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Geburtshilfe Frauenheilkd 2013; 73(12): 1241-1246
DOI: 10.1055/s-0033-1360163
Review
GebFra Science
Georg Thieme Verlag KG Stuttgart · New York

Polyhydramnios: Causes, Diagnosis and Therapy

Das Polyhydramnion: Ursachen, Diagnostik und Therapie
A. Hamza
1   Gynäkologie und Geburtshilfe, Universitätsklinikum des Saarlandes, Homburg/Saar
,
D. Herr
1   Gynäkologie und Geburtshilfe, Universitätsklinikum des Saarlandes, Homburg/Saar
,
E. F. Solomayer
2   Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar
,
G. Meyberg-Solomayer
1   Gynäkologie und Geburtshilfe, Universitätsklinikum des Saarlandes, Homburg/Saar
› Author Affiliations
Further Information

Publication History

received 21 October 2013
revised 12 November 2013

accepted 12 November 2013

Publication Date:
20 December 2013 (online)

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Abstract

Polyhydramnios is defined as a pathological increase of amniotic fluid volume in pregnancy and is associated with increased perinatal morbidity and mortality. Common causes of polyhydramnios include gestational diabetes, fetal anomalies with disturbed fetal swallowing of amniotic fluid, fetal infections and other, rarer causes. The diagnosis is obtained by ultrasound. The prognosis of polyhydramnios depends on its cause and severity. Typical symptoms of polyhydramnios include maternal dyspnea, preterm labor, premature rupture of membranes (PPROM), abnormal fetal presentation, cord prolapse and postpartum hemorrhage. Due to its common etiology with gestational diabetes, polyhydramnios is often associated with fetal macrosomia. To prevent the above complications, there are two methods of prenatal treatment: amnioreduction and pharmacological treatment with non-steroidal anti-inflammatory drugs (NSAIDs). However, prenatal administration of NSAIDs to reduce amniotic fluid volumes has not been approved in Germany. In addition to conventional management, experimental therapies which would alter fetal diuresis are being considered.

Zusammenfassung

Als Polyhydramnion bezeichnet man eine pathologische Vermehrung von Fruchtwasser bei der Schwangeren, die mit einer erhöhten perinatalen Morbidität und Mortalität vergesellschaftet ist. Häufige Ursachen eines Polyhydramnions sind der Gestationsdiabetes, fetale Fehlbildungen, die z. B. zu einem gestörten Schluckvorgang von Fruchtwasser führen, fetale Infektionen und andere seltene Ursachen. Die Diagnostik des Polyhydramnions erfolgt dabei v. a. sonografisch. Die Prognose des Polyhydramnions hängt von der Ursache sowie der klinischen Ausprägung ab: Typische Folgen des Polyhydramnions beinhalten maternale Atembeschwerden, die Frühgeburtlichkeit, den vorzeitigen Blasensprung, regelwidrige Kindslagen, den Nabelschnurvorfall, sowie die postpartale Blutung. Aufgrund einer gemeinsamen Ätiologie mit einem Gestationsdiabetes ist das Polyhydramnion darüber hinaus mit einer fetalen Makrosomie assoziiert. Zur Vermeidung der o. g. Komplikationen bestehen pränatal grundsätzlich 2 Therapieformen: die invasive Entlastungspunktion und die medikamentöse Amnionreduktion mit z. B. Non-Steroidal Anti-inflammatory drugs (NSAID), die jedoch in Deutschland bei dieser Indikation nicht zugelassen sind. Darüber hinaus gibt es in jüngster Zeit experimentelle Therapieansätze, die auf die Beeinflussung der fetalen Diurese zielen.

Key words

polyhydramnios - amniotic fluid - high risk pregnancy

Schlüsselwörter

Polyhydramnion - Fruchtwasser - Risikoschwangerschaft

Supporting Information

 

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