Pregnancy. Signs and course of pregnancy. The body of a pregnant woman. A course of lectures during pregnancy from a to z

Pregnancy is a wonderful state that completely changes a woman's life for the next 9 months. Normal pregnancy lasts 38 weeks from the date of conception, or 40 obstetric weeks from the date of the last menstruation. Every woman, even before a visit to the doctor, can determine pregnancy at home with the help of. Seeing 2 cherished stripes, the expectant mother has a huge number of questions, the answers to which you can find in this section:

• - this is the first thing expectant mothers have to face. Pain in the lower abdomen may be a physiological phenomenon that does not require medical attention, or indicate the threat of spontaneous abortion.
• - with the onset of pregnancy in the body of the expectant mother, the hormonal background changes, which can lead to increased discharge from the genital tract. Sometimes abundant vaginal discharge during pregnancy may indicate the presence of thrush or other serious diseases;
• - the diet of the expectant mother should be as useful and balanced as possible, because the health of the woman herself and the fetus growing in the womb fundamentally depends on this;
• - another exciting future mothers question. At the first sign of a cold, a woman previously took the usual remedy, and everything went away, however, during the period of bearing a baby, taking certain medications can lead to serious anomalies in the development of the fetus and spontaneous abortion.

Many future mothers, having registered with the antenatal clinic, are perplexed why they need to take blood tests so many times and what this will show. allow the doctor to monitor the state of the work of the internal organs of a woman and, with the slightest deviations from the norm, to conduct adequate treatment.

They pose a threat to the health and successful development of the fetus in the womb. The immune system of the expectant mother is weakened and cannot resist viruses and microbes, so it is very important to follow all kinds of preventive measures so as not to expose the developing pregnancy to unjustified risk.

You can use, and many other useful services.

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Usually pregnancy lasts from 266 to 294 days, and childbirth - no more than 18 hours. But there are less common facts about pregnancy and childbirth…. They break stereotypes and inspire optimism even in the most restless.

Count until birth

In Korea, the age of a person includes 9 months of intrauterine life, and in India, the day of conception is considered a birthday.

Smarties and smarties

Some research suggests that children conceived in the fall or winter tend to have high IQs. So, the kids planned in spring and summer are leading in other indicators!

Weight doesn't matter

Parents of newborns tend to worry if the baby's weight does not match. Meanwhile, the smallest girl, and her twin sister, already go to school and do not differ from their peers. Twins weighing 260 and 600 grams were born in 2004 at Loyola University Medical Center, Illinois.

Do you consider those born with a weight of more than 4 kg to be heroes? Obstetrics knows the case of the birth of a child weighing 10.2 kg (height 76 cm)! The event took place in 1955 in Italy.

... and calendars lie

The actual date of birth coincides with the estimated date only in 10% of cases. Scientists have proven that it is not scary if childbirth begins a little earlier or later than the period set by the doctor (within the normal range, of course).

They are real!

For those who have medical indications for a caesarean section, it is useful to know that every third child appeared to the world in this way.

Don't need DNA

Moms take note!

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Everything will be but not immediately

Thanks uncle

The life of Pablo Picasso was saved by a case, outrageous by modern standards. The fact is that the midwife considered Pablo stillborn and was about to tell his mother. Meanwhile, the cigar-smoking uncle blew smoke into the baby's face, causing the future genius to make a displeased grimace and utter his first cry.

Children of the sea

The concentration of salt in the amniotic fluid is equal to the concentration of salt in the waters of the ocean. There are many explanations for this, including the confirmation of some theories about the origin of mankind.

For one push...

... a resident of Great Britain gave birth to a healthy daughter. After the discharge of amniotic fluid, the path of the baby to the world took only minutes. Both the husband and the obstetricians were surprised. The weight of the baby was 3500g.

There is no limit to motherhood

How many can you give birth? The question is rhetorical. So far, Elizabeth Greenhill from Abbots Langley, Hertfordshire, UK, is considered to be the mother of the record. She gave birth to 32 girls and 7 boys! And that was in the 17th century...

Expectant mothers and fathers, even when planning a pregnancy, should know the basic information about this important stage of life. Pregnancy and childbirth are difficult periods for both spouses. The better prepared you are morally and informationally, the happier the moment of the birth of your child will be. We read online magazines on our portal for free, on various topics, including a magazine for expectant mothers.

Preparing for pregnancy

To conceive a child should be prepared in advance. Both spouses should lead a healthy lifestyle, give up alcohol and smoking, play sports.

Eggs have been in a woman's body since birth. Therefore, any disease, from childhood, in one way or another, affects the future generation. The spermatozoa of men mature in 72 days, but even during this time they manage to subject them to various negative actions.

If you want to have healthy kids so that your pregnancy and childbirth go smoothly, prepare seriously for conceiving a child:

• pay attention to the general level of health of both spouses,
• Get tested for infectious diseases.

If you are healthy and there are no infections, then it is almost certain that pregnancy and childbirth will proceed as expected.

All about pregnancy

For a woman, for all nine months, a daily regimen should be observed that will be most comfortable for her.

• Sleep required- at least nine hours.
• To make the pregnancy go well, you need to try avoid stressful situations and worries. Your loved ones should take care of this. Read our section.
• Mandatory walks- preferably away from polluted streets, in parks, squares, gardens. During this period, the body requires an increased amount of oxygen.

Many pregnant women try to minimize physical exercise. It is not right. They are needed, but dosed, recommended by the doctor in whom the woman is observed. Swimming, special exercises, yoga, Pilates are of course within the normal range for pregnant women. Childbirth will be much better if it is developed.

Especially carefully you need to monitor your condition for women who have not yet gone to and work.

• Constant, unchanging postures
• work with heavy lifting, with toxic materials,
• at high humidity or low and high temperatures - are contraindicated for pregnant women.

Indeed, in the future, all these negative factors can affect how the birth will go and, as a result, the condition of the child.

It is possible, and even necessary, to do feasible housework - cooking and cleaning (without tilting and without using chemicals).

And, of course, any magazine for expectant mothers, or a blog, will remind you that during the period of bearing a baby, you should forget about all bad habits - alcohol and smoking, not to mention drugs. All this can lead to sad consequences - premature birth of a child, placental abruption, etc.

Everything about pregnancy should be told to you by your attending physician.

If you need more information:

• go to our;
• open numerous sites dedicated to these issues;
• read blogs where accomplished moms share their advice.

1 week of pregnancy is a conditional period that starts from the first day of the last menstruation before carrying the baby. This is the period of preparation of the mother's body for the fertilization of the egg. For each woman, ovulation (the release of an egg from the ovary) occurs on different days of the menstrual cycle, and that is why, for the accuracy of calculations, obstetricians consider the gestational age from the first day of the previous menstruation.

Second week of pregnancy

Your body is now ready to carry a baby. There are changes in the ovaries: a dominant follicle has already formed, and it is during this period that ovulation occurs - the release of an egg ready for fertilization from the follicle. You may feel pain in the lower abdomen, mild discomfort. It is the period of ovulation that is most favorable for fertilization.

Third week of pregnancy

The 3rd week of pregnancy is the period when two cells - the egg and the sperm - give rise to a new life. Fertilization has just occurred, but absolutely all the unique signs of your baby have already been laid: facial features, hair and eye color, even his character. The fertilized egg begins to divide, forming a blastocyst. You still can’t know for sure if the pregnancy has come, but the baby is already starting to develop inside you!

Fourth week of pregnancy

At the 4th week of pregnancy, the most important process takes place - implantation. The blastocyst is fixed in the endometrium, villi begin to form, with the help of which the embryo will receive nutrients through the placenta. The process of cell division and embryo formation continues. Already now you can feel the subjective signs of pregnancy - nausea, dizziness, increased drowsiness, sometimes - abdominal pain.

Fifth week of pregnancy

5 weeks of pregnancy is the period when you can probably already find out that you are pregnant! During this period, you would normally begin menstruation, and its delay may indicate the development of pregnancy. The level of hCG has already increased in the body, and if you take a pregnancy test, you will see the treasured two strips. At this time, germ layers have formed, the laying of the most important organs and systems begins.

sixth week of pregnancy

At the 6th week of pregnancy, the head of the embryo is already determined, the formation of arms and legs begins. The intestinal tube is laid, the formation of the excretory system, endocrine glands begins. The neural tube develops, and the heart already has four chambers. On the ultrasound, you can already clearly trace the heartbeat. In the body of a woman, hormonal changes occur, signs of toxicosis may appear.

seventh week of pregnancy

At 7 weeks pregnant, your baby is already the size of a pea! Fingers begin to form on his arms and legs, and the eyes, nose, and mouth are visible on his face. The sex glands are formed, then the nervous system develops, the digestive tract is transformed, and the development of the respiratory system begins. The musculoskeletal system is being laid (so far in the form of a cartilaginous skeleton).

eighth week of pregnancy

At the 8th week of pregnancy, the embryo is already called a fetus. The placenta is developing, and now the baby will receive all the nutrients through it. The baby is still quite tiny, but already resembles a little man. Arms, legs are formed, the face is drawn. The active development of the nervous system continues. You may experience mood swings due to fluctuating hormone levels.

Ninth week of pregnancy

The 9th week of pregnancy is characterized by the further formation of the central nervous system: two hemispheres of the brain have formed, the cerebellum is being formed. The arms and legs of the fetus thicken, muscles develop. Between the fingers the membranes disappear, the back of the baby gradually straightens. Mom may notice that the usual clothes have become a little tight at the waist, but others do not notice the changes in your condition yet.

tenth week of pregnancy

At the 10th week of pregnancy, all organs are already laid, and then their improvement takes place. The most difficult and most dangerous period of pregnancy is coming to an end, when any negative factors (even acute respiratory infections, medication) can disrupt the normal process of fetal development. The placenta is fully formed and actively functioning. The development of nerve endings begins.

Eleventh week of pregnancy

At the 11th week of pregnancy, the baby can already respond to external stimuli, his movements are becoming more and more distinct. The kid can already clench his hands into fists. Usually at this time, the expectant mother notes that the signs of toxicosis are decreasing. The uterus is growing in size, and you begin to feel it. Hormone levels stabilize, you become more emotionally stable. .

Twelfth week of pregnancy

A baby at 12 weeks pregnant looks more and more like a person, but his head is still larger than his body. The eyelids have already formed, and there are marigolds on the fingers. The kid knows how to open and close his mouth, squint. The urinary system is well developed, and the fetus can already urinate. You feel better, and the tummy begins to noticeably round. .

Thirteenth week of pregnancy

Behind the first trimester of pregnancy. You have probably already registered, done all the necessary research. The fetus at the 13th week of pregnancy already has the laying of milk teeth, the synthesis of insulin by the pancreas begins. The active growth of the body begins, and soon the baby will become more proportional. The musculoskeletal apparatus of the fetus is actively developing. Important processes accompany the development of the digestive tract - intestinal villi are formed. .

Fourteenth week of pregnancy

The 14th week of pregnancy is the beginning of the most pleasant and, as most mothers note, an easy period - the second trimester. During this period, your health is good, because far behind the phenomenon of toxicosis, and the uterus is not yet large enough to cause inconvenience. The baby already looks like a newborn, but adipose tissue does not accumulate yet, and he is very thin. Facial expressions begin to develop, the baby already has eyebrows and cilia. .

Fifteenth week of pregnancy

At the 15th week of pregnancy, the growth of the baby can already exceed 10 centimeters! Sexual organs are already formed. The auricles are almost formed, facial features are being improved. The pituitary gland is active. The movements of the baby are more and more active. You can notice the appearance of spasms of the calf muscles at this time. This is due to the fact that for normal development, the baby needs a lot of trace elements, which he takes from you. .

sixteenth week of pregnancy

At the 16th week of pregnancy, the baby already knows how to turn the head to the sides. His urinary system is actively working - he urinates every 40-50 minutes. The liver is fully formed and actively working. The baby's legs are growing rapidly, and now they are not much shorter than the handles. Your tummy has noticeably increased, your chest has increased. You have a good appetite and excellent health. If you are pregnant for the second time, you can already feel the baby's movements! .

seventeenth week of pregnancy

At the 17th week of pregnancy, the formation of the fetal immune system begins. Interferon, immunoglobulins begin to be produced. The baby already has protection against infections. From this period, subcutaneous fat begins to form, and the baby becomes more well-fed. The baby already hears voices, distinguishes mother's emotions well. You notice that the skin and hair become more beautiful. The enlarged uterus is already squeezing the bladder, and frequent urination is absolutely normal. .

eighteenth week of pregnancy

The 18th week of pregnancy is the period when most mothers have a long-awaited event - they feel the baby moving! If you have a second pregnancy, you can enjoy these unforgettable sensations for two weeks already. The baby is already strong enough. His eyes are still closed, but he reacts to light. Already now it is time to read him fairy tales, to sing affectionate songs. It is very important for the baby to get used to the voice of the father. .

nineteenth week of pregnancy

The baby is gaining weight and is becoming more and more like a newborn. The brain continues to actively develop, and the movements of the baby become more and more coordinated. At the 19th week of pregnancy, the baby already weighs about 200 g. The tummy has already grown significantly, and it may be difficult for you to find a comfortable sleeping position. At this stage of pregnancy, pain may appear in the lumbar region, sacrum. .

