Low water in pregnant women causes. Possible consequences for the child. What is oligohydramnios
Amniotic fluid is the baby's first habitat. It is from it that the child receives the nutrients he needs.
Composition and volume amniotic fluid have a significant impact on the safety of the fetus and its intrauterine development. For each period of pregnancy, their own boundaries of the normal volume of water are established. If their number is less than the allowable value, oligohydramnios is diagnosed.
The concept of the norm of the amount of water
The normal amount of intrauterine fluid varies within fairly wide limits. On average, this is 0.6-1.5 liters. A lot depends on their number, because. it is this liquid that developing fetus freedom of movement, promotes normal metabolism and provides reliable protection umbilical cords from squeezing.
As noted, the volume of intrauterine fluid increases in accordance with the gestational age. If we consider pregnancy by weeks, then the volume intrauterine waters changes like this:
- At week 10, it is 30 ml.
- At 13-14 weeks - about 100 ml.
- At 18-20 weeks, the amount of fluid increases to an average of 400 ml.
- By the end of the term (starting from 36-37 weeks) - about 1-1.5 liters.
Closer to the date of delivery, the volume of amniotic fluid may decrease to 0.8 liters. The same amount of water is typical for a post-term pregnancy.
Based on the above information, at the birth of a baby, approximately 1.3-1.8 kg of a mixture of amniotic fluid and placenta comes out of the womb of a woman. At the same time, the placenta accounts for about 0.5-1 kg, the remaining mass is occupied by water.
Low water: description and forms of the disease
Sometimes, due to certain circumstances, the content of intrauterine water deviates from normal values. In case of their decrease, we are talking about oligohydramnios.
There are several classifications of oligohydramnios. It can be:
1. chronic and acute. Chronic oligohydramnios is characterized by the absence of severe symptoms. As a rule, the pregnant woman feels normal. Confirm the lack of amniotic fluid is possible only on ultrasound.
The acute form is characterized by the presence of a number of adverse symptoms, namely: a decrease in the height of the fundus of the uterus, the size of the abdomen, the uterus as a whole; pain when the fetus moves; the appearance of weakness, nausea and general malaise; pain in the lower abdomen.
2. Early and late. The early form develops mainly with functional insufficiency of the membranes and is diagnosed most often at 16-20 weeks of pregnancy.
The late form is determined on average after 25-26 weeks. May develop against the background of endometrial disorders of the uterus and different kind secondary diseases, including diabetes, arterial hypertension and others.
3. Primary and secondary. In primary oligohydramnios, there may be no violation of the integrity of the amniotic sac.
Secondary oligohydramnios always develops with a violation of the integrity of the membranes, which is why the liquid begins to gradually flow out.
Signs and main symptoms of oligohydramnios
The diagnosis is confirmed during ultrasound.
In most situations, the well-being of women with a moderate form of the disease does not seriously deteriorate.
For a pronounced ailment, the presence is characteristic:
- Nausea, general weakness and dryness in the oral cavity.
- Also, patients have pain in the lower abdomen, the intensity of which increases with the mobility of the child. After the 20th week of pregnancy, the fetus begins to behave much more actively. Against the background of an insufficient amount of amniotic fluid, its depreciation properties are significantly reduced. Because of this, the woman has quite intense pain.
Among the main signs of oligohydramnios diagnosed in the process gynecological examination and ultrasound, it can be noted
- lagging behind the size of the uterus from the normal for the current gestational age.
- There is also a decrease in the circumference of the abdomen and restriction of the child's mobility.
The diagnosis is confirmed during an ultrasound examination. It also allows you to determine the volume of intrauterine water and the severity of oligohydramnios, if any. Most often, a woman first undergoes an ultrasound scan, and then goes to a more detailed gynecological examination.
Amniotic fluid deficiency can lead to miscarriage or premature birth. During the period of contractions, a woman will feel very severe pain. The cervix dilates more slowly.
Generic activity in most situations is protracted. After opening amniotic sac a small amount of viscous liquid, colored by the child's stool, is found.
The danger of oligohydramnios for women and children
Lack of water leads to a number of complications. With insufficient volume of amniotic fluid, the walls of the uterus begin to put pressure on fetal sac and, as a result, the child. As a result, he has to bend into an abnormal posture, which can cause a series of side effects, among which:
- fusion of the skin with the amniotic sac;
- clubfoot;
- various kinds of anomalies of the spine.
- the baby's skin becomes dry and wrinkled.
Low water adversely affects pregnancy. As noted, patients feel pain, especially intensifying with an increase in the activity of the child.
Due to fluid deficiency, pregnancy can be terminated. The risk of miscarriage is especially high in the 1st trimester.
Regardless of the type of disease, there are complications during childbirth. The most common is the weakness of the process, expressed in insufficiently strong attempts and minor contractions.
These problems appear due to the low pressure of the amniotic sac. Due to its reduced size, it is not able to influence the speed and degree of cervical dilatation.
If the pregnancy is premature, childbirth is most often carried out using a caesarean section.
Additionally, the doctor may prescribe special medications that stimulate contractions. Usually drugs are prescribed for a period of more than 35 weeks.
With a favorable outcome, the woman manages to give birth on her own.
The main causes of oligohydramnios
Many diseases lead to the appearance of the disease. various reasons, among which;
- pathology of the urinary system;
- genetic predisposition to the disorders in question;
- high blood pressure;
- exacerbation of chronic diseases during pregnancy;
- bacterial infections;
- multiple pregnancy;
- overwearing. Having served its purpose, the placenta rapidly ages, exfoliates and loses its function. With the development of oligohydramnios against the background of overgrowth, doctors, as a rule, provoke an artificial birth;
- metabolic disorder;
- overweight;
- incompatibility of the Rh factor in the blood of mother and child;
- feto placental insufficiency;
- various diseases of the placenta;
- diabetes;
- pathology or underdevelopment secretory epithelium.
