Print out the exam form in computer science. To successfully pass the Unified State Examination you must

Polyhydramnios is a pathology during pregnancy, which is characterized by an excess of amniotic fluid in the amniotic bladder. Amniotic fluid is the natural environment for embryo development. It protects the unborn child from external physical impact, provides suitable temperature (about 37°), freedom of movement. In addition, amniotic fluid contains nutrients necessary for the fetus to develop normally.

If the volume of amniotic fluid exceeds the norm, then we are talking about a dangerous complication. A similar problem occurs in 1% of women at 33–34 weeks of pregnancy. To avoid serious consequences or prevent this condition, you need to learn more about the disease.

Polyhydramnios - information about pathology

As already mentioned, polyhydramnios is characterized by excessive accumulation of amniotic fluid in the uterus. It protects the embryo from external damage, infectious diseases, and provides it with nutrition. The fetus systematically swallows a small portion of liquid, then it is excreted along with urine from the body. This is how the volume of amniotic fluid is regulated. But sometimes this balance is upset, and the amount of fetal fluid exceeds the norm.

To calculate the volume, doctors use the amniotic fluid index, which is determined during an ultrasound examination. During the study, the uterus is conditionally divided into 4 squares, the largest space in each is measured, and the results obtained are summed up. Thus, the amniotic fluid index equal to the sum four sizes.

The normal volume of amniotic fluid changes at different stages of pregnancy. If the values ​​exceed the norm, then we are talking about high water levels.

The amniotic fluid index norms are presented in the table:

Based on the amniotic fluid index, the following types of polyhydramnios are divided:

1. Acute is a condition in which the volume of amniotic fluid sharply increases, which is very dangerous. The pathology develops within several hours, and the pregnant woman’s well-being deteriorates sharply. This type of polyhydramnios is diagnosed early and carries a risk of uterine rupture.

2. Chronic polyhydramnios has moderate current, does not manifest itself with severe symptoms and is detected in the 3rd trimester. For this reason, diagnosing the disease is quite difficult. The consequences of chronic polyhydramnios can also be negative.

3. Moderate polyhydramnios in pregnant women is defined in the absence of external signs. In this condition, the deviation from the norm is minimal, the volume of amniotic fluid increases gradually. In this case, the woman can give birth in a natural way, although a certain risk still exists.

To prevent pathology, it is important to understand why polyhydramnios develops.

Causes of the disease

Doctors still cannot answer the question of what are the causes of polyhydramnios in pregnant women. According to statistics, in more than 30% of cases they remain unknown. But there is a risk group, which includes pregnant women with a high predisposition to polyhydramnios:

Diabetes mellitus.
Impaired kidney function.
Infectious diseases (cytomegalovirus infection, rubella, herpes, etc.).
Serious illnesses cardiovascular system.
Rhesus conflict.
Pregnancy with more than one fetus.
Disorders of fetal development (genetic abnormalities, pathologies of the central nervous system, heart, stomach, intestines, etc.).

The likelihood of polyhydramnios increases when the embryo swallows too much amniotic fluid, which does not have time to renew itself. It is important to diagnose the pathology as early as possible so that a woman can carry and give birth to a child normally. That is why it is necessary to remember the characteristic symptoms of polyhydramnios initial stages development.

Symptoms

The amniotic fluid constantly moves and is periodically renewed. And therefore its volume differs at different stages of pregnancy:

10 weeks of pregnancy – 30 ml of amniotic fluid;
14 weeks – 100 ml;
by 37–38 weeks, the volume of amniotic fluid reaches 1 to 1.5 liters.

If this indicator is higher, then polyhydramnios is diagnosed.

Certain symptoms will help identify problems, and if they occur, you should consult a gynecologist:

Heaviness, discomfort in the abdomen;
constant weakness and malaise, which becomes chronic before childbirth;
dyspnea;
increased heart rate;
swelling;
the abdominal circumference at the navel reaches 100–120 cm or more;
rough stretch marks appear on the stomach;
a specific gurgling sound in the stomach, which doctors call fluctuation.

In addition, before childbirth with polyhydramnios, the uterus constantly tenses, its size deviates from normal, and the activity of the embryo increases. During the examination, the gynecologist will detect an increase in the height of the uterine fundus. It is important to be attentive to your condition in order to recognize these symptoms as early as possible.

Consequences of polyhydramnios

Many women at risk are interested in the question of why polyhydramnios is dangerous in pregnant women. Pathology threatens dangerous complications for the mother, especially in the 3rd trimester of pregnancy:

Consequences of polyhydramnios for the fetus:

Impaired functionality of the placenta, which causes oxygen starvation the fetus, until its death;
developmental disorder of the nervous and digestive system;
infectious diseases;
birth on early stages, with low body weight (about 2.5 kg and height less than 45 cm);
weakening of the immune system.

To protect the woman and unborn child from negative consequences, doctors recommend giving birth by caesarean section.

If a woman insists on giving birth on her own, she should become familiar with the complications that await her:

premature birth (from 28 to 37 weeks);
rupture of membranes before the onset of labor;
loss of small parts (arms or legs) of the embryo or umbilical cord;
incorrect presentation of the fetus (transverse, breech, etc.);
weak labor activity;
severe uterine bleeding;
overstretching of the uterus and premature separation of the placenta.

