What to do when pregnant mother is lacking amniotic fluid?

The article was professionally consulted by Specialist Doctor II Bui Minh Phuc - Department of Obstetrics and Gynecology - Vinmec Ha Long International General Hospital.

Amniotic fluid plays an important role in the survival and development of the fetus. In case the amount of amniotic fluid in the mother's womb is low, which is called oligohydramnios, there are potential risks such as causing pulmonary hypoplasia, club limbs, umbilical cord compression, etc. timely prevention and treatment. Below is the advice of Doctor Bui Minh Phuc, Department of Obstetrics and Gynecology, Vinmec Ha Long Hospital.

Oliguria is a condition in which amniotic fluid is less than normal, when the amniotic index (AFI) is less than 5cm and the amniotic membrane is intact.

If the mother has some diseases such as: high blood pressure, pre-eclampsia, liver disease, kidney disease, ... will cause poor fetal development and amniotic fluid regeneration function. Because these diseases affect the function of the placenta and the permeability of the amniotic membrane. Mother taking some drugs: ACE inhibitor. Inhibits Prostaglandin Synthesis...

At every stage of pregnancy, the most common cause of oligohydramnios is premature rupture of membranes. There are often some congenital abnormalities of pregnancy with oligohydramnios. The most common fetal abnormalities associated with oligohydramnios are:
Chromosomal abnormalities. Congenital malformations: Urinary, digestive, respiratory,... Fetal growth retardation in utero. Pregnancy past the date of birth. Fetal infection.

Premature rupture of membranes, premature rupture of membranes. Infarction of the placenta. Fetal transfusion syndrome.

The measurement and height of the uterus is usually lower and smaller for gestational age and tends to go down compared to the standard curve.
Weak movement of the fetus . When performing 4 procedures of Leopol, there is a clear feeling of the fetal parts lying close to the hand without feeling amniotic fluid, difficult to move the fetal head. Ultrasound has a low amniotic index, usually below the 5th percentile for gestational age or when gestational age after 35 weeks has an amniotic fluid index (AFI) ≤5, or maximum amniotic fluidity is ≤2.

The feeling of the mothers who monitor the baby's movements is reduced, the belly is not big. When measuring the height of the uterus, it is found to increase slowly, the fetus feels close to the abdomen when palpated. A fetal ultrasound revealed a lack of amniotic fluid. There are 2 levels of oligohydramnios:
Severe amniotic fluid loss if the amniotic index is 3-5cm. Amniotic fluid when measured amniotic index < 3m. If ultrasound confirms oligohydramnios, further examination of fetal abnormalities, placenta and umbilical cord should be performed. Fetal risk prognosis is based on each stage of oligohydramnios:
Lack of amniotic fluid in the first 3 months, the risk of miscarriage is high from 65-80%. In the second trimester of oligohydramnios, the risk of fetal malformations is high. Low amniotic fluid in the last 3 months of pregnancy, the possibility of fetal malnutrition.

First, the history should be taken and a vaginal discharge test (Nitrazine test) to rule out amniotic fluid leakage, ruptured membranes. Then, perform prenatal ultrasound to survey and detect fetal morphological abnormalities, especially fetal urinary system pathology such as renal dysplasia, urinary tract obstruction. The patient will be advised of the benefits and complications, conduct amniotic fluid transfer procedure in case the amniotic fluid is too little to interfere with the fetal morphological investigation. In addition, amniotic fluid can be taken simultaneously for immunological and genetic testing to reduce compression of the umbilical cord and fetal movement. In case of associated intrauterine growth retardation, fetal echocardiography should be performed. , Doppler ultrasound (AFI, middle cerebral artery Doppler), obstetric monitor,...

If lack of amniotic fluid without major congenital malformations in the urinary, digestive, nervous systems, etc., it may be due to failure or partial obstruction of the utero-placental circulation, the patient lies on the left side, control comorbidities, ensure adequate nutrition to improve uterine - placental circulation in order to try to keep the pregnancy developing evenly over 35 weeks. In case of oligohydramnios and fetal structural malformations, further tests are required to determine whether there are chromosomal abnormalities or not to decide on treatment to keep the pregnancy or to terminate the pregnancy. The case of intrauterine growth retardation without a cause will depend on the progress of fetal distress in the uterus. The possibility of termination of pregnancy should be considered in the presence of fetal distress and/or mature fetal lungs. Indications to use drugs to support fetal lung maturation are necessary.

When it is confirmed that the pregnancy is full term and oligohydramnios is present, monitoring should be done. If the fetal heart rate slows or changes during the test are not performed or during the test, a cesarean section should be indicated to terminate the pregnancy. If the fetal heart rate test is still within the normal range, the Bishop index should be further evaluated to indicate the induction of labor.

oligohydramnios increases the risk of fetal distress and difficult delivery because of compression of the umbilical cord and difficulty in normalization of the fetus during labor. Therefore, it is necessary to closely monitor labor factors for timely prognosis and management. It is necessary to closely monitor labor factors for timely prognosis and management.

Depending on the condition, cause and gestational age, the lack of amniotic fluid will affect more or less.
In case a pregnant woman has a lack of amniotic fluid in the first 3 months of pregnancy or a few weeks after, there is a possibility of miscarriage and stillbirth. At the same time, this will also affect the development and lung function of the fetus. In case the mother has a lack of amniotic fluid in the last 3 months of pregnancy, the mother can be somewhat relieved because most of them do not cause dangerous complications. The patient will be closely monitored the health of both mother and child and may be given water to replenish amniotic fluid for pregnant women. However, oligohydramnios during this stage can cause the fetal position to be reversed because there is not enough amniotic fluid needed to rotate the head downwards. Lack of amniotic fluid can also lead to premature rupture of membranes. The doctor will consider the risk of amniotic fluid infection and the condition of the fetus to decide whether to intervene to help the mother deliver early.

Mothers should practice the habit of drinking plenty of water per day on average 2 liters / day such as mineral water, fruit juice. Combined with adequate nutrition, it helps to prevent low amniotic fluid or lack of amniotic fluid, especially in the last 3 months of pregnancy.
Low amniotic fluid causes severe consequences for the fetus as well as psychological panic for pregnant women. Therefore, do not forget the regular antenatal check-ups as directed by the obstetrician, to detect early and promptly treat any complications that may occur during pregnancy.

Amniotic fluid deficiency in the last 3 months of pregnancy is especially dangerous, reflecting the poor health of the mother and the fetus. Therefore, during this period, you should have regular prenatal check-ups for early detection and timely intervention. You should choose reputable medical facilities with a team of highly qualified and experienced obstetricians and gynecologists who are experienced in diagnosing and handling problems with amniotic fluid and premature birth.
To protect the health of mother and baby comprehensively as well as help mothers feel more secure during labor, Vinmec offers a Package Maternity Care Program. With this package, the mother will have regular antenatal check-ups and routine tests to monitor her health. The fetus is monitored for fetal heart rate and uterine contractions by obstetric monitor at 37-40 weeks of expected time of delivery. If the baby is born prematurely, they will be cared for and raised with international standards. Premature births are organized in a methodical manner under the coordination of many specialties: obstetrics, anesthesiology, and especially neonatology and paediatrics. This helps to reduce the risks and increase the effectiveness of treatment for health problems that premature babies may have. Currently, Vinmec is the only hospital in the North that can save 24 weeks premature babies.