Which births are complicated? Complications during pregnancy: what are they, their causes, risk groups Manifestations of pregnancy complications and measures to be taken if they occur

Medical advice for expectant mothers: planning pregnancy, normal fetal development by trimester, advisability of ultrasound and indications for caesarean section.

Plan a new pregnancy after the previous one, especially if it was accompanied by some complications, preferably no earlier than a year later. You should first assess the nature of menstrual function and, if necessary, correct it. It is also important to exclude the presence of urogenital infections (chlamydia, mycoplasma, etc.).

If the future parents are over 35 years old, and the planned pregnancy is the first for both or one of the spouses, then it is advisable to consult a geneticist to exclude a possible chromosomal pathology.

When planning a pregnancy, it is necessary to determine the most favorable days for conception. The fact is that a woman’s menstrual cycle (the period from the 1st day of one menstruation to the 1st day of the next menstruation) on average, in most cases, lasts 28-30 days. During the first half of the menstrual cycle, a follicle matures in one of the ovaries, and ovulation occurs on days 14-15. In this case, a mature egg is released from the follicle. Taking into account that a mature egg is capable of fertilization within 2 days after ovulation, and sperm have fertilizing activity within 4 days after ejaculation, the total period of the most probable possibility of conception is about 6 days.

Stages of pregnancy

It is generally accepted that during the normal course of pregnancy, its duration is on average about 280 days, if counted from the first day of the last menstruation - this is the “obstetric gestational age”, the calculation of which is most often used by doctors in obstetric practice.

It is also possible to determine the gestational age by the size of the uterus and the movement of the fetus. However, these criteria are not precise, as they are individual in nature. The size of the uterus at the same stage of pregnancy varies widely among different women, making it difficult to estimate the duration of pregnancy.

The sensation of fetal movement is also very subjective and depends on the sensitivity threshold of each woman. So, some women can begin to feel fetal movements from 18 weeks, while others only from 22 weeks. In fact, the fetus begins to move from 7-8 weeks.

A fairly typical and widespread misconception is that the gestational age is determined using ultrasound (ultrasound). This doesn't actually happen. In the process of this study, another equally important question is solved: for what period of pregnancy are the fetal sizes obtained during the study typical, provided that the expected period of pregnancy is known, which, in turn, is calculated from the first day of the last menstruation or from the date of conception.

The entire period of pregnancy is usually divided into three parts - trimesters. The first trimester is the early fetal period, which lasts up to 12 weeks. The second trimester is the mid-fetal period, which lasts from 13 to 27 weeks. The third trimester, or as it is also called the “fetal period,” begins at 28 weeks and continues until the due date.

I trimester of pregnancy

One of the most important conditions for the normal development of pregnancy is the prediction and prevention of possible complications. In this regard, already in the 1st trimester of pregnancy it is necessary to identify risk factors for these complications. To do this, it is advisable to consult a doctor as soon as possible.

Regarding pregnancy, it is necessary to undergo an examination, which includes:

• Determination of blood group and Rh factor (even though such a study has already been carried out before and these indicators are already known).
• Blood test for syphilis (RW), HIV infection, hepatitis.
• Clinical blood test to assess its cellular composition, hemoglobin level and ESR value.
• Assessment of the activity of the blood coagulation system.
• General urine analysis.
• Studying discharge from the vagina, cervical canal and urethra for the presence of pathogens of various infections.

In addition, a serological test should be used to detect specific antibodies of immunoglobulins class M and G using the enzyme immunoassay method.

One of the most objective diagnostic methods is ultrasound examination, It is advisable to do the first ultrasound after 10 weeks. The main objectives of this study are: confirmation of progressing pregnancy; clarification of the expected duration of pregnancy; detection of multiple pregnancies; determining the site of implantation of the fertilized egg and the location of the placenta; measuring the thickness of the collar space (at 10-14 weeks); identifying signs of a complicated pregnancy (threat of spontaneous miscarriage, chorionic detachment, isthmic-cervical insufficiency, hydatidiform mole, etc.). In addition, in the period from 8 to 11 weeks, it is possible to conduct a combined screening test to exclude the risk of possible disorders in fetal development, which includes the determination of the free?-subunit of hCG, PAPP-A.

The most common complications in the first trimester are: non-developing pregnancy, spontaneous miscarriage and early toxicosis.

The reasons for non-developing pregnancy and its termination in different periods of the first trimester are not the same. So, up to 3 weeks, these are most often genetic and chromosomal damage, as well as insufficient preliminary preparation of the endometrium for the upcoming implantation of the fertilized egg. At 4-8 weeks, as a rule, the main causes are hormonal disorders, infection, leading to primary placental insufficiency and impaired embryogenesis. At 9-12 weeks, the main negative impact can manifest itself both from the factors already listed, and from insufficient stretching of the uterus, for example, with genital infantilism or malformations of the uterus.

The use of medications in early pregnancy should be strictly limited due to the risk of their damaging effects on the fetus. You should not self-medicate. The advisability of using certain medications should be agreed with your doctor.

II trimester of pregnancy

In the second trimester of pregnancy, the placenta and fetus continue to grow. Therefore, it is important to monitor the normal development of the fetus and the course of pregnancy, as well as prevent possible complications.

During this period, the pregnant woman should visit the doctor at least once a month, and in some situations, more often. At each visit, the doctor examines the patient, monitors weight gain, measures the circumference of the abdomen and the height of the uterine fundus above the womb, determines blood pressure, and listens to the fetal heartbeat. Prescribes the necessary additional studies.

At 20-24 weeks of pregnancy, a second mandatory ultrasound examination is performed., which is necessary for: determining the correspondence of the size of the fetus to the expected period of pregnancy in order to exclude delayed fetal development; detection of fetal malformations; assessing the amount of amniotic fluid; studying the condition of the placenta. Doppler examination, which is carried out during ultrasound examination, is also important to assess the intensity of uteroplacental and fetal placental blood flow.

During this period, as well as during the next planned examination at 32-34 weeks, it is possible to perform a three-dimensional ultrasound scan for a more accurate assessment of the condition of the fetus.

In the interval from 16 to 20 weeks, for prenatal possible fetal abnormalities, it is advisable to determine the blood level of alpha-fetoprotein (AFP), free estriol E3, inhibin-A and human chorionic gonadotropin (total hCG).

The most typical complications of the 2nd trimester of pregnancy are: threat of late spontaneous miscarriage, bleeding due to placental abruption, anemia, early forms of gestosis, intrauterine infection. These complications contribute to the formation of placental insufficiency and fetal growth retardation.

Due to the increasing size of the uterus, which begins to shift the abdominal organs towards the chest, shortness of breath and heartburn may begin to bother you after 15-16 weeks. The kidneys begin to experience significant stress.

In women with extragenital diseases (kidney disease, hypertension, neurocirculatory dystonia) from 20 weeks there is a risk of developing gestosis. In this regard, you should pay attention to the appearance of edema, excessive and uneven weight gain, increased blood pressure, and the appearance of protein in the urine.

If there are no contraindications, after 17 weeks you can begin to perform a special set of physical exercises for pregnant women, which allow you to control the muscles of the perineum and abdominals. It is also important to master breathing exercises.

III trimester of pregnancy

The third trimester of pregnancy is characterized by the most intense growth of the fetus and an increase in the functional activity of its organs and systems.

Until 32-33 weeks of pregnancy, the fetus can change its position in the uterus many times during the day and, as a rule, after 35-36 weeks it takes its final position until birth.

During this period of pregnancy, the most careful and in-depth monitoring of the nature of the pregnancy is required, with a comprehensive examination and assessment of the risk of possible complications. After 28 weeks, a pregnant woman should visit a doctor at least once every 2 weeks, and more often if indicated.

At the third mandatory ultrasound, which is performed at 32-34 weeks, determine the size of the fetus, study the condition of the placenta, and assess the amount of amniotic fluid. In addition, an echographic functional assessment of the condition of the fetus and its behavioral reactions is carried out, and Doppler measurements are repeated. After 32 weeks, cardiotocography is used to assess the state of the fetal cardiovascular system. CTG (cardiotocography) is a method of functional assessment of the condition of the fetus during pregnancy and childbirth based on recording the frequency of its heartbeats and their changes depending on contractions of the uterus, the action of external stimuli or the activity of the fetus itself. CTG is currently an integral part of a comprehensive assessment of the fetal condition, along with ultrasound and Doppler. This method is completely safe for the fetus and has no contraindications.

