Polyhydramnios in the early stages. Classical treatment of polyhydramnios. How to Lower Your Amniotic Fluid

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Pregnancy is undoubtedly the happiest period in a woman's life, but even he can sometimes be overshadowed. different kind troubles and pathologies. One of these pathological conditions during pregnancy is polyhydramnios, which must be treated.

Compound amniotic fluid changes throughout pregnancy, so it is important to monitor their number in each trimester.

Polyhydramnios is called the appearance of an excess amount amniotic fluid significantly higher than the norm. The diagnosis of polyhydramnios can put a woman on the most different terms pregnancy. These complications occur in 1 in 100 pregnancies.

At normal course pregnancy is formed required amount amniotic fluid for fetal development, approximately 1000-1500 ml. The amniotic fluid consists of 97% water, which contains proteins, calcium, chlorine and sodium salts. Thus, the baby receives oxygen, necessary nutrients and reliable protection from the external environment. Also, the embryo can calmly move and swim in the mother's abdomen, make movements with the limbs.

Amniotic fluid is the environment in which the fetus develops. The water temperature is 37 degrees.

Properties of amniotic fluid:

The amniotic fluid protects the embryo from impact and shock. In addition, the noise coming from the outside world is also muffled.
Amniotic fluid protects the umbilical cord from being squeezed between the wall of the uterus and the fetus.
Amniotic fluid helps reduce pain during labor.
They help open the cervix during childbirth.
The bubble, in which the fetus and amniotic fluid are located, creates an airtight shell into which nothing can enter from the outside.
Amniotic fluid contains immunoglobulins.

The amount of amniotic fluid changes every week. Therefore, for each trimester of pregnancy, there are rules. At the very beginning of pregnancy, the amount of amniotic fluid is approximately 30 ml. At 23 weeks, the amount of amniotic fluid is about 600-700 ml. By 30, 32, 33 and 34 weeks, this figure is approximately 600-900 ml. By week 36, the amount of water already increases to 1000. At 37 and 38 weeks of pregnancy, the amount of amniotic fluid becomes maximum. At 39 weeks and closer to the birth itself, there is a decrease in amniotic fluid to 800 ml.

In the presence of some predisposing factors, the amount of water may decrease or increase. When amniotic fluid less than normal, then this condition is called oligohydramnios. Oligohydramnios is also a pathology and affects the development of the fetus and the condition of the pregnant woman.

Causes of polyhydramnios

Although the causes of polyhydramnios are not yet fully understood, there are some factors that contribute to the occurrence of this pathology.

Polyhydramnios during pregnancy can occur due to such reasons:

pathology of fetal development;
infectious diseases pregnant woman;
bacterial infection;
diseases of the cardiovascular system;
Rhesus conflict between mother and fetus;
metabolic disease;
diabetes;
pyelonephritis;
multiple pregnancy;
large fruit.

Types of polyhydramnios

This condition in a pregnant woman can proceed in different ways: in an acute form or chronic form. There may be severe or moderate polyhydramnios.

The acute form is characterized by a violation of the general condition of the pregnant woman and the fetus. Such childbirth, as a rule, ends in miscarriage, stillbirth, or such a child will have developmental defects. Polyhydramnios appears in an acute form, usually starting from the 16th to the 24th week. Sometimes the amount of amniotic fluid can increase even within a few hours. In this case, immediate health care, in a dangerous state.

Moderate polyhydramnios during pregnancy is characterized by a gradual increase in symptoms and signs. Moderate polyhydramnios can lead to the birth of a child with developmental anomalies. This is due to the constant lack of oxygen. Very often, moderate polyhydramnios occurs in a chronic asymptomatic form, and therefore can go unnoticed for a long time.

Signs of polyhydramnios

Sometimes a pregnant woman herself may suspect polyhydramnios, by the presence of some signs characteristic of this condition.

The belly of a pregnant woman with an excess amount of amniotic fluid reaches a circumference of more than 100 cm. It has a slightly round shape. There is a feeling of heaviness in the abdomen and back. The uterus increases in size and begins to squeeze the internal neighboring organs. Therefore, as a consequence, a pregnant woman often has shortness of breath and other ailments.
Lower limbs may swell. In some cases, early rupture of amniotic fluid may even occur.
A fluctuation appears: in a pregnant woman, gurgling in the abdomen is quite clearly audible. There are pains in the perineum.
A large number of stretch marks appear on the abdomen.
The pregnant woman's pulse quickens. The fetal heartbeat is weakly audible.
Since there is more free space, the fetus takes the wrong position in the uterus (pelvic, oblique). This is directly reflected in the childbirth itself: the stretched uterus contracts incorrectly and childbirth with polyhydramnios will be characterized by weak labor activity.

Polyhydramnios is also dangerous because the child can wrap around the umbilical cord. Hypoxia may develop, the fetus will receive less oxygen. Even if the birth is on time, the fetus may have intrauterine pathology, such a child may be born with a developmental disorder internal organs or systems.

It should be remembered that the earlier polyhydramnios appears in a woman, the more amniotic fluid accumulates and the risk of complications increases.

Moderate polyhydramnios

The diagnosis of moderate polyhydramnios is made when the amount of amniotic fluid is approximately 1.5 or 2 liters. And although such a diagnosis is made even in the first trimester of pregnancy, it is possible to seriously talk about the presence of pathology only starting after the 16th week. The cause of this condition is often the Rh-conflict of the mother and fetus or the presence of infections.

woman at moderate polyhydramnios feels tension in the abdomen. It becomes more elastic. When you feel the fetus, you will notice that it often changes its position. You can hear the rolling of water in the stomach. The uterus increases in size and becomes edematous.

You can determine moderate polyhydramnios at a scheduled ultrasound examination or at an examination. For moderate polyhydramnios are characteristic early birth and placental abruption.

A pregnant woman with moderate polyhydramnios should be constantly monitored by specialists, as it sometimes happens that this diagnosis wrong or temporary.

In the absence of a serious pathology, the doctor tries to keep the pregnancy and so that the birth goes through naturally without artificial intervention. Appointed conservative treatment: vitamins, hypothiazide. If necessary, antibiotic therapy is carried out.

Polyhydramnios at the end of pregnancy

Polyhydramnios at the end of pregnancy is approximately 0.6% of all other pathologies. Its appearance may be due to late toxicosis. This threatens with serious complications during childbirth:

prolapse of the umbilical cord;
oxygen starvation of the fetus;
weakness labor activity.

Therefore, such a diagnosis is an indicator for carrying out. Treatment of such polyhydramnios is carried out depending on the cause.

Diagnosis of polyhydramnios

You can diagnose polyhydramnios during an examination by a gynecologist at an appointment in antenatal clinic. To do this, the doctor examines the pregnant woman for the presence of relevant signs. The most reliable method for diagnosing polyhydramnios is an ultrasound examination. Doplerometry is also prescribed. Thus, it is possible to identify a more accurate amount of amniotic fluid, check the blood flow in the umbilical cord and placenta.

Careful examination of the fetus reveals possible anomalies in its development.

Polyhydramnios can be diagnosed using the "amniotic index". There is a special table that allows you to determine the amount of amniotic fluid is normal in a certain trimester of pregnancy.

If the diagnosis is confirmed, then the woman is sent for an additional examination of the fetus.

Consequences

With polyhydramnios, the following consequences are possible:

or termination of pregnancy;
fetal death or developmental defects;
if an infection becomes the cause of polyhydramnios, then there is a possibility of infection of the fetus;
prolapse of the umbilical cord or handle (leg) of the fetus during childbirth;
the presenting part of the fetus does not fall during childbirth or is not fixed;
malposition.
bleeding;
various gestoses.

Treatment

The main treatment for the diagnosis of polyhydramnios is aimed at eliminating the cause that caused this pathology. First, the expectant mother surrenders everything necessary tests confirming the presence of polyhydramnios: fetal cardiotocography, ultrasound examination, blood test for the Rh factor, dopplerography and others.

Typically carried out complex treatment. When moderate or unexpressed pathology of the pregnant woman is prescribed drug therapy. Depending on the condition of the woman, treatment can take place in a hospital or in home environment(outpatient). This condition does not require termination of pregnancy or delivery.

Diuretics (diuretics), vitamins and antibiotics are prescribed. Antibiotics are necessary to fight microorganisms, since the main cause of polyhydramnios often lies in the infectious process. Also, starting from 24 weeks and up to 38, indomethacin is prescribed.

If the prescribed treatment does not help or polyhydramnios takes a severe form, then the doctor prescribes early delivery. use medical preparations that help artificially induce labor.

During artificial delivery, it is necessary to carefully open the membranes, and gradually release the amniotic fluid so as not to cause fetal asphyxia. This procedure is carried out using a thin catheter. Measures are taken to prevent prolapse of the umbilical cord or limbs of the fetus.

Medicines to stimulate labor should be used no earlier than 2 hours after the outflow of amniotic fluid.

On early dates when it is impossible to carry out delivery, amniotic fluid is released. Amniotic fluid helps the baby move through the birth canal, regardless of artificial or natural opening amniotic sac. But this should be done carefully so that the umbilical cord does not fall out.

If the fetus has malformations that are incompatible with life, then for up to 28 weeks, an abortion is performed.

childbirth

If polyhydramnios does not affect the condition of a pregnant woman or her fetus, then in this case, childbirth is carried out naturally. Mandatory procedure in this case: artificial opening of the fetal bladder. In this case, the volume of the uterus decreases, and this helps to make contractions more productive. Often such childbirth is delayed, and then there is a need for rhodostimulation. Rhodostimulation is carried out by the introduction of labor-accelerating drugs. And already as the most extreme remedy, a caesarean section is performed.

The postpartum period may be complicated by bleeding due to poor uterine contractility. Therefore, the woman is prescribed the introduction of reducing drugs, such as oxytocin and methylergometrine.

Prevention of polyhydramnios

Since polyhydramnios is a pathology, then given state can be avoided if precautions are taken.

It is very important to immediately exclude the presence of an Rhesus conflict. During pregnancy, a woman should move as much as possible. It is necessary to calculate the amount of fluid taken. It also does not hurt to adjust the diet a little.

To prevent polyhydramnios, the expectant mother should take vitamin complexes or medicines prescribed by a doctor.

It is necessary to undergo all examinations and analyzes on time, as they will help to identify a pathology or deviation in the development of the fetus even at the earliest stages.

In this case, you can avoid serious consequences during childbirth and in postpartum period. It is important to remember that regular examinations by an obstetrician-gynecologist are not just a formality, but a vital necessity on which the condition of the baby depends.

Useful video

The article describes the signs of polyhydramnios in expectant mothers. Find out why polyhydramnios is dangerous for the fetus and how to treat it.

All future mothers dream that everything is in order with their child. And, of course, they worry when a doctor discovers an ailment during pregnancy. Immediately they begin to get very worried because of ignorance of the situation.

What to do if you have polyhydramnios? First of all, calm down and follow all the doctor's instructions. Next, we will study in detail all the questions on this diagnosis.

How to determine polyhydramnios during pregnancy?

At different stages of the ongoing pregnancy, the volume of amniotic water is different
After all, the fetus grows, and with it the amount of fluid that it needs to receive useful substances and for normal development
In addition, two pregnant women cannot have the same amount of amniotic fluid. But there are allowable limits for the volume of liquid on different periods pregnancy
If a woman is found to have a deficiency or excess of amniotic fluid, then a diagnosis is made: oligohydramnios or polyhydramnios

Diagnosis - polyhydramnios can be put by a gynecologist if there are complaints from the patient and on the basis of measurements of the volume of the abdomen, which are carried out at each appointment.

It is possible to accurately determine polyhydramnios in a future woman in labor during an ultrasound examination. Where is it installed amniotic index. As mentioned above, it should not exceed allowable limits:

at 16-17 weeks: 72-221 mm
at 21-23 weeks: 88-239 mm
at 33 weeks: 76-279 mm

IMPORTANT: If your polyhydramnios index is equal to the upper acceptable value, then do not neglect the suggestion of your obstetrician - go to the hospital for examination. This is required for the safety of your baby.

Signs of polyhydramnios during pregnancy

This pathology can occur in chronic,acute form. If this - chronic form, then polyhydramnios responds well to medical treatment.

Symptoms may not be present at all. moderate course of the disease, or the following symptoms And external changes:

stretch marks on the abdomen, big size uterus and the volume of the tummy of a pregnant woman can reach 115-120 centimeters
abdominal pain, discomfort
frequent or persistent ailments, feelings of weakness
swelling of the legs
increased heart rate, unpleasant gurgling in the abdominal part
dyspnea

acute form polyhydramnios can develop very rapidly. Sometimes its manifestation disappears in just a few hours.
With such a course of the disease, a woman needs to be urgently hospitalized
You may have to do an abortion, otherwise the fetus will be born with a number of serious diseases, even his death is not ruled out

Moderate polyhydramnios during pregnancy

This type of pathology does not great danger the baby and the future woman in labor, in contrast to the pronounced, acute polyhydramnios. Still, it doesn't hurt to see your doctor. If this is not done, the consequences may be different:

intrauterine freezing
baby developmental anomalies
prolongation of pregnancy
premature birth

This pathology occurs for the following reasons:

Increased blood sugar in the expectant mother
Various fetal diseases (diseases of the gastrointestinal tract, central nervous system)
Differences in the blood types of the baby and mom
Preeclampsia
Diseases of a pregnant woman (heart, kidneys), infections
Genetics
Problems in the functioning of the placenta
Multiple pregnancy, large baby

As a rule, moderate polyhydramnios is found on later dates. In the early stages, there is idiotic polyhydramnios, which occurs without any reason and also passes with time.

In the presence of such an ailment, the patient should go to the gynecologist on time and follow his instructions.

On recent weeks quantity amniotic fluid should be 1-1.5 liters, depending on the size of the baby. If there are more amniotic waters, then this is polyhydramnios
To avoid premature birth, disorders of the functioning of blood circulation in the placenta, premature detachment her, bleeding, it is necessary to hospitalize the expectant mother
Ensure control over her condition and the condition of the fetus, carry out the necessary drug treatment

Why is polyhydramnios dangerous during pregnancy?

In the worst case, if the polyhydramnios of the future woman in labor is not controlled by a specialist doctor, the following consequences can await you:

due to a strong stretching of the walls of the uterus, a violation occurs birth process placental abruption prematurely
it happens that a large amount of amniotic fluid causes labor before the due time
since the child has a lot of space, he may take the wrong position, as needed during childbirth
38.4% of pregnant women have bleeding
in 20% of cases, late gestosis occurs
24.3% of women in labor have miscarriages
36% have prolonged, uncontrollable vomiting
for a child, polyhydramnios is dangerous because he develops various pathologies Gastrointestinal and nervous system

Polyhydramnios. Dangerous Consequences

What to do with polyhydramnios during pregnancy?

To accurately establish polyhydramnios, the doctor gives direction to:

ultrasound diagnostics
cardiotocography to establish the condition of the baby
dopplerography for the study of the uterus, the development of the child
blood tests, lab smear test

Upon confirmation of the diagnosis, the specialist doctor will prescribe an individual treatment for the patient.

How to treat polyhydramnios during pregnancy?

The pathology will be treated by a gynecologist. The most commonly prescribed medications are:

Curantil, Actovegin - preventive pills
antibacterial drugs: Ampicillin, Vilprafen, Cefazolin, (some of these drugs cannot be used while in interesting position, but they are used to treat irreversible consequences)
diuretics facilities
Wobenzym, as a complex medicine with antibiotics
Indomethacin (as decongestant means)
vitamin drugs

Treatment of polyhydramnios in pregnant women. What drugs to drink?

How to determine the tendency to polyhydramnios during pregnancy?

The tendency to polyhydramnios is determined on ultrasound by the IAI coefficient (amniotic fluid index). If it is equal to the upper limit of the volume of amniotic fluid, then this is a tendency to the pathology of polyhydramnios.

If it is detected, the specialist doctor constantly monitors the patient. See the table below for the lower and upper limits of the IAI at various periods of embryonic development.

IAI table at various stages of pregnancy development

Polyhydramnios in multiple pregnancy

Multiple pregnancy itself is more difficult than normal. If future mother polyhydramnios is detected, then it is determined for stationary observation.

After all, this pathology means that in the body of a woman there are some processes that do not correspond to the norm. Depending on the source of the disease, your attending obstetrician will prescribe the appropriate treatment.

What to do with multiple pregnancy during pregnancy: tips and reviews

With an increased volume of amniotic fluid, even moderate, it is necessary to without fail be seen by experts.

Video: polyhydramnios, pregnancy

Polyhydramnios is a condition in which the amount of amniotic fluid exceeds the norm established for this period pregnancy. If the amount of water is at the upper limit of the norm or slightly exceeds it, they speak of moderate polyhydramnios. Why is this condition dangerous and how can a pregnant woman be helped?

General information

Amniotic fluid (amniotic fluid) is a special environment in which the fetus is located throughout pregnancy. This space creates conditions for the harmonious existence of the child, namely:

li class="text">provides transport nutrients and excretion of metabolic products;

protects the fetus from mechanical injury;

supports optimum temperature inside the fetal egg;

creates space for active movements of the fetus.

Normally, at the term of full-term pregnancy, the amount of amniotic fluid should be 500-1500 ml (according to foreign sources - up to 2000 ml). Excess amniotic fluid is called polyhydramnios. With moderate polyhydramnios, the amount of water will be in the range of 1500-2000 ml. For other periods of pregnancy, there are other standards known to doctors. ultrasound diagnostics.

Causes

There are several possible causes polyhydramnios:

mother's diseases: diabetes mellitus, infectious diseases, connective tissue pathology and other inflammatory processes;
fetal malformations;
intrauterine infection;
hemolytic disease of the fetus;
malignant tumors;
pathology of the fetal blood coagulation system;
pathology of the placenta (chorioangioma, etc.).

An increase in the volume of amniotic fluid is often associated with malformations of the nervous system, digestive tract and urine excretory system fetus. Often, with polyhydramnios, anomalies in the development of the heart, bones, and facial part of the skull are found. Some hereditary diseases and oncological processes are also associated with the pathology of amniotic fluid. In 50% of cases, the cause of polyhydramnios cannot be determined.

Symptoms

Polyhydramnios occurs in 0.5-1.5% of the total number of births. Clinical manifestations pathologies are usually noted when the amount of water is exceeded by more than 3000 ml (at the term of full-term pregnancy).

Symptoms to suspect polyhydramnios:

rapid increase in the size of the abdomen;
rapid weight gain;
decreased fetal activity;
swelling of the legs;
expansion of the veins of the lower extremities and perineum;
the appearance of striae (stretch marks);
swelling of the skin of the abdomen.

With moderate polyhydramnios, the symptoms will be mild. In most cases, polyhydramnios is an incidental finding during a routine ultrasound.

Diagnostics

The following methods are used to detect pathology:

Inspection

Starting from 16 weeks of pregnancy, at each visit to the doctor, the height of the fundus of the uterus (VDM) and the circumference of the abdomen (OC) are measured. Increase in VDM and coolant indicators - feature polyhydramnios. Similar symptom also occurs in twin pregnancies or large fruit. An accurate diagnosis can only be made after an ultrasound examination.

