Normal number of accumulate waters. High bone, mm. Amniotic fluid index - why know it
The child in the womb is in the amniotic fluid - these are the ambrid waters surrounding the embryo and necessary for the normal existence of the baby in the intrauterine period. Amniotic fluid performs protective and metabolic function. Water absorbs the noise and shocks the blows, protects the fetus from infections, maintains a comfortable temperature.
The exchange function lies in the nutrition of the embryo: it swallows the amniotic fluid together with the nutrients contained in it and then highlights it back. With a sufficient amount of accumulating waters, the embryo is reliably protected and provided with optimal conditions for development.
What is the indicator of an exercise, what is it needed for?
Where does the accumulating fluid come from and what does it consist of? In terms of composition and properties, intrauterine water at the beginning of the gestational period are similar to the plasma: they contain vitamins, hormones and enzymes. In the second trimester in the waters there are cells of dead skin, embryonic lubricant, toddler lins and its livelihoods. Updated amniotic fluid every few hours. In this case, the amount of water must comply with a certain norm, depending on the period of pregnancy. With a small amount of water, there is a risk of infection and even the death of the fetus.
To determine the rate of accumulating water, the indicator of the IAZH is an amniotic fluid index. It allows you to control whether the number of accumulating waters in the woman in labor or the embryo suffers from the lowland either multi-way. How many pregnant intrauterine waters are determined by ultrasound.
Methods for diagnosing an amniotic fluid index
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Subjective method
Determination of the index of the accumulating water occurs with the help of an ultrasound. That is why it is important to pass all the necessary ultrasound studies on time: a planned ultrasound allows you to diagnose the lack of accumulating waters and take the necessary measures to prevent the pathologies of the fetus. The specialist will examine the uterus in different planes and visually determines the volume of the fluid, visually assess the thickness of the aqueous layer between the embryo and the abdominal wall and will make a conclusion about the lowland or multi-way. This method of diagnostics is not accurate, so it should not be relying on it.
Objective way
The determination of the volume of octuroper water with an objective method according to ultrasound is carried out by separating the uterine cavity into 4 equal segments. The stomach is divided into squares, the axis of markup is carried out through the middle vertically and through the navel horizontally. In each square, the space is chosen free from the fetus, and the maximum distance from the child is measured to the wall. The four indicators obtained (the depth of the "pocket" in each square) is summed and find the general value of the amniotic fluid index.
IAU norms in susceptibility from pregnancy week
The norms of the amniotic fluid index are changing throughout the pregnancy. What time limit is maximized? The first 27 weeks the index grows smoothly, and then by 30-32 weeks of gestation begins to decrease. The average of 36 weeks is 13.8 cm. By 40 week, the indicator reaches its minimum value.
The exemplary standards for each woman are different and can be slightly smaller or more average, which is permissible. The amount of amniotic fluid (in centimeters) at different times is given in the table below.
| Number of weeks | Middle, cm | Possible range of oscillations, cm |
| 16 | 12,2 | 7,20-20,2 |
| 18 | 13,4 | 8,1-22,1 |
| 20 | 14,2 | 8,7-23,1 |
| 22 | 14,5 | 9-24,1 |
| 24 | 14,8 | 9,1-24,3 |
| 27 | 15,6 | 9-24,5 |
| 30 | 14,5 | 8,3-25 |
| 32 | 14,5 | 8,0-26,8 |
| 33 | 14,4 | 7,4-27,5 |
| 34 | 14,3 | 7,3-27,4 |
| 35 | 14 | 6,9-27,2 |
| 36 | 13,8 | 6,8-27,1 |
| 40 | 12,1 | 6,4-24,5 |
Causes of possible deviations
The volume of accumulating water may deviate up to increase or decrease. Excessive accumulation of amniotic fluid (multi-way) is not as often as low. The excess of the fluid leads to a berium prevention, contributes to early childbirth, as well as fetal hypoxia and, accordingly, the pathologies of its development. Causes of multi-way: intrauterine infection, conflict of rhust factors of women and baby, diabetes, immune diseases, strong impairment of metabolism in the parent organism.
The state is considered to be a state when the volume of waters originates 2000 ml. Multi-way arises in the second half of the gestation and is clearly diagnosed in 34-35 weeks. In this case, the IAA indicator may exceed the average value of 2 times. Waters in some cases - more than four liters. It is necessary to conduct treatment aimed at the regulation of placental uterine circulation.
