1. POLYHYDRAMNIOS

3. AMNIOTIC FLUID ORIGIN- Precise origin is still unsolved
Probably of maternal and fetal origin
Speculative theories;
TRANSUDATE FROM MATERNAL SERUM across fetal membrane or maternal circulation in placenta
TRANSUDATE ACROSS THE UMBILICAL CORD or from fetal circulation in placenta or secretion from the amniotic epithelium
TRANSUDATE OF FETAL PLASMA through fetal skin before keratinised at 20th week
CONTRIBUTION FROM FETUS

6. Liquor Volume
. 10 weeks – 30 ml . 20 weeks – 250 ml weeks - 500ml to 1500ml

7. DEFINITION -D C Dutta ANATOMICALLY
Polyhydramnios is defined as a state where liquor amnii exceeds 2000 ml
DIAGNOSTICALLY
when A.F.I. is more than cm or a single pocket of amniotic fluid is greater than 8 cm by ultrasonography.
CLINICALLY
the excessive accumulation of liquor amnii causing discomfort to the patient and or when an imaging help is needed to substantiate the clinical diagnosis of the lie and presentation of the fetus.
-D C Dutta

8. INCIDENCE 1% to 2 % of the cases More common in multiparae than primi
Minor degrees are fairly common
Clinical symptoms probably occurs in 1 in 1000 pregnancies

9. CAUSES Maternal (15%) Rh iso-immunization GDM Placental (less than 1%)
Placental chorioangioma
Circumvallate placental syndrome
Fetal (18% -20%)
Multiple pregnancies
Fetal anomalies
Idiopathic (65%)

10. CAUSES FETAL ANOMALIES (20%): ANECEPHALY (50%)
Transudation from exposed meninges
Absence of fetal swallowing reflex
Suppression of fetal ADH leading >urination
OPEN SPINA BIFIDA
OESOPHAGEAL OR DUODENAL ATRESIA(15%)
FACIAL CLEFTS AND NECK MASSES
HYDROPS FETALIS
Cardiothoracic anomalies
Fetal cirrhosis

11. CAUSES……Contd II. Placenta
Chorioangioma- tumor growing from single villus with increased hyperplasia of blood vessels

12. CAUSES…….Contd III. MULTIPLE PREGNANCY (10%)
Uniovular twins- second sac
Twin to twin transfusion syndrome.

13. CAUSES…….Cont IV. MATERNAL (30%) DIABETES (30%)
Raised maternal blood sugar
raised fetal blood sugar
fetal diuresis
hydramnios
RENAL OR CARDIAC DISEASE edema of placenta & trasnudation.

14. CLINICAL TYPES Depending on the rapidity of onset hydramnios can be
ACUTE
Sudden onset
Appear in few days
Appear acutely on pre-existing chronic type
CHRONIC
Onset insidious
Taking few weeks

15. CHRONIC POLYHYDRAMNIOS

16. CLINICAL FEATURES Dysponea PALPATION Oedema of legs
SYMPTOMS
RESPIRATORY
Dysponea
PALPATION
Oedema of legs
Varicosities in the legs or vulva
Haemorrhoids

17. CLINICAL FEATURES……Contd
ABDOMINAL EXAMINATION
INSPECTION
Markedly enlarged
Looks globular
Fullness at the flanks
Skin is tense shiny with large striae

18. CLINICAL FEATURES……Contd
ABDOMINAL EXAMINATION…….Contd
PALPATION
Height of uterus is more than the periods of Amenorrhoea
Abdominal girth is more
Fetal parts cannot be well defined
external ballotment is more easily elicited
Malpresentations are more common
presenting part is usually high up
Fluid thrill is present in all directions
AUSCULTATION
Fetal heart sounds are not heard distinctly

19. CLINICAL FEATURES……Contd
INTERNAL EXAMINATION
Cervix is pulled up or partially taken up
dilated and admits tip of finger through which bag of membranes can be felt

20. Diagnosis
Sonography
To detect abnormally large echo free space between fetus & uterine wall >8cm. AFI> 25cm
To exclude multiple fetuses
To note the lie & presentation of the fetus
To diagnose any fetal
malformation

21. Cont… Radiolography- not common Blood- 1. ABO & Rh grouping
2. Post prandial sugar & GTT
Amniotic fluid- Estimation of alpha feto protein, neural tube defect
Differential diagnosis:
1. Twins
2. Pregnancy with huge ovarian cyst
3. Maternal ascites

22. COMPLICATIONS: Maternal- During pregnancy; pre-eclampsia(25%)
Malpresentation
Premature rupture of membranes
Preterm labour
Accidental haemorrhage
During labour;
Early rupture of membrane
Cord prolapse
Uterine inertia

23. Cont… 4. Increased operative delivery Retained placenta PPH Shock
During puerperium;
Subinvolution
Increased puerperial morbidity
FETAL: Increased perinatal mortality(50%)
Death mostly due to prematurity(20%)

24. MANAGEMENT To relieve the symptoms To find out the causes
Principles
To relieve the symptoms
To find out the causes
To avoid and to deal with the comlication

25. General mangement Supportive theraphy Bed rest with back rest
Analgesics when ever required in presence of GDM or PIH
Diuretics
Indomethacin orally 25 mg every 6 hourly (to decrease amniotic fluid)
Investigations to rule out complications
Actual management- response to treatment
- period of gestation
-presence of fetal malformation
- associated complications

26. Hospitalisation
Post prandial bld sugar
ABO & Rh group
USG
No fetal abnormality Fetal abnormality
Responsive to treatment Maternal distress Termination of pregnancy
irrespective of gestation
pregnancy 38wks Cervical ripening & ARM
To continue pregnancy Less 37 wk Amnioreduction
Management of complications correction of lie
stabilising oxytocin
Amnioreduction
ARM controlled

27. Acute Polyhydramnios

28. Signs & Symptoms
Onset is acute usually occurs before 20 weeks of pregnancy and presents usually with symptoms and labour starts before 28 weeks of pregnancy.
It may present as
Acute abdomen - abdominal pain, nausea, vomiting
Breathlessness which increases on lying down position
Palpitation
Oedema of legs, varicosities in legs, vulva and hemorroids
Signs: Patient looks ill, with out features of shock
Oedema of legs with signs of PIH
Abdomen unduly enlarged with shiny skin
Fluid thrill may be present

29. Cont… Fetal parts & FHS cannot be felt
Internal examination shows taking up of cervix or even dilatation with bulging membranes
Sonography- may show fetal anomalies or multiple fetuses
Differential diagnosis-
1. Accidental haemorhage
2. Retrovertd gravid uterus
3. Hydatidiform mole

30. TREATMENT To relieve the distress, decompression has to be done
Repeated abdominal amniocenthesis to continue pregnancy
Pregnancy is terminated by LROM
Due precuations to allow slow escape of fluid

31. PROGNOSIS Major fetal congenital malformation occurs in 20%
Incidence of prematurity twice more than normal rate
Prolapse of the cord may occur when membrane rupture so increase the operative
Placental abruption due rapid decompression of uterus when membranes rupture result in increased mortality & morbidity
Pregnancy complicated with GDM consequent risk for fetus

32. THANK YOU