What should be done so that there is no lack of water. Amniotic fluid rate. Why amniotic fluid is needed

01.08.2019

Low water occurs somewhat less frequently than an excess amount of amniotic fluid.

At the same time, lack of water during pregnancy serves as a signal that during its course there are any deviations that are dangerous to the health of the fetus, preventing its normal development.

The composition of amniotic fluid is very diverse, it contains nutrients for the child, oxygen, vitamins, salts, hormones, and a number of other substances, without which the normal intrauterine development of the child is impossible. At the same time, amniotic fluid is not only a source of nutrition for the fetus, but also its reliable protection from adverse factors, infections ...

The amount of amniotic fluid varies depending on the duration of pregnancy and the needs of the fetus. So, in the third trimester of pregnancy, the normal amount of amniotic fluid ranges from 1000 to 1500 ml. If these indicators are less, we can talk about low water levels of varying degrees. There are cases when a pregnant woman had practically no amniotic fluid at all.

Depending on the severity, oligohydramnios can be moderate or severe.

At moderate low water when the amount of amniotic fluid is slightly less than the norm, a woman should establish a diet, eat a variety of foods rich in vitamins and minerals, adhere to a sparing regimen, and regularly see a doctor in order to avoid deterioration of the condition.

Severe oligohydramnios requires more serious measures, the appointment of medications, hospital treatment. With severe low water, such negative consequences as deformation of the fetal skeletal system, abnormal development of its limbs, asphyxia, which leads to disruption of the activity of the central nervous system, can be observed ...

Symptoms of low water

As a rule, with oligohydramnios, a woman does not feel any special symptoms, deviations in her well-being. Sometimes a pregnant woman can feel pain in the abdomen, which are aggravated at the moment the fetus moves.

Thus, only a doctor can determine the presence of oligohydramnios. For example, if a doctor notices a lag in the height of the standing of the fundus of the uterus, its obvious discrepancy with the gestational age, as well as the abdominal circumference insufficient for a given period, he can draw conclusions regarding the possibility of oligohydramnios.

In order to fully confirm or refute this diagnosis, an ultrasound examination is required, which will help determine the amount of amniotic fluid, if oligohydramnios occurs, then assess the severity of it, the condition of the fetus. If you suspect low water, a woman is also prescribed a gynecological examination.

Causes of lack of water

The reasons for the insufficient amount of amniotic fluid are not so fully understood. As medical practice shows, the following reasons most often lead to lack of water:

1. Insufficient development of the epithelium, which covers the aqueous membrane, or a reduced secretory function of this membrane itself.

2. Defects and abnormalities in the development of the fetus. These defects include pathologies in the development of the kidneys of the child, hereditary anomalies in the development of the kidneys and face.

3. To oligohydramnios during pregnancy can lead to high blood pressure observed in a pregnant woman.

Of course, during pregnancy, pressure rises in almost every woman, however, such deviations during the normal course of pregnancy are usually insignificant.

If the pressure rises strongly, this can cause the development of oligohydramnios. It should be noted that the severity of low water directly depends on the pressure indicators. Also, in the case when the cause of oligohydramnios was hypertension, there may be delays in the development of the fetus, its lagging behind the norm in size.

4. Low water can also cause various kinds of bacterial infections, transferred by a pregnant woman and not properly cured. In this case, pathogenic microflora is detected during analyzes not only in the birth canal, but also in the amniotic fluid itself.

5. Low water can be observed with multiple pregnancies. This is due to the possible uneven distribution of blood flow in the common placenta, when one of the babies gets more nutrients and oxygen, and the other gets less.

6. Often with prolonged pregnancy, oligohydramnios develops. This is due to the fact that the placenta, which has served its due date, begins to age and exfoliate, is not able to fully perform its functions. In this case, doctors raise the question of artificial birth.

7. Low water can develop against the background of metabolic disorders in a pregnant woman, for example, with obesity, so it is so important to eat right and gain weight smoothly, according to the norm:

Treatment of oligohydramnios

In order to choose the most effective methods of treating oligohydramnios, the doctor must establish the cause that caused the lack of amniotic fluid and the severity of oligohydramnios.

To do this, the pregnant woman must undergo examinations, such as:

1. Ultrasound, Doppler ultrasound, during which the amount of amniotic fluid is determined. The degree of fetal developmental delay, the quality of blood flow in the umbilical cord, uterine arteries of a woman, as well as in the cerebral artery of the fetus.

2. Tests and smears for sexually transmitted diseases, bacteria.

3. CTG of the fetus, which allows to determine the state and well-being of the fetus.

Treatment methods vary. For example, in case of metabolic disorders and obesity, a woman, in addition to taking medications that normalize the activity of the placenta, is recommended to adhere to a dietary regimen determined by a doctor.

