Have put low water. An infantile form of polycystic kidney disease. Taking certain medications

03.07.2019

Neither the age of the expectant mother, nor the number of births affect the fact of the onset of the disease.

Very often this pathology is provoked by hypertension, metabolic disorders, diseases of the urinary tract or genital organs.

Often, oligohydramnios is diagnosed with multiple pregnancies and prolonged pregnancy.

Another possible cause of the disease is underdevelopment of the epithelium, which covers the water membrane, or a reduced secretory function of this membrane.

Unfortunately, some abnormalities in the development of the child can cause oligohydramnios (for example, pathology in the development of the kidneys or face).

Symptoms of the disease

Low water can be diagnosed by the following symptoms:

the size of the uterus does not correspond to the gestational age
mom is in pain when wiggling baby
regular aching pains in the lower abdomen
weakness
dry mouth and nausea

It happens that in the last weeks of pregnancy, oligohydramnios (coupled with other pregnancy pathologies) can cause labor to be stimulated. And if the doctor insists on this, it makes sense to take a balanced approach to this recommendation: the risk of an unfavorable outcome of childbirth increases

Why is oligohydramnios dangerous during pregnancy?

Low water is a signal that there is a place for some pathologies of pregnancy, which, first of all, affect the development of the baby.

Amniotic fluid performs not only a protective function: they are involved in the metabolism between the baby and the mother, they contain oxygen, vitamins, salts, hormones and other useful substances. They help protect the fetus from dangerous infections and other adverse factors.

You need to understand that at different stages of pregnancy, the amount of amniotic fluid also changes. In the third trimester, they should be about 1-1.5 liters.... If the indicators of the pregnant woman are below these values, we can talk about lack of water.

Low water happens:

moderate (not too less than normal)
pronounced (seriously below normal)

In the second case, the expectant mother will need to be hospitalized in the pregnancy pathology department. This is due to the fact that medical supervision of a pregnant woman with a similar problem should be constant and drug treatment cannot be avoided.

Leaving oligohydramnios (especially pronounced) without treatment means putting the baby's life at great risk. Here are just a few of the dangers that this diagnosis can entail:

Child developmental defects
The risk of compression of the umbilical cord and, as a result, intrauterine death of the child
Intrauterine fetal infection

Diagnosis of the disease

Necessary tests and examinations

Low water is detected by ultrasound. But even without special equipment, the doctor can make this diagnosis.

To do this, he will find that abdominal circumference and fundus height the pregnant woman does not meet the deadline, and the woman's complaints about low fetal activity only reinforce the diagnosis. Besides flat fetal bladder can be seen on vaginal examination.

But the doctor will not rely only on examination: a pregnant woman whose doctor questions the diagnosis of oligohydramnios will be made Ultrasound and dopplerography.

CTG will give information about the state of the baby's heartbeat, and smears and standard analyzes will help to identify the very cause of low water, which must be dealt with in the first place.

Only a comprehensive diagnosis, as well as staging the severity of oligohydramnios, can provide a basis for choosing a course of treatment.

Treatment and prevention during pregnancy

Treatment

It all depends on the severity of the disease and the reasons that caused it. For example, if oligohydramnios has provoked metabolic disorders in a pregnant woman (obesity), the woman will be instructed to change her diet and diet.

At moderate polyhydramnios usually the pregnant woman is treated on an outpatient basis. Regular consultations with a doctor, taking special medications, reducing physical activity and physical activity at this time are mandatory.

Often, a "paired" diagnosis is made: aging of the placenta and oligohydramnios. This requires taking certain medications, as a dangerous pregnancy pathology develops - placental insufficiency. Most often, agents such as Actovegin are prescribed.

At low water expressed degree admission to inpatient treatment is mandatory. If the risk of fetal life is high, your doctor may order a caesarean section. If the gestational age allows, and the diagnosis does not tolerate other decisions, they also resort to early delivery.

Prophylaxis

Unfortunately, there can be no direct preventive measures for dryness. True, there is a few simple rules, which reduce the risks of this pathology. It is not difficult for them to follow almost every pregnant woman:

Eliminate serious physical activity not lifting weights from the very beginning of pregnancy
Monitor your diet, eat fractionally, at least five times a day. Refuse fast food and other "harmful", monitor weight gain
Timely take all tests, follow all the doctor's prescriptions in order to diagnose on time in case of danger
Walks in the open air, rest, positive emotions, the ability to relax. No matter how much they talk about the psychology of a pregnant woman, the importance of this aspect will not diminish. Unfortunately, constant stress and inability to control your own emotions, one way or another, affects the course of pregnancy. Therefore, from this point it is worth starting the whole process of preparing for bearing a baby.

Do not be afraid of this diagnosis, severe lack of water is not so common. But if the diagnosis is made, medical intervention cannot be avoided.

Only disciplined, responsible patients, with such a difficult diagnosis, can hope for a successful outcome of pregnancy and childbirth.