Twentieth week of pregnancy

There is still half way ahead. The formation of all the organs of the baby has almost ended, but there is still a long improvement ahead. The baby already hears well, he has developed a sucking reflex - he often sucks his finger. He can now open his eyes. The skin becomes denser, subcutaneous fat gradually accumulates. You can already feel the baby's movements well. Usually at the 20th week of pregnancy, a second screening ultrasound is performed. .

twenty-first week of pregnancy

At the 21st week of pregnancy, the baby's height is equal to half of his height at birth, but the weight is only about 360 g, since the fat layer is not too developed yet. The digestive tract is actively developing. The baby can swallow amniotic fluid that enters the esophagus and beyond. The baby has already developed taste buds, and he distinguishes the taste of the food that the mother eats. It's time to instill healthy eating habits in him. .

twenty-second week of pregnancy

At the 22nd week of pregnancy, the baby already distinguishes tactile sensations. He can touch his face, umbilical cord, legs, uterine wall with his hands. You already feel very well the activity of the baby and know when he sleeps and when he is awake. The nervous system and sense organs continue to develop. The kid well distinguishes light, melodious music, mother's voice. If he doesn't like something, he will let you know with strong pushes. .

twenty third week of pregnancy

The baby continues to actively gain weight. His movements become more and more powerful, and you can already distinguish where the heels are and where the elbows are. At 23 weeks pregnant, your baby can already dream! He is more and more interested in the world around him, touches everything he gets with his hands. You may feel tired, pain in the back, but the correct daily routine, physical activity perfectly cope with this. .

twenty-fourth week of pregnancy

At the 24th week of pregnancy, the baby is already cramped in the uterus, and his movements are becoming more active. Usually, by this time, the babies are already in a position upside down, but if this does not happen, do not worry, because the baby is very active and will roll over more than once. You notice wonderful changes in your appearance - this applies to a noticeably rounded tummy, and thick shiny hair. .

twenty-fifth week of pregnancy

At the 25th week of pregnancy, the baby's lungs are already formed, and the surfactant is actively synthesized. From this period, the risk of preterm birth is significantly reduced. The baby often breathes in and out, while amniotic fluid enters his respiratory system. So he trains before independent breathing. You can feel your baby's movements at any time of the day, and your sleep and wake schedules may not match. .

twenty-sixth week of pregnancy

26 weeks of pregnancy - the end of the second trimester. It's time to sign up for mothers-to-be. Your tummy has grown significantly, and you may experience heartburn, shortness of breath. The baby is so strong that his thrusts can be painful for you. The baby already has a well-developed hearing, vision. He calms down when he hears his mother's voice, and he has long been used to the sound of your heartbeat. .

twenty-seventh week of pregnancy

The third trimester of your pregnancy has begun. For you, this is the most difficult period, which is accompanied by a heavy load, frequent painful sensations. But this is also the most pleasant time, because your connection with the baby is already very close, you understand him well, you know when and why he is worried. Your baby already weighs almost a kilogram. Now the immune system is actively developing, and you must protect your baby from an excess of allergens. .

twenty-eighth week of pregnancy

At the 28th week of pregnancy, the baby is very strong and active, and mom and dad are happy to put their hands on their tummy and feel small heels, elbows, and back. The kid likes it very much, and he calms down. Adipose tissue continues to accumulate, and a thermoregulation system is formed. This week, mothers with a negative Rh factor are being tested for the presence of antibodies. .

twenty-ninth week of pregnancy

Another week - and the long-awaited vacation! It's time to decide on the choice of the hospital. The baby is actively storing fat, and his cheeks have become plump. The sense organs are already fully formed - the baby perfectly distinguishes sounds, light, taste. The improvement of the nervous system and reflexes continues. Surfactant accumulates in the alveolar apparatus. At this stage of pregnancy, it is very important for you to control your weight well.

thirtieth week of pregnancy

You are finally on maternity leave! Now you can pay maximum attention to changing your feelings, communicating with your baby, walking. The baby looks like a newborn, his body is covered with fluffy hairs - lanugo. Due to the increase in the uterus, you may notice that your gait has changed, pain in the legs and lower back may periodically bother you. It's time to go to the gymnastics classes for pregnant women, yoga or swimming.

thirty-first week of pregnancy

The baby is gaining weight every day, and you feel it by changing your well-being. At the 31st week of pregnancy, an important process in the development of the nervous system begins - the myelination of fibers. Under the skin, the baby has already accumulated enough adipose tissue, and his skin has brightened. The kid is more and more susceptible to external stimuli - with sharp loud sounds or bright lights, he shudders and protests. The formation of the epithelium lining the alveoli continues.

Pregnancy- a physiological process in which a fetus develops from a fertilized egg in the female body.

Conception and development of the "fetal egg"

The connection of the male reproductive cell - spermatozoon with the female reproductive cell - egg occurs, as a rule, in the ampullar part of the fallopian tube.

A fertilized egg, or zygote (see), moving along the tube towards the uterus due to peristaltic contractions of the smooth muscles of the tube wall and the flickering of the cavities of its epithelium, is divided mitotically (see Mitosis) into poorly differentiated daughter cells - blastomeres (see Cleavage of the egg). Thus, a unicellular embryo - a zygote, which is already an organism of a new, daughter generation, turns into a multicellular embryo - a morula, consisting of 8-12 cells. At this stage, the embryo (see) gets from the fallopian tube into the uterine cavity, usually 3 days after ovulation and fertilization. Here, cell reproduction is sharply accelerated, and by 5.5 days the embryo takes the form of a hollow vesicle - a blastocyst. In the middle of the 7th day, implantation begins, that is, the introduction of the embryo into the uterine mucosa. In humans and great apes, interstitial (submersible) implantation occurs, thus the embryo, destroying the adjacent section of the mucous membrane with the help of proteolytic enzymes, is completely immersed in its thickness, where it continues to develop. The hole formed in this case - the implantation crater - closes due to the restoration of the integrity of the mucous membrane above the embryo that has sunk into it. It is implantation that should be considered the beginning of pregnancy in the proper sense of the word, since only with the onset of implantation, hormonal changes occur in a woman's body. The embryo, together with the embryonic membranes it forms - the chorion and the amnion (see Embryo, Fetal membranes) - in obstetric and gynecological practice is often referred to as the "fetal egg" (a term not accepted in scientific embryology, where only an egg cell with egg cells is called an egg, but not germinal membranes). In humans, the first 2 months of intrauterine development are called the actual embryonic (embryonic, from the Greek embryon embryo), and the remaining 7 months - the fetal (fetal, from the Latin fetus fruit) period.

Normal (physiological) pregnancy

Numerous and complex changes occur in a woman's body during pregnancy. These physiological changes create conditions for intrauterine development of the fetus, prepare the woman's body for the birth act and breastfeeding of the newborn.

During pregnancy, a complex of interrelated immunological reactions occurs between the mother and the fetus (see Immunology of Embryogenesis). In order to explain the conditions and mechanisms that determine the normal development of pregnancy, I. A. Arshavsky put forward the concept of the dominant pregnancy: the emergence of a corresponding focus of excitation in the central nervous system after fertilization of the egg and its implantation in the uterine mucosa; in this case, a constant source of afferent impulses arises from the interoreceptors of the uterus.

Reflex reactions arising from the complex relationship between the organisms of the pregnant woman and the fetus and beginning with the excitation of uterine receptors are an integral part of the mechanism for the development of pregnancy (N. L. Garmashova).

In the first months of pregnancy, a decrease in the excitability of the cerebral cortex is observed, which leads to an increase in the reflex activity of the subcortical centers, as well as the spinal cord (IM Sechenov, IP Pavlov).

Subsequently, the excitability of the cerebral cortex increases and remains elevated until the end of pregnancy.

By the time of delivery, the excitability of the cerebral cortex decreases sharply, which is accompanied by an increase in the excitability of the spinal cord. This ratio of excitability of the head and spinal parts of the central nervous system at the end of pregnancy leads to an increase in spinal reflexes, an increase in neuroreflex and muscle excitability of the uterus (MA Petrov-Maslakov, 1963).

Endocrine glands

Significant changes occur in the endocrine glands during pregnancy. With the onset of pregnancy, the ovaries increase somewhat, ovulation in them stops; in one of the ovaries the corpus luteum functions (see). The hormones he secretes (progesterone and, to a lesser extent, estrogens) contribute to the creation of conditions for the proper development of pregnancy. The corpus luteum undergoes reverse development after the fourth month due to the formation of the hormonal function of the placenta.

Placenta

The placenta is a powerful endocrine gland in which the processes of synthesis, secretion and transformation of a number of hormones of both steroid and protein nature proceed intensively. The placenta produces hormones of protein nature (chorionic gonadotropic and chorionic somatomammotropic) and hormones of steroid origin (gestagens and estrogens).

Chorionic gonadotropin in its biological properties is similar to the luteinizing hormone of the pituitary gland. It is believed that biol. the action of this hormone is to preserve the function of the corpus luteum of the ovary and influence the development of the adrenal glands and gonads of the fetus, the impact on the processes of steroid metabolism in the placenta. Chorionic somatomammotropic hormone (CSMG), or chorionic somatotropic placental lactogen, in its chemical and immunological properties approaches the anterior pituitary growth hormone and prolactin. Placental lactogen, due to its anti-insulin action, leads to an increase in gluconeogenesis in the liver, a decrease in the body's tolerance to glucose, and an increase in lipolysis.

The placenta also produces a number of other protein-peptide hormones, such as melanocyte-stimulating hormone, thyroid-stimulating hormone, relaxin, vasopressin, oxytocin. The biological effect of estrogens during pregnancy is aimed at the growth of the uterus: estrogens contribute to hyperplasia and hypertrophy of the muscle cells of the uterus; in addition, estrogens cause the growth of the mammary glands.

The placenta releases large amounts of progesterone during pregnancy. This steroid hormone is formed in the placenta from maternal cholesterol.

The physiological role of progesterone during pregnancy is not entirely clear. It has been established that with the progression of pregnancy, the concentration of progesterone in the mother's blood increases significantly. The excretion of pregnandiol, the main metabolite of progesterone, also increases.

There is a hypothesis about the "progesterone block", according to which progesterone, which is formed during pregnancy in the placenta and penetrates into the myometrium by local diffusion, inhibits the contractile activity of the uterus. The uterine muscle, being under the influence of progesterone, but responds to oxytocin and is not sensitive to the action of estrogens. However, the question of the significance of progesterone and the “progesterone block” in the trigger of childbirth in women is controversial, since convincing evidence of a drop in the level of this hormone by the onset of labor has not yet been obtained.

There is a functional relationship between the placenta and the fetus, which is considered as a single endocrine system - a “feto-placental unit”, which, to a certain extent, has some autonomy.

It has been established that the human fetus, along with the placenta, is involved in the synthesis of estrogens and that the metabolic activity of the fetus and placenta complements the maternal one. Steroidogenesis involves the fetus, placenta and maternal organism, which complement each other in such a way that the “feto-placental unit” is able to support the synthesis of all biologically active steroid hormones.

Pituitary

The anterior pituitary gland during pregnancy increases due to the multiplication and hypertrophy of cells that produce hormones. At the beginning of pregnancy, the production of gonadotropic hormones, especially luteinizing and luteotropic (prolactin), is significantly enhanced. These hormones enhance the development and endocrine function of the corpus luteum, and also help prepare the mammary glands for lactation. The formation of thyroid-stimulating and adrenocorticotropic hormones that affect the thyroid gland and adrenal glands, as well as growth hormone, increases. The latter affects the growth of the uterus and other organs of the reproductive system, and can also cause a transient increase in the limbs, lower jaw in some pregnant women.

During pregnancy, the formation of oxytocin and vasopressin by the supraoptic and paraventricular nuclei of the hypothalamus increases. Oxytocin has a specific tonomotor effect on the myometrium. The accumulation and action of oxytocin is directly dependent on the accumulation of estrogen and placental serotonin, which block oxytocinase (cystinaminopeptidase) - an enzyme that inactivates oxytocin in the blood of a pregnant woman. It is assumed that this enzyme is formed from the trophoblast and is the enzyme of pregnancy.

