Amniotic fluid volume at 40 weeks. Water for life: amniotic fluid

We continue to talk about amniotic fluid, the changes that can occur with them and the methods of diagnosing any pathologies using them. We have already said earlier that during pregnancy and during childbirth, the color of the amniotic fluid can change. Let's continue our conversation.

If the water is dark brown.
If amniotic fluid of a dark brown color is found during pregnancy and childbirth, this indicates serious problems that should greatly disturb both doctors and the woman herself. In almost 90% of cases, this color of amniotic fluid indicates the presence of intrauterine fetal death. And in the presence of such odds, the question is no longer about saving the fetus, but about saving the life of the pregnant woman, since such a condition is also dangerous for her. But today, when diagnostic methods are actively practiced and a woman's health is carefully monitored, such situations are very rare, therefore, we simply will not talk in detail about this option. With regular observation by a gynecologist, such problems are identified in a timely manner, in advance, and then the situation simply does not reach a similar state of amniotic fluid.

Amniotic fluid is red or reddish in color.
The presence of red amniotic fluid indicates a serious danger not only for the baby in the mother's abdomen, but also for herself. Often, a red or pink tint of amniotic fluid will occur when blood enters the fetal bladder in the presence of bleeding in both the mother in the body and the fetus. You can assess for yourself how dangerous this situation is for the mother and her child. If you find yourself in amniotic fluid of a similar color, you should immediately take a horizontal position and under no circumstances, do not move. And your relatives should, without delay, call the ambulance team and immediately take you to the hospital. When you call the ambulance, it is imperative to inform the dispatcher who accepts the call that the departed amniotic fluid in the pregnant woman is red or bloody.

In such cases, the resuscitation team immediately leaves for pregnant women, which is equipped with all the drugs and devices necessary to provide assistance. In this case, assistance with the arrival of an ordinary ambulance brigade may be inadequate, since the situation is urgent and the bill can go literally for minutes. It is strictly forbidden to try to deliver a pregnant woman to the maternity hospital on their own, even if the maternity hospital is literally 3-5 minutes away from home. With any careless movement, irreparable damage can occur and this can lead to the death of the mother and child from bleeding. It is important to remember that we are already talking about two people at once, therefore, do not risk it. It is worth noting the fact that such situations rarely occur, usually with serious injuries after an accident or after falling, severe injuries and blows to the abdomen. Pregnancies usually end well.

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When talking about pregnancy and amniotic fluid, the question of oligohydramnios cannot be omitted. The state of moderate lack of water during pregnancy is not very common, usually by the end of pregnancy no more than 5% of expectant mothers suffer from this condition. Malnutrition in pregnant women is called an insufficient amount of amniotic fluid for the full development of the fetus. We have already said what important functions are performed by amniotic fluid and why there should be a strictly specified amount. In terms of composition, amniotic fluid can remain relatively constant, their complete renewal will occur approximately every three hours. If the process of production of amniotic fluid and from absorption is disrupted, then the amount of amniotic fluid may exceed the norm or be insufficient. With a deficiency of amniotic fluid, a state of low water occurs.

It is worth noting that the fact of lack of water in itself will not be any disease, this is just one of the symptoms. And then the consequences of low water will be primarily the consequences of the reasons that caused it. The presence of moderate low water by the end of pregnancy may also have a physiological nature, and then it will not pose any danger. However, on the other hand, if oligohydramnios begins in the early stages of pregnancy, and further developed to pronounced, oligohydramnios by the middle or third trimester of pregnancy can lead to sad outcomes.

The reasons for the development of low water.
The development of low water during pregnancy can be formed as a result of many reasons and at different times of pregnancy. Thus, tendencies towards oligohydramnios, manifested from the earliest stages of pregnancy, may indicate the presence of severe congenital abnormalities in the fetus. This type of low water, the causes of which may be pathologies in the structure of the fetus itself, unfortunately, are unfavorable in terms of the prognosis for the course of pregnancy and childbirth. Usually this is a congenital absence or abnormalities of the kidneys incompatible with life, and such a pregnancy is often recommended to be interrupted for medical reasons, since after birth the baby simply cannot live without kidneys.

