Number of amniotic fluid. Amniotic fluid. Causes that can provoke pathology

Every woman who is expecting a baby should understand the importance of amniotic fluid, because they perform many useful and significant functions for life. There are pathologies that cannot be ignored.

The value of amniotic fluid is justified by their necessity for the normal development of the baby. This fact has been proven by many medical studies. Pathologies can lead to serious disturbances in the development of the fetus, so each makes it possible to control the condition and volume of amniotic fluid.

Having become pregnant, a woman must understand that the first element for a child is water. All 9 months of gestation, the fetus lives in the amniotic fluid. The baby develops there, grows, all organs and systems are formed in him. This environment is of great importance for the child.

Amniotic fluid satisfies the needs of the baby and carries data on the condition and immunity of the baby. Amniotic fluid during pregnancy has a very large list of renewal functions and the maintenance of immunity, necessary for both mother and child. That is why alarming symptoms that may indicate problems cannot be ignored.

Functions of amniotic fluid:

• The thermoregulatory function is necessary for the baby, because for the normal development of the child, the optimum temperature in the womb must be maintained - 37 degrees.
• Immune protection. The amniotic fluid contains all the necessary components for the development and protection of the baby.
• The mechanical function protects the baby from the influence of external factors. Thanks to it, a comfortable stay of the child in the womb is ensured.
• The umbilical cord protection function greatly softens shocks. Also, thanks to the amniotic fluid, the umbilical cord is protected from mechanical influences.
• Hermetic isolation from infections. Thanks to the liquid, the baby is under reliable protection.
• In the amniotic fluid there are also elements that do not allow the splicing of parts of the baby's body.
• The function of ensuring optimal development is no less important. Thanks to this, the baby grows, develops and receives all the necessary elements.
• Metabolic support.
• Formation of the circulatory system of the fetus.
• Prevention of bleeding.
• Due to the structure and composition of the amniotic fluid, it is facilitated.

Compound

About 97% of the amniotic fluid is water, it contains elements such as proteins, salts. Also present are skin particles, hair, and constituents called alkaloids. It is believed that the smell of the liquid is similar to breast milk.

For this reason, only a baby born into the world understands exactly where the mother's breast is, at the level and by smell. When it appears amniotic fluid, the child's kidneys begin to work, the defenses of the baby's body are updated.

Volume

By the end of gestation, the amount of water approaches one to one and a half liters, every 3 hours the liquid is renewed, while the third part is processed by the baby. There are pathologies in which the volume of amniotic fluid can be more than normal - polyhydramnios or less than normal - oligohydramnios. More on the reasons below.

Color

According to known norms, water in the womb should have a transparent light color. They should not contain any impurities. In another case, there may be a pathological process that can be harmful. In case of deviation from the norm, the water may become cloudy or green.

Diagnostic value

Amniotic fluid is not without reason considered a living environment, due to being in which the correct functioning of organs and systems is formed in babies. The kidneys begin their work due to the fact that the baby swallows water that is excreted in the urine (in the child's bladder, amniotic fluid appears already on).

After a while, the baby, in the likeness of a fish, begins to “breathe” with water, carrying out a significant exercise for his respiratory system, thereby preparing himself for breathing in an ordinary environment.

Also for diagnosis, amniotic fluid can be used to detect genetic diseases.

Pathologies

Polyhydramnios - one of the types of pathological processes during pregnancy. This condition is characterized by the fact that the amniotic fluid begins to exceed the norm in volume. The exact quantitative indicator of the fluid is determined by the doctor on ultrasound.

It was not possible to establish 100% causes of these problems. But at the same time, there are certain groups whose risk of getting a pathology is slightly higher than others:

• Chronic diseases in a pregnant woman, for example, diabetes, heart disease.
• Infections in any organs.
• - a large volume of water of one fruit often comes with an oligohydramnios of another.
• Large fruit size.
• Defects in the formation of the child.

With polyhydramnios, the following manifestations are characteristic: abdominal pain, shortness of breath, swelling of the limbs, too frequent pulse. The patient with such symptoms will need to go to the hospital and undergo a set of additional examinations.

The plan and duration of treatment depends on the cause of polyhydramnios. The patient may be prescribed vitamins, antibiotics, diuretics. During the treatment, the doctor controls the weight, pressure, temperature. Passage of cardiotography, ultrasound is prescribed. The general condition of the child and mother is kept under control, the doctor monitors the slightest changes in the patient's health.

There is another side of this pathology, called oligohydramnios . This condition is characterized by insufficient fluid volumes. Low water is a problem that any expectant mother can face.

