Causes, treatment and consequences of oligohydramnios during pregnancy. Severe oligohydramnios in pregnant women: basic information and recommendations
Many pregnant women are wondering if this frequent scheduled examination by a gynecologist and checking with ultrasound, which, according to some beliefs, harms the unborn cub. Maybe, if nothing bothers, then these analyzes and measurements are not needed? But many problems are outwardly asymptomatic, and they can affect a newborn in a completely unpredictable way and cripple him not only physically, but also mentally for the entire life span allotted to him. This problem also includes low water.
What is amniotic fluid, why is it needed, the volume is normal
The medical term for this concept is amniotic fluid. It is located inside the fetal membranes (bladder) and surrounds the fetus. From this environment, the embryo (human embryo) receives nutrients for early stages development, it also performs a protective function and ensures the comfort of the baby. It is a clear or slightly turbid liquid that contains proteins, fats, glucose, hormones, salts, vitamins, and fetal waste products.
From protective functions amniotic fluid allocate:
- mechanical ( water environment absorb shocks and external pressure);
- infectious (due to tightness and the presence of immunoglobulins in it);
- noise (muffles external sounds).
To ensure favorable living conditions for its inhabitants, the environment creates:
- constant pressure mode;
- constant temperature regime;
- freedom and ease of movement.
The amount of these waters has importance to determine the condition and development of the fetus. The index is used to measure them. amniotic fluid(IAJ).
The amniotic fluid index depends on the gestational age, and, starting from 16 weeks, its value gradually increases, reaching a peak at 32 weeks, and then the AFI values decrease.
Sozinova A.V., practicing obstetrician-gynecologist. More than 12 years of professional experience.
http://diagnos.ru/procedures/analysis/iazh
IAG norms:
- 16 weeks - 73-201 mm (average 121 mm);
- 17 weeks - 77-211 mm (average 127 mm);
- 18 weeks - 80-220 mm (average 133 mm);
- 19 weeks - 83-230 mm (average 137 mm);
- 20 weeks - 86-230 mm (average 141 mm);
- 21 weeks - 88-233 mm (average 143 mm);
- 22 weeks - 89-235 mm (average 145 mm);
- 23 weeks - 90-237 mm (average 146 mm);
- 24 weeks - 90-238 mm (average 147 mm);
- 25 weeks - 89-240 mm (average 147 mm);
- 26 weeks - 89-242 mm (average 147 mm);
- 27 weeks - 85-245 mm (average 156 mm);
- 28 weeks - 86-249 mm (average 146 mm);
- 29 weeks - 84-254 mm (average 145 mm);
- 30 weeks - 82-258 mm (average 145 mm);
- 31 weeks - 79-263 mm (average 144 mm);
- 32 weeks - 77-269 mm (average 144 mm);
- 33 weeks - 74-274 mm (average 143 mm);
- 34 weeks - 72-278 mm (average 142 mm);
- 35 weeks - 70-279 mm (average 140 mm);
- 36 weeks - 68-279 mm (average 138 mm);
- 37 weeks - 66-275 mm (average 135 mm);
- 38 weeks - 65-269 mm (average 132 mm);
- 39 weeks - 64-255 mm (average 127 mm);
- 40 weeks - 63-240 mm (average 123 mm);
- 41 weeks - 63-216 mm (average 116 mm);
- 42 weeks - 63-192 mm (average 110 mm).
What is oligohydramnios, classification
In a situation where the AFI is below normal, we are dealing with oligohydramnios. Statistics show that such cases are 0.3–5.5% (according to various authors). 
The amount of water is determined by the uzist in two ways: subjective and objective
Video: Dr. Komarovsky's commentary on ultrasound during pregnancy
Low water is of two types:
- Moderate (slight deviation from the norm).
- Expressed (less than the norm by 2-3 times).
It can also be:
- Acute (appeared suddenly due to a new causative factor).
- Chronic (it develops slowly and the causative factor cannot be quickly eliminated).
Causes of pathology and possible consequences
What causes oligohydramnios:
- congenital malformations (CM) of the fetus;
- fetal pathologies;
- mother's illnesses;
- delayed pregnancy;
- premature rupture of membranes;
- fetal death;
- pathology of the placenta;
- placental abruption.
For those who smoke or drink alcohol, do not adhere to healthy lifestyle life of women in demolition, the development of oligohydramnios has more likely than women who do not have bad habits.
Almost 50% of pregnancies with oligohydramnios end in miscarriages. In other cases, with very pronounced oligohydramnios, there is a risk of getting an adhesion between the skin of the fetus and the amnion (bladder), the so-called threads or strands. Sometimes strands entangle parts of the fetus and the umbilical cord - disfigurement or amputation of the limbs occurs. 
In the absence of treatment for oligohydramnios, the mother risks giving birth to a physically handicapped child.
When there is little water, the child does not have enough space. The walls of the uterus, as it were, squeeze it, which can lead to deformation of the skull and limbs of the child. Congenital dislocation of the hip (dysplasia), spinal curvature is also not excluded, which in the first months of life will require treatment by a pediatric orthopedist.
Symptoms of oligohydramnios, diagnosis
With oligohydramnios, there is a lag in such an indicator as the height of the fundus of the uterus (VDM), as well as one of obvious signs is a small volume of the mother's abdomen, uncharacteristic for due date pregnancy. These data are analyzed by the gynecologist at each scheduled inspection pregnant. A decrease in fetal activity can also signal a decrease in amniotic fluid.
Spend also laboratory research: they take blood for analysis, according to some indications, amniocentesis is done. 
With the help of a syringe and under the control of ultrasound, not a large number of amniotic fluid followed by karyotyping
Oligohydramnios should be differentiated from an error in determining the duration of pregnancy.
Treatment
It should be noted that the most harmless terms for this pathology are the 1st and 3rd trimesters. In the first case, the fetus is so small that the amount of water has no effect on it, and in the latter, a premature caesarean section is possible without irreparable consequences. With moderate oligohydramnios, too, do not worry.
