What is considered a pathology during pregnancy. Of the complications of the course of pregnancy, the most common are: early and late gestosis, threatening termination of pregnancy, during pregnancy with extragenital pathology. The effect of nicotine on the fetus

Unfortunately, pregnancy does not always proceed smoothly and is accompanied by various pathologies. Some pathological conditions can be corrected, while others cannot be corrected. We will find out what pathologies a pregnant woman may face, who is at risk, how they are diagnosed and what should be done to minimize the risks of such deviations.

What is pathology

Pathology is a condition characterized by a painful deviation from normal, which in the case of pregnancy means a violation of the norms of its course and fetal development. The pathology of pregnancy is considered to be processes leading to disruption of homeostasis, illness and dysfunction, which endangers the health of the mother and the maturity of the child.

When is the greatest risk of pathology

Pathological processes during pregnancy are a threat to the health of the expectant mother and child, therefore, factors that can cause various pathologies when carrying a child should be taken into account:

• existing chronic diseases - diseases of the cardiovascular system, liver and kidneys, problems with the functioning of the endocrine system;
• bad habits - alcoholism, smoking, drugs;
• bad heredity;
• multiple pregnancy;
• age over 35 years... In this case, the likelihood of genetic or chromosomal abnormalities in the fetus increases. In addition, by this age, people often acquire various chronic diseases;
• unfavorable history. If a woman has already had miscarriages and fetal death, she already has an unhealthy child;
• infectious diseases during pregnancy. The greatest danger is posed by rubella, toxoplasmosis, herpes, hepatitis and urinary tract infections. Common flu, which has caused complications, can also affect;
• unfavorable ecology, harmful working conditions;
• taking some medications;
• severe stress and physical activity.

When the fetus is forming and growing, a woman should always be attentive to her health. During this period, time intervals are distinguished, defined as critical:

• the first 2 weeks. Adverse factors can cause the death of the nascent life at the very beginning of pregnancy. In this case, the woman usually does not even know that there was conception;
• - th week. In the fetus, the internal organs are laid, and pathogenic processes can lead to severe deviations. During this period, it is very dangerous for a woman to get sick, to be very nervous and it is strictly forbidden to take many medicines;
• from the 12th week until delivery. The formation of the brain, lungs, genitals and teeth continues, therefore, at this time, with unfavorable factors in them, there is a risk of gross violations. In already formed systems, under the influence of inflammatory processes, secondary defects may appear.

Already at the earliest stages of development, chromosomal abnormalities (trisomies) can be found in the embryo. These are congenital abnormalities in the set of chromosomes, the most famous of which is Down's syndrome. The risk of their appearance is high in the presence of such deviations in direct relatives, it increases in parents after 35 years.

Did you know? Often, the extent to which a child with chromosomal abnormalities will live fully depends on the parents and upbringing. Of course, this is primarily influenced by aberration and the state of the body as a whole, but usually such people can learn to serve themselves, get a job. For example, among people with Down syndrome there are famous actors, athletes and musicians.

Now the number of genetic abnormalities has increased. The genetic risks of fetal abnormalities significantly increase in the following group of parents:

• over 35 years old;
• , the birth of a dead or unviable child;
• the birth of a baby with pathologies;
• infertility of unknown origin and unsuccessful IVF;
• bad heredity. If there are genetic abnormalities in the family, family ties and so on. Sometimes both parents are carriers of recessive genes for congenital diseases;
• taking drugs that are heavy for the body;
• exposure to radiation.

Pathology of the course of pregnancy

Let's consider the most common obstetric pathologies of pregnancy and the reasons for their occurrence.

Toxicosis and gestosis

The onset of toxicosis is characteristic of the first half of pregnancy and occurs in half of pregnant women, but only a tenth needs treatment. Symptoms of this condition are vomiting (mainly in the morning), and if it occurs 1-2 times a day and disappears after the 13-16th week, then it does not cause concern. Weakness, drowsiness, and salivation are also observed. If vomiting occurs not only in the morning, but also after eating, then it is referred to as early gestosis.

If there is repeated vomiting during the day, weight loss, palpitations, fever, a woman needs treatment. And if the number of gagging has reached 20 and there is a significant loss in weight, then urgent hospitalization is required. The cause of early toxicosis is the restructuring of the body of a pregnant woman for bearing the fetus and the formation of the placenta. The causes of late toxicosis are already different, and it is referred to as gestosis, which also manifests itself as edema, high blood pressure, and the presence of protein in the urine.
The risk of gestosis increases in the presence of the following factors:

• age. More commonly diagnosed in mothers under 18 or over 35;
• heredity. If preeclampsia occurs in women in the family;
• chronic diseases. Usually found with ailments of the cardiovascular system or kidneys, high blood pressure;
• endocrine pathologies;
• lack of vitamin B9 (folic acid);
• nervous stress;
• thrombophilia and a tendency to thrombosis.

Did you know? In the presence of gestosis, the death of the fetus and the newborn increases by 5-7 times. The causes of this condition often remain a mystery to doctors.

Placenta previa

It is the attachment of the placenta over or near the cervical pharynx. In this case, the pharynx partially or completely overlaps. This condition manifests itself mainly in bleeding from the female organs. They occur most often in the second half of pregnancy, after the 30th week. They can be provoked by the slightest load, but they can also occur at rest. This bleeding worsens before delivery.
Types of placenta previa

The factors that caused may be:

• endometrial diseases (, etc.);
• diseases and abnormalities of the uterus (, etc.);
• surgical interventions (, and others);
• multiple pregnancy;
• diseases of the cervix;
• inflammatory processes that affect the endometrium.

Anemia

A decrease in hemoglobin manifests itself as the appearance of increased weakness, migraines, shortness of breath, low blood pressure and can cause fainting. Any physical activity begins to seem overwhelming. This condition is easily detected by a blood test. The most common reasons are as follows:

• defective. Lack of protein, iron, or vitamins B and C, necessary for the absorption of this trace element, can lead to a lack of hemoglobin. It often happens with vegetarians;
• toxicosis and gestosis. Vomiting and weight loss in these conditions deprives the body of a pregnant woman of essential substances;
• chronic diseases of the digestive system. These diseases reduce the digestibility of food;
• multiple pregnancy;
• frequent uninterrupted labor.

Miscarriage

If the pregnancy was interrupted by itself before the 37th week from the day of the last menstruation, then this is referred to as pathology. This condition is accompanied by the following symptoms:

• , spasms;
• bloody discharge from the birth canal;
• painful condition, weakness, dizziness;
• nausea and vomiting;
• high temperature.

The reasons for fetal loss can be the following:

• pathology of the uterus (fibroids, cysts, two-horned uterus, etc.);
• chromosomal diseases of the fetus;
• endocrine problems;
• infections that have affected the genital area (sexually transmitted diseases, herpes, etc.);
• immunological factors (incompatible cells in parents, etc.);
• adverse environmental impact;
• chronic diseases of the heart and other organs, anemia;
• other pathologies of pregnancy.

Low water and polyhydramnios

Deviations of amniotic fluid from the normal amount adversely affect the fetus. With their excess (), the pressure on the internal organs increases. In this case, the following symptoms appear: shortness of breath, abdominal pain, swelling and other ailments. All these signs are typical for normal pregnancy in later stages, but appear earlier. The greatest danger is posed by the acute form, when the volume of water increases sharply over several days.

In severe cases, the bladder is punctured (amniocentesis) and excess fluid is drained. An insufficient amount of amniotic fluid (oligohydramnios) negatively affects the development of the child and can lead to premature placental abruption. Severe polyhydramnios reveals itself as an increase in the abdomen, which can drop due to its severity, pain in the lower back and perineum. Often, polyhydramnios and oligohydramnios do not manifest themselves in any way and are detected during examination using ultrasound.
The causes of polyhydramnios can be:

• infectious diseases (, and others);
• diabetes;
• rhesus conflict;
• pathology of fetal development.

develops as a result of the influence of the following factors:

• infections;
• high pressure;
• obesity in a pregnant woman;
• prolongation of pregnancy;
• pathology of fetal development;
• abnormalities in the placenta;
• late gestosis.

Malposition

The situation when the axis of the fetus does not coincide with the axis of the uterus does not begin to interest obstetricians earlier and can be corrected with the help of gymnastics (if there are no contraindications). The doctor can determine the wrong position of the fetus by the shape of the uterus, but he will give the most complete information.
Fetal position

The reason for this condition may be the following:

• multiple pregnancy;
• violations of the shape of the uterus;
• polyhydramnios;
• in women who have often given birth due to poor uterine tone;
• heredity. If such a situation occurred with close relatives.

If the situation has not improved, then a few weeks before the planned birth, the woman is hospitalized in the maternity ward.

