Low water during pregnancy: causes and consequences, what is dangerous for a child, moderate, pronounced. Treatment. Low water - causes of development
Oligohydramnios during pregnancy is a relatively common occurrence. It occurs in 4% of cases. The development of the condition indicates deviations from the normal physiological course of pregnancy, and therefore requires reliable diagnosis causes of development with subsequent appointment of adequate treatment.
The physiological role of amniotic fluid
During pregnancy, the fetus is in the uterine cavity, namely in the fetal bladder, which is filled with amniotic fluid (amniotic fluid). They perform a number of important physiological functions:
- Creating a unique habitat for the fetus.
- Protection against excessive mechanical influences and injuries.
- Mechanical protection of the placenta and umbilical cord vessels from fetal movements.
- Smoothing out sudden movements of the fetus, which reduces the feeling of discomfort and pain for the mother.
- Prevention of fusion of the skin of the fetus with inner surface walls of the fetal bladder.
- Help in the active movements of the unborn child, which is necessary for normal development.
- Provided there is sufficient volume, amniotic fluid helps the unborn child to take the correct position before childbirth (posterior occipital presentation is considered optimal).
- Together with fetal bladder promote sufficient opening of the cervix during the onset of labor.
Volume reduction amniotic fluid makes it impossible to do everything physiological functions in sufficient volume, which is the cause of complications during pregnancy or childbirth.
Development mechanism
Maintaining a certain volume of amniotic fluid (amniotic fluid) is a dynamic process that includes:
- Synthesis of amniotic fluid by special glandular cells.
- Reverse absorption (resorption) of amniotic fluid.
The mechanism of development (pathogenesis) of oligohydramnios is to reduce the production of amniotic fluid or excessive resorption. A change in the activity of the course of the processes of maintaining the level of amniotic fluid in most cases occurs with the development of pathological processes in the body of the fetus or pregnant woman.
The reasons
Oligohydramnios during pregnancy is a polyetiological pathological condition that develops as a result of exposure to a significant number of the following causes:
- Insufficient development of the glandular epithelium responsible for the production of amniotic fluid, or a decrease in its functional activity. This is usually due to genetic abnormalities, infectious, endocrine or somatic diseases of the mother.
- The presence of microorganisms of representatives of pathogenic or conditionally pathogenic microflora in the amniotic fluid, as a result of which its production is disturbed. Usually bacteria or viruses appear due to the presence of a chronic infectious pathology in the organs. reproductive system mother.
- Prolongation of pregnancy, which leads to placental abruption. It ceases to perform its basic physiological functions, as a result of which oligohydramnios develops.
- Severe genetic pathology and birth defects, which are displayed on functional state placenta and epithelium of the fetal membranes (hereditary anomalies in the development of the kidneys, face). Severe malformations may be an indication for artificial interruption pregnancy.
- A significant increase in systemic blood pressure during pregnancy, which is a common cause of oligohydramnios in the third trimester.
- Multiple pregnancy, which affects the redistribution of blood in the placenta, as well as the functional activity of the epithelium of the membranes of each fetus. Usually, oligohydramnios does not develop in all fetuses, but only in one of them.
- Violation of metabolism in the body of a woman, in particular against the background of obesity.
All causative factors do not always lead to the development of oligohydramnios during pregnancy, they increase the likelihood of a pathological condition.
Clinical signs
In most cases, especially on early dates pregnancy, oligohydramnios does not cause development clinical signs pathological process. For more later dates in a severe course of the pathological process, the following symptoms may appear:
- Dry mouth.
- General weakness of varying severity.
- Nausea.
- Growth retardation of the uterus (the volume of the abdomen increases slowly and does not correspond to the gestational age).
- Limited fetal mobility, which is a direct consequence of a decrease in the amount of amniotic fluid.
- Periodic, which are predominantly of a pulling nature. The appearance of discomfort in late pregnancy usually provokes fetal movement.
In most cases, oligohydramnios during pregnancy is detected during a routine preventive examination of a woman by a gynecologist. He evaluates the circumference of the abdomen, conducts gynecological examination and also appoints appropriate laboratory, instrumental and functional studies.
Diagnostics
Clinical symptoms and objective signs can only suspect the development of oligohydramnios. For reliable diagnosis, especially in the case of an unexpressed course of the pathological process, an ultrasound examination is mandatory, with the help of which several important indicators can be determined:
- The volume of amniotic fluid is the main criterion on the basis of which the severity of oligohydramnios is established.
- condition of the placenta.
- The state of the fetus.
- The frequency and rhythm of fetal heart contractions in later pregnancy.
To determine the cause of oligohydramnios, a gynecologist may prescribe additional research. These include clinical analysis blood, urine, examinations for the presence of infectious processes, functional tests. The final diagnosis, including the severity, as well as the cause of oligohydramnios, is established on the basis of an analysis of all the results of an objective examination of a pregnant woman (ultrasound, CTG or fetal cardiotocography, tests for infections with sexual transmission).
Consequences for the mother
Oligohydramnios, regardless of the causes of development and severity, is always a pathological condition. It significantly increases the likelihood of developing negative consequences for the mother's body, which include:
- Negative effect on the course of pregnancy.
- The appearance of discomfort in the form of pulling pain lower abdomen.
- The development of weakness of labor activity, which is associated with insufficient opening of the cervix due to the small volume of amniotic fluid in the cavity of the fetal membrane.
- Sudden spontaneous abortion, including against the background of the absence of changes in the body developing fetus.
The negative impact of oligohydramnios on the mother's body is also reflected in the development of the fetus.
Consequences for the fetus
Amniotic fluid is the environment for the normal development and vital activity of the fetal body, therefore, a decrease in its volume can lead to the following consequences:
- Growth retardation and, which is more pronounced in the early stages of pregnancy.
- Malformations of the structures of the musculoskeletal system - clubfoot, skull deformity, congenital dislocations of the hip.
- A complication of the course of childbirth, which is often associated with a breech or foot presentation of the fetus.
- fetal brain, which is a consequence of the protracted process of childbirth. Often the changes are irreversible and remain with the child for life.
- Fetal hypotrophy in late pregnancy is often the result of the simultaneous development of oligohydramnios and placental insufficiency.
Oligohydramnios with a slight decrease in the volume of amniotic fluid, which develops in late pregnancy, has practically no effect negative impact on the developing fetus.
Effective treatment
After establishing the fact of the development of oligohydramnios during pregnancy, a study is required to identify or exclude defects. In the presence of significant changes, the therapeutic tactics is determined depending on the severity of the changes, as well as the duration of the pregnancy. Sometimes it may be necessary to perform an artificial termination of pregnancy under strict medical indications(the presence of malformations incompatible with life, a combination of oligohydramnios with insufficient development of the fetoplacental complex). Also, the choice of treatment method is influenced by the cause of the development of oligohydramnios. If a decrease in the volume of amniotic fluid was detected in the early stages of pregnancy, then the following areas of therapeutic measures may be prescribed:
- Use of special vitamin preparations for pregnant women, as well as funds that provide favorable influence on metabolism.
- Changing the diet, the menu necessarily includes lean meat, fruits and vegetables rich in vitamins and vegetable fiber.
- Limitation of motor activity, exclusion of excessive physical exertion.
- The appointment of medicines of various pharmacological groups (antibiotics, if necessary, drugs that affect metabolism, minerals, vitamins, drugs that improve blood flow in the placenta), which is usually carried out in an obstetric and gynecological hospital.
