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Physiological oligohydramnios. What is oligohydramnios during pregnancy, its causes, what is dangerous for the fetus and mother

Oligohydramnios during pregnancy: causes and consequences. Signs and treatment of pathology

Amniotic fluid is the baby's habitat. It protects it from damage, regulates body temperature and is involved in metabolism. The volume of fluid for each stage of pregnancy is different. The largest value is recorded at 33-, and it approaches 1000 ml.

It has also been noted that children born to women with oligohydramnios have reduced adaptive abilities and an increased risk of developing infectious complications in the postpartum period.

Why is oligohydramnios dangerous during pregnancy? Consequences for the child

Severe oligohydramnios can lead to serious complications. Due to a lack of amniotic fluid, adhesions form between the baby's skin and the amnion. As they grow, they become like threads and cords that can compress the umbilical cord, which will cause intrauterine oxygen deficiency. Very rarely, such connective tissue strands can entwine parts of the body and lead to deformity or amputation of a limb.

Oligohydramnios can negatively affect the birth process and lead to complications affecting the baby:

• primary weakness of labor due to the absence of the amniotic sac;
• intrauterine oxygen starvation of the fetus;
• incorrect position of the child;
• umbilical cord compression and fetal death.

It is also possible to develop postpartum hemorrhage due to remaining tissue from the placenta or membranes in the uterus.

Moderate oligohydramnios during pregnancy

The percentage of decrease in amniotic fluid may vary. The moderate form is diagnosed when amniotic fluid is less than 500 ml in late pregnancy, but more than 300 ml. This situation can be corrected. Moderate oligohydramnios does not require hospitalization.

Oligohydramnios is considered pronounced when the amount of water decreases to less than 300 ml (according to some sources, less than 200 ml). This is a serious condition that must be treated in the pregnancy pathology department.

Also, oligohydramnios can have an acute or chronic course, depending on the rate of development and duration of existence.

Signs of oligohydramnios during pregnancy

You can suspect the development of oligohydramnios on your own without an ultrasound based on some external signs. At each visit to the gynecologist, the pregnant woman has her abdominal volume measured in the supine position and the height of the uterine fundus. These indicators should constantly increase as the child grows. If there is a lag in their value, then oligohydramnios can be suspected.

Fetal activity is also important in diagnosis. A pronounced decrease in mobility, a small and weak number of movements speaks in favor of oligohydramnios. During childbirth, oligohydramnios manifests itself as a flat amniotic sac, which stretches over the fetal head and does not perform its shock-absorbing function.

Diagnosis of the condition begins with an ultrasound. The amniotic fluid index is used to determine oligohydramnios. This is a calculated indicator that is based on measurements of amniotic fluid pockets. The pregnant woman's abdomen is conventionally divided into 4 quadrants by two lines. One runs vertically along the white line of the abdomen, and the second perpendicular to it through the navel.

Then, using the apparatus, the depth of the largest pocket of liquid in each quadrant is measured, the resulting values ​​​​from 4 measurements are added. The result is compared with a special percentile table. It contains data on the normal amount of water for each week of pregnancy. A deviation below the 5th percentile is considered oligohydramnios. If the value is below the 2.5 percentile, then severe oligohydramnios is diagnosed. It requires a particularly careful study of the fetus.

Laboratory research methods help determine the cause of oligohydramnios. It is necessary to carry out PCR diagnostics for TORCH complex infection. If chromosomal pathologies are suspected, amniocentesis and subsequent karyotyping are performed. Consultation with a geneticist is also necessary.

Oligohydramnios during pregnancy: causes

It is not always possible to determine the exact cause of oligohydramnios. But most often the following pathological conditions are considered a tendency to its occurrence:

• diseases of the pregnant woman: chronic pathology of the cardiovascular system, kidney disease, collagenosis;
• pathology of the placenta: multiple infarctions, developmental anomalies and insufficiency;
• congenital malformations of the fetus: underdevelopment or stenosis of the urethra, posterior urethral valve, disruption of the formation or junction of them with the renal pelvis, underdevelopment of the kidneys or multiple cysts;
• intrauterine infection;
• chromosomal diseases of the fetus;
• intrauterine growth retardation;
• antenatal death;
• leakage due to premature rupture of membranes;
• post-term pregnancy;
• iatrogenic oligohydramnios caused by taking prostaglandin synthetase inhibitors: Aspirin, Ibuprofen, Indomethacin, Naproxen;
• oligohydramnios for an unknown reason.

Given the possibility of developing oligohydramnios, especially in the 3rd trimester, it is not recommended to take non-steroidal anti-inflammatory drugs for pregnant women.

What should you do if oligohydramnios is detected?

The doctor’s tactics when detecting oligohydramnios depend on the condition of the fetus. If a moderate decrease in the amount of water is combined with the normal development of the child, then the pregnancy is prolonged until the moment, but dynamic monitoring of the woman’s condition is required.

A pronounced acute decrease in the volume of amniotic fluid in the 2nd trimester, combined with delayed development of the child, is an indication for abortion. If pathology is detected or developed after, then an examination is necessary to assess the feto-placental complex and the condition of the child. In case of congenital defects or developmental delay, it is recommended to terminate the pregnancy for medical reasons: the outcome of pregnancy with such a combination of pathologies is impossible to predict. Drug therapy with a normal amount of water is effective in 72% of cases, and with oligohydramnios only in 12% of pregnant women.

