Inflammation of the bladder in women during pregnancy. Symptoms and rational treatment of cystitis in pregnant women in the early and late stages. Medication therapy, approved tablets in early pregnancy
Cystitis is a disease that often overshadows one of the most enjoyable periods in a woman's life - pregnancy. According to statistics, every tenth pregnant woman has experienced this disease. Medicine explains such a prevalence of this pathology among expectant mothers by structural features. female body and the hormonal and physiological changes occurring in it during pregnancy. So what is cystitis and how can a pregnant woman cope with this ailment without harming herself and the child?
What is cystitis during pregnancy?
Cystitis - inflammation of the wall Bladder... This is the most common urological disease of infectious and non-infectious origin.
Infectious cystitis can provoke opportunistic microflora: staphylococci, streptococci, E. coli, etc., as well as pathogens such as chlamydia, ureaplasma, vaginal Trichomonas, etc.
Lead to non-infectious cystitis: hypothermia, overwork, weakened immunity, intestinal dysbiosis and vaginal dysbiosis, irritation of the bladder mucosa chemicals that stand out through its wall (for example, with uncontrolled intake of drugs), damage to the mucous membrane during medical manipulations, etc.
Cystitis in early pregnancy
Cystitis on early dates pregnancy can even be called a certain pattern. It is not uncommon for a woman to find out about pregnancy by accident, having consulted a doctor because of exacerbated cystitis. Therefore, experts attribute this disease to conditional signs of early pregnancy. Why is this happening?
In pregnant women, cystitis often occurs due to a change hormonal background and immunosuppression (natural suppression of the immunity of a pregnant woman, necessary to prevent immunological rejection of the embryo). The weakened defense of the immune system allows infections to multiply actively, which in turn, getting into the bladder, cause inflammation.
In addition, from the very first days of pregnancy, old sores and ailments begin to intensify. Therefore, if you have a history of chronic cystitis, then there is a rather high probability of its recurrence already in the early stages of pregnancy.
Signs of cystitis during pregnancy
There are two forms of cystitis: acute and chronic. Symptoms acute form cystitis include:
- frequent painful urination;
- lower abdominal pain (from pulling pains lower abdomen and slight soreness at the end of the act of urination to sharp debilitating pains and the impossibility of keeping urine);
- discharge of blood in the urine;
- increased body temperature.
With exacerbation chronic cystitis symptoms may be less severe and depend on the cause of the disease.
Often the symptoms of cystitis are similar to some other diseases, therefore, at the first manifestations of the disease, you need to contact your doctor for a correct diagnosis.
How is cystitis diagnosed and treated during pregnancy?
Since there are several reasons for the onset of cystitis, the doctor will prescribe the following studies for an accurate diagnosis and selection of the correct treatment.
After the diagnosis is confirmed and the causes of cystitis are established, the gynecologist, together with the urologist (the urologist must take part in the diagnosis and prescribing treatment, since it is this specialist who deals with cystitis) prescribes treatment.
Treatment of pregnant women is complicated by the fact that commonly used drugs cannot be used during pregnancy. but modern medicine has the ability to help you cope with this ailment and carry a healthy baby.
Today, there are antibiotics and drugs based on plant components that do not harm the health of the mother and child. Also, one of the methods of treatment is the instillation of the bladder. This procedure allows medications to be injected directly into the bladder. In the course of treatment, several such procedures are carried out, which in turn eliminate the symptoms of cystitis, restore the bladder wall and prevent possible relapses during pregnancy. Often this is enough to eliminate the symptoms of the disease and the subsequent (after childbirth) full treatment.
It must be remembered that the body of each woman is unique and the treatment should be individual. This rule is especially true for pregnant women. In no case should you self-medicate and trust folk remedies, since during this period some drugs (tetracycline antibiotics and sulfonamides), herbs and procedures can be dangerous, and the consequences are irreparable. Therefore, the advice of a friend, mother, grandmother and other "experienced healers" in your case should be "postponed for later." Trust your doctor, and if you have doubts about his competence, then contact another specialist.
Why is cystitis dangerous during pregnancy?
The most important thing in the process of your recovery is a timely visit to a doctor. Ignoring the disease and self-medication can lead to serious complications: the occurrence (kidney infection), premature labor difficulties, or the birth of a low birth weight baby.
Prophylaxis
To avoid this unpleasant disease during pregnancy, you need to follow a few simple rules:
- control your well-being and, at the first deviations, immediately consult a doctor,
- emptying the bladder regularly,
- avoid hypothermia,
- drink enough liquids (if there are no contraindications from a doctor),
- exercise (if there are no contraindications from a doctor).
And most importantly, do not be discouraged: a positive attitude can become a very effective weapon in the fight against any ailment.
Specially for- Ksenia Dakhno
One in ten women will experience cystitis. Very often, this disease darkens the happy period when a woman is preparing to become a mother. Some doctors believe that this is due to many changes in the body of the pregnant woman. How to recognize cystitis during pregnancy and how to treat it? Let's try to understand this in detail.
Types of cystitis
Cystitis is an inflammation of the bladder, which is accompanied by frequent urination, pain, and sometimes blood in the urine.
There are many types of this disease.
The body of the pregnant woman adapts to the new condition, therefore suppression immune system
... Bacteria can easily enter the bladder, which can lead to the risk of developing cystitis in the early stages.
Most often, cystitis occurs due to a pathogen such as E. coli. The risk increases in the presence of vaginal and intestinal dysbiosis, hypothermia, severe fatigue, the use of some drugs... If a woman has chronic cystitis, then most likely it will make itself felt during pregnancy.
Is cystitis dangerous during pregnancy
Expectant mothers who develop cystitis are worried can the disease harm the development of the fetus... By itself, cystitis causes discomfort and for a pregnant woman with a weakened immune system, it raises even more serious concern.
Of course, cystitis is dangerous during pregnancy, but negative consequences can be avoided if will contact a specialist in time... Self-medication can cause kidney infections, which can be bad for both the woman and her unborn child. Inflammation of the bladder can adversely affect the development of the fetus. A child may be born early.
Symptoms of cystitis in pregnant women
It is not difficult to recognize cystitis during pregnancy, as it usually proceeds with pronounced symptoms... These include:
- frequent and painful urination;
- severe pain in the lower abdomen;
- cloudy urine, urine mixed with blood;
- false urge to use the toilet.
If a pregnant woman has noticed at least one of these symptoms, she need to visit a doctor, since cystitis needs to be treated as quickly as possible. It is worth noting that in the early stages, frequent, but not painful urination should not cause concern for a woman, this is quite normal.
