Malnutrition during pregnancy: causes, effects and treatment
May 25, 2018
In obstetrical practice under malovodium( oligohydramnion), a reduced amount of amniotic fluid( amniotic) is meant.In the case of a full-term pregnancy at the term of 40-41 weeks, the amount is less than 500 ml.For earlier terms, norms are established( with the possible maximum and minimum), determined by special methods, which we consider below.
Quantitatively, amniotic fluid is a dynamic unit, constantly changing in volume. Their secretion begins approximately from 8 weeks of pregnancy, continuing until the onset of labor.Table of Contents: Causes of development of hypochlorism in pregnancy Variants of classification of malnutrition Diagnosis of malnutrition in pregnant women
According to specially created tables from 14 weeks of pregnancy, the doctor has the ability to determine the norm, an increased and lower number of amniotic fluid in a pregnant woman. If the future mother has a history of low water, and after a while it is included in the parameters of the norm, then one should think about functional disorders.
Note : most of these conditions are not pathological and do not pose a hazard for pregnancy.
In the case of constancy of the increased index for several weeks, doctors begin to suspect the existing pathology of .To differentiate this condition, an ultrasound is made to pregnant women, in which the expert can definitely draw a conclusion about whether there are any defects in the development of the placenta and the baby, or not.
In the presence of pathological inferiority, a complex of developmental malformations of the developing fetus can arise.Ultrasound can make a preliminary output of .In case of suspicion of true hypotension, the study is necessarily supplemented by cardiotocography( CTG), dopplerometry, biochemical analyzes( ACE, hCG).
Causes of development of hypochlorism in pregnancy
Several factors that can be considered in groups are among the factors that contribute to low water quality:
- Congenital malformations of a developing child. These include: lack of or insufficient degree of development of the valve apparatus of the urethra, absence or significant constriction of the canal, pronounced narrowing of the ureters on both sides, complete absence of kidneys, absence of the anterior wall muscles in the infant( syndrome of the undercut stomach), polycystic kidney pathology( syndromePotter I, and Potter II syndrome).
- Acquired pathology of the developing fetus. Intrauterine infection with certain types of pathological microorganisms - cytomegaloviruses, chlamydia, ureaplasmas, etc., developmental delays, chromosomal pathologies( eg Down's syndrome).
- Diseases of a pregnant woman. Cardiovascular pathology( hypertension, arterial and venous diseases), expressed toxemia of pregnancy, systemic connective tissue diseases( systemic lupus erythematosus, rheumatoid arthritis, etc.), metabolic pathology - diabetes mellitus, alimentary obesity, endocrine diseases( thyroidGlands), conditions that cause a pronounced dehydration in a woman( vomiting, diarrhea), chronic intoxication( alcohol, smoking).
- Placental pathology. Functional deficiency of the placenta, infarcts, anomalies( atrophic and sclerotic changes in the membranes, necrosis of the amnion).
- Others. This group includes: a pregnant pregnancy, violation of the integrity of the membranes( tearing, full rupture), fetal death of the child, inoculum with an unknown cause, drug hypochondria( against indomethacin, naproxen and other drugs).
Please note : waterlogging caused by most of the causes can be successfully treated with therapeutic effects other than malformations.
Among the many reasons for this condition can be identified the main:
- gestosis ( toxicosis of pregnancy) leading to loss of fluid;
- hypertensive disease of in pregnant women.Constantly increased pressure figures leading to disruption of water-salt metabolism, leading to low water level;
- diabetes mellitus. Hormonal-enzymatic failures in this condition cause disruption of the formation and functionality of amniotic fluid;
- infectious diseases - acute forms of angina, bacterial damage of the kidneys( nephritis, pyelitis), medium and severe forms of viral infections( influenza, torch complex - herpes, measles rubella, toxoplasma);
- state of chronic hypoxia of the developing child .
Variants of classification of malnutrition
Classification taking into account the duration( speed) of the development of pathology:
- Acute bareness - it is characterized by a rapid onset.In most cases, the acute variant is benign and is treated quite well by eliminating the cause that caused it.Most often this condition develops against the background of acute infectious processes;
- chronic aspiration - requires a thorough examination of the pregnant woman for the purpose of finding the causal pathology.The development of this condition is slow and requires compulsory treatment, since without it it does not go away on its own.
Types of malaria, depending on the duration of pregnancy:
- earlier - is determined during 16-20 weeks from the beginning of pregnancy.Detection of pathology at these times is a finding in ultrasound diagnosis.The most probable cause of this problem is changes in the membranes.From the prognostic position - a more unfavorable form, in connection with the initial stages of the formation of organs;
- later - from 26 weeks, until delivery.The main cause is the pathology of the fetus.Most often refers to functional types of malnutrition.
Based on pathological changes in the membranes, the following is distinguished:
- Primary malnutrition ( for whole fetal membranes).The emergence of malnutrition in this case is caused by violations of fetal formation, placental pathology, serious chronic diseases in the future mother.
- secondary maltreatment of - is a consequence of traumatic changes in the membranes.
Most often doctors face primary low water.
Diagnostic criteria for the determination of hypoabrasion in pregnant women
The doctor may be at risk of this problem during routine examinations.
Signs of lack of water are:
- Insufficiency of abdominal circumference and height of uterine standing during pregnancy development.Indicators do not match the deadline;
- inadequate activity of the child being formed( less than 12-10 traffic signs per day);
- low IOL( amniotic fluid index).More about it will be discussed later.
Note : Primarily suspected malnutrition is not a basis for establishing a diagnosis, but only a functional disorder.A painful condition is confirmed after a dynamic observation of the development of pregnancy, on the basis of repeated examinations( at least 3, with an interval of 2 weeks).
If during this time the problem has not gone away, then the specialist has every reason to establish a diagnosis - hypochlorism.
More precisely this condition reveals the method of ultrasound.But all the same, requires confirmation of 3 studies performed at the above-mentioned time interval to confirm pathological, rather than functional, inadequacy.
If, after the first ultrasound diagnosis, the doctor still suspects the onset of the development of true hypochondria, then he prescribes cardiotocography( KGT), which accurately determines whether the fetus has a problem or not. Suspected of changes in the placenta, Doppler is recommended. With the problem indicators of these studies, you can immediately diagnose pathological hypotension, without waiting for dynamic ultrasound data.
- vitamin therapy( especially in groups of vitamins B and C);
- predominantly protein-vegetable diet;
In the 3rd trimester:
- hospitalization in the antenatal clinic;
- continued therapy with vitamins and diet;
- is assigned to Kurantil, as a means of improving the process of circulation in the placental tissue;
- recommended Actovegin, as a drug that promotes active oxygenation of the developing baby;
- symptomatic therapy of high blood pressure;
- normalization of blood sugar;
- treatment of all causative pathologies - infectious, and identified diseases of internal organs;
During daily medical treatment, KGT is monitored daily.Other methods - as needed.
If the condition of the child worsens, emergency delivery( caesarean section) is used.
Prognosis for functional infertility - favorable.In other cases, the outcome is determined individually.
Alexander Lotin, medical reviewer