For every woman, pregnancy is a mystery, which is sometimes overshadowed by various indicators that go beyond the concept of “norm”. Most often, this is a rather vague concept that has a significant gap, but sometimes it happens that even the smallest deviation may indicate problems in the health of the expectant mother or her baby. The norm of the amniotic fluid index also has blurred boundaries, but these data may indicate oligohydramnios or polyhydramnios.

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16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 weeks of pregnancy IAZ value: mm

What is amniotic fluid, oligohydramnios and polyhydramnios?

As you know, the baby is kept in a kind of sac - the amniotic sac - throughout the mother's pregnancy, which is filled with fluid - amniotic or amniotic. Throughout pregnancy, the fetus is safe, as the fluid and bladder reliably protect and protect it. When the time comes for childbirth, the amniotic sac ruptures, and the woman’s water “breaks” - this is the same amniotic fluid. The development of a child in the womb occurs spasmodically: there are periods when he grows very intensively, and there are weeks when growth slows down a little.

Amniotic fluid performs three main functions:

1. Protection against infection.
2. Protection from external damage.
3. Helps in the development of two important systems: respiratory and digestive.

Such a difficult-to-understand phrase as the amniotic fluid index simply means the amount of amniotic fluid during pregnancy. If the index is noticeably lower than the normal value, then the gynecologist diagnoses “oligohydramnios,” and if it is higher, then “polyhydramnios.”

Such a deviation as oligohydramnios can be provoked both by various ailments of a woman, and by some individual pathologies in the development of the baby. The causes of polyhydramnios may be infectious diseases of the mother, Rh conflict or fetal anomalies. Regardless of the diagnosis, a woman should be observed by a doctor, undergo various additional tests and be sure to undergo the appropriate recommended treatment.

Indicator norm

Amniotic fluid is the baby's first habitat, so both quantity and composition are important for the normal development of your baby. It is the optimal amount of amniotic fluid that indicates that the fetus is developing according to norms and there is no threat to its life.

In order to find out the volume of amniotic fluid, a woman needs to undergo an ultrasound examination. For each stage of pregnancy there is its own index, according to which the doctor looks at how the pregnancy is progressing. Just as the composition of amniotic fluid changes literally every week, so does its quantity. In addition to the average, there is a fairly large difference in possible fluctuations of this index. Please note that possible fluctuations are very large, so if your indicator is far from normal, this does not mean that you should worry and be nervous.

Table

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

Why does the amount of amniotic fluid either increase or decrease literally every day? This is due to the fact that the child grows, he begins to swallow liquid, and then remove it from his body - that is, to urinate. But, do not worry about the condition of the baby - the amniotic fluid is renewed every three hours, and completely changes every three days.

Limit values ​​of sizes The largest vertical pockets for defining oligohydramnios are somewhat arbitrary and vary in their positive predictive value and sensitivity. Based on our clinical experience with more than 5,500 high-risk patients, a maximum water pocket cut-off value of 2 cm appears to be the most appropriate and recommended for use, as the greatest increase in adverse perinatal outcomes is observed from around this level.

Results more 145,000 examinations with measurements of amniotic fluid volume in more than 75,000 high-risk pregnant women, including more than 10,000 patients with suspected IUGR, allowed us to discover certain clinical rules.

1. Availability of normal volume amniotic fluid does not completely exclude the diagnosis of any of the etiological types of IUGR, but the likelihood of this pathology in such situations is sharply reduced.

2. U fetus with signs of growth retardation according to fetometry, with the confirmed presence of kidneys and their functioning, as well as with intact membranes, oligohydramnios (with a maximum “pocket” of less than 2 cm) is a sign that with high statistical power indicates IUGR due to placental insufficiency. Identification of this sign is important for developing optimal management tactics, since it implies delivery of a fetus without malformations, for which extrauterine survival is at least the method of choice.

In our experience, practical rule that a fetus with oligohydramnios always suffers from retarded development, unless proven otherwise, is reliable and eminently useful.

3. It is important to distinguish between secondary oligohydramnios, caused by placental insufficiency, which can also occur with chromosomal disorders, especially with trisomies 13 and 18.

