Abnormal amniotic fluid

　　At any time during pregnancy, if the amniotic fluid volume exceeds 2000ml, it is called polyhydramnios. If the amniotic fluid volume is less than 300ml, it is called oligohydramnios. The causes of the disease are as follows: depending on the classification of the disease.

　　1. Causes of polyhydramnios

　　(1) Fetal malformation

　　Among pregnant women with polyhydramnios, about 18% to 40% are accompanied by fetal malformation, among which neural tube defects such as anencephaly, encephalocele, and spina bifida are the most common, accounting for about half.

　　(2) Multifetal pregnancy

　　Monozygotic twins are more common. If twin-to-twin transfusion syndrome occurs, the fetus with greater weight is more likely to appear. Pregnant women with diabetes, hepatitis, pregnancy-induced hypertension, abnormal blood type, and other diseases.

　　(3) Fetal placental cord lesions

　　Such as velamentous cord, placental chorioamnionitis, etc. Idiopathic polyhydramnios: No symptoms, fetal or placental abnormalities, etiology unknown.

　　2. Causes of oligohydramnios

　　(1) Fetal malformation

　　Most of them are accompanied by congenital urinary system problems, leading to oliguria or anuria in the fetus, causing oligohydramnios.

　　(2) Post-term pregnancy

　　Towards the end of pregnancy, due to placental aging, the amount of amniotic fluid tends to decrease gradually.

　　(3) Intrauterine growth restriction of the fetus

　　Sometimes, oligohydramnios is the result of intrauterine growth restriction of the fetus. The baby may not have any abnormalities, but the growth and development is slower than that of a fetus of the same gestational age. It is generally believed to be related to maternal malnutrition or viral infection.

　　Acute polyhydramnios patients may experience vulvar and lower limb edema, varicose veins due to high abdominal pressure and blocked venous return. Due to excessive uterine tension, premature labor is easy to occur. When the amniotic membrane ruptures, a large amount of amniotic fluid flows out rapidly, the uterus suddenly shrinks, which is easy to cause placental abruption.

　　羊水过少的并发症也是较严重的，主要有有妊娠期高血压疾病、胎儿生长受限、脐带缠绕、羊水粪染率及胎儿窘迫、新生儿窒息等。

　　What are the typical symptoms of amniotic fluid abnormalities

　　Amniotic fluid abnormalities include amniotic hydramnios and amniotic oligohydramnios. According to different classifications, their clinical manifestations are also different. The specific introduction is as follows:

　　Firstly, Amniotic Hydramnios

　　1. Acute Amniotic Hydramnios

　　Less common. More often occurs between 20-24 weeks of pregnancy, with a sharp increase in amniotic fluid, the uterus increases significantly in a short period of time, and a series of symptoms of compression occur: abdominal distension, difficulty in movement, facial expression of distress, difficulty in breathing, cyanosis, and even unable to lie flat.

　　2. Chronic Amniotic Hydramnios

　　More common. More often occurs in the later stages of pregnancy. The amniotic fluid increases slowly over several weeks, and the symptoms are relatively mild. There is no obvious discomfort or only slight symptoms of pressure: chest tightness, shortness of breath, tolerable.

　　Secondly, Amniotic Fluid Insufficiency

　　How to prevent abnormal amniotic fluid

　　The reasons for abnormal amniotic fluid are numerous. Through the following measures, the occurrence of abnormal amniotic fluid can be reduced.

　　1. Starting from 37 weeks of pregnancy, do B-ultrasound regularly. If amniotic fluid insufficiency is found, it can be admitted to the hospital appropriately earlier. During the period of waiting for delivery, oxygen therapy can be carried out twice a day for 3 minutes each time, and fetal heart sounds should be listened to frequently, and changes in fetal heart sounds should be paid attention to.

　　2. Teach pregnant women to self-monitor, pay attention to the changes in fetal movement, and take a left lateral position more often. At the same time, drink water reasonably, neither too much nor too little. Repeat fetal heart monitoring every 1-3 days, and also repeat B-ultrasound examination to facilitate timely understanding of the fetus's condition in utero.

