Is it possible to get rid of polyhydramnios during pregnancy. Polyhydramnios during pregnancy is a serious pathology requiring treatment.

The pathology of amniotic fluid, the most common of which is polyhydramnios, is an urgent, yet insufficiently studied problem in obstetrics. What does polyhydramnios mean and why is it dangerous during pregnancy?

It is a condition characterized by the presence of excess fluid in the amniotic cavity. This is considered to be a volume of more than 1.5 liters by the end of a full-term pregnancy, and in accordance with multiple foreign monographs - more than 2 liters. The frequency of this pathology among all births ranges from 0.3 to 1.2%. Usually, clinical symptoms appear when the volume of fluid is more than 3 liters.

The role of amniotic fluid and their source

The amniotic environment plays a huge role in ensuring normal growth and development of the fetus both during a physiologically proceeding pregnancy, and in conditions unfavorable for it - complications of pregnancy or mother's disease. Amniotic waters provide the growing fetus with the necessary free space, mechanical and noise protection, participate in maintaining its temperature balance, in gas exchange, nutrition and removal of metabolic products, in the formation of immunity and hormonal state.

In addition, in the last weeks of pregnancy and during childbirth, amniotic fluid is involved in the preparation of the birth canal for the passage of the fetus, protects the umbilical cord from compression and prevents blood flow disturbance in it.

Source of amniotic fluid formation on early dates pregnancy is not well understood. It is assumed that it is formed as a result of "wetting" (transudation) of the mother's plasma through the chorionic and amniotic membranes or of the fetus's plasma through its permeable skin.

The process of maintaining a balance between products is somewhat more studied. amniotic fluid and their resorption (reverse absorption) in the second trimester. The main source is the fetus itself - its alveolar fluid, which is secreted by the lungs up to 400 ml during the day, and urine, daily amount which by the end of pregnancy is already from 400 ml to 1.2 liters.

The decrease in fluid occurs in part due to a decrease in its production by the lungs as a result of their preparation for external respiration, swallowing it (at the 18th week - 200 ml) and further resorption through the epithelium of the lungs into the lymphatic vessels due to the difference in osmotic pressure between the fetal plasma and alveolar fluid . The intensity of fluid swallowing gradually increases to a volume of 500 ml at 40 weeks.

A decrease in fluid production by the alveoli of the lungs also occurs under the influence of the release of certain hormones and biologically active substances by the fetus, for example, vasopressin and catecholamines. In addition, its excess is partially removed due to the difference in osmotic pressure in the plasma of the mother and child.

What threatens polyhydramnios?

It poses a danger both to the fetus, the pregnancy itself, and to the mother. Often in the early stages it is accompanied by early toxicosis in the form of "vomiting of pregnant women" (in 36%), spontaneous abortions, malnutrition of the fetus and chronic hypoxia, intrauterine growth retardation are possible.

Polyhydramnios on later dates also contributes to intrauterine growth retardation. As a result of its excessive mobility, entanglement with the umbilical cord, the development of chronic asphyxia, the formation of an incorrect position in the uterine cavity (about 6%) in the form of a breech presentation or a transverse position are possible. Premature termination of pregnancy may occur, premature, which threatens not only the death of the fetus, but also massive bleeding.

Polyhydramnios in the last stages of pregnancy and during childbirth can lead to late (in 5-20%), early or premature outflow of water with prolapse of the umbilical cord, handle or leg of the fetus. Also, protracted labor is not excluded as a result of the development of weakness of the generic forces and the absence of contractions due to a decrease in the contractility of the uterus or its atony, the absence of attempts due to overstretching of the muscles of the abdominal wall. Often there are facial or breech presentation and fetal hypoxia, premature detachment of the placenta and other complications.

Possible consequences for the child, in addition to asphyxia and death (the stillbirth rate with polyhydramnios is an average of 10%), is intrauterine infection with septic complications, some delay in physical development, decreased immune defenses, susceptibility to respiratory diseases.

In the postpartum period, the recovery of a woman is longer. The danger is purulent and septic complications due to protracted labor and the need to provide obstetric benefits or surgical interventions, the possibility of re-bleeding.

Reasons for the development of pathology

Violations of the above processes can lead to an excess of amniotic fluid. Polyhydramnios can occur mainly in the following cases:

Intrauterine infection and the development of amniotic fluid infection syndrome. This reason is the most common. Moreover, the main percentage falls on infections that are sexually transmitted (chlamydia, ureaplasma, herpes simplex virus, etc.). The causative agents can also be mycoplasma, respiratory viral infections, infection with inflammatory diseases of the genitourinary system (colpitis, adnexitis, pyelonephritis, cystitis, etc.).
Diabetes mellitus (average 12%).
Incompatibility of mother and fetus according to the Rh factor and the development of hemolytic disease.
Much less frequently, polyhydramnios occurs during twin pregnancy, when feto-fetal hemotransfusion syndrome can develop, with abnormalities in the development of the fetus, especially abnormalities in the development of the digestive organs or the nervous system, with hereditary diseases, blood diseases, placental pathology.

The share of pathology with unexplained causes accounts for more than 60%. How to define polyhydramnios?

Signs of polyhydramnios during pregnancy

Depending on the nature of the course, this pathology is distinguished as:

Acute, which usually occurs in pregnant women with short terms - in the second trimester (ranging from 16 to 20 weeks).
Chronic, developing, as a rule, in the third trimester.

Acute polyhydramnios

Compared with chronic, it is characterized by a particularly unfavorable course. Its symptoms increase very quickly - within a few days or even a few hours. The pregnant woman complains of a rapid increase in the volume of the abdomen, a pronounced heaviness in its lower sections and in the perineum, sometimes on severe pain in the lumbar region and in the perineum, increased blood pressure. On general examination, the anterior wall of the abdomen was swollen and smooth with stretch marks, and the uterus was tense. On auscultation of the fetus, heart sounds are muffled and difficult to hear.

The death of the fetus or its birth with malformations is quite likely. In connection with acute placental insufficiency and premature detachment of the placenta, spontaneous abortion, life-threatening intrauterine bleeding (in 41%), uterine rupture or the threat of rupture are possible.

Chronic polyhydramnios

Chronic polyhydramnios in the third trimester of pregnancy is characterized by a gradual increase in volume amniotic waters and slow development. The prognosis largely depends on the severity of the pathology and the rate of increase in fluid volume. Sometimes, with a very slow increase in its number, it is quite difficult to recognize a pathology without an instrumental examination.

In the chronic course, the symptoms of polyhydramnios during pregnancy are less pronounced than in the acute course. There is no pain syndrome or the degree of pain intensity is insignificant. The diagnosis is made on the basis of subjective complaints, general examination and instrumental examination.

A woman may complain about:

excessive activity of the fetus;
shortness of breath even with slight physical exertion;
moderate heaviness, and sometimes pain in the abdomen;
heartburn and belching, especially after taking even a small amount of food;
palpitations and weakness;
persistent swelling of the legs;
the formation of stretch marks on the skin of the abdomen;

General examination reveals:

Increased density and its palpation.
Fluctuation in the abdomen (fluid fluctuations).
Excessive activity of the fetus, as well as its excessive mobility and unstable position on palpation.
Difficulty in identifying small fetal parts.
Muted or muffled fetal heartbeat.
Discrepancy (excess) of the results of measurements of the circumference of the abdomen and the distance from the womb to the fundus of the uterus (height of the state of the fundus of the uterus) for this gestational age.
Swelling of the legs and varicose veins.
On vaginal examination during childbirth - a tense fetal bladder, regardless of the presence or absence of contractions.

The severity of the pathology and its diagnosis

Depending on the volume of amniotic fluid, it is customary to distinguish three degrees of severity of the pathology:

I degree - 3,000 ml;
II degree - from 3,000 to 5,000 ml;
III degree - more than 5,000 ml.

Of particular importance is the diagnostic value of ultrasound. With its help, from 16 weeks, the index of polyhydramnios during pregnancy, which is called the amniotic fluid index (AFI), is calculated.

The method consists in mentally dividing the abdomen into 4 zones by means of two mutually perpendicular lines that intersect at the navel. Then, during ultrasound examination, the largest vertical pocket with liquid is selected in each zone and measured. The sum of the results obtained is the numerical value of the IAF, expressed in millimeters.

From the 16th week of pregnancy, its average value gradually increases and becomes maximum by the 27th week - 156 mm (the lower limit of the norm is 85 mm, the upper one is 245 mm), after which the average value decreases every week. For example, at week 32, the average IAI is 144 mm (76-269 mm), at week 33 - 143 mm (74-274 mm), and at 35 weeks - 140 mm (70-279 mm).

IAI values at the upper limit of the norm or slightly above it mean moderate or relative polyhydramnios, in which there is no threat to the fetus. This indicator is the most significant in terms of characterizing its functional state and development. Constant monitoring of IAI helps prevent the development of pathological complications in the fetus.

With the help of ultrasound, the state of the placental structure and the timeliness of its maturation are also determined. In addition, by conducting cardiotocography, the general condition of the fetus is checked, additional studies are prescribed to identify defects and anomalies in fetal development. How to treat a diagnosed pathology?

Polyhydramnios treatment

When establishing a diagnosis, it is necessary to hospitalize a woman in the department of pathology of pregnant women in order to clarify the diagnosis, identify the cause of the pathology and draw up a treatment plan. The tactics of treatment depends on the period of development of the pathological condition, the cause and the degree of its severity. The presence of anomalies of fetal development is an indication for termination of pregnancy.

In chronic polyhydramnios of I and II degrees, which develop in the third trimester, usually on an outpatient basis, treatment is carried out aimed at maintaining pregnancy and physiological delivery. With an unexpressed acute form and III degree of the disease after 28 weeks of pregnancy, it is necessary to carry out treatment before the onset of symptoms of fetal maturity (effectiveness is about 71%). The acute form of the pathology, which developed before the specified period, is an indication for termination of pregnancy.

Treatment includes a normal diet with limited intake of salt, spices, spicy and pickled foods, extractive dishes. Of the drugs, diuretics with potassium and magnesium preparations, antiviral, antibacterial drugs and antibiotics (mandatory) of a wide spectrum of action, as well as agents that improve microcirculation (Curantil, Actovegin) and vitamin complexes are prescribed.

In the acute form of pathology or the presence of a very large volume of fluid, a repeated one is sometimes indicated. The increase in the clinical picture of an increase in the volume of amniotic fluid against the background of ongoing therapy is an indication for early delivery.

The feasibility of using traditional medicine

Polyhydramnios treatment folk remedies it is not recognized by official medicine, since they contain unpurified components that can cause adverse reactions in the mother and, especially, in the fetus. In addition, they do not have a selective effect and a sufficient degree of effectiveness, which contributes to the loss of time required for treatment. It is only possible to use drugs that have a diuretic effect and vitamin supplements of plant origin, and only on the recommendation of a doctor.

Condition prevention

How to avoid polyhydramnios? Prevention consists in an additional examination of a woman planning a pregnancy in order to identify and treat chronic infections and diabetes.

In the antenatal clinic, pregnant women with RH-negative blood, diabetes mellitus, a history of fetal developmental anomalies, amniotic fluid pathology and chronic inflammatory diseases of the genital organs are at risk.

Polyhydramnios during pregnancy is a pathological condition in which the amount of amniotic fluid exceeds the levels considered normal for a certain period.

Amniotic fluid ensures the full intrauterine development of the unborn baby. They protect the fetus from external influences and enable it to move, participate in the metabolic process and prevent clamping of the umbilical cord. The amniotic fluid is regularly replaced (about every 3 hours) and gradually increases. If at week 10 the volume is approximately 30 ml, then in the prenatal period it is already 1-1.5 liters.

They talk about polyhydramnios when there is more than one and a half liters of fluid in the later stages.

Causes of polyhydramnios during pregnancy

The exact cause of polyhydramnios has not been established to date. There is an opinion that genetic (family) predisposition has a certain value. Allocate a risk group; in women included in it, this pathology of pregnancy is much more common.

Predisposing factors:

large size of the fetus;
multiple pregnancy;
kidney pathology;
Rhesus conflict;
infections;
pathology of the excretory system of the unborn child.

Note:the likelihood of developing a pathological condition increases with infection with viruses, and. Often leads to polyhydramnios.

Among the predisposing factors is a violation of the function of swallowing in the fetus. In the later stages, he absorbs up to 4 liters of amniotic fluid daily.

Symptoms

There are a number of clinical signs that make it possible to suspect polyhydramnios during pregnancy.

The following symptoms may appear:

Note:the cause of shortness of breath is the so-called "high standing" of the dome of the diaphragm.

According to the nature of the course, polyhydramnios is divided into acute and chronic. Of particular danger is the acute variant of development, most often diagnosed during II trimester. It is characterized by a sharp increase in the volume of water in a very short time - from several hours to 1-3 days. The circumference of the patient's abdomen at the level of the navel increases rapidly, and in the inguinal and lumbar region there is pain of medium or high intensity. During the examination, swelling of the abdominal wall and hypertonicity of the myometrium are determined.

In the chronic form, the volume of amniotic fluid increases gradually, but the likelihood of complications is also very high.

According to the severity of the course of the pathological process, mild, moderate and severe degrees are distinguished.

Consequences of polyhydramnios during pregnancy

Polyhydramnios during pregnancy in many cases leads to serious consequences, especially in the absence of early diagnosis and adequate medical care.

Possible complications of the pathological condition are:

spontaneous abortion (in almost 30% of cases);
(almost 40% of cases);
fetoplacental insufficiency;
early and massive discharge of water;
intrauterine malformations (most often the nervous system and gastrointestinal tract of the fetus suffer);
, oblique or transverse presentation;
premature detachment of the placenta;
childbirth ahead of time.

Fetoplacental insufficiency leads to a lack of oxygen by the fetus (), which can cause the death of the unborn baby or serious developmental disorders.

If a bacterial or viral infection has led to the pathology, the probability of infection of the fetus is high.

According to medical statistics, almost 20% of patients diagnosed with polyhydramnios develop late (preeclampsia).

Important:pathology can lead to weakening labor activity in the 1st and 2nd periods, since there is an overstretching of the uterine wall, which negatively affects muscle tone. During childbirth, against the background of a rupture of the fetal bladder and a massive outpouring of water, the umbilical cord or parts of the child's body may fall out. Often postpartum hemorrhage develops.

Diagnostics

The basis for suspicion of polyhydramnios is the data of the anamnesis (the presence of certain symptoms) and general examination (with measurement of the circumference of the abdomen).

During the examination, it is necessary to study the parameters of blood (and) and urine. In case of Rh-conflict, antibodies are examined.

The laboratory also examines the smear for the possible presence of pathogenic microflora.

During palpation, the tension of the uterus and the discrepancy between its size (increasing) and the gestational age are determined. The high mobility of the fetus is also characteristic; he is constantly trying to change his position.

Important:excessively free position of the fetus and its active movements often lead to entanglement with the umbilical cord, which is fraught with asphyxia.

Verification of the diagnosis is carried out in the course. With ultrasound, the largest area between the uterine wall and the fetus is measured, receiving the so-called. amniotic fluid index.

Table of indicators of amniotic fluid:

Among the very informative diagnostic methods are CTG (cardiotocography is needed to assess the condition of the fetus) and dopplerometry.

Treatment of polyhydramnios during pregnancy and prognosis

If mild or moderate severity is detected, obstetrician-gynecologists make every effort to keep the pregnancy up to physiological delivery. In severe cases, disorders of vital functions are possible, therefore, early (operative) delivery is often indicated to save the patient's life.

To determine the medical tactics, it is important to identify the factors that provoked the pathological condition.

If multiple pregnancy is due to infection, bacterial pathogens require(it is advisable to prescribe broad-spectrum drugs - Rovamycin or Erythromycin).

Important:during pregnancy, the use of tetracycline antibiotics is unacceptable!

According to indications, diuretics are prescribed (Hypothiazid, Furosemide), and and.

To improve uterine and placental blood flow, Actovegin and Curantil are recommended.

Note:pregnant women diagnosed with polyhydramnios should have daily cardiotocography, weight and blood pressure measurements. Ultrasound procedure and Doppler sonography to assess uterine and placental blood flow are performed at least weekly.

Polyhydramnios may be an indication for an abdominal amniocentesis procedure, during which a puncture is performed, followed by a slow removal of excess amniotic fluid (pumped up to 200 ml).

With a weakened labor activity, its drug stimulation is carried out.

With a mild degree, therapy can be carried out at home, but moderate severity is already becoming an indication for hospitalization.

The prognosis for the chronic form of polyhydramnios is quite favorable. If there are no contraindications, childbirth is carried out naturally.

To prevent a sudden rupture of the fetal bladder, they resort in advance to a puncture of the membranes - amniotomy. Through this procedure, the amniotic fluid is poured out in a thin stream, and the uterus contracts. In emergency cases, it is shown.

Polyhydramnios during pregnancy is a pathology with unpleasant consequences, bleak news for every expectant mother. By the name of the diagnosis, it is easy to guess that we are talking about amniotic fluid, when their volume exceeds all standard indicators. We will talk about the causes, clinical signs and outcome of this condition further.

