Low Water During Pregnancy: Causes, Consequences, Treatment, Diagnosis

2024 Author: Rachel Wainwright | [email protected]. Last modified: 2024-01-15 19:51

Malnutrition

The content of the article:

1. Causes of low water
2. Kinds
3. Signs
4. Diagnostics
5. Treatment of oligohydramnios
6. Prevention
7. Consequences of low water
8. Video

Low water during pregnancy (oligohydramnios) is a complication of pregnancy associated with a reduced amount of amniotic fluid.

It is considered by doctors as a serious obstetric pathology, as it can cause the development of a number of congenital anomalies in the fetus:

• deformation of bone tissue;
• curvature of the spine;
• clubfoot.

In addition, lack of water can provoke intrauterine growth retardation.

Amniotic fluid (amniotic fluid) plays an important role in the growth and development of the fetus. They prevent unnecessary pressure by the walls of the uterus on the baby, and besides, they are rich in nutrients, trace elements.

Low water can be dangerous to the fetus, depriving it of the necessary protection and part of its nutrition

Low water is observed in about 4% of pregnant women. Pathology can develop at any gestational age, but most often it is diagnosed in the third trimester (usually after 35-36 weeks) of pregnancy. This is due to a decrease in the functional activity of the placenta due to its aging.

In the early stages of pregnancy, oligohydramnios is extremely rare. With this development of events, there is always a high risk of spontaneous miscarriage.

Causes of low water

Low water is not an independent disease. It should be considered as a symptom that occurs against the background of one or another obstetric or somatic pathology. Consider the most common causes of oligohydroamnion:

Cause	Description
Congenital malformations of the fetus	Usually, an insufficient volume of amniotic fluid is detected after 20-21 weeks of pregnancy. In the fetus, an ultrasound scan reveals anomalies in the structure of the kidneys and the facial part of the skull.
Intrauterine infections	Various types of pathogenic microorganisms (viruses, bacteria) circulating in the mother's blood can penetrate the membranes and cause damage to the chorionic villi. As a result, there is a violation of the formation of amniotic fluid.
Metabolic diseases	Oligohydroamnion often develops in women who are obese or diabetic. In this case, pathology is often detected already in the early stages of pregnancy.
Diseases of the urinary and cardiovascular system	Low water in this case is associated with disorders of the uteroplacental circulation. Pathology can develop at any stage of pregnancy
Multiple pregnancy	The development of oligohydroamnion is due to the increased need of the fruit for the intake of nutrients.
Placental pathology	With malformations, low attachment of the placenta, blood flow to individual parts of the placenta worsens, which causes an increased risk of reduced formation of amniotic fluid by the villi of the chorion.
Intoxication	An increased risk of oligohydramnios is observed in women who use psychotropic substances, alcohol, nicotine, as well as among workers in hazardous industries.

Kinds

Depending on the duration of pregnancy, oligohydramnios is:

1. Early. Its development is associated with abnormalities in the development and functioning of the membranes. Diagnosed before 20-21 weeks of pregnancy.
2. Later. The cause of the occurrence is a number of somatic and obstetric pathologies leading to placental insufficiency. Appears in the II-III trimester of pregnancy.

Signs

The severity of the clinical manifestations of low water directly depends on the degree of decrease in the volume of amniotic fluid. Moderate oligohydroamnion is said to be when the amount of amniotic fluid is slightly reduced, by no more than 400-700 ml. Such a pathology proceeds without any objective symptoms and is diagnosed only according to ultrasound data.

The diagnosis "severe polyhydramnios" is made to patients in cases where the amniotic fluid deficit exceeds 700 ml. This condition is always accompanied by the appearance of clinical signs, which include:

• dry mucous membranes;
• dizziness;
• nausea, vomiting;
• decrease in abdominal circumference;
• painful fetal movements.

Diagnostics

The doctor can identify oligohydramnios on the basis of obstetric examination data and a survey of a pregnant woman. During a routine examination, attention should be paid to the height of the uterine fundus and abdominal circumference inappropriate to the gestational age. To confirm the diagnosis, an ultrasound examination is performed to determine the amniotic fluid index. Indicators of the norm and possible deviations are presented in the table:

Gestation period	Allowable variations	Average value of the norm
16 weeks	73–201 mm	121 mm
17 weeks	77-211 mm	127 mm
18 weeks	80-220 mm	133 mm
19 weeks	83-225 mm	137 mm
20 weeks	86-230 mm	141 mm
21 week	88-233 mm	143 mm
22 weeks	89-235 mm	145 mm
23 weeks	90-237 mm	146 mm
24 weeks	90-238 mm	147 mm
25 weeks	89-240 mm	147 mm
26 weeks	89–242 mm	147 mm
27 weeks	85-245 mm	156 mm
28 weeks	86-249 mm	146 mm
29 weeks	84-254 mm	145 mm
30 weeks	82-258 mm	145 mm
31 week	79-263 mm	144 mm
32 weeks	77-269 mm	144 mm
33 weeks	74-274 mm	143 mm
34 weeks	72-278 mm	142 mm
35 weeks	70-279 mm	140 mm
36 weeks	68-279 mm	138 mm
37 weeks	66-275 mm	135 mm
38 weeks	65-269 mm	132 mm
39 weeks	64-255 mm	127 mm
40 weeks	63-240 mm	123 mm
41 weeks	63-216 mm	116 mm
42 week	63-192 mm	110 mm

To confirm the diagnosis of oligohydramnios, the ultrasound assessment of the amniotic fluid index should be repeated 2-3 times, since due to the peculiarities of the child's position, a one-time assessment may be unreliable.

