Norms of the amniotic fluid index by week. Causes, diagnosis and treatment of oligohydramnios in pregnant women. What is the rate of the amniotic fluid index: a description by week Amniotic fluid rate at 33 weeks of gestation
The entire period of intrauterine development, the child spends in the fetal bladder filled with amniotic fluid or amniotic fluid.
Amniotic fluid, which has a complex chemical composition, is necessary for the normal life and development of the fetus, it protects the unborn child from infections and external influences, and ensures freedom of movement.
The composition and amount of amniotic fluid are constantly changing throughout pregnancy, the maximum volume of fluid inside the fetal bladder is reached by 32 weeks, then gradually decreases and by the end of pregnancy is about 1.5 liters.
To assess the amount of amniotic fluid, the amniotic fluid index is used, which is determined during an ultrasound examination by summing up the four values of the amniotic space on the monitor, the vertical size of the amniotic fluid, measured in mm, is displayed in black. To obtain these data, during the examination, the uterus is conditionally divided into 4 squares, the largest space in each of them is measured, then the obtained indicators are summarized.
Below is a table of the norm of the amount of amniotic fluid for different periods of pregnancy. If the amniotic fluid index goes beyond the upper limit of these norms, then, in accordance with the gestational age, the doctor speaks of polyhydramnios. If this index slightly exceeds the norm, then it is customary to talk about moderate polyhydramnios during pregnancy.
Table of norms of amniotic fluid at different stages of pregnancy
Pregnancy period, weeks | Average normal indicator, mm | Probable fluctuations, mm |
Amniotic fluid index at different stages of pregnancy
Gestational age, | Amniotic fluid index, mm |
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percentile |
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You need to focus on the middle column of the 50th percentile, the 2.5th shows the lower, and the 97.5th shows the upper limits of the norm. That is, if the vertical value of amniotic fluid is slightly higher than the 97.5 percentile, this indicates moderate polyhydramnios.
For the diagnosis of polyhydramnios, an ultrasound examination, doplerometry, examination by a doctor are carried out, and to confirm the diagnosis, it is carried out.
Causes
There are several reasons why moderate polyhydramnios develops. These include:
- - large fruit;
- - multiple pregnancy (two or more fetuses);
- - Rh-conflict of mother and fetus;
- - the presence of a woman with chronic diseases;
- - intrauterine infections;
- - various pathologies of fetal development (including genetic ones);
- - late toxicosis ()
- - placental disorders;
- - diabetes mellitus in a pregnant woman;
- - anatomical features of the structure of the uterus.
In general, the causes of moderate polyhydramnios have not been fully studied to date.
signs
Even before the examination and examination, a woman may suspect moderate polyhydramnios for the following signs:
- - swelling;
- - increased heart rate;
- - heaviness and pain in the abdomen;
- - the circumference of the abdomen along the navel increases sharply and reaches 100-120 cm;
- - weakness and general malaise;
- - shortness of breath, which is a consequence of the high standing of the fundus of the uterus and the pressure of the diaphragm on the lungs.
If you suspect that you have developed even moderate polyhydramnios, a pregnant woman should contact her doctor in order to establish an accurate diagnosis and conduct timely treatment, which can be either outpatient or inpatient. It necessarily includes the appointment of vitamin preparations, diuretics and antibiotics. The process is usually simple and treatment is prescribed after establishing the cause of the development of this pathology. And it is necessary to carry it out, since polyhydramnios can have serious consequences for the child:
- - rupture of membranes and premature birth;
- - cord entanglement (including multiple) and complicated childbirth (weak labor activity) and others.
But with timely and adequate treatment under the supervision of a doctor observing the pregnancy, moderate polyhydramnios is not so dangerous and does not carry the described consequences.
AFI - amniotic fluid index is an important indicator of fetal development. By controlling these indicators, various pathologies in the fetus can be prevented in advance.
The amniotic fluid index is determined in 2 ways:
1. Subjectively (visual inspection)
2. With the help of ultrasound.
If a large amount of fluid is determined between the abdominal wall and the fetus, then the specialist diagnoses polyhydramnios, if not enough - oligohydramnios.
