Does polyhydramnios always indicate infection of the fetus? Increased amniotic fluid

Moderate polyhydramnios is an excessive amount amniotic fluid... Such a diagnosis can be made at any stage of pregnancy. This is not a very common complication. It occurs in about 2-3 women out of 99. Expectant mothers need to monitor the amount of fluid during pregnancy. That is, it is necessary to regularly visit an ultrasound scan and regularly go to an appointment with a gynecologist.

For the normal development of pregnancy, the amount should not exceed 1-1.5 liters. It contains proteins, calcium salts, sodium, chlorine and water, which is approximately 96%. Thanks to the amniotic fluid, the child receives all the necessary substances for normal development. Another function of the waters is to protect the toddler. In it, he can move and move without risking injury and other damage.

Amniotic fluid properties

Amniotic fluid has the following properties:

It protects the fetus from external stimuli: noise, shock, shock.
Prevents the umbilical cord from being squeezed.
Reduces pain during contractions.
Helps to open the cervix.
Prevents the ingress of substances harmful to the fetus from the outside world.
Contains immunoglobulins.

Norm

The amount of fluid changes during pregnancy. Each trimester has its own norms. What they are, you can find out from the table below.

Term (weeks)	Amount of water (ml)

From 39-40 weeks until the very birth, the amount of water decreases. Doctors are guided by average indicators. And if there is a deviation from the norm in any direction, they are diagnosed with oligohydramnios or moderate polyhydramnios.

Norm after 30 weeks of pregnancy

The doctor can diagnose polyhydramnios at any stage of pregnancy. But we can talk about a deviation only after 20 weeks. If the diagnosis was not confirmed on the second ultrasound, then the next time only during the third planned ultrasound, moderate polyhydramnios will be found. 32 weeks is the time when you need to constantly go to the antenatal clinic. An experienced doctor will help the pregnant woman to control her condition. He diagnoses the problem even if the woman has no complaints.

By the way, it can be detected not only by ultrasound, but also by Doppler, and during examination. Moderate (32 weeks) is set when the amount of amniotic fluid reaches 1500-1900 ml. At the same time, the woman feels how water rolls in her stomach, and the child often moves. A pregnant woman can feel this discomfort for more late date... In the eighth month, she may be tormented by moderate polyhydramnios. 34 weeks - another critical period... At this time, a similar diagnosis is made when the normal amount of fluid is exceeded by 200-400 ml.

Reasons that can provoke polyhydramnios

Currently, doctors have not yet fully studied the reasons due to which moderate polyhydramnios appears during pregnancy. But they highlight several hypothetical factors that can provoke the problem:

Abnormalities in fetal development.
Diseases of an infectious nature that a woman has suffered.
Bacterial diseases.
Some diseases of the vascular system and heart.
Conflict of the Rh factor in the fetus and the mother.
Increased sugar levels in a pregnant woman.
Diseases and the like).
When multiple fruits develop.
If the baby is large enough.

Even if there is one reason, moderate polyhydramnios may appear.

Symptoms

You can recognize the appearance of abnormalities associated with polyhydramnios by the following symptoms:

An enlarged belly that is out of date.
It is hard to hear during the child.
Increased fetal mobility.
Dyspnea.
Weakness.
Puffiness.
Heartburn.
Painful sensations in the abdomen.
The appearance of stretch marks.

On examination and palpation, the doctor will notice the tension of the abdomen and the highly located presenting part. Most often, with this deviation of a pregnant woman, it is difficult to notice polyhydramnios on her own.

Treatment

Moderate polyhydramnios is treated by eliminating the cause of its occurrence. After passing all the necessary tests and examinations, the doctor will be able to determine the causes of this pathology. Therapy is prescribed in a complex manner. It includes diuretics (diuretics), antibiotics and vitamins. They help to reduce the amount of water, destroy harmful microorganisms, increase immunity and improve health. If the treatment does not work, then in some cases labor is caused. It doesn't happen before

Danger of pathology

Deviation is dangerous because it can cause serious consequences for both the mother and the child. These include:

Premature birth.
Placental abruption.
Death of the fetus.
The appearance of abnormalities in the development of the baby.
Infectious infection of the mother and child.
Prolapse of the umbilical cord or limb of the fetus.
Undescended and unrecorded presentation.
Bleeding.
Gestosis of a different nature.

