Materiały źródłowe

• #1 Polyhydramnios – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK562140/

  Polyhydramnios is a pathological condition characterized by an excess of amniotic fluid associated with increased rates of maternal and neonatal morbidity and mortality. This condition develops when the mechanisms regulating amniotic fluid volume are disrupted, most commonly due to excess fetal urine production, impaired swallowing, or gastrointestinal obstruction. The diagnosis is made through ultrasonography when the single deepest vertical pocket of fluid is at least 8 cm or the amniotic fluid index is at least 24 cm. Polyhydramnios can be classified as mild, moderate, or severe based on these parameters. […] Approximately 60% to 70% of patients with polyhydramnios have mild disease, which is frequently idiopathic and has an excellent prognosis. Patients with mild disease typically require only a basic evaluation that includes a detailed medical and prenatal history, targeted anatomy ultrasound, routine screening for aneuploidy and gestational diabetes, and consideration of a potential congenital infection.

• #2 Amniotic Fluid: Physiology and Assessment | Article | GLOWM

  https://www.glowm.com/article/heading/vol-4–fetal-development-and-maternal-adaptation–amniotic-fluid-physiology-and-assessment/id/410553

  Polyhydramnios, also called hydramnios, is defined as increased amniotic fluid for gestational age. Using actual fluid volume, polyhydramnios is defined as an amniotic fluid volume of greater than 2 liters. Sonographically, it is defined as a single deepest pocket greater than 8 cm or amniotic fluid index greater than 24 or 25 cm. Others define polyhydramnios as subjectively increased amniotic fluid volume or above the 95th centile for gestational age. Polyhydramnios affects 0.4-1.08% of pregnancies. Pregnancies complicated by polyhydramnios are at increased risk of respiratory distress, hypoglycemia, macrosomia, preterm birth, nonreactive non-stress tests, perinatal morbidity and congenital anomalies. […] Polyhydramnios can be due to decreased absorption of the amniotic fluid, overproduction of amniotic fluid, or idiopathic. Decreased absorption is typically due to obstruction of fetal swallowing; this can be due to anatomic abnormalities such as tracheal or bowel obstruction or neurologic abnormalities. Overproduction can be due to fetal hyperglycemia and subsequent polyuria with maternal diabetes. It can also be due to fetal arrhythmias, fetal anemia, and twin-twin transfusion syndrome. Chromosomal abnormalities and TORCH infections are also causes of polyhydramnios. Idiopathic hydramnios accounts for the majority of polyhydramnios and is seen in approximately 65% of cases.

• #3 Polyhydramnios as a Predictor of Adverse Pregnancy Outcomes

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3616801/

  Polyhydramnios was diagnosed in 1.8% of pregnancies. […] The perinatal mortality rate with polyhydramnios was 42 per 1,000 births compared to 14 per 1000 births in the control group. […] These data demonstrate that polyhydramnios is associated with an increased risk of adverse perinatal outcomes, and there is a significant positive relation with maternal age, diabetes, fetal anomalies, and fetal macrosomia. […] Polyhydramnios refers to an excessive accumulation of amniotic fluid, which is associated with an increased risk of adverse pregnancy outcomes. […] The association between diabetes and polyhydramnios is well known. […] The mode of delivery was also influenced by polyhydramnios, with a higher proportion of Caesarean deliveries as compared with those mothers who had a normal volume of amniotic fluid.

• #4 Polyhydramnios: Causes, Symptoms, Complications & Treatment

  https://my.clevelandclinic.org/health/diseases/17852-polyhydramnios

  Polyhydramnios means theres too much amniotic fluid in your uterus during pregnancy. A mild case of polyhydramnios may not cause any symptoms or problems, but more severe forms may require treatment. […] Polyhydramnios is rare and affects about 1% of pregnancies. […] Polyhydramnios is generally not treated if its a mild case or if youre at the end of your pregnancy. Your provider may schedule additional appointments to monitor your condition. In most cases, monitoring your pregnancy closely is the best plan. […] Too much amniotic fluid in your uterus puts pressure on your nearby organs and causes pregnancy complications. The condition is usually more serious if it occurs early in pregnancy because theres more time for amniotic fluid to continue to build up. The excess fluid itself is not harmful to the fetus.

