Medical aspects of pregnancy and childbirth, complications of a course of pregnancy. An instruction for future mother of
When planning pregnancy, not very well what, it is necessary to remember that in general pregnancy has to come on a favorable background. If the previous pregnancy ended for any reasons unsuccessfully, it is absolutely optional that the same complications can arise again. However these failures in the anamnesis deserve a certain attention, and prerequisites for their emergence have to be excluded at a pregnancy planning stage.
to Plan new pregnancy after previous, especially if it was followed by any complications, it is desirable not earlier, than in a year. Previously it is necessary to estimate nature of menstrual function and if necessary to carry out its correction. It is also important to exclude existence of urogenital infections (hlamidiya, a mycoplasma, an ureaplasma, etc.) .
If to future parents is more than 35 years old, and the planned pregnancy at both or at one of spouses the first, then it is expedient to consult at the geneticist for an exception of possible chromosomal pathology.needs to define
When planning pregnancy optimum days for conception. The matter is that the menstrual cycle of the woman (the period from 1 - go day of one periods to 1 - go day of the subsequent periods) on average, in most cases, proceeds 28 - 30 days. For the first half of a menstrual cycle in one of ovaries the follicle ripens, and for 14 - 15 day there is an ovulation. At the same time the follicle leaves the ripened ovum. In view of that the ripened ovum is capable to fertilization within 2 days after an ovulation, and spermatozoa possess the impregnating activity within 4 days after an ejaculation, the general period of the most probable possibility of conception makes about 6 days.
is Usually considered to be that at the normal course of pregnancy its duration averages about 280 days if to consider of the first day of the last periods is “the obstetric term of pregnancy“ which calculation is most often used by doctors in obstetric practice.also determination of term of pregnancy by the sizes of a uterus and on stir of a fruit Is possible
. However these criteria are not exact as have individual character. The uterus sizes in the same terms of pregnancy at different women vary in rather wide limits, it complicates a pregnancy term assessment.the Feeling of stir of a fruit is also very subjective
and depends on a threshold of sensitivity of each woman. So, one women can begin to feel stirs of a fruit from 18 weeks, and others only from 22 weeks. Actually the fruit begins to make the movements from 7 - 8 weeks.
Rather typical and widespread is the delusion that determine pregnancy term by ultrasonic research (ultrasonography). It not really happens. In the course of this research resolve other not less important issue: of what term of pregnancy the fruit sizes received in the course of research are characteristic provided that the estimated term of pregnancy which is counted, in turn, of the first day of the last periods or of date of conception is known.
the Entire period of a course of pregnancy can be divided into three parts - trimesters. The I trimester represents the early fetalny period which lasts till 12 weeks. The II trimester is a srednefetalny period which proceeds from 13 to 27 weeks. The III trimester or as it still call “the fruit period“, begins with 28 weeks and proceeds to the term of childbirth.
the I trimester of pregnancy
One of the most important conditions of normal development of pregnancy is forecasting and prevention of possible complications. In this regard already in the I trimester of pregnancy it is necessary to reveal risk factors of these complications. It is for this purpose expedient to see a doctor as soon as possible.
concerning the come pregnancy needs to pass inspection which includes:
- Definition of a blood type and a Rhesus factor - a factor (even in spite of the fact that earlier such research was already conducted and these indicators are already known).
- the Blood test on syphilis (RW), HIV - an infection, hepatitises.
- Clinical blood test for an assessment of its cellular structure, level of hemoglobin and size SOE.
- the Assessment of activity of the curtailing system of blood.
- General analysis of urine.
- Studying separated from a vagina, the channel of a neck of a uterus and an urethra on existence of causative agents of various infections.
Besides, it is necessary to use serologichesky research for identification of specific antibodies of immunoglobulins of a class M and G by means of an immunofermental method.
One of the most objective methods of diagnostics is ultrasonic research, it is expedient to to make the first ultrasonography after 10 weeks . The main objectives of this research are: confirmation of the progressing pregnancy; specification of estimated term of pregnancy; identification of polycarpous pregnancy; definition of the place of implantation of fetal egg and localization of a placenta; measurement of thickness of vorotnikovy space (in 10 - 14 weeks); identification of signs of the complicated course of pregnancy (threat of a spontaneous abortion, an otsloyka of a horion, istmiko - tservikalny insufficiency, puzyrny drift, etc.) . Besides, in terms from 8 to 11 weeks carrying out the combined screening test for an exception of risk of possible violations in development of a fruit which includes definition of free is possible? - subjedinitsa of HGCh, PAPP - A.
the Most frequent complications in the I trimester are: not developing pregnancy, a spontaneous abortion and early toxicosis.
