Medicines for Polyhydramnios

What it is

Polyhydramnios is the term for having too much amniotic fluid — the fluid that surrounds and protects the baby in the womb during pregnancy. This fluid is important: it cushions the baby, allows it to move and develop, and is involved in the development of the baby’s lungs and digestive system. The amount of fluid is normally kept in balance (the baby swallows the fluid and passes urine into it), and polyhydramnios occurs when there is an excess. It is usually detected during pregnancy, often on an ultrasound scan, or when the womb (bump) is measuring larger than expected, or the mother has symptoms of the extra fluid (such as increased discomfort, breathlessness, swelling, or a feeling of tightness). In many cases, polyhydramnios is mild, has no identifiable cause, and does not cause any problems, with the pregnancy and baby being fine. However, in some cases, polyhydramnios is associated with an underlying cause or condition — such as gestational diabetes (or diabetes) in the mother; certain conditions in the baby (for example problems that affect the baby’s ability to swallow the fluid, such as some conditions affecting the digestive tract, like oesophageal atresia, or other conditions); certain infections; a multiple pregnancy; or other factors — so, when polyhydramnios is found, an important part of care is looking for any underlying cause, so that it can be identified and managed. Polyhydramnios can also, particularly if more marked, be associated with some increased risks in the pregnancy — such as premature birth, the baby lying in an awkward position, and certain complications around birth — which is why it is monitored. The management of polyhydramnios depends on how much extra fluid there is, whether a cause is found, and the situation: mild polyhydramnios with no cause and no problems is often simply monitored, while more marked polyhydramnios, or where there is an underlying cause, is monitored more closely and managed with specialist input, and treatment is directed at any cause and at managing the pregnancy safely. The key messages are that polyhydramnios is too much fluid around the baby in the womb, that it often has no clear cause and causes no problems, but that it is sometimes linked to conditions needing monitoring and specialist care.

How it is treated

Polyhydramnios is managed by looking for any underlying cause, monitoring the pregnancy and baby, and managing any cause and the pregnancy safely, with specialist input where needed; the approach depends on how much extra fluid there is and whether a cause is found. When polyhydramnios is detected (often on an ultrasound scan, or because the bump is measuring large or the mother has symptoms), an important part of care is assessment to look for any underlying cause — this may include checking the mother for gestational diabetes (a common association), a detailed scan of the baby (to look for any conditions in the baby that could be associated, such as problems affecting swallowing), checking for infections, and other assessments as relevant; identifying any cause allows it to be managed. In many cases, particularly with mild polyhydramnios, no cause is found and the pregnancy and baby are fine. Management then depends on the situation: mild polyhydramnios with no identifiable cause and no problems is often managed with monitoring (keeping an eye on the fluid, the baby, and the mother), with reassurance; more marked polyhydramnios, or where an underlying cause is found, is monitored more closely and managed with specialist (obstetric) input. Managing any underlying cause is important — for example, managing gestational diabetes (with the appropriate care for diabetes in pregnancy), which can help; treating an infection; or planning care around any condition in the baby (so that the baby can be assessed and cared for appropriately after birth, sometimes with paediatric or surgical specialists involved if a condition such as a digestive tract problem is identified). Because polyhydramnios, particularly if more marked, can be associated with some increased risks in the pregnancy (such as premature birth, the baby lying awkwardly, and certain complications around birth), the pregnancy is monitored and the birth is planned appropriately, with the maternity team, to manage these risks safely; the mother is advised about symptoms to watch for. In some cases of significant polyhydramnios causing symptoms or risks, procedures to remove some of the excess fluid, or other measures, may occasionally be considered by specialists. Support and clear information for the mother, particularly where there is a cause or increased risk, are part of care. The reassuring messages are that polyhydramnios often has no clear cause and causes no problems, with the pregnancy and baby being fine, that where it is found an important part of care is looking for and managing any underlying cause, and that it is monitored and the pregnancy managed safely with specialist input where needed; so assessment for any cause, monitoring, and specialist care where appropriate are the keys to managing polyhydramnios.