Reasons that can provoke pathology:

• Complex congenital malformations of the kidneys in the fetus.
• Chronic diseases of the future mother, for example, diabetes, cardiovascular diseases.
• Infections in the genitals.
• The presence of bad habits in the expectant mother.
• The presence of viruses and infections, the transferred flu.
• The presence of a late
• Pathological changes in the placenta.
• Multiple pregnancy - when one embryo has little water, it often comes with polyhydramnios of the other.
• The time when the baby is worn longer (the placenta becomes obsolete, and the amount of water decreases).

A future mother who is faced with such problems may experience aching pains in the abdomen, the movement of the fetus becomes painful, the general condition worsens, and weakness may appear. An important symptom is high fever.

The woman is admitted to the hospital. All manipulations will be aimed at maintaining the baby and the expectant mother in a normal state. Thanks to special preparations and procedures, the health and condition of mother and child is normalized.

Pathology is also leakage . When water begins to leak prematurely, this can lead to serious consequences. The signs of this pathology include the fact that the amount of fluid released becomes much larger in the process of changing position. This is a rather dangerous process, so the patient must definitely contact the attending physician. Cause leakage of infection, presentation of the fetus and bad habits of the expectant mother.

Another pathology -green amniotic fluid not too rare. The cause of such waters may be a baby - when there is not enough oxygen, contraction of the anus may occur, which leads to the release of feces in the child. This gives the liquid a green tint and negatively affects the development of the baby, who swallows contaminated water.

So, amniotic fluid is a significant substance for a baby in the womb. There are pathologies when the rate of amniotic fluid during pregnancy is exceeded or reduced. The color, composition, volume of the liquid is also important - all this matters. Pathologies of this kind should be treated inpatients with the use of drugs and vitamins. For the patient, peace and regularity of life are important. Excessive activity and physical activity is contraindicated.

Useful video about the outflow of amniotic fluid

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Water is the natural environment for a developing fetus. In the process of formation, the baby swallows a liquid that is processed and poured back into the fetal bladder. The question arises: how amniotic fluid is renewed during pregnancy? Indeed, the composition includes many useful substances, the density does not change, and the child moves freely and is protected from overheating or hypothermia.

Functionality

• The exchange of substances between mother and child. The water contains nutrients that the baby swallows and then releases back, while there is a constant renewal.
• The fetal bladder and its contents serve as a kind of shock absorber for minor shocks, protect against infections and prevent clamping of the umbilical cord.
• There is no doubt about sterility, because amniotic fluid is renewed during pregnancy every three hours. The body constantly maintains the same composition, which can only change depending on the gestation period.
• During labor, amniotic fluid softens the period of contractions and promotes comfortable progress through the birth canal.

The contents of the shell is a transparent substance with an odor that resembles mother's milk. Many experts believe that it is precisely because of this property that the baby after birth accurately recognizes where the mother's breast is.

How and for what period amniotic fluid is renewed?

At the same time, the composition, which is unstable depending on the state of health of the mother, is very useful for the formation of the embryo. Here are the main components of nutrition (fats, proteins, carbohydrates), oxygen, immunoglobulin cells, as well as antigens. Since the baby lives in this substance, waste products (skin, hair) are not uncommon during tests.

Renewal of amniotic fluid during pregnancy occurs quite often - every three hours. The walls of the amnion secrete fluid, which is subsequently swallowed by the fetus, approximately 20 ml in 60 minutes. The exchange is carried out by suction, through special tubules or through the placental membrane with the umbilical cord.

The quantity and composition, depending on the period and individual characteristics of the organism, is constantly changing. On average, the volume reaches from 0.6 to 1.5 liters. An excess of this indicator indicates polyhydramnios, and an underestimated one indicates oligohydramnios. Any of these extremes is a deviation from the norm and requires treatment.

Pathologies of the development of amniotic fluid

1. Low water is characterized by the fact that the amnion is not updated in sufficient volume. A pregnant woman manifests a painful syndrome, since fetal movements occur in a smaller amount of fluid, while the size of the uterus does not correspond to the period of gestosis. Pathology threatens the normal formation of the child, a curvature of the spine may develop as a result of compression and an uncomfortable position.
2. Polyhydramnios is more common and is caused by an acute and chronic condition. In the acute form, the increase occurs very quickly, which can lead to the death of the fetus or, as a result of strong pressure, rupture of the uterus. The chronic form is characterized by a gradual increase in the volume of fluid, the uterus is in good shape and a “gurgling” is heard if you click on the stomach. The symptoms are quite bright, the woman feels pain, edematous reactions appear on the limbs. The baby begins to actively move in the womb, the heartbeat is practically not audible, and the function of nutrition and blood circulation is impaired.
3. Turbid fetal waters are diagnosed when ultrasound examination. The norm is a clear amniotic fluid, with a small amount of impurities of particles of skin and hair. On early dates this type of pathology is very dangerous, doctors often recommend terminating the pregnancy. In the second half of gestation, a change in state indicates the development of an infectious disease.

The detection of pathology in the early stages of gestation requires immediate treatment in a hospital, since the renewal of the composition during pregnancy should occur in accordance with generally accepted standards. At a late stage of gestation, a decision may be made to perform a caesarean section in order to save the life of the child.

Amniotic fluid. Volume of amniotic fluid. The amount of amniotic fluid. Functions of amniotic fluid.

amniotic fluid, or amniotic fluid, are the biologically active environment surrounding the fetus. Throughout pregnancy, amniotic fluid performs the most various functions, ensuring the normal functioning of the mother-placenta-fetus system. The amniotic sac appears at the 8th week of pregnancy as a derivative of the embryoblast. In the future, as the fetus grows and develops, a progressive increase in the volume of the amniotic cavity occurs due to the accumulation of amniotic fluid in it.

amniotic fluid is mainly a filtrate of the mother's blood plasma. In its formation, an important role also belongs to the secret of the amniotic epithelium. At later stages of intrauterine development, the kidneys and lung tissue of the fetus take part in the production of amniotic fluid.

Volume of amniotic fluid depends on the gestational age. The increase in volume is uneven. So, at 10 weeks of pregnancy, the volume of amniotic fluid averages 30 ml, at 13-14 weeks - 100 ml, at 18 weeks - 400 ml, etc. The maximum volume is noted by 37-38 weeks of pregnancy, averaging 1000-1500 ml. By the end of pregnancy, the amount of water may decrease to 800 ml. When pregnancy is prolonged (41-42 weeks), there is a decrease in the volume of amniotic fluid (less than 800 ml).

amniotic fluid characterized by a high exchange rate. At full-term pregnancy, about 500 ml of water is exchanged for 1 hour. A complete exchange of amniotic fluid takes place on average in 3 hours. During the exchange, 1/3 of the amniotic fluid passes through the fetus, which swallows approximately 20 ml of water in 1 hour. In the third trimester of pregnancy, as a result of the respiratory movements of the fetus, 600-800 ml of liquid per day. Up to 24 weeks of pregnancy, the exchange of amniotic fluid is also carried out through the skin of the fetus, and later, when keratinization of the epidermis occurs, the skin of the fetus becomes almost impermeable to the liquid medium.

The fetus not only absorbs the liquid medium surrounding it, but is itself the source of its formation. It has been proven that at the end of pregnancy, the fetus produces about 600-800 ml of urine per day. Fetal urine is an important constituent of amniotic fluid.

Amniotic fluid exchange occurs through the amnion and chorion. Along with this, an important role in the exchange of water belongs to the so-called paraplacental pathway, i.e. through the extraplacental part of the membranes.

At the beginning of pregnancy amniotic fluid are a colorless transparent liquid, which later changes its appearance and properties. From transparent, it becomes unclear due to the ingress of the separated sebaceous glands of the skin of the fetus, fluffy hairs, scales of desquamated epithelium, droplets of fat and some other substances into it. From a chemical point of view, amniotic fluid is a colloidal solution of complex chemical composition. The acid-base composition of the amniotic fluid changes during pregnancy. It should be noted that the pH of the amniotic fluid correlates with the pH of the fetal blood.

IN amniotic fluid in dissolved form, they contain oxygen and CO2, they contain all the electrolytes that are present in the blood of the mother and fetus. Proteins, lipids, carbohydrates, hormones, enzymes, various biologically active substances, and vitamins were also found in the amniotic fluid. Of great diagnostic importance is the detection of phospholipids in the amniotic fluid, which are part of the surfactant. For a physiologically proceeding full-term pregnancy, the optimal ratio between the concentration in the waters of lecithin and sphingomyelin, equal to 2, is characteristic (the concentration of lecithin is 2 times higher than the concentration of sphingomyelin). This ratio of these chemical agents is typical for a fetus with mature lungs. Under these conditions, they easily straighten out during the first extrauterine breath, thereby ensuring the formation of pulmonary respiration.

An important diagnostic value is also the determination of the concentration of a-fetoprotein in the amniotic fluid. This protein is produced in the liver of the fetus, and then, along with urine, enters the amniotic fluid. A high concentration of this protein indicates anomalies in the development of the fetus, mainly from the nervous system.