The paraventricular and supraoptic nuclei are also involved in the regulation of secretion by the adenohypophysis of follicle-stimulating and luteinizing, adrenocorticotropic and thyroid-stimulating hormones.

Thyroid

The thyroid gland during pregnancy increases in 35-40% of women due to hyperemia, an increase in the number of follicles and the content of colloid in them. The content of protein-bound iodine in the blood increases to 8-11 µg%, however, without symptoms of thyrotoxicosis.

adrenal glands

The adrenal glands undergo significant changes during pregnancy. The formation of glucocorticoids (corticosterone, hydrocortisone), which regulate carbohydrate and protein metabolism, and mineralocorticoids, which regulate mineral metabolism, is enhanced. There is evidence that during pregnancy, the synthesis of estrogens, progesterone and androgens increases in the adrenal cortex. The cortex and medulla of the adrenal glands, in interaction with ACTH, contribute to the creation of a high level of metabolic processes in the organs and tissues of the pregnant woman by the onset of childbirth.

During pregnancy, the concentration of corticosteroids circulating in the blood increases. However, this increase in corticosteroids does not cause pronounced clinical manifestations of hypercortisolism during pregnancy, which is explained by the interaction of hydrocortisone with a specific globulin (transcortin). During pregnancy, there is an increase in plasma levels of not only corticosteroids, but also transcortin. The binding of hormones to plasma proteins seems to be one of the additional factors regulating the concentration of biologically active hormones. During pregnancy, insulin secretion also increases, which is determined by the physiological needs of the body, as well as the influence of placental lactogen.

metabolism during pregnancy

Metabolism during pregnancy undergoes significant changes, which is associated with a restructuring of the function of the nervous system and endocrine glands.

During pregnancy, a number of enzymes contained in the blood change significantly in quantity or activity. In particular, during pregnancy, the activity of phosphatases, enzymes that catalyze the reaction of decomposition and synthesis of phosphoric esters, increases significantly. The activity of histaminase, an enzyme that breaks down histamine, is enhanced. During pregnancy, there is a noticeable decrease in the activity of cholinesterase, an enzyme that catalyzes the breakdown of acetylcholine (a mediator that plays a role in stimulating labor).

Basal metabolic rate and oxygen consumption increase during pregnancy. After the fourth month of pregnancy, there is an increase in basal metabolism up to 15-20%, which can be explained by the upcoming stimulation of the pituitary gland during pregnancy. The basal metabolism is especially enhanced in the second half of pregnancy and during childbirth.

Protein metabolism

Protein metabolism changes markedly. Pregnant women accumulate nitrogen, the supply of which is necessary for both the mother and the fetus. Nitrogen retention is 1.84 g per day, starting from the 17th week of pregnancy; by the end of pregnancy reaches 4-5 g per day. In the blood, the amount of residual nitrogen does not increase, the amount of urea is reduced. Urea is excreted in the urine less than normal, ammonia and amino acids - more than normal.

carbohydrate metabolism

Fasting blood sugar concentration during pregnancy is usually normal, however, during a glucose tolerance test, a decrease in tolerance is noted in 6-40% of pregnant women. Many pregnant women have a tendency to glycosuria. Glycogen is deposited not only in the liver and muscles, but also in the placenta. The possibility of significant fluctuations in blood sugar levels during normal pregnancy depends on the functional potency of the islet apparatus of the pancreas in relation to insulin secretion, as well as the activity of contrainsular hormones in the body of a pregnant woman.

lipid metabolism

In the blood of pregnant women, the amount of neutral fat, fatty acids, cholesterol, phospholipids and other lipids is increased. The accumulation of lipids also occurs in the adrenal glands, placenta and mammary glands. Lipids are spent on the formation of fetal tissues.

Mineral and water exchange

During pregnancy, there is a delay in the body of a woman and the accumulation of many inorganic substances. The absorption of phosphorus, which is necessary for the development of the nervous system and the skeleton of the fetus, calcium salts, which are necessary for building the bones of the fetus, is enhanced. There is a significant accumulation of iron - 950-1150 mg. Of this amount, 180 mg (based on 0.6 mg per day throughout pregnancy) are the costs of the body of the pregnant woman herself due to an increase in bone marrow hematopoiesis, 300-570 mg is used to produce additional hemoglobin, 250-400 mg is spent on the needs of the fetus, 50-100 mg - for the construction of the placenta, 50 mg is deposited in the muscles of the uterus and, finally, with milk during lactation lasting 6 months. 180 mg of iron is lost. Throughout pregnancy, a pregnant woman should receive 4-5 mg of iron per day. There is a delay in the body of a pregnant woman and other inorganic substances: potassium, sodium, magnesium, chlorine, cobalt, copper and other trace elements. These substances also pass to the fetus and determine the normal course of metabolic and growth processes. The accumulation of inorganic substances is of biological importance for the mother's body, in particular for preparing for childbirth and lactation.

The accumulation of inorganic substances affects water metabolism, which is characterized during pregnancy by a tendency to retain water in the body. The hormones of the adrenal cortex (mineralocorticoids) play an important role in the regulation of water metabolism during pregnancy. During normal pregnancy, there is no significant retention of water and chlorides, the fluid is quickly removed from the body.

The need of the body of a pregnant woman for vitamins (A, B1, D, E, K, PP and especially C) increases due to the need to supply them to the fetus and maintain an intensive metabolism. The daily requirement for vitamin C increases by 2-3 times; it is of great importance, in particular for the development of the fetus, embryonic membranes and placenta. The role of vitamin A in the processes of fetal growth is great, vitamin B1 - in the regulation of the functions of the nervous system and many enzymatic processes. Vitamin E contributes to the development of pregnancy. With its deficiency, a miscarriage may occur, which is associated with necrotic changes in the placenta and secondary death of the fetus.

The cardiovascular system

During normal pregnancy, there are increased demands on the work of the heart and vascular system, which is associated with an increase in the volume of circulating blood, an increase in peripheral resistance, an increase in the volume of the uterus and the development of a powerful uteroplacental circulation system.

The heart of a pregnant woman gradually adapts to the load: physiological hypertrophy of the left ventricle occurs, the minute volume increases, there is a slight increase in vascular tone and an increase in heart rate. Due to the high position of the diaphragm in the last months of pregnancy, the axis of the heart acquires a more horizontal position and the kinks of large vessels can cause the appearance of functional systolic murmurs. All these changes completely disappear after childbirth. Blood pressure during physiological pregnancy changes slightly: in the first weeks it decreases slightly; after 16 weeks, there is a slight upward trend (by 5-10 mm Hg). For a correct judgment about the level and dynamics of blood pressure, it is necessary to know the initial value of blood pressure before pregnancy, since among pregnant women there are women with hypotension (for example, 90/60 mm Hg), for which arterial blood pressure is normal for other women (120 /80 mmHg) means undoubted hypertension. It is important to take into account not so much the absolute figures of blood pressure as the percentage of its increase to the initial value. An increase in systolic pressure by 30% of the original should be regarded as a pathological symptom. It is very important to take into account the dynamics of diastolic and pulse pressure: in a normal pregnancy, it should not exceed 75-80 mm Hg. Art., and the pulse should not be lower than 40 mm Hg. Art.

Blood

During pregnancy, blood formation increases, the number of red blood cells, the amount of hemoglobin and blood plasma increase. The volume of circulating blood by the end of pregnancy increases by 35-40%.

During normal pregnancy, due to the development of the fetus, hormonal changes and metabolic characteristics, changes in the acid-base state of the blood are observed, which is expressed in the accumulation of acidic metabolic products. Simultaneously, hypocapnia develops. As the gestational age increases, the phenomena of metabolic acidosis and respiratory alkalosis increase. In most pregnant women, these changes are compensated, and there is no pH shift, which indicates a sufficient capacity of the body's buffer systems during physiological pregnancy.

Respiratory system

Despite the high standing of the diaphragm at the end of pregnancy, the respiratory surface and vital capacity of the lungs do not decrease due to the expansion of the chest. Breathing in the last months of pregnancy becomes a little more frequent and deeper, gas exchange increases.

Digestive organs. Sometimes there is a decrease in the acidity of gastric juice.

The urinary organs during physiological pregnancy do not undergo functional changes.

Musculoskeletal system. Changes during pregnancy are characterized by serous impregnation and loosening of the articular ligaments, symphyseal cartilage and synovial membranes of the pubic and sacroiliac joints, due to the influence of relaxin produced in the placenta. In this regard, there is a slight increase in mobility in the joints of the pelvis and the possibility of a slight increase in the capacity of the pelvis during childbirth.

The skin during pregnancy undergoes peculiar changes. Quite often in the skin of the face, the white line of the abdomen, nipples and areola, there is a deposition of brown pigment. The increased pigmentation of the skin of pregnant women is explained by the fact that in the adrenal glands (zona reticularis) there is an increased production of yellow-brown pigment, very close to melanin.

As the uterus grows, the woman's anterior abdominal wall stretches. Under the influence of mechanical stretching and under the influence of hypercortisolism, pregnancy stripes (striae gravidarum) appear. These arc-shaped bands, pointed at the ends, look like scars; their color during pregnancy is pinkish-reddish; after childbirth, the color changes to a silvery-whitish. The localization of these bands is diverse: around the navel, in the lower abdomen, often on the thighs and on the mammary glands.

Mammary gland

Growth and hyperplasia of the mammary glands and iodine preparation for lactation (see) occurs under the influence of hormones produced in the placenta (estrogen, progesterone). Secretion is activated by lactogenic (luteotropic) pituitary hormone.

Sex organs

Uterus. During pregnancy, the size, shape, position, consistency and reactivity (excitability) of the uterus changes. The uterus gradually enlarges throughout pregnancy. The increase in the uterus occurs mainly due to hypertrophy of the muscle fibers of the uterus; at the same time, there is a reproduction of muscle fibers, the growth of newly formed muscle elements of the mesh-fibrous and argyrophilic "frame" of the uterus.

The uterine mucosa, which was in the secretion phase prior to implantation, undergoes a complex of complex morphological and biochemical changes from the moment the blastocyst attaches. In the spongy layer of the mucous membrane, processes of hypertrophy of the glands and the growth of the vascular network are noted. From this point on, the mucous membrane of the uterus is called decidual - falling away (see Decidua). The vascular network of the uterus undergoes a significant increase. The arteries and especially the veins of the uterus lengthen and expand, new vessels form; at the same time, the lymphatic vessels lengthen and expand. The nervous elements of the uterus hypertrophy, their number increases, the number of sensitive receptors increases sharply. These receptors are important in the transmission of impulses from the fetus to the central nervous system of a pregnant woman (H. L. Garmashova).

In the isthmus of the uterus, the processes of hypertrophy and hyperplasia are much less pronounced than in the body, the connective tissue is loosened, the number of elastic fibers increases. There are fewer muscle elements in the cervix than in her body. The position of the uterus changes in accordance with its growth.

The uterus is not only a fetal place that protects the fetus from adverse external influences, but also a metabolic organ that provides the fetus with enzymes, complex compounds necessary for the plastic processes of a rapidly developing fetus. Some of the compounds necessary for the fetus are synthesized in subcellular structural formations of the myometrium, others are deposited in the tissues of the uterus and are actively transported through biological membranes and the vascular bed of the fetus.

With the onset of pregnancy and in the process of its development, the amount of actomyosin (a complex compound of contractile proteins - actin and myosin) increases two or more times, which creates conditions for reducing the motor function of the uterus, term pregnancy and accumulation of substances necessary for the normal course of labor activity.

Very important components that provide energy for the muscular contraction of the uterus are phosphorus compounds. With the onset of pregnancy in the uterus, the content of phosphorus compounds progressively increases. By the end of pregnancy, there is an increase in total phosphorus by 71.5%, acid-soluble - by 103.8% and protein - by 16% compared with the state before pregnancy.

During pregnancy, the accumulation of energy-important compounds, such as creatine phosphate and glycogen, increases in the uterine muscle. By the end of pregnancy and childbirth, the content of glycogen increases several times.

With an increase in the duration of pregnancy, there is an accumulation in the muscle of the uterus and the placenta of very important biologically active substances (biogenic amines) - serotonin (see), catecholamines (see), etc. Serotonin is a progesterone antagonist and a synergist of estrogenic hormones. The maximum accumulation of serotonin in the uterus and placenta takes place by the time of delivery, which leads to a sharp increase in spontaneous excitability and energy readiness of contractile proteins to perform a mechanical function.

Fallopian tubes during pregnancy thicken due to hyperemia and serous impregnation of tissues. The ligaments of the uterus lengthen and thicken, which helps to keep the uterus in the required position during childbirth, especially the round and sacro-uterine ligaments are hypertrophied. The round ligaments of the uterus are palpated through the anterior abdominal wall in the form of strands.

