Common problems arising during pregnancy, (include) polyhydraminos, swelling and edema, urinary-tract problems (infections)

POLYHYDRAMNIOS

This is the excess of liquor amnii to cause abnormality in pregnancy or labor as detected clinically at any stage of pregnancy. Statistically, the excess means more than two liters of liquor amnii.

Incidence rate is about 05-1% according to various estimates.

Causes- the cause is still unknown. The liquor amnii is not static but is constantly changing to new production and absorption. The hydramnios possibly results from deficient absorption and/or excessive production of liquor amnii. A malformed fetus (with that of Central Nervous System) lacks behind in swallowing liquor and in antidiuretic hormone leading to excess of urination.

Clinical conditions commonly associated with polyhydramnios are-

1. Twin pregnancy especially monozygotic twins.

2. Certain fetal malformations- anencephaly(50%) cases, open spina bifida and atresia of the esophagus.

3. Diabetis mellitus. 20-30% cases develop polyhydramnios.

4. Hydrops fetalis due to Rh-isoimmunization.

5. Chorioangioma of placenta may be an associated factor.

As a rule, composition of liquor amnii in polyhydramnios does not differ from the normal cases.

Symptoms-

§ Undue enlargement of abdomen occurs with difficulty in walking.

§ Breathlessness, palpitation especially in the recumbent position and also coming on exertion.

§ Pain abdomen.

Signs-

§ Signs of pregnancy.

§ There may signs of Pre-ecclampsia. High BP, edema leg, proteinuria are commonly detected.

Investigation-

§ Ultrasonography is possibly the easiest and definitive investigation.

Treatment-

§ In early cases, expectant treatment is tried by bed rest, restriction of extra salt and drinks.

§ Amniocentesis- abdominal amniocentesis gives relief in maternal discomfort and tends to prolong pregnancy when fetal malformation is excluded in chronic or acute polyhydramnios.

SWELLING AND EDEMA

Edema is not uncommon during pregnancy because of accumulation of fluid in body tissues. Swelling of the feet, ankles and hands is most common. Face may also become puffy. The problem usually is worse at the end of the day and in warm weather. This is most common in the last three months.

It usually regresses after giving birth. If edema is so severe that it hampers mother’s daily work, restriction of fluid intake, salt restricted diet is prescribed.

URINARY TRACT INFECTION

Urinary tract infection is detection of significant amount of 100,000 colonies or more per ml. of on two occasions in bladder urine of pregnant women collected by midstream voiding. This is called Asymptomatic Bacteriuria (ASB).

About 25% of women with ASB complicates into Pyelonephritis.

Treatment is by third or fourth generation cephalosporin after urine culture and sensitivity.