Polyhydramnios is an abnormal excess of amniotic fluid volume (AFV) during pregnancy.
It signifies a high-risk obstetric situation with elevated perinatal and maternal morbidity and mortality because of a greater occurrence of fetal death inside the uterus, early labor, premature rupture of membranes, cord slipping, oversized fetus, breech presentation, surgical delivery, and postpartum bleeding.
In pregnancies impacted by polyhydramnios, around 20% are caused by a congenital abnormality.
Oligohydramnios is defined as reduced amniotic fluid volume (AFV) for gestational age.
The quantity of amniotic fluid fluctuates over gestation, escalating consistently until 34 to 36 weeks gestation, at which juncture the AFV levels off and remains stable until term.
The AFV then initiates a gradual decline after 40 weeks gestation, resulting in diminished quantity in post-term gestations. This sequence enables clinical evaluation of AFV throughout pregnancy utilizing fundal height measurements and ultrasound assessment.
Epidemiology
Prevalence: Polyhydramnios is estimated to occur in approximately 1-2% of pregnancies.
It is frequently recognized coincidentally in the asymptomatic patient during sonographic assessment for other ailments in the final trimester.
Idiopathic excessive amniotic fluid is frequently a condition that resolves on its own, but, in rare cases, a reason for elevated AFV may be found after birth.
Maternal diabetes is one of the most common underlying causes of polyhydramnios and is seen in about 8-12% of cases. The fetal anomalies contribute to polyhydramnios in around 10-25% of cases, with gastrointestinal and neurological abnormalities being common.
Polyhydramnios is more frequently observed in pregnancies with twins or other multiples. The incidence is higher in these cases, ranging from
Prevalence: Oligohydramnios affects approximately 4-8% of pregnancies.
The incidence of oligohydramnios increases as pregnancy advances beyond the expected due date. It is more commonly seen in post-term pregnancies.
Oligohydramnios can occur in pregnant individuals with chronic hypertension, preeclampsia, or chronic kidney disease, but the exact prevalence in these cases is variable.
Anatomy
Pathophysiology
Certain fetal abnormalities can disrupt the normal balance of amniotic fluid production and absorption. The gastrointestinal or neurological defects may impair the fetus’s ability to swallow and absorb the amniotic fluid, leading to its accumulation.
Fluid absorption primarily takes place via fetal swallowing. It is approximated that the fetus generates 500 to 1200 ml of urine and consumes 210 to 760 ml of amniotic fluid daily.
Bartter syndrome is a rare autosomal recessive disorder that impacts the functioning of the fetal renal tubules and leads to sodium depletion and excessive urination, which consequently causes significant excess amniotic fluid.
In twin-twin transfusion syndrome, there exists a donor and recipient fetus. In this situation, the placenta induces an uneven distribution of fluid between the twins, resulting in the recipient twin being overwhelmed with volume and generating a higher amount of urine.
When the amniotic sac ruptures before the onset of labor, the amniotic fluid leaks or is lost, leading to oligohydramnios.
Insufficient blood flow to the placenta can reduce fetal urine production, resulting in low amniotic fluid levels.
Structural abnormalities or functional issues in the fetal kidneys or urinary tract can result in reduced urine production, leading to oligohydramnios.
Etiology
The primary reason for polyhydramnios is unknown. The most frequent fetal origin of polyhydramnios is a problem with the fetus’s ability to swallow, resulting in the inability to absorb amniotic fluid.
In monochorionic diamniotic twin pregnancies, twin-twin transfusion syndrome is an uncommon but severe factor for polyhydramnios in the twin receiving the fluid.
When the amniotic sac ruptures before the onset of labor, it can lead to the leakage or loss of amniotic fluid, causing oligohydramnios.
The amount of amniotic fluid in the pregnancy sac is a consequence of an equilibrium between fluid generation and fluid exit from the sac.
During the initial 20 weeks, lung secretions, in addition to hydrostatic and osmotic transfer of maternal plasma through the fetal membranes, constitute most amniotic fluid generation.
Genetics
Prognostic Factors
The prognosis for both the mother and the fetus worsens as the severity of polyhydramnios increases. Most cases of idiopathic polyhydramnios are temporary and typically resolve on their own without any medical intervention.
The chances of complications rise as the uterus becomes overly distended. These complications may include difficulty breathing for the mother, going into labor prematurely, the amniotic sac rupturing too soon, the baby being in a breech position, the umbilical cord slipping out of the birth canal, excessive bleeding after childbirth, the baby being larger than average due to maternal diabetes, high blood pressure disorders, and infections in the urinary tract.
The treatment and prediction of low amniotic fluid levels differ significantly depending on the root cause, the time of diagnosis during pregnancy, and the severity of the oligohydramnios.
Identifying low amniotic fluid levels in the second trimester is more commonly linked to abnormalities in the fetus or mother, whereas identification in the third trimester is more commonly unexplained.
Out of the fetuses diagnosed in the second trimester, only 10.2% survived, whereas the survival rate was 85.3% for those diagnosed in the third trimester.
Clinical History
Age Group:Â Â
Polyhydramnios and oligohydramnios can occur across various age groups of pregnant individuals. These conditions are not limited to a specific age range but can affect individuals of reproductive age, including teenagers, women in their 20s and 30s, and older women.
