Amniotic fluid leakage symptoms. Intrauterine period: what contributes to the normal course of pregnancy At the beginning of gestation

Amniotic fluid is not just a water shell that protects the fetus from injury and allows the baby to move freely. Without amniotic fluid (and even if it is, but its amount is less than normal), the child cannot fully develop. Therefore, a woman should know how to determine the leakage of amniotic fluid by simple symptoms and with the help of home tests.

Amniotic fluid is formed from the moment of conception. Gradually, their number increases, reaching a peak by the second trimester. By the time of delivery, amniotic fluid is not formed so intensively. Leakage of water during pregnancy can occur at any time. Up to 22 weeks, this is a sign of a miscarriage that has begun, after - the onset of childbirth.

Why amniotic fluid leaks

The reasons for the leakage of amniotic fluid in different periods are different. Depending on this, the tactics of conducting a pregnant woman are built.

At the beginning of gestation

At this time, isolated leakage of amniotic fluid is rarely observed. More often, a miscarriage begins with bloody discharge and only then, as the uterus contracts and the ovum is expelled, amniotic fluid is released. It mixes with blood and is difficult to isolate separately.

In the middle and end of gestation

Even the slightest leakage of amniotic fluid before 22 weeks is considered the beginning of a miscarriage. After this period and up to 37 weeks, the release of amniotic fluid is a signal of the imminent onset of preterm labor. However, even at this time, the prognosis in many cases is not entirely favorable. After 37 weeks, the appearance of amniotic fluid is considered the norm and indicates the onset of labor.

Leakage of amniotic fluid occurs for various reasons, which can not always be established even after a thorough examination. The main ones include the following:

Infectious diseases. Sexual infections and TORCH-complex (recently transferred rubella, cytomegalovirus, herpes) are in 95% of cases the cause of premature leakage of amniotic fluid in the first and second trimesters. When the focus of inflammation is localized in the vagina and cervix, pathogens penetrate further into the cervical canal, uterine cavity, and fetal membranes. Infection of the membranes is the cause of premature rupture of amniotic fluid.
Chronic processes. Serious chronic diseases, such as pyelonephritis, autoimmune pathologies, can also indirectly cause water outflow.
Rhesus conflict. With the incompatibility of blood groups of the fetus and mother according to the Rh factor, Rh sensitization occurs. In such a situation, the body tries to "get rid" of an unwanted pregnancy, which is the cause of water leakage.
Multiple pregnancy. When carrying two or more fetuses, a woman has an increased risk of developing premature birth due to excessive stress on the body. Often, multiple pregnancy is accompanied by isthmic-cervical insufficiency of the cervix (ICN, premature opening of the cervix). With monochorionic twins, triplets (one placenta for all), a “steal syndrome” may occur. As a result, one baby develops polyhydramnios, the other - oligohydramnios. All this is often accompanied by leakage of amniotic fluid.
Pathology of the cervix. ICI leads to premature outflow of water. At the same time, as the gestational age increases, the cervix cannot withstand the load and begins to open. The result - the fetal bladder prolapses (falls) into the cervical canal and its rupture occurs.
Manipulations on the neck. When applying an obstetric suture in case of insolvency of the cervix, an accidental puncture of the fetal bladder may occur, followed by outpouring of water.
diagnostic procedures. Amniocentesis (puncture of the uterus through the anterior abdominal wall and sampling of a small amount of amniotic fluid), cordocentesis (puncture of the umbilical cord for blood sampling or transfusion), chorionic villus biopsy (the procedure is similar to amniocentesis, but chorionic cells are harvested) due to their invasiveness are always accompanied by risk water leaks.
Myoma of the uterus. In the presence of several myoma nodes or even one large one, the extensibility of the myometrium decreases. And after 12-16 weeks, intensive growth of the uterus begins. If the nodes "interfere" with this, the integrity of the fetal membranes is violated under pressure and water leaks.
Anomalies in the structure of the uterus. In this case, a similar picture develops, as with nodes. A uterine septum, one horn, or a saddle shape can lead to the outpouring of water.
Fetal pathology. If the baby has some kind of malformation, the likelihood of outflow of water before the onset of a full-term pregnancy is also higher.
Injuries. Injuries in the abdomen (blunt, sharp) can lead to compression of the amniotic sac and rupture of the membranes.
Thrombophilia. A change in the properties of connective tissue and blood leads to destructive transformations of the cervix and membranes, which provoke rupture of the fetal bladder.
Diabetes . Changes in metabolism, especially with sugar decompensation, increase the risk of preterm birth and amniotic fluid leakage.

Premature birth sometimes occurs against the background of specific circumstances, for example, infection, fetal pathology. But often there are no obvious reasons for the early onset of labor.

What does it look like

Amniotic fluid leakage can look different. It all depends on the level of stress.

Abundant and medium discharge. When the bulk of the amniotic fluid flows out, which are located in front of the presenting part of the fetus (like a “wedge”), the woman notes that it “flows down the legs”, ordinary maxi pads cannot absorb all the amniotic fluid.
Minor discharge. With a high tear of the fetal bladder or when the layers of the membranes are displaced relative to each other, the defect zone may overlap and the amniotic fluid stops leaking. In this case, the amount of water may be insignificant - up to 200 ml or less. In such a situation, it is sometimes difficult to diagnose and confirm whether it was amniotic fluid or not.
Color and presence of impurities. Amniotic fluid can be with blood (in this case, it is necessary to exclude placental abruption), with an admixture of meconium - green or yellow (a sign of fetal hypoxia). Normally, the color of amniotic fluid during leakage should approach a transparent, with a milky tint, it may contain vellus hair of the fetus and particles of its epithelium - all this provides a kind of suspension.
Smell . Amniotic fluid does not have a pungent odor, let's say a slight sour. Fetid, unpleasant - a sign of infection of the membranes and, most likely, the baby.
With or without contractions. Water can leak both with the onset of uterine contractions and contractions, and without them.

Leakage can occur both after physical activity and during well-being, for example, during sleep or after a night's rest. When the position of the body changes, the amniotic fluid may flow more abundantly.

So, the main symptoms of amniotic fluid leakage are as follows:

increased amount of vaginal discharge;
secretions are liquid;
appear periodically or leak constantly.

How to understand what kind of discharge

In preterm pregnancy, it is extremely important to distinguish true leakage from ordinary vaginal leucorrhoea. It is not always easy to do this without additional examination and dynamic observation. It is especially difficult to establish a diagnosis in the following cases.

With urinary incontinence. Even in young women, especially after repeated childbirth, the tone of the pelvic floor muscles can decrease, resulting in urinary incontinence - when straining, sneezing, coughing. This is especially characteristic in the later stages, when the uterus creates additional pressure on the bladder and pelvic floor. If the pregnant woman does not notice this, there may be an impression of water leakage.
With a pessary in place. After installing a RAP (unloading obstetric pessary) - a foreign body - the amount of vaginal discharge increases due to constant inflammation. They collect in the posterior fornix and may flow more profusely when turning the body. Sometimes it seems that it is water.
With inflammation in the vagina. The infectious process in the vagina is always associated with an increase in the amount of discharge. Depending on the nature of the inflammation, they can be transparent, white, yellow or green.
When the mucous plug comes off. When the moment of childbirth approaches and the cervix opens, mucus comes out, which during pregnancy “like a cork” closes the cervical canal from infection. Sometimes it is quite liquid in consistency and can resemble water.

By what signs it is possible to differentiate the leakage of water from other conditions, the following table shows.

Table - How to distinguish water from other secretions

Criterion	Water	Allocations with a pessary	Discharge during inflammation	Mucus plug
Quantity	Usually a lot		Enough daily panty liners for personal hygiene	Not plentiful
Colour	Normally clear, but may be bloody, green or yellow	Most often white or yellowish	Depending on the cause of inflammation - from transparent (with vaginosis) to yellow, white, curdled	Transparent, but may be interspersed with streaks of blood, whiter than the vagina
Smell	Usually not, but with inflammation, an unpleasant putrefactive	Sour, often unpleasant	"Fishy" with vaginosis and purulent, putrefactive - with other types of inflammation	Doesn't have
Consistency	watery	Creamy	dense	Like egg white or thicker
Appearance time	Suddenly	2-3 weeks after insertion of the pessary	No pattern	Before childbirth, including premature
Do they pass	Only at high bubble burst	After removal of the pessary and sanitation	After treatment	Before childbirth, they no longer go away, but may decrease slightly

In order to recognize the leakage of amniotic fluid and distinguish it from other conditions, the following is carried out.

