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).