2. •Definition:
• Polyhydramnios is defined as a state where liquor amnii exceeds 2000 ml or when A.F.I.
is more than 24-25 cm or a single pocket of amniotic fluid is greater than 8 cm by
ultrasonography.
• Incidence: 1% to 2 % of the cases
• Causes
• Maternal (15%)
Rh iso-immunization
DM
• Placental (less than 1%)
Placental chorioangioma
Circumvallate placental syndrome
• Fetal (18%)
Multiple pregnancies
Fetal anomalies
• Idiopathic (65%)
3. • Clinical types: Depending on the rapidity of onset
hydramnios can be
Acute – rare – appear in a matter of few
days
Chronic – more common 10 times more
commoner to acute appear in a matter of few
months
4. • Routine OBH
• History suggestive of Rh iso- immunization such as still birth, fetal hydrops,
jaundice in new born requiring exchange transfusion etc.
• History suggestive of DM – Previous big baby fetal death at 35 weeks,
classical symptoms of DM like polyurea, polydypsia, polyphagia
• History of Drug intake especially in First trimester
• History of Previous fetal anomalies like Anencephaly-risk of recurrence is
2%
5. • Acute Polyhydramnios: Onset is acute usually occurs before
20 weeks of pregnancy and presents usually with symptoms and labour starts
before 28 weeks of pregnancy.
• It may present as
Acute abdomen - abdominal pain, nausea, vomiting
Breathlessness which increases on lying down position
Palpitation
Oedema of legs, varicosities in legs, vulva and hemorroids
• Signs:
Patient looks ill, with out features of shock
Oedema of legs with signs of PIH
Abdomen unduly enlarged with shiny skin
Fluid thrill may be present
• Internal examination shows taking up of cervix or even dilatation with bulging
membranes
6. • Chronic Polyhydramnios: More common than
acute 10% more common
• Since accumulation of liquor is gradual and so patient may be
symptomatic or asymptomatic.
• Symptomsare mainly due to mechanical causes
Dyspnoea is more in supine position
Palpitation
Oedema
Oliguria may result from ureteral obstruction by enlarged
uterus
• Pre-eclampsia 25 %( oedema, hypertension and proteinuria)
7. Signs GPE
• Patient may be dyspnoic at rest
• Pedal Oedema
• Evidence of PIH
Abdominal examination
Inspection
• Abdomen is markedly enlarged globular with fullness in flanks
• Skin over the abdomen is tense shiny with large striae
Palpation
• Height of uterus is more than the corresponding periods of Amenorrhoea
• Abdominal girth is more
• Fetal parts cannot be well defined external ballotment is more easily elicited
• Malpresentations are more common and presenting part is usually high up
• Fluid thrill is present
Auscultation
• Fetal heart sounds are not heard distinctly
8. Internal examination :
Cervix is pulled up
May be sometimes dilated and admits tip of finger through
which bag of membranes which is tense is felt.
• At times patient may present with complicationslike
Pre ecclampsia
PROM
Preterm labour
Placental abruption
Cord prolapse