Hypertonicity of the uterus

The increased tone of the uterus in the early juices manifests itself as heaviness and pain in the lower abdomen, radiating to the lower back. For some, they are similar to ailments during menstruation. In the second half of pregnancy, with these symptoms, you can also observe abdominal hardening.

Important! When such a threatening symptom as bloody discharge appears, the pregnant woman must immediately seek medical help.

The reasons for the appearance may be:

• hormonal abnormalities ();
• severe toxicosis;
• abnormalities of the uterus;
• inflammation of the genitals;
• rhesus conflict;
• multiple births or large sizes of the fetus;
• polyhydramnios;
• chronic diseases (hypertension, diabetes mellitus and others);
• increased gas formation;

These are the most common factors that provoke increased uterine tone, but there may be other reasons.

Extragenital pathology

Pregnancy against the background of extragenital diseases can proceed with complications and affect the health of the fetus. The most common pathologies in pregnant women are:

• diseases of the cardiovascular system;
• hypertension or hypotension;
• kidney and liver diseases;
• blood diseases;
• lupus erythematosus and other connective tissue problems;
• diabetes;
• respiratory diseases;
• gastrointestinal ailments.

And this is not a complete list. Most often, pregnancy pathologies occur against the background of cardiovascular diseases (80%). All these diseases during the period of childbearing worsen and require constant monitoring by the attending physician (therapist, cardiologist, endocrinologist, nephrologist, etc., depending on the disease).
In case of a planned pregnancy, you should seek advice from a specialist in an existing chronic disease before conception, undergo a comprehensive examination and treatment. Observation and proper timely treatment before and during pregnancy can significantly reduce the negative consequences.

Did you know? According to statistics conducted in obstetric hospitals, only 30% of pregnant women are in good health, and 70% suffer from extragenital diseases.

Fetal pathology

Pathological changes in the fetus occur under the influence of genetic and external factors. In this regard, congenital and acquired deviations from the norms appear. Genetic pathology arises from the moment of pregnancy and is diagnosed in the early stages, but acquired ones can appear at any period of expectation of the baby. Chromosomal abnormalities are congenital. Consider the main such deviations:

Diseases arising from the wrong number of chromosomes:

• shereshevsky-Turner syndrome. One X chromosome is missing in female children. Signs - small stature, disorders of the genital area, deformity of the joints, folds in the neck, somatic deviations;
• polysomy of the X chromosome. Signs - a slight lag in the development of intelligence, mental disorders, usually further high growth with a curvature of the spine. In the future, such a woman can give birth to a healthy child;
• polysomy of the Y chromosome.The signs are the same as on the X chromosome;
• klinefelter's syndrome. It is observed only in male children. Signs - poorly expressed growth of hair throughout the body, anomalies of the genital area (both external and internal), high growth, often lagging in the development of intelligence.

Important! Genetic pathologies cannot be corrected and cannot be treated.

Acquired pathologies arise under the influence of adverse external influences on the development of the embryo. These factors are:

• mother's illnesses while waiting for the baby - viral and bacterial infections (influenza, rubella, hepatitis B and others), sexually transmitted diseases (syphilis, and others);
• poor ecology, increased radiation, the presence of many harmful industries near the residence;
• chronic diseases of the mother;
• stress;
• unhealthy lifestyle of the expectant mother (alcohol, drug addiction, smoking, etc.).

With acquired pathology, the following deviations are most common:

• deformation processes in organs inside the body or their absence (for example, there is no kidney or pancreas), the absence of some parts of the body (for example, legs, fingers or hands);
• facial defects;
• cardiac disorders;
• cerebral hypoexcitability. Observed after the birth of children. Signs - muscle weakness, constant drowsiness, lack of appetite, the baby does not cry. Such disorders can be cured;
• cerebral hyperexcitability. Signs - strong muscle tension, chin trembling, constant anxiety (the baby is constantly crying and screaming). This deviation can also be cured;
• hypertensive-hydrocephalic syndrome accompanied by increased intracranial pressure. It occurs due to the excessive production of cerebrospinal fluid (cerebrospinal fluid), which is then retained in the meninges and ventricles. It is very important to diagnose this disease in a timely manner. It is expressed by an increase in the size of the head, the fontanelle protrudes somewhat, strabismus, convulsions, mental retardation may appear.

Anomalies of fetal development for undefined reasons can be attributed to a separate group. These are, first of all:

• pathological abnormalities of the umbilical cord of the fetus. Such anomalies can contribute to a lack of oxygen and the death of an unborn baby;
• multiple pregnancy (Siamese twins);
• lack of water or polyhydramnios;
• pathological processes in the placenta.

All of these deviations require special attention from doctors and future parents. For a pregnant woman in such a situation, it is important to remain calm and feel the support of loved ones.

Diagnosis of pathologies

A woman should register with a antenatal clinic and regularly observe pregnancy with a gynecologist, provide the doctor with all the necessary information about her health and working conditions. Even if the pregnancy is proceeding normally, a woman must pass the following tests at a certain time to identify pathological processes:

• general blood analysis;
• blood chemistry... Allows you to determine the level of sugar and identify deviations;
• general urine analysis. They are done at least 1 time per month and help control kidney function and other problems;
• vaginal smear. They are taken first when registering and at the 30th week. Reveals the presence of infections of the genitourinary tract;
• a blood test that determines its group and rhesus. Rent in the presence of a Rh-conflict with the father of the child at the beginning of pregnancy;
• blood test for sexually transmitted infections (syphilis and others);
• . It shows blood clotting. It is performed every trimester, but in case of hemostasis disorders, it is more often deposited;
• "Triple test" (, NE,). It is done at 16–20 weeks to establish pregnancy anomalies in the fetus.

Alpha-feroprotein (AFP) is a protein produced at conception, just like hCG ("pregnancy hormone"). Their lack or excess can indicate various complications of pregnancy and fetal abnormalities. A reduced result indicates chromosomal abnormalities, but such a result may be the result of other problems.

Let's get acquainted with the AFP norms by week of pregnancy in the table:

class \u003d "table-bordered"\u003e

Consider the norms of hCG by week in the blood of pregnant women:

Term	Average value, (mIU / ml)	Acceptable limits, (mIU / ml)
2 n.	150	50–300
3-4 N.	2000	1500–5000
4-5 n.	20000	10000–30000
5-6 n.	50000	20000–100000
6-7 n.	100000	50000–200000
7-8 n.	80000	40000–200000
8-9 n.	70000	35000–145000
9-10 n.	65000	32500–130000
10-11 n.	60000	30000–120000
11-12 n.	55000	27500–110000
13-14 n.	50000	25000–100000
15-16 n.	40000	20000–80000
17-20 n.	30000	15000–60000

class \u003d "table-bordered"\u003e

When registering, a pregnant woman makes a round of doctors (therapist, ophthalmologist, dentist), makes an ECG. When determining the pathologies of pregnancy associated with the threat of its failure, the expectant mother can be put in an obstetric hospital and there to observe, diagnose and treat.

in the th week. The same studies are done as in the second ultrasound. The parameters of the placenta are also evaluated. Pathologies not previously seen may be found. This study is usually accompanied by cardiotocography, which is necessary to assess the baby's heartbeat, and Doppler imaging, which examines the blood flow between the baby and his mother.

An ultrasound examination can be performed before childbirth to determine the position of the fetus and its entanglement with the umbilical cord, its general condition. Such studies largely depend on the competence of the doctor and the quality of the equipment. Cases when, according to the results of ultrasound, a boy is expected, and a girl is born, or abnormalities were diagnosed, but a healthy child was born (and vice versa), are not uncommon.

Therefore, the definition of pathology should be approached comprehensively in order to exclude errors. If an ultrasound scan again (by another doctor and using more modern equipment) diagnoses abnormalities in the fetus and markers show a high probability of malformations, then the possibility of having a child with abnormalities is great, but not 100%, and it is better to additionally be examined .. Blood from the umbilical cord is examined ... It is carried out after the 20th week.
All these studies are carried out in the first half of pregnancy, and only cordocentesis is done after the 20th week. The collection of biological material is traumatic and associated with risks of 1–5% (miscarriage, infection, etc.), and the woman herself decides whether to undergo it. If a woman, for ethical or religious convictions, wants to keep a child with disabilities, then there is no point for her to go through them. The decision to maintain or terminate the pregnancy is always made by the woman.

Therapeutic treatment of all types of pathology is carried out without fail at a hospital in the department of gynecology. Outpatient treatment is allowed only for mild forms of early toxicosis and the initial stage of gestosis.

As a rule, in order to avoid problems, preventive measures against the occurrence of pathology during a planned pregnancy can be started already before it, eliminating bad habits, changing harmful work to an easier one, taking vitamin B9 and passing tests for infections that can interfere with the normal course of pregnancy.

Important! First of all, it is necessary to register in a medical institution in a timely manner and visit a gynecologist, pass all the necessary tests and undergo all the necessary studies. Follow all the doctor's recommendations for taking vitamins, nutrition, lifestyle.

