The author - Sozinova AV practicing obstetrician-gynecologist. Experience in the specialty since 2001.
Oligohydramnios (oligohydramnios) is a pathology of amniotic fluid, full-term pregnancy when observed with a decrease in their amount to 500 ml and less. According to various sources such abnormality occurs in 0,3-5,5 cases of all sorts.
Causes
The reasons that lead to a decrease in the volume of amniotic fluid, are divided into several large groups:
Due to congenital abnormalities of fetal development
- These include various defects of the urinary system of the fetus (or the absence of a sharp narrowing urethral, ureteral contraction, no kidney, polycystic kidney disease, immature valves urethra).
Due to fetal abnormalities
- intrauterine infection (cytomegalovirus, Chlamydial, mycoplasma and other infections)
- oligohydramnios may also be caused by intrauterine growth retardation (VZRP) or chromosomal abnormalities (syndrome Down, Marfan).
Reasons due to chronic extragenital diseases women
- pathology of the cardiovascular system (arterial hypertension, thrombophlebitis, Cardiovascular collapse)
- chronic renal disease (pyelonephritis, glomerulonephritis),
- preeclampsia and systemic diseases (systemic lupus lupus, rheumatoid arthritis and rheumatism and others).
Obesity and diabetes also can provoke the development of water scarcity. Dehydration (dehydration) women with diarrhea, vomiting, poisoning. Chronic nicotine poisoning.
Reasons caused placental pathology
- fetoplacental insufficiency,
- multiple infarcts of the placenta,
- vices placental development,
- premature maturation of the placenta.
other causes
- intrauterine fetal death,
- prolonged pregnancy,
- multiple pregnancy,
- leakage of amniotic fluid.
Oligohydramnios due to prolonged use of certain drugs (prostaglandin synthesis inhibitors: indomethacin, naproxen). Also isolated idiopathic or oligohydramnios with unknown cause.
Diagnostics
oligohydramnios diagnosis is based on observation of the dynamics of the course of pregnancy and additional methods of research:
Physical examination
- Marked discrepancy stomach size (abdominal circumference and height of standing uterus) pregnancy. When the pathology of the amniotic fluid is much less than the size of the accepted norms.
- The woman observes a decrease in the number of fetal movements, and in some cases it is possible and the occurrence of pain associated with perturbation of the child.
- Fetal heartbeat is listened well, but the fruit is well palpable due to the small amount of water. At birth palpated flat membranes.
Ultrasonography
- Often oligohydramnios detected by ultrasound as a random finding.
- In determining the amniotic fluid index height and greatest pocket amniotic fluid of oligohydramnios indicates a decrease in its size up to 1 cm and less. However, ultrasound to confirm low water should be carried out several times during 1-3mesyatsev.
Lab tests
- By reducing the number of suspected amniotic fluid woman assigned screening for intrauterine infection (PCR), toxoplasmosis, cytomegalovirus, rubella, and others.
- Also shown determining blood glucose level marker intrauterine fetal malformations (AFP and hCG) in the blood type and Rh factor.
- According to indications (suspicion of chromosomal abnormalities) is appointed amniocentesis from karyotyping fetal cells.
Cardiotocography (HIC) and Doppler
- Assess the condition of the fetus helps cardiotocography (assessment of heart rate) and Doppler (blood flow assessment in the system of the fetus, umbilical cord, placenta).
Treatment for oligohydramnios
Clinical management of pregnancy depends on the degree of water scarcity and gestational age.
Upon detection of a small amount of water in the second trimester of pregnancy and congenital malformations of the fetus offered patient to terminate a pregnancy.
Oligohydramnios diagnosed in the third trimester, is an indication for hospitalization of women and destination treatment aimed at preventing placental insufficiency, intrauterine hypoxia and delay development of the fetus. For this purpose is shown receiving drugs with vasodilatory, blood thinning and enhancing uteroplacental blood flow properties (Curantylum, Trental). Also appointed tocolysis (uterine relaxing muscles) ginipral, partusisten, aktovegin to improve nutrition and fetal assimilation of oxygen, vitamins (vitamin E, ascorbic acid). If the identified fetal intrauterine infection, shown antibiotics and antivirals.
Moderate oligohydramnios in the third trimester of pregnancy and satisfactory condition of the fetus does not require hospitalization and treatment, pregnant only observed (with the mandatory ultrasound and amniotic index control liquid).
In the case of positive dynamics of a woman prescribed therapy allowed in the independent delivery vaginally. In childbirth produce early amniotomy, ie (Flat complicate fetal bladder during labor).
If there is no effect of treatment, fetal condition deteriorates, solve the issue of early termination of pregnancy (cesarean section).
During labor and the impact of water scarcity on the fetus
Due to insufficient amount of water in front lineages when oligohydramnios formed flat fetal a bubble, which is not able to perform its function (it promotes cervical dilatation) and leads to development weakness of tribal forces and prolonged labor.
Also oligohydramnios can cause premature birth.
In the third stage of labor and in the early postpartum period may occur hypotonic bleeding due to a delay in uterine membranes and parts of the placenta. Oligohydramnios increases the risk cervical rupture intrapartum (in 24% of cases).
Lack of amniotic fluid promotes placental insufficiency, intrauterine fetal hypoxia and malnutrition.
The consequences for the fetus
The disadvantage of membranes stimulates growth retardation and fetal growth (birth weight infants with hypotrophy) and fetal hypoxia.
If there is a marked oligohydramnios may develop curvature of the spine and the child's hips (constant trauma owing small size of the uterus), the occurrence of adhesions between the integuments and fetal membranes that further growth of the fetus can result in amputation limbs.
High probability of late miscarriages, antenatal fetal death and the death of a child in the first days after birth.
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.