Hypamnion

Hypamnion
[Summary]



Late pregnancy less than 300 ml of amniotic fluid, called Hypamnion (oligohydramnios). Pregnancy early and middle Hypamnion more to end abortion. Oligohydramnios low, the amniotic fluid was viscous and turbidity, dark green. Hypamnion past that the incidence rate is about 0.1%, but in recent years due to B-mode ultrasonography of the extensive application of Hypamnion the detection rate of 0.5% to 4%, the incidence rate has increased. Hypamnion serious impact on the prognosis of perinatal and infant attention.



[Diagnosis]




According to clinical manifestations and auxiliary diagnosis can be made.

[Treatment]




Hypamnion fetus is dangerous, very important signal. If full-term pregnancy has been, as soon as possible induction AA, AA after less if the amniotic fluid and thick meconium serious pollution, fetal distress at the same time, it is estimated that a short period of time can not be the end of maternity leave, except in the fetal deformity, post-mortem should be selected Palace-end delivery. Cesarean section than vaginal deliveries significantly reduce perinatal mortality.

In recent years applications amniotic infusion in late pregnancy prevention Hypamnion produce good results. One way is labor amniotic manometry catheter placement and monitoring of fetal scalp electrode, 37 ℃ 0.85% saline to 15 to 20 minutes per ml of amniotic pumping speed, the drop has been slow to disappear fetal heart rate variability, or AFI reached 8 cm. Slow fetal heart rate variability normally lift about 250 ml saline infusion (100 ~ 700ml). If the infusion of 800 ml variation slowdown does not disappear for failure. Amniotic infusion can be lifted through the umbilical cord compression, slow fetal heart rate variability, and the rate of meconium from the lower rate of cesarean section and improve the survival rate of newborns, is a safe, economical and effective, but many amniotic infusion go far in a chorionic amniotic complications.


[Etiology:




The amniotic fluid production and circulation mechanism have not yet been fully clarified, many Hypamnion cases for reasons unknown.多见the following clinical situations.

1. Fetal malformations such as the absence of fetal congenital kidney, renal hypoplasia, ureter or urethral stricture by Nishao deformity or urine caused Hypamnion.

2. Prolonged pregnancy prolonged pregnancy, placental dysfunction, infusion of insufficient fetal dehydration, resulting in less amniotic fluid. Some scholars think that expired pregnancy, fetal maturity over its tubular confrontation hormone sensitivity increased urine output less lead Hypamnion. Caused by the prolonged pregnancy Hypamnion the occurrence rate of 20% to 30%.

3. Intrauterine growth retardation (IUGR) Hypamnion intrauterine growth retardation is one of the characteristics of chronic hypoxic fetal blood circulation weight distribution, the major suppliers of brain and heart, and decreased renal blood flow, reduced fetal urinary production Hypamnion result.

4. Amniotic membrane lesions electron microscope found in the amniotic epithelium oligohydramnios was less thinning, epithelial cells shrink microvilli Short, and advanced swelling number of small and squamous metaplasia phenomenon within cells rough texture and Golgi network Complex also reduced epithelial cells and the basement membrane between desmosomes and hemidesmosomes tablets reduced. Think that some unexplained Hypamnion amniotic membrane itself may be related to the disease.


[Clinical]




Pregnant women in the sense of fetal movement often abdominal pain, abdominal circumference examination revealed that the height of a smaller than the same period of pregnancy, the uterus high sensitivity, a slight stimulation can induce contractions, the labor pains after intense, more uncoordinated contractions, I Palace expansion slow, labor extension. If Hypamnion occurred in early pregnancy, and fetal membranes with matrix adhesion, causing fetal deformity, and even physical shortage. If pregnancy occurred in the late pressure around the uterus direct role in the fetus, making it easy for musculoskeletal abnormalities, such as torticollis, Qubei, hand, foot deformities. Has now been confirmed that, when inhaled a small amount of amniotic fluid pregnancy help and the expansion of fetal lung development, Hypamnion can be induced pulmonary hypoplasia. Some academics have also proposed prolonged pregnancy, intrauterine growth retardation, pregnancy-induced hypertension pregnant women, in the formal labor before a fetal heart rate changes, should consider the possibility of hypamnion. Hypamnion prone to fetal distress and neonatal asphyxia, increased perinatal mortality. Shanghai Statistics perinatal mortality, Hypamnion normal pregnancy compared to those five times higher. Therefore, focus on the prevention and treatment of diseases.


[Auxiliary]




B-mode ultrasonography in the diagnosis of this method in the diagnosis hypamnion made considerable progress, but there are different views on the diagnostic criteria. 28 weeks of pregnancy to 40 weeks, the B-diameter pool of the largest sheep stability in the line of 5.1 ± 2.1cm, the largest sheep uterine contour of the pool and depth measurements of the vertical (AFD) ≤ 2 cm for Hypamnion; ≤ 1 cm as serious Hypamnion. In recent years, advocates of amniotic fluid index (AFI). This method is more sensitive than the AFD, more accurate. AFI ≤ 8.0 cm to diagnosis Hypamnion as the critical value; ≤ 5.0 cm diagnosis Hypamnion as the absolute value. Apart from sheep pond, the B-also found in amniotic fluid and fetal interface unclear, placenta and fetal face contact and matrix obvious curly extrusion, such as fetal limb.

AA, direct measurement of amniotic fluid to less than 300 ml of amniotic fluid for the diagnosis Hypamnion standards, the nature of viscosity, turbidity, dark green. In addition, a number of amniotic membrane surface that often round or oval nodules, 2 to 4 mm in diameter, Light Sierozem yellow, opaque, includes rehabilitation of squamous cell and fetal fat. Direct measurement method is not the greatest shortcomings of early diagnosis.