Polyhydramnios In Twin Pregnancy – How Does It Happen? And Its Complications
Acute polyhydramnios in twin pregnancy causes the mother a lot of pain and makes it more likely that she will have to give birth early.
About 2% of all pregnancies are affected by polyhydramnios.
Polyhydramnios is usually a benign condition that develops due to amniotic fluid accumulation in the second part of pregnancy.
Severe shortness of breath, premature labor and other symptoms are possible with severe polyhydramnios.
Your doctor will closely monitor your pregnancy if polyhydramnios is identified to ensure nothing goes wrong.
How severe a problem is will determine how it is treated.
A mild case of polyhydramnios may resolve on its own.
Extreme polyhydramnios may need more frequent checks.
When there is an excessive amount of amniotic fluid during pregnancy, it is called polyhydramnios.
The liquid that surrounds a fetus in the uterus is called amniotic fluid.
The baby's development and growth are greatly aided by the amniotic fluid.
It is more common in the second part of pregnancy but may arise as early as 16 weeks.
Complications from mild polyhydramnios are uncommon.
If your situation worsens, your obstetrician will be there to help you through it.
Polyhydramnios affects only 1% of all pregnancies.
Those who have the mildest problem may not show any signs at all. The following symptoms may be present if polyhydramnios is further advanced:
- Feeling of constriction or tightness in the abdomen
- Breath shortening
- Increased frequency of urination
- Experience swelling in the vulva, thighs, and/or feet
It's not good for your lungs, stomach, rectum, or bladder if your uterus becomes too large.
Your symptoms are most likely due to this increased pressure.
Your doctor may assume you have an excess of amniotic fluid if you show signs like:
- Your uterus is bigger than usual for the stage of your pregnancy.
- Trouble finding your baby's heartbeat.
- Trouble to tell where the baby is in the womb by touching you.
The following are some of the recognized causes of polyhydramnios:
- A congenital disability affects the baby's digestive tract or central nervous system.
- Diabetes in mothers
- Twin-twin transfusion - a potential complication of identical twin pregnancies in which one twin gets too much blood and the other receives too little (fetal anemia)
- Incompatibility of mother's and baby's blood
- Pregnancy-related infection
Polyhydramnios is linked to:
- Premature delivery
- Membrane rupture occurs when water bursts too soon.
- Placental abruption occurs when the placenta separates from the uterine inner wall before birth.
- Umbilical cord prolapse occurs when the umbilical cord enters the vagina before the baby's C-section.
- Heavy bleeding after birth owing to a lack of uterine muscle tone
The sooner polyhydramnios begins in pregnancy and the more amniotic fluid there is, the greater the risk of problems.
Clinical suspicion of twin-twin transfusion syndrome should arise immediately upon the detection of increased amniotic fluid in the gestational sac of one twin and reduced amniotic fluid in the amniotic sac of the second twin.
This unusual syndrome arises when one of two identical twins who share a placenta develops extensive vascular anastomoses that lead to a unidirectional shunt between them.
Different anomalies in amniotic fluid volume might be caused by various diseases affecting each twin simultaneously, although this is an improbable clinical coincidence.
When a doctor notices that placentation is monochorionic, twin-twin transfusion syndrome is always at the top of the list of possible diagnoses.
Monozygotic (two babies conceived from the same egg) and monochorionic (one placenta) twins are the only ones who may have twin-twin transfusion syndrome.
For some time now, it has been known that monochorionic twins have a higher risk of complications and fetal loss than dichorionic twins.
In severe hydramnios, the incidence of major malformations increases in dichorionic and monochorionic twins, reaching approximately 20%.
In monochorionic pregnancies, severe hydramnios are correlated with an increased risk of stillbirth.
Hydramnios is not linked to premature birth, slow fetal growth, admission to the neonatal critical care unit, or death of the newborn in either dichorionic or monochorionic pregnancies.
One in every six dichorionic and monochorionic pregnancies is affected by hydramnios.
The severity of hydramnios was correlated with the likelihood of stillbirth in monochorionic pregnancies and with the occurrence of anomalies in multichorionic pregnancies.
Even so, hydramnios in twin pregnancies aren't linked to a higher risk of nasty things.
Most pregnancies with mild polyhydramnios do not need therapy and resolve without intervention.
In most situations, even those uncomfortable may be handled without medical attention.
Polyhydramnios might be able to be cured by treating the underlying cause, like diabetes.
Preterm labor, shortness of breath, and stomach discomfort are all symptoms that may need medical attention, including a possible hospital stay.
The following are examples of potential treatment modalities to reduce amniotic fluid:
If your doctor determines that there is too much amniotic fluid in your uterus, they may perform amniocentesis and drain amniotic fluid from the uterus.
Some of this therapy's rare but possible side effects are early labor, placental separation, and early rupture of the membranes.
Indomethacin (Indocin) is a medicine that may be taken orally and has been shown to lower fetal urine output and amniotic fluid volume, which may be why your doctor has prescribed it to you.
Indomethacin is not advised after the first 31 weeks of pregnancy.
Fetal echocardiography and Doppler ultrasound monitoring may be recommended if your doctor suspects your unborn child may have heart defects.
Gastritis is an inflammation of the lining of the stomach.
It can cause nausea, vomiting, acid reflux, and stomach lining irritation.
Amniotic fluid levels are something your doctor will want to check on once every few weeks after therapy is over.
Tonus and contraction intensity in polyhydramnios are affected by two key factors:
- As the uterus swells beyond its normal size, the tonus rises and the contractions weaken.
- In many situations, uterine contractility grows too quickly and reaches labor levels too early in pregnancy. Because of this, many women with polyhydramnios enter labor before their due date.
During labor, in cases of polyhydramnios, the uterine fibers can contract as strongly as in normal cases.
However, contractions are weaker because of the uterus's enlargement, and labor advances more slowly.
That's the fundamental reason why labor takes so long when that happens.
If the body holds on to less fluid, the uterus's ability to contract returns to normal and labor moves along more quickly.
In situations of polyhydramnios with high contractility, the extraction of the excess fluid by abdominal puncture will induce labor.
The pregnancy will probably continue even if fluid is removed when contractility is low.
According to research, the average amount of amniotic fluid in each sac is anything from 155 mL to 5430 mL.
Therefore, the amount of amniotic fluid in a twin pregnancy is either the same as that of a single pregnancy or slightly higher.
Monozygotic twins are the only ones who may develop acute polyhydramnios during pregnancy.
The risk of prenatal abnormalities is not enhanced, unlike in cases of chronic hydramnios.
All the clinical symptoms result from the rapid distension of one of the amniotic sacs.
Polyhydramnios can be brought on by many different factors, including but not limited to: having more than one baby in the womb; the mother having diabetes (including gestational diabetes), the baby having a blockage in their digestive tract (gut atresia), or the mother having an infection.
Polyhydramnios in twin pregnancy is a pregnancy issue that usually does not need treatment.
Your physician will continuously monitor you and may prescribe an infusion.
It's normal to be worried if you've been diagnosed with having too much amniotic fluid.
Amniotic taps are safe if the amniotic fluid is extracted slowly under preventive tocolysis.
It relieves the mother's symptoms and may postpone birth until the twins' gestational age is more compatible with survival.
Talk to your prenatal care provider about your worries and ask any questions about the situation.