Signs of low water. How dangerous is relative or severe oligohydramnios for the fetus, is it worth treating and how will the doctor determine the course of childbirth: diagnosis, classification

Low water during pregnancy: causes, symptoms, treatment

What is low water?

Oligohydramnios is somewhat less common than excess amniotic fluid. At the same time, oligohydramnios serves as a signal that any deviations are observed in its course that are dangerous to the health of the fetus, preventing its normal development. The composition of amniotic fluid is very diverse, they contain nutrients for the child, oxygen, vitamins, salts, hormones, and a number of other substances, without which the normal intrauterine development of the child is impossible. At the same time, about amniotic fluid- this is not only a source of nutrition for the fetus, but also its reliable protection from adverse factors, infections.

The amount of amniotic fluid varies depending on the duration of pregnancy and the needs of the fetus. So, in the third trimester of pregnancy, the normal amount of amniotic fluid ranges from 1000 - 1500 ml. If these figures are less, we can talk about oligohydramnios of varying degrees. There are cases when there was practically no amniotic fluid in a pregnant woman at all. Depending on the severity, oligohydramnios can be moderate and severe. With moderate oligohydramnios, when the amount of amniotic fluid is insignificant less than normal, a woman should establish a diet, eat a variety of foods rich in vitamins and minerals, adhere to a sparing regimen, regularly see a doctor to avoid worsening the condition.

Severe oligohydramnios requires more serious measures, the appointment of medications, treatment in a hospital. With severe oligohydramnios, such negative consequences can be observed as deformation of the skeletal system of the fetus, abnormal development of its limbs, asphyxia, which leads to disruption of the activity of the central nervous system.

Symptoms of oligohydramnios

As a rule, with oligohydramnios, a woman does not feel any special symptoms, deviations in her well-being. Sometimes a pregnant woman may feel pain in the abdomen, which worsens when the fetus moves. Thus, only a doctor can determine the presence of oligohydramnios. For example, if the doctor notices a lag in the size of the standing height of the uterine fundus, its obvious inconsistency with the gestational age, and also insufficient for this period the size of the circumference of the abdomen, he can draw conclusions regarding the possibility of oligohydramnios. In order to fully confirm or refute this diagnosis, it is required to conduct an ultrasound examination, which will help determine the amount of amniotic fluid, if oligohydramnios occurs, then assess its severity, the condition of the fetus. If oligohydramnios is suspected, a woman is also prescribed a gynecological examination.

Causes of oligohydramnios

The reasons for the insufficient amount of amniotic fluid are not fully understood. As medical practice shows, most often lead to oligohydramnios the following reasons:

1. Insufficient development of the epithelium that covers the water membrane, or a reduced secretory function of this membrane itself.

2. Defects and anomalies in the development of the fetus. These defects include pathologies in the development of the child's kidneys, hereditary anomalies development of the kidneys and face.

3. High blood pressure observed in a pregnant woman can lead to oligohydramnios during pregnancy. Of course, during pregnancy, the pressure rises in almost every woman, however, such deviations during the normal course of pregnancy are usually insignificant. If the pressure rises strongly, this can cause the development of oligohydramnios. It should be noted that the severity of oligohydramnios directly depends on the pressure indicators. Also, in the case when hypertension was the cause of oligohydramnios, there may be delays in the development of the fetus, its lagging behind the norm in size.

4. Oligohydramnios can cause various kinds bacterial infections transferred by a pregnant woman and not properly treated. At the same time, pathogenic microflora is detected during analyzes not only in the birth canal, but also in the amniotic fluid itself.

5. Low water can be observed in multiple pregnancies. This is due to the possible uneven distribution of blood flow in the common placenta, when one of the babies gets more nutrients and oxygen, and the other less.

6. Often, when pregnancy is overdue, oligohydramnios develops. This is due to the fact that the placenta, which has served its due date, begins to age and exfoliate, is not able to fully perform its functions. In this case, doctors raise the question of artificial labor induction.

7. Oligohydramnios can develop against the background of a metabolic disorder in a pregnant woman, for example, with obesity.

Treatment of oligohydramnios

In order to select the most effective methods of treating oligohydramnios, the doctor must establish the cause that caused the insufficiency of the amount of amniotic fluid, the severity of oligohydramnios. For this, a pregnant woman must undergo examinations, such as:

1. Ultrasound, dopplerography, during which the amount of amniotic fluid is determined. The degree of fetal retardation in development, the quality of blood flow in the umbilical cord, uterine arteries women, as well as cerebral artery fetus.

