Oligohydramnios during pregnancy: causes and consequences. Signs and treatment of pathology

Amniotic fluid is the baby's habitat. It protects it from damage, regulates body temperature and is involved in metabolism. The volume of fluid for each stage of pregnancy is different. The largest value is recorded at 33-, and it approaches 1000 ml.

It has also been noted that children born to women with oligohydramnios have reduced adaptive abilities and an increased risk of developing infectious complications in the postpartum period.

Why is oligohydramnios dangerous during pregnancy? Consequences for the child

Severe oligohydramnios can lead to serious complications. Due to a lack of amniotic fluid, adhesions form between the baby's skin and the amnion. As they grow, they become like threads and cords that can compress the umbilical cord, which will cause intrauterine oxygen deficiency. Very rarely, such connective tissue strands can entwine parts of the body and lead to deformity or amputation of a limb.

Oligohydramnios can negatively affect the birth process and lead to complications affecting the baby:

• primary weakness of labor due to the absence of the amniotic sac;
• intrauterine oxygen starvation of the fetus;
• incorrect position of the child;
• umbilical cord compression and fetal death.

It is also possible to develop postpartum hemorrhage due to remaining placental tissue or membranes in the uterus.

Moderate oligohydramnios during pregnancy

The percentage of decrease in amniotic fluid may vary. The moderate form is diagnosed when amniotic fluid is less than 500 ml in late pregnancy, but more than 300 ml. This situation can be corrected. Moderate oligohydramnios does not require hospitalization.

Oligohydramnios is considered pronounced when the amount of water decreases to less than 300 ml (according to some sources, less than 200 ml). This is a serious condition that must be treated in the pregnancy pathology department.

Also, oligohydramnios can have an acute or chronic course, depending on the rate of development and duration of existence.

Signs of oligohydramnios during pregnancy

You can suspect the development of oligohydramnios on your own without an ultrasound based on some external signs. At each visit to the gynecologist, the pregnant woman has her abdominal volume measured in the supine position and the height of the uterine fundus. These indicators should constantly increase as the child grows. If there is a lag in their value, then oligohydramnios can be suspected.

Fetal activity is also important in diagnosis. A pronounced decrease in mobility, a small and weak number of movements speaks in favor of oligohydramnios. During childbirth, oligohydramnios manifests itself as a flat amniotic sac, which stretches over the fetal head and does not perform its shock-absorbing function.

Diagnosis of the condition begins with an ultrasound. The amniotic fluid index is used to determine oligohydramnios. This is a calculated indicator that is based on measurements of amniotic fluid pockets. The pregnant woman's abdomen is conventionally divided into 4 quadrants by two lines. One runs vertically along the white line of the abdomen, and the second perpendicular to it through the navel.

Then, using the apparatus, the depth of the largest pocket of liquid in each quadrant is measured, the resulting values ​​​​from 4 measurements are added. The result is compared with a special percentile table. It contains data on the normal amount of water for each week of pregnancy. A deviation below the 5th percentile is considered oligohydramnios. If the value is below the 2.5 percentile, then severe oligohydramnios is diagnosed. It requires a particularly careful study of the fetus.

Laboratory research methods help determine the cause of oligohydramnios. It is necessary to carry out PCR diagnostics for TORCH complex infection. If chromosomal pathologies are suspected, amniocentesis and subsequent karyotyping are performed. Consultation with a geneticist is also necessary.

Oligohydramnios during pregnancy: causes

It is not always possible to determine the exact cause of oligohydramnios. But most often the following pathological conditions are considered a tendency to its occurrence:

• diseases of the pregnant woman: chronic pathology of the cardiovascular system, kidney disease, collagenosis;
• pathology of the placenta: multiple infarctions, developmental anomalies and insufficiency;
• congenital malformations of the fetus: underdevelopment or stenosis of the urethra, posterior urethral valve, disruption of the formation or junction of them with the renal pelvis, underdevelopment of the kidneys or multiple cysts;
• intrauterine infection;
• chromosomal diseases of the fetus;
• intrauterine growth retardation;
• antenatal death;
• leakage due to premature rupture of membranes;
• post-term pregnancy;
• iatrogenic oligohydramnios caused by taking prostaglandin synthetase inhibitors: Aspirin, Ibuprofen, Indomethacin, Naproxen;
• oligohydramnios for an unknown reason.

Given the possibility of developing oligohydramnios, especially in the 3rd trimester, it is not recommended to take non-steroidal anti-inflammatory drugs for pregnant women.

What should you do if oligohydramnios is detected?

The doctor’s tactics when detecting oligohydramnios depend on the condition of the fetus. If a moderate decrease in the amount of water is combined with the normal development of the child, then the pregnancy is prolonged until the moment, but dynamic monitoring of the woman’s condition is required.

A pronounced acute decrease in the volume of amniotic fluid in the 2nd trimester, combined with delayed development of the child, is an indication for abortion. If pathology is detected or developed after, then an examination is necessary to assess the feto-placental complex and the condition of the child. In case of congenital defects or developmental delay, it is recommended to terminate the pregnancy for medical reasons: the outcome of pregnancy with such a combination of pathologies is impossible to predict. Drug therapy with a normal amount of water is effective in 72% of cases, and with oligohydramnios only in 12% of pregnant women.

