The author - Sozinova AV practicing obstetrician-gynecologist. Experience in the specialty since 2001.
Continues the second trimester of pregnancy from 14 to 26 weeks gestation.
List of dangerous conditions
Ranked first anemia of pregnant women (as a rule, Iron-deficiency anemia) And its frequency is 21-80% depending on the geographical place of residence a woman.
In second place is the threat of termination of pregnancy or late miscarriage, although the 2nd trimester of pregnancy, the risk of this complication is slightly lower than in the first, and reaches 5-10%.
The third place was given to placenta previa and its frequency in the second trimester reaches 10% (in the third greatly reduced).
The causes of hazardous conditions
The factors causing the threat of late miscarriage include:
- development cervical incompetence (Both anatomical and functional);
- uterine defects (malformations of the uterus, cancer);
- Rh-conflict pregnancy;
- infectious processes, including genital infections;
- premature rupture of membranes, water leakage.
Anemia in pregnant women provoke:
- poor living conditions;
- poor nutrition;
- Chronic toxicity (harmful working conditions, destruction of the environment);
- chronic somatic diseases (renal diseases, gastritis, diabetes, Chronic infections, cardiovascular diseases);
- existing anemia before pregnancy;
- bleeding during pregnancy;
- multiple pregnancy;
- a large number of births;
- frequent deliveries;
- heredity.
A sufficiently high frequency of placenta previa in the 2nd trimester of pregnancy due to the rapid growth of the uterus, especially from 18 to 22 per week. Predisposing factors include:
- burdened obstetric and gynecological history (abortion, Curettage, obstructed labor);
- surgery on the uterus;
- genital infantilism;
- gynecological pathology (myoma, endometriosis, chronic endometritis).
symptoms
Signs of threat of termination in the 2nd trimester are:
- the appearance of pulling / aching pain in the lower abdomen;
- hypertonicity of the uterus, both permanent and periodic (womb as "a stone");
- appearance of dark bleeding;
- cervix when viewed transmits the fingertip or the entire cervical canal pass the finger).
Anemia is characterized by pregnant
- the occurrence of weakness, fatigue,
- change in taste,
- low blood pressure, dizziness and tendency to fainting,
- skin and hair is prone to dryness,
- hair and nails become brittle,
- Pregnant looks very pale, it appears blue under the eyes.
Placenta previa occurs on the background of repetitive bleeding from the genital tract, which lead to anemizatsii pregnant. The intensity of bleeding depends on the gestational age and the nature of the previa (lateral or full). Painless bleeding may occur at rest, and are characterized by the appearance of bright red blood from the vagina.
complications
All of these endangered status of the 2nd trimester of pregnancy contribute to the development of the following complications:
- placentofetal failure;
- the lag in the development of the amnion and the chorion;
- worsening anemia, placenta previa, and the threat of interruption;
- intrauterine growth retardation;
- anemia contributes to threatened abortion and low placentation;
- chronic hypoxia fetus;
- spontaneous abortion;
- anomaly tribal forces;
- postnatal morbidity period;
- Anemia increases the risk of gestosis in 1.5 times;
- incorrect position and fetal presentation with placenta previa.
Treatment and prevention
pregnant anemia treatment is to appoint dietRich in proteins and iron, as well as iron supplements. In anemia grade 2 and 3 female subject hospital where she appointed iron preparations orally (tablet form iron is better absorbed by the body). These drugs include: tardiferon, Sorbifer-durules, fenyuls and others. The number of tablets is dependent on the iron content in the preparation. Also shown threat prophylactic treatment interruption and placental insufficiency. In case of intolerance to oral iron supplements or malabsorption of iron in the intestine are assigned iron preparations parenterally (ferrum-lek, Venofer, ektofer). In severe anemia (hemoglobin less than 60 g / l) shows red cell transfusion.
In case of bleeding in placenta previa, a pregnant necessarily hospitalized. At the hospital it is assigned strict bed rest and psycho-emotional comfort. The therapy aimed at lowering the tone of the uterus and prevent threats of abortion. Appointed by antispasmodics (no-spa, papaverine, magnesium sulfate) and tocolysis (ginipral, partusisten). Also shown is prophylactic treatment of iron deficiency anemia of iron preparations. Transfusion of packed red cells and fresh-frozen plasma is carried out indicated (when expressed and / or repeated bleeding, abrupt decrease in hemoglobin). In parallel, treatments improving uteroplacental blood flow (Trental, chimes, aktovegin, Magne-B6, vitamin E, C and B). Termination of pregnancy is carried out for health of the mother.
The threat also treat late miscarriage stationary bed mode where assigned, antispasmodics, tocolytics, vitamins and metabolic medication (improved uteroplacental blood flow). In the case of cervical incompetence surgical treatment - suturing the cervix (13 to 27 week).
The prevention of anemia focuses on proper and balanced nutrition, preventive reception of multivitamins and minerals, normalize the regime of the day of rest.
For the prevention of bleeding in placenta previa or threatened interruption of the woman recommended to refrain from strenuous exercise and heavy lifting, to avoid stressful situations and take preventive treatments.
Forecast
Iron deficiency anemia is to be cured in almost 99% of cases, and the prognosis for this condition favorable for women, delivery is carried out vaginally.
Forecast with placenta previa always serious, and the percentage of successful completion of pregnancy depends on the type of previa (worse prognosis in full previa), the frequency of recurrent bleeding of pregnancy related complications (anemia, fetal growth retardation) and other factors. In 90% of cases with incomplete breech delivery end surgically, with the full - absolute indication for cesarean section.
The percentage of successful completion of pregnancy in threatened abortion in the second trimester depends on the reason she was called, timely and appropriate treatment. However, in most cases, the threat of termination in the second trimester successfully docked and reaches 75-80%.
Some studies in pregnancy
- Smears during pregnancy.
- Tests during pregnancy by trimester.
- Ultrasound during pregnancy.
- Urinalysis in pregnancy.
- Coagulation.
- Installing pessary.
- Glucose tolerance test.
- Homocysteine in pregnancy.
- Amniocentesis.
- Anesthesia during childbirth.
- Fetal CTG (cardiotocography)
- Cordocentesis.
- Epidural anesthesia during childbirth.