Nutrition

Treatment involves changing the nature of nutrition and a salt-free diet. The amount of salt is significantly reduced. It is optimal to prepare dishes without it, adding salt little by little directly into a portioned plate.

The diet is enriched with a large number of foods containing potassium: melon, raisins, grapes, dried apricots. Helps correct pathology of apricots, apples, zucchini,... To stimulate the kidneys, fresh kefir and herbal decoctions of chokeberry and lingonberry leaves are recommended.

Treatment of oligohydramnios during pregnancy

In the treatment of pathology of the feto-placental complex, Trental is used. It improves blood microcirculation, helps cope with hypoxia and malnutrition of the fetus. Actovegin and Curantil are used simultaneously. Their action is aimed at maintaining the function of the placenta and preventing its pathological changes.

If there are signs of fetal infection, tactics depend on the type of pathogen. If the disease has developed before, and the type of pathogen belongs to the TORCH complex, then termination of pregnancy is recommended for medical reasons. In other cases, the mother is treated with drugs (antibiotics) appropriate to the type of infection. After birth, such children should be observed by a pediatrician to detect symptoms of congenital infectious pathology.

Labor management tactics for oligohydramnios include amniotomy for a mature cervix. This ensures tight contact of the fetal head with the opening neck. If there is a significant lack of water, combined with fetal pathology, a caesarean section can be performed.

Oligohydramnios is an easily diagnosed symptom that can indicate many pathological processes in the body of a pregnant woman. With timely detection, it is possible to correct this condition and prolong pregnancy until fetal maturity.

The doctor identifies those who are registered for pregnancy at the antenatal clinic as a risk group for the development of oligohydramnios. These are those in whom it was detected during previous pregnancies, women with chronic infectious processes, heart and kidney diseases, as well as those who had a history of congenital anomalies of the fetus. To prevent pathology of amniotic fluid, it is necessary to promptly treat concomitant diseases, and take Curantil and Trental and vitamin complexes for preventive purposes during times of crisis.

Oligohydramnios is a lack of amniotic fluid. It occurs in 20% of pregnant women. This condition can have serious consequences; it is fraught with complications and deviations from the normal course of pregnancy, and the risk of fetal development pathologies increases. The composition of amniotic fluid is quite diverse. The waters inside the fertilized egg contain nutrients necessary for the life and development of the child, oxygen, hormones, salts, vitamins and other substances that ensure the normal course of intrauterine development of the fetus.

Another function of amniotic fluid is protective. The water that is inside the placenta creates a semblance of weightlessness and in this way protects the baby from possible damage due to pressure from the woman’s internal organs.

In the event of an impact, it absorbs it, so the consequences for the fetus are minimal. In addition, amniotic fluid protects the child from infections and other adverse factors. Thus, oligohydramnios during pregnancy is very dangerous, because such a phenomenon is a decrease in the quality of the protective functions of amniotic fluid.

Why does oligohydramnios occur?

The amount of water inside the placenta changes depending on the needs of the baby and the length of pregnancy; it is clear that at 20 weeks the volume of water is less than at 37 weeks. By the 38th week of a normal pregnancy, the fluid volume is 1500 ml, and at 39 and 40 weeks it begins to gradually decrease.

Most often, signs of oligohydramnios are detected in the second trimester (by about 20 weeks), but if oligohydramnios is detected at 30–32 weeks, this can lead to serious problems.

If at 30–32 weeks the amniotic fluid is less than 1000 ml, then we are talking about oligohydramnios. Depending on the amount of fluid deficiency in the placenta, severe or moderate oligohydramnios during pregnancy is diagnosed. Ultrasound is most often used for diagnosis.

Sometimes moderate oligohydramnios during pregnancy is the result of poor nutrition. In such a situation, a pregnant woman does not require treatment; it is enough to establish a routine and diet. Typically, doctors prescribe a gentle regimen in such a situation, which includes eating a variety of foods rich in vitamins and minerals. In parallel with the diet, it is important to be periodically examined by a doctor.

If the ultrasound showed severe oligohydramnios, then serious measures will be required, including drug treatment. In such a situation, the woman will be kept in a day hospital. The more severe the oligohydramnios, the more serious the consequences for the baby. Severe oligohydramnios threatens the development of the following pathologies:

• deformations of the child’s skeletal system,
• asphyxia, which can lead to disruption of the nervous system and negatively affect brain activity,
• abnormal development of the limbs in the fetus.

A pregnant woman should know that a decrease in the volume of amniotic fluid in the later stages (37, 38, 39 weeks) is not considered pathological. This is a natural process of preparation for childbirth, which in most cases occurs at 39 or 40 weeks.

Symptoms of oligohydramnios

The most dangerous thing about this condition is that there are no obvious signs of oligohydramnios. Physically, the woman feels great and her health does not deviate from the norm. Only sometimes, when the fetus moves, a woman may feel pain in the lower abdomen, but this is an unreliable symptom.

Only a specialist can accurately determine whether a pregnant woman has oligohydramnios. So, an experienced doctor can diagnose pathology in the case of:

• lag in size or discrepancy in the height of the uterine fundus,
• its serious discrepancy with the timing of pregnancy,
• insufficient abdominal size for this period.

If such symptoms are detected, the doctor may come to the conclusion that the pregnant woman has oligohydramnios. Every doctor knows the consequences of oligohydramnios if left untreated. The risk of giving birth to a baby with developmental pathologies is very high, especially with severe oligohydramnios.