Nutrition

Treatment involves changing the nature of nutrition and a salt-free diet. The amount of salt is significantly reduced. It is optimal to prepare dishes without it, adding salt little by little directly into a portioned plate.

The diet is enriched with a large number of foods containing potassium: melon, raisins, grapes, dried apricots. Helps correct pathology of apricots, apples, zucchini,... To stimulate the kidneys, fresh kefir and herbal decoctions of chokeberry and lingonberry leaves are recommended.

Treatment of oligohydramnios during pregnancy

In the treatment of pathology of the feto-placental complex, Trental is used. It improves blood microcirculation, helps cope with hypoxia and malnutrition of the fetus. Actovegin and Curantil are used simultaneously. Their action is aimed at maintaining the function of the placenta and preventing its pathological changes.

If there are signs of fetal infection, tactics depend on the type of pathogen. If the disease has developed before, and the type of pathogen belongs to the TORCH complex, then termination of pregnancy is recommended for medical reasons. In other cases, the mother is treated with drugs (antibiotics) appropriate to the type of infection. After birth, such children should be observed by a pediatrician to detect symptoms of congenital infectious pathology.

Labor management tactics for oligohydramnios include amniotomy for a mature cervix. This ensures tight contact of the fetal head with the opening neck. If there is a significant lack of water, combined with fetal pathology, a caesarean section can be performed.

Oligohydramnios is an easily diagnosed symptom that can indicate many pathological processes in the body of a pregnant woman. With timely detection, it is possible to correct this condition and prolong pregnancy until fetal maturity.

The doctor identifies those who are registered for pregnancy at the antenatal clinic as a risk group for the development of oligohydramnios. These are those in whom it was detected during previous pregnancies, women with chronic infectious processes, heart and kidney diseases, as well as those who had a history of congenital anomalies of the fetus. To prevent pathology of amniotic fluid, it is necessary to promptly treat concomitant diseases, and take Curantil and Trental and vitamin complexes for preventive purposes during times of crisis.

Amniotic fluid (amniotic fluid) is a comfortable environment in which the baby develops for nine months. It serves as mechanical protection, a nutrient medium, and a “liquid simulator” that helps the child practice swallowing techniques. There is no question whether amniotic fluid is needed - pregnancy cannot develop without it. But how much is needed and what to do if there is not enough amniotic fluid? How bad is oligohydramnios?

Oligohydramnios: first suspicions

All women differ in height and build, and the sizes of newborn babies also vary. Therefore, “normal” volume is a rather vague concept. The upper and lower limits of the norm differ by more than twice: 600-1500 ml.

” Most amniotic fluid is present, then its volume decreases slightly.

Often, even an experienced gynecologist cannot confidently say whether we are talking about a slight deficiency/excess of amniotic fluid or about the physiological characteristics of a particular pregnant woman. Therefore, suspicion of moderate oligohydramnios (the volume of amniotic fluid is 500 ml or less) often arises when the expectant mother begins to feel an unpleasant symptom: the child’s movements become painful for her.

” Even slight oligohydramnios is a fairly rare pathology; it is detected in 1 out of 20 pregnant women.

Diagnosis of oligohydramnios

Ultrasound examination is intended to confirm the diagnosis. During the examination, the doctor determines the so-called “vertical pocket” - the greatest distance from the anterior abdominal wall to the fetus. Normally, this distance should be from 5 to 8 cm.

You can more accurately determine the state of affairs by calculating the amniotic fluid index: this is still the same “vertical pocket”, only measured at four different points (top right, top left, and bottom right and bottom left). The sum of the four measurements can range from 5 to 24 cm (some doctors narrow this interval to 8-18 cm) and varies depending on the stage of pregnancy.

Normal amniotic fluid index values

But a one-time study can reveal only the most serious violation. Much depends on the child’s activity and the settings of the ultrasound machine. Therefore, if in doubt, it is better to repeat the examination, perhaps with a different doctor and on a different device.

Causes of oligohydramnios

There are many reasons for the occurrence of oligohydramnios, and depending on what condition caused the oligohydramnios, a prognosis is made for the course of pregnancy and treatment tactics are determined.

• Genetic diseases

Sometimes oligohydramnios is caused by genetic abnormalities in the fetus. Unfortunately, this is the most pessimistic scenario, since the pregnancy often ends.

• Chronic diseases of the mother

Problems with the kidneys, urinary tract, hypertension - a number of diseases of the mother can cause oligohydramnios. In this case, the gynecologist will focus on the treatment of this particular disease, and the baby’s condition will be monitored especially carefully.

• Anomalies in the development of membranes

Perhaps the problem is not in the state of health of the mother or fetus, but in the uterus: there is underdevelopment of the amnion, separation of the layers of the membranes, insufficient secretory activity of the epithelial (constituting the mucous membrane) cells of the fetal bladder, responsible for the production of water.

