Выявление маловодия во II триместре беременности является высоким риском летального исхода у плода и новорожденного. Известна динамика увеличения количества вод с увеличением срока беременности в норме. На современном этапе диагностика маловодия осуществляется при помощи ультразвукового исследования. Измерение вертикальных карманов околоплодных вод является основой для вычисления индекса околоплодной жидкости. Имеются технические проблемы в точной оценке количества околоплодных вод, особенно во II триместре. Высказано предположение о перспективах использования 3D/4D-ультразвука в таких случаях. Ключевые слова: беременность, маловодие, кальцификаты, внутриутробная инфекция, полное отсутствие вод.
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The identification of oligohydramnios during the second trimester of pregnancy is a high risk of death in the fetus and newborn. Known growth of volume amnion with increasing gestation of pregnancy is normal. At the present stage oligohydramnios diagnosis is carried out using ultrasound. Measurement of the vertical pockets of amniotic fluid is the basis for calculating the index of amniotic fluid. There are technical problems in accurate estimation of the amount of amniotic fluid especially in the II trimester. Show the assumption on the prospects of using 3D/4D ultrasound such cases. Key words: pregnancy, oligohydramnion, calcifications, intrauterine infection, ahydramnion.
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9. Савельева Г.М., Сухих Г.Т., Серов В.Н., Радзинский В.Е. Акушерство. Национальное руководство. М.: ГЭОТАР-Медиа, 2015. / Savel'eva G.M., Sukhikh G.T., Serov V.N., Radzinskii V.E. Akusherstvo. Natsional'noe rukovodstvo. M.: GEOTAR-Media, 2015. [in Russian]
10. Сичинава Л.Г., Горюшина Н.Б., Устинова В.А. Течение беременности и родов при маловодии. Акуш. и гинекол. 2003; 2: 25–8. / Sichinava L.G., Goriushina N.B., Ustinova V.A. Techenie beremennosti i rodov pri malovodii. Akush. i ginekol. 2003; 2: 25–8. [in Russian]
11. Цхай В.Б., Фадеев С.В. Взаимосвязь между количественной патологией околоплодной среды и состоянием плода. Журн. Рос. общест. акуш. гинекол. 2008; 4: 22–3. / Tskhai V.B., Fadeev S.V. Vzaimosviaz' mezhdu kolichestvennoi patologiei okoloplodnoi sredy i sostoianiem ploda. Zhurn. Ros. obshchest. akush. ginekol. 2008; 4: 22–3. [in Russian]
12. Abdel-Fattah SA, Bhat A, Illanes S, Bartha JL. TORCH test for fetal medicine indications: only CMV is necessary in the United Kingdom Prenat Diagn 2005; 25: (11): 1028–31.
13. Ahmad H, Munim S. Isolated oligohydramnios is not an indicator for adverse perinatal outcome. J Pak Med Assoc 2009; 59 (10): 691–4.
14. Akter MD, Kabir N, Shah MS, Islam F. Effect of maternal oral hydration therapy in oligohydramnios. Mymensingh Med J 2012; 21 (4): 723–8.
15. Alberry М, Soothill Р. Management of fetal growth restriction. Arch Dis Child Fetal Neonatal Ed 2007; 92 (1): 62–7.
16. Benacerraf BR. Examination of the second-trimester fetus with severe oligohydramnios using transvaginal scanning. Obstet Gynecol 1990; 75 (3): 491–3.
17. Camanni D, Zaccara A, Capitanucci ML et al. Acute oligohydramnios: antenatal expression of VURD syndrome? Fetal Diagn Ther 2009; 26 (4): 185–8.
18. Chhabra S, Dargan R, Bawaskar R. Oligohydramnios: a potential marker for serious obstetric complications. J Obstet Gynaecol 2007; 27 (7): 680–3.
19. Ch HN. Heparin successfully improved an early onset intrauterine growth restriction accompanied by severe oligohydramnios. Int J Gen Med 2008; 1: 1–2.