4. In all cases, inalienable part of an echographic examination confirmation of the presence of kidneys and their functioning in the fetus remains, since renal agenesis, which is a lethal anomaly, in classical cases manifests itself in the second half of pregnancy in the form of severe IUGR and oligohydramnios.

Fetal examination with non-functioning urinary system due to agenesis or primary dysgenesis of the renal parenchyma presents significant difficulties. In such situations, after 20 weeks of pregnancy, an echographic examination almost always reveals pronounced IUGR and oligohydramnios, which worsens the conditions for imaging and makes it extremely difficult to diagnose fetal kidney pathology. Differential diagnosis of such conditions from true severe IUGR is of critical clinical importance, since the tactics for managing pregnancy in patients will be radically different. Detection of fetal urine in the bladder and changes in its volume over time (hourly assessment) will indicate a diagnosis of IUGR, provided that the integrity of the membranes is established.

In such situations It was proposed to prescribe furosemide to the mother, which was expected to have a diuretic effect on the fetus by penetrating the placenta. Despite the attractiveness of this theoretical assumption, it was not confirmed, since in the experiment, transplacental penetration of furosemide was not detected in sheep fetuses. According to some researchers, the administration of diuretics to pregnant women with fetal growth retardation and established functioning of the urinary system did not stimulate diuresis in antenatal conditions. The discovery of a pronounced decrease in the ratio of chest circumference to abdominal circumference most likely indicates the presence of pulmonary hypoplasia, which is almost always found in fetuses with renal agenesis/dysgenesis.

There are descriptions of experimental techniques, which could help resolve this kind of differential diagnostic difficulties, for example, by adding saline solution to the amniotic cavity to improve visualization of the area where the kidneys are located in the abdominal cavity of the fetus, as well as intramuscular and intravenous administration of diuretics to the fetus or intravenous administration of other infusion solutions that will help improve glomerular filtration.

Pregnancy is the time when a woman, more than ever, needs to constantly closely monitor her health. During this period, it is necessary to undergo all necessary examinations in a timely manner, including measuring the amniotic fluid index. IAF is the average required volume of amniotic fluid inside the uterus, which should be equal to the norm corresponding to the average in a particular week of pregnancy. Normally, the amount of amniotic fluid ensures the healthy development of the unborn child and makes it easier to endure the birth process. The norm has quite broad indicators, since it largely depends on the individual characteristics of the mother and child, however, there is a standardized amniotic fluid index by week, which allows doctors to determine whether the pregnancy is progressing well and whether there is a need to prescribe additional treatment.

Functions of amniotic fluid

Throughout pregnancy, the baby is in a special bladder, which is filled with amniotic fluid. It is an important protective environment that surrounds the fetus throughout its development inside the mother, which is why it is so important to monitor fluid index readings week by week throughout pregnancy.

Functions of amniotic fluid:

• Protection of the fetus from infectious diseases (it contains a certain amount of immunoglobulin fractions that provide protection from the penetration of viruses and infections);
• Protection from external influences and mechanical damage (amniotic fluid forms the average level of pressure and temperature necessary for the full development of the child);
• Ensuring the functioning of respiratory and digestive functions;
• Nutrition of the child (normally, amniotic fluid contains a large amount of useful substances that are absorbed through the skin and later swallowed by the fetus);
• Protection of the embryo from loud sounds occurring outside; Provides enough space for the child to move freely and learn primary coordination of movement;
• During childbirth, substances contained in the amniotic fluid cause the uterus to dilate.

The development of the fetus is greatly influenced not only by the composition of this fluid, but also by its quantity, therefore, throughout pregnancy, AFI inside the uterus should be measured at each stage. The amniotic fluid is partially replaced within three hours, and then completely changes after two days. This provides maximum protection for the child.

Composition of amniotic fluid:

• Vitamins;
• Hormones;
• Immunoglobulins;
• Enzymes;
• Useful microelements;
• Antibodies.

