The amniotic fluid index is normal. What does an obstetrician-gynecologist usually prescribe? What does the weekly amniotic fluid index look like?

Throughout pregnancy, amniotic fluid performs a wide variety of tasks, ensuring the normal functioning of the "mother - placenta - fetus" system. From quantity and quality about amniotic fluid the successful outcome of pregnancy depends on a lot.

Amniotic fluid (that's the "scientific" name for amniotic fluid) is basically a filtrate from the mother's plasma (the liquid part of the blood). In its formation, an important role is also played by the secretions of cells lining the fetal bladder from the inside. The fetus not only absorbs the liquid medium surrounding it, but is itself the source of its formation, since in the later stages prenatal development in development amniotic fluid the kidneys and lung tissue of the fetus are involved. It has been proven that at the end of pregnancy every day the fetus excretes about 600-800 ml of urine, which is important integral part amniotic fluid.

The volume of amniotic fluid depends on the duration of pregnancy. The increase in volume is uneven. In, in, the amount of amniotic fluid is on average 30 ml, in - about 100 ml, in - 400 ml, etc. The maximum volume is noted to, averaging 1000-1500 ml. By the end of pregnancy, the amount of water may decrease to 800 ml as a result of increased excretion of fluid from the woman's body.

Amniotic fluid performs a number of important functions. They create conditions for the free movement of the fetus, protect its body from adverse external influences, protect the umbilical cord from compression between the body of the fetus and the walls of the uterus. Thus, the volume of amniotic fluid is a kind of indicator of the normal course of pregnancy.

What is low water?

Oligohydramnios - a decrease in the amount of amniotic fluid to 500 ml or less, associated with a violation of their formation and absorption. This condition occurs in about 0.3-0.5% of pregnant women.

Among the causes leading to oligohydramnios, such as preeclampsia, hypertension in the mother are more often distinguished, and the severity of oligohydramnios and the frequency of its development depend on the duration of this pathology and its severity. A decrease in the amount of amniotic fluid also occurs against the background of infectious and inflammatory diseases of the mother, such as toxoplasmosis, cytomegalovirus, mycoplasma infection and other sexually transmitted diseases, as well as chronic inflammatory diseases of the mother (chronic tonsillitis - inflammation of the tonsils, kidney disease, gynecological diseases and etc.). Insufficient production of amniotic fluid occurs with lesions of the excretory system of the fetus, such as blockage of the urethra, ureters, as well as with impaired renal function due to a decrease in the amount of primary fetal urine. Chronic hypoxia (oxygen deficiency) of the fetus is also one of the causes of oligohydramnios.

The mechanism of development of oligohydramnios in chronic hypoxia fetus has not been fully studied, but it is suggested that against the background of oxygen deficiency, a reflex redistribution of blood flow occurs in favor of vital important organs: brain, fetal heart, adrenal glands - while bypassing the lungs and kidneys, which are the main sources of amniotic fluid production at the end of pregnancy.

It should be noted that the appearance of oligohydramnios does not depend on the age of the patients - it occurs with the same frequency in both primiparous and multiparous.

Diagnosis of oligohydramnios

The doctor can suggest a decrease in the amount of amniotic fluid when the standing height of the uterine fundus (its uppermost part) and abdominal circumference lag behind the normative indicators for the expected gestational age, as well as when the fetal motor activity decreases. With external examination, parts of the fetus are clearly defined, heart tones are heard, while the uterus is dense. More precise definition the severity of oligohydramnios is possible with ultrasound.

The diagnosis of oligohydramnios on ultrasound is based on determining the amount of amniotic fluid and on the calculation of the amniotic fluid index (AFI), which is automatically calculated by the device ultrasound after measuring the amount of water in several places. The amount of amniotic fluid is considered normal if the IAI value is in the range of 5 to 8 cm; IAI from 2 to 5 cm is regarded as moderate oligohydramnios, IAI less than 2 cm as pronounced oligohydramnios.

Doppler study of blood flow in the system "mother - placenta - fetus", which is carried out in the umbilical artery, in the middle cerebral artery of the fetus and both uterine arteries pregnant women are also necessary, because with oligohydramnios, there may be a violation of blood flow.

As the amount of amniotic fluid decreases, the frequency of pronounced forms of fetal growth retardation (hypotrophy) increases, determined using ultrasonic fetometry - the most reliable objective method for assessing the growth and development of the fetus, which allows at each specific gestational age to accurately determine the correspondence of the size of the fetus to this period, as well as the degree their deviations from the norm. At the I degree of malnutrition, there is a lag of fetometry indicators from the normative indicators by , at II - by , at III - by more than . In newborns born from mothers with severe oligohydramnios, signs of malnutrition of varying degrees are more often noted. Sometimes, with severe oligohydramnios, premature "ripening" of the placenta is detected (a condition in which the placenta begins to "prepare" for childbirth earlier than necessary, as a result of which its functions are impaired), which leads to a deterioration in the condition of the fetus. In most pregnant women with oligohydramnios, Doppler examination of the state of blood flow shows changes in its parameters. For clarification, cardiotocography (CTG) - registration of the fetal heartbeat - modern method diagnostics prenatal state fetus, which is carried out after 32 weeks of pregnancy.

There are also primary oligohydramnios, which develops with intact membranes, and secondary, or traumatic, associated with damage to the membranes and the gradual outflow of amniotic fluid - a woman may not feel this. Elements of amniotic fluid can be detected when examining vaginal discharge; the so-called amniotest is the most effective and fastest method for diagnosing premature rupture of the membranes, based on the determination of placental protein in the vaginal discharge. Normally, this protein is not present in the vaginal discharge. If the outflow of water is significant, the woman feels discomfort from the fact that her underwear periodically becomes wet from the water. In case of detection of the outflow of amniotic fluid (premature rupture of membranes) with premature pregnancy the woman needs to be hospitalized in a separate room, bed rest and mandatory monitoring of the state of health of the mother and fetus to resolve the issue of further management of the patient. If the pregnancy is full-term, then in the absence of contractions, labor stimulation begins.

What is low water?
There are two forms of oligohydramnios:

early, which is due to functional insufficiency of the fetal membranes. This form is diagnosed using ultrasound at term;
late, usually detected after, when oligohydramnios occurs due to insufficient functional activity of the membranes or violations of the fetus.

Why is low water dangerous?

An extremely unfavorable prognostic sign is the detection of severe oligohydramnios in the second trimester of pregnancy, i.e. on deadlines. With the development of oligohydramnios during these periods, abortion occurs, intrauterine death of the fetus or newborn in the first days of life. During this period, the body of the fetus is not yet adapted to independent extrauterine existence, and special equipment is needed to maintain the life of the newborn, however, the earlier the abortion occurs, the more unfavorable the prognosis.

As mentioned above, an insufficient amount of amniotic fluid, especially pronounced oligohydramnios, is a marker of an unfavorable course of pregnancy. If there is a suspicion of the development of oligohydramnios, it is necessary first of all to exclude fetal malformations (using ultrasound), since the relationship between these pathologies has been proven. But oligohydramnios itself (its pronounced forms) can lead to the development of intrauterine malformations (the occurrence of adhesions between the skin of the fetus and the water membrane, which lead to entanglement of parts of the fetus and the umbilical cord and prevent normal growth and fetal development). With a decrease in the amount of amniotic fluid, there is a high risk of compression of the umbilical cord and intrauterine death of the fetus, as well as its intrauterine infection. All of these complications often dictate the need for a speedy delivery by caesarean section at any stage of pregnancy if there is a risk to the woman's health.

With moderate oligohydramnios, quite often children are born with malnutrition of varying severity (discrepancy between the size of the newborn this deadline pregnancy). But at the same time, the outcome of pregnancy is favorable for the vast majority of women - children are born in a satisfactory condition.