• #5 Polyhydramnios | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/27411

  Polyhydramnios is a pathological condition characterized by an excess of amniotic fluid volume. The prognosis for mild idiopathic polyhydramnios is excellent, though the maternal and fetal prognosis worsens as the severity of polyhydramnios increases. Patients with mild idiopathic polyhydramnios frequently have a self-limited disease that resolves without any intervention. A 2016 study found that polyhydramnios resolved in 37% of patients, all with mild disease. In patients with normal antenatal anatomy ultrasound results and mild-to-moderate polyhydramnios, the chance of a significant congenital anomaly being first identified postnatally is 1% to 2%; this risk increases to 11% in patients with severe polyhydramnios. Idiopathic polyhydramnios is also associated with a 3-fold increase in 5-minute APGAR scores less than 7. For the fetus, the prognosis directly correlates with the underlying cause of polyhydramnios. Growth-restricted fetuses with polyhydramnios frequently have significant underlying pathology and, therefore, tend to have the poorest prognosis. In addition, multiple studies suggest that even isolated polyhydramnios is associated with increased rates of intrauterine fetal demise or perinatal fetal mortality. Severe and rapidly progressing polyhydramnios is an independent risk factor for perinatal mortality.

• #6 Polyhydramnios: Causes, Symptoms, Complications & Treatment

  https://my.clevelandclinic.org/health/diseases/17852-polyhydramnios

  People with polyhydramnios may be monitored more closely for the remainder of the pregnancy. You can expect more frequent appointments as well as more ultrasounds to measure amniotic fluid volume. […] Mild cases of polyhydramnios shouldnt affect your baby. In diabetes-related cases, the fetus may grow too large for a vaginal delivery. Severe cases of polyhydramnios may lead to premature labor and your baby being born early. […] Yes, most people will not have pregnancy complications from too much amniotic fluid and will have a healthy baby. […] Polyhydramnios is a complication of pregnancy that typically doesnt require treatment. Your provider will watch you closely and may recommend an induction. If youve been diagnosed with having too much amniotic fluid, its OK to be concerned. Talk to your pregnancy care provider about your concerns and ask any questions you have about the condition. Your provider is there to support you and make sure you and your baby are healthy. Most people with polyhydramnios have healthy babies without complications.

• #7 Polyhydramnios (too much amniotic fluid)

  https://www.nhs.uk/conditions/polyhydramnios/

  Polyhydramnios is when there’s too much amniotic fluid (the fluid that surrounds the baby in the womb) during pregnancy. It’s not usually serious and there’s often no cause. […] Polyhydramnios (too much amniotic fluid) usually does not need any treatment. You may have extra check-ups for the rest of your pregnancy and during labour and birth. […] Complications of polyhydramnios (too much amniotic fluid) are rare. […] If you have moderate or severe polyhydramnios, you may be advised to give birth in hospital. This is so you can be monitored closely and treatment will be available quickly if needed.

• #8 Polyhydramnios – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK562140/

  The prognosis for mild idiopathic polyhydramnios is excellent, though the maternal and fetal prognosis worsens as the severity of polyhydramnios increases. Patients with mild idiopathic polyhydramnios frequently have a self-limited disease that resolves without any intervention. […] In patients with normal antenatal anatomy ultrasound results and mild-to-moderate polyhydramnios, the chance of a significant congenital anomaly being first identified postnatally is 1% to 2%; this risk increases to 11% in patients with severe polyhydramnios. […] For the fetus, the prognosis directly correlates with the underlying cause of polyhydramnios. […] Severe and rapidly progressing polyhydramnios is an independent risk factor for perinatal mortality. […] Perinatal and maternal morbidity and mortality increase as the severity of polyhydramnios increases. Polyhydramnios is associated with a higher incidence of fetal macrosomia, malpresentation, placental abruption, cord prolapse, cesarean birth, neonatal respiratory distress, low 5-minute APGAR scores, postpartum hemorrhage, and perinatal mortality.

• #9 Polyhydramnios as a Predictor of Adverse Pregnancy Outcomes

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3616801/

  In our study, polyhydramnios had an impact on perinatal outcomes, the occurrence of fetal macrosomia and fetal congenital anomalies, and SCBU admissions of neonates. […] The perinatal mortality rate in the polyhydramnios group was 42 per 1,000 births as compared to 14 per 1,000 births in the control. […] This study demonstrates that the likelihood of an adverse perinatal outcome increases in association with polyhydramnios. […] Collectively, data from other studies as well as our own suggests that if polyhydramnios is diagnosed a thorough evaluation for fetal or maternal factors is indicated.

• #10 Prenatal diagnosis of fetal growth restriction with polyhydramnios, etiology and impact on postnatal outcome | Scientific Reports

  https://www.nature.com/articles/s41598-021-04371-9

  To assess the spectrum of different etiologies, the intrauterine course, outcome and possible prognostic markers in prenatally detected fetal growth restriction (FGR) combined with polyhydramnios. […] Fetuses prenatally diagnosed with FGR combined with polyhydramnios are affected by a high morbidity and mortality. […] Even without recognizable patterns prenatally, long-term-follow up is necessary, as neurodevelopmental or growth delay may occur. […] Considering that polyhydramnios describes an independent risk factor for an adverse perinatal outcome, a combination of both conditions seems to have a more serious negative impact on fetal outcome. […] In conclusion prenatal detection of an FGR combined with polyhydramnios represents a rare phenomenon with an extremely high mortality rate.

