Future mothers can face the problem of increasing the amount of amniotic fluid at any time, however, it is polyhydramnios during pregnancy that causes the greatest concern among doctors. later dates. Do you know why?

It turns out that at this time, pathology can provoke at best premature birth, and at worst - bleeding during labor activity, and even endanger the health and life of the baby. And after all, it can be prevented and independently identified, the main thing is to know how.

The amniotic fluid surrounds the baby in the womb. It performs several functions at once: it protects, provides freedom of movement, takes part in metabolic processes, and is also responsible for the development of basic skills in the fetus (swallowing, motor). They say that it smells like milk, and this explains how a newborn baby finds the breast so quickly.

Nature intended that this fluid be regularly updated. That is why its volume is different for different periods:

• at 10 weeks it is about 10 ml;
• at 14 - 100 ml;
• at 21 - 22 - 400 ml;
• at 30 - 32 - 700 ml;
• at 37 - 38 - up to 1500 ml (this is the maximum);
• in 39 - 40 - about 800 ml.

This is ideal. And if the volume significantly exceeds the norm, they put polyhydramnios. As a rule, doctors are alarmed by a significant excess - by 1.5 - 2 times. The most interesting thing is that modern medicine distinguishes between several types of polyhydramnios, sometimes making a borderline diagnosis, which sounds like a "tendency to polyhydramnios." In other words, there is no pathology yet, but the risk of its development has been identified.

How to suspect and detect

To answer this question, it should be recalled that there are two stages of polyhydramnios: acute and chronic. Moreover, the signs in both cases are the same, the difference is only in the speed of their manifestation.

In the first case, the amount of amniotic fluid increases sharply and quickly, literally in a day, or even a few hours. Changes are visible to the naked eye, as the woman's tummy also grows. The situation is aggravated by the appearance pain in the perineum, lower back, swelling of the abdominal wall, and finally, a sharp increase in pressure, due to which the fetal heartbeat is poorly heard.

But in the later stages, you should not worry about this: acute polyhydramnios is most often diagnosed in the first trimester, which cannot be said about chronic. It is from him that expectant mothers in demolition suffer. How is it characterized?

• Slow and gradual increase in the volume of water.
• As a result, a gradual increase in the size of the abdomen, which a woman may not even pay attention to.
• Less commonly - swelling in the lower extremities, nausea, abdominal pain.

You may also experience:

• weakness;
• worsening condition;
• feeling of heaviness in the abdomen;
• shortness of breath.

At this time, you can often hear gurgling in the stomach. He himself, with polyhydramnios, reaches a volume of 100 - 120 cm. A lot of stretch marks appear on it.

If you suspect these symptoms in yourself, you should not postpone going to the doctor. Simply because the condition is dangerous not only for the mother, but also for the child. But first things first.

Why does

Modern medicine can name the main reasons for the development of polyhydramnios, but not all. In about 30% of cases, it is not possible to understand why this happened. Most often, the situation occurs when the woman herself is no different large sizes(she is small and fragile), and the child she bears is a hero.

But there are other factors, including:

• (leads to the development of pathology in 95% of cases);
• diabetes mellitus (it is the cause in every third case);
• intrauterine infection;
• diseases of the cardiovascular system;
• placental disorders;
• kidney disease;
• preeclampsia and the same nausea in the later stages;
• multiple pregnancy;
• infectious diseases transferred in an interesting position;
• malformations of the fetus (problems with the central nervous system, decrease in excretory function, problems with swallowing).

Few people know that almost before childbirth, the child absorbs up to 4 liters of fluid per day, and so every day. But you should not worry about this, because it is updated every three hours.

What is dangerous

The consequences of the development of polyhydramnios can be deplorable if no action is taken. First of all, the condition is dangerous for the crumbs themselves, who are now becoming more active and at risk of “earning” an entanglement with the umbilical cord.

What else is dangerous condition?

• The development of late gestosis, if they were not. This happens, for example, if the amount of amniotic fluid increases at 32-33 weeks.
• Premature birth due to early outflow of water.
• Placental insufficiency, which can provoke chronic fetal hypoxia and, as a result, a threat to its normal development.
• Complications in childbirth.

It has been proven that polyhydramnios prevents the child from taking the correct position immediately before delivery. As a result, they make a diagnosis of "previa", with which they are sent to, of course, if the situation does not change.

Other possible consequences:

• Weakness of labor activity, which is due to excessive stretching of the uterus. Under such conditions, the placenta may exfoliate even ahead of time, which will lead to the development of bleeding.
• Prolapse of the umbilical cord at the time of delivery or the handle, the legs of the child, which, on the one hand, will increase the risk of developing injuries in him, and on the other hand, will complicate the work of doctors, prolong the process. At the same time, asphyxia sometimes occurs, which in the future may affect mental development. At risk are women who were diagnosed with polyhydramnios at 36-37 weeks.

