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Polyhydramnios during pregnancy is a serious pathology that requires treatment.

In this article, we will consider in detail one of the pathologies of amniotic fluid - polyhydramnios. We will analyze what types of polyhydramnios are, at what time this pathology can occur. The main consequences of polyhydramnios and treatment will also be described.

What is polyhydramnios

Polyhydramnios is a pathology of amniotic fluid, during which they exceed the norm in volume. In domestic medical practice, a volume of 1.5 liters is considered the norm (with a normal full-term pregnancy). In foreign practice, - 2 liters.

This is an average figure, since the rate of amniotic fluid volume changes throughout. You can see these changes in the graph below.

Varieties of polyhydramnios

Polyhydramnios can be acute and chronic. In the case of an acute form, the volume of amniotic fluid increases rapidly, within a few hours or days. This is a very dangerous condition. In a situation of chronic polyhydramnios, the volume of amniotic fluid gradually increases throughout pregnancy, just an “increase” in volume, more than the norm. In this case, the magnitude of the excess of the standard volume, the rate of increase in volume and the timing when the “growth” went beyond the norm will matter. This pathology occurs, on average, 0.3-1.25% (0.6%) of pregnant women.

At what stage of pregnancy can polyhydramnios occur

As a rule, chronic polyhydramnios occurs (becomes noticeable and diagnosed) in the third trimester, at a period of about 30 weeks. But, this is not necessarily the case. Both chronic and acute forms of polyhydramnios can occur at almost any time.

What are the consequences of polyhydramnios

Polyhydramnios leads to various complications of pregnancy, and can also affect the development of the fetus and the process of childbirth.
In acute polyhydramnios often occurs, even uterine rupture can occur. With acute polyhydramnios in the early stages, the child usually dies.
Termination of pregnancy may occur, the risk of preterm birth and premature detachment of the placenta increases.
Childbirth is usually because the uterus cannot handle the extra fluid.
During childbirth, the risk of prolapse of the umbilical cord, arms or legs of the baby increases.
Increased risk of bleeding after childbirth;
There is an increased risk of bleeding (especially in the acute form of polyhydramnios), but the risk is also increased in the chronic form.
There may be a weakening of labor activity (stretched uterus is poorly reduced).
The risk of entanglement of the umbilical cord around the neck of the fetus increases, since with polyhydramnios the child is more mobile.
Frequent cases (transverse, oblique or pelvic).
May cause severe vomiting in pregnant women, leading to dehydration.
It can cause severe swelling of the legs, gestosis.
In a child, polyhydramnios can be the cause of malformations of the central nervous system, the digestive system.
The risk of asphyxia in a child during childbirth increases.
If the cause of polyhydramnios is an infection, then the fetus itself may also be infected.
Often during childbirth, you have to do (wrong position of the fetus, prolapse of umbilical cord loops, etc.).
The risk of incorrect insertion of the baby's head into the pelvis during childbirth (face, forehead) is increased.

How polyhydramnios manifests itself, symptoms

The movements of the baby become less active.
A woman hears and feels gurgling in her stomach when the baby moves.
Heaviness is felt by almost all pregnant women. But with polyhydramnios, this heaviness is felt even more strongly.
Painful shortness of breath, hard to breathe.
Increased heart rate, weakness.
Strong impassable.
Constipation.
Phlebeurysm.
Enlargement or abrupt appearance on the abdomen.
When you change the position of the body, you feel the rolling of water inside.
The circumference of the abdomen at the level of the navel is 100-120 cm or higher.
When pressing and releasing the abdomen on one side, vibrations are felt on the other side (as in a balloon filled with water).
lower abdomen, back.
Swelling (visible even visually) of the anterior abdominal wall.
With control measurements of the height of the fundus of the uterus and the circumference of the abdomen, it is clear that the dimensions exceed the norm for this period.
It is difficult for a doctor to hear the fetal heartbeat, it is "suppressed" by a layer of liquid.

