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

2. 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.

3. 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.

4. POLYHYDRAMNIOS

5. 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

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

7. 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

8. POLYHYDRAMNIOS
SPINA BIFIDA
ANENCEPHALY

9. POLYHYDRAMNIOS
ANENCEPHALY

10. 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

11. 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

12. 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

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17. POLYHYDRAMNIOS
POLYHYDRAMNIOS
AFI > 24

18. 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

19. POLYHYDRAMNIOS

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

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

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

23. 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