Polyhydramnios and oligohydramnios can occur in pregnant teenagers. Teenagers may have a higher risk of certain causes of polyhydramnios, like inadequate prenatal care or increased rates of certain medical conditions.
Advanced maternal age, typically defined as 35 years or older at the time of pregnancy, is associated with a higher risk of certain complications during pregnancy.
Associated Comorbidity or Activity:Â Â
Fetal Anomalies: Certain fetal abnormalities, such as gastrointestinal obstructions, central nervous system abnormalities, or chromosomal abnormalities, can be associated with polyhydramnios. These abnormalities may disrupt fetal swallowing or urine production, leading to an imbalance in amniotic fluid levels.
Maternal Diabetes: Uncontrolled diabetes in the mother can lead to polyhydramnios due to increased fetal urine production. Poorly controlled blood sugar levels can affect the fetal kidneys’ ability to reabsorb amniotic fluid, resulting in excess fluid accumulation.
Placental Dysfunction: Placental insufficiency or abnormalities can result in reduced blood flow to the fetal kidneys, leading to decreased urine production and subsequent oligohydramnios.
Premature Rupture of Membranes (PROM): If the amniotic sac ruptures before the onset of labor, it can lead to oligohydramnios. The loss of amniotic fluid can result in decreased fluid volume.
Physical Examination
Age group
Associated comorbidity
In many cases, polyhydramnios develops gradually over time, and the symptoms may not be immediately apparent. Pregnant individuals may notice an increase in abdominal size or experience discomfort due to the enlarged uterus.
Severe polyhydramnios can lead to respiratory symptoms in the pregnant individual, such as shortness of breath or difficulty breathing, especially when lying down. This occurs due to the compression of the diaphragm by the enlarged uterus.
Oligohydramnios can develop gradually over time or occur suddenly, depending on the underlying cause. In some cases, it may be identified during routine ultrasound examinations.
Severe oligohydramnios can increase the risk of fetal complications, such as fetal growth restriction, umbilical cord compression, or fetal distress. These may present with decreased fetal heart rate variability or abnormalities on fetal monitoring.
Associated activity
Acuity of presentation
In many cases, polyhydramnios develops gradually over time, and the symptoms may not be immediately apparent. Pregnant individuals may notice an increase in abdominal size or experience discomfort due to the enlarged uterus.
Severe polyhydramnios can lead to respiratory symptoms in the pregnant individual, such as shortness of breath or difficulty breathing, especially when lying down. This occurs due to the compression of the diaphragm by the enlarged uterus.
Oligohydramnios can develop gradually over time or occur suddenly, depending on the underlying cause. In some cases, it may be identified during routine ultrasound examinations.
Severe oligohydramnios can increase the risk of fetal complications, such as fetal growth restriction, umbilical cord compression, or fetal distress. These may present with decreased fetal heart rate variability or abnormalities on fetal monitoring.
Symmetrical Enlargement: The abdominal enlargement in polyhydramnios is usually symmetrical, meaning that the enlargement is consistent throughout the abdomen.
Small-Gestational-Age/Height: Oligohydramnios can lead to reduced fundal height, which is measured during prenatal visits. The size of the uterus may be smaller than expected for the gestational age.
Lack of Abdominal Distension: Oligohydramnios is associated with a decreased amount of amniotic fluid, which can result in reduced abdominal distension compared to the expected size for gestational age.
Differential Diagnoses
Maternal Diabetes: Uncontrolled maternal diabetes can lead to fetal hyperglycemia and subsequent polyuria, resulting in polyhydramnios.
Fetal Anomalies: Certain fetal abnormalities, such as gastrointestinal obstructions, neural tube defects, or chromosomal abnormalities can cause polyhydramnios.
Placental Chorioangioma: A placental tumor known as chorioangioma can stimulate excessive fetal blood flow, leading to increased urine production and polyhydramnios.
Maternal Hydrops: Maternal conditions such as maternal heart failure or renal disease can cause fluid overload, resulting in polyhydramnios.
Twin-to-Twin Transfusion Syndrome (TTTS): In pregnancies with monochorionic twins, imbalanced blood flow between the twins can result in polyhydramnios in one twin and oligohydramnios in the other.
Fetal Renal Abnormalities: Fetal renal anomalies, such as renal agenesis, renal dysplasia, or urinary tract obstruction, can lead to reduced urine production and subsequent oligohydramnios.
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
The specific treatment approach will depend on the severity of Polyhydramnios and Oligohydramnios, gestational age, the presence of associated conditions, and individual circumstances.
Identification and Evaluation: Polyhydramnios is typically diagnosed through ultrasound examination, which measures amniotic fluid index (AFI) or deepest vertical pocket (DVP).
Relief and Monitoring: Depending on the severity of symptoms or associated complications, measures may be taken to provide symptomatic relief and monitor the pregnancy closely.
Amnioinfusion: In severe cases of oligohydramnios where there is a risk to the fetus, amnioinfusion may be considered. This procedure involves infusing a sterile fluid into the amniotic cavity to increase the amniotic fluid volume temporarily.
Maternal Hydration: Adequate maternal hydration is important for maintaining amniotic fluid volume. Ensuring the mother is properly hydrated can support amniotic fluid production.
