Identification of high-risk groups in gynecology. Possible risk factors in pregnancy
Risk stratification in obstetrics provides for the identification of groups of women in whom pregnancy and childbirth can be complicated by a violation of the vital activity of the fetus, obstetric or extragenital pathology. Based history, physical examination data and laboratory tests reveal the following unfavorable prognostic factors.
I. Sociobiological:
- mother's age (up to 18 years old; over 35 years old);
- the age of the father is over 40;
- occupational hazards of parents;
- smoking, alcoholism, drug addiction, substance abuse;
- weight and height indicators of the mother (height 150 cm or less, weight 25% above or below the norm).
II. Obstetric and gynecological history:
- number of births 4 or more;
- repeated or complicated abortions;
- surgical interventions on the uterus and appendages;
- malformations of the uterus;
- infertility;
- miscarriage;
- non-developing pregnancy (NB);
- premature birth;
- stillbirth;
- death in the neonatal period;
- birth of children genetic diseases and developmental anomalies;
- the birth of children with low or large body weight;
- complicated course of a previous pregnancy;
- bacterial-viral gynecological diseases(genital herpes, chlamydia, cytomegaly, syphilis,
gonorrhea, etc.).
III. Extragenital diseases:
- cardiovascular: heart defects, hyper and hypotensive disorders;
- diseases of the urinary tract;
- endocrinopathy;
- blood diseases;
- liver disease;
- lung diseases;
- connective tissue diseases;
- acute and chronic infections;
- violation of hemostasis;
- alcoholism, drug addiction.
IV. Complications of pregnancy:
- vomiting of pregnant women;
- the threat of abortion;
- bleeding in the I and II half of pregnancy;
- preeclampsia;
- polyhydramnios;
- oligohydramnios;
- placental insufficiency;
- multiple pregnancy;
- anemia;
- Rh and AB0 isosensitization;
- exacerbation viral infection(genital herpes, cytomegaly, etc.).
- anatomically narrow pelvis;
- incorrect position of the fetus;
- delayed pregnancy;
- induced pregnancy.
For quantitative assessment of factors, a scoring system is used, which makes it possible not only to assess the probability of an unfavorable outcome of childbirth under the action of each factor, but also to obtain a total expression of the probability of all factors.
Based on the calculation of the assessment of each factor in points, the authors distinguish the following degrees of risk: low - up to 15 points; medium - 15–25 points; high - more than 25 points. The most common mistake in scoring is that the doctor does not sum up indicators that seem insignificant to him.
The first scoring screening is carried out at the first visit of the pregnant woman to the antenatal clinic. The second - at 28-32 weeks, the third - before childbirth. After each screening, the pregnancy management plan is clarified. Selection of a group of pregnant women with a high degree risk allows you to organize intensive monitoring of the development of the fetus from the beginning of pregnancy.
From the 36th week of pregnancy, women from the medium and high risk groups are re-examined by the head of the antenatal clinic and the head of the obstetric department, in which the pregnant woman will be hospitalized until delivery.
This inspection is important point administered to pregnant women at risk. In areas where there are no maternity wards, pregnant women are hospitalized for preventive treatment in certain obstetric hospitals.
Since antenatal hospitalization for examination and comprehensive preparation for childbirth for women at risk is mandatory, the duration of hospitalization, a suggested management plan recent weeks pregnancy and childbirth should be developed jointly with the head of the obstetric department. Antenatal hospitalization at the time determined jointly by the doctors of the consultation and the hospital is the last, but very important task of the antenatal clinic. Having timely hospitalized a pregnant woman from the medium or high risk groups, the doctor of the antenatal clinic can consider his function fulfilled.
A group of pregnant women at risk of perinatal pathology. It has been established that 2/3 of all cases of PS occur in women from the high-risk group, constituting no more than 1/3 of the total number of pregnant women.
On the basis of literature data, their own clinical experience, as well as the multifaceted development of birth histories in the study of PS, O. G. Frolov and E. N. Nikolaev (1979) identified individual risk factors. They include only those factors that led to more high level PS in relation to this indicator in the entire group of surveyed pregnant women. The authors divide all risk factors into two large groups: prenatal (A) and intranatal (B).
Prenatal factors, in turn, are divided into 5 subgroups:
Sociobiological;
- obstetric and gynecological history;
- extragenital pathology;
- complications of this pregnancy;
- assessment of the state of the fetus.
Intranatal factors were also divided into 3 subgroups. These are factors from the side:
mothers;
- placenta and umbilical cord;
- fetus.
Among prenatal factors, 52 factors are distinguished, among intranatal factors - 20. Thus, a total of 72 factors are identified
risk.
DAY HOSPITAL
Day hospitals are organized at outpatient clinics (antenatal clinic), maternity homes, gynecological departments of general hospitals in order to improve the quality medical care pregnant and gynecological patients who do not require round-the-clock monitoring and treatment.
The hospital provides continuity in the examination, treatment and rehabilitation of patients with other health care institutions: if the condition of sick women worsens, they are transferred to the appropriate departments hospitals.
· The recommended capacity of a day hospital is at least 5–10 beds. To provide a complete medical of the diagnostic process, the duration of the patient's stay in the day hospital should be at least 6-8 hours day.
· Management of the day hospital chief physician(head) of the institution on the basis of which organized by this structural unit.
The staff of medical personnel and the mode of operation of the day hospital of the antenatal clinic depend on the volume assistance provided. For each patient of the day hospital, a "Card of the patient of the day hospital" clinics, home hospitals, hospitals day stay in the hospital".
Indications for the selection of pregnant women for hospitalization in a day hospital:
Vegetovascular dystonia and hypertension in the I and II trimesters of pregnancy;
- exacerbation of chronic gastritis;
- anemia (Hb not lower than 90 g/l);
- early toxicosis in the absence or presence of transient ketonuria;
- the threat of abortion in the I and II trimesters in the absence of a history of habitual miscarriages and preserved cervix;
- critical periods of pregnancy with a history of miscarriage without clinical signs interrupt threats;
- medical genetic testing, including invasive methods (amniocentesis, chorionic biopsy, etc.) in pregnant women of a high perinatal risk group in the absence of signs of a threatened abortion;
- non-drug therapy (acupuncture, psycho and hypnotherapy, etc.);
- Rh conflict in the I and II trimesters of pregnancy (for examination, non-specific desensitizing therapy);
- suspicion of PN;
- suspicion of heart disease, pathology of the urinary system, etc.;
- conducting special therapy for alcoholism and drug addiction;
- at discharge from the hospital after suturing the cervix for CCI;
- continuation of observation and treatment after a long stay in the hospital.
Risk factors include maternal health problems, physical and social characteristics, age, complications of previous pregnancies (eg, spontaneous abortions), complications of the current pregnancy, labor and delivery.
Arterial hypertension. Pregnant women suffer from chronic arterial hypertension (CHH) if they had arterial hypertension before pregnancy or developed before the 20th week of pregnancy. CAH must be differentiated from pregnancy-induced hypertension occurring after the 20th week of gestation. Arterial hypertension is defined as systolic when blood pressure is more than 140 mm Hg. and diastolic with blood pressure over 90 mm Hg. more than 24 hours. Arterial hypertension increases the risk of intrauterine growth retardation and reduces uteroplacental blood flow. CAH increases the risk of developing preeclampsia by up to 50%. Poorly managed hypertension increases the risk of placental abruption by 2 to 10%.
When planning a pregnancy, women with hypertension should be counseled taking into account all risk factors. In the presence of pregnancy in such women, it is recommended to start prenatal preparation as early as possible. It is necessary to study the function of the kidneys (measurement of creatinine and urea in the blood serum), an ophthalmoscopic examination, as well as an examination of the cardiovascular system (auscultation, ECG, echocardiography). In each trimester of pregnancy, protein is determined in daily urine, uric acid, serum creatinine and hematocrit are determined. Ultrasonography is used to monitor fetal growth at 28 weeks and every few weeks thereafter. Fetal growth retardation is diagnosed using Doppler ultrasound by a specialist in prenatal diagnosis (to manage hypertension during pregnancy).