Along with this, the determination of the creatinine content in the amniotic fluid, which reflects the degree of maturity of the fetal kidneys, has a well-known diagnostic value.

IN amniotic fluid there are factors that affect the blood coagulation system. These include thromboplastin, fibrinolysin, and factors X and XIII. In general, amniotic fluid has relatively high coagulating properties.

amniotic fluid perform and important mechanical function. They create conditions for the implementation of free movements of the fetus, protect the body of the fetus from adverse external influences, protect the umbilical cord from compression between the body of the fetus and the walls of the uterus. The fetal bladder contributes to the physiological course of the first stage of labor.

All structures of the unified system "mother - placenta - fetus" take an active part in the formation and exchange of amniotic fluid: the mother's body; amnion (cells lining the fetal membrane); fetus (the kidneys of the fetus in the last stages of pregnancy produce an average of 600-800 ml of urine per day, which is released into the amniotic cavity, while in 1 hour the fetus swallows an average of 20 ml of water; the skin of the fetus up to 24 weeks of pregnancy is also involved in metabolic water processes, absorbing some of them until it becomes keratinized, after which the skin becomes impermeable to the amniotic fluid).

Compound amniotic fluid during pregnancy changes. If in the early stages the amniotic fluid in its chemical composition is similar to the plasma (liquid part of the blood) of the mother, then by the end of pregnancy it contains the urine of the fetus in large quantities. The amniotic fluid contains oxygen, carbon dioxide, electrolytes present in the blood of the mother and fetus, proteins, lipids, carbohydrates, enzymes, hormones, vitamins, biologically active substances, phospholipids, blood coagulation factors, epithelial cells desquamated from the skin of the fetus, vellus hair , secrets of the sebaceous glands of the fetus, droplets of fat, etc. The concentration of one or another component of amniotic fluid depends on the duration of pregnancy.

Volume amniotic fluid increases towards the end of pregnancy, reaching a maximum value at 38 weeks, then, closer to childbirth, it may decrease slightly. Normally, at 37-38 weeks of gestation, the volume of amniotic fluid is 1000-1500 ml, while at 10 weeks it was only 30 ml, and at 18 weeks - approximately 400 ml. With a post-term pregnancy, a decrease in the amount of amniotic fluid is noted, with various pathologies of pregnancy, a change in volume can occur both upward and downward.

Why is amniotic fluid needed?

Amniotic fluid not only provides the exchange of substances between the fetus and mother, but also performs the function mechanical protection You , protecting the fetus from external influences, also protecting the body of the fetus from being squeezed by the walls of the uterus and being a shock absorber in cases of mother's falls, that is, the amniotic fluid smooths out the push or blow transmitted to the fetus during blows to the stomach or falls. Of course, that the "degree of protection" in this case is not great, that is, when hitting a large force, the integrity of the fetal bladder can be broken.

The fetal bladder contributes to the opening of the cervix during childbirth, playing a role hydraulic wedge during the first stage of labor (during the opening of the cervix). It also protects the fetus from infection by being physiological barrier on the path of infection, which can enter the uterine cavity from the vagina and cervix.

Diagnostic methods using amniotic fluid

For the diagnosis of the course of pregnancy, the quantity, color, transparency of amniotic fluid, their hormonal, biochemical, cellular composition, etc. are of great importance. In the arsenal of doctors there are various diagnostic methods.

ultrasound. Much attention is paid to ultrasound amount of amniotic fluid , since a relationship was found between this parameter and the pathology of pregnancy: post-term pregnancy, preeclampsia (it is manifested by an increase in blood pressure, edema, the presence of protein in the urine), fetal hypoxia (a state of oxygen starvation of the fetus in the womb). The amount of water is estimated by the size of free areas of amniotic fluid (the so-called "pockets" or "packages").

Ultrasound can also assess homogeneity (uniformity) amniotic fluid.

The presence of suspended matter in the water most often indicates infection.

Amnioscopy. This is an examination of the lower pole of the fetal bladder and amniotic fluid using a special device that is inserted into the cervical canal through the vagina. Such a study allows you to evaluate the color of amniotic fluid and their amount. With fetal oxygen deficiency, the amniotic fluid becomes green due to the admixture of meconium (original feces). Amnioscopy is carried out, as a rule, at the end of pregnancy, when the cervix is ​​already preparing for childbirth and may miss the optical apparatus - the amnioscope.