20. Grijseels EW, van-Hornstra PT, Govaerts LC et al. Outcome of pregnancies complicated by oligohydramnios or anhydramnios of renal origin. Prenat Diagn 2011; 31 (11): 1039–45.
21. Guin G, Punekar S, Lele A, Khare SA. Рrospective clinical study of feto-maternal outcome in pregnancies with abnormal liquor volume. J Obstet Gynaecol India 2011; 61 (6): 652–5.
22. Hashimoto BE, Kramer DJ, Brennan L. Amniotic fluid volume: fluid dynamics and measurement technique. Semin Ultrasound 1993; 14 (1): 40–55.
23. Hsu TL, Hsu TY, Tsai CC, Ou CY. The experience of amnioinfusion for oligohydramnios during the early second trimester. Taiwan J Obstet Gynecol 2007; 46 (4): 395–8.
24. Jiang SS, Zhu XJ, Ding SD et al. Expression and localization of aquaporins 8 and 9 in term placenta with oligohydramnios. Reprod Sci 2012; 19 (12): 1276–84.
25. Kim BJ, Romero R, Mi Lee S et al. Clinical significance of oligohydramnios in patients with preterm labor and intact membranes. J Perinat Med 2011; 39 (2): 131–6.
26. Lacoste M, Cai Y, Guicharnaud L et al. Renal tubular dysgenesis, a not uncommon autosomal recessive disorder leading to oligohydramnios: Role of the Renin-Angiotensin system. J Am Soc Nephrol 2006; 17 (8): 2253–63.
27. Leibovitch L, Kuint J, Rosenfeld E et al. Short-term outcome among term singleton infants with intrapartum oligohydramnios. Acta Paediatr 2012; 101 (7): 727–30.
28. Lowenstein L, Solt I, Reiss A et al. Prenatal imaging of the Meckel-Gruber syndrome. Harefuah 2004; 143 (3): 182–3.
29. Magann EF, Haas DM, Hill JB et al. Oligohydramnios, small for gestational age and pregnancy outcomes: an analysis using precise measures. Gynecol Obstet Invest 2011; 72 (4): 239–44.
30. Manzanares S, Carrillo MP, González-Perán E et al. Isolated oligohydramnios in term pregnancy as an indication for induction of labor. J Matern Fetal Neonatal Med 2007; 20 (3): 221–4.
31. Mehler K, Beck BB, Kaul I et al. Respiratory and general outcome in neonates with renal oligohydramnios – a single-centre experience. Nephrol Dial Transplant 2011; 26 (11): 3514–22.
32. Mittermayer C, Lee A, Brugger PC. Prenatal diagnosis of the Meckel-Gruber syndrome from 11th to 20th gestational week. Ultraschall Med 2004; 25 (4): 275–9.
33. Moore TR. Sonographie screening for oligohydramnios: does it decrease or increase morbidity? Obstet Gynecol 2004; 104 (1): 3–4.
34. Peshev ZV, Krusteva MB, Danev VH. A case of prune belly syndrome. Folia Med (Plovdiv) 2000; 42 (1): 66–8.
35. Petrozella LN, Dashe JS, McIntire DD, Leveno KJ. Clinical significance of borderline amniotic fluid index and oligohydramnios in preterm pregnancy. Obstet Gynecol 2011; 117 (2). Pt 1: 338–42.
36. Rossi AC, Prefumo F. Perinatal outcomes of isolated oligohydramnios at term and post-term pregnancy: a systematic review of literature with meta-analysis. Eur J Obstet Gynecol Reprod Biol 2013; 169 (2): 149–54.
37. Tassin M, Martinovic J, Mirand A et al. A case of congenital Echovirus 11 infection acquired early in pregnancy. J Clin Virol 2014; 59 (1): 71–3.
38. Tsankova M, Marinov B. Characteristics of the severe fetalanomalies terminated in general obstetrics department for 4,5 years period. Akush Gineko (Sofiia) 2011; 50 (4): 22–9.
39. Van Teeffelen AS, van der Ham DP, Oei SG et al. The accuracy of clinical parameters in the prediction of perinatal pulmonary hypoplasia secondary to midtrimesterprelabour rupture of fetal membranes: a meta-analysis. Eur J Obstet Gynecol Reprod Biol 2010; 148 (1): 3–12.
