Polyhydramnios, hypochlorous - Causes, symptoms and treatment. MF.
Polyhydramnios is a pathology of pregnancy, in which excess accumulation of amniotic fluid occurs - more than 1.5-2 liters of fluid. Accordingly, anhydrase is a deficiency of amniotic fluid, in which the amount of amniotic fluid is less than 500 ml.
Both conditions are very dangerous in pregnancy and can cause serious complications.
Ambulatory water( a synonym for amniotic fluid) plays a very important role for the fetus. They perform a protective function, protecting the baby from the harmful effects of the environment and participate in the metabolism, and also contribute to the normal course of labor.
During pregnancy, the amount of amniotic fluid is constantly changing. For each term of pregnancy, there are indicators of the norm of the amniotic fluid. By the end of pregnancy the amount of amniotic fluid in the norm ranges from 600 to 1500 ml of fluid. Deviation from these indicators to a greater or lesser extent leads to polyhydramnios or low salinity.
What causes can lead to amniotic fluid pathology?
If to talk about polyhydramnios, in most cases it occurs as a result of infectious and viral diseases in the pregnant woman, such as chlamydia, mycoplasmosis, cytomegalovirus infection, and so on. Also, polyhydramnios can cause diabetes maternal, rhesus-conflict between the blood of the mother and fetus, congenital malformations of the fetus. Polyhydramnios are almost always found in multiple pregnancies.
Malnutrition, as well as polyhydramnios, can be caused by infectious and inflammatory diseases of the mother. Other, important factors that provoke lethargy include elevated blood pressure of the pregnant woman, late gestosis, obesity in the mother, pregnancy retardation, fetal malformations, violations of the urinary system of the fetus, impaired blood flow in the placenta.
How is polyhydramnios and hypochondria manifested?
If there are no significant deviations from the normal parameters of the amniotic fluid, in most cases the pregnant woman feels completely normal. In this case, polyhydramnios or hypochondria are a random finding during ultrasound.
Rarely, with severe malnutrition, there may be pain in the abdomen. Pain increases with the movements of the fetus. A woman may notice that the fetus is less than usual, moves, which is a warning signal and requires an immediate appeal to the gynecologist.
Dimensions of the abdomen in case of malnutrition may be less than the normal size of the due date. However, it is quite difficult to discern such deviations with a "simple look".
With expressed polyhydramnios clinical manifestations of the disease are quite pronounced. The abdomen of the pregnant woman grows rapidly, falls under the pressure of gravity. Usually there are pain in the lower back and in the perineum. The fetus is actively moving.
With these symptoms, a woman should contact her obstetrician-gynecologist. The doctor examines the pregnant woman, listens to the heartbeat of the fetus. If the pregnancy is low in water, the height of the standing of the bottom of the uterus and the circumference of the abdomen will be less than the required time, and parts of the fetus are clearly palpated due to a decrease in the volume of amniotic fluid. The palpitation of the fetus is clearly audible.
In case of polyhydramnios, the opposite picture is observed. Palpitation of the baby is muffled due to the abundance of amniotic fluid. Fetus palpates with difficulty. The circumference of the abdomen and the height of the standing of the uterus greatly outstrip the norm.
After examination, ultrasound examination of the fetus is carried out, which allows you to clearly determine the severity of polyhydramnios or malovodiia. Pri confirmation of the diagnosis, both in maluvodia and in polyhydramnios conducted dopplerometry - the blood flow in the vessels of the fetus, in the umbilical cord, in the uterus.
The cardiotocography( CTG) of the fetus must be performed to assess the cardiac activity of the baby.
Based on ultrasound, CTG and Doppler, you can find out how polyhydramnios or hypochlorism has affected the development of the baby.
To determine the cause of the pathology, additionally assign a blood test for intrauterine infection, take a swab from the vagina for examination for sexual infections. If a pregnant woman has Rhesus negative blood, then the blood is rhesus-tested for antibodies.
Treatment of water scarcity and polyhydramnios
Depending on the detected pathology, treatment is prescribed. But if the pathology is not revealed during the examination, and if polyhydramnios or oligohydramnios are moderate according to ultrasound and the fetus does not suffer, treatment is not prescribed. Dynamic observation in a gynecologist is shown.
If infertility revealed fetal development and a violation of utero-placental blood flow, then appoint vasodilator drugs( Kurantil, Trental), beta-adrenomimetiki( Ginipral);To improve the absorption of glucose and oxygen, prescribe Actovegin. Also prescribed vitamins C and E.
During the treatment of malnutrition, careful monitoring of hemodynamic parameters of the fetus is carried out. All pregnant women with deviations of fetal development are shown hospitalization in the maternity hospital.
If there is a positive dynamics in the treatment and the fetus is satisfactory - a woman can give birth through the natural birth canals at a full term of pregnancy. But, unfortunately, sometimes there is a negative dynamics, when the fetal condition worsens, the amount of water decreases, which can lead to fetal death in utero. In this case, an emergency delivery by caesarean section is indicated.
Treatment of expressed polyhydramnios implies the appointment of diuretics( Hypothiazide) and vitamins in the maternity hospital.
In case of expressed polyhydramnios, amniocentesis is carried out - into the amnion, that is, the catheter is injected into the aquatic environment of the fetus and a certain amount of amniotic fluid is removed under ultrasound guidance.
