Polyhydramnios is an abnormality occurring during pregnancy in which there is an excessive amount of amniotic fluid in the womb. Polyhydramnios occurs in about 2% of pregnancies.
Although excessive amniotic fluid is not inherently harmful to the baby, it can lead to other complications and condition (such as prematurity) that are potentially harmful. Approximately 30% of pregnancies with polyhydramnios end in neonatal death. Polyhydramnios is often caused by infections, gestational diabetes, and genetic fetal anomalies.About Polyhydramnios
During pregnancy the womb fills with a critical liquid substance called amniotic fluid. Amniotic fluid serves several important functions in fetal development. It acts like a cushion to protect the baby from external trauma and insulates the baby from temperature changes. During gestation the baby also inhales or "eats" the amniotic fluid which facilitates lung development.
The volume of amniotic fluid in the mother's womb varies somewhat depending on the mother and size of the baby, but generally stays within certain ranges that are considered normal. The normal amount of fluid also varies depending on the stage of gestation. The normal maximum volume of amniotic fluid shoulder never exceed 1000 ml during any stage of pregnancy.
In a certain percentage of pregnancies, the mother retains excess levels of amniotic fluid in her womb. This is an abnormal complication called polyhydramnios. Polyhydramnios can range from mild to severe depending on how much excess amniotic fluid is being retained in the womb.
So polyhydramnios is just too much fluid. The delicate yin and yang to maintain fluid balance has gone awry. Typically, the problem is the fetus is producting too much urine or whatever secretions are being made aren't being re-absorbed.
Mild cases of polyhydramnios are often harmless and symptomless while more severe cases can trigger significant physical symptoms and lead to major complications.Symptoms of Polyhydramnios
There are three classifications for polyhydramnios: mild, moderate and severe. Mild polyhydramnios is characterized by a value of 8 to 11 centimeters. Moderate polyhydramnios between 12 to 15 centimeters. Severe polyhydramnios are above 16 cm. Severe polyhydramnios may necessitate early labor. However, mild cases of polyhydramnios are managed expectantly meaning that the patient is monitored until the condition goes away on its own.
Mild polyhydramnios will usually not have any physical symptoms at all and is generally harmless. Severe cases of polyhydramnios, where the level of excess amniotic fluid is very high, will have a number of acute physical symptoms. The physical symptoms are caused by the expansion of the womb as it swells with excess fluid and begins pushing up against the mother's internal organs. The most common symptoms associated with severe or moderate cases of polyhydramnios include:
- Difficulty or pain when breathing
- Swelling in lower body
- Abnormal urination or bowel movements
- Pelvic pressure / abdominal pain
- Swelling of the vulva
The majority of polyhydramnios cases are diagnosed in the last phase of pregnancy. However, more problematic cases tend to occur earlier and the condition can start as early as the 15th week of pregnancy.Polyhydramnios Risks and Complications
Excess amniotic fluid is not directly harmful to the baby, however, it frequently leads to the development of other complications and problems that can be very dangerous. The most serious pregnancy or childbirth complications that are often triggered by polyhydramnios include:
- Premature Birth: when there is too much amniotic fluid in the womb it creates outward uterine pressure as the baby grows. This is known to stimulate premature labor forcing the baby to be born before it is fully ready. Premature birth can be disastrous for the baby's health and greatly increase the risk of numerous health problems and birth injuries.
- Fetal Malposition: excessive levels of amniotic fluid frequently cause the baby to floats into an abnormal delivery presentation such as breech or transverse. Breech position and other abnormal presentations make vaginal delivery much more difficult and potentially hazardous for the baby. The risk of harmful complications or events during childbirth such as umbilical cord prolapse is significantly increased.
- Placenta Abnormalities: polyhydramnios significantly increases the risk of developing placental abnormalities or complications such as placental abruption or placenta previa. Complication involving the placenta can be very harmful to the baby since the placenta and umbilical cord are critically important to the delivery or oxygen and nutrients to the baby.
Polyhydramnios is frequently a key component in birth injury cases. Amniotic fluid levels are not difficult for doctors to measure so you don't really see any birth injury malpractice claims based on failure to diagnose polyhydramnios. What you do see are cases in which polyhydramnios is diagnosed in advance but doctors fail to properly manage the condition or take proper precautions to account for the increased risk of secondary complications.
Some doctors use Indocin to treat polyhydramnios. This drug is not approved for polyhydramnios. Indomethacin is actually non-steroidal anti-inflammatory analgesic used to treat rheumatoid arthritis, ankylosing spondylitis, and osteo-arthritis. But many doctors prescribe it anyway for excessive amniotic fluid, arguing that it is the cheapest, fastest, and least complicated solution. This is arguably an acceptable practice. But the lack of research is troubling. There is confusion as to what is the appropriate dosage. Also, the doctor has to manage and monitor the complications and consider an amnioreduction if the Indocin does not do the trick. There is a risk of rupture with an amnioreduction because it is invasive and requires a large needle to be injected remove the excessive fluid.
