What refers to the pathology of pregnancy. Causes and symptoms of pregnancy pathology: diagnosis and prevention. Prevention of hereditary pathologies

18.04.2019

During pregnancy, many women experience various pathological complications that endanger not only the life of the fetus, but also the mother. Among the most common complications are fetal underdevelopment, maternal anemia, ectopic pregnancy, fetal hemolytic disease, toxicosis. Competent monitoring of the course of pregnancy allows you to timely identify this or that pathology and provide timely assistance.

Pregnancy risk assessment

The main point in obstetric practice during pregnancy monitoring is to assess the risk of pregnancy. This takes into account all factors that can affect the health of the expectant mother and the course of pregnancy in general.

Socio-biological factors affect the pregnancy of women over 30 years of age. This can also include bad habits, and not only of a woman carrying a fetus, but also of a father. In this group, the third place is occupied by harmful working conditions, which can cause increased risk chromosomal diseases developing fetus.

Obstetric and gynecological aspect. This information determined by interviewing and examining a pregnant woman. This group includes those more than 4 abortions, the first abortion before childbirth, an abortion between two pregnancies, giving birth to dead children. This includes women suffering from various gynecological diseases and those who have been diagnosed with infertility. This group also includes those who have had a fetal disease in previous pregnancies.

Frequent pathologies

The most common complication of pregnancy is anemia. Moreover, in most cases, premature birth is observed. If the pregnancy can be maintained, then there is a risk of fetal development disorders due to lack of oxygen.

What causes anemia? As a rule, it manifests itself in the body of a woman in labor due to a lack of minerals and vitamins. In this case, it is necessary to revise the diet and add food with an increased amount of vitamins to the menu. And if the products do not have the required amount nutrients, then it is necessary to drink vitamins that have elements missing for a woman (iron, folic acid).

The consequence of all kinds of developmental disorders intrauterine fetus is the underdevelopment of the fetus. These disorders are a consequence of various diseases of a woman, which have negative influences on the development of the fetus. One example is a disease such as cretinism, which occurs when there is a lack of hormones. thyroid gland or lack of iodine. As a result of calcium deficiency, skeletal growth is impaired, which also leads to fetal pathology.

Among other pathologies, an ectopic pregnancy can be noted, in which the attachment and development of the embryo outside the uterus occurs. In this case, the growth of this embryo leads to rupture of the fallopian tube. This pathology is caused by various diseases of the genital organs. This also includes toxicosis, which is common in pregnant women. It occurs when there is a metabolic disorder of a woman carrying a fetus.

The pathology of pregnancy is complications during the period of gestation that arise as a result of gestation and lead to a violation of its natural course. On initial stage they are asymptomatic, and when the disorders develop, the pregnant woman begins to complain of algia in the abdominal region, discharge, edema, migraines and lack of fetal movement.

To diagnose the problem, ultrasound, tests, invasive prenatal diagnostics, MRI pelviometry, and more are used. Depending on the state of the expectant mother and baby, therapy may be aimed at both preserving and artificial interruption bearing the fetus.

Pregnancy pathology: Common types

Based on obstetric statistics, only 50% of pregnancies proceed without problems and complications. Gynecologists most often have to deal with:

Toxicosis;
Miscarriages;
Premature birth;
The birth of children with deep prematurity;
Babies with disabilities;
Low water;
Preeclampsia and eclampsia;
Gestosis;
Placenta previa.

Other types of pathologies are extremely rare.

What provokes the appearance of pregnancy pathologies

Complications arising at the stage of gestation are provoked by many factors, both from the unborn baby and from the maternal body.

The most common pathological conditions are:

Extragenital somatic pathology - if a woman has problems with the cardiovascular system or suffers from chronic kidney disease, she may develop late gestosis. In addition, these problems can exacerbate any existing chronic ailments.
Endocrinopathy - if the hypothalamic-pituitary regulation and the endocrine functional of the ovaries are disturbed in the expectant mother, then there is a violation of the implantation process of the egg, and the contractility of the inner layer of the walls of the uterus also changes. The presence of diabetes leads to microcirculatory abnormalities both in the female body and in the baby's placenta.
Gynecological ailments of the inflammatory type - if a woman has salpingitis, endometritis or adnexitis, serious risks arise ectopic pregnancy... In chronic cervicitis, cervical insufficiency may occur. And with ailments infectious etiology, there are risks of infecting the unborn baby in utero.
Abnormalities of uterine development - if the uterus has a septum or it is infantile, bicorn or saddle-shaped, then these deficiencies often provoke miscarriages, premature birth, placental abruption and insufficiency, as well as oxygen starvation of the fetus.

Pathology of pregnancy or complications of childbirth in the past

Postponed premature birth or spontaneous abortion with past pregnancy leads to early miscarriages. If you have scarring on your cervix from a previous birth, your current pregnancy can be complicated by a ruptured uterus and severe bleeding, especially if it is multiple.

Leakage, polyhydramnios and late toxicosis - such problems often concern women with multiple pregnancies and can lead to miscarriage.
Ailments of infectious etiology - diseases provoked by viruses or bacteria can lead to miscarriage or premature birth, exacerbate chronic ailments, aggravate existing gestosis, and also cause intrauterine infection or inflammation of the membrane fetal bladder.
Immunological problems - often miscarriage is observed with Rh-conflict or with antiphospholipid syndrome in the expectant mother.
Genetic abnormalities in the fetus - the most common cause of early miscarriage is chromosomal abnormalities that make the embryo unviable.
Iatrogenic complications - performed amniocentesis, placental biopsy, amnioscopy, cordocentesis, or performed cervical suturing, can lead to rupture of the membranes and premature birth, or intrauterine infection.

To additional, causing pathology factors include bad habits and an asocial lifestyle. The risk of developing a pathological course of bearing a fetus is in women who have not reached the age of majority or in those who have crossed the thirty-five-year milestone, are obese, lead a sedentary lifestyle, experience excessive psycho-emotional and physical stress.

Pathology of pregnancy: classification of complications

The classification of pathologies of bearing a fetus is based on who is the carrier of the abnormalities and at what level they have arisen - in the expectant mother, in the child, in the embryonic structure or in the "fetus-mother" system.

The most common complications are:

Ailments and conditions arising from bearing a fetus ... They are presented gestational diabetes, early toxicosis, thyrotoxicosis, late gestosis, anemia, varicose veins. Since pregnancy leads to functional changes in the kidneys, it may develop urological diseases inflammatory nature.
Complications of pre-existing diseases ... Since during pregnancy there are significant loads on the body, they lead to an exacerbation of chronic somatic and endocrine pathologies, represented by hypertension, thyrotoxicosis, diabetes, hypothyroidism, gastrointestinal diseases and hypertension. In some cases, renal or heart failure develops.
Threatened miscarriage and miscarriage ... Pregnancy in this case ends with the early birth of the baby or early or late miscarriage.

Ectopic pregnancy

Pathology when fetal egg is implanted not into the uterine cavity, but into the fallopian tube. In this case, the embryo develops, grows and leads to rupture of the tube and severe internal bleeding, which without proper medical care ends in death.

