Moderate oligohydramnios during pregnancy: causes and consequences, diagnosis and treatment. The value of amniotic fluid. How oligohydramnios manifests itself, symptoms

oligohydramnios- This pathological condition during pregnancy, manifested by a decrease in the volume in the amniotic cavity compared to the normal values characteristic of this period.

Information Quantity amniotic fluid evaluated on ultrasound using an index amniotic fluid. A decrease in its value indicates the development of oligohydramnios.

Causes

To the main reasons, most often causing a decrease in the volume of amniotic fluid, include:

Severe congenital malformations of the kidneys of the fetus. In this case, the tendency to oligohydramnios is already outlined from the early stages of pregnancy.
Chronic diseases of a woman(pathology of the cardiovascular, urinary systems).
Infectious diseases of the genital organs(ureaplasmosis, chlamydia, trichomoniasis, etc.).
Past viral and bacterial infections(including SARS and influenza).
Severe late gestosis.
Pathologies of the placenta(developmental anomalies,).
(oligohydramnios of one fetus is often combined with polyhydramnios of another).
Prolongation of pregnancy(associated with the aging of the placenta, the amount of water is reduced slightly).
Idiopathic oligohydramnios(the exact cause of the development of pathology has not been clarified).

Symptoms

Allocate two forms of oligohydramnios: moderate and pronounced.

With moderate form the symptoms are practically not expressed, the woman's well-being is not disturbed. In this case, it is possible to determine the lack of amniotic fluid only on ultrasound.

In severe form, the following symptoms are characteristic:

Reducing the size of the uterus. With external obstetric examination there is a decrease in the circumference of the abdomen and the height of the fundus of the uterus compared with normal values for this period of pregnancy.
Painful fetal movement.
Periodic aching.
Deterioration of general well-being (weakness, nausea,).

Treatment

Important Treatment oligohydramnios is a difficult task, because. There are no specific drugs for this, and it is currently impossible to artificially increase the volume of amniotic fluid.

A woman, when detecting a decrease in the amount of amniotic fluid in without fail is hospitalized in a hospital, where the whole complex of therapeutic measures will be aimed at maintaining the condition of the fetus and improving uteroplacental circulation:

vitamin therapy;
drugs to improve the functions of the placenta;
drugs to improve uteroplacental blood flow ( , );
antibiotic therapy when finding infections of the genital organs (, Josamycin).

During treatment, constant monitoring of the amount of amniotic fluid and the condition of the fetus is necessary: fetal cardiotography is performed daily, ultrasound is repeated after 4-5 days and.

If the complex of therapeutic measures does not give an effect and the condition of the fetus worsens, the severity of oligohydramnios increases, then a decision is made on early delivery, regardless of the gestational age. Considering high risk development of complications in childbirth, preference is given to delivery by caesarean section.

Complications

Low water renders extremely negative impact on the course of pregnancy and childbirth and leads to serious complications niyam:

premature termination of pregnancy;
hypodynamia and fetal compression due to a decrease free space in the uterus, which leads to developmental abnormalities (curvature of the spine, congenital clubfoot, dislocation of the hip, deformities of the skull bones, etc.);
fetal hypoxia,;
pronounced weakness of labor activity;
increased risk of postpartum hemorrhage.

Every woman dreams that her pregnancy proceeds easily and naturally, so that no one and nothing can distract the expectant mother from pleasant thoughts about the unborn child. However, in reality, not everything goes so smoothly.

One of the serious complications can be oligohydramnios. About what it is and how to treat it, we will tell in this article.

What it is?

In a broad sense, oligohydramnios refers to a decrease in the amount amniotic fluid from the norms characteristic of a particular period of pregnancy. However, in the classical sense of the word, oligohydramnios is considered a small amount of amniotic fluid on the eve of childbirth, at about 39-40 weeks.

When there was no ultrasound, and one could only guess about the amount of water, oligohydramnios was really determined already before the very birth. Now, thanks to the development of diagnostics, to identify the tendency to decrease in water in the fetal bladder is possible already from the 16th week.

Water is needed for normal development child. They are also nature's intended shock absorber, softening the shaking, swaying, which the baby could feel quite significantly when walking or other actions of the pregnant woman, if the water did not interfere with this.

Amniotic fluid begins to be produced around the 8th week of pregnancy, and with an increase in gestational age, it also increases in volume. In the 3rd trimester, there is a slight decrease in fluid, because the uterus is already greatly stretched by a grown child.

Long years of studying intrauterine development have allowed physicians and scientists to calculate the normal amounts of amniotic fluid determined for each period. It is not customary to measure them with standard liquid measures - milliliters, for example.

To assess their number, there is a special parameter - the amniotic fluid index. You can determine it in millimeters starting from the 16th week of the gestational age during the passage of an ultrasound scan.

IAI norms - table:

obstetric term, (a week)	IAI (normal limits), mm	Obstetric term (week)	IAI (normal limits), mm

Since the amount of water in the fetal bladder is not a constant value, at different times in the same future mother can find oligohydramnios, and after a few weeks it is not detected. Such natural phenomenon called functional oligohydramnios. This is the most harmless of all types of this complication.

