| 词条 | Polyhydramnios |
| 释义 |
| name = | synonyms = Polyhydramnion, hydramnios, polyhydramnios | image = Ultrasound Scan ND 145330 1455290 cr.png | caption = | pronounce = | field = | symptoms = | complications = | onset = | duration = | types = | causes = | risks = | diagnosis = | differential = | prevention = | treatment = | medication = | prognosis = | frequency = | deaths = }}Polyhydramnios is a medical condition describing an excess of amniotic fluid in the amniotic sac. It is seen in about 1% of pregnancies.[1][2][3] It is typically diagnosed when the amniotic fluid index (AFI) is greater than 24 cm.[4][5] There are two clinical varieties of polyhydramnios: chronic polyhydramnios where excess amniotic fluid accumulates gradually, and acute polyhydramnios where excess amniotic fluid collects rapidly. The opposite to polyhydramnios is oligohydramnios, not enough amniotic fluid. PresentationAssociated conditionsFetuses with polyhydramnios are at risk for a number of other problems including cord prolapse, placental abruption, premature birth and perinatal death. At delivery the baby should be checked for congenital abnormalities. CausesIn most cases, the exact cause cannot be identified. A single case may have one or more causes, including intrauterine infection (TORCH), rh-isoimmunisation, or chorioangioma of the placenta. In a multiple gestation pregnancy, the cause of polyhydramnios usually is twin-to-twin transfusion syndrome. Maternal causes include cardiac problems, kidney problems, and maternal diabetes mellitus, which causes fetal hyperglycemia and resulting polyuria (fetal urine is a major source of amniotic fluid). A recent study distinguishes between mild and severe polyhydramnios and showed that Apgar score of less than 7, perinatal death and structural malformations only occurred in women with severe polyhydramnios.[6] In another study, all patients with polyhydramnios, that had a sonographically normal fetus, showed no chromosomal anomalies.[4] (M/C for polyhydramnio is fetal anomalies 'Williams Obstetrics, 24th Edition – Cunningham, Leveno, Bloom et al. Table 11-2) but these anomalies include:
DiagnosisThere are several pathologic conditions that can predispose a pregnancy to polyhydramnios. These include a maternal history of diabetes mellitus, Rh incompatibility between the fetus and mother, intrauterine infection, and multiple pregnancies. During the pregnancy, certain clinical signs may suggest polyhydramnios. In the mother, the physician may observe increased abdominal size out of proportion for her weight gain and gestation age, uterine size that outpaces gestational age, shiny skin with stria (seen mostly in severe polyhydramnios), dyspnea, and chest heaviness. When examining the fetus, faint fetal heart sounds are also an important clinical sign of this condition. TreatmentMild asymptomatic polyhydramnios is managed expectantly. A woman with symptomatic polyhydramnios may need hospital admission. Antacids may be prescribed to relieve heartburn and nausea. No data support dietary restriction of salt and fluid.{{citation needed|date=September 2012}} In some cases, amnioreduction, also known as therapeutic amniocentesis, has been used in response to polyhydramnios.[9] See also
References1. ^Alexander, ES, Spitz, HB, Clark, RA. Sonography of polyhydramnios. AJR Am J Roentgenol 1982; 138:343 2. ^Hill LM; Breckle R; Thomas ML; Fries JK, Polyhydramnios: ultrasonically detected prevalence and neonatal outcome, Obstet Gynecol 1987 Jan;69(1):21–5, {{PMID|3540761}} 3. ^Hobbins JC; Grannum PA; Berkowitz RL; Silverman R; Mahoney MJ, Ultrasound in the diagnosis of congenital anomalies., Obstet Gynecol 1979 Jun 1;134(3):331–45., {{PMID|453266}} 4. ^1 Y Barnhard; I Bar-Hava; MY Divon, Is polyhydramnios in an ultrasonographically normal fetus an indication for genetic evaluation?, Obstet Gynecol. 1995 Nov;173(5):1523-7. 5. ^Brady K, Polzin WJ, Kopelman JN, Read JA. Risk of chromosomal abnormalities in patients with idiopathic polyhydramnios. Obstet Gynecol 1992;79:234–8. 6. ^Bundgaard A, Andersen BR, Rode L, Lebech M, Tabor A, Prevalence of polyhydramnios at a Danish hospital—a population-based study. Acta Obstet Gynecol Scand. 2007; 86(12): 1427–31. 7. ^{{cite journal |author=Seyberth HW. |title=An improved terminology and classification of Bartter-like syndromes. |journal=Nat Clin Pract Nephrol |volume=4 |issue=10 |pages=560–7 |year=2008 |pmid=18695706 |doi=10.1038/ncpneph0912}} 8. ^{{cite web|url=http://www.moldiag.de/en/dis/bartter.htm |title=Hereditary disease: Bartter syndrome |publisher=Moldiag.de |date= |accessdate=2012-09-28}} 9. ^{{cite journal |vauthors=Piantelli G, Bedocchi L, Cavicchioni O, etal |title=Amnioreduction for treatment of severe polyhydramnios |series=75 |journal=Acta bio-medica : Atenei Parmensis |volume=Suppl 1 |issue= |pages=56–8 |year=2004 |pmid=15301292 |doi=}} External links{{Medical resources| DiseasesDB = 10319 | ICD10 = {{ICD10|O|40||o|30}} | ICD9 = {{ICD9|657}} | ICDO = | OMIM = | MedlinePlus = 003267 | eMedicineSubj = radio | eMedicineTopic = 566 | MeshID = D006831 }}
1 : Pathology of pregnancy, childbirth and the puerperium |
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