Why is there polyhydramnios in pregnant women. What threatens polyhydramnios at different stages of pregnancy, treatment of pathology. Moderate polyhydramnios causes and treatment

It is said that a pregnant woman is like a crystal vessel with a goldfish swimming inside.

This comparison is not accidental. The future little man in the mother's womb, almost from the very moment of conception until the birth, is in a safe environment, the creation of which was taken care of by an amazing female body.

We are talking about amniotic fluid or amniotic fluid. However, the deviation of the amount of amniotic fluid from the norm is already an unsafe phenomenon for the condition of the expectant mother and the baby to be born.

Visually, the liquid in which the embryo is located before childbirth resembles ordinary water, especially in the early stages of pregnancy, the same transparent or slightly cloudy.

However, for the fetus, this is truly “living water”, which plays a significant role in ensuring its vital activity and normal development, as well as for the successful course of pregnancy.

The fluid produced by the amnion (the fetal membrane facing the fetus) is needed to:

Supplying the future baby with nutrients (proteins, fats, carbohydrates, vitamins, minerals), immunoglobulins, molecules that regulate metabolic processes, oxygen, hormones and other biologically active substances.

The baby swallows about a tablespoon of amniotic fluid every hour, and until the end of the second trimester, he absorbs part of the nutrient fluid through the skin.

creation and maintenance of a comfortable environment for the fetus: constant temperature and pressure, mitigation of external noise, etc.;
protection against external mechanical influences - shock absorption, shock, etc.;
creating a barrier against the penetration of infections, thanks to the immunoglobulins in the composition.

The composition of the amniotic fluid changes with the development of the fetus. In the very first weeks of pregnancy, the amniotic fluid is close in composition to the maternal blood plasma, as the fetus develops, particles of its skin, waste products, etc. enter the fetal water. The amniotic fluid is updated, on average, 8 times a day.

The volume of amniotic fluid also changes with the course of pregnancy, and its growth occurs at an unstable pace and ends by the 36-38th week of pregnancy, there may even be a slight decrease in the volume of amniotic fluid immediately before childbirth, and this is considered one of the signs of an early delivery.

The quantitative and qualitative characteristics of the amniotic fluid are important for diagnostic information about the well-being of the development of the unborn child and the pregnancy itself, therefore, from the second half of the gestation period, the observing doctors monitor the changes in these indicators.

What does polyhydramnios mean during pregnancy?

Polyhydramnios is a pathology of pregnancy that has a “speaking” name, meaning that the volume of fluid in the fetal bladder exceeds normal values for a given gestational age.

Doctors diagnose "polyhydramnios" in the case when the volume of amniotic fluid in the last weeks of pregnancy is more than 2000 ml.

Polyhydramnios is diagnosed in about 1% of all pregnant women, this pathology is considered a fairly common occurrence and by no means harmless.

It can have very negative consequences for the health of the future parent, the fetus, the course of both the gestational period and labor, and cause problems with the health of the newborn child.

With polyhydramnios, a woman must be prescribed treatment, as a rule, in a hospital for constant medical supervision.

Childbirth with polyhydramnios requires special tactics on the part of the medical staff.

Causes

The development of polyhydramnios always provokes some kind of ill-being on the part of the health of the mother or fetus. The most common causes of this pathology are:

aggravated medical history of the mother, such as:
infectious diseases (viral and bacterial) transferred or after the conception of a child;
inflammatory processes of the genitourinary system;
cardiovascular diseases, etc.
complications during the current pregnancy:
maternal and fetal blood;
intrauterine diseases of the fetus:
intrauterine infection;
serious deviations in the development of vital organs and systems of the fetus (often incompatible with life);
violations of the amnion itself (very rarely - chorionangioma).

Often the causes of polyhydramnios are not found, but this condition is always considered a pathology of pregnancy and requires medical intervention.

Consequences: what threatens polyhydramnios for the fetus?

Excessive amniotic fluid can seriously complicate pregnancy and even lead to the death of the fetus or baby.

Depending on the severity and severity, polyhydramnios can have consequences for the child, such as:

, including due to uterine bleeding;
preeclampsia;
intrauterine infection of the fetus, all the more likely if the cause of polyhydramnios is an infection;
premature rupture of amniotic fluid, which, with polyhydramnios, is dangerous by the loss of parts of the child's body, umbilical loops;
entanglement of the fetus with the umbilical cord, especially dangerous in childbirth;
, due to the above reasons, which can cause serious abnormalities in the development of the fetus and neonatal death;
presentation of the fetus, in which it may be impossible to carry out natural childbirth (oblique, transverse, etc.);
weakness of the uterus in labor due to overstretching;
poor contractility of the distended uterus in the postpartum period, etc.

