Polyhydramnios and Ultrasounds?

[PlayaMama]

hi all~

i am seeing a CNM for my second child. i've been measuring ahead for most of my pregnancy (starting with 2cm at 16 weeks) i jumped to 5cm ahead at 32 weeks and an ultrasound was scheduled. my afi was measured at 31 cm. when i went back a week later i was back down to 2.5 cm ahead (36.5 at almost 34 weeks) and my afi was 27.5 cm.

my midwife has me scheduled for monitoring once a week (last session went great) and agreed with her backup doctor that a biophysical profile once a week was a good idea.

everything i've read in the literature indicates that ultrasound monitoring in this situation is recommended but that's all standard practice/medical establishment stuff.

i don't really want to have 4-6 more ultrasounds since my baby is doing just fine (10/10 on the first biophysical) but i also don't want to miss something and regret it later. the doctor is not someone i trust (they have a sign up in the office advertising their 20$ ultrasound special to find out the sex of your baby) but my midwife has been totally awesome and is into no interventions.

what would be your recommendations for this situation? are the ultrasounds warranted?

thanks so much!
carrie

[MsBlack]

I think it is excessive. Some women have more anmiotic fluid than others. While this is sometimes an indication of fetal anomalies/other issues, that is NOT a general rule. Perfectly normal pregnancies/babies sometimes just gather more fluid than others.

In your shoes, I would refuse the serial u/s unless/until some other indicators arise to warrant it.

[balancedmama]

I had true polyhydramnios with my DD's pregnancy. It was discovered at my 20-week anomaly u/s. I also had some shortening of my cervix and fluid in my cervix. What we chose to do was to see a perinatologist and have him do another scan (to more thoroughly look for some of the defects which are associated with polyhydramnios). The peri we chose is one of the best in the metro area. He is also not known for over-treating conditions, which was my concern with seeing just a regular OB. That they might not be familiar enough with what was going on and they would want to scan every 8 minutes, and I would get risked out of homebirth. The peri cleared me as safe for homebirth after not detecting anything else abnormal. I think the only other test we did was a postprandial to see how I was managing my sugars, since I have PCOS/IR and polyhydramnios is associated with GD. My MW continued to monitor my growth and checked for a fluid thrill at my visits. We felt that as long as my growth didn't hit a certain rate and a thrill wasn't detected, the risks of extra monitoring outweighed the benefits.

I did end up with some of the risks of polyhydramnios - my baby didn't engage until labor and was malpositioned. I also had PPH. Who knows if those things would have happened otherwise. Ultimately I had a great birth though.

[PlayaMama]

thanks!

i realized (after staying up most of last night!) that what i need to clarify with my midwife is what exactly would be the result of an abnormal test?

the baby is too early to deliver anyway! so, why test if the result is not going to dictate any different treatment?

it seemed a bit extreme to me too but it seemed like everywhere i looked it promoted the serial ultrasounds to monitor the progress of the fluid levels.

thanks again!!

[PlayaMama]

Originally Posted by balancedmama

My MW continued to monitor my growth and checked for a fluid thrill at my visits. We felt that as long as my growth didn't hit a certain rate and a thrill wasn't detected, the risks of extra monitoring outweighed the benefits.

what is a fluid thrill?

my diabetes test came back with great results and no other indicators showed up on the ultrasound. i think the doctor who is advising is just really machine/intervention happy and i'm so glad that i have my midwife as a barrier between me and the medical establishment.

[Reha]

Originally Posted by MsBlack

I think it is excessive. Some women have more anmiotic fluid than others. While this is sometimes an indication of fetal anomalies/other issues, that is NOT a general rule. Perfectly normal pregnancies/babies sometimes just gather more fluid than others.

In your shoes, I would refuse the serial u/s unless/until some other indicators arise to warrant it.

:

[jengacnm]

I would continue to get the ultrasounds unless/until the AFI went back down to normal, and still plan a home birth if the downward trend continues. FYI, "normal" is 25 or less at 35 weeks, and 20 or less at 40 weeks.

I did end up with some of the risks of polyhydramnios - my baby didn't engage until labor and was malpositioned. I also had PPH. Who knows if those things would have happened otherwise.

Each of those things are known potential complications of polyhydramnios. The risks of cord prolapse and abruption are also higher.

so, why test if the result is not going to dictate any different treatment?

Ultimately, further testing would be to determine if home birth is still a safe option. At what level of polyhydramnios are you and your midwife comfortable staying at home? 25 at 40 weeks? 30? 40?

I've seen polyhydramnios in three of my clients in the past three and a half years. One of them risked out of home birth because of it-her AFI was 40. A cause was never determined; the perinatologists called it glucose intolerance even though she passed the glucose tolerance test. Her labor and birth were ultimately fine, though her water breaking became legend in that hospital.

The other two were planned hospital births. One was a late diagnosis of gestational diabetes at 36 weeks. The other was a tough birth for unrelated reasons, but her baby was ultimately diagnosed with tracheo esophageal fistula. So her polyhydramnios was because the baby couldn't swallow.

I know this isn't happy information, but it's my experience. HTH!

Jennifer

[kate3]

I would continue to get the ultrasounds unless/until the AFI went back down to normal, and still plan a home birth if the downward trend continues.

I would also agree with this advice. I actually had polyhydramnios, and this became a huge issue when my water broke. The head was no where near engaged and there was some question as to the position of the cord. Thankfully, there was no prolapse and I had a very nice delivery. And then one heck of a pph. Because we knew my AFI was around 30, everyone was prepared and my bleeding was controlled to the point that I did not need a transfusion.

While it is true that some women make more fluid than others, the issue isn't necessarily why, but the potential complications that can result.

[PlayaMama]

i've been researching all yesterday and i think that i will continue with the ultrasounds.

i've been planning a hospital birth since we live about two hours from the nearest medical facility (except our local clinic with a nurse) anyway so the problem isn't that i'll risk out of homebirth but that they will want to induce me due to a low bpp score. plus i want to avoid lots of ultrasounds.

i've decided that i will just do everything i can to make sure that the baby is awake and moving so the ultrasounds are short and the results are accurate (food and a big cup of ice ).

thanks so much for sharing all of your experiences!! with my first i never had any issues and with this baby i've had one right after the other so i feel like i've been researching all. the. time.