Pregnancy is a significant and very important period in the life of every woman. It can be divided into three trimesters, in each of which an “abnormal” situation may arise, that is, a complication of pregnancy. In such circumstances, the main thing is not to panic, but to immediately seek medical help. In order not to miss the moment and notice the first signs of trouble in time, the expectant mother should know what complications can occur in each of the trimesters and their symptoms. nine0006

I TRIMESTR

ERROR IS OUT

For the first time, a woman is suspected of being pregnant when her period is delayed. To make sure that this is really the case, a blood test for human chorionic gonadotropin, a hormone whose level rises sharply during pregnancy, helps. And here it is necessary, without delay, to visit an obstetrician-gynecologist and do an ultrasound. It should confirm that the fetal egg is in the uterine cavity. Sometimes (recently, according to the literature, the percentage is growing), a fetal egg can also attach outside the uterine cavity. nine0006

In this case, one speaks of an ectopic pregnancy. Its most common form is tubal, when the fetal egg begins to develop in the fallopian tube. It happens that it is attached in the ovary, abdominal cavity or in the cervix. This condition is life-threatening and requires urgent surgical intervention. The risk is that no organ other than the uterus itself is fit for carrying a baby. A pipe, for example, has a very small volume and, under the “onslaught” of a growing embryo, it will burst sooner or later. The resulting bleeding poses a serious threat to a woman's life. nine0006

Against the background of a delay in menstruation, paroxysmal pains, often accompanied by weakness, dizziness, nausea, and bloody discharge from the genital tract, should cause anxiety. It is urgent to go to the doctor, since it is possible to accurately determine an ectopic pregnancy only with the help of ultrasound. When an ectopic pregnancy is detected, laparoscopic surgery is most often performed. After restorative treatment, a normal pregnancy often occurs.

EXPECTED COMPLICATION - TOXICOSIS

Everyone has heard about it, everyone is waiting with horror when it comes. What is it? That's right - toxicosis. The most anticipated and most common complication of early pregnancy. Mild nausea, intolerance to certain odors, sometimes dizziness - these are the symptoms of early toxicosis, which, not without reason, are also considered indirect signs of pregnancy.

If vomiting is repeated no more than 3-5 times a day and the expectant mother generally feels fine, there is no need to change her usual lifestyle. But when nausea and vomiting occur 10 or even 20 times a day and any food and even a sip of water do not go for the future, a woman needs hospitalization. Lack of food and dehydration - that's what will worry doctors the most. After all, the expectant mother is losing weight, heart palpitations begin, blood pressure drops, but she needs strength to carry the baby. In the hospital, the fluid deficiency will be replenished with the help of droppers, vomiting will be eliminated with the help of special medications approved for pregnant women, and a full examination of the expectant mother will be carried out. Thanks to this, the unborn child and his expectant mother will feel much better and return to their normal lifestyle again. nine0006

I-II TRIMESTER

THREAT OF TERMINATION OF PREGNANCY

At the beginning of pregnancy, this condition is associated with a hormonal imbalance. For some reason, the hormones that support pregnancy begin to be produced in smaller quantities. Genetic malformations of the embryo can also provoke such a complication. This will seem strange to many, but in Western Europe, doctors do not seek to keep the pregnancy at any cost in the early stages. It is believed that in this way nature conducts natural selection. nine0006

No matter how you feel about this problem and whatever the causes of the complication, the expectant mother should be alerted by pulling pains in the lower abdomen and lower back, bloody discharge from the genital tract. Any of these symptoms may indicate a threatened miscarriage. Moreover, if there is a discharge, the doctors diagnose "a miscarriage that has begun", but this does not mean that the situation cannot be reversed and the situation normalized. So, when you see such a record in medical documents, do not be alarmed. Doctors will make every effort to still save the pregnancy. nine0006

And in order for the efforts of doctors to be successful, you should visit a doctor as soon as possible and have an ultrasound scan done. With it, you can find out how the pregnancy develops, but if a woman is concerned about the discharge, then find out their cause: for example, malformations of the uterus or too low location of the placenta, as well as premature opening of the cervix caused by its shortening (isthmic-cervical insufficiency - ICI ). Another mandatory study is the level of hormones in the urine and blood.