Also, the child cannot take a normal position, as he is in constant motion due to the large amount of water.

Prevention of pathology

In order to prevent its occurrence, it is necessary to apply several simple rules... It is recommended for the expectant mother:

Move more.
Drink liquid in a normal way.
Eat a balanced diet.
Drink vitamins and medications prescribed by your doctor.
Timely and regularly undergo examinations, take tests.
See a doctor.

Also, in the early stages, it is necessary to exclude the conflict of the Rh factor in the mother and the fetus. If you follow all the recommendations and adhere to these simple rules, then the likelihood of a deviation will decrease as much as possible. By the way, pathology occurs most often due to infections and the conflict of the Rh factor. Therefore, before pregnancy, undergo an examination and, if necessary, treatment.

In this article:

Pregnancy is undoubtedly the happiest period in a woman's life, but even that can sometimes be overshadowed. different kinds troubles and pathologies. One of these pathological conditions during pregnancy is polyhydramnios, which must be treated without fail.

Composition amniotic fluid changes throughout pregnancy, so it is important to monitor their number in each trimester.

Polyhydramnios is the appearance of an excess amount of amniotic fluid that is significantly higher than the norm. The diagnosis of polyhydramnios can be made to a woman at the most different timeframes pregnancy. These complications occur in 1 in 100 pregnancies.

At normal course pregnancy, the required amount of amniotic fluid is formed for the development of the fetus, approximately 1000-1500 ml. The amniotic fluid is 97% water, which contains proteins, calcium, chlorine and sodium salts. Thus, the baby receives oxygen, essential nutrients and reliable protection from external environment... Also, the embryo can calmly move and swim in the mother's abdomen, make movements with its limbs.

The amniotic fluid is the environment in which the fetus develops. The water temperature is 37 degrees.

Amniotic fluid properties:

Amniotic fluid protects the embryo from shock and shock. In addition, noise coming from the outside world is also muted.
The amniotic fluid protects the umbilical cord from being squeezed between the wall of the uterus and the fetus.
The amniotic fluid can help reduce pain during labor.
They facilitate the opening of the cervix during childbirth.
The bubble, in which the fetus and amniotic fluid are located, creates an airtight shell into which nothing can enter from the outside.
Amniotic fluid contains immunoglobulins.

The amount of amniotic fluid changes every week. Therefore, there are norms for each trimester of pregnancy. At the very beginning of pregnancy, the amount of amniotic fluid is approximately 30 ml. At 23 weeks, the amount of amniotic fluid is about 600-700 ml. By 30, 32, 33 and 34 weeks, this figure is approximately 600-900 ml. By week 36, the amount of water increases to 1000. At 37 and 38 weeks of gestation, the amount of amniotic fluid becomes maximum. At 39 weeks and closer to the birth itself, there is a decrease in amniotic fluid to 800 ml.

In the presence of some predisposing factors, the amount of water may decrease or increase. When amniotic fluid is less than normal, then this condition is called oligohydramnios. Low water is also a pathology and affects the development of the fetus and the condition of the pregnant woman.

Causes of polyhydramnios

Although the causes of polyhydramnios have not yet been fully understood, there are some factors that contribute to the onset of this pathology.

Polyhydramnios during pregnancy can occur due to the following reasons:

fetal developmental pathology;
infectious diseases of a pregnant woman;
bacterial infection;
diseases of the cardiovascular system;
Rh-conflict between mother and fetus;
metabolic disease;
diabetes;
pyelonephritis;
multiple pregnancy;
large fruits.

Types of polyhydramnios

This condition in a pregnant woman can proceed in different ways: in an acute form or in a chronic form. There may be pronounced or moderate polyhydramnios.

