Oligohydramnios at 36-37 weeks. Is oligohydramnios a reason to panic or is it a temporary phenomenon? Signs and main symptoms of oligohydramnios

Amniotic fluid is necessary to ensure normal intrauterine development of the fetus. For the future baby, it is a comfortable physiological environment, an additional source of nutrition and oxygen, and also a protective barrier that protects him from numerous external threats. In addition, amniotic fluid plays an important role in the process of childbirth, forcing the dilation of the cervix, as it is capable of exerting a mechanical effect on it.

Therefore, a relative lack of water can lead to various developmental disorders of the fetus and interfere with the normal course of pregnancy. Why is oligohydramnios dangerous? What are the different degrees of this condition, and what therapeutic method is most effective in this situation?

What is “moderate oligohydramnios”

Indicators of normal amniotic fluid volume vary depending on the specific stage of pregnancy. During the first 8 weeks this is approximately 5 ml. Next, the amount of fluid begins to increase, and by the end of pregnancy its total volume reaches an average of 1-1.5 liters. Immediately before birth, the water becomes smaller (their volume is approximately 600-700 ml).

The composition of amniotic fluid (from the word “amnion” - fetal sac) includes amino acids, vitamins, hormones, trace elements, some types of salts, enzymes, etc.

Amniotic fluid is formed due to the functioning of the epithelial layer of cells in the aqueous membrane of the amnion. They are constantly updated. At the extreme stages of pregnancy, this happens at least every 3 hours.

On average, per day the fetus has the ability to swallow 4 ml of amniotic fluid, and through the pores of the fetal sac, waste products enter the maternal excretory system. With a non-critical “shift” from normal volume indicators amniotic fluid(closer to the lower limit of normal), a pregnant woman is diagnosed with moderate oligohydramnios.

Causes

It happens that this condition is registered already in the initial stages of pregnancy. A similar diagnosis is made based on calculating the oligohydramnios index. In this case, the woman needs constant medical supervision and the use of certain methods of drug therapy.

The reasons for the formation of such a violation may be:

• persistent hypertension (increased total blood pressure);
• the presence in the body of a pregnant woman of any inflammatory process of an infectious nature;
• fetoplacental insufficiency;
• hypoxia (oxygen “starvation”) of the fetus;

• diseases of a pregnant woman associated with metabolic disorders;
• the presence of any pathologies in the fetus (underdevelopment of the excretory system will lead to a sharp decrease in the level of primary urine production, which leads to a reduction in the volume of amniotic fluid);
• post-term pregnancy - the placenta can be reversed and therefore no longer has the ability to provide the fetus with all the necessary substances, including producing a sufficient volume of amniotic fluid;
• multiple pregnancy - here there may be a disruption in the distribution of placental blood, which can also lead to water deficiency;
• violation of secretion in epithelial cells of the aqueous membrane of the amnion.

Types of oligohydramnios

Based on the duration of the course, there are two types of oligohydramnios: acute and chronic.

Chronic oligohydramnios has several levels of development. This condition requires long-term therapy. If qualified assistance is not provided on time, the disease will worsen., which will lead to serious consequences for both the expectant mother and the child.

Chronic deficiency of amniotic fluid can occur if a pregnant woman suffers from a systemic disease, such as diabetes.

In order to minimize all possible risks and apply appropriate therapy in a timely manner, in case of oligohydramnios, a woman needs to register with the antenatal clinic as early as possible and regularly undergo all the necessary examinations.

The most common cause of acute oligohydramnios is an infectious disease. This form of pathology leaves fewer negative consequences for the baby’s health and does not require special treatment, since the situation usually stabilizes with the successful elimination of the disease that caused it.

In addition, oligohydramnios is classified depending on the functional activity of the cells of the aqueous membrane. Based on this principle, primary and secondary forms are distinguished. Primary oligohydramnios is characterized by the absence of any functional disorders in the membranes. With secondary oligohydramnios, damage to the structure of the amnion is observed, causing water to leak out.

Symptoms

Quite often, the clinical picture of moderate oligohydramnios does not have pronounced manifestations (therefore, this condition in some cases can be regarded as borderline with the norm). However, a pregnant woman should pay attention to some signs characteristic of this condition, if they occur. Among these symptoms:

• lower abdominal pain;
• painful tremors;
• weak and infrequent tremors;
• the size of the uterus does not correspond to the duration of pregnancy (detected by an obstetrician-gynecologist).

