Amniotic fluid index 25. Ultrasound scanning in the III trimester of pregnancy. Composition of amniotic fluid

13.05.2019

The symptoms, causes and methods of diagnosing oligohydramnios and polyhydramnios are considered.

The first thing that the future baby encounters in the mother's body is water. Doctors call it amniotic fluid. It provides the baby with everything necessary and performs many functions.

Where does amniotic fluid come from and what does it consist of?

After implantation of a fertilized egg in the uterus, not only the embryo grows, but also the fetal membranes are formed, the placenta and the fluid in which the baby will be.

Water is formed from the blood plasma of a pregnant woman. We can say that the body filters out everything unnecessary from the plasma and provides the child with this liquid with a new composition.

The composition of the amniotic fluid:

97% plain water
Proteins
Amino acids
Minerals
Hormones
child's urine

The composition of the fluid, depending on the duration of pregnancy, changes. Moreover, if in the early stages the liquid really resembles blood plasma, then by the end of pregnancy the water contains a lot of fetal urine. A child swallows about 20 ml of amniotic fluid every hour. Up to 14 weeks, water enters the baby's body through the skin. Later, the skin becomes keratinized, and the fluid enters through other channels.

Participation of amniotic fluid in the birth process

In the first period of contractions, all the water is divided into two parts. The first part is located directly under the head of the fetus and rests against the cervix.

A bubble with fluid stretches the cervix and provokes the opening of the uterus
With insufficient water, the pressure on the uterine os is minimal, respectively, the opening is very slow. The birth process is slowing down, the midwife states a weak labor activity. This condition is dangerous due to fetal hypoxia and various birth injuries. In this case, doctors resort to amniotomy, in other words, pierce the bladder
While the bubble is bursting, the water washes the birth canal of the woman, ensures the sliding of the child during the birth
The rest of the fluid continues to protect the baby until birth. It pours out at the time of birth

With rapid childbirth, some children are born "in a shirt", this is a fetal sac with water that did not have time to burst.

Functions of amniotic fluid during pregnancy: 7 main functions

Amniotic fluid is not only food for the crumbs, it also performs many other functions:

Protects against mechanical damage
Prevents loud sounds from entering
Is a source of nutrients
Provides a constant temperature for the baby
Participates in metabolism
Starts the birth process
Washes the birth canal, cleaning them and making them slippery

What should be the volume of amniotic fluid? What threatens excess and lack of water?

The amount of amniotic fluid changes as the baby grows. Accordingly, the volume of liquid gradually increases:

At 10 weeks, the amount of water is very small. Approximately a teaspoon
By 14 weeks, the volume of water is half a glass
At 25 weeks, the amount of water will fit in a half-liter jar
By 30 weeks, this is 0.7 liters
Before childbirth, the amount of water is approximately 800-1500 ml

Of course, the amount of amniotic fluid depends on the mother's physique and genetic factors. But with a significant excess of the permissible volume, doctors diagnose polyhydramnios. This condition is very dangerous and can lead to the following consequences:

preterm birth
Incorrect position of the fetus in the womb
Uterine bleeding
Complications during childbirth. Placental abruption or umbilical cord prolapse often occurs

But not only an excessive amount of amniotic fluid is dangerous, but also their lack. Usually there are such violations with oligohydramnios:

Fetal bone deformity
Asphyxia, which leads to disturbances in the functioning of the nervous system
Abnormal development of the limbs of the fetus

How to diagnose polyhydramnios?

It is possible to determine something was wrong already at the 30th week of pregnancy. The doctor can do this during a routine examination.

With an excessive amount of water, the stomach is larger, tense
When patting the abdomen on one side, a noise is heard from the other side
The heart rhythm is poorly heard, it is drowned out by gurgling sounds
The uterus is tense, it is impossible to feel the parts of the child's body
If the bottom of the uterus is located much higher than it should, then the doctor may conduct an examination on a chair to diagnose the tension of the fetal bladder

But usually the antenatal clinic doctor is worried and does not conduct a vaginal examination in order to avoid undesirable consequences. The pregnant woman is sent for an ultrasound.