To avoid such complications, it is necessary to carry out timely diagnosis and proper treatment.

Treatment methods

If, after an ultrasound, the diagnosis of polyhydramnios was confirmed, then the pregnant woman should be under the supervision of doctors. The method of therapy depends on the cause of the pathology:

If a Rh conflict is detected between mother and fetus, the woman is given immunoglobulin.
In case of an infectious disease, a pregnant woman is prescribed antibacterial drugs.
If diabetes mellitus is detected, the woman is given treatment that corrects blood glucose levels.

However, it is not always possible to determine the cause of the disease. In this case, treatment of polyhydramnios in pregnant women is carried out according to a standard scheme, which consists of a set of procedures. Therapy is carried out using the following drugs:

Vitamin complexes, which must include elements of groups B, E, C.
Magnesium-containing preparations.
Diuretics.
Antibacterial drugs with a wide spectrum of action.

In addition, patients need to follow a diet.

If polyhydramnios becomes chronic, then at 33–34 weeks of pregnancy the question of an amniotomy may arise. This is an operation during which the amniotic sac is opened and amniotic fluid is released. The fact is that the uterus overstretches with polyhydramnios and cannot contract normally during childbirth.

If the bladder spontaneously ruptures, the amniotic fluid will rapidly come out, which increases the likelihood of prolapse of the fetal limbs or umbilical cord. Amniotomy allows you to regulate the release of amniotic fluid and prevent complicated births.

If polyhydramnios occurs between 36 and 41 weeks, the doctor will decide to induce labor. In some cases, it is necessary to induce labor at 34 or 35 weeks. However, doctors try to maintain the pregnancy until the 37th week, since at this stage the embryo is already full-term.

Thus, polyhydramnios is a dangerous condition that threatens the life of the mother and child. This pathology indicates that the pregnancy is not proceeding well or that there are pathologies in the woman or fetus. To save the life of the mother and child, it is necessary to identify the disease in time and treat it.

Amniotic fluid is the first living environment every person. The woman’s well-being, the development of the fetus, and the characteristics of labor depend on their quantity and composition.

The volume of amniotic fluid increases every week as the baby grows. In some women, the amount of water does not correspond to the norm.

Both polyhydramnios and oligohydramnios during pregnancy can bring various unpleasant surprises expectant mother, so such deviations cannot be ignored.

Polyhydramnios during pregnancy: what does it mean?

Polyhydramnios during pregnancy is an excess of amniotic fluid in the amniotic sac. The role of amniotic fluid in the development of a child is enormous: maintaining the body in space, ensuring freedom of movement, a source of nutrients, protection from damage and infections. But their quantity must always correspond to the norm.

During an ultrasound examination, the doctor determines the amniotic fluid index (AFI), an indicator of the amount of amniotic fluid, and compares it with the table.

When determining the IAF, the sonologist visually divides the amniotic sac cavity into 4 equal parts and in each one identifies a space that is filled with water and does not contain parts of the baby’s body (vertical pocket). If the largest pocket has a depth of 2 cm or less, oligohydramnios is diagnosed; if the depth is more than 8 cm, polyhydramnios is diagnosed.

Gynecologists distinguish between different forms of polyhydramnios:

1 Relative polyhydramnios– a slight deviation from the norm at this stage, usually associated with carrying a large fetus, and in the absence of other pathologies, it can be safe for the woman and the fetus.

2 Borderline state, or a tendency to polyhydramnios during pregnancy is a case when the amount of water reaches the upper limit of normal, and it is possible that in the future an excess of it may appear.

Due to polyhydramnios, a woman may not develop labor, so in the last weeks she should be under the supervision of doctors, and if necessary, she will undergo labor.

Polyhydramnios during pregnancy: treatment

How to treat polyhydramnios during pregnancy depends on the cause of the disorder. If amniotic fluid accumulates due to a woman's illness, appropriate therapy is needed.

In severe cases, when the mother’s condition sharply deteriorates, the pregnancy has to be terminated in order to save the woman’s life. If the situation is not so critical, the pregnant woman will simply have to spend some time in the hospital and undergo a course of treatment to save the baby.

All women, without exception, having learned about their pregnancy, dream of bearing a strong and healthy baby. However, expectant mothers, like no one else, are susceptible to all sorts of diseases and infections. This is because their immunity weakens, as a result of which all protective functions body.

A common phenomenon that can threaten the life of the unborn baby is polyhydramnios during pregnancy. Knowing what kind of disease this is and how to prevent it, sad consequences can be avoided.

Amniotic fluid and its functions

The baby in the mother’s tummy feels warm and cozy for all nine months. He is full and warm. And all thanks to amniotic fluid (also called amniotic fluid). This is a kind of biological environment that is necessary for the full development of the baby. The amount of water depends on the stage of pregnancy. Of course, a two-week-old embryo needs much less water than, say, a fetus at twenty-fifth week of development.

Amniotic fluid contains proteins, mineral salts, hormones, enzymes, fats and other substances that are useful for the growth of the baby. The smell of the waters is reminiscent of mother's milk. This is why it is easier for a newborn to find the breast. The fluid is renewed every three to four hours.