During pregnancy, hypertrophy and hyperplasia of the muscular and connective tissue elements of the vagina occurs, in connection with which it lengthens, expands, the folds of the mucous membrane protrude sharper. In the contents of the vagina during normal pregnancy, vaginal sticks predominate (I-II degree of purity), the reaction is acidic.

The external genitalia loosen during pregnancy, the mucous membrane of the entrance to the vagina becomes cyanotic.

Pregnancy recognition

In the early stages, the diagnosis of pregnancy is established on the basis of doubtful and probable signs.

Doubtful signs are various kinds of subjective sensations, as well as objectively determined changes in the body, outside the internal genital organs: taste whims, changes in olfactory sensations, easy fatigue, drowsiness, skin pigmentation on the face, along the white line of the abdomen, nipples and areola.

Probable signs - objective signs from the genitals, mammary glands and when setting up biological reactions to pregnancy. These include: the cessation of menstruation in women of childbearing age, an increase in the mammary glands and the appearance of colostrum when squeezed out of the nipples, cyanosis of the mucous membrane of the vagina and cervix, a change in the shape and consistency of the uterus, an increase in its size.

Of the signs indicating a change in the shape and consistency of the uterus in connection with pregnancy, the most important are the following:

Genter's sign. In a vaginal examination in the early stages of pregnancy, on the anterior surface of the uterus, strictly along its midline, a ridge-like protrusion is found (Fig. 1), which, in consistency, differs from the rest of the body of the uterus.

Horvitz-Hegar sign. A two-handed examination reveals softening in the isthmus (Fig. 2).

Piskacek sign. On vaginal examination, the contours of the uterus appear asymmetrical due to the protrusion of the angle corresponding to the site of implantation of the ovum (Fig. 3).

Sign of Snegirev. During vaginal examination, the pregnant uterus, due to mechanical irritation, begins to contract under the fingers and becomes more dense.

Identification of probable signs of pregnancy is carried out by questioning, palpation, examination of the external genital organs and the mucous membrane of the vagina using mirrors and vaginal examination.

In doubtful cases, in addition to a thorough clinical examination of a woman, methods of diagnosing pregnancy are used, based on determining the content of chorionic gonadotropin in the urine of pregnant women (see Ashheim-Zondeka reaction, Galli-Mainini reaction, Friedman reaction).

They also use immunological methods for diagnosing pregnancy, which are based on the reaction between chorionic gonadotropin in the urine of pregnant women and antiserum. The most applicable method is based on the suppression (inhibition) of the hemagglutination reaction of erythrocytes containing chorionic gonadotropin with the appropriate antiserum in the presence of chorionic gonadotropin present in the urine of pregnant women.

In the second half of pregnancy, reliable, or undoubted, signs of pregnancy appear, indicating the presence of a fetus in the uterus. All these signs are objective. These include: fetal movements determined by hand or during auscultation, listening to fetal heart sounds, probing parts of the fetus, x-ray data, electrophonocardiography, fetal echography.

Determining the gestational age is of great importance not only for determining the date of the upcoming birth, but also for the timely provision of prenatal leave (see Maternity leave).

For the most accurate diagnosis of the duration of pregnancy and childbirth, it is necessary to take into account the anamnesis data and the totality of data from an objective examination of the pregnant woman. From the data of the anamnesis, information about the time of the last menstruation and the first movement of the fetus is important.

The day of delivery can be determined by adding 280 days to the date of the first day of the last menstrual period. These calculations can be simplified using the Naegele formula; while counting from the first day of the last menstruation 3 months ago and adding 7 days to the resulting number (365 - 92 + 7 = 280).

To determine the duration of pregnancy and childbirth, the time of the first movement of the fetus is taken into account, which is felt primiparous from 20 weeks, and multiparous - about 2 weeks earlier.

The duration of pregnancy can be judged on the basis of taking into account the time elapsed from the first day of the last menstruation to the time of the examination. For this purpose, the ovulation period is determined, which usually coincides with the onset of pregnancy. From the first day of the expected (non-occurring) menstruation, 14-16 days are counted back and thus the possible time of ovulation and the onset of pregnancy is determined.

To determine the gestational age and date of birth, the data of an objective examination are of great importance: determining the size of the uterus, the volume of the abdomen, the length of the fetus and the size of its head.

The size of the uterus after 3 months of pregnancy is determined by measuring the height of the fundus of the uterus above the womb (Fig. 4). Using the data of the anamnesis and the obtained size of the uterus, with appropriate combinations of signs, it is possible to determine the gestational age with a sufficient degree of probability. Figure 5 schematically shows the levels of standing of the uterine fundus at different stages of pregnancy.

For an approximate determination of the gestational age in its last months, you can use the formula proposed by M. K. Skulsky: X \u003d (L * 2 - 5) / 5, where X is the desired gestational age; L is the length of the fetus in the uterus; 2 - doubling factor; 5 in the numerator - the thickness of the walls of the abdomen and the walls of the uterus; 5 in the denominator is the number by which the number of months of pregnancy is multiplied to obtain the length of the fetus according to the Haase scheme (see Fetus).

The measurement of the fetal head provides an auxiliary number to clarify the later stages of pregnancy. The frontal-occipital size of the fetal head at the end of the VIII month (32 weeks) is on average 9.5 cm, at the end of the IX month (35-36 weeks) - 11 cm.

I. F. Zhordania proposed the following formula for determining the gestational age: X = L + C, where X is the desired gestational age in weeks: L is the length of the fetus in the uterus, obtained by measuring with a tazomer (Fig. 6); C - fronto-occipital size of the fetus, also determined by the pelvis.

Determining the true duration of a woman's pregnancy is difficult due to the fact that it is difficult to establish the exact date of ovulation and the time of fertilization. Therefore, data on the duration of pregnancy are contradictory. However, in most cases, a woman's pregnancy lasts 10 obstetric months (a month of 28 days), or 280 days, if we calculate its beginning from the first day of the last menstruation.

Primary early attendance and systematic monthly visits to a pregnant antenatal clinic significantly reduce the percentage of errors in determining the duration of pregnancy and, consequently, the duration of prenatal leave.

Hygiene and nutrition of pregnant women

Pregnancy does not require any special changes in the general regimen. However, pregnant women are exempted from night duty, heavy physical work, work associated with body vibration or adverse effects on the body of chemical agents. substances. During pregnancy, sudden movements, heavy lifting and significant fatigue should be avoided. A pregnant woman needs to sleep at least 8 hours a day. Walking before bed is recommended.

A pregnant woman must be carefully protected from infectious diseases that pose a particular danger to the body of the pregnant woman and the fetus.

During pregnancy, it is necessary to carefully monitor the cleanliness of the skin. Cleanliness of the skin contributes to the removal of metabolic products harmful to the body with sweat.

A pregnant woman should wash her external genitalia twice a day with warm water and soap. Douching during pregnancy should be administered with great caution.

During pregnancy, you should carefully monitor the condition of the oral cavity and make the necessary sanitation.

The mammary glands should be washed daily with warm water and soap and wiped with a towel. These methods prevent cracked nipples and mastitis. If the nipples are flat or inverted, then they should be massaged.

Sexual intercourse during pregnancy should be limited. Alcohol and smoking are prohibited, as they have a toxic effect on the body of a pregnant woman and adversely affect the fetus.

The clothes of a pregnant woman should be comfortable and loose: no tightening belts, round garters, tight bras, etc. should be worn. A pregnant woman should wear low-heeled shoes. In the second half of pregnancy, it is recommended to wear a bandage that should support the stomach, but not squeeze it.

Proper nutrition during pregnancy is extremely important for maintaining the health of the woman and the normal development of the fetus.

In the first half of pregnancy, a special diet is not required. Food should be varied and deliciously cooked. Nutrition in the second half of pregnancy should take into account the physiological characteristics of the body. The amount of proteins is 100-120 g per day. Of the products containing complete proteins, kefir, yogurt, milk, cottage cheese, eggs, cheese, lean meat (100-120 g per day), fish (150-250 g per day) should be recommended. The amount of carbohydrates is about 500 g per day, with an overweight pregnant woman - 300 g. Fruits, berries, vegetables, as well as bread (a source of fiber and B vitamins) are recommended.

The amount of liquid is limited to 1 - 1.2 liters. The amount of table salt is limited, especially in the second half of pregnancy (up to 8-5 g per day).

During pregnancy, the need for vitamins increases (see). A good source of vitamin A are the liver and kidneys of animals, milk, eggs, butter, carrots, fish oil, spinach. Vitamin B1 is rich in brewer's yeast, liver, kidneys, cereals and legumes. The daily dose of vitamin B1 is 10-20 mg. The daily requirement for vitamin B2 (riboflavin) is 2 mg. There is a lot of vitamin PP in yeast, meat, liver, wheat grains; The daily requirement for this vitamin is 15 mg. Vitamin C per day requires 1.0-1.5 g. In winter and spring, it is recommended to prescribe ready-made vitamin C preparations (pellets, tablets) or ascorbic acid to pregnant women. Vitamin C is found in vegetables, berries, fruits. Vitamin E is found in the germ part of wheat and corn, eggs, liver, soybean oil. Vitamin D is rich in fish oil, liver, caviar, butter.

Physical education of pregnant women

Physical education during pregnancy improves the general condition of a woman, has a beneficial effect on the autonomic nervous system, helps to reduce the effects of toxicosis of pregnancy, shorten the duration of labor and a more prosperous postpartum period. Her special tasks are: strengthening the abdominal muscles; improvement of straining activity during childbirth; prevention of sagging of the abdomen and prolapse of internal organs; strengthening and increasing the elasticity of the pelvic floor muscles to prevent prolapse and prolapse of the internal genital organs; strengthening the entire muscles of the body, especially the muscles of the back, on which the greatest load falls when walking, due to a shift in the center of gravity during pregnancy; increased mobility of the joints of the pelvis and spine; teaching the skill of mastering breathing during childbirth, improving the function of external respiration in order to enhance the oxidative processes of the body necessary for the development of the fetus.

Physical exercises are indicated for all women with a normal pregnancy, as well as for pregnant women with diseases of the cardiovascular system in the compensation stage. Contraindications for physical education:

1) all acute stages of the disease of the cardiovascular system with circulatory disorders, thrombophlebitis, tuberculosis (complicated by pleurisy, hemoptysis), diseases of the kidneys and bladder (nephritis, nephrosis, pyelocystitis);

2) pronounced toxicosis of pregnancy (uncontrollable vomiting, nephropathy, preeclampsia, eclampsia); 3) uterine bleeding; 4) habitual miscarriage. During pregnancy, those types of physical exercises are prohibited, where there is a sharp shaking of the body (jumps, dismounts), sharp turns, strength exercises. It is strictly forbidden to participate in sports competitions due to strong physical and nervous tension.

Systematic control over the conduct of classes is carried out by the doctor of the antenatal clinic, he determines the total amount of permissible load and changes it during pregnancy. Pregnant women with a disease of the cardiovascular system in the stage of compensation, in addition, should be under the constant supervision of a therapist.

Rice. 7. Complexes of basic physical exercises at different stages of pregnancy: 1-12 first 16 weeks; 13-26 - 16-32 weeks of pregnancy; 27-37 - 32-36 weeks.

The training methodology varies depending on the duration of pregnancy Up to 16 weeks (with caution during menstruation), exercises are used in lying, sitting, standing positions at a slow pace for all muscle groups, special breathing exercises for learning to control breathing (Fig. 7, 1-12 ). The duration of classes for previously engaged in gymnastics is 20 - 25 minutes, not engaged in - no more than 15 minutes. During pregnancy of 16-24 weeks, when the uterus is not yet large in volume, exercises are used in the prone position, sitting, standing on all fours with an emphasis on training the muscles of the back, anterior abdominal wall, for the hip joints at a slow and medium pace, as well as breathing exercises. In the period from 24 to 32 weeks of pregnancy, the same exercises are applied, but taking into account the size of the enlarged uterus (Fig. 7, 13-26). In view of the possible swelling of the legs and changes in posture during pregnancy, special corrective exercises for the muscles of the back, feet and improve venous circulation in the legs are added to the exercises of the previous period. During pregnancy 32-36 weeks, half of all exercises to facilitate their implementation are performed in the supine and sitting position, the pace is mostly slow, exercises for the body are limited, the number of exercises for the shoulder girdle and arms increases due to the decrease in exercises for the lower extremities; relaxation exercises are applied (Fig. 7, 27-37).

During pregnancy from 36 weeks to delivery, the volume of all exercises performed is limited, which in 90% of cases are carried out in the supine position; the nature of the exercises is similar to the previous one. Particular attention is paid to breathing exercises with mastering the skills of deep breathing in various starting positions. In the second and third trimesters of pregnancy, the doctor explains to the woman the importance of exercise for a quick and successful delivery.

In addition to exercise, during the entire pregnancy, it is recommended to include walks at any time of the year for up to 2 hours with rest stops in the general daily routine. In the second half of pregnancy, the walking distance is reduced, and the time spent in the air increases, in winter it should be at least 1.5 hours, and in summer much more.

Special studies have found that physical exercises during pregnancy improve the course of childbirth, reduce the likelihood of perineal rupture and other complications.

Pathology of pregnancy

Complications of pregnancy can occur with developmental anomalies and pathological conditions of the reproductive system, with extra genital diseases, disorders of the fetus, placenta, fetal membranes and the relationship between the mother and fetus.

Malformations of the female genital organs

With underdevelopment of the genital organs (infantilism, hypoplasia), pregnancy is often terminated prematurely (see Miscarriage), and during childbirth, primary weakness of labor activity often occurs. It is difficult to identify objective signs of underdevelopment of the genital organs during pregnancy. The diagnosis of infantilism in a pregnant woman is based mainly on anamnesis data: adverse developmental conditions in childhood, late menarche, late onset of the first pregnancy, spontaneous abortions or premature births. Prevention of abortion consists in the elimination of adverse factors that contribute to the premature onset of contractions, the timely and rational use of hormonal and other medications that regulate the tone and contractile function of the uterus. In women with underdevelopment of the genital organs, pregnancy usually has a beneficial effect on the state of the reproductive system, as a result of which the course of subsequent pregnancies and childbirth becomes more physiological.

One of the types of anomalies in the development of the genital organs is the doubling of the uterus (the presence of two separate uteruses and two vaginas). Functionally, both uterus do not differ from normal. Pregnancy can alternate (sometimes in the right, then in the left uterus) and often ends in normal childbirth. In cases where the pregnancy that has occurred in one of the uterus is interrupted, it is necessary, after removing the fetal egg from the pregnant uterus, to curettage the other uterus, in which the mucous membrane turns into a lushly developed decidua (danger of uterine bleeding after an abortion!).

Pregnant women with a doubling of the uterus should be under especially strict supervision of the antenatal clinic, since their pregnancy is often terminated spontaneously in the first months. Pregnancy can also develop in one of the horns of a bicornuate uterus with two cervixes and one vagina. The vaginal parts of the cervix of the bicornuate uterus are not always well expressed, and during vaginal examination and examination with the help of mirrors, they appear as one formation. In this case, one of the uterine horns can be mistaken for its enlarged appendages. In women with such an anomaly in the development of the uterus, normal menstrual and childbearing functions are usually preserved. In some cases, a bicornuate unicervical uterus does not have equally pronounced horns: one horn may be underdeveloped and not communicate with the cervical canal. In such a separate (rudimentary) horn, a fetal egg can rarely develop (Fig. 8). The occurrence of such a pregnancy is explained by the movement of the egg from the ovary of the normally developed half of the uterus into the tube on the side of the closed horn or by the movement of the spermatozoon from the tube of the developed horn to the opposite tube. In the case of pregnancy in the rudimentary horn, the wall of the latter in the area of ​​implantation of the fetal egg, which before the onset of pregnancy is a rather powerful formation, is stretched by the growing fetal egg and destroyed by the chorionic villi. Then, most often in the third month of pregnancy, a rupture of the fetus occurs and massive, life-threatening bleeding occurs. Very rarely, such a pregnancy develops to the end. It is very difficult to diagnose pregnancy in the rudimentary horn of the uterus. Delayed menstruation, the absence of pain that often occurs during tubal pregnancy, the definition of a thick leg between the two horns and a round ligament outward from the fetus, the detection of contractions of the fetal sac at hand in the presence of an "empty uterus", significant mobility of the fetus may indicate the development of pregnancy in a rudimentary horn.

In differential diagnosis with pregnancy in the uterine part of the tube, it is necessary to take into account the absence of a dense leg connecting the fetus with the uterus. Cystoma (cyst) of the ovary in combination with uterine pregnancy differs from the pregnant rudimentary horn in a tight elastic consistency (the uterine horn is dense in the first months of pregnancy). Upon re-examination, the size of the horn increases markedly, the cystoma usually does not grow so quickly.

Treatment of progressing or disturbed pregnancy in the rudimentary horn of the uterus is the surgical excision of this horn.

The pathological course of pregnancy may be due to abnormalities in the position of the female genital organs. Of practical importance is mainly the posterior bend of the uterus. Often this bend is accompanied by inflammatory changes in the pelvic organs, and the uterus is fixed by adhesions to neighboring organs and the walls of the small pelvis, as a result of which it loses mobility. If the fetal egg develops in a retroflexed but mobile uterus, the position of the latter usually corrects itself and no deviations from the physiological course of pregnancy are observed. The uterus fixed by adhesions, even with a developing pregnancy, remains motionless. In the first 3 months, this condition does not manifest itself in any way. In the future, the uterus, no longer fitting into the cavity of the small pelvis and being deprived of the opportunity to go beyond the latter, begins to squeeze neighboring organs, especially the bladder. If at the same time there was no spontaneous miscarriage, the pregnant uterus is infringed in the small pelvis. The first signs of an incipient infringement are a feeling of heaviness in the lower abdomen and painful urination. Then urination becomes difficult, there is a symptom of paradoxical ischuria (see), abdominal pain, body temperature rises, flatulence, symptoms of peritoneal irritation appear. The external genitalia are edematous and cyanotic, the cervix is ​​highly elevated and pressed against the pubic joint, the entire pelvic cavity is filled with a soft, rounded “tumor”. To prevent this serious complication, all pregnant women who have a fixed bend of the uterus in the first weeks of pregnancy should be under the constant supervision of a antenatal clinic doctor. In the process of observation, attempts to carefully correct the position of the uterus by two-handed manipulations are acceptable. If the removal of the uterus fails, you need to try to straighten the uterus under anesthesia. If there is no effect, artificial termination of pregnancy is indicated. However, this is not always feasible. With dense adhesions, when the uterus cannot be removed, abdominotomy is indicated to avoid the formation of urogenital fistulas. After opening the abdominal cavity, the adhesions are carefully dissected with scissors without suturing the uterus, after which the pregnancy can develop normally and spontaneous childbirth can occur.

Inflammatory diseases of the female genital organs

In acute endometritis (gonorrheal, tuberculous), as a rule, conception does not occur; in chronic cases, pregnancy is possible. However, in this case, the fertilized egg does not find sufficiently favorable conditions for implantation, since the uterine mucosa is changed by the inflammatory process. Pregnancy occurring in such patients may end in abortion due to early detachment of the fetal egg. With endometritis, the structure and function of the falling off membrane are disturbed, that is, the so-called decidual endometritis is formed. The decidua macroscopically appears compacted, having a coarse fibrous structure; on microscopic examination, the vessels in some places are compressed or thrombosed; cells are in a state of fatty degeneration. In this case, premature termination of pregnancy, placenta previa, placenta accreta are often observed.

Inflammatory diseases of the fallopian tubes with bilateral lesions prevent pregnancy. In some cases, a tubal pregnancy is possible (see Ectopic pregnancy). With a unilateral lesion, pregnancy rarely occurs. During pregnancy, an exacerbation of the inflammatory process rarely occurs; on the contrary, in some cases improvement can be noted. However, in the first half of pregnancy, prolonged aching pains in the lower abdomen may occur. In such cases, prescribe calcium chloride, autohemotherapy, painkillers.

Neoplasms of the female genital organs

Uterine fibromyoma relatively often complicates the course of pregnancy. The severity of complications depends on the location of the tumor and its size. In most women with small subserous or intramural fibromatous nodes, pregnancy and childbirth proceed without complications. The significant size of the tumor can cause various complications (necrosis or infarction of the fibromatous node, twisting of its legs, compression of the tumor, spontaneous abortion or premature birth). The size of the tumor during pregnancy, as a rule, increases significantly, which depends on increased blood circulation in the uterus. Infringement, necrosis of the fibromatous node during pregnancy may require urgent surgical intervention. Uterine fibromyoma often contributes to the occurrence of breech presentation, transverse or oblique position of the fetus, placenta previa.

Detection of uterine fibroids is usually not difficult. It is more difficult to establish the presence of pregnancy in this case, especially in its early stages. Diagnostic difficulties are encountered with large sizes of fibromyoma nodes, their swelling. In such situations, in order to correctly resolve the issue, it is advisable to resort to biological or immunological methods for diagnosing pregnancy, to the use of fetal electrocardiography, echography, and amnioscopy.

The presence of uterine fibroids, as a rule, is not an indication for artificial termination of pregnancy. Even with very large tumors, pregnancy can be full-term (Fig. 9).

Sometimes you have to resort to surgery. The question of the method and extent of the operation (enucleation of fibromatous nodes, sometimes with preservation of the integrity of the fetal egg, supravaginal amputation or extirpation of the uterus) is decided individually depending on the gestational age, tumor size, number of fibromatous nodes, their localization, the nature of the changes that have occurred, the presence or absence of infection , age of the pregnant woman, etc.

Uterine cancer and pregnancy rarely go together. Cancer of the body of the uterus can occur both before pregnancy and during it. Opinions about the effect of pregnancy on the cancer process (intensification or inhibition) are contradictory. Pregnancy with uterine cancer is often interrupted spontaneously, less often (with cervical cancer) it is carried to term. Some women with cancer during pregnancy are accompanied by characteristic symptoms of cancer (leucorrhea, bleeding), while others do not have these symptoms.

Recognition of uterine cancer is based on the above symptoms and the results of a comprehensive examination (examination with mirrors, vaginal, rectal, colposcopic, cytological and histological examinations). When diagnosing, it should be borne in mind that squamous cell carcinoma of the cervix often develops against the background of pseudo-erosion; when pseudo-erosion heals, benign squamous epithelial ingrowths into erosive glands sometimes bear some resemblance to cancerous ingrowths.

Therapy for cervical cancer during pregnancy should be as radical as possible: in stages I-II of cancer, extended extirpation of the uterus with appendages, regional lymph nodes, periuterine tissue and subsequent radiation therapy are indicated. At stage III of cervical cancer, pregnancy is first terminated (in the early stages of pregnancy - instrumental removal of the fetal egg, in the later stages - caesarean section and amputation of the uterus), then combined radiation therapy is performed; at stage IV of the disease, termination of pregnancy and symptomatic therapy are indicated.

Tumors of the ovaries. The most common combination of pregnancy and pedunculated cysts and ovarian cysts, which have an adverse effect on pregnancy. The long stalk of the cyst can become twisted and cause inflammation of the peritoneum and associated abortion. A tumor located between the sheets of the broad ligament of the uterus, sometimes contributes to the formation of a transverse or oblique position of the fetus.

The diagnosis of an ovarian tumor in the first half of pregnancy is usually not difficult, it is more difficult to determine it in the second half of pregnancy.

Treatment is usually surgical (removal of the tumor). The risk of spontaneous abortion after surgery is significantly reduced with the appointment of corpus luteum hormone, vitamin E, sodium bicarbonate. In cases of infringement of the tumor in the small pelvis during childbirth, one has to resort to a caesarean section.

Trophoblast diseases- see Trophoblastic disease.

Infectious diseases in pregnant women

Infectious diseases in pregnant women can be more severe. The result of infection of the ovum or fetus may be the death of the ovum, abortion, premature birth, stillbirth, disease of the newborn.

Disease influenza dangerous for both the pregnant woman and the fetus. This significantly increases the risk of spontaneous miscarriage and premature birth, stillbirth. Prevention of influenza during pregnancy is the most important task of a doctor of any specialty.

Treatment for influenza during pregnancy is the same as outside of pregnancy.

Tuberculosis. Active tuberculosis can lead to miscarriages, premature births, one of the reasons for which is the effect of tuberculosis intoxication on the fetal egg.

Pregnancy can activate latent or sluggish pulmonary tuberculosis and cause deterioration of the patient's condition. However, with systematic observation and treatment in a tuberculosis dispensary and hospital, it is possible to maintain pregnancy in most tuberculosis patients. So, timely recognition and systematic treatment allows you to save pregnancy in patients with freshly diagnosed small-focal processes, limited fibro-focal formations, as well as hematogenous disseminated pulmonary tuberculosis. Tuberculosis of the lungs, cured several years before the onset of pregnancy, with a good general condition of the pregnant woman, poses a danger to either the woman or the fetus.

The combination of pregnancy with tuberculosis of the larynx is very dangerous; at the same time, the course of the process deteriorates sharply, there is a rapid increase in edema, infiltration and ulceration.

