Changes in the nervous and humoral systems of a pregnant woman. Changes in the autonomic NS. How can you help

One of the key factors necessary for the successful bearing of a child is the emotional stability of the expectant mother. Surely every woman has heard more than once that it is impossible to be nervous during pregnancy, but why it is recommended to avoid stressful situations and what is the reason for such violent reactions to external stimuli, few people know. Today we will try to give answers to these questions, and also tell you how to avoid a nervous breakdown for a woman who is expecting a baby.

What causes increased nervousness in pregnant women?

In our lives, both big and small troubles happen. Expectant mothers react to such events very violently and emotionally, with tears and screams, and the scale of the problem usually does not matter. Even a broken nail can knock a woman off balance. Why are nervous breakdowns during pregnancy repeated with enviable regularity?

During the period of bearing a child, the female body undergoes significant changes. In particular, there is an intensive production of hormones necessary to ensure the normal development of the fetus. But if such changes are beneficial for the baby, then for the expectant mother, hormonal changes result in frequent mood swings and emotional vulnerability, due to which tears appear even for the most trifling reasons.

Why should pregnant women not be nervous and worried?

Despite the fact that a woman often begins to get nervous during pregnancy, physiological reasons, you can’t indulge in the variability of your mood. It turns out that frequent tantrums of the mother can be dangerous for the health of the unborn child. It has been scientifically proven that:

1. Severe stress, especially in the first trimester, can cause a miscarriage;
2. Women prone to nervous breakdowns are twice as likely to have children with malformations than those whose pregnancy proceeded against the background of emotional balance;
3. Excessive anxiety of the expectant mother can result in sleep disturbances in the child, which becomes an additional reason for worries;
4. Adrenaline, which is released into the blood during significant emotional stress, leads to vasoconstriction, as a result of which the baby begins to receive less oxygen and nutrients;
5. Excessive experiences during pregnancy increase the likelihood of developing heart pathologies in a child. The constant worries and fears of the expectant mother are accompanied by increased production of cortisol (the so-called stress hormone) in the body of the fetus. This hormone is responsible for the development of heart disease. vascular system. In addition to this, cortisol increases blood glucose levels and provokes oxygen starvation;
6. Nervous breakdowns during pregnancy can cause asymmetry in the location of the limbs, fingers and ears of the unborn baby;
7. Violations of the nervous system of the fetus, due to strong feelings of the mother, turn around negative consequences for the memory, thinking and perception of the child, up to mental disability;
8. If a woman is often nervous during pregnancy, this can provoke a change in the presentation of the fetus, which creates certain difficulties in the process of delivery;
9. Even during the period prenatal development the baby subtly feels everything that happens to the mother. Any emotions experienced by a woman during pregnancy will certainly affect the condition of the crumbs. Often worrying about trifles, the expectant mother runs the risk of giving birth to an overly excitable and shy or inattentive and inert child with a low level of self-control. Often, these babies require treatment with antidepressants;
10. An unstable emotional state in the later stages of gestation can provoke premature birth.

It is noteworthy that the effects of stress experienced by a pregnant woman will vary depending on the sex of the newborn. So, for a girl, strong feelings of the mother can turn into a rapid course of childbirth and the absence of a reflex cry at birth, and when carrying a boy emotional instability may lead to premature withdrawal amniotic fluid and the onset of labor.

How to stop being nervous during pregnancy?

We found out why pregnant women should not be nervous, but it is equally important to figure out how to avoid stressful situations and what to do with yourself when you really want to quarrel, quarrel with loved ones and burst into tears. All types of means to prevent a nervous breakdown can be divided into two groups: medications and distractions.

As for medicines, they can be used only after consulting a therapist or obstetrician-gynecologist. As a rule, pregnant women are prescribed light sedatives, including: Persen, Glycine, Magne B6, Novo-Passit. But besides taking medications, there are many other effective ways to help calm down, namely:

• Deep and even breathing is a long-known and extremely simple method to pull yourself together;
• Tea from mint, lemon balm, motherwort and valerian;
• Aromatherapy. Coniferous and citrus essential oils help to be less nervous during pregnancy;
• Moderate physical activity. Dancing, yoga, gymnastics for pregnant women and even a regular walk in the park will not only be an excellent prevention of stress, but will also help prepare the pelvic muscles for the upcoming birth;
• Meditation. To stop worrying about trifles, learn to control yourself. Just 10-15 minutes a day, spent in a calm and relaxed state, will help to cope with emotional stress.

Remember that nervous breakdowns during pregnancy do not bode well for you or your baby. Try to fence yourself off from negativity and get joy from every moment: very soon you will give life to a new person, and this is the greatest happiness.

The emergence and development of pregnancy is associated with the formation of a new functional mother-fetus system. The creation of the concept of the mother-fetus functional system made it possible to assess from new positions the whole variety of changes that take place in the body of the mother and fetus during a physiologically proceeding pregnancy.

As a result of numerous experimental and clinical studies, it has been established that changes in the state of the mother during pregnancy actively affect the development of the fetus. In turn, the condition of the fetus is not indifferent to the mother's body. At different periods of intrauterine development, numerous signals come from the fetus, which are perceived by the corresponding organs and systems of the mother's body and under the influence of which their activity changes. Therefore, under the name "functional mother-fetus system" is understood the totality of two independent organisms, united by the common goal of ensuring the correct, physiological development of the fetus. Therefore, all the activities of the maternal organism during pregnancy should be aimed at maximizing the normal growth of the fetus and maintaining necessary conditions that ensure its development according to a genetically encoded plan.

The main link between the mother and fetus is the placenta. However, this organ, which has both maternal and fetal origin, cannot be considered as an independent functional system. At a certain stage of development, the mother and fetus can exist independently of the placenta, but the placenta itself cannot exist outside the mother-fetus system. Nevertheless, the concept of "fetoplacental system" still exists in the literature.

For a more visual and detailed understanding of how the mother-fetus or mother-placenta-fetus system functions during a physiologically proceeding pregnancy, one should first of all separately consider the most important processes that take place in the mother's body, the placenta and the fetus's body, and then follow how they interact.

During a physiologically proceeding pregnancy, in connection with the development of the fetus and placenta in the mother's body, significant changes in the function of all the most important organs and systems are observed. These changes are of a pronounced adaptive nature and are aimed at creating optimal conditions for the growth and development of the fetus.

Endocrine system. The onset and development of pregnancy are accompanied by endocrine changes in the mother's body. The complexity of the changes is determined by the fact that the hormones of the placenta, as well as the fetus, have a great influence on the activity of the endocrine glands of the mother.

The anterior lobe of the pituitary gland increases during pregnancy by 2-3 times, while the mass of the adenohypophysis reaches 100 mg by the end of pregnancy. Histological examination of the anterior pituitary gland reveals large acidophilic cells, called "pregnancy cells". The nature of basophilic cells does not change significantly. It is believed that the appearance of "pregnancy cells" is due to the stimulating effect of sex steroid hormones of the placenta.

Morphological changes in the anterior pituitary gland affect the function of this organ. First of all, this is expressed in a sharp inhibition of the production of follicle-stimulating (FSH) and luteinizing (LH) hormones. Production of prolactin (Prl) during pregnancy, on the contrary, increases and increases by 5-10 times by the end of pregnancy compared with the indicators typical for non-pregnant women. In the postpartum period, the content of FSH and LH in the blood serum increases in parallel with the decrease in Prl production.

During a physiologically proceeding pregnancy, the content of somatotropic hormone (GH) in the blood is practically not changed, only at the end of pregnancy there is a slight increase in it.

There are significant changes in the production of thyroid-stimulating hormone (TSH). Already soon after the onset of pregnancy in the blood of the mother, an increase in its content is noted. In the future, as pregnancy progresses, it increases significantly and reaches its maximum before childbirth.