At different stages of pregnancy, the amniotic fluid changes its chemical composition. At the beginning of pregnancy (first trimesters), it is transparent, but over time, towards the end of pregnancy, it becomes cloudy. Based on the color change, many pathologies can be detected, such as sepsis, fetal hypoxia, and bleeding.
To measure the amniotic fluid index, the doctor divides the uterine cavity into equal four parts. In each part defines the pocket with the maximum amount of liquid. All the indicators made are summarized and the same amniotic fluid index is obtained.
If you already have indicators, you can enter your data into the calculator and then compare them with the norms in the table.
Table of norms for weeks during pregnancy
The amniotic index during pregnancy, its norm for each of the weeks of pregnancy are shown in the table.| week of pregnancy | Average rate, mm | Possible fluctuations, mm |
|---|---|---|
| 16 weeks | 121 | 73-201 |
| 17 weeks | 127 | 77-211 |
| 18 weeks | 133 | 80-220 |
| 19 weeks | 137 | 83-225 |
| 20 weeks | 141 | 86-230 |
| 21 weeks | 143 | 88-233 |
| 22 weeks | 145 | 89-235 |
| 23 weeks | 146 | 90-237 |
| 24 weeks | 147 | 90-238 |
| 25 weeks | 147 | 89-240 |
| 26 weeks | 147 | 89-242 |
| 27 weeks | 156 | 85-245 |
| 28 weeks | 146 | 86-249 |
| 29 weeks | 145 | 84-254 |
| 30 weeks | 145 | 82-258 |
| 31 weeks | 144 | 79-263 |
| 32 weeks | 144 | 77-269 |
| 33 weeks | 143 | 74-274 |
| 34 weeks | 142 | 72-278 |
| 35 weeks | 140 | 70-279 |
| 36 weeks | 138 | 68-279 |
| 37 weeks | 135 | 66-275 |
| 38 weeks | 132 | 65-269 |
| 39 weeks | 127 | 64-255 |
| 40 week | 123 | 63-240 |
| 41 weeks | 116 | 63-216 |
| 42 weeks | 110 | 63-192 |
During the first pregnancy, many are faced with such a concept as the amniotic fluid index, abbreviated AFI. To fully understand what it is and how important it is to adhere to the IAI standards, it is necessary to consider all aspects of this issue.
Ultrasound amniotic
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Amniotic fluid is the official name for the amniotic fluid in the womb of a pregnant woman, which provides the biological environment for the normal development of the baby.
The main functions of the biological environment.
- Child nutrition. The composition of amniotic fluid contains many necessary and beneficial substances for the fetus. During maturation, they enter the child's body by absorption through the skin. As the degree of maturity, the baby begins to independently consume the required amount.
- Ensuring normal pressure as well as temperature.
- Protection of the fetus from external environmental factors.
- The composition of amniotic fluid includes the required amount of immunoglobulin fractions, which create a sterile barrier, preventing infections. This is due to the fact that amniotic fluid has the ability to constantly renew itself, the process will stop after childbirth.
- An important factor is the complete sealing of the bladder, as well as the movement of the fetus in space.
Table of values
Various modulations of the norms of the index of AF-amniotic fluid by weeks indicates the development of an anomaly or pathology in the fetus. To avoid adverse situations, pregnant women need to be constantly examined.
Checking with a gynecologist
For the correctness of the diagnostic results, doctors carry out a number of preparatory measures.
- Analysis of the cytological and biochemical composition of amniotic fluid.
- Checking transparency, shade AJ.
- Accounting for the contained hormones.
- Checking, studying the volume. The gestational period affects the volume of amniotic fluid, which is calculated relative to the trimesters of pregnancy.
