Swelling during pregnancy - Causes, symptoms and treatment. MF.

Edema, large or small, brushes, feet, edema of other location somehow accompany most of the pregnancies. A rare woman, who bore and gave birth to a child, does not face this problem. Edema is a pathological accumulation of fluid in the intercellular space of tissues and organs. It appears as a swelling in this or that place of the body. In itself, edema can either not manifest itself at all or only bring unpleasant sensations. However, this may be a sign of another formidable pathology. Osteal syndrome accompanies many diseases of various organs and systems of the body: inflammatory, cardiovascular, renal, endocrine.

During pregnancy, swelling is associated with an increase in the permeability of capillaries - the smallest vessels, which leads to sweat fluid from the bloodstream into the tissue.

Most often swollen fingers and toes, as well as ankles. The condition makes the weather hotter. It is easier to notice edema in the places where the rings are worn on the fingers of the hands, where after their removal, circular grooves remain, which remain for some time. Swelling on the ankles of the legs can be easily verified by herself. A thumb or forefinger is pressed against the skin in the area of ​​the front surface of the shin or ankle, pressing it against the bony protrusion. If swelling is - after the finger is removed, remains a visible deepening. If the fovea is not clearly visible, but with the finger still feels a slight depression - this is the easiest degree of edematous syndrome, often called "pastoznostyu."

It is necessary to distinguish between physiological and pathological swelling in pregnancy. Clear criteria for the separation of these two concepts is not, the border is very unstable, and the diagnosis of a particular woman is difficult even for high-class specialists. Nevertheless: physiological edema of , as a rule, not pronounced, is pasty and more often localized in the area of ​​hands and feet. They, unlike pathological ones, do not lead to the development of complications and either pass on their own or accompany the entire pregnancy, without causing any special trouble for a woman, except for worrying about the perfection of her appearance.

Pathological edema of is part or symptom of a broader concept - gestosis. In this case, the classic triad of symptoms in this disease is the development of edema, proteinuria( excretion of protein with urine, which is absent in the norm), arterial hypertension( increase in blood pressure above 140/90 mm Hg).The name comes from the Latin word pregnancy, and reflects the nature of the disease. That is, this pathological condition is caused by pregnancy itself and does not occur outside of it. The causes of gestosis, despite the close attention of scientists and doctors for many decades, are not fully understood and depend on many factors. A lot of research has been done on this topic, but there is still no consensus on the true causes of its occurrence. Undoubtedly, it is only a fact that the disease is directly related to pregnancy. This condition never arises outside of pregnancy and when it ends, most often a successful recovery comes.

Degree of edema

Clinically abnormal edema of pregnant women is classified in degrees, or stages, which are also diagnosed.

Hidden edema is manifested by increased weight gain, nicturia( frequent nocturnal urination), decreased urine output( the amount of urine released, normally not less than 30-40 ml per hour, depends on the amount of fluid consumed).

Visible edema:

1 degree - swollen legs and hands;

2nd degree - swelling passes to the abdomen;

3 degree - edema passes to the face;

4 degree - anasarca( generalized edema).

Swelling usually begins with the feet, often with the ankles. With the progression of the disease, swelling spreads from the bottom up. However, sometimes the hands swell first, then the feet, less often the edema is localized on the face and hands. With edema of the face, its features coarsen, especially swelling on the eyelids. Often swollen labia. The swelling is less noticeable in the morning. More precisely, we do not see them, the liquid does not disappear anywhere, it's just more evenly distributed throughout the body during the night when we sleep. After all, we usually do it in a reclining position. During the day, due to the fact that we are more in an upright position, swelling, according to the laws of physics, "drain" down and localize on the lower limbs, reminding ourselves of the pain and fatigue of the feet, footprints from shoes and socks. Possible accumulation of fluid in the cavities inside the body( latent edema).

The expression of edematous syndrome often does not correspond to the severity of the disease. Even with severe swelling, a pregnant woman can not complain, and the general condition remains satisfactory. Nevertheless, in more than 90% of cases the disease passes into the next stage, there are the phenomena of hypertension and proteinuria.

At risk for the development of gestosis include:

• women who had a previous pregnancy complicated by the development of gestosis;

• pregnant with concomitant diseases of the cardiovascular system( hypertension), kidney, liver, thyroid, diabetes, lipid metabolism( obesity);

• young( under 18 years) pregnant, perverse after 30 years;

• who suffered toxicosis in the first half of pregnancy( vomiting of pregnant women, drooling, etc.);

• pregnant with revealed concealed edema;

• pregnant with multiple birth;

• pregnant women with occupational hazards;

• pregnant with unfavorable social and living conditions.

