With a little more than 10 weeks to go in my fourth pregnancy, I knew that something was wrong.
I mean, I had always been an, ahem, larger pregnant woman.
I like to say that us women who are on the shorter side just don’t have the extra room in our torsos, which makes those babies stand straight out. But, of course, that’s just to make myself feel better.
I had my fair share of pregnancy weight gain with my three previous pregnancies and experienced the fun of delivering a 9-pound, 2-ounce bouncing baby boy. But this time around, things just felt a little different.
For starters, I was huge. Like busting-out-of-my-maternity-clothes-at-barely-30-weeks huge.
So when my doctor first paused while measuring my belly at a routine checkup, I knew something was up.
“Hmmm…” she said, whipping her tape measure around for another go. “It looks like you’re measuring 40 weeks already. We’ll have to do some testing.”
Yes, you read that right — I was measuring a full-term 40 weeks at only 30 — and I still had almost three long, miserable months of pregnancy to go.
Further testing revealed that there was nothing wrong with the baby (thank goodness) and I didn’t have gestational diabetes (a common cause of larger-than-life bellies), but that I did have a pretty severe case of polyhydramnios.
Polyhydramnios is a condition where a woman simply has too much amniotic fluid during her pregnancy.
The first is the Amniotic Fluid Index (AFI), where the amount of fluid is measured in four different pockets in specific areas within the uterus. A normal AFI ranges from 5 to 24 centimeters (cm).
The second is to measure the deepest pocket of fluid within the uterus. Measurements over 8 cm are diagnosed as polyhydramnios.
The range depends on how far along you are in your pregnancy, as the fluid levels will increase up to your third trimester, then decrease.
As a rule of thumb, polyhydramnios is usually diagnosed with an AFI over 24 or a big pocket of fluid on the ultrasound of over 8 cm. Polyhydramnios is estimated to occur in only about 1 to 2 percent of pregnancies. Lucky me!
Polyhydramnios has six main causes:
- a physical abnormality with the fetus, such as a spinal cord defect or digestive system blockage
- twins or other multiples
- gestational or maternal diabetes
- fetal anemia (including anemia that’s caused by Rh incompatibility, when the mother and baby have different blood types)
- genetic defects or other issues, such as an infection
- no known cause
Fetal abnormalities are the most worrisome causes of polyhydramnios, but luckily, they’re also the least common.
In most cases of mild to moderate polyhydramnios, however, there’s simply no known cause.
You should also keep in mind that even with ultrasound testing, 100 percent accurate diagnosis may not be completely possible. There are associations between an elevated AFI and poor outcomes for your baby. These can include:
- increased risk for preterm delivery
- increased risk for admission to the neonatal intensive care unit (NICU)
Some cases of polyhydramnios resolve spontaneously. However, your doctor will continue to check the fluid levels regularly once the diagnosis is made to ensure that you and your baby are managed accordingly.
The risks of polyhydramnios will vary based on how far along you are in your pregnancy and how severe the condition is. In general, the more severe the polyhydramnios, the higher the risk of complications during pregnancy or delivery.
Some of the risks with more advanced polyhydramnios include:
- increased risk of a breech baby (with more fluid, the baby can have trouble getting head down)
- increased risk of umbilical cord prolapse, which is when the umbilical cord slips out of the uterus and into the vagina before delivery of the baby
- increased risk of bleeding complications after birth
- premature rupture of membranes, which can lead to preterm labor and delivery
- increased risk of placental abruption, where the placenta separates from the uterine wall prior to delivery of the baby
If your doctor suspects polyhydramnios, the very first thing they’ll do is order additional testing to ensure that there’s nothing wrong with your baby. Mild to moderate polyhydramnios may need no additional treatment other than monitoring.
Only in very rare, severe cases is treatment considered. This includes medication and draining the excess amniotic fluid.
In my case, I was monitored frequently with biweekly non-stress tests and worked very hard to get my baby to flip head-down.
Once she did, my doctor and I agreed on an early, controlled induction so that she wouldn’t flip again or have my water break at home. She was born perfectly healthy after my doctor broke my water — and there was a lot of water.
For me, polyhydramnios was a really scary experience during my pregnancy because there were so many unknowns with the condition.
If you receive the same diagnosis, be sure to talk to your healthcare provider to rule out any underlying causes and weigh the pros and cons of an early delivery to determine the best route for you and your baby.
Chaunie Brusie, BSN, is a registered nurse with experience in labor and delivery, critical care, and long-term care nursing. She lives in Michigan with her husband and four young children, and is the author of the book “Tiny Blue Lines.”