Genetic defects ... Abnormalities at the genetic level lead to malformations, miscarriages and serious illnesses the unborn child.
Intrauterine infection ... Infection with viruses or bacteria occurs as a result of the expectant mother's negligence towards her health and untimely access to a specialist. As a result of infection, a miscarriage may occur, pathology may develop, a pregnancy may be terminated, or problems may arise during childbirth.
Oxygen deficiency of the fetus ... A similar condition develops during hypoxia, which causes ischemia and necrotic changes in various organs. As a result of such problems, the fetus develops pathology or the child is born dead.
Hypotrophy ... If the baby is lagging behind in development, he may develop birth hypoxia, he will not be able to breathe on his own, after childbirth, his thermoregulation will be impaired, the brain is damaged, or pneumonia will develop, which is fraught with death.
Presentation ... If the child has oblique or breech presentation, then complications may arise during childbirth, therefore, to avoid them, cesarean section.

Frozen pregnancy

With intrauterine fetal death, serious inflammatory pathologies develop in the uterine cavity up to peritonitis and blood poisoning, which can result in the death of a woman.

Placental pathology ... In the tissue structures of the placenta, cystic or tumor formations, infectious and inflammatory processes, as well as various anomalies can develop, leading to an increment of the placenta to the uterine wall, its detachment or presentation.
Umbilical cord pathologies ... Untreated diseases of infectious etiology lead to the development of inflammation of the umbilical cord, as a result of which it can shorten, lengthen, and also cysts, nodes and hematomas can form in it.
Pathologies of the membranes of the membranes ... In case of problems with the fetal sac, chorioamnionitis, water leakage, a lot or lack of water and premature rupture of the amniotic fluid may develop.
Placental insufficiency ... This complication leads to disturbances in the structure and function of the placenta, which provokes fetal death, hypoxia or malnutrition.
Rhesus conflict ... When there is this state the erythrocyte cells of the child begin to collapse and hemolytic jaundice develops.

If complications are found, first of all, you should take into account the time when they appeared. Complications are early and they lead to miscarriages, as well as late ones, which affect the course of gestation and the development of the unborn baby.

Symptoms of pregnancy pathology

Despite the fact that there is a certain connection between some pathologies and the gestational age, there are symptoms that indicate the presence of complications. The first symptom manifests itself in algia in the abdominal region, which can radiate into lumbar... It occurs with an ectopic pregnancy, the threat of termination and premature birth... Dizziness, weakness, and in some cases future mom may pass out. If a woman has an ailment of inflammatory etiology, then an increase is also added to the pain. temperature indicators.

In case of miscarriage, premature birth, placental abruption or presentation, the pregnant woman is disturbed bloody issues... Purulent can appear with inflammation, and watery with leakage or outpouring of amniotic fluid.

If we judge sensibly, then when carrying a fetus, any negative changes in a woman's condition can be a symptom of possible pathologies. The first trimester is characterized by toxicosis with vomiting and nausea. With gestosis at the end of the second - beginning of the third trimester, migraine appears with localization in the occiput, swelling of the lower extremities, nausea, dizziness and vomiting.

An increase in temperature indicators indicates the presence of ailments of an infectious etiology or their complications. Extragenital pathology of pregnancy is manifested by dry mouth, tachycardia, heartburn and varicose veins.

If pathologies are observed not in the mother, but in the baby, this can be determined by the frequency of movements. If future baby does not move for more than four hours and does not respond to irritants, you should immediately consult a doctor. Frequent movements are also evidence of deviations such as hypoxia.

Diagnosis of pathologies

If a gynecologist suspects that a woman has pathologies of bearing a fetus, she is sent for examination in order to determine the type and degree of violations.

Diagnostic techniques are presented:

Outdoor obstetric research to determine the size, shape and tone of the uterus, as well as areas of pain;
Examination with mirrors. The gynecologist assesses the mucous membrane of the cervix and vaginal walls, as well as the presence of discharge;
Microscopy and bacterial cultures. These analyzes are carried out in order to identify the causative agents of diseases of infectious etiology;
Organ ultrasound examination pelvic floor... With the help of ultrasound, the doctor determines the size of the uterus, the condition of the walls of the organ and assesses the size of the fetus, umbilical cord, placenta and volume amniotic fluid;
MRI pelviometry. This screening is necessary for abnormalities in the development of the unborn baby and the fetal bladder;
Invasive prenatal diagnosis... With its help, the condition of the membranes of the fetus is assessed, genetic abnormalities in the development of the baby and the volume of amniotic fluid;
Non-invasive rapid tests. They are carried out to diagnose ectopic pregnancy and leakage of amniotic fluid;
A standard set of laboratory tests. To determine the level of certain hormones, as well as to identify placental disorders and pathologies in the fetus;
Torch complex. Screening is necessary to identify infectious diseases affecting the fetus in utero;
Doppler ultrasonography of blood flow in the uterus and placenta. Allows to assess transplacental hemodynamics;
Cardiotocography. It is necessary for the examination of cardiovascular ailments in a child, as well as the presence of hypoxia;

To track the dynamics of the state of the future mother and the work of her body, general analyzes blood and urine tests, pressure control, electrocardiogram and consultation with the necessary specialists.

Therapy for pathologies of bearing the fetus

Treatment of the pathology will depend on its nature, the presence of complications, as well as the risks to the fetus and the expectant mother.

If the baby's condition does not cause any concern, and there are no threats to the woman's life, therapy will be prescribed that allows you to preserve, carry the child, consisting of:

Hormonal drugs that allow you to normalize the concentration of hormones in the female body;
Tocolytics, which reduce the contractions of the inner layer of the uterus;
Antibacterial agents for the destruction of pathogenic microflora;
Anti-inflammatory drugs that are prescribed for relief inflammatory process;
Glucocorticoids to accelerate fetal lung maturation;
Sedatives to relieve psycho-emotional stress.

In the presence of extragenital abnormalities, a woman is prescribed vitamins and infusion solutions. If necessary, the cervix is sutured. To eliminate phytoplacental insufficiency, drugs are prescribed that have a beneficial effect on the placental blood flow.

When diagnosing a rhesus-conflict, they write out anti-rhesus immunoglobulin... If gross malformations or intrauterine fetal death were found, cause artificial childbirth or a medical or surgical abortion is performed depending on the length of the pregnancy.

Pathology of pregnancy: Predictions and prevention

The prognosis will depend on the presence of complications and the nature of the identified pathological condition. If genetic defects or ectopic pregnancy have been found, the baby cannot be saved. In other cases, doctors try to do everything so that the expectant mother informs and safely gives birth to a baby.

As a prophylaxis for the pathologies described above, at the stage of pregnancy planning, a woman must cure all existing diseases and abandon bad habits. After diagnosing pregnancy, she should register with a gynecologist in a timely manner and follow all the recommendations given to him, in this case it will be possible to reduce the risk of pathologies to a minimum.

Unfortunately, not all women who are waiting for the addition to the family are doing well. Sometimes pathologies of the development of pregnancy are encountered, complicating this period and threatening the health of the expectant mother and baby. Such deviations include trophoblastic disease, infection of the amniotic fluid, violation of the birth membrane, inhibition of fetal growth, early activity of the uterus, etc.