During this diagnostic method, using an ultrasonic sensor, the amount of water is measured on four sides of the fetus. After that, calculations are carried out and the index of the amniotic fluid is derived. If it is more than 24 cm, then it is polyhydramnios. According to another calculation method, polyhydramnios is diagnosed with an IAI value of 8 cm.

How can polyhydramnios threaten a fetus and a pregnant woman?

This is a dangerous condition, and the more water, the higher the likelihood of complications:

In the early stages with acute polyhydramnios, the fetus dies
In the later stages, an excessive amount of amniotic fluid leads to uterine rupture
Malposition
The risk of the umbilical cord wrapping around the baby's neck due to his excessive freedom
Late preeclampsia
Edema in the mother
Bouts of vomiting
Persistent heartburn
During childbirth, the child can take an oblique position, which is fraught with birth injuries
Decreased uterine tone during childbirth. The contractions are very weak and the woman cannot give birth

All this ends in premature birth, emergency caesarean section, or the use of forceps, which can cause a child's disability.

Features of pregnancy management with polyhydramnios: what should a pregnant woman avoid?

With critical polyhydramnios, treatment is carried out in a hospital. The hospital determines the causes of polyhydramnios.

If it is an infection, then the pregnant woman is treated with antibiotics.
If polyhydramnios is caused by a Rh conflict, then special preparations specified in the protocol are administered.
Often polyhydramnios is due to fetal pathology. In this case, the woman is prepared to terminate the pregnancy.
Together with the elimination of the cause of polyhydramnios, drugs are administered in the hospital to restore the lack of oxygen and nutrients in the fetus. These are vasodilators, oxybarotherapy, antioxidants, vitamins

When diagnosing polyhydramnios, a pregnant woman should not refuse hospitalization. It is dangerous for mother and fetus. No diet and proper nutrition can cure polyhydramnios. It is necessary to find the cause and eliminate it, and this can only be done in a hospital.

Oligohydramnios: causes and symptoms

Low water is diagnosed very poorly. Accordingly, there is a risk of aggravating the problem with fetal growth. With severe oligohydramnios in a pregnant woman, there is:

Nausea
Dry mouth
Pain with fetal movement

A doctor can diagnose or suspect oligohydramnios at a routine examination. The main signs of oligohydramnios are:

Very small abdomen
The fundus of the uterus is very low
Poor fetal mobility
Causes of low water:
Fetal malformations
Fetal pathologies
Chronic ailments of the mother
Pathologies of the placenta

Accordingly, oligohydramnios is not necessarily due to the poor health of the mother, because the fetus is also involved in the formation and renewal of the amniotic fluid. Most often, with oligohydramnios, problems of the excretory system in the fetus are diagnosed. This may be the absence of kidneys, kidney dysplasia, underdevelopment of the pelvis or fetal urethra. That is, the child cannot normally process the liquid and remove it from the body.

What problems can arise due to oligohydramnios and how to diagnose them?

In 50% of cases, pregnancy with oligohydramnios ends in premature birth.

Due to lack of water, the baby is not protected from mechanical damage.
He cannot move freely inside the mother, respectively, there is a developmental delay
Often observed clubfoot and curvature of the spine in the fetus
Often there is a fusion of the walls of the placenta with the fetus. This can lead to fetal malformations.

In order to prevent pathologies of fetal development in time, an unscheduled ultrasound is performed. If a child is diagnosed with some serious pathology, the pregnant woman is prepared for an abortion for medical reasons. If the cause of oligohydramnios is obesity, diabetes mellitus, or some kind of illness in a woman, treatment is prescribed. With a slight oligohydramnios, a pregnant woman is treated on an outpatient basis, hospitalization is not required.

Follow all doctor's recommendations. Often the cause of the development of pathology is the underdevelopment of the fetus. Don't skip the amniocentesis. This is a manipulation during which amniotic fluid is taken for analysis. In the course of research, you can not only verify the correctness of the diagnosis, but also determine the condition of the child.

If the doctor prescribes a diet, try to stick to it. It is important to eat right and not overeat with diabetes and obesity.

Oligohydramnios and polyhydramnios are serious disorders that can lead to premature birth and malformation of the fetus. Don't let things drift and don't skip scheduled checkups and screenings. Early diagnosis will help you keep your pregnancy and give birth to a healthy baby.