　　3. During delivery, be prepared for all rescue items, and in case of amniotic fluid meconium contamination, clean the mouth, nose, and pharyngeal secretions in time, and suck out the mucous fluid and amniotic fluid containing meconium. If the situation does not improve, especially in cases with amniotic fluid turbidity accompanied by membrane rupture, it is necessary to terminate the delivery as soon as possible. If it is estimated that delivery cannot be completed in a short period of time, an emergency cesarean section should be performed in time.

　　The incidence of abnormal amniotic fluid in pregnant women is generally low, and the following examination methods can usually be used for diagnosis:

　　1. Ultrasound Examination

　　When the amniotic fluid level is greater than 7cm, it can assist in diagnosis, and can also simultaneously understand whether the fetus has malformations or twins.

　　2. Fetal Imaging in Amniotic Cavity

　　Can further understand fetal malformations, and can determine whether the fetus has malformations in the digestive tract, head, trunk, and limbs.

　　3. Determination of Amniotic Fluid Alpha-Fetoprotein (AFP) Content

　　Can assist in the diagnosis of anencephaly, spina bifida, and hydrocephalus, the content can be 4-10 times higher than normal.

　　For polyhydramnios with a normal fetus, the symptoms of pregnant women are relatively mild, and they can continue their pregnancy. They should pay attention to appropriate rest, low-salt diet, and use diuretics under the guidance of a doctor if necessary; when experiencing nausea and indigestion, they can eat more easily digestible foods such as congee, milk, and soup; when experiencing difficulty breathing, they can use soft cotton blankets to support their backs, or they can also breathe some oxygen; when experiencing edema in the lower limbs, they can elevate their lower limbs.

　　There is no food that can correct oligohydramnios. In recent years, the application of amniotic fluid cavity infusion to prevent and treat oligohydramnios in the second and third trimesters of pregnancy has achieved good results. One method is to place a pressure measurement catheter and scalp electrode in the amniotic cavity during labor and to monitor the fetus. Inject 0.85% saline at a speed of 15-20ml per minute into the amniotic cavity until the variability of fetal heart rate deceleration disappears or AFI reaches 8cm. It usually takes about 250ml (100-700ml) of normal saline to relieve the variability of fetal heart rate deceleration. If the variability of fetal heart rate deceleration does not disappear after injecting 800ml, it is considered a failure. Amniotic fluid cavity infusion can relieve umbilical cord compression, reduce the rate of variability of fetal heart rate, the rate of meconium excretion, and cesarean section rate, improve the survival rate of newborns, and is a safe, economical, and effective method. However, multiple amniotic fluid cavity infusions may have complications such as chorioamnionitis.

　　The traditional Chinese medicine name for polyhydramnios is 'Fetal Edema', also known as 'Zi Man'. Such diseases and their treatment methods and principles are recorded in medical books such as 'Beiji Qianjin Yaofang' and 'Tai Chan Xinfa'. The etiology of this disease is believed to be due to spleen deficiency, which cannot transform the body's water, or Qi blockage, leading to abnormal metabolism of amniotic fluid after its production, thus making it easy to form polyhydramnios. Treatment methods include strengthening the spleen and removing dampness, reducing water, and achieving the goal of reducing amniotic fluid. For example, the classic formula from 'Qianjin Yaofang', such as the crucian carp decoction, the specific usage is: one crucian carp, remove the internal organs, add 15g of Baizhu, 6g of Chenpi, 15g of Fuling, 12g of Danggui, 12g of Baishao, 6g of Shengjiang, boil into a concentrated decoction, remove the herbs, drink the decoction and eat the fish. It is usually effective after taking 3-5 doses. The crucian carp meat in this formula is sweet and mild, enters the spleen and stomach meridians, and has the functions of replenishing the spleen and stomach, and promoting diuresis and reducing swelling. Baizhu, Fuling, Shengjiang, and Chenpi have the functions of strengthening the spleen and regulating Qi. Combined with Danggui and Baishao to nourish blood and tranquilize the fetus, this formula can achieve the dual effect of removing water without harming the fetus.