Importance of amniotic fluid for a child.

 Importance of amniotic fluid for a child.

• nutrition;

• gas exchange;

• removal of fetal waste products;

• protects against infection and toxins, thanks to the bactericidal component;

• maintains a constant comfortable temperature.

Through the amniotic fluid, the embryo receives hormones, vitamins, oxygen and other useful substances. Through the fetal bladder and amniotic fluid, the baby contacts the mother's body as an autonomous organism. This explains the fact that many children do not take the maternal blood type, but the paternal one. Also, before the birth of a child, it is the amniotic fluid that exerts pressure on the cervix, as a result of which it begins to open.

Amniotic fluid provides the child with a comfortable existence in the womb.

However, at different periods of bearing a baby, the volume of amniotic fluid is different: this is due to the need for nutrients. If at the beginning of pregnancy the volume of water is 500 ml, then by the end it increases to 1500 ml. Just before the birth, it decreases to 600 - 500 ml. But if the volume of liquid is below 500 ml, then we are talking about oligohydramnios.

What is amniotic fluid?

Where is the amniotic fluid (amniotic fluid) located, what function do they perform? Amniotic fluid fills the fetal bladder in which the child develops. As soon as a fertilized egg enters the uterine cavity and attaches to its walls, shells begin to form around it. They form a closed space, grow together with the fetus.

Inside the fetal bladder is a sterile liquid that provides the embryo with everything necessary. Through this fluid, the body of the child communicates with the body of the mother. What is amniotic fluid made of? Its component is the mother's blood plasma. Already in the third week of the life of the embryo, amniotic fluid can be seen (on ultrasound).

The amniotic fluid is self-renewing every 3 hours, so the embryo is constantly in sterile conditions.

The course of childbirth and the effect of oligohydramnios on the fetus.

Due to the insufficient amount of anterior waters in childbirth with oligohydramnios, a flat fetal bladder is formed, which is not able to perform its function (it contributes to the opening of the cervix) and leads to the development of weakness of the labor forces and prolonged labor.

Also, oligohydramnios can cause premature birth.

In the third stage of labor and in the early postpartum period, hypotonic bleeding may occur due to retention of membranes and parts of the placenta in the uterus. Oligohydramnios increases the risk of cervical rupture during childbirth (in 24% of cases).

The lack of amniotic fluid contributes to the development of fetoplacental insufficiency, intrauterine hypoxia and fetal hypotrophy.

Consequences for the fetus.

The lack of amniotic fluid provokes a delay in the growth and development of the fetus (the birth of underweight children with malnutrition) and intrauterine fetal hypoxia.

If there is severe oligohydramnios, it is possible to develop a curvature of the child's spine and hip joints (permanent trauma due to the small size of the uterus), the appearance of adhesions between the skin of the fetus and the fetal bladder, which, with further growth of the fetus, can lead to amputation of the limbs.

There is a high probability of late miscarriages, antenatal death of the fetus and death of the child in the first days after birth.

Treatment for oligohydramnios during pregnancy.

The same symptoms may be signs of different diseases, and the disease may not proceed according to the textbook. Do not try to treat yourself - consult your doctor.

The tactics of pregnancy management depends on the degree of oligohydramnios and gestational age.

If a small amount of water is detected in the second trimester of pregnancy and congenital malformations of the fetus, the patient is offered to terminate the pregnancy.

Oligodiasis, diagnosed in the third trimester, is an indication for hospitalization of a woman and the appointment of treatment aimed at preventing placental insufficiency, intrauterine hypoxia and fetal growth retardation. If intrauterine infection of the fetus is detected, antibiotics and antiviral drugs are indicated.

Moderate oligohydramnios in the third trimester of pregnancy and a satisfactory condition of the fetus does not require hospitalization and treatment, pregnant women are only observed (with mandatory monitoring of ultrasound and amniotic fluid index).

In the case of positive dynamics from the prescribed therapy, the woman is allowed into independent childbirth through the natural birth canal. In childbirth, an early amniotomy is performed, i.e. (a flat fetal bladder will complicate the course of childbirth).

If there is no effect from the treatment, the condition of the fetus worsens, the issue of early termination of pregnancy (caesarean section) is decided.

Diagnosis of oligohydramnios during pregnancy.

The diagnosis of oligohydramnios is made on the basis of monitoring the dynamics of the course of pregnancy and additional research methods:

Physical examination.