• Infectious diseases

ORV, influenza, chickenpox, measles - many infections can affect the membranes. As a result, they lose elasticity, separations appear, through which amniotic fluid leaks unnoticed by the woman herself.

• Amnionic hydrorhea

Sometimes leakage of amniotic fluid occurs for no apparent reason - doctors are not always able to detect the location of the microscopic rupture. In this case, a smear is made to detect amniotic fluid. Unlike the previous case, secondary infection of the membranes may occur here.

• Post-term pregnancy

Both the placenta and the amniotic membranes gradually cease to perform their functions, which means that the amount of newly produced amniotic fluid also decreases sharply.

Why is oligohydramnios dangerous?

Depending on the degree of insufficiency of amniotic fluid, various pathologies of fetal development occur. The umbilical cord may become sandwiched between the wall of the uterus and the fetus, which will lead to oxygen starvation of the baby. When it is pronounced, the baby is squeezed by the walls of the uterus, which causes curvature of the spine, clubfoot, and in some cases even fusion of the skin with the amnion. In this case, Simonart's ligaments are formed - when the child tries to change position, they can wrap around him, causing severe injuries.

” Even when the baby is developing normally, oligohydramnios can significantly complicate the birth itself. The lack of amniotic fluid leads to the fact that the amniotic sac does not press on the cervix (a “flat” amniotic sac), its opening slows down or does not occur at all.

What tests should be done for oligohydramnios?

If there is a suspicion of leakage of amniotic fluid, a vaginal smear is made to reveal the content of amniotic fluid.

Suspicion of infectious diseases is supported by tests for the presence of viral and bacterial infections - first, the expectant mother must undergo at least a general blood test.

If it is known about the mother’s chronic diseases that can cause oligohydramnios, then tests are carried out that will reveal the degree of their exacerbation.

Finally, it is important to monitor the baby’s condition: for this purpose, the doctor may prescribe CTG (cardiotocography, showing both fetal heart contractions and uterine contractions), vascular Dopplerography and amnioscopy to assess the quality of the amniotic fluid.

How is oligohydramnios treated?

First of all, it should be noted that the amount of additional fluid the mother drinks does not in any way affect the amount of amniotic fluid. With moderate oligohydramnios, regular monitoring is important: if the situation worsens, the mother will most likely be asked to go to hospital. In addition to specific treatment related to diseases detected in a pregnant woman, general recommendations for oligohydramnios are as follows.

• Bed rest or reduced physical activity so as not to provoke increased leakage of amniotic fluid.
• Healthy nutrition, taking vitamins.
• Taking medications aimed at reducing uterine tone and improving blood microcirculation - they should compensate for the lack of placental nutrition associated with oligohydramnios.
• Prevention of the development of intrauterine infections.
• When pregnancy is carried beyond term, labor is initiated.

Oligohydramnios is not a disaster, although the mother may have to spend most of the pregnancy in a hospital. A positive attitude, compliance with medical recommendations and, most likely, the pregnancy will be successfully maintained until the due date, and the damage to the child’s health will be minimal.

In obstetric practice, oligohydramnios (oligohydramnios) means a reduced amount of amniotic fluid. In the case of a full-term pregnancy at 40-41 weeks, we are talking about a volume of less than 500 ml. For earlier dates, standards have been established (with a possible maximum and minimum), determined by special methods, which we will consider below.

In quantitative terms, amniotic fluid is a dynamic unit, constantly changing in volume.

Their secretion begins approximately from the 8th week of pregnancy, continuing until the onset of labor.

Using specially created tables, from the 14th week of pregnancy, the doctor has the opportunity to determine the norm, increased and decreased amount of amniotic fluid in a pregnant woman. If the expectant mother experiences oligohydramnios for some period of time, and after some time it becomes normal, then one should think about functional disorders. note

If the elevated level persists for several weeks, doctors begin to suspect an existing pathology. To differentiate this condition, pregnant women are given a test, in which a specialist can definitely make a conclusion about whether there are any malformations of the placenta and the child or not.

In the presence of pathological oligohydramnios, a complex of malformations of the developing fetus may occur. Ultrasound allows us to make a preliminary conclusion. In case of suspicion of true oligohydramnios, the study must be supplemented with cardiotocography (CTG), Doppler measurements, and biochemical tests (ACE, hCG).

Reasons for the development of oligohydramnios during pregnancy

Among the factors that contribute to oligohydramnios, there are several that can be considered in groups:

Using specially created tables, from the 14th week of pregnancy, the doctor has the opportunity to determine the norm, increased and decreased amount of amniotic fluid in a pregnant woman. If the expectant mother experiences oligohydramnios for some period of time, and after some time it becomes normal, then one should think about functional disorders. : oligohydramnios, caused by most causes, can be successfully treated therapeutically, except for developmental defects.

Among the many reasons for this condition, the main ones can be identified:

• gestosis(pregnancy toxicosis), leading to fluid loss;
• in a pregnant woman. Constantly elevated blood pressure numbers lead to disruption of water-salt metabolism, leading to oligohydramnios;
• . Hormonal-enzymatic disruptions in this condition cause disruption of the formation and functionality of amniotic fluid;
• infectious diseases– acute forms, bacterial kidney damage (, pyelitis), moderate and severe forms of viral infections (, –, measles,);
• chronic condition of a developing child.

Variants of classifications of oligohydramnios

Classification taking into account the duration (speed) of development of the pathology:

• acute oligohydramnios– it tends to start quickly. In most cases, the acute variant is benign and can be treated quite well by eliminating the cause that caused it. Most often, this condition develops against the background of acute infectious processes;
• chronic oligohydramnios– requires a thorough examination of the pregnant woman to determine the causative pathology. The development of this condition occurs at a slow pace and requires mandatory treatment, since without it it does not go away on its own.

Types of oligohydramnios depending on the stage of pregnancy:

• early – determined within 16-20 weeks from the start of pregnancy. Detection of pathology at these times is a finding in ultrasound diagnostics. The most likely cause of this problem is changes in the membranes. From a prognostic point of view - a more unfavorable form, due to the initial stages of organ formation;
• later – from 26 weeks until birth. The main reason is fetal pathology. Most often it refers to functional types of oligohydramnios.

Based on pathological changes in the membranes, the following are distinguished:

• primary oligohydramnios(with intact membranes). The occurrence of oligohydramnios in this case is caused by disturbances in the formation of the fetus, pathology of the placenta, and serious chronic diseases in the expectant mother.
• secondary oligohydramnios– is a consequence of traumatic changes in the membranes.

Most often, doctors encounter primary oligohydramnios.

Diagnostic criteria for determining oligohydramnios in pregnant women

A doctor may suspect the presence of this problem during routine examinations.

Signs of oligohydramnios are:

• insufficient increase in abdominal circumference and uterine height during pregnancy. Indicators do not meet deadlines;
• insufficient activity of the developing child (less than 12-10 signs of movement per day);
• low AFI (amniotic fluid index). It will be discussed in more detail below.

Using specially created tables, from the 14th week of pregnancy, the doctor has the opportunity to determine the norm, increased and decreased amount of amniotic fluid in a pregnant woman. If the expectant mother experiences oligohydramnios for some period of time, and after some time it becomes normal, then one should think about functional disorders. : primary suspected oligohydramnios is not the basis for a diagnosis, but only a functional disorder. The painful condition is confirmed after dynamic monitoring of the development of pregnancy, based on repeated examinations (at least 3, with an interval of 2 weeks).

If during this time the problem does not go away, then the specialist has every reason to make a diagnosis of oligohydramnios.

More accurately, this condition is detected by ultrasound. But still, to confirm pathological rather than functional oligohydramnios, confirmation of 3 studies performed at the above-mentioned time interval is required.

If, after the first ultrasound diagnosis, the doctor still suspects the onset of the development of true oligohydramnios, then he prescribes cardiotocography (CGT), which accurately determines whether the fetus has a problem or not. If changes in the placenta are suspected, Doppler testing is recommended. If the indicators of these studies are problematic, a diagnosis of pathological oligohydramnios can be immediately made, without waiting for dynamic ultrasound data.

With the functional version, it is recommended that the pregnant woman undergo vitamin therapy and drink Curantil for a month, then do an ultrasound again. In 95% of cases, oligohydramnios is no longer detectable. If pathology is present, further examination is carried out and the necessary treatment is prescribed.

Additional examination includes detection and identification of pathogens of infectious diseases using blood tests and determination of Rh conflict. Of diagnostic value are the AFP (alpha-fetoprotein) test to detect fetal defects, hCG (human chorionic gonadotropin), to identify placental problems, certain types of pregnancy pathologies, and chromosomal genetic abnormalities.

In the most serious cases, amniocentesis (examination of amniotic fluid by puncture) is indicated, followed by karyotyping. This study makes it possible to identify abnormalities at the gene and chromosomal levels.

Amniotic fluid index values ​​during pregnancy

When considering the diagnosis of oligohydramnios, it is worth mentioning the determination of the amniotic fluid index (AFI).

Before the concept of the AFI index was introduced, the sonographer measured the longest gap of free amniotic fluid, which is located between the anterior abdominal wall of the mother and the developing fetus ( vertical pocket).

When establishing IAF, the doctor identifies 4 vertical pockets in certain study squares. The sum of these pockets represents the desired index, which is the main indicator of the presence or absence of oligohydramnios during ultrasound diagnostics.

Each stage of pregnancy has a corresponding index, which can be seen in the table:

Note: IAH norms differ in different countries, sometimes very significantly.

Oligohydramnios is established when the index value is below normal. If there is a slight deviation (up to 10-15%), the doctor determines moderate oligohydramnios, and for large numbers – oligohydramnios.

If the values ​​are sharply reduced, it is diagnosed pronounced oligohydramnios. It requires continued examination of the pregnant woman to establish in more detail the cause, find the corresponding disease, defect, and determine the prognosis of the pregnancy.