It is also necessary to resolve the issue of chronic diseases that can affect the process of bearing a child. Parents-to-be at risk should consult a geneticist and undergo recommended examinations. It is important to follow all the doctor's prescriptions and recommendations:

• control diseases of a chronic nature, which can worsen during the period of gestation. Be sure to inform your gynecologist about them;
• monitor your health and, if something bothers you, seek the advice of a doctor;
• only with a trusted partner;
• adhere to a healthy diet, take the necessary;
• special physical exercises and walks in the fresh air help keep the expectant mother in good shape and strengthen the body;
• control of body weight, weight gain;
• giving up bad habits (smoking, alcoholic beverages, coffee, etc.);
• prevention and timely treatment as prescribed by a doctor of colds and infectious diseases;
• avoid stress and physical overload;
• when working in hazardous production, change the type of activity;
• carry out timely prophylaxis of gestosis, constantly weigh ourselves, monitor pressure, take the necessary tests, undergo an ultrasound scan.

Pathologies can darken any pregnancy, negatively affect the child, so it is important to monitor your health, take all tests and undergo all recommended studies. With a planned pregnancy, many of them should be passed before conception and get rid of bad habits. Women with extragenital diseases should also consult doctors with whom they are registered even before pregnancy. Couples at risk are advised to undergo testing with a geneticist.

Every woman wants to have a child. This state is psychologically inherent in every female, and physiologically, it is possible in any woman. But, the modern world shows that not everyone succeeds in getting pregnant, enduring such a pregnancy throughout its entire period and at the end to see their beautiful baby.

Some women who have a well-established reproductive function do not understand their happiness, and do rash acts in the form of their first abortion. Some, on the contrary, would gladly give birth to a child, but they fail to conceive. And in the first and in the other situation, the woman remains "unprotected" in terms of health.

As for those women who managed to get pregnant, it is not always enough to have a desire to conceive, preserve, deliver and give birth to a child. Very often, especially in our modern world, pathologies occur during pregnancy.

In the presence of a pathology of pregnancy, a problem may arise that is dangerous to the health of not only the mother herself, but also the fetus.

How to identify pathologies in a pregnant woman?

Most often, in the presence of pathology, a woman does not feel something unusual in the body. Pregnancy itself changes the mother's body, so a lot is written off to the development of the fetus. For example, one of the most important functions of the body of any person is the correct functioning of the heart.

If there are problems associated with heart diseases, which the young mother knew about before the onset of pregnancy, she is obliged to tell her doctor obstetrician-gynecologist about them, and he, for his part, is obliged to give all the necessary assistance to ensure constant monitoring of the condition of the pregnant woman.

It is much worse when pathology of the heart or blood vessels occurs during pregnancy. In many cases, this pathology and pregnancy are incompatible. Since this type is directly related to the threat to the life of both the woman and the child, if there is evidence, the pregnancy can be terminated.

Signs of pathology

In general, signs of pathology during pregnancy should be identified early in order to coordinate treatment and follow up.

Currently, the world health organization has allocated only three terms for which a woman needs to undergo an ultrasound examination. At the first stage of twelve weeks, the presence of pregnancy as such, its location (in the uterus or not), as well as the main signs of its development are determined.

For the second time, at a period of twenty weeks, the ultrasound machine can already determine the pathology of the fetus during pregnancy. If such a pathology can be eliminated, for example, then a pregnant woman is admitted to a hospital, and as part of inpatient treatment receives all the necessary drugs that will allow, if not eliminate the cause of the pathological problems, then at least prevent the negative consequences of its appearance.

In addition, for a period of twenty weeks, if there is a pathology of pregnancy, in connection with which the child cannot exist outside the mother's body, an operation is prescribed to interrupt it.

In the third period, namely at 36-37 weeks, the location of the fetus is determined. If at this time any pathology of pregnancy is determined, then the attending physician of the pregnant woman should make a decision about calling for early birth. The most common reason for calling premature birth, at such a late date, is the occurrence of infectious diseases in a woman's body.

However, abnormalities during pregnancy are not always determined by ultrasound. To determine its occurrence, it is sometimes necessary to undergo a course of laboratory tests. If there are any changes in sensations, the woman should pay close attention to this, and.

The most common reason for the development of pregnancy pathology is a lack of hemoglobin protein in the mother's body. Due to its absence, the woman suffers from anemia, and her child is at risk of serious developmental disabilities.

It is probably not worth explaining what anemia is, it is a well-known fact. But, the fact that due to the presence of anemia, not only the mother's body can suffer, but oxygen is not brought to the child, many forget about this. With deficiencies of any vitamins, nutrients, and, moreover, oxygen, there may be serious problems with the development of the child's brain.

Also, with the help of analyzes, it is possible to affect the work of the thyroid gland, which, in the presence of such a pathology of pregnancy, can lead to underdevelopment of the fetus.

The main causes of pathology during pregnancy

We can talk about what pathologies can arise for a long time. But what are the main reasons for their manifestation.

Firstly, it is our ecology. Pollution, lack of fresh air, and, accordingly, oxygen, can become the most likely cause of not only anemia, but also congenital abnormalities of the fetus.

The next factor that determines the causes of the origin of certain pathologies in a pregnant woman is the presence of such negative habits as smoking and drinking alcohol in the mother. Both nicotine and alcohol strongly affect the development of the infant's nervous system as well as his physical development. Incorrect nutrition of the mother can also be attributed to the same point, it does not affect the child much better.

Well, and, probably, the last factor that causes pathology during pregnancy is the presence of surgical intervention. When this intervention was necessary, for example, if the first one, then its presence is possible, but in a small percentage of cases.

Much more often pathologies occur after an abortion. Therefore, women who terminated their first pregnancy for any reason need more close medical supervision.

In any case, in the presence of pathological symptoms, the main task of any mother is to preserve her health, and the health of her child. Do not neglect the recommendations of doctors, even with relatively good health.

A physiological process during which a fetus capable of extrauterine life develops from a fertilized egg in a woman's body. Pregnancy with one fetus is more often observed, the simultaneous development of two or more fetuses is possible (see. Multiple pregnancy). A normal pregnancy lasts from 266 to 294 days (an average of 280 days, that is, 40 weeks, or 10 obstetric months), counting from the first day of the last menstruation, and ends with childbirth.

Diagnosis of pregnancy. Currently, immunological methods for diagnosing pregnancy are widespread: the qualitative and quantitative determination of chorionic gonadotropin (CG) - the hormone is released by the chorionic structures, from which the placenta is formed. The amount of hCG in the blood and urine increases in the earliest stages of pregnancy - 2 days after the introduction of a fertilized egg into the lining of the uterus (implantation) and is the first diagnosed sign of pregnancy. Determination of hCG in a qualitative way is carried out using special test kits in the urine within a few minutes. Quantification in urine or blood is performed by immunological methods.

Ultrasound is widely used, which makes it possible to diagnose pregnancy at the 3rd - 4th week, when it is possible to register the contraction of the heart of the embryo.

The two-handed gynecological examination, which determines such signs of pregnancy as cyanosis of the vaginal mucosa, cervix, has not lost its significance; softening of the isthmus of the uterus; globular enlargement of the body of the uterus is recorded from the 4th week of pregnancy.
In the diagnosis of early pregnancy, signs such as nausea, drowsiness, changes in taste, absence of menstruation, and engorgement of the mammary glands are used.

In the later stages (from about the second half of pregnancy), the diagnosis of pregnancy is confirmed by reliable (undoubted) clinical signs of pregnancy: fetal movement, determined by palpation of the abdomen, palpation of parts of the fetus, listening to fetal heart sounds. The fetal heartbeat is heard from the 18th to 20th week of pregnancy using an obstetric stethoscope. To determine the heartbeat of the fetus, an electrocardiographic study is also used (starting from the 4th month of pregnancy). The widespread introduction of ultrasound into obstetric practice makes it possible to consider this method the most accurate for determining the duration of pregnancy, the size of the fetus, the size of its parts and placenta. Modern guidelines for obstetrics and gynecology are provided with tables containing indicators of the size of the embryo and fetus, as well as the size of the thigh, breast volume, abdomen, etc. at various stages of pregnancy, from the first trimester to delivery. In the normal course of pregnancy, ultrasound examination is performed at 10-11 weeks, 24 weeks and 32-33 weeks of pregnancy. According to indications - at any time. Modern ultrasound machines, according to the data of the last menstruation and indicators of the size of the fetus, calculate the approximate term of delivery and the weight of the fetus.

The most accurate period of pregnancy can be established when a woman turns to a doctor (midwife) in the early stages of pregnancy. Two-handed research is still widely used. With a vaginal-abdominal examination, the length of the uterus at 4 weeks of gestation is approximately 7 - 8 cm, at 8 weeks - 9 - 10 cm, at 12 weeks - 12 - 13 cm.After 16 weeks, the gestational age is judged by the height of the bottom uterus, starting from the 32nd week, also measure the circumference of the pregnant woman's abdomen.