During pregnancy, increased secretion of adrenocorticotropic hormone (ACTH) is observed, which, apparently, is associated with hyperproduction of corticosteroids by the adrenal glands.

The posterior lobe of the pituitary gland, unlike the anterior lobe, does not increase during pregnancy. Oxytocin produced in the hypothalamus is stored in the posterior pituitary gland. The synthesis of oxytocin especially increases at the end of pregnancy and in childbirth. It is believed that its release at the end of a full-term pregnancy is the trigger for the onset of labor.

The emergence and development of pregnancy is associated with the function of a new endocrine gland - corpus luteum pregnancy. The corpus luteum produces sex hormones (progesterone and estrogens), which huge role in implantation and further development of pregnancy. From the 3-4th month of pregnancy, the corpus luteum undergoes involution and its function is entirely taken over by the placenta. Stimulation of the corpus luteum is carried out by chorionic gonadotropin.

The blockade of the secretion of FSH and LH of the adenohypophysis is accompanied by a natural inhibition of the maturation of follicles in the ovaries; ovulation also stops.

Most women experience an increase in size during pregnancy. thyroid gland. This is due to its hyperplasia and active hyperemia. The number of follicles increases, the content of colloid in them increases. These morphological changes are reflected in the function of the thyroid gland: the concentrations of protein-bound thyroxine (T 4) and triiodothyronine (T3) in the blood increase. An increase in the thyroxin-binding capacity of serum globulins, apparently, is due to the influence of hormones of the fetoplacental system.

The function of the parathyroid glands is often somewhat reduced, which is accompanied by impaired calcium metabolism. This, in turn, may be accompanied by the occurrence of convulsive phenomena in the calf and other muscles in some pregnant women.

The adrenal glands undergo significant changes during pregnancy. Hyperplasia of the adrenal cortex and increased blood flow in them are observed. This is reflected in increased production of glucocorticoids and mineralocorticoids. It is characteristic that during pregnancy not only the production of glucocorticoids increases, but also the synthesis of a specific globulin, granscortin, increases. Transcortin, by binding the free hormone, significantly lengthens its half-life. The increased content of corticosteroids in the blood serum of a pregnant woman, apparently, is associated not only with the activation of the function of the adrenal cortex, but also with the transition of fetal corticosteroids into the maternal circulation. Morphological changes in the adrenal medulla during pregnancy were not found.

Nervous system. This system of the mother plays a leading role in the perception of numerous impulses coming from the fetus. During pregnancy, the uterine receptors are the first to begin to respond to impulses from the growing fetal egg. The uterus contains a large number of a variety of nerve receptors: sensory, chemo-, baro-, mechano-, osmoreceptors, etc. The impact on these receptors leads to a change in the activity of the central and autonomic (vegetative) nervous system of the mother, aimed at providing proper development future child.

The function of the central nervous system (CNS) undergoes significant changes during pregnancy. From the moment of pregnancy, an increasing flow of impulses begins to enter the mother's CNS, which causes the appearance in the cerebral cortex of a local focus of increased excitability - a gestational dominant. Around the gestational dominant, according to the physiological laws of induction, a field of inhibition of nervous processes is created. Clinically, this process manifests itself in a somewhat inhibited state of the pregnant woman, the predominance of her interests directly related to the birth and health of the unborn child. At the same time, other interests seem to fade into the background. In the event of various stressful situations (fear, fear, strong emotional experiences etc.), in the CNS of a pregnant woman, along with the gestational dominant, other foci of persistent excitations may also occur. This greatly weakens the effect of the gestational dominant and is often accompanied by a pathological course of pregnancy. It is on this basis that all pregnant women need, if possible, to create conditions for mental peace both at work and at home.

During pregnancy, the state of the central nervous system changes. Until the 3-4th month of pregnancy, the excitability of the cerebral cortex is generally reduced, and then gradually increases. The excitability of the underlying parts of the central nervous system and the reflex apparatus of the uterus is reduced, which ensures the relaxation of the uterus and the normal course of pregnancy. Before childbirth, the excitability of the spinal cord and the nervous elements of the uterus increases, which creates favorable conditions for the onset of labor.

During a physiologically proceeding pregnancy, the tone of the autonomic nervous system changes, and therefore, pregnant women often experience drowsiness, tearfulness, increased irritability, sometimes dizziness and other autonomic disorders. These disorders are usually characteristic of the early period of pregnancy, and then gradually disappear.

The cardiovascular system. During pregnancy, there are significant changes in the activity of the mother's cardiovascular system. These changes make it possible to provide the intensity of oxygen delivery necessary for the fetus and various nutrients and removal of metabolic products.

The cardiovascular system functions during pregnancy with increased stress. This increase in load is due to an increase in metabolism, an increase in the mass of circulating blood, the development of the utero-placental circulation, a progressive increase in the body weight of a pregnant woman and a number of other factors. As the size of the uterus increases, the mobility of the diaphragm is limited, intra-abdominal pressure rises, the position of the heart in the chest changes (it is located more horizontally), at the top of the heart, some women experience an unsharply pronounced functional systolic murmur.

Among the numerous changes in the cardiovascular system inherent in a physiologically proceeding pregnancy, first of all, an increase in the volume of circulating blood (BCC) should be noted. An increase in this indicator is already noted in the first trimester of pregnancy and in the future it increases all the time, reaching a maximum by the 36th week. The increase in BCC is 30-50% of the initial level (before pregnancy).

Hypervolemia occurs mainly due to an increase in blood plasma volume (by 35-47%), although the volume of circulating red blood cells also increases (by 11-30%). Since the percentage increase in plasma volume exceeds the increase in red blood cell volume, the so-called physiological anemia of pregnancy occurs. It is characterized by a decrease in hematocrit (up to 30%) and hemoglobin concentration from 35-140 to 110-120 g/l. Since a decrease in hematocrit is observed during pregnancy, a decrease in blood viscosity also occurs. All these changes, which have a pronounced adaptive character, ensure the maintenance of optimal conditions for microcirculation (oxygen transport) in the placenta and in such vital organs of the mother as the central nervous system, heart, and kidneys during pregnancy and childbirth.

With a normal pregnancy, systolic and diastolic blood pressure decreases in the II trimester by 5-15 mm Hg. Peripheral vascular resistance is also usually reduced. This is mainly due to the formation of the uterine circulation, which has low vascular resistance, as well as the effect on the vascular wall of estrogens and progesterone of the placenta. A decrease in peripheral vascular resistance, together with a decrease in blood viscosity, greatly facilitates the processes of hemocirculation.

Venous pressure measured on the arms of healthy pregnant women does not change significantly.

During pregnancy, physiological tachycardia is observed. The heart rate reaches its maximum in the third trimester of pregnancy, when this figure is 15-20 per minute higher than the initial data (before pregnancy). Thus, the normal heart rate in women in late dates pregnancy is 80-95 per minute.

The most significant hemodynamic shift during pregnancy is an increase in cardiac output. The maximum increase in this indicator at rest is 30-40% of its value before pregnancy. Cardiac output begins to increase from the earliest stages of pregnancy, with its maximum change observed at 20-24 weeks. In the first half of pregnancy, an increase in cardiac output is mainly due to an increase in the stroke volume of the heart, later - to a slight increase in heart rate. The minute volume of the heart increases partly due to the effect on the myocardium of placental hormones (estrogens and progesterone), partly as a result of the formation of the uteroplacental circulation.

Electrocardiography, carried out in the dynamics of pregnancy, allows you to detect a persistent deviation of the electrical axis of the heart to the left, which reflects the displacement of the heart in this direction. According to echocardiography. There is an increase in the mass of the myocardium and the size of individual parts of the heart. An X-ray examination reveals changes in the contours of the heart, resembling a mitral configuration.

