Composition and norm of amniotic fluid. Acute polyhydramnios - what causes excess amniotic fluid during pregnancy

Unfortunately, pregnancy does not always proceed without complications. In some cases, for the safety of mother and baby, a woman is offered hospitalization in a maternity hospital, in the pathology department. What can be the reason for hospitalization?

The diagnosis of "oligohydramnios" usually causes anxiety in expectant mothers. Why is this condition dangerous for the baby, how can it affect the course of childbirth and is it possible to fight it?

"Habitat"

Throughout pregnancy, the baby's living space is limited by the uterine cavity. In addition to the fetus itself, the uterus contains the fetal membranes and the placenta - the so-called organs of pregnancy. These organs actually appear and function in the body future mother only during pregnancy; after the birth of the baby, they are separated from the wall of the uterus and are born in the form of an afterbirth.

The main function is to create and maintain normal conditions For intrauterine life baby. A significant role in ensuring the optimal microclimate for the fetus belongs to the amnion.

Amnion, or water shell, is a closed bag in which the fetus is located, surrounded by water. The water membrane tightly adheres to the inner surface of the uterine wall, lines inner surface placenta and passes to the umbilical cord, covering it in the form of a case. In the area of the baby's navel, the shell passes to the skin of the tummy, gradually merging with it.

The fetal bladder (amnion) consists of a thin membrane in which two layers are distinguished. The inner layer - epithelial - faces the fetus. The outer layer is called connective tissue and is closely adjacent to the wall of the uterus. The fetal bladder is thin, but dense and very elastic. Its surface is transparent, smooth and slightly shiny.

The walls of the fetal bladder during pregnancy produce a special fluid - amniotic fluid. Normally, the amount of water by the end of pregnancy is from 800 to 1500 ml. The composition of amniotic fluid, or includes protein, various salts, urea, carbohydrates (sugar) and hormones (folliculin, gonadotropic hormone), necessary for normal metabolism and fetal development. In the first half of pregnancy, the fetal waters are clear and clean. In the second half, and especially towards the end of pregnancy, the water becomes somewhat cloudy. This turbidity depends on the elements of the fetus mixed with the amniotic waters. These elements include:

lanugo - the so-called delicate hairs that cover the baby's skin in certain period embryonic development;
original lubricant - fatty lumps covering the skin of the fetus in the form of a curdled or cheese-like mass and protecting it from maceration (wrinkling, skin damage from constant exposure to a liquid medium);
desquamated epidermis - scales of dead skin cells of the fetus

The composition of amniotic fluid is controlled by the walls of the fetal bladder: amniotic sac penetrated by the thinnest blood vessels, from the plasma of which the fetal waters are formed. The amniotic waters are constantly being renewed; a complete change in the composition of water normally occurs in about three days.

The physiological significance of amniotic fluid in the development of pregnancy and fetus is enormous.

The amount of amniotic fluid gradually increases during pregnancy. In the first months there are relatively many waters, and the baby can move freely, "swim" in his water reservoir. By the end of pregnancy, the amount of water increases, stretching the walls of the uterus, but at the same time, the fetus grows significantly, and it grows quite quickly. In the third trimester, the fetus already occupies almost the entire uterine cavity, the baby’s movements are limited: he cannot, as before, constantly change his position and position in the uterus.

The physiological significance of amniotic fluid in the development of pregnancy and fetus is enormous. The waters create a unique habitat for the baby. They prevent the formation of adhesions between the amnion and the skin of the fetus. Amniotic waters create an opportunity for unhindered active movements of the baby, which is so necessary for his correct, normal development. At the same time, the waters protect the umbilical cord and placenta from pressure from large parts of the fetal body. The amnion and amniotic fluid protect the baby from shocks and bruises from the outside, make the baby’s movements less noticeable for the expectant mother, the normal amount of amniotic fluid ensures the formation right position fetus in the uterus towards the end of pregnancy. The fetal bladder, filled with water, participates in the process of opening the cervix in the first stage of childbirth: during the contraction, the walls of the uterus are compressed, causing the elastic fetal bladder to "bulge" into the lumen of the cervix; the pressure of the fetal bladder on the cervix increases its opening.

And, it turns out, without water ...

As already mentioned, the normal amount of amniotic fluid during a full-term pregnancy ranges from 800 to 1500 ml. A situation in which the amount of water “does not reach” the lower limit of the norm is commonly referred to in obstetrics as oligohydramnios.

The reasons for the insufficient amount of amniotic fluid are different. Almost always, the main cause of oligohydramnios is a variety of pathologies of the fetal membranes (amnion, or fetal bladder). This is not surprising: after all, it is the amnion that is responsible for the production and exchange of fetal fluid. We list the most common factors affecting the decrease in the amount of water:

Infection of the membranes- the most common cause of an infectious lesion of the amnion are viruses (SARS, influenza, the so-called "childhood infections": chicken pox, measles, etc.), because they are able to penetrate through placental barrier. Less commonly, infectious agents enter the fetal membranes in an ascending way - from the vagina. The introduction of an infectious agent into the fetal membrane, the poisoning effect of its metabolic products (toxins) has a damaging effect on the amnion, violating its basic properties and functions. As a result, the fetal membranes lose their elasticity and resistance to tearing, delaminate, acquire increased permeability or break. As a result, it is observed, which leads to a decrease in their volume. In some cases, on the contrary, the fetal membranes become too dense, lose their transparency. In any case, almost always, as a result of infection of the amnion, one of its most important functions suffers - the exchange and production of fetal water.
Anomalies in the development of fetal membranes- underdevelopment of the amnion, stratification of the sheets of the membranes, insufficient secretory activity of the epithelial (constituting the mucous membrane) cells of the fetal bladder responsible for the production of water. The cause of the development of any of these anomalies may be adverse factors. environment that affect the expectant mother during the formation of membranes (first trimester of pregnancy), genetic disorders (hereditary factor), etc.
Amnionic hydrorrhea- so called from the uterine cavity during pregnancy. This condition arises in connection with the appearance of a small high rupture of the membranes. The gap formed in this case between the membrane and the wall of the uterus is so narrow that only a negligible amount of water passes through. In this case, the water gradually, drop by drop, flows out of the uterus.
If the expectant mother lies in bed and observes complete rest, the pregnancy can continue, as the functioning amnion gradually replenishes the lost water, but remains high risk infection, so the pregnant woman should be in the hospital all this time.
True re-carrying of pregnancy- the main sign of overgestation is a gradual decrease in the functional activity of the fetal membranes and placenta, which, in turn, is reflected in the deterioration of the general condition of the fetus. Oligohydramnios during pregnancy is associated with the aging of the amniotic membranes and the placenta, impaired blood circulation in them, and, consequently, a decrease in the production of fetal fluids.