Instead of a conclusion:

oligohydramnios is a lack of amniotic fluid, which affects metabolic disorders between the mother and baby's organisms and can lead to serious problems with the growth and development of the child;
a timely diagnosis and implementation of all medical prescriptions for a pregnant woman speak of favorable prognosis for the outcome of pregnancy;
with low water, the cause of this pathology is necessarily identified, which requires correction;
at moderate low water a pregnant woman is treated on an outpatient basis, severe form of the disease requires hospitalization;
if the diagnosis is a direct threat to the life of the baby, and the gestational age hypothetically suggests delivery, stimulation of labor or a cesarean section is likely;
the occurrence of low water does not depend on the age of the pregnant woman or on the number of births;
a frequent reason provoking this pathology is an impaired metabolism, therefore, doctors strongly recommend that women with obesity go on a diet before planning a child

This is a decrease in the amount of amniotic fluid to 500 ml or less.

Causes of low water during pregnancy

The reasons for this violation are not well understood. It is believed that oligohydramnios is associated with insufficient formation of amniotic fluid by the membranes or with their increased absorption by the placenta or membranes. Often, lack of water is associated with malformations of the kidneys of the fetus, the form of their complete absence, narrowing of the ureters.

Also of some importance is a violation of blood flow in the placenta-fetus system.

Low water negatively affects the course of pregnancy and fetal development. A small amount of water constrains the fetal movement, the forced position bends the spine, torticollis or clubfoot form, and other skeletal deformities. With a small amount of water, the skin of the fetus touches the membranes, which can form threads (strands) of adhesions of the parts of the fetal body with the membranes. Such strands during fetal movements can entail entanglement with the umbilical cord, squeeze fingers and limbs, sometimes even up to their amputation, cause impaired fetal circulation when the umbilical cord vessels are compressed.

The diagnosis is made by ultrasound, in dynamics. A pregnant woman with oligohydramnios is hospitalized in a maternity hospital, where treatment is carried out to improve blood flow in the placenta, to improve its nutritional function. Often oligohydramnios is complicated by premature birth, placental abruption.

If oligohydramnios is diagnosed in combination with fetal malformations, then the pregnancy is terminated for medical reasons. With fetal growth retardation, the outcome of pregnancy becomes problematic. In the third trimester, pregnancy is prolonged up to 37 weeks and early delivery is carried out with careful monitoring of the condition of the fetus.

A pronounced oligohydramnios is characterized by a decrease in their number to 100 ml or less (in severe cases, there may even be several milliliters of fluid in the amniotic fluid).

The reasons for the development of low water are diverse, although, as with polyhydramnios, the reliable reasons are not precisely established and little studied. Most often, this pathology is formed with insufficient development of the amniotic epithelium (inner cystic membrane) or a decrease in its secretory (excretory) function. It is believed that a certain value in the occurrence belongs to the increased ability of the amnion (fetal bladder) to resorption (reabsorption) of amniotic fluid (cases of complete disappearance of amniotic fluid are described in the scientific literature, the amount of which was normal at the beginning of pregnancy). By itself, a decrease in the volume of water does not have pronounced harmful consequences in the case when it does not last long and then gradually recovers to the proper level. However, along with a reduced amount of water, fetal growth retardation syndrome is more common. This is due to the fact that in a hypotrophic (low-weight) fetus, the normal functioning of the kidneys is naturally disrupted, and a decrease in hourly urine output gradually leads to a decrease in the volume of amniotic fluid. Low water is quite common in cases of development of identical twins, which is explained by the uneven distribution of blood circulating in the common placental apparatus between the two twins. These reasons are put forward as the most often assumed, however, along with them, the cause of oligohydramnios can be associated with various extragenital (outside the reproductive system) pathology of the mother (cardiovascular failure, impaired renal and liver function).

When this kind of pathology appears in most cases, complications of pregnancy and the course of childbirth occur, which ends in spontaneous miscarriage, premature birth.

The presence of low water during pregnancy adversely affects the growth and development of the fetus, therefore, this condition belongs to the category of painful conditions and requires a full examination and treatment. Developmental disorders are a consequence of limiting the motor activity of the fetus due to insufficient amniotic fluid. Against this background, the most common congenital clubfoot, in some cases curvature of the spine and deformities of other bones of the skeleton. Often, with low water, adhesions are formed between the skin of the child and the amnion. With a further increase in the size of the fetus, they stretch out, and after delivery they take the form of strands and threads. It is not excluded, however, the possibility of the development of such strands against the background of an anomaly in the development of the ectoderm. These formations sometimes cover the torso and limbs of the child, the umbilical cord, which causes disfigurement or even amputation of various parts of the body. Possible fetal death as a result of cord clamping. Possible fetal malformations with low water levels.

Primary low water is characterized by a relatively favorable course, since it is not associated with a violation of the integrity of the amniotic membranes. Traumatic or secondary, a much less common form of this pathology, is characterized by damage to the membranes and a gradual outflow of amniotic fluid during pregnancy. Outpouring of amniotic fluid occurs through the gap formed between the membranes and the inner surface of the uterus. The amount of damage can be different, but, as a rule, its size is small and water flows in small portions for a long time into the abdominal cavity (amnional hydrorhea). The process of the flow of amniotic fluid can be either constant or periodic. In the case when the amniotic epithelium has the potential for synthesis, such an outflow of water is compensated for for some time. Persistent cases of progression of oligohydramnios end in early termination of pregnancy.

A pregnant woman with a decrease in the amount of water may notice the appearance of pain in the uterus. The pain is constant, aching, aggravated by fetal movements, with a change in the position of the body of the pregnant woman herself. Initially, with the development of the disease, its signs are not very pronounced, they become noticeable for a woman with the development of severe low water and with the addition of fetal malformations (such children are inactive, the heartbeat is slow).

