In addition to pregnancy-specific minor disorders and health problems, women should know what is normal and what is not during pregnancy, and know about the health services available to them. for emergency use.
2.1 Anemia, 2.2 Gestational hypertension, 2.3 Gestational diabetes
3.1 Sciatica, 3.2 Metrorrhagia, 3.3 Premature rupture of membranes, 3.4 Threat of preterm birth, 3.5 Delay in intrauterine growth, 3.6 Fetal death, 3.7 Chronologically prolonged gestation
Recognition of the following signs promotes early diagnosis of pregnancy-related health problems:
- Metrorrhagia - Genital bleeding similar to menstruation.
- Intense abdominal pain that does not give up at rest.
- Regular and intense contractions before the 37th week of gestation.
- Absence of perception of fetal movements, during one day, starting from the 6th month.
- Exaggerated tiredness and drowning after small efforts.
- Loss of fluid through the vagina.
- Changes in flow (color, odor or quantity) and discomfort or vulvovaginal itching.
- More than 38oC fever.
- Persistent migraine that does not give in with painkillers or physical measures.
- Urinary discomfort.
- Intense diarrhea.
- Pain or inflammation of a varicella.
- Persistent swelling of feet, hands and face.
- Persistent vomiting
- Alteration of vision.
- Absence of perception of fetal movements from the 5th month onwards.
Metrorrhagia is a genital hemorrhage similar to menstruation. During the first trimester, metrorrhagia usually indicates a gestational anomaly, such as a threat of abortion or an ectopic pregnancy. It is important to make a clinical and ultrasound diagnosis.
Abortion is the expulsion or removal of the mother of a fetus or embryo weighing less than 500 g (or less than 22 full weeks of gestation), whether or not there are signs of life and the abortion has been spontaneous or provoking.
In general, about 15% of pregnancies in western countries end in miscarriage, so it is a relatively common occurrence in women with no health problems. In most cases, the cause is unknown, although they may be ovular or maternal. Ovules are linked to chromosomal alterations or malformations of the embryo, placenta abnormalities, or hormonal disorders. Maternity is due to maternal illness, teratogen exposure, or uterine problems.
The following situations are considered:
- Voluntary interruption of pregnancy (IVE). The legislation on the IVE is very variable of a country to another, even inside the European Union. In Spain, Organic Law 2/2010, of March 3, on sexual and reproductive health regulates the IVE and specifies:
"Article 14. Interruption of pregnancy at the woman's request.
Pregnancy may be interrupted within the first fourteen weeks of pregnancy at the request of the pregnant woman, provided the following requirements are met:
a) The pregnant woman has been informed of the rights, benefits and public support for maternity support, in the terms established in sections 2 and 4 of article 17 of this Law.
b) A period of at least three days has elapsed, from the information mentioned in the previous paragraph and the completion of the intervention.
Article 15. Interruption for medical reasons.
Exceptionally, pregnancy can be interrupted for medical reasons if any of the following circumstances occur:
a) Not more than twenty-two weeks of gestation and whenever there is a serious risk to the life or health of the pregnant woman and so recorded in a ruling issued before the intervention by a different specialist doctor of the one who practices or directs it. In the event of an emergency due to the vital risk to the pregnant woman, the opinion may be dispensed with.
b) That the twenty-two weeks of gestation are not exceeded and provided that there is a risk of serious abnormalities in the fetus and this is stated in an opinion issued prior to the intervention by two specialist doctors other than the one who practices or directs it. .
c) When fetal abnormalities incompatible with life are detected and this is stated in an opinion issued previously by a specialist doctor, other than the one performing the intervention, or when an extremely serious and incurable disease is detected in the fetus at the time of the diagnosis and confirmed by a clinical committee. "
The IVE can be done by surgical or medical techniques. Surgical techniques include uterine aspiration and uterine scraping (both of which are aimed at emptying the uterine cavity). Medical techniques include the administration of two drugs: mifepristone, which terminates the pregnancy, and misoprostol, which causes its expulsion. The choice of one or another technique depends on such criteria as: the professional criterion, the time of pregnancy and the preference of the woman.
- Threat of abortion. There is intermittent hemorrhage of red or brown blood, intermittent and usually scarce, accompanied or not pain, without dilation of the cervix. An ultrasound can confirm the presence of the embryo and fetal heartbeat. There is no consensus as to the conduct or treatment of the threat of abortion, however, rest, sexual abstinence, and expectant behavior are generally recommended, but these tips have not been shown to prevent abortion. It is recommended to have an ultrasound scan in a few days.
