PREGNANCY

A B B D E F G And K L M N O U R C T Y P X C H W E I

PREGNANCY - physiological process, during which a woman's body from a fertilized egg develops the fetus is capable of extrauterine life. Most often there is a pregnancy with one fetus, possibly simultaneous development of two or more fruit (see. Multiple pregnancy). Normal pregnancy lasts 266 to 294 days (average 280 days, t. E. 40 weeks, or 10 obstetric months) counting from the first day of the last menstrual period, and ends with birth.

Diagnosis of pregnancy. At present, widely used immunological methods of diagnosis of pregnancy: a qualitative and quantitative determination of human chorionic gonadotropin (hCG) - a hormone released chorionic structures from which the placenta is formed. The amount of hCG in the blood and urine increases in the earliest stages of pregnancy - 2 days after the introduction of a fertilized egg in the lining of the uterus (implantation) and is the first sign of pregnancy diagnosed. Determination of HCG qualitative method is performed by means of special test kits in the urine within a few minutes. Quantitative determination of blood in urine or produced by immunological methods.

Widely used ultrasound, allowing to diagnose pregnancy in the 3 to 4-week, when it is possible to register the reduction of fetal heart.

Not lost value bimanual pelvic exam, which determines such pregnancy symptoms as cyanosis of the mucous membrane of the vagina, the cervix; softening of the uterus isthmus; globular increase in uterine body register with the 4 th week of pregnancy.

In the diagnosis of early pregnancy signs of use such as nausea , drowsiness, changes in taste, absence of menstruation, breast engorgement.

In later periods (about the second half of pregnancy) pregnancy diagnosis confirmed by reliable (undoubted) clinical signs of pregnancy: fetal movement, determined by palpation of the abdomen, palpation of fetal parts, auscultation of fetal heart tones. Fetal heartbeat is listened to 18 -20 th week of pregnancy using obstetrical stethoscope. also electrocardiography is used to determine the fetal heart rate (since IV months of pregnancy). The widespread introduction in obstetric practice ultrasound allows us to consider this method is the most accurate to determine the gestational age, the value of the fruit, the size of its parts and the placenta. Current guidelines in obstetrics and gynecology are equipped with tables containing indicators of the size of the embryo and fetus and hip size, the volume of the chest, abdomen, and so on. E. At different stages of pregnancy starting from the first trimester before birth. In the normal course of pregnancy ultrasound conducted on 10- 11th week, 24 weeks and 32 - 33 weeks of pregnancy. According to the testimony - at any time. Modern ultrasound machines on. According to the last menstrual period and the size of the fetus indicators calculated the approximate delivery time and weight of the fetus.

The most accurate gestational age can be established for handling a woman to the doctor (midwife) in early pregnancy. Still widely used two-handed exploration. When vaginal study bryushnostenochnom-uterine body length of 4 weeks of pregnancy is about 7 - 8 cm in 8 weeks - 9-10 cm in 12 weeks - 12 - 13 cm. After 16 weeks of gestation is judged by the height of standing uterus, starting with the 32 th week of manufacture and measurement of abdominal circumference pregnant.

The height of standing uterus is determined by measuring tape centimeter distance between the upper edge of the pubic symphysis and the highest point of the uterine fundus. Measurements are made in the status of women while lying on your back with legs straight; bladder before the test should be emptied. Fundal height standing at 16 weeks of gestation is approximately 6 cm to 20 weeks - 12-14 cm, 24 cm -20 weeks, 28 weeks - 24 -26 cm to 32 weeks - 28 - 30 cm (about border between the navel and the xiphoid process of the sternum, stomach starts to flatten), 36 weeks - 32-34 cm (up to the xiphoid process of the sternum, navel flattened), 40 weeks - 28 - 30 cm, ie the same as in 32 weeks.. but jutting navel.

abdominal circumference was measured in the same position of women, as well as the determination of the height of standing uterus. A measuring tape in the middle of the back of the lumbar region, the front of the navel. Abdominal circumference of 32 weeks of pregnancy is 80 - 85 cm and 36 weeks - in average 90 cm, 40 weeks - 95 - 98 cm (much longer than 32 weeks, even though the height of standing uterus at 32 weeks and 40 weeks about the same).