In the future, the attending physician determines the further tactics of managing a pregnant woman and possible obstetric care. With a significant decrease in the volume of amniotic fluid against the background of a breech or foot presentation of the fetus in late pregnancy, a caesarean section is recommended. It can be carried out earlier than the expected date of birth, which will reduce the likelihood of further deterioration of the fetus. At each stage of therapeutic measures, a thorough monitoring of the condition of the fetus, placenta is performed, and the dynamics of changes in the volume of amniotic fluid is also determined.
Development prevention
Today, it is possible to prevent the development of oligohydramnios during pregnancy by performing simple measures, which include:
- Limiting excessive physical activity. The best option for a pregnant woman is unhurried hiking on the fresh air, which generally have a beneficial effect on the course of pregnancy and help reduce the likelihood of other complications.
- Rational nutrition with the inclusion in the diet of dietary lean meat (rabbit, chicken, beef), vegetables, fruits, products that contain enough fiber in their composition. Food is recommended to be taken at least 5 times a day in small portions. Dinner is allowed no later than 2-3 hours before the intended sleep.
- Pregnancy planning - at the planning stage, it is possible to carry out a full treatment of possible infectious, endocrine or somatic diseases, which will make it possible to avoid the development of a significant number of complications, including oligohydramnios, improve the course of pregnancy and facilitate subsequent childbirth.
- A disciplined visit to the local obstetrician-gynecologist, who, in accordance with modern medical obstetric protocols, monitors the course of pregnancy, and, if necessary, prescribes additional laboratory, instrumental or functional studies.
If a diagnosis of oligohydramnios has been established, it is not worth despairing. modern medicine makes it possible to successfully endure and give birth to a child, provided that he does not have severe malformations.
oligohydramnios during pregnancy- this is a pathologically small amount of amniotic fluid in pregnant women. According to the classical definition, oligohydramnios in pregnant women is defined as the presence of a small (less than half a liter) volume of amniotic fluid in the uterus on the eve of childbirth, that is, during full-term pregnancy. This definition, of course, is correct and serves as the basis for the final diagnosis, but it does not take into account the quantitative fluctuations in the volume of amniotic fluid throughout pregnancy. The fact is that most of the short episodes of oligohydramnios, which is diagnosed during pregnancy, are episodic and do not need to be corrected from the outside. Such conditions are classified as functional, not pathological, for example, diagnosed oligohydramnios during pregnancy at 32 weeks may not be detected during a re-examination in a few weeks.
Meanwhile, an insufficient amount of amniotic fluid in the uterine cavity of a protracted nature is no longer harmless. And if diagnosed oligohydramnios at 32 weeks (or at any other time) continues to be detected in subsequent periods, it is classified as a pathology that threatens the normal development of the fetus. True, pathological, oligohydramnios is always combined with pathology of the fetus and / or placenta.
Oligohydramnios cannot be classified as a common condition. Most of the diagnosed conditions of oligohydramnios (only 3-4 cases out of 1000 births) in pregnant women are functional, and pathologies account for only 0.2% -0.3% of them.
In fact, oligohydramnios has never been considered as an independent nosological unit; it is part of a large symptom complex that reflects the pathology of the course of pregnancy and, accordingly, the development of the fetus in the womb. In addition, modern diagnostic technologies make it possible to very accurately detect changes in the formation of the fetus at almost any time, which in to a large extent downplays the importance of oligohydramnios as an important criterion.
The diagnosis of "oligohydramnios", obtained after an ultrasound scan, often unreasonably scares pregnant women. So that vain worries do not bother, the expectant mother should know as much as possible about her condition and the “norms” of its development. This also applies to amniotic fluid.
Amniotic fluid is a liquid that fills the so-called "fetal bladder" - a sterile cavity in which the fetus begins and completes development. As soon as a fertilized egg, having passed through the fallopian tube, enters the mucous membrane of the uterine cavity, embryonic membranes begin to form around it - chorionic (it is also the outer shell of the fetal egg) from the outside and amniotic (water) from the inside. They form a closed cavity, forming a fetal bladder, and grow with the fetus.
The fetal bladder is filled with fluid (amniotic fluid), which is 97% water. Since the amnion is involved in its production, it is called amniotic. It serves as a source of nutrition, metabolism, immune and antibacterial protection for a long time. developing child, therefore, contains a large amount of minerals, hormones, immune complexes, nutritional and bactericidal compounds.
The formation of amniotic fluid begins even at a short time (5-6 weeks), when part of the maternal blood passes through the fetal membranes. The first slight level of fluid around the fetus is visible on ultrasound as early as the 3rd week of its development. The amount and composition of amniotic fluid changes as the fetus grows. There is a constant exchange between the child and the surrounding waters. Until the 14th week, the substances necessary for the fetus enter through its skin, then, when the skin of the child becomes dense, it literally swallows the surrounding fluid. When the absorbed fluid gives the baby everything it needs, it returns to the amniotic space again with his urine. Thus, the amniotic fluid provides the fetus with the necessary substances and eliminates unnecessary ones. The amniotic fluid is in a state of constant self-renewal (every three hours) in order to maintain the necessary composition and get rid of harmful products secreted by the fetus.
Amniotic fluid also performs a number of extremely important functions for pregnancy:
- Maintain the constancy of the environment in which the fetus grows, and also makes its existence comfortable. The amniotic fluid not only "feeds" the baby, it also has a constant temperature of 37°C, isolates the fetus from external noise.
- Perform shock-absorbing properties, protecting the fetus from injury during active movements of the mother.
- Thanks to the bactericidal component, infection of fetal tissues is prevented.
- “Help” the child to be born safely.
The volume of amniotic fluid in different dates gestation is not the same, each term has its own conditional "norm", which is significant diagnostic criterion to ascertain oligohydramnios or, conversely,.
Oligohydramnios is diagnosed during an ultrasound scan. It is known that the fluid around the fetus is in the recesses (pockets). By the height of the liquid level in these recesses, its total volume is determined and compared with generally accepted indicators.
It should be noted that moderate oligohydramnios during pregnancy is often diagnosed. If it does not progress and does not affect the fetus, then it does not apply to pathology.
Causes of oligohydramnios during pregnancy
As already mentioned, a slight physiological deviation from the normal volume of amniotic fluid can be observed sporadically throughout pregnancy. If, after the examination, the diagnosis of a functionalist (ultrasound specialist) includes moderate oligohydramnios during a pregnancy of 30 weeks (or another period), but at the same time he does not diagnose any other abnormalities, there is no reason to worry. However, if during a re-examination, the specialist again writes in the conclusion, for example, “oligohydramnios during pregnancy 33 weeks”, “oligohydramnios during pregnancy 34 weeks”, and so on, given state clearly indicates pathology.
Pathological oligohydramnios is often associated with serious conditions. Among them are more often distinguished:
- Associated with congenital malformations of the fetus, more often - the urinary system: the absence or narrowing of the urethra, unilateral or bilateral occlusion (blockage) of the ureters, polycystic or underdevelopment of the kidneys up to their absence.
- Chromosomal abnormalities in the fetus.
- Caused by pathology of the fetus, not associated with congenital malformations of organs and systems.
- Based on the pathology of the placenta: structural anomalies in its development, fetoplacental insufficiency.
- Unspecified causes. If the examination does not reveal the causes of oligohydramnios, it is considered idiopathic, that is, a condition with an unknown genesis. As a rule, idiopathic oligohydramnios is moderate, does not affect either the course of pregnancy or the birth process. It can go away on its own with an increase in the duration of pregnancy, or it can remain so until its completion, without increasing.
It is extremely important to clarify that oligohydramnios can only provoke external pathologies of fetal development, but cannot cause chromosomal abnormalities, and even more so, congenital malformations of internal organs. On the contrary, these are malformations and chromosomal diseases provoke malnutrition. Thus, when oligohydramnios is mentioned together with "deformities" or genetic ailments, they mean only their frequent simultaneous presence.