Types of polyhydramnios during pregnancy

To determine the nature of the disease, its severity, the danger to the health of the fetus and mother, polyhydramnios is classified according to the following criteria:

depending on the causes and manifestations:
borderline - the amniotic fluid index tends or is at the upper mark of the norm, but did not overcome it;
relative (moderate polyhydramnios) - the amniotic fluid index is at the upper mark of the norm or has slightly overcome it, but no threatening reasons have been identified.

Moderate polyhydramnios does not pose a serious threat to pregnancy. At the same time, the amount of amniotic fluid remains at the same level or slightly increases.

Such a condition can occur when carrying a large, giant fetus, multiple pregnancy and requires monitoring in dynamics.

idiopathic - polyhydramnios, the causes of which could not be established;
expressed - it is easily visualized: the woman's stomach becomes huge, the woman herself complains of pain in the lower back, notes the increased activity of the fetus. IAI significantly exceeds the norm.
depending on the severity of the disease:
mild - the volume of amniotic fluid during a full-term pregnancy exceeds 2000 ml, but is within 3000 ml;
medium - the volume of amniotic fluid during full-term pregnancy exceeds 3000 ml, but is within 5000 ml;
severe - the volume of amniotic fluid during a full-term pregnancy exceeds 5000 ml.
depending on clinical manifestations:
chronic - an increase in the volume of amniotic fluid occurs gradually, as a rule, develops in the last stages of pregnancy;
acute - an increase in the volume of amniotic fluid occurs rapidly, within a few hours, in most cases it develops in the early stages of pregnancy.

Symptoms and signs

The development of this pathology during pregnancy in a future mother can be predicted from the second period. A woman can recognize polyhydramnios by unpleasant symptoms.

Often, the accumulation of excess amniotic fluid in the fetal bladder is accompanied by a deterioration in the well-being of the expectant mother:

sensations of constant heaviness in the abdomen;
lethargy, fatigue;
shortness of breath, shortness of breath;
increased heart rate;
the appearance of stretch marks, a pronounced venous pattern on the abdomen, etc.

The most pronounced sign of polyhydramnios is gurgling in the abdomen when bending over due to the large amount of fluid.

In some cases, polyhydramnios develops asymptomatically. Therefore, the expectant mother should not neglect regular visits to the observing obstetrician.

How to diagnose polyhydramnios

At each scheduled appointment with a doctor during pregnancy, a woman undergoes the procedure for the necessary measurements. Including . The change in these indicators ahead of the age of the fetus and their inconsistency with their norms, and, coupled with this, also increased uterine tone and excessive activity of the fetus, with poor listening to its heartbeat, help the obstetrician visually suspect an excess amount of amniotic fluid in the uterus of his patient.

These signs serve as a reason for an ultrasound of a woman in order to diagnose polyhydramnios. During the examination of the patient on an ultrasound device, the specialist clarifies the correspondence of the volume of amniotic fluid to the gestational age, the estimated weight of the unborn child and calculates the amniotic fluid index (amniotic fluid index).

To calculate the woman's belly in the area of the protruding uterus, mentally divide it into four sections, perpendicular to each other, passing through the woman's navel, in each of which the greatest depth of the “pocket” between the fetus and the fetal membrane is measured.

The sum of all four values \u200b\u200bis the IAI, for which there are norms and permissible deviations according to the gestational age.

If the diagnosis of "polyhydramnios" was confirmed by ultrasound, then it is necessary to determine the cause of the pathology.

In this case, an expert ultrasound is indicated to exclude congenital malformations of the fetus and assess its general condition. As a rule, at the same time, during ultrasound, blood flow indicators in the mother-placenta-fetus system are also evaluated with the help of, and the fetal heart rate is also monitored using a cardiotachograph.

With special indications, a woman is offered, both for diagnosing the condition of the fetus, and as a technique for dealing with polyhydramnios.

In addition, to establish the causes of polyhydramnios on the maternal side, a woman is prescribed a referral for laboratory examinations:

blood analysis:
to identify possible antibodies to fetal antigens (with a negative Rh factor of the mother's blood);
to detect TORCH infections;
to determine the presence of immune cells that appeared in the blood in response to the attack of pathogens of infectious, viral, microbial diseases (serological blood test);
to determine the level of sugar in the blood (if diabetes is suspected).
analysis of vaginal secretion for the purity of microflora, to detect urogenital infections.

Treatment

Polyhydramnios in a pregnant woman certainly requires therapeutic measures in relation to the patient.

Fight against root causes.