Usually, with a medical verdict of "oligohydramnios", a woman falls into a stupor. Expectant mothers should be reassured by the following official statistics from the Ministry of Health:

oligohydramnios is accompanied by about 4% of all pregnancies;
only 0.5-1.2% of such cases have pathological causes;
all other women (and the vast majority) perfectly carry and give birth to healthy children, since their oligohydramnios was physiological.

Pathological oligohydramnios is considered to be a persistent insufficient amount of amniotic fluid, which can be registered repeatedly at various times, starting from the 16th week.

Classification

Oligohydramnios can be acute if it appeared suddenly under the influence of negative factors, or it can develop gradually and almost imperceptibly, and then it will qualify as chronic.

With acute oligohydramnios, the body of a pregnant woman can react to a viral disease, influenza or SARS, from which the expectant mother could not protect herself during the period of bearing the baby. This disruption is usually temporary and does not mean that the baby has pathologies.

More dangerous chronic oligohydramnios. It usually develops due to problems that cannot be called quick-fixed - mother's diabetes, obesity, as well as malformations of the child and its prolonged hypoxia. Such a disorder will not go away on its own, it definitely needs treatment. Also, a violation may be early if it was detected between 16 and 20 weeks and late if the problem was detected only after 26 weeks.

In the case of early oligohydramnios, the forecasts of doctors are less optimistic, because the process of formation has not yet been completed internal organs and baby systems.

Severe oligohydramnios in the early stages may be an indicator of gross genetic abnormalities in the baby, and therefore such a “find” on ultrasound needs a detailed study through other diagnostic methods. On later dates the violation is often functional, quite natural, it is easily corrected or goes away on its own.

Sometimes the development of such a violation is affected by the fetal membranes, or rather their integrity:

if they are not changed, not injured, then doctors talk about primary oligohydramnios;
if the shells are damaged and water leaks, this is a secondary violation.

Primary oligohydramnios occurs in 80% of cases. According to the quantitative indicator of deviations from the norms indicated in the table, moderate and pronounced oligohydramnios.

Causes

The reasons for the decrease in amniotic fluid so important for the baby are diverse. These can be malformations of the child, his diseases, pathologies of the placenta, as well as diseases of the expectant mother, both acute and chronic.

Some genetic, including chromosomal disorders that arose during the period of conception, during the formation of the genetic code, the karyotype of the fetus, occur precisely against the background of a decrease in the amount of amniotic fluid.

In particular, such defects as lead to the development of oligohydramnios misdevelopment urethra and its valves, as well as abnormal narrowing of the baby's urethra or her complete absence, solidary (on both sides) narrowing of the ureters or anomalies in their structure.

Severe oligohydramnios is observed in pregnant women if, due to the “mistake” of nature, the baby has no kidneys as such.

Polycystic kidney disease of the baby (Potter's syndrome) is also a very obvious cause of pregnancy failure. Among chromosomal anomalies, oligohydramnios is most often accompanied by Down syndrome and Turner's disease.

If everything is in order with the genetics of the baby, and this was confirmed using other diagnostic methods, then doctors consider the likelihood of infection of the fetus. The most dangerous in terms of the risk of oligohydramnios are cytomegalo viral infection and chlamydia. The lag in the amount of water from the norm often occurs with a delay in the development of the fetus.

The main maternal ailment that can lead to oligohydramnios is preeclampsia. Besides similar condition can cause venous insufficiency, a tendency to form blood clots, diseases of the cardiovascular system.

Adversely affect the amount of water and kidney ailments in the expectant mother, and diabetes. Dehydration can also cause a decrease in amniotic fluid, as well as smoking, with which some of the expectant mothers, even while in " interesting position', so they can't say goodbye.

Pathologies of the placenta lead to oligohydramnios - insufficiency, heart attacks " children's place”, any anomalies in its development that occurred during the formation of this temporary organ at the very initial stages.

Among other reasons that can lead to such an unpleasant complication of pregnancy is overwearing, in which natural aging placenta, membrane injury amniotic sac, mother taking a large amount of medication for a long time, as well as fetal death and multiple pregnancy.

Symptoms and signs

A woman practically cannot determine oligohydramnios on her own, this is a matter for specialists. Only a few signs can indirectly indicate the likelihood of a decrease in the amount of amniotic fluid.

Usually in women with oligohydramnios, the size of the abdomen is smaller than it should be. It becomes possible to establish a violation thanks to measurements of the height of the day the uterus is standing, which are carried out at each scheduled examination in the antenatal clinic.

When the expectant mother begins to feel the movements of her child, with oligohydramnios they can be quite painful for a woman.

It is impossible to remain silent about such sensations if the symptom has not been diagnosed earlier, you should definitely inform your doctor about your suspicions, who will prescribe all the diagnostics required in this case.

Diagnostics

The amniotic fluid index is determined by the doctor ultrasound diagnostics. It measures the distance free from the limbs of the baby and the umbilical cord, between the baby and the anterior abdominal wall, its inner surface. This measurement is called a vertical pocket.

If the measurement result after comparative analysis with tables shows that the amount of water is reduced, the degree of violation is revealed. With moderate oligohydramnios, the index is reduced by 10-15% compared to the above norm, and the vertical pocket, which is 5-8 cm with a normal amount of water, is reduced to a size of less than 5 cm.

Such a violation is pronounced, in which the vertical pocket does not exceed 2 cm, and the amniotic fluid index deviates from the norm downward by 15-20%. To imagine in more detail all of the above, we present a comparative table.