If an intrauterine infection is suspected, material from the urogenital tract is examined and the level of specific antibodies to infectious agents in the blood serum is determined.

One of the most common complications of the third trimester of pregnancy is, which is accompanied by a decrease in arterial blood supply to the placenta and fetus; a decrease in the supply of the required amount of nutrients to the fetus and the excretion of metabolic products. All these changes reduce the protective and adaptive capabilities of the mother-placenta-fetus system; slow down the growth and development of the fetus; cause complicated pregnancy and childbirth.

The most typical clinical manifestations of fetoplacental insufficiency are: impaired motor activity of the fetus, increased tone of the uterus, discrepancy (reduction) in the size of the pregnant woman’s abdomen with the gestational age, post-term pregnancy, polyhydramnios or oligohydramnios.

Due to a violation of the protective function of the placenta, intrauterine infection of the fetus may occur, which manifests itself in the form of delayed development, thinning or increased thickness of the placenta, placental calcification and cyst-like inclusions in its structure, polyhydramnios or oligohydramnios.

The most dangerous complication of the 3rd trimester of pregnancy is gestosis, which occurs as a result of fetoplacental insufficiency and externally manifests itself in the form of edema and uneven weight gain (fluid retention in the body), increased blood pressure (impaired regulation of vascular tone), and the appearance of protein in the urine (impaired renal function). ). Preeclampsia is accompanied by the most severe complications from the fetus and poses a threat to the health of the pregnant woman.

Rh conflict during pregnancy

One of the serious complications of pregnancy is isoserological incompatibility of the blood of mother and fetus according to the Rh factor or blood group (according to the AB0 system).

The Rh factor is a protein substance that is localized on red blood cells. Approximately 15% of people do not have the Rh factor in their blood. If a pregnant woman is Rh negative and her husband is Rh positive, then the planned child will most likely also have a positive Rh factor. Rh-positive fetal blood enters the maternal bloodstream and causes the pregnant woman to form antibodies against the Rh factor. Antibodies enter the fetal bloodstream and destroy its red blood cells. Rh conflict can cause serious complications in the fetus, including hypoxia. As a rule, problems do not arise during the first pregnancy. But, since the antibodies remain in the woman’s body, when the next pregnancy occurs, their number increases, and they begin to show their negative effects.

To prevent Rh conflict, anti-Rhesus human immunoglobulin preparations are used. These drugs are administered to Rh-negative women under the condition of their first pregnancy, the absence of Rh antibodies in their blood, and the birth of a child with Rh-positive blood. The drug is administered twice: one dose at 28 weeks of pregnancy, second - within the first 72 hours after birth.

Indications for caesarean section

Closer to the end of pregnancy, it is very important to have a clear understanding of the physiology of the birth process, to know how labor begins and how it proceeds, as well as how to behave during childbirth and much more. A pregnant woman can be delivered vaginally or by caesarean section.

The question of the need to perform a cesarean section in each specific case is decided individually according to strict medical indications. In this case, all the pros and cons and the degree of possible risk are taken into account. A positive decision in favor of surgery is made only in cases where vaginal birth poses a higher risk to the health of both the woman and her child than a caesarean section. Unfortunately, choosing a cesarean section does not always guarantee the successful completion of pregnancy and the birth of a healthy baby.

What reasons make one prefer a caesarean section?

Among the indications for this operation are the so-called "absolute readings"- these are those circumstances when childbirth through natural means is simply impossible and poses a danger to the life of mother and child:

• Severe narrowing of the pelvis or abnormal shape of the pelvis with a significant decrease in its size.
• Tumors and scar changes of the cervix, vagina and perineum, preventing the birth of a child.
• The presence of genitourinary and enterogenital fistulas.
• Severe varicose veins in the vagina and vulva.
• Incorrect position of the fetus (transverse and oblique).
• Placenta previa (the placenta covers the internal os of the uterus).

There are also "relative readings", situations where the possibility of delivering a vaginal birth cannot be ruled out, but the risk of complications in the mother and fetus is higher than the risk of possible complications during surgery:

• The presence of a scar on the uterus.
• In case of breech presentation of the fetus, especially if there is an extension position of the fetal head, leg presentation of the fetus, posterior view of the breech presentation of the fetus.
• Fruit weight is more than 3500 g.
• Delayed fetal development.
• Presentation of the umbilical cord loop.
• Severe fetoplacental insufficiency (subcompensated or decompensated form).
• Various diseases in which vaginal delivery is dangerous to a woman’s health (high myopia, epilepsy, post-traumatic encephalopathy, heart defects, etc.).
• Large uterine fibroids.
• Anomalies of uterine development.
• Lack of readiness of the cervix for childbirth during full-term pregnancy and in the absence of effect from preparing the cervix for childbirth.
• Post-term pregnancy in combination with an immature cervix.
• Combination of indications (complicated obstetric history, infertility, use of assisted reproduction methods, age of primigravida over 30 years, post-term pregnancy, large fetus, hypoxia, feto-placental insufficiency, etc.).

In addition, during multiple pregnancies, a cesarean section is performed in case of excessive overstretching of the uterus (large fetuses); unprepared birth canal after 38 weeks of pregnancy; transverse position of the first fetus of twins or both fetuses; breech presentation of the first fetus; conjoined twins; triplets and more fetuses.

The listed situations are mainly indications for performing a cesarean section as planned.

If a pregnant woman is diagnosed with any of the above circumstances and there is a need to perform an operation, she should be informed in advance and hospitalized in advance at the maternity hospital (at least 8-10 days in advance) to clarify the diagnosis and prepare for the operation.

However, in a number of cases situations arise both during pregnancy and childbirth when it is necessary to perform emergency caesarean section. These situations include the following:

• Increasing severity of fetoplacental insufficiency or gestosis that cannot be treated, in the absence of conditions for rapid delivery through the natural birth canal.
• An attack of eclampsia.
• Discrepancy in the size of the baby's head and the mother's pelvis during childbirth.
• Immature cervix and absence of labor during prenatal rupture of amniotic fluid.
• Lack of effect from labor induction or labor stimulation in case of fetoplacental insufficiency within 2-3 hours.
• Disturbances in the contractile activity of the uterus during childbirth with ineffective treatment, as well as in the presence of additional complications of pregnancy or their occurrence during childbirth.
• Threat of uterine rupture.
• Premature abruption of a normally located placenta and its progression in the absence of conditions for urgent delivery through the natural birth canal.

Special mention should be made performed in the interests of the fetus:

• Progressive deterioration in the condition of the fetus or acute hypoxia in the absence of conditions for rapid delivery through the vaginal canal.
• Deterioration of the fetus's condition due to the administration of uterine contractions during labor induction or during labor stimulation.
• Loss of umbilical cord loops and small parts of the fetus.
• The formation of a transverse position of the second fetus after the birth of the first during multiple pregnancy.

Caesarean section is performed only with the consent of the woman. If, due to some circumstances, a woman is not legally competent, and a caesarean section is performed to save her life, then it is enough to obtain consent to the operation from her closest relatives.

Natural childbirth

In all other cases, if the pregnancy went well, there are no signs of impairment in the condition of the fetus, and the patient’s health condition is not in doubt, childbirth is carried out through the natural birth canal. The basis for the successful course of labor and its favorable outcome is the normal course of pregnancy, appropriate monitoring and timely prevention of possible complications.

The duration of labor depends on many circumstances and on average is 9-11 hours for primiparous women, and 8-9 hours for multiparous women.

