Consequences of oligohydramnios for the child. Moderate oligohydramnios during pregnancy: causes and consequences, diagnosis and treatment. Low level of AFI - oligohydramnios

According to statistics, about 4% of all pregnant women on ultrasound hear the diagnosis of "oligohydramnios". The expectant mother begins to worry about how the lack of amniotic fluid will affect the child. And this is a completely normal reaction. After all, oligohydramnios during pregnancy can be a consequence of serious disorders in both the child and the mother. What to do in such a situation? What causes this condition and what consequences does it have?

Appointment of amniotic fluid

Water, or amniotic fluid, surrounds the baby throughout pregnancy. They are in the fetal bladder - a kind of "pouch" in which the fetus is formed and develops. By the end of pregnancy, the amount of water is 800-1500 ml. They are constantly updated - approximately once every 3 days.

With each subsequent month, the amount of amniotic fluid increases. At first, the baby moves easily. However, in the last trimester, despite the increase in the amount of amniotic fluid, he becomes cramped.

Amniotic fluid plays an important role:

Helps create the right environment for the fetus.
Contains nutrients and vitamins.
Prevent the fusion of the skin of the child and the fetal bladder.
Protect from injury.
Allow to move. Movement is very important for fetal development.
Protect the umbilical cord and placenta from damage as a result of the movements of the child.
If there is a sufficient amount of amniotic fluid in the fetal bladder, the baby takes the desired position by the time of birth.
Thanks to the waters, it is easier for the mother to transfer the motor activity of the fetus.
Water helps open the cervix during childbirth.

Why is there little water?

Oligohydramnios is a decrease in the amount of amniotic fluid. Usually such a diagnosis is made in the last weeks of pregnancy if the amount of water decreases to 500 ml. In the classic version, oligohydramnios is a deviation from the norm just before childbirth. However, this phenomenon occurs at 20, and at 30, and at 33 and even at 35 weeks. Why does this condition develop?

Factors that cause oligohydramnios during pregnancy are divided into 5 groups.

Congenital malformations of the fetus

Incorrect formation and development of the urethral valves.
The complete absence of the urethra or its narrowing.
Too narrow ureters.
The complete absence of the muscles of the anterior wall of the abdomen and malfunctions of the urinary system.
Absence of kidneys.
Polycystic (formation of cysts in both kidneys).

Fetal pathologies

Infection of the fetus with cytomegalovirus, chlamydia, etc.
Slow development.
Down syndrome and other chromosomal disorders.

Chronic diseases of the mother

Diseases of the heart and blood vessels, such as hypertension or venous insufficiency.
Preeclampsia (toxicosis of the second or third trimester).
Pyelonephritis, renal failure and other kidney diseases.
Lupus, arthritis, rheumatism and other diseases from the collagen group.
Overweight.
Diabetes.
Dehydration.
Smoking.

Problems with the placenta

Failure.
placenta infarcts.
Improper development, for example, amnion necrosis or atrophy.

Other factors

More than 42 weeks of pregnancy.
Injuries of the amniotic sac.
Outflow of water.
The death of the fetus inside the womb.
Long-term use of drugs that allow you to save pregnancy and delay childbirth.

It turns out that most causes of oligohydramnios can be prevented. It is impossible to correct only congenital malformations.

However, they can be detected on ultrasound, which are performed at 12, 20 and 35-36 weeks.

Now the most common causes of oligohydramnios in pregnant women are preeclampsia, hypertension, diabetes mellitus, colds or SARS, TORCH infections (toxoplasmosis, rubella, etc.), chronic oxygen starvation of the fetus.

TORCH infections, in addition to oligohydramnios, cause malformations of the child. To avoid problems, you need to be tested for these infections even before conception.

If oligohydramnios is caused by SARS or the common cold, there is no cause for concern. The amount of water will be restored within a month.

Classification

By duration, oligohydramnios during pregnancy can be acute and chronic:

Acute occurs spontaneously and is called benign. Such oligohydramnios is usually associated with external circumstances, for example, with colds.
In the second case, oligohydramnios develops hidden, and its causes are difficult to eliminate. A woman must undergo a thorough examination to prescribe therapy. Chronic oligohydramnios will not go away on its own - it can progress.

According to the time of development, oligohydramnios is early or late:

Early oligohydramnios is considered the most dangerous. It usually appears between 16 and 20 weeks of gestation. During this period, the child develops most actively. Therefore, it is worth undergoing a detailed examination and immediately begin treatment.
Late oligohydramnios appears mainly in the third trimester. It may be due to abnormalities in the development of the fetus.

