Hydramnios (Polyhydramnios) : Is It Serious?

Polyhydramnios or Hydramnios simply means excess amniotic fluid. In the mother’s womb, the baby grows in a sac called amniotic sac which is filled with fluid, called amniotic fluid or liquor. 

The volume of amniotic fluid increases as the baby grows to facilitate appropriate growth and expansion of the structure and organs of the baby.  

Amniotic fluid is around 50 ml at the end of the third month and increases to almost 400 ml at 20 weeks. It is maximum, 800 to 1000ml, around 34 to 36 weeks and around 600 to 800 ml at 39 to 40 weeks.

“Polyhydramnios or excessive accumulation of amniotic fluid occurs rarely, in 1-2% of all pregnancies. Mild polyhydramnios occurs in most of these cases,” says Dr. Anita Sabherwal Anand, Consultant Obstetrician – Gynecologist at Sitaram Bhartia Hospital in South Delhi. 

Polyhydramnios treatment is advised depending on the severity of the condition. 

Prakriti Raheja was 26 weeks pregnant when she visited her mother who commented that her baby bump was unusually big. Her mother advised her to watch what she ate as her baby seemed to be growing very fast. 

Prakriti reassured her mother that she would consult her dietician in her next visit to the hospital.

 “When Prakriti visited us, she seemed a little uncomfortable walking and breathing at 7 months. Upon examination, her uterus definitely seemed bigger, as it would be at 32 weeks in contrast to her actual 28 weeks, “ says her gynecologist, Dr. Anita.

“We performed an ultrasound, which revealed mild polyhydramnios.” 

How is Hydramnios diagnosed?

Hydramnios is diagnosed by an obstetric ultrasound. The amniotic fluid volume is described in two methods:

  • The Single Deepest or Single Largest Pocket of Amniotic Fluid. The uterus is divided into four quadrants and the largest pocket of fluid is identified and measured in cms. The normal range is 2 to 8 cm.

    Mild polyhydramnios is when the single pocket is more than 8cm.

    A pocket deeper than 15 cm denotes severe hydramnios. This method is used in early pregnancies, around 20 to 26 weeks. 
  •  Amniotic fluid index (AFI): Beyond 26 to 28 weeks, amniotic fluid pockets are measured in each quadrant and  the sum of four quadrants is labelled as AFI. The normal values are between 8 to 24 cm. AFI of 25 cm or more indicates mild polyhydramnios. In severe cases of hydramnios, AFI is more than 35cm.

“Prakriti’s ultrasound confirmed the diagnosis of mild polyhydramnios,” says Dr. Anita.

We then counselled her about the condition and polyhydramnios treatment

What is the most common cause of polyhydramnios?

The causes of polyhydramnios may vary based on the condition.

  •  Mild polyhydramnios: In 80% cases there is no cause or reason for the condition. Occasionally there is an underlying disorder. The most common causes are deranged blood sugar levels or gestational diabetes. It is more common in twins. In rare cases there may be a small congenital defect in the baby, mostly involving the intestines. 
  • Severe polyhydramnios: If hydramnios is seen particularly in the level II scan, there is a high chance of congenital or genetic defects in the baby or infections like TORCH. These are the only cases which require thorough evaluation of the fetus.

Polyhydramnios is usually seen in the third trimester and in the majority of cases it is mild. 

What are the signs and symptoms of polyhydramnios?

Women with mild polyhydramnios usually don’t exhibit any symptoms. In some mild cases and in most moderate to severe cases, you will have symptoms such as:

  • Breathlessness and discomfort, especially while sitting and lying down due to the                      pressure of a large uterus.
  • Heartburn 
  • Frequency and urgency in passing urine
  • Difficulty passing stool (constipation)
  • Big uterus leading to backache and swelling in the feet and ankles

Is polyhydramnios serious?

For a majority of women suffering from hydramnios, the condition is not serious. 

In very few instances, polyhydramnios may lead to  complications such as 

  • Premature labour pains and premature birth
  • Sudden breaking of water bag, in which large amounts of fluid may be released, which can cause separation of placenta before delivery, a condition known as abruption. This is associated with bleeding and can have grave consequences for the baby and mother.
  • A higher risk of induced labour and a cesarean section

Severe cases are associated with poor fetal outcome or even stillbirth. 

Prakriti became afraid upon hearing about the complications. She wanted to know about the treatment for polyhydramnios and what could be done to keep her and her baby safe. 

What is the recommended Hydramnios treatment ?

You may require treatment if you experience persistent and severe symptoms like breathlessness or abdominal pain. 

“If your doctor deems appropriate, she may advise either of these options.”

  • Drainage through Amniocentesis: In this a needle is inserted into the uterus and the excess fluid is removed. There is a small risk of preterm labour and complications.  
  • Oral medications: Based on your history and your baby’s health, medications may be prescribed to reduce the baby’s urine output.

Women with mild polyhydramnios do not require treatment as the condition resolves with time.

Polyhydramnios treatment involves intensive monitoring to ensure you and your baby are well. 

This will be done through regular checkups with emphasis on weight gain, blood pressure and blood sugar monitoring. The baby’s progress will be assessed through serial ultrasounds. 

A non-stress test may be done near term. In this a probe is strapped around your belly and your baby’s heart rate is recorded on the monitor for 20 to 40 minutes. 

The doctor informed Prakriti that she did not need any polyhydramnios treatment as her condition was not serious.

Still, Prakriti felt like she should do something and so inquired about home remedies.

Can polyhydramnios treatment be done at home?

There is no home treatment for polyhydramnios.

“Depending on your condition, you may be advised bedrest.”

Prakriti asked the doctor whether she should modify her diet in any way. 

“There is no specific polyhydramnios diet. Make sure your pregnancy diet consists of fruits, vegetables, protein and whole grains in equal measure.”

“It would be best to stay away from sweets, biscuits, juices and refined sugars.”

Having understood that all she needed to do was to wait and watch and be careful of her diet, she finally brought up her main concern. 

Is normal delivery possible with polyhydramnios?

A normal delivery is possible with mild polyhydramnios. In cases of moderate or severe polyhydramnios, it depends on how your pregnancy is progressing.

Satisfied with the honest discussion around polyhydramnios and its treatment, Prakriti understood that she was in good hands. 

“As expected, Prakriti was able to carry forth her pregnancy till 40 weeks when she went into labour. She delivered normally and both mother and baby are absolutely fine,” completes Dr. Anita.

dr-anita-sabherwal-anand-imageMedically Reviewed by Dr. Anita Sabherwal Anand
MBBS, Lady Hardinge Medical College, University of Delhi (1992); MD (Obstetrics & Gynaecology), Lady Hardinge Medical College, University of Delhi (1997); DNB Secondary (Obstetrics & Gynaecology), National Board of Medical Education, New Delhi (1999)

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