of the Reason for not developing pregnancy and its interruptions during various periods of the I trimester are not identical. So, till 3 weeks it is most often genetic and chromosomal damages, and also insufficient preliminary preparation an endometriya to the forthcoming implantation of fetal egg. In 4 - 8 weeks, as a rule, the main reasons are the hormonal violations, an infection, an anti-phospholipidic syndrome resulting in primary fetoplatsentarny insufficiency and violation of an embryogenesis. In 9 - 12 weeks the main negative influence can be shown both from already listed factors, and at insufficient stretching of a uterus, for example, at genital infantility or malformations of a uterus.Should be limited to
strictly use of medicines in early terms of pregnancy from - for dangers of their damaging impact on a fruit. It is not necessary to self-medicate. Expediency of use of these or those medicines has to be coordinated with the doctor.
the II trimester of pregnancy
In the II trimester of pregnancy proceeds growth of a placenta and fruit. Therefore, control of normal development of a fruit and the course of pregnancy, and also the prevention of possible complications is important.
During this period the pregnant woman has to visit the doctor at least, than once a month, and in a number of situations and is more often. At each visit the doctor examines the patient, controls a body weight increase, measures length of a circle of a stomach and height of standing of a bottom of a uterus over a bosom, determines arterial pressure, listens to heartbeat of a fruit. Appoints necessary additional researches.
B 20 - 24 of week of pregnancy conduct the second obligatory ultrasonic research which is necessary for: determination of compliance of the sizes of a fruit to the estimated term of pregnancy for the purpose of an exception of an arrest of development of a fruit; detection of malformations of a fruit; estimates of amount of amniotic waters; studying of a condition of a placenta. Also Doppler research which is conducted at ultrasonic research for an intensity assessment matochno - placentary and plodovo - a placentary blood-groove is important.During this period, also as well as at the following planned research in 32 - 34 weeks, performance of three-dimensional ultrasonic scanning for more exact assessment of a condition of a fruit is possible
. > it is expedient to p to determine by
In an interval from 16 to 20 weeks for prenatal screening of possible anomalies of development of a fruit in blood level an alpha - a fetoprotein (AFP), a free estriol of E3, an ingibin - And yes a horionichesky gonadotrophin of the person (the general HGCh).
the Most characteristic complications of the II trimester of pregnancy are: threat of a late spontaneous abortion, bleeding from - for an otsloyka of a placenta, anemia, early forms of a gestoz, a pre-natal infection. The specified complications promote formation of fetoplatsentarny insufficiency and an arrest of development of a fruit.
From - for the uterus increasing in sizes which begins to displace abdominal organs towards a thorax after 15 - 16 weeks short wind and heartburn can begin to disturb. Kidneys begin to experience considerable strain.
women with ekstragenitalny diseases (diseases of kidneys, a hypertensive illness, neurocirculator dystonia) from 20 weeks have a danger of development of a gestoz. In this regard it is necessary to pay attention to emergence of hypostases, an excess and uneven increase of body weight, increase of arterial pressure, emergence of protein in urine.If do not have
contraindications, after 17 weeks it is possible to begin to carry out a special complex of physical exercises for pregnant women who allow to operate muscles of a crotch and an abdominal tension. It is important to master breathing exercises also.
the III trimester of pregnancy
III the trimester of pregnancy is characterized by the most intensive growth of a fruit and increase of functional activity of its bodies and systems.
Till 32 - 33 weeks of pregnancy the fruit can change repeatedly within a day the situation in a uterus and, as a rule, after 35 - 36 weeks holds the final position before the childbirth.to
During this period of pregnancy needs the most attentive and profound supervision over character of a course of pregnancy with carrying out complex inspection and an assessment of degree of risk of possible complications. After 28 weeks the pregnant woman has to visit the doctor at least 1 time in 2 weeks, and according to indications and a thicket.
At the third obligatory ultrasonography which is carried out to 32 - 34 weeks , are defined by the fruit sizes, study a condition of a placenta, estimate amount of amniotic waters. Besides, conditions of a fruit and its behavioural reactions carry out an ekhografichesky functional assessment, repeat a dopplerometriya. After 32 weeks for an assessment of a state it is warm - vascular system of a fruit use a kardiotokografiya. KTG (kardiotokografiya) represents a method of a functional assessment of a condition of a fruit during pregnancy and in labor on the basis of registration of frequency of its serdtsebiyeniye and their changes depending on reductions of a uterus, action of external irritants or activity of the fruit. KTG is an integral part of a complex assessment of a condition of a fruit along with ultrasonic research and a dopplerometriya now. This method is absolutely safe for a fruit and has no contraindications.
At suspicion on a pre-natal infection investigate material from an urogenital path and determine the level of specific antibodies to causative agents of an infection in blood serum.