The acute form is characterized by a violation of the general condition of the pregnant woman and the fetus. Such childbirth, as a rule, ends in miscarriage, stillbirth, or such a child will have developmental defects. Polyhydramnios appears in an acute form, usually starting from the 16th to the 24th week. Sometimes the amount of amniotic fluid can increase even over a period of several hours. In this case, immediate health care, in view of a dangerous condition.

Moderate polyhydramnios during pregnancy is characterized by a gradual increase in symptoms and signs. Moderate polyhydramnios can lead to the birth of a child with developmental abnormalities. It's connected with constant disadvantage oxygen. Very often, moderate polyhydramnios occurs in a chronic asymptomatic form, and therefore can go unnoticed for a long time.

Signs of polyhydramnios

Sometimes a pregnant woman herself may suspect that she has polyhydramnios, by the presence of some signs characteristic of this condition.

The abdomen of a pregnant woman with an excess amount of amniotic fluid reaches more than 100 cm in circumference.It has a slightly rounded shape... There is a feeling of heaviness in the abdomen and back. The uterus increases in size and begins to squeeze the internal adjacent organs. Therefore, as a result, the pregnant woman often has shortness of breath and other ailments.
Lower limbs may swell. In some cases, it may even happen early effusion amniotic fluid.
Fluctuation appears: a gurgling in the stomach is quite clearly audible in a pregnant woman. There is pain in the perineum.
Appears on the stomach a large number of stretch marks.
The pulse of the pregnant woman quickens. The fetal heartbeat is weakly audible.
As more free space appears, the fetus takes up wrong position in the uterus (pelvic, oblique). This is directly reflected in the childbirth itself: the stretched uterus contracts incorrectly and childbirth with polyhydramnios will be characterized by weak labor.

Polyhydramnios is also dangerous because the child can be entwined with the umbilical cord. Hypoxia may develop, the fetus will receive less oxygen. Even if the delivery takes place on time, the fetus may have an intrauterine pathology, such a child may be born with a developmental disorder internal organs or systems.

It should be remembered that the earlier a woman has polyhydramnios, the more amniotic fluid accumulates and the risk of complications increases.

Moderate polyhydramnios

Moderate polyhydramnios is diagnosed when the amount of amniotic fluid is approximately 1.5 or 2 liters. And although such a diagnosis is made even in the first trimester of pregnancy, it is possible to seriously talk about the presence of pathology only after 16 weeks. The reason for this condition is often the Rh-conflict between the mother and the fetus or the presence of infections.

A woman with moderate polyhydramnios feels tension in the abdomen. It becomes more elastic. When you feel the fetus, you will notice that it often changes its position. You can hear water rolling in the abdomen. The uterus grows in size and becomes edematous.

You can determine moderate polyhydramnios on a routine ultrasound examination or examination. Moderate polyhydramnios are characterized by early childbirth and placental abruption.

A pregnant woman with moderate polyhydramnios should be constantly monitored by specialists, as sometimes it happens that this diagnosis is erroneous or temporary.

In the absence of a serious pathology, the doctor tries to preserve the pregnancy and so that the birth passes naturally without artificial interference. Appointed conservative treatment: vitamins, hypothiazide. If necessary, antibiotic therapy is performed.

Polyhydramnios at the end of pregnancy

Polyhydramnios at the end of pregnancy accounts for approximately 0.6% of all other pathologies. Its appearance can be caused by late toxicosis... This threatens with serious complications during childbirth:

prolapse of the umbilical cord;
oxygen starvation of the fetus;
weakness of labor.

Therefore, such a diagnosis is an indicator for carrying out. Treatment of such polyhydramnios is carried out depending on the cause.

Diagnostics of polyhydramnios

You can diagnose polyhydramnios on examination by a gynecologist at an appointment at antenatal clinic... For this, the doctor examines the pregnant woman for the presence of relevant signs. Most reliable method diagnosis of polyhydramnios is an ultrasound examination. Dopplerometry is also prescribed. Thus, you can identify a more accurate amount of amniotic fluid, check the blood flow in the umbilical cord and placenta.