• #11 Polyhydramnios – Gynecology and Obstetrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/gynecology-and-obstetrics/antenatal-complications/polyhydramnios

  Polyhydramnios is excessive amniotic fluid; it is associated with maternal and fetal complications. […] With polyhydramnios, risk of the following complications is increased: Preterm contractions and possibly prelabor rupture of membranes (sometimes followed by placental abruption) or preterm labor, fetal malposition, maternal respiratory compromise, umbilical cord prolapse, uterine atony, postpartum hemorrhage, fetal death (risk is increased even when polyhydramnios is idiopathic). […] Risk of complications tends to be proportional to the degree of fluid accumulation and vary with the cause. […] Polyhydramnios is usually suspected based on ultrasonographic findings or uterine size that is larger than expected for dates. […] If polyhydramnios is present, further testing is recommended to determine the cause.

• #12 Polyhydramnios | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/27411

  Perinatal and maternal morbidity and mortality increase as the severity of polyhydramnios increases. Polyhydramnios is associated with a higher incidence of fetal macrosomia, malpresentation, placental abruption, cord prolapse, cesarean birth, neonatal respiratory distress, low 5-minute APGAR scores, postpartum hemorrhage, and perinatal mortality. Rates of preterm labor and preterm prelabor rupture of membranes are also both increased in patients with more severe polyhydramnios compared to the general obstetric population. […] The pathophysiology of polyhydramnios is not fully understood. However, any imbalance in the complex regulatory mechanisms maintaining the amniotic fluid volume can result in polyhydramnios.

• #13 Term Idiopathic Polyhydramnios, and Labor Complications

  https://www.mdpi.com/2077-0383/12/3/981

  Term idiopathic polyhydramnios is independently associated with macrosomia, CD and neonatal complications. […] The severity of polyhydramnios was found to be associated with macrosomia and CD. […] Polyhydramnios was associated with a higher rate of CD, macrosomia and neonatal respiratory complications. […] A multivariate regression analysis demonstrated an independent relation between polyhydramnios and higher rates of CD, aOR 1.62 (CI 1.20–2.19 p = 0.002) and composite adverse neonatal outcome aOR 1.28 (CI 1.01–1.63 p = 0.043). […] The degree of polyhydramnios was mild in 559 (75.0%) cases, moderate in 137 (18.0%) cases and severe in 54 (7.0%) cases. […] Severity of polyhydramnios was significantly associated with higher rates of macrosomia and CD (p for trend <0.01 in both). [...] A composite adverse neonatal outcome occurred in 12.5% of mild polyhydramnios, 13.9% of moderate polyhydramnios and 7.4% of severe polyhydramnios compared to 9.3% for controls.

• #14 Too much amniotic fluid (polyhydramnios): Signs, causes, and risks

  https://www.medicalnewstoday.com/articles/323232

  Polyhydramnios occurs when too much amniotic fluid surrounds the fetus in the womb. This excess fluid can slightly increase the risk of complications during pregnancy and delivery. […] Research has linked polyhydramnios to an increased risk of certain complications for both the woman and baby. […] Women with polyhydramnios may experience premature contractions, longer labor, difficulties breathing, and other problems during delivery. The condition can also cause complications for the fetus, including anatomical problems, malposition, and, in severe cases, death. […] Treatment aims to remove excess amniotic fluid. A doctor may withdraw fluid in a procedure called amnioreduction, or they may recommend medications. In most cases, doctors will carefully monitor the fetus to check for signs of complications.

• #15 Polyhydramnios | Texas Children’s

  https://www.texaschildrens.org/content/conditions/polyhydramnios

  Polyhydramnios is a condition in which there is too much amniotic fluid during pregnancy, the fluid that surrounds the developing fetus. Excess amniotic fluid can put both mother and baby at risk of complications. […] While polyhydramnios can occur at any time during pregnancy, it is most common in the second and third trimesters. The condition can range from mild to severe. The earlier it occurs and the greater the volume of amniotic fluid, the higher the risk of complications. […] Complications caused by too much amniotic fluid range from mild to severe, depending on the amount of excess fluid and the underlying cause. Risks to mother and baby include: Preterm contractions and labor, Premature rupture of membranes (PROM) (your water breaks early), Placental abruption, where the placenta pulls away from the uterine wall before birth, Umbilical cord prolapse, when the umbilical cord moves into the vagina before the fetus and is compressed by the baby during labor, cutting off the baby’s blood and oxygen supply, Baby grows too quickly and too large (macrosomia), Heavy maternal bleeding after delivery, Fetus is abnormally positioned, requiring cesarean delivery (feet or bottom first, for example, known as breech presentation), Maternal respiratory distress, Stillbirth.