The height of the standing of the fundus of the uterus is determined by measuring the distance between the upper edge of the pubic symphysis and the highest point of the fundus with a centimeter tape. The measurement is made with the woman lying on her back with her legs straight; the bladder must be emptied before examination. The height of the standing of the uterine fundus at 16 weeks of pregnancy is approximately 6 cm, at 20 weeks - 12-14 cm, at 24 weeks -20 cm, at 28 weeks - 24 - 26 cm, at 32 weeks - 28 - 30 cm (approximately at the border between the navel and the xiphoid process of the sternum, the navel begins to smooth out), at 36 weeks - 32-34 cm (reaches the xiphoid process of the sternum, the navel is smoothed), at 40 weeks - 28 - 30 cm, i.e. the same as at 32 weeks but the navel is protruding.

The abdominal circumference is measured in the same position of the woman as when determining the height of the uterine fundus. A centimeter tape is placed in the back in the middle of the lumbar region, in front at the level of the navel. The abdominal circumference at 32 weeks of pregnancy is 80 - 85 cm, at 36 weeks - an average of 90 cm, at 40 weeks - 95 - 98 cm (much more than at 32 weeks, although the height of the fundus of the uterus at 32 weeks and 40 weeks is approximately is the same).

The gestational age can be roughly established by measuring the length of the fetus with a pelvimeter, carried out in the second half of pregnancy. At the same time, the woman lies on her back, her legs are slightly bent at the hip joints, the bladder must be emptied before measurement. Feeling through the abdominal wall of a part of the fetus, one button of the pelvis is placed on the lower pole of the head, the other on the buttocks of the fetus (more often they are in the area of \u200b\u200bthe bottom of the uterus). The value obtained when measuring the distance from the lower pole of the head to the buttocks is multiplied by 2. With a significant development of the subcutaneous tissue of the abdominal wall, 3-5 cm are subtracted from the obtained number. If the head is deep in the entrance to the pelvis, then the measurement is made from the upper edge of the pubic symphysis to the buttocks of the fetus, and add 2 cm to the result obtained, then multiply the result by 2. Having thus established the length of the fetus, divide this number by 5 and get the approximate gestational age (in obstetric months).

The estimated date of delivery can be determined by the time of the last menstruation (from the first day of the last menstruation, 3 calendar months are counted back and 7 days are added), as well as by the date of the first fetal movement (20 weeks are added to it in primiparous and 22 weeks in multiparous). Various calendars and rulers are available to determine when prenatal leave is granted and the expected due date.

Monitoring a pregnant woman. When pregnancy is established, a woman should be examined (see Obstetric research) and taken under dispensary supervision in a antenatal clinic (in rural areas at a feldsher-obstetric station). At the first visit of a pregnant woman, in addition to the vaginal examination, the size of her pelvis is determined, the height and body weight, blood pressure on both arms are measured, the condition of the internal organs (heart, lungs, etc.) is examined, a laboratory study of vaginal discharge, clinical blood tests are performed, urine, Wasserman reactions and HIV infection, determine the blood group and Rh factor. Each pregnant woman should be examined by a therapist, dentist, ophthalmologist, and, if necessary, a neurologist, surgeon and other specialists.

In the normal course of pregnancy, a healthy woman with an unburdened obstetric history should visit an obstetrician-gynecologist (midwife) in the first half of pregnancy once a month, starting from 20 weeks and up to 32 weeks of pregnancy - 2 times a month, after 32 weeks - 3-4 times per month. During repeated examinations, her body weight, blood pressure are determined, the position of the fetus is specified, the height of the uterine fundus and the abdominal circumference are measured. Particular attention is paid to the functional state of the fetus (movement, palpitations); establish its estimated mass, which can be calculated using Johnson's formula. From the value of the standing height of the bottom of the uterus (in centimeters), subtract 11 (with a mass of a pregnant woman up to 90 kg) or 12 (with a mass of more than 90 kg) and the resulting number is multiplied by 155; the result corresponds to the approximate weight of the fruit in grams. At 32 weeks, the pregnant woman is re-examined by the therapist.

During pregnancy, at least 2-3 times, a clinical blood test is performed (after the first visit, at 22 and 32 weeks of pregnancy), a clinical analysis of urine (at each visit), Wasserman's reaction and HIV infection (at the first visit and at 32 weeks pregnancy).

When visiting a doctor (midwife), a woman is assigned the date of the next visit, and if she does not appear on the specified date, she is visited at home; in addition, the FAP midwife visits the pregnant woman at home twice (after registration and at 35-36 weeks of pregnancy) and at the workplace at 18-20 weeks of pregnancy.

With regard to every woman throughout pregnancy, health-improving measures are carried out in order to ensure a favorable outcome of pregnancy and childbirth for the mother and the fetus: psycho-preventive preparation of pregnant women for childbirth is carried out, sanitary and educational work on hygiene of pregnant women is carried out, if necessary, the pregnant woman is transferred to an easier work, etc.

A midwife working independently at a feldsher-obstetric station, during dispensary observation of a pregnant woman, should strive to ensure that each pregnant woman is examined by an obstetrician-gynecologist, therapist and other specialists at the appointed time, the necessary laboratory tests are carried out in a timely manner and that the birth takes place in a observation of an obstetrician-gynecologist.

Pregnancy pathology.

Often, the course of pregnancy is complicated by various diseases or pathological conditions that pose a certain danger (increased risk) for the mother and the fetus, both directly during pregnancy and later in the process of childbirth and after them. They can lead to the emergence of such obstetric and antenatal pathologies as premature termination of pregnancy, uterine bleeding, fetal growth retardation, intrauterine fetal death, etc. The course of pregnancy is very aggravated when a woman develops toxicosis of pregnant women, which poses a particular danger to the fetus. Complications of pregnancy are often observed when the fetus is in the wrong position (for example, pelvic presentation of the fetus), polyhydramnios, multiple pregnancies and post-term pregnancy. Severe complications (bleeding, premature termination of pregnancy, fetal death) occur when the development and growth of the trophoblast of the embryo - trophoblastic disease - is impaired. An increased risk for the mother and especially for the fetus is the incompatibility of their blood according to the Rh factor or the AB0 system (see Hemolytic disease of the fetus and newborn).

Special attention is also required for women who, before the present pregnancy, had artificial or spontaneous abortions, premature births, especially repeated ones (see Non-surviving pregnancy), stillbirths, infertility.

A significant risk to the mother and fetus arises during pregnancy and childbirth if women have a number of diseases that are not causally related to fertility, as well as with various pathologies of the female genital organs.

In case of identifying risk factors for complications of pregnancy and childbirth, an individual plan of dispensary observation should be drawn up for each pregnant woman in the antenatal clinic, taking into account the specifics of the existing or possible pathology, the woman's condition, anamnesis data, etc. a plan of adjustments and additions in accordance with changes in the condition of the woman and the fetus. An individual dispensary observation plan usually provides for more frequent targeted examinations of a woman by an obstetrician-gynecologist, a therapist, and, if indicated, by doctors of other specialties (ophthalmologist, endocrinologist, urologist, etc.). In this case, special diagnostic studies are usually carried out, including studies that allow to determine the condition of the fetus: registration of its cardiac activity, amnioscopy, ultrasound examination.

For pregnant women of high risk groups, a special regimen is established, if necessary, appropriate therapy is prescribed. In some cases, they resort to hospitalization for therapeutic and prophylactic purposes at various stages of pregnancy, as well as to prenatal hospitalization (in a hospital where highly qualified care can be provided, sometimes in a specialized obstetric hospital).

Pregnancy and extragenital pathology.

The combination of pregnancy and diseases that are not causally related to fertility is quite common. Pregnant women may have diseases of the cardiovascular system ( heart defects, hypertension, arterial hypotension and others), blood diseases (mainly anemia), kidneys ( pyelonephritis, glomerulonephritis etc.), respiratory organs (for example, bronchial asthma), gastrointestinal tract ( gastritis, gastric ulcer and duodenal ulcer, cholecystitis, cholelithiasis, appendicitis and others), endocrine diseases (for example, diabetes), etc. A combination of pregnancy with infectious diseases is possible (for example, tuberculosis, viral hepatitis).

Extragenital diseases often disrupt the normal course of pregnancy and childbirth, lead to the development of pathological conditions of the mother, fetus and newborn. Pregnancy can aggravate the course of these diseases, contribute to the manifestation of some diseases of the internal organs.
The role of the midwife is the early detection of signs of extragenital diseases in pregnant women, the implementation of therapeutic measures as prescribed by the doctor, and the prevention of infectious diseases.