Diagnosis of oligohydramnios
Amniotic waters are the first environment of a child's life, so it is very important that the composition and, of course, the amount of fluid are acceptable for full development baby.
It is the normal volume of water that is one of the most important indications that the child is developing correctly.
To determine the amount of fluid, a woman, as already noted, undergoes an ultrasound examination. Based on the results of the survey, a conclusion is drawn up, which, among other things, indicates amniotic fluid index. This indicator characterizes the volume of water present in the amniotic sac. At each stage of pregnancy, the fluid rate is individual. Thanks to this indicator, the doctor can draw conclusions about the nature of the development of pregnancy.
The volume of amniotic fluid, as well as its composition, change almost weekly. In addition to the average value, there is a fairly significant difference in the allowable values of the amniotic fluid index.
It is important to understand that these fluctuations are quite significant, so even if yours is far from the established norm, this is not necessarily a cause for concern and worry.
In general, study normal performance amniotic fluid and tolerances from the norm at each stage of pregnancy can be in the following table:
Pregnant women are often interested in: why amniotic fluid does it get bigger or smaller? The reason is that the fetus develops, and as it grows, it swallows intrauterine fluids, and then removes them from the body along with urine. You don’t have to worry about the baby’s condition: the renewal of intrauterine water occurs at intervals of 3-4 hours, and they completely change every 3-4 days.
As noted, oligohydramnios is a decrease in the volume of amniotic fluid below an acceptable level, and it can be moderate or severe. The moderate form is diagnosed much more often.
For moderate oligohydramnios a relatively small decrease in the volume of intrauterine water is characteristic. This form is less dangerous compared to severe oligohydramnios. But moderate oligohydramnios during pregnancy can deliver no less worries and troubles. Yes, and all sorts of complications can also appear, not in the best way affecting the fetus.
For example, the result of the considered deviation quite often becomes the birth of a low-weight baby. Also frequent consequences are dysplasia hip joints, various pathologies of the spine.
But you don’t need to start worrying right away - in the vast majority of situations, pregnancy with the considered form of oligohydramnios passes and ends safely and the baby is born in relatively good condition.
A woman only needs to react in time to the problem that has arisen, behave appropriately, visit a doctor and follow all his advice.
If during the next ultrasound examination a moderate form of oligohydramnios was diagnosed, no one will consider it as a final conclusion. Must be re-examined. It is better to do this in another office and with another doctor.
Also, the doctor will try to determine the reasons against which oligohydramnios began to develop. The exact reasons for the appearance of such an anomaly have not been fully established, but most often this problem leads to:
- urinary tract infections. Even those ailments that the patient suffered without being pregnant can lead to the occurrence of oligohydramnios;
- high blood pressure;
- chronic inflammatory processes in organism.
Can lead to the occurrence of moderate oligohydramnios various problems, experienced directly developing child. For example, the problem is often caused by chronic hypoxia and other anomalies of intrauterine development.
Usually, when a moderate form of oligohydramnios is detected, doctors recommend that a pregnant woman adjust her diet and, in general, the nature of her life. Such patients are recommended to eat foods high in minerals and vitamins.
It is also recommended to have a normal regular rest and, in general, a sparing regimen without tension, stress, etc. And most importantly, you need to be regularly observed by a doctor in charge of pregnancy in order to detect deterioration in a timely manner, if any, and take appropriate measures.
Severe oligohydramnios in pregnant women: basic information and recommendations
The main symptom is pain in the lower abdomen
A pronounced type of oligohydramnios is more dangerous for a mother and her unborn child than a moderate one. Woman is disturbed discomfort in the abdomen (mainly in the lower part), there is nausea and general malaise. The fetus very often develops hypoxia - a condition caused by an insufficient amount of incoming oxygen. Hypoxia is dangerous for the whole body of the baby as a whole and to the greatest extent for the nervous system.
Against the backdrop of a long and pronounced oligohydramnios simonart ligaments are formed that wrap around the baby. They interfere with the mobility of the fetus, and sometimes lead to extremely serious injuries. If the simonart ligaments wrap around the umbilical cord, there is a violation of blood flow in the vessels. The result can be unpredictable - from developmental delays to the death of the baby.
The main symptom in a woman is pain in the lower abdomen. They become especially pronounced towards the end of the term, when the child is already quite large. Due to oligohydramnios, labor activity often weakens, which becomes a prerequisite for a caesarean section.
In the rest, if pronounced oligohydramnios is detected, medical recommendations should be followed. The course of treatment is selected individually, taking into account the patient's condition and the characteristics of her problem.
Treatment of oligohydramnios
For the treatment of the disease in question are used various methods. A specific therapy option is selected taking into account the intensity of the disease, the causes of its occurrence, as well as the duration. For example, if obesity and metabolic disorders led to the appearance of oligohydramnios during 1-2 trimesters, the doctor will prescribe an individual diet and drugs for the woman to normalize the function of the placenta.
If oligohydramnios is detected after 31 weeks, complex therapy is most often prescribed, including medications to normalize metabolism, vitamins, as well as medicines to eliminate the main cause of the disease.
Upon detection moderate degree disease is treated as an outpatient. Patients with a pronounced nature of the disease are treated permanently.
For outpatient therapy, it is prescribed:
- activity restriction;
- gentle mode;
- exclusion of heavy loads;
- medication (prescribed by a doctor);
- regular visits to the doctor.
As a rule, outpatient treatment is resorted to in the 2nd trimester.