Violations of the amount of amniotic fluid:

Obstetric term, week	Moderate oligohydramnios - amniotic fluid index, mm	Severe oligohydramnios - amniotic fluid index, mm

If the ultrasound specialist indicates in the conclusion that the woman has signs moderate oligohydramnios, obstetrician-gynecologist will definitely refer her for doplerometry and expert ultrasound to more accurately know the state of the baby, placenta and blood flow in the uterine vessels.

When the ultrasound protocol indicates that the pregnant woman has severe oligohydramnios, she is hospitalized for a more thorough examination.

If the reason lies in congenital pathologies baby, it is recommended to terminate the pregnancy medical indications. Agree or not, it is up to the pregnant woman to decide. If she refuses, then the child is kept until the very birth, they provide him with the necessary medicinal support.

Possible consequences for the mother

A woman’s lack of water threatens with an abortion in the later stages, traumatizing both the psyche and physical health reproductive system. If the child dies, there will be no other option. After an interruption for a long time, a woman may experience breakdown develop secondary infertility.

A small amount of amniotic fluid aggravates the very process of childbirth. Weakness of tribal forces often develops, a woman is threatened C-section. The postpartum period in such women is more difficult, complications are likely.

Pregnancy itself can deliver a lot to the expectant mother. discomfort: the larger the child becomes, the harder for a woman will withstand his movements.

The probability of miscarriage during pregnancy with oligohydramnios is high, the risk of preterm birth is even higher - it reaches 26%.

Possible consequences for the child

Children born after pregnancy with oligoamnios have little weight, they are weaker than their peers, even if the pregnancy is full-term before the expected date of birth.

To the most grave consequences prolonged polyhydramnios include various adhesions of the skin of the fetus and the membranes of the amniotic bladder. As a result of such adhesions, cords can fill all the free space of the uterine cavity. They can also entangle a baby.

Due to the pressure that the strands will exert on the tissues of the fetus, irreversible deformities are formed - babies self-amputate or severely twisted limbs, there are facial defects, chest. The appearance of the baby is completely disfigured. The frequency of such consequences is small, but this cannot be ruled out.

The likelihood of such an outcome increases if oligohydroamnion is diagnosed early, at 16-20 weeks, and persists throughout pregnancy.

In childbirth, a baby may experience other troubles associated with a small amount of amniotic fluid - prolapse of the umbilical cord, premature violation of the integrity of the amnion and, as a result, a long anhydrous period, which can result in hypoxia and infection.

Many women mistakenly believe that oligohydramnios is the cause of ailments such as Down syndrome, as well as other chromosomal abnormalities. The logical connection here is reversed - with Down's syndrome, oligohydramnios often develops, and not vice versa.

Almost always, prolonged oligohydramnios causes a delay in intrauterine development of the baby. Dangerous in this case is the underdevelopment of the lungs, with which mothers give birth to such babies.

However, if help was provided to the baby correctly and in a timely manner, then the child quickly enough then begins to gain weight and soon catches up with his peers in physical development. However, intellectually, the baby can develop late for a long time.

Dangerous from the point of view of the likelihood of complications are also cases of detection of oligohydramnios later, at 30 weeks pregnant, but only on condition that the pathological condition persists for 4-6 weeks or more.

For any negative consequences of oligohydramnios for the health of a child, a pattern is characteristic - the earlier this condition occurs, the more serious the consequences can be.

Treatment

Therapy of oligohydramnios is always complex. And it begins with the establishment of the exact cause that caused the pathological decrease in the amount of amniotic fluid.

First of all the version with chromosomal abnormalities is being tested. For this, a woman, depending on the term, is sent to one of the methods of invasive prenatal diagnosis.

With oligohydramnios detected at 16 weeks, a chorionic biopsy can be performed. If the fact of oligohydramnios became known later, a woman can be referred for cordocentesis, amniocentesis.

These procedures will help to obtain samples of amniotic fluid with particles of the baby's epithelium, cord blood from the umbilical cord. An analysis will be carried out in the genetic laboratory, which allows us to speak with a high degree of accuracy about the presence or absence of the baby's Down syndrome, Cornelia de Lange syndrome and other anomalies associated with a violation of the number of chromosomes in the karyotype and causing oligohydramnios. Such studies are usually carried out for free.

IN Lately opportunity to make non-invasive prenatal test DNA, which is still expensive. It is absolutely safe for the baby and is based on the isolation of the child's DNA from the venous blood of a pregnant woman. This test detects chromosomal abnormalities with a 99.9% probability and is an ideal alternative to invasive tests that can be dangerous for both the pregnant woman and the fetus.

If the cause of oligohydramnios due to chromosomal abnormalities is confirmed, termination of pregnancy is recommended.

If, in addition, the examination does not show the presence of gross chromosomal abnormalities in the child, then specialists in the ultrasound of the expert class will look for malformations of physical development. To do this, carefully study the urinary system of the baby - the ureters, urethra, kidneys. Special attention will be given to the health of the placenta. Ultrasound is performed to assess blood flow in the uterine vessels.

The attending physician will refer the woman to blood tests that can confirm or deny the presence of infections, including sexually transmitted infections.

