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Examination of pregnant women for child pathology. Intrauterine malformations of the fetus, definition (screening, analysis), prevention, causes

Congenital defects Fetal development (FDP) is one of the most dangerous complications of pregnancy, which ranks first among the causes leading to childhood disability and mortality. The birth of a child with congenital developmental defects always stuns the family; this topic is one of the most difficult.

The statistics are frightening; against the backdrop of declining child mortality, an increase in the number of congenital malformations is observed in most countries of the world. If in European countries the incidence of congenital birth defects is 3-4 cases per 1000 births, then in Russia it reaches 5-6 cases per 1000.

Congenital malformations include developmental defects nervous system- anencephaly (absence of the brain), spina bifida (open herniation of the spinal cord), defects of cardio-vascular system(heart defects, etc.), limb defects - atresia (absence), maxillofacial deformities - cleft lip, cleft palate and much more.

Causes of congenital malformation of the fetus

The reasons that cause the formation of congenital malformations are different. This pathology can be hereditary if future parents have abnormalities in the chromosome set. In other cases, the source of the problem is various harmful factors: infections, frequent alcohol consumption, drugs.

One of the reasons is the lack of vitamins in the diet of a pregnant woman, in particular - folic acid. The recommended micronutrient intake for a pregnant woman is one and a half times greater than for women of childbearing age. And this is no coincidence - the health of the child depends on it both when he is in the womb and after his birth.

Pediatricians believe that, in addition to congenital malformations, diseases of newborns such as iron deficiency anemia, rickets or developmental delays are often associated with the fact that the expectant mother did not have enough vitamins and minerals during pregnancy.

Other violations may make themselves known much later - already in kindergarten and school: these are diseases gastrointestinal tract and metabolic diseases, primarily, as well as diabetes and obesity.

It is important to remember that the lifestyle of the expectant mother, her diet, and bad habits create the basis for the health of her unborn baby. A lack of vitamins can cause physical and mental development child. This significantly increases the risk of having children with various developmental disabilities and low body weight.

Key Factor: Folic Acid

The leading role in the prevention of congenital malformations in the fetus is folic acid. It is necessary for cell division, growth and development of all organs and tissues, normal development embryo, hematopoietic processes. Folic acid prevents the occurrence of premature birth and rupture of the amniotic membrane.

This vitamin ensures the necessary speed of growth and development of the unborn child, especially at early stages pregnancy. Folic acid deficiency during pregnancy significantly increases the risk of the fetus developing birth defects, in particular neural tube, hydrocephalus and anencephaly. To prevent neural tube development in the embryo, a woman should take at least 800 mcg (0.8 mg) of folic acid daily both before and throughout pregnancy.

Today doctors are confident in the need for large-scale educational events, promoting planned pregnancy and preventive measures that can significantly reduce the risk of having a child with congenital birth defects - in particular, taking medications containing folic acid.

A number of countries, such as Argentina and Türkiye, are already implementing government programs on prevention congenital pathologies development. They consist of an educational part that explains to medical specialists and women themselves how to prevent fetal malformations and an incentive part - compensation for 70-80% of the cost of multivitamin preparations containing folic acid.

Vitamins for life

There is an opinion that a well-balanced daily diet of a pregnant woman contains a sufficient amount of vitamins and microelements and in this case is not required additional purpose multivitamin complexes. However, according to European data, vitamin deficiency in pregnant women is 20-30%, even with the most balanced and varied diet.

Modern research conducted regularly in last years RAMS showed that the diet modern woman, made up of natural products, which is quite adequate to our energy consumption and even excessive in calorie content, is unable to provide the body with the necessary amount of vitamins during pregnancy and lactation.

More detailed information you can find it on the website elevite.ru

*A.E.Czeizel Use of multivitamins containing folic acid during the period of conception. Europ. J. Obstetr. Gynecol. Reproductive Biology, 1998, 151-161.

Congenital malformations of the fetus (CHD) are perhaps the most dangerous complication pregnancy, leading to childhood disability and mortality.

The birth of a child with congenital developmental defects is always a great trauma for any parents. The statistics in this regard are not reassuring: in Russia, the incidence of congenital malformation reaches 5-6 cases per 1000 children.

