Bleeding during pregnancy is the most common pathology. And this is not just a pathology, but also a serious complication, which, alas, not every pregnant woman is aware of. This is primarily due to the common misconception that during pregnancy there may be periods. But in fact, there should not be any normal bleeding during pregnancy. Very rarely (in 3% of cases out of 100), some pregnant women experience small spotting bleeding at the very beginning of pregnancy, when the woman does not yet know about her pregnancy. This occurs at the time of attachment of the fetal egg to the uterus, and, as a rule, corresponds to the expected period. Only in this case, bleeding is the norm. In other cases, any bleeding is regarded as a pathology.

Causes of bleeding during pregnancy

Bleeding can occur both early and late in pregnancy. Depending on the period at which the bleeding occurred - early or late, one can assume the pathology that caused the bleeding.

Bleeding in early pregnancy (before 12 weeks of gestation) may indicate:

About the miscarriage that has begun;
- about ectopic pregnancy;
- about non-developing “frozen” pregnancy;
- about the vesicular skid.

Bleeding in late pregnancy (after 12 weeks) may be due to abruption or placenta previa.

It should be noted that if bleeding occurred during pregnancy, this does not mean that it is associated specifically with the pathology of the fetus. The reason for this may be exacerbation of gynecological diseases in the expectant mother - erosion of the cervix, uterine fibroids, polyps of the cervical canal, and so on. Bleeding can also be due to a banal injury to the genital organs.

Bleeding during pregnancy can be of varying intensity - spotting, moderate or heavy with clots. Quite often, bleeding is accompanied by painful sensations. Pain can be intense and sharp, spreading throughout the abdomen. Often they resemble contractions, as happens, for example, with a miscarriage. Or there may be slightly tangible pulling pains in the lower abdomen. In addition to pain and blood discharge, a pregnant woman’s blood pressure decreases, her pulse quickens, and weakness appears. But by the nature and intensity of pain and bleeding, it is impossible to make a diagnosis, since with one pathology in different women these figures are different.

If the bleeding is insignificant, this does not mean that you need to lie at home and wait until they pass. Any bleeding during pregnancy is a reason for an emergency visit to the gynecologist. Such conditions can be dangerous for both the life of the fetus and the mother.

Diagnosis of the cause of bleeding during pregnancy

In order to identify the exact cause of bleeding, an examination by a gynecologist and a number of diagnostic tests in a hospital or maternity hospital.

During the examination, the doctor takes a smear from the vagina. A pregnant woman takes a general and biochemical blood test, a coagulogram, a blood test for HIV, hepatitis, syphilis; general urine analysis. She is determined by the blood group and the Rh factor. An ultrasound of the pelvic organs and the fetus is obligatory.

Further, depending on the identified pathology, additional studies may be prescribed. So, in case of miscarriage, non-developing pregnancy, blood is additionally examined for hCG (human chorionic gonadotropin), hormones, tests are given for TORCH infections (herpes, rubella, cytomegalovirus, toxoplasmosis); swab for sexually transmitted infections. If an ectopic pregnancy is suspected, a diagnostic laparoscopy is done. With hydatidiform mole also examine hCG level.

To diagnose the cause of bleeding in late pregnancy, additional studies, as a rule, are not required, due to the high information content of ultrasound.

Treatment of bleeding during pregnancy

Treatment is prescribed depending on the pathology and stage of the disease. With the onset of a miscarriage, measures should be aimed at maintaining pregnancy and stopping bleeding. If, according to the results of ultrasound, the fetus is viable, early dates Pregnancy is prescribed hemostatic drugs (Dicinon), antispasmodics to lower the tone of the uterus (No-shpa, suppositories with papaverine), hormonal drugs - gestagens (Dufaston or Utrozhestan) up to 16 weeks of pregnancy to maintain the level of progesterone - the “hormone of pregnancy”, vitamins and trace elements ( vitamin E, Iodomarin, folic acid, MagneB6). With a good effect, the bleeding stops and the pregnancy is maintained. If the miscarriage nevertheless occurred and the discharge is abundant, the uterine cavity is scraped with the removal of the remnants of the fetal egg.

When confirming the diagnosis of a “frozen” pregnancy or cystic drift, as in the case of a miscarriage, curettage of the uterine cavity is indicated. After curettage, the hormone Oxytocin and hemostatic drugs are prescribed to reduce the uterus. Bleeding after scraping stops after a week.

With an ectopic pregnancy, treatment is surgical. Laparoscopy or laparotomy is done and the affected fallopian tube is removed or the fetal egg is squeezed out of the tube.

With placenta previa, if the discharge is insignificant, antispasmodics, droppers with magnesia, beta-adrenergic agonists (Ginipral), antiplatelet agents (Trental or Curantil) and vitamins are prescribed to maintain pregnancy. With placenta previa, bleeding may continue until delivery. All this time the woman is supposed to be in the hospital. Upon reaching full term (38 weeks of pregnancy), a caesarean section is performed. If bleeding is heavy, a caesarean section is performed on an emergency basis, even if the fetus is premature. To compensate for blood loss, infusion therapy is carried out (transfusion of fresh frozen plasma and erythrocyte mass).

If placental abruption is suspected, an urgent caesarean section is performed, regardless of the gestational age and the viability of the fetus. In parallel, carry out infusion therapy.

All women with Rh-negative blood immediately after curettage, surgery for ectopic pregnancy and caesarean section are injected with anti-Rh D-immunoglobulin to prevent Rh conflict between mother and fetus when fetal blood enters the mother's bloodstream.

All pregnant women who have experienced bleeding and managed to maintain pregnancy are recommended sexual abstinence and emotional peace. Many drugs that are prescribed in a hospital must also be used after discharge, even if there is no blood discharge, in order to protect yourself from a repeated threat of abortion. With the reappearance of blood discharge, the pregnant woman should also immediately contact a gynecologist.

In the rehabilitation period after stopping the bleeding, sedatives are used - tinctures of motherwort or valerian. They recommend non-drug and physiotherapeutic treatment - acupuncture, endonasal galvanization, and so on.

With regard to funds traditional medicine, except for motherwort and valerian tinctures, which have been used in obstetrics for a very long time, it is better not to use other herbs for bleeding, since in most cases they are ineffective, and in the worst case, harmful during pregnancy and can further aggravate the situation.

Complications of bleeding during pregnancy:

Miscarriages that are not treatable;
- antenatal fetal death;
- infectious complications, septic shock, which occurs due to the presence of remnants of the tissues of a dead fetus in the uterine cavity;
- with a large blood loss, hemorrhagic shock may develop, which can lead to death;
Choriocarcinoma is a rare malignant cancer that can occur after curettage for a mole.

Prevention of bleeding:

Natural family planning - no abortion;
- restriction of physical and sexual activity during pregnancy;
- timely treatment of chronic gynecological diseases (especially genital infections) before pregnancy;
- implementation of reproductive function up to 35 years.

Doctor's advice on bleeding during pregnancy

1. Can I use any drugs to stop bleeding at home?
You can't, you need to see a doctor immediately.

2. How fast can you get pregnant again after scraping?
After 3-6 months, after examination and appropriate hormonal treatment.

3. Are there periods during pregnancy?
They don't.

4. Can you experience bleeding during pregnancy due to sex?
They can.

5. Went to storage at 5 weeks. The bleeding did not go away and a miscarriage occurred, although she drank hormones. Tell me, maybe the dose of hormones was insufficient?
Maybe, but not likely. It is necessary to find out for what reason you had a miscarriage after the examination. The doctor probably prescribed hormones to compensate for the lack of progesterone in the body, which often happens with miscarriages. But a miscarriage can also occur due to genetic defects in the fetus (in 75% of cases) and then the hormones have nothing to do with it.

6. How to understand by the nature of blood discharge - is it a miscarriage or a frozen pregnancy?
No, only a doctor can accurately determine after an examination and ultrasound.

7. I have placenta previa. There are no more bleeding. Is it possible to have sex?
It is forbidden. It is necessary to refrain from sexual intercourse until delivery.

8.I had spotting bleeding after my period was delayed for a week. What's this?
Take a pregnancy test and see a gynecologist. Either it's pregnancy or ovarian dysfunction.

9. Can there be bleeding due to the bath?
Maybe all thermal procedures are undesirable during pregnancy, especially in the short term.

While the baby is in the womb, a woman is subjected to a lot of research. It is worth noting that some tests for fetal pathology reveal a lot of diseases that are not treated. This is what will be discussed in this article. You will learn how the diagnosis of fetal pathology during pregnancy is carried out (tests and additional studies). Also find out what the normal results of a particular examination should be.

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Tests for fetal pathology

Almost every two weeks, the expectant mother has to take tests: blood, urine, flora smear and others. However, these studies do not show the condition of the baby. Tests for fetal pathology are given at certain periods established by medicine. The initial study is carried out in the first trimester. It includes a blood test for fetal pathology and ultrasound diagnostics. Further, the study is shown only to those women whose first results were not very good. It should be noted that this only applies to blood tests. Ultrasound diagnostics (analysis for fetal pathology) is carried out in the second and third trimesters.

Who is assigned to study

Every expectant mother can take an analysis for fetal chromosomal pathologies in the first trimester if desired. However, there are categories of women to whom this diagnosis is assigned without their desire. These groups of people include the following:

• women over 35 years of age;
• if the parents are blood relatives;
• those future mothers who have already had pathological pregnancies or premature births;
• women who have children with various genetic pathologies;
• future mothers with a long threat of abortion or those who have had to take illegal drugs.

Of course, you can challenge the doctor's decision and refuse such studies. However, this is not recommended. Otherwise, the baby may be born with some deviations. Many pregnant women avoid such tests. If you are sure that under no circumstances will you terminate the pregnancy, then feel free to write a refusal to diagnose. However, before that, weigh the pros and cons.

When is the diagnosis of fetal pathologies performed?

So, you already know that the study is carried out in the first trimester. The delivery of the analysis can be carried out in the period from 10 to 14 weeks of pregnancy. However, many doctors insist that a diagnosis be made at 12 weeks to find out if there is a pathology in the development of the fetus. Causes (tests show a positive result) and diagnoses are clarified a little later.

If a positive result was obtained on the first blood test, then an additional study is carried out for a period from 16 to 18 weeks. Also, this analysis can be carried out for some groups of women at their own request.

Ultrasound diagnostics for the detection of pathologies is carried out at 11-13 weeks, 19-23 weeks, 32-35 weeks.

What research reveals

Analysis of the pathology of the fetus (decoding will be presented below) allows you to identify the likelihood of the following diseases in the baby:

• Edwards and Down syndromes.
• Syndrome of Patau and de Lange.
• Violations in the work and structure of the cardiac system.
• Various neural tube defects.

Remember that the result of the analysis is not a final diagnosis. Decoding should be done by a geneticist. Only after consultation with a specialist can we talk about the presence or absence of the likelihood of a pathology in an infant.

Blood test for pathology

Before diagnosis, some preparation is necessary. For a few days, it is recommended to give up fatty foods, smoked sausages and meat products, as well as a large number spices and salt. You also need to exclude possible allergens from the diet: chocolate, eggs, citrus fruits, red vegetables and fruits. Directly on the day of sampling, you should refuse any meal. You can drink water no later than four hours before blood sampling.

It is quite simple to pass tests for fetal pathology. You just need to expose the elbow bend of the arm and relax. The lab technician will take a blood sample and let you go home.

How is a blood test done?

Physicians carefully examine the material received. This takes into account the woman's age, weight and height. Laboratory assistants study the chromosomes that are in the blood. With some deviations from the norm, the result is entered into the computer. After that, computer technology issues a conclusion, which spells out the likelihood of a particular disease.

At the first screening, the diagnosis is carried out on two gomons. Later, in the second trimester, lab technicians examine three to five substances. In a period of two to four weeks, the expectant mother can receive ready-made tests for fetal pathology. The norm is always indicated on the form. The result is displayed next to it.

Analysis for fetal pathology: norm, interpretation

As mentioned above, the final diagnosis can only be made by a geneticist. However, your gynecologist can also provide a transcript of the result. What are the standards for test results? It all depends on the duration of pregnancy and the level of chorionic gonadotropin in the woman's blood at the time of the study.

In the second trimester, the following indicators are still being evaluated: Inhibin A, Placental lactogen and Unconjugated estriol. After calculations of computer technology, a result is produced, which may contain the following values:

• 1 in 100 (the risk of pathology is very high);
• 1 in 1000 (normal values);
• 1 in 100,000 (very low risk).

If the value obtained is lower than 1 to 400, then the expectant mother is offered to undergo additional research.

Ultrasound diagnostics for pathology

In addition to a blood test, the expectant mother must undergo an ultrasound diagnosis. The first screening evaluates the general structure of the future baby, but special attention is paid to the size of the nasal bone and the thickness of the collar space. So, normally in children without pathologies, the nasal bone is clearly visible. TVP should be less than 3 millimeters. It is imperative that during the diagnosis it is necessary to take into account the gestational age and the size of the baby.

In the second trimester, ultrasound diagnostics reveals pathologies of the cardiac system, brain and other organs. During this period, the child is already large enough and you can clearly see all his parts of the body.

Additional diagnostics

If during the diagnosis a high risk of pathology was revealed, then the expectant mother is recommended to undergo additional studies. So, it can be taking blood from the umbilical cord or taking material from the amniotic fluid. Such a study can accurately identify possible deviations or refute them. However, remember that after diagnosis there is a high risk premature birth or spontaneous miscarriage.