Gestational age can be roughly set by measuring the length of the fruit tazomera, held in the second half of pregnancy. A woman with lying on his back, legs slightly bent at the hips, the bladder must be emptied prior to measurement. Probing through the abdominal wall of the fetus, one tazomera a button mounted on the lower pole of the head, another. - Fetal buttocks (often they are in the uterus). The value obtained in the measurement of the distance from the lower pole of the head to the buttocks, is multiplied by 2. In a significant development the subcutaneous tissue of the abdominal wall from the resulting number is subtracted 3 - 5 cm If the head is deep at the entrance to a small basin, the measurement is made from the upper edge of the pubic. symphysis to the buttocks of the fetus, and to the result add 2 cm, then the result is multiplied by 2. Having thus established the fetus length, divide that number by 5 to obtain the approximate gestational age (in obstetric months).

Estimated delivery date can be determined from the last menstrual period of time (from the first day of the last menstrual period is counted back 3 calendar months and added 7 days) as well as on the date of the first fetal movements (it is added to the 20 weeks in nulliparous and multiparous 22 weeks). To determine the time of pre-natal leave and the expected delivery date, there are different calendars and rulers. Prenatal care. In determining the pregnancy, a woman should be examined (see. OB) and taken under medical observation in the antenatal clinic (in rural areas of FAPs). The first time a pregnant woman, in addition to vaginal examination, determine the size of her pelvis, measured height and weight, blood pressure on both arms, examined the condition of internal organs (heart, lungs, and others.), Carried out laboratory testing of discharge from the vagina, clinical blood tests, urine, Wasserman and HIV infection, determine the blood group and Rh factor. Every pregnant woman should be examined by a therapist, dentist, ophthalmologist, neurologist and, if necessary, the surgeon and other specialists.

In the normal course of pregnancy healthy woman without a history of obstetric history should visit the obstetrician (midwife) in the first half of pregnancy, 1 time per month, starting at 20 weeks and before 32 weeks of pregnancy - 2 times a month, after 32 weeks - 3 - 4 times per month. Repeated inspections it has determined the body weight, blood pressure, specify the position of the fetus, measure the height of standing uterus and abdomen circumference. Particular attention is paid to the functional state of the fetus (stirring, palpitations); establish its estimated mass which can be calculated using the formula Johnson. From heights standing uterus (in inches) 11 is subtracted (in the pregnant weight 90 kg) or 12 (with a weight of 90 kg) and the resulting number is multiplied by 155; It corresponds to an output fetal weight in grams. At 32 weeks pregnant therapist re-examines.

During pregnancy, at least 2 - 3 times produce blood count (after the first visit, at 22 and 32 weeks of pregnancy), urinalysis (each visit), Wassermann reactions and HIV infection (the first visit in 32 weeks pregnancy).

When visiting a doctor (midwife) woman appointed date of the next visit, and if it is not within the specified term, it is visited at home; In addition, the FAP midwife visited twice at home pregnant (after registration and 35 - 36 weeks of gestation) and in the workplace in the 18 - 20 weeks of pregnancy.

For each woman throughout the pregnancy carried out corrective measures to ensure a favorable outcome of pregnancy and childbirth for mother and fetus: held psychoprophylactic preparing pregnant women for childbirth, conducted health education on hygiene during pregnancy, if necessary, a pregnant transferred to lighter work and al.

Midwife, independently working on FAPs under dispensary observation of pregnant woman should strive to ensure that each pregnant woman was examined by an obstetrician-gynecologist, therapist and other specialists on schedule, it was promptly made necessary laboratory tests and that deliveries in hospital under supervision of an obstetrician-gynecologist.