Amniocentesis(from the Greek words "amnion" - the fetal membrane and "centesis" - piercing). This is a puncture (puncture) of the fetal bladder, the purpose of which is to take amniotic fluid for diagnostic studies: biochemical, hormonal, immunological, cytological, in order to have an idea about the condition of the fetus and determine the further management of pregnancy. The indications for this procedure are: rhesus conflict ; in this case, the content of bilirubin in the amniotic fluid is determined (it increases as the concentration of bilirubin secreted by the kidneys of the fetus increases, which serves as an indicator of the severity of the process); the study also determines the blood type of the fetus, the amount of antibodies to the Rh factor; suspected fetal chromosomal pathology; suspicion of chronic fetal hypoxia (oxygen deficiency); the need to determine the maturity of the lungs of the fetus when there is a question about early birth; this determines the concentration of phospholipids in the amniotic fluid and their ratio.

Amniocentesis is done under ultrasound control, through the anterior abdominal wall or the anterior or posterior fornix of the vagina: the puncture site is selected based on the location of the placenta. Before the operation, the bladder is emptied to avoid injury, the skin is treated with an antiseptic solution, local anesthesia is made with a novocaine solution, then the anterior abdominal wall, uterine wall and fetal bladder are punctured with a long thick needle; 15 ml of water is drawn into the syringe. The procedure is invasive (i.e. accompanied by a puncture of the abdominal wall, uterine wall, introduction into the uterine cavity), it can lead to various complications (mainly miscarriage or premature birth, amniotic fluid rupture, infection of the fetal membranes, injury to the fetal vessels and as a result of this - internal bleeding, injury of the bladder or intestines of the mother). In modern conditions, these complications are very rare, due to the introduction of ultrasound - control, compliance with the rules of asepsis and antisepsis.

Amniocentesis is not performed with the threat of miscarriage or premature birth, with the location of the placenta or myomatous node on the anterior abdominal wall, malformations of the uterus, the results of smears and bacterial cultures from the vagina and cervical canal, indicating the presence of an inflammatory process. After the operation, a therapeutic regimen is recommended for several days (up to 1 week), for prophylactic purposes, drugs that relax the uterus are prescribed, and if necessary, antibiotics.

oligohydramnios during pregnancy

Oligohydramnios is a reduction in the amount of amniotic fluid to 500 ml or less as a result of an imbalance between their absorption and production. Most often, this condition is observed in younger pregnant women with high blood pressure in the third trimester of pregnancy and in women with an increased risk of developing fetal malnutrition (lagging behind the size of the fetus from normal for a given period).

First of all, if you suspect oligohydramnios, it is necessary to exclude congenital malformations of the fetus, especially if it is detected in the second trimester (up to 28 weeks) of pregnancy, because sometimes severe oligohydramnios can be combined with such defects as polycystic kidney disease or their absence. Oligohydramnios, as well as polyhydramnios, can be a sign of intrauterine infection of the fetus, so it is necessary to conduct an examination for hidden

that infection. Oligohydramnios can occur against the background of a decrease in the excretion of urine by the fetus into the amniotic cavity during chronic hypoxia, which is observed with intrauterine growth retardation. In 40% of women with oligohydramnios, there is a lag in the size of the fetus from the norm. Due to a sharp decrease in the volume of amniotic fluid, compression of the umbilical cord (compression between the fetus and the walls of the uterus) may occur, which can lead to acute oxygen deficiency and fetal death; extremely rarely, adhesions (fusions) are formed between the walls of the uterus and the skin of the fetus.

Since the fetal bladder is “flat” in oligohydramnios, it does not perform the function of a hydraulic wedge, does not contribute to the opening of the cervix, as a result, there is a danger of weakness in labor activity. Due to the violation of the active motor movements of the fetus in the uterine cavity, the frequency of breech presentation increases, and, as a result, in some cases, caesarean section operations. More often, weakness of labor activity and intrauterine hypoxia of the fetus lead to operational childbirth with oligohydramnios. Oligohydramnios can be primary (observed with whole membranes) and secondary, or traumatic (as a result of damage to the membranes with a gradual outflow of water, which sometimes goes unnoticed by a woman: amniotic fluid is mistaken for whites).

Diagnosis of oligohydramnios is mainly based on an ultrasound examination. However, during the examination, the doctor may pay attention to the fact that the height of the fundus of the uterus and the circumference of the abdomen are behind normal for a given period of pregnancy, the motor activity of the fetus is reduced, the uterus is dense on palpation, parts of the fetus and heartbeat are clearly defined. During vaginal examination during childbirth, a “flat” fetal bladder stretched over the fetal head is determined.