Diagnosis of oligohydramnios during pregnancy

The main diagnostic criterion of pathology is to determine the discrepancy between the size of the uterus and the true gestational age. For diagnostic purposes, an ultrasound examination can be carried out, which helps to determine the exact amount of water, to clarify the gestational age by the size of the fetus, to identify the presence or absence of fetal malformations, to determine its position in the uterus, and also to perform a medical and genetic examination by chorion biopsy. This study involves the collection of material (blood from the umbilical cord or other vessels) under ultrasound control for the presence or predisposition to the development of genetic developmental abnormalities.

The course of oligohydramnios during pregnancy

The course of pregnancy with the development of oligohydramnios is characterized by frequent miscarriage - early miscarriages or premature birth at a later date.

Labor act in the presence of oligohydramnios also proceeds with various complications. Prolonged labor is most common. The opening of the uterine pharynx is extremely slow. This situation is explained by the lack of proper functioning of the fetal bladder, which normally leads to adequate smoothing of the cervix and the opening of the uterine pharynx. Contractions of the uterus are very painful and do not cause the desired reaction on the part of the fetal movement and, accordingly, the opening of the birth canal.

Consequences of oligohydramnios during pregnancy

One of the most common complications of childbirth with oligohydramnios is premature detachment of the normally located placenta. This situation is dangerous by the development of bleeding, up to the death of the mother and fetus. Vaginal (transvaginal) examination during childbirth reveals the absence of tension of the fetal bladder during contractions (flat fetal bladder), while the membranes adhere tightly to the presenting part of the fetus and only interfere with the normal course of the disclosure period. Spontaneous rupture or artificial dilution of the membranes accelerates the opening of the uterine pharynx and reduces the overall duration of labor. After opening the membranes, a small amount of turbid amniotic fluid is released (often with an admixture of meconium - fetal feces).

Low water leads to unfavorable pregnancy outcomes, however, the severity of the result depends on the gestational age at which the AFV pathology began. On the other hand, if oligohydramnios is the only finding in the third trimester, the fetal outcome is usually good. Since accurate ultrasound assessment of AFF has its limitations, care should be taken to avoid misusing the diagnosis of amniotic fluid loss to avoid unnecessary use of invasive interventions during pregnancy, such as early induction of labor. Despite this controversy, it is prudent to evaluate ultrasound evidence of a decrease in amniotic fluid volume to ensure that this is indeed the only finding.

Fetal anomalies / aneuploidy

Congenital malformations and fetal aneuploidy are usually associated with oligohydramnios seen in the second trimester. Most of the fetal abnormalities occur in the genitourinary system; defects in the skeleton, central nervous system and cardiovascular system are also associated with oligohydramnios. It is important to remember that secondary oligohydramnios as a result of renal abnormalities is not detected until 18 weeks of gestation, since up to 14-18 weeks the maternal contribution to the formation of amniotic fluid remains high. A comprehensive ultrasound assessment of the structure of the internal organs of the fetus, especially the kidneys and bladder, is required. Usually, with transabdominal ultrasound, it is possible to accurately diagnose renal agenesis, impaired outflow from the bladder, polycystic kidney dysplasia, and infant polycystic kidney disease. In the absence of both kidneys and fluid in the fetal bladder, renal agenesis is diagnosed. For further examination of the fetus with kidney agenesis, color Doppler ultrasonography is used to determine the location of the renal arteries and identify the "lying" adrenal glands. Ultrasound picture of multicystic dysplastic kidneys and infantile polycystic kidney disease - enlarged hyperechoic or cystic kidneys. In case of obstruction of the exit from the bladder associated with the syndrome of the posterior valve of the urethra, an enlarged bladder in the form of a keyhole and a significantly enlarged renal pelvis are determined. Due to severe oligohydramnios, accurate antenatal diagnosis of these fetal conditions using transabdominal ultrasound is sometimes difficult.

With poor visualization of fetal anatomy at the beginning of the second trimester, transvaginal ultrasound is useful. To improve the ultrasound resolution, amnioinfusion was proposed; the advent of MRI made it possible in most cases non-invasive confirmation of early ultrasound findings. With severe oligohydramnios, it is difficult to perform amniocentesis to assess the karyotype of the fetus. The method of choice is placental biopsy. With the exception of posterior urethral valve syndrome, when in some cases intrauterine surgery can improve the outcome, the fetus is not viable due to pulmonary hypoplasia that develops in these conditions.

Rupture of membranes

The rupture of the membranes is easily determined based on the history and examination. During vaginal examination with sterile mirrors, the accumulation of amniotic fluid is confirmed, the alkaline pH is determined with nitrisin, and the typical phenomenon of arborization is revealed. If the history and examination data are questionable, other methods are used for diagnosis. If, after amnioinfusion of indigo-carmine in Ringer's solution (100-150 ml), staining of the vaginal swab occurs, this indicates a premature rupture of the membranes.