The processes of hemodynamics during pregnancy are greatly influenced, as already noted, by the new uteroplacental circulation. Although the blood of the mother and fetus does not mix with each other, changes in hemodynamics in the uterus are immediately reflected in the blood circulation in the placenta and in the body of the fetus and vice versa. Unlike the kidneys, central nervous system, myocardium, and skeletal muscles, the uterus and placenta are not able to maintain their blood flow at a constant level during changes in systemic blood pressure. The vessels of the uterus and placenta have low resistance and the blood flow in them is passively regulated mainly due to fluctuations in systemic arterial pressure. In late pregnancy, the vessels of the uterus are maximally dilated. The mechanism of neurogenic regulation of uterine blood flow is mainly associated with adrenergic influences. Stimulation of alpha-adrenergic receptors causes vasoconstriction and a decrease in uterine blood flow. Reducing the volume of the uterine cavity (prenatal rupture of amniotic fluid, the appearance of contractions) is accompanied by a decrease in uterine blood flow.

Despite the existence of separate circles of blood circulation in the uterus and placenta (there is a placental membrane in the way of two blood flows), the hemodynamics of the uterus is closely connected with the circulatory system of the fetus and placenta. The participation of the capillary bed of the placenta in the blood circulation of the fetus consists in the rhythmic active pulsation of the chorionic capillaries, which are in constant peristaltic motion. These vessels with varying blood volume cause alternate elongation and contraction of the villi and their branches. Such movement of the villi has a significant impact not only on the blood circulation of the fetus, but also on the circulation of maternal blood through the intervillous space. Therefore, the capillary bed of the placenta can rightly be considered as the "peripheral heart" of the fetus. All these features of the hemodynamics of the uterus and placenta are usually combined under the name "uteroplacental circulation".

Respiratory system. Significant changes that have a pronounced adaptive character occur during pregnancy and with the respiratory system. Along with the circulatory system, the respiratory organs provide a continuous supply of oxygen to the fetus, which increases by more than 30-40% during pregnancy.

With an increase in the size of the uterus, the abdominal organs gradually mix, the vertical size of the chest decreases, which, however, is compensated by an increase in its circumference and an increase in diaphragm excursion. However, the restriction of diaphragmatic excursion during pregnancy makes it somewhat difficult to ventilate the lungs. This is expressed in a certain increase in breathing (by 10 %) and in a gradual increase in the respiratory volume of the lungs by the end of pregnancy (by 30-40%). As a result, the minute volume of breathing increases from 8 l / min at the beginning of pregnancy to 11 l / min at the end of it.

An increase in the respiratory volume of the lungs occurs due to a decrease in the reserve volume, while the vital capacity of the lungs remains unchanged and even slightly increases. During pregnancy, the respiratory work of the mouse increases, although airway resistance decreases towards the end of pregnancy. All these changes in the function of respiration ensure the creation of optimal conditions for gas exchange between the organisms of the mother and fetus.

Digestive system. Many women in the early stages of pregnancy experience nausea, vomiting in the morning, taste sensations change, and intolerance to certain foods appears. As the gestational age increases, these phenomena gradually disappear.

Pregnancy has an inhibitory effect on the secretion of gastric juice and its acidity. All sections of the gastrointestinal tract are in a state of hypotension due to changes in the topographic and anatomical relationships in the abdominal cavity due to an increase in the pregnant uterus, as well as neuro hormonal changes inherent in pregnancy. Here, the effect of placental progesterone on the smooth muscles of the stomach and intestines is of particular importance. This explains the frequent complaints of pregnant women about constipation.

Liver function undergoes significant changes. There is a significant decrease in glycogen stores in this organ, which depends on the intensive transition of glucose from the mother's body to the fetus. The intensification of glycolysis processes is not accompanied by hyperglycemia, therefore, in healthy pregnant women, the nature of glycemic curves does not change significantly. The intensity of lipid metabolism changes. This is expressed by the development of lipemia, a higher content of cholesterol in the blood. The content of cholesterol esters in the blood also increases significantly, which indicates an increase in the synthetic function of the liver.

During the physiological course of pregnancy, the protein-forming function of the liver also changes, which is aimed primarily at providing the growing fetus with the necessary amount of amino acids, from which it synthesizes its own proteins. At the beginning of pregnancy, the content of total protein in the blood of pregnant women is within the normal range for non-pregnant women. However, starting from the second half of pregnancy, the concentration of total protein in the blood plasma begins to decrease slightly. Pronounced shifts are also observed in the protein fractions of the blood (a decrease in the concentration of albumin and an increase in the level of globulins). This, apparently, is due to the increased release of finely dispersed albumins through the capillary walls into the mother's tissues, as well as their increased consumption by the growing body of the fetus.

An important indicator of liver function in pregnant women is the enzyme spectrum of blood serum. It has been established that in the course of physiological pregnancy there is an increase in the activity of aspartate-minotransferase (ACT), alkaline phosphatase (AP), especially its thermostable fraction. Other liver enzymes undergo somewhat smaller changes.

During pregnancy, the processes of inactivation of estrogens and other steroid hormones produced by the placenta intensify in the liver. The detoxification function of the liver during pregnancy is somewhat reduced. Pigment metabolism during pregnancy does not change significantly. Only at the end of pregnancy, the content of bilirubin in the blood serum slightly increases, which indicates an increase in the process of hemolysis in the body of pregnant women.

Urinary system. During pregnancy, the mother's kidneys function with increased load, removing from her body not only the products of its metabolism, but also the products of the metabolism of the fetus.

The processes of blood supply to the kidneys undergo significant changes. A feature of renal blood flow is its increase in the first trimester of pregnancy and a gradual decrease in the future. Such a decrease in renal blood flow can be considered as a kind of adaptive reaction, which enables other organs to receive additional blood at the end of pregnancy. A decrease in renal blood flow may underlie the activation of the juxtaglomerular apparatus of the kidneys with hypersecretion of renin and angiotensin. In parallel with changes in the blood supply to the kidneys, glomerular filtration also changes, which increases significantly in the first trimester of pregnancy (by 30-50%), and then gradually decreases. The filtration capacity of the kidneys increases during pregnancy, while tubular reabsorption remains unchanged throughout pregnancy.

Such a decrease in glomerular filtration with an almost unchanged tubular reabsorption of water and electrolytes contributes to fluid retention in the body of a pregnant woman, which is manifested by pasty tissues on the lower extremities at the end of pregnancy.

Changes in kidney function have a pronounced effect on the entire water-salt metabolism during pregnancy. There is an increase in the total fluid content in the body, mainly due to its extracellular part. In general, by the end of pregnancy, the amount of fluid in the body of a pregnant woman may increase by 7 liters.

With a physiologically proceeding pregnancy, the concentration of sodium and potassium in the blood and the excretion of these electrolytes in the urine are within the normal range. At the end of pregnancy, sodium is retained in the extracellular fluid, which increases its osmolarity. However, since the sodium content in the blood plasma of pregnant women is equal to that of non-pregnant women, the osmotic pressure remains without significant fluctuations. Potassium, in contrast to sodium, is mainly found inside cells. The increased potassium content promotes tissue proliferation, which is especially important for organs such as the uterus.

Some women experience orthostatic proteinuria during uncomplicated pregnancies. This may be due to compression by the liver of the inferior vena cava and the uterus of the veins of the kidneys. Sometimes glucosuria occurs during pregnancy. Glycosuria in pregnancy is not a sign diabetes, since such women have no carbohydrate metabolism disorders and the blood glucose content is at a normal level. Most likely, the cause of glucosuria in pregnancy is an increase in glomerular filtration of glucose. Along with glucosuria, lactosuria can also be observed, due to an increase in the concentration of lactose in the mother's blood. It should be noted that lactose, unlike glucose, is not absorbed by the tubules of the kidneys.

