Meconium in amniotic fluid: why does it manifest itself and why is the condition dangerous for the child?

The text is presented for informational purposes only. We strongly urge you not to self-medicate. When the first symptoms appear, consult a doctor. We recommend reading: “Why you can’t self-medicate?”

Meconium in amniotic fluid is a reflection of intrauterine fetal hypoxia. When a newborn baby is distressed, an involuntary act of defecation occurs with the contents of the intestines - meconium. The original feces themselves are perinatal hair, interstitial cells, fragments of bile, amniotic contents, and mucus digested in the prenatal period. The appearance of such feces is a dark green, almost black, sticky viscous mass that gives the water a dirty appearance.

Where does the fluid in the amniotic sac come from?

In the first trimester of pregnancy, it is produced by the cells of the amnion itself. In the last trimester, the baby's kidneys take an active part in the formation of fluid. The fetus swallows amniotic fluid, it is absorbed in its gastrointestinal tract and, together with urine, is excreted from the child's body back into the amnion. The water cycle in the amnion promotes the renewal of amniotic fluid every few hours throughout the entire 40 weeks.

The volume of fluid increases, increasing by 40-50 milliliters with each subsequent week of pregnancy. By about 38 weeks, its volume reaches a maximum of 1 to 1.5 liters. The amount of water in each specific case is determined by specialists, guided by the amniotic fluid index during an ultrasound examination.

What does amniotic fluid consist of?

Normally, amniotic fluid is clear and odorless. At the end of pregnancy, it may become slightly cloudy due to the entry of epidermal cells and waste from the sebaceous glands. The green tint of the water should alert specialists; this is one of the signs of intrauterine fetal hypoxia.

The amniotic fluid includes the baby's secretions (urine, discharge from the lungs), and the presence of oxygen, carbon dioxide, salts, fats, glucose, hormones and antigens that correspond to the baby's blood type.

Management of pregnancy and childbirth in the presence of meconium in the waters, treatment of the condition

If meconium amniotic fluid is detected, a number of diagnostic measures are carried out to determine the condition of the fetus (listening to the heartbeat, CTG, ultrasound diagnostics). It is recommended to send the amniotic fluid itself for analysis to identify intrauterine infection of the fetus.

Depending on the diagnostic results obtained, labor management tactics are determined:

• in case of disturbances in the respiratory movements of the fetus (indicating the baby’s suffering due to intrauterine hypoxia), emergency labor stimulation with oxytocin is performed; to suppress the respiratory movements of the fetus and prevent aspiration of meconium, relanium or seduxen is administered;
• if respiratory activity is normal, which indicates the absence of fetal distress, and the appearance of green amniotic fluid, labor stimulation is not performed, only seduxen or relanium is administered;
• When dirty green amniotic fluid appears in combination with signs of fetal hypoxia on CTG and a decrease in heart rate, emergency delivery is performed using a cesarean section.

After the child is born, his condition is assessed by a neonatologist. Atmosal aspiration of the contents of the nasopharynx and oropharynx is mandatory to prevent meconium from entering the respiratory tract and improve their patency. Also, such babies need additional administration of a surfactant drug to prevent “sticking” of the alveoli and adequate gas exchange.

What are the functions of amniotic fluid during fetal development?

Throughout pregnancy, amniotic fluid provides reliable protection for the fetus from injury, bruises, blows and other mechanical damage. Besides

• this is a source of comfortable habitat for the embryo
• amniotic fluid is intensively involved in metabolism
• they protect the umbilical cord from compression
• serve as a barrier that prevents the fusion of the skin of the fetus with the walls of the uterus
• protect the child’s body from various infections from the genital tract
• help prepare the baby’s gastrointestinal tract, respiratory and excretory systems for work outside the mother’s body

The role of amniotic fluid during childbirth

At the very beginning of labor, the amnion presses on the cervix and promotes its soft opening. If the birth is physiological, the amnion ruptures when the cervix dilates by 5-6 centimeters. Its timely rupture ensures a normal process of opening and smoothing, which provides comfortable conditions for the child during contractions.

