The fruit is provided with enough water. Amount of amniotic fluid

In nature, everything is thought out to the smallest detail, including the habitat of babies in the mother's stomach - amniotic fluid. During pregnancy, the state of amniotic fluid changes every week. Why it depends and how the changes affect the development of the fetus - obstetrician-gynecologist Anna Sorokina will tell.

All nine months of life before birth, the baby swims in the amniotic fluid. This is a wonderful environment that fully meets the needs of the baby.

To understand where amniotic fluid comes from, let's remember school anatomy lessons: an egg fertilized by a sperm cell attaches to the uterus and begins to divide. As a result, four components appear - the fetal membranes, the chorion (the future placenta), the umbilical cord and the embryo itself (the unborn child). By the end of the second week of pregnancy, the fetal bladder already occupies the entire uterine cavity; the liquid inside it is absolutely sterile. Up to 14 weeks of pregnancy, amniotic fluid (amniotic fluid) seeps into the baby's body through the skin, and when its skin is enriched with keratin and thickens, the baby swallows amniotic fluid and excretes them in the urine. Over time, the volume of liquid processed reaches several liters per day.

Amniotic fluid is formed due to the penetration of blood plasma through the mother's blood vessels into the cavity of the fetal egg. In the last months of pregnancy, the kidneys and lungs of the baby begin to take part in the production of amniotic fluid. By the end of the gestation period, the amount of amniotic fluid reaches 1-1.5 liters, and, surprisingly, every three hours they are completely renewed!

We follow the norm

Since everything related to the state of the amniotic fluid is very important for the development of the child, obstetrician-gynecologists are closely monitoring what happens during this period. Usually, up to 18 weeks of pregnancy, the volume of fluid is proportional to the weight of the baby. In other words, if there is not enough fluid, it means that the child is growing more slowly. The volume of amniotic fluid depends on the individual characteristics of the body of the expectant mother. Usually this indicator fluctuates between 1–1.5 liters, and by 37–38 weeks it approaches the mark of 800 ml. And yet there are critical situations: when there is not enough amniotic fluid (less than 0.5 l), they talk about oligoamnios when there is a lot (more than 2 l), - about polyhydramnios. The amount of amniotic fluid is estimated by the results of ultrasound.

oligohydramnios

occurs with congenital malformations of the fetus (especially the urinary system), fetoplacental insufficiency, against the background of hypertension, infectious and inflammatory diseases, metabolic disorders (obesity III degree) of the mother. Features of pregnancy management and the outcome of childbirth depend on how long the oligohydramnios occurred and to what extent it is expressed.

Polyhydramnios

can be associated with Rh conflict, diabetes mellitus, maternal cardiovascular diseases, genetic diseases or intrauterine infection of the fetus. Polyhydramnios is also possible with identical twins. Often pregnant women with polyhydramnios complain of general weakness, shortness of breath, rapid pulse, and swelling. They may experience an incorrect position of the fetus, its increased mobility. In chronic polyhydramnios, treatment with conservative methods may be necessary - diuretics, vitamins, and sometimes antibiotics are prescribed. In acute polyhydramnios, an amniotomy is performed (opening the fetal bladder) with careful release of water. In any case, if doctors tell you about polyhydramnios or oligohydramnios, you need to listen very carefully to their recommendations.

Important indicator

Since there are fetal cells in the amniotic fluid, their analysis reveals a number of diseases in the child, including genetic abnormalities. This study is called amniocentesis and consists in a puncture of the abdomen of a pregnant woman under ultrasound control. At 15–17 weeks of development, the chromosomal set in the fetus is determined using amniocentesis, later the stage of hemolytic disease (with Rhesus conflict), abnormalities in the development of the kidneys and lungs, and the infectious agent is detected. The study of cells takes from 2 to 6 weeks, and the result is ready by 20-22 weeks.
Amniocentesis is performed under local anesthesia. A contraindication to this analysis is the threat of termination of pregnancy, since the procedure itself in 1% of cases can lead to termination of pregnancy. Ultrasound and special genetic blood tests can only lead doctors to suspect any fetal disease, but the final diagnosis can only be made after amniocentesis.

Who would like to have this procedure? Women over 40 years old (or if the father of the unborn child is over 45 years old); those who have already had a child with genetic abnormalities. However, every woman always has the right to refuse an amniocentesis.

Childbirth begins!

Usually, the rupture of the fetal bladder and the outflow of water occur after the onset of regular contractions and the opening of the cervix by 5–6 cm. the birth of a child.
If the amniotic sac has ruptured before 37 weeks of pregnancy and the baby's lungs have not yet matured, doctors will try to keep the pregnancy going as long as possible.
If the leakage of water is also accompanied by infection, the woman immediately begins to prepare for childbirth and is given drugs for the rapid maturation of the child's lungs.