40. Vermillion ST, Kooba AM, Soper DE. Amniotic fluid index values after preterm premature rupture of the membranes and subsequent perinatal infection. Am J Obstet Gynecol 2000; 183 (2): 271.
41. Vink J, Hickey K, Ghidini A et al. Earlier gestational age at ultrasound evaluation predicts adverse neonatal outcomes in the preterm appropriate-for-gestational-age fetus with idiopathic oligohydramnios. J Perinatol 2009; 26 (1): 25–6.
42. Weichert A, Vogt M, Dudenhausen JW, Kalache KD. Evidence in a human fetus of micrognathia and cleft lip as potential effects of early cytomegalovirus infection. Fetal Diagn Ther 2010; 28 (4): 225–8.
43. Williams Obsetrics, 24 th EDITION, McGraw-Hill Education, New York, 2014; p. 2968.
44. Zhang J, Troendle J, Meikle S et al. Isolated oligohydramnios is not associated with adverse perinatal outcomes. Br J Obstet Gynaecol 2004; 111 (3): 220–5.
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1. Ailamazian E.K., Kulakov V.E., Radzinskii V.E., Savel'eva G.M. Akusherstvo. Rukovodstvo. M.: GEOTAR-Media, 2013; s. 420–5. [in Russian]
2. Voevodin S.M., Shemanaeva T.V., Dubova E.A. Ul'trazvukovaia i kliniko-morfologicheskaia otsenka platsentarnoi disfunktsii pri kriticheskom sostoianii u ploda. Gynecology. 2013; 15 (5): 65–9. [in Russian]
3. Kondrat'eva E.N. Patogenez, diagnostika i profilaktika oslozhnennogo techeniia rodov pri patologii okoloplodnoi sredy. Dis. … d-ra med. nauk. M., 1991. [in Russian]
4. Lutsenko N.N. Optimizatsiia dlitel'nosti prolongirovaniia nedonoshennoi beremennosti, oslozhnennoi prezhdevremennym razryvom plodnykh obolochek. Avtoref. dis. … kand. med. nauk. M., 2008. [in Russian]
5. Makarov O.V., Kozlov P.V., Nikolaev N.N. Sovremennye perinatal'nye podkhody pri vedenii nedonoshennoi beremennosti, oslozhnennoi prezhdevremennym razryvom plodnykh obolochek. Vestn. RGMU. 2006; 4 (51): 64–7. [in Russian]
6. Pustotina O.A., Gurtovoi B.L., Pavliutenkova Iu.A., Mel'ko A.I. Chastota, faktory riska i prichiny razvitiia malo- i mnogovodiia. Akush. i ginekol. 2005; 5: 19–22. [in Russian]
7. Radzinskii V.E., Kondrat'eva E.N., Milovanov A.P. Patologiia okoloplodnoi sredy. Kiev, 1993. [in Russian]
8. Rudenko A.V. Prognosticheskie i rannie diagnosticheskie kriterii infektsionnykh oslozhnenii materi pri nedonoshennoi beremennosti, oslozhnennoi prezhdevremennym razryvom plodnykh obolochek. Avtoref. dis. … kand. med. nauk. M., 2008. [in Russian]
9. Savel'eva G.M., Sukhikh G.T., Serov V.N., Radzinskii V.E. Akusherstvo. Natsional'noe rukovodstvo. M.: GEOTAR-Media, 2015. [in Russian]
10. Sichinava L.G., Goriushina N.B., Ustinova V.A. Techenie beremennosti i rodov pri malovodii. Akush. i ginekol. 2003; 2: 25–8. [in Russian]
11. Tskhai V.B., Fadeev S.V. Vzaimosviaz' mezhdu kolichestvennoi patologiei okoloplodnoi sredy i sostoianiem ploda. Zhurn. Ros. obshchest. akush. ginekol. 2008; 4: 22–3. [in Russian]
12. Abdel-Fattah SA, Bhat A, Illanes S, Bartha JL. TORCH test for fetal medicine indications: only CMV is necessary in the United Kingdom Prenat Diagn 2005; 25: (11): 1028–31.
