Becoming a mother and having a healthy child is a great happiness! However, complications during pregnancy can occur in any woman, even a completely healthy woman. That’s why it’s so important to see a good specialist from the earliest stages of pregnancy (see pregnancy management).
The following complications of pregnancy are distinguished:
- toxicosis;
- gestosis;
- ectopic pregnancy;
- premature birth;
- miscarriage (spontaneous abortion);
- frozen (non-developing pregnancy).
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Diagnosis of complications during pregnancy
2 Diagnosis of complications during pregnancy
3 Diagnosis of complications during pregnancy
Toxicoses
Toxicosis occurs in the first half of the term and is manifested by dyspeptic disorders and disorders of all types of metabolism.
In almost 90% of cases, early toxicosis in the first half of pregnancy is manifested by nausea and vomiting. If pregnancy is proceeding normally, then nausea or vomiting may occur no more than 2-3 times during the morning, more often on an empty stomach. These disorders do not require treatment and should go away on their own after 12-13 weeks.
Toxicosis is a condition in which nausea and vomiting occur at any time of the day, regardless of meals, and are accompanied by decreased appetite, exhaustion, weakness and weight loss.
Acute pancreatitis
Acute pancreatitis complicates <0.1% of pregnancies and develops predominantly in the third trimester, which is associated with an increase in plasma triglyceride levels. The risk group includes patients with cholecystitis, hypertension, and alcoholism. Complications for the mother can be severe and include hypotension, hypoglycemia, acidosis, congestive heart failure, and pulmonary hemorrhage. Maternal mortality can reach 10%, perinatal - 10-40%.
Diagnosis is based on the presence of nausea, vomiting, epigastric pain, which spreads to the back area and becomes encircling. A pathognomonic sign is an increase in the activity of amylase and lipase in the blood, hypocalcemia, but their level does not always correspond to the severity of the disease.
Treatment includes analgesia, prescription of antispasmodics, cessation of oral food to reduce pancreatic secretion, nasogastric suction, intravenous hydration, antibacterial therapy, administration of fibrinolysis inhibitor drugs (Gordox, Contrical). The need for surgical treatment is rare.
Vaginal delivery is usually carried out with the prevention of bleeding during childbirth. Peptic ulcers of the stomach and duodenum in 20-25% of cases can worsen during pregnancy, which is accompanied by epigastric pain associated with eating food, which decreases after vomiting, consumption of alkaline solutions, as well as dyspeptic disorders (nausea, belching, flatulence). Diagnosis is based on fibrogastroscopy data, studies of basal gastric secretion. Treatment includes prescribing an appropriate diet, antacids and astringents, antispasmodics, and anticholinergics.
Preeclampsia
Preeclampsia develops in the second half of pregnancy (after 20 weeks) and poses a great danger not only to the pregnancy itself, but also to the health of the woman and her child. Typically, gestosis is manifested by the occurrence of edema (hydropsis of the pregnant woman).
The next stage of gestosis - preeclampsia - is accompanied by increased blood pressure and the appearance of protein in the urine. This indicates changes in the biochemical composition of the blood, deterioration of blood circulation in the capillaries and small vessels (and in the placenta too). As gestosis progresses, eclampsia may occur with a critical decrease in cerebral circulation, cerebral ischemia and cytotoxic cerebral edema. Convulsions appear and coma is possible.
Preeclampsia ranks third among the causes of death in pregnant women, perinatal mortality with preeclampsia is 18-30%.
Therefore, it is so important for all pregnant women to be observed by an experienced obstetrician-gynecologist, who can promptly detect and prevent such complications during pregnancy.
Acute appendicitis
Acute appendicitis during pregnancy occurs with the same frequency as in the general population (1: 1500 births). The diagnosis of appendicitis during pregnancy can be difficult, especially in the second half of pregnancy. Nausea, anorexia, and mild leukocytosis may contribute to misdiagnosis. In addition, appendicitis should be differentiated from acute gynecological pathology (distortion of the uterine appendages, necrosis of the myomatous node). Thus, late diagnosis of appendicitis occurs in 18% of patients in the second trimester and in 75% in the third trimester. During pregnancy, the peritoneum of the anterior abdominal wall moves upward, which can contribute to the appearance of the vagal reflex and the generalization of pain. The appendix in pregnant women is usually localized in a typical location. The incidence of appendix rupture in pregnant women is slightly higher (55%) than average. In the first half of pregnancy, laparoscopic appendectomy can be performed.
Ectopic pregnancy
In an ectopic pregnancy, the fetus does not develop in the uterus, but in the cervical canal, fallopian tube, abdominal and pelvic cavities.