To combat diseases - the causes of an abnormal amount of amniotic fluid, if any - or bring them into remission.

For example, with the infectious nature of polyhydramnios, as well as with idiopathic polyhydramnios, they are treated with broad-spectrum antibiotics (with the exception of tetracycline groups) not only for the expectant mother, but also for the fetus, injecting drugs into the amniotic fluid.

With diabetes, a woman is prescribed a strict diet and drugs that maintain a stable blood sugar level, carbohydrate metabolism. With hypertension - drugs that stabilize blood pressure, etc.

Fight against hypoxia.

To prevent the development of oxygen starvation of the fetus. For this, drugs are used that improve blood flow in the vessels of the uterus, placenta and prevent the formation of blood clots ("", "Trental", etc.);

for removal and prevention: tocolytics ("Ginipral", "Partusisten", "Indomethacin", which also has an anti-inflammatory effect, etc.) and antispasmodics (no-shpu,);
to normalize glucose and oxygen metabolism, improve uteroplacental blood flow, Actovegin is prescribed;
to maintain the immunity of a pregnant woman;
to reduce the amount of amniotic fluid - taking light diuretics, sometimes taking part of the water using amniocentesis.

In the acute course of polyhydramnios or chronic polyhydramnios that has reached a severe form, the treatment may be to stimulate preterm labor or terminate the pregnancy, depending on the age of the fetus.

Depending on the severity of polyhydramnios and its manifestations, a woman may be shown delivery through a "caesarean section".

Natural labor activity in a pregnant woman with polyhydramnios is often associated with complications, so the management of childbirth should take place in compliance with special techniques:

with polyhydramnios, a gentle amniotomy is used - a lateral puncture of the fetal bladder, above the cervix. At the same time, the doctor manually controls the rate of outflow of water in order to avoid falling out of parts of the child's body, loops of his umbilical cord;
if there is a rupture of the amniotic sac, the doctor's hand should be in the vagina, protecting the arms and legs of the child and the loop of the umbilical cord from falling out;
if during labor activity it became necessary to stimulate it (for example, with oxytocin), then it should be started no earlier than 2 hours after the outflow of water, to prevent premature detachment of the placenta;
often during childbirth (from the second period) drugs are used that improve the contractility of the uterus.

Infants born after pregnancy with severe, acute polyhydramnios, often immediately after birth, need resuscitation, and then special observation by neonatologists.

Personal experience
As such, I was diagnosed with moderate polyhydramnios during my second pregnancy at 32 weeks. The causes of this pathology were not entirely clear. Since I did not have STDs: I underwent a full examination at the stage of pregnancy planning.

I also did not suffer from serious inflammatory diseases. Although at the time of pregnancy, my first daughter entered the kindergarten and was often sick. Well, I kept picking it up from her. In general, during pregnancy I had ARVI 5 times. Perhaps this fact influenced the amount of water. By the way, polyhydramnios can be noticed independently. When bending over, you can hear gurgling in the stomach.

The child was normal. Therefore, the question of hospitalization was not raised. I was put on placenta maintenance therapy and a multivitamin. I drank Curantil for a month - 3 times a day. I went to the antenatal clinic for injections. They did glucose. Then they did a follow-up ultrasound. The amount of water was the same. Doppler is good, CTG is normal, there are no developmental delays. Basically just watching. The only thing the doctor at the maternity hospital said was that she would most likely have to give birth ahead of schedule, because the uterus is too stretched due to polyhydramnios.

As a result, in childbirth, it will be poorly reduced. Therefore, she appointed me to come for an examination at 39 weeks, in order to definitely decide and see the condition of the fetus. But at 38 weeks I already arrived at the hospital with contractions. There was really a lot of water (they pierced the bladder and lowered the amniotic fluid), but the birth was easy and fast.

Xenia, 35.

Prevention

Since in most cases the causes of polyhydramnios remain unknown, it is difficult to say with certainty which measures can be taken to exclude the development of this pathology during pregnancy.

However, it is reliably known that certain diseases are risk factors for polyhydramnios. Therefore, for the prevention of pregnancy complicated by polyhydramnios, the expectant mother should take the following measures:

bring chronic diseases into remission before pregnancy, especially such as diabetes mellitus, hypertension and during the prenatal period maintain stabilization of the condition with the help of drugs;
get rid of infectious diseases, especially of a urogenital nature;
take vitamin and mineral complexes for pregnant women;
regularly visit an obstetrician-gynecologist leading the pregnancy and follow all medical prescriptions, take tests in a timely manner.

Unfortunately, it is impossible to completely insure against the development of polyhydramnios during pregnancy. However, for the timely detection of this pathology and successful treatment, the expectant mother should take the supervision of medical specialists in the early stages of pregnancy.