If any of these symptoms appear, even if they seem minor, you should immediately report them to your doctor so that he can prescribe a series of examinations that can help identify oligohydramnios.

Possible complications

Insufficient volume of amniotic fluid can become an impetus for the development of a number of complications, among which:

• Impaired blood flow in the umbilical cord. Because of this, the baby does not get enough oxygen and food. Persistent hypoxia can provoke the development of irreversible disorders in a child and even lead to his death.
• “Failure” in the process of circulation of amniotic fluid. This condition can lead to infection, and also greatly increases the likelihood of a traumatic birth.
• Flat amnion. This complication can provoke a weakening of labor in the first stage of labor.
• Placental abruption. Small fragments of the placenta are retained in the uterus, which increases the risk of bleeding.
• Fetal underdevelopment. If during the process of intrauterine development a child regularly did not receive the amount of nutrients and microelements he needed, then his body weight at birth will be less than normal.

Diagnostic methods

The main instrumental diagnostic methods used by the doctor to determine the volume of amniotic fluid are ultrasound and Doppler sonography. With their help, you can evaluate umbilical blood flow, how much the child is lagging behind in development, as well as the condition of the blood vessels of the expectant mother and fetus.

In addition, an obstetrician-gynecologist may additionally prescribe cardiotocography to study the functional capacity of the baby’s cardiovascular system. With established moderate oligohydramnios in the third trimester This study is carried out at 30, 32, 34 and 36 weeks of pregnancy.

When registering, a woman must undergo screening for sexually transmitted infections.

Therapy

Correction of this condition should be carried out in several directions:

• prescribing medications that normalize metabolic processes in the placenta;
• drug therapy for the underlying disease.

If a pregnant woman suffers from any disease associated with metabolic disorders or is overweight, then most likely the specialist monitoring the pregnancy will recommend adhering to a special diet.

Moderate oligohydramnios usually does not require constant monitoring in a hospital setting, the future condition can be normalized on an outpatient basis.

In addition to drug therapy, with moderate oligohydramnios, the expectant mother must observe some restrictions regarding her physical activity. She should also make sure that her daily diet includes foods rich in vitamins and microelements.

The duration of pregnancy plays a largely determining role in drawing up a treatment plan. This pathology requires the most careful monitoring in the 2nd trimester. If oligohydramnios is diagnosed at 37 weeks, this may be an indication for a cesarean section.

Prevention

Not currently developed effective methods to prevent the risk of developing oligohydramnios. But there are a number of recommendations, the exact implementation of which will help a pregnant woman reduce the risk of this pathology.

Plays an important role diet of the expectant mother. It must be rich in all the elements (vitamins, proteins, microelements and other valuable substances) necessary for the normal development of the fetus and ensuring the satisfactory condition of the pregnant woman.

It is very useful for the expectant mother and the health of her baby to follow a balanced regime of physiological stress and rest. Work should be moderate, since excessive overwork can have a detrimental effect on the health of the woman and her baby.

However, you should not go to extremes and completely deprive yourself of even minimal exercise, as this can lead to rapid weight gain. excess weight which can complicate pregnancy

One of the main factors determining the nature of pregnancy and the success of delivery is emotional background of a woman. The presence of stress and regular mental overload sharply increases the risk of developing any associated complications, including oligohydramnios. A pregnant woman needs to undergo all examinations prescribed by a doctor on time.

It is necessary to use any supplements or medications only with the approval of a specialist, and not based on incompetent reviews.

Conclusion

Moderate oligohydramnios occurs against the background of certain pathologies of intrauterine development of a child or diseases of a pregnant woman. Its distinguishing feature is the absence of pronounced symptoms. At timely therapy this deviation does not pose a great threat to the normal development of the fetus and the health of the expectant mother. The period at which moderate oligohydramnios was diagnosed is important, since in different periods pregnancy, such a violation can have its consequences.

20% of pregnant women are diagnosed with oligohydramnios. This phenomenon is expressed in a lack of amniotic fluid. Depending on the complexity of the course, it can be very dangerous and in some cases threatens miscarriage.

Amniotic fluid is an important component for the proper development of the fetus. They contain the oxygen he needs, vitamins, other useful substances, salts and hormones. In addition, they perform a protective function, protecting the baby from blows and pressure from the mother’s organs. They also prevent the penetration of infections and other aggressive phenomena.