Heart defects (congenital and acquired). During pregnancy and childbirth, patients with heart defects may develop heart failure, sometimes exacerbation of the rheumatic process, which in some cases leads to the death of a woman. With decompensated defects, premature birth, fetal hypoxia and other complications are possible. Obstetric tactics in relation to pregnant women with heart defects depends on the form of the defect, the state of the myocardium, and the stage of circulatory failure. All this should be clarified in the early stages of pregnancy (up to 12 weeks) to resolve the issue of the possibility of maintaining pregnancy.

In rheumatic heart diseases, the activity of the rheumatic process in conjunction with other clinical and laboratory data is evidenced by leukocytosis over 11 000 in 1 μl, a pronounced shift to the left of the leukocyte formula, ESR more than 35 mm / h.
Of great importance for predicting the course of pregnancy and the outcome of childbirth in women with heart defects is to determine the degree of risk of developing various complications in a woman and a fetus. I degree of risk is observed in the presence of heart defects in pregnant women without pronounced signs of heart failure and exacerbation of rheumatism; II degree of risk - with the initial symptoms of heart failure and the identification of the I degree of activity of the rheumatic process; III degree of risk - with signs of a predominance of right ventricular failure, the presence of II degree of activity of the rheumatic process, recent atrial fibrillation, pulmonary hypertension of the II stage; IV degree of risk - with signs of left ventricular or total insufficiency, the presence of a III degree of activity of the rheumatic process, a significant increase in the size of the heart (cardiomegaly) or its atria (atriomegaly), long-standing atrial fibrillation with thromboembolic manifestations, with stage III pulmonary hypertension. Pregnancy is permissible and can be maintained only in the case of I and II degree of risk, subject to maintenance therapy. With III - IV degrees of risk, a woman should be warned that pregnancy is undesirable, and if it has occurred, then its preservation is contraindicated due to the danger of a rapid increase in circulatory failure.
The question of the admissibility of pregnancy or the possibility of its preservation in women who have undergone heart surgery is decided strictly individually, depending on the patient's condition. Due to the fact that the restoration of blood circulation after surgery occurs no earlier than 1 - 1.5 years, the woman should be explained that pregnancy during this period is undesirable. Pregnancy is contraindicated after valve replacement.

An obstetrician-gynecologist and a therapist should be involved in choosing the optimal tactics for managing pregnancy in pregnant women with heart defects. Regardless of the condition, a patient with a heart defect must be hospitalized routinely at least 3 times during pregnancy. The first hospitalization is carried out at 8-10 weeks of pregnancy to clarify the diagnosis and resolve the issue of the possibility of maintaining pregnancy, the second - at 26-32 weeks of pregnancy (the period of the greatest hemodynamic load on the heart), the third - 3 weeks before the expected date of birth (about 37 weeks) to prepare for childbirth and develop delivery tactics. If signs of decompensation appear, the patient should be urgently hospitalized at any stage of pregnancy.

In the hospital, a set of measures is carried out, including a hygienic regime, nutritional therapy, physiotherapy exercises, psychoprophylactic preparation for childbirth, oxygen therapy. Drug treatment is determined by the patient's condition. According to indications, cardiovascular, antirheumatic, hyposensitizing, diuretics and anticoagulants are used.

Hypertonic disease. Recognition of hypertension is not difficult if it arose before pregnancy. The diagnosis of hypertension during pregnancy is based on the following symptoms: blood pressure above 140/90 mm Hg. Art. in the early stages (up to 16 weeks) of pregnancy and the maintenance of elevated blood pressure in the second half of pregnancy in the absence of other symptoms characteristic of late toxicosis of pregnant women (edema, proteinuria, etc.). The solution to the question of maintaining pregnancy depends on the stage of the disease: at stage I of hypertension, pregnancy and childbirth can proceed normally, at stage IIA, pregnancy can be saved only with the persistent desire of the woman, in this case the patient needs systematic observation and treatment, and when the condition worsens - in early termination of pregnancy. With 11B and III stages of the disease, pregnancy must be terminated for medical reasons. The course of pregnancy in hypertensive disease, as a rule, is complicated by prematurity, the occurrence of late toxicosis of pregnant women, often premature detachment of the normally located placenta, stillbirth.

With an exacerbation of hypertension, possible at any stage of pregnancy, there is a deterioration in the general condition of the patient, increased headaches, a significant increase in blood pressure, changes in the fundus. Perhaps the development of a hypertensive crisis, which must be distinguished from preeclampsia, which usually occurs against the background of nephropathy of pregnancy.

Arterial hypotension (systolic blood pressure does not exceed 100, and di-astolic - 60 mm Hg. Art.). Distinguish between acute and chronic arterial hypotension. Acute is observed in acute cardiovascular or vascular insufficiency (for example, with fainting, collapse, shock). Chronic arterial hypotension is physiological and pathological. With physiological arterial hypotension, there are no complaints, the woman's ability to work is preserved. With pathological arterial hypotension, weakness, sweating, fatigue, dizziness, palpitations, and a significant decrease in blood pressure are noted. Pregnancy is often complicated by early toxicosis, premature birth, weakness of labor, fetal hypoxia. Pregnant women with blood pressure below 1OO / 6O mm Hg. Art. should be under the systematic supervision of an obstetrician-gynecologist and therapist. Pregnant women with physiological arterial hypotension do not need treatment. With pathological arterial hypotension, the underlying disease is treated, restorative therapy, physiotherapy exercises, and drugs that stimulate the activity of the central nervous system are prescribed.

Anemias in pregnant women are observed very often (up to 30% of cases). The most common is iron deficiency anemia (7O - 95% of all anemias of pregnant women), much less often folate deficiency, hemolytic and hypoplastic anemias.

Relative, or false, anemia can occur in pregnant women due to a significant increase in blood plasma volume during pregnancy; it differs from true anemia in its normal color index and in the absence of morphological changes in erythrocytes.
The appearance of iron deficiency anemia is associated with an increased consumption of iron, which is necessary for the development of the placenta and the fetus. In healthy pregnant women, this process is compensated by both exogenous intake of iron (with food) and iron stores deposited in the liver. The occurrence of iron deficiency anemia during pregnancy is facilitated by gastritis, cholecystitis, pancreatitis, enterocolitis, helminthic invasions, hypothyroidism, leading to impaired absorption of iron in a woman's body, as well as frequent childbirth with a short interval between them, prolonged lactation, multiple pregnancies, placenta previa.

The clinical picture of iron deficiency anemia in pregnant women is characterized by the same symptoms as in non-pregnant women. The course of pregnancy in women with iron deficiency anemia is often complicated by early and late toxicosis of pregnant women.

Treatment of iron deficiency anemia in pregnant women consists in the appointment of iron supplements. You need a high-calorie diet with a predominance of proteins and a sufficient amount of trace elements. Most of the iron is found in meat, liver, and it is easier to digest than plant-based iron. In the diet of patients, it is recommended to include 15O - 2OO g of boiled meat or 1OO g of liver (boiled or fried) daily. Transfusion of erythrocyte mass to pregnant women due to the risk of immunization or transfusion complications is carried out only in case of severe anemia or urgent preparation for childbirth. To prevent chronic hypoxia and fetal malnutrition, developing with iron deficiency anemia, drugs are prescribed that improve uteroplacental blood circulation (sygetin, theonicol, heparin, etc.).

Pyelonephritis - the most common kidney disease in pregnant women. Its occurrence is due to a violation of the urodynamics of the upper urinary tract and blood circulation in the kidneys as a result of pregnancy, compression of the ureters by the growing uterus, the presence of a focus of infection in the body (angina, carious teeth, furunculosis, etc.). Acute pyelonephritis during pregnancy has a typical picture, is successfully treatable and, as a rule, does not significantly affect the course of pregnancy. Chronic pyelonephritis is often diagnosed for the first time during pregnancy and is, as a rule, a consequence of pyelonephritis that was latent before pregnancy. Pregnancy contributes to the progression of the disease. Often, pregnant women develop severe forms of pyelonephritis. Studies reveal leukocyturia, proteinuria, sometimes microhematuria, bacteriuria, anemia. In chronic pyelonephritis, miscarriage is often observed.

Patients with pyelonephritis should be closely monitored by an obstetrician-gynecologist and nephrologist. If chronic pyelonephritis in pregnant women is accompanied by arterial hypertension or renal failure, termination of pregnancy is indicated, regardless of its duration. Children born to mothers with acute and chronic pyelonephritis often show signs of intrauterine malnutrition.

Glomerulonephritis. Acute and chronic glomerulonephritis occurs in pregnant women. In acute glomerulonephritis, preterm labor, antenatal fetal death are often observed; termination of pregnancy is recommended.