Management of pregnancy and childbirth with oligohydramnios

The tactics of conducting pregnancy and childbirth largely depends on the time of occurrence and the severity of oligohydramnios. If oligohydramnios is detected before, then the woman needs comprehensive examination(hormonal, biochemical, ultrasound) to determine the condition of the fetus. If fetal malformations are detected, the pregnancy is terminated by medical indications. If oligohydramnios is detected at the beginning of the third trimester of pregnancy, in combination with intrauterine growth retardation of the fetus, the outcome of pregnancy is difficult to predict. In this regard, with oligohydramnios, especially combined with intrauterine growth retardation of the fetus, early delivery is carried out after.

Pregnant women with oligohydramnios are prescribed complex therapy aimed at improving uteroplacental blood flow, metabolic processes in the placenta, restoration of gas exchange in the "mother - placenta - fetus" system and treatment of the underlying disease. During treatment, every 7-10 days, ultrasound is performed, once every three days - dopplerography of the vessels in the "mother - placenta - fetus" system and daily - cardiomonitor monitoring of the fetus. If there is no result of outpatient treatment or if the condition of the fetus worsens, hospitalization is necessary for constant monitoring and determination of further tactics for managing pregnancy.

If the condition of the fetus worsens according to cardiotocography and indicators of fetal-placental blood flow, delivery is performed by caesarean section on an emergency basis.

If a flat fetal bladder is found during childbirth, when there is no or little amniotic fluid in front of the baby’s head, as a result of which the fetal bladder does not wedged into the cervix during childbirth, an amniotomy is performed (artificial opening of the fetal bladder). This is necessary for the further development of labor activity, because. flat amniotic sac normal course labor activity - dilatation of the cervix.

Thus, the health of the unborn child with oligohydramnios depends on the degree of decrease in the amount of amniotic fluid, the severity of intrauterine fetal retention, the duration of pregnancy, the effectiveness of the therapy and the method of delivery.

Polyhydramnios

Polyhydramnios is a condition characterized by excessive accumulation of amniotic fluid. With polyhydramnios, the amount of amniotic fluid exceeds 1.5 liters and can reach 2-5 liters, and sometimes more. The causes of polyhydramnios are not fully understood, but more often polyhydramnios is observed in diabetes mellitus (a disease in which glucose metabolism is impaired), the presence of an acute or chronic infectious process in the mother, Rh conflict (the presence of a positive Rh factor in the mother and negative in the fetus, development of antibodies to fetal erythrocytes in the mother), multiple pregnancy, fetal abnormalities.

One of the causes of polyhydramnios is a violation of the function of the cells lining inner surface the water membrane of the fetus, which leads to an increase in the production of amniotic fluid and a delay in their excretion. It is assumed that in this case great importance have infectious (including viral) diseases of a pregnant woman (chlamydia, mycoplasmosis, cytomegalovirus infection, syphilis, acute respiratory infections). As already mentioned, polyhydramnios often accompanies fetal malformations. With malformations, the amniotic fluid is not swallowed by the fetus - this is the main mechanism that regulates the amount of amniotic fluid and thereby prevents polyhydramnios. The most common malformations in polyhydramnios are congenital malformations of the central nervous system And gastrointestinal tract fetus.

There are acute and chronic polyhydramnios. Chronic develops gradually, so a pregnant woman has time to adapt to this condition and, as a rule, does not experience discomfort from an increase in the uterus. Acute polyhydramnios occurs quickly, and in this case, the pregnant woman complains of shortness of breath (due to the high standing of the diaphragm), general weakness, increased heart rate, and swelling. As a rule, acute polyhydramnios develops in earlier stages of pregnancy - in. Unlike acute polyhydramnios, in chronic intrauterine pressure does not exceed the norm. If fetal malformations are excluded, foci of infection are treated, as well as prevention of further progression of polyhydramnios, then the state of the fetus does not suffer under these conditions and the baby is born healthy.

Diagnosis of polyhydramnios

With the development of polyhydramnios, there is a significant increase in the size of the uterus: the circumference of the abdomen and the height of the fundus of the uterus (the distance from the womb to the bottom of the uterus) significantly exceed those of the expected gestational age. The uterus is tense, parts of the fetus are difficult to feel, while the fetus easily changes its position, and its excessive motor activity can be observed. Fetal heart sounds are not clearly audible.

In the diagnosis of polyhydramnios important role belongs to ultrasound. During the study, the size of the vertical pocket is determined (ultrasonic criterion for assessing the amount of amniotic fluid): when mild degree polyhydramnios its value is 8-11 cm, with an average degree - 12-15 cm, with pronounced polyhydramnios this figure reaches 16 cm or more. If the diagnosis of polyhydramnios is established, then it is necessary to exclude the presence of possible fetal malformations using additional methods research, in particular amniocentesis - the sampling of a small amount of amniotic fluid (through a puncture of the anterior abdominal wall, uterine wall) for biochemical, hormonal, immunological, genetic research. Of great diagnostic importance is the determination of the concentration of alpha-fetoprotein in the amniotic fluid. This protein is produced in the liver of the fetus, and then, along with urine, enters the amniotic fluid. A high concentration of alpha-fetoprotein indicates anomalies in the development of the fetus, mainly from the nervous system. Amniocentesis is always performed under ultrasound guidance. The most important information on the condition of the fetus can give the results of a direct study of his blood, obtained by taking it from the umbilical cord (cordocentesis). This procedure is carried out strictly according to the indications, which are the diagnosis of congenital and hereditary pathology, intrauterine infection etc. Cordocentesis is performed after 18 weeks of pregnancy under ultrasound control.

Possible complications of polyhydramnios

In chronic polyhydramnios of mild degree, pregnancy proceeds favorably, and in most cases, childbirth occurs on time. The most common complication is miscarriage. With severe polyhydramnios, premature birth often occurs. With increasing circulatory disorders in a pregnant woman (pronounced edema, severe shortness of breath), sometimes there is a need for artificial termination of pregnancy.

Management of pregnancy and childbirth with polyhydramnios

Pregnant women with polyhydramnios are subject to hospitalization and a thorough examination to identify the cause of its occurrence (diabetes mellitus, the presence of a chronic infection, fetal malformations, etc.). The method of treatment depends on the identified pathology - in the presence of an infectious process, immunoglobulin therapy (intravenous administration of immunoglobulin preparations) is used, it is also possible to use antibiotic therapy. If during the study revealed fetal malformations that are incompatible with life, the pregnancy is terminated regardless of the term.

Childbirth with polyhydramnios is often complicated. One of the frequent complications is the weakness of labor activity, which is associated with overstretching of the uterus due to an excess amount of amniotic fluid. As a result, the excitability of the uterus and its contractility are reduced. The course of childbirth can be protracted.

Due to the fact that the outflow of amniotic fluid can be complicated by prolapse of the umbilical cord, small parts of the fetus, as well as premature detachment normally located placenta, there is a need for artificial opening of the fetal bladder (amniotomy) with incomplete opening of the uterine os (3-4 cm), in order to release the amniotic fluid, delaying its flow with a hand inserted into the vagina.

For the prevention of bleeding in the aftermath and early postpartum period(in the first 2 hours after childbirth) prevent bleeding by intravenous or intramuscular administration of drugs that increase uterine contractility (oxytocin, methylergometrine).

In conclusion, it should be noted that for the timely diagnosis and, consequently, the treatment of the conditions described, it is necessary to follow all the recommendations of the doctor leading your pregnancy on time. This will avoid severe complications and help you have a healthy baby.

Eleonora Shagerbieva,
Obstetrician-gynecologist,
Science Center
obstetrics, gynecology
and perinatology RAMS

Discussion

I have 33 weeks IAI-44mm, moderate or severe oligohydramnios?