Treatment of oligohydramnios during pregnancy depends on the degree of its course, the effect on the fetus and the causes of its occurrence. The diagnosis can be made at any stage of pregnancy. It is often detected in the second trimester, but it is not uncommon for it to be detected in the third.

If the amount of amniotic fluid in recent weeks fluctuates between 1-1.5 liters, then this indicates their insufficient quantity. In some cases, it turns into serious problems during this period.

There are two types of amniotic fluid deficiency:

• Moderate. It is usually caused by poor nutrition, so to eliminate it, a woman just needs to adjust her diet and eating routine. Doctors recommend eating more foods high in nutrients and vitamins. When following a diet, it is necessary to undergo periodic examinations with an observing gynecologist;
• Expressed. Poses a danger to the fetus. Treatment is complex and includes medication. The woman must be placed in a hospital for safekeeping. The more severe the oligohydramnios, the higher the risks for the child, because it can lead to deformation of the fetal skeletal system, pathology of the development of the limbs and asphyxia, which disrupts the functioning of the nervous system and brain.

What are the dangers of severe oligohydramnios during pregnancy?

The woman usually does not notice any abnormalities, feels well, and her condition does not deviate from the norm. We can say that this pathology does not have pronounced symptoms, which greatly complicates its diagnosis. However, many people experience pain when the fetus moves, so in some ways this can be called one of the signs.

Only a doctor can detect a lack of amniotic fluid.

The observing gynecologist conducts routine examinations and, based on their results, can determine its presence.:

• Uterine growth retardation;
• Inappropriate height of the uterine fundus;
• Abdominal dimensions inappropriate for the duration of pregnancy.

Doctors are well aware of the dangers of oligohydramnios - the risks for the unborn baby are significantly increased. In addition, the more pronounced it is, the higher they are.

To verify the accuracy of his diagnosis, the doctor sends the woman for an ultrasound, the results of which confirm or refute the doctor’s conclusion. At the same time, the amount of fluid inside the placenta and the severity of the disorder, as well as its effect on the fetus, are determined.

Causes of oligohydramnios during pregnancy

• High blood pressure. Throughout the entire period of bearing a child, its jumps are noted, but they are insignificant and within normal limits. But if the fluctuations significantly exceed the permissible values ​​and are observed quite often, then they may well become the cause of a lack of amniotic fluid. Severe hypertension affects the development of the fetus, slows down its growth and can even lead to pregnancy failure. Often, pathology caused by this particular reason is detected at approximately 21 weeks, but throughout the entire first trimester it is not uncommon;
• Abnormal development of the embryo can also be a provoking factor. It can be detected during a second routine ultrasound;
• Reduced secretion of the membrane and poor development of the epithelium that covers it;
• Multiple pregnancy. The cause is uneven blood flow in the placenta. In this case, one baby receives more nutrients and other elements than the second. This can lead to the death of a weaker child, so such women are observed in a hospital setting;
• Bacterial infections before and during pregnancy. Pathogenic microflora sometimes enters not only the birth canal, but also the amniotic fluid. At first it does not manifest itself, but usually by 21 weeks, under the influence of hormones, it begins to develop sharply and after 10 weeks, oligohydramnios becomes quite pronounced;
• Post-maturity. It is diagnosed in women after 36 weeks. By this time, the baby is completely ready for birth and can appear at any time. In some cases, women carry a child for up to 40 weeks. From about 38, the amount of water decreases due to the aging of the placenta. It has already fulfilled its functions and is gradually peeling off. In this case, doctors induce premature birth or perform C-section;
• There are cases when oligohydramnios develops from conception. Under such circumstances, it is detected during a routine ultrasound at 12 or 22 weeks. Often occurs against the background of metabolic disorders and obesity of the expectant mother. Doctors assess the degree of its severity and impact on the child. If there are no serious violations, then there is a chance to save the fetus. A woman in this condition will be treated in a hospital until the birth itself. Children in this case are born at a maximum of 37 weeks, since the placenta begins to exfoliate ahead of schedule. Often the birth of a baby is carried out by caesarean section.

Diagnostics

First of all, after making a diagnosis, the doctor determines the cause, and then the severity of this phenomenon.

