Polyhydramnios and oligohydramnios. How is oligohydramnios treated in a pregnant woman? How can I normalize the amount of amniotic fluid

Talismans, charms, amulets
14.10.2021

Unfortunately, pregnancy does not always proceed without complications. In some cases, for the safety of mother and baby, a woman is offered hospitalization in a maternity hospital, in the pathology department. What can be the reason for hospitalization?

The diagnosis of "oligohydramnios" usually causes anxiety in expectant mothers. Why is this condition dangerous for the baby, how can it affect the course of childbirth and is it possible to fight it?

"Habitat"

Throughout pregnancy, the baby's living space is limited by the uterine cavity. In addition to the fetus itself, the uterus contains the fetal membranes and the placenta - the so-called organs of pregnancy. These organs actually appear and function in the body future mother only during pregnancy; after the birth of the baby, they are separated from the wall of the uterus and are born in the form of an afterbirth.

The main function is to create and maintain normal conditions for the intrauterine life of the baby. A significant role in ensuring the optimal microclimate for the fetus belongs to the amnion.

Amnion, or water shell, is a closed bag in which the fetus is located, surrounded by water. The water membrane tightly adheres to the inner surface of the uterine wall, lines the inner surface of the placenta and passes to the umbilical cord, covering it in the form of a case. In the area of ​​​​the baby's navel, the shell passes to the skin of the tummy, gradually merging with it.

The fetal bladder (amnion) consists of a thin membrane in which two layers are distinguished. The inner layer - epithelial - faces the fetus. The outer layer is called connective tissue and is closely adjacent to the wall of the uterus. The fetal bladder is thin, but dense and very elastic. Its surface is transparent, smooth and slightly shiny.

The walls of the fetal bladder during pregnancy produce a special fluid - amniotic fluid. Normally, the amount of water by the end of pregnancy is from 800 to 1500 ml. The composition of amniotic fluid, or includes protein, various salts, urea, carbohydrates (sugar) and hormones (folliculin, gonadotropic hormone), necessary for normal metabolism and fetal development. In the first half of pregnancy, the fetal waters are clear and clean. In the second half, and especially towards the end of pregnancy, the water becomes somewhat cloudy. This turbidity depends on the elements of the fetus mixed with the amniotic waters. These elements include:

  • lanugo - the so-called delicate hairs that cover the baby's skin at a certain period of embryonic development;
  • original lubricant - fatty lumps covering the skin of the fetus in the form of a curdled or cheese-like mass and protecting it from maceration (wrinkling, skin damage from constant exposure to a liquid medium);
  • desquamated epidermis - scales of dead skin cells of the fetus

Compound amniotic fluid It is controlled by the walls of the fetal bladder: the fetal bladder is penetrated by the thinnest blood vessels, from the plasma of which the fetal waters are formed. The amniotic waters are constantly being renewed; a complete change in the composition of water normally occurs in about three days.

The physiological significance of amniotic fluid in the development of pregnancy and fetus is enormous.

The amount of amniotic fluid gradually increases during pregnancy. In the first months there are relatively many waters, and the baby can move freely, "swim" in his water reservoir. By the end of pregnancy, the amount of water increases, stretching the walls of the uterus, but at the same time, the fetus grows significantly, and it grows quite quickly. In the third trimester, the fetus already occupies almost the entire uterine cavity, the baby’s movements are limited: he cannot, as before, constantly change his position and position in the uterus.

The physiological significance of amniotic fluid in the development of pregnancy and fetus is enormous. The waters create a unique habitat for the baby. They prevent the formation of adhesions between the amnion and the skin of the fetus. Amniotic waters create an opportunity for unhindered active movements of the baby, which is so necessary for its correct, normal development. At the same time, the waters protect the umbilical cord and placenta from pressure from large parts of the fetal body. The amnion and amniotic fluid protect the baby from shocks and bruises from the outside, make the baby's movements less noticeable for the expectant mother, the normal amount of amniotic fluid ensures the formation of the correct position of the fetus in the uterus by the end of pregnancy. The fetal bladder, filled with water, participates in the process of opening the cervix in the first stage of childbirth: during the contraction, the walls of the uterus are compressed, causing the elastic fetal bladder to "bulge" into the lumen of the cervix; the pressure of the fetal bladder on the cervix increases its opening.

And, it turns out, without water ...

As already mentioned, the normal amount of amniotic fluid during a full-term pregnancy ranges from 800 to 1500 ml. A situation in which the amount of water “does not reach” the lower limit of the norm is commonly referred to in obstetrics as oligohydramnios.

The reasons for the insufficient amount of amniotic fluid are different. Almost always, the main cause of oligohydramnios is a variety of pathologies of the fetal membranes (amnion, or fetal bladder). This is not surprising: after all, it is the amnion that is responsible for the production and exchange of fetal fluid. We list the most common factors affecting the decrease in the amount of water:

