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  1. More than 2 litre of amniotic fluid is termed as polyhydramnios, or
  2. AFI ≥25 cm or
  3. Single largest vertical pocket of liquor >8 cm (normal = 2-8 cm)



Single Largest Vertical Pocket (cm)


Mild                 >8-11


Moderate            12-15


Severe             >15


  1. MC cause = idiopathic
  2. Fetal anomalies:
    • Obstruction of fluid transit through the gastrointestinal tract: esophageal duodenal atresia and diaphragmatic hernia
    • Anencephaly
    • Open spina bifida
  3. Multiple pregnancy
  4. Hydrops fetalis (immune and nonimmune)
  5. Chromosomal abnormalities (e.g., trisomy 18)
  6. Twin-twin transfusion syndrome
  7. Diabetes insipidus/Bartter syndrome
  8. Maternal: diabetes mellitus and cardiac disease
  9. Placental: chorioangioma (a/w acute polyhydramnios)


  1. Preterm labor
  2. PROM
  3. Malpresentation
  4. Cord prolapse
  5. Abruption
  6. PPH
  7. Subinvolution of uterus
  1. Polyhydramnios associated with fetal hydrops may cause the MIRROR SYNDROME, whereby the maternal condition mimics the fetus and mother develops edema, proteinuria, and PIH.
  2. Indomethacin and sulindac are NSAIDs that decrease fetal urine production and are used in medical management of polyhydramnios in symptomatic patients.
  3. A major concern for the use of indomethacin/sulindac is the risk of premature closure of the fetal ductus arteriosus. Hence, these drugs should not be used beyond 34 weeks of gestation.

Chorioangioma (Hemangioma)

  1. These are the only benign tumors of the placenta.
  2. They most likely are hamartomas of primitive chorionic mesenchyme and have an incidence of about 1 %.
  3. Small growths are usually asymptomatic, but large tumors may be associated with polyhydramnios or antepartum hemorrhage.


  1. API <5 cm
  2. Amniotic fluid less than 100 mL



Chromosomal Abnormalities

Uteroplacental Insufficiency

Congenital anomalies (e.g., renal agenesis and posterior


urethral valves)



NSAIDs, angiotensin-converting enzyme inhibitors

Postdatism/ postterm pregnancy




Twin-to-twin transfusion


  1. Amnion nodosum are tiny, light tan, creamy nodules in the amnion made up of vernix caseosa with hair, degenerated squames, and sebum. They result from oligohydramnios and are most commonly found in fetuses with renal agenesis and prolonged preterm ruptured membranes, or in the placenta of the donor fetus with twin to twin transfusion syndrome.
  2. Amniotic bands are caused when disruption of the amnion leads to formation of bands or strings that entrap the fetus and impair growth and development of the involved structure. Fetal conditions that appear to be the consequence of this phenomenon include intra-uterine amputations.
  3. Tetrad of earl -onset oligohydramnios:
    1. Facial clefts (cleft lip / palate
    2. IUGR
    3. Limb reduction defects
    4. Pulmonary hypoplasia

Renal agenesis: This defect has an incidence of about 1 in 4000 births. No kidneys are seen ultrasonographically at any point during gestation. The adrenal glands typically enlarge and occupy the renal fossae, which is termed the lying down adrenal sign. Without kidneys, no urine is produced and the resulting severe oligohydramnios leads to pulmonary hypoplasia, limb contractures, a distinctive compressed face, and death from cord compression or pulmonary hypoplasia. When this combination of abnormalities results from renal agenesis, it is called Potter syndrome after Dr. Edith Potter who described it in 1946. When these abnormalities result from scanty amniotic fluid of some other etiology, it is called oligohydramnios sequence.

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