According to injuries of the membranes, oligohydramnios is primary and secondary:

Primary may appear in intact fetal membranes.
The secondary appears when the fetal membranes are damaged and the water is leaking.

How is it manifested?

It is very difficult to notice oligohydramnios on your own at any time, whether it is 20, 33 or 35 weeks of pregnancy. For a woman to suspect something, there must be critically little water. With moderate oligohydramnios, the expectant mother does not experience any symptoms.

If oligohydramnios is pronounced, the baby becomes cramped in the uterus, and each of his movements gives pain in the body of the pregnant woman.

A gynecologist may suspect oligohydramnios if the size of the uterus does not match the gestational age or parts of the baby's body are easily palpable. At the slightest suspicion, a pregnant woman will be sent for an ultrasound scan, where a specialist will determine the index of the amniotic fluid (measured in millimeters).

What is the danger?

Does oligohydramnios always have a negative effect on the child and mother? What could be the consequences of this condition? It is difficult to give an unequivocal answer to these questions - it all depends on the timing and reasons.

If the lack of amniotic fluid happened in the middle of pregnancy, in the period from 17 to 27 weeks, the walls of the uterus are squeezed from all sides of the child. It leaves no room for movement and growth.

As a result, some deviations in its development may appear:

clubfoot,
hip dislocation,
skull deformity.

If you consult a doctor in time, these defects can be eliminated.

What could be the consequences if oligohydramnios caught up in the later stages, from 35 weeks until the moment of delivery? Childbirth will be fraught with some difficulties. With oligohydramnios, the amniotic sac becomes flat and does not contribute to the opening of the cervix. As a result, the birth process is delayed. In most cases, doctors decide to perform a caesarean section.

In women who suffered from oligohydramnios, the risk of bleeding in the postpartum period is much higher.

most dangerous period

The critical period is the period of 30-33 weeks. Low water at 30-33 weeks is noted more often than at other times, and is a consequence of oxygen starvation of the fetus. In this state, all blood is collected in the brain and heart. The lungs and kidneys are starving. The process of producing amniotic fluid, for which these organs are responsible, is disrupted.

For a period of 30-33 weeks, the amniotic fluid index ranges from 74 to 274 mm.

Doctors call this period critical: oligohydramnios can lead to serious consequences and even provoke the death of a child.

How is it treated

The management of pregnancy and childbirth, as well as possible therapy, depend on the trimester in which oligohydramnios occurred and how severe it is. The most risky is the second trimester. In case of danger, doctors try to prolong the pregnancy for the maximum possible period so that the baby has time to develop and become viable. This process is called prolongation.

If oligohydramnios is detected in the third trimester, it will be difficult to prolong the pregnancy. In the absence of violations in the development of the child, delivery is indicated for a period of 37-38 weeks.

To alleviate the condition of the pregnant woman, doctors eliminate the cause that caused oligohydramnios. They also prescribe drugs to improve blood flow in the placenta. It is important to constantly monitor the baby's condition with the help of ultrasound, CTG (cardiotocography) and dopplerometry.

If the condition of the fetus deteriorates sharply according to CTG, a caesarean section is performed.

Reverse situation

Sometimes a woman develops a condition that is completely opposite to oligohydramnios - moderate polyhydramnios during pregnancy. This is an increased level of amniotic fluid.

As with oligohydramnios, the causes of polyhydramnios are chronic diseases and problems in the development of the fetus. Also, this condition may be a consequence of pregnancy with twins, triplets, etc.

Even moderate polyhydramnios during pregnancy can seriously complicate childbirth and postpartum recovery. In addition, it is very dangerous for the child.

So, oligohydramnios and polyhydramnios during pregnancy occur due to diseases of the maternal organism or disorders in the development of the fetus. It doesn’t matter what the gestational age is: 20, 33, 35 or 40 weeks, in order to avoid serious consequences, all doctor’s prescriptions must be followed.

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

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

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

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

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

Classification of oligohydramnios

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

chronic;
sharp shape.

Oligohydramnios, related to the first type, develops in stages. Treatment in this situation requires a long time. In the absence of the necessary therapy, the phenomenon will progress. The chronic form of this condition occurs when a woman has serious diseases, such as diabetes. To minimize possible negative consequences, the expectant mother should undergo regular examinations and receive appropriate therapy.

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

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

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

Signs of oligohydramnios

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

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

Complications with oligohydramnios

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

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

Examination and therapy

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

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

Treatment of moderate oligohydramnios during pregnancy involves an integrated approach. A woman is prescribed medications, the action of which is aimed at stabilizing metabolic processes in the placenta. With the help of medicines, the underlying disease that caused oligohydramnios is eliminated.

