Description: Pregnancy (Latin – graviditas) is a special condition of a woman’s body, at which her developing reproductive organs contain a developing embryo or fetus.
In obstetrics, physiological and pathological pregnancies are distinguished. Normally, any pregnancy ends with act of delivery – a child is born, and in case of multiple pregnancy – twins (homozygous – identical or heterozygous – different).
As with any pregnancy, onset is associated with the process of fertilization (conception), that is, fusion of a mature male germ cell (or gamete), called sperm and an egg cell – a female germ cell (or gamete). Thus, common cell (zygote) formed after the process of fertilization or fusion of two gametes is the beginning of a new organism.
Contraception is a method of family planning aimed at preventing development of unwanted pregnancy during sexual intercourse. Currently, many methods and means of contraception have been developed, with most of them being achievement of the second half of the last century.
Until now, disputes about usefulness and acceptability of various of methods with demographic, medical, moral and ethical and other points of view have not ceased, but absolute majority of specialists agree that contraception is better than another “method of family planning” – abortion.
Most often there distinguish the following types of contraception:
- implantation (intrauterine);
Effectiveness of this or that method of contraception is estimated by Pearl index. Perl index is the number of pregnancies that occurred in 100 women who used one particular contraceptive method within one year.
Signs & Symptoms
All signs that make it possible to diagnose pregnancy are divided into suspected (doubtful), probable and reliable. They can be based on subjective or objective data. However, at present, in connection with widespread introduction of ultrasound diagnostics into obstetric practice, signs of pregnancy described in classical textbooks on gynecology and obstetrics are no longer so significant.
Doubtful (suspected) signs (based on subjective data):
- vomiting or nausea (especially in morning hours), changes in smell, appetite or food preferences;
- intolerance of some odors;
- disorders of nervous system (drowsiness, frequent mood changes, dizziness, malaise, irritability);
- frequent urination;
- enlargement of mammary glands, their increased sensitivity;
- change (intensification) of skin pigmentation (darkening) on face, in the area of nipples, along the white line of abdomen;
- appearance of scars (bands) of pregnancy (striae) on mammary glands, hips, skin of abdomen;
- increased abdomen in volume;
- sensation of fetal movement (in primiparous women during 18 – 20 week, in maternity patients – at 16 – 18 weeks).
Probable signs (objective signs, determined at inspection):
- amenorrhea (absence of menstruation);
- increased mammary glands, appearance of colostrum;
- cyanosis of vaginal mucosa and cervix;
- change in shape, volume, consistency of uterus (at internal obstetric research);
- increase in uterus from 5 – 6 weeks gestation, first in anteroposterior size, then in transverse;
- Horwitz-Geghar symptom: softening of uterus, especially in isthmus. In a two-handed study, fingers touch isthmus without resistance. Characteristic for 6 – 8 weeks from the last menstruation;
- Snegirev’s sign: change in uterus consistency: with mechanical stimulation or two-handed examination, uterus becomes denser and contractible, then again becomes soft.
- Piskachek sign: in early period, asymmetry of uterus is observed, protrusion of one of the corners where implantation was performed;
- Gubarev and Gauss sign: at early terms there is a slight mobility of cervix, which is associated with significant softening of isthmus;
- Genter sign: in early period, because of softening of isthmus, uterine inflection is noted in front and crest-like thickening on anterior surface of uterus along median line (not always determined);
- express pregnancy test.
Reliable (unquestionable) signs (revealed in second half of pregnancy):
- heartbeat of fetus is determined (with the help of obstetrical stethoscope one can hear fetal heart contractions);
- detection and palpation of large (head, pelvis) and small (arms, legs) parts of fetus and / or its movements (from the second trimester of pregnancy) during external obstetric study. When carrying out palpation of abdomen with Leopold’s methods (external methods of obstetric examination) position, appearance of fetus and ratio of presenting part to small pelvis are determined;
- on roentgenogram and echogram skeleton of fetus is determined;
- determination of fetus and placenta with the help of ultrasound diagnosis.
Diagnosis of pregnancy is unquestionable, if at examination parts of fetus, palpitation and wiggling of fetus are determined, at ultrasound examination – fetal egg. These reliable signs of pregnancy do not appear at the beginning, but in later periods (V – VI month). In early period, diagnosis of pregnancy is established on the basis of suspected and probable signs.
Modern methods of pregnancy diagnosis are divided into biological, immunological, echographic (ultrasound) and others.
Both biological and immunological methods are based on determination in biological material (most often in urine) of chorio gonadotropin (HG) – a hormone secreted by chorion. Synthesis of HG begins from the first days of pregnancy and continues until delivery with maximum output on 60 – 70 day after implantation. Then its level decreases and remains stable until delivery.
At present, immunological methods are used to diagnose early pregnancy terms. Immunological methods are based on precipitation reaction with rabbit antiserum, either on fixing complement, or on suppressing hemagglutination reaction.
Radioimmunoassay method is 10 times more sensitive than immunological method. The most common is method of double antibodies, based on precipitation of antibodies to the hormone.