When the water starts to leak, many moms confuse it with urinary incontinence; in order not to be mistaken, strain the muscles of the perineum - the flow of urine can be stopped by an effort of will, but amniotic fluid cannot.

Every woman expecting a baby should understand the importance of amniotic fluid, because they perform many useful and significant functions for life. There are pathologies that cannot be ignored.

The value of amniotic fluid is justified by their necessity for the normal development of the baby. This fact has been proven by many medical studies. Pathologies can lead to serious disturbances in the development of the fetus, so each makes it possible to control the condition and volume of amniotic fluid.

Having become pregnant, a woman must understand that the first element for a child is water. All 9 months of gestation, the fetus lives in the amniotic fluid. The baby develops there, grows, all organs and systems are formed in him. This environment is of great importance for the child.

Amniotic fluid satisfies the needs of the baby and carries data on the condition and immunity of the baby. Amniotic fluid during pregnancy has a very large list of renewal functions and the maintenance of immunity, necessary for both mother and child. That is why alarming symptoms that may indicate problems cannot be ignored.

Functions of amniotic fluid:

• The thermoregulatory function is necessary for the baby, because for the normal development of the child, the optimum temperature in the womb must be maintained - 37 degrees.
• Immune protection. The amniotic fluid contains all the necessary components for the development and protection of the baby.
• The mechanical function protects the baby from the influence of external factors. Thanks to it, a comfortable stay of the child in the womb is ensured.
• The umbilical cord protection function greatly softens shocks. Also, thanks to the amniotic fluid, the umbilical cord is protected from mechanical influences.
• Hermetic isolation from infections. Thanks to the liquid, the baby is under reliable protection.
• In the amniotic fluid there are also elements that do not allow the splicing of parts of the baby's body.
• The function of ensuring optimal development is no less important. Thanks to this, the baby grows, develops and receives all the necessary elements.
• Metabolic support.
• Formation of the circulatory system of the fetus.
• Prevention of bleeding.
• Due to the structure and composition of the amniotic fluid, it is facilitated.

Compound

About 97% of the amniotic fluid is water, it contains elements such as proteins, salts. Also present are skin particles, hair, and constituents called alkaloids. It is believed that the smell of the liquid is similar to breast milk.

For this reason, only a baby born into the world understands exactly where the mother's breast is, at the level and by smell. When the amniotic fluid appears, the baby's kidneys begin to work, the defenses of the baby's body are updated.

Volume

By the end of gestation, the amount of water approaches one to one and a half liters, every 3 hours the liquid is renewed, while the third part is processed by the baby. There are pathologies in which the volume of amniotic fluid can be more than normal - polyhydramnios or less than normal - oligohydramnios. More on the reasons below.

Color

According to known norms, water in the womb should have a transparent light color. They should not contain any impurities. In another case, there may be a pathological process that can be harmful. In case of deviation from the norm, the water may become cloudy or green.

Diagnostic value

Amniotic fluid is not without reason considered a living environment, due to being in which the correct functioning of organs and systems is formed in babies. The kidneys begin their work due to the fact that the baby swallows water that is excreted in the urine (in the child's bladder, amniotic fluid appears already on).

After a while, the baby, in the likeness of a fish, begins to “breathe” with water, carrying out a significant exercise for his respiratory system, thereby preparing himself for breathing in an ordinary environment.

Also for diagnosis, amniotic fluid can be used to detect genetic diseases.

Pathologies

Polyhydramnios - one of the types of pathological processes during pregnancy. This condition is characterized by the fact that the amniotic fluid begins to exceed the norm in volume. The exact quantitative indicator of the fluid is determined by the doctor on ultrasound.

It was not possible to establish 100% causes of these problems. But at the same time, there are certain groups whose risk of getting a pathology is slightly higher than others:

• Chronic diseases in a pregnant woman, for example, diabetes, heart disease.
• Infections in any organs.
• - a large volume of water of one fruit often comes with an oligohydramnios of another.
• Large fruit size.
• Defects in the formation of the child.

With polyhydramnios, the following manifestations are characteristic: abdominal pain, shortness of breath, swelling of the limbs, too frequent pulse. The patient with such symptoms will need to go to the hospital and undergo a set of additional examinations.

The plan and duration of treatment depends on the cause of polyhydramnios. The patient may be prescribed vitamins, antibiotics, diuretics. During the treatment, the doctor controls the weight, pressure, temperature. Passage of cardiotography, ultrasound is prescribed. The general condition of the child and mother is kept under control, the doctor monitors the slightest changes in the patient's health.

There is another side of this pathology, called oligohydramnios . This condition is characterized by insufficient fluid volumes. Low water is a problem that any expectant mother may face.

