Oligohydramnios at 8 weeks. Oligohydramnios: diagnosis, causes, treatment

A pathological condition during pregnancy, expressed by a decrease in the amount of amniotic fluid, is called oligohydramnios. Pathology is quite rare (4% of cases) and usually indicates that the pregnancy of the child is abnormal.

Fetal development is largely dependent on amniotic fluid. It is she who protects the placenta and umbilical cord, protects the fetus from mechanical influences, and ensures the exchange of substances between it and the mother. The amount of amniotic fluid increases with the duration of pregnancy. Normally, by 38 weeks they reach 1000-1500 ml. Severe oligohydramnios- the amount of water is only about 500 ml. Their deficiency can negatively affect the health of the unborn baby. If the quantity has decreased by 400-700 ml, then they talk about moderate pathology.

Reasons

Oligohydramnios during pregnancy can occur for the following reasons:

• Congenital malformations of the fetal kidneys. A small amount of water, in this case, is observed from an early date.
• Severe chronic diseases in women (diseases of the cardiovascular system, diabetes, kidney disease, etc.).
• Infectious diseases of the genital organs (chlamydia, ureaplasmosis, trichomoniasis, mycoplasmosis, etc.)
• Obesity.
• Metabolic disorder.
• Severe dehydration of a woman caused by diarrhea and vomiting.
• Smoking of the expectant mother.
• Past bacterial and viral infections (Flu, ARVI).
• Past TORCH infections (herpes, rubella, toxoplasmosis).
• Pathologies of the placenta (placental insufficiency, premature aging of the placenta, developmental abnormalities).
• Multiple pregnancy (oligohydramnios in one fetus is often combined with polyhydramnios in the other).
• Post-term pregnancy.
• Leakage of amniotic fluid as a result of damage to the membranes.

Symptoms of oligohydramnios

Symptoms of a moderate decrease in the amount of amniotic fluid are practically not expressed; the state of health of pregnant women is not affected. Severe oligohydramnios is characterized by the following symptoms:

• Discrepancy between the size of the abdomen and the duration of pregnancy. During an external examination by a gynecologist, a decrease in the height of the uterine fundus and abdominal circumference is noted compared to the indicators for a given period.
• The appearance of painful sensations during fetal movements.
• The appearance of periodic aching pain in the lower abdomen.
• Deterioration in general health (nausea, weakness, dry mouth).

It is possible to confirm or refute oligohydramnios during pregnancy only with an ultrasound. However, an ultrasound procedure alone will not be enough to make a diagnosis. The study must be carried out several times in a row over 1-2 months.

Consequences

With oligohydramnios, the fetus becomes vulnerable to external mechanical influences; the likelihood of it being compressed by internal organs is quite high, which can lead to the development of clubfoot and curvature of the spine. In a small amount of water, the fetus cannot move freely, its movements are constrained, and this does not have the best effect on its physical development. In addition, the baby begins to experience a deficiency of nutrients found in the amniotic fluid. The fetus may lag behind in development, experience oxygen starvation, as a result of which the brain begins to suffer. His skin dries out and malnutrition develops.

Oligohydramnios increases the likelihood of umbilical cord compression and intrauterine fetal death. Sometimes adhesions form between the amnion and the skin of the fetus, which later acquire the character of threads or cords. These strands and threads wrap around parts of the umbilical cord and fetus, causing its disfigurement, amputation of fingers and limbs.

In half of the cases, pregnancy with oligohydramnios ends in premature birth.

How does the treatment work?

Severe oligohydramnios is treated depending on the duration. If the pathology was detected in the third trimester, the pregnant woman is hospitalized in the hospital, where she is given vitamins, drugs that improve the delivery of oxygen to the fetus (Actovegin) and blood circulation in the placenta (Curantil). Medications are also prescribed to maintain normal blood sugar levels and blood pressure. If necessary, treatment of infections and other diseases that provoked the pathology is carried out. The condition of the fetus is monitored daily using CTG (cardiotocography). If possible, pregnancy is prolonged until natural birth. If the baby's condition worsens, an emergency caesarean section is performed.

If oligohydramnios was detected before 28 weeks, then doctors usually recommend interrupting it, since its outcome in most cases cannot be predicted.

Treatment of moderate oligohydramnios can be carried out on an outpatient basis, provided that the pregnant woman takes all prescribed medications, limits physical activity, and avoids heavy physical activity.