1. Hereditary

Hereditary diseases are the result of gene mutations. A mutation is a change in the hereditary properties of an organism due to rearrangements in the structures that are responsible for the storage and transmission of genetic information. These include Down syndrome, Patau syndrome, etc.

2. Congenital

Congenital anomalies- diseases acquired in the womb due to exposure external factors(and microelements, trauma during pregnancy, etc.). They can affect almost any organ. Congenital malformations of the fetus include heart defects, underdevelopment of the brain, maxillofacial deformities, etc.

3. Multifactorial (combined factor)

The division of fetal developmental anomalies into types is quite arbitrary, because in the vast majority of cases, developmental delays are a combination of hereditary and congenital factors.

Classification of fetal malformations

The most common malformations of intrauterine development of the fetus:

Aplasia (absence of any organ);
Dystopia (location of an organ in an uncharacteristic place);
Ectopia (displacement of an organ outward or into an adjacent body cavity);
Hypotrophy, hypoplasia (decreased fetal body weight, underdevelopment);
Hypertrophy, hyperplasia (increase in the size of any organ);
Atresia (closure of natural openings);
Fusion of paired organs;
Stenosis (narrowing of the canals and openings of the fetal organs);
Gigantism (enlargement of the body and internal organs fruit size);
Dyschronia (acceleration or inhibition of development of processes).

I would like to note that the severity of pathologies can be completely different. This depends on the location of the genetic defect, as well as on the duration and intensity of the toxic effect on the fetus. There is no clear relationship between them.

A woman who has been exposed to toxicity during pregnancy may give birth absolutely healthy child. At the same time, the risk of developmental delays in the future offspring of this fetus remains, as a consequence of genetic damage with the absence of clinical manifestations.

Causes of fetal malformations

The issue of studying pathologies of fetal development is very diverse. This topic is dealt with by specialists different levels and areas - geneticists, embryologists, neonatologists, prenatal diagnostics specialists.

Understanding the reasons for the appearance of CDF is sometimes not so easy. Deviations in the chromosome set of one or both parents lead to the birth of a child with diseases such as Down syndrome, Patau syndrome, Edwards syndrome, hemophilia, color blindness, etc.

The cause of hereditary pathologies is a gene mutation. The appearance of congenital anomalies is caused by various adverse effects on the fetal organs during pregnancy, especially during critical periods of its development. Factors that cause congenital malformation are called teratogenic.

The most studied teratogenic factors:

medications (taking medications prohibited during pregnancy or during a certain period of pregnancy);
infectious (measles, chicken pox transmitted from mother to fetus);
ionizing radiation (x-rays, radioactive radiation);
alcohol factor (taken by a pregnant woman large quantity alcohol can lead to severe alcohol syndrome in the fetus, incompatible with life);
nicotine factor (smoking during pregnancy can cause developmental delays in the child);
toxic and chemical (women working in hazardous industries should avoid contact with aggressive chemicals and toxic substances several months before pregnancy and for its entire duration in order to avoid a teratogenic effect in the fetus);
lack of vitamins and microelements (lack of folic acid and polyunsaturated acids Omega-3, proteins, iodine, lack balanced nutrition can lead to delays in fetal development and brain dysfunction).

Often in the appearance of congenital malformation of the fetus big role Hereditary predisposition plays a role. If the parents or close relatives of the child have congenital malformations, then the risk of giving birth to a child with the same defects increases many times.

Critical periods of fetal development

Intrauterine development of the fetus lasts on average 38-42 weeks. All this time, the fetus is well protected from external factors by the placental barrier and immune system mother. But there are 3 critical periods during which it is very vulnerable to harmful agents. Therefore, at this time, a pregnant woman should especially take care of herself.

First critical period occurs approximately 7-8 days after fertilization, when the embryo goes through the stage of implantation into the uterus. Next dangerous period- from 3 to 7 and from 9 to 12 weeks of pregnancy, when the placenta is formed. Illness, chemical or radiation exposure to a pregnant woman during these periods can lead to intrauterine malformations of the fetus.

The third critical period of pregnancy is 18-22 weeks, when the formation of neural connections in the brain occurs and the hematopoietic system begins its work. This period is associated with delayed mental development of the fetus.