If the expectant mother running form cystitis, nausea and vomiting may appear.
Diagnosis and treatment of cystitis in pregnant women
The doctor puts diagnosis based on:
- patient complaints;
- general inspection;
- anamnesis;
- analysis of blood and urine;
- examination of gynecological smears and.
How to treat cystitis in pregnant women? Cystitis treatment in pregnant women in the early stages, only the attending physician determines. Pregnant women are not advised to self-medicate, as many medications can harm the baby.
During the treatment of cystitis during pregnancy, it is recommended to refuse meals that retain fluid in the body. It is necessary to take plenty of fluids to clear the infection from the urinary system.
The doctor may prescribe antibiotic drugs approved for pregnant women. For expectant mothers, the disease can be treated with semi-synthetic penicillins with clauvonic acid or an antibiotic of the phosphonic acid group. But in the early stages, cystitis in pregnant women is forbidden to be treated with antibiotics.
Another safe method treatment of cystitis during early pregnancy is the herbal combined preparation kanefron, cestone. It includes wild rose, rosemary, centaury, lovage. This medication can be taken in any trimester.
To avoid cystitis against the background of reduced immunity, pregnant women are advised to take measures to maintain the body. It is worth increasing the number of walking hours by clean air doing yoga for pregnant women.
It is important not to endure the urge to urinate for a long time, as this may cause cystitis. A pregnant woman should go to the toilet every 2-3 hours... It is also recommended to empty the bladder before and after intercourse.
Video about cystitis during pregnancy
We suggest watching a video about cystitis, which explains in detail why pregnant women are often found with a disease such as pregnancy. How to treat cystitis during pregnancy on different timeframes what can pregnant women with cystitis and what medicines for cystitis can not be used.
Knowing common features and the causes of cystitis, it can be avoided or treated early in pregnancy. Have you experienced cystitis during pregnancy? If yes, please share what treatment for cystitis during pregnancy the doctor prescribed for you, and did the disease affect your baby?
During pregnancy, every woman becomes vulnerable to many bacterial infections... The high risk of disease is attributed to reduced immunity. Before conception immune barrier rejected pathogens, but during pregnancy they easily enter the body through the respiratory system and the gastrointestinal tract. The most common infectious disease, which pregnant women contract, is considered cystitis.About 10% of pregnant girls become hostages of bacteriuria. Its insidiousness is based on its asymptomatic course. Pathology can negatively affect the formation and development of the fetus. Also, 20% of women in the position show obvious problems in terms of the urological system, this is inflammation of the bladder membrane, in other words, cystitis. Among the complications of infection of the genitourinary system during pregnancy, pyelonephritis is the most common. According to statistics, this disease occurs in 2% of pregnant women. This explains the need for constant monitoring of the genitourinary system. That is why gynecologists insist on frequent urine tests. In the first and second trimesters, twice a month, and in the third, every 7-10 days.
Why are pregnant women at high risk of developing cystitis?
We have already mentioned the main reason, this is a decrease in immunity. In addition, pregnant women are exposed to a violation of the outflow of urine due to the constantly growing uterus. Thus, there is stagnation of urine in the kidneys, which is extremely dangerous for women in position. Pregnant women who have had cystitis in childhood are at 27% more risk of developing it during gestation than women who have never encountered such a problem. If cystitis in childhood was complicated by pyelonephritis, then the risk of getting infections of the genitourinary system during pregnancy increases by 47%.
When an examination by doctors of other specialties is necessary
During pregnancy, an indication for examination by a therapist and urologist may be any changes in urine tests, pain in the lower back and abdomen, changes in the color of urine. This leads to high risk termination of pregnancy or premature birth in the background acute cystitis.
Classification of cystitis
This classification of cystitis was proposed by G.I. Goldin.
A. Primary cystitis
1. Acute cystitis
- infectious (specific and non-specific);- chemical;
- thermal;
- toxic;
- medicinal;
- alimentary;
- neurogenic.
B. Secondary cystitis
1. Bubble origin:
- with stones and foreign bodies;- in case of injuries and wounds;
- with tumors;
- with developmental anomalies;
- after bladder surgery.
2. Extravesical origin:
- with prostate adenoma;- for diseases and injuries of the spine;
- with strictures of the urethra;
- during pregnancy, childbirth and postpartum;
- with diseases of the pelvic organs.
The essence of the danger of cystitis for a pregnant woman and a fetus
Any infection of the genitourinary system during pregnancy can provoke serious consequences, including:
Intrauterine fetal death;
Premature delivery;
Deficiency of birth weight in a child;
Anemia in a pregnant woman;
Arterial hypertension of pregnant women.
Scientific evidence suggests that infections during pregnancy can be the cause of development of cerebral palsy(child cerebral palsy) and delay psychomotor development for the period of puberty.
Causes of cystitis during pregnancy
Cystitis is divided into: infectious and non-infectious.
Non-infectious cystitis develops when:
Availability urinary stones that can provoke damage to the mucous membrane;
Due to irritation of the mucous membrane by chemicals present in the urine;
Reactions to certain types of drugs.
Non-infectious cystitis tends to "reincarnate" when an infection is attached to the initial process of inflammation.
Infectious cystitis is more common, among the pathogens are:
E. coli (80%);
- Klebsiella (3.7%);
- Staphylococcus aureus (5%);
- streptococcus (2.5%);
- enterococcus (2.2%);
- Proteus vulgaris (8.2%);
- causative agents of gas gangrene (extremely rare).
Often cystitis develops against the background of STIs (sexually transmitted infections):
Chlamydia;
- gonorrhea;
- ureplasmosis;
- mycoplasmosis.
Also among the causative agents of cystitis (infectious) are tuberculous microbacteria and treponema. Cases of infection of the bladder during the catheterization procedure are common. Pregnant women and women who have recently given birth are at risk; during this period, the tone of the bladder walls is greatly weakened.
Pathogenesis
Pathways of transmission of the pathogen:
Ascending;
- descending;
- lymphatic;
- hematogenous;
- contact.
The infectious agent enters the pregnant woman's bladder from the urinary canal. Physiological structure female body provides a wide and short urination channel, which is located close to the anus. The entry of bacteria into the urethra most often occurs from the vagina. Normal female microflora consists of lactobacilli (Dederlein's sticks), bifidobacteria in small numbers and other types of microorganisms. The norm provides for the balance of all bacteria. Their number is controlled by each other. The bacteria provide for colonization resistance. In this ideal balance, disturbances can sometimes occur - dysbiosis.