During childbirth, the woman in labor should be closely monitored by a midwife and a doctor. In the first stage of labor, in all cases it is necessary to carry out monitoring control using cardiotocography for a dynamic assessment of the condition of the fetus and contractile activity of the uterus. In all cases, labor must be anesthetized. Methods of pain relief may vary depending on the condition of the mother and fetus, the activity of labor and the stage of labor, and the intensity of pain. For pain relief, drugs are used that are inhaled using a special device (inhalation anesthesia); certain painkillers can be administered intramuscularly or intravenously. Epidural anesthesia is popular. However, there are some contraindications for this method. Immediately after birth, the birth canal must be examined. The postpartum woman is observed for 2 hours in the delivery room, and after that she and the baby are transferred to the postpartum ward. It is advisable to put the baby to the breast early in the first hours after birth.

Makarov Igor Olegovich,
Doctor of Medical Sciences, professor, doctor of the highest qualification category.
Medical center "Art-Med"

Pregnancy is the physiological process of development of a fertilized egg in the female body, as a result of which a fetus is formed that is capable of extrauterine existence.

Pregnancy begins from the moment of fertilization of an egg matured in the ovary (female reproductive cell) by a sperm (male reproductive cell) and lasts in most cases 10 lunar (approximately 9 calendar) months - 40 weeks, or 280 days, counting from the first day of the last menstruation; ends with childbirth.

Development of the embryo:

Fertilization occurs in the abdominal cavity or in the ampulla of the fallopian tube - the enlarged part of the fallopian tube facing the ovary. Thanks to the rhythmic contractions of the fallopian tubes, the fertilized egg (one-celled embryo) moves into the uterine cavity.

As it moves through the fallopian tube, a multicellular embryo (fertilized egg) is formed, densely covered with delicate villi. With their help, the embryo that has entered the uterine cavity attaches to the mucous membrane of the uterus.
With diseases of the fallopian tubes, the progress of the fertilized egg is disrupted and it can attach to the fallopian tube.

From the moment of attachment to the mucous membrane of the uterus, the development of the embryo and the laying of its organs occurs. Starting from the 9th week. intrauterine life and until the end of pregnancy, the developing organism is called a fetus; during this period, its organs and systems are improved.

At the site of attachment of the embryo, the villi grow luxuriantly; from them the placenta (baby place) is formed, connected to the fetus through the umbilical cord. Through the placenta, nutrients and oxygen flow from the mother through the blood vessels of the umbilical cord to the fetus, and metabolic products are removed. The membranes surrounding the fetus form an amniotic sac filled with amniotic fluid.

In some cases, several fetuses develop in the uterus at once - multiple pregnancy. This is possible when two or more simultaneously matured eggs are fertilized or when several embryos develop from one fertilized egg. In recent years, due to the use of drugs that stimulate ovarian function for the treatment of infertility, the incidence of multiple pregnancies has increased. More often two fetuses develop (twins), less often - three or more. Fetuses that have a common placenta are called identical, while separate placentas are called fraternal.

From the moment the embryo attaches to the mucous membrane of the uterus, an intensive change in the functions of many organs and systems of the pregnant woman’s body begins, aimed at providing the most favorable conditions for the development of the fetus and preparing the woman’s body for childbirth and feeding the child.

Symptoms of pregnancy:

In the first weeks of pregnancy, due to changes in the function of the nervous system, drowsiness, irritability, dizziness, changes in appetite, taste and smell, increased salivation, nausea, and occasionally vomiting in the morning may be observed. Symptoms of pregnancy are mild and go away quickly on their own.

What happens during pregnancy?

During pregnancy, the excitability of the central nervous system (subcortical structures of the brain, spinal cord) decreases, which leads to relaxation of the muscles of the uterus, providing it with a state of rest. The newly formed endocrine glands (the corpus luteum at the site of the burst follicle in the ovary, the placenta) produce the hormones necessary for the normal course of pregnancy. Under the influence of placental hormones, the mammary glands enlarge; at the end of pregnancy and in the first 2-3 days after birth, they secrete colostrum, and then milk.

During pregnancy, menstruation stops. The size of the uterus increases due to stretching of its walls and an increase in muscle mass, and the network of large and small vessels of the uterus, carrying blood to the placenta, intensively develops. The contractility of the heart increases noticeably, and the pulse increases somewhat. Blood pressure normally does not exceed 140/90 mm Hg. Art. The formation of red blood cells in the bone marrow increases.

The amount of circulating blood increases, blood vessels dilate. Gas exchange increases. The kidneys work under increased load, removing metabolic products not only from the pregnant woman, but also from the fetus. Often the tone of the lower intestine decreases, which is accompanied by constipation.

During pregnancy, the mobility of the pelvic joints increases, and its volume increases slightly. Sometimes flat feet develop. Many pregnant women experience skin pigmentation in the area of ​​the white line of the abdomen, areola, forehead, bridge of the nose, and upper lip. There may be a slight increase in the brow ridges, lower jaw and hands, which disappears after childbirth. In areas of greatest stretching of the skin of the abdominal wall, associated with an enlargement of the uterus, pinkish stripes may appear, which after childbirth turn into whitish scars.

During pregnancy, body weight increases by 12-14%. This is due to the growth of the fetus and uterus, an increase in the amount of amniotic fluid and total blood mass, and increased fat deposition in the subcutaneous tissue. The increase in body weight is especially noticeable in the second half of pregnancy; on average, the increase in body weight per week is 300-350 g.

For the normal functioning of the organs and systems of a pregnant woman’s body and, therefore, the favorable development of the fetus, more nutrients and oxygen are needed. The state of health of a pregnant woman and her behavior, especially in the first weeks of pregnancy, when the formation of fetal organs occurs, largely determine the nature of the course of pregnancy, the further development of the fetus and the health of the unborn child.

To ensure the normal course of B., if menstruation is delayed, you should immediately go to the antenatal clinic, where the necessary studies are carried out to confirm pregnancy and determine the woman’s health status, monitor the course of pregnancy, preventive and, if necessary, therapeutic measures.

Hygiene during pregnancy:

Hygiene during pregnancy is of great importance. You need to be especially careful about keeping your body clean during pregnancy. Secretions of the sweat and sebaceous glands of the skin, accumulating on the surface of the body, contribute to the proliferation of microorganisms that cause pustular skin diseases, dangerous for both the pregnant woman and the fetus. In the morning, it is recommended not only to wash your hands, face and neck, but also to wipe your body with a damp towel and then rub it with a hard one.

Before going to bed, it is useful to take a warm shower or wash your face, neck, chest, arms, and legs with warm water. Taking baths is not recommended, because... Pathogenic microorganisms can enter the genital tract with contaminated water. You should not take a steam bath - this can lead to premature termination of pregnancy. Due to the fact that during pregnancy the amount of vaginal discharge increases, which, accumulating and decomposing, contributes to the proliferation of microorganisms and the development of diseases of the vagina, uterus and fetus, you need to wash yourself in the morning and evening with warm running water and soap.

The external genitalia should be washed from front to back (from the pubis to the anus), thereby preventing microorganisms from entering the rectum into the vagina. Vaginal douching during pregnancy is contraindicated. For intimate hygiene during pregnancy, you need to have a separate towel behind the genitals, regularly wash and boil it, and after drying, iron it with a hot iron.

Hygiene for the mammary glands during pregnancy will help not only prevent nipple deformation, which makes it difficult to feed the baby, but also avoid the formation of cracked nipples and the development of mastitis. The mammary glands are washed daily with boiled water at room temperature and baby soap, and wiped with a clean, hard towel. You can put a piece of canvas in the cups of the bra - the resulting friction makes the skin of the nipples rougher.

It is not recommended to use ointments, ethyl alcohol, cologne and other products to harden nipples. Flat and inverted nipples are massaged in the last two months of pregnancy 2-3 times a day for 3-4 minutes: with the index and thumb, grab the nipple, previously lubricated with Vaseline, and try to pull it back.

Clothing should be loose and easy to wash. Underwear and bed linen are changed at least once a week. Tight belts and elastic bands for stockings, squeezing the superficial veins, impede blood circulation, and this can lead to dilation of the veins of the lower extremities. Starting from the 5th month of B. it is recommended to wear a bandage. Shoes should be comfortable, with wide, low heels; It must be remembered that the center of gravity of the body with B. shifts forward due to an increase in the abdomen, and it is more difficult to maintain balance in high heels.