Often, the pathological course of pregnancy is observed in women with an existing pathology. Pathology is paramount of cardio-vascular system pregnant women. With diseases of the cardiovascular system in pregnant women, disruptions of the processes occurring in the circulatory system are often observed. Various purchased and congenital defects heart, myocarditis, cardiomyopathy, ischemic heart disease, arterial hypertension can significantly complicate the course of pregnancy. Therefore, a woman suffering from any cardiovascular disease should be monitored by a specialist cardiologist throughout her pregnancy.

What other pathologies can occur during pregnancy is described in detail in this material.

Ectopic pregnancy

An ectopic pregnancy can also be one of the pathological changes in a woman's body during gestation. Pregnancy that develops outside the uterus, and most often in the oviduct, must be recognized and treated in advance. An ectopic pregnancy can be life and health hazardous to the expectant mother.

With such a pathological pregnancy, a woman usually has the following symptoms: severe, stabbing pain that extends to the entire abdominal cavity; frequent profuse bleeding from the vagina; nausea, vomiting, dizziness, weakness.

In case of manifestation of these symptoms of pregnancy pathology, it is important to immediately deliver the patient for consultation to qualified specialist... Recognizing an ectopic pregnancy is very important for maintaining the woman's health and the possibility of her further childbirth. This type of pregnancy is determined on the basis of the joint use of two scientifically proven methods: periodically repeated pregnancy testing and transillumination with high-resolution ultrasound equipment.

Trophoblastic disease and premature pregnancy

Approximately 0.05% of all women suffer from trophoblastic disease. In this disease, the structure of the cells surrounding the vesicle of pregnant women (from which the placenta is formed during the normal course of pregnancy), under conditions of correct formation of the placenta membrane, is not transformed into a healthy child's place, but into a conglomerate of light vesicles. The reason for this pathology of pregnancy is usually chromosomal disorder fertilized egg.

Another type of pathology is premature pregnancy. If future mother suspects that for some reason he will not be able to deliver the fetus to deadlines, she should see a doctor immediately. Signs of premature pregnancy are brown leucorrhoea; intensification of such morning ailments as nausea and vomiting; generic toxicosis; decrease in body weight and thyroid activity.

Fetal membrane cancer and diabetes mellitus

An exceptional, extremely rare disease is cancer of the fruit shell. In half of the cases, it develops on the basis of trophoblastic disease, in 30-40% of cases it occurs after a miscarriage, and in 10-20% - after a correct pregnancy. Signs of this disease are irregular bleeding that occurs after miscarriage, childbirth, or after removal of the uviform prematurity; the presence of a tumor in the vagina, uterus, or lungs. It is extremely important to recognize such a pregnancy pathology at early stages and in a timely manner to carry out a course of treatment, since the health of the mother and the possibility of subsequent pregnancy depend on this.

One of the pathological changes in the body of a pregnant woman is diabetes mellitus, which develops during gestation. It is a transient state in which the body does not produce enough insulin in response to an increase in blood glucose levels. Serious consequences for the mother and her baby can occur when the excess sugar in the mother's blood enters the fetal circulation through the baby's seat.

As signs of diabetes mellitus, experts note the presence of sugar in the urine, intense thirst, frequent and profuse urination. Do not worry, however, as the main threats associated with diabetes during pregnancy can be addressed through accurate monitoring of blood sugar levels. Knowing what the pathologies of pregnancy can be, it is possible to carry out regular tests at home, from time to time doing control tests in the clinic.

Infection of amniotic fluid

Perhaps this pathological change the course of pregnancy, as an infection of amniotic fluid when any infection enters the vagina and uterus of a pregnant woman. This can cause premature rupture. fetal membranes or premature birth. It is quite difficult to identify this disease, since there is no special test that can determine and confirm the presence of an infection. However, the symptoms are always the same, and an experienced obstetrician should keep in mind: the following features of the condition of a pregnant woman: tachycardia (rapid heartbeat); an increase in body temperature above 38 ° C; soreness of the uterus on palpation.

Choosing a way to treat this pregnancy pathology, experienced doctor must take into account the type of microorganism that caused the disease process, and the state of health of the mother and fetus. If by this time the fetus is on later dates development, it is recommended to end the pregnancy. In the same case, when the fetus is not yet ripe and is not able to survive in ectopic conditions, preserving substances are used with the simultaneous administration of large doses of antibiotics that penetrate the membrane barrier, as well as careful monitoring of the condition of the fetus.

Pregnancy pathology associated with fetal development

Pathologies during pregnancy include intrauterine inhibition of fetal growth. This is due to the fact that the intrauterine environment in which the fetus was located is not optimal enough for it correct development... The reasons for this pathology of pregnancy can be some diseases of the mother, her wrong way of life, impaired functioning. children's place- all this affects insufficiently fast growth fetus. Most often, intrauterine inhibition of fetal growth occurs in the first pregnancy. The age of pregnant women is also a risk factor: most often this pathological change occurs in pregnant women under 17 years old, as well as in those over 34 years old.

The occurrence of intrauterine inhibition of fetal growth is difficult to determine, since in most cases this pathology does not have any external manifestations. An experienced obstetrician, having measured the size of the abdomen, may suspect that the size of the uterus or fetus is less than normal. A similar diagnosis pathology of pregnancy can be confirmed or refuted only by ultrasound transmission.

The following predisposing factors can be identified that are responsible for failures in the intrauterine development of the fetus. This is poor antenatal care, the risk of which can be significantly reduced through systematic obstetric supervision; inappropriate nutrition and too little weight gain in pregnancy (which can be avoided by adhering to correct diet); excessive alcohol consumption - in this case, a fight with a bad habit is simply necessary.

However, one should not forget that some of the factors causing this fetal pathology during pregnancy, unfortunately, are very difficult or even impossible to eliminate. Such factors include the low socioeconomic and educational level of pregnant women, which prevents them from providing adequate nutrition and prenatal care; previous childbirth of a child with features of malnutrition or congenital defect; bleeding in the first or third trimester of pregnancy; deviation of the location of the child's place, expressed in its premature allocation or protrusion; severe nausea and vomiting that last more than three months; lack of water or polyhydramnios; wrong hemoglobin level; premature bursting of the fruit bladder; serological conflict for the Rh factor.

Mothers who have carried a baby with a low weight in a previous pregnancy are only slightly at risk of re-birth of such a child. As a rule, statistics show the trend in the growth of the child's weight in relation to the previous one. For childbirth too little child in addition to the above, the following factors can also affect: physical or mental stress of the expectant mother; an abnormal increase in the amount of plasma in a pregnant woman, as well as the absence of progesterone in the body.

With intrauterine inhibition of fetal growth, of all the methods recommended in the literature, hospitalization or treatment at home can be used. Improving the diet is recommended, especially the amount of protein, iron and the energy value of the food introduced; the introduction of drugs that improve blood circulation in the child's place. In the case when the increase in pathology is so great that no way can reduce the threat to the life or health of the mother, it is necessary to resort to abortion.

Bulging baby seat

Among the main pathologies of pregnancy, one can single out such as a bulging baby seat. In this case, the baby's place is located in the lower part of the uterus, completely or partially covers its inner mouth or reaches its edge. Typically on early weeks During pregnancy, a low-lying baby seat protrudes quite often, but as pregnancy develops and the uterus grows, the baby seat in most cases moves up. Although even in situations where its migration to the higher parts of the uterus is not observed, it rarely comes to the appearance of serious deviations. The tight fit of the child's seat to the inner mouth can cause bleeding. In situations where the baby's place completely or even partially enters the mouth, childbirth in a natural way will most likely be impossible.

The risk of a bulging child's seat is higher in women who have mechanical cleaning the walls of the uterus in connection with a miscarriage or childbirth, as well as in women who have undergone a cesarean section or surgery on the uterine muscle. The likelihood of developing a bulging child's place arises in situations requiring an increase in the surface of the placenta. Such development of the embryo is observed in states of oxygen starvation and fetal malnutrition. The low-lying baby seat is moved with the help of the stretching part of the uterus; sometimes this happens already before the 28th week of pregnancy, but usually it occurs between the 34th and 38th weeks of pregnancy.

Most often, this deviation manifests itself in bleeding without pain, which has light red color not accompanied by moderate or profuse abdominal pain. The baby's place, entering the inner mouth, is on the path of the fetus through the birth canal, as a result, birth is impossible in a natural way.

The situation of the bulging out of the child's place, proceeding without manifestations, is easy to diagnose with the help of ultrasound, but sometimes this pathology remains unnoticed until the very birth.

There is no need to worry for no reason: an early recognized low-lying baby seat in most cases corrects itself before childbirth and does not create any particular problems. Before the 20th week of pregnancy similar state does not require treatment. After this period, if the expectant mother does not complain of any ailments, she is recommended to change the daily model of physical activity.

Early activity of the uterus in pathology of pregnancy

Before the 37th week of pregnancy, a phenomenon is sometimes observed, which is called in medicine "early, or premature, grasping activity of the uterus." In this case, contractions are similar to pain during menstruation, sometimes diarrhea, nausea and other disorders appear. digestive tract, pain in the lower abdomen, tenderness and pressure in the pelvic ring, groin or thigh areas, watery pink and brown discharge, preceded by the exit of a thick mucous plug or oozing or leakage of water from the vagina.

With such a pathology of the uterus during pregnancy, rapid diagnosis is extremely important. Since every day the fetus is in the uterus increases its chances of survival after childbirth, it should be used only if there is a serious threat to the life or health of the child. In order to prevent premature grasping activity, doctors recommend excluding sexual intercourse and severe physical activity v last months pregnancy and, if necessary, place the expectant mother in the hospital.

What other pathologies of pregnancy are there and how to identify them

If a pregnant woman develops bleeding, she must be hospitalized in order to accurately assess the condition of the mother and fetus. If the bleeding is moderate and easy to stop, in this case, doctors recommend conservative treatment, which includes hospitalization with compulsory lying down, careful monitoring of the condition of the pregnant woman and the fetus, additional intake of iron and vitamin C, if necessary, blood transfusion. If the condition of the expectant mother does not cause serious concern, doctors sometimes allow bed rest at home.

As shown in the photo, with such a pathology of pregnancy, a child's place can grow into the deep layers of the uterine muscle and become constantly associated with it:

Distinguish between an adherent baby seat and an ingrown baby seat, depending on the depth of penetration of the cells of the baby seat. If the baby seat does not separate from the walls of the uterus during the third generic process, then it should be removed surgically in order to stop bleeding. If it is not possible to tie up open blood vessels and thereby stop the bleeding, then doctors have no choice but to complete removal uterus.

The reason is about 25% late bleeding is the separation or premature separation of the child's place from the walls of the uterus. Risk factors in this case are the mother's age, her use of nicotine, high blood pressure, taking aspirin in late pregnancy, or a previously transferred premature separation of the child's place.

Bleeding during the separation of the child's seat can be both mild (with a small degree of separation) and severe (with a moderate separation), which may be accompanied by pain in the lower abdomen. Also, the expectant mother and fetus may experience symptoms of exsanguination.

Diagnosis of this pathology is made on the basis of a survey, medical examination, ultrasound examination.

For small separations, an ordinary one is often recommended. bed rest which helps to stop bleeding. In cases of a moderate degree of separation of the child's place, bed rest and close medical supervision are unconditionally recommended.

Currently, the premature separation of a child's place does not pose a particular threat, and over 90% of mothers and newborns get out of this crisis situation without serious consequences.

Premature rupture of the fetal bladder is another type of pathology in the course of pregnancy, which consists in a violation of the membrane of the fetal bladder, preceding the onset of contractions. The symptom of this phenomenon is the leakage of fluid from the vagina.

Within a day from the moment of the onset of premature bursting of the bladder, it is imperative to carry out careful medical observation of the condition of the pregnant woman. At this time, it is necessary to regularly measure the body temperature and the number of white blood cells in the blood of the expectant mother in order to prevent possible manifestation infections. In case of the onset of contractions with an immature fetus, labor should be suspended, and most obstetricians try to delay labor, thus, up to 33-34 weeks. If the bladder bursts at or after 37 weeks, it is advisable to initiate labor induction as there is a high potential for infection.

Sometimes, in the event of a rupture of the fetal membrane, the umbilical cord slips out through the cervical canal or through the vagina, pushed out by the flowing water. A prolapsed umbilical cord can easily be trapped by the front of the fetus, resulting in a restriction or complete lack of oxygen for the fetus to breathe. Often, the umbilical cord falls out during premature birth or in the case when the front of the fetus is not the head of the fetus, but most often this occurs when the membranes are prematurely ruptured before the onset of labor contractions of the uterus.

To identify such a pathology during pregnancy, you need to carry out a diagnosis. It is quite easy to do this: the dropped cord of the umbilical cord can be in the vagina or hang down from the genitals. If the umbilical cord is pinched, there is a danger of fetal hypoxia.

In the event that the expectant mother notices the presence of the umbilical cord in the vagina or suspects its prolapse, she should protect the umbilical cord from being pinched as much as possible. If the umbilical cord is hanging outwards, it should be carefully protected with a warm and damp diaper, clean towel or diaper, and then immediately go to the nearest hospital.

During pregnancy, childbirth, as well as in the postpartum state in circulatory system mothers often have blood clots in the veins. The reason for this deviation is revitalization natural mechanisms blood clotting. They manifest themselves in prenatal period and are associated with difficulties in returning blood from low-lying parts of the body to the heart due to an enlarged uterus.

Blockage of superficial veins is a rather rare abnormality, and it occurs once in 100 pregnancies. The coagulability of blood inside deep vessels is a danger to the life of a pregnant woman and a fetus. Risk factors in in this case are the age of the mother over 30 years old, a large number of childbirth, prolonged immobility in a supine position, overweight, anemia, varicose veins, surgical delivery - forceps operation or cesarean section.

When superficial veins are blocked, fibrous, painful indurations usually develop along the path of the thigh vein or in the calf area, covered with reddish skin. When deeper veins are blocked, the symptoms are often soreness and increased density calves or thighs, swelling of the limbs, enlarged superficial veins, pain in the calf (thigh).

An external blockage can be detected using an ultrasound examination or direct examination by a doctor. Treatment is necessary if the blood clot moves, causing blockage of blood vessels in the lungs and pain in chest, cough with blood-stained phlegm, increased heart and respiratory rate, blue lips and fingertips.

The best therapy for such pathologies of pregnancy is prevention: bandaging the limbs with a tendency to thrombophlebitis; avoiding sitting motionless postures for an hour; strengthening the limbs by walking and running; performing light motor exercises lying down.

When treating blockage of superficial veins, bed rest should be observed (the diseased limb should be raised). It is also necessary to apply the appropriate ointments recommended by the doctor, apply moist warming compresses, wear tightening elastic leggings, take aspirin in the postpartum period.

If deep veins clogged and inflamed, then with such a pathology, a pregnant woman is usually injected with an absorbable drug intravenously for 10 days, but after the onset of regular contractions, the administration of the drug should be discontinued. A few hours after giving birth, it is recommended to re-administer the medication. Also, the doctor may prescribe therapy for several weeks postpartum.

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Pregnancy is a very important time when a new life is being formed. But this life period does not always go smoothly. Pregnancy pathologies, in our time, are very common, so it is important to identify the disease as soon as possible and take the necessary measures. Unfortunately, expectant mothers , sometimes have pathologies of a large severity and in some cases it is necessary to terminate the pregnancy. But some, nevertheless, are treatable.

The most common pathology is toxicosis It is caused by many factors, and late toxicosis is especially dangerous! This condition is accompanied by constant feeling nausea. A pregnant girl may not tolerate certain smells, tastes, and weight loss. As soon as a new life begins develop, in the future mothers become irritable, loss of appetite, weakness and, of course, a change in taste buds. severe toxicosis appear regardless of the sex of the unborn child.

Next ailment already more serious. Anemia can lead to a threat of miscarriage, therefore expectant mother It is very important to take the correct vitamins, which are prescribed by your doctor, on time. anemic women who had the precondition of iron deficiency before pregnancy suffer. In the early stages, the pathology does not manifest itself at all. It is possible to identify the cause if a woman has a craving for the use of clay, chalk. But it is best to pass a certain blood test.

Hypertonicity of the uterus This is the name of contractions of the uterus in the early stages of pregnancy. These contractions can provoke a miscarriage or premature birth. It can be determined by the tummy of a pregnant girl. It becomes hard, like a stone. Of course, this brings discomfort. But in the early stages it is almost impossible to notice. the doctor can during an ultrasound examination or on examination. Uterine hypertonicity is not dangerous only in the late stages of pregnancy, because this is already training contractions.

Placenta previa Explaining in an accessible language, presentation is the attachment of the placenta to the lower part of the uterus. It can be close to the birth canal, thereby blocking them. It will be difficult for the baby to get out into the light. There are several types of presentation: full, partial, low. Let's start with the first. Full presentation completely prevents the baby from moving forward. Unfortunately, this pathology interferes normal process the birth of a child. natural childbirth replace with a cesarean section. Partial previa - the placenta does not completely block the passage, but doctors just as strongly begin the surgical method of childbirth. low presentation the placenta allows the expectant mother to safely give birth to her baby in a natural way.

Low water and polyhydramnios... This is a condition when the amount of water exceeds or, on the contrary, is below the norm. Again, it is dangerous with the threat of spontaneous miscarriage.

Premature pregnancy The reason may be various diseases of the expectant mother, including chronic ones. An important feature of this pathology is that it is unpredictable. A large number of factors affect. Miscarriage is the termination of a pregnancy before 37 weeks.

In fact, pregnancy is a very serious process. negative factors can provoke a miscarriage and interruption. To avoid this, you need to strictly follow all the recommendations of the gynecologist, take vitamins, be sure to lead a correct lifestyle, worry less and take care of yourself, because the baby feels the mother's condition and reacts to her mood. It would not be bad follow a diet, drink fruit drinks, juices, because excess weight can lead to gestosis, and this negatively affects the functioning of the kidneys, blood vessels and the brain. For this, a pregnant woman will be constantly weighed, monitor weight gain and, if necessary, she can be assigned fasting days. If you do not neglect such simple rules, you can endure a healthy and a full-fledged kid!

Pathological course of pregnancy, childbirth, postpartum period

Currently, there are less and less pregnant women in whom the process of bearing a child proceeds without complications. According to statistics, approximately 95% of all pregnancies are pathological.

The pathology of pregnancy is any deviation from its normal course. The pathology of pregnancy adversely affects not only the unborn child, but also the woman, threatens various complications, sometimes up to lethal outcome... The pathology of pregnancy is very diverse and can relate to both the condition of the woman and the condition of the fetus, placenta and amniotic fluid.

Determination of the risk group for the development of pregnancy pathology

After a woman is registered for pregnancy, the doctor determines the degree of risk for the development of pathology. This takes into account many factors:

Socio-biological factors

These include: the mother's age (over 30 years old and under 18), the father's age (over 40 years old), harmful working conditions, the presence of bad habits in future parents, being in the radiation zone, and others.

Obstetric and gynecological history

Parity (number of births), the presence of abortions and diagnostic curettage, past gynecological diseases, the course of previous pregnancies (premature birth, placenta previa, miscarriages), infertility, a history of fetal disease or death.

Extragenital pathology in a woman

The presence of chronic diseases (hypertension, heart defects, diabetes mellitus, bronchial asthma, etc.), hormonal disorders in the past and more.

Fetal condition

The presence or absence of congenital fetal malformations, intrauterine fetal hypoxia, fetal growth retardation.

Risk assessment is performed throughout pregnancy. If, for example, in the first trimester the risk was mild, then in the second or third trimester it may shift towards a heavier one.

Pregnancy risk assessment
Nowadays an important point obstetric practice and pregnancy monitoring is an assessment of the risk of pregnancy and perinatal pathology... This takes into account all factors that can complicate the course of pregnancy, as well as the health status of the parents of the unborn child.

Factors that can complicate the course of pregnancy can be divided into several main groups:

1. Socio-biological factors: the mother's age is over 30 years old and the father's age is over 40 years old, bad habits of the parents (smoking and alcohol abuse), harmful working conditions - increase the risk of chromosomal and other fetal diseases;
2. Obstetric and gynecological factors (established by questioning and examining a pregnant woman): a large number of births (more than 4), abortions before childbirth in primiparous, abortions between two pregnancies, premature birth, stillbirth, infertility, gynecological diseases of the expectant mother, fetal diseases in a past pregnancy;
3. Various diseases of a woman during pregnancy: diseases of internal organs, chronic and acute infections, toxicosis of pregnant women, bleeding during pregnancy, mothers with a negative Rh factor (Rh-);
4. Various fetal diseases: hypoxia (lack of oxygen), hypotrophy (low fetal weight), paratrophy (increase in fetal body weight above the physiologically acceptable);

Assessment of the degree of risk of pregnancy is carried out by a specialist doctor together with the parents of the unborn child at the beginning of pregnancy and at 35-36 weeks to determine the appropriate tactics of pregnancy care and planning of childbirth.
The main types of pregnancy pathology

Early toxicosis

This condition develops in about 50% of all pregnant women. The characteristic manifestations of early toxicosis include: lack of appetite, nausea, vomiting, loss of energy, irritability, salivation. There are three degrees of severity of early toxicosis: mild (vomiting up to 5 times a day), moderate (vomiting up to 10 times a day) and severe (multiple and indomitable vomiting). Early toxicosis is associated with the development of a foreign organism and hormonal changes mother. As a rule, early toxicosis disappears after 12 weeks.

The gestosis of pregnant women includes a number of pathological conditions that occur during pregnancy, complicating its course. There are early gestosis, which usually occur in the first trimester of pregnancy, and late gestosis, which develop in the second half of pregnancy. Early preeclampsia include: vomiting of pregnant women (mild form), excessive vomiting and ptyalism (salivation). The etiological factor in the onset of gestosis, according to many authors, is the failure of the mechanisms of adaptation to the pregnancy that has arisen. The onset of gestosis is predisposed by congenital and acquired insufficiency of the system of neuroendocrine regulation of adaptive reactions (hypoxia, infection, intoxication, hypotrophy in the antenatal period, hereditary factors).

The onset of gestosis is facilitated by the presence in a woman extragenital pathology(on the part of the cardiovascular system - hypertension, hypotension, heart defects, endocrine diseases - diabetes mellitus, hyper- and hypothyroidism, diseases urinary tract- pyelonephritis, glomerulonephritis).

Early gestosis (vomiting of pregnant women) includes vomiting, which is repeated several times during the day, accompanied by nausea, decreased appetite, changes in taste and olfactory sensations. In accordance with the severity of the disease, there are: 1) mild form; 2) moderate (moderate); and 3) excessive vomiting (severe).

The light form corresponds to the phase of functional shifts in nervous system(phase of neuroses), the form of moderate severity - the phase of intoxication (phase of toxicosis), the severe form corresponds to the phase of dystrophy.

Eclampsia is life-threatening for both the mother and the fetus.

Gestosis (late toxicosis)

Gestosis develops after 20 weeks of pregnancy and is characterized by a triad of symptoms: edema, increased blood pressure and the presence of protein in the urine. The reasons for the development of preeclampsia have not yet been studied. Gestosis is a formidable complication of pregnancy. In severe cases, preeclampsia and eclampsia develop. Preeclampsia is characterized by the appearance of flies before the eyes, nasal congestion, tinnitus Tinnitus: the main thing is not to get nervous, headache. In the absence adequate treatment preeclampsia turns into eclampsia. Eclampsia is a woman's convulsive seizure with loss of consciousness. Eclampsia is dangerous sudden death pregnant woman and fetus.

Late gestosis often occurs in the third trimester of pregnancy and is characterized by multiple organ failure. Late gestosis is manifested by three main symptoms - edema, proteinuria, arterial hypertension, less often - more severe symptoms (convulsions, coma, etc.). In modern obstetrics, late gestosis is designated OPG-gestosis (by the name of the main three symptoms). There are many classifications of late gestosis, but in practical obstetrics it is customary to distinguish 4 main clinical forms:

1) dropsy of pregnant women;
2) nephropathy (mild, moderate, severe);
3) preeclampsia;
4) eclampsia.

It should also highlight the preclinical stage of gestosis - pregestosis. All clinical forms of late gestosis are certain stages in the development of a single pathological process.

Excessive weight gain in a pregnant woman is one of the early signs gestosis, indicating the appearance of first latent, and then, possibly, obvious edema.

Latent edema is detected with regular measurement of the body location (weighing the patient) and determination of urine output. If the increase in body weight exceeds 300-400 g per week and negative diuresis is revealed, then these symptoms indicate hidden edema.

Explicit, visible edema varies in degree of spread:

I degree - swelling of the feet and legs;
II degree - edema of the lower extremities and the anterior abdominal wall;
III degree - generalized edema up to anasarca.

Arterial hypertension with gestosis can reach 170/100 mm. rt. Art. and higher. The borderline figures for blood pressure are 130/85 mm. rt. Art.

Proteinuria with gestosis is a consequence of spasm and increased permeability in the vessels of the renal glomeruli. At severe forms ah of gestosis, the loss of protein is 5 g / day or more.

Preeclampsia pregnancy is divided into three degrees:

1) mild form (hypertension not higher than 150/100 mm Hg, edema not higher than the feet and legs, proteinuria not more than 1 g / l, uneven caliber of retinal vessels is noted on the fundus);
2) moderate (blood pressure is not higher than 175/115 mm Hg, edema extends to lower limbs and abdominal wall, proteinuria from 1 g / l to 3 g / l, retinal edema appears);
3) severe degree (blood pressure above 175/115 mm Hg, anasarca, proteinuria more than 3 g / l, hemorrhages appear on the fundus, dystrophic changes are noted).

Preeclampsia is a critical but reversible condition that developed against the background of severe preeclampsia. In addition to the triad of symptoms of preeclampsia (OPG), the patient has a headache, nasal congestion, and visual disturbances. These signs are regarded as a violation. cerebral circulation... "Convulsive readiness" is noted, when a seizure - eclampsia - can develop on any stimulus.

Eclampsia is the most severe form of gestosis, which is characterized by seizures with loss of consciousness. The duration and number of seizures of eclampsia can vary. During a seizure, cerebral circulation disorders, hemorrhages in the brain and its membranes develop. Hemorrhages in internal organs are not uncommon. Hypoxia and metabolic disorders increase sharply, acidosis occurs. Kidney function sharply worsens, oliguria grows. Dystrophic changes often occur in the internal organs.

Underdevelopment of the fetus
As a rule, fetal underdevelopment is the result of various violations of its intrauterine development. As you know, the supply of the fetus nutrients and oxygen depends on the state of the mother's body. Therefore, various diseases or deficiency conditions of a pregnant woman can negatively affect the intrauterine development of the fetus. One of the examples of fetal underdevelopment is cretinism, which occurs when there is a lack of iodine or thyroid hormones. The body of the fetus is not able to synthesize these hormones on its own, so it receives them from the mother's blood. With a lack of iodine or various diseases of the thyroid gland, the mother's body synthesizes less hormones, as a result of which the development of the fetus stops.
Thyroid hormones are very important for the development of the fetal nervous system and bones. Therefore, cretinism is characterized by pronounced mental retardation and impaired growth of the bones of the child.
Impaired growth of the fetal skeleton can also be caused by a lack of calcium.

Ectopic pregnancy
With an ectopic pregnancy, the embryo attaches and develops outside the uterine cavity. The most common ectopic pregnancy occurs in the fallopian tubes (tubal pregnancy). Other possible localizations of ectopic pregnancy are the ovaries, various organs abdominal cavity, cervix (very rare).
In a tubal pregnancy, the growth of the embryo leads to stretching and destruction of the walls of the fallopian tube, which end in rupture of the fallopian tube and severe internal bleeding or rejection of the developing embryo. Usually complications of tubal pregnancy occur at 4-8 weeks of gestation. When the fallopian tube ruptures, severe pain in the lower abdomen, which are accompanied by signs of internal bleeding: dizziness, severe weakness, pallor, loss of consciousness. When the fetus is rejected, bleeding may be insignificant, and the pain is much weaker, while dark-colored spotting from the genital tract may appear.

If one or more of the above symptoms occurs (against the background of disappearance of menstruation within a few weeks and the presence of other signs of pregnancy), you need to urgently seek help from a doctor. Bleeding from a ruptured fallopian tube is extremely life-threatening for a woman.

One of the factors that increase the risk of ectopic pregnancy are chronic diseases of the internal genital organs, which lead to obstacles on the way of the egg cell from the fallopian tube into the uterine cavity.

Spontaneous abortion (miscarriage)
developing embryo. The causes of spontaneous abortion can be various inflammatory diseases of the genital organs of a pregnant woman, intrauterine fetal pathology, lack of vitamins and minerals, hormonal disorders. Termination of pregnancy before 12 weeks of development is called early abortion, in the period from 12 to 20 weeks of late abortion. Termination of pregnancy beyond 28 weeks is called premature birth; at this stage of development, the fetus is viable and can survive with the provision of specialized medical care... The process of fetal rejection goes through several stages: at the initial stage, cramping pains in the lower abdomen and bloody discharge from the genital tract appear; the ovum partially exfoliates (at this stage, the evolution of abortion can be stopped, and pregnancy saved). Further, pain in the lower abdomen and spotting intensify, the fetus exfoliates completely and is expelled from the uterine cavity. In some cases, the evolution of a miscarriage can be complicated by infectious processes or disruption of the internal organs of a pregnant woman.

Placenta previa

Normally, the placenta is located on the anterior or posterior wall of the uterus. If the localization of the placenta falls on the lower segment of the uterus with partial or complete overlap of the internal os, they speak of presentation. Placenta previa is dangerous because of sudden bleeding for no apparent reason. The bleeding can be very massive and lead to the death of a woman.

The most common complication of pregnancy is the threat of termination and prematurity - one of the main causes of prenatal morbidity and mortality. The main reasons for the threat of termination of pregnancy and miscarriage include:

1) infectious diseases of the mother;
2) complications associated with pregnancy;
3) traumatic injuries;
4) isoserological incompatibility of the blood of the mother and the fetus;
5) anomalies in the development of the female genital area;
6) neuroendocrine pathology;
7) various non-communicable diseases mothers;
8) chromosomal abnormalities.

There are genetic causes of miscarriage. In the presence of chromosomal aberrations of the embryo, the threat of termination develops in the early stages of pregnancy. Spontaneous miscarriage in this case can be considered as an adaptation developed in the process of evolution, as a result of which the birth of children with deformities is quite rare. Of the endocrine causes of miscarriage, ovarian hypofunction, hyperandogenism of various origins (adrenal, ovarian genesis), and thyroid dysfunction are distinguished. Among the causes of miscarriage, one of the first places is occupied by infectious diseases of the mother. These are, first of all, latent infectious diseases, such as chronic tonsillitis, urinary tract infection, listeriosis, toxoplasmosis, mycoplasma infection, chronic inflammatory diseases of the genital organs and viral infections... When considering the immunological aspects of miscarriage, the fetus can be considered as an allograft in the mother's body, since it carries genetically foreign (paternal) antigens. The presence of a wide range of antigens in the fetus activates the system of "immunological surveillance" and contributes to the development of many different types of immunological reactions aimed at maintaining immunological equilibrium. Under certain conditions, an immunological conflict arises in the mother-placenta-fetus system, leading to a threat of termination of pregnancy and spontaneous miscarriage.

Among the malformations of the uterus, as causes of miscarriage, the most common are: two-horned, saddle-shaped, one-horned uterus, intrauterine septum, doubling of the uterus, rudimentary uterus.

The reasons contributing to the occurrence of miscarriage also include genital infantilism, isthmic-cervical insufficiency, uterine fibroids and extragenital diseases of the mother.

The course of pregnancy also complicates the presence of extragenital pathology in the mother.

The group of increased risk of miscarriage is primarily women with diseases of the cardiovascular system, hypertension, chronic kidney disease, diabetes mellitus, anemia.

Significant changes in the body contribute to the premature termination of pregnancy in such women: hypoxia, metabolic disorders and complications of pregnancy that accompany extragenital pathology (toxicosis of the second half of pregnancy, placental insufficiency).

Placental abruption - This is its separation (partial or complete) from the mucous membrane of the uterus. In this case, blood accumulates between the child's place and the wall of the uterus, which pushes the placenta away from the uterus. The placenta should not move away during pregnancy. Its separation from the uterus should take place in the third labor period. However, there are times when the placenta leaves prematurely.

What is the risk of placental abruption during childbirth? This process dangerous for the baby, as it can deprive him of oxygen and nutrients.

Causes of premature detachment of a normally located placenta

Premature discharge of the placenta is experienced by women in 0.4-1.4% of cases. It can occur both during pregnancy and during childbirth in the first or second period. Why does placental abruption occur? The reasons for this process are different.

The separation of the child's seat can be caused disorders in the vascular system... The capillaries of the uterus and placenta may become more fragile and brittle. Because of this, a violation of the permeability of the blood is possible. Similar changes in the female body may occur with gestosis. Also they are observed in the presence of certain diseases: cardiovascular pathology, hypertension, kidney disease, obesity, diabetes, etc.

The threat of placental abruption can come from inflammatory, degenerative and other pathological processes flowing in the baby's place and the uterus. Violations can be observed with uterine fibroids, malformations, and prolongation.

To premature discharge of the placenta predispose bad habits: excessive consumption of beverages containing alcohol, addiction to cigarettes, drugs. The situation may worsen with anemia (anemia, a decrease in the number of red blood cells, low hemoglobin).

Bleedingcan be external (visible), internal (hidden) or mixed. External bleeding is easy to notice, as it appears from the vagina with placental abruption brown discharge... It is observed with detachment of the edges of the placenta. If the baby's place is disconnected from the uterus in the center, and the edges remain attached to its wall, then the bleeding in this case will be called internal. Fluid will build up between the uterus and the placenta.

When detaching a child's seat, one feels tension of the uterus... On palpation, it is felt pain... She can be dumb, jerky. Sometimes the pain radiates in the thigh and bosom, as well as in the lumbar region. It is felt most strongly with internal bleeding.

Anemia of pregnancy

Anemia (or anemia) is the most common complication of pregnancy. At the same time, the overwhelming majority of cases of premature termination of pregnancy or fetal developmental disorders are caused precisely by the lack of oxygen supply to the fetus in case of anemia. As a rule, anemia occurs due to a lack of vitamins and minerals in the body of a pregnant woman. Sometimes, even normal nutrition, cannot satisfy the woman's need for these elements. Most often, anemia occurs due to a lack of iron and folic acid... At the same time, a pregnant woman complains of dry skin, brittle nails and hair, and the appearance of hard-to-heal cracks on the lips. Fetal development with anemia occurs at a slower pace or stops altogether. The central nervous system is especially sensitive to a lack of oxygen, therefore, with a lack of iron and folic acid, disorders of the development of the brain often occur. It should also be noted that folic acid is directly involved in the development of the brain and nerves.

Hemolytic disease of the fetus and newborn

Such a disease occurs in cases where a pregnant woman is a carrier of a negative Rh factor (Rh-), and the fetus developing in her womb is Rh positive (Rh +) (in such cases, the father is always Rh positive). In this case, the mother's body recognizes the blood cells as foreign and produces antibodies in order to destroy them. Antibodies from the mother's blood enter the blood of the fetus and cause the destruction of its red blood cells. In severe cases, massive destruction of the blood cells of the fetus or newborn can lead to death. Usually, the Rh conflict develops during the second pregnancy, if during the first pregnancy the fetus was also Rh positive. On this moment effective methods of preventing and eliminating rhesus conflict have been developed. The main point is the timely establishment of the blood group belonging to the mother and fetus and the preparation of a pregnancy care plan.