In any case, bleeding, too much pain in the lower abdomen, increased uterine tension are a good reason for hospitalization. If hormonal deficiency is detected, hormonal therapy is prescribed to maintain the pregnancy. With a low location of the placenta, a woman will be advised to lead a calm lifestyle and take drugs that relieve tension in the uterus.

When signs of CCI are detected, the cervix is ​​sutured. All these measures help to prolong the pregnancy to full term - 37 weeks. If the baby is still born earlier, modern equipment and advances in medicine make it possible to nurse babies even with low body weight (from 500 g). nine0006

III TRIMESTER

PLACENTA PRESENTATION

The placenta is formed during pregnancy and is excreted from the body after childbirth. Normally, it should be located in the upper and middle third of the uterus so that the child can be safely born at the time appointed by nature. If the placenta occupies a place near the exit from the uterus, is attached at least partially to the cervix, they speak of placenta previa. The reasons for this situation may be malformations of the internal genital organs, chronic inflammation of the uterus and others. nine0006

A characteristic symptom is bloody discharge from the genital tract, most often after 7 months of pregnancy. To determine this complication, it is enough to do an ultrasound. The woman is recommended hospitalization and bed rest, as well as drug therapy. If placenta previa persists at the time of delivery, the baby can only be born by caesarean section. The expectant mother is hospitalized at the 37-38th week of pregnancy (at this time the pregnancy is considered full-term) in order to prepare for the operation. But if a woman has heavy bleeding, a caesarean section will have to be done on an emergency basis. nine0006

PLACENTAL DETECTION

This complication occurs when the placenta separates from the uterine wall before the baby is born. Most often this occurs at the end of the third trimester or during childbirth. Women with high blood pressure are most at risk, which is why doctors strongly recommend expectant mothers to carefully monitor their blood pressure levels and strictly follow the doctor's recommendations when it rises.

An expectant mother should be alerted by prolonged abdominal pain, increased activity of the uterus, bleeding from the genital tract. This situation is risky both for the woman herself and for her unborn child. The woman is threatened with blood loss, and the baby is in danger of hypoxia: extensive placental abruption in the truest sense of the word cuts off oxygen to him. The actions of doctors depend on how strong the labor activity is and how great the woman's blood loss is. If the bleeding is weak, the contractions continue, the baby's heartbeat is normal, the baby feels good, the doctors allow the birth to go naturally, but closely monitor the well-being of the mother and baby. With heavy bleeding and the appearance of signs of hypoxia in crumbs, an emergency caesarean section is performed. nine0006

PREMATURE ROUTING OF WATER

This complication is said to occur when the amniotic fluid breaks before contractions begin. There can be many reasons for this development of events, but the main one is infection. That is why doctors carefully monitor expectant mothers and during pregnancy several times do bacteriological culture of flora from the cervical canal. According to modern international recommendations, it is also desirable to take a smear for group B streptococci before childbirth at about 36-37 weeks. If an infection is detected during childbirth, a woman is given antibiotic therapy. nine0006

If the amniotic fluid is shed, regardless of the gestational age, call an ambulance or go to the maternity hospital. Making sure that this is really amniotic fluid is quite simple. If the flow of urine can be stopped by tensing the muscles, then the amniotic fluid will continue to flow even if the muscles are tensed. In addition, you can use the amniotest (test for amniotic fluid). If amniotic fluid is expelled, the test strip will change color. There are also special pads that are much easier to use. The principle of their action is the same: if amniotic fluid gets on them, the pads change color. nine0006

You should also see a doctor if the amniotic fluid starts to leak a little. Only a doctor can clarify the situation. Don't refuse hospitalization. If the leakage intensifies, medical attention is indispensable. In most cases, after the outflow of amniotic fluid, a woman and her unborn child begin to prepare for childbirth. If this happened before the 34th week of pregnancy, the baby is given medication to help his lungs open up. But when the waters have not completely poured out, it is possible to prolong the pregnancy. And the efforts of doctors will be directed precisely at this. nine0006