13. Ahmad H, Munim S. Isolated oligohydramnios is not an indicator for adverse perinatal outcome. J Pak Med Assoc 2009; 59 (10): 691–4.
14. Akter MD, Kabir N, Shah MS, Islam F. Effect of maternal oral hydration therapy in oligohydramnios. Mymensingh Med J 2012; 21 (4): 723–8.
15. Alberry М, Soothill Р. Management of fetal growth restriction. Arch Dis Child Fetal Neonatal Ed 2007; 92 (1): 62–7.
16. Benacerraf BR. Examination of the second-trimester fetus with severe oligohydramnios using transvaginal scanning. Obstet Gynecol 1990; 75 (3): 491–3.
17. Camanni D, Zaccara A, Capitanucci ML et al. Acute oligohydramnios: antenatal expression of VURD syndrome? Fetal Diagn Ther 2009; 26 (4): 185–8.
18. Chhabra S, Dargan R, Bawaskar R. Oligohydramnios: a potential marker for serious obstetric complications. J Obstet Gynaecol 2007; 27 (7): 680–3.
19. Ch HN. Heparin successfully improved an early onset intrauterine growth restriction accompanied by severe oligohydramnios. Int J Gen Med 2008; 1: 1–2.
20. Grijseels EW, van-Hornstra PT, Govaerts LC et al. Outcome of pregnancies complicated by oligohydramnios or anhydramnios of renal origin. Prenat Diagn 2011; 31 (11): 1039–45.
21. Guin G, Punekar S, Lele A, Khare SA. Рrospective clinical study of feto-maternal outcome in pregnancies with abnormal liquor volume. J Obstet Gynaecol India 2011; 61 (6): 652–5.
22. Hashimoto BE, Kramer DJ, Brennan L. Amniotic fluid volume: fluid dynamics and measurement technique. Semin Ultrasound 1993; 14 (1): 40–55.
23. Hsu TL, Hsu TY, Tsai CC, Ou CY. The experience of amnioinfusion for oligohydramnios during the early second trimester. Taiwan J Obstet Gynecol 2007; 46 (4): 395–8.
24. Jiang SS, Zhu XJ, Ding SD et al. Expression and localization of aquaporins 8 and 9 in term placenta with oligohydramnios. Reprod Sci 2012; 19 (12): 1276–84.
25. Kim BJ, Romero R, Mi Lee S et al. Clinical significance of oligohydramnios in patients with preterm labor and intact membranes. J Perinat Med 2011; 39 (2): 131–6.
26. Lacoste M, Cai Y, Guicharnaud L et al. Renal tubular dysgenesis, a not uncommon autosomal recessive disorder leading to oligohydramnios: Role of the Renin-Angiotensin system. J Am Soc Nephrol 2006; 17 (8): 2253–63.
27. Leibovitch L, Kuint J, Rosenfeld E et al. Short-term outcome among term singleton infants with intrapartum oligohydramnios. Acta Paediatr 2012; 101 (7): 727–30.
28. Lowenstein L, Solt I, Reiss A et al. Prenatal imaging of the Meckel-Gruber syndrome. Harefuah 2004; 143 (3): 182–3.
29. Magann EF, Haas DM, Hill JB et al. Oligohydramnios, small for gestational age and pregnancy outcomes: an analysis using precise measures. Gynecol Obstet Invest 2011; 72 (4): 239–44.
30. Manzanares S, Carrillo MP, González-Perán E et al. Isolated oligohydramnios in term pregnancy as an indication for induction of labor. J Matern Fetal Neonatal Med 2007; 20 (3): 221–4.
31. Mehler K, Beck BB, Kaul I et al. Respiratory and general outcome in neonates with renal oligohydramnios – a single-centre experience. Nephrol Dial Transplant 2011; 26 (11): 3514–22.