Most often, with oligohydramnios, complex treatment is prescribed, which includes taking medications to improve metabolism in the placenta, vitamins, drugs intended to treat the underlying disease, which was the cause of oligohydramnios.

Treatment can be carried out on an outpatient basis (with a moderate degree of oligohydramnios). In this case, a woman should limit her physical activity, adhere to a sparing regimen, exclude heavy physical exertion, take medications prescribed by a doctor, and regularly attend an antenatal clinic.

If the lack of water is pronounced, is associated with an increased tone of the uterus, the woman will have to go to the hospital.

With oligohydramnios, the doctor may prescribe a weekly ultrasound scan, Doppler ultrasound, which must be performed every three days, and an extraordinary CTG of the fetus.

All these measures are necessary in order to control the pathology, prevent its development, and in some cases, take the necessary measures in a timely manner.

If oligohydramnios is of a pronounced severity, threatens the health of the fetus, the doctor may decide on early delivery by the Caesarean section method, if, of course, the timing of pregnancy allows it.

Influence of low water on a woman's condition

Low water is a pathological condition that is observed during pregnancy, has an extremely negative effect on its course. A woman may experience painful sensations that intensify at those moments when the fetus begins to actively move.

In addition, lack of water can lead to much more dire consequences, for example, termination of pregnancy.

Low water, moderate or severe, significantly complicates the course of labor. This manifests itself, first of all, in the weakness of labor, because the fetal bladder, small in size, is not able to have a sufficient effect on the rate of dilatation of the cervix. In this case, the use of drugs that stimulate contractions may be required.

The effect of low water on the condition of the fetus

Amniotic fluid is the natural habitat for the fetus. Lack of amniotic fluid can adversely affect its condition and development.

Of course, the outcome of pregnancy can be favorable, many women who had low water during pregnancy gave birth to completely healthy children, albeit with a slight lag in height and weight.

However, there are other situations when water deficiency has had a very negative impact on the health of the child. For example, with oligohydramnios, the walls of the uterus are located close to the surface of the fetus's body, thus, the child does not have enough space necessary for normal development. As a result, the fetus may experience deviations in the development of the skeletal system, limbs. The child, to one degree or another, begins to lag behind in growth and weight, his skin becomes dry, covered with numerous wrinkles.

Pathologies in the development of the fetus can be observed both with moderate lack of water, although the degree of such malnutrition is, as a rule, lighter, there are more chances for the birth of a healthy baby, and with pronounced, when the fetus has obvious developmental delays, hypoxia, disorders of brain and nervous activity , decreased limb tone, lethargy.

Children born to mothers who have experienced oligohydramnios during pregnancy, subsequently, as a rule, often get sick, are more excitable.

Prevention of oligohydramnios during pregnancy

Unfortunately, there are no preventive measures that can be guaranteed to protect against dryness.

However, there are still a number of rules that must be followed by a pregnant woman at the very beginning of this period. For example, a pregnant woman should not lift heavy objects, as excessive physical activity can lead to the development of oligohydramnios. But this does not mean at all that you need to completely abandon movement. Well suited for women in an interesting position, leisurely walks in the fresh air.

It is necessary to carefully consider the diet; it is best to eat in small portions, 5 times a day, in small portions.

It is important to pass all examinations in a timely manner, get tested, and if a problem is identified that can lead to oligohydramnios, start the treatment prescribed by the doctor as soon as possible.

Naturally, you need to periodically come for an examination to a doctor - a gynecologist who leads a pregnancy, strictly follow all his instructions.

Conclusion

It is worth noting that oligohydramnios is far from the worst pathology that can be observed in a pregnant woman. Therefore, the risk that the baby may receive some very serious injury as a result is not so great.

The main thing is to identify low water in a timely manner and take measures to eliminate it. In addition, modern medical equipment and medications make it possible to carry a baby and give birth to a healthy baby in most problematic cases.

Therefore, in no case should you panic, get nervous and fall into despair, otherwise no, even super-modern drugs and equipment, will help.

During pregnancy, the expectant mother undergoes mandatory scheduled ultrasound examinations (ultrasound). One of the indicators that the doctor evaluates is the volume of amniotic fluid. If it is below normal, then there is a suspicion of lack of water. After additional research, this diagnosis may not be confirmed. But, if it is nevertheless confirmed, it is very important to find the causes of low water in order to prescribe treatment as soon as possible and bring the volume of amniotic fluid back to normal.