If oligohydramnios is detected before 28 weeks of gestation, a comprehensive examination of the pregnant woman is carried out to determine the possible cause and assess the condition of the fetus. If fetal malformations are detected, pregnancy is terminated for medical reasons. When oligohydramnios is combined with intrauterine hypoxia and fetal growth retardation, appropriate therapy is carried out until 33-34 weeks of pregnancy, and if the treatment is ineffective and the fetus's condition worsens, early delivery. During childbirth, a “flat” fetal bladder is opened to prevent weakness of labor activity.

In severe forms of placental insufficiency and intrauterine fetal malnutrition, drip intra-amniotic administration of amino acid solutions is possible after preliminary removal of an amount of fluid equal to that administered. Attempts are also being made to paraplacental oxygenation of the fetus during childbirth to treat chronic fetal oxygen deficiency by introducing oxygenated amniotic fluid into the amniotic cavity. These methods have not yet found wide application and require further research.

Polyhydramnios during pregnancy

Not only a decrease in the amount of amniotic fluid is bad, but also its increase. Polyhydramnios is considered to be the volume of water exceeding 1500 ml. Most often it happens in multiple pregnancies, diabetes mellitus in the mother, Rh-conflict pregnancy, intrauterine infection, abnormalities in the development of the fetus.

With anomalies (malformations) of fetal development, the process of swallowing water by the fetus is disrupted, as a result of which the balance between their production and excretion changes. On examination, the height of the fundus of the uterus and the circumference of the abdomen exceed the normal for this period of pregnancy.

The fetus actively swims in the amniotic fluid, which can cause the umbilical cord to wrap around the neck and torso. If polyhydramnios is suspected, the doctor clarifies the diagnosis with the help of ultrasound, while excluding intrauterine infection, fetal malformations. Due to the strong stretching of the membranes with severe polyhydramnios, an untimely discharge of amniotic fluid may occur. Premature birth, premature detachment of a normally located placenta, prolapse of small parts of the fetus (handles, legs) and the umbilical cord during the outflow of water are also possible (therefore, after the outflow of water, a vaginal examination is mandatory). If fetal malformations that are incompatible with life are detected, an abortion is performed. If the cause of polyhydramnios was intrauterine infection, treatment is carried out taking into account the identified pathogen. Childbirth with polyhydramnios may be accompanied by weakness of labor activity due to a strong stretching of the uterus, resulting in a decrease in its contractility and excitability. Based on the foregoing, it often becomes necessary to open the fetal bladder. This is done very carefully, the water is released slowly, after which a vaginal examination is performed to exclude the prolapse of the arms, legs, umbilical cord loops. In the postpartum period, reducing drugs are introduced to prevent postpartum hemorrhage, since the overstretched uterus does not contract well.

How is the outpouring of water

Normally, amniotic fluid is poured out in the first stage of labor (until the cervix is ​​fully dilated, but not before the cervix is ​​4 cm dilated). At the height of one of the contractions, the bubble becomes tense and bursts. As a result, the anterior waters are poured out, which are located between the head of the fetus and the membranes of the fetal bladder. “Born in a shirt,” they say about children who were born with a whole fetal bladder. In modern conditions, if a woman gives birth not at home, but in a hospital, this is very rare (the exception is rapid labor), since if the cervical dilatation is complete, and the bladder is still intact, then obstetricians open it themselves: at birth "in a shirt" fetal membranes block the access of oxygen to the fetus. The outpouring of water before the onset of labor (before contractions) is considered prenatal or premature, and if the waters poured out with regular contractions, but with insufficient opening of the cervix, they talk about early outpouring of waters. In these cases, it is necessary to monitor the duration of the anhydrous period: it should not exceed 12 hours, since with a long anhydrous period, the likelihood of infection of the membranes, uterus, and fetus increases. Therefore, in the event of an outpouring of amniotic fluid at home, a woman must immediately go to the maternity hospital. With prenatal rupture of amniotic fluid, a glucose-vitamin-hormonal background is usually created; for this intravenous and intramuscular injection of glucose, vitamins, hormones that prepare the birth canal. If contractions do not start, labor induction is carried out with drugs intravenously using a dropper. In case of ineffectiveness of such therapy, a caesarean section is performed.

ABOUT high rupture of membranes they say when the fetal bladder breaks not in the lower pole, but above. If there is any doubt whether it is water or just liquid leucorrhea from the vagina (a typical situation with a high lateral rupture of the membranes), you need to go to your doctor, first placing a “control” diaper to show the nature of the discharge. In doubtful cases, a vaginal swab is taken for the presence of amniotic fluid or an amnitest is performed .