If you suspect the fact of oligohydramnios, it is necessary to immediately perform an ultrasound scan to exclude fetal developmental anomalies, an analysis for alpha-fetoprotein (AFP) to diagnose fetal malformations and a karyotype for the completeness of the set of chromosomes. If the symptoms of oligohydramnios are mild, there are no fetal abnormalities and the 3rd trimester has already begun, the pregnancy is extended until its logical conclusion in the hospital.
Doctors will look for and treat the medical condition that has led to oligohydramnios. At the same time, the most pregnant woman will be prescribed special medications to improve placental circulation, metabolism in the placenta, to enhance the supply of oxygen and other necessary substances to the fetus.
If severe oligohydramnios is determined in the 2nd trimester and fetal growth retardation (FGR) is detected, the issue of the advisability of maintaining pregnancy should be decided. Similarly, in a period of more than 28 weeks and the detection of congenital malformations and IUGR, pregnancy is interrupted by medical indications.
Prevention, gestation and childbirth
In addition to therapeutic measures, preventive measures are no less important. Avoid stress and overwork, walk daily on fresh air, eat balanced, additionally consume vitamins and microelements in the form of preparations. Your menu should include plenty of liquids, including milk, enough meat and fish, fruits and vegetables. Bad habits must be completely abandoned.
From the 20th week until the end of the 2nd trimester, pay attention to how you feel. If the movements of the child are painful for you, your stomach is very small, there are leaks on the linen, weakness, nausea, constant dry mouth - this is another reason go to the doctor.
Video: comments by professor of obstetrics and gynecology Petrikovsky B.M. about low water
With oligohydramnios, about amniotic sac flat and does not function as a wedge in stimulating and opening the cervix for further delivery, so in 80% of cases, labor lasts longer or with surgical intervention. In 50% of cases with this pathology, a caesarean section (CS) is planned.
Oligohydramnios is not a disaster if the issue of pregnancy as a whole is approached responsibly and in a sound mind. A woman should be registered in a timely manner and be observed by specialists for the entire period, without being lazy or postponing. At the slightest suspicion and peculiarities, do not hesitate to consult a gynecologist or call ambulance if necessary. After all, we don't give birth every day. But what you invest for 40 or less than weeks in yourself, will be an invaluable investment in long years forward for your whole family.
IN obstetric practice oligohydramnios (oligohydramnios) means a reduced amount of amniotic fluid. In the case of a full-term pregnancy at a period of 40-41 weeks, we are talking about a volume of less than 500 ml. For earlier periods, norms are established (with a possible maximum and minimum), determined by special methods which we will consider below.
In quantitative terms, amniotic fluid is a dynamic unit, constantly changing in volume. Their secretion begins approximately from the 8th week of pregnancy, continuing until the onset labor activity.
According to specially created tables, from the 14th week of the onset of pregnancy, the doctor has the opportunity to determine the norm, increased and decreased amount of amniotic fluid in a pregnant woman. If the expectant mother has oligohydramnios for some time, and after some time it is included in the parameters of the norm, then one should think about functional disorders.
note : most of these conditions are not pathological and do not pose a danger to pregnancy.
In case of persistence increased rate within a few weeks, doctors begin to suspect the existing pathology. To differentiate this condition, pregnant women are made, in which the specialist can definitely conclude whether there are any malformations of the placenta and the child or not.
In the presence of pathological oligohydramnios, a complex of malformations of the developing fetus may occur. Ultrasound makes it possible preliminary conclusion. In case of suspicion of true oligohydramnios, the study is necessarily supplemented by cardiotocography (CTG), dopplerometry, biochemical analyzes (ACE, hCG).
Reasons for the development of oligohydramnios during pregnancy
Among the factors that contribute to oligohydramnios, there are several that can be considered in groups:
note : oligohydramnios, caused by most of the reasons, can be successfully subjected to therapeutic effects, except for malformations.
Among the many reasons for this condition, the main ones can be distinguished:
- preeclampsia(toxicosis of pregnancy), leading to loss of fluid;
- in a pregnant woman. Constantly elevated pressure figures leading to a violation of water-salt metabolism, leading to oligohydramnios;
- . Hormonal-enzymatic failures in this condition cause a violation of the formation and functionality of amniotic fluid;
- infectious diseases– sharp forms, bacterial damage to the kidneys (, pyelitis), medium and severe forms viral infections( , – , root , );
- chronic developing child.
Variants of classifications of oligohydramnios
Classification taking into account the duration (speed) of the development of pathology:
- acute oligohydramnios- characteristic of him quick start. In most cases, the acute variant is benign and is treated quite well by eliminating the cause that caused it. Most often, this condition develops against the background of acute infectious processes;
- chronic oligohydramnios- requires a thorough examination of the pregnant woman in order to find a causative pathology. The development of this state is slow and requires mandatory treatment, because without it, it does not go away on its own.
Types of oligohydramnios depending on the timing of pregnancy:
- early - determined for 16-20 weeks from the onset of pregnancy. The detection of pathology at these times is a finding in ultrasound diagnostics. Most probable cause this problem - changes in the fetal membranes. From prognostic positions - a more unfavorable form, due to initial stages organ formation;
- later - from 26 weeks to childbirth. The main reason is the pathology of the fetus. Most often refers to the functional types of oligohydramnios.
Based on pathological changes in the fetal membranes, the following are distinguished:
- primary oligohydramnios(with whole membranes). The occurrence of oligohydramnios in this case is caused by impaired fetal formation, pathology of the placenta, and serious chronic diseases in the expectant mother.
- secondary oligohydramnios- is a consequence of traumatic changes in the membranes.
Most often, doctors are faced with primary oligohydramnios.
Diagnostic criteria for determining oligohydramnios in pregnant women
The doctor may suspect the presence of this problem during routine examinations.
Signs of oligohydramnios are:
- failure to increase the circumference of the abdomen and the height of the uterus in the process of pregnancy. Indicators do not correspond to the deadline;
- insufficient activity of the emerging child (less than 12-10 signs of movement per day);
- low IAI (amniotic fluid index). More about it will be discussed later.
note
: initially suspected oligohydramnios is not a basis for establishing a diagnosis, but only functional disorder. Painful condition confirmed after dynamic observation of the development of pregnancy, based on repeated examinations (at least 3, with an interval of 2 weeks).