Assessment of risk factors in pregnancy
Pre-existing
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Cardiovascular and renal disorders |
Moderate and severe preeclampsia |
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Chronic arterial hypertension |
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Moderate to severe renal impairment |
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Severe heart failure (class II-IV, NYHA classification) |
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History of eclampsia |
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Pyelitis in history |
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Moderate heart failure (Class I, NYHA classification) |
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moderate preeclampsia |
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Acute pyelonephritis |
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history of cystitis |
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Acute cystitis |
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History of preeclampsia |
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metabolic disorders |
insulin dependent diabetes |
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Previous endocrine ablation |
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Thyroid disorders |
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Prediabetes (diet-controlled gestational diabetes) |
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Family history of diabetes |
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Obstetric history |
Exchange transfusion to the fetus with Rh-incompatibility |
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Stillbirth |
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Postterm pregnancy (more than 42 weeks) |
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Premature newborn |
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Newborn, small for gestational age |
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Pathological position fetus |
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polyhydramnios |
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Multiple pregnancy |
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Stillborn |
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C-section |
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habitual abortion |
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Newborn >4.5 kg |
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Childbirth parity >5 |
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Epileptic seizure or cerebral palsy |
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Fetal malformations |
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Other violations |
Pathological findings cytological examination of the cervix |
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sickle cell disease |
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Positive serological results for STIs |
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Severe anemia (hemoglobin |
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History of tuberculosis or induration of injection site with purified protein derivative >10 mm |
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Moderate anemia (hemoglobin 9.0-10.9 g/dl) |
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Anatomical disorders |
Malformations of the uterus |
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Isthmic-cervical insufficiency |
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narrow pelvis |
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Mother characteristics |
Age 35 or |
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Body weight 91 kg |
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emotional problems |
Prenatal factors
During childbirth
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maternal factors |
Moderate to severe preeclampsia |
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Polyhydramnios (polyhydramnios) or oligohydramnios (oligohydramnios) |
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Amnionitis |
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Rupture of the uterus |
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Pregnancy >42 weeks |
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moderate preeclampsia |
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Premature rupture of membranes >12 h |
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preterm birth |
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Primary weakness of labor activity |
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Secondary weakness of labor activity |
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Meperidine >300 mg |
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Magnesium sulfate >25 g |
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Second stage of labor >2.5 h |
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Clinically narrow pelvis |
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Medical induction of labor |
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rapid delivery ( |
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Primary caesarean section |
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Repeated caesarean section |
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Selective induction of labor |
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Prolonged latent phase |
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Uterine tetanus |
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Oxytocin overdose |
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| Placental factors | central presentation placenta | |
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Placental abruption |
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marginal presentation placenta |
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Fetal factors |
Abnormal presentation (breech, frontal, facial) or transverse position |
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Multiple pregnancy |
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Fetal bradycardia >30 min |
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Childbirth in breech presentation, extraction of the fetus by the pelvic end |
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Cord prolapse |
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Fruit weight |
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Fetal acidosis |
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Fetal tachycardia >30 min |
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Meconium-stained amniotic fluid (dark) |
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Amniotic fluid stained with meconium (light) |
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Operative delivery using forceps or vacuum extractor |
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Birth in breech presentation, spontaneous or assisted |
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General anesthesia |
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Exit forceps |
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Shoulder dystocia |
1 10 or more points indicate high risk.
NYHA - New York Heart Association; STIs are sexually transmitted infections.
Diabetes. Diabetes mellitus occurs in 3-5% of pregnancies, its impact on the course of pregnancy increases with increasing weight of patients. Pregnant women with pre-existing insulin-dependent diabetes are at increased risk of pyelonephritis, ketoacidosis, pregnancy-related hypertension, fetal death, malformations, fetal macrosomia (weight >4.5 kg), and, if vasculopathy is present, fetal growth retardation. The need for insulin usually increases during pregnancy.
Women with gestational diabetes are at risk of hypertensive disorders and fetal macrosomia. Testing for gestational diabetes is usually done between 24 and 28 weeks of gestation or, in women with risk factors, during the 1st trimester of pregnancy. Risk factors include previous gestational diabetes, neonatal macrosomia in a previous pregnancy, family history of non-insulin dependent diabetes, unexplained fetal loss, and a body mass index (BMI) greater than 30 kg/m 2 . A glucose tolerance test is applied using 50 g of sugar. If the result is 140-200 mg/dl, then a glucose test is performed after 2 hours; if the glucose level is more than 200 mg/dl or the results are abnormal, then women are treated with diet and, if necessary, with insulin.
Good blood glucose control during pregnancy minimizes the risk of adverse outcomes associated with diabetes (treatment of diabetes during pregnancy).
Sexually transmitted infections. Intrauterine infection with syphilis can cause fetal death, congenital malformations, and disability. The risk of transmission of HIV infection from mother to fetus in utero or perinatally is 30-50% within 6 months. Bacterial vaginosis, gonorrhea, urogenital chlamydia during pregnancy increase the risk of preterm birth and premature rupture of the membranes. Plain prenatal diagnosis includes screening tests to identify hidden forms of these diseases at the first prenatal visit.
Testing for syphilis is repeated during pregnancy if there is still a risk of infection at delivery. All pregnant women with these infections are treated with antimicrobials.
Treatment of bacterial vaginosis, gonorrhea, and chlamydia can prevent premature rupture membranes during childbirth and reduce the risk of intrauterine infection of the fetus. Treatment of HIV infection with zidovudine or nevirapine reduces the risk of transmission by 2/3; the risk is much lower
Pyelonephritis. Pyelonephritis increases the risk of premature rupture of the membranes, preterm labor, and fetal respiratory distress syndrome. Pregnant women with pyelonephritis are hospitalized for diagnosis and treatment. First of all, a bacteriological examination of urine is carried out with seeding for sensitivity to antibiotics.
Intravenous antibiotics (eg, third-generation cephalosporins with or without aminoglycosides), antipyretics, and drugs to correct hydration are used. Pyelonephritis is the most common non-obstetric cause of hospitalization during pregnancy.
Prescribe specific antibiotics for oral administration, taking into account the pathogenic agent within 24-48 hours after the cessation of fever, and also carry out full course antibiotic therapy for 7-10 days. Prophylactic antibiotics (eg, nitrofurantoin, trimethoprim-sulfamethoxazole) are given during the remainder of the pregnancy, with periodic urine cultures.
Acute surgical diseases. Major surgical interventions, especially intra-abdominal ones, increase the risk of preterm birth and intrauterine fetal death. During pregnancy, physiological changes occur that make it difficult to diagnose acute surgical diseases requiring emergency surgical intervention (eg, appendicitis, cholecystitis, intestinal obstruction), and thus worsen the results of treatment. After the operation, antibiotics and tocolytics are prescribed for 12-24 hours. If planned surgical treatment is necessary during pregnancy, it is better to perform it in the 2nd trimester.
Pathology of the reproductive system. Malformations of the uterus and cervix (eg, uterine septum, bicornuate uterus) lead to abnormal fetal development, abnormal delivery, and increase the frequency of caesarean section. Fibroid tumors of the uterus can be the cause of placental pathology, growth may increase or node degeneration occurs during pregnancy; node degeneration leads to severe pain and peritoneal symptoms. Isthmic-cervical insufficiency often leads to premature birth. In women who have had a myomectomy, spontaneous uterine rupture may occur during vaginal delivery. Uterine defects that require surgical correction, which cannot be performed during pregnancy, worsen the prognosis of pregnancy and childbirth.
Mother's age. Adolescents, in whom pregnancy occurs in 13% of cases, neglect prenatal preparation. As a result, the incidence of pre-eclampsia, preterm labor and anemia increases, which often lead to intrauterine growth retardation.
In women over 35 years of age, the frequency of preeclampsia increases, especially against the background of gestational diabetes mellitus, the frequency of abnormal contractile activity of the uterus during childbirth, placental abruption, stillbirth and placenta previa increases. Pre-existing disorders (eg, chronic hypertension, diabetes) are also most common in these women. Genetic testing is necessary, as the risk of chromosomal abnormalities in the fetus increases with increasing maternal age.
Mother's body weight. Pregnant women with a BMI less than 19.8 (kg/m) prior to pregnancy are considered underweight, which predisposes to low birth weight (
Pregnant women with a BMI over 29.0 (kg/m) before pregnancy are considered overweight patients, which leads to hypertension, diabetes, post-term pregnancy, fetal macrosomia, and increases the risk of caesarean section. Such women are advised to limit weight gain to 7 kg during pregnancy.
Influence of teratogenic factors. Teratogenic factors (agents that cause fetal malformations) are infections, drugs, and physical agents. Malformations most often form between the 2nd and 8th weeks after conception (4-10th weeks after the last menstruation), when organs are laid. Other adverse factors are also possible. Pregnant women who have been exposed to teratogenic factors or who have elevated risk factors should be carefully evaluated with ultrasound in order to detect malformations.
Teratogenic infections include: herpes simplex, viral hepatitis, rubella, chicken pox, syphilis, toxoplasmosis, cytomegaly virus and Coxsackie virus. Teratogenic substances include alcohol, tobacco, some anticonvulsants, antibiotics, and antihypertensive drugs.
Smoking is the most common addiction among pregnant women. The percentage of women who smoke moderately and significantly is increasing. Only 20% of women who smoke stop smoking during pregnancy. Carbon monoxide and nicotine present in cigarettes lead to hypoxia and vasoconstriction, increasing the risk of spontaneous abortion (miscarriage or delivery in less than 20 weeks), lead to intrauterine growth retardation (birth weight is on average 170 g less than that of newborns whose mothers do not smoke), placental abruption, placenta previa, premature rupture of membranes, preterm labor, chorioamnionitis and stillbirth. Newborns whose mothers smoke are more likely to have anencephaly, congenital heart defects, cleft jaw, physical and mental retardation. intellectual development and behavioral disorders. Sudden death of an infant during sleep has also been noted. Limiting or stopping smoking reduces the risk of teratogenic effects.
Alcohol is the most common teratogenic factor. Drinking alcohol during pregnancy increases the risk of spontaneous abortion. The risk depends on the amount of alcohol consumed, any amount is dangerous. Regular intake of alcohol reduces the weight of the child at birth by about 1-1.3 kg. Even drinking as much as 45 ml of alcohol per day (equivalent to about 3 drinks) can cause fetal alcohol syndrome. This syndrome occurs in 2.2 per 1000 live births and includes intrauterine growth retardation, facial and cardiovascular defects, and neurological dysfunction. Fetal alcohol syndrome is the main cause of mental retardation and can cause neonatal death.
Cocaine use also has indirect risks (for example, maternal stroke or death during pregnancy). Cocaine use can also lead to vasoconstriction and fetal hypoxia. Cocaine use increases the risk of spontaneous abortion, intrauterine delay fetal development, placental abruption, preterm labor, stillbirth, and congenital malformations (eg, CNS, urinary tract, skeletal malformations, and isolated atresia).
