In this post of mine, we will talk about oligohydramnios during pregnancy at 32 weeks. It was discovered in me on an ultrasound examination, at that moment I was very worried that my baby did not want to take it in any way. correct position in the uterus, I had breech presentation fetus, and the birth was getting closer and closer. But you can read more about this in Here I want to talk about what to do with oligohydramnios.

Well, so, I’m lying on an ultrasound scan and so there are enough different experiences, and then the doctor says that I have oligohydramnios. Then I still did not fully understand what this meant, but intuitively understood that low water on later dates This is not good.

With the results of the study, I turned to my gynecologist. She replied that oligohydramnios is due to any infection transferred during pregnancy. This did not surprise me, since in the last 8 months I have had ARVI as many as six times. And the last time was about two weeks ago. She suggested that we didn’t finish something, and therefore a complication developed. You can read about how to avoid a cold during pregnancy and how to properly treat it without harming your baby in the article:

Oligohydramnios in the later stages is dangerous, since the baby may develop hypoxia, i.e. lack of oxygen, this is what I read on the Internet when I came home, as well as a bunch of various horrors. I was depressed and began to search the forums for stories of women who gave birth to babies, having similar diagnosis. This is partly why I decided to write this post, I just remember how upset I was then and hopefully looked for a positive experience of another mom.

What to do with low water?

So what to do with low water? So what's this? I will not write encyclopedic terms and data here, there is a lot of this on other sites. Let me just say that this phenomenon is characterized by an insufficient amount of water. But back to what the gynecologist told me. She recommended that I urgently be treated so that there would be no serious consequences for the baby. Ideally, I needed to go to a day hospital, but everything was occupied there, and the nearest place was vacated after a couple of weeks. The doctor said that it is impossible to delay, oligohydramnios in the later stages needs to be quickly treated, and prescribed the necessary drugs for me to take them at home.

How is oligohydramnios treated during pregnancy? To be honest, I don't remember the exact names. I only remember that I took a course of antibiotics, they were expensive. A two-week course cost about 4 thousand, but they were safe during pregnancy, it was even written in the annotation for the drug, which surprised me very much, usually they don’t write this there. Together with antibiotics, I drank Wobenzym, it has an anti-inflammatory and immunomodulatory effect. I also took Actovegin. In total, the treatment cost me as much as eight thousand, but to be honest, without even thinking, I purchased all the drugs that the doctor insisted on, since the treatment of oligohydramnios during pregnancy is mandatory, the well-being of your baby depends on it.

When I did an ultrasound before giving birth, there was no oligohydramnios. My birth went well, you can read more about this in I hope my post: “Orywater during pregnancy 32 weeks” will be able to cheer you up, and you will understand that this is not so terrible diagnosis You just need to listen to your doctor and follow his recommendations. And of course, read less horror stories on the Internet, since your child is absolutely healthy and no diagnosis will change this. These are just minor troubles, overcoming which you will finally meet your baby.

P.S. I remind you that I am not a doctor. The information is presented for informational purposes only, self-medication during pregnancy is unacceptable and dangerous. Contact your physician.

Even if after the next examination you heard a formidable diagnosis: oligohydramnios, stop panicking! An insufficient amount amniotic fluid- this is not a sentence, but only 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 against external influence 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 normal amount 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

1. 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;
2. A specialist may suspect oligohydramnios if this space is less than 2 cm, while the norm is 5 cm;
3. 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. The 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:

1. 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, had problematic childbirth, you must warn your doctor and geneticist about this.

1. If you notice a decrease in the volume of the abdomen earlier due date, there is a risk of amniotic fluid leakage (important article

Thanks

According to the classical medical definition, oligohydramnios(oligohydramnion - lat.) is called a decrease in the volume of amniotic fluid (amniotic fluid) less than 500 ml at full-term pregnancy. That is, if a woman in the period of 40 - 41 weeks of pregnancy, the amount of amniotic fluid is 500 ml or less, then this condition is oligohydramnios. But this definition reflects only one aspect - what is considered low water on the eve of childbirth. Consider what is in modern obstetric practice can be understood as oligohydramnios in general, and what is the significance of this parameter for assessing the course of pregnancy, as well as the growth and development of the fetus.

Low water in pregnant women - what is it?

The amount of amniotic fluid is not a static value, because as the fetus grows and develops, the volume of amniotic fluid changes, which begins to be secreted from the 8th week of gestation and continues until the very birth. Thus, the amount of amniotic fluid at each stage of pregnancy is different. Moreover, at any stage of pregnancy, their number may be less than normal, which will also be oligohydramnios. That is, expanding the classical definition of oligohydramnios, we can say that this is a condition in which the volume of amniotic fluid is less than the lower limit of normal for a given specific date gestation.