Looking in mirrors. In most situations, when examining the mucous membrane of the vagina and cervix in gynecological mirrors, it is possible to understand whether it is water or just discharge.
Smear. With a positive analysis, after staining the secretions, a “fern symptom” is detected - under magnification after drying, the picture on the glass slide resembles the leaves of this plant.
Amniotest. There are special test strips for determining the presence of amniotic fluid. They are based on a change in the pH of vaginal secretions when mixed with amniotic fluid. It is freely sold in a pharmacy, and a woman can perform it herself at home.
Fetal ultrasound. Identified oligohydramnios by ultrasound of the fetus is suspected of rupture of amniotic fluid is another symptom of "for". However, a normal amniotic fluid index does not exclude leakage, especially a high tear.
Laboratory methods. In some clinics, there are methods for identifying certain substances in the vaginal secretion, which appear only after the amniotic fluid enters them. However, the method is expensive and not always informative, so it is rarely used.

In doubtful cases, expectant tactics are used. The woman is being monitored in a hospital setting. The secretions are carefully monitored, ultrasound is performed in dynamics, a test and a laboratory study.

Management of pregnant women with leakage

If signs of amniotic fluid leakage are obvious or there is reliable confirmation of this process, the pregnant woman undergoes a series of examinations, after which further management tactics are established. In many ways, it depends on the period in which the water flowed.

1 trimester. Bloody discharge and water in this period begin together if the integrity of the fetal bladder is violated and the miscarriage progresses. Medical or surgical termination of pregnancy is indicated.
2 trimester. Until 22 weeks, any leakage of amniotic fluid equates to the onset of a miscarriage. Its further stimulation and subsequent curettage of the uterine cavity is carried out.
3rd trimester. Tactics is determined based on the period, condition of the mother and fetus. With the outflow of water up to 37 weeks, it is possible to prolong pregnancy from several days to a month or even more with simultaneous antibiotic therapy and the introduction of drugs for the maturation of the lungs of the fetus. There are methods to prevent further leakage of amniotic fluid, which helps to grow the baby in utero for some more time. Since the waters are re-produced every four to eight hours, their volume soon increases to normal values. With signs of detachment, inflammation, or according to the testimony of a woman, delivery can be immediate. The outpouring of water after 37 weeks is equated with the onset of childbirth.

Is it dangerous for the fetus

The outpouring of water during a full-term pregnancy is most often accompanied by the onset of active contractions on the following day. Therefore, at this time it is the least dangerous. When amniotic fluid leaks from 22 to 37 weeks, the severity of the baby's condition is determined by the cause that led to this, as well as the degree of outflow of water. The most favorable prognosis is with a high tear of the bladder without concomitant inflammation. In all other cases, the outpouring of water ends in premature birth.

The consequences of the onset of water leakage for a child ahead of time are as follows:

increased risk of infectious complications- chorioamnionitis, congenital pneumonia;
hypoxia occurs- the outflow of water affects the uteroplacental blood flow, especially if it occurs against the background of what diseases of the woman;
there is a chance of being born prematurely- with the outflow of water in the early stages, it is difficult (up to 30-32 weeks) to keep the pregnant woman for more than a month;
parts of the body of the fetus may fall out - with a headless presentation, along with the waters, loops of the umbilical cord or parts of the fetus (usually arms, legs) may fall out through the opened neck, which can threaten his life.

If a woman is able to suspect or even accurately determine the leakage of amniotic fluid at home, then the sooner she seeks medical help, the better, since the condition without amniotic fluid is dangerous for the fetus. It does not matter what the gestational age is when the water is poured out, only a specialist can determine the most appropriate tactic in each case.

The water shell (amnion or fetal bladder) is a closed sac. Inside it is the fetus, surrounded by amniotic fluid. The walls of the amnion are very thin, but strong and elastic: they stretch well and are very elastic. Normally, the water shell is transparent, smooth and has a shiny, pearlescent hue.

Amniotic fluid (amniotic fluid) is produced by the walls of the amnion and fills its cavity. For the entire period of pregnancy, amniotic fluid is constantly changing (a complete change occurs every three hours) its quantitative and qualitative composition in direct proportion to the duration of pregnancy and the growth of the baby. Every week the volume of liquid steadily increases by an average of 40-50 ml. The maximum volume is noted by the 37-38th week of pregnancy and averages 1000-1500 ml. By the end of pregnancy, the amount of water may decrease to 800 ml as a result of increased excretion of fluid from the woman's body. The amount of water is determined by calculating the amniotic fluid index (AFI) during ultrasound.

The waters are transparent, do not have a specific smell, they really resemble water in viscosity and consistency. Approximately 1/3 of the water consists of the urine of the child, his secretions from the lungs and through the skin, and also includes: glucose, fats, salts, urea, oxygen, carbon dioxide, vitamins, antigens corresponding to the fetal blood type and hormones. Scales of the epidermis (desquamated skin cells of the fetus), products of the activity of the sebaceous glands of the skin and vellus hair can be mixed with water. If the amniotic fluid has shades of green, this indicates intrauterine fetal hypoxia.

The IAI table contains data on the normal volume of amniotic fluid for each week of pregnancy and the maximum allowable deviations from generally accepted indicators. If the IAI indicator goes beyond the upper limit of these norms, then, in accordance with the gestational age, the doctor speaks of polyhydramnios. If the index exceeds the norm slightly, then it is customary to talk about moderate polyhydramnios.

Pregnancy period, weeks	Average normal indicator, mm	Probable fluctuations, mm

What function do they perform?

During pregnancy, the water shell protects the baby from mechanical damage (trauma, bruises, bumps), creates a comfortable living environment, participates in metabolism, protects the umbilical cord from compression, prevents the formation of adhesions between the baby's skin and the walls of the uterus, protects against infections from the genital tract . The baby constantly swallows liquid, training the digestive, excretory and respiratory systems.

During childbirth, the fetal bladder presses on the cervix, ensuring its opening. During physiological childbirth, the fetal bladder ruptures in the first stage of labor with full or almost (5-6 cm) full opening of the cervix. Timely rupture of the fetal bladder not only contributes to the normal process of smoothing and opening the cervix, but also maintains favorable conditions for the fetus during contractions. As long as the membranes are intact, the baby is not at risk of infection. In addition, the contracting walls of the uterus do not directly cover the fetus, do not disrupt blood circulation between the mother and fetus. The discharge of water after the opening of the cervix 3 cm or more rarely changes the normal course of childbirth. The absence of a fetal bladder at the beginning of labor can lead to the development of weakness in labor.

When water is scarce

If the amount of water by the end of pregnancy is less than 300-500 ml, doctors diagnose oligohydramnios. This is not a disease, but a consequence of certain complications.

Among the causes leading to oligohydramnios, such as preeclampsia, hypertension in the mother, infectious and inflammatory diseases (toxoplasmosis, cytomegalovirus, mycoplasma infection, etc.), malformations of the fetal excretory system (blockage of the urethra, ureters), fetoplacental insufficiency , chronic hypoxia.

The doctor can suggest a decrease in the amount of amniotic fluid when the standing height of the uterine fundus and abdominal circumference lag behind the normative indicators for the expected gestational age, as well as when the fetal motor activity decreases. With external examination, parts of the fetus are clearly defined, heart tones are heard, while the uterus is dense. A more accurate determination of the severity of oligohydramnios is possible with ultrasound. The diagnosis of oligohydramnios is established by ultrasound. A Doppler study of blood flow in the "mother - placenta - fetus" system is also necessary, since with oligohydramnios there may be a violation of blood flow.

