Consequences of polyhydramnios for mother and child. Risk of complications during childbirth

Causes of polyhydramnios

In most cases, the exact cause of the condition is difficult to identify. Polyhydramnios during pregnancy can be caused by several factors.

Maternal reasons:

• heart disease, kidney disease;
• diabetes. The disease causes fetal hyperglycemia and, as a result, polyuria (fetal urine is the main source of amniotic fluid);
• multiple pregnancy;
• inflammatory diseases of the pelvic organs;
• hemolytic anemia.

Causes of polyhydramnios due to fetal pathologies:

• inability to swallow amniotic fluid due to gastrointestinal malformations (esophageal and duodenal atresia);
• malformations of the central nervous system (hydrocephalus, anencephaly, meningocele);
• tracheoesophageal fistula;
• diaphragmatic hernia, for example, Bochdalek's hernia, in which the pleuro-peritoneal membranes are not developed and the stomach prolapses into the chest cavity. Because of this defect, the fetus is not able to swallow a sufficient amount of amniotic fluid;
• fetal kidney disorders leading to increased urine production, such as in antenatal Bartter's syndrome;
• chromosomal abnormalities such as Down syndrome and Edwards syndrome;
• skeletal dysplasia (dwarfism);
• sacrococcal teratoma.

Diagnostics

Polyhydramnios is suspected upon examination based on the indicators described above. Be sure to tell your doctor about all the symptoms that bother you. To confirm polyhydramnios, ultrasound diagnostics are done. The amniotic fluid index is calculated. This is the gold standard for diagnosing the pathology in question. The data of this index is measured every day.

Other diagnostic methods:

• vaginal smear to determine microflora
• blood sugar test to look for possible diabetes
• clinical blood and urine tests
• PCR for torch infections
• blood test for antibela in case of negative rhesus in a pregnant woman
• Dopplerometry (monitoring the baby’s condition)
• cardiotocography

When treating a patient in a specialized medical institution, every day they measure her abdominal circumference, listen to the fetal heartbeat and look at its position.

Symptoms of polyhydramnios

Clinical signs:

• abdominal enlargement;
• uterine size advances gestational age;
• shiny skin with stretch marks;
• dyspnea;
• swelling.

Symptoms are more pronounced in acute polyhydramnios: the abdomen quickly enlarges, a nagging pain appears in the lower abdomen and perineum, and shortness of breath increases. Chronic polyhydramnios during pregnancy is not so pronounced, since amniotic fluid accumulates gradually. A pregnant woman may feel well, so hydramnios is often diagnosed during a routine ultrasound. Mobility, abnormal position, and weak heart rhythm (dull heartbeat) of the fetus are noted. Ultrasound helps to identify extensive hypoechoic zones and assess the volume of amniotic fluid. Polyhydramnios during late pregnancy is manifested by a discrepancy between the size of the uterus and the gestational age.

Also, to make a diagnosis, the content of prolactin in the amniotic fluid is determined. With polyhydramnios, its content is reduced (relative to the norm for a certain period of pregnancy).

Complications

Everyone who has been diagnosed with this pathology is interested in the dangers of polyhydramnios for pregnant women. An acute form of pathology, as already noted, can provoke termination of pregnancy. Until the 28th week of gestation, termination is carried out for medical reasons. With polyhydramnios, labor may occur prematurely because the uterus is greatly distended. Complications may include prenatal rupture of water, bleeding in the first two hours after birth and in the afterbirth period.

Polyhydramnios often causes placental abruption to occur too early. In such cases, doctors may resort to abdominal delivery. During the release of amniotic fluid, small parts of the baby or umbilical cord loops may fall out, then surgery will be urgently needed.

With polyhydramnios, the fetus is often too active, which can cause it to become entangled in the umbilical cord or become incorrectly positioned. This may also be the reason for the inability to give birth naturally. There is also a risk of suffocation for the baby. Polyhydramnios causes disruption of blood flow in the uterus and placenta, therefore intrauterine hypoxia (lack of oxygen) is possible, and developmental delays in the child are also likely. With polyhydramnios, pregnant women may develop gestosis, uncontrollable vomiting and a persistent increase in blood pressure.

Consequences of polyhydramnios

The prognosis for the fetus is unfavorable. Perinatal mortality is about 50%. The main causes of death are prematurity and developmental defects. The consequences of polyhydramnios for a child are intrauterine hypoxia, umbilical cord strangulation, development of neonatal pneumopathy, malnutrition (underweight), hyperglycemia.

Polyhydramnios significantly increases the risk of complications during childbirth:

• incorrect presentation of the fetus;
• premature contractions;
• premature rupture of membranes;
• umbilical cord prolapse;
• placental abruption.