Oligohydramnios during pregnancy is fraught with the development of various complications. In some cases, there is so little water that the walls of the uterus, tightly adjacent to fetal sac, strongly bend the fetus and bring it into prolonged and close contact with the fetal bladder. As a result, a number of complications may develop: curvature of the spine, clubfoot, fusion skin fetus with amnion. From the lack of water, the baby's skin becomes dry and wrinkled. With close and prolonged contact of the amniotic membrane with the skin of the fetus, the so-called Simonart ligaments can form between them - quite strong strands and threads. They can encircle the fetus, significantly limiting its activity, and sometimes causing severe injuries (fusion of the fetal organs with each other, with membranes, defects in the formation of limbs, face, etc.). These same ligaments can compress the umbilical cord, disrupting blood flow in the umbilical vessels. The latter may result in a delay physical development(due to lack of nutrients and oxygen) and even death of the fetus.

At pronounced oligohydramnios the mother-to-be also suffers. Oligohydramnios is often the cause of spontaneous abortions (miscarriages) and premature birth. During the second and third trimester, the expectant mother is worried about constant pain in the lower abdomen. In later periods, there is additional soreness caused by the movements of the fetus.

Childbirth with oligohydramnios also has its own characteristics. The period of opening the cervix is usually delayed, as there is no proper pressure of the fetal bladder. Often develops primary and secondary weakness of tribal forces. At the same time, contractions are painful from the very beginning, but unproductive. In succession and early postpartum period(in the first 2 hours after birth) more often develop bleeding.

The fight against oligohydramnios

Slight (400-700 ml) oligohydramnios may be a variant of the norm. In this case, the expectant mother is recommended a protective regimen (minimum physical exercise), good nutrition vitamin therapy and regular medical supervision antenatal clinic. If necessary, a second ultrasound examination is performed to exclude the increase in oligohydramnios. With an increase in symptoms and confirmation of severe (less than 400 ml) oligohydramnios, treatment in a hospital is necessary.

To clarify the diagnosis and choose the tactics of treating the expectant mother, they offer hospitalization in the maternity hospital. In the department of pathology of pregnant women, an extended examination is carried out, including ultrasound diagnostics (this study allows you to fairly accurately judge the amount of amniotic fluid), cardiotocography (monitoring the baby’s cardiac activity and contractile activity of the uterus), laboratory methods (general and biochemical analysis blood, urine). If amniotic fluid leakage is suspected, a swab is performed on the water. To clarify the amount and density of water, amnioscopy is performed - an endoscopic examination that allows the doctor to assess the composition of the water "by eye" without violating the integrity of the membranes. This study can be done if the cervix is already preparing for childbirth, the cervical canal misses the amnioscope - this is more often possible at the end of pregnancy. Therapeutic tactics largely depend on the specific cause that caused the decrease in the amount of amniotic fluid. If amnionic hydrorrhea (water leakage) is detected, the expectant mother is prescribed strict bed rest, heavy drinking, vitamin therapy, drugs aimed at reducing the tone of the uterus and preventing infection of the fetus and membranes. It is likely that in this case, hospitalization and treatment aimed at prolonging (prolonging) the pregnancy will last until the very birth. Treatment is carried out under constant monitoring of the condition of the fetus.

When identifying viral infection conduct antiviral and restorative therapy, prescribe vitamins and drugs that improve microcirculation (blood circulation at the level small vessels). In this case, upon completion of treatment and in the presence of positive dynamics, the expectant mother can be discharged home under the supervision of a doctor at the antenatal clinic.

When detected, treatment is also directed to maintaining pregnancy and preventing the development of intrauterine infection. Therapy is carried out in the conditions of the department of pathology of pregnant women under the control of the state of the mother and fetus.

When confirming the diagnosis of true over-pregnancy, a planned amniotomy is performed - a puncture of the fetal bladder, after which the expectant mother naturally goes into labor.

With timely diagnosis and the beginning of treatment, the prognosis for mother and baby is favorable.

Table of norms of the amniotic fluid index by ultrasound
Week: from (mm) to (mm) inclusive.
16: 73 – 201
17: 77 – 211
18: 80 – 220
19: 83 – 225
20: 86 – 230
21: 88 – 233
22: 89 – 235
23: 90 – 237
24: 90 – 238
25: 89 – 240
26: 89 – 242
27: 85 – 245
28: 86 – 249
29: 84 – 254
30: 82 – 258
31: 79 – 263
32: 77 – 269
33: 74 – 274
34: 72 – 278
35: 70 – 279
36: 68 – 279
37: 66 – 275
38: 65 – 269
39: 64 – 255
40: 63 – 240
41: 63 – 216
42: 63 – 192

Most of the time that the baby spends in the womb, he is under the protection of the placenta or, as it is also called, the amniotic sac. Amnion constantly produces amniotic fluid, in which the baby will be until the very moment of his birth. Such a liquid protects the baby from bacteria and viruses, creates favorable conditions for its development, allows it to stay warm and comfortable during the most important and crucial months of its life.

