COLLEGE OF NURSING

UDAIPUR

CASE STUDY ON

POLYHYDRAMINOS

SUBMITTED TO SUBMITTED BY

Mrs. Geetanjali Sharma Miss. Manju Kumar Dhaker

HOD , Obstetrics and Gynaecology M.Sc Nursing Final Year

Submitted On : 25/06/2019
 CASE PRESENTATION ON POLYHYDRAMNIOS
Guide - Mrs. Geetanjali Sharma
Name - Mrs. Manju Kumar Dhaker
Group - M.Sc. Nursing 2 nd t year student
Subject - Obstetrics &gynaecology
Date - 25/06/2016
Time - 10 am
Method of teaching - lecture,discussion
A V AIDS - poster ,ohp,blackboard

General objectives - At the end of the class the student will be able
To gain knowledge about polyhydramnios
And they will be able to apply this
Knowledge in their clinical and teaching area

Specific objectives -
All he of the class the student will be able to:-
 To introduce about polyhydramnios
 To know about definition of polyhydramnios
 To know about classification/type polyhydramnios
 To know about etiology of polyhydramnios
 To know about sign and symptom of polyhydramnios
 To know about medical and nsg management of polyhydramnios
 to know about complication of polyhydramnios
 MIDWIFERY CASE STUDY
( I ) IDENTIFICATION DATA:

Name of the patient : Mrs. Aarti

Name of husband : Mr. Chandan

Age : 24 year

Marital status : Married

Doctors name : Mrs. Ratna singh thakur

Address : 38415, khediya goan .

Date of admission : 06/01/19

Hospital number/ IPD number : 165498

LMP :05/6/18

EDD :12/01/19

GPLA :G2P1L1

Diagnosis : 32 weeks of pregnancy, with severe polyhydramnios

II) HISTORY OF THE PATIENT:

My patient admitted with the complaint of backache,nausea and vomiting

III) ANTENATAL EXAMINATION:

Medical history:no any history of DM/TB/ASTHMA/

Chronic illness: she has no history of chronic illness

Surgery: not having any type of surgery

Allergy: my patient is not allergic to any thing.

Communicable disease: no history of communicable disease in her family.

FAMILY HISTORY:

TYPE OF FAMILY:
She belongs to a joint family and there are total 7 members in the family.

History of multiple births: no history of multiple pregnancy

SOCIOECONOMIC BACKGROUND:

Religion: Hindu;

Family Income: Rs.10000/to Rs.18000/-

Education: Husband 12th

Wife 10th

Occupation: Husband: family business

Wife: Housewife

MENSTRUAL HISTORY:

Menarche: 14 years old

Duration: 4-5 days

Flow: regular.

Interval: 30 days

MARITAL HISTORY:

Age of marriage: 2o years.

Married life: 4 years.

DIETARY PATTERN:

My patient is non- vegetarian. She has no special likes; she said she would eat everything that is
cooked well. She has no special dislikes.

Habits: My patient no habits of smoking, drinking alcohol, chewing pan, tobacco.

 HISTORY OF PREVIOUS PREGNANCIES

S. YEAR FULL PRE- ABORT MODE Baby

N TERM TERM ION OF
O DELIV
ERY

sex alive stillb weight Remark

irth

male alive 2.8 kg.

1. 2010 Full FTND
term

PRENATAL HISTORY

DATE HEI WEI UR BP FHR GEST HT ABD PRESENT POSITIO TREAT

GH GHT IN ATIO OF GIR ATION N MENT
T E N FUND TH AND
US REMA
KS

10-09- 154c 54 kg S> 11 140 20 13 cm 65 Cephalic LOA Iron tab

11 m Nil 0/7 weeks cm Calciu
0 m tab
A- T.T 1st
Nil dose

10-10- 154 55 kg S> 12 140 24 18 cm 69 cephalic Loa Iron tab

11 cm Nil 0/8 weeks cm Calciu
0 m tab
A- T.T 2 nd
Nil dose

OBSERVATION & ASSESSMENT

GENERAL APPEARANCE: - good

SENSORIUM: -conscious
EMOTIONAL STATE: - stable
FOUL BODY ODOUR: - Absent
FOUL BREATH: - Absent

