A woman may have a lower abdominal belly at 34 weeks gestation for various reasons. Some of them are considered physiological, others are pathological in nature and require therapy. Even if the pains occur periodically and not very pronounced, they still need to know the doctor who leads the pregnancy.
During the period of gestation, chronic diseases are exacerbated and pathologies develop, to which there is a predisposition. Therefore, a woman should pay attention to changes in her body.
Causes of physiological pain
At 34 weeks the weight of the child is not much different from what will be at birth. All systems and organs are already formed. The crumb has already turned head over to the birth canal. The child is already big enough, and it is difficult to wear it.
Intensive pain in the abdomen at 34 weeks of gestation may be manifested as a result of physiological processes, such as:
- stretching of the ligamentous apparatus supporting the uterus;
- displacement of organs of the abdominal space;
- slowing the motility of the intestines and stomach due to the relaxing effect of the hormone progesterone on smooth muscle.
In addition, the child can touch the body during the movement, which will cause a strong sharp pain, which will gradually subside. A woman is able to feel the so-called training fights. Pain in the abdomen at 34 weeks gestation they do not cause, rather, just bring inconvenience.
They are described as pulling and gradually descending. They arise, as a rule, because of the uncomfortable position of the body, emotional tension, physical activity, fullness of the bladder. There is a feeling due to the stress of the uterus, at week 34 they are considered a variant of the norm.
Since the backbone is heavily loaded, the pregnant women notice pain in the back and waist. If they are of a physiological nature, then they will be helped by a bandage or medical gymnastics. Due to the fact that the uterus squeezes the organs of the digestive tract, and also the intestinal atony is expressed, there may be disturbances in the digestive function.
Often in pregnant women there is diarrhea or constipation, heartburn, nausea
Diseases of the gastrointestinal tract
In two out of ten pregnant women, abdominal pains arise not because of the physiological processes occurring in the body, but as a result of pathology. During pregnancy, the hormonal background varies greatly, the protective function decreases, the volume of circulating blood increases by one and a half times, the production of insulin increases, the secretion of gastric juice slows down.
All this is necessary for the development of pregnancy, but at the same time it negatively affects the mother's body. During pregnancy, the detoxification function of the liver is decreased, heartburn and predisposition to the formation of concrements appear, fluid retention occurs, digestion is disrupted, as food stagnates in the stomach and intestines.
If the abdomen has a strong abdominal pain at 34 weeks of gestation, the woman must necessarily consult a doctor to exclude obstetric pathology or disease of the digestive system. Only a specialist will be able to establish why the abdomen hurts. Eliminate symptoms such as heartburn, constipation, diarrhea, nausea, medicines are capable of, and their administration should be carried out under the supervision of a specialist.
When urgent medical attention is needed
During pregnancy, the risk of a disease that requires surgery is small, appendicitis is diagnosed in one pregnant woman out of a thousand. But if time is missed and the operation goes on later for several hours, then the probability of complicating the disease is high.
Therefore, a woman should know, with what symptoms it is necessary to urgently call an ambulance. Emergency care is needed when there is a symptom complex, called "acute stomach".It manifests itself by abdominal pain, abdominal wall tension and impaired intestinal motility.
These symptoms occur in any pathology caused by acute inflammatory disease or impaired circulation. If patients are operated on in the first 6 hours after the onset of the symptom, the risk of complications is reduced 5-8 times.
Causes of "acute abdomen"
When a baby is growing, the growing uterus displaces adjacent organs, which causes deterioration of their work and causes the appearance of atypical symptoms of many pathologies. In addition, the symptoms of diseases characterized by an "acute abdomen" are similar to physiological pain during pregnancy.
The woman has a lowered tonus of smooth muscles, the hormonal background is changed, the vessels of the uterus and pelvis are dilated, the reactivity of the organism is noted. These factors can lead to diagnostic errors and procrastination in the provision of surgical care, which is potentially dangerous for the life of both women and children.
If symptoms of "acute abdomen" appear, then urgent surgery is needed, delay increases the risk of complications formation. Most often, acute appendicitis is diagnosed, cholecystitis takes second place, then intestinal obstruction and pancreatitis.
In rare cases, liver and spleen rupture, perforation of the ulcer, rupture of the splenic artery may occur."Acute abdomen" provoke torsions and ruptures of cysts and tumors, ovarian cancer, uterine myomas. For the correct diagnosis, the physician should carefully collect the anamnesis and accurately know the duration of the pregnancy.
A patient with a "sharp abdomen" should be examined not only by the surgeon, but also by the obstetrician-gynecologist, so that obstetric or gynecological pathology can be excluded. In this case, the number of probes of the abdomen should be minimal, so as not to cause the tone of the uterus.
For the operation, the 2nd trimester of pregnancy is most safe, so if the intervention is not urgent, it can be prescribed for the postpartum period.
