The author - Sozinova AV practicing obstetrician-gynecologist. Experience in the specialty since 2001.
The fruit is surrounded by amniotic fluid, the amount of which varies throughout pregnancy (the higher the gestational age, the greater the amniotic fluid).
Hydramnios called this pathology of the amniotic fluid in which there is an excess of it, and even a surplus. Thus, the end of pregnancy (37-38 weeks) the number of water should not exceed 1.5 liters.
Causes
The reasons that lead to high water, not well understood. They can be divided into several groups:
maternal causes
First and foremost in this group are chronic diseases of women.
Diabetes in 25% of cases causes hydramnion during gestation. Also here include chronic diseases of the cardiovascular and urinary systems (glomerulonephritis and pyelonephritis, hypertension disease, heart defects).
An important role in the development of polyhydramnios play a chronic or acute infection. Especially those that are provided TORCH-infection group (rubella, herpes, cytomegalovirus, toxoplasmosis).
Furthermore, the reason of increasing the volume of amniotic fluid are used and genital diseases (myoma uterus, endometriosis, Chronic inflammation of the uterus and appendages).
Reasons due to fetal abnormalities
The first is congenital malformations and chromosomal diseases (anencephaly, a pathology of the spinal cord and urinary system, neoplastic processes, etc.).
Also polyhydramnios it develops in multiple pregnancies or large amounts of fruit.
Factors caused by pregnancy pathology
This group includes: various pathological placenta (placenta tumors) preeclampsia (Lesion vessel walls and increase their permeability), reduction hemoglobin, Rh-conflict pregnancy.
Also found idiopathic polyhydramnios, the cause of which could not be determined.
Diagnostics
Diagnosis polyhydramnios includes physical examination and additional methods of research:
Physical examination
With their considerable size in excess of indicators measuring the circumference of the abdomen and the height of standing uterus determined specific to the gestational age. This is especially noticeable with regular prenatal care. uterine palpation reveals its voltage and excessive mobility of the embryo.
Table height standing uterus and abdominal circumference by week pregnancy
When listening to the heartbeat of the fetus is determined muted or muffled heart sounds.
In the case of pelvic examination of women in childbirth can identify fetal bladder busy even outside combat.
instrumental examination
"Gold standard" of determining the amount of amniotic fluid is amniotic fluid index count (AFI) During ultrasound.
Polyhydramnios diagnosed with increasing AFI and maximum sizes of amniotic fluid pockets 8 cm and above. However, ultrasound should be performed in the dynamics of (repeatedly).
Norms of the amniotic fluid index by week
- 16 weeks - 73-201mm (average 121mm);
- 17 weeks - 77-211mm (average 127 mm);
- 18 weeks - 80-220mm (average 133mm);
- 19 weeks - 83-230mm (average 137mm);
- 20 weeks - 86-230mm (average 141mm);
- Week 21 - 88-233mm (average 143mm);
- 22 weeks - 89-235mm (average 145mm);
- 23 weeks - 90-237mm (average 146mm);
- 24 weeks - 90-238mm (average 147mm);
- 25 weeks - 89-240mm (average 147mm);
- 26 weeks - 89-242mm (average 147mm);
- 27 weeks - 85-245mm (average 156mm);
- 28 weeks - 86-249mm (average 146mm);
- 29 weeks - 84-254mm (average 145mm);
- 30 weeks - 82-258mm (average 145mm);
- Week 31 - 79-263mm (average 144mm);
- 32 weeks - 77-269mm (average 144mm);
- 33 weeks - 74-274mm (average 143mm);
- 34 weeks - 72-278mm (average 142mm);
- 35 weeks - 70-279mm (average 140mm);
- 36 weeks - 68-279mm (average 138mm);
- 37 weeks - 66-275mm (average 135mm);
- 38 weeks - 65-269mm (average 132mm);
- 39 weeks - 64-255mm (average 127mm);
- 40 weeks - 63-240mm (average 123mm);
- Week 41 - 63-216mm (average 116mm);
- 42 weeks - 63-192mm (average 110mm).
