Polyhydramnios

Polyhydramnios is a condition when the amount of amniotic fluid during pregnancy is excessive. Although generally not causing serious problems, this condition requires regular monitoring from a doctor.

Amniotic fluid is the fluid that surrounds the fetus. Its functions include protecting the fetus from pressure outside the uterus, providing space for bone growth, and maintaining a warm temperature for the fetus.

Polyhydramnios is a condition that is rarely experienced by pregnant women. Usually, this condition occurs during the third trimester. However, polyhydramnios can also occur from the second trimester of pregnancy.

Causes of Polyhydramnios

Under normal conditions, the volume of amniotic fluid will increase slowly from the beginning of pregnancy until it reaches a maximum amount (about 800 ml–1 liter) in the 34th to 36th week. After that, the amniotic fluid will slowly decrease as labor approaches.

The volume of amniotic fluid remains stable because the fetus swallows and excretes it as urine. Meanwhile, in polyhydramnios, the balance of amniotic fluid in the uterus is disrupted. Disturbances in the balance of amniotic fluid can occur due to a number of factors, namely:

• Birth defects in the fetus that affect its ability to swallow amniotic fluid, such as abnormalities in the digestive tract or central nervous system of the fetus, and impaired fetal muscle control
• Anemia in the fetus
• Diabetes in the mother, both gestational diabetes and diabetes that existed before pregnancy
• Infection of the fetus during pregnancy, such as toxoplasma or rubella
• Accumulation of fluid in one part of the body of the fetus ( hydrops fetalis )
• Problems with the placenta
• Disturbances in the baby's heartbeat
• Twin to twin transfusion syndrome ( TTTS ) which causes one fetus to receive too much blood from the placenta so that the fluid excreted by the fetus through urine increases and increases the volume of amniotic fluid
• Abnormal chromosomal or genetic conditions, such as Down syndrome , Edward syndrome , achondroplasia , and Beckwith Wiedemann syndrome
• Blood incompatibility between mother and fetus

Symptoms of Polyhydramnios

Polyhydramnios, which is mild and develops gradually, may not cause significant symptoms. However, in some cases, the volume of amniotic fluid can increase very quickly to more than 2 liters.

Meanwhile, severe polyhydramnios can cause the uterus to stretch excessively, pressing against the surrounding organs. Complaints that usually arise include:

• Mother's weight gain more than expected
• Difficulty breathing or shortness of breath
• Heartburn
• snore
• Digestive disorders, such as constipation
• Tension or contraction of the uterus
• Less urination
• Swelling in the lower limbs and genitals which may be accompanied by varicose veins
• Difficulty feeling fetal movement
• Stretch marks on the skin

When to see a doctor

Consult with your obstetrician if you experience complaints as mentioned above. Most of the above symptoms are commonly felt by pregnant women, especially in the third trimester or nearing the time of delivery. However, in women with polyhydramnios, symptoms can be very bothersome or occur earlier.

If you have been diagnosed with polyhydramnios and experience new symptoms or worsening of the previous symptoms, immediately consult a doctor. With early treatment, complications that can arise from polyhydramnios can be prevented.

Seek medical help immediately if:

• Rupture of membranes occurs early
• Bleeding from the vagina for more than 24 hours
• Visual disturbances, such as blurred vision

Diagnosis of Polyhydramnios

To diagnose polyhydramnios, the doctor will conduct a question and answer regarding the symptoms experienced and the drugs that are being used by the mother. After that, the doctor will carry out a physical examination.

Polyhydramnios can generally be detected through routine pregnancy checks, such as measuring the height of the uterus. The doctor will suspect polyhydramnios if the size of the uterus is larger than normal for gestational age. Polyhydramnios can also be suspected if the doctor has difficulty detecting the position or heartbeat of the fetus.

