Polyhydramnios Flashcards
What is polyhydramnios
Refers to an abnormally large level of amniotic fluid during pregnancy
>95th centile for gestational age
What causes polyhydramnios
Idiopathic (50-60%)
Any condition that prevents the foetus from swallowing - oesophageal atresia, CNS abnormalities, muscular dystrophies, congenital diaphragmatic hernia
Duodenal atresia
Anaemia
Fetal hydrops
Twin to twin transfusion syndrome
Increased lung secretions
Genetic or chromosomal abnormalities
Maternal diabetes
Maternal indigestion of lithium
Macrosomia
How is polyhydramnios diagnosed?
USS examination
Amniotic fluid index - measuring maximum cord-free vertical pocket of fluid in four quadrants of the uterus and adding them together
Maximum pool depth - vertical measurement in any area
Describe examination of polyhydramnios
Palpate the uterus - does it feel tense?
USS - repeat measurement of liquor volume, assess foetal size, assess foetal anatomy to detect any structural causes, doppler
Maternal glucose tolerance test
Karyotyping
TORCH - viral causes
What is a torch screen?
Toxoplasmosis Other - parvovirus Rubella Cytomegalovirus Hepatitis
Describe the management of polyhydramnios
No medical intervention is required in the majority of women with polyhydramnios
If maternal symptoms are severe an amnioreduction can be considered
Indomethacin - enhance water retention and reduced foetal urine output. Associated with premature closure of ductus arteriosus and should not be used greater than 32 weeks
What is amnioreduction associated with?
Infection
Placental abruption
Describe the prognosis of polyhydramnios
Severe and persistently unexplained polyhydramnios is associated with increased perinatal mortality
- Presence of underlying abnormality or congenital malformation
- Increased incidence of preterm labour
Malpresentation is also more likely
Higher incidence of PPH after delivery
