Polyhydramnios

Dr. Agus Rusdhy Hariawan Hamid,SpOG

Polyhydramnios is the pathologic

accumulation of excessive quantities of
amniotic fluid.
When polyhydramnios is diagnosed, a
thorough examination for underlying
abnormalities is indicated and the risk of
adverse pregnancy outcome is increased.

While the presence of polyhydramnios may

be idiopathic, it should alert the physician
that congenital or chromosomal anomalies
may be present.
Because pregnancies complicated by
polyhydramnios are at significantly
increased risk for perinatal mortality and
other complications, heightened
surveillance and monitoring, as well as
possible interventions must be considered.

Polyhydramnios complicates approximately 1% of pregnancies.

The amniotic fluid volume (AFV) increases from early in
pregnancy until term.
The AFV is kept in balance by fetal micturation, pulmonary
secretions, and fluid passing through membranes.
As pregnancy progresses, AFV constitutes a decreasing portion
of the total uterine volume.
It may represent 50% at 16 weeks gestation but only 17% at
term.
Normal AFVs generally increase from early pregnancy until
approximately 3638 weeks gestation, at which time the
maximum volume may be 1.01.5 L.
As the pregnancy approaches term, the volume may decrease,
which continues as the pregnancy goes past term.

The pathophysiology of polyhydramnios is dependent on the

underlying abnormality.
In pregnancies complicated by diabetes, maternal hyperglycemia
results in fetal hyperglycemia and increased fetal micturation.
When there are anatomic abnormalities, such as esophageal atresia,
fetal swallowing is impaired and may result in polyhydramnios.
Multiple gestations are at increased risk for polyhydramnios resulting
from twintwin transfusion syndrome.
Pregnancies complicated by abnormalities of the central nervous
system (CNS), such as anencephaly, neural tube defects, or
substance abuse,may have polyhydramnios from CNS depression.
Neuromuscular disorders with impaired fetal swallowing may also
result in polyhydramnios.
Fetal anemia, caused by Rh-isoimmunization, parvovirus infection, or
fetalmaternal hemorrhage, may cause polyhydramnios through
increased cardiac output.