09/17/2018 02:44:13 PM, Janet

Pregnancy 23 weeks, they did an ultrasound of the amniotic fluid index of 133 mm, in conclusion they wrote signs of oligohydramnios, how serious and dangerous is this for the child?

05/14/2018 03:51:22 PM, Anastasia

Briefly and clearly

25.02.2018 12:39:48, nargis

I liked the article, the description is specific and clear.

09.03.2007 18:39:09

This topic is well described on the site http://babyblog.ru/
Look! I myself was looking for an answer for a long time, but then I found it on this site.

Feb 20, 2007 12:19:42 pm

Comment on the article "Nothing less ... How much amniotic fluid do you need?"

Amniotic fluid: quantity and quality. When and how do the waters break. By the turbidity of the waters, I can only say that they somehow look at the amount of suspension there. Starting at about the 28th week in the amniotic fluid on ultrasound, you can see ...

The amount of amniotic fluid increases during pregnancy. Replenishment occurs due to the liquid that perspires from blood vessels mother, as well as the amniotic sac appears at 8 weeks of gestation as a derivative of the embryoblast.

Discussion

From 36 weeks I was given moderate, and even 24 with something. CTG and Uzi once a week, looked at the dynamics, once came - and 14 - the norm. A week later, again 23. I was told that even if the couple caught a cold, the number of waters increases. When I gave birth, there were really a lot of mobs. The waters receded while we were going to the maternity hospital, probably a bucket)), the stomach immediately decreased so noticeably, I thought everything, there was no water, but on the ultrasound it turned out that there was still a fig left - and even 14. In general, the baby had something else to swim in during childbirth .

thanks for the infu.
Analyzes couple of weeks ago have been handed over under the expanded program - and all apprx.
gave up again yesterday. the pressure is excellent (only one day during the entire pregnancy and skipped, the swelling is minimal - there is something to compare with) of course, there was a lot of excess weight initially, but now the increase is only 7 - this is taking into account that each child has a weight, as if they were one by one, the placenta is huge, etc.
in general, I will try not to panic ahead of time and wait for the Friday visit to the residential complex ...

If my friend with polyhydramnios was prescribed to drink little water, why should I drink a lot? but it seems to me that everything is in order with you, as far as I remember in America, the indicators of the norm of water are much wider. How much amniotic fluid is needed? Oligohydramnios and polyhydramnios during pregnancy.

Discussion

They put oligohydramnios at 21-22 weeks. Just like you below the border. After 4 weeks, the control is the same.
Then at 33 weeks it somehow resolved by itself. It's back to normal. The child was born healthy.

Do you have any water leaks? I know that oligohydramnios is associated with 3 things: the child's kidneys (well, I'm sure everything is in order with you, N most likely it is "no pathologies"), the work of the placenta and water leakage.

Drinking a lot of water won't help you. it's a delusion. also, even if the water is normal, in the ultrasound picture it still looks like the child is directly clamped. I tracked this moment very well during this pregnancy, how much ultrasound they did to me, it always seemed to me that there was not enough water, but they always told me that everything was perfect :)

but it seems to me that everything is in order with you, as far as I remember, in America, the indicators of the water norm are much wider than Russian ones, that is, yours is "on the lower limit of the norm", it’s quite good norm in America!

The amount of amniotic fluid increases during pregnancy. Replenishment occurs due to the fluid that sweats from the blood vessels of the mother, as well as the urine of the fetus. Normally, amniotic fluid is poured out in the first stage of labor, when at a height ...

Discussion

a lot of water is pouring))) at the first moment (it was at three in the morning, half asleep), I thought that I had peed myself)) but where did so much come from ??? Yes, it felt like something was broken.
doctor said the right way to distinguish water from Popis (well, in addition to quantity, of course))) - this is the smell. water does not smell like urine. Here.
then, even before the start of contractions, and then until the very birth, fluid leaked all ten hours.

Even if you are in the shower, you will not confuse. They are different in temperature

Normally, the amount of water by the end of pregnancy is from 800 to 1500 ml. The composition of amniotic, or amniotic, water includes protein. The low content of amniotic fluid, in the vast majority of cases, indicates various deviations ...

Discussion

I was diagnosed with oligohydramnios at 22 weeks and they didn’t do ultrasound anymore like this and I’m walking now we are already 32 weeks old and it seems nothing scary child actively moving, and when they said about low water, the reason for it was not in the development of the child, but in the functioning of the placenta, and the baby was fine with both the kidneys and all other organs, so I hope everything will be fine! remake and do not go in cycles in it!

03/01/2006 19:35:31, lexandra

Although I am not a big specialist in amniotic fluid, I am sure that there is nothing to worry about. -) Although, of course, it also means a lot how much they less than normal. Although officially if it sounds like this. With oligohydramnios, the volume of liquid is not more than 60 ml. . Doctors associate its occurrence with the presence of malformations of the kidneys and urinary tract in the fetus, which limits or stops the flow of urine into the amniotic cavity. Oligohydramnios may be accompanied by intrauterine hypoxia and developmental delay. Harmful for skeletal system because the baby is limited in movement. Premature birth (after 28 weeks) is more common. The very process of childbirth can be delayed, because the opening of the cervix is slow. This is what I quoted from the book. BUT! in fact, if everything was so neglected for you, then the doctor would already be taking some action. Apparently, everything is not catastrophic for you, well, a little below average. I would clarify, if I were you, what does “below the norm” mean in your case, does the baby suffer? Just in case. My friend not so long ago gave birth to a healthy daughter, although she washed herself with oligohydramnios until the very birth. -)) I was terribly nervous! Don't worry. -)

Normally, the amount of water by the end of pregnancy is from 800 to 1500 ml. Amniotic fluid (aka amniotic fluid) during the entire pregnancy is COMPLETELY RENEWED in the fetal bladder every 3-4 hours.

Discussion

Before my first pregnancy, I had size A, during pregnancy it grew to B, but the worst thing happened when milk came after childbirth - my breasts were so wide open (Samantha Fox is resting) and immediately my entire breast was covered with stretch marks. There are no stretch marks elsewhere. And in this pregnancy, the size is already S.
If there is a lot of milk and you decide to stop feeding abruptly, then this is very painful and uncomfortable - you have to bandage your breasts to reduce lactation. If you gradually reduce the number of feedings, then all this can be avoided. But in any case, the chest will not be the same - usually it sags a little. But that doesn't mean it will get worse - just
a little different.

11/15/2002 12:03:30 PM, Liska(28)

1. The baby does not choke, because his lungs do not yet work, he does not breathe through them. Oxygen enters him directly into the blood from his mother through the umbilical cord.
3. Amniotic fluid is formed from body fluids, food affects kidney function
4. Allocations are normal for pregnant women if the amount does not exceed 2 panty liners in a day. This is what the doctor told me.
5. It is better, of course, to feed longer, at least until 6 months, when the child's digestion improves. But this is Vapshe's solution. Milk ends when you stop feeding, gradually reduce the number of feedings and the milk will automatically decrease to zero. If you stop abruptly, then there may be lactostasis.
2. I don't know :-))) An interesting question :-)

The color of amniotic fluid ... or fetal - in general, those in which the child swims :-) Does anyone know what color they should be in the norm and why it may not be as it should be? Let me explain - during the first pregnancy during childbirth, it was discovered that the waters were green (or greenish ...

Discussion

The color should be light straw, transparent. This I know for sure.

why green? Was it like this when you were born or during pregnancy? If during childbirth, it means that meconium got into the water - this is the baby's original feces. This is not fatal, it’s just that the child is given lavage after birth - they pump out water from the lungs and that’s it.
And if the color is green during pregnancy, then this is another question ...