2. Tests and swabs for sexually transmitted diseases, bacteria.

3. CTG of the fetus, which allows you to determine the condition and well-being of the fetus.

Treatment methods may vary. For example, in case of metabolic disorders, obesity, a woman, in addition to taking medications that normalize the activity of the placenta, is recommended to adhere to a diet determined by the doctor. Most often, with oligohydramnios prescribed complex treatment, which includes taking drugs to improve the metabolism in the placenta, vitamins, drugs intended to treat the underlying disease, which was the cause of oligohydramnios. Treatment can be carried out on an outpatient basis (with moderate degree oligohydramnios). In this case, the woman must limit her motor activity, adhere to a sparing regimen, exclude heavy physical exercise, take medications prescribed by a doctor, regularly visit a antenatal clinic. If oligohydramnios is of a pronounced degree, it is associated with increased tone uterus, the woman will have to go to the hospital.

With oligohydramnios, the doctor may prescribe a weekly ultrasound, Dopplerography, which must be done every three days, an extraordinary fetal CTG. All these measures are necessary in order to control the pathology, prevent its development, and in some cases, take timely necessary measures.

If oligohydramnios is severe, threatens the health of the fetus, the doctor may decide on early delivery by caesarean section, unless, of course, the timing of pregnancy allows.

The effect of oligohydramnios on the condition of a woman

Low water - pathological condition, which is observed during pregnancy, has an extremely negative effect on its course. A woman may have pain, intensifying at those moments when the fetus begins to actively move. In addition, oligohydramnios can lead to much more disastrous consequences, such as abortion. Oligohydramnios, moderate or severe, significantly complicates the course of childbirth. It manifests itself primarily in weakness labor activity, because the fetal bladder, small in size, is not able to exert sufficient influence on the rate of cervical dilatation. In this case, the use of drugs that stimulate contractions may be required.

The effect of oligohydramnios on the condition of the fetus

Amniotic fluid is the natural habitat for the fetus. Insufficiency of amniotic fluid can most negatively affect its condition and development. Of course, the outcome of pregnancy can be favorable, many women who experienced oligohydramnios during pregnancy had completely healthy children, although with a slight lag in height and weight. However, there are other situations where oligohydramnios has had a very negative impact on the health of the child. For example, with oligohydramnios, the walls of the uterus are located close to the surface of the body of the fetus, so the child does not have enough space necessary for normal development. As a result, the fetus may experience deviations in the development of the skeletal system, limbs. The child, to one degree or another, begins to lag behind in growth and weight, his skin becomes dry, covered with numerous wrinkles.

Pathologies in the development of the fetus can be observed as with moderate oligohydramnios, although the degree of such malnutrition is usually milder, more likely to give birth healthy baby, and when expressed, when the fetus has obvious developmental delays, hypoxia, disorders of brain and nervous activity, decreased tone of the limbs, lethargy. Children born from mothers who had oligohydramnios during pregnancy, subsequently, as a rule, often get sick, are more excitable.

Prevention of oligohydramnios during pregnancy

Unfortunately, there are no preventive measures that are guaranteed to protect against oligohydramnios. However, there are still a number of rules that must be observed by a pregnant woman at the very beginning of this period. For example, a pregnant woman should not lift heavy objects, as excessive physical activity can lead to the development of oligohydramnios. But this does not mean that you need to completely abandon the movement. Well suited for women in an interesting position leisurely walks on fresh air. It is necessary to carefully consider the diet, it is best to eat fractionally, 5 times a day, in small portions. It is important to pass all examinations in a timely manner, take tests, and if a problem is identified that can lead to oligohydramnios, start the treatment prescribed by the doctor as soon as possible.

Naturally, you need to periodically come for an examination to a gynecologist who is pregnant, strictly follow all his instructions. Conclusion. It is worth noting that oligohydramnios is far from the most terrible pathology that can be observed in a pregnant woman. Therefore, the risk that the baby may receive some very serious injuries as a result of this is not so great. The main thing is to identify oligohydramnios in a timely manner and take measures to eliminate it. In addition, modern medical equipment and drugs allow you to carry a baby and give birth. healthy child in most problematic cases. Therefore, in no case should you panic, get nervous and fall into despair, otherwise no, even ultra-modern drugs and equipment, will help.