Modern methods of treatment of patients with tuberculosis in the USSR have reduced the risk of a combination of tuberculosis and pregnancy.

Termination of pregnancy is indicated: 1) with fibrous-cavernous pulmonary tuberculosis; 2) with an active form of tuberculosis of the spine, pelvic bones, hip, knee, ankle joints; 3) with bilateral, advanced tuberculosis of the kidneys; 4) with tuberculosis of the larynx.

If there are indications for termination of pregnancy, it should be done early (up to 12 weeks of pregnancy); termination of pregnancy at a later date contributes to the exacerbation and progression of the tuberculous process.

If tuberculosis is detected in pregnant women, it is necessary to immediately begin its complex (including surgical) treatment (see Tuberculosis).

Malaria. During an attack of malaria, spontaneous abortion often occurs, but malaria, which occurs without attacks, is hidden, leads to the death of the fetal egg, miscarriages and premature births. This is especially common in tropical malaria. The placenta in such cases is increased in volume and weight, a significant part of the vessels of the villi is obliterated; in the tissues of the placenta, necrotic areas and small hemorrhages are found.

By changing the reactivity of the organism, pregnancy can provoke malaria that was hidden before.

With early recognition and rational therapy, malaria attacks stop, and pregnancy usually ends safely.

Syphilis can be the cause of spontaneous miscarriage and premature birth. In cases where childbirth occurs in a timely manner, children are often born dead, with maceration phenomena or with signs of a syphilitic infection. The latter penetrates to the fetus through a pathologically altered placenta. Significant changes are found in the placenta: chorionic villi are sharply thickened, rich in connective tissue; vessels obliterated completely or partially. As a result of these pathological changes, the placenta acquires a pale pink color; it is dense and significantly increased in volume and weight - the afterbirth with syphilis is often twice as large and heavier than the afterbirth of a healthy puerperal.

Infection of the fetus occurs only through the body of a pregnant woman with syphilis. The more time has passed from the moment of infection of the mother to the onset of pregnancy and the more intensively she was treated before pregnancy and during it, the less the risk of infection of the fetus and its intrauterine death.

With timely and correctly performed antisyphilitic treatment, the pregnant woman recovers, and the child is born healthy. Therefore, timely early detection of the disease and rational treatment are crucial.

Every woman, regardless of whether she had syphilis or not, should be carefully examined clinically and serologically at the antenatal clinic at the very beginning of pregnancy (Wasserman reaction, etc.). Serological tests are repeated in the second half of pregnancy. Modern drugs used to treat syphilis are usually well tolerated by pregnant women, which allows vigorous antisyphilitic treatment - 2-3 courses during pregnancy (see Syphilis).

Gonorrhea often leads to obstruction of the fallopian tubes, but if pregnancy does occur, its course may be complicated by early miscarriage or premature birth.

Chronic gonorrheal inflammation in the uterine appendages can be the cause of ectopic pregnancy.

Acute gonorrhea during pregnancy proceeds very rapidly, with pronounced symptoms, of which the main ones are copious, purulent, corrosive leucorrhoea, acute inflammation of the vagina, extensive acute condylomas of the external genitalia, vagina and cervix. The mucous membrane of the vagina in the presence of condylomas or in areas free from them is hyperemic and has a granular appearance. In addition to the above complications (spontaneous miscarriage, ectopic pregnancy, premature birth), it is possible for newborns to become infected during childbirth and develop blennorrhea in them, and in girls and colpitis (see). Treatment of gonorrhea in pregnancy is based on the general principles of gonorrhea treatment and should be gentle in order to avoid disruption of pregnancy. It is impossible to carry out any manipulations on the cervix. In the treatment of gonorrheal urethritis, the urethra is washed with a weak (up to 1%) solution of potassium permanganate, instillation with a 0.5-1% solution of silver nitrate. Vulvar condylomatosis is treated surgically, electrocoagulation or powders of a mixture of resorcinol with boric acid, depending on the duration of pregnancy and the intensity of the lesion. Cervical warts are not removed during pregnancy.

For the treatment of gonorrheal cervicitis and endocervicitis up to 8 obstetric months of pregnancy, vaginal-cervical baths are used using a mirror (300,000 units of penicillin in 10 ml of isotonic sodium chloride solution). After 8 months of pregnancy, for 6-7 days, 500,000 BD of penicillin in 10 ml of isotonic sodium chloride solution are injected into the vagina through a rubber catheter; intramuscularly - according to the accepted scheme (see Gonorrhea).

Toxoplasmosis during pregnancy, it is often the cause of stillbirths, spontaneous miscarriages and fetal malformations - hydrocephalus and microcephaly, spinal hernia, microphthalmia, cleft palate, cleft lip. See toxoplasmosis, pregnancy.

Brucellosis. With brucellosis, premature termination of pregnancy, stillbirth, complications in childbirth (bleeding) and in the postpartum period are often observed. In turn, pregnancy adversely affects the course of brucellosis. See brucellosis, pregnancy.

Viral hepatitis. If viral hepatitis is detected, the pregnant woman should be hospitalized. In the absence of the effect of the treatment, the pregnancy should be terminated. See viral hepatitis, pregnancy.

Diseases of the cardiovascular system

Among the diseases of the cardiovascular system, the most important during pregnancy are heart defects, which rank first among the causes of maternal death from extragenital diseases.

When examining a pregnant woman suffering from heart disease, it is necessary to establish the form of the defect, the state of the myocardium, the degree of circulatory failure. Pregnant women with identified heart defects should be under the supervision of a therapist and an obstetrician, a consultation with a rheumatologist is mandatory. A pregnant woman with suspected heart disease should be examined in a specialized hospital. Only after a comprehensive examination is it permissible to decide on the possibility of carrying a pregnancy. Timely detection of heart disease in a pregnant woman, careful treatment with re-hospitalization during pregnancy, proper management of childbirth and the postpartum period can dramatically reduce the mortality of pregnant women with heart defects.

Pregnancy can be continued: 1) in the presence of only mitral valve insufficiency or the prevalence of insufficiency in patients with concomitant heart disease; at the same time, a necessary condition is the absence of circulatory disorders in the past and present; 2) patients with aortic heart disease in the absence of circulatory disorders.

Termination of pregnancy is indicated: with an active rheumatic process or its exacerbation and the resulting circulatory failure at the beginning of pregnancy; with narrowing of the left atrioventricular orifice of stage III and above, even if the blood circulation is compensated; with any form of heart disease with signs of circulatory disorders of the HA degree; with congenital heart defects of the "blue" type with pulmonary hypertension; with restenosis after mitral commissurotomy.

Pregnant women with combined heart defects should be hospitalized at 27 - 28 weeks of pregnancy (the so-called critical period). In case of cardiac decompensation, pregnant women are hospitalized immediately for an in-depth examination and a decision on the admissibility of carrying a pregnancy or the need for early delivery. Discharge of patients is carried out only after stable compensation of cardiac activity. These patients do not return to work, they are hospitalized two or three times during pregnancy and always before childbirth. Pregnancy at them quite often comes to an end with timely childbirth; be sure to turn off the attempts in the second period.

The first condition for the treatment of pregnant women suffering from heart disease is adherence to the regimen. With compensated heart defects, it is recommended to sleep 9-10 hours, daytime rest in bed for 1-2 hours. Pregnant women with symptoms of circulatory disorders are placed in a hospital, where, depending on the degree of heart failure, semi-bed or bed rest is determined.

In the complex therapy of rheumatic heart disease in a pregnant woman, therapeutic nutrition is of great importance. In the acute period of the disease, nutrition should be sparing. The total calorie content should be slightly higher than recommended for healthy pregnant women. Proteins, mainly animals, are given at the rate of 1-1.5 g per 1 kg of weight, fats - only 50-60 g. One third of the fats should be vegetable oils. The amount of carbohydrates should be limited to 400-500 g. In the absence of repeated attacks of rheumatism, the duration of stay on a sparing diet is 2-4 weeks. In the future, the diet is expanded by introducing additional proteins and fats into it with the same amount of carbohydrates. Food must be fortified.

Pregnant women in whom heart disease is accompanied by anemia should be given iron-containing foods (buckwheat, pomegranate juice, apples, pears, etc.) and foods that are dominated by potassium salts that help remove excess fluid from the body (potatoes, raisins). , dried apricots, melon, watermelon, etc.). Fluid intake is limited to 800 ml per day, the salt content in food is up to 2.5 g.

In the treatment of pregnant women with rheumatic heart disease, cardiac, antirheumatic and sedative drugs are prescribed. Antirheumatic therapy includes acetylsalicylic acid (1 g 4 times a day), prednisolone (15-20 mg per day) or triamcinolone in an equivalent dose. At the same time, high doses of ascorbic acid (0.5-1 g per day) and potassium preparations are used. In the first 7-10 days of treatment, penicillin is prescribed at 600,000 units per day. The choice of cardiac agents depends on the form of heart disease, the stage of circulatory disorders, the presence of changes in rhythm and conduction, as well as the timing of pregnancy.

If intensive drug therapy does not give the desired effect (more often in patients with degree III-IV mitral stenosis), mitral commissurotomy can be performed during pregnancy. In patients in serious condition with a long gestation period, the question may arise of the need for urgent commissurotomy for health reasons.

Hypertonic disease. The diagnosis of hypertension during pregnancy is based on the following signs: 1) early (in the first 4 months) increase in blood pressure; 2) high blood pressure in the absence of edema and proteinuria in the second half of pregnancy. When making a diagnosis, it is necessary to differentiate hypertension from symptomatic hypertension, chronic nephritis, late toxicosis of pregnancy.

The complication of hypertension by late toxicosis of pregnancy dramatically worsens the prognosis. The issue of early delivery is decided together with the therapist.

Therapy of hypertension in pregnant women is carried out individually and depends on the stage of the disease. A protective regimen, diet therapy and drug treatment are needed. Psychoprophylactic preparation for childbirth and labor pain relief are important. In case of violation of cerebral circulation during pregnancy or in childbirth, in the absence of conditions for rapid delivery through the natural birth canal, an abdominal caesarean section is indicated under general anesthesia.

With long-term follow-up after childbirth, it was found that hypertension progresses in patients with stage II diseases; at stage 1B, progression of hypertension after childbirth does not occur (see Hypertension).

Hypotension. Pregnancy with hypotension is accompanied by a number of complications. In pregnant women with hypotension, early toxicosis of pregnancy and abortion are more common.

Pregnant women with hypotension need general strengthening treatment, systematic dispensary observation. Of the medications, it is advisable to prescribe caffeine, strychnine, Chinese magnolia vine.

Blood diseases

Anemia in pregnant women it is observed very often (up to 30%). In 70-95% of cases, this is hypochromic iron deficiency anemia, other forms are much less common (see Anemia, pregnant women).

Thrombocytopenic purpura (Werlhof's disease)- the most common form of hemorrhagic diathesis during pregnancy (see thrombocytopenic purpura).

The diagnosis is based on the data of the anamnesis, clinical and hematological examination. In the anamnesis there is often an indication of hyperpolymenorrhea, which in most patients begins with menarche. Much less often, the first symptoms of the disease occur only during pregnancy.

Werlhof's disease often complicates pregnancy with late toxicosis, the phenomena of a threatening abortion.

In view of the danger of these complications, it is necessary to promptly resolve the issue of the admissibility of maintaining pregnancy. It is contraindicated to maintain pregnancy with a long course of the disease, frequent severe crises, severe thrombocytopenia. All other patients need inpatient examination, dynamic observation of an obstetrician and a hematologist. Treatment during pregnancy during the period of remission of the disease consists in the appointment of restorative agents; carry out repeated transfusions of freshly citrated blood, dry plasma, prescribe iron, antianemin, folic acid, cyanocobalamin.

In case of recurrence of thrombocytopenic purpura during pregnancy, the use of corticosteroid hormones (hydrocortisone in injections of 100 mg per day or oral prednisone 25-50 mg per day) is indicated until clinical remission occurs. During the period of bleeding, transfusions of blood and its fractions - erythro- and platelet mass are indicated. With persistent, life-threatening bleeding, an urgent splenectomy is indicated, regardless of the gestational age; after removal of the spleen, bleeding immediately stops, which makes it possible for normal delivery.

Urinary tract diseases

Cystitis during pregnancy is observed quite often. A predisposing factor is pressure on the bladder of the presenting part of the fetus, etc. The causative agents of the disease in most cases are Escherichia coli, staphylococcus aureus and other microbes. They enter the bladder more often from the urethra: in addition, the infection can be brought into the bladder by the hematogenous and lymphogenous route.

Cystitis is recognized mainly by laboratory examination of urine.

Treatment of acute and chronic cystitis in most cases leads to a rapid recovery of the pregnant woman.