The use of methylene blue should be avoided as it can lead to jejunal atresia in the fetus. After 22 weeks of pregnancy, fetal fibronectin is determined in the contents of the posterior fornix, although in uncomplicated pregnancy this test is not very informative. Its definition has been used as a non-invasive method for confirming premature rupture of the membranes with questionable results of anamnesis and clinical examination. The earlier the premature rupture of the membranes occurs, the more careful the prognosis. A gap with the occurrence of severe oligohydramnios before 24 weeks of gestation carries an additional risk of lung hypoplasia, although not as pronounced as with fetal kidney anomalies. In case of leakage of amniotic fluid after amniocentesis in the second trimester, the prognosis is quite good, the survival rate is more than 90%.

Intrauterine growth retardation

Uteroplacental insufficiency leads to a redistribution of blood flow in the fetus in favor of vital organs. The patient's history and examination data indicate risk factors for intrauterine growth retardation syndrome (FGRS) - drug addiction, chronic hypertension, previous obstetric history, birth weight of children and preeclampsia. With fetal biometrics, fetal weight is below the 10th percentile. For FGRP, detected at the end of the II and in the III trimester, asymmetry of the biometric parameters of the fetus (inconsistency of the head circumference with the abdominal circumference) is characteristic, whereas with severe FGR in the II trimester, symmetrical growth retardation is observed.

Ultrasound reveals premature maturation of the placenta (early placental calcification). Additional clues are provided by Doppler examination, which measures the blood flow velocity in the mother and the fetus. Pathological results of Doppler examination of the uterine artery at 18-24 weeks suggest abnormal placentation and are of some importance for the prognosis of an unfavorable pregnancy outcome. Doppler examination of the umbilical artery reveals an increase in placental resistance, noted in uteroplacental insufficiency. In the early stages of development of FGRP, Doppler examination of the middle cerebral artery of the fetus reveals the "brain steal syndrome" associated with the redistribution of blood flow. It is expressed in an increase in diastolic blood flow velocity and a decrease in the pulse index. Although there is no separate antenatal study to confirm FGR, pathological dynamic ultrasound results in combination with the history allow calculating the prognosis and choosing a rational treatment regimen.

Perinatal morbidity and mortality are inversely related to gestational age at diagnosis. With early onset of severe FGR, the patient must be examined in detail in order to exclude fetal malformations.

Itrogenic causes

Many iatrogenic causes lead to oligohydramnios. These include fetal procedures - chorionic villus sampling or amniocentesis and various medications. Careful collection of anamnesis allows you to exclude these causes. NSAIDs and angiotensin-converting enzyme inhibitors reduce renal perfusion and lead to oligohydramnios. Fortunately, in most cases, oligohydramnios is reversible when these drugs are discontinued.

Postmaturity

A decrease in the volume of amniotic fluid during post-term pregnancy is a reflection of uteroplacental insufficiency that occurs in late pregnancy. With a post-term pregnancy, it is recommended to monitor the volume of amniotic fluid and, if signs of oligohydramnios appear, induction of labor is performed. However, it is unclear whether these measures result in improved fetal outcomes.

Low water - a lack of amniotic fluid. It occurs in 20% of pregnant women. This condition can have serious consequences, it is fraught with complications and deviations from the normal course of pregnancy, and the risk of fetal pathologies increases. The composition of amniotic fluid is quite diverse. The waters inside the ovum contain nutrients necessary for the life and development of the baby, oxygen, hormones, salts, vitamins and other substances that ensure the normal course of intrauterine development of the fetus.

Another function of amniotic fluid is protective. The water inside the placenta creates a kind of weightlessness and in this way protects the child from possible damage due to the pressure of the woman's internal organs.

In the event of an impact, it absorbs it, so the consequences for the fetus are minimal. In addition, amniotic fluid protects the baby from infections and other adverse factors. Thus, lack of water during pregnancy is very dangerous, because a similar phenomenon is a decrease in the quality of the protective functions of the amniotic fluid.

Why does oligohydramnios occur?

The amount of water inside the placenta changes depending on the needs of the baby and the duration of pregnancy, it is clear that at a period of 20 weeks the volume of water is less than at a period of 37 weeks. By 38 weeks of normal pregnancy, the volume of fluid is 1500 ml, and at 39 and 40 weeks, it begins to gradually decrease.

Most often, the signs of oligohydramnios are detected in the second trimester (by about 20 weeks), but if oligosity is detected at 30-32 weeks, then this can pose serious problems.

If for a period of 30 - 32 weeks the amniotic fluid is less than 1000 ml, then we are talking about oligohydramnios. Depending on the amount of fluid deficiency in the placenta, severe or moderate oligohydramnios is diagnosed during pregnancy. For diagnostics, ultrasound is most often used.

Sometimes mild oligohydramnios during pregnancy is the result of poor nutrition. In such a situation, a pregnant woman does not need treatment; it is enough to establish a regimen and diet. Usually, doctors prescribe a gentle regimen in such a situation, which includes eating a variety of foods rich in vitamins and minerals. In parallel with the diet, it is important to periodically see a doctor.

If the ultrasound showed a pronounced lack of water, it means that serious measures will be required, including drug treatment. In such a situation, the woman will be placed in a day hospital for preservation. The more pronounced oligohydramnios, the more serious the consequences for the baby can be. Severe oligohydramnios threatens the development of the following pathologies:

deformation of the child's skeletal system,
asphyxiation, which can lead to disruption of the nervous system and negatively affect the activity of the brain,
abnormal development of the limbs in the fetus.

