What should a pregnant woman do if her legs are swollen? Treatment of edema during pregnancy. Subjective feelings of a woman

20.04.2019

Twenty-seventh week of pregnancy refers to the third trimester. This period is also fraught with a lot of new and beautiful, but the doctor's advice about the 27th week of pregnancy will be very appropriate. First, you need to know what happens to your baby at 27 weeks of gestation. The baby is 34 cm tall and weighs 900 g. He can already open and close his eyes. He developed a certain pattern of sleep and wakefulness. At this time, the baby's lungs are actively developing. At this stage of pregnancy, the expectant mother can feel how the baby is hiccuping. Also, the organs of vision are already fully formed. These are, perhaps, all the changes that occur with your baby at this stage of pregnancy.

Some changes are also taking place with the expectant mother, which you need to know about in order to be aware of all the events and not to worry on various occasions. Posture under belly weight at 27 weeks gestation future mom slightly changes, the back deviates forward, which often causes lower back pain.

At this stage of pregnancy, hands can become very swollen. To make the swelling painless and noticeable doctors advise:
- Consume vitamin B6 daily.
- Try not to bother your wrists.
- You can raise your hands and shake them.
- Avoid drinking a lot of fluids before going to bed.

Spasms of the muscles of the legs. To prevent and get rid of them, it is necessary:
- Massage the limb.
- You can do special physical exercises, which your doctor will tell you about.

It is worth noting that doctors strongly advise expectant mothers who are at this stage of pregnancy to take a urine test. Because, starting from this period of pregnancy, gestosis may develop - dangerous complication for mother and child. This pathology is accompanied by discharge at 27 weeks of gestation. That is why now you should not neglect visits to the antenatal clinic.

An ultrasound scan at the 27th week of pregnancy can be done if a doctor has prescribed it for you. No ultrasound should be done without special permission. By the way, if expectant mothers do ultrasound at this stage of pregnancy, then they can definitely find out the gender of their unborn child. Because the fetus is quite mobile, and it will not be difficult for the doctor to determine whether it is a boy or a girl.

Childbirth at 27 weeks is quite possible for a number of different reasons. Maybe there are any pathologies of the child or diseases of the mother. Such childbirth is considered early, and the baby is born prematurely. Such a baby is carefully cared for, and his life completely depends on correct actions doctors.

Well, that very soon you will become a mommy, there is very little left to enjoy pregnancy. Therefore, spend this time with the benefit of yourself and your baby.

During pregnancy, the woman's body adapts to the changed condition. This process is considered natural.

Now let's dwell on this in more detail.

Causes of edema during pregnancy

As a result of changes in the body of the expectant mother, a lot of fluid accumulates. Its volume at 8 weeks can reach 6-8 liters. It is necessary for:

an increase in the volume of blood in the mother's body;
filling the placenta;
ensuring the growth of the mammary glands and uterus;
creating amniotic fluid.

However, often the amount of fluid created by the body exceeds the required volume. In this case, edema may appear. They are especially unpleasant on later dates pregnancy and can lead to health problems for the mother and baby.

Swelling of the legs can also appear as a result of a number of other reasons, the list of which includes:

Having bowel problems. If a girl encounters frequent diarrhea during pregnancy, this can lead to disruptions in work. digestive system and cause swelling in the legs.
Varicose veins. During pregnancy, the uterus develops rapidly. The enlarged organ exerts a squeezing effect on the vessels. This can lead to the formation of varicose veins. Veins overflowing with blood cause edema.
Gestosis. The problem is considered to be very dangerous. She is characterized not only by swelling of the legs, but also internal organs... A similar phenomenon can occur with the placenta, which is a direct threat to the child's life.
Impaired kidney function. Pregnancy significantly increases the burden on this organ. Excess fluid accumulating in the body is not always fully eliminated. This causes the appearance of edema. If they have arisen due to a disturbance in the activity of the kidneys, the girl can observe the formation of bruises under her eyes and a decrease in the frequency of urination.
Acute thrombophlebitis. Doctors include the disease in the list of extremely dangerous. Swelling of the legs is considered one of the signs of its presence. In addition to them, the temperature may rise, there may be redness of the legs and appear painful sensations.
The girl wears uncomfortable shoes and clothes. The crushing effect of clothing can also lead to leg swelling during pregnancy. This is due to impaired circulation. Experts strongly recommend that you avoid wearing high-heeled shoes and tight-fitting clothing.
Viral diseases that the expectant mother suffered recently. The infection can complicate the kidney. The functioning of the organs will deteriorate, leading to inadequate excretion of fluid from the body. This can cause leg swelling during pregnancy.
Disruptions in the functioning or work of the heart. If there are problems, not only the legs, but also the tongue can swell. Additionally, the girl can observe increased sleepiness, fatigue and constipation.

The reasons leading to edema are individual in each case. The problem may appear due to a sedentary lifestyle, the presence of joint diseases or prolonged sitting with crossed legs. To pinpoint the cause of the puffiness, experts advise mandatory visit a doctor.

Swelling of the legs during pregnancy

If the swelling is caused pathological changes occurring in the body, the condition of a pregnant woman can constantly worsen. Gradually, the problem will become noticeable not only on the legs, but also on other parts of the body. Experts distinguish four stages of edema:

The problem appears in the area of the feet and legs.
Gradually, the edema spreads to the thighs, lumbar region and lower abdomen.
Then the presence of the problem becomes noticeable and higher. Hands and face may be affected.
General body edema occurs.

If a girl is carrying a child, a lot of sodium salts accumulate in the body. They tend to attract water. Under their influence, edema is formed, which is classified as physiological. The factors leading to the occurrence of the problem may be:

the girl is eating too much salty food;
a pregnant woman gives herself excessive physical exertion;
the air temperature is too high.

Physiological edema is considered normal. If such a phenomenon occurs during pregnancy, it should not cause concern. If you get rid of the provoking factors, the problem will disappear instantly.

Pathological edema differs from physiological. They appear due to the presence of diseases. Usually the problem is accompanied by additional symptoms:

the girl is rapidly gaining excess weight;
edema gradually spreads to other parts of the body;
the girl is weak;
there are difficulties with movement;
hypertension is observed;
the temperature rises.

It is much more difficult to get rid of such edema. Only a doctor can determine the type of problem and develop a scheme for dealing with it. If a girl observes increased puffiness in herself, it is worth immediately contacting a specialist. Self-treatment fraught with additional health problems.

