Polyhydramnios

Polyhydramnios
Authors
Ron Beloosesky, MD
Michael G Ross, MD, MPH
Section Editors
Charles J Lockwood, MD
Deborah Levine, MD
Deputy Editor
Vanessa A Barss, MD
Disclosures
All topics are updated as new evidence becomes available and our peer review process is
complete.
Literature review current through: Oct 2012. | This topic last updated: Nov 8, 2010.
INTRODUCTION Polyhydramnios refers to excessive accumulation of amniotic fluid, which
is associated with increased risks of adverse pregnancy outcome [1-3]. It is typically diagnosed
by ultrasound examination and may be described qualitatively or quantitatively by various
methods. (See "Assessment of amniotic fluid volume".)
INCIDENCE The incidence of polyhydramnios in a general obstetric population ranges from
0.2 to 1.6 percent [4-6]. Reported rates are influenced by variations in diagnostic criteria, the
population studied (low or high risk), the threshold used (eg, mild, moderate, or severe), and the
gestational age (preterm, term, or postterm). In one series of 93,332 singleton pregnancies
delivering at a single hospital from 1991 to 1997, polyhydramnios was diagnosed during
antepartum sonography in 708 pregnancies (0.7 percent of deliveries); mild, moderate, and
severe disease occurred in 66, 22, and 12 percent of cases, respectively [7].
PATHOPHYSIOLOGY The integration of fluid flow into and out of the amniotic sac
determines the ultimate volume of amniotic fluid. Fetal urination, lung fluid production and
swallowing, and intramembranous absorption (into the fetal vascular compartment) make
significant contributions to fluid movement in late gestation; other factors (eg, saliva production)
make minimal contributions. The relative contribution of each route of fluid exchange varies
across gestation. Variations in fetal body fluid or endocrine homeostasis also affect the volume
of fetal urine production, swallowing, and lung liquid secretion. During the last trimester, urine
output is equivalent to approximately 30 percent of fetal body weight, swallowing 20 to 25
percent, lung secretions 10 percent (one-half of lung secretions are swallowed and the other half
are excreted into the amniotic fluid), while oral-nasal secretion and transmembranous flow
(directly into the maternal compartment) represent <1 percent of fetal body weight [8]. The near-
term fetus excretes 500 to 1200 mL of urine and swallows 210 to 760 mL of amniotic fluid each
day [9]. Thus, relatively minor daily changes in fetal urine production or swallowing can result
in marked changes in amniotic fluid volume [9-11]. Excessive accumulation of amniotic fluid is
typically related to decreased fetal swallowing or increased fetal urination.
The physiology of normal amniotic fluid production and volume regulation are discussed
separately. (See "Physiology of amniotic fluid volume regulation".)
ETIOLOGY The likelihood of identifying the etiology of polyhydramnios depends upon its
severity. In one series, as an example, the cause was determined in only 17 percent of
pregnancies with mild polyhydramnios, but in 91 percent of those with moderate or severe
disease [5]. Historically, approximately 60 percent of cases were considered idiopathic. The
etiology of the remaining cases usually fell into one of the following categories [5,7,12-19]: