How amniotic fluid is renewed during pregnancy. Amniotic fluid during pregnancy How to increase the amount of amniotic fluid during pregnancy

During pregnancy, an amniotic sac forms in the uterus, which will produce amniotic fluid. This fluid protects your baby. Reduced amniotic fluid is called oligohydramnios or oligohydramnios. Reduced amniotic fluid can lead to problems, so it is very important to maintain normal fluid levels with medical or folk remedies. The article provides some tips on this topic.

Steps

Increasing amniotic fluid with medications

The type of treatment is selected depending on the stage of pregnancy. Therefore, the doctor's choice of treatment will be based on the stage of pregnancy. Doctors usually prescribe one of the following treatments along with water restoration.

If your pregnancy is still in the early stages, your doctor will carefully monitor your condition and fluid levels. To analyze the child's activity, a non-stress test or a contractile stress test can be performed. Your doctor may recommend one of the following types treatment.
If there is oligohydramnios in the last trimester, the doctor may recommend childbirth with caesarean section, since a decrease in the amount of amniotic fluid right before birth can be dangerous for both mother and baby.

Injection with amniotic fluid. This injection is a syringe filled with leaked amniotic fluid, which the doctor injects back into the uterus, into the amniotic sac. This method can improve the condition of the pregnant woman. This procedure is very similar to amniocentesis (testing of amniotic fluid), but instead of taking a sample of amniotic fluid, the doctor injects the leaked fluid into the amniotic sac.
- This procedure is often used as a short-term solution to oligohydramnios because fluid levels may drop again after a few weeks. However, doctors decided to use this method because it helps them find the problem that is causing the amniotic fluid levels to decrease.
We administer fluid intravenously. Some pregnant women are admitted to the hospital to receive additional intravenous fluid therapy. This method is used if conventional means (for example, drinking large amounts of water) are not able to increase the amount of amniotic fluid. If you have tried increasing the fluid yourself and there is no change, you will most likely be given intravenous fluid.
- You will be discharged as soon as your amniotic fluid levels return to normal.
- Keep in mind that sometimes intravenous therapy may have to be continued until delivery.
Catheter to increase amniotic fluid. Amnioinfusion is the injection of Ringer's solution or normal saline solution into the amniotic sac using a catheter. This procedure will increase the level of amniotic fluid, which will better protect the baby and the umbilical cord.
- The amount of saline administered will depend on how low the amniotic fluid level is.
Talk to your doctor about having a shunt placed in your body. Shunts are used to move fluid from one place in the body to another. In this case, the shunt directs fetal urine into your amniotic sac if the cause low level amniotic fluid is due to chronic fetal uropathy (kidney problems that reduce amniotic fluid).

Talk to your doctor about stopping taking ACE inhibitors if you are prescribed them. ACE inhibitors are medications that help lower high blood pressure by stopping the conversion of angiotensin I to angiotensin II in your body. These medications are generally harmless, but they should not be taken during pregnancy because they may reduce the amount of amniotic fluid.

What is oligohydramnios?

What is amniotic fluid needed for? The most important function of amniotic fluid is to protect the child while he is in the womb. It plays the role of a pillow, protecting the child from blows. But it also performs other functions:
- Keeps baby warm.
- Acts as a lubricant. Sometimes some babies are born with webbed fingers and toes due to insufficient amniotic fluid.
- Ensures proper development of the kidney lungs.
- Helps the child move freely, which in turn allows him/her to develop limbs.
Let's get acquainted with the symptoms of decreased amniotic fluid. Oligohydramnios is a condition that occurs when the amniotic fluid is greatly reduced (below 300 ml). If you suspect the development of oligohydramnios, you should definitely talk to your doctor. If you think that similar problem may appear in the future, you should be aware of the following signs:
- Leakage of amniotic fluid.
- Your belly is smaller than it should be during gestation.
- The feeling that the child began to move less.
- When you urinate, less urine is released.
- Visible lack of amniotic fluid when examined by ultrasound.
You should be familiar with the risk factors that can lead to a decrease in amniotic fluid. Some of the most common reasons are described below:
- The baby is small for its gestational age.
- You have high blood pressure during pregnancy (a condition called preeclampsia).
- The placenta partially or completely detaches from the wall of the uterus before labor occurs. This condition is known as placental abruption.
- If you have identical twins and they share the placenta, sometimes your amniotic fluid levels may decrease. This occurs when one twin receives more blood through the placenta than the other.
- If you have certain diseases, such as lupus.
- Post-maturity. If you are more than 42 weeks pregnant, you are at higher risk of low amniotic fluid levels due to decreased placental function. Amniotic fluid begins to decrease at 38 weeks of pregnancy.

In this article:

Introduction

Pregnancy is a natural process for every woman, when not only her appearance changes, but also her worldview. There are so many worries, concerns, worries and reasons to rejoice, for example, the first movement of a baby. But, unfortunately, sometimes problems arise associated with this interesting situation. What can darken the life of a future mother? On early stages– this is toxicosis, threat of miscarriage, later – polyhydramnios, gestosis and more. Why do you have to suffer and endure unpleasant trials while expecting a baby, what are the causes of polyhydramnios and other problematic conditions?

When there is a lot of water...

Almost every woman knows what amniotic fluid is - this is the liquid that surrounds the baby in the womb throughout almost the entire pregnancy. Their number ranges from 20-30 to 1200, less often up to 1500 ml, depending on the period.

What problems can be associated with amniotic fluid?

Low water.
Polyhydramnios.
Infection of amniotic fluid.

Polyhydramnios is an excess amount of amniotic fluid. This problem can occur at any time and it is extremely important to find out and eliminate the cause.

Is there something wrong…

In most cases, a moderate increase in amniotic fluid has almost no effect on the well-being of pregnant women, or they simply think that this is how it should be (especially if this is their first pregnancy). What are the symptoms?

An excessively large belly that does not correspond to the age and size of the fetus.
Nagging pain in the lower abdomen, a feeling of muscle fatigue due to excess load.
Tachycardia, sensations of lack of air, heartburn and nausea - all this develops due to the higher position of the uterus, which in turn compresses the stomach and disrupts the movements of the chest (diaphragm).
Often, after polyhydramnios, edema develops, most often in the legs.

If these symptoms appear, you should consult a doctor without waiting for a scheduled visit.

Causes

The causes of polyhydramnios are varied, but it is customary to highlight the most common ones.

From the fetus:

excess fetal weight;
pathology of the gastrointestinal tract;
pathology of the urinary system;
congenital endocrine pathology, in particular hypothyroidism;
gene and chromosomal diseases;
dysfunction of the membranes and uteroplacental circulation.

Hormones are the conductors of the body

The hormonal system is a very fine structure that includes many direct and feedback. That is why violations of one link, the pathology of one endocrine gland leads to a serious malfunction in the entire body. This also applies to the process of bearing a child.

When the mother has diabetes mellitus, the process of glucose absorption by the cell is disrupted in the body and, as a result, a large amount of this substance remains in the bloodstream and amniotic fluid. Almost all sugars have the property of attracting water. Thus, the increased content of glucose in the blood and amniotic fluid helps to attract additional fluid there in order to restore the proper concentration of substances. By the way, this is the most common reason polyhydramnios.

A similar mechanism occurs with reduced functional activity of the thyroid gland, otherwise with hypothyroidism. This endocrine organ produces substances responsible for metabolism and energy. A reduced amount of thyroid hormones leads to metabolic disorders and, as a result, glycosaminoglycans can accumulate in tissues and amniotic fluid, which in turn, like glucose, attract a large volume of water. Usually in these cases, pregnant women experience dense swelling of the skin and subcutaneous fat.

Similar troubles can arise from pathology of any part of the endocrine system responsible for the metabolism of substances and water in the body.

Local and general infections

Any infectious process is stress for the body. Local infectious diseases are usually divided into nonspecific (germs and viruses of any strain and class) and specific, for example, gonorrhea and syphilis. The latter are extremely dangerous for the unborn child, not only due to the development of polyhydramnios, but also the formation of severe congenital pathology, including developmental defects. Nonspecific infections, as a rule, can cause infection of the amniotic fluid, then the placenta and, as a result, have a toxic effect on the vessels, which become more permeable. The latter directly leads to an increase in amniotic fluid.

As for common infectious diseases, these can be viruses, bacteria, fungi. The more severe the illness for the mother, the worse it is for the unborn baby. Flu, measles, chickenpox and new herpes infections are especially dangerous. All of them synthesize toxins into the bloodstream and promote the production of inflammatory substances, antibodies, immune complexes, which negatively affect the blood vessels of the placenta, increasing their permeability, and the unborn baby. Secondary infection of the placenta, amniotic fluid and baby may also develop, which can lead to the development of polyhydramnios.

Any stress, including infectious stress, can cause an exacerbation of the mother’s chronic diseases.

Extragenital pathology

This is a group of diseases that are not associated with the reproductive system, but can have an adverse effect on the development of pregnancy, for example, diseases of the cardiovascular system.

Hypertension or other pathology accompanied by increased blood pressure during decompensation in pregnant women is almost always accompanied by an excess amount of amniotic fluid and edema. It also poses a threat of premature placental abruption and disruption of the normal course of labor.

Diseases of the urinary system, unfortunately, are not uncommon in our time and are one of the main causes of problematic conditions during pregnancy, including increased formation of water. Most often, the latter is caused by pyelonephritis, glomerulonephritis and other types of nephritis with impaired excretory function of the kidneys.

Exacerbations and reactivation of systemic problems, which most often affect small vessels of the kidneys and placenta, are extremely dangerous.

When immunity becomes the enemy

Our immune system is designed to protect the body from foreign genetic information - these are transplants, infections, foreign bodies. And the couple is the unborn child. After all, he only has half the genetic material of a woman, the other half from his father.

Most often, the immune system rebels against the child if there are some differences in the blood type and Rh factor, although there are other incompatibilities. Such conflicts lead to acute inflammation, which in turn causes an increase in amniotic fluid.

Child

Amniotic fluid and processes in the placenta are regulated by both the expectant mother and the child. Therefore, there is some pathology or abnormality on the part of the fetus that contributes to the development of polyhydramnios.

It is considered normal for a person to bear one fetus; in other cases, this is already a deviation from the norm. Female body undergoes enormous stress during pregnancy. Around each baby, especially if they are fraternal, amniotic fluid is formed, which performs protective, nutritional and training functions. Therefore, multiple pregnancies are almost always accompanied by an excess amount of amniotic fluid.

If a child develops endocrine pathology in the womb, accompanied by metabolic and water disorders, then there is more amniotic fluid. Unfortunately, the baby also suffers from this; usually such congenital diseases are accompanied by deviations in neuropsychic development and an increase in body weight (often due to edema) and individual organs.

Amniotic fluid, among other things, acts as a trainer, that is, the child swallows, digests and excretes. Partial absorption of water with dissolved substances occurs and, accordingly, its quantity is controlled. If a child has a pathology of the gastrointestinal tract, for example, atresia, membranes in the lumen, then the child will not be able to swallow liquid, reducing its amount around him.

Polyhydramnios due to genetic and chromosomal abnormalities in the fetus is one of the most unpleasant. The mechanism of the increase in water in Down and Edwards disease has not been fully studied; most likely this is due to combined pathology of the organs.

Quite often the cause of polyhydramnios remains unclear, then treatment is symptomatic.

Consequences

The danger of polyhydramnios is determined, first of all, by the reason why it arose. Indeed, in some cases, an increase in the volume of amniotic fluid is far from the worst symptom and consequence.

In itself, an increase in amniotic fluid is dangerous for premature birth. A woman's uterus can only expand to a certain size and, unfortunately, sometimes this is not due to the normal size of the child.

Treatment

How to avoid polyhydramnios? It is best to start with prevention, which means that pregnancy needs to be planned in order to put your body in order and compensate for chronic diseases of the endocrine, cardiovascular and genitourinary systems.

Most often, a deviation in the normal volume of intrauterine fluid is determined by the results of an ultrasound examination. After which you need to install the real problem. Only treatment of the causative disease will provide lasting results.

Symptomatic treatment is allowed only if the cause is not established.

Useful video

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

Amniotic fluid (the scientific name for amniotic fluid) is basically a filtrate from the mother's plasma (the fluid part of the blood). The secretions of the cells lining the fetal bladder from the inside also play an important role in its formation. The fetus not only absorbs the liquid environment surrounding it, but is also the source of its formation, since in later stages intrauterine development The kidneys and lung tissue of the fetus take part in the production of amniotic fluid. It has been proven that at the end of pregnancy, every day the fetus secretes about 600-800 ml of urine, which is an important component of the amniotic fluid.

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

Amniotic fluid perform a number of important functions. They create conditions for the free movement of the fetus, protect its body from adverse external influences, and protect the umbilical cord from compression between the fetal body 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 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 approximately 0.3-0.5% of pregnant women.

Among the causes leading to oligohydramnios, the most common are gestosis and maternal hypertension, and the severity of oligohydramnios and the frequency of its development depend on the duration of this pathology and the degree of its severity. A decrease in the amount of amniotic fluid also occurs against the background of infectious inflammatory diseases mothers, such as 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, etc.). Insufficient production of amniotic fluid occurs with lesions of the fetal excretory system, 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 reasons for the development of oligohydramnios.

The mechanism of development of oligohydramnios during chronic fetal hypoxia has not been fully studied, but it is assumed that against the background of oxygen deficiency, a reflex redistribution of blood flow occurs in favor of vital organs: the brain, fetal heart, adrenal glands, while bypassing the lungs and kidneys, which are the main ones. 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 equal frequency in both primiparous and multiparous women.

Diagnosis of oligohydramnios

The doctor can assume a decrease in the amount of amniotic fluid if the height of the fundus of the uterus (its uppermost part) and abdominal circumference lag behind the normative indicators for the expected period of pregnancy, as well as if the motor activity of the fetus decreases. During external examination, parts of the fetus are clearly identified, heart sounds are heard, and the uterus is dense. A more accurate determination of the severity of oligohydramnios is possible with ultrasound examination.

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

A Doppler study of blood flow in the “mother-placenta-fetus” system, which is carried out in the umbilical cord artery, in the middle cerebral artery of the fetus and both uterine arteries of pregnant women, is also necessary, because With oligohydramnios, blood flow may be impaired.

As the amount of amniotic fluid decreases, the frequency of pronounced forms of fetal growth retardation (hypotrophy) increases, determined using ultrasound fetometry - the most reliable objective method for assessing the growth and development of the fetus, which allows, at each specific stage of pregnancy, to accurately determine the correspondence of the size of the fetus to this period, as well as the degree their deviations from normal indicators. With I degree of malnutrition, there is a lag of fetometry indicators from the normative indicators by , with II - by , with III - by more than . Newborns born to mothers with severe oligohydramnios often show signs of malnutrition of varying degrees. 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 disrupted), 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 indicators. To clarify, cardiotocography (CTG) - recording the fetal heartbeat - is a modern method for diagnosing the intrauterine condition of the fetus, which is carried out after 32 weeks of pregnancy.

There are also primary oligohydramnios, which develops when the membranes are intact, and secondary, or traumatic, associated with damage to the membranes and the gradual flow of amniotic fluid - the 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 membranes, based on the determination of placental protein in the vaginal discharge. Normally, this protein is not present in vaginal discharge. If the flow of water is significant, the woman feels discomfort from the fact that her underwear periodically becomes wet from the water. If leakage of amniotic fluid (premature rupture of the membranes) is detected during a premature pregnancy, the woman must be hospitalized in a separate room, bed rest and mandatory monitoring of the health of the mother and fetus to decide on further tactics for managing the patient. If the pregnancy is full term, then in the absence of contractions, labor stimulation begins.

What is oligohydramnios like?
There are two forms of oligohydramnios:

early, which is caused by functional insufficiency of the membranes. This form is diagnosed using ultrasound examination at term;
late, usually detected after, when oligohydramnios occurs due to insufficient functional activity of the membranes or disturbances in the condition of the fetus.

Why is oligohydramnios dangerous?

An extremely unfavorable prognostic sign is the detection of severe oligohydramnios in the second trimester of pregnancy, i.e. on timing. When oligohydramnios develops during these periods, pregnancy is terminated and intrauterine death of the fetus or newborn occurs in the first days of life. During this period, the fetal body is not yet adapted to independent extrauterine existence, and special equipment is needed to support the life of the newborn, but the earlier the pregnancy is terminated, the more unfavorable the prognosis.

As mentioned above, insufficient amniotic fluid, especially severe 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 defects (the occurrence of adhesions between the fetal skin and the aqueous 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 umbilical cord compression and intrauterine fetal death, as well as intrauterine infection. All of these complications often dictate the need for early delivery by cesarean 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 degrees of severity (discrepancy between the size of the newborn and the given stage of pregnancy). But at the same time, the outcome of pregnancy is favorable for the vast majority of women - children are born in satisfactory condition.

Management of pregnancy and childbirth during oligohydramnios

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

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

If the fetal condition deteriorates according to cardiotocography data and indicators of fetal-placental blood flow, delivery is carried out by cesarean section on an emergency basis.

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

Thus, the health of the unborn child with oligohydramnios depends on the degree of reduction in the amount of amniotic fluid, the severity of intrauterine 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 polyhydramnios is more often observed with diabetes mellitus (a disease in which glucose metabolism is impaired), the presence of acute or chronic infectious process in the mother, (the presence of a positive Rh factor in the mother and negative in the fetus, the development of antibodies to fetal red blood cells in the mother), multiple pregnancy, anomalies of fetal development.

One of the causes of polyhydramnios is a dysfunction of the cells lining the inner surface of the fetal aqueous membrane, which leads to an increase in the production of amniotic fluid and a delay in its excretion. It is believed that in this case, infectious (including viral) diseases of the pregnant woman (mycoplasmosis, cytomegalovirus infection, syphilis, acute respiratory diseases) are of great importance. As already mentioned, polyhydramnios often accompanies fetal developmental defects. With malformations, the fetus does not swallow amniotic fluid - this is the main mechanism that regulates the amount of amniotic fluid and thereby prevents polyhydramnios. The most common malformations with polyhydramnios are congenital malformations of the central nervous system and the fetal gastrointestinal tract.