An extremely unfavorable prognostic sign is the detection of severe oligohydramnios in the second trimester of pregnancy, i.e. at 18-26 weeks. With the development of oligohydramnios during these periods, abortion occurs, intrauterine death of the fetus or newborn in the first days of life. As the amount of amniotic fluid decreases, fetal growth retardation (hypotrophy) increases, determined using ultrasonic fetometry. At the I degree of malnutrition, there is a lag of fetometry indicators from the normative indicators by 2 weeks, at II - by 3-4 weeks, at III - by more than 4 weeks. Oligohydramnios can also lead to the development of fetal defects and intrauterine infection.

When oligohydramnios is moderate, the pregnancy is usually carried to the end, an emergency caesarean section is done in exceptional cases. Oligohydramnios in childbirth requires the opening of the amniotic sac, due to the insufficient amount of water, a flat bubble is formed, which interferes with full-fledged labor activity.

When there is a lot of water

The diagnosis of "polyhydramnios" is made if the amount of amniotic fluid during a full-term pregnancy exceeds 1.5–2 liters. It usually develops in the middle or in the second half of pregnancy.

Most often, the causes of polyhydramnios are: diabetes mellitus, the presence of an acute or chronic infectious process in the mother, Rh conflict, cardiovascular diseases, fetal anomalies (congenital malformations of the central nervous system and gastrointestinal tract).

Polyhydramnios is divided into acute (a sharp increase in the amount of water, accompanied by shortness of breath, malaise, pain, heaviness in the abdomen, swelling) and chronic, when the amount of water increases gradually, without causing significant ailments.

With the development of polyhydramnios, there is a significant increase in the size of the uterus: the circumference of the abdomen and the height of the fundus of the uterus. The uterus is tense, parts of the fetus are difficult to feel, while the fetus easily changes its position, and its excessive motor activity can be observed. Fetal heart sounds are not clearly audible. In the diagnosis of polyhydramnios, an important role belongs to ultrasound. During the study, the size of the vertical pocket is determined (ultrasonic criterion for assessing the amount of amniotic fluid): with a mild degree of polyhydramnios, its value is 8-11 cm, with an average degree - 12-15 cm, with severe polyhydramnios this figure reaches 16 cm or more.

Why is polyhydramnios dangerous? A child who feels spacious in the uterus may not sink into the pelvis for a long time or take the wrong position. An overstretched uterus contracts poorly, which causes weakness in labor (prolonged labor) and bleeding in the postpartum period. Due to polyhydramnios during childbirth, prolapse of the umbilical cord, placental abruption can occur. With this diagnosis, at the beginning of labor, the fetal bladder is pierced (this procedure is called “amniotomy”) and the amniotic fluid is slowly released through a needle or catheter so that the volume of the uterus decreases, its walls thicken, which will reduce the risk of serious complications. After the birth of a child, in order to prevent hypotonic uterine bleeding, drugs are prescribed that stimulate the contraction of the muscles of the uterus.

In chronic polyhydramnios of a mild degree, pregnancy proceeds favorably, childbirth occurs on time, but in parallel, the disease that caused polyhydramnios is treated. With severe polyhydramnios, premature birth often occurs. With increasing circulatory disorders in a pregnant woman (pronounced edema, severe shortness of breath), sometimes there is a need for artificial termination of pregnancy.

And if the waters leak or overflow prematurely

If there was a rupture of the membranes before the onset of labor, this is called premature rupture of the membranes, or premature rupture of amniotic fluid. According to statistics, every tenth woman faces this, and more often primiparous.

The symptoms of outflow of water depend on where the rupture occurred. Most often, the bubble ruptures directly above the cervix; such a gap is called central. With it, the waters pour out in a stream, this happens unexpectedly and simultaneously. It is simply impossible to miss such an event!

If the rupture has occurred high and the hole is covered by the wall of the uterus, such a rupture is called a high lateral one. In this case, water will constantly leak in small quantities, wetting the sanitary napkin for 2-3 hours. In this case, there may be no pain at all. The danger is that this phenomenon is easily confused with urinary incontinence or profuse vaginal discharge. You can find out what really happened on your own using diagnostic FRAUTEST amnio test pads. A positive test result allows you to figure out at home whether water is leaking or not and quickly decide what to do next.

There is no physical contact with the diagnostic components in this test, the risk of infection (if the bladder has really lost its integrity) is minimal.

If you suspect a leak of amniotic fluid, you should immediately consult a doctor in a antenatal clinic or in the emergency department of any maternity hospital. If a rupture of the fetal bladder is detected, a woman must be hospitalized.

Causes of premature rupture

The reasons may be the following:

overstretching of the membranes (occurs with multiple pregnancies, large fetuses, polyhydramnios);
pathological conditions of the cervix (flaccid, inelastic cervix, more often in women after 30 years of age, nulliparous) due to prolonged inflammation, cicatricial deformity after ruptures of previous births, a scar on the cervix after cauterization of erosion before the first birth;
incorrect position of the fetus (transverse, oblique and pelvic presentation of the fetus, large head of the fetus);
incorrect size and shape of the pelvis (change in the structure of the pelvic bones);
change in the fetal membranes (increased permeability, low elasticity, impaired fetal-placental blood flow, infection, overmaturity).

If the bubble bursts before 34 weeks and the baby's lungs have not yet matured, doctors do everything to prolong the pregnancy, often protecting the baby and mother with antibiotics from a possible infection. At this time, the expectant mother will be prescribed medications, with the help of which the baby's lungs will ripen, and the cervix will prepare for childbirth. If the gestational age is more than 34 weeks, the woman begins to prepare for childbirth.

Water is the natural environment for a developing fetus. In the process of formation, the baby swallows a liquid that is processed and poured back into the fetal bladder. The question arises: how amniotic fluid is renewed during pregnancy? Indeed, the composition includes many useful substances, the density does not change, and the child moves freely and is protected from overheating or hypothermia.

Functionality

The role of amniotic fluid in the development of the embryo is very large, because it is here that he will have to spend all 9 months. The comfortable presence of the fetus in the womb depends on the volume and quality, and the functional features are multifaceted and difficult to overestimate:

The exchange of substances between mother and child. The water contains nutrients that the baby swallows and then releases back, while there is a constant renewal.
The fetal bladder and its contents serve as a kind of shock absorber for minor shocks, protect against infections and prevent clamping of the umbilical cord.
There is no doubt about sterility, because amniotic fluid is renewed during pregnancy every three hours. The body constantly maintains the same composition, which can only change depending on the gestation period.
During labor, amniotic fluid softens the period of contractions and promotes comfortable progress through the birth canal.

Throughout the entire gestation, the baby feels comfortable and moves freely, so the properties must be unchanged and correspond to the norm.

The contents of the shell is a transparent substance with an odor that resembles mother's milk. Many experts believe that it is precisely because of this property that the baby after birth accurately recognizes where the mother's breast is.

How and for what period amniotic fluid is renewed?

The baby is not just in the uterus, but also in the fetal bladder, which produces amnion at the cellular level. After the 20th week of pregnancy, when active growth begins, the kidneys and lungs of the child contribute to the production of amniotic water.

At the same time, the composition, which is unstable depending on the state of health of the mother, is very useful for the formation of the embryo. Here are the main components of nutrition (fats, proteins, carbohydrates), oxygen, immunoglobulin cells, as well as antigens. Since the baby lives in this substance, waste products (skin, hair) are not uncommon during tests.

Renewal of amniotic fluid during pregnancy occurs quite often - every three hours. The walls of the amnion secrete fluid, which is subsequently swallowed by the fetus, approximately 20 ml in 60 minutes. The exchange is carried out by suction, through special tubules or through the placental membrane with the umbilical cord.

The quantity and composition, depending on the period and individual characteristics of the organism, is constantly changing. On average, the volume reaches from 0.6 to 1.5 liters. An excess of this indicator indicates polyhydramnios, and an underestimated one indicates oligohydramnios. Any of these extremes is a deviation from the norm and requires treatment.

Pathologies of the development of amniotic fluid

Any of the deviations from the norm indicates the formation of serious pathologies that require immediate treatment:

Low water is characterized by the fact that the amnion is not updated in sufficient volume. A pregnant woman manifests a painful syndrome, since fetal movements occur in a smaller amount of fluid, while the size of the uterus does not correspond to the period of gestosis. Pathology threatens the normal formation of the child, a curvature of the spine may develop as a result of compression and an uncomfortable position.
Polyhydramnios is more common and is caused by an acute and chronic condition. In the acute form, the increase occurs very quickly, which can lead to the death of the fetus or, as a result of strong pressure, rupture of the uterus. The chronic form is characterized by a gradual increase in the volume of fluid, the uterus is in good shape and a “gurgling” is heard if you click on the stomach. The symptoms are quite bright, the woman feels pain, edematous reactions appear on the limbs. The baby begins to actively move in the womb, the heartbeat is practically not audible, and the function of nutrition and blood circulation is impaired.
Turbid fetal water is diagnosed by ultrasound. The norm is a clear amniotic fluid, with a small amount of impurities of particles of skin and hair. In the early stages, this type of pathology is very dangerous, doctors often recommend terminating the pregnancy. In the second half of gestation, a change in state indicates the development of an infectious disease.

For diagnostic purposes, analyzes are carried out by amniocentesis (puncture of the fetal bladder), which allows you to determine genetic disorders, formation defects and malformations.

The detection of pathology in the early stages of gestation requires immediate treatment in a hospital, since the renewal of the composition during pregnancy should occur in accordance with generally accepted standards. At a late stage of gestation, a decision may be made to perform a caesarean section in order to save the life of the child.

During pregnancy, the female body is characterized by various kinds of discharge. The reason for this is hormonal changes, the presence of diseases, colds. Allocations can be transparent, watery, thick. It is quite natural to have beige or brown blobs. Such a phenomenon can seriously scare the expectant mother, who does not yet know how to recognize their character, which is quite logical.

Table big diagram
baby inside measurements
pain observation development
pregnant mother drinking

Very often, discharge indicates the development of a pathology that requires urgent medical intervention. This type of pathology includes leakage of amniotic fluid.

What is dangerous and does the smell matter?

What is amniotic fluid? Amniotic fluid or amniotic fluid is a biologically active substance found inside the fetal membranes. It provides protective, shock-absorbing and other functions, is fully responsible for the life of the fetus.

The outflow of amniotic fluid before the onset of natural childbirth according to the established deadlines is considered normal. During contractions, the cervix opens and the fetal bladder bursts, after which the water leaves. Rarely, the process can begin without contractions. In this case, the pregnant woman immediately goes to the maternity ward.

When the state is not happy

There are times when amniotic fluid is secreted in a small amount long before the onset of labor. This phenomenon indicates that the integrity of the fetal bladder is broken. As a result, the sterility inside it is under threat. The closer to childbirth a pathology is detected, the less threat it poses to the child, which means that medical prognosis will be better. It is important to know how to distinguish amniotic fluid leakage from pathological discharge, genital infection and other diseases.

Leakage of amniotic fluid contributes to the development of infection, which can get to the baby through the cracks in the bladder. Untimely provision of medical assistance in the allocation of amniotic fluid in late pregnancy leads to premature birth, abortion, fetal death in utero. In addition, pathology leads to weak labor activity at the onset of childbirth, as well as the development of infectious complications in the mother.

Reasons for the release of amniotic fluid

Determining the cause, as well as understanding how the pathology occurs, is difficult. There are several main reasons for this phenomenon. These include the following.

Infections that affect the genitals. This reason often occurs during premature pregnancy, in particular, at 39 weeks.
The cervix develops rapidly, as a result, enzymes are released that have a stratifying effect on the placenta. There is a softening of the shell of the fetus. Lack of medical intervention can lead to fetal hypoxia during labor, as well as severe bleeding from the uterus.
Incorrect presentation of the fetus or a narrow pelvis of the expectant mother. In this case, the pathology develops in the first stage of childbirth, the opening of the uterus occurs very slowly.
Cervical insufficiency leading to rupture of membranes, leakage of amniotic fluid at 40 weeks of gestation. This pathology occurs in about a quarter of all pregnant women in the last trimester. As a result, the fetal bladder protrudes, due to which the fetus becomes vulnerable. Viruses that enter the amniotic fluid lead to rupture of the membranes with minimal physiological impact.
Bad habits, chronic diseases. This includes women who are alcoholic, smokers, suffering from anemia, dystrophic pathologies, connective tissue diseases.
When carrying two babies or more.
Anomalies in the development of the uterus. This includes a shortened uterus, isthmic-cervical insufficiency and the presence of a uterine septum. Diseases such as colpitis, endocervicitis, tumors of various kinds also cause pathology. The use of invasive methods of prenatal diagnosis is shown, that is, a sample of amniotic fluid, a biopsy.

It is very important for a woman to know how to determine the leakage of amniotic fluid at home using special tests.

Doctor's examination

Symptoms of the development of pathology

There are cases when the amniotic fluid at the rupture of the fetal bladder departs at once. Then the selection becomes obvious. However, there are cases of leakage of a periodic nature in a small volume. At the same time, it is difficult for a woman to determine the development of pathology.

Many women mistakenly confuse signs of amniotic fluid leakage during the third trimester with urinary incontinence. In rare cases, pathology is the norm in late pregnancy. During pregnancy, the amount of vaginal discharge increases, which is quite possible in the early stages. Thus, the presence of colpitis, the erroneous acceptance of amniotic fluid for normal discharge, causes the development of symptoms of amniotic fluid leakage in the third trimester.

Mommy in feelings

The symptoms of amniotic fluid leakage are simple. However, not everyone knows how to recognize them correctly. Many women wonder what amniotic fluid leakage looks like. There is only one rule for their definition. Amniotic fluid is odorless and colorless.

Many women wonder what amniotic fluid smells like? There is only one answer - the discharge is odorless.

If at any month of pregnancy a woman has identified discharge of an incomprehensible nature, even if it is a false suspicion of amniotic fluid leakage, you should immediately seek help from a doctor. It is difficult to independently determine the presence / absence of pathology even with the help of a special test. This will require medical attention. The photo shows what the leakage of amniotic fluid looks like.

Diagnosis of the release of amniotic fluid

Only a doctor confirms the presence / absence of amniotic fluid in the third trimester. For this, an examination is carried out on a gynecological chair. On examination, a pregnant woman should cough to increase pressure on the intra-abdominal zone. So, if there is a rupture of the bladder, a new portion of the amniotic fluid will be released.

This is what fetal development looks like

Additionally, a smear is taken for the elements of the water, a test is performed for the presence of leakage of amniotic fluid. How to check for amniotic fluid leakage at home using medical supplies? A test pad for determining the leakage of amniotic fluid, the price of which is from 2000 rubles, is based on the determination of placental microglobulin. If the strip changes color upon contact, it means that there has been a leak. Ultrasound is performed to determine what amniotic fluid looks like when leaking.

How to prevent water leakage

When treating the release of amniotic fluid at 34 weeks or any other period, there is no specific technique or single therapy that would equally help all women. All treatment is aimed at eliminating the problem that caused this kind of pathology, as well as maintaining the health of the fetus and mother within the framework of safety. The time of the last exit plays an important role; no more than six hours is considered a safe period. A pregnant woman is prescribed antibiotics to prevent infection of the fetus.

Leakage of amniotic fluid, as in the photo of the pad, for a long time indicates an early birth. If after three hours there are no contractions, stimulation is carried out medically. For this, a hormonal background is preliminarily created for the maturation of the cervix. Alternatively, a caesarean section is performed.

If the pregnancy is premature, then expectant management is mainly used. It is very important to monitor the viability of the fetus. The woman is under the supervision of doctors all the time, bed rest is observed.

At the slightest signs of the body, consult a doctor

To prevent the release of amniotic water at week 25, it is recommended to carry out antiseptic treatment of the genital tract, as well as other mucous membranes to prevent and remove infection. To determine the leakage of amniotic fluid, there are special pads for home use, the Amnishur test. The test pad shows, depending on what color the inner shell has, the presence / absence of pathology.

When the amniotic fluid comes out, the expectant mother remains powerless. Therefore, it is important to prevent the development of pathology in advance. Do not neglect the analysis, hygiene. If you find any suspicious discharge, you should immediately consult a doctor. As support, you can visit the forums of mothers who share experiences, you can find friends who have had a pathology, read a lot of reviews.

: Borovikova Olga

gynecologist, ultrasound doctor, geneticist

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 the amniotic fluid and excretes them in the urine. Over time, the volume of liquid processed reaches several liters per day.

How does it threaten 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, as a result of which even its death can occur.

For example, if the integrity of the membranes is lost - this is when there is leakage of amniotic fluid - the child becomes vulnerable to infections entering the fetal bladder.

The genital tract of a woman is not sterile, pathogenic microorganisms constantly live in the vagina, “plus” immunity is weakened due to pregnancy. All this can lead to the multiplication of harmful bacteria that can penetrate the uterine cavity and infect the fetal membranes, causing their inflammation, called chorioamnionitis in gynecology. Without timely treatment, infection of the fetus itself occurs.

This is with regard to oligohydramnios, caused by a violation of the integrity of the membranes.

With severe oligohydramnios, regardless of the causes of its occurrence, the baby suffers from hypoxia (lack of oxygen), because of this, it lags behind in fetal development. In addition to all this, the baby is uncomfortable to be in such a “nest”, his neck is often twisted, and the bones of the face and head are susceptible to deformation due to squeezing them 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 weight gain (so-called malnutrition is observed), his muscle tone is reduced (torticollis, clubfoot may develop), and mild fetal hypoxia occurs.

If the screening and urine / blood / smear tests are normal, the cardiotocogram (CTG) is in order and the fetus is developing well, and the pregnant woman has no complaints about her well-being, then the diagnosis of oligohydramnios is conditional. It’s just that obstetricians will prepare for labor induction, since there is a high probability of a post-term pregnancy, or for a caesarean section with a non-standard position of the fetus at the time of birth.

Diagnosis of oligohydramnios

With 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.

Miscarriage

A gynecologist can also suggest little or polyhydramnios during the next measurement of the circumference of the abdomen and the height of the fundus of the uterus, but a more accurate diagnosis can only be made with the help of ultrasound.

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

The test can be done at home by observing the discharge for some time, or by buying a special amniotic fluid leak test 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), dry yourself with a towel and lie down on a dry diaper. Lie still for 15 minutes, and then get up and see if a wet spot has appeared on the diaper. Ordinary secretions are not able to form and flow out so quickly, most likely, amniotic fluid is leaking. You can find out more precisely by contacting the LCD with a complaint about unusual discharge. There they will conduct a special test and say it is water or ordinary vaginal discharge.

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

Staining also occurs with bacterial / viral discharge, so if spots of a blue-green hue are noticed on the surface of the pad, contact your gynecologist.

Any test for amniotic fluid leakage is recommended after 12 hours from the last intercourse, douching or use of vaginal suppositories.

Treatment of oligohydramnios

It is impossible to artificially increase the amount of amniotic fluid, so the treatment of oligohydramnios comes down to determining the causes of its occurrence. Further, the treatment of the root causes of oligohydramnios is carried out.

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

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

Moreover, Curantyl is often prescribed as a preventive measure for placental insufficiency.

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

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

Childbirth with oligohydramnios

With 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 can 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, childbirth takes place safely for both the mother and her child.

Insufficient amount of amniotic fluid does not give the baby the opportunity to move freely inside the womb. Therefore, often the child takes a transverse or gluteal position and he can no longer roll over correctly.

There are various exercises that can help turn the baby into the right position, but their effectiveness has not been medically confirmed. Exercise can lead to cord entanglement, so you need to weigh the pros and cons before doing them.

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63-192

During 9 months of pregnancy, the unborn child develops in a special sac, which obstetricians call the amniotic sac. This transparent and tightly closed bag is filled with a special liquid that protects the baby throughout pregnancy. This fluid is called amniotic fluid.

When the time comes for childbirth, the bubble breaks, and all the fluid comes out. Obstetricians call this the outpouring of amniotic fluid, and often the rupture of the fetal bladder indicates the beginning of the birth process and provokes contractions.

Amniotic fluid performs a number of important functions.

Firstly, they protect the child from infections, as they contain antibacterial and antimicrobial substances.

Secondly, water is a kind of shock absorber, and protects the child from various possible injuries, shocks or shocks.

And, thirdly, they help the child to master digestion and breathing, since with their help the baby can train the lungs, and also learns to swallow.

The consistency of amniotic fluid is not like the water we are used to. They are transparent, but thick, sometimes yellowish or pinkish. While the baby is developing in the womb, he tastes them, and if the mother ate something sweet, the child feels it, as the sugar enters the mother's body. Also, the child exercises the lungs by inhaling the amniotic fluid and exhaling it back.

From the very beginning of pregnancy, the amount of amniotic fluid gradually increases, and by the end of the third trimester, it gradually decreases to give the growing baby more space in the uterus. Sometimes they can be too small throughout pregnancy, and then the doctor makes a diagnosis - oligohydramnios. Sometimes too much, and then we can talk about polyhydramnios.

IAI norm

The composition and quantity of the contents of the fetal bladder plays a big role in the formation of the future baby and his well-being. If their volume corresponds to the norm, then the doctor concludes that the child feels well and develops normally. Too little amniotic fluid and, conversely, too high an indicator, indicate that something is wrong in the body of the expectant mother, which means that the health of the fetus may be in danger.

To find out if everything is in order, you need to do an ultrasound. With the help of ultrasound, the doctor will be able to determine the approximate amount of water in the bladder. Your baby is constantly swallowing amniotic fluid and also urinating, so the difference in the amount of water can be noticeable throughout the day.

It must be remembered that this fluid changes in composition every 3-4 hours a day, and is completely renewed every 24 hours, which means that its composition and quantity also change constantly. Therefore, do not be afraid if the IAI, according to the study, differs from the one that results in our table. In any case, check it with our calculator and check with the values.

2 comments: Amniotic fluid index - table and calculator

Mamalysha86

The amount of amniotic fluid during pregnancy: norms and deviations

The rate of amniotic fluid during pregnancy depends on its duration. You can even find a special plate where the values \u200b\u200bare indicated for each week. They are determined by simple measurements during an ultrasound examination. The doctor in his conclusion must write the index of the amniotic fluid is normal or not. Let's talk about what is a violation, what are the possible causes of deviations and how to treat them.

There are two pathologies - polyhydramnios and oligohydramnios. When making these diagnoses, doctors are guided both by the examination data (the length of the uterus, the volume of the abdomen, including the rate of growth in the size of the uterus, fetal mobility), and the results of measurements by an ultrasound diagnostic doctor.

Severe polyhydramnios, when the amniotic index is more than 240 mm (the length of the vertical pocket according to ultrasound is more than 800 mm) is a reason to suspect one of the following conditions:

diabetes mellitus (possibly gestational);
pathology of the central nervous system of the fetus, for this reason, it may not have a swallowing reflex, which means that the amount of amniotic fluid is constantly growing;
heart rhythm disturbances (can be caused by a variety of reasons, for example, dropsy of the fetus);
pathology of the respiratory and digestive organs in a child;
chromosomal abnormalities.

The last item is excluded by ultrasound, carried out at strictly designated terms of pregnancy, as well as by triple screening. To exclude diabetes (gestational) mellitus - a test for tolerance to carbohydrates. Plus, you need to exclude cytomegalovirus, toxoplasmosis, syphilis, parvovirus, and also do the Kleihauer test (if there is a possibility of a Rh conflict). Naturally, after discovering the cause, it is necessary to eliminate it or at least minimize its harmful effects.

If polyhydramnios is detected, the woman should repeat the ultrasound in 7-10 days to see if there is a sharp increase in water. The same fact can be seen in the sharp growth of the abdomen. If yes, in this case, the woman is admitted to the hospital and treated with indomethacin or / and a reduction amniocentesis is performed - excess fluid is removed from the fetal bladder.

