Every woman dreams that her pregnancy would proceed easily and naturally, so that no one and nothing could distract the expectant mother from pleasant thoughts about her future child. However, in reality, not everything goes so smoothly.
Low water can become one of the serious complications. We will tell you about what it is and how to treat it in this article.
What it is?
In a broad sense, oligohydramnios is called a decrease in the amount of amniotic fluid from the norms characteristic of a particular period of pregnancy. However, in the classical sense of this word, oligohydramnios is considered a small amount of amniotic fluid on the eve of childbirth, at about 39-40 weeks.
When there was no ultrasound, and one could only guess about the amount of water, the lack of water was really determined just before the very birth. Now, thanks to the development of diagnostics, to identify a tendency towards a decrease in water in the fetal bladder is possible from the 16th week.
Water is essential for the normal development of a child. They are also a naturally provided shock absorber, softening shaking, swaying, which the baby could quite significantly feel when walking or other actions of a pregnant woman, if the water did not prevent this.
Amniotic fluid begins to be produced at about 8 weeks of gestation, and with an increase in gestational age, it also increases in volume. In the 3rd trimester, there is a slight decrease in fluid, because the uterus is already strongly stretched by the grown child.
Long years of studying intrauterine development have allowed doctors and scientists to calculate the normal amounts of amniotic fluid determined for each period. It is not customary to measure them with standard liquid measures - milliliters, for example.
To assess their number, there is a special parameter - the amniotic fluid index. It can be determined in millimeters starting from the 16th week of gestation when undergoing an ultrasound scan.
IAZH standards - table:
Since the amount of water in the fetal bladder is not a constant value, at different periods, the same expectant mother may find low water, and after a few weeks it is not detected. This natural phenomenon is called functional dryness. This is the most harmless of all types of this complication.
Usually, with a medical verdict "lack of water", a woman falls into a stupor. Future mothers should be reassured by the following official statistics from the Ministry of Health:
- low water is accompanied by about 4% of all pregnancies;
- only 0.5-1.2% of such cases have pathological causes;
- all other women (and from the overwhelming majority) perfectly wear out and give birth to healthy children, since their lack of water was physiological.
Malnutrition pathological is considered to be a persistent insufficient amount of amniotic fluid, which can be registered repeatedly at a variety of times, starting from 16 weeks.
Classification
Low water can be acute if it appeared suddenly under the influence of negative factors, or it can develop gradually and almost imperceptibly, and then it will qualify as chronic.
With acute oligohydramnios, the body of a pregnant woman can react to a viral disease, flu or ARVI, from which the expectant mother could not protect herself during the period of bearing the baby. This violation is usually temporary and does not mean that the baby has pathologies.
Chronic lack of water is more dangerous. It usually develops due to problems that cannot be called quickly eliminated - mom's diabetes, obesity, as well as child's malformations and prolonged hypoxia. Such a violation will not go away by itself, it definitely needs treatment. Also, the violation can be early if it was detected between 16 and 20 weeks and late if the problem was detected only after 26 weeks.
In the case of early dryness, doctors' forecasts are less optimistic, because the process of formation of the baby's internal organs and systems has not yet been completed.
Pronounced lack of water at an early stage can be an indicator of gross genetic abnormalities in a baby, and therefore such a "find" on an ultrasound scan needs a detailed study by means of other diagnostic methods. In the later stages, the violation is often functional, completely natural, it can be easily corrected or goes away on its own.
Sometimes the development of such a violation is influenced by the membranes, or rather their integrity:
- if they are not changed, not injured, then doctors talk about primary oligohydramnios;
- if the shells are damaged and water leaks, this is a secondary violation.
Primary oligohydramnios occurs in 80% of cases. According to the quantitative indicator of deviations from the norms indicated in the table, moderate and severe low water are distinguished.
Wrong to count oligohydramnios (this is the scientific name for dryness) an independent disease. This is a pathological condition during pregnancy, which is only a symptom of a true disorder.
Causes
The reasons for the decrease in amniotic fluid, which are so important for the baby, are diverse. It can be malformations of the child, his diseases, pathology of the placenta, as well as diseases of the expectant mother, both acute and chronic.
Some genetic, including chromosomal abnormalities that arose during conception, during the formation of the genetic code, the karyotype of the fetus, proceed precisely against the background of a decrease in the amount of amniotic fluid.
In particular, such defects as abnormal development of the urethra and its valves, as well as abnormal narrowing of the baby's urethra or its complete absence, solidary (on both sides) narrowing of the ureters or anomalies in their structure, lead to the development of oligohydramnios.
Pronounced oligohydramnios is observed in pregnant women in the event that the baby, by a "mistake" of nature, completely lacks the kidneys as such.