Why are swelling during pregnancy dangerous?

The danger that edema carries in itself directly depends on the cause that caused their appearance. The problem arising from physiological factors should not be a cause for concern. It is easily eliminated if you remove the cause of its appearance and, as a result, no longer worries.

The greatest concern during pregnancy should be caused by edema, which appeared due to gestosis. V initial stage the disease leads to the formation of dropsy. Over time, the problem can cause the appearance of nephropathy - damage to the renal apparatus, and in the future - to. This disease is almost incurable. It is characterized by frequent seizures. Sometimes they can be so strong that the girl runs the risk of falling into a coma.

Gestosis often causes a strong violation of the blood supply to the internal organs. The problem can also affect the placenta. As a result of the impact of the disease, the child ceases to receive sufficient oxygen and nutrients. This will affect the development of the internal organs and systems of the fetus. The condition in the future can lead to the occurrence in the child chronic diseases... Due to gestosis, premature birth or even fetal death is possible. Experts advise to seek immediate medical attention in the following situations:

swelling in the girl appeared not only on the legs, but also on the lower back, abdomen or arms;
swelling and a feeling of heaviness do not go away for a long time;
prolonged rest or sleep does not fix the problem;
the general condition of the expectant mother is deteriorating;
the appearance of protein in the urine;
pressure increases.

A girl should be able to distinguish edema from other problems. If the legs are swollen, this does not mean that swelling is taking place. Often this phenomenon is observed due to an increase in the total body weight while carrying a child.

The appearance of edema can be seen by the enlargement of the foot. The expectant mother will no longer fit into the shoes that she previously wore all the time.

You can also distinguish swelling from other problems by the reaction of the foot to pressure. To do this, experts advise to conduct a simple experiment. Press lightly with your finger on the skin in the area where the swelling is observed, and then release. If the cover immediately leveled off, there is no edema. If a small dent appears after exposure, there is a problem.

Symptoms usually become more noticeable in the evening. This is due to the fact that a lot of fluid accumulates in the legs during the day due to exertion. In the morning, the problem usually recedes. Such edema is caused by physiological reasons. The problem is not painful and should not be a cause for concern. In a different situation, you should immediately consult a doctor.

What to do? First steps

A girl can independently get rid of swelling of the legs during pregnancy if the problem is caused by physiological reasons. In this situation, she does not require special treatment. To help in the fight against it can be:

Herbal teas with a diuretic effect. They allow you to remove excess fluid from the girl's body. Such properties are possessed by tea made from dried apricots, lingonberry leaves, bearberry, wild rose, horsetail and cranberry. To positive effect became noticeable, you need to drink decoctions for at least a month. Chemical diuretics are strictly prohibited during pregnancy. They can negatively affect the condition of the fetus.
Reducing the amount of salt in the diet. The product prevents the elimination of fluid from the body. If there is swelling of the legs during pregnancy, it is better to undersalt the dishes. Smoked, spicy and spicy must be removed from the everyday menu. It is best to steam food.
Carrying out a foot massage. The impact helps to reduce puffiness. The effect of the massage can be enhanced if carried out with oil. grape seed, jojoba or peach.
Reducing the amount of fluid consumed. Particular attention should be paid to the volume of drinking c. Do not take more than one and a half liters of water per day. The volume should include not only drinks, but also soups, as well as juicy fruits or vegetables.
Usage homeopathic remedies... So, sodium chloride restores fluid exchange in the body. Manual therapy, osteopathy or acupuncture normalize blood circulation and improve urinary function. However, all types of influences should be carried out only after preliminary consultation with a doctor.
Reception of vaso-strengthening vitamin complexes... By acting on the body, they prevent the penetration of excess fluid into the tissues and minimize the likelihood of edema.

If the presence of pathology led to the appearance of a problem, treatment should be carried out strictly under the supervision of a specialist. So, gestosis is treated only in a hospital setting. Correctly selected drug therapy will reduce Negative influence diseases on the body of the expectant mother and child. Independent use drugs leads to an increased risk of problems with

Wear comfortable clothes and shoes. Can't be preferred too tight dresses or trousers. Shoes with heels should be excluded from the wardrobe during pregnancy.
Show sufficient physical activity... During pregnancy, you cannot constantly sit still. A girl should walk a lot, do daily exercises and perform special exercises... The following effect can help remove stagnant phenomena: you need to lie on a bed or on the floor, raise your legs, rest them against the wall and lie there for 10-15 minutes. The exercise is best done in the evening. At the same time, the blood will begin to flow down, and the swelling will decrease.
Avoid overheating. If a girl is expecting a child, from adoption sunbathing, it is better to refuse visiting saunas and steam rooms.
Follow a special diet. It is better to exclude carbonated, sugary drinks from the diet. The consumption of coffee and tea should also be minimized. It is better to undersalt the dishes. If you are very thirsty, it is better to eat a juicy vegetable or fruit or give preference to mineral water.
Include in daily diet vegetables and fruits that have a beneficial effect on urinary function. The list includes celery, orange, garlic, onion, lemon and tangerines.
When resting and sleeping, you should put a pillow under your feet. This will allow them to be slightly above their heads.

Gestosis, restriction of salt and fluid, Laman's diet, "diuretic herbs" and treatment of edema in pregnant women in the light of modern medical science.

They were afraid of fear where there is no fear (Ps 13: 5).

On business medical profession in Germany and Holland, I learned and highly appreciated one of the principles of teaching in these countries (teaching in general and obstetrics, in particular). This is “always doubt, check and don’t just trust anyone”. Not a textbook, not a teacher, not an authoritative magazine, not a luminary. Study the question yourself and make your own judgment. After all, there are libraries with books and magazines on different languages, Internet with forums and databases, there are excellent specialists and have their own common sense. Both in Germany and in Holland this is taught with school years... This develops independence of thought and the need for constant learning. If this is not the case, backward and false views and practices reign for decades.

This is what I mean. Unfortunately, in our Russian community, among obstetricians and parents, the habit of checking everything and keeping abreast of modern knowledge is not widespread. Many people also trust authorities too much. Just think: we still have doctors and midwives "treating" edema in pregnant women, believing that this is the very life-threatening gestosis and that by removing the swelling, they will help the woman. They seem to think excess fluid is at the root of the problem. Meanwhile, everything is just the opposite. The whole world has long known that edema of pregnant women is not dangerous and, as a symptom of pathology, are unreliable, that gestosis can be without edema, and then it is much worse, that limiting pregnant women in drinking, food and salt is not a therapeutic and prophylactic measure, but a dangerous measure, and therefore , prohibitive diets - not the case of pregnant bellies.