But the worst thing is that polyhydramnios at any time, including at 38-39 weeks, can cause the appearance of intrauterine pathologies that, at a minimum, threaten the health of the child, and at most, his life.

Diagnostics

Detect polyhydramnios during additional ultrasound, where the doctor sets the amniotic index, that is, the volume of fluid.

There are rules for different periods. So:

• at 16 - 18 weeks, the indicator should be in the range of 73 - 220 ml;
• at 22 - 26 weeks - 89 - 238 ml;
• at 32 - 34 weeks - 77 - 278 ml.

Polyhydramnios is an insidious pathology, so if at 34-35 weeks, when the mother feels great, she is given the upper limit of the norm and hospitalization is recommended, she must agree. This pathology must be constantly monitored in order to prevent the terrible! Remember this!

Sometimes the diagnosis of Polyhydramnios is preceded by the diagnosis of Moderate Polyhydramnios. What does it mean? The presence of a problem and its slow, rather than abrupt development. That is, the amount of water is increasing, although not as fast as it could, but there is time to correct the condition.

When the pathology is revealed, it's time to find its causes, because the treatment depends on them. Therefore, the mother is prescribed:

To confirm the diagnosis, cardiotocography may be prescribed.

Prevention and treatment

Ideally, therapy is prescribed, depending on the identified cause of the pathology. So:

• with Rhesus conflict, immunoglobulins are administered;
• intrauterine infection - prescribe antibiotics that are allowed for women in an interesting position;
• diabetes- diet and additional therapy to correct sugar levels.

True, due to a third of the unidentified causes of pathologies, the question of how to treat polyhydramnios in each specific case is sometimes not even raised, because there is a “universal scheme” to get rid of the problem for sure.

What does it mean? What is prescribed for the expectant mother all at once:

• antibiotic therapy with broad-spectrum drugs;
• diet
• diuretics;
• preparations containing magnesium.

To maintain immunity, improve the general condition of the mother and fetus, vitamin complexes containing vitamins B, C, E are also prescribed.

In extreme cases, at 33-34 weeks, an amniotomy can be done in the chronic course of the pathology. This is a procedure in which the bubble is opened to pour out part of the waters. Thus, doctors can protect themselves and the pregnant woman from a rupture, in which the waters leave rapidly, taking the umbilical cord or limbs of the baby with them and endangering his life and health.

In the later stages, at 36 - 41 weeks, they may decide to stimulate labor.

You can prevent all these problems by planning a pregnancy (this is an examination before conception), regularly undergoing examinations, listening to the doctor's recommendations.

The pathology of amniotic fluid, the most common of which is polyhydramnios, is an urgent, yet insufficiently studied problem in obstetrics. What does polyhydramnios mean and why is it dangerous during pregnancy?

It is a condition characterized by the presence of excess fluid in the amniotic cavity. This is considered to be a volume of more than 1.5 liters by the end of a full-term pregnancy, and in accordance with multiple foreign monographs - more than 2 liters. The frequency of this pathology among all births ranges from 0.3 to 1.2%. Usually, clinical symptoms appear when the volume of fluid is more than 3 liters.

The role of amniotic fluid and their source

The amniotic environment plays a huge role in ensuring normal growth and development of the fetus both during a physiologically proceeding pregnancy, and in conditions unfavorable for it - complications of pregnancy or mother's disease. Amniotic waters provide the growing fetus with the necessary free space, mechanical and noise protection, participate in maintaining its temperature balance, in gas exchange, nutrition and removal of metabolic products, in the formation of immunity and hormonal state.

In addition, on recent weeks Pregnancy and during childbirth, amniotic fluid is involved in the preparation of the birth canal for the passage of the fetus, protects the umbilical cord from compression and prevents blood flow disturbance in it.

Source of amniotic fluid formation on early dates pregnancy is not well understood. It is assumed that it is formed as a result of "wetting" (transudation) of the mother's plasma through the chorionic and amniotic membranes or the fetal plasma through its permeable skin.

The process of maintaining a balance between the production of amniotic fluid and their resorption (reversal absorption) in the second trimester has been studied somewhat more. The main source is the fetus itself - its alveolar fluid, which is secreted by the lungs up to 400 ml during the day, and urine, the daily amount of which by the end of pregnancy is already from 400 ml to 1.2 liters.

The decrease in fluid occurs in part due to a decrease in its production by the lungs as a result of their preparation for external respiration, swallowing it (at the 18th week - 200 ml) and further resorption through the epithelium of the lungs into the lymphatic vessels due to the difference in osmotic pressure between the fetal plasma and alveolar fluid . The intensity of fluid swallowing gradually increases to a volume of 500 ml at 40 weeks.

A decrease in fluid production by the alveoli of the lungs also occurs under the influence of the release of certain hormones and biologically active substances by the fetus, for example, vasopressin and catecholamines. In addition, its excess is partially removed due to the difference in osmotic pressure in the plasma of the mother and child.

What threatens polyhydramnios?

It poses a danger both to the fetus, the pregnancy itself, and to the mother. Often in the early stages it is accompanied by early toxicosis in the form of "vomiting of pregnant women" (in 36%), spontaneous abortions, malnutrition of the fetus and chronic hypoxia, intrauterine growth retardation are possible.

Polyhydramnios in the later stages also contributes to the delay in intrauterine development of the fetus. As a result of its excessive mobility, entanglement with the umbilical cord, the development of chronic asphyxia, the formation of an incorrect position in the uterine cavity (about 6%) in the form of a breech presentation or a transverse position are possible. Premature termination of pregnancy may occur, premature, which threatens not only the death of the fetus, but also massive bleeding.

Polyhydramnios in the last stages of pregnancy and during childbirth can lead to late (in 5-20%), early or premature outflow of water with prolapse of the umbilical cord, handle or leg of the fetus. Also, protracted labor is not excluded as a result of the development of weakness of the generic forces and the absence of contractions due to a decrease in the contractility of the uterus or its atony, the absence of attempts due to overstretching of the muscles of the abdominal wall. Often there are facial or breech presentation and fetal hypoxia, premature detachment of the placenta and other complications.

Possible consequences for the child, in addition to asphyxia and death (the stillbirth rate with polyhydramnios is an average of 10%), is intrauterine infection with septic complications, some delay in physical development, decreased immune defenses, susceptibility to respiratory diseases.

In the postpartum period, the recovery of a woman is longer. The danger is purulent and septic complications due to protracted labor and the need to provide obstetric benefits or surgical interventions, the possibility of re-bleeding.

Reasons for the development of pathology

Violations of the above processes can lead to an excess of amniotic fluid. Polyhydramnios can occur mainly in the following cases:

1. Intrauterine infection and the development of amniotic fluid infection syndrome. This reason is the most common. Moreover, the main percentage falls on infections that are sexually transmitted (chlamydia, ureaplasma, herpes simplex virus, etc.). The causative agents can also be mycoplasma, respiratory viral infections, infection with inflammatory diseases of the genitourinary system (colpitis, adnexitis, pyelonephritis, cystitis, etc.).
2. Diabetes mellitus (average 12%).
3. Incompatibility of mother and fetus according to the Rh factor and the development of hemolytic disease.
4. Much less often, polyhydramnios occurs during pregnancy with twins, when feto-fetal hemotransfusion syndrome can develop, with abnormalities in the development of the fetus, especially abnormalities in the development of the digestive organs or the nervous system, with hereditary diseases, blood diseases, placental pathology.

The share of pathology with unexplained causes accounts for more than 60%. How to define polyhydramnios?

Signs of polyhydramnios during pregnancy

Depending on the nature of the course, this pathology is distinguished as:

1. Acute, which usually occurs in pregnant women with short terms - in the second trimester (ranging from 16 to 20 weeks).
2. Chronic, developing, as a rule, in the third trimester.

Acute polyhydramnios

Compared with chronic, it is characterized by a particularly unfavorable course. Its symptoms increase very quickly - within a few days or even a few hours. The pregnant woman complains of a rapid increase in the volume of the abdomen, severe heaviness in its lower sections and in the perineum, sometimes severe pain in the lumbar region and in the perineum, increased blood pressure. On general examination, the anterior wall of the abdomen was swollen and smooth with stretch marks, and the uterus was tense. On auscultation of the fetus, heart sounds are muffled and difficult to hear.

The death of the fetus or its birth with malformations is quite likely. Due to acute fetoplacental insufficiency and premature detachment of the placenta, spontaneous abortion, life-threatening intrauterine bleeding (in 41%), uterine rupture or the threat of rupture are possible.

Chronic polyhydramnios

Chronic polyhydramnios in the third trimester of pregnancy is characterized by a gradual increase in the volume of amniotic fluid and slow development. The prognosis largely depends on the severity of the pathology and the rate of increase in fluid volume. Sometimes, with a very slow increase in its number, it is quite difficult to recognize a pathology without an instrumental examination.

In the chronic course, the symptoms of polyhydramnios during pregnancy are less pronounced than in the acute course. There is no pain syndrome or the degree of pain intensity is insignificant. The diagnosis is made on the basis of subjective complaints, general examination and instrumental examination.