The temperature of the amniotic fluid is maintained by the body at a constant level and is about 37 ° C, provided that the woman is healthy. As for the amount of fluid, this indicator is constantly changing and directly depends on what week of pregnancy it is. future mother. It is also worth noting that the larger the baby becomes in the womb, the more fluid the amnion produces. The rate of amniotic fluid during pregnancy is 1-2 liters at the 36th week of the term, but in the following days this figure may decrease somewhat, because during the preparation for childbirth, the body begins to actively remove fluid.

Among the components of the amniotic fluid, you can find a wide variety of components, for example, proteins and carbohydrates, hormones and enzymes, fats and salts, various vitamins and glucose. Amniotic fluid also contains oxygen, carbon dioxide, immunoglobulin, baby waste products and many other substances. The composition of the liquid is always unstable and changes at least every 3 hours. In addition, the composition of the water also depends on the gestational age, because in different periods The development of crumbs requires different substances.

Why amniotic fluid is needed

The role of amniotic fluid in the process of growth and development of the fetus is difficult to overestimate, because thanks to the many functions that given substance, the child is not only under constant protection, but also has the opportunity to be born. Read more about the functions of amniotic fluid below:

One of the purposes of amniotic fluid is the metabolism between maternal and child organisms. Those components that the baby needs for his development and maintenance of life come to him precisely through the amniotic fluid. Processed food, being excreted from a tiny organism, also first enters the amniotic fluid, and only then is completely removed from the woman's body. The waste products that enter the liquid also include the upper scales of the epidermis, particles of the original lubricant, the hairs of the child and the components of the mother's blood.
The second important function amniotic fluid is its ability to protect the unborn baby from all sorts of harmful factors of the world. Due to the constant temperature of the waters, the child in the womb will not be able to freeze, moreover, he is not afraid of physical influences such as blows, compressions, pressure. Amniotic fluid eliminates the risk of squeezing the umbilical cord, gives the baby the opportunity to move freely in the mother's abdomen.
The female body also made sure that the amniotic fluid was always absolutely sterile. Due to the fact that viruses, bacteria and other pathogens do not penetrate into them, the baby is reliably protected from diseases. Sterility is mainly maintained by constant renewal of the composition of the liquid, which occurs at least every 3 hours.
amniotic fluid not only help the baby grow and develop in safe environment, but also directly involved in the process of delivery. Firstly, the so-called anterior waters, by their pressure on the uterus, provide a better opening of its cervix. Secondly, while the baby is trying to be born, the amniotic fluid protects him until the very moment of birth. Thirdly, during the passage of the child's birth canal, water plays the role of a lubricant, facilitating this process.

In addition to the above useful features, amniotic fluid also has important diagnostic value. After conducting certain water tests, the doctor can find out a lot of necessary information regarding the health of the child and the characteristics of his development. Thanks to diagnostics, it is possible not only to establish the sex of the baby and his blood type, but also to obtain information about possible hereditary diseases or other abnormalities, the development of which can be prevented even at the stage of pregnancy.

Volume, composition, degree of transparency, color and consistency - all these parameters of the amniotic fluid can be found with the help of the necessary tests. In addition, in the case of some pathologies, when emergency delivery is required, with the help of such a diagnosis, it is possible to establish the degree of readiness of the child for the birth. Based on the data obtained, a decision is made on the use of special medical equipment to support the life of the baby for a certain period.

Amniotic fluid pathologies

oligohydramnios during pregnancy

The condition when there is little amniotic fluid during pregnancy is called oligohydramnios. Such a pathology can occur if the amnion produces less fluid than is excreted from the body. It should be said that such a disease is not so common and accounts for no more than 1% of cases in the total number of pregnancies. Low water - serious problem that needs attention and timely treatment. If this phenomenon is not eliminated, certain complications may arise:

Firstly, the pressure of the amniotic fluid on the uterine canal is significantly reduced, which, in turn, leads to difficulties in the delivery process.
Secondly, oligohydramnios is fraught with such complications as premature birth. A child who was born before the due time will need special medical care.
Oligohydramnios is also dangerous because the baby is not able to move normally, which increases the risk of breech presentation of the fetus.
Hypoxia is considered a very frequent companion of this pathology - a lack of oxygen necessary for a child. Hypoxia results in growth retardation and fetal abnormalities.

As a rule, it is not possible to notice such a pathology on your own, since oligohydramnios has almost no symptoms that are physically palpable. Occasionally, a woman with a similar problem may feel slight pain in the abdomen, but often this manifestation is simply absent. You can identify the disease using ultrasound, which is why timely testing and passing planned ultrasound so important for a pregnant woman.

If it is possible to detect oligohydramnios before a period of 28 weeks, an examination of the body of the expectant mother will allow you to find out the cause of the pathology and, if possible, eliminate it. So that the child does not suffer from a lack of oxygen, it is important to start treatment as soon as possible - this will allow gas exchange and uteroplacental blood flow to be established. In the process of therapy, the doctor monitors the baby's condition and sometimes, in case of emergency, prescribes an early caesarean section.

Let us examine in more detail what are the causes of oligohydramnios during pregnancy:

the presence of hypertension in the expectant mother;
significant overweight pregnant;
infections and inflammatory diseases;
violations of the development of the placenta;
inflammation in the pelvic organs;
polycystic kidney disease of the fetus, anomalies in the development of its genitourinary system.

Polyhydramnios during pregnancy

Approximately as rare as oligohydramnios, the opposite pathology, polyhydramnios, can also occur. This problem occurs in 1-1.5% of pregnant women and is an excess of amniotic fluid relative to the norm.

