Polyhydramnios in Pregnancy: When there is too much amniotic fluid

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If you're found to have too much amniotic fluid at any point in your pregnancy, it's called polyhydramnios.

Polyhydramnios in pregnancy is a rare condition that happens when excess amniotic fluid accumulates in the uterus during pregnancy. 

Amniotic fluid is the fluid that surrounds your baby in your uterus (womb). During pregnancy, your baby needs amniotic fluid to grow.  Your baby stays in this fluid throughout pregnancy. It helps to cushion and protect your baby, and is also essential for your baby’s development.

During the first 14 weeks of your pregnancy, fluid passes from your circulatory system into the amniotic sac. Early in the second trimester, your baby starts to swallow the fluid and pass it out as urine (and the cycle goes on). The waste is taken away through your placenta.

Pregnant women normally have about 500 to 1,000 ml of amniotic fluid. Too much or too little amniotic fluid can can affect how your baby develops and/or cause pregnancy complications. 

What causes too much amniotic fluid or polyhydramnios?

When your amniotic fluid index reaches 20-24, then it is termed as a high level of amniotic fluid. This amniotic high index level would result in polyhydramnios.

Additionally, high level of amniotic fluid may also result in placental abruptions, preterm or premature labor, postpartum hemorrhage, and cesarean delivery.

Higher concentration of amniotic fluid may develop for several reasons, like the following:

  • twin or multiple pregnancies, with two or more fetuses in the womb
  • maternal diabetes, which doctors also determine as gestational diabetes
  • the fetus having difficulty swallowing the amniotic fluid
  • the fetus producing higher amount of urine
  • congenital malformation, such as a blockage of fetus’ gastrointestinal or urinary tract, or an abnormal growth of brain and spinal cord
  • your fetus might have infection
  • the fetus may have an anemia, or lack of red blood cells
  • infections to the mother
  • blood incompatibilities between the fetus and the mother

How to reduce amniotic fluid in pregnancy naturally

Here are some tips to lessen or reduce the level of amniotic fluid during pregnancy in natural ways:

  • Sometimes, the amniotic fluid increases due to a disease. Treating this disease may help lower the level of amniotic fluid.
  • Amniocentesis is an approach used to drain out the excess amniotic fluid in your body. This must be the last resort because it might cause or trigger preterm labor and delivery.
  • The doctor may put you on indomethacin. It helps in lowering the level of amniotic fluid. It is also generally prescribed 31 weeks before delivery (third trimester).

The right level of amniotic fluid is important for the baby’s welfare. Get your amniotic fluid checked regularly during pregnancy and make sure it is always in the range index of 8-20. This will guarantee you that your baby is safe inside the womb.

Polyhydramnios in pregnancy or too much amniotic fluid

If you’re found to have too much amniotic fluid at any point in your pregnancy, it’s called polyhydramnios.
Polyhydramnios occurs in about 1 to 2 percent of pregnancies. It can occur as early as 16 weeks, but it is usually seen in the later part of pregnancy.
Polyhydramnios is usually harmless, but in rare cases it can lead to serious pregnancy complications, especially if it occurs early on in the pregnancy, and depending on the amount of excess amniotic fluid.

polyhydramnios in pregnancy - caused by excess amniotic fluid

Causes Of Polyhydramnios in Pregnancy related on having too much amniotic fluid

In many cases, it would be impossible to determine the exact cause of polyhydramnios.
The gradual buildup of amniotic fluid over the course of the pregnancy might result in mild polyhydramnios.
Moderate to severe polyhydramnios have the following causes:

  • A birth defect or congenital disability that affects the baby’s gastrointestinal tract or central nervous system

Sometimes the baby’s ability to swallow may be impaired, due to a birth defect.
While inside the womb, babies will swallow amniotic fluid and then urinate it out. This keeps the amount of amniotic index at a steady level. If the baby cannot swallow due to a genetic defect, the amniotic liquid will build up.

  • Maternal diabetes

Elevated blood glucose levels can lead to an excessive buildup of amniotic fluid.
This can happen when the mother has diabetes before getting pregnant or becomes diabetic during pregnancy (gestational diabetes).

  • Being pregnant with twins or other multiples

Polyhydramnios is especially likely in the case of twin-to-twin transfusion syndrome, in which one twin has too little amniotic level while the other has too much.

  • Mismatched blood types between mother and baby

When a mother has Rh-negative blood type, and her baby has Rh-positive blood type, there is a risk of the baby developing, Rh-factor or Rh disease, a type of anemia. This can cause, among other complications, polyhydramnios.

  • A problem with the baby’s heart rate

This includes anything from fetal arrhythmia, a faintness of heartbeat due to a large amount of amniotic liquid or a congenital heart defect.

