Few amniotic fluid consequences. Congenital malformations of the fetus. Anemia varies in severity

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, amniotic fluid(namely, this is how amniotic fluid is still called) there should be not a lot, but not a little, but in those quantities in which nature originally provided.

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 number 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. At 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 vascular doppleography (to exclude a slowdown in the development of the baby) and cardiomonitoring (to assess the general condition of the 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 blood pressure; sexually transmitted infections (even those infectious diseases, which 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

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

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

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

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

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

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

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

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

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

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

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

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

- “Help” the child to be born safely.

The volume of amniotic fluid in different dates gestation is not the same, each period has its own conditional "norm", which is a significant diagnostic criterion for ascertaining oligohydramnios or, on the contrary,.

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

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

Causes of oligohydramnios during pregnancy

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

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

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

- Chromosomal abnormalities in the fetus.

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

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

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

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

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

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

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

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

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

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

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

Symptoms and signs of oligohydramnios during pregnancy

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The change in the amount of amniotic fluid is a very dynamic criterion. One-time statement of oligohydramnios clinical significance does not have. Oligohydramnios, especially moderate, is often only a short-term episode, not threatening pregnancy. It is much more important to know how the volume of water changes with increasing gestational age. With the physiological development of pregnancy, it increases and becomes maximum to (one and a half liters), and then begins to decline.

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

Treatment of oligohydramnios during pregnancy

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

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

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

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

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

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

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

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

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

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

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

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

Examine the amniotic fluid in general amniotic sac also possible. In case of overdose, chronic severe fetal hypoxia, amnioscopy can be performed. It allows you to evaluate amniotic fluid visually using an optical device (amnioscope) and diagnose pathologies.

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

Consequences of oligohydramnios during pregnancy for a child

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

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

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

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

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

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

amniotic fluid plays important role for the normal development of the child in any trimester of pregnancy. Their function is to supply the baby nutrients protecting it from mechanical injury. During childbirth, the amniotic fluid promotes the early opening of the cervix. Diagnosed with moderate oligohydramnios during pregnancy at any time, whether it be 20 or 37 weeks, is alarming and makes you look for information about this pathology - what it threatens, how to determine it and what to actually do.

medical definition

According to the classical definition, a similar conclusion is given to women at 40-41 weeks of gestation, if the volume of amniotic fluid has decreased to 500 ml or less. This formulation takes into account the deviation from the norm only before childbirth. But meanwhile, oligohydramnios can be delivered at week 20 and at 30, and at 37, than closer birth, the more the placenta "ages" (37, 38, 39 weeks).

Throughout the 9 months of a child's development, the volume of amniotic fluid is constantly changing. Its specific values for each week of gestation have become known as a result of numerous studies. At any time, a situation may arise when the amount of amniotic fluid is abnormally low. Doctors diagnose and prescribe treatment for oligohydramnios during pregnancy, fixing a special indicator - the amniotic fluid index (AFI), which for each week has average and the range of the norm, for each week it has its own (starting from the 16th week onwards - 20, 30, 34, 35, 36, 37, 38, 39), and in addition, each ultrasound machine has its own table of these indicators.

Given the severity, there are moderate and severe oligohydramnios during pregnancy. The first type of disease is much easier to deal with. The condition will return to normal if the expectant mother stops being nervous, starts to eat rationally, pays more attention to her health - it is enough to do this and things will get better, and this also applies to the terms at 37 - 39 weeks. And the second case is serious problem for woman. To eliminate it, you will have to go to the hospital and undergo a course of therapy.

Oligohydramnios in pregnant women is a dynamic condition. Its tendency is unpredictable - it can suddenly appear and also disappear at any time. About functional deviation we are talking in the event that at the 20th week of pregnancy it was, and at the 32nd week it disappeared, and at recent weeks- 37-39 and further reduction of water is considered normal. These are temporary disorders that are not considered pathological.

A persistent abnormal condition for many weeks, that is, severe oligohydramnios, is a sign of severe deviations in the development of the child and the course of pregnancy. According to statistics, the incidence of serious pathology is 0.2-0.3% of all cases. In each of them, violations in the development of the fetus and placenta are visible on ultrasound.

Prevention of oligohydramnios is not carried out during pregnancy - at 34 or 35 weeks, for example, but during the planning period for the birth of a child.