The causes of oligohydramnios also lie in possible infectious processes in the mother's body, as well as malformations of the fetus. These causes should be excluded in severe oligohydramnios. This is especially considered dangerous in the early stages. In this case, oligohydramnios is almost always combined with a severe malformation of the fetus. Often, ultrasound in such children reveals polycystic kidney dysplasia, Potter's syndrome and other pathologies of the urinary system. The most difficult situation is when there is no water at all. This condition is called ahydramnios and is both a symptom of severe fetal disease and a cause for additional fetal malformations (usually skeletal deformities, especially of the facial bones).

If moderate oligohydramnios is fixed for a long time, it is less dangerous. And it can often be a variant of the norm if the rest of the ultrasound data is normal and the patient is healthy (the size of the uterus is normal, the tests are in order). Knowing what is the rate of amniotic fluid and the woman's history, the doctor can quite easily conclude whether it is worth worrying and conducting additional examination and treatment. If amniotic fluid leakage is suspected, an amniotest should be done.

Often, oligohydramnios accompanies gestosis (late toxicosis) of pregnant women. But it is fairly easy to diagnose and treat. But more often, women with oligohydramnios diagnosed on ultrasound give birth to healthy babies, and after the discharge of amniotic fluid, it turns out that there was no oligohydramnios (more than 500 ml of water). If oligohydramnios is true, then a woman is waiting for a difficult protracted birth due to the weakness of labor activity. The risk of birth trauma in the child and rupture of the cervix in the mother increases. Unlike polyhydramnios, oligohydramnios, unfortunately, cannot be corrected. In the event of a serious condition of the fetus, a great risk to his health and life, a woman can undergo an emergency caesarean section.

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Amniotic Fluid Index

Throughout pregnancy (with the exception of the very early stages of pregnancy), the fetus is surrounded by amniotic fluid, or amniotic fluid. the environment in which the baby soars, like an astronaut in outer space, not only protects him from external influences and maintains the required temperature, but also participates in metabolism. The amount of amniotic fluid for nine months is constantly changing, however, for each period of pregnancy, there are norms for the volume of amniotic fluid. Deviations in one direction or another may mean that the fetus is not all right.

The volume of amniotic fluid can be 600-1500 ml. The amount of amniotic fluid less than 500 ml is considered oligohydramnios, more than 1.5-2 liters - polyhydramnios. Ultrasound helps to make an accurate diagnosis.

During the ultrasound procedure, the specialist visually determines the amount of fluid using a transverse scan. If there is a lot of amniotic fluid, polyhydramnios is diagnosed, if there is little - oligohydramnios. With any deviation from the norm, the doctor conducts a more thorough examination - the calculation of the amniotic fluid index. To do this, the uterine cavity is conditionally divided into 4 equal parts by two lines, one of which runs vertically along the white line of pregnancy, and the other horizontally at the level of the navel. In each part, the maximum vertical pocket (free space between the wall of the uterus and the fetus) is measured, the results are summed up to obtain the amniotic fluid index.

For each period of pregnancy, there are norms for this indicator. For example, the amniotic fluid index is normal for a period of 22 weeks will be 14.5 cm, or 145 mm (possible fluctuations should be in the range of 89-235 mm). And for a period of 32 weeks, the amniotic fluid index will be 144 mm, with deviations in the range of 77-269 mm. Values for different stages of pregnancy can be found in the table of indicators of the amniotic fluid index.

Amniotic fluid index - deviations from the norm

Deviations from the norm are said if the amniotic fluid index is lower or higher than the values \u200b\u200bspecified in the table. Both polyhydramnios and oligohydramnios indicate possible pathologies in the development of the fetus or the course of pregnancy.

With polyhydramnios, the child often takes the wrong position in the uterus, and sometimes it is wrapped around the umbilical cord. Excess amniotic fluid can provoke their premature discharge and premature birth. An overstretched uterus contracts worse during childbirth and in the postpartum period, which can lead to weakness in labor and the development of bleeding.

The main causes of polyhydramnios are:

malformations (nervous and digestive systems) and chromosomal abnormalities of the fetus;
pregnancy against the background of Rhesus conflict;
infectious disease of a pregnant woman;
diabetes mellitus in pregnancy.

If the amniotic fluid index indicates severe oligohydramnios already in the second trimester of pregnancy, then a life-threatening situation for the fetus may occur - compression of the umbilical cord. In addition, the child is trapped in the uterus, his movements are limited. Such babies often have problems with the spine and hip joints after birth.

The development of oligohydramnios can lead to:

malformations of the fetus (excretory system and kidneys);
hypoxia and hypotrophy of the fetus;
fetoplacental insufficiency;
delayed pregnancy;
infection;
hypertension in pregnancy;
smoking.

Contrary to the beliefs of some women, the amount of fluid they drink does not affect the change in the volume of amniotic fluid in the placenta.

The protection of the baby in the mother's abdomen, its stable growth and proper development is provided by amniotic fluid during pregnancy. The enlarged uterus contains a fetal bladder filled with a special liquid substance. It is the "home" for the baby for the entire long period of pregnancy, almost from the very conception. Therefore, it is especially important to monitor the condition of this fluid and correct emerging deviations in time.

Formation and functions of amniotic fluid

The Greek concept "amnion", denoting the membrane of the fetus, gave the name of the amniotic fluid - a nutrient medium for the intrauterine development of the child. Immediately after the fertilized egg enters the uterus and attaches to it from the inside, a chorion is formed at the attachment site (in the future it will become the placenta). With the help of the umbilical cord, the chorion is connected to the amnion - the fetal bladder. Inside the amnion, real magic happens - a baby develops from several cells after the allotted time. Reliable protection is provided by thin and elastic, but very strong bladder walls.

The fetus is in the amnion filled with amniotic fluid or amniotic fluid

The amnion is filled with a fluid, the sterility of which is achieved by regular renewal. How is amniotic fluid renewed during pregnancy? Until the middle of the term, they are produced by the cells of the fetal bladder, and after the 20th week they are mainly formed by the kidneys of the child. At the end of pregnancy, the fluid is updated 8 times a day.

Amniotic fluid provides comprehensive protection for the baby:

Due to the content of immunoglobulins, the baby is reliably protected from all kinds of infections.
In the event of an accidental fall of the mother, the shock is cushioned by the presence of liquid, and no harm is done to the child.
The umbilical cord remains free and is not pinched.

The temperature inside the bubble is constant at 37 degrees Celsius. Until about the third trimester, the baby can even make swimming movements, as long as there is enough space for this.

Characteristics of the waters

More than 95% of the composition of the amniotic fluid is water. The rest is made up of vitamins, trace elements, even particles of the skin and hair of the fetus. Toward the end of pregnancy, when the child masters urination, urine also appears in the composition of the liquid. But due to frequent renewal, the composition of the liquid remains unchanged. There is an opinion that the liquid smells like breast milk, which is why a newborn baby unmistakably finds the mother's breast.

The amount of amniotic fluid increases from week to week, reaching a maximum two weeks before the planned date of delivery.

At 38 weeks, the volume of amniotic fluid is approximately 1-1.5 liters. Further, the amount of water decreases, and by the time they are born, about 800 ml remain.

Various pathologies of pregnancy can affect the decrease or increase in the amount of amniotic fluid.

Normally, amniotic fluid should be clean and clear. If a suspension appears in the waters, this most often indicates infection.

Diagnosis of the condition of a pregnant woman and a child using amniotic fluid

The state of the amniotic fluid is one of the main indicators of the normal or pathological course of pregnancy, as well as the condition of the unborn child. You can evaluate the amount and homogeneity of waters on an ultrasound examination, which every woman must undergo at least three times during pregnancy.

If necessary, the analysis of amniotic fluid can determine the sex of the child and his blood type. In addition, the suspicion of the presence of genetic abnormalities in the fetus can be confirmed or refuted by analyzing the amniotic fluid.

If it is necessary to determine whether the child is ready for birth, amniotic fluid is also taken for analysis. Based on the results of the analysis, an emergency delivery by caesarean section can be performed. Also, fluid analysis makes it possible to find out about the readiness of the respiratory system of the newborn for independent work.

Possible problems

Unfortunately, pregnancy does not always go smoothly. There are cases when violations of the quantitative or qualitative composition of the amniotic fluid provoke the occurrence of various pathologies.

Polyhydramnios.