Inpatient treatment is used in the following situations:
- when diagnosing a pronounced degree of the disease;
- with a significant deficiency of intrauterine fluid;
- when oligohydramnios is detected after the 31st week.
The doctor may recommend weekly ultrasound and doppleography to the patient. It is also often recommended to do a fetal CTG. These measures allow you to control the disease and timely respond to deterioration.
If the severity of oligohydramnios threatens the health and life of the baby, the doctor may take extreme measures - terminate the pregnancy or resort to a caesarean section. The possibility of early delivery is considered only in the case of patients at 33 weeks and later.
There are no specific preventive recommendations that allow 100% to eliminate the risk of developing oligohydramnios. Pregnant women are advised to proper diet nutrition and follow all doctor's recommendations.
It is also necessary to regularly take tests and undergo the required examinations. Heavy lifting and other strenuous physical activity should be avoided. Respond in a timely manner to uncharacteristic changes in your body, follow the advice of a doctor and be healthy!
The value of amniotic fluid during childbearing is great importance. The amniotic fluid provides metabolic processes between mother and fetus. It also protects the baby from mechanical impact, as well as the umbilical cord and placenta, contributes to the timely opening of the cervix. Low water during pregnancy is not the norm and requires medical attention.
Normally, the amount of physiological fluid increases throughout the entire period of bearing a child. But having reached its maximum at week 38, its volume gradually begins to decrease.
Factors provoking a decrease in amniotic fluid
The causes of the pathological condition are different, some of them depend on the period. If it is noted from the very beginning of pregnancy, this indicates a possible presence congenital pathology kidneys in a baby. In this case, the prognosis cannot be called favorable, abortion is often indicated, because the child cannot live without kidneys.
Another reason is stable high performance blood pressure at mother. More often this happens after 30 weeks, and all because, following blood flow disorders, the placenta ceases to cope with all its functions. Sometimes a slight oligohydramnios is caused by the fact that the expectant mother is overstepping the deadline, which is why the placenta is aging.
It often happens that when twins are born, blood is discharged from one fetus to the other. In this case, there are no consequences for the development and health of the child, which cannot be said about the insufficient volume of physiological fluid, especially if this is provoked by a sexual infection chronic form. It may be latent or simply not fully cured in due time. It happens that the reason for the small volume of amniotic fluid cannot be established. In such situations, doctors suggest that there has been a violation of the functioning of the epithelium responsible for the production of amniotic fluid.
Even if it is not possible to immediately understand what the essence of the problem is, every doctor should know how to determine the cause and do everything possible for this. You should always remember that oligohydramnios is a symptom of pathology dangerous for the child and mother.
Clinical picture
Before you figure out how to prevent a decrease in the amount of fluid vital for the fetus, you should study the symptoms of a pathological condition. It is immediately worth noting that it is not so easy to notice them, especially if we are talking about a moderate deviation from the norm. If it is pronounced, then from the fact that it becomes difficult for the child to move in the uterus, his movements are accompanied by pain, the expectant mother notices that her baby is kicking hard.
Regularly visiting an obstetrician-gynecologist, there is a chance that the pathology will be detected in time. On examination, the doctor notices secondary symptoms disease state, and this:
- ease of probing certain parts of the child's body;
- the size of the genital organ that does not correspond to the gestational age.
It is worth noting that the reason low location the bottom of the uterus can be not only insufficient fluid content in it, but also wrong position child in the womb, developmental delay. Reviews of mothers who had to deal with this prove that it is impossible to establish an accurate diagnosis without using special techniques.
What is the danger?
It is difficult to answer the question unambiguously, because it all depends on the gestational age. As has been said, the most dangerous thing is if it occurs in the first weeks, in which case interruption is indicated. With the onset of 20 weeks, in favorable conditions, the fetus has enough space in the uterus. But! If oligohydramnios is diagnosed in the second trimester, then this means the opposite. When the child is already 23 weeks old, the walls of the reproductive organ press on him from all sides, which is fraught with serious deviations in physical development. They are manifested by clubfoot, congenital dislocation of the hips, or worse, deformity of the skull.
The diagnosis is established only using the results of ultrasound, similar diagnostic tools are powerless here. The amniotic fluid index has diagnostic value. To determine it, the free space between the fetus and the wall of the uterus is measured. This is done in at least four places. The results of the study are summarized, divided by 4.
The danger of oligohydramnios during pregnancy after 32 weeks
Knowing about the possible reasons for the decrease in physiological fluid, as well as how it manifests itself, it will not be superfluous to figure out how dangerous this phenomenon is for a period far beyond 28 weeks. If we talk about a child, then his spine is bent, there is a lag in physical development in the womb due to a lack of oxygen. If measures are not taken in time, then for a period of 34 weeks the child's brain will remain underdeveloped, and mental development will stop. What is the most dangerous pathological condition may adversely affect labor activity. An oligohydramnios detected at 36 weeks can cause the birth to be delayed or not be able to be carried out at all naturally. If at a period of 38 weeks, along with oligohydramnios, a breech presentation of the fetus is detected, then the doctor prescribes an operation.
Pain in the pubis and pelvis after childbirth and how to determine symphysitis
Moderate oligohydramnios during pregnancy and its other varieties
There are 2 groups of pregnant women with a similar diagnosis. In conditions of moderate low water clinical picture expressed very weakly, the woman does not feel any discomfort. It is possible to establish deviations from the norm only on ultrasound. Under such circumstances, the expectant mother is recommended to adjust her diet by including foods with a high content of vitamins and minerals in her diet. The most important thing is constant medical supervision.
If a woman has severe oligohydramnios, then she is sent to a hospital where medications are used. Measures taken in time increase the chance that any pathological changes will not occur in the development of the child. Absolute oligohydramnios is often the reason that a child is born with low weight or insufficient viability.