  • Infection of the membranes- the most common cause of an infectious lesion of the amnion are viruses (ARVI, influenza, the so-called "childhood infections": chicken pox, measles, etc.), because they are able to penetrate the placental barrier. Less commonly, infectious agents enter the fetal membranes in an ascending way - from the vagina. The introduction of an infectious agent into the fetal membrane, the poisoning effect of its metabolic products (toxins) has a damaging effect on the amnion, violating its basic properties and functions. As a result, the fetal membranes lose their elasticity and resistance to tearing, delaminate, acquire increased permeability or break. As a result, it is observed, which leads to a decrease in their volume. In some cases, on the contrary, the fetal membranes become too dense, lose their transparency. In any case, almost always, as a result of infection of the amnion, one of its most important functions suffers - the exchange and production of fetal water.
  • Anomalies in the development of fetal membranes- underdevelopment of the amnion, stratification of the sheets of the membranes, insufficient secretory activity of the epithelial (constituting the mucous membrane) cells of the fetal bladder responsible for the production of water. The cause of the development of any of these anomalies may be adverse factors. environment that affect the expectant mother during the formation of membranes (first trimester of pregnancy), genetic disorders (hereditary factor), etc.
  • Amnionic hydrorrhea- this is the name of oligohydramnios from the uterine cavity during pregnancy. This condition arises in connection with the appearance of a small high rupture of the membranes. The gap formed in this case between the membrane and the wall of the uterus is so narrow that only a negligible amount of water passes through. In this case, the water gradually, drop by drop, flows out of the uterus.
    If the expectant mother lies in bed and observes complete rest, the pregnancy can continue, since the functioning amnion gradually replenishes the lost water, but there is a high risk of infection, so the pregnant woman must be in the hospital all this time.
  • True re-carrying of pregnancy- the main sign of overgestation is a gradual decrease in the functional activity of the fetal membranes and placenta, which, in turn, is reflected in the deterioration of the general condition of the fetus. Oligohydramnios during pregnancy is associated with the aging of the amniotic membranes and the placenta, impaired blood circulation in them, and, consequently, a decrease in the production of fetal fluids.

Oligohydramnios during pregnancy is fraught with the development of various complications. In some cases, there is so little water that the walls of the uterus, tightly adjoining the fetal sac, strongly bend the fetus and bring it into prolonged and close contact with the fetal bladder. As a result, a number of complications may develop: curvature of the spine, clubfoot, fusion of the skin of the fetus with the amnion. From the lack of water, the baby's skin becomes dry and wrinkled. With close and prolonged contact of the amniotic membrane with the skin of the fetus, the so-called Simonart ligaments can form between them - quite strong strands and threads. They can encircle the fetus, significantly limiting its activity, and sometimes causing severe injuries (fusion of the fetal organs with each other, with membranes, defects in the formation of limbs, face, etc.). These same ligaments can compress the umbilical cord, disrupting blood flow in the umbilical vessels. The latter may result in a delay physical development(due to lack of nutrients and oxygen) and even death of the fetus.

With severe oligohydramnios, the expectant mother also suffers. Oligohydramnios is often the cause of spontaneous abortions (miscarriages) and premature births. During the second and third trimester, the expectant mother is worried about constant pain in the lower abdomen. In later periods, there is additional soreness caused by the movements of the fetus.

Childbirth with oligohydramnios also has its own characteristics. The period of opening the cervix is ​​usually delayed, as there is no proper pressure of the fetal bladder. Often develops primary and secondary weakness of tribal forces. At the same time, contractions are painful from the very beginning, but unproductive. In the afterbirth and early postpartum period (in the first 2 hours after birth), bleeding often develops.

The fight against oligohydramnios

Slight (400-700 ml) oligohydramnios may be a variant of the norm. In this case, the expectant mother is recommended a protective regimen (minimal physical activity), good nutrition, vitamin therapy and regular medical supervision. antenatal clinic. If necessary, a second ultrasound examination is performed to exclude the increase in oligohydramnios. With an increase in symptoms and confirmation of severe (less than 400 ml) oligohydramnios, treatment in a hospital is necessary.

To clarify the diagnosis and choose the tactics of treating the expectant mother, they offer hospitalization in the maternity hospital. In the department of pathology of pregnant women, an extended examination is carried out, including ultrasound diagnostics (this study allows you to accurately judge the amount of amniotic fluid), cardiotocography (monitoring the baby’s cardiac activity and contractile activity of the uterus), laboratory methods (general and biochemical analysis of blood, urine) . If amniotic fluid leakage is suspected, a swab is performed on the water. To clarify the amount and density of water, amnioscopy is performed - an endoscopic examination that allows the doctor to assess the composition of the water "by eye" without violating the integrity of the membranes. This study can be done if the cervix is ​​already preparing for childbirth, the cervical canal misses the amnioscope - this is more often possible at the end of pregnancy. Therapeutic tactics largely depend on the specific cause that caused the decrease in the amount of amniotic fluid. If amnionic hydrorrhea (water leakage) is detected, the expectant mother is prescribed strict bed rest, heavy drinking, vitamin therapy, drugs aimed at reducing the tone of the uterus and preventing infection of the fetus and membranes. It is likely that in this case, hospitalization and treatment aimed at prolonging (prolonging) the pregnancy will last until the very birth. Treatment is carried out under constant monitoring of the condition of the fetus.

When a viral infection is detected, antiviral and restorative therapy is carried out, vitamins and drugs that improve microcirculation (blood circulation at the level of small vessels) are prescribed. In this case, upon completion of treatment and in the presence of positive dynamics, the expectant mother can be discharged home under the supervision of a doctor at the antenatal clinic.

When detected, treatment is also directed to maintaining pregnancy and preventing the development of intrauterine infection. Therapy is carried out in the conditions of the department of pathology of pregnant women under the control of the state of the mother and fetus.

When confirming the diagnosis of a true pregnancy prolongation, a planned amniotomy is performed - a puncture of the fetal bladder, after which the expectant mother naturally goes into labor.