Fetal Surveillance: Regular fetal monitoring is essential to assess fetal well-being. This may involve non-stress tests, biophysical profiles, or Doppler studies to evaluate fetal heart rate, movements, breathing, and blood flow.
Modification of the environment or lifestyle changes can play a supportive role in managing certain aspects of polyhydramnios (excessive amniotic fluid) and oligohydramnios (insufficient amniotic fluid).
Maternal positioning: Modifying the maternal positioning can provide some relief from the discomfort caused by excessive abdominal distension. Suggesting positions that promote better comfort, such as lying on the side or elevating the upper body during sleep, can be helpful.
Sufficient Hydration: Adequate hydration is essential during pregnancy. It’s important for pregnant individuals with oligohydramnios to maintain appropriate hydration levels by drinking an adequate amount of water.
abdomen and provide more comfort for individuals with polyhydramnios.
Physical Activities: Engaging in gentle physical activity, such as walking or prenatal yoga, can promote circulation, reduce edema, and improve overall well-being.
Rest and Relaxation: Prioritizing rest and reducing stress levels can promote overall well-being and indirectly support fetal health. Practicing relaxation techniques, such as deep breathing exercises.
Use of nonsteroidal anti-inflammatory (NSAID) for treatment of Polyhydramnios
The medications such as indomethacin, which is a nonsteroidal anti-inflammatory drug (NSAID), have been used to decrease amniotic fluid volume in cases of polyhydramnios.
Indomethacin: It works by reducing fetal urine production and thus decreasing amniotic fluid levels. for patients under 32 weeks who are having amnioreduction because to significant stomach pain or shortness of breath and who are also experiencing periprocedural uterine contractions. To benefit from both of indomethacin’s tocolytic and therapeutic properties, provide a brief course for 48 hours before the procedure or after.
Use of isotonic solution for treatment of Polyhydramnios
Isotonic sodium chloride: Some patients may benefit from receiving isotonic sodium chloride solution throughout the second trimester. Transabdominal amnioinfusion of 400 to 600 ml may enhance ultrasonographic visualisation and boost the amount of amniotic fluid.
Role of Amnioinfusion for treatment of Oligohydramnios Specialty- Obstetrician, Perinatologist
In cases of severe oligohydramnios where there is a risk to the fetus, amnioinfusion may be performed. This procedure involves infusing a sterile fluid such as normal saline into the amniotic cavity to increase the amniotic fluid volume temporarily.
Amnioinfusion can provide cushioning for the umbilical cord and improve fetal well-being during labor or delivery.
Administration of Betamethasone: In cases where polyhydramnios is associated with fetal lung immaturity or potential preterm delivery, the administration of betamethasone to the pregnant individual can be considered. Betamethasone helps accelerate fetal lung maturation, reducing the risk of respiratory distress syndrome in the newborn.
Timing of delivery: Depending on the severity of oligohydramnios and fetal well-being, the timing of delivery may need to be carefully considered. In some cases, early delivery may be recommended to mitigate risks associated with oligohydramnios.
Initial Diagnosis and Evaluation: The initial phase involves the diagnosis and evaluation of polyhydramnios or oligohydramnios. This includes a thorough medical history, physical examination, and diagnostic tests such as ultrasound to assess the amniotic fluid volume and determine the underlying cause of the condition.
Management and Treatment: In this phase focuses on addressing the underlying cause, managing symptoms, and preventing complications. The management approach will depend on the specific condition and its severity.
Follow-up and supportive care: After delivery, appropriate postnatal care and follow-up are essential for both the mother and baby. This includes monitoring the baby’s health, assessing for any long-term consequences of the amniotic fluid abnormalities.
»
Home » CAD » Polyhydramnios and Oligohydramnios
Polyhydramnios and Oligohydramnios
Updated :
February 16, 2024
Polyhydramnios is an abnormal excess of amniotic fluid volume (AFV) during pregnancy.
It signifies a high-risk obstetric situation with elevated perinatal and maternal morbidity and mortality because of a greater occurrence of fetal death inside the uterus, early labor, premature rupture of membranes, cord slipping, oversized fetus, breech presentation, surgical delivery, and postpartum bleeding.
In pregnancies impacted by polyhydramnios, around 20% are caused by a congenital abnormality.
Oligohydramnios is defined as reduced amniotic fluid volume (AFV) for gestational age.
The quantity of amniotic fluid fluctuates over gestation, escalating consistently until 34 to 36 weeks gestation, at which juncture the AFV levels off and remains stable until term.
The AFV then initiates a gradual decline after 40 weeks gestation, resulting in diminished quantity in post-term gestations. This sequence enables clinical evaluation of AFV throughout pregnancy utilizing fundal height measurements and ultrasound assessment.
Prevalence: Polyhydramnios is estimated to occur in approximately 1-2% of pregnancies.
It is frequently recognized coincidentally in the asymptomatic patient during sonographic assessment for other ailments in the final trimester.
Idiopathic excessive amniotic fluid is frequently a condition that resolves on its own, but, in rare cases, a reason for elevated AFV may be found after birth.
Maternal diabetes is one of the most common underlying causes of polyhydramnios and is seen in about 8-12% of cases. The fetal anomalies contribute to polyhydramnios in around 10-25% of cases, with gastrointestinal and neurological abnormalities being common.