A pregnant woman should know that a decrease in the volume of amniotic fluid at a later date (37, 38, 39 weeks) is not read as a pathology. This is a natural preparation process for childbirth, which in most cases occurs at 39 or 40 weeks.

Symptoms of low water

The most dangerous thing in this condition is that there are no obvious signs of low water. Physically, a woman feels great and her state of health does not deviate from the norm. Only sometimes at the moment the fetus moves, a woman can feel pain in the lower abdomen, but this is an unreliable symptom.

It is only a specialist who can determine exactly whether a pregnant woman has oligohydramnios. So, an experienced doctor can diagnose pathology in the case of:

lag in size or discrepancy in the height of the fundus of the uterus,
its serious discrepancy with the timing of pregnancy,
insufficient size of the abdomen for this period.

If such symptoms are found, the doctor may come to the conclusion that oligohydramnios is found in a pregnant woman. Every doctor knows what oligohydramnios threatens if not treated. The risk of giving birth to a baby with developmental pathologies is very high, especially with severe lack of water.

In order to refute or, conversely, to confirm this diagnosis, it is necessary to conduct an ultrasound scan, on the basis of which a diagnosis should be made. Ultrasound examination will allow you to accurately determine the amount of fluid inside the placenta, and when confirming the diagnosis, the doctor will use ultrasound to assess the severity and condition of the fetus. If you suspect the presence of oligohydramnios, a pregnant woman should be examined by a gynecologist.

They can diagnose oligohydramnios at 20, 30 and 37 weeks. Although oligohydramnios in the classical sense can only be diagnosed at 39 or 40 weeks, if the volume of fluid has decreased to 500 ml or less.

However, the classical definition is outdated, in modern medicine we can talk about low water starting from 20 weeks. The closer the term of delivery (37, 38, 39 weeks), the more the placenta ages and the more often oligohydramnios is detected.

Causes of lack of water

If the doctor diagnoses oligohydramnios during pregnancy, the causes of this condition may be different. Experts to this day cannot come to a common opinion about why oligohydramnios occurs. From a long list of reasons, scientists have pinpointed the following:

Reduced function of secretion of the membrane that forms the ovum, insufficient or abnormal development of the epithelium covering this membrane. If a pregnant woman does not know what the danger of lack of water during pregnancy is, then this is even better. Most of the difficulties for doctors are not diagnosed, but "false symptoms" that arise as a result of excitation of the woman's nervous system.
Abnormal fetal development. Other options for abnormal development include hereditary anomalies in the development of the face and kidneys. It is possible to clarify this in the period between 20 and 30 weeks, when the second compulsory ultrasound examination has already been performed.
High blood pressure in a pregnant woman. Naturally, throughout the entire period of pregnancy, the pressure will be increased, but its jumps will be insignificant. If the jumps in blood pressure are too high, it can cause oligohydramnios. In the case of hypertension, fetal growth retardation, growth retardation or freezing may occur. This happens especially often after 20 weeks.

Another reason for low water is all kinds of bacterial infections that were transferred by a pregnant woman and were not cured efficiently. Sometimes the danger is hidden in infections that a woman was sick with long before pregnancy. In such a situation, the pathogenic microflora with the help of analyzes is detected both in the birth canal and in the amniotic fluid. The manifestation of such a danger can be detected at 20 weeks of pregnancy, when, under the influence of hormones, the infection begins to progress, in parallel with this, oligohydramnios develops. At a period of 30 weeks, lack of water becomes pronounced.
Low water is often observed in the case of multiple pregnancies. The cause of this ailment in such a situation may be the uneven distribution of blood flow in the placenta. In this case, one child gets more oxygen and nutrients than another. This situation can lead to the death of a weaker embryo; therefore, stationary observation is necessary.
Another reason for lack of water is overweight. At 36 or 37 weeks, the baby is already fully formed and may appear at any time. Sometimes women carry a baby for more than 40 weeks, but it is important to know that oligohydramnios can develop from 38 weeks. The reason for this is the "expiration date" of the placenta, which has already served the due time and begins to age. Sometimes a clear aging of the placenta is noted as early as 37 weeks. As a result, it flakes off and is unable to perform its functions. Under these circumstances, doctors raise the issue of caesarean section or induction of labor by piercing the placenta. Do not be alarmed if doctors suggest surgery at 37 or 38 weeks. By this period, the child is already completely ready for birth.

Low water can develop gradually, starting from the first week of pregnancy, and can be detected at 12 or after 20 weeks with an ultrasound scan. It can be caused by the obesity of a pregnant woman as a result of serious metabolic disorders. In such a situation, it is important to know how pronounced it is, and how seriously it affected the development of the fetus. If the lack of water has not yet had time to become pronounced and acquire a critical character, then the child can be saved. To do this, the pregnant woman is placed in a hospital, where she will be under the supervision of doctors throughout the entire gestation period. With such a pathology, you need to introduce a strict diet and find out the causes of obesity. Even with the best option, the baby will be born no later than at 37 or, in extreme cases, 38 weeks. This is due to the death of the placenta. In this case, a cesarean section is required.