Malnutrition (or oligohydramnios) is a pathology that occurs during pregnancy, which is characterized by a reduced volume of amniotic fluid. At each stage of pregnancy, the rate of amniotic fluid is determined.

It is customary to distinguish four classifications of oligohydramnios in pregnant women.

According to the timing of appearance, early (at a period of 14-20 weeks) and later (at a period of 21-40 weeks) oligohydramnios are distinguished. Early oligohydramnios passes against the background of insufficient functions of the membranes. Later, oligohydramnios often occurs when the membranes are damaged.
Localization distinguishes between primary and secondary oligohydramnios. Primary oligohydramnios passes against the background of intact membranes. Secondary - due to rupture of the membranes (leakage of amniotic fluid).
According to the duration of the course, acute and chronic oligohydramnios are distinguished. The first occurs after the infectious diseases suffered by the expectant mother. The second requires more careful research to identify the causes.
According to the severity, moderate and pronounced lack of water is distinguished. To diagnose these types of oligohydramnios, the amniotic fluid index (AFI) is used. If the value of this index is within 2-5 cm, then moderate low water is diagnosed during pregnancy. If less than 2 cm, then pronounced.

With a moderate degree of oligohydramnios, the pregnant woman feels well. And only a doctor can indicate the presence of this problem during an ultrasound scan.

For a pronounced degree of low water, the following symptoms are characteristic:

the circumference of the abdomen and the height of the fundus of the uterus are less than normal;
AFI value according to ultrasound data is below normal;
low fetal mobility (less than 10 times a day);
pain when moving the fetus;
lower abdominal pain;
general malaise, dry mouth.

To diagnose oligohydramnios, ultrasound results with an AFI value, a doctor's examination with measurements of the abdominal circumference and the height of the uterine fundus, and the subjective feelings of the expectant mother are required. Moreover, the monitoring of the change in the above indicators should be carried out in dynamics. If during at least three observations a deviation from the norm was recorded, then a diagnosis of oligohydramnios can be made.

According to statistics, in 95% of the repeated ultrasound, there are no signs of oligohydramnios. This means that its previous manifestation was not a sign of pathology.

If the diagnosis is confirmed, then it is necessary to identify the cause of oligohydramnios in order to prescribe effective treatment and avoid complications.

Low water during pregnancy: causes and consequences

The causes of dryness are conventionally divided into 5 groups according to general characteristics.

Congenital malformations of the fetus. This is mainly an anomaly in the development of the urinary system of the fetus and chromosomal abnormalities. The manifestation of oligohydramnios for these reasons begins in early pregnancy.
Infections. These are female genital infections (chlamydia, trichomoniasis, ureaplasmosis), viral and bacterial infections (ARVI, flu, toxoplasmosis, rubella) transferred during pregnancy.
Chronic diseases of a pregnant woman. These are diseases of the cardiovascular system (high blood pressure, increased blood clotting, venous insufficiency), kidneys (pyelonephritis, renal failure), diabetes mellitus, obesity, gestosis, diseases of the endocrine system.
Placental pathology. This is mainly placental insufficiency, various abnormalities in the development of the placenta.
Other circumstances. This is a multiple pregnancy, prolongation of more than 2 weeks, tear or rupture of the membranes, alcohol, nicotine, narcotic and drug intoxication, causeless (idiopathic) oligohydramnios.

In each of these cases, violations occur that affect the full development of the fetus. The main complications and consequences of the manifestation of low water during pregnancy include:

delayed fetal development;
underweight;
deformities associated with the fusion of the skin of the fetus and the amnion.

The risk of severe complications of oligohydramnios is more likely with its early onset. Those. if oligohydramnios appears late in pregnancy, then its consequences will be less significant than if it develops at the beginning or in the middle of pregnancy.

Treatment of oligohydramnios

After diagnosing oligohydramnios during pregnancy and the reasons for its occurrence, it is important to immediately begin effective treatment.

The main task of treatment is to eliminate the cause that led to the occurrence of oligohydramnios. Treatment methods mainly boil down to:

vitamin therapy;
the use of drugs that improve the function of the placenta and uteroplacental blood flow;
antibiotic therapy;
the introduction of a special diet;
giving up bad habits.

During therapy, it is important to constantly do ultrasound, dopplerometry and cardiotocography (CTG) in order to quickly monitor the child's condition.

With moderate lack of water, outpatient treatment is most often prescribed, with a pronounced degree - inpatient treatment.

When diagnosing oligohydramnios, the expectant mother should not worry too much. It is necessary to help the doctor understand the cause of this pathology so that he can choose the correct and specific method for treating oligohydramnios during pregnancy. And its effective and timely use will help to give birth to a healthy baby.

