Extragenital pathology in pregnant women: prevention, treatment. Effect of extragenital pathology on pregnancy
Such a joyful event as a long-awaited pregnancy, unfortunately, can darken some unpleasant moments. For example, it can be exacerbation of chronic diseases on the background of hormonal changes in the body. And only taking into account the influence of extragenital pathology on pregnancy, you can successfully endure and give birth to a healthy baby without risking your own health or even life.
What is extragenital pathology in pregnant women
All diseases, syndromes and conditions of the pregnant woman, which are not gynecological and are not obstetric complications, belong to one group, called "extragenital pathologies"( EGP).
This begs the logical question: are there many pregnant women with extragenital pathology? Statistics in this regard is not very consoling. As practice shows, the number of women suffering from chronic diseases is growing every year. To date, only about 40% of pregnancies go without any complications. The threat of termination of pregnancy and late toxicosis are the two most common problems that are noted in having extragenital pathology. But besides them there are other diseases, which also belong to EGP.
Diseases that are included in the concept of "extragenital pathology":
- severe anemia;
- arterial hypertension;
- heart disease;
- liver disease;
- kidney disease;
- connective tissue diseases;
- of the gastrointestinal tract;
- respiratory disease;
- viral hepatitis and infection.
Let's stop and consider in more detail each of the groups of diseases. This will help to better understand how pregnancy and childbirth take place in extragenital pathology and what special measures must be taken in each case.
Diseases of the cardiovascular system
Diseases from this group are found in 2-5% of pregnant women. In case of detection of any cardiovascular diseases, the pregnant woman should immediately contact the district therapist. Based on the results of the examinations, the doctor will decide whether to conceive or interrupt pregnancy.
If there is no severe extragenital pathology( development of cardiac insufficiency of the 3rd and 4th grades with increased heart rate and dyspnea with minimal exercise or at rest), then there are no prerequisites for miscarriage of the fetus. In such cases, only the necessary medical therapy is selected, which will help to maintain the stability of the mother and future baby.
Rheumatism during pregnancy
In case of an exacerbation of rheumatism, the issue of prolonging pregnancy becomes very acute. If the problem is manifested in the first trimester, a decision is made to terminate the pregnancy, since in this case, drugs that are incompatible with its further development in the early stages are needed.
If extragenital pathology in the form of rheumatism has manifested itself over a period of more than 24 weeks, it becomes possible to have a safe treatment while preserving the life of the future child.
However, the presence of this disease in 40% of cases is accompanied by late toxicosis, possible fetal hypoxia and the appearance of a high risk of abortion. Newborns also have a special predisposition to allergies and infectious diseases.
Pregnancy against extragenital pathology in the form of hypertension is quite common. Increased blood pressure can provoke premature birth or become one of the causes of placental abruption.40% of pregnant women with hypertension suffer from late toxicosis, which can cause fetal hypoxia.
In the absence of any complications in the form of coronary insufficiency, placental abruption, cerebral circulation disorders, "hypertension"( both extragenital pathology) and "pregnancy" are quite compatible concepts. The only thing, the future mum should as much as possible observe the modes of work and rest, and also limit the consumption of salt( no more than 5 mg per day).
Lowering blood pressure during pregnancy carries no less risks than its increase. Women with extragenital pathology in the form of hypotension are at great risk of spontaneous abortion at any time. They may have problems associated with impaired attachment and separation of the placenta, as well as complications of the birth process. In addition, there may be delays in the development of the fetus due to poor blood flow in the placenta.
There are three main types of disease: atrial fibrillation, extrasystole and paroxysmal tachycardia.
Atrial fibrillation is the most dangerous, because it can lead to a heart deficit and heart failure. Also, with this disease, there is a large percentage of deaths: perinatal - 50%, maternal - 20%.Therefore, if atrial fibrillation is detected, a decision is made on delivery by caesarean section, natural births are prohibited.
Extrasystoles usually do not require special treatment and are not of great danger. As a rule, it is observed in the last months of pregnancy( third trimester), and its appearance is provoked by raising the diaphragm and emotional excitement during childbirth.
Paroxysmal tachycardia is very rare and differs in a reflex character. Symptoms of the disease may be dizziness, weakness, pain in the heart, nausea. To improve the condition, sedatives are usually used.
Diseases of the kidneys and urinary organs
Extragenital pathology in pregnant women in the area of urinary organs is most often manifested in the form of urolithiasis or pyelonephritis.