Treatment of oligohydramnios during pregnancy
Every pregnant woman should know and understand that the amount of fluid drunk does not affect the volume of amniotic fluid. Do not try to solve the problem with folk remedies, as you will only aggravate the situation. If state future mother is not assessed as critical, it is recommended to reduce physical exercise and watch your diet. As a supplement, the doctor will prescribe a multivitamin. But if during the observation of the patient it is established that the situation is aggravated, she can be hospitalized. The first injections are prescribed, and different ones. Together they are capable of:
- stimulate uteroplacental blood flow;
- increase the level of placental metabolism;
- restore metabolic processes.
Complex therapy involves the use of Actovegin, vitamins and more.
If the doctor managed to establish the exact cause of oligohydramnios, namely infectious diseases, then antibiotics are used, as well as drugs that stimulate blood supply, antioxidants, vitamins. When it is simply impossible to do without adequate treatment, Cefazolin is prescribed, only the attending physician can do this. He must first examine the patient, assess the state of her health.
If there is no menstruation a year after childbirth, is it worth sounding the alarm
Many women are interested in the prevention of oligohydramnios, but as such, there are no ways to prevent this. The future mother is simply recommended to exclude excessive physical activity from her life while carrying a child, often walk on fresh air, eat fractionally, from time to time take tests for the presence / absence of genital infections. The same applies biochemical analysis blood.
If the expectant mother was diagnosed with "oligohydramnios" - this is not a reason to panic.
Oligohydramnios is treatable, and if detected in a timely manner, it is by no means a guarantee of difficult childbirth and health problems for the baby and mother.
Causes of the disease
Neither age future mother, nor the number of births affect the occurrence of the disease.
Very often, this pathology is provoked by hypertension, metabolic disorders, diseases urinary tract or genitals.
Often, oligohydramnios is diagnosed with multiple pregnancies and overcarrying.
Another possible cause of the disease is the underdevelopment of the epithelium that covers the water membrane or the reduced secretory function of this membrane.
Unfortunately, some anomalies in the development of the child can cause oligohydramnios (for example, pathology of the development of the kidneys or face).
Symptoms of the disease
Anemia can be diagnosed by the following symptoms:
- the size of the uterus does not correspond to the gestational age
- mom is in pain when moving baby
- regular aching pain in the lower abdomen
- weakness
- dry mouth and nausea
It happens that on recent weeks Pregnancy oligohydramnios (together with other pathologies of pregnancy) can cause labor stimulation. And if the doctor insists on this, it makes sense to consider this recommendation in a balanced way: the risk of an unsuccessful birth outcome increases.
Why is oligohydramnios dangerous during pregnancy?
Low water is a signal that there is a place for some pathologies of pregnancy, which, first of all, affect the development of the baby.
Amniotic fluid performs not only a protective function: they are involved in the metabolism between the baby and the mother, they contain oxygen, vitamins, salts, hormones and others. useful material. They help protect the fetus from dangerous infections and other adverse factors.
It must be understood that in different term pregnancy, the amount of amniotic fluid also changes. In the third trimester, they should be about 1-1.5 liters. If the indicators of a pregnant woman are below these values, we can talk about oligohydramnios.
Low water happens:
- moderate (not too small)
- pronounced (seriously below normal)
In the second case, the expectant mother will need to be hospitalized in the pregnancy pathology department. This is because medical supervision for a pregnant woman with a similar problem should be constant and drug treatment can't be avoided.
To leave oligohydramnios (especially pronounced) without treatment means to expose the life of the baby big risk. Here are just a few of the dangers that this diagnosis can entail:
- Malformations of the child
- The risk of squeezing the umbilical cord and, as a result, intrauterine death of the child
- Intrauterine infection of the fetus
Diagnosis of the disease
Necessary tests and examinations
Oligohydramnios is detected on ultrasound. But even without special equipment, the doctor can make this diagnosis.
To do this, he discovers that abdominal circumference And uterine fundus height pregnant do not correspond to the term, and the woman's complaints about low fetal activity only reinforce the diagnosis. Besides flat amniotic sac can be seen on vaginal examination.
But the doctor will not rely only on the examination: a pregnant woman, in whom the doctor questions the diagnosis of "oligohydramnios", will be made ultrasound And dopplerography.
KTG will give information about the state of the baby's heartbeat, and smears And standard analyzes will help to identify the very cause of oligohydramnios, which must be dealt with in the first place.
Only a comprehensive diagnosis, as well as setting the severity of oligohydramnios, can provide a basis for choosing a course of treatment.
Treatment and prevention during pregnancy
Treatment
It all depends on the severity of the disease and the causes that caused it. For example, if a metabolic disorder in a pregnant woman (obesity) provoked oligohydramnios, a woman will be prescribed to change her diet and diet.
At moderate polyhydramnios usually a pregnant woman is treated on an outpatient basis. Regular consultations with a doctor, taking special medications, reducing physical activity and physical activity at this time are mandatory.
Often put "paired" diagnosis: aging of the placenta and oligohydramnios. This requires taking certain drugs, as it develops dangerous pathology pregnancy - fetoplacental insufficiency. Most often, drugs such as Actovegin are prescribed.
At severe oligohydramnios required admission to hospital. If the risk of fetal life is quite high, the doctor may prescribe a caesarean section. If the gestational age allows, and the diagnosis does not tolerate other solutions, they also resort to early delivery.