PRE-ECLAMPSIA

Another insidious complication in late pregnancy is preeclampsia, or, as it used to be called, preeclampsia. Another name for this complication is late toxicosis of pregnant women. Its main symptom is the presence of protein in the urine. It is for this reason that during pregnancy it is necessary to take this analysis so often. In addition, preeclampsia is manifested by an increase in blood pressure up to 130/90 mm Hg. and above, internal and external edema, due to which the expectant mother gains excess weight. DO NOT refuse hospitalization: adverse symptoms may increase, due to which the well-being of the unborn baby may deteriorate sharply. Complex therapy prescribed by the attending physician, as a rule, leads to a positive result. If the symptoms increase, you have to resort to emergency delivery - depending on the situation, induce labor or do a caesarean section. nine0006

To avoid trouble, doctors advise expectant mothers not to abuse salt, but rather to stop consuming it, lead a healthy lifestyle, drink 2 liters of fluid a day and observe a sleep and rest regimen.

A.V.A.T.A.R. - Marginal placenta previa

Marginal placenta previa is a pathological attachment of an embryonic organ that provides a connection between the mother and the fetus, in which there is a partial overlap of the internal os of the uterus (no more than a third of it). Clinically, the disease is manifested by bleeding of varying intensity, not accompanied by discomfort. It is possible to identify marginal placenta previa with the help of a planned ultrasound in the second trimester or when pathological signs occur. Treatment involves hospitalization, bed rest, symptomatic therapy. Expectant management is indicated before the term of the expected birth, subject to the normal condition of the woman and the fetus. nine0006

Marginal placenta previa is a pathology of pregnancy, accompanied by abnormal attachment of the placenta and partial overlap of the internal os of the uterus. This condition is dangerous for both the woman herself and the fetus. Marginal placenta previa in the early stages is associated with less risk, since with the subsequent growth of the baby and stretching of the myometrium, it can shift and acquire the correct location. Otherwise, there is a possibility of squeezing the supply vessels, partially blocking the access of oxygen and nutrients to the fetus, which can cause its hypoxia and even antenatal death. nine0006

Marginal placenta previa can lead to placental abruption. This is due to the fact that the lower segment of the uterus has less ability to stretch. Also, marginal placenta previa often provokes massive bleeding during childbirth. Such an outcome is possible during natural childbirth, if there was a sharp separation of the membranes as a result of the passage of the fetus through the birth canal. In obstetrics, placenta previa occurs predominantly in repeated pregnancies. Pathology requires careful monitoring, since in about 25% of cases it is accompanied by stillbirth. nine0006

Marginal placenta previa may be due to abnormal attachment of the trophoblast during implantation or anatomical features of the myometrium. In the latter case, a violation of the structure of muscle fibers in the wall of the uterus occurs against the background of inflammatory changes, the consequences of genital infections. Marginal placenta previa is more often diagnosed with thinning of the myometrium, provoked by frequent curettage and abortion. Also, the cause of abnormal attachment of the trophoblast can be uterine deformities caused by benign tumors or resulting from congenital pathologies. nine0006

Marginal placenta previa often develops in women with concomitant diseases of the internal organs, in particular, with the pathology of the cardiovascular system. Due to insufficient blood circulation and congestion in the pelvis, the placenta cannot fully attach. In addition, marginal placenta previa is possible against the background of abnormal development of the embryo immediately after fertilization. A similar outcome is observed with a belated appearance of the enzymatic functions of the trophoblast. As a result, it attaches to the myometrium later than it normally does, staying in the lower part of the uterus. nine0006

Marginal placenta previa can be of two types depending on the place of its attachment:

• Localization along the anterior wall is the most dangerous variant of the pathology. With marginal placenta previa of this type, there is a high risk of mechanical damage to it, followed by detachment due to the physical activity of the woman, the movements of the baby, against the background of a strong stretching of the uterus in the third trimester of pregnancy. Despite this, when placing the embryonic organ on the anterior wall of the uterus, there is a possibility of its movement upwards. nine0122
• Posterior attachment is a more favorable variant of marginal placenta previa. It is accompanied by a lower risk of complications in the process of gestation and childbirth for the mother and baby.