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 enlarged uterus. Acute polyhydramnios occurs quickly, and in this case the pregnant woman complains of shortness of breath (due to the high position 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, with chronic polyhydramnios the intrauterine pressure does not exceed normal. If fetal malformations are excluded, foci of infection are treated, and further progression of polyhydramnios is prevented, then the condition of the fetus under these conditions does not suffer and the baby is born healthy.

Diagnosis of polyhydramnios

With the development of polyhydramnios, a significant increase in the size of the uterus is observed: the abdominal circumference and the height of the uterine fundus (the distance from the womb to the fundus of the uterus) significantly exceed those at the expected stage of pregnancy. The uterus is tense, parts of the fetus are difficult to palpate, while the fetus easily changes its position, and its excessive physical activity. Fetal heart sounds are not heard clearly.

Ultrasound plays an important role in the diagnosis of polyhydramnios. During the study, the size of the vertical pocket is determined (ultrasound criterion for assessing the amount of amniotic fluid): with a mild degree of polyhydramnios, its value is 8-11 cm, with a moderate degree - 12-15 cm, with severe 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 research methods, in particular amniocentesis - taking a small amount of amniotic fluid (by puncture of the anterior abdominal wall, uterine wall) for biochemical, hormonal, immunological, genetic research. Determining the concentration of alpha-fetoprotein in the amniotic fluid is of great diagnostic importance. This protein is produced in the fetal liver and then enters the amniotic fluid along with urine. A high concentration of alpha-fetoprotein indicates fetal developmental abnormalities, mainly in the nervous system. Amniocentesis is always performed under ultrasound guidance. Important information The condition of the fetus can be determined by the results of direct examination of its blood obtained by taking it from the umbilical cord (cordocentesis). This procedure is carried out strictly according to indications, such as diagnosis of congenital and hereditary pathologies, intrauterine infection, etc. Cordocentesis is performed after 18 weeks of pregnancy under ultrasound guidance.

Possible complications of polyhydramnios

With mild chronic polyhydramnios, pregnancy proceeds favorably, and in most cases, birth occurs at term. The most common complication is pregnancy. With severe polyhydramnios, there are often premature birth. With increasing circulatory problems in a pregnant woman (severe swelling, 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 antibacterial therapy. If the examination reveals fetal malformations that are incompatible with life, the pregnancy is terminated regardless of the term.

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

Due to the fact that the rupture of amniotic fluid can be complicated by the prolapse of the umbilical cord, small parts of the fetus, as well as premature detachment of the normally located placenta, there is a need for artificial opening of the amniotic sac (amniotomy) when the uterine pharynx is not fully dilated (3-4 cm), in order to release the amniotic fluid by holding back its flow with the hand inserted into the vagina.

To prevent bleeding in the afterbirth and early postpartum period (in the first 2 hours after birth), bleeding is prevented by intravenous or intramuscular administration of drugs that increase the contractility of the uterus (methylergometrine).

In conclusion, it should be noted that for timely diagnosis, and therefore treatment of the described conditions, it is necessary to promptly follow all the recommendations of the doctor managing your pregnancy. This will avoid serious complications and help give birth to a healthy baby.

Eleonora Shagerbieva,
Obstetrician-gynecologist,
Science Center
obstetrics, gynecology
and perinatology of the Russian Academy of Medical Sciences

We don’t remember what happened to us before birth, but, apparently, we were fine. Firstly, warmth: amniotic fluid always remains at around 37.C. Secondly, it’s quiet: the liquid absorbs shock well and muffles noise coming from the outside world. Thirdly, it’s calm, because thanks to the absolute tightness of the bubble (some compare it to a ship that “delivers” the baby to its destination), nothing unnecessary gets into it. In addition, there are substances in the amniotic fluid that protect well little man from possible troubles. Amniotic fluid can also be compared to a kind of buffer that protects the baby from pressure from the outside world and ensures that the main means of communication with the mother - the umbilical cord - is not pinched. In addition, the child is not deprived of freedom of movement (especially in the early stages). He swims in the amniotic fluid, and this trains his muscles well. It consists of proteins, carbohydrates, fats and hormones, in general, everything that nourishes the baby for nine months.

Experts note that during the first bath after birth (its purpose is to wash away the original lubricant), children relax perfectly, feeling at home in a familiar environment. And this is very important before you start completely new life in a completely different world - a world of fresh air.

How are they formed

When a fertilized egg attaches to the 5th wall of the uterus and begins to divide, three components of a complex mechanism appear: membranes, the placenta and the umbilical cord, in fact, the embryo ( future baby). Membranes - two thin shells - are a sealed bubble with an absolutely sterile liquid inside. By the end of the second week of pregnancy, the bladder completely fills the uterus, and up to 14 weeks, amniotic fluid seeps into the baby’s body through the skin. Then he skin are enriched with keratin and become thicker, and from that moment water enters through other channels. For example, along the digestive tract: the baby absorbs liquid and removes it from the body along with urine. Over time, the volume of water it processes reaches several liters per day, despite the fact that about one liter of liquid is constantly in the uterus. Where does it come from?

Amniotic fluid is formed due to the sweating of blood plasma from the mother's blood vessels. On later During pregnancy, the baby's lungs also begin to take part in the production of amniotic fluid. By the end of the period, its quantity reaches 1-1.5 liters, and every three hours it is completely renewed, with one third being processed by the baby.

Almost 97% of the amniotic fluid is water, in which a variety of nutrients: proteins, mineral salts (calcium, sodium, chlorine). In addition, skin cells, hair cells and aromatic substances - alkaloids - can be found in it. There is an opinion that the smell of amniotic fluid is similar to the aroma of mother's milk, which allows a newly born baby to accurately determine where the mother's breast is. By the way, in the West, in some maternity hospitals, newborns’ hands are not washed so that they can suck their fingers, “flavored” with amniotic fluid, the smell of which they are so accustomed to.

Starting the system

Amniotic fluid is a living environment, thanks to its presence in which many vital functions begin to work in the child. The baby’s kidneys begin to work due to the fact that he swallows water, processes it and excretes it along with urine (they are found in the baby’s bladder already in the 9th week of pregnancy). Over time, the child, like a fish, begins to “inhale” the liquid, doing the first and very important exercise for the lungs, preparing them for breathing in a normal atmosphere. During childbirth, the lungs compress, the remaining amniotic fluid is expelled, and immediately after this the baby takes his first breath.