Pyelitis. The causative agents are the same as with cystitis. The disease begins with a sudden rise in temperature with chills and back pain. Positive symptom of Pasternatsky. Of great importance is the detection in urine taken by a catheter from the bladder, a large number of leukocytes and pelvic epithelial cells.

The prognosis for treatment in most cases is favorable.

Nephritis and pyelonephritis may occur during pregnancy due to various infectious diseases and poisonings. Acute nephritis often leads to spontaneous abortion.

Of great practical importance is the differential diagnosis between chronic nephritis and nephropathy in pregnant women. Chronic nephritis is characterized by indications of a history of kidney disease that existed before pregnancy, and signs of the disease found in the first half of pregnancy: expansion of the boundaries of the heart, the appearance or intensification of edema, increased blood pressure, the appearance of protein in the urine, hyaline and granular cylinders. With nephropathy of pregnant women, these phenomena are usually observed in the second half of pregnancy.

All pregnant women with kidney disease, especially if the disease is not treatable or progressing, should be hospitalized in a maternity hospital to decide on the possibility of carrying a pregnancy (see Glomerulonephritis, in pregnant women. Nephropathy of pregnancy, Pyelonephritis, in pregnant women).

Diseases of the endocrine glands

In women with impaired pituitary function, pregnancy aggravates the course of the disease.

Pregnancy Itsenko-Cushing's disease occurs rarely, and if it occurs, it ends in miscarriage, premature birth, stillbirth. Pregnancy in women with impaired pituitary function is possible only with a mild degree of the disease.

Hypothyroidism (myxedema) often leads to female infertility. Latently flowing myxedema is often the cause of miscarriage. In cases where pregnancy continues, the birth of children with goiter and cretinism is often observed.

Thyrotoxicosis is also one of the causes of female infertility. If a woman with an elevated thyroid function becomes pregnant, the course of thyrotoxicosis usually worsens, although there are cases when pregnancy improves the course of the process. Often, the course of thyrotoxicosis becomes so severe that it becomes necessary to terminate the pregnancy. An important task is the timely diagnosis of thyrotoxicosis; it is necessary to differentiate this pathological condition with a physiological increase in basal metabolism in order to start treatment on time.

It is necessary to prescribe therapeutic agents in such a way that the basal metabolism is kept on the figures corresponding to those during physiological pregnancy, that is, that it increases by no more than 15-20%. Prescribe iodine preparations in small doses (2 times a day, 3 drops of Lugol's solution) to avoid the formation of goiter in a newborn. In hyperthyroidism, treatment should continue after childbirth.

Diabetes has an adverse effect on the course of pregnancy and childbirth. Pregnancy, in turn, has a negative impact on the course of diabetes (see Diabetes diabetes, pregnancy).

Toxicosis of pregnant women

Toxicosis of pregnant women - pathological conditions that arise in connection with pregnancy and after its completion are gradually completely eliminated. Toxicosis can occur both in early and late pregnancy. The most common forms of early toxicosis of pregnant women include: vomiting (see Vomiting, pregnant women), salivation (see Ptyalism), dermatoses (see), late dropsy of pregnant women (see), nephropathy of pregnant women (see), preeclampsia and eclampsia (see).

Isoserological incompatibility between the mother and fetus. In some cases, fetal cells (erythrocytes, leukocytes, organ cells) can be antigens that, when they enter the mother's body, lead to the production of antibodies and immunoconflict. The isoserological incompatibility of the blood of the mother and fetus according to the Rh factor (see) and the AB0 system has been studied in more detail.

Allergy

Communication between pregnancy and an allergy (see) can be considered in two aspects: 1) the course of allergic diseases against pregnancy and 2) a role of an allergy in emergence of complications of pregnancy and a possibility of a fetal sensitization.

It has been established that many allergic and autoallergic diseases can disappear during pregnancy, sometimes their manifestation is significantly weakened, and in some cases the patient's condition worsens. Cases of a positive effect of pregnancy on the course of bronchial asthma, allergic rhinitis, Quincke's edema, migraine, primary fibrous osteitis, intermittent hydrarthrosis, rheumatoid arthritis, arthritis in psoriasis, ankylosing spondylitis are described. The most studied effect of pregnancy on the course of rheumatoid arthritis. Improvement in the course of the disease occurred already at the end of the first month of pregnancy or at the end of the first third of pregnancy. The resumption of the disease was observed within the first month after delivery and was not associated with either the resumption of menstruation or the cessation of lactation.

If improvement occurred during the first pregnancy, then it was usually observed in subsequent ones. It was shown that the administration of estrogen, relaxin, progesterone, human chorionic gonadotropin, transfusion of blood from pregnant women or cord blood, although in some cases led to an improvement, did not provide the same effect that was observed during pregnancy. Only the introduction of glucocorticoids gave a pronounced therapeutic effect in allergic diseases.

It is known that during pregnancy, the concentration of cortisol in the blood increases significantly; this is due to both an increase in its formation and a decrease in metabolism. A few days after birth, cortisol levels drop to normal. At the same time, an increase in the concentration of cortisol in pregnant women is accompanied by an increase in its binding to transcortin, which reduces the physiological activity of cortisol. At the same time, the free (not associated with transcortin) fraction of cortisol is slightly higher than normal. With this, obviously, the favorable effect of pregnancy on the course of allergic diseases is associated. The influence of cortisol is not the only reason for improvement in the course of allergic diseases; it acts together with other humoral factors, the ratio of which can change the final effect.

On the other hand, sensitization of the fetus and the occurrence of pregnancy complications due to the inclusion of allergic mechanisms are possible. The placenta (see) protects the fetus, which contains many foreign antigens, from the effects of the mother's immune mechanisms. It selectively passes immunoglobulins of various classes. In humans, almost only class G immunoglobulins (IgG) are actively transported. Other classes of immunoglobulins (A, E, M), as a rule, do not cross the placental barrier. This determines the nature of antibodies passing through the placenta and the possibility of fetal sensitization. Since IgE do not pass through the placenta, therefore, there is no transition of reagins (see Antibodies, allergic) and atopy-type sensitization (see). Therefore, in this case, there is no passive transmission of hypersensitivity, which is based on the reagin mechanism. Antibodies are transferred to fetus c, which can cause fetal sensitization. Female guinea pigs sensitized with horse serum or egg white give birth to offspring with hypersensitivity to these allergens. Obviously, such passive sensitization is also possible in pregnant women if they are given antitoxic sera. On the other hand, the foreign protein itself, which is antitoxic serum, can cross the placenta. In studies on rabbits and guinea pigs, it was found that fetal membranes pass heterologous anti-tetanus and anti-diphtheria antibodies (antitoxins). Compared with them, homologous antibodies pass through the placenta better. Enzymatic digestion of the homologous antitoxin disrupted its ability to pass through the placenta in guinea pigs and completely removed this ability from the heterologous antitoxin. The introduction of enzymatically processed diphtheria antitoxin into pregnant women with diphtheria did not lead to its appearance in blood taken from the umbilical cord. The development of hemolytic disease of the newborn is associated with the same class of immunoglobulins (see). A certain role belongs to allergic, exactly autoallergic, mechanisms in the development of such complications as spontaneous abortion (see), toxicosis of pregnant women (see). The role of allergies in the development of spontaneous abortion can only be hypothesized when it begins against the background of an allergic disease. With toxicosis of the second half of pregnancy, many researchers found autoallergens and antibodies to the placenta and fetal tissues in the blood of pregnant women. Anti-placental antibodies can sometimes cause damage to the glomerular apparatus of the kidneys.

Mental disorders during pregnancy

Psychoses in pregnant women are observed in 3-14% of cases. They can occur in both normal and abnormal pregnancy. Psychosis during pregnancy does not represent any special form. In the first half of pregnancy, perversions of taste, smell, drowsiness, changes in libido, etc. are found, often accompanied by low mood with tearfulness, irritability or lethargy. In the second half of pregnancy, in some cases, there is a shallow depression with disturbing fears about the outcome of childbirth.

In psychopathic personalities, under the influence of unfavorable circumstances or autochthonously throughout pregnancy, distinct affective phases can occur in the form of anxious or inhibited depression, depression with fear, increased psychopathic personality traits, and disorders in the form of obsessive phenomena. Hypomanic states during pregnancy are less common. With hypomania, general well-being improves, patients become sociable, optimistic. Delusional psychoses usually occur in the second half of pregnancy. They can occur at any age and are equally common in primiparas and multiparas. Psychoses occur in the form of depression with anxiety or depressive-delusional phenomena. There are also oneiroid-catatonic disorders.

Affective disorders and psychosis during pregnancy often precede the onset of postpartum psychosis. The described mental disorders in some cases may be the debut of schizophrenia or manic-depressive psychosis. Approximately in 1/4 of cases, the emerging mental disorders represent an exacerbation of an earlier pathological process.

Eclamptic and choreatic psychoses of pregnancy, as well as polyneuritis of pregnant women associated with vitamin deficiency, are very rare as a result of the timely prevention of such complications.

The course of epilepsy during pregnancy is usually worsened. The increase in seizures in some patients is an indication for termination of pregnancy.

The etiology and pathogenesis of mental disorders during pregnancy are associated with changes in the hormonal balance of the body and heredity. Undoubtedly, psychogenic traumas have an impact.

Treatment: in case of severe mental disorders requiring active specific therapy, termination of pregnancy is necessary. Mental disorders are eliminated under the influence of sedatives and psychotherapy.

X-ray examination during pregnancy

Davis (1896) and Levi-Dorn (1897) were the first to use the X-ray method of research during pregnancy. X-rays for the diagnosis of pregnancy during the first two decades after their discovery, due to the imperfection of the equipment, were rarely used and only to determine the presence of pregnancy. In the future, in connection with the improvement of X-ray equipment, the method began to be used to diagnose various pathologies of pregnancy.

The total dose of radiation on modern x-ray machines with 2-3 images varies between 0.5-3 r, which, according to almost all foreign and domestic researchers, does not have a harmful effect on the course of pregnancy and fetal development. However, X-ray examination during pregnancy should be carried out only under strict indications, when it is difficult to make a correct diagnosis using conventional clinical methods of examination.

The X-ray method of research is used to determine the shape and size of the pelvis of a pregnant woman with anomalies of its development and pathological changes in the bones of the pelvis, to establish the proportionality of the head of the fetus and the pelvis of the pregnant woman if their mismatch is suspected, to recognize placenta previa, deformities and intrauterine death of the fetus, ectopic (abdominal ) late pregnancy, to determine the multiple pregnancy, the presenting part of the fetus, when it is impossible to establish this by other methods, to determine the maturity of the fetus.

When examining pregnant women, only radiography is used, since the shadow of the skeleton of the fetus is not detected during transillumination.

In early pregnancy, X-ray of the pelvis is used in direct and lateral projections, which allows detecting pregnancy only from the 16-18th week, hysterosalpingography (see Metrosalpingography), pneumopelvigraphy (see Pelvigraphy) and radiography of the mammary glands (see Mammography). However, all of the above methods of research find very limited application in practice due to the fact that it is undesirable to irradiate the embryo in the early stages.

Rice. 10. The position of the pregnant woman in a direct survey image. Rice. eleven. The position of the pregnant woman in the side view (in Fig. 10 and 11, the arrow indicates the direction of the central beam).

Direct radiographs can be made in the position of a woman on her back and on her stomach (Fig. 10), the latter is preferable, as it allows you to get more distinct images, reduces the radiation dose. The side picture is taken in the position of the pregnant woman on her side, in the first position - on the left, in the second position - on the right (Fig. 11). It is desirable to take photographs at maximum voltage, sufficient radiation intensity and low shutter speed, on the film of the highest sensitivity using intensifying screens with the highest luminous intensity. Pictures are taken on films measuring 30 X 40 cm on a deep exhalation, with the abdomen drawn in, in the absence of contractions and fetal movement.

The main task of X-ray examination in late pregnancy is the diagnosis of various pathologies. This method allows to establish with great accuracy various types of deformities and anomalies of the fetal bone skeleton, the degree of placenta previa, the presence of an ectopic (abdominal) pregnancy in the later stages, intrauterine death of the fetus, as well as to determine the shape and size of the pelvis, the proportionality of the head of the fetus and the waist of the pregnant woman. You can also diagnose changes in the pubic joint during pregnancy and in the postpartum period, etc.