• #16 Polyhydramnios and Oligohydramnios: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/975821-overview

  When Chamberlin used ultrasonography to evaluate the perinatal mortality rate (PMR) in 7562 patients with high-risk pregnancies, the PMR of patients with normal fluid volumes was 1.97 deaths per 1000 patients. […] However, the PMR increased to 4.12 deaths per 1000 patients with polyhydramnios and 56.5 deaths per 1000 patients with oligohydramnios. […] Studies show an increased risk of associated fetal anomalies in more severe forms of polyhydramnios. In a series, 20% of cases of polyhydramnios involved associated fetal anomalies, including problems of the gastrointestinal system (40%), central nervous system (26%), cardiovascular system (22%), or genitourinary system (13%). […] The mortality rate in oligohydramnios is high. The lack of amniotic fluid allows compression of the fetal abdomen, which limits movement of its diaphragm.

• #17 Prenatal diagnosis of fetal growth restriction with polyhydramnios, etiology and impact on postnatal outcome | Scientific Reports

  https://www.nature.com/articles/s41598-021-04371-9

  Further genetic testing (CMA/NGS) should be performed, especially if the karyotype is unremarkable. […] Based on our data, these patients should receive long-term follow up, with emphasis on endocrinological and neurodevelopmental assessment. […] Signs of neurodevelopmental or growth delay should be recognized.

• #18 Polyhydramnios and Oligohydramnios: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/975821-overview

  If polyhydramnios is not associated with any other findings, the prognosis is usually good. According to Desmedt et al, there is a 61% perinatal mortality in polyhydramnios associated with a fetal or placental malformation. […] About 20% of infants with polyhydramnios have some type of an anomaly; in these cases, the prognosis depends on the severity of the anomaly. Yefet et al reported that even with normal detailed prenatal ultrasonographic evaluation, polyhydramnios (amniotic fluid index [AFI] 24 cm) is associated with an increased rate of fetal malformations, genetic syndromes, neurologic disorders, and developmental delay, conditions that may only be diagnosed postnatally. […] In a study of 163 women with idiopathic polyhydramnios, resolution was more likely when it was diagnosed early in pregnancy and when the AFI was low.

• #19 Polyhydramnios – Gynecology and Obstetrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/gynecology-and-obstetrics/antenatal-complications/polyhydramnios

  Recommendations for prenatal monitoring depend on the severity of polyhydramnios, based on AFI: AFI 30 cm (which increases risk of fetal death): Prenatal monitoring should begin as early as 32 weeks or whenever it is diagnosed thereafter; it should include nonstress testing at least once a week. […] Delivery at about 39 weeks should be planned when AFI is 30 cm. […] It is associated with increased risk of preterm contractions, preterm labor, prelabor rupture of membranes, maternal respiratory compromise, fetal malposition or death, and various problems during labor and delivery. […] Consider reducing amniotic fluid volume only if polyhydramnios causes severe maternal symptoms.

• #20 Amniotic Fluid: Physiology and Assessment | Article | GLOWM

  https://www.glowm.com/article/heading/vol-4–fetal-development-and-maternal-adaptation–amniotic-fluid-physiology-and-assessment/id/410553

  Polyhydramnios has increased incidence in twin pregnancies, affecting up to 1 in 6 twin gestations. Maternal diabetes is linked to polyhydramnios and macrosomia. Patients with known diabetes and polyhydramnios have been found to have increased hemoglobin A1C (a marker of poor control). […] When polyhydramnios is discovered, it is recommended that a review of maternal history is undertaken, maternal glucose tolerance assessed, fetal anatomy be evaluated, and fetal growth be assessed. After 24 weeks, antenatal testing is recommended although the optimal type of testing or interval between assessments are not clear, as there is no current consensus. Additionally, optimal timing of delivery for patients with polyhydramnios has not been established.

• #21 Polyhydramnios | Texas Children’s

  https://www.texaschildrens.org/content/conditions/polyhydramnios

  A diagnosis of any underlying fetal birth defects during pregnancy enables your family and your healthcare team to plan ahead for the special needs of your baby at birth and to arrange for the earliest possible treatment. […] Increased amniotic fluid increases the risk of serious maternal and fetal complications at delivery. We recommend delivery at a hospital with the specialized expertise and resources required to treat these high-risk deliveries, including the highest level neonatal intensive care unit (NICU), if needed. […] Treatment needs at birth vary for each baby depending on the severity and underlying cause of the excess amniotic fluid and the presence of any associated birth defects or genetic conditions. In severe cases, your newborn may require specialized care in the NICU and surgery soon after birth to repair a congenital abnormality, such as a gastrointestinal blockage, lung masses or congenital diaphragmatic hernia. […] Our researchers are continually working to better understand the causes of polyhydramnios and improve treatment options and outcomes for families around the world facing this diagnosis.

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