Currently, based on numerous observations and calculations, tables have been developed with the average, maximum and minimum volumes of amniotic fluid characteristic of each week of gestation, starting from the 14th. That is, oligohydramnios can be determined starting from the 14th week of pregnancy.

However, we repeat that the concept of oligohydramnios is dynamic, that is, it can periodically appear or disappear during pregnancy. This means that the same woman, for example, at 23 weeks had oligohydramnios, and at 33 weeks of pregnancy it is gone. In such cases, doctors talk about functional oligohydramnios, which occurs in response to various impacts external environment and goes away on its own within a month. Strictly speaking, such low water is transient, that is, temporary, and therefore refers to functional disorders rather than pathology. The vast majority of cases of oligohydramnios are just such transient, functional disorders that are not dangerous for the growth and development of the fetus and do not violate normal course pregnancy and childbirth.

If oligohydramnios is persistent, that is, it does not go away and is fixed in different dates pregnancy, for example, at 23, at 25, at 30 weeks of pregnancy, then we are talking about pathology. In such cases, oligohydramnios is a sign of severe violations of the course of pregnancy and fetal development.

Therefore, when a woman is diagnosed with oligohydramnios according to the results of ultrasound, there is no need to be upset or nervous, since in the vast majority of cases this is a functional feature of her pregnancy, and not a pathology. But if oligohydramnios is combined with malformations or does not go away within a month, then given state considered pathological and requires treatment. Remember that the incidence of pathological oligohydramnios is only 0.2 - 0.3% of cases, and it is necessarily combined with developmental disorders of the fetus and placenta, visible on ultrasound. Therefore, if the ultrasound doctor did not see malformations of the fetus or placenta, but diagnosed "oligohydramnios", then this always indicates functional feature women and does not require any treatment, with the exception of vitamin prophylaxis.

In principle, oligohydramnios is not so much an independent pathology as a single symptom, reflecting a combination of various disorders of the growth and development of the fetus or the course of pregnancy. Therefore, the isolated determination of oligohydramnios without CTG, dopplerometry and screening for malformations by ultrasound and biochemical tests (AFP, hCG, etc.) is not diagnostically accurate and justified.

Oligohydramnios in pregnant women - the diagnostic significance of the indicator

The diagnostic significance and value of such an indicator as oligohydramnios is currently very low. The fact is that before the advent of ultrasound, dopplerometry, CTG and other methods of examining a pregnant woman, fetal pathology and the likelihood of various deformities were determined indirectly, according to various indicators that correlated with impaired growth and development of the child.

One of these indicators is the amount of amniotic fluid. Doctors of past centuries determined their number in order to indirectly assess how well and according to the norm the fetus is developing. Indeed, until the middle of the 20th century, there was simply no such informative method as ultrasound, which allows you to examine the fetus and determine how it develops, accurately measuring its size and seeing all the organs and parts of the body. And the doctor, not seeing the child in the womb, had to somehow assess whether it is developing normally. It was in that era that doctors determined the amount of amniotic fluid and many other parameters that indirectly made it possible to judge the growth and development of the fetus.

However, at present, the norms of growth and development of the fetus are perfectly monitored by ultrasound, the pathology of the placenta is determined using dopplerometry, and fetal hypoxia is detected by KGT. That is, there are instrumental methods that allow much more accurate detection of fetal pathologies, placental dysfunction, etc. And so the definition of oligohydramnios is a kind of tribute to tradition. Because of this, many gynecologists do not pay attention to oligohydramnios at all, if, according to the results of ultrasound and CTG, the child develops normally, since they quite rightly consider this condition to be a feature of a particular pregnant woman.

Low water - causes of development

The reasons for the development of oligohydramnios can be various pathologies of the fetus and placenta or severe chronic diseases that a pregnant woman has. That is why the entire set of causes of oligohydramnios is divided into the following large groups:
1. Causes associated with congenital malformations in the fetus;
2. Causes associated with fetal pathology;
3. Causes associated with metabolic disorders in a pregnant woman due to severe chronic diseases;
4. Causes associated with the pathology of the placenta;
5. Other.

Specific causative factors of oligohydramnios, attributable to each of the five listed groups, are reflected in the table:

