Associate Professor Iolanda-Elena Blidaru MD, PhD POLYHYDRAMNIOS Associate Professor Iolanda-Elena Blidaru MD, PhD

Excessive amount of amniotic fluid > 2 L POLYHYDRAMNIOS Excessive amount of amniotic fluid > 2 L Amniotic Fluid Index (AFI) = largest vertical pocket in 4 quadrants polyhydramnios  24 cm.

CLASSIFICATION POLYHYDRAMNIOS ACUTE: Symptoms are severe as accumulation rate is rapid and uterus is distended rapidly. Pregnancy ends before 28 weeks. It is common with monozygotic twins. It is an OBSTERICAL EMERGENCY. CHRONIC : More common in the 2-nd half of pregnancy. The rate of collection is slow so uterus may reach a bigger size than acute type but symptoms are not so severe.

POLYHYDRAMNIOS

POLYHYDRAMNIOS - Etiology Fetal causes Twin to twin transfusion syndrome Central nervous system abnormalities Esophageal blockage High gut obstruction Thoracic tumors Myotonic dystrophy Rare conditions Inherited disorders of renal function Fetal / placental tumors

POLYHYDRAMNIOS - Etiology Maternal causes Maternal diabetes Rh Iso-immunization Infections: CMV, Toxoplasmosis, Syphilis Heart disease Pre-eclampsia Anemia

POLYHYDRAMNIOS - ETIOPATHOLOGy Defect in amniotic fluid resorbtion - problems with swallowing and gastrointestinal passage Increased transsudation of cerebrospinal fluid: anencephaly spina bifida Excess fetal urine: anencephaly (lack of ADH ► stimulation of urination centers) Excess lung fluid - hypoplastic lungs

POLYHYDRAMNIOS SPINA BIFIDA ANENCEPHALY

POLYHYDRAMNIOS ANENCEPHALY

POLYHYDRAMNIOS Clinical diagnosis SEVERE → ACUTE: severe distressing pain that necessitates terminations of pregnancy (rare type) MODERATE - MILD → CHRONIC: more common, symptoms are gradual and tolerable Dyspnea and palpitation (raising the diaphragm) Edema in the lower limbs (↑pressure on the pelvic veins) Marked abdominal enlargement Easy fatigability, abdominal and lumbar pain, indigestion

POLYHYDRAMNIOS SIGNS Uterus is globular (normally ovoid) and larger than expected size Uterus ► tensed Skin ► stretched and shiny Fetal parts ► not easily felt Dificulty in defining presentation Fetal heart ► not easily heard

Sonography POLYHYDRAMNIOS CONFIRM DIAGNOSIS Laboratory tests Sonography CONFIRM DIAGNOSIS Diagnosis of multiple pregnancy Diagnosis of congenital anomalies as anencephaly, spina bifida, gastrointestinal tract anomaly Macrosomia

POLYHYDRAMNIOS

POLYHYDRAMNIOS

POLYHYDRAMNIOS

POLYHYDRAMNIOS POLYHYDRAMNIOS AFI > 24

Radiography Amniography POLYHYDRAMNIOS A large radiolucent area around the fetal skeleton polyhydramnios, anencephaly and other gross skeletal defects Amniography may identify excess of amniotic fluid and the presence or absence of fetal swallowing

POLYHYDRAMNIOS

Other tests AFP evaluation Anti-Rh antibodies BW reaction POLYHYDRAMNIOS Other tests AFP evaluation Anti-Rh antibodies BW reaction Toxoplasma detection glucosemia

Differential diagnosis POLYHYDRAMNIOS Differential diagnosis multiple pregnancy fetal macrosomia ovarian cyst with abdominal location ascites a full bladder.

Prognosis POLYHYDRAMNIOS Maternal placental abruption, uterine dysfunction postpartum hemorrhage Fetal fetal malformations - 15-20% erythroblastosis, maternal diabetes prolapse of the umbilical cord preterm delivery (PROM)

POLYHYDRAMNIOS Treatment hospitalization, bed rest non-steroidal anti-inflammatory drugs (indomethacin) severe cases → repeated amniocentesis to relieve the tension mild to moderate hydramnios: rarely requires treatment NO diuretics, water and salt restriction. Acute cases → TERMINATION OF PREGNANCY