Examinations and analyzes for lack of water

Before starting treatment, the doctor needs to establish what led to the pathology and diagnose. First of all, it is important to clarify the reason that was the result of insufficient amniotic fluid and the severity of low water. In this case, you need to go through a series of analyzes and studies:

ultrasound and dopplerography, as a result of which you can:

determine the amount of water in the ovum;
to clarify the degree of the child's developmental delay;
to assess the quality of blood flow in the uterine arteries of a pregnant woman, as well as in the umbilical cord and cerebral artery of the fetus.

a general urine test, a general blood test, a smear for the presence of possible infections and other sexually transmitted diseases. These analyzes will exclude the possibility of infection of the fetus, as a result of which oligohydramnios develops;
CTG in order to determine the health and condition of the fetus.

In addition, it is extremely important to conduct an oral survey of the pregnant woman. The more honest her answers are, the faster it will be possible to find out the reason for the lack of water. It is important to clarify whether she abused any products, whether she used alcohol, whether the pregnant woman smokes. The sooner the cause of oligohydramnios is established, the sooner it will be possible to begin treatment, and therefore to save the child.

If oligohydramnios is diagnosed at an early stage, then the pregnant woman will need to undergo additional examinations throughout the gestation period to identify the amniotic fluid index (AFI). For each week, starting from 16, it is necessary to determine the AFI. The frequency of determination is 20, 30, 32, 34, 35, 36, 37, 38, 39 and 40 weeks of pregnancy (provided that childbirth by caesarean section does not occur at 37 weeks).

Treatment of oligohydramnios

Treatment methods for this ailment vary. It all depends on the severity of low water, the reasons for its occurrence and the timing of pregnancy. For example, in the case of metabolic disorders and obesity for a period of 30 or 32 weeks, a woman is prescribed medication that normalizes the activity of the placenta.

The doctor will also make a special diet. If the gestation period is 33 or 34 weeks or more, then a complex treatment is prescribed, which includes taking drugs that improve the metabolism in the placenta, vitamins, drugs for the main cause of the disease.

Treatment can take place in two versions: outpatient - with a moderate degree of oligohydramnios, or in a hospital - if the degree of oligohydramnios is pronounced. Outpatient treatment consists of:

limitation of physical activity,
maintaining a sparing regime,
exclusion of heavy physical exertion,
taking medications prescribed by a doctor,
periodic visits to the antenatal clinic.

Usually, outpatient treatment is prescribed if a woman is in the second trimester of pregnancy. A woman is placed in a hospital if:

if lack of water has a pronounced degree;
if the amount of amniotic fluid is slightly below normal, but the tone of the uterus is detected;
oligohydramnios at 34 - 35 weeks of gestation and later.

If oligohydramnios is diagnosed, the doctor may prescribe a weekly ultrasound scan, starting at 34 or 35 weeks, fetal CTG and Doppler ultrasound. Such measures are extremely important in order to control the pathology. Then, if something goes wrong, it will be possible to take the necessary measures in time.

If oligohydramnios is pronounced and the severity of the pathology threatens the health of the child, then the doctor is obliged to take measures and perform a cesarean section. Premature birth in this case is possible only with a gestational age of 33 weeks or more.

However, whenever possible, doctors try to do everything to keep the pregnancy up to at least 35 weeks, since the fetus is considered fully ripe only by the end of 36 weeks. But this does not mean that you need to abandon the operation for a period of 34 or 35 weeks, since with oligohydramnios the fetus can be severely damaged.

Woman's condition with oligohydramnios

Low water has serious consequences and has a negative effect on the course of pregnancy, resulting in painful sensations, this is especially pronounced during the period of active fetal movement. In addition, a small amount of amniotic fluid can lead to termination of pregnancy. The risk of miscarriage is especially high in the first trimester of pregnancy.

Regardless of the form of oligohydramnios (moderate or severe), there is a complication of the course of labor. This can manifest itself in the weakness of the birth process - minor contractions and weak attempts.

This occurs as a result of the low pressure of the fetal bladder, which, due to its small size, is not able to influence the speed of preparation of the birth canal and dilatation of the cervix. For a period less than 34 weeks, a cesarean section will have to be performed.

In such a situation, it may be necessary to inject special drugs that stimulate contractions. This is especially important for a period of more than 35 weeks. In this case, the woman will be able to give birth herself.

Prevention of oligohydramnios

Since the consequences of dryness can be serious and difficult to treat, preventive measures must be taken. They consist in proper nutrition and in adherence to all medical recommendations. It is important to undergo examinations and tests on time. It is forbidden to lift weights.

Amniotic fluid (amniotic fluid) on different can vary in volume. It depends on the presence of various diseases and the duration of pregnancy. In this article, we will understand the causes and symptoms of low water, and also talk about methods of treatment, prevention and possible consequences.

Causes

Did you know? According to statistics, oligohydramnios occurs in 4% of pregnant women.

Low water during pregnancy can be in moderate and severe form. In the first case, the symptoms practically do not make themselves felt. A moderate lack of amniotic fluid is determined only after an ultrasound examination.
If the lack of amniotic fluid in the mother is in a pronounced form, then following symptoms:

when the fetus moves.
decreases in size (the size of the abdomen decreases, and this can be observed even visually; during obstetric examination, a decrease in the height of the fundus of the uterus is noted).
Fatigue and feeling unwell (nausea, weakness, dry mouth).
Discomfort in the lower abdomen with occasional aching and pulling.

Only a doctor can confirm the lack of amniotic fluid. Therefore, when the first symptoms appear, you should immediately consult a doctor for further examination and treatment.

Possible consequences

Low water during pregnancy is a dangerous disease that entails adverse consequences for both the mother and the child.