Reasons that can provoke pathology:

• Complex congenital malformations of the kidneys in the fetus.
• Chronic diseases of the future mother, for example, diabetes, cardiovascular diseases.
• Infections in the genitals.
• The presence of bad habits in the expectant mother.
• The presence of viruses and infections, the transferred flu.
• The presence of a late
• Pathological changes in the placenta.
• Multiple pregnancy - when one embryo has little water, it often comes with polyhydramnios of the other.
• The time when the baby is worn longer (the placenta becomes obsolete, and the amount of water decreases).

A future mother who is faced with such problems may experience aching pains in the abdomen, the movement of the fetus becomes painful, the general condition worsens, and weakness may appear. An important symptom is high fever.

The woman is admitted to the hospital. All manipulations will be aimed at maintaining the baby and the expectant mother in a normal state. Thanks to special preparations and procedures, the health and condition of mother and child is normalized.

Pathology is also leakage . When water begins to leak prematurely, this can lead to serious consequences. The signs of this pathology include the fact that the amount of fluid released becomes much larger in the process of changing position. This is a rather dangerous process, so the patient must definitely contact the attending physician. Cause leakage of infection, presentation of the fetus and bad habits of the expectant mother.

Another pathology -green amniotic fluid not too rare. The cause of such waters may be a baby - when there is not enough oxygen, contraction of the anus may occur, which leads to the release of feces in the child. This gives the liquid a green tint and negatively affects the development of the baby, who swallows contaminated water.

So, amniotic fluid is a significant substance for a baby in the womb. There are pathologies when the rate of amniotic fluid during pregnancy is exceeded or reduced. The color, composition, volume of the liquid is also important - all this matters. Pathologies of this kind should be treated inpatients with the use of drugs and vitamins. For the patient, peace and regularity of life are important. Excessive activity and physical activity is contraindicated.

Useful video about the outflow of amniotic fluid

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All structures of the unified system "mother - placenta - fetus" take an active part in the formation and exchange of amniotic fluid: the mother's body; amnion (cells lining the fetal membrane); fetus (the kidneys of the fetus in the last stages of pregnancy produce an average of 600-800 ml of urine per day, which is released into the amniotic cavity, while in 1 hour the fetus swallows an average of 20 ml of water; the skin of the fetus up to 24 weeks of pregnancy is also involved in metabolic water processes, absorbing some of them until it becomes keratinized, after which the skin becomes impermeable to the amniotic fluid).

Compound amniotic fluid during pregnancy changes. If in the early stages the amniotic fluid in its chemical composition is similar to the plasma (liquid part of the blood) of the mother, then by the end of pregnancy it contains the urine of the fetus in large quantities. The amniotic fluid contains oxygen, carbon dioxide, electrolytes present in the blood of the mother and fetus, proteins, lipids, carbohydrates, enzymes, hormones, vitamins, biologically active substances, phospholipids, blood coagulation factors, epithelial cells desquamated from the skin of the fetus, vellus hair , secrets of the sebaceous glands of the fetus, droplets of fat, etc. The concentration of one or another component of amniotic fluid depends on the duration of pregnancy.

Volume amniotic fluid increases towards the end of pregnancy, reaching a maximum value at 38 weeks, then, closer to childbirth, it may decrease slightly. Normally, at 37-38 weeks of gestation, the volume of amniotic fluid is 1000-1500 ml, while at 10 weeks it was only 30 ml, and at 18 weeks - approximately 400 ml. With a post-term pregnancy, a decrease in the amount of amniotic fluid is noted, with various pathologies of pregnancy, a change in volume can occur both upward and downward.

Why is amniotic fluid needed?

Amniotic fluid not only provides the exchange of substances between the fetus and mother, but also performs the function mechanical protection You , protecting the fetus from external influences, also protecting the body of the fetus from being squeezed by the walls of the uterus and being a shock absorber in cases of mother's falls, that is, the amniotic fluid smooths out the push or blow transmitted to the fetus during blows to the stomach or falls. Of course, that the "degree of protection" in this case is not great, that is, with blows of great force, the integrity of the fetal bladder may be violated.

The fetal bladder contributes to the opening of the cervix during childbirth, playing a role hydraulic wedge during the first stage of labor (during the opening of the cervix). It also protects the fetus from infection by being physiological barrier on the path of infection, which can enter the uterine cavity from the vagina and cervix.

Diagnostic methods using amniotic fluid

For the diagnosis of the course of pregnancy, the quantity, color, transparency of amniotic fluid, their hormonal, biochemical, cellular composition, etc. are of great importance. In the arsenal of doctors there are various diagnostic methods.

ultrasound. Much attention is paid to ultrasound amount of amniotic fluid , since a relationship was found between this parameter and the pathology of pregnancy: post-term pregnancy, preeclampsia (it is manifested by an increase in blood pressure, edema, the presence of protein in the urine), fetal hypoxia (a state of oxygen starvation of the fetus in the womb). The amount of water is estimated by the size of free areas of amniotic fluid (the so-called "pockets" or "packages").