The supporting examination needed to ensure polyhydramnios is an ultrasound examination. Through pregnancy ultrasound , the doctor can find out the approximate amount of amniotic fluid. In addition, the severity of polyhydramnios can also be known through the value of the amniotic fluid index (AFI) on ultrasound. Here is the explanation:

• Mild polyhydramnios, if the AFI value is 24 cm–29.9 cm
• Moderate polyhydramnios, if the AFI value is 30cm–34.9cm
• Severe polyhydramnios, if the AFI value is more than 35cm

Ultrasound can also be done to see the body size of the fetus, the condition of the kidneys and urinary tract of the fetus, as well as blood flow in the fetal kidneys and placenta. This examination can help doctors find out the cause of polyhydramnios.

If the diagnosis of polyhydramnios has been established, the doctor will carry out several further tests to find out the cause of polyhydramnios and monitor the condition of the fetus. Here are some checks that can be done:

• Amniocentesis or the procedure for taking amniotic fluid containing fetal cells, to detect chromosomal abnormalities that can cause abnormalities in the fetal organs and trigger polyhydramnios
• Blood tests, to check for infections or diabetes that are known to cause polyhydramnios
• Nonstress test , to check changes in fetal heart rate when the fetus moves
• Biophysical profile test, to check breathing, muscle condition, and fetal movement using ultrasound

Polyhydramnios Treatment

Mild polyhydramnios will generally heal on its own without special treatment. Patients will usually be advised to rest as much as possible and undergo more routine pregnancy control.

If polyhydramnios occurs due to health problems in the fetus or mother, these disorders need to be addressed first so that polyhydramnios can improve too. This can be done on an outpatient basis.

Treatments that can be given to patients include changing diet and administering medication if the patient is known to have diabetes, as well as administering antibiotics to patients suffering from toxoplasmosis .

Meanwhile, severe polyhydramnios that causes shortness of breath, abdominal pain, or premature labor, needs to be treated at the hospital. Handling steps include:

Administration of indomethacin

Indomethacin can be used to reduce fetal urine output and amniotic fluid volume. However, this drug cannot be given after the 31st week of pregnancy because of the risk of causing heart problems.

The condition of the fetal heart also needs to be monitored while being given this drug. In addition, side effects in pregnant women after consuming indomethacin , such as nausea, vomiting, and heartburn also need to be monitored.

Amniocentesis

If needed, the doctor can remove excess amniotic fluid through amniocentesis. However, this action carries the risk of causing complications, such as placental abruption , premature rupture of membranes, or preterm labor.

Laser ablation

Laser ablation may be used to treat polyhydramnios caused by multiple pregnancies with transfusion syndrome (TTTS) . This procedure is used to partially close the placental vessels that are supplying excess blood to one of the fetuses.

After the patient is treated, the doctor will still monitor the amount of amniotic fluid every 1-3 weeks. Although polyhydramnios can cause anxiety, in general, patients can still give birth to healthy children.

In mild or moderate polyhydramnios, delivery can still be carried out normally and when fetal growth is complete. However, in severe polyhydramnios, delivery may need to be hastened to avoid the risk of complications to the mother and fetus, such as fetal distress .

Early labor can be done by induction or caesarean section . This procedure is also recommended if the patient with polyhydramnios has had contractions before the 37th week of pregnancy or premature rupture of membranes.

Polyhydramnios Complications

Complications of pregnancy and childbirth that can arise due to polyhydramnios, in the form of:

• Premature birth
• Baby is growing too big
• The waters broke early
• Placental abruption
• The umbilical cord that comes out precedes the baby in labor
• Fetal death in the womb ( stillbirth )
• Post partum bleeding

Prevention of Polyhydramnios

Polyhydramnios is difficult to prevent. However, there are several things that can be done to reduce the risk of this condition occurring, namely:

• Do not smoke
• Eat a nutritious diet, which includes fruits, vegetables, low-fat dairy products, lean meats and nuts
• Take prenatal vitamins, such as folic acid , as directed by your doctor
• Control existing conditions or diseases, such as diabetes