I am quoting from an article in the latest issue of "Lisa. My Child" (November, Life in Water, p. 30). "Amniotic fluid arises as a result of the secretion of the amnion epithelium and filtration of the blood of the mother and fetus, and after 18 weeks they are mainly formed by the kidneys of the baby and by the end of pregnancy they represent almost the primary urine of the fetus. ... Scales of the skin of the fetus, fluffy hair, cheesy a lubricant that protects the skin of the fetus from constant exposure to the aquatic environment, products of the sebaceous glands... But the admixture of meconium (original feces) indicates the suffering of the fetus, since its anus opens only if it develops intrauterine hypoxia(oxygen starvation). Normally, the water is clear, slightly yellowish. The meconium-stained ones are green, which always alarms doctors and forces them to take urgent measures to normalize the child's condition, since this indicates an intrauterine suffering of the baby.

Violation of the formation and absorption of amniotic fluid threatens with oligohydramnios. Let's consider this concept in more detail.

What is low water?

An insufficient amount of amniotic fluid in obstetrics and gynecology is called oligohydramnios.

Amniotic fluid (or amniotic fluid)- the liquid environment in which the fetus is located during pregnancy.

This biological fluid performs several important functions. These include:

protective function- the water shell protects the child from the penetration of infections (due to the tightness of the shells and the immunoglobulins that make up the water), from mechanical influences from the outside (for example, from shocks and shocks), loud sounds (water muffles them), external fluctuations in pressure and temperature (maintaining optimal pressure and a constant temperature of 37 ºС, of course, if the mother is healthy and her body temperature does not exceed 37.8 ºС);
exchange function- the child absorbs the amniotic fluid, enriched with nutrients, and releases it back.
To all this, the fetal waters provide free movement of the crumbs inside the womb. Therefore, with a normal amount of amniotic fluid, the baby is cozy and comfortable, he is protected and provided with everything necessary.

What is in the amniotic fluid?

With increasing gestational age, the composition of the amniotic fluid changes, and becomes more diverse and saturated, which makes the waters slightly cloudy in appearance. The amniotic fluid is secreted by cells of the aquatic membrane.

At the beginning of pregnancy, amniotic fluid is almost the same in composition as blood plasma. They contain nutrients (proteins and fats), vitamins and minerals, hormones, enzymes, and more.

From the second trimester, the composition of this biologically active fluid is supplemented by dead skin cells (as a result of the natural process of changing the old skin layer to a new one), the fluff (hairs) of the fetus, the original cheese-like lubricant of the fetal body and its waste products (sterile urine).

Fertile waters are updated every 3 hours.
Drinking water does not affect the amount of amniotic fluid. From excessive fluid intake in a pregnant woman, only edema will appear.

The norm of the amount of amniotic fluid

When the amount of amniotic fluid deviates from the norm, doctors diagnose oligohydramnios or polyhydramnios. The doctor-diagnostician determines the amount of fluid during an ultrasound scan, starting from the second trimester of pregnancy.

The volume of amniotic fluid in medicine is commonly referred to as the amniotic fluid index (AFI).

Table - The norm of the amniotic fluid index by week

The norms may differ slightly from those given above, depending on the type of ultrasound machine. And also the value can be written not in millimeters, but in centimeters (1 cm = 10 mm).

Also, the amount of fetal water characterizes another indicator - the vertical size of the largest (free) water pocket (VC). This size should normally be in the range from 2 to 8 cm (or from 20 to 80 mm), with a borderline amount of water - from 2 to 1 cm (from 20 to 10 mm), and with oligohydramnios - less than 1 cm (or 10 mm).

What are the causes of oligohydramnios?

Depending on the severity of the pathology, moderate and severe oligohydramnios are distinguished.

Often you can find in the ultrasound protocol the inscription - "tendency to moderate oligohydramnios." This means that it is possible that the expectant mother has health problems and needs more careful monitoring.

Moderate oligohydramnios - this is a slight deviation in the amount of fetal water from the norm. This type of deviation can be caused individual feature body of a pregnant woman or, in the worst case, may be a prerequisite for the occurrence of a more severe form of this pathology. In any case, doctors recommend prophylaxis of fetoplacental insufficiency (FPI).

Moderate oligohydramnios is not a critical situation, because the amount of water is a variable number, and can change several times a day. Perhaps there was an error in establishing the diagnosis and the doctor was to blame for this, who made a not very accurate calculation during the ultrasound, because the determination of the amniotic fluid index is a subjective and approximate matter. Therefore, you should not panic, in 8 out of 10 cases, pregnancy ends with a successful birth of a healthy baby.

Severe oligohydramnios poses a danger to the health of the fetus, so you must follow all the instructions of the doctor observing the pregnancy.

The causes of oligohydramnios, regardless of the degree of its severity:

feto placental insufficiency;
problems with the cardiovascular system in a pregnant woman (hypertension and others);
diseases of the urinary system of the fetus (kidneys, for example);
leakage of amniotic fluid (in violation of the integrity of the membranes);
pathology in the development of fetal membranes;
transferred bacterial infections during pregnancy or shortly before its onset;
diabetes;
late gestosis.

Most often, oligohydramnios occurs due to a metabolic disorder in a pregnant woman, as well as after viral diseases (ARI, SARS, and others) and with fetoplacental insufficiency.

Personal practice shows that ultrasound doctors often exaggerate the magnitude of the problem, and a slight deviation from the norm is already a disaster for them. Such pseudo-low water causes unnecessary stress in future mother, but in fact, babies are born relatively healthy.

The only thing is that childbirth with oligohydramnios (even slight ones) can take place with some complications (poor opening of the cervix, painful contractions and prolonged labor due to breech or breech presentation of the fetus, which arose due to oligohydramnios). Although complicated childbirth can occur in any woman in labor, regardless of the amount of water.

obstetrician-gynecologist A. Berezhnaya

The occurrence of oligohydramnios during a post-term pregnancy is considered a common occurrence, since the placenta has grown old and can no longer fully perform its functions, therefore it exfoliates. Then doctors prescribe labor induction or conduct a planned caesarean section.

Why is oligohydramnios dangerous for the fetus?

Oligohydramnios (or oligohydramnios) is a complication of pregnancy, sometimes even dangerous for the fetus, because it is at risk of infection, as a result of which even its death can occur.

For example, with the loss of the integrity of the membranes - this is when there is leakage of amniotic fluid - the child becomes vulnerable to infections entering the membranes.

The genital tract of a woman is not sterile, pathogenic microorganisms constantly live in the vagina, “plus” immunity is weakened due to pregnancy. All this can lead to the multiplication of harmful bacteria that can penetrate the uterine cavity and infect membranes, causing their inflammation, called chorioamnionitis in gynecology. Without timely treatment infection occurs in the fetus.

This is with regard to oligohydramnios, caused by a violation of the integrity of the membranes.

At pronounced oligohydramnios, regardless of the reasons for its occurrence, the baby suffers from hypoxia (lack of oxygen), because of this, it lags behind in fetal development. In addition to all this, the baby is uncomfortable to be in such a “nest”, his neck is often twisted, and the bones of the face and head are susceptible to deformation due to squeezing them by the walls of the uterus.

Moderate oligohydramnios does not have such a critical effect on the health of the fetus: the baby is weak and lags behind in weight gain (so-called malnutrition is observed), it muscle tone reduced (possible development of torticollis, clubfoot), there is also mild fetal hypoxia.

If the screening and urine / blood / smear tests are normal, the cardiotocogram (CTG) is in order and the fetus is developing well, and the pregnant woman has no complaints about her well-being, then the diagnosis of oligohydramnios is conditional. It’s just that obstetricians will prepare for labor induction, since there is a high probability of a post-term pregnancy, or for a caesarean section with a non-standard position of the fetus at the time of birth.