Pathology of pregnancy. Often during pregnancy complicated by a variety of diseases or conditions that represent a danger (increased risk) for the mother and the fetus both directly during pregnancy and subsequently during and after delivery. They can give rise to such obstetric and antenatal pathology as premature termination of pregnancy, uterine bleeding, fetal growth retardation, fetal death, and others. The course of pregnancy is very burdened by the development of a woman's pregnancy toxicosis that represents a particular danger to the fetus. Pregnancy complications are often observed at the wrong position of the fetus (eg breech), polyhydramnios, multiple pregnancy and prolonged pregnancy. Severe complications (bleeding, premature termination of pregnancy, fetal death) arise in violation of the embryo trophoblast development and growth - trophoblastic disease. Increased risk for the mother and the fetus is especially for their blood incompatibility Rh factor or AB0 system (see. Hemolytic disease of the fetus and newborn).

Special attention should also women who were observed to present pregnancy artificial or spontaneous abortions, premature births , especially repeated (see. Miscarriage), stillbirth, infertility .

A significant risk to the mother and the fetus occurs during pregnancy and childbirth in the presence of women in a number of diseases are not causally related to the reproductive function, as well as in various pathologies female genitals.

In case of detection of risk factors for complications of pregnancy and childbirth for every pregnant woman in the antenatal clinic should be drawn up an individual plan of follow-up, taking into account the specificity of the existing or possible pathology, condition of the woman, the history and others. In the process of prenatal care may be necessary to make this corrections and additions to the plan in accordance with changes in the status of women and the fetus. Individual plan of follow-up usually involves more frequent targeted inspections female obstetrician-gynecologist, internist, and on the testimony of doctors and other specialists (ophthalmologist, endocrinologist, urologist, etc.). This is usually carried out special diagnostic studies, including studies to determine the status of the fetus: the registration of its cardiac activity, amnioscopy, ultrasound.

For pregnant women at high risk establish a special regime, prescribed the appropriate treatment if necessary. In some cases, resorting to hospitalization for therapeutic and prophylactic purposes in the different stages of pregnancy, as well as antenatal hospitalization (in a hospital, where a highly qualified assistance can be provided, sometimes in a specialized maternity hospital).

Pregnancy and extragenital pathology. The combination of pregnancy and diseases are not causally related to the reproductive function, it is very common. Pregnant women may experience diseases of the cardiovascular system (heart disease, hypertension , hypotension, etc.), Blood disorders (mainly anemia), kidney (pyelonephritis, glomerulonephritis , etc..), Respiratory (eg, asthma) gastrointestinal tract (gastritis, peptic ulcer stomach and duodenal ulcer, cholecystitis , cholelithiasis , appendicitis , etc.), endocrine disorders (eg, diabetes), and others. The combination of pregnancy infectious diseases (such as tuberculosis, viral hepatitis) .

Extragenital disease often disrupt the normal course of pregnancy and childbirth, lead to the development of pathological states of the mother, fetus and newborn. Pregnancy can be a burden for these diseases, contribute to the manifestation of some internal diseases.

The role of the midwife is early detection of signs of extragenital diseases in pregnant women, the implementation of therapeutic measures prescribed by a doctor, prevention of infectious diseases.

Heart defects (congenital and acquired). During pregnancy and childbirth in patients with heart disease may develop heart failure , sometimes exacerbation of rheumatic process, which in some cases leads to the woman's death. If urological defects are possible premature birth , fetal hypoxia and other complications. Obstetric tactics in respect of pregnant women with heart defects depends on the shape defect, myocardial status, stage of circulatory failure. All this should be clarified in the early stages of pregnancy (up to 12 weeks) to resolve the question of the possibility of continuing the pregnancy.

