Ambulatory water or amniotic fluid is a nutrient medium in which an embryo grows and develops from conception to birth. It is responsible for the normal process of fetal development, its full growth and provision with all important substances. At each individual pregnancy, the amount of this fluid is different, but it is very important that all indicators are within the established norms. Only 1% of pregnant women are diagnosed with polyhydramnios, which entails concealing a threat to the fetus and its mother. In order to timely determine this deviation from the norm and prevent the negative consequences, you need to know what dangerous polyhydramnios during pregnancy and how to treat this ailment.
- Polyhydramnios in pregnancy - what is meant by this diagnosis
- Polyhydramnios during pregnancy - causes a pathological condition
- forms, types and severity of polyhydramnios during pregnancy
- Signs polyhydramnios during pregnancy
- diagnosis of polyhydramnios during gestation
- Polyhydramnios during pregnancy - the consequences for the child
- Polyhydramnios during pregnancy - treatment
- How to prevent the development of polyhydramnios - preventive measures
- Tactics of labor management for polyhydramnios
- Polyhydramnios during pregnancy - reviews
- Video "Polyhydramnios Pregnancy»
Polyhydramnios in pregnancy - what is meant by this diagnosis
Amniotic water - the liquid that is produced inside of the fetal membranes( amniotinom).Outwardly this substance resembles ordinary transparent water. But for a baby, it is comparable to oxygen for humans. It contains useful chemicals that are responsible for the full development of the entire body of the baby.
So it is inherent in nature that the amount of amniotic fluid should be within clear limits of the norm according to the gestation period. Their volume increases by jerks as the period increases until the 38th week of pregnancy. After this period, the amount of fluid can decrease, which indicates the approach of labor.
During the gestational period, the water composition also changes. In the first weeks after conception, the amniotic fluid resembles a blood plasma. But over time it becomes contaminated with the products of the fetus. Therefore, starting from the second trimester, special attention is paid to the amount and composition of water in the pregnant woman. The results obtained after the examination indicate the level of the successful course of pregnancy.
For purification from excess impurities, the water is renewed about 8 times a day.
normal volume and composition of the water needed for fetal:
- Security fetal nutrient substrate( amino acids, hormones, mother's antibodies, immunoglobulins).This occurs in the process of swallowing the baby with amniotic fluid. And he does it quite often - on a teaspoon every hour.
- Creation of comfortable conditions for stay in the tummy( reduction of noise vibrations, stable temperature regime, normal pressure).
- Protection against force stimuli from the outside( shocks, shocks and shocks).
- The formation of a barrier against infection with infections, viruses, fungi.
If a female body fails, a special pathological condition called polyhydramnios may occur. The very name of the disease says that there is too much amniotic water in the fetal bladder. For example, normally the volume of fluid varies from 600 ml to 1.5 liters, and in case of polyhydramnios this figure exceeds 2 liters.
No matter how careless this pathology may seem, in reality it is a dangerous condition requiring a special campaign and competent treatment in a hospital. Without such measures, the process of delivery will be complicated in the future woman in labor, and the baby will have various pathologies.
Polyhydramnios during pregnancy - causes of pathological condition
Modern medicine has not yet established the exact causes of the development of this disease. But physicians, relying on years of experience, identify a number of pathologies, the presence of which enrolls a woman to a group of high-risk. Such states include:
- Acute bacterial and viral diseases, which a woman had a few days before conception or during pregnancy. For example, rubella, genital herpes, toxoplasmosis, gonorrhea. Diabetes mellitus of a pregnant woman.
- Multiple pregnancy, especially with identical twins.
- Problems with the cardiovascular system.
- Too large fruit.
- Pathological condition of the placenta. For example, premature aging, phytoplacental insufficiency, the formation of tumors.
- Rh-conflict of a married couple. Pathological work of the excretory function of the baby.
- Genetic abnormalities, immaturity of the nervous system, diseases of the fetal organs.
- Disturbance of amniotin.
In 50% of cases, polyhydramnios during pregnancy are a consequence of inflammation of the uterine tissues, which confirms the infectious nature of the disease.
With the arrival of the final trimester, the cause of polyhydramnios is the anomalous development of the baby's swallowing function. Normally the child swallows 4 liters of fluid, and then allocates it. In some pathologies, for example, in the splitting of the sky, he can not do this, as a result of which there is an excess of amniotic water.