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

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

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

Preventive measures

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

Conclusion

Moderate oligohydramnios occurs against the background of a woman’s diseases or abnormalities in the development of a child. The moderate form of this condition is characterized by less pronounced consequences and, with a timely response, does not pose a significant danger. Oligohydramnios is not always accompanied by symptoms, and only a doctor can determine it. Therefore, a woman should regularly undergo the necessary examinations. At different stages of gestation, the lack of amniotic fluid has different consequences. So, moderate oligohydramnios during pregnancy at 30 weeks is less dangerous than during the second trimester.

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

Throughout pregnancy, the baby develops in a water bladder that contains amniotic fluid. As the fetus grows, the fluid volume also increases. It allows the fetus to move quietly in the womb, is a protection against injury. Also, the liquid contains the necessary nutrients, hormones and vitamins.

What is low water?

By the end of the third trimester, the volume of amniotic fluid can be from 1 to 1.5 liters. If the ultrasound value is below the norm, then the woman is diagnosed with oligohydramnios.

Distinguish between severe and moderate oligohydramnios . With moderate oligohydramnios, the indicator in most cases does not fall below 600-700 ml. Signs of expressed - 400-500 ml.

Usually, with moderate oligohydramnios, there is no reason for hospitalization, no treatment is prescribed. Symptoms are corrected by proper nutrition and daily routine. But if a woman has a pathology, then she is immediately sent to the hospital for preservation / treatment, because this threatens with serious deviations in the development of the child. And in this case, it does not matter what week of pregnancy is: they are hospitalized both in the second trimester and in the third.

Also, with severe oligohydramnios, there is a tendency to premature birth and spontaneous miscarriages.

Causes

Upon learning of pregnancy, every girl should register with the antenatal clinic and be constantly monitored by a gynecologist. But even the most responsible mothers, who take all the tests every two weeks, have a tendency to unforeseen complications that can threaten the life of the child.

Reasons for insufficient amniotic fluid:

Insufficient secretion of amniotic fluid.
Water leakage.
Anomaly in the development of the fetal membranes. They can fix up to 20 weeks.
Deviations in the development of the fetus. If the fetus has a kidney defect, then the diagnosis of oligohydramnios is usually made already in the early stages of pregnancy.
Hypertension in pregnancy. During pregnancy, a woman's blood pressure may increase. The danger is represented by pronounced jumps from low to high rates. If you do not start treatment, then the consequences can be sad: there may be a delay in the development of the child, slow growth and weight gain. Quite often, such symptoms are detected at 20–21 weeks.

bacterial infections. The danger is chlamydia, ureaplasmosis, etc. Often, diseases do not occur during pregnancy, but long before it. It's just that the woman was not treated, and the disease became chronic. Such infections are detected by tests at 20 weeks. It is at this time that bacteria begin to multiply under the influence of hormones. If it was not possible to fix dangerous infections in time, then at a period of 30 weeks the woman already has serious oligohydramnios and all the ensuing consequences.
This diagnosis is made to mothers who are carrying more than one baby. The reasons are the uneven distribution of water and abnormal blood flow in the placenta. As a result, one child develops in comfortable conditions, and the second has to fight for survival. Polyhydramnios is also observed in one child and signs of severe oligohydramnios in the second. Between children there may be a difference in development - a week or more. If the specialists failed to make the necessary diagnosis, then one of the fetuses may die.
The norm is considered to be childbirth that falls on the 36-40th week. But already from the 38th week, the placenta ceases to perform all the functions assigned to it. That's when the lack of fluid can begin. If labor does not begin at week 38, then a caesarean section may be prescribed. This question is especially acute if the 40-42nd week is already underway.
With overweight mothers, such a diagnosis can be made already at the first or second ultrasound, that is, at 12 or 22 weeks, respectively. Mommy should be taken to the hospital, she is prescribed proper nutrition. Most often, babies are born no later than 36-37 weeks.

Cardiovascular diseases affect oligohydramnios. The reasons for their occurrence: smoking before and during gestation, past illnesses, viral infections like influenza and SARS, obesity and diabetes, congenital anomalies.

Basically, the causes of oligohydramnios are associated with the state of health of a woman before and during pregnancy. Only in some cases occurs due to pathologies.

What is the danger of the diagnosis?

Low water is also divided into earlier and later. If the diagnosis is made for up to 20 weeks, this is early, at 26–40 weeks it is later.