Factors causing pathology

Any pregnant woman can face a similar problem, regardless of age and number of births. When oligohydramnios is observed during pregnancy, the reasons may be the following:

violations metabolic processes in organism;
damage to the fetal bladder;
hypertension;
dependence on nicotine in a pregnant woman;
injuries to tissues that protect the aquatic membrane;
multiple pregnancy;
dehydration caused by vomiting or diarrhea;
the action of bacterial infections and viruses;
preeclampsia;
genetic abnormalities in the development of the child;
overweight;
diabetes;
prolongation of pregnancy.

Medicine does not yet know which of the signs of oligohydramnios from the above list play a major role in reducing the volume of amniotic fluid. 90% of expectant mothers suffer from hypertension. Only 4% of these women subsequently experience a severe form of the disease.

On later dates bearing a child (starting from 32 weeks), problems arise due to an anguish of the bladder. When overwearing, there is less water, as the placenta ages.

Most of the causes of oligohydramnios during pregnancy are successfully eliminated with proper treatment. There is no need to panic. Doctors are powerless with genetic abnormalities in the development of the baby, which are detected by ultrasound. Moderate oligohydramnios in other cases can be treated, and a healthy baby is born.

Consequences

What will be the trend of oligohydramnios in a particular case, it is difficult to predict, because possible complications with an underestimated IAI, there may be:

The contracting walls of the uterus create additional pressure on the fetus. He has to bend over, make himself uncomfortable. This situation threatens that the baby's spine may be bent, clubfoot may develop. There is a possibility that the skin will grow to the fetal membrane. The tissues of the child dry out and wrinkle.
Prolonged close contact of the bladder and children's skin is the cause of the appearance of simonart ligaments. Formations wrap around the baby, impede his movements. If they affect the umbilical cord, blood circulation is disturbed. Consequences - developmental delay. The extreme case is fetal death.
It is known that oligohydramnios is dangerous during pregnancy directly for the expectant mother. This is a non-releasing pain in the lower abdomen. It is especially difficult in the 2nd and 3rd trimesters. Every movement of the fetus causes discomfort. Sensitivity increases starting at 36 weeks, as the baby is already large.
During childbirth, the cervix dilates slowly. Contractions are painful but not productive. The mother may bleed.

The likelihood of negative consequences for the fetus increases when moderate oligohydramnios has developed early enough. If we compare problems with fluid at the 20th and 33rd week, then in the first case the risk of disfigurement is greater. This statement is true in a situation where the volume of water does not return to normal within 30 days.

Early symptoms

Moderate oligohydramnios is not accompanied by bright pronounced signs and health problems. This is the main difficulty in comparison with the case if there is pronounced oligohydramnios. Not every gynecologist will determine the pathology during the examination. The doctor may notice a discrepancy between the circumference of the abdomen and the gestational age.

An accurate diagnosis is made after several ultrasound procedures. With the help of technology, the amount of water, the severity of the disease are calculated, the condition of the baby is analyzed. Sessions are carried out several times over 1 or 2 months.

A woman needs to worry if she is overcome by abdominal pain. Each movement of the fetus causes an exacerbation. And the general condition leaves much to be desired: the pregnant woman feels nausea, weakness, dry mouth.

Health care

Treatment for oligohydramnios will depend on its type and cause. If moderate oligohydramnios is the norm, then they will be treated in this way: the expectant mother will be advised to rest more, monitor nutrition, take vitamins and periodically consult a gynecologist. If this is not done, or when the measures taken do not help, the situation worsens, the woman will have to go to the department of pathology of pregnant women.

When diagnosing a decrease in water, the patient is sent to the hospital for additional studies. It is necessary to undergo ultrasound, cardiotocography, donate blood and urine to the laboratory. A swab on the water will help to find out about the leakage of amniotic fluid.

In late pregnancy (37 and more than 38 weeks), an amnioscope can pass through the cervical canal. The gynecologist will precise research liquids that will not harm the baby in any way.

If fetal malformations are detected, the woman will be offered to terminate the pregnancy. In case of refusal, they will be treated without changing the methodology. The expectant mother will be provided with the same assistance as in the absence of abnormalities in the child.