Diagnosis of oligohydramnios

With an ultrasound examination, the doctor makes some measurements and calculations to determine the amount of amniotic fluid, after which he makes a conclusion about oligohydramnios, a normal amount of water, or polyhydramnios.

A gynecologist can also suggest little or polyhydramnios at the next measurement of the circumference of the abdomen and the height of the fundus of the uterus, but a more accurate diagnosis can only be made with the help of ultrasound.

At home, you can only test for leakage of amniotic fluid. If the underwear is often observed watery discharge, and the kicks of the baby began to be painfully perceived by the pregnant woman, although such discomfort was not felt before, or the size of the abdomen is small, although the gestational age has already exceeded 20 weeks, it is advisable to carry out special test. Perhaps the reason for everything is lack of water, caused by leakage of water due to a violation of the integrity of the membranes.

The test can be done at home by monitoring the discharge for some time, or by buying a special amniotic fluid leak test at the pharmacy and using it.

The “free” test is carried out as follows: empty your bladder, take a shower (without douching and possible water getting inside the vagina), dry yourself with a towel and lie down on a dry diaper. Lie still for 15 minutes, and then get up and see if a wet spot has appeared on the diaper. Ordinary secretions are not able to form and flow out so quickly, most likely, amniotic fluid is leaking. You can find out more precisely by contacting the LCD with a complaint about unusual discharge. There they will conduct a special test and say it is water or ordinary vaginal discharge.

The pharmacy test looks like a gasket, the surface of which will change color to blue or green if amniotic fluid leaks.

Staining also occurs with bacterial / viral discharge, so if spots of a blue-green hue are noticed on the surface of the pad, contact your gynecologist.

Any test for amniotic fluid leakage is recommended after 12 hours since the last intercourse, douching or use of vaginal suppositories.

Treatment of oligohydramnios

It is impossible to artificially increase the amount of amniotic fluid, so the treatment of oligohydramnios comes down to determining the causes of its occurrence. Further, the treatment of the root causes of oligohydramnios is carried out.

To determine the causes of oligohydramnios, a pregnant woman is referred for doppler ultrasound or cardiotocography (CTG), in order, first of all, to refute or confirm a violation of blood flow in the placenta.

If the fetoplacental circulation is still disturbed, then the patient is prescribed drugs to normalize it - Curantil, Actovegin.

Moreover, Curantyl is often prescribed as a preventive measure for placental insufficiency.

Often, the complex of treatment includes medications that contribute to the normalization of metabolic processes in the body of a pregnant woman (for example, Magne + B6) and maintain the normal functioning of important internal organs women (for example, Hofitol).

It is also necessary to exclude the presence of infections in a pregnant woman. For this purpose, urogenital smears for STIs and from the throat + nose for cocci are re-taken, a blood test for TORCH infection is performed. If an infection is present, antibiotic therapy is prescribed.

Childbirth with oligohydramnios

With severe oligohydramnios, a planned caesarean section is prescribed. With a small volume of amniotic fluid, the fetal bladder takes on a flat appearance. Because of this, contractions will be irregular and weak, and labor can be long and difficult.

Moderate oligohydramnios is not a contraindication for natural childbirth. Even with pelvic or breech presentation fetus caused by oligohydramnios, childbirth takes place safely for both the mother and her child.

Insufficient amount of amniotic fluid does not give the baby the opportunity to move freely inside the womb. Therefore, often the child takes a transverse or gluteal position and he can no longer roll over correctly.

There are various exercises that can help turn the crumbs into the desired position, but their effectiveness has not been confirmed with medical point vision. Exercise can lead to cord entanglement, so you need to weigh the pros and cons before doing them.

The symptoms, causes and methods of diagnosing oligohydramnios and polyhydramnios are considered.

The first thing that the future baby encounters in the mother's body is water. Doctors call it amniotic fluid. It provides the baby with everything necessary and performs many functions.

Where does amniotic fluid come from and what does it consist of?

After implantation of a fertilized egg in the uterus, not only the embryo grows, but also the fetal membranes are formed, the placenta and the fluid in which the baby will be.

Water is formed from the blood plasma of a pregnant woman. We can say that the body filters out everything unnecessary from the plasma and provides the child with this liquid with a new composition.

The composition of the amniotic fluid:

97% ordinary water
Proteins
Amino acids
Minerals
Hormones
child's urine

The composition of the fluid, depending on the duration of pregnancy, changes. Moreover, if in the early stages the liquid really resembles blood plasma, then by the end of pregnancy the water contains a lot of fetal urine. A child swallows about 20 ml of amniotic fluid every hour. Up to 14 weeks, water enters the baby's body through the skin. Later, the skin becomes keratinized, and the fluid enters through other channels.

Participation of amniotic fluid in the birth process

In the first period of contractions, all the water is divided into two parts. The first part is located directly under the head of the fetus and rests against the cervix.

A bubble with fluid stretches the cervix and provokes the opening of the uterus
With insufficient water, the pressure on the uterine os is minimal, respectively, the opening is very slow. generic process slows down, the midwife states a weak labor activity. This condition is dangerous due to fetal hypoxia and various birth trauma. In this case, doctors resort to amniotomy, in other words, pierce the bladder
While the bubble is bursting, the water washes the birth canal of the woman, ensures the sliding of the child during the birth
The rest of the fluid continues to protect the baby until birth. It pours out at the time of birth

With rapid childbirth, some children are born "in a shirt", this is a fetal sac with water that did not have time to burst.

Functions of amniotic fluid during pregnancy: 7 main functions

Amniotic fluid is not only food for the crumbs, it also performs many other functions:

Protects against mechanical damage
Prevents loud sounds from entering
Is a source of nutrients
Provides a constant temperature for the baby
Participates in metabolism
Starts the birth process
Washes the birth canal, cleansing them and making them slippery

What should be the volume of amniotic fluid? What threatens excess and lack of water?

The amount of amniotic fluid changes as the baby grows. Accordingly, the volume of liquid gradually increases:

At 10 weeks, the amount of water is very small. Approximately a teaspoon
By 14 weeks, the volume of water is half a glass
At 25 weeks, the amount of water will fit in a half-liter jar
By 30 weeks, this is 0.7 liters
Before childbirth, the amount of water is approximately 800-1500 ml

Of course, the amount of amniotic fluid depends on the mother's physique and genetic factors. But with a significant excess of the permissible volume, doctors diagnose polyhydramnios. This condition is very dangerous and can lead to the following consequences:

preterm birth
Incorrect position of the fetus in the womb
Uterine bleeding
Complications during childbirth. Placental abruption or umbilical cord prolapse often occurs

But not only an excessive amount of amniotic fluid is dangerous, but also their lack. Usually there are such violations with oligohydramnios:

Fetal bone deformity
Asphyxia, which leads to disturbances in the functioning of the nervous system
Abnormal development of the limbs of the fetus

How to diagnose polyhydramnios?

It is possible to determine something was wrong already at the 30th week of pregnancy. The doctor can do this during a routine examination.

With too much water, the stomach bigger size, tense
When patting the abdomen on one side, a noise is heard from the other side
The heart rhythm is poorly heard, it is drowned out by gurgling sounds
The uterus is tense, it is impossible to feel the parts of the child's body
If the bottom of the uterus is located much higher than it should, then the doctor may conduct an examination on a chair to diagnose the tension of the fetal bladder

But usually the antenatal clinic doctor is worried and does not perform a vaginal examination in order to avoid undesirable consequences. The pregnant woman is sent for an ultrasound.

During this diagnostic method, using an ultrasonic sensor, the amount of water is measured on four sides of the fetus. After that, calculations are carried out and the index of the amniotic fluid is derived. If it is more than 24 cm, then it is polyhydramnios. According to another calculation method, polyhydramnios is diagnosed with an IAI value of 8 cm.