PHYSICAL EXAMINATION:
TEMPERATURE: - 98.8o F
PULSE: -82 beats/ min
RESPIRATION: -22 breath / min
B.P: - 120/80 mm/hg
SKIN COLOUR: - pale
POSTURE: - Normal
GAIT: - Normal
BLEEDING: - absent
HAIR: -Clean,normal hair growth,dandruff ,lies absent
Eye/ ENT: - normal vision,sclera pink in colour,pupils response to light,not
Having any complication
TEETH & GUMS: - number of teeth 32. No Dental caries present
ORAL MUCOSA: - Healthy
GLANDS: - Not enlarged
CHEST: -Normal, Bilateral movement present,normal breathing
pattern,breast
Enlarged,nipple dark in colour
ABDOMEN: -
 Fundus height-37 cm
 Abdominal girth- 85 cm
 Fundal palpation-hard irregular surface absent
 Lateral palpation-cephalic presentation
 Pawlik’s grip- ballotment is present,head is not engaged
 Pelvic palpation-head is not engaged
 FHR-140 beats/mint
FLUID: -more than normal
SHAPE: -oval shape
DISTENSION: -present
LIMBS: - Normal,pedal oedema present
TOES AND NAILS: - Normal
BACK: -Pain present [in back]
SKIN: -Hydrated
DEPENDENCY LEVEL OF THE PATIENT: Partial dependent

INVESTIGATIONS:
BLOOD GROUP  AB +VE
HIV, AUSTRALIAN ANTIGEN  NEGATIVE
Hb  12.6 gm%
T&D 12,400 per cum
PTT  28.4 SEC
PLATELET COUNT  2.63
RBS  120mg%

URINE ROUTINE
ALBUMIN ABSENT
PC 0/HPF
EC  0/HPF
RBC NIL
Specific gravity- 1.025
Acetone- nil
Sugar nil

BLOOD TEST-
Blood glucose[random/post prandial]- 107 [normal value-70-140 mg/dl]
Blood urea nitrogen - 12 [8-25 mg/dl]
USG -a single live interauterine fetus 32 weeks with no gross anomaly seen,AFI-27-
28cm,EFW-2.3 kg

DEFINITION-

Polyhydramnios is an excessive amount of amniotic fluid, which exceeds 1,500 ml. it occurs
in 0.9 percent of pregnancies. It is typically diagnosed when the amniotic fluid index (AFI) is
greater than 20 cm ( ≥ 20 cm).

ETIOLOGY-

IN GENERAL IN MY PATIENT
 FETAL ANOMALIES-
1. Anencephaly. Cause unknown
2. Open spina bifida.
3. Oesophageal Artesia.
4. Facial cleft and neck masses.
5. Hydrops fetalis.
 PLACENTA-
1. Chorioangioma of the
placenta.
 MULTIPLE PREGNANCIES
 MATERNAL
 Diabetes.
 cardiac or renal disease,

TYPES OF POLYHYDRAMNIOS-

In general In my patient
 Chronic polyhydramnios. 
 Acute hydramnios
 CHRONIC POLYHYDRAMNIOS-it is gradual in onset, usually from about 30th
week of pregnancy. This most common type.
 ACUTE POLYHYDRAMNIOS –it is very rare. It occurs at about 20 weeks and
comes on very suddenly.th uterus reaches the xiphisternum in about 3-4 days .it is
often associated with monozygotic twins and severe foetal abnormalities.

SIGN AND SYMPTOMS-The sign and symptom of polyhydramnios include the following
–

In general In my patient
 Uterine inlargement, abdominal girth 
and fundal height are far beyond
expected for gestational age.
 Tenseness of the uterine wall making 
it difficult to-auscultate foetal heart
 tones; palpate the foetal outline, large
and small part.
 Elicitation of uterine fluid thrill.
 Mechanical problem such as-
1. Severe dyspnoea. 
2. Lower extremity and vulval Pedal oedema
edema.
3. Pressure pains in back, 
abdomen and thighs.
4. Nausea and vomiting. 
 Frequent change in fetal lie. 
 Auscultation of the fetal heart is 
difficult.
 Screening for diabetes.
Screening for ABO/RH disease

COMPLICATIONS-

In general In my patient
 Maternal.
 Fetal.

MATERNAL-
 DURING PREGNANCY-
1. Pre-eclamcia. No complication
2. Malpresentation
3. PROM
4. Preterm labour
5. Accidental haemorrhage
 DURING LABOUR-
1. Early rupture of membrane
2. Cord prolapsed
3. Retained placenta
4. Postpartum haemorrhage
5. Shock
6. Increased operative delivery due
to malpresentation.
 Puerperium-
1. Sub involution
2. Increased puerperal morbidity.
FETAL-
 Increased perinatal mortality.

INVESTIGATION-

In general In my patient
 SONOGRAPHY-To detect 
abnormally large single pool>8
 cm.AFI is
More than 25 CM.
 RADIOGRAPHY-not commonly
performed. it is used to detect bony
congenital malformation of the fetus. 
 ABO AND RH GROUPING-rhesus
isoimmunisation may cause hydrops
fetalis and fetal ascites.
 AMNIOTIC FLUID-estimation of 
alfa feto protein which is markedly
elevated in the presence of fetus with
open neural tube defect.

MANAGEMENT –[in general]

PRINCIPLES-

 To relieve the symptoms.

 To find out the cause.
 To avoid and deal with the complication.