Although the main metabolite of marijuana crosses the placenta, however, episodic use of marijuana does not increase the risk of congenital malformations, intrauterine growth retardation, or postnatal neurological status disorders.
Prior stillbirth. Stillbirths (intrauterine fetal death >20 weeks gestation) can be caused by maternal, placental, or fetal factors. A history of stillbirth increases the risk of fetal death in subsequent pregnancies. It is recommended to monitor the development of the fetus and assess its viability (non-stress tests are used and biophysical profile fetus). Treatment of maternal disorders (eg, chronic hypertension, diabetes, infection) may reduce the risk of stillbirth in the current pregnancy.
Previous preterm birth. A history of preterm birth increases the risk of preterm birth in subsequent pregnancies; if the weight of the newborn was less than 1.5 kg during previous preterm birth, then the risk of preterm birth in a subsequent pregnancy is 50%. Causes of preterm birth include multiple pregnancies, preeclampsia or eclampsia, abnormalities in the placenta, premature rupture of the membranes (resulting from ascending uterine infection), pyelonephritis, certain transmissible sexual diseases, and spontaneous uterine activity. Women with previous preterm labor need an ultrasound examination with measurement of the length of the cervix, at 16-18 weeks monitoring should be carried out to diagnose pregnancy-induced hypertension. If symptoms of threatened preterm labor progress, it is necessary to monitor uterine contractility, tests for bacterial vaginosis; determination of fetal fibronectin can identify women who need more careful monitoring by a doctor.
Previous birth of a newborn with genetic or congenital defects. The risk of having a fetus with a chromosome disorder is increased for most couples who have had a fetus or newborn with a chromosome disorder (diagnosed or undiagnosed) in previous pregnancies. The risk of recurrence for most genetic disorders is unknown.
Most congenital malformations are multifactorial; the risk of developing a subsequent fetus with genetic disorders is 1 % or less. If couples in previous pregnancies have had a newborn with a genetic or chromosomal disorder, then genetic screening is indicated for such couples. If couples have had a newborn with a congenital malformation, then high-resolution ultrasonography and examination by a specialist in prenatal medicine is necessary.
Polyhydramnios (polyhydramnios) and oligohydramnios. Polyhydramnios (excess amniotic fluid) can lead to severe maternal dyspnea and preterm labor. Risk factors include uncontrolled maternal diabetes, multiple pregnancies, isoimmunization, and fetal malformations (eg, esophageal atresia, anencephaly, spina bifida). Oligohydramnios (deficiency of amniotic fluid) often accompanies congenital malformations of the urinary tract in the fetus and severe intrauterine growth retardation.
Pregnancy in patients with Potter's syndrome in a fetus with pulmonary hypoplasia or superficial compression disorders can be interrupted (more often in the 2nd trimester of pregnancy) or end in fetal death.
Polyhydramnios or oligohydramnios may be suspected when the size of the uterus does not match the gestational date or is found incidentally on diagnostic ultrasonography.
Multiple pregnancy. At multiple pregnancy increases the risk of intrauterine growth retardation, preterm birth, placental abruption, congenital malformations of the fetus, perinatal morbidity and mortality, uterine atony and bleeding after childbirth. Multiple pregnancy is detected during routine ultrasonography at 18-20 weeks of gestation.
Previous birth trauma. Injury to the neonate during delivery (eg, cerebral palsy, developmental delay or injury from forceps or vacuum extractor, shoulder dystocia with Erbe-Duchenne palsy) does not increase the risk in subsequent pregnancies. However, these factors should be assessed and not allowed at a subsequent delivery.
However, one should turn to these methods only after carefully weighing all the pros and cons. The probability of miscarriage when taking chorionic villi is 1:100, and when taking amniotic fluid - 1:200. If a woman's risk of fetal damage is greater than the risk of pregnancy loss during diagnostic tests (for example, 1:80), then it is rational to conduct them with the consent of the woman. If the risk of fetal damage is less than the risk of pregnancy loss, the doctor has no right to insist on the use of an invasive diagnostic test. For example, a screening result of 1:300 is a 0.3% chance of fetal damage, which is actually a low rate. At the same time, when collecting lint...
How are examinations for genetic abnormalities and malformations carried out: ultrasound, amniocentesis and others
Are flights dangerous during pregnancy, what month is it better to organize a trip, the rules for "transporting" the belly, and other useful answers to disturbing questions. Pregnancy is shrouded in many different prejudices. Grandmother says that you can’t have a haircut, mom says that you can’t buy a dowry for a baby in advance; we reject thousands of nonsense instructions and continue to lead our usual rich life, continue to work ...
... However, there is no scientific evidence for it. Of course, premature births are not uncommon, they can occur on earth. But it is in the air that there will be no resuscitation for children, a team of doctors and the opportunity to provide qualified assistance. You can find out the risk of preterm birth on an ultrasound by measuring the length of the cervix. Many airlines are imposing restrictions on the flight of women who have a high chance of experiencing the joy of motherhood right on the plane. These include late-term pregnant women, women with multiple pregnancies, and those who already have a history of preterm birth. 2. Lack of oxygen During the flight in the cabin of the aircraft, the oxygen concentration ...
Discussion
I accepted for myself the fact that if the baby has Down syndrome it is better to know about it in advance. It was just at my first screening. And another indisputable fact is that in such suspicious cases it is better to find out everything in advance as accurately as possible, to accept it, to find the strength in yourself to accept it. Raising such a child in the future will be very difficult. Prenetix, by the way, is able to identify a similar problem (and many others) even in the early stages, I did it with them, I remember how everything went. Safe and results are fast. Thank God, at least everything turned out to be in order in the end.
Screening
26.04.2017 22:19:37, LEILAFeatures of the course of diabetes mellitus in pregnant women. Symptoms of diabetes. Treatment of diabetes during pregnancy.
Discussion
I have been suffering from diabetes for 14 years (I got sick at the age of 19). She gave birth to her first child quite a bit prematurely, weighing 3.8 kg. Now pregnant with a second. Glycosylated hemoglobin - 6.2. In the first pregnancy, even 6.1. I generally tend to low sugar as a response to injected insulin. But without it, in any way - very high sugar. Why am I? If diabetes is well compensated, then normal children with normal weight are born. The article writes as if all pregnant women with diabetes have children over 4.5 kg., Edema, etc. Not true! I have a very smart, healthy son, my daughter is also with quite normal weight. Should be born soon. So if you keep diabetes under control, everything will be fine! By the way, I have type 1 diabetes, on insulin. And I eat sweets almost as much as I want. I just clearly and often enough control the level of sugar in the blood and reduce high sugar immediately. But without fanaticism. Gipy - also not autumn good (too low blood sugar). True, the doctor tells me that low blood sugar in the mother's blood does not affect the baby, it affects high if it is not lowered by insulin for a long time. All health and more optimism!
08/08/2018 15:52:48, Irina KhazeI was diagnosed at 35 weeks high sugar. This analysis was done because of my large weight gain (22 kg). There is no protein in the urine, only edema, pressure is normal. What happened with me? Is it diabetes? Can a woman gain that much weight without being diabetic? Everyone says that I have big belly. I have pain in the pubic area and increased tone uterus. But thank God I have a long term and I feel the movements of the fetus. This gives at least some hope that he will be born alive. I'm already sick of going to the doctors, then they are not in place, then there is a large record, etc. And in general they are rude to me. Is it possible to yell at a woman just because she scored excess weight? Especially for a pregnant woman. Like it's my fault! They put me on a diet where to eat last time not later than 18.00. So what? I got out of the hospital and still eat what I want. The only thing is that I drink sugar-reducing tea before meals. Why do doctors love to prescribe diets and insulin so much, completely forgetting about herbal medicine? And further. Insulin must be produced by the pancreas. So it would be nice to write the reasons why insulin itself is not produced. Is it really that hard?
01.11.2007 00:30:15, LanaHow to avoid the threat?
Discussion
Please help. I'm 7 weeks pregnant. And I've had brown discharge for 2 days already. I'm drinking dufaston. I'm afraid of losing my baby. What should I do?
06/09/2016 19:50:30, AidanaHello, I am 15 weeks pregnant, I was already in bed with preservation, now I am worried about pain in my back and lower abdomen, I still have erosion, purulent discharge and something else. I don't know what to do, please help me. Thank you
05/04/2008 10:45:18, DidaraTreatment of SARS during pregnancy
... Children, the elderly and pregnant women are at increased risk. According to different authors, SARS occur in pregnant women with a frequency of 55 to 82%. What is SARS Acute respiratory infections- this is the general name for a number of infectious diseases caused by viruses and bacteria and occurring with symptoms of lesions of the mucous membranes respiratory tract(nose, larynx, trachea, bronchi), and sometimes with ...
Discussion
Well, this is a common topic of SARS. It's just that pregnant women should not be treated with antibiotics, but with something simple, such as hot milk, honey, tea with lemon. It's easier. and everything will pass
Drinking homeopathy is a waste of money. It does not contain active ingredient molecules, only lactose. If there is a lactase deficiency, it will also swell. The disease itself will pass from 2 to 7 days. After does not mean due to. You might as well eat a cucumber and get well. As for the danger to the fetus, it probably makes sense to voice in which trimester this happened ...
25.09.2018 22:20:45, NinaVa
Discussion
"The frequency of examinations should not be less than 10-12 times." A scarecrow appeared in our city: what if the number of entries in the dispensary book ( exchange card) will be less than 12, then they will not issue a birth certificate :) On this occasion, many women like me, who, due to constant hospitalization, say, by 22 weeks, have only 2 records, were somewhat puzzled. In the regiment I was reassured that this was invented by bureaucrats who had little idea of the process of observing women. After all, there are those who are immediately hospitalized until the birth and they will have only a couple of epicrises and 1 entry in the exchange office.