Specialists use a variety of examinations and analyzes for this purpose.:

• Dopplerography, ultrasound. They help determine the amount of water in the fertilized egg, as well as identify the child’s developmental delay. In addition, these methods are used to assess blood flow in the arteries of the fetal brain, umbilical cord and uterus;
• General blood and urine tests, smear for the presence of diseases of the genital area. These methods will eliminate the possibility of infecting the baby;
• CHT allows you to determine the condition and well-being of the child.

How to treat moderate and severe oligohydramnios during pregnancy

Depending on the severity, causes and degree of influence, different methods are used. For example, if a lack of amniotic fluid is detected at week 27 in case of obesity, medications are prescribed that improve the functions of the placenta.

Starting from 31 weeks, an integrated approach to treatment is carried out, including taking drugs to stimulate metabolism in the placenta. Vitamins and, of course, remedies to eliminate the cause are also prescribed.

There are two treatment methods: outpatient and inpatient. The first is used for moderate flow, the second – for severe flow.

– an anomaly accompanied by a decrease in the volume of amniotic fluid (AFV), which can be diagnosed at different stages of embryogenesis. As a rule, the disease is asymptomatic; only with a significant decrease in the amount of amniotic fluid can a woman feel discomfort when the baby moves. On the part of the child, oligohydramnios during pregnancy is manifested by intrauterine growth retardation. Diagnosis of pathology is carried out by objective examination and ultrasound. Treatment involves hospitalization, drug therapy, and if ineffective, delivery by cesarean section.

General information

Oligohydramnios during pregnancy, or oligohydramnios, is a serious obstetric pathology characterized by a downward deviation in the amount of amniotic fluid. This condition poses a threat to the baby, as it causes intrauterine growth retardation and can provoke multiple congenital anomalies: clubfoot, curvature of the spine, deformation of bone tissue. Oligohydramnios during pregnancy is diagnosed relatively infrequently - in approximately 4% of patients. OPV play an important role in the formation and growth of the fetus, they are enriched with minerals and nutritional components, help expand the space of the uterus and prevent pressure from its walls on the baby.

As for timing, oligohydramnios during pregnancy can occur at any stage of embryonic development. However, according to statistics, most often such a diagnosis in obstetrics is made in the third trimester - closer to 37-38 weeks of gestation, which is due to the aging of the placenta and a decrease in its functional activity. Often, oligohydramnios during pregnancy causes premature birth. In isolated cases, this condition can occur in the first trimester; in such a situation there is a high risk of spontaneous abortion.

Causes of oligohydramnios during pregnancy

The causes of oligohydramnios during pregnancy are usually due to abnormal development of the villi of the aqueous membrane or a violation of their ability to produce a sufficient amount of amniotic fluid. In the latter case, the triggering factor for oligohydramnios may be infection, metabolic diseases, or congenital malformations of the fetus. Experts often associate the pathogenesis of oligohydramnios during pregnancy with the insufficient ability of the chorion to produce OPV, which can be provoked by various negative circumstances affecting the body of the expectant mother.

The most common cause of oligohydramnios during pregnancy is congenital malformations of the fetus. In most cases, the pathology is diagnosed after the 20th week of embryogenesis and is combined with anomalies in the development of the kidneys and facial skull. Intrauterine infections that penetrate the fetal membranes from the woman’s genital organs can cause oligohydramnios during pregnancy. Other viral and bacterial pathologies are also dangerous, in particular, influenza and ARVI suffered after conception. The pathogen circulating in the mother’s blood freely penetrates through the veins of the umbilical cord to the chorion and provokes a disruption in the production of OPV.

A fairly common cause of oligohydramnios during pregnancy is a violation of metabolic processes in the patient’s body. This is why women with diabetes and obesity are at risk. In this case, oligohydramnios during pregnancy is observed already in the first trimester. This condition can also be provoked by concomitant diseases of internal organs - pathologies of the urinary tract, cardiovascular system, kidneys. The risk of developing oligohydramnios during pregnancy increases with multiple pregnancy. In most cases, it is due to the increased need of babies for nutritional components.

Oligohydramnios during pregnancy can also occur due to pathology of the placenta, in particular, if there is a disturbance in blood flow, uneven flow of blood to its individual parts. The risk increases with abnormal attachment, in the case of premature abruption of the placenta or its aging, and with malformations of the placenta. Women who are prone to drinking alcohol, nicotine, and psychotropic substances are at risk for oligohydramnios during pregnancy. There is also danger when working in hazardous industries. Therefore, in order to reduce the likelihood of the formation of oligohydramnios, the effects of these factors on the body should be avoided.