Prevention
- Avoid strenuous exercise do not lift heavy things from the beginning of pregnancy
- Monitor your diet, eat fractionally, at least five times a day. Give up fast food and other "harmful things", monitor weight gain
- Timely submit all tests, follow all the doctor's instructions so that in case of danger, make a diagnosis in time
- Walks in the open air, rest, positive emotions, the ability to relax. No matter how much they talk about the psychology of a pregnant woman, the significance of this aspect will not decrease. Unfortunately, constant stress and inability to control one's own emotions, one way or another, affects the course of pregnancy. Therefore, from this point it is worth starting the whole process of preparing for bearing a baby.
Do not be afraid of this diagnosis, severe oligohydramnios is not so common. But if the diagnosis is made, medical intervention cannot be avoided.
Only disciplined, responsible patients can hope for a successful outcome of pregnancy and childbirth with such a complex diagnosis.
Instead of a conclusion:
- oligohydramnios is a lack of amniotic fluid, which affects the metabolism between the mother and baby and can lead to serious problems growth and development of the child;
- a timely diagnosis and the fulfillment of all medical prescriptions for a pregnant woman indicate favorable predictions for the outcome of pregnancy;
- with oligohydramnios, the cause of this pathology is necessarily revealed, which requires correction;
- at moderate oligohydramnios a pregnant woman is treated on an outpatient basis, severe form of the disease requires hospitalization;
- if the diagnosis is a direct threat to the life of the baby, and the gestational age hypothetically suggests delivery, labor induction or caesarean section is likely;
- the occurrence of oligohydramnios does not depend on the age of the pregnant woman, nor on the number of births;
- a common cause that provokes this pathology is a disturbed metabolism, therefore, doctors strongly recommend women with obesity to go on a diet before planning a child
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Update: October 2018
Amniotic fluid is the fluid that surrounds the fetus throughout pregnancy. It consists of minerals, urea, glucose, proteins, fats and carbohydrates. Among the components of water are a large number of hormones, immune factors, bactericidal substances. With an increase in the duration of pregnancy, water accumulates hairs and skin scales of the fetus.
Why is amniotic fluid needed?
Amniotic fluid plays a very important role in keeping a little person alive. In fact, this is the only fetal habitat that performs the following tasks:
- prevents mechanical damage fetus
- creates a favorable space for the fetus to move freely
- protects the umbilical cord from compression during childbirth
- actively involved in the metabolism of the fetus
- stimulates the development of the lungs (due to the movement of fluid in them in two directions)
- has antimicrobial properties
How is amniotic fluid formed?
Amniotic fluid accompanies the fetus for almost the entire pregnancy. In the first trimester, when the organs of the embryo are just being formed, part of the maternal blood penetrates through membranes, forming a small liquid level. This level can be seen as early as the 3rd week of pregnancy. It is believed that the baby's blood plasma can also "leak" through his skin in the shortest possible time.
In the second trimester, the main source of amniotic fluid is the fetus itself. Urine and fluid secreted by the lungs enters the space surrounding it.
From there, it can be swallowed by the fetus, and part is absorbed immediately into the mother's blood. For example, during a full-term pregnancy, the lungs of the fetus secrete up to 400 ml of fluid per day, the volume of urine per day can reach 1 liter.
Ingestion of water begins from 18-20 weeks of gestation, by 40 weeks the fetus swallows up to 500 ml of water per day (see). In 3 hours, the amniotic fluid is completely renewed.
The total amount of amniotic fluid depends on the balance of these two processes (formation and excretion of fluid).
What is low water?
Oligohydramnios - a decrease in the level of amniotic fluid to 0.3-0.5 liters during a full-term pregnancy. About 0.3-5.5% of all pregnancies are accompanied by oligohydramnios of varying severity.
Causes of oligohydramnios
The main cause of oligohydramnios during pregnancy is considered a violation of the kidneys of the fetus. But there are many more factors that affect the balance of amniotic fluid:
- Fetal malformations
- posterior urethral valves
- absence or narrowing of the urethra
- bilateral obstruction of the ureters and other parts of the urinary tract
- cut belly syndrome
- absence of two kidneys
- bilateral cystic dysplasia of the kidneys
- polycystic kidney disease (infantile form)
- cloacal anomalies
- Chromosomal abnormalities of the fetus
- Violation of the placenta (anomalies in the development of the placenta,)
- Postterm pregnancy
- Antenatal fetal death
- Syndrome of "strapped twin" in multiple pregnancy
- Oligohydramnios caused by prescription of prostaglandin synthetase inhibitors
- Oligohydramnios due to prenatal water leakage
- causeless (idiopathic) oligohydramnios
Absence of both kidneys
The malformation, more common in boys, is characterized by the complete absence of both kidneys and severe oligohydramnios. This condition is lethal, that is, the fetus dies in utero or immediately after birth. The causes of pathology are also considered chromosomal abnormalities and exposure to adverse factors (maternal diabetes, smoking and cocaine use, rubella virus damage).
During an ultrasound, the doctor notes low level amniotic fluid, the absence of a shadow of the kidneys and bladder. It is important to note that if bladder is visible, then the fetus still has at least one kidney. And with unilateral agenesis (absence of a kidney), the condition of the fetus usually does not suffer, the quality of life of such a child is practically no different from other children.
Infantile form of polycystic kidney disease
A hereditary disease, the main symptom of which is huge kidneys with cystic deformity (in the form of large cavities). The disease is usually detected in the second half of pregnancy with the help of ultrasound, an additional sign is severe oligohydramnios. The prognosis of the disease is quite poor, most children do not survive the first year. If a pathology is detected, it is necessary to undergo a complete karyotyping (determination of the number and shape of chromosomes), since the risk of recurrence of polycystic kidney disease in future children is 1:4.
