POLYHYDRAMNIOS

Polyhydramnios is defined as a state where liquor amnii exceeds 2000 ml or when A.F.I. is more than 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 Rh iso-immunization DM DM Placental (less than 1%) Placental chorioangioma Placental chorioangioma Circumvallate placental syndrome Circumvallate placental syndrome Fetal (18%) Multiple pregnancies Multiple pregnancies Fetal anomalies Fetal anomalies Idiopathic (65%)

Clinical types: Depending on the rapidity of onset hydramnios can be Acute – rare – appear in a matter of few days 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 Chronic – more common 10 times more commoner to acute appear in a matter of few months

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%

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 Acute abdomen - abdominal pain, nausea, vomiting Breathlessness which increases on lying down position Breathlessness which increases on lying down position Palpitation Palpitation Oedema of legs, varicosities in legs, vulva and hemorroids Oedema of legs, varicosities in legs, vulva and hemorroidsSigns: Patient looks ill, with out features of shock Patient looks ill, with out features of shock Oedema of legs with signs of PIH Oedema of legs with signs of PIH Abdomen unduly enlarged with shiny skin Abdomen unduly enlarged with shiny skin Fluid thrill may be present Fluid thrill may be present Internal examination shows taking up of cervix or even dilatation with bulging membranes

Chronic Polyhydramnios : More common than acute 10% more common Since accumulation of liquor is gradual and so patient may be symptomatic or asymptomatic. Symptoms are mainly due to mechanical causes Dyspnoea is more in supine position Dyspnoea is more in supine position Palpitation Palpitation Oedema Oedema Oliguria may result from ureteral obstruction by enlarged uterus Oliguria may result from ureteral obstruction by enlarged uterus Pre-eclampsia 25 %( oedema, hypertension and proteinuria)

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 Auscultation Fetal heart sounds are not heard distinctly

Internal examination : Cervix is pulled up Cervix is pulled up May be sometimes dilated and admits tip of finger through which bag of membranes which is tense is felt. 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 complications like Pre ecclampsia Pre ecclampsia PROM PROM Preterm labour Preterm labour Placental abruption Placental abruption Cord prolapse Cord prolapse