Postpartum hemorrhage

Unfortunately, only 14% of births are uneventful. Most frequent symptom pathological postpartum period - bleeding.

Causes

· Delay in the uterine cavity of parts of the placenta (lobes of the placenta or membranes);

· Atony and hypotension of the uterus;

· Injury of the soft tissues of the birth canal;

· Disorder of the blood coagulation system (coagulopathy).

Diagnostics and treatment

Massive bleeding from the uterus can occur early (in the first 2 hours) or late (2 hours or more after the end of labor) postpartum period... With hypo- and atony, the uterus is large, relaxed, with external massage it can contract somewhat, and then relaxes again, and the bleeding resumes.

Treatment for hypotonic bleeding is complex and begins immediately.

Conservative treatment includes:

· Emptying the bladder with a catheter;

· External massage of the uterus through the abdominal wall;

· Intravenous and intramuscularly injected drugs that contract the uterus (oxytocin, etc.);

· Ice on the stomach;

· Replenishment of blood loss.

If, after the massage, the uterus does not contract or contracts, and then relaxes again, and the blood loss has reached 300 ml, then proceed to further measures. Carry out manual examination of the uterine cavity during which blood clots are removed, the placental site is revised (if a lingering placenta lobe is detected, it is removed), the integrity of the uterine walls is checked.

If performed in a timely manner, this operation can stop bleeding and prevent further blood loss. If hypotension is detected, massage the uterus on the fist (very carefully).

To consolidate the effect of stopping bleeding, a transverse suture is applied to the cervix, a tampon moistened with ether is inserted into the posterior fornix of the vagina, oxytocin or prostaglandin (means that reduce the uterus) are injected into the cervix, an ice bladder is placed on the lower abdomen, and blood loss is restored.

In the absence of an effect from all manipulations and ongoing bleeding (blood loss over 1000 ml), they proceed to an operation - ligation of the uterine and ovarian vessels or removal of the uterus (supravaginal amputation or extirpation of the uterus). At the same time, blood-substituting solutions are injected, blood transfusion is performed.

POSTURAL PURULENT SEPTIC DISEASES arise as a result of infection of the birth canal through the wound surfaces of the postpartum uterus, cracks and abrasions, tears on the cervix, in the vagina and on the perineum. In this case, the macroorganism is of decisive importance. An undoubted role is played by microorganisms, while the most common pathogens are pathogenic staphylococci, (3-hemolytic streptococci of groups A and D, anaerobic streptococci, some types of E. coli, chlamydia, etc. Infection can come from the outside (exogenous) and from the body (endogenous). An important role in the development of postpartum infections belongs to nosocomial (hospital) infection.The development of postpartum infection is facilitated by modern invasive methods for diagnosing the state of the fetus (amnioscopy, amniocentesis, direct fetal ECG, etc.), a long anhydrous interval, surgical intervention, trauma to the birth canal, etc.
Postpartum diseases begin with an inflammatory process in the area of the wound surface (postpartum ulcer on the perineum, vaginal wall, cervix, postpartum endometritis), and later the infection can spread along the lymphatic, bloodstream and canalicularly beyond the primary focus, affecting the myometrium, peri-uterine tissue, pelvic peritoneum, veins of the uterus, pelvis and thigh (metritis, parametritis, metrothrombophlebitis, pelvic thrombophlebitis, thrombophlebitis of leg veins, adnexitis, pelvioperitonitis). In the future, generalization of the process may occur: diffuse postpartum peritonitis, septic shock, progressive thrombophlebitis, sepsis without visible manifestations of metastases and sepsis with metastases.
With any form of postpartum infection, it is necessary to strive to identify the pathogen microbe and determine its sensitivity to antibiotics. Over the past decades, the number of severe forms of postpartum diseases has decreased and the number of erased, unexpressed forms of infection, which are difficult to diagnose, and therefore are not adequately treated, has increased.

A postpartum ulcer can occur in the area of tears and fissures in the cervix, vagina, and perineum.

Postpartum thrombophlebitis - inflammation of the vein wall, followed by the formation of a thrombus in this area, which completely or partially closes the lumen of the vessel. Sometimes thrombophlebitis is preceded by aseptic thrombosis, that is, microbes entering the blood settle on a thrombus, infecting it, and from a thrombus, the infection spreads to the vein wall.
By localization, postpartum thrombophlebitis are divided into thrombophlebitis of the uterine veins, pelvic veins and deep veins of the legs.

Metrothrombophlebitis - defeat of the veins of the uterus. General state the patient suffers. Prolonged subfebrile condition (37-38.8 ° C), chills. The pulse is quickened, subinvolution of the uterus, soreness in the region of the ribs of the uterus, prolonged profuse bleeding. Sometimes, with a vaginal examination, painful bands on the uterus are determined. In the blood, a slight increase in the number of leukocytes, a moderate shift of the formula to the left, increased ESR, hypercoagulation. Ultrasound scanning is of great help in diagnostics.

Thrombophlebitis of the pelvic veins comes to light at the end of the 2nd week of the postpartum period. The general condition of the patient suffers. The temperature is subfebrile, the pulse is quickened. Subinvolution of the uterus. On vaginal examination, the affected veins are sometimes palpated at the base of the broad ligament and on the lateral wall of the pelvis in the form of painful, dense convoluted cords. There are changes in the blood (moderate leukocytosis, shift of the formula to the left, increased ESR), hypercoagulation. Ultrasound scanning is indicative.

Deep vein thrombophlebitis of the legs develops in the 2-3rd week after childbirth. The disease begins with acute pain in the leg, a significant increase in temperature, chills. After 1-2 days, swelling and coldness of the legs appear, a feeling of crawling in the affected leg. Palpation of the vascular bundle at the site of its lesion is painful, often it is possible to palpate the painful cord. With the defeat of superficial veins, diagnosis does not cause difficulties (this is more often the case with varicose veins veins). The duration of the disease is 4-6 weeks. The febrile period lasts from several days to 2-3 weeks. Usually the fever is replaced by subfebrile condition. Relapses are sometimes observed. Often, blood clots are located not only in the veins of the legs, but also in the iliac vessels, and then edema is observed on both legs, and the clinical course becomes severe and immediate surgical treatment is required. For the diagnosis of thrombophlebitis, Doppler vascular examination, hemostasiogram are informative.

Treatmentthrombophlebitis (thrombosis) should be complex. Bed rest with an elevated position of the legs, bandaging the legs with elastic bandages, broad-spectrum antibiotics, desensitizing agents, antispasmodics. Of the anticoagulants, heparin is used in combination with pelentan, phenylin, and others. Aspirin is used. When treating with anticoagulants and antiplatelet agents, strict control of hemostasis is required.
With thrombophlebitis (thrombosis) of large vessels, sometimes they resort to surgical removal of blood clots and install a filter in the inferior vena cava.