Polyhydramnios is more frequently observed in pregnancies with twins or other multiples. The incidence is higher in these cases, ranging from
Prevalence: Oligohydramnios affects approximately 4-8% of pregnancies.
The incidence of oligohydramnios increases as pregnancy advances beyond the expected due date. It is more commonly seen in post-term pregnancies.
Oligohydramnios can occur in pregnant individuals with chronic hypertension, preeclampsia, or chronic kidney disease, but the exact prevalence in these cases is variable.
Certain fetal abnormalities can disrupt the normal balance of amniotic fluid production and absorption. The gastrointestinal or neurological defects may impair the fetus’s ability to swallow and absorb the amniotic fluid, leading to its accumulation.
Fluid absorption primarily takes place via fetal swallowing. It is approximated that the fetus generates 500 to 1200 ml of urine and consumes 210 to 760 ml of amniotic fluid daily.
Bartter syndrome is a rare autosomal recessive disorder that impacts the functioning of the fetal renal tubules and leads to sodium depletion and excessive urination, which consequently causes significant excess amniotic fluid.
In twin-twin transfusion syndrome, there exists a donor and recipient fetus. In this situation, the placenta induces an uneven distribution of fluid between the twins, resulting in the recipient twin being overwhelmed with volume and generating a higher amount of urine.
When the amniotic sac ruptures before the onset of labor, the amniotic fluid leaks or is lost, leading to oligohydramnios.
Insufficient blood flow to the placenta can reduce fetal urine production, resulting in low amniotic fluid levels.
Structural abnormalities or functional issues in the fetal kidneys or urinary tract can result in reduced urine production, leading to oligohydramnios.
The primary reason for polyhydramnios is unknown. The most frequent fetal origin of polyhydramnios is a problem with the fetus’s ability to swallow, resulting in the inability to absorb amniotic fluid.
In monochorionic diamniotic twin pregnancies, twin-twin transfusion syndrome is an uncommon but severe factor for polyhydramnios in the twin receiving the fluid.
When the amniotic sac ruptures before the onset of labor, it can lead to the leakage or loss of amniotic fluid, causing oligohydramnios.
The amount of amniotic fluid in the pregnancy sac is a consequence of an equilibrium between fluid generation and fluid exit from the sac.
During the initial 20 weeks, lung secretions, in addition to hydrostatic and osmotic transfer of maternal plasma through the fetal membranes, constitute most amniotic fluid generation.
The prognosis for both the mother and the fetus worsens as the severity of polyhydramnios increases. Most cases of idiopathic polyhydramnios are temporary and typically resolve on their own without any medical intervention.
The chances of complications rise as the uterus becomes overly distended. These complications may include difficulty breathing for the mother, going into labor prematurely, the amniotic sac rupturing too soon, the baby being in a breech position, the umbilical cord slipping out of the birth canal, excessive bleeding after childbirth, the baby being larger than average due to maternal diabetes, high blood pressure disorders, and infections in the urinary tract.
The treatment and prediction of low amniotic fluid levels differ significantly depending on the root cause, the time of diagnosis during pregnancy, and the severity of the oligohydramnios.
Identifying low amniotic fluid levels in the second trimester is more commonly linked to abnormalities in the fetus or mother, whereas identification in the third trimester is more commonly unexplained.
Out of the fetuses diagnosed in the second trimester, only 10.2% survived, whereas the survival rate was 85.3% for those diagnosed in the third trimester.
Age Group:Â Â
Polyhydramnios and oligohydramnios can occur across various age groups of pregnant individuals. These conditions are not limited to a specific age range but can affect individuals of reproductive age, including teenagers, women in their 20s and 30s, and older women.
Polyhydramnios and oligohydramnios can occur in pregnant teenagers. Teenagers may have a higher risk of certain causes of polyhydramnios, like inadequate prenatal care or increased rates of certain medical conditions.
Advanced maternal age, typically defined as 35 years or older at the time of pregnancy, is associated with a higher risk of certain complications during pregnancy.
Associated Comorbidity or Activity:Â Â
Fetal Anomalies: Certain fetal abnormalities, such as gastrointestinal obstructions, central nervous system abnormalities, or chromosomal abnormalities, can be associated with polyhydramnios. These abnormalities may disrupt fetal swallowing or urine production, leading to an imbalance in amniotic fluid levels.
Maternal Diabetes: Uncontrolled diabetes in the mother can lead to polyhydramnios due to increased fetal urine production. Poorly controlled blood sugar levels can affect the fetal kidneys’ ability to reabsorb amniotic fluid, resulting in excess fluid accumulation.
Placental Dysfunction: Placental insufficiency or abnormalities can result in reduced blood flow to the fetal kidneys, leading to decreased urine production and subsequent oligohydramnios.
Premature Rupture of Membranes (PROM): If the amniotic sac ruptures before the onset of labor, it can lead to oligohydramnios. The loss of amniotic fluid can result in decreased fluid volume.
In many cases, polyhydramnios develops gradually over time, and the symptoms may not be immediately apparent. Pregnant individuals may notice an increase in abdominal size or experience discomfort due to the enlarged uterus.
