Excess amniotic fluid - when is it a problem?

[MittensKittens]

I have seen assessment of the amount of amniotic fluid used as a reason for ultrasounds quite often. I understand it can point to gestational diabetes, but if there is "too much" amniotic fluid without GD, is it really a problem? Does anyone know of any good information or studies on this?

Thanks!

[Ambyrkatt]

I'd love to hear this, too. With DS, I had what seemed like an excessive amount of fluid (water broke before contractions started and I was still gushing fluid 12 hours later), but was never diagnosed as having an excess. I was borderline GD... had to take the 3 hour test 3 times because of borderline numbers. In the end, the extra fluid didn't seem to be a problem other than my provider was convinced that DS was going to be HUGE (kept saying 12 lbs ++) because of my fundal height (4-6 weeks ahead). DS was 7lbs 15 oz when he came at 38w1d.

This time around, I am measuring ahead again but have been diagnosed as GD. I seriously don't believe the measuring ahead is baby, though. It's all me and the fluid.

[AlexisT]

Originally Posted by MittensKittens

I have seen assessment of the amount of amniotic fluid used as a reason for ultrasounds quite often. I understand it can point to gestational diabetes, but if there is "too much" amniotic fluid without GD, is it really a problem? Does anyone know of any good information or studies on this?

Thanks!

It can also be related to problems with the baby, so you need to rule those out as well.

My understanding is that polyhydramnios places the mother at risk for cord prolapse, placental abruption, and other problems.

[Vaquitita]

in my last 2 pregnancies i had lots of amniotic fluid, but it didn't seem to worry my mw's. and my babies/births had no problems. this time the dr i've been to at the clinic does seem worried about it, i'm measuring ahead and she suggested i get an u/s.

i looked it up on wikipedia and this is what it said (italics mine):

A single case of polyhydramnios may have one or more causes. About 20% of cases are due to maternal diabetes mellitus, which causes fetal hyperglycemia and resulting polyuria (fetal urine is a major source of amniotic fluid). About another 20% of cases are associated with fetal anomalies that impair the ability of the fetus to swallow (the fetus normally swallows the amniotic fluid). These anomalies include:

gastrointestinal abnormalities such as esophageal atresia, duodenal atresia, facial cleft, neck masses, and tracheoesophageal fistula
fetal renal disorders that results in increased urine production during pregnancy, such as in antenatal Bartter syndrome[6]. Molecular diagnosis is available for these conditions [7].
chromosomal abnormalities such as Down's syndrome and Edwards syndrome (which is itself often associated with GI abnormalities)
neurological abnormalities such as anencephaly, which impair the swallowing reflex
In a multiple gestation pregnancy, the cause of polyhydramnios usually is twin-twin transfusion syndrome.

It can also be caused by some systemic medical conditions in the mother, including cardiac or kidney problems.

Additionally, chorioangioma of the placenta can also cause this condition.

However, it should be reported that in 60-65% of cases it is unknown why polyhydramnios happens.

Fetuses with polyhydramnios are at risk for a number of other problems including cord prolapse, placental abruption premature birth and perinatal death. At delivery the baby should be checked for congenital abnormalities. Another cause of polyhydramnios is skeletal dysplasia, or dwarfism, in the baby. There is a possibility of the chest cavity not being large enough to house all of the baby's organs causing the trachea and esophagus to be restricted, not allowing the baby to swallow the appropriate amount of amniotic fluid.

since I didn't have any of these problems in my previous births, i think this is just normal for *me*. she's also worried that my baby will be 'big', but as I've birthed a 9lb 7oz baby with only a tiny tear (no stitches needed) and a 8lb 13oz baby with no tearing, I'm sure I can birth whatever size baby this one is just fine.

[MittensKittens]

Thanks, Vaquitita! That got me thinking about whether OBs vs midwives react differently to it. I do see how it could cause cord prolapse, if the bag of waters ruptured early in labor.

But if you saw "I was induced for polyhydramnios", or I had a c-section for polyhydramnios", what would you think?

I am generally a UP-er though I do see an OB for an ultrasound, and have access to a midwife for prenatals whenever I want them. I am wondering if polyhydramnios should be anywhere on my radar? Mind you, I tend to be small in pregnancy, and my babies are not huge either. I definitely didn't have polyhydramnios in my previous pregnancies, so I assume it won't happen .

[Vaquitita]

and when does having plenty of fluid cross over into 'too much'? how much is too much? has anyone actually measured and said if you have more than x amount of fluid you have polyhydramnios?

i can see how having lots of fluid + early rupture of you water could equal cord prolapse. but you can't predict cord prolapse, so just going on having the 'risk factor' of lots of fluid how much does your chance of having prolapse actually go up? the whole thing seems pretty subjective to me. i'm sure you watch for signs of gd, so if you don't have that i wouldn't worry about it.

this is my first mostly UP. it wasn't my original plan per se, but i am enjoying it. saw a dr halfway through for bloodtests and u/s. then went in again this week mostly to make sure the test results were being sent to the ob who will deliver my babe, i will have 2-3 appts with her mostly to get to know each other.