With a shortage of the accumulative fluid develops at least agencies. Causes of small amounts of amnimization in pregnant women:
- depressurization of the fetal bubble shell and leakage of fluid;
- fruit shell defects;
- kidney pathology in the baby and the blockage of the ureters of the embryo;
- kidney diseases or cardiovascular system in a woman;
- late toxicosis (starting from 33 weeks);
- blood impairment in the placenta (fetoplacentage failure).
Major can be moderate and strongly pronounced. A moderate degree involves a minor deviation of the volume of intrauterine fluid from permissible values. This is not a big danger: water renewal occurs regularly, their quantity changes and depends on the individual characteristics of the woman. Strongly pronounced lowland is observed, most often, at the end of pregnancy.
The amniotic fluid index can reach the values \u200b\u200bin half the smaller average norm. This degree of pathology is a threat to the baby and may cause complications during childbirth.
Related symptoms Pathological deviations in the volume of amniotic fluid
With multicastly, pregnant women have shortness of breath and attacks of tachycardia. Feet and face swelling hard. The woman strongly adds in weight and can complain about pulling pain in the groin. The stomach becomes very large and covered with stretch marks. General well-being - apathetic, weak; Violated night's sleep.
With a strongly pronounced, the stomach has small sizes, the bottom of the uterus is lowered. Fetal movements are weak, unworthy. The child suffers from oxygen starvation and weightless weight. In rare cases, it is possible to dry the skin of the baby and his battle with a fruit sheath. Most often, the fruit is in the buttock preview. If lowland is caused by the legend, the woman will notice the colorless discharge from the vagina.
In the study of the discharge from the vagina (amniotest), a placental protein is found - a faithful symptom for the leakage of amniotic waters. Birth with a scant amount of water flows with complications: the neck is revealed slowly, the fights are painful, childbirth long. With docking pregnancy and damage to the fetal shells, when the water treatment is present, the question of stimulating childbirth and artificial activation of generic activity is solved.
IAE does not match the norm: what to do?
When identifying the deviation of the IAA from acceptable values, a comprehensive examination of the future mother should be carried out in order to identify and eliminate the causes of pathology. In cases where the oily water is formed in excessive amounts, it is important to normalize the proper nutrition of the woman and adjust its drinking mode. The feminine will be assigned a course of vitamins (C, E, B), drugs containing magnesium and diuretics. In the presence of intrauterine infection, the course of antibacterial therapy is shown.
Moderate lowland during gestation involves a slight change in the volume of water. In this situation, the woman in labor is enough to adjust the diet and routine of the day - in most cases, the exercise will rise to permissible limits without prejudice to the health of the fetus. A woman with a strongly pronounced lowland is defined in the hospital to prevent complications from the kid. Conduct therapy of fetoplacentage insufficiency and try to maintain the fetus as much as possible so that it becomes ready to appear. When pregnancy, more than 33 weeks are made a decision to stimulate generic activities.
In the formation and exchange of accumulating waters, all the structures of the Unified System "Mother - Placenta - Fruit" are actively involved: Maternal organism; amnion (cells lining the fetal shell); the fetus (the kidney of the fetal in the last period of pregnancy is produced on average 600-800 ml of urine, which is highlighted in the amniotic cavity, while in 1 hour, on average, the fetus swallows 20 ml of water; fetal skin up to 24 weeks of pregnancy also participates in exchange Water processes, sucking some of their number until its oroging occurs, after which the skin becomes impermeable for amniotic fluid).
Structure the accumulating waters change during pregnancy. If, in the early periods, the amniotic fluid in its chemical composition is similar to the plasma (liquid part of the blood) of the mother, then by the end of pregnancy in large quantities it contains the urine of the fetus. Oxygen, carbon dioxide, electrolytes present in the blood of mother and fetus, proteins, lipids, carbohydrates, enzymes, hormones, vitamins, biologically active substances, phospholipids, blood coagulation factors, epithelial cells, broken fruit , secrets of the fetal gland glands, fat droplets, etc. The concentration of one or another component of the accumulative water depends on the period of pregnancy.
Volume amniotic fluid increases by the end of pregnancy, reaching the maximum value of 38 weeks, then, closer to childbirth, it can slightly decrease. Normally, in 37-38 weeks of pregnancy, the volume of accumulating water is 1000-1500 ml, despite that at 10 weeks it was only 30 ml, and in 18 weeks - approximately 400 ml. Under the transferred pregnancy, there is a decrease in the number of accumulating waters, with different pathologies of pregnancy, the volume can occur both in the direction of increasing and towards the decrease.
Why do you need oily water?