It is accompanied by pains in the lower back, discomfort and cuts during urination. In addition, nausea, vomiting, constipation may occur, and in the case of pyelonephritis, fever and inflammatory changes in the blood are observed.
Regardless of the period of pregnancy, surgical operations can be prescribed if necessary. If after they have been carried out and the course of drug therapy, the functionality of the kidneys is restored, the pregnancy remains.
Acute gestational pyelonephritis
Most often the disease occurs at a period of about 12 weeks, although it can be observed throughout the pregnancy. This extragenital pathology is accompanied by fever and chills.
Treatment is carried out in a hospital using antibacterial drugs. At the end of the course of therapy, pregnant women need to take uroantiseptics of plant origin( renal teas, etc.).
In the absence of complications, further pregnancy and childbirth are normal.
Glomerulonephritis is a severe extragenital pathology, during which prolongation of pregnancy is contraindicated, as it leads to the development of renal failure.
Fortunately, among pregnant women the disease is quite rare - in only one case of a thousand.
Extragenital pathology in the form of diseases of the gastrointestinal tract is not a contraindication to pregnancy. Women who have gastritis, duodenitis or even peptic ulcer, safely nurse and give birth to a healthy child.
The only thing that can become a problem for a pregnant woman is reflux. Because of them, the future mother has heartburn, which intensifies with each month until the very birth. In addition, a pregnant woman may be disturbed by permanent constipation.
Usually, the appearance of heartburn occurs from the 20-22th week of pregnancy, but at this time it is periodic and quickly passes. At a period of 30 weeks, every third woman complains about her, and closer to childbirth this number increases, and unpleasant symptoms are observed in three pregnant women out of four.
As for constipation, their number also increases towards the end of pregnancy. To admit such a state is extremely undesirable, since it can worsen the general state of health of a pregnant woman and affect the contractile function of the musculature of the uterus. A strong straining during defecation can cause the tone of the uterus and lead to premature termination of pregnancy.
The main and most effective way to get rid of the problems described above is a special diet, which includes products that have a slight weakening effect( beets, prunes, wheat bran, etc.), as well as bifidobacteria( kefir).
Diseases of the respiratory system
An ordinary cold, as a rule, does not cause significant harm to the pregnant woman and her fetus. But with bronchitis and pneumonia things are a little worse.
Acute and chronic bronchitis
Bronchitis is characterized by damage to the bronchial mucosa and is an inflammatory disease. It is accompanied by pain in the chest, a strong cough, and in some cases, marked symptoms of intoxication of the body.
Chronic bronchitis is not the reason why continuing pregnancy is impossible. It is also possible to have minor complications in the form of dyspnea with minimal loads or respiratory insufficiency of the first degree. But in advance it is worth considering that such a pregnancy will be difficult.
In cases of development of respiratory failure of the second or third degree, a decision is made to terminate the pregnancy in order to preserve the health and life of the woman.
Acute and chronic pneumonia
Pneumonia is an inflammatory infectious disease that affects the lungs. It is accompanied by a high fever and other symptoms, depending on the type of the virus-pathogen and the reaction of the pregnant woman to it.
Hospitalization of pregnant women with extragenital pathology in the form of pneumonia is mandatory! Treatment is conducted under the supervision of a therapist and an obstetrician-gynecologist.
Clear symptoms of this disease are attacks of suffocation that occur at night or in the morning and are accompanied by a strong dry cough and dyspnea of the expiratory type. The attack ends with an expectoration of a small amount of purulent sputum.
Bronchial asthma in mild and moderate form is not an indication for abortion, but it can cause premature birth, late toxicosis, mild labor and bleeding during the birth process.
Because of a violation of inactivation in the liver of estrogen, chronic diseases such as cirrhosis and hepatitis can cause infertility. If the pregnancy is still there, the probability of its favorable outcome is quite small. In such cases, it often ends with miscarriage, the birth of dead children, and a high percentage of maternal mortality during the birth process. In addition, during pregnancy, a woman may develop liver failure.
If an exacerbation of chronic diseases has been detected before the 20th week, the pregnancy is interrupted. If more than 20 weeks have passed, then everything is done to prolong it, since abortion can only exacerbate the situation.
If chronic liver disease is not exacerbated during pregnancy, there is no indication for its interruption and the percentage of successful outcome is almost the same as in healthy women.
The most common endocrine diseases include diabetes mellitus, thyrotoxicosis and hypothyroidism. Let us dwell in more detail on each of them.