One of the most frequent complications of the III trimester of pregnancy is fetoplatsentarny insufficiency which is followed by decrease in arterial blood supply of a placenta and fruit; reduction of receipt to a fruit of necessary amount of nutrients and removal of products of a metabolism. All these changes reduce protectively - adaptive opportunities of system mother - a placenta - a fruit; slow down growth and development of a fruit; cause the complicated course of pregnancy and childbirth.
the Most typical clinical manifestations of fetoplatsentarny insufficiency are: violation of physical activity of a fruit, increase of a tone of a uterus, discrepancy (reduction) of the sizes of a stomach of the pregnant woman to pregnancy term, perenashivany pregnancies, abundance of water or lack of water.
From - for violations of protective function of a placenta pre-natal infection of a fruit which is shown in the form of a delay of its development, thinning or increase in thickness of a placenta, kaltsinozy placentae and kistozno - similar inclusions in its structure, by abundance of water or lack of water can arise.
the Most dangerous complication of the III trimester of pregnancy is gestoz which arises owing to fetoplatsentarny insufficiency and is externally shown in the form of hypostases and an uneven increase of body weight (a liquid delay in an organism), increases of arterial pressure (violation of regulation of a vascular tone), emergence of protein in urine (dysfunction of kidneys). Gestoz is followed by the most expressed complications from a fruit and bears threat for health of the pregnant woman.
the Rhesus factor - the conflict
One of serious complications of pregnancy is izoserologichesky incompatibility of blood of mother and a fruit on a Rhesus factor - to a factor or on a blood type (on the AB0 system).
the Rhesus factor - the factor represents proteinaceous substance which is localized on blood erythrocytes. Approximately at 15% of people a Rhesus factor - the factor in blood is absent. If the pregnant woman a Rhesus factor - negative, and her spouse a Rhesus factor - positive, then at the planned child with high probability is a positive Rhesus factor too - a factor. The Rhesus factor - positive blood of a fruit gets into a maternal blood-groove and causes in the pregnant woman formation of antibodies against a Rhesus factor - a factor. Antibodies get to a blood-groove of a fruit and destroy its erythrocytes. The Rhesus factor - the conflict can cause serious complications in a fruit, including a gipokisiya. As a rule, during the first pregnancy of problems does not arise yet. But, as antibodies remain in the woman`s organism, at emergence of the following pregnancy their quantity increases, and they begin to show the negative impact.
For the prevention a Rhesus factor - the conflict preparations of immunoglobulin of the person use an anti-Rhesus factor. These preparations enter a Rhesus factor - to negative women on condition of the first pregnancy, absence at them into blood a Rhesus factor - antibodies, and the child`s birth about a Rhesus factor - positive blood. The drug is injected twice: one dose on 28 - y to week of pregnancy , the second - within the first 72 hours after the delivery .is closer than
of the Indication to Cesarean section to
to the end of pregnancy very important to have a clear idea of physiology of patrimonial process, the nobility with what childbirth and as they proceed and also how to behave in labor and many other things begins. The pregnant woman can be a rodorazreshena in natural patrimonial ways or by means of Cesarean section.the Issue of need performance of Cesarean section in each case is resolved by
individually on strict medical indications. At the same time all circumstances of pros and cons and degree of possible risk are considered. The positive decision in favor of operation is made only in cases when childbirth in natural patrimonial ways represents higher risk for health of both the woman, and her child, than Cesarean section. Unfortunately, not always the choice for Cesarean section is a guarantee of a successful completion of pregnancy and the birth of the healthy kid.
What reasons force to give preference to Cesarean section?“absolute indications“ distinguish to
From indications to this operation so-called are those circumstances when childbirth in natural ways is simply impossible and poses hazard to life of mother and child:
- the Expressed narrowing of a basin or abnormal forms of a basin with considerable reduction of its sizes.
- of the Tumour and the cicatricial changes of a neck of a uterus, vagina and crotch interfering the child`s birth.
- Existence urinogenital and kishechno - sexual fistulas.
- Expressed varicosityNov expansion of veins in a vagina and a vulva.
- Wrong provision of a fruit (cross and slanting).
- Predlezhany placentae (the placenta blocks an internal pharynx of a uterus).
as well “relative indications“ , situations when the possibility of conducting childbirth in natural patrimonial ways is not excluded Exist, however danger of development of complications in mother and a fruit is higher, than risk of possible complications during operation:
- Existence of a hem on a uterus.
- At pelvic prelying of a fruit, especially if razgibatelny position of the head of a fruit, foot prelying of a fruit, a rear view of pelvic prelying of a fruit takes place.