During pregnancy, a woman, while doing her work, should alternate it with rest. You cannot lift weights or make sudden movements. According to labor laws, pregnant women are exempt from heavy work, night work and overtime. They are provided with paid prenatal leave of 70 days.

The duration of sleep should be at least 8 hours; it is useful to take a walk before bed. A pregnant woman should have a separate comfortable bed. From the first days of pregnancy, you need to be in the fresh air as much as possible and ventilate the room more often. Fresh air has a beneficial effect on the physical and mental state of a woman, as well as on the development of the fetus, which is especially sensitive to a lack of oxygen.

Healthy women can take air and sun baths, the latter as prescribed by a doctor, taking into account the state of the nervous and cardiovascular systems. Swimming in the sea or river is allowed only during normal pregnancy. It is not recommended for pregnant women living in a different climate zone to travel to the sea.

Nutrition during pregnancy:

Rational nutrition is one of the main conditions for a favorable pregnancy and normal fetal development. During normal pregnancy, you should eat 4 times a day. In the daily diet, 50-60% of proteins should be animal proteins (25-30% fish or meat, 20-25% dairy products, 5% eggs).

The need for proteins of plant origin is satisfied by potatoes, cabbage, beans, rice, buckwheat and oatmeal. In addition to sugar, bread, cereals, vegetables, and fruits are used as sources of carbohydrates - substances that compensate for the body's energy costs.

Approximately 40% of the fats in the daily diet should be vegetable oils. Beef, pork and lamb lard is not recommended during pregnancy. You should not, especially in the second half of pregnancy, consume spices, canned food, smoked foods, as well as excessively salty, fatty and sweet foods. The amount of table salt in the diet should not exceed 6 g per day. If you are prone to edema, table salt is replaced with the drug "Sanasol", which has a salty taste, but contains mainly potassium salts, which do not retain fluid in the body.

Potassium salts have a beneficial effect on the cardiovascular system and are indicated for kidney disease and high blood pressure. During pregnancy, especially in the second half, the amount of free liquid consumed (water, milk, tea, soup, compote) should not exceed 1-1.2 liters per day.

The need for vitamins during pregnancy increases by 2-2.5 times. In summer and autumn it is provided by vegetables and fruits. In the winter and spring months, the lack of vitamins is compensated by taking multivitamin preparations - undevita or gendevita, 1 tablet 2 times a day. Pregnant women living in the northern regions should take Gendevit containing vitamin D, or Undevit in combination with vitamin D (the dose is determined by the doctor).

Due to the fact that during pregnancy there is usually a tendency to constipation, it is useful to eat raw vegetables and fruits (prunes, apples, carrots) on an empty stomach, and yogurt or one-day kefir at night. Laxatives are not recommended, especially in the first half of pregnancy. Many laxatives increase intestinal motility and at the same time stimulate contractile activity of the uterus.

Therefore, taking laxatives is very dangerous if a woman has previously had spontaneous miscarriages or during a current pregnancy there is a threat of termination. For constipation in such cases, it is better to use wheat bran. Two tablespoons of dry bran are poured with half a glass of boiling water for 20-30 minutes, the swollen bran is consumed 2 times a day before or during meals. Bran is also useful for pregnant women because it contains B vitamins.

Any drinks containing alcohol are excluded. A lot has been said and written about the dangers of alcohol for pregnant women, and yet some women forget about it. Alcohol easily dissolves in the blood and penetrates the placental barrier to the fetus. The level of alcohol in the blood of the fetus is 80-100% of the amount contained in the mother's blood. The damaging effect of alcohol on the fetus is much more pronounced than on an adult. First of all, the fetal brain is affected, so mothers who drank alcohol during pregnancy often give birth to children with underdevelopment or diseases of the central nervous system.

It has been established that approximately 50% of mentally retarded children were born to parents who abused alcohol. Often there are malformations of the bones of the skull, face, chest, etc., as well as damage to the endocrine glands and the cardiovascular system. In recent years, the special term “fetal alcohol syndrome” has entered the medical literature, denoting a set of developmental defects or congenital pathological changes in the fetuses of alcoholic parents.

A pregnant woman should not smoke. Women who smoke are more likely to experience spontaneous miscarriages and stillbirths. Nicotine contained in tobacco easily penetrates a woman’s blood and passes through the placenta to the fetus. Nicotine suppresses the normal development of the fetal respiratory system and disrupts the rhythm of its heart contractions. Under the influence of nicotine, placental vasospasm occurs, the supply of oxygen and nutrients to the fetus decreases, intrauterine development of the fetus is delayed, and children are born weakened.

So-called passive smoking, i.e., a pregnant woman staying in a smoky room, also has an adverse effect on the fetus. Daily smoking by others in the presence of a pregnant woman can lead to delayed fetal development. If a pregnant woman both smokes and drinks alcohol, her risk of stillbirth is 6 times higher than that of women who lead a healthy lifestyle.

Sexual activity during pregnancy should be limited, especially in the first 2-3 months, when spontaneous miscarriage most often occurs. Sexual intercourse in the last 2 months is also not recommended. pregnancy.

During pregnancy, regular exercise is necessary. The exercises are selected by a doctor or a specially trained midwife, taking into account the duration of pregnancy and the characteristics of fetal development. Under the influence of exercise, pregnant women improve their appetite and sleep, develop proper breathing, strengthen the abdominal and perineal muscles, and experience less nausea and vomiting. Women who exercise have easier labor.

Complications of pregnancy:

Any disease of a pregnant woman (sore throat, flu, tuberculosis, rheumatism, diabetes mellitus, anemia, damage to the liver, kidneys, cardiovascular system, etc.), unhealthy diet, overwork, taking certain medications, smoking, drinking alcoholic beverages, exposure to industrial hazards, ionizing radiation can adversely affect the course of pregnancy and the fetus. The most common complications during pregnancy are toxicosis and miscarriage.

Toxicosis of pregnant women (or gestosis)- a pathological condition caused by the development of the fertilized egg. In the first half of pregnancy, it can manifest as poor health, depression, drooling, nausea, vomiting; in the second half - edema, the presence of protein in the urine, high blood pressure, headache, blurred vision, convulsions, loss of consciousness. Toxicosis in the first half of pregnancy is called early, and in the second half of pregnancy - late.

Toxicosis in pregnant women can lead to premature termination of pregnancy, impaired fetal development and death. Impaired fetal development causes stillbirth, infant mortality in the first week of life, as well as morbidity in the first years of life. In multiple pregnancies, toxicosis of pregnant women is somewhat more common.

Miscarriage- this is a spontaneous premature (before the 38th week) interruption. In the first 28 weeks, termination of pregnancy is called a miscarriage, between the 28th and 38th weeks - premature birth. In a number of countries, according to the recommendations of the World Health Organization, premature birth is considered to be termination of pregnancy starting from 22 weeks. The first signs of spontaneous miscarriage and premature birth are pain in the lower abdomen and bloody discharge from the genital tract.

Relatively rare, severe complications of pregnancy include premature placental abruption (separation from the wall of the uterus) and hydatidiform mole. When a normally located placenta is detached (above the internal os, or exit from the uterus), abdominal pain and bloody discharge from the genital tract occur. Detachment of the placenta previa (low-lying, partially or completely covering the internal uterine os) is accompanied by uterine bleeding, often very profuse.

Hydatidiform mole is a kind of uterine tumor that develops from the tissues of the placenta and looks like a cluster of small bubbles. This tumor is manifested mainly by uterine bleeding, which occurs in the 2-3rd month of pregnancy and recurs periodically. Sometimes the tumor grows into the wall of the uterus and metastasizes to other organs (malignant form). Spontaneous miscarriage and toxicosis of pregnant women are often observed with hydatidiform mole.

Quite common ectopic pregnancy, mainly tubal (development of a fertilized egg in the fallopian tube), which is usually interrupted at 4-8 weeks. Termination of an ectopic pregnancy is manifested by pain in the lower abdomen, often one-sided, bloody vaginal discharge and symptoms of blood loss (weakness, dizziness, pale skin, fainting) due to bleeding into the abdominal cavity. As a rule, signs of termination of an ectopic pregnancy occur after a short delay of menstruation, against the background of subjective signs of pregnancy.