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How is polyhydramnios determined (diagnosed)

As a rule, a woman feels the symptoms described above and consults a doctor. Even if the woman is not worried about anything, and the doctor sees the following symptoms during the examination:

The uterus is tense, it is difficult to feel the parts of the body of the fetus;
The fetal heartbeat is difficult to hear, it is drowned out by gurgling sounds;
When pressed on one side of the abdomen, vibrations are felt on the other side;
Control measurements of the height of the fundus of the uterus and the volume of the abdomen are above normal;

If the doctor observes such manifestations, he directs the woman to be checked for. The ultrasound specialist measures the amount of fluid in four areas around the baby (the largest free areas between the wall of the uterus and the fetus) to determine your amniotic fluid index (AFI). If the IAI is more than 24 cm or more than 8 cm, according to another calculation method, then you have polyhydramnios. The higher the IAI, the more serious that condition is expressed.

In addition to ultrasound, a gynecologist can conduct a vaginal examination. This study is done to determine the tension of the fetal bladder.

Causes of polyhydramnios

These reasons have not yet been fully explored. About 30% of cases of polyhydramnios remain of "unclear origin". Here are the main causes of this pathology.

Attention! The following are factors that increase the risk of polyhydramnios. But, the presence of these factors does not mean that polyhydramnios will necessarily arise.

The occurrence of polyhydramnios does NOT depend on how much the pregnant woman drinks fluids.
With infectious diseases of a pregnant woman (rubella, cytomegalovirus, toxoplasmosis, mycoplasmosis, ureaplasmosis, chlamydia, SARS, etc.). By the way, according to statistics, this is the cause of 60% of cases of polyhydramnios.
In violation of the function (as a rule, this is a consequence of exposure to the infections described in the previous paragraph).
With kidney disease in a pregnant woman.
With cardiovascular diseases in a pregnant woman.
In the presence of Rh-conflict in mother and child.
With multiple pregnancy (especially with identical twins).
If the fetus is too large.
In violation of the excretory function of the fetus itself.
In violation of the swallowing function of the fetus itself.
With malformations of the fetus (problems with the central nervous system, heart or kidneys).

How is polyhydramnios treated during pregnancy

In acute polyhydramnios (it develops rapidly, within a few hours), you should immediately go to the hospital. This condition is very dangerous, and you need to get under the supervision of doctors as soon as possible.

If there are no pronounced changes in the blood circulation and breathing of a woman, then doctors (taking into account the results of ultrasound) will strive to continue (save) the pregnancy until the normal delivery time. If the condition of the pregnant woman poses a threat to her life, then there is a need for early delivery (accelerated delivery, termination of pregnancy).
If a decision is made to keep the pregnancy, then a search is made for the cause of polyhydramnios (in order to choose the right way to treat it). It is impossible not to treat polyhydramnios, since this condition leads to the consequences described above, and almost always leads to oxygen starvation of the fetus. To determine the cause, a pregnant woman can be sent for an ultrasound with Doppler, CTG, a blood test and a smear for infections, with a Rh conflict, for an antibody test.
Thus, the cause of polyhydramnios is determined to the maximum (as we wrote above, in 30% of cases the cause has not been found). It turns out what provoked this condition.
If the problem is pregnancy diabetes, then you will be referred to a specialist who will help lower your blood sugar, and this will lead to a decrease in the volume of amniotic fluid. If you don't know if you have diabetes or not, you will be given a glucose tolerance test (GTT) (usually given in at-risk groups immediately upon presentation and at 24-28 weeks gestation) to determine your blood sugar levels.

In any case, you will be prescribed a special diet to maintain the body. Try to buy high-quality lungs in the Mom's Store, with a good composition selected specifically for pregnant and lactating women.

Note. Food products can only be returned if the packaging is intact.

If polyhydramnios is provoked by any disease (kidney, heart, etc.), then doctors will stop this disease to the maximum.
If the problem is infection, you will be referred for additional tests and treated with broad-spectrum antibiotics.
If the problem is in the Rhesus conflict, then immunoglobulin preparations are prescribed.
If the condition is provoked by the fetus itself, then there are several options. According to the results of ultrasound, doctors look at what kind of malformations in the development of the fetus. With CNS defects, doctors will advise you to terminate the pregnancy. In case of malformations of the digestive system, it was also advised to terminate the pregnancy, now it is not, since newborns with this pathology are assisted right at birth, and they are able to develop further normally. In general, if the malformations can be corrected at birth, then you will be offered to maintain the pregnancy until the normal delivery date, and medical therapy for such preservation.
If polyhydramnios is diagnosed, and the cause is not identified, then the doctor may prescribe drugs that improve blood microcirculation, uterine - placental blood flow, and metabolic processes. These are, as a rule, vitamins, magnesium preparations, diuretics, sometimes a broad-spectrum antibiotic.
Treatment of polyhydramnios, as a rule, is aimed at improving the condition of the fetus (preventing hypoxia), and at reducing the amount of amniotic fluid. Alternatively, an amniocentesis procedure may be performed to reduce the amount of amniotic fluid. This is a procedure for removing a certain volume of amniotic fluid by piercing the fetal bladder. But this procedure is rarely used.