In rheumatic heart disease on the activity of rheumatic process in conjunction with other clinical and laboratory data show leukocytosis in excess of 000 and a 1-L, a pronounced shift to the left leukocyte counts, erythrocyte sedimentation rate 35 mm / h.

Of great importance for predicting the outcome of pregnancy and childbirth in women with heart defects is defined as the degree of risk of various complications in the woman and the fetus. I risk observed in the presence of heart disease in pregnant women without overt signs of heart failure and acute rheumatism; II degree of risk - with the initial symptoms of heart failure, and I identify the degree of activity of rheumatic process; III degree of risk - with the prevalence of symptoms of right heart failure, the presence of II degree of activity of rheumatic process, the newly emerging atrial fibrillation , pulmonary hypertension stage II; IV degree of risk - with signs of left ventricular failure or total, the presence of III degree of activity of rheumatic process, a significant increase in the size of the heart (cardiomegaly) or atrial (atriomegaly); a long-term atrial fibrillation with thromboembolic manifestations in pulmonary hypertension stage III. Pregnancy is permissible and can be preserved only if I and II provided the risk of maintenance therapy. In III - IV degrees of risk woman should be warned that the pregnancy is not desirable, but if it comes, its retention is contraindicated due to the risk of rapid increase of blood circulation failure.

The question of the admissibility of the pregnancy or the possibility of its preservation in women who have undergone heart surgery, decided strictly individually depending on the condition of the patient. Due to the fact that the restoration of blood flow after the operation takes place no earlier than 1 - 1.5 years, the woman should be clarified that pregnancy in this period is undesirable. After prosthetic heart valves is contraindicated in pregnancy.

The choice of optimal tactics of pregnancy in women with heart defects should involve an obstetrician-gynecologist and a therapist. Regardless of the condition of patients with heart disease need to be hospitalized during pregnancy are routinely at least 3 times. First hospitalization performed 8-10 weeks of pregnancy to confirm the diagnosis and decide on the possibility of continuing the pregnancy, the second - in 26 -32 weeks of pregnancy (the period of maximum hemodynamic stress on the heart), the third - for 3 weeks before the expected date of delivery (approximately 37 weeks) to prepare for the birth and development of the tactics of delivery. If signs of decompensation of the patient should be hospitalized immediately at any stage of pregnancy.

The hospital carried out a set of measures, including a hygienic regimen, clinical nutrition, exercise therapy, psycho-prophylactic preparation for childbirth, oxygen therapy. Drug treatment is determined by the condition of the patient. According to the testimony used cardiovascular, anti-rheumatic, hyposensitization, diuretics and anticoagulants.

Hypertonic disease. Recognition of essential hypertension is not difficult if it occurred before the pregnancy. The diagnosis of hypertensive disease in pregnancy is based on the following criteria: blood pressure above 140/90 mm Hg. Art. in early (before 16 weeks) of pregnancy, and the preservation of high blood pressure in the second half of pregnancy in the absence of other symptoms characteristic of late toxicosis pregnant (edema, proteinuria, etc.). The issue of preservation of pregnancy depends on the stage of the disease: in stage I hypertensive disease, pregnancy and childbirth can proceed normally, with stage IIA pregnancy can be maintained only if the persistent desire of women, in this case, the patient needs to be systematic observation and treatment, while the deterioration of the - in the early termination of pregnancy. When IIB and III stages of the disease it is necessary to terminate the pregnancy for medical reasons. The course of pregnancy in hypertensive disease, usually complicated by premature birth, the emergence of late toxicosis pregnant, often premature detachment of normally situated placenta, stillbirth.

During exacerbation of hypertension, is possible at any stage of pregnancy, the deterioration of the general condition of the patient, increased headaches, a significant increase in blood pressure, changes in the fundus. Perhaps the development of hypertensive crisis, which must be distinguished from pre-eclampsia usually occurs on the background of nephropathy pregnant.