Due to the fact that the baby is constantly in the amniotic fluid, a white greasy coating appears on his skin, the so-called vernix. On the day of birth, after the membranes rupture (whether this occurs naturally or artificially), fluid enters the birth canal and washes it, which helps the baby move forward. If the baby lies head down, then at the beginning of labor only those waters that are in front are poured out, while the rest protect him further, and only come out when the baby is born. There is an assumption that there are substances in the amniotic fluid that give a signal for the onset of labor, but since this mechanism has not yet been fully studied, one cannot say about their existence with complete confidence. Only one thing is known for sure: at the end of pregnancy, it begins to put pressure on the cervix, which helps it open.

Required volume

Amniotic fluid is secreted by the cells of the fetal bladder, and after 20 weeks it is mostly formed by the fetal kidneys. By the end of pregnancy, the baby absorbs about 4 liters of amniotic fluid every day, swallowing it. They are absorbed in the gastrointestinal tract and then excreted through the urinary tract. Excess water is removed from the fetal bladder through special tubules and pores along with fetal urine, epidermal scales and secretion products of the sebaceous glands of the skin. The composition of amniotic fluid is constantly changing depending on the health of the mother and child and the duration of pregnancy. Amount of amniotic fluid must be certain. Doctors set the norm in the range from 600 to 1500 ml. If it exceeds 1.5 liters, then a condition called m occurs. When the amount of amniotic fluid is less than 0.5 liters, they speak of oligohydramnios.

A lot depends on this volume. The waters ensure free movement of the baby, participate in metabolism, and protect the umbilical cord from compression between the wall of the uterus and the baby. During childbirth, the lower part of the amniotic sac, filled with water, helps the normal opening of the uterus. When it opens completely, the waters pour out. This process indicates the imminent birth of the baby.

Without amniotic fluid, the baby can stay in your baby for no more than 6 hours. The baby will feel an increase or decrease in the amount of amniotic fluid immediately. And the first thing he will feel is discomfort. But you can protect your baby from unpleasant sensations. Try not to get sick during pregnancy, monitor your blood pressure and be sure to tell your doctor about everything that worries you. This will help you quickly recognize the problem and prevent complications.

Polyhydramnios

Polyhydramnios (polyhydramnios) occurs in 0.5-1.5% of all pregnancies. If the baby's movements have become less active, and you hear a distinct gurgling sound in your hiccups, it is possible that the amount of amniotic fluid has exceeded the norm. Hurry in antenatal clinic, where the doctor will compare your gestational age and the size of your uterus. With polyhydramnios, it becomes tense.

Why does this happen

Polyhydramnios does not mean that you are drinking too much fluid. The causes of the disease can be infections or diabetes, blood incompatibility according to the Rh factor of the mother and baby or multiple births, intrauterine infection, fetal development abnormalities. Do not panic or worry under any circumstances! Together with your doctor, you can prevent dangerous consequences.

What do you feel

With polyhydramnios, you may be bothered by vomiting, a feeling of heaviness and pain in the lower a. Sometimes accompanied by swelling. An enlarged uterus can put pressure on neighboring organs and interfere with their normal functioning. As a result of great mobility, the fetus can take incorrect positions. In very rare cases, doctors resort to early delivery. Volume a at the level of the navel with polyhydramnios reaches 100-120 cm or more. Childbirth with polyhydramnios is most often premature; it is accompanied by early rupture of amniotic fluid. Due to overstretching of the uterus, labor weakness, postpartum hemorrhage and other complications may occur. In some cases, in order to avoid a threat to the life of the mother, with severe polyhydramnios, impaired breathing and circulatory function of the fetus, there is a need for early delivery. But if there is no threat to your health, then you can carry the child as prescribed. Another trouble is that due to overstrain of the skin, numerous (striae) are formed on it. Do not forget to lubricate problem areas with special creams from the series for pregnant women.

What happens to the baby

With polyhydramnios, it is much more difficult for a doctor to assess the baby’s condition, palpate his body and listen to his heartbeat. In this situation, there is a high probability of developing malformations of the baby’s nervous system and gastrointestinal tract. With anomalies (malformations) of fetal development, the process of ingestion of water by the fetus is disrupted, as a result of which the balance between their production and excretion changes. On examination, the height of the uterine fundus and circumference a exceed normal values for this stage of pregnancy. The fetus actively floats in the amniotic fluid, which can cause the umbilical cord to become entwined around the neck and torso.

How to treat

It is possible that you will have to lie down for conservation. At the hospital, you will be prescribed medications that will increase urination, vitamin therapy, and other means to regulate amniotic fluid. The doctor will constantly monitor your baby's development to prevent any troubles. If a diagnosis is suspected, the doctor will clarify the diagnosis with the help of, while excluding intrauterine infection and fetal malformations.

There are two forms of polyhydramnios: acute and chronic.

With chronic polyhydramnios, the amount of water increases gradually. If the pregnant woman’s condition remains satisfactory, the doctor carries out outpatient treatment: limits the use of table salt, prescribes diuretics - drugs that stimulate the removal of fluid from the body.

Acute is much less common than chronic. In this case, the amount of amniotic fluid increases sharply within several hours or days. With this condition, there is a sharp increase in the size of the uterus, in some cases the woman experiences pain in the uterus, shortness of breath, and severe symptoms. The pregnant woman's condition may deteriorate so much that she will need emergency care. Note that this condition often causes premature birth. To confirm the diagnosis, methods for identifying intrauterine developmental defects are also used (the content of alpha-fetoprotein in the amniotic fluid is determined).

In case of acute polyhydramnios, the woman is hospitalized and put on bed rest. In case of severe shortness of breath and pain, abdominal amniocentesis is performed (piercing the amniotic sac through the anterior abdominal wall). The fluid is released slowly, at a rate of 500 ml/hour, because rapid removal of even a small amount of amniotic fluid can be complicated by placental abruption and premature birth.

Low water

Do you feel pain when your baby moves? Contact your doctor and he will prescribe additional examination. Typically, the appearance of oligohydramnios is explained by a decrease in the excretory capacity of the fetal bladder cells. This pathology is observed in 0.3 -0.4% of all births, but with congenital malformations of the fetus it can occur 10 times more often.