Before the birth itself, the amniotic fluid recedes - the pregnant woman feels as if she has involuntarily wet herself. Based on the color of the liquid, we can talk about the intrauterine state of the child:

• A yellow, slightly cloudy liquid is considered normal.
• If there are bloody streaks, but nothing bothers the pregnant woman, there is no need to worry either.
• The dark brown color of the liquid often indicates the death of the baby.
• Red water - there may be internal hemorrhage that threatens the child’s life.
• Green liquid - defects and developmental deviations.

What is polyhydramnios?

Sometimes there may be excess amniotic fluid. Then doctors make a diagnosis - polyhydramnios. You can determine the normal amount of fluid by feeling the fundus of the uterus (it will be raised when pathological condition water) or using ultrasound diagnostics.

There are three forms of polyhydramnios - acute, chronic and moderate. Why is polyhydramnios dangerous during pregnancy?

1. Acute form. Extremely difficult for both mother and baby. The amount of fluid increases rapidly and in a matter of hours, uterine rupture can occur. The disease requires immediate treatment and hospitalization. Fortunately, this form is extremely rare.
2. Chronic form. Less dangerous than the previous one. More common on latest dates pregnancy (33 - 35 weeks). Develops evenly. Needs treatment and supervision by a specialist.
3. Moderate polyhydramnios during pregnancy is a minor deviation from the norm and occurs quite often. The disease can be recognized already at 16-20 weeks.

Each of three forms polyhydramnios poses a potential threat to the baby and his mother. Treatment cannot be avoided once a diagnosis is made. Otherwise, placental abruption and fetal death may occur.

Reasons for increasing the amount of amniotic fluid

Polyhydramnios itself develops very rarely. There must always be a logical explanation for this.

Polyhydramnios during pregnancy has a variety of causes:

1. Maternal diseases (chronic - diabetes mellitus, vascular diseases, defects; infectious - chlamydia, trichomoniasis, ureoplasmosis and other STDs).
2. TORCH - infections.
3. Rhesus conflict.
4. Carrying twins.
5. Large fruit.
6. Pathologies in child development.

Only a doctor can diagnose polyhydramnios after examination and ultrasound results.

Symptoms of polyhydramnios during pregnancy

The development of polyhydramnios can be judged by the following symptoms:

• Heaviness in the abdomen, which causes discomfort and is sometimes accompanied by pain.
• Weakness, fatigue.
• High blood pressure.
• Nausea.
• Dyspnea.
• Swelling of the extremities, mainly the lower ones.
• Noticeable enlargement of the abdomen, which does not correspond to the period.
• The appearance of a large number of stretch marks.
• With the development of the acute form, pressure is observed in the perineal area.

The seriousness of the disease is that all symptoms are taken for granted by the pregnant woman. Therefore, they may be detected late by a doctor. A final diagnosis can only be made after an ultrasound.

Why is polyhydramnios dangerous?

Like any disease, polyhydramnios, if not properly treated, can cause unpleasant consequences, including the death of the mother or baby.

An increased amount of amniotic fluid can cause:

1. Early discharge of amniotic fluid and intrauterine infection of the fetus.
2. Delivery ahead of schedule.
3. Miscarriage.
4. Bleeding.
5. Functional disorders of the fetal organs.
6. Oxygen starvation.
7. Placental abruption and death of the baby.

Polyhydramnios is also the reason for the absence of labor, as a result of which doctors very often perform a caesarean section.

Therefore, to avoid polyhydramnios during pregnancy, it is better to prevent the causes of the disease than to treat it. A pregnant woman should always take responsibility for her health. Any changes accompanied by pain and discharge are a signal to call an ambulance. Ignoring symptoms always leads to severe consequences. Often - to death.

Moderate polyhydramnios during pregnancy

Acute and chronic forms of polyhydramnios are extremely rare. But moderate polyhydramnios is a common phenomenon and can be observed in every tenth pregnant woman.

With moderate polyhydramnios, amniotic fluid accumulates gradually. Most often, such a deviation is not diagnosed in a pregnant woman. The diagnosis can be made on the basis of ultrasound diagnostics, as well as during examination by a doctor. In the second case, the uterus is raised 3 centimeters higher than usual.

Moderate polyhydramnios, like its other forms, needs treatment. Otherwise, premature birth and some fetal pathologies cannot be avoided, in particular prematurity, hypoxia and developmental delays.

There are cases when a moderate form of polyhydramnios is temporary and soon goes away on its own. However, this is an exception rather than a pattern.

How to reduce amniotic fluid levels?

Polyhydramnios during pregnancy lately Doctors are diagnosing more and more often. The disease has unpredictable consequences for the mother and her baby, and therefore requires mandatory treatment.

A woman suffering from polyhydramnios has severe swelling of the limbs and shortness of breath. It is difficult for her not only to stand and move, but even to sit and lie down. The pulse is disrupted and the blood pressure rises. Self-medication is very dangerous for the health of both mother and baby. After all, in order to treat this disease, it is necessary to determine in what form it occurs. What only an experienced specialist can do.