It is early low water that is most unfavorable for the development of the embryo. Indeed, in the first and vitor trimesters, the vital organs of the unborn child begin to form and develop.

In the third trimester, it is much easier to treat a lack of water, as this is a completely normal symptom. This is especially true in the last weeks of pregnancy.

Why is oligohydramnios dangerous during pregnancy? A sufficient amount of amniotic fluid ensures the free movement of the fetus. In an advanced case, such a phenomenon at week 20 or less threatens the development of defects and deformities. Still fragile arms and legs are also bent.

Due to the small amount of amniotic fluid, there are: improper development of the urinary system, kidney defects and much more. Low water is not a permanent process. Sometimes it only lasts a few months or even weeks. Provoke serious deviations in development is capable of only prolonged pronounced oligohydramnios.

signs

An insufficient amount of amniotic fluid is dangerous because there are practically no pronounced symptoms. During pregnancy, the female body is rebuilt, some discomfort appears. And few mothers recognize in this the symptoms of a dangerous disease. An accurate diagnosis is made only by a specialist.

Moderate oligohydramnios during pregnancy is almost always asymptomatic. The expectant mother feels great and full of energy.

With severe oligohydramnios in a pregnant woman, symptoms such as:

Constant or periodic cutting and aching pain in the lower abdomen.
Sharp pains during fetal movement. This is especially true for a period of 36 weeks.
Poor health of the mother - weakness, nausea, dizziness.
Leakage of water - the release of a clear liquid from the vagina.
The size of the abdomen does not correspond to the terms.
Delayed development by several weeks.

You should be attentive to your condition and, at the slightest suspicion, immediately seek help.

Diagnostics

If oligohydramnios is suspected, a woman must undergo mandatory diagnostic procedures that will show the vital status of the fetus:

Laboratory examination.

Ultrasound examination will allow you to find out the exact volume of amniotic fluid. For this, a special test is carried out, which allows you to determine the values \u200b\u200bof IAI (amniotic fluid index). And already starting from the received figures, they make a diagnosis.

Normal indicators of IAI

	Average IAI (mm)	Term	Average IAI (mm)
	120	28	146
	126	29, 30 weeks
	134	31, 32 weeks
	136	33, 34 weeks
	140	35
	144	36
	145	37
	146	38
24, 25, 26, 27 weeks	Approximately 147	39, 40	Approximately 127

According to the data in the table, it can be seen that the AFI at 22–30 weeks is approximately the same. Then the amount of amniotic fluid goes down. The seventh month is characterized by a slight drop in value.

Please note that this table is an average. For example, at week 20, the IAI can vary from 73 to 200 mm. At 32 and 33 weeks from 74 to 274 mm. So, when you see a figure in the conclusion of a doctor, do not panic.

Doctors sometimes want to play it safe and once again not expose the mother and child to risks.

The consequences of low water are far from the most pleasant. If the doctor does not like something, he offers to go to the hospital. You should not refuse this, because one week is nothing compared to the health of a son or daughter. However, moderate oligohydramnios at 35–37 weeks is quite a normal symptom and does not require treatment.

Treatment

As already mentioned, the reasons for the insufficient amount of amniotic fluid are different. Therefore, treatment is prescribed separately for each case. It matters here the mother's disease, abnormal development of the fetus, a week of pregnancy, etc. For example, if the mother is overweight, drugs are already prescribed from the 27th week to maintain the work of the placenta.

Moderate oligohydramnios during pregnancy is usually treated simply by adjusting the regimen. It is strongly recommended to reduce physical activity at least for a while and rest more, drink a course of vitamins (prescribed by a doctor, do not self-medicate!), Eat right and observe sleep patterns. After some time, you will be assigned a second ultrasound, and if the condition has stabilized, then you should simply follow these recommendations.

Even mild oligohydramnios can harm the baby.

If the change in the rhythm of life did not help you, then the doctor will prescribe outpatient or inpatient treatment in a hospital. The first option is usually suitable for women in the second trimester. You will have to take urine and blood tests. In case of water leakage - also a smear of liquid.

In the hospital, with a severe lack of amniotic fluid, a woman is given drugs that stimulate blood flow in the placenta. For example, Curantil and Actovegin, glucose. If the disease is caused by chlamydia or ureaplasmosis, then first of all, treatment for the infection will be prescribed.

If the drugs do not help, and the condition worsens, then they can stop treatment and prescribe an early birth. Such decisions are made extremely rarely and only if the woman is only a few weeks away from spontaneous delivery. Usually this is at least the 33rd week. If the gestational age is more than 35 weeks, then drugs are prescribed that cause contractions so that the woman can give birth on her own.