In 30% of cases, it is not possible to establish the true cause of polyhydramnios.
Forms, types and severity levels of polyhydramnios during pregnancy
An increase in the number of amniotic waters can be acute or chronic.
- The acute form of is characterized by rapid accumulation of water for several hours or days. At the same time, the abdomen grows right in front of the eyes, women are troubled by the pains that give back to the lumbar and inguinal section. This form of polyhydramnios develops in the first months of gestation( 14-20 weeks) and can end in miscarriage or rupture of the uterus. There is such a disease very rarely and mainly with monozygotic double or viral diseases. Malformations in the fetus are determined in 100% of cases.
- The chronic form of involves a gradual increase in the volume of water that begins to exceed the permissible level. A woman rarely feels unwell, because she easily adapts to subtle symptoms, her condition is stably normal. Such polyhydramnios occur on the last stages of pregnancy and rarely ends in serious complications in the baby.
There are three degrees of severity of polyhydramnios:
- Light - the volume of amniotic water is less than 3 liters.
- Medium - the volume of the liquid varies from 3 to 5 liters.
- Heavy - the volume of water exceeds 5 liters and can reach up to 12 liters.
In view of the causes and general health indicators of women, polyhydramnios are divided into several types:
- Relative polyhydramnios - the condition of a woman and the fetus does not threaten anything, provided there is no infection in the uterine cavity. This happens when the fruit is too large.
- measured polyhydramnios during pregnancy - the amniotic fluid only slightly exceeds the upper permissible threshold. If the situation is not corrected, a characteristic symptomatic picture will appear over time.
- Border polyhydramnios - a state where the water level is between the norm and pathology. It is only fitting to monitor the status of a woman and a baby.
- Idiopathic polyhydramnios - exceeding the amniotic secret for no apparent reason. Regardless of what caused the pathology, adequate treatment is conducted.
- Expressed polyhydramnios - a strong increase in the volume of water, which is noticeable even without diagnosis. The woman's girth is rapidly growing, pain, weakness, nausea.
From the timely diagnosis of polyhydramnios and the elimination of the causes of its appearance depends on the health of the fetus and the way of delivery.
Symptoms of polyhydramnios during pregnancy
The disease can develop without symptoms or show only some of the signs that are perceived by a woman as a variant of the norm. What symptoms are worth paying attention to:
- Any discomfort in the abdomen at the level of the uterine fundus.
- Chronic causeless weakness.
- A sharp increase in heart rate.
- Shortness of breath without any motor activity.
- Strong swelling of the legs, genitals.
- The mismatch of the parameters of the girth of the abdomen and the height of the day of the uterus for the duration of gestation.
- Reduction of daily diuresis.
- Increased motor activity of the baby.
- Strong "squelch"( fluctuation).
- Appearance of wide and deep striae.
- Tension of the uterus, its painfulness upon palpation.
- With gynecological examination, the tension of the fetal bladder is seen.
- In the last weeks of pregnancy, women may experience severe nausea or vomiting.
Diagnosis of polyhydramnios during gestation
To confirm the diagnosis of polyhydramnios, a list of patient complaints is collected, the results of clinical analyzes and all external obstetric examination data. But the main tool for determining the pathology and degree of its severity is ultrasound.
There are two ways to determine the status of amniotic water by ultrasound:
- Calculation of the index of the amniotic fluid or IOL.This diagnostic procedure looks like this: the stomach is divided into 4 segments, then in each conventional square the maximum depth of the fluid pocket is calculated. Then all the data is summed up, and the IWR is obtained. An index of less than 5% indicates a lack of water, and above 97.5% - a polyhydramnios.
- Measurement of the largest pocket of amniotic water, free from fetal body parts and umbilical cord. Normally, this figure is 2-8 cm, less than 1 cm - low water, more than 8 cm - polyhydramnios.
If the diagnosis of polyhydramnios is confirmed, the woman is offered to do a triple test for possible malformations of the fetus or placenta. In addition, the determination of the level of prolactin in the blood can be prescribed, which is greatly reduced in case of polyhydramnios. With polyhydramnios during pregnancy in later terms, such studies are not informative.
Given that polyhydramnios may be the result of chronic infection or Rhesus-conflict, a woman is screened for TORCH infection and for antibodies to Rh factor.