On examination, the following symptoms are noted:

tension of the skin of the abdomen (due to edema);
increased fetal mobility;
incorrect position of the baby (oblique or transverse);
muffled heartbeat.

During the examination, it is difficult to feel large parts of the fetus due to the excess amount of amniotic fluid. For the same reason, the baby's heart is poorly audible through the anterior abdominal wall. To diagnose the condition of the fetus, an additional examination is carried out (ultrasound, dopplerometry, CTG).

ultrasound

Ultrasonography- the main method for diagnosing polyhydramnios. The total volume of water will depend on the gestational age. For each period, there are rules that the doctor of ultrasound diagnostics is guided by. If the amount of amniotic fluid exceeds the established norm, they speak of polyhydramnios. At a period after 36 weeks (with a full-term pregnancy), the amount of water should be no more than 1500 ml.

Complications of pregnancy and consequences for the fetus

Moderate polyhydramnios can cause an incorrect position of the fetus. Moving in in large numbers amniotic fluid, the baby cannot take a stable position. Often the child is located across the uterus or in an oblique line. With polyhydramnios, the frequency also increases breech presentation fetus.

Against the background of an excess amount of amniotic fluid, the load on the placenta increases. Hypoxia develops - a condition in which the baby does not receive enough oxygen. The development of the fetus slows down, the rate of weight gain decreases. The brain suffers - a structure that is very sensitive to a lack of oxygen. All this in the future can lead to a delay in the development of the child after his birth.

With polyhydramnios, the risk of stillbirth and intrauterine death of the fetus increases significantly. Such complications are associated with severe hypoxia. The cause of fetal death can also be severe malformations of internal organs, which are often found in polyhydramnios.

Other complications of pregnancy and childbirth:

preeclampsia;
premature detachment of a normally located placenta (PONRP);
bleeding during pregnancy, childbirth and the postpartum period;
anomalies of labor activity;
prolapse of the umbilical cord.

Polyhydramnios is a risk factor for the development of pneumopathy (lung pathology) in newborns. This condition develops as a result intrauterine infection or aspiration of amniotic fluid during labor. Pneumopathy is difficult to treat and can cause the death of a newborn. With polyhydramnios, the likelihood of premature birth increases significantly.

Polyhydramnios, which occurs with diabetes in the mother, goes against the background of hyperglycemia (increased blood glucose levels). With this condition, children weighing more than 4000 kg are often born. After birth big kids be screened for diabetes. For diagnosis, a blood test for sugar is taken in the first days of life.

Management of pregnancy with polyhydramnios

The tactics of pregnancy will depend on its duration and severity of symptoms. If polyhydramnios is detected for up to 22 weeks, a control ultrasound is performed. During the study, the doctor pays attention to the condition of the fetus. If severe malformations and anomalies of the placenta are detected, the question of termination of pregnancy is raised.

Moderate polyhydramnios without fetal CM is a reason for dynamic monitoring of the woman's condition. If polyhydramnios is detected in the third trimester, pregnancy is prolonged to the maximum possible term. In the case of an increase in the volume of amniotic fluid, early delivery is performed.

Treatment

Specific treatment for polyhydramnios has not been developed. Influence the volume of amniotic fluid medicines impossible. The amount of amniotic fluid is also not affected by the amount of fluid a woman drinks. All that a doctor can do is to find the cause of polyhydramnios and, having eliminated it, get rid of the excess production of water during pregnancy.

With polyhydramnios associated with infectious diseases, antibiotic therapy is prescribed. Antibiotics are selected taking into account the duration of pregnancy, effective and safe for the fetus. The course of therapy lasts up to 10 days. At the end of the course, a control ultrasound is performed.

With polyhydramnios against the background of diabetes mellitus, the treatment regimen for the underlying disease is being revised. The dose of insulin is adjusted, drugs are selected to stabilize the condition of the expectant mother. Until the very birth, a woman falls under the supervision of an endocrinologist. The condition of the fetus is monitored using ultrasound and CTG.

For severe forms hemolytic disease fetus (GBP) intrauterine blood transfusion is performed. After the procedure, the symptoms of GBP decrease, the level of hemoglobin increases, and swelling subsides. Against the background of treatment, the level of amniotic fluid also returns to normal.

Birth management

Childbirth with polyhydramnios does not always proceed safely. An excess amount of amniotic fluid leads to the development of such complications:

weakness of labor activity;
premature rupture of amniotic fluid;
prolapse of the loops of the umbilical cord and parts of the fetus (threatens with asphyxia and death of the fetus);
bleeding (against the background of placental abruption) during pregnancy and childbirth;
atonic bleeding in the postpartum period.

With polyhydramnios, the child often takes an oblique or transverse position in the uterus. This condition is considered an indication for caesarean section. Emergency surgery is also performed for prolapsed umbilical cord loops and bleeding.