A detailed analysis of amniotic fluid week by week makes it possible not only to ensure that the fetus is well supplied with all the necessary substances and to ensure complete protection, but with its help the doctor can determine the sex of the child and even the blood type. Despite the fact that the average AFI during pregnancy represents exclusively the normal volume of amniotic fluid in the uterus in a given week of pregnancy, it is a very important indicator that allows us to identify such disorders during pregnancy as oligohydramnios and polyhydramnios. These pathologies have a very strong impact on the development of the child and can then cause serious illness and even miscarriage, so AFI should be measured every three weeks of pregnancy.

Study of AFI norms by week

In order to promptly notice negative changes in the course of pregnancy and then prevent the development of complications and diseases of the fetus, women should frequently undergo various examinations.

One of them is determining the fluid index, for which in most cases ultrasound is prescribed.

Thanks to IAF, you can find out not only the average volume of water within the uterus by week, but also the degree of its homogeneity. This diagnostic method is quite simple and does not take much time. During each examination, the doctor examines the size of the space between the wall of the uterus and the fetus, thanks to which he determines the fullness of the amniotic sac.

For a more detailed and high-quality study, the doctor, using perpendicular lines, conditionally divides the uterine cavity into four sectors (pockets), then examines each of them separately, after which he adds up the results obtained from each pocket and determines the average AFI.

It should be remembered that the AFI is not a specific number, but a whole range of values, which has rather imprecise boundaries. This is due to the individual characteristics of each pregnant woman, which are quite difficult to adjust to specific standards. However, there is a special table. A similar table contains data for each week of pregnancy. Such AFI indicators significantly help in detecting possible pathologies and associated risks. The maximum amount of water is observed in the fifth month of pregnancy, after which the average AFI normally gradually decreases to approximately one liter at the time of birth. Also, this volume may not change significantly over the course of a week or even several days. This begins to happen when the child learns to swallow and periodically absorbs some water, and then it is expelled back.

The average IAF has rather vague boundaries of the norm, which means that the presence of pathologies and prerequisites for diseases must be determined by a highly qualified doctor who will take into account the individual characteristics of the pregnant woman’s body and the conditions of embryo development. Average:

• By ten weeks, the normal level should be about 30 ml;
• By fourteen weeks - about 100 ml;
• By eighteen weeks - about 400 ml;
• By the thirty-sixth week - about 1 liter 200 ml;
• By the end of pregnancy, the amount of water normally decreases to 1 liter.

If the AFI is much less than normal, the doctor diagnoses oligohydramnios, but if the indicators are significantly higher than the normal amount of water, then it is polyhydramnios. Each pathology has a negative impact on the development of the fetus, including disruption of important functions, so it is extremely necessary to constantly monitor the IAF in order to begin treatment in time if abnormalities occur. If measurements correspond to the norm throughout pregnancy, this facilitates simple spontaneous childbirth and ensures the absence of possible complications.

Low water

The diagnosis of oligohydramnios during pregnancy is made when the water volume does not reach the lower limit of the AFI and does not exceed 500 ml. A significant lack of performance may be due to the following reasons:

• Genetic predisposition of a woman;
• High blood pressure;
• Dysfunction of the mother's genitourinary system;
• Exacerbation of chronic diseases during pregnancy;
• The presence of two or more embryos;
• Infectious diseases;
• Fetal anomalies (genetic diseases, poor development);
• Diabetes mellitus;
• Metabolic dysfunction;
• Placental abruption;
• Post-maturity.

A doctor can preliminarily determine oligohydramnios by the following symptoms:

• Pain in the abdominal area;
• Nausea and weakness, a depressed state are detected;
• Difficulty moving the fetus inside the uterus and severe pain during its activity;
• Small roundness of the abdomen.

If a woman is diagnosed with oligohydramnios during pregnancy by a doctor, she must undergo all necessary treatment and be under constant supervision by a doctor throughout pregnancy until childbirth, as well as adhere to a gentle regimen and follow a special diet.

If the pregnancy is overdue, it becomes necessary to induce artificial labor.

