Polyhydramnios , oligohydramnios - Causes, Symptoms and Treatment .MF .
Polyhydramnios - a pathology of pregnancy, at which there is an excessive accumulation of amniotic fluid - a 1.5- 2 liters of fluid.Accordingly, oligohydramnios - is the lack of amniotic fluid, wherein the amount of amniotic fluid is less than 500 mL.
Both conditions are very dangerous during pregnancy and can cause serious complications.
Amniotic fluid (synonym - amniotic fluid) are very important for the fetus.They perform a protective function, preventing the baby from the harmful effects of the environment and are involved in metabolism, and promote the normal flow of labor.
During pregnancy the amount of amniotic fluid is constantly changing.For each stage of pregnancy has its own performance standards amniotic fluid.By the end of pregnancy, the number of membranes normally ranges from 600 to 1500 ml.Deviation from these indicators higher or lower results in polyhydramnios or oligohydramnios.
What reasons could lead to the pathology of the amniotic fluid?
Speaking of polyhydramnios, in mos
water shortage, as well as polyhydramnios, may be due to infectious and inflammatory diseases of the mother.For others, the important factors causing oligohydramnios, include high blood pressure, pregnant, late preeclampsia, maternal obesity, perenashivanie pregnancy, fetal malformations, fetal disorders of the urinary system, circulatory disorders in the placenta.
How does polyhydramnios and oligohydramnios?
If there are no significant deviations from the normal values of amniotic fluid, in most cases pregnant feels completely normal.In this case, polyhydramnios or oligohydramnios are accidental discovery during an ultrasound.
Rarely, in severe oligohydramnios may be abdominal pain.The pain intensified when fetal movement.A woman may notice that the fetus is smaller than normal moves, that is alarming and requires immediate treatment to the gynecologist.
belly size with oligohydramnios may be less than normal due date dimensions.However, a "simple eye" to see such deviations is difficult.
In marked polyhydramnios clinical manifestations of the disease quite pronounced.Belly of a pregnant growing rapidly, falls under the pressure of gravity.Usually there are pains in the perineum.Fruit while actively moving.
When these symptoms women should contact their obstetrician-gynecologist.A doctor examines a pregnant woman, listens to the heartbeat of the fetus.If oligohydramnios pregnant, then the height of standing uterus and abdominal circumference will be smaller than they are due, and the fruit is clearly palpable due to the decrease in the volume of amniotic fluid.Fetal heartbeat is clearly audible.
polyhydramnios If the opposite is true.The heartbeat of the baby is muted because of the abundance of amniotic fluid.The fetus is palpated with difficulty.Abdominal circumference and height of standing uterus strongly ahead of the rules.
After the inspection is conducted ultrazukovoe examination of the fetus, which allows you to clearly identify the degree of polyhydramnios or malovodiya.Pri confirmation of the diagnosis, as in oligohydramnios and polyhydramnios when held Doppler - investigate the blood flow in the fetal vessels in the umbilical cord in the womb.
ALWAYS cardiotocography (CTG) to assess fetal cardiac activity baby.
Based on ultrasound, CTG and Doppler can be identified as affected polyhydramnios or oligohydramnios on the development of the baby.
to identify the cause of disease, in addition prescribe a blood test for fetal infection, taking a swab from the vagina to the survey on sexual infections.If a pregnant Rh-negative blood, examined blood Rh antibodies.
Treatment oligohydramnios and polyhydramnios
Depending on the identified pathology prescribe.But if the disease in the survey have been identified, and if polyhydramnios or oligohydramnios by ultrasound moderate and the fruit is not affected, treatment is not indicated.Displaying dynamic observation by a gynecologist.
If oligohydramnios found lagging development of the fetus and the violation of utero-placental blood flow, then prescribe vasodilators (chimes, Trental), beta-agonists (ginipral);to improve glucose uptake and oxygen administered Aktovegin.It is also prescribed vitamins C and E.
During treatment, water scarcity, a thorough monitoring of the hemodynamic parameters of the fetus.All pregnant women with fetal abnormalities hospitalization in a maternity hospital.
If there is a positive trend in the treatment and the condition of the fetus is satisfactory - a woman can give birth vaginally at term gestation.But, unfortunately, sometimes there is the negative dynamics when fetal condition deteriorates, the amount of water is reduced, which can lead to fetal death.In this case, it shows an emergency delivery by caesarean section.
Treatment expressed polyhydramnios includes diuretics (Hypothiazid) and vitamins in a maternity hospital.
In marked polyhydramnios spend amniocentesis - in the amnion, ie caul under ultrasound catheter is removed and a certain amount of amniotic fluid.
prognosis of polyhydramnios is more favorable than in oligohydramnios.Pregnant women with polyhydramnios often give birth vaginally, unless, of course, at the time of childbirth complications do not arise.However, deliveries are more protracted than normal, due to the overstretching of the uterus and decrease its contractile capacity.To stimulate labor in polyhydramnios often spend amniotomy (pierce the bag of waters).