Why, in fact, should you believe it? That's right, you don't have to believe, you just need to understand the physiology. That is, to understand how the body works and how it works and by what mechanism the disease develops. Then you yourself will figure out what is good and what is bad.

Recently, a group of respected physicians reviewed the abstracts of 260 articles published in the American medical journal "Surgery, Gynecology and Obstetrics" for 1935-1999. It turned out that half of the "firmly established medical facts and theories for 45 years passed into the category of "mistakes of the past." Another study reviewed 474 abstracts of articles on liver disease published in the journals Lancet and Gastroenterology between 1945 and 1999. And here, too, over 45 years, half of the medical knowledge has turned out to be outdated. The famous British neurologist John Hughlings Jackson (1836-1911) once said: "It takes 50 years to expel a false idea from medicine, and 100 to establish a correct one." "Science and Life" 1/2007

Water is a key element of pregnancy

It is known that the human body is approximately 80 percent water. This means that water is the most important component of our body. At normal pregnancy even more water is collected, as much as 6-8 liters, 4-6 of which are outside the tissues of the body, and 2-3 - in the tissues. By the end of pregnancy, the baby, placenta and amniotic fluid... Another three liters is used to increase the mother's blood volume, to grow and enlarge the uterus and mammary glands. Such is the flood! Note: this is so arranged so that there is a lot of water. Whether someone likes it or not.

The volume of the liquid part of the blood begins to increase very early, from 8 weeks of pregnancy. But, for example, the number of red blood cells - only from 18 weeks. It seems that the accumulation of fluid is of paramount importance, since the body begins to do this so early. And the truth: after all, how liquid and fluid the blood is, so quickly it will be able to deliver nutrients for the growth of the child, uterus, and mammary glands. And fill in a whole new one vascular system blood can only if there is a lot of it.

However, it is not the mother's blood or plasma that fills the child's vascular system and the entire water space around him. Then where does the liquid come from?

The placenta is a key character in pregnancy

So, we come to the most important point in the physiology of pregnancy. From the mother's blood, everything necessary, and first of all water, extracts another main character pregnancy, about which little is known, is the baby's temporary organ called the placenta.

The placenta begins to form like this. Approximately on the 7th day after conception, passing long way on fallopian tube, the embryo ends up in the uterus. The embryo is a future child in a bubble, the shell of which is covered with villi. When the bubble is at the wall of the uterus, it first attaches to it with its villi, and then gets to work: with the villi it rebuilds the vessels of the uterus so that they become dilated, full-blooded, and around the villus itself they form a mini-pool of mother's blood, which is constantly and quickly renewed ... At the same time, the child's blood in the villus and mother's blood in the pool do not mix. It is similar to how a germinating seed absorbs water and everything necessary from the soil by its roots, but not sand, clay and other large objects. “You provide us with building materials, and we know what and how to build,” as if both the embryo-child and the seed of the plant say.

The seed takes roots from the soil only what it offers him. It cannot cause rain, turn an underground source to itself. Not so with the placenta: it is not a simple pump that pumps what is given. No, she, as Michel Auden aptly put it, is a "baby advocate" who, among other things, knows how to intervene in the physiology of the mother's body and "squeeze" out of it what the baby needs. And if the blood pressure (and it is provided by water) in the placenta and the child begins to fall, she will do everything to get the necessary fluid.

The placenta grows and develops, for its construction, nutrients from the mother's blood are also needed, and by 18 weeks its formation as a whole ends. That is, by the time the child begins to grow rapidly, there should already be a powerful, workable placenta.

So, let's remember two facts well. First, the amount of water in the mother's blood determines the amount of water in the child, as well as how well building substances will flow to him. Second: the placenta, as an active advocate for the child, in case of a shortage, will manipulate the mother's body so as to get enough food and water. Up to conflicts.

Two More Essential Substances - Salt and Protein

The reader already understands why a lot of water is needed for the normal course of pregnancy. Now, in order to understand where and how problems with the "water supply" can arise, we need to understand something else from physiology. Water for admission to the child must be in the blood, in the vessels (and not, say, under the skin, in tissues, body cavities). What keeps it in the vessels? Two substances, and pregnant women and obstetricians should remember them strongly: table salt and albumin protein. If there is a shortage of them, water will leave the vessels in the tissue, causing edema. Vessels in such a situation as hoses with holes: no matter how much water you pour in, you won't get the required pressure, and everything around is wet.

Albumin synthesizes mom's liver from the amino acids in the food mom eats. Therefore, it is important what she eats and how her liver works. Salt - comes with food, can be saved by the kidneys; salt metabolism is also regulated by some hormones. Remember from physiology that the volume of the liquid part of the blood begins to increase very early, from the eighth week? Now remember what pregnant women want at the same time: pickles, sauerkraut, herring, salted tomatoes.

Gestosis: dehydration and thickening of the blood

Now you have all the necessary data in order to understand what happens during gestosis. There is a conflict between what requirements the placenta places on the mother's body and what the mother can provide her without prejudice to herself. Three situations are possible:

my mother's body does not give enough nutrients and water, for example, with poor nutrition and insufficient drinking (including with non-physiological diets), with hepatic disorders, a defect in the vessels of the uterus or its wall, general diseases);
the placenta (it belongs to the child's body) cannot absorb enough of the same nutrients and water (the wrong structure of the placenta);
mixed version - both together.

The common thing for all cases is that with gestosis there is always (!) A lack of water and albumin in the bloodstream, that is, there is always dehydration and thickening of the blood. Due to the thickening of blood, the pressure in the vessels is insufficient, the blood does not flow quickly enough, and the placenta manipulates the mother's body, causing a narrowing, spasm of the vessels in her body in order to increase the blood pressure. The pressure increases, and at first more blood flows to the child. But this very spasm eventually damages the blood vessels. At the sites of damage, platelets and fibrin filaments - blood clotting products - are deposited. This, as well as the very thickening of the blood and the peculiarities of clotting during pregnancy, leads to the formation of blood clots (!) In the vessels throughout the mother's body. Particularly affected are those organs on which the load during pregnancy is increased: the liver and kidneys. Also, thickening of the blood leads to poor nutrition and hypoxia in the child. Good blood supply can be compared to skillfully organized traffic, poor - to the widespread traffic jams, when we say: "Yes ... the whole city is standing." Not that it is moving, but how ineffective! Good circulation is like good roads.