Risk factors for fetal anomalies

Risk factors for congenital malformation on the maternal side:

age over 35 years - delay intrauterine development, genetic disorders;
age under 16 years - prematurity, lack of vitamins and microelements;
short social status- infections, fetal hypoxia, prematurity, intrauterine growth retardation;
lack of folic acid - congenital malformations of the nervous system;
consumption of alcohol, drugs and smoking - intrauterine growth retardation, syndrome sudden death, fetal alcohol syndrome;
infections (chickenpox, rubella, herpetic infections, toxoplasmosis) - congenital malformation, intrauterine growth retardation, pneumonia, encephalopathy;
arterial hypertension - intrauterine growth retardation, asphyxia;
polyhydramnios - congenital malformations of the central nervous system, gastrointestinal tract and kidney pathologies;
diseases thyroid gland- hypothyroidism, thyrotoxicosis, goiter;
kidney diseases - intrauterine growth retardation, nephropathy, stillbirth;
diseases of the lungs and heart - congenital heart defects, intrauterine growth retardation, prematurity;
anemia - intrauterine growth retardation, stillbirth;
bleeding - anemia, prematurity, stillbirth

Risk factors for congenital malformation from the fetus:

anomalies of fetal presentation - hemorrhage, congenital malformations, trauma;
multiple pregnancy - fetofetal transfusion, asphyxia, prematurity;
intrauterine growth retardation - stillbirth, congenital malformations, asphyxia,
Risk factors during delivery:
premature birth - fraught with the development of asphyxia;
late birth (delay of birth by 2 weeks or more) - possible development of asphyxia or stillbirth;
long labor - asphyxia, stillbirth;
prolapse of the umbilical cord - asphyxia.

Abnormalities of placenta development:

small placenta - intrauterine growth retardation;
large placenta - development of fetal hydrops, heart failure;
premature placental abruption - possible large blood loss, development of anemia;
Placenta previa is fraught with blood loss and the development of anemia.

Diagnosis of fetal malformations

Prenatal diagnosis of fetal developmental anomalies and genetic pathologies is a very complex process. One of the stages of this diagnosis is screening examinations prescribed to a pregnant woman at 10-12, 20-22 and 30-32 weeks (in each trimester). This test is a blood test for biochemical serum markers of chromosomal pathology (developmental defects).

This will allow us to make an assumption about the presence or absence of the fetus chromosomal abnormalities, and performing an ultrasound is like additional method diagnostics will show whether there are deviations in physical development fetus Ultrasound must be performed by a highly qualified specialist and using high-quality equipment. The results of each study are assessed jointly, without breaking with each other.

Screening does not guarantee one hundred percent pathology; it only allows one to identify a high-risk group among pregnant women. This is an important and necessary measure and, despite its voluntary nature, most expectant mothers understand this. There are often cases when specialists find it difficult to answer the question about the presence of genetic defects in the fetus. Then, depending on the trimester of pregnancy, the patient is prescribed invasive methods research:

(chorionic villus study)

It is done in the 1st trimester of pregnancy (11-12 weeks) and allows you to identify genetic abnormalities of fetal development.

amniocentesis (examination of the anatomical fluid in which the fetus is located)

In 1st trimester this analysis reveals hyperplasia of the adrenal cortex, in 2 - diseases of the central nervous system, chromosomal pathologies.

placentocentesis (examination of placental particles)

Performed from 12 to 22 weeks of pregnancy to identify genetic pathologies.

(blood collection from the fetal umbilical cord)

Allows you to identify the susceptibility of the fetus to genetic or infectious diseases.

Pregnant women are referred for mandatory consultation with a geneticist:

whose age exceeds 35 years;
having a child or children with genetic disorders;
have a history of miscarriages, undeveloped pregnancy, stillbirth;
whose family has relatives with Down syndrome and other chromosomal abnormalities;
recovered from viral diseases in the 1st trimester of pregnancy;
taking medications prohibited during pregnancy;
exposed to radiation.

To diagnose fetal pathologies after birth, they are used following methods research: tests of blood, urine and other biological fluids, X-rays, computed tomography and magnetic resonance imaging, ultrasound, angiography, bronchial and gastroscopy, other immune and molecular methods...

