Unfortunately, not all women have a smooth pregnancy. Some people just have a hard time taking it, while others may have serious complications. It is for this reason that a woman needs to be observed by a doctor throughout her pregnancy in order to prevent complications, to be sure that the child is developing correctly, without pathologies. Before pregnancy or already during it, experienced doctors, taking into account the age and history of the patient, can determine whether she is in one of the genetic risk groups for pregnancy complications and fetal pathologies and whether she may experience complications.
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There is a perinatal risk group, obstetric and extragenital. The perinatal risk group includes perinatal and intrapartum risk factors.
The extragenital risk group includes women with the following problems:
- diabetes;
- diseases of the digestive tract;
- cardiovascular pathology;
- kidney disease;
- diseases of the urinary tract.
The obstetric risk group includes women with the following problems:
- isoimmune conflict;
- miscarriage;
- malposition;
- burdened history;
- burdened heredity;
- bleeding;
- purulent-septic complications;
- weak labor activity.
The age of the woman is of great importance. If she is younger than 18 years old or older than 38 years old, she automatically falls into a risk group and requires more close supervision.
If it is 4 or 5 children or more, there are also risks, both on the part of the body and on the part of the woman herself, or rather her behavior. The uterus can lose its normal contractile activity after such a number of births. In addition, the risks increase due to the fact that a mother who has given birth to three children considers herself experienced in these matters, can visit a gynecologist irregularly, ignore any rules.
Especially if there are more than 2 babies in the womb, it is also considered very risky. Therefore, the expectant mother should visit the doctor more often than others and monitor the development of the babies, their location and the state of the uterus. She needs to choose in advance a maternity hospital and an experienced doctor who can take delivery, or decide in a timely manner whether it will be natural or whether there is a need for a Caesarean section.
A woman's financial situation also affects the course of pregnancy.... If a woman is experiencing financial difficulties, she has more children to look after, she cannot afford proper, healthy, nutritious food, there are risks premature birth... Women have to look after older children, carry them in their arms. You often have to travel to work in crowded public transport during peak hours, which is also very difficult in this situation.
Already, a woman must undergo an examination to be sure that there are no fetal pathologies, and everything is in order. There are a number of procedures and tests that a woman must undergo after learning about her situation. This set of tests is called prenatal screening.
Blood test must be taken twice during the first and second screening tests. The first screening is called double screening and is performed at 8-13 weeks. It is so called because a blood test is taken in order to check the level of two proteins. These are HCG and PAPP-A. Then a new screening is done at 16-20 weeks. AFP, NE, hCG and inhibin A are already being tested here.
Ultrasound is also performed as part of the screening. It must be done at least 3 times in each trimester. In the first trimester, an ultrasound scan is required in order to confirm the fact of pregnancy, to make sure that it is not ectopic, and also that there are no gross developmental pathologies. In the second trimester, this examination is required to thoroughly study the anatomy of the fetus to be sure that all organs are properly formed and developing. The task of the third ultrasound in the last trimester is the same as in the previous one. In addition to the correct development, the weight of the fetus, volume amniotic fluid and the location of the child.
Thanks to such screening throughout pregnancy, you can monitor the development and growth of the fetus, be sure that everything is in order.
If something is wrong, especially in the analysis, do not panic. Very often, the blood sampling could be carried out with some kind of violation, or the woman herself was incorrectly prepared for the tests. This all skews the results. Therefore, doctors in such cases always prescribe a second test.
What are the complications of a second pregnancy?
During the second pregnancy, the risks of complications are quite high. It all depends on when the previous birth was, how old the woman was. If she decided to have a second child almost immediately after the birth of the first, risks also arise.
Pregnancy is a huge stress for the body, after which it is necessary to recover, gain strength.
If you become pregnant after a short period of time, the exhausted body is not yet ready for a new load, therefore anemia, varicose veins, preeclampsia, toxicosis and other complications may develop.
Other women take a long break between the birth of their first and second child. Therefore, the second pregnancy occurs at a more mature age. In this case, the difficulties appear even more, since more mature women are more likely to have any chronic diseases.
Risks of complications can arise if during the first pregnancy there were complications, injuries, as a result of which scars were formed on the uterus, cervix. It takes time for the uterus to recover, heal, restore its contractile function. Otherwise, there are risks of miscarriages, and if the pregnancy continues, there is a likelihood of suture divergence, which is fraught with internal hemorrhage, which, if not admitted to the hospital on time, can lead to death.
Complications after medical termination of pregnancy, abortion, or frozen pregnancy are divided into early and late. Early complications arise immediately after the procedure. This is bleeding, incomplete abortion, which requires repeated cleaning, penetration of infection.