Polyhydramnios is of two types:

Chronic polyhydramnios is characterized by the fact that the amount of amniotic fluid arrives gradually. If the pregnant woman is healthy and feels fine, the doctor may prescribe her diuretics - special medications that are responsible for removing fluid from the body. In addition, the doctor prescribes a certain diet, which involves reducing the amount of salt in the diet. It is important to follow all the doctor's recommendations, because polyhydramnios can turn into backfire. An excessively enlarged uterus oppresses the rest of the organs, disrupting their work. In addition, polyhydramnios sometimes causes circulatory disorders in female body, it complicates labor activity and can cause heavy bleeding after childbirth.
The second type of polyhydramnios is acute. It is characterized by a sudden increase in amniotic fluid that occurs over several hours. As a rule, such a disease makes itself felt by the following symptoms: abdominal pain, severe edema, the appearance of shortness of breath. With such a pathology, a woman needs hospitalization. While in hospital, the pregnant woman observes bed rest, which makes it possible to reduce the risk of preterm birth. If acute polyhydramnios is characterized by the incessant presence of water and threatens the health of the woman and her baby, abdominal amniocentesis can be used as a remedy for the problem. During this operation, the placenta is pierced and excess fluid is removed to the outside.

Among the causes of pathology are the following:

diabetes mellitus in a pregnant woman;
the conflict of Rh blood of mother and baby;
carrying twins;
the child has a genetic disease;
infection to the fetus in utero;
disruption of the fetal bladder, which manifests itself in excessive production of amniotic fluid, even in early pregnancy.

Leakage of amniotic fluid during pregnancy

Another pathology of amniotic fluid is their leakage. This condition is characterized by the appearance of copious liquid discharge from the female genital tract. From ordinary secretions, amniotic fluid is distinguished by transparency, colorlessness, a very liquid consistency, and the absence of odor. Often, leakage of amniotic fluid during pregnancy does not show any symptoms other than the aforementioned discharge. But the expectant mother may not pay attention to such manifestations, because during pregnancy there are abundant vaginal discharge are the norm.

In the event that a woman suspects a similar pathology in herself, she should immediately see a doctor. The specialist will prescribe tests that will determine the nature and origin of the discharge, after which the leakage of water can be refuted or confirmed. By the way, in pharmacies you can find special tests with which such an analysis is carried out independently. But it is recommended to use this method only if it is absolutely impossible to see a doctor for any reason. Moreover, if the analysis positive result, pregnant one way or another will have to go to the hospital for inpatient treatment.

If a similar phenomenon has made itself felt after the 36th week of the term, doctors can stimulate childbirth, and the baby will be born prematurely for only 1 week. If the leakage of water happened in the early stages, the woman needs hospitalization in order to maintain pregnancy as much as possible. possible period. During hospitalization, strict bed rest should be observed. In some cases, when the period is too short and it is not possible to keep the pregnancy for a long time, the situation is fraught with abortion.

The most common causes of amniotic fluid leakage are genital tract infections. To avoid such a risk, it is very important to monitor your health, observe the rules of personal hygiene, engage only safe sex and periodically take tests for the presence of pathogenic flora in the vagina.

Amniotic fluid green

Transparency, colorlessness, odorlessness and liquid consistency are characteristics of normal amniotic fluid. Slightly turbid amniotic fluid during pregnancy can be observed at the very end of the term and are also considered the norm, since their appearance is due to the presence of epidermal flakes and lubricant flakes that enter the liquid from the baby's body. But in the event that the amniotic fluid has acquired a greenish tint, we can talk about pathology. The green color of the amniotic fluid is often due to particles of the original feces, which the baby releases if he lacks oxygen. Hypoxia is considered one of the most dangerous conditions of the fetus, because it not only interferes with the normal development of a small organism, but sometimes causes irreparable consequences.

Possible reasons why amniotic fluid may turn green are described below:

If during the entire pregnancy the waters were normal and turned into greenish color already in the process of childbirth, very often this can cause stress for the child. Experiencing childbirth, the baby sometimes secretes meconium, due to which the liquid acquires a characteristic shade.
As mentioned above, the cause of this pathology during pregnancy can be such dangerous state like fetal hypoxia. It is caused by over-term pregnancy. If the baby is in the womb for too long, the amniotic sac ages and does not perform its functions properly. Because of this, the baby experiences a lack of oxygen.
Sometimes a greenish tint in the amniotic fluid indicates an infection. This happens if the expectant mother has had a cold, flu, bronchitis, suffered an infection of the genitourinary system or some other inflammatory disease.
Very rarely, the cause of an abnormal shade of amniotic fluid can be genetic diseases fetus.

Green waters can be dangerous for a child if he swallows contaminated fluid. If such a phenomenon was found in later dates pregnancy, a woman may be prescribed C-section. If such a pathology was detected in the early stages, the causes of the condition should first be identified and measures taken to eliminate them. Since the amniotic fluid is often updated, it will be enough to eliminate the causes of the pathology in order to correct the situation.

In the event that the pregnant woman's green waters have departed, the delivery process should be started as soon as possible in order to eliminate the risk oxygen starvation and related consequences.

Amniotic fluid tests during pregnancy

There are several ways to assess the condition of amniotic fluid during pregnancy, the simplest of which is considered to be ultrasound. This procedure does not harm the health of the woman and her fetus, but is the least informative. With the help of ultrasound, you can only visually determine the transparency of the liquid and determine its amount. For more detailed information, other studies are being conducted, which we will consider in more detail:

Amniocentesis is a complex procedure in which fluid is taken directly from the amniotic sac. To do this, a woman's stomach is pierced special tool and draw out a small amount of amniotic fluid. The procedure is carried out under local anesthesia. Then this material is sent for research, where immunological, biochemical, cytological and hormonal analyzes are carried out. Depending on the location of the amniotic sac, doctors determine the puncture site, in addition, during the procedure, a device is used to ultrasound diagnostics. Amniocentesis is performed if there is a conflict between the Rhesus blood of the mother and the child, as well as if there are suspicions of chromosomal pathologies, hypoxia, genetic diseases. Such an analysis is also carried out when the age of the future woman in labor exceeds 40 years, and also in the case when it becomes necessary to determine the maturity of the child's lungs. Amniocentesis is not used if a woman has any inflammation in her body, if the pregnant woman suffers from pathologies in the development of the uterus or from diseases of the genitourinary system. If there is a threat of miscarriage, the procedure should also be abandoned.
Amnioscopy is another method for determining the state of the amniotic fluid. During the procedure, the doctor inserts an amnioscope into the cervix and examines the lower pole of the placenta and amniotic fluid. Using the procedure, you can set the amount of amniotic fluid, examine its color and identify the presence of hypoxia in the fetus.