Posterior urethral valve syndrome
Pathology of male fetuses, in which valves form in the urethra. These outgrowths interfere with the outflow of urine from the bladder. It stretches over time. With the progression of the disease, the kidneys also increase. Therefore, on ultrasound, these babies are found big kidneys, distended bladder and oligohydramnios. The prognosis depends on the onset of the disease and the degree of development of the lungs (very often they are underdeveloped).
Prune Belly Syndrome
A rather rare congenital malformation of a child, combining three main features:
- absence or underdevelopment of the muscles of the anterior abdominal wall
- violation of the structure of the urinary system in the form of a large bladder
- undescended testicles into the scrotum
In the case of a severe form of the syndrome, other anomalies can be added to these signs: dilatation of the ureters, dysplasia of the kidneys, and dilatation of the renal pelvis. Sometimes this syndrome is combined with Potter's syndrome, when the kidneys are affected in a child due to blockage of the urinary tract, the lungs do not develop, and a state of oligohydramnios occurs.
The syndrome is diagnosed already from the end of the second trimester, when an ultrasound scan reveals a huge fetal bladder. The prognosis of this disease is unfavorable, especially with the development of oligohydramnios (in this case, abortion is suggested). If diagnosed light form, then observation and surgical intrauterine treatment are possible, although in this case the chances of the child surviving the first year are very small.
Cloacal anomalies
Anomalies of the cloaca are a rare combination of malformations of the genitourinary system and digestive tract fetus. Violations occur at the stage when these two systems are still combined into one.
Ultrasound reveals fluid and cysts in the child's abdomen, absence or misdevelopment kidneys, defects of the duodenum. Often the bladder and intestines are on the outside of the abdomen and are not covered by skin. With such pathologies, screening may indicate elevated level AFP.
Often pathology leads to the death of the child, but modern surgical methods make the chances for the life of such babies quite high.
General features of malformations of the urinary system of the fetus:
- Most of these defects are accompanied by a reduced amount of amniotic fluid (due to the small amount of urine produced)
- Severe oligohydramnios in pregnant women or anhydramnios (complete absence of water) are an unfavorable prognostic sign. In such cases, underdevelopment of the lungs is often observed - main reason death of newborns with similar defects.
- Some malformations can be treated with surgery (bypass surgery) during pregnancy.
- There is an isolated increase in the kidneys, not accompanied by oligohydramnios, passing independently during pregnancy.
Chromosomal abnormalities of the fetus
Most chromosomal diseases occur with polyhydramnios or a normal amount of water. In some cases (if the syndrome is associated with disorders in the urinary system), there may be a decrease in the level of amniotic fluid. The main diagnostic value is the second trimester and others ultrasonic signs chromosomal pathologies.
Intrauterine infections
In 30-40% of cases of severe oligohydramnios, infection of the membranes occurs. In the transmission of infection from the mother to the fetus, it is the placenta and the membranes of the fetus that serve as an intermediary. Their inflammatory changes lead to placental insufficiency, a decrease in the level of water and a delay in the development of the child. Complete absence water is often observed during infection in the 1st trimester, resulting in the formation of congenital malformations of the fetus.
Fetoplacental insufficiency
Insufficient blood supply to the fetus by the placenta can occur for many reasons:
- genetic disorders of the placental bed
- infections
- preeclampsia
- diabetes mellitus and other chronic maternal diseases
- impaired ovarian function and many other factors
But the result is always the same: gradual (and sometimes abrupt) oxygen starvation fetus. The most sensitive organ to hypoxia is the brain. Nature has invented a way to protect it by redistributing blood through the vessels of the fetus. As a result, other organs begin to receive less oxygen. These include the kidneys with the lungs, which are directly responsible for the amount of amniotic fluid. Therefore, with placental insufficiency, oligohydramnios is a common occurrence.
Postterm pregnancy
The exact causes of oligohydramnios in post-term pregnancy are still not clear. Possible cause is the inability of the mother's body to meet the needs of an overripe fetus, which leads to placental insufficiency and, as a result, to oligohydramnios.
Antenatal fetal death
Prenatal death of a child is almost always accompanied by oligohydramnios. First, most often, acute fetoplacental insufficiency leads to death. Secondly, immediately after the death of the fetus, its kidneys and lungs stop producing amniotic fluid. Therefore, the decrease in the level of amniotic fluid can be very sharp, and the volume of the abdomen can decrease significantly.
"Squeezed Twin" Syndrome
With multiple pregnancy with twins, that is, as a result of the fertilization of one egg, subsequently divided, the number of complications is quite large. One of the most formidable and frequent pathologies is the syndrome of fetal blood transfusion.
Almost 70% identical twins have common placenta, that is, they are monochorionic monozygotic twins. It often happens that additional vessels are formed in the thickness of this placenta, connecting the twins. If, at the same time, the part of the placenta that supplies blood to one child (donor) begins to work worse, then most of the blood passes to the second twin (recipient). As a result, the recipient begins to allocate more urine, he has polyhydramnios. And the donor receives less blood and oxygen, begins to lag behind in growth and oligohydramnios is formed.
Without treatment, such a pathology first leads to the death of the donor from oxygen starvation, and then the recipient from severe swelling and intoxication. But modern methods can significantly reduce the mortality and morbidity of such twins:
- coagulation of additional vessels with a laser
- C-section as soon as possible after the death of the donor fetus (to save the life of the recipient fetus)
- in the short term, with the death of a donor - closing his umbilical cord (so that decay products and hormones do not enter the living fetus)
Iatrogenic oligohydramnios (caused by indomethacin)
The production of urine by the fetus, and hence the level of amniotic fluid, is controlled by many hormones and substances. These substances include prostaglandins, which regulate the diameter of the renal arteries. Drugs that inhibit the synthesis of prostaglandins reduce renal blood flow and the amount of urine excreted by the child, which threatens the kidneys.