Causes associated with congenital malformations in the fetus	Underdevelopment of the urethral valves
	Agenesis (absence) or narrowing of the urethra
	Bilateral narrowing of the ureters
	Bilateral narrowing of the junction of the ureters with the renal pelvis
	Prune belly syndrome
	Agenesia (absence) of the kidneys
	Bilateral polycystic kidney dysplasia (Potter-I syndrome)
	Polycystic kidney disease (Potter-II syndrome)
Causes associated with fetal pathology	Intrauterine infection of the fetus (for example, cytomegalo viral infection, chlamydia, mycoplasmosis, etc.)
	Delay prenatal development fetus
	Chromosomal abnormalities of the fetus (for example, Down syndrome, Marfan, etc.)
Causes associated with severe chronic diseases present in a pregnant woman	chronic diseases of cardio-vascular system(e.g. hypertension, thrombophlebitis, venous insufficiency, etc.)
	Preeclampsia
	Chronic kidney disease (eg, pyelonephritis, glomerulonephritis, kidney failure etc.)
	Collagen diseases (eg, systemic lupus erythematosus, scleroderma, dermatomyositis, periarteritis nodosa, rheumatoid arthritis, rheumatism, serum sickness, etc.)
	Obesity
	Diabetes
	Dehydration of the mother's body, for example, after severe diarrhea, vomiting, etc.
	Smoking more than 10 cigarettes per day
Causes associated with pathology of the placenta	placental insufficiency
	Multiple infarctions of the placenta
	Anomalies in the development of the placenta (for example, atrophy and focal sclerosis of the decidua, necrosis of the amnion, etc.)
Other	Pregnancy over 42 weeks
	Premature rupture of membranes
	Rupture of membranes with leakage of amniotic fluid
	Intrauterine (antenatal) fetal death
	Idiopathic oligohydramnios (cause unknown)
	Iatrogenic oligohydramnios caused by long-term use medicines from the group of prostaglandin synthetase inhibitors (for example, Indomethacin, Naproxen, Fenoprofen, flufenamic acid, etc.). These drugs are commonly used to stop preterm labor.

Thus, most of the causes of oligohydramnios are quite successfully treated with modern methods, and therefore this condition is not a cause for panic. The only group of causes of oligohydramnios that is not treated are congenital malformations of the fetus, which, however, are always detected on control ultrasounds performed at 12, 22 and 32 weeks of pregnancy. In other cases, oligohydramnios can be cured, and the woman will give birth to a perfectly healthy child.

Currently the most common causes oligohydramnios in pregnant women are the following factors:

• preeclampsia;
• Maternal hypertension;
• Maternal diabetes;
• Any infectious and inflammatory diseases in the mother (for example, tonsillitis, pyelonephritis, influenza, acute respiratory infections, etc.);
• TORCH complex infections (toxoplasmosis, rubella, cytomegalovirus, herpes) during pregnancy;
• Chronic intrauterine hypoxia fetus.

Hypertension and diabetes mellitus cause oligohydramnios, the severity of which is determined by the duration of the course and the compensation of the disease. Therefore, it is very important to control the blood pressure of pregnant women with modern, effective and safe drugs. A pregnant woman with diabetes, for the prevention of oligohydramnios and other complications, must adhere strictly to the diet, without making mistakes.

If oligohydramnios has developed before 28 weeks, then doctors recommend termination of pregnancy, since in most cases it is impossible to predict its outcome.

Low water - reviews of outcomes

In the vast majority of cases, women in various forums indicate that their oligohydramnios successfully passed in a month, and they gave birth healthy babies on time naturally. Some women indicate that they took the metabolic complex (vitamins + Curantil + Actovegin), while others did not treat the identified condition. However, both in those who took the metabolic complex and in those who did not take it, oligohydramnios disappeared after a month, which was recorded according to the results of ultrasound. Such observations of women indicate that the vast majority of cases of oligohydramnios are physiological. Before use, you should consult with a specialist.

Oligohydramnios is diagnosed if the amount of amniotic fluid is less than the established norm. There are moderate and severe forms of this condition. The amniotic fluid provides the necessary conditions for the life of the embryo. They are a source of nutrients and oxygen. And also perform protective function protecting the child from negative influences and penetration of infections. During childbirth, the fluid exerts pressure on the cervix, causing it to dilate. The fluid is placed in the amnion - the amniotic sac, where the fetus is located.

On the different stages pregnancy, there is a different volume of amniotic fluid. During the first one and a half months, its amount is 5 ml. Then there is a gradual increase and two weeks before the baby appears, the volume of liquid varies from 1 to 1.5 liters. Immediately before childbirth, the amount of water in the amniotic sac decreases and amounts to 600 ml. They include amino acids, proteins, hormonal substances, urea, vitamins, enzymes, mineral elements.

Amniotic waters are regularly renewed. On the final stages gestation, this process is carried out after every 3 hours. During the day, the child swallows about 4 liters of amniotic fluid, and through the pores of the amnion and special channels, its waste products are excreted. This fluid is formed due to the activity of the epithelium of the aquatic membrane.

With a slight deviation from the norm in the direction of decrease, moderate oligohydramnios is determined. In some cases, this phenomenon develops during the first weeks of pregnancy. This is a condition in which a woman requires regular monitoring by specialists and a certain medication correction.