VIDEO: Polyhydramnios during pregnancy

During the first pregnancy, many are faced with such a concept as the amniotic fluid index, abbreviated AFI. To fully understand what it is and how important it is to adhere to the IAI standards, it is necessary to consider all aspects of this issue.

Ultrasound amniotic
convenience inside water
rest schedule analyzes
table why why

Amniotic fluid is the official name for the amniotic fluid in the womb of a pregnant woman, which provides the biological environment for the normal development of the baby.

The main functions of the biological environment.

Child nutrition. The composition of amniotic fluid contains many necessary and beneficial substances for the fetus. During maturation, they enter the child's body by absorption through the skin. As the degree of maturity, the baby begins to independently consume the required amount.
Ensuring normal pressure as well as temperature.
Protection of the fetus from external environmental factors.
The composition of amniotic fluid includes the required amount of immunoglobulin fractions, which create a sterile barrier, preventing infections. This is due to the fact that amniotic fluid has the ability to constantly renew itself, the process will stop after childbirth.
An important factor is the complete sealing of the bladder, as well as the movement of the fetus in space.

Table of values

Various modulations of the norms of the index of AF-amniotic fluid by weeks indicates the development of an anomaly or pathology in the fetus. To avoid adverse situations, pregnant women need to be constantly examined.

Checking with a gynecologist

For the correctness of the diagnostic results, doctors carry out a number of preparatory measures.

Analysis of the cytological and biochemical composition of amniotic fluid.
Checking transparency, shade AJ.
Accounting for the contained hormones.
Checking, studying the volume. The gestational period affects the volume of amniotic fluid, which is calculated relative to the trimesters of pregnancy.

There is a special table that lists the norms of the index of AF-amniotic fluid by week in mm.

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

As can be seen from the table, the calculation principle is quite simple. For example, you need to know the rate of the amniotic fluid index at 19 weeks of pregnancy. The values in the table show 83-137-225 where the first value is the minimum, followed by the average and then the maximum allowed.

At 20-21 weeks, the lowest limit of the AF index - amniotic fluid is 86-88, this is a deviation from the norm. With such indicators, you should be observed by a doctor.

There are two ways to diagnose IAI.

Subjective: examination with ultrasound, when longitudinal and transverse scanning is performed.
Objective: the diagnostician, using the method of certain calculations, summarizes 4 indicators that determine the amniotic fluid index by week in cm. At week 16, it amounts to a value of 12 cm.

This is what a baby looks like in the womb

Additionally, the size of the amniotic fluid pocket is diagnosed, which is determined in two perpendicular planes. An additional test analysis is possible, which is carried out at 16-18 weeks.

Such an analysis is useful for the timely detection of anomalies, pathologies in the development of the fetus or placenta. After diagnosing the body of a pregnant woman, doctors take the necessary measures. In rare acute cases, termination of pregnancy is recommended.

Possible risks when a problem is discovered

The discrepancy between the norms of the amniotic fluid index by week of pregnancy indicates the occurrence of polyhydramnios or oligohydramnios in a woman. The manifestation of such conditions is quite dangerous, even threatens with serious complications.

Dangers with polyhydramnios:

placental abruption is possible;
development of infection of the birth canal;
violation of the development of the fetus;
possible miscarriage.

Most often, oligohydramnios is detected after 26-30 weeks or when overdue at 41 weeks. In addition, oligohydramnios threatens with serious diseases of the fetus.

Ultrasound procedure

If the index of AF-amniotic fluid at 31 weeks is 66, with an average value of 14 cm at 31 weeks, then you need urgent specialist intervention.

Dangers with oligohydramnios:

disorders of the respiratory, genitourinary system;
hypodynamics and pressure on the fetus, which can cause various anomalies: changes in the weight of the fetus, dislocations, deformities of the bones, spine;
the occurrence of hypoxia;
the possibility of premature miscarriage;
risk of bleeding after childbirth.

Excess amniotic fluid (polyhydramnios) is detected in 1 to 3% of women in labor. For example, at week 34, your IAI is more than 278 units, this indicates a critical level of amniotic fluid. The causes of polyhydramnios are influenced by the presence of certain factors.

From the mother's side:

Rh factor, blood type;
the presence of diabetes;
the presence of infections or inflammatory processes in the body.