And when preparing for conception, lead a healthy lifestyle and do not forget that the main purpose of a woman is motherhood.

Amniotic fluid is the first living environment of every person. The well-being of a woman and the development of the fetus, the features of labor activity depend on their number and composition.

The volume of amniotic fluid increases every week as the baby grows. In some women, the amount of water does not correspond to the norm.

Both polyhydramnios and oligohydramnios during pregnancy can bring various unpleasant surprises to the expectant mother, so such a deviation cannot be ignored.

Polyhydramnios during pregnancy: what does it mean

Polyhydramnios during pregnancy is an excess of the volume of amniotic fluid in the amniotic sac. The role of amniotic fluid in the development of the child is enormous: maintaining the body in space, ensuring freedom of movement, a source of nutrients, protection from damage and infections. But their number should always correspond to the norm.

During an ultrasound examination, the doctor determines the amniotic fluid index (AFI) - an indicator of the amount of amniotic fluid, and compares it with the table.

When determining the IAI, the sonologist visually divides the cavity of the amniotic sac into 4 equal parts and in each determines the space that is filled with water and does not contain parts of the baby's body (vertical pocket). If the largest pocket has a depth of 2 cm or less, oligohydramnios is diagnosed; if the depth is more than 8 cm, polyhydramnios is diagnosed.

Gynecologists distinguish different forms of polyhydramnios:

1 Relative polyhydramnios- a slight deviation from the norm at this time, usually associated with the bearing of a large fetus, and in the absence of other pathologies, it can be safe for the woman and the fetus.

2 border state, or a tendency to polyhydramnios during pregnancy - a case when the amount of water reaches the upper limit of the norm, and it is possible that in the future their excess may appear.

Due to polyhydramnios, a woman may not develop labor activity, so in the last weeks she should be under the supervision of doctors, and if necessary, she is done.

Polyhydramnios during pregnancy: treatment

How to treat polyhydramnios during pregnancy depends on the cause of the disorder. If amniotic fluids accumulate due to a woman's illness, appropriate therapy is needed.

In severe cases, with a sharp deterioration in the mother's condition, it is necessary to terminate the pregnancy in order to save the woman's life. If the situation is not so critical, the pregnant woman will simply have to spend some time in the hospital and undergo a course of treatment to save the baby.

These signs familiar to pregnant women may indicate a dangerous pathology -.

The entire period of its stay in the womb, the baby swims in the amniotic fluid. These waters are its source of nutrition and protection from various mechanical damage and infections.

During pregnancy, amniotic fluid is renewed, and at the same time, their quantity changes, which may indicate pathologies in the process of bearing a child.

The volume of water should be equal to 30 ml. This figure will increase to 100 ml. And at 37 - up to 1-1.5 liters. If the water turns out to be from 1.5-2 liters, then doctors talk about polyhydramnios.

REASONS FOR THE POLYGODOM

The course of this disease can be acute and chronic. In the first case, there is a lot of water so quickly that the child either dies in the womb, because placental insufficiency or premature detachment of the placenta occurs, or is born with significant malformations.

If a woman has chronic polyhydramnios, then the amount of water increases gradually and the doctor monitors the course of pregnancy.

In almost 30% of cases, doctors cannot determine the cause of polyhydramnios, but experts identify the main factors that can cause such complications.

Causes of polyhydramnios:

too large fetus or multiple pregnancy;
transferred infections, ARVI, acute respiratory infections;
chronic kidney and cardiovascular diseases;
intrauterine infections of the mother, for example, chlamydia, mycoplasmosis, etc.
fetal malformations;
Rhesus conflict in mother and child.

To accurately diagnose, a pregnant woman will have an ultrasound scan. In addition, the gynecologist can also conduct a vaginal examination, which will help determine the tension of the fetal bladder.

WHAT IS POLYHYDRAULIC

Polyhydramnios can provoke serious complications, and if it is not cured in time, you can earn placental insufficiency, preeclampsia, chronic hypoxia of the baby, and even cause premature birth.

A large amount of fluid allows the baby to swim and somersault in the womb, instead of getting into the correct position before birth. Such freedom can turn into an umbilical cord around the neck for a little one, as well as before going out into the world.

Threats with polyhydramnios:

urinary tract infections;
incorrect position of the fetus in the uterine cavity, which requires a caesarean section;
increased blood pressure;
premature;
pathological growth of the fetus;
premature rupture of the fetal bladder with the outflow of amniotic fluid;
prolapse of the umbilical cord;
stillborn children;
high risk of postpartum hemorrhage against the background of weak uterine contractility;
in a baby, polyhydramnios can cause malformations in the development of the central nervous system and the gastrointestinal tract.