So, it is clear where the increase in pressure (attempts to preserve food for the child), edema (due to a lack of albumin, water goes into the tissues) and a large amount of protein in the urine come from during gestosis (damaged renal vessels miss what they should not). It is also clear that those who eat poorly and drink little, and those with large children, twins, triplets (due to increased needs) will be at risk. By the way, the fact that extensive physiological edema often develops in those women who carry large children - known fact... The first sign of preeclampsia may be an increase in the amount of hemoglobin in general analysis blood after 18-20 weeks of pregnancy. (Normally, hemoglobin should decrease slightly). The growth of the hematocrit index will be even more eloquent. Both of them will talk about blood thickening, that is, about a lack of water.

Diet for gestosis

Anyone who studies the mechanism of preeclampsia can easily deduce the necessary diet. Drink plenty of water (2 - 2.5 liters), eat more protein food(this is by no means only meat!), not forgetting about carbohydrates (because with a shortage of the latter, proteins are burned as fuel) and fats (they are both fuel and construction material, in particular for the brain of the baby). The diet should be balanced, one of the components should not prevail to the detriment of the other. Salt should not be limited because it retains fluid in the blood. Clear and logical.

The same applies to the diet for the prevention of preeclampsia, because while the placenta is forming, building substances are needed to form a "strong root system". If the placenta has already formed defective, then you need to place those few "roots" in a nutrient solution to make it easier for her to work. By any means - both natural and medicinal.

Medicines for gestosis

Treatment of gestosis - an increase in blood flow, an improvement in the child's nutrition, a decrease in critical high blood pressure at the mother. In this case, judge for yourself whether it is appropriate to give drugs that increase blood flow (for example, courantil, aspirin) without a prescription drink plenty of water? Is it possible to do with just droppers with saline and albumin without normal drinking and food? And if it is possible, then why?

Nowadays, it has also become known that calcium and magnesium preparations, as well as omega-3 and -6 fatty acids (fish oil, linseed oil and evening primrose oil). The benefits of these substances have been proven scientific research... We can easily understand why if we remember that gestosis is a conflict. Calcium is a building material for all cells, for bones, it is absorbed only in the presence of magnesium. Omega-3 and -6 fatty acids are building substances for the brain of a child, and nutrition of the brain in humans during intrauterine development is a priority. If the mother does not have enough of these substances, the placenta “demands” what is necessary for the child, which will result in a disturbance for the mother in her own body.

If the situation cannot be corrected by either diet or medication, if the child suffers from a lack of nutrition and oxygen, the mother suffers from hypertension and damage to the liver and kidneys, then the only way treatment - childbirth.

Swelling in pregnant women

Now let's return to the question of edema, because, as I said, it is the accumulation of fluid in the body ( rapid increase weight, edema) we take for manifestations of preeclampsia.

“There is no convincing evidence that significant fluid retention in the body or even the occurrence of obvious edema is a factor leading to the development of preeclampsia [preeclampsia. - VN] or require the patient to be assigned to the group high risk on the development of preeclampsia ". M. Enkin et al. Guidelines for effective assistance during pregnancy and childbirth, St. Petersburg, "Petropolis", 2003, p. 124

Based on the foregoing, it is clear that edema with gestosis can be. The concern should be especially caused by edema, which builds up quickly, spreading above the level of the legs, up to the abdomen and upper body. BUT!!! Edema, even with severe gestosis, may not be! In a woman suffering from gestosis (that is, knowingly dehydrated), the absence of edema is more dangerous, because water from the edematous fluid can return to the vessels if there is more salt and albumin, and without edema and with insufficient drinking, there is simply nowhere to take it.

It is important to note that with a combination of hypertension and edema or hypertension and accelerated weight gain in pregnant women, the incidence of intrauterine fetal death is lower than in the presence of isolated hypertension. Preeclampsia without edema ("dry preeclampsia") has long been known as an unfavorable variant of this pathology, accompanied by a higher incidence maternal mortality and fetal death compared with that in preeclampsia, combined with edema. M. Enkin et al. Guidelines for effective care during pregnancy and childbirth, St. Petersburg, "Petropolis", 2003, p.81

Gestosis almost never proceeds without an increase in blood pressure, this is the most important point... Usually, in addition to it, there is also protein in the urine (its amount is variable: either more, then less, then it is, then it is not). Swelling in modern clinical obstetrics is excluded from the criteria for the diagnosis of preeclampsia. Because too often they happen during pregnancy, and their presence or absence does not say anything about the severity of preeclampsia!

Let us also mention where different types of edema come from during pregnancy.

Considering the amount of water that normally accumulates during pregnancy, it is not surprising that swelling of the ankles and legs by the end of the term occurs in most women, especially at the end of the day. In the later stages, this is facilitated by the large uterus: it presses on the inferior vena cava and prevents the outflow of venous blood from the veins lower limbs... Most often, slight swelling of the legs is a sign of sufficient blood dilution.

Edema can also be of venous origin. In this case, they predominate on the legs, intensify with prolonged standing and walking, and are accompanied by a peculiar marbling of the skin of the legs. Often, such pregnant women in the family on the female line have varicose veins.

Another type of edema is constitutional. Women of hypersthenic constitution: short, plump, with roundness, small hands and feet, gain more weight than thin ones. If such a woman gains 25 kg during pregnancy, she will have significant swelling in her legs, but she will not have an increase in blood pressure, or an increase in blood hemoglobin, or protein in urine - this will mean that she has constitutional edema, no gestosis here and no trace of it.

All these edema of pregnant women (except for cases of gestosis) may not be aesthetic and unpleasant, but they are not dangerous - once; they do not cure dehydration (because it is dangerous) - two. I leave aside edema in congestive heart failure, in severe liver and kidney disease, thyroid gland and other pathology not related to pregnancy. Women usually know about the existence of such a pathology before pregnancy and are monitored by appropriate specialists.

Swelling is too common in healthy pregnant women to serve hallmark[preeclampsia - VN], so they are no longer considered as a diagnostic indicator of this condition. Williams Obstetrics, 22nd Edition, 2005

Water accumulation and blood loss

This is also why you should endure the flood that pregnancy brings with it, and not prescribe dehydrating drugs and diets: a woman will lose blood in childbirth. I'm not even talking about bleeding (although this happens), just about normal blood loss, after which you will have to recover.

Now call on common sense to help: which woman will better tolerate blood loss and recover faster: the one who has a lot of blood, or the one who has little? The one that was losing thick concentrated blood, or the one that was losing diluted blood? Which one will lose more form elements and nutrients?

A normally well-fed and not dehydrated woman tolerates even significant blood loss surprisingly easily.

Headaches and dehydration

First trimester headaches are almost as common as nausea. Very often they leave after the expectant mother begins to drink plenty of water, as well as eat enough protein and carbohydrate foods.

Diets of all stripes

Now it is necessary to briefly list all those restrictions on food and drink that are now imposed on pregnant women. The most common is what obstetricians-gynecologists still recommend in antenatal clinics: limiting salt (do not salt) and drinking (two glasses a day) with edema or rapid weight gain. We will not repeat ourselves, it has been explained above why this recommendation should be considered outdated and anti-physiological.

There is a smaller recommendation so that the child is not “fed”, since little kid it's easier to give birth. Usually given in conjunction with advice to drink less so that there is no edema. This belief contradicts physiology and is fraught with disturbances in water metabolism and nutrition in the mother and child. Already in the 1930s, several special diets to limit the weight gain of the child (for example, the diet of Dr. Prokhovnik with limited drinking to 300-400 g and others). At the same time, they refused to use such diets, as "their effect is doubtful, and compliance is difficult." And, let us add, it is not useful, and for some it is dangerous.

Diet to prevent allergies in a child. Research shows that prescribing an allergen-free diet does not significantly reduce the risk of having an allergic baby. Such a diet can adversely affect the nutrition of the mother or baby in the womb.

Fast. Religious fasts have no (or should not have) the goal of causing exhaustion or illness. If mom can carefully plan her meals so that she gets everything she needs from lean food, then let her fast. In practice, we, obstetricians, often see a large family with a mother who gives birth and feeds continuously, and they all eat sandwiches and cereals, cookies, bread and sweets. Unfortunately, eating disorders in religious families is the rule rather than the exception. It is not surprising that pregnancy and childbirth are sometimes difficult, and postpartum recovery takes a long time.

Laman's diet. This new Moscow trend is a kind of dry eating. The diet consists in not drinking water, but only bound liquid (the one found in vegetables and fruits, juices and other foods). In plain text, it is to make it difficult for the body to access water. It should be noted here that the German naturopathic physician Heinrich Laman, who lived and worked in the late 19th and early 20th centuries, introduced 5 different diets for patients with various diseases. I have not been able to find data on him recommending his diets to pregnant women. Most likely, given the great popularity of this doctor, Russian doctors recommended to edematous pregnant women the Laman diet with dry eating according to the principle "what if it helps?" The swelling, of course, decreased. The possible consequences of such dehydration were mentioned above. At the beginning of the twentieth century, doctors did not know enough about the physiology of pregnancy, about where edema comes from and how they are associated with gestosis. And we know. Therefore, the appointment of the Laman diet to pregnant women seems to us anti-physiological, and for the unhealthy and malnourished, it is dangerous.

Self-adherence to a diet with the goal of "not gaining weight, not getting fat." The goal is good. But the remedy should only be such that the provision of mother and child with proteins, healthy fats and carbohydrates were complete. In order not to gain weight, you need to limit refined sugars, white flour products, store-bought baked sweets, animal fats and exclude trans fatty acids. And choose foods with a low glycemic index. And move for at least an hour every day. That's all. You need to eat well and enough. We want healthy mom and baby, not wasp waist immediately after childbirth?

The use of diuretics. Diuretics for pregnant women with edema are now rarely prescribed and only by those obstetricians who are completely unaware of modern scientific data. But the appointment of "diuretic herbs" is widespread and ubiquitous. They use bearberry lingonberry leaf... It may be less dangerous than pills, but in this case completely "at the wrong address."

A little philosophy in the end

The doctor and midwife, as well as most pregnant women, know that pregnancy is not a disease, but one of natural states... Therefore, all of them should be primarily interested in three natural questions:

lifestyle of a pregnant woman;
by what she eats and drinks;
whether she is happy, and if not, why.

And only then delve into everything else. Because ninety-five percent of the problems in ninety-five out of a hundred pregnant women will grow from these three areas. Because sometimes everything is very simple and you just have to ask: “Have you tried eating? And drink? " Obstetricians and parents will be helped by the image of a flower. What does he need to "prosper"? The same is true for a pregnant woman and a child. Soil (food), watering (water), sun (sunlight and love), air, loosening (movement), weeding (physical and mental hygiene).

And what categorically should not be done by a professional who is called upon to help a pregnant woman is to "load" her - with her fears, false ideas, unnecessary treatment. And especially dry eating!

Why, in fact, the reader, you have to believe me? You don't owe anyone anything, including public health. Believe it or not. Better yet, check it out. Do your own research on the subject (I provide sources below for your convenience). I wish you fruitful research work - both in this case and in all others!

Glossary of Medical Terms:

Hematocrit - the ratio of the volume of blood corpuscles to the volume of plasma; gives an idea of the total volume of red blood cells, characterizes the degree of thickening or dilution of blood.

Arterial hypertension (hypertensio; hyper- + lat. Tensio tension) - increased hydrostatic pressure in the arterial vessels of the body. In everyday language, it is called hypertension.

Trans fatty acid isomers. Fatty acid isomers are organic acids that have the same chemical formula, but differing in the spatial arrangement of individual atoms (that is, geometry). In the structure of trans-dimensions, hydrogen atoms are located along different sides from the double bond "carbon-carbon", in the structure of cis-isomers - one each. For this reason, the chains of the cis-isomers of poly- and monounsaturated fatty acids are bent, the chains of the trans-isomers are straight. The geometry of the molecules affects their biological function.

The glycemic index of a food is a measure of its ability to raise blood sugar levels. Foods with a high glycemic index (such as sugar) provide rapid rise blood sugar levels. They are easily digested and absorbed by the body. Foods with a low glycemic index (such as cereals) raise blood sugar more slowly because the carbohydrates in these foods are not immediately absorbed.

Gestosis (preeclampsia) is the general name for conditions caused by pregnancy, accompanied by high blood pressure (hypertension), the presence of a significant amount of protein in the urine and sometimes edema. Gestosis can manifest itself in the second half of pregnancy and in the first week after childbirth (mainly during the first 48 hours). Severe forms are accompanied by seizures (eclampsia).

Reference materials:

Murray Enkin, Mark J.N.S. Keirs, Mary Renfrew, James Neilson / Ed. Murray Enkin. A guide to effective care during pregnancy and childbirth. Third edition. Per. from English SPb .: "Petropolis", 2003.
Williams Obstetrics. - 22nd ed. / F. Gary Cunningham et al. - McGraw-Hill Medical Publishing Division 2005.
Oxford Handbook of Midwifery. Edited by Janet Medforth, Sue Battersby, Maggie Evans et al. Oxford University Press 2006.
Anatomy and Physiology for Midwives by Jane Coad, Melvyn Dunstall, second edition, Churchill Livingstone 2005.
V. Shtekkel Fundamentals of obstetrics. Per. from German. State Medical Publishing House, Leningrad, 1933.
Ann Frye, Understanding Diagnostic Tests in the Childbearing Year. 6th ed Labrys Press Publishers, Oregon 1997.
Discussion Club of the Russian Medical Server http://forums.rusmedserv.com/archive/index.php/
Wikipedia. http://en.wikipedia.org/wiki/Heinrich_Lahmann

About the author: Veronika Nazarova (Maslova) - family doctor, obstetric practice for 19 years, representative of the international obstetric organization Midwifery Today in Russia, scientific editor of the Russian translation of Dr. Michel Auden's books "Caesarean Section" and "Scientific Cognition of Love".

As a postscript

I would like to highlight one of the questions that came in response to this article.

Yes, the article really stands out. My doctors panicked when edema began (at week 27) and immediately diagnosed preeclampsia for early stage... They are going to treat them like everyone else and in the light of the fact that I had acute pyelonephritis before pregnancy ... now they are afraid ... and I do not know what to do - listen to them or not ... ???

Let me once again highlight the accents in the topic of "Gestosis". Real gestosis, which is dangerous for the health of the mother and the baby, is the problem of the placenta! Is it wrong or underdevelopment placenta! And the placenta refers to the body of the child. Gestosis is not a problem of blood vessels, kidneys or mother's psyche! If a mother has or once had a kidney disease, then it does not automatically follow that she will have gestosis. And yet, remember, please: edema is excluded from the signs of gestosis in modern medicine... Because they may not have anything to do with gestosis, and on the other hand, with severe gestosis, they may be absent.

Look at a plant: what is the reason why it can grow very poorly? Either its root is initially weak and poorly developed (this is a problem of a plant, that is, a child, and there is nothing to be done about it, it is necessary to save), or the soil and watering are bad (this is a problem of the earth, that is, mothers, the soil can be fertilized, loosened and watered ). And can the root of an initially healthy plant develop poorly due to malnutrition... Yes! If mom has serious illnesses vessels, kidneys, liver, if she smokes, eats and drinks almost nothing, this can provoke the development of preeclampsia. Because the placenta, this advocate of the child, requires nutrition at any cost, even at the cost of the mother's illness. And can there be gestosis because the child is large or the mother has twins? Yes, if the mother's body cannot provide the children with enough nutrition without harming itself. Is it clear from this how important it is to eat healthy and well and not smoke? However, I will repeat once again: severe gestosis is a congenital defect of the placenta, it cannot be cured by nutrition or medication, you need to give birth to a child and take care of it “outside the mother”. But a lot of variants of "gestosis" due to poor nutrition of the mother are treated easily and quickly - name this method of treatment yourself.

From what you write, it is difficult for me to conclude whether you have gestosis or not. What kind of swelling did you start: swelling of the ankles (normal) or swelling of the legs, abdomen, face (bad)? Is the child growing well (the norm), or is he moving, “beating” almost constantly (badly)? Does the hemoglobin level fall ( good sign, he speaks of a sufficient amount of blood in the vessels)? Really serious signs of preeclampsia are: increased blood pressure (without this, there is almost never gestosis, I wrote about the level of its increase earlier), the appearance of protein in the urine and growth retardation of the child. If, despite your excellent nutrition and healthy lifestyle, there are bad signs, doctors are really worried about business. If there are no bad signs, do not worry, do not pay attention to the diagnosis, just check your pressure and urine regularly. Under any circumstance - eat right, drink a lot, move and tune in for the best!

Pregnancy is a time that is filled with pleasant impressions and hopes. Pending little miracle expectant mothers attend special courses, buy dowry for crumbs, study useful information... Unfortunately, not always the most wonderful period in a woman's life goes smoothly. Sometimes complications arise during it, for example, swelling of the legs during pregnancy. You should not panic about this. If a pathology is found, you should immediately consult a doctor and follow his recommendations.

Why swelling of the legs occurs during pregnancy

Most expectant mothers face edema during pregnancy. The reasons that cause this phenomenon, are different. They can be both completely harmless and quite serious.

When carrying a baby, the need for water increases. Besides, hormonal changes makes a woman thirsty. The pregnant woman begins to consume large amounts of fluids. Water builds up in the body, causing swelling. As a rule, this occurs already in the second half of the term and does not require treatment.

The body of the expectant mother works "for two." This increases the stress on the kidneys, liver, thyroid, intestines and heart, which leads to various malfunctions. So, if the kidneys do not cope with their work, then the woman, as a rule, finds bags under the eyes, as well as problems with urination. Diarrhea indicates a malfunction in the intestines. When the thyroid gland is abnormal, the legs, tongue and shoulder girdle usually swell. In addition, during pregnancy, the uterus grows, increasing pressure on the internal organs. This sometimes causes varicose veins and swelling of the lower extremities.

Also, an unpleasant condition can lead to: the presence excess weight body, long-term wearing uncomfortable shoes, the habit of sitting cross-legged, a sedentary lifestyle, the abuse of salty foods, excessive physical activity.

Often, other painful sensations inherent in any pathology join the edema. That is why a woman should be sensitive to her body. If the swelling is accompanied by redness of the skin, pain, especially in the legs or in one of them, for example, in the left, then this may indicate the onset of thrombosis.