This condition is said when the amount of amniotic fluid exceeds one and a half liters. This condition can be caused by kidney problems in the mother, infectious diseases, cardiovascular pathologies of the mother, or congenital diseases of the child. In the case of multiple pregnancies, polyhydramnios is also quite common.

With polyhydramnios, the amount of amniotic fluid exceeds 1.5 liters

Polyhydramnios is found, usually in the second or third trimester of pregnancy. If polyhydramnios occurred suddenly against the background of the previous normal state, delivery should be carried out immediately.

Low water.

The opposite situation is when the amount of water does not exceed 500 ml. Oligohydramnios can be caused by hypertension in a pregnant woman, inflammatory diseases of the female genital organs, overweight of the expectant mother, or disorders in the urinary system of the fetus. The condition is dangerous with the risk of hypoxia (oxygen starvation) of the child, therefore, appropriate treatment aimed at enhancing the production of amniotic fluid should be carried out immediately.

Oligohydramnios can also have a negative impact on the process of childbirth - the fetal bladder will not be able to press on the cervix with sufficient force, so its slow opening will lead to weakness in labor.

With oligohydramnios, the risk of preterm birth is doubled, and babies, due to lack of space, are much more likely to take the wrong position in the uterus, not having time to turn into head presentation in time.

Oligohydramnios often makes itself felt with abdominal pain in a future mother - the child does not have enough space, and his every movement is difficult and painful. Reducing the amount of amniotic fluid can lead to clamping of the umbilical cord, as a result - to oxygen starvation and even death of the fetus.

Water leakage.

In a normal state, the fetal bladder remains intact throughout pregnancy, and the outpouring of water indicates the beginning of active labor. However, there are times when water starts to flow prematurely. Such a situation, or even the slightest suspicion of it, requires an urgent examination by a doctor, since a decrease in the amount of amniotic fluid can seriously harm the health of the child in case of untimely assistance.

You can check if water is leaking using special tests

A sign of water leakage is a sharp increase in fluid released when changing body position. You can accurately determine the leakage of water using pharmacy tests. If the condition is confirmed, it is necessary to contact the maternity hospital as soon as possible - perhaps this is a signal of the onset of premature birth.

Water of an atypical color.

In the normal state, the waters are transparent in color, and there are no impurities in them. True, towards the end of pregnancy, impurities inevitably appear - these are epidermal cells and vellus hair of the fetus. This state of the water is quite normal and does not threaten the development of the child. However, the green color and turbidity of the waters may indicate a serious pathology - fetal hypoxia. In this case, with a lack of oxygen, the muscles of the anus contract reflexively, and meconium is released into the amniotic fluid.

Another cause of premature meconium excretion is the aging of the placenta as a result of prolonged pregnancy. In this case, the placenta ceases to fully supply the fetus with oxygen, as a result of which the child develops oxygen starvation. The muscles of the anus contract again, and meconium is excreted.

Ingestion of amniotic fluid mixed with meconium by a baby negatively affects its development, so green waters require immediate medical attention.

Is it possible to avoid problems

Amniotic fluid is a nutrient medium that ensures the development of the child in the womb until the very birth. Any violations and deviations require close attention and medical supervision. Most amniotic fluid pathologies are successfully corrected in a hospital setting with the help of medications and vitamins. The patient must maintain complete calm, both physical and mental. You will have to forget about physical activity and an active lifestyle for a while.

It will not be superfluous to remind you of the need to visit a doctor observing pregnancy. It is constant monitoring that allows you to avoid many problems that negatively affect the normal course of pregnancy.

19.01.12

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 outflow 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 child's development is impaired, especially with malformations of the kidneys and excretory systems, as well as in 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.

Most of the time that the baby spends in the womb, he is under the protection of the placenta or, as it is also called, the amniotic sac. Amnion constantly produces amniotic fluid, in which the baby will be until the very moment of his birth. Such a liquid protects the baby from bacteria and viruses, creates favorable conditions for its development, allows it to stay warm and comfortable during the most important and crucial months of its life.

The temperature of the amniotic fluid is maintained by the body at a constant level and is about 37 ° C, provided that the woman is healthy. As for the amount of fluid, this indicator is constantly changing and directly depends on what week of pregnancy the expectant mother is in. It is also worth noting that the larger the baby becomes in the womb, the more fluid the amnion produces. The rate of amniotic fluid during pregnancy is 1-2 liters at the 36th week of the term, but in the following days this figure may decrease slightly, because during preparation for childbirth, the body begins to actively remove fluid.

Among the components of the amniotic fluid, you can find a wide variety of components, for example, proteins and carbohydrates, hormones and enzymes, fats and salts, various vitamins and glucose. Amniotic fluid also contains oxygen, carbon dioxide, immunoglobulin, baby waste products and many other substances. The composition of the liquid is always unstable and changes at least every 3 hours. In addition, the composition of the water also depends on the gestational age, because at different periods of development, the crumbs require different substances.

Why amniotic fluid is needed

The role of amniotic fluid in the process of growth and development of the fetus is difficult to overestimate, because thanks to the many functions that this substance performs, the child is not only under constant protection, but also has the opportunity to be born. Read more about the functions of amniotic fluid below:

One of the purposes of amniotic fluid is the metabolism between maternal and child organisms. Those components that the baby needs for his development and maintenance of life come to him precisely through the amniotic fluid. Processed food, being excreted from a tiny organism, also first enters the amniotic fluid, and only then is completely removed from the woman's body. The waste products that enter the liquid also include the upper scales of the epidermis, particles of the original lubricant, the hairs of the child and the components of the mother's blood.
The second important function of the amniotic fluid is its ability to protect the unborn baby from all sorts of harmful factors in the outside world. Due to the constant temperature of the waters, the child in the womb will not be able to freeze, moreover, he is not afraid of physical influences such as blows, compressions, pressure. Amniotic fluid eliminates the risk of squeezing the umbilical cord, gives the baby the opportunity to move freely in the mother's abdomen.
The female body also made sure that the amniotic fluid was always absolutely sterile. Due to the fact that viruses, bacteria and other pathogens do not penetrate into them, the baby is reliably protected from diseases. Sterility is mainly maintained by constant renewal of the composition of the liquid, which occurs at least every 3 hours.
Amniotic fluid not only helps the baby grow and develop in a safe environment, but is also directly involved in the delivery process. Firstly, the so-called anterior waters, by their pressure on the uterus, provide a better opening of its cervix. Secondly, while the baby is trying to be born, the amniotic fluid protects him until the very moment of birth. Thirdly, during the passage of the child's birth canal, water plays the role of a lubricant, facilitating this process.

In addition to the above useful functions, amniotic fluid also has an important diagnostic value. After conducting certain water tests, the doctor can find out a lot of necessary information regarding the health of the child and the characteristics of his development. Thanks to diagnostics, it is possible not only to establish the sex of the baby and his blood type, but also to obtain information about possible hereditary diseases or other abnormalities, the development of which can be prevented even at the stage of pregnancy.

Volume, composition, degree of transparency, color and consistency - all these parameters of the amniotic fluid can be found with the help of the necessary tests. In addition, in the case of some pathologies, when emergency delivery is required, with the help of such a diagnosis, it is possible to establish the degree of readiness of the child for the birth. Based on the data obtained, a decision is made on the use of special medical equipment to support the life of the baby for a certain period.

Amniotic fluid pathologies

oligohydramnios during pregnancy

The condition when there is little amniotic fluid during pregnancy is called oligohydramnios. Such a pathology can occur if the amnion produces less fluid than is excreted from the body. It should be said that such a disease is not so common and accounts for no more than 1% of cases in the total number of pregnancies. Oligohydramnios is a serious problem that requires attention and timely treatment. If this phenomenon is not eliminated, certain complications may arise:

Firstly, the pressure of the amniotic fluid on the uterine canal is significantly reduced, which, in turn, leads to difficulties in the delivery process.
Secondly, oligohydramnios is fraught with such complications as premature birth. A child who was born before the due time will need special medical care.
Oligohydramnios is also dangerous because the baby is not able to move normally, which increases the risk of breech presentation of the fetus.
Hypoxia is considered a very frequent companion of this pathology - a lack of oxygen necessary for a child. Hypoxia results in growth retardation and fetal abnormalities.