Indications for termination of pregnancy

Any detection of congenital malformation of the fetus presupposes a proposal to terminate the pregnancy according to the so-called medical indications. If a woman refuses this and decides to keep the child, she is taken under special control and monitor the pregnancy more carefully.

But to the expectant mother it should be understood that not only her feelings and experiences are important here, but also the fact that children born with serious defects and pathologies often turn out to be unviable or remain deeply disabled for life, which, of course, is very difficult for any family.

There are other indications for termination of pregnancy:

malignant neoplasms (pregnancy with cancer contraindicated);
diseases of the cardiovascular system (heart defects, deep vein thrombosis, thromboembolism);
neurological diseases ( multiple sclerosis, myasthenia gravis);
infectious diseases( , V active form, in the acute and severe stage, );
diseases of the blood and hematopoietic organs (hemoglobinopathy, aplastic anemia, leukemia);
eye diseases (diseases of the optic nerve and retina);
kidney diseases ( urolithiasis disease V acute form and with large stones, acute);
diffuse connective tissue diseases;
endocrine disorders (thyrotoxicosis, uncompensated hypothyroidism in severe forms);
some gynecological diseases;
obstetric indications (refractory to therapy and severe, accompanied by severe vomiting, gestational trophoblastic disease, severe hereditary diseases detected during pregnancy, etc.)

Abortion for medical reasons is carried out only with the consent of the patient.

Prevention of congenital malformations of the fetus

The main measure aimed at preventing the occurrence of congenital malformation of the fetus is pregnancy planning. From quality training Not only the success of conception may depend, but also the process of carrying a pregnancy, quick and correct delivery and the health of the mother and child in the future.

Before planning a pregnancy, it is necessary to undergo a number of examinations: take tests for (STDs), HIV, hepatitis, syphilis, check blood clotting, hormonal status, sanitation of the oral cavity, do an ultrasound of the pelvic organs to exclude inflammatory diseases and neoplasms, visit a therapist to identify all possible chronic diseases, ideally undergo genetic testing for both parents.

The key point in the prevention of congenital anomalies of the fetus is maintaining a healthy lifestyle, avoiding bad habits, balanced and good nutrition, eliminating the impact on your body of any negative and harmful factors. During pregnancy, it is important to treat everything in a timely manner possible diseases and follow the instructions of the obstetrician-gynecologist.

Treatment of congenital malformation of the fetus

Treatment options for congenital malformations of the fetus vary greatly depending on the nature and severity of the anomaly. Statistics on this problem, unfortunately, are not reassuring. A quarter of children with congenital anomalies die within the first year of life.

While the baby is in the womb, the woman undergoes a lot of research. It is worth noting that some tests for fetal pathology can reveal a lot of diseases that cannot be treated. This is exactly what this article will discuss. You will learn how fetal pathology is diagnosed during pregnancy (tests and additional research). Also find out what the normal results of a particular examination should be.

Tests for fetal pathology

Almost every two weeks, the expectant mother has to undergo tests: blood, urine, flora smear and others. However, these studies do not show the baby’s condition in any way. Tests for fetal pathology are taken 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 indicated only for those women whose first results were not very good. It is worth noting that this only applies to blood tests. Ultrasound for fetal pathology) is carried out in the second and third trimesters.

Who is assigned to the study?

Every expectant mother can be tested for chromosomal pathologies of the fetus in the first trimester. However, there are categories of women to whom this diagnosis is prescribed without their desire. These groups of persons include the following:

women whose age is over 35 years;
if parents - blood relatives;
those expectant mothers who have already had pathological pregnancies or premature births;
women who have children with various genetic pathologies;
expectant mothers with long-term debt or those who 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 abnormalities. Many pregnant women avoid such tests. If you are sure that under any circumstances you will not terminate the pregnancy, then feel free to write a refusal of diagnosis. However, before doing so, weigh the pros and cons.

When is fetal pathology diagnosed?

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

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

Ultrasound diagnostics to identify pathologies is carried out at 11-13 weeks, 19-23 weeks, 32-35 weeks.