Severe polyhydramnios can lead to respiratory symptoms in the pregnant individual, such as shortness of breath or difficulty breathing, especially when lying down. This occurs due to the compression of the diaphragm by the enlarged uterus.
Oligohydramnios can develop gradually over time or occur suddenly, depending on the underlying cause. In some cases, it may be identified during routine ultrasound examinations.
Severe oligohydramnios can increase the risk of fetal complications, such as fetal growth restriction, umbilical cord compression, or fetal distress. These may present with decreased fetal heart rate variability or abnormalities on fetal monitoring.
In many cases, polyhydramnios develops gradually over time, and the symptoms may not be immediately apparent. Pregnant individuals may notice an increase in abdominal size or experience discomfort due to the enlarged uterus.
Severe polyhydramnios can lead to respiratory symptoms in the pregnant individual, such as shortness of breath or difficulty breathing, especially when lying down. This occurs due to the compression of the diaphragm by the enlarged uterus.
Oligohydramnios can develop gradually over time or occur suddenly, depending on the underlying cause. In some cases, it may be identified during routine ultrasound examinations.
Severe oligohydramnios can increase the risk of fetal complications, such as fetal growth restriction, umbilical cord compression, or fetal distress. These may present with decreased fetal heart rate variability or abnormalities on fetal monitoring.
Symmetrical Enlargement: The abdominal enlargement in polyhydramnios is usually symmetrical, meaning that the enlargement is consistent throughout the abdomen.
Small-Gestational-Age/Height: Oligohydramnios can lead to reduced fundal height, which is measured during prenatal visits. The size of the uterus may be smaller than expected for the gestational age.
Lack of Abdominal Distension: Oligohydramnios is associated with a decreased amount of amniotic fluid, which can result in reduced abdominal distension compared to the expected size for gestational age.
Maternal Diabetes: Uncontrolled maternal diabetes can lead to fetal hyperglycemia and subsequent polyuria, resulting in polyhydramnios.
Fetal Anomalies: Certain fetal abnormalities, such as gastrointestinal obstructions, neural tube defects, or chromosomal abnormalities can cause polyhydramnios.
Placental Chorioangioma: A placental tumor known as chorioangioma can stimulate excessive fetal blood flow, leading to increased urine production and polyhydramnios.
Maternal Hydrops: Maternal conditions such as maternal heart failure or renal disease can cause fluid overload, resulting in polyhydramnios.
Twin-to-Twin Transfusion Syndrome (TTTS): In pregnancies with monochorionic twins, imbalanced blood flow between the twins can result in polyhydramnios in one twin and oligohydramnios in the other.
Fetal Renal Abnormalities: Fetal renal anomalies, such as renal agenesis, renal dysplasia, or urinary tract obstruction, can lead to reduced urine production and subsequent oligohydramnios.
The specific treatment approach will depend on the severity of Polyhydramnios and Oligohydramnios, gestational age, the presence of associated conditions, and individual circumstances.
Identification and Evaluation: Polyhydramnios is typically diagnosed through ultrasound examination, which measures amniotic fluid index (AFI) or deepest vertical pocket (DVP).
Relief and Monitoring: Depending on the severity of symptoms or associated complications, measures may be taken to provide symptomatic relief and monitor the pregnancy closely.
Amnioinfusion: In severe cases of oligohydramnios where there is a risk to the fetus, amnioinfusion may be considered. This procedure involves infusing a sterile fluid into the amniotic cavity to increase the amniotic fluid volume temporarily.
Maternal Hydration: Adequate maternal hydration is important for maintaining amniotic fluid volume. Ensuring the mother is properly hydrated can support amniotic fluid production.
Fetal Surveillance: Regular fetal monitoring is essential to assess fetal well-being. This may involve non-stress tests, biophysical profiles, or Doppler studies to evaluate fetal heart rate, movements, breathing, and blood flow.
OB/GYN and Women\'s Health
Modification of the environment or lifestyle changes can play a supportive role in managing certain aspects of polyhydramnios (excessive amniotic fluid) and oligohydramnios (insufficient amniotic fluid).
Maternal positioning: Modifying the maternal positioning can provide some relief from the discomfort caused by excessive abdominal distension. Suggesting positions that promote better comfort, such as lying on the side or elevating the upper body during sleep, can be helpful.
Sufficient Hydration: Adequate hydration is essential during pregnancy. It’s important for pregnant individuals with oligohydramnios to maintain appropriate hydration levels by drinking an adequate amount of water.
abdomen and provide more comfort for individuals with polyhydramnios.
Physical Activities: Engaging in gentle physical activity, such as walking or prenatal yoga, can promote circulation, reduce edema, and improve overall well-being.
Rest and Relaxation: Prioritizing rest and reducing stress levels can promote overall well-being and indirectly support fetal health. Practicing relaxation techniques, such as deep breathing exercises.
Other Clinical
The medications such as indomethacin, which is a nonsteroidal anti-inflammatory drug (NSAID), have been used to decrease amniotic fluid volume in cases of polyhydramnios.
Indomethacin: It works by reducing fetal urine production and thus decreasing amniotic fluid levels. for patients under 32 weeks who are having amnioreduction because to significant stomach pain or shortness of breath and who are also experiencing periprocedural uterine contractions. To benefit from both of indomethacin’s tocolytic and therapeutic properties, provide a brief course for 48 hours before the procedure or after.