Low water is provoked late toxicosis, infectious conditions (acute and chronic) and in the mother.
Infection of the amnion membranes is considered extremely dangerous in terms of the formation of oligohydramnios, when unwanted microorganisms from the mother penetrate the placental protective barrier, infecting both the amnion and the fetus. It is intrauterine infections that more often (up to 40%) provoke severe oligohydramnios. More often, the infection penetrates to the fetus "from below" - from the vaginal or cervical cavity. If the placenta becomes infected, it ceases to perform its proper functions and the physiological regime of fetal development is disturbed, so the child may develop with a delay.
Often, oligohydramnios accompanies fetoplacental insufficiency - insufficient blood supply to the developing fetus. The only source of oxygen for the child during development is the blood that circulates in the placenta. If the fetus does not receive enough of it, oxygen starvation (hypoxia) appears, it slows down (and sometimes stops) the proper development of pregnancy.
Post-term pregnancy sometimes provokes oligohydramnios. The reliable reasons for such oligohydramnios are unclear, perhaps the mother's body is not able to meet the needs for amniotic fluid longer than the due date, so its reserves are depleted.
Identical twins with a common placenta (monochorionic monozygotic twins) are often complicated by oligohydramnios, since both children have common sources of nutrition and metabolism. If additional vessels form in the placenta, the redistribution of blood between children is disturbed: one of the fetuses receives more blood, excretes more urine, and thereby increases the amount of surrounding fluid. In a fetus with insufficient blood supply, hypoxia develops, lags behind in development, and oligohydramnios is formed. Sometimes the term “strapped twin syndrome” is used for this condition.
Amnotic sac with normal developing pregnancy always closed, and the fluid that fills it never leaves the fetal bladder ahead of time. When completed, the bubble spontaneously bursts, the waters pour out, and the uterus begins to expel the fetus. If the fetal bladder begins to release water before the 36-week period, the outflow of water is considered premature. Sometimes the waters are completely evacuated, but more often, if the rupture of the bladder membranes is high, they leak. The constant loss of amniotic fluid provokes oligohydramnios and threatens the course of pregnancy. In this situation, even moderate oligohydramnios during pregnancy is fraught with complications. Diagnosis of premature outflow of water from the amnion allows special tests and ultrasound. If the pregnant woman notes an increase in the amount of liquid vaginal discharge, and the functionalist makes a diagnosis, for example, "oligohydramnios during pregnancy at 34 weeks", the situation is analyzed and eliminated after the hospitalization of the pregnant woman.
It should be noted that most diagnosed episodes of oligohydramnios are not combined with "terrible" causes and consequences.
Symptoms and signs of oligohydramnios during pregnancy
Oligohydramnios can be moderate or severe, as well as acute or chronic. Moderate oligohydramnios during pregnancy is recorded more often.
Acute oligohydramnios appears suddenly, but does not pose a serious threat. More often it is preceded by an acute infectious condition of the mother: a viral infection and, tonsillitis and the like. Acute oligohydramnios of a functional nature is well stopped and quickly passes.
Chronic oligohydramnios is not so harmless, as it has a pathological basis.
Oligohydramnios can be diagnosed at any time, but the time of its appearance has different meaning. The most dangerous is the oligohydramnios of the second trimester, since the pregnancy still needs to be prolonged due to the underdevelopment of the fetus, and the causes of oligohydramnios may not allow this. Oligohydramnios of the last trimester is also not harmless, but if necessary, the pregnancy can be terminated without prejudice to the life of the child.
Early oligohydramnios is called if it appeared before, later it is diagnosed with. Prolonged is considered oligohydramnios, continuing both in the early and late periods.
The clinical picture of the lack of amniotic fluid does not have symptoms indicating only oligohydramnios. More often it includes constant pain in the abdomen, sometimes aggravated by the movements of the fetus and a decrease in the motor activity of the child. Moderately expressed oligohydramnios is diagnosed only with additional diagnostic methods.
Severe oligohydramnios provokes a decrease in the size of the uterus, therefore, upon examination, the doctor may notice a discrepancy between its size and the gestational age and suspect pathology, especially if there are complaints from the pregnant woman about insufficient activity (movement) of the fetus. Monitoring changes in the size of the uterus, the position of the fetus and vaginal discharge accompanies each visit to the consultation.
However, similar signs are also observed in other pathologies, for example, fetal growth retardation, and there is also the possibility of an erroneous calculation of the gestational age. Therefore, it is impossible to make a reliable diagnosis during the examination.
A completely different clinical situation develops in the presence of leakage of amniotic fluid outside the onset of labor. Unfortunately, pregnant women sometimes pay attention to leaking water only when they are significantly lost and accompanying negative symptoms appear. Any increase in vaginal discharge in the form of a clear liquid may be a manifestation of premature amniotic fluid leakage. If the amniotic fluid leaks, it means that there is a defect in the amniotic membrane through which an infection can penetrate to the fetus. To prevent negative consequences, it is necessary to study the composition of the microflora of the vagina (smears and crops), as well as to examine the composition of the amniotic fluid itself.
In addition to infection, leaking amniotic fluid threatens the fetus with premature birth. Medical tactics is determined by the gestational age. If water leakage has complicated oligohydramnios during pregnancy at 34 weeks and earlier, when the lungs of the fetus are not ready to function, it is necessary to “help” them form early with medication.
Ultrasound scan data, which is the most reliable and reliable diagnostic method, allows determining oligohydramnios. There are specially developed criteria for determining the volume of amniotic fluid in different periods gestation:
Measurement of the vertical level of fluid accumulated in two cavities between the fetus and the amnion wall (pockets). As a rule, oligohydramnios is indicated by a level of fluid that has accumulated in the largest of the pockets, not exceeding 1 cm.
Determination of the amniotic fluid index. Conventionally, the uterine cavity of a pregnant woman is divided by two perpendicular planes into four parts, so that they intersect in the navel zone. Then, in each of the obtained quadrants, the maximum liquid volume is measured and the obtained figures are summed up. The result obtained is amniotic index. It is correlated with the available norm indicators for each specific date pregnancy:
- 0-5 cm - the index is very low (severe oligohydramnios);
5.1-8 cm - low index (moderate oligohydramnios);
- 8.1-8 cm - the index correlates with the norm.
The amniotic fluid index can significantly exceed the established norms and indicate an excess volume of amniotic fluid (polyhydramnios). With polyhydramnios, it exceeds 18 cm.
The change in the amount of amniotic fluid is a very dynamic criterion. A one-time statement of oligohydramnios has no clinical significance. Oligohydramnios, especially moderate, is often only a short-term episode, not threatening pregnancy. It is much more important to know how the volume of water changes with increasing gestational age. At physiological development pregnancy, it increases and becomes maximum to (one and a half liters), and then begins to decline.
So, if the examination reveals oligohydramnios during pregnancy of 30 weeks, and then - oligohydramnios during pregnancy of 33 weeks, we can talk about pathology.
Treatment of oligohydramnios during pregnancy
Therapy for oligohydramnios is not always required. If the fact of oligohydramnios is established in the first trimester, this condition is likely to pass without serious therapy. If it continues to exist for more than three months, a search for the causes and their elimination is required.
An oligohydramnios does not have an independent value, as it is a symptom of an ailment or a temporary physiological state. Any oligohydramnios, in order to eliminate it, requires a detailed diagnosis of its causes. Examination for genital infections, genetic diseases is necessary. AT last trimesters it is necessary to assess how oligohydramnios affects the fetus, for which ultrasound scanning, CTG and dopplerography are performed.