Consequences of oligohydramnios

If severe oligohydramnios persists for a long period of time, a condition may develop in which the tissues of the developing fetus and the membranes become fused.

This process is characterized by the growth of connective tissue cords, which begin to fill the cavities and wrap around the umbilical cord and the child. Disorders of tissue trophism develop, curvature of developing bones, amputation of limbs, developmental delay, and other deformities occur. Fetal hypoxia may progress.

Using specially created tables, from the 14th week of pregnancy, the doctor has the opportunity to determine the norm, increased and decreased amount of amniotic fluid in a pregnant woman. If the expectant mother experiences oligohydramnios for some period of time, and after some time it becomes normal, then one should think about functional disorders. : It should be noted that the consequence of oligohydramnios cannot be chromosomal and genetic defects, which themselves can be the cause of oligohydramnios.

Thanks to the modern level of medicine, timely diagnosis and treatment methods, complications caused by oligohydramnios occur in rare cases in practice.

The discovery of oligohydramnios is a diagnostic sign rather than a condition that requires treatment. The primary diagnosis is oligohydramnios; in the absence of detected pathologies, it requires an immediate search for the cause that led to it.

In the later stages, oligohydramnios is caused by leakage of water through cystic tears, especially in the case of post-term pregnancy.

Using specially created tables, from the 14th week of pregnancy, the doctor has the opportunity to determine the norm, increased and decreased amount of amniotic fluid in a pregnant woman. If the expectant mother experiences oligohydramnios for some period of time, and after some time it becomes normal, then one should think about functional disorders. : a decrease in amniotic fluid before childbirth reflects the physiological process of aging of the placenta, and is not a pathology.

Principles of treatment for oligohydramnios

If diagnostic methods have not revealed the presence of deformities in the fetus, and the woman unconditionally insists on childbirth, then treatment of oligohydramnios is carried out taking into account the duration of pregnancy.

In the 1st and 2nd trimester the following is prescribed on an outpatient basis:

• vitamin therapy (especially groups of vitamins B and C);
• predominantly protein-vegetable diet;

In the 3rd trimester:

• hospitalization in the antenatal department;
• continuation of vitamin and diet therapy;
• Curantil is prescribed as a means of improving blood circulation in the placental tissue;
• Actovegin is recommended as a drug that promotes active oxygenation of a developing child;
• symptomatic therapy;
• normalization;
• treatment of all causative pathologies - infectious and identified diseases of internal organs;

During treatment, daily CHT monitoring is carried out. Other methods - as needed.

If the child's condition worsens, emergency delivery is used ().

The prognosis for functional oligohydramnios is favorable. In other cases, the outcome is determined individually.

Lotin Alexander, medical columnist

Even if, after the next examination, you heard a terrible diagnosis: oligohydramnios, stop panicking! Insufficient amniotic fluid is not a death sentence, but just a symptom. In addition, there are different stages of oligohydramnios and, perhaps, for your body, such indicators are the norm. It's time to figure out what oligohydramnios is during pregnancy, the causes and consequences of which worry you.

What is amniotic fluid?

Your body, like a clock, is tuned to bear and give birth to a child. Not only is the fetus protected by the placenta, it is constantly in the amniotic fluid, which simultaneously serves as food and protects it from external influences of infections. This amniotic fluid contains vitamins and hormones, salts and oxygen necessary for the baby’s growth. All of them enter the child’s body when he swallows liquid.

Unfortunately, not only food can affect amniotic fluid. Infections and viruses easily penetrate the amniotic fluid, which negatively affects the development of the child. As a result, quantitative changes in amniotic fluid and diagnosis, for example, of oligohydramnios.

Oligohydramnios – what is it?

Oligohydramnios is a deviation from the normal amount of amniotic fluid in the direction of its decrease. There is a distinction between moderate and severe oligohydramnios. In the latter case, the amount of amniotic fluid is reduced by 3 or more times.

• The first good news: such a deviation is quite rare, medical indicators range from 0.7 to 5.5%, and even then the highest number characterizes moderate oligohydramnios during pregnancy, which is not considered critical;
• The second positive argument is that in the first and third trimester, oligohydramnios, especially moderate ones, is not a 100% threat to the development of the baby, and it is even possible that the small amount of amniotic fluid you have is of a genetic nature.

Amniotic fluid index table

The amount of amniotic fluid can be determined by the ratio of the volume of the abdomen and the height of the uterus, as well as during an ultrasound examination (read the article on the topic: Is it possible to determine the gestational age by ultrasound?>>>).

Measurements during ultrasound

1. During an ultrasound, the presence of a so-called free pocket is determined. This pocket is nothing more than the distance between your baby and the front wall of your tummy;
2. A specialist may suspect oligohydramnios if this space is less than 2 cm, while the norm is 5 cm;
3. At the same time, the amniotic fluid index will be calculated for you; the principle is the same, but measurements are taken at four different points around the baby. The AFI norm is determined by week, but please note that even within a day the data may fluctuate slightly.