Amniotic fluid during pregnancy. Video

The fetal bladder in which your unborn baby grows and develops is called the amnion. From the very beginning of pregnancy, it provides the baby with the conditions for intrauterine life. And one of the most important tasks membranes is the production of a fluid called amniotic. It fills the entire cavity of the amnion and performs a number of vital functions for the fetus. The waters form the first habitat of the fruit, so their importance cannot be overestimated. Thanks to the amniotic fluid, the baby feels comfortable (there is always a stable temperature here - 37 degrees, quiet and cozy) and protected (the waters prevent the entry of microorganisms from outside world, as well as any other negative effects on the fetus from the outside).

Amniotic fluid is released continuously, but unevenly. With an increase in the term, its volume also increases, reaching its maximum at approximately 36 weeks of gestation, while averaging 1000-1500 ml. Then, just before the birth, the amount of fetal water may decrease slightly, which is explained by the increased excretion of fluid from the mother's body.

The composition and properties of amniotic fluid

On different stages The development of the baby changes not only the quantity, but also the composition of the amniotic fluid. It is also unstable and quite complex. The fetal waters contain proteins, fats, carbohydrates, hormones, enzymes, vitamins, microelements, carbon dioxide, oxygen, antigens and other substances that determine the fetal blood group. They can also contain products of work sebaceous glands(flakes of the original lubricant that covers the baby's body), skin, hair, and also substances from the mother's blood. There is a constant exchange of substances between the fetus, amniotic fluid and the mother's body.

The baby urinates directly into the amniotic fluid, which, by the way, is updated every 3 hours, all the time maintaining the composition necessary for a small one.

What are the functions of amniotic fluid?

The role of amniotic fluid in intrauterine development and the baby's habitat is simply awesome! Throughout the entire period - from the very beginning of pregnancy and up to the moment the baby is born - they perform a number of important functions:

Metabolism: a significant part of the substances necessary for life enters children's body just from the amniotic fluid. In return, the baby secretes waste products into the amniotic fluid, which is excreted through the mother's excretory system.
Mechanical protection: the fetal bladder and water protect the child from a variety of mechanical damage. They create a reliable "safety cushion". Also, amniotic fluid prevents squeezing of the umbilical cord and tissue fusion. In addition, the waters make possible the free active movement crumbs, which contributes to its intensive development.
Sterility: amniotic fluid is always sterile and maintains a perfectly clean living environment. They protect the little one from penetration and exposure to infections. Interestingly, throughout pregnancy, the fetal fluid is updated every 3 hours, always maintaining the required chemical composition. And this process continues until their complete outpouring, when after the birth of a child, the so-called back waters flow out.
Participation in childbirth: amniotic fluid plays an important role not only during gestation, but also directly in childbirth. Actually, from the outpouring of the so-called anterior waters, which are located in the lower part of the fetal bladder. They press their weight on, forcing her to open up. The waters maintain favorable conditions for the fetus during contractions, and when poured out, they wash the birth canal, which then makes it easier for the child to move along them.

Amniotic fluid analysis

The amniotic fluid contains many important information about the condition and development of the fetus. The volume, composition, transparency, consistency, color of the amniotic fluid, which can be determined during laboratory tests, matter.

An analysis of the fetal waters can determine the blood type and gender of the child, warn of probable hereditary diseases, metabolic disorders, occurrence.

If you suspect the development of anomalies, pathologies and genetic disorders in the fetus, a pregnant woman is also recommended to do an amniocentesis to make sure that everything is fine with the baby.

The composition of the amniotic fluid informs about the degree of readiness of the baby for birth, when it becomes necessary to carry out emergency delivery, in particular, determines the stage of maturity of the respiratory system and lungs of the child.

The main pathologies of amniotic fluid

In order for the child to develop safely, the amniotic fluid must be present and maintained in a certain amount and condition. Changing its volumes and chemical composition in some cases speaks of violations and pathologies:

Polyhydramnios. They say about when the volume of amniotic fluid exceeds 1.5 liters. Why this happens, doctors cannot find out for sure, but nevertheless they identify a number of probable causes: nephritis, cardiovascular diseases, intrauterine infections, Rhesus conflict. Most often, this pathology is found in the second and third trimesters. If polyhydramnios developed suddenly, then childbirth must be carried out urgently.
Low water. Oligohydramnios is less common, but it is also dangerous for the fetus and negatively affects its development. Childbirth with oligohydramnios often occurs ahead of time and pass with complications. With oligohydramnios, the volume of amniotic fluid does not exceed 500 ml. At the same time, the woman experiences constant pain in the abdomen, aggravated by, and the child's activity is reduced.
Water leakage. The fetal bladder must maintain its integrity until the birth itself, otherwise, the baby will not be able to survive. The rupture of the fetal bladder and the outflow of amniotic fluid mark the onset of labor and ideally should occur in a timely manner. Premature discharge of water indicates early start childbirth and should be a reason for urgent admission to the hospital. You should also tell your doctor about water leakage immediately if you suspect it. In this case, the fetal bladder bursts in the upper lateral part, and amniotic fluid leaks from the hole in small portions.
Green waters. Normally, fetal water is clear, like water. By the end of pregnancy, they may become a little cloudy and contain whitish flakes, because the baby “sheds”: fluffy lanugo hair and epidermal cells, as well as original lubricant, come off the skin. Such waters are normal and create a favorable habitat for the baby. But when the baby experiences a lack of oxygen (which doctors call fetal hypoxia), a reflex release of meconium from the rectum can occur. In this case, the waters turn green or brown and pose a certain danger to the crumbs.