According to the analysis of the placenta:

in the event of a benign tumor of the fetal membrane;
with placental edema.

Fetal diagnosis:

multiple pregnancy;
hereditary pathologies or diseases.

Causes of oligohydramnios:

abnormalities of the fetus inside the womb;
various pathologies: infections, chromosomal abnormalities, poor fetal development, etc.;
the presence of diseases in a woman: problems with the heart, blood vessels, inflammatory and infectious symptoms, kidney disease;
placental insufficiency, defects, heart attack;
gestation of the fetus;
placental abruption;
premature death of the child inside the womb.

People in white coats

Polyhydramnios is of a different nature.

In a moderate condition, the size of the inner pocket is from 7 cm to 18.
With pronounced polyhydramnios, the value manifests itself in the range from 18 to 24 cm.
In chronic, the rate is slightly higher, but stable.
In borderline and acute conditions, the index value varies between the average and the highest. In this case, inpatient treatment is recommended.
With an acute excess of fluid, specialists will prescribe an amniotomy, with a chronic one - a complex therapeutic treatment.

These recommendations also apply to oligohydramnios, with acute symptoms, a pregnant woman will be offered inpatient treatment. For example, your amniotic fluid index is 5 5, which indicates critical oligohydramnios, which can be a threat to the life of the fetus.

everyone, without exception, is prescribed Curantil, Actovegin;
minimum physical activity;
healthy diet, diet in combination with a vitamin complex;
preventive treatment for insurance against the formation of infectious and inflammatory processes;
when overwearing - stimulation of childbirth.

As the baby grows

In traditional treatment, antibiotics are usually used to restore hypodynamic functions. For various infections, immunomodulators are prescribed. Diuretics are required.

Optimal Treatment

The optimal treatment is determined individually for each pregnant patient, taking into account the diagnosis, characteristics and cause of the problem.

Let's say you are 32 weeks pregnant and your amniotic fluid index is 77. This means that you have borderline oligohydramnios.

Polyhydramnios and oligohydramnios are far from a tragedy, but with oligohydramnios, you will have to spend most of the time on conservation in a hospital.

With proper medication and strict adherence to the doctor's recommendations, the level of polyhydramnios will decrease, and the value of oligohydramnios will increase to the desired numbers. In this case, your AF index - amniotic fluid will be kept at a stable value.

Good mood, positive emotions, positive attitude, strict adherence to all recommendations of doctors guarantees minimal risk to the health of the mother and the normal development of the child.

: Andrey Fergert

gynecologist, pediatrician

Not really

You will be interested in these articles:

Attention!

The information published on the site is for informational purposes only and is intended for informational purposes only. Site visitors should not use them as medical advice! The editors of the site do not recommend self-medication. Determining the diagnosis and choosing a treatment method remains the exclusive prerogative of your doctor! Remember that only a complete diagnosis and therapy under the supervision of a doctor will help to completely get rid of the disease!

Medical Center	The address	Price
1st Clinical City Hospital	Minsk, Independence Ave., 64

Amniotic fluid begins to form at a period of 5-6 weeks, and during pregnancy, their volume changes.

If at 5-6 weeks the volume of amniotic fluid is about 5 ml, then at the 38th week this volume is about 1 liter, and at the 40th week it is about 600 ml.

In this article, we will consider what amniotic fluid consists of, what they are for, what methods for studying amniotic fluid exist. We will also analyze common pathologies of amniotic fluid.

Why amniotic fluid is needed

Amniotic fluid plays a crucial role in the development and protection of the baby throughout pregnancy and in.

protection of the fetus from mechanical damage;
creating conditions for the movement of the fetus and preventing contractures of the limbs;
adhesion prevention;
the presence of amniotic fluid prevents squeezing of the umbilical cord;
amniotic fluid creates the necessary "purified" environment for the child, protects the fetus from infection. The volume of amniotic fluid is renewed every 3 hours, and thus this medium always remains "fresh";
creating conditions for the development of the lungs of the fetus;
fetal nutrition;
the baby "throws out" all the processed products into the amniotic fluid, and this makes it possible to remove these products through the mother's excretory system, thereby cleansing the child's body;
when the time of birth comes, the amniotic fluid with its weight acts on the cervix, forcing it to open. During childbirth, amniotic fluid makes it easier for the baby to move through the birth canal.