Polyhydramnios in the last stages of pregnancy, as in any other period, is often treated in a hospital under the supervision of a doctor. You can choose the right treatment tactics using tests:

• blood (total and glucose);
• urine;
• flora smear;

• Drugs to improve the functions of the placenta.
• Diuretics.
• Drugs aimed at stabilizing the blood flow of the placenta.
• Complex of vitamins.
• Sometimes antibiotics (if infection occurs).

In acute and chronic forms, the doctor can perform amniodrainage (pumping out excess water through a special needle).

Polyhydramnios at 32 weeks of pregnancy is mostly treatable. A woman has a chance to carry her child to term. However, for this you need to consult a doctor for help as soon as possible. In rare cases, treatment for the disease does not bring results. Premature birth occurs. The child is born premature, but may not have any developmental defects.

Polyhydramnios at 38 weeks of pregnancy almost always ends in childbirth. The main task of the doctor is to prevent the death of the baby, which occurs as a result of early breaking of water and suffocation.

Prevention of polyhydramnios

It is always better to prevent any disease than to treat it. This also applies to polyhydramnios. Especially when the disease poses a serious danger to the baby’s life.

Most the best prevention polyhydramnios is correct and healthy image life, namely:

1. Proper, balanced nutrition. If you have a tendency to excess weight, it is better to stick to light diets so as not to overfeed your baby. After all, a large fruit is one of the reasons for polyhydramnios.
2. Compliance drinking regime. Do not eat too salty or spicy foods, after which water intake increases.
3. Hiking, physical culture, exercise and yoga always have a good effect on health.
4. Avoid stressful situations And negative emotions. Stress is the beginning of many diseases.
5. Don't forget about vitamins. In the case of polyhydramnios, vitamins B, C, E, which a huge number found in greens and vegetables, meat and fish, cereals and cereals.

Treatment of polyhydramnios during pregnancy is a complex process. It is not always possible to carry a child to term.

As already mentioned, there can be several causes of the disease. However, the most common are chronic and infectious diseases of the mother. Therefore, when planning a pregnancy, you should undergo all tests and treatment in advance. When a baby already lives under your heart, it is much more difficult to do this. And most importantly, never let any disease become chronic!

Childbirth with polyhydramnios

Polyhydramnios during pregnancy is always a prerequisite for difficult childbirth. In the unborn baby, an excessive amount of amniotic fluid causes:

1. Oxygen starvation (hypoxia).
2. Incorrect presentation.
3. Large weight.
4. Prolapse of the umbilical cord, leg or arm during the discharge of amniotic fluid.

Natural childbirth becomes impossible, and doctors perform a caesarean section. Childbirth almost never occurs on time. Amniotic fluid always leaves earlier than expected. Therefore, a pregnant woman diagnosed with polyhydramnios should be hospitalized earlier and observed by a doctor until delivery.

Is oligohydramnios good or bad?

The second common phenomenon during pregnancy is insufficiency of amniotic fluid or oligohydramnios. Occurs in 7-10% of women. The reasons for this condition may be:

• Smoking.
• Maternal defects, in particular kidney disease.
• Chronic diseases and STIs.
• Viral diseases acquired during pregnancy.
• Carrying twins.
• Incorrect development of the placenta (premature aging).

Only a doctor can determine oligohydramnios after examination and ultrasound results. The following symptoms may also indicate the disease:

1. Low position of the uterine fundus.
2. The baby's movements cause discomfort and pain.
3. The lower abdomen is painful.
4. The general condition of the pregnant woman is characterized by weakness, nausea and fatigue.

Insufficient amniotic fluid leads to a shrinkage of the uterus and as a result a child may be born:

• With a curved spine, dislocations or club feet.
• Developmentally delayed. Oxygen starvation of the brain develops.
• Ahead of schedule.
• Dead.

Fetal freezing often occurs in the early stages. Oligohydramnios during pregnancy is much more difficult to treat. It is very difficult to select drugs that would increase rather than decrease the amount of amniotic fluid.

The main task of the doctor remains to maintain the placenta and baby. This is possible with the help of vitamins and medications that improve blood flow in the placenta.

Low water - dangerous phenomenon in the early stages of pregnancy, because it may have death. At later stages, premature birth occurs. Labor activity in this case is weakly expressed. Doctors often perform a caesarean section. The child may be born with disabilities.

Conclusion

Waiting for a baby is a great happiness and joy, which can be overshadowed by such an unpleasant phenomenon as pathology of amniotic fluid.

Polyhydramnios during pregnancy, like oligohydramnios, have negative impact on the development of the fetus and lead to defects. Labor almost always begins prematurely and is often performed by caesarean section.

At risk are women carrying twins, as well as those who have chronic diseases and inflammation. Therefore, before planning a pregnancy, it is better to undergo a full examination and cure all ailments before conception.

Polyhydramnios in pregnant women, what is it and why does it occur? Unfortunately, there are many pathologies that can appear during pregnancy. And this is one of them. For each stage of pregnancy, a certain norm for the amount of amniotic fluid is established, but if the amount of amniotic fluid exceeds it, then there is a pathology - polyhydramnios.