MILD ASYMPTOMATIC POLYHDRAMNIOS -is managed expectantly. The woman is

not admitted. She is advised to get adequate rest. She should be advised that if she suspects
that membranes have ruptured, immediate admission would be necessary.

FOR A WOMAN WITH SYMPTOMATIC P0LYHYDRAMNIOS -admission to a

hospital is required. Care will depend on the condition of the woman and fetus, the cause and
degree of hydramnios and the stage of pregnancy. Upright position will help to relieve
heartburn and nausea.

 SUPPORTIVE THERAPY-includes bed rest with back rest,analgesics and treatment

of theassociated conditions like pre-eclampsia,diabetes.indomethacin given orally to
the mother 25 mg 6 hourly has been found to decrease amniotic fluid.
 INVESTIGATIONS ARE TO BE DONE.
 PREGNANCY LESS THAN 37 WEEKS-If the discomfort from the swollen
abdomen is severe, amniocenteses or amniocentesis or amnioreduction may
beconsidered. Up to 500 ml of amniotic fluid may be removed to provide temporary
relief. Fluid will accumulate again and there is risk of introducing infection with this
procedure.
 PREGNANCY MORE THAN 37 WEEKS-Labor will be induced if the symptoms
become worse or gross abnormality is diagnosed. For induction, the fetal lie must be
corrected if it is not longitudinal. Membranes will be ruptured cautiously; allowing
the amniotic fluid to drain out very slowly in order to avoid altering the lie and
 prevent cord prolapsed of placental abruption. Labour will be usually normal, but
postpartum haemorrhage is a possibility. Te baby will need to be examined for
abnormalities.
 WITH COGENITAL FETAL ABNORMALITY-termination of pregnancy is to be
done irrespective of the duration of pregnancy.
 DURING LABOUR-if intrauterine contraction become sluggish, oxytocin infusion
may be started if not contraindicated. To prevent PPH intravenous methargin 0.2 mg
should be given with the delivery of anterior shoulder

PREVENTIVE MEASURE-

 Regular antenatal check up at frequent interval from the beginning of pregnancy to detect at
the earliest the rapid gain in weight or a tendancy of rising blood pressure especially the
diastolic pressure
 Advice to take adequate rest in bed on her left side at least for two hours in the fternoon
from the 20th week of pregnancy onwards.
 Calcium suplimentation [2 gm/day]
 Antioxidants ,vitamin c,and e from 16-22 week onward
 Well balance diet

NURSING PROCESS-[in general]

ASSESSMENT-

 Ballottement results in fluid waves.

 Fundal height excessive for gestation.
 Fetus difficult to outline with palpation.
 Supine hypotension.
 Fetal abnormalities of central nervous system or GI tract.
 Easy fatigability.

ANALYSIS AND NURSING DIAGNOSIS-

 RISK for fetal injury.

 Impaired physical mobility.
 Actual risk for fluid volume deficit.
 Anxiety.
 Anticipatory grieving.

PLANNING-

 Promot maternal comfort.

 Promote maternal –fetal well being.
 Provide opportunities for counselling and support.
 Provide education for selfcare measures in increasing comfort.

IMPLEMENTATION-
  Facilitate testing –amniocentasis, sonography.
 Assess FHR.
 Anticipate premature labour and postpartum haemorrhages caused by over distension
of the uterine muscle
 Instruct and explain-nature of problem.
 -need to obtain immediate medical attention for problems
 -need to observe for preeclampsia.

EVALUATION-

 Verbalize increased expectant mother.

 Progresses to uneventful birth, as dos her baby.
 Verbalizes support.
 Verbalizes self-care measures.

Management:- [in my patient]

Treatment modalities-

 REST-admission in hospital and rest is helpful for continued evaluation and treatment of the
patient .patient should be in upright position will help to relieve heart burn and nausea Rest
increase the renal blood flow ,Increase the uterine blood flow
 DIET-the diet contain adequate amount of protein[about 100 gm].fluid need not be restricted
.total calories approximate 1600 cal/day.
 DRUG- indomethacin given orally to the mother 25 mg 6 hourly has been found to
decrease amniotic fluid

DRUG Dose
 Tab.indomethacin 25 mg,6 hourly
 Tab.Hb -14 plus OD
 Tab. Ccm OD
 Tab. Domped BD
 Protein powder 2 tsf with milk OD

NURSING CARE PLAN OF MY PATIENT-

 HEALTH EDUCATION:

SNO TOPIC CONTENT

1 PERSONAL  Explained the importance of maintaining good personal hygiene.
HYGIENE  Keep perineum clean, dry.
 Told the patient to take regular bath & change cloth.

2 DIET  Explained the importance of high caloric diet & protein rich diet.
 Also explained iron rich diet & calcium diet.
 Advice to take green leafy vegetables.
 Take plenty of oral fluid.