Chronic glomerulonephritis in pregnant women, it often occurs in a latent form, less often there is a hypertensive, nephrotic and mixed forms. The course of pregnancy can be complicated by late toxicosis, premature birth, fetal hypoxia, and the threat of its death. Pregnancy can be saved with a latent form of glomerulonephritis, characterized by slight proteinuria, intermittent hematuria, cylindruria. Throughout pregnancy, patients should be under the strict supervision of an obstetrician-gynecologist and nephrologist. Treatment is symptomatic. In the nephrotic form with intact kidney function, it is possible to maintain pregnancy with careful observation and treatment in a specialized hospital. In hypertensive and mixed forms of chronic glomerulonephritis, pregnancy is contraindicated.

Bronchial asthma. During pregnancy, the course of bronchial asthma can be different. In some cases, the attacks subside and even disappear, in others, the disease becomes more severe. Rarely, bronchial asthma manifests itself only during pregnancy (asthma of pregnant women). At the same time, pregnancy and childbirth can proceed without any particular complications. Treatment is symptomatic. Patients with long-term bronchial asthma with repeated severe attacks and signs of pulmonary heart failure are contraindicated in pregnancy and must be terminated early.

Gastritis (acute and chronic) with uncomplicated course does not adversely affect the development of pregnancy and its outcome. Treatment of acute and chronic gastritis in pregnant women does not differ from the conventional one.

Peptic ulcer of the stomach and duodenum. Pregnancy usually has a beneficial effect on the course of peptic ulcer disease. Complications of peptic ulcer disease (bleeding, ulcer perforation) during pregnancy are rare. They can occur before childbirth, during childbirth, in the early postpartum period. Therefore, women suffering from peptic ulcer disease, 2-3 weeks before childbirth and immediately after childbirth, need to undergo preventive treatment.

Appendicitis. A feature of appendicitis in pregnant women is the rapid progression of the inflammatory process in the abdominal cavity, due to a change in the position of organs in it in connection with pregnancy. Diagnosis is difficult, since a similar clinical picture and changes in the hemogram can be observed with ovarian apoplexy, torsion of the ovarian tumor, cholecystitis and other diseases. Consultation with a surgeon and dynamic (every 2-3 hours) observation of the patient is mandatory. Surgical treatment. Pregnancy is not disturbed after appendectomy.

Cholecystitis and gallstone disease. Pregnancy can provoke the development of cholecystitis and cholelithiasis due to biliary dyskinesia often occurring in pregnant women, obstruction of blood outflow, hypercholesterolemia. Clinical signs of diseases, diagnosis and treatment during pregnancy have no peculiarities. The prognosis for pregnancy and childbirth is relatively favorable.

Diabetes may first appear during pregnancy. Pregnancy against the background of diabetes mellitus is often complicated by spontaneous abortion, premature birth, late toxicosis, and death-birth.

Absolute contraindications for pregnancy are severe forms of diabetes mellitus (insulin-dependent form), especially complicated by diabetic glomerulonephritis or retinopathy, diabetes mellitus in both spouses (the possibility of a hereditary form of diabetes mellitus and congenital malformations in a child), a combination of diabetes mellitus with other somatic diseases. In such cases, in the antenatal clinic in early pregnancy, it is necessary to warn the patient about possible complications and offer an abortion. If a woman refuses to interrupt, urgent hospitalization is required for a comprehensive examination (including consultation with an endocrinologist) and the choice of optimal treatment. In the future, the patient should be under constant supervision of an obstetrician-gynecologist and endocrinologist. Antenatal hospitalization is shown no later than 32 weeks of pregnancy for examination and decision on the choice of the method of delivery. Patients with diabetes mellitus often have a large fetus and polyhydramnios.

Tuberculosis. Preservation of pregnancy (subject to systematic observation and treatment in a hospital) is possible in most patients with tuberculosis. The prognosis of pregnancy and childbirth in the context of specialized care for both the mother and the fetus is relatively favorable. Specific treatment (antibacterial). Termination of pregnancy is indicated for fibrocavernous pulmonary tuberculosis, active osteoarticular tuberculosis and bilateral renal tuberculosis. It should be remembered that it is necessary to terminate pregnancy in these forms of tuberculosis within 12 weeks, since termination at a later date contributes to the progression of the tuberculosis process.

Viral hepatitis. During pregnancy, the two most common forms of hepatitis can occur - hepatitis A and hepatitis B (see Hepatitis viral). The clinical course of hepatitis A during pregnancy does not have any peculiarities. The differential diagnosis of this form of hepatitis in the first trimester of pregnancy should be carried out with early toxicosis of pregnant women, which can also manifest itself as decreased appetite, vomiting, and a feeling of heaviness in the epigastric region. With hepatitis A, the listed symptoms are observed, as a rule, no more than a week, the pregnant woman usually does not lose body weight, there is an increase in body temperature (often chills), an increase in the liver and spleen, an increase in transaminase activity, detected by blood tests. The prognosis for the pregnant woman and the fetus is favorable. Treatment is symptomatic.

Hepatitis B in pregnant women the course is the same as usual. The disease is life-threatening for a pregnant woman due to the possibility of liver failure and encephalopathy. Pregnancy can be complicated by spontaneous miscarriage, premature birth, antenatal fetal death. In the acute stage, infection of the fetus is possible. The patient should be admitted to the infectious diseases hospital, where there are special boxes for pregnant women. In severe cases, artificial termination of pregnancy is performed after the elimination of acute manifestations of the disease. Termination of pregnancy in the acute stage of the disease is not recommended, as it worsens the patient's condition.

Malformations of the internal genital organs. Pregnancy is possible with such malformations of the internal genital organs as the longitudinal septum of the vagina, doubling of the uterus and vagina, saddle uterus, two-horned and one-horned uterus. It is extremely rare that pregnancy occurs in the rudimentary (closed) uterine horn.

Cervical erosion. Symptoms and diagnosis of cervical erosion in pregnant women are the same as outside of pregnancy. Pregnant women with cervical erosion should be supervised by a gynecologist. The vagina is sanitized, the cervix is \u200b\u200btreated with sea buckthorn oil, 1% synthomycin emulsion. Cauterizers, diathermocoagulation are not shown. Pregnancy and childbirth are usually uneventful.

Cervical polyp may be the cause of vaginal bleeding in a pregnant woman. Diagnostics of the cervical polyp is not difficult: when examining the cervix in the mirrors, a bright red polyp protruding from the cervical canal is visible. When a polyp is found, the midwife should take a scraping from its surface for cytological examination and refer the patient to an obstetrician-gynecologist for colposcopy. A bleeding polyp in a pregnant woman is subject to removal (in a hospital) and mandatory histological examination. The course of pregnancy and childbirth, as a rule, is not disturbed.

Cervical cancer rare in pregnant women. Pregnancy can occur against the background of cervical cancer and contributes to its more rapid development. The first manifestations of cervical cancer are the same as outside of pregnancy: leucorrhoea, bleeding. When these signs are detected, an examination of the cervix in the mirrors and a vaginal-abdominal examination are shown. The midwife should take a swab-scraping from the surface of the cervix for cytological examination, refer the pregnant woman to an obstetrician-gynecologist for colposcopy and biopsy of a suspicious tissue site. Upon confirmation of the diagnosis, the pregnant woman is immediately referred to a hospital for termination of pregnancy and appropriate treatment.

Myoma of the uterus is one of the most common tumors. During pregnancy, the growth of myomatous nodes is noted, they soften, become mobile.

With uterine myoma, the diagnosis of early pregnancy is often difficult, but it is possible with the use of immunological methods, the detection of chorionic gonadotropin in the urine and ultrasound scanning.

With uterine myoma in pregnant women, there is often a threat of termination of pregnancy, spontaneous miscarriage, possible infringement of the myomatous node, dysfunction of adjacent organs, etc.

The prognosis of pregnancy and childbirth with uterine fibroids largely depends on the location, size of the fibroid nodes and the localization of the placenta in relation to them. So, spontaneous abortions are more often observed with a submucous location of the nodes and with the localization of the placenta on the myoma node. In the case of subserous or intermuscular arrangement of nodes, as a rule, prolongation of pregnancy is possible.

The question of maintaining pregnancy is decided individually, taking into account the age of the patient, the duration of the disease, the size and localization of myomatous nodes, the presence of concomitant diseases. Pregnancy is contraindicated with large initial sizes of uterine fibroids, rapid tumor growth (both outside and during pregnancy), with the location of the myoma node in the cervical region. A high degree of risk is observed in primiparas aged 35 and older, with submucous and intermuscular location of the myomatous node (especially if the tumor grows towards the uterine cavity), in the presence of signs of circulatory disorders in the node.

Pregnant women with uterine fibroids should be monitored regularly by an obstetrician-gynecologist. In the event of complications (the threat of termination of pregnancy, etc.), urgent hospitalization is indicated at any stage of pregnancy to resolve the issue of the expediency of its preservation. All pregnant women with uterine fibroids should be hospitalized 3 - 4 weeks before delivery to decide on the tactics of labor management.