Normally, when an egg leaves the ovary, it enters the opening of the fallopian tube. Moving with the help of special cilia that cover the fallopian tube, after a few days the egg reaches the uterus. In normal cases, the process of fertilization of the egg occurs in the tube, then the cell appears in the uterus.
In the case of infectious obstruction of the tube or other pathology, the egg freezes in place or moves very slowly, never having time to reach the uterus. This is how an ectopic pregnancy occurs.
A blood test for hCG helps in establishing the diagnosis of ectopic pregnancy.
HCG is human chorionic gonadotropin. HCG contains alpha and beta units. Using blood tests to detect an increase in hCG levels, the presence of pregnancy can be accurately determined. So, during a normal pregnancy, the hCG level increases by 65% every two days. But with an ectopic pregnancy, this dynamics is not obvious.
In a normal pregnancy, hCG rises until the 10th week, then begins to decline. Stopping the increase in hCG levels may be a consequence of a missed or undeveloped pregnancy.
Miscarriage
Miscarriage is a spontaneous termination of pregnancy, independent of the woman’s will, at up to 22 weeks. The phenomenon is quite common. Every fifth pregnancy in women can end in spontaneous miscarriage.
The symptoms of miscarriage in the early stages (6-8 weeks) may not be very noticeable. There may be a delay in menstruation, a change in the nature of bleeding during menstruation, and moderate lower back pain. According to statistics, about 80% of all miscarriages occur before 12 weeks.
A miscarriage in late pregnancy is accompanied by symptoms such as nagging pain in the lower back, abdomen and sacral area, brown or scarlet spotting from the vagina. If treatment is not carried out, then the detachment of the fruiting body from the wall of the uterus and its expulsion begins. In this case, bleeding may increase and intense cramping pain may occur. A miscarriage can result in the release of the entire fruiting body or its parts getting stuck in the uterus (in such a case, medical intervention will be required).
A recurrent miscarriage is a spontaneous termination of pregnancy (up to 22 weeks), which is repeated with each pregnancy.
If a woman has had 2 or more spontaneous miscarriages, doctors can diagnose “recurrent miscarriage.”
1 Diagnosis of complications during pregnancy
2 Diagnosis of complications during pregnancy
3 Diagnosis of complications during pregnancy
External signs of pregnancy
A change in a woman’s appearance already in the early stages may indicate pregnancy.
Acne during pregnancy
A sharp hormonal change in the body of a pregnant woman and increased activity of the sebaceous glands can trigger the appearance of acne, even if the woman has not previously encountered this problem.
Most often, the rash goes away after the baby is born and does not require any treatment.
If a pregnant woman decides to deal with rashes before delivery, then she should remember that during this period it is forbidden to use drugs that contain retinoids and salicylic acid. In addition, removal of rashes using laser, deep peeling, or mechanical cleaning is contraindicated. Phytotherapeutic procedures should also be treated with caution.
Facial redness during pregnancy
Such an early sign of pregnancy as facial redness is associated not only with hormonal levels, but also with increased blood circulation during this period.
Many pregnant women experience the so-called “pregnant mask”, which is characterized by the appearance of age spots localized in the forehead, cheeks and nose. You should not be afraid of such spots, since after childbirth they will go away on their own over time.
Veins during pregnancy
The onset of pregnancy may be marked by the appearance of venous patterns (or spider veins) on the chest, neck, arms and legs. Such spider-like patterns of dark red or bluish color, like skin pigmentation, will disappear on their own with the birth of the child.
Edema during pregnancy
In the early stages of pregnancy, slight puffiness of the face may be observed. In addition, your hands may swell, which is especially noticeable if you clench your hand into a fist.
It should be remembered that swelling in the first months of bearing a child is not normal and may indicate that the expectant mother has kidney disease or cardiovascular disease. Therefore, if this symptom appears, you should consult a doctor.
Breast enlargement during pregnancy
Many women, due to the absence of menstruation, may suspect pregnancy in the first weeks of conception due to breast enlargement by 1 - 2 sizes. Moreover, this sign can be observed even if a woman loses her appetite and loses weight.
Breast enlargement may be accompanied by pain and tingling in both mammary glands.
Important! During pregnancy, both breasts increase in size exactly the same. Enlargement of one mammary gland or any part of it should alert you, as it may signal the presence of serious diseases.
Nipple changes during pregnancy
Early signs of pregnancy are darkening and swelling of the nipples, as well as the appearance of Montgomery tubercles - small outgrowths localized in the nipple area. Outwardly, such formations resemble small warts that are filled with a sebaceous substance.