- the Mass of a fruit is more than 3500 g
- a fruit Arrest of development.
- Predlezhany loops of an umbilical cord.
- the Expressed feta - the placentary insufficiency (subcompensated or a dekompensirovanny form).
- Various diseases at which childbirth in natural patrimonial ways is hazardous to health of the woman (a miopiya of high degree, epilepsy, post-traumatic encephalopathy, heart diseases, etc.).
- Myoma of a uterus of the big sizes.
- of Anomaly of development of a uterus.
- Lack of readiness of a neck of a uterus for childbirth at the full-term pregnancy and in the absence of effect of preparation of a neck of a uterus for childbirth.
- Perenashivany pregnancies in combination with an unripe neck of a uterus.
- the Combination of indications (the burdened obstetric anamnesis, infertility, application of methods of an auxiliary reproduction, age of pervorodyashchy is more senior than 30 years, a perenashivaniye, a large fruit, a hypoxia, feta - placentary insufficiency, etc.) .
Besides, at polycarpous pregnancy Cesarean section is carried out in case of excessive restretching of a uterus (large fruits); unpreparedness of patrimonial ways after 38 weeks of pregnancy; the cross provision of the first fruit from twins or both fruits; pelvic prelying of the first fruit; accrete twins; triplets and bigger quantity of fruits.
the Listed situations are generally indications for performance of Cesarean section in a planned order.If are diagnosed by
for the pregnant woman some of the listed above circumstances, and there is a need of performance of operation, she has to be beforehand informed and in advance hospitalized in maternity hospital (at least in 8 - 10 days) for specification of the diagnosis and preparation for operation.
However in some cases situations both during pregnancy, and in labor when it is necessary to execute Cesarean section in the emergency order arise. The following belongs to these situations:
- Increase of weight of fetoplatsentarny insufficiency or the gestoz who are not giving in to treatment in the absence of conditions for a fast rodorazresheniye in natural patrimonial ways.
- eklampsiya Attack.
- Discrepancy of the sizes of a head of the child and mother`s basin in labor.
- the Unripe neck of a uterus and lack of patrimonial activity at prenatal izlitiya of amniotic waters.
- Absence of effect of a rodovozbuzhdeniye or rodostimulyation at fetoplatsentarny insufficiency within 2 - 3 hours.
- of Violation of sokratitelny activity of a uterus in labor at its inefficient treatment, and also in the presence of additional complications of pregnancy or their emergence in labor.
- Threat of a rupture of a uterus.
- the Premature otsloyka of normally located placenta and its progressing in the absence of conditions for an urgent rodorazresheniye in natural patrimonial ways.
of the indication to the Cesarean section which is carried out for the benefit of a fruit:
- the Progressing deterioration in a condition of a fruit or a sharp hypoxia in the absence of conditions for a fast rodorazresheniye in natural patrimonial ways.
- Deterioration in a condition of a fruit against introduction of the means reducing a uterus at a rodovozbuzhdeniye or at a rodostimulyation.
- Loss of loops of an umbilical cord and small parts of a fruit.
- Formation of cross provision of the second fruit after the birth of the first at polycarpous pregnancy.
Cesarean section is carried out only in the woman`s consent. If owing to any circumstances the woman is not capable, and Cesarean section lives do for rescue her, then it is enough to receive a consent to operation from her immediate family.
In all other cases if pregnancy took place safely, is not present signs of violation of a condition of a fruit, and the state of health of the patient does not raise doubts, childbirth conducts in natural patrimonial ways. Foundation of the successful course of childbirth of their favorable outcome is the normal course of pregnancy, the corresponding supervision and timely prevention of possible complications.
the Duration of delivery depends on many circumstances and averages at pervorodyashchy 9 - 11 hours, and at povtornorodyashchy 8 - 9 hours.by
At the time of delivery for the woman in labor careful supervision by the midwife and doctor has to be carried out. In the first period of childbirth in all cases it is necessary to carry out monitor control by means of a kardiotokografiya for a dynamic assessment of a condition of a fruit and sokratitelny activity of a uterus. In all cases childbirth has to be anesthetized. Methods of anesthesia can be different depending on a condition of the woman in labor and a fruit, activity of patrimonial activity and a stage of childbirth, intensity of pain. Apply preparations which are inhaled by means of the special device (inhalation anesthesia), certain anesthetics to anesthesia it is possible to enter intramuscularly or intravenously. Epiduralny anesthesia enjoys popularity. However for this method there are some contraindications. Right after childbirth survey of patrimonial ways is surely carried out. For the woman in childbirth carry out supervision within 2 hours in the delivery room, and after that her and the child transfer to postnatal chamber. Expediently early applying of the child to a breast during the first hours after the delivery.