Arterial hypotension (systolic blood pressure less than 100 and diastolic - 60 mm Hg..). There are acute and chronic hypotension. Acute observed in acute cardiovascular or circulatory failure (eg, in a faint, collapse, shock). Chronic hypotension is physiological and pathological. At physiological hypotension no complaints, disabled women are kept. When pathological arterial hypotension observed weakness, sweating, fatigue, dizziness , palpitations, a significant reduction in blood pressure. Pregnancy is often complicated by the early toxicosis, premature birth, the weakness of labor, fetal hypoxia. Pregnant women with blood pressure below 100/60 mm Hg. Art. should be under systematic observation obstetrician-gynecologist and a therapist. Pregnant women with physiological arterial hypotension in the treatment is not needed. When pathological arterial hypotension treats the underlying disease, prescribe restorative therapy, exercise therapy, agents that stimulate the central nervous system activity.

Anemia in pregnant women occur quite frequently (up to 30% of cases). The most common iron deficiency anemia (70 - 95% of anemia in pregnant women), much less folic acid, hemolytic and aplastic anemia .

Relative or false, anemia can occur in pregnant women due to a significant increase in the volume of blood plasma during pregnancy; the true anemia it differs normal color indicator and morphological changes in the absence of erythrocytes.

Occurrence of iron -deficiency anemia is associated with an increased rate of iron necessary for development of the placenta and fetus. In healthy pregnant women, this process is compensated as the exogenous iron intake (food), and supplies the iron deposited in the liver. Occurrence of iron deficiency anemia during pregnancy contribute to gastritis , cholecystitis , pancreatitis , enterocolitis, worm infestation, hypothyroidism , leading to disruption of iron absorption in the body of the woman, as well as frequent deliveries with short intervals between them prolonged lactation , multiple pregnancy , placenta previa .

The clinical picture of iron deficiency anemia in pregnant women is characterized by the same symptoms as that of non-pregnant. The course of pregnancy in women with iron deficiency anemia is often complicated by early and late toxicosis pregnant.

Treatment of iron deficiency anemia in pregnant women is to appoint iron preparations. It should be high-calorie diet with a predominance of protein and enough minerals. Most of the iron contained in meat, liver, and it is easier to digest as compared to the plant in iron. The diet of the patients are encouraged to include 150 - 200 grams of cooked meat or 100 grams of liver (cooked or fried) on a daily basis. Transfusion of red blood cells in pregnant women due to the risk of immunization or transfusion complications carried out only in case of severe anemia or immediate preparation for childbirth. To prevent chronic hypoxia and fetal malnutrition, while developing iron- deficiency anemia , prescribe drugs that improve the utero-placental circulation (sigetin, teonikol, heparin, etc..).

Pyelonephritis - the most common kidney disease in pregnant women. Its origin is due to a violation of urodynamics of the upper urinary tract and blood circulation in the kidneys as a result of pregnancy, compression of the ureter growing uterus, the presence of the infection in the body (angina, carious teeth, abrasions, etc.). Acute pyelonephritis during pregnancy is a typical pattern, it can be treated successfully and, as a rule, does not have a significant influence on the course of pregnancy. Chronic pyelonephritis is often first diagnosed during pregnancy is usually the result of latent current pre-pregnancy pyelonephritis. Pregnancy promotes lrogressirovaniyu disease. Often pregnant women develop severe pyelonephritis. When studies revealed leucocyturia, proteinuria, sometimes microscopic hematuria, bacteriuria, and anemia. In chronic pyelonephritis often observed miscarriage .

Patients with pyelonephritis should be monitored carefully obstetrician and nephrologist. If chronic pyelonephritis in pregnant women is accompanied by arterial hypertension or renal failure, shown abortion regardless of its term. Children born to mothers with acute and chronic pyelonephritis, often showing signs of fetal malnutrition.

Glomerulonephritis. Pregnant common acute and chronic glomerulonephritis . In acute glomerulonephritis are often observed premature birth , fetal death; It recommends abortion.