Polyhydramnios during pregnancy: symptoms, causes, treatment

What is polyhydramnios?

Expecting a child is the most wonderful period in the life of every woman. However, these bright moments can be overshadowed by such troubles as, for example, polyhydramnios. Ideally, nature creates optimal conditions for the correct and full development of the fetus in the womb. The fetus is surrounded by amniotic fluid, which not only creates the necessary conditions for the development of the baby, but also provide him with oxygen and nutrients. However, numerous negative factors, such as poor ecology, malnutrition, the presence of infectious diseases in a pregnant woman, can provoke deviations in the formation of the baby's development environment. Among such deviations is polyhydramnios during pregnancy.

Polyhydramnios is an excess volume of amniotic fluid surrounding the fetus. There are certain norms for the amount of amniotic fluid. So, at the tenth week, their number should be about 30 ml., At fourteen weeks of pregnancy - 100 ml., And during the period last trimester this amount can range from 1000 to 1500 ml. If the amount of amniotic fluid exceeds the specified norms, we can talk about the presence of polyhydramnios. Modern medicine knows several types of polyhydramnios: acute and chronic polyhydramnios, and it also differs depending on the severity. For example, if the excess amniotic fluid is negligible, we are talking about a mild degree of polyhydramnios, if the amount of water greatly exceeds the norm, then the doctor ascertains severe polyhydramnios.

Symptoms of polyhydramnios during pregnancy

The symptoms that a pregnant woman may experience with polyhydramnios vary. For example, acute polyhydramnios, which, by the way, does not develop so often, mainly in the early stages of pregnancy, and is characterized by a rapid increase in the amount of amniotic fluid, a feeling of heaviness in the abdomen, and a sharp increase in its size. In this case, the pregnant woman may feel sharp pains in the lower back and perineum. Often, a woman's blood pressure rises, while the fetal heartbeat is poorly heard.

Chronic polyhydramnios most often shows its symptoms in the third trimester of pregnancy. Moreover, these symptoms are not as noticeable as in the case of acute polyhydramnios. With such polyhydramnios, the size of the pregnant woman's abdomen increases gradually, most often the woman adapts to such changes without attaching much importance to them. Meanwhile, chronic polyhydramnios is a sign of any pathologies during pregnancy. Such pathologies can serve as bacterial or infectious diseases transferred to a pregnant woman, kidney disease, cardio - vascular system, diabetes.

Diagnostics

Diagnosis of polyhydramnios during pregnancy is carried out on the basis of the woman's complaints, to confirm the diagnosis, the doctor prescribes an additional ultrasound examination, and also determines the so-called " amniotic index". If its indicators exceed the norm, the doctor diagnoses "polyhydramnios during pregnancy."

Reasons for the development of polyhydramnios during pregnancy

In general, the reasons that can lead to the development of polyhydramnios in a pregnant woman have not been studied enough to date. Although qualified doctors conclude that the following factors can lead to the appearance of an excess amount of amniotic fluid:

1. The presence of bacterial or infectious diseases that a woman suffered during pregnancy or immediately before conception.
2. Also, diseases such as diabetes mellitus, pyelonephritis, when metabolic disorders and fluid exchange in the body are observed, can also lead to the development of polyhydramnios.
3. Cardiovascular diseases, disturbing activity of the circulatory system, can contribute to the development of polyhydramnios.
4. An excess amount of amniotic fluid can be observed with the so-called Rh conflict, when the mother's Rh factor is negative, and the father's is positive.
5. Multiple pregnancy can also cause polyhydramnios. In this case, phenomena such as an excess amount of water in one fetus and insufficient in another can be observed.
6. Polyhydramnios can also occur in pathologies in the development of the fetus.

Depending on what causes polyhydramnios during pregnancy, the treatment of this deviation is prescribed. Naturally, for successful treatment, it is necessary to identify the cause of the development of polyhydramnios, and eliminate it, if, of course, this is possible.