Ideally, this doctor's office should be visited during pregnancy preparation. If the future parents have not done this, then the couple should consult a geneticist in cases where there is increased risk the birth of a child with a hereditary pathology. We list the circumstances that may be the reason for seeking advice from a geneticist. the birth of a child with hereditary diseases ...
...After talking with future parents and receiving test results, the geneticist determines the degree of genetic risk for each particular family. Genetic risk is the probability of occurrence of a certain hereditary pathology in the person who applied for a consultation or in his descendants. It is determined by calculations based on the analysis of genetic patterns, or using the data of the analyzes performed. The ability to calculate genetic risk depends mainly on the accuracy of the diagnosis and the completeness of genealogical data (data on the families of spouses), therefore married couple must...
Discussion
Hello, please help me understand. They put the risk for Down syndrome 1: 146. KTP 46 mm, TVP 2.0 mm. Visualization of the nasal bone +. There are no features of the anatomy of the fetus. Chorion: localization along the anterior wall of the uterus. pregnancy. High risk with these indicators of fetal disease? Missed pregnancy at 5 weeks in 2015
10/25/2016 11:22:59 PM, ValeriaHello. My husband and I are planning to undergo a genetic examination before conception, because. my husband's older brother has some kind of mental illness. Their parents are stubbornly silent and do not want to talk about this topic, and find out that it is not possible with the elder, and I am frankly afraid that because of such a close relationship this problem may affect us ... Please tell me where in Moscow you can to pass or take place such inspection, and whether probably in general to define or determine hereditary it unknown mental disease? In advance thanks a lot!
Good afternoon I found this appeal in your blog, and I have a similar question. I will wait for an answer!
The causative agents of childhood infections (more often these are viruses) have a high ability to cause disease and are transmitted by airborne droplets from a sick person to a healthy person when sneezing, coughing, breathing. It should be noted right away that the risk of contracting childhood infections during pregnancy is not higher than in non-pregnant women. However, the manifestations of such acute infectious diseases during pregnancy have a number of features: firstly, in most cases they proceed non-specifically, which makes diagnosis difficult; secondly, the causative agents of childhood infections (viruses) penetrate the placenta into the blood of the fetus, so they can disrupt the development of tissues and or...
Discussion
Hello! I read your article about childhood infectious diseases during pregnancy. Interested in information about whooping cough during B? Could you tell something? I got whooping cough at 8 weeks B, while they found out that two weeks had passed with me, at 10 weeks B, I drank Vilprafen, the doctors reassure me that nothing should affect the child, but I'm still very scared for the baby. It’s not possible to consult with various infectious disease specialists (((According to ultrasound and screenings, everything is fine, now it’s 27 weeks B. It’s still very scary for the baby, he poor has suffered before he was born !!! And another question about scarlet fever ... for the older child in the garden (not in our group yet!) quarantine for scarlet fever, I'm afraid to take him to the garden (even more because of my pregnancy), leave him at home or take him to the garden? maybe scarlet fever at 27 weeks B? I can't take a second infectious disease in B!! Thanks in advance for your reply!
During this period of the life of a thrombus, there is a very high probability of a part of it being torn off, which can be transferred with the blood flow to the chambers of the heart or, most dangerously, to the pulmonary arteries. Blockage of even small branches of the pulmonary artery can lead to the exclusion of part of the lung from breathing, which is a direct threat to life. During pregnancy, vein thrombosis is not uncommon, therefore, at this time, the efforts of doctors are aimed at identifying the risk of thrombosis, prescribing preventive measures. However, the following situation often develops: the birth went well; it would seem that everything is over, the danger has passed, no more prevention is required. But it is at this time that the risk of late complications of pregnancy and childbirth of postpartum thrombosis increases. Causes of thrombosis First of all, r...
Why is gestational diabetes dangerous during pregnancy?
Where does fibroid come from and how to treat it?
...Figures and facts 4% of pregnancies occur against the background of uterine fibroids. At the same time, in 50-60% of cases, slight changes in the size of myomatous nodes are observed: according to various scientists, 22-32% of pregnant women have their growth, and 8-27% - a decrease. During pregnancy occurring against the background of uterine fibroids, complications are observed in 10-40%. These are abortion, premature birth, fetal damage and malnutrition (stunting). Yet most pregnancies with uterine fibroids proceed normally. Quite often, the nodes prevent the proper contraction of the uterus during childbirth, so about half of pregnant women with uterine myoma are sent for caesarean section.
What is placental insufficiency - treatment and prevention
Let's see if this is true, shall we? Repeated births with a scar on the uterus mostly pass without any special complications. However, in 1-2% of a hundred such births may end in partial or complete rupture of the suture. Other studies have estimated the chance of uterine rupture at 0.5%, provided that labor was not initiated medically. Also, one of the factors that increase the risk of rupture, according to some reports, is the age of the mother and too short an interval between pregnancies. Divergence of the suture on the uterus repeated births- potentially dangerous state, for both mother and child, and requires immediate surgical intervention. Fortunately, uterine rupture, if the operation was performed with a horizontal incision in its lower segment, is a rather rare phenomenon, which occurs in less than 1% of women giving birth ...
If there is no certainty that a weakened child will endure birth stress, a caesarean section is preferred. Prevention of FPI It is necessary to think about the well-being of the unborn child even before pregnancy. It must be remembered that abortions, injuring the uterus, can later lead to violations of the uteroplacental circulation. During pregnancy, it is better to strongly refrain from smoking and drinking alcohol, contact with toxic substances and radiation sources - especially in early pregnancy, when the placenta is forming. It is necessary to timely (and better - in advance) treat infectious diseases and possible foci of infection, such as carious teeth or chronic tonsillitis. To all expectant mothers without exception...
... It is necessary to treat infectious diseases and possible foci of infection, such as carious teeth or chronic tonsillitis, in a timely manner (or better, in advance). All expectant mothers, without exception, are recommended to take multivitamin preparations for pregnant. Sometimes high-risk pregnant women (too young; women over 30 expecting their first child; suffering from chronic diseases; who have given birth to small children in the past; with long intervals between pregnancies) are recommended courses drug prevention FPI for up to 12 weeks, 20-23 weeks and 30-32 weeks, which include vasodilators and vitamins. Separated Consequences How ...
Discussion
Very informative. They did CTG for me, but we were told the scores (from 0 to 10), and not the heart rate of the child.
Also: there are rare cases when the cycle lasts not the "usual" 28-36 days, but more, then you have to prove that you are "not a camel". My two babies were given IUGR 2 weeks behind. And according to ultrasound in dynamics and according to CTG, everything was also in dynamics, but ultrasound showed a delay just for my two weeks and for some reason the doctor did not want to hear about my native even 43 day cycle. In general, the babies were born on their due date, and not set for a 28-day cycle (I don’t remember what this lag is called, but in general, this is an imaginary lag). And although the babies were born with a weight of exactly 3.0 kg each, there was no IUGR. But, my case is an exception :).
Every time we decide to get pregnant, we take a certain risk. This risk can be eliminated and unavoidable. Unavoidable risks include ACCIDENTAL genetic changes and some chronic diseases. The area of avoidable risks is much wider. Pre-pregnancy studies of the state of your body will in many cases significantly (very significantly!) Reduce the risk of an unfavorable outcome. Here we are talking about miscarriages, and missed pregnancies, and about birth ...
Discussion
There has become a lot of information, it must be laid out separately and categorized.
I started hosting www.planirovanie.hut2.ru, while it is not available, but by Monday, I hope, I will start uploading it.
Preparation for pregnancy. What should be included in the consultation for a planned pregnancy:
Folic acid prescription: 400 mcg per day. For diabetes and epilepsy, 1 mg per day, 4 mg for women with children with neural tube defects.
ethnic history.
Family history.
Tests for HIV, syphilis.
If necessary, immunization against hepatitis B, rubella, chickenpox.
Discussion of ways to prevent infection with CMV, toxoplasmosis, parvovirus B19.
Discussion of factors harmful to pregnancy in everyday life (pesticides, solvents, etc.), as well as at the place of work of a woman. A special form from the employer is desirable.
Discussing issues of alcohol abuse and smoking. If necessary, help in the rejection of bad habits.
Clarification of medical problems:
Diabetes - control optimization.
Hypertension - replacement of ACE inhibitors, angiotensin II receptor antagonists, thiazide diuretics with drugs that are not contraindicated in pregnancy.
Epilepsy - control optimization, folic acid - 1 g per day.
Deep vein thrombosis - replacement of coumadin with heparin.
Depression/anxiety - exclude from drug therapy benzodiazepines.
Avoid overheating (avoid hot baths, saunas, steam rooms).
Discuss problems of obesity and excessively low weight (if necessary).
Discuss possible problems with a shortage of necessary nutrients in vegetarians, women with milk intolerance, lack of calcium and iron.
Warn about the need to avoid overdose:
Vitamin A - (limit - 3000 IU per day)
Vitamin D (limit - 400 IU per day)
Caffeine (limit 2 cups of coffee and 6 glasses of caffeinated drinks (coca-cola) per day)
__________________
When registering and further managing pregnancy in Russia, the following examination must be performed:
-dab on Gn and trich
-RW, f-50, HbSAg, HCV,
-an. blood vol.
-an. urine
-feces on i \ worm
- examination for toxoplasmosis, CMV
- sowing on ureaplasma and mycoplasma
- test for chlamydia
- consultations of specialists: therapist, ENT, dentist, ophthalmologist; the rest according to indications
There is no hiding from this examination, there is an order of the Ministry of Health No. 50, all of Russia is working on it.
Hi all! I still won’t leave the next conference for you, I’m just afraid, because. Failed 2 times. Now, too, not everything is going smoothly, but I'm still on another issue. The thing is, I have a deadline. on monthly and on US differs. If according to the monthly, according to the standard calculation (LPM on January 26), it should be 11 weeks and 4 days today, then according to the ultrasound it turned out 10 weeks 5 days. There is an ultrasound of April 14 (term 10 weeks 3 days). The doctor, when she saw him, said that it was too early for screening and you would come for an ultrasound on April 25, and for ...
Discussion
Here is the info about the first screening. About everything, including timing.
Pregnancy-associated plasma protein-A. In prenatal screening of the first trimester of pregnancy, a risk marker for Down syndrome and other fetal chromosomal abnormalities.
PAPP-A is a high molecular weight glycoprotein (m.v. about 800 kDa). During pregnancy, it is produced in in large numbers trophoblast and enters the maternal circulation, its concentration in the mother's serum increases with increasing gestational age. Based on their biochemical properties, PAPP-A is classified as a metalloprotease. It has the ability to cleave one of the proteins that bind the insulin-like growth factor. This causes an increase in the bioavailability of insulin-like growth factor, which is an important factor fetal development during pregnancy. It is assumed that PAPP-A is also involved in the modulation of the maternal immune response during pregnancy. A similar protein is also present in low concentrations in the blood of men and non-pregnant women. The physiological role of PAPP-A continues to be explored.
A number of serious clinical studies indicate the diagnostic significance of PAPP-A as a screening marker for the risk of fetal chromosomal abnormalities in early pregnancy (in the first trimester), which is fundamentally important in the diagnosis of chromosomal abnormalities. The level of PAPP-A is significantly reduced if the fetus has trisomy 21 (Down syndrome) or trisomy 18 (Edwards syndrome). In addition, this test is also informative in assessing the threat of miscarriage and termination of pregnancy in the short term.
An isolated study of the level of PAPP-A as a marker of the risk of Down syndrome has diagnostic value, starting from 8-9 weeks of pregnancy. In combination with the determination of beta-hCG (human chorionic gonadotropin), the determination of PAPP-A is optimally carried out at a period of about 12 weeks of pregnancy (11 - 14 weeks). After 14 weeks of gestation, the diagnostic value of PAPP-A as a risk marker for Down syndrome is lost. It has been established that the combination of this test with the determination of the free beta subunit of hCG (or total beta-hCG), ultrasound data (nuchal thickness), assessment of age-related risk factors significantly increases the effectiveness of prenatal screening for Down syndrome in the first trimester of pregnancy, bringing it to 85 - 90% detection rate of Down syndrome at 5% false positive results. The study of PAPP-A as a biochemical marker of congenital and hereditary pathology in the fetus in combination with the determination of hCG at a period of 11-13 weeks of pregnancy is currently included in the scheme of screening examinations of pregnant women in first trimester.
The detection of deviations in the levels of biochemical markers in the mother's blood is not an unconditional confirmation of fetal pathology, but, in combination with the assessment of other risk factors, it is the basis for the use of more complex special methods for diagnosing fetal anomalies.
Indications for the purpose of the analysis:
Screening examination of pregnant women to assess the risk of fetal chromosomal abnormalities in the 1st and early 2nd trimesters of pregnancy (11 - 13 weeks);
Severe complications of pregnancy in history (in order to assess the threat of miscarriage and stop the development of pregnancy in the short term);
The woman's age is over 35;
The presence of two or more spontaneous abortions in the early stages of pregnancy;
Bacterial and viral (hepatitis, rubella, herpes, cytomegalovirus) infections transferred during the period preceding pregnancy;
The presence in the family of a child (or in history - the fetus of an interrupted pregnancy) with Down's disease, other chromosomal diseases, congenital malformations;
Hereditary diseases in close relatives;
Radiation exposure or other harmful effects on one of the spouses before conception.
Preparation for the study: not required.
Material for research: blood serum.
Method of determination: immunoanalysis.
Girls, hello everyone! I recently asked you for advice on how to support yourself in the early stages before a visit to the doctor. Finally got in yesterday. Outcome: 6 weeks. 2 days, continue treatment. HOORAY! Thank you for your advice. Now here's what I'm thinking. I am 36, I want to do everything right and give birth to a child without diabetes. The doctor says that non-invasive diagnostics is, of course, good and the only question here is money. But screenings still need to be done, because. while there is not enough accumulated in non-invasive diagnostics ...
Discussion
Good afternoon I don’t really understand the doctor’s position, the fact is that screenings and a non-invasive test are fundamentally different. Screenings are probabilities, they do not make any diagnoses, since all results can indirectly indicate pathologies. Non-invasive screening is the isolation of the child's blood from the mother's blood and the study of the child's DNA from these cells. Accordingly, the result is more accurate. I write more, because they have an error in very small cases, but in general they are accurate. The most accurate methods are invasive. I would do a non-invasive screening right away.
02/07/2019 13:06:39, Svetlana__1982Donov ultrasound, excellent doctor. For example, I saw my third large teeth in the gums on the second ultrasound, while I have ordinary ones, and my husband and older children have large ones - he didn’t know this!
About the analysis, now there is some kind of super-duper blood test in the PMC, they definitely did it a year ago.
Well, I just can’t resist talking about the meaning of life ... If you are not ready to accept what life gives you, keep in mind that it will still force you to accept something, which is very repulsive, and the degree of rejection, unfortunately, will be higher each time (
Girls, I would like to hear opinions, maybe there are among you who had 3 caesarean sections. We are thinking about another baby, well, we really want to. But I am 40 years old and already had 2 caesarean sections, the last 7 years ago. The gynecologist said that there are very big risks. What do you think?
Discussion
There were 4 cesareans. 4th 2 weeks before my 43 years old .. I brought everyone to the end (a week before the deadline they were scheduled to get it), but I’m large, and the children were standard, mb lucky in this .. The risks are big after 40 according to Down and it’s not easy for you it will most likely be due to health (in 30 years everything is different, much easier). Usually they scare everyone, and then there’s just nowhere to go and everything becomes normal .. You can also somehow see the viability of the seam, why you are so afraid for it .. I know people and 6 times Caesar (mostly believers), somehow withstand All..
I had three cesarean sections, I still think about it, but the doctors say there is a risk, but after the third one everything was fine
12/19/2018 02:12:00 PM, Oksana AstrelinYesterday they called me at home and told me to come urgently to the clinic - the results of the first screening came. I’ll omit about the sleepless night, perhaps, because I want to rely on facts. The gynecologist did not answer the questions, said that this was not about her part and redirected. The numbers are: The risk of having Down syndrome is 1:325 Mom according to HCGB- 3.10 according to PAPP-A 2.1 It is written that the limits for Mom are from 0.5 to 2.0, but I get 3.1, is it really much higher than the norm? What is the upper bound when the threshold risk goes to...
Discussion
Most likely nothing to worry about. Your HCGB is indeed elevated, but with Down syndrome it is usually in combination - PAPP-A is reduced. And yours is even slightly higher than normal. The program considers you a threshold risk due to elevated HCGB, although there are many other reasons for its increase, not only chromosomal problems. And what do you have on the ultrasound? Collar space, nasal bone?
It was 1 to 300 everything is ok. girlfriend 1k 180 everything is ok. the second girlfriend has 1 to 80 and amnio - everything is ok! @@@ [email protected]@@[email protected]@@[email protected]@@@@@
Girls, who did it? My gynecologist said that they only do it if the blood test for Down came up bad. I visited a geneticist, so she silently, without telling me anything, wrote that she recommends a puncture. Next week I'm going to the doctor, the result of a blood test for Down should already come. So I'm sitting all in confusion ... Who did they do it to? Who knows what?
Discussion
I did it on April 15 at the perinatal center at the 27th maternity hospital near Sypchenko. The indications are poor screening and age (I am 40 years old).
05/04/2010 13:27:19, MakhryutaThanks for answers. My due date is 21-22 weeks. I will talk to the geneticist again, on the basis of which she recommends me. I have all the tests, ultrasounds are good, only age. I am already 37 years old. I think that, probably, only by age and directs .... (((
Women who are overweight and obese are more likely to experience pregnancy complications and have an increased chance of having a baby with birth defects, warn the authors of a report published by the Public Relations Committee of the Teratological Society of the United States. According to the report, overweight women are more likely to suffer from infertility and pregnancy complications such as hypertension, cardiovascular disease and diabetes. Physicians are more likely to...
Pregnant women with periodontitis are more likely to late toxicosis- preeclampsia, informs the Journal of Periodontology. Studies have shown that 64% of women suffering from periodontal disease were diagnosed with preeclampsia, and 36% of the study participants had an uneventful pregnancy. Preeclamptic mothers-to-be have been noted to have more severe gum disease. As part of the study, women were tested for Eikenella bacteria ...
Please advise. I went to the first ultrasound, they determined the pregnancy of 4-6 weeks. The doctor who did the ultrasound said there was a risk of miscarriage, but did not explain why. The gynecologist prescribed duphaston, buscopan suppositories and vitamin E. The annotation says that buscopan should be taken with caution during pregnancy, the rest, in principle, too. Can, in fact, I have a risk of miscarriage (I'm 26 years old, nothing hurts, I don't bleed) or are doctors playing it safe? Isn't it bad...