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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 baby’s development, 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.

Reasons

You will not find clear medical parameters in any reference book, but there are certain assumptions:

1. There is a tendency towards 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

The female body has all the necessary resources for the full conception of a child, its bearing and successful birth. The mother's womb is an ideal environment where the child is provided with peace, comfort, and safety from aggressive external factors. Amniotic fluid plays an important role in protecting the baby from possible negative influences from the outside, giving him the opportunity to move freely, develop correctly and take the most comfortable positions. However, sometimes it happens that the amount of this vital fluid is insufficient.

Moderate oligohydramnios during pregnancy - what is it?

Moderate water deficiency is one of the pathological conditions that can occur in a woman during pregnancy. The baby in the uterus is surrounded by amniotic fluid, which performs many important functions that ensure the proper development of the baby. The waters warm the fetus, serve as a “safety cushion”, a kind of shock absorber that protects it from mechanical influences from the outside world and gives it the opportunity to move freely. In addition, amniotic fluid also serves as a source of various nutrients for the child. They contain protein, microelements and a lot of vitamins. There is a constant process of the child swallowing these waters and defecating in them, resulting in the formation of a completely sterile environment in which the baby feels comfortable and safe. And if the amount of this fluid is less than normal, this condition is called oligohydramnios.

Amniotic fluid has a relatively constant composition, and the completely aqueous environment is renewed every 3 hours.

The amount of amniotic fluid is influenced by many factors: the size and weight of the fetus, the duration of pregnancy, the size of the placenta, the woman’s lifestyle, her diet and much more. Over time, the ratio of the volume of water and the size of the child changes: the baby grows faster than the amount of water increases. Thus, at later stages the child becomes increasingly cramped. Around week 37, the normal volume of amniotic fluid should be between 1–1.5 liters. When the time comes to give birth, this volume decreases somewhat.

Modern medicine is able to detect pathology in the second and third trimesters

Another name for amniotic fluid is amniotic fluid.

We can talk about moderate oligohydramnios if the volume of amniotic fluid is only slightly less than normal, i.e., approximately 500 ml in the later stages of pregnancy. In most cases, moderate oligohydramnios does not pose a serious danger, proceeds favorably and is relatively easy to correct. Modern diagnostic equipment makes it possible to easily identify this pathology in the second and third trimesters.

Differences between moderate and severe oligohydramnios

In addition to moderate, there is also severe oligohydramnios. With this pathology, there is a lack of intrauterine water that is significantly less than normal, i.e., the volume of fluid is 200 ml or less. If severe oligohydramnios is diagnosed, a pregnant woman requires mandatory hospitalization and inpatient treatment, since this type poses a much greater danger to both the woman and the unborn baby.

Sometimes severe oligohydramnios can be an indication for termination of pregnancy, since in some cases it leads to abnormalities in the formation of the child’s limbs, facial bones and, in general, deformation of his skeletal system.

Norm of amniotic fluid

The normal volume of amniotic fluid can vary from 600 ml to one and a half liters. As already noted, intrauterine waters are very important for the development and growth of the baby, creating a reliable and safe environment for him. As pregnancy progresses, the volume of water also increases. Here is what the approximate norm of amniotic fluid looks like at different stages of pregnancy:

Norm of amniotic fluid at different stages of pregnancy

Immediately before the birth itself, the volume of fluid decreases somewhat and is approximately 800–900 ml. If the pregnancy is post-term, the amount of water may be the same.

Reasons

Various reasons contribute to the development of oligohydramnios:

• a pregnant woman's tendency to have high blood pressure. It leads to disturbances in blood flow and placental function;
• abnormal development of the kidneys in the fetus. Unfortunately, in such situations, the pregnancy is often subject to termination, since the further prognosis is unfavorable - it is impossible for the child to live without kidneys;
• post-term pregnancy (aging of the placenta). It is advisable to induce labor or perform a caesarean section;
• twin pregnancy. This occurs due to the discharge of placental blood from one child to the second. Usually, oligohydramnios of this kind does not pose a threat to the fetus;
• untreated, undetected or hidden infections. In this situation, tests detect pathogenic microflora not only in the birth canal, but also in the fetal fluid itself;
• overweight in a pregnant woman, obesity, impaired metabolism.

Finally, it must be said that in some cases it is not possible to establish the cause.