In any situation, if serious malformations or anomalies in the development of the fetus are not detected, specialists strive to prolong the pregnancy for the maximum possible period. In this case, therapy is aimed at improving the functioning of the placenta, oxygenating the blood of the fetus, and improving metabolism in the tissues of the placenta.
The choice between outpatient and inpatient treatment is up to the doctor. Unfortunately, pregnant women do not always adequately assess the ongoing events and do not agree to hospitalization. Meanwhile, the well-being of a mother does not always imply that her child has one, so the recommendations of a doctor who has studied all the indicators are much more important.
If the examination reveals a deterioration in the child's condition that threatens his life, delivery is required immediately.
Leakage of amniotic fluid is more likely to threaten infectious complications therefore always requires adequate antibiotic therapy. To choose the right necessary funds, amniotic fluid is analyzed in the laboratory.
If the loss of amniotic fluid is too great, delivery is required.
Normal amniotic fluid is sterile, odorless, and colorless. Sometimes they can acquire a whitish tint or contain inclusions that look like small white flakes. With premature outflow of water, pathological signs are:
- Green color indicating severe hypoxia. This color of water is acquired due to meconium (original feces), which the child releases into the water when there is a lack of oxygen. The smell of green waters is correspondingly unpleasant.
- Bright yellow color. Indicates incompatibility between mother and child in terms of Rhesus or blood types.
- Red color. Appears when blood enters the water. The source of bleeding is the placenta that begins to exfoliate.
Severe hypoxia indicates the need for early termination of pregnancy. Placental abruption always requires hospitalization and, in most cases, an emergency caesarean section. Incompatibility of blood or Rh mother and child are treated conservatively.
It is also possible to study amniotic fluid with a whole fetal bladder. In case of overdose, chronic severe fetal hypoxia, amnioscopy can be performed. It allows you to evaluate the amniotic fluid visually using an optical device (amnioscope) and diagnose pathologies.
If it is required to investigate the composition of waters, it is necessary to take a small amount of them and examine them in the laboratory. More often, such a need arises when genetic abnormalities are suspected. Amniocentesis is performed - puncture of the largest "pocket" and suction a small amount material (water).
Consequences of oligohydramnios during pregnancy for a child
Amniotic fluid is significant not only for a developing child, they also help him to be born freely, making it easier. On the eve of childbirth, the amniotic sac shifts towards the cervical cavity, contributing to its opening, and also “signals” the uterus to start contracting. Before the beginning birth process when the bladder bursts, the outflowing anterior waters disinfect the birth canal. In childbirth, water facilitates the outward movement of the fetus.
During pregnancy, oligohydramnios provokes fusion of the skin of the fetus and the amniotic membrane. Original strands are formed that prevent the normal development of the child's body, so external anomalies appear. This complication is not common.
Insufficient amount of amniotic fluid leads to malnutrition of the developing fetus, oxygen starvation and slow metabolism. The fetus may lag behind in development, have a small mass. Also, with oligohydramnios, the placenta also suffers, which is poorly supplied with blood and experiences an oxygen deficiency.
Violations of labor activity (weakness) with oligohydramnios is observed in 80% of women in labor. The uterus for the correct strong contractions in childbirth needs a command from the brain. She receives such a command when her size corresponds to a full-term pregnancy. Severe oligohydramnios is always combined with an insufficient size of the uterus, so labor either does not begin or is poorly expressed.
Oligohydramnios is fraught with birth traumatism. A child in the absence of the necessary "shock absorber" can hit his head on the uterine wall or get injured in the birth canal. In these situations, hematomas appear in children, the blood supply to the brain is disturbed.
With oligohydramnios, the fetus can press the umbilical cord, or it wraps around it. If this happens early, the umbilical cord tissue can become necrotic (die off), and in childbirth, such entanglement disrupts the birth process.
Every woman dreams that her pregnancy proceeds easily and naturally, so that no one and nothing can distract the expectant mother from pleasant thoughts about the unborn child. However, in reality, not everything goes so smoothly.
One of the serious complications can be oligohydramnios. About what it is and how to treat it, we will tell in this article.
What it is?
In a broad sense, oligohydramnios is a decrease in the amount of amniotic fluid from the norms characteristic of a particular period of pregnancy. However, in the classical sense of the word, oligohydramnios is considered a small amount of amniotic fluid on the eve of childbirth, at about 39-40 weeks.
When there was no ultrasound, and one could only guess about the amount of water, oligohydramnios was really determined already before the very birth. Now, thanks to the development of diagnostics, to identify the tendency to decrease in water in the fetal bladder is possible already from the 16th week.
Water is necessary for the normal development of the child. They are also nature's intended shock absorber, softening the shaking, swaying, which the baby could feel quite significantly when walking or other actions of the pregnant woman, if the water did not interfere with this.
Amniotic fluid begins to be produced around the 8th week of pregnancy, and with an increase in gestational age, it also increases in volume. In the 3rd trimester, there is a slight decrease in fluid, because the uterus is already greatly stretched by a grown child.
Long years of studying intrauterine development have allowed physicians and scientists to calculate the normal amounts of amniotic fluid determined for each period. It is not customary to measure them with standard liquid measures - milliliters, for example.
To assess their number, there is a special parameter - the amniotic fluid index. You can determine it in millimeters starting from the 16th week of the gestational age during the passage of an ultrasound scan.
IAI norms - table:
|
Obstetric period, (week) |
IAI (normal limits), mm |
Obstetric period (week) |
IAI (normal limits), mm |
Since the amount of water in the fetal bladder is not a constant value, at different times in the same expectant mother can find oligohydramnios, and after a few weeks it is not detected. This natural phenomenon is called functional oligohydramnios. This is the most harmless of all types of this complication.
Usually, with a medical verdict of "oligohydramnios", a woman falls into a stupor. Expectant mothers should be reassured by the following official statistics from the Ministry of Health:
- oligohydramnios is accompanied by about 4% of all pregnancies;
- only 0.5-1.2% of such cases have pathological causes;
- all other women (and the vast majority) perfectly carry and give birth to healthy children, since their oligohydramnios was physiological.
Pathological oligohydramnios is considered to be a persistent insufficient amount of amniotic fluid, which can be registered repeatedly at various times, starting from the 16th week.
Classification
Oligohydramnios can be acute if it appeared suddenly under the influence of negative factors, or it can develop gradually and almost imperceptibly, and then it will qualify as chronic.
With acute oligohydramnios, the body of a pregnant woman can respond to viral disease, flu or SARS, from which the expectant mother could not protect herself during the period of bearing the baby. This disruption is usually temporary and does not mean that the baby has pathologies.
More dangerous chronic oligohydramnios. It usually develops due to problems that cannot be called quick-fixed - mother's diabetes, obesity, as well as malformations of the child and its prolonged hypoxia. Such a disorder will not go away on its own, it definitely needs treatment. Also, a violation may be early if it was detected between 16 and 20 weeks and late if the problem was detected only after 26 weeks.
In the case of early oligohydramnios, the forecasts of doctors are less optimistic, because the process of formation of the internal organs and systems of the baby has not yet been completed.
Severe oligohydramnios in the early stages may be an indicator of gross genetic abnormalities in the baby, and therefore such a “find” on ultrasound needs a detailed study using other diagnostic methods. In the later stages, the violation is often functional, quite natural, it can be easily corrected or goes away on its own.
Sometimes the development of such a violation is affected by the fetal membranes, or rather their integrity:
- if they are not changed, not injured, then doctors talk about primary oligohydramnios;
- if the shells are damaged and water leaks, this is a secondary violation.
Primary oligohydramnios occurs in 80% of cases. According to the quantitative indicator of deviations from the norms indicated in the table, moderate and severe oligohydramnios are distinguished.