Due to the distension of the abdomen when polyhydramnios, the skin on the belly of a pregnant severely stretched - there are striae (stretch marks), so for the prevention of stretch marks all women with polyhydramnios, it is recommended to use a special cream for stretch marks, such as "Sanosan", "Vichy", "Avent, "" 9 months, "and so on.Cream should be used, starting from the 2nd trimester of pregnancy to the postpartum period, inclusive.
For successful treatment of both water scarcity and polyhydramnios requires correction of comorbidity, or treatment may not be entirely effective.For example, the presence of diabetes requires correction glucose, obesity - special diet, the presence of infection - antibiotics and so on.
In general, the prognosis is more favorable for those pregnant women who have polyhydramnios or oligohydramnios developed at the end of pregnancy.When these diseases develop during the second trimester, the risk of complications during pregnancy and childbirth increased significantly.
Possible complications of:
- when polyhydramnios: premature birth, miscarriage in late pregnancy, premature rupture of membranes, uterine inertia, bleeding in the postpartum period due to uterine hypotension, incomplete separation of the placenta after childbirth, cardiopulmonary failure inmother, detachment of normally situated placenta;
- with oligohydramnios: delayed growth and development of the fetus, fetal hypoxia, in severe oligohydramnios due to constant trauma possible curvature of the fetal spine and hip joints;the formation of adhesions between fetal skin and amnion, with the growth of the fetus, these strands can lead to amputation of the limbs of the fetus;intrauterine infection of the fetus, uterine inertia, late miscarriages, intrauterine fetal death, fetal death in the first days of life after birth.
Genera with polyhydramnios or oligohydramnios
Amniotic fluid play an important role in childbirth.That is the amount of amniotic fluid zavisit- be able to pregnant self-start labor or this would require amniotomy.Normally, when the normal amount of water and a full-term pregnancy, when entering the labors under the intrauterine pressure there is a spontaneous rupture of membranes, amniotic fluid poured out and fight usilivayutsya.No with oligohydramnios and polyhydramnios, there are certain barriers to entry into the normal labor.What are they related?
oligohydramnios When there is a lack of water front, ie water, located directly in front of the head ploda.Iz of this shell membranes "stretched" to the head of the fetus, forming a "flat bag of waters".Flat fetal intrauterine pressure by bubble can not burst on their own, as it happens in normal, and because of this, the birth process is suspended and new mothers develop uterine inertia.In such cases, make sure amniotomy to enhance generic activities and '' run '' bout.
If polyhydramnios is observed the opposite situation.Under pressure from a large number of water front, fetal bladder can rupture prematurely.Water when it is poured in large quantities and rapidly.Because of this, the fetus may fall, arms and legs.To avoid such a situation, svoeremenno iebefore the start of labor produce amniotomy.With the opening of the amniotic fluid membranes produced slowly, in a thin stream.Thanks amniotomy, and reduced size of the uterus contractions increase.
Prevention polyhydramnios and oligohydramnios:
- timely examination and treatment of infectious and inflammatory diseases of the sexual sphere to the planned pregnancy;
- correction of endocrine disorders, such as diabetes and obesity;
- regular follow-up at the obstetrician-gynecologists throughout pregnancy.
Doctor's consultation on oligohydramnios and polyhydramnios:
1. I gestational age of 30 weeks.Diagnosed by ultrasound - moderate polyhydramnios, but no treatment is appointed.Is it correct?
right, with moderate polyhydramnios treatment is not indicated if the fetus is not affected.Displaying dynamic outpatient.
2. I moderate polyhydramnios.The gynecologist said that we should go to the hospital and treated with antibiotics.Is it so?
No, moderate polyhydramnios not be treated with antibiotics, of course, if you have not found some infection.
3. How often can I do ultrasound to look at the dynamics of how to develop oligohydramnios or polyhydramnios?
Twice a month, we can more often if necessary.
4. If diagnosed "polyhydramnios", is it possible that the amount of water returned to normal, if not treated?
possible, especially if you have mild polyhydramnios.
5. I moderate oligohydramnios, as it may affect the baby?
moderate oligohydramnios usually does not affect the fetus.Keep track of the fetal movement, normal fetus must move at least 10 times in den.Takzhe CTG recommended once a week.
6. sure whether with severe oligohydramnios go to the hospital?
sure.In addition to treatment, in your case it is necessary to carry out CTG every day.
7. I moderate oligohydramnios and fetal breech presentation.Doctors persuaded to go to a cesarean section.Maybe, I'll be able to give birth?
breech and moderate oligohydramnios are not indications for cesarean section.Perhaps there are other indications for which you want to operate on, for example, a large fruit or delay development of the fetus.
8. How much time a child can be no amniotic fluid after amniotomy?
About 12 hours.
9. I punctured bag of waters, saying that I can not enter into their own labor because of the fact that I have a little water front.It's true?
Obstetrician-gynecologist, Ph.D.Christina Frambos