Oligohydramnios is not an independent disease, but a symptom of a particular disease, therefore, special attention should be paid to identifying the causes of this pathology, since they can pose a real threat to both the expectant mother and the child.

Symptoms

Most often, moderate oligohydramnios is not accompanied by any typical symptoms that definitely indicate this pathology. It is worth paying attention to painful sensations in the lower abdomen, especially when the baby begins to move. Thus, only a doctor can determine the presence of this pathology. Therefore, regular examination by a gynecologist is mandatory.

Diagnostics

The basis for the diagnosis is data obtained as a result of observations of the expectant mother. To unambiguously confirm or refute it, an ultrasound is prescribed. Signs of oligohydramnios include:

• rare movements of the fetus (the mother feels less than ten movements per day);
• the height of the uterine fundus, as well as the abdominal circumference, lags behind the average for this period of pregnancy;
• the amniotic fluid index detected by ultrasound is lower than normal at this stage of pregnancy.

To diagnose oligohydramnios, examination and ultrasound should be performed several times with an interval of 2 weeks.

It must be borne in mind that a single examination is not enough. Examinations and ultrasounds should be performed several times with an interval of 2 weeks. If in each of these examinations a persistent deviation from normal values ​​is detected, then this is the basis for a diagnosis of “oligohydramnios”.

But at this time, a woman is informed about the pathology during a single ultrasound examination. This can be called not so much a diagnosis as a statement of the presence of insufficient intrauterine fluid at the time of the examination. Their shortage is explained by recent colds, stress and other reasons. In this case, CTG of the fetus or Doppler vascular testing of the placenta is prescribed. If the data from these studies show normality, then there is no reason to worry. The doctor may prescribe a vitamin course, and after a month, send you for an ultrasound again. In more than 95% of such cases, this deviation is not detected on a repeat ultrasound examination.

But if a repeat ultrasound procedure again shows oligohydramnios, a detailed examination should be carried out. In this case, it is necessary to donate blood for infections, glucose and anti-Rhesus bodies; measure blood pressure, check hCG and ACE levels, undergo a targeted ultrasound to identify possible developmental defects of the child or developmental delays. If necessary, karyotyping and amniocentesis are performed to help detect chromosomal and genetic abnormalities. When the cause of oligohydramnios is established, treatment is prescribed or the issue of termination of pregnancy is considered.

If the results of CHT are normal, the doctor may prescribe a vitamin course and then refer you for an ultrasound again.

Features of the disease at different stages of pregnancy

The presence of pathology in early pregnancy often indicates significant abnormalities in the development of the fetus

At different periods, moderate oligohydramnios occurs in its own way. In the first trimester, it indicates significant abnormalities in the development of the fetus. Sometimes the only option is to terminate such a pregnancy. However, each case is individual. Thanks to timely diagnosis and treatment, it is possible to normalize the volume of fetal fluid and the child is born healthy.

In mid-pregnancy the picture is different. At the age of 15–27 weeks, the baby needs enough free space in the uterus so that nothing interferes with movement and proper development. And if oligohydramnios is detected at such a time, this means that there is little free space, the child feels cramped and is forced to take unnatural positions. Such conditions can lead to quite serious consequences. There is a risk of clubfoot, cranial deformities, etc., which requires active and long-term treatment by specialists, but in most cases the outcome is favorable.

In the third trimester, pathology, as a rule, already affects the process of childbirth. The amniotic sac is flat, therefore, it cannot perform the function of dilating the cervix. The birth will be protracted, with weak contractions; for a fairly large percentage of women, giving birth naturally with oligohydramnios is contraindicated. In this case, a caesarean section is prescribed. The pathology can also lead to postpartum hemorrhage.

When oligohydramnios is diagnosed late in pregnancy, in most cases the treatment outcome is favorable.

Treatment and diet

Treatment depends on the severity of the pathology and the causes that caused it. As a rule, it is performed on an outpatient basis and hospitalization is not required. Constant observation, consultations with a doctor, periodic ultrasound, CTG, Doppler sonography, prescription of necessary medications, strict control of physical activity and stress are prerequisites for a favorable pregnancy outcome. Therapeutic and treatment-and-prophylactic measures are most often complex in nature and are aimed at improving metabolic and circulatory processes in the placenta and uterus.

Often, the doctor prescribes vitamin complexes or hormonal medications, which are designed to improve blood circulation and stabilize the placenta.

