Management

 If the maternal symptoms are severe (e.g breathlessness),

an aminoreduction can be considered.
 Indomethacin can be used to enhance water retention, and
thus reduces fetal urine output.
 In cases of idiopathic polyhydramnios, the baby must be
examined before its first feed by a paediatrician.
A nasogastric tube should be passed to ensure there is not a
tracheoesophageal fistula or oesophageal atresia.

*There is no specific treatment, other than monitoring the mother closely. If

the fluid volume becomes excessive and the risks of premature labour is high,
then an amniocentesis can be done to drain away some of the excess fluid.
UTZ Assessment of Amniotic Fluid Volume

 Single deepest pocket measurement

uterus is divided into four quadrants. The amniotic fluid volume is
measured vertically in the deepest amniotic fluid pocket. Values
below 2 cm indicate oligohydramnios, values over 8 cm indicate
polyhydramnios. With this method, polyhydramnios is classified as
mild, moderate or severe. Mild polyhydramnios is characterized by a
value of 8–11 cm, moderate polyhydramnios by a value between 12–
15 cm and severe polyhydramnios by values above 16 cm.
 The 4-quadrant method (Amniotic Fluid Index)
deepest amniotic pocket in each of the four quadrants is measured
vertically and the values added together. The uterus is divided
vertically into two halves by an imaginary line along the linea nigra.
An imaginary horizontal line through the umbilicus divides the uterus
into an upper and a lower half. The Amniotic Fluid Index (AFI) is the
sum of measurements of all four quadrants. Based on AFI values
obtained during prenatal screening, some clinicians categorize
polyhydramnios into three groups according to severity: mild
polyhydramnios (AFI of 25–30 cm), moderate polyhydramnios (30.1–
35 cm) and severe polyhydramnios (≥ 35.1 cm)
 1st tri 2nd tri

placenta Amniotic fluid Fetal fluid

void breathe
swallow

GDM HPL

hyperglycemia

Fetal “

Glucose
attracts h2o
Approximate volume at different gestational
periods:
10 weeks – 30 ml
20 weeks – 250 ml
30 to 40 weeks – 500 to 1500 ml

Polyhydramnios
clinical types
Chronic Acute
(most common) (rarer)

 excess amniotic fluid  excess amniotic fluid

accumulates gradually collects rapidly

sonographical types

 Mild hydramnios (80%)

a pocket of amniotic fluid measuring 8 to 11 cm
 Moderate hydramnios (15%)
a pocket of amniotic fluid measuring 12 to 15 cm
 Severe hydramnios (5%) TTTS
a pocket of amniotic fluid measuring 16 cm or more
Polyhydramnios
Polyhydramnios is
the excessive
accumulation of
amniotic fluid — the
fluid that surrounds
the baby in the
uterus during
pregnancy.
Polyhydramnios
occurs in about 1 to
2 percent of
pregnancies.

Fetal causes Maternal causes

a. Congenital a. GDM
anomalies
b. Uniovular twins