There are many reasons for this phenomenon, let's consider the most compelling ones:
Stressful conditions;
- changes in the hormonal background;
- pregnancy;
- hypothermia.
Dysbacteriosis is explained by the growth of bacteria of some species and their oppression of others. Among the harmful bacteria that provoke dysbiosis are distinguished: gardnerella, fungi of the genus Candida and others. Such microorganisms have pathogenic activity. Often, vaginal dysbiosis is triggered by an intestinal imbalance in bacteria. Human physiology is designed in such a way that it is difficult for any kind of infection to invade the body and infect healthy organs. It is the same with bladder, its mucous membrane is dense, capable of resisting infections and the only pathogen alone is not enough for the progress of cystitis.
Here some provocative reasons play a separate role, namely:
Hypothermia;
overwork, hypovitaminosis;
neglect of personal hygiene;
leading a promiscuous sex life;
immunodeficiency;
transferred surgical interventions;
problems with hormonal levels and more.
Pathogenesis of complications of gestation
In pregnant women, cystitis can manifest itself as a result of hormonal imbalances, namely the growth of progesterone, which contributes to the weakening of smooth uterine muscles, and other muscle tissues, including the bladder. If there is no pathogen, then complications should not be feared, but with bacterial vaginosis and urogenital infections, a reduced tone and favorable conditions (humidity and temperature 37 ° C) can provoke inflammatory processes... If a woman has chronic cystitis, then the risk of repeated recurrence during pregnancy is very high. A changed background of hormone levels, a weakened immune barrier, a change in microflora - these factors create excellent conditions to exacerbate existing diseases, even if they long time were in remission. Physiological changes in the structure of certain parts of the urinary system (relaxation of the smooth muscles of the bladder, an increase in its volume and insufficient excretion, physiological hydronephrosis of pregnant women, physiological hydronephrosis of pregnant women), as well as significant changes in the composition of urine (excess of pH, glucosuria) are associated with the effect of some mechanisms:
The pressure of the growing uterus;
increased estrogen, progesterone, PG-E2 and hCG;
hypertrophy of the muscular longitudinal bundles of the lower divisions of the ureters.
These complex changes affect the possibility of recurrence of cystitis in women in position.
Cystitis, as a consequence of labor
This trouble occurs due to some moments in the course of the birth process, as well as when E. coli penetrates into the cavity of the bladder or staphylococcus / streptococcus (very rare). Here are the factors that provoke the disease:
Retention of urine in the bladder cavity;
changes in the mucous membrane;
protracted natural childbirth;
injury sustained in generic process.
In the process of labor activity, the movement of the child along the birth canal provokes inhibition of the blood circulation of the organs in the small pelvis. This often becomes the cause of exacerbation of cystitis. The rules for labor activity provide for the obligatory catheterization of women, immediately after the birth of the baby. This is because a full bladder prevents increased postpartum uterine contraction... This rule can cause an infectious agent to enter the bladder cavity. An additional motive for the development of cystitis is considered to be poor-quality emptying and stagnation of urine. In some women in labor, in the first days after childbirth, there may be no urge to urinate, this is due to squeezing nerve endings... Therefore, newly minted mothers need to write regularly, after 1.5-2 hours. Moms often forget about such important rule... As a result, a lot of urine accumulates and this can cause the development of cystitis.
Symptoms of cystitis in pregnant women
Distinguish between chronic and acute cystitis. Acute cystitis often progresses immediately after the influence of a provocateur, for example, hypothermia. Among the main symptoms of acute cystitis are:
Frequent urge to urinate, but urine itself is discharged into minimum quantities;
pain and cramps in the lower abdomen;
pyuria (discharge of urine with purulent impurities).
Sometimes the pain doesn't subside long time... The most severe discomfort occurs when urinating and at the end of this process. It happens that the patient is unable to hold back urine at the next desire to write. It so happens that acute cystitis proceeds without much severity. In such cases, patients are accompanied only by a feeling of fullness in the lower abdomen, moderate pollakiuria ( frequent urination) and minor pain at the end of the urinary process. It so happens that mild symptoms of acute cystitis last no more than two days and go away on their own without any treatment. However, in most cases, exacerbated cystitis lasts from 6 days to two weeks, even if treatment was started in a timely manner. A longer period of the course of the disease may indicate an additional disease that provides favorable, supportive conditions for the inflammatory process. In such situations, the patient needs further examination.
The complex course of acute cystitis is characterized by symptoms:
Heat;
- intoxication
- oliguria.
V similar cases the duration of the course of the disease increases and can be complicated by a serious condition. For complicated types of acute cystitis, an increase in body temperature, intoxication, and oliguria are characteristic. If the patient feels a sharp, piercing pain at the end of the urination process, then most likely the inflamed focus is localized on the bladder neck. Severe pain is associated with convulsive contractions of the bladder sphincter. The patient needs constant emptying of the bladder, so the pain is constantly present. In addition to leukocyturia during the period of acute cystitis, bloody impurities in the urine can join. Hematuria occurs at the end of the urination process. This phenomenon is explained by the fact that the inflamed membrane of the bladder neck, as well as the Lieto triangle, is injured at the end of urination. Postpartum cystitis is accompanied by urinary retention, the initial portion has a cloudy appearance, there is pain at the end of urination. Chronic cystitis is different from acute. The variety lies both in the clinical picture and in the therapy method. Cystitis of the chronic form is completely determined by the patient's health condition and the etiological factor. The symptomatology of chronic cystitis is similar to acute, the difference is only in a less pronounced manifestation.
In the chronic form, 2 scenarios of the course of the disease can be expected:
1. A continuous process with regular complaints about pain discomfort and changes in the patient's urine (bacteriuria, leukocyturia).
2. Alternating remission ( complete absence painful symptoms) and relapse (exacerbation period, with symptoms as in acute cystitis).
Complications of gestation
Inflammation of the bladder, accompanied by infection, can cause fetal freezing, miscarriage, as well as the birth of a premature baby;
An infection inside the bladder can provoke acute pyelonephritis with a further complicated course if the infection goes through the ureters to the kidneys.
Anamnesis. Diagnosing cystitis during pregnancy
Anamnesis plays a colossal role in acute inflammation and its further growth. Exactly as with the previously present inflammation and the development of acute cystitis into a chronic type.
Physical examination:
Palpation examination;
- percussion (tapping).
