Polyhydramnios is a condition characterized by an excessive accumulation of amniotic fluid during pregnancy.
This nursing diagnosis can pose significant health risks to both the mother and the fetus, often associated with other nursing diagnoses such as risk for impaired fetal gas exchange or risk for premature birth.
Causes (Related to)
Polyhydramnios can result from various maternal, fetal, or placental conditions. The following are common causes of polyhydramnios:
- Maternal causes:
- Gestational diabetes
- Preexisting diabetes mellitus
- Multiple gestation
- Rh incompatibility
- Fetal causes:
- Congenital anomalies
- Chromosomal abnormalities
- Fetal macrosomia
- Twin-to-twin transfusion syndrome
- Placental causes:
- Chorioangioma
- Placental tumors
- Idiopathic (no identifiable cause)
Signs and Symptoms (As evidenced by)
Polyhydramnios can manifest with various signs and symptoms. During a physical assessment, a patient with polyhydramnios may present with one or more of the following:
Subjective: (Patient reports)
- Abdominal discomfort or pain
- Shortness of breath
- Decreased fetal movement
- The feeling of fullness or tightness in the abdomen
- Back pain
Objective: (Nurse assesses)
- Rapid uterine growth
- Fundal height measurement greater than expected for gestational age
- Difficulty palpating fetal parts
- Abnormal fetal position
- Elevated amniotic fluid index (AFI) > 24 cm or single deepest pocket (SDP) > 8 cm on ultrasound
- Maternal edema
- Increased maternal weight gain
Expected Outcomes
The following are the common nursing care planning goals and expected outcomes for polyhydramnios:
- The patient will maintain amniotic fluid volume within normal limits
- The patient will report decreased abdominal discomfort
- The patient will demonstrate normal fetal growth and development
- The patient will maintain stable maternal vital signs
- The patient will exhibit no signs of preterm labor
- The patient will verbalize understanding of the condition and its management
- The patient will demonstrate compliance with prescribed treatments and follow-up appointments
Nursing Assessment
The first step of nursing care is the assessment, during which the nurse gathers physical, psychosocial, emotional, and diagnostic data.
The following section will cover subjective and objective data related to polyhydramnios.
- Monitor vital signs
Assess blood pressure, heart rate, respiratory rate, and temperature. Polyhydramnios can lead to maternal discomfort and increased risk of complications, which may affect vital signs. - Perform abdominal examination
Assess fundal height, uterine tone, and fetal position. Polyhydramnios often presents with a fundal height greater than expected for gestational age and difficulty palpating fetal parts. - Evaluate fetal well-being
Monitor fetal heart rate, movement, and reactivity. Excessive amniotic fluid can affect fetal positioning and movement. - Assess for signs of preterm labor.
Check for uterine contractions, cervical changes, or vaginal discharge. Polyhydramnios increases the risk of preterm labor. - Review ultrasound results
Analyze amniotic fluid index (AFI) or single deepest pocket (SDP) measurements. An AFI > 24 cm or SDP > 8 cm indicates polyhydramnios. - Assess maternal comfort level.
Evaluate abdominal discomfort, shortness of breath, and overall well-being. Increased amniotic fluid volume can cause maternal discomfort and respiratory difficulties. - Monitor maternal weight gain.
Track maternal weight gain throughout pregnancy. Excessive weight gain may be associated with polyhydramnios. - Assess for associated conditions.
Screen for gestational diabetes, multiple gestation, or other conditions that may contribute to polyhydramnios. - Evaluate psychosocial status
Assess the patient’s understanding of the condition, anxiety levels, and support system. Polyhydramnios can cause significant emotional stress for the expectant mother.
Nursing Interventions
Nursing interventions and care are essential for managing polyhydramnios and ensuring the well-being of both mother and fetus.
In the following section, you’ll learn about possible nursing interventions for a patient with polyhydramnios.
- Provide patient education
Explain the condition, potential causes, and management strategies to the patient and family. Proper understanding can reduce anxiety and improve compliance with treatment. - Monitor amniotic fluid volume.
Assist with regular ultrasound assessments to track amniotic fluid levels. Early detection of changes in fluid volume allows for timely interventions. - Encourage optimal positioning
Advise the patient to rest in a left lateral position to improve uteroplacental blood flow and reduce pressure on major blood vessels. - Implement comfort measures
Suggest supportive garments, pillows, or maternity belts to alleviate abdominal discomfort and back pain associated with polyhydramnios. - Promote adequate nutrition and hydration.