If during this time the problem has not gone away, then the specialist has every reason to establish a diagnosis - oligohydramnios.
More accurately given state reveals the ultrasound method. But still, to confirm pathological, and not functional, oligohydramnios, confirmation of 3 studies performed with the above time interval is required.
If, after the first ultrasound diagnosis, the doctor still suspects the onset of the development of true oligohydramnios, then he prescribes cardiotocography (KGT), which accurately determines whether the fetus has a problem or not. If changes in the placenta are suspected, dopplerometry is recommended. With problematic indicators of these studies, you can immediately diagnose pathological oligohydramnios, without waiting for dynamic ultrasound data.
At functional version a pregnant woman is recommended to undergo vitamin therapy and drink Curantyl for a month, then again do an ultrasound. In 95% of cases, oligohydramnios is no longer defined. If there is a pathology, further examination is carried out and the necessary treatment is prescribed.
An additional examination includes the detection and identification of pathogens of infectious diseases by blood tests, the determination of the Rh conflict. Of diagnostic value is the AFP test (alpha-fetoprotein) to detect fetal defects, hCG ( chorionic gonadotropin), to identify placental problems, certain types pathologies of pregnancy, chromosomal genetic abnormalities.
In the most serious cases, amniocentesis is indicated (study amniotic fluid by piercing) followed by karyotyping. This study makes it possible to identify anomalies laid down at the gene and chromosomal levels.
Amniotic Fluid Index Values During Pregnancy
Considering the diagnosis of oligohydramnios, one should mention the determination of the amniotic fluid index (AFI).
Before the advent of the concept of the AFI index, the sonographer measured the longest gap of free amniotic fluid, which is located between the anterior abdominal wall of the mother and the developing fetus ( vertical pocket).
When establishing the IAI, the doctor determines 4 vertical pockets in certain squares of the study. The sum of these pockets is the desired index, which is the main indicator of the presence or absence of oligohydramnios in ultrasound diagnostics.
Each gestational age has a corresponding index, which can be seen in the table:
Note: IAI standards differ in different countries sometimes very significantly.
Low water is established when the index value is below the norm. With a slight deviation (up to 10-15%), the doctor determines moderate oligohydramnios , and when big numbers – oligohydramnios.
At sharply reduced values, it is diagnosed marked malnutrition. It requires the continuation of the examination of a pregnant woman in order to establish in more detail the cause, find the corresponding disease, defect, and determine the prognosis of pregnancy.
Consequences of oligohydramnios
In the presence of severe oligohydramnios long term, it is possible to develop a condition in which the tissues of the developing fetus and fetal membranes fuse. This process is characterized by the growth of connective tissue strands, which begin to fill the cavity, wrap around the umbilical cord, the child. Violations of tissue trophism develop, there is a curvature of the emerging bones, amputation of limbs, developmental delay, and other deformities. Fetal hypoxia may progress.
The earlier oligohydramnios formed, the higher the risk of getting the described complications.
note : it should be noted that the consequence of oligohydramnios cannot be chromosomal and genetic defects, which themselves can be the cause of oligohydramnios.
Thanks to the modern level of medicine, timely diagnosis and methods of treatment of complications, which gives oligohydramnios, in practice, they occur in a queue of rare cases.
Detection of oligohydramnios is rather diagnostic sign than a condition that requires treatment. The primary diagnosis is oligohydramnios, in the absence of detected pathologies, it requires an immediate search for the cause that led to it.
On the later dates oligohydramnios is caused by leakage of water through cystic tears, especially in the case of a post-term pregnancy.
note : decrease in amniotic fluid before childbirth reflects physiological process aging of the placenta, and is not a pathology.
Principles of treatment for oligohydramnios
If diagnostic methods did not reveal the presence of deformities in the fetus, and the woman unconditionally insists on childbirth, then the treatment of oligohydramnios is carried out taking into account the duration of pregnancy.
In the 1st and 2nd trimester on an outpatient basis:
- vitamin therapy (especially groups of vitamins B and C);
- predominantly protein-vegetable diet;
In the 3rd trimester:
- hospitalization in the antenatal ward;
- continued therapy with vitamins and diet;
- Curantyl is prescribed as a means of improving the process of blood circulation in the placental tissue;
- Actovegin is recommended as a drug that promotes active oxygenation of a developing child;
- symptomatic therapy;
- normalization ;
- treatment of all causative pathologies - infectious, and identified diseases internal organs;
During medical measures daily monitoring of KGT is carried out. Other methods - as needed.
If the child's condition worsens, emergency delivery is used ().
The prognosis for functional oligohydramnios is favorable. In other cases, the outcome is determined individually.
Lotin Alexander, medical columnist
Every woman dreams that her pregnancy proceeds easily and naturally, so that no one and nothing can distract the expectant mother from pleasant thoughts about the unborn child. However, in reality, not everything goes so smoothly.
One of the serious complications can be oligohydramnios. About what it is and how to treat it, we will tell in this article.
What it is?
In a broad sense, oligohydramnios is a decrease in the amount of amniotic fluid from the norms characteristic of a particular period of pregnancy. However, in the classical sense of the word, oligohydramnios is considered a small amount of amniotic fluid on the eve of childbirth, at about 39-40 weeks.
When there was no ultrasound, and one could only guess about the amount of water, oligohydramnios was really determined already before the very birth. Now, thanks to the development of diagnostics, to identify the tendency to decrease in water in the fetal bladder is possible already from the 16th week.
Water is needed for normal development child. They are also nature's intended shock absorber, softening the shaking, swaying, which the baby could feel quite significantly when walking or other actions of the pregnant woman, if the water did not interfere with this.
Amniotic fluid begins to be produced around the 8th week of pregnancy, and with an increase in gestational age, it also increases in volume. In the 3rd trimester, there is a slight decrease in fluid, because the uterus is already greatly stretched by a grown child.
Long years of study prenatal development allowed physicians and scientists to calculate the normal amounts of amniotic fluid determined for each period. It is not customary to measure them with standard liquid measures - milliliters, for example.