Prognosis for polyhydramnios is more favorable than in case of malnutrition. Pregnant women with polyhydramnios often give birth through natural birthmarks, unless, of course, complications arise during childbirth. However, labor is more protracted than normal, which is associated with overgrowth of the uterus and a decrease in its contractility. In order to stimulate labor activity in case of polyhydramnios, amniotomy is often performed( pierce the fetal bladder).
Because of over-stretching of the abdomen with polyhydramnios, the skin on the abdomen of the pregnant woman is greatly stretched - striae appear( stretch marks), therefore, to prevent stretch marks for all women with polyhydramnios, it is recommended to use special creams from stretch marks, such as "Sanosan", "Vichy", "Avent"," 9 months "and so on. Cream should be used from the 2nd trimester of pregnancy to the postpartum period, inclusive.
For successful treatment of both infertility and polyhydramnios, correction of the concomitant pathology is necessary, otherwise the treatment may not be quite effective. For example, in the presence of diabetes, glucose level correction is necessary, for obesity - a special diet, in the presence of infection - treatment with antibiotics and so on.
In general, the prognosis is more favorable in those pregnant women, whose hydramnios or malic acid developed at the end of pregnancy. When similar pathologies develop in the second trimester, the risk of complications during pregnancy and childbirth is significantly increased.
Possible complications:
- with polyhydramnios: premature birth, miscarriage in late pregnancy, premature discharge of amniotic fluid, weakness of labor, bleeding in the postpartum period due to hypotension of the uterus, incomplete separation of the placenta after birth, cardiopulmonary insufficiency in the mother,abruption of the normally located placenta;
- in case of malnutrition: retardation of growth and development of the fetus, fetal hypoxia, with severe malnutrition due to constant trauma, the curvature of the spine of the fetus and hip joints is possible;the formation of fusion between the fetal skin and amnion, with fetal growth, these cords can lead to amputation of the fetus's limbs;intrauterine infection of the fetus, weakness of labor, late miscarriages, intrauterine fetal death, fetal death in the first days of life after birth.
Births with anhydrous or hydrazine
Amblerous waters play an important role in childbirth. It depends on the amount of the amniotic fluid depends on whether the pregnant woman will be able to enter into labor or to require an amniotomy. Normally, with a normal amount of water and at a term of pregnancy, when entering into labor under intrauterine pressure, spontaneous rupture of the membranes occurs, amniotic fluid pours out and contractions intensify. But with malignancy and polyhydramnios, there are certain obstacles to normal entry into labor. What are they related to?
When there is malnutrition, there is a shortage of the front waters, that is, the waters located just in front of the fetal head. Because of this, the envelope of the fetal bladder "stretches" on the fetal head, forming a "flat fetal bladder".A flat fetal bladder under intrauterine pressure can not self-tear itself, as is normal, and because of this the process of labor is suspended and the labor of the labor-giving child develops a weakness of labor. In such cases, necessarily produce an amniotomy, to strengthen the labor activity and to "start" the contractions.
In case of polyhydramnios, the opposite situation is observed. Under the pressure of a large number of front waters, the fetal bladder may burst ahead of time. The water is poured in large quantities and sharply. Because of this, the umbilical cord of the fetus, the handle, the leg may fall out. To prevent such a situation,before the onset of labor, amniotomy. When the fetal bladder is opened, the amniotic fluid is released slowly, with a thin stream. Thanks to amniotomy, the size of the uterus decreases and contractions intensify.
Prevention of polyhydramnios and lack of water:
- timely examination and treatment of infectious and inflammatory diseases of the genital area before the planned pregnancy;
- correction of endocrine disorders, in particular, diabetes and obesity;
is a regular dynamic observation in an obstetrician-gynecologist throughout pregnancy.
Consultation of a doctor on the topic of hypochlorous and hydramnios:
1. I have a gestation period of 30 weeks. Have diagnosed on US - moderate polyhydramnios, but any treatment have not appointed or nominated. Is it correct?
Correctly, with moderate polyhydramnios, treatment is not prescribed if the fetus does not suffer from this. Dynamic ambulatory monitoring is shown.
2. I have moderate hydramnios. The gynecologist said that you need to go to the hospital and be treated with antibiotics. Is it so?
No, moderate polyhydramnios can not be treated with antibiotics, unless, of course, you have been diagnosed with an infection.
3. How often can an ultrasound be performed to see the dynamics of the development of hypohydrate or polyhydramnios?
Twice a month, if necessary, you can often.
4. If you have been diagnosed with polyhydramnios, is it possible that the amount of water is normal, if not treated?
Probably, especially if you have moderate hydramnios.
5. I have moderate water shortage, how can it affect the baby?
Moderate hypotension usually does not affect the fetus. Watch for fetal movements, the fetus should normally move at least 10 times a day. It is also recommended to do CTG once a week.
6. Do I have to go to the hospital with severe malnutrition?
Required. In addition to treatment, in your case it is necessary to conduct CTG every day.
7. I have moderate water retention and pelvic fetal presentation. Doctors persuade me to lie down on caesarean section. Maybe I can give birth to myself?
Pelvic presentation of the fetus and mild water retention are not indications for cesarean section. Perhaps there are other indications for which you want to undergo surgery, for example, a large fetus or a delay in fetal development.
8. How long can a baby be without amniotic fluid after an amniotomy?
About 12 hours.
9. I was pierced by a fetal bladder, saying that I can not enter into childbirth alone due to the fact that I have few front waters. It's true?
Yes.
Obstetrician-gynecologist, Ph. D.Christina Frambos