Laboratory samples:
Urine analysis (general);
- blood test (clinical);
- urine analysis according to Nechiporenko;
- test of Zimnitsky;
- study of urine for the presence of harmful bacteria;
- analysis of vaginal microflora for dysbateriosis;
- PCR analysis for STI pathogens (Trichomonas, gonococcus, chlamydia);
- determination of the level of glucose in blood serum.
Instrumental examination:
Ultrasound of the bladder, kidneys and organs in the small pelvis;
- cystoscopy;
- catheterization (diagnosis and treatment);
- biopsy of the bladder.
Cystoscopy is not provided for acute cystitis, so as not to exacerbate it even more. In chronic cystitis, cystoscopy makes it possible to detect hyperemia, swelling, bleeding, thickening and disturbance of the mucous membrane, areas with ulcers and fibrous-purulent films.
Differential diagnosis
Acute cystitis differentiates with renal diseases, cystalgia, urolithiasis, urethritis and other diseases of the woman's urogenital organs. If stones are present in the bladder cavity, the symptoms are very similar to cystitis. Manifestation pain syndrome in the presence of stones, it grows when walking, running or shaking crossings. The pain radiates into the vagina. Violation of urination is added, in the form of frequent urges, especially when moving. During rest and lying down, the pain tends to subside.
In the presence of cystalgia, changes in the bladder are not observed. There is no pyuria either. But despite this, the pain can wear enough a strong character... Thus, the diagnosis is made on the basis of the patient's complaints, if there is no pyuria, bacteriuria and due to the absence of indicative changes in cystitis in the membranes of the bladder mucosa.
Cystitis can be a symptom of acute pyelonephritis. Acute pyelonephritis has a number characteristic symptoms, but the main symptom is considered to be a body temperature of 38-39 ° C and severe chills. Also, patients note pain in the lumbar region, nausea and vomiting. Acute pyelonephritis is very dangerous, and even more so for a pregnant woman, therefore, the disease requires inpatient treatment. With urethritis, the patient has pain when urinating, and a purulent mass is released from the urethra. Urethritis can be combined with bartholinitis and cervicitis.
The most common causative agents of urethritis are:
Urogenital microplasmosis;
- chlamydia;
- gonorrhea.
Vulvovaginitis is characterized by discomfort in the vulva area, it increases with the emission of urine. Purulent discharge from the vaginal opening is also noted.
Among the frequent provocateurs of vulvovaginitis are noted:
Urogenital microplasmosis;
- urogenital chlamydia;
- genital herpes.
Treatment of cystitis during pregnancy
For the treatment of cystitis during pregnancy, the following are prescribed:
Amoxicillin (dose 250-500 mg, break for 8 hours for 3 days);
Clavulanic acid together with amoxicillin (dose 375-625 mg, break 8-12 hours);
Cefuroxime (dose 250-500 mg, break 10 hours) duration of treatment 3 days;
Ceftibuten (dose 400 mg per day);
Cephalexin (dose 250-500 mg at 6 hour intervals) duration of treatment up to 3 days;
Nitrofurantoin (100 mg dose at 6 hour intervals). Continue treatment for no more than three days.
Maintenance therapy:
Nitrofurantoin (100 mg dose) at bedtime;
- amoxicillin (250 mg) before bedtime;
- cephalexin (250 mg) at night;
- fosfomycin (dosage 3.0 g), the duration of the treatment course is 7-10 days.
Also, local treatment is prescribed, which has an antimicrobial effect. Therapy with herbal uroseptics, lasting 7 days:
Kanefron three doses a day, 2 tablets;
- phytolysin three doses per day orally for 1 tsp;
- decoction of herbs with a diuretic effect, half a glass of 3 doses per day. At the same time, treatment of bacterial vaginosis and STIs is prescribed.
Treatment of cystitis with folk remedies
For the treatment of cystitis, a pregnant woman can use herbal infusions and decoctions after consulting a doctor.
Herbs are brewed in the evening and infused overnight. Typically 0.5 liters. boiling water is required
2-3 st. l. mixture of herbs. The prepared infusion is drunk during the day. The course is 3-6 weeks.
In chronic cystitis, herbal treatment should be continued for several years. Fees should be alternated and take a break every two months. Monitoring urine during treatment is mandatory.
1 collection
Take 5 parts of bearberry leaves, 3 parts of birch buds and 5 parts of horsetail herb. Take 2-3 weeks.
2 collection
Take 2 parts of calamus root, 4 parts of black elderberry flowers, 5 parts of St. John's wort, 3 parts of flax seeds, 2 parts of lemon balm, 3 parts of bud tea leaves, 5 parts of knotweed herb, 5 parts of bearberry leaves, 2 parts of fennel fruit.3 collection
Take 5 parts of Veronica officinalis herb, 5 parts of wild rosemary shoots, 5 parts of St. John's wort, 3 parts corn silk, 2 parts of flax seeds, 3 parts of peppermint leaves, 3 parts of pine buds, 4 parts of horsetail herb.
4 collection
Take 5 parts of parsley herb, 5 parts of knotweed herb, 7 parts of oregano herb, 3 parts of St. John's wort, 2 parts of white birch buds, 3 parts of flax seeds, 2 parts of peppermint leaves, 2 parts of asparagus rhizome, 4 parts of thuja shoots western, 1 part eucalyptus leaves.
5 collection for alkaline urine reaction
Take 2 tbsp. l. bearberry leaves and pour 0.5 l. boiling water, let stand and drink the resulting infusion during the day. The course is 7-10 days.
Preventive measures and prognosis regarding complications
Prevention in order to prevent the aggravation of the disease is to observe the rules of personal hygiene, correct treatment acute cystitis, prevention of hypothermia, adherence to asepsis during endovesical examinations and catheterization of the bladder, as well as timely and accurate diagnosis of diseases of the genitourinary system with further optimal correction of the condition.
Features of the treatment of complications
Gestation in the first half of pregnancy is fraught with the risk of fetal freezing and abortion. Then classical therapy is carried out.
Indications for appointment:
Bacteriuria;
- leukocyturia;
- hematuria.
The main treatment is determined solely by the physician. Provided local therapy, infusion of antimicrobial solutions into the bladder. At the same time, treatment of STIs and bacterial vaginosis is prescribed.
The effectiveness of medical therapy is assessed according to the following criteria:
Clinical symptoms disappear;
Urine tests are within the normal range.
Making a medical decision regarding the timing and method of delivery
If the disease is diagnosed on time and effective treatment takes place, then the birth process takes place according to due date... For caesarean section only gynecological indications are necessary.