There is a special table that lists the norms of the index of AF-amniotic fluid by week in mm.
| Pregnancy (weeks) | Lower limit of normal | Average value | Upper limit of normal |
| 16 | 73 | 121 | 201 |
| 17 | 77 | 127 | 211 |
| 18 | 80 | 133 | 220 |
| 19 | 83 | 137 | 225 |
| 20 | 86 | 141 | 230 |
| 21 | 88 | 143 | 233 |
| 22 | 89 | 145 | 235 |
| 23 | 90 | 146 | 237 |
| 24 | 90 | 147 | 238 |
| 25 | 89 | 147 | 240 |
| 26 | 89 | 147 | 242 |
| 27 | 85 | 156 | 245 |
| 28 | 86 | 146 | 249 |
| 29 | 84 | 145 | 254 |
| 30 | 82 | 144 | 258 |
| 31 | 79 | 144 | 263 |
| 32 | 77 | 143 | 269 |
| 33 | 74 | 142 | 274 |
| 34 | 72 | 140 | 278 |
| 35 | 70 | 138 | 279 |
| 36 | 68 | 135 | 279 |
| 37 | 66 | 132 | 275 |
| 38 | 65 | 127 | 269 |
| 39 | 64 | 123 | 255 |
| 40 | 63 | 116 | 240 |
| 41 | 63 | 110 | 216 |
| 42 | 63 | 110 | 192 |
As can be seen from the table, the calculation principle is quite simple. For example, you need to know the rate of the amniotic fluid index at 19 weeks of pregnancy. The values in the table show 83-137-225 where the first value is the minimum, followed by the average and then the maximum allowed.
At 20-21 weeks, the lowest limit of the AF index - amniotic fluid is 86-88, this is a deviation from the norm. With such indicators, you should be observed by a doctor.
There are two ways to diagnose IAI.
- Subjective: examination with ultrasound, when longitudinal and transverse scanning is performed.
- Objective: the diagnostician, using the method of certain calculations, summarizes 4 indicators that determine the amniotic fluid index by week in cm. At week 16, it amounts to a value of 12 cm.
This is what a baby looks like in the womb
Additionally, the size of the amniotic fluid pocket is diagnosed, which is determined in two perpendicular planes. An additional test analysis is possible, which is carried out at 16-18 weeks.
Such an analysis is useful for the timely detection of anomalies, pathologies in the development of the fetus or placenta. After diagnosing the body of a pregnant woman, doctors take the necessary measures. In rare acute cases, termination of pregnancy is recommended.
Possible risks when a problem is discovered
The discrepancy between the norms of the amniotic fluid index by week of pregnancy indicates the occurrence of polyhydramnios or oligohydramnios in a woman. The manifestation of such conditions is quite dangerous, even threatens with serious complications.
Dangers with polyhydramnios:
- placental abruption is possible;
- development of infection of the birth canal;
- violation of the development of the fetus;
- possible miscarriage.
Most often, oligohydramnios is detected after 26-30 weeks or when overdue at 41 weeks. In addition, oligohydramnios threatens with serious diseases of the fetus.
Ultrasonography
If the index of AF-amniotic fluid at 31 weeks is 66, with an average value of 14 cm at 31 weeks, then you need urgent specialist intervention.
Dangers with oligohydramnios:
- disorders of the respiratory, genitourinary system;
- hypodynamics and pressure on the fetus, which can cause various anomalies: changes in the weight of the fetus, dislocations, deformities of the bones, spine;
- the occurrence of hypoxia;
- the possibility of premature miscarriage;
- risk of bleeding after childbirth.
Excess amniotic fluid (polyhydramnios) is detected in 1 to 3% of women in labor. For example, at week 34, your IAI is more than 278 units, this indicates a critical level of amniotic fluid. The causes of polyhydramnios are influenced by the presence of certain factors.
From the mother's side:
- Rh factor, blood type;
- the presence of diabetes;
- the presence of infections or inflammatory processes in the body.
According to the analysis of the placenta:
- in the event of a benign tumor of the fetal membrane;
- with placental edema.
Fetal diagnosis:
- multiple pregnancy;
- hereditary pathologies or diseases.
Causes of oligohydramnios:
- abnormalities of the fetus inside the womb;
- various pathologies: infections, chromosomal abnormalities, poor fetal development, etc.;
- the presence of diseases in a woman: problems with the heart, blood vessels, inflammatory and infectious symptoms, kidney disease;
- placental insufficiency, defects, heart attack;
- gestation of the fetus;
- placental abruption;
- premature death of the child inside the womb.
People in white coats
Polyhydramnios is of a different nature.
- In a moderate condition, the size of the inner pocket is from 7 cm to 18.
- With pronounced polyhydramnios, the value manifests itself in the range from 18 to 24 cm.