The resulting numbers in mm are checked against the table. Interestingly, the average reaches its peak at week 27 – 156 mm, and at week 42 it drops to 110 mm. The table also shows possible fluctuations, again by week:

Term pregnancy, weeks	Average normal indicator, mm	Probable fluctuations, fluctuations mm
16	121	73-201
17	127	77-211
18	133	80-220
19	137	83-225
20	141	86-230
21	143	88-233
22	145	89-235
23	146	90-237
24	147	90-238
25	147	89-240
26	147	89-242
27	156	85-245
28	146	86-249
29	145	84-254
30	145	82-258
31	144	79-263
32	144	77-269
33	143	74-274
34	142	72-278
35	140	70-279
36	138	68-279
37	135	66-275
38	132	65-269
39	127	64-255
40	123	63-240
41	116	63-216
42	110	63-192

Thus, oligohydramnios during pregnancy at week 32 is diagnosed when the AFI is below 77 mm. (read the current article: Ultrasound at 32 weeks of pregnancy >>>), while at 22-26 weeks only at 89 and below AFI.

Conventional measurements

You can also talk about oligohydramnios if the size of the uterus and abdominal girth do not correspond to your gestational age, but no one will diagnose you without an additional ultrasound.

Why is oligohydramnios dangerous?

Low hydramnios is a sign that a certain malfunction has occurred in your body. The causes of oligohydramnios during pregnancy, namely whether these disorders are genetic, or whether external factors have affected the functioning of the placenta and the production of amniotic fluid, will be determined by a specialist, but the fact that such a condition can be dangerous is a fact.

Consequences

Check out the list of dangers associated with oligohydramnios during pregnancy.

• There is a 50% risk of premature birth;
• During delivery at term, there is a decrease or absence of labor in 80% of pregnant women;
• The risk of miscarriage increases significantly (up to 50%);
• In a third of pregnant women, oligohydramnios developed as a consequence of an infectious or inflammatory process;
• With a critically low amount of amniotic fluid, the risk of fetal hypoxia is 20%, and hypertrophy or asphyxia is 75%;
• In half of the cases with oligohydramnios, childbirth is carried out by caesarean section.

Causes

You won’t find clear medical parameters in any reference book, but there are certain assumptions:

1. There is a tendency to oligohydramnios during pregnancy due to genetic factors. If your mother or grandmother had small babies with a small belly, you may have the same story;

There is no need to worry when oligohydramnios is moderate and the child feels normal. Another thing is if your relatives, as a result of oligohydramnios during pregnancy, had problematic childbirth, you need to warn your doctor and geneticist about this.

1. If you notice a decrease in abdominal volume ahead of schedule, there is a risk of leakage of amniotic fluid (important article

In this article you will learn on what basis the diagnosis of “oligohydramnios” is made and how it is dangerous for a woman and her baby. And also what are the causes of this deviation, how oligohydramnios is treated and what measures need to be taken to prevent complications from occurring

• There is such a diagnosis as “oligohydramnios”. This means that the amount of amniotic fluid is less than normal at a certain stage of pregnancy.
• Now, thanks to ultrasound examinations, oligohydramnios is easy to detect, and this diagnosis is made in only 5% of pregnant women
• But, unfortunately, it still exists and this deviation must be treated as early as possible in order to avoid unwanted complications, including defects in the physical development of the fetus

What does oligohydramnios mean during pregnancy?

• Amniotic fluid contains many substances necessary for the baby, such as salts, hormones, oxygen and vitamins. Also, amniotic fluid protects the fetus from many harmful external factors.
• But such a deviation occurs when there is little amniotic fluid and this seriously complicates the healthy bearing of a child
• At different stages, the amount of fluid is different, so, in the last trimester, it should be 0.8-1.5 liters. If the amount of water is less, then we are talking about low water
• There is a division of oligohydramnios into moderate and severe; to determine the severity of the deviation, the degree of fluid deficiency is important

With moderate oligohydramnios, the volume of fluid is slightly less than it should be during a normal pregnancy, and is about 400-700 ml.

Treatment for such oligohydramnios consists of establishing a diet; you need to adhere to a special diet rich in vitamins and minerals, lead a healthy lifestyle, and regularly visit a doctor to monitor the dynamics of the disease and not miss the deterioration of the condition. As a rule, this is enough and moderate oligohydramnios does not harm the fetus.

Severe oligohydramnios during pregnancy

Severe oligohydramnios means a strong deviation from the normal volume of amniotic fluid. In case of severe oligohydramnios, urgent and radical measures must be taken, because This condition is very dangerous for the life and health of the baby.

Treatment is usually carried out in a hospital under the constant supervision of doctors. If you have been diagnosed with this, it can affect your unborn child - due to oligohydramnios, there may be a delay in the development of the fetus, hypoxia, which in turn will lead to problems with the central nervous system, improper formation of the bone skeleton and tissues, and even abortion. pregnancy.

There are only 0.3-0.5% of women suffering from severe oligohydramnios.

Signs of oligohydramnios during pregnancy

The pregnant woman herself usually does not feel that she has such a deviation as oligohydramnios. The only thing that can alert you is the appearance of a sharp pain in the abdomen when the baby pushes. This may indicate a lack of fluid in the amniotic sac.