Ultrasound can also assess homogeneity (uniformity) amniotic fluid.

The presence of suspended matter in the water most often indicates infection.

Amnioscopy. This is an examination of the lower pole of the fetal bladder and amniotic fluid using a special device that is inserted into the cervical canal through the vagina. Such a study allows you to evaluate the color of amniotic fluid and their amount. With fetal oxygen deficiency, the amniotic fluid becomes green due to the admixture of meconium (original feces). Amnioscopy is carried out, as a rule, at the end of pregnancy, when the cervix is ​​already preparing for childbirth and may miss the optical apparatus - the amnioscope.

Amniocentesis(from the Greek words "amnion" - the fetal membrane and "centesis" - piercing). This is a puncture (puncture) of the fetal bladder, the purpose of which is to take amniotic fluid for diagnostic studies: biochemical, hormonal, immunological, cytological, in order to have an idea about the condition of the fetus and determine the further management of pregnancy. The indications for this procedure are: rhesus conflict ; in this case, the content of bilirubin in the amniotic fluid is determined (it increases as the concentration of bilirubin secreted by the kidneys of the fetus increases, which serves as an indicator of the severity of the process); the study also determines the blood type of the fetus, the amount of antibodies to the Rh factor; suspected fetal chromosomal pathology; suspicion of chronic fetal hypoxia (oxygen deficiency); the need to determine the maturity of the lungs of the fetus when there is a question about early birth; this determines the concentration of phospholipids in the amniotic fluid and their ratio.

Amniocentesis is done under ultrasound control, through the anterior abdominal wall or the anterior or posterior fornix of the vagina: the puncture site is selected based on the location of the placenta. Before the operation, the bladder is emptied to avoid injury, the skin is treated with an antiseptic solution, local anesthesia is made with a novocaine solution, then the anterior abdominal wall, uterine wall and fetal bladder are punctured with a long thick needle; 15 ml of water is drawn into the syringe. The procedure is invasive (i.e. accompanied by a puncture of the abdominal wall, uterine wall, introduction into the uterine cavity), it can lead to various complications (mainly miscarriage or premature birth, amniotic fluid rupture, infection of the fetal membranes, injury to the fetal vessels and as a result of this - internal bleeding, injury to the bladder or intestines of the mother). In modern conditions, these complications are very rare, due to the introduction of ultrasound - control, compliance with the rules of asepsis and antisepsis.

Amniocentesis is not performed with the threat of miscarriage or premature birth, with the location of the placenta or myomatous node on the anterior abdominal wall, malformations of the uterus, the results of smears and bacterial cultures from the vagina and cervical canal, indicating the presence of an inflammatory process. After the operation, a therapeutic regimen is recommended for several days (up to 1 week), for prophylactic purposes, drugs that relax the uterus are prescribed, and if necessary, antibiotics.

oligohydramnios during pregnancy

Oligohydramnios is a reduction in the amount of amniotic fluid to 500 ml or less as a result of an imbalance between their absorption and production. Most often, this condition is observed in younger pregnant women with high blood pressure in the third trimester of pregnancy and in women with an increased risk of developing fetal malnutrition (lagging behind the size of the fetus from normal for a given period).

First of all, if you suspect oligohydramnios, it is necessary to exclude congenital malformations of the fetus, especially if it is detected in the second trimester (up to 28 weeks) of pregnancy, because sometimes severe oligohydramnios can be combined with such defects as polycystic kidney disease or their absence. Oligohydramnios, as well as polyhydramnios, can be a sign of intrauterine infection of the fetus, so it is necessary to conduct an examination for hidden

that infection. Oligohydramnios can occur against the background of a decrease in the excretion of urine by the fetus into the amniotic cavity during chronic hypoxia, which is observed with intrauterine growth retardation. In 40% of women with oligohydramnios, there is a lag in the size of the fetus from the norm. Due to a sharp decrease in the volume of amniotic fluid, compression of the umbilical cord (compression between the fetus and the walls of the uterus) may occur, which can lead to acute oxygen deficiency and fetal death; extremely rarely, adhesions (fusions) are formed between the walls of the uterus and the skin of the fetus.

Since the fetal bladder is “flat” in oligohydramnios, it does not perform the function of a hydraulic wedge, does not contribute to the opening of the cervix, as a result, there is a danger of weakness in labor activity. Due to the violation of the active motor movements of the fetus in the uterine cavity, the frequency of breech presentation increases, and, as a result, in some cases, cesarean section operations. More often, weakness of labor activity and intrauterine hypoxia of the fetus lead to operational childbirth with oligohydramnios. Oligohydramnios can be primary (observed with whole membranes) and secondary, or traumatic (as a result of damage to the membranes with a gradual outflow of water, which sometimes goes unnoticed by a woman: amniotic fluid is mistaken for whites).