Discussion
good luck to you! @@@ [email protected]
Girls! I went again to the same doctor, as it was necessary to take all the tests that were ready today. Once again I asked her about the threat, she said that there was no detachment and tone, but the shape of the fetus, which should be round, was oblong. The diagnosis sounds: pathology of fetal development. Once again she said that she needed to take medicine. The analyzes are all right. Again I don't know what to do. Perhaps I am wasting my time looking for another doctor.
02/03/2012 08:50:58, EvaKGirls, Good evening! I will gladly join you, if you accept of course). I am 40 years old, B 14 weeks now, twins. I myself am still in shock, we don’t have such a husband in our family. I have an 18 year old son from my first marriage. I had an ultrasound at 12 weeks for screening, everything was normal. A blood test is now ready and a blood test. Down's syndrome (only for biochemistry) high risk 1:94, risk limit 1:250. The rest is low risk, they gave a referral to genetics. I read information that with twins, blood screening does not ...
Discussion
Do an amnio. You will know for sure.
I was done at 16 weeks, SVS.
08.11.2013 23:45:05, masha__usaI was in your situation 1.5 years ago. I had an even higher risk than you, 1:53, only for Edwards syndrome. And I was only 33 years old. I did a biopsy of the placenta at 14 weeks on the recommendation of a geneticist. Suspicions were not confirmed, fortunately. But it is quite possible that because of this invasive procedure, my son is not quite healthy in neurology. If I were you with twins, I wouldn't risk it and hope for the best.
What pathologies can occur in a child as a result of stress during pregnancy (for example, a mother experienced a break with her beloved, or problems at work, or just had a fight with her parents forever!) ... How dangerous is this for the unborn child? (I asked the same question in "Pregnancy and childbirth" - but here I hope to hear the opinion of a specialist or links to medical articles)
Discussion
I am an expert, so my opinion is amateurish, but I have my own experience. The first pregnancy was very nervous, I had to hide the pregnancy, my husband could not get a divorce from his first wife and my father kicked me out of the house. The child was born normal, as I later realized, not even very noisy. The second pregnancy proceeded in absolute peace of mind, there was not even any unrest at work, since I was sitting at home. And the baby was born restless, with-hands-not descending.
The child has the type of nervous system that he inherits from his parents. After all, it often happens that the same parents have completely different children: one is completely calm, the other is hyperactive with scattered attention. That is, what is pledged is pledged. So it doesn't depend on stress. IMHO If, during pregnancy, a woman endures prolonged stressful situations, it all depends, in my opinion, firstly, on the type of nervous system of the woman herself, secondly, on her state of health at the current moment, and, thirdly, on the attitude of the woman herself women to what happened. And since any stress can cause unpredictable consequences for human health (from a headache to a heart attack), it is precisely the peculiarities of the course of these consequences in a pregnant woman that will affect the fetus. The consequences can be different and are known, probably, to everyone. These are mainly vegetative-vascular disorders: increased pressure, seizures panic attack, palpitations, headaches, lack of appetite, insomnia, depression, etc. This, in turn, can cause (as in a chain reaction) complications during pregnancy and even the threat of miscarriage. It seems to me that mother nature tried to protect the nervous system of a woman from such things during pregnancy. If the pregnancy is desired and the child is long-awaited, then this is so positive emotion for a woman, that she endures many stressful situations much easier. So, I think there will be no pronounced pathologies in a child born to a mother whose pregnancy proceeded in stressful situations, but without complications and consequences for her health. If, as a result of these stresses, the mother's health deteriorated and, as a result, complications arose during pregnancy, then the answer is obvious - there will be deviations, but not necessarily in the development of the child's nervous system. Here, everything will depend on the stage of pregnancy at which these stressful situations that led to the illness of the mother were.
My sister-in-law is offered to undergo a study: a puncture of the amniotic fluid. Motivated by the fact that her age is 36 years. Childbirth 2nd. I would like to hear the pros and cons. Who faced it? She needs to decide whether or not to puncture.
Discussion
Thanks to all who answered! The question is really very important. And forgive me for opening up the wounds and making me nervous again. Health to you and your children!
I did 2 times (in 2 and 3 pregnancies).
The first pregnancy was 10 years ago, there were no screenings at that time. The girl is healthy and smart. They really wanted a second child, but could not zaB., I was stimulated, zaB. in 2008 The pregnancy was very difficult: on hormones, low placentation, tone, bled once, lay on conservation.
But according to the ultrasound, at first everything was fine with the child: at 12 weeks - the collar zone (one of the SD markers) was normal, at 16 weeks - the ultrasound was normal. 1st screening was elevated, 2nd screening was normal.
At 18 weeks, I decided to have an amniocentesis, but my husband and parents were against it - everyone was afraid of a miscarriage. After 2 weeks, the result came - a child with diabetes. They did an ultrasound (it was already 20 weeks old) - there were changes in the heart, enlarged pelvises, the child began to lag behind in terms. They said it would only get worse. Uzi reworked into different places(without voicing the diagnosis obtained after amniocentesis). The geneticists said it was a spontaneous mutation. I was then only 32 years old.
Now I'm pregnant again! Zab. alone, without hormones.
My husband and I went for a consultation to the Institute of Genetics on Kashirskoye Highway. They said that the risk of screenings would immediately be increased, tk. there was such a situation in the past. On ultrasound chromosomal pathologies you may not see it. Knowing myself that I will fray all the nerves for myself and the child, I decided to have a chorion biopsy at 10 weeks. I was madly afraid, because again afraid of losing the child. Everything went well - the child is healthy. Now I sleep peacefully at night, I go and enjoy my pregnancy, I have not taken any screenings.
If your sister-in-law does not panic if you receive bad result screening (or will not take them at all), if she will give birth in any case, then you can not do amniocentesis. It depends on her inner mood, on her attitude to all this.
Moreover, amniocentesis (collection of amniotic fluid is considered) is the safest, and chorion biopsy (collection of chorion particles) is the most dangerous, because. little time.
I did no-shpy injections 2 days before and after the procedure and inserted papaverine suppositories. 1 case in the Center for Psychological Prevention and Rehabilitation in Sevastopolsky (doctor in charge of the department - Gnetetskaya), 2 times in the perinatal center at the 27th maternity hospital (doctor in charge of the department Yudina).
Good luck! Health to your sister-in-law and baby! Everything will be fine!!!
Has anyone taken atenolol? I have a brutal arrhythmia with extrasystoles .. It seems to be giving birth in special. maternity hospital is necessary: (((((. And they write about atenolol that it is necessary to take it with caution .. and if the benefit for me is higher than the risk for the baby. Now I'm afraid ...
Received today the result of the second screening. The first one was perfect, I relaxed and drove for a week after the result. And then they doused it with ice water. High risk of Down syndrome 1:30. The first screening is 1::2200, although I am 36 years old, it should be 1:290 by age. In general, I’m still in shock, my doctor for Oparin is on vacation (only for an appointment on August 8), until that time you can move your mind. I looked at the markers, the problem is in hcg. I'm in the morning, maybe, of course, it also affected ... I'm afraid to do amniocentesis ...
Girls, hello. Here was today at the doctor in ZhK. The result came from the second screening (the first screening was good), a high risk for Down syndrome, the calculated risk is 1: 160, I am now 20 weeks old, I called at 17 p.m. (I was given a referral to a genetics consultation), they said that the appointment was only for On July 1, and at that time, the geneticist no longer consults. Who should I contact, no one will advise a competent specialist in order to finally understand everything? I know that I will...
Discussion
Many doctors say, including Voevodin, that the first screening is most indicative of Down syndrome, and not the second.
I had a similar situation, the first screening was good, the second was bad for Down syndrome, everything darkened in my eyes from such news - shock, tears. I’ll give up the child. They wanted to withdraw a small amount of water, but I wrote a refusal and didn’t even visit genetics. I went for an ultrasound to a specialist in the Voevodin syndrome, at that time, somewhere in October, he worked at the Planet of Health, showed me everything, explained and said that I shouldn’t take a steam bath and don’t take water because this procedure carries a high risk of miscarriage. And my gynecologist said that such screenings have become more frequent, but absolutely everyone gives birth to healthy babies. The laboratory mows down, and the result often depends on many factors - excess weight, even from the products that they ate the day before. I can perfectly understand you anyway, after such news, I could not fully enjoy the expectation of a miracle, even when they didn’t bring me a child on the first day, I thought that the doctors were hiding something. But my baby is just relaxing after a difficult birth. Go to Vojvodina.
Today I visited a geneticist at the TsPSiR in Sevastopol. The doctor suggested a study of amniotic fluid, I agreed. I was surprised when I found out that the study is carried out even without local anesthesia. I ask those who have passed the same research to respond. Please tell me how painful it is and how quickly you recovered.
Discussion
Mytil, this study is not very painful, it looks like an injection or blood sampling from a vein. Anesthesia is not required. But rest is needed for a few days. Immediately after the procedure, they are left in the ward for 2-3 hours, and then you can go home, lie down, and relax.
I have great respect for the specialists of the Center for Social and Social Development, and I thank them for their help. However, I cannot but be surprised that it is in this institution that the indications for cordocentesis (analysis of cord blood, results in 5-7 days) and amniocentesis (analysis for amniotic fluid, result in 2-3 weeks) due to different features in the results of ultrasound and blood tests, almost every pregnant woman is prescribed. I have an assumption that the geneticists working there write dissertations, and this requires research statistics.
Do an analysis if you are restless - half the pregnancy to live in anxiety is an even greater risk for the baby. I wish you everything goes well.