- In chronic, the rate is slightly higher, but stable.
- In borderline and acute conditions, the index value varies between the average and the highest. In this case, inpatient treatment is recommended.
- With an acute excess of fluid, specialists will prescribe an amniotomy, with a chronic one - a complex therapeutic treatment.
These recommendations also apply to oligohydramnios, with acute symptoms, a pregnant woman will be offered inpatient treatment. For example, your amniotic fluid index is 5 5, which indicates critical oligohydramnios, which can be a threat to the life of the fetus.
- everyone, without exception, is prescribed Curantil, Actovegin;
- minimum physical activity;
- healthy diet, diet in combination with a vitamin complex;
- preventive treatment for insurance against the formation of infectious and inflammatory processes;
- when overwearing - stimulation of childbirth.
As the baby grows
In traditional treatment, antibiotics are usually used to restore hypodynamic functions. For various infections, immunomodulators are prescribed. Diuretics are required.
Optimal Treatment
The optimal treatment is determined individually for each pregnant patient, taking into account the diagnosis, characteristics and cause of the problem.
Let's say you are 32 weeks pregnant and your amniotic fluid index is 77. This means that you have borderline oligohydramnios.
Polyhydramnios and oligohydramnios are far from a tragedy, but with oligohydramnios, you will have to spend most of your time in hospital.
With proper medication and strict adherence to the doctor's recommendations, the level of polyhydramnios will decrease, and the value of oligohydramnios will increase to the desired numbers. In this case, your AF index - amniotic fluid will be kept at a stable value.
Good mood, positive emotions, positive attitude, strict adherence to all recommendations of doctors guarantees minimal risk to the health of the mother and the normal development of the child.
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Attention!
The information published on the site is for informational purposes only and is intended for informational purposes only. Site visitors should not use them as medical advice! The editors of the site do not recommend self-medication. Determining the diagnosis and choosing a treatment method remains the exclusive prerogative of your doctor! Remember that only a complete diagnosis and therapy under the supervision of a doctor will help to completely get rid of the disease!
Throughout pregnancy, amniotic fluid performs a wide variety of tasks, ensuring the normal functioning of the "mother - placenta - fetus" system. The successful outcome of pregnancy largely depends on the quantity and quality of amniotic fluid.
Amniotic fluid (that's the "scientific" name for amniotic fluid) is basically a filtrate from the mother's plasma (the liquid part of the blood). In its formation, an important role is also played by the secretions of cells lining the fetal bladder from the inside. The fetus not only absorbs the liquid medium surrounding it, but is itself a source of its formation, since at later stages of intrauterine development, the kidneys and lung tissue of the fetus take part in the production of amniotic fluid. It has been proven that at the end of pregnancy every day the fetus secretes about 600-800 ml of urine, which is an important part of the amniotic fluid.
The volume of amniotic fluid depends on the duration of pregnancy. The increase in volume is uneven. In, in, the amount of amniotic fluid is on average 30 ml, in - about 100 ml, in - 400 ml, etc. The maximum volume is noted to, averaging 1000-1500 ml. By the end of pregnancy, the amount of water may decrease to 800 ml as a result of increased excretion of fluid from the woman's body.
Amniotic fluid performs a number of important functions. They create conditions for the free movement of the fetus, protect its body from adverse external influences, protect the umbilical cord from compression between the body of the fetus and the walls of the uterus. Thus, the volume of amniotic fluid is a kind of indicator of the normal course of pregnancy.
What is low water?
Diagnosis of oligohydramnios
The doctor can suggest a decrease in the amount of amniotic fluid when the standing height of the uterine fundus (its uppermost part) and abdominal circumference lag behind the normative indicators for the expected gestational age, as well as when the fetal motor activity decreases. With an external examination, parts of the fetus are clearly defined, heart tones are heard, and the uterus is dense. A more accurate determination of the severity of oligohydramnios is possible with ultrasound.
The diagnosis of oligohydramnios on ultrasound is based on determining the amount of amniotic fluid and on the calculation of the amniotic fluid index (AFI), which is automatically calculated by the ultrasound machine after measuring the amount of water in several places. The amount of amniotic fluid is considered normal if the IAI value is in the range of 5 to 8 cm; IAI from 2 to 5 cm is regarded as moderate oligohydramnios, IAI less than 2 cm as pronounced oligohydramnios.
