Complications of Polyhydramnios

Polyhydramnios is a condition that pregnant women sometimes have to suffer from, especially during the second half of their pregnancy. Polyhydramnios is a condition in which the amniotic fluid surrounding the foetus inside the womb of the mother increases in an excessive amount. If polyhydramnios is mild, it goes away on its own. However, severe Polyhydramnios requires treatment as it can cause several other complications.

Before paying attention to this condition of Polyhydramnios, where there is an excessive increase in the quantity of amniotic fluid in the amniotic sac or the mother’s womb, it is a must that what this fluid is all about is known clearly. The amniotic fluid –

• Protects the foetus within the mother’s womb from infection
• Protects the foetus from temperature change
• Cushions the foetus from external impacts
• Helps the foetus to swallow, digest and recycle the fluid
• Helps in building the respiratory and digestive organs
• Makes enough room for the foetus to move and thereby, build muscles
• Removes the wastes from the baby.

Usually, the amount of amniotic fluid gradually increases during the final stage of pregnancy, especially after 30 weeks of gestation. Mild increases are balanced automatically, however, with excessive increase, problems may arise.

Though the amniotic fluid plays a vital role in the development of the foetus, with excessive increase in its volume, severe and serious complications may arise. In case of Polyhydramnios, there is about 3 times more amniotic fluid in the amniotic sac than normal. Though the exact amount of this fluid cannot be measured externally, unless there is a caesarean delivery, the usual measurement is a volume that is greater than 25 cm AFI or amniotic fluid index.

The normal range of Amniotic Fluid Index is 5 to 25 cm. Any number greater than this measure, is considered as Polyhydramnios. To measure this condition, the vertical depth of the amniotic fluid in each quadrant of uterus is measured and this measurement is called the AFI. With high AFI, problem with pregnancy is suspected and there is a higher possibility of adverse pregnancy outcomes.

In most cases, Polyhydramnios goes away on its own. In serious cases, the complications of Polyhydramnios are mostly associated with the mother. The foetus, however, also can be affected much by Polyhydramnios. The complications that the pregnant mother as well as the baby in the womb, have to face are –

• Premature Labour as a Complication of Polyhydramnios: In most cases of Polyhydramnios, there is a premature labour and premature delivery of the baby before the 37th gestation week.
• Polyhydramnios Complications Involving Premature Membrane Rupture: Due to the excessive pressure of the amniotic fluid, there is often the premature rupture of the membranes. This means that the water will break prematurely. Usually, breakage of membrane occurs after the 37th week of gestation, but often it occurs before the onset of labour.
• Umbilical Cord Prolapse: This is a very common complication associated with Polyhydramnios, in which the umbilical cord drops into the vagina, before the baby, through the cervix.
• Placental Abruption: In this condition, the placenta starts to separate from the uterus wall, even before the baby is born. The placenta slowly peels away from the inner uterine wall.
• Birth Defects: Certain serious birth defects that can be caused as a consequence of this condition of Polyhydramnios are cleft palate and Down’s syndrome.
• Delivery Related Complications Due to Polyhydramnios: In case of Polyhydramnios, normal delivery is not an option. C-section is often the only possible option, especially because of the need for premature delivery, absence of premature labour or the possibility of other complications like placental abruption and umbilical cord prolapse.
• Malposition of the Foetus: Yet another reason for C-section delivery in women with polyhydramnios is because the baby often lies in an atypical head-down position.
• Heavy Bleeding or Postpartum Haemorrhage: Since there is a lack of uterine muscle tone, heavy bleeding after delivery is often a common complication associated with this condition.
• Effects on Foetal Growth: With Polyhydramnios, the foetus often tends to grow excessively.

Apart from these complications, the mother might also suffer from urinary tract infection or high blood pressure.

In most of the cases, the exact cause of polyhydramnios or increased levels of amniotic fluid levels cannot be clearly identified. Experts believe that about 50% of the causes are idiopathic. Still, some of the common reasons are –

• Maternal diabetes
• A birth defect associated with the central nervous system or gastrointestinal tract of the foetus
• Foetal anaemia or lack of red blood cells in the foetus
• Twin or multiple pregnancies in which twin-to-twin transfusions are common. This means that one baby will have too much of amniotic fluid and the other one will have too less.
• Certain infections like toxoplasmosis, rubella and syphilis.

If Polyhydramnios has occurred in your pregnancy, routine antenatal check-ups will easily help the doctor to diagnose the condition. With an ultrasound, it can also be determined, whether the cause of this condition is an abnormality associated with the foetus.

Though routine check will help the doctor to diagnose the condition if any, it is a must that you keep a check on your signs and symptoms, so that you can report to the doctor at once. The common signs and symptoms would be –

• Rapid increase in the abdominal size of the mother.
• Rapid weight gain, much higher than normal. Usual weight gain during pregnancy is 12 kg.
• Breathlessness.
• Difficulty in climbing stairs.
• Swelling of legs.
• Indigestion and heartburn, feeling uncomfortable with usual amount of food that is eaten.
• Decreased urine production.
• Tight abdomen.
• Slow movement of the baby.

If any of these signs and symptoms is felt, seeing a doctor at once is a must, as it could be Polyhydramnios. If it is Polyhydramnios, treatment must not be delayed as this condition can cause serious complications for the foetus.

Polyhydramnios cannot be treated in any way as such. However, with a close and regular monitoring of this condition, the doctor will be able to take care of the condition and prevent further complications associated with polyhydramnios. In case of excessive amniotic fluid volume in the amniotic sac, amniocentesis might be done. This process drains away some of this excessive amount of amniotic fluid from the sac. Sometimes there is a manual reduction of the amniotic fluid through the amnio-reduction process. This can reduce the risks of foetal death.

It is a must that the mother with Polyhydramnios takes enough rest and does not indulge in any stressful activity so that the physical discomfort is removed. In case the water breaks without or before labour, make sure that there is no significant movement before the medical team arrives, as this can rupture the umbilical cord.

Also Read:

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• What is a Cordocentesis Test and When is it Performed?
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