Also, another known reason for the formation of oligohydramnios is an increase in blood pressure in the expectant mother. Usually, this condition is formed by the end of pregnancy, and the mechanisms of its occurrence are caused by dysfunctions of the placenta. This occurs as a result of impaired blood flow due to the fact that the mother has high blood pressure and small vessels in the placenta come into a state of spasm. Slight oligohydramnios may be normal in the presence of prolonged pregnancy, which is associated with the physiological aging process of the placenta. No less rare is the relative lack of water in one twin fetus. It is associated with shunting syndrome (shunting of blood) in the placenta from one baby to another. This is often referred to as fetal transfusion syndrome or "stealing" from one fetus to another. Usually, violations in the overwhelming majority of cases are insignificant and do not threaten the development of any of the children.

The reasons for the formation of oligohydramnios among pregnant women can also become the presence of chronic, old or latent genital infections that have not been previously treated or treated incorrectly, and which has passed into a latent, sluggish current state. In some cases, factors unknown to doctors become the reasons for low water among pregnant women. Theories are put forward that it is possible that there is a violation of the functions of the epithelium producing amniotic fluid in the region of the fetal bladder itself. Because of what, in this or that case, there is a lack of water, it is far from always possible to establish. However, it is always necessary to look especially carefully for the causes of oligohydramnios in pregnant women, because oligohydramnios is only a symptom, and the very reason that caused it can become dangerous for the mother and her baby.

Manifestations and symptoms of oligohydramnios during pregnancy.
The manifestations of low water during pregnancy, the symptoms of which the pregnant woman herself can reveal, will be very pronounced and severe. In such cases, there should be very, very little amniotic fluid so that the pregnant woman herself can think that something is not happening in pregnancy in the way that it should. This is extremely rare and usually in very severe pathologies. If the manifestations of lack of water are moderate, and at the same time the woman is not worried about any manifestations of pathology, there may be no external manifestations. Only with a pronounced decrease in the amount of amniotic fluid can minor signs appear, which will make it possible to assume that something is wrong with the amount of amniotic fluid.

If a pregnant woman has severe lack of water, there is very little amniotic fluid so that her baby can move peacefully inside the uterus. This leads to the formation of painful for the mother and distinct fetal movements. Women complain to the doctor that the child kicks violently and frequently and that his movements cause pain or severe discomfort. Moderate oligohydramnios, which often occurs in women, practically does not manifest itself in anything, does not have any dangerous symptoms and is diagnosed only during an ultrasound examination.

We will continue our conversation tomorrow.

The amniotic index is an indicator that characterizes the amount of amniotic fluid during pregnancy. Amniotic fluid is also called amniotic fluid: the liquid natural environment provides the baby with everything necessary for the formation of strong immunity from birth. Its volume is of great diagnostic value when examining a woman during pregnancy.

The biological environment surrounding the fetus in the mother's womb is multifunctional - the child cannot survive without it. This is what amniotic fluid is remarkable for:

• "Feeds" the growing organism. In terms of energy value, amniotic fluid can be called an ideal breeding ground for the fetus at all stages of its development. For some time after conception, beneficial substances from the amniotic fluid enter the body of the embryo, simply being absorbed through its cells. When the fetus grows up, he himself regularly swallows the surrounding fluid in small portions;
• protects the fetus from the mechanical impact of the world on the other side of the mother's belly - pressure and shocks coming from the outside are not terrible for the baby;
• protects the fetus from developing infection. The amniotic fluid is rich in immunoglobulins that keep your baby healthy. In addition, 100% closure of the fetal bladder and constant renewal of amniotic fluid provide the baby with a sterile environment for a safe existence;
• provides the child with complete freedom of action in the uterine cavity;
• mutes harsh sounds coming from the outside world.

Main characteristics of amniotic fluid

As pregnancy progresses, the quantitative and qualitative indicators of amniotic fluid are constantly changing. Deviations of these figures from the norm are of great importance for doctors - on the basis of this information, one can assume the presence or absence of certain pathologies in the expectant mother. Timely diagnostics can reduce the risk for a woman and her child even before childbirth or, in extreme cases, after the baby is born.

