Malnutrition
The content of the article:
- Causes of low water
- Kinds
- Signs
- Diagnostics
- Treatment of oligohydramnios
- Prevention
- Consequences of low water
- 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:
- Early. Its development is associated with abnormalities in the development and functioning of the membranes. Diagnosed before 20-21 weeks of pregnancy.
- 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!