Encourage a balanced diet and proper fluid intake. Proper nutrition supports maternal and fetal well-being, while monitoring fluid intake can help manage amniotic fluid production. - Assist with fetal surveillance.
Perform or assist with non-stress tests, biophysical profiles, or other fetal monitoring techniques as ordered. Regular fetal assessment helps detect any signs of fetal distress. - Administer medications as prescribed.
Provide medications such as indomethacin or nifedipine if ordered to reduce amniotic fluid production or manage preterm labor symptoms. - Prepare for potential interventions.
Be ready for possible amnioreduction procedures or early delivery if necessary. Familiarize yourself with the equipment and protocols for these interventions. - Monitor for complications
Assess for signs of umbilical cord prolapse, placental abruption, or other polyhydramnios-related complications. Early detection can improve outcomes. - Provide emotional support
Offer reassurance and empathy to the patient and family. Polyhydramnios can be a source of significant anxiety and stress. - Collaborate with the healthcare team.
Work closely with obstetricians, perinatologists, and other specialists to ensure comprehensive care for the patient with polyhydramnios. - Educate about warning signs.
Teach the patient to recognize and report signs of preterm labor, rupture of membranes, or decreased fetal movement. Early reporting of these symptoms can lead to prompt intervention.
Nursing Care Plans
Nursing care plans help prioritize assessments and interventions for both short and long-term goals of care. In the following section, you will find nursing care plan examples for polyhydramnios.
Care Plan 1: Risk for Impaired Fetal Gas Exchange
Nursing Diagnosis: Risk for Impaired Fetal Gas Exchange related to excessive amniotic fluid volume secondary to polyhydramnios.
Related factors/causes:
- Excessive amniotic fluid volume
- Potential cord compression
- Altered fetal positioning
Nursing Interventions and Rationales:
- Monitor fetal heart rate patterns regularly.
Rationale: Helps detect early signs of fetal distress or compromised oxygenation. - Encourage maternal position changes every 2 hours.
Rationale: Promotes optimal fetal oxygenation and reduces the risk of cord compression. - Educate the mother about fetal movement counting.
Rationale: Increases awareness of fetal well-being and promotes early detection of potential issues. - Assist with regular ultrasound assessments.
Rationale: Allows for evaluation of fetal position, amniotic fluid volume, and placental function. - Prepare for potential emergency interventions (e.g., amnioreduction, early delivery).
Rationale: Ensures readiness for rapid response to fetal distress or other complications.
Desired Outcomes:
- Fetal heart rate patterns will remain within normal limits.
- The patient will report regular fetal movements.
- Amniotic fluid index will stabilize or decrease towards normal range.
Care Plan 2: Acute Pain
Nursing Diagnosis: Acute Pain related to abdominal distention secondary to polyhydramnios.
Related factors/causes:
- Excessive uterine stretching
- Increased abdominal pressure
- Maternal weight gain
Nursing Interventions and Rationales:
- Assess pain characteristics (location, intensity, duration) using a standardized pain scale.
Rationale: Provides a baseline for pain management and evaluates the effectiveness of interventions. - Encourage the use of supportive garments or maternity belts.
Rationale: Helps redistribute abdominal weight and reduce strain on muscles and ligaments. - Teach relaxation techniques and breathing exercises.
Rationale: Promotes pain relief and reduces anxiety associated with discomfort. - Assist with position changes and suggest the use of supportive pillows.
Rationale: Alleviates pressure on the abdomen and improves comfort. - Administer analgesics as prescribed.
Rationale: Provides pharmacological pain relief when non-pharmacological methods are insufficient.
Desired Outcomes:
- The patient will report pain level as three or less on a 0-10 scale.
- The patient will demonstrate the use of non-pharmacological pain management techniques.
- The patient will maintain adequate rest and sleep patterns despite abdominal discomfort.
Care Plan 3: Risk for Ineffective Breathing Pattern
Nursing Diagnosis: Risk for Ineffective Breathing Pattern related to diaphragmatic elevation secondary to polyhydramnios.
Related factors/causes:
- Abdominal distension
- Upward displacement of the diaphragm
- Increased intra-abdominal pressure
Nursing Interventions and Rationales:
- Assess respiratory rate, depth, and use of accessory muscles regularly.