Manifestations of pregnancy complications and measures to be taken if they occur:

Vomit, which is a symptom of early toxicosis of pregnant women, occurs in the first weeks of pregnancy and continues until the 14-15th week. It is repeated several times a day - on an empty stomach, after meals. A pregnant woman complains of constant nausea, weakness, drowsiness, and irritability. Sometimes drooling is observed - up to 1-1.5 liters of saliva can be released per day. If these symptoms appear, a pregnant woman should contact an antenatal clinic. Treatment is carried out in a hospital, in mild cases, with the permission of a doctor, at home.

It is recommended that a pregnant woman spend most of her time lying down, drink chilled, lightly salted water often and little by little, and if she is salivating, rinse her mouth with an infusion of sage, chamomile or oak bark. Food should be predominantly liquid and easily digestible; It should be taken lying down, in small portions every 3-4 hours. Infusions of valerian and motherwort, metoclopramide (cerucal, raglan) are prescribed orally, 1 tablet (10 mg) 2-3 times a day before meals. As a rule, these measures are quite effective.

If hidden or visible edema appears, a pregnant woman should contact an antenatal clinic. During examination, elevated blood pressure and (or) protein in the urine are detected; the patient is urgently hospitalized in the pregnancy pathology department of the maternity hospital. In some cases (lack of effect from treatment, delayed fetal development), early delivery is performed. For dropsy in pregnancy, the doctor sometimes allows you to stay at home if it is possible to provide the conditions necessary for treatment.

First of all, it is recommended that a pregnant woman establish a balanced diet. The protein content in the daily diet should be 120 g, the amount of carbohydrates should be limited to 300 g, fat to 80 g, table salt to 3-5 g. It is especially strictly necessary to ensure that the volume of liquid consumed does not exceed 1 liter per day. Once a week it is useful to carry out fasting days (apple, cottage cheese, kefir).

The duration of night sleep should be at least 9-10 hours; if possible, it is recommended to increase your stay in the fresh air. Among medications, you should take gendevit, infusions of diuretic herbs, papaverine 1 tablet (0.04 g) orally 3 times a day, potassium preparations - for example, potassium orotate 1 tablet (0.5 g) orally 2-3 times a day .

During treatment, it is necessary to keep track of the amount of fluid taken per day and urine excreted during this time, and control body weight. A positive fluid balance (the amount of fluid consumed per day is greater than the amount excreted) and a weekly weight gain not exceeding 300 g indicate the effectiveness of the measures taken.

Failure to consult a doctor in a timely manner when edema appears and insufficiently strict implementation of his recommendations in the treatment of dropsy in pregnancy contributes to the development of nephropathy.

Headache, which suddenly appears in the second half of pregnancy (usually in the last third) against the background of manifestations of nephropathy (edema, high blood pressure, the presence of protein in the urine), indicates a sharp rise in blood pressure, impaired cerebral circulation and an increase in intracranial pressure, i.e. about the development of a more severe stage of late toxicosis of pregnancy - preeclampsia.

The addition of visual disturbances to the headache (flickering “flies” before the eyes), pain in the epigastric region indicate threatening cerebral edema. Preeclampsia can quickly turn into eclampsia - the most life-threatening stage of late toxicosis of pregnancy for the woman and the fetus, in which convulsions and (or) loss of consciousness develop as a result of a pronounced cerebrovascular accident.

If a headache appears in the second half of pregnancy in the presence of edema and indications of increased blood pressure and (or) detection of protein in the urine, you should immediately call an ambulance doctor to carry out emergency measures aimed at reducing high blood pressure and transport the patient to the pathology department pregnancy in a maternity hospital, where the necessary intensive care is provided. In some cases, early delivery is carried out.

Before the doctor arrives, the woman needs to be laid down, given 1 tablet of no-shpa (0.04 g) and 1 tablet of papazole (a drug containing 0.03 g of papaverine and dibazol), put 2-3 on the back of the neck at the hair growth line mustard plaster If the headache is accompanied by flashing “floaters” before the eyes and pain in the epigastric region, the pregnant woman should be placed in a darkened room, where, if possible, conditions of peace and quiet can be created. The patient should take 1-2 tablets of no-shpa and 1-2 tablets of papazole; instead of papazole, you can give 1 tablet of clonidine (0.000075 g). It is recommended to place a warm heating pad on the lower back to improve blood circulation in the kidneys.

Even if after the measures taken the patient’s condition has improved, her stay at home is unacceptable, because At any moment, deterioration may occur with the development of convulsions and loss of consciousness, and sometimes death.

Convulsions, which occur in the second half of pregnancy when its course is unfavorable (swelling, increased blood pressure, protein in the urine), are a sign of eclampsia - the most severe stage of late toxicosis of pregnancy. They are often preceded by symptoms of preeclampsia - headache, blurred vision, pain in the epigastric region.

At the beginning of a convulsive attack, twitching of the facial muscles is observed for 20-30 s, the eyelids almost close. Then tonic convulsions occur - a sharp tension of all skeletal muscles, they are accompanied by cessation of breathing, blueness of the face, dilation of the pupils, and loss of consciousness. After 20-30 s, tonic convulsions are replaced by twitching of the muscles of the face, torso, and limbs, and after another 20-30 s, breathing appears and the convulsions stop.

Initially, breathing is irregular, hoarse, with foam coming from the mouth, which, due to biting the tongue, can be stained with blood. After the seizures stop, the patient usually regains consciousness no later than 1 hour, sometimes after several hours or even days. A convulsive seizure can be a single seizure; in some cases, seizures are repeated at short intervals. Sometimes eclampsia manifests itself only by loss of consciousness (non-convulsive form).

With eclampsia, fetal death is possible due to oxygen starvation during respiratory arrest. A woman may die due to cerebral edema, hemorrhage into the brain, or a decrease in its blood supply.

If a pregnant woman experiences convulsions, it is necessary to call an ambulance as quickly as possible and provide first aid before its arrival. During an attack of convulsions, the patient should be laid on a flat surface with her head turned to the side; protect from bruises, relieve the pressure of tight clothing.

The patient's jaws should be unclenched using the handle of a spoon or similar object wrapped in a clean handkerchief, gauze or bandage and held in this position, leaving the said object between the large molars of the upper and lower jaw - this avoids biting the tongue. The oral cavity must be cleared of contents, because... it may enter the respiratory tract and cause suffocation. In case of cessation of cardiac activity and absence of spontaneous breathing, indirect cardiac massage and artificial respiration are indicated.

The emergency doctor carries out measures to help stop seizures and restore cardiac activity and breathing. After the elimination of seizures, the patient is carefully transported to the pregnancy pathology department of the maternity hospital to continue intensive care. According to indications, early delivery is carried out.

Abdominal pain observed with such complications of pregnancy as spontaneous premature termination (miscarriage, premature birth), premature detachment of a normally located placenta, as well as with an interrupted ectopic pregnancy.

When a miscarriage occurs, abdominal pain is the first symptom. They can be aching or cramping and are localized in the lower abdomen. Subsequently, blood begins to be released from the genital tract, sometimes in significant quantities, and parts of the fertilized egg leave with the blood.

Premature labor occurs in the last third of pregnancy (between the 28th and 38th weeks) and begins with pain in the lower abdomen and lower back. Then labor develops (contractions, pushing) and an immature but viable fetus is born, followed by the afterbirth. Premature rupture of amniotic fluid and uterine bleeding are often observed.

Premature detachment of a normally located placenta, which occurs during pregnancy (usually in the last third), is manifested by abdominal pain, which, when a large area of ​​the placenta is separated from the wall of the uterus, is very strong, bursting and bloody discharge from the genital tract. In severe cases, a significant amount of blood can accumulate between the detached placenta and the wall of the uterus, which leads to signs of severe blood loss, including fainting.