If the leakage of amniotic fluid is confirmed, but there are no contractions, the doctor decides on the further management of the pregnancy, depending on its duration. Until 34 weeks, obstetricians do everything possible to prolong the pregnancy, since the lungs of the fetus are immature and respiratory disorders may be found in the newborn after delivery. The woman is under constant supervision (body temperature is measured, a study of the content of leukocytes in the blood, a clinical blood test, ultrasound, CTG - a study of the cardiac activity of the fetus, a study of secretions from the genital tract for infections), expectant mother strict bed rest is prescribed in stationary conditions, if necessary, antibiotic therapy, drugs that accelerate the maturation of the lungs of the fetus. If there are no conditions for prolonging pregnancy, a surfactant is used to prevent and treat respiratory disorders in newborns. In the absence of signs of infection and a sufficient amount of water in the fetal bladder by ultrasound, pregnancy can be extended up to 34 weeks. If, as a result of the study, it is found that the uterus tightly covers the fetus, and there are no waters, it is impossible to wait more than 2 weeks even in the absence of signs of infection (however, this situation is extremely rare). With a period of 34 weeks or more, with leakage of water, a woman is prepared for the upcoming birth.

Thus, the amniotic fluid is not only the habitat of the baby, but also helps to diagnose various "malfunctions" during pregnancy. Your doctor will monitor their number and, in case of deviation from the norm, will take the necessary measures.

Amnitest is a method by which the presence of α-microglobulin, which is not normally found in the vagina, is determined in the discharge from the vagina.

A sterile tampon is placed in the vagina for 5-10 minutes, then the result is determined using the test strip by the express method. If there is placental α - microglobulin in the contents of the vaginal secretion, a control strip appears in the test strip window.

During pregnancy, the baby in the tummy bathes in the amniotic fluid. In addition to being more comfortable for the baby, and thanks to the waters he can move, they perform several more important functions:

Waters perform the function of shock absorption and protect the fetus from external influences (shocks and shocks);

The fluid protects the umbilical cord from compression between the body of the fetus and the walls of the uterus;

The lower pole of the fetal bladder, in which the so-called anterior waters (that is, located in front of the head of the fetus) are located, participates in labor activity, performing the function of a hydraulic wedge and contributing to the opening of the cervix;

The presence of amniotic fluid makes contractions less painful for both mother and fetus.

In the formation and maintenance of the amount of amniotic fluid (amniotic fluid), the fetal surface of the placenta and the fetal membranes, which can secrete and absorb water, as well as the fetus itself, which swallows the amniotic fluid and excretes urine, take part. Thus, the waters are constantly renewed. Fully exchange of amniotic fluid is carried out approximately every 3 hours.

Normally, the amount of amniotic fluid is 600-1500 ml. The maximum number is determined at 37-38 weeks, then it decreases slightly. With oligohydramnios, the amount of amniotic fluid is less than 500 ml, with polyhydramnios - more than 1.5-2 liters. Oligohydramnios is extremely rare, polyhydramnios - more often.

Causes of polyhydramnios and oligohydramnios:

The causes of polyhydramnios can be:

Infection (both sexually transmitted diseases and chronic infection in the mother's body);

Malformations of the fetus and chromosomal abnormalities of the fetus (most often with polyhydramnios, defects of the nervous and digestive systems are detected);

Maternal diabetes;

Rh-conflict pregnancy;

Feto-placental insufficiency;

Low water can occur when:

Post-term pregnancy;

infectious process;

Fetal malformations (with oligohydramnios, there are more often malformations of the excretory system and kidneys of the fetus);

Chronic hypoxia and fetal growth retardation, as it produces little urine;

Hypertension in the mother;

Feto-placental insufficiency;

smoking during pregnancy;

When detecting oligohydramnios, it is imperative to exclude a violation of the integrity of the fetal bladder and leakage of amniotic fluid.

Often the reasons that caused high or low water are more dangerous than the “wrong” amount of water in itself, so a thorough examination is always carried out to identify the cause.

Clinic of low and polyhydramnios

With polyhydramnios the size of the abdomen increases. Because of this, stretch marks occur more often, the venous pattern on the abdomen is strengthened. During the examination, the doctor can hardly feel the parts of the fetus, the heartbeat is heard indistinctly. The fetus easily changes its position (unstable position of the fetus). A woman with severe polyhydramnios may feel difficulty in breathing, heaviness, and increased heart rate.

With polyhydramnios, an incorrect position of the fetus is often observed: a transverse or oblique position, or a breech presentation. Excessive free movement of the fetus in a large amount of fluid can lead to entanglement of the umbilical cord around the neck or trunk of the fetus. Due to the strong stretching of the membranes, premature rupture of amniotic fluid and premature birth occur more often. Due to the strong stretching of the uterus, its contractile activity worsens, which can lead to weakness in labor activity. In severe cases, when there is a lot of water, due to the pressure of the enlarged uterus on the lungs and difficulty in breathing, the mother may experience hypoxia (lack of oxygen in the blood), which causes or aggravates fetal hypoxia.

