Polyhydramnios is a condition seen in pregnancy. Necessary management should be taken to prevent further complications.

1. “HYDRAMNIOS”
MS LIPI MONDAL
SENIOR TUTOR, JCN

2. DEFINITION
• Anatomically, polyhydramios is defined as a state where liquor amnii exceeds 2,000 mL.
• Clinical definition states, the excessive accumulation of liquor amnii causing discomfort
to the patient and/or when an imaging help is needed to substantiate the clinical
diagnosis of the lie and presentation of the fetus. Sonographic diagnosis is made when
amniotic fluid index (AFI) is more than 24 cm & a deepest vertical pocket (DVP) is more
than 8 cm.

3. CONCEPT OF HYDRAMNIOS
• The volume of amniotic fluid increases steadily until 33 weeks of gestation. It plateaus
from 33-38 weeks, and then declines – with the volume of amniotic fluid at term
approximately 500ml.
• It is predominantly comprised of the fetal urine output, with small contributions from
the placenta and some fetal secretions (e.g. respiratory, oral).
• The fetus breathes and swallows the amniotic fluid. It gets processed, fills the bladder
and is voided, and the cycle repeats. Problems with any of the structures in this pathway
can lead to either too much or too little fluid.

4. ETIOLOGY
Fetal anomalies
Placental
abnormalities
Multiple pregnancy
Maternal causes Idiopathic

5. CLINICAL TYPES
• Depending on the rapidity of onset, hydramnios may be-
a. Chronic (onset is insidious taking few weeks)
b. Acute (onset is sudden, within few days or may appear acutely on pre-existing chronic
variety)
• Polyhydramnios may be-
a. Mild (DVP more than 8-11 cm)
b. Moderate (DVP : 12-15 cm)
c. Severe (DVP more than or equal to 16 cm)

6. SYMPTOMS

7. ABDOMINAL EXAMINATION
• Inspection
a. Abdomen is markedly enlarged, looks globular with fullness at the flanks.
b. The skin is tense, shiny with large striae.
• Palpation
a. Height of the uterus is more than the period of amenorrhea.
b. Girth of the abdomen round the umbilicus is more than normal.
c. Fluid thrill can be elicited.
d. Fetal parts cannot be well defined.

8. COMPLICATIONS
DURING PREGNANCY
• Pre-eclampsia
• Malpresentation
• PROM
• Pre-term labor
• Accidental haemorrhage
DURING LABOR
• Early rupture of membrane
• Cord prolapse
• Uterine inertia
• Retained placenta
• PPH
• Shock

9. MANAGEMENT

10. ABNORMALITIES OF PLACENTA

12. ABNORMALITIES OF UMBILICAL
CORD