Tactics of conducting natural childbirth with polyhydramnios:

Timely opening of the fetal bladder (the membranes of the bladder are opened along the lateral edge above the level of the internal pharynx).
Slow release of water when opening the bladder (to avoid prolapse of the umbilical cord).
At break membranes amniotic fluid is released slowly, without removing the hand from the vagina (to keep the limbs of the fetus and the loop of the umbilical cord inside).
The use of oxytocin to stimulate labor begins no earlier than 2 hours after the passage of water (to prevent placental abruption).
If possible, childbirth is carried out without the use of drugs that increase the tone of the uterus.

In childbirth with polyhydramnios, the risk of fetal injury, rupture of the perineum and cervix increases. All children born to women with polyhydramnios are subject to close observation neonatologists.

Polyhydramnios is a pathological condition, which is expressed in the form of excessive accumulation of amniotic fluid in the uterus during pregnancy.

The volume of amniotic or amniotic fluid during pregnancy changes, for example, at the tenth week their amount should not exceed 30 ml, at the fourteenth - 100 ml, and in last trimester the volume of amniotic fluid varies between 1000-1500 ml. If these norms are exceeded in terms of the amount of amniotic fluid, polyhydramnios occurs during pregnancy.

In medical practice, acute and chronic polyhydramnios occur, it all depends on the severity. For example, with a mild degree of polyhydramnios, the excess fluid in the uterus is insignificant, but if the volume of water is significantly higher than normal, we are talking about severe polyhydramnios.

Pregnant women diagnosed with polyhydramnios are recommended to be under continuous medical supervision in order to prevent the development of serious complications. If, with this diagnosis, a woman did not have circulatory and respiratory disorders, specialists until the last try to keep the pregnancy until the natural process of delivery, otherwise it is resolved prematurely, since it poses a threat to the woman's life.

Treatment of this pathology is carried out taking into account the severity of the condition of the expectant mother. If such an anomaly in a pregnant woman is not very pronounced, then it can disappear on its own and without the intervention of doctors.

In the treatment of severe and acute polyhydramnios, an amniotomy (or opening of the amniotic sac) is often prescribed to drain excess amniotic fluid.

Symptoms of polyhydramnios.
Symptoms of the manifestation of such a pathology of pregnancy can be very different, due primarily to the pressure of the enlarged uterus on nearby organs. For example, when acute polyhydramnios, the cases of which are quite rare, and which occur mainly in the early stages of bearing a child, there is a rapid increase in the volume of amniotic fluid, heaviness appears in the abdomen and its rapid increase in size. At the same time, the expectant mother may experience pain in the lower back and perineum of an acute nature, swelling of the lower extremities, vulva and abdominal wall, shortness of breath or difficulty breathing, decreased urination. In addition, a pregnant woman has an increase in blood pressure, and, in addition, it is difficult to listen to the fetal heartbeat and feel it with your fingers.

Chronic polyhydramnios in most cases manifests itself in the third trimester of pregnancy. It must be said that the symptoms this case less pronounced than with an acute degree of polyhydramnios: the size of the abdomen increases gradually, allowing the woman to adapt to them. However, it should be noted that in this case there are various diseases mothers during pregnancy. These include diabetes mellitus, future mother bacterial or infectious diseases, kidney and cardiovascular diseases.

Causes of polyhydramnios.
It often happens that the causes of polyhydramnios remain unclear. But the most common causes of this condition are:

congenital pathologies in the development of the fetus, influencing the development gastrointestinal tract, kidney or heart, the central nervous system of the child;
deviations in a child of a chromosomal nature;
pregnancy identical twins, during which one fetus has polyhydramnios, and the other - oligohydramnios;
diabetes mellitus, pyelonephritis, metabolic disorders and body fluids;
diseases of the cardiovascular system;
fetal anemia;
Rh-conflict of the blood of the mother and child (the mother has a negative Rh factor, and the father has a positive one);
infections (rubella, cytomegalovirus);
bacterial or infectious diseases suffered by a pregnant woman before conception or during pregnancy;
placental tumor.

Complications of polyhydramnios:

urinary tract infections;
incorrect position of the fetus in the uterine cavity, which requires a caesarean section;
promotion blood pressure;
pathological growth of the fetus;
premature rupture of the fetal bladder with the outflow of amniotic fluid;
prolapse of the umbilical cord;
premature birth;
premature exfoliation of the placenta;
stillborn children;
high risk of postpartum hemorrhage against the background of weak uterine contractility.

The earlier polyhydramnios develops, the higher the level of fluid accumulated in the uterus, and the higher the likelihood of complications.

Diagnosis of polyhydramnios.
Diagnostics of this pathological condition during pregnancy is carried out on the basis of the woman's complaints. To make a diagnosis, an ultrasound examination of the fetus is prescribed, in which the amount of amniotic fluid is determined and the "amniotic index" is calculated. If the obtained indicator exceeds the norm, polyhydramnios is put.