Pregnancy has a pronounced effect on the topography and function of organs adjacent to the uterus. This primarily concerns the bladder and ureters. As the size of the uterus increases, compression of the bladder occurs. By the end of pregnancy, the base of the bladder moves upwards beyond the small pelvis. The walls of the bladder hypertrophy and are in a state of increased hyperemia. The ureters are hypertrophied and slightly elongated. Sometimes there is the development of a hydroureter, which often occurs on the right. The reason for the more frequent right-sided hydroureter is the fact that the pregnant uterus turns somewhat to the right, while squeezing the right ureter and pressing it against the innominate line.

Dilatation of the urinary tract begins in the first trimester and reaches a maximum by the 5-8th month of pregnancy. These changes are based on hormonal factors (production of progesterone by the placenta); to a lesser extent, this is due to mechanical compression of the urinary tract by the pregnant uterus. It should be noted that these physiological changes in the urinary system are a factor contributing to the development of infection during pregnancy (pyelonephritis).

Hematopoietic organs. During pregnancy, the processes of hematopoiesis intensify. However, due to hypervolemia (plasma volume increases by 35%, and the number of erythrocytes by 25%), the activation of hematopoietic processes becomes imperceptible. As a result, by the end of pregnancy, there is a decrease in hemoglobin, erythrocyte count and hematocrit. Activation during pregnancy of the erythropoietic function of the bone marrow is associated with increased production of the hormone erythropoietin, the formation of which is stimulated by placental lactogen.

During pregnancy, not only the number, but also the size and shape of red blood cells changes. The volume of erythrocytes increases especially noticeably in the II and III trimesters of pregnancy. A certain role in this process belongs to systemic hypoosmolarity and an increase in sodium concentration in erythrocytes. The increased volume of erythrocytes increases their aggregation and changes the rheological properties of the blood as a whole. Starting from early pregnancy, an increase in blood viscosity is observed. However, this process is leveled by hyperplasia and corresponding changes in hemodynamics. All these multidirectional processes lead to the fact that at the end of pregnancy the rheological properties of blood improve.

Thus, during a physiologically proceeding pregnancy, the average indicators of red blood are as follows: erythrocytes 3.5-5.010 12 / l, hemoglobin 110-120 g / l, hematocrit 0.30-0.35 l / l.

The concentration of serum iron during pregnancy is reduced compared to that of non-pregnant women (at the end of pregnancy to 10.6 µmol/l). The decrease in iron concentration is mainly due to physiological hypovolemia, as well as increased needs for this element of the placenta and fetus.

During pregnancy, the activation of the white blood germ is also observed. As a result, the number of leukocytes increases. By the end of pregnancy, leukocytosis rises to 10x10 9 /l, and the number of neutrophils reaches 70%. There is also an increase in ESR (up to 40-50 mm/h).

The immune system. Great attention deserves the state during pregnancy immune system mother and fetus. The human embryo and fetus receive from the father 50% of the genetic information that is foreign to the mother's body. The other half of the fetus's genetic information is shared between him and the mother. Thus, the fetus is always a genetically "semi-compatible transplant" in relation to the mother's body.

In the process of pregnancy development, very complex immunological relationships arise and form between the organisms of the mother and the fetus, based on the principle of direct and feedback. These relationships ensure the correct, harmonious development of the fetus and prevent the rejection of the fetus as a kind of allograft.

The antigenic activity of the fetus occurs and develops gradually. The earliest immune barrier is the zona pellucida, which forms a protective layer around the ovum and is subsequently maintained from the moment of fertilization almost to the stage of implantation. It has been established that the zona pellucida is impermeable to immune cells, as a result of which maternal antibodies, which could be formed in a fertilized egg and embryo in the early stages of development, cannot pass through this barrier. In the future, the immune protection of the embryo and fetus begins to be carried out by other complex mechanisms due to changes in the maternal organism and the placenta.

Trophoblast antigens occur around the 5th week of fetal development, and fetal antigens occur around the 12th week. It is from this period that the immune "attack" of the fetus begins and progresses. How does the mother's body react to this progressive immunological attack? What are the most important mechanisms for protecting the fetus from maternal immunological aggression, which ultimately contributes to the non-rejection of the fetal egg as an allograft? It should be noted that these issues, despite a significant number of clinical and experimental studies, have not been studied enough to date, and the data obtained are often contradictory.

The most important factor in the protection of the fetus is the immunological tolerance of the maternal organism to the antigens of the fetus of paternal origin, due to various mechanisms. Antigen-antibody reactions are known to be regulated by humoral and cellular mechanisms. During the physiological development of pregnancy, the animal's humoral immunity, assessed on the basis of the blood level of immunoglobulins of classes A, M and G, does not change significantly, with the exception of the concentration of immunoglobulin G, which at the end of pregnancy somewhat decreases as a result of the transfer of IgG through the placenta to the fetus. Does not undergo significant changes during pregnancy and such an important part of the immune system as the complement system. Consequently, the body of a pregnant woman not only adequately responds to antigenic stimulation of the fetus, but also produces antibodies that bind antigens of paternal origin.

During pregnancy, the ratio of T-, B-lymphocytes, T-helpers and T-suppressors does not change significantly, although the absolute number of these cells is subject to certain fluctuations. The increase in the number of lymphocytes, characteristic of pregnancy, is not significant in the processes of immunomodulation. Therefore, a physiologically proceeding pregnancy is characterized by the well-known immunological tolerance of the maternal organism to the antigens of the fetus of paternal genesis. This tolerance is due to a number of factors. Hormones and specific proteins of the placenta play an important role.

Chorionic gonadotropin, which is produced by the trophoblast from the earliest stages of pregnancy, has pronounced immunosuppressive properties. Placental lactogen has similar properties. Along with these hormones, glucocorticoids, progesterone and estrogens, which are produced in increasing amounts by the placenta during pregnancy, also play a certain role in the processes of immunosuppression. In addition to hormones, alpha-fetoprotein, a protein produced by embryonic liver cells, as well as some proteins of the placenta of the pregnancy zone (o-glyco-protein and trophoblastic (3-glycoprotein)) contribute to the suppression of maternal immunity reactions. These proteins of the placenta, together with chorionic gonadotropin and placental lactogen creates, as it were, a zone of biological protection of the fetoplacental complex from the action of cellular and humoral components of the mother's immune system.

The placenta plays an important role in the immune defense of the fetus. The presence of trophoblastic, and then placental barriers, separating the body of the mother and fetus, determines the pronounced protective functions. It has been established that the trophoblast is resistant to immune rejection. In addition, the trophoblast is surrounded on all sides by a layer of amorphous fibrinoyl substance, consisting of mucopolysaccharides. This elephant reliably protects the fetus from the immunological aggression of the mother's body. A known role in the suppression of immune reactions in the placenta also belongs to T- and B-lymphocytes, macrophages, granulocytes and some other cellular elements that are found in the tissues of the placenta. Thus, the immunological relationship of the mother-fetus system is a physiological process aimed at creating and maintaining the necessary conditions for the normal development of the fetus. Violation of this process often leads to the development of pregnancy pathology (miscarriage, gestosis, etc.).

hemostasis system. Physiologically occurring pregnancy and physiological roles are associated with the adaptation of the hemostasis system, which is characterized by certain qualitative changes in various parts of this system. They are characterized by a significant (up to 150-200%) increase in the content of all plasma factors (except factor XIII) of blood coagulation, a decrease in the activity (but not the content) of natural inhibitors of blood coagulation - antithrombin III, protein C, inhibition of fibrinolysis activity and a slight increase in the adhesive-but-aggregation properties of platelets. However, this, as a rule, is not combined with pathological hyperthrombinemia and intravascular coagulation.