Thorough examination of the fetus reveals possible anomalies in its development.

Polyhydramnios can be diagnosed using the "amniotic index". There is a special table that allows you to determine the amount of amniotic fluid in the norm in a certain trimester of pregnancy.

If the diagnosis is confirmed, then the woman is sent for additional examination of the fetus.

Effects

With polyhydramnios, the following consequences are possible:

or termination of pregnancy;
fetal death or developmental defects;
if the cause of polyhydramnios is an infection, then there is a possibility of infection of the fetus;
prolapse of the umbilical cord or hand (leg) of the fetus during childbirth;
the presenting part of the fetus does not descend during childbirth or is not fixed;
malposition.
bleeding;
various gestosis.

Treatment

The main treatment for the diagnosis of polyhydramnios is aimed at eliminating the cause that caused this pathology. At first future mom passes all the necessary tests confirming the presence of polyhydramnios: fetal cardiotocography, ultrasound examination, blood test for Rh factor, Doppler ultrasonography and others.

As a rule, complex treatment is carried out. When moderate or unexpressed pathology of a pregnant woman is prescribed drug therapy. Depending on the woman's condition, treatment can take place in a hospital or in home environment(outpatient). This condition does not require termination of pregnancy or delivery.

Diuretics (diuretics), vitamins and antibiotics are prescribed. Antibiotics are necessary to fight microorganisms, since the main cause of polyhydramnios often lies in the infectious process. Also, starting from 24 weeks and up to 38 weeks, indomethacin is prescribed.

If the prescribed treatment does not help or polyhydramnios takes a severe form, then the doctor prescribes early delivery. Use medical drugs that help to artificially induce labor.

During artificial delivery, it is necessary to carefully open the membranes, and gradually release the amniotic fluid so as not to cause fetal asphyxia. This procedure is performed using a thin catheter. Measures are taken to prevent the umbilical cord or fetal extremities from falling out.

Medicines to stimulate labor should be used no earlier than 2 hours after the outpouring of amniotic fluid.

In the early stages, when it is impossible to carry out delivery, amniotic fluid is released. The amniotic fluid helps the child move along the birth canal, regardless of the artificial or natural opening of the fetal bladder. But this should be done carefully so that the umbilical cord does not fall out.

If the fetus has malformations that are incompatible with life, then an abortion is carried out for up to 28 weeks.

Childbirth

If polyhydramnios does not affect the condition of a pregnant woman or her fetus, then in this case, childbirth is carried out naturally. Mandatory procedure in this case: artificial opening of the fetal bladder. In this case, the volume of the uterus decreases, and this helps to make the contractions more productive. Often such childbirth is delayed, and then there is a need for rhodostimulation. Rhodostimulation is carried out by the introduction of rhodostimulation drugs. And already as the most extreme measure, a cesarean section is performed.

The postpartum period can be complicated by bleeding due to poor uterine contractility. Therefore, the woman is prescribed the introduction of reducing drugs, such as oxytocin and methylergometrine.

Prevention of polyhydramnios

Since polyhydramnios is a pathology, this condition can be avoided if precautions are taken.

It is very important to immediately exclude the presence of Rh-conflict. During pregnancy, a woman should move as much as possible. It is necessary to calculate the amount of fluid taken. It also does not hurt to adjust the diet a little.

For the prevention of polyhydramnios, the expectant mother should take vitamin complexes or medicines prescribed by your doctor.

It is necessary to pass all examinations and analyzes on time, as they will help to identify pathology or abnormalities in the development of the fetus at the earliest stages.

In this case, you can avoid serious consequences during childbirth and in postpartum period... It is important to remember that regular examinations by an obstetrician-gynecologist are not just a formality, but a vital necessity, on which the baby's condition depends.

Useful video

Hello, dear mothers! Have you ever asked yourself the question: what is the liquid in which your future child? Or, for example, what should be its volume? I am often asked about various abnormalities during pregnancy. This article will focus on polyhydramnios. Unfortunately, any expectant mother can face such a diagnosis.