The reasons
The reasons for the decrease in amniotic fluid so important for the baby are diverse. These can be malformations of the child, his diseases, pathologies of the placenta, as well as diseases of the expectant mother, both acute and chronic.
Some genetic, including chromosomal disorders that arose during the period of conception, during the formation of the genetic code, the karyotype of the fetus, occur precisely against the background of a decrease in the amount of amniotic fluid.
In particular, such defects as lead to the development of oligohydramnios misdevelopment the urethra and its valves, as well as abnormal narrowing of the baby's urethra or its complete absence, solidary (on both sides) narrowing of the ureters or anomalies in their structure.
Severe oligohydramnios is observed in pregnant women if, due to the “mistake” of nature, the baby has no kidneys as such.
Polycystic kidney disease of the baby (Potter's syndrome) is also a very obvious cause of pregnancy failure. Among chromosomal anomalies, oligohydramnios is most often accompanied by Down syndrome and Turner's disease.
If everything is in order with the genetics of the baby, and this was confirmed using other diagnostic methods, then doctors consider the likelihood of infection of the fetus. The most dangerous in terms of the risk of oligohydramnios are cytomegalovirus infection and chlamydia. The lag in the amount of water from the norm often occurs with a delay in the development of the fetus.
The main maternal ailment that can lead to oligohydramnios is preeclampsia. Besides similar condition can cause venous insufficiency, tendency to form blood clots, diseases of cardio-vascular system.
Adversely affect the amount of water and kidney ailments in the expectant mother, and diabetes. Dehydration can also cause a decrease in amniotic fluid, as well as smoking, with which some of the expectant mothers, even while in " interesting position', so they can't say goodbye.
Pathologies of the placenta lead to oligohydramnios - insufficiency, heart attacks " children's place”, any anomalies in its development that occurred during the formation of this temporary organ at the very initial stages.
Among other reasons that can lead to such an unpleasant complication of pregnancy are overgestation, in which natural aging of the placenta occurs, injury to the membrane of the membranes of the bladder, the mother taking a large amount of medication for a long time, as well as fetal death and multiple pregnancy.
Symptoms and signs
A woman practically cannot determine oligohydramnios on her own, this is a matter for specialists. Only a few signs can indirectly indicate the likelihood of a decrease in the amount of amniotic fluid.
Usually in women with oligohydramnios, the size of the abdomen is smaller than it should be. It becomes possible to establish a violation thanks to measurements of the height of the day of standing of the uterus, which are carried out at each scheduled inspection in women's clinic.
When the expectant mother begins to feel the movements of her child, with oligohydramnios they can be quite painful for a woman.
It is impossible to remain silent about such sensations if the symptom has not been diagnosed earlier, you should definitely inform your doctor about your suspicions, who will prescribe all the diagnostics required in this case.
Diagnostics
The amniotic fluid index is determined by the doctor ultrasound diagnostics. It measures the distance free from the limbs of the baby and the umbilical cord, between the baby and the front abdominal wall, its inner surface. This measurement is called a vertical pocket.
If the measurement result after comparative analysis with tables shows that the amount of water is reduced, the degree of violation is revealed. With moderate oligohydramnios, the index is reduced by 10-15% compared to the above norm, and the vertical pocket, which, when normal amount water is 5-8 cm, reduced to a size of less than 5 cm.
Such a violation is pronounced, in which the vertical pocket does not exceed 2 cm, and the amniotic fluid index deviates from the norm downward by 15-20%. To imagine in more detail all of the above, we present a comparative table.
Violations of the amount of amniotic fluid:
|
Obstetric term, week |
Moderate oligohydramnios - amniotic fluid index, mm |
Severe oligohydramnios - amniotic fluid index, mm |
If the ultrasound specialist indicates in the conclusion that the woman has signs of moderate oligohydramnios, the obstetrician-gynecologist will definitely refer her for doplerometry and expert ultrasound to more accurately know the state of the baby, placenta and blood flow in the uterine vessels.
When the ultrasound protocol indicates that the pregnant woman has severe oligohydramnios, she is hospitalized for a more thorough examination.
If the reason lies in congenital pathologies baby, it is recommended to terminate the pregnancy for medical reasons. Agree or not, it is up to the pregnant woman to decide. If she refuses, then the child is kept until the very birth, they provide him with the necessary medicinal support.
Possible consequences for the mother
A woman’s lack of water threatens with an abortion in the later stages, traumatizing both the psyche and physical health reproductive system. If the child dies, there will be no other option. After interruption for long term a woman may experience a nervous breakdown, develop secondary infertility.
A small amount of amniotic fluid aggravates the very process of childbirth. Weakness of tribal forces often develops, a woman is threatened C-section. The postpartum period in such women is more difficult, complications are likely.
Pregnancy itself can bring a lot of discomfort to the expectant mother: the larger the child becomes, the more difficult it will be for a woman to withstand his movements.
The probability of miscarriage during pregnancy with oligohydramnios is high, the risk of preterm birth is even higher - it reaches 26%.
Possible consequences for the child
Children born after pregnancy with oligoamnios have little weight, they are weaker than their peers, even if the pregnancy is full-term before the expected date of birth.
The most severe consequences of prolonged polyhydramnios include various adhesions of the skin of the fetus and the membranes of the amniotic bladder. As a result of such adhesions, cords can fill all the free space of the uterine cavity. They can also entangle a baby.
Due to the pressure that the strands will exert on the tissues of the fetus, irreversible deformities are formed - babies self-amputate or severely twisted limbs, there are defects in the face and chest. The appearance of the baby is completely disfigured. The frequency of such consequences is small, but this cannot be ruled out.
The likelihood of such an outcome increases if oligohydroamnion is diagnosed early, at 16-20 weeks, and persists throughout pregnancy.
In childbirth, a baby may experience other troubles associated with a small amount of amniotic fluid - prolapse of the umbilical cord, premature violation of the integrity of the amnion and, as a result, a long anhydrous period, which can result in hypoxia and infection.
Many women mistakenly believe that oligohydramnios is the cause of the development of ailments such as Down syndrome, as well as other chromosomal abnormalities. The logical connection here is reversed - with Down's syndrome, oligohydramnios often develops, and not vice versa.
Almost always, prolonged oligohydramnios causes a delay in intrauterine development of the baby. Dangerous in this case is the underdevelopment of the lungs, with which mothers give birth to such babies.
However, if help was provided to the crumbs correctly and in a timely manner, then the child quickly enough then begins to gain weight and soon catches up with his peers in physical development. However, intellectually, the baby can develop late for a long time.
Dangerous from the point of view of the likelihood of complications are also cases of detection of oligohydramnios later, at 30 weeks pregnant, but only on condition that the pathological condition persists for 4-6 weeks or more.
For any negative consequences of oligohydramnios for the health of a child, a pattern is characteristic - the earlier this condition occurs, the more serious the consequences can be.
Treatment
Therapy of oligohydramnios is always complex. And it begins with the establishment of the exact cause that caused the pathological decrease in the amount of amniotic fluid.
First of all the version with chromosomal abnormalities is being tested. For this, a woman, depending on the term, is sent to one of the methods of invasive prenatal diagnosis.
With oligohydramnios detected at 16 weeks, a chorionic biopsy can be performed. If the fact of oligohydramnios became known later, a woman can be referred for cordocentesis, amniocentesis.
These procedures will help to obtain samples of amniotic fluid with particles of the baby's epithelium, cord blood from the umbilical cord. An analysis will be carried out in the genetic laboratory, which allows us to speak with a high degree of accuracy about the presence or absence of the baby's Down syndrome, Cornelia de Lange syndrome and other anomalies associated with a violation of the number of chromosomes in the karyotype and causing oligohydramnios. Such studies are usually carried out is free.