A Doppler study of blood flow in the "mother - placenta - fetus" system, which is performed in the umbilical artery, in the middle cerebral artery of the fetus and in both uterine arteries of pregnant women, is also necessary, because. with oligohydramnios, there may be a violation of blood flow.
As the amount of amniotic fluid decreases, the frequency of pronounced forms of fetal growth retardation (hypotrophy) increases, determined using ultrasonic fetometry - the most reliable objective method for assessing the growth and development of the fetus, which allows at each specific gestational age to accurately determine the correspondence of the size of the fetus to this period, as well as the degree their deviations from the norm. At the I degree of malnutrition, there is a lag of fetometry indicators from the normative indicators by , at II - by , at III - by more than . In newborns born from mothers with severe oligohydramnios, signs of malnutrition of varying degrees are more often noted. Sometimes, with severe oligohydramnios, premature "ripening" of the placenta is detected (a condition in which the placenta begins to "prepare" for childbirth earlier than necessary, as a result of which its functions are impaired), which leads to a deterioration in the condition of the fetus. In most pregnant women with oligohydramnios, Doppler examination of the state of blood flow shows changes in its parameters. To clarify, cardiotocography (CTG) - registration of the fetal heartbeat - is a modern method for diagnosing the intrauterine state of the fetus, which is carried out after 32 weeks of pregnancy.
There are also primary oligohydramnios, which develops with intact membranes, and secondary, or traumatic, associated with damage to the membranes and the gradual outflow of amniotic fluid - a woman may not feel this. Elements of amniotic fluid can be detected when examining vaginal discharge; the so-called amniotest is the most effective and fastest method for diagnosing premature rupture of the membranes, based on the determination of placental protein in the vaginal discharge. Normally, this protein is not present in the vaginal discharge. If the outflow of water is significant, the woman feels discomfort from the fact that her underwear periodically becomes wet from the water. In case of detection of amniotic fluid leakage (premature rupture of the membranes) during premature pregnancy, the woman needs to be hospitalized in a separate room, bed rest and mandatory monitoring of the health of the mother and fetus to decide on further management of the patient. If the pregnancy is full-term, then in the absence of contractions, labor stimulation begins.
What is low water?
There are two forms of oligohydramnios:
- early, which is due to functional insufficiency of the fetal membranes. This form is diagnosed using ultrasound at term;
- late, usually detected after, when oligohydramnios occurs due to insufficient functional activity of the membranes or violations of the fetus.
Why is low water dangerous?
An extremely unfavorable prognostic sign is the detection of severe oligohydramnios in the second trimester of pregnancy, i.e. on deadlines. With the development of oligohydramnios during these periods, abortion occurs, intrauterine death of the fetus or newborn in the first days of life. During this period, the body of the fetus is not yet adapted to independent extrauterine existence, and special equipment is needed to maintain the life of the newborn, however, the earlier the abortion occurs, the more unfavorable the prognosis.
As mentioned above, an insufficient amount of amniotic fluid, especially pronounced oligohydramnios, is a marker of an unfavorable course of pregnancy. If there is a suspicion of the development of oligohydramnios, it is necessary first of all to exclude fetal malformations (using ultrasound), since the relationship between these pathologies has been proven. But oligohydramnios itself (its pronounced forms) can lead to the development of intrauterine malformations (the occurrence of adhesions between the skin of the fetus and the water membrane, which lead to entanglement of parts of the fetus and the umbilical cord and prevent the normal growth and development of the fetus). With a decrease in the amount of amniotic fluid, there is a high risk of compression of the umbilical cord and intrauterine death of the fetus, as well as its intrauterine infection. All of these complications often dictate the need for an early delivery by caesarean section at any stage of pregnancy if there is a risk to the woman's health.
With moderate oligohydramnios, quite often children are born with malnutrition of varying severity (discrepancy between the size of the newborn and the given gestational age). But at the same time, the outcome of pregnancy is favorable for the vast majority of women - children are born in a satisfactory condition.