The disease is characterized by insufficient insulin or its insufficient efficiency, resulting in intolerance to carbohydrates and metabolic disorders. In the future, there may be changes in the organs and tissues of the body.
Diabetes manifests itself in the form of weight loss, impaired vision, itchy skin, polyuria, thirst. For an accurate diagnosis of the disease, it is necessary to take tests for blood sugar, as well as urinalysis.
Women with diabetes during pregnancy are hospitalized in the hospital at least three times: at the initial terms, within 20-24 weeks and at 34-36 weeks.
Diabetes mellitus( both extragenital pathology) and pregnancy are completely compatible. The disease is not an indication for abortion, and the birth of a child is allowed both by natural means and by the operation of a cesarean section.
The only thing to consider: a pregnant woman must take tests and undergo examinations at doctors at least 2-4 times a month.
The disease is associated with changes in the thyroid gland: its increase and hyperfunction. It is accompanied by thyrotoxicosis with a strong palpitation, sweating, rapid fatigue, a feeling of heat, sleep disorders, trembling of hands and increased blood pressure. As a result, the disease can provoke severe toxicosis and miscarriage.
With a mild form of thyrotoxicosis, pregnancy is relatively normal, with medium and heavy form a decision is made about its interruption.
During the birth process, all necessary measures are taken to avoid possible bleeding.
The disease is also associated with impaired functionality of the thyroid gland that have arisen as a result of surgery or are congenital defects.
During hypothyroidism, there may be exchange-hypothermic or cardiovascular syndromes, as well as edematous and skin changes. The disease is not best reflected in the future child: he can have congenital malformations or lag behind in mental development.
In the presence of moderate and severe disease, pregnancy and childbirth are contraindicated.
The presence of viral infections during pregnancy can harm not only the health of the future mother, but also her future baby.
ARVI and influenza
As mentioned above, acute respiratory viral infection( ARVI) does not have a big impact on the development and health of the fetus. But when the common cold flows into the flu, there is a danger of complications, which can cause interruption of pregnancy. In particular, this applies to the severe form of the disease in the first and second trimesters of pregnancy, since it has a teratogenic effect on the fetus.
Prevention of extragenital rubella pathology should be carried out before the onset of pregnancy. It consists in mandatory routine vaccination, which is carried out even in childhood or adolescence.
The measles rubella virus is able to penetrate the placenta and, for a period of up to 16 weeks, to exert embryotoxic and teratogenic effects on the fetus. Moreover, congenital malformations can be observed even in children of those mothers who did not get sick, but simply contacted people who had rubella.
The disease is characterized by the following symptoms: increased lymph nodes, prolonged fever, thrombocytopenia, articular syndrome, hepatomegaly.
Measles rubella in the first trimester of pregnancy is an indication for its mandatory interruption.
HSV( herpes simplex virus) is able to penetrate the placenta and cause damage to the central nervous system, heart and liver of the fetus. As a result, a born child may lag behind in mental development or have calcification in the brain, microcephaly.
The most dangerous virus in the first trimester, as it has an irreparable effect on the future of the child, and pregnancy must be interrupted. Herpes in the third trimester becomes a prerequisite for emergency delivery by Caesarean section.
Treatment of extragenital pathology in pregnant women
As we have already explained, the concept of extragenital pathology includes many diseases. Therefore, it becomes clear that there is no single way to treat it. All the necessary therapy is carried out based on the type of disease, the degree of its severity, the presence or absence of exacerbations in any of the trimesters and so on.
What medications should I take if extragenital pathology is observed? When miscarriage is prescribed, some drugs, with infectious, viral, inflammatory diseases - quite different. Do not self-medicate. Only the responsible doctor( gynecologist, therapist, endocrinologist and others) has the right to make a decision and prescribe the taking of one or another medication.
Prevention of EGD
Prevention of extragenital pathology is primarily to identify possible chronic diseases. At a time when some are well aware of all the health problems, for others, exacerbation of a disease during pregnancy can be a real surprise. That is why many obstetricians-gynecologists advise to undergo a full medical examination even during the planning period of the child.
The next moment is pregnancy itself. In the presence of extragenital pathology, it can be resolved or contraindicated. And in the first and second cases( if a woman refused to terminate her pregnancy), it is necessary to register with the appropriate specialist and visit it at least once a month. This will help to notice the occurrence of possible complications in time and eliminate them.
In addition to this, pregnant women can offer scheduled hospitalizations several times. It is not necessary to refuse them, in order to protect themselves and their future baby from the negative consequences.
Easy pregnancy for you, be healthy!