4.8 Polyhydramnios

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    Excess amniotic fluid (more than 2 litres at term). There are two clinical situations:
    – In the second trimester: acute polyhydramnios;
    – In the third trimester: chronic polyhydramnios.

    4.8.1 Acute polyhydramnios (rare but serious)

    Diagnosis

    – Rapid increase in the size of the uterus
    – Painful abdomen, abdominal pressure, dyspnoea
    – Distended, hard uterus, foetus cannot be palpated

     

    Usually associated with foetal malformation, sometimes a complicated twin pregnancy.

    Management

    Do not intervene; let the patient abort or deliver spontaneously.

    4.8.2 Chronic polyhydramnios

    Diagnosis

    – More moderate increase in the size of the uterus, occurring in spurts
    – Foetus cannot be palpated
    – Receding head on vaginal examination, fluid wave
    – Foetal heartbeat muffled

    Management

    – Look for diabetes and treat if found.
    – Examine the neonate for malformation.
    – Risk of neonatal hypoglycaemia (Chapter 10, Section 10.3.4).

     

    Notes:
    In acute and chronic polyhydramnios:
    – Do not puncture or drain amniotic fluid during pregnancy: risk of infection.
    – Use of oxytocin during labour is dangerous and oxytocin should be administered with caution as the over-distended uterus may rupture.
    – Amniotomy carries risk of cord prolapse. In the event of cord prolapse, a caesarean section may be considered taking into account gestational age and potential presence of foetal malformation. In the event of acute polyhydramnios in the second trimester, perform vaginal delivery.
    – Risk of postpartum haemorrhage (routinely insert an IV line).