Almost always, doctors try to prolong pregnancy with signs of polyhydramnios for as long as possible (closer to). And only in cases of deterioration, they resort to early delivery.

How to alleviate your condition with polyhydramnios

If polyhydramnios is mild (your doctor will tell you about this) and you can stay at home, then try to relieve the symptoms of polyhydramnios (they are not very different from the usual symptoms of pregnancy).

If you are short of breath, rest more, avoid lifting. Don't "jump", move smoothly.
If you have swelling, see the article , and recommendations in the article .

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Amniotic fluid is the first living environment of every person. The well-being of a woman and the development of the fetus, the features of labor activity depend on their number and composition.

The volume of amniotic fluid increases every week as the baby grows. In some women, the amount of water does not correspond to the norm.

Both polyhydramnios and oligohydramnios during pregnancy can bring various unpleasant surprises to the expectant mother, so such a deviation cannot be ignored.

Polyhydramnios during pregnancy: what does it mean

Polyhydramnios during pregnancy is an excess of the volume of amniotic fluid in the amniotic sac. The role of amniotic fluid in the development of the child is enormous: maintaining the body in space, ensuring freedom of movement, a source of nutrients, protection from damage and infections. But their number should always correspond to the norm.

During an ultrasound examination, the doctor determines the amniotic fluid index (AFI) - an indicator of the amount of amniotic fluid, and compares it with the table.

When determining the IAI, the sonologist visually divides the cavity of the amniotic sac into 4 equal parts and in each determines the space that is filled with water and does not contain parts of the baby's body (vertical pocket). If the largest pocket has a depth of 2 cm or less, oligohydramnios is diagnosed; if the depth is more than 8 cm, polyhydramnios is diagnosed.

Gynecologists distinguish different forms of polyhydramnios:

1 Relative polyhydramnios- a slight deviation from the norm at this time, usually associated with the bearing of a large fetus, and in the absence of other pathologies, it can be safe for the woman and the fetus.

2 border state, or a tendency to polyhydramnios during pregnancy - a case when the amount of water reaches the upper limit of the norm, and it is possible that in the future their excess may appear.

Due to polyhydramnios, a woman may not develop labor activity, so in the last weeks she should be under the supervision of doctors, and if necessary, she is done.

Polyhydramnios during pregnancy: treatment

How to treat polyhydramnios during pregnancy depends on the cause of the disorder. If amniotic fluids accumulate due to a woman's illness, appropriate therapy is needed.

In severe cases, with a sharp deterioration in the mother's condition, it is necessary to terminate the pregnancy in order to save the woman's life. If the situation is not so critical, the pregnant woman will simply have to spend some time in the hospital and undergo a course of treatment to save the baby.

Polyhydramnios during pregnancy is a pathological condition in which the amount of amniotic fluid exceeds the levels considered normal for a certain period.

Amniotic fluid ensures the full intrauterine development of the unborn baby. They protect the fetus from external influences and enable it to move, participate in the metabolic process and prevent clamping of the umbilical cord. The amniotic fluid is regularly replaced (about every 3 hours) and gradually increases. If at week 10 the volume is approximately 30 ml, then in the prenatal period it is already 1-1.5 liters.

They talk about polyhydramnios when there is more than one and a half liters of fluid in the later stages.

Causes of polyhydramnios during pregnancy

The exact cause of polyhydramnios has not been established to date. There is an opinion that genetic (family) predisposition has a certain value. Allocate a risk group; in women included in it, this pathology of pregnancy is much more common.