With timely diagnosis and the beginning of treatment, the prognosis for mother and baby is favorable.

Table of index norms amniotic fluid by ultrasound
Week: from (mm) to (mm) inclusive.
16: 73 – 201
17: 77 – 211
18: 80 – 220
19: 83 – 225
20: 86 – 230
21: 88 – 233
22: 89 – 235
23: 90 – 237
24: 90 – 238
25: 89 – 240
26: 89 – 242
27: 85 – 245
28: 86 – 249
29: 84 – 254
30: 82 – 258
31: 79 – 263
32: 77 – 269
33: 74 – 274
34: 72 – 278
35: 70 – 279
36: 68 – 279
37: 66 – 275
38: 65 – 269
39: 64 – 255
40: 63 – 240
41: 63 – 216
42: 63 – 192

Even if after the next examination you heard a formidable diagnosis: oligohydramnios, stop panicking! Insufficient amount of amniotic fluid is not a sentence, but just a symptom. In addition, there are various stages of oligohydramnios and, perhaps for your body, such indicators are the norm. It's time to figure out what oligohydramnios is during pregnancy, the causes and consequences of which bother you.

What is amniotic fluid?

Your body, like a watch, is adjusted to the bearing and birth of a child. Not only is the fetus protected by the placenta, it is always in the amniotic fluid, which both serves as food for it and protects it from external influences of infections. These amniotic fluid contain vitamins and hormones, salts and oxygen necessary for the growth of the baby. All of them enter the body of the child when he swallows the liquid.

Unfortunately, not only food can affect the amniotic fluid. Infections and viruses easily penetrate the amniotic fluid, which negatively affects the development of the child. As a result - quantitative changes in amniotic fluid, and diagnosing, for example, oligohydramnios.

Low water - what is it?

Low water is a deviation from the normal amount of amniotic fluid in the direction of its decrease. There is a difference between moderate and severe oligohydramnios. In the latter case, the amount of amniotic fluid is reduced by 3 or more times.

  • The first good news is that such a deviation is quite rare, medical indicators range from 0.7 to 5.5%, and even the highest number characterizes moderate oligohydramnios during pregnancy, which is not considered critical;
  • The second positive argument is that in the first and third trimester, oligohydramnios, especially moderate ones, do not pose a 100% threat to the development of the baby, and it is even possible that a small amount of amniotic fluid in you is of a genetic nature.

amniotic fluid index table

The amount of amniotic fluid can be determined by the method of the ratio of the volume of the abdomen and the height of the uterus, as well as during an ultrasound examination (read the article on the topic: Is it possible to determine the gestational age by ultrasound?>>>).

Measurements during an ultrasound

  1. During ultrasound, the presence of a so-called free pocket is determined. This pocket is nothing but the distance between your baby and the front wall of your tummy;
  2. A specialist may suspect oligohydramnios if this space is less than 2 cm, while the norm is 5 cm;
  3. At the same time, the amniotic fluid index will be calculated for you, the principle is the same, but measurements are taken at four different points around the baby. The IAI norm is determined by weeks, but please note that even during the day the data may fluctuate slightly.

The resulting figures in mm are verified according to the table. Interestingly, the average reaches its peak at week 27 - 156 mm, and at week 42 it drops to 110 mm. The table also shows possible fluctuations, again by week:

Term
pregnancy,
weeks		 Average
normal
indicator, mm		 Probable
hesitation,
mm
16 121 73-201
17 127 77-211
18 133 80-220
19 137 83-225
20 141 86-230
21 143 88-233
22 145 89-235
23 146 90-237
24 147 90-238
25 147 89-240
26 147 89-242
27 156 85-245
28 146 86-249
29 145 84-254
30 145 82-258
31 144 79-263
32 144 77-269
33 143 74-274
34 142 72-278
35 140 70-279
36 138 68-279
37 135 66-275
38 132 65-269
39 127 64-255
40 123 63-240
41 116 63-216
42 110 63-192

So, oligohydramnios during pregnancy at 32 weeks is diagnosed when the IAI is below 77 mm. (read the current article: Ultrasound at 32 weeks of gestation >>>), while at 22-26 weeks only at 89 and below IAI.

Regular measurements

You can also talk about oligohydramnios in the case when the size of the uterus and the girth of the abdomen do not correspond to your gestational age, but no one will diagnose you without an additional ultrasound.

Why is low water dangerous?

Low water is a sign that a certain failure has occurred in your body. The causes of oligohydramnios during pregnancy, namely, these disorders are genetic, or external factors influenced the work of the placenta and the production of amniotic fluid, the specialist will establish, but the fact that such a condition can be dangerous is a fact.

Consequences

Check out the list of the dangers of oligohydramnios during pregnancy.

  • There is a 50% risk of preterm birth;
  • During childbirth on time, there is a decrease or absence of labor activity in 80% of pregnant women;
  • Significantly increases the risk of abortion (up to 50%);
  • In a third of pregnant women, oligohydramnios developed as a result of an infectious or inflammatory process;
  • With a critically low amount of amniotic fluid, the risk of fetal hypoxia is 20%, and hypertrophy or asphyxia - 75%;
  • In half of the cases with oligohydramnios, childbirth is carried out by caesarean section.

Causes

You will not find clear medical parameters in any reference book, but there are certain assumptions:

  1. There is a tendency to oligohydramnios during pregnancy on a genetic basis. If your mother or grandmother gave birth to small babies, while the stomach was small, you may have the same story;

You can not worry when the oligohydramnios is moderate, and the child feels fine. Another thing is if your relatives, as the consequences of oligohydramnios during pregnancy, had problematic childbirth, you must warn your doctor and geneticist about this.