For woman

Low water during pregnancy poses a certain danger to the mother. First of all, a woman will feel constant unpleasant pulling pains in the lower abdomen, which are constantly intensifying during moments of active movement of the child. In addition, a lack of amniotic fluid in rare cases can lead to miscarriage.

Low water in the last weeks of pregnancy leads to complications with. This often manifests itself in the form of weak labor. Weakness occurs when the fluid cannot press down on the cervix with sufficient force. As a result, doctors have to use drugs that stimulate labor.

For a child

Low water during pregnancy can lead to serious consequences for the child. With a lack of amniotic fluid, the walls of the uterus begin to actively adhere to the fetal sac, and this leads to strong pressure on the fetus. As a result, the child bends into the wrong position, which leads to an increment of the skin to the fetal membrane.

In addition, due to pressure on the fetus, the child may experience curvature of the spine, impaired development of the skeletal system, impaired nervous and brain activity, abnormal formation of limbs, wrinkling and dryness of the skin, hypoxia, and lagging in weight and height.

Important!With low water, drinking plenty of fluids (water, juice, milk, etc.), about 2 liters per day, helps.

However, ultrasound diagnostics should be based on repeated research.

A one-time ultrasound scan can only indicate that a woman has some kind during this particular period of pregnancy. They can be associated with the transferred viral diseases, and later disappear independently and irrevocably. If an ultrasound scan is done continuously for 1-3 months, and there is always a lack of amniotic fluid, then this indicates the presence of pronounced oligohydramnios.

Currently, many doctors diagnose oligohydramnios on the basis of a single ultrasound scan, which in itself can only mean a statement of fact. In this case, active drug treatment is not prescribed. Pregnant women can be prescribed a course of treatment based on harmless complexes.

If ultrasound repeatedly shows a pronounced insufficiency of amniotic fluid, then pregnant women are additionally prescribed dopplerometry of the placenta vessels(duplex ultrasound scanning of blood vessels) or CTG of the fetus(cardiotocography, which helps to assess the characteristics of the fetal heartbeat). If the results of the above two diagnostic methods are normal, then this means that there are no serious deviations, and oligohydramnios was only temporary, functional in nature.
In the case of poor data in the study of CTG and Dopplerometry, doctors prescribe additional examinations and: studies for anti-rhesus bodies, the presence of infection in the blood, glucose indicators, etc. It is imperative to do a targeted ultrasound, which gives a detailed picture of everything that is happening. If possible, karyotyping and amniocentesis are also prescribed. The last two diagnostic methods allow you to identify the chromosomal and genetic abnormalities of the child.

Did you know?Down syndrome and trisomy 8 and 13 in the fetus cause oligohydramnios in almost 100% of cases.

Sometimes a gynecologist may suspect a woman has amnional hydrorhea (leakage of amniotic fluid). In such cases, water smears are prescribed. In late pregnancy, amnioscopy, a procedure that is safe for both the mother and the fetus, can help identify a lack of amniotic fluid.

Treatment methods

If you find yourself with any of the symptoms listed above, then you do not need to self-medicate and immediately consult a doctor to prescribe a certain course of treatment for oligohydramnios during pregnancy. Doctors first carry out a complete diagnosis and exclude options for fetal malformations. Otherwise, a different specialized treatment will be prescribed.
If gynecologists have established amnional hydrorhea, then they prescribe to a pregnant woman special preparations and vitamin complexes, which help prevent infection of the child and reduce the tone of the uterus. In addition, in this case, it is necessary to observe the bedding. Doctors often prescribe inpatient care under full supervision until the onset of labor.

Sometimes a viral infection can cause a lack of amniotic fluid in pregnant women. In such cases, antiviral and restorative medications are prescribed. Additionally, they prescribe the intake of vitamin complexes and drugs that stimulate blood microcirculation.

If the pregnancy is delayed, then an amniotomy (bladder puncture) is done and the delivery is immediately taken. In addition, there are cases when a pregnant woman has an abnormality in the development of the membranes, which is why oligohydramnios occurs.

In such cases, prevention of intrauterine infectious lesions and therapy aimed at preserving pregnancy are needed. And do not forget that timely diagnosis of a lack of amniotic fluid and quality treatment lead to a favorable outcome.

Prophylaxis

For the prevention of low water, you can use birch sap, which has a good diuretic effect. To reduce and enrich the body with vitamins, you need to eat chokeberry.
It contains vitamins that doctors prescribe when symptoms of a lack of amniotic fluid are detected. Rowan can be consumed both in the form of berries and in the form of juice.

So that oligohydramnios does not arise against the background, stress or overwork, you need to take tinctures of medicinal herbs. The best of this kind will be tinctures of motherwort herbs or. These drinks are taken before bedtime, they are excellent soothing and relieve spasms.

The diagnosis of oligohydramnios is made by 20% of pregnant women. This phenomenon is expressed in a lack of amniotic fluid. Depending on the complexity of the course, it can be very dangerous and in some cases threatens with miscarriage.

Amniotic fluid is an important component for the proper development of the fetus. They contain the oxygen it needs, vitamins, other nutrients, salts and hormones. In addition, they perform a protective function, protecting the baby from the blows and pressure of the mother's organs. And also prevent the penetration of infections and other aggressive phenomena.