The amniotic fluid index (AFI) is an indicator that reflects how much amniotic fluid fills the fetal bladder at a given stage of pregnancy.

In addition, experts take into account other characteristics of the natural liquid environment in which the fetus develops:

1. Color and transparency. Normally, the amniotic fluid is colorless or slightly yellowish. This liquid is quite transparent, and the presence in it of a certain amount of fragments of the skin and hair of the fetus is not a deviation from the norm.
2. Quantity. The volume of amniotic fluid is determined by the gestational age, so when they talk about this indicator, the trimester of pregnancy must be taken into account. For example, the norm of the amniotic index at 22 weeks of an "interesting" position is 145 ml and this is the average. The lower limit reaches 89 ml and the upper limit reaches 235 ml. the volume of water increases by 40 - 45 ml every day up to 32 weeks. When the AFI reaches its highest value (144 ml at 32 weeks), the amount of fluid begins to gradually decrease. A few days before the birth of the baby, the indicators of amniotic fluid fluctuate between 0.5 - 1.500 ml.
3. The presence of hormones.
4. Biochemical and cytological indicators of the composition.

Diagnosis of amniotic fluid

Analysis of amniotic fluid using ultrasound allows you to diagnose two common abnormalities during pregnancy - oligohydramnios and polyhydramnios, as well as take timely measures to eliminate them. During the ultrasound, the specialist will determine the amniotic fluid index and establish the multiplicity of the vertical pocket. If the indicators exceed the limits of the norm or, conversely, less than them, the conclusion indicates polyhydramnios or low water.

What is a vertical pocket and what is its size for? The vertical pocket is the longest stretch of free water that lies between the baby and the anterior abdominal wall. It is undesirable for the limbs or umbilical cord of the fetus to be located in this area. The permissible length of the vertical pocket is 5 - 8 cm.

Amniotic index rate during pregnancy

To assess the volume of amniotic fluid using the amniotic fluid index, the gynecologist will divide the belly of the expectant mother into 4 sections, drawing two conditional perpendicular lines that intersect in the navel. Then, in each of the four zones, he will determine the index of the largest vertical pocket. The final index value is calculated by adding up the values ​​of all the pockets.

The rate of the amniotic index is calculated by week, starting from a period of 16 weeks. With an increase in the gestational age, the AFI indicators will also increase: the highest indicator will be at 32 weeks - 77 - 169 ml. Amniotic index rates are shown in the table.

If the AFI indicators do not coincide with the specific stages of pregnancy, the expectant mother is diagnosed with oligohydramnios or polyhydramnios.

Deviation during pregnancy: oligohydramnios

This pathology accompanies the bearing of a child quite often. The amniotic index with oligohydramnios is slightly or significantly underestimated. Moderate oligohydramnios is diagnosed when the volume of amniotic fluid differs slightly from the normal AFI. The situation can be corrected with the help of a special diet and adjusting the daily routine, then the amount of water will soon return to normal and will not affect the child's health in any way.

Malnutrition is considered pronounced if the amniotic fluid index during pregnancy is significantly less than the standard indicator. In this case, the pregnant woman is urgently sent to the hospital - the likelihood of developing complications of the child is too high. Severe lack of water can cause underdevelopment of vital organs and systems, significant curvature of the skeleton.

In addition, oligohydramnios threatens the child with a number of other complications, including:

• developmental delay;
• fusion of the fetus with the fetal membrane;
• hypoxia;
• underweight at birth;
• drying out of the child's skin due to lack of water;
• intrauterine fetal death.

When a significantly underestimated AFI was found over a long period (30 - 34 weeks), serious pathologies of the child's development are most likely already present, therefore, the question of artificial termination of pregnancy is often raised, since treatment, unfortunately, will not bring positive results.