With an interrupted ectopic pregnancy, pain in the lower abdomen is often one-sided. They can be very sharp, cramping and accompanied by a disturbance in the general condition and function of vital organs (due to the outpouring of a large amount of blood into the abdominal cavity) with a slight discharge of blood from the genital tract; this is characteristic of a ruptured fallopian tube. With a tubal abortion - the separation of the fertilized egg from the walls of the fallopian tubes and its release into the abdominal cavity - the pain in the abdomen is less intense, sometimes aching, and blood loss is not so significant.

Due to the fact that abdominal pain is often a symptom of severe complications during pregnancy, in which life-threatening conditions for the pregnant woman and the fetus can develop, if even minor pain occurs, you should immediately contact an antenatal clinic, and in case of severe abdominal pain, pain accompanied by a violation of the general condition or uterine bleeding, call an ambulance.

To clarify the cause of abdominal pain and carry out appropriate treatment, as a rule, hospitalization in a maternity hospital is necessary. With a threatened miscarriage that occurs in the first 3 months. pregnancy, treatment, with the permission of the antenatal clinic doctor, can be carried out at home.

Early contact with a doctor in case of spontaneous premature termination of pregnancy, mild premature abruption of a normally located placenta allows us to limit ourselves to conservative treatment and maintain the pregnancy. Timely hospitalization during an ectopic pregnancy increases the chances of saving a woman’s life.

Uterine bleeding may be associated with spontaneous premature termination of pregnancy (miscarriage, premature birth), interrupted ectopic pregnancy, hydatidiform mole, premature placental abruption (normally located and presenting).

The cause of uterine bleeding in the first 28 weeks of pregnancy is often a spontaneous miscarriage, usually starting with pain in the lower abdomen. Blood loss with a miscarriage that occurs before the 14th week of pregnancy is greater than with a miscarriage at a later date. Heavy uterine bleeding is possible when parts of the fertilized egg are retained in the uterus. When an ectopic pregnancy is terminated, which usually occurs in the 4-8th week of development of the fertilized egg, the discharge of blood from the genital tract is usually insignificant, pain in the lower abdomen and signs of internal bleeding are noted.

Uterine bleeding is sometimes a consequence of hydatidiform mole. It usually occurs in the first third of pregnancy, is often minor and recurs periodically, and in some cases heavy bleeding is observed. As a rule, there is no abdominal pain.

Uterine bleeding that occurs after the 28th week of pregnancy is mainly caused by premature detachment of a normally located or presenting placenta. When a normally located placenta abruptly occurs during pregnancy, uterine bleeding is usually small, accompanied by abdominal pain and symptoms of blood loss due to internal bleeding.

Uterine bleeding during abruption of the placenta previa during pregnancy, which often occurs 2-3 weeks before the due date, can begin against the background of complete well-being (often at night) in the absence of any symptoms indicating a disruption in the course of pregnancy. Due to the fact that the bleeding is usually very profuse, death of the fetus (due to disruption of its blood supply) and the woman can quickly occur. Sometimes the bleeding is minor and stops on its own, but then recurs.

Since uterine bleeding during pregnancy poses a high risk of death for the fetus and the pregnant woman, if it occurs, you should call an ambulance as quickly as possible and hospitalize the patient in the maternity hospital. Until the cause of the bleeding is determined, it is unacceptable to use any measures to stop it at home. Even if the bleeding has stopped on its own, the woman cannot be left at home, because... at any moment it can resume and lead to catastrophic consequences.
Intrauterine infection of the fetus during pregnancy

Possible complications during pregnancy

Some diseases or complications that may arise during pregnancy, during childbirth or in the postpartum period pose a significant danger to mother and child. Complications can lead to premature termination of pregnancy, uterine bleeding, intrauterine growth retardation and even the death of the baby.

Toxicosis and gestosis

Toxicosis is a complication of pregnancy that occurs before 10 weeks and is manifested by nausea, vomiting, changes in taste, and drooling. With gestosis, the functions of vital organs and systems are disrupted due to disturbances in the vascular system. Typically, the manifestation of gestosis occurs in the second half of pregnancy: edema, protein excretion in the urine, and increased blood pressure.

The appearance of toxicosis in the first and gestosis in the second half of pregnancy is a consequence of certain risk factors, such as non-gynecological diseases, early and late age of the pregnant woman, intoxication, bad habits, difficult and harmful working conditions. The result of a violation of the woman’s body’s adaptation to pregnancy is toxicosis and gestosis. This disorder can occur in women who are completely healthy, because if you look at it, risk factors such as stress, certain diseases of the internal organs during or before pregnancy are found in almost any woman.

Mild toxicosis in the first half does not seriously disturb the course of pregnancy, but in severe cases it can complicate it. If toxicosis is severe, vomiting, which is characteristic of it, causes dehydration of the body and sudden weight loss of the pregnant woman, which leads to disruption of the functioning of the organs and systems of the body. In addition, the fetus suffers from insufficient oxygen and nutrients.

Toxicosis is diagnosed by characteristic manifestations; To determine the severity of the disease, a woman takes blood and urine tests. Mild forms of toxicosis are treated under the supervision of a doctor at the antenatal clinic on an outpatient basis. If treatment is ineffective and symptoms increase, the pregnant woman is hospitalized. In the hospital, the woman receives medications that help cope with the symptoms of toxicosis, as well as solutions containing nutrients.

Preeclampsia also poses a danger to the health of pregnant women; in addition, it is one of the main causes of morbidity and mortality in children during intrauterine development, during childbirth and in the early postpartum period. Most often, gestosis is manifested by increased pressure, swelling, and the appearance of protein in the urine. A antenatal clinic doctor observing a pregnant woman, when signs of gestosis appear, prescribes the necessary treatment, and if there is no effect from the therapy, refers her to inpatient treatment.

Abnormal fetal positions

Incorrect positions of the baby in the uterus: transverse, oblique, pelvic can also disrupt the normal course of pregnancy. They lead to prenatal rupture of amniotic fluid, prolapse of small parts of the fetus and umbilical cord, abnormalities in labor, fetal hypoxia, and uterine rupture. The causes of such complications may be:

• polyhydramnios;
• multiple pregnancy;
• tumors and abnormalities of the uterus;
• insufficient tone of the muscles of the uterus and abdominal muscles (which often happens in women who have had multiple births).

Breech presentation of the fetus can be hereditary. Incorrect position of the child is determined in the last trimester of pregnancy using an external examination and confirmed by ultrasound examination. If a woman is diagnosed with an incorrect position of the fetus in time, then during pregnancy, with the help of special gymnastics, they try to correct it to the correct one, in which the fetus is turned head down.

If this fails, early hospitalization in the maternity hospital (at 34-35 weeks) is required to decide on the method of delivery. In addition, if a pregnant woman breaks her amniotic fluid prematurely or goes into labor, the medical staff will be there to provide her with the necessary assistance.

Polyhydramnios and oligohydramnios

Polyhydramnios is excessive accumulation of amniotic fluid in the amniotic cavity (more than 1.5-2 liters). Due to the fact that the size of the uterus is longer than the term due to the excessive amount of amniotic fluid, it puts pressure on neighboring organs and the diaphragm (this also happens during a normal pregnancy at longer periods, but with polyhydramnios it manifests itself more strongly and earlier), making breathing difficult, disrupting blood circulation, function of the kidneys and other organs. As a result, the woman feels shortness of breath, malaise, heaviness and pain in the abdomen, and swelling of the legs may appear. A child with polyhydramnios is excessively mobile, which leads to his incorrect positions, and this, in turn, complicates the course of pregnancy and childbirth.

Oligohydramnios is said to occur when the amount of amniotic fluid is less than 0.5 liters. Due to the insufficient amount of water, the walls of the uterus are close to the surface of the fetal body and interfere with its movements and normal position. Oligohydramnios affects the condition of the fetus: its skin becomes dry and wrinkled, it lags behind in height and body weight, curvature of the spine, clubfoot and other pathologies are possible. During childbirth, oligohydramnios can lead to labor pathology and premature placental abruption.

The presence of polyhydramnios or oligohydramnios can be suggested by a number of clinical signs, but more often the diagnosis is made during an ultrasound scan. Polyhydramnios, as well as oligohydramnios, in itself is also the result of any pathological processes, such as infection, developmental defects, etc. Therefore, when diagnosing this complication, an examination is carried out in order to identify the causes of its occurrence, and if found, then prescribed appropriate treatment.

