, as well as improving and stabilizing the baby's condition. In the process of this, specialists should constantly monitor the condition of the woman and the child.

Almost always, doctors try to maintain and prolong a high-water pregnancy as close as possible to the expected date of birth. If, with the observance of the necessary measures, no improvement trend is observed, then a decision is made on early delivery. In cases where this is not possible (for example, in early pregnancy), doctors resort to removing some of the amniotic fluid by piercing the amniotic sac (amniocentesis). But it rarely comes to that.

Of decisive importance in the treatment of polyhydramnios during pregnancy is the timely appeal for help. Therefore, do not delay the visit to the doctor if you observe likely signs of polyhydramnios: against the background of general malaise, shortness of breath and increased heart rate, a woman notices that the number of stretch marks is rapidly increasing in the abdomen, and when her position changes, she feels gurgling and rolling water. There is also swelling of the legs, pain and heaviness in the abdomen. If you notice that the volume of the abdomen increases right before your eyes (within a day or even hours), the uterus tenses up, and the anterior abdominal wall swells, then we are talking about acute polyhydramnios, in which you should go to the hospital immediately, without even wasting time on the arrival of the ambulance. But in life, such cases are rare. Still, be careful! And may you and your baby be fine!

Especially for- Elena Kichak

Polyhydramnios is a pathological condition during pregnancy when the amniotic fluid in the amniotic cavity exceeds the norm.

The value of amniotic fluid for the normal development and life of the fetus is invaluable. They protect it from external mechanical impact, provide the embryo with freedom of movement, participate in metabolism, and protect the umbilical cord from squeezing. Amniotic fluid is in constant motion and is systematically updated. At different stages of pregnancy, the norms of amniotic fluid are different: in, for example, the volume of water is 30 ml, in - 100 ml, by 37-38 weeks of pregnancy - 1-1.5 liters. If this limit is exceeded by the end of the term, we are talking about polyhydramnios in pregnant women.

But how do you know how many of these waters you have there? There are certain symptoms, the presence of which can tell a woman that something is wrong. In this case, you need to contact a gynecologist and tell everything about it.

Signs of polyhydramnios during pregnancy:

feeling of heaviness and pain in the abdomen;
malaise, weakness;
shortness of breath (due to the high standing of the diaphragm);
swelling of the legs;
the volume of the abdomen at the level of the navel reaches 100-120 cm or more;
the stomach with polyhydramnios can be strenuously covered with stretch marks;
a distinct gurgling inside the abdomen (fluctuation) is often heard.

Why is it dangerous?

There are acute polyhydramnios, in which the amount of amniotic fluid increases rapidly and sharply, which is very dangerous. Everything happens literally within a few hours or days: the size of the pregnant woman's abdomen increases dramatically, pain in the groin and lower back, tension of the walls of the uterus and noticeable swelling of the anterior abdominal wall are noted. In chronic polyhydramnios, the volume of water increases gradually, but this also causes a number of complications.

The consequences of polyhydramnios can be very sad:

28.4% of pregnant women experience premature termination of pregnancy;
36% of women experience vomiting;
incorrect positions and presentation of the fetus are diagnosed in 6.5% of women;
fetoplacental insufficiency may develop and, consequently, chronic hypoxia and fetal death;
possible malformations of the central nervous system of the fetus and the gastrointestinal tract;
if the cause of polyhydramnios was an infectious process, infection of the fetus is possible;
38.4% of women experience bleeding (with acute polyhydramnios - 41.3%, with chronic - 6.2%);
late gestosis observed in 5-20% of pregnant women with polyhydramnios;
early outpouring of amniotic fluid and;
possible prolapse of the handle or leg of the fetus or umbilical cord during childbirth;
indications for caesarean section (due to the increased space inside the uterus, the child often takes the wrong position: transverse, oblique, pelvic);
due to overstretching of the uterus, weakness of labor, premature, postpartum hemorrhage and other complications may occur.