There is no need to worry about the appearance of such tubercles, since they in no way disrupt the functioning of the sebaceous glands and do not affect the health of the expectant mother, much less the fetus.
Pain and burning sensations that occur when touching the nipples may also indicate pregnancy.
Discharge from the breast during pregnancy
An early (albeit rare) sign of conception may be clear fluid released from the nipple when pressure is applied to it.
Sometimes, in early pregnancy, colostrum may begin to be released, which indicates galactorrhea, a condition in which there is increased production of the hormone prolactin.
In general, the appearance of colostrum is more typical in the second and third trimesters of pregnancy.
Stripe on the stomach during pregnancy
Many people believe that a brown line on the abdomen, running from the navel down, appears in late pregnancy. In fact, this line can be seen already in the first weeks of pregnancy, it will simply be white, whereas from the 12th week it will begin to acquire a brown tint.
Premature birth
Preterm labor is the onset of labor before 37 weeks. Premature birth can occur suddenly or follow an existing threat of miscarriage.
The process can begin with uterine hypertonicity, isolated contractions and moderate abdominal pain. Another scenario is rupture of the membranes and rupture of amniotic fluid. Sometimes premature labor can begin with bleeding. This happens with placenta previa or placenta abruption.
In any case, urgent hospitalization of the pregnant woman is necessary, in which all necessary measures will be taken to maintain the pregnancy.
In case of critical placental abruption and rupture of the amniotic sac, emergency delivery may be performed.
Acute cholecystitis and choledocholithiasis
Acute cholecystitis and choledocholithiasis in the absence of effect from conservative management (intravenous infusion, antibacterial therapy, cessation of oral intake of food and drugs) are subject to surgical treatment. Laparoscopic surgery is the method of choice in the first half of pregnancy. Laparoscopy reduces surgical trauma, manipulation of the uterus, shortens the recovery period and return to a normal diet, and therefore reduces the risk of preterm birth compared to open surgery. If there is a threat of premature birth in the postoperative period, tocolysis with beta-agonists is recommended.
Assessment of the fetus if surgery is necessary is usually carried out immediately before and immediately after surgery. In the third trimester of pregnancy, postoperative care and monitoring are recommended to be carried out in the obstetric department.
Frozen pregnancy
Frozen pregnancy (or non-developing pregnancy) is one of the types of miscarriage. We can talk about miscarriage in situations where the beginning of pregnancy complied with all medical standards, and then there was a complete stop in the development of the fetus and its death.
In addition, pregnancy failure can occur in the case of successful conception, when the egg is fertilized and has time to attach to the uterus, in the complete absence of embryo development. This is called an “empty fertilized sac” - all extra-embryonic organs are formed, but the embryo is missing from the egg.
Quite often, a non-developing pregnancy is diagnosed in the early stages of pregnancy.
Signs of a non-developing pregnancy may be erased. More often, scanty blood discharge from the genital tract occurs with or without nagging pain in the lower abdomen. In this case, an ultrasound scan is necessary. With a fertilized egg size of 20 mm, an embryo with a heartbeat should be visualized. If the period is shorter and the average internal diameter of the ovum is less than 20 mm, and there is no pain, then the doctor prescribes a control ultrasound after 7-10 days (based on the results of the study, the diagnosis of a non-developing or frozen pregnancy is finally established or refuted).
1 Diagnosis of complications during pregnancy
2 Diagnosis of complications during pregnancy
3 Diagnosis of complications during pregnancy
Abdominal pain
Abdominal pain during periods of sudden changes in the size of the uterus (in the second trimester and after childbirth) may be associated with the following conditions:
- distortion of the uterine appendages, especially if they are enlarged (tumor-like formations);
- adhesive intestinal obstruction (intestinal obstruction due to adhesion after previous surgical interventions).
Pain in the right upper quadrant of the abdomen during pregnancy should be differentiated from the following conditions:
- severe preeclampsia (nausea, vomiting, and pain in the right upper quadrant of the abdomen may be present);
- Rupture of the liver capsule is a catastrophic complication of severe preeclampsia, which may be accompanied by acute abdominal pain, nausea, vomiting, and fever. Rupture of the liver capsule may lead to hypotension and shock; the diagnosis is rarely determined by laparotomy. Maternal mortality exceeds 60%;
- acute fatty liver (associated with heterozygous deficiency of long chain 3-hydroxyacyl-CoA dehydrogenase, the presence of an affected homozygous fetus). This rare condition (1: 1000 births) is accompanied by acute liver and kidney failure, hypoglycemia, coma, hemorrhagic diathesis and metabolic acidosis. Maternal and perinatal mortality exceeds 25%.