Baby polycystic kidney disease (Potter's syndrome) is also an obvious cause of abnormal pregnancy. Among chromosomal abnormalities, oligohydramnios are most often accompanied by Down's syndrome and Turner's disease.
If everything is in order with the baby's genetics, and this was confirmed using other diagnostic methods, then doctors consider the likelihood of infection of the fetus. The most dangerous in terms of the risk of oligohydramnios are cytomegalovirus infection and chlamydia. The lag in the amount of water from the norms often occurs with a delay in fetal development.
The main maternal ailment that can lead to oligohydramnios is gestosis. In addition, this condition can cause venous insufficiency, a tendency to form blood clots, and diseases of the cardiovascular system.
Adversely affect the amount of water and kidney ailments in the expectant mother, and diabetes mellitus. Dehydration can also cause a decrease in amniotic fluid, as well as smoking, with which some of the expectant mothers, even being in an "interesting position", can not say goodbye.
Pathologies of the placenta - insufficiency, heart attacks of the "child's place", any anomalies in its development that occurred during the formation of this temporary organ at the very initial stages lead to lack of water.
Among other reasons that can lead to such an unpleasant complication of pregnancy are overmaturity, in which natural aging of the placenta occurs, trauma to the membrane of the membranes, mothers taking a large number of medications for a long time, as well as fetal death and multiple pregnancies.
Symptoms and Signs
A woman practically cannot determine her oligohydramnios on her own, this is a matter of specialists. Only a few signs can indirectly indicate the likelihood of a decrease in the amount of amniotic fluid.
Usually, in women with oligohydramnios, the size of the abdomen is smaller than the due date. It becomes possible to establish a violation thanks to measurements of the height of the day of standing of the uterus, which are carried out at each scheduled examination in the antenatal clinic.
When the expectant mother begins to feel the movements of her child, with oligohydramnios, they can be quite painful for a woman.
One cannot be silent about such sensations, if the symptom has not been diagnosed earlier, it is imperative to inform the doctor about your suspicions, who will prescribe all the diagnostics required in this case.
Diagnostics
The amniotic fluid index is determined by the ultrasound doctor. It measures the distance, free from the baby's limbs and the umbilical cord, between the baby and the anterior abdominal wall, its inner surface. This measurement is called a vertical pocket.
If the result of measurements after a comparative analysis with the tables shows that the amount of water is reduced, the degree of violation is revealed. With moderate low water, the index is reduced by 10-15% compared to the above norm, and the vertical pocket, which with a normal amount of water is 5-8 cm, is reduced to less than 5 cm.
A pronounced violation is such a violation in which the vertical pocket does not exceed 2 cm, and the amniotic fluid index deviates from the norm downward by 15-20%. To imagine in more detail all of the above, we present a comparative table.
Violations of the amount of amniotic fluid:
If the ultrasound specialist indicates in the conclusion that a woman has signs of moderate low water, an obstetrician-gynecologist be sure to send her for Doppler and expert ultrasound, in order to more accurately know what condition the baby is in, the placenta and blood flow in the uterine vessels.
When the ultrasound protocol indicates that the pregnant woman has severe oligohydramnios, she is hospitalized for a more thorough examination.
If the reason lies in the congenital abnormalities of the baby, it is recommended to terminate the pregnancy for medical reasons. To agree or not, it is up to the pregnant woman herself to decide. If she refuses, then the child is kept until the very birth, they provide him with the necessary drug support.
Potential consequences for the mother
A woman with low water threatens with termination of pregnancy in the late stages, traumatizing both the psyche and the physical health of the reproductive system. If the child dies, there will be no other option. After interruption for a long time, a woman may experience a nervous breakdown and develop secondary infertility.
A small amount of amniotic fluid aggravates the very process of childbirth. Weakness of labor forces often develops, the woman is threatened with a cesarean section. The postpartum period in such women is more difficult, complications are likely.
The pregnancy itself can give the expectant mother a lot of unpleasant sensations: the larger the child becomes, the more difficult it will be for a woman to withstand his movements.
The likelihood of miscarriage during pregnancy with oligohydramnios is high, the risk of premature birth is even higher - it reaches 26%.
Possible consequences for the child
Children born after pregnancy with oligohydramnios are low in weight, weaker than their peers, even if the pregnancy is full-term before the expected date of delivery.
The most severe consequences of prolonged polyhydramnios include various adhesions of the skin of the fetus and the membranes of the amniotic bladder. As a result of such adhesions, all the free space of the uterine cavity can be filled with cords. They can also entangle a baby.
Due to the pressure that the strands will exert on the tissues of the fetus, irreversible deformities are formed - in babies, limbs are self-amputated or severely curved, there are defects in the face and chest. The baby's appearance is completely disfigured. The frequency of such consequences is low, but this cannot be ruled out.