Chronic glomerulonephritis in pregnancy often occurs in a latent form, is less common hypertension, nephrotic and sour cream form. The course of pregnancy may be complicated by late toxicosis, premature birth, fetal hypoxia, the threat of death. Pregnancy can be maintained with a latent form of glomerulonephritis characterized by low proteinuria, hematuria unstable, cylindruria. Throughout pregnancy, patients should be under the strict supervision of an obstetrician-gynecologist and a nephrologist. Treatment is symptomatic. In nephrotic form undisturbed renal function possible continuation of the pregnancy with careful observation and treatment in a specialized hospital. In hypertensive and mixed forms of chronic glomerulonephritis pregnancy is contraindicated.

Bronchial asthma . During pregnancy, during asthma may be different. In some cases, attacks weaken and even disappear, in others - the disease becomes more severe. Rarely bronchial asthma occurs only during pregnancy (asthma, pregnant women). At the same time pregnancy and birth can take place without any complications. Treatment is symptomatic. Patients with long flowing bronchial asthma in repeated severe attacks and symptoms of pulmonary heart failure is contraindicated in pregnancy and is subject to termination in the early stages.

Gastritis (acute and chronic) in patients with uncomplicated no negative influence on the development of the pregnancy and its outcome. Treatment of acute and chronic gastritis in pregnant women is no different from the usual.

Gastric ulcer and duodenal ulcer. Pregnancy has a generally beneficial effect on the course of ulcer disease. Ulcer complications (bleeding, perforation, ulcers) during pregnancy are rare. They can occur before birth, during birth, in the early postpartum period. Therefore, women who suffer from peptic ulcer disease, for 2 - 3 weeks before the birth and immediately after birth is necessary to carry out preventive treatments.

Appendicitis. A feature of appendicitis in pregnant women is the rapid progression of the inflammatory process in the abdominal cavity due to a change in the position of her authorities in connection with pregnancy. Diagnosis is difficult, as a similar clinical picture and the changes can be observed in the hemogram apoplexy ovarian torsion tumor of the ovary, cholecystitis and other diseases. Mandatory surgeon and dynamic consultation (every 2 -3 hours) monitoring the patient. Surgical treatment. After appendectomy pregnancy is not broken.

Cholecystitis and cholelithiasis . Pregnancy can provoke the development of cholecystitis and cholelithiasis due to often occurring in pregnant dyskinesia biliary tract, obstruction of blood flow, hypercholesterolemia. Clinical signs of disease, diagnosis and treatment during pregnancy do not have the features. Prediction of pregnancy and childbirth relatively favorable.

Diabetes may first appear during pregnancy. Pregnancy diabetes mellitus is often complicated by spontaneous abortion, preterm birth, late toxicosis, stillborn.

Absolute contraindications for pregnancy are severe diabetes (insulin-dependent form), especially complicated diabetic retinopathy, or glomerulonephritis, diabetes mellitus of both spouses (the possibility of the hereditary form of diabetes and birth defects in the child), the combination of diabetes with other medical conditions. In such cases, the women's clinic at the early stages of pregnancy is necessary to warn the patient of possible complications and offer abortion. In case of refusal of the woman interrupts needed urgent hospitalization for a thorough examination (including an endocrinologist consultation) and the choice of optimal treatment. Subsequently, the patient should be under the constant supervision of an obstetrician-gynecologist and endocrinologist. Shown antenatal hospitalization no later than 32 weeks of pregnancy for examination and a decision on the choice of mode of delivery. Diabetic patients are often marked by large fruit and polyhydramnios.