Diagnosis of oligohydramnios is mainly based on an ultrasound examination. However, during the examination, the doctor may pay attention to the fact that the height of the fundus of the uterus and the circumference of the abdomen are behind normal for a given period of pregnancy, the motor activity of the fetus is reduced, the uterus is dense on palpation, parts of the fetus and heartbeat are clearly defined. During vaginal examination during childbirth, a “flat” fetal bladder stretched over the fetal head is determined.

If oligohydramnios is detected before 28 weeks of gestation, a comprehensive examination of the pregnant woman is carried out to determine the possible cause and assess the condition of the fetus. If fetal malformations are detected, pregnancy is terminated for medical reasons. When oligohydramnios is combined with intrauterine hypoxia and fetal growth retardation, appropriate therapy is carried out until 33-34 weeks of pregnancy, and if the treatment is ineffective and the fetus's condition worsens, early delivery. During childbirth, a “flat” fetal bladder is opened to prevent weakness of labor activity.

In severe forms of placental insufficiency and intrauterine fetal malnutrition, drip intra-amniotic administration of amino acid solutions is possible after preliminary removal of an amount of fluid equal to that administered. Attempts are also being made to paraplacental oxygenation of the fetus during childbirth to treat chronic fetal oxygen deficiency by introducing oxygenated amniotic fluid into the amniotic cavity. These methods have not yet found wide application and require further research.

Polyhydramnios during pregnancy

Not only a decrease in the amount of amniotic fluid is bad, but also its increase. Polyhydramnios is considered to be the volume of water exceeding 1500 ml. Most often it happens in multiple pregnancies, diabetes mellitus in the mother, Rh-conflict pregnancy, intrauterine infection, abnormalities in the development of the fetus.

With anomalies (malformations) of fetal development, the process of swallowing water by the fetus is disrupted, as a result of which the balance between their production and excretion changes. On examination, the height of the fundus of the uterus and the circumference of the abdomen exceed the normal for this period of pregnancy.

The fetus actively swims in the amniotic fluid, which can cause the umbilical cord to wrap around the neck and torso. If polyhydramnios is suspected, the doctor clarifies the diagnosis with the help of ultrasound, while excluding intrauterine infection, fetal malformations. Due to the strong stretching of the membranes with severe polyhydramnios, an untimely discharge of amniotic fluid may occur. Premature birth, premature detachment of a normally located placenta, prolapse of small parts of the fetus (handles, legs) and the umbilical cord during the outflow of water are also possible (therefore, after the outflow of water, a vaginal examination is mandatory). If fetal malformations that are incompatible with life are detected, an abortion is performed. If the cause of polyhydramnios was intrauterine infection, treatment is carried out taking into account the identified pathogen. Childbirth with polyhydramnios may be accompanied by weakness of labor activity due to a strong stretching of the uterus, resulting in a decrease in its contractility and excitability. Based on the foregoing, it often becomes necessary to open the fetal bladder. This is done very carefully, the water is released slowly, after which a vaginal examination is performed to exclude the prolapse of the arms, legs, umbilical cord loops. In the postpartum period, reducing drugs are introduced to prevent postpartum hemorrhage, since the overstretched uterus does not contract well.

How is the outpouring of water

Normally, amniotic fluid is poured out in the first stage of labor (until the cervix is ​​fully dilated, but not before the cervix is ​​4 cm dilated). At the height of one of the contractions, the bubble becomes tense and bursts. As a result, the anterior waters are poured out, which are located between the head of the fetus and the membranes of the fetal bladder. “Born in a shirt,” they say about children who were born with a whole fetal bladder. In modern conditions, if a woman gives birth not at home, but in a hospital, this is very rare (the exception is rapid childbirth), since if the cervical dilatation is complete, and the bladder is still intact, then obstetricians open it themselves: at birth "in a shirt" fetal membranes block the access of oxygen to the fetus. The outpouring of water before the onset of labor (before contractions) is considered prenatal or premature, and if the waters poured out with regular contractions, but with insufficient opening of the cervix, they talk about early outpouring of waters. In these cases, it is necessary to monitor the duration of the anhydrous period: it should not exceed 12 hours, since with a long anhydrous period, the likelihood of infection of the membranes, uterus, and fetus increases. Therefore, in the event of an outpouring of amniotic fluid at home, a woman must immediately go to the maternity hospital. With prenatal rupture of amniotic fluid, a glucose-vitamin-hormonal background is usually created; for this intravenous and intramuscular injection of glucose, vitamins, hormones that prepare the birth canal. If contractions do not start, labor induction is carried out with drugs intravenously using a dropper. In case of ineffectiveness of such therapy, a caesarean section is performed.