If the probability of pathology is confirmed, then the expectant mother is offered to terminate the pregnancy. However, the final decision always remains with the woman.

Summarizing

So, now you know what diagnostic measures exist to identify pathologies in an unborn baby. Go through all the studies on time and always listen to the doctor's recommendations. Only in this case, you can be sure that your child is completely healthy and has no abnormalities.

There is one belief: in order for the pregnancy to proceed normally, you need to tie a small baby thing, for example, takes. The knitting pattern (crochet) of the beret can be found in a needlework magazine. Also you can buy already ready product. Good luck with your test results and happy pregnancy!

• Varieties
• The reasons
• Diagnosis and timing
• At-risk groups
• Forecasts

Pregnancy is a joyful and at the same time anxious expectation of the mystery of nature, which is about to happen. All the way prenatal development the baby's mother sensitively listens to his every movement, awaits with trepidation the results of all the tests and the results of any study 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 on different terms pregnancy and force parents to make a serious decision - will the baby be born or not. Painful deviations from the normal developmental process can be congenital or acquired.

Varieties

Since the causes of pathologies in the fetus can be due to 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 pathologies 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 due to the wrong number of chromosomes:

• Down syndrome - problems with the 21st chromosome; signs - dementia, peculiar appearance, growth retardation;
• Patau syndrome - disorders with the 13th chromosome; manifestations - multiple malformations, idiocy, multi-fingering, 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 palpebral fissures, 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, psychosis and schizophrenia;
• polysomy on the Y chromosome, the symptoms are similar to the previous pathology;
• Klinefelter's syndrome affects boys, signs - weakened hair growth on the body, infertility, sexual infantilism; in most cases - mental retardation.

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

• triploidy;
• tetraploidy;
• cause - gene mutations of the fetus;
• 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 throughout the world, but you need to understand that these are a few, happy exceptions to the rules.

Acquired

It also happens that an embryo can be absolutely healthy genetically, but 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, an unhealthy lifestyle, etc.

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

• deformation or absence (complete, partial) internal organs(most often the brain suffers) or parts of the body (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, lack of crying, but this pathology is treatable;
• cerebral hyperexcitability (perinatal) is also successfully treated, symptoms - severe tension, trembling of the chin, long crying, screaming;
• hypertensive-hydrocephalic syndrome is characterized by an increased volume of the head, bulging of the fontanel, disproportions between the facial and cerebral lobes of the skull, and developmental delays.

In a special group, deviations from normal intrauterine development can also be distinguished, the causes of which are very difficult to determine. This is what nature has decreed, 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, prolapse of its loops, knots, abnormal attachment, thrombosis and cysts - all this can lead to hypoxia and death of the child;
• multiple pregnancy (including Siamese twins);
• many and low water;
• placental pathology: hyperplasia (its weight is too large) and hypoplasia (if its mass is less than 400 g), 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 they are carrying, utmost care, 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 the factors that can cause acquired fetal pathologies. This is in the power of every woman who is expecting a child.

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

The reasons

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 include 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 tests.

Unfavorable environmental conditions

Mom's work at a chemical plant, in a laboratory with toxic substances, living near 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 the baby:

• influenza up to 12 weeks ends either in a miscarriage, or the child will be completely healthy;
• influenza after 12 weeks can lead to hydrocephalus and placental pathologies;
• rubella is fraught with deafness, blindness, glaucoma and damage to the skeletal system of the fetus;
• toxoplasmosis, transmitted through cats, provokes the development of microcephaly, meningoencephalitis, dropsy of the brain, damage to the eyes and 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 the baby in the womb, and he risks being born blind, deaf, with cirrhosis of the liver, damage to the intestines and kidneys, and encephalopathy.

Venereal 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;
• in a fetus infected with syphilis, a specific rash, damage to the skeletal system, liver, kidneys, and central nervous system are observed;
• gonorrhea leads to eye disease, 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 causes. Quit hazardous work, move away from the industrial zone, stop smoking and drinking, eat well, avoid diseases and treat them at the first symptoms. You can learn about the pathology of the fetus as early as 12 weeks, when the first examination for its presence is performed.

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

Diagnosis and timing

Prenatal diagnosis of abnormalities in the development of the fetus is a complex and capacious process. One of the most important stages is the screening of fetal pathology, which 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 disorders. Usually, checking the fetus for pathology includes the following activities.

Blood tests

I trimester (double test):

• free β-subunit (its concentration) hCG;
• PAPP-A: plasma protein A.

II trimester (triple test for fetal pathology):

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

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

Chorionic biopsy

This is the receipt of chorion tissue for the detection and prevention of chromosomal diseases, the carriage of chromosomal abnormalities and monogenic diseases. It is performed in the form of a uterine puncture, 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 that diagnostics are performed already at 9-12 weeks, as well as quick results (2-3 days). Indications for carrying out:

• age over 35;
• the presence of a child with CM (congenital malformation), monogenic, chromosomal diseases;
• heredity of chromosomal abnormality, gene mutation;
• 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 staff everything goes without complications.

Cordocentesis

This is a method of obtaining cord (cord) blood of a child for research. It is usually performed in parallel with amniocentesis (analysis amniotic fluid). Available up to 18 weeks.

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

More about the method here.

ultrasound

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

Ultrasound at 12 weeks reveals:

• CNS defects (anencephaly);
• absence of the peritoneal anterior wall (gastroschisis);
• pathology of the spine in the fetus;
• umbilical hernia (omphalocele);
• absence of limbs;
• Down syndrome.

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

At week 30, an ultrasound examination can only confirm or refute the data obtained by other methods (using a blood test, cordocentesis, chorionbiopsy).

Now - about what fetal pathologies are not detected by ultrasound:

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

However, the last group of these deviations does not elude doctors, as they are helped by a pregnant woman's blood test for fetal pathology and other diagnostic methods.

A young mother cannot herself feel any symptoms that something is wrong with her baby. Only a set of diagnostic measures at different stages of pregnancy can reveal deviations. 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, the features of skin folds, etc.

Unfortunately, there are cases when a child is born with pathologies not detected prenatally. This happens either due to inexperience and lack of professionalism. medical personnel, or due to malfunction or decrepitude of the ultrasonic equipment.

Data. Thanks to ultrasound, up to 80% is detected in time congenital pathologies in the fetus, of which 40% of pregnancies are terminated due to severe, disabling or life-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. They are required to take blood for fetal pathology and carry out other diagnostic measures at different stages of pregnancy. These are the following cases:

• age over 35;
• if the family already has a child with a pathology;
• previous miscarriages, stillbirths, miscarriages;
• 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 prescribe all the necessary measures for this. The main purpose of such screenings is to find out if the child can be helped and whether such a pregnancy should be left until delivery.