Oligohydramnios is a serious problem that can lead to the birth of a child with severe pathologies. Therefore, it is very important to follow all the doctor's instructions.

Sometimes, in order to preserve the pregnancy, a woman may be sent to the maternity hospital (or rather, to the pathology department) ahead of the due date. We will consider one of the reasons that can lead the expectant mother to the hospital of a medical institution for treatment.

After the next ultrasound, a woman can hear the diagnosis of "oligohydramnios". After that, the pregnant woman hurries to her doctor to find out why oligohydramnios is dangerous during pregnancy, how a small amount of fluid can affect childbirth, the condition of the fetus, and what treatment is effective.

The value of amniotic fluid

Throughout pregnancy, the fetus is confined to the space of the uterus. In addition to the baby itself, the placenta and fetal membranes are necessarily present in the womb. These components are necessary only during pregnancy and are formed after conception, therefore, after the birth of a child, they are rejected from the body of the woman in labor in the form of an afterbirth.

The water shell (or fetal bladder) is a kind of "bag" in which the fetus develops, washed from all sides by amniotic fluid. In most cases, the amount of liquid at the end of the period is approximately 800-1500 ml. The waters are constantly updated, the full cycle of renewal is about 3 days.

The amount of fluid during pregnancy is constantly growing. In the first and second trimester, the child can still move relatively freely in the uterus, but by the third trimester the amount of water increases, and with them the child himself becomes larger, which leads to severe "crowding".

The value of amniotic fluid for a child is invaluable:

They create a necessary and unique habitat for the fetus.
They prevent the fusion of the skin of the baby with the fetal bladder.
Protect the baby from injury.
They help the child to actively move, which is very necessary for the proper development of the fetus.
Protect the placenta and umbilical cord vessels from baby movements.
The required amount of water allows the child to take the correct position by the end of the pregnancy.
They smooth and make the movements of the child less noticeable for the mother.
Together with the fetal bladder, they contribute to the opening of the cervix during childbirth.

Low level of AFI - oligohydramnios

The case when the level of amniotic fluid does not reach the norm in obstetrics is called oligohydramnios. The causes of this condition are various, here are the most common:

Amnionic hydrorrhea. When the amniotic fluid begins to leak much earlier than the PDR (). This complication appears due to rupture of the membranes. The causes of this condition have not yet been studied, experts believe that the rupture may occur due to the thinness of the fetal membranes, which occurred as a result of viral infection or their aging. A very small amount of water flows out through the gap that has arisen as a result of the gap, but this happens all the time. In this case, the woman needs bed rest - in this case, the amniotic fluid has time to renew itself and the child is not in danger.
Anomalies in the development of the membranes - there are quite a few of them. The cause of any of these disorders may be poor ecology, genetic factor and others.
Infection of the fetal membranes. This situation occurs most often. Infection of the fetal bladder with viruses (it can be measles, SARS, chicken pox, influenza, and many others) occurs because the placental barrier is unable to protect the fetus from this type of infection. Sometimes infection occurs due to STDs (sexually transmitted diseases). Toxins that are produced as a result of the activity of viruses poison the fetal membranes and disrupt its functioning.
A true reversal of pregnancy. In this case, the fetal membranes and the placenta already cease to perform their functions at full strength, and this leads to the fact that the child begins to lack nutrients and his general condition worsens. Blood circulation in the amniotic membranes worsens, as a result - a decrease in the production of amniotic fluid.

What is the danger?

This condition while waiting for a child is fraught with various complications. If there is very little amniotic fluid, then the walls of the uterus begin to adjoin the fetal sac tightly, which leads to strong pressure on the child - he bends in an uncomfortable position. This can lead to such consequences: curvature of the spine, clubfoot, increment of the skin to the fetal membrane. The skin of the fetus becomes all wrinkled and dry.

With prolonged and severe oligohydramnios, close contact of the amniotic sac with the child's skin can lead to the formation of simonart ligaments. They wrap around the fetus, interfere with its activity, in some cases can even lead to serious injuries. When they wrap around the umbilical cord, this leads to impaired blood flow in the vessels, as a result, the child may experience a delay in physical development, and in especially dangerous cases, the death of the fetus.

Pronounced polyhydramnios is physically felt even by a pregnant woman. These are constant pains in the lower abdomen in the second and third trimester. When the child moves, the mother experiences pain. This is especially felt at 36-42 weeks of gestation, when the fetus is already quite large.