Causes of polyhydramnios during pregnancy

The causes of polyhydramnios are still not exactly established. But doctors distinguish women at risk, in whom polyhydramnios develops more often than others. However, in 30% of cases, doctors still cannot find out what is the cause of polyhydramnios. With any of the following phenomena, polyhydramnios may (although not necessarily) develop:

if a woman has;
with infectious diseases;
kidney disease;
cardiovascular diseases;
Rhesus conflict in mother and child;
multiple pregnancy (moreover, polyhydramnios of one fetus is often combined with oligohydramnios of another);
large fruit;
decreased excretory function of the fetus;
violation of the swallowing function (at the end of pregnancy, the child absorbs about 4 liters of amniotic fluid every day, which are completely renewed every 3 hours);
with fetal malformations.

Treatment of polyhydramnios in pregnant women

Mostly the diagnosis of polyhydramnios is made according to the results of an ultrasound examination. From the moment the pathology is detected, the expectant mother should be under constant medical supervision. If there is no pronounced circulatory and respiratory disorder (mild and moderate polyhydramnios), doctors tend to keep the pregnancy until its physiological completion. Otherwise, there is a need for early delivery, as the situation may pose a threat to the woman's life.

If the pregnancy is saved, the cause of polyhydramnios should be established, since it threatens the development of chronic oxygen starvation of the fetus. Depending on the identified cause of the disease, appropriate treatment is carried out.

Treatment of polyhydramnios includes antibiotic therapy for viral etiology, immunomodulatory therapy, the appointment of diuretics and vitamins, abdominal amniocentesis. As a rule, hypothiazide, B vitamins are prescribed, in some cases, broad-spectrum antibiotics (except tetracycline), biyoquinol. With weakness of labor, appropriate treatment is prescribed.

Especially for- Elena Kichak

The amount of amniotic fluid changes throughout the gestational period. Indicators should be within normal limits. Otherwise, we are talking about a pathology that adversely affects the health of the mother and her baby. Fortunately, the excess of the amniotic fluid index, although dangerous, is observed in only 1% of pregnant women and can be successfully treated.

Polyhydramnios and the norm of amniotic fluid.

Before childbirth, the amount of amniotic fluid is 800 ml (as well as at 35 weeks of gestation). At the 10th week of pregnancy, its volume is only 30 ml, by 14 weeks it grows to 100 ml, and by 20 weeks - up to 400 ml. At 30 weeks of pregnancy, the amount of amniotic fluid is 700 ml, and by 38 weeks it reaches its maximum value - from 1 to 1.5 liters. If there is too much amniotic fluid in the uterus, then we are talking about polyhydramnios.

According to the degree of severity, relative (mild) polyhydramnios is distinguished, which is diagnosed if the volume of the amniotic fluid is very slightly higher than normal, as well as moderate polyhydramnios, which is detected if there are slight deviations from acceptable indicators. With a significant excess of the normal amount of amniotic fluid, we are talking about a severe form of pathology.

Moderate polyhydramnios during pregnancy is not considered a serious threat to the health of the mother and child. In this case, the volume of amniotic fluid increases slowly, and the woman does not feel any pronounced unpleasant symptoms. Additionally, there is tension in the uterine and abdominal walls. Moderate polyhydramnios during pregnancy threatens with unpleasant consequences for the mother and her baby, however, the chances that the birth will go well are quite high.

There are acute and chronic forms of pathology. In the first case, the volume of amniotic fluid increases very rapidly (within hours or days). At the same time, the woman complains of an increase in the volume of the abdomen, pain in the inguinal and lumbar regions. In the chronic form of pathology, there is a tendency to a gradual increase in symptoms.

Polyhydramnios: causes and signs.

For the successful treatment of polyhydramnios, it is necessary to find out the reasons that provoked it. In 30% of cases, this is not possible. There are women who are at risk for the occurrence of polyhydramnios during pregnancy.

Most often, this pathology appears due to the following reasons:

Polyhydramnios in late pregnancy sometimes means that the baby swallows too much amniotic fluid, as a result of which it is not updated in time. The success of its treatment, as well as the normal course of pregnancy and childbirth, largely depends on the timely diagnosis of pathology.

