- Ron Beloosesky, MD
Ron Beloosesky, MD
- Assistant Professor, Obstetrics and Gynecology Department
- Rambam Medical Center at the Technion Faculty of Medicine, Haifa, Israel
- Michael G Ross, MD, MPH
Michael G Ross, MD, MPH
- Distinguished Professor of Obstetrics and Gynecology
- David Geffen School of Medicine at UCLA
- Section Editors
- Lynn L Simpson, MD
Lynn L Simpson, MD
- Section Editor — Obstetrics
- Professor of Obstetrics and Gynecology
- Columbia University College of Physicians and Surgeons
- Deborah Levine, MD
Deborah Levine, MD
- Section Editor — Imaging
- Professor of Radiology
- Director of Ob/Gyn Ultrasound
- Department of Radiology
- Beth Israel Deaconess Medical Center
Polyhydramnios (also known as hydramnios) refers to an excessive volume of amniotic fluid. It has been associated with an increased risk of various adverse pregnancy outcomes, including preterm birth, placental abruption, and fetal anomalies [1-3]. Polyhydramnios should be suspected clinically when uterine size is large for gestational age. The diagnosis is made prenatally by ultrasound examination using a noninvasive qualitative or quantitative approach. (See "Assessment of amniotic fluid volume".)
The incidence of polyhydramnios in a general obstetric population generally ranges from 1 to 2 percent [4-8]. Reported rates are influenced by variations in diagnostic criteria, the population studied (low or high risk), the subjective volume of fluid where polyhydramnios is diagnosed (eg, mild, moderate, or severe), and the gestational age (preterm, term, or postterm) at examination. In one series of 93,332 singleton pregnancies delivering at a single hospital from 1991 to 1997, polyhydramnios was diagnosed during antepartum sonography in 708 pregnancies (0.7 percent of deliveries); mild, moderate, and severe disease occurred in 66, 22, and 12 percent of cases, respectively .
Any condition that results in even a relatively minor increase in daily fetal urine production or decrease in fetal swallowing can result in a marked increase in amniotic fluid volume (AFV) [9-11]. The volume of amniotic fluid reflects the balance between fluid production and movement of fluid out of the amniotic sac; the regulation of this process is incompletely understood (see "Physiology of amniotic fluid volume regulation"). In late gestation, the primary sources of amniotic fluid production are fetal urination and secretion of lung fluid; oral and nasal secretions make minimal contributions. The main routes of amniotic fluid removal are fetal swallowing and absorption via the intramembranous pathway.
CONDITIONS ASSOCIATED WITH POLYHYDRAMNIOS
Polyhydramnios may be idiopathic or associated with a variety of fetal disorders, including:
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- CONDITIONS ASSOCIATED WITH POLYHYDRAMNIOS
- CLINICAL MANIFESTATIONS
- CLINICAL SIGNIFICANCE
- POST-DIAGNOSTIC EVALUATION
- MANAGEMENT OF POLYHYDRAMNIOS
- Antepartum fetal monitoring
- Indications for intervention
- - Gestational age based approach
- Pregnancies under 32 weeks
- Pregnancies over 32 weeks
- - Amnioreduction
- - Prostaglandin synthetase inhibitors
- - Investigational approaches
- Management of labor
- Timing of delivery
- SUMMARY AND RECOMMENDATIONS