The hemostasis systems of the mother and fetus during pregnancy function relatively separately; the placenta has only an indirect effect on maternal and fetal hemostasis. The function of the spiral arterioles, through which the blood supply to the placenta is carried out, is affected by the hemostasis system of the maternal organism, primarily the platelet link. Platelets regulate blood flow in the spiral arterioles through the interaction of their thromboxan-generating system and the prostacyclin-generating system of the endothelium. Local processes of activation of hemostasis in the uteroplacental blood flow with intra- and extravasal fibrin deposition cause a mild consumption of blood coagulation factors. An increase in hemostatic potential during pregnancy provides physiological hemostasis during placental separation, which, together with smooth muscle contraction, stops bleeding from the vessels of the placental site. Thus, changes in the blood coagulation system during pregnancy consist in a constant decrease in fibrinolytic activity and an increase in blood coagulation. These changes have a pronounced adaptive character and are aimed primarily at reducing the volume of physiological blood loss during childbirth.

Metabolism. With the onset of pregnancy, significant changes occur in metabolism. These changes are adaptive in nature and are aimed at ensuring the proper development of the embryo and fetus. The basal metabolism and oxygen consumption increase significantly, which is especially noticeable in the second half of pregnancy.

Significant changes are observed in protein, carbohydrate and lipid metabolism. As pregnancy progresses, the accumulation of protein substances in the body of the tire wives occurs, which is necessary to meet the needs of the growing fetus in amino acids. Changes in carbohydrate metabolism are characterized by the accumulation of glycogen in the cells of the liver, muscle tissue, uterus and placenta. During the physiological course of pregnancy in the mother's blood, there is a slight increase in the concentration of neutral fat, cholesterol and lipids.

Mineral and water metabolism undergoes various changes. During pregnancy, a delay in calcium and phosphorus salts is observed in a woman's body. Both of these elements pass through the placenta and are used to build the bones of the fetus. Iron also passes from the mother to the fetus, which is used in the synthesis of fetal hemoglobin. With severe iron deficiency anemia mother, the fetus also develops anemia, so the diet of pregnant women should always have a sufficient amount of calcium, phosphorus and iron. Along with these elements, potassium, sodium, magnesium, copper and some other electrolytes are also retained in the mother's body. All these substances pass through the placenta and are actively involved in metabolic processes.

Significant changes concern water exchange. An increase in oncotic and osmotic pressure in tissues, primarily due to the retention of albumin and sodium salts, creates conditions for an increase in the hydrophilicity of tissues, mainly as a result of the accumulation of interstitial fluid. This process is of great physiological importance, causing softening of tissues and ligaments, and thereby facilitating the passage of the fetus through the birth canal during childbirth. In the regulation of water metabolism during pregnancy important role belongs to adrenal aldosterone, corpus luteum and placenta progesterone, pituitary antidiuretic hormone and some other factors. Thus, for the physiological course of pregnancy, fluid retention in the body is characteristic. When the compensatory mechanisms that regulate water metabolism are disrupted, edema occurs relatively easily in pregnant women, which already indicates the occurrence of pathology (preeclampsia).

During pregnancy, the need for vitamins increases significantly. Vitamins are necessary both for the physiological course metabolic processes in the mother's body, and for the proper development of the fetus. The intensity of the use of iron for the synthesis of hemoglobin depends on the sufficient intake of vitamins C, B1, B 2, B 12, PP and folic acid into the mother's body.

Vitamin E contributes to the proper development of pregnancy and, if it is deficient, spontaneous abortion may occur. The role of other vitamins during pregnancy is also great: A, D, C, PP, etc. Most of the vitamins pass through the placenta to one degree or another and are used by the fetus in the process of its growth and development. It must be emphasized that vitamins are not formed in the body, but come from outside with food. From this it becomes clear how important the role of supplying vitamins to the organisms of the mother and fetus during pregnancy is. Often, food products contain insufficient amounts of vitamins, which occurs in the winter and spring months of the year due to a seasonal shortage of vegetables and fruits. In such cases, the appointment of multivitamins in the form of drugs is indicated.

Certain adaptive changes during a physiological pregnancy are observed in the acid-base state (ACS). It has been established that in pregnant women there is a state of physiological metabolic acidosis and respiratory alkalosis.

The musculoskeletal system. During the physiological course of pregnancy, pronounced changes occur in the entire musculoskeletal system of a woman. There is serous impregnation and loosening of the ligaments, cartilage and synovial membranes of the pubic and sacroiliac joints. As a result, there is some divergence of the pubic bones to the sides (by 0.5-0.6 cm). With a more pronounced discrepancy and the appearance of pain in this area, they speak of symphysiopathy. This pathological condition requires appropriate therapy.

Changes in the joints, characteristic of pregnancy, lead to some increase in the direct size of the entrance to the small pelvis, which has a positive effect during childbirth. Rib cage expands, the costal arches are located more horizontally, the lower end of the sternum somewhat moves away from the spine. All these changes leave an imprint on the entire posture of a pregnant woman.

Leather. The skin undergoes certain changes. In many pregnant women, brown pigment is deposited on the face, nipples, areola, due to changes in the function of the adrenal glands. As the gestational age increases, a gradual stretching of the anterior abdominal wall occurs. So-called pregnancy scars appear, which are formed as a result of the divergence of the connective tissue and elastic fibers of the skin. Pregnancy scars look like pink or blue-purple bands of an arched shape. Most often they are located on the skin of the abdomen, less often - on the skin of the mammary glands and thighs. After childbirth, these scars lose their pink color and take on the appearance of white stripes. In subsequent pregnancies, against the background of old pregnancy scars, new ones may appear, having a characteristic pink color.

The navel in the second half of pregnancy is smoothed out, and later protrudes. In some cases, during pregnancy, hair growth is noted on the skin of the face, abdomen, and thighs, which is due to increased production of androgens by the adrenal glands and partly by the placenta. Hypertrichosis is temporary and gradually disappears after childbirth.

Body mass. The increase in body weight of a pregnant woman is due to a number of factors: the growth of the uterus and fetus, the accumulation amniotic fluid, an increase in the volume of circulating blood, fluid retention in the body, an increase in the layer subcutaneous tissue(adipose tissue). Body weight increases most intensively in the second half of pregnancy, when the weekly increase is 250-300 g. With a higher rate of weight gain, we can first talk about latent, and then about obvious edema (preeclampsia). Throughout pregnancy, a woman's body weight increases by an average of 9-12 kg, depending on the constitution.

Mammary gland. The glandular tissue of the mammary gland is a complex of tubular-alveolar glands, which consist of a tree-like system of ducts that drain collections of sac-like structures called alveoli, or anines. These alveoli form the basic structural unit of the secreting system. Each alveolus is surrounded by a network of myoepithelial cells and a dense capillary network. Alveoli form lobules, consisting of 10-100 alveoli. A group of 20-40 lobules forms larger lobes, each of which has a common milk duct. The total number of milk ducts ranges from 15 to 20. Milk ducts come to the surface in the nipple area.

The mammary gland has an abundant blood supply and developed innervation, represented by sensory and autonomic nerve fibers. In the cellular elements of the mammary glands there are numerous receptors for protein and steroid hormones.

With the onset and development of pregnancy, pronounced changes occur in the tissues of the mammary glands, which are preparatory to subsequent lactation. Significantly increases the blood supply to the mammary glands; under the influence of hormonal changes, active cell proliferation of both ducts and acinar structures occurs (mammogenesis). Proliferative changes in the milk ducts begin earlier than in the acinar parts. Proliferative processes are usually observed from the 3-4th week of pregnancy and decrease somewhat in the second half.

