Polyhydramnios

Excerpt

Polyhydramnios is a pathologic excess of amniotic fluid volume (AFV) in pregnancy. It represents a high-risk obstetric condition with increased perinatal and maternal morbidity and mortality due to a higher incidence of intrauterine fetal demise, preterm labor, premature rupture of membranes, cord prolapse, fetal macrosomia, breech presentation, cesarean delivery, and postpartum hemorrhage. In pregnancies affected by polyhydramnios, approximately 20% are due to a congenital anomaly. However, 60% to 70% are idiopathic with no identified underlying cause.

Polyhydramnios is caused by a disruption of the AFV equilibrium, which under normal circumstances balances fluid production and absorption. The clinical presentation and severity of polyhydramnios depend on the extent of the amniotic fluid volume and the underlying cause. The diagnosis is made by ultrasound with a single deepest measure fluid pocket that exceeds eight centimeters or an amniotic fluid index that is 25 centimeters or more.

Antepartum evaluation and fetal surveillance are indicated in severe polyhydramnios to identify the underlying cause, direct care, and time the delivery. Reductive amniocentesis and indomethacin are indicated only for severe cases of polyhydramnios. Delivery is recommended at a tertiary care center.