How can polyhydramnios threaten a fetus and a pregnant woman?

This dangerous state, and the more water, the higher the likelihood of complications:

In the early stages of acute polyhydramnios fetus dies
On later dates excessive amniotic fluid leads to uterine rupture
Malposition
The risk of the umbilical cord wrapping around the baby's neck due to his excessive freedom
Late preeclampsia
Edema in the mother
Bouts of vomiting
Persistent heartburn
During childbirth, the baby may take oblique position, which is fraught with birth trauma
Decreased uterine tone during childbirth. The contractions are very weak and the woman cannot give birth

All this ends with premature birth, emergency caesarean section, or using forceps, which can cause disability in the child.

Features of pregnancy management with polyhydramnios: what should a pregnant woman avoid?

With critical polyhydramnios, treatment is carried out in a hospital. The hospital determines the causes of polyhydramnios.

If it is an infection, then the pregnant woman is treated with antibiotics.
If polyhydramnios is caused by a Rh conflict, then special preparations specified in the protocol are administered.
Often polyhydramnios is due to fetal pathology. In this case, the woman is prepared to terminate the pregnancy.
Together with the elimination of the cause of polyhydramnios, drugs are administered in the hospital to restore the lack of oxygen and nutrients at the fetus. These are vasodilators, oxybarotherapy, antioxidants, vitamins

When diagnosing polyhydramnios, a pregnant woman should not refuse hospitalization. It is dangerous for mother and fetus. No diet and proper nutrition can cure polyhydramnios. It is necessary to find the cause and eliminate it, and this can only be done in a hospital.

Oligohydramnios: causes and symptoms

Low water is diagnosed very poorly. Accordingly, there is a risk of aggravating the problem with fetal growth. With severe oligohydramnios in a pregnant woman, there is:

Nausea
Dry mouth
Pain with fetal movement

A doctor can diagnose or suspect oligohydramnios at a routine examination. The main signs of oligohydramnios are:

Very small abdomen
The fundus of the uterus is very low
Poor fetal mobility
Causes of low water:
Fetal malformations
Fetal pathologies
Chronic ailments of the mother
Pathologies of the placenta

Accordingly, oligohydramnios is not necessarily due to the poor health of the mother, because the fetus is also involved in the formation and renewal of the amniotic fluid. Most often, with oligohydramnios, problems of the excretory system in the fetus are diagnosed. This may be the absence of kidneys, kidney dysplasia, underdevelopment of the pelvis or fetal urethra. That is, the child cannot normally process the liquid and remove it from the body.

What problems can arise due to oligohydramnios and how to diagnose them?

In 50% of cases, pregnancy with oligohydramnios ends in premature birth.

Due to lack of water, the baby is not protected from mechanical damage.
He cannot move freely inside the mother, respectively, there is a developmental delay
Often observed clubfoot and curvature of the spine in the fetus
Often there is a fusion of the walls of the placenta with the fetus. This can lead to fetal malformations.

In order to prevent pathologies of fetal development in time, an unscheduled ultrasound is performed. If a child is diagnosed with some serious pathology, the pregnant woman is prepared for an abortion according to medical indications. If the cause of oligohydramnios is obesity, diabetes mellitus, or some kind of illness in a woman, treatment is prescribed. With a slight oligohydramnios, a pregnant woman is treated on an outpatient basis, hospitalization is not required.

Follow all doctor's recommendations. Often the cause of the development of pathology is the underdevelopment of the fetus. Don't skip the amniocentesis. This is a manipulation during which amniotic fluid is taken for analysis. In the course of research, you can not only verify the correctness of the diagnosis, but also determine the condition of the child.

If the doctor prescribes a diet, try to stick to it. It is important to eat right and not overeat with diabetes and obesity.

Low water and polyhydramnios - serious violations, which can lead to premature birth and fetal malformation. Don't let things drift and don't skip scheduled checkups and screenings. Early diagnosis will help you keep your pregnancy and give birth to a healthy baby.

VIDEO: Polyhydramnios during pregnancy

Pregnancy is considered the most the best period in the life of every woman. Waiting for the birth little miracle inspires happiness and fills life with bright colors. However, apart from positive emotions women also have others associated with fear and ignorance of many processes that occur in a pregnant woman in the body. What are the norms of the amniotic fluid index by week? This is one of the questions that women think about. Let's look into it, because according to the values \u200b\u200bof the indicator (abbreviated designation - IAI, JOB), the state of the fetus is determined.

The concept of amniotic fluid

The fetus develops in the uterus during pregnancy. It is surrounded by fetal membranes and fluid, which acts as a natural environment for the fetus. It protects it from mechanical damage, creates conditions for movement and proper location in the uterus. Each period of pregnancy is characterized by a certain amount of fluid. Taking it into account, experts make diagnoses about the presence of certain diseases in the fetus.

In the first trimester, the volume of water surrounding the embryo is determined by the function female body. Subsequently, the fetus begins to influence the amount of fluid. It is swallowed by them and excreted in the urine. When natural processes are disturbed, the volume of the liquid changes up or down. Normally, at the 18th week, this figure is 300 ml. By the 34th week, it increases to 800 ml. With the approach of childbirth, the volume of fluid decreases to 600 ml.

Calculation of the volume of amniotic fluid

There are several ways to find out the volume of amniotic fluid. The first one is subjective. A specialist during an ultrasound scan can identify deviations from the norm according to some signs and features:

An insufficient amount of fluid is observed, as a rule, in the II and III trimester. In the uterine cavity, areas of amniotic fluid free from the umbilical cord are not detected. The body of the fetus is excessively bent. Parts of the body are close to each other.
Excessive fluid is most often observed in the third trimester. The anatomical features of the fetus are very well distinguishable. Bottom part body is surrounded by fluid.

When using the subjective method, you can make a mistake. That is why J. Phelan proposed the calculation of the AFI. The conducted studies made it possible to determine the norms of the amniotic fluid index by weeks. When comparing them with the values obtained during examinations of pregnant women, one can judge the presence of a lack or excess of water.

Amniotic fluid index: what is it and how is it calculated

In order to determine whether the volume of amniotic fluid is normal, experts measure a special index. This is done during ultrasound examinations. The specialist does the following:

scans the entire uterine cavity;
the area under study is divided into 4 quadrants;
in each quadrant visualizes the deepest pocket of amniotic fluid, free from the extremities of the fetus and umbilical cord;
defines the maximum vertical depth of each pocket;
the resulting values are summarized.

The index is measured in centimeters or millimeters. The value obtained by adding the vertical depths is an approximation. Despite this, it can accurately identify an excess (polyhydramnios) or a lack (oligohydramnios) of amniotic fluid.

Ultrasound examination in the first trimester of pregnancy

For the first time, a pregnant woman is sent for a planned ultrasound in the first trimester. For this period, the norms of the amniotic fluid index by week are not defined, because the fetus is very small. Scanning is performed for slightly different purposes:

confirm pregnancy;
clarify the deadline;
clarify the location of the fetal egg;
identify multiple pregnancy;
exclude cystic skid;
exclude false pregnancy if a woman has neoplasms in the pelvic area;
timely diagnosis of tumors, which in the future could prevent normal course pregnancy and childbirth.

Index in the II trimester of pregnancy

The next ultrasound examination of a woman takes place in the second trimester of pregnancy, which lasts from the 14th to the 26th week. At this time, various fetometric parameters of the fetus are determined. The amniotic fluid index is also calculated. The norm at 20 weeks and at other times of the II trimester is presented in the table below.

