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1. POLYHYDRAMNIOS

2. POLYHYDRAMNIOS
INTRODUCTION
DEFINITION
INCIDENCE
ETIOLOGY
CLINICAL TYPES
INVESTIGATIONS
COMPLICATIONS
MANAGEMENT

3. INTRODUCTION
Amniotic fluid normally increase in amount
throughout pregnancy from a few milliliters to a liter at
38th week. The fluid is not static ; the water and
solutes in it are change every few hours. There are
two chief abnormalities of amniotic fluid.
 Polyhydramnios
 Oligohydramnios
Polyhydramnios is a medical condition excess
of amniotic fluid in the amniotic sac. There are 2
clinical varieties of polyhydramnios.
 Chronic
 Acute
The opposite to Polyhydramnios is Oligohydramnios a
deficiency of amniotic fluid.

4. DEFINITION
Polyhydramnios is defined as a state where liquor
amnii exceeds 1500 to 2000 ml.
Clinical Definition: The excessive accumulation
of liquor amnii causing discomfort to the patient or when
a imaging help needed to substantiate the clinical
diagnosis of the lie and presentation of foetus.
INCIDENCE
The incidence varies from 1-2% of the cases. it is
more common of multipare than the premigravidae. it
occurs 1 in 1000 pregnancies.

5. ETIOLOGY
 Fetal Anomalies: Congenital fetal malformation is
associated with polyhydramnios in about 20% cases.
⚫ Anencephaly
⚫ Open Spina Bifida
⚫ Esophageal or DuodenalAtresia
⚫ Facial Cleft
⚫ Hydrops Fetalis
 Placenta: Chorioangioma of the placenta.
 Multiple Pregnancies: Hydromnios is more
common in uniovular twins, usually affecting the
second sac.
 Maternal:
⚫ Diabetis
⚫ Cardiac or Renal Disease

6. CLINICAL TYPES
Depending on the rapidly of onset, hydramnios may
be:
 Chronic: It is the commonest onset in insidious
taking few weeks.
 Acute: It is extremely rare acutely on pre-existing
chronic variety. The chronic variety is 10 times
commoner than the acute one.

7. CHRONIC POLYHYDRAMNIOS
 Symptoms:
⚫ Dyspnoea.
⚫ Palpitation.
⚫ Oedema of legs.
 Signs:
⚫ The patient may be dyspnoea state in the lying down
position.
⚫ Evidence of pre-eclampsia (edema, hypertension &
protenuria) may be present.

8. ABDOMINAL EXAMINATION
 Inspection:
⚫ Abdominal marked enlarge.
⚫ The skin is tense shiny with large straiae.
 Palpation:
⚫ Height of the uterus is more than the period of
amenorrhoea.
⚫ Girth of the abdomen round the umbilicus more than the
normal.
⚫ Foetal parts can’t be well defined: so also the
presentation or the position.
 Auscultation:
⚫ Foetal heart sound is not heard easily.

9. INVESTIGATION
 USG:
⚫ Amniotic fluid index is more than 25cm.
⚫ To note the lie and presentation of the foetus.
⚫ To diagnose any foetal congenital malformation.

10. COMPLICATION
 Maternal:
⚫ During Pregnancy:
 Pre eclampsia.
 Malpresentation.
 Pre rupture of the membrane.
 Pre term labour.
⚫ During Labour:
 Early rupture of the membrane.
 Cord prolaps.
 Increase operative delivery due to malpresentation.
⚫ Puerperium:
 Sub involuation
 Increase puerperial morbidity due to infection resulting from
increase operative interpherence and blood loss.
 Foetal Complication:
⚫ Foetal death are mostly due to prematurity & congenital
abnormalities.

11. MANAGEMENT
 Principles Of Management:
⚫ To relieve the symptoms.
⚫ To find out the causes.
⚫ To avoid and to deal with the complication.
 Supportive Therapy:
⚫ Bed rest, treatment associate with condition like
preeclampsia.
⚫ Investigation are done to exclude congenital foetal
malformation.
⚫ Further management depends on
 Response to treatment.
 Period of gestation.
 Presence of foetal malformation.
 Associated complicating factors.

12. ⚫ Response to treatment is good means pregnancy is
continued.
⚫ Unresponsive:
 Pregnancy less than 37 weeks – Amniocentesis
 Pregnancy more than 37 week – Induction of labour is done.
⚫ Amniocentesis, termination of pregnancy.
 During Labour:
⚫ Usual management is followed.
⚫ If the uterine contration become sluggish, oxytocin
infusion may be started.
⚫ To prevent post partum haemorrhage.
⚫ IV administraion of methergin.