In addition, the doctor may prescribe additional studies:

The procedure of amniocentesis, in which samples of amniotic fluid are taken for analysis, containing fetal cells, the products of its vital activity.
Glucose uptake assay, which is a screening test for gestational diabetes(arising during the bearing of the baby). The woman is given syrup to drink, and half an hour later, blood is taken for analysis to determine the level of glucose. If the blood sugar level exceeds allowable norms, perform an additional glucose uptake test that detects the presence or absence of gestational diabetes.
Biochemical analysis of a pregnant woman's blood serum, which determines the levels of substances associated with certain birth defects.
Karyotyping or analysis of the quality and quantity of chromosomes for all 23 pairs of chromosomes. For analysis, samples of amniotic fluid or placenta are used, which are taken during amniocentesis or chorionic biopsy.

Treatment of polyhydramnios in pregnant women.
The effectiveness of treatment directly depends on the establishment and elimination of the cause of the development of polyhydramnios, for which the specialist prescribes some examinations:

Ultrasound of the fetus and dopplerography (with its help, vessels, the fetus, uterus and umbilical cord are examined), in which the condition of the uterus and fetus, as well as blood flow in the placenta, is established.
CTG (cardiotocography) of the fetus, in order to assess the general condition.
Blood test for intrauterine infection.
Blood test and smear for sexually transmitted infections (chlamydia, mycoplasma, ureaplasma).
In the presence of negative Rh factor, a woman in position needs to take a blood test for antibodies.

Taking into account the causes and severity of this pathology, appropriate treatment is prescribed. So in the case of unexpressed polyhydramnios and polyhydramnios of moderate severity, treatment is used medications, as in outpatient ( mild degree), and stationary conditions (with moderate polyhydramnios). In this case, the pregnancy is maintained until its natural physiological completion (delivery) with continuous treatment. Usually, women are prescribed antibiotics (except tetracycline), diuretics (diuretics), vitamins (hypothiazid, B vitamins), immunomodulatory therapy. Also at 24-38 weeks of pregnancy, a woman is prescribed Indomethacin. If the measures taken do not bring positive result, and polyhydramnios continues to develop, turning into a severe degree, while there are all signs of intrauterine suffering of the fetus, in most cases, pregnancy is resolved ahead of schedule. With weakness of labor activity, appropriate treatment is also applied (drugs are used no earlier than two hours after the outflow of amniotic fluid).

How to alleviate the condition with polyhydramnios on your own?
With shortness of breath, you should rest more, avoid climbing to the floor without an elevator, do all household chores slowly.

With heartburn against the background of uterine pressure on the stomach:

should eat small meals as often as possible;
do not eat at night and eat immediately before bedtime;
you need to give up foods and drinks that provoke it ( fatty food, carbonated drinks, etc.);
put pillows under your back before going to bed (to form a reclining position);
Take antacids as directed by your doctor.

If new symptoms occur or the condition worsens, call your doctor right away.

Influence of polyhydramnios on the condition of a pregnant woman.

Feelings of pain and discomfort.
Complication of the process of childbirth: weakness of contractions, early detachment placenta, excessive bleeding due to excessive distension of the uterus.
Complications during the recovery period.

The effect of polyhydramnios on the fetus.

The occurrence of various defects and pathologies in the development of the fetus.
perinatal death.
Asphyxia of the fetus against the background of a weakening of labor activity, which negatively affects general condition baby and his central nervous system.

Prevention.
Polyhydramnios during pregnancy is enough serious phenomenon, even in the case of a mild degree of pathology, because it indicates the presence of disorders during pregnancy, certain diseases that can seriously harm the health of a woman and a child. Therefore it is important to take preventive measures to prevent development this phenomenon. These, first of all, include various surveys that will help to timely identify factors contributing to the development of polyhydramnios. It is also recommended to adhere to a certain diet, consume a certain amount of fluid, visit more often fresh air while walking. And most importantly, strictly follow the recommendations of the doctor leading the pregnancy, take all the vitamins and prescribed drugs, and also undergo the prescribed procedures. Identified polyhydramnios on initial stage development is simply, quickly and effectively treated without harm to the health of the mother and fetus.

Polyhydramnios during pregnancy is a pathological condition in which the amount of amniotic fluid exceeds the levels considered normal for a certain period.

Amniotic fluid provides complete intrauterine development future baby. They protect the fetus from external influences and give him the opportunity to move, participate in the metabolic process and prevent clamping of the umbilical cord. The amniotic fluid is regularly replaced (about every 3 hours) and gradually increases. If at week 10 the volume is approximately 30 ml, then in the prenatal period it is already 1-1.5 liters.

They talk about polyhydramnios when there is more than one and a half liters of fluid in the later stages.

Causes of polyhydramnios during pregnancy

The exact cause of polyhydramnios has not been established to date. There is an opinion that genetic (family) predisposition has a certain value. Allocate a risk group; in women included in it, this pathology of pregnancy is much more common.

