Polyhydramnios

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Polyhydramnios
Classification and external resources
Ultrasound Scan ND 145330 1455290 cr.png
ICD-10O40
ICD-9657
DiseasesDB10319
MedlinePlus003267
eMedicineradio/566
Patient UKPolyhydramnios
MeSHD006831
 
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Polyhydramnios
Classification and external resources
Ultrasound Scan ND 145330 1455290 cr.png
ICD-10O40
ICD-9657
DiseasesDB10319
MedlinePlus003267
eMedicineradio/566
Patient UKPolyhydramnios
MeSHD006831

Polyhydramnios (polyhydramnion, hydramnios, polyhydramnios) is a medical condition describing an excess of amniotic fluid in the amniotic sac. It is seen in about 1% of pregnancies.[1][2][3] It is typically diagnosed when the amniotic fluid index (AFI) is greater than 24 cm.[4][5] There are two clinical varieties of polyhydramnios:

The opposite to polyhydramnios is oligohydramnios, a deficiency in amniotic fluid.

Causes[edit]

Ultrasound Scan ND 152505 1531230 cr.png

In most cases, the exact cause cannot be identified. A single case may have one or more causes, including intrauterine infection (TORCH), rh-isoimmunisation, or chorioangioma of the placenta. In a multiple gestation pregnancy, the cause of polyhydramnios usually is twin-to-twin transfusion syndrome. Maternal causes include cardiac problems, kidney problems, and maternal diabetes mellitus, which causes fetal hyperglycemia and resulting polyuria (fetal urine is a major source of amniotic fluid).

A recent study distinguishes between mild and severe polyhydramnios and showed that Apgar score of less than 7, perinatal death and structural malformations only occurred in women with severe polyhydramnios.[6] In another study, all patients with polyhydramnios, that had a sonographically normal fetus, showed no chromosomal anomalies.[4]

Few cases are associated with fetal anomalies that impair the ability of the fetus to swallow (the fetus normally swallows the amniotic fluid), but these anomalies include:

Diagnosis[edit]

There are several pathologic conditions that can predispose a pregnancy to polyhydramnios. These include a maternal history of diabetes mellitus, Rh incompatibility between the fetus and mother, intrauterine infection, and multiple pregnancies.

During the pregnancy, certain clinical signs may suggest polyhydramnios. In the mother, the physician may observe increased abdominal size out of proportion for her weight gain and gestation age, uterine size that outpaces gestational age, shiny skin with stria (seen mostly in severe polyhydramnios), dyspnea, and chest heaviness. When examining the fetus, faint fetal heart sounds are also an important clinical sign of this condition.

Associated conditions[edit]

Fetuses with polyhydramnios are at risk for a number of other problems including cord prolapse, placental abruption, premature birth and perinatal death. At delivery the baby should be checked for congenital abnormalities.

Treatment[edit]

See also[edit]

References[edit]

  1. ^ Alexander, ES, Spitz, HB, Clark, RA. Sonography of polyhydramnios. AJR Am J Roentgenol 1982; 138:343
  2. ^ Hill LM; Breckle R; Thomas ML; Fries JK, Polyhydramnios: ultrasonically detected prevalence and neonatal outcome, Obstet Gynecol 1987 Jan;69(1):21-5, PMID 3540761
  3. ^ Hobbins JC; Grannum PA; Berkowitz RL; Silverman R; Mahoney MJ,Ultrasound in the diagnosis of congenital anomalies.,Obstet Gynecol 1979 Jun 1;134(3):331-45., PMID 453266
  4. ^ a b Y Barnhard; I Bar-Hava; MY Divon, Is polyhydramnios in an ultrasonographically normal fetus an indication for genetic evaluation?, Obstet Gynecol. 1995 Nov;173(5):1523-7.
  5. ^ Brady K, Polzin WJ, Kopelman JN, Read JA. Risk of chromosomal abnormalities in patients with idiopathic polyhydramnios. Obstet Gynecol 1992;79:234-8.
  6. ^ Bundgaard A, Andersen BR, Rode L, Lebech M, Tabor A, Prevalence of polyhydramnios at a Danish hospital--a population-based study. Acta Obstet Gynecol Scand. 2007 ; 86(12): 1427-31.
  7. ^ Seyberth HW. (2008). "An improved terminology and classification of Bartter-like syndromes.". Nat Clin Pract Nephrol. 4 (10): 560–7. doi:10.1038/ncpneph0912. PMID 18695706. 
  8. ^ "Hereditary disease: Bartter syndrome". Moldiag.de. Retrieved 2012-09-28. 
  9. ^ Piantelli G, Bedocchi L, Cavicchioni O, et al. (2004). "Amnioreduction for treatment of severe polyhydramnios". Acta bio-medica : Atenei Parmensis. 75. Suppl 1: 56–8. PMID 15301292. 

External links[edit]