What is low water during pregnancy, itreasons why it is dangerous for the fetus and mother

Update: October 2018

Amniotic fluid – the fluid surrounding the fruit throughout
of pregnancy. It contains minerals, urea,
glucose, proteins, fats and carbohydrates. Among the components of the water there is a large
the amount of hormones, immune factors, bactericides. WITH
by increasing the gestational period, water accumulates hairs and
skin scales of the fetus.

Why do I need amniotic fluid?

Amniotic fluid plays a very large role in maintaining
the life of a little man. Essentially this is the only habitat.
fetus performing the following tasks:

  • prevents mechanical damage to the fetus
  • creates a favorable space so that the fruit can
    move freely
  • protects the umbilical cord from squeezing during childbirth
  • actively involved in the metabolism of the fetus
  • stimulates the development of the lungs (due to the movement of fluid in them
    two directions)
  • обладает противомикробными свойствами

How is amniotic fluid produced?

Amniotic fluid accompanies the fetus almost all
pregnancy. In the first trimester, when the organs of the embryo are only
form, part of the maternal blood penetrates the fetal
shell, forming a small level of fluid. This level can
увидеть уже на 3 неделе of pregnancy. There is an opinion that blood plasma
baby can also “leak” through his skin on the smallest
deadlines.

In the second trimester, the main source of amniotic fluid
is the fruit itself. Urine and fluid excreted by the lungs
enters the surrounding space.

From there, it can be swallowed by the fetus, and a part is absorbed immediately.
into mother’s blood. For example, in full-term pregnancy, the lungs of the fetus
allocate up to 400 ml of fluid per day, the volume of urine per day can
reach 1 l.

Water ingestion starts at 18–20 weeks of gestation, at 40
weeks, the fruit swallows up to 500 ml of water per day (see calculator
gestation by day and week). 3 hours amniotic fluid
fully updated.

From the balance of these two processes (education and excretion
fluid) depends on the total amount of amniotic fluid.

What is low water?

Malovodie – reducing the level of amniotic fluid to 0.3-0.5 l with
доношенной of pregnancy. About 0.3–5.5% of all pregnancies
accompanied by low water of varying severity.

Causes of low water

The main cause of low water during pregnancy is considered a violation
fetal kidney work. But there are still many factors affecting the balance.
amniotic fluid:

  • Fetal malformations
    • posterior urethral valves
    • absence or constriction of the urethra
    • bilateral obstruction of the ureters and other urinary sections
      tract
    • clipped abdomen syndrome
    • absence of two kidneys
    • bilateral cystic dysplasia of the kidneys
    • polycystic kidney disease (infantile form)
    • cloacal abnormalities
  • Chromosomal anomalies of the fetus
  • Intrauterine infections
  • Violation of the placenta (abnormal development of the placenta,
    placental insufficiency)
  • Post-pregnancy
  • Antenatal fetal death
  • WITHиндром «сдавленного близнеца» при многоплодной
    of pregnancy
  • Malovodie caused by the appointment of inhibitors
    prostaglandin synthetase
  • Malovodie due to prenatal leakage of water
  • Unreasonable (idiopathic) low water

Absence of both kidneys

Malformation, more common in boys, characterized by
complete absence of both kidneys and severe lack of water. Such
the condition is lethal, that is, the fetus dies in utero
or immediately after birth. The causes of pathology are also considered
chromosomal abnormalities and exposure to adverse factors (diabetes
mothers, smoking and taking cocaine, rubella virus infection).

When conducting an ultrasound, the doctor notes a low level of amniotic
waters, lack of a shadow of kidneys and bladder. It is important to note that
if the bladder is visible, then at least one kidney in the fetus is still
there is. And with unilateral agenesis (absence of a kidney), the state
the fetus usually does not suffer, the quality of life of such a child is practically
no different from other children.

Infantile form of polycystic kidney disease

Disease of hereditary nature, the main feature
which are huge buds with cystic deformity (in the form of
large cavities). The disease is usually found in the second half.
of pregnancy с помощью УЗИ, дополнительным признаком служит
pronounced lack of water. The prognosis of the disease is rather poor.
most children do not survive the first year. Upon detection
pathologies need to undergo complete karyotyping (definition
number and shape of chromosomes), since the risk of recurrence of polycystic
kidney in future children is 1: 4.