A woman may complain about:

• excessive activity of the fetus;
• shortness of breath even with slight physical exertion;
• moderate heaviness, and sometimes pain in the abdomen;
• heartburn and belching, especially after taking even a small amount of food;
• palpitations and weakness;
• persistent swelling of the legs;
• the formation of stretch marks on the skin of the abdomen;

General examination reveals:

1. Increased density and its palpation.
2. Fluctuation in the abdomen (fluid fluctuations).
3. Excessive activity of the fetus, as well as its excessive mobility and unstable position on palpation.
4. Difficulty in identifying small fetal parts.
5. Muted or muffled fetal heartbeat.
6. Discrepancy (excess) of the results of measurements of the circumference of the abdomen and the distance from the womb to the bottom of the uterus (height of the state of the bottom of the uterus) this deadline pregnancy.
7. Swelling of the legs and varicose veins.
8. On vaginal examination during childbirth - a tense fetal bladder, regardless of the presence or absence of contractions.

The severity of the pathology and its diagnosis

Depending on the volume of amniotic fluid, it is customary to distinguish three degrees of severity of the pathology:

• I degree - 3,000 ml;
• II degree - from 3,000 to 5,000 ml;
• III degree - more than 5,000 ml.

Of particular importance is the diagnostic value of ultrasound. With its help, from 16 weeks, the index of polyhydramnios during pregnancy, which is called the amniotic fluid index (AFI), is calculated.

The method consists in mentally dividing the abdomen into 4 zones by means of two mutually perpendicular lines that intersect at the navel. Then, during ultrasound examination, the largest vertical pocket with liquid is selected in each zone and measured. The sum of the results obtained is the numerical value of the IAF, expressed in millimeters.

From the 16th week of pregnancy, its average value gradually increases and becomes maximum by the 27th week - 156 mm (the lower limit of the norm is 85 mm, the upper one is 245 mm), after which the average value decreases every week. For example, at week 32, the average IAI is 144 mm (76-269 mm), at week 33 - 143 mm (74-274 mm), and at 35 weeks - 140 mm (70-279 mm).

IAI values ​​​​at the upper limit of the norm or slightly above it mean moderate or relative polyhydramnios, in which there is no threat to the fetus. This indicator is the most significant in terms of characterizing its functional state and development. Constant monitoring of IAI helps prevent the development of pathological complications in the fetus.

With the help of ultrasound, the state of the placental structure and the timeliness of its maturation are also determined. In addition, by conducting cardiotocography, the general condition of the fetus is checked, additional studies are prescribed to identify defects and anomalies in fetal development. How to treat a diagnosed pathology?

Polyhydramnios treatment

When establishing a diagnosis, it is necessary to hospitalize a woman in the department of pathology of pregnant women in order to clarify the diagnosis, identify the cause of the pathology and draw up a treatment plan. The tactics of treatment depends on the period of development of the pathological condition, the cause and the degree of its severity. The presence of anomalies of fetal development is an indication for termination of pregnancy.

In chronic polyhydramnios I and II degrees, which develop in the third trimester, usually on an outpatient basis, treatment is carried out aimed at maintaining pregnancy and physiological delivery. With an unexpressed acute form and III degree of the disease after 28 weeks of pregnancy, treatment is necessary before the onset of symptoms of fetal maturity (efficiency is about 71%). The acute form of the pathology, which developed before the specified period, is an indication for termination of pregnancy.

Treatment includes a normal diet with limited intake of salt, spices, spicy and pickled foods, extractive dishes. Of the drugs, diuretics with potassium and magnesium preparations, antiviral, antibacterial drugs and antibiotics (mandatory) of a wide spectrum of action, as well as agents that improve microcirculation (Curantil, Actovegin) and vitamin complexes are prescribed.

In the acute form of pathology or the presence of a very large volume of fluid, a repeated one is sometimes indicated. The increase in the clinical picture of an increase in the volume of amniotic fluid against the background of ongoing therapy is an indication for early delivery.

The feasibility of using traditional medicine

Treatment of polyhydramnios with folk remedies is not recognized by official medicine, since they contain unpurified components that can cause adverse reactions in the mother and, especially, in the fetus. In addition, they do not have a selective effect and a sufficient degree of effectiveness, which contributes to the loss of time required for treatment. It is only possible to use drugs that have a diuretic effect and vitamin supplements of plant origin, and only on the recommendation of a doctor.

Condition prevention

How to avoid polyhydramnios? Prevention consists in an additional examination of a woman planning a pregnancy in order to identify and treat chronic infections and diabetes.

In the antenatal clinic, pregnant women with RH-negative blood, diabetes mellitus, a history of fetal development anomalies, amniotic fluid pathology and chronic inflammatory diseases of the genital organs are at risk.