The risks are usually proportional to the volume of accumulated amniotic fluid. The consequences of polyhydramnios for a woman are hypertension, respiratory failure, postpartum hemorrhage.

Functions of amniotic fluid

During pregnancy, the baby in the tummy bathes in amniotic fluid. In addition to the fact that it is more convenient for the baby, and thanks to the water he can move, they perform several more important functions:

— water performs the function of shock absorption and protects the fetus from external influences (shocks and shocks);

- the fluid protects the umbilical cord from compression between the fetal body and the walls of the uterus;

- the lower pole of the amniotic sac, which contains the so-called anterior waters (that is, located in front of the fetal head), participates in labor, performing the function of a hydraulic wedge and facilitating the opening of the cervix;

— the presence of amniotic fluid makes contractions less painful for both mother and fetus.

The fetal surface of the placenta and fetal membranes, which can secrete and absorb water, as well as the fetus itself, which swallows amniotic fluid and secretes urine, take part in the formation and maintenance of the amount of amniotic fluid (amniotic fluid). Thus, the waters are constantly renewed. Complete exchange of amniotic fluid occurs approximately every 3 hours.

Normally, the amount of amniotic fluid is 600-1500 ml. The maximum amount is determined at 37-38 weeks, then it decreases slightly. With oligohydramnios, the amount of amniotic fluid is less than 500 ml, with polyhydramnios - more than 1.5-2 liters. Oligohydramnios is extremely rare, polyhydramnios is more common.

How is polyhydramnios treated?

Treatment of polyhydramnios is carried out when there is a threat of premature birth or acute respiratory failure in a pregnant woman. To eliminate polyhydramnios, multiple amniocentesis is used - a puncture in the amniotic membrane and collection of amniotic fluid. If the condition is caused by fetal polyuria, the pregnant woman is prescribed a short course of indomethacin. If diabetes mellitus is detected in the mother, hypoglycemic therapy is selected to correct blood glucose levels. If an inflammatory disease is suspected, antibacterial drugs are prescribed. If the cause of the pathology has not been established, normalization of the uteroplacental blood flow is carried out. Antiplatelet agents, vitamins, and antispasmodics are usually prescribed. Read more about the treatment of hydramnios on our website Dobrobut.com.

Related services: Consultation with a gynecologist during pregnancy

Diet

In the second trimester, there is a risk of developing gestational diabetes , which is associated with polyhydramnios. Therefore, a mandatory condition is to limit simple carbohydrates - candies, waffles, sweet pastries, halva, cookies, condensed milk, etc. There is no point in restricting fluid intake, since it does not affect the amount of amniotic fluid.

The consumption of table salt should be limited, which will reduce water retention in the body, therefore internal swelling, swelling of the anterior abdominal wall and legs will be significantly reduced. They recommend a diet excluding canned food, salty, spicy foods, sausages and smoked meats, and extractive dishes. The diet should include protein (meat, fish, cottage cheese), fruits, berries, vegetables, vegetable juices, as well as complex carbohydrates in the form of whole grain bread, whole cereals, bran bread, and legumes.

Twins

There is data on the frequency of twins with anomalies in the development of the uterus, characterized by its bifurcation (bicornuate uterus, having a septum in the cavity, etc.). The cause of polyembryony may be the separation of blastomeres (in the early stages of fragmentation), resulting from hypoxia, cooling, disturbances in the acidity and ionic composition of the environment, exposure to toxic and other factors. Multiple pregnancy can occur: as a result of fertilization of two or more simultaneously matured eggs, as well as the development of two or more embryos from one fertilized egg.

Twins formed from two (three, etc.) eggs are called fraternal (multi-ovular), those formed from one - identical. Origin of fraternal twins (multi-zygotic twins): it is possible for two or more follicles to mature (and ovulate) simultaneously in one ovary. There may be maturation of two or more follicles and ovulation in both ovaries.

A third way of origin of fraternal (multi-zygotic) twins is possible - fertilization of two or more eggs matured in one follicle. Origin of identical twins: most often the occurrence of identical twins is associated with fertilization of an egg that has two or more nuclei. a single embryonic rudiment at the cleavage stage is divided into two parts; from each part an embryo (fruit) is formed. Fraternal twins. Fertilized eggs develop independently. After penetration into the mucous membrane, each embryo develops its own aqueous and villous membranes; Subsequently, each twin develops its own placenta with an independent network of blood vessels; each fertilized egg, except for the chorion and amnion, has an independent capsular membrane (decidua capsularis). In some cases, anastomoses are formed between the vessels of independent placentas. Fraternal twins can be same-sex (both boys or both girls) or opposite-sex (a boy and a girl). Their blood type may be the same or different. Identical twins. Identical twins share a common capsular and villous membrane and a common placenta; The vessels (both arterial and venous) of both twins in the placenta communicate through numerous anastomoses. Each twin has a separate aqueous membrane; the septum between the fetal sacs consists of two aqueous membranes (biamniotic twins).