  1. If you notice a decrease in the volume of the abdomen earlier due date, there is a risk of amniotic fluid leakage (important article

68955

Water is the first thing a child is introduced to. Even in the womb, he swims in a fluid called amniotic. What amniotic fluid looks like and what is the norm by week (table) of pregnancy you will learn from the article.

Why amniotic fluid is needed

Amniotic fluid is necessary for the normal development of the child in the womb, they are needed for

  • protecting the child from loud sounds, shocks (water - absorbs noise and is a shock absorber during shocks);
  • maintaining a comfortable temperature (amniotic fluid has a temperature of 37 degrees);
  • protection from external threats (the bladder with amniotic fluid is sealed, which allows you to protect the child from external influences);
  • feeding the baby (water does not allow the bladder to shrink, preventing clamping of the umbilical cord);
  • freedom of movement of the baby (in the 1-2 trimester, the baby can move freely, swim in the amniotic fluid).

At birth, leaving the native environment, the child experiences stress, which water helps to relieve. When the birth ligament is washed off a newborn baby, he relaxes. This is very important to prepare for a new stage of his life.

The composition and rate of amniotic fluid

The membranes of the fetus begin to form after the fertilized egg attaches to the wall of the uterus. Then a complex process starts. From the fetal membranes (amnion and chorion), a protective bubble is formed with a sterile liquid inside. As the fetus grows, the bubble increases.

Amniotic fluid is formed due to the "leakage" of maternal blood plasma. On later dates the child himself, his lungs, and kidneys are already involved in the production and renewal of amniotic fluid.

Amniotic fluid consists of water (97%) with proteins dissolved in it, mineral salts (calcium, sodium, chlorine). It can also detect skin cells, hair, aromatic substances.

There is an opinion that the smell of amniotic fluid is similar to the smell of mother's milk, so a newborn baby can easily find his mother's breast, because he drank a liquid similar to milk in the womb.

Norm and pathology

The normal amount of amniotic fluid by the end of pregnancy is 600-1500 ml. For a number of reasons, these figures may deviate from the norm up or down. Then doctors talk about polyhydramnios or oligohydramnios.

Oligohydramnios is diagnosed when the expectant mother has less than 500 ml of amniotic fluid. The reason for the decrease in the amount of water lies in the insufficient development of the endometrium (water membrane) or a decrease in its secretory ability. Other causes of pathology include

  1. anomalies in the development of the genitourinary system of the child;
  2. maternal hypertension;
  3. inflammatory diseases of a woman;
  4. metabolic disorders, obesity;
  5. fetoplacental insufficiency.

Oligohydramnios in one fetus during the bearing of twins is explained by the uneven distribution of blood in the placenta.

With oligohydramnios, there are severe pains in the abdomen, painful movements of the child, the uterus is reduced, the size of its bottom does not correspond to the gestational age.

With polyhydramnios, the secretory function of the aqueous membrane is increased. Polyhydramnios can lead to:

  1. diabetes mellitus, infectious and viral diseases of the mother;
  2. diseases of the heart, kidneys;
  3. incompatibility of the Rh factor in the blood of mother and child;
  4. multiple pregnancy(polyhydramnios in one fetus, oligohydramnios in another);
  5. placental disease.

Signs of polyhydramnios are heaviness in the abdomen, swelling of the legs, breathing and blood circulation become difficult, the child's movements become too active.

Oligohydramnios and polyhydramnios are dangerous pathologies. To eliminate them, the help of a specialist is required. At the slightest suspicion, you should consult a doctor.

Deviations in the color of amniotic fluid

Normal amniotic fluid is colorless and clear. The consistency is similar to water, odorless. Most often, expectant mothers are concerned about the change in the color of amniotic fluid.

You can judge the color of amniotic fluid during their outflow, which occurs during childbirth. In most cases, if the pregnancy is full-term, the water is clear or hazy yellow. This is their normal color, it does not pose a danger. The task of a woman after the outpouring of water is to get to the maternity hospital within 2-3 hours.

Amniotic fluid may be of a different color.

  1. In red dots. A slight admixture of blood in a fluid of a normal (light or hazy yellow) color is considered normal, as it indicates the opening of the cervix.
  2. Green color. The original feces of the child stain the greenish or marsh color of the water. The child experiences oxygen starvation, swallowing such water is dangerous for the development of pneumonia in the baby.
  3. Red. Dangerous color, indicates internal bleeding in the mother or fetus. The most correct decision is to take a horizontal position, urgently call an ambulance.
  4. Dark brown. This color indicates the death of the fetus, you should immediately consult a doctor.

If the color of the amniotic fluid changes, the mother and child may be in danger. Therefore, it is better not to get to the maternity hospital on your own, it is worth calling an ambulance, reporting the color of the waters.

Water research methods

To date, there are several ways to obtain information about the state of the amniotic fluid before the onset of the birth process. All methods are divided into invasive (requiring direct material sampling) and non-invasive (not requiring penetration into the uterine cavity).

The only non-invasive method is ultrasound. This study can provide information about the amount of amniotic fluid, allows you to diagnose oligohydramnios or polyhydramnios.

The remaining methods of research (invasive) are associated with high risks, therefore, they are carried out according to serious indications.

