Increased fluid around the baby during pregnancy (Polyhydramnios) - is it something to be worried about?

If you are a mother-to-be, you probably know that your little one is safely encased in a fluid called amniotic fluid, or as we call it, the water that surrounds the baby. This fluid is what keeps the baby comfortable, safe, and helps it move and grow. But sometimes, in a very small minority of cases, this fluid can become a little too much. Has your doctor told you that? So that's what we're talking about. This is medically called Polyhydramnios.

Simply put, what is Polyhydramnios?

Polyhydramnios is a condition in which there is more than the normal amount of amniotic fluid in your uterus and around your baby during pregnancy. It usually occurs in the second half of pregnancy, but can sometimes occur as early as 16 weeks.

But remember this. This condition is very rare. It affects about one in 100 (1%) pregnant women. Also, it is often accompanied by a mild increase in amniotic fluid (mild polyhydramnios). This slight increase usually does not cause any major complications. Your doctor will check you regularly and monitor your condition.

How do I know if I have this condition? What are the symptoms?

Most of the time, this condition is mild, so some mothers may not experience any symptoms. However, if the water level is a bit higher (severe case), you may experience these symptoms.

What actually happens is that as the water increases, the uterus gets bigger. Then it puts pressure on the surrounding organs like the lungs, stomach, and bladder. That's what causes these symptoms.

Things the doctor sees

Even if you don't experience these symptoms, your doctor may suspect this if they see these things during a routine exam:

• The uterus looks bigger than it is in weeks: For example, if you are 30 weeks pregnant, your belly looks like it is 32 weeks.
• Difficulty hearing the baby's heartbeat: Due to the high amount of water, it may be a little difficult to hear the baby's heartbeat.
• Not being able to feel the baby's position properly: Since the baby is in a lot of water, it is difficult to check the baby's position accurately by hand.

Why is this happening? What are the reasons?

This is the question that many mothers have: "Why did this happen to me?"

However, in cases where the amount of water has increased significantly (moderate to severe), there may be certain reasons for it. These are:

• The baby cannot swallow the fluid: Normally, the baby swallows this water little by little, which is how the amount of water is controlled. If the baby is unable to do this due to some congenital disorder, water will accumulate.
• Mother has diabetes: This risk exists whether the mother had diabetes before pregnancy or developed it during pregnancy (gestational diabetes). As the mother's blood sugar level increases, the baby's urine volume increases, which in turn increases the amount of fluid in the baby's urine.
• Identical Twins: Twin to Twin Transfusion Syndrome (TTTS), a condition in which the blood supply between the twins is unbalanced, can cause fluid to build up around one baby.
• Rh factor incompatibility: This can occur due to complications that occur if the mother is Rh-negative and the baby is Rh-positive.
• Problems with the baby's heartbeat: This condition can be caused by certain problems with the baby's heartbeat.
• Infection in the baby: An infection in the baby in the womb can also be a cause.

How exactly does the doctor find this?

If your doctor suspects this, they will do several tests to confirm it.

The first thing you will do is measure the height of your belly (fundal height). Then, you will have an ultrasound scan to confirm this. This scan is the only way to accurately measure the amount of water in your uterus. There are two main methods used for this:

1. Amniotic Fluid Index (AFI): The uterus is divided into four sections, the depth of the water in each section is measured, and the total is added together.

2. Maximum Vertical Pocket (MPV): This measures the deepest point in the uterus where the most water is present.

If this scan confirms that you have polyhydramnios, your doctor may suggest several more tests to find the cause.

• Fetal Echocardiogram: A special, more detailed scan that looks at the function and structure of the baby's heart.
• Nonstress test: A test that checks for abnormalities in the baby's heart rate.
• Biophysical profile: A scan checks the baby's breathing patterns and body movements.
• Amniocentesis: A test that takes a small sample of amniotic fluid to check for certain birth defects.
• Glucose challenge test: A test to find out if you have gestational diabetes.

What is the treatment for this?

Often, if the condition is mild or if you are nearing the end of your pregnancy, no special treatment is needed. Your doctor will simply check you and your baby regularly and monitor the condition. This means you may need to visit the clinic more often and have more scans. In most cases, this close monitoring is the best option.

However, if the amount of water is too much (severe polyhydramnios) and you are having a lot of discomfort, you may need treatment. There are several options for this:

• Treating the underlying cause: For example, if the cause is diabetes, your diabetes will be treated to get it under control.
• Removal of excess water: In some cases, a small amount of excess water in the uterus is removed with the help of a needle.
• Preterm labor: If the condition is severe and the baby is fully developed, the doctor may decide to induce labor, usually between 37 and 39 weeks.

What risks could this pose?

Understand this well. The excess water will not directly harm the baby. However, there is a slight risk of complications due to the uterus becoming enlarged and the pressure caused by this excess water. If this condition occurs early in pregnancy, the risk may be slightly higher because the water has had more time to accumulate.

Don't be afraid of these things. These are "possible" things, not "certain" things. Your doctor is there to help you manage these risks.

What should I do? Can I get some help?

It's normal to feel scared and anxious when you find out you have this condition. But there are things you can do to reduce this discomfort and anxiety.

• Get plenty of rest: Get as much rest as possible. Don't overexert yourself.
• Find ways to relax: Engage in things that relax you. Read a book, listen to music, do something you enjoy.
• Talk openly with your doctor: Talk to your doctor about all your concerns and fears. Don't keep anything to yourself.
• Be aware of changes: If your stomach suddenly feels bigger or you develop new symptoms, call your doctor immediately.
• Is a C-section necessary? Most of the time, you can have a normal delivery. However, if your doctor feels that a C-section is safer due to factors such as the baby's position, he or she may opt for it. The increased risk is very small.
• Can't we prevent this? No, we can't prevent this. But if you have diabetes, you can reduce your risk by controlling your blood sugar levels well.

You and your baby will be closely monitored after delivery. As soon as the baby is born, a pediatrician will examine the baby to make sure that he or she is doing well.

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