Recently, it has become possible to do a non-invasive prenatal DNA test, which is still expensive. It is absolutely safe for the baby and is based on the isolation of the child's DNA from the venous blood of a pregnant woman. This test reveals chromosomal abnormalities with a probability of 99.9% and is an ideal alternative to invasive tests that can be dangerous for both the pregnant woman and the fetus.
If the cause of oligohydramnios due to chromosomal abnormalities is confirmed, termination of pregnancy is recommended.
If, in addition, the examination does not show the presence of gross chromosomal abnormalities in the child, then look for defects physical development There will be ultrasound experts of an expert class. To do this, carefully study the urinary system of the baby - the ureters, urethra, kidneys. Particular attention will be paid to the health of the placenta. Ultrasound is performed to assess blood flow in the uterine vessels.
The attending physician will refer the woman to blood tests that can confirm or deny the presence of infections, including sexually transmitted infections.
Be sure to donate blood for sugar and urine for protein content. The doctor monitors the blood pressure of the expectant mother in order to exclude preeclampsia as the cause of oligohydramnios.
If the cause is found, doctors decide how to treat the underlying disease, almost all of them, except for congenital malformations of the fetus and chromosomal pathologies are amenable to therapy. At the same time, control over the condition of the fetus is enhanced.
Moderate oligohydramnios can be treated at home, in most cases, hospitalization is not required if the expectant mother follows all the recommendations of the doctor.
Severe oligohydramnios, if it is detected early, is also an indication for termination of pregnancy; none of the doctors will dare to make predictions about its outcome. At pronounced oligohydramnios diagnosed after 26 weeks, the woman is hospitalized.
Medical treatment
A future mother with severe oligohydramnios is injected with vitamin solutions intramuscularly. In addition, she is given droppers with drugs that improve uteroplacental blood flow. Usually used for this "Actovegin". In addition, doctors recommend taking "Curantil", dosage and frequency of taking this drug is determined by the doctor.
Pregnant women may be prescribed broad-spectrum antibiotics to deal with the infection, if any. During the period of bearing a baby, for these purposes it is often recommended "Amoxiclav". To improve the metabolic processes in a woman's body, she may be recommended drugs such as "Hofitol", as well as multivitamin complexes designed and created specifically for pregnant women.
Simultaneously with taking drugs in a hospital, the condition of the baby is checked daily or every other day. A woman is given a CTG if the gestational age is already above 28 weeks, the functionality of the placenta is monitored with an ultrasound scan, an ultrasound scan can be performed at any time to assess the amount of water in dynamics.
Any anxiety symptoms, which may indicate a fetal problem, at any time can become a decisive reason for doctors to carry out a caesarean section ahead of schedule.
With moderate oligohydramnios, which, according to the doctor, is of physiological origin, the woman is prescribed "Kurantil", "
Long walking, playing sports with such a complicated pregnancy is undesirable. Additionally, you will have to limit sex. Pregnant women with excess weight, obesity are recommended to sit on special diet to rule out more larger set body weight.
Nutrition for oligohydramnios should include a large amount of fruits and vegetables, proteins and fats should be balanced, and fast carbohydrates (sweets and pastries) should be completely abandoned.
If there are edema, you should definitely consult with your doctor, to work out together the correct and sufficient drinking regimen. With preeclampsia and hypertension, it is important to measure arterial pressure twice a day. blood pressure. With a significant increase, a woman needs qualified medical care.
Folk methods of treatment
Alternative medicine is ready to offer pregnant women with mild oligohydramnios a lot of useful and enjoyable recipes and products that, if they do not increase the amount of water, will definitely be able to satisfy the needs of a future mother with amniotic fluid deficiency in essential minerals and vitamins.
Folk remedies should not even try to treat severe oligohydramnios. But with minor deviations from the norm, a woman may well take some advice if her doctor has nothing against it.
The mineral needs of oligohydramnios will help restore figs, melons, and grapes. Also good, according to expectant mothers, zucchini and fresh tomatoes help.
A real storehouse, a natural "pharmacy" for a pregnant woman with a deficiency of amniotic fluid can be chokeberry. A woman can take 50 grams of juice from her per day or about 100 grams of berries.
Another favorite remedy that helps with oligohydramnios is strawberry berries. They are eaten in fresh or brew homemade juice with them to establish the normal functioning of the kidneys. If the pregnancy fell on winter time and there is nowhere to get strawberries, you can drink weak tea with strawberry jam. If this is not in stock, it can be purchased.
Prevention
Correct and responsible planning of the child will help to avoid oligohydramnios during pregnancy. A woman should be examined in advance by doctors of different specialties who will be able to answer questions about her state of health and the presence or absence of chronic diseases.
Of course, it is not necessary to conduct a full medical examination, but a woman who dreams of a child is simply obliged to visit a cardiologist, therapist and nephrologist. Visiting these specialists will help you to be sure that the heart, kidneys and general state health will help a woman bear a baby without complications.
If the age of the expectant mother exceeds 35 years, it is worth consulting with a geneticist, because the likelihood of conceiving and giving birth to a child with Down syndrome or Patau increases in proportion to the age of the mother.
It would be correct to do tests for sexual and other infections even before conception, and if something like this is found, treat them before the child is conceived.
Quit smoking should be before conception, at least as soon as it becomes known about the pregnancy. Smoking, and this has been proven, very often acts as a provoking factor in oligohydramnios.
During pregnancy, a woman preventive purposes it is important not to refuse to undergo mandatory screening studies in the first, second and third trimester, do not refuse ultrasound and take certain tests recommended by the doctor.
Expectant mothers should beware of viral infections, especially during periods of mass morbidity with SARS and influenza, in order to avoid the development of oligohydramnios after illness. To do this, you should refrain from visiting shopping centers and public transport during seasonal epidemics, observe the rules of personal hygiene.
If the doctor insists on hospitalization, you should not refuse it, even if the woman herself thinks that she feels great, and she does not have time to stay in the hospital at all.
Throughout pregnancy, the baby develops in a water bladder that contains amniotic fluid. As the fetus grows, the fluid volume also increases. It allows the fetus to move quietly in the womb, is a protection against injury. Also, the liquid contains the necessary nutrients, hormones and vitamins.
What is low water?
By the end of the third trimester, the volume of amniotic fluid can be from 1 to 1.5 liters. If the ultrasound value is below the norm, then the woman is diagnosed with oligohydramnios.
Distinguish between severe and moderate oligohydramnios . With moderate oligohydramnios, the indicator in most cases does not fall below 600-700 ml. Signs of expressed - 400-500 ml.
Usually, with moderate oligohydramnios, there is no reason for hospitalization, no treatment is prescribed. Symptoms are corrected by proper nutrition and daily routine. But if a woman has a pathology, then she is immediately sent to the hospital for preservation / treatment, because this threatens with serious deviations in the development of the child. And in this case, it does not matter what week of pregnancy is: they are hospitalized both in the second trimester and in the third.
Also, with severe oligohydramnios, there is a tendency to premature birth and spontaneous miscarriages.
Causes
Upon learning of pregnancy, every girl must register with women's consultation and be constantly monitored by a gynecologist. But even among the most responsible mothers, who take all the tests every two weeks, there is a tendency for unforeseen complications that can threaten the life of the child.
Reasons for not enough amniotic fluid:
- Insufficient secretion of amniotic fluid.
- Water leakage.
- Anomaly in the development of the fetal membranes. They can fix up to 20 weeks.
- Deviations in the development of the fetus. If the fetus has a kidney defect, then the diagnosis of oligohydramnios is usually made already in the early stages of pregnancy.