Attention: radiation! If a young mother has been exposed to radiation, she must be sure to inform the doctor about it, since it is for this reason that babies are most often born with irreversible and incorrigible external deformities.

Forecasts

Further development of events largely depends on how long fetal pathologies are detected (the sooner 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 entails the inevitable death of the child (intrauterine or in the first year of life), abortion is suggested. If external deformities are few, modern plastic surgery works wonders, and the child in the future may look the same as the rest of the children. Each case is too individual and unique, therefore it requires a special approach.

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

The right 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 rely entirely on the professional opinion of an experienced, knowledgeable doctor in this matter.

Blood test for fetal chromosomal pathology in pregnant women

Even a healthy woman can have a baby with genetic disorders. Pregnant women need to donate blood for chromosomal pathology in order to exclude such a possibility. Laboratory tests are carried out for all women, but there are also strict indications in which the gynecologist gives a referral for a blood test.

The time of the analysis is limited by a clear framework. During pregnancy, every two to three weeks, a woman takes various tests: blood, urine, smear, and others. All these studies can not show violations in the development of the fetus. Special tests for various pathologies of the child are taken at 10-12 weeks of pregnancy. Such tests consist of ultrasound and blood tests for chromosomal abnormalities. Every woman can go through them at will. Repeatedly, with a positive result of the first examination, it is prescribed to donate blood and undergo an ultrasound for expectant mothers at 16-18 weeks.

Who needs to be tested

1. The age of the pregnant woman is from 30-35 years.
2. Parents are close relatives.
3. If the pregnant woman's fetus froze or the child was stillborn.
4. If a woman already has a child (children) with a pathology.
5. The pregnant woman had a history of miscarriages, premature births.
6. The expectant mother, shortly before the onset of pregnancy, suffered a bacterial or viral pathology.
7. The pregnant woman was taking illegal drugs.
8. One of the parents underwent x-rays, that is, they were exposed to ionizing radiation.
9. Certain results of ultrasound diagnostics have been obtained, requiring more thorough verification.
10. The family lives in an ecologically unfavorable area or the parents of the future baby work in hazardous chemical production.

The disorders at the chromosomal level that help to identify this analysis include the following syndromes:

In addition, thanks to laboratory research it is possible to determine such pathologies as a defect in the neural tube and a violation in the work and structure of the heart muscle.

Preparing to donate blood for analysis

The expectant mother must prepare for the examination without fail.

The preparation period lasts several days and consists in the fact that it is necessary to exclude for 3-4 days from your diet:

• fatty, smoked, fried foods;
• spicy seasonings;
• limit salt;
• oranges, chocolate, coffee, eggs, red vegetables and fruits.

Attention! On the day of blood sampling, you can not eat, and it is also necessary to limit fluid intake. Drinking is allowed 4-6 hours before the start of material sampling to determine the pathology of the fetus.

Features of passing the analysis

There is nothing terrible and complicated in taking material for possible fetal pathologies. The laboratory assistant takes blood from a vein and transfers this material for research to geneticists. Doctors study the chromosomes found in the blood, taking into account physiological characteristics women. When deviations from the norm are detected, the data are entered into the computer. After processing the indicators, a result is obtained, which indicates the probability of the disease of the unborn child.

After receiving computer results for chromosomal pathologies, geneticists decipher the analysis, compare the results with computer diagnostics and draw conclusions about the presence or absence of various disorders in the baby.

In addition to taking blood to detect abnormalities, pregnant women must undergo an ultrasound examination at 10-14 weeks. Ultrasound allows you to assess the structure of the unborn child, as well as the size of the nasal bone and TVP. In babies without disorders, the nasal bone is clearly visible, and the thickness of the collar space is 3 mm or more. With such an examination, the gestational age and the size of the fetus must be taken into account.

At 20-22 weeks of pregnancy, a second ultrasound is performed, which allows you to determine the pathology of the heart system, brain and other parts of the baby's body.

What to do if the baby has a pathology

With a positive result about the presence of violations in the baby, doctors suggest making a more reliable analysis:

• take blood from the umbilical cord;
• take amniotic fluid material.

Studies of these materials provide more accurate information about the presence or absence of violations in the development of the child.

Today, medicine has stepped far forward and some of the detected developmental disorders can be corrected. So, for example, heart disease can be eliminated by surgery in the first days of a child's life.

Genetic deviations from the norm cannot be corrected.

Prenatal screening or blood test of pregnant women for markers of fetal pathology

September 5, 2008

A blood test of pregnant women for markers (French marqueur, from marquer - mark) of fetal pathology or biochemical screening of pregnant women.

Such a blood test is the only means of searching for abnormalities in the development and pathology of the fetus, because it reflects the state of the fetus and placenta through specific proteins that enter the blood of a pregnant woman.

Timely detection of changes allows the doctor to form risk groups for pregnant women with fetal chromosomal pathology.

With early biochemical screening (10-14 weeks), the level of two placental proteins is determined in the blood of a pregnant woman: PAPP-A (pregnancy associated plasma protein or plasma protein A associated with pregnancy) and the free beta subunit of hCG (human chorionic gonadotropin).

This analysis is called a "double test".

Various changes in the level of early markers indicate an increased risk of chromosomal and some non-chromosomal disorders in the fetus.

Suspicion of the presence of Down's syndrome in the fetus causes a decrease in the level of PAPP-A and an increase in the level of the free beta subunit of hCG.

For biochemical screening of the second trimester (16-20 weeks), most often in the blood of a pregnant woman, the level of AFP (alpha-fetoprotein) is determined. hCG (human chorionic gonadotropin) and free (unconjugated) estriol.

This analysis is called a “triple test”.

Significantly elevated levels of AFP are observed with gross malformations of the fetal brain and spinal cord, with an unfavorable course of pregnancy, the threat of termination, Rhesus conflict, intrauterine death of the fetus and is a prognostically unfavorable sign.

In multiple pregnancies, elevated AFP levels are normal.

A reduced level of AFP can be with Down syndrome, with a low placenta, obesity, the presence of diabetes mellitus in a pregnant woman, and hypothyroidism. May occur during normal pregnancy. There is a dependence of the level of AFP on race.

HCG and free estriol are placental proteins, their level characterizes the state of the placenta at a particular stage of pregnancy, it can change if the fetus (and, accordingly, in the placenta) has chromosomal abnormalities, if there is a threat of abortion, changes in the placenta due to infectious damage. Altered levels of hCG and free estriol can occur with a normal pregnancy.

Typical of a fetus with Down's syndrome is an elevated hCG level combined with a reduced level of AFP and free estriol.

The level of serum markers in the blood of pregnant women varies in accordance with the duration of pregnancy.