As a rule, it is not possible to notice such a pathology on your own, since oligohydramnios has almost no symptoms that are physically palpable. Occasionally, a woman with a similar problem may feel slight pain in the abdomen, but often this manifestation is simply absent. You can identify the disease with the help of ultrasound, which is why the timely delivery of tests and the passage of planned ultrasounds are so important for a pregnant woman.

If it is possible to detect oligohydramnios before a period of 28 weeks, an examination of the body of the expectant mother will allow you to find out the cause of the pathology and, if possible, eliminate it. So that the child does not suffer from a lack of oxygen, it is important to start treatment as soon as possible - this will allow gas exchange and uteroplacental blood flow to be established. In the process of therapy, the doctor monitors the baby's condition and sometimes, in case of emergency, prescribes an early caesarean section.

Let us examine in more detail what are the causes of oligohydramnios during pregnancy:

the presence of hypertension in the expectant mother;
significant overweight pregnant;
infections and inflammatory diseases;
violations of the development of the placenta;
inflammation in the pelvic organs;
polycystic kidney disease of the fetus, anomalies in the development of its genitourinary system.

Polyhydramnios during pregnancy

Approximately as rare as oligohydramnios, the opposite pathology, polyhydramnios, can also occur. This problem occurs in 1-1.5% of pregnant women and is an excess of amniotic fluid relative to the norm.

Polyhydramnios is of two types:

Chronic polyhydramnios is characterized by the fact that the amount of amniotic fluid arrives gradually. If the pregnant woman is healthy and feels fine, the doctor may prescribe her diuretics - special medications that are responsible for removing fluid from the body. In addition, the doctor prescribes a certain diet, which involves reducing the amount of salt in the diet. It is important to follow all the recommendations of the doctor, because polyhydramnios can lead to unpleasant consequences. An excessively enlarged uterus oppresses the rest of the organs, disrupting their work. In addition, polyhydramnios sometimes causes circulatory disorders in the female body, it makes labor difficult and can cause heavy bleeding after childbirth.
The second type of polyhydramnios is acute. It is characterized by a sudden increase in amniotic fluid that occurs over several hours. As a rule, such a disease makes itself felt by the following symptoms: abdominal pain, severe swelling, shortness of breath. With such a pathology, a woman needs hospitalization. While in hospital, the pregnant woman observes bed rest, which makes it possible to reduce the risk of preterm birth. If acute polyhydramnios is characterized by the incessant presence of water and threatens the health of the woman and her baby, abdominal amniocentesis can be used as a remedy for the problem. During this operation, the placenta is pierced and excess fluid is removed to the outside.

Among the causes of pathology are the following:

diabetes mellitus in a pregnant woman;
the conflict of Rh blood of mother and baby;
carrying twins;
the child has a genetic disease;
infection to the fetus in utero;
disruption of the fetal bladder, which manifests itself in excessive production of amniotic fluid, even in early pregnancy.

Leakage of amniotic fluid during pregnancy

Another pathology of amniotic fluid is their leakage. This condition is characterized by the appearance of copious liquid discharge from the female genital tract. From ordinary secretions, amniotic fluid is distinguished by transparency, colorlessness, a very liquid consistency, and the absence of odor. Often, leakage of amniotic fluid during pregnancy does not show any symptoms other than the aforementioned discharge. But the expectant mother may not pay attention to such manifestations, because during pregnancy, abundant vaginal discharge is the norm.

In the event that a woman suspects a similar pathology in herself, she should immediately see a doctor. The specialist will prescribe tests that will determine the nature and origin of the discharge, after which the leakage of water can be refuted or confirmed. By the way, in pharmacies you can find special tests with which such an analysis is carried out independently. But it is recommended to use this method only if it is absolutely impossible to see a doctor for any reason. In addition, if the analysis gives a positive result, the pregnant woman one way or another will have to go to the hospital for inpatient treatment.

If a similar phenomenon has made itself felt after the 36th week of the term, doctors can stimulate childbirth, and the baby will be born prematurely for only 1 week. If the leakage of water happened in the early stages, the woman needs hospitalization in order to maintain the pregnancy for the maximum possible period. During hospitalization, strict bed rest should be observed. In some cases, when the period is too short and it is not possible to keep the pregnancy for a long time, the situation is fraught with abortion.

The most common causes of amniotic fluid leakage are genital tract infections. To avoid such a risk, it is very important to monitor your health, follow the rules of personal hygiene, engage only in safe sex and periodically take tests for the presence of pathogenic flora in the vagina.

Amniotic fluid green

Transparency, colorlessness, odorlessness and liquid consistency are characteristics of normal amniotic fluid. Slightly turbid amniotic fluid during pregnancy can be observed at the very end of the term and are also considered the norm, since their appearance is due to the presence of epidermal flakes and lubricant flakes that enter the liquid from the baby's body. But in the event that the amniotic fluid has acquired a greenish tint, we can talk about pathology. The green color of the amniotic fluid is often due to particles of the original feces, which the baby releases if he lacks oxygen. Hypoxia is considered one of the most dangerous conditions of the fetus, because it not only interferes with the normal development of a small organism, but sometimes causes irreparable consequences.

Possible reasons why amniotic fluid may turn green are described below:

If during the entire pregnancy the waters were normal and turned greenish already in the process of childbirth, very often this can cause stress for the baby. Experiencing childbirth, the baby sometimes secretes meconium, due to which the liquid acquires a characteristic shade.
As mentioned above, the cause of this pathology during pregnancy can be such a dangerous condition as fetal hypoxia. It is caused by over-term pregnancy. If the baby is in the womb for too long, the amniotic sac ages and does not perform its functions properly. Because of this, the baby experiences a lack of oxygen.
Sometimes a greenish tint in the amniotic fluid indicates an infection. This happens if the expectant mother has had a cold, flu, bronchitis, suffered an infection of the genitourinary system or some other inflammatory disease.
Very rarely, genetic diseases of the fetus can become the cause of an abnormal shade of amniotic fluid.

Green waters can be dangerous for a child if he swallows contaminated fluid. If such a phenomenon was detected in late pregnancy, a woman may be prescribed a caesarean section. If such a pathology was detected in the early stages, the causes of the condition should first be identified and measures taken to eliminate them. Since the amniotic fluid is often updated, it will be enough to eliminate the causes of the pathology in order to correct the situation.

In the event that the pregnant woman's green waters have departed, the delivery process should be started as soon as possible in order to eliminate the risk of oxygen starvation and the associated consequences.

Amniotic fluid tests during pregnancy

There are several ways to assess the condition of amniotic fluid during pregnancy, the simplest of which is considered to be ultrasound. This procedure does not harm the health of the woman and her fetus, but is the least informative. With the help of ultrasound, you can only visually determine the transparency of the liquid and determine its amount. For more detailed information, other studies are being conducted, which we will consider in more detail:

Amniocentesis is a complex procedure in which fluid is taken directly from the amniotic sac. To do this, the woman's stomach is pierced with a special tool and a small amount of amniotic fluid is drawn out. The procedure is performed under local anesthesia. Then this material is sent for research, where immunological, biochemical, cytological and hormonal analyzes are carried out. Depending on the location of the amniotic sac, doctors determine the puncture site, and during the procedure, an apparatus for ultrasound diagnostics is used. Amniocentesis is performed if there is a conflict between the Rh blood of the mother and the child, as well as if there are suspicions of chromosomal pathologies, hypoxia, and genetic diseases. Such an analysis is also carried out when the age of the future woman in labor exceeds 40 years, and also in the case when it becomes necessary to determine the maturity of the child's lungs. Amniocentesis is not used if a woman has any inflammation in her body, if the pregnant woman suffers from pathologies in the development of the uterus or from diseases of the genitourinary system. If there is a threat of miscarriage, the procedure should also be abandoned.
Amnioscopy is another method for determining the state of the amniotic fluid. During the procedure, the doctor inserts an amnioscope into the cervix and examines the lower pole of the placenta and amniotic fluid. Using the procedure, you can set the amount of amniotic fluid, examine its color and identify the presence of hypoxia in the fetus.