Polyhydramnios

Question 1

Define

Answer 1

Polyhydramnios – AFI >95th centile, 2-3L fluid, deepest pool >8cm | affects 1-4% pregnancies

Risk factors for polyhydramnios (may be idiopathic):

Basics anything which incr foetal urine production or decreases foetal swallowing

Maternal

• Diabetes mellitus
• AV fitsula
• Chorioangioma

Foetal

• Multiple pregnancy -> usually TTTS causes this
• Idiopathic
• Oesophageal/duodenal atresia -> baby unable to swallow Amniotic fluid
• Neuromusc disorders/ Anencephaly -> baby unable to swallow fluid

Question 2

Symptoms

Answer 2

Symptoms of underlying cause

Abdomen – increased fundal height, impalpable foetal parts, tense abdo

Question 3

Investigations

Answer 3

Liquor volume, foetal growth, umbilical artery dopplers, exclude foetal anomalies

Other – exclude maternal diabetes

Question 4

Management

Answer 4

Antenatal monitoring of foetus, ensure diabetes control, paediatrician present at delivery

Amnioreduction (if gross polyhydramnios à discomfort)

COX inhibitors to decrease foetal urine output

Question 5

Complication

Answer 5

Pre-term labour (PTL), malpresentation, placental abruption, cord prolapse, PPH, increased risk CS

o Prognosis – increased perinatal morbidity and mortality, related to PTL/congenital