Predisposing factors:

large size of the fetus;
multiple pregnancy;
kidney pathology;
Rhesus conflict;
infections;
pathology of the excretory system of the unborn child.

Note:the likelihood of developing a pathological condition increases with infection with viruses, and. Often leads to polyhydramnios.

Among the predisposing factors is a violation of the function of swallowing in the fetus. In the later stages, he absorbs up to 4 liters of amniotic fluid daily.

Symptoms

There are a number of clinical signs that make it possible to suspect polyhydramnios during pregnancy.

The following symptoms may appear:

Note:the cause of shortness of breath is the so-called "high standing" of the dome of the diaphragm.

According to the nature of the course, polyhydramnios is divided into acute and chronic. Of particular danger is the acute variant of development, most often diagnosed during II trimester. It is characterized by a sharp increase in the volume of water in a very short time - from several hours to 1-3 days. The circumference of the patient's abdomen at the level of the navel increases rapidly, and in the inguinal and lumbar region there is pain of medium or high intensity. During the examination, swelling of the abdominal wall and hypertonicity of the myometrium are determined.

In the chronic form, the volume of amniotic fluid increases gradually, but the likelihood of complications is also very high.

According to the severity of the course of the pathological process, mild, moderate and severe degrees are distinguished.

Consequences of polyhydramnios during pregnancy

Polyhydramnios during pregnancy in many cases leads to serious consequences, especially in the absence of early diagnosis and adequate medical care.

Possible complications of the pathological condition are:

spontaneous abortion (in almost 30% of cases);
(almost 40% of cases);
fetoplacental insufficiency;
early and massive discharge of water;
intrauterine malformations (most often the nervous system and gastrointestinal tract of the fetus suffer);
, oblique or transverse presentation;
premature detachment of the placenta;
childbirth ahead of time.

Fetoplacental insufficiency leads to a lack of oxygen by the fetus (), which can cause the death of the unborn baby or serious developmental disorders.

If a bacterial or viral infection has led to the pathology, the probability of infection of the fetus is high.

According to medical statistics, almost 20% of patients diagnosed with polyhydramnios develop late (preeclampsia).

Important:pathology can lead to a weakening of labor activity in the 1st and 2nd periods, since there is an overstretching of the uterine wall, which negatively affects muscle tone. During childbirth, against the background of a rupture of the fetal bladder and a massive outpouring of water, the umbilical cord or parts of the child's body may fall out. Often postpartum hemorrhage develops.

Diagnostics

The basis for suspicion of polyhydramnios is the data of the anamnesis (the presence of certain symptoms) and general examination (with measurement of the circumference of the abdomen).

During the examination, it is necessary to study the parameters of blood (and) and urine. In case of Rh-conflict, antibodies are examined.

The laboratory also examines the smear for the possible presence of pathogenic microflora.

During palpation, the tension of the uterus and the discrepancy between its size (increasing) and the duration of pregnancy are determined. The high mobility of the fetus is also characteristic; he is constantly trying to change his position.

Important:excessively free position of the fetus and its active movements often lead to entanglement with the umbilical cord, which is fraught with asphyxia.

Verification of the diagnosis is carried out in the course. With ultrasound, the largest area between the uterine wall and the fetus is measured, receiving the so-called. amniotic fluid index.

Table of indicators of amniotic fluid:

Among the very informative diagnostic methods are CTG (cardiotocography is needed to assess the condition of the fetus) and dopplerometry.

Treatment of polyhydramnios during pregnancy and prognosis

If mild or moderate severity is detected, obstetrician-gynecologists make every effort to keep the pregnancy up to physiological delivery. In severe cases, disorders of vital functions are possible, therefore, early (operative) delivery is often indicated to save the patient's life.

To determine the medical tactics, it is important to identify the factors that provoked the pathological condition.

If multiple pregnancy is due to infection, bacterial pathogens require(it is advisable to prescribe broad-spectrum drugs - Rovamycin or Erythromycin).

Important:during pregnancy, the use of tetracycline antibiotics is unacceptable!

According to indications, diuretics are prescribed (Hypothiazid, Furosemide), and and.

To improve uterine and placental blood flow, Actovegin and Curantil are recommended.