- Ongoing abortion. Genital hemorrhage is accompanied by abdominal or lumbar pain, with dilation of the cervix. You can be expectant and wait for a complete abortion or decide to go to the hospital for anesthesia.
- Complete abortion. The entire uterine contents are expelled: egg, membranes and placenta. Hemorrhage and pain end spontaneously. The cervix closes and the uterus returns to its size.
- Delayed abortion. It is the interruption of gestation without the expulsion of the embryo. It is ultrasound diagnosed by the absence of the fetal heartbeat and the stagnation in the growth of the embryo. Behavior can be expectant or require medical or surgical treatment.
Management of miscarriage
Handling can be expectant (let the abortion process follow its natural course, without interfering with medication or surgery) or with pharmacological or surgical treatment.
The doctors will tell you what the different options are
It must be borne in mind that the woman who has an abortion, whether it is provoked or spontaneous, suffers a loss and has to go through a process of mourning. It is necessary to respect the process ofacceptance of the lossEncourage the woman and the couple to express their feelings, if they have one, and provide her with good professional guidance on therapeutic alternatives.
There is no evidence that the woman who has an abortion has to wait a while before she can become pregnant again.
Ectopic gestation is the one that occurs outside the uterine cavity. 95% of these pregnancies occur in the fallopian tubes.
Es manifest with the signs and symptoms typical of pregnancy, scarce genital bleeding and general abdominal pain. In the most severe cases, the compromised tube may rupture, lead to severe bleeding, and acute pain.
The doctors will explain the different treatment options in the case of a diagnosis of ectopic pregnancy.
Although nausea and vomiting They are common until the 16th week of gestation in most pregnant women, and severe hyperemia is a syndrome characterized by:
- persistent nausea and vomiting,
- intolerance to liquid and solid foods,
- weight loss,
- renal impairment.
In the most severe cases, a hospital admission is required.
Twin or multiple pregnancies are more likely to suffer from this complication, although they are also associated with psycho-emotional factors and maternal stress. Apart from medical treatment to correct dehydration, the woman's feelings and mental state must be explored; psychological and emotional support for women and families is often the basis for solving the problem.
There are different types of anemia but the most common is ferropenic anemia. Hemoglobin values below 9 g / dl are considered severe anemia and in this case gestation is high risk. According to the World Health Organization (WHO), pregnancy anemia is the hemoglobin concentration in the mother's blood below 11 g / dl. The physiological anemia of the pregnancy is considered the one with hemoglobin values up to 11mg / dl, 34% hematocrit and 3.200.000 red blood cells. The physiological anemia of gestation is due to different factors:
- Increased blood volume, especially between the 2nd and 3rd month, which causes the blood iron to become thinner.
- Increased iron and folate consumption, which are directly involved in iron uptake, due to an increased number of erythrocytes and fetal growth, especially after the second half of pregnancy.
- Alteration in the gastric absorption of iron.
Often, the pregnant woman suffering from anemia manifests symptoms, such as palpitations, tiredness, pallor, dizziness, etc., which can be confused with the typical manifestations of pregnancy. That is why it is important to confirm the suspicion of anemia with a test. The diagnosis is usually made from the second trimester analysis; Once you have been diagnosed with ferropenic anemia, it is especially important to follow a diet with iron and folic acid supplements and follow the dietary recommendations to ensure its absorption.
A anemia during pregnancy increases the risk of abortion, prematurity, perinatal death and postpartum infections.
It is hypertension (HTA) that is diagnosed during pregnancy in women with previous normal blood pressure (TA).
HTA is considered when values greater than or equal to 140 mmHG of systolic (maximum) and 90 diastolic (minimum) TA are obtained after 20 weeks of gestation and in two separate shots for a minimum of four hours.
More severe HG increases the risk of prematurity and severe maternal and fetal complications.
HG may present with varying degrees of severity.
- Gestational hypertension. Presents high values of TA associated or not with the presence of protein in the urine. It is the mildest HTA and only a specific gestation tracking, which a woman can do at home, is needed to control the TA and the presence of protein in the urine. You also need to adjust your diet and lifestyle.