Management of pregnancy and childbirth with oligohydramnios
The tactics of conducting pregnancy and childbirth largely depends on the time of occurrence and the severity of oligohydramnios. If oligohydramnios is detected before, then the woman needs a comprehensive examination (hormonal, biochemical, ultrasound) to determine the condition of the fetus. If fetal malformations are detected, the pregnancy is terminated for medical reasons. If oligohydramnios is detected at the beginning of the third trimester of pregnancy, in combination with intrauterine growth retardation of the fetus, the outcome of pregnancy is difficult to predict. In this regard, with oligohydramnios, especially combined with intrauterine growth retardation of the fetus, early delivery is carried out after.
Pregnant women with oligohydramnios are prescribed complex therapy aimed at improving uteroplacental blood flow, metabolic processes in the placenta, restoring gas exchange in the "mother - placenta - fetus" system and treating the underlying disease. During treatment, every 7-10 days, ultrasound is performed, once every three days - dopplerography of the vessels in the "mother - placenta - fetus" system and daily - cardiomonitor monitoring of the fetus. If there is no result of outpatient treatment or if the condition of the fetus worsens, hospitalization is necessary for constant monitoring and determination of further tactics for managing pregnancy.
If the condition of the fetus worsens according to cardiotocography and indicators of fetal-placental blood flow, delivery is performed by caesarean section on an emergency basis.
If a flat is found during childbirth, when there is no amniotic fluid in front of the baby's head or there are few of them, as a result of which the fetal bladder does not wedged into the cervix during childbirth, an amniotomy is performed (artificial opening of the fetal bladder). This is necessary for the further development of labor activity, because. a flat fetal bladder delays the normal course of labor activity - the opening of the cervix.
Thus, the health of the unborn child with oligohydramnios depends on the degree of decrease in the amount of amniotic fluid, the severity of intrauterine fetal retention, the duration of pregnancy, the effectiveness of the therapy and the method of delivery.
Polyhydramnios
Polyhydramnios is a condition characterized by excessive accumulation of amniotic fluid. With polyhydramnios, the amount of amniotic fluid exceeds 1.5 liters and can reach 2-5 liters, and sometimes more. The causes of polyhydramnios are not fully understood, but more often polyhydramnios is observed in diabetes mellitus (a disease in which glucose metabolism is impaired), the presence of an acute or chronic infectious process in the mother, (the presence of a positive Rh factor in the mother and a negative in the fetus, the development of antibodies to fetal erythrocytes), multiple pregnancy, fetal abnormalities.
One of the reasons for the occurrence of polyhydramnios is a violation of the function of the cells lining the inner surface of the aqueous membrane of the fetus, which leads to an increase in the production of amniotic fluid and a delay in their excretion. It is assumed that in this case, infectious (including viral) diseases of the pregnant woman (mycoplasmosis, cytomegalovirus infection, syphilis, acute respiratory diseases) are of great importance. As already mentioned, polyhydramnios often accompanies fetal malformations. With malformations, the amniotic fluid is not swallowed by the fetus - this is the main mechanism that regulates the amount of amniotic fluid and thereby prevents polyhydramnios. The most common malformations in polyhydramnios are congenital malformations of the central nervous system and gastrointestinal tract of the fetus.
There are acute and chronic polyhydramnios. Chronic develops gradually, so a pregnant woman has time to adapt to this condition and, as a rule, does not experience discomfort from an increase in the uterus. Acute polyhydramnios occurs quickly, and in this case, the pregnant woman complains of shortness of breath (due to the high standing of the diaphragm), general weakness, increased heart rate, and swelling. As a rule, acute polyhydramnios develops in earlier stages of pregnancy - in. Unlike acute polyhydramnios, in chronic intrauterine pressure does not exceed the norm. If fetal malformations are excluded, foci of infection are treated, as well as prevention of further progression of polyhydramnios, then the state of the fetus does not suffer under these conditions and the baby is born healthy.
Diagnosis of polyhydramnios
With the development of polyhydramnios, there is a significant increase in the size of the uterus: the circumference of the abdomen and the height of the fundus of the uterus (the distance from the womb to the bottom of the uterus) significantly exceed those of the expected gestational age. The uterus is tense, parts of the fetus are difficult to feel, while the fetus easily changes its position, and its excessive motor activity can be observed. Fetal heart sounds are not clearly audible.