• There is a discrepancy between the size of the abdomen (circumference of the abdomen and the height of the fundus of the uterus) to the gestational age. With this pathology of amniotic fluid, the dimensions are much smaller than the accepted norms.

• A woman notes a decrease in the number of fetal movements, and in some cases, pain may also occur when the child moves.

• The fetal heartbeat is heard clearly, and parts of the fetus are well palpable due to the small amount of water. During childbirth, a flat fetal bladder is palpated.

Ultrasonography.

• Often, oligohydramnios is detected on ultrasound as an accidental finding.

• When determining the index of amniotic fluid and the height of the largest pocket of amniotic fluid, oligohydramnios is indicated by a decrease in its size to 1 cm or less. However, ultrasound to confirm oligohydramnios must be performed several times in a row for 1-3 months.

Lab tests.

• If a decrease in the amount of amniotic fluid is suspected, a woman is prescribed an examination for intrauterine infections (PCR): toxoplasmosis, cytomegalovirus, rubella, and others.

• Also shown is the determination of blood glucose levels, the level of markers of intrauterine fetal malformations (AFP and hCG), blood per group and Rh factor.

• According to indications (suspicion of chromosomal abnormalities), amniocentesis with karyotyping of fetal cells is prescribed.

Cardiotocography (CTG) and dopplerometry.

• Assess the condition of the fetus helps cardiotocography (assessment of heart contractions) and dopplerometry (assessment of blood flow in the fetus-umbilical cord-placenta system).

What causes oligohydramnios during pregnancy?

Oligohydramnios (oligohydramnios) is the pathology of amniotic fluid, when during a full-term pregnancy there is a decrease in their number to 500 ml or less. According to various data, such a pathology occurs in 0.3-5.5 cases of all births.

Causes

The reasons leading to a decrease in the volume of amniotic fluid are divided into several large groups:

Caused by congenital anomalies in the development of the fetus.

• These include various malformations of the urinary system of the fetus (absence or sharp narrowing of the urethra, narrowing of the ureters, absence of kidneys, polycystic kidney disease, underdeveloped valves of the urethra).

Caused by fetal pathology.

• intrauterine infection of the fetus (cytomegalovirus, chlamydia, mycoplasma and other infections),

• oligohydramnios can also be caused by intrauterine growth retardation (IUGR) or chromosomal abnormalities (Down syndrome, Marfan syndrome).

Causes due to chronic extragenital diseases of a woman.

• pathology of the cardiovascular system (arterial hypertension, thrombophlebitis, cardiovascular insufficiency),

• chronic kidney disease (pyelonephritis, glomerulonephritis),

• preeclampsia and systemic diseases (systemic lupus erythematosus, rheumatoid arthritis and rheumatism, and others).

Excess weight and diabetes can also provoke the development of oligohydramnios. Dehydration (dehydration of the body) of a woman with diarrhea, vomiting, poisoning. Chronic nicotine intoxication.

Causes due to the pathology of the placenta.

• fetoplacental insufficiency,

• numerous infarcts of the placenta,

• malformations of the placenta,

• premature maturation of the placenta.

Other reasons.

• intrauterine fetal death,

• delayed pregnancy,

• multiple pregnancy,

• leakage of amniotic fluid.

Oligohydramnios due to long-term use of certain drugs (prostaglandin synthesis inhibitors: indomethacin, naproxen). Also isolated idiopathic or oligohydramnios with an unidentified cause.

Forecast and prevention of oligohydramnios during pregnancy.

Timely detection and treatment of oligohydramnios during pregnancy allows you to bring the fetus to 37-38 weeks of gestation and give birth to a healthy baby. The most unfavorable prognosis is observed in the case of obstetric pathology in the 2nd-3rd trimester in combination with intrauterine growth retardation. In such a situation, the death of the child or its significant growth retardation and functional immaturity are possible. To avoid the development of oligohydramnios during pregnancy, a woman, even before conception, must undergo a complete examination and treatment of concomitant diseases of the internal organs. After fertilization, the prevention of oligohydramnios involves timely registration with a gynecologist, the delivery of all necessary tests. To prevent the development of oligohydramnios during pregnancy, stress, physical activity, and the influence of negative factors on the body of the expectant mother and fetus should be excluded. Be sure to provide a balanced diet rich in fortified foods.