  1. Amnioscopy. Inspection of amniotic fluid with an amnioscope. This device is a tube with a light fixture at the end. Examination of the expectant mother is carried out on a gynecological chair by inserting the device into the cervix. The doctor pays attention to the color, consistency of the water. Examination is possible after 37 weeks if fetal hypoxia is suspected, Rhesus conflict.
  2. Amniocentesis. Unlike amnioscopy, amniocentesis is performed after 16 weeks of pregnancy, when the fluid volume reaches 150 ml. a needle is inserted into the amniotic cavity under ultrasound control, not a large number of liquids. Amniocentesis requires serious indications: suspicion of genetic diseases or intrauterine infections, Rh conflict, insufficient oxygen supply, chronic diseases of the mother.

Invasive diagnostic methods are associated with the risks of abortion, premature rupture of amniotic fluid, miscarriage, placental abruption. Only a doctor can prescribe the procedure.

Amniotic fluid rates by week of pregnancy

With increasing gestational age, the amount of amniotic fluid increases. Approximate calculations look like this:

  • 30 ml at 10-11 weeks;
  • 100 ml for 13-14;
  • 400 ml for 17-20;
  • 1200ml for 36-38;
  • 600-800 a few days before delivery.

The amount of amniotic fluid is individual for each expectant mother, the above calculations are approximate, so doctors do not measure the amount of amniotic fluid in milliliters, using the definition of "amniotic fluid index". It is measured using an ultrasound machine starting at 16 weeks. The rules look like this:

  • 73-201 mm (average 121) at 16 weeks;
  • 77-211 (127) at 17;
  • 80-220 (133) at 18;
  • 83-230 (137) at 19;
  • 86-230 (143) at 20;
  • 88-233 (143) at 21;
  • 89-235 (145) at 22;
  • 90-237 (146) at 23;
  • 90-238 (147) at 24;
  • 89-240 (147) at 25;
  • 89-242 (147) at 26;
  • 85-245 (156) at 27;
  • 86-249 (146) at 28;
  • 84-254 (145) at 29;
  • 82-258 (145) at 30;
  • 79-263 (144) at 31;
  • 77-269 (144) at 32;
  • 74-274 (143) at 33;
  • 72-278 (142) at 34;
  • 70-279 (140) at 35;
  • 68-279 (138) at 36;
  • 66-275 (135) at 37;
  • 65-269 (132) at 38;
  • 64-255 (127) at 39;
  • 63-240 (123) at 40;
  • 63-216 (116) at 41;
  • 63-192 (110) at 42.

These figures can be seen in the medical card, in parentheses are the average figures for each stage of pregnancy. Only a doctor can correctly decipher the data, since the norms of the amniotic fluid index depend on the individual characteristics of the body.

Leakage of amniotic fluid

You can determine the leakage of amniotic fluid at home. There is a special test pad for this. The method is quite popular, but such a gasket is quite expensive (400-600 rubles), and the result is not always reliable. So positive result can show not only leaking water, but also inflammatory diseases.

An accurate result can be obtained in the hospital after examining the discharge.

The most informative way to determine the leakage of water is amniocentesis. A safe dye is injected into the fetal bladder with a needle, and a swab is placed in the pregnant woman's vagina. Staining the swab will show leakage of amniotic fluid. This method is used in special occasions when a child's life is at stake.

Violation of the formation and absorption of amniotic fluid threatens with oligohydramnios. Let's consider this concept in more detail.

What is low water?

An insufficient amount of amniotic fluid in obstetrics and gynecology is called oligohydramnios.

Amniotic fluid (or amniotic fluid)- the liquid environment in which the fetus is located during pregnancy.

This biological fluid performs several important functions. These include:

  • protective function- the water shell protects the child from the penetration of infections (due to the tightness of the shells and the immunoglobulins that make up the water), from mechanical influences from the outside (for example, from shocks and shocks), loud sounds (water muffles them), external fluctuations in pressure and temperature (maintaining optimal pressure and a constant temperature of 37 ºС, of course, if the mother is healthy and her body temperature does not exceed 37.8 ºС);
  • exchange function- the child absorbs the amniotic fluid, enriched with nutrients, and releases it back.
    To all this, the fetal waters provide free movement of the crumbs inside the womb. Therefore, with a normal amount of amniotic fluid, the baby is cozy and comfortable, he is protected and provided with everything necessary.

What is in the amniotic fluid?

With increasing gestational age, the composition of the amniotic fluid changes, and becomes more diverse and saturated, which makes the waters slightly cloudy in appearance. The amniotic fluid is secreted by cells of the aquatic membrane.

At the beginning of pregnancy, amniotic fluid is almost the same in composition as blood plasma. They contain nutrients (proteins and fats), vitamins and minerals, hormones, enzymes, and more.

From the second trimester, the composition of this biologically active fluid is supplemented by dead skin cells (as a result of the natural process of changing the old skin layer to a new one), the fluff (hairs) of the fetus, the original cheese-like lubricant of the fetal body and its waste products (sterile urine).

Fertile waters are updated every 3 hours.
Drinking water does not affect the amount of amniotic fluid. From excessive fluid intake in a pregnant woman, only edema will appear.

The norm of the amount of amniotic fluid

When the amount of amniotic fluid deviates from the norm, doctors diagnose oligohydramnios or polyhydramnios. The doctor-diagnostician determines the amount of fluid during an ultrasound scan, starting from the second trimester of pregnancy.

The volume of amniotic fluid in medicine is commonly referred to as the amniotic fluid index (AFI).