To assess their number, there is a special parameter - the amniotic fluid index. You can determine it in millimeters starting from the 16th week of the gestational age during the passage of an ultrasound scan.
IAI norms - table:
|
Obstetric period, (week) |
IAI (normal limits), mm |
Obstetric term (week) |
IAI (normal limits), mm |
Since the amount of water in the fetal bladder is not a constant value, at different times in the same future mother can find oligohydramnios, and after a few weeks it is not detected. Such natural phenomenon called functional oligohydramnios. This is the most harmless of all types of this complication.
Usually, with a medical verdict of "oligohydramnios", a woman falls into a stupor. Expectant mothers should be reassured by the following official statistics from the Ministry of Health:
- oligohydramnios is accompanied by about 4% of all pregnancies;
- only 0.5-1.2% of such cases have pathological causes;
- all other women (and the vast majority) perfectly carry and give birth to healthy children, since their oligohydramnios was physiological.
Pathological oligohydramnios is considered to be a persistent insufficient amount of amniotic fluid, which can be registered repeatedly at various times, starting from the 16th week.
Classification
Oligohydramnios can be acute if it appears suddenly under the influence of negative factors, but it can develop gradually and almost imperceptibly, and then it will qualify as chronic.
With acute oligohydramnios, the body of a pregnant woman can respond to viral disease, flu or SARS, from which the expectant mother could not protect herself during the period of bearing the baby. This disruption is usually temporary and does not mean that the baby has pathologies.
More dangerous chronic oligohydramnios. It usually develops due to problems that cannot be called quick-fixed - mother's diabetes, obesity, as well as malformations of the child and its prolonged hypoxia. Such a disorder will not go away on its own, it definitely needs treatment. Also, a violation may be early if it was detected between 16 and 20 weeks and late if the problem was detected only after 26 weeks.
In the case of early oligohydramnios, the forecasts of doctors are less optimistic, because the process of formation of the internal organs and systems of the baby has not yet been completed.
Severe oligohydramnios at an early stage, it can be an indicator of gross genetic abnormalities in the baby, and therefore such a “find” on ultrasound needs a detailed study through other diagnostic methods. In the later stages, the violation is often functional, quite natural, it can be easily corrected or goes away on its own.
Sometimes the development of such a violation is affected by the fetal membranes, or rather their integrity:
- if they are not changed, not injured, then doctors talk about primary oligohydramnios;
- if the shells are damaged and water leaks, this is a secondary violation.
Primary oligohydramnios occurs in 80% of cases. According to the quantitative indicator of deviations from the norms indicated in the table, moderate and severe oligohydramnios are distinguished.
Causes
The reasons for the decrease in amniotic fluid so important for the baby are diverse. These can be malformations of the child, his diseases, pathologies of the placenta, as well as diseases of the expectant mother, both acute and chronic.
Some genetic, including chromosomal disorders that arose during the period of conception, during the formation of the genetic code, the karyotype of the fetus, occur precisely against the background of a decrease in the amount of amniotic fluid.
In particular, such defects as lead to the development of oligohydramnios misdevelopment urethra and its valves, as well as abnormal narrowing of the baby's urethra or her complete absence, solidary (on both sides) narrowing of the ureters or anomalies in their structure.
Severe oligohydramnios is observed in pregnant women if, due to the “mistake” of nature, the baby has no kidneys as such.
Polycystic kidney disease of the baby (Potter's syndrome) is also a very obvious cause of pregnancy failure. Among chromosomal anomalies, oligohydramnios is most often accompanied by Down syndrome and Turner's disease.
If everything is in order with the genetics of the baby, and this was confirmed using other diagnostic methods, then doctors consider the likelihood of infection of the fetus. The most dangerous in terms of the risk of oligohydramnios are cytomegalovirus infection and chlamydia. The lag in the amount of water from the norm often occurs with a delay in the development of the fetus.
The main maternal ailment that can lead to oligohydramnios is preeclampsia. Besides similar condition can cause venous insufficiency, a tendency to form blood clots, diseases of the cardiovascular system.
Adversely affect the amount of water and kidney ailments in the expectant mother, and diabetes. Dehydration can also cause a decrease in amniotic fluid, as well as smoking, with which some of the expectant mothers, even while in " interesting position', so they can't say goodbye.
Pathologies of the placenta lead to oligohydramnios - insufficiency, heart attacks of the "children's place", any anomalies in its development that occurred during the formation of this temporary organ at the very initial stages.
Among other reasons that can lead to such an unpleasant complication of pregnancy are overgestation, in which natural aging of the placenta occurs, injury to the membrane of the membranes of the bladder, the mother taking a large amount of medication for a long time, as well as fetal death and multiple pregnancy.
Symptoms and signs
A woman practically cannot determine oligohydramnios on her own, this is a matter for specialists. Only a few signs can indirectly indicate the likelihood of a decrease in the amount of amniotic fluid.
Usually in women with oligohydramnios, the size of the abdomen is smaller than it should be. It becomes possible to establish a violation thanks to measurements of the height of the day the uterus is standing, 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 remain silent about such sensations if the symptom has not been diagnosed earlier, you should definitely inform your doctor about your suspicions, who will prescribe all the diagnostics required in this case.
Diagnostics
The amniotic fluid index is determined by the doctor ultrasound diagnostics. It measures the distance free from the limbs of the baby and the umbilical cord, between the baby and the front abdominal wall, its inner surface. This measurement is called a vertical pocket.
If the measurement result after comparative analysis with tables shows that the amount of water is reduced, the degree of violation is revealed. With moderate oligohydramnios, the index is reduced by 10-15% compared to the above norm, and the vertical pocket, which is 5-8 cm with a normal amount of water, is reduced to a size of less than 5 cm.
Such a violation is pronounced, in which the vertical pocket does not exceed 2 cm, and the amniotic fluid index deviates from the norm downward by 15-20%. To imagine in more detail all of the above, we present a comparative table.