The accumulative water not only provide the metabolism between the fruit and mother, but also perform the function mechanical protection you , protecting the fruit from external influences, preventing the body of the fetus from the compression by the walls of the uterus and being a shock absorber in the cases of mom's falls, that is, the oily water can smooth the push or a blow, transmitted to the fetus when shuffling in the stomach or drops. Of course, the "degree of protection" in this case is not large, that is, when hitting a large force, the integrity of the fruit bubble can break.
Fercent bubble contributes to the opening of the cervix in childbirth, playing a role hydraulic wedge in the first period of childbirth (during the revelation period of the cervix). He also protects the fetus from infection, being physi-General Barrier in the way of spreading infection, which can fall into the uterine cavity from the vagina and cervix.
Diagnostic methods with accumulating waters
To diagnose the course of pregnancy, the quantity, color, transparency of octoperwater, their hormonal, biochemical, cellular composition, etc. have great importance. In the arsenal doctors there are various diagnostic methods.
Ultrasound.Much attention is paid to ultrasound the number of spindle water Since the dependence between this parameter and the pathology of pregnancy is revealed: transferred by pregnancy, gestosis (it is manifested by an increase in blood pressure, edema, the presence of protein in the urine), the hypoxy of the fetus (the state of oxygen famine of the fetus in the mother's womb). The amount of water is estimated in the size of the free sections of the octic flooded water (the so-called "pockets" or "packets").
When ultrasound can also be assessed homogeneity (homogeneity) acid water.
The presence of suspension in waters most often indicates infection.
Amnioscopy. This is an inspection of the lower pole of the fetal bubble and the accumulating waters using a special device, which is entered into the cervical channel through the vagina. Such a study makes it possible to evaluate the color of the oil-free waters and their number. With oxygen deficiency of the fetus, the oily water acquires the green color due to the impurities of the micronium (original feces). Amnoscopy is carried out, as a rule, at the end of pregnancy, when the cervix is \u200b\u200balready preparing for childbirth and can miss an optical apparatus - an amnoscope.
Amniocentesis(From the Greek words "Amnion" - a fruit shell and "Centrey" - puncturing). This puncture (puncture) of the fruit bubble, the purpose of which is to take the accumulative water for diagnostic research: biochemical, hormonal, immunological, cytological, to have an idea of \u200b\u200bthe state of the fetus and determine the further pregnancy. Indications for this procedure are: resoud Flict ; In this case, the content of bilirubin in the oilyoploid waters is determined (it increases as the concentration of bilirubin, isolated by the kidneys of the fetus, is determined, which serves as an indicator of the severity of the process flow); The study also defines the fetal blood group, the number of antibodies to the rhesus - factor; suspicion of chromosomal pathology of the fetus; suspicion of chronic hypoxia of the fetus (oxygen deficiency); the need to determine the absorption of light fetus when there is a question about early childbirth; At the same time, the concentration of phospholipids in the oilyotic waters and their ratio is determined.
Amniocentesis is made under the ultimate control, through the front abdominal wall or front either rear vaginal arch: the place of puncture is selected based on the location of the placenta. Before the operation, the bladder is empty in order to avoid its injury, the skin is treated with antiseptic solution, make local anesthesia with a solution of novocaine, then puncture the front abdominal wall, the walls of the uterus and the fruit bubble with a long thick needle; In the syringe are gaining 15 ml of water. The procedure is invasive (i.e. is accompanied by a bunch of the abdomen wall, the walls of the uterus, the introduction of the uterus in the cavity), it may entail various complications (mainly it is a miscarriage or premature genera, the infringement of the oily water, infection of the fetal shells, the injury of the fetus vessels and As a result, internal bleeding, injury of the bladder or intestines of the mother). In modern conditions, these complications are found very rarely, thanks to the introduction of ultrasound controls, compliance with the rules of asepsis and antiseptics.
Amniocentesis is not carried out in the threat of miscarriage or premature genera, when the placenta or myomatous node is located on the front abdominal wall, the vices of the uterus, the results of smears and bakposev from the vagina and the cervical canal, indicating the presence of an inflammatory process. After the operation, the hospitals are recommended for several days (up to 1 week), preparations are prescribed, relaxing the uterus, if necessary - Nibiotics.
Malotion during pregnancy
Anywood is called the reduction in the amounts of accumulating waters of up to 500 ml and less as a result of the balance of the balance between their suction and development. Most often, this state is observed in younger pregnant women with increased arterial pressure in the third trimester of pregnancy and in women with an increased risk of developing the hypotrophy of the fetus (lag of the fruit of the fetus from normal for this period).