Around the baby in the womb is a constant amniotic fluid, which is vital for its safety and development. These waters are the protection of the fetus from mechanical shocks, infections, temperature changes, they are important for the formation of the processes of respiration and digestion, as well as for the development of the bones and muscles of the baby. What is polyhydramnios? This is when too much amniotic fluid accumulates in the uterus, this diagnosis occurs in 1% of all pregnancies.

Types of polyhydramnios

Relative - not dangerous if the doctor is sure that the pregnant woman does not have any infection. It is most common in women who are expecting a large child.

Idiopathic - polyhydramnios, the cause of which has remained unclear.

Moderate - the size of the vertical pocket is 8-18 cm.

Pronounced - the size of the vertical pocket is above 18cm, and more than 24cm.

Borderline, a tendency to polyhydramnios - when the level is at the borderline between the norm and the elevated level. Observation is required.

Acute - when the amount of water increases at a high speed. Quite dangerous for the life of the fetus, if no action is taken by the doctors.

Chronic - the amount of fluid is above normal, but stable.

Causes of polyhydramnios during pregnancy

Experts say that it is possible to find out the causes of polyhydramnios only in 2 cases out of 3. It turns out that one third of pregnant women with this diagnosis have idiopathic polyhydramnios (for no apparent reason). Why does a woman have this problem?

• Uncontrolled diabetes mellitus in a woman.
• Multiple pregnancy. In most cases, it happens that one child receives more blood and nutrients than another, which leads to complications.
• Anomalies in the development of the fetus. In this case, it can be difficult for the baby to swallow and process the amniotic fluid. This occurs due to cleft lip or palate, hydrocephalus, problems with the gastrointestinal tract, nervous system or heart.
• Fetal anemia.
• Cardiovascular disease in pregnancy.
• Incompatibility of blood of mother and child.
• Problems in the work of the placenta.

Signs and Diagnosis

If we are talking about a mild form, then usually a woman does not feel any suspicious abnormalities.

If the case is severe, then there is shortness of breath, swelling in the lower abdomen and rare trips to the toilet in a small way.

Polyhydramnios is usually diagnosed after an ultrasound. It can be prescribed unscheduled if the gynecologist suddenly noticed some signs - high blood pressure, a urinary tract infection suddenly appeared, the stomach became larger than normal and edema appeared.

Treatment Methods

If polyhydramnios is acute, then an amniotomy will be prescribed to remove excess water. If it is chronic, then it will be better to prolong the pregnancy until the due date and prescribe complex therapy.

Is it possible to recover at home folk remedies? I strongly recommend that you follow the doctor's instructions and do not use any herbal remedies or homeopathy. There are a number of drugs that are used depending on the cause of polyhydramnios, we will talk about them in detail below. BUT folk remedies leave for the treatment of colds.

What does an obstetrician-gynecologist usually prescribe?

• Actovegin, Curantil. These funds are prescribed to everyone in a row, with the slightest deviation from the norm. To use them or not for prevention is the decision of every woman. Here are interesting data on each of the drugs: Curantil and Actovegin.
• Antibacterial drugs (Amoxiclav, Ampicillin, Wilprafen, Rovamycin, Cefazolin). Some of them are prohibited during pregnancy, but their use is possible if the benefit exceeds possible risk. In most cases, polyhydramnios reveals the infection that led to it. It is necessary to take tests and determine which antibiotic these bacteria have an increased sensitivity to. This method is an order of magnitude more effective than just drinking a randomly selected drug for prevention.
• Wobenzym. The drug of animal and vegetable origin. It is used in complex therapy with antibacterial drugs.
• Diuretics (Canephron, Hypothiazid).
• Indomethacin. Decongestant and anti-inflammatory drug. Helps to normalize fluid levels.
• Vitamins.

Polyhydramnios during late pregnancy - what is dangerous, causes and consequences for the child

The increase in amniotic fluid depends on the gestational age. Its relative volume increases by 45% from gestation, by 25% from . Starting from, amniotic fluid increases by 10% per week, and from 33 its growth stops.

If delivery did not occur on, then there is a weekly decrease in the volume of water by 8%.

If production exceeds resorption, then polyhydramnios develops. For each week of gestation, its own amount of water is determined. Polyhydramnios during pregnancy is considered to be an excess of more than 1500 ml by the end of pregnancy. Abroad, the number 2000 ml is accepted.

An increase in the volume of fluid is reflected in the position of the child (still the fetus). Even in the last stages of pregnancy, his unstable position remains. A large room for movement leads to a change in presentation from head to breech or transverse. This poses a risk during childbirth.

Polyhydramnios during pregnancy may be evidence of various pathologies of the fetus, which are not always amenable to correction or subsequent treatment.