It is rather difficult to say unequivocally whether edema is a danger during pregnancy. In each case, a specialist consultation is necessary to determine whether given state the norm or requires immediate treatment. One of the most serious pathologies is gestosis, in which not only parts of the body swell, but also other internal organs, for example, the placenta. It is important to recognize this disease in time and consult a gynecologist.

Identifying leg edema during pregnancy

Swelling can be suspected by the following:

Weight gain was more than 300 g per week.
The ring has become more difficult to remove from the finger.
Shoes, which were recently on time, began to crush.
The shin girth has increased by more than 1 cm per week.

On routine inspection the doctor is obliged to control the weight of the pregnant woman. Excessive increase in body weight may be a sign of gestosis, which requires treatment. This pathology is easy to confirm by detecting high blood pressure in a woman and detecting protein in the urine. Sometimes, to clarify the diagnosis, it is necessary additional examinations and ultrasound diagnostics.

Treatment of edema during pregnancy caused by gestosis

The doctor who identified gestosis in the expectant mother will prescribe treatment for her or give her a referral to the hospital. You should not refuse hospitalization, since its need usually indicates the severity of the pathology. Gestosis can lead to eclampsia, a disease in which blood pressure rises greatly, which poses a threat to a woman and her baby. If the pregnant woman is under medical supervision, then this practically reduces the likelihood of adverse consequences to zero.

Gestosis is one of the causes of edema

For the treatment of gestosis, medications are shown that reduce blood pressure and seizures, as well as improve blood circulation. Taking these medications contributes to the birth of healthy child... As a rule, women who have been diagnosed with this pathology are recommended to give birth by caesarean section.

Prevention of leg edema during pregnancy

While carrying a baby, not all mothers want to take drugs. Hence, swelling is better prevented than treated. To do this, you can do the following:

wear special tights;
while resting (including at night), put a pillow under your feet;
give up shoes with heels;
avoid prolonged exposure to heat;
periodically do foot baths with cool water;
walk more often in the fresh air.

In the first half of the term, consume about 2 liters of liquid per day, from 20-22 weeks, limit its amount to 1.5 liters per day (taking into account first courses, fruits and vegetables), after 30 weeks (with normal course pregnancy) drink no more than 1.2 liters of water and other drinks per day, and in the presence of complications, follow the recommendations of the gynecologist.

Swelling when carrying a baby is not always a sign of any pathology. In most cases, they are natural and do not need treatment. Your doctor may recommend lifestyle and dietary adjustments.

During pregnancy, it is best to play it safe and follow the instructions of a specialist. This will help prevent complications, carry and give birth to a healthy baby. Edema in the first half of the term deserves special attention. If they are identified, you must immediately contact your gynecologist.

Edema is an excess accumulation of fluid in the interstitial space of any part of the body. During pregnancy, the amount of fluid circulating in a woman's body almost doubles, since it is contained in amniotic fluid, the placenta, and is also needed by the growing baby and his circulatory system... At the same time, water-salt metabolism changes (sodium accumulates in the vessels, which delays the excretion of fluid), and the growing uterus presses on the vessels and organs, which slows down blood circulation and promotes fluid retention. On top of all this, the change hormonal background during this period, it causes a feeling of thirst, which also leads to edema.

Edema as a syndrome accompanies many diseases of various organs and systems of the body: endocrine, cardiovascular, renal and other inflammatory processes.

Edema (especially large) is not just a symptom that looks unaesthetic and gives discomfort. They can be quite dangerous. Because of severe swelling mothers, the child may experience hypoxia (oxygen starvation), and the expectant mother herself may suffer from edema of internal organs and, as a result, disruption of their work. Edema can also be one of the symptoms of gestosis - a condition, with a severe degree of which the question may even arise about premature birth... Therefore, the appearance (and even their possible appearance) is important to track at the earliest stage.

However, sometimes even severe edema does not bother a pregnant woman, and her health remains satisfactory. Even in such a situation, it is better to consult a doctor, since in more than 90% of such cases, the condition worsens (protein appears in the urine, blood pressure rises) and turns into gestosis.

As a rule, edema begins to bother the expectant mother from about the 30th week (and with gestosis - from the 20th week) of pregnancy.

Severe edema can accompany pregnant women expecting twins or simply carrying a large fetus.

Hidden edema during pregnancy - what is it?

It seems that puffiness is always an obvious problem. However, this is not entirely true. In addition to obvious edema, there are so-called hidden (edema of internal organs and tissues). An obstetrician-gynecologist who is observing you can help you find them by performing several examinations:

Weighing regularly. Very often, hidden edema is indicated by too much weight gain - more than 300 g per week.
Regular measurement of leg circumference. Complicated latent edema is indicated by an increase in the circumference of the lower leg by 1 cm or more (measurements are taken once a week).
Research indicators daily urine output... Diuresis is the volume of urine produced over a specific period of time. It compares the amount of liquid that was drunk with the volume of urine excreted. Normally, 3⁄4 of all liquid drunk is released per day (this includes water, and other drinks, and fruits, and soups).

As a rule, the doctor can find out whether a woman is prone to edema in the first weeks of pregnancy. He receives information about this from the examination of the patient, the study of her constitution, heredity, medical history, as well as from a blood test for biochemistry. The sooner it is known whether you may have edema, the sooner you can take measures to prevent it.

Physiology and pathology of edema during pregnancy

Edema can be physiological and pathological. Physiological edema usually does not cause complications and gives the pregnant woman only a feeling of dissatisfaction with her appearance... Their origin is due to the fact that the growing uterus compresses the vessels - this prevents the normal outflow of blood. The uterus also presses on the ureters, which causes fluid retention during pregnancy and, as a result, swelling. Physiological edema can also be associated with the constitution of the pregnant woman herself - in women short stature and with increased body weight, they occur more often.

Pathological edema, as a rule, accompanies gestosis ( late toxicosis) Is a complication of pregnancy that can occur in the third trimester. Its symptoms are high blood pressure, urinary excretion of protein (normally absent), nausea, vomiting, headaches, convulsions (eclampsia), fever, drowsiness, or, conversely, strong arousal plus severe edema. However, gestosis may not be accompanied by edema, and such a "dry" gestosis is considered a more severe case. Also, gestosis is not necessarily accompanied by all of the above symptoms. The most dangerous thing is the presence of seizures. In any case, gestosis almost always requires the help of a doctor and the presence of a pregnant woman in a hospital. The sooner you start treating it, the less likely it is that it will become severe.