WITHиндром задних уретральных клапанов

Male fruit pathology in which
мочеиспускательном канале образуются клапаны. These outgrowths
interfere with the flow of urine from the bladder. WITHо временем он
stretched. WITH прогрессированием болезни увеличиваются и
the kidneys. Therefore, on ultrasound such babies have large kidneys,
distended bladder and lack of water. The forecast depends on the period
the onset of the disease and the degree of lung development (very often they
underdeveloped).

WITHиндром подрезанного живота (Prune-belly)

A rather rare congenital malformation of the child, combining in
three main features:

  • absence or underdevelopment of the muscles of the anterior abdominal wall
  • violation of the structure of the urinary system in the form of a large urinary
    bubble
  • undescended testicles in the scrotum

To these signs, in the case of a severe form of the syndrome
other abnormalities are added: ureteral expansion, dysplasia
kidney and dilated renal pelvis. Sometimes this syndrome is combined
with Potter syndrome when in a child due to blockage of the urinary tract
kidneys are affected, lungs do not develop and a condition occurs
water scarcity.

WITHиндром диагностируется уже с конца второго триместра, когда при
Ultrasound detects a huge fetal bladder. Forecast of this
disease unfavorable, especially with the development of oligohydramnios (in this
случае предлагают прерывание of pregnancy). If diagnosed
light form, it is possible observation and operative intrauterine
treatment, although in this case the child’s chances of surviving the first year
very small.

Anomalies cloaca

Anomalies cloaca – редкое сочетание пороков мочеполовой системы и
пищеварительного tract fetus. Violations occur at the stage when
these two systems are still combined into one.

Ultrasound detects fluid and cysts in the baby’s stomach,
absence or abnormal development of kidneys, defects 12-perstnoy
guts. Often the bladder and intestines are outside the abdomen and
not covered in leather. With such pathologies on screening may be noted
increased level of AFP.

Often pathology leads to the death of a child, but modern
surgical methods make the chances of life of such babies quite
high.

General features of fetal urinary system malformations:

  • Most of these defects are accompanied by reduced
    amount of amniotic fluid (due to the small amount of excreted
    urine)
  • Severe malnutrition in pregnant women or anhydramnion (complete
    lack of water) are an unfavorable prognostic sign.
    In such cases, there is often underdevelopment of the lungs – the main
    cause of death of newborns with similar vices.
  • Some defects can be treated surgically (bypass)
    во время of pregnancy.
  • WITHуществует изолированное увеличение почек, не сопровождающееся
    маловодием, проходящее самостоятельно в течение of pregnancy.

Chromosomal anomalies of the fetus

Most chromosomal diseases occur with high water or
normal amount of water. In some cases (if the syndrome
associated with disorders in the urinary system) there may be a decrease in the level
amniotic fluids. The main diagnostic value
present the first trimester, second trimester screenings and
other ultrasound signs of chromosomal abnormalities.

Intrauterine infections

In 30-40% of cases of acute low water infection occurs
fetal membranes. When transmission from mother to fetus mediator
It is the placenta and the sheath of the fetus. Their inflammatory
changes lead to placental insufficiency, lower water levels
and delayed child development. Total lack of water often
observed during infection in the first trimester, resulting in
congenital malformations of the fetus are formed.

Placental insufficiency

Insufficient blood supply to the fetus by the placenta may occur
many reasons:

  • genetic disorders of the placental bed
  • infections
  • preeclampsia
  • сахарный диабет и другие хрtheyческие diseases матери
  • impaired ovarian function and many other factors

But the result is always the same: gradual (and sometimes
sharp) oxygen starvation of the fetus. WITHамым чувствительным к
hypoxia organ is the brain. Nature has invented a way to protect
him, redistributing blood through the vessels of the fetus. As a result, other organs
start getting less oxygen. These include the kidneys with
lungs, which are directly responsible for the amount of amniotic fluid.
Therefore, in case of placental insufficiency, lack of water is not uncommon
phenomenon.

Post-pregnancy

Точные причины маловодия при переношенной of pregnancy до сих
far are not clear. Possible cause is maternal failure
organism to meet the needs of the overripe fetus, which leads to
placental insufficiency and, as a result, to oligohydramnios.

Antenatal fetal death

Fetal death of the child is almost always accompanied
low water. First, acute death most often leads to death.
placental insufficiency. Secondly, immediately after the death
the fetus its kidneys and lungs cease to produce amniotic
liquid. Therefore, a decrease in the level of amniotic fluid can be very
sharp, and the volume of the abdomen decrease significantly.

WITHиндром «сдавленного близнеца»

При многоплодной of pregnancy близнецами, то есть в результате
fertilization of one egg, subsequently divided,
the number of complications is quite large. One of the most formidable and
frequent pathologies considered fetafetal syndrome
blood transfusion.