The likelihood of such outcomes increases if oligohydroamnion is diagnosed early, at 16-20 weeks, and persists throughout pregnancy.
In childbirth, the baby may face other troubles associated with a small amount of amniotic fluid - prolapse of the umbilical cord, premature violation of the integrity of the amnion and, as a result, a long anhydrous period, which can turn into hypoxia and infection.
Many women mistakenly believe that lack of water is the cause of the development of diseases such as Down syndrome, as well as other chromosomal abnormalities. The logical connection here is the opposite - with Down syndrome, oligohydramnios often develops, and not vice versa.
Almost always, a protracted oligohydramnios causes a delay in the intrauterine development of the baby. Dangerous in this case is the underdevelopment of the lungs, with which mothers give birth to such babies.
However, if the help to the baby was provided correctly and in a timely manner, then the child quickly enough then begins to gain weight and soon catches up with his peers in physical development. However, intellectually, the baby can develop late for a long time.
Cases of detection of oligohydramnios later are also dangerous in terms of the likelihood of complications. at 30 weeks pregnant, but only on condition that the pathological condition persists for 4-6 weeks or more.
For any negative consequences of low water for a child's health, a pattern is inherent - the earlier this condition occurs, the more serious the consequences can be.
Treatment
Low water therapy is always comprehensive. And it begins with establishing the exact cause that caused the pathological decrease in the amount of amniotic fluid.
Primarily the version with chromosomal abnormalities is being checked. For this, a woman, depending on the period, is sent to one of the methods of invasive prenatal diagnosis.
If oligohydramnios is diagnosed at 16 weeks, a chorionic biopsy can be performed. If the fact of lack of water became known later, the woman can be referred for cordocentesis, amniocentesis.
These procedures will help to obtain samples of amniotic fluid with particles of the baby's epithelium, cord blood from the umbilical cord. An analysis will be carried out in the genetic laboratory, which allows to speak with a high degree of accuracy about the presence or absence of Down syndrome, Cornelia de Lange syndrome and other anomalies associated with a violation of the number of chromosomes in the karyotype and causing oligohydramnios. Such studies are usually carried out is free.
Recently, it has become possible to do a non-invasive prenatal DNA test, which is still expensive. It is absolutely safe for the baby and is based on the isolation of the baby's DNA from the venous blood of the pregnant woman. This test detects chromosomal abnormalities with a probability of 99.9% and is an ideal alternative to invasive tests that can be dangerous for both the pregnant woman and the fetus.
When confirming the cause of oligohydramnios due to chromosomal pathologies, termination of pregnancy is recommended.
If the additional examination does not show the presence of gross chromosomal abnormalities in the child, then ultrasound specialists of an expert class will look for physical defects. To do this, they will carefully study the baby's urinary system - the ureters, urethra, kidneys. Particular attention will be paid to the health of the placenta. To assess blood flow in the uterine vessels, ultrasound is performed.
The attending physician will refer the woman for blood tests, which can confirm or deny the presence of infections, including sexually transmitted infections.
Blood must be donated for sugar and urine for protein content. The doctor monitors the arterial pressure of the expectant mother to exclude gestosis as a cause of oligohydramnios.
If the cause is found, doctors decide how to treat the underlying disease, almost all of them, except for congenital malformations of the fetus and chromosomal pathologies, are amenable to therapy. At the same time, the control over the state of the fetus is enhanced.
Moderate dryness can be treated at home. in most cases, hospitalization is not required, if the expectant mother follows all the doctor's recommendations.
Severe oligohydramnios, if detected early, is also an indication for termination of pregnancy; none of the doctors will dare to make predictions about its outcome. With severe lack of water, diagnosed after 26 weeks, the woman is hospitalized.
Drug treatment
An expectant mother with severe lack of water is injected intramuscularly with vitamin solutions. In addition, she is given droppers with drugs that improve uteroplacental blood flow. Typically used for this Actovegin. Additionally, doctors recommend taking "Courantil", the dosage and frequency of taking this drug is determined by the doctor.
A pregnant woman may be prescribed broad-spectrum antibiotics to help control the infection, if any. During the period of carrying a baby for these purposes, it is often recommended "Amoxiclav". To improve metabolic processes in a woman's body, drugs such as "Hofitol", as well as multivitamin complexes designed and created specifically for pregnant women.
Simultaneously with taking drugs in a hospital, the baby's condition is checked daily or every other day. A woman is given CTG, if the gestational age is already above 28 weeks, the functionality of the placenta is monitored using ultrasound, ultrasound scanning can be performed at any time to assess the amount of water over time.
Any alarming symptoms that may indicate a fetal dysfunction can at any time become a decisive reason for doctors to carry out a cesarean section ahead of schedule.