Any of these conditions require medical care Therefore, if you suspect any violations, you should contact your gynecologist. And for greater peace of mind - do not miss scheduled regular examinations and do not neglect referrals for examinations. I help control the state of amniotic fluid with ultrasound, CTG, blood tests for intrauterine infections, for Rh antibodies, for TORCH infections.

Especially for- Elena Kichak

Every woman who is expecting a baby should understand the importance of amniotic fluid, because they perform many useful and significant functions for life. There are pathologies that cannot be ignored.

The value of amniotic fluid is justified by their necessity for the normal development of the baby. This fact has been proven by many medical studies. Pathologies can lead to serious violations in the development of the fetus, so each makes it possible to control the state and volume of amniotic fluid.

Having become pregnant, a woman must understand that the first element for a child is water. All 9 months of gestation, the fetus lives in the amniotic fluid. The baby develops there, grows, all organs and systems are formed in him. This habitat has great importance for a child.

Amniotic fluid satisfies the needs of the baby and carries data on the condition and immunity of the baby. Amniotic fluid during pregnancy has a very large list of renewal functions and the maintenance of immunity, necessary for both mother and child. That's why you can't ignore anxiety symptoms which may indicate problems.

Functions of amniotic fluid:

The thermoregulatory function is necessary for the baby, because for the normal development of the child must be supported optimum temperature in the womb - 37 degrees.
Immune protection. The amniotic fluid contains all necessary components for the development and protection of the baby.
Mechanical function protects the baby from influence external factors. Thanks to it, a comfortable stay of the child in the womb is ensured.
The umbilical cord protection function greatly softens shocks. Also, thanks to the amniotic fluid, the umbilical cord is protected from mechanical influences.
Hermetic isolation from infections. Thanks to the liquid, the baby is under reliable protection.
In the amniotic fluid there are also elements that do not allow the splicing of parts of the baby's body.
Provision function optimal development no less important. Thanks to this, the baby grows, develops and receives all the necessary elements.
Metabolic support.
Formation of the circulatory system of the fetus.
Prevention of bleeding.
Due to the structure and composition of the amniotic fluid, it is facilitated.

Compound

About 97% of the amniotic fluid is water, it contains elements such as proteins, salts. Also present are skin particles, hair, and constituents called alkaloids. It is believed that the smell of the liquid is similar to breast milk.

For this reason, only a baby born into the world understands exactly where the mother's breast is, at the level and by smell. When the amniotic fluid appears, the baby's kidneys begin to work, the defenses of the baby's body are updated.

Volume

By the end of gestation, the amount of water approaches one to one and a half liters, every 3 hours the liquid is renewed, while the third part is processed by the baby. There are pathologies in which the volume of amniotic fluid may be more than normal - polyhydramnios or less than normal- oligohydramnios. More on the reasons below.

Color

According to known norms, water in the womb should have a transparent light color. They should not contain any impurities. In another case, there may be a pathological process that can be harmful. In case of deviation from the norm, the water may become cloudy or green.

Diagnostic value

Amniotic fluid is not without reason considered a living environment, due to being in which the correct functioning of organs and systems is formed in babies. The kidneys begin their work due to the fact that the baby swallows water that is excreted in the urine (in the child's bladder, amniotic fluid appears already on).

After a while, the baby, in the likeness of a fish, begins to “breathe” with water, carrying out a significant exercise for his respiratory system, thereby preparing himself for breathing in an ordinary environment.

Also for diagnosis, amniotic fluid can be used to detect genetic diseases.

Pathologies

Polyhydramnios - one of the types of pathological processes during pregnancy. This condition is characterized by the fact that the amniotic fluid begins to exceed the norm in volume. The exact quantitative indicator of the fluid is determined by the doctor on ultrasound.

It was not possible to establish 100% causes of these problems. But at the same time, there are certain groups whose risk of getting a pathology is slightly higher than others:

Chronic diseases in a pregnant woman, for example, diabetes, heart disease.
Infections in any organs.
- a large volume of water of one fruit often comes with an oligohydramnios of another.
Large fruit size.
Defects in the formation of the child.

With polyhydramnios, the following manifestations are characteristic: abdominal pain, shortness of breath, swelling of the limbs, too frequent pulse. The patient with such symptoms will need to go to the hospital and undergo a set of additional examinations.

The plan and duration of treatment depends on the cause of polyhydramnios. The patient may be prescribed vitamins, antibiotics, diuretics. During the treatment, the doctor controls the weight, pressure, temperature. Passage of cardiotography, ultrasound is prescribed. The general condition of the child and mother is kept under control, the doctor monitors the slightest changes in the patient's health.

There is another side of this pathology, called oligohydramnios . This condition is characterized by insufficient fluid volumes. Low water is a problem that any expectant mother can face.

Reasons that can provoke pathology:

Complex congenital malformations of the kidneys in the fetus.
Chronic diseases of the future mother, for example, diabetes, cardiovascular diseases.
Infections in the genitals.
The presence of bad habits in the expectant mother.
The presence of viruses and infections, the transferred flu.
The presence of a late
Pathological changes in the placenta.
Multiple pregnancy - when one embryo has little water, it often comes with polyhydramnios of the other.
The time when the baby is worn longer (the placenta becomes obsolete, and the amount of water decreases).

A future mother who is faced with such problems may experience aching pains in the abdomen, the movement of the fetus becomes painful, the general condition worsens, and weakness may appear. An important symptom is high fever.