Why oligohydramnios develops

There are many factors that directly or indirectly affect the development of oligohydramnios during pregnancy. Let's list the most likely ones:

• insufficient development of the membranes;
• reduced water production;
• abnormalities in the development of the child (problems with the kidneys and skeleton);
• high blood pressure in a pregnant woman;
• bacterial infections that have penetrated the amniotic fluid;
• pregnancy with twins or triplets;
• uneven maturation of the placenta;
• overburdening;
• impaired metabolism in a pregnant woman;
• excess weight of the expectant mother.

Signs of pathology

Low water does not manifest itself to such an extent that the pregnant woman immediately suspects that something was wrong - the clinical picture of the deviation in this case is blurred. With severe lack of water, a woman may suffer from weakness, dry mouth, and frequent nausea. Sometimes the expectant mother feels pain in the lower abdomen, which intensifies when the baby moves.

During a diagnostic study of a pregnant woman with oligohydramnios, the doctor will certainly note that the patient's uterus is too small for the current gestational age, and the fetal movement is significantly constrained. An ultrasound scan is used to confirm the diagnosis.

Specificity of treatment of oligohydramnios

Correction of oligohydramnios begins with an assessment of the test results - this is the only way the doctor can establish the cause of what happened, determine the degree of the disease and the condition of the child. Only then can a treatment plan be developed.

If pregnancy proceeds against the background of obesity and impaired metabolism in a woman, she is prescribed a special sparing diet, healthier nutrition, vitamin therapy and drugs that stimulate the blood supply to the membranes of the placenta. Moderate polyhydramnios can be treated on an outpatient basis, therapy of severe pathology is carried out exclusively in stationary conditions.

Regardless of the severity of the disease, physical activity and physical activity are minimized; in most cases, a woman is shown bed rest. During the treatment of oligohydramnios, the expectant mother will more often do ultrasound and Doppler ultrasound - these procedures will help to notice unwanted metamorphoses in the body of the mother and her child in time. When, as a result of an ultrasound examination, it turns out that at 33 weeks (and later) the AFI values ​​are too low, and the child, meanwhile, is ready to be born, the doctor will most likely decide on an early birth.

Low water during pregnancy. Video

Deviation during pregnancy: polyhydramnios

With polyhydramnios, the IAI indicators are significantly overestimated. About 1% of pregnant women face such a problem when more amniotic fluid appears than necessary. The deviation can only be detected by ultrasound examination. Statistics say that a third of pregnancies from 1% end in miscarriages.

The reasons for the development of polyhydramnios

Doctors find it difficult to say exactly what underlies the pathology, but they still identified the main risk groups. Here are the diseases in which there is a high likelihood of developing polyhydramnios:

• chromosomal breakdowns;
• chronic diseases of the heart and blood vessels;
• all stages of diabetes mellitus;
• diseases of infectious origin;
• diseases of the genitourinary system;
• Rh-conflict between a pregnant woman and a fetus;
• TORCH infections;
• kidney disease;
• severe anemia;
• severe toxicosis;
• multiple pregnancy;
• anomalies of intrauterine development of the child.

Forms of pathology

Depending on the rate of development, polyhydramnios is acute and chronic.

The acute form of the deviation develops very rapidly - literally within a few hours. This is a very serious problem, since its consequences are irreversible: the fetus either dies in the second trimester of pregnancy, or survives, but is born with severe developmental disabilities.

The chronic form of polyhydramnios does not develop immediately, therefore, with timely diagnosis, doctors have time to intervene in this process and save the child. Often, the deviation does not make itself felt in any way, and the expectant mother needs to very carefully monitor her well-being in order to go to the hospital with the slightest suspicious symptoms.

You can suspect the development of pathology by the following signs:

• painful sensations in the abdomen;
• "Stone" in the lower abdomen;
• general weakness, fatigue;
• swelling in the legs;
• dyspnea;
• fast heart rate;
• the appearance of a huge number of stretch marks on the skin;
• big belly (more than 110 - 120 cm in volume);
• enlargement of the uterus prematurely;
• persistent constipation.

Only a timely response to what is happening and competent treatment will help a woman to inform her baby.