• promotion blood pressure mother. Slight increase this indicator observed in almost every pregnant woman. BUT strong rise provokes a lack of amniotic fluid;
• the presence of infectious and inflammatory diseases;
• fetoplacental insufficiency;
• fetal oxygen deficiency;
• violation of the metabolic process in the body of a woman;
• the presence of anomalies in the development of the fetus - mainly oligohydramnios occurs due to a violation of the activity of the kidneys and a decrease in the volume of primary urine;
• prolongation - in this case, the placenta ages and abruption occurs, as a result of which it ceases to provide the baby necessary elements and oxygen;
• the presence of two or more fetuses in the uterine cavity - placental blood flow distributed unevenly, one fetus is provided essential substances and oxygen in full, and the rest are deficient;
• decrease in the secretory activity of the aquatic membrane.

Classification of oligohydramnios

Oligohydramnios is divided into types according to several criteria. Depending on the duration, there are:

• chronic;
• sharp shape.

Oligohydramnios, related to the first type, develops in stages. Treatment in this situation requires a long time. In the absence of the necessary therapy, the phenomenon will progress. Chronic form This condition occurs when a woman has serious illnesses, for example, diabetes. To minimize possible Negative consequences future mom should undergo regular examinations and receive appropriate therapy.

The most common causes of acute oligohydramnios are infectious diseases. This form has fewer complications and does not require special therapy. Acute oligohydramnios proceeds along with the disease that caused it.

Depending on the degree of deviation from the norm, a moderate and pronounced type of condition is distinguished. Moderate oligohydramnios during pregnancy at 20 weeks is considered early and occurs as a result of impaired function of the amniotic membranes. late form develops at 26 weeks. In addition to dysfunction of the amniotic membranes, the reasons for this may be deviations in the condition of the fetus.

Primary and secondary oligohydramnios are also distinguished. The first type develops without deviations in the functioning of the amniotic membranes. Oligohydramnios of the second type occurs against the background of this pathology, as a result of which the amniotic fluid flows out.

Signs of oligohydramnios

Moderate oligohydramnios during pregnancy, in contrast to the pronounced type, is not always accompanied by symptoms. But still, in some cases, a woman experiences certain sensations. Let's consider them in more detail:

1. Soreness in the lower abdomen should alert.
2. Nausea or pain when moving the baby.
3. In the second trimester, the activity of the fetus increases. If there is a deficiency of fluid in the amniotic sac, the movements of the baby cause discomfort to the mother.
4. The doctor can also diagnose oligohydramnios based on the insufficient size of the uterus, the discrepancy between the abdominal circumference and the norms.
5. Weak fetal mobility.

Complications with oligohydramnios

Oligohydramnios, including the moderate type, can lead to a number of complications.

1. One of them is squeezing the umbilical cord. As a result, the supply of oxygen is hindered and oxygen starvation develops. This condition can result in fetal death.
2. When not enough amniotic fluid, its circulation is complicated and the likelihood of infections in the uterine cavity increases. This violation increases the likelihood of injury during delivery.
3. A flat fetal bladder becomes the cause of primary weakness in the process of labor.
4. Placental abruption is often observed, and the risk of damage to the cervix also increases. Fragments of amniotic membranes remain in the uterine cavity and placental tissue which causes bleeding.
5. If moderate oligohydramnios during pregnancy of 32 weeks is accompanied by a delay in the formation of the fetus, this complicates the conduct of drug therapy.
6. Lack of amniotic fluid negative impact and on fetal development. The child does not receive required quantity nutrients as a result of which his weight at birth does not reach the norm.
7. With oligohydramnios, the baby is deprived of the opportunity to move freely in the uterine cavity. After birth, such children are diagnosed with dysplasia. hip joint and curvature of the spine. But don't panic right away. With timely identification of the problem and the correct response, the negative consequences of oligohydramnios can be minimized or completely eliminated.

Examination and therapy

In order for the doctor to be able to choose an effective therapy, it is necessary to undergo a preliminary examination. In order to determine the amount of amniotic fluid is carried out ultrasound procedure and dopplerography. Also, these methods allow you to get an idea about the blood flow of the umbilical cord, the degree of fetal lag in development, the arteries of the mother and baby. To determine the condition of the child, the doctor prescribes a CTG procedure.

A woman must also be tested for the presence of sexually transmitted diseases. To exercise full control over the condition of the pregnant woman ultrasound diagnostics can be carried out weekly, and Doppler examination - once every three days. Based on the results of an ultrasound examination, a specialist using the amniotic fluid index (AFI) determines the amount of water in which the child resides. An indicator of 5-8 cm is considered the norm. If the index varies within 2-5 cm, oligohydramnios is moderate.

Treatment of moderate oligohydramnios during pregnancy involves A complex approach. A woman is assigned medical preparations, whose action is aimed at stabilizing metabolic processes in the placenta. With help medicines the underlying disease that caused oligohydramnios is eliminated.

