Polyhydraminos

Causes and risk factors

Physiologically the amniotic fluid increases as the gestation progress. It is maximum800-1000ml by 34-37weeks.The baby swallows the amniotic fluid and is expelled in the urine. Again the baby swallows the fluid; this cycle goes on thus maintaining the normal amount. The amniotic fluid inhaled by the baby is essential for the normal development of the lungs. The baby swallows the amniotic fluid and is expelled in the urine. The exact cause of this excessive amount of amniotic fluid still remain unkown.In most of the cases the exact cause becomes difficult to be diagnosed. However it has been postulated that either there might be an excessive production of amniotic fluid or the absorption is less. Certain fetal and maternal reasons can predispose polyhydrminos. If the mother is suffering from diabetes, any cardiac or renal diseases it increases the chances of polyhydraminos. It is commonly seen during twin pregnancy and in mother having rhesus diseases. Fetal causes also contribute to the causation; a few among them are genetic abnormality in the fetus, gut atresia in baby, open spina bifida, facial clefts or neck masses etc. It is more common in multipara women.

Clinical presentation:

Depending upon the onset of complaints they are classifies as acute and chronic. Acute polyhydraminos is more commonly seen during 20 weeks of pregnancy. Chronic polyhydraminos is more common than the acute one. The presenting symptoms of both the types is different. The most diagnostic feature of polyhydraminos is when the abdominal girth is large as compared to the date of pregnancy. It becomes to palpate the baby and identity its parts. It becomes difficult for the patient to breathe leading to dyspnoe. The complaint is aggravated in lying position and is ameliorated while sitting. Edema on legs along with varicosity can be seen. These symptoms are seen in chronic variety. In acute polyhydraminos along with the above mentioned complaints the patient suffers from nausea, vomiting and patient becomes severely ill. Pain in abdomen occurs. Polyhydraminos can lead to certain maternal and fetal complications. It can cause pre eclampsia, premature rupture of membrane, hemorrhages, cord prolapsed etc. In cases of fetus the chances of mortality increases.

Investigations:

Diagnosis is done of the basis of the symptoms narrated by the patient and the routine examination carried out by the gynecologist help in confirming the diagnosis. Abdominal or transvaginal ultrasonography is the diagnostic investigation. Blood test for ABO and Rh typing is done. Along with this the amniotic fluid is also examined.

Treatment:

If the mother is suffering from any diseases, Treatment of the underlying disease is the main line of treatment. Treatment plan depends upon the degree of polyhydraminos. In cases of minor polyhdraminos usually no treatment is required; the excess amount diminishes as the pregnancy advances. In major degree of polyhydraminos, the patient is hospitalized and supportive therapy is started. Medications are given to relief the complaints, if the pregnancy is less than 37 weeks then amniocentesis is done to relief the complaints and continue to the pregnancy. Whereas in cases where the pregnancy is more than 37 weeks labor is induced. In cases where the complications persist, termination of pregnancy needs to be done.

Other modes of treatment:

The other modes of treatment can also be effective in treating the complaints. Homoeopathy is a science which deals with individualization considers a person in a holistic way. This science can be helpful in combating the symptoms. Similarly the Ayurvedic system of medicine which uses herbal medicines and synthetic derivates are also found to be effective in combating the sufferings.