ABOUT high rupture of membranes they say when the fetal bladder breaks not in the lower pole, but above. If there is any doubt whether it is water or just liquid leucorrhea from the vagina (a typical situation with a high lateral rupture of the membranes), you need to go to your doctor, first placing a “control” diaper to show the nature of the discharge. In doubtful cases, a vaginal swab is taken for the presence of amniotic fluid or an amnitest is performed .

If the leakage of amniotic fluid is confirmed, but there are no contractions, the doctor decides on the further management of the pregnancy, depending on its duration. Until 34 weeks, obstetricians do everything possible to prolong the pregnancy, since the lungs of the fetus are immature and respiratory disorders may be found in the newborn after delivery. The woman is under constant supervision (body temperature is measured, a study of the content of leukocytes in the blood, a clinical blood test, ultrasound, CTG - a study of the cardiac activity of the fetus, a study of secretions from the genital tract for infections), the expectant mother is prescribed strict bed rest in stationary conditions, with necessary - antibacterial therapy, drugs that accelerate the maturation of the lungs of the fetus. If there are no conditions for prolonging pregnancy, a surfactant is used to prevent and treat respiratory disorders in newborns. In the absence of signs of infection and a sufficient amount of water in the fetal bladder by ultrasound, pregnancy can be extended up to 34 weeks. If, as a result of the study, it is found that the uterus tightly covers the fetus, and there are no waters, it is impossible to wait more than 2 weeks even in the absence of signs of infection (however, this situation is extremely rare). With a period of 34 weeks or more, with leakage of water, a woman is prepared for the upcoming birth.

Thus, the amniotic fluid is not only the habitat of the baby, but also helps to diagnose various "malfunctions" during pregnancy. Your doctor will monitor their number and, in case of deviation from the norm, will take the necessary measures.

Amnitest is a method by which the presence of α-microglobulin, which is not normally found in the vagina, is determined in the discharge from the vagina.

A sterile tampon is placed in the vagina for 5-10 minutes, then the result is determined using the test strip by the express method. If there is placental α - microglobulin in the contents of the vaginal secretion, a control strip appears in the test strip window.

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While the baby is growing in the mother's belly, it is surrounded by amniotic fluid, in which it swims freely throughout the entire period of pregnancy. The outpouring of amniotic fluid indicates the onset of labor. How important is the amount of this fluid for a child's life? Let's try to figure it out.

The main function of the waters is protective. They smooth out sudden movements from the outside that could harm the unborn child, and also protect the umbilical cord from being pressed against the wall of the uterus by the fetus, and the blood flow does not stop. Amniotic fluid plays an important role in the metabolism of the child. It is they who deliver nutrients, hormones and immunoglobulins and remove metabolic products from the body - urine, hairs, skin flakes, and so on. In addition, it is the amniotic fluid that is actively involved in the birth process - firstly, it makes contractions less painful, as they serve as a natural buffer, and secondly, the lower waters (located under the head of the child, if he is in the most common head presentation) press from the inside to the uterus, causing it to open faster and better.

Renewal of amniotic fluid

Amniotic fluid (or amniotic fluid) is not a static substance. They are constantly updated, “waste”, “contaminated” waters are removed from the body, and their place is occupied by updated ones. The inner surface of the placenta and the fetal membranes are involved in the formation of amniotic fluid. And even the child himself affects the amount of amniotic fluid, since he swallows the fluid surrounding him and excretes urine.

The process of water exchange takes place continuously - they are completely renewed within 3 hours.

A terrible complication of pregnancy is the leakage of amniotic fluid. Signs of amniotic fluid leakage may go unnoticed. A woman may mistake wet underwear for sweat or vaginal discharge. Do not draw conclusions on your own, describe the situation in detail to the gynecologist. When amniotic fluid leaks, there is a risk of infection for mother and child.

The amount of amniotic fluid: polyhydramnios and oligohydramnios

The amount of amniotic fluid throughout pregnancy is not the same. In the first 18-20 weeks, their volume is proportional to the size of the child. Toward the end of pregnancy, the normal amount of water is from 600 to 1500 ml. It is for the purpose of determining the amount of amniotic fluid that women are advised to do an ultrasound for a period of 37-38 weeks, since a deviation from these parameters can adversely affect the health of the mother and child.

Polyhydramnios during pregnancy

Polyhydramnios during pregnancy is called a situation when the amount of amniotic fluid in the fetal bladder exceeds 1.5 - 2 liters. You can notice the symptoms that this is happening even externally - in women with polyhydramnios, as a rule, the stomach grows very much, a lot of "stretch marks" appear on the skin. During the examination, one has to resort to additional examination methods, since it is difficult for the doctor to determine the location of the organs in the fetus and hear the heartbeat. It is difficult for a woman to breathe, her pulse quickens, her legs swell.