Tuberculosis. Saving pregnancy (subject to systematic observation and treatment in a hospital) is possible in the majority of patients with tuberculosis. Prediction of pregnancy and childbirth in a specialized care for both the mother and the fetus relatively favorable. Specific treatment (antibacterial). Termination of pregnancy is shown with fibro-cavernous pulmonary tuberculosis, active form of osteoarticular tuberculosis and bilateral renal tuberculosis. Keep in mind that an abortion under these forms of tuberculosis is necessary in terms of up to 12 weeks, as the interruption ce at a later date contributes to the progression of tuberculosis.

Viral hepatitis . If pregnancy can meet the two most common forms of hepatitis - hepatitis A and hepatitis B (see Viral Hepatitis.). The clinical course of hepatitis A during pregnancy does not have any features. The differential diagnosis of this form of hepatitis in the I trimester of pregnancy should be carried out early toxicosis of pregnant women, which can also occur decreased appetite, vomiting, feeling of heaviness in the epigastric region. Hepatitis A symptoms listed occur, usually not more than a week, a pregnant usually do not lose weight, there is an increase in body temperature (sometimes fever), enlarged liver and spleen, increased transaminases, detectable at a blood test. The forecast for the pregnant woman and the fetus favorable. Treatment is symptomatic.

Hepatitis B in pregnant women occurs in the same way as usual. The disease is dangerous for the life of the pregnant because of the possibility of occurrence of liver failure and encephalopathy. Pregnancy may be complicated by spontaneous abortion, premature birth, fetal death. In the acute stage of infection of the fetus is possible. The patient should be hospitalized in an infectious diseases hospital, where there are special boxes for pregnant women. In severe cases make abortion after the elimination of acute manifestations of the disease. Termination of pregnancy in the acute stage of the disease is not recommended, as it worsens the condition of the patient.

Malformations of the internal genital organs. Pregnancy is possible with such malformations of internal genital organs, as a longitudinal vaginal septum, the doubling of the uterus and vagina, uterus saddle, and the two-horned horned uterus. Very rarely pregnancy occurs in a rudimentary (closed) of the uterus horn.

Cervical erosion. Symptomatology and diagnosis of cervical erosion in pregnant women is the same as outside pregnancy. Pregnant women with cervical erosion should be under the supervision of a gynecologist. Perform Vaginal, cervix treated with sea buckthorn oil, 1% emulsion sintomitsina. Cautery, diathermocoagulation not shown. Pregnancy and childbirth , as a rule, take place without complications.

cervical polyp can cause bleeding from the vagina of a pregnant. Diagnosis of cervical polyps is not difficult: the examination of the cervix in mirrors can be seen protruding from the cervical canal polyp bright red color. Midwife polyp detection is to take a scraping from the surface for cytology and send the patient to an obstetrician-gynecologist for a colposcopy. Bleeding polyp in a pregnant subject to deletion (in the hospital) and the obligatory histological examination. During pregnancy and childbirth usually not disturbed.

Cervical cancer in pregnancy is rare. Pregnancy can occur against the background of cervical cancer and contributes to more rapid development. The first manifestations of cervical cancer are the same as non-pregnant: whites , bleeding. If any of these signs are shown in the examination of the cervix and vaginal speculum-bryushnostenochnoe study. The midwife should take a swab scraping from the surface of the cervix for cytological examination, to send pregnant obstetrician-gynecologist for colposcopy and biopsy suspicious tissue site. If the diagnosis is confirmed pregnant immediately sent to the hospital for an abortion, and appropriate treatment.

Uterine fibroids is one of the most common tumors. When pregnancy is on the rise fibroids, they soften, become mobile.

When uterine cancer diagnosis early pregnancy is often difficult, but possible using immunological methods, detection of human chorionic gonadotropin in urine and ultrasound scanning.

When uterine fibroids in pregnancy often have the threat of termination of pregnancy, spontaneous miscarriage, possible impairment of myoma node dysfunction related bodies and others.

Prediction of pregnancy and childbirth for uterine fibroids depends on the location, size of fibroids and placental localization of nodes in relation to them. So, most miscarriages occur when submucous location node and placental localization of myoma node. If subserous or intermuscular location of nodes, usually wearing out possible pregnancy.