The outcome of the disease largely depends on the time of its onset. It is most dangerous in the second and third trimesters. It is at this time that the baby needs space so that he can actively move.

Doctors explain it by suffering from a viral infection or worsening chronic diseases. This problem often occurs in women who smoke. In addition, it may be a consequence of metabolic disorders, diseases of the genital organs, and hypertension. Regular tests will help doctors detect the problem early and correct it.

With oligohydramnios, complications of pregnancy and childbirth often occur: primary weakness of labor develops, and the frequency of bleeding increases. Frequency breech presentation fetus increases to 13%.

Oligohydramnios is a reduction in the amount of amniotic fluid to 500 ml or less as a result of an imbalance between its absorption and production. Most often, this condition is observed in younger pregnant women with elevated blood pressure in the third trimester of pregnancy and in women with an increased risk of developing fetal malnutrition (fetal size lagging behind normal for a given period).

First of all, if you suspect it, it is necessary to exclude congenital malformations of the fetus, especially if it is detected in the second trimester (up to 28 weeks) of pregnancy, because sometimes severe malformations can be combined with such malformations as polycystic kidney disease or their absence. Oligohydramnios, like oligohydramnios, may be a sign of intrauterine infection of the fetus, so it is necessary to conduct an examination for a hidden infection. Oligohydramnios can occur against the background of a decrease in fetal urine excretion into the amniotic cavity during chronic hypoxia, which is observed with intrauterine growth retardation. In 40% of women with m, there is a lag in the size of the fetus from the norm. Due to a sharp decrease in the volume of amniotic fluid, compression of the umbilical cord (between the fetus and the walls of the uterus) may occur, which can lead to acute oxygen deficiency and fetal death; It is extremely rare that adhesions (adhesions) form between the walls of the uterus and the skin of the fetus.

Since in case of oligohydramnios it is “flat”, it does not perform the function of a hydraulic wedge and does not contribute to the dilation of the cervix, as a result of which there is a danger of weakness of labor. Due to disruption of active motor movements of the fetus in the uterine cavity, the frequency of breech presentations increases, and, as a result, in some cases, cesarean sections. More often, operative birth with oligohydramnios is caused by weakness of labor and intrauterine fetal hypoxia. Oligohydramnios can be primary (observed with intact membranes) and secondary, or traumatic (as a result of damage to the membranes with a gradual leakage of water, which sometimes goes unnoticed by the woman: they lag behind normal for a given stage of pregnancy, the motor activity of the fetus is reduced, the uterus is palpable dense, parts of the fetus and the heartbeat are clearly visible. During vaginal examination, a “flat” shape is detected, stretched over the fetal head. Most likely, doctors will fight the disease against which the complication has developed. To avoid intrauterine growth retardation of the child, you will be corrected for placental insufficiency. If detected before 28 weeks of pregnancy, a comprehensive examination of the pregnant woman is carried out to determine possible reason and assessing the condition of the fetus. If fetal malformations are detected, the pregnancy is terminated for medical reasons. When oligohydramnios is combined with intrauterine hypoxia and fetal growth retardation, appropriate therapy is carried out until 33-34 weeks of pregnancy, and if treatment is ineffective and the condition of the fetus worsens, early delivery is carried out. During childbirth, the “flat” amniotic sac is opened to prevent labor weakness.

I remember this taste

Food preferences are established early in human development, in fact even before birth. As American researchers have found, love for garlic or citrus fruits appears with the very first taste sensations of a child. Future food preferences are determined by what was included in the mother’s diet during pregnancy and breastfeeding. For example, if a woman loves carrots and eats them regularly, then the baby will eat the bright vegetable with pleasure.

Important

To be aware of what is happening in your home and whether it is comfortable for your baby, be sure to do tests on time. Follow all doctor's instructions. Monitor status amniotic fluid will help:

Fetal and Doppler;

Fetal CTG (cardiotocography);

blood test for intrauterine infection;

blood test for Rh antibodies if your blood is negative (serological conflict);

blood test and smear for TORCH infections.

As we see, both and are quite serious conditions. However, constant monitoring makes it possible to recognize these pathological conditions in the early stages of development, carry out medical supervision of the woman and thereby save the mother and child.

In the formation and exchange of amniotic fluid they take Active participation all structures unified system“mother - placenta - fetus”: maternal organism; amnion (cells lining the membranes of the fetus); fetus (fetal kidneys in last deadlines pregnancy produces an average of 600-800 ml of urine per day, which is released into the amniotic cavity, while in 1 hour on average the fetus swallows 20 ml of water; the skin of the fetus up to 24 weeks of pregnancy also participates in the metabolic processes of water, absorbing some of it until it becomes keratinized, after which the skin becomes impermeable to amniotic fluid).

Compound amniotic fluid changes during pregnancy. If in the early stages the amniotic fluid in its own way chemical composition similar to the plasma (liquid part of the blood) of the mother, then by the end of pregnancy in large quantities contains fetal urine. Amniotic fluid contains oxygen, carbon dioxide, electrolytes present in the blood of the mother and fetus, proteins, lipids, carbohydrates, enzymes, hormones, vitamins, biologically active substances, phospholipids, blood clotting factors, epithelial cells exfoliated from the skin of the fetus, vellus hair , secretions of the fetal sebaceous glands, droplets of fat, etc. The concentration of one or another component of amniotic fluid depends on the duration of pregnancy.

Volume amniotic fluid increases towards the end of pregnancy, reaching a maximum value at 38 weeks, then, closer to childbirth, it may decrease slightly. Normally, at 37-38 weeks of pregnancy, the volume of amniotic fluid is 1000-1500 ml, while at 10 weeks it was only 30 ml, and at 18 weeks - approximately 400 ml. In post-term pregnancy, there is a decrease in the amount of amniotic fluid; with various pathologies of pregnancy, a change in volume may occur, both in the direction of increase and decrease.

Why amniotic fluid is needed?