Since laboratories use different norms to evaluate markers, depending on the reagents used, it is customary to evaluate the levels of serum markers in relative units - MoM (multiples of median - a multiple of the average value).

The MoM norm for any serum marker at any stage of pregnancy is 0.5-2.0 MoM.

A change in any one indicator of biochemical screening is not significant.

Correctly assess the results of prenatal screening using computer programs calculation of genetic risk, which take into account the individual indicators of each pregnant woman - age, weight, ethnicity, the presence of certain diseases. Fetal ultrasound data.

The results of the PRISC calculation are not a diagnosis of a disease, but an assessment of an individual risk.

Feel

The 12th week of pregnancy has already come, which means that, starting from this moment, the future mother, if she suffered from toxicosis, will most likely begin to become easier. Yes, yes, the placenta is slowly taking over life-supporting functions, the corpus luteum has “done” its work, and, therefore, nausea and vomiting, most likely, will now remain in the past. But, unfortunately, this concerns more “traditional” pregnancy, but if the pregnancy is designated as multiple, the effects of toxicosis may remain with it for some time. Like emotional outbursts, irritability and nervousness caused by hormonal changes in the body.

Even if a woman, due to toxicosis in the first weeks of pregnancy, lost a little weight, starting from the 12th week, body weight will begin to increase: plus 500 grams weekly is considered the norm. Growing in a woman's womb new life demands from the mother's body "to the maximum", in connection with which all its systems and organs work in full force. The volume of blood increases, its circulation increases, the lungs and kidneys work more actively, the heart beats more often. At the same time, urination is “debugged” - frequent urges to go to the toilet “little by little” will no longer disturb the woman, as at the beginning of pregnancy. But there may be a problem with emptying the intestines: the growing uterus presses on it, the work of the intestines slows down, against which constipation may occur.

Stomach

At the 12th week of pregnancy, the expectant mother can already feel how her belly slowly begins to grow. Usually, if pregnancy is new for a woman, then the tummy begins to grow later, at week 12 it practically did not increase, the expectant mother feels comfortable and ordinary clothes still fit her. If the pregnancy is not the first for a woman, then the stomach usually begins to grow earlier, often forcing the expectant mother already at 12 weeks to start looking for looser-fitting clothes. Often, the growth of the abdomen is accompanied by itching, this is a kind of “hint” for a woman to be concerned about the choice of suitable means that will help avoid the formation of stretch marks, not only on the abdomen, but also on the chest and hips. In addition, on the stomach, at the 12th week of pregnancy, it can also be indicated age spots, and a dark stripe, which, starting from the navel, goes down. Experts reassure: there is nothing wrong with this, these phenomena are temporary and are not a cause for concern.

uterus at 12 weeks pregnant

It is probably not difficult to guess that the stomach begins to grow just in connection with the gradual increase in the size of the uterus. So, the uterus at 12 weeks of pregnancy usually increases to such a size that it simply becomes cramped in the hip area. At this stage, the width of the uterus "grows" up to about 10 centimeters, therefore, it goes beyond its usual location and rises into the abdominal cavity. A woman can even fully feel and feel her enlarged sizes.

ultrasound

Usually, the first ultrasound examination occurs at the 12th week of pregnancy, with the help of which the doctor determines the size of the fetus, and also sets the estimated time of delivery. Ultrasound at the 12th week of pregnancy becomes a real revelation for the expectant mother: her first acquaintance with the baby takes place, she already distinguishes him as a tiny little man who is destined to be born in the near future. Although such indicators are extremely important in an ultrasound examination, ultrasound at the 12th week of pregnancy can also show other, much more important results.

So, during the ultrasound examination, the doctor assesses the condition of the uterus and determines its tone, analyzes the location of the placenta, excludes the possibility of an ectopic pregnancy and clearly establishes how many fetuses develop in the womb. A woman can already observe her future baby on an ultrasound monitor, but without the help and explanation of a doctor, she will not always be able to make out where everything is and how the baby feels now. Do not be shy to ask the doctor for clarification - he can answer all the questions for the mother, thereby introducing her closer to her baby.

The doctor compares the results of ultrasound at the 12th week of pregnancy with the indicators indicated in the table of normal values. This will make it possible to establish whether everything is going “as usual”, and in the future, the results of the first ultrasound will be compared with the indicators of repeated ultrasound examinations. Thus, the specialist will be able to monitor whether the pregnancy is proceeding normally, whether there are any abnormalities.

It happens that early diagnosis becomes a disappointing “surprise” for parents: ultrasound at the 12th week of pregnancy can already give an answer if the baby is threatened with congenital defects or chromosomal abnormalities. Unfortunately, such diseases cannot be treated, and parents, learning about deviations, are tormented by a difficult choice: to leave the baby or still resort to abortion.

Screening at 12 weeks pregnant

An even more informative method for assessing the development of the fetus and the course of pregnancy according to the norm can be screening at the 12th week of pregnancy. This is a comprehensive study that covers not only ultrasound, but also a biochemical blood test. A blood test involves measuring two markers in a woman's body - free b-hCG (free beta subunit of chorionic gonadotropin) and PAPP-A (plasma protein A associated with pregnancy). In this regard, the first screening is also called a double test.

Optimal screening for the entire duration of pregnancy is carried out three times, and the first is recommended to be carried out just between 11 and 13 weeks. The fact is that screening at the 12th week of pregnancy, which includes a mandatory ultrasound of the fetus, is aimed at studying the so-called "collar zone" of the fetus. Such a study makes it possible to exclude gross malformations of the fetus and even anomalies that are not compatible with life. Collar zone - the area of ​​the neck between the skin and soft tissues, in which liquid accumulates, refers to non-permanent markers. As the baby develops, the norms of the collar space change, and therefore its study must be carried out strictly within a certain time frame. And, besides, the analysis of the state of the collar zone can be performed under the condition of high qualification and special training of the operator, otherwise the presumptive diagnosis can be strongly doubted.

In turn, the study of the level of hormones (free b-hCG and PAPP-A) carried out as part of screening makes it possible to determine the risk of developing certain abnormalities in the fetus. For example, an increase in the values ​​of free b-hCG on average twice can be a reason for suspicion that the fetus has trisomy 21 (Down syndrome), a decrease in trisomy 18 (Edwards syndrome).

However, despite the high information content, screening at the 12th week of pregnancy is by no means a reason for the final analysis. This study only establishes the degree of risk and the possibility of having trisomy 21, trisomy 18, and also a neural tube defect. The results of screening become an occasion for further research using special methods. Among other things, the doctor usually refers the expectant mother to a geneticist with dubious analyzes, and he, in turn, recommends other additional studies.