Other Clinical
Isotonic sodium chloride: Some patients may benefit from receiving isotonic sodium chloride solution throughout the second trimester. Transabdominal amnioinfusion of 400 to 600 ml may enhance ultrasonographic visualisation and boost the amount of amniotic fluid.
Other Clinical
In cases of severe oligohydramnios where there is a risk to the fetus, amnioinfusion may be performed. This procedure involves infusing a sterile fluid such as normal saline into the amniotic cavity to increase the amniotic fluid volume temporarily.
Amnioinfusion can provide cushioning for the umbilical cord and improve fetal well-being during labor or delivery.
OB/GYN and Women\'s Health
Administration of Betamethasone: In cases where polyhydramnios is associated with fetal lung immaturity or potential preterm delivery, the administration of betamethasone to the pregnant individual can be considered. Betamethasone helps accelerate fetal lung maturation, reducing the risk of respiratory distress syndrome in the newborn.
Timing of delivery: Depending on the severity of oligohydramnios and fetal well-being, the timing of delivery may need to be carefully considered. In some cases, early delivery may be recommended to mitigate risks associated with oligohydramnios.
OB/GYN and Women\'s Health
Initial Diagnosis and Evaluation: The initial phase involves the diagnosis and evaluation of polyhydramnios or oligohydramnios. This includes a thorough medical history, physical examination, and diagnostic tests such as ultrasound to assess the amniotic fluid volume and determine the underlying cause of the condition.
Management and Treatment: In this phase focuses on addressing the underlying cause, managing symptoms, and preventing complications. The management approach will depend on the specific condition and its severity.
Follow-up and supportive care: After delivery, appropriate postnatal care and follow-up are essential for both the mother and baby. This includes monitoring the baby’s health, assessing for any long-term consequences of the amniotic fluid abnormalities.
Polyhydramnios is an abnormal excess of amniotic fluid volume (AFV) during pregnancy.
It signifies a high-risk obstetric situation with elevated perinatal and maternal morbidity and mortality because of a greater occurrence of fetal death inside the uterus, early labor, premature rupture of membranes, cord slipping, oversized fetus, breech presentation, surgical delivery, and postpartum bleeding.
In pregnancies impacted by polyhydramnios, around 20% are caused by a congenital abnormality.
Oligohydramnios is defined as reduced amniotic fluid volume (AFV) for gestational age.
The quantity of amniotic fluid fluctuates over gestation, escalating consistently until 34 to 36 weeks gestation, at which juncture the AFV levels off and remains stable until term.
The AFV then initiates a gradual decline after 40 weeks gestation, resulting in diminished quantity in post-term gestations. This sequence enables clinical evaluation of AFV throughout pregnancy utilizing fundal height measurements and ultrasound assessment.
Prevalence: Polyhydramnios is estimated to occur in approximately 1-2% of pregnancies.
It is frequently recognized coincidentally in the asymptomatic patient during sonographic assessment for other ailments in the final trimester.
Idiopathic excessive amniotic fluid is frequently a condition that resolves on its own, but, in rare cases, a reason for elevated AFV may be found after birth.
Maternal diabetes is one of the most common underlying causes of polyhydramnios and is seen in about 8-12% of cases. The fetal anomalies contribute to polyhydramnios in around 10-25% of cases, with gastrointestinal and neurological abnormalities being common.
Polyhydramnios is more frequently observed in pregnancies with twins or other multiples. The incidence is higher in these cases, ranging from
Prevalence: Oligohydramnios affects approximately 4-8% of pregnancies.
The incidence of oligohydramnios increases as pregnancy advances beyond the expected due date. It is more commonly seen in post-term pregnancies.
Oligohydramnios can occur in pregnant individuals with chronic hypertension, preeclampsia, or chronic kidney disease, but the exact prevalence in these cases is variable.
Certain fetal abnormalities can disrupt the normal balance of amniotic fluid production and absorption. The gastrointestinal or neurological defects may impair the fetus’s ability to swallow and absorb the amniotic fluid, leading to its accumulation.
Fluid absorption primarily takes place via fetal swallowing. It is approximated that the fetus generates 500 to 1200 ml of urine and consumes 210 to 760 ml of amniotic fluid daily.
Bartter syndrome is a rare autosomal recessive disorder that impacts the functioning of the fetal renal tubules and leads to sodium depletion and excessive urination, which consequently causes significant excess amniotic fluid.
In twin-twin transfusion syndrome, there exists a donor and recipient fetus. In this situation, the placenta induces an uneven distribution of fluid between the twins, resulting in the recipient twin being overwhelmed with volume and generating a higher amount of urine.
When the amniotic sac ruptures before the onset of labor, the amniotic fluid leaks or is lost, leading to oligohydramnios.
Insufficient blood flow to the placenta can reduce fetal urine production, resulting in low amniotic fluid levels.
Structural abnormalities or functional issues in the fetal kidneys or urinary tract can result in reduced urine production, leading to oligohydramnios.
The primary reason for polyhydramnios is unknown. The most frequent fetal origin of polyhydramnios is a problem with the fetus’s ability to swallow, resulting in the inability to absorb amniotic fluid.