With moderate low water, which, according to the doctor, is of a physiological origin, the woman is discharged "Courantil", "Actovegin" in tablets and multivitamin preparations, she will have to come to her appointment once a week, each appointment will be accompanied by a cardiotocographic study (CTG) until the doctor removes the diagnosis based on the normal values of the amniotic fluid index based on the results of additional ultrasound.
General recommendations
A woman with identified oligohydramnios should limit physical activity. This recommendation applies to both outpatient and inpatient care. Any heavy loads are categorically contraindicated.
Initially it is recommended to revise the diet and drinking regime. An increase in the amount of fluid you drink, according to statistics, can increase the amount of amniotic fluid by 20-25%.
Long walking, playing sports with such a complicated pregnancy are undesirable. Additionally, you will have to limit sex. Overweight, obese pregnant women are advised to go on a special diet in order to exclude even more weight gain.
Nutrition with oligohydramnios should include a large amount of fruits and vegetables, proteins and fats should be balanced, and fast carbohydrates (sweets and pastries) should be avoided altogether.
If there is swelling, you should definitely consult a doctor, to work out together a correct and sufficient drinking regime. With gestosis and hypertension, it is important to measure arterial blood pressure twice a day. With a significant increase in it, a woman needs qualified medical care.
Traditional methods of treatment
Alternative medicine is ready to offer pregnant women with moderate low water content a lot of useful and enjoyable recipes and products that, if they do not increase the amount of water, they will definitely be able to meet the needs of a future mother with a deficiency of amniotic fluid in essential minerals and vitamins.
Folk remedies should not even try to treat severe lack of water. But with minor deviations from the norm, a woman may well use some advice, if her doctor has nothing against it.
The need for minerals in oligohydramnios will help restore figs, melons and grapes. Also well, according to the reviews of expectant mothers, zucchini and fresh tomatoes help.
A real treasure, a natural "pharmacy" for a pregnant woman with a deficiency of amniotic fluid can become chokeberry. A woman can take 50 grams of juice from her or about 100 grams of berries per day.
Another favorite remedy for oligohydramnios is strawberries. They are eaten fresh or brewed with homemade fruit drink in order to improve the normal functioning of the kidneys. If the pregnancy fell out in the winter and there is nowhere to take strawberries, you can drink weak tea with strawberry jam. If this is not in stock, you can purchase it.
Prevention
Correct and responsible planning of the baby will help to avoid low water during pregnancy. A woman should be examined in advance by doctors of different specialties.who will be able to answer questions about her state of health and the presence or absence of chronic diseases.
Of course, it is not necessary to carry out a full medical examination, but a woman who dreams of a child is simply obliged to visit a cardiologist, therapist and nephrologist. Visits to these specialists will help ensure that the heart, kidneys and general health will help the woman carry her baby without complications.
If the age of the expectant mother is over 35, it is worth consulting with a geneticist, because the likelihood of conceiving and giving birth to a child with Down syndrome or Patau increases in proportion to the mother's age.
It will be correct to do tests for genital and other infections even before conception, and, if something like this is found, to treat them before the child is conceived.
You should quit smoking before conception, in extreme cases, as soon as it becomes known about the pregnancy. Smoking, and it has been proven, very often acts as a provoking factor of oligohydramnios.
During pregnancy, a woman for preventive purposes it is important not to refuse to undergo mandatory screening tests in the first, second and third trimester, do not give up ultrasound and the delivery of certain tests recommended by the doctor.
Expectant mothers should beware of viral infections, especially during periods of massive incidence of acute respiratory viral infections and influenza, in order to avoid the development of oligohydramnios after an illness. To do this, you should refrain from visiting shopping centers and public transport during seasonal epidemics, observe the rules of personal hygiene.
If the doctor insists on hospitalization, you should not refuse it either, even if the woman herself thinks that she is feeling fine, and she does not have time to stay in the hospital at all.
Reviews
In most cases, according to reviews of pregnant women left on the Internet, pregnancy with oligohydramnios ended quite well, children appeared on time or a few days earlier, weighing from 3 to 3.5 kilograms.
Sometimes there are stories about practically inconsistent diagnoses, when an ultrasound scan gives a woman both oligohydramnios and a large fetus. Almost all of these cases resulted in a planned caesarean section.
In some cases, doctors had to resort to stimulation of labor with medications or to have a cesarean section.
Many pregnant women complain about the ambiguity of the assessments and criteria for the violation. In one consultation, they are diagnosed, and in another or in a paid clinic on an ultrasound scan, they say that the amount of water corresponds to the lower limit of the norm, and therefore no treatment is required.
Indeed, the approaches and devices are different everywhere, and a difference of 2-3 millimeters can give a woman a lot of worries even when there is no reason for them.
For more information on the causes, treatment and consequences of low water, see the next video.