If serious abnormalities are observed at 20 weeks, the patient will be asked to consider abortion. This decision has its own reason - the inability to predict the outcome of pregnancy. True, in most cases, by the birth of a child, the situation changes, and people regret all their lives that they succumbed to the persuasion of a doctor.

The method of treatment of oligohydramnios depends on several factors:

the reason for which it developed;
the severity of oligohydramnios;
gestational age.

The most common drug prescribed for pregnant women is Actovegin, due to its ability to maintain normal condition child in many critical situations. The consequences of oligohydramnios are higher in terms of the degree of threat to the fetus, depending on when it appeared, the earlier, the more critical. What does this mean? For example, oligohydramnios at the 20th week and at the 30th differs in that in the first case, the risk of developmental delay and the appearance of deformities is increased. And at 32 weeks and above, oligohydramnios in most cases is due to water leakage. Identified oligohydramnios during the third semester (27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40 weeks) is the basis for the fact that the woman is sent to the antenatal department and prescribed a number of procedures: the introduction of vitamins B, C and others, as well as taking Curantyl preparations, which affects in the best way on the process of blood circulation in the placenta. Or Actovegin, which provides oxygen delivery to the fetus. The development of oligohydramnios in the first trimester (from 20 to 27 weeks) is unpredictable based on the results, even doctors do not undertake to predict the outcome of such a pregnancy and recommend terminating the pregnancy.

AFI is calculated using ultrasound - subjective or in an objective way, the data that is obtained as a result is compared with the table of amniotic fluid norms for all weeks. For example, at week 16, the range of the limits of the IAI norm is 73-201 mm. 20 week: 86 - 230 mm; 30 week: 82 - 258; 31:79–263; 32:77-269; 33:74-274; 34:72-278; 35:70-279; 36:68-279; 37:66-275; 38:65-269; 39: 64 - 255; 40: 63 - 240. Accordingly, the obtained indicators for different weeks, after comparison, indicate polyhydramnios or oligohydramnios.

Meanwhile, there is an average indicator, which is considered the norm. 20 week - 141 mm; 30 - 145; 31-32 - 144; 33 - 143; 34 - 142; 35 - 140; 36 - 138; 37 - 135; 38 - 132; 39 - 127; 40-123.

With a one-time ultrasound examination, oligohydramnios is not immediately diagnosed, since the amniotic fluid changes throughout the entire pregnancy, their quantitative composition depends on the week of pregnancy and the growth of the child. In addition, each ultrasound machine has its own table.

Not every woman can boast of excellent health, therefore, during pregnancy, one cannot avoid taking various drugs, for example, the same vitamins. A frequent appointment of doctors is actovegin, which contributes to the normal development of the child. Moreover, it can be prescribed at any time, and sometimes actovegin can be prescribed even at the planning stage of pregnancy, for example, with impaired blood supply.

The dosage form of the drug is chosen by the doctor depending on the condition of the woman and how severe the disease is. Actovegin is produced in tablets, ointments, ampoules, cream, gel. During pregnancy, Actovegin should not be taken on the basis of one's own considerations and having read reviews, even knowing the standard dosage prescribed by the doctor - Actovegin is not an ordinary analgin that you can drink without a doctor's instructions. Always and all medicines have side effects and there is a risk of an allergic reaction. Only the attending physician individually calculates the dosage, time and method of using a medicine such as Actovegin. After all, the doctor, based on the condition of the pregnant woman, may prescribe Actovegin in tablets, or may prescribe a course of treatment in the form of injections, and in critical situations Actovegin may be administered parenterally.

Moderate oligohydramnios is not the worst threat when carrying a little man. The most important thing is to stop being nervous, monitor your health and respond to problems in time.

The classic diagnosis of oligohydramnios is determined if the volume of amniotic fluid before delivery is less than 500 ml.

Modern medicine says that oligohydramnios can appear and disappear at any stage of pregnancy, starting from the 14th week. The periodic deviation of the amount of amniotic fluid from the maximum allowable values is a functional oligohydramnios. That is, this state is temporary and caused external influence or changes in the body.

With a constant lack of fluid and persistent oligohydramnios, we are talking about pathological process dangerous for the expectant mother and her baby.