Polyhydramnios during late pregnancy: causes

In 60% of cases, it is not possible to establish why polyhydramnios developed. Amniotic fluid is constantly in a state of exchange. It is absorbed by the amniotic membrane, swallowed by the fetus. So there is a decrease in its volume. The secretion of new portions occurs directly from the placenta, due to the urine of the fetus and lung fluid. A complete exchange cycle takes 3 hours.

The defeat of one of the links of the exchange leads to polyhydramnios. The causes of polyhydramnios may be:

• maternal diseases: diabetes mellitus, infections, inflammatory diseases;
• multiple pregnancy with feto-fetal blood transfusion syndrome;
• congenital malformations: acardia-acephaly, malformations of the nervous or urinary system, digestive tract, lungs, heart, skeleton;
• hereditary diseases and chromosomal abnormalities: Down syndrome, trisomy 13.18 chromosomes;
• neoplastic processes (congenital tumors);
• blood diseases,
• intrauterine infections;
• hemolytic disease of the fetus;
• non-immune dropsy of the fetus;
• pathology of the placenta: chorionangioma, placenta surrounded by a roller.

Polyhydramnios that occurs during pregnancy with twins can be called physiological if it is not associated with other pathological conditions. Two fruits release the amount of liquid required for each, so the total volume will be increased.

Symptoms and clinical signs of polyhydramnios

You can suspect polyhydramnios with rapid weight gain. With the obligatory measurement of the volume of the abdomen and the height of the fundus of the uterus during a visit to the doctor, there is an advance in terms of pregnancy.

In, and weeks of pregnancy, mandatory screening studies are carried out using ultrasound, during which amniotic fluid is measured. A change in their number requires further examination and treatment.

If an infection is detected, antibiotic treatment is given. To improve placental blood flow, Trental, Curantil, and magnesium preparations are prescribed.

With polyhydramnios in combination with malformations, symptoms of genetic abnormalities, a consultation with a geneticist is necessary. If the expressed amount of fluid is not combined with other abnormalities and intrauterine infection, then it is possible to remove part of the water during amniocentesis.

Termination of pregnancy for medical reasons is offered for acute polyhydramnios, which appeared before and is combined with severe defects.

A woman who has been diagnosed with amniotic fluid pathology should listen to the doctor's recommendations, if necessary, not avoid hospitalization, because. this condition can threaten the life of the fetus.

How to avoid polyhydramnios?

It is impossible to influence the volume of amniotic fluid by restricting fluid intake: their balance is offline.

Those who have become pregnant with existing diabetes mellitus should carefully monitor their glucose levels, be observed by an endocrinologist and adjust insulin doses in a timely manner.

Pregnancy planning involves a complete examination of the spouses. If a woman has foci of chronic infection, it is necessary to achieve a stable remission so that they do not cause illness in the fetus.

If at, then the introduction of anti-D immunoglobulin helps to avoid conflict with the child's blood and the development of hemolytic disease of the fetus.

Nutrition for polyhydramnios during pregnancy

Must be balanced. In order not to create an excessive load on the pancreas, you need to remove from the menu an excess of simple carbohydrates - sweet and flour. This will be a kind of diet to reduce the risk of developing hyperglycemia.

To bear a child and avoid the consequences of polyhydramnios, you need to consciously approach its planning. Three months before conception, you can start the examination and undergo treatment, if necessary. Then the pregnancy will be easy, and childbirth will give a healthy baby.

In this article:

Pregnancy is undoubtedly the happiest period in a woman's life, but even he can sometimes be overshadowed by all sorts of troubles and pathologies. One of these pathological conditions during pregnancy is polyhydramnios, which must be treated.

The composition of amniotic fluid changes throughout pregnancy, so it is important to monitor their amount in each trimester.

Polyhydramnios is the appearance of an excess amount of amniotic fluid, significantly exceeding the norm. The diagnosis of polyhydramnios can put a woman at a variety of stages of pregnancy. These complications occur in 1 in 100 pregnancies.

In the normal course of pregnancy, the necessary amount of amniotic fluid is formed for the development of the fetus, approximately 1000-1500 ml. The amniotic fluid consists of 97% water, which contains proteins, calcium, chlorine and sodium salts. Thus, the baby receives oxygen, necessary nutrients and reliable protection from the external environment. Also, the embryo can calmly move and swim in the mother's abdomen, make movements with the limbs.

amniotic fluid are the environment in which the fetus develops. The water temperature is 37 degrees.

Properties of amniotic fluid:

1. The amniotic fluid protects the embryo from impact and shock. In addition, the noise coming from the outside world is also muffled.
2. Amniotic fluid protects the umbilical cord from being squeezed between the wall of the uterus and the fetus.
3. Amniotic fluid helps reduce pain during labor.
4. They help open the cervix during childbirth.
5. The bubble, in which the fetus and amniotic fluid are located, creates an airtight shell into which nothing can enter from the outside.
6. Amniotic fluid contains immunoglobulins.