Oligohydramnios can cause the walls of the uterus, with a decreased AFI, to begin to put pressure on the baby, which causes a large number of pathologies in development and can even lead to miscarriage. Consequences of oligohydramnios during pregnancy:

• Improper formation of the musculoskeletal system, dislocations, bone deformation;
• Insufficient fetal weight;
• Development of oxygen deficiency;
• Fusion of the skin of the fetus and the walls of the uterus;
• Improper formation of the respiratory system;
• Disturbances in the functioning of the genitourinary system;
• Heavy bleeding after childbirth;
• Difficult labor and high chance of needing a caesarean section.

Polyhydramnios

An increased AFI is also a signal that negative changes are occurring in a woman’s body. Polyhydramnios is too much fluid, which, like oligohydramnios, can then lead to the development of disorders during the formation of the child. The amount of amniotic fluid in such a disease can significantly exceed the average IAF value by several times and reach six liters.

Causes of polyhydramnios:

• Genetic predisposition;
• Anomalies in embryo development;
• Rh factor incompatibility;
• Infection;
• Diabetes mellitus and overweight;
• Metabolic dysfunction and poor nutrition;
• Disorders of the functioning of a woman’s immune system;
• Violation of the child's swallowing function;
• Swelling of the placenta.

Symptoms of oligohydramnios:

• Abdominal pain;
• Weakness of a woman, depressed state;
• Formation of stretch marks;
• Gurgling sound when moving;
• Significant enlargement of the uterus;
• Swelling of the legs;
• Exceeding the permissible size of the uterus;
• Significant increase in heart rate during light exercise.

Polyhydramnios can cause the following disorders:

• Developmental disorders of the child due to insufficient oxygen in the amniotic fluid;
• Threat of miscarriage;
• Complication of childbirth due to improper positioning of the fetus during pregnancy;
• Placental abruption;
• Development of infectious diseases.

Just as during oligohydramnios, if a significantly increased AFI is detected, a woman should urgently begin the treatment prescribed by the doctor in order to eliminate the risks and prevent inevitable changes in the child’s development. It also requires constant monitoring throughout pregnancy by a doctor who will monitor IAF in the uterus.

The child spends the entire period of intrauterine development in the fetal bladder filled with amniotic fluid or amniotic fluid.

Amniotic fluid, which has a complex chemical composition, is necessary for the normal functioning and development of the fetus; it protects the unborn child from infections and external influences, and ensures freedom of movement.

The composition and quantity of amniotic fluid constantly changes throughout pregnancy, the maximum volume of fluid inside the amniotic sac is reached at 32 weeks, then gradually decreases and by the end of pregnancy is about 1.5 liters.

To assess the amount of amniotic fluid, the amniotic fluid index is used, which is determined during an ultrasound examination by summing the four values ​​of the amniotic space; the vertical size of the amniotic fluid, measured in mm, appears black on the monitor. To obtain this data, during the examination, the uterus is divided into 4 squares, the largest space in each of them is measured, then the obtained indicators are summed up.

Below is a table of the normal amount of amniotic fluid for different stages of pregnancy. If the amniotic fluid index goes beyond the upper limit of these norms, then, in accordance with the gestational age, the doctor speaks of polyhydramnios. If this index exceeds the norm slightly, then it is customary to talk about moderate polyhydramnios during pregnancy.

Table of amniotic fluid norms at different stages of pregnancy

Gestation period, weeks	Average normal value, mm	Probable fluctuations, mm

Amniotic fluid index at different stages of pregnancy

Gestational age	Amniotic fluid index, mm
	percentile

You need to focus on the middle column of the 50th percentile, the 2.5th shows the lower, and the 97.5th the upper limit of the norm. That is, if the vertical value of amniotic fluid is slightly higher than the 97.5 percentile, this indicates moderate polyhydramnios.

To diagnose polyhydramnios, an ultrasound examination, Dopplerometry, examination by a doctor are performed, and to confirm the diagnosis it is carried out.