The importance of amniotic fluid in the fetal bladder for the formation of a future person can not be overestimated. The specific fluid creates optimal conditions for the growth of the embryo for the next 9 months. It protects the baby from the influence of environmental factors and mechanical shocks, allows him to move without any constraint. In addition, the liquid medium simplifies the process of intrauterine nutrition and prevents even a slight clamping of the umbilical cord.

Polyhydramnios during pregnancy. The dynamics of the development of amniotic fluid after conception

Amniotic fluid is a very mobile substance that changes regularly. Their volume is determined by the term of the "interesting" position. At 11 weeks, by the way, the fetal bladder contains 30 ml of fluid, and after 1 month its volume is already 100 ml. After 36 weeks, the water norm is approaching the mark of 1.0 - 1.5 liters. If at any stage of the intrauterine life of a child, the indicators of the liquid environment of its habitat exceed the extreme limits, the pregnant woman most likely has polyhydramnios.

Causes of polyhydramnios during pregnancy

Despite the prevalence of the problem among pregnant women, reliable and objective reasons for its development have not yet been clarified. However, scientists name a number of circumstances that indirectly affect the abnormal change in the volume of amniotic fluid:

The pregnant woman has diabetes.
The patient was diagnosed with a disease caused by an infection.
In the anamnesis of the pregnant woman there is information about diseases of the heart or kidneys.
Incompatibility of mother and child on the Rh factor of blood.
A woman carries several babies (it often happens that one fetus is in conditions of polyhydramnios, and the second has severe oligohydramnios).
The fruit is too big.
Weak excretory function in the baby.
The child does not swallow amniotic fluid correctly (shortly before birth, a fully formed fetus should normally "drink" about 4 liters of amniotic fluid, and the aquatic environment should be restored every 3 hours).
The growth of the crumbs is associated with anomalies in development.

Symptoms of polyhydramnios during pregnancy

A number of eloquent signs suggest a suspicion of a pathology in a patient of doctors. The same signs should alert the expectant mother herself and become the basis for an urgent visit to the antenatal clinic:

Persistent heaviness or painful discomfort in the pubic region.
General malaise.
The appearance of shortness of breath.
Rapid pulse.
Systematic swelling of the lower extremities.
Large abdominal circumference along the navel line (100 - 120 cm).
"Decoration" of the skin with coarse striae.
Expressive "gurgling" in the stomach.

What is polyhydramnios during pregnancy

According to the specifics of the symptoms and the well-being of a woman with polyhydramnios, several forms of pathology are distinguished.

acute form

The volume of amniotic fluid grows rapidly in volume. The process has a rapid development - in a few hours or days. Outwardly, this is manifested by a sharp increase in the abdomen of the pregnant woman and the appearance of pain covering the lumbar and inguinal region. On this basis, the uterus is fettered by a strong tone, and edema appears on the anterior abdominal wall. At the same time, the pregnant woman does not have enough air for free breathing. It is very difficult to listen to the fetal heartbeat. The consequence of acute polyhydramnios during pregnancy may be uterine rupture.

Chronic form

With this form of pathology, the volume of fluid around the fetus grows steadily, but there is still a danger to the condition of the mother and child. Due to the lack of a pronounced clinical picture, the diagnosis of an anomaly is rarely timely. Usually, chronic polyhydramnios develops during late pregnancy. The expectant mother has already managed to get used to the next discomfort, which brought her the 3rd trimester of pregnancy, so she will not be able to note the alarming "bells" that indicate a deviation. Most often, chronic polyhydramnios accompanies viral diseases, infectious lesions of the genitals, inflammation in the kidneys and ovaries, cardiovascular pathologies and diabetes mellitus.

moderate form

It happens that in the chronic form of pathology, the diagnosis is clarified to moderate polyhydramnios during pregnancy. Experts make such a verdict if the indicators of the volume of amniotic fluid deviate from the norm slightly and not sharply, while the woman feels satisfactory and does not complain about anything. In most cases, with moderate polyhydramnios, there is a chance for a calm childbearing and natural delivery.

Sometimes a pregnant woman is informed on ultrasound about polyhydramnios with a suspension, and not knowing what it is, future mom may get flustered. However, this diagnosis can not always be taken for pathology. Suspension in most cases is desquamated fragments of the epithelium and particles of a protein nature. These substances do not pose any danger to the mother and fetus. A doctor may suspect a deviation when the suspension looks like large flakes. If in the process of further research it turns out that the nature of the flakes is meconial, then in the presence of concomitant symptoms, there is reason to talk about fetal hypoxia. This condition requires further research and medical correction.

Diagnosis of polyhydramnios during pregnancy

An experienced gynecologist can diagnose polyhydramnios in a pregnant patient even before an ultrasound scan. The specialist focuses on the following signs:

the height of the fundus of the uterus is 3 cm above the norm;
the uterus, when palpated, seems soft and unsteady;
parts of the fetus are difficult to feel;
the fetus is overly active, and its heartbeat is hard to listen to.

What is the danger of polyhydramnios during pregnancy

Exceeding the extreme indicators of the volume of amniotic fluid has many negative consequences for the intrauterine development of the baby, and therefore requires close attention of physicians. So, what should be feared if the diagnosis of "polyhydramnios" was confirmed?

Spontaneous termination of pregnancy (more than 28.5% of pregnant women).
Severe vomiting causing dehydration of the body (in 36% of cases).
The development of fetoplacental insufficiency, which entails chronic hypoxia of the fetus, in extreme cases - its death.
Anomalies in the development of the central nervous system and gastrointestinal tract defects in a little man.
If polyhydramnios is based on an infection, there is a high risk that the baby will become infected from the mother.
Massive bleeding (in about 38.4% of cases).
Severe late preeclampsia (5 - 20% of cases).
Early outflow of amniotic fluid, which threatens premature birth and prematurity of the child.
Prolapse of a loop of the umbilical cord or one of the limbs is another unpleasant and dangerous consequence of polyhydramnios during pregnancy for a child.
Repeated entanglement of the umbilical cord with the neck or other part of the fetal body due to its high activity.
Unfortunate position of the child in the uterus (transverse, oblique, gluteal) for natural childbirth, and this is a real indication for operative delivery through caesarean section.
Lack of full-fledged contractions due to excessive stretching of the uterus.
Premature aging of the placenta.
Placental abruption.
Massive bleeding after childbirth.