Every woman dreams that her pregnancy would proceed easily and naturally, so that no one and nothing could distract the expectant mother from pleasant thoughts about her future child. However, in reality, not everything goes so smoothly.

Low water can become one of the serious complications. We will tell you about what it is and how to treat it in this article.

What it is?

In a broad sense, oligohydramnios is called 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, the lack of water was really determined just before the very birth. Now, thanks to the development of diagnostics, it is possible to identify a tendency to a decrease in water in the fetal bladder is possible from the 16th week.

Water is essential for the normal development of a child. They are also a nature-provided shock absorber, softening shaking, swaying, which the baby could quite significantly feel when walking or other actions of a pregnant woman, if the water did not interfere with this.

Amniotic fluid begins to be produced at about 8 weeks of gestation, and with an increase in gestation, it also increases in volume. In the 3rd trimester, there is a slight decrease in fluid, because the uterus is already strongly stretched by the grown child.

Many years of studying intrauterine development have allowed doctors 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. It can be determined in millimeters starting from the 16th week of gestation when undergoing an ultrasound scan.

IAZH standards - table:

Obstetric term, (week)	IAZH (normal limits), mm	Obstetric term (week)	IAZH (normal limits), mm

Since the amount of water in the fetal bladder is not a constant value, at different periods, the same expectant mother may find lack of water, and after a few weeks it is not detected. This natural phenomenon is called functional dryness. This is the most harmless of all types of this complication.

Usually, with a medical verdict "lack of water", a woman falls into a stupor. Future 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 from the overwhelming majority) perfectly wear out and give birth to healthy children, since their lack of water was physiological.

Malnutrition pathological is considered to be a persistent insufficient amount of amniotic fluid, which can be registered repeatedly at a variety of times, starting from 16 weeks.

Classification

Low water 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 react to a viral disease, influenza or ARVI, from which the expectant mother could not protect herself during the period of bearing the baby. This violation is usually temporary and does not mean that the baby has pathologies.

Chronic oligohydramnios is more dangerous. It usually develops due to problems that cannot be called quickly eliminated - mom's diabetes, obesity, as well as child's malformations and prolonged hypoxia. Such a violation will not go away by itself, it definitely needs treatment. Also, the violation can 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 low water, the doctors' forecasts are less optimistic, because the process of the formation of the baby's internal organs and systems has not yet been completed.

Pronounced lack of water at an early stage can be an indicator of gross genetic abnormalities in a baby, and therefore such a "find" on an ultrasound scan needs a detailed study by means of other diagnostic methods. In the later stages, the violation is often functional, completely natural, it can be easily corrected or goes away on its own.

Sometimes the development of such a violation is influenced by the 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 low water are distinguished.

Causes

The reasons for the decrease in amniotic fluid, which are so important for the baby, are manifold. It can be malformations of the child, his diseases, pathology of the placenta, as well as diseases of the expectant mother, both acute and chronic.

Some genetic, including chromosomal abnormalities that arose during conception, during the formation of the genetic code, the karyotype of the fetus, proceed precisely against the background of a decrease in the amount of amniotic fluid.

In particular, such defects as abnormal development of 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, lead to the development of oligohydramnios.

Pronounced oligohydramnios is observed in pregnant women if, by a "mistake" of nature, the kidneys are completely absent from the baby.

Polycystic kidney disease of the baby (Potter's syndrome) is also a very obvious cause of abnormal pregnancy. Among chromosomal abnormalities, oligohydramnios are most often accompanied by Down's syndrome and Turner's disease.

If everything is in order with the baby's genetics, 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 norms often happens with a delay in fetal development.

The main maternal ailment that can lead to oligohydramnios is gestosis. In addition, such a condition can cause venous insufficiency, a tendency to form blood clots, and diseases of the cardiovascular system.

The amount of water and ailments of the kidneys in the expectant mother, and diabetes mellitus, have a detrimental effect on the amount of water. Dehydration can also cause a decrease in amniotic fluid, as well as smoking, with which some of the expectant mothers, even being in an "interesting position", can not say goodbye.

Pathologies of the placenta - insufficiency, heart attacks of the "child's place", any anomalies in its development, which occurred during the formation of this temporary organ at the very initial stages, lead to lack of water.

Among other reasons that can lead to such an unpleasant complication of pregnancy are prolongation, in which natural aging of the placenta occurs, trauma to the membrane of the membranes, mothers taking a large number of medications for a long time, as well as fetal death and multiple pregnancies.