First of all, when suspected, it is necessary to exclude congenital malformations of the fetus, especially if it is detected in the second trimester (up to 28 weeks) of pregnancy, because sometimes pronounced lowland can be combined with such vices as kidney polycystosis or their absence. Major, as well as multi-way, can be a sign of intrauterine fetal infection, so it is necessary to conduct a survey on
thus infection. Major can arise against a reduction in the separation of urine fruit into an amniotic cavity in chronic hypoxia, which is observed when the fetus intrauterine growth is delayed. In 40% of women with a lowland, the lag behind the size of the fetus from the norm is noted. Because of the sharp decrease in the volume of spindle water, the burst compression may occur (compression between the fruit and walls of the uterus), which may entail acute oxygen deficiency and fetal death; Extremely rarely formed spikes (fits) between the walls of the uterus and the fetal skin.
Since at least a fruit bubble "flat", it does not perform the function of the hydraulic wedge, does not contribute to the disclosure of the cervix, as a result, the risk of weakness of labor activity arises. Due to the violation of the active motor movements of the fetus in the uterine cavity, the frequency of pelvic premiums increases, and, as a result, in some cases of cesarean operations. More often to operational acquisitions, at least a weakness of generic activity and intrauterine hypoxia of the fetus are given. Major can be primary (observed with entire fetal shells) and secondary, or traumatic (as a result of damage to the fetal shells with a gradual expiration of water, which sometimes remains unnoticed by a woman: the accumulating waters are accepted for her).
Diagnosis Maldia is mainly based on the Uzbar. However, during an inspection, the doctor may pay attention to the fact that the standing height of the bottom of the uterus and the abdominal circle is lagging behind normal for this period of pregnancy, the motor activity of the fetus, the uterus during palpation is dense, are clearly determined by parts of the fetus and heartbeat. With a vaginal study in childbirth, a "flat" fetal bubble is determined, stretched on the head of the fetus.
If the lowest is detected by up to 28 weeks of pregnancy, a comprehensive examination of a pregnant woman is being carried out to determine the possible cause and evaluation of the state of the fetus. When determining the malformations of the fetus, pregnancy is carried out under medical testimony. With a combination of low-voltage with intrauterine hypoxia and a retention of a fetal growth, appropriate therapy is carried out to 33-34 weeks of pregnancy, and if the treatment is ineffective and the state of the fetus deteriorates - early delivery. In childbirth, the "flat" fetal bubble is opened to prevent the weakness of generic activity.
With severe forms of placental insufficiency and intrauterine hypotrophy of the fetus, drip intimenional administration of amino acid solutions after pre-removing the amount of fluid equal to the input. Attempts by paraglotary oxygenation of the fetus in kinds for the treatment of chronic oxygen deficiency of the fetus by introducing into the amniotic cavity of oxygen-free waters, saturated with oxygen. These methods have not yet been widely used and need further research.
Multi-way during pregnancy
It is bad not only a decrease in the number of accumulating waters, but also its increase. The volume of water exceeding 1500 ml is considered. Most often, this is a non-flopful pregnancy, diabetes mellitus in mothers, rescus conflict pregnancy, with intrauterine infection, fetal development anomalies.
With anomalies (vices) of the fetal development, the process of gas in the fruit is disturbed, as a result of which the balance between their development and elimination changes. When examining the height of the bottom of the uterus and the abdomen circumference exceeds normal for this period of pregnancy.
The fruit is actively swimming in the amusement waters, which is why the cord of the umbilical cords can occur around the neck, the body. In case of suspicion of a multi-way, the doctor clarifies the diagnosis with the help of an ultrasound, while eliminating the intrauterine infection, the malformations of the fetus. Due to the strong stretching of the fetal shells with a pronounced multi-way, an untimely oral influence can occur. Premature genera are also possible, premature detachment of a normally located placenta, loss of small parts of the fetus (handles, legs) and umbilical umbilical umbilical systems (therefore, after expulsion of water, a vaginal study is required). When identifying the development of the fetus incompatible with life, pregnancy interruption is carried out. If the cause of the multi-stranded is the intrauterine infection, treatment is carried out taking into account the detected pathogen. Birth with multi-ways may be accompanied by weakness of generic activities due to severe stretching of the uterus, as a result of which its reduction and excitability decreases. Based on the foregoing, it is often necessary to open the fret bubble. This is done very carefully, the water is slow, after which a vaginal study is carried out to exclude the falling out of the handles, legs, cord loops. In the postpartum period, cutting drugs are introduced with the aim of preventing postpartum bleeding, as the operated uterus is poorly reduced.