In order to refute or, conversely, confirm this diagnosis, it is necessary to conduct an ultrasound, on the basis of which a diagnosis can be made. An ultrasound examination will allow you to accurately determine the amount of fluid inside the placenta, and when confirming the diagnosis, the doctor will use ultrasound to assess the severity and condition of the fetus. If you suspect the presence of oligohydramnios, a pregnant woman should undergo an examination by a gynecologist.

Oligohydramnios can be diagnosed at 20, 30 and 37 weeks. Although oligohydramnios in the classical sense can be diagnosed only at 39 or 40 weeks, if the fluid volume has decreased to 500 ml or less.

However, the classical definition is outdated; in modern medicine, we can talk about oligohydramnios starting from the 20th week. The closer the due date (37, 38, 39 weeks), the more the placenta ages and the more often oligohydramnios is detected.

Causes of oligohydramnios

If a doctor diagnoses oligohydramnios during pregnancy, the causes of this condition may be different. Experts to this day cannot come to a common opinion on why oligohydramnios occurs. From a long list of reasons, scientists have pinpointed the following:

• Reduced function of the secretion of the membrane that forms the fertilized egg, insufficient or improper development of the epithelium covering this membrane. If a pregnant woman does not know the dangers of oligohydramnios during pregnancy, then this is even better. What causes the most difficulty for doctors is not diagnosis, but “false symptoms” that arise as a result of stimulation of a woman’s nervous system.
• Abnormal fetal development. Other types of abnormal development include hereditary anomalies in the development of the face and kidneys. This can be clarified between 20 and 30 weeks, when the second mandatory ultrasound examination has already been carried out.
• High blood pressure in a pregnant woman. Naturally, throughout the entire period of pregnancy, blood pressure will be elevated, but its fluctuations will be insignificant. If the blood pressure surges too high, it can cause oligohydramnios. In the case of hypertension, fetal development may be delayed, its growth may slow down, or fetal death may occur. This happens especially often after 20 weeks.

• Another cause of oligohydramnios is all kinds of bacterial infections that were suffered by a pregnant woman and were not properly treated. Sometimes the danger is hidden in infections that a woman had long before pregnancy. In such a situation, pathogenic microflora is detected using tests both in the birth canal and in the amniotic fluid. The manifestation of such a danger can be detected at 20 weeks of pregnancy, when, under the influence of hormones, the infection begins to progress, in parallel with this, oligohydramnios develops. At 30 weeks, oligohydramnios becomes more pronounced.
• Oligohydramnios is often observed in cases of multiple pregnancies. The cause of this disease in such a situation may be the uneven distribution of blood flow in the placenta. In this case, one child receives more oxygen and nutrients than the other. Such a situation can lead to the death of a weaker embryo, so inpatient monitoring is necessary.

• Another reason for oligohydramnios is postmaturity. At 36 or 37 weeks, the baby is already fully formed and can appear at any time. Sometimes women carry a baby for over 40 weeks, but it is important to know that starting from 38 weeks, oligohydramnios can develop. The reason for this is the “expiration date” of the placenta, which has already served its allotted time and is beginning to age. Sometimes obvious aging of the placenta is observed as early as 37 weeks. As a result, it peels off and is unable to perform its functions. Under such circumstances, doctors raise the question of a caesarean section or inducing labor by piercing the placenta. Don't be alarmed if doctors suggest surgery at 37 or 38 weeks. By this period, the child is already completely ready to be born.

• Oligohydramnios can develop gradually, starting from the first week of pregnancy, and can be detected at 12 weeks or after 20 weeks during an ultrasound scan. It may be caused by obesity in a pregnant woman as a result of serious metabolic disorders. In such a situation, it is important to know how pronounced it is and how seriously it affects the development of the fetus. If oligohydramnios has not yet become pronounced and critical, then the child can be saved. To do this, the pregnant woman is placed in a hospital, where she will be under the supervision of doctors throughout the entire gestation period. With such a pathology, you need to introduce a strict diet and find out the causes of obesity. Even in the best case scenario, the baby will be born no later than 37 or, at most, 38 weeks. This is due to the death of the placenta. In this case, a caesarean section is mandatory.

Examinations and tests for oligohydramnios

Before starting treatment, the doctor needs to determine what led to the pathology and conduct a diagnosis. First of all, it is important to clarify the reason that resulted from insufficiency of amniotic fluid and the severity of oligohydramnios. In this case, you need to undergo a series of tests and studies:

1. Ultrasound examination and Dopplerography, as a result of which you can:

• determine the amount of water in the fertilized egg;
• determine the degree of developmental delay of the child;
• assess the quality of blood flow in the uterine arteries of a pregnant woman, as well as in the umbilical cord and cerebral artery of the fetus.

1. general urine test, general blood test, smear for possible infections and other sexually transmitted diseases. These tests will exclude the possibility of infection of the fetus, as a result of which oligohydramnios develops;
2. CTG to determine the well-being and condition of the fetus.

In addition, it is extremely important to conduct an oral interview with the pregnant woman. The more honest her answers are, the faster the cause of oligohydramnios will be found out. It is important to clarify whether she abused any products, drank alcohol, or whether the pregnant woman smokes. The sooner the cause of oligohydramnios is determined, the sooner treatment can begin, which means saving the child.

If oligohydramnios is diagnosed at an early stage, the pregnant woman will need to undergo additional examinations throughout the entire gestation period to identify the amniotic fluid index (AFI). For each week, starting from 16, it is necessary to determine the AFI. The frequency of determination is 20, 30, 32, 34, 35, 36, 37, 38, 39 and 40 weeks of pregnancy (provided that birth by cesarean section does not occur at 37 weeks).

Treatment of oligohydramnios

Treatment methods for this disease may vary. It all depends on the severity of oligohydramnios, the reasons for its occurrence and the timing of pregnancy. For example, in case of metabolic disorders and obesity at 30 or 32 weeks, a woman is prescribed medications that normalize the activity of the placenta.

The doctor will also create a special diet. If the pregnancy is 33 or 34 weeks or more, then complex treatment is prescribed, which includes taking drugs that improve metabolism in the placenta, vitamins, and medications for the main cause of the disease.

Treatment can take place in two options: outpatient – ​​for moderate degrees of oligohydramnios, or in a hospital – if the degree of oligohydramnios is severe. Outpatient treatment consists of:

• restriction of physical activity,
• maintaining a gentle regime,
• excluding heavy physical activity,
• taking medications prescribed by the doctor,
• periodic visits to the antenatal clinic.

Typically, outpatient treatment is prescribed if a woman is in the second trimester of pregnancy. A woman is admitted to hospital if:

• if oligohydramnios is severe;
• if the amount of amniotic fluid is slightly below normal, but uterine tone is detected;
• oligohydramnios at 34–35 weeks of pregnancy and later.

If oligohydramnios is diagnosed, the doctor may prescribe a weekly ultrasound, starting at 34 or 35 weeks, fetal CTG and Doppler ultrasound. Such measures are extremely important in order to control the pathology. Then, if something goes wrong, you can take the necessary measures in time.

If oligohydramnios is severe and the severity of the pathology threatens the health of the child, then the doctor is obliged to take action and perform a caesarean section. In this case, early birth is possible only if the pregnancy is 33 weeks or more.

However, whenever possible, doctors try to do everything to maintain the pregnancy until at least 35 weeks, since the fetus is considered fully mature only at the end of the 36th week. But this does not mean that you need to refuse surgery at 34 or 35 weeks, since with oligohydramnios the fetus can be seriously damaged.

Condition of a woman with oligohydramnios

Oligohydramnios has serious consequences and has a negative impact on the course of pregnancy, resulting in painful sensations, which is especially pronounced during the period of active fetal movement. In addition, a small amount of amniotic fluid can lead to termination of pregnancy. There is a particularly high risk of miscarriage in the first trimester of pregnancy.

Regardless of the form of oligohydramnios (moderate or severe), complications during labor occur. This may manifest itself in the weakness of the birth process - minor contractions and weak attempts.

This occurs as a result of low pressure of the fetal bladder, which, due to its small size, is not able to influence the speed of preparation of the birth canal and dilatation of the cervix. If you are less than 34 weeks pregnant, you will have to have a caesarean section.

In such a situation, you may need to inject special drugs that stimulate contractions. This is especially important for periods over 35 weeks. In this case, the woman will be able to give birth herself.

Prevention of oligohydramnios

Because the consequences of oligohydramnios can be serious and difficult to treat, preventive measures are necessary. They consist of proper nutrition and compliance with all medical recommendations. It is important to undergo examinations and tests on time. Lifting heavy objects is prohibited.

The phenomenon of oligohydramnios during pregnancy is quite rare (three to four cases per thousand births) and is expressed in an insufficient amount of amniotic fluid (less than 500 ml). This condition serves as evidence that there are abnormalities in the body of a pregnant woman that are dangerous to the health and proper development of the fetus.

Amniotic fluid (amniotic fluid) serves as a source of nutrition for the fetus. They contain nutrients, vitamins, hormones, oxygen, salts, that is, everything that is necessary for the growth and development of the fetus. In addition, all the products of its metabolism (mucus, urine, etc.) are secreted into it. At the same time, they protect it from the effects of adverse factors and various infections. As labor approaches, the amniotic sac puts pressure on the cervix, causing it to open.

It should be noted that the amount of amniotic fluid at different stages of pregnancy is different, which is associated with changes in the needs of the fetus. For example, in the first six weeks of pregnancy the amount of amniotic fluid is small, but by the third trimester (thirty-eighth week) their level ranges from 1000 to 1500 ml, which is considered normal (in the next two weeks the amount of amniotic fluid decreases to 600 ml, which indicates the approach childbirth). If their number is below this level, then oligohydramnios of varying degrees occurs. In practice, there are cases when a pregnant woman had practically no amniotic fluid.

There are moderate and severe oligohydramnios during pregnancy, depending on the severity. In the first option, the amount of amniotic fluid has slight deviations from the norm. In this case, the pregnant woman is recommended to normalize her diet, include in her diet various foods that contain many vitamins and minerals, and also be under constant medical supervision to prevent deterioration of the condition. In case of severe oligohydramnios, treatment in a hospital with the use of medications is required, since this condition is fraught with the development of negative complications in the form of deformation of the fetal skeletal system (injury of the spine, large joints), abnormal development of its limbs, asphyxia leading to a malfunction of the central nervous system, fusion the surface of the fetus with amnion and, as a result, the formation of developmental defects, retardation in growth and weight (the baby’s skin becomes dry and covered with wrinkles). In most cases, for health reasons, women undergo a caesarean section. Oligohydramnios also causes children to be born with low weight and insufficient vitality.

