Oligoamnios: How to treat the small amount of amniotic fluid?

During pregnancy is the fetus develops in the liquid amniotic fluid, which is secreted by the embryo itself. The amount of this fluid evolves over time amenorrhea, so there is a normal rate of secretion. So if the amniotic fluid is in insufficient quantity in relation to the stage of development of the pregnancy of which we are speakingOligoamnios. This phenomenon can lead to fetal death. What is oligohydramnios? What are the causes, symptoms and treatments? focus

Oligoamnios: definition

Amniotic fluid is an environment in which the fetus bathes throughout pregnancy. This liquid consists of water laden water carbohydratesfrom lipidsfrom mineral salts and from proteins, so that both can nourish and protect the future baby. The amount of amniotic fluid gradually increases during the first 35 weeks of pregnancy until it reaches 1 liter. By the end of pregnancy, the amount drops to values ​​between 0.5 and 0.8 liters, during childbirth.

In fact, in certain situations, the amniotic fluid may not be present in sufficient quantities. Therefore, under 250 ml during the second or third trimester, we evoke a oligoamnias. When there is no amniotic fluid at all, it is calledanamnios : This is the most extreme situation.

What are the causes of oligohydramnios?

Low amount of amniotic fluid can be caused by Tear in the water bag : This is explained by vaginal fluid loss in the carrier. If the sac containing the amniotic fluid does not rupture, there are several other factors that can favor oligohydramnios:

  • the fetal malformationmainly at the urinary or renal level;
  • the intrauterine growth retardation (RCIU);
  • Abnormal development of the cardiovascular system, central nervous system (spinal cord and brain), skeleton….in the fetus;
  • A chromosomal abnormality: trisomy 13 and 18 for example;
  • the Transfusion-Transfused Syndrome (STT) ;
  • A vascular disease caused by diabetes in the expectant mother;
  • exceeding the period of pregnancy;
  • A pre-eclampsiawhich leads to the occurrence of a high blood pressure at the mother;
  • the maternal smoking ;
  • A maternal-fetal infection.

Note, however, that in 30% of oligoamnios cases no real cause has been identified.

Oligohydramnios: symptoms and diagnosis

Oligoamnios is caused when the amniotic fluid level is below 0.2 liters. This deficit can be manifested by simple palpitations of the abdomen at the future mother, which can affect the fetus abnormally. the uterine cavity may be lower than normal condition or height.

When oligohydramnios is caused by a tear in the amniotic sac, the patient may observe: a flow of clear liquid, which she may mistake for urinary leakage. A decreased fetal movements can also be observed in the future mother.

In addition, the diagnosis at the beginning consists of determining the height of the uterus and the circumference of the navel with a measuring tape. This is done by the midwife or gynecologist responsible for monitoring the pregnancy. There are two types of measures for this: Surveying the largest cistern (this is the black part that surrounds the baby) and Measurement of the four quadrants (allows determination of the amniotic index).

If the large cistern varies between one and two centimeters, it is called moderate or borderline oligohydramnios. The same applies if the amniotic fluid index is between five and eight centimeters. But if the large cistern is less than a centimeter, or the amniotic fluid index is less than five centimeters, then it is detected, even severe oligohydramnios.

The suspicion of oligohydramnios can also be drawn from the appearance of the uterus or from the movements of the fetus observed during itUltrasonic.

Because the amount of amniotic fluid naturally fluctuates and oligohydramnios can be transient, these measurements must be repeated several times to confirm and refine the diagnosis.

Oligoamnios: what are the treatments for low amniotic fluid?

Treatment for oligohydramnios depends on the underlying cause(s) and stage of pregnancy.

In the context of premature rupture of membranes, one of the options to consider is the initiation of work, especially if the pregnancy is close to term. On the other hand, if the pregnancy is not close to term (less than 17 weeks of amenorrhea), the prognosis is generally poor.

In the case of an occasional low volume of amniotic fluid, treatment consists of close monitoring and instructing the patient to rest. Maternal hypertension should be treated and monitored the pregnancy to avoid that Complication of the oligoamnios.

When oligohydramnios is diagnosed early and/or is accompanied by a chromosomal abnormality or fetal malformation, the treatment offered is medical termination of pregnancy (IMG). However, the decision to practice or not the IMG must be made by the parents.

Another option that can be considered in very rare cases is theamniotic infusion. Saline is injected into the amniotic fluid to perform an ultrasound and amniocentesis to refine the diagnosis.

Oligoamnios: risks to the fetus

Oligohydramnios remains a very dangerous condition for the unborn child, especially when it occurs during the second semester of pregnancy.. Especially since this phenomenon can owe its occurrence among others fetal malformation or exercise. Complications of oligohydramnios for the fetus can include:

  • L’pulmonary hypoplasia : a problem with lung development;
  • the lack of mobility of the fetus, which can lead to malformations of the limbs (clubfeet and hands), articulations (joint cankylosis);
  • the Potter syndrome : Facial dysmorphia accompanied by a flattened nose and a backward-sloping jaw.

Other potential complications of oligohydramnios relate to childbirth, as preterm labor can be a treatment option. In this case, cesarean section is popular.

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