As for the topic...
She herself went through this 3 times, and if it was still required, she still went through it.
The first time there were also deviations triple test. After amniocentesis, it was necessary to do cordocentesis (the same puncture, only blood from the umbilical cord is taken for analysis). They found that the placenta is slightly mutated, hence the discrepancies in the analyzes. But after the analysis, there is complete confidence that everything is in order. "The child has a genetic passport that there are no gene deviations 99.9%" (c)
Third time in my second pregnancy. The analyzes are also slightly outside the norm. And I went through it again.
As for the procedure itself, it is almost painless, they ask me to lie down for 2 hours after that, they do a control ultrasound and, if everything is in order, they send me home. On this day, they give sick leave, and the next. day to work is possible. The first 2 times the procedure took 20 minutes (in 2002), the third time - 5 minutes (probably already filled with a hand).
IMHO I wouldn't be able to do otherwise. It is my choice.
Received today analysis. "high risk of down syndrome" ......... 1 to 197 ......... The doctor said: "redo the screening, suddenly the error of the laboratory" . I did the screening in Art-med, I have a doctor in another clinic, and I will redo it in it. I'll go on Monday. Keep your fists..........
Discussion
With my second son, I had almost the same screening result of 1:175. But I found out about it by the time the second screening came up. I didn’t do the second one, I went for an ultrasound to Malmberg (I think it’s spelled that way) - she is an excellent specialist in developmental anomalies - the ultrasound showed that everything is fine. I also went to a geneticist - he asked everything about hereditary diseases, bad habits and said that this was most likely a false positive. result. Also, in the initial stages, I took duphaston, the doctor said that he could have an effect. She explained that they take the mother's blood and try to determine what is happening with the child. This is a VERY unreliable analysis, which can be influenced by a bunch of factors. In short, I didn’t worry anymore, everything is fine with the child.
My risk was much higher. She refused amnio, but when the second screening was done, the result was even worse. Did for fidelity in two different places. I had a cordocentesis at 22 weeks. 3 minutes, not painful and not scary. They did it in RD 17, head of the department of genetics. I got there in the direction from the LCD. In the end, everything is fine. But my nerves to wait until the birth of a child would not be enough. And for sure, it would be worse for the child.
Relevance this issue V Lately everything is more obvious:) Girls, don't be lazy, connect! Pregnancy FAQ Managers, please include the collected statistics in the FAQ. So. Please look into your documents and see all 1st trimester screening figures. I explain: this is an ultrasound in terms of 10-13 obstetric weeks(from menstruation) and blood for PAPP-A and free betta hCG. 1) Gestational age 2) TVP ( collar space) by ultrasound 3) Result of PAPP-A in units (and norms in brackets) 4)...
Discussion
Hello. Help dispel my worries about the results of 1 screening.
I am 37 years old, we are on the 5th, there was no birth. Previously, there were 2 deputy pregnancies, ectopic and after an accident (2009) long treatment and rehabilitation (this is all that is indicated in the anamnesis). According to genetics, a predisposition to Thrombophilia, but none of the relatives was noticed. I give Enoxaparin 4000 injections 1 injection per day. Dufaston 1 tab. 3 times a day.
The results of 1 screening came yesterday. Although the doctor warned on the ultrasound that the blood would definitely not be ice with age and taking Duphaston, but the main thing is that according to the ultrasound, everything is fine with us.
1) The term was set at 12 weeks 3 days (everything is the same day to day) both according to ultrasound and DPM.
2) TVP -2.1 mm, CTE -61 mm, BPR - 19 mm, OG - 73 mm, coolant -58 mm, Chorion - low on the back wall, Nasal bone - is determined, no fetal pathologies were detected by ultrasound, the length of the church canal was at 10-11 weeks 35-36mm, at the time of ultrasound 39mm.
3) PAPP-A 3.340 IU/l
4) PAPP-A 1.494 MoM
5) betta hCG 22.00 IU/l
6) betta hCG 0.584 MoM
Uterine arteries PI: 1.490 or 0.937 MoM
7) Trisomy 21 Base Risk 1:145, Individual adjusted risk 1:2906
Trisomy 18 Baseline risk 1:350, Individual adjusted risk 1:7000
Trisomy 13 Baseline risk 1:1099, Individually adjusted risk Pre-eclampsia before 34 weeks 1:1288
Preeclampsia up to 37 weeks 1:244
Growth retardation up to 37 weeks. 1:720
Spontaneous delivery up to 34 weeks. 1:1461
8) At the time of the research on 08/08/18 (12 weeks and 3 days):
- Defects and anomalies of the fetus - NOT DETECTED
-Risk of fetal chromosomal abnormalities - INCREASED
- Risk of preeclapsia and fetal growth retardation -LOW
Pregnancy 2a, 29 years old, first with a healthy boy. Real 13 weeks 3 days, TVP 1.8. By Uzi nasal bone 1.6. But the ultrasound was redone the next day and the nasal bone was 2.2 mm, KTP 64MM. And the blood data and risks were calculated for the 1st ultrasound: B-hCG 44.01 IU / l / 1.336 MoM (norms not indicated), PAPP-a PAPP-2.719 IU/l/0.597 MoM...equipment BRAHMS kryptor. Trisomy 21 baseline risk 1:724, individual 1:42, others do not exceed
13.02.2018 19:21:01, [email protected]Health experts have long been saying that women should take at least a two-year break between births, but a new study suggests that this is not enough. Several recent studies show that babies born three to five years after previous births are less likely to be born prematurely or underweight than those born after a shorter interval. The increase in the break between children is also beneficial for mothers ...
At present, the optimal mode of delivery for infected women has not been fully determined. To make a decision, the doctor needs to know the results of a comprehensive virological study. Natural childbirth includes a whole range of measures aimed at adequate pain relief, prevention of fetal hypoxia and early rupture of amniotic fluid, reduction of birth canal injuries in the mother and skin baby. Only when all preventive measures are observed ...
Discussion
Absolutely agree. Unfortunately, at the moment there is no consensus on the safest management of childbirth with hepatitis C. According to statistics, the likelihood of a child being infected with hepatitis is slightly lower with a planned caesarean section than with natural childbirth. However, none of these methods can guarantee the safety of the child in terms of infection with hepatitis. Therefore, the choice of method of delivery is based more on the obstetric history than on knowledge of the presence of this infection.
Any person who is preparing to become a parent wants his child to be healthy, so that the pregnancy goes as smoothly and easily as possible. And possible threats come not only from external negative factors, but also from internal ones, and one of them is genetics. All biological characteristics that are inherited are contained in the 46 chromosomes that make up the genetic set of each person. These chromosomes contain encrypted information about many, many generations of the genus...
The most common complications associated with twin/twin/triple pregnancy are: Premature birth. Low weight at birth. Retardation of intrauterine development of the fetus. Preeclampsia. Gestational diabetes. Placental abruption. C-section. premature birth. Births that occur before the 37th week of pregnancy are considered premature. The duration of a multiple pregnancy decreases with each additional child. On average, a pregnancy with one baby lasts 39 weeks ...
Recently, the number of women who decide to give birth to their first child after 35 and even after 40 years is growing. And if earlier women who gave birth after 28 years were already considered “old-timers”, today this does not surprise anyone. IN modern world many women postpone the birth of children indefinitely because they first want to achieve career success, improve their financial situation, stabilize their personal lives, because now marriageable age also increased. Due to the fact that under...
Discussion
Hello Olga!
I really liked your article about late children. So detailed and very well built logically. And most importantly - so well conveying my own thoughts. I also gave birth to a child at almost 40 and do not regret it at all. I think if I had given birth earlier, there would have been more problems and much less satisfaction. I hope you raise this topic in your blog more than once, and we will read and comment :-) Therefore, I subscribe to your RSS feed. Thanks again!
Over the past decades, life has made significant changes in the relationship between the doctor and the patient. Currently phrases like; “The doctor forbade me to give birth!” - evoke a smile and seem borrowed from women's magazine middle of the last century. Now doctors do not “prohibit” anything, and even if they did, the patients, it seems, would not be in a hurry to follow such directives. A woman has the right to independently decide the issue of motherhood - this is evidenced by the current legislation and common sense. Meanwhile, it should be noted that over these decades, health indicators female population Russia has not become much better. In addition, the proportion of older women in childbirth is increasing year by year - modern woman often seeks to first strengthen their position in society and only then have children. It is no secret that over the years we do not get younger, and accumulate a number of chronic diseases that can affect the course of pregnancy and childbirth.
Igor Bykov
Obstetrician-gynecologist
Modern science knows several thousand diseases. Here we will talk about the diseases that are most typical for women of childbearing age, and their impact on the course of pregnancy.
Hypertension 1 is one of the most common chronic diseases among young women. Manifested by vascular spasm and a persistent increase in blood pressure above 140/90 mm Hg. In the I trimester, under the influence of the natural factors of pregnancy, the pressure usually decreases somewhat, which creates the appearance of relative well-being. In the second half of pregnancy, the pressure increases significantly, pregnancy, as a rule, is complicated by preeclampsia (this complication is manifested by an increase in blood pressure, the appearance of edema, protein in the urine) and insufficient supply of oxygen and nutrients to the fetus. In pregnant women and women in labor with hypertension, complications such as premature detachment of a normally located placenta, postpartum hemorrhage, and cerebrovascular accident are not uncommon. That is why patients with severe hypertension (a significant increase in blood pressure) are sometimes recommended to terminate the pregnancy at any time.