Amniotic fluid not only ensures the metabolism between the fetus and the mother, but also performs the function mechanical protection You , protecting the fetus from external influences, also protecting the fetal body from compression by the walls of the uterus and acting as a shock absorber in cases of mother falls, that is, the amniotic fluid smoothes out the shock or blow transmitted to the fetus during blows to the stomach or falls. Of course, the “degree of protection” in this case is not great, that is, with impacts of great force, the integrity of the fetal bladder may be damaged.

The amniotic sac promotes dilatation of the cervix during childbirth, playing a role hydraulic wedge in the first stage of labor (during the dilatation of the cervix). It also protects the fetus from infection by being physiological barrier on the path of the spread of infection, which can enter the uterine cavity from the vagina and cervix.

Diagnostic methods using amniotic fluid

For diagnosing the course of pregnancy, the quantity, color, transparency of amniotic fluid, its hormonal, biochemical, cellular composition, etc. are of great importance. Doctors have various diagnostic methods at their disposal.

Ultrasound. Much attention is paid during ultrasound amount of amniotic fluid , since a relationship has been identified between this parameter and the pathology of pregnancy: post-term pregnancy, gestosis (it is manifested by increased blood pressure, edema, the presence of protein in the urine), fetal hypoxia (a state of oxygen starvation of the fetus in the womb). The amount of water is estimated by the size of free areas of amniotic fluid (the so-called “pockets” or “packages”).

Ultrasound can also assess homogeneity (homogeneity) amniotic fluid.

The presence of suspended matter in waters most often indicates infection.

Amnioscopy. This is an examination of the lower pole of the amniotic sac and amniotic fluid using a special device that is inserted into the cervical canal through the vagina. This study allows you to evaluate the color of amniotic fluid and its quantity. With oxygen deficiency of the fetus, the amniotic fluid becomes green color due to the admixture of meconium (original feces). Amnioscopy is carried out, as a rule, at the end of pregnancy, when the cervix is already preparing for childbirth and can be missed by an optical device - an amnioscope.

Amniocentesis(from the Greek words “amnion” - fetal membrane and “centesis” - piercing). This is a puncture (puncture) of the amniotic sac, the purpose of which is to take amniotic fluid for diagnostic studies: biochemical, hormonal, immunological, cytological, in order to have an idea of the condition of the fetus and determine the further management of the pregnancy. Indications for this procedure are: rhesus conflict ; in this case, the content of bilirubin in the amniotic fluid is determined (it increases as the concentration of bilirubin secreted by the fetal kidneys increases, which serves as an indicator of the severity of the process); The study also determines the fetal blood type and the number of antibodies to the Rh factor; suspicion of chromosomal pathology of the fetus; suspicion of chronic fetal hypoxia (oxygen deficiency); the need to determine the maturity of the fetal lungs when there is a question about early birth; in this case, the concentration of phospholipids in the amniotic fluid and their ratio are determined.

Amniocentesis is done under ultrasound control, through the anterior abdominal wall or the anterior or posterior vaginal fornix: the puncture site is selected based on the location of the placenta. Before the operation, the bladder is emptied to avoid injury, the skin is treated with an antiseptic solution, local anesthesia is given with a novocaine solution, then the anterior abdominal wall, uterine wall and fetal bladder are punctured with a long thick needle; 15 ml of water is drawn into the syringe. The procedure is invasive (i.e. accompanied by a puncture of the abdominal wall, uterine wall, penetration into the uterine cavity), it can lead to various complications (mainly miscarriage or premature birth, rupture of amniotic fluid, infection of the membranes, injury to fetal vessels and as a result of this - internal bleeding, injury to the mother's bladder or intestines). IN modern conditions These complications are very rare, thanks to the introduction of ultrasound control, compliance with the rules of asepsis and antisepsis.

Amniocentesis is not performed if there is a threat of miscarriage or premature birth, if the placenta or myomatous node is located on the anterior abdominal wall, malformations of the uterus, the results of smears and culture from the vagina and cervical canal, indicating the presence of an inflammatory process. After the operation, a therapeutic regimen is recommended for several days (up to 1 week); for prophylactic purposes, drugs that relax the uterus are prescribed, and, if necessary, antibiotics.

Oligohydramnios during pregnancy

Oligohydramnios is a reduction in the amount of amniotic fluid to 500 ml or less as a result of an imbalance between its absorption and production. Most often, this condition is observed in younger pregnant women with high blood pressure in the third trimester of pregnancy and in women with an increased risk of developing fetal malnutrition (fetal size falling short of normal for a given period).

First of all, if oligohydramnios is suspected, it is necessary to exclude congenital malformations of the fetus, especially if it is detected in the second trimester (up to 28 weeks) of pregnancy, because sometimes severe oligohydramnios can be combined with defects such as polycystic kidney disease or their absence. Oligohydramnios, as well as polyhydramnios, may be a sign of intrauterine infection of the fetus, so it is necessary to conduct an examination for secretions.

this infection. Oligohydramnios can occur against the background of a decrease in fetal urine excretion into the amniotic cavity during chronic hypoxia, which is observed with intrauterine growth retardation. In 40% of women with oligohydramnios, the size of the fetus lags behind the norm. Due to a sharp decrease in the volume of amniotic fluid, compression of the umbilical cord (compression between the fetus and the walls of the uterus) may occur, which can lead to acute oxygen deficiency and fetal death; It is extremely rare that adhesions (adhesions) form between the walls of the uterus and the skin of the fetus.

Since in oligohydramnios the fetal bladder is “flat”, it does not function as a hydraulic wedge and does not contribute to the dilatation of the cervix, resulting in a risk of weak labor. Due to disruption of active motor movements of the fetus in the uterine cavity, the frequency of breech presentations increases, and, as a result, in some cases, cesarean sections. More often, operative birth with oligohydramnios is caused by weakness of labor and intrauterine fetal hypoxia. Oligohydramnios can be primary (observed with intact membranes) and secondary, or traumatic (as a result of damage to the membranes with a gradual leakage of water, which sometimes goes unnoticed by the woman: amniotic fluid is mistaken for leucorrhoea).

Diagnosis of oligohydramnios is mainly based on Ultrasound examination. However, during the examination, the doctor may notice that the height of the uterine fundus and the abdominal circumference lag behind normal for this stage of pregnancy, the motor activity of the fetus is reduced, the uterus is dense on palpation, parts of the fetus and the heartbeat are clearly visible. A vaginal examination during labor reveals a “flat” amniotic sac stretched over the fetal head.