Symptoms and Signs

A woman practically cannot determine her oligohydramnios on her own, this is a matter of 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 the due date. It becomes possible to establish a violation thanks to measurements of the height of the day of the standing of the uterus, which are carried out at each scheduled examination in the antenatal 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 keep silent about such sensations, if the symptom has not been diagnosed earlier, it is imperative to inform the doctor about your suspicions, who will prescribe all the diagnostics required in this case.

Diagnostics

The amniotic fluid index is determined by the ultrasound doctor. It measures the distance, free from the baby's limbs and the umbilical cord, between the baby and the anterior abdominal wall, its inner surface. This measurement is called a vertical pocket.

If the result of measurements after a comparative analysis with the tables shows that the amount of water has been reduced, the degree of violation is revealed. With moderate low water, the index is reduced by 10-15% compared to the above norm, and the vertical pocket, which with a normal amount of water is 5-8 cm, is reduced to a size of less than 5 cm.

A pronounced violation is such a violation 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 an ultrasound specialist indicates in the conclusion that a woman has signs of moderate low water, an obstetrician-gynecologist be sure to send her for Doppler and expert ultrasound, in order to more accurately know the state of the child, the placenta and blood flow in the uterine vessels.

When the ultrasound protocol indicates that a pregnant woman has severe oligohydramnios, she is hospitalized for a more thorough examination.

If the reason lies in the congenital abnormalities of the baby, it is recommended to terminate the pregnancy for medical reasons. To agree or not, it is up to the pregnant woman herself to decide. If she refuses, then the child is kept until the very birth, they provide him with the necessary drug support.

Possible consequences for the mother

A woman with low water threatens to terminate her pregnancy at a later date, traumatizing both the psyche and the physical health of the reproductive system. If the child dies, there will be no other option. After interruption for a long time, a woman may experience a nervous breakdown and develop secondary infertility.

A small amount of amniotic fluid aggravates the very process of childbirth. Weakness of labor forces often develops, the woman is threatened with a cesarean section. The postpartum period in such women is more difficult, complications are likely.

The pregnancy itself can give the expectant mother a lot of unpleasant sensations: the larger the child becomes, the more difficult it will be for a woman to withstand his movements.

The likelihood of miscarriage during pregnancy with oligohydramnios is high, the risk of premature birth is even higher - it reaches 26%.

Possible consequences for the child

Children born after pregnancy with oligohydramnios are low in weight, they are weaker than their peers, even if the pregnancy is full-term before the expected date of delivery.

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, all the free space of the uterine cavity can be filled with cords. They can also entangle a baby.

Due to the pressure that the strands will exert on the fetal tissue, irreversible deformities are formed - in babies, limbs are self-amputated or severely bent, there are defects in the face and chest. The baby's appearance is completely disfigured. The frequency of such consequences is low, but even this cannot be ruled out.

The likelihood of such outcomes increases if oligohydroamnion is diagnosed early, at 16-20 weeks, and persists throughout pregnancy.

In childbirth, the baby may face 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 lack of water is the cause of the development of diseases such as Down syndrome, as well as other chromosomal abnormalities. The logical connection here is the opposite - with Down syndrome, oligohydramnios often develops, and not vice versa.

Almost always, a protracted oligohydramnios causes a delay in the 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 baby 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 the 30th week of pregnancy, but only on condition that the pathological condition persists for 4-6 weeks or more.

For any negative consequences of low water for a child's health, there is a regularity - the earlier this condition occurs, the more serious the consequences can be.

Treatment

Low water therapy is always comprehensive. And it begins with establishing the exact cause that caused the pathological decrease in the amount of amniotic fluid.

First of all the version with chromosomal abnormalities is being checked. For this, a woman, depending on the period, is sent to one of the methods of invasive prenatal diagnosis.

If oligohydramnios is diagnosed at 16 weeks, a chorionic biopsy can be performed. If the fact of lack of water became known later, the 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 to speak with a high degree of accuracy about the presence or absence of 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 baby's DNA from the venous blood of a pregnant woman. This test detects chromosomal abnormalities with a 99.9% probability and is an ideal alternative to invasive tests that can be dangerous for both the pregnant woman and the fetus.

When confirming the cause of oligohydramnios due to chromosomal abnormalities, termination of pregnancy is recommended.

If the additional examination does not show the presence of gross chromosomal abnormalities in the child, then ultrasound specialists of an expert class will look for physical defects. To do this, they will carefully study the baby's urinary system - the ureters, urethra, kidneys. Particular attention will be paid to the health of the placenta. To assess the blood flow in the uterine vessels, ultrasound is performed.

The attending physician will refer the woman for blood tests, which can confirm or deny the presence of infections, including sexually transmitted infections.