Table - The norm of the amniotic fluid index by week

The norms may differ slightly from those given above, depending on the type of ultrasound machine. And also the value can be written not in millimeters, but in centimeters (1 cm = 10 mm).

Also, the amount of fetal water characterizes another indicator - the vertical size of the largest (free) water pocket (VC). This size should normally be in the range from 2 to 8 cm (or from 20 to 80 mm), with a borderline amount of water - from 2 to 1 cm (from 20 to 10 mm), and with oligohydramnios - less than 1 cm (or 10 mm).

What are the causes of oligohydramnios?

Depending on the severity of the pathology, moderate and severe oligohydramnios are distinguished.

Often you can find in the ultrasound protocol the inscription - "tendency to moderate oligohydramnios." This means that it is possible that the expectant mother has health problems and needs more careful monitoring.

Moderate oligohydramnios- this is a slight deviation in the amount of fetal water from the norm. This type of deviation may be caused by the individual characteristics of the body of a pregnant woman or, in the worst case, may be a prerequisite for the occurrence of a more severe form of this pathology. In any case, doctors recommend prophylaxis of fetoplacental insufficiency (FPI).

Moderate oligohydramnios is not a critical situation, because the amount of water is a variable number, and can change several times a day. Perhaps there was an error in establishing the diagnosis and the doctor was to blame for this, who made a not very accurate calculation during the ultrasound, because the determination of the amniotic fluid index is a subjective and approximate matter. Therefore, you should not panic, in 8 out of 10 cases, pregnancy ends with a successful birth of a healthy baby.

Severe oligohydramnios poses a danger to the health of the fetus, so you must follow all the instructions of the doctor observing the pregnancy.

The causes of oligohydramnios, regardless of the degree of its severity:

  • fetoplacental insufficiency;
  • problems with the cardiovascular system in a pregnant woman (hypertension and others);
  • diseases of the urinary system of the fetus (kidneys, for example);
  • leakage of amniotic fluid (in violation of the integrity of the membranes);
  • pathology in the development of fetal membranes;
  • transferred bacterial infections during pregnancy or shortly before its onset;
  • diabetes;
  • late gestosis.

Most often, oligohydramnios occurs due to a metabolic disorder in a pregnant woman, as well as after viral diseases (ARI, SARS, and others) and with fetoplacental insufficiency.

Personal practice shows that ultrasound doctors often exaggerate the magnitude of the problem, and a slight deviation from the norm is already a disaster for them. Such pseudo-low water causes unnecessary stress for the expectant mother, but in fact, babies are born relatively healthy.

The only thing is that childbirth with oligohydramnios (even slight ones) can take place with some complications (poor opening of the cervix, painful contractions and prolonged labor due to breech or breech presentation of the fetus, which arose due to oligohydramnios). Although complicated childbirth can occur in any woman in labor, regardless of the amount of water.

obstetrician-gynecologist A. Berezhnaya

The occurrence of oligohydramnios during a post-term pregnancy is considered a common occurrence, since the placenta has grown old and can no longer fully perform its functions, therefore it exfoliates. Then doctors prescribe stimulation of labor activity or carry out a planned C-section.

Why is oligohydramnios dangerous for the fetus?

Oligohydramnios (or oligohydramnios) is a complication of pregnancy, sometimes even dangerous for the fetus, because it is at risk of infection, as a result of which even its death can occur.

For example, with the loss of the integrity of the membranes - this is when there is leakage of amniotic fluid - the child becomes vulnerable to infections entering the membranes.

The genital tract of a woman is not sterile, pathogenic microorganisms constantly live in the vagina, “plus” immunity is weakened due to pregnancy. All this can lead to the multiplication of harmful bacteria that can penetrate the uterine cavity and infect the fetal membranes, causing their inflammation, called chorioamnionitis in gynecology. Without timely treatment, infection of the fetus itself occurs.

This is with regard to oligohydramnios, caused by a violation of the integrity of the membranes.

With severe oligohydramnios, regardless of the causes of its occurrence, the baby suffers from hypoxia (lack of oxygen), because of this, it lags behind in fetal development. In addition to all this, the baby is uncomfortable to be in such a “nest”, his neck is often twisted, and the bones of the face and head are susceptible to deformation due to squeezing them by the walls of the uterus.

Moderate oligohydramnios does not have such a critical effect on the health of the fetus: the baby is weak and lags behind in weight gain (so-called malnutrition is observed), his muscle tone is reduced (torticollis, clubfoot may develop), and mild fetal hypoxia occurs.

If the screening and urine / blood / smear tests are normal, the cardiotocogram (CTG) is in order and the fetus is developing well, and the pregnant woman has no complaints about her well-being, then the diagnosis of oligohydramnios is conditional. It’s just that obstetricians will prepare for labor induction, since there is a high probability of a post-term pregnancy, or for a caesarean section with a non-standard position of the fetus at the time of birth.

Diagnosis of oligohydramnios

With an ultrasound examination, the doctor makes some measurements and calculations to determine the amount of amniotic fluid, after which he makes a conclusion about oligohydramnios, a normal amount of water, or polyhydramnios.

A gynecologist can also suggest little or polyhydramnios at the next measurement of the circumference of the abdomen and the height of the fundus of the uterus, but a more accurate diagnosis can only be made with the help of ultrasound.