How is the expulsion of water
Normally, the accumulative water is poured in the first period of birth (until the cervical disclosure of the uterus, but not before the opening of the neck is 4 cm). At the altitude of one of the bubble bubble becomes tense and bursts. As a result, the front waters are poured, which are between the fetus head and the fetal bubble shells. "Born in a shirt," they say about the children who were born with a whole fruit bubble. In modern conditions, if the woman does not give birth at home, but in the hospital, such a very rarely occurs (the exception is rapid childbirth), since if the cervical disclosure is complete, and the bubble is still intact, then the obstetrics themselves open it: at the birth of "in a shirt" Frenet shells overlap oxygen access to the fetus. Pullen water before the start of generic activity (up to the bouts) is considered prenatal or premature, and if the water strengthened at regular fights, but with insufficient disclosure of the cervix, they say about early royalty free. In these cases, it is necessary to monitor the lack of anhydrous period: it should not exceed 12 hours, since with a long-term anhydrous gap increases the probability of infection of the fetal shells, uterus, fetus. Therefore, in the event of an influence of arrogant water at home, a woman needs to immediately go to the maternity hospital. In the prenatal influence of accumulating waters, glucose-vitamin-hormonal background is usually created; For this, glucose, vitamins, hormones, preparing generic paths are administered intravenously and intramuscularly. If the bouts do not begin, it is carried out by the reception of drugs intravenously with a dropper. In the event of the ineffectiveness of such therapy, the cesarean section is carried out.
ABOUT high breaking of the fetal shellsthey say when the fetal bubble is torn not in the lower pole, and above. If there are doubts, this is water or simply liquid blenced from the vagina (a typical situation with a high side break of the fetal shells), it is necessary to go to his doctor, pre-laying the "control" diaper to show the character of the selection. In doubtful cases, smear is taken from the vagina for the presence of accumulating waters or amnestest .
If the leakage of the accumulation waters is confirmed, and there is no bouts, the doctor solves the question of further making pregnancy depending on its term. Up to 34 weeks, obstetrics are doing everything possible to extend pregnancy, since the light fetus immature and after childbirth, breathing disorders can be discovered. The woman is under constant supervision (the body temperature is measured, the blood leukocyte content is carried out in the blood, a clinical analysis of blood, an ultrasound, CTG - the study of the heart activities of the fetus, the study of sexual tract sections on infections), the future mother is prescribed strict bed regime in stationary conditions, The need is antibacterial therapy, drugs that accelerate the ripening of light fetus. If there are no conditions for renewing pregnancy, a surfactant applies to the prevention and treatment of respiratory disorders of the newborns. In the absence of signs of infection and sufficient water in the fruit bubble on the ultrasound, pregnancy can be extended to 34 weeks. If, as a result of the study, it is found that the uterus tightly covers the fetus, and there are no water, it is impossible to wait for more than 2 weeks even in the absence of signs of infection (however, this situation is extremely rare). Under a period of 34 weeks and more when weaving the waters, a woman is preparing for the upcoming birth.
Thus, the accumulating water is not only the habitat of the baby, but also help to diagnose various "malfunctions" during pregnancy. Your doctor will control their number and in the case of a deviation from the norm, will take the necessary measures.
The amnitest is the method by which the presence of α - microglobulin is determined in the separated from the vagina, which is normal in the vagina.
Sterile tampon is placed in the vagina for 5-10 minutes, then with the help of a test strip by the express method determine the result. If there is in the contents of the vaginal secretion of a placental α - microoglobulin in the test bar, the test bar appears in the test strip.
Determination of the amount and quality of ammunition water during pregnancy is an important component of the control of the child to wear the process. Amniotic fluid (the scientific name of the octoped waters) performs many very important functions during pregnancy. Probably, all future mothers are familiar with this term, and some have to meet with some of the pathologies associated with this indicator. So what are the oily water, and why are they so important to wear a baby?
What is oily water
Consider where the amniotic fluid comes from and what it consists of. After attaching the fertilized egg to the wall of the uterus, its division begins. In this case, embryo, umbilical cord, placenta and fetal shells are formed. Ferny shells are a hermetic bubble, which is filled with sterile liquid. On the 13-14 days of pregnancy, the bubble fills the entire uterus, and until the end of the 14th week of pregnancy, the amniotic fluid seeps into the body of the baby through his skin. The skin of the fetas becomes thicker, and the water falls into its body by other paths, in particular, according to the digestive tract.
The amniotic fluid is formed as a result of the height of blood plasma from the blood vessels of a woman. In the last trimester of pregnancy in the production of arrogant waters take part lungs and kidney kid.
At the beginning of the generic process, after breaking the fruit bubble, the liquid penetrates into the generic paths and wash them. It helps the child move forward.