Be sure to donate blood for sugar and urine for protein content. Doctor is watching blood pressure future mother to exclude preeclampsia as the cause of oligohydramnios.

If the cause is found, doctors decide how to treat the underlying disease, almost all of them except birth defects fetal development and chromosomal pathologies are amenable to therapy. At the same time, control over the condition of the fetus is enhanced.

Moderate oligohydramnios can be treated at home, in most cases, hospitalization is not required if the expectant mother follows all the recommendations of the doctor.

Severe oligohydramnios, if it is detected early, is also an indication for termination of pregnancy; none of the doctors will dare to make predictions about its outcome. With severe oligohydramnios diagnosed after 26 weeks, the woman is hospitalized.

Medical treatment

A future mother with severe oligohydramnios is injected with vitamin solutions intramuscularly. In addition, she is given droppers with drugs that improve uteroplacental blood flow. Usually used for this "Actovegin". In addition, doctors recommend taking "Curantil", dosage and frequency of taking this drug is determined by the doctor.

Pregnant women may be prescribed antibiotics a wide range actions to deal with infection, if present. During the period of bearing a baby, for these purposes it is often recommended "Amoxiclav". To improve metabolic processes in a woman's body, she may be recommended drugs such as "Hofitol", as well as multivitamin complexes designed and created specifically for pregnant women.

Simultaneously with taking drugs in a hospital, the condition of the baby is checked daily or every other day. A woman is given a CTG if the gestational age is already above 28 weeks, the functionality of the placenta is monitored using ultrasound, an ultrasound scan can be performed at any time to assess the amount of water in dynamics.

Any anxiety symptoms, which may indicate a fetal problem, at any time can become a decisive reason for doctors to carry out a caesarean section ahead of schedule.

With moderate oligohydramnios, which, according to the doctor, is of physiological origin, the woman is prescribed "Kurantil", "

Long walking, playing sports with such a complicated pregnancy is undesirable. Additionally, you will have to limit sex. pregnant with overweight, obese people are advised to go on a special diet to eliminate more larger set body weight.

Nutrition for oligohydramnios should include a large number of fruits and vegetables, proteins and fats should be balanced, and fast carbohydrates (sweets and pastries) should be completely abandoned.

If there are edema, you should definitely consult with your doctor, to work out together the correct and sufficient drinking regimen. With preeclampsia and hypertension, it is important to measure arterial blood pressure twice a day. With a significant increase, a woman needs qualified medical care.

Folk methods of treatment

Alternative medicine is ready to offer pregnant women with mild oligohydramnios a lot of useful and enjoyable recipes and products that, if they do not increase the amount of water, will definitely be able to satisfy the needs of a future mother with a deficiency of amniotic fluid in essential minerals and vitamins.

Folk remedies should not even try to treat severe oligohydramnios. But with minor deviations from the norm, a woman may well take some advice if her doctor has nothing against it.

The mineral needs of oligohydramnios will help restore figs, melons, and grapes. Also good, according to expectant mothers, zucchini and fresh tomatoes help.

A real storehouse, a natural "pharmacy" for a pregnant woman with a deficiency of amniotic fluid can be chokeberry. A woman can take 50 grams of juice from her per day or about 100 grams of berries.

Another favorite remedy that helps with oligohydramnios is strawberry berries. They are eaten in fresh or brew homemade juice with them to establish the normal functioning of the kidneys. If the pregnancy fell on winter time and there is nowhere to get strawberries, you can drink weak tea with strawberry jam. If this is not in stock, it can be purchased.

Prevention

Correct and responsible planning of the child will help to avoid oligohydramnios during pregnancy. A woman should be examined in advance by doctors of different specialties who will be able to answer questions about her state of health and the presence or absence of chronic diseases.

Of course, it is not necessary to conduct a full medical examination, but a woman who dreams of a child is simply obliged to visit a cardiologist, therapist and nephrologist. Visits to these specialists will help to be sure that the heart, kidneys and general health will help the woman bear the baby without complications.

If the age of the expectant mother exceeds 35 years, it is worth consulting with a geneticist, because the likelihood of conceiving and giving birth to a child with Down syndrome or Patau increases in proportion to the age of the mother.

It would be correct to do tests for sexual and other infections even before conception, and if something like this is found, treat them before the child is conceived.

Stop smoking before conception last resort as soon as it becomes known about the pregnancy. Smoking, and this has been proven, very often acts as a provoking factor in oligohydramnios.

During pregnancy, a woman for preventive purposes it is important not to refuse to undergo mandatory screening studies in the first, second and third trimester, do not refuse ultrasound and take certain tests recommended by the doctor.

Expectant mothers should beware of viral infections, especially during periods of mass morbidity with SARS and influenza, in order to avoid the development of oligohydramnios after illness. To do this, you should refrain from visiting shopping centers And public transport during seasonal epidemics, observe the rules of personal hygiene.

If the doctor insists on hospitalization, you should not refuse it, even if the woman herself thinks that she feels great, and she does not have time to stay in the hospital at all.

In this article, you will learn on what basis the diagnosis of "oligohydramnios" is made and why it is dangerous for a woman and her baby. And also what are the causes of this deviation, how oligohydramnios is treated and what measures should be taken to prevent the occurrence of complications

There is such a diagnosis of "oligohydramnios". This means that the amount of amniotic fluid less than normal on a certain period pregnancy
Now, thanks to ultrasound examinations, oligohydramnios is easy to detect, and this diagnosis is made in only 5% of pregnant women.
But, unfortunately, it still exists and this deviation needs to be treated as early as possible in order to avoid unwanted complications, including defects in the physical development of the fetus.