In monochorionic diamniotic twin pregnancies, twin-twin transfusion syndrome is an uncommon but severe factor for polyhydramnios in the twin receiving the fluid.
When the amniotic sac ruptures before the onset of labor, it can lead to the leakage or loss of amniotic fluid, causing oligohydramnios.
The amount of amniotic fluid in the pregnancy sac is a consequence of an equilibrium between fluid generation and fluid exit from the sac.
During the initial 20 weeks, lung secretions, in addition to hydrostatic and osmotic transfer of maternal plasma through the fetal membranes, constitute most amniotic fluid generation.
The prognosis for both the mother and the fetus worsens as the severity of polyhydramnios increases. Most cases of idiopathic polyhydramnios are temporary and typically resolve on their own without any medical intervention.
The chances of complications rise as the uterus becomes overly distended. These complications may include difficulty breathing for the mother, going into labor prematurely, the amniotic sac rupturing too soon, the baby being in a breech position, the umbilical cord slipping out of the birth canal, excessive bleeding after childbirth, the baby being larger than average due to maternal diabetes, high blood pressure disorders, and infections in the urinary tract.
The treatment and prediction of low amniotic fluid levels differ significantly depending on the root cause, the time of diagnosis during pregnancy, and the severity of the oligohydramnios.
Identifying low amniotic fluid levels in the second trimester is more commonly linked to abnormalities in the fetus or mother, whereas identification in the third trimester is more commonly unexplained.
Out of the fetuses diagnosed in the second trimester, only 10.2% survived, whereas the survival rate was 85.3% for those diagnosed in the third trimester.
Age Group:Â Â
Polyhydramnios and oligohydramnios can occur across various age groups of pregnant individuals. These conditions are not limited to a specific age range but can affect individuals of reproductive age, including teenagers, women in their 20s and 30s, and older women.
Polyhydramnios and oligohydramnios can occur in pregnant teenagers. Teenagers may have a higher risk of certain causes of polyhydramnios, like inadequate prenatal care or increased rates of certain medical conditions.
Advanced maternal age, typically defined as 35 years or older at the time of pregnancy, is associated with a higher risk of certain complications during pregnancy.
Associated Comorbidity or Activity:Â Â
Fetal Anomalies: Certain fetal abnormalities, such as gastrointestinal obstructions, central nervous system abnormalities, or chromosomal abnormalities, can be associated with polyhydramnios. These abnormalities may disrupt fetal swallowing or urine production, leading to an imbalance in amniotic fluid levels.
Maternal Diabetes: Uncontrolled diabetes in the mother can lead to polyhydramnios due to increased fetal urine production. Poorly controlled blood sugar levels can affect the fetal kidneys’ ability to reabsorb amniotic fluid, resulting in excess fluid accumulation.
Placental Dysfunction: Placental insufficiency or abnormalities can result in reduced blood flow to the fetal kidneys, leading to decreased urine production and subsequent oligohydramnios.
Premature Rupture of Membranes (PROM): If the amniotic sac ruptures before the onset of labor, it can lead to oligohydramnios. The loss of amniotic fluid can result in decreased fluid volume.
In many cases, polyhydramnios develops gradually over time, and the symptoms may not be immediately apparent. Pregnant individuals may notice an increase in abdominal size or experience discomfort due to the enlarged uterus.
Severe polyhydramnios can lead to respiratory symptoms in the pregnant individual, such as shortness of breath or difficulty breathing, especially when lying down. This occurs due to the compression of the diaphragm by the enlarged uterus.
Oligohydramnios can develop gradually over time or occur suddenly, depending on the underlying cause. In some cases, it may be identified during routine ultrasound examinations.
Severe oligohydramnios can increase the risk of fetal complications, such as fetal growth restriction, umbilical cord compression, or fetal distress. These may present with decreased fetal heart rate variability or abnormalities on fetal monitoring.
In many cases, polyhydramnios develops gradually over time, and the symptoms may not be immediately apparent. Pregnant individuals may notice an increase in abdominal size or experience discomfort due to the enlarged uterus.
Severe polyhydramnios can lead to respiratory symptoms in the pregnant individual, such as shortness of breath or difficulty breathing, especially when lying down. This occurs due to the compression of the diaphragm by the enlarged uterus.
Oligohydramnios can develop gradually over time or occur suddenly, depending on the underlying cause. In some cases, it may be identified during routine ultrasound examinations.
Severe oligohydramnios can increase the risk of fetal complications, such as fetal growth restriction, umbilical cord compression, or fetal distress. These may present with decreased fetal heart rate variability or abnormalities on fetal monitoring.
Symmetrical Enlargement: The abdominal enlargement in polyhydramnios is usually symmetrical, meaning that the enlargement is consistent throughout the abdomen.
Small-Gestational-Age/Height: Oligohydramnios can lead to reduced fundal height, which is measured during prenatal visits. The size of the uterus may be smaller than expected for the gestational age.
Lack of Abdominal Distension: Oligohydramnios is associated with a decreased amount of amniotic fluid, which can result in reduced abdominal distension compared to the expected size for gestational age.
Maternal Diabetes: Uncontrolled maternal diabetes can lead to fetal hyperglycemia and subsequent polyuria, resulting in polyhydramnios.