Doctors have not been able to fully identify all the causes of polyhydramnios in pregnant women. This pathology can occur when the membranes of the fetus are damaged by infections; for diabetes mellitus and Rh conflict. Polyhydramnios can also be observed in a woman carrying a large fetus or during a multiple pregnancy. If there is more than one fetus, then it happens and this is recorded on an ultrasound: for one fetus there is polyhydramnios, and for the other there is oligohydramnios.

What are the symptoms of polyhydramnios in a pregnant woman? Future mother may feel heaviness or pain in the lower abdomen, fatigue. You may also hear gurgling sounds in your stomach. Some pregnant women vomit, which can lead to dehydration. Swelling is another unfavorable sign. Especially if they appear on the face in the morning, this almost always means kidney damage.

A doctor can also diagnose polyhydramnios during pregnancy during an examination. The size of the uterus will not correspond to the duration of pregnancy; it will be enlarged. The abdominal circumference in the navel area with polyhydramnios is much more than 100 cm. During an ultrasound examination, the fetal heartbeat is difficult to hear.

Polyhydramnios can be dangerous. Since if there is a lot of amniotic fluid, there is a lot of space in the mother’s tummy for the baby, so he can actively move. At the same time, when the time comes for childbirth, the baby may take an unfavorable position in the uterus - pelvic or transverse. Therefore, with polyhydramnios, a caesarean section is often performed. Also, with polyhydramnios, premature birth is not uncommon. Children are born premature. Hypoxia occurs in the fetus due to the entanglement of the umbilical cord around the neck. A cosmetic defect after such a pregnancy is numerous stretch marks in the abdominal area.

For treatment, you need to understand why polyhydramnios occurs in pregnant women in each specific case. For an infectious disease caused by pathogens, antibiotics are prescribed. They are selected depending on the disease, as well as the result of a sensitivity test for the drug - often this helps to avoid ineffective treatment.

Vitamins and other medications may also be prescribed, depending on the cause. And of course, pregnant women with polyhydramnios need constant medical supervision, so they are put into storage. If there is a lot of amniotic fluid, then doctors use a thin catheter to remove some of the fluid. There are three forms of polyhydramnios. The first is the acute form. In this case, the amniotic fluid index (determined by ultrasound) increases significantly literally within a day. This is often noticeable even visually. The situation is very dangerous and can lead to rupture of uterine tissue. The second form is chronic, it is not so dangerous because the increase in water occurs gradually. The chronic form of polyhydramnios manifests itself mainly in the later stages. But moderate polyhydramnios is more common in pregnant women, in which there is every chance of carrying a good pregnancy and giving birth to a child, and naturally.

Polyhydramnios in pregnant women is not so common in obstetric practice. This pathology requires special attention and treatment, because it can pose a serious danger to both the woman and the child. We will talk about why the amount of amniotic fluid increases and what to do if this happens in this material.

What is it?

Amniotic fluid, bounded by the walls of the amnion (fetal bladder), is an ideal nutrient medium for the growth and development of the baby before his birth. They protect the baby from injury, acting as a reliable shock absorber. They take in the baby’s waste products and remove them, nourish the baby and protect his delicate skin.

If for some reason the amount of amniotic fluid increases relative to the norm, we're talking about about polyhydramnios - a dangerous condition that can lead to dire consequences. The water can arrive gradually, then the excess will be smooth, or it can increase in volume rapidly.

On medical language The problem is called "polyhydrmonion". This pathology is recorded in approximately 1-2% of total number pregnancies. During a healthy pregnancy, the amount of water increases gradually, and by 15-16 weeks it can already be determined and measured using an ultrasound machine.

Since they cannot be drained and the volume measured, a special indicator is used to determine the amount of amniotic fluid - the amniotic fluid index (AFI). In a normal pregnancy, not burdened by pathologies, it looks like this:

Norms of amniotic fluid index (AFI) - table:

Exceeding the upper threshold of norms for a certain period is the basis for judging whether a woman has polyhydramnios. Most often, the problem becomes obvious in the 2nd and 3rd trimesters of pregnancy.

Classification

Polyhydramnios is conventionally divided into moderate and severe. If the amount of water exceeds upper limit normal values no more than 10%, we are talking about a moderate degree. But for the assessment of polyhydramnios during pregnancy, it plays not so much a role exact quantity excess water as much as the speed at which it arrives.

The amniotic fluid index, determined over time, allows you to set this speed. If there is an increase at a slow pace, then we are talking about chronic polyhydramnios. With this pathology, the prognosis is most favorable, in most cases It is possible to carry the pregnancy to term and give birth to a completely normal baby.

If the waters arrive very quickly, their quantity increases rapidly, literally within a few hours or days, then such polyhydramnios is considered acute. This is a serious pathology.

If it develops early (14-16 weeks of pregnancy), it usually leads to termination of pregnancy, because the amniotic membranes simply cannot withstand the pressure of large amounts of water. If a rupture does not occur, the risks of congenital malformations of the child increase. Acute polyhydramnios can also occur in later stages, and then the risk of losing the child will also be significant.

In addition, polyhydramnios can be mild (with a slight excess), moderate (with an approximate amount of amniotic fluid of 3-5 liters) and severe (if the amount of water exceeds the volume of 5 liters).

In each specific case, the forecasts are purely individual: it is very difficult to predict how the organisms of the mother and baby will behave, what the condition of the amnion and placenta will be.