What is amniotic fluid made of

Throughout pregnancy, the composition and volume of amniotic fluid changes. The composition includes: epidermal flakes, vellus hair and the original lubricant of the fetus, proteins, fats, carbohydrates, enzymes, vitamins, glucose, hormones and waste products of the fetus.

Amniotic fluid, main indicators

Amount of amniotic fluid

Amniotic fluid is produced by the amnion (fetal bladder) throughout pregnancy. But the amount (volume) of water is not the same at different times. The largest volume of amniotic fluid is at about 36 weeks, and is about 1-1.5 liters. By the amount of amniotic fluid, such conditions as polyhydramnios and oligohydramnios are diagnosed. The amount of water is determined by . Approximate norms for the volume of amniotic fluid (depending on the gestational age) are shown in the diagram below.

amniotic fluid color

Normally, amniotic fluid is colorless, odorless, colorless, transparent, sometimes (normal variant) may be slightly whitish. Also, a small amount of white flakes is considered a normal indicator. The color of the amniotic fluid becomes clear when the water is poured out, or when the water leaks. The presence of "flakes" can be seen on ultrasound. With the outflow or leakage of amniotic fluid, dangerous symptoms are:

the unpleasant odor of the waters and their green color. Green "color" indicates oxygen starvation of the fetus, and requires urgent delivery (). Green waters become because, during oxygen starvation, the child releases original feces (meconium) into the waters and it colors the waters in a characteristic color.
bright yellow color - indicates the development of the Rhesus conflict, or incompatibility of the mother and child in terms of blood groups. Requires urgent treatment in a hospital.
red color - indicates the onset of bleeding (due to premature detachment of the placenta or for other reasons). Urgent hospitalization of the pregnant woman is required, and, as a rule, urgent delivery.

At the beginning of labor, the amniotic fluid may have bloody streaks (in the main transparent volume). This is a variant of the norm, since micro-tears can occur when the cervix opens.

Biochemical, cytological and hormonal composition of amniotic fluid

The composition changes during pregnancy, and according to the composition of the amniotic fluid, specialists can draw conclusions about the condition of the fetus, as well as about the work of the mother-placenta-fetus system. Also, according to these indicators, various genetic pathologies can be diagnosed. For analysis, amniotic fluid sampling is needed, it is carried out using the amniocentesis procedure.

Transparency of amniotic fluid

A small amount of flakes in the amniotic fluid is considered normal. These "flakes" begin to be visible on ultrasound around the middle of the second trimester. By the end of pregnancy, their number increases. These are particles of the skin of the fetus, elements of the original lubricant.

Amniotic fluid, research methods

ultrasound. During an ultrasound, a specialist can check the transparency and volume of amniotic fluid. The presence of a large amount of flakes in the waters (in the third trimester) may be a symptom of fetal hypoxia. According to the results of ultrasound, the amniotic fluid index is also calculated and such pathologies of the amount of amniotic fluid as polyhydramnios and oligohydramnios are diagnosed.
Amnioscopy. During the amnioscopy procedure, amniotic fluid is examined visually using an amnioscope. Amnioscopy makes it possible to assess the color of amniotic fluid, as well as to determine the composition of impurities (meconium, lubricants, flakes, sometimes blood). During the examination, an amnioscope is inserted into the cervix. The procedure is performed without anesthesia, on a gynecological chair. Amnioscopy is performed with a whole.

Indications for amnioscopy: gestation of the fetus, chronic fetal hypoxia.

Contraindications to amnioscopy: inflammatory processes in the cervix,.
Amniocentesis.The procedure for the study of amniotic fluid, in which the fetal bladder is pierced and 20-25 ml of amniotic fluid is taken for analysis. With such a sampling of material, it is possible to conduct a hormonal, biochemical and cytological analysis of amniotic fluid. An indication for such a study may be suspicions (according to ultrasound) of genetic abnormalities of the fetus. The place for puncture is determined based on the results of ultrasound (the largest "free" pocket of amniotic fluid, without umbilical cord loops).

Of the listed research methods, ultrasound and amnioscopy are non-invasive methods (without a puncture), and amniocentesis is an invasive method.

Amniotic fluid, pathologies

By the volume of amniotic fluid, such pathologies are diagnosed.