At home, you can only test for leakage of amniotic fluid. If watery discharge is often observed on the underwear, and the baby’s kicks began to be painfully perceived by the pregnant woman, although such discomfort was not felt before, or the size of the abdomen is small, although the gestational age has already exceeded 20 weeks, then it is advisable to conduct a special test. Perhaps the reason for everything is lack of water, caused by leakage of water due to a violation of the integrity of the membranes.

The test can be done at home by monitoring the discharge for some time, or by buying a special amniotic fluid leak test at the pharmacy and using it.

The “free” test is carried out as follows: empty your bladder, take a shower (without douching and possible water getting inside the vagina), dry yourself with a towel and lie down on a dry diaper. Lie still for 15 minutes, and then get up and see if a wet spot has appeared on the diaper. Ordinary secretions are not able to form and flow out so quickly, most likely, amniotic fluid is leaking. You can find out more precisely by contacting the LCD with a complaint about unusual discharge. There they will conduct a special test and say it is water or ordinary vaginal discharge.

The pharmacy test looks like a gasket, the surface of which will change color to blue or green if amniotic fluid leaks.

Staining also occurs with bacterial / viral discharge, so if spots of a blue-green hue are noticed on the surface of the pad, contact your gynecologist.

Any test for amniotic fluid leakage is recommended after 12 hours since the last intercourse, douching or use of vaginal suppositories.

Treatment of oligohydramnios

It is impossible to artificially increase the amount of amniotic fluid, so the treatment of oligohydramnios comes down to determining the causes of its occurrence. Further, the treatment of the root causes of oligohydramnios is carried out.

To determine the causes of oligohydramnios, a pregnant woman is referred for doppler ultrasound or cardiotocography (CTG), in order, first of all, to refute or confirm a violation of blood flow in the placenta.

If the fetoplacental circulation is still disturbed, then the patient is prescribed drugs to normalize it - Curantil, Actovegin.

Moreover, Curantyl is often prescribed as a preventive measure for placental insufficiency.

Often, the treatment complex includes medications that help normalize metabolic processes in the body of a pregnant woman (for example, Magne + B6) and maintain the normal functioning of important internal organs women (for example, Hofitol).

It is also necessary to exclude the presence of infections in a pregnant woman. For this purpose, urogenital smears for STIs and from the throat + nose for cocci are re-taken, a blood test for TORCH infection is performed. If an infection is present, antibiotic therapy is prescribed.

Childbirth with oligohydramnios

With severe oligohydramnios, a planned caesarean section is prescribed. With a small volume of amniotic fluid, the fetal bladder acquires flat view. Because of this, contractions will be irregular and weak, and labor can be long and difficult.

Moderate oligohydramnios is not a contraindication for natural childbirth. Even with a breech or breech presentation of the fetus caused by oligohydramnios, childbirth takes place safely for both the mother and her child.

Insufficient amount of amniotic fluid does not give the baby the opportunity to move freely inside the womb. Therefore, often the child takes a transverse or gluteal position and he can no longer roll over correctly.

There are various exercises that can help turn the crumbs into the desired position, but their effectiveness has not been confirmed with medical point vision. Exercise can lead to cord entanglement, so you need to weigh the pros and cons before doing them.

In this article:

Introduction

Pregnancy is a natural process for every woman, when not only her appearance changes, but also her worldview. There are so many worries, worries, worries and reasons to rejoice, for example, the first stirring of a baby. But, unfortunately, sometimes there are problems associated with this interesting situation. What can darken the life of a future mother? On early dates- this is toxicosis, the threat of miscarriage, later - polyhydramnios, gestosis and more. Why do you have to suffer, endure unpleasant trials while waiting for a baby, what are the reasons for polyhydramnios and other problematic conditions?

When there is a lot of water...

Almost every woman knows what amniotic fluid is - this is the fluid that surrounds the baby in the womb for almost the entire pregnancy. Their number ranges from 20-30 to 1200, less often up to 1500 ml, depending on the period.

What problems can be associated with amniotic fluid?

  1. Low water.
  2. Polyhydramnios.
  3. Infection of amniotic fluid.

Polyhydramnios is an excess amount of amniotic fluid. This problem can occur at any time and it is extremely important to find and eliminate the cause.

Is there something wrong…

In most cases, a moderate increase in amniotic fluid has almost no effect on the well-being of pregnant women, or they simply think that this is how it should be (especially if the pregnancy is the first). What are the symptoms?

  1. An excessively large belly that does not correspond to the term and size of the fetus.
  2. Drawing pains in the lower abdomen, a feeling of muscle fatigue due to excessive load.
  3. Tachycardia, feelings of lack of air, heartburn and nausea - all this develops due to the higher standing of the uterus, which in turn compresses the stomach and interferes with movement chest(diaphragms).
  4. Often, after polyhydramnios, edema develops, more often in the legs.

If these symptoms appear, you should consult a doctor without waiting for a planned visit.

Causes

The causes of polyhydramnios are varied, but it is customary to single out the most common ones.

From the side of the fetus:

  • excess weight of the fetus;
  • pathology of the gastrointestinal tract;
  • pathology of the urinary system;
  • congenital endocrine pathology, in particular hypothyroidism;
  • gene and chromosomal diseases;
  • dysfunction of the fetal membranes and uteroplacental circulation.

Hormones are conductors of the body

The hormonal system is a very fine structure that includes many feed-forward and feedback mechanisms. That is why violations of one link, the pathology of one endocrine gland leads to a gross failure throughout the body. This also applies to the process of bearing a child.