- Hypertension in pregnancy. During pregnancy, a woman's blood pressure may increase. The danger is represented by pronounced jumps from low to high rates. If you do not start treatment, the consequences can be sad: there may be a delay in the development of the child, slow growth and weight gain. Quite often, such symptoms are detected at 20–21 weeks.
- bacterial infections. The danger is chlamydia, ureaplasmosis, etc. Often, diseases do not occur during pregnancy, but long before it. It's just that the woman was not treated, and the disease became chronic. Such infections are detected by tests at 20 weeks. It is at this time that bacteria begin to multiply under the influence of hormones. If it was not possible to fix in time dangerous infections, then at a period of 30 weeks, a woman already has serious oligohydramnios and all the ensuing consequences.
- This diagnosis is made to mothers who are carrying more than one baby. The reasons are the uneven distribution of water and abnormal blood flow in the placenta. As a result, one child develops into comfortable conditions, and the second has to fight for survival. Polyhydramnios is also observed in one child and signs of severe oligohydramnios in the second. Between children there may be a difference in development - a week or more. If the specialists failed to make the necessary diagnosis, then one of the fetuses may die.
- The norm is considered to be childbirth that falls on the 36-40th week. But already from the 38th week, the placenta ceases to perform all the functions assigned to it. That's when the lack of fluid can begin. If labor does not begin at week 38, then a caesarean section may be prescribed. This question is especially acute if the 40-42nd week is already underway.
- At overweight mothers can make such a diagnosis already at the first or second ultrasound, that is, at 12 or 22 weeks, respectively. Mommy should be taken to the hospital, she is prescribed proper nutrition. Most often, babies are born no later than 36-37 weeks.
Influence on oligohydramnios cardiovascular diseases. The reasons for their occurrence: smoking before and during gestation, past illnesses, viral infections like influenza and SARS, obesity and diabetes, congenital anomalies.
Basically, the causes of oligohydramnios are associated with the state of health of a woman before and during pregnancy. Only in some cases occurs due to pathologies.
What is the danger of the diagnosis?
Low water is also divided into earlier and later. If the diagnosis is made for up to 20 weeks, this is early, at 26–40 weeks it is later.
It is early low water that is most unfavorable for the development of the embryo. Indeed, in the first and vitor trimesters, the vital organs of the unborn child begin to form and develop.
In the third trimester, it is much easier to treat a lack of water, as this is quite normal symptom. This is especially true in the last weeks of pregnancy.
Why is oligohydramnios dangerous during pregnancy? Sufficient quantity amniotic fluid guarantees the free movement of the fetus. In an advanced case, such a phenomenon at week 20 or less threatens the development of defects and deformities. Still fragile arms and legs are also bent.
Due to the small amount of amniotic fluid, there are: abnormal development urinary system, kidney defects and much more. Low water is not a permanent process. Sometimes it only lasts a few months or even weeks. Provoke serious deviations in development is capable of only prolonged pronounced oligohydramnios.
signs
An insufficient amount of amniotic fluid is dangerous because there are practically no pronounced symptoms. During pregnancy female body rebuilt, there is some discomfort. And few mothers recognize in this the symptoms of a dangerous disease. An accurate diagnosis is made only by a specialist.
Moderate oligohydramnios during pregnancy is almost always asymptomatic. The expectant mother feels great and full of energy.
With severe oligohydramnios in a pregnant woman, symptoms such as:
- Continuous or intermittent cutting and aching pain lower abdomen.
- Sharp pains during fetal movement. This is especially true for a period of 36 weeks.
- Poor health of the mother - weakness, nausea, dizziness.
- Leakage of water - the release of a clear liquid from the vagina.
- The size of the abdomen does not correspond to the terms.
- Delayed development by several weeks.
You should be attentive to your condition and, at the slightest suspicion, immediately seek help.
Diagnostics
If oligohydramnios is suspected, a woman must undergo mandatory diagnostic procedures that will show the state of the fetus's vital functions:
- Laboratory examination.
Ultrasound examination will allow you to find out the exact volume of amniotic fluid. For this, a special test is carried out, which allows you to determine the values \u200b\u200bof IAI (amniotic fluid index). And already starting from the received figures, they make a diagnosis.
Normal indicators of IAI
| Average IAI (mm) | Term |
Average IAI (mm) |
|
| 120 | 28 | 146 | |
| 126 | 29, 30 weeks | ||
| 134 | 31, 32 weeks | ||
| 136 | 33, 34 weeks | ||
| 140 | 35 | ||
| 144 | 36 | ||
| 145 | 37 | ||
| 146 | 38 | ||
| 24, 25, 26, 27 weeks | Approximately 147 | 39, 40 |
Approximately 127 |
According to the data in the table, it can be seen that the AFI at 22–30 weeks is approximately the same. Then the amount of amniotic fluid goes down. The seventh month is characterized by a slight drop in value.
Please note that this table is an average. For example, at week 20, the IAI can vary from 73 to 200 mm. At 32 and 33 weeks from 74 to 274 mm. So, when you see a figure in the conclusion of a doctor, do not panic.
Doctors sometimes want to play it safe and once again do not expose mother and child to risks.
The consequences of low water are far from the most pleasant. If the doctor does not like something, he offers to go to the hospital. You should not refuse this, because one week is nothing compared to the health of a son or daughter. However, moderate oligohydramnios at 35–37 weeks is quite a normal symptom and does not require treatment.
Treatment
As already mentioned, the reasons for the insufficient amount of amniotic fluid are different. Therefore, treatment is prescribed separately for each case. It matters here the mother's disease, abnormal development of the fetus, a week of pregnancy, etc. For example, if the mother is overweight, drugs are already prescribed from the 27th week to maintain the work of the placenta.
Moderate oligohydramnios during pregnancy is usually treated simply by adjusting the regimen. It is strongly recommended to reduce physical activity at least for a while and rest more, drink a course of vitamins (prescribed by a doctor, do not self-medicate!), Eat right and observe sleep patterns. After some time, you will be assigned a second ultrasound, and if the condition has stabilized, then you should simply follow these recommendations.
Even mild oligohydramnios can harm the baby.
If the change in the rhythm of life did not help you, then the doctor will prescribe outpatient or inpatient treatment in a hospital. The first option is usually suitable for women in the second trimester. You will have to take urine and blood tests. In case of water leakage - also a smear of liquid.
In the hospital, with a severe lack of amniotic fluid, a woman is given drugs that stimulate blood flow in the placenta. For example, Curantil and Actovegin, glucose. If the disease is caused by chlamydia or ureaplasmosis, then first of all, treatment for the infection will be prescribed.
If the drugs do not help, and the condition worsens, then they can stop treatment and prescribe premature birth. Such decisions are made extremely rarely and only if the woman is only a few weeks away from spontaneous delivery. Usually this is at least the 33rd week. If the gestational age is more than 35 weeks, then drugs are prescribed that cause contractions so that the woman can give birth on her own.
Oligohydramnios is a serious problem that can lead to the birth of a child with severe pathologies. Therefore, it is very important to follow all the doctor's instructions.
Thanks
According to the classical medical definition, oligohydramnios(oligohydramnion - lat.) is called a decrease in the volume of amniotic fluid (amniotic fluid) less than 500 ml at full-term pregnancy. That is, if a woman in the period of 40 - 41 weeks of pregnancy, the amount of amniotic fluid is 500 ml or less, then this condition is oligohydramnios. But this definition reflects only one aspect - what is considered low water on the eve of childbirth. Consider what in modern obstetric practice can be understood as oligohydramnios in general, and what is the significance of this parameter for assessing the course of pregnancy, as well as the growth and development of the fetus.
Low water in pregnant women - what is it?