Treatment of polyhydramnios during pregnancy

As mentioned earlier, in order for the treatment of polyhydramnios to be as effective as possible, it is necessary to identify the cause of this deviation during pregnancy. To do this, the doctor prescribes a number of necessary examinations. This:

1. Ultrasound and dopplerography (a method that allows you to examine the vessels, fetus, uterus and umbilical cord), during which the condition of the uterus and fetus, the state of blood flow in the placenta are determined.
2. CTG (cardiotocography) of the fetus, which allows to assess its general condition.
3. A pregnant woman must take a blood test that allows you to diagnose the presence of an intrauterine infection.
4. A blood test, as well as a smear for sexually transmitted infections, for example, chlamydia, mycoplasma, ureaplasma.
5. If a woman has a negative Rh factor, then she will also have to take a blood test for antibodies.

Depending on the causes of polyhydramnios, as well as the severity of the pathology, appropriate treatment is used. For example, with unexpressed polyhydramnios and polyhydramnios medium degree gravity appoint drug treatment, which can be carried out both on an outpatient basis (with mild polyhydramnios) and in a hospital (with moderate polyhydramnios). At the same time, premature delivery is not required, that is, the pregnancy proceeds to its natural completion against the background of the prescribed continuous treatment. In this case, the woman is prescribed antibiotics, vitamins, diuretics (diuretics). In addition, at a gestational age of twenty-four to thirty-eight weeks, a pregnant woman is prescribed indomethacin. If, despite the measures taken, polyhydramnios develops, becomes severe, and at the same time there are signs of intrauterine suffering of the child, the doctor, as a rule, makes a decision on early delivery.

To do this, use special drugs - stimulants, which act in a special way, giving a signal to the onset of labor. With artificial induction, it is necessary to observe following rules. Firstly, the fetal membranes surrounding the child must be opened from the side, slightly above the location internal os and not in the center. Secondly, fetal fluids should be released gradually to avoid asphyxia (suffocation) of the fetus. In addition, it is necessary to take appropriate measures to help prevent the loop of the umbilical cord or the limb of the baby from falling out. And, finally, drugs that stimulate labor activity should be used no earlier than two hours after the outflow of amniotic fluid.

If in the early stages of pregnancy, when the question of early delivery is unacceptable, a woman is often prescribed a release amniotic fluid. The procedure should be carried out with the utmost care to prevent the loop of the umbilical cord from falling out.

The effect of polyhydramnios on the condition of a pregnant woman

In addition to the sensation of discomfort and pain that can be observed with polyhydramnios, this pathology can significantly complicate the process of childbirth, cause such negative phenomena as weakness of contractions, premature detachment of the placenta, which had previously developed and functioned quite normally, excessive bleeding, which is associated with excessive stretching uterus during pregnancy. In addition, recovery processes after polyhydramnios pregnancy and childbirth proceed with some complications.

The effect of polyhydramnios on the fetus

Polyhydramnios during pregnancy can harm not only the mother, but also adversely affects the condition of the fetus. The organ that provides an aqueous intrauterine environment for the fetus is very important element, which plays a responsible role in protecting the fetus from negative influences, infections, provides nutrition to the fetus, its breathing. Therefore, violations of the activity of this body, such as polyhydramnios, can change in the worst side habitat of the fetus, which leads to its intrauterine suffering.

Polyhydramnios is a common cause of various kinds of malformations in the development of the fetus, all kinds of pathologies, up to his perinatal death. In addition, polyhydramnios complicates, which, as you know, are a difficult test not only for the mother, but also for the child. As a result of the weakening of labor activity, which is often observed with polyhydramnios, the child may experience asphyxia, which negatively affects the general condition of the baby, the activity of his central nervous system.

Prevention of polyhydramnios

Polyhydramnios during pregnancy is not at all a harmless phenomenon, even if we are talking about a mild degree of pathology. The fact is that polyhydramnios indicates any violations during pregnancy, the presence of certain diseases that can harm the health of a woman and a child. In this regard, it is necessary to think about preventive measures that can prevent the development of polyhydramnios. Among such measures, first of all, is the need for appropriate examinations that will confirm or refute the presence of diseases, Rh conflict, and other causes that can lead to polyhydramnios. You should adjust the diet, clearly determine the amount of fluid consumed.

From the very beginning of the waiting period of the child, she should be in the fresh air more often. Walking is very helpful. And, most importantly, you must strictly follow all the prescriptions of the doctor who leads your pregnancy, take all the vitamins and medicines that he prescribes for you, undergo an ultrasound procedure on time, which can show the development of polyhydramnios on initial stage when the treatment of this pathology will be as simple and effective as possible.