Complications of edema during pregnancy

As such, swelling, as mentioned above, can cause only cosmetic anxiety, in contrast to edema accompanying gestosis. The most formidable complications of gestosis are preeclampsia and eclampsia - a generalized convulsive fit, which can end with stopping breathing, cardiac activity and leading to death.

Pre-eclampsia, i.e., a condition preceding the onset of eclampsia, is characterized by the following symptoms:

• with headache;

• impaired vision;

• with nausea and vomiting;

• pain in the liver and stomach;

• with hearing loss;

• with speech difficulties;

• fever, hot flashes, sweating;

• by itching;

• with excitement or drowsiness;

• tearfulness, inadequate behavior, motor excitement.

If any of these signs occur in the normal course of pregnancy without swelling, proteinuria and hypertension - the probability of developing eclampsia is minimal, but if the symptoms of gestosis on the face - there is a threat of a serious complication.

Eclampsia is the most severe stage of gestosis, characterized by the occurrence of seizures of generalized or isolated( limited) nature. Anyone who has ever seen an epileptic attack can roughly imagine what eclampsia looks like. There are, however, other forms of eclampsia, including non-convulsive, when the clinic is limited only to the unconscious state of the patient. Presence of the above signs of pre-eclampsia or eclampsia requires urgent medical attention.

Gestosis may be mild, or severe. An optional condition is the presence of a classical "triad" of symptoms. The manifestation of the disease can be limited only to edema or hypertension, and also by two or more symptoms in addition to the classical in various combinations. Most often, of course, the disease occurs in mild forms. Occasionally, however, severe forms may occur unexpectedly. This can happen in a few weeks, in rare cases it will take days and hours. When a severe form of gestosis occurs, not only the mother suffers, but her future baby as well. The decision to prolong pregnancy is taken individually, on the basis of the state of the mother and the fetus, the interests of the first are put in the first place. In a life-threatening condition, the only effective measure is emergency delivery, since there are no other methods of treatment.

Pregnant with edema

Pregnant with edema is given increased attention at the stage of reference in the women's consultation. She systematically leads the dynamics of weight, monitoring the performance of the cardiovascular system( blood pressure), kidney function( proteinuria).Everything is aimed to prevent complications. Often prescribed preventive medicinal complexes consisting of phytospores.

Into the preventive complex enter:

• sedative( valerian rhizome infusion of 30 ml 3 times a day, motherwort infusion of 30 ml 3-4 times a day), soothing for 1/2 tablespoon 3 times a day;

• improving kidney function( "Kidney tea", birch buds, bearberry leaves, cowberry leaves, corn fish extract, horsetail grass field);

• normalizing vascular tone( hawthorn flowers, fruits, extract).

Prophylaxis of edema during pregnancy

For the prevention of development and progression of edema, rational management of work and rest, walking on fresh air, naturally taking into account weather conditions, is recommended. It is necessary to correct nutrition with the predominance of the protein component, rich in vitamins and microelements, limited in the content of table salt, spices. The amount of fluid consumed must necessarily be discussed with the doctor. In this case, it depends on the dynamics of edema, the weight index, the clinical course of gestosis. Self-reduction or increase in consumption of juices, tea, and other beverages can lead to deterioration. It should be noted, however, that strict control of both the consumed liquid and diuresis is necessary only with pathological, sufficiently pronounced swelling.

The important thing is to choose the right clothes. It must let in air, that is, consist primarily of natural fabrics. Do not allow collars, girdles, cuffs, rubber bands that are tightening your body and forcing you and your baby to suffer because of a lack of oxygen for the sake of dubious beauty. The swelling of the lower extremities is annoyed by the increased fatigue of the legs. Shoes should not be bought "back to back" with the hope that "the natural skin will stretch."Pregnancy is not the right time for experiments. Welcome orthopedic shoes, insoles, arch supports. Often with swelling of the lower extremities helps a frequent rest, during which the legs should be kept in an elevated position. At the same time, a foot massage made by the future father will be pleasant and useful.

Treatment of edema during pregnancy

It should be clarified that, from the point of view of evidence-based medicine, there are no truly effective preventive and curative measures, both edema and gestosis in general, in the world today. Therefore, any doctor who has encountered this problem, prescribes treatment based on a specific situation, based on his medical experience and numerous recommendations. It should be critical of all methods of treating edema and gestosis, particularly on the Internet, especially if they guarantee a 100% cure. Never take any even the most innocuous, in your opinion, medicines, including herbal medicine and folk remedies, without consulting YOUR doctor. Also, I consider it a mistake to consult "on the side", with several specialists who will undoubtedly contradict each other.

Prepare for pregnancy in advance, choose a competent specialist in advance, who is right for you, who will be able to answer all your questions, listen and endure you, help to remove fear of pregnancy and childbirth. Based on the trust between the doctor and the patient, the baby has more chances to be born strong and healthy.

Obstetrician-gynecologist Nikulichev DV