The most common medications are:

1. Trental. Improves blood microcirculation. It can be prescribed either in tablet form or intravenously.
2. Chimes. The main task of this drug is to protect the placenta from negative and irreversible changes. In addition, it improves blood flow in the “children's place”.
3. Actovegin. It is usually prescribed simultaneously with Curantil to enhance the effect.

Depending on the causes of the pathology, the doctor may prescribe certain medications in various variations.

Constant observation by a doctor and regular examinations contribute to a favorable course of pregnancy.

Traditional methods

As for traditional treatment methods, the following recipes will help normalize the volume of amniotic fluid:

1. Birch sap. It is a strong diuretic and an excellent prophylactic. The decoction will require young birch leaves and buds. You need to pour boiling water in the amount of one glass of a teaspoon of kidneys, then put it in a thermos to infuse for 4 hours. After this, drink one teaspoon three times a day. To prepare a decoction of the leaves, you need two teaspoons of the raw material per glass of boiling water, and you need to take it in the amount of a quarter glass 4 times a day.
2. Chokeberry. This berry reduces blood pressure and saturates the body with vitamins. To forget about problems with blood pressure and lack of vitamin C for a long time, you should eat 100 grams of chokeberry daily or drink 50 grams of juice a few minutes before a meal.
3. If oligohydramnios occurs due to overwork, stress or lack of sleep, herbs will help. An infusion of valerian roots can improve sleep and calm the nervous system. Brew 1 teaspoon of crushed root in a glass of boiling water and leave overnight. Take half or 1/4 cup. Instead of valerian, motherwort is suitable - a good sedative that relieves spasms. This infusion is prepared in the same way.
4. Lingonberry leaves are another diuretic and anti-inflammatory agent. Two teaspoons of the leaves of this plant are poured into a glass of water and boiled for 15 minutes, then the decoction is infused for 30 minutes. Take 1/4 cup before meals 15 minutes. If consumed regularly, you can greatly strengthen your immune system.
5. In the event that oligohydramnios was caused by inflammatory processes of the genitourinary system, this remedy is used. Take two parts each of birch leaves and wild strawberry leaves, peppermint, yarrow and bean leaves; one part of rowan fruit; three parts of string and nettle leaves, rose hips. This whole mixture is poured with half a liter of boiling water and infused for 10 hours. Drink half a glass three times a day.

Before taking any folk remedies against oligohydramnios, be sure to consult your doctor.

Diet

To provide the body with the necessary substances and reduce the risk of a small volume of fetal fluid, it is recommended to increase the amount of fruits, vegetables, dairy and potassium-rich products (melon, raisins, grapes, figs). Currants, watermelon, apples, apricots, and gooseberries help improve digestive function because they contain a lot of fiber. The presence of olives, walnuts, squash and pumpkin dishes, tomatoes, and lettuce in the daily diet will also help enrich the body with all the necessary substances. Fresh strawberries prevent inflammatory processes.

Currant

In addition, renal stimulation works very well: fresh kefir, the herbal teas mentioned above, tea with lemon. It is worth giving preference to sour drinks, and the amount of salt should be reduced to three grams per day. If there are no contraindications, you can also arrange fasting days, during which you follow a fruit or kefir diet. Throughout your pregnancy, strive for a balanced diet.

Childbirth with moderate low water

With moderate oligohydramnios, natural childbirth is possible. Often they proceed safely for the woman in labor and the baby, even if there is a breech or breech presentation of the fetus, provoked by oligohydramnios. However, sometimes pathology leads to weakness of labor, and a lack of anterior waters (in front of the child’s head) leads to pulling of the amniotic membranes over the baby’s head.

This phenomenon is called a flat amniotic sac.

In such cases, an artificial rupture of the membranes of the amniotic sac (amniotomy) is indicated in order to start the process of contractions and allow the baby to properly move towards the exit.

With moderate oligohydramnios, natural childbirth is also possible, but often the doctor recommends a cesarean section

In some cases, the doctor may recognize the need to artificially replenish the amniotic sac with saline a day before birth to reduce the risk of umbilical cord strangulation and other complications, and also decide on the need for a cesarean section.

Possible consequences for women and children

In some cases, moderate oligohydramnios is not dangerous, but sometimes it can result in premature birth and poor muscle activity during childbirth. However, if the deviation is left unattended, even it can cause serious defects in the development of the baby or even miscarriage, postpartum hemorrhage, premature placental abruption and cervical rupture.