Ovarian tumors. Diagnosis of ovarian tumors in the first half of pregnancy is not difficult, especially with ultrasound. In the second half of pregnancy, diagnosis is difficult due to the large size of the uterus. Pregnancy can be complicated by torsion of the leg of the tumor, its necrosis as a result of compression by the pregnant uterus. When the uterus is displaced by a rapidly growing tumor of the ovary, the fetus may not be in the correct position. Treatment of ovarian tumors is prompt, carried out at any stage of pregnancy. There is little risk of termination of pregnancy after surgery. If the histological examination of the tumor reveals signs of malignancy, termination of pregnancy (at any time) and appropriate treatment are indicated.

The effect of nicotine and alcohol on the fetus.

Nicotine - one of the main toxic components of tobacco smoke - has a pronounced vasoconstrictor effect and, due to this, has a negative effect on the processes of blood circulation in the uterus and placenta. In intensively smoking women (20 cigarettes a day), pregnancy often ends in spontaneous abortion. Nicotine quickly crosses the placenta and inhibits the processes associated with an increase in the weight of the fetus (its malnutrition develops). In women who smoke during pregnancy, children are born with a low score on the Apgar scale, and the lag in body weight during full-term pregnancy can reach 300 g or more; body weight deficiency persists during the 1st year of a child's life. Therefore, smoking during pregnancy should be prohibited.

With the systematic use of alcoholic beverages during pregnancy, fetal alcohol syndrome may occur, which is characterized by multiple developmental anomalies, as well as impaired physical and mental development of the child. The syndrome is manifested by impaired development and activity of the central nervous system; slowdown in growth; characteristic anomalies of the facial skull; malformations of internal organs, limbs, etc.

Microcephaly, intellectual disturbances of a progressive nature are observed. Growth retardation begins during intrauterine life and becomes especially noticeable after the birth of the child. Congenital heart defects, abnormal development of the upper and lower extremities are common. Perinatal mortality in fetal alcohol syndrome is high. When pregnancy occurs in persons suffering from chronic alcoholism, it is necessary to raise the question of its termination.

Effect on the fetus of ionizing radiation.

The human embryo and fetus are very sensitive to the effects of ionizing radiation. Disorders of embryogenesis under radiation exposure depend on the stage of intrauterine development and the dose of radiation. Irradiation in the pre-plantation period causes intrauterine death of embryos (embryotoxic effect). Exposure to ionizing radiation during organogenesis and placentation leads to fetal malformations; during this period, the percentage of embryo death is also high. The greatest radiosensitivity is possessed by the central nervous system, organs of vision and the hematopoietic system of the fetus. With radiation exposure in the period after 10 - 12 weeks, a general delay in fetal development and the onset of typical symptoms of radiation sickness inherent in an adult body are usually observed.

In connection with the particularly high radiosensitivity of the embryo in the early stages of development, it is necessary to exercise great caution when prescribing therapeutic and diagnostic procedures for women involving the use of internal and external irradiation. In the first 2-3 months of pregnancy, it is necessary, if possible, to completely abandon all X-ray studies, especially those associated with irradiation of the small pelvis. In the later stages of pregnancy, X-ray examinations in the presence of strict indications are permissible, however, it is always necessary to strive to replace X-ray examinations with ultrasound.

Pregnancy is a joyful and at the same time anxious expectation of the mystery of nature, which is about to happen. Throughout the entire path of intrauterine development of the baby, the mother sensitively listens to his every movement, awaits with trepidation the results of all the tests passed and the results of any research passed. Everyone wants to hear the same phrase from doctors: "Your child is healthy." But this is not always the case.

There are various fetal pathologies that are diagnosed at different stages of pregnancy and force parents to make a serious decision - whether the baby will be born or not. Painful deviations from the normal developmental process can be congenital and acquired.

Since the causes of abnormalities in the fetus can be caused by genetics or external factors, congenital and acquired abnormalities differ. The former are present from the very moment of conception and are diagnosed most often in the early stages, while the latter can appear in a child and be detected by doctors at any stage of pregnancy.

Congenital

Congenital, genetic abnormalities of the fetus in medicine are called trisomies. This is a deviation from the norm of the child's chromosomes, which appears at the earliest stages of its intrauterine formation.

Pathologies caused by the wrong number of chromosomes:

• down syndrome - problems with the 21st chromosome; signs - dementia, specific appearance, growth retardation;
• patau syndrome - disorders with the 13th chromosome; manifestations - multiple malformations, idiocy, multiple fingers, problems with the genitals, deafness; sick children rarely live up to 1 year;
• edwards syndrome - pathology of the 18th chromosome; symptoms - small lower jaw and mouth, narrow and short eye slits, deformed auricles; 60% of children do not live up to 3 months, only 10% reach 1 year.

Diseases dictated by the wrong number of sex chromosomes:

• shereshevsky-Turner syndrome - the absence of an X chromosome in a girl; signs - short stature, infertility, sexual infantilism, somatic disorders;
• polysomy on the X chromosome is manifested by a slight decrease in intelligence, psychoses and schizophrenia;
• polysomy on the Y chromosome, symptoms are similar to the previous pathology;
• klinefelter's syndrome affects boys, signs - weakened hair growth, infertility, sexual infantilism on the body; in most cases, mental retardation.

Pathologies caused by polyploidy (the same number of chromosomes in the nucleus):

• triploidy;
• tetraploidy;
• the reason is fetal gene mutations;
• lethal before birth.

If the causes of fetal pathology during pregnancy are genetic in nature, they can no longer be corrected, such diseases are incurable. The child will have to live with them all his life, and the parents will have to sacrifice a lot to raise him. Of course, among patients with Down syndrome, for example, there are talented, even gifted people who have become famous all over the world, but you need to understand that these are just a few, happy exceptions to the rules.

Acquired

It also happens that an embryo can be absolutely healthy genetically, but it acquires deviations in the process of its uterine development under the influence of a variety of unfavorable factors. These can be diseases of the mother that she suffered during pregnancy, poor environmental conditions, improper lifestyle, etc.

Acquired fetal pathology during pregnancy can affect a wide variety of organs and systems. Among the most common are the following:

• deformation or absence (complete, partial) of internal organs (most often the brain suffers) or body parts (limbs, for example);
• anatomical defects of the facial skeleton;
• heart defects;
• non-closure of the spinal canal;
• cerebral hypoexcitability (perinatal) manifests itself after the birth of a baby in the form of low muscle tone, lethargy, drowsiness, unwillingness to suckle the breast, lack of crying, but this pathology is treatable;
• cerebral hyperexcitability (perinatal) is also successfully treated, symptoms - severe tension, long crying, screaming;
• hypertensive-hydrocephalic syndrome is characterized by an increased head volume, bulging fontanelle, imbalances between the facial and cerebral lobes of the skull, and developmental delays.

Deviations from normal intrauterine development, the causes of which are very difficult to determine, can also be distinguished into a special group. So nature has ordered, and nothing can be done about it. These include:

• the pathology of the umbilical cord of the fetus detected at different stages of pregnancy: it can be too long or very short, the loss of its loops, knots, abnormal attachment, thrombosis and cysts - all this can lead to the death of the child;
• fertility (including Siamese twins);
• many and;
• pathology of the placenta: hyperplasia (its weight is too large) and hypoplasia (if its weight is less than 400 grams), heart attack, chorioangioma, trophoblastic disease, placental insufficiency;
• incorrect presentation of the fetus, some doctors also call pathology.

Each of these deviations requires doctors and parents to have a special attitude towards the child being born, to be extremely attentive, and most importantly, to remain calm. In order not to hear a disappointing diagnosis from a doctor, you need to try to exclude from your life all factors that can cause acquired fetal pathologies. This is within the power of every woman expecting a child.

Stars with Down Syndrome. People with Down syndrome can be gifted. Celebrities with such a congenital pathology include artist Raymond Hu, swimming champion Maria Langovaya, lawyer Paula Sage, actors Pascal Duquesne and Max Lewis, musician and composer Ronald Jenkins.

Causes

Prevention of fetal pathologies involves the exclusion from the life of a young mother of those factors that can provoke the development of intrauterine abnormalities. The most common causes of such diseases are the following.

Heredity

If you know about the presence of genetic abnormalities in your family, even before conception you need to undergo a series of examinations and.

Unfavorable environmental conditions

Mom's work in a chemical plant, in a laboratory with toxic substances, living next to large industrial enterprises or a radiation zone can lead to irreversible consequences.

Wrong way of life

External deformities of newborns are very often caused by smoking, alcoholism, drug addiction, insufficient or poor nutrition of the mother during pregnancy.