Analyzes

Apart from ultrasound and a biochemical blood test, the doctor may prescribe to the expectant mother and some other tests at 12 weeks of pregnancy. Usually, a woman has to take all planned tests already when registering in a antenatal clinic. But it happens that tests at the 12th week of pregnancy may be needed due to the woman's late visit to the gynecologist about pregnancy. Or it happens that tests at the 12th week of pregnancy are needed for an extended examination of the expectant mother in connection with her condition - as an additional control tool.

In addition to the traditional blood test for AIDS, syphilis, hepatitis B, for blood group and Rh factor, by this time a blood test for sugar, as well as a biochemical analysis, should already be passed. Among other things, an analysis at the 12th week of pregnancy, exploring "biochemistry", will determine the level of hCG in the body of the expectant mother. And a biochemical blood test is performed, as mentioned above, as part of a screening examination of a pregnant woman. If there is any suspicion of specific diseases, a woman may also be sent for hormone tests and tests for urogenital infections.

fetus at 12 weeks pregnant

All these actions are necessary both in order to control the condition of the future mother, and in order to carefully monitor the formation and normal development of the fetus at the 12th week of pregnancy. At this stage, it has already grown significantly: the fetus at the 12th week of pregnancy, when it is 10 weeks old, weighs about 14 g, and reaches a length of 6 to 9 cm (from the top of the head to the coccyx). From this moment, by the way, the speed of its growth and length are a much more important indicator for doctors than weight.

The fetus at the 12th week of pregnancy is already practically formed, all its systems and organs are actively working and continue to develop. So, the fingers are divided and marigolds are formed on them, a unique imprint is formed on the fingertips, the top layer of the skin is updated, and where eyebrows and cilia appear in the future, fluff appears. Also, fluffy hairs are born on the chin and on the upper lip.

By the way, the face of the fetus at the 12th week of pregnancy is already actively “expressing emotions”: it grimaces, opens and closes its mouth, and even takes a finger in its mouth. At the same time, the baby waves its arms and legs, and also somersaults and “floats” freely in the mother’s womb.

The internal organs of the baby at this stage, in parallel with the fact that they are functioning, still continue to develop. The baby's intestines, having “taken” their place, are already periodically contracting, the liver synthesizes bile, and the pituitary and thyroid glands produce hormones and iodine. The bone tissue continues to mature, the muscles of the crumbs are strengthened, the heart, kidneys and nervous system work fully. And at this stage, in addition to erythrocytes, leukocytes also begin to form in the blood of the fetus - the immune system is improving more and more.

pain

All this "magic" that happens in mom's tummy is normal painful sensations should not be accompanied. True, mild and mild pains at the 12th week of pregnancy, felt in the lower abdomen, can be explained by the tension of the ligaments that support the growing uterus. At the same time, doctors often justify low back pain by a change in the center of gravity due to a gradually growing abdomen, and also by softening of the supporting ligaments and discs under the influence of progesterone.

At the same time, lower back pain can also be triggered by an infection. Bladder Therefore, it is still better to consult a doctor in such a situation and, if necessary, undergo an examination. It will not be superfluous to consult a specialist if the pains at the 12th week of pregnancy appear periodically in the lower abdomen, are aching and pulling, and also if the pains in the lower abdomen last for 2-3 hours. And, moreover, they are accompanied by spotting - this dangerous sign indicates the threat of premature termination of pregnancy. If a woman reacts in time when pain occurs, a miscarriage can be avoided, therefore, it is necessary to seek help immediately.

Allocations

Bloody discharge at the 12th week of pregnancy, even insignificant, should always alert a woman. Especially if they are still accompanied by pain in the abdomen - all this indicates a risk spontaneous abortion. But spotting that appears after a gynecological examination or sexual intercourse can be explained by erosion of the cervix. And this condition is also a sufficient reason for contacting a specialist and additional examination.

Normally, the discharge at the 12th week of pregnancy is moderate, light or milky, of a uniform consistency and with a slight sour smell. There should be no pus, mucus, green or yellow, cheesy discharge or discharge with a sharp and unpleasant odor: such discharge becomes a sign of an infection. A change in the consistency and color of the discharge can be a symptom of thrush, chlamydia, trichomoniasis, which require mandatory treatment, because the infection is quite capable of infecting the fetus.

Bleeding

Bleeding at the 12th week of pregnancy always requires consultation with a doctor, because it is always defined as a very dangerous sign. Though bleeding different nature and are considered a fairly common occurrence in the early stages of pregnancy, nevertheless, in no case should you take risks and let the situation take its course - in order to prevent a possible miscarriage, the harbinger of which is bleeding at the 12th week of pregnancy.

Bleeding is especially dangerous, which is accompanied by cramping or pulling pain in the lower abdomen, pain in the lower back. Indeed, in addition to the threat of spontaneous abortion, such bleeding can also indicate an ectopic pregnancy - a complex and pathological pregnancy that poses a threat to the health and life of a woman.

Cold at 12 weeks pregnant

The twelfth week ends one of the critical periods of pregnancy - the first trimester, after which most of the anomalies and malformations of the baby will no longer be afraid. But for now, in this last and crucial week of the first trimester, you still need to be careful, including colds.

A cold in the early stages can cause a lot of trouble: provoke the development of placental insufficiency, fetal hypoxia, and significantly increase the risk of miscarriage. After all, carried on the legs and “untreated”, a cold at the 12th week of pregnancy is still a significant danger: it can cause malformations of the baby, which are not even compatible with life, which can eventually result in spontaneous abortion.

Significantly complicates the situation and the fact that it is forbidden to treat a cold in early pregnancy in order to avoid negative consequences. medications. In this case, only traditional medicine is suitable, and even some herbal remedies- and then, only after consulting a doctor.

Mandatory for a woman in the process of treating a cold is rest and bed rest. Plentiful drinking is shown (warm, but not hot) - herbal teas, rosehip broth, berry fruit drinks from lingonberries, raspberries, currants. Honey is also useful - however, in small quantities, since it has a strong allergenic effect. Honey can be added to tea, drink with warm milk. Also a good remedy in the treatment of colds, primarily against coughs, it is considered warm milk in half with Borjomi mineral water. You can also fight a cough with the help of a mixture with marshmallow, syrup or lozenges Dr. MOM, Gedelix.

It is imperative to consult a doctor again if a cold at the 12th week of pregnancy does not go away within 3-4 days, if its symptoms worsen, headaches are observed against the background of a cold and a cough accompanied by wheezing does not go away. Moreover, a mandatory consultation with a specialist is required if a cold at the 12th week of pregnancy is accompanied by a high temperature - within 38 degrees or more.

Temperature

The temperature at the 12th week of pregnancy, which is slightly higher than normal and fluctuates at around 37-37.5 degrees, can be either a variant of the norm (this is how the body reacts to elevated levels of progesterone in a woman’s body), and indicate latent diseases. Tests will help identify these diseases - usually inflammatory ones provoke changes in the levels of leukocytes, as well as the erythrocyte sedimentation rate (ESR). And, nevertheless, more often a slightly elevated temperature at the 12th week of pregnancy is a characteristic feature of the body of the expectant mother.