Polyhydramnios is a pathology of amniotic fluid, during which amniotic fluid exceeds the norm in volume. In domestic medical practice, a volume of 1.5 liters is considered the norm (with a normal full-term pregnancy). In foreign practice, - 2 liters. Polyhydramnios can be acute and chronic (depending on the course and increase in symptoms). You can read in detail about the consequences, symptoms, diagnosis and causes of this pathology in the article.
Oligohydramnios is a pathology of amniotic fluid, in which the volume of amniotic fluid (with advanced pregnancy) is lower than 500 ml (in domestic medical practice), and less than 300 ml in foreign practice.There are moderate and severe oligohydramnios. To make a diagnosis (according to ultrasound data), the doctor calculates the so-called “amniotic fluid index”, IAF. According to the timing of occurrence, oligohydramnios can occur in the first, second, and third trimester. You can read in detail about the consequences, symptoms, diagnosis and causes of this pathology in the article.

The amniotic index is an indicator that characterizes the amount of amniotic fluid during pregnancy. Amniotic fluid is also called amniotic fluid: a liquid natural environment provides the baby with everything necessary for the formation of strong immunity from birth. Its volume is of great diagnostic importance when examining a woman during pregnancy.

The biological environment surrounding the fetus in the mother's womb is multifunctional - without it, the child cannot survive. What is remarkable about amniotic fluid:

"feeds" the growing body. From the point of view of energy value, amniotic fluid can be called an ideal nutrient medium for the fetus at all stages of its development. For some time after conception, useful substances from the amniotic fluid enter the body of the embryo, simply being absorbed through its cells. When the fetus grows up, he regularly swallows the liquid surrounding him in small portions;
protects the fetus from the mechanical influence of the world on the other side of the mother's belly - the pressure and shocks coming from the outside are not terrible for the baby;
protects the fetus from infection. The amniotic fluid is rich in immunoglobulins, which ensure the health of the baby. In addition, 100% closure of the fetal bladder and constant renewal of the amniotic fluid provide the baby with a sterile environment for a safe existence;
provides the child with complete freedom of action in the uterine cavity;
muffles harsh sounds coming from the outside world.

Main characteristics of amniotic fluid

As pregnancy develops, the quantitative and qualitative indicators of amniotic fluid are constantly changing. Deviations of these figures from the norm are of great importance for physicians - based on this information, it can be assumed that the expectant mother has or does not have certain pathologies. Timely diagnosis can reduce the risk for a woman and her child even before childbirth or, in extreme cases, after the baby is born.

The amniotic fluid index (AFI) is an indicator that reflects how much amniotic fluid fills the fetal bladder at a particular stage of pregnancy.

In addition, experts take into account other characteristics of the natural liquid environment in which the fetus develops:

Color and degree of transparency. Normally, amniotic fluid is colorless or has a slightly yellowish tint. This liquid is quite transparent, and the presence in it of a certain amount of fragments of the skin and hair of the fetus is not a deviation from the norm.
Quantity. The volume of amniotic fluid is determined by the gestational age, so when talking about this indicator, be sure to take into account the trimester of pregnancy. For example, the norm of the amniotic index at week 22 of an “interesting” position is 145 ml and this is an average. The lower limit value reaches 89 ml, and the upper limit value reaches 235 ml. the volume of water increases by 40 - 45 ml every day up to a period of 32 weeks. When the IAI reaches its highest value (144 ml at 32 weeks), the amount of fluid begins to gradually decrease. A few days before the birth of the baby, the indicators of amniotic fluid range from 0.5 to 1.500 ml.
The presence of hormones.
Biochemical and cytological indicators of the composition.

Diagnosis of amniotic fluid

The analysis of amniotic fluid using ultrasound allows you to diagnose two common abnormalities during pregnancy - oligohydramnios and polyhydramnios, as well as take timely measures to eliminate them. During the ultrasound, the specialist will determine the index of the amniotic fluid and set the multiplicity of the vertical pocket. If the indicators exceed the limits of the norm or, conversely, are less than them, polyhydramnios or oligohydramnios are indicated in the conclusion.