Note:pregnant women diagnosed with polyhydramnios should have daily cardiotocography, weight and blood pressure measurements. Ultrasound and dopplerography to assess uterine and placental blood flow are performed at least weekly.

Polyhydramnios may be an indication for an abdominal amniocentesis procedure, during which a puncture is performed, followed by a slow removal of excess amniotic fluid (pumped up to 200 ml).

With a weakened labor activity, its drug stimulation is carried out.

With a mild degree, therapy can be carried out at home, but moderate severity is already becoming an indication for hospitalization.

The prognosis for the chronic form of polyhydramnios is quite favorable. If there are no contraindications, childbirth is carried out naturally.

To prevent a sudden rupture of the fetal bladder, they resort in advance to a puncture of the membranes - amniotomy. Through this procedure, the amniotic fluid is poured out in a thin stream, and the uterus contracts. In emergency cases, it is shown.

Polyhydramnios is a pathological condition, which is expressed in the form of excessive accumulation of amniotic fluid in the uterus during pregnancy.

The volume of amniotic fluid or amniotic fluid during pregnancy changes, for example, in the tenth week their amount should not exceed 30 ml, in the fourteenth - 100 ml, and in the last trimester the volume of amniotic fluid varies within 1000-1500 ml. If these norms are exceeded in terms of the amount of amniotic fluid, polyhydramnios occurs during pregnancy.

In medical practice, acute and chronic polyhydramnios occur, it all depends on the severity. For example, with a mild degree of polyhydramnios, the excess fluid in the uterus is insignificant, but if the volume of water is significantly higher than normal, we are talking about severe polyhydramnios.

Pregnant women diagnosed with polyhydramnios are recommended to be under continuous medical supervision in order to prevent the development of serious complications. If, with this diagnosis, a woman did not have circulatory and respiratory disorders, specialists until the last try to keep the pregnancy until the natural process of delivery, otherwise it is resolved prematurely, since it poses a threat to the woman's life.

Treatment of this pathology is carried out taking into account the severity of the condition of the expectant mother. If such an anomaly in a pregnant woman is not very pronounced, then it can disappear on its own and without the intervention of doctors.

In the treatment of severe and acute polyhydramnios, an amniotomy (or opening of the amniotic sac) is often prescribed to drain excess amniotic fluid.

Symptoms of polyhydramnios.
Symptoms of the manifestation of such a pathology of pregnancy can be very different, due primarily to the pressure of the enlarged uterus on nearby organs. For example, in acute polyhydramnios, the cases of which are quite rare, and which occur mainly in the early stages of bearing a child, there is a rapid increase in the volume of amniotic fluid, heaviness appears in the abdomen and its rapid increase in size. At the same time, the expectant mother may experience pain in the lower back and perineum of an acute nature, swelling of the lower extremities, vulva and abdominal wall, shortness of breath or difficulty breathing, decreased urination. In addition, a pregnant woman has an increase in blood pressure, and, in addition, it is difficult to listen to the fetal heartbeat and feel it with your fingers.

Chronic polyhydramnios in most cases manifests itself in the third trimester of pregnancy. I must say that the symptoms in this case are less pronounced than with an acute degree of polyhydramnios: the size of the abdomen increases gradually, allowing the woman to adapt to them. However, it is worth noting that in this option there are various diseases of the mother during pregnancy. These include diabetes mellitus, bacterial or infectious diseases transferred by the expectant mother, kidney and cardiovascular diseases.

Causes of polyhydramnios.
It often happens that the causes of polyhydramnios remain unclear. But the most common causes of this condition are:

congenital pathologies in the development of the fetus that affect the development of the gastrointestinal tract, kidney or heart, the central nervous system of the child;
deviations in a child of a chromosomal nature;
pregnancy with identical twins, during which one fetus has polyhydramnios and the other has oligohydramnios;
diabetes mellitus, pyelonephritis, metabolic disorders and body fluids;
diseases of the cardiovascular system;
fetal anemia;
Rh-conflict of the blood of the mother and child (the mother has a negative Rh factor, and the father has a positive one);
infections (rubella, cytomegalovirus);
bacterial or infectious diseases suffered by a pregnant woman before conception or during pregnancy;
placental tumor.