Immunoenzyme express methods for determining HG or b-HG in urine make it possible to diagnose pregnancy 1 – 2 weeks after nidation of fetal egg.
There are test systems for rapid detection of presence or absence of pregnancy, which can be used by women themselves.
Basal temperature test is based on effect of progesterone on thermoregulatory center located in hypothalamus (hyperthermic effect). The first 3 months of pregnancy basal temperature, measured in the morning on an empty stomach in bed by the same thermometer, is above 37° С.
Investigation of properties of cervical mucus is also based on effect of progesterone on physicochemical properties of mucus. During pregnancy, from the earliest of its terms, there is no symptom of “pupil”, since diameter of cervical canal is less than 0.2 cm. When air is secreted from cervical canal, there are no large crystals in it.
Diagnosis of uterine pregnancy with ultrasound is possible from 4 – 5 weeks (from the first day of the last menstruation). In thickness of endometrium, fetal egg is defined as a rounded formation of lowered echogenicity with internal diameter of 0.3 – 0.5 cm. In the I trimester, rate of weekly increase in average size of fetal egg is approximately 0.7 cm, and by 10 weeks it fills all uterine cavity. By 7 weeks of pregnancy, in most pregnant women when examining cavity of fetal egg, it is possible to identify embryo as a separate formation 1 cm in length. When performing biometrics in the first trimester, determination of mean internal diameter of fetal egg and coccygeal-parietal size (CTE) of embryo, values of which are strictly correlated with gestational age, is of primary importance for determining gestational age. The most informative method of ultrasound in early pregnancy is transvaginal scanning; transabdominal scanning is used only with filled bladder to create “acoustic window”.
During pregnancy it is unacceptable:
- to smoke, drink strong drinks, use drugs;
- it is pointless, ridiculous and cruel to blame the child in your own unwanted pregnancy;
- perform heavy physical work, especially associated with lifting weights;
- to allow thoughts about unfavorable outcome of pregnancy, pathology of fetus;
- neglect advice of doctors, although blindly follow them, too, is undesirable. It’s better if you are monitored by a specialist who can be trusted.
- tormenting yourself with thoughts that you can not cope, that you will not have anything to live on. Even if you are alone, you can always find a way out.
- get enough sleep;
- do excersises;
- try not to travel a lot;
- carefully watch your teeth;
- get enough rest.
At the normal course of pregnancy, physical activity is necessary for a woman. Physical training reduces risk of complications during childbirth, and also helps a woman recover faster after childbirth. In some situations, any physical load is absolutely contraindicated, since possibility of severe complications is very high, and any, even a small load, can lead to irreparable consequences.
Contraindications to exercise are:
- presence of signs of threat of termination of pregnancy (increase of tone of uterus, presence of bloody discharge from genital tract) and treatment in this regard;
- bleeding and its threat;
- partial or complete placenta previa (placenta partially or completely blocks birth canal);
- increase in blood pressure caused by pregnancy;
- retardation of fetal development;
Eliminate or limit consumption of fried and fatty, smoked, spicy, pickled food, sausages, pates, and cream pastries. Flour products, foods with high content of sugar and fats will not do you good.
Your body will be pleased with raw vegetables, fruits, boiled on water beans, porridges, seafood. Choose low-fat dairy products, eat meat without sauces, vegetable oils, but in small quantities. Avoid dyes, fragrances, taste simulators.
Eat poultry meat, but without skin, fish, red meat, beans and nuts. You will receive additional energy with beans, grains, bread from flour of coarse grinding, sprouted grains of wheat.
To improve digestion, include in diet products containing fiber. Use fresh juices, but avoid canned vegetables and fruits. Dairy products with a high content of amino acids, vitamins and calcium are also useful. Drink yogurt, milk, eat cottage cheese, but do not overdo. Limit salt and sugar in dishes.
Not always pregnancy runs smoothly. Complications include:
- nausea and excessive vomiting;
- missed miscarriage;
- threat of abortion;
- varicose veins of lower extremities;
- varicose veins of vagina;
- late toxicosis: nephropathy of pregnant women, preeclampsia and eclampsia;
- hypoxia of fetus;
- back pain;
- anemia in the mother;
- immunological conflicts and Rh-conflict of mother and fetus;
- fetoplacental insufficiency;
- feto-fetal transfusion syndrome;
A separate type of complicated pregnancy is ectopic pregnancy. Development of fetus is impossible, and sooner or later it ends with miscarriage.
In most cases, with timely detection, modern medicine is able to prevent and reduce undesirable consequences to a minimum.
Nature of the course of perinatal period to significant extent determines features of development and health of fetus, as well as in childhood and adulthood. Significant influence on the course of perinatal period of ontogenesis is provided by factors determining features of embryo and fetus development before reaching 28-week period, as well as state of gametes, which gave rise to a new life. Modern science knows that anomalies of development and diseases of fetus are primarily due to:
- chromosomal and genetic disorders (mutations);
- influence of unfavorable environmental factors;
- genetic infringements, capable to be realized (to be shown) only as a result of influence of adverse factors of environment.
In connection with the fact that pathological factors affecting risk of perinatal pathology have a different effect, they distinguish:
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