The rate of ammunition for pregnancy
The volume of amniotic fluid depends on the period of pregnancy. Thus, the rate of accumulating waters at the 10th week of pregnancy is about 30 ml, on July 13-14 - 100 ml, at the 18th week - 400 ml, on the 37-38th week - 1000-1500 ml. However, by the end of the pregnancy, as a result of increased release of fluid from the body of a woman, the volume of ammunition can decrease to 800 ml.
Deviation
The volume of amniotic fluid is an indicator of the course of pregnancy. Sometimes at the future mother there is a small one or a multi-way.
Malovodie
Anywood is called a decrease in the volume of spindle water, which is associated with impaired their formation and suction. Especially dangerous at least in the 18-26th weeks of pregnancy. It can lead to the interruption of pregnancy, the intrauterine death of the fetus or the death of the child in the first day of life. In addition, sometimes lowland contributes to the development of intrauterine fetal defects, intrauterine infection. With moderately small, the child can be born with hypotrophy of varying degrees, that is, the inconsistency of the size of its body to this period of pregnancy.
The main causes of the lowland call the development of such diseases in mom, like prestosis, hypertension, infectious inflammatory diseases, chronic inflammatory ailments. Diagnostic Maloveodie most often on ultrasound. Tactics of therapy depends on the term of pregnancy and its other indicators.
Multi-way
For multi-frame, the excess accumulation of spindle water is characterized. The most frequent complications of this state during pregnancy are unbearable and premature childbirth. Rarely, but still, there are circulatory disorders from a woman, which becomes an indication for the interruption of pregnancy.
Most often, the multi-way is found in women suffering from diabetes, infectious diseases, during the reserves conflict, anomalies for the development of the fetus and multiple pregnancy.
Usually, the multi-way is diagnosed on the ultrasound. The treatment method depends on the cause of the multi-way and its degree.
The leakage of spindle water
The amniotic fluid flows out of the fruit bubble as a result of its thinning and the appearance of microcracks on its walls.
The leakage of ferrywater waters in the early periods of pregnancy is a very dangerous symptom, which often becomes the reason for the need for an abortion. In addition, often such a leakage of amniotic fluid is missing, both pregnant and doctor, or accept urine incontinence.
The leakage of accumulating waters on the last weeks of pregnancy is difficult not to notice, since in this case a large amount of fluid is released. Typically, after that the contractions begin.
What is the reason for the leakage of the accumulating waters? Most often, experts indicate the following factors:
- misconception of a child;
- genital infections of a woman;
- chronic diseases and harmful habits of the future mother;
- cervical failure;
- multiple pregnancy.
In order to notice the leakage of the accumulating waters in time, a woman is recommended to wear bright underwear and use a white daily gasket. With the slightest suspicion, you should consult a doctor.
To independently determine the leakage of amniotic fluid, you can use the pharmacy nitrazine test. The doctor clarifies the diagnosis using a microscopy smear study.
The tactics of the treatment of the leakage of spindle water depends on the period of pregnancy and other factors of its development.
Muddy spindle water during pregnancy
Normally, the amniotic fluid must be transparent. However, after the 37th week of pregnancy, its transparency decreases, and a small turbidity appears, which indicates the approaching childbirth.
4.80 out of 5 (5 votes)During pregnancy, the kid, in the tummy, bathes in the oily water. In addition, the baby is so more convenient, and thanks to the waters, it can move, they perform some more important functions:
Water perform the function of depreciation and protect the fetus from external influences (concussions and shocks);
The liquid protects the umbilical cord from the compression between the body of the fetus and the walls of the uterus;
The lower pole of the fruit bubble, in which there are so-called front water (that is, located in front of the fetus head) participates in the generic activity, performing the function of the hydraulic wedge and contributing to the opening of the cervix;
The presence of accumulating waters makes the fight less painful both for the mother and for the fetus.
The fruit surface of the placenta and the fruit shells, which can also be separated and absorbed by water, as well as the fruit, which swallows the amniotic fluid itself, is involved in the formation of the oral water (amniotic fluid). Thus, the water is constantly updated. Fully exchange of accumulating waters is carried out approximately every 3 hours.
Normally, the number of accumulating water is 600-1500 ml. The maximum amount is determined in 37-38 weeks, then it decreases somewhat. At a low, the number of accumulate waters is less than 500 ml, with multi-way - more than 1.5-2 liters. Malotodie is extremely rare, multi-way - more often.