What does oligohydramnios mean during pregnancy?

Amniotic fluid contains many substances necessary for the baby, such as salts, hormones, oxygen and vitamins. Also, amniotic fluid protects the fetus from many harmful external factors.
But such a deviation happens when there is little amniotic fluid and this seriously complicates the healthy bearing of a child.
At different times, the amount of fluid is different, so, in the last trimester, it should be 0.8-1.5 liters. If the amount of water is less, then we are talking about oligohydramnios
There is a division of oligohydramnios into moderate and pronounced, to determine the severity of the deviation, the degree of lack of fluid matters

With moderate oligohydramnios, the volume of fluid is slightly less than it should be with normal pregnancy, and is about 400-700 ml.

The treatment of such oligohydramnios is to establish a diet, you need to adhere to special diet rich in vitamins and minerals, lead healthy lifestyle life, regularly visit a doctor to monitor the dynamics of the disease and not miss the deterioration. As a rule, this is enough and moderate oligohydramnios does not harm the fetus.

Severe oligohydramnios during pregnancy

Severe oligohydramnios means a strong deviation from the normal volume of amniotic fluid. With severe oligohydramnios, urgent and radical measures, because This condition is very dangerous for the life and health of the baby.

Treatment is usually carried out in a hospital under the constant supervision of doctors. If you have been diagnosed with such a diagnosis, it may affect your unborn child - due to oligohydramnios, there may be a lag in the development of the fetus, hypoxia, which in turn will lead to problems with the central nervous system, to improper formation of the bone skeleton and tissues, and even to termination of pregnancy.

Women suffering from severe oligohydramnios, only 0.3-0.5%.

Signs of oligohydramnios during pregnancy

The pregnant woman herself usually does not feel that she has such a deviation as oligohydramnios. The only thing that can alert is the appearance of a sharp pain in the abdomen when the baby is pushing. This may indicate a lack of fluid in the fetal bladder.

The doctor on examination can identify the likelihood of oligohydramnios by lagging behind the following indicators:

growth of the abdomen
fundus measurements

According to these data, the doctor can make an assumption about a deviation from the norm, he must definitely send the pregnant woman for an ultrasound examination, where the diagnosis will be made exactly.

The ultrasound machine makes it possible to measure the amount of amniotic fluid and determine whether it is enough or not.

If, according to ultrasound, you have moderate oligohydramnios, do not rush to be upset, it is better to redo ultrasonography in another place, perhaps the doctor is mistaken or the device is not accurate enough, and the results will differ.

Causes of oligohydramnios during pregnancy

All the reasons due to which oligohydramnios occurs are not fully understood, but experts distinguish the following:

Leakage of amniotic fluid or scientifically - amnionic hydrorrhea. Leakage of water occurs long before the due date due to rupture of the fetal membrane. Doctors believe that this happens due to infection of the membrane or its premature aging, which leads to its thinning and the appearance of a gap. This deviation is treated bed rest, while the fluid has time to recover and its loss does not harm the child
Violations in the development of the fetal membrane. There are quite a few such disorders and the reasons for their occurrence, too, the most common include genetic disorders and the harmful effects of the environment.
Infection of the fetal bladder. There are a number of viruses from which the placenta cannot protect the child and infection of the fetal bladder occurs, its proper functioning is disrupted, which leads to oligohydramnios
Overgrowth of the fetus. placenta and fetal membrane are no longer working at full capacity, the child does not receive the necessary nutrients and the state of his body is deteriorating, blood circulation in the membranes is also difficult, which in turn leads to a decrease in the production of amniotic fluid
Underdevelopment of the tissues of the fetal bladder or their poor secretory work
Pathologies in the development of the fetus. Here, doctors identify genetic anomalies in the development of the face and kidneys.
Bacterial infections in rare cases are able to penetrate not only into the birth canal of a woman, but also into the amniotic fluid.
At multiple pregnancy, there are times when blood is not distributed correctly in the placenta and therefore one child does not receive the necessary substances, and the other receives too much of them

What threatens oligohydramnios during pregnancy?

Low water during pregnancy can cause quite a few complications. If there is not enough water, the walls of the uterus begin to strongly compress the fetal bladder, which puts excessive pressure on the baby.
In this case, the baby will be in a bent state in an uncomfortable and unnatural position for him. This development of events leads to a curvature of the spine in a child and clubfoot, as well as skin can grow together with the fetal membrane
In addition, simonart ligaments can form, which wrap around the fetus and limit its movement, can even lead to injury.
If these ligaments encircle the umbilical cord, the child will receive less nutrients, fetal hypoxia, impaired blood flow may occur, which will lead to a developmental delay and possibly even death of the fetus.
Amniotic fluid, in addition, protects the baby from the external environment that can harm him, and their lack will lead to unreliable protection or its absence.
With a lack of water, the cervix during childbirth can slowly open, labor activity becomes weak. The contractions are painful but not strong enough. Bleeding may occur after childbirth

If severe oligohydramnios was detected late and has irreversible fetal developmental disorders, doctors insist on early termination pregnancy.