In case of metabolic disorders, excessive body weight of a pregnant woman, the doctor recommends a certain nutrition system and prescribes special drugs. Moderate oligohydramnios mostly does not require a woman's stay in a hospital, stabilization of her condition is carried out on an outpatient basis.

Along with the prescription of medications, the expectant mother receives recommendations that limit physical activity and physical activity, as well as the intake of sufficient amounts of vitamins and nutrients.

The choice of treatment tactics is influenced by the gestational age at which oligohydramnios is detected. This condition requires the most serious approach during the second trimester. Moderate oligohydramnios at 37 weeks of gestation can be considered as an indication for delivery by caesarean section.

Preventive measures

Unfortunately, there are no ways to completely eliminate oligohydramnios. But by following certain recommendations, you can reduce the likelihood of occurrence this phenomenon. First of all, it is important good nutrition women, the absence of stress factors and excessive physical exertion, as well as regular examination.

Conclusion

Moderate oligohydramnios occurs against the background of a woman’s diseases or abnormalities in the development of a child. The moderate form of this condition differs less pronounced consequences and poses no significant hazard if dealt with in a timely manner. Oligohydramnios is not always accompanied by symptoms, and only a doctor can determine it. Therefore, a woman should regularly undergo the necessary examinations. On the different stages gestation lack of amniotic fluid has various consequences. So, moderate oligohydramnios during pregnancy at 30 weeks is less dangerous than during the second trimester.

The opinion of a specialist regarding oligohydramnios during pregnancy can be seen in the fragment:

oligohydramnios during pregnancy- this is a pathologically small amount of amniotic fluid in pregnant women. According to the classical definition, oligohydramnios in pregnant women is defined as the presence of a small (less than half a liter) volume of amniotic fluid in the uterus on the eve of childbirth, that is, during full-term pregnancy. This definition, of course, is correct and serves as the basis for the final diagnosis, but it does not take into account the quantitative fluctuations in the volume of amniotic fluid throughout pregnancy. The fact is that most of the short episodes of oligohydramnios, which is diagnosed during pregnancy, are episodic and do not need to be corrected from the outside. Such conditions are classified as functional, not pathological, for example, diagnosed oligohydramnios during pregnancy at 32 weeks may not be detected during a re-examination in a few weeks.

Meanwhile, an insufficient amount amniotic fluid in the uterine cavity of a protracted nature is no longer harmless. And if diagnosed oligohydramnios at 32 weeks (or at any other time) continues to be detected in subsequent periods, it is classified as a pathology that threatens normal development fetus. True, pathological, oligohydramnios is always combined with pathology of the fetus and / or placenta.

Oligohydramnios cannot be classified as a common condition. Most of the diagnosed conditions of oligohydramnios (only 3-4 cases out of 1000 births) in pregnant women are functional, and pathologies account for only 0.2% -0.3% of them.

In fact, oligohydramnios has never been considered as an independent nosological unit; it is part of a large symptom complex that reflects the pathology of the course of pregnancy and, accordingly, the development of the fetus in the womb. In addition, modern diagnostic technologies make it possible to very accurately detect changes in the formation of the fetus at almost any time, which in to a large extent downplays the importance of oligohydramnios as an important criterion.

The diagnosis of "oligohydramnios", obtained after an ultrasound scan, often unreasonably scares pregnant women. So that vain worries do not bother, the expectant mother should know as much as possible about her condition and the “norms” of its development. This also applies to amniotic fluid.

Amniotic fluid is a liquid that fills the so-called "fetal bladder" - a sterile cavity in which the fetus begins and completes development. As soon as a fertilized egg, having passed through the fallopian tube, enters the mucous membrane of the uterine cavity, embryonic membranes begin to form around it - chorionic (it is also the outer shell gestational sac) outside and amniotic (water) inside. They form a closed cavity, forming a fetal bladder, and grow with the fetus.

The fetal bladder is filled with fluid (amniotic fluid), which is 97% water. Since the amnion is involved in its production, it is called amniotic. She long time serves as a source of nutrition, metabolism, immune and antibacterial protection for developing child, so it contains a large number of minerals, hormones, immune complexes, nutritional and bactericidal compounds.

The formation of amniotic fluid begins even at a short time (5-6 weeks), when part of the maternal blood passes through membranes. The first slight level of fluid around the fetus is visible on ultrasound as early as the 3rd week of its development. The amount and composition of amniotic fluid changes as the fetus grows. There is a constant exchange between the child and the surrounding waters. Until the 14th week, the substances necessary for the fetus enter through its skin, then, when skin the child becomes dense, he literally swallows the surrounding fluid. When the absorbed fluid gives the baby everything it needs, it returns to the amniotic space again with his urine. Thus, the amniotic fluid provides the fetus with the necessary substances and eliminates unnecessary ones. The amniotic fluid is in a state of constant self-renewal (every three hours) in order to maintain the necessary composition and get rid of harmful products secreted by the fetus.