What complications can a child experience? Timely diagnosed and promptly corrected oligohydramnios, as a rule, does not have or has a minimal effect, which can subsequently be corrected (mild hypoxia, decreased immunity, low weight). In its advanced form, it can lead to various anomalies of intrauterine development, injuries to the joints and spine, infection of the fetus in the womb, and its death as a result of oxygen starvation.

Timely diagnosis and treatment will help avoid unpleasant consequences for both mother and child

If moderate oligohydramnios occurs at the end of pregnancy, it may pose no threat to either the mother or the baby. But if the pathology develops in the early stages, then there is a possibility that it will further develop into a pronounced degree and will have disastrous consequences.

Prevention

To date, there are no specific recommendations that would guarantee the absence of oligohydramnios during pregnancy. To reduce the likelihood of the disease to a minimum, expectant mothers should eat a healthy and balanced diet, lead a healthy lifestyle and strictly follow all doctor’s instructions.

Special gymnastics is very useful for pregnant women

It is recommended to undergo prescribed examinations in a timely manner and take the necessary tests, and to refrain from excessive physical activity, however, special gymnastics for pregnant women and feasible physical activity will be very useful.

In addition, preventive measures include planning pregnancy, minimizing unprotected sex, and avoiding casual sex. It is necessary to prepare for conception in advance: identify and cure all chronic diseases and be sure to register with the antenatal clinic. Following these tips can significantly reduce the risk of oligohydramnios.

Video “Moderate oligohydramnios during pregnancy”

The discovery of moderate oligohydramnios should not cause you to panic. Statistics show that in most cases, babies are born healthy. The capabilities of modern medicine make it possible to identify pathology in time and correct the course of pregnancy, so be attentive to yourself, do not neglect medical examinations, follow the doctor’s recommendations, then your pregnancy will proceed successfully. Be healthy!

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Only four women out of a thousand are diagnosed with oligohydramnios. The pathology consists in an insufficient amount of amniotic fluid in which the fetus develops, which signals trouble in the female body. Why is oligohydramnios dangerous during pregnancy and what to do if you have to face such a problem?

Amniotic fluid or amniotic fluid is the natural habitat of the fetus, which is responsible for its life support. The correct development of the baby depends on the quantity and quality of intrauterine fluid, which allows him to be born healthy.

Amniotic fluid forms in the uterus 12 days after implantation of the fertilized egg. A bladder consisting of durable membranes forms in the uterus. They ensure the tightness of the amniotic sac and are called chorion and amnion.

The amount of fluid increases as the gestational age increases. So, with the onset of the 38th gestational week, 1-1.5 liters of amniotic fluid is observed. But closer to 40 weeks, the water level drops to 0.6 l. Compliance with these indicators plays an important role, therefore, during a routine ultrasound, the volume of fluid in the uterus must be measured. For measurement, a specific indicator is used - the amniotic fluid index.

Note! On the eve of labor, the bladder ruptures on its own, which in obstetrics is called “water breaking.”

The physiological volume of amniotic fluid is variable and differs from woman to woman. If the indicator drops below the critical level (below 500 ml), this phenomenon is called oligohydramnios. The deviation is more often observed in the last trimester and may well provoke the development of fetal pathology.

A pregnancy disorder such as fetal oligohydramnios is associated with inadequate functioning of the placenta. Although previously this pathology was associated only with a violation of the water-salt balance in women. But regardless of the cause of oligohydramnios, the risk of developmental delay, heart defects and even fetal death increases.

Classification of oligohydramnios during pregnancy

Oligohydramnios can be transient (temporary) and chronic:

• Acute (transient) oligohydramnios occurs suddenly under the influence of a certain factor. For example, temporary oligohydramnios develops against the background of acute respiratory infections, sore throat, or food poisoning. This form of oligohydramnios is benign and often goes away on its own after the woman recovers.
• Chronic oligohydramnios forms slowly and progresses with increasing gestational age. Sometimes it is possible to notice the deviation only in the third trimester, when treatment for oligohydramnios during pregnancy no longer brings results. At the initial diagnosis, a woman undergoes a comprehensive examination to find out the cause of the pathology.