Indomethacin, a common drug with this effect, is used to reduce the amount of amniotic fluid and prolong pregnancy. It must be used with extreme caution, as it can lead to kidney failure fetus.
Leakage of amniotic fluid
Classic, followed by the outflow of amniotic fluid. Often, the membranes rupture before contractions. At full-term pregnancy, after this, childbirth begins, and their course differs little from classic version. Completely different outcomes and prognosis occur if the fetal bladder ruptures before 36 weeks of gestation.
Causes premature rupture membranes
- failure of the cervix (isthmic-cervical insufficiency)
- infection of the membranes
- polyhydramnios
- malposition of the fetus and narrow pelvis
- medical manipulations (amniocentesis, cordocentesis and others)
If the rupture of the membranes occurred from below, then more often there is a complete outpouring of water and subsequent childbirth. If the gap is located at the top, then the water can leak gradually, with little or no decrease in the overall level of amniotic fluid. Therefore, the combination of even moderate oligohydramnios with suspicious liquid vaginal discharge can be dangerous for the health of the mother and child, it is advisable to conduct additional research. Test strips can detect amniotic fluid in the vagina and prescribe treatment. Depending on the gestational age, the condition of the fetus and mother, blood and urine tests, the pregnancy will be extended or labor induction will be carried out.
Idiopathic oligohydramnios
Oligohydramnios, not accompanied by any of the above pathologies, is considered idiopathic, that is, without cause. Most often, the amniotic index is slightly reduced, and the condition of the mother and fetus is stable. With an increase in the period, the amount of water can return to normal, or it can remain small until the very birth, without affecting the health of the child.
Symptoms of oligohydramnios
- the volume of the abdomen and the height of the fundus of the uterus lags behind the timing of pregnancy
- low fetal activity
- liquid discharge from the vagina (when the membranes rupture)
On every visit to women's consultation pregnant women measure the volume of the abdomen, which can indirectly reflect the amount of water. By the end of a full-term pregnancy, it reaches 90-100 cm, but the value may vary with obesity in a woman.
The main method for diagnosing oligohydramnios is the definition amniotic index with the help of ultrasound.
How is the amount of amniotic fluid determined by ultrasound?
The main way to determine the level of amniotic fluid is to conduct an ultrasound examination. There are several methods that allow you to estimate the volume of amniotic fluid with great accuracy.
- Measurement of the vertical "pocket"
If the largest of the pockets in two planes does not exceed 1 cm, then oligohydramnios can be diagnosed.
- Determination of the amniotic fluid index
During this method, the entire cavity of the pregnant uterus is divided into 4 parts using two perpendicular lines passing through the navel. The maximum diameter of the liquid volume is then measured in each quadrant. Summing up the data obtained in all quadrants, the amniotic fluid index is obtained.
To evaluate the results for each period of pregnancy, special centile tables have been created, according to which doctors write a conclusion. If the index value is less than 5 percentiles, then oligohydramnios can be diagnosed. Although oligohydramnios is of practical importance only when the index is less than 2.5 percentile.
If you need to assess the level of amniotic fluid in the first half of pregnancy, then the uterus is divided into two quadrants by a vertical line.
Gestational age Amniotic fluid index, cm 5th percentile 50 percentile 95th percentile 14 weeks 2,8 5,0 8,6 16 weeks 3,6 5,8 9,6 18 weeks 4,6 6,8 11,1 20 weeks 5,5 8,0 12,9 22 weeks 6,3 9,3 14,9 24 weeks 7,0 10,7 16,9 26 weeks 7,5 12,0 18,7 28 weeks 7,6 13,0 19,9 30 weeks 7,5 13,6 20,6 32 weeks 7,1 13,6 20,4 34 weeks 6,4 12,9 19,4 36 weeks 5,6 11,8 17,9 38 weeks 4,7 10,3 15,9 40 weeks 3,7 8,6 13,9 Why is oligohydramnios dangerous during pregnancy?
- Appearance of amniotic bands. If the amount of amniotic fluid is sharply reduced, then adhesions may occur between the skin of the fetus and the amniotic membrane. They can wrap around or pull parts of the fetus, which leads to deformation or even amputation of the limbs.
- Violation of labor activity (due to a fetal flat bubble). Contractions may be too weak, irregular.
- Compression of the umbilical cord during childbirth, up to acute hypoxia and death of the fetus.
- Disturbed position of the fetus in the uterus.
How to treat oligohydramnios?
The main principle of treatment of oligohydramnios during pregnancy is pathogenetic. This means that it is impossible to cure a decrease in the level of amniotic fluid in itself, you need to find the cause of this condition. To do this, a gynecological examination, monitoring of fetal heartbeats, genetic screenings, and tests are connected to ultrasound.
If, apart from low water, there are no additional features then no treatment is needed. Monitoring of the condition of the mother and child is required. There is information that mothers can lead to oligohydramnios. Some pregnant women with edema begin to arrange "unloading" days with a restriction of the fluid they drink, which is highly undesirable. An adequate amount of fluid per day is necessary to maintain balance in the body.
If additional signs of trouble are found, the primary disease should be treated:
- At birth defects fetus – surgical treatment(if appropriate) or termination of pregnancy. Possible expectant tactics.
- For chromosomal abnormalities- assessment of the viability of the child, after which - termination of pregnancy or expectant management
- At intrauterine infection - antiviral or antibacterial treatment (if necessary), monitoring the child's condition. Before treating such diseases, it is necessary to carry out all the necessary tests.