What research reveals

Analysis for fetal pathology (deciphering will be presented below) allows us to identify the likelihood of the following diseases in the baby:

and Down.
Patau and de Lange syndrome.
Disturbances in the work and structure of the cardiac system.
Various neural tube defects.

Remember that the test result is not a final diagnosis. The decoding must be carried out by a geneticist. Only after consultation with a specialist can we talk about the presence or absence of a likelihood of pathology in the baby.

Blood examination for pathology

Some preparation is required before diagnosis. For several days, it is recommended to give up fatty foods, smoked sausages and meat products, as well as large amounts of spices and salt. You also need to exclude possible allergens from your diet: chocolate, eggs, citrus fruits, red vegetables and fruits. Immediately on the day of sampling, you should refuse any food intake. You can drink water no later than four hours before blood sampling.

Testing for fetal pathology is quite simple. You just need to expose the elbow bend of your arm and relax. The laboratory technician will draw blood and send you home.

How is a blood test performed?

Doctors carefully examine the obtained material. This takes into account the woman’s age, weight and height. Laboratory assistants study chromosomes that are in the blood. In case of some deviations from the norm, the result is entered into the computer. After this, computer technology issues a conclusion that states the probability of a particular disease.

During the first screening, diagnosis is carried out on two levels. Later, in the second trimester, laboratory technicians examine three to five substances. Within 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, only a geneticist can make a final diagnosis. However, your gynecologist can also provide an interpretation of the result. What are the norms for test results? It all depends on the stage of pregnancy and the level human chorionic gonadotropin in the woman’s blood at the time of the study.

Weeks of pregnancy	Protein PAPP	Human chorionic gonadotropin
	From 0.32 to 2.42	From 20000 to 95000
	From 0.46 to 3.73	From 20000 to 90000
	From 0.7 to 4.76	From 20000 to 95000
	From 1.03 to 6.01	From 15000 to 60000

In the second trimester, the following indicators are still assessed: Inhibin A, Placental lactogen and Unconjugated estriol. After computer calculations, a result is produced that 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 obtained value is lower than 1 in 400, then the expectant mother is offered to undergo additional research.

Ultrasound diagnostics on pathology

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

In the second trimester ultrasound diagnostics allows you to identify pathologies of the cardiac system, brain and other organs. During this period, the child is already quite large and you can clearly see all of him.

Additional diagnostics

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

If the likelihood of pathology is confirmed, then the expectant mother is offered. However, the final decision always remains with the woman.

Summarizing

So now you know which ones exist diagnostic measures to identify pathologies in the unborn baby. Complete all tests on time and always listen to your doctor’s recommendations. Only in this case can you be sure that your child is completely healthy and has no abnormalities.

There is one belief: in order for pregnancy to proceed normally, you need to knit a small child's item, for example a beret. A pattern for a beret can be found in a craft magazine. You can also buy already ready product. Good test results and a pleasant pregnancy!

It is very difficult for parents to hear that their child has been diagnosed with developmental disabilities. This information often becomes known during prenatal diagnosis. As a rule, the family experiences severe psychological shock, but what’s even worse is that parents often begin to blame themselves for what happened, not hoping that they will ever be able to give birth to a healthy child. Why do birth defects occur, and what next for children with developmental defects?

First of all, you need to know: a child with congenital defects can be born in any family, even young and healthy parents. The frequency of these cases reaches 5% according to statistics. Identification of the causes of congenital malformations of the fetus (CHD) is one of the most important tasks medicine, but at the same time it must be said that so far not all of them have been studied and classified. Up to 50% of pathologies cannot be associated with any specific cause. However big job in this regard has already been produced.

Developmental defects (anomalies, defects) are considered to be functional and structural deviations from the norm. The most severe defects include:

Congenital heart defects;
Neural tube defects;
Down syndrome.

Fetal malformations: causes

All congenital malformations can be divided into two large groups: hereditary (gene mutations) and acquired during intrauterine development. Often, both of these factors can affect the occurrence of congenital malformation, and such causes are called multifactorial.

According to the severity, fetal anomalies can be classified as moderately severe (those that require treatment, but do not threaten the life of the child), severe - requiring immediate treatment, and fatal, incompatible with life.