The following signs indirectly indicate the excess of the amount of amniotic fluid:

feeling of heaviness and discomfort in the abdomen;
often occurring weakness, which is constantly observed by the end of gestation;
severe shortness of breath;
sudden increase in heart rate;
the appearance of edema;
excessive increase in the size of the abdomen;
the appearance of a large number of noticeable stretch marks;
fluctuation (gurgling in the stomach);
excess of the normal size of the reproductive organ.

Diagnosis of polyhydramnios.

For the timely diagnosis of pathology, doctors use the amniotic fluid index, which is calculated in two ways: objectively (by ultrasound) or subjectively. In the latter case, an examination is carried out using a transverse scan and a thorough examination. If a large amount of fluid is visualized between the fetus and the anterior abdominal wall, then this indicates polyhydramnios.

A more significant deviation from normal values is detected by ultrasound diagnostics. To do this, the uterine cavity is conditionally divided into four identical squares. In each of the areas, the maximum pocket is determined, then the indicators are calculated and summarized among themselves. The results obtained are compared with the data of a special table.

In the last stages of gestation, an excess of the amniotic fluid index is very dangerous. It is accompanied by tension of the reproductive organ, deviation of its parameters from acceptable values, excessive activity of the fetus. During a gynecological examination, an increase in the height of the uterine fundus is revealed. If pathological symptoms are detected, treatment should be started as soon as possible.

Consequences of polyhydramnios.

What threatens polyhydramnios during pregnancy? Amniotic fluid is a source of nutrition for the fetus, as well as a natural habitat that protects it from external negative factors. With an increase in the volume of amniotic fluid, there is a threat to the health of the mother and her child.

If polyhydramnios during pregnancy is not treated, the following complications may occur:

miscarriage or premature birth;
incorrect presentation of the fetus, which can adversely affect the process of natural childbirth or become an indication for caesarean section;
uterine bleeding;
pathologies of childbirth, for example, weak labor activity, premature detachment of the placenta;
polyhydramnios in the last stages of pregnancy is fraught with the development of preeclampsia.

Exceeding the amniotic fluid index for the baby is no less dangerous than for his mother. It can provoke various deviations, lead to disruption of the life support processes of the fetus, up to its intrauterine death. Polyhydramnios complicates the process of childbirth, preventing the normal birth of a child. Sometimes it causes weak labor activity, which is one of the causes of asphyxia.

How to treat polyhydramnios during pregnancy?

Treatment of polyhydramnios is complex. To determine the therapeutic tactics, they are trying to find out the reasons that served as an impetus for the development of the disease. For this purpose, various examinations are carried out, for example, fetal CTG, ultrasound, Dopplerography. To exclude or confirm the infectious nature of the pathology, a vaginal smear is examined for flora. In order to diagnose diabetes, a blood glucose test is performed.

With moderate or mild polyhydramnios, drug therapy is usually carried out. For this, diuretics, vitamin-mineral complexes, as well as medicines aimed at normalizing the functioning of the placenta are used. Antibiotics are prescribed if abnormalities are due to infection. In severe pathology, amniotic fluid is partially removed by inserting a thin catheter into the amniotic cavity.

Delivery is carried out very carefully. In the initial period of childbirth, lateral amniotomy (puncture of the fetal bladder) is used and measures are taken to prevent prolapse of the umbilical cord and fetal arms. Due to amniotomy, the volume of the uterus decreases, and contractions become more productive. If the birth of the baby is delayed, then drugs are used to stimulate labor. In extreme cases, a caesarean section is performed.

Polyhydramnios detected in a woman during pregnancy is dangerous not only for her, but also for her baby. However, there is no need to panic ahead of time. If the pathology is treated in a timely manner, then adverse effects can be reduced to zero. Depending on the severity of the disease, the expectant mother may be prescribed inpatient or outpatient treatment.

During pregnancy, up to 15-20% of women are faced with such a problem as polyhydramnios. Pathology is an excessive accumulation of amniotic fluid in the uterus. As you know, the baby during intrauterine growth and development "floats" in a liquid medium, which provides him with protection and complete safety from shocks, bruises, shocks, pressure and other mechanical influences, as well as from many infections. Thanks to the amniotic fluid, the fetus can move, and it releases waste products into it.