The amount of amniotic fluid changes every week. Therefore, for each trimester of pregnancy, there are rules. At the very beginning of pregnancy, the amount of amniotic fluid is approximately 30 ml. At 23 weeks, the amount of amniotic fluid is about 600-700 ml. By 30, 32, 33 and 34 weeks, this figure is approximately 600-900 ml. By week 36, the amount of water already increases to 1000. At 37 and 38 weeks of pregnancy, the amount of amniotic fluid becomes maximum. At 39 weeks and closer to the birth itself, there is a decrease in amniotic fluid to 800 ml.

In the presence of some predisposing factors, the amount of water may decrease or increase. When amniotic fluid is less than normal, then this condition is called oligohydramnios. Oligohydramnios is also a pathology and affects the development of the fetus and the condition of the pregnant woman.

Causes of polyhydramnios

Although the causes of polyhydramnios are not yet fully understood, there are some factors that contribute to the occurrence of this pathology.

Polyhydramnios during pregnancy can occur due to such reasons:

• pathology of fetal development;
• infectious diseases of a pregnant woman;
• bacterial infection;
• diseases of the cardiovascular system;
• Rhesus conflict between mother and fetus;
• metabolic disease;
• diabetes;
• pyelonephritis;
• multiple pregnancy;
• large fruit.

Types of polyhydramnios

This condition in a pregnant woman can proceed in different ways: in an acute form or a chronic form. There may be severe or moderate polyhydramnios.

The acute form is characterized by a violation of the general condition of the pregnant woman and the fetus. Such childbirth, as a rule, ends in miscarriage, stillbirth, or such a child will have developmental defects. Polyhydramnios appears in an acute form, usually starting from the 16th to the 24th week. Sometimes the amount of amniotic fluid can increase even within a few hours. In this case, immediate health care, in a dangerous state.

Moderate polyhydramnios during pregnancy is characterized by a gradual increase in symptoms and signs. Moderate polyhydramnios can lead to the birth of a child with developmental anomalies. This is due to the constant lack of oxygen. Very often, moderate polyhydramnios occurs in a chronic asymptomatic form, and therefore can go unnoticed for a long time.

Signs of polyhydramnios

Sometimes a pregnant woman herself may suspect polyhydramnios, by the presence of some signs characteristic of this condition.

1. The belly of a pregnant woman with an excess amount of amniotic fluid reaches a circumference of more than 100 cm. It has a slightly rounded shape. There is a feeling of heaviness in the abdomen and back. The uterus increases in size and begins to squeeze the internal neighboring organs. Therefore, as a consequence, a pregnant woman often has shortness of breath and other ailments.
2. Lower limbs may swell. In some cases, early rupture of amniotic fluid may even occur.
3. A fluctuation appears: in a pregnant woman, gurgling in the abdomen is quite clearly audible. There are pains in the perineum.
4. A large number of stretch marks appear on the abdomen.
5. The pregnant woman's pulse quickens. The fetal heartbeat is weakly audible.
6. Since there is more free space, the fetus takes the wrong position in the uterus (pelvic, oblique). This is directly reflected in the childbirth itself: the stretched uterus contracts incorrectly and childbirth with polyhydramnios will be characterized by weak labor activity.

Polyhydramnios is also dangerous because the child can wrap around the umbilical cord. Hypoxia may develop, the fetus will receive less oxygen. Even if the birth takes place on time, the fetus may have intrauterine pathology, such a child may be born with a developmental disorder internal organs or systems.

It should be remembered that the earlier polyhydramnios appears in a woman, the more amniotic fluid accumulates and the risk of complications increases.

Moderate polyhydramnios

The diagnosis of moderate polyhydramnios is made when the amount of amniotic fluid is approximately 1.5 or 2 liters. And although such a diagnosis is made even in the first trimester of pregnancy, it is possible to seriously talk about the presence of pathology only starting after the 16th week. The cause of this condition is often the Rh-conflict of the mother and fetus or the presence of infections.

A woman with moderate polyhydramnios feels tension in the abdomen. It becomes more elastic. When you feel the fetus, you will notice that it often changes its position. You can hear the rolling of water in the stomach. The uterus increases in size and becomes edematous.

You can determine moderate polyhydramnios at a scheduled ultrasound examination or at an examination. For moderate polyhydramnios are characteristic early birth and placental abruption.

A pregnant woman with moderate polyhydramnios should be constantly under the supervision of specialists, as sometimes it happens that this diagnosis is erroneous or is temporary.