Classification and symptoms of oligohydramnios during pregnancy

This pathology, depending on the gestational age, can be of two types:

• Early oligohydramnios during pregnancy– diagnosed before 20 weeks, most often due to incompetent membranes.
• Late oligohydramnios during pregnancy– manifests itself in the 2-3 trimester, develops mainly against the background of other diseases and complications associated with the attachment and functioning of the placenta.

The clinical picture of oligohydramnios during pregnancy is determined by the degree of decrease in OPV levels. In the case of a slight decrease (within 400-700 ml), they speak of a moderate severity of the pathology. Such oligohydramnios during pregnancy appears only on ultrasound; there are no objective symptoms. If the amniotic fluid deficiency is more than 700 ml, a diagnosis of “severe oligohydramnios” is made. Patients experience nausea, vomiting, dizziness, and often dry mucous membranes. A characteristic symptom is also pain during fetal motor activity.

Diagnosis of oligohydramnios during pregnancy

The diagnosis of oligohydramnios during pregnancy is established based on data obtained from a survey of the patient and an objective examination performed by an obstetrician-gynecologist. A number of laboratory tests and instrumental studies are also prescribed. You can suspect oligohydramnios during pregnancy during a routine examination of a woman. Characteristic features Insufficient volume of OPV will result in a discrepancy between the abdominal circumference and the height of the uterine fundus and the gestational age with a deviation to the smaller side. It is important to carefully collect anamnesis and establish the probable cause of this condition, since subsequent treatment tactics depend on it.

To exclude an infectious factor in the formation of oligohydramnios during pregnancy, laboratory tests of urine and blood are prescribed. The collection of smears from the genital tract is indicated in order to determine pathogenic microflora and exclude or confirm suspicion of its introduction to the fetus. It is possible to definitively confirm oligohydramnios during pregnancy using ultrasound. During the examination, the specialist accurately determines the volume of OPV, assesses the condition of the placenta and the child, and identifies congenital anomalies that could contribute to the development of this pathological condition. Also, oligohydramnios during pregnancy requires a CTG to determine the child’s well-being.

Treatment of oligohydramnios during pregnancy

Medical care in case of oligohydramnios during pregnancy depends on the form of the pathological condition, as well as the well-being of the patient and the fetus. If the course is moderate in the second trimester of gestation and in the absence of symptoms, expectant management is used. In this situation, treatment of oligohydramnios during pregnancy is carried out on an outpatient basis. Hospitalization is indicated for severe forms of oligohydramnios, if uterine hypertonicity is additionally present, as well as if obstetric pathology is diagnosed at 34 weeks of gestation or later. The presence of at least one of these criteria is a reason for the expectant mother to be placed in the department and stay in the clinic until the baby is born.

Treatment of oligohydramnios during pregnancy, regardless of its form, begins with proper organization of lifestyle. It is important to provide the patient with bed rest, protect her from stress, overwork, physical activity and homework, and eliminate the influence of negative factors on the body. Drug assistance in confirming oligohydramnios during pregnancy involves the prescription of medications that improve uteroplacental blood flow. It is necessary to use means to normalize the functions of the placenta and vitamin complexes. If oligohydramnios during pregnancy is accompanied by uterine hypertonicity, the use of tocolytics is indicated.

Oligohydramnios during pregnancy suggests an impact on the causative factor. If this is an infection, antibacterial or antiviral agents are prescribed taking into account the sensitivity of the pathogen. Additionally, treatment is carried out for concomitant diseases that can provoke insufficient secretion of amniotic fluid. In case of oligohydramnios during pregnancy, careful monitoring by an obstetrician-gynecologist of the condition of the mother and fetus is necessary. All efforts are aimed at continuing pregnancy management until the expected date of birth and the full maturation of the baby.

If conservative treatment of oligohydramnios during pregnancy does not produce positive dynamics, the OPV level continues to decline, and the condition of the fetus rapidly deteriorates, premature delivery is indicated, regardless of the period of embryogenesis. Due to the high likelihood of complications during childbirth, preference is given to caesarean section. Often, oligohydramnios during pregnancy causes primary weakness of labor, as well as intrauterine fetal hypoxia. If conservative therapy gives positive results, a planned cesarean section is performed upon reaching 38 weeks of gestation.

