PREGNANCY PROBLEMS EXTRACTED FROM "WOMAN`S PASSIONS"

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Pregnancy problems. Complications
12Nov2009 Filed under: Pregnancy Author: admin


Most common complications during pregnancy: early and late gestosis, threatening interruption of pregnancy, pregnancy with extragenital pathology.

Gestosis
Gestosis of pregnant women include a number of pathological conditions that occur during pregnancy, complicating its course. There are early gestosis, usually occurring in the first trimester of pregnancy, and late gestosis, developing in the second half of pregnancy.

Early gestosis includes: vomiting in pregnancy (mild form), excessive vomiting and ptializm (salivation). Etiological factor of gestosis, according to many authors, is the failure of mechanisms to adapt to emerged pregnancy. Congenital and acquired deficiency of neuroendocrine regulation of adaptive responses (hypoxia, infection, intoxication, malnutrition in the antenatal period, hereditary factors) contribute to gestosis development, as well as presence of extragenital pathology in a woman (on the part of cardiovascular system - hypertension, hypotension, cardiac defects, endocrine disease - diabetes mellitus, hyper-and hypothyroidism, urinary tract disease - pyelonephritis, glomerulonephritis).

Early gestosis (vomiting during pregnancy) include vomiting, which is repeated several times during the day, accompanied by nausea, a decrease in appetite, change in taste and olfactory sensations. In accordance with the severity of the disease they distinguish:

• light form;

• moderate (moderate);

• excessive vomiting (severe).

Mild form corresponds to a phase of functional changes in nervous system (phase neuroses), the form of medium gravity - intoxication phase (phase toxicity), a severe form corresponds to a phase of dystrophy.

Late gestational toxicosis 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, at least - more severe symptoms (convulsions, coma, etc.). In modern obstetrics late gestosis is denoted as OPG-gestosis (under the name of three major symptoms). There are many classifications of late gestosis, but in practical obstetrics they distinguish 4 main clinical forms:

• hydrocephalus of pregnant;

• nephropathy (mild, moderate, severe);

• pre-eclampsia;

• eclampsia.

We should also note pre-clinical stage of gestosis - pregestoz. All clinical forms of late gestosis are specific stages of a single pathological process.

Excess weight gain during pregnancy is one of early signs of pregnancy complications called gestosis, an evidence of initially hidden, and then, perhaps, obvious edema.

Hidden edema are detected with regular measurement of body weight (weighing a patient) and definition of diuresis. If weight gain exceeds 300-400 g per week and negative diuresis will be identified, these symptoms indicate underlying edema.

Explicit, visible swelling differ in the degree of distribution:

• I degree - swelling of feet and legs;

• II degree - edema of the lower extremities and the anterior abdominal wall;

• III degree - generalized edema up to anasarca.

Nephropathy of pregnancy is divided into three levels:

• mild (hypertension is not higher than 150/100 mm Hg. Art., swelling of feet not higher than shins, proteinuria less than 1 g / l, the fundus has uneven caliber of retinal vessels);

• moderate (blood pressure not higher than 175/115 mm Hg. Art., swelling extended to the lower extremities and abdominal wall, proteinuria of 1 g / l to 3 g / l, there is swelling of the retina);

• severe degree (blood pressure above 175/115 mm Hg. Art., Anasarca, proteinuria more than 3 g / l, the fundus has hemorrhage, marked degenerative changes).

Pre-eclampsia - a critical, but a reversible condition, which developed against the background of severe gestosis. In addition to the triad of symptoms of gestosis (OPG), a patient has a headache, nasal congestion, visual disturbances. These signs are regarded as cerebral circulation disorder.

Eclampsia - the most severe form of pregnancy problem called gestosis, which is characterized by seizures with loss of consciousness. The duration and number of seizures of eclampsia may be different. During a seizure there develop abnormalities of cerebral blood flow, bleeding in the brain and its membranes. Hemorrhages in internal organs are frequent. Hypoxia and metabolic disease are sharply increasing, there occurs acidosis. Renal function is rapidly deteriorating, oligouriya increases. Internal organs often have degenerative changes. Eclampsia is life-threatening for both mother and fetus.

The threat of termination and miscarriage

The most frequent complication of pregnancy is a threat of interruption and premature birth - one of the main perenataln cause of morbidity and mortality. The main reasons for threat of abortion and miscarriage are:

• infectious diseases of mother;

• complications related to pregnancy;

• traumatic injuries;

• iso serological incompatibility of blood between mother and fetus;

• developmental anomalies of female genitalia;

• neuroendocrine pathology;

• various non-communicable diseases of mother;

• chromosomal abnormalities.

There are genetic reasons for miscarriage. In presence of chromosomal aberrations of an embryo there develops the threat of interruption on early stages of pregnancy. Spontaneous miscarriage in this case can be regarded as a device, worked out in the process of evolution, resulting in the birth of children with deformities is quite rare.

Endocrine causes of miscarriage include hypovaria, hyperandrogenism of different genesis (adrenal, ovarian), thyroid dysfunction. The first place is occupied by mother’s infectious diseases. These are primarily latent infectious diseases such as chronic tonsillitis, urinary organs infections, listeriosis, toxoplasmosis, mycoplasma infection, chronic inflammatory diseases of genital organs and viral infections.

Under certain circumstances, there occurs an immunologic conflict in the mother-placenta-fetus, leading to the risk of abortion and spontaneous abortion.

Among malformations of the uterus as a cause of miscarriages most common are: bicornuate, saddle, unicorns uterus, intrauterine septum, doubling of the uterus, rudimentary uterus.

The reasons contributing to emergence of miscarriages also include genital infantilism, isthmic-cervical insufficiency, uterine myoma and extragenital diseases of mother.

Extragenital pathology

Course of pregnancy is also complicated by presence of mother’s extragenital pathology.

A group of increased risk of miscarriage primarily includes women with cardiovascular system diseases, hypertension, chronic kidney disease, diabetes, anemia.

Premature termination of pregnancy in these women is also contributed by significant changes in the body: hypoxia, metabolic disturbances and complications of pregnancy, which is accompanied by extragenital pathology (toxaemia in the second half of pregnancy, fetoplacental insufficiency).



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