Excessive amniotic fluid does not itself cause oxygen loss that can lead to brain damage. But it can set off a chain reaction that causes loss of oxygen causing hypoxia or death. What can happen is polyhydramnios can cause uterine overdistension. This can induce placental dysfunction or uteroplacental insufficiency. Damage to the placenta can deprive the child of oxygen that can lead to a brain injury.
Excessive amniotic fluid can cause a more challenging labor. It can cause prolonged labor because the uterus does not properly contract. Some obstetricians attempt to reduce the polyhydramnios by breaking the bag of water. So if the uterus is overdistended, it may not contract properly which will cause extended labor.
There is a higher correlation between excessive amniotic fluid and congenital defects and you see that in one of the sample polyhydramnios settlements below.
Lawsuits for failing to treat excessive amniotic fluid are less common. The more viable claims tend to involve the chain reaction we discussed above and that causes oxygen deprivation during the birthing process, leading to a hypoxic injury.
Below are example verdicts and settlements from birth injury malpractice cases involving negligent management or treatment of polyhydramnios and resulting complications.
- Graham v. Elite OB/GYN P.C. (New Jersey 2020) $1 million: This is an atypical polyhydramnios birth injury case. An expectant mother underwent an ultrasound. The result indicated polyhydramnios. Her OB/GYN failed her mention this to her. Two months later, her son was delivered with Beckwith-Wiedemann Syndrome. This syndrome is not a birth injury; it is genetic defect. The child requires lifelong treatments and 24-hour care. His mother alleged that her OB/GYN failed to inform her of possible genetic abnormalities. What's is the connection? High amniotic fluid levels are a marker for Beckwith-Wiedemann Syndrome. She claimed she would have undergone amniocentesis, sought genetic counseling, and considered terminating the pregnancy if she was properly informed. The lawsuit settled for $1 million.
- McDaniel v Ritchey (Alaska 2018) $1 million: mother goes to OB/GYN office for prenatal care visit midway through pregnancy and she is diagnosed with polyhydramnios and a calcifying placenta. Doctors take no action at the point except to schedule her for a follow up visit the next week. Before the follow up visit occurs the baby dies and mother sues doctors alleging that they negligently failed to recognize the danger signs resulting from polyhydramnios and her placental issues which should have prompted immediate intervention.
- Harris v University of Penn (Pennsylvania 2013) $41.6 million: mother with high-risk pregnancy goes to her OB/GYN office at University of Penn Hospital for prenatal examination with complaints of pelvic pressure. Examination indicates funneling of the cervix and severe polyhydramnios but no course of action is taken at that time. 3 days later the baby has to be delivered via emergency C-section and is extremely premature at just 25 weeks gestation. She suffers numerous health problems related to her prematurity including brain bleeds, hydrocephalus, respiratory distress syndrome. She is permanently blind, deaf, and diagnosed with very severe cerebral palsy. Her mother sues the hospital and doctors alleging that they were negligent in failing to administer steroids and admit her to hospital after noting polyhydramnios and cervical funneling in prenatal exam. Doctors deny wrongdoing insisting they acted appropriately. A jury in Philadelphia disagrees and awards plaintiff $41.6 million in damages.
- Coverdale v Women's Health Services (Pennsylvania 2011) $5 million: plaintiff mother presents to defendant hospital and is diagnosed with polyhydramnios. Her levels of excess amniotic fluid are found to be very high. Doctors decide to delivery baby but instead of performing C-section they opt for vaginal delivery and administer Pitocin to induce labor. Several hours into labor a placental abruption occurs and the baby dies from oxygen deprivation. Plaintiff alleges that doctors were negligent in failing to deliver via C-section and in administering Pitocin which is never supposed to be used on mother's with polyhydramnios. Case is settled out of court for $5 million.
- Hughes DS, et al. Accuracy of the Ultrasound Estimate of the Amniotic Fluid Volume (Amniotic Fluid Index and Single Deepest Pocket) to Identify Actual Low, Normal, and High Amniotic Fluid Volumes as Determined by Quantile Regression. J Ultrasound Med 2020; 39:373. Study found that
- Bruner JP, Crean DM. Equalization of amniotic fluid volumes after amniocentesis for treatment of the twin oligohydramnios - polyhydramnios sequence. Fetal Diagn Ther 14: 80-5, 1999.
- Bruner JP, Rosemond RL. Twin-to-twin transfusion syndrome: A subset of the twin oligohydramnios/polyhydramnios sequence (TOPS). Am J Obstet Gynecol 169:925, 1993. (You can read more about the twin-twin transfer problem.)
- Damato N, et. al: Frequency of fetal anomalies in sonographically detected polyhydramnios.) Ultrasound Med 1993; 12:11-15
- Kirshon B, et.al: Indomethacin therapy in the treatment of symptomatic polyhydramnios. Obstet Gynecol 1990;75:202-5.
- Hashimoto B, et. al: Ultrasound evaluation of polyhydramnios and twin pregnancy. Am J Obstet Gynecol 1986; 154:1069-1072
If you believe your doctors mishandled your polyhydramnios and it harmed your baby call the birth injury lawyers at Miller & Zois for a free consultation. Our malpractice lawyer are based in Maryland but handle birth injury cases all over the country. Call us at 800-553-8082 or request a consultation online.