The danger of polyhydramnios

A pathological condition can threaten a pregnant woman and her child with the following problems:

1. Miscarriage or artificial termination of pregnancy.
2. Extremely severe toxicosis in late pregnancy.
3. Fetoplacental insufficiency, due to which the full development of the child is impossible.
4. Massive bleeding.
5. Placental abruption. As a result of her premature aging, the child is deprived of nutrients and vital oxygen.
6. Premature birth. This is very dangerous, since not all premature babies are able to fight for life.
7. Insufficient labor activity or its complete absence.

For a child, the consequences of polyhydramnios are no less dangerous. Here's what can happen due to this pathology:

1. The fetus will not position itself correctly in the uterus, because of which the natural delivery will have to be replaced with a cesarean section.
2. Entanglement of the fetus with the umbilical cord, which can lead to its death.
3. Acute hypoxia of the child.
4. Development of heart and central nervous system abnormalities.
5. Infectious diseases of the fetus.

Features of the treatment of polyhydramnios during pregnancy

To improve the condition of the expectant mother with polyhydramnios, doctors will first of all conduct a comprehensive examination of her - it is necessary to establish and eliminate the cause of what happened.

In parallel with the main course of treatment, the patient is prescribed a multivitamin preparation with mandatory vitamins C, E and a group of B vitamins in its composition, preparations containing magnesium, diuretic drugs and, possibly, some antibacterial drug of a broad spectrum of action. Usually, with a chronic course of polyhydramnios, the child can be saved.

Every woman who is preparing to become a mother should at least in general terms understand what the amniotic index means during pregnancy. Often it is this kind of ignorance that prevents pregnant women from realizing how important it is to be on the lookout for a baby. Even the smallest suspicious symptoms in your well-being cannot be ignored, because behind them there can be a serious illness that threatens the well-being of the mother and baby. With the help of modern diagnostic procedures, doctors have a chance to detect and eliminate the problem in time, and the determination and assessment of the amniotic fluid index during pregnancy is one of them.

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Water is the first thing a child gets to know. Even in the womb, he floats in a fluid called amniotic fluid. What amniotic fluid looks like and what is the norm for weeks (table) of pregnancy you will learn from the article.

Why amniotic fluid is needed

Amniotic fluid is necessary for the normal development of the baby in the womb, it is needed for

• protection of the child from loud sounds, impacts (water - absorbs noise and is a shock absorber during impacts);
• maintaining a comfortable temperature (amniotic fluid has a temperature of 37 degrees);
• protection from outside threats (the amniotic fluid bubble is sealed, which allows you to protect the child from external influences);
• providing nutrition for the baby (water does not allow the bladder to shrink, preventing the umbilical cord from being squeezed);
• freedom of movement of the baby (in the 1-2 trimester, the baby can move freely, swim in the amniotic fluid).

At birth, leaving the home environment, the child experiences stress, which helps to relieve water. When the birth ligament is washed off a newborn baby, it relaxes. This is very important to prepare for a new stage in his life.

Composition and rate of amniotic fluid

The membranes of the fetus begin to form after the fertilized egg is attached to the wall of the uterus. Then a complex process starts. A protective bubble with a sterile liquid inside is formed from the membranes (amnion and chorion). As the fetus grows, the bubble expands.

Amniotic fluid is formed due to the "leakage" of the maternal blood plasma. At a later stage, the child himself, his lungs, and kidneys are already involved in the production and renewal of amniotic fluid.

Amniotic fluid consists of water (97%) with proteins dissolved in it, mineral salts (calcium, sodium, chlorine). It also contains skin cells, hair cells, aromatic substances.

There is an opinion that the smell of amniotic fluid is similar to the smell of mother's milk, so a newborn baby can easily find her mother's breast, because he drank a milk-like liquid while still in the womb.

Norm and pathology

The normal amount of amniotic fluid by the end of pregnancy is 600-1500 ml. For a number of reasons, these numbers may deviate from the norm up or down. Then doctors talk about polyhydramnios or oligohydramnios.

Low water is diagnosed when the expectant mother has less than 500 ml of amniotic fluid. The reason for the decrease in the amount of water lies in the insufficient development of the endometrium (water membrane) or a decrease in its secretory capacity. Among other causes of pathology, they call

1. anomalies in the development of the child's genitourinary system;
2. mom's hypertension;
3. inflammatory diseases of a woman;
4. metabolic disorders, obesity;
5. fetoplacental insufficiency.