Identical twins always belong to the same sex (both boys or both girls), look alike, and have the same blood type.

In case of dizygotic twins, the membranes in the septum are located as follows: amnion - chorion, chorion - amnion; with monozygotic amnion—amnion. Important signs for the diagnosis are: blood type (and other blood factors), eye color, hair color, skin texture of the fingertips, shape and location of the teeth. In identical twins, these characteristics are completely the same. Fraternal twins share characteristics of similarity to the same extent as ordinary brothers and sisters.

COURSE OF MULTIPLE PREGNANCY

During a multiple pregnancy, increased demands are placed on a woman’s body: the cardiovascular system, lungs, liver, kidneys and other organs function under great strain. In this regard, multiple pregnancy is more difficult than singleton pregnancy.

• Pregnant women often complain of fatigue and shortness of breath, which worsens towards the end of pregnancy. The cause of shortness of breath is difficulty in the activity of the heart due to a significant displacement of the diaphragm by the fundus of the uterus, the size of which in a multiple pregnancy is larger than in a singleton pregnancy.
• Dilatation of the veins of the lower extremities often occurs. Towards the end of pregnancy, there is often an increase in the urge to urinate due to the pressure of the large fetal sac on the bladder.
• Pregnant women often complain of heartburn and constipation.
• In multiple pregnancies, toxicoses occur more often than in singleton pregnancies: vomiting, drooling, edema, nephropathy, eclampsia.
• In case of twins, polyhydramnios of one of the fetuses often occurs, which leads to a sharp enlargement and overstretching of the uterus, shortness of breath, tachycardia and other disorders. Polyhydramnios is more common in one of the identical twins. In some cases, polyhydramnios in one twin is accompanied by oligohydramnios in the other twin.
• Premature termination of multiple pregnancies often occurs.
• With twins, premature birth occurs in at least 25% of women.
• With triplets, premature termination of pregnancy occurs more often than with twins. The greater the number of fetuses gestated, the more often premature births are observed.
• The development of twins born at term is normal in most cases. However, their body weight is usually less than that of single fruits. There is often a difference in the body weight of twins by 200-300 g, and sometimes more.
• Uneven development of twins is associated with unequal supply of nutrients from the single placental circulation.
• There is often a difference not only in weight, but also in the body length of twins. In this regard, the theory of supergeneration (superfoetatio) was put forward. Proponents of this hypothesis believe that it is possible to fertilize eggs of different ovulation periods, i.e., the onset of a new pregnancy in the presence of an existing, previously occurring pregnancy.
• Due to uneven delivery of nutrients and oxygen, significant developmental disruption and even death of one of the twins can occur. This is more common in identical twins. The dead fetus is compressed by the second, well-growing fetus, amniotic fluid is absorbed, and the placenta undergoes regression. The compressed mummified fetus ("paper fetus") is released from the uterus along with the placenta after the birth of a live twin. Polyhydramnios in one fetus, which occurs during multiple pregnancies, often also interferes with the proper development of the other twin. With severe polyhydramnios, certain anomalies in the development of the fetus are often observed, growing with an excess of amniotic fluid. Occasionally, fused twins are born (fusion can occur in the head, chest, abdomen, pelvis) and twins with other developmental defects.
• The position of the fetus in the uterine cavity in most cases (about 90%) is normal. In the longitudinal position, different presentation options are observed: both fetuses are presented with the head, both with the pelvic end, one with the head, and the other with the pelvic end. With a longitudinal presentation, one fetus may be behind the other, making diagnosis difficult. Less commonly observed is the longitudinal position of one fetus and the transverse position of the other. The most rare occurrence is the transverse position of both twins.
• Position of twins in the uterus: both fetuses are presented with the head, one fetus is presented with the head, the second - with the pelvic end, both fetuses are in a transverse position
• During multiple pregnancies, women are specially registered and closely monitored. When the earliest signs of complications appear, the pregnant woman is sent to the pregnancy pathology department of the maternity hospital. Considering the frequent occurrence of premature birth, it is recommended that a pregnant woman with twins be sent to the maternity hospital 2 - 3 weeks before birth, even in the absence of complications.

RECOGNITION OF MULTIPLE PREGNANCY

Diagnosis of multiple pregnancy often presents significant difficulties, especially in the first half. In the second half, towards the end of pregnancy, recognition of twins (triplets) becomes easier. However, diagnostic errors occur during examinations at the end of pregnancy and even during childbirth.