What is a vertical pocket and why is its size determined? The vertical pocket is the longest section of free water, which is located between the child and the anterior abdominal wall. It is undesirable that the limbs or umbilical cord of the fetus be located in this area. Permissible indicators of the length of the vertical pocket are 5 - 8 cm.

The norm of the amniotic index during pregnancy

To assess the volume of amniotic fluid using the amniotic fluid index, the gynecologist will divide the belly of the expectant mother into 4 sections, drawing two conditional perpendicular lines that intersect at the navel. Then, in each of the four zones, he will determine the indices of the largest vertical pocket index. The final value of the index is calculated by adding the values of all pockets.

The norm of the amniotic index is calculated by weeks, starting from a period of 16 weeks. With an increase in the gestational age, the IAI indicators will also increase: the highest indicator will be at 32 weeks - 77 - 169 ml. The norms of the amniotic index are displayed in the table.

If the IAI indicators do not coincide with the specific terms of pregnancy, the expectant mother is diagnosed with oligohydramnios or polyhydramnios.

Deviation during pregnancy: oligohydramnios

This pathology accompanies the bearing of a child quite often. The amniotic index with oligohydramnios is slightly or significantly underestimated. Moderate oligohydramnios is diagnosed when the volume of amniotic fluid differs slightly from the norm of IAF. The situation can be corrected with the help of a special diet and adjustment of the daily routine, then the amount of water will soon return to normal and will not affect the child's health in any way.

Oligohydramnios is considered pronounced if the amniotic fluid index during pregnancy is significantly less than the standard indicator. In this case, the pregnant woman is urgently sent to the hospital - the likelihood of complications in the child is too high. Severe oligohydramnios can cause underdevelopment of vital organs and systems, a significant curvature of the skeleton.

In addition, oligohydramnios threatens the child with a number of other complications, including:

developmental delay;
fusion of the fetus with the fetal membrane;
hypoxia;
low birth weight of the child;
drying of the skin of the child due to a lack of water;
intrauterine fetal death.

When a significantly underestimated IAI was found over a long period (30–34 weeks), serious pathologies of the child’s development most likely already exist, so the question of artificial termination of pregnancy is often raised, since treatment, unfortunately, will not bring positive results.

Why oligohydramnios develops

There are many factors that directly or indirectly affect the development of oligohydramnios during pregnancy. We list the most likely:

insufficient development of fetal membranes;
reduced water production;
anomalies in the development of the child (problems with the kidneys and skeleton);
high blood pressure in a pregnant woman;
bacterial infections that have entered the amniotic fluid;
pregnancy with twins or triplets;
uneven maturation of the placenta;
overwearing;
impaired metabolism in a pregnant woman;
overweight expectant mother.

Signs of pathology

Oligohydramnios does not manifest itself to such an extent that the pregnant woman immediately suspected something was wrong - the clinical picture of the deviation in this case is blurred. With severe oligohydramnios, a woman can be tormented by weakness, dry mouth, and frequent nausea. Sometimes the expectant mother feels pain in the lower abdomen, which intensifies when the baby moves.

During a diagnostic study of a pregnant woman with oligohydramnios, the doctor will certainly note that the patient's uterus is too small for the current gestational age, and the movements of the fetus are significantly constrained. Ultrasound is used to confirm the diagnosis.

The specifics of the treatment of oligohydramnios

Correction of oligohydramnios begins with an assessment of the test results - only in this way can the doctor determine the cause of the incident, determine the degree of the disease and the condition of the child. Only then can a treatment plan be developed.

If the pregnancy proceeds against the background of obesity and impaired metabolism in a woman, she is prescribed a special sparing diet, healthier nutrition, vitamin therapy and drugs that stimulate the blood supply to the membranes of the placenta. Moderate polyhydramnios can be treated on an outpatient basis, the treatment of severe pathology is carried out exclusively in stationary conditions.

Regardless of the severity of the disease, physical activity and physical activity are minimized; in most cases, a woman is shown bed rest. During the treatment of oligohydramnios, the expectant mother will more often do ultrasound and dopplerography - these procedures will help to notice unwanted metamorphoses in the body of the mother and her child in time. When, as a result of an ultrasound examination, it turns out that at 33 weeks (and later) the AFI values \u200b\u200bare too low, and the baby, meanwhile, is already ready to be born, the doctor will most likely decide on an early birth.