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

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

Treatment of oligohydramnios during pregnancy depends on the degree of its course, the effect on the fetus and the causes of its occurrence. The diagnosis can be made at any stage of bearing a child. Often it is detected in the second trimester, but it is not uncommon for it to be detected in the third.

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

There are two types of amniotic fluid deficiency:

Moderate. It is usually caused malnutrition, therefore, to eliminate it, it is enough for a woman to adjust her diet and eating habits. Doctors recommend using more products high content useful substances and vitamins. When following a diet, it is necessary to periodically undergo examinations with an observing gynecologist;
Expressed. Represents a danger to the fetus. Treatment is complex and includes medication. A woman is necessarily placed in a hospital for preservation. The more pronounced oligohydramnios, the higher the risks for the child, because it can lead to deformation of the skeletal system of the fetus, developmental pathology of the limbs and asphyxia, which disrupts the functioning of the nervous system and brain.

What threatens severe oligohydramnios during pregnancy?

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

Only a doctor can detect a lack of amniotic fluid.

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

lag of the uterus in growth;
Inappropriate height of the uterine fundus;
The size of the abdomen that does not correspond to the gestational age.

Doctors are well aware of the dangers of oligohydramnios - the risks for not yet born baby. In addition, the stronger it is expressed, the higher they are.

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

Causes of oligohydramnios during pregnancy

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

Diagnostics

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

Specialists use a variety of examinations and analyzes for this.:

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

How to treat moderate and severe oligohydramnios during pregnancy

Depending on the severity, causes and degree of influence, apply different methods. For example, if a lack of amniotic fluid is detected at week 27, obesity is prescribed medical preparations that improve the functions of the placenta.

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

There are two methods of treatment: outpatient and inpatient. The first - is used for moderate flow, the second - for severe.

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

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

What is low water?

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

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

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

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

Causes

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

Reasons for insufficient amniotic fluid:

Insufficient secretion of amniotic fluid.
Water leakage.
Anomaly in development membranes. They can fix up to 20 weeks.
Deviations in the development of the fetus. If the fetus has a kidney defect, then the diagnosis of oligohydramnios is usually made already in the early stages of pregnancy.
Hypertension in pregnancy. During pregnancy, a woman's blood pressure may increase. The danger is represented by pronounced jumps from low scores to high. If you do not start treatment, then the consequences can be sad: there may be a delay in the development of the child, slow growth and weight gain. Quite often, such symptoms are detected at 20-21 weeks.
bacterial infections. The danger is chlamydia, ureaplasmosis, etc. Often, diseases do not occur during pregnancy, but long before it. It's just that the woman was not treated, and the disease became chronic. Such infections are detected by tests at 20 weeks. It is at this time that bacteria begin to multiply under the influence of hormones. If it was not possible to fix in time dangerous infections, then at a period of 30 weeks, a woman already has serious oligohydramnios and all the ensuing consequences.
This diagnosis is made to mothers who are carrying more than one baby. The reasons are the uneven distribution of water and abnormal blood flow in the placenta. As a result, one child develops into comfortable conditions, and the second has to fight for survival. Polyhydramnios is also observed in one child and signs of severe oligohydramnios in the second. Between children there may be a difference in development - a week or more. If the specialists failed to make the necessary diagnosis, then one of the fetuses may die.
The norm is considered to be childbirth that falls on the 36-40th week. But already from the 38th week, the placenta ceases to perform all the functions assigned to it. That's when the lack of fluid can begin. If labor does not begin at week 38, then a caesarean section may be prescribed. This question is especially acute if the 40-42nd week is already underway.
At overweight mothers can make such a diagnosis already at the first or second ultrasound, that is, at 12 or 22 weeks, respectively. Mommy should be taken to the hospital, she is prescribed proper nutrition. Most often, babies are born no later than 36-37 weeks.

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

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

What is the danger of the diagnosis?

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

It is early low water that is most unfavorable for the development of the embryo. After all, in the first and vitor trimesters, vital signs begin to form and develop. important organs future child.

In the third trimester, it is much easier to treat a lack of water, as this is a completely normal symptom. Especially it concerns recent weeks pregnancy.

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

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

signs

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

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

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

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

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

Diagnostics

If oligohydramnios is suspected, a woman must undergo mandatory diagnostic procedures, which will show the state of life of the fetus:

Laboratory examination.