To determine placenta previa, various radiological methods are used, each of which has its own positive and negative sides. Method Muller, Holly in 1930 for the first time used amniography for the diagnosis of placenta previa. The essence of the method is to identify a defect in the filling of amniotic fluid after the preliminary introduction of low-toxic water-soluble contrast agents into the amnion cavity through the anterior abdominal wall. At the same time, the amniotic fluid contrasts quite well and absorbs X-rays to a greater extent than other tissues. The radiograph clearly shows the shadow of the skeleton of the pdoda and the location of the placenta in the form of a crescent against the background of amniotic fluid. However, this method is too dangerous due to the possibility of needle damage to the fetus itself and large vessels of the uterus and umbilical cord during injection. In addition, a contrast agent introduced into the amniotic fluid sometimes causes premature birth, and in some cases, the death of iodine. The combined technique - radiography of the soft tissues of the abdomen and pneumocystography (see Cystography) - is simpler, very evident and does not give any complications. With this technique, the radiographic signs of placenta previa are: expansion of the vesicocephalic space up to 5-7 cm, thickening of the lower parts of the anterior or posterior wall of the uterus, displacement of the presenting part of the fetus upwards, increasing the distance from the presenting part of the fetus to the cape of the sacrum or the anterior edge of the pubic bones.

To measure the size of the pelvis and the proportionality of the head of the fetus and the pelvis of the mother with X-ray pelvimetry (see Pelvimetry), various scales are widely used. This technique is simple, accurate and widely available. X-ray pelvimetry is indicated if there is a suspicion of a discrepancy between the sizes of the fetal head and the pelvis of the pregnant woman, with congenital and acquired pathological changes in the bones of the pelvis, spine and lower extremities.

Recognition of fetal deformities by clinical research methods is possible only in exceptionally rare cases, therefore, the use of the X-ray method for this purpose, as more reliable and highly conclusive, is fully justified. With its help, deformities of the skull (hydrocephalus, anencephaly), double deformities (fused twins, a fetus with two heads, a two-faced fetus), etc. are recognized.

X-ray diagnosis of intrauterine death of the fetus has reached great perfection (see. Intrauterine death). More than 20 radiological signs of this pathology have been described, based on changes in the bones of the skull, the position of the spine and limbs of the fetus, the presence of gas in the cavity of his heart, in large vessels, etc.

X-ray method can be used to diagnose ectopic abdominal pregnancy in the later stages. The reason for this is the following radiological signs: the absence of shadows of the pregnant uterus and fetus in their normal position, the unusual arrangement of parts of the fetus, the absence of a shadow of the uterus and placenta around the fetus; with hysterosalpingography - the presence of a shadow of the uterine cavity filled with a contrast agent and at some distance from it the shadow of the fetal skeleton.

The X-ray method of research also makes it possible to diagnose a combination of intrauterine and ectopic pregnancy in the later stages, when there is a live fetus in the uterine cavity, and a mummified or calcified fetus in the abdominal cavity.

Forensic Pregnancy

The reasons for the appointment of a pregnancy examination are varied. The practical activity of a forensic medical examination is usually reduced to solving the following issues: recognizing the presence of pregnancy, determining its duration, analyzing pregnancy complications and causes of death (especially sudden) of the mother and newborn (stillborn), detecting evidence of a former pregnancy.

Forensic medical examinations of women during the examination of pregnancy have specific features and difficulties in comparison with general obstetric practice. Since in the forensic medical determination of the presence and course of pregnancy, anamnestic data can sometimes be incomplete, misunderstood by a woman, or even deliberately distorted, it is mandatory for an expert to rely only on objective data as the basis for his conclusions. The appearance in a woman of nausea, vomiting, special taste and olfactory sensations and various functional disorders of the nervous system (changes in sleep, mood, excitability), especially in combination with a delay in menstruation, can lead a woman to the assumption of pregnancy. Sometimes the named phenomena and sensations are absent at undoubted pregnancy. Distortion of anamnesis is committed both in order to simulate pregnancy, and in an attempt to conceal it. When recognizing pregnancy, a forensic expert most often has to examine a woman only if she has probable signs of pregnancy. In a diagnostic assessment, one should always take into account not one any sign, but necessarily their complex in relation to the general condition of the woman's body. In the early period of pregnancy, hormonal and biological reactions with a critical analysis of their results are appropriate for examination. In late pregnancy, when there are reliable signs, expert and obstetric practice are the same.

Examination of the presence of pregnancy is carried out when considering issues of punishment or postponement of the execution of a sentence (Articles 23, 25, 26, 38 of the Criminal Code of the RSFSR and 361 of the Code of Criminal Procedure of the RSFSR and the corresponding articles of the Criminal Code and Code of Criminal Procedure of the Union Republics); when committing the murder of a pregnant woman as an aggravating circumstance (Article 102 of the Criminal Code of the RSFSR and the corresponding articles of the Criminal Code of the Union Republics); during examination in connection with sexual crimes, when pregnancy is one of his evidence (Articles 117-120 of the Criminal Code of the RSFSR and the corresponding articles of the Criminal Code of the Union Republics); when initiating maintenance claims and in cases of termination of marriage; in cases of refusal to hire women or dismissal due to pregnancy (Article 139 of the Criminal Code of the RSFSR); in case of violation of the legislation on benefits and allowances for pregnancy and on the right of pregnant women to switch to easier work.

An expert usually has to determine the normal course of a diagnosed pregnancy when qualifying the severity of bodily injuries, when it is necessary to decide whether the termination of pregnancy occurred as a result of an injury (Article 108 of the Criminal Code of the RSFSR and the corresponding articles of the Criminal Code of the Union Republics). In this case, the expert is obliged to exclude the simulation of a violation of pregnancy. Termination of pregnancy may become an object of examination in cases of spontaneous and induced abortion. When examining the presence and course of pregnancy, there are cases when a woman, in the presence of probable, and sometimes reliable signs, does not consider herself pregnant (unconscious pregnancy). This may be due to sexual intercourse in an unconscious state (in particular, when intoxicated), in persons with mental disabilities and with incomplete sexual intercourse.

The determination of the gestational age is made when alimony claims and divorce cases are initiated, as well as when investigating abortion cases. The conclusions are based on ordinary obstetric data, but with their careful analysis. To determine the gestational age in the event of a woman's death, the following are taken into account: the condition of the uterus, its microscopic examination, the length of the fetus, and changes in the corpus luteum. The question of the examination of the duration of pregnancy practically means the determination of the calendar term of conception according to the data on the term of delivery. In this case, a reliable and categorical conclusion is usually not possible, since the duration of pregnancy, ending with the birth of a mature full-term baby, is subject to fluctuations below and above the average gestation duration of 280 days.

It may be useful for an expert to compare medical data from the antenatal clinic and the maternity hospital with the materials of the investigation. This analysis may reveal inconsistencies between medical records and the testimony of the defendants (for example, in cases of so-called disputed paternity).

Observed during pregnancy, complications and the onset of death are often the object of forensic medical examination. In this case, hydatidiform drift, ectopic pregnancy and eclampsia, especially its non-convulsive form, are of the greatest importance. In these cases, a forensic medical examination is appointed to resolve the issue of the presence of a medical error, negligence or failure to provide proper medical care. Symptoms preceding the onset of death in eclampsia or rupture of the fallopian tube during ectopic pregnancy, in their nature and rapid increase in threatening phenomena, are similar to the development and course of some poisonings and injuries. This creates the need for a forensic examination of the woman's corpse.

In pregnant women in the presence of pathological processes, especially the cardiovascular system (mitral valve stenosis, congenital malformations, myocarditis, hypertension, etc.), death can occur suddenly. Cases of sudden death due to spontaneous uterine ruptures are known.

An examination of a former pregnancy is carried out when investigating cases of criminal abortion, suspected infanticide (Article 103 of the Criminal Code of the RSFSR and the corresponding articles of the Criminal Code of the Union Republics), kidnapping or substitution of a child (Article 125 of the Criminal Code of the RSFSR and the corresponding articles of the Criminal Code of the Union Republics), deliberate abandonment of a baby without help - throwing up (Article 127 of the Criminal Code of the RSFSR and the corresponding articles of the Criminal Code of the Union Republics). The establishment of a former pregnancy that ended in abortion (see) is reduced to the diagnosis of early signs of pregnancy.

When examining a pregnancy that ended in childbirth, signs of recent or long-term childbirth are established; the basis for the conclusions are obstetric data observed after childbirth and in the nearest future - up to 6 weeks (discharge from the vagina, uterine involution, the presence of mammary secretions, etc.), as well as changes that remain in a woman as a consequence of pregnancy and childbirth (change in the shape external os of the uterus, the presence of scars on it, scars on the perineum, "pregnancy scars", etc.). The value of these signs as evidence varies, some of them may not be related to childbirth, such as "pregnancy scars". An expert conclusion always requires a set of features, and not just one of them. If an examination of a former pregnancy is carried out during the examination of a woman's corpse, then the same data are used as in the examination of living persons, but with the obligatory use of microscopic examination of the relevant objects.

Pregnancy in animals

Pregnancy in animals begins with the moment of internal fertilization of the egg and ends with the birth of a live young. Pregnancy has been described in some lower vertebrates: fish (eelpout, rays, sharks and some carps) in amphibians (alpine salamander); in higher vertebrates: reptiles (vipers, viviparous lizard) in mammals. In reptiles, the same species under different conditions can be viviparous and oviparous. In most reptile fish, during development, the embryos are not connected with the mother's genital tract and feed on the yolk of the egg. However, in some species of fish (sharks), amphibians (salamander) and reptiles (viviparous lizard), a yolk placenta of various forms forms during pregnancy.

In marsupial mammals, it is short and not as complex as in higher ones. So, in a giant kangaroo, pregnancy lasts only 39 days and the cub is born underdeveloped and small; its further development proceeds (about 8 months) in a bag on the mother's stomach.

Pregnancy in higher mammals is a complex process of intrauterine development of the embryo, which is accompanied by significant morphological and physiological changes in the maternal organism, aimed at creating the necessary conditions for bearing the fetus. The early stages of development of the zygote (fertilized egg) pass in a free state. This is followed by attachment of the embryo to the wall of the uterus (in ungulates, cetaceans, lemurs, proboscis) or its introduction into the wall of the uterus (part of insectivores, rodents, great apes), at the same time the placenta is formed. In animals of different systematic groups, a placenta of different types and types is formed (see. Placenta).

The duration of pregnancy in different mammals varies greatly. So, in mice pregnancy lasts 19-20 days, in elephants 660 days.

There is a certain relationship between the duration of pregnancy and the level of maturity of the newborn, the environmental conditions in which this species lives, as well as the size of the animal. Depending on these factors, embryos in different animals develop at different rates and reach different levels of maturity. In small animals pregnancy is shorter than in large ones. So, pregnancy in a squirrel is 35 days, while in a larger beaver it is 90 days; the duration of pregnancy in a sheep is 150 days, and in humans 280 days. Meanwhile, in terms of development, the newborn lamb is significantly superior to the newborn child. The lamb soon after birth is able to follow the mother; the child acquires this ability only a year after birth. The duration of pregnancy can vary even in the same species of animal, depending on the breed, the number of fetuses in the litter, the time of year, the sex of the fetus, and other factors. For example, pregnancy in early maturing breeds of horses, sheep, and pigs is shorter than in late maturing breeds of the same animal species. Domestic animals (pigs, sheep, goats) have a shorter gestation period than their wild ancestors. With multiple pregnancies in sheep and cows, childbirth occurs a few days earlier. Female offspring are worn somewhat longer than female offspring. Depending on the environmental conditions, pregnancy can be lengthened due to the onset of a latent period (a temporary delay in the development of the embryo at the blastocyst stage, which is observed in some animals: roe deer, sable, marten, mink, ermine, badger, bat, bear, etc.).

In the process of evolution, different animals in the struggle for the existence of the species developed different fecundity. So, in large animals (cetaceans, proboscis, rhinoceroses, corns, horses), pregnancy is long, singleton. In other species - ungulates (saiga, sheep, goat, pig) and predatory animals, a shortened multifetal pregnancy (several fetuses in one litter) is observed. In rodents, multiple and multi-litter pregnancy is observed, that is, the animal brings several many fetal litters in one breeding season. In armadillos (armadilus), multiple pregnancy occurs by the formation of several embryos from one zygote (the phenomenon of polyembryony).

External signs of pregnancy in an animal are expressed in the cessation of estrus and sexual hunting, a change in the behavior of the animal, an increase in appetite, an increase in the volume of the abdomen and mammary glands; by the end of pregnancy, the abdomen sags, the groin sinks and the vagina swells.

Bibliography:

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Physical education of pregnant women

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pregnancy and allergies

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X-ray examination for B

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B. forensic

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B. in animals

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G. M. Savelyeva; II. n. Demidkin (rents.), T. S. Zaichkina (psychiat.), I. V. Ilyin (path. physical.), A. G. Knorre (ambr.), K. M. Kurnosov (biol.), V. I. Pytskyi (allerg.), V. M. Smolyaninov (court.), G. S. Fedorova (to lay down. physical.).