Violations of the amount of amniotic fluid:
|
Obstetric term, week |
Moderate oligohydramnios - amniotic fluid index, mm |
Severe oligohydramnios - amniotic fluid index, mm |
If the ultrasound specialist indicates in the conclusion that the woman has signs of moderate oligohydramnios, the obstetrician-gynecologist will definitely refer her for doplerometry and expert ultrasound to more accurately know the state of the baby, placenta and blood flow in the uterine vessels.
When the ultrasound protocol indicates that the pregnant woman has severe oligohydramnios, she is hospitalized for a more thorough examination.
If the cause lies in the congenital pathologies of the baby, it is recommended to terminate the pregnancy for medical reasons. Agree or not, it is up to the pregnant woman to decide. If she refuses, then the child is kept until the very birth, they provide him with the necessary medicinal support.
Possible consequences for the mother
A woman’s lack of water threatens with an abortion in the later stages, traumatizing both the psyche and physical health reproductive system. If the child dies, there will be no other option. After interruption for long term a woman can have breakdown develop secondary infertility.
A small amount of amniotic fluid aggravates the very process of childbirth. Often the weakness of the tribal forces develops, the woman is threatened with a caesarean section. The postpartum period in such women is more difficult, complications are likely.
Pregnancy itself can deliver a lot to the expectant mother. discomfort: the larger the child becomes, the harder for a woman will withstand his movements.
The probability of miscarriage during pregnancy with oligohydramnios is high, the risk of preterm birth is even higher - it reaches 26%.
Possible consequences for the child
Children born after pregnancy with oligoamnios have little weight, they are weaker than their peers, even if the pregnancy is full-term before the expected date of birth.
To the most grave consequences prolonged polyhydramnios include various adhesions skin fetus and membranes of the amniotic sac. As a result of such adhesions, cords can fill all the free space of the uterine cavity. They can also entangle a baby.
Due to the pressure that the strands will exert on the tissues of the fetus, irreversible deformities are formed - babies self-amputate or severely twisted limbs, there are facial defects, chest. The appearance of the baby is completely disfigured. The frequency of such consequences is small, but this cannot be ruled out.
The likelihood of such an outcome increases if oligohydroamnion is diagnosed early, at 16-20 weeks, and persists throughout pregnancy.
In childbirth, the baby may experience other troubles associated with a small amount of amniotic fluid - prolapse of the umbilical cord, premature violation of the integrity of the amnion and, as a result, a long anhydrous period, which can result in hypoxia and infection.
Many women mistakenly believe that oligohydramnios is the cause of ailments such as Down syndrome, as well as other chromosomal abnormalities. The logical connection here is reversed - with Down's syndrome, oligohydramnios often develops, and not vice versa.
Almost always, prolonged oligohydramnios causes a delay in intrauterine development of the baby. Dangerous in this case is the underdevelopment of the lungs, with which mothers give birth to such babies.
However, if help was provided to the crumbs correctly and in a timely manner, then the child quickly enough then begins to gain weight and soon catches up with his peers in physical development. However, intellectually, the baby can develop late for a long time.
Dangerous from the point of view of the likelihood of complications are also cases of detection of oligohydramnios later, at 30 weeks pregnant, but only on condition that pathological condition persists for 4-6 weeks or more.
For any negative consequences oligohydramnios for the health of the child is characterized by a regularity - the earlier this condition has come, the more serious the consequences can be.
Treatment
Therapy of oligohydramnios is always complex. And it starts with establishing the exact cause that caused pathological reduction amount of amniotic fluid.
First of all the version with chromosomal abnormalities is being tested. For this, a woman, depending on the term, is sent to one of the methods of invasive prenatal diagnosis.
With oligohydramnios detected at 16 weeks, a chorionic biopsy can be performed. If the fact of oligohydramnios became known later, a woman can be referred for cordocentesis, amniocentesis.
These procedures will help to obtain samples of amniotic fluid with particles of the baby's epithelium, cord blood from the umbilical cord. An analysis will be carried out in the genetic laboratory, which allows us to speak with a high degree of accuracy about the presence or absence of the baby's Down syndrome, Cornelia de Lange syndrome and other anomalies associated with a violation of the number of chromosomes in the karyotype and causing oligohydramnios. Such studies are usually carried out is free.
IN Lately opportunity to make non-invasive prenatal test DNA, which is still expensive. It is absolutely safe for the baby and is based on the isolation of the child's DNA from the venous blood of a pregnant woman. This test 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.
If the cause of oligohydramnios due to chromosomal abnormalities is confirmed, termination of pregnancy is recommended.
If, in addition, the examination does not show the presence of gross chromosomal disorders then look for vices physical development There will be ultrasound experts of an expert class. To do this, carefully study the urinary system of the baby - the ureters, urethra, kidneys. Special attention will be given to the health of the placenta. Ultrasound is performed to assess blood flow in the uterine vessels.
The attending physician will refer the woman to blood tests that can confirm or deny the presence of infections, including sexually transmitted infections.
Be sure to donate blood for sugar and urine for protein content. The doctor monitors the blood pressure of the expectant mother in order to exclude preeclampsia as the cause of oligohydramnios.
If the cause is found, doctors decide how to treat the underlying disease, almost all of them except birth defects fetal development and chromosomal pathologies are amenable to therapy. At the same time, control over the condition of the fetus is enhanced.
Moderate oligohydramnios can be treated at home, in most cases, hospitalization is not required if the expectant mother follows all the recommendations of the doctor.
Severe oligohydramnios, if it is detected early, is also an indication for termination of pregnancy; none of the doctors will dare to make predictions about its outcome. With severe oligohydramnios diagnosed after 26 weeks, the woman is hospitalized.
Medical treatment
A future mother with severe oligohydramnios is injected with vitamin solutions intramuscularly. In addition, she is given droppers with drugs that improve uteroplacental blood flow. Usually used for this "Actovegin". In addition, doctors recommend taking "Curantil", dosage and frequency of taking this drug is determined by the doctor.
Pregnant women may be prescribed broad-spectrum antibiotics to deal with the infection, if any. During the period of bearing a baby, for these purposes it is often recommended "Amoxiclav". To improve the metabolic processes in a woman's body, she may be recommended drugs such as "Hofitol", as well as multivitamin complexes designed and created specifically for pregnant women.