Lab tests
From the study additionally appointed laboratory methods
- blood Rh factor and antibodies
- blood sugar (To avoid gestational diabetes),
- PCR for the detection of pathogens TORCH infections.
Cardiotocography (HIC) and Doppler
To assess the fetal condition is carried out cardiotocography (Instrumental listening the fetal heart), and Doppler (blood flow study in fruit, uterine and umbilical vessels).
polyhydramnios treatment
Treatment of excess amniotic fluid is directed at eliminating the causes that caused it. In the case (high blood sugar) detecting hyperglycemia treatment is aimed at the normalization of its level. In the case of pregnant rhesus sensitization is carried appropriate therapy (treatment or prophylaxis of hemolytic disease of the fetus).
Upon detection of the fetus fetal malformations that led to the development of polyhydramnios and incompatible with the child's life, pregnancy is terminated for medical reasons.
Moderate polyhydramnios, trimeter identified in the third, the indication for further prolonging amid treatment of chronic placental insufficiency (Improved uteroplacental blood flow).
With moderate polyhydramnios appointed:
- tocolytic (uterine vessels expand and reduce the tone of the uterus) partusisten, ginipral;
- antispasmodics: papaverine, no-spa, magnesium;
- antiplatelet agents (to improve rheology or "fluidity" blood): Trental, Curantylum;
- vitamins (ascorbic acid, group B, tocopherol as an antioxidant);
- aktovegin (improves the absorption of glucose and oxygen).
In identifying intrauterine infection assigned causal treatment (drugs, harmful to pathogens infection): macrolide antibiotics (erythromycin, josamycin), antiviral or antikandidoznye facilities.
If diagnosed with acute polyhydramnios or severe chronic polyhydramnios after 28 weeks treatment is carried out to signs of fetal lung maturation (in this case are assigned glucocorticoids, surfactant), followed by early delivery.
Indication for termination of pregnancy is a gestational age less than 28 weeks and acute polyhydramnios.
In some cases administration of a treatment amniocentesisAlthough its efficiency is quite low.
At birth shown early opening of membranes and careful (under the control of the hands) slow their outpouring in order to prevent loss of the umbilical cord loops. End of the second and third stage of labor is carried out under intravenous uterotonic (oxytocin).
During labor and the impact on the fetus polyhydramnios
Polyhydramnios has on the course of pregnancy and childbirth adverse effect.
Often there is premature rupture of water, which causes premature birth or abortion in the later stages.
Also hydramnion preeclampsia or exacerbates the starting torque is in its development.
The birth of the uterus hyperextension often occurs weakness of tribal forces, Early prenatal rupture or water hypotonic bleeding in sequence and early postnatal periods.
It is also possible premature detachment of the placenta, both during pregnancy and at childbirth.
For the post-partum period is characterized subinvoljutcija (slow contraction of the uterus).
Polyhydramnios causes abnormal fetal presentation and position due to its increased motor activity, extensor insertion of the fetal head during childbirth.
Also, delivery may be complicated by prolapse of the umbilical cord loops and small parts of the child. Increased fetal activity in the overstretched uterus contributes to cord entanglement, which can lead to a breach of fetoplacental blood flow, fetal hypoxia and even his death in childbirth.
Polyhydramnios influence on the fetus
Excess amniotic fluid can lead to the following consequences for the fetus:
- fetal death during pregnancy or childbirth (intrauterine hypoxia, termination of pregnancy, the umbilical cord strangulation);
- pneumopathy development (non-infectious pulmonary disease) due to aspiration syndrome or intrauterine infection;
- fetal small birth weight (wasting) due to intrauterine fetal growth retardation;
- large fruit size (4 kg or more) due to diagnosed hyperglycemia.
Some studies in pregnancy
- Smears during pregnancy.
- Tests during pregnancy by trimester.
- Ultrasound during pregnancy.
- Urinalysis in pregnancy.
- Coagulation.
- Installing pessary.
- Glucose tolerance test.
- Homocysteine in pregnancy.
- Amniocentesis.
- Anesthesia during childbirth.
- Fetal CTG (cardiotocography)
- Cordocentesis.
- Epidural anesthesia during childbirth.