To late consequences include menstrual irregularities, endocrine disruption, developmental risks ectopic pregnancy.
As for an ectopic pregnancy, the next conception will depend on the time it is detected and the problem is corrected. It is worth remembering that, despite the surgical intervention, while maintaining the tubes, it is possible to become pregnant naturally... But, even if the pipes could not be saved, IVF can help in the appearance of a baby in the family. For those who do not have a financial issue in the last place, special programs are carried out for which money is allocated from the budget, but for this you need to register in the database and join the queue.
How to minimize the risks of complications?
To make everything go as smoothly as possible, prevention of complications of pregnancy and childbirth is carried out. To do this, in advance, eliminate the shortcomings identified in relation to health, switch to healthy image life and food. During pregnancy, it is worth adhering to all the doctor's recommendations, if there is no trust in him, you should look for another doctor who you can entrust your life and the life and health of the unborn child. These activities will significantly reduce possible risks and help to give birth to a healthy baby.
How to prepare for a healthy pregnancy and reduce the risks of complications in the video:
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Complicated pregnancy is a pathological process that is established in more than 30% of cases, and, unfortunately, this figure continues to increase. There are causes and factors that cause complications at the time of gestation. Of the factors, occupational hazards, an unfavorable ecological situation 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 bearing a baby).
These include:
- diabetes mellitus 1, 2 and;
- diffuse toxic goiter;
Of cardio-vascular system:
Nephrological causes:
- glomerulonephritis;
- proteinuria (leads to).
Gynecological:
- anomalies 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;
- a woman or her partner;
- tears and scar on the uterus, left in the previous birth;
- 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 such a time when the existing chronic diseases pass into the subcompensatory stage, and some anomalies are detected for the first time.
Due to the reduced body defenses, the risk of infection with influenza or ARVI viruses increases.
Depending on one reason or another, pregnant women are assigned to a high-risk group and carefully monitored.
The consequences of pathologies have a deplorable prognosis:
- the risk of early abortion increases;
- the habitual develops;
- deep prematurity;
- early or;
- high and low water;
- late and.
Classification
Changes can be observed not only from the mother, but also from the fetus.
Based on this, an attempt was made to classify various deviations in carrying a child:
- The changes took place in the maternal organism. These are somatic and systemic pathologies, anatomical abnormalities, hormonal disorders.
- Pathological changes occurred in the fetus. These include: hypotrophic or dystrophic deviations, genetic abnormalities, hypoxia, b, incorrect position.
- By: conflict over the AVO system or because of, violation of the MPPK.
- Failures that have arisen at the time of 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 1 trimester. In most cases, they end with spontaneous interruption of gestation.
- At a later date. They account for about 11% of cases. Late complications negatively affect the state of health of the mother, the intrauterine development of the fetus and the course of labor.
Symptoms
The clinical picture of developing abnormalities in the gestational period has similar features, regardless of the causes of the pathology:
- pulling pains 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 toxicosis is the cause. AT late dates the pregnant woman may notice, or frequent painful tremors.
With endocrine pathologies, there is a constant feeling of dry mouth and nervousness. Dizziness is possible.
For any pathological deviation, 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 by well-known methods:
- gynecological examination with or without mirrors;
- organs of the pelvis or fetus and children's place;
- dopplerography;
- by intrauterine method;
- laboratory tests:, general analysis and, biochemical research,;
- tank study of vaginal discharge;
- consultation of narrow specialists: endocrinologist, nephropathologist, cardiologist;
- invasive and non-invasive tests:,.
Diagnostic manipulations will identify concomitant pathologies and prescribe adequate treatment.
Despite the large number of diagnostic procedures, the main place belongs to ultrasound and laboratory analyzes.
Treatment
Therapy depends on the identified abnormality and the cause of the complication of gestation. Treatment is prescribed by a doctor depending on the type of pathology and the intensity of the disease.
In 95% of cases, conservative therapy is performed. 5% are intrauterine operations and surgical interventions to maintain maternal health (epidectomy, for example).
- Drug therapy is carried out using the following drugs:
- with infectious and inflammatory processes (Amoxiclav or Flemoklav). The therapy is carried out after establishing the type of pathogen;
- hormone therapy means oral or parenteral administration of hormonal drugs to prolong pregnancy;
- antispasmodics and tocolytics;
- pain relieving intramuscular injections;
- drugs to enhance the synthesis of pulmonary surfactant.
With systemic blood diseases, therapy with antiaggregatory and antianemic drugs is not excluded.
With various deviations in the biochemical composition of the blood, hepatoprotectors and enterosorbents become an addition to the main treatment.
The obstetrician-gynecologist evaluates the pathology and describes the treatment regimen. In case of serious illnesses and conditions, the pregnant woman is placed in a hospital under round-the-clock supervision.
