Amniotic fluid

What is amniotic fluid?

In normal pregnancy, the production and absorption of amniotic fluid is in a dynamic balance, and excessive amniotic fluid refers to the amount of amniotic fluid in pregnant women during pregnancy more than 2000 ml. If the amniotic fluid volume increases slowly, often mild symptoms, called chronic excessive amniotic fluid; if the amniotic fluid in a few days rapidly increased, severe compression symptoms, known as acute excessive amniotic fluid.

The incidence of amniotic fluid is about 1%-3%. Proper amount of amniotic fluid can protect fetus and maternal body, and when excessive amount of amniotic fluid, the incidence of maternal and fetal complications increased significantly. Therefore, pregnant women should pay attention to their amniotic fluid condition. Once abnormal findings are found, they should be treated immediately.

Symptoms of amniotic fluid

1, chronic amniotic fluid: more. It usually occurs at 28-32 weeks of gestation. Specifically, amniotic fluid increased slowly within a few weeks, with mild symptoms of compression or asymptomatic, most pregnant women can gradually adapt, pregnant women only feel abdominal enlargement faster. The uterine tension, uterine height and abdominal circumference were greater than those of the same pregnancy. The fluid tremor was obvious. The fetal position could be detected or unclear, the fetal heart sounds were remote or inaudible.

2, acute amniotic fluid: less common. More than 20-24 weeks of pregnancy onset, amniotic fluid suddenly increased, the uterus increased significantly within a few days. The patient feels abdominal distension and pain, lumbar acid, inconvenience, skin tight and shiny, due to the elevation of the diaphragm caused by breathing difficulties, even cyanosis, can not lie flat. Examination showed high abdominal bulge, skin tension, thinning, abdominal vein dilatation, vulvar varicose veins and edema; uterus greater than the gestational month, tension, fetal examination is not clear, fetal heart sounds remote or inaudible.

Causes of amniotic fluid

About 1/3 of the causes of excessive amniotic fluid are unknown, but most severe cases may be associated with fetal malformations and pregnancy complications.

1. Fetal malformation: 18%-40% is associated with fetal malformation in pregnant women with amniotic fluid. Neural tube defects are the most common diseases, accounting for about 50% of which are mainly open neural tube defects. When anencephaly, dominant spina bifida, meningeal exposure, choroidal tissue proliferation, increased exudation, and central dysphagia plus antidiuretic hormone deficiency, resulting in excessive amniotic fluid formation, reduced reflux; fetal esophageal and duodenal atresia can make fetal swallowing amniotic fluid disorders, resulting in excessive amniotic fluid.

2. Chromosome abnormality: 18-trisomy, 21-trisomy, 13-trisomy fetus can appear fetal dysphagia amniotic fluid, resulting in excessive amniotic fluid.

3, twin pregnancy: about 12% of twin pregnancies complicated with amniotic fluid is 10 times more than single pregnancy. When single egg single chorion double amniotic sac, two placental arteriovenous anastomosis, easy to complicate twin blood transfusion syndrome, increased blood circulation, fetal urine volume, resulting in excessive amniotic fluid.

4. Pregnancy with diabetes mellitus: maternal hyperglycemia leads to increased fetal blood glucose, osmotic diuresis, increased placental membrane exudation leads to excessive amniotic fluid.

5. Fetal edema: excessive amniotic fluid and fetal immune edema (such as maternal and fetal blood group incompatible hemolysis) and non-immune edema (mostly caused by intrauterine infection).

6. Placental umbilical cord lesions: large placenta and velamentum of umbilical cord can lead to excessive amniotic fluid. When the diameter of placental villi is larger than 1cm, 15%-30% can merge with amniotic fluid.

7, idiopathic amniotic fluid: about 30%, not pregnant women, fetal and placental abnormalities. Unknown cause.

Diagnosis of amniotic fluid

Excessive amniotic fluid can be diagnosed from clinical symptoms and signs, but generally need to pass B ultrasound and other auxiliary examination, to grasp the specific situation of amniotic fluid volume and speculate the causes of excessive amniotic fluid volume.

B ultrasonic examination is the main examination method for amniotic fluid. The abdomen was divided into four quadrants with umbilical transverse line and abdominal white line as coordinate axis. The sum of the vertical diameters of each quadrant was amniotic fluid index. It is generally believed that the normal range of amniotic fluid index is 9-24 cm, amniotic fluid index (AFI) > 25 cm is diagnosed as excessive amniotic fluid, of which, AFI in 25-35 cm for mild excessive amniotic fluid, 36-45 cm for moderate excessive amniotic fluid, > 45 cm for severe excessive amniotic fluid; AFI < 5 cm for oligohydramnios, < 8 cm for oligohydramnios.

While the amniotic fluid volume is examined by B-ultrasound, it is also necessary to check whether the fetus has structural deformities such as anencephaly, dominant spina bifida, edema and twins in order to choose the correct treatment.

What happens if there is too much amniotic fluid?

Day-to-day care

Pregnant women with amniotic fluid need to ensure a low salt diet and reduce the amount of drinking water. Rest in bed, take the left lying position, improve the uterus and placenta circulation, prevent premature delivery. The amniotic fluid index and fetal growth should be reviewed weekly.