Causes of multi-way and lowland:
The causes of multi-way can be:
Infection (both sexually transmitted diseases and chronic infection in the mother's body);
Malformations of the fetus and chromosomal anomalies of the fetus (most often with multi-way defects of nervous and digestive systems);
Diabetes of mother;
Rhow-conflict pregnancy;
Feto-placental insufficiency;
Malotion may occur when:
Transferred pregnancy;
Infectious process;
Pulks of the development of the fetus (at least more often there are vices of the excretory system and the kidneys of the fetus);
Chronic hypoxia and delay in the development of the fetus, because at the same time he highlights little urine;
Hypertensive disease in the mother;
Feto placental insufficiency;
Smoking during pregnancy;
When identifying the lowland, it is necessary to eliminate the disruption of the integrity of the fruit bubble and the leakage of the accumulative water.
Often the reasons that caused many or low are more dangerous than in itself the "wrong" amount of water, therefore a thorough examination is always carried out on identifying the cause.
Clinic small and multi-way
With multi-way The size of the belly increases. Because of this, stretch marks occur more often, the venous drawing on the stomach is reinforced. The doctor during inspection with difficulty provers parts of the fetus, the heartbeat is listened to fuzzy. The fruit easily changes its position (the unstable position of the fetus). A woman with expressed multi-way can feel difficulty breathing, gravity, heartbeat.
With multi-way, the fetal position is often observed: cross or oblique position, or pelvic preview. Excessively free movement of the fetus in a large amount of liquid can lead to a hitch of umbilical cords around the neck or fetal body. Due to the strong stretching of the fruit shells, the premature oral influence and premature childbirth occurs more often. Due to the strong stretch of the uterus, its contractile activity deteriorates, which can lead to weakness of labor activity. In severe cases, when waters are very much, due to the pressure of an enlarged uterus, hypoxia (lack of oxygen in the blood) may occur, which causes or weighting the hypocia of the fetus.
At lowland The dimensions of the abdomen lag behind the norm. Motor activity of the fetus may decrease, since the baby is "closely". Sometimes the motion of the fetus can cause a woman pain.
At least such a complication may occur as a complication of umbilical cord between the fruit and the walls of the uterus, which can entail acute oxygen deficiency and fetal death. Since with a small amount of water, the frozen frost in the uterus and its movement is difficult, the newborn is more often the curvature of the spine, problems with hip joints, Krivoshoy, closure. If the lowland appears in the second trimester of pregnancy, the intrauterine fetal death often occurs.
The lower pole of the fetal bubble with a flat one is flat and cannot perform its function of the hydraulic wedge during childbirth, it is opposite it delays the head promotion, so the weakness of generic activity arises.
Typically, the number of accumulating water is determined by the ultrasound.
Ultrasounds are determined by such indicators as a vertical pocket (VC) and an amniotic fluid index (IEA). Vertical pocket is the maximum area of \u200b\u200bfree fluid between the fruit and the front abdominal wall. Normally, it is 5-8 cm. Jews is a more accurate indicator, it constitutes the amount of values \u200b\u200bof vertical pockets in four quadrants of the uterus (the uterus is conditionally divided into 4 parts, and each measurement is measured the maximum vertical pocket). The norms of this index are their own for each period of pregnancy (they can differ slightly on different devices). On average, the exercise is normally 5-24 cm.
VK and IAI is not 100% methods of diagnosis Multi-and low. Sometimes errors are possible.
Since multi-way, and lowland, there may be signs of anomalies for the development of the fetus, on ultrasound, they are particularly carefully studying the anatomy of the fetus. If, in addition to the "wrong" amount of water, some other signs of chromosomal anomalies are detected, the woman is sent to the cordocentsis - the blood test from the umbilical system, in which the genotype of the fetus is determined.
Treatment
Treatment is aimed at eliminating the cause that caused a change in the amount of water. Complex therapy of fetotic placental insufficiency is usually carried out, since at least, and with multi-ways, it almost always takes place.
When the infection is detected, antibiotics treatment is assigned. With this pathology, antibiotic treatment can be assigned, even if no infection is detected (which often causes bewilderment in future mothers). The fact is that it is impossible to be examined for all existing microorganisms, and if the doctor does not see any other causes of multi-way, treatment is carried out against infection, since this is the most common cause of multi-way.
If up to 28 weeks revealed the malformations of the fetus, incompatible with life, the woman is offered to interrupt pregnancy.
When identifying other reasons (increase in pressure from mothers, diabetes, rhesus conflict, etc.), the main disease is treated.
An increase or decrease in the drinking liquid to the amount of accumulating water does not affect.
Rhodework
By themselves, many and lowers are not indications for cesarean section. If the fruit does not suffer and the position of the fetus is correct (longitudinal position, head preview), childbirth is carried out through the natural generic paths.