Moderate oligohydramnios can be said to never have negative impact per child, unless, of course, the diet and lifestyle of the pregnant woman is adjusted.

Low water during pregnancy, what to do?

If the doctor has diagnosed you with oligohydramnios, he will definitely prescribe you treatment and tell you what to do.

First of all, don't worry. A timely diagnosis is 50% of the success of the treatment. Follow strictly the instructions of the doctor, if you need to go to the hospital, do not even think about it - go to bed, because the health of your unborn baby and, in some cases, even his life depends on it.

How to treat oligohydramnios during pregnancy?

A woman should understand that even with a diagnosis of "moderate oligohydramnios", she should not self-medicate or ignore it altogether.

The doctor will prescribe additional examinations: general analyzes blood and urine tests, tests for infections, fetal CTG (cardiotocography), ultrasound, a swab for water if there is a suspicion that they are leaking.

Ultrasound for oligohydramnios during pregnancy

These examinations will help to assess the condition of the child and the severity of the deviation. According to their results, the gynecologist will prescribe necessary treatment. You also need to try to determine the cause of oligohydramnios, this will help choose the right treatment.

If the cause of oligohydramnios is obesity and metabolic disorders in the body, then you need proper diet, taking vitamins and drugs that improve the blood supply to the placenta. If oligohydramnios is moderate, treatment can be done at home, but if it is severe, then hospitalization is necessary.
If the cause of oligohydramnios was a viral infection, then they are prescribed antiviral drugs and general strengthening therapy. The doctor will make an appointment vitamin complex and drugs that improve blood microcirculation
If the cause lies in the violation of the development of the fetal bladder, doctors try to keep the pregnancy and prevent infection of the fetus. In this case, the treatment is carried out exclusively in the hospital and the woman is prescribed additional examinations to assess the condition of her body and the condition of the fetus.
When overdue, doctors puncture the fetal bladder and induce labor with stimulant drugs
It is also important to reduce physical activity, reduce motor activity and bed rest
With oligohydramnios, doctors direct the woman to do ultrasound and dopplerography more often to monitor the dynamics of the deviation and changes for better or worse in the mother's body and the child's condition
If the pregnancy is already long and the baby is full-term, the doctor may recommend premature birth, which will be caused by special stimulant drugs

Be sure to tell your doctor if previous pregnancies you have already had such a diagnosis, and it is better to conduct a couple of additional ultrasound examinations in order to exclude this deviation or detect it as early as possible.

The index of oligohydramnios during pregnancy

An ultrasound examination diagnoses oligohydramnios based on the amniotic fluid index (AFI), which is calculated by an ultrasound machine. The device measures the amount of water in several places and calculates the IAI.

IAI table in different dates pregnancy

In the third trimester:

if the index is within 5-8 cm, then the amount of water is normal
if the index is 2-5 cm, then this is "moderate oligohydramnios"
with an index below 2 cm, a diagnosis of "pronounced oligohydramnios" is made

However, it is worth noting that the IAI varies depending on the gestational age:

at 16 weeks, the norm is from 73 to 201 mm
at 20 weeks from 86 to 230 mm
at 25 weeks from 89 to 240 mm
at 30 weeks from 82 to 258 mm
at 35 weeks from 70 to 279 mm
at 40 weeks from 63 to 240 mm

The amount of amniotic fluid changes as the fetus grows, swallows the fluid, and urinates. But do not worry about the condition of the baby, because. amniotic fluid is renewed every 3 hours, and every 3 days they are completely changed.

Nutrition for oligohydramnios during pregnancy

You need to eat with oligohydramnios correctly and balanced:

try to eat several times a day (more than 5 meals), but in small portions
foods should contain many vitamins and minerals, be nutritious
choose natural products with minimal processing
exclude foods from the menu fast food(hamburgers, hot dogs, etc.)
reduce the amount of sugar and salt you eat
exclude fatty foods from your diet
try to reduce the use of spices and spices
avoid products containing preservatives, flavors and dyes
meat, fish and seafood should be well cooked, they should not be eaten raw or semi-finished
refrain from eating blue cheese, unboiled milk and raw eggs
do not drink strong tea, try to do without coffee and completely eliminate alcohol
eat more fruit instead of sweets and sugar

Be sure to keep an eye on weight gain, because. a rapid set of it can also lead to oligohydramnios or worsening of an already existing deviation.

Tendency to oligohydramnios during pregnancy: how to determine?

A woman may be prone to oligohydramnios during pregnancy in the following cases:

mother-to-be smokes
multiple pregnancy
the woman has metabolic disorders in the body
there are abnormalities in the development of the fetal bladder
preeclampsia - late toxicosis
dehydration due to vomiting or diarrhea
have a bacterial or viral infection
woman suffering from diabetes
the presence of chronic diseases in the expectant mother
prolongation of pregnancy
fetal kidney defects
had oligohydramnios in previous pregnancies

If you fall into the risk category, the doctor will prescribe you additional examinations and tests in order to detect deviations from the normal volume of amniotic fluid in time and start treatment as soon as possible.