Symptoms and signs of oligohydramnios.
There are no obvious deviations in the well-being of a pregnant woman with oligohydramnios. With severe oligohydramnios, a pregnant woman may experience weakness, dry mouth, and nausea. In addition, a woman may experience aching pain, which is especially pronounced when the fetus moves. This is due to the fact that after twenty weeks of pregnancy, the child’s activity in the womb increases significantly; if amniotic fluid is insufficient, its shock-absorbing function is lost, against which the woman experiences severe pain. Therefore, only a specialist can diagnose this pathological condition using a gynecological examination and ultrasound.

The main signs of oligohydramnios are a lag in the size of the uterus from the norm at a given stage of pregnancy, non-compliance with the norms for abdominal circumference at a given stage of pregnancy, and limited fetal mobility. To confirm the diagnosis, an ultrasound is prescribed, with the help of which the amount of amniotic fluid is determined, and if oligohydramnios occurs, then the degree of its severity is determined, as well as the condition of the fetus is assessed. If the presence of this pathology is suspected, a woman is also prescribed a gynecological examination.

It is worth noting that when there is insufficient amniotic fluid, spontaneous miscarriages and premature births are often observed. Contractions during childbirth are ineffective and very painful, and the cervix dilates slowly. In most cases, labor has a long period, and when the amniotic sac is opened, a small amount of thick fluid stained with fetal feces is formed.

Causes of oligohydramnios.
The reasons for this anomaly in the development of pregnancy are not fully understood. According to medical practice, in most cases the reasons for the development of oligohydramnios at different periods can be:

• Severe congenital pathologies and malformations in the development of the fetus, among which pathologies in the development of the kidneys and hereditary anomalies of facial development can be noted. In most cases, this pregnancy is terminated.
• Insufficient development of the epithelium of the fetal bladder, or reduced secretory function of the aqueous membrane.
• High blood pressure during pregnancy. An increase in blood pressure (blood pressure) can be observed in every pregnant woman, but during the normal course of pregnancy this phenomenon is insignificant. But with a strong increase in blood pressure, oligohydramnios may develop, usually at the end of the third trimester. The mechanism of development of this pathology is due to dysfunction of the placenta against the background of impaired blood flow due to increased blood pressure in the mother. It is worth noting that the severity of oligohydramnios depends on pressure readings. With oligohydramnios and hypertension, delays in fetal development may be observed (lag in size compared to the norm).
• Transferred but not fully treated bacterial infections. Pathogenic flora can be found not only in the birth canal, but also in the amniotic fluid. All this is revealed using special tests.
• Multiple pregnancy, in which the distribution of blood flow in the common placenta is uneven, as a result of which one of the fetuses receives more nutrients and oxygen, while the other receives practically nothing. Often this pathology occurs in one of the fetuses in twins due to the syndrome of shunting (discharge) of blood in the placenta from one fetus to the other. Usually the violations are minor and not dangerous for the baby.
• Post-term pregnancy. In this case, the placenta ages and detaches, as a result of which it can no longer perform its functions. In this case, doctors artificially induce labor.
• Metabolic disorders, in particular obesity.

Diagnosis of oligohydramnios.
The diagnosis is made only after an ultrasound examination. For diagnosis, calculation of AFI or amniotic fluid index is used. This indicator is calculated by measuring in four places the free space between the fetus and the wall of the uterus. The resulting numbers are added up, and the result is divided by 4. If the index is 5-8 cm, this indicates a normal amount of amniotic fluid; if the IAF is 2-5 cm, this indicates moderate oligohydramnios; if the amniotic fluid index is less than 2 cm, there is pronounced oligohydramnios.

Treatment of oligohydramnios.
To treat this pathology of pregnancy, it is necessary to identify the cause of its development, for which the pregnant woman is prescribed:

• Ultrasound, Dopplerography, which allows you to determine the amount of amniotic fluid, the quality of blood circulation in the umbilical cord, the fetal cerebral artery and the woman’s uterine arteries, and the degree of fetal developmental delay.
• Tests and smears for bacteria and STDs.
• Fetal CTG to determine the condition and well-being of the fetus.

Various methods of treating pathology can be used. In particular, in case of metabolic disorders or obesity, the pregnant woman is prescribed medications and is also recommended a certain diet. In most cases, oligohydramnios is treated with complex treatment, including vitamins, medications to improve metabolism in the placenta, and medications to treat the underlying disease that caused the oligohydramnios. Treatment is carried out both on an outpatient basis (in the case of moderate oligohydramnios) and in a hospital (severe oligohydramnios, accompanied by increased uterine tone). In the first case, the woman is recommended to limit physical activity, eliminate any physical activity, follow a gentle regimen, take prescribed medications, and also regularly see a gynecologist.

In case of oligohydramnios, specialists may prescribe an ultrasound examination (every week), Doppler sonography once every three days, and an extraordinary CTG of the fetus in order to monitor the anomaly and prevent its development, as well as to take timely measures, if necessary, that will preserve the health of the mother and the fetus.

In case of severe severe oligohydramnios, which threatens the health of the fetus, the doctor may raise the question of early delivery, provided that the timing of pregnancy allows.

If, with oligohydramnios in early pregnancy, fetal malformations are discovered that are incompatible with its life, then a decision is made to terminate the pregnancy.

If ultrasound results show aging of the placenta and oligohydramnios, treatment for fetoplacental insufficiency is prescribed. On an outpatient basis, drugs such as Actovegin and Curantil are often prescribed for the treatment of oligohydramnios.

Severe oligohydramnios in pregnant women in combination with fetal hypoxia is often eliminated by cesarean section even in premature pregnancy, which is due to severe suffering of the fetus.