In case of diabetes in the mother, the process of absorption of glucose by the cell is disrupted in the body, and as a result, a large amount of this substance remains in the bloodstream, the amniotic fluid. Almost all sugars have the ability to attract water. Thus, an increased content of glucose in the blood, amniotic fluid helps to attract additional fluid there in order to restore the proper concentration of substances. Incidentally, this is the most common cause polyhydramnios.

A similar mechanism occurs with a reduced functional activity of the thyroid gland, otherwise with hypothyroidism. This endocrine organ produces substances responsible for metabolism and energy. A reduced amount of thyroid hormones leads to metabolic disorders and, as a result, glycosaminoglycans can accumulate in tissues and amniotic fluid, which, in turn, like glucose, attract a large amount of water. Usually in these cases, pregnant women experience dense swelling of the skin and subcutaneous fat.

Such troubles can occur with the pathology of any link in the endocrine system responsible for the metabolism and water in the body.

Local and general infections

Any infectious process is a stress for the body. Local infectious diseases are usually divided into non-specific (germs and viruses of any strain and class) and specific, such as gonorrhea and syphilis. The latter are extremely dangerous for the unborn child, not only by the development of polyhydramnios, but also by the formation of severe congenital pathology, up to malformations. Non-specific infections, as a rule, can cause infection of the amniotic fluid, then the placenta and, as a result, have a toxic effect on the vessels, which will become more permeable. The latter directly leads to an increase in amniotic fluid.

As for common infectious diseases, these can be viruses, bacteria, fungi. The more severe the disease for the mother, the worse it is for the unborn baby. Influenza, measles, chickenpox and first-time herpetic infections are especially dangerous. All of them synthesize toxins into the bloodstream and contribute to the production of inflammatory substances, antibodies, immune complexes that negatively affect the vessels of the placenta, increasing their permeability, and the unborn baby. Secondary infection of the placenta, amniotic fluid and the baby may also develop, which can lead to the development of polyhydramnios.

Any stress, including infectious, can cause an exacerbation of chronic diseases of the mother.

Extragenital pathology

This is a group of diseases that are not related to the reproductive system, but can have an adverse effect on the development of pregnancy, for example, diseases of the cardiovascular system.

Hypertension or other pathology, accompanied by an increase in blood pressure, during decompensation in pregnant women is almost always accompanied by an excess amount of amniotic fluid and edema. It is also a threat of premature placental abruption and disruption of the normal course of childbirth.

Diseases of the urinary system, unfortunately, are not uncommon in our time and are one of the main causes of problematic conditions during pregnancy, including increased water formation. Most often, pyelonephritis, glomerulonephritis and other types of nephritis with impaired renal excretory function lead to the latter.

Exacerbations and reactivation of systemic problems are extremely dangerous, which most often affect the small vessels of the kidneys and placenta.

When Immunity Becomes the Enemy

Our immune system is designed to protect the body from foreign genetic information - these are transplants, infections, foreign bodies. And a couple of it future child. After all, he only has half the genetic material of a woman, the other half from his father.

Most often, immunity revolts against a child if there are some differences in blood type and Rh factor, although there are other incompatibilities. Such conflicts lead to acute inflammation, which in turn causes an increase in amniotic fluid.

Child

Amniotic waters, processes in the placenta are regulated by both the expectant mother and the child. Therefore, there is some pathology or deviation from the norm on the part of the fetus, contributing to the development of polyhydramnios.

For a person, the bearing of one fetus is considered the norm, in other cases this is already a deviation from the norm. The female body undergoes tremendous stress during pregnancy. Around each baby, especially if they are fraternal, amniotic fluid is formed, which performs protective, nutritional and training functions. Therefore, multiple pregnancy is almost always accompanied by an excess amount of amniotic fluid.

If a child still in the womb develops an endocrine pathology, accompanied by a violation of metabolism and water, then there is more amniotic fluid. Unfortunately, the baby also suffers from this, usually such congenital diseases are accompanied by deviations in neuropsychic development and an increase in body weight (often due to edema) and individual organs.

Amniotic fluid, among other things, performs the function of a coach, that is, the child swallows, digests and excretes. Partially, the assimilation of water with dissolved substances occurs and, accordingly, its amount is controlled. If the child has a pathology of the gastrointestinal tract, for example, atresia, membranes in the lumen, then the child will not be able to swallow the liquid, reducing its amount around him.

Polyhydramnios due to gene and chromosomal abnormalities in the fetus is one of the most unpleasant. The mechanism of water increase in Down syndrome, Edwards disease has not been fully studied, most likely this is due to a combined pathology of organs.

Quite often, the cause of polyhydramnios remains unexplained, then the treatment is symptomatic.

Consequences

The danger of polyhydramnios is determined, first of all, by the reason for which it arose. Indeed, in some cases, an increase in the volume of amniotic fluid is far from the worst symptom and consequence.

By itself, an increase in amniotic fluid is dangerous for premature birth. A woman's uterus can only grow to a certain size, and unfortunately, sometimes this is not due to the normal size of the baby.

Treatment

How to avoid polyhydramnios? It is best to start with prevention, which means that pregnancy should be planned in order to put your body in order and compensate for chronic diseases of the endocrine, cardiovascular and genitourinary systems.

Most often, a deviation in the normal volume of intrauterine fluid is ascertained by the results of an ultrasound examination. After that, you need to establish the true problem. Only the treatment of the causative disease will provide a lasting result.

Symptomatic treatment is allowed only if the cause is not established.

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