If there is very little amniotic fluid, childbirth is often accompanied by a slow opening of the cervix, weakness of labor activity develops. The contractions are painful, but their effectiveness is very small. Bleeding may occur after childbirth.

Treatment. Should moderate oligohydramnios be treated?

Quite often, a moderate (slight) decrease in the amount of water (400-700 ml.) Is the norm. In this case, a pregnant woman is recommended to reduce physical activity, eat well, take multivitamin complexes and be sure to be observed by a gynecologist in a antenatal clinic. An additional unscheduled ultrasound may be required to exclude a further decrease in water. If the symptoms of oligohydramnios become more pronounced, and the amount of fluid becomes less than 400 ml, mandatory treatment in the department of pathology of pregnant women is necessary.

As soon as the doctor determines that a woman has oligohydramnios, she is sent to the maternity hospital for additional tests. In the hospital, additional studies are carried out:

CTG (cardiotocography);
laboratory tests (blood and urine tests).

If the gynecologist suggests that the woman has amniotic hydrorrhea (amniotic fluid is leaking), then a swab should be done on the water.

When a woman is 38 weeks pregnant or more, the cervix is already preparing for childbirth and its canal may miss the amnioscope. In this case, the doctor can more accurately determine the amount and composition of the amniotic fluid using amnioscopy. This procedure does not violate the integrity of the membranes and is not dangerous for the child.

The tactics that the doctor chooses for treatment largely depends on the cause that caused this complication.

If the cause is amnionic hydrorrhea, then the pregnant woman needs strict bed rest, vitamin complexes, drugs that help reduce the tone of the uterus and prevent infection of the child and fetal membranes. Most likely, the woman will stay in hospital until the very birth, in order to constantly monitor the condition of the fetus.
Is the cause of oligohydramnios a viral infection? Then general tonic and antiviral drugs are needed. In addition to them, vitamin therapy and drugs that improve blood microcirculation are needed. If the doctor sees a positive trend, he can send the expectant mother home with mandatory monitoring of the condition in the LCD.
Does the future mother have an anomaly in the development of the fetal membranes? In this case, therapy is needed aimed at maintaining pregnancy and preventing intrauterine infection. Treatment is carried out in the department of pathology of pregnant women. A constant diagnosis of the condition of the fetus and the woman herself is carried out.
If there is a prolongation, then they will make a puncture of the bladder - an amniotomy. After that, childbirth begins.

If you determine oligohydramnios in time and start treatment, then the prognosis of this pregnancy is favorable in most cases.

Content

The natural life support system of a baby in the womb is the amniotic fluid. They are also called amniotic fluid. It is responsible for the development of the fetus, provides it with hormones, salts, oxygen and vitamins. If the amount of amniotic fluid does not match the gestational age, the woman is diagnosed with oligohydramnios.

What is oligohydramnios during pregnancy

Amniotic (fetal) water is a biologically active liquid medium in which the fetus is located throughout pregnancy. Amniotic fluid plays an important role in keeping the developing baby alive:

creates a favorable environment where the fetus can move;
stimulates the development of the lungs;
prevents mechanical damage to the fetus;
controls metabolism;
during childbirth protects the umbilical cord from squeezing;
exhibits antibacterial properties.

After the penetration of a fertilized egg into the mucosa of the uterine cavity, embryonic membranes begin to form around it: external (chorionic), internal (amniotic water). Together they form the amniotic sac, which grows with the fetus. Inside, this cavity is filled with amniotic fluid, which is 97% water. Its formation can be seen on ultrasound as early as the 3rd week of gestation, when part of the maternal blood penetrates through the fetal membranes.

As the fetus grows, the amount of amniotic fluid changes. There is a constant exchange between her and the child:

In the second trimester, the source of amniotic fluid is the fetus itself. His urine (up to 1 liter per day) and fluid secreted by the lungs (up to 400 ml per day) enter the surrounding space.
From 18-20 weeks of pregnancy, the fetus begins to swallow water. By week 40, the amount of liquid swallowed is about 500 ml daily. When the absorbed waters give the baby everything it needs, they again return to the amniotic space along with his urine.

The amniotic fluid is constantly completely renewed - approximately every 3 hours. Their total amount depends on the balance of formation and excretion of amniotic fluid. Oligohydramnios is a condition in which the volume of amniotic fluid during a full-term pregnancy decreases to 0.3-0.5 liters, depending on the gestational age. Another name for pathology is oligohydramnios. This condition is not very common:

Functional oligohydramnios occurs in only 3-4 pregnant women out of 1000. This type of it is not considered pathological. Oligohydramnios occurs as a response to the actions of the external environment and disappears on its own within a month. For example, at 23 weeks there was not enough amniotic fluid, and at 33 its level had already become normal.
Pathological oligohydramnios is diagnosed in only 0.2-0.3% of pregnant women. It does not go away and is fixed at different gestations, and not at a certain week.