Causes

The list of factors that can affect a small amount of intrauterine fluid is quite extensive. There are 3 main groups.

heavy chronic diseases and the state of the expectant mother, among which are dominated by:

autoimmune disorders,
diseases of the cardiovascular and genitourinary systems,
metabolic disorders,
tobacco intoxication, preeclampsia.

Pathological conditions of the placenta:

placental muscle infarction,
placental insufficiency,
sclerosis,
placental necrosis.

Pathologies in the development of the fetus and its congenital malformations:

chromosomal abnormalities,
intrauterine infection,
intrafetal hypoxia,
developmental delay,
narrowing of the urethra
bilateral narrowing of the ureters,
many congenital kidney diseases.

Among other causes of oligohydramnios during pregnancy, it is worth noting:

gestation of the fetus for more than 42 weeks,
frozen pregnancy,
premature rupture of membranes,
long-term use of inhibitors.

Symptoms

Changes in the state of health of a pregnant woman with moderate oligohydramnios are not observed. With severe oligohydramnios, expectant mothers may have complaints about:

nausea,
dry mouth
general weakness and constant feeling thirst
pain during fetal movement after 20 weeks of pregnancy.

If oligohydramnios is functional, that is, caused by a deviation in women's health, then it will appear clinical picture underlying disease.

During a gynecological examination, the doctor may find the following signs insufficient amount of amniotic fluid:

discrepancy between the size of the uterus with normal indicators,
a small abdominal circumference compared to the norm of the term,
limited fetal mobility.

Diagnosis of oligohydramnios during pregnancy

To confirm the diagnosis, determine its severity, it is necessary to conduct an ultrasound scan and determine the index of the amniotic fluid.

To determine the type of oligohydramnios (functional or pathological), the dynamics of diagnosis is necessary. Delay in readings from the norms for specific deadline gestation must last at least three months.

If the results of repeated ultrasound confirm the persistence of oligohydramnios, then additional procedures are necessary to establish its causes:

blood pressure assessment,
blood sampling to determine its composition, the presence of antibodies, markers of malformation,
targeted ultrasound of children's internal organs to detect pathologies and congenital malformations,
studies to identify chromosomal and genetic abnormalities fetus.

Complications

The consequences of oligohydramnios depend on the complexity of the pathology and the duration of pregnancy.

In the early stages, pathological oligohydramnios in pregnant women in most cases ends in miscarriage and premature birth without saving the life of the child.

A decrease in amniotic fluid from the middle of the second trimester can provoke an incorrect position of the fetus, a lag in the development of some organs and systems.

In late pregnancy, oligohydramnios in pregnant women increases the risk of infection of the child.

Treatment

What can you do

With the initial diagnosis of "oligohydramnios", the expectant mother should not worry. It is possible that the reason for the decrease in the volume of AFI was a recent infection. In this case, you need to inform the gynecologist about this and undergo the prescribed course of treatment. To evaluate the effectiveness of treatment, you should undergo a second ultrasound in a month.

If you do not want to conduct unscheduled ultrasounds, then regularly visit a gynecologist to assess your condition by external factors. To control general condition child undergo CTG and dopplerometry of placental vessels.

If an ultrasound is detected, it is recommended to undergo screening tests to identify possible anomalies in the development of the child. If these are found, you will be offered to terminate the pregnancy. The decision to maintain or terminate the pregnancy can only be made by the patient herself.

While maintaining pregnancy, it is worth agreeing to all the procedures and methods of therapy prescribed by the attending physician, who, before prescribing, must assess the risks to the health and life of the mother and her baby.

Do not self-medicate, do not resort to methods traditional medicine. Only an experienced specialist, having studied your individual condition, can prescribe a suitable and safe therapy. Therefore, even a diet for oligohydramnios in pregnant women should be agreed with the doctor.

What does a doctor do

After external gynecological examination the doctor prescribes additional tests and studies to determine the index of the amniotic fluid and the reasons for the development of this pathology.

If severe oligohydramnios is diagnosed as abnormal for up to 28 weeks, then doctors insist on terminating the pregnancy, since this condition is fraught with the life of the pregnant woman herself.

With a decrease in amniotic fluid in the third trimester, treatment is carried out in stationary conditions. Medical actions are aimed at maintaining pregnancy and preventing infection of the fetus. Therapy is based on taking the following drugs:

b vitamins,
medicines to normalize and maintain the level of pressure,
drugs to maintain normal blood sugar,
drugs that improve placental circulation.