Causes

Even with modern level development of medicine and science find out real reasons The occurrence of polyhydramnios has not yet been possible. But for many years Observations and practice give obstetricians-gynecologists grounds to assert: polyhydramnios is a very controversial pathology.

On the one hand, the secretory ability of the villi of the amniotic membrane is impaired due to excess fluid. On the other hand, excess fluid begins to accumulate due to the fact that the membranes begin to absorb fluid less well.

The waters are renewed every three hours. A new portion is produced to replace the previous portion of fluid, which is almost completely absorbed by the amniotic membrane, as well as by the lungs and intestines of the child. If the old one has not yet been completely absorbed, then this causes an increase in the amount of liquid. This, in short, is the mechanism for the development of pathology. There is still heated scientific debate about the reasons that trigger this mechanism.

Most often, polyhydramnios develops in women suffering from the following pathologies:

• diabetes mellitus and gestational diabetes (this cause accounts for almost 30% of all cases of polyhydramnios);
• infectious diseases, including chronic and sexually transmitted diseases (the most common infections are herpes viruses, rubella, toxoplasmosis and cytomegalovirus infections);
• inflammatory diseases of organs reproductive system;
• chronic and acute diseases of the heart and blood vessels;
• chronic or acute diseases of the kidneys and urinary system;
• anemia of various origins.

The development of polyhydramnios can also be caused by some features of pregnancy itself:

• gestosis;
• multiple pregnancy;
• immunological incompatibility of mother and fetus (usually due to a difference in Rh factors).

Some developmental pathologies of the baby itself can also lead to polyhydramnios:

• congenital malformations (most often anomalies of the brain and spine - anencephaly, hydrocephalus, microcephaly, etc., as well as malformations of the stomach, intestines - artesia of various areas digestive tract);
• genetic chromosomal abnormalities (Down syndrome, Patau syndrome, etc.).

The likelihood of polyhydramnios is also affected by some pathologies of the placenta, in particular Chorioangioma.

At risk for the development of polyhydramnios are women who have chronic diseases, who have had them in the early stages of gestation, including acute respiratory viral infections and influenza, as well as women who are in disadvantaged conditions. social conditions- influenced by poor nutrition, lack of essential vitamins and minerals. Polyhydramnios is often accompanied by pregnancy in women who abuse alcohol, drugs and smoking.

Experts include women in the risk group who have a high risk of giving birth to a child with chromosomal abnormalities (those who became pregnant after 35 years, who have disabled children with chromosomal ailments, who have relatives with genetic pathologies, who have a history of several miscarriages in a row).

Among all identified cases of polyhydramnios in pregnant women about 20% are due to polydramnios caused by fetal developmental abnormalities.

All of the above factors can cause the accumulation of amniotic fluid. If a woman has infections or inflammatory diseases of the reproductive organs, the amnion may produce amniotic fluid components too actively, and their excretion will be slow.

If the baby has a malformation of the esophagus, he will swallow water less actively or will not swallow it at all, which will also lead to overfilling of the amniotic sac.

Symptoms and signs

The severity of symptoms with polyhydramnios depends on the type of pathology. If chronic polyhydramnios is observed, then the woman’s body adapts to the gradual accumulation of amniotic fluid, and compensatory mechanisms begin to work.

As a result, the expectant mother no clear clinical picture appears, the symptoms “smooth out” and sometimes proceed almost unnoticed. It is usually discovered by the middle of the second trimester, not earlier.

Acute polyhydramnios occurs much less frequently, and a woman’s complaints appear almost immediately. She complains of a worsening condition, pain and a feeling of “fullness” in the abdomen.

For the most part, the acute form of the pathology develops in the period from 14 to 24 weeks of pregnancy, most often before 20 weeks. With such a violation, in almost 95% of cases the most terrible suspicions are confirmed - chromosomal disorders fetus, whereas with chronic polyhydramnios, defects and anomalies are not always present.

It is practically impossible for an expectant mother to determine chronic polyhydramnios on her own. Symptoms characteristic of polyhydramnios are more pronounced in acute disorders. But sometimes, in a quieter form, they can be present in gradually developing pathology.

For polyhydramnios:

• the fetus moves too actively;
• a woman often feels heaviness and fullness in her stomach;
• appears severe pain in the abdomen (with acute polyhydramnios);
• a woman develops severe shortness of breath even after minor physical activity;
• the expectant mother shows all the signs of premature birth or spontaneous abortion if the problem is identified on recent months pregnancy.

The third trimester is the brightest and characteristic feature polyhydramnios indicates late toxicosis. Unlike early, it acquires alarming proportions - sometimes with polyhydramnios, the frequency of vomiting in a pregnant woman reaches several episodes per hour.

In later stages, swelling of the anterior abdominal wall also becomes noticeable. Half of the patients with polyhydramnios have fluctuation. This term refers to the characteristic sound - the “squelching” of amniotic fluid in different situations, for example, when changing body position.

The uterus, which with polyhydramnios has significantly large sizes, puts pressure on the diaphragm, because of this, difficulty breathing occurs, problems with cardiac activity may begin to be felt - tachycardia is most often recorded in women.