- Mild preeclampsia. It presents high values of TA and a significant amount of protein in the urine in two strip strip determinations separated for a minimum of four hours.
- Severe preeclampsia. Presents TA values above 160/110 mmHg, with significant amount of protein in urine, platelet reduction, hemogram alteration, epigastric pain and neurological symptoms (headache, visual disturbances, etc.).
- Eclampsia. It presents all the signs and symptoms of the previous point, as well as seizures and coma.
Once HG is diagnosed, strict follow-up should be performed to monitor TA, blood and urine tests, and control of fetal well-being with RCTG, and in the most severe cases, hospitalization and the end of gestation are recommended.
Although HG is due to pregnancy-related factors, hygienic-diet measures (proper nutrition, exercise, stress management, and salt and alcohol consumption control) should also be applied to control HTA.
Gestational diabetes is the first diagnosis of gestation. It is usually asymptomatic and for this reason it is recommended that you take the O'Sullivan test (venous plasma glucose titration one hour after oral intake of 50g glucose) in all pregnant women in the 2nd trimester test. It is also advisable to test every pregnant woman over 35 with a family history of diabetes or a history of gestational diabetes in previous pregnancies and pregnant women with obesity (with a body mass index greater than 25).
In order to achieve good metabolic control, the pregnant woman needs to learn to control blood and urine sugar levels and to take good care of herself and exercise. In some cases, insulin treatment will be required.
In diabetes control, these should also be followed dietary recommendations specific.
We call sciatica the low back pain caused by compression of the sciatic nerve that starts in the buttock and can reach the heel. The weight of the gravid uterus involves modifications to the spine that can cause the nerve to pinch.
In most cases, symptoms improve with specific exercises (stretching, yoga, etc.), anti-inflammatory, and rest.
Genital hemorrhage in the third trimester is a serious problem that is usually associated with anomalous insertion of the placenta (previous placenta and variants) or a detachment of the placenta.
- Placenta previa. The placenta is inserted near or above the internal cervical orifice (OCI). OCI is a part of the cervix that is the output of the womb. Therefore, implantation of the placenta in this area may impede the natural outflow of the baby and lead to significant bleeding if the cervix begins to dilate. Thus, placental insertion is one of the aspects that is always sought in obstetric ultrasound. Bleeding from previous placenta usually does not produce pain.
- Detachment of placenta. In normal situations, the placenta gives off after the birth of the baby. One of the most serious problems that you may have is that the placenta breaks off before birth. This can result in the death of the baby and the mother. Detachment of the placenta may or may not be accompanied by genital bleeding, but there is always severe abdominal pain.
In both cases, hospitalization is required. If placenta previa is confirmed, the magnitude of the bleeding and gestational age should be assessed at the end of gestation or for admission to a high-risk obstetric unit. In the event of detachment of the placenta, an urgent cesarean section should be performed.
The fetus is in the amniotic bag, surrounded by amniotic fluid, until the end of pregnancy. The rupture of the bag may occur days or hours before or during delivery. When the rupture occurs before the pregnancy reaches completion, that is, at 37 weeks, it is considered a premature rupture of preterm membranes. The appearance of contractions or a maternal infection can cause this rupture, but in most cases the cause is unknown. RPM can sometimes be accompanied by contractions that the woman perceives as abdominal and lumbar discomfort. The discharge of amniotic fluid is very evident, that is, the woman notices getting wet, but this fact can be confused with the abundant vaginal discharge typical of the end of pregnancy. In this case, it is especially important to confirm the diagnosis of RPM with a specific biochemical test that detects the characteristics of the amniotic fluid, such as, for example, alkalinity. Keep in mind that RPM increases the risk of fetal and preterm birth infections.
The management of preterm PMR is different depending on the gestational age: in gestations before week 35 it is advisable to be hospitalized, to rest completely, to begin a treatment to mature the fetal lungs (administration of corticosteroids to the pregnant woman intramuscularly). ) and take a set of measures to address the threat of preterm birth. Antibiotic treatment is also indicated to prevent infection and, if RPM is accompanied by contractions, appropriate pharmacological treatment should be started to stop them.
From week 35 no measures are taken to stop the delivery if it is triggered.