Amniotic fluid also performs a number of extremely important functions for pregnancy:

- Maintain the constancy of the environment in which the fetus grows, and also makes its existence comfortable. The amniotic fluid not only "feeds" the baby, it also has a constant temperature of 37°C, isolates the fetus from external noise.

- Perform shock-absorbing properties, protecting the fetus from injury during active movements of the mother.

- Thanks to the bactericidal component, infection of fetal tissues is prevented.

- “Help” the child to be born safely.

The volume of amniotic fluid at different gestation periods is not the same, each period has its own conditional "norm", which is significant diagnostic criterion to ascertain oligohydramnios or, conversely,.

Oligohydramnios is diagnosed during an ultrasound scan. It is known that the fluid around the fetus is in the recesses (pockets). By the height of the liquid level in these recesses, its total volume is determined and compared with generally accepted indicators.

It should be noted that moderate oligohydramnios during pregnancy is often diagnosed. If it does not progress and does not affect the fetus, then it does not apply to pathology.

Causes of oligohydramnios during pregnancy

As already mentioned, a slight physiological deviation from the normal volume of amniotic fluid can be observed sporadically during pregnancy. If, after the examination, the diagnosis of a functionalist (ultrasound specialist) includes moderate oligohydramnios during a pregnancy of 30 weeks (or another period), but at the same time he does not diagnose any other abnormalities, there is no reason to worry. However, if during a re-examination, the specialist again writes in the conclusion, for example, “oligohydramnios during pregnancy 33 weeks”, “oligohydramnios during pregnancy 34 weeks”, and so on, this condition clearly indicates a pathology.

Pathological oligohydramnios is often associated with serious conditions. Among them are more often distinguished:

- Associated with congenital malformations of the fetus, more often - the urinary system: the absence or narrowing of the urethra, unilateral or bilateral occlusion (blockage) of the ureters, polycystic or underdevelopment of the kidneys up to their absence.

— Chromosomal disorders at the fetus.

- Caused by pathology of the fetus, not associated with congenital malformations of organs and systems.

- Based on the pathology of the placenta: structural anomalies in its development, fetoplacental insufficiency.

- Unspecified causes. If the examination does not reveal the causes of oligohydramnios, it is considered idiopathic, that is, a condition with an unknown genesis. As a rule, idiopathic oligohydramnios is moderate, does not affect either the course of pregnancy or the birth process. It can go away on its own with an increase in the duration of pregnancy, or it can remain so until its completion, without increasing.

It is extremely important to clarify that oligohydramnios can only provoke external pathologies fetal development, but is not capable of causing chromosomal abnormalities, and even more so, birth defects internal organs. On the contrary, these are malformations and chromosomal diseases provoke malnutrition. Thus, when oligohydramnios is mentioned together with "deformities" or genetic ailments, they mean only their frequent simultaneous presence.

Low water is provoked late toxicosis, infectious conditions (acute and chronic) and in the mother.

Infection of the amnion membranes is considered extremely dangerous in terms of the formation of oligohydramnios, when unwanted microorganisms from the mother penetrate the placental protective barrier, infecting both the amnion and the fetus. Exactly intrauterine infections more often (up to 40%) provoke severe oligohydramnios. More often, the infection penetrates to the fetus "from below" - from the vaginal or cervical cavity. If the placenta becomes infected, it ceases to perform its proper functions and the physiological regime of fetal development is disturbed, so the child may develop with a delay.

Often, oligohydramnios accompanies fetoplacental insufficiency - insufficient blood supply developing fetus. The only source of oxygen for the child during development is the blood that circulates in the placenta. If the fetus does not receive enough of it, oxygen starvation (hypoxia) appears, it slows down (and sometimes stops) the proper development of pregnancy.

Post-term pregnancy sometimes provokes oligohydramnios. The reliable reasons for such oligohydramnios are unclear, perhaps the mother's body is not able to meet the needs for amniotic fluid longer than the due date, so its reserves are depleted.

Identical twins with a common placenta (monochorionic monozygotic twins) are often complicated by oligohydramnios, since both children have common sources of nutrition and metabolism. If additional vessels form in the placenta, the redistribution of blood between children is disturbed: one of the fetuses receives more blood, excretes more urine, and thereby increases the amount of surrounding fluid. In a fetus with insufficient blood supply, hypoxia develops, lags behind in development, and oligohydramnios is formed. Sometimes for similar condition the term "strangled twin syndrome" is used.