The amount of amniotic fluid is not a static value, because as the fetus grows and develops, the volume of amniotic fluid changes, which begins to be secreted from the 8th week of gestation and continues until the very birth. Thus, the amount of amniotic fluid at each stage of pregnancy is different. Moreover, at any stage of pregnancy, their number may be less than normal, which will also be oligohydramnios. That is, expanding the classical definition of oligohydramnios, we can say that this is a condition in which the volume of amniotic fluid is less than the lower limit of normal for this particular gestational age.Currently, based on numerous observations and calculations, tables have been developed with the average, maximum and minimum volumes of amniotic fluid characteristic of each week of gestation, starting from the 14th. That is, oligohydramnios can be determined starting from the 14th week of pregnancy.
However, we repeat that the concept of oligohydramnios is dynamic, that is, it can periodically appear or disappear during pregnancy. This means that the same woman, for example, at 23 weeks had oligohydramnios, and at 33 weeks of pregnancy it is gone. In such cases, doctors talk about functional oligohydramnios, which occurs in response to various impacts external environment and goes away on its own within a month. Strictly speaking, such oligohydramnios is transient, that is, temporary, and therefore refers to functional disorders, and not to pathologies. The vast majority of cases of oligohydramnios are just such transient, functional disorders that are not dangerous for the growth and development of the fetus and do not violate the normal course of pregnancy and childbirth.
If oligohydramnios is persistent, that is, it does not go away and is fixed at different stages of pregnancy, for example, at 23, at 25, at 30 weeks of pregnancy, then we are talking about pathology. In such cases, oligohydramnios is a sign of severe violations of the course of pregnancy and fetal development.
Therefore, when a woman is diagnosed with oligohydramnios according to the results of ultrasound, there is no need to be upset or nervous, since in the vast majority of cases this is a functional feature of her pregnancy, and not a pathology. But if oligohydramnios is combined with malformations or does not go away within a month, then this condition is considered pathological and requires treatment. Remember that the incidence of pathological oligohydramnios is only 0.2 - 0.3% of cases, and it is necessarily combined with developmental disorders of the fetus and placenta, visible on ultrasound. Therefore, if the ultrasound doctor did not see malformations of the fetus or placenta, but diagnosed "oligohydramnios", then this always indicates functional feature women and does not require any treatment, with the exception of vitamin prophylaxis.
In principle, oligohydramnios is not so much an independent pathology as a single symptom, reflecting a combination of various disorders in the growth and development of the fetus or the course of pregnancy. Therefore, the isolated determination of oligohydramnios without CTG, dopplerometry and screening for malformations by ultrasound and biochemical tests (AFP, hCG, etc.) is not diagnostically accurate and justified.
Oligohydramnios in pregnant women - the diagnostic significance of the indicator
The diagnostic significance and value of such an indicator as oligohydramnios is currently very low. The fact is that before the advent of ultrasound, dopplerometry, CTG and other methods of examining a pregnant woman, fetal pathology and the likelihood of various deformities were determined indirectly, according to various indicators that correlated with impaired growth and development of the child. One of these indicators is the amount of amniotic fluid. Doctors of past centuries determined their number in order to indirectly assess how well and according to the norm the fetus is developing. Indeed, until the middle of the 20th century, there was simply no such informative method as ultrasound, which allows you to examine the fetus and determine how it develops, accurately measuring its size and seeing all the organs and parts of the body. And the doctor, not seeing the child in the womb, had to somehow assess whether it is developing normally. It was in that era that doctors determined the amount of amniotic fluid and many other parameters that indirectly made it possible to judge the growth and development of the fetus.
However, at present, the norms of growth and development of the fetus are perfectly monitored by ultrasound, the pathology of the placenta is determined using dopplerometry, and fetal hypoxia is detected by KGT. That is, there are instrumental methods that allow much more accurate detection of fetal pathologies, placental dysfunction, etc. And so the definition of oligohydramnios is a kind of tribute to tradition. Because of this, many gynecologists do not pay attention to oligohydramnios at all, if, according to the results of ultrasound and CTG, the child develops normally, since they quite rightly consider this condition to be a feature of a particular pregnant woman.
Low water - causes of development
The reasons for the development of oligohydramnios can be various pathologies of the fetus and placenta or severe chronic diseases that a pregnant woman has. That is why the entire set of causes of oligohydramnios is divided into the following large groups:1. Causes associated with congenital malformations in the fetus;
2. Causes associated with fetal pathology;
3. Causes associated with metabolic disorders in a pregnant woman due to severe chronic diseases;
4. Causes associated with the pathology of the placenta;
5. Other.
Specific causative factors of oligohydramnios, attributable to each of the five listed groups, are reflected in the table:
| Causes associated with congenital malformations in the fetus | Underdevelopment of the urethral valves |
| Agenesis (absence) or narrowing of the urethra | |
| Bilateral narrowing of the ureters | |
| Bilateral narrowing of the junction of the ureters with the renal pelvis | |
| Prune belly syndrome | |
| Agenesia (absence) of the kidneys | |
| Bilateral polycystic kidney dysplasia (Potter-I syndrome) | |
| Polycystic kidney disease (Potter-II syndrome) | |
| Causes associated with fetal pathology | Intrauterine infection of the fetus (for example, cytomegalovirus infection, chlamydia, mycoplasmosis, etc.) |
| Retardation of intrauterine development of the fetus | |
| Chromosomal abnormalities of the fetus (for example, Down syndrome, Marfan, etc.) | |
| Causes associated with severe chronic diseases present in a pregnant woman | Chronic diseases of the cardiovascular system (for example, hypertension, thrombophlebitis, venous insufficiency, etc.) |
| Preeclampsia | |
| Chronic kidney disease (eg, pyelonephritis, glomerulonephritis, kidney failure etc.) | |
| Collagen diseases (eg, systemic lupus erythematosus, scleroderma, dermatomyositis, periarteritis nodosa, rheumatoid arthritis, rheumatism, serum sickness, etc.) | |
| Obesity | |
| Diabetes | |
| Dehydration of the mother's body, for example, after severe diarrhea, vomiting, etc. | |
| Smoking more than 10 cigarettes per day | |
| Causes associated with pathology of the placenta | placental insufficiency |
| Multiple infarctions of the placenta | |
| Anomalies in the development of the placenta (for example, atrophy and focal sclerosis of the decidua, necrosis of the amnion, etc.) | |
| Other | Pregnancy over 42 weeks |
| Premature rupture of membranes | |
| Rupture of membranes with leakage of amniotic fluid | |
| Intrauterine (antenatal) fetal death | |
| Idiopathic oligohydramnios (cause unknown) | |
| Iatrogenic oligohydramnios caused by long-term use medicines from the group of prostaglandin synthetase inhibitors (for example, Indomethacin, Naproxen, Fenoprofen, flufenamic acid, etc.). These drugs are commonly used to stop preterm labor. |
Thus, most of the causes of oligohydramnios are quite successfully treated with modern methods, and therefore this condition is not a cause for panic. The only group of causes of oligohydramnios that is not treated are congenital malformations of the fetus, which, however, are always detected on control ultrasounds performed at 12, 22 and 32 weeks of pregnancy. In other cases, oligohydramnios can be cured, and the woman will give birth to a perfectly healthy child.
Currently the most common causes oligohydramnios in pregnant women are the following factors:
- preeclampsia;
- Maternal hypertension;
- Maternal diabetes;
- Any infectious and inflammatory diseases in the mother (for example, tonsillitis, pyelonephritis, influenza, acute respiratory infections, etc.);
- TORCH complex infections (toxoplasmosis, rubella, cytomegalovirus, herpes) during pregnancy;
- Chronic intrauterine hypoxia fetus.
If oligohydramnios has developed before 28 weeks, then doctors recommend termination of pregnancy, since in most cases it is impossible to predict its outcome.