TREATMENT OF POLYGONY

As soon as the fact of polyhydramnios is proven, the pregnant woman will be prescribed treatment. Usually these are drugs that improve microcirculation, uteroplacental blood flow and metabolic processes.

Future mothers are constantly monitored by doctors. Antibiotic therapy is carried out so as not to lead to fetal hypoxia.

Treatment is prescribed based on the disease or the reasons for which it arose. Although, practice shows that in more than half of the cases, the causes of polyhydramnios cannot be established.

Content

For the normal development of the child inside the womb, the value of amniotic fluid is invaluable. They protect the embryo from mechanical stress, participate in metabolism, and provide it with freedom of movement. Amniotic fluid is constantly moving and renewing. However, polyhydramnios during pregnancy is very dangerous, because it is the cause of many diseases in both the woman and the unborn child.

What is polyhydramnios during pregnancy

This is a condition in which a pregnant woman has a large increase in the amount of amniotic fluid. In medicine, there is a classification of polyhydramnios. It should be noted that not always an increase in amniotic fluid is a pathology. Sometimes the term "moderate polyhydramnios" is characterized only by approaching the highest norm, but not exceeding the permissible limit. At different times, the rate of amniotic fluid varies. For example, at 10 weeks of pregnancy, the normal volume is 30 ml, at 14 - 100 ml, and by the 38th week, 1.5 liters will be the norm.

When this limit is exceeded, then we are already talking about polyhydramnios in a pregnant woman. There is a certain classification. The increase in amniotic fluid can be mild, acute, or chronic. The most dangerous condition during pregnancy is acute, when the water level begins to rise very intensively, within a few days or even hours. Chronic polyhydramnios is characterized by a slow increase in fluid volume.

signs

There are certain signs, the presence of which will tell a woman about the presence of pathology. But not always a pregnant woman can diagnose herself. In the chronic course of polyhydramnios, a woman often learns about the pathology only during the next examination by a doctor. In acute pathology, it is easy to notice that the abdomen grows very quickly. Its circumference at the level of the navel sometimes exceeds 120 cm.

A pregnant woman complains of the rapid appearance of stretch marks, fatigue, heaviness when walking, shortness of breath. It is advisable to pay attention to unusual symptoms in order to maintain pregnancy:

gurgling inside the abdomen;
reduced activity of the child;
severe swelling of the legs;
feeling of pressure on the perineum;
increased heart rate;
malaise, weakness.

Acute

Excessive fluid accumulation can be diagnosed immediately. A sharp increase in the abdomen cannot go unnoticed, because the condition develops over a very short time. A pregnant woman experiences discomfort in the abdomen, pain in the lumbar region and inguinal region. The abdominal wall noticeably swells, there is a strong shortness of breath. The woman does not hear the movement of the fetus, and listening to his heartbeat is very difficult. The rapid development of pathology may be accompanied by rupture of uterine tissues.

Chronic

In the case of chronic development of the disease, the growth of amniotic fluid occurs slowly. More often, doctors observe such polyhydramnios at the end of pregnancy. Excess fluid of a chronic nature does not have strongly pronounced symptoms. Pregnant women have time to get used to a certain discomfort, associating it with their position, so the diagnosis of pathology is difficult. For this reason, the chronic form of polyhydramnios is no less dangerous than the acute form and entails very unpleasant consequences for both the mother and the baby.

Causes

Doctors still cannot point out the causes of polyhydramnios during pregnancy with 100% certainty and name specific prerequisites for the development of pathology. However, there are some trends in the occurrence of this disease. The risk group includes pregnant women diagnosed with diabetes mellitus. Next on the list are chronic diseases of the genitourinary system, infections, vascular diseases, and heart defects. High risk of polyhydramnios in a patient with Rh-conflict pregnancy. The reason for the deviation may be too large a fetus or its pathology:

deviations in the development of the intestine or stomach;
malformations of the heart;
defects of the central nervous system;
genetic abnormalities.

Forms, types and degrees

As already noted, polyhydramnios in a pregnant woman can be chronic or acute. Pass moderately or develop rapidly. By severity, obstetric pathology is divided into:

light, when the amount of water does not exceed 3000 ml;
moderate, in which the amniotic fluid has volumes from 3000 to 5000 ml;
severe if the amniotic fluid exceeds the volume of 5000 ml.

There are several more basic gradations of polyhydramnios: relative, borderline, idiopathic and pronounced. The first does not pose a danger to the woman and the fetus. Borderline polyhydramnios is also considered normal, but it already requires constant medical supervision. Idiopathic excess of water has no characteristic signs and causes, it develops at any time.