- With placental insufficiency- treatment with vascular drugs up to 20 weeks (Kurantil), after 20 weeks - expectant management. With a strong delay in fetal development - deliver the pregnant woman as early as possible (preferably after 33 weeks)
- With a delayed pregnancy- labor induction or expectant management normal condition fetus)
- With complications of multiple pregnancy- treatment by shunting the vessels of the placenta, pumping out excess amniotic fluid from the recipient fetus. When the donor fetus dies, they usually try to deliver the pregnant woman as early as possible to save the life of the recipient fetus.
- Breaking the fruit membranes- induction of labor or expectant management. the main task- prevent infection of the fetus and allow the lungs to develop (with the help of hormone therapy).
How is childbirth conducted with severe oligohydramnios?
If the ultrasound reveals significant oligohydramnios, then doctors perform an early opening of the amniotic sac. The fact is that with a small volume of amniotic fluid, the bladder acquires a flat shape. As a result, it not only does not stimulate tribal activity, but may also break it. Therefore, it is better to open such a fetal bladder.
If oligohydramnios is extremely severe, then if indicated, a caesarean section may be used.
Prevention of oligohydramnios
You can reduce the risks of oligohydramnios (but not make them zero) with the help of proper preparation to pregnancy and compliance with all doctor's recommendations:
- Take folate 400 mcg daily
- Get tested for HIV, syphilis and TORCH-complex
- If a woman did not have chickenpox and rubella in her childhood, get vaccinated against rubella and chickenpox before pregnancy.
- To refuse from bad habits
- Control diabetes, hypertension and other chronic diseases
- Avoid taking medication without consulting a doctor during pregnancy
A pathological condition during pregnancy, expressed by a decrease in the amount of amniotic fluid, is called oligohydramnios. Pathology is quite rare (4% of cases) and usually indicates that the bearing of a child proceeds with deviations.
The development of the fetus is largely dependent on the amniotic fluid. It is she who protects the placenta and umbilical cord, protects the fetus from mechanical influences, and ensures the metabolism between him and the mother. The amount of amniotic fluid increases with the gestational age. Normally, by week 38, they reach 1000-1500 ml. At pronounced oligohydramnios the amount of water is only about 500 ml. Their lack can adversely affect the health of the unborn baby. If the amount of water has decreased by 400-700 ml, then they talk about moderate pathology.
Causes
Low water during pregnancy can occur for the following reasons:
- Congenital malformations of the kidneys of the fetus. A small amount of water, in this case, is observed from early dates.
- Severe chronic diseases in a woman (diseases of cardio-vascular system, diabetes, kidney disease, etc.).
- Infectious diseases genital organs (chlamydia, ureaplasmosis, trichomoniasis, mycoplasmosis, etc.)
- Obesity.
- Metabolic disease.
- Severe dehydration of a woman caused by diarrhea, vomiting.
- Smoking future mother.
- transferred bacterial, viral infections(Influenza, SARS).
- Past TORCH infections (herpes, rubella, toxoplasmosis).
- Pathologies of the placenta (placental insufficiency, premature aging of the placenta, developmental anomalies).
- Multiple pregnancy (oligohydramnios in one fetus is often combined with the presence of polyhydramnios in another).
- Postponed pregnancy.
- Leakage of amniotic fluid, as a result of damage to the fetal bladder.
Symptoms of oligohydramnios
Symptoms of a moderate decrease in the amount of amniotic fluid are practically not expressed, the state of health in pregnant women is not disturbed. Severe oligohydramnios is characterized by the following features:
- Inconsistency in the size of the abdomen with the gestational age. During external examination by a gynecologist, there is a decrease in the height of the fundus of the uterus and the circumference of the abdomen compared with indicators for this period.
- The appearance of pain during fetal movements.
- The appearance of periodic aching pains lower abdomen.
- Deterioration of general well-being (nausea, weakness, dry mouth).
It is possible to confirm or refute oligohydramnios during pregnancy only on ultrasound. However, one ultrasound procedure will not be enough to make a diagnosis. The study must be carried out several times in a row within 1-2 months.
Consequences
With oligohydramnios, the fetus becomes vulnerable to external mechanical influences, the likelihood of squeezing it internal organs quite high, which can lead to the development of clubfoot, curvature of the spine. In a small amount of water, the fetus cannot move freely, its movements are constrained, and this does not affect its physical development in the best way. In addition, the baby begins to experience deficiency nutrients located in amniotic fluid. The fetus may lag behind in development, experience oxygen starvation, as a result of which the brain begins to suffer. His skin dry out, hypotrophy develops.
Oligohydramnios increases the likelihood of umbilical cord compression and intrauterine fetal death is very high. Sometimes adhesions form between the amnion and the skin of the fetus, which later acquire the character of threads, strands. These strands and threads wrap around parts of the umbilical cord, the fetus, causing its disfigurement, amputation of fingers, limbs.
In half of the cases, pregnancy ends with oligohydramnios premature birth.
How is the treatment
Treatment of severe oligohydramnios depends on the period. If the pathology was detected in the third trimester, then the pregnant woman is hospitalized to the hospital, where she is given vitamins, drugs that improve oxygen delivery to the fetus (Actovegin) and blood circulation in the placenta (Kurantil). Medications are also prescribed to maintain normal blood sugar levels and pressure. If necessary, treatment of infections and other diseases that provoked the pathology is carried out. The condition of the fetus is monitored daily by CTG (cardiotocography). If possible, the pregnancy is extended to natural childbirth. If the child's condition worsens, then an urgent caesarean section is performed.
If oligohydramnios was detected before 28 weeks, then doctors usually recommend interrupting it, since its outcome in most cases cannot be predicted.
Treatment of moderate oligohydramnios can be carried out on an outpatient basis, provided that the pregnant woman will take all prescribed drugs, limit motor activity, eliminate heavy physical exertion.
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