Reasons

There are several reasons why moderate polyhydramnios develops. These include:

1. - large fruit;
2. - multiple pregnancy (two or more fetuses);
3. - Rh conflict between mother and fetus;
4. - the woman has chronic diseases;
5. - intrauterine infections;
6. — various pathologies of fetal development (including genetic ones);
7. - late toxicosis ()
8. — placental disorders;
9. - diabetes mellitus in a pregnant woman;
10. - anatomical features of the structure of the uterus.

In general, the causes of moderate polyhydramnios have not been fully studied to date.

Signs

Even before examination and examination, a woman may suspect that she has moderate polyhydramnios based on the following signs:

1. - swelling;
2. - increased heart rate;
3. - heaviness and pain in the abdominal area;
4. - the abdominal circumference at the navel increases sharply and reaches 100-120 cm;
5. - weakness and general malaise;
6. - shortness of breath, which is a consequence of the high position of the uterine fundus and the pressure of the diaphragm on the lungs.

If you suspect that you are developing even moderate polyhydramnios, a pregnant woman should contact your doctor to establish an accurate diagnosis and carry out timely treatment, which can be either outpatient or inpatient. It necessarily includes the prescription of vitamin preparations, diuretics and antibiotics. The process is usually simple and treatment is prescribed after the cause of the development of this pathology has been established. But it is necessary to carry it out, since polyhydramnios can have serious consequences for the child:

• - rupture of membranes and premature birth;
• - umbilical cord entanglement (including multiple ones) and complicated childbirth (weak labor) and others.

But with timely and adequate treatment under the supervision of a doctor observing the pregnancy, moderate polyhydramnios is not so dangerous and does not carry the described consequences.

Violation of the formation and absorption of amniotic fluid threatens oligohydramnios. Let's take a closer look at this concept.

What is oligohydramnios?

In obstetrics and gynecology, insufficient amniotic fluid is called oligohydramnios.

Amniotic fluid (or amniotic fluid)- the liquid environment in which the fetus is located during pregnancy.

This biological fluid performs several important functions. These include:

• protective function– the water shell protects the child from the penetration of infections (due to the tightness of the shells and the immunoglobulins included in the water), from mechanical influences from the outside (for example, from blows and jolts), loud sounds (water muffles them), external fluctuations in pressure and temperature (maintaining optimal pressure and a constant temperature of 37 ºС, of course, if mommy is healthy and her body temperature does not exceed 37.8 ºС);
• exchange function– the child absorbs amniotic fluid, enriched with nutrients, and releases it back.
  In addition to all this, fetal fluid ensures free movement of the baby inside the womb. Therefore, with a normal amount of amniotic fluid, the baby is cozy and comfortable, he is protected and provided with everything he needs.

What does amniotic fluid contain?

As pregnancy progresses, the composition of the amniotic fluid changes and becomes more varied and rich, making the waters slightly cloudy in appearance. Amniotic fluid is secreted by cells of the aqueous membrane.

At the beginning of pregnancy, amniotic fluid is almost the same in composition as blood plasma. They contain nutrients (proteins and fats), vitamins and minerals, hormones, enzymes and more.

From the second trimester, the composition of this biologically active liquid is supplemented by dead skin cells (as a result of the natural process of replacing the old layer of skin with a new one), fetal fluff (hairs), vernix cheese-like lubricant of the fetal body and waste products (sterile urine).

The fetal waters are renewed every 3 hours.
Drinking water has no effect on the amount of amniotic fluid. Excessive fluid intake will only cause swelling in a pregnant woman.

Normal amount of amniotic fluid

If the amount of amniotic fluid deviates from the norm, doctors diagnose oligohydramnios or polyhydramnios. The amount of fluid is determined by a diagnostician during an ultrasound scan, starting from the second trimester of pregnancy.

The volume of amniotic fluid in medicine is usually referred to as the amniotic fluid index (AFI).

Table - Norm of amniotic fluid index by week

The standards may differ slightly from those given above depending on the type of ultrasound machine. And also the value can be written not in millimeters, but in centimeters (1 cm = 10 mm).

Also, the amount of fetal fluid is characterized by another indicator - the vertical size of the largest (free) water pocket (WC). This size should normally be in the range from 2 to 8 cm (or from 20 to 80 mm), with a borderline amount of water - from 2 to 1 cm (from 20 to 10 mm), and with low water - less than 1 cm (or 10 mm).