The effect of oligohydramnios on a woman’s condition.
Oligohydramnios has an extremely negative effect on the course of pregnancy, complicating it. In addition to pain, this pathology of pregnancy development can lead to its termination. In addition, it causes weakness in labor, since an amniotic sac of insufficient size cannot influence the rate of dilatation of the cervix (usually it is opened artificially). In this case, they may prescribe medications that stimulate contractions.

The effect of oligohydramnios on the fetus.
Amniotic fluid is the site of fetal growth and development. Their insufficiency negatively affects the growth and development of the baby, in particular in the early stages of pregnancy, due to this pathology, clubfoot can form, various types of deformations of the skull can be observed, congenital dislocations of the hips can occur, and in the later stages, oligohydramnios complicates the course of childbirth. With this anomaly, the amniotic sac does not function as a wedge that promotes dilatation of the cervix. In most cases, due to contraindications to natural childbirth, a caesarean section is performed.

It is worth noting that in most cases of pregnancies with moderate oligohydramnios, healthy children are born. Only fetal malnutrition of varying degrees of severity can be observed, which is understandable, since malnutrition and oligohydramnios are the result of fetoplacental insufficiency. It should be said that children of mothers who experienced oligohydramnios during pregnancy subsequently often get sick and are very excitable.

Prevention of oligohydramnios.
To prevent oligohydramnios, it is recommended to avoid vigorous physical activity, but this does not mean giving up movement. Therefore, leisurely walks in the fresh air are recommended for pregnant women.

Eat balanced meals at least five times a day in small portions.

Timely examination, passing the necessary tests that will help identify the presence of factors that provoke the development of oligohydramnios and prescribe appropriate treatment.

In conclusion, I would like to note that in no case, when diagnosing “oligohydramnios,” do not panic, do not be nervous or despair, because this is not the worst thing that can happen during this difficult period for a woman. Nowadays, modern medical equipment and the latest drugs make it possible to carry a baby to term and give birth to him healthy in most problematic cases. Therefore, follow all medical recommendations and have a successful delivery!

According to statistics, about 4% of all pregnant women are diagnosed with “oligohydramnios” on ultrasound. The expectant mother begins to worry about how the lack of amniotic fluid will affect the child. And this is a completely normal reaction. After all, oligohydramnios during pregnancy can be a consequence of serious disorders in both the child and the mother. What to do in such a situation? For what reasons does this condition occur and what consequences does it have?

Purpose of amniotic fluid

Water, or amniotic fluid, surrounds the baby throughout the pregnancy. They are located in the amniotic sac - a kind of “sac” in which the fetus forms and develops. By the end of pregnancy, the amount of water is 800-1500 ml. They are constantly updated - approximately once every 3 days.

With each subsequent month, the amount of amniotic fluid increases. At first, the baby moves easily. However, in the last trimester, despite the increase in the amount of amniotic fluid, he becomes cramped.

Amniotic fluid plays an important role:

1. They help create the habitat necessary for the fetus.
2. Contains nutrients and vitamins.
3. Prevents fusion of the baby's skin and the amniotic sac.
4. Protects from injury.
5. Allows you to move. Movement is very important for fetal development.
6. Protect the umbilical cord and placenta from damage as a result of the baby's movements.
7. If there is a sufficient amount of amniotic fluid in the amniotic fluid, the baby will take the desired position at the time of birth.
8. Thanks to the waters, it is easier for the mother to tolerate the motor activity of the fetus.
9. The waters help open the cervix during childbirth.

Why is there not enough water?

Oligohydramnios is a decrease in the amount of amniotic fluid. Typically, this diagnosis is made in the last weeks of pregnancy if the amount of water decreases to 500 ml. In the classic version, oligohydramnios is a deviation from the norm just before childbirth. However, this phenomenon occurs at 20, 30, 33 and even 35 weeks. For what reasons does this condition develop?

Factors that cause oligohydramnios during pregnancy are divided into 5 groups.

Congenital malformations of the fetus

• Improper formation and development of urethral valves.
• Complete absence of the urethra or its narrowing.
• Too narrow ureters.
• Complete absence of the muscles of the anterior abdominal wall and malfunctions of the urinary system.
• Lack of kidneys.
• Polycystic disease (formation of cysts in both kidneys).

Fetal pathologies

• Infection of the fetus with cytomegalovirus, chlamydia, etc.
• Slow development.
• Down syndrome and other chromosomal disorders.

Chronic diseases of the mother

• Diseases of the heart and blood vessels, such as hypertension or venous insufficiency.
• Preeclampsia (toxicosis of the second and third trimester).
• Pyelonephritis, renal failure and other kidney diseases.
• Lupus, arthritis, rheumatism and other diseases from the collagen group.
• Overweight.
• Diabetes.
• Dehydration.
• Smoking.

Problems with the placenta

• Failure.
• Placental infarctions.
• Abnormal development, for example, amnion necrosis or atrophy.

Other factors

• More than 42 weeks of pregnancy.
• Injuries to the amniotic sac.
• Water leakage.
• Death of the fetus inside the womb.
• Long-term use of drugs that allow you to maintain pregnancy and delay childbirth.

It turns out that most causes of oligohydramnios can be prevented. It is impossible to correct only congenital malformations.

However, they can be detected by ultrasound, which is performed at 12, 20 and 35-36 weeks.