Active proliferative processes in the epithelium of the excretory ducts and acini lead to a significant increase in the size of the lobules of the mammary glands due to the processes of hyperplasia and hypertrophy. From the second half of pregnancy, against the background of a decrease in proliferation, the preparation of the mammary glands for their most important function, milk secretion, begins. In the protoplasm of cells, fatty inclusions are formed, the alveoli begin to fill with protein-like substances, consisting of desquamated epithelial cells and leukocytes. However, during pregnancy, neither lipids nor proteins, which are the main components of future milk, enter the alveolar sacs from the alveoli. At the end of pregnancy, when pressing on the nipples, colostrum begins to stand out from them.

Along with changes in the epithelial structures of the mammary glands, the smooth muscles of the nipples are activated. As a result of all these physiological processes, the mass of the mammary glands increases significantly from 150-250 g (before pregnancy) to 400-500 g (at the end of it).

The function of the mammary glands is mainly dependent on hormonal factors. At the beginning of the process of mammogenesis, an important role belongs to ovarian hormones (progesterone and estrogens of the corpus luteum of pregnancy). The function of the corpus luteum then passes to the placenta, which releases ever-increasing amounts of both estrogen and progesterone. Placental lactogen plays an important role in the processes of mammogenesis during pregnancy. The role of thyroid and adrenal hormones is also great. The cumulative effect of all these hormones on the corresponding receptors of the mammary glands carries out the most complex processes of preparation for lactation.

Sexual system. During pregnancy, the most pronounced changes occur in the reproductive system and especially in the uterus.

The uterus increases in size throughout pregnancy, however, this increase is asymmetrical, which largely depends on the site of implantation. During the first few weeks of pregnancy, the uterus is pear-shaped. At the end of the 2nd month of pregnancy, the size of the uterus increases approximately 3 times and it has a rounded shape. During the second half of pregnancy, the uterus retains its rounded shape, and at the beginning of the third trimester it becomes ovoid.

As the uterus grows, due to its mobility, some of its rotation occurs, more often to the right. It is believed that this process is due to pressure on her sigmoid colon, located on the left rear side of the pelvic cavity.

At the end of pregnancy, the weight of the uterus reaches an average of 1000 g (50-100 g before pregnancy). The volume of the uterine cavity at the end of pregnancy increases by more than 500 times. The increase in the size of the uterus occurs due to the progressive processes of hypertrophy and hyperplasia of muscle elements. The processes of hypertrophy prevail over the processes of hyperplasia, as evidenced by the weak severity of mitotic processes in myocytes. As a result of hypertrophy, each muscle fiber lengthens 10 times and thickens approximately 5 times. Along with hypertrophy and hyperplasia, the number of smooth muscle cells increases. New muscle cells originate from the corresponding elements of the walls of the uterine vessels (arteries and veins).

In parallel with changes in smooth muscles, complex processes are taking place to transform the connective tissue of the uterus. There is hyperplasia of the connective tissue, which makes up the reticulate-fibrous and argyrophilic skeleton of the uterus. As a result, the uterus acquires excitability and contractility, so characteristic of this organ during pregnancy. Significant changes also occur in the uterine mucosa, which turns into a developed decidua.

As pregnancy progresses, significant changes in the vascular system of the uterus occur. There is a pronounced lengthening of the vascular, especially the venous system, the course of the vessels becomes corkscrew, which allows them to adapt as much as possible to the changed volume of the uterus. The vascular network of the uterus increases not only as a result of lengthening and expansion of the venous and arterial network, but also due to neoplasm of blood vessels. All these changes contribute to increased blood circulation in the uterus. According to its oxygen regime, the pregnant uterus approaches such vital organs as the heart, liver and brain. Some scientists tend to consider the uterus during pregnancy a "second heart". Characteristically, the uterine circulation, closely associated with placental and fetal circulation, is relatively independent of general hemodynamics and is characterized by a certain constancy. These features of uterine circulation are of fundamental importance in the uninterrupted supply of oxygen and various nutrients to the fetus.

During pregnancy, the nervous elements of the uterus change, the number of various receptors (sensitive, baro-, osmo-, chemo-, etc.) increases. They are very important in the perception of a variety of nerve impulses that come from the fetus to the mother. With the excitation of a number of these receptors, the onset of labor activity is associated.

Biochemical and electrostatic changes in the myometrium, which prepare the uterus for labor, deserve special consideration. The uterus is rich in various muscle proteins. The main proteins include myosin, actin and actomyosin. The main complex of contractile proteins is actomyosin, a combination of actin and myosin. Myosin is a globulin and makes up about 40% of all muscle proteins. Myosin has the properties of an enzyme that catalyzes the hydrolysis of adenosine triphosphate (ATP) and inorganic phosphorus.

Actin is the second protein of the contractile complex and makes up approximately 20% of fibrillar proteins. The connection of actin and myosin is a complex biochemical process that is of decisive importance in the contractile properties of the myometrium. With the onset of pregnancy and in the process of its development, the amount of actomyosin increases significantly.

Along with contractile proteins, the myometrium also contains sarcoplasmic proteins involved in the metabolic processes of the muscle cell. These include myogen, myoglobulin and myoglobin. These proteins play an important role in lipid and carbohydrate metabolism.

During a physiological pregnancy, various phosphorus compounds accumulate in the myometrium, as well as such energy-important compounds as creatine phosphate and glycogen. There is an increase in the activity of enzyme systems, among which the most important is the ATPase of actomyosin. This enzyme is directly related to the contractile properties of the myometrium. The activity of this enzyme especially noticeably increases at the end of pregnancy.

The contractility of the myometrium also depends on the intensity of metabolic processes in the uterus. The main indicators of the metabolism of muscle tissue is the intensity of oxidative and glycolytic processes. These processes cause the accumulation in the uterine muscle of various chemical high-energy compounds (glycogen, macroergic phosphates), muscle proteins, and electrolytes (calcium, sodium, potassium, magnesium, chlorine ions, etc.).

With the onset of pregnancy, the activity of oxidative processes increases sharply with simultaneous inhibition of the activity of glycolytic (uneconomical) metabolism.

The excitability and mechanical activity of the neuromuscular apparatus of the uterus is in a certain dependence on the ionic composition of the extracellular environment and the permeability of individual electrolytes through the protoplasmic membrane. The excitability and contractile activity of a smooth muscle cell (myocyte) depend on the permeability of its membrane for ions. The change in permeability occurs under the influence of the resting potential or action potential. At rest (membrane polarization), K + is inside the cell, and Na + is on the outer surface of the cell membrane and in the intercellular environment. In this situation, a positive charge is created on the surface of the cell and in its environment, and a negative charge is created inside the cell.

When excitation occurs, depolarization of the cell membrane occurs, which causes an action potential (contraction of the muscle cell), while K + leaves the cell, and Na +, on the contrary, enters the cell. Ca 2+ is a powerful activator of muscle cell excitation processes. During the physiological course of pregnancy, estrogens and progesterone of the placenta, as well as biologically active substances, maintain an optimal ionic balance and ensure the distribution of the flow of electrical charges in the required direction.

A large role in the excitability and contractility of the myometrium belongs to alpha- and beta-adrenergic receptors, which are located on the membrane of a smooth muscle cell. Excitation of alpha-adrenergic receptors leads to uterine contractions, excitation of beta-adrenergic receptors is accompanied by the opposite effect. These are the most important mechanisms that ensure during pregnancy physiological state myometrium, namely: at the beginning of pregnancy, there is a low excitability of the uterus, with an increase in the duration of pregnancy, excitability increases, reaching the highest degree by the beginning of childbirth.

Along with the uterus, other parts of the female reproductive system undergo significant changes during pregnancy.

The fallopian tubes thicken, blood circulation in them is greatly enhanced. Their topography also changes (by the end of pregnancy, they hang down along the ribs of the uterus).