The integrity of the membranes during childbirth provides the fetus with protection from infections. While in the amniotic fluid, the baby avoids the direct impact of the uterine walls, which contract during contractions. But rupture of the bladder before the onset of labor often leads to weak labor, which has to be stimulated.

Amniotic fluid - from a to z

Everything in a pregnant woman’s body is designed to safely carry and give birth to a child. For example, amniotic fluid is an amazing environment in which the baby lives during the entire nine months of pregnancy and which helps him to be born softly and comfortably.

Water cycle in nature

Where does amniotic fluid come from? Let's start with the fact that the child floats in the uterus for a reason: around him, like around the astronaut, there is a kind of spacesuit - special membranes, they are called: fetal membranes . Together with the placenta, they form the amniotic sac, which is filled with amniotic fluid.

.
At the very beginning of pregnancy, it is the cells of the amniotic sac that produce amniotic fluid. In later stages, amniotic fluid is additionally produced by the baby's kidneys. The baby first swallows water, it is absorbed in the gastrointestinal tract, and then leaves the body along with urine back into the fetal bladder. Approximately every three hours, the fluid in the amniotic sac is completely renewed
.
That is, the “waste” waters come out, and their place is taken by new ones - completely renewed
. And this water cycle continues for 40 weeks.

Why do we need water?

It would seem that man is a land creature, and cannot breathe for a long time, and simply cannot be under water. So why is the baby in the water during pregnancy? It's very simple: for a child to develop, at any stage of life, a harmonious environment is needed. And water is great for this. It softens the effect of the law of universal gravitation; the too loud noises of our world do not reach through the water. And the amniotic fluid is always the same temperature, which means that the baby will not overheat or become hypothermic, even if the mother suffers from the heat or, conversely, is freezing from the cold. Together with the walls of the uterus and the muscles of the anterior abdominal wall, water reliably protects the child from blows, jolts or unnecessary squeezing, which are always present in our everyday life. .

Naturally, this does not mean that you can fall off a bicycle or ski during pregnancy; no, it is still dangerous. But there is no need to be afraid that by tilting or turning the body one more time, the woman will squeeze something and crush something in the child.

What about breathing? Will the baby not choke in the water? Certainly. the baby in the mother’s belly breathes, but not through the lungs yet - oxygen comes to it through the placenta. And only after birth and the first cry will the lungs expand and the baby take their first real breath. In the meantime, he simply periodically swallows amniotic fluid, but it cannot get into the lungs.

By the way, even during childbirth you can’t do without water

– during contractions, the baby’s head presses on the cervix and helps it open. But the waters located in the amniotic sac in front of the baby’s head soften this pressure and the cervix opens more smoothly.

So everything in a pregnant woman’s body is thought out, and water is perfect for the life of the unborn baby.

Quantity and quality

With each ultrasound of the baby, the doctor also evaluates the amniotic fluid: its quantity, transparency, presence of foreign matter.

.

Quantity.

If there is less or more water than it should be in a certain period, then perhaps something is wrong in the woman’s body.
But fortunately, this happens rarely, but the conclusion “moderate oligohydramnios”
after an ultrasound examination is quite common. The expectant mother is always worried about this diagnosis, but it usually means that the amount of amniotic fluid has decreased slightly. If additional examinations (CTG, Dopplerography) show that everything is fine with the baby, then there is nothing wrong with moderate oligohydramnios; perhaps this is a feature of pregnancy.

Quality.

Normally, amniotic fluid is clear, like water. Towards the end of pregnancy, they sometimes become a little cloudy due to the fact that epidermal cells from the baby’s skin and particles of vernix lubrication get into them - they give a small suspension in the waters, which is visible on an ultrasound. This is also a variant of the norm.

The final stage

All expectant mothers have heard about the fact that at some point during childbirth or right before it, amniotic fluid flows out. And naturally, pregnant women have the same questions: how and when does this happen? what will I feel? what to do after your water breaks? Everything is simple here.

When your water breaks.