32. Mittermayer C, Lee A, Brugger PC. Prenatal diagnosis of the Meckel-Gruber syndrome from 11th to 20th gestational week. Ultraschall Med 2004; 25 (4): 275–9.
33. Moore TR. Sonographie screening for oligohydramnios: does it decrease or increase morbidity? Obstet Gynecol 2004; 104 (1): 3–4.
34. Peshev ZV, Krusteva MB, Danev VH. A case of prune belly syndrome. Folia Med (Plovdiv) 2000; 42 (1): 66–8.
35. Petrozella LN, Dashe JS, McIntire DD, Leveno KJ. Clinical significance of borderline amniotic fluid index and oligohydramnios in preterm pregnancy. Obstet Gynecol 2011; 117 (2). Pt 1: 338–42.
36. Rossi AC, Prefumo F. Perinatal outcomes of isolated oligohydramnios at term and post-term pregnancy: a systematic review of literature with meta-analysis. Eur J Obstet Gynecol Reprod Biol 2013; 169 (2): 149–54.
37. Tassin M, Martinovic J, Mirand A et al. A case of congenital Echovirus 11 infection acquired early in pregnancy. J Clin Virol 2014; 59 (1): 71–3.
38. Tsankova M, Marinov B. Characteristics of the severe fetalanomalies terminated in general obstetrics department for 4,5 years period. Akush Gineko (Sofiia) 2011; 50 (4): 22–9.
39. Van Teeffelen AS, van der Ham DP, Oei SG et al. The accuracy of clinical parameters in the prediction of perinatal pulmonary hypoplasia secondary to midtrimesterprelabour rupture of fetal membranes: a meta-analysis. Eur J Obstet Gynecol Reprod Biol 2010; 148 (1): 3–12.
40. Vermillion ST, Kooba AM, Soper DE. Amniotic fluid index values after preterm premature rupture of the membranes and subsequent perinatal infection. Am J Obstet Gynecol 2000; 183 (2): 271.
41. Vink J, Hickey K, Ghidini A et al. Earlier gestational age at ultrasound evaluation predicts adverse neonatal outcomes in the preterm appropriate-for-gestational-age fetus with idiopathic oligohydramnios. J Perinatol 2009; 26 (1): 25–6.
42. Weichert A, Vogt M, Dudenhausen JW, Kalache KD. Evidence in a human fetus of micrognathia and cleft lip as potential effects of early cytomegalovirus infection. Fetal Diagn Ther 2010; 28 (4): 225–8.
43. Williams Obsetrics, 24 th EDITION, McGraw-Hill Education, New York, 2014; p. 2968.
44. Zhang J, Troendle J, Meikle S et al. Isolated oligohydramnios is not associated with adverse perinatal outcomes. Br J Obstet Gynaecol 2004; 111 (3): 220–5.
Авторы
С.М.Воеводин*1, Т.В.Шеманаева2, А.В.Cерова3
1. ФГБОУ ВО «Московский государственный медико-стоматологический университет им. А.И.Евдокимова» Минздрава России. 127473, Россия, Москва, ул. Делегатская, д. 20, стр. 1;
2. ФГАОУ ВО «Первый Московский государственный университет им. И.М.Сеченова» Минздрава России. 119991, Россия, Москва, ул. Трубецкая, д. 8, стр. 2;
3. ФГБОУ ВО «Тверской государственный медицинский университет» Минздрава России. 170100, Россия, Тверь, ул. Советская, д. 4
*voevod37@yandex.ru
________________________________________________
S.M.Voevodin*1, T.V.Shemanaeva2, A.V.Serova3
1. A.I.Evdokimov Moscow State University of Medicine and Dentistry of the Ministry of Health of the Russian Federation. 127473, Russian Federation, Moscow, ul. Delegatskaia, d. 20, str. 1;
2. I.M.Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation. 119991, Russian Federation, Moscow, ul. Trubetskaia, d. 8, str. 2;
3. Tver State Medical University of the Ministry of Health of the Russian Federation. 170100, Russian Federation, Tver, ul. Sovetskaja, d. 4
*voevod37@yandex.ru