Important for a patient with chronic cystitis
Before pregnancy or immediately after conception, you should consult your doctor about chronic ailments, including tooth decay and tonsillitis. Chronic infections can serve as provocateurs to excite inflammation in the bladder and other organs. If there is bacterial vaginosis, it is advisable to hold it curative therapy even before pregnancy.
Postpartum prophylaxis of cystitis
The prevention of cystitis should be taken into account by the doctor during the labor process, which is characterized by the provision of maximum assistance to the woman in labor. After childbirth, it is imperative to avoid urinary retention. Asepsis must be observed during catheterization. V postpartum period it is necessary to give up sour, fried, spicy foods, spices and exclude alcohol. Such rules are recommended not only for the prevention of cystitis, but also for normal breastfeeding. Monitor the frequency of stools, in every possible way to prevent constipation. Retention of feces in the intestine provokes a violation of the blood supply to the organs in the small pelvis, which can lead to cystitis. It is important to avoid hypothermia even during the warm season.
Cystitis during pregnancy
Urinary tract infections in pregnant women, in particular cystitis, are complex and actual problem, which is due to their widespread prevalence, the limited scope of possible diagnostic procedures, the complexity of the selection of therapy, as well as increased risks for maternal and fetal health.
The prevalence of infectious and inflammatory processes of the urinary system during pregnancy is higher than in non-pregnant women. However, the choice of drugs for the treatment of cystitis during pregnancy is limited by the possible negative consequences, the effect on the developing fetus.
That is why, with the development of inflammation of the bladder in a pregnant woman, the obstetrician-gynecologist must adhere to the "golden mean": to correctly cure the patient and not harm the baby. Self-medication during pregnancy is unacceptable.
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1. Basic concepts
Acute cystitis means an acute, infectious-mediated inflammation of the mucous membrane of the bladder (less often other layers of the wall).
The main causative agents of infection, including in pregnant women, are the Enterobacteriaceae family of bacteria, in particular Escherichia coli.
Information on the structure of the main causative agents of inflammatory diseases of the urinary system in pregnant women was obtained in the course of an extensive study carried out in Russia "DARMIS" (2010-2011). According to the results of this study, the causative agent of acute cystitis in pregnant women (as in women in the general population) is representatives of the normal intestinal microbiota, which colonize the area in the urethra.
Table 1 - The main causative agents of MEP infections in pregnant women ("DARMIS", 2010-2011)
The most common pathogen is Escherichia coli. Under normal conditions, it is a non-pathogenic microorganism that lives comfortably at the expense of a person, without harming him and is part of the normal intestinal microbiota. However, when it enters the urinary system, it causes an inflammatory process.
Why does the risk of penetration of uropathogens into the bladder increase during pregnancy?
1.1. Factors predisposing to the development of acute cystitis during pregnancy
Cystitis is a widespread disease and is most common among women. During pregnancy, the likelihood of its occurrence increases several times.
Factors predisposing to bladder infection during pregnancy include:
- 1 Anatomical features of the female urinary system: short and wide urethra, close to the vagina and anus.
- 2 Developing in the background hormonal changes in the expectant mother (an increase in estradiol and progesterone), urodynamic disorders, such as dyskinesia, hypokinesia, hypotension of the urinary tract.
- 3 Compression of the ureters and bladder by the enlarging uterus, some relaxation of the external urethral sphincter (on later dates gestation).
- 4 Changes in the physical or chemical properties of urine during pregnancy. The urine is somewhat alkalized, due to an increase in the rate of filtration of urine by the glomeruli and increased secretion bicarbonates. Alkalization of urine creates a favorable microclimate for the reproduction of uropathogens.
- 5 Aggravation of various kinds gynecological diseases against the background of altered immunity.
- 6 Changes in the immune status of a pregnant woman's body.
2. Clinical picture
Cystitis during pregnancy is accompanied by typical symptoms that make it possible to quickly diagnose this pathology. To the most frequent symptoms include:
- 1 Frequent and painful urination. Patients experience strong burning and painful sensations, especially with short acts of urination.
- 2 Pain and discomfort in the lower abdomen, in the suprapubic region.
- 3 Desire to urinate at intervals of less than 30 minutes (urgency).
- 4 Feeling of incompleteness of the act of urination and constant fullness of the bladder.
- 5 The presence of symptoms of intoxication: fever, sweating, weakness or malaise. In uncomplicated cystitis in pregnant women, these symptoms are rare.
Laboratory, when performed and determined:
- 1 An increase in the number of leukocytes of more than 10 cells in 1 μl of urine.
- 2 Detection of bacteriuria (bacteria in urine in a titer of more than 10x3 CFU / ml (for colibacteria and uropathogens) and 10x5 CFU / ml for other types of microorganisms));
- 3 Terminal hematuria (appearance of blood in the final urinary portion) is not a necessary sign.
3. Basics of diagnosis
Diagnosis of acute cystitis in pregnant women is based on typical symptoms in combination with leukocyturia and bacteriuria c.
It is important to remember that the presence of only leukocyturia in pregnant women (an increase in the number of leukocytes in the urinary sediment) is not enough to make a diagnosis ("MONIKI" 2016).
If an isolated increase in the level of leukocytes in the urine of a pregnant woman is detected, it is important to clarify their source, because leukocyturia can also lead to inflammatory diseases reproductive system.
For this, the following examinations are necessarily included in the range of diagnostic measures for these complaints:
- 1 OAM with quantitative calculation of urinary sediment elements.
- 2 Bacterial urine culture.
- 3 Urine analysis according to Nechiporenko.
- 4, to exclude the inflammatory process.
- 5 ultrasound of the kidneys and bladder.
In pregnant women, leukocyturia without bacteriuria can also occur in the following cases:
- 1 Self-administration of antibacterial drugs before passing urine for culture or clinical analysis.
- 2 Contact of urine sample with disinfectants(treatment of the jar with disinfectant solution).
- 3 Availability and.
- 4 Tumor processes in the urinary tract.
- 5 Infection with sexually transmitted infections (STI-related urethritis).
If you suspect the above situations, urine analysis should be redone again, explaining to the pregnant woman the rules of preliminary toilet and collection of material for research.
The main mistakes in the diagnosis and management of pregnant women:
- 1 Diagnosis of acute cystitis based on symptoms alone.
- 2 Collect urine for examination after initiation of antibiotic therapy.
- 3 Lack of appointment for recurrent cystitis.