The ovaries increase somewhat in size, although the cyclic processes in them stop. During the first 4 months of pregnancy, a corpus luteum exists in one of the ovaries, which subsequently undergoes involution. In connection with the increase in the size of the uterus, the topography of the ovaries, which are located outside the small pelvis, changes.

The ligaments of the uterus are significantly thickened and lengthened. This is especially true of the round and sacro-uterine ligaments.

Vagina. During pregnancy, hyperplasia and hypertrophy of the muscular and connective tissue elements of this organ occur. The blood supply to its walls increases, there is a pronounced serous impregnation of all its layers. As a result, the walls of the vagina become easily extensible. The mucous membrane of the vagina due to congestive venous plethora acquires a characteristic cyanotic color. The processes of transudation intensify, as a result of which the liquid part of the vaginal contents increases. A lot of glycogen is deposited in the protoplasm of the stratified squamous epithelium, which creates optimal conditions for the reproduction of lactobacilli. The lactic acid secreted by these microorganisms maintains the acidic reaction of the vaginal contents, which is an important deterrent to ascending infection.

The external genitalia loosen during pregnancy, the mucous membrane of the entrance to the vagina has a distinct cyanotic color. Sometimes varicose veins appear on the external genitalia.

Other internal organs. Along with the urinary system, significant changes in connection with pregnancy are also observed in the abdominal organs. The lean, ileal and caecum, appendix are displaced by the pregnant uterus up and to the right. At the end of pregnancy, the appendix may be located in the area of ​​the right hypochondrium, which should be taken into account during an appendectomy performed at the end of pregnancy. The sigmoid colon is displaced upward and may be pressed against the upper edge of the pelvis at the end of pregnancy. At the same time, there is compression of the abdominal aorta, inferior vena cava, which can lead to varicose veins veins of the lower extremities and rectum (hemorrhoids).

During pregnancy, a woman's body undergoes numerous and complex physiological changes that determine homeostasis and the normal course of all body functions. These physiological changes contribute to the proper functioning of the fetoplacental system, the development of the fetus, the preparation of the woman's body for childbirth and lactation.

The occurrence and development of changes associated with pregnancy are regulated by the nervous system and the activity of the endocrine glands.

Nervous system

From the beginning of pregnancy fertilized egg affects the receptor apparatus of the uterus. The resulting irritations are transmitted along the nerve pathways to the central nervous system. In accordance with the impulses emanating from the nerve endings of the pregnant uterus, a process of combining the activity of many nerve centers occurs in the central nervous system, directing the integral activity of the body to successful development pregnancy. This complex functional association of nerve centers and effectors acquires the character of a dominant (gestational dominant). Gestational dominant ensures the emergence and development of physiological changes in various body systems aimed at performing the most important functions at the moment - carrying a pregnancy [Yakovlev II, 1955; Arshavsky I. A., I960, etc.].

Afferent impulses entering the central nervous system from many organs reinforce and strengthen the focus of the gestational dominant (it mainly captures the structures of the limbic-reticular complex and the hypothalamus), which conjugately inhibits the body's reactions to extraneous impulses [Lebedeva L. I., Orlov R. C, 1969]. In this regard, during pregnancy, the threshold of sensitivity to the action of stimuli (including pathogenic ones) increases, which is a biological reaction that helps to reduce pregnancy.

The formation of the gestational dominant occurs against the background of hormones of the corpus luteum and placenta and in closest connection with the activity of the entire endocrine system. In the development of changes in the nervous system of a pregnant woman, the fetus also takes part, the vital activity of which determines the system of reflex relationships with the mother's body. The fetus is also involved in the synthesis of hormones of the fetoplacental system, which is important for functional state pregnancy dominance.

During pregnancy, complex physiological changes occur in the nervous system. In the cerebral cortex there is a periodic decrease and increase in the intensity of neurodynamic processes . In the first months of pregnancy and on the eve of childbirth, there is a decrease in the excitability of the cerebral cortex, which reaches its greatest degree by the time of childbirth. At the same time, the excitability of the reticular formation and the spinal cord increases. By the same time, the excitability of the subcortical centers, the spinal cord and the receptors of the pregnant uterus increases. These changes, which increase at the end of pregnancy, contribute to the onset of childbirth. Throughout pregnancy (with the exception of the end of it), the excitability of the spinal cord and uterus is lowered, which causes inertness (“rest”) of the uterus and contributes to right course pregnancy.

Processes occurring in the nervous system, contribute to the emergence of physiological, adaptive changes in the cardiovascular, hematopoietic, excretory, digestive and other systems.

Any pregnant woman should know that the waste of nerves during pregnancy can have extremely negative consequences, both for her own condition and for the baby inside the womb. Because the expectant mother is closely connected with the child at the level of all life-support systems and internal organs. A small organism feels even the slightest anxiety of the mother, and the activity of the nervous system is reflected in it. It is necessary to know and consider how nerves affect pregnancy in order to avoid dangerous consequences.

Trouble happens to each of us regularly, be it small everyday problems or serious life troubles, it doesn't matter. People react differently to such situations, but the intensity of the nerves during pregnancy increases and what for ordinary person may not be a problem, for a pregnant woman it will become a tragedy. This is due to the hormonal restructuring of the body, which originates in the first trimester of pregnancy and ends after the birth of a small organism. In women during this period, the mood often changes, emotionality, vulnerability, susceptibility increase.

Consequences

How can frequent experiences affect the health of the mother and her child. What threats do they pose?

1. miscarriage or premature birth.
2. Defects of various systems of the child's body, developmental delays.
3. Anxious sleep of the child, restlessness, inability to sleep and, as a result, poor health.
4. Beginning with early age, problems with memory, thinking and perception of the world around. Possible dementia or mental retardation.
5. Diseases of the heart and cardiovascular system. An increase in the stress hormone - cortisol, which entails oxygen starvation, thinning of blood vessels and a lack of useful substances necessary for the development of the baby.
6. Fearfulness, irritability and hyperactivity of a child born in stressful condition. It is difficult for them to manage and control his actions. In this case, you can not do without treatment and the use of special methods of psychology.
7. Asymmetry of various parts of the child's body. These can be differences in the face, limbs, etc.
8. Fetal presentation - common consequence nervous tension women during gestation. This greatly complicates the process of natural childbirth and can be fraught with consequences for two organisms: mother and child.

Ways to get rid of anxiety

It is impossible not to be nervous at all, but it is possible to reduce these experiences to a minimum. Emotions are better controlled when you realize what harm they bring to the body inside the womb.

1. Information about pregnancy and childbirth. Today, there is a lot of access to information about pregnancy and childbirth, parenting: forums, audio books, e-books, magazines, etc. Passion for knowledge during the period of gestation will help to distract from minor troubles, learn more about the processes of the relationship between mother and child and realize the changes that occur in the female body.
2. Compliance with the daily routine. These rules apply to all people who want to stay healthy, but for pregnant women they are fundamental. It is necessary to balance your diet with vitamins and essential elements, visit more often fresh air, perform minimal loads and sleep well. You can do gymnastics, dance, yoga or other useful hobby that will not only charge you with positive, but also limit the time for extraneous restless thoughts.
3. Planning. Make a to-do list for the day or month. Then anxiety will visit you less often, because you will follow a clearly defined plan.
4. Close ones. The help of relatives and people close to you will not leave you alone with your problems, they will help you find a way out of difficult situations and give advice in time. Feel free to contact them for support and help.
5. Positive emotions. Draw positive from the daily little things: good film or a book, dancing, singing, meeting with interesting people, favorite hobby. All this will fill the day with colors and will not let it fade away.

Relationship with the child. Talk to him, tell him about your plans, send him songs, stroke. This will establish a closer emotional connection and drive away feelings.