Swelling of the legs during pregnancy

Swelling of the legs during pregnancy is the most common type of edema. They are especially troubling for those who spend a lot of time on their feet, or just after a long walk. Swelling is usually visible on the feet and legs. At the same time, favorite shoes become small or press hard. It is important to choose one that will not cause discomfort, made of well-stretched materials, so that it is comfortable to wear in the afternoon. It is also worth abandoning high heels, preferring short and stable ones. If you are concerned about leg swelling during pregnancy, try to avoid long walks, stay on your feet for long periods of time, lie down at home and lift your legs up, and massage your feet regularly.

Swelling of the hands during pregnancy

Swelling of the hands during pregnancy, as a rule, appears in those women who work at a computer, do handicrafts and any other monotonous work - fluid stagnation is formed due to monotonous movements. In this case, it is necessary to regularly do gymnastics for the fingers. Also, starting from the second half of pregnancy, doctors advise not to wear rings on your hands. If you do not remove them in time, you can wait for such a degree of puffiness, in which it will be very difficult or impossible to remove them.

Facial swelling during pregnancy

Swelling of the face during pregnancy is easy to notice - the face becomes round and puffy. Puffiness of the eyelids causes particular discomfort, bags appear under the eyes. This is due to specific anatomical features eyelids - in this area there is loose fiber, which strongly absorbs liquid. You can reduce swelling on the face by observing general rules for the prevention of body edema.

Swelling of the nose during pregnancy

The nose may swell as a result of general swelling of the face, as well as due to possible allergic reactions, which during the period of expectation of the child are greatly exacerbated. It is advisable to avoid nasal congestion and swelling, because breathing problems make it difficult for oxygen to reach the baby. You can eliminate edema with drops, but do not forget that pregnant women are prohibited from using whole line from the usual drugs, so it is better if the medicine is prescribed to you by a doctor who knows exactly what drugs are allowed.

Prevention and treatment of edema during pregnancy

Pregnant women with edema are given increased attention at the stage of reference in antenatal clinic... The expectant mother is regularly weighed, blood pressure is measured and kidney function is monitored using urine tests. Everything is aimed at the prevention (prophylaxis) of complications. Tips from doctors:

Set up food. Eliminate fried and smoked (food prepared in this way has a bad effect on vessels), boil meat and vegetables, steam, bake. Food must contain enough protein (to avoid its deficiency, which can occur with gestosis). It is also better not to eat fatty, spicy, pickled, sweet foods, baked goods. But low-fat broths, cereals, fruits and vegetables should be eaten regularly. For the prevention of puffiness, it is useful to carry out and fasting days, but without getting carried away, no more than once a week and always after consultation with the doctor.
Limit salt intake (ideally 1–1.5 g per day). It contains sodium, thanks to which it retains fluid in the body. It is important not only to undersalt (or not salt at all) food during cooking, but also to remove pickles from the diet, sauerkraut, herring, chips, crackers, sausages and sausages, canned food.
Drink more. Adequate amount of fluid will speed up the water-salt metabolism in your body. If you drink a little, you can bring the body to dehydration, which is no less dangerous. It is worth drinking up to 1.5 liters of water per day (not counting soups, compotes), and drink most of the liquid before lunch, leaving less for the evening. It is better to drink not in large glasses, but in small sips, often, but little by little. However, you should not abuse the liquid either - this is fraught with the appearance of even greater puffiness. You can drink not only water, but also juices (preferably unsweetened and freshly squeezed), fruit drinks, tea with milk. At the same time, it is better not to get carried away with black tea and coffee, they can affect blood vessels and pressure. Green tea also not as useful as many believe: it contains a large amount of caffeine and can also affect the state of blood vessels. You can drink no more than two cups per day. Forget about soda, all the more sweet. In addition to fluid retention, it also provokes heartburn. If you are going to start drinking so-called diuretic teas, be sure to consult your doctor - not all such drinks can be beneficial, and you need to take them very carefully.
Move and do gymnastics as you can. With active movements, the risk of edema is reduced by half. Engage special gymnastics for pregnant women, yoga, visit the pool. The main thing is not to overdo it and do as much as you can. The load should be uniform and dosed.
Let's rest our legs. Try not to stand still or walk for too long. If you are sitting, place your feet on a stand or stool. At the same time, it is categorically impossible to sit with one leg over the other. When sitting for a long time, about once an hour, do gymnastics of the feet - twist them in different directions. Get up alternately on your heels and half-toes. Do not sit in one position for a long time. Lying down, place a roller under your feet. Do cool foot baths and massage.
Try not to stay for a long time in the heat or in stuffy rooms.
Wear special compression garments as recommended by your doctor. Swelling of the legs may be accompanied by varicose veins. The phlebologist should deal with the treatment of this problem, he will also appoint you underwear of the required degree of compression. The main thing is to choose it by size, it should not press.

Edema is a symptom that accompanies almost every pregnancy. Small swelling is almost inevitable, but there is nothing dangerous about it. Therefore, there is no need to worry. The main thing is to show responsibility in time and not forget about the rules of their prevention, so as not to bring it to a severe degree. At the same time, after childbirth, the edema disappears quickly enough, because the woman's body leaves about 8 liters of excess fluid. And you will quickly forget about this problem.

Signs of edema: when to see a doctor

The easiest way to tell if you have swelling or not is to press your finger on your skin. If there is no edema, not a trace will remain on the skin; if there is, you will see a fossa that will level out rather slowly, and the skin itself becomes pale and tense with edema.

A slight swelling will not harm the pregnant woman, however, there are signs that, having noticed, it is better not to hesitate to see a doctor:

Sharp weight gain. If you gain more than 300 g in a week, this speaks of severe edema and a large number excess fluid in the body.
Manifestation of edema in the morning. As a rule, puffiness is temporary and worsens in the evening, and in the morning there are no traces of it. If she bothers you in the morning, it means that she can go to a dangerous degree.
Burning, tingling, and numbness of the toes and hands. This is due to the compression of the nerves. With severe edema, difficulties in bending the fingers may also appear, and it becomes painful to step on the legs.
Shoes press and become tight, rings can hardly be removed from the fingers or do not come off at all.
Great rounding of the face, swelling of the nose and lips.
Rapid heartbeat, shortness of breath, increased blood pressure.