IAI norms by weeks in the II trimester of pregnancy

Term, in weeks	Indicator, in mm
	Percentile
	97,5	95	50	5	2,5
16-18	201-220	185-202	121-133	79-87	73-80
19-21	225-233	207-214	137-143	90-95	83-88
22-24	235-238	216-219	145-147	97-98	89-90
25-26	240-242	221-223	147	97	89

Ultrasound scanning in the third trimester of pregnancy

The last trimester of pregnancy lasts from the 27th week until the moment of delivery. During this period, every pregnant woman undergoes a final ultrasound scan. This trimester is optimal for:

determining the amount of water;
diagnosing fetal growth retardation;
detection of fetal pathologies not detected during previous scans;
determining the position of the fetus and identifying placenta previa;
exclusion of any pathologies that can occur during pregnancy.

The table below shows the norms of the amniotic fluid index by week for last trimester childbearing period.

IAI in the third trimester of pregnancy

Term, in weeks	Indicator, in mm
	Percentile
	97,5	95	50	5	2,5
27-29	245-254	226-231	Decreased from 156 to 145	From 95 to 92	From 85 to 84
30-32	258-269	234-242	From 145 to 144	From 90 to 86	From 82 to 77
33-35	274-279	245-249	From 143 to 140	From 83 to 79	From 74 to 70
36-38	from 279 to 269	from 249 to 239	From 138 to 132	From 77 to 73	From 68 to 65
39-40	from 255 to 240	from 226 to 214	from 127 to 123	from 72 to 71	from 64 to 63

Polyhydramnios during pregnancy

Polyhydramnios in the medical literature is called excessive accumulation of amniotic fluid. At full-term pregnancy, their volume exceeds 1500 ml. In foreign sources, a figure equal to 2 liters is noted. According to the index, polyhydramnios is determined very easily. This pathology is characterized by an increase in the numerical values of the indicator by more than 97.5 percentile. For example, the rate of the amniotic fluid index at 32 weeks can reach a maximum of 269 mm. For cases in which the IAF is greater than this figure, an excess of water is characteristic.

Polyhydramnios is divided by experts into acute and chronic. First form pathological condition diagnosed at 16-27 weeks. It is considered extremely rare. The most common form of chronic polyhydramnios. It is detected in women, usually in the third trimester of pregnancy. For chronic form erased clinical picture.

The amniotic fluid index exceeds the norm at 30 weeks and at other times according to different reasons. They are associated with inflammation and infectious diseases a pregnant woman, fetal pathologies (for example, with intrauterine infections, hereditary diseases, chromosome abnormalities, developmental disorders of the digestive system, central nervous system), placental pathologies.

oligohydramnios in pregnant women

In medicine, oligohydramnios is considered to be a reduction in the volume of water to 500 ml or less during a full-term pregnancy. In foreign sources, the figure characterizing this pathology is indicated - 300 ml. The diagnosis of "oligohydramnios" is made by doctors in cases where the IAI values are below the 5th percentile. For example, 80 mm is the amniotic fluid index at 26 weeks. It doesn't fit the norm. This is pronounced malnutrition.

Causes of oligohydramnios are associated with birth defects development of the fetus, due to which urine is not excreted in normal quantities from the body. Such pathologies include renal agenesis, bilateral multicystic renal dysplasia. In some cases, the causes of low AFI and oligohydramnios are fetal growth retardation, chromosomal abnormalities, intrauterine infections, chronic renal and cardiovascular diseases available in women, preeclampsia, placental insufficiency, post-term pregnancy, antenatal fetal death.

Importance of Index Calculation

IAG - important indicator. For example, comparing the calculated amniotic fluid index at 33 weeks with the norm does not just allow you to fix the presence of oligohydramnios or polyhydramnios. Thanks to the calculation of the indicator, it is possible to prevent the development of complications. Due to polyhydramnios, for example, there may be:

incorrect presentation of the fetus;
premature detachment of a normally located placenta;
postpartum and prenatal bleeding;
prolapse of the umbilical cord.

Oligohydramnios also has complications. It leads to intrauterine retention development of the fetus, the appearance of adhesions, increased risk of perinatal death. In children born to women diagnosed with oligohydramnios, underdevelopment of the skeleton and lungs, low body weight are often observed.

After comparing with the norm of the amniotic fluid index at 31 weeks and at other times, after identifying oligohydramnios or polyhydramnios, doctors prescribe the appropriate treatment, determine the tactics of pregnancy and childbirth. In some cases, termination of pregnancy is required. The indications for it are a combination of polyhydramnios or oligohydramnios with intrauterine malformations and an acute form of polyhydramnios that arose before

The amniotic index is an indicator that characterizes the amount of amniotic fluid during pregnancy. Amniotic fluid is also called amniotic fluid: a liquid natural environment provides the baby with everything necessary for the formation of strong immunity from birth. Its volume is of great diagnostic importance when examining a woman during pregnancy.

The biological environment surrounding the fetus in the mother's womb is multifunctional - without it, the child cannot survive. What is remarkable about amniotic fluid:

"feeds" the growing organism. From the point of view of energy value, amniotic fluid can be called an ideal nutrient medium for the fetus at all stages of its development. For some time after conception useful material from the amniotic fluid enter the body of the embryo, simply absorbed through its cells. When the fetus grows up, he regularly swallows the liquid surrounding him in small portions;
protects the fetus from the mechanical impact of the world on the other side mother's belly- pressure and shocks coming from outside are not terrible for the crumbs;
protects the fetus from infection. The amniotic fluid is rich in immunoglobulins, which ensure the health of the baby. In addition, 100% closure of the fetal bladder and constant renewal of the amniotic fluid provide the baby with a sterile environment for a safe existence;
provides the child complete freedom actions in the uterine cavity;
muffles harsh sounds coming from the outside world.

Main characteristics of amniotic fluid

As pregnancy develops, the quantitative and qualitative indicators of amniotic fluid are constantly changing. Deviations of these figures from the norm are of great importance for physicians - based on this information, it can be assumed that the future mother has or does not have certain pathologies. Timely diagnosis can reduce the risk for a woman and her child even before childbirth or, in extreme cases, after the baby is born.

The amniotic fluid index (AFI) is an indicator that reflects how much amniotic fluid fills the fetal bladder at a particular stage of pregnancy.

In addition, experts take into account other characteristics of the natural liquid environment in which the fetus develops:

Color and degree of transparency. Normally, amniotic fluid is colorless or has a slightly yellowish tint. This liquid is quite transparent, and the presence in it of a certain amount of fragments of the skin and hair of the fetus is not a deviation from the norm.
Quantity. The volume of amniotic fluid is determined by the gestational age, so when talking about this indicator, be sure to take into account the trimester of pregnancy. For example, the norm of the amniotic index at week 22 of an “interesting” position is 145 ml and this average. The lower limit value reaches 89 ml, and the upper limit value reaches 235 ml. the volume of water increases by 40 - 45 ml every day up to a period of 32 weeks. When the IAI reaches its highest value (144 ml at 32 weeks), the amount of fluid begins to gradually decrease. A few days before the birth of the baby, the indicators of amniotic fluid range from 0.5 to 1.500 ml.
The presence of hormones.
Biochemical and cytological indicators of the composition.

Diagnosis of amniotic fluid

The analysis of amniotic fluid using ultrasound allows you to diagnose two common abnormalities during pregnancy - oligohydramnios and polyhydramnios, as well as take timely measures to eliminate them. During the ultrasound, the specialist will determine the index of the amniotic fluid and set the multiplicity of the vertical pocket. If the indicators exceed the limits of the norm or, conversely, are less than them, polyhydramnios or oligohydramnios are indicated in the conclusion.

What is a vertical pocket and why is its size determined? The vertical pocket is the longest section of free water, which is located between the child and the anterior abdominal wall. It is undesirable that the limbs or umbilical cord of the fetus be located in this area. Permissible indicators the length of the vertical pocket is 5 - 8 cm.