4. How to properly collect urine for research?
Collection of urine for OAM and bacteriological examination in pregnant women is carried out with independent urination. It is preferable to collect the first portion of urine, if this is not feasible, then more than 3-4 hours should pass from the moment of the last urination.
Urine collection algorithm:
- 1 Carry out the preliminary toilet of the external urogenital organs under running water from front to back, without using soap and washcloths.
- 2 Prepare a sterile urine collection container in advance, open it without touching inner surface or edges.
- 3 With one hand, part the outer labia slightly and hold them in this position.
- 4 Start urinating down the toilet.
- 5 Collect the middle portion of urine in a container to the required level (50-70 ml).
- 6 Finish the process of urinating in the toilet.
- 7 Carefully close the container used for collecting urine.
- 8 Sign the container (date, surname, site number, purpose of the analysis - bacterial culture, Nechiporenko's sample or OAM). Attach the referral from the clinic using a thin rubber band.
- 9 Deliver to laboratory, optimally within 2 hours of collection.
4.1. Signs of contamination of the urine sample
The frequency of false positive results (in the test results) is quite high, which is most often associated with a violation of the algorithm for collecting material for research. The main signs of sample contamination are:
- An admixture of mucus in the urine.
- The abundance of various microflora (with bacterial sowing, several types of microorganisms are determined).
- A significant amount (layers) of squamous epithelium.
- False proteinuria (no more than 1 g / l).
If there is a suspicion of contamination of the urine sample, the test is repeated.
5. Possible complications
Cystitis that develops during pregnancy is not as harmless as it seems at first glance. In pregnant women, due to physiological reasons, cystitis is dangerous, as complications of urinary tract infections are much more common.
One of the most formidable complications is the ascending spread of the infection and severe gestational pyelonephritis, which in turn can lead to:
- 1 Infectious toxic shock, abscess formation, paranephritis.
- 2 Acute renal failure.
- 3 Intrauterine fetal infection.
- 4 Premature birth, early termination of pregnancy.
- 5 Development of placental insufficiency, etc.
That is why the detection and timely treatment of cystitis in pregnant women is especially important. Cystitis usually does not affect conception, but complicates the course of pregnancy.
6. Tactics of management of a pregnant woman
When choosing tactics for managing a pregnant woman with acute cystitis, one should be guided by following rules developed by the urological association:
- 1 The main component of the treatment of cystitis during pregnancy is the use of antibiotics with proven efficacy and maximum safety for the fetus.
- 2 Therapy for acute cystitis should be started empirically, pending urine culture results.
- 3 Broad spectrum antibiotics are recommended, with proven safety and regional resistance.
- 4 Upon receipt of the results of urine bacterial culture, correction of the therapy is possible.
7. Choosing an antibiotic
Antibiotics for acute cystitis in pregnant women are an essential component of therapy. This is the only group of drugs whose prescription for acute cystitis is justified from the point of view of evidence-based medicine.
An antibacterial drug for the treatment of cystitis in a pregnant woman must meet the following criteria:
- 1 High activity relative to the main uropathogens.
- 2 Achievement of high concentrations in urine.
- 3 Availability of oral forms (it is more convenient for pregnant women to drink tablets, capsules and powders).
- 4 Possibilities of single use during the day.
- 5 Possibilities of the shortest therapeutic course.
- 6 Evidence-based safety for the child.
- 7 Minimal impact on intestinal and vaginal microflora.
- 8 Adequate price.
Currently, E. coli (the main uropathogen) isolated from the urine of patients with urinary tract infections is highly resistant to the following antibiotics:
- 1 Ampicillin;
- 2 Ciprofloxacin;
- 3 Levofloxacin (cross-resistance).
As for pregnant women, here, according to a study conducted on the basis of MO MONIIAG, there are slightly different data.
Table 2 - Resistance of E. coli to the main antimicrobial drugs. Comparison of resistance in the general population and among pregnant women,% (“DARMIS” 2010-2011).
Colibacteria sown for urinary tract infections in pregnant women show a high degree of resistance not only to ampicillin, but also to amoxicillin / clavulanate (drugs - Amoxiclav, Augmentin), some cephalosporins (2 generations), as well as nitrofurantoin (drug - Furadonin).
Today urologists are alarmed by the detection of bacteria with the possibility of producing B-lactamases and resistance to Amoxiclav.
7.1. Determination of the safety of an antimicrobial drug
One of the fundamental requirements for the possibility of using a particular antibiotic during pregnancy is its safety.
Most rational for determining security medicinal product use a specially developed classification developed by the FDA (USA).
According to this classification, all drugs can be conditionally divided into five main groups (safety classes) according to their degree negative impact on the fetus:
- 1 Group (safety class) A - when conducting controlled clinical trials negative impact the fetus was not detected (including in the 1st trimester, in the early stages of pregnancy).
- Group 2 (safety class) B - during clinical trials on animals, no negative effects on the fetus were found. Human testing has not been conducted. During the period of application, no cases of teratogenic effects on the human fetus have been registered.
- 3 Group (safety class) C - during testing on animals, a negative effect on the fetus of the animal was revealed. The presence of a negative effect on the human fetus has not been proven, due to the lack of clinical trials. Prescribing a drug can be justified if the intended benefit is higher than the risk of adverse effects.
- 4 Group (safety class) D: evidence recorded negative action on human embryo, however, the use of the drug may be justified by the potential benefit to the patient.
- 5 Group (safety class) X: strictly contraindicated in pregnancy. Have a proven high risk of developing congenital anomalies fetus.
Table 3 - Distribution of drugs with antimicrobial action used in pregnant women with acute cystitis by hazard classes.
As can be seen from Table 3, there are currently no antibiotics classified as safety group A. This is because testing on pregnant women is against moral and ethical considerations.
Safety group B is considered sufficient, where the absence of harm has been confirmed in animals, and there have been no cases of teratogenic effects on the fetus in humans over the entire period of use of the drug.
The following antibiotics are contraindicated during pregnancy:
- 1 Quinolones / fluoroquinolones - when taken, there is a high risk of damage to cartilage and joints in the fetus.
- 2 Oxolinic and pipemidic acids - cause intracranial hypertension in the fetus.
- 3 Preparations of the tetracycline series - cause disorders in the formation of the skeleton and teeth.
- 4 Co-trimoxazole - in early pregnancy affects the development of neural tube, in the late - leads to jaundice of newborns.
- 5 Nitrofurans - when taken, the risk of hemolytic anemia in the newborn increases.
