By Dr Low Kah Tzay, Paediatrician | Mt. Elizabeth Hospital
reprinted with permission from "Great Expectations by Today's Parents magazine
I’m due to have my second baby soon. My doctor says there is a lot of water in the water bag.What does this mean?
It can be difficult to find out the cause of polyhydramnios (excessive fluid) and, sometimes, no cause can be found. Sometimes the extra fluid is due to a problem with the baby, or with the placenta or with you, the mother.
Possible causes include:
> Maternal diabetes, where your blood sugar levels are not well controlled. Your baby’s urine output increases and this in turn increases the volume of amniotic fluid
> Being pregnant with twins. There may be a particular problem if the babies are identical (monozygotic).
> Infections that affect your baby, such as rubella, cytomegalovirus,toxoplasmosis and syphilis, may be associated with polyhydramnios.
> A congenital problem with the baby occurs in about 20 per cent of polyhydramnios cases. There may be a blockage in the oesophagus (swallowing tube), meaning he cannot swallow the amniotic fluid and control the amount of it around him. It may also be a sign that the baby has a problem with his central nervous system, or with his heart or kidneys.
> Sometimes, polyhydramnios is associated with babies who have chromosomal abnormalities, such as Down’s or Edward syndrome
> In rare cases, the placenta may have developed a tumour or there may be a problem with the arteries in the umbilical cord resulting in polyhydramnios.
Most women with polyhydramnios go on to have healthy babies, particularly if the condition is mild. If you are not known to have diabetes, you will be given an oral glucose tolerance test (OGTT). If this is high, you may be referred to a diabetes specialist who can get your blood sugar levels down. This will reduce the amount of fluid.
Ultrasound scanning can help spot any problems with your baby. If a detailed scan shows nothing untoward, your baby is usually fine and the polyhydramnios is caused by something else.
There are other laboratory tests for investigating polyhydramnios if infection is suspected. You would be followed up at more frequent intervals as you are at higher risk of going into premature labour, cord prolapse when your water bag ruptures or the placenta starting to come away from the wall of the uterus (abruption placenta).
In mild cases of polyhydramnios, your doctor will advise you to rest or even start your maternity leave early. Even then, because your uterus is so swollen, you may go into labour prematurely.
Go to the hospital immediately if your waters break or you start having contractions.
Dr. Low Kah Tzay is a paediatrician working at Mt Elizabeth Hospital. He specializes in the management of growth and development of children; such as feeding difficulties, language delay, sleep disorders, attention disorders, autistic spectral disorders and learning diffi culties. His website is at www.pediatricdoctor.net.
Sources: Pregnancy Tips: Too Much Water in Water Bag
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