Most congenital malformations occur during the first trimester. Gametopathies are the result of mutations in germ cells or abnormalities of sperm and eggs. Blastopathy develops during the first two weeks after fertilization. Embryopathies are the most common pathologies and occur between 2 and 8 weeks of pregnancy. Finally, fetopathy can occur after 9 weeks - for example, cryptorchidism or organ hypoplasia.

Fetal malformations can affect one organ or several at the same time. Systemic disturbances include anomalies respiratory system, nervous, cardiovascular, musculoskeletal, reproductive, urinary and digestive systems. Defects such as defects of the face, eyes, ears, neck, palate and lips are divided into separate groups.

Is it possible to assume in advance that the child may have congenital malformation? There are risk groups that include the following categories of parents:

Families in which children with congenital malformation have already been born;
Families where parents have blood relatives with congenital malformation;
Parents' age is over 35 years for women and 50 years for men;
Consanguinity between parents;
Exposure to teratogenic factors (living in an environmentally unfavorable place, radiation, working in hazardous industries).

Teratogenic causes of fetal malformations are extremely extensive - there are at least four hundred of them. All parents, without exception, know about the dangers of drug addiction, alcoholism and smoking during pregnancy, but the causes of congenital malformation are not limited to these points.

One of the very hazardous factors impacts are viral diseases suffered by a woman in the first trimester of pregnancy. This is especially true for the rubella virus. Unfortunately, in some cases, the fetus may experience irreversible changes that are not life-threatening.

Reception medicines(especially hormonal) in the first trimester can also be extremely dangerous, so doctors never tire of warning that any treatment during this period should only be carried out under the supervision of a doctor.

Endocrine disorders in the mother, including diabetes mellitus, are also at risk. Irradiation (radiation, x-rays) in some cases can cause fetal development abnormalities, and that is why such examinations in the first trimester are carried out only for health reasons and under reliable protection.

Living in an environmentally unfavorable area - near mines, metallurgical enterprises and similar places - poses a great danger to the development of a child. In addition, anomalies in the development of the fetal cardiovascular system are also found in women living in high mountains with thin air. Injuries and falls incorrect position fetus, the presence of tumors can affect the blood supply to the fetus and cause congenital birth defects.

Maternal nutrition can also have an impact on the occurrence of fetal malformations - for example, folic acid deficiency has been proven to increase the risk of neural tube developmental abnormalities in the child. Finally, the child’s father’s work in hazardous work can lead to sperm abnormalities, which is also one of the causes of congenital malformation.

What to do if a child has a developmental defect

We have already spoken about the shock that invariably befalls parents at this news. But you need to try to deal with it quickly - perhaps with the help of specialists. If the pathologies are incompatible with life and the timing allows for termination of the pregnancy, doctors will immediately say so.

The life of children with fetal developmental defects largely depends on the timeliness measures taken. Today, even the most complex defects are successfully operated on, and operations are often carried out in the first days of life. A number of defects allow you to postpone surgery or even undergo it altogether. conservative treatment. Parents should try to collect maximum amount information about this disease in order to know all its symptoms and treatment features. Of course, such babies will be under constant medical supervision and undergo regular examinations. There are a number of dietary and physical activity restrictions that your pediatrician will tell you about.

Pregnancy is a period of increased stress on female body. Not everyone approaches this consciously and engages in planning and preparation. The state of health before conception affects subsequent gestation. Various disorders can cause pregnancy pathologies and disrupt its normal course.

The expectant mother is responsible for her condition and the health of the child. Abnormalities in the mother's body can affect the development of the fetus, the formation of the placenta and the maintenance of pregnancy progression.

The reasons why pathological pregnancy develops can be divided into several groups:

Diseases of internal organs that existed before conception.
Acute somatic and infectious diseases that develop during pregnancy.
Bad habits of the expectant mother.
Use of certain medications.
Genetic predisposition.
Environmental influence, harmful conditions work.

Often there is a combination of several factors. But it is not always possible to say exactly what led to the development of pathologies.

Main symptoms

It is sometimes difficult to suspect the development of pathology during pregnancy. Carrying a child is accompanied by hormonal changes and changes in the functioning of all systems. Therefore, it is often taken for a violation physiological processes, occurring in the body of a pregnant woman.

