HYDRAMNION (synonym gidramnion) — the morbid condition which is characterized by existence of excess amount of amniotic waters in an amniotic cavity (over 1,5 l). Meets in 0,3 — 0,6% of cases of childbirth.
The etiology and a pathogeny
the Aetiology and a pathogeny are studied insufficiently. Assume that M. can develop at the pregnant women suffering from a noncompensated diabetes mellitus, diseases of kidneys, cardiovascular and other diseases after postponed inf. diseases, and also owing to incompatibility of blood of mother and a fruit on a Rhesus factor. The m develops at disturbance of secretory and rezorbtsionny function of amnion (see. Fetal membranes ) usually in the middle or in the second half of pregnancy.
The course of pregnancy and influence of a hydramnion on a fruit
M. can be acute and chronic. At acute M. quantity amniotic waters (see) accrues quickly, sometimes within several days. The pregnant woman has a febricula, concern, an asthma, difficulty of breath, increase of pulse, painful feelings in a stomach, hypostases. At acute M. pregnancy, as a rule, is interrupted prematurely; the fruit often perishes or is born with malformations.
At hron. The m amount of amniotic waters increases gradually. An asthma, disturbances of cordial activity and other symptoms are expressed unsharply or can be absent. At hron. The m the course of pregnancy depends on degree of manifestation of pathology: pregnancy can prematurely be interrupted or the fruit is worn to the term of timely childbirth; sometimes the fruit is born with malformations.
The m quite often develops at an uniovular twin (see. Polycarpous pregnancy ); at the same time in an amniotic cavity of one of fruits the excess amount of amniotic waters, in a cavity of other fruit is noted — oligoamnios (see), the second fruit at the same time is developed more weakly.
the Diagnosis is made on the basis of data of a research of a uterus: increase in the sizes of a uterus does not correspond to durations of gestation, the uterus loses a usual pasty consistence, becomes tugoelastichesky and intense; the roundish or barrel-shaped uterus is palpated (it is normal of an ovoidny form). At a palpation of a stomach clear fluctuation is defined. The fruit is mobile, often changes the situation, its palpation is complicated. At easy degree of M. it is possible to define the mobile head of a fruit giving clearly the expressed feeling of balloting; at strongly expressed M. parts of a fruit are not probed. Listening of cardiac sounds of a fruit is complicated, sometimes they are not defined. At vaginal examonation the neck of uterus is shortened, quite often almost maleficiated, the bag of waters is, as a rule, intense. It is necessary to differentiate M. from polycarpous pregnancy (see), vesical drift (see), cystoma and thin-walled fast-growing cyst ovary (see), ascites (see). The diagnosis is confirmed by an electrocardiography, an ekhografiya and other methods of a research of a fruit.
Treatment of a hydramnion and tactics of conducting childbirth. At acute M., and also at a heavy current hron. M, especially at the accruing symptoms of disturbance of blood circulation and breath, abortion is shown. Hron. M, proceeding with unsharply expressed symptoms, treat conservatively (according to indications antibiotics, diuretic means, vitamins of a complex B, a diet, etc.).
Childbirth at M. often premature with untimely izlitiy amniotic waters, quite often is complicated by weakness of patrimonial forces because of restretching of a uterus, a prolapse of the umbilical cord, small parts of a fruit, the wrong provision of a fruit and insertion of its prelying part, premature placental detachment (see), a hypoxia of a fruit (see. Asphyxia of a fruit and newborn ), hypotonic bleedings (see) from a uterus. Conducting childbirth waiting. In the first period apply anesthetics, spasmolysants; even at incomplete disclosure of a uterine pharynx (on 3 — 4 cm) carefully open a bag of waters sideways, above an isthmus of a uterus, slowly, without taking out fingers from a vagina, produce amniotic waters. At weakness of patrimonial forces appoint the means strengthening sokratitelny activity of a uterus (oxytocin, prostaglandins, etc.), carry out prevention of a hypoxia of a fruit and bleeding in afterbirth and early puerperal the periods.
Forecast and Preventive measures
Forecast quite often adverse; often there come premature birth, complications in labor, septic puerperal diseases and infection of a fruit are observed. Perinatal mortality considerable; the fruit often is born with malformations.
It is difficult to carry out preventive measures since it is difficult to provide a possibility of development of this pathology. In a certain measure M.'s prevention is timely treatment of the diseases of the woman previous or accompanying pregnancy; systematic observation and treatment of pregnant women with diseases of kidneys, cardiovascular system, prevention of exacerbations of diabetes, etc.
Bibliography: Dorofeyev H. M. K to a question of the volume of amniotic waters at the full-term pregnancy, Vopr. okhr. mat. also it is put., t. 10, No. 11, page 61, 1965; it, To a problem of artificial waters in obstetrics, Kemerovo, 1966; N an e at e R. L. and. Blanc W. A. Fetal renal structure and the genesis of amniotic fluid disorders, Amer. J. Path., v. 67, p. 95, 1972.
I. V. Ilyin.