In the outpatient clinic, I met a 32-week-old woman with polyhydramnios, and the ultrasound showed that the amniotic fluid was 130mm deep, and the stomach was very distended, and the mother was very painful. Now for polyhydramnios. Ultrasound criteria for diagnosing polyhydramnios include: AFV 8 cm can be diagnosed as polyhydramnios, of which AFV 8 11 cm is mild polyhydramnios, 12 15 cm is moderate polyhydramnios, and 15 cm is severe polyhydramnios. Diagnosis of polyhydramnios can be made by AFI 25 cm, where AFI 25 35 cm is mild polyhydramnios, 36 45 cm is moderate polyhydramnios, and 45 cm is severe polyhydramnios.
Polyhydramnios may be associated with maternal diabetes mellitus (20-25% of cases), fetal malformations (mainly gastrointestinal obstruction, cardiac and central nervous system malformations), placental tumors, fetal infections, disorders leading to anemia and hyperdynamic circulation, chromosomal and genetic abnormalities, or may be idiopathic (50-60% of cases). Because idiopathic hyperhydrautry is a diagnosis of exclusion, a detailed sonogram of the fetus and placenta should be performed at the time of detection of polyhydramnios to check for signs of anemia (including peak rate of MCA contraction) and the results of previous fetal aneuploidy or congenital infection** screening should be repeated.
If polyhydramnios is combined with a normal fetus, the treatment should be determined according to the degree of polyhydramnios and gestational age.
1.General**: Try to take the left decubitus position to improve uteroplacental circulation and prevent preterm birth. Eat a low-salt diet and reduce the amount of water you drink for pregnant women. Pay attention to monitoring the intrauterine condition of the fetus, prolong the gestational age as much as possible for those with immature fetal lungs, recheck the amniotic fluid index and fetal growth every week, and at the same time carry out effective ** for the ** that causes polyhydramnios.
2.If the symptoms are severe and the pregnant woman cannot tolerate it (gestational age is less than 36 weeks), the amniotic fluid should be released under the guidance of B ultrasound, and the amniotic fluid should be released at a rate of 500 ml per hour, and one time should not exceed 1500 ml, to the extent that the pregnant woman's symptoms are relieved. Strict disinfection to prevent infection, and use sedative and fetal protection drugs as appropriate to prevent preterm birth. 3 It can be repeated after 4 weeks to reduce intrauterine pressure.
3.Treatment during delivery: After natural labor, the membrane should be artificially ruptured as soon as possible, attention should be paid to preventing umbilical cord prolapse, and the intrauterine condition and labor progress of the fetus should be closely observed. Oxytocin should be used promptly after delivery to prevent postpartum hemorrhage.