Blood must be donated for sugar and urine for protein content. The doctor monitors the blood pressure of the expectant mother to exclude gestosis as a 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, the control over the state 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 doctor's recommendations.

Severe oligohydramnios, if detected early, is also an indication for termination of pregnancy; none of the doctors will dare to make predictions about its outcome. With severe lack of water, diagnosed after 26 weeks, the woman is hospitalized.

Drug treatment

Expectant mothers with severe lack of water are injected with solutions of vitamins intramuscularly. In addition, she is given droppers with drugs that improve uteroplacental blood flow. Typically used for this Actovegin. Additionally, doctors recommend taking "Courantil", the dosage and frequency of taking this drug is determined by the doctor.

A pregnant woman may be prescribed broad-spectrum antibiotics to help control the infection, if any. During the period of carrying a baby for these purposes, it is often recommended "Amoxiclav". To improve metabolic processes in a woman's body, drugs such as "Hofitol", as well as multivitamin complexes designed and created specifically for pregnant women.

Simultaneously with taking drugs in a hospital, the baby's condition is checked daily or every other day. A woman is given CTG, if the gestational age is already above 28 weeks, the functionality of the placenta is monitored using ultrasound, ultrasound scanning can be performed at any time to assess the amount of water in dynamics.

Any alarming symptoms that may indicate a fetal dysfunction can at any time become a decisive reason for doctors to carry out a cesarean section ahead of schedule.

With moderate lack of water, which, according to the doctor, is of a physiological origin, the woman is discharged "Courantil", "

Long walking, playing sports with such a complicated pregnancy are undesirable. Additionally, you will have to limit sex. Overweight, obese pregnant women are advised to go on a special diet in order to exclude an even greater gain in body weight.

Nutrition with oligohydramnios should include a large amount of fruits and vegetables, proteins and fats should be balanced, and fast carbohydrates (sweets and pastries) should be avoided altogether.

If there is swelling, you should definitely consult a doctor, to work out together a correct and sufficient drinking regime. With preeclampsia and hypertension, it is important to measure arterial blood pressure twice a day. With a significant increase in it, a woman needs qualified medical care.

Traditional methods of treatment

Alternative medicine is ready to offer pregnant women with moderate low water content a lot of useful and enjoyable recipes and products that, if they do not increase the amount of water, will definitely be able to meet the needs of a future mother with a deficiency of amniotic fluid in essential minerals and vitamins.

Folk remedies should not even try to treat severe lack of water. But with minor deviations from the norm, a woman may well use some advice if her doctor has nothing against it.

The need for minerals with oligohydramnios will help restore figs, melons and grapes. It is also good, according to the reviews of expectant mothers, zucchini and fresh tomatoes help.

A real treasure, a natural "pharmacy" for a pregnant woman with a deficiency of amniotic fluid can become chokeberry. A woman can take 50 grams of juice from her or about 100 grams of berries per day.

Another favorite remedy for oligohydramnios is strawberries. They are eaten fresh or brewed with homemade fruit drink to improve the normal functioning of the kidneys. If the pregnancy fell out in the winter and there is nowhere to take strawberries, you can drink weak tea with strawberry jam. If this is not in stock, you can purchase it.

Prophylaxis

Correct and responsible planning of the baby will help to avoid low water during pregnancy. A woman should be examined in advance by doctors of various 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 carry out a full medical examination, but a woman who dreams of a child is simply obliged to visit a cardiologist, therapist and nephrologist. Visits to these specialists will help to ensure that the heart, kidneys and general health will help a woman carry her baby without complications.

If the age of the expectant mother is over 35 years old, it is worth consulting with a geneticist, because the likelihood of conceiving and giving birth to a child with Down's or Patau's syndrome increases in proportion to the mother's age.

It will be correct to do tests for genital and other infections even before conception, and if something like this is found, treat them before the child is conceived.

You should quit smoking before conception, in extreme cases, as soon as it becomes known about the pregnancy. Smoking, and it has been proven, very often acts as a provoking factor of oligohydramnios.

During pregnancy, a woman for preventive purposes it is important not to refuse to undergo mandatory screening tests in the first, second and third trimester, do not give up ultrasound and the delivery of certain tests recommended by the doctor.

Expectant mothers should beware of viral infections, especially during periods of massive incidence of ARVI and influenza, in order to avoid the development of oligohydramnios after an illness. To do this, you should refrain from visiting shopping centers and public transport during seasonal epidemics, and observe the rules of personal hygiene.

If the doctor insists on hospitalization, one should not refuse it either, even if the woman herself thinks that she is feeling great and she does not have time to stay in the hospital at all.