If the risk is low, the district gynecologist observes the pregnancy together with the therapist. Treatment of hypertension during pregnancy is mandatory and differs little from the treatment of hypertension outside of pregnancy. Delivery, in the absence of other indications for surgery, is performed through the natural birth canal.
Arterial hypotension 2 quite common in young women and is manifested by a persistent decrease in blood pressure to 100/60 mm Hg. and below. It is easy to guess that problems with hypotension begin in the first trimester, when blood pressure already tends to decrease.
Complications of arterial hypotension are the same as in hypertension. In addition, during pregnancy there is often a tendency to overbearing, and childbirth is almost always complicated by the weakness of the birth forces.
Treatment of hypotension during pregnancy consists in normalizing the regime of work and rest, taking fortifying agents and vitamins. Hyperbaric oxygen therapy is also used (a method of saturating the body with oxygen under elevated barometric pressure). Delivery is carried out through the natural birth canal. Sometimes prenatal hospitalization is required before childbirth in order to prepare the cervix for childbirth and prevent overgestation.
Varicose disease 3(violation of the outflow of venous blood as a result of a deterioration in the functioning of the valvular apparatus of the veins, expansion of the veins) affects mainly the lower extremities and the vulva. Most often, varicose veins are first detected or first appear during pregnancy. The essence of the disease consists in changes in the wall and valvular apparatus of peripheral veins.
Uncomplicated varicose veins are manifested by dilatation of the veins (which is perceived by pregnant women as a cosmetic defect) and pain in the lower extremities. Complicated varicose disease suggests the presence of other diseases, the cause of which is a violation of the venous outflow from the lower extremities. These are thrombophlebitis, acute thrombosis, eczema, erysipelas ( infection skin, caused by pathogenic microbes - streptococci). Fortunately, complicated varicose veins are rare in young women.
Childbirth in patients with varicose veins is often complicated premature detachment placenta, postpartum hemorrhage. Childbirth is carried out through the natural birth canal, if pronounced varicose veins of the external genital organs do not prevent this. During pregnancy and in the postpartum period, physiotherapy exercises and elastic compression of the lower extremities are necessary - the use of special tights, stockings or bandages that have a compressive (compressive) effect on the venous wall, which reduces the lumen of the veins, helps the venous valves work.
Heart defects are diverse, so the course of pregnancy and its prognosis in such cases are very individual. A number of severe defects, in which the heart cannot cope with its functions, is an absolute contraindication to carrying a pregnancy.
The gynecologist observes the rest of the pregnant women with heart defects in close contact with the therapist. Even if the pregnant woman feels good, she is sent for planned hospitalization at least three times during pregnancy: at terms of 8-12, 28-32 weeks and 2-3 weeks before delivery. In the absence of heart failure, delivery is through the natural birth canal. To exclude attempts, the imposition of obstetric forceps is sometimes used. Particular attention is paid to anesthesia in order to prevent an increase in the load on the heart under stress. A caesarean section is not advantageous in women with heart defects, since the operation itself is no less stressful on the cardiovascular system than natural childbirth.
Bronchial asthma- an allergic disease. Pregnancy sometimes alleviates the course of asthma, sometimes it aggravates it significantly.
Bronchial asthma during pregnancy requires the usual treatment for this disease with bronchodilator drugs, used mainly in the form of inhalations. Asthma attacks are not as dangerous for the fetus as it is commonly believed, since the fetus is much more resistant to hypoxia (oxygen starvation) than the mother's body. Conducting childbirth on the background of bronchial asthma does not require any significant adjustments.
Pyelonephritis 4 fairly common among women of childbearing age. This is an inflammatory disease of a microbial nature that affects the tissue of the kidney and the walls of the pelvicalyceal apparatus - the system through which urine flows from the kidneys. During pregnancy, pyelonephritis is often first detected, and long-term chronic pyelonephritis is often exacerbated due to the fact that pregnancy represents an increased functional load for the kidneys. In addition, the physiological bends of the ureters are aggravated, which creates favorable conditions for the habitation of pathogens in them. The right kidney is affected somewhat more often than the left or both.
A contraindication to pregnancy is a combination of pyelonephritis with hypertension, renal failure, and pyelonephritis of a single kidney.
Pyelonephritis is manifested by lower back pain, fever, detection of bacteria and leukocytes in the urine. The concept of "asymptomatic bacteruria" is distinguished - a condition in which there are no signs of an inflammatory process in the kidneys, but pathogenic bacteria are found in the urine, which suggests that they inhabit the renal pelvis and urinary tract in abundance. Like any inflammatory process, pyelonephritis is a risk factor for intrauterine infection of the fetus and other elements of the fetal egg (chorioamnionitis, placentitis - inflammation of the membranes, placenta). In addition, pregnancy in patients with pyelonephritis is much more often complicated by preeclampsia with all its attendant troubles.
Pyelonephritis and asymptomatic bacteruria are subject to mandatory treatment with antibiotics and agents that improve urine excretion. Childbirth in this case, as a rule, proceeds without features. Children born to mothers with pyelonephritis are more likely to be prone to purulent-septic diseases.
diabetes mellitus 5 during pregnancy poses a serious threat to the health of the mother and fetus. The obstetric classification of diabetes distinguishes pregestational (existing before pregnancy) diabetes and gestational diabetes, or "diabetes in pregnancy" (impaired glucose tolerance, manifested in connection with pregnancy).
Diabetes mellitus has a number of categorical contraindications to pregnancy. This is diabetes complicated by retinopathy (damage to the vessels of the eyes) and diabetic nephropathy (damage to the vessels of the kidneys); diabetes resistant to insulin treatment; a combination of diabetes and Rhesus conflict; the birth of children with congenital defects in the past; as well as diabetes mellitus in both spouses (since in this case there is a high probability of having children with diabetes).
The first half of pregnancy in diabetic patients often proceeds without complications. In the second half, pregnancy is often complicated by polyhydramnios, preeclampsia, pyelonephritis.
1 You can read about folk remedies used for hypertension during pregnancy in the magazine "9 months" No. 7/2005.
2 You can read about folk remedies used for hypotension during pregnancy in the magazine "9 months" No. 6/2005.
3 Read more about varicose veins of the lower extremities in the magazine "9 months" No. 7/2005.
4 You can read more about pyelonephritis during pregnancy in the Pregnancy magazine No. 6/2005.
When it is necessary?
Day hospital- this is a short-term stay department, where a pregnant woman spends several hours a day while performing the necessary procedures (for example, droppers), and after they are completed, she goes home
.
In many conditions, already from the beginning of pregnancy, the doctor can warn that in certain deadlines you will need to go to the hospital. This planned hospitalization. This is especially true for women who have various diseases internal organs, such as arterial hypertension ( high blood pressure), diabetes mellitus, heart and kidney disease. Also, hospitalization is planned for women with miscarriage (previously had 2 or more miscarriages) and other adverse outcomes of previous pregnancies, or if the current pregnancy did not occur naturally, but with the help of hormone therapy or IVF (in vitro fertilization). Such hospitalization will be critical periods(dangerous in terms of miscarriage and premature birth) and for the period in which the previous pregnancy was lost.
In the case of planned hospitalization in the hospital, first of all, an additional examination is carried out, which is not possible on an outpatient basis, and prevention of possible complications of pregnancy. The timing of such hospitalizations can be discussed with the doctor in advance, they can be shifted by 2-3 weeks if necessary.
emergency hospitalization recommended for conditions that threaten the health of the expectant mother, the health of the baby and abortion. In this case, refusing hospitalization, a woman may lose her only chance for a successful pregnancy.
The need for hospitalization may arise at any stage of pregnancy, starting from the first days and ending with those cases when childbirth does not occur at the expected time (pregnancy prolongation). Women up to 12 weeks of pregnancy are hospitalized in the gynecology department of the hospital, and after 12 weeks in the department of pathology of pregnant women of the maternity hospital.
High risk pregnant women
1. Severe toxicosis of the 11th half of pregnancy.
2. Pregnancy in women with Rh and ABO - incompatibility.
3. Polyhydramnios.
4. The alleged discrepancy between the size of the fetal head and the mother's pelvis (anatomical narrow pelvis, large fruit, hydrocephalus).
5. Incorrect positions of the fetus (transverse, oblique).
6. Post-term pregnancy.
7. Antenatal fetal death.
8. Threatening premature birth.
11 . Pregnancy and extragenital pathology.
(gestational age 22 weeks or more).
1. Cardiovascular diseases (heart defects, arterial hypertension).
2. Anemia.
3. Diabetes.
4. Pyelonephritis.
5. Thyrotoxicosis.
6. High myopia.
7. Chronic lung diseases (chronic bronchitis, bronchial asthma history of lung surgery).
8. Pregnant women with a gestational age of up to 35 weeks and extragenital pathology are hospitalized in somatic departments of the appropriate profile.
111. Pregnancy and certain risk factors.
1. Pregnancy in a nulliparous 30 years and older.
2. Pregnancy and uterine fibroids.
3. Breech presentation.
4. A scar on the uterus from a previous operation.
5. Multiple pregnancy.
6. Pregnancy in women who gave birth to children with malformations.
7. Pregnant women with intrauterine growth retardation.
8. Threat of abortion.
9. habitual miscarriage during critical periods of pregnancy from 22 weeks
10. Anomalies in the development of the fetus.
11. Chronic placental insufficiency.
12. Delayed intrauterine development of the fetus.
13. Pregnancy and uterine fibroids.
14. Termination of pregnancy for medical reasons.
15. Placenta previa.
16. Hepatosis of pregnant women.