Treatment of polyhydramnios during pregnancy

When the ultrasound procedure does not leave the diagnostician with the slightest doubt, and the verdict "polyhydramnios" is confirmed, the attention of doctors to the state of health of the expectant mother will double. With a mild and moderate degree of pathology, doctors will undoubtedly be able to save the fetus and bring it to the full completion of intrauterine development. If the situation of the expectant mother is complicated by an acute form of polyhydramnios, she may have to go through the procedure for early operative delivery, as the current situation threatens her life.

While preserving the fetus, the doctor who controls the pregnancy will try to find out the reasons that provoked the development of polyhydramnios, and only after that will prescribe the appropriate treatment. A pregnant woman must completely trust the doctors, otherwise the pathology can cause an exacerbation of chronic hypoxia of the unborn child.

Drug correction of viral polyhydramnios during pregnancy primarily involves therapy with broad-spectrum antibacterial drugs, to which a course of immunomodulators can be connected (depending on the characteristics of the etiology of the pathological condition). Also, to stabilize the condition of a pregnant woman, diuretic drugs and vitamins are used (for example, Hypothiazide in combination with B vitamins).

Childbirth with polyhydramnios

Labor activity with polyhydramnios in most cases occurs prematurely. The fetal bladder bursts suddenly, as a result of which there is a sharp and abundant outflow of amniotic fluid. At this point, a complication may develop in the form of prolapse of the umbilical cord, handle or leg of the fetus. The sooner the waters break, the more weakened will be the labor activity of a woman. Sometimes there are no fights at all. Recall that in childbirth with polyhydramnios can be associated with some complications, including:

placental abruption;
heavy bleeding after childbirth;
"unsuccessful" intrauterine position of the child in the womb (for example, buttocks down).

To prevent the development of such complications and delay the premature rupture of amniotic fluid, doctors resort to the amniotomy procedure, which consists in puncturing the fetal bladder. After a puncture, the amniotic fluid flows out in a thin stream, the uterus contracts, and contractions intensify. The effect, it should be noted, is positive, however, most often doctors prefer to resolve the issue of childbirth with polyhydramnios through a caesarean section.

Prevention of polyhydramnios during pregnancy

Why polyhydramnios occurs during pregnancy is still not known for certain, so it is impossible to say exactly what precautions should be taken to avoid this pathology. However, expectant mothers should, in any case, regularly undergo all scheduled examinations in order to detect any deviations from the norm in time.

Also, during pregnancy, a woman should pay great attention to her diet and drinking regime, every day to be in the fresh air and give preference to walking. Need to limit physical activity to give up unreasonable experiences and negative emotions. The most effective preventive measure is cooperation with the doctor who leads the pregnancy - if you obey the specialist in everything, the birth will be successful and the baby will be born healthy.

About polyhydramnios during pregnancy firsthand. Video

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Pregnancy is undoubtedly the happiest period in a woman's life, but even he can sometimes be overshadowed by all sorts of troubles and pathologies. One of these pathological conditions during pregnancy is polyhydramnios, which must be treated.

The composition of amniotic fluid changes throughout pregnancy, so it is important to monitor their amount in each trimester.

Polyhydramnios is the appearance of an excess amount of amniotic fluid, significantly exceeding the norm. The diagnosis of polyhydramnios can put a woman on the most different terms pregnancy. These complications occur in 1 in 100 pregnancies.

In the normal course of pregnancy, the necessary amount of amniotic fluid is formed for the development of the fetus, approximately 1000-1500 ml. The amniotic fluid consists of 97% water, which contains proteins, calcium, chlorine and sodium salts. Thus, the baby receives oxygen, necessary nutrients and reliable protection from the external environment. Also, the embryo can calmly move and swim in the mother's abdomen, make movements with the limbs.

Amniotic fluid is the environment in which the fetus develops. The water temperature is 37 degrees.

Properties of amniotic fluid:

The amniotic fluid protects the embryo from impact and shock. In addition, the noise coming from the outside world is also muffled.
Amniotic fluid protects the umbilical cord from being squeezed between the wall of the uterus and the fetus.
Amniotic fluid helps reduce pain during labor.
They help open the cervix during childbirth.
The bubble, in which the fetus and amniotic fluid are located, creates an airtight shell into which nothing can enter from the outside.
Amniotic fluid contains immunoglobulins.

The amount of amniotic fluid changes every week. Therefore, for each trimester of pregnancy, there are rules. At the very beginning of pregnancy, the amount of amniotic fluid is approximately 30 ml. At 23 weeks, the amount of amniotic fluid is about 600-700 ml. By 30, 32, 33 and 34 weeks, this figure is approximately 600-900 ml. By week 36, the amount of water already increases to 1000. At 37 and 38 weeks of pregnancy, the amount of amniotic fluid becomes maximum. At 39 weeks and closer to the birth itself, there is a decrease in amniotic fluid to 800 ml.

In the presence of some predisposing factors, the amount of water may decrease or increase. When amniotic fluid less than normal, then this condition is called oligohydramnios. Oligohydramnios is also a pathology and affects the development of the fetus and the condition of the pregnant woman.

Causes of polyhydramnios

Although the causes of polyhydramnios are not yet fully understood, there are some factors that contribute to the occurrence of this pathology.

Polyhydramnios during pregnancy can occur due to such reasons:

pathology of fetal development;
infectious diseases of a pregnant woman;
bacterial infection;
diseases of the cardiovascular system;
Rhesus conflict between mother and fetus;
metabolic disease;
diabetes;
pyelonephritis;
multiple pregnancy;
large fruit.