Amniotic fluid (amniotic fluid) is a comfortable environment in which a baby develops for nine months. It serves as both a mechanical protection, and a nutrient medium, and a "liquid simulator" that helps the child to practice the technique of swallowing. The question of whether amniotic fluid is needed is not worth it - without it, pregnancy cannot develop. But how much of it is needed and what to do if there is not enough amniotic fluid? How scary is oligohydramnios?

Low water: first suspicions

All women differ in height and physique, and the sizes of newborn babies also differ. Therefore, “normal” volume is a rather vague concept. The upper and lower limits of the norm differ by more than half: 600-1500 ml.

” Most of the amniotic fluid is on, then their volume decreases slightly.

Often, even an experienced gynecologist cannot say with confidence whether we are talking about a slight deficiency / excess of amniotic fluid or about the physiological characteristics of a particular pregnant woman. Therefore, a suspicion of moderate lack of water (the volume of amniotic fluid is 500 ml or less) often arises when the expectant mother begins to feel an unpleasant symptom: the child's movements become painful for her.

” Even a slight lack of water is a fairly rare pathology, it is determined in 1 out of 20 pregnant women.

Diagnostics of low water

An ultrasound examination is intended to confirm the diagnosis "". During the examination, the doctor determines the so-called "vertical pocket" - the greatest distance from the anterior abdominal wall to the fetus. Normally, this distance should be from 5 to 8 cm.

It is possible to more accurately determine the state of affairs by calculating the amniotic fluid index: this is the same "vertical pocket", only measured at four different points (right-top, left-top and right-bottom and left-bottom). The sum of the four measurements can range from 5 to 24 cm (some doctors narrow this interval to 8-18 cm) and varies depending on the gestational age.

Normal Amniotic Fluid Index Scores

But a single study can reveal only the most flagrant violation. Much depends on the child's activity and on the settings of the ultrasound machine. Therefore, if in doubt, it is better to repeat the examination, and it is possible with another doctor and on another device.

Causes of oligohydramnios

There are many reasons for the occurrence of oligohydramnios, and depending on what condition caused oligohydramnios, a prognosis of the course of pregnancy is made and treatment tactics are determined.

Genetic diseases

Sometimes oligohydramnios is caused by genetic abnormalities in the fetus. Unfortunately, this is the most pessimistic scenario, as pregnancy often freezes.

Chronic diseases of the mother

Problems with the kidneys, urinary tract, hypertension - a number of diseases of the mother can cause oligohydramnios. In this case, the gynecologist will focus on the treatment of this particular disease, and the baby's condition will be monitored especially carefully.

Anomalies in the development of the membranes

Perhaps the problem is not in the state of health of the mother or fetus, but in the uterus: there is an underdevelopment of the amnion, stratification of the membranes of the membranes, insufficient secretory activity of the epithelial (making up the mucous membrane) cells of the membranes responsible for the production of water.

Infectious diseases

ODS, influenza, chickenpox, measles - many infections can affect the membranes. As a result, they lose their elasticity, stratifications appear, through which there is a leakage of amniotic fluid, imperceptible for the woman herself.

Amnional hydrorhea

Sometimes the leakage of amniotic fluid occurs for no apparent reason - doctors do not even always manage to find the place of a microscopic rupture. In this case, a smear is made to detect amniotic fluid. Unlike the previous case, a secondary infection of the membranes may already occur here.

Postponing pregnancy

Both the placenta and the amniotic membranes gradually cease to perform their functions, which means that the amount of newly produced amniotic fluid also sharply decreases.

Why is oligohydramnios dangerous?

Depending on the degree of amniotic fluid deficiency, various pathologies of fetal development occur. The umbilical cord can become trapped between the wall of the uterus and the fetus, leading to oxygen starvation of the baby. When pronounced, the baby is squeezed by the walls of the uterus, which causes curvature of the spine, clubfoot, and in some cases even fusion of the skin with the amnion. In this case, simonart's ligaments are formed - when a child tries to change position, they can twist around him, causing severe injury.

” Even when the baby is developing normally, lack of water can significantly complicate the course of the birth itself. Lack of amniotic fluid leads to the fact that the fetal bladder does not press on the cervix ("flat" fetal bladder), its opening slows down or does not occur at all.

What tests need to be done with oligohydramnios

If there is a suspicion of leakage of fetal fluid, then a vaginal smear is done to reveal the content of amniotic fluid.

Suspicion of infectious diseases is supported by tests for viral and bacterial infections - first, the expectant mother must pass at least a general blood test.