Every woman who is preparing to become a mother should be aware of the dangers of experiences and why it is necessary to control her nerves during this period. First of all, you need to remember about the child and the possible consequences for him. If the case is serious and you cannot cope on your own, seek help from a doctor who will prescribe safe sedatives for you. But do not use medications on your own.

Changes that occur normally during pregnancy from the side of the central and peripheral nervous system of the mother are aimed at ensuring normal flow pregnancy and the proper development of the child. However, in some cases, pregnant women have certain pathological deviations in the activity of the nervous system .

In the vast majority of cases, during pregnancy, the pathology of the nervous system is noted, which has already taken place earlier, before the onset of this pregnancy. This pathology often becomes more pronounced character, which negatively affects the nature of the course of pregnancy. Let us dwell on the most typical diseases of the nervous system that can manifest themselves during pregnancy.

Epilepsy is a chronic disease characterized by seizures. At the same time, both primary and secondary or symptomatic are distinguished, which occurs against the background of various metabolic disorders in vascular pathology, with cerebral edema, with its tumor, as well as after injury, with hypoxia or intoxication. Epileptic seizures should be distinguished from those in other diseases (encephalitis, concussion, brain tumors, etc.), as well as from seizures of eclampsia. Epilepsy can be not only before the onset of pregnancy, but also first manifest itself during this pregnancy. With this pathology, the risk of intrauterine death of the fetus or death of the newborn is higher than in healthy patients, which is primarily due to the damaging effect of anticonvulsants used during pregnancy in epilepsy. In this regard, if possible, it is advisable to reduce the dose of anticonvulsants taken, especially in the first trimester. To reduce the risk of congenital anomalies when using anticonvulsant drugs, folic acid is prescribed. However, if a dose reduction would result in a worsening of the course of the disease, then the dose of the anticonvulsant drug should be increased to the optimal dose in order to prevent a major epileptic seizure that threatens the life of the pregnant woman and the fetus. In addition, the course of pregnancy with epilepsy is often complicated by preeclampsia and fetoplacental insufficiency.

The main tasks of managing pregnant women with epilepsy are: a thorough examination of the state of the fetoplacental system and the fetus; dynamic control over the development of the fetus; identification and elimination of factors that provoke the occurrence of epileptic seizures; ensuring adequate hemodynamics and oxygenation; prevention of possible complications during pregnancy; the use of long-acting anticonvulsants. The intensity of observation of pregnant women with epilepsy depends on the severity of the disease. With a compensated state and remission of epilepsy, a pregnant woman is examined by a neurologist with an electroencephalogram (EEG) performed once every 2 months. With persistent seizures, the neuropathologist examines the patient once a month with an EEG. Examination by an obstetrician is carried out 1 time in 2 weeks.

Indications for early delivery by caesarean section are the tendency to serial seizures in recent weeks pregnancy and status epilepticus. In the absence of these complications, pregnant women with epilepsy can be delivered through the natural birth canal. Childbirth in these patients in some cases occurs prematurely. In general, the management of childbirth and its pain management do not differ from those in healthy women. There are no specific contraindications to epidural anesthesia in epilepsy.

Due to the risk of exacerbation of epilepsy in the postpartum period, regular intake of antiepileptic drugs and adherence to a rational regimen are necessary. It is important to avoid an overdose of antiepileptic drugs, which is possible due to a decrease in the total weight of the puerperal and blood loss during childbirth. In addition, it must be taken into account that the use of a number of anticonvulsants leads to a deficiency of vitamin K and related blood coagulation factors in the fetus, which can lead to bleeding on the first day after birth. At breastfeeding, which is not contraindicated in epilepsy, it is necessary to monitor the development of possible adverse reactions in children. It is advisable to breastfeed under the supervision of staff or loved ones in order to prevent injury to the child in the event of an unexpected attack of epilepsy in his mother.

myasthenia gravis- This is a disease of the neuromuscular system due to the pathology (hyperplasia or tumor) of the thymus gland, in which, due to the resulting immunological disorders, nerve impulses to the muscles are blocked. This disease is characterized by weakness and pathological fatigue of the muscles that are innervated by the cranial nerves. In this case, there is a dysfunction of predominantly oculomotor and facial muscles, as well as muscles that provide the function of swallowing and chewing. In some cases, breathing may also be disturbed. The manifestation of the disease is mainly incomplete opening upper eyelids. In some cases, this phenomenon is asymmetric. During pregnancy, both an improvement in the condition and an exacerbation are possible. With frequent exacerbations of the disease, the patient should be hospitalized in the first trimester to resolve the issue of the possibility of prolonging the pregnancy. Pregnancy with myasthenia gravis can be saved, however, it is necessary careful observation obstetrician-gynecologist, internist and neuropathologist. With progressive deterioration general condition pregnancy should be terminated. A pregnant woman is also hospitalized no later than 2 weeks before delivery to resolve the issue of the timing and method of delivery.

Childbirth most often occurs on time and can provoke an exacerbation of the disease. In patients with stable remission of the disease, childbirth should be carried out expectantly. Readiness for operative delivery and the use of an artificial respiration apparatus is necessary. Patients with myasthenic crisis before childbirth or in the first period perform a caesarean section under endotracheal anesthesia. For labor pain relief, regional anesthesia is preferred. In the postpartum period, a severe myasthenic crisis is possible, in which shortness of breath, complete paralysis of the respiratory muscles, tachycardia, psychomotor agitation, followed by lethargy, apathy, paresis of the intestines and sphincters are detected.

Myopathy is a chronic, gradually progressive hereditary disease of the neuromuscular apparatus, which is characterized by gradual muscle atrophy. The activity of smooth muscles is not disturbed. In the presence of this disease, pregnancy is absolutely contraindicated.

Multiple sclerosis is a chronic progressive disease of the nervous system, which develops as a result of a number of immunological disorders and leads to damage to a number of structures of the brain and spinal cord. The first symptoms can also be noted during pregnancy or after childbirth. Variety of manifestation clinical symptoms and the course of the disease significantly complicate its diagnosis. Pregnancy has a negative impact on the course of the disease. Childbirth with multiple sclerosis is conservative, and children are born, as a rule, healthy. Treatment and monitoring of a pregnant woman is carried out jointly by obstetricians and neuropathologists. Depending on the clinical course of multiple sclerosis, the use of prednisolone is indicated. In some cases, antibiotics are used. A constant intake of B vitamins and ascorbic acid is necessary. Before childbirth, early hospitalization is mandatory.

At neuralgia of the lateral femoral cutaneous nerve due to its compression under the inguinal ligament, paresthesia, burning, numbness and decreased sensitivity along the outer surface of the thigh occur. These sensations increase in the standing position and decrease with hip flexion. This complication usually occurs in the third trimester of pregnancy and disappears within a few weeks after delivery.

One of the complications in caesarean section May be femoral nerve compression, which is manifested by paresis of the quadriceps femoris and iliopsoas muscles with a decrease or absence of a knee jerk, a decrease in sensitivity along the anterior surface of the thigh and paresthesia. Full recovery after a complication occurs, it usually takes from several weeks to several months.

Neuralgia of the obturator nerve may occur during prolonged labor or labor with a large fetus, as well as with hemorrhages or other volumetric formations in the small pelvis due to prolonged compression of the obturator nerve. The complication is characterized by pain and paresis of the adductor muscles of the thigh, lack of sensitivity along its inner surface.

sciatica It is formed due to the occurrence of a herniated disc and compression of the spinal roots, which is accompanied by acute pain along the sciatic nerve.

lumbosacral plexitis may develop due to compression of the lumbosacral plexus by the fetal head or obstetric forceps. Symptoms of complications that appear after childbirth are characterized by unilateral dysfunction of the flexors and extensors of the foot with a simultaneous decrease in its sensitivity.