Now the most common causes of oligohydramnios in pregnant women are considered to be gestosis, hypertension, diabetes mellitus, colds or ARVI, TORCH infections (toxoplasmosis, rubella, etc.), chronic oxygen starvation of the fetus.

TORCH infections, in addition to oligohydramnios, cause developmental defects in the child. To avoid problems, you need to get tested for these infections before conception.

If oligohydramnios is caused by an acute respiratory viral infection or a common cold, there is no reason to worry. The amount of water will be restored within a month.

Classification

The duration of oligohydramnios during pregnancy can be acute or chronic:

• Acute occurs spontaneously and is called benign. Such oligohydramnios is usually associated with external circumstances, such as colds.
• In the second case, oligohydramnios develops latently, and its causes are difficult to eliminate. A woman must undergo a thorough examination to prescribe therapy. Chronic oligohydramnios will not go away on its own; it can progress.

According to the time of development, oligohydramnios can be early or late:

• Early oligohydramnios is considered the most dangerous. It usually appears between 16 and 20 weeks. During this period, the child develops most actively. Therefore, it is worth undergoing a detailed examination and starting treatment immediately.
• Late oligohydramnios appears mainly in the third trimester. May be a consequence of abnormalities in fetal development.

Based on injuries to the membranes, oligohydramnios can be primary or secondary:

• Primary may appear in intact membranes.
• Secondary appears when the membranes are damaged and water leaks.

How does it manifest?

It is very difficult to notice oligohydramnios on your own at any stage, be it 20, 33 or 35 weeks of pregnancy. For a woman to suspect something, there must be critically little water. With moderate oligohydramnios, the expectant mother does not experience any symptoms.

If oligohydramnios is severe, the baby becomes cramped in the uterus, and his every movement is reflected in pain in the pregnant woman’s body.

A gynecologist may suspect oligohydramnios if the size of the uterus does not correspond to the gestational age or parts of the baby’s body are easily palpable. At the slightest suspicion, a pregnant woman will be sent for an ultrasound, where a specialist will determine the amniotic fluid index (measured in millimeters).

What is the danger?

Does oligohydramnios always have a negative effect on the child and mother? What could be the consequences of this condition? It is difficult to give an unambiguous answer to these questions - it all depends on the timing and reasons.

If a lack of amniotic fluid occurs in the middle of pregnancy, between 17 and 27 weeks, the baby is squeezed from all sides by the walls of the uterus. There is no room left for him to move and grow.

As a result, some deviations in its development may appear:

• clubfoot,
• dislocated hips,
• deformation of the skull.

If you consult a doctor in time, these defects can be eliminated.

What could be the consequences if oligohydramnios occurs in the later stages, from 35 weeks to the time of birth? Childbirth will involve some difficulties. With oligohydramnios, the amniotic sac becomes flat and does not in any way contribute to the opening of the cervix. As a result, the birth process is delayed. In most cases, doctors decide to perform a caesarean section.

Women who suffer from oligohydramnios have a much higher risk of bleeding in the postpartum period.

The most dangerous period

The critical period is considered to be 30-33 weeks. Oligohydramnios occurs more often at 30-33 weeks than at other periods and is a consequence of oxygen starvation of the fetus. In this condition, all the blood collects in the brain and heart. The lungs and kidneys are starving. The process of producing amniotic fluid, for which these organs are responsible, is disrupted.

At 30-33 weeks, the amniotic fluid index ranges from 74 to 274 mm.

Doctors call this period critical: oligohydramnios can lead to serious consequences and even provoke the death of a child.

How is it treated

Management of pregnancy and childbirth, as well as possible therapy, depend on the trimester in which oligohydramnios occurred and how severe it is. The most risky is the second trimester. In case of danger, doctors try to prolong the pregnancy for as long as possible so that the baby has time to develop and become viable. This process is called prolongation.

If oligohydramnios is detected in the third trimester, it will be difficult to prolong the pregnancy. In the absence of disturbances in the development of the child, delivery is indicated at a period of 37-38 weeks.

To alleviate the condition of a pregnant woman, doctors eliminate the cause of oligohydramnios. They also prescribe medications to improve blood flow in the placenta. It is important to constantly monitor the baby’s condition using ultrasound, CTG (cardiotocography) and Doppler.

If the fetal condition worsens sharply according to CTG data, a cesarean section is performed.

Reverse situation

Sometimes a woman develops a condition that is completely opposite to oligohydramnios - moderate polyhydramnios during pregnancy. This is an increased level of amniotic fluid.

As with oligohydramnios, the causes of polyhydramnios are chronic diseases and problems in fetal development. This condition can also be a consequence of pregnancy with twins, triplets, etc.

Even moderate polyhydramnios during pregnancy can seriously complicate childbirth and postpartum recovery. In addition, it is very dangerous for the child.

So, oligohydramnios and polyhydramnios during pregnancy occur due to diseases of the mother’s body or disorders in the development of the fetus. It doesn’t matter what stage of pregnancy you are: 20, 33, 35 or 40 weeks, in order to avoid serious consequences, you need to follow all doctor’s orders.

Amniotic fluid (amniotic fluid) is a comfortable environment in which the baby develops for nine months. It serves as mechanical protection, a nutrient medium, and a “liquid simulator” that helps the child practice swallowing techniques. There is no question whether amniotic fluid is needed - pregnancy cannot develop without it. But how much is needed and what to do if there is not enough amniotic fluid? How bad is oligohydramnios?