What are the causes of oligohydramnios?

Depending on the severity of the pathology, moderate and severe oligohydramnios are distinguished.

You can often find an inscription in an ultrasound report: “a tendency towards moderate oligohydramnios.” This means that the expectant mother may have health problems and needs more careful monitoring.

Moderate oligohydramnios– this is a slight deviation in the amount of fetal fluid from the norm. This type of deviation may be caused by the individual characteristics of the pregnant woman’s body or, in the worst case, may be a prerequisite for the occurrence of a more severe form of this pathology. In any case, doctors recommend preventing fetoplacental insufficiency (FPI).

Moderate lack of water is not a critical situation, because the amount of water is not constant and can change several times a day. Perhaps there was an error in establishing the diagnosis and the fault was with the doctor who made a not very accurate calculation during the ultrasound, because determining the amniotic fluid index is a subjective and approximate matter. Therefore, there is no need to panic; in 8 out of 10 cases, pregnancy ends in the successful birth of a healthy baby.

Severe oligohydramnios poses a danger to the health of the fetus, so you must follow all the instructions of the doctor monitoring the pregnancy.

The causes of oligohydramnios, regardless of the degree of its severity:

• fetoplacental insufficiency;
• problems with the cardiovascular system in a pregnant woman (hypertension and others);
• diseases of the fetal urinary system (kidneys, for example);
• leakage of amniotic fluid (if the integrity of the membranes is violated);
• pathology in the development of membranes;
• bacterial infections suffered during pregnancy or shortly before its onset;
• diabetes mellitus;
• late gestosis.

Most often, oligohydramnios occurs due to metabolic disorders in a pregnant woman, as well as after viral diseases (acute respiratory infections, acute respiratory viral infections, etc.) and with fetoplacental insufficiency.

Personal practice shows that ultrasound doctors often exaggerate the scale of the problem, and a slight deviation from the norm is already a disaster for them. Such pseudo-oligohydramnios causes unnecessary stress for the expectant mother, but in fact the babies are born relatively healthy.

The only thing is that childbirth with oligohydramnios (even slight) can occur with some complications (poor opening of the cervix, painful contractions and prolonged labor due to pelvic or breech presentation of the fetus, which arose due to oligohydramnios). Although complicated childbirth can occur in any woman in labor, regardless of the amount of water.

obstetrician-gynecologist A. Berezhnaya

The occurrence of oligohydramnios during post-term pregnancy is considered a common occurrence, since the placenta has grown old and can no longer fully perform its functions, so it exfoliates. Then doctors prescribe induction of labor or perform a planned caesarean section.

How dangerous is oligohydramnios for the fetus?

Oligohydramnios (or oligohydramnios) is a complication of pregnancy, sometimes even dangerous for the fetus, because it is at risk of infection, which can even result in its death.

For example, when the integrity of the membranes is lost - this is when amniotic fluid leaks - the child becomes vulnerable to infections entering the membranes.

A woman’s reproductive tract is not sterile, pathogenic microorganisms constantly live in the vagina, “plus” the immune system is weakened due to pregnancy. All this can lead to the proliferation of harmful bacteria, which can penetrate inside the uterine cavity and infect the membranes, causing inflammation, called chorioamnionitis in gynecology. Without timely treatment, the fetus itself becomes infected.

This applies to oligohydramnios caused by a violation of the integrity of the membranes.

With severe oligohydramnios, regardless of the reasons for its occurrence, the baby suffers from hypoxia (lack of oxygen), because of this it lags behind in intrauterine development. In addition to all this, it is uncomfortable for the baby to be in such a “nest”; his neck is often curved, and the bones of the face and head are susceptible to deformation due to compression by the walls of the uterus.

Moderate oligohydramnios does not have such a critical effect on the health of the fetus: the baby is weak and lags behind in gaining body weight (so-called malnutrition is observed), his muscle tone is reduced (possible development of torticollis, clubfoot), and mild fetal hypoxia occurs.