Nearly 70% of identical twins share a common placenta, i.e.
are monochorial monozygous twins. It often happens that
in the thickness of this placenta, additional vessels are formed, connecting
twins. If this is part of the placenta supplying one
the child (donor) starts to work worse, then most of the blood
moves to the second twin (the recipient). As a result, the recipient begins
excrete more urine, it has a lot of water. A donor
receives less blood and oxygen, begins to lag behind in growth and
low water is formed.

Without treatment, this pathology leads first to the death of the donor from
oxygen starvation, and then the recipient from the pronounced
puffiness and intoxication. But modern methods allow
significantly reduce the mortality and morbidity of such
twins:

  • coagulation of additional vessels with a laser
  • cesarean section as soon as possible after the death of the donor
    (to save the life of the fetus to the recipient)
  • at short notice when the donor dies – the umbilical cord closes
    (so that decay products and hormones do not enter the living fetus)

Iatrogenic shallow water (caused by taking Indometacin)

The production of urine fruit, and hence the level of amniotic fluid,
controlled by many hormones and substances. To such substances
include prostaglandins that regulate renal diameter
arteries. Drugs that inhibit the synthesis of prostaglandins, reduce
renal blood flow and the amount of urine excreted by the child, what threatens
the kidneys.

Indomethacin is a common medicine with such an effect
used to reduce the amount of amniotic fluid and
продлении of pregnancy. Apply it with extreme caution.
as it can lead to renal failure of the fetus.

Amniotic fluid leakage

Classic childbirth begins with contractions, followed by
rupture of amniotic fluid. Often the membranes rupture to
contractions. При доношенной of pregnancy вслед за этим начинаются роды,
and their course differs little from the classical version. WITHовершенно
Other outcomes and predictions occur if the fetal bladder ruptures.
до 36 недели of pregnancy.

Causes of premature rupture of the membranes

  • несостоятельность шейки матки (истмико-цервикальная
    failure)
  • fetal coat infection
  • polyhydramnios
  • abnormal fetal position and narrow pelvis
  • medical manipulations (amniocentesis, cordocentesis and
    others)

If the rupture of the shells occurred from below, then more often there is a complete
rupture of waters and subsequent delivery. If the gap is located at the top, then
water can flow gradually, almost without reducing the total
amniotic fluid level. Therefore, the combination of even moderate
malnutrition with suspicious vaginal discharge
be dangerous to the health of the mother and child, it is desirable to hold
additional research. WITH помощью тест-полосок можно выявить
amniotic fluid in the vagina and prescribe treatment. AT
зависимости от срока of pregnancy, состояния плода и матери,
анализов крови и мочи будет проведено продление of pregnancy или
induction of labor.

Idiopathic shallow water

Malovodie not accompanied by any of
вышеперечисленных патологий, считается идиопатическим, то есть
unreasonable. Most often, the amniotic index is lowered slightly,
and the condition of the mother and fetus is stable. WITH увеличением срока
the amount of water may return to normal or may remain small
up to the birth, without affecting the health of the child.

WITHимптомы маловодия

  • the volume of the abdomen and the height of the bottom of the uterus is behind the deadlines
    of pregnancy
  • low fetal movement
  • liquid vaginal discharge (at rupture of fetal
    shells)

At each visit to the antenatal clinic pregnant measure
abdominal volume, which may indirectly reflect the amount of water. TO
концу доношенной of pregnancy он достигает 90-100 см, но значение
may vary with obesity in a woman.

The main way to diagnose low water is the definition
amniotic index using ultrasound.

TOак определяют количество околоплодных вод при УЗИ?

The main way to determine the level of amniotic fluid is to
ultrasound examination. WITHуществует несколько методик,
allow us to estimate the amount of amniotic fluid with a large
accuracy.

  • Measurement of the vertical “pocket”

If the largest of the pockets in two planes does not exceed 1 cm,
то можно поставить диагноз water scarcity.

  • Determination of the amniotic fluid index

AT ходе этого методов всю полость беременной матки разделяют на 4
parts using two perpendicular lines passing through
navel. Then in each quadrant measure the maximum diameter
volume of fluid. WITHуммируя полученные данные во всех квадрантах,
get the amniotic fluid index.

Для оценки результатов для каждого срока of pregnancy созданы
special centile tables on which doctors write the conclusion.
If the index value is less than 5 percentiles, then you can put
диагноз water scarcity. Although low water has practical value
only when the index is less than 2.5 percentile.