- 6 Nitroxoline - can cause neuritis and optic nerve atrophy in the fetus.
- 7 Aminoglycosides - have a toxic effect on the kidneys and hearing organs.
7.2. Drugs of choice
For the treatment of acute cystitis in early and late pregnancy, oral antibacterial agents are preferred. It is necessary to use funds that can maintain the required concentration in the urine even with one or two use during the day.
Regimens for the treatment of acute cystitis in early and late pregnancy:
- 1 Fosfomycin trometamol (class B) 3 g, powders, once by mouth;
- 2 Cefixime 400 mg (class B) 1 r / day, 7 days;
- 3 Ceftibuten 400 mg (class B) 1 r / day, 7 days;
- 4 Nitrofurantoin (only from the 2nd trimester), tablets 100 mg 3 r / day, 7 days (class B);
- 5 Cefuroxime 250-500 mg (class B) tablets, orally 2 r / day, 7 days;
- 6 Amoxicillin / clavulanate, tablets, capsules - 500/125 mg (class B) 3 r / day, 7 days.
A few weeks after the completion of one of the indicated schemes of the course of antibiotics, it is necessary to conduct a control bacteriological study of urine. In the absence of infectious agents, treatment usually ends.
When the uropathogen is re-detected, even in the absence clinical signs disease, the treatment regimen is again prescribed. Further, every month, before the onset of labor, urine culture is performed, even if the uropathogen is not detected.
If, at the end of the second course of antibiotics, the uropathogen is sown again, then the appointment of periodic microbial suppressive therapy is recommended until the term of labor.
Main problems drug therapy during pregnancy:
- 1 Transience clinical picture inflammation.
- 2 Duration of urine bacterial culture.
- 3 The tendency of women to self-medicate, which complicates the diagnosis.
- 4 An increase in antibiotic resistance.
- 5 Presence of concomitant vaginal dysbiosis.
- 6 High risk of chronicity and tendency to relapse.
7.3. Possibilities of herbal medicine
Herbal medicine, as an auxiliary treatment for acute cystitis during pregnancy, is permissible and can be used:
- 1 In the period active phase inflammation (exclusively in combination with antibiotics).
- 2 In the period of remission, to prolong the achieved therapeutic effect.
- 3 For prophylactic purposes, to prevent recurrence of urinary infections in pregnant women with a burdened history.
The only official phytopreparation allowed today during pregnancy is Kanefron. Canephron is a combination of extracts medicinal herbs with mild diuretic, antispasmodic, antioxidant and anti-inflammatory effects.
The drug prevents E. coli from adhering to the bladder wall. Among the advantages are the safety of the drug for the fetus and good tolerance by pregnant women at any time. You need to take Kanefron 2 capsules 3 times a day, the duration of use is set by the attending physician.
The drug can be prescribed:
- 1 In addition to antibacterial therapy.
- 2 After completing the course antimicrobial therapy acute cystitis, to prevent recurrence.
- 3 in preventive purposes, to prevent acute cystitis with existing urodynamic disorders.
- 4 If a pregnant woman has anomalies in the structure of the urinary tract, polycystic kidney disease, nephropathy, urolithiasis, anomalies in the structure of the bladder and ureters. Prevention is recommended to start from the first weeks of pregnancy.
- 5 In addition to Canephron, during the period of active inflammation, infusions, decoctions and fruit drinks based on bearberry, lingonberry, cranberry can be prescribed.
It should be remembered that phytotherapy is not always safe during pregnancy. Herbs contraindicated in pregnancy include:
- 1 barberry;
- 2 wormwood;
- 3 juniper;
- 4 smokehouse;
- 5 mint mint;
- 6 sanguinaria and others.
Pregnant women should not self-medicate cystitis, use folk remedies at home. It is important to apply for medical help!
8. Prevention of cystitis
Preventive measures aimed at preventing cystitis during pregnancy are quite simple and differ little from the recommendations for non-pregnant women.
Remember that cystitis during pregnancy occurs much more often, so about doing preventive measures you should think about it from the first weeks of gestation and pre-gravid preparation.
Among the events, we note:
- 1 Compliance with intimate hygiene. Daily washes under running water from front to back. It is possible to use special gentle hypoallergenic products for intimate hygiene. The use of soap is not recommended (the acid-base balance of the mucous membranes is disturbed).
- 2 Timely emptying of the bladder, sufficient fluid intake in the 1-2 trimester.
- 3 Avoidance of hypothermia, especially local.
- 4 Compliance by the expectant mother with an exception diet a large number salt and spices.
- 5 Wearing underwear made from natural, breathable fabrics.
- 6 Timely treatment of gynecological infections, STIs.
Estimated reading time: 12 minutes
In the early stages pregnancy characterized by pain that may wear different character... It ranges from mild pain in the lower abdomen and mild soreness at the end of urination to severe pain with urinary incontinence. The urge to urinate becomes frequent with discharge small amount urine.
Many expectant mothers are faced with the unpleasant urological disease "cystitis". Among other troubles, frequent urge the toilet and painful urination darken the joy of motherhood for the patients, and the disease itself is fraught with serious complications from the genitourinary system.
The disease requires timely and serious treatment, so most women have a question: "How to treat cystitis during pregnancy so that it does not harm the child?"
The essence of the disease and symptoms of cystitis
Cystitis, in fact, is an inflammatory process of the mucous membranes of the bladder, which leads to its dysfunction. Inflammation is provoked external factors(hypothermia, improper nutrition, substandard regular hygiene, hormonal system disorders, etc.), as well as bacterial microflora. In pregnant women, the appearance of the disease is also facilitated by a weakening of the immune system, general weakness of the body, a lack of micro- and macroelements and vitamins.
The main danger of the disease is the absence timely treatment or self-medication without consulting a specialist. A complication of cystitis is kidney damage and disruption of the entire genitourinary system, which is extremely dangerous for a pregnant woman. Launched inflammatory processes can provoke premature birth, as well as the birth of a baby with a lack of body weight and height. 
How to treat pregnant cystitis will depend on the symptoms of the disease. As a rule, the symptoms are pronounced even before the first analyzes and tests.
If cystitis gave complications to genitourinary system and kidneys, the following symptoms additionally appear:
- hyperthermia (38 ° C and above);
- regular aching pain in the lumbar region and pelvis;
- acute colic in the side;
- fever;
- food disorders (nausea, vomiting, diarrhea);
- lack of appetite;
- general weakness.
Why does cystitis occur?
Cystitis in pregnant women can appear for a variety of reasons.