Ideally,
the waters break during the first stage of labor, when the cervix is ​​completely or almost completely open
.
The amniotic sac becomes thinner and ruptures during contractions. Immediately after this, the contractions intensify significantly, and the birth of the child is not far off. But the waters can break even before the contractions begin, so to speak, “out of the blue.” This moment is called premature
rupture of water.
If there are contractions, but the cervix is ​​not yet ready, then such rupture of water is called early
.

How does your water break?

.
Amniotic fluid is discharged in different ways. It can be like in feature films - suddenly, in a public place, water starts flowing down the legs of the expectant mother. Yes, this happens, but still the drama of the situation in the movies is somewhat exaggerated. The amniotic fluid does not always flow in a strong stream; very often not all the waters come out, but only the so-called anterior ones
, that is, those that are located in front of the baby’s head, and there are usually 100–200 ml of them.
The remainder of the amniotic fluid, the posterior
fluid, is expelled after the baby is born.

So usually the expectant mother feels that her underwear has suddenly become very wet. or she thinks she has involuntary urination. But there may be this option: the amniotic sac has not completely ruptured, but has only ruptured somewhere and the waters are leaking in small portions. Then the woman will just feel that the discharge has become more abundant and watery than before. This is called amniotic fluid leakage.

What to do after your water breaks

.
It doesn’t matter whether there are contractions or not, a lot of water has broken or just a little - all this is a reason to immediately go to the maternity hospital
. There is nothing to be afraid of here: today it is believed that the safe water-free period is no longer 6 hours as before, but much longer. But, nevertheless, if the water has poured out, the mother needs to be under the constant supervision of doctors.

Pregnancy fears

Expectant mothers are often worried, and various horror films from the Internet and stories from good friends only increase anxiety. What usually worries a woman when it comes to amniotic fluid?

The amniotic sac will rupture (tear) ahead of time, and I won’t notice it.

This fear usually appears at the end of pregnancy, when the amount of vaginal discharge increases under the influence of hormones. Often there are so many of them and they are so abundant that the woman feels like her water is leaking. In fact, water and discharge can be distinguished: the discharge is mucous, denser or thicker, and leaves a characteristic white color or dried stain on the laundry. Amniotic fluid is still water, it is not viscous, does not stretch like discharge, and dries on the laundry without a characteristic mark. But if doubts remain, whether it is water or just liquid discharge from the vagina, you should not sit at home and be afraid. It’s better to go to the doctor for a consultation - he will definitely see what it is. If the situation repeats, you can buy a special test at the pharmacy that shows whether there is leakage of water or not (it can be in the form of a regular strip, similar to a pregnancy test, or even in the form of a special pad).

During childbirth, all women have their amniotic sac pierced, but what if they do it to me too?

The opening of the amniotic sac is very actively discussed and condemned on the Internet, and this is understandable: many women do not understand why they had it done.
Yes, this manipulation is indeed often carried out, but rumors that the amniotic sac is opened for everyone in maternity hospitals are somewhat exaggerated. So why is it still being opened? Ideally, just to help mother and child.
“For example, if contractions have weakened, then opening the amniotic sac can strengthen them and then there will be no need to prescribe stimulation with oxytocin.

— Sometimes the fetal bladder does not have anterior waters; such a bladder is called flat. As a result, its membranes are pulled over the baby’s head, and the bubble not only does not help normal labor, but also delays it.

— It’s rare, but it happens that the membranes are so dense that even with the cervix fully opened, the bladder does not open on its own. If it is not opened, then the period of pushing is prolonged, since such a fetal sac interferes with the advancement of the baby's head. Previously, if the bladder was not opened, the child could be born in the membranes in a state of asphyxia. They said about such children: “Born in a shirt, he will be happy!” And the happiness here is in one thing - they managed to get him out of this “shirt” alive.

After birth, the baby no longer needs an aquatic environment. Now he has a different type of breathing, blood circulation, and digestion. And a new, amazing and interesting life on land begins.

Memo for mothers

1. Water can break both during contractions and without them (“out of the blue”).

2. Amniotic fluid flows out in different ways: it can gush like a fountain, or it can leak unnoticed.

3. It doesn’t matter whether there are contractions or not, a lot of water has broken or just a little, you need to go to the maternity hospital in any case.