Anemia in pregnancy

Anemia is a decrease in the amount of hemoglobin in red blood cells, a substance that carries oxygen. No pregnant woman is immune from anemia, since the cause of this condition is most often insufficient replenishment of iron reserves, the need for which is significantly increased during pregnancy. Anemia in pregnant women is combined with hypoxia, malnutrition (weight loss) and anemia of the fetus, suppression of hematopoiesis in the child’s body and in a baby under the age of 1 year.

Pregnant women complain of weakness, shortness of breath, headache, blurred vision, low blood pressure, and fainting with little physical exertion. But more often the diagnosis is made based on the results of a blood test. Also, with anemia, pregnant women develop late toxicosis, and premature birth is more common. The birth itself is complicated by weakness of labor, pathological blood loss, septic diseases and decreased lactation.

Prevention and treatment of anemia in pregnant women consists of a fully balanced diet of proteins, fats, carbohydrates, vitamins and microelements and the administration of an iron supplement when hemoglobin decreases below the permissible norm (110 g/l).

Rhesus conflict

This phenomenon can only occur in Rh-negative mothers who are pregnant with an Rh-positive child. The essence of this pathology lies in a pathological immune reaction: the mother’s body perceives the fetus as a “foreign object,” which can lead to serious complications, primarily on the part of the baby. Antibodies are produced, which, entering the child’s bloodstream, destroy his erythrocytes (red blood cells), causing anemia, intoxication, dysfunction of vital organs, possible termination of pregnancy, premature birth.

This condition of a child and newborn is called hemolytic disease (hemolysis - destruction of red blood cells). The breakdown of red blood cells leads to damage to the child's kidneys and brain. In the most severe cases, it may die in utero or be born nonviable. In milder cases, Rh conflict manifests itself simply as birth jaundice or anemia of the newborn. To prevent such severe complications during pregnancy, women who are at risk for the development of this pathology (these are Rh-negative women who have suffered miscarriages, abortions, childbirth, which led to the formation of antibodies), repeatedly take blood tests for the presence of antibodies.

If necessary, the pregnant woman is hospitalized in a hospital that specializes in this pathology to carry out the necessary treatment, including blood transfusion to the fetus, which allows the pregnancy to continue until the period when the child is viable (under ultrasound control, the umbilical cord vein is penetrated through the mother’s anterior abdominal wall and transfuse the child with 20-50 ml of donor red blood cells).

Pregnancy problems➤ Although the vast majority of pregnancies do not have serious problems, the entire prenatal care system is designed to identify potential complications and help prevent avoidable ones. Through a series of prenatal checks - monitoring your blood pressure, urine, blood and weight, measuring the tip of the uterus and a variety of other things - your doctor tries to keep you and your baby healthy so that you have the safest and best possible birth.

These checks also help your healthcare provider find and treat potential pregnancy complications early, before they become more serious problems.

There are some pregnancy complications that are more common than others. Although they may still only affect a small percentage of pregnant women, they can be painful and potentially dangerous to both the mother and/or baby.

Here's a starting list of complications you might want to screen for in an average pregnancy.

However, know that your doctor or midwife will also personalize this list for you based on your medical and family history to provide you with the best care possible.

Rh factor

Pregnancy problems➤ Everyone has a blood type and Rh factor. In addition to the blood group (A, B, O, AB), the Rh factor is recorded as positive (present) or negative (absent). Most people (85 percent) are Rh positive. This factor does not affect your health and is generally not important unless you are pregnant.

A pregnant woman is at risk when she is Rh negative and her partner is Rh positive. This combination can give the child Rh positive.

If the mother and baby's blood mixes, it can cause the mother to create antibodies against the Rh factor, and thus the baby will be treated as an interloper in her body. Usually the blood of mother and child does not mix; There are certain times when there is a small chance of this happening, such as at birth, certain prenatal tests (such as amniocentesis), or after a miscarriage. The drug RhoGAM is used to prevent this sensitization.

If you and your partner are Rh negative, this will not be a problem for your pregnancy. Don't worry if you don't know your blood type. This is something that will be checked early in your prenatal care.

Diabetes mellitus during pregnancy

Pregnancy problems➤ Gestational diabetes (GD) is high blood sugar (glucose) during pregnancy; about 4 percent of pregnant women develop it. Most mothers need to be screened with a blood test, which usually occurs around the twenty-eighth week of pregnancy. If you need additional screening with a glucose tolerance test (GTT), this will be done at this stage.

If you have GD, your labor may be triggered as you approach the 40-week mark.

You will need to monitor your blood sugar levels from diagnosis until the end of your pregnancy if you have gestational diabetes, and your doctor will teach you how and when to do this. Diet and exercise will be key components of your blood sugar control strategy. Medicines are only used if diet and exercise don't work. You will typically contact a nutritionist for help with this process, in addition to your primary care physician.

Preeclampsia

Pregnancy problems➤ Preeclampsia, or pregnancy-induced hypertension (PIH), is a disorder of high blood pressure during pregnancy. This has long been one of the top concerns for mothers during pregnancy, and it affects 7 percent of first-time mothers. Labor can be induced early if you suffer from severe PH.

Evidence suggests that kidney and liver problems can occur without evidence of protein and that the amount of protein in the urine does not predict how severe the disease will progress.

Currently, preeclampsia should be diagnosed by persistent high blood pressure that develops during pregnancy or the postpartum period, which is associated with large amounts of protein in the urine or the new development of low platelets, kidney or liver problems, fluid in the lungs, or signs of brain damage , such as seizures and/or visual disturbances.

Given the possible consequences of this complication, it is checked from the very beginning of pregnancy. The sooner it appears, the more serious it becomes. Your doctor will monitor your blood pressure and other signs and symptoms to determine how long you want to continue your pregnancy. Obviously, there is a desire to ensure that you carry your baby as close to term as possible and protect your health, so there is a fine balance that needs to be struck, which is different for every pregnant woman.

Placenta previa

Pregnancy problems➤ Placenta previa is when all or part of the placenta covers the cervix or opening of the uterus. True placenta previa occurs in approximately one in 200 pregnancies. In many cases, placenta previa shows early, but this condition resolves later as the uterus grows. If the problem persists at the end of pregnancy, a procedure may be performed to prevent bleeding during labor.

Most mothers will not have any signs or symptoms of placenta previa, although some mothers may experience bleeding. This is why it is important to talk to your doctor if you experience bleeding during pregnancy.
Oligohydramnios (low amniotic fluid volume)

Oligohydramnios, or low amniotic fluid, is diagnosed with an ultrasound, but this ultrasound may be ordered after your doctor notices a difference in the growth of your uterus compared to measurements taken during prenatal visits. There are some signs that amniotic fluid levels are dropping as the time of birth approaches. Many practitioners will have you drink fluids (to make sure low fluid levels are not due to poor hydration) and re-evaluate you with an ultrasound before talking about induction of labor or other interventions.

Polyhydramnios (large volume of amniotic fluid)

Pregnancy problems➤ Polyhydramnios is the opposite of oligohydramnios, which means there is excess amniotic fluid. This occurs in less than a percentage of all pregnancies.

While some believe that polyhydramnios is a cause of preterm labor due to uterine distension, a similar predictor is a large amount of amniotic fluid. Rather, it may indicate whether the pregnancy will end or not.

Polyhydramnios is more common when:

1. There is multiple pregnancy;
2. There is maternal diabetes;
3. There is a congenital malformation or certain birth defects;

While some practitioners try to drain the fluid from the uterus through a needle, this is often not a long-term solution as the fluid replaces itself. This may mean that not much is done during pregnancy to address the problem. Because polyhydramnios can increase the risk of something like umbilical cord prolapse, when the water breaks during labor, you will be monitored once labor begins.