Conducted if necessary acceptable treatment underlying disease.

If oligohydramnios in pregnant women is caused by leakage of water, then the patient is prescribed bed rest, a special menu and plenty of fluids. Even such a simple treatment requires hospitalization for constant monitoring of the condition of the mother and baby.

In the hospital, CTG and dopplerometry are regularly performed to assess the condition of the placenta and fetus.

Even with hospitalization, doctors try to bring the pregnancy to natural childbirth. If indicated, a caesarean section may be performed.

Most problems with the placenta are solved by artificial induction of labor.

Prevention

For prevention obstetric pathology should carefully prepare for pregnancy. Go ahead to healthy lifestyle life, undergo examination and, if necessary, cure existing diseases.

When oligohydramnios is diagnosed, you should not be upset, having studied the problem from all sides, you can prepare for it and solve it even in the early stages.

Oligohydramnios: possible risks and treatment

Amniotic fluid is a liquid that helps the child develop, supplying him with everything he needs.

But here there may be deviations. There may be little water, then the diagnosis of oligohydramnios is established. There are different levels of diagnosis, depending on which treatment is selected.

What is oligohydramnios during pregnancy: risks

The volume of amniotic fluid is 300-500 ml, if it is less, then oligohydramnios is diagnosed. A pathology that can lead to serious consequences for both the baby and the mother, so it is so important to know its signs and consider them in time. timely medical intervention will avoid problems with the development and manifestation of anomalies. Statistics show that most often the diagnosis is made at the 37th week of pregnancy, and the reason for this is the aging of the placenta, a decrease in its activity.

1 trimester

If oligohydramnios is diagnosed from the very beginning of pregnancy, then it is not dangerous, because it does not affect the fetus. There is still time to get everything back to normal before the baby grows up. It can be diagnosed at week 16 during a planned ultrasound. The cause of the occurrence may be the failure of the fetal membranes, which I do not perform the functions assigned to them.

2nd trimester

Oligohydramnios becomes a dangerous diagnosis from the 26th week, because with an exacerbation of the condition, the doctor will not perform delivery. At this time, the cause may be leakage of amniotic fluid, which is fraught with premature birth, and at such times the child may not survive. Such an unfavorable diagnosis can lead to:

To complications in the development of the unborn child - malnutrition, hemicephaly, amniotic constriction, deformities of the limbs.
TO premature birth or termination of pregnancy.
To complex, long childbirth.

3rd trimester

The diagnosis at the end of pregnancy is dangerous, but the timing allows for delivery. If the water indicator was normal throughout the pregnancy, and in recent months a problem was discovered, then it is worth preparing for a long generic process. With oligohydramnios, the bladder becomes flat and cannot act as a wedge during cervical dilation stimulation. Doctors try to prescribe a caesarean section.

What is low water: pronounced, moderate and relative

Low water occurs in several types. Diagnosis, consequences, symptoms are radically different:

Moderate oligohydramnios is diagnosed with minor deviations from the norm. It is often determined at an early stage, so it can be eliminated quickly. Appointed various diets, nutrition is corrected. With the right lifestyle, it is possible to bring the indicator of amniotic fluid to normal. The moderate form has no obvious symptoms, the woman feels normal. Only ultrasound will allow to come to such a diagnosis. But even with moderate, healthy babies are born, one has only to follow the recommendations of doctors. Statistics show that such a diagnosis occurs only in 5 percent of pregnant women by the end of the term.
With severe oligohydramnios, there are significant deviations from the norm. To avoid possible consequences requires hospitalization, constant medical supervision. With a pronounced form, the following features are characteristic:

Painful sensations when active movements fetus;
Aching pain in the lower abdomen;
Reducing the size of the uterus, and with it the circumference of the abdomen;
Deterioration of well-being.

Only with this kind of oligohydramnios are long births possible, increased risk manifestations of bleeding after childbirth. To avoid complications during childbirth, doctors try to perform a caesarean section.

Relative oligohydramnios occurs in recent months pregnancy and is most often associated with aging of the placenta. If such a diagnosis is made, you should not be upset, because proper treatment will allow you to determine the causes and return everything back to normal. The main thing is that the development of the fetus should not be disturbed with such a diagnosis. It's just that a pregnant woman will be under stricter control by doctors.