Causes

Oligohydramnios in a pregnant woman still has no clearly defined causes. Gynecologists on the basis of medical practice only highlight the risk factors for the development of this pathology. There is a tendency to oligohydramnios during pregnancy with the following deviations:

pathologies in the development of the fetus, including the absence of both kidneys, their polycystic or dysplasia, abnormalities of the cloaca;
underdevelopment of the tissues of the fetal bladder;
chromosomal abnormalities;
gestation of the fetus;
multiple pregnancy;
infection of the fetal bladder;
fetoplacental insufficiency, anomalies in the development of the placenta;
history of bacterial infections;
chronic intoxications;
diabetes mellitus, chronic hypoxia, eclampsia, high blood pressure, diseases of the kidneys and bladder in a pregnant woman;
facial abnormalities in the fetus, including a massive bridge of the nose, low-set ears, wide-set eyes;
amnionic hydrorrhea - leakage of amniotic fluid;
severe toxicosis, gestosis;
systemic diseases of the connective tissue of a pregnant woman, such as systemic lupus erythematosus, rheumatoid arthritis.

Varieties

Medicine has several different classifications of oligohydramnios. Depending on the root cause of development, this deviation is divided into two main types:

Primary. Such oligohydramnios occurs against the background of intact fetal membranes.
Secondary. It develops as a result of rupture of the amniotic membranes, leading to leakage of amniotic fluid.

According to the nature of the course, oligohydramnios is divided into acute and chronic. In the first case, the cause is infectious diseases carried by the mother. Oligohydramnios here is more often functional. Chronic oligohydramnios accompanies a woman during almost the entire pregnancy and requires closer study. Depending on the gestational age, oligohydramnios occurs:

early. It is diagnosed at 14-20 weeks of gestation. Often associated with insufficiency of the functions of the amniotic membranes.
Late. Occurs at 21-40 weeks of gestation due to damage to the membranes.

signs

Oligohydramnios has few specific symptoms. Its manifestations may accompany other pathologies of pregnancy. It is possible to suspect a lack of amniotic fluid by a complex of symptoms. Characteristic signs of oligohydramnios:

aching pain in the lower abdomen, reminiscent of the sensations during menstruation;
dry mouth and nausea, especially in the morning;
general weakness, similar to the condition with influenza or acute respiratory infections;
lack of appetite;
low motor activity of the fetus;
liquid discharge from the vagina (with rupture of the amniotic membranes);
lagging behind the size of the uterus from the norm;
pain during fetal movement;
restless sleep.

What is the danger of oligohydramnios during pregnancy

Olighydramnios can cause many different complications. When a woman has little amniotic fluid during pregnancy, the baby begins to experience too much pressure from the walls of the uterus, which compress the amniotic sac. As a result, the fetus takes an uncomfortable and unnatural position, which is fraught with the development of the following pathologies in the baby:

curvature of the spine;
clubfoot;
deformities and dislocations of the hips;
fetal hypoxia and developmental delay (hypotrophy).

For a woman, oligohydramnios is dangerous with a miscarriage and the development of complications during childbirth. With a reduced volume of amniotic fluid, the cervix may not dilate enough during delivery. At the same time, labor activity is weak, contractions are painful, but not strong. Even after childbirth, oligohydramnios can cause a woman to bleed. If the pathology was discovered late and there are irreversible developmental disorders of the child, doctors may insist on early termination of pregnancy.

Diagnostics

A doctor can suspect oligohydramnios even during a gynecological examination based on the subjective sensations of a pregnant woman. The signs of this pathology are:

low motor activity of the fetus (less than 10 perturbations throughout);
lag of the standing height of the fundus of the uterus and the circumference of the abdomen from normal values at a certain gestational age;
amniotic fluid index (AFI) according to ultrasound is below normal.

The last criterion is the main one in the process of diagnosing oligohydramnios. To calculate the amniotic fluid index, the uterus is conventionally divided into four sections. Next, the following calculations are made:

Determine how deep the amniotic fluid is in each of the selected sections. To do this, measure the free space between the fetus and the wall of the uterus in centimeters.
Next, the resulting numbers are summed up and divided by 4. This will be the amniotic fluid index.
If the value obtained is within 5-8 cm, this indicates a sufficient amount of amniotic fluid. Moderate oligohydramnios during pregnancy is diagnosed with an IAI of 2-5 cm, pronounced - if a figure is less than 2 cm.