The aquatic environment is constantly updated and moving, and as the fetus increases in size, its quantity also increases. The exact amount of fluid is determined by ultrasound, for which a special amniotic index is calculated. Normally, the volume should be:

10 weeks - 30 ml;
14 weeks - 100 ml;
38 weeks - up to 1.5 l;
40 weeks - 700-1000 ml. (the amount of fluid decreases towards childbirth).

Polyhydramnios in pregnant women is considered a complication of the course of pregnancy, since the amount of amniotic fluid increases greatly (in contrast to such a pathology as oligohydramnios, in which the volume of fluid decreases to 500 ml.). In most cases, polyhydramnios is diagnosed in late pregnancy, but sometimes it can be detected during the first, second trimester.

Forms and types of polyhydramnios

There are two forms of pathology:

Acute polyhydramnios. The amount of amniotic fluid grows rapidly, leading to severe symptoms. This development of events, as well as oligohydramnios, is more typical for women in the early stages of pregnancy.
Chronic polyhydramnios. The volume of amniotic fluid is almost always higher than normal, but there is no sudden increase in it. The prognosis depends on the degree of polyhydramnios.

As the pregnancy develops, polyhydramnios can appear at different times. At any time during pregnancy, the pathology is differentiated into the following types:

A tendency to polyhydramnios, or borderline polyhydramnios. In this case, the amniotic fluid is quantitatively at the upper limit of normal.
Relative polyhydramnios. In most cases, it is not pathological. Relative polyhydramnios and a large fetus are often combined.
Primary (idiopathic) polyhydramnios. It develops for no apparent reason at any stage of pregnancy.
Moderate polyhydramnios. The amount of fluid increased slightly. Moderate polyhydramnios, as a rule, develops gradually, and the course of pregnancy and childbirth is not complicated.

In terms of severity, the pathology can be as follows:

Easy degree. In this case, in the last stages of pregnancy, the volume of fluid does not exceed 2-3 liters.
Moderate severity (up to 4-5 liters of liquid).
Severe degree (above 5 liters of liquid).

Severe and moderate degrees of pathology cause serious consequences and carry a high risk of fetal death against the background of placental abruption and severe bleeding.

Causes of polyhydramnios in pregnant women

Unexplained causes of polyhydramnios in pregnant women remain in a third of cases. But most often, polyhydramnios, like oligohydramnios, develops after a woman has had infections and severe viral diseases (especially CMV, herpes, toxoplasmosis, rubella). In addition, with the existence of chronic infectious diseases of the genital area (chlamydia, ureaplasmosis, mycoplasmosis), polyhydramnios and oligohydramnios are quite common.

Also during gestation, the following reasons can cause polyhydramnios:

metabolic disorders in the mother (in particular, diabetes mellitus);
hypertension and preeclampsia (cause polyhydramnios at the end of pregnancy);
kidney disease;
pathology of the placenta;
Rhesus conflict;
malformations and diseases of the fetus (failures in the act of swallowing, the functioning of the urinary system, anemia, malformations of the central nervous system, gastrointestinal tract, hydrocephalus, structural disorders of the face).

The causes of polyhydramnios may be due to multiple pregnancy (in this case, moderate polyhydramnios and even oligohydramnios of one fetus with polyhydramnios of another are often diagnosed). Moderate polyhydramnios during pregnancy may accompany the development of a large fetus. If a woman is at risk for the occurrence of pathology, she is more carefully monitored from the moment of registration until delivery.

How to identify polyhydramnios: a clinical picture

Moderate polyhydramnios may not appear during the entire period of bearing a baby. That is, if there are no significant deviations in the volume of amniotic fluid, the woman feels fine. Therefore, moderate polyhydramnios during pregnancy is almost always a diagnostic finding.