Complications of polyhydramnios during pregnancy

Pregnancy becomes a heavy burden for the mother in the truest sense of the word, and the child is completely exposed to a mortal threat. Since too much space allows for additional movement, and at this time the umbilical cord can wrap itself around the neck. Also, the presence of excess amniotic fluid can lead to incorrect presentation - pelvic or transverse.

An increased amount of amniotic fluid is often poured out before the term, which provokes preterm labor. But since the uterus itself was too swollen during pregnancy, it can contract worse, which will lead to a weakening of labor. In this case, childbirth can be delayed, which negatively affects both the health of the mother and the condition of the child, both may have hypoxia (lack of oxygen in the blood).

Causes of polyhydramnios during pregnancy

There can be several reasons for the increase in the amount of amniotic fluid. Basically, polyhydramnios is caused by infections transferred at different times that disrupt the functioning of the amnion, disturbances in the development of the fetus (most often the nervous and digestive systems, when the baby either does not swallow enough or releases too much fluid), as well as feto-placental insufficiency, when the placenta does not produces amniotic fluid in the required amount. Often polyhydramnios occurs in women with diabetes mellitus, or during pregnancy aggravated by the Rhesus conflict.

Pregnant women in whom studies have identified polyhydramnios should be constantly under the supervision of specialists.

Ultrasound during pregnancy determines polyhydramnios

If you have been diagnosed with polyhydramnios, you will need additional ultrasound diagnostics, since ultrasound is the best way to determine the amount of amniotic fluid and see possible fetal malformations. If polyhydramnios is not pronounced, does not interfere with the woman and does not disrupt blood circulation, the pregnancy is maintained until its natural completion, and the expectant mother is offered treatment for the cause that caused the increase in the amount of water. Most often, this is an infection in the body, in which case the doctor will prescribe antibiotics. If the matter is in other health problems (such as diabetes, or with an Rhesus conflict), they are treated.

oligohydramnios during pregnancy

Oligohydramnios is much less common than excess amniotic fluid. Oligohydramnios is a condition when the amount of amniotic fluid is less than 500 ml. The expectant mother herself can notice and feel it: the stomach grows poorly, prints of parts of the child's body can even be seen from the outside, the baby's movements cause pain. On the fetus itself, oligohydramnios also has a negative effect: the wall of the uterus is too close, they squeeze both the child and the umbilical cord. Because of this, the baby lags behind in development, he is too small and weak in time, his skin becomes dry, covered with extra folds. Possible defects of the musculoskeletal system - curvature of the spine, torticollis, clubfoot and others.

Causes of oligohydramnios during pregnancy

Usually, oligohydramnios during pregnancy occurs due to insufficient work of the amnion (embryonic membrane), which, as with polyhydramnios, can be caused, for example, by an infectious process in the body of a pregnant woman. The amount of amniotic fluid may decrease if the development of the child is impaired, especially with defects in the kidneys and excretory systems, as well as in the case of fetal hypoxia, since at this time the fetus also excretes little urine. Oligohydramnios can occur in one of the identical twins, if the second is characterized by polyhydramnios. This happens when the blood circulating from the common placenta is unevenly distributed. The amount of water also decreases during post-term pregnancy. Smoking during pregnancy also causes oligohydramnios.

Treatment of oligohydramnios during pregnancy

Treatment of oligohydramnios is carried out in almost the same way as in the case of polyhydramnios. The woman is under the constant supervision of doctors, and in case of severe suffering, she and / or the child is offered early delivery. If the mother and child feel well, independent childbirth is possible on time. However, with both excessive and insufficient amounts of amniotic fluid, childbirth rarely begins spontaneously, usually a woman is punctured with a rupture of the fetal bladder, since a large amount of water interferes with uterine contraction, and with oligohydramnios, the flat fetal bladder does not open the uterus from the inside. In extreme cases, if there is an entanglement of the umbilical cord, the fetus is located incorrectly, or the condition of the mother and child is extremely difficult, a caesarean section will be performed. However, we wish you that your birth proceeds in accordance with the norms, and problems do not frighten you.

Information Amniotic fluid (amniotic fluid) is a biologically active liquid medium that is inside the fetal membranes, surrounds the fetus and plays an important role in ensuring its vital activity.

The main functions of amniotic fluid:

1. Fetal nutrition. The amniotic fluid contains nutrients that are absorbed through the skin in the early stages; in the later stages, the fetus itself swallows a small amount of amniotic fluid;
2. Maintaining a constant temperature regime(about 37 degrees Celsius) and pressure;
3. Protection of the fetus from mechanical influences. Amniotic fluid reduces the force of shocks and pressure coming from outside;
4. Protecting the fetus from infections. This function is provided by the content of immunoglobulins in the waters, as well as the tightness of the fetal bladder;
5. Ensuring free movement of the fetus;
6. Protecting the fetus from loud noise(amniotic fluid muffles sounds).