When recognizing a multiple pregnancy, the following signs are taken into account:

• The enlargement of the uterus during multiple pregnancy occurs faster than during pregnancy with one fetus, so the size of the uterus does not correspond to the duration of pregnancy. The fundus of the uterus is usually high, especially at the end of pregnancy; the abdominal circumference during this period reaches 100-110 cm or more.
• The following signs are inconsistent and not sufficiently reliable: a) deepening of the fundus of the uterus (saddle uterus), the formation of which is associated with protrusion of the corners of the uterus by large parts of the fetus; b) the presence of a longitudinal depression on the anterior wall of the uterus, formed as a result of the adjoining of fetuses located in a longitudinal position to each other; c) the presence of a horizontal groove on the anterior wall of the uterus with the transverse position of the fetus.
• The small size of the presenting head with a significant volume of the pregnant uterus and a high position of its fundus also allows one to suspect a multiple pregnancy. The presence of this sign is explained by the fact that during the study, the head of one and the pelvic end (in the fundus of the uterus) of another fetus, lying slightly higher, are determined.
• Feeling the fetus move in different places and feeling parts of the fetus in different parts of the abdomen (both right and left) also indicate multiple pregnancy.

List of sources

• Sidorenko V.N., Bugrov V.Yu., Kletsky S.K., Sakharov I.V. A modern view on the etiopathogenesis of oligohydramnios and polyhydramnios and ways to solve them for polyhydramnios of an infectious nature/Medical news. - 2021. - No. 4. — P. 53-57.
• Ishchenko A.I., Demenina N.K. // Women's health. - 2014. - No. 6. - pp. 26-28.
• Kulavsky E.V. Features of the course of pregnancy and childbirth with polyhydramnios. Abstract for the academic degree of Candidate of Medical Sciences. Ufa 2004, 26 p.
• Zubkova M.V. Clinical and genetic characteristics of oligohydramnios and polyhydramnios: Abstract of thesis. dis. ...cand. honey. Sci. - M., 2007. - 21 p.
• Pustotina O.A., Bubnova N.I., Ezhova L.S. Clinical and morphological characteristics of the fetoplacental complex in polyhydramnios and oligohydramnios of infectious origin / Obstetrics and Gynecology. - 2007. - No. 3. — P.42-46.

Treatment and prognosis

Therefore, it is important to identify this disease as early as possible and apply timely measures. Treatment depends on the cause of polyhydramnios: for infection, it can be antibacterial drugs, and for extragenital pathology, treatment of the underlying disease. In any case, a pregnant woman with polyhydramnios should receive increased attention, because she is at risk of developing complications. She is required to undergo additional ultrasound diagnostics; a CTG (cardiotocography) is performed on the baby to monitor his heartbeat and movements. Even with such a diagnosis, you can give birth to a completely healthy child if you follow the doctor’s recommendations and are attentive to your health.

Medicines

Photo: yaprelest.ru

For polyhydramnios, the following groups of medications can be prescribed:

• anti-inflammatory drugs - prescribed in the presence of an inflammatory process in a woman’s body. The mechanism of action of the drugs is aimed at suppressing the activity of inflammatory mediators, which can be produced under the influence of various exo- and endogenous damaging factors;
• antibacterial agents - used to treat infectious diseases of bacterial etiology. The choice of a specific drug is made depending on the sensitivity of the pathogen that was the source of the development of the infectious disease. Of course, only those antibacterial agents that do not have a teratogenic effect should be prescribed;
• medicines that help improve microcirculation. Representatives of this group of drugs normalize capillary permeability and also improve metabolic processes in the walls of blood vessels;
• vitamin and mineral complexes, the purpose of which helps to saturate a woman’s body with all the necessary vitamins and minerals, thereby enhancing the body’s protective properties.

Photos from our own practice:

Ultrasound. Pregnancy 32 weeks. Polyhydramnios. A single water pocket of 10.9 cm is a sign of moderate polyhydramnios.

Pregnancy 30 weeks. Polyhydramnios. A single water pocket of 9.3 cm is a sign of moderate polyhydramnios.

Ultrasound 4D. Pregnancy 33 weeks. Polyhydramnios due to infection (CMV). Photos of the fetal face are best obtained in conditions of polyhydramnios, however, in the case of polluted, “turbid” waters, interference from the suspended matter contained in the water is visible and the “portrait of the fetus” seems unclear

Chorioangioma of the placenta is one of the causes of polyhydramnios.
Congenital malformations of the fetus, congenital heart defect of the fetus, polyhydramnios and pregnancy 4d