Diseases

Viral and bacterial diseases can turn into the most dangerous pathologies for a baby:

• flu before 12 weeks ends either in miscarriage, or the child will be completely healthy;
• flu after 12 weeks can lead to abnormalities in the placenta;
• rubella is fraught with deafness, blindness, glaucoma and damage to the fetal skeletal system;
• toxoplasmosis, transmitted through cats, provokes the development of microcephaly, meningoencephalitis, dropsy of the brain, damage to the eyes and the central nervous system;
• hepatitis B: intrauterine infection of the fetus with this virus is dangerous, as a result, 40% of children can be cured, but 40% die before the age of 2 years;
• cytomegaly can be transmitted to a baby in the womb, and he runs the risk of being born blind, deaf, with cirrhosis of the liver, intestinal and kidney damage.

Sexually transmitted diseases are no less dangerous for the intrauterine development of the fetus:

• herpes can be transmitted to a child and cause pathologies such as microcephaly, malnutrition, blindness;
• a fetus infected with syphilis has a specific rash, damage to the skeletal system, liver, kidneys, central nervous system;
• gonorrhea leads to eye diseases, conjunctivitis, generalized infection (sepsis), amnionitis, or chorioamnionitis.

To avoid such dangerous consequences for the life and health of an unborn baby, parents should do everything possible to eliminate the above reasons. Quit harmful work, move away from the industrial zone, quit smoking and drinking, eat well, avoid diseases and treat them at the first symptoms. You can find out about the pathology of the fetus as early as 12 weeks, when the first examination is made for its presence.

Multi-speaking statistics. With alcoholism of the mother, toxicosis is found in 26%, intrauterine death of a child - in 12%, miscarriages - in 22%, difficult childbirth - in 10%, premature babies - in 34%, birth injuries - in 8%, asphyxia - in 12%, weakened newborns - in 19%.

Diagnostics and timing

Prenatal diagnosis of fetal abnormalities is a complex and capacious process. One of the most important stages is a set of examinations prescribed for pregnant women at 12, 20 and 30 weeks. As a rule, this is a blood test for the presence of biochemical serum markers of chromosomal abnormalities. Usually, checking the fetus for pathology includes the following activities.

Blood tests

I trimester (double test):

• free β-subunit (its concentration) of hCG;
• PAPP-A: Plasma Protein A.

II trimester (triple test for fetal pathology):

• either total hCG is detected, or, as in the first trimester, the free β-subunit of hCG;
• α-fetoprotein (AFP protein);
• free estriol (unconjugated).

An obligatory addition to blood tests is an ultrasound scan. Evaluation of results is always complex. However, a blood test for fetal pathology, coupled with an ultrasound scan, cannot give a 100% guarantee, therefore, if abnormalities are suspected, invasive diagnostic methods are performed: chorionic biopsy and cordocentesis.

Chorion biopsy

This is the receipt of chorionic tissue for the detection and prevention of chromosomal diseases, the carriage of chromosomal abnormalities and monogenic diseases. It is produced in the form of a puncture of the uterus, which can be carried out through the abdominal wall, vagina or cervix with special forceps or an aspiration catheter.

Those parents who want to know how to determine the pathology of the fetus in the early stages can use this analysis, since its main advantage is the implementation of diagnostics already at 9-12 weeks, as well as quick results (2-3 days). Indications for conducting:

• age over 35;
• the presence of a child with congenital malformation (congenital malformation), monogenic, chromosomal diseases;
• heredity of chromosomal abnormalities, gene mutations;
• at 10-14 weeks of pregnancy, according to echography, the thickness of the collar space is more than 3 mm.

This analysis for fetal pathology is quite painful and can provoke bleeding, but with experienced medical personnel, everything goes without complications.

Cordocentesis

This is a method of obtaining the umbilical cord (cord) blood of a child for research. It is usually performed in parallel with amniocentesis (analysis of amniotic fluid). Possible no earlier than 18 weeks.

Under infiltration anesthesia, a needle is punctured through the abdominal anterior wall and the required amount of blood is pumped out of the umbilical cord vessel. Such examination of the fetus for pathology can reveal chromosomal and hereditary diseases, Rh conflict, hemolytic disease.

Ultrasound

One of the most accurate and reliable diagnostics is ultrasound. Many parents are worried about which fetal pathologies can be detected during pregnancy by ultrasound, and which can remain, as they say, “behind the scenes”.

Ultrasound at 12 weeks reveals:

• defects of the central nervous system (anencephaly);
• absence of the peritoneal anterior wall (gastroschisis);
• pathology of the spine in the fetus;
• umbilical hernia (omphalocele);
• lack of limbs;
• down syndrome.

At week 20, almost all visible fetal pathologies on ultrasound can be diagnosed. This is due to the fact that most of the baby's internal organs and systems are already well formed.

At 30 weeks, ultrasound can only confirm or deny data obtained by other methods (using a blood test, cordocentesis, chorionic biopsy).

Now - about what pathologies of the fetus are not detected by ultrasound:

• blindness;
• mental retardation;
• deafness;
• minor organ defects in the fetus - obstruction of the liver ducts, defects in the heart septa;
• genetic diseases: Duchenne myopathy, cystic fibrosis, phenylketonuria;
• chromosomal abnormalities of the fetus - Edwards, Patau, Turner syndrome.

However, the last group of these deviations does not elude doctors after all, since they can be detected by a blood test of a pregnant woman for fetal pathology and other diagnostic methods.

A young mother herself cannot feel any symptoms that something is wrong with her baby. Only a set of diagnostic measures at different stages of pregnancy can reveal abnormalities. Thus, signs of fetal pathology in the early stages, detected by ultrasound, should be visually noticeable. These are external deviations in its development: the shape of the skull, the ratio of sizes, features of the skin folds, etc.

Unfortunately, there are times when a child is born with pathologies that were not identified prenatally. This happens either due to the inexperience and unprofessionalism of the medical staff, or due to the malfunction or dilapidation of the ultrasound equipment.

Facts. Thanks to ultrasound, up to 80% of congenital abnormalities in the fetus are detected in time, of which 40% of pregnancies are terminated due to severe, disabling or incompatible defects.

At-risk groups

There is a group of women who come under the closest attention of geneticists, since the risk of developing abnormalities is very high. Blood is taken from them without fail for fetal pathology and other diagnostic measures are taken at different stages of pregnancy. These are the following cases:

• age over 35;
• if the family already has a child with pathology;
• previous miscarriages, stillbirths, frozen pregnancies;
• heredity (if one of the parents has Down syndrome);
• long-term use of strong medications during pregnancy;
• the effect of radiation on the mother's body.

If a woman falls into a risk group, she is given a detailed consultation on how to find out if the fetus has pathologies, and all the necessary measures are prescribed for this. The main purpose of such screenings is to find out if the baby can be helped and whether such a pregnancy can be left until delivery.

Attention: radiation! If a young mother was irradiated with radiation, she must definitely inform the doctor about this, since it is for this reason that babies are most often born with irreversible and incorrigible external deformities.

Forecasts

The further development of events largely depends on how long the fetal pathology is detected (the earlier, the better) and what kind of deviation was diagnosed. The doctor can only advise, but the decision is made by the parents themselves.

If the genetic mutation is strong and leads to the inevitable death of the child (intrauterine or in the first year of life), abortion is offered. If external deformities are few in number, modern plastic surgery works wonders, and a child in the future may look just like other children. Each case is too individual and unique, therefore it requires a special approach.

If pathologies of fetal development have been identified, parents need to first of all listen to the opinion of doctors. If the deviations are too serious and will make the baby's life unbearable in the future, and at the same time the young couple has every chance of conceiving a healthy child next time, doctors suggest terminating the pregnancy. Each case is unique and requires an individual approach.

The correct decision can be made by weighing all the pros and cons. Do not panic or despair: this will only aggravate the situation. Modern medicine works wonders, and you need to completely rely in this matter on the professional opinion of an experienced doctor who knows a lot about this.

Pathological conditions in obstetric practice that have arisen in connection with gestation and disrupt its natural course. At the initial stages, they may not be accompanied by clinical symptoms, later they are manifested by pain in the lower abdomen, vaginal discharge, impaired fetal movement, headaches, edema. For diagnostics, ultrasound of the uterus and fetus, MRI pelviometry, laboratory tests, invasive prenatal methods, CTG and other techniques are used. Depending on the condition of the woman and the unborn child, treatment may be aimed at maintaining or terminating the pregnancy.

Forecast and prevention

The prognosis of a complicated pregnancy depends on the nature of the pathology. With genetic defects, ectopic pregnancy and miscarriage, the fetus cannot be saved. In other cases, the likelihood of continuing pregnancy and the birth of a healthy child is determined by the time of detection and the degree of pathological disorders, as well as the correctness of obstetric tactics. For the prevention of complications of pregnancy, women who plan to conceive a child are recommended to treat concomitant diseases, give up bad habits, timely register with an antenatal clinic and regularly visit a doctor, especially if there are risk factors.