With oligohydramnios the size of the abdomen is behind the norm. The motor activity of the fetus may decrease, as the baby is “cramped”. Sometimes the movements of the fetus can cause pain to the woman.

With oligohydramnios, a complication such as compression of the umbilical cord between the fetus and the walls of the uterus can occur, which can lead to acute oxygen deficiency and death of the fetus. Since with a small amount of water, the fetus is more strongly clamped in the uterus and its movement is difficult, the newborn often has a curvature of the spine, problems with the hip joints, torticollis, and clubfoot. If oligohydramnios appears already in the second trimester of pregnancy, intrauterine fetal death often occurs.

The lower pole of the fetal bladder with oligohydramnios is flat and cannot perform its function as a hydraulic wedge during childbirth; on the contrary, it delays the advancement of the head, so there is a weakness in labor activity.

Usually the amount of amniotic fluid is determined by ultrasound. According to ultrasound, such indicators as a vertical pocket (VC) and an amniotic fluid index (AFI) are determined. The vertical pocket is the maximum area of ​​free fluid between the fetus and the anterior abdominal wall. Normally, it is 5-8 cm. IAI is a more accurate indicator, it is the sum of the values ​​​​of vertical pockets in four quadrants of the uterus (the uterus is conditionally divided into 4 parts, and the maximum vertical pocket is measured in each). The norms of this index are different for each period of pregnancy (they may differ slightly on different devices). On average, IAI is normally 5-24 cm.

VK and IAI are not 100% methods for diagnosing poly- and oligohydramnios. Sometimes mistakes are possible.

Since both polyhydramnios and oligohydramnios can be signs of fetal developmental abnormalities, the anatomy of the fetus is especially carefully studied by ultrasound. If, in addition to the “wrong” amount of water, some other signs of chromosomal abnormalities are detected, the woman is sent for cordocentesis, a blood test from the umbilical cord, which determines the fetal genotype.

Treatment

Treatment is aimed at eliminating the cause that caused the change in the amount of water. Usually, complex therapy of feto-placental insufficiency is carried out, since both with oligohydramnios and polyhydramnios it almost always takes place.

If an infection is detected, antibiotic treatment is prescribed. With this pathology, antibiotic treatment can be prescribed even if no infection is detected (which often causes confusion among expectant mothers). The fact is that it is impossible to be examined for all existing microorganisms, and if the doctor does not see any other causes of polyhydramnios, treatment is carried out against the infection, since this is the most common cause of polyhydramnios.

If fetal malformations that are incompatible with life are detected before 28 weeks, the woman is offered an abortion.

If other causes are identified (increased maternal pressure, diabetes mellitus, Rhesus conflict, etc.), the underlying disease is treated.

An increase or decrease in the amount of fluid you drink does not affect the amount of amniotic fluid.

delivery

By themselves, polyhydramnios and oligohydramnios are not indications for caesarean section. If the fetus does not suffer and the position of the fetus is correct (longitudinal position, head presentation), childbirth is carried out through the natural birth canal.

In childbirth, both in oligohydramnios and in polyhydramnios, an amniotomy is indicated (instrumental opening of the fetal bladder). In case of oligohydramnios, the lower pole of the fetal bladder is opened, since its membranes are stretched over the fetal head and delay its advancement (flat fetal bladder), with polyhydramnios, a large amount of fluid stretches the uterus and interferes with its contractile activity, so some of the water must be released. With polyhydramnios, the amniotomy should be performed carefully, the water is released a little bit, otherwise, with a sharp outflow of water, there may be complications such as prolapse of the umbilical cord, fetal arms or legs, or placental abruption.

Even despite the ongoing amniotomy, with polyhydramnios and oligohydramnios, there is often a weakness in labor and prolonged labor, so you have to resort to stimulation of labor, and if stimulation is ineffective, a caesarean section.

With polyhydramnios, due to poor contraction of the uterus, the risk of bleeding in the postpartum period is increased. For prevention, contracting drugs (oxytocin, methylergometrine) are prescribed.

Early delivery is resorted to in cases of impaired fetal condition according to ultrasound, CTG and dopplerometry and the ineffectiveness of the therapy for several days.

As they say, everything is good in moderation. And amniotic fluid is no exception. Therefore, with the “wrong” number of them, it is necessary to undergo examination and treatment.