In view of the fact that the statistics of complicated pregnancies have significantly increased, enhanced measures have been developed when examining a pregnant patient.
Forecast and prevention
In each case, the prognosis of gestation will be different. Modern medicine offers many methods for eliminating 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, listen to the advice of a doctor.
Interesting video: possible complications of pregnancy and what are they associated with
When it is necessary?
Day hospital - this is a short-term stay department, where the pregnant woman spends several hours a day while performing the necessary procedures (for example, droppers), and after they are finished she goes home
.
In many conditions, already from the beginning of pregnancy, the doctor may warn that at certain times it will be necessary to go to the hospital. it planned hospitalization... First of all, this applies to women who have various diseases of internal organs, such as arterial hypertension (high blood pressure), diabetes mellitus, heart and kidney disease. They also plan hospitalization for women with miscarriage (previously there were 2 or more miscarriages) and other adverse outcomes of previous pregnancies, or if the current pregnancy did not occur naturally, but with the help of hormone therapy or IVF (in vitro fertilization). Such hospitalization will occur at critical periods (dangerous in terms of miscarriage and premature birth) and for the period in which the previous pregnancy was lost.
In the case of planned hospitalization in the hospital, first of all, additional examination, which is not possible on an outpatient basis and prevention of possible complications of pregnancy. The timing of such hospitalizations can be discussed in advance with the doctor, they can be shifted by 2-3 weeks if necessary.
Emergency hospitalization recommended for health-threatening conditions future mother, baby health and termination of pregnancy. In this case, refusing hospitalization, the woman may lose the only chance of a successful pregnancy.
The need for hospitalization can arise at any stage of pregnancy, from the first days to those cases when childbirth does not occur at the expected time (prolonged pregnancy). Women before 12 weeks of pregnancy are hospitalized in the department of gynecology of the hospital, and after 12 weeks in the department of pathology of pregnant women in the maternity hospital.
High-risk pregnant women
1. Severe toxicosis 11 half of pregnancy.
2. Pregnancy in women with Rh and ABO - incompatibility.
3. Polyhydramnios.
4. The alleged discrepancy between the size of the fetal head and the mother's pelvis (anatomical narrow pelvis, large fetus, hydrocephalus).
5. Incorrect fetal position (transverse, oblique).
6. Postterm pregnancy.
7. Antenatal fetal death.
8. Threatening premature birth.
11 . Pregnancy and extragenital pathology.
(gestational age 22 weeks and above).
1. Cardiovascular diseases (heart defects, arterial hypertension).
2. Anemia.
3. Diabetes mellitus.
4. Pyelonephritis.
5. Thyrotoxicosis.
6. High myopia.
7. Chronic lung diseases (chronic bronchitis, bronchial asthma, history of lung surgery).
8. Pregnant women with gestational age up to 35 weeks and extragenital pathology are hospitalized in somatic departments of the appropriate profile.
111. Pregnancy and certain risk factors.
1. Pregnancy in primipara 30 years and older.
2. Pregnancy and uterine fibroids.
3. Breech presentation.
4. Scar on the uterus from previous surgery.
5. Multiple pregnancy.
6. Pregnancy in women who have given birth to children with developmental defects.
7. Pregnant women with delay intrauterine development fetus.
8. Threat of termination of pregnancy.
9. Habitual miscarriage at critical stages of pregnancy from 22 weeks
10. Anomalies of fetal development.
11. Chronic placental insufficiency.
12. Delayed intrauterine development of the fetus.
13. Pregnancy and uterine fibroids.
14. Termination of pregnancy for medical reasons.
15. Placenta previa.
16. Hepatosis of pregnant women.
Allocation of pregnant women into risk groups. There are groups of perinatal risk from the fetus and groups of pregnant women with obstetric and extragenital pathology.
Among the factors of perinatal risk, prenatal (socio-biological: obstetric and gynecological history, extragenital pathology, complication of this pregnancy, assessment of the fetal condition) and intranatal factors (from the mother's body, placenta, umbilical cord and fetus) are distinguished. Each risk factor is assessed in points, summing them up, the degree of risk is established. Distinguish between high (10 points and above), medium (5-9 points) and low (up to 4 points) degrees of risk.
The group of pregnant women with obstetric pathology includes women with the following pathology: late gestosis, miscarriage, isoimmune conflict (for rhesus and group systems), purulent-septic complications and bleeding, anemia, weakness of labor, abnormal positions and breech presentation of the fetus, undergone surgery on the uterus, burdened by history and heredity.