Let's summarize and define the main measures for the prevention of oligohydramnios:

Correct fractional nutrition, products should be as useful as possible
Dieting if you have problems with being overweight
Additional intake of complex vitamins
Exclusion of physical activity, replace them with walking in the fresh air
Timely visits to a gynecologist, passing tests, passing the necessary examinations
If there endocrine disorders(diabetes mellitus, for example, or obesity) you need to undergo appropriate treatment

When I was pregnant, everyone could not get enough of the fact that I had a small stomach, as it turned out later on an ultrasound scan - oligohydramnios. But, probably, it was moderate, because. the doctor did not prescribe any medicines and only said that they would not allow me to walk, but my son did not wait long, he was born a little ahead of time- the birth was easy, there were no problems with the health of the child.
Masha, 24 years old.

In fact, doctors exaggerate everything, there is nothing wrong with oligohydramnios. Well, this is understandable, they are reinsured. But here my girlfriend was persuaded to give birth prematurely, she did not agree and informed the child. My son was born healthy and on time. Grows and strengthens.
Diana, 32 years old

In both pregnancies, I was given "moderate oligohydramnios", and both times at 30-32 weeks. In the first pregnancy, no treatment was prescribed, they said that at such a period moderate is not scary, but in the second they gave injections. The doctors were different. Both girls are healthy, and this is the most important thing! Christina, 27 years old

VIDEO: oligohydramnios during pregnancy

With a confluence of certain negative circumstances, pregnancy may be accompanied by a number of different kind problems and complications, among which oligohydramnios is reasonably considered one of the most dangerous. This pathological condition is characterized by a decrease in the volume of amniotic fluid, without which the developing fetus can simply die.

Amniotic fluid is a nutrient medium from which the developing fetus receives the substances it needs during its stay in the mother's womb. The composition of the amniotic fluid includes many nutritional components, without which normal growth and child development are impossible. The main components of the environment are: oxygen, vitamins and microelements, salts, some hormones, as well as many additional useful substances.

In addition to providing the child with the necessary nutritional components, the amniotic fluid protects the fetus from all sorts of infections and, in general, all kinds of negative effects. Quantity intrauterine waters changes as the child grows and his needs increase.

Based on the average statistical data obtained in the course of numerous clinical studies, amniotic fluid indices were determined for each period of pregnancy. This index reflects the rate of amniotic fluid volume and tolerances that are not cause for concern.

We are talking about oligohydramnios in cases where the amniotic fluid index in the patient is not included in the lower limit of the norm for her term. Information regarding the normal volume of intrauterine fluid for different weeks pregnancy is shown in the following table.

Table. Amniotic fluid index for different weeks of pregnancy (16-25)

Pregnancy period, weeks	Average normal rate, mm	Probable fluctuations, mm
16	121	73-201
17	127	77-211
18	133	80-220
19	137	83-225
20	141	86-230
21	143	88-233
22	145	89-235
23	146	90-237
24	147	90-238
25	147	89-240

The determination of the mentioned indicators is performed by the doctor during the next ultrasound examination.

The list of factors contributing to the development of oligohydramnios practically does not change for each stage of pregnancy. The most common reasons include the following:

kidney pathology in the fetus. In the presence of severe congenital diseases of this nature, oligohydramnios is usually noted with initial terms pregnancy;
ailments of a chronic nature, usually affecting the genitourinary and cardiovascular systems of the mother;
diseases of an infectious nature that affect the genitourinary system of the mother;
bad habits in women;
previously transferred diseases of a bacterial and viral nature;
pathology of the placenta;
multiple pregnancy (often there is a combination of oligohydramnios of one child with simultaneous polyhydramnios of the second).

How does low water manifest itself?

The problem under consideration can be expressed and moderate. For oligohydramnios of a moderate nature, the almost complete absence of subjective manifestations felt directly by the patient is characteristic - the well-being of the pregnant woman practically does not deviate from the norm, and the lack of intrauterine fluid is determined only during an ultrasound examination.

For the expressed form of the disease in question, the following manifestations are characteristic:

shrinkage of the uterus. During the next medical examination, the specialist notes a decrease in the circumference of the patient's abdomen. During a vaginal examination, it is found that the height of the uterine fundus does not correspond to the indications of the norm, characteristic of a particular period of the patient's pregnancy;
pain while moving the child;
periodic discomfort of a aching nature in the abdomen;
deterioration of the woman's condition as a whole, accompanied by a feeling of dry mouth, as well as nausea, severe weakness.

Oligodiagnosis, diagnosed in the II trimester (namely, the 20th week is included in this period of pregnancy), is the most dangerous for both developing fetus, and for the woman carrying it. The task of the specialist at this stage is to determine the feasibility of prolonging the pregnancy.

It was previously noted that there are 2 main varieties of oligohydramnios. The most dangerous, in this case, is a pronounced form of the disease, which can lead to the following problems:

disorders and pathologies of child development. In children born with oligohydramnios, deformities of the limbs and muscles, anomalies of the spine, a general slowdown in development, pathologies of the formation of the brain and skull are often noted. Most serious complication oligohydramnios is hypoxia that develops against the background of oxygen starvation. The possibility of the death of the child is not ruled out;
problems during childbirth. Even if the pregnancy can be maintained, labor activity in the future will most likely be extremely weak. There is a high risk of severe blood loss after delivery;
termination of pregnancy.

In patients with moderate oligohydramnios, the likelihood and intensity of the manifestation of these abnormalities is lower, however, the risks of the occurrence of the described problems are also present.