Low water in one fetus when carrying twins is explained by the uneven distribution of blood in the placenta.

With oligohydramnios, severe abdominal pains, painful movements of the child are observed, the uterus is reduced, the size of its bottom does not correspond to the gestational age.

With polyhydramnios, the secretory function of the aqueous membrane is increased. Polyhydramnios can be caused by:

1. diabetes mellitus, infectious and viral diseases of the mother;
2. diseases of the heart, kidneys;
3. incompatibility of the Rh factor of the blood of the mother and the child;
4. multiple pregnancy (polyhydramnios in one fetus, oligohydramnios in another);
5. diseases of the placenta.

Signs of polyhydramnios are heaviness in the abdomen, swelling of the legs, difficulty breathing and blood circulation, the child's movements become too active.

Low water and polyhydramnios are dangerous pathologies. To eliminate them, the help of a specialist is required. At the slightest suspicion, you should consult a doctor.

Deviations in the color of amniotic fluid

Normally, the amniotic fluid is colorless and transparent. It is water-like in consistency, odorless. Most often, expectant mothers are worried about the change in the color of the amniotic fluid.

You can judge the color of amniotic fluid during their outpouring, which occurs during childbirth. In most cases, if the pregnancy is full-term, the waters are clear or cloudy yellow. This is their normal color and is not dangerous. The task of a woman after the outpouring of water is to get to the hospital within 2-3 hours.

The amniotic fluid can be different colors.

1. Red speckled. A slight admixture of blood in a fluid of a normal (light or dull yellow) color is considered normal, since it indicates the opening of the cervix.
2. Green color. The water stains the baby's original feces with a greenish or marsh color. The child is experiencing oxygen starvation, swallowing such waters is dangerous for the development of pneumonia in the baby.
3. Red. Dangerous color, indicates internal bleeding in the mother or fetus. The most correct decision is to take a horizontal position, urgently call an ambulance.
4. Dark brown. This color indicates the death of the fetus, you should immediately consult a doctor.

If the color of the amniotic fluid changes, the mother and baby may be in danger. Therefore, it is better not to get to the hospital on your own, it is worth calling an ambulance, informing about the color of the waters.

Water research methods

Today, there are several ways to obtain information about the state of the amniotic fluid before the onset of the labor process. All methods are divided into invasive (requiring direct material collection) and non-invasive (not requiring penetration into the uterine cavity).

The only non-invasive method is ultrasound. This study can provide information about the amount of amniotic fluid, allows you to diagnose oligohydramnios or polyhydramnios.

The rest of the research methods (invasive) are associated with high risks, therefore, they are carried out for serious indications.

1. Amnioscopy. Examination of the amniotic fluid with an amnioscope. This device is a tube with a lighting device at the end. Examination of the expectant mother is carried out on the gynecological chair by inserting the device into the cervix. The doctor pays attention to the color, consistency of the waters. Examination is possible after 37 weeks with suspicion of fetal hypoxia, Rh - conflict.
2. Amniocentesis. Unlike amnioscopy, amniocentesis is performed after 16 weeks of pregnancy, when the volume of fluid reaches 150 ml. a needle is inserted into the amniotic cavity under ultrasound control, a small amount of fluid is taken. For amniocentesis, serious indications are needed: suspicion of genetic diseases or intrauterine infections, Rh-conflict, insufficient oxygen supply, chronic diseases of the mother.

Invasive diagnostic methods are associated with the risks of termination of pregnancy, premature rupture of amniotic fluid, miscarriages, placental abruption. Only a doctor can prescribe the procedure.

Amniotic fluid rates by week of pregnancy

As the gestational age increases, the amount of amniotic fluid increases. The approximate calculations are as follows:

• 30 ml at 10-11 weeks;
• 100 ml for 13-14;
• 400 ml for 17-20;
• 1200ml for 36-38;
• 600-800 a few days before delivery.

