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POLYHYDRAMNIOS

POLYHYDRAMNIOS
Definition

  1. amniotic fluid volume > 2 L at any stage in pregnancy
  2. > 8 cm x 8 cm pocket on U/S
  3. 1/250 deliveries
  4. up to 2/3 of fetuses with severe polyhydramnios have chromosomal problems
Causes

  1. idiopathic
    • most common
  2. maternal
    • DM: causes abnormalities of transchorionic flow (IDDM)
  3. maternal-fetal
    • chorioangiomas, multiple gestation, erythroblastosis
  4. fetal
    • chromosomal anomaly
    • respiratory - cystic adenomatoid malformed lung
    • CNS (anencephaly, hydrocephalus, meningocele)
    • GI (tracheoesophageal fistula, duodenal atresia)
  5. facial clefts, neck masses (interfere with swallowing)
Complications

  1. cord prolapse
  2. placental abruption
  3. malpresentation
  4. preterm labour
  5. uterine dysfunction and postpartum hemorrhage
  6. increased perinatal mortality rate
Clinical Features 

  1. pressure symptoms from overdistended uterus (dyspnea, edema, hydronephrosis) 
  2. uterus large for dates, difficulty palpating fetal parts and hearing fetal heart tones
Management

  1. find cause (40% idiopathic)
  2. complete fetal U/S evaluation
  3. mild to moderate cases require no treatment
  4. screen for maternal disease/infection as indicated 
  5. if severely symptomatic, hospitalize and consider therapeutic amniocentesis
  6. admit if contracting or cervix dilating
POLYHYDRAMNIOS POLYHYDRAMNIOS Reviewed by Radiology Madeeasy on January 10, 2011 Rating: 5
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