Predisposing factors:

large size of the fetus;
multiple pregnancy;
kidney pathology;
Rhesus conflict;
infections;
pathology of the excretory system of the unborn child.

Note:the likelihood of developing a pathological condition increases with infection with viruses, and. Often leads to polyhydramnios.

Among the predisposing factors is a violation of the function of swallowing in the fetus. In the later stages, he absorbs up to 4 liters of amniotic fluid daily.

Symptoms

There are a number clinical signs, allowing to suspect polyhydramnios during pregnancy.

The following symptoms may appear:

Note:the cause of shortness of breath is the so-called "high standing" of the dome of the diaphragm.

According to the nature of the course, polyhydramnios is divided into acute and chronic. Of particular danger is the acute variant of development, most often diagnosed during II trimester. It is characterized by a sharp increase in the volume of water over a very a short time– from several hours to 1-3 days. The circumference of the patient's abdomen at the level of the navel increases rapidly, and in the inguinal and lumbar region there is pain of medium or high intensity. During the examination, swelling of the abdominal wall and hypertonicity of the myometrium are determined.

In the chronic form, the volume of amniotic fluid increases gradually, but the likelihood of complications is also very high.

According to the severity of the current pathological process distinguish mild, moderate and severe.

Consequences of polyhydramnios during pregnancy

Polyhydramnios during pregnancy in many cases leads to serious consequences, especially in the absence of early diagnosis and adequate medical care.

Possible complications of the pathological condition are:

spontaneous abortion (in almost 30% of cases);
(almost 40% of cases);
fetoplacental insufficiency;
early and massive discharge of water;
intrauterine malformations (most often nervous system and fetal gastrointestinal tract)
, oblique or transverse presentation;
premature detachment of the placenta;
childbirth ahead of time.

Fetoplacental insufficiency leads to a lack of oxygen by the fetus (), which can cause the death of the unborn baby or serious developmental disorders.

If bacterial or viral infection, the risk of fetal infection is high.

According to medical statistics, almost 20% of patients diagnosed with polyhydramnios develop late (preeclampsia).

Important:pathology can lead to a weakening of labor activity in the 1st and 2nd periods, since there is an overstretching of the uterine wall, which negatively affects muscle tone. During childbirth, against the background of a rupture of the fetal bladder and a massive outpouring of water, the umbilical cord or parts of the child's body may fall out. Often postpartum hemorrhage develops.

Diagnostics

The basis for suspicion of polyhydramnios is the data of the anamnesis (the presence of certain symptoms) and general examination (with measurement of the circumference of the abdomen).

During the examination, it is necessary to study the parameters of blood (and) and urine. In case of Rh-conflict, antibodies are examined.

The laboratory also examines the smear for the possible presence of pathogenic microflora.

During palpation, the tension of the uterus and the discrepancy between its size (increasing) and the duration of pregnancy are determined. The high mobility of the fetus is also characteristic; he is constantly trying to change his position.

Important:excessively free position of the fetus and its active movements often lead to entanglement with the umbilical cord, which is fraught with asphyxia.

Verification of the diagnosis is carried out in the course. With ultrasound, the largest area between the uterine wall and the fetus is measured, receiving the so-called. amniotic fluid index.

Table of indicators of amniotic fluid:

Among the very informative diagnostic methods are CTG (cardiotocography is needed to assess the condition of the fetus) and dopplerometry.

Treatment of polyhydramnios during pregnancy and prognosis

If mild or average degree severity, obstetrician-gynecologists make every effort to keep the pregnancy up to physiological delivery. In severe cases, disorders of vital functions are possible, therefore, early (operative) delivery is often indicated to save the patient's life.

To determine the medical tactics, it is important to identify the factors that provoked the pathological condition.

If multiple pregnancy is due to infection, bacterial pathogens require(it is advisable to prescribe drugs a wide range actions - Rovamycin or Erythromycin).

Important:during pregnancy, the use of tetracycline antibiotics is unacceptable!

According to indications, diuretics are prescribed (Hypothiazid, Furosemide), and and.

To improve the uterine and placental blood flow Actovegin and Curantil are recommended.

Note:pregnant women diagnosed with polyhydramnios should have daily cardiotocography, weight and blood pressure measurements. Ultrasound and dopplerography to assess uterine and placental blood flow are performed at least weekly.

Polyhydramnios may be an indication for an abdominal amniocentesis procedure, during which a puncture is performed, followed by a slow removal of excess amniotic fluid (pumped up to 200 ml).

With a weakened labor activity, its drug stimulation is carried out.

With a mild degree, therapy can be carried out at home, but moderate severity is already becoming an indication for hospitalization.

The prognosis for the chronic form of polyhydramnios is quite favorable. If there are no contraindications, childbirth is carried out naturally.

To prevent a sudden rupture of the fetal bladder, they resort in advance to a puncture of the membranes - amniotomy. Through this procedure, the amniotic fluid is poured out in a thin stream, and the uterus contracts. In emergency cases, it is shown.