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4.8 Polyhydramnios _ MSF Medical Guidelines

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5 views

4.8 Polyhydramnios _ MSF Medical Guidelines

Uploaded by

bizuneh lubago
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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4.

8 Polyhydramnios
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4.8.1 Acute polyhydramnios (rare but serious)

Diagnosis

Management

4.8.2 Chronic polyhydramnios

Diagnosis

Management

Excess amniotic fluid (more than 2 litres at term). T here are two clinical situations:
– In the second trimester: acute polyhydramnios;
– In the third trimester: chronic polyhydramnios.

4.8.1 Acute polyhydramnios (rare but serious)


Diagnosis
Rapid increase in the size of the uterus
Painful abdomen, abdominal pressure, dyspnoea
Distended, hard uterus, foetus cannot be palpated

Usually associated with foetal malformation, sometimes a complicated twin pregnancy.

Management
Do not intervene; let the patient abort or deliver spontaneously.

4.8.2 Chronic polyhydramnios


Diagnosis
More moderate increase in the size of the uterus, occurring in spurts
Foetus cannot be palpated
Receding head on vaginal examination, fluid wave
Foetal heartbeat muffled

Management
Look for diabetes and treat if found.
Examine the neonate for malformation.
Risk of neonatal hypoglycaemia (Chapter 10, Section 10.3.4).

Notes:
In acute and chronic polyhydramnios:
Do not puncture or drain amniotic fluid during pregnancy: risk of infection.
Use of oxytocin during labour is dangerous and oxytocin should be administered with caution as the
over-distended uterus may rupture.
Amniotomy carries risk of cord prolapse. In the event of cord prolapse, a caesarean section may
be considered taking into account gestational age and potential presence of foetal malformation.
In the event of acute polyhydramnios in the second trimester, perform vaginal delivery.
Risk of postpartum haemorrhage (routinely insert an IV line).

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