Simultaneously with taking drugs in a hospital, the condition of the baby is checked daily or every other day. A woman is given a CTG if the gestational age is already above 28 weeks, the functionality of the placenta is monitored using ultrasound, ultrasound scan can be carried out at any time to assess the amount of water in dynamics.
Any anxiety symptoms, which may indicate a fetal problem, at any time can become a decisive reason for doctors to carry out a caesarean section ahead of schedule.
With moderate oligohydramnios, which, according to the doctor, is of physiological origin, the woman is prescribed "Kurantil", "
Long walking, playing sports with such a complicated pregnancy is undesirable. Additionally, you will have to limit sex. pregnant with overweight, obese recommended to sit on special diet to rule out more larger set body weight.
Nutrition for oligohydramnios should include a large amount of fruits and vegetables, proteins and fats should be balanced, and fast carbohydrates (sweets and pastries) should be completely abandoned.
If there are edema, you should definitely consult with your doctor, to work out together the right and sufficient drinking regimen. With preeclampsia and hypertension, it is important to measure arterial pressure twice a day. blood pressure. With a significant increase, a woman needs qualified medical care.
Folk methods of treatment
Alternative medicine is ready to offer pregnant women with mild oligohydramnios a lot of useful and enjoyable recipes and products that, if they do not increase the amount of water, will definitely be able to satisfy the needs of a future mother with amniotic fluid deficiency in essential minerals and vitamins.
Folk remedies should not even try to treat severe oligohydramnios. But with minor deviations from the norm, a woman may well take some advice if her doctor has nothing against it.
The mineral needs of oligohydramnios will help restore figs, melons, and grapes. Also good, according to expectant mothers, zucchini and fresh tomatoes help.
A real storehouse, a natural "pharmacy" for a pregnant woman with a deficiency of amniotic fluid can be chokeberry. A woman can take 50 grams of juice from her per day or about 100 grams of berries.
Another favorite remedy that helps with oligohydramnios is strawberry berries. They are eaten in fresh or brew homemade juice with them to establish the normal functioning of the kidneys. If the pregnancy fell on winter time and there is nowhere to get strawberries, you can drink weak tea with strawberry jam. If this is not in stock, it can be purchased.
Prevention
Correct and responsible planning of the child will help to avoid oligohydramnios during pregnancy. A woman should be examined in advance by doctors of different specialties who will be able to answer questions about her state of health and the presence or absence of chronic diseases.
Of course, it is not necessary to conduct a full medical examination, but a woman who dreams of a child is simply obliged to visit a cardiologist, therapist and nephrologist. Visiting these specialists will help you to be sure that the heart, kidneys and general state health will help a woman bear a baby without complications.
If the age of the expectant mother exceeds 35 years, it is worth consulting with a geneticist, because the likelihood of conceiving and giving birth to a child with Down syndrome or Patau increases in proportion to the age of the mother.
It would be correct to do tests for sexual and other infections even before conception, and if something like this is found, treat them before the child is conceived.
Quit smoking should be before conception, at least as soon as it becomes known about the pregnancy. Smoking, and this has been proven, very often acts as a provoking factor in oligohydramnios.
During pregnancy, a woman for preventive purposes it is important not to refuse to undergo mandatory screening studies in the first, second and third trimester, do not refuse ultrasound and take certain tests recommended by the doctor.
Expectant mothers should beware of viral infections, especially during periods of mass morbidity with SARS and influenza, in order to avoid the development of oligohydramnios after illness. To do this, you should refrain from visiting shopping centers And public transport during seasonal epidemics, observe the rules of personal hygiene.
If the doctor insists on hospitalization, you should not refuse it, even if the woman herself thinks that she feels great, and she does not have time to be in the hospital at all.
Such a phenomenon as oligohydramnios during pregnancy is quite rare (three to four cases per thousand births) and is expressed in an insufficient amount of amniotic fluid (less than 500 ml). This condition serves as evidence that there are abnormalities in the body of a pregnant woman that are dangerous to health and proper development fetus.
Amniotic fluid (amniotic fluid) is the source of nutrition for the fetus. They contain nutrients, vitamins, hormones, oxygen, salts, that is, everything that is necessary for the growth and development of the fetus. In addition, all the products of its metabolism (mucus, urine, etc.) are excreted into it. At the same time, they protect it from the effects of adverse factors and various infections. When labor is approaching, the amniotic sac presses on the cervix, as a result of which it should open.
It should be noted that the amount of amniotic fluid at different stages of pregnancy is different, which is associated with changes in the needs of the fetus. For example, in the first six weeks of pregnancy, the amount of amniotic fluid is small, but by the third trimester (thirty-eighth week), their level ranges from 1000 to 1500 ml, which is considered normal (in the next two weeks, the amount of amniotic fluid drops to 600 ml, which indicates the approach childbirth). If their number is below this level, then there is an oligohydramnios of varying degrees. In practice, there are cases when there was practically no amniotic fluid in a pregnant woman.
There are moderate and severe oligohydramnios during pregnancy, depending on the severity. In the first variant, the amount of amniotic fluid has minor deviations from the norm. IN this case a pregnant woman is recommended to normalize her diet, include in the diet various foods that are rich in vitamins and minerals, and also be under the constant supervision of a doctor to prevent deterioration. With severe oligohydramnios, treatment in a hospital with the use of medications is required, since this condition is fraught with the development of negative complications in the form of deformation skeletal system fetus (injuries of the spine, large joints), abnormal development of its limbs, asphyxia, leading to a malfunction of the central nervous system, splicing of the surface of the fetus with the amnion and, as a result, the formation of malformations, stunting and weight loss (the baby's skin becomes dry and wrinkled). In most cases, for health reasons, women are given a caesarean section. Oligohydramnios is also the reason for the birth of children with low weight and insufficient vitality.
Symptoms and signs of oligohydramnios.