But a noticeable high temperature at the 12th week of pregnancy, accompanying any disease, poses a significant threat to the baby. So, under the influence of high temperatures, the fading of pregnancy can occur at such a period, therefore, a long-term high temperature is simply not permissible. But after all, most antipyretics are banned at the 12th week of pregnancy (the only exception is paracetamol, and then only with the permission of a doctor). So what to do?

First of all, do not "disdain" folk methods lowering the temperature - rubbing with cool water with the addition a small amount vinegar, wet and cool lotions on the ankles and hands, cool showers. But all this - only after the doctor was called to the house: he will help determine the degree of danger of high fever, and prescribe a dosage in which paracetamol will not cause much harm.

Alcohol

You should also refrain from alcohol at the 12th week of pregnancy, as well as during the entire period of bearing a baby. After all, a conscious mother is clearly interested in her baby being born a full-fledged and healthy baby, while alcohol at the 12th week of pregnancy, consumed even in the smallest doses, can prevent this.

At this stage, the formation of the brain is still ongoing, and no specialist will take the responsibility to suggest how alcohol will affect this process. So, alcohol can cause irreparable damage to brain cells - up to the destruction of some of them, which will not be restored in the future. The impact of alcohol can manifest itself in this case even a few years after the birth of the baby: at some point it will become clear that we are hard to train, overly excitable and hyperactive, and suffer from poor memory.

In a more severe case, alcohol at the 12th week of pregnancy can still cause severe malformations of the child and physical deformities, affecting bone formation and muscle development. Alcohol in large quantities, constantly penetrating the placenta to the baby and exerting a toxic effect on him, can even lead to a miscarriage. Therefore, alcohol at the 12th week of pregnancy should definitely be excluded from the life of the expectant mother.

Sex at 12 weeks pregnant

But from sex, if a woman feels satisfactory, and there are no contraindications for carnal pleasures, it is not at all necessary to refuse. Moreover, at the end of the first trimester of pregnancy, toxicosis and its accompanying symptoms slowly recede, the woman enters a certain period of “heyday” and the dangers that were characteristic in the early stages of pregnancy also gradually remain in the past.

The only contraindication to sex, both in the first weeks and at the 12th week of pregnancy, may be the threat of miscarriage. And then, in this case, restrictions on sex are usually imposed by doctors just before 12 weeks. Other reasons that will become a reason for a woman to take care of herself may be multiple pregnancy and low location of the placenta (it will be determined by a planned ultrasound). If pregnancy is not accompanied by such characteristic "features", sex at week 12 can be safely practiced.

The only thing - not too active and not "zealous", avoiding the partner's pressure on the stomach and tracking the internal sensations after intercourse. For example, convulsions that may appear after carnal pleasures are usually classified as normal. But, if convulsions do not go away for some time after sex, and even accompanied by bleeding, you should immediately call a doctor.

You should also, if possible, consult a doctor if spotting is observed after sex at the 12th week of pregnancy, but they are not accompanied by pain. Such a sign may indicate the presence of cervical erosion in a pregnant woman.

Food

Nutrition at the 12th week of pregnancy - without fail, complete and balanced: rapidly developing organism the baby needs the most nutrition and useful substances. They are contained in the required quantities in “healthy” food: meat and fish, dairy and sour-milk products, cereals, vegetables and fruits. Moreover, the method of their preparation occupies an important place: it is better to boil or bake food when cooking (fried causes heartburn), vegetables and fruits are eaten raw (fiber improves intestinal motility and reduces the likelihood of constipation).

A full breakfast is important, for the first it is advisable to always eat a portion of the first, and dinner should be light. It is better to eat, again, more often, but in small portions, avoiding overeating. If some products in connection with pregnancy suddenly began to cause rejection in a woman, you can always find an “alternative” for them: for example, if you do not want and do not perceive meat, you can completely replace it with fish. Don't like boiled fish? You can try baking it. Yes, and one more thing: there is no point in torturing yourself and trying to “squeeze” into the stomach a product that the expectant mother is simply on this moment disliked, but which, according to all the characteristics, is extremely useful for pregnant women. For example, many women during pregnancy simply cannot look at cottage cheese, although it seems to bring exceptional benefits to the body of the mother and baby. But only food eaten through force will definitely not work for the future, so it’s still better not to go against your taste “sensations”.

Bleeding during pregnancy is a fairly common pathology. Some pregnant women may experience small spotting at the very beginning of pregnancy, when the fetal egg attaches to the wall of the uterus (approximately 7 days after conception). Only in this case, bleeding is a variant of the norm.

There is a fairly common belief that during pregnancy, menstruation can go "through the fetus." This is a misconception, any bloody discharge from the genital tract when carrying a child is a serious complication. In this case, a woman should immediately consult a doctor.

Bloody discharge may occur in the early (before) and on later dates pregnancy.

Causes of bleeding in early pregnancy

Causes of bleeding up to 12 weeks:

1. Bubble drift.

Spontaneous miscarriage

Spontaneous miscarriage (abortion) is the termination of pregnancy up to 22 weeks (according to WHO classification).

Main reasons:

• History of medical termination of pregnancy (vacuum aspiration, abortion);
• Acute and chronic infections;
• Endocrine disorders;
• genetic diseases;
• Excessive physical activity;
• Immune disorders;
• Anomalies and diseases of the uterus.

Stages of development of spontaneous abortion:

1. threatened miscarriage. At this stage, only aching pains in the lower abdomen or in the lower back are characteristic, there are no bloody discharges from the genital tract;
2. Started abortion. Pain in the lower abdomen intensifies, becomes cramping. There are spotting of varying intensity (from spotting to heavy bleeding);
3. Abortion in progress. Characterized by severe pain, profuse bleeding. The opening and shortening of the cervix begins;
4. incomplete abortion. The fertilized egg is partially expelled from the uterine cavity. The cervix is ​​ajar, passes a finger, severe pain in the lower abdomen and bleeding continue;
5. Complete abortion. The fetal egg is completely removed from the uterine cavity, may be in the vagina. Bleeding and pain stop.

Important When the first signs of a threatened abortion appear, a woman urgently hospitalized and begin treatment to maintain the pregnancy.

Ectopic pregnancy

Ectopic pregnancy- this is the development of a fertilized egg not in the uterine cavity, but outside it (more often, in the fallopian tubes). Until a certain period, it develops as usual, without specific signs. It is possible to diagnose such a pregnancy only during a gynecological examination or during an ultrasound diagnosis. By 6-7 weeks, the fetal egg increases, the fallopian tube can no longer stretch, and an ectopic pregnancy is terminated in the form of a tubal abortion or rupture of the tube.