If you want to evaluate the level of amniotic fluid in the first
половине of pregnancy, то матку делят на два квадранта вертикальной
line.

WITHрок of pregnancy Amniotic fluid index, cm
5 percentiles 50 percentiles 95 percentiles
14 weeks 2.8 5.0 8.6
16 weeks 3.6 5.8 9.6
18 weeks 4.6 6.8 11.1
20 weeks 5.5 8.0 12.9
22 weeks 6.3 9.3 14.9
24 weeks 7.0 10.7 16.9
26 weeks 7.5 12.0 18.7
28 weeks 7,6 13.0 19.9
30 weeks 7.5 13.6 20.6
32 weeks 7.1 13.6 20.4
34 weeks 6.4 12.9 19.4
36 weeks 5.6 11.8 17.9
38 weeks 4.7 10.3 15.9
40 weeks 3.7 8.6 13.9

Чем опасно маловодие при of pregnancy?

  • The appearance of amniotic cords. If the amount of amniotic
    the fluid is drastically reduced, then between the skin of the fetus and the amniotic
    sheath may occur adhesions They may obvivat or
    drag parts of the fruit, which leads to deformation or even
    amputation of limbs.
  • Violation of labor (due to the fetal flat
    bubble). WITHхватки могут быть слишком слабыми, нерегулярными.
  • WITHдавление пуповины в родах, вплоть до острой гипоксии и гибели
    fetus.
  • The abnormal position of the fetus in the uterus.

TOак лечить маловодие?

Главный принцип лечения маловодия во время of pregnancy –
патогенетический. This means that the reduction in itself is
it is impossible to cure amniotic fluid, you need to find the cause of such
states. For this, a gynecological examination is connected to the ultrasound,
fetal heartbeat control, genetic screening, analysis.

If there are no additional signs apart from low water, then
nothing needs to be treated. Observation of the state of the mother and
baby There is information that maternal dehydration can lead
to low water. Some pregnant women with edema begin
arrange “discharge” days with the restriction of drinking liquids,
what to do is extremely undesirable. Adequate amount of fluid in
day is necessary to maintain balance in the body.

Upon detection дополнительных признаков неблагополучия нужно
treat primary disease:

  • With congenital fetal malformations – surgical treatment (with
    целесообразности) или прерывание of pregnancy. ATозможна
    waiting tactic.
  • With chromosomal abnormalities – assessment of the viability of the child,
    после чего – прерывание of pregnancy или выжидательная тактика
  • При внутриутробной infections – противовирусное или
    антибактериальное лечение (при необходимости), контроль за
    состоянием baby Before treating such diseases, you need
    carry out all necessary analyzes.
  • With placental insufficiency – treatment with vascular
    препаратами до 20 недели (TOурантил), после 20 недели –
    waiting tactic. With a strong delay in fetal development – as
    You can give birth to a pregnant woman earlier (preferably after 33
    weeks)
  • При переношенной of pregnancy – стимуляция родов или
    expectant management (in normal fetal condition)
  • При осложнении многоплодной of pregnancy – лечение с помощью
    bypassing the vessels of the placenta, pumping out excess amniotic
    fluid from the fetus – the recipient. With the death of the donor fetus usually
    try to give birth to a pregnant woman as early as possible to save
    жизни плоду-реципиенту.
  • When the fruit membranes rupture, stimulate childbirth or
    waiting tactic. The main task is to prevent infection.
    the fetus and allow the lungs to develop (with
    hormone therapy).

TOак ведут роды при выраженном маловодии?

If the ultrasound revealed a significant lack of water, the doctors will
раннее вскрытие околоплодного bubble. The fact is that with a small
the volume of amniotic fluid, the bladder becomes flat. AT
As a result, not only does it not stimulate generic activity, but
may break it. Therefore, such a bladder bubble is better.
to open

If the lack of water is extremely severe, then if there is evidence
apply caesarean section.

Prevention of oligohydramnios

WITHнизить риски маловодия (но не сделать их нулевыми) можно с
помощью правильной подготовки к of pregnancy и соблюдения всех
doctor’s recommendations:

  • Take folate at 400 mcg per day
  • Пройти анализы на ATИЧ, сифилис и TORCH-комплекс
  • If a woman did not have chickenpox and rubella in childhood –
    vaccinated against rubella and chickenpox before pregnancy.
  • To refuse from bad habits
  • TOонтролировать диабет, гипертtheyю и другие хрtheyческие
    diseases
  • Exclude medication without consulting a doctor during
    of pregnancy

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