There are no obvious deviations in the state of health of a pregnant woman with oligohydramnios. With severe oligohydramnios, a pregnant woman may experience weakness, dry mouth, and nausea. In addition, a woman may experience pain of a aching nature, which is especially pronounced when the fetus moves. This is due to the fact that after twenty weeks of pregnancy, the activity of the child in the womb increases significantly, with insufficient amniotic fluid, their depreciation function is lost, against which the woman experiences severe pain. Therefore, only a specialist can diagnose this pathological condition with the help of gynecological examination, Ultrasound.
The main signs of oligohydramnios are lagging behind the size of the uterus from the norm at a given gestational age, non-compliance with the norms of the abdominal circumference at a given gestational age, and limited fetal mobility. To confirm the diagnosis, an ultrasound is prescribed, with the help of which the amount of amniotic fluid is determined, and if oligohydramnios occurs, then determine its severity, as well as assess the condition of the fetus. If you suspect the presence of this pathology, a woman is also prescribed a gynecological examination.
It should be noted that with an insufficient amount of amniotic fluid, spontaneous miscarriages and premature birth. Contractions during childbirth are ineffective and very painful, while there is a slow opening of the cervix. In most cases, labor activity has a long period, and when the fetal bladder is opened, a small amount of thick liquid colored by the feces of the fetus is formed.
Causes of low water.
The reasons for this anomaly in the development of pregnancy are not fully understood. According to medical practice, in most cases, the reasons for the development of oligohydramnios at different times can be:
- Severe congenital pathologies and malformations in the development of the fetus, among which pathologies in the development of the kidneys, hereditary anomalies in the development of the face can be noted. In most cases, such a pregnancy is terminated.
- Insufficiency of development of the epithelium of the fetal bladder, or reduced secretory function of the aqueous membrane.
- High blood pressure during pregnancy. An increase in blood pressure (blood pressure) can be observed in every pregnant woman, but with normal course pregnancy, this phenomenon is insignificant. But at strong rise AD may develop oligohydramnios, usually at the end of the third trimester. The mechanism of development of this pathology is due to impaired function of the placenta against the background of impaired blood flow due to increased blood pressure in the mother. It should be noted that the severity of oligohydramnios depends on the pressure indicators. With oligohydramnios against the background of hypertension, there may be delays in the development of the fetus (lag in size compared to the norm).
- Transferred but not cured bacterial infections. At the same time, pathogenic flora can be found not only in the birth canal, but also in the amniotic fluid. All this is revealed with the help of special analyses.
- Multiple pregnancy, in which the distribution of blood flow in the common placenta is uneven, as a result of which one of the fetuses receives more nutrients and oxygen, while the other gets practically nothing. Often, this pathology occurs in one of the fetuses in twins against the background of the syndrome of shunting (dumping) of blood in the placenta from one fetus to another. Usually violations are minor and not dangerous for the baby.
- Pregnancy reversal. In this case, the placenta ages and exfoliates, as a result of which it can no longer perform its functions. In this case, doctors artificially induce labor.
- Metabolic disorders, in particular obesity.
The diagnosis is made only after an ultrasound examination. For diagnosis, the calculation of the IAI or the amniotic fluid index is used. This indicator is calculated by measuring at four places the free space between the fetus and the uterine wall. The resulting numbers are added up, and the result is divided by 4. If the index is 5-8 cm, this indicates a normal amount of amniotic fluid, if the IAF is 2-5 cm - about moderate oligohydramnios, if the amniotic fluid index is less than 2 cm - there is a pronounced oligohydramnios.
Treatment of oligohydramnios.
To treat this pathology of pregnancy, it is necessary to identify the cause of its development, for which the pregnant woman is prescribed:
- Ultrasound, dopplerography, which allow you to determine the amount of amniotic fluid, the quality of blood circulation in the umbilical cord, cerebral artery fetus and uterine arteries women, the degree of fetal retardation in development.
- Tests and swabs for bacteria and STDs.
- Fetal CTG to determine the condition and well-being of the fetus.
In case of oligohydramnios, specialists can prescribe an ultrasound examination (every week), dopplerography every three days, an extraordinary fetal CTG in order to monitor the anomaly and prevent its development, as well as to take timely measures if necessary, which will keep the mother and fetus healthy.
With severe severe oligohydramnios that threatens the health of the fetus, the doctor may raise the issue of early delivery, provided that the timing of pregnancy allows.
If fetal malformations that are not compatible with his life are found with oligohydramnios in early pregnancy, then a decision is made to terminate the pregnancy.
If the ultrasound results show aging of the placenta and oligohydramnios, treatment of fetoplacental insufficiency is prescribed. On an outpatient basis, drugs such as Actovegin, Curantil are often prescribed for the treatment of oligohydramnios.
Severe oligohydramnios in pregnant women in combination with fetal hypoxia is often eliminated by caesarean section even with premature pregnancy, which is due to severe suffering of the fetus.
Influence of oligohydramnios on the condition of a woman.
Low water extremely negatively affects the course of pregnancy, complicating it. Apart from pain this pathology of the development of pregnancy can lead to its termination. In addition, it is the cause of the weakness of labor activity, since the fetal bladder, insufficient in size, cannot affect the rate of cervical dilatation (usually it is opened artificially). In this case, they may prescribe medications that stimulate contractions.
The effect of oligohydramnios on the fetus.
Amniotic fluid is the site of growth and development of the fetus. Their insufficiency negatively affects the growth and development of the baby, in particular early dates Pregnancy due to this pathology, clubfoot can form, various kinds of skull deformities can be observed, congenital dislocations of the hips can occur, and in the later stages, oligohydramnios complicates the course of childbirth. The amniotic sac with this anomaly does not perform the function of a wedge that promotes the opening of the cervix. In most cases, due to contraindications to natural childbirth perform a caesarean section.
It is worth noting that in most cases of pregnancies with moderate oligohydramnios, healthy children are born. Only fetal malnutrition of varying severity can be observed, which is quite understandable, since malnutrition and oligohydramnios are the result of placental insufficiency. It should be said that the children of mothers, who had oligohydramnios during the period of gestation, subsequently often get sick and are very excitable.
Prevention of low water.