Low water during pregnancy. Video

Deviation during pregnancy: polyhydramnios

With polyhydramnios, the IAI indicators are significantly overestimated. About 1% of pregnant women face such a problem when amniotic fluid appears more than necessary. Deviation can only be detected by ultrasound. Statistics say that a third of pregnancies from 1% end in miscarriages.

Reasons for the development of polyhydramnios

Doctors find it difficult to say exactly what underlies the pathology, but they nevertheless identified the main risk groups. Here are diseases in which there is a high probability of developing polyhydramnios:

chromosomal "breakdowns";
chronic diseases of the heart and blood vessels;
all stages of diabetes;
diseases of infectious origin;
diseases of the genitourinary system;
Rhesus conflict between the pregnant woman and the fetus;
TORCH infections;
kidney disease;
severe anemia;
severe toxicosis;
multiple pregnancy;
anomalies of intrauterine development of the child.

Forms of pathology

Depending on the rate of development, polyhydramnios can be acute or chronic.

The acute form of deviation develops very rapidly - literally within a few hours. This is a very serious problem, since its consequences are irreversible: the fetus either dies in the second trimester of pregnancy, or survives, but is born with severe developmental abnormalities.

The chronic form of polyhydramnios does not develop immediately, therefore, with timely diagnosis, doctors have time to intervene in this process and save the child. Often, the deviation does not make itself felt, and the expectant mother needs to carefully monitor her well-being in order to go to the hospital with the slightest suspicious symptoms.

You can suspect the development of pathology by the following signs:

pain in the abdomen;
"stone" in the lower abdomen;
general weakness, fatigue;
swelling in the legs;
dyspnea;
rapid heart rate;
the appearance of a huge number of stretch marks on the skin;
large belly (more than 110 - 120 cm in volume);
premature enlargement of the uterus;
permanent constipation.

Only a timely reaction to what is happening and competent treatment will help a woman carry a baby.

The danger of polyhydramnios

A pathological condition can threaten a pregnant woman and her child with the following problems:

Miscarriage or artificial termination of pregnancy.
Extremely severe toxicosis in late pregnancy.
Fetoplacental insufficiency, because of which the full development of the child is impossible.
Massive bleeding.
Placental abruption. As a result of her premature aging, the child will be deprived of nutrients and vital oxygen.
premature birth. This is very dangerous, because not all premature babies are able to fight for life.
Insufficient generic activity or its complete absence.

For a child, the consequences of polyhydramnios are no less dangerous. Here is what can happen on the basis of this pathology:

The fetus will not be positioned correctly in the uterus, due to which natural delivery will have to be replaced by a caesarean section.
Entanglement of the fetus by the umbilical cord, which can lead to its death.
Acute hypoxia of the child.
Development of anomalies of the heart and central nervous system.
Infectious diseases of the fetus.

Features of the treatment of polyhydramnios during pregnancy

To improve the condition of the expectant mother with polyhydramnios, doctors will first of all conduct a comprehensive examination of her - it is necessary to establish and eliminate the cause of the incident.

In parallel with the main course of treatment, the patient is prescribed a multivitamin preparation with the obligatory vitamins C, E and a group of vitamins B in its composition, preparations containing magnesium, diuretic drugs and, possibly, some kind of broad-spectrum antibacterial drug. Usually, in the chronic course of polyhydramnios, the child can be saved.

Every woman who is preparing to become a mother should at least in general terms understand what the amniotic index means during pregnancy. Often, it is precisely this ignorance that prevents pregnant women from understanding how important it is to be on the alert in anticipation of a baby. You can’t even ignore the minimal suspicious symptoms in your well-being, because they can hide a serious illness that threatens the well-being of mother and baby. With the help of modern diagnostic procedures, doctors have a chance to detect and eliminate the problem in time, and the determination and evaluation of the amniotic fluid index during pregnancy is one of them.

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 labor induction or conduct a planned caesarean 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, if the integrity of the membranes is lost - 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 health, 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 during 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 observing 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 from 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 a 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 support the normal functioning of important internal organs of a woman (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 takes on a flat appearance. 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 baby into the right position, but their effectiveness has not been medically confirmed. Exercise can lead to cord entanglement, so you need to weigh the pros and cons before doing them.