So as not to miss pathological symptoms During pregnancy, you need to listen to your body and tell your doctor about any changes. And he will decide how serious it is.

Symptoms of pathology during pregnancy may include a change in the nature of the discharge:

the appearance of an unpleasant odor;
bloody at any stage of pregnancy;
liquid and transparent in the third trimester;
impurities of yellow pus;
white discharge resembling cottage cheese.

Changes in well-being are also associated with pregnancy pathology. Slight dizziness, especially when changing body position, nausea can bother a young mother. But a constant feeling of objects rotating, unsteady gait, flickering spots before the eyes, and headache are signs of impaired blood circulation in the brain.

Pregnant women often feel pain in various locations. It appears after a long walk in the lower back and legs, after a long standing. On later cramping pain in the lower abdomen indicates that the uterus is gradually preparing for. You should immediately consult a doctor if you experience acute abdominal pain, regardless of the duration. Its combination with tachycardia, cold sweat, dizziness, etc. is especially dangerous.

An alarming symptom are, especially hidden ones, which are accompanied by a sharp set excess weight. At the end of the day, in the last stages, your legs may swell; after rest, this condition should go away. If swelling persists after a night's sleep, be sure to inform your doctor.

A warning sign pathological pregnancy is a change in fetal activity. If the child freezes or, on the contrary, pushes too actively, then this is evidence of his intrauterine suffering.

When do risks increase?

During fetal development, there are periods of time that are critical. Exposure to pathogenic factors can lead to the death of the embryo and disruption of the formation of internal organs. The first such critical period is considered to be the first 2 weeks of development. If damage occurs to the embryo, in most cases it dies, spontaneous interruption pregnancy.

The second critical period is the period from 4 to 12 weeks of development. This is the period of time during which internal organs are formed. Exposure to pathological factors leads to severe defects.

The third critical period lasts from 12 weeks until birth. The main organs continue to mature, and their fine differentiation occurs. The development of the brain, teeth, genitals and lungs is not complete. Gross defects can form in them. The remaining organs undergo secondary malformations under the influence of inflammatory reactions.

Common pathologies during pregnancy

If a woman is planning to conceive, then several months before the expected date it is recommended to undergo examination and treat infectious and somatic diseases, to achieve stable remission of chronic diseases. This will reduce the chances of various complications occurring.

Toxicosis and gestosis

The first trimester of pregnancy is characterized by development. This condition is manifested by nausea of varying intensity and vomiting. At mild degree attacks appear in the morning, on an empty stomach. Vomiting may occur several times during the day.

Severe toxicosis violates general state pregnant woman, tachycardia, fall blood pressure. Vomiting can occur up to 10-15 times a day. Some people experience yellowing of the sclera of the eyes, decreased urine output and stool retention. Such women should undergo hospital treatment.

Malpresentation of the fetus

In the first and second trimester, the position of the fetus does not matter. By the time of birth, he should be in an occipital presentation - this means that the baby lies head down, and the back of the head is the point that will move forward during labor. Changing the position of the fetus leads to disruption of the biomechanism of labor.

Sometimes, by the time of birth, the child remains in. This means that the legs and buttocks will be the first to move through the birth canal. Such labor may last longer, because normally the head pushes the tissues wide apart, and rear end the torso can pass through unhindered.

The most severe pathological posture is the extensor head position, in which the child throws his head back, the chin being born first. Transverse position corrected by turning the fetus on its leg before birth.

Placenta previa

Normally, the placenta is attached to the wall of the uterus at the back, front, or fundus. They speak of its presentation when the fetal place is located in the lower part of the uterus and covers the internal os. This arrangement makes the process of childbirth impossible. naturally: when the cervix opens in the first stage of labor due to tissue tension, the placenta will begin to separate from the walls, massive bleeding will begin, which will end with detachment and death of the fetus.

Throughout pregnancy, there is a threat of bleeding, even at the time of examination on the gynecological chair. Therefore, women with diagnosed pathology need increased attention and hospitalization for spotting bloody discharge from the genital tract.

The cause of improper attachment of the placenta may be abnormalities in the structure of the uterus, the presence of myomatous nodes, and endometritis. Sometimes the cause of the pathology remains unknown. Delivery at full presentation placenta is only possible through .