Acute and chronic types of pathology have different symptoms. Acute polyhydramnios is rare. It develops quickly (from a couple of hours to a day) and has the most serious consequences (preterm birth, fetal death, etc.). Symptoms of polyhydramnios are reduced to a sudden increase in the amount of amniotic fluid with a strong increase in the size of the abdomen, tension in the walls of the uterus. There are sharp, cutting pains in the abdomen, sacrum, groin. An increase in pressure in the peritoneum causes shortness of breath, swelling of the anterior wall of the peritoneum. The heart rhythms of the fetus are almost not audible due to their jamming with a large amount of water, as well as the outlines of the fetal body are not palpable.

Signs of polyhydramnios in chronic form are as follows:

long course: often the amount of amniotic fluid pathologically increases during the entire pregnancy;
the onset of clinical signs, mainly after 33-35 weeks;
discrepancy between the circumference of the abdomen to the norm in time (more than 110 cm);
stretch marks on the abdomen (striae);
deviations in the height of the uterus;
unnatural protrusion of the navel;
an increase in the tone of the uterus, which, when palpated, feels too tight, tense;
aching pain in the abdomen;
lower back pain of the type of sciatica;
increased pain during fetal movements;
periodic shortness of breath, increasing as pregnancy grows (this is due to squeezing by the uterus of neighboring organs and raising the diaphragm);
functional disorders of the cardiovascular system (arrhythmia, increased heart rate);
the appearance of signs of varicose veins (dilated veins, spider veins, severe leg fatigue);
increased fatigue during the day;
increased urge to defecate, urinate due to compression of the bladder, intestines;
periodic gurgling inside the abdomen, especially with sudden movement;
somewhat muffled fetal heartbeat during a medical examination;
slowness of the fetus (small number of movements), or, on the contrary, abnormal mobility.

Polyhydramnios at the end of pregnancy is often manifested by the fact that the fetus is forced to take the wrong position, which will complicate natural childbirth or make it completely impossible. Oligohydramnios in pregnant women may have similar symptoms in terms of reducing the number of fetal movements, the appearance of abdominal pain. But there is a significant difference: oligohydramnios does not cause excessive growth of the abdomen, on the contrary, it has a pathologically small size. Oligohydramnios requires urgent medical attention to avoid fetal growth retardation, miscarriage, skeletal malformations, and death.

Consequences of polyhydramnios

Both polyhydramnios and oligohydramnios threaten with serious complications, especially in the absence of an attentive attitude to health and a woman's late appeal for help. Especially dangerous consequences are acute polyhydramnios. In most cases, if an emergency cesarean section is not performed, placental abruption occurs, or acute fetoplacental insufficiency develops. As a result, the fetus dies, or is born prematurely with malformations, birth injuries.

Chronic polyhydramnios has a more favorable prognosis, but in 10-30% of women it is also complicated:

premature birth;
early miscarriages;
prolonged vomiting with dehydration;
incorrect position of the fetus;
placenta previa;
hypoxia of the fetus with a delay in its development;
infection of the fetus with viral infections (if, together with polyhydramnios, a woman was infected with ARVI or other diseases);
bleeding;
late gestosis;
complicated childbirth with prolapse of the limbs of the fetus;
weakness of labor activity;
postpartum hemorrhage against the background of uterine hypotension;
non-separation of the placenta;
maternal cardiopulmonary insufficiency.

Treatment of polyhydramnios during pregnancy is mandatory. Otherwise, the above complications often lead to deformities or death of the fetus.

Diagnosis of polyhydramnios

The doctor can assume polyhydramnios already by the description of the main complaints of the woman, as well as after a simple measurement of the height of the uterus, the circumference of the abdomen. These indicators are compared with the norm for a given gestational age, as a result of which deviations are detected. In addition, with polyhydramnios, excessive pallor of the skin, a decrease in the thickness of the fat layer on the abdomen, and translucent veins are often found.

To assess the cardiac activity of the fetus, CTG (cardiotocography) is mandatory, as well as listening to heart rhythms through the abdominal wall. With polyhydramnios, the heart is not auscultated, or very muffled tones are heard.

Vaginal examination reveals shortening of the cervix, opening of the internal os of the uterus, and a strongly strained fetal bladder is visualized through it.

