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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).