For tubal abortion characteristic:

• Paroxysmal pain, often on one side;
• Spotting spotting;
• Marked weakness.

Complete rupture of the fallopian tube the following signs are observed:

• A sharp onset of severe pain, which may be preceded by less intense pain sensations;
• Profuse spotting;
• Nausea, vomiting, loose stools;
• , drop in blood pressure;
• Paleness of the skin;
• General weakness up to loss of consciousness.

dangerous An ectopic pregnancy is extremely dangerous state threatening a woman's life and requiring immediate hospitalization and surgical intervention.

If a woman is diagnosed in advance before the onset of bleeding and pain, then it is possible to perform an operation to remove the embryo without removing the fallopian tube. If the operation is performed on an emergency basis, then the tube or part of it is removed, and the ovary on this side will no longer participate in the function of childbearing.

Non-developing pregnancy

A non-developing pregnancy is a spontaneous cessation of the development of the fetus and its death. In most cases, the fading of pregnancy occurs in the early stages up to 12 weeks.

The main causes of spontaneous fetal death are:

• Genetic abnormalities of the fetus incompatible with life;
• Hormonal disorders (lack of progesterone,);
• Acute and chronic infections.

Signs of an undeveloped pregnancy:

• A sharp disappearance of signs of pregnancy (, swelling of the mammary glands);
• Inconsistency of the size of the uterus with the gestational age;
• Periodic spotting from the genital tract;
• Absence of fetal heartbeat and motor activity on ultrasound;
• Periodic pulling in the lower back.

A woman with a missed pregnancy should be admitted to hospital to the gynecological department, where it is carried out with the removal of the fetal egg. After the operation, a course of antibiotic therapy is prescribed to prevent infectious complications.

bubble skid

Cystic drift is a disease of the fetal egg, characterized by the growth of chorionic villi. By appearance it resembles bunches of grapes with transparent contents. The exact causes of hydatidiform mole have not been identified.

The main signs of cystic drift:

• Frequently recurring moderate bleeding;
• The content of small bubbles in the secretions from the genital tract;
• The size of the uterus does not correspond to the term (much more);
• There are no signs of a normal fetus on ultrasound;
• An increase in the content of chorionic gonadotropin over 100,000 mIU / ml.

When a woman is diagnosed urgently hospitalized to the hospital where carry out the following treatment:

• Vacuum aspiration to remove the mole, after the operation, oxytocin is administered to contract the uterus;
• Hysterectomy(removal of the uterus) in the absence of a woman's desire to have more children;
• Prophylactic chemotherapy in the absence of signs of remission;
• Controlling the level of human chorionic gonadotropin.

Causes of bleeding in late pregnancy

Causes of bleeding after 12 weeks:

Detachment of a normally located placenta

Detachment of a normally located placenta is its premature separation from the walls of the uterus before the birth of the child.

There are three degrees of placental abruption:

• First degree(up to 1/3 of the placenta). There are chances to save the pregnancy, the child practically does not suffer;
• Second degree(from 1/3 to 2/3). The child suffers from hypoxia and may die;
• Third degree(more than 2/3 of the placenta). The child dies in all cases.

The main symptoms of placental abruption:

• Profuse bleeding of their genital tract;
• Cramping pains;
• Pain on palpation of the abdomen;
• Stormy physical activity fetus.

When signs of placental abruption appear, a woman. Treatment of placental abruption depends on the following parameters:

• Detachment time (second or third trimester);
• The severity of bleeding;
• General condition of mother and child.

Extension of pregnancy is possible only in a hospital under the following conditions:

• Detachment of the placenta of the first degree, lack of progression;
• Pregnancy less than 36 weeks;
• Satisfactory condition of the woman and the fetus.

In this case, the woman is prescribed the following treatment:

• Strict bed rest;
• Careful monitoring of the condition of the fetus: ultrasound,;
• Monitoring the state of the woman's blood coagulation system;
• Preparations for removing the tone of the uterus (,);
• Hemostatic drugs (Vikasol, Decinon);
• Iron-containing drugs for the treatment of anemia ().

If the condition of the child or woman worsens, if bleeding resumes or increases, emergency delivery is indicated by caesarean section regardless of gestational age.

placenta previa

In the normal course of pregnancy, the placenta is located in the fundus or body of the uterus, along the back or front wall. Placenta previa is a pathology in which the placenta is located in the lower part of the uterus, partially or completely blocking the internal pharynx.

Classification of placenta previa:

• Complete: the placenta completely covers the internal os;
• Partial: the internal os is partially blocked by the placenta;
• Low: the placenta is located at a distance of 7 cm or less from the internal pharynx.

The main symptom of placenta previa is bleeding from the genital tract, which occurs suddenly in the midst of full health. The flowing blood is bright scarlet in color and is not accompanied by pain.

When a pregnant woman is diagnosed urgently admitted to the hospital where it should be until the onset of childbirth. In the absence of bleeding, prolongation of pregnancy is possible; for this, it is prescribed next treatment:

• Strict bed rest;
• Antispasmodics ();
• Iron-containing preparations (Sorbifer);
• Preparations for improving blood microcirculation;
• Beta-agonists ();
• Disaggregants ().

Pregnancy in the absence of contraindications is maintained until 36-37 weeks, then carried out. A neonatologist must be present in the operating room. With the appearance of heavy bleeding at any time, an emergency operative delivery is performed.

Prevention

Prevention of bleeding during pregnancy:

• Examination for sexually transmitted infections during pregnancy planning;
• Timely treatment of chronic gynecological diseases;
• Rejection of bad habits;
• Avoiding heavy physical exertion and stressful situations during pregnancy;
• Natural family planning: rejection of artificial termination of pregnancy.

Bleeding may occur in early pregnancy varying degrees intensity. This phenomenon occurs in 30% of cases. If bleeding occurs, you should definitely consult a gynecologist to avoid serious complications in the future. Next, we will take a closer look at the main causes of bleeding in early pregnancy.

Causes of bleeding at 12 weeks gestation

1. Bleeding during implantation. During the attachment of the fetus to the walls of the uterus, slight bleeding may occur. This is quite normal and should not be confused with menstruation.

2. The threat of miscarriage. In 50% of cases of bleeding in early pregnancy is precisely the risk of miscarriage. In addition to bleeding, pain in the lower abdomen is also observed.

3. Miscarriage. In this case, there is severe bleeding and pain, which gradually stops.

4. Incomplete miscarriage. In this case, the bleeding does not stop, blood clots are observed, the uterus is half open. But there is no longer any chance of saving the pregnancy.

5. Fading pregnancy. The selection is minor. Only after ultrasound can an accurate diagnosis be made.

6. Improper development of the fetus, which grows with tissues. This can happen due to a genetic malfunction in the body.

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