Complications of polyhydramnios:

urinary tract infections;
incorrect position of the fetus in the uterine cavity, which requires a caesarean section;
increased blood pressure;
pathological growth of the fetus;
premature rupture of the fetal bladder with the outflow of amniotic fluid;
prolapse of the umbilical cord;
premature birth;
premature exfoliation of the placenta;
stillborn children;
high risk of postpartum hemorrhage against the background of weak uterine contractility.

The earlier polyhydramnios develops, the higher the level of fluid accumulated in the uterus, and the higher the likelihood of complications.

Diagnosis of polyhydramnios.
Diagnosis of this pathological condition during pregnancy is carried out on the basis of the woman's complaints. To make a diagnosis, an ultrasound examination of the fetus is prescribed, in which the amount of amniotic fluid is determined and the "amniotic index" is calculated. If the obtained indicator exceeds the norm, polyhydramnios is put.

In addition, the doctor may prescribe additional studies:

The procedure of amniocentesis, in which samples of amniotic fluid are taken for analysis, containing fetal cells, the products of its vital activity.
A glucose uptake test, which is a screening test for gestational diabetes (which occurs during pregnancy). The woman is given syrup to drink, and half an hour later, blood is taken for analysis to determine the level of glucose. If the blood sugar level exceeds acceptable limits, an additional glucose uptake test is performed, which reveals the presence or absence of gestational diabetes.
Biochemical analysis of a pregnant woman's blood serum, which determines the levels of substances associated with certain birth defects.
Karyotyping or analysis of the quality and quantity of chromosomes for all 23 pairs of chromosomes. For analysis, samples of amniotic fluid or placenta are used, which are taken during amniocentesis or chorionic biopsy.

Treatment of polyhydramnios in pregnant women.
The effectiveness of treatment directly depends on the establishment and elimination of the cause of the development of polyhydramnios, for which the specialist prescribes some examinations:

Ultrasound of the fetus and dopplerography (with its help, vessels, the fetus, uterus and umbilical cord are examined), in which the condition of the uterus and fetus, as well as blood flow in the placenta, is established.
CTG (cardiotocography) of the fetus, in order to assess the general condition.
Blood test for intrauterine infection.
Blood test and smear for sexually transmitted infections (chlamydia, mycoplasma, ureaplasma).
In the presence of a negative Rh factor, a woman in position must take a blood test for antibodies.

Taking into account the causes and severity of this pathology, appropriate treatment is prescribed. So in the case of unexpressed polyhydramnios and polyhydramnios of moderate severity, treatment with medications is used, both in outpatient (mild) and inpatient conditions (with polyhydramnios of moderate severity). In this case, the pregnancy is maintained until its natural physiological completion (delivery) with continuous treatment. Usually, women are prescribed antibiotics (except tetracycline), diuretics (diuretics), vitamins (hypothiazid, B vitamins), immunomodulatory therapy. Also at 24-38 weeks of pregnancy, a woman is prescribed Indomethacin. If the measures taken do not bring a positive result, and polyhydramnios continues to develop, turning into a severe degree, while there are all signs of intrauterine suffering of the fetus, in most cases, pregnancy is resolved ahead of schedule. With weakness of labor activity, appropriate treatment is also applied (drugs are used no earlier than two hours after the outflow of amniotic fluid).

How to alleviate the condition with polyhydramnios on your own?
With shortness of breath, you should rest more, avoid climbing to the floor without an elevator, do all household chores slowly.

With heartburn against the background of uterine pressure on the stomach:

should eat small meals as often as possible;
do not eat at night and eat immediately before bedtime;
you need to give up foods and drinks that provoke it (fatty foods, carbonated drinks, etc.);
put pillows under your back before going to bed (to form a reclining position);
Take antacids as directed by your doctor.

If new symptoms occur or the condition worsens, call your doctor right away.

Influence of polyhydramnios on the condition of a pregnant woman.

Feelings of pain and discomfort.
Complication of the process of childbirth: weakness of contractions, early detachment of the placenta, excessive bleeding against the background of excessive stretching of the uterus.
Complications during the recovery period.

The effect of polyhydramnios on the fetus.

The occurrence of various defects and pathologies in the development of the fetus.
perinatal death.
Asphyxia of the fetus against the background of a weakening of labor activity, which negatively affects the general condition of the baby and its central nervous system.