If oligohydramnios is detected before 28 weeks of pregnancy, a comprehensive examination of the pregnant woman is performed to determine the possible cause and assess the condition of the fetus. If fetal malformations are detected, pregnancy is terminated for medical reasons. When oligohydramnios is combined with intrauterine hypoxia and fetal growth retardation, appropriate therapy is carried out until 33-34 weeks of pregnancy, and if treatment is ineffective and the condition of the fetus worsens, early delivery is carried out. During childbirth, the “flat” amniotic sac is opened to prevent labor weakness.

In severe forms of placental insufficiency and intrauterine fetal malnutrition, intra-amnionic drip administration of amino acid solutions is possible after preliminary removal of an amount of liquid equal to the injected one. Attempts are also being made to paraplacental oxygenation of the fetus during labor to treat chronic fetal oxygen deficiency by introducing oxygen-saturated amniotic fluid into the amniotic cavity. These methods have not yet found widespread use and require further research.

Polyhydramnios during pregnancy

Not only is a decrease in the amount of amniotic fluid bad, but also its increase. Polyhydramnios is considered to be a volume of water exceeding 1500 ml. Most often this happens in multiple pregnancy, diabetes mellitus in the mother, Rh-conflict pregnancy, intrauterine infection, fetal development abnormalities.

With anomalies (malformations) of fetal development, the process of ingestion of water by the fetus is disrupted, as a result of which the balance between their production and excretion changes. Upon examination, the height of the uterine fundus and abdominal circumference exceed normal values for this stage of pregnancy.

The fetus actively floats in the amniotic fluid, which can cause the umbilical cord to become entwined around the neck and torso. If polyhydramnios is suspected, the doctor will clarify the diagnosis using ultrasound, while excluding intrauterine infection and fetal malformations. Due to the strong stretching of the membranes with severe polyhydramnios, untimely release of amniotic fluid may occur. Premature birth, premature detachment of a normally located placenta, prolapse of small parts of the fetus (arms, legs) and umbilical cord during rupture of water are also possible (therefore, after the rupture of water, a vaginal examination is required). If fetal malformations that are incompatible with life are detected, the pregnancy is terminated. If the cause of polyhydramnios is intrauterine infection, treatment is carried out taking into account the identified pathogen. Childbirth with polyhydramnios may be accompanied by weakness of labor due to strong distension of the uterus, as a result of which its contractility and excitability decrease. Based on the above, it is often necessary to open the amniotic sac. This is done very carefully, the water is released slowly, after which a vaginal examination is performed to exclude prolapse of the arms, legs, and umbilical cord loops. In the postpartum period, contracting drugs are administered to prevent postpartum hemorrhage, since the overstretched uterus does not contract well.

How does water pour out?

Normally, amniotic fluid flows out in the first stage of labor (until the cervix is fully dilated, but not before the cervix is dilated by 4 cm). At the height of one of the contractions, the bubble becomes tense and bursts. As a result, the anterior waters, which are located between the fetal head and the membranes of the amniotic sac, are poured out. “Born in a shirt,” they say about children who were born with an intact amniotic sac. In modern conditions, if a woman gives birth not at home, but in a hospital, this is very rare (the exception is rapid labor), since if the cervix is fully dilated and the bladder is still intact, then the obstetricians open it themselves: at birth “in the shirt” the membranes block the access of oxygen to the fetus. The outpouring of water before the onset of labor (before contractions) is considered prenatal or premature, and if the water pours out during regular contractions, but with insufficient dilatation of the cervix, they talk about early outburst of water. In these cases, it is necessary to monitor the duration of the anhydrous period: it should not exceed 12 hours, since with a long anhydrous period the likelihood of infection of the membranes, uterus, and fetus increases. Therefore, in case of rupture of amniotic fluid at home, a woman must immediately go to the maternity hospital. During prenatal rupture of amniotic fluid, a glucose-vitamin-hormonal background is usually created; To do this, glucose, vitamins, and hormones are administered intravenously and intramuscularly to prepare the birth canal. If contractions do not begin, labor is induced with intravenous medications using a drip. If such therapy is ineffective, a caesarean section is performed.

ABOUT high rupture of membranes they say when the amniotic sac ruptures not in the lower pole, but above. If there is any doubt whether it is water or just liquid leucorrhoea from the vagina (a typical situation with a high lateral rupture of the membranes), you need to go to your doctor, first placing a “control” diaper to show the nature of the discharge. In doubtful cases, a vaginal smear is taken to check for the presence of amniotic fluid or an amnitest is performed .

If leakage of amniotic fluid is confirmed, but there are no contractions, the doctor decides on further management of the pregnancy depending on its duration. Until 34 weeks, obstetricians do everything possible to prolong pregnancy, since the fetus’s lungs are immature and after birth the newborn may experience respiratory distress. The woman is under constant observation (body temperature is measured, the content of leukocytes in the blood is examined, a clinical blood test, ultrasound, CTG - a study of fetal cardiac activity, a study of discharge from the genital tract for infections is carried out), to the expectant mother Strict bed rest is prescribed in a hospital setting, and, if necessary, antibacterial therapy and drugs that accelerate the maturation of the fetal lungs. If there are no conditions to prolong pregnancy, surfactant is used to prevent and treat respiratory disorders in newborns. If there are no signs of infection and there is a sufficient amount of water in the amniotic sac according to ultrasound, pregnancy can be extended to 34 weeks. If, as a result of the study, it is discovered that the uterus tightly covers the fetus and there is no water, you cannot wait more than 2 weeks even if there are no signs of infection (however, this situation is extremely rare). At 34 weeks or more, when water leaks, the woman is prepared for the upcoming birth.

Thus, amniotic fluid not only provides a habitat for the baby, but also helps diagnose various “problems” during pregnancy. Your doctor will monitor their number and, if they deviate from the norm, take the necessary measures.

Amnitest is a method by which the presence of α-microglobulin is determined in vaginal discharge, which is not normally present in the vagina.

A sterile tampon is placed in the vagina for 5-10 minutes, then the result is determined using a test strip using the express method. If there is placental α-microglobulin in the vaginal secretion contents, a control line appears in the window of the test strip.