When conducting an ultrasound scan, the doctor also carefully examines the structural features and attachment of the placenta, determines the degree of its maturity, identifies possible fetal anomalies that could cause an insufficient amount of amniotic fluid.

A thoroughly collected anamnesis allows us to identify the presumptive cause of the occurrence of oligohydroamnion, which plays a huge role in determining the subsequent tactics of examination and treatment.

If an infectious factor is suspected in the occurrence of oligohydroamnion, a number of laboratory research methods are included in the examination plan:

• general blood analysis;
• general urine analysis;
• test according to Nechiporenko;
• microscopy and bacteriological examination of discharge from the vagina, urethra and cervix.

According to the indications, they also carry out:

• electrocardiography (ECG);
• echocardiography (Echo-KG);
• determination of the level of glucose in blood serum;
• Ultrasound of the kidneys.

In the presence of somatic pathology, the obstetrician-gynecologist directs the pregnant woman for consultation with the appropriate specialists (cardiologist, endocrinologist).

All pregnant women with oligohydramnios should regularly undergo cardiotocography (CTG) - a modern method for diagnosing the condition of the fetus, based on recording its heart rate, as well as its changes under the influence of fetal movements, external stimuli and contractile activity of the myometrium.

Treatment of oligohydramnios

Expectant tactics is justified in the event of a moderate oligohydroamnion in the II-III trimester of pregnancy, the absence of fetal pathology and the general well-being of the expectant mother. A woman should be under dispensary observation by a local doctor (obstetrician-gynecologist) and, if indicated, receive drug therapy.

The need for urgent hospitalization in the department of pathology of pregnant women arises in the following cases:

• gestation period over 33-34 weeks;
• pronounced lack of water;
• the presence of uterine hypertonicity.

Therapy of oligohydroamnion, regardless of the form of pathology, should begin with the organization of a therapeutic and protective regimen, including:

• a full night's sleep lasting at least 8-9 hours;
• rational balanced nutrition;
• compliance with the daily routine;
• avoidance of stressful situations and physical overwork;
• giving up bad habits (smoking, drinking alcohol, psychotropic drugs).

With low water, mandatory medical supervision is required.

Drug treatment is carried out as prescribed by an obstetrician-gynecologist and includes multivitamin complexes, drugs that improve the function of the placenta and uteroplacental blood flow. With an increased tone of the uterus, tocolytics must be prescribed.

If the etiological factor is somatic diseases, then their therapy is carried out.

The patient must be in the hospital under close medical supervision. The necessary measures are taken to prolong the pregnancy and the normal development of the fetus.

Indications for emergency delivery regardless of gestational age are:

• rapid deterioration of the fetus;
• a progressive decrease in the volume of amniotic fluid.

Pregnant women with oligohydramnios have a high risk of complications during natural childbirth (intrauterine fetal hypoxia, primary weakness of labor, bleeding), therefore, it is preferable to carry out delivery by cesarean section.

If, against the background of conservative therapy, it is possible to achieve stabilization of the condition of the mother and fetus, then the cesarean section is performed after 37-38 weeks of pregnancy.

Prevention

Prevention of oligohydramnios should begin at the planning stage and continue throughout the gestation period. It is expressed in the following activities:

• timely diagnosis and treatment of any gynecological and somatic pathology;
• early registration of a pregnant woman (up to 12 weeks);
• compliance with the daily routine;
• correct alternation of work and rest;
• avoidance of stressful situations;
• rational nutrition with the obligatory inclusion of fresh vegetables and fruits in the menu;
• rejection of bad habits.

Consequences of low water

In most cases, with timely diagnosis and active therapy of oligohydroamnion, doctors manage to maintain pregnancy until 37-38 weeks and thereby allow a woman to give birth to a healthy full-term baby.

When oligohydramnios occurs in early pregnancy, as well as when it is combined with other obstetric pathology, the prognosis is poor. In this situation, there is a high risk of a number of dangerous complications:

• intrauterine fetal death;
• hypoxia and fetal malnutrition;
• spontaneous termination of pregnancy;
• the formation of malformations of the musculoskeletal system in the fetus (clubfoot, torticollis).

Video

We offer for viewing a video on the topic of the article.

Elena Minkina Doctor anesthesiologist-resuscitator About the author

Education: graduated from the Tashkent State Medical Institute, specializing in general medicine in 1991. Repeatedly passed refresher courses.

Work experience: anesthesiologist-resuscitator of the city maternity complex, resuscitator of the hemodialysis department.

The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!