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 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. I was having trouble breathing, walking felt like total misery, my feet were more swollen than a boxer's ear, and don't even get me started on the struggle that was trying to roll over in my bed at night.
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 was not diabetic (a common cause of larger-than-life bellies), but that I did have a pretty severe case of polyhydramnios.
What Is Polyhydramnios?
Polyhydramnios is a condition where a woman simply has too much amniotic fluid during her pregnancy.
In routine ultrasounds, there are two ways to measure the amount of amniotic fluid in the uterus. The first is the Amniotic Fluid Index, or AFI, where the amount of fluid is measured in four different pockets in specific areas within the uterus. A normal AFI ranges from 8 to 24 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 25 or a big pocket of fluid on the ultrasound of over 8 cm. Polyhydramnios is estimated to occur in only about 1 percent of pregnancies. Lucky me!
What Causes It?
Polyhydramnios has three main causes:
- an abnormality with the fetus
- maternal gestational diabetes
- no known cause
The first one is obviously the most terrifying, but luckily it's also the least common.
In general, the more severe the polyhydramnios, the higher the risk of complications during pregnancy or delivery. If your doctor suspects polyhydramnios, the very first thing they will do is order additional testing to ensure that there is nothing wrong with your baby.
You will also most likely have to undergo more rigorous blood sugar testing to rule out gestational diabetes.
In most cases of mild to moderate polyhydramnios, however, there is simply no known cause. You should also keep in mind that even with ultrasound testing, 100 percent accurate diagnosis may not be completely possible. In addition, there is no association between an elevated AFI and poor outcomes for your baby.
What Are the Risks of Polyhydramnios?
The risks of polyhydramnios will vary based on how far along you are in your pregnancy and how severe the condition is.
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 uterine 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 (the uterus can simply get stretched out and tired)
- premature labor and delivery
How Is Polyhydramnios Treated?
Mild to moderate polyhydramnios may need no additional treatment other than monitoring.
Only in very rare, severe cases is treatment considered. This includes draining the excess amniotic fluid, and medication.
You can expect more frequent monitoring and testing and many doctors will discuss a cesarean delivery if they feel the baby is too large, or breech or vaginal birth is too risky.
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 would not 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 are so many unknowns with the condition.
If you receive the same diagnosis, be sure to talk to your care 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, B.S.N., 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.”