4. If you are afraid that water is leaking, go to the doctor, he will see exactly what it is. You can buy a special test for water leaks.

5. Are you offered to open the amniotic sac? Don't worry - this is a completely painless procedure.

Amniotic fluid index - upper and lower limits of normal

The volume of fluid in the amniotic sac is assessed by a medical specialist during all routine ultrasound scans. For each week of pregnancy, the IAF table contains data on the normal fluid volume along with maximum permissible deviations from these indicators. If the AFI value exceeds the upper limit of normal, the doctor can conclude that there is polyhydramnios. A slight excess of the norm means moderate polyhydramnios.

Polyhydramnios: types, symptoms, causes, danger of the condition

A conclusion about polyhydramnios is made by a specialist if the fluid volume exceeds 1.5-2 liters during normal pregnancy. Polyhydramnios is usually diagnosed at the end of the second or beginning of the third trimester.

There are acute polyhydramnios with a sudden increase in the volume of water, which is accompanied by shortness of breath, a feeling of heaviness and pain in the abdomen, severe swelling, and chronic, in which the amount of amniotic fluid increases gradually, without worsening the well-being of the pregnant woman.

Among the causes of polyhydramnios are the following:

• presence of diabetes mellitus in the mother
• an acute or chronic infectious process was detected in the mother’s body
• diseases of the cardiovascular system
• various fetal developmental anomalies
• Rhesus conflict between mother and fetus

Ultrasound is the main tool in diagnosing this condition. The main criterion for assessing the amount of amniotic fluid is the size of the vertical pocket. If during the examination the specialist determined its value to be 8-11 cm, this is a mild degree of polyhydramnios. We can talk about the average degree of this condition when the size of the vertical pocket is from 12 to 15 centimeters, but if this figure reaches 16 cm, then a conclusion is made about pronounced polyhydramnios.

Upon manual examination of the pregnant woman, a significant increase in the circumference of the abdomen, as well as the height of the uterine fundus, is noted. The uterus itself is in good shape, which is why parts of the fetus are difficult to palpate. Excessive motor activity of the child is noted, heart sounds are heard indistinctly.

The danger of polyhydramnios is that a large amount of water greatly stretches the uterus, as a result of which it contracts poorly during childbirth. This leads to a protracted labor and possible bleeding in the postpartum period. Polyhydramnios can cause placental abruption and prolapse of the umbilical cord, which poses a great danger to both the mother and the unborn child.

The birth strategy for polyhydramnios involves performing an amniotomy (puncture of the amniotic sac) at the very beginning of labor. Amniotic fluid is then slowly released through a needle or catheter to reduce the volume of the uterus and tighten its walls. After the baby is born, the mother in labor is prescribed medications to stimulate contraction of the uterine muscles.

Mild chronic polyhydramnios has virtually no effect on the course of pregnancy; childbirth usually occurs on time and is not complicated. However, parallel treatment of the disease that causes polyhydramnios is required.

Severe polyhydramnios often provokes premature birth. If there are symptoms indicating circulatory disorders in the expectant mother with severe swelling and severe shortness of breath, the question of artificial termination of pregnancy is raised.

Meconium aspiration syndrome

Mortality from aspiration of meconium by a baby during childbirth or in the prenatal period reaches more than 10% of all cases. The syndrome can occur even several days after birth. The syndrome of imaginary well-being is formed as a result of compensatory reactions of the baby’s body, which is accustomed to surviving in conditions of hypoxia throughout the entire period of pregnancy.

Symptoms

During aspiration of contaminated amniotic fluid, small particles of meconium penetrate into the opened alveoli and contribute to the disruption of alveolar oxygen exchange between the blood and lungs, as well as the destruction of surfactant. As a result, atelectasis of the lung area occurs - it is excluded from the respiratory act. The child shows signs of respiratory failure:

• breathing movements become more frequent and superficial;
• auxiliary muscles are connected to the act of breathing (the wings of the nose expand, the intercostal spaces retract, the supraclavicular fossae recede);
• breathing becomes noisy;
• the heartbeat increases compensatorily;
• the child is restless at first, then becomes lethargic, drowsy, and consciousness is depressed;
• the skin becomes cyanotic.