In childbirth, both at least angiodies and in many models are shown amniotomy (tool opening of the fruit bubble). When the lower pole of the fruit bubble is opened, since its shells are tensioned on the fetal head and delay its promotion (flat fret bubble), with a large amount of liquid stretches the uterus and interferes with its contractile activity, so part of the waters need to be released. With amniotomy multi-aliodine, it should be carried out carefully, the water is released on a little bit, otherwise, with a sharp expiration of water, such complications may be such complications as a fallout of umbilical cords, knobs or legs of the fetus or a placenta detachment.
Even despite the amniotomy, with multi-ways and lowers, there is often weakness of generic activities and delayed labor, so you have to resort to stimulation of generic activities, and in the ineffectiveness of stimulation - to the cesarean operation.
With multi-way due to poor cutting, the risk of bleeding in the postpartum period is increased. For the prevention, cutting preparations (oxytocin, methyl ergometrine) are prescribed.
In cases of prevalence of the Fetal State of the Fetal, CTG and Dopplerometry and the ineffectiveness of therapy for several days are resorted to early delivery.
As they say, everything is good in moderation. And the accumulate waters are no exception. Therefore, with "incorrect" their quantities, it is necessary to undergo a survey and treatment.
The rate of oily water during pregnancy depends on its term. You can even find a special plate where values \u200b\u200bare valid for each week. They are determined by uncomplicated measurements during ultrasound research. The doctor in his conclusion necessarily writes the amniotic fluid index normally or not. Talk about what is a violation, what are the possible causes of deviations and how to treat them.
There are two pathologies - multi-way and lowland. When these diagnoses are set, doctors are focused on the inspection data (the length of the uterus, the volume of the abdomen, including the speed of the increase in the size of the uterus, fetus mobility) and the measurement results by the physician of ultrasonic diagnostics.
Pronounced multi-way when an amniotic index is more than 240 mm (the length of the vertical pocket on the ultrasound is more than 800 mm) is a reason to suspect one of the states listed below:
- diabetes mellitational (possibly gestational);
- the pathologies of the central nervous system of the fetus, for this reason he may have no swallowing reflex, which means that the number of accumulating waters is constantly growing;
- heart rate disorders (may be caused by a mass of reasons, for example, water of the fetus);
- pathology of respiratory and digestion in the child;
- chromosomal anomalies.
The last item excludes an ultrasound, conducted in strictly designated terms of pregnancy, as well as triple screening. To eliminate sugar (gestational) diabetes - test for tolerance to carbohydrates. Plus, it is necessary to exclude cytomegalovirus, toxoplasmosis, syphilis, parvovirus, as well as to make a hyperheera test (if there is a probability of rhesus conflict). Naturally, after detection of the cause, it is necessary to eliminate it or at least minimize its harmful effects.
If a multi-way is found, a woman must re-pass an ultrasound after 7-10 days to watch there is no sharp increase in waters. The same fact can be seen by the sharp increase in the abdomen. If so, in this case, the woman is put in the hospital and conduct treatment with indomethacin or / and reduction amniocentesis - remove excess liquid from the fetus bubble.
The causes of the lowland are also included in possible infectious processes in the body of the mother, as well as defects for the development of the fetus. These reasons must be excluded with pronounced lowland. This is especially considered dangerous in the early deadlines. In this case, the lowland is almost always combined with severe fetal defect. Often, a polycystic dysplasia of the kidneys, Potter syndrome and other pathology of the urinary system, are found on ultrasound. The hardest situation when there are no water at all. This condition is called Ahydramnion and is as a symptom of severe fruit disease, as well as the reason for the formation of additional deformations of its development (usually deformities of the skeleton, especially facial bones).
If moderate lowland is fixed on a large period - it is less dangerous. And often it may be an option for the norm if the rest of the ultrasound data is normal and the patient is healthy (the size of the uterus corresponds to the norm, analyzes in order). Knowing what the rate of ammunition waters and the history of women, the doctor will be quite easy to conclude whether it is worth worrying and conducting an additional examination and treatment. If there is a suspicion of the leakage of amniotic fluid, it is necessary to make amniotest.
Often, lowland accompanies gestosis (late toxicosis) of pregnant women. But it is quite easily diagnosed and treatable. But more often a woman with an ultrasound put in the ultrasound give birth to healthy children and after the disheaval of the arrogant waters, it turns out that there was no one (waters more than 500 ml). If Malovodie is true, then a woman is waiting for heavy protracted labor due to the weakness of labor activity. The risk of generic injuries in the child and the gaps of the cervix from the mother is increasing. Unlike multi-way, unfortunately, unfortunately can not be adjusted. In the event of a severe state of the fetus, a big risk for his health and life, a woman can hold