[JessicaS]

I had polyhydramnios in my second pregnancy, I did not have GD

They do measure the amniotic fluid here is an article about it

http://www.gentlebirth.org/archives/polyhydr.html

and from March of Dimes

http://www.marchofdimes.com/professi...14332_4536.asp

My AFI was 30+ for much of my pregnancy. 80% of cases of polyhydramnios are idiopathic but part of the reason there is a lot of concern is that in that 20% there are generally birth defects, some severe.

The baby has too much room to move malpositioning is a risk. Also an issue is that with severe polyhydramnios your uterus can become over distended and have difficulties producing strong contractions.

Excess fluid was not normal for me. If you often have a lot of fluid then it likely isn't something you really need to be concerned about.

Generally you do not need to be induced or c/s for polyhydramnios but it really depends on how the baby is doing. If the baby is ok then they can make a pinpoint hole in your waters and let them drain very slowly, this reduces some of the risks. They can do amnio to remove excess fluid but this is risky and can send you straight into labor.

I risked out of homebirth due to polyhydramnios, not just because of the fluid but they saw ds was having issues on the u/s I was very much a VBAC patient until my ds started struggling towards the end and a c/s was performed. My ds does have a genetic mutation associated with polyhydraminios so we pretty much know why it happened to me.

People might "say" they had a c/s due to polyhydraminios or were induced due to polyhydraminios but usually that is because they see something going on with the baby, not because of the fluid itself.

I do think a u/s is a good idea.

I will quote some information that was given to me at the time...

Originally Posted by Defenestrator

My friend courtenay asked me to check in here and offer up what I had in the way of advice, so I thought I would.

Do whichever of these things you can, up to and including all of them

1) Homeopathic natrum muriaticum. If you can find 200c potency, take 2-3 pellets every other day for 1 week. If it makes a difference, then continue after that point to take natrum muriaticum 6x every day for the rest of your pregnancy.

2) Make sure that you are getting at least 2 liters of non-diuretic fluid per day. I know this is counter-intuitive, but many of the fruit cravings are probably dehydration-based and your body will have an easier time maintaining a good water balance if you have enough.

3) Add nettle or dandelion root to your tea. Nettle actually tastes pretty good, but it is more nutritional than medicinal. Dandelion root (you can buy it dried or take it as a tincture, or even better! pull up some from a non-herbicided yard and wash and grate it into boiling water. Both support the liver and kidneys and help remove excess water from the body.

4) After every meal, do something to raise your heart rate for 10 minutes. Walking on a treadmill, stepping in place, walking up and down steps, going outside for a walk -- all good. If you are having blood sugar issues, then this will help almost as much as diet.

5) Once you are 36 weeks, consider taking a fenugreek capsule with every meal -- fenugreek does make some women's uteri contract, but it is usually not particularly strong. A gentler alternative would be to start drinking a nursing tea with fenugreek after that time. Fenugreek both helps remove excess water from the body and helps your body process blood sugar.

6) If you use stevia, stop.

That's about it -- good luck!

[Sudonk]

Originally Posted by Ambyrkatt

With DS, I had what seemed like an excessive amount of fluid (water broke before contractions started and I was still gushing fluid 12 hours later), but was never diagnosed as having an excess.

I don't have any additional information on polyhydamnios for the OP, but I wanted to comment to Ambyrkatt that what she described is normal and not a sign of excess amniotic fluid. The fluid continues to gush after the membranes release for a number of reasons. First, the baby's head (or other presenting part, but hopefully it's a head!) can act as a cork of sorts, keeping some of the fluid behind the baby from coming out initially. That is why new "gushes" often happen when mom moves around and changes position. Also, amniotic fluid continues to be created as the birth progresses, so there is fresh fluid to be released throughout the birth as well.

[Vaquitita]

Originally Posted by abimommy

I had polyhydramnios in my second pregnancy, I did not have GD

They do measure the amniotic fluid here is an article about it

http://www.gentlebirth.org/archives/polyhydr.html

I do think a u/s is a good idea.

thanks for that link, that is the first time i've really seen polyhydramnios really defined well and the risks explained. it makes much more sense now. reading through it, it seems clear to me that what *I* have is not polyhydramnios I just have a bit more fluid than is common.

if i remember correctly the op said she gets an u/s, so that should rule out the serious defects that can cause polyhydramnios, right?

[JessicaS]

Originally Posted by Vaquitita

thanks for that link, that is the first time i've really seen polyhydramnios really defined well and the risks explained. it makes much more sense now. reading through it, it seems clear to me that what *I* have is not polyhydramnios I just have a bit more fluid than is common.

if i remember correctly the op said she gets an u/s, so that should rule out the serious defects that can cause polyhydramnios, right?

Well they do the u/s and if it looks like polyhydramnios then they do a lvl 2 u/s with a peri who can measure all the different pockets of fluid. They will also look for issues with the baby at that time.