Once the diagnosis is made, vaginal touches should be avoided because they increase the risk of infection, and you need to provide information on the entire process and the risks involved. The woman suffering from RPM is in a state of distress over the possibility of the premature birth of the child and all that this entails. You need to learn to observe the symptoms, such as abdominal and lower back pain, and the characteristics of amniotic fluid loss (quantity, color, and odor).
The threat of preterm birth (APP) is the appearance of contractions that produce cervical modifications before the end of gestation. The main risk for APP, if not made early diagnosis and specific treatment, is premature birth, which, depending on the gestational age, can lead to very serious problems for the baby due to its immaturity and even everything, death.
Types of prematurity:
- Extreme prematurity. Birth occurs between 20 and 27 weeks of gestation.
- Moderate prematurity. Birth occurs between 28 and 31 weeks of gestation.
- Mild prematurity. Birth occurs between 32 and 36 weeks of gestation.
From the 34th week of gestation, the risk of severe sequelae is reduced and the prognosis is improved.
APP has a very nonspecific symptomatology, such as abdominal pain, increased flow, lower back pain, etc .; Occasionally, it may be accompanied by amniotic fluid loss or hemorrhage.
If APP is confirmed, hospitalization is recommended, absolute rest, specific treatment to inhibit contractions, and other treatment to mature fetal lungs (administration of corticosteroids to the pregnant woman intramuscularly). Careful information should be given to the wife and family on the possibilities of life of the fetus and its consequences, according to gestational age.
One of the aspects that must be considered in the cases of APP is lung maturation. Pulmonary maturation involves administering corticosteroids to the pregnant woman intramuscularly to accelerate fetal lung maturation. Pulmonary maturation significantly reduces the risk of respiratory complications caused by prematurity. It also has beneficial effects on other fetal organs. Therefore, it is indicated in all women who are between the 24th and 34th weeks of gestation at risk of prematurity.
The fetus grows and matures as the gestation progresses. Ultrasound examinations take measurements of the fetus: of the femur and humerus, of the cephalic and abdominal perimeters, etc., to confirm their growth. On the third trimester ultrasound, fetal weight is estimated and compared with the estimated weight of tables with data classified by gestational age. A fetus with RCI is considered to be less than the 10th percentile for gestational age; statistically, only 10 in 100 fetuses of the same gestational age have this weight or less. There are different types of RCI according to fetal biometrics. The RCI may be caused by:
- Fetoplacental factors: placental insufficiency, multiple gestation or fetal disease.
- Fetal malformations.
- Maternal Factors: Severe malnutrition, drug or drug intake, or maternal illnesses (e.g., HTA).
In any case, it is important to evaluate fetal well-being with tests, with study of the fetoplacental circulation and with ultrasound monitoring. Depending on the result of the tests and the gestational age, the possibility of applying the treatments for fetal lung maturation and the end of gestation is evaluated.
Fetal death is one of the worst experiences a pregnant woman may have. Even if the woman is healthy, her gestation is normal and the obstetric team is well monitored, the fetus may die, due to known factors, such as cord choking, or unknown all after the autopsy. The reaction to this fact, both to the wife and to the family, depends on the moment of the loss and the reason; in general, the more advanced the pregnancy, the worse the experience.
In the cases of fetal death, gestation usually ends with induction of labor. It is recommended to accompany the mother during all stages of the grieving process, accept any kind of reaction, allow the expression of feelings and emotions, offer the possibility of enjoying an isolated space and allowing contact with the dead child.
This gestation is traditionally considered to be more than 42 weeks or 294 days. Studies from 2002 suggest that a small percentage of pregnancies can be past week 42 without the risk to the fetus. To consider gestation as prolonged presupposes that all babies should be born within a standard period of time without regard to individual differences; but there are genetic factors that influence the duration of gestation: family histories of prolonged gestations are common. Each intrauterine baby has an adequate gestation time, just as in infancy some infants hold their heads, sit or walk before others.
El amniotic fluid it diminishes as labor approaches and is considered physiological. There are no clear studies that determine sensitively the optimum amount of amniotic fluid a fetus must have at the end of pregnancy.
In order to diagnose a prolonged pregnancy, it is necessary to have an accurate pregnancy date. In the management of the GCP it is recommended to make the controls of fetal well-being let the pregnant woman and the professional agree. If spontaneous delivery does not occur, from week 42, the pregnant woman will have to be informed of the risks and benefits of the induction of labor and of expectant behavior in order to be able to make the decision that you consider most appropriate.