Types of polyhydramnios

This condition in a pregnant woman can proceed in different ways: in an acute form or a chronic form. There may be severe or moderate polyhydramnios.

The acute form is characterized by a violation of the general condition of the pregnant woman and the fetus. Such childbirth, as a rule, ends in miscarriage, stillbirth, or such a child will have developmental defects. Polyhydramnios appears in an acute form, usually starting from the 16th to the 24th week. Sometimes the amount of amniotic fluid can increase even within a few hours. In this case, immediate medical attention is required, in view of the dangerous condition.

Moderate polyhydramnios during pregnancy is characterized by a gradual increase in symptoms and signs. Moderate polyhydramnios can lead to the birth of a child with developmental anomalies. This is due to the constant lack of oxygen. Very often, moderate polyhydramnios occurs in a chronic asymptomatic form, and therefore can go unnoticed for a long time.

Signs of polyhydramnios

Sometimes a pregnant woman herself may suspect polyhydramnios, by the presence of some signs characteristic of this condition.

The belly of a pregnant woman with an excess amount of amniotic fluid reaches a circumference of more than 100 cm. It has a slightly rounded shape. There is a feeling of heaviness in the abdomen and back. The uterus increases in size and begins to squeeze the internal neighboring organs. Therefore, as a consequence, a pregnant woman often has shortness of breath and other ailments.
Lower limbs may swell. In some cases, early rupture of amniotic fluid may even occur.
A fluctuation appears: in a pregnant woman, gurgling in the abdomen is quite clearly audible. There are pains in the perineum.
A large number of stretch marks appear on the abdomen.
The pregnant woman's pulse quickens. The fetal heartbeat is weakly audible.
Since there is more free space, the fetus takes the wrong position in the uterus (pelvic, oblique). This is directly reflected in the childbirth itself: the stretched uterus contracts incorrectly and childbirth with polyhydramnios will be characterized by weak labor activity.

Polyhydramnios is also dangerous because the child can wrap around the umbilical cord. Hypoxia may develop, the fetus will receive less oxygen. Even if the birth takes place on time, the fetus may have intrauterine pathology, such a child may be born with a developmental disorder internal organs or systems.

It should be remembered that the earlier polyhydramnios appears in a woman, the more amniotic fluid accumulates and the risk of complications increases.

Moderate polyhydramnios

The diagnosis of moderate polyhydramnios is made when the amount of amniotic fluid is approximately 1.5 or 2 liters. And although such a diagnosis is made even in the first trimester of pregnancy, it is possible to seriously talk about the presence of pathology only starting after the 16th week. The cause of this condition is often the Rh-conflict of the mother and fetus or the presence of infections.

A woman with moderate polyhydramnios feels tension in the abdomen. It becomes more elastic. When you feel the fetus, you will notice that it often changes its position. You can hear the rolling of water in the stomach. The uterus increases in size and becomes edematous.

You can determine moderate polyhydramnios at a scheduled ultrasound examination or at an examination. Moderate polyhydramnios is characterized by early labor and placental abruption.

A pregnant woman with moderate polyhydramnios should be constantly under the supervision of specialists, as sometimes it happens that this diagnosis is erroneous or is temporary.

In the absence of a serious pathology, the doctor tries to keep the pregnancy and that the birth takes place naturally without artificial intervention. Conservative treatment is prescribed: vitamins, hypothiazide. If necessary, antibiotic therapy is carried out.

Polyhydramnios at the end of pregnancy

Polyhydramnios at the end of pregnancy is approximately 0.6% of all other pathologies. Its appearance may be caused by late toxicosis. This threatens with serious complications during childbirth:

prolapse of the umbilical cord;
oxygen starvation of the fetus;
weakness of labor activity.

Therefore, such a diagnosis is an indicator for carrying out. Treatment of such polyhydramnios is carried out depending on the cause.

Diagnosis of polyhydramnios

You can diagnose polyhydramnios at an examination by a gynecologist at an appointment in a antenatal clinic. To do this, the doctor examines the pregnant woman for the presence of relevant signs. Most reliable method The diagnosis of polyhydramnios is an ultrasound examination. Doplerometry is also prescribed. Thus, it is possible to identify a more accurate amount of amniotic fluid, check the blood flow in the umbilical cord and placenta.

A thorough examination of the fetus allows you to identify possible anomalies in its development.

Polyhydramnios can be diagnosed using the "amniotic index". There is a special table that allows you to determine the amount of amniotic fluid is normal in a certain trimester of pregnancy.

If the diagnosis is confirmed, then the woman is sent for an additional examination of the fetus.

Consequences

With polyhydramnios, the following consequences are possible:

or termination of pregnancy;
fetal death or developmental defects;
if an infection becomes the cause of polyhydramnios, then there is a possibility of infection of the fetus;
prolapse of the umbilical cord or handle (leg) of the fetus during childbirth;
the presenting part of the fetus does not fall during childbirth or is not fixed;
malposition.
bleeding;
various gestoses.

Treatment

The main treatment for the diagnosis of polyhydramnios is aimed at eliminating the cause that caused this pathology. First, the expectant mother surrenders everything necessary tests confirming the presence of polyhydramnios: fetal cardiotocography, ultrasound examination, blood test for the Rh factor, dopplerography and others.

As a rule, complex treatment is carried out. In case of moderate or unexpressed pathology, the pregnant woman is prescribed drug therapy. Depending on the condition of the woman, treatment can take place in a hospital or at home (outpatient). This condition does not require termination of pregnancy or delivery.

Diuretics (diuretics), vitamins and antibiotics are prescribed. Antibiotics are necessary to fight microorganisms, since the main cause of polyhydramnios often lies in the infectious process. Also, starting from 24 weeks and up to 38, indomethacin is prescribed.