Prevention.
Polyhydramnios during pregnancy is a rather serious phenomenon, even in the case of a mild degree of pathology, because it indicates the presence of disorders during pregnancy, certain diseases that can seriously harm the health of a woman and a child. Therefore, it is important to take preventive measures to prevent the development of this phenomenon. These, first of all, include various surveys that will help to timely identify factors contributing to the development of polyhydramnios. It is also recommended to adhere to a certain diet, consume a certain amount of fluid, and often be in the fresh air, taking walks. And most importantly, strictly follow the recommendations of the doctor leading the pregnancy, take all the vitamins and prescribed drugs, and also undergo the prescribed procedures. Revealed polyhydramnios at the initial stage of development is simply, quickly and effectively treated without harm to the health of the mother and fetus.

The entire period of intrauterine development, the child spends in the fetal bladder filled with amniotic fluid or amniotic fluid.

Amniotic fluid, which has a complex chemical composition, is necessary for the normal life and development of the fetus, it protects the unborn child from infections and external influences, and ensures freedom of movement.

The composition and amount of amniotic fluid are constantly changing throughout pregnancy, the maximum volume of fluid inside the fetal bladder is reached by 32 weeks, then gradually decreases and by the end of pregnancy is about 1.5 liters.

To assess the amount of amniotic fluid, the amniotic fluid index is used, which is determined during an ultrasound examination by summing up the four values of the amniotic space on the monitor, the vertical size of the amniotic fluid, measured in mm, is displayed in black. To obtain these data, during the examination, the uterus is conditionally divided into 4 squares, the largest space in each of them is measured, then the obtained indicators are summarized.

Below is a table of the norm of the amount of amniotic fluid for different periods of pregnancy. If the amniotic fluid index goes beyond the upper limit of these norms, then, in accordance with the gestational age, the doctor speaks of polyhydramnios. If this index slightly exceeds the norm, then it is customary to talk about moderate polyhydramnios during pregnancy.

Table of norms of amniotic fluid at different stages of pregnancy

Pregnancy period, weeks	Average normal indicator, mm	Probable fluctuations, mm

Amniotic fluid index at different stages of pregnancy

Gestational age,	Amniotic fluid index, mm
	percentile

You need to focus on the middle column of the 50th percentile, the 2.5th shows the lower, and the 97.5th shows the upper limits of the norm. That is, if the vertical value of amniotic fluid is slightly higher than the 97.5 percentile, this indicates moderate polyhydramnios.

For the diagnosis of polyhydramnios, an ultrasound examination, doplerometry, examination by a doctor are carried out, and to confirm the diagnosis, it is carried out.

Causes

There are several reasons why moderate polyhydramnios develops. These include:

- large fruit;
- multiple pregnancy (two or more fetuses);
- Rh-conflict of mother and fetus;
- the presence of a woman with chronic diseases;
- intrauterine infections;
- various pathologies of fetal development (including genetic ones);
- late toxicosis ()
- placental disorders;
- diabetes mellitus in a pregnant woman;
- anatomical features of the structure of the uterus.

In general, the causes of moderate polyhydramnios have not been fully studied to date.

signs

Even before the examination and examination, a woman may suspect moderate polyhydramnios for the following signs:

- swelling;
- increased heart rate;
- heaviness and pain in the abdomen;
- the circumference of the abdomen along the navel increases sharply and reaches 100-120 cm;
- weakness and general malaise;
- shortness of breath, which is a consequence of the high standing of the fundus of the uterus and the pressure of the diaphragm on the lungs.

If you suspect that you have developed even moderate polyhydramnios, a pregnant woman should contact her doctor in order to establish an accurate diagnosis and conduct timely treatment, which can be either outpatient or inpatient. It necessarily includes the appointment of vitamin preparations, diuretics and antibiotics. The process is usually simple and treatment is prescribed after establishing the cause of the development of this pathology. And it is necessary to carry it out, since polyhydramnios can have serious consequences for the child:

- rupture of membranes and premature birth;
- cord entanglement (including multiple) and complicated childbirth (weak labor activity) and others.

But with timely and adequate treatment under the supervision of a doctor observing the pregnancy, moderate polyhydramnios is not so dangerous and does not carry the described consequences.

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