Treatment of oligohydramnios during pregnancy depends on the degree of its course, the effect on the fetus and the reasons for its occurrence. The diagnosis can be made at any stage of childbearing. It is often found in the second trimester, but it is not uncommon for it to be detected in the third.

If the amount of amniotic fluid in the last weeks fluctuates within 1-1.5 liters, then this indicates their insufficient amount. In some cases, it turns into serious problems during this period.

There are two types of amniotic fluid deficiency:

Moderate. Usually it is caused by improper nutrition, therefore, to eliminate it, a woman just needs to adjust her diet and eating regimen. Doctors recommend consuming more foods high in nutrients and vitamins. If you follow a diet, you must periodically undergo examinations by an observing gynecologist;
Expressed. Dangerous to the fetus. Treatment is carried out in a comprehensive manner and includes taking medications. A woman must be admitted to a hospital for conservation. The more pronounced oligohydramnios, the higher the risks for the child, because it can lead to deformation of the fetal skeletal system, pathology of limb development and asphyxia, which disrupts the functioning of the nervous system and the brain.

What is the threat of pronounced oligohydramnios during pregnancy?

A woman usually does not notice violations, she feels well, her condition does not deviate from the norm. We can say that this pathology does not have pronounced symptoms, which greatly complicates its diagnosis. However, many people experience pain when the fetus moves, so in some way this can be called one of the signs.

Only a doctor can detect a lack of amniotic fluid.

The observing gynecologist conducts routine examinations and, based on their results, can state its presence:

Growth retardation of the uterus;
Inappropriate height of the fundus of the uterus;
The size of the abdomen, inappropriate for the gestational age.

Doctors are well aware of the risks of lack of water - the risks for an unborn baby are significantly increased. In addition, the more pronounced it is, the higher they are.

To verify the accuracy of his diagnosis, the doctor sends the woman to an ultrasound scan, the results of which confirm or deny the doctor's conclusion. In parallel, the amount of fluid inside the placenta and the severity of the disorder, as well as its effect on the fetus, are established.

Causes of low water during pregnancy

High blood pressure. Throughout the entire period of bearing the child, his jumps are ascertained, but they are insignificant and are within the normal range. But if fluctuations significantly exceed the permissible ones and are observed quite often, then they may well cause a lack of amniotic fluid. Severe hypertension affects the development of the fetus, slows down its growth and can even lead to the fading of pregnancy. Often the pathology caused by this particular cause is found at about 21 weeks, but throughout the entire first trimester it is not uncommon;
Abnormal development of the embryo can also be a provoking factor. It can be found during the second planned ultrasound scan;
Reduced secretion of the membrane and poor development of the epithelium that covers it;
Multiple pregnancy. The cause is uneven blood flow in the placenta. In this case, one baby receives more nutrients and other elements than the other. This can lead to the death of a weaker child, therefore, such women are monitored in a hospital;
Bacterial infections before and during pregnancy. Pathogenic microflora sometimes gets not only into the birth canal, but also into the amniotic fluid. At first, it does not manifest itself, but usually by 21 weeks, under the influence of hormones, it begins to develop sharply and after 10 weeks the lack of water becomes quite pronounced;
Overburdening. Ascertained in women after 36 weeks. By this time, the child is completely ready for birth and can appear at any time. In some cases, women carry a baby for up to 40 weeks. From about 38th, the amount of water decreases due to aging of the placenta. It has already fulfilled its functions and is gradually peeling off. Doctors in this case cause premature birth or perform a cesarean section;
There are times when oligohydramnios develops from the very moment of conception. Under such circumstances, it is found during a routine ultrasound scan at 12 or 22 weeks. Often occurs against the background of metabolic disorders and obesity of the expectant mother. Doctors assess the degree of its severity and impact on the child. If there are no serious violations, then there is a chance to save the fetus. A woman in this condition will be treated in a hospital until the birth itself. Children in this case are born at a maximum of 37 weeks, since the placenta begins to exfoliate ahead of schedule. Often the birth of a baby is carried out through a cesarean section.

Diagnostics

First of all, after the diagnosis is made, the doctor determines the cause, and then the severity of this phenomenon.

For this, specialists use a variety of examinations and analyzes.:

Doppler ultrasound, ultrasound. They help to determine the amount of water in the ovum, as well as to identify the child's developmental lag. In addition, these methods are used to assess blood flow in the arteries of the fetal brain, umbilical cord and uterus;
General blood and urine tests, smear for the presence of diseases of the genital area. These methods will eliminate the possibility of infection of the baby;
KGT allows you to determine the state and well-being of the child.

How to treat moderate to severe oligohydramnios during pregnancy

Depending on the severity, causes and degree of influence, different methods are used. For example, if a lack of amniotic fluid is detected at week 27 with obesity, medications are prescribed that improve the function of the placenta.

Starting from the 31st week, an integrated approach is carried out to treatment, including the administration of drugs to stimulate the metabolism in the placenta. Vitamins are also prescribed and, of course, remedies to eliminate the cause.

There are two methods of treatment: outpatient and inpatient. The first is used in case of a moderate course, the second - with a pronounced one.

In the first case, a pregnant woman should adhere to a sparing regimen, reduce physical activity, not overexert herself, take medications prescribed by a doctor and visit a consultation regularly. Basically, this method is prescribed in the second trimester.