Eclampsia

Severe gestosis can progress to an extreme state -. Pathology can develop during pregnancy, childbirth and the early postpartum period.

To the symptoms severe gestosis convulsions occur, the duration of seizures is 1-2 minutes. After which consciousness is restored, but the woman does not remember anything, feels extremely tired, complains of headache. Another option for recovering from an attack may be coma.

A poor prognosis is associated with the following conditions:

cerebral edema;
hemorrhage in the brain structures;
a sharp increase in temperature;
tachycardia;
yellowness of the skin;
uncoordinated movements of the eyeballs;
decreased urine output.

Treatment is carried out jointly with resuscitators in the intensive care unit. Its main directions are the relief and prevention of seizures, restoration of the function of vital internal organs. Within 2-3 hours, early delivery is carried out by caesarean section: Eclampsia is a pathology caused by pregnancy, therefore childbirth is the only correct etiological treatment.

Hypertonicity of the uterus

A high level of progesterone in a pregnant woman prevents an increase in uterine tone. Muscle contraction at any time can lead to spontaneous miscarriage. It is dangerous in the early stages, it is accompanied by vasospasm, and the child does not receive enough oxygenated blood and nutrients. This leads to intrauterine growth retardation.

In the later stages, it is important not to confuse hypertonicity with training contractions. The pathology is characterized by the following signs:

pain in the lower abdomen, feeling of tension;
change in the shape of the abdomen;
the uterus becomes very hard to the touch.

Extragenital pathology

What pathologies are there that can affect the course of pregnancy? Any disease of internal organs can lead to complications:

diseases of the digestive tract interfere with the absorption of iron, which causes anemia;
Arterial hypertension before pregnancy becomes more severe and can lead to gestosis and kidney disease;
the course worsens diabetes mellitus, it can also lead to the development of preeclampsia, congenital diabetes in a child;
Hypothyroidism disrupts the normal progression of pregnancy and creates a threat of miscarriage.

Infectious diseases, regardless of location, can lead to intrauterine infection fetus Matter as acute diseases(ARVI, pneumonia, diseases of the genitourinary system), and chronic (bronchitis, caries, cystitis, sinusitis, etc.). Infection with rubella, toxoplasmosis, and cytomegalovirus in the first trimester of pregnancy leads to severe malformations, often incompatible with life.

Fetal pathologies

The condition of the child directly depends on the course of pregnancy and the health of the mother. Prevent development pathological conditions not always possible. Congenital anomalies and genetic disorders cannot be corrected; they are often inherited. Some congenital syndromes are a consequence of the aging of the mother's body and the influence of unfavorable factors. For example, with age, the risk of having a child with.

Sometimes future parents are carriers of a recessive (dormant) gene congenital syndrome. When two recessive traits are combined in one child, Clinical signs hereditary pathology.

Some developmental defects require surgical treatment in the first few days after birth. For example, atresia, or obstruction of the anus, an incomplete esophagus that does not connect to the stomach, a violation of the formation of the urethra.

Non-union upper lip and cleft soft palate The operation is performed some time after birth in several stages.

The expectant mother has the power to prevent the development intrauterine infection The child has. To do this, you need to avoid infection yourself and promptly treat existing diseases.

Prevention

It is possible to prevent the development of pathology during pregnancy if you plan for its occurrence. Spouses can be examined for infections, and if they are detected, receive treatment.

Many chronic diseases have long been no longer a contraindication for pregnancy. But they need to be controlled, to lead a lifestyle that will not allow diseases to worsen.

Helps prevent pathologies during pregnancy healthy image life and proper nutrition pregnant. You cannot torture yourself with diets during this period of life. The diet should be balanced and contain sufficient amounts of vitamins, minerals and nutrients.

It is not for nothing that pregnant women undergo a multi-stage examination when registering. This is a way to determine the initial level of health in order to anticipate the possibility of the formation of pathologies. After such an examination, as well as taking into account the presence and course of previous pregnancies, the woman’s lifestyle, the doctor can identify a risk group for the development of complications. This is necessary for timely prevention of the progression of unfavorable conditions.