During an examination, a doctor can identify the likelihood of oligohydramnios by the lag in the following indicators:

• increase in abdominal volume
• uterine fundus measurements

Based on these data, the doctor can make an assumption about a deviation from the norm and must refer the pregnant woman for an ultrasound examination, where an accurate diagnosis will be made.

An ultrasound machine makes it possible to measure the amount of amniotic fluid and determine whether it is enough or not.

If according to an ultrasound you have moderate oligohydramnios, do not rush to be upset, it is better to redo the ultrasound examination in another place, perhaps the doctor is mistaken or the device is not accurate enough, and the results will be different.

Causes of oligohydramnios during pregnancy

All the reasons why oligohydramnios occurs have not been fully studied, but experts identify the following:

1. Leakage of amniotic fluid or, scientifically, amnionic hydrorhea. Leakage of water occurs long before PDR due to rupture of the membranes. Doctors believe that this happens due to infection of the membrane or its premature aging, which leads to its thinning and the appearance of a gap. This deviation is treated with bed rest, while the fluid has time to be restored and its loss does not harm the child
2. Disturbances in the development of the fetal membrane. There are quite a few such disorders and the reasons for their occurrence, too, the most common include genetic disorders and the harmful effects of the environment
3. Infection of the amniotic sac. There are a number of viruses from which the placenta cannot protect the baby and the fetal bladder becomes infected, its proper functioning is disrupted, which leads to oligohydramnios.
4. Postmaturity of the fetus. The placenta and fetal membrane no longer work at full capacity, the baby does not receive the nutrients he needs and the condition of his body worsens, blood circulation in the membranes also becomes difficult, which in turn leads to a decrease in the production of amniotic fluid
5. Underdevelopment of amniotic sac tissue or poor secretory function
6. Pathologies in fetal development. Here doctors identify genetic abnormalities in the development of the face and kidneys
7. Bacterial infections in rare cases can penetrate not only into a woman’s birth canal, but also into the amniotic fluid
8. During multiple pregnancies, there are cases that the blood in the placenta is not distributed correctly and therefore one child does not receive enough of the necessary substances, while the other receives too much of them

What are the dangers of oligohydramnios during pregnancy?

• Oligohydramnios during pregnancy can cause quite a few complications. If there is not enough water, the walls of the uterus begin to strongly compress the amniotic sac, which puts unnecessary pressure on the baby
• In this case, the baby will be bent in a position that is uncomfortable and unnatural for him. This development of events leads to curvature of the child’s spine and clubfoot, and the skin can grow together with the fetal membrane
• In addition, Simonartian ligaments may form, which wrap around the fetus and limit its movements, which can even lead to injury.
• If these ligaments become entangled in the umbilical cord, the child will not receive enough nutrients, fetal hypoxia and impaired blood flow may occur, which will lead to developmental delays and possibly even fetal death.
• Amniotic fluid, moreover, protects the baby from the external environment, which can harm him, and its lack will lead to unreliable protection or its absence
• If there is a lack of water, the cervix may open slowly during childbirth, and labor becomes weak. The contractions are painful, but not strong enough. Bleeding may occur after childbirth

If severe oligohydramnios was discovered late and has irreversible developmental disorders of the fetus, doctors insist on early termination of pregnancy.

Moderate oligohydramnios can be said to never have a negative effect on the child, if, of course, the diet and lifestyle of the pregnant woman is adjusted.

Oligohydramnios during pregnancy, what to do?

If your doctor has diagnosed you with oligohydramnios, he will definitely prescribe you treatment and tell you what to do.

First of all, don't worry. A timely diagnosis is 50% of the success of treatment. Follow the doctor’s instructions strictly; if you need to go to the hospital, don’t even think about it - go to bed, because the health of your unborn baby and, in some cases, even his life depends on it.

How to treat oligohydramnios during pregnancy?

A woman should understand that even with a diagnosis of “moderate oligohydramnios,” she should not self-medicate or ignore it altogether.

The doctor will prescribe additional examinations: general blood and urine tests, tests for infections, fetal CTG (cardiotocography), ultrasound, water smear if there is a suspicion that they are leaking.

Ultrasound for oligohydramnios during pregnancy

These examinations will help to assess the child’s condition and the severity of the deviation. Based on their results, the gynecologist will prescribe the necessary treatment. You should also try to determine the cause of oligohydramnios, this will help you choose the right treatment.