  • Infection during pregnancy

  • A lack of red blood cells in the baby (fetal anemia)

polyhydramnios in pregnancy

Polyhydramnios effect on baby in third trimester

Most pregnant mothers with polyhydramnios may not have any significant problems during pregnancy. Their baby will be healthy, too.
However, there is a slightly increased risk of pregnancy and birth complications like:
  • giving birth prematurely (before 37 weeks of the third trimester)
  • your waters breaking earlier
  • a problem with the position of the umbilical cord
  • your baby has a health condition
You will need extra check-ups to look for these problems more importantly during the third trimester of pregnancy. You will be advised to give birth in the hospital.
Additionally, during third trimester pregnancy, the placenta may pull away from the womb before delivery. The umbilical cord will drop into your vagina before the baby. This will prevent your baby from getting enough oxygen during delivery.

Symptoms of Polyhydramnios in pregnancy 

There may not be any symptoms in the case of mild polyhydramnios.
Moderate to severe Polyhydramnios may cause the following symptoms, due to the enlarged uterus exerting pressure on the other organs:
  • Difficulty breathing
  • Swelling in the lower extremities and abdominal wall
  • Uterine discomfort or contractions
  • Swelling of the vulva
  • Decreased urine production
  • Swollen feet
  • Constipation
  • Heartburn
  • Feeling huge or tightness in the belly
  • Fetal malposition, such as breech presentation

Complications from Polyhydramnios

Mild polyhydramnios usually does not cause complications during pregnancy. But in severe cases, there are certain risks, including:
  • Premature rupture of membranes — when your water breaks early
  • Premature Birth
  • Excess fetal growth
  • Placental abruption (premature separation of the placenta from the wall of the uterus)
  • Postpartum hemorrhage – Heavy bleeding due to lack of uterine muscle tone after delivery
  • Umbilical cord prolapse (the cord falling out of the vagina before the baby)
  • Fetal malposition such as breech presentation
  • Stillbirth
  • Cesarean section delivery

polyhydramnios in pregnancy

Polyhydramnios in cesarean section

You can usually wait for your labor to start naturally. At some point, induction (starting labor with medicine) or a cesarean section may be needed if there will be risks to you or your baby.
You will probably pass a lot of fluid when you give birth. Yet, this is normal and nothing to worry about. Your baby’s heartbeat would need close observation during labor.

Testing for Polyhydramnios in pregnancy

If your doctor suspects that you have polyhydramnios during pregnancy, he or she will perform a more detailed ultrasound to estimate how much amniotic fluid is inside your uterus, and to look for any fetal abnormalities.

Your doctor may also perform the following tests:

  • Glucose challenge test (for gestational diabetes)
  • Amniocentesis (sampling of amniotic fluid to test the baby for genetic abnormalities or defects)
  • Non-Stress Test (to check for abnormalities in the baby’s heart rate)
  • Doppler ultrasound (a stronger ultrasound that can see the baby’s circulatory system)

Treatment for Polyhydramnios in relation to amniotic fluid

If you have polyhydramnios, you will usually have ultrasounds weekly or more often to check amniotic liquid levels. You may also have tests to check your baby’s health.
Treatment for polyhydramnios depends on the cause of the condition, and how severe it is. Mild cases of polyhydramnios usually do not require any treatment and may go away on their own.
Severe polyhydramnios may require closer monitoring, especially from week 32 of pregnancy.
In later pregnancy, some cases of moderate polyhydramnios arise and bed rest could be a treatment. Laying horizontal and resting is a recommended position to delay any preterm labor as long as possible.
n more severe cases, a regular draining of amniotic liquid from the uterus using a large needle can treat polyhydramnios.
This procedure is called amnioreduction and carries a risk of complications, so your doctor will only recommend it if the danger of continuing the pregnancy with untreated polyhydramnios is greater than the risk of draining the fluid.
If your doctor determines that your polyhydramnios is a result of your baby’s heart rate, he or she might give you medication to correct the heart rate.
Polyhydramnios has a treatment with medication that reduces the amount of urine the fetus produces.
In some cases of severe polyhydramnios, your doctor may decide that the best course of action is to induce labor early, at 37 weeks, or even sooner.
Doctors may also consider a cesarean delivery if they feel that the baby is too large, or a breech or vaginal birth is too risky.

Diet and tips for pregnant with polyhydramnios or too much amniotic fluid

You may not be able to prevent polyhydramnios, but you can reduce the risks of it.

  • Do not smoke. 

Nicotine increases the risk of problems with your pregnancy and your baby’s health. Using an e-cigarette will not help you to quit smoking and they still have nicotine. Consult a doctor to help you quit smoking.

  • Eat healthy foods. 

This healthy food diet against polyhydramnios includes fruits, vegetables, low-fat dairy, lean meats, and beans. Healthy foods can help you gain a healthy amount of weight during pregnancy, and prevent diabetes.
The vitamins should compose at least 4000 micrograms of folic acid. Folic acid helps in preventing birth defects.

  • Control diabetes and other health conditions. 

Diabetes can cause problems for your baby, such as too much weight gain. Work with your healthcare provider to manage your blood sugar levels before and during your next pregnancy.
So mommies, if you have polyhydramnios in pregnancy, it is important to follow your doctor’s advice to help you have a safe delivery.

 

Republished with permission from theAsianparent Singapore

Additional information by Nathanielle Torre

AmericanPregnancy, MayoClinic, Stanford Children’s Health, NHS, Parenting First Cry, Medical News Today, Healthline

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