Another characteristic external sign of polyhydramnios is the formation of extensive and rough stretch marks on the skin of the abdomen.

Danger and consequences

Polyhydramnios is dangerous due to termination of pregnancy. The amniotic membranes that surround the baby along with the fluids are elastic and strong, but not to such an extent that they can withstand too much fluid.

The most tragic scenario is the rupture of the membranes and the death of the baby. Approximately every third pregnancy with polyhydramnios ends in spontaneous termination.

Distended amniotic sac and large number liquid inside it create a large space for the child to move, and he actively uses it. Because of this, umbilical cord entanglement, pelvic or transverse presentation are often detected, which will require special approach to delivery. Most often, a child is born through a caesarean section.

During childbirth, polyhydramnios threatens to result in massive bleeding. Medical statistics report that fairly heavy postpartum bleeding is observed in approximately half of pregnant women with a confirmed diagnosis of polyhydramnios.

In 7-8% of women, premature rupture of water is observed, which threatens a long anhydrous period and the onset of hypoxia or infection of the baby. In 5% of pregnant women with polyhydramnios, premature placental abruption is observed.

The pathological condition in every fifth expectant mother in the late stages causes nausea and vomiting, increased blood pressure. In 6% of cases, the child has intrauterine growth retardation.

Diagnostics

The first suspicions about possible polyhydramnios usually arise from an obstetrician-gynecologist. When examining a pregnant woman at each scheduled visit, the uterine fundus height (UFH) is measured. In an expectant mother with polyhydramnios, this size, which normally corresponds to the term (at 18 weeks - 18 cm, at 38 weeks - 38 cm), is significantly exceeded. The abdominal circumference has also increased.

A “manual” gynecological examination shows that the uterus has a tight-elastic consistency, its walls are “tight”, the doctor’s manipulations when trying to palpate parts of the fetal body cause “gurgling” and “squelching”, and it is quite difficult to palpate the baby, because in the large space of the enlarged uterus it is easier for him to hide from such an examination.

Quite often, the baby is located in the uterine cavity in a breech or transverse presentation, with the presenting part of his body located quite high above the entrance to the pelvis. The baby's heart tone, which any obstetrician can easily listen to at an appointment, is heard inaudibly and muffled. It is difficult to listen to the baby's heart normally due to the large amount of fluid surrounding it.

If a woman has other symptoms of polyhydramnios, the problem becomes clear to an experienced doctor almost immediately. But to make such a diagnosis, he must be confident in the correctness of his assumptions. Therefore, the woman receives a referral to an ultrasound diagnostic room.

A somnologist examines the amount of amniotic fluid. This is done in a very interesting way. The doctor visually divides the abdomen into four equal sectors. In each of them using an ultrasonic sensor, the amount of amniotic fluid is measured, free from umbilical cord loops and parts of the baby’s body. The amount of liquid is measured by the depth of these “pockets”.

Then all four results are added up, and the same amniotic fluid index is obtained, which is the main criterion for normality or pathology. Borderline excess is a tendency towards polyhydramnios. This condition is also studied in detail and carefully monitored.

If the AFI exceeds the norm, then the doctor carefully examines the baby using an ultrasound, trying to detect possible signs of genetic pathologies and developmental defects internal organs. Then the condition of the placenta and uteroplacental blood flow is subject to detailed study. For this purpose, ultrasound Doppler ultrasound is used, popularly called “ultrasound with Doppler”.

Screening studies in the first and second trimester can provide a lot of information. If they have not shown an increased risk of having a baby with chromosomal abnormalities, then doctors will consider other reasons for the development of polyhydramnios. In some cases, the expectant mother may be recommended to donate blood for hormones, in particular, for the concentration of prolactin. An increase in amniotic fluid is often accompanied by a drop in the level of this hormone.

Must be assigned unscheduled general clinical blood and urine tests, and a vaginal smear is taken to identify possible infections that could be the root cause of the problem with the amniotic fluid.

If a woman and her baby have different Rh factors, then if polyhydramnios is suspected, the expectant mother will also go to donate blood for antibodies. When an increase in the amount of water is associated with immune rejection of the fetus by the maternal body, which occurs during Rh conflict, the antibody titer also shows an increase.

Invasive diagnostic methods, in particular amniocentesis or cordocentesis, are rarely prescribed for suspected polyhydramnios.

If there is such a need, you should not refuse the procedure. It will allow you to find out with great accuracy whether the baby has hereditary or chromosomal pathologies.

An alternative to unsafe and controversial invasive diagnostics is a non-invasive DNA test, in which fetal blood cells are isolated from a sample of the mother’s venous blood in a genetic laboratory, and based on their DNA, a conclusion is drawn about the child’s health status. Such an analysis is expensive - several tens of thousands of rubles, and therefore is not accessible to everyone.

Treatment

Confirmed polyhydramnios requires doctors to pay more attention to the expectant mother. She is prescribed to go to appointments more often - depending on the degree of polyhydramnios - up to 1 time per week.

Starting from the 28th week of pregnancy, she will undergo weekly CTG, based on the results of which it will be possible to monitor the baby’s well-being, his heart rhythms, and a possible state of hypoxia.