What is dangerous

The main danger of polyhydramnios in pregnant women is the threat of miscarriage. This is how the pathology ends in 35% of women. In most cases, pregnant women have severe toxicosis at any time, which often turns into vomiting, which threatens with dehydration. A large amount of water interferes with the correct presentation of the fetus, so the incorrect position of the child is often observed: pelvic or transverse. The risk of placental insufficiency is not excluded when the work of the placenta is disturbed. The fetus develops oxygen starvation, which harms its full development.

Diagnostics

In addition to studying the complaints of a pregnant woman, the antenatal clinic doctor examines her for the presence of relevant signs. There are several types of diagnosis of polyhydramnios. The most reliable is ultrasound, in which a woman is assigned to determine the amniotic fluid index (AFI). An additional examination method is a triple test to determine the concentration in blood serum (16-18 weeks of pregnancy) of free estriol, human chorionic gonadotropin and α-fetoprotein. Analyzes show possible fetal malformations, often found in polyhydramnios.

Today, there are two methods for measuring amniotic fluid. The first is called the "gold standard". To do this, the uterine cavity is divided into 4 quadrants, in each of which the doctor determines the depth of the largest pocket of amniotic fluid, free from all parts of the embryo. IAI is the sum of all four values. If the result is below 5%, then a diagnosis of oligohydramnios is made. When the values exceed 97.5%, then this is characterized by polyhydramnios.

IAH

The second option is to determine the largest pocket of fluid that is free from umbilical cord loops and small parts of the fetus, measured in 2 perpendicular planes. The norm is a value from 2 to 8 centimeters. If the result shows 1-2 cm, then this is considered a borderline condition. Polyhydramnios is defined as when the largest pocket of fluid is larger than 8 cm.

Treatment

When a disease such as polyhydramnios occurs during pregnancy, the gynecologist, if possible, should establish its cause and, based on this, prescribe appropriate therapy. A pregnant woman receives classical treatment in a hospital under the strict supervision of doctors. They try to keep the pregnancy to the last. As a rule, antibiotics, B vitamins, drugs that restore uteroplacental blood flow and improve metabolic processes, as well as drugs that improve blood microcirculation and diuretics are prescribed.

If polyhydramnios occurs early in pregnancy, then it is treated without consequences for the fetus and mother. With a sudden and acute course of the disease, doctors often resort to the procedure for opening the fetal bladder (amniotomy) to drain excess amniotic fluid. Otherwise, there is a threat not only to pregnancy complications, but also to the life of the mother and / or child.

Antibiotics

Since the etiology of the disease is very difficult to identify, a gynecologist with polyhydramnios must be very careful in choosing antibiotics. In acute pathology, the doctor often prescribes treatment with Rovamycin or analogues. There are data on therapy with Indomethacin (every 6 hours, 25 mg), but it should be remembered that there is a high probability of premature closure of the ductus arteriosus in the fetus.

Consequences

Polyhydramnios negatively affects the health of the mother and the development of the fetus. If the problem is not eliminated in time, an increase in the amount of amniotic fluid threatens with the following consequences:

the uterus, enlarged due to an excess of fluid, compresses large and small blood vessels for a long period, which provokes an increase in blood pressure and edema in the mother;
the uterus with polyhydramnios is greatly stretched, which can provoke massive bleeding and placental abruption;
childbirth against the background of polyhydramnios in 30% of cases occurs ahead of schedule, because due to the large accumulation of fluid, the uterus increases to the size of a full-term pregnancy;
leaving the uterus prematurely, the amniotic fluid can pull out the handle, leg or umbilical cord;
early outflow of amniotic fluid weakens labor activity, sometimes to a complete cessation.

For a child

In addition to the complications listed above, polyhydramnios also negatively affects the future baby in the mother's womb. The development of placental insufficiency at an early stage leads to poor development of the embryo, and at a later stage to fetal growth retardation. Doctors call the following negative consequences for the child:

intrauterine infectious process;
malformations of the gastrointestinal tract;
insufficient formation of the nervous system;
chronic fetal hypoxia;
decreased immunity;
birth prematurely.