The woman is admitted to the hospital. All manipulations will be aimed at supporting the baby and the expectant mother in normal condition. Thanks to special preparations and procedures, the health and condition of mother and child is normalized.

Pathology is also leakage . When water begins to leak prematurely, this can lead to serious consequences. The signs of this pathology include the fact that the amount of fluid released becomes much larger in the process of changing position. This is a rather dangerous process, so the patient must definitely contact the attending physician. Cause leakage of infection, presentation of the fetus and bad habits of the expectant mother.

Another pathology -green amniotic fluid not too rare. The cause of such waters may be a baby - when there is not enough oxygen, contraction of the anus may occur, which leads to the release of feces in the child. This gives the liquid a green tint and negatively affects the development of the baby, who swallows contaminated water.

So, amniotic fluid is a significant substance for a baby in the womb. There are pathologies when the rate of amniotic fluid during pregnancy is exceeded or reduced. The color, composition, volume of the liquid is also important - all this matters. Pathologies of this kind should be treated inpatients with the use of drugs and vitamins. For the patient, peace and regularity of life are important. Excessive activity and physical activity is contraindicated.

Useful video about the outflow of amniotic fluid

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Violation of the formation and absorption of amniotic fluid threatens with oligohydramnios. Let's consider this concept in more detail.

What is low water?

An insufficient amount of amniotic fluid in obstetrics and gynecology is called oligohydramnios.

Amniotic fluid (or amniotic fluid)- the liquid environment in which the fetus is located during pregnancy.

This biological fluid performs several important functions. These include:

protective function- the water shell protects the child from the penetration of infections (due to the tightness of the shells and the immunoglobulins that make up the water), from mechanical influences from the outside (for example, from shocks and shocks), loud sounds (water muffles them), external fluctuations in pressure and temperature (maintaining optimal pressure and a constant temperature of 37 ºС, of course, if the mother is healthy and her body temperature does not exceed 37.8 ºС);
exchange function- the child absorbs the amniotic fluid, enriched with nutrients, and releases it back.
To all this, the fetal waters provide free movement of the crumbs inside the womb. Therefore, with a normal amount of amniotic fluid, the baby is cozy and comfortable, he is protected and provided with everything necessary.

What is in the amniotic fluid?

With increasing gestational age, the composition of the amniotic fluid changes, and becomes more diverse and saturated, which makes the waters slightly cloudy in appearance. The amniotic fluid is secreted by cells of the aquatic membrane.

At the beginning of pregnancy, amniotic fluid is almost the same in composition as blood plasma. They contain nutrients (proteins and fats), vitamins and minerals, hormones, enzymes, and more.

From the second trimester, the composition of this biologically active fluid is supplemented by dead skin cells (as a result of the natural process of changing the old skin layer to a new one), the fluff (hairs) of the fetus, the original cheese-like lubricant of the fetal body and its waste products (sterile urine).

Fertile waters are updated every 3 hours.
Drinking water does not affect the amount of amniotic fluid. From excessive fluid intake in a pregnant woman, only edema will appear.

The norm of the amount of amniotic fluid

When the amount of amniotic fluid deviates from the norm, doctors diagnose oligohydramnios or polyhydramnios. The doctor-diagnostician determines the amount of fluid during an ultrasound scan, starting from the second trimester of pregnancy.

The volume of amniotic fluid in medicine is commonly referred to as the amniotic fluid index (AFI).

Table - The norm of the amniotic fluid index by week

The norms may differ slightly from those given above, depending on the type of ultrasound machine. And also the value can be written not in millimeters, but in centimeters (1 cm = 10 mm).

Also, the amount of fetal water characterizes another indicator - the vertical size of the largest (free) water pocket (VC). This size should normally be in the range from 2 to 8 cm (or from 20 to 80 mm), with a borderline amount of water - from 2 to 1 cm (from 20 to 10 mm), and with oligohydramnios - less than 1 cm (or 10 mm).

What are the causes of oligohydramnios?

Depending on the severity of the pathology, moderate and severe oligohydramnios are distinguished.

Often you can find in the ultrasound protocol the inscription - "tendency to moderate oligohydramnios." This means that it is possible that the expectant mother has health problems and needs more careful monitoring.

Moderate oligohydramnios- this is a slight deviation in the amount of fetal water from the norm. This type of deviation can be caused individual feature body of a pregnant woman or, in the worst case, may be a prerequisite for the occurrence of a more severe form of this pathology. In any case, doctors recommend prophylaxis of fetoplacental insufficiency (FPI).

Moderate oligohydramnios is not a critical situation, because the amount of water is a variable number, and can change several times a day. Perhaps there was an error in establishing the diagnosis and the doctor was to blame for this, who made a not very accurate calculation during the ultrasound, because the determination of the amniotic fluid index is a subjective and approximate matter. Therefore, you should not panic, in 8 out of 10 cases, pregnancy ends with a successful birth of a healthy baby.

Severe oligohydramnios poses a danger to the health of the fetus, so you must follow all the instructions of the doctor observing the pregnancy.

The causes of oligohydramnios, regardless of the degree of its severity:

fetoplacental insufficiency;
problems with the cardiovascular system in a pregnant woman (hypertension and others);
diseases of the urinary system of the fetus (kidneys, for example);
leakage of amniotic fluid (in violation of the integrity of the membranes);
pathology in the development of fetal membranes;
transferred bacterial infections during pregnancy or shortly before its onset;
diabetes;
late gestosis.

Most often, oligohydramnios occurs due to a metabolic disorder in a pregnant woman, as well as after viral diseases (ARI, SARS, and others) and with fetoplacental insufficiency.

Personal practice shows that ultrasound doctors often exaggerate the magnitude of the problem, and a slight deviation from the norm is already a disaster for them. Such pseudo-low water causes extra stress the expectant mother, but in fact, babies are born relatively healthy.