How is it diagnosed

The doctor makes a diagnosis after certain procedures. First, the volume of the abdomen, the height of the fundus of the uterus are measured, if there are obvious deviations from the norm, the specialist sends for an ultrasound scan. The examination will determine the amount of amniotic fluid, diagnose the development of the fetus according to the gestational age.

Attention is paid to the index of the amniotic fluid index. If it is 5-8, then all indicators are within the normal range. If 2-5 - moderate oligohydramnios; less than 2x - pronounced oligohydramnios. To determine the condition of the fetus, dopplerography is often prescribed, which shows the level of oxygen and nutrients supply. Cardiac monitoring may also be prescribed.

Signs and manifestation

In addition to traditional measurements and research clear signs low water are:

Pain during fetal movement.
Drawing pains in the lower abdomen.
After 4 months small size belly. The circumference is not correct;
Weakness, nausea, dry mouth.

Is it possible to determine yourself

It is impossible to independently determine oligohydramnios, a diagnosis can only be made by a specialist after additional studies.

Risks of oligohydramnios for a child

Possible risks:

The fetus becomes vulnerable under the influence external factors. There is a high probability of compression of internal organs, the development of clubfoot and curvature of the spine.
violated physical activity, because the movements are constrained, the baby cannot rotate in the womb like the rest.
If there is little water, then the metabolic process between mother and child may be disrupted, which is fraught with developmental delay, and sometimes even missed pregnancy. In this case, it is necessary to act quickly, conduct an ultrasound scan and make sure the condition of the fetus, modernly extract it in order to save the woman.
The lack of oxygen during the development of the baby is reflected in the development of the nervous system.
Babies are born underweight and with certain developmental disabilities.
The likelihood of cord compression increases.
The skin also suffers and dries out gradually, hypotrophy may develop.
Frequent fetal contact with fetal membrane may lead to growth in it.

How to treat with medication?

Treatment is aimed at restoring blood flow in the uterus, placenta. It is important to identify the cause that provoked the problem and eliminate it. In the process of treatment, measures are taken to normalize the process of oxygen supply from the mother to the fetus through the placenta. Treatment as such does not exist, because artificially increasing the amount of water will not work. The task is to improve the condition of the mother, and with it the baby.

Treatment is selected taking into account the time. If the problem is detected in the third trimester, then the woman is hospitalized, where she receives vitamins, as well as drugs that help restore oxygen levels and improve blood circulation.

Trying to bring blood sugar levels back to normal possible infections, which could provoke pathology. CTG is performed every day, which allows you to determine the condition of the fetus. Once every five days, an ultrasound or dopplerometry is prescribed. Doctors are trying to prolong the pregnancy and make it to natural childbirth. If the baby's health worsens, then a caesarean section is performed.

If the problem is identified at week 28 and installed serious deviations in the process of fetal formation, some experts suggest interrupting it, because it is difficult to predict the outcome. With moderate oligohydramnios, treatment is carried out at home, but it is important to follow the recommendations - take medication, eliminate stress and visit more often. fresh air by increasing the number of walks.

Doctors are trying to identify and stop the disease that caused oligohydramnios. Having determined the cause, it is always easier to eliminate the consequences. Since oligohydramnios can be caused by a metabolic disorder of a pregnant woman, then a diet is prescribed that will allow all indicators to return to normal.

Prevention

The earlier oligohydramnios is detected, the more likely it is to restore the amount of water and come to normal. Prevention prevents a problem.

A pregnant woman is advised to avoid stressful situations, increase the number of walks in the fresh air. The diet should include not only vitamins and minerals, but also a lot of liquid. Not only water, but also milk, compotes, juices.

To prevent oligohydramnios, even before pregnancy, it is worth going through certain tests that will allow you to identify deviations and eliminate them in a modern way. Solve the problems of the cardiovascular, urinary systems, if any. To refuse from bad habits.

Low water is not yet the final verdict. You need to believe in yourself, tune in to childbirth in a positive way. It is important to listen to the recommendations of doctors and everything will be fine. Even with such a diagnosis, healthy babies are born, just the development process requires more careful monitoring.