Be sure to read:

Stool color in newborns: where is the norm and where is the pathology?

When the doctor auscultates the child, moist rales of various sizes are heard, characteristic of the development of pneumonia, sometimes parts of the lung are not audible at all. The x-ray shows areas of triangular darkening (atelectasis) - collapse of the lung. Replacement emphysema is often observed around this area - an increase in the airiness of the lung tissue.

Complications

The provoked area of ​​the lung is often overlaid with a secondary infection and the development of an inflammatory process. Since the newborn’s immune system is immature, and the baby is in a state of hypoxia, this condition can develop into a septic process.

In addition to the development of the infectious process, prolonged hypoxia contributes to the suppression of nervous tissue, including the death of areas of the cerebral cortex, which manifests itself in the form of hypoxic-ischemic encephalopathy. The child may subsequently lag behind in motor and psychological development, and the risk of developing cerebral palsy and epileptic syndrome increases.

Oligohydramnios: etiology and danger to the fetus

This condition is diagnosed if by the end of pregnancy the amount of amniotic fluid does not exceed 300 milliliters. Typically, oligohydramnios is a consequence of a complicated pregnancy.

Among the reasons leading to this condition

• gestosis in pregnant women;
• maternal hypertension;
• toxoplasmosis, cytomegalovirus, mycoplasma and similar infections in the mother;
• malformations of the fetal urinary system;
• chronic fetal hypoxia;

One of the signs of a decrease in the amount of amniotic fluid is a lag in the height of the uterine fundus and a discrepancy between the abdominal circumference and the normative indicators of the expected period of pregnancy. There is also a decrease in fetal motor activity.

On manual examination, the pregnant part of the fetus is clearly identified, the audibility of heart sounds is good, the uterus is dense. The severity of oligohydramnios is more accurately determined using ultrasound.

Oligohydramnios, detected in the 2nd trimester of pregnancy, is a serious symptom. It is at the period of 18-26 weeks that the probability of spontaneous termination of pregnancy and intrauterine fetal death is high.

A decrease in the amount of amniotic fluid leads to delayed fetal development (hypotrophy), intrauterine infection and contributes to the development of intrauterine defects. The degree of oligohydramnios is determined by ultrasound fetometry.

With moderate oligohydramnios, the pregnancy is most often carried to term; only in exceptional cases is an emergency caesarean section performed.

If childbirth occurs naturally, oligohydramnios involves opening of the amnion: a small amount of water leads to the formation of a flat bladder without anterior waters, which delays normal labor.

Why does the condition appear and why is it dangerous?

The mere presence of meconium in the discharged amniotic fluid indicates hypoxia of the child and his intrauterine suffering caused by various reasons. The symptom may indicate:

Medical products (drugs, medicines, vitamins, dietary supplements) are mentioned for informational purposes only. We strongly do not recommend using them without a doctor's prescription. We recommend reading: “Why can’t you take medications without a doctor’s prescription?”

• post-term pregnancy (more than 40 weeks);
• addition of intrauterine infection;
• violation of placental metabolism (premature abruption, preeclampsia and eclampsia in the mother).

Prolonged fetal hypoxia threatens its death. It is necessary to determine the baby’s viability: his heartbeat is examined, the baby’s vitality is monitored, and emergency measures are taken to prevent major complications.

The danger of meconium water is the possibility of the baby swallowing it and getting into the respiratory tract. Polluted waters contribute to:

• Destruction of surfactant . This substance is necessary for the opening of the alveoli during the baby's first breath. In its absence, the lungs do not open and the child may not take his first breath.
• Obstruction of the bronchial lumen with viscous meconium. This also makes it impossible for the baby to take his first breath, since the airways are closed.
• Formation of aspiration pneumonia. When fine particles of meconium enter the lumen of the alveoli. Parts of the lung fall out of the act of breathing due to impaired gas exchange in the alveoli.

Be sure to read:

Gastroenteritis in children: how does the pathology manifest itself and be treated?