Forecast and prevention of oligohydramnios during pregnancy

Timely detection and treatment of oligohydramnios during pregnancy allows you to carry the fetus to 37-38 weeks of gestation and give birth to a healthy baby. The most unfavorable prognosis is observed in the case of obstetric pathology occurring in the 2-3 trimester in combination with intrauterine growth retardation. In such a situation, the death of the child or his significant growth retardation and functional immaturity are possible. To avoid the development of oligohydramnios during pregnancy, a woman must undergo a full examination and treatment of concomitant diseases of the internal organs before conception. After fertilization, prevention of oligohydramnios involves timely registration with a gynecologist and passing all the necessary tests. To prevent the development of oligohydramnios during pregnancy, stress, physical activity, and the influence of negative factors on the body of the expectant mother and fetus should be excluded. It is imperative to provide balanced diet, rich in fortified foods.

Oligohydramnios is a lack of amniotic fluid. It occurs in 20% of pregnant women. This condition can have serious consequences; it is fraught with complications and deviations from the normal course of pregnancy, and the risk of fetal development pathologies increases. The composition of amniotic fluid is quite diverse. The waters inside the fertilized egg contain nutrients necessary for the life and development of the child, oxygen, hormones, salts, vitamins and other substances that ensure the normal course of intrauterine development of the fetus.

Another function of amniotic fluid is protective. The water that is inside the placenta creates a semblance of weightlessness and in this way protects the baby from possible damage due to pressure from the woman’s internal organs.

In the event of an impact, it absorbs it, so the consequences for the fetus are minimal. In addition, amniotic fluid protects the child from infections and other adverse factors. Thus, oligohydramnios during pregnancy is very dangerous, because such a phenomenon is a decrease in the quality of the protective functions of amniotic fluid.

Why does oligohydramnios occur?

The amount of water inside the placenta changes depending on the needs of the baby and the length of pregnancy; it is clear that at 20 weeks the volume of water is less than at 37 weeks. By the 38th week of a normal pregnancy, the fluid volume is 1500 ml, and at 39 and 40 weeks it begins to gradually decrease.

Most often, signs of oligohydramnios are detected in the second trimester (by about 20 weeks), but if oligohydramnios is detected at 30–32 weeks, this can lead to serious problems.

If at 30–32 weeks the amniotic fluid is less than 1000 ml, then we are talking about oligohydramnios. Depending on the amount of fluid deficiency in the placenta, severe or moderate oligohydramnios during pregnancy is diagnosed. Ultrasound is most often used for diagnosis.

Sometimes moderate oligohydramnios during pregnancy is the result poor nutrition. In such a situation, a pregnant woman does not require treatment; it is enough to establish a routine and diet. Typically, doctors prescribe a gentle regimen in such a situation, which includes eating a variety of foods rich in vitamins and minerals. In parallel with the diet, it is important to be periodically examined by a doctor.

If the ultrasound showed severe oligohydramnios, then serious measures will be required, including drug treatment. In such a situation, the woman will be kept in a day hospital. The more severe the oligohydramnios, the more serious the consequences for the baby. Severe oligohydramnios threatens the development of the following pathologies:

• deformations of the child’s skeletal system,
• asphyxia, which can lead to disruption of the nervous system and negatively affect brain activity,
• abnormal development of the limbs in the fetus.

A pregnant woman should know that a decrease in the volume of amniotic fluid in the later stages (37, 38, 39 weeks) is not considered pathological. This is a natural process of preparation for childbirth, which in most cases occurs at 39 or 40 weeks.

Symptoms of oligohydramnios

The most dangerous thing about this condition is that there are no obvious signs of oligohydramnios. Physically, the woman feels great and her health does not deviate from the norm. Only sometimes, when the fetus moves, a woman may feel pain in the lower abdomen, but this is an unreliable symptom.

Only a specialist can accurately determine whether a pregnant woman has oligohydramnios. So, an experienced doctor can diagnose pathology in the case of:

• lag in size or discrepancy in the height of the uterine fundus,
• its serious discrepancy with the timing of pregnancy,
• insufficient abdominal size for this period.

If such symptoms are detected, the doctor may come to the conclusion that the pregnant woman has oligohydramnios. Every doctor knows the consequences of oligohydramnios if left untreated. The risk of giving birth to a baby with developmental pathologies is very high, especially with severe oligohydramnios.