In the diagnosis of polyhydramnios, an important role belongs to ultrasound. During the study, the size of the vertical pocket is determined (ultrasonic criterion for assessing the amount of amniotic fluid): with a mild degree of polyhydramnios, its value is 8-11 cm, with an average degree - 12-15 cm, with severe polyhydramnios this figure reaches 16 cm or more. If the diagnosis of polyhydramnios is established, then it is necessary to exclude the presence of possible fetal malformations using additional research methods, in particular amniocentesis - taking a small amount of amniotic fluid (by puncturing the anterior abdominal wall, uterine wall) for biochemical, hormonal, immunological, genetic research. Of great diagnostic importance is the determination of the concentration of alpha-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 alpha-fetoprotein indicates anomalies in the development of the fetus, mainly from the nervous system. Amniocentesis is always performed under ultrasound guidance. The most important information about the condition of the fetus can be given by the results of a direct study of its blood obtained by taking it from the umbilical cord (cordocentesis). This procedure is carried out strictly according to the indications, which are the diagnosis of congenital and hereditary pathologies, intrauterine infection, etc. Cordocentesis is performed after 18 weeks of pregnancy under ultrasound control.
Why are we so calm and relaxed when we are in water, or when water flows smoothly over our body? Have you ever thought that water makes us feel comfortable and carefree precisely because you were surrounded by water while in the womb? Water subconsciously connects us with the closest person - with mom, because the entire intrauterine period we were in water - amniotic fluid.
Amniotic fluid is a protective shield for the baby, which protects it and the umbilical cord from mechanical influences, infections, lowers the noise level, always keeps the fetus at the right temperature (subject to the mother's normal temperature), and also performs the function of nutrition (in the early stages - through the skin, or swallowing, starting from) , while simultaneously training the digestive and respiratory systems of the fetus during pregnancy.
Amniotic fluid includes fluff hairs, epidermal cells, and original lubricant. It is updated every 3-4 hours. Amniotic fluid comes out of the bladder in a few hours or during childbirth due to rupture of the amniotic bladder or its puncture for. But for some women, it happens long before the onset of labor.
Amnioscopy
This is a procedure that reveals a violation of the composition of amniotic fluid. It is carried out after pregnancy or, if necessary, with. Indications for carrying out may be a conflict between the Rh factor of the mother and the child, suspicion of hypoxia or fetal death, suspicion of chronic fetal hypoxia; prolongation of pregnancy, diabetes mellitus or maternal hypertension. Contraindications for carrying out: inflammation of the cervix, vaginal walls or fetal membranes; placenta previa.
Important! If you feel that you are leaking amniotic fluid or, as many people think, that you simply did not have time to go to the toilet, see a doctor. Leakage can occur due to cracks in the amniotic sac, and this is fraught with intrauterine infection.
Amniocentesis
Amniocentesis is performed to detect defects or genetic diseases. The procedure is carried out by examining the chromosomes of the fetus to exclude / identify diseases associated with the number or quality of chromosomes (for example, Down syndrome), as well as by examining the cells in order to find out if a genetic disease has been transmitted to the child. This amniotic fluid test is given to women who are diagnosed with problems during an ultrasound scan or as a result of their first or “second screening” and who are at risk of inherited diseases.
There are two types: early 10-14 weeks and late 17-20 weeks.
Did you know? Amniocentesis can detect up to 200 gene mutations and diseases in the fetus.
ultrasound
There are several ways to study amniotic fluid, but only ultrasound (ultrasound diagnostics) is a method that does not require penetration into the amniotic sac. With the help of ultrasound, the doctor will determine the amount of amniotic fluid, and determine: normal, low or high water. This is called the amniotic fluid index (AFI).
