Polyhydramnios

• Normal amniotic fluid is 500-1500 ml

Symptoms

• Chronic

  • discomfort

  • dyspnoea

  • indigestion

  • oedema

  • increased varicose veins, haemorrhoids

  • abdominal pain

• Acute

  • acute abdominal pain

  • feeling of 'bursting'

  • vomiting

Signs

• Chronically

  • Uterus bigger than expected

  • identification of foetal parts difficult

  • foetal heart difficult to hear

  • ballottement of foetus easy

  • fluid thrill detected

  • abdominal girth at umbilicus greater than 100cm - varies (ebb and flow)

• Acutely

  • abdominal skin

    • glazed

    • oedematous

    • fresh striae

  • uterus

    • tense

    • tender

Causes

• foetal abnormality

  • anencephaly
  • spina bifida
  • oesophageal atresia
  • hydrops fetalis
  • monozygotic twins
  • (rarely) haemangioma of placenta
• maternal abnormality
  • diabetes
  • heart disease
  • pre-eclampsia

Differential diagnosis

• multiple pregnancy
  • no fluid thrill
• ovarian cyst
  • presses cervix into pelvis
• hydatidiform mole
  • usually accompanied by bleeding
• full bladder

Complications

• abortion
• premature labour

Management

• detailed USS
• glucose tolerance test
• indomethacin
• amniocentesis

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