In order to refute or, conversely, confirm this diagnosis, it is necessary to conduct an ultrasound, on the basis of which a diagnosis can be made. An ultrasound examination will allow you to accurately determine the amount of fluid inside the placenta, and when confirming the diagnosis, the doctor will use ultrasound to assess the severity and condition of the fetus. If you suspect the presence of oligohydramnios, a pregnant woman should undergo an examination by a gynecologist.

Oligohydramnios can be diagnosed at 20, 30 and 37 weeks. Although oligohydramnios in the classical sense can be diagnosed only at 39 or 40 weeks, if the fluid volume has decreased to 500 ml or less.

However, the classical definition is outdated; in modern medicine, we can talk about oligohydramnios starting from the 20th week. The closer the due date (37, 38, 39 weeks), the more the placenta ages and the more often oligohydramnios is detected.

Causes of oligohydramnios

If a doctor diagnoses oligohydramnios during pregnancy, the causes of this condition may be different. Experts to this day cannot come to a common opinion on why oligohydramnios occurs. From a long list of reasons, scientists have pinpointed the following:

• Reduced function of the secretion of the membrane that forms the fertilized egg, insufficient or improper development of the epithelium covering this membrane. If a pregnant woman does not know the dangers of oligohydramnios during pregnancy, then this is even better. What causes the most difficulty for doctors is not diagnosis, but “false symptoms” that arise as a result of stimulation of a woman’s nervous system.
• Abnormal fetal development. Other types of abnormal development include hereditary anomalies in the development of the face and kidneys. This can be clarified between 20 and 30 weeks, when the second mandatory ultrasound examination has already been carried out.
• High blood pressure in a pregnant woman. Naturally, throughout the entire period of pregnancy, blood pressure will be elevated, but its fluctuations will be insignificant. If the blood pressure surges too high, it can cause oligohydramnios. In the case of hypertension, fetal development may be delayed, its growth may slow down, or fetal death may occur. This happens especially often after 20 weeks.

• Another cause of oligohydramnios is all kinds of bacterial infections that were suffered by a pregnant woman and were not properly treated. Sometimes the danger is hidden in infections that a woman had long before pregnancy. In such a situation, pathogenic microflora is detected using tests both in the birth canal and in the amniotic fluid. The manifestation of such a danger can be detected at 20 weeks of pregnancy, when, under the influence of hormones, the infection begins to progress, in parallel with this, oligohydramnios develops. At 30 weeks, oligohydramnios becomes more pronounced.
• Oligohydramnios is often observed in cases of multiple pregnancies. The cause of this disease in such a situation may be the uneven distribution of blood flow in the placenta. In this case, one child receives more oxygen and nutrients than the other. Such a situation can lead to the death of a weaker embryo, so inpatient monitoring is necessary.
• Another reason for oligohydramnios is postmaturity. At 36 or 37 weeks, the baby is already fully formed and can appear at any time. Sometimes women carry a baby for over 40 weeks, but it is important to know that starting from 38 weeks, oligohydramnios can develop. The reason for this is the “expiration date” of the placenta, which has already served its allotted time and is beginning to age. Sometimes obvious aging of the placenta is observed as early as 37 weeks. As a result, it peels off and is unable to perform its functions. Under such circumstances, doctors raise the question of a caesarean section or inducing labor by piercing the placenta. Don't be alarmed if doctors suggest surgery at 37 or 38 weeks. By this period, the child is already completely ready to be born.

• Oligohydramnios can develop gradually, starting from the first week of pregnancy, and can be detected at 12 weeks or after 20 weeks during an ultrasound scan. It may be caused by obesity in a pregnant woman as a result of serious metabolic disorders. In such a situation, it is important to know how pronounced it is and how seriously it affects the development of the fetus. If oligohydramnios has not yet become pronounced and critical, then the child can be saved. To do this, the pregnant woman is placed in a hospital, where she will be under the supervision of doctors throughout the entire gestation period. With such a pathology, you need to introduce a strict diet and find out the causes of obesity. Even in the best case scenario, the baby will be born no later than 37 or, at most, 38 weeks. This is due to the death of the placenta. In this case, a caesarean section is mandatory.