These pathologies can be latent, and appear only some time after birth. For example, polyhydramnios in the last stages of pregnancy in an infant can cause a delay in mental and mental development, which pediatricians determine after 1-1.5 years. The birth of a baby prematurely threatens with a low level of body defenses and is fraught with the development of respiratory and infection with infectious diseases.

childbirth

As already mentioned, labor activity occurs ahead of schedule with polyhydramnios. At the last stage of pregnancy, a dense bubble can burst suddenly, after which the amniotic fluid pours out profusely and abruptly. At this point, the limb of the fetus or the umbilical cord may fall out, and the woman's labor activity will be weakened. Sometimes a pregnant woman does not feel contractions at all. With polyhydramnios, childbirth is associated with other complications:

the unfortunate position of the child inside the womb (for example, down the buttocks);
severe bleeding after childbirth;
placental abruption.

Prevention

Can polyhydramnios be avoided? Prevention of pathology consists in regular examination of a woman during pregnancy. This will allow to identify and quickly eliminate the pathology. Pregnant women at risk, that is, women with a diagnosis of diabetes mellitus, the presence of a negative Rh blood factor and with chronic diseases of the genital organs, are especially in need of an additional examination.

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Polyhydramnios is a pathological condition, which is expressed in the form of excessive accumulation of amniotic fluid in the uterus during pregnancy.

The volume of amniotic fluid or amniotic fluid during pregnancy changes, for example, in the tenth week their amount should not exceed 30 ml, in the fourteenth - 100 ml, and in the last trimester the volume of amniotic fluid varies within 1000-1500 ml. If these norms are exceeded in terms of the amount of amniotic fluid, polyhydramnios occurs during pregnancy.

In medical practice, acute and chronic polyhydramnios occur, it all depends on the severity. For example, with a mild degree of polyhydramnios, the excess fluid in the uterus is insignificant, but if the volume of water is significantly higher than normal, we are talking about severe polyhydramnios.

Pregnant women diagnosed with polyhydramnios are recommended to be under continuous medical supervision in order to prevent the development of serious complications. If, with this diagnosis, a woman did not have circulatory and respiratory disorders, specialists until the last try to keep the pregnancy until the natural process of delivery, otherwise it is resolved prematurely, since it poses a threat to the woman's life.

Treatment of this pathology is carried out taking into account the severity of the condition of the expectant mother. If such an anomaly in a pregnant woman is not very pronounced, then it can disappear on its own and without the intervention of doctors.

In the treatment of severe and acute polyhydramnios, an amniotomy (or opening of the amniotic sac) is often prescribed to drain excess amniotic fluid.

Symptoms of polyhydramnios.
Symptoms of the manifestation of such a pathology of pregnancy can be very different, due primarily to the pressure of the enlarged uterus on nearby organs. For example, in acute polyhydramnios, the cases of which are quite rare, and which occur mainly in the early stages of bearing a child, there is a rapid increase in the volume of amniotic fluid, heaviness appears in the abdomen and its rapid increase in size. At the same time, the expectant mother may experience pain in the lower back and perineum of an acute nature, swelling of the lower extremities, vulva and abdominal wall, shortness of breath or difficulty breathing, decreased urination. In addition, a pregnant woman has an increase in blood pressure, and, in addition, it is difficult to listen to the fetal heartbeat and feel it with your fingers.

Chronic polyhydramnios in most cases manifests itself in the third trimester of pregnancy. I must say that the symptoms in this case are less pronounced than with an acute degree of polyhydramnios: the size of the abdomen increases gradually, allowing the woman to adapt to them. However, it is worth noting that in this option there are various diseases of the mother during pregnancy. These include diabetes mellitus, bacterial or infectious diseases transferred by the expectant mother, kidney and cardiovascular diseases.

Causes of polyhydramnios.
It often happens that the causes of polyhydramnios remain unclear. But the most common causes of this condition are:

congenital pathologies in the development of the fetus that affect the development of the gastrointestinal tract, kidney or heart, the central nervous system of the child;
deviations in a child of a chromosomal nature;
pregnancy with identical twins, during which one fetus has polyhydramnios and the other has oligohydramnios;
diabetes mellitus, pyelonephritis, metabolic disorders and body fluids;
diseases of the cardiovascular system;
fetal anemia;
Rh-conflict of the blood of the mother and child (the mother has a negative Rh factor, and the father has a positive one);
infections (rubella, cytomegalovirus);
bacterial or infectious diseases suffered by a pregnant woman before conception or during pregnancy;
placental tumor.

Complications of polyhydramnios:

urinary tract infections;
incorrect position of the fetus in the uterine cavity, which requires a caesarean section;
increased blood pressure;
pathological growth of the fetus;
premature rupture of the fetal bladder with the outflow of amniotic fluid;
prolapse of the umbilical cord;
premature birth;
premature exfoliation of the placenta;
stillborn children;
high risk of postpartum hemorrhage against the background of weak uterine contractility.