Pain in the left upper quadrant of the abdomen may be associated with rare conditions such as:
1) rupture of the spleen—accompanied by hypervolemia and anemia;
2) rupture of the splenic artery aneurysm. The disposition of the splenic artery during pregnancy is caused by an increase in the size of the uterus and an enlargement of the spleen associated with pregnancy. Even with emergency laparotomy, maternal mortality is high.
When using general anesthesia during pregnancy, one should take into account physiological gestational changes that may affect the course of anesthesia or contribute to the development of adverse reactions and complications :
1. An increase in the time of gastric emptying and an increase in the residual volume of the stomach significantly increases the risk of aspiration of gastric contents during intubation. Therefore, it is necessary to take antacids before surgery (they neutralize the contents of the stomach and help reduce the severity of aspiration pneumonia in the event of aspiration). Emptying the stomach before intubation prevents passive reflux.
2. Hyperemia leads to narrowing of the upper airways and increases the risk of injury during intubation, so small endotracheal tubes with a diameter of 6-7 mm should be used.
3. A decrease in the functional residual capacity of the lungs can reduce the oxygen reserve, so even a short period of apnea leads to a significant decrease in pO2, so inhalation of 100% oxygen is necessary before intubation. If within 30 seconds of intubation, failed attempts are stopped and mask inhalation of 100% oxygen is performed again before the second attempt of intubation.
4. Compression of the inferior vena cava by an enlarged uterus is associated with hypotension of the mother and fetus, therefore, during surgery after the first trimester of pregnancy, it is recommended to disposition the uterus to the left side by approximately 15°.
5. Hypercoagulation during pregnancy increases the risk of thromboembolic complications. To reduce the risk of thrombosis, prophylactic perioperative use of heparin (mainly low molecular weight) and pneumatic compression of the lower extremities with an elastic bandage or stockings is recommended.
The risk of radiological examinations during pregnancy depends on exposure and the extent of the procedure. If the radiation dose does not exceed 10 councils, there is no significant risk to the fetus. Significant doses of radiation are associated with fetal microcephaly and mental retardation.
Causes of miscarriage
The reasons for a non-developing pregnancy in the early stages are quite similar to the general situation when a woman cannot bear a child.
There are many reasons why a pregnant woman may lose her baby:
- the presence of infectious diseases (bacterial, fungal and viral diseases lead to inflammation of the endometrium, and this prevents the fetus from gaining a foothold in the uterus and developing);
- sexually transmitted infections (herpes, trichomoniasis, mycoplasmosis, toxoplasmosis, chlamydia);
- endocrine diseases, which can lead to hormonal imbalance and, as a result, miscarriage;
- mental, physical and emotional exhaustion;
- lack of female hormones, such as progesterone, which can lead to termination of pregnancy;
- chromosomal and other fetal abnormalities;
- congenital and acquired pathology of the uterus (for example, as a result of abortions and miscarriages in the past);
- Rh conflict (a negative Rh factor in the mother and a positive Rh factor in the father can lead to a conflict of antibodies, as a result of which the mother’s body perceives the fetus as a foreign body and tries to push it out of the body);
- the presence of bad habits in a pregnant woman (smoking, drinking alcohol, drugs, which leads to intoxication of the body;
- unfavorable environmental conditions, radiation.
1 Diagnosis of complications during pregnancy
2 Diagnosis of complications during pregnancy
3 Diagnosis of complications during pregnancy
Treatment for indigestion
If stomach upset occurs, even if it is mild, the pregnant woman still needs to undergo treatment to eliminate the problem. The fact is that an expectant mother needs more nutrients than the average person. Stomach dyspepsia interferes with the complete absorption of food, and, as a result, the supply of essential substances is significantly reduced. The fetus suffers from this, since it does not receive enough of the “building material” it needs.
In addition, the regular occurrence of symptoms of dyspepsia (nausea, vomiting, heartburn) physically exhausts a woman, she becomes physically weaker and becomes irritable. For pregnant women, the following methods are used to treat gastric dyspepsia:
- Adjustment of the diet and structure of nutrition. Fruit juices, spicy, salty and fatty foods are removed from the list of foods consumed. Reduce the amount of flour products. Food is taken in small portions 5 or 6 times a day.
- Eliminating bad habits. If there are habits that provoke the development of dyspepsia, then the pregnant woman is recommended to get rid of them.
- Stopping inappropriate medications. Some medications can cause stomach upset (sedatives or antidepressants), so if necessary, the doctor adjusts the course of medication prescribed for the pregnant woman.