• If the cause of oligohydramnios is obesity and metabolic dysfunction in the body, then you need a proper diet, vitamins and medications that improve blood supply to the placenta. If oligohydramnios is moderate, treatment can be done at home, but if it is severe, then hospitalization is necessary.
• If the cause of oligohydramnios is a viral infection, then antiviral drugs are prescribed and restorative therapy is carried out. The doctor will definitely prescribe a vitamin complex and medications that improve blood microcirculation
• If the reason lies in impaired development of the amniotic sac, doctors try to maintain the pregnancy and prevent infection of the fetus. In this case, treatment is carried out exclusively in a hospital and the woman is prescribed additional examinations to assess the condition of her body and the condition of the fetus.
• If the pregnancy is overdue, doctors puncture the amniotic sac and induce labor with stimulating drugs.
• It is also important to reduce physical activity, reduce physical activity and adherence to bed rest.
• In case of oligohydramnios, doctors direct the woman to do ultrasound and Doppler ultrasound more often in order to monitor the dynamics of the deviation and changes for the better or worse in the mother’s body and the condition of the child
• If the pregnancy is already long and the baby is full-term, the doctor may recommend premature birth, which will be caused by special stimulating drugs

Do not forget to tell your doctor if you have already had this diagnosis in previous pregnancies, and it is better to conduct a couple of additional ultrasound examinations to exclude this abnormality or detect it as early as possible.

Index of oligohydramnios during pregnancy

During an ultrasound examination, a diagnosis of “oligohydramnios” is made based on the amniotic fluid index (AFI), which is calculated by an ultrasound machine. The device measures the amount of water in several places and calculates the IAF.

Table of AFI at different stages of pregnancy

In the third trimester:

• if the index is within 5-8 cm, then the amount of water is normal
• if the index is 2-5 cm, then this is “moderate oligohydramnios”
• if the index is below 2 cm, a diagnosis of “severe oligohydramnios” is made

However, it is worth noting that AFI varies depending on the stage of pregnancy:

• at 16 weeks the norm is considered to be from 73 to 201 mm
• at 20 weeks from 86 to 230 mm
• at 25 weeks from 89 to 240 mm
• at 30 weeks from 82 to 258 mm
• at 35 weeks from 70 to 279 mm
• at 40 weeks from 63 to 240 mm

The amount of amniotic fluid changes as the fetus grows, swallows fluid, and urinates. But you shouldn’t worry about the baby’s condition, because... amniotic fluid is renewed every 3 hours, and every 3 days it completely changes.

Nutrition for oligohydramnios during pregnancy

When you have oligohydramnios, you need to eat properly and in a balanced manner:

• try to eat several times a day (more than 5 meals), but in small portions
• products must contain many vitamins and minerals and be nutritious
• choose natural, minimally processed foods
• exclude fast food products from the menu (burgers, hot dogs, etc.)
• reduce the amount of sugar and salt you consume
• eliminate fatty foods from your diet
• try to use less spices and spices
• avoid products containing preservatives, flavors and dyes
• meat, fish and seafood must be well-heated; you should not eat them raw or half-cooked
• refrain from eating blue cheese, unboiled milk and raw eggs
• do not drink strong tea, try to avoid coffee and completely eliminate alcohol
• Instead of sweets and sugar, eat more fruits

Be sure to monitor your weight gain, because... its rapid increase can also lead to oligohydramnios or worsening of an existing deviation.

Tendency to oligohydramnios during pregnancy: how to determine?

A woman may be prone to oligohydramnios during pregnancy in the following cases:

• expectant mother smokes
• multiple pregnancy
• the woman has metabolic disorders in the body
• there are abnormalities in the development of the amniotic sac
• gestosis - toxicosis in late stages
• dehydration due to vomiting or diarrhea
• there is a bacterial or viral infection
• woman suffers from diabetes
• presence of chronic diseases in the expectant mother
• post-term pregnancy
• there are fetal kidney defects
• I had oligohydramnios in previous pregnancies

If you fall into the risk category, the doctor will prescribe additional examinations and tests for you in order to promptly identify deviations from the normal volume of amniotic fluid and begin treatment as early as possible.

Let's summarize and determine the main measures to prevent oligohydramnios:

1. Proper fractional nutrition, products should be as healthy as possible
2. Dieting if you have problems with excess weight
3. Additional intake of complex vitamins
4. Eliminate physical activity and replace it with walking in the fresh air
5. Timely visit to the gynecologist, taking tests, passing the necessary examinations
6. If there are endocrine disorders (diabetes mellitus, for example, or obesity), you need to undergo appropriate treatment

When I was pregnant, I couldn’t get enough of the fact that I had a small belly, as it later turned out on an ultrasound - oligohydramnios. But it was probably moderate, because... The doctor did not prescribe any medications and only said that I would not be allowed to nurse, but my son did not wait long, he was born a little premature - the birth was easy, there were no problems with the child’s health.
Masha, 24 years old.

In fact, doctors exaggerate everything; there is nothing wrong with oligohydramnios. Well, this is understandable, they are playing it safe. But my friend was persuaded to give birth prematurely, she did not agree and carried the child to term. The son was born healthy and on time. It grows and gets stronger.
Diana, 32 years old

In both pregnancies I was diagnosed with “moderate oligohydramnios”, and both times at 30-32 weeks. During the first pregnancy, they did not prescribe treatment; they said that at this stage, moderate is not scary, but in the second, they gave injections. The doctors were different. Both girls are healthy, and this is the most important thing! Christina, 27 years old

VIDEO: Oligohydramnios during pregnancy