The norm of the amniotic index during pregnancy

To assess the volume of amniotic fluid using the amniotic fluid index, the gynecologist will divide the belly of the future mother into 4 sections, drawing two conditional perpendicular lines that intersect at the navel. Then, in each of the four zones, he will determine the indices of the largest vertical pocket index. The final value of the index is calculated by adding the values of all pockets.

The norm of the amniotic index is calculated by weeks, starting from a period of 16 weeks. With an increase in the gestational age, the IAI indicators will also increase: the highest indicator will be at 32 weeks - 77 - 169 ml. The norms of the amniotic index are displayed in the table.

If the IAI values do not match with specific dates pregnancy, the expectant mother is diagnosed with oligohydramnios or polyhydramnios.

Deviation during pregnancy: oligohydramnios

This pathology accompanies the bearing of a child quite often. The amniotic index with oligohydramnios is slightly or significantly underestimated. Moderate oligohydramnios is diagnosed when the volume of amniotic fluid differs slightly from the norm of IAF. The situation can be improved with special diet and adjustments to the daily routine, then the amount of water will soon return to normal and will not affect the child’s health in any way.

Oligohydramnios is considered pronounced if the amniotic fluid index during pregnancy is significantly less than the standard indicator. In this case, the pregnant woman is urgently sent to the hospital - the likelihood of complications in the child is too high. Severe oligohydramnios can cause underdevelopment of vital organs and systems, a significant curvature of the skeleton.

In addition, oligohydramnios threatens the child with a number of other complications, including:

developmental delay;
fusion of the fetus with the fetal membrane;
hypoxia;
low birth weight of the child;
drying of the skin of the child due to a lack of water;
intrauterine fetal death.

When a significantly underestimated IAI was found on long term(30 - 34 weeks), serious pathologies development of the child, most likely, are already available, so the question of artificial termination of pregnancy is often raised, since treatment, unfortunately, will not bring positive results.

Why oligohydramnios develops

There are many factors that directly or indirectly affect the development of oligohydramnios during pregnancy. We list the most likely:

insufficient development of fetal membranes;
reduced water production;
anomalies in the development of the child (problems with the kidneys and skeleton);
high arterial pressure in a pregnant woman;
bacterial infections that have entered the amniotic fluid;
pregnancy with twins or triplets;
uneven maturation of the placenta;
overwearing;
impaired metabolism in a pregnant woman;
overweight expectant mother.

Signs of pathology

Oligohydramnios does not manifest itself to such an extent that the pregnant woman immediately suspected something was wrong - the clinical picture of the deviation in this case is blurred. With severe oligohydramnios, a woman can be tormented by weakness, dry mouth, frequent nausea. Sometimes the expectant mother feels pain in the lower abdomen, which intensifies when the baby moves.

During a diagnostic study of a pregnant woman with oligohydramnios, the doctor will certainly note that the patient's uterus is too small for the current gestational age, and the movements of the fetus are significantly constrained. Ultrasound is used to confirm the diagnosis.

The specifics of the treatment of oligohydramnios

Correction of oligohydramnios begins with an assessment of the test results - only in this way can the doctor determine the cause of the incident, determine the degree of the disease and the condition of the child. Only then can a treatment plan be developed.

If the pregnancy proceeds against the background of obesity and impaired metabolism in a woman, she is prescribed a special sparing diet, healthier food, vitamin therapy and medications that stimulate the blood supply to the membranes of the placenta. Moderate polyhydramnios can be treated on an outpatient basis, the treatment of severe pathology is carried out exclusively in stationary conditions.

Regardless of the severity of the disease, motor activity and physical activity is minimized, in most cases, a woman is shown bed rest. During the treatment of oligohydramnios, the expectant mother will more often do ultrasound and dopplerography - these procedures will help to notice unwanted metamorphoses in the body of the mother and her child in time. When, as a result of an ultrasound examination, it turns out that at 33 weeks (and later) the AFI values \u200b\u200bare too low, and the baby, meanwhile, is already ready to be born, the doctor will most likely decide on an early birth.

Low water during pregnancy. Video

Deviation during pregnancy: polyhydramnios

With polyhydramnios, the IAI indicators are significantly overestimated. About 1% of pregnant women face such a problem when amniotic fluid appears more than necessary. Deviation can only be detected by ultrasound. Statistics say that a third of pregnancies from 1% end in miscarriages.

Reasons for the development of polyhydramnios

Doctors find it difficult to say exactly what underlies the pathology, but they nevertheless identified the main risk groups. Here are diseases in which there is a high probability of developing polyhydramnios:

chromosomal "breakdowns";
chronic diseases of the heart and blood vessels;
all stages of diabetes;
diseases of infectious origin;
diseases of the genitourinary system;
Rhesus conflict between the pregnant woman and the fetus;
TORCH infections;
kidney disease;
severe anemia;
severe toxicosis;
multiple pregnancy;
anomalies of intrauterine development of the child.

Forms of pathology

Depending on the rate of development, polyhydramnios can be acute or chronic.

The acute form of deviation develops very rapidly - literally within a few hours. This is very serious problem, since its consequences are irreversible: the fetus either dies in the second trimester of pregnancy, or survives, but is born with severe developmental abnormalities.

The chronic form of polyhydramnios does not develop immediately, therefore, with timely diagnosis, doctors have time to intervene in this process and save the child. Often, the deviation does not make itself felt, and the expectant mother needs to carefully monitor her well-being in order to go to the hospital with the slightest suspicious symptoms.

You can suspect the development of pathology by the following signs:

pain in the abdomen;
"stone" in the lower abdomen;
general weakness, fatigue;
swelling in the legs;
dyspnea;
rapid heart rate;
the appearance of a huge number of stretch marks on the skin;
large belly (more than 110 - 120 cm in volume);
premature enlargement of the uterus;
permanent constipation.

Only a timely reaction to what is happening and competent treatment will help a woman carry a baby.

The danger of polyhydramnios

A pathological condition can threaten a pregnant woman and her child with the following problems:

Miscarriage or artificial termination of pregnancy.
Extremely severe toxicosis in late pregnancy.
Fetoplacental insufficiency, due to which full development child is impossible.
Massive bleeding.
Placental abruption. As a result of her premature aging, the child will be deprived of nutrients and vital oxygen.
premature birth. This is very dangerous, because not all premature babies able to fight for life.
Insufficient generic activity or its complete absence.

For a child, the consequences of polyhydramnios are no less dangerous. Here is what can happen on the basis of this pathology:

The fetus will not be positioned correctly in the uterus, which is why natural delivery will have to be replaced by a caesarean section.
Entanglement of the fetus by the umbilical cord, which can lead to its death.
Acute hypoxia of the child.
Development of anomalies of the heart and central nervous system.
Infectious diseases of the fetus.

Features of the treatment of polyhydramnios during pregnancy

To improve the condition of the expectant mother with polyhydramnios, doctors will first of all conduct a comprehensive examination of her - it is necessary to establish and eliminate the cause of the incident.

In parallel with the main course of treatment, the patient is prescribed a multivitamin preparation with the obligatory vitamins C, E and a group of vitamins B in its composition, preparations containing magnesium, diuretic medicines and possibly some antibacterial drug a wide range actions. Usually, in the chronic course of polyhydramnios, the child can be saved.

Every woman who is preparing to become a mother should, at least in general terms, understand what the amniotic index means during pregnancy. Often, it is precisely this ignorance that prevents pregnant women from understanding how important it is to be on the alert in anticipation of a baby. You can’t even ignore the minimal suspicious symptoms in your well-being, because they can hide a serious illness that threatens the well-being of mother and baby. With the help of modern diagnostic procedures, doctors have a chance to detect and eliminate the problem in time, and the determination and evaluation of the amniotic fluid index during pregnancy is one of them.