Polyhydramnios is usually treated in a hospital. The expectant mother is instructed to maintain complete rest so that through her actions and physical activity do not provoke premature labor or rupture of water.

She is strictly forbidden to be nervous, worry, or sort things out with her household. If necessary, the doctor prescribes light sedatives on a natural basis, which will help the pregnant woman cope with anxiety and worries.

A ban is also imposed on sex, because contractions of the uterine muscles that accompany orgasm can provoke rupture of the amnion.

Polyhydramnios cannot be cured, but you can support the woman and her baby with medication. This is exactly what doctors do. Treatment is based on the treatment of the underlying disease that caused the increase in water.

If these are inflammatory processes reproductive organs mothers, then the course of treatment is chosen by the gynecologist; if the cause is heart disease, then the main therapy is a cardiologist. In case of diabetes mellitus or gestational diabetes, the decision on prescribing certain medications is made by an endocrinologist.

If developmental defects are detected in the child, the woman is offered to terminate the pregnancy for medical reasons. If she refuses to do this, doctors will do everything possible to keep the baby alive and his mother healthy. For pathologies of the placenta, a course of drugs that improve placental blood flow and multivitamins is prescribed.

If the true reasons for the increase in amniotic fluid remain unknown, then a standard treatment regimen is used medical care for polyhydramnios - treatment with antibiotics. The goal of such therapy is avoid the development of intrauterine infection.

Among antibacterial drugs most often prescribed to expectant mothers "Cefotaxime", "Vilprafen" and "Ceftriaxone". Tetracycline antibiotics are not prescribed during pregnancy.

At the same time, it is recommended to take "Curantila" and "Actovegina" To improve uteroplacental blood flow, multivitamin complexes are also prescribed. To remove excess fluid from the body, the standard treatment regimen includes diuretics - drugs with a diuretic effect.

If the dynamics are positive, then the pregnancy will continue until 37-38 weeks. The expectant mother will need to come to the maternity hospital earlier to meet the 37th week under the round-the-clock supervision of specialists who are ready to deliver her at any time if the baby’s condition worsens.

Doctors decide which method of childbirth to choose during the last weeks of pregnancy. It is not recommended to give birth naturally, because the copious outpouring of water under the pressure of its mass can literally wash out small parts of the fetal body from the uterus. In addition, there is a high probability of developing weakness of the generic forces. If natural childbirth is allowed, then the bladder is opened artificially.

90% of women with polyhydramnios give birth by elective cesarean section. So the risks during childbirth associated with large quantity amniotic fluid can be minimized.

If a woman is admitted to hospital with acute stage polyhydramnios, she is advised to terminate the pregnancy. When this happens in the third trimester, especially with a large fetus, it is not advisable to continue the pregnancy, because the baby is already viable.

A caesarean section performed on time will save the lives of both the woman and her child.

After childbirth, doctors pay special attention baby. The mortality rate among such newborns is more than two times higher than among other groups of children. On the very first day, blood is taken from the baby for infections, to determine the group and Rh factor (in case of conflict), and also the necessary therapy is carried out, if necessary.

Folk remedies

Polyhydramnios cannot be treated with folk remedies. There is no grass and root that could affect internal processes in the amniotic sac. Classical drug therapy is considered the only reasonable treatment regimen.

However, in some cases, a woman may turn to prescriptions traditional medicine, but only to replace the symptomatic pill with an alternative method. For example, diuretic drugs for mild chronic polyhydramnios can, with the permission of the doctor, be replaced with cranberry juice or parsley decoction, which also have a diuretic effect.

If the blood pressure rises, the expectant mother can drink carrot juice or weak chamomile tea V small quantities. If she has diabetes, she will have to adhere to a strict diet. However, all these methods do not cancel the traditional medical treatment, including antibiotics.

It is impossible to refuse therapy, because no folk remedies can affect Rh-conflict or congenital malformations of the baby, and even more so, TORCH infections and diseases of the cardiovascular system are not treated with plantain and nettle.

Predictions and prevention

If polyhydramnios is detected at an early stage, and it is not acute in nature, and is not associated with genetic defects and abnormalities of the fetus, then the prognosis is quite favorable. Timely treatment helps eliminate the complication completely.

Acute polyhydramnios has unfavorable prognosis, especially in the early stages - most of these babies die in utero. Death is not excluded in case of acute polyhydramnios at a later stage.

Before conception, you need to take a blood test for infections, including sexually transmitted infections, urine for bacterial cultures, blood and urine for sugar. If pathologies are detected, you should be treated before conceiving a son or daughter. If there are risks of genetic pathologies, it is advisable to visit a geneticist in advance and consult with him.

To avoid the development of polyhydramnios, women should register as early as possible in the antenatal clinic and do not refuse to undergo mandatory screening tests in the first and second trimesters.

Regular testing, adherence to the principles proper nutrition, preventing large weight gain and the development of gestosis - these are the main tasks facing the expectant mother. If she has bad habits, for example, smoking, and she did not stop doing this at the stage of planning a child, then she should say goodbye to cigarettes as soon as possible, because, according to doctors, the likelihood of polyhydramnios in a smoking pregnant woman is three times higher than in pregnant women. women leading a healthy lifestyle.