The only thing is that childbirth with oligohydramnios (even slight ones) can take place with some complications (poor opening of the cervix, painful contractions and prolonged labor due to breech or breech presentation of the fetus, which arose due to oligohydramnios). Although complicated childbirth can occur in any woman in labor, regardless of the amount of water.

obstetrician-gynecologist A. Berezhnaya

The occurrence of oligohydramnios during a post-term pregnancy is considered a common occurrence, since the placenta has grown old and can no longer fully perform its functions, therefore it exfoliates. Then doctors prescribe stimulation labor activity or a planned caesarean section.

Why is oligohydramnios dangerous for the fetus?

Oligohydramnios (or oligohydramnios) is a complication of pregnancy, sometimes even dangerous for the fetus, because it is at risk of infection, as a result of which even its death can occur.

For example, with the loss of the integrity of the membranes - this is when there is leakage of amniotic fluid - the child becomes vulnerable to infections entering the membranes.

The genital tract of a woman is not sterile, pathogenic microorganisms constantly live in the vagina, “plus” immunity is weakened due to pregnancy. All this can lead to the multiplication of harmful bacteria that can penetrate the uterine cavity and infect the fetal membranes, causing their inflammation, called chorioamnionitis in gynecology. Without timely treatment, infection of the fetus itself occurs.

This is with regard to oligohydramnios, caused by a violation of the integrity of the membranes.

With severe oligohydramnios, regardless of the causes of its occurrence, the baby suffers from hypoxia (lack of oxygen), because of this, it lags behind in fetal development. In addition to all this, the baby is uncomfortable to be in such a “nest”, his neck is often twisted, and the bones of the face and head are susceptible to deformation due to squeezing them by the walls of the uterus.

Moderate oligohydramnios does not have such a critical effect on the health of the fetus: the baby is weak and lags behind in weight gain (so-called malnutrition is observed), it muscle tone reduced (possible development of torticollis, clubfoot), there is also mild fetal hypoxia.

If the screening and urine / blood / smear tests are normal, the cardiotocogram (CTG) is in order and the fetus is developing well, and the pregnant woman has no complaints about her well-being, then the diagnosis of oligohydramnios is conditional. It’s just that obstetricians will prepare for labor induction, since there is a high probability of a post-term pregnancy, or for a caesarean section with a non-standard position of the fetus at the time of birth.

Diagnosis of oligohydramnios

At ultrasound examination the doctor makes some measurements and calculations to determine the amount of amniotic fluid, after which he makes a conclusion about oligohydramnios, a normal amount of water, or polyhydramnios.

A gynecologist can also suggest little or polyhydramnios at the next measurement of the circumference of the abdomen and the height of the fundus of the uterus, but a more accurate diagnosis can only be made with the help of ultrasound.

At home, you can only test for leakage of amniotic fluid. If on underwear often seen watery discharge, and the kicks of the baby began to be painfully perceived by the pregnant woman, although such discomfort was not felt before, or the size of the abdomen is small, although the gestational age has already exceeded 20 weeks, it is advisable to carry out special test. Perhaps the reason for everything is lack of water, caused by leakage of water due to a violation of the integrity of the membranes.

The test can be done at home by monitoring the discharge for some time, or by buying a special amniotic fluid leak test at the pharmacy and using it.

The "free" test is carried out as follows: empty bladder, take a shower (without douching and possible water getting inside the vagina), dry yourself with a towel and lie down on a dry diaper. Lie still for 15 minutes, and then get up and see if wet spot on a diaper. Ordinary secretions are not able to form and flow out so quickly, most likely, amniotic fluid is leaking. You can find out more precisely by contacting the LCD with a complaint about unusual discharge. There they will conduct a special test and say it is water or ordinary vaginal discharge.

The pharmacy test looks like a gasket, the surface of which will change color to blue or green if amniotic fluid leaks.

Staining also occurs with bacterial / viral discharge, so if spots of a blue-green hue are noticed on the surface of the pad, contact your gynecologist.

Any test for amniotic fluid leakage is recommended after 12 hours since the last intercourse, douching or use of vaginal suppositories.

Treatment of oligohydramnios

It is impossible to artificially increase the amount of amniotic fluid, so the treatment of oligohydramnios comes down to determining the causes of its occurrence. Further, the treatment of the root causes of oligohydramnios is carried out.

To determine the causes of oligohydramnios, a pregnant woman is referred for doppler ultrasound or cardiotocography (CTG), in order, first of all, to refute or confirm a violation of blood flow in the placenta.

If the fetoplacental circulation is still disturbed, then the patient is prescribed drugs to normalize it - Curantil, Actovegin.

Moreover, Curantyl is often prescribed as a preventive measure for placental insufficiency.

Often, the treatment complex includes medications that help normalize metabolic processes in the body of a pregnant woman (for example, Magne + B6) and maintain the normal functioning of important internal organs women (for example, Hofitol).

It is also necessary to exclude the presence of infections in a pregnant woman. For this purpose, urogenital smears for STIs and from the throat + nose for cocci are re-taken, a blood test for TORCH infection is performed. If an infection is present, antibiotic therapy is prescribed.

Childbirth with oligohydramnios

With severe oligohydramnios, a planned caesarean section is prescribed. With a small volume of amniotic fluid, the fetal bladder takes on a flat appearance. Because of this, contractions will be irregular and weak, and labor can be long and difficult.

Moderate oligohydramnios is not a contraindication for natural childbirth. Even with pelvic or breech presentation fetus caused by oligohydramnios, childbirth takes place safely for both the mother and her child.

Insufficient amount of amniotic fluid does not give the baby the opportunity to move freely inside the womb. Therefore, often the child takes a transverse or gluteal position and he can no longer roll over correctly.

There are various exercises that can help turn the crumbs into the desired position, but their effectiveness has not been confirmed with medical point vision. Exercise can lead to cord entanglement, so you need to weigh the pros and cons before doing them.