If the prescribed treatment does not help or polyhydramnios takes a severe form, then the doctor prescribes early delivery. They use medications that help artificially induce labor.

During artificial delivery, it is necessary to carefully open the membranes, and gradually release the amniotic fluid so as not to cause fetal asphyxia. This procedure is carried out using a thin catheter. Measures are taken to prevent prolapse of the umbilical cord or limbs of the fetus.

Medicines to stimulate labor should be used no earlier than 2 hours after the outflow of amniotic fluid.

In the early stages, when it is impossible to carry out delivery, amniotic fluid is released. Amniotic fluid helps the baby move through the birth canal, regardless of the artificial or natural opening of the fetal bladder. But this should be done carefully so that the umbilical cord does not fall out.

If the fetus has malformations that are incompatible with life, then for up to 28 weeks, an abortion is performed.

childbirth

If polyhydramnios does not affect the condition of a pregnant woman or her fetus, then in this case, childbirth is carried out naturally. Mandatory procedure in this case: artificial opening of the fetal bladder. In this case, the volume of the uterus decreases, and this helps to make contractions more productive. Often such childbirth is delayed, and then there is a need for rhodostimulation. Rhodostimulation is carried out by the introduction of labor-accelerating drugs. And already as the most extreme remedy, a caesarean section is performed.

The postpartum period may be complicated by bleeding due to poor uterine contractility. Therefore, the woman is prescribed the introduction of reducing drugs, such as oxytocin and methylergometrine.

Prevention of polyhydramnios

Since polyhydramnios is a pathology, this condition can be avoided if precautions are taken.

It is very important to immediately exclude the presence of an Rhesus conflict. During pregnancy, a woman should move as much as possible. It is necessary to calculate the amount of fluid taken. It also does not hurt to adjust the diet a little.

To prevent polyhydramnios, the expectant mother should take vitamin complexes or medications prescribed by a doctor.

It is necessary to undergo all examinations and analyzes on time, as they will help to identify a pathology or deviation in the development of the fetus even at the earliest stages.

In this case, you can avoid severe consequences during childbirth and in the postpartum period. It is important to remember that regular examinations by an obstetrician-gynecologist are not just a formality, but a vital necessity on which the condition of the baby depends.

Useful video

Polyhydramnios is a pathology of pregnancy characterized by the accumulation of excess amniotic fluid in the uterus. The anomaly occurs in 0.3-1.2% of women. Who and under what circumstances does it develop and how to treat it?

Formation and role of amniotic fluid

After fertilization, the egg is implanted in the uterus, where the embryo begins to form. Already at the 2nd week of pregnancy, an amniotic bladder is formed, filled with amniotic fluid. In the early stages of embryo development, the mother's circulatory system produces fluid, and then the baby's lungs take part in its production.

Amniotic fluid is 97% water with minerals, proteins and other beneficial substances dissolved in it. In the 1st trimester, vitamins and minerals “penetrate” the fetus through the skin, and then through the digestive organs, when the baby swallows liquid.

The volume of amniotic fluid throughout pregnancy is not the same: the increase occurs abruptly and by the 36th week its secretion ends. In addition to delivering nutrients and oxygen from the mother to the baby, the liquid performs a number of important functions:

provides normal development the fetus (protects it in case of mother's illnesses, complications of pregnancy, etc.);
maintains temperature;
removes metabolic products;
provides a comfortable environment by suppressing noise from the outside world and shock absorption;
due to the presence of immunoglobulins creates a barrier against infections;
prevents squeezing of the umbilical cord;
reduces pain during childbirth, helps in opening the cervix.

The qualitative characteristics of amniotic fluid and their volume are important for the development of the embryo. From the 2nd half of pregnancy, doctors constantly monitor these indicators.

Causes of pathology

The causes of polyhydramnios in 60% remain unknown. Amniotic fluid is constantly updated: the fluid is swallowed by the child and absorbed by the amniotic bladder, as a result of which its volume decreases. In parallel, it is produced by the placenta, and is also formed from the urine and lung fluid of the baby. A failure in one of the links in this process leads to fluid hypersecretion. The cause of the pathology may be:

infection of amniotic waters due to maternal diseases (chlamydia, ureoplasmosis, cystitis, colpitis, SARS, etc.);
Rhesus conflict;
malformations of the vital systems of the embryo;
splitting of the upper lip or palate in a child;
large fruit;
improper functioning of the placenta due to defects in its development;
prolongation of pregnancy and late toxicosis;
anemia;
kidney disease.

There is a tendency to polyhydramnios in patients with diabetes mellitus. If the anomaly appeared against the background of this disease, the possibility of having a baby weighing more than 4 kg increases significantly.

Polyhydramnios almost always accompanies multiple pregnancy. Two babies excrete twice as much fluid, so the total volume of water will be increased. This condition is physiological if it is not associated with any pathologies.

The danger and consequences of polyhydramnios

The danger of polyhydramnios depends on its cause. In the early stages, this condition threatens pregnant women with late toxicosis, spontaneous abortion, increased pressure and the appearance of edema due to squeezing of the vessels by the swollen uterus.

For a baby, polyhydramnios is dangerous due to constant oxygen starvation, intrauterine infection, decreased immunity and developmental anomalies. Severe hypoxia in 10% of cases can lead to fetal death.

Polyhydramnios in the last stages of pregnancy can lead to asphyxia of the child - due to its increased mobility, which is not characteristic of the third trimester, entanglement of the umbilical cord may occur. In 6% of cases, the child is incorrectly located in the uterus - across it or with the buttocks to the pelvis.

Polyhydramnios in the last weeks of pregnancy is dangerous with unpredictable consequences, including preterm delivery (30% of cases), early release of amniotic fluid, and prolapse of the baby's limbs or umbilical cords. Due to the strong stretching of the muscles of the peritoneum and uterus, contractions may stop.

The consequence of polyhydramnios after delivery may be bleeding due to poor uterine contractility. Complications are possible due to prolonged labor.

