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Home |  Pregnancy overview |  Reproductive Health | Complications | Labor & Birth

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It is worth mentioning here that the outcome of excess fluid associated with gestational diabetes depends on how well-controlled the diabetes is.  Poorly controlled dia­betes in pregnancy will lead to uncertain - even poor - results.

 

Effects of excessive fluid on the mother

If the abdominal distension is excessive, then there could be considerable discomfort and backache. She may not be able to find a comfortable sleeping position. In extreme cases, she may even get breathless. These are exceptional circum­stances.

 

The risk of a caesarean delivery is higher in this group of women, regardless of the cause of increased fluid volume. This is because the fact that there is excess fluid makes her prone to complications such as placental abruption, abnormal lie of the fetus and premature labor, all of which may make caesarean section unavoidable.

Management options for Excessive Amniotic Fluid

Treatment will depend on the cause. The mainstay of any treatment regime is to ensure the relief of symptoms for the mother and to prolong pregnancy and prevent prematurity, whenever possible.

 

Rest is generally advised and avoidance of physical over-exertion may be useful in this regard.

In conditions like anencephaly, where the baby has no hope of survival outside the womb, termination of pregnancy may be advised unless the mother has objections to this.

 

Indomethacin is one drug that may be used both to control the amount of amniotic fluid (through reduction of the fetal urine output) and to prolong the pregnancy (through suppression of uterine activity).

Indomethacin is not always successful and can sometimes cause fetal complications of its own. Indomethacin can only be used at gestations below 35 weeks.

 

In some conditions, such as twin-to-twin transfusion (TTTS), the use of Indomethacin is considered unwise.

 

Relieving  symptoms in polyhydramnios

In very excessive fluid accumulation, the one effective method of relieving the symptoms is to repeatedly drain the fluid. This is called "amnio-reduction". A certain amount of fluid is removed each time using a fine long needle through the abdominal wall, under direct ultrasound guidance.

 

The relief from symptoms following amnio-reduction is usually short-lived, certainly not more than a day or two. The procedure has to be performed repeatedly.

 

Risks associated with amnio-reduction

Amnio-reduction could lead to rupture of the membranes, which will almost certainly lead to labor within days, if not hours.

 

The procedure could also provoke a more serious condition in the form of placental abruption which, in most cases, calls for immediate delivery by caesarean section. This could be at an extremely premature stage and the baby may not survive.

 

The other major risk is that of introducing infection, which may also lead to the baby not surviving. All these are serious potential complications but are uncommon. Decision making for the parents is never easy in such circumstances.