Rationale: Helps identify early signs of respiratory distress. - Elevate the head of the bed 30-45 degrees during rest periods.
Rationale: Promotes lung expansion and reduces pressure on the diaphragm. - Teach and encourage deep breathing and coughing exercises.
Rationale: Improves lung expansion and helps clear secretions. - Monitor oxygen saturation levels.
Rationale: Provides objective data on oxygenation status. - Collaborate with the healthcare team to determine the need for supplemental oxygen.
Rationale: Ensures adequate oxygenation if breathing difficulties persist.
Desired Outcomes:
- The patient will maintain a respiratory rate within normal limits (12-20 breaths per minute).
- The patient will demonstrate effective use of breathing techniques.
- Oxygen saturation levels will remain above 95% on room air.
Care Plan 4: Anxiety
Nursing Diagnosis: Anxiety related to uncertainty of pregnancy outcomes secondary to polyhydramnios diagnosis.
Related factors/causes:
- Limited understanding of the condition
- Concerns about fetal well-being
- Fear of potential complications
Nursing Interventions and Rationales:
- Provide clear, concise information about polyhydramnios and its management.
Rationale: Increases patient understanding and helps alleviate the fear of the unknown. - Encourage expression of feelings and concerns.
Rationale: Allows for emotional ventilation and helps identify specific anxiety triggers. - Teach stress-reduction techniques such as guided imagery or progressive muscle relaxation.
Rationale: Provides coping mechanisms to manage anxiety. - Facilitate communication between the patient and healthcare providers.
Rationale: Ensures that patient concerns are addressed promptly and comprehensively. - Offer referral to support groups or counseling services if needed.
Rationale: Provides additional emotional support and coping strategies.
Desired Outcomes:
- The patient will verbalize decreased anxiety levels.
- The patient will demonstrate the use of at least one stress-reduction technique.
- The patient will express feeling well-supported by the healthcare team.
Care Plan 5: Risk for Preterm Labor
Nursing Diagnosis: Risk for Preterm Labor related to uterine overdistention secondary to polyhydramnios.
Related factors/causes:
- Excessive uterine stretching
- Increased uterine irritability
- Premature cervical changes
Nursing Interventions and Rationales:
- Monitor for signs of preterm labor (e.g., regular contractions, cervical changes, pelvic pressure).
Rationale: Allows for early detection and intervention to prevent preterm birth. - Teach the patient to recognize and report signs of preterm labor.
Rationale: Empowers the patient to seek timely medical attention if symptoms occur. - Encourage adequate rest and limited physical activity as prescribed.
Rationale: Reduces stress on the uterus and may help prevent premature contractions. - Assist with regular cervical length measurements via ultrasound.
Rationale: Helps identify cervical changes that may indicate an increased risk of preterm labor. - Administer tocolytic medications as ordered.
Rationale: Helps suppress uterine contractions if preterm labor is detected.
Desired Outcomes:
- The patient will remain free from signs and symptoms of preterm labor.
- The patient will verbalize understanding of preterm labor warning signs.
- Pregnancy will progress to full term (37 weeks or beyond) without complications.
References
- Abele H, Starz S, Hoopmann M, Yazdi B, Rall K, Kagan KO. Idiopathic polyhydramnios and postnatal abnormalities. Fetal Diagn Ther. 2012;32(4):251-5. doi: 10.1159/000338659. Epub 2012 Jun 28. PMID: 22760013.
- American College of Obstetricians and Gynecologists. (2021). Polyhydramnios. Practice Bulletin No. 229. Obstetrics & Gynecology, 137(6), e190-e203.
- Hamza, A., Herr, D., Solomayer, E. F., & Meyberg-Solomayer, G. (2013). Polyhydramnios: Causes, Diagnosis and Therapy. Geburtshilfe und Frauenheilkunde, 73(12), 1241-1246.
- Magann, E. F., Chauhan, S. P., Doherty, D. A., Lutgendorf, M. A., Magann, M. I., & Morrison, J. C. (2007). A review of idiopathic hydramnios and pregnancy outcomes. Obstetrical & Gynecological Survey, 62(12), 795-802.
- Pilliod, R. A., Page, J. M., Burwick, R. M., Kaimal, A. J., Cheng, Y. W., & Caughey, A. B. (2015). The risk of fetal death in nonanomalous pregnancies affected by polyhydramnios. American Journal of Obstetrics and Gynecology, 213(3), 410.e1-410.e6.