To prevent oligohydramnios, it is recommended to exclude strong physical exertion, but this does not mean giving up movements. Therefore, pregnant women are shown leisurely walks in the fresh air.
A balanced diet at least five times a day in small portions.
Timely examination, delivery necessary analyzes, which will help to identify the presence of factors that provoke the development of oligohydramnios, and prescribe appropriate treatment.
In conclusion, I note that in no case, when making a diagnosis of "oligohydramnios", do not panic, do not be nervous and do not despair, because this is not the worst thing that can happen in this difficult period for a woman. Today, modern medical equipment and the latest drugs make it possible to bear the baby and give birth to him healthy in most problematic cases. So follow all medical recommendations and good luck with your delivery!
Even if after the next examination you heard a formidable diagnosis: oligohydramnios, stop panicking! An insufficient amount amniotic fluid is not a sentence, but just a symptom. In addition, there are various stages of oligohydramnios and, perhaps for your body, such indicators are the norm. It's time to figure out what oligohydramnios is during pregnancy, the causes and consequences of which bother you.
What is amniotic fluid?
Your body, like a watch, is adjusted to the bearing and birth of a child. Not only is the fetus protected by the placenta, it is always in the amniotic fluid, which both serves as food for it and protects it from external influences of infections. These amniotic fluid contain vitamins and hormones, salts and oxygen necessary for the growth of the baby. All of them enter the body of the child when he swallows the liquid.
Unfortunately, not only food can affect the amniotic fluid. Infections and viruses easily penetrate the amniotic fluid, which negatively affects the development of the child. As a result - quantitative changes in amniotic fluid, and diagnosing, for example, oligohydramnios.
Low water - what is it?
Low water is a deviation from the normal amount of amniotic fluid in the direction of its decrease. There is a difference between moderate and severe oligohydramnios. In the latter case, the amount of amniotic fluid is reduced by 3 or more times.
- First good news: such a deviation is quite rare, medical indicators range from 0.7 to 5.5%, and even then the highest number characterizes moderate oligohydramnios during pregnancy, which is not considered critical;
- The second positive argument is that in the first and third trimester, oligohydramnios, especially moderate ones, do not pose a 100% threat to the development of the baby, and it is even possible that a small amount of amniotic fluid in you is of a genetic nature.
amniotic fluid index table
The amount of amniotic fluid can be determined by the ratio of the volume of the abdomen and the height of the uterus, as well as during ultrasound examination(read the article on the topic: Is it possible to determine the gestational age by ultrasound?>>>).
Measurements during an ultrasound
- During ultrasound, the presence of a so-called free pocket is determined. This pocket is nothing but the distance between your baby and the front wall of your tummy;
- A specialist may suspect oligohydramnios if this space is less than 2 cm, while the norm is 5 cm;
- At the same time, the amniotic fluid index will be calculated for you, the principle is the same, but measurements are taken at four different points around the baby. The IAI norm is determined by weeks, but please note that even during the day the data may fluctuate slightly.
The resulting figures in mm are verified according to the table. What's interesting, its peak average reaches 156 mm at week 27, and at week 42 it decreases to 110 mm. The table also shows possible fluctuations, again by week:
| Term pregnancy, weeks |
Middle normal indicator, mm |
Probable hesitation, mm |
| 16 | 121 | 73-201 |
| 17 | 127 | 77-211 |
| 18 | 133 | 80-220 |
| 19 | 137 | 83-225 |
| 20 | 141 | 86-230 |
| 21 | 143 | 88-233 |
| 22 | 145 | 89-235 |
| 23 | 146 | 90-237 |
| 24 | 147 | 90-238 |
| 25 | 147 | 89-240 |
| 26 | 147 | 89-242 |
| 27 | 156 | 85-245 |
| 28 | 146 | 86-249 |
| 29 | 145 | 84-254 |
| 30 | 145 | 82-258 |
| 31 | 144 | 79-263 |
| 32 | 144 | 77-269 |
| 33 | 143 | 74-274 |
| 34 | 142 | 72-278 |
| 35 | 140 | 70-279 |
| 36 | 138 | 68-279 |
| 37 | 135 | 66-275 |
| 38 | 132 | 65-269 |
| 39 | 127 | 64-255 |
| 40 | 123 | 63-240 |
| 41 | 116 | 63-216 |
| 42 | 110 | 63-192 |
So, oligohydramnios during pregnancy at 32 weeks is diagnosed when the IAI is below 77 mm. (read the current article: Ultrasound at 32 weeks of gestation >>>), while at 22-26 weeks only at 89 and below IAI.
Regular measurements
You can also talk about oligohydramnios in the case when the size of the uterus and the girth of the abdomen do not correspond to your gestational age, but without additional ultrasound no one can diagnose you.
Why is low water dangerous?
Low water is a sign that a certain failure has occurred in your body. Causes of oligohydramnios during pregnancy, namely, these disorders are genetic, or the work of the placenta and the production of amniotic fluid were affected external factors, a specialist will install, but the fact that such a condition can be dangerous is a fact.
Consequences
Check out the list of the dangers of oligohydramnios during pregnancy.
- There is a 50% risk of preterm birth;
- During childbirth on time, there is a decrease or absence of labor activity in 80% of pregnant women;
- Significantly increases the risk of abortion (up to 50%);
- In a third of pregnant women, oligohydramnios developed as a result of an infectious or inflammatory process;
- With a critically low amount of amniotic fluid, the risk of fetal hypoxia is 20%, and hypertrophy or asphyxia - 75%;
- In half of the cases with oligohydramnios, childbirth is carried out by caesarean section.
Causes
You will not find clear medical parameters in any reference book, but there are certain assumptions:
- There is a tendency to oligohydramnios during pregnancy on a genetic basis. If your mother or grandmother gave birth to small babies, while the stomach was small, you may have the same story;
You can not worry when the oligohydramnios is moderate, and the child feels fine. Another thing is if your relatives, as the consequences of oligohydramnios during pregnancy, were problem childbirth, you need to warn your doctor and geneticist about this.
- If you notice a decrease in the volume of the abdomen earlier due date, there is a risk of amniotic fluid leakage (important article