Abnormal fetal positions

Pregnancy problems➤ Breech babies are not in the normal head down position. It occurs in 3 to 4 percent of all births late in pregnancy. Babies are commonly malpositioned for a variety of reasons, including:

Uterine anomalies

1. Fetal problems
2. Multiple
3. Other conditions

There is also a position known as a transverse lie, which means the baby lies on the side of the uterus. Because it would be difficult to deliver the baby this way, your practitioner may do an external version, in which the baby is turned externally, or recommend a caesarean section. There are also some practitioners who will perform vaginal breech births for certain women and babies in certain breech positions.

Premature birth

Pregnancy problems➤ Premature birth is a very serious complication of pregnancy. Early detection can help prevent premature birth, possibly allowing you to carry your pregnancy to term or give your baby a better chance of survival. There are many causes of preterm birth, including infections, uterine problems, multiple births, and maternal illnesses. No matter what causes preterm labor, it's important to know what the signs are so you can get emergency help.

You should call your doctor or midwife if you have any of the following signs of preterm labor:

1. Contractions or spasms;
2. Bright red bleeding;
3. swelling or puffiness of the face or hands;
4. Pain during urination;
5. Acute or prolonged abdominal pain;
6. Acute or persistent vomiting;
7. A sudden flow of clear, watery fluid;
8. Lumbago;
9. Intense pelvic pressure;

There may be other signs that your doctor tells you to look for; Be sure to call if you are concerned. If you can't get hold of your doctor, you can go to the emergency room for help.

Slightly open cervix

Pregnancy problems➤ A patent cervix is ​​essentially a cervix that is too weak to remain closed during pregnancy, leading to premature birth and possible loss of the baby (due to shortened gestational length). Cervical incompetence is thought to account for 20 to 25 percent of all second trimester losses. This problem usually appears at the beginning of the second trimester, but it can be detected as early as the beginning of the third trimester. Diagnosis can be made either manually or using ultrasound.

If a problem is suspected...

Pregnancy problems➤ If you or your practitioner think there is a problem, talk about a plan of action. This may lead to specific tests for your specific or suspected condition. It may also involve watchful waiting. The latter can sometimes be very difficult. Of course you want to take action, but it may not always be best. Whether the problem is suspected or confirmed, it usually involves more frequent visits to the doctor.

What happens if you have complications

Pregnancy problems➤ The good news is that with good prenatal care, most complications can be prevented, detected early and/or successfully treated. Some require extra care during or after pregnancy, and sometimes into the future, while others do not. After your baby is born, it's best to schedule a time to talk with your healthcare provider before planning another pregnancy to find out what you can do before you get pregnant to reduce the risk of complications recurring or deal with it sooner.

Specialists for high risk pregnancies

Pregnancy problems➤ Sometimes, if your complication is more than normal or severe enough to constitute a high-risk pregnancy, you may need a higher level of care. If you work with a midwife, this may mean that you will need to collaborate with your doctor, or perhaps even hand over your care entirely to the doctor. If you are an obstetrics and gynecologist, you may also need to transfer your care to a high-risk specialist known as a maternal-fetal medicine specialist.

Complicated pregnancy is a pathological process that is diagnosed in more than 30% of cases, and, unfortunately, this figure continues to increase. There are causes and factors that cause complications during gestation. Of the factors, occupational hazards, unfavorable environmental conditions and an asocial lifestyle play a special role.

Causes of pregnancy complications

The first group includes endocrine diseases (endocrine pathologies occupy a leading position during the period of pregnancy).

These include:

• diabetes mellitus 1, 2 and;
• diffuse toxic goiter;

Of cardio-vascular system:

Nephrological reasons:

• glomerulonephritis;
• proteinuria (leads to).

Gynecological:

• abnormalities of the reproductive organs;
• underdevelopment of the birth canal;
• , salpingitis and a history.

There are other equally significant causes of complications during gestation and childbirth:

• a large number of births;
• the woman or her partner;
• ruptures and scar on the uterus left during previous births;
• chromosomal abnormalities;
• genetic mutations;
• immunological problems;
• blood diseases;
• neglectful eating and obesity;
• complications that developed after intrauterine manipulations: intravascular blood components, or;
• diseases of viral and infectious etiology.

The gestational period is the time when existing chronic diseases enter the subcompensatory stage, and some anomalies are detected for the first time.

Due to the reduced defenses of the body, the risk of infection with influenza or ARVI viruses increases.

Depending on one reason or another, pregnant women are identified as a high-risk group, and they are closely monitored.

The consequences of pathologies have a disastrous prognosis:

• the risk of early abortion increases;
• the habitual develops;
• deep prematurity;
• early or ;
• high and low water levels;
• late and .

Classification

Changes can be observed not only in the mother, but also in the fetus.

Based on this, it was attempted to classify various deviations during childbearing:

• Changes have occurred in the mother's body. These are somatic and systemic pathologies, anatomical abnormalities, and hormonal disorders.
• Pathological changes occurred in the fetus. These include: hypotrophic or dystrophic abnormalities, genetic abnormalities, hypoxia, b, incorrect position.
• By: conflict under the ABO system or due to a violation of the IPC.
• Failures that occurred during embryogenesis: placenta previa, pathological changes in the umbilical artery or amniotic membranes.

In addition, complicated gestations are classified according to the moment of development:

• In the early stages, no later than the 1st trimester. In most cases, they end with spontaneous termination of gestation.
• At a later date. They account for about 11% of cases. Late complications negatively affect the health of the mother, the intrauterine development of the fetus and the course of labor.

Symptoms

The clinical picture of developing anomalies during the gestational period has similar features, regardless of the causes of the pathology:

• nagging pain in the lower abdomen;
• frequent fatigue;
• apathy;
• change in the nature of mucous discharge from the vagina;
• decreased appetite;
• loss of consciousness.

Nausea and bouts of vomiting appear if the cause is toxicosis. In the later stages, a pregnant woman may notice frequent painful tremors.

With endocrine pathologies, there is a constant feeling of dry mouth and nervousness. Dizziness is not excluded.

In case of any pathological abnormality, you should immediately seek qualified medical help.

Diagnostics

Since there are many pathological phenomena, it is impossible to list them all. But complications of gestation are diagnosed using known methods:

• gynecological examination with or without speculum;
• pelvic organs or fetus and child's place;
• Dopplerography;
• intrauterine method;
• laboratory tests: general analysis and biochemical research;
• tank examination of vaginal discharge;
• consultation of narrow specialists: endocrinologist, nephropathologist, cardiologist;
• invasive and non-invasive tests: , .

Diagnostic manipulations will allow us to identify concomitant pathologies and prescribe adequate treatment.

Despite the large number of diagnostic procedures, the main place belongs to ultrasound and laboratory tests.

Treatment

Therapy depends on the identified anomaly and the cause of the gestational complication. Treatment is prescribed by the doctor depending on the type of pathology and intensity of the disease.

In 95% of cases, conservative therapy is carried out. 5% are intrauterine operations and surgical interventions to preserve maternal health (epidectomy, for example).

• Drug therapy is carried out using the following drugs:
• for infectious and inflammatory processes (Amoxiclav or Flemoklav). Therapy is carried out after identifying the type of pathogen;
• hormone therapy involves oral or parenteral administration of hormonal drugs to prolong pregnancy;
• antispasmodics and tocolytics;
• painkillers intramuscular injections;
• drugs to enhance the synthesis of pulmonary surfactant.

In case of systemic blood diseases, therapy with antiplatelet and antianemic medications is not excluded.

For various deviations in the biochemical composition of the blood, hepatoprotectors and enterosorbents become additions to the main treatment.

An obstetrician-gynecologist evaluates the pathology and prescribes a treatment regimen. In case of severe illnesses and conditions, the pregnant woman is placed in a hospital under round-the-clock supervision.

Due to the fact that the statistics of complicated pregnancies has increased significantly, enhanced measures have been developed when examining a pregnant patient.

Prognosis and prevention

In each individual case, the prognosis for gestation will be different. Modern medicine offers many methods to eliminate ailments. The possibility of their implementation is determined by the course of gestation.

Prevention of complications depends on the woman and her lifestyle. She should take care of her health, monitor her well-being, give up bad habits, and listen to the doctor’s advice.

Interesting video: possible complications of pregnancy and what they are associated with