The infectious form is caused colibacillus and other bacteria. This is facilitated by the natural structure of the woman's urethra (too short and located next to the anus). Bacteria penetrate into the canal with insufficient hygiene in this area, as well as during intercourse.
In the early stages, the cause of the disease can be immunosuppression - suppression of the immunity of the expectant mother, as well as hormonal imbalance. Pathogenic microflora actively multiplies and develops, causing inflammatory processes various bodies and systems.
There are also more rare non-infectious forms of the disease associated with taking certain medications, allergies, hypothermia, etc. Drugs that cause the disease are absorbed into the urine and excreted through it from the body, irritating the delicate mucous membrane of the bladder. Allergies can occur as a result of a reaction to cosmetic products(intimate lubricant, bubble bath, intimate hygiene product, etc.), hygiene products (pads, tampons, condoms), some products (cabbage, beans, beans, nuts, etc.). Thermal cystitis occurs when the lower abdomen is exposed to high or low temperatures.
Also expectant mother you should be prepared for the fact that chronic cystitis in the first week of pregnancy may worsen.
Diagnosis of the disease in pregnant women
If you have noted the symptoms listed above, you should immediately make an appointment with a urologist. The doctor will carefully examine the complaints, conduct an examination and ask you to do the necessary tests. 
Analysis of urine allows you to detect the presence of impurities in urine (blood, purulent, protein, etc.) and pathogenic microorganisms.
Cystoscopy will help to examine in detail the condition of the bladder. To conduct the study, the doctor inserts a cystoscope (a thin tube with a light source and a camera) into the urethra, gradually moving into the urethra cavity.
The urologist may also order imaging tests to determine the shape and extent of the infection. As a rule, an ultrasound examination is used in pregnant women, and X-ray examination is contraindicated.
Treatment of the disease with medical methods
Treatment will depend on the form of the disease (acute, chronic), stage, symptoms and, of course, the reasons that caused the disease.
Infectious cystitis requires antibiotic treatment that does not affect the fetus.
Non-infectious forms require treatment with analgesics and anesthetics, anticholinergics, drugs that relax the muscles of the urethra and suppress the urge to urinate.
In addition, pregnant women are prescribed bed rest and special diet based on regular use liquids.
Complex cases of the disease require hospital treatment. Unfortunately, you cannot do without taking antibiotics, since serious complications such as pyelonephritis may develop. Antibacterial drugs are also prescribed to help eliminate inflammation. The most known medicine from cystitis during pregnancy is Monural (safe antibiotic). It is used once, which contributes to the favorable treatment of the disease. The safety of the drug has been proven for the health and development of the fetus, while during use does not occur side effects... Amoxiclav is also used - a less safe drug that is prescribed in rare cases. Canephron with cystitis allows you to get rid of acute pain.
In addition to drug treatment expectant mothers are prescribed procedures. One of these is instillation. Antiseptic and antimicrobial solutions ( boric acid, rivanol, saline, silver nitrate, etc.) using a thin and flexible catheter. The procedure is effective in the early stages and is used in a hospital setting.
Treatment of the disease at the beginning of the first trimester
During this period, it is forbidden to use many medications, including nirofurans.
Pregnant women are prescribed drinking regimen based on purified water, green tea and cranberry juice. The more fluid enters the bladder, the faster harmful microorganisms and toxins are flushed out. Spicy, too salty, fatty, smoked and fried foods, as well as soda, sugar, coffee drinks, sweets and pastries are excluded from the diet.
It is contraindicated for patients to take hot baths - only warm showers.
In the early stages (for example, at the 11th week of pregnancy), antibacterial drugs of the cephalosporin group, fosfomycin, are sometimes prescribed, but under strict medical supervision. After a while, urine culture is performed, which determines the sensitivity of bacteria to a particular drug, in order to increase the effectiveness of treatment. Also, herbal preparations are prescribed, instillations using medicinal decoctions and medicinal oils.
Canferon N is a herbal preparation (in lovage, centaury, rosemary) and is recommended by doctors for the treatment of cystitis in the 1st trimester. It has a diuretic and anti-inflammatory effect, relieves pain in the abdomen, as well as when urinating. It also promotes the expansion of the vessels of the bladder and kidneys, protecting them from increased stress. The drug enhances the effect of other antibacterial drugs, is suitable for the prevention of chronic cystitis in pregnant women.
Expectant mothers are interested in how to treat cystitis during pregnancy besides medical supplies... Herbal medicine comes to the aid of patients - a complex treatment with the help of medicinal herbs. A specialist in this field prescribes washing and instillation for cystitis based on decoctions of horsetail, asparagus roots, rowan and lingonberry leaves, rose hips, unrefined oats, etc.
Physiotherapy is also effective for treatment, for example, electrophoresis, which allows you to act on the inflamed area without harm to mother and child.
How to treat cystitis at home and folk methods
It is increasingly difficult for pregnant women in the second and especially third trimester to visit hospitals regularly for procedures that can be performed at home. In this case, the urologist prescribes home treatment, which requires compliance with certain rules.
- Diet based on plant and dairy products. Fried, canned, pickled, spicy, salty and fatty foods are excluded. You should also exclude coffee drinks, sugar, confectionery and baked goods.
- You need to consume at least 7 glasses per day pure water... In this case, you should definitely drink after using the toilet.
- It is necessary to reduce the acidity of urine, for which ½ teaspoon of baking soda is dissolved in water (200 ml).
- During therapy, sexual intercourse should be abandoned, as this can slow down the treatment process or even cause re-infection.
- A pregnant woman should regularly drink vitamin and mineral complexes and special nutritional supplements.
- The diet must contain natural fruit drink from cranberries and lingonberries.
- It is forbidden to take warm sitz baths without the proper permission of a doctor. Also, do not apply warming compresses, heating pad, mustard plasters, etc. to the affected area. Any thermal procedures can provoke a miscarriage.
The older generation can also tell how to treat cystitis at home during pregnancy.
Grandmothers have long used a healing drink from the roots of rose hips to treat ailment. To do this, take 1000 ml of pure water and pour 4 tablespoons of dry collection, boil for 20 minutes over low heat. The resulting drink is filtered and cooled. We consume at least 2 glasses daily for a month.
There is another tea recipe based on the collection of lingonberry, winter lover, borax and bergenia. We take 1 teaspoon of each plant, pour 1000 ml of pure water and cook according to the previous recipe.
Many patients respond positively to the treatment with a half-palate, but it can only be used with the approval of the attending physician.