If screening and urine/blood/smear tests are normal, the cardiotocogram (CTG) is normal and the fetus is developing well, and the pregnant woman has no complaints about her health, then the diagnosis of oligohydramnios is conditional. Obstetricians will simply prepare to induce labor, since there is a high probability of a post-term pregnancy, or for a cesarean section if the fetus is not in a standard position at the due date.

Diagnosis of oligohydramnios

During an ultrasound examination, the doctor makes some measurements and calculations to determine the amount of amniotic fluid, after which he makes a conclusion about oligohydramnios, a normal amount of water, or polyhydramnios.

A gynecologist can also assume low or high hydramnios at the next measurement of the abdominal circumference and the height of the uterine fundus, but a more accurate diagnosis can only be made with the help of an ultrasound.

At home, you can only conduct a test for leakage of amniotic fluid. If watery discharge is often observed in the underwear, and the baby’s kicks have become painful for the pregnant woman, although such discomfort was not felt before, or the size of the abdomen is too small, although the pregnancy has already exceeded 20 weeks, then it is advisable to conduct a special test. Perhaps the reason for everything is oligohydramnios, caused by leakage of water due to a violation of the integrity of the membranes.

The test can be carried out at home by observing the discharge for some time, or by purchasing a special test for leakage of amniotic fluid at the pharmacy and using it.

The “free” test is carried out as follows: empty your bladder, take a shower (without douching and possible water getting inside the vagina), wipe yourself dry with a towel and lie down on a dry diaper. Lie motionless for 15 minutes, and then get up and see if a wet spot appears on the diaper. Normal discharge is not capable of forming and flowing out so quickly; most likely, it is amniotic fluid leaking. You can find out more accurately by contacting the LCD with a complaint about unusual discharge. There they will conduct a special test and tell you if it is water or normal vaginal discharge.

The pharmacy test looks like a pad, the surface of which will change color to blue or green if amniotic fluid leaks.

Coloring also occurs with bacterial/viral discharge, so if you notice blue-green spots on the surface of the pad, contact your gynecologist.

Any test for leakage of amniotic fluid is recommended to be carried out 12 hours after the last sexual intercourse, douching or use of vaginal suppositories.

Treatment of oligohydramnios

It is impossible to artificially increase the amount of amniotic fluid, so treatment of oligohydramnios comes down to determining the causes of its occurrence. Next, the root causes of oligohydramnios are treated.

To determine the causes of oligohydramnios, the pregnant woman is referred for Doppler ultrasound or cardiotocography (CTG) in order, first of all, to refute or confirm disturbances in blood flow in the placenta.

If the fetoplacental blood circulation is still impaired, then the patient is prescribed drugs to normalize it - Curantil, Actovegin.

Moreover, Curantil is often prescribed as a measure to prevent fetoplacental insufficiency.

Often, the treatment complex includes medications that help normalize metabolic processes in the pregnant woman’s body (for example, Magne + B6) and support the normal functioning of the woman’s important internal organs (for example, Chofitol).

It is also necessary to exclude the presence of infections in the pregnant woman. For this purpose, urogenital smears are taken again for STIs and from the throat + nose for cocci, and a blood test is performed for TORCH infections. If infection is present, antibiotic therapy is prescribed.

Childbirth with oligohydramnios

In case of severe oligohydramnios, a planned caesarean section is prescribed. With a small volume of amniotic fluid, the fetal bladder takes on a flat appearance. Because of this, contractions will be irregular and weak, and labor may be long and difficult.

Moderate oligohydramnios is not a contraindication for natural childbirth. Even with a breech or breech presentation of the fetus caused by oligohydramnios, the birth proceeds safely for both the mother and her child.

An insufficient amount of amniotic fluid does not allow the baby to move freely inside the womb. Therefore, the child often takes a transverse or buttock position and can no longer roll over correctly.

There are various exercises that can help turn the baby into the desired position, but their effectiveness has not been confirmed from a medical point of view. Exercise can lead to umbilical cord entanglement, so you need to weigh the pros and cons before doing it.