Oligohydramnios: first suspicions

All women differ in height and build, and the sizes of newborn babies also vary. Therefore, “normal” volume is a rather vague concept. The upper and lower limits of the norm differ by more than twice: 600-1500 ml.

” Most amniotic fluid is present, then its volume decreases slightly.

Often, even an experienced gynecologist cannot confidently say whether we are talking about a slight deficiency/excess of amniotic fluid or about the physiological characteristics of a particular pregnant woman. Therefore, suspicion of moderate oligohydramnios (the volume of amniotic fluid is 500 ml or less) often arises when the expectant mother begins to feel an unpleasant symptom: the child’s movements become painful for her.

” Even slight oligohydramnios is a fairly rare pathology; it is detected in 1 out of 20 pregnant women.

Diagnosis of oligohydramnios

Ultrasound examination is intended to confirm the diagnosis. During the examination, the doctor determines the so-called “vertical pocket” - the greatest distance from the anterior abdominal wall to the fetus. Normally, this distance should be from 5 to 8 cm.

You can more accurately determine the state of affairs by calculating the amniotic fluid index: this is still the same “vertical pocket”, only measured at four different points (top right, top left, and bottom right and bottom left). The sum of the four measurements can range from 5 to 24 cm (some doctors narrow this interval to 8-18 cm) and varies depending on the stage of pregnancy.

Normal amniotic fluid index values

But a one-time study can reveal only the most serious violation. Much depends on the child’s activity and the settings of the ultrasound machine. Therefore, if in doubt, it is better to repeat the examination, perhaps with a different doctor and on a different device.

Causes of oligohydramnios

There are many reasons for the occurrence of oligohydramnios, and depending on what condition caused the oligohydramnios, a prognosis is made for the course of pregnancy and treatment tactics are determined.

• Genetic diseases

Sometimes oligohydramnios is caused by genetic abnormalities in the fetus. Unfortunately, this is the most pessimistic scenario, since the pregnancy often ends.

• Chronic diseases of the mother

Problems with the kidneys, urinary tract, hypertension - a number of diseases of the mother can cause oligohydramnios. In this case, the gynecologist will focus on the treatment of this particular disease, and the baby’s condition will be monitored especially carefully.

• Anomalies in the development of membranes

Perhaps the problem is not in the state of health of the mother or fetus, but in the uterus: there is underdevelopment of the amnion, separation of the layers of the membranes, insufficient secretory activity of the epithelial (constituting the mucous membrane) cells of the fetal bladder, responsible for the production of water.

• Infectious diseases

ORV, influenza, chickenpox, measles - many infections can affect the membranes. As a result, they lose elasticity, separations appear, through which amniotic fluid leaks unnoticed by the woman herself.

• Amnionic hydrorhea

Sometimes leakage of amniotic fluid occurs for no apparent reason - doctors are not always able to detect the location of the microscopic rupture. In this case, a smear is made to detect amniotic fluid. Unlike the previous case, secondary infection of the membranes may occur here.

• Post-term pregnancy

Both the placenta and the amniotic membranes gradually cease to perform their functions, which means that the amount of newly produced amniotic fluid also decreases sharply.

Why is oligohydramnios dangerous?

Depending on the degree of insufficiency of amniotic fluid, various pathologies of fetal development occur. The umbilical cord may become sandwiched between the wall of the uterus and the fetus, which will lead to oxygen starvation of the baby. When it is pronounced, the baby is squeezed by the walls of the uterus, which causes curvature of the spine, clubfoot, and in some cases even fusion of the skin with the amnion. In this case, Simonart's ligaments are formed - when the child tries to change position, they can wrap around him, causing severe injuries.

” Even when the baby is developing normally, oligohydramnios can significantly complicate the birth itself. The lack of amniotic fluid leads to the fact that the amniotic sac does not press on the cervix (a “flat” amniotic sac), its opening slows down or does not occur at all.

What tests should be done for oligohydramnios?

If there is a suspicion of leakage of amniotic fluid, a vaginal smear is made to reveal the content of amniotic fluid.

Suspicion of infectious diseases is supported by tests for the presence of viral and bacterial infections - first, the expectant mother must undergo at least a general blood test.

If it is known about the mother’s chronic diseases that can cause oligohydramnios, then tests are carried out that will reveal the degree of their exacerbation.

Finally, it is important to monitor the baby’s condition: for this purpose, the doctor may prescribe CTG (cardiotocography, showing both fetal heart contractions and uterine contractions), vascular Dopplerography and amnioscopy to assess the quality of the amniotic fluid.

How is oligohydramnios treated?

First of all, it should be noted that the amount of additional fluid the mother drinks does not in any way affect the amount of amniotic fluid. With moderate oligohydramnios, regular monitoring is important: if the situation worsens, the mother will most likely be asked to go to hospital. In addition to specific treatment related to diseases detected in a pregnant woman, general recommendations for oligohydramnios are as follows.

• Bed rest or reduced physical activity so as not to provoke increased leakage of amniotic fluid.
• Healthy nutrition, taking vitamins.
• Taking medications aimed at reducing uterine tone and improving blood microcirculation - they should compensate for the lack of placental nutrition associated with oligohydramnios.
• Prevention of the development of intrauterine infections.
• When pregnancy is carried beyond term, labor is initiated.

Oligohydramnios is not a disaster, although the mother may have to spend most of the pregnancy in a hospital. A positive attitude, compliance with medical recommendations and, most likely, the pregnancy will be successfully maintained until the due date, and the damage to the child’s health will be minimal.