The amnotic sac during a normally developing pregnancy is always closed, and the fluid that fills it never leaves the fetal bladder ahead of schedule. When completed, the bubble spontaneously bursts, the waters pour out, and the uterus begins to expel the fetus. If the fetal bladder begins to release water before the 36-week period, the outflow of water is considered premature. Sometimes the waters are completely evacuated, but more often, if the rupture of the bladder membranes is high, they leak. The constant loss of amniotic fluid provokes oligohydramnios and threatens the course of pregnancy. In this situation, even moderate oligohydramnios during pregnancy is fraught with complications. Diagnosis of premature outflow of water from the amnion allows special tests and ultrasound. If the pregnant woman notes an increase in the amount of liquid vaginal discharge, and the functionalist makes a diagnosis, for example, "oligohydramnios during pregnancy at 34 weeks", the situation is analyzed and eliminated after the hospitalization of the pregnant woman.

It should be noted that most diagnosed episodes of oligohydramnios are not combined with "terrible" causes and consequences.

Symptoms and signs of oligohydramnios during pregnancy

Oligohydramnios can be moderate or severe, as well as acute or chronic. Moderate oligohydramnios during pregnancy is recorded more often.

Acute oligohydramnios appears suddenly, but does not pose a serious threat. More often it is preceded by an acute infectious condition of the mother: a viral infection and, tonsillitis and the like. Acute oligohydramnios of a functional nature is well stopped and quickly passes.

Chronic oligohydramnios is not so harmless, as it has a pathological basis.

Oligohydramnios can be diagnosed at any time, but the time of its appearance has different meaning. The most dangerous is the oligohydramnios of the second trimester, since the pregnancy still needs to be prolonged due to the underdevelopment of the fetus, and the causes of oligohydramnios may not allow this. Oligohydramnios of the last trimester is also not harmless, but if necessary, the pregnancy can be terminated without prejudice to the life of the child.

Early oligohydramnios is called if it appeared before, later it is diagnosed with. Prolonged is considered oligohydramnios, continuing both in the early and late periods.

The clinical picture of the lack of amniotic fluid does not have symptoms indicating only oligohydramnios. More often it includes constant pain in the abdomen, sometimes aggravated by the movements of the fetus and a decrease in the motor activity of the child. Moderately severe oligohydramnios is diagnosed only when additional methods diagnostics.

Severe oligohydramnios provokes a decrease in the size of the uterus, therefore, upon examination, the doctor may notice a discrepancy between its size and the gestational age and suspect a pathology, especially if there are complaints from the pregnant woman about insufficient activity (movement) of the fetus. Monitoring changes in the size of the uterus, the position of the fetus and vaginal discharge accompanies each visit to the consultation.

However, similar signs are also observed in other pathologies, for example, fetal growth retardation, and there is also the possibility of an erroneous calculation of the gestational age. Therefore, it is impossible to make a reliable diagnosis during the examination.

A completely different clinical situation develops in the presence of leakage of amniotic fluid outside the onset of labor. Unfortunately, pregnant women sometimes pay attention to leaking water only when they are significantly lost and accompanying negative symptoms appear. Any increase in vaginal discharge in the form of a clear liquid may be a manifestation of premature amniotic fluid leakage. If the amniotic fluid leaks, it means that there is a defect in the amniotic membrane through which an infection can penetrate to the fetus. To prevent negative consequences, it is necessary to study the composition of the microflora of the vagina (smears and crops), as well as to examine the composition of the amniotic fluid itself.

In addition to infection, leaking amniotic fluid threatens the fetus with premature birth. Medical tactics is determined by the gestational age. If water leakage has complicated oligohydramnios during pregnancy at 34 weeks and earlier, when the lungs of the fetus are not ready to function, it is necessary to “help” them form early with medication.

Ultrasound scan data, which is the most reliable and reliable, allows you to determine oligohydramnios diagnostic method. There are specially developed criteria for determining the volume of amniotic fluid in different periods gestation:

Measurement of the vertical level of fluid accumulated in two cavities between the fetus and the amnion wall (pockets). As a rule, oligohydramnios is indicated by a level of fluid that has accumulated in the largest of the pockets, not exceeding 1 cm.

Determination of the amniotic fluid index. Conventionally, the uterine cavity of a pregnant woman is divided by two perpendicular planes into four parts, so that they intersect in the navel zone. Then, in each of the obtained quadrants, the maximum liquid volume is measured and the obtained figures are summed up. The result obtained is amniotic index. It is correlated with the existing norm indicators for each specific gestational age:

- 0-5 cm - the index is very low (severe oligohydramnios);

5.1-8 cm - low index (moderate oligohydramnios);

- 8.1-8 cm - the index correlates with the norm.

The amniotic fluid index can significantly exceed established norms and indicate an excess volume of amniotic fluid (polyhydramnios). With polyhydramnios, it exceeds 18 cm.