Norms of the amniotic fluid index by week of pregnancy
Every week the amount of amniotic fluid changes. With the amount of water increases and grows up to . From this point on, the IAI has been decreasing.
| A week | Lower value (mm) | Upper value (mm) | Average value (mm) |
| 16 | 72 | 201 | 121 |
| 17 | 77 | 212 | 127 |
| 18 | 80 | 221 | 133 |
| 19 | 83 | 231 | 137 |
| 20 | 85 | 230 | 141 |
| 21 | 88 | 233 | 143 |
| 22 | 89 | 235 | 145 |
| 23 | 90 | 237 | 146 |
| 24 | 90 | 238 | 147 |
| 25 | 89 | 240 | 147 |
| 26 | 89 | 243 | 147 |
| 27 | 85 | 245 | 156 |
| 28 | 86 | 249 | 146 |
| 29 | 84 | 254 | 145 |
| 30 | 82 | 259 | 145 |
| 31 | 79 | 263 | 144 |
| 32 | 77 | 269 | 144 |
| 33 | 74 | 274 | 143 |
| 34 | 72 | 278 | 142 |
| 35 | 70 | 280 | 140 |
| 36 | 68 | 278 | 138 |
| 37 | 66 | 275 | 135 |
| 38 | 65 | 268 | 132 |
| 39 | 64 | 254 | 127 |
| 40 | 63 | 240 | 123 |
| 41 | 63 | 216 | 116 |
| 42 | 63 | 192 | 110 |
But do not sound the alarm if the norms of your amniotic fluid indicators differ by weeks from the data in the table. Do not rush to draw conclusions on your own, contact your gynecologist.
oligohydramnios
Such a diagnosis occurs only in 1-4% of cases. This means that the pregnancy proceeds with deviations.
Causes of oligohydramnios
- Multiple pregnancy.
- Obesity, smoking or other bad habits in the expectant mother.
- Bacterial, viral infections.
- Chronic diseases of the mother (diabetes mellitus, diseases of the cardiovascular system, etc.).
- Venereal infectious diseases.
- Pathology of the placenta.
- Postponed pregnancy.
Oligohydramnios negatively affects the physical development of the fetus, it is less protected from the mechanical influences of the outside world, the internal organs of the mother can press on it, which will lead to a curvature of the spine or clubfoot. In addition, the fetus does not have enough nutrients that it receives from the amniotic fluid.
Oligo causes compression of the umbilical cord and is likely to end prematurely.
Depending on the duration of pregnancy, the doctor prescribes treatment. The expectant mother can follow this herself: this is a diet, a healthy lifestyle. If oligohydramnios is in the 3rd trimester, then the pregnant woman is admitted to the hospital, vitamins are prescribed, the condition of the fetus is monitored, in addition, infections in the mother are treated and, if necessary, they can perform a “caesarean section”.
Polyhydramnios
Types of polyhydramnios:
- acute(due to rupture of the walls of the uterus; noticeable externally: a sharp increase in the volume of the abdomen);
- chronic(the volume of the abdomen does not grow as quickly as with acute polyhydramnios, but gradually). It often happens in late pregnancy and is difficult to diagnose;
- moderate(the amount of water is not critical).
Polyhydramnios occurs due to chronic diseases of a pregnant woman (diabetes mellitus), Rh conflict between mother and child, multiple pregnancies (one child has a lot, and the other has an oligohydramnios), intrauterine infections and viruses.
The greatest danger with polyhydramnios is premature termination of pregnancy. In addition, severe toxicosis and frequent vomiting are possible (which will lead to dehydration). Sometimes placental insufficiency occurs. Also, the fetus may suffer due to hypoxia, its nervous system and gastrointestinal tract suffer.
During childbirth, polyhydramnios leads to bleeding of the uterus, labor activity can be weak, and childbirth can be difficult.
Treatment of polyhydramnios depends on the causes that caused it. In infections, antibiotic therapy is prescribed (except for tetracycline), in case of a Rh-factor conflict - immunoglobulin. But there is also a general treatment regimen: multivitamins, diuretics, magnesium, diet. In rare cases, doctors resort to amniocentesis (removal of some amniotic fluid). The woman is observed in the hospital and, if necessary, a caesarean section is performed.
Video interview about amniotic fluid and its role during pregnancy
Another look at the problem and its solution. Answers to the questions of Professor, Honored Doctor of the Russian Federation Baev Oleg Radomirovich.
Oligohydramnios or polyhydramnios is a rather dangerous diagnosis. But the most important thing is to identify the problem in time and follow the prescribed treatment. What do you know about it? Share information or experience that you have. Perhaps this will warn someone against mistakes in the future.