If you know about the chronic diseases of the mother, which can cause oligohydramnios, then tests are carried out that will reveal the degree of their exacerbation.

Finally, it is important to monitor the baby's condition: for this purpose, the doctor may prescribe CTG (cardiotocography, showing both fetal heart contractions and uterine contractions), vascular Doppler sonography and amnioscopy to assess the quality of the amniotic fluid.

How oligohydramnios is treated

First of all, it should be noted that the volume of additional liquid drunk by the mother does not in any way affect the amount of amniotic fluid. With moderate low water, regular observation is important: if the situation worsens, the mother will most likely be offered to go to the hospital. In addition to the specific treatment associated with the diseases found in a pregnant woman, general recommendations for oligohydramnios are as follows.

Bed rest or a decrease in physical activity, so as not to provoke an increased leakage of amniotic fluid.

Healthy nutritious food, taking vitamins.

Taking medications aimed at reducing the tone of the uterus and improving blood microcirculation - they should compensate for the lack of placental nutrition associated with oligohydramnios.

Prevention of the development of intrauterine infections.

With prolonged pregnancy - initiation of labor.

Low water is not a disaster yet, although, perhaps, the mother will have to spend most of her pregnancy in a hospital. A positive attitude, adherence to medical recommendations and, most likely, pregnancy can be safely maintained until the due date, and the damage to the child's health will be minimal.

The woman's body was originally conceived by nature for the birth of a new life in it, its formation with subsequent development and a successful birth. Everything in the female body is fine-tuned so that the baby, as it grows in the mother's tummy, feels comfort and is maximally protected from the influences of the external environment. Such functions are performed by and, in which the baby swims and tumbles freely during pregnancy. And in order for the baby to develop according to the norm and not experience any inconvenience, there should be not much amniotic fluid (and this is how amniotic fluid is also called), but not enough, but in the quantities in which nature was originally provided.

Amniotic fluid is a necessity, an obligatory fluid to ensure the normal development of the baby. Amniotic fluid is a kind of nutrient medium, consisting of oxygen, vitamins, hormonal compounds, salts. In addition to the "nutritional" function, the amniotic fluid also plays a protective role - amniotic fluid protects the baby from the effects of multiple negative factors and infectious agents. As pregnancy progresses, the amount of amniotic fluid changes - depending on the timing and needs of the baby. And the doctor is obliged to monitor these changes, because a decrease (low water) or an increase (high water) in the amount of amniotic fluid can threaten the development and even the life of a child, cause serious complications.

Low water during pregnancy, as the name suggests, is defined as a decrease in the volume of amniotic fluid. Low water can be moderate and pronounced, moreover, moderate low water during pregnancy is more common. With moderate low water, a slight decrease in amniotic fluid is observed, which, of course, is less dangerous than severe low water. However, moderate lack of water during pregnancy can cause no less hassle, and complications of pregnancy may well cause, affecting the intrauterine development of the fetus. So, often the result of moderate low water during pregnancy is the birth of a small baby. Other consequences of moderate low water can be curvature of the spine, hip dysplasia.

But you shouldn't panic ahead of time - in most cases, pregnancy with moderate lack of water ends well, the baby is born in a satisfactory condition. Of course, subject to a timely response to the problem, correct behavior of the expectant mother, regular visits to the doctor and the implementation of all his recommendations.

Even if a woman at the next heard the diagnosis "moderate lack of water during pregnancy", it should not be considered final. So, it is necessary to undergo a second examination - in another clinic and under the guidance of another doctor. Also, the doctor may prescribe vascular doppleography (to eliminate the slowdown in the development of the baby) and cardiac monitoring (to assess the general condition of the fetus). If possible, together with your doctor, you should determine the likely prerequisites that led to moderate oligohydramnios during pregnancy.

The reasons for the development of moderate low water are not fully understood, but the most probable may be: high blood pressure; sexually transmitted infections (even those infectious diseases that the mother suffered from before pregnancy, and which were not completely cured), chronic inflammatory diseases of the mother (gynecological, urinary). Also, the reasons for the development of moderate low water during pregnancy include the problems experienced by the fetus - chronic hypoxia in the baby, disorders and anomalies of its intrauterine development.

The first and most important step in confirming moderate low water during pregnancy is changing the mother's lifestyle and eating behavior. So, a woman with moderate lack of water is simply obliged to eat foods containing sufficient amounts of vitamins and minerals. Also shown is a sparing regimen and sufficient rest, avoiding stressful situations and nervous stress. And the most important thing is regular observation by the attending physician, which will avoid the deterioration of the condition.

Specially for- Tatiana Argamakova