The change in the amount of amniotic fluid is a very dynamic criterion. A one-time statement of oligohydramnios has no clinical significance. Oligohydramnios, especially moderate, is often only a short-term episode, not threatening pregnancy. It is much more important to know how the volume of water changes with increasing gestational age. At physiological development pregnancy, it increases and becomes maximum to (one and a half liters), and then begins to decline.

So, if the examination reveals oligohydramnios during pregnancy at 30 weeks, and then - oligohydramnios during pregnancy at 33 weeks, we can talk about pathology.

Treatment of oligohydramnios during pregnancy

Therapy for oligohydramnios is not always required. If the fact of oligohydramnios is established in the first trimester, this condition is likely to pass without serious therapy. If it continues to exist for more than three months, a search for the causes and their elimination is required.

An oligohydramnios does not have an independent value, as it is a symptom of an ailment or a temporary physiological state. Any oligohydramnios, in order to eliminate it, requires a detailed diagnosis of its causes. Examination for genital infections, genetic diseases is necessary. IN last trimesters it is necessary to assess how low water affects the fetus, for which ultrasound scan, CTG and dopplerography.

In any situation, if serious malformations or anomalies in the development of the fetus are not detected, specialists strive to prolong the pregnancy as much as possible. possible term. In this case, therapy is aimed at improving the functioning of the placenta, oxygenating the blood of the fetus, and improving metabolism in the tissues of the placenta.

The choice between outpatient and inpatient treatment is up to the doctor. Unfortunately, pregnant women do not always adequately assess the ongoing events and do not agree to hospitalization. Meanwhile, good health mothers do not always mean that her child has one, so the recommendations of a doctor who has studied all the indicators are much more important.

If the examination reveals a deterioration in the child's condition that threatens his life, delivery is required immediately.

Leakage of amniotic fluid often threatens with infectious complications, therefore, it always requires adequate antibiotic therapy. To choose the right necessary funds, amniotic fluid is analyzed in the laboratory.

If the loss of amniotic fluid is too great, delivery is required.

Normal amniotic fluid is sterile, odorless, and colorless. Sometimes they can acquire a whitish tint or contain inclusions that look like small white flakes. With premature outflow of water, pathological signs are:

— Green color indicating severe hypoxia. This color of water is acquired due to meconium (original feces), which the child releases into the water when there is a lack of oxygen. The smell of green waters is correspondingly unpleasant.

— bright yellow color. Indicates incompatibility between mother and child in terms of Rhesus or blood types.

- Red color. Appears when blood enters the water. The source of bleeding is the placenta that begins to exfoliate.

Severe hypoxia indicates the need for early termination of pregnancy. Placental abruption always requires hospitalization and, in most cases, an emergency caesarean section. Incompatibility of blood or Rh mother and child are treated conservatively.

It is also possible to study amniotic fluid with a whole fetal bladder. In case of overdose, chronic severe fetal hypoxia, amnioscopy can be performed. It allows you to evaluate amniotic fluid visually using an optical device (amnioscope) and diagnose pathologies.

If it is required to investigate the composition of waters, it is necessary to take a small amount of them and examine them in the laboratory. More often, such a need arises when there is a suspicion of genetic abnormalities. Amniocentesis is performed - puncture of the largest "pocket" and suction a small amount material (water).

Consequences of oligohydramnios during pregnancy for a child

Amniotic fluid is significant not only for a developing child, they also help him to be born freely, making it easier. On the eve of childbirth, the amniotic sac shifts towards the cervical cavity, contributing to its opening, and also “signals” the uterus to start contracting. Before the onset of the birth process, when the bladder bursts, the outflowing anterior waters disinfect the birth canal. In childbirth, water facilitates the outward movement of the fetus.

During pregnancy, oligohydramnios provokes fusion of the skin of the fetus and the amniotic membrane. Original strands are formed that prevent the normal development of the child's body, so external anomalies appear. This complication is not common.

Insufficient amount of amniotic fluid leads to malnutrition of the developing fetus, oxygen starvation and slow metabolism. The fetus may lag behind in development, have a small mass. Also, with oligohydramnios, the placenta also suffers, which is poorly supplied with blood and experiences an oxygen deficiency.

Violations of labor activity (weakness) with oligohydramnios is observed in 80% of women in labor. The uterus for the correct strong contractions in childbirth needs a command from the brain. She receives such a command when her size corresponds to a full-term pregnancy. Pronounced oligohydramnios is always combined with an insufficient size of the uterus, therefore generic activity either does not start or is weakly expressed.

Oligohydramnios is fraught with birth traumatism. A child in the absence of the necessary "shock absorber" can hit his head on the uterine wall or get injured in the birth canal. In these situations, hematomas appear in children, the blood supply to the brain is disturbed.

With oligohydramnios, the fetus can press the umbilical cord, or it wraps around it. If this happens early, the umbilical cord tissue can become necrotic (die off), and in childbirth, such entanglement disrupts the birth process.