Examinations and tests for oligohydramnios

Before starting treatment, the doctor needs to determine what led to the pathology and conduct a diagnosis. First of all, it is important to clarify the reason that resulted from insufficiency of amniotic fluid and the severity of oligohydramnios. In this case, you need to undergo a series of tests and studies:

1. Ultrasound examination and Dopplerography, as a result of which you can:

• determine the amount of water in the fertilized egg;
• determine the degree of developmental delay of the child;
• assess the quality of blood flow in the uterine arteries of a pregnant woman, as well as in the umbilical cord and cerebral artery of the fetus.

1. general urine test, general blood test, smear for possible infections and other sexually transmitted diseases. These tests will exclude the possibility of infection of the fetus, as a result of which oligohydramnios develops;
2. CTG to determine the well-being and condition of the fetus.

In addition, it is extremely important to conduct an oral interview with the pregnant woman. The more honest her answers are, the faster the cause of oligohydramnios will be found out. It is important to clarify whether she abused any products, drank alcohol, or whether the pregnant woman smokes. The sooner the cause of oligohydramnios is determined, the sooner treatment can begin, which means saving the child.

If on early If oligohydramnios is diagnosed, the pregnant woman will need to undergo additional examinations throughout the entire gestation period to identify the amniotic fluid index (AFI). For each week, starting from 16, it is necessary to determine the AFI. The frequency of determination is 20, 30, 32, 34, 35, 36, 37, 38, 39 and 40 weeks of pregnancy (provided that birth by cesarean section does not occur at 37 weeks).

Treatment of oligohydramnios

Treatment methods for this disease may vary. It all depends on the severity of oligohydramnios, the reasons for its occurrence and the timing of pregnancy. For example, in case of metabolic disorders and obesity at 30 or 32 weeks, a woman is prescribed medications that normalize the activity of the placenta.

The doctor will also create a special diet. If the pregnancy is 33 or 34 weeks or more, then complex treatment is prescribed, which includes taking drugs that improve metabolism in the placenta, vitamins, and medications for the main cause of the disease.

Treatment can take place in two options: outpatient – ​​for moderate degrees of oligohydramnios, or in a hospital – if the degree of oligohydramnios is severe. Outpatient treatment consists of:

• restriction of physical activity,
• maintaining a gentle regime,
• excluding heavy physical activity,
• taking medications prescribed by the doctor,
• periodic visits antenatal clinic.

Typically, outpatient treatment is prescribed if a woman is in the second trimester of pregnancy. A woman is admitted to hospital if:

• if oligohydramnios is severe;
• if the amount of amniotic fluid is slightly below normal, but uterine tone is detected;
• oligohydramnios at 34–35 weeks of pregnancy and later.

If oligohydramnios is diagnosed, the doctor may prescribe a weekly ultrasound, starting at 34 or 35 weeks, fetal CTG and Doppler ultrasound. Such measures are extremely important in order to control the pathology. Then, if something goes wrong, you can take the necessary measures in time.

If oligohydramnios is severe and the severity of the pathology threatens the health of the child, then the doctor is obliged to take action and perform a caesarean section. In this case, early birth is possible only if the pregnancy is 33 weeks or more.

However, whenever possible, doctors try to do everything to maintain the pregnancy until at least 35 weeks, since the fetus is considered fully mature only at the end of the 36th week. But this does not mean that you need to refuse surgery at 34 or 35 weeks, since with oligohydramnios the fetus can be seriously damaged.

Condition of a woman with oligohydramnios

Oligohydramnios has serious consequences and has a negative impact on the course of pregnancy, resulting in painful sensations, which is especially pronounced during the period of active fetal movement. In addition, a small amount of amniotic fluid can lead to termination of pregnancy. There is a particularly high risk of miscarriage in the first trimester of pregnancy.

Regardless of the form of oligohydramnios (moderate or severe), complications during labor occur. This may manifest itself in the weakness of the birth process - minor contractions and weak attempts.

This occurs as a result of low pressure of the fetal bladder, which, due to its small size, is not able to influence the speed of preparation of the birth canal and dilatation of the cervix. If you are less than 34 weeks pregnant, you will have to have a caesarean section.

In such a situation, you may need to inject special drugs that stimulate contractions. This is especially important for periods over 35 weeks. In this case, the woman will be able to give birth herself.

Prevention of oligohydramnios

Because the consequences of oligohydramnios can be serious and difficult to treat, preventive measures are necessary. They consist of proper nutrition and in compliance with all medical recommendations. It is important to undergo examinations and tests on time. Lifting heavy objects is prohibited.