The earlier polyhydramnios develops, the higher the level of fluid accumulated in the uterus, and the higher the likelihood of complications.

Diagnosis of polyhydramnios.
Diagnosis of this pathological condition during pregnancy is carried out on the basis of the woman's complaints. To make a diagnosis, an ultrasound examination of the fetus is prescribed, in which the amount of amniotic fluid is determined and the "amniotic index" is calculated. If the obtained indicator exceeds the norm, polyhydramnios is put.

In addition, the doctor may prescribe additional studies:

The procedure of amniocentesis, in which samples of amniotic fluid are taken for analysis, containing fetal cells, the products of its vital activity.
A glucose uptake test, which is a screening test for gestational diabetes (which occurs during pregnancy). The woman is given syrup to drink, and half an hour later, blood is taken for analysis to determine the level of glucose. If the blood sugar level exceeds acceptable limits, an additional glucose uptake test is performed, which reveals the presence or absence of gestational diabetes.
Biochemical analysis of a pregnant woman's blood serum, which determines the levels of substances associated with certain birth defects.
Karyotyping or analysis of the quality and quantity of chromosomes for all 23 pairs of chromosomes. For analysis, samples of amniotic fluid or placenta are used, which are taken during amniocentesis or chorionic biopsy.

Treatment of polyhydramnios in pregnant women.
The effectiveness of treatment directly depends on the establishment and elimination of the cause of the development of polyhydramnios, for which the specialist prescribes some examinations:

Ultrasound of the fetus and dopplerography (with its help, vessels, the fetus, uterus and umbilical cord are examined), in which the condition of the uterus and fetus, as well as blood flow in the placenta, is established.
CTG (cardiotocography) of the fetus, in order to assess the general condition.
Blood test for intrauterine infection.
Blood test and smear for sexually transmitted infections (chlamydia, mycoplasma, ureaplasma).
In the presence of a negative Rh factor, a woman in position must take a blood test for antibodies.

Taking into account the causes and severity of this pathology, appropriate treatment is prescribed. So in the case of unexpressed polyhydramnios and polyhydramnios of moderate severity, treatment with medications is used, both in outpatient (mild) and inpatient conditions (with polyhydramnios of moderate severity). In this case, the pregnancy is maintained until its natural physiological completion (delivery) with continuous treatment. Usually, women are prescribed antibiotics (except tetracycline), diuretics (diuretics), vitamins (hypothiazid, B vitamins), immunomodulatory therapy. Also at 24-38 weeks of pregnancy, a woman is prescribed Indomethacin. If the measures taken do not bring a positive result, and polyhydramnios continues to develop, turning into a severe degree, while there are all signs of intrauterine suffering of the fetus, in most cases, pregnancy is resolved ahead of schedule. With weakness of labor activity, appropriate treatment is also applied (drugs are used no earlier than two hours after the outflow of amniotic fluid).

How to alleviate the condition with polyhydramnios on your own?
With shortness of breath, you should rest more, avoid climbing to the floor without an elevator, do all household chores slowly.

With heartburn against the background of uterine pressure on the stomach:

should eat small meals as often as possible;
do not eat at night and eat immediately before bedtime;
you need to give up foods and drinks that provoke it (fatty foods, carbonated drinks, etc.);
put pillows under your back before going to bed (to form a reclining position);
Take antacids as directed by your doctor.

If new symptoms occur or the condition worsens, call your doctor right away.

Influence of polyhydramnios on the condition of a pregnant woman.

Feelings of pain and discomfort.
Complication of the process of childbirth: weakness of contractions, early detachment of the placenta, excessive bleeding against the background of excessive stretching of the uterus.
Complications during the recovery period.

The effect of polyhydramnios on the fetus.

The occurrence of various defects and pathologies in the development of the fetus.
perinatal death.
Asphyxia of the fetus against the background of a weakening of labor activity, which negatively affects the general condition of the baby and its central nervous system.

Prevention.
Polyhydramnios during pregnancy is a rather serious phenomenon, even in the case of a mild degree of pathology, because it indicates the presence of disorders during pregnancy, certain diseases that can seriously harm the health of a woman and a child. Therefore, it is important to take preventive measures to prevent the development of this phenomenon. These, first of all, include various surveys that will help to timely identify factors contributing to the development of polyhydramnios. It is also recommended to adhere to a certain diet, consume a certain amount of fluid, and often be in the fresh air, taking walks. And most importantly, strictly follow the recommendations of the doctor leading the pregnancy, take all the vitamins and prescribed drugs, and also undergo the prescribed procedures. Revealed polyhydramnios at the initial stage of development is simply, quickly and effectively treated without harm to the health of the mother and fetus.