The amount of amniotic fluid is individual for each expectant mother, the calculations are approximate, so doctors do not measure the amount of amniotic fluid in milliliters, using the definition of "amniotic fluid index". It is measured using an ultrasound machine from week 16. The norms look like this:

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

These numbers can be seen on the medical card, in parentheses are the average values ​​for each gestational age. Only a doctor can correctly decipher the data, since the norms of the amniotic fluid index depend on the individual characteristics of the organism.

Leakage of amniotic fluid

You can determine the leakage of amniotic fluid at home. There is a special test strip for this. The method is quite popular, but such a gasket is quite expensive (400-600 rubles), and the result is not always reliable. So a positive result can be shown not only by leaking water, but also by inflammatory diseases.

The exact result can be obtained in the hospital after examining the discharge.

The most informative way to determine water leakage is amniocentesis. A safe dye is injected into the fetal bladder with a needle, and a tampon is placed in the pregnant woman's vagina. Swab staining will show amniotic fluid leaking. This method is used in special cases when the life of the child is at risk.

Pregnancy is considered the best period in the life of every woman. Waiting for the birth of a small miracle instills happiness and fills life with bright colors. However, in addition to positive emotions, women also have others associated with fear and ignorance of many processes that occur in a pregnant woman in the body. What are the weekly amniotic fluid index rates? This is one of the questions women ponder. Let's figure it out, because the state of the fetus is determined by the values ​​of the indicator (abbreviated designation - IAZH, IOV).

Amniotic fluid concept

The fetus develops in the uterus during pregnancy. It is surrounded by fetal membranes and fluid, which is the natural environment for the fetus. It protects it from mechanical damage, creates conditions for movement and proper positioning in the uterus. For each period of pregnancy, a certain volume of fluid is characteristic. Taking it into account, experts diagnose the presence of certain diseases in the fetus.

In the first trimester, the volume of water surrounding the embryo is determined by the function of the female body. Subsequently, the fetus begins to influence the amount of fluid. It is swallowed by it and excreted in the urine. In violation of natural processes, the volume of the liquid changes up or down. Normally, at the 18th week, this figure is 300 ml. By the 34th week, it rises to 800 ml. When labor approaches, the volume of fluid decreases to 600 ml.

Calculation of the volume of amniotic fluid

There are several ways to find out the volume of amniotic fluid. The first one is subjective. A specialist during an ultrasound scan can identify deviations from the norm for some signs and characteristics:

1. An insufficient amount of fluid is observed, as a rule, in the II and III trimester. In the uterine cavity, areas of amniotic fluid that are free from the umbilical cord are not detected. The fetal body is excessively bent. The body parts are close to each other.
2. An excessive amount of fluid is most often observed in the third trimester. The anatomical features of the fetus are very well distinguishable. The lower torso is surrounded by fluid.

If you use the subjective method, you can be wrong. That is why J. Phelan proposed the calculation of the AFI. The studies carried out made it possible to determine the norms of the amniotic fluid index by week. When comparing them with the values ​​obtained during examinations of pregnant women, one can judge the presence of a lack or excess of water.

Amniotic fluid index: what is it and how is it calculated

In order to determine whether the volume of amniotic fluid corresponds to the norm, experts measure a special index. This is done during ultrasound examinations. The specialist performs the following actions:

• scans the entire uterine cavity;
• divides the area of ​​interest into 4 quadrants;
• in each quadrant visualizes the deepest pocket of amniotic fluid, free from the fetal limbs and umbilical cord;
• determines the maximum vertical depth of each pocket;
• the resulting values ​​are summed up.

The index is measured in centimeters or millimeters. The value resulting from the addition of the vertical depths is approximate. Despite this, it can accurately identify an excess (polyhydramnios) or a deficiency (low water) amniotic fluid.

Ultrasound examination in the first trimester of pregnancy

For the first time, a pregnant woman goes for a planned ultrasound scan in the first trimester. For this period, the norms of the amniotic fluid index by week have not been determined, because the fetus is very small. Scanning is performed for slightly different purposes:

• confirm pregnancy;
• clarify the term;
• clarify the location of the ovum;
• identify multiple pregnancies;
• exclude cystic drift;
• exclude false pregnancy if a woman has neoplasms in the pelvic area;
• timely diagnose tumors that in the future could interfere with the normal course of pregnancy and childbirth.