In the absence of a serious pathology, the doctor tries to keep the pregnancy and that the birth takes place naturally without artificial intervention. Conservative treatment is prescribed: vitamins, hypothiazide. If necessary, antibiotic therapy is carried out.

Polyhydramnios at the end of pregnancy

Polyhydramnios at the end of pregnancy is approximately 0.6% of all other pathologies. Its appearance may be caused by late toxicosis. This threatens with serious complications during childbirth:

• prolapse of the umbilical cord;
• oxygen starvation of the fetus;
• weakness of labor activity.

Therefore, such a diagnosis is an indicator for carrying out. Treatment of such polyhydramnios is carried out depending on the cause.

Diagnosis of polyhydramnios

You can diagnose polyhydramnios at an examination by a gynecologist at an appointment in a antenatal clinic. To do this, the doctor examines the pregnant woman for the presence of relevant signs. The most reliable method for diagnosing polyhydramnios is an ultrasound examination. Doplerometry is also prescribed. Thus, it is possible to identify a more accurate amount of amniotic fluid, check the blood flow in the umbilical cord and placenta.

A thorough examination of the fetus allows you to identify possible anomalies in its development.

Polyhydramnios can be diagnosed using the "amniotic index". There is a special table that allows you to determine the amount of amniotic fluid is normal in a certain trimester of pregnancy.

If the diagnosis is confirmed, then the woman is sent for an additional examination of the fetus.

Effects

With polyhydramnios, the following consequences are possible:

• or termination of pregnancy;
• fetal death or developmental defects;
• if an infection becomes the cause of polyhydramnios, then there is a possibility of infection of the fetus;
• prolapse of the umbilical cord or handle (leg) of the fetus during childbirth;
• the presenting part of the fetus does not fall during childbirth or is not fixed;
• malposition.
• bleeding;
• various gestoses.

Treatment

The main treatment for the diagnosis of polyhydramnios is aimed at eliminating the cause that caused this pathology. First future mom passes all the necessary tests confirming the presence of polyhydramnios: fetal cardiotocography, ultrasound examination, blood test for the Rh factor, dopplerography and others.

As a rule, complex treatment is carried out. In case of moderate or unexpressed pathology, the pregnant woman is prescribed drug therapy. Depending on the condition of the woman, treatment can take place in a hospital or at home (outpatient). This condition does not require termination of pregnancy or delivery.

Diuretics (diuretics), vitamins and antibiotics are prescribed. Antibiotics are necessary to fight microorganisms, since the main cause of polyhydramnios often lies in the infectious process. Also, starting from 24 weeks and up to 38, indomethacin is prescribed.

If the prescribed treatment does not help or polyhydramnios takes a severe form, then the doctor prescribes early delivery. They use medications that help artificially induce labor.

During artificial delivery, it is necessary to carefully open the membranes, and gradually release the amniotic fluid so as not to cause fetal asphyxia. This procedure is carried out using a thin catheter. Measures are taken to prevent prolapse of the umbilical cord or limbs of the fetus.

Medicines to stimulate labor should be used no earlier than 2 hours after the outflow of amniotic fluid.

In the early stages, when it is impossible to carry out delivery, amniotic fluid is released. Amniotic fluid helps the baby move through the birth canal, regardless of the artificial or natural opening of the fetal bladder. But this should be done carefully so that the umbilical cord does not fall out.

If the fetus has malformations that are incompatible with life, then for up to 28 weeks, an abortion is performed.

childbirth

If polyhydramnios does not affect the condition of a pregnant woman or her fetus, then in this case, childbirth is carried out naturally. Mandatory procedure in this case: artificial opening of the fetal bladder. In this case, the volume of the uterus decreases, and this helps to make contractions more productive. Often such childbirth is delayed, and then there is a need for rhodostimulation. Rhodostimulation is carried out by the introduction of labor-accelerating drugs. And already as the most extreme remedy, a caesarean section is performed.

The postpartum period may be complicated by bleeding due to poor uterine contractility. Therefore, the woman is prescribed the introduction of reducing drugs, such as oxytocin and methylergometrine.

Prevention of polyhydramnios

Since polyhydramnios is a pathology, this condition can be avoided if precautions are taken.

It is very important to immediately exclude the presence of an Rhesus conflict. During pregnancy, a woman should move as much as possible. It is necessary to calculate the amount of fluid taken. It also does not hurt to adjust the diet a little.

To prevent polyhydramnios, the expectant mother should take vitamin complexes or medications prescribed by a doctor.

It is necessary to undergo all examinations and analyzes on time, as they will help to identify a pathology or deviation in the development of the fetus even at the earliest stages.

In this case, you can avoid serious consequences during childbirth and in the postpartum period. It is important to remember that regular examinations by an obstetrician-gynecologist are not just a formality, but a vital necessity on which the condition of the baby depends.

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