To prescribe adequate treatment for a woman, the doctor needs to find out the cause of oligohydramnios. To do this, he appoints a number of additional studies:

dopplerography;
analyzes for biochemical markers of chromosomal diseases, including Down syndrome, Marfan, Edwards;
a smear on the water, if there is a suspicion of their leakage;
general blood and urine tests;
fetal cardiotocography to determine its condition;
tests and swabs for bacteria and sexually transmitted infections.

Treatment

The treatment regimen depends on the cause of the pathology. If it is a viral infection, then antiviral drugs are prescribed and general strengthening therapy is additionally carried out. The latter consists in taking vitamin complexes and drugs that improve blood flow. Other ways to treat oligahydramnios:

If the pathology was provoked by obesity or metabolic disorders in the body, then the treatment is carried out in an outpatient clinic. It consists in the observance of proper nutrition, the use or intramuscular administration of vitamins.
With pathologies of the fetal bladder, doctors direct all their efforts to maintain pregnancy and prevent infection of the child. Treatment in such cases is carried out exclusively in a hospital.
If oligohydramnios is associated with prolonged pregnancy, then doctors puncture the fetal bladder and stimulate labor with the help of special preparations.
In the early stages, when malformations that are incompatible with life are detected, doctors decide to terminate the pregnancy.
Severe oligohydramnios in combination with fetal hypoxia is eliminated by caesarean section. This method is used even in premature pregnancy, since the fetus suffers from oxygen starvation.

If oligahydromnion was detected late in pregnancy (from 27 to 40 weeks), then the woman is hospitalized in the antenatal ward. She is prescribed intravenous administration of the following drugs:

Curantyl, which improves blood circulation in the placenta;
Actovegin, which provides oxygen delivery to the fetus;
vitamins of groups B and C;
maintaining normal blood pressure and sugar levels.

During therapy, the child's condition is constantly monitored using cardiotocography and dopplerometry. The latter study allows the assessment of placental insufficiency. If the child's health worsens, then the doctors urgently perform a caesarean section. If oligahydramnios is detected before 28 weeks, doctors recommend termination of pregnancy, since its outcome is very difficult to predict. This applies to pathological oligohydramnios. Functional in many women passes in a month on its own. Hospitalization is required in the following cases:

with placental abruption;
severe fetal hypoxia;
uterine hypertonicity;
pronounced form of oligohydramnios.

An obligatory part of therapy is the correct organization of a way of life. A woman should avoid overwork, stress and physical activity. The patient should be provided with bed rest. Doctors recommend following a special diet with the following basic principles:

eat several times a day (more than 5) in small portions;
choose natural products with minimal processing;
refuse fast food;
reduce the amount of sugar and salt in the diet;
exclude fried, salty, spices and spices, products with flavorings, dyes and preservatives;
it is good to thermally process seafood, fish and meat, do not eat them half-finished;
do not drink strong tea and coffee;
replace sweets with fruits;
refrain from blue cheese, raw eggs, unboiled milk.

Childbirth with oligohydramnios

In the case of oligohydramnios, the size of the uterus does not correspond to the norms for a certain week of gestation. As a result, the woman’s brain does not receive the appropriate signal about the need to start labor, because the cervix does not open. In this case, doctors pierce the amniotic sac. Then, special preparations are administered to the woman to artificially stimulate labor. If oligohydramnios is extremely severe, then experts decide on childbirth by caesarean section.

Forecast and prevention

If oligohydramnios was detected in a timely manner, then it is amenable to medical correction. If the woman follows all the recommendations of the doctor, unpleasant consequences can be avoided. Pregnant women in such cases successfully carry the fetus to 37-38 weeks and give birth to a healthy baby. Exceptions are cases of oligohydramnios due to chromosomal abnormalities or congenital pathologies of fetal development. In such cases, the child may not survive or be born with certain abnormalities.

The prognosis is the most unfavorable when oligohydramnios is detected in the 2nd or 3rd trimester of pregnancy in combination with intrauterine growth retardation. In this case, the death of the child, his lag in growth or functional immaturity is possible. To avoid oligohydramnios, a woman is advised to:

even before pregnancy, undergo a complete examination and cure diseases of internal organs;
timely register with a gynecologist, pass the necessary tests;
exclude physical activity, stress and other negative factors during pregnancy;
eat a balanced diet;
daily walk in the fresh air;
take vitamin complexes prescribed by a doctor.

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