According to an ultrasound study with Dopplerography, you can definitely determine the volume of amniotic fluid by calculating the amniotic index (normally it is 6-24 cm). Polyhydramnios is diagnosed by an increased amniotic index. Also, by ultrasound and CTG, you can determine what consequences and complications the pathology brought and how it affected the development of the baby.

Detection of polyhydramnios necessarily requires a search for its cause. In this regard, blood tests and smears for STIs are mandatory, blood is taken for Rh antibodies (if the mother has a negative Rh factor). It also requires an examination in terms of kidney function, diabetes mellitus, etc. (according to indications).

Polyhydramnios treatment

If the cause of the pathology is identified, it is eliminated or corrected. Often the culprit is STDs in a chronic form. In this regard, antibiotics are prescribed to eliminate the infection. Antibiotics are selected only from the group allowed during pregnancy (more often - broad-spectrum antibiotics). Tetracyclines, fluoroquinolones are strictly excluded. In most cases, the doctor prescribes antibiotics from the macrolide group, since they have short courses and practically do not harm the fetus (Josamycin, Rovamycin, Azithromycin). If the cause of polyhydramnios was not an STI, but another bacterial infection, antibiotics are also prescribed in a course of 3-6 days. With the development of pyelonephritis or other severe infectious processes, antibiotics can be selected from the group of cephalosporins. Antibacterial therapy causes dysbiotic processes in the intestines, therefore, as soon as the pregnant woman has finished taking antibiotics, dysbacteriosis is treated with probiotics and prebiotics.

Since the exact cause is not always clarified with a pathology such as polyhydramnios, treatment is often carried out according to a universal scheme:

multivitamins (vitamins C, E, gr. B are especially useful);
antibiotics (as indicated above, antibiotics of the macrolide group are prescribed);
diuretics (Furosemide, Lasix, Hypothiazid);
drugs to optimize placental blood flow (Actovegin, Pentoxifylline);
antispasmodics (Papaverine, No-Shpa);
drugs to relax the walls of the uterus (Ginepral).

Since the treatment is carried out only in a hospital, this allows for daily monitoring of the fetal condition using CTG. Every day they also measure the circumference of the pregnant woman, and ultrasound is done at least once a week.

In severe cases, an emergency amniocentesis is performed with pumping out amniotic water in 200 ml. by slowly withdrawing fluid through a catheter under ultrasound guidance. If the treatment of polyhydramnios in pregnant women is effective, the gestation of the fetus is extended to 38 weeks, after which a caesarean section is performed. In many cases, polyhydramnios has a good prognosis and allows a woman to have a baby naturally.

Childbirth with polyhydramnios

In childbirth, amniotic fluid is of great importance, and the fact that a pregnant woman can give birth on her own depends on its volume. If the amount of amniotic fluid is normal, then under their pressure the membranes rupture, contractions intensify, the child is born through the natural birth canal. Childbirth with polyhydramnios can be very complicated. Under pressure, the fetal membranes rupture prematurely, the waters pour out quickly. As a result, the limb of the fetus or the umbilical cord may fall out, which requires an urgent caesarean section. That is why childbirth should be carried out in a planned manner and begin with an amniotomy (opening the bladder) with a slow release of fluid. If the amniotomy is performed with a small opening of the cervix, after such a procedure, further contractions proceed normally.

With severe polyhydramnios, the pregnant woman is in the hospital until the moment when the birth of a viable child is possible. Childbirth is carried out by caesarean section. Also indications for operative delivery are a large fetus or its incorrect position, placental abruption, bleeding, maternal diabetes, twin pregnancy, and others.

Prevention of polyhydramnios

To prevent polyhydramnios, women from risk groups should be identified as early as possible and scheduled preventive drug courses should be carried out. In addition, all infections of the genital area should be treated, hormonal disorders, metabolic pathologies should be corrected.

When polyhydramnios is detected, a woman should rest more, spend as little time as possible on her feet, avoid walking up stairs, eat, drink in small portions, and if any abnormal symptoms develop, immediately contact an obstetrician-gynecologist.