Oligohydramnios is also classified according to the period of development:

• Early oligohydramnios forms between 16 and 20 gestational weeks. Oligohydramnios in early pregnancy is easily detected during an ultrasound. The main reason is the inferiority of the chorion. It is the most unfavorable type of oligohydramnios, since it occurs at the time of fetal formation and often provokes congenital malformations. If the diagnosis of oligohydramnios is confirmed, screening is required to identify chromosomal abnormalities in the fetus.
• Late oligohydramnios occurs after the 26th gestational week. This is a more favorable form of pathology, since the fetus is already fully developed and the risk of chromosomal diseases is minimal. However, oligohydramnios during late pregnancy requires vigilant monitoring of the baby’s condition, especially during childbirth.

Depending on the condition of the fetal membrane, oligohydramnios is divided into two subtypes:

• Primary― decrease in the amount of water without signs of damage to the amniotic sac. The cause of the pathology is abnormal development of the fetus, chromosomal abnormalities, and inferiority of the placenta.
• Secondary- lack of water caused by trauma to the shell. As a result of damage to the wall of the fetal bladder, slight leakage of water occurs.

Causes of oligohydramnios during pregnancy

The factors for the development of oligohydramnios have not been fully studied. But a study of similar cases in obstetric practice showed the following possible causes of this pathology:

• Underdevelopment and decreased functionality of the amniotic sac.
• Severe pathologies of the fetus (underdevelopment of the kidneys, deformities, chromosomal abnormalities).
• Hypertension. A severe and prolonged hypertensive crisis provokes placental dysfunction, which leads to oligohydramnios.
• Infectious diseases. Bacterial flora, when released into the amniotic fluid, complicates the functioning of the placenta.
• Improper blood flow in multiple pregnancies.
• Post-term pregnancy.
• Metabolic disorders in women, in particular severe obesity.

Symptoms of oligohydramnios during pregnancy

Confirmation of oligohydramnios is based on characteristic symptoms. So, the signs of oligohydramnios during pregnancy are as follows:

• Discomfort caused by fetal movement.
• Pain in the lower abdomen, reminiscent of pain during menstruation.
• Morning sickness and increased dry mouth.
• Weakness, body aches, apathy.
• Restless sleep.
• Refusal of food.

How to determine oligohydramnios during pregnancy

A gynecologist may suspect oligohydramnios in a woman during a routine examination. This pathology is indicated by:

• Insufficient fetal activity.
• Discrepancy between the height of the uterine fundus and the gestational age.
• Abdominal circumference is less than the established norms.
• The basic criterion for oligohydramnios is the amniotic fluid index, which is included in the list of indicators determined by ultrasound.

However, to confirm chronic oligohydramnios, all parameters are studied over a period of 1-2 months. If oligohydramnios progresses, the diagnosis is finally confirmed.

After this, the woman unscheduled undergoes additional screening:

• Donates blood for infections.
• Does a glucose tolerance test.
• Donates blood for indicators of developmental defects.
• An additional ultrasound is performed.
• Sent for amniocentesis with karyotyping to exclude genetic pathologies of the fetus.

Based on the research results, the doctor decides what to do in case of oligohydramnios during pregnancy: terminate the pregnancy or continue with subsequent treatment and observation.

Amniotic fluid index: norms

The optimal method for determining oligohydramnios is ultrasound. During the study, the amniotic fluid index (AFI) is calculated, and the length of the vertical pouch is measured. Using these two quantities, the water level is determined. If the index is below normal, oligohydramnios is confirmed.

• A vertical pocket is a free sector of amniotic fluid between the baby and the anterior wall of the peritoneum. At the time of measurement, there should be no fragments of the placenta or parts of the fetal body. Normally, the length of the pocket is from 5 to 8 cm.
• IAF - for measurement, the abdomen is conventionally divided by two perpendicular lines passing through the navel. As a result, 4 even squares are visualized. Then the height of the pocket is determined in each of them. At the end, these values ​​are added and the IAF is obtained.

Moderate oligohydramnios during pregnancy

With moderate oligohydramnios, the length of the pocket varies between 2 and 5 cm. In this case, the AFI should be as follows:

This degree of oligohydramnios is insignificant and is often an echographic sign without clinical manifestations. Moderate oligohydramnios requires mandatory CTG, as well as Doppler ultrasound, to exclude defects in the fetus. The woman will be prescribed short-term multivitamins and medications to improve the functioning of the placenta.