3 REST & SAFETY  Explained the importance of strict bed rest.

 To decrease anxiety by providing accurate information.
 Monitor breathing patter
 Monitor accurate intake & output.
 Encourage time for women & partner.
4 MEDICATIONS  Explained the importance of medication.
 Instruct to take regular medicine
 Educated regarding side effects of medication.

Prognosis:-

In my patient having some anxiety about there condition.She feel some time sad because of their
problem .In my patient the prognosis was good; she recovered and developed no complication till date
of discharge

CONCLUSION:-

Polyhydramnios is an excessive amount of amniotic fluid, which exceeds 1,500 ml. it occurs
in 0.9 percent of pregnancies. It is typically diagnosed when the amniotic fluid index (AFI) is
greater than 20 cm ( ≥ 20 cm). But many times it is very essential to the couple to preserve
the life of the either mother or fetus or both but it has very good & effective medical &
nursing management so that potential complications & solutions to the problems are carried
out & help to preserve all aspects of the health is met.

Summary and conclusion:

My patient Mrs. Aarti admitted with the complaint with backache and nausea and vomiting Patient
was fine at the time of discharge and developed no complication.
ASSESSMENT NURSING GOAL INTERVENTION/PLANNING IMPLEMENTATION RATIONAL EVALUAT
DIAGNOSIS ION
SUBJECTIVE Pain related To reduce the To Assess patient condition, Vital signs of the client is checked at TO find out
DATA-Pt. having to increased intensity of To assess vital signs. 10:30am. anywhether Pt
backache excessive pain. To palpate the fundus for deviation express
amount of height, location, and firmness. Up right position is given to pt. from relief
OBJECTIVE amniotic Pt will express To provide comfortable position normal from
DATA-I observe fluid relief from pain To provide relaxation therapy condition pain and
that pt. having and comfort comfort
mild backache To relieve
pain

Subjective data- fluid volume To provide adequate amount of Assess pt. Condition To reduce
pt .told me that Risk for level in the fluid Tab domped BD administored nausea
she having altered body.will be Intake output should be Tab. Indomethacin 25 mg ,6 hourly is Nausea
nausea and fluid maintained monitored. administered to decrease amount of To reduced
vomiting volume amniotic fluid maintain gradually
deficient nausea will be Instruct patient to take adequate fluid and
Objective data-I related to reduced amount of fluid like fruit juices electrolyte Pt was
observe that pt less intake Moniter intake and output chart balance well
looks lethargic hydrated
and weak due Nausea
to nausea and related to
vomotting physiologic
al changes
during
pregnancy
Pt. will be free To assess pt. For sign of infection Hand washing must be done before and To reduce
Subjective data- from infection after procedure chances of
pt. Told me that To maintained proper aseptic tech infection
she having nique In all procedure aseptic technique must Pt. Is
weakness be maintained free from
Risk for infection
Objective data-i infection Vital signs are monitored and
observe that pt related to observed for any signs infection
looks lithargic hospitalizati
on
Nutritional To assess nutritional status of the assess nutritional status of the patient To maintain
Subjective data- status will be patient health education given regarding nutritional
Pt.told me that maintained To provide knowledge regarding antenatal diet according to economical status of
she not take antenatal diet status and pt’s like and dislike the patient Pt take
proper diet include green leafy proper
vegetables,fruits,fruit juices,sprouted diet
Objective data-i Imbalanced seeds,dry fruits,plenty of water,rice dal accordin
observe that pt, nutrition ,chapaties ,milk,curd et g
not take proper less than To my
diet surgical body advice
condition. requiremen
t related to Pt .will have less To assess anxiety level of pt. assess pt. Condition To reduce
Subjective data- poor intake anxiety To provide information regarding provide information regarding disease anxiety
Pt.told me that disease condition condition and treatment
she having To provide psychological support provide psychological support to the
anxiety patient
Pt.havin
Objective data- g less
I observe that pt anxiety
having anxiety Anxiety
due to disease related to
condition and disease
pt. Looks tense condition
 Bibliography

 Cooper, A, Margaret &Fraser, M, Daine. (2005).Myles Textbook for midwives. (14th edition).London.Elsevier.
 Pilliteri, Adere. (1999).Maternal & child health nursing. (3rd edition).Philadelphia.Lippincott.P-P 199-202.
 Wong,l,Donna &Peery,E,Shannon.(1998).Maternal child nursing care.Philadelphia.Mosby.p-p234-256.
 D.c. Dutta, text book of obstetrics, sixth edition 2004, 221-240

 Neelam Kumari, midwifery and gynacological nursing, first edition 2010, 332-342

 Annnama jacob,text book of obtetrics,second edition,319-326

 Myles, text book for midwives, 14th edition, 338-348

 C.s. Dawn, text book of obstetrics, sixteenth edition, 2004, 256-265

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