The group of pregnant women with extragenital pathology includes women with pathology of the cardiovascular system, diabetes mellitus, diseases of the digestive system, diseases of the kidneys and urinary tract. These groups of pregnant women are allocated by the therapist when they are registered and during pregnancy of 30 and 36-37 weeks
Belonging to a risk group and its degree are specified at 28-30 and 36-38 weeks of pregnancy, when the plan for the management of pregnancy and childbirth is being finalized.
The tactics of managing patients in risk groups depends on the type of pathology. In case of organic lesions of the heart, the following are indicated: planned hospitalization in early pregnancy, at 28-32 weeks and 2-3 weeks before childbirth; regular consultations of a therapist and obstetrician-gynecologist 2 times a month in the first half of pregnancy and 3 times a month in the second. In diabetes mellitus, regardless of its severity, the following are indicated: planned hospitalization in early pregnancy, at 20-24 weeks and 32-33 weeks to prepare for early delivery; early appointment and constant adjustment of the insulin dose; diet therapy with restriction of carbohydrates and fats; a visit to an obstetrician-gynecologist and therapist once every 10 days throughout pregnancy.
In case of diseases of the kidneys and urinary tract, it is necessary to visit an obstetrician-gynecologist and a therapist once every 2 weeks in the first half of pregnancy and once every 7-10 days in the second; consultation of a urologist and nephrologist - according to indications; planned hospitalization in early pregnancy, at 28-30 and 37 weeks of pregnancy.
Specialized care for women suffering from miscarriage is provided in antenatal clinic at the place of residence. An examination is carried out (ultrasound scanning, a study of ovarian function and the state of the endometrium, the exclusion of toxoplasmosis and listeriosis, a study of the immunological incompatibility of the blood of the mother and the fetus, a medical and genetic examination of the spouses) and treatment (correction of the function of the ovaries and adrenal glands, anti-inflammatory treatment, complex treatment of infantilism, suture on the cervix with isthmic-cervical insufficiency) outside and during pregnancy. Routine hospitalization is carried out at 5-6, 15-16, 27-28 weeks of pregnancy or at the time when the previous pregnancy was terminated, emergency hospitalization - according to indications (pain in the lower abdomen, mucous bloody discharge, increased uterine tone). Upon establishing the presence of pregnancy, the woman is immediately transferred to easy labor... As a rule, drug therapy in a antenatal clinic should not be carried out, only the completion of the course of treatment started in the hospital (turinal, tocopherol acetate, tablet forms of beta-adrenergic agonists) is allowed.
Prevention of Rh and ABO isosensitization (Rh and group) should be carried out before the planned pregnancy (identification of girls and women with Rh negative blood affiliation, determination of Rh blood affiliation in all nulliparous women when they are sent for an abortion at will and with persistent unwillingness to preserve the pregnancy - to ensure the introduction of anti-Rh immunoglobulin after an abortion; allocation to the risk group for the onset of immunoconflict for dispensary observation of women who have a history of Rh and ABO conflict during pregnancy and childbirth, women with Rh-negative blood, who after childbirth or anti-Rh-immunoglobulin was not administered to abortion, and women who received blood transfusions without taking into account the Rh-belonging of blood).
Prevention and early diagnosis of isoimmune conflicts during pregnancy are based on determining the Rh identity and blood group in all pregnant women and their husbands when registering, identifying groups at risk of isoimmune conflict. In terms of pregnancy management, it is necessary to provide for a study of blood serum for the presence of antibodies once every 2 months before 28 weeks of pregnancy and once a month after 28 weeks. Regardless of the absence of antibodies at 12, 20 and 30 weeks of pregnancy, 2-week courses of nonspecific desensitizing therapy (glucose, vitamin C, cocarboxylase, vitohepat, methionine, oxygen foam with vitamin syrups).
Pregnant women with isoimmune conflict (with identified antibodies to the Rh factor) should be hospitalized at 12, 16, 24, 30, 32-34 weeks of pregnancy, preferably in specialized hospitals, where they will undergo desensitizing therapy (infusion of hemodez, aminocaproic acid, the introduction of dexamethasone, hemosorption, transplantation of a skin flap to a woman or the introduction of lymphocytes from her husband) and preparation for early delivery was carried out.
The basic principles of management of pregnant women with breech presentation, transverse and oblique fetal positions are as follows: early diagnosis, corrective gymnastics according to the method of I.I. Grishchenko and A.E. Shuleshova (1968) in terms of 29 to 32 weeks of pregnancy - with breech presentation and from 29 weeks to delivery - with the transverse and oblique positions of the fetus; timely referral to a hospital at 33-34 weeks of gestation for external rotation of the fetus with the ineffectiveness of corrective gymnastics; hospitalization of pregnant women with a corrected position of the fetus 1 week with an uncorrected one - 2 weeks before delivery.