During pregnancy, the baby is in a shell that is filled with special liquid... This fluid is called amniotic fluid. Outwardly it resembles ordinary water, but it contains many nutrients necessary for the normal development of the child.

For each term, there are standards for the level of amniotic fluid. The gynecologist must monitor their number, because any deviation from the norm can pose a threat.

V normal condition the amount of liquid varies in the range of 0.6 -1.5 liters. If its amount increases and is more than 2 liters, we should talk about polyhydramnios. This condition requires observation and treatment in a hospital setting.

There are no obvious reasons for the manifestation of such a deviation, but experts identify a number of reasons that contribute to such a diagnosis:

Bacterial or viral infection.
Diseases of the cardiovascular system.
Diabetes mellitus in the mother.
Placental pathology.
Large fruit.
Rhesus conflict in parents.
Genetic abnormalities of the fetus.
Anemia.
Chronic kidney disease.

In practice, infections are the main cause, as is known in most cases.

According to the severity of the course, two forms of polyhydramnios are distinguished: acute (an increase in fluid within a couple of hours or days) and chronic (the amount of water increases by last weeks pregnancy, asymptomatic).

Depending on the amount of liquid, three degrees are distinguished: light (the volume of the liquid is less than 3 liters); medium (the volume of water is 3-5 liters); heavy (the amount of water is more than 5 liters).

Types and symptoms of polyhydramnios

Based on the reasons for the occurrence of such a pathological condition in a pregnant woman, a list of symptoms is distinguished. These include:

Decrease in the number of urination per day.
Severe swelling of the limbs.
Increased increase in fetal activity.

Almost always, polyhydramnios is almost asymptomatic, which is why any deterioration in well-being, even if not significant, can be a reason to tell your doctor about the changes.

Diagnosis and treatment of the disease

To diagnose polyhydramnios, the doctor relies on the patient's complaints. To confirm the diagnosis is prescribed. There are two ways in which ultrasound can confirm the diagnosis:

Calculation of the amniotic fluid index. This procedure is the division of the abdomen into 4 parts, in each of which the greatest depth of the pocket of liquid is calculated, then the data are compared, and an index is obtained. Indicators less than 5% speak about low water, and indicators exceeding 97.5% about high water.
Measure the largest pocket amniotic fluid free from the umbilical cord and fetus. If the indicator is more than 8 cm, this indicates polyhydramnios, if less than 1 cm, oligohydramnios is diagnosed.

After confirming the diagnosis by ultrasound, a test is prescribed for the development of defects in the placenta and fetus. It is also worth taking a blood test for prolactin levels. But in the last weeks of pregnancy, these tests are not informative.

Possible consequences

Polyhydramnios can lead to a number of consequences, namely:

Abnormalities in fetal development.
Fetal infection.
Leakage of amniotic fluid.
Placental abnormalities.
Weak generic activity.
Poor contraction of the uterine muscles after childbirth.

An increase in amniotic fluid can adversely affect pregnancy and cause death of the fetus or newborn. but effective treatment with moderate polyhydramnios contributes to a favorable outcome in most cases.

How is the treatment going

If the diagnosis is confirmed, treatment takes place in a hospital. After a series of tests, if the fetus is diagnosed with pathologies incompatible with life, the pregnancy is terminated.

During treatment, an antibiotic is prescribed if the presence of an infection is confirmed, diuretics, B vitamins and drugs to normalize blood flow through the placenta.

Do not panic when you experience unusual symptoms. To prevent such a disease, you should regularly visit a doctor and conduct healthy image life. I hope the article will be useful and informative for expectant mothers.

I look forward to your questions and comments!

Until new interesting topics!

Polyhydramnios is pathological condition during pregnancy, when the amniotic fluid in the amniotic cavity exceeds the norm.

The importance of amniotic fluid for the normal development and life of the fetus is invaluable. They protect him from outside mechanical impact, provide the embryo with freedom of movement, participate in metabolism, protect the umbilical cord from being squeezed. The amniotic fluid is in constant motion and is systematically updated. At different stages of pregnancy, the norms of amniotic fluid are different: in, for example, the volume of water is 30 ml, in - 100 ml, by 37-38 weeks of pregnancy - 1-1.5 liters. If this limit is exceeded by the end of the term, it comes about polyhydramnios in pregnant women.