Medical treatment

The treatment of excessive amniotic fluid mainly depends on whether the fetus has abnormalities, gestational age and the severity of compressive symptoms of pregnant women. If the diagnosis of excessive amniotic fluid, the general doctor will require a high-definition B-ultrasound examination to see whether the fetus is malformed; and may also do amniocentesis to see whether the fetus has genetic defects. At the same time, during the rest of the pregnancy, fetal heart rate monitoring and B ultrasonic examination should be done regularly to closely monitor the growth and development of the fetus.

If there is amniotic fluid complicated with fetal malformation, termination of pregnancy is necessary. Usually artificial rupture of membranes is used to induce labor. If the fetus is normal, the following measures should be taken for treatment:

1. Amniocentesis decompression: severe compression symptoms, small gestational age, fetal lung immaturity, may consider transabdominal amniocentesis discharge to alleviate symptoms, prolong gestational age.

2, prostaglandin synthetase inhibitor treatment: indomethacin 2.2-2.4mg/ (kg? D), divided into 3 times orally. Indomethacin has the effect of inhibiting diuresis, and it can inhibit the urine output of the fetus to reduce the amount of amniotic fluid. However, the amniotic fluid volume and fetal heart rate should be closely observed at the same time. If the amniotic fluid volume is significantly reduced or arterial catheter stenosis occurs, the drug should be stopped immediately.

3. Etiological treatment: if pregnancy with diabetes mellitus caused by excessive amniotic fluid, blood glucose should be suppressed; if maternal and fetal blood group insoluble caused by excessive amniotic fluid, fetal immaturity and edema, or umbilical cord blood shows Hb < 60 g / L, should consider fetal intrauterine transfusion.

4, childbirth treatment: after natural labor, artificial rupture of membranes should be done as early as possible. If uterine contraction is still weak after rupture of membranes, low concentration oxytocin can be given intravenously to enhance uterine contraction, and closely observe the progress of labor. After delivery, the fetus should apply contractions in time to prevent postpartum hemorrhage.

Harm of amniotic fluid

1. The influence on the mother: The influence of excessive amniotic fluid on pregnant women is mainly placental abruption, uterine atony, postpartum hemorrhage and so on. Acute amniotic fluid excess is easy to cause obvious compression symptoms, leading to increased risk of pregnancy-induced hypertension. Due to excessive stretching of uterine myofibers, uterine inertia, prolonged labor and increased postpartum hemorrhage can be caused; if the sudden rupture of the uterine membrane can cause a sudden drop in intrauterine pressure, resulting in placental abruption, shock. In addition, the possibility of premature rupture of membranes and premature birth will also increase.

2. Influences on the fetus: fetal abnormalities, umbilical cord prolapse, fetal distress and premature birth caused by immature neonatal development, plus excessive amniotic fluid often associated with fetal malformations, so excessive amniotic fluid perinatal mortality increased significantly, about 7 times the normal pregnancy. The incidence of premature delivery, umbilical cord prolapse, placental abruption and other complications in patients with excessive amniotic fluid increased, affecting the prognosis of perinatal infants. Pregnancy complicated with diabetes and neonatal polycythemia caused poor prognosis of perinatal infants.

How to prevent excessive amniotic fluid

1. Dietary Attention: During pregnancy, pregnant women should pay attention to rest, maintain a light diet and balanced nutrition, if not need to eat a large number of high salt and high cholesterol food.

2. Careful medication: Pregnant women need to take medicine carefully, if not as far as possible to avoid taking drugs, if the need to take medicine because of illness, you need to consult a doctor in advance, in order to prevent improper medication increases the risk of pregnancy.

3. Periodic maternity check-up: Pregnant women need to do a good job of regular maternity check-up, through B-ultrasound and other examinations to observe the fetal condition, once found abnormal need to be treated immediately.

What is eating too much amniotic fluid?

Nutritional needs of pregnant women with amniotic fluid

If pregnant women have too much amniotic fluid, care should be taken to keep the diet light and reduce the intake of salt. You can eat some foods such as wax gourd, watermelon and so on.

Diet for amniotic fluid

1. Carp soup

MATERIALS: 1 carp (viscera removed), 15g Atractylodes macrocephala, 6G orange peel, 15g poria, 12g angelica, 12g paeony and 6G ginger.

Practice: Pan Fried thick soup. After carp is cooked, go to medicinal herbs, drink soup and eat fish.

Efficacy: Carp meat has the functions of invigorating spleen and stomach, promoting water and detumescence, while Atractylodes macrocephala, Poria cocos, ginger and tangerine peel have the functions of invigorating spleen and regulating qi, cooperating with Angelica sinensis and Paeonia lactiflora, nourishing blood and stabilizing fetus, can achieve the dual effects of removing water without injuring fetus.

2. White gourd peel and red bean drink.

Ingredients: wax gourd peel, red bean and half bowl, two spoons of brown sugar.

Practice: Wax gourd rinse peeling, will wax gourd skin, red beans, brown sugar into casserole, add water, boil over a high fire, fried over a low heat. Cook until the red bean is rotten.

Efficacy: reduce edema and relieve heat.