Composition of amniotic fluid quite complex and varies depending on the timing of pregnancy:

1. Proteins, carbohydrates, fats;
2. Vitamins, minerals;
3. Hormones, enzymes;
4. oxygen, carbon dioxide;
5. Immunoglobulins;
6. Vellus hair, lubrication elements covering the body of the fetus.

Examination of amniotic fluid

Basic indicators amniotic fluid of interest for diagnostic purposes:

1. Color, transparency. Normally, amniotic fluid should be light, transparent, not contain a large amount of impurities (only single particles in the field of view);
2. Quantity. The volume of amniotic fluid varies significantly with the duration of pregnancy: it increases by 40-45 ml every day until 32 weeks, then gradually begins to decrease. By the end of pregnancy, the norm of amniotic fluid is 500-1500 ml;
3. Hormone content;
4. Cytological and biochemical composition.

Basic methods for examining amniotic fluid:

Ultrasonography

During the ultrasound, the doctor may see the transparency and amount of amniotic fluid.
The appearance of more suspensions and flakes in the amniotic fluid may indicate fetal oxygen deficiency (hypoxia) and requires mandatory treatment.

Important An important indicator is the determination of the amount of amniotic fluid, for this purpose, the amniotic fluid index is measured on ultrasound. The uterine cavity is conditionally divided into 4 parts and the largest free area between the uterine wall and the fetus is measured (vertical pocket).

The norm of the amniotic fluid index

Pregnancy period, weeks	Index index (10th percentile), mm	Index score (50th percentile), mm	Index index (95th percentile), mm
16	73	121	201
17	77	127	211
18	80	133	220
19	83	137	225
20	86	141	230
21	88	143	233
22	89	145	235
23	90	146	237
24	90	147	238
25	89	147	240
26	89	147	242
27	85	156	245
28	86	146	249
29	84	145	254
30	82	145	258
31	79	144	263
32	77	144	269
33	74	143	274
34	72	142	278
35	70	140	279
36	68	138	279
37	66	135	275
38	65	132	269
39	64	127	255
40	63	123	240
41	63	116	216
42	63	110	192

When the parameters of the amniotic fluid go beyond the boundaries of these norms, we can talk about polyhydramnios or oligohydramnios.

Amnioscopy

Amnioscopy- This is a visual method for examining amniotic fluid using an amnioscope.

Indications for amnioscopy:

1. Prolongation of pregnancy;
2. Chronic fetal hypoxia.

Contraindications:

1. Pelvic fetus;
2. Inflammatory diseases of the vagina and cervix.

The procedure is performed without anesthesia with a mature, smoothed cervix and a whole fetal bladder. The woman is placed in a gynecological chair, the tube of the amnioscope is carefully inserted into the cervical canal and the light is directed (the size of the tube is selected depending on the width of the cervical canal).

During amnioscopy, the color of amniotic fluid is studied, the presence of impurities: meconium, blood, lubricant flakes.

Amniocentesis

Amniocentesis is an invasive procedure that is performed by puncturing the amniotic membranes in order to obtain amniotic fluid.

A sample of amniotic fluid is used for biochemical, hormonal and cytological analysis. The main indication for this procedure is the diagnosis of chromosomal diseases of the fetus.

Contraindications for amnioscopy are acute and chronic inflammatory diseases of any localization.

Under ultrasound control, a place for puncture is chosen (the largest pocket of amniotic fluid, free from umbilical cord loops) and about 20-25 ml of amniotic fluid are taken.

The main pathologies of amniotic fluid

For the normal development of pregnancy, amniotic fluid must be in a certain amount and chemical composition. Any changes in the amniotic fluid indicate the appearance of pathology:

Polyhydramnios- This is a pathological condition in which the amount of amniotic fluid exceeds normal levels. May leak in acute form when the amount of amniotic fluid rises sharply, and in chronic(characterized by a gradual increase in water).

Polyhydramnios is a dangerous pathology and can lead to to a number of complications during pregnancy and childbirth.

If an increase in the volume of amniotic fluid is detected, a woman must admitted to hospital.

You can learn more about the causes, clinical symptoms, complications and treatment of this pathology in the topic of polyhydramnios

oligohydramnios- this is a decrease in the volume of amniotic fluid less than normal.

Clinical signs are not always present, so in most cases, oligohydramnios is detected during ultrasound.

Treatment of oligohydramnios practically absent: it is impossible to artificially increase the amount of amniotic fluid. All therapy is aimed at maintaining uteroplacental blood flow and improving the condition of the fetus. In severe cases, urgent delivery is indicated.

Detailed information about the course of oligohydramnios and its impact on pregnancy and the condition of the fetus is in the topic oligohydramnios.

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