Mnogodody during pregnancy - consequences for the child
Exceeding the boundary values of amniotic water can significantly complicate the course of pregnancy and cause death of the fetus or newborn. In addition, 20 children of one hundred are diagnosed with numerous developmental defects. For example:
- Atresia of the esophagus or large intestine.
- Diaphragmatic hernia.
- Chromosomal abnormalities.
- Hirschsprung syndrome.
Depending on the shape and severity of percolation, there is the following:
- Placental abnormality( phytoplacental insufficiency, placental abruption, bleeding).
- Embracing the baby's neck with an umbilical cord, which can cause suffocation during delivery.
- Severe forms of gestosis( in 21% of cases).
- Leakage or complete outflow of water is premature.
- Hypertensive crisis or attacks of vomiting in a pregnant woman.
- Fetal hypoxia with a predicted developmental delay or neonatal death.
- Happens to the fetus of intrauterine infection, especially if it is the cause of polyhydramnios.
- Advance the baby, which entails a cesarean section.
- Low generic activity caused by excessive stretching of uterine muscles.
- The inability of the uterus to contract itself after delivery.
A favorable outcome is observed with moderate water retention with effective treatment.
Polyhydramnios during pregnancy - treatment
Treatment of women with this diagnosis is carried out in a hospital. If the tests confirmed incompatible with life pathology in the fetus, the pregnancy is interrupted. If the baby is healthy, the patient is prescribed treatment taking into account her condition and the severity of polyhydramnios.
In general, the treatment of polyhydramnios is reduced to the appointment of such funds:
- Course of antibiotics if pathology is caused by an infection. Most often prescribed drugs of a wide spectrum of action, for example, Rovamycin or Erythromycin.
- Vitaminotherapy, including all B vitamins, as well as ascorbic acid and tocopherol.
- Diuretic drugs in the presence of edema( Furosemide, Veroshpiron)
- preparations for normalization of the utero-placental circulation( Curantil).
How to treat polyhydramnios during pregnancy is decided by an obstetrician-gynecologist. Independently take any medication is strictly contraindicated because of the risk of death.
In extremely severe cases, when there is a risk of rupture of the uterus, amniocentesis is prescribed. This is a procedure that involves drawing a small amount of water from the fetal bladder with a needle. But the risk of serious complications after this is very high.
Throughout the treatment period, a woman is measured daily by the blood pressure, her weight, and also cardiotocography of the fetus and once a week dopplerography.
How to prevent the development of polyhydramnios - prevention measures
Understanding the seriousness of the situation, future moms are wondering how to prevent polyhydramnios. Unfortunately, there are no specific preventive measures for this pathology, since provoking factors have not yet been established.
The only thing that remains for women is to undergo a full examination before pregnancy, and after conception regularly visit a gynecologist and adhere to a healthy lifestyle.
Clinical management of labor with polyhydramnios
Depending on the form and severity of polyhydramnios general symptomatic pattern, the woman may be assigned to elective caesarean section.
If polyhydramnios are in acute form and progress strongly, a decision is made to stimulate preterm delivery if the gestation period is more than 35 weeks or if pregnancy is interrupted.
The natural method of delivery in women in labor with polyhydramnios often passes with different complications. To reduce the risk to the mother and baby, the birth process is carried out using such preventive measures:
- Carrying out a careful amniotomy - puncturing the blister from the side, just above the uterus of the uterus. During the procedure, the obstetrician-gynecologist controls the rate of outpouring of the fetal water in order to prevent partial loss of body parts of the baby or the umbilical cord.
- Cautious use of stimulation - the administration of oxytocin is carried out no earlier than 2-3 hours after the passage of water, so that the placenta does not exfoliate prematurely.
- Readiness of neonatologists to provide resuscitation assistance to a newborn.
Mnogodody during pregnancy - reviews
Most women who have experienced polyhydramnios managed to safely endure and give birth to a baby. At observance of all prescriptions of the doctor, pregnancy developed normally, and kids were born healthy and high-grade.
But in the presence of severe forms of polyhydramnios, women did not tolerate the last months of pregnancy: their body swelled, their back ached, breathing was difficult.
Remember, if you are diagnosed with polyhydramnios, you should treat this situation with full seriousness. Refusing treatment and completely ignoring the problem can result in irreparable consequences for you and your baby.