But how do you know how much of these waters you have there? There are certain symptoms, the presence of which can tell a woman that something is wrong. In this case, you need to contact the gynecologist and tell everything about it.

Signs of polyhydramnios during pregnancy:

feeling of heaviness and pain in the abdomen;
malaise, weakness;
shortness of breath (due to the high standing of the diaphragm);
swelling of the legs;
the volume of the abdomen at the level of the navel reaches 100-120 cm or more;
the stomach with polyhydramnios can be heavily covered with stretch marks;
a distinct gurgle inside the abdomen (fluctuation) is often heard.

Why is it dangerous?

There is acute polyhydramnios, in which the amount of amniotic fluid rapidly and sharply increases, which is very dangerous. Everything happens literally within a few hours or days: the size of the pregnant woman's abdomen increases sharply, there are painful sensations in the groin and lower back, tension in the walls of the uterus and noticeable swelling of the anterior abdominal wall. With chronic polyhydramnios, the volume of water increases gradually, but this also causes a number of complications.

The consequences of polyhydramnios can be very sad:

28.4% of pregnant women experience premature termination of pregnancy;
vomiting occurs in 36% of women;
incorrect position and presentation of the fetus is diagnosed in 6.5% of women;
fetoplacental insufficiency may develop and, therefore, chronic hypoxia and fetal death;
possible malformations of the central nervous system fetus and gastrointestinal tract;
if the cause of polyhydramnios was an infectious process, infection of the fetus is possible;
in 38.4% of women bleeding occurs (with acute polyhydramnios - 41.3%, with chronic - 6.2%);
late gestosis is observed in 5-20% of pregnant women with polyhydramnios;
early outpouring of amniotic fluid and;
possible loss of the arm or leg of the fetus or the umbilical cord during childbirth;
indications for caesarean section(due to the increased space inside the uterus, the child often takes an incorrect position: transverse, oblique, pelvic);
due to overstretching of the uterus, weakness of labor, premature, postpartum hemorrhage and other complications may occur.

Causes of polyhydramnios during pregnancy

The reasons for polyhydramnios have not yet been precisely established. But doctors single out women at risk, in whom polyhydramnios develops more often than others. However, in 30% of cases, doctors still cannot find out what is the cause of polyhydramnios. With any of the following phenomena, polyhydramnios may (although not at all necessary) develop:

if a woman has it;
at infectious diseases;
kidney disease;
cardiovascular diseases;
Rh-conflict between mother and child;
multiple pregnancy (and often polyhydramnios of one fetus is combined with oligohydramnios of another);
large fruit;
decline excretory function fetus;
dysfunction of swallowing (at the end of pregnancy, the child absorbs about 4 liters of amniotic fluid every day, which is completely renewed every 3 hours);
with fetal malformations.

Treatment of polyhydramnios in pregnant women

Predominantly, the diagnosis of polyhydramnios is based on the results ultrasound examination... From the moment the pathology is detected, the expectant mother should be under constant medical supervision... If there is no pronounced circulatory and respiratory disorder (mild and moderate polyhydramnios), doctors strive to preserve the pregnancy until its physiological completion. Otherwise, there is a need for early delivery, since the situation can pose a threat to the woman's life.

If the pregnancy is preserved, the cause of polyhydramnios should be established, since it threatens the development of chronic oxygen starvation of the fetus. Depending on the identified cause of the disease, appropriate treatment is carried out.

Treatment of polyhydramnios includes antibiotic therapy for viral etiology, immunomodulatory therapy, the appointment of diuretics and vitamins, and abdominal amniocentesis. As a rule, hypothiazide, B vitamins are prescribed, in some cases - broad-spectrum antibiotics (except for tetracycline), biloquinol. With weakness of labor, appropriate treatment is prescribed.

Specially for- Elena Kichak