Index in the II trimester of pregnancy

The woman undergoes the next ultrasound examination in the second trimester of pregnancy, which lasts from the 14th to the 26th week. At this time, various fetometric parameters of the fetus are determined. The amniotic fluid index is also calculated. The norm at 20 weeks and at other times of the second trimester is presented in the table below.

Ultrasound scanning in the third trimester of pregnancy

The last trimester of pregnancy lasts from week 27 until delivery. During this period, every pregnant woman undergoes a final ultrasound scan. This trimester is optimal for:

• determining the amount of water;
• diagnosing fetal growth retardation;
• identification of fetal pathologies that were not detected during previous scans;
• determining the position of the fetus and identifying placenta previa;
• exclusion of any pathologies that may occur during pregnancy.

The table below shows the rates of the amniotic fluid index by week for the last trimester of the gestation period.

Polyhydramnios during pregnancy

Excessive accumulation of amniotic fluid is called polyhydramnios in the medical literature. At full-term pregnancy, their volume exceeds 1500 ml. In foreign sources, a figure equal to 2 liters is noted. The polyhydramnios index is very easy to determine. This pathology is characterized by an increase in the numerical values ​​of the indicator over the 97.5 percentile. For example, the rate of amniotic fluid index at 32 weeks can reach a maximum of 269 mm. For cases in which the IAI is greater than this figure, an excess of water is characteristic.

Polyhydramnios are divided by experts into acute and chronic. The first form of the pathological condition is diagnosed at 16-27 weeks. It is considered extremely rare. Most often, there is a chronic form of polyhydramnios. It is detected in women, as a rule, in the third trimester of pregnancy. The chronic form is characterized by an erased clinical picture.

The amniotic fluid index exceeds the norm at 30 weeks and at other times for various reasons. They are associated with inflammatory and infectious diseases of a pregnant woman, fetal pathologies (for example, with intrauterine infections, hereditary diseases, chromosome abnormalities, disorders of the digestive system, central nervous system), pathologies of the placenta.

Low water in pregnant women

Low water in medicine is considered to be a reduction in the volume of water to 500 ml or less during full-term pregnancy. Foreign sources indicate a figure characterizing this pathology - 300 ml. The diagnosis of oligohydramnios is made by doctors when the AFI values ​​are below the 5th percentile. For example, 80 mm is the amniotic fluid index at 26 weeks. It does not correspond to the norm. This is a pronounced lack of water.

The causes of low water are associated with congenital malformations of the fetus, due to which urine is not excreted in normal quantities from its body. These pathologies include renal agenesis, bilateral multicystic renal dysplasia. In some cases, the causes of low AFI and oligohydramnios are fetal growth retardation, chromosome abnormalities, intrauterine infections, chronic renal and cardiovascular diseases in a woman, gestosis, placental insufficiency, post-term pregnancy, antenatal fetal death.

The importance of calculating the index

IAI is an important indicator. For example, a comparison of the calculated amniotic fluid index at 33 weeks with the norm does not just allow fixing the presence of oligohydramnios or polyhydramnios. Thanks to the calculation of the indicator, it is possible to prevent the development of complications. Due to polyhydramnios, for example, there may be:

• incorrect presentation of the fetus;
• premature detachment of a normally located placenta;
• postpartum and prenatal bleeding;
• loss of umbilical cord loops.

Low water also has complications. It leads to intrauterine growth retardation of the fetus, the appearance of adhesions, and an increased risk of perinatal death. Children born to women diagnosed with oligohydramnios often have underdevelopment of the skeleton and lungs, low body weight.

After comparing with the norm of the amniotic fluid index at 31 weeks and at other times, after the detection of oligohydramnios or polyhydramnios, doctors prescribe appropriate treatment, determine the tactics of pregnancy and childbirth. In some cases, termination of pregnancy is required. The indications for it are a combination of polyhydramnios or oligohydramnios with intrauterine malformations and an acute form of polyhydramnios that arose before