What to do if there is too much amniotic fluid in late pregnancy

In the later stages of pregnancy, if there is too much amniotic fluid, it will pose a great threat to the health of the fetus, because at this time too much amniotic fluid may cause fetal malformations, especially the fetal central nervous system, or digestive tract malformations. Therefore, this situation must be dealt with in a timely manner. The principle of treatment is generally to terminate the pregnancy in a timely manner. If the child is well developed, induced labor should be performed in a timely manner.

1. Causes and symptoms of polyhydramnios in late pregnancy

1. Excessive amniotic fluid in pregnant women is often accompanied by fetal malformations, among which central nervous system malformations and digestive system malformations are the most common.

2. There are abnormalities in the placenta and umbilical cord of the fetus, such as placental chorioamnionitis, velamentous umbilical cord, etc.

3. Multiple pregnancies are more likely to have polyhydramnios than single pregnancies, especially monozygotic twins.

4. If the pregnant woman suffers from diabetes, hypertension, acute hepatitis, severe anemia, or there is blood type incompatibility between mother and baby, it may also lead to polyhydramnios.

2. The impact of excessive amniotic fluid in late pregnancy

1. For the fetus, excessive amniotic fluid will increase the perinatal mortality rate, and it will also make premature birth, umbilical cord prolapse, and placental abruption more likely to occur, affecting the prognosis of the perinatal baby.

2. For pregnant women, excessive amniotic fluid may cause placental abruption, uterine atony, postpartum hemorrhage, etc. It may also cause fetal abnormalities and lead to difficulties in delivery.

3. What to do if there is too much amniotic fluid in late pregnancy

The treatment of polyhydramnios depends mainly on whether the fetus has any malformations and the severity of the pregnant woman's symptoms.

1. The principle of treatment for polyhydramnios combined with fetal malformation is to terminate the pregnancy in a timely manner.

(1) Pregnant women with chronic polyhydramnios are in good general condition with no obvious symptoms of cardiopulmonary compression. Transabdominal amniocentesis is used to release an appropriate amount of amniotic fluid and then inject 50-100 mg of rivanol to induce labor.

(2) Use a high-position membrane rupture device to puncture the fetal membrane 15 to 16 cm upward from the cervical os, allowing the amniotic fluid to flow out slowly at a rate of 500 ml per hour to prevent a sudden drop in intrauterine pressure from causing placental abruption. Pay attention to blood pressure, pulse and vaginal bleeding during rupture of membranes and release of amniotic fluid. After the amniotic fluid is released, a sand bag is placed on the abdomen or a belly bandage is applied to prevent shock. If there are still no uterine contractions 12 hours after rupture of membranes, antibiotics are needed. If there is still no uterine contraction after 24 hours, appropriate use of prazidor sodium sulfate to promote cervical ripening, or oxytocin, prostaglandins, etc. can be used to induce labor.

(3) First, release some amniotic fluid through abdominal puncture to reduce the pressure before artificial rupture of membranes to avoid placental abruption.

2. The treatment of polyhydramnios combined with a normal fetus should be determined based on the degree of polyhydramnios and gestational age.

(1) If the symptoms are severe and the pregnant woman cannot tolerate it (gestational age less than 37 weeks), amniocentesis should be performed using a 15-18 lumbar puncture needle. The amniotic fluid should be released at a rate of 500 ml per hour. The amount of amniotic fluid released at one time should not exceed 1500 ml, and the amount should be stopped when the pregnant woman's symptoms are relieved. Excessive release of amniotic fluid can cause premature birth. Amniotic fluid should be released under B-ultrasound monitoring to prevent damage to the placenta and fetus. Strict disinfection is performed to prevent infection, and sedatives and pregnancy-preserving drugs are used as appropriate to prevent premature birth. It can be repeated after 3 to 4 weeks to reduce intrauterine pressure.

(2) Prostaglandin inhibitor - Indomethacin treatment: Indomethacin has a diuretic inhibitory effect. Indomethacin is used to inhibit fetal urination to treat polyhydramnios. The specific dosage is 2.0-2.2 mg/(kg·d), and the medication duration is 1-4 weeks. It can be repeated if the amniotic fluid increases again. During the medication period, B-mode ultrasound monitoring was performed once a week. In the late pregnancy, the amniotic fluid is mainly formed by fetal urine, which can be detected in the fetal blood 15 minutes after the pregnant woman takes indomethacin. Since indomethacin has the side effect of causing closure of the ductus arteriosus, it should not be widely used.

(3) If the pregnancy is close to 37 weeks and the fetus is confirmed to be mature, artificial rupture of membranes is performed to terminate the pregnancy.