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

Normal indicators of IAI

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

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

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

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

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

Treatment

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

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

Even mild oligohydramnios can harm the baby.

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

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

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

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

Amniotic fluid is essential for normal prenatal development fetus. For the future baby, it is a comfortable physiological environment, additional source supply and oxygen, as well as a protective barrier that protects it from numerous external threats. In addition, the amniotic fluid plays an important role in the process of childbirth, forcing the opening of the cervix, as it is able to exert a mechanical effect on it.

Therefore, the relative lack of water can lead to various fetal developmental disorders and interfere with the normal course of pregnancy. Why is low water dangerous? What are the degrees of this condition, and what therapeutic method is most effective in such a situation?

What is "moderate malnutrition"

Indicators of the normal volume of amniotic fluid vary depending on specific date pregnancy. During the first 8 weeks, this is approximately 5 ml. Further, the amount of fluid begins to increase, and by the end of pregnancy, its total volume reaches an average of 1-1.5 liters. Immediately before childbirth, there is less water (their volume is approximately 600-700 ml).

The composition of the amniotic fluid (from the word "amnion" - a fetal sac) includes amino acids, vitamins, hormones, trace elements, some types of salts, enzymes, etc.

Amniotic fluid is formed due to the functioning of the epithelial layer of the cells of the amnion aqueous membrane. They are constantly updated. At the last stages of pregnancy, this happens at least every 3 hours.

On average, the fetus has the ability to swallow 4 ml of amniotic fluid per day, and through the pores of the fetal sac, the products of its vital activity enter the maternal excretory system. With a non-critical "shift" from the normal indicators of the volume of amniotic fluid (closer to the lower limit of the norm), a pregnant woman is diagnosed with moderate oligohydramnios.

Causes

It happens that this state is already registered on early stages pregnancy. A similar diagnosis is made on the basis of the calculation of the oligohydramnios index. In this case, a woman needs constant medical supervision and the use of certain methods of drug therapy.

The reasons for the formation of such a violation can be:

persistent hypertension (increase in general blood pressure);
the presence in the body of a pregnant woman of any inflammatory process infectious nature;
fetoplacental insufficiency;
hypoxia (oxygen "starvation") of the fetus;

diseases of a pregnant woman associated with metabolic disorders;
the presence of any pathologies in the fetus (underdevelopment of the excretory system will lead to a sharp decrease in the level of production of primary urine, which leads to a decrease in the volume of amniotic fluid);
prolonged pregnancy - the placenta is amenable to reverse development, therefore it no longer has the ability to provide the fetus with all the necessary substances, including the production of a sufficient amount of amniotic water;
multiple pregnancy- here there may be a violation of the process of distribution of placental blood, which can also lead to a shortage of water;
violation of secretion in the epithelial cells of the aqueous membrane of the amnion.

Types of oligohydramnios

According to the duration of the course, two types of oligohydramnios are distinguished: acute and chronic.

Chronic oligohydramnios has several levels of development. This condition requires long-term therapy. If qualified assistance is not provided on time, the disease will worsen., which will lead to serious consequences for both the expectant mother and the child.

Chronic amniotic fluid deficiency can occur if a pregnant woman suffers from some kind of systemic disease, such as diabetes.

In order to minimize all possible risks and apply appropriate therapy in time, in case of oligohydramnios, a woman needs to register with a antenatal clinic as soon as possible and regularly undergo all necessary examinations.

The most common cause formation of acute oligohydramnios - infection. This form of pathology leaves fewer negative consequences for the health of the baby and does not need special treatment, since the situation usually stabilizes when successful elimination disease that caused it.

In addition, oligohydramnios is classified depending on the functional activity of the cells of the aquatic membrane. According to this principle, primary and secondary forms are distinguished. Primary oligohydramnios is characterized by the absence of any functional disorders in fruit membranes. With secondary oligohydramnios, damage to the structure of the amnion is observed, as a result of which water flows out.

Symptoms

Quite often, the clinical picture of moderate oligohydramnios does not have pronounced manifestations (therefore, this condition in some cases can be regarded as borderline with the norm). However, some features characteristic of given state, a pregnant woman should pay attention if they occur. Among these symptoms:

lower abdominal pain;
painful tremors;
weak and rare tremors;
the size of the uterus does not correspond to the gestational age (identified by an obstetrician-gynecologist).