That is why the main task of a woman who had to deal with oligohydramnios at the 20th week of pregnancy or any other period is strict adherence to medical recommendations.

Treatment of the problem under consideration is an extremely difficult and responsible task that requires a qualified approach. Currently, medicine does not have medicines and special techniques to artificially increase or decrease the content of amniotic fluid.

If oligohydramnios is detected, a woman is hospitalized in a hospital and all necessary medical measures are taken, the main task which boils down to maintaining normal state child and balancing the uteroplacental circulation, are carried out under close medical supervision.

Directly the course of treatment is determined by a specialist. As a rule, women are prescribed vitamins, drugs to normalize the function of the placenta and improve uteroplacental blood flow, antibiotics (if various kinds have led to the occurrence of oligohydramnios). infectious diseases).

During therapy, doctors constantly monitor the amount of amniotic fluid and monitor the condition developing child. Such procedures as: fetal cardiotography, ultrasound, dopplerometry are regularly performed.

If the measures taken do not have a positive effect on the condition of the patient and the child, and oligohydramnios progresses, doctors in the vast majority of cases recommend early delivery, which at the 20th week of pregnancy is often identical to abortion.

In general, as practice shows, provided timely diagnosis And proper treatment the problem of low water can be quite successfully solved. Many experts regard this ailment as a symptom of another disease, so the main goal of the prescribed therapy in most situations is to identify and eliminate the causes that led to the development of a lack of amniotic fluid.

In addition to drugs, women are recommended to reconsider some aspects of their life and. For example, experts often advise reducing physical activity.

Thus, oligohydramnios, although it is quite dangerous disease, often threatening with the death of the fetus, subject to a timely and competent approach, there is a high probability of normalization of the condition of the child and mother and the chances of giving birth significantly increase healthy baby. The main thing is to strictly adhere to the recommendations of specialists, do not self-medicate and treat the solution of the problem as responsibly as possible.

The body of a woman was conceived by nature initially for the birth of a new life in it, its formation with subsequent development and a successful birth. All in female body adjusted so that the baby, as it grows in the mother's tummy, feels comfortable and is maximally protected from the effects of the external environment. Such functions are performed and, in which the baby freely swims and somersaults during pregnancy. And in order for the baby to develop according to the norm and not experience any inconvenience, there should be not a lot of amniotic fluid (namely, this is what amniotic fluid is called) but not a little, but in those quantities that were originally provided by nature.

Amniotic fluid is a necessity, an indispensable fluid to ensure the normal development of the baby. Amniotic fluid is a kind of nutrient medium, consisting of oxygen, vitamins, hormonal compounds, salts. In addition to the "nutritional" function, the amniotic fluid also plays a protective role - amniotic fluid protects the baby from the effects of multiple negative factors and infectious agents. As pregnancy progresses, the amount of amniotic fluid changes - depending on the timing and needs of the baby. And the doctor must monitor these changes, because a decrease (oligohydramnios) or an increase (polyhydramnios) in the amount of amniotic fluid can threaten the development and even the life of a child, causing serious complications.

Oligohydramnios during pregnancy, as the name suggests, is defined as a decrease in the volume of amniotic fluid. Oligohydramnios can be moderate and severe, and moderate oligohydramnios during pregnancy is more common. With moderate oligohydramnios, there is a slight decrease in amniotic fluid, which, of course, is less dangerous than severe oligohydramnios. However, moderate oligohydramnios during pregnancy can cause no less trouble, and complications of pregnancy may well cause, affecting intrauterine development fetus. So, often the result of moderate oligohydramnios during pregnancy is the birth of a small baby. Other consequences of moderate oligoamnios can be curvature of the spine, hip dysplasia.

But you should not panic ahead of time - in most cases, pregnancy with moderate oligohydramnios ends safely, the baby is born in a satisfactory condition. Of course, subject to timely response to the problem, correct behavior expectant mother, regular visits to the doctor and the implementation of all his recommendations.

Even if a woman at the next time heard the diagnosis of "moderate oligohydramnios during pregnancy", it should not be considered final. So, it is necessary to undergo a second examination - in another clinic and under the guidance of another doctor. Also, the doctor may prescribe doppleography of the vessels (to exclude a slowdown in the development of the baby) and cardiomonitoring (to assess general condition fetus). If possible, together with the doctor, it is necessary to determine the likely prerequisites that led to moderate oligohydramnios during pregnancy.

The reasons for the development of moderate oligohydramnios have not been fully studied, but the most likely may be: high pressure; sexually transmitted infections (even those infectious diseases that the mother suffered before pregnancy and which were not completely cured), chronic inflammatory diseases of the mother (gynecological, urinary). Also, the reasons for the development of moderate oligohydramnios during pregnancy include the problems experienced by the fetus - chronic hypoxia in a baby, violations and anomalies of its intrauterine development.

The first and most important step in confirming moderate oligohydramnios during pregnancy is lifestyle changes and eating behavior mother. So, a woman with moderate oligohydramnios is simply obliged to eat foods that contain vitamins and minerals in sufficient quantities. A sparing regimen and sufficient rest are also shown, avoidance stressful situations and nervous stress. And most importantly - regular monitoring by the attending physician, which will avoid deterioration of the condition.

Especially for- Tatyana Argamakova