Fetal Anomalies: Certain fetal abnormalities, such as gastrointestinal obstructions, neural tube defects, or chromosomal abnormalities can cause polyhydramnios.
Placental Chorioangioma: A placental tumor known as chorioangioma can stimulate excessive fetal blood flow, leading to increased urine production and polyhydramnios.
Maternal Hydrops: Maternal conditions such as maternal heart failure or renal disease can cause fluid overload, resulting in polyhydramnios.
Twin-to-Twin Transfusion Syndrome (TTTS): In pregnancies with monochorionic twins, imbalanced blood flow between the twins can result in polyhydramnios in one twin and oligohydramnios in the other.
Fetal Renal Abnormalities: Fetal renal anomalies, such as renal agenesis, renal dysplasia, or urinary tract obstruction, can lead to reduced urine production and subsequent oligohydramnios.
The specific treatment approach will depend on the severity of Polyhydramnios and Oligohydramnios, gestational age, the presence of associated conditions, and individual circumstances.
Identification and Evaluation: Polyhydramnios is typically diagnosed through ultrasound examination, which measures amniotic fluid index (AFI) or deepest vertical pocket (DVP).
Relief and Monitoring: Depending on the severity of symptoms or associated complications, measures may be taken to provide symptomatic relief and monitor the pregnancy closely.
Amnioinfusion: In severe cases of oligohydramnios where there is a risk to the fetus, amnioinfusion may be considered. This procedure involves infusing a sterile fluid into the amniotic cavity to increase the amniotic fluid volume temporarily.
Maternal Hydration: Adequate maternal hydration is important for maintaining amniotic fluid volume. Ensuring the mother is properly hydrated can support amniotic fluid production.
Fetal Surveillance: Regular fetal monitoring is essential to assess fetal well-being. This may involve non-stress tests, biophysical profiles, or Doppler studies to evaluate fetal heart rate, movements, breathing, and blood flow.
OB/GYN and Women\'s Health
Modification of the environment or lifestyle changes can play a supportive role in managing certain aspects of polyhydramnios (excessive amniotic fluid) and oligohydramnios (insufficient amniotic fluid).
Maternal positioning: Modifying the maternal positioning can provide some relief from the discomfort caused by excessive abdominal distension. Suggesting positions that promote better comfort, such as lying on the side or elevating the upper body during sleep, can be helpful.
Sufficient Hydration: Adequate hydration is essential during pregnancy. It’s important for pregnant individuals with oligohydramnios to maintain appropriate hydration levels by drinking an adequate amount of water.
abdomen and provide more comfort for individuals with polyhydramnios.
Physical Activities: Engaging in gentle physical activity, such as walking or prenatal yoga, can promote circulation, reduce edema, and improve overall well-being.
Rest and Relaxation: Prioritizing rest and reducing stress levels can promote overall well-being and indirectly support fetal health. Practicing relaxation techniques, such as deep breathing exercises.
Other Clinical
The medications such as indomethacin, which is a nonsteroidal anti-inflammatory drug (NSAID), have been used to decrease amniotic fluid volume in cases of polyhydramnios.
Indomethacin: It works by reducing fetal urine production and thus decreasing amniotic fluid levels. for patients under 32 weeks who are having amnioreduction because to significant stomach pain or shortness of breath and who are also experiencing periprocedural uterine contractions. To benefit from both of indomethacin’s tocolytic and therapeutic properties, provide a brief course for 48 hours before the procedure or after.
Other Clinical
Isotonic sodium chloride: Some patients may benefit from receiving isotonic sodium chloride solution throughout the second trimester. Transabdominal amnioinfusion of 400 to 600 ml may enhance ultrasonographic visualisation and boost the amount of amniotic fluid.
Other Clinical
In cases of severe oligohydramnios where there is a risk to the fetus, amnioinfusion may be performed. This procedure involves infusing a sterile fluid such as normal saline into the amniotic cavity to increase the amniotic fluid volume temporarily.
Amnioinfusion can provide cushioning for the umbilical cord and improve fetal well-being during labor or delivery.
OB/GYN and Women\'s Health
Administration of Betamethasone: In cases where polyhydramnios is associated with fetal lung immaturity or potential preterm delivery, the administration of betamethasone to the pregnant individual can be considered. Betamethasone helps accelerate fetal lung maturation, reducing the risk of respiratory distress syndrome in the newborn.
Timing of delivery: Depending on the severity of oligohydramnios and fetal well-being, the timing of delivery may need to be carefully considered. In some cases, early delivery may be recommended to mitigate risks associated with oligohydramnios.
OB/GYN and Women\'s Health
Initial Diagnosis and Evaluation: The initial phase involves the diagnosis and evaluation of polyhydramnios or oligohydramnios. This includes a thorough medical history, physical examination, and diagnostic tests such as ultrasound to assess the amniotic fluid volume and determine the underlying cause of the condition.
Management and Treatment: In this phase focuses on addressing the underlying cause, managing symptoms, and preventing complications. The management approach will depend on the specific condition and its severity.
Follow-up and supportive care: After delivery, appropriate postnatal care and follow-up are essential for both the mother and baby. This includes monitoring the baby’s health, assessing for any long-term consequences of the amniotic fluid abnormalities.
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