Symptoms of polyhydramnios

A pregnant woman may assume the presence of polyhydramnios by the following signs:

fast weight gain;
chronic weakness;
heaviness in the abdomen;
heartburn;
the appearance of striae on the abdomen;
increase in heart rate;
swelling of the legs and the appearance of a vascular network;
shortness of breath after even a short walk;
gurgling in the stomach.

It is impossible to independently diagnose this pathology - a doctor's consultation is required. In addition to the analysis of symptoms, he conducts an examination, which reveals:

uterine hypertonicity;
fluid fluctuations in the abdomen;
muffled sound of the fetal heartbeat;
difficulties with palpation of the fetus;
excessive mobility of the baby and its unstable position when you press on the stomach.

Polyhydramnios in the later stages is characterized by an ongoing tone of the uterus, abnormal activity of the child, and back pain that increases with the movement of the baby. A woman's urine production is reduced, but the urge to urinate and defecate becomes more frequent.

The severity of the pathology

There are two types of pathology:

Acute polyhydramnios, in which the volume of amniotic fluid increases in just a few hours. The anomaly is typical for 16-18 weeks of gestation, can cause miscarriage, serious anomalies in the development of the baby, stillbirth and complications after delivery.
Chronic polyhydramnios - the anomaly develops gradually (usually it is determined in the middle of the 3rd trimester) and is accompanied by mild symptoms. The probability of a favorable outcome and the birth of a baby on time is very high.

The severity of the pathology depends on the volume of fluid:

light - up to 3 l;
medium - 3-5 l;
heavy - more than 5 liters.

There is also such a thing as moderate polyhydramnios. The condition is diagnosed quite often, but is not considered pathological, since it is not a consequence of the diseases of the pregnant woman. A woman may feel slight tension in the abdomen and feel the constant activity of the baby.

Doctors determine the tendency to polyhydramnios if the amount of fluid deviates slightly from the norm, and the patient has no complaints. An increase in their volume to 3000 ml is considered moderate. If there are more of them, the pathology is already considered severe and is accompanied by characteristic symptoms.

Diagnosis of polyhydramnios

Polyhydramnios can be determined by ultrasound. There are two diagnostic methods:

Calculation of the amniotic fluid index. When performing the procedure, the abdomen is divided into 4 squares with the center at the navel, and in each of them the depth of the liquid pocket is calculated. The data during the examination are recorded in millimeters and compared with the norms from a special table. From the 16th week of pregnancy, the values begin to rise and reach a maximum by the 27th week.
Calculation of the largest pocket of amniotic fluid, which at the time of the study is not occupied by the baby or the umbilical cord. With an indicator of more than 8 cm, polyhydramnios is diagnosed.

To clarify the diagnosis and find out the causes of the pathology, additional studies are prescribed:

screening for suspected gestational diabetes;
amniocentesis (taking amniotic fluid for research);
blood chemistry;
cryotyping to detect genetic abnormalities of the fetus;
cardiotocography (rarely prescribed).

Methods of treatment and diet

In a severe form of pathology, the patient requires hospitalization. For a period of more than 28 weeks, treatment will continue until the fetus matures. Moderate polyhydramnios during pregnancy also requires therapy, otherwise premature birth, hypoxia, and sometimes lagging behind the child in development cannot be avoided. There are cases when a moderate-type pathology goes away on its own, but this is an exception to the rule, not a pattern. Treatments often used include:

A drug	Action
No-shpa, Magnesia	Relief of pain syndrome
Ginipral, Partusisten	Improvement of metabolism and placental circulation, removal of uterine hypertonicity
Diuretics, such as Furosemide (we recommend reading:)	Reducing the volume of amniotic fluid
Vilprafen (antibiotic often used for urogenital infections), Ceftriaxone (broad spectrum drug)	Destruction of pathogenic microorganisms during inflammation
Actovegin	Normalization of oxygen, glucose metabolism
Vitamins C, B and E	Stabilization of the body and raising immunity

Antibiotics are prescribed regardless of whether an infection has been identified, since infectious diseases are a common cause of the development of an anomaly. Most patients, after undergoing therapy, give birth on their own at the scheduled time.

In addition to treatment, a woman is prescribed a diet: products containing in large numbers protein, dairy products, salt intake is limited, the amount of fruits and vegetables in the diet is increased. Proper nutrition is especially important if you are overweight, because you can easily “feed” the baby, and a large child is one of the growth factors in the volume of amniotic fluid.

With a severe degree of polyhydramnios, amniocentesis is done - the removal of 200 ml of water from the uterus. If treatment fails, a caesarean section is performed.

How does childbirth go with polyhydramnios?

Childbirth begins suddenly with a sharp outpouring of water, so often the patient is placed in a hospital in the last weeks of pregnancy. To avoid incorrect discharge of water and weakening of contractions, obstetricians sometimes resort to perforation of the fetal bladder. The gradual release of fluid provokes uterine contractions.

Childbirth usually takes place with complications, contractions may be completely absent or randomly appear and disappear. To strengthen them, obstetricians use stimulant drugs. If a woman before 36 weeks is found to have an oblique or transverse position of the baby in the uterus, the gynecologist makes an obstetric turn. An emergency delivery can be performed at 37-38 weeks if the woman is undergoing treatment, but it does not work.

Preventive measures

There are no specific measures to prevent polyhydramnios. However, a woman can minimize the risks of developing pathology by following the recommendations:

pregnancy should be planned by undergoing examination with a partner;
in the presence of chronic ailments (including infectious ones), it is necessary to achieve their stable remission before conception;
with diabetes, you need to control the level of insulin;
woman with Rh negative anti-D immunoglobulin should be administered during pregnancy;
the patient needs to be registered with a gynecologist in a timely manner, not to miss examinations and ultrasound;
a pregnant woman should eat fully, eating wholesome food in the prescribed amount.