Treatment of oligohydramnios during pregnancy.

Medical care in case of oligohydramnios during pregnancy depends on the form of the pathological condition, as well as the well-being of the patient and the fetus. With a moderate course in the second trimester of gestation and in the absence of symptoms, expectant management is used. In this situation, the treatment of oligohydramnios during pregnancy is carried out on an outpatient basis. Hospitalization is indicated for a severe form of oligohydramnios, if additional uterine hypertonicity is present, and also if obstetric pathology is diagnosed at 34 weeks of gestation or later. The presence of at least one of these criteria is the reason for placing the expectant mother in the department and staying in the clinic until the baby is born.

Treatment of oligohydramnios during pregnancy, regardless of its form, begins with the correct organization of lifestyle. It is important to provide the patient with bed rest, to protect her from stress, overwork, physical activity and homework, to exclude the influence of negative factors on the body. Medical assistance in confirming oligohydramnios during pregnancy involves the appointment of drugs that improve uteroplacental blood flow. Be sure to use funds to normalize the functions of the placenta, vitamin complexes. If oligohydramnios during pregnancy is accompanied by uterine hypertonicity, the use of tocolytics is indicated.

Low water during pregnancy suggests an impact on the causative factor. If this is an infection, antibacterial or antiviral agents are prescribed, taking into account the sensitivity of the pathogen. Additionally, concomitant diseases that can provoke insufficient secretion of amniotic fluid are treated. With oligohydramnios during pregnancy, careful monitoring by the obstetrician-gynecologist of the condition of the mother and fetus is necessary. All efforts are directed to the continuation of pregnancy until the expected date of birth and the full maturation of the baby.

If conservative treatment of oligohydramnios during pregnancy does not give positive dynamics, the level of OPV continues to decrease, and the condition of the fetus is rapidly deteriorating, premature delivery is indicated, regardless of the period of embryogenesis. Due to the high likelihood of complications during childbirth, caesarean section is preferred. Often, oligohydramnios during pregnancy becomes the cause of primary weakness of labor, as well as intrauterine fetal hypoxia. If conservative therapy gives positive results, a planned caesarean section is carried out upon reaching 38 weeks of gestation.

Diagnosis of oligohydramnios during pregnancy.

The diagnosis of oligohydramnios during pregnancy is established on the basis of data obtained as a result of a patient interview and an objective examination conducted by an obstetrician-gynecologist. A number of laboratory tests and instrumental studies are also prescribed. It is possible to suspect oligohydramnios during pregnancy during a routine examination of a woman. The characteristic signs of an insufficient volume of OPV will be a discrepancy between the circumference of the abdomen and the height of the fundus of the uterus and the gestational age with a downward deviation. At the same time, it is important to carefully collect an anamnesis and establish the probable cause of this condition, since the subsequent treatment tactics depend on it.

To exclude an infectious factor in the formation of oligohydramnios during pregnancy, laboratory tests of urine and blood are prescribed. The sampling of smears from the genital tract is shown in order to determine the pathogenic microflora and exclude or confirm the suspicion of its introduction to the fetus. It is possible to finally confirm oligohydramnios during pregnancy with the help of ultrasound. During the examination, the specialist accurately determines the volume of OPV, assesses the condition of the placenta and the child, and identifies congenital anomalies that could contribute to the development of this pathological condition. Also, oligohydramnios during pregnancy involves a CTG to determine the well-being of the child.

Classification and symptoms of oligohydramnios during pregnancy.

This pathology, depending on the gestational age, can be of two types:

• Early oligohydramnios during pregnancy - diagnosed before 20 weeks, often due to failure of the membranes.

• Late oligohydramnios during pregnancy - manifests itself in the 2-3 trimester, develops mainly against the background of other diseases and complications associated with the attachment and functioning of the placenta.

The clinic of oligohydramnios during pregnancy is determined by the degree of decrease in the level of OPV. In the case of a slight decrease (within 400-700 ml), they speak of a moderate severity of the pathology. Such oligohydramnios during pregnancy is manifested only on ultrasound, there are no objective symptoms. If the deficit of amniotic fluid is more than 700 ml, the diagnosis is "pronounced oligohydramnios". Patients experience nausea, vomiting, dizziness, and dry mucous membranes are often present. A characteristic feature is also pain during the motor activity of the fetus.