Both types of anomalies are pathologies of pregnancy and require obligatory observation by an obstetrician-gynecologist.

Marginal placenta previa has a characteristic symptomatology - the appearance of bloody discharge without deterioration in general well-being. Often this pathological symptom occurs at rest or at night. As for the timing of embryogenesis, the marginal placenta previa manifests itself mainly at 28-32 weeks. It is during this period that the uterus is characterized by increased activity due to the preparation of the myometrium for the upcoming birth. Somewhat less often, abnormal discharge is observed already at the beginning of the second trimester. The volume of bleeding can be different and depends on the degree of damage to the vessels. nine0006

With marginal placenta previa in the third trimester of pregnancy, bleeding can be triggered by physical activity, sexual intercourse, fetal movement and other factors that provoke rupture of nutrient vessels. The appearance of this symptom is possible even during a gynecological examination. Sometimes marginal placenta previa is combined with the threat of miscarriage. With this combination, there is discomfort in the lower abdomen, hypertonicity of the uterus. With systematic bleeding in pregnant women with such a diagnosis, iron deficiency anemia develops. In such cases, there is increased fatigue, weakness. On the part of the fetus, growth and development may be slowed down, hypoxia due to insufficient intake of nutrients. Marginal placenta previa is often combined with an abnormal position of the fetus, which can be oblique or transverse. nine0006

A provisional diagnosis is established on the basis of the patient's complaints of spotting in the absence of pain. Another characteristic sign of the abnormal location of the embryonic organ is the high standing of the uterine fundus, which does not correspond to the period of embryogenesis. It is possible to confirm the marginal presentation of the placenta with the help of ultrasound. During the scanning process, a specialist can accurately visualize the location of the placenta and the degree of overlap of the uterine os, determine the condition of the child and assess the possible risks to the woman and the fetus. nine0006

Treatment of placenta previa depends on the identified symptoms, the period of embryogenesis, as well as the condition of the expectant mother and fetus. If the diagnosis is established only on the basis of ultrasound scanning and bleeding is not observed, it is possible to control the patient's condition on an outpatient basis. Hospitalization is indicated if marginal placenta previa is accompanied by secretions of any volume of blood. In this case, careful monitoring in the hospital is required. Women with such a diagnosis are assigned complete rest, it is recommended to exclude sexual intercourse and stress. You must wear a bandage. In the second trimester, a special exercise therapy for pregnant women sometimes helps to correct the location of the placenta. nine0006

Marginal placenta previa often develops anemia due to systematic blood loss. Therefore, pregnant women are shown a diet enriched with foods high in iron. The diet should contain red fish, offal, buckwheat, beef, apples. Pregnancy management with marginal placenta previa involves a protective regime in order to achieve the expected date of birth and the birth of a full-term baby. Also, patients with a similar diagnosis are prescribed medications, taking into account the general condition and comorbidities. nine0006

In case of marginal placenta previa, symptomatic drug therapy is carried out. With uterine hypertonicity, tocolytics and antispasmodics are used, and preparations containing iron are prescribed to eliminate anemia. To maintain the general condition of the patient and the fetus, vitamin complexes can be used. Sometimes, with marginal placenta previa, it is advisable to use sedatives. According to indications, antiplatelet agents are introduced, the doctor calculates the dosage of drugs in order to avoid a negative impact on the baby. nine0006

If placenta previa is accompanied by massive bleeding, delivery is carried out regardless of the time of embryogenesis by emergency caesarean section. In the case of a full-term pregnancy, vaginal delivery is acceptable provided that the cervix is ​​ripe, active labor activity, and the patient and fetus are in good condition. When opening the cervix by 3 cm, an amniotomy is performed. Oxytocin is administered to prevent bleeding. If, with marginal presentation, the placenta significantly overlaps the uterine os or childbirth through the natural canal is impossible, a caesarean section is indicated. nine0006

The prognosis for marginal placenta previa is favorable.

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