If any of these symptoms appear, even if they seem insignificant, you must immediately inform your doctor about them so that he can prescribe a series of examinations with which it will be possible to detect oligohydramnios.

Possible Complications

Insufficient volume of amniotic fluid can be an impetus for the development of a number of complications, among which:

Violation of blood flow in the umbilical cord. Because of this, the baby does not get enough oxygen and food. Persistent hypoxia can provoke the development of irreversible disorders in a child and even lead to his death.
"Fault" in the process of circulation of amniotic fluid. Similar state can lead to infection, and also significantly increases the likelihood of traumatic childbirth.
Flat amnion. This complication can provoke a weakening of labor activity in the first stage of labor.
Placental abruption. Small fragments of the placenta are retained in the uterus, which increases the risk of bleeding.
Fetal underdevelopment. If in the process of intrauterine development a child regularly did not receive the amount of nutrients and trace elements he needed, then his body weight at birth would be less than normal.

Diagnostic methods

The main methods of instrumental diagnostics used by the doctor to determine the volume of amniotic fluid are ultrasound and dopplerography. With their help, you can assess the umbilical blood flow, how much the child lags behind in development, as well as the condition of the vessels of the expectant mother and fetus.

In addition, in addition to the study of the functional ability of cardio-vascular system an obstetrician-gynecologist may prescribe cardiotocography for a baby. With established moderate oligohydramnios in the third trimester this study is carried out at 30, 32, 34 and 36 weeks of pregnancy.

When registering, a woman must be screened for the presence of sexually transmitted infections.

Therapy

Correction of this state should be carried out in several directions:

appointment medicines, normalizing metabolic processes in the placenta;
drug therapy for the underlying disease.

If a pregnant woman suffers from any disease associated with a violation metabolic processes, or is overweight, then, most likely, a pregnancy specialist will recommend a special diet.

Moderate oligohydramnios usually does not need constant monitoring in a hospital, it is possible to normalize the state of the future on an outpatient basis.

In addition to drug therapy, with moderate oligohydramnios future mother must comply with certain restrictions regarding its physical activity. She should also make sure that her daily diet contains foods rich in vitamins and trace elements.

In many ways, the duration of pregnancy plays a decisive role in drawing up a therapy plan. This pathology requires the most careful control in the 2nd trimester. If oligohydramnios is diagnosed at 37 weeks, then this may be an indication for a caesarean section.

Prevention

Currently, no effective methods have been developed to prevent the risk of developing oligohydramnios. But there are a number of recommendations, the exact implementation of which will help a pregnant woman reduce the risk of this pathology.

Plays an important role diet of the expectant mother. It should be rich in all the elements (vitamins, proteins, trace elements and other valuable substances) necessary for the normal development of the fetus and ensuring the satisfactory condition of the pregnant woman.

For the future mother and the health of her baby, it is very useful to observe a balanced regimen of physiological stress and rest. Labor should be moderate, as excessive overwork can adversely affect the health of a woman and her baby.

However, you should not go to extremes and completely deprive yourself of even minimal loads, as this can lead to a rapid set excess weight which can complicate pregnancy

One of the main factors determining the nature of the course of pregnancy and the success of delivery is emotional background women. The presence of stress and regular mental overload dramatically increases the risk of developing any associated complications, including oligohydramnios. A pregnant woman needs to undergo all examinations prescribed by a doctor on time.

It is necessary to use any supplements or medications only with the approval of a specialist, and not relying on incompetent reviews.

Conclusion

Moderate oligohydramnios is formed against the background of some pathologies of intrauterine development of a child or diseases of a pregnant woman. His hallmark- absence of pronounced symptoms. At timely therapy this deviation does not pose a big threat to the normal development of the fetus and the health of the expectant mother. Importance has a period at which moderate oligohydramnios was diagnosed, since in different periods pregnancy, such a violation can have its consequences.

Sometimes, for the safety of pregnancy, a woman may ahead of schedule Send the PDR to the hospital (or rather, to the pathology department). We will consider one of the reasons that can lead the expectant mother to the hospital of a medical institution for treatment.

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

The value of amniotic fluid

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

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

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

The value of amniotic fluid for a child is invaluable:

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

Low level of AFI - oligohydramnios

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

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

What is the danger?

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

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

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

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

Treatment. Should moderate oligohydramnios be treated?

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

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

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

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

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

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

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

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