Reducing the amount of flour products
Prescribing medications based on antacids or alginates. They neutralize the acidic environment of the stomach, thereby eliminating most of the symptoms of dyspepsia. Pregnant women are not prescribed medications containing magnesium trisilicate or sodium bicarbonate, as they can disrupt the development of the embryo.
Prescription of drugs that block the synthesis of hydrochloric acid. If taking medications containing antacids or alginates is ineffective, the young mother is prescribed Omeprazole or Ranitidine. These drugs inhibit the secretion of hydrochloric acid.
In conclusion, I would like to say that if symptoms of indigestion appear, do not worry. In most cases, after some time, these symptoms disappear on their own, since their appearance is most often associated with hormonal fluctuations. At the same time, in no case should you self-medicate using “proven” grandmother’s methods. No heating pads or herbal infusions.
After all, what may be safe for an ordinary person can become dangerous for an expectant mother. At best, it will at least be ineffective or cause allergies. If you have complaints about an upset stomach, you need to tell the doctor leading the pregnancy about this so that he can determine the necessary method of treatment.
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Abortion and contraception clinic in St. Petersburg - department of the medical gynecological association "Diana"
Make an appointment, tests or ultrasound via the contact form or by calling +8 (812) 62-962-77. We work seven days a week from 09:00 to 21:00.
We are located in the Krasnogvardeisky district, next to the Novocherkasskaya, Ploshchad Alexander Nevsky and Ladozhskaya metro stations.
The cost of a medical abortion in our clinic is 3,300 rubles. The price includes all pills, an examination by a gynecologist and an ultrasound to determine the timing of pregnancy.
Diagnosis of complications during pregnancy
Diagnosis of pregnancy or its complications begins with a visit to a gynecologist. The doctor pays attention to the woman’s complaints, which include weakness, malaise, delayed menstruation, the appearance of toxicosis, engorgement of the mammary glands, etc.
A home test for determining pregnancy based on the level of the hCG hormone in the urine is indicative (a study of the morning urine sample is especially informative).
A gynecological examination can reveal an enlarged uterus and other signs of pregnancy.
Ultrasound examination of the pelvic organs up to 10-11 weeks of pregnancy is carried out in cases where the attending physician needs to determine the location of pregnancy (uterine or ectopic) or exclude a frozen pregnancy.
Then tests are prescribed to determine the level of hCG in the blood, blood and urine tests for infections such as herpes simplex virus and type 2, chlamydia, toxoplasmosis, mycoplasmosis, cytomegalovirus, etc.
To prevent pregnancy complications, consultations are held with related specialists: ophthalmologist, therapist, ENT doctor, dentist, etc.
Treatment of miscarriage
When a pregnant woman consults a gynecologist, a thorough examination of the problem is carried out, based on the results of which treatment is prescribed.
If a pregnant woman has a tendency to form blood clots or signs of antiphospholipid syndrome have been identified, the doctor may prescribe special medications that thin the blood.
In case of bleeding or a diagnosis of frozen pregnancy, surgical methods can be used. For example, medical evacuation of the uterus during a non-developing pregnancy (performed on an outpatient basis for up to 8 weeks).
Many problems in the field of reproductive health can be avoided by regularly visiting a gynecologist, starting from adolescence. Timely elimination of foci of infection, STIs, and menstrual irregularities will help prevent various complications in the future.
It is important for pregnant women to be observed by the same specialist and not to neglect his recommendations.
The MedikCity clinic has experienced, professional, sensitive doctors and high-precision diagnostic equipment. We will help make your pregnancy comfortable!
The material was prepared with the participation of a specialist:
Anorexia and pregnancy
An anorexic girl with a big belly - in the understanding of most, this is simply incompatible. Indeed, the cult of a thin, underweight body often leads to infertility, and the fear of gaining excess weight during pregnancy drives expectant mothers to despair. However, some emaciated women still manage to find themselves in an “interesting situation.” In the practice of the general practitioner, nutritionist at the Family Clinic “Maternity Hospital on Furshtatskaya” (health care facility “Maternity Hospital No. 2”), Irina Stanislavovna Andreeva, pregnant women with eating disorders were encountered. As a rule, these clients adhered to strict diets and were fond of vegetarianism or a raw food diet. According to Irina Stanislavovna, thinness of a pregnant woman can have a bad effect on the course of pregnancy if the weight gain is less than 200 grams per week.
And yet, despite the admonition of experts that weight gain during pregnancy is a natural and logical process, women continue to limit nutrition, and therefore harm themselves and the child. The already exhausted body of a pregnant woman with anorexia receives a colossal load, because all her strength goes towards the development of the unborn baby.