The question of the continuation of the pregnancy is solved individually, taking into account the patient's age, disease duration, size and location of fibroids, the presence of comorbidities. Pregnancy is contraindicated for large initial size of uterine fibroids, the rapid growth of tumors (both outside and during pregnancy), at the location of myoma node in the cervical region. High risk observed in nulliparous aged 35 years and older, with submucosal and intramuscular myoma node location (especially if the tumor grows in the direction of the uterus), with signs of circulatory disorders in the node.

Pregnant women with uterine fibroids should be systematically observed obstetrician-gynecologist. In case of complications (threatened miscarriage, and others.) Shows the urgent hospitalization at any stage of pregnancy for a decision on the advisability of maintaining it. All pregnant women with uterine fibroids need to be hospitalized for 3 - 4 weeks before delivery to a decision on the tactics of delivery.

Ovarian tumors. Diagnosis of ovarian cancer in the first half of pregnancy is not difficult especially when ultrasound. In the second half of pregnancy diagnosis is difficult due to the large size of the uterus. Pregnancy may be complicated by torsion leg tumor , necrosis due to compression of the gravid uterus. By moving the uterus rapidly growing tumor of the ovary may malposition. Treatment of ovarian tumors operative, carried out at any stage of pregnancy. The threat of termination of pregnancy 'after the operation is small. If the histological examination of the tumor show signs of malignancy, showing abortion (at any stage) and the appropriate treatment.

Influence of nicotine and alcohol on the fetus. Nicotine - one of the major toxic components of tobacco smoke - has a strong vasoconstrictive action and thereby exerts a negative influence on the circulatory process in the uterus and placenta. We intensively female smokers (20 cigarettes per day) pregnancy often ends in spontaneous abortion. Nicotine is rapidly transferred through the placenta and inhibits the processes associated with an increase in fetal weight (wasting it develops). At smoking women during pregnancy babies are born with low Apgar scores, and the backlog of body weight at term can be up to 300 grams or more; underweight persists for the 1st year of life. Therefore, smoking during pregnancy should be banned.

The systematic use of alcoholic beverages during pregnancy can occur fetal alcohol syndrome, which is characterized by multiple congenital malformations, as well as impaired physical and mental development of the child. The syndrome manifests developmental disorders and central nervous system; growth retardation; characteristic facial abnormalities of the skull; malformations of the internal organs, limbs, etc.

Observed microcephaly, intellectual disability, who have a progressive character. Stunting begins during fetal life and is particularly noticeable after birth. Often there are congenital heart defects , abnormal development of the upper and lower extremities. Perinatal mortality fetal alcohol syndrome is high. In the event of pregnancy in patients with chronic alcoholism, it is necessary to raise the question of its termination.

Effect of ionizing radiation on the fetus. The embryo and the human fetus has a very high sensitivity to ionizing radiation. Violations during embryogenesis radiation exposure depend on the stage of fetal development, and radiation dose. Irradiation in predymplantatsibnnom period causing intrauterine fetal death (embryotoxicity). Exposure to ionizing radiation during the period of organogenesis and placentation leads to fetal malformation; in this period, as a high percentage of embryo destruction. The biggest radiosensitivity have central nervous system, organs of vision and fetal blood-forming system. When radiation exposure in the period after 10-12 weeks usually observed total delay fetal development and the appearance of the typical symptoms of radiation sickness inherent in an adult organism.

Due to the particularly high radiosensitivity of the embryo early stages of development are very great caution must be exercised in the appointment of women to medical and diagnostic procedures related to the use of internal and external irradiation. In the first 2-3 months of pregnancy to completely abandon all radiological examinations, especially those related to pelvic irradiation should be possible. In the later stages of pregnancy in the presence of X-ray examinations strict indications are allowed, but you must always seek to replace X-ray examinations ultrasound.