Severe oligohydramnios during pregnancy

Severe oligohydramnios is an obvious pathology, indicating significant disturbances in the functioning of the placenta and the development of the baby. The diagnostic criterion for the anomaly is that the length of the vertical pocket does not exceed 2 cm, and the AFI is equal to the following values:

After the diagnosis is confirmed, the woman is sent for examination. Its goal is to exclude chromosomal abnormalities and assess the functional viability of the placenta. If the cause of the pathology turns out to be a woman’s illness (diabetes, gestosis) or phytoplacental insufficiency, the pregnancy is maintained and the woman’s condition is corrected. If chromosomal defects in the fetus are detected, the woman is advised to terminate the pregnancy.

How to treat oligohydramnios during pregnancy

Moderate oligohydramnios often does not require treatment. It does not progress and in most cases is temporary. In this case, there is no danger to the mother and fetus, so the woman is not given recommendations on a healthy lifestyle.

The situation is completely different with severe oligohydramnios. There is no clear treatment plan for the pathology, so the doctor selects an individual strategy for each case. Unfortunately, the outcome is not always favorable. Some women have a miscarriage or the fetus is born with deformities, while others have babies born weak and in need of resuscitation.

A common method of treating oligohydramnios is to inject saline into the amniotic sac through the cervix. This procedure allows you to delay the aging of the placenta or its detachment, as well as the premature death of the umbilical cord. But such measures are effective only if the fetus has no signs of developmental pathology.

If screening shows developmental abnormalities before the 26th gestational week, the pregnancy is terminated. If treatment for oligohydramnios does not bring improvement, and the pregnancy is already long (at least 28 weeks), premature birth is stimulated.

Oligohydramnios during pregnancy: consequences for the child and woman

Oligohydramnios in the 1st or 2nd trimester can cause multiple defects in the fetus or miscarriage. In the second half of pregnancy, pathology complicates the growth and development of the baby and often provokes premature onset of labor.

What are the dangers of oligohydramnios during pregnancy for a woman:

• Insufficiency of amniotic fluid leads to pain in the uterus.
• The risk of miscarriage increases.
• During childbirth, insufficient labor activity is observed, and incomplete dilatation of the cervix occurs.
• Often it is necessary to resort to stimulation of contractions, and the bladder is opened artificially.

The effect of oligohydramnios on the fetus:

• The baby cannot grow and development is delayed.
• The fetus develops clubfoot, a skeletal deformity.
• Increased risk of chromosomal abnormalities or deformities.
• The baby cannot be born naturally, so a caesarean section is performed.
• Perinatal mortality of the baby is possible.

Oligohydramnios during pregnancy - prevention

The only way to prevent oligohydramnios is to eliminate the factors that provoke this pathology both at the stage of pregnancy planning and after conception. To do this, you need to detect these factors (if they exist) and eliminate them in time.

• Thus, metabolic disorders in a woman, including water imbalance, decreased metabolism due to endocrine disorders, and poor nutrition are deviations from the norm that need to be corrected at the stage of pregnancy planning.
• And during pregnancy, you need to avoid intoxication with alcohol, nicotine, medications and chemical elements. This leads to slower placental blood flow and oligohydramnios.
• For prevention, a woman is also recommended to have good nutrition, moderate physical activity, regular visits to the doctor and undergo all routine examinations.

Oligohydramnios during pregnancy - reviews of outcomes

In most cases, women report slight oligohydramnios in the second half of pregnancy, which went away successfully after short-term treatment. Women carried the baby to term normally and gave birth naturally.

Some ladies say that they were prescribed vitamins and a metabolic complex (Curantil with Actovegin), while other women did without treatment.

The described cases indicate the prevalence of transient physiological oligohydramnios, which does not threaten either the woman or the fetus.

Only in rare cases is there information about early oligohydramnios (before 26-28 gestational weeks), when examination showed impaired fetal development. In these cases, the pregnancy ended in artificial termination.

As you can see, the dangerous consequences of oligohydramnios during pregnancy are rare, and it is not always possible to prevent them. But in most cases, minor oligohydramnios goes away on its own, leaving no sad consequences.

Video “Olihydramnios during pregnancy”

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.

Please note : Most of these conditions are not pathological and do not pose a danger to pregnancy.

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:

Please note : 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.

Please note : 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:

Please 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 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.

The earlier oligohydramnios formed, the higher the risk of experiencing the described complications.

Please note : 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.

Please note : 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