The main sign of the "acute abdomen" in pregnancy is pain. At its epicenter, it can be assumed in which organ the pathological process develops. Generalized pain is mainly caused by inflammation of the abdominal cavity due to bleeding, exudate, the presence of intestinal contents.
The pain that occurs in the lower abdomen in the center can be triggered by an increase in the tone of the uterus. The side of the bottom hurts more often due to the rupture or torsion of the ovarian neoplasm. Soreness in the middle of the abdomen is probably caused by bowel disease.
With pain in the upper abdominal cavity, the doctor suspects a disruption of the liver, spleen, stomach, small intestine, gallbladder, pancreas. Pain in the abdomen, vomiting and nausea are often provoked during pregnancy by the disease of the upper gastrointestinal tract or toxicosis.
Acute surgical condition in pregnant women develops diarrhea. The need for intervention is indicated by irritation of the peritoneum, as well as loss of consciousness. These symptoms are manifested in violation of the integrity of the organs and bleeding. Hyperthermia to febrile values indicates the presence of infection in the body.
Appendicitis
Most often, pregnant women are operated on inflammation of the appendix. Typically, women go to the clinic only 12 hours after the onset of the first symptoms of inflammation, which can be explained by the following reasons:
- loss of appetite, nausea and vomiting are perceived as natural processes occurring during pregnancy;
- vermiform appendix gradually rises as the uterus grows, so the pain has uncharacteristic localization;
- at an early stage of the disease, the temperature and pulse are normal, in a quarter of patients, the temperature does not rise at all;
- blood tests do not accurately determine appendicitis, since elevated levels of white blood cells are the norm during pregnancy.
Because of delay in treatment and difficulties in diagnosing, treatment is late, therefore, in pregnant women 2-3 times more often develop destructive forms of appendicitis when a purulent secret is already leaking from the lumen.
The woman after the 24th week of pregnancy may not show typical symptoms of the disease
The pain is felt in the right side below or in the center, but it is written off to stretch the ligaments or urinary tract diseases. The longer the gestation period, the less muscle tension and signs of irritation of the peritoneum appear( in the third trimester symptom is present only in a third of patients).
The caecum rises high, so a large omentum can not limit infection, hence the risk of developing peritonitis increases. Almost all patients have a pulse more than 100 beats per minute, despite the fact that the temperature rises only in half.
After the operation, the patient is assigned bed rest, antispasmodics, vitamin E. if a complicated appendicitis, then magnesium sulfate is given to prevent uterine contraction. An inflamed appendix often leads to the fact that labor begins.
Until the uterus has contracted, it limits the spread of the infection, but after birth pus enters the abdominal space and signs of an "acute abdomen" manifest within a couple of hours after delivery.
Cholecystitis
3.5% of pregnant women have concrements in the gallbladder. If the organ is inflamed due to the exit of the calculus, surgical intervention may also be required. The following factors influence the development of cholecystitis:
- use of oral contraceptives prior to pregnancy;
- in bile increases lithogenic properties( there is a tendency to the formation of stones due to changes in its composition);
- impairment of motility of the bile ducts, stasis of secretion;
- after the 20th week of pregnancy, the bladder increases, but the ability to excrete a secret decreases.
Symptoms of the disease:
- lack of appetite;
- vomiting, nausea;
- subfebrile temperature;
- pain is noted in the right side from above.
Pain can spread to the upper or lower left abdominal area. Typically, the pain syndrome is noted after eating and lasts for minutes or hours. The gallbladder is not probed by a pregnant woman.
The diagnosis is confirmed by laboratory tests of blood and ultrasound
. First, drug treatment is recommended, but if the clinic is strongly pronounced and pancreatitis developed, then surgery is indicated. Conservative therapy consists in removing the functional load from the body( hunger, intravenous nutrition), taking antibacterial, antispasmodic and analgesic drugs. The outlook for rendering assistance on time is favorable.
Acute pancreatitis
Pancreatitis in the pancreas contains activated digestive enzymes. Pathology develops due to cholelithiasis, the effects of medications( estrogens, tetracyclines, diuretics), hereditary predisposition, pancreatic and small intestinal abnormalities, infection, abdominal trauma, vascular disease, alcoholism.
In the second half of pregnancy, pancreatitis develops:
- bile stasis and gallbladder motility disorder due to the action of the hormone progesterone;
- because of activation of the pancreas during this period there is an increase in the secretion of enzymes( lipase, amylase, acid proteases);
- increase in lipids in the blood;
- increase in intra-abdominal pressure;
- uterine contraction and spasm of bile duct sphincter occur simultaneously;
- deterioration of mineral metabolism.
The disease has the following clinic:
- abdominal pain( it can be shinier, acute, or gradually increasing);
- nausea, vomiting;
- subfebrile temperature;
- tachycardia;
- tension of the muscles of the peritoneum;
- arterial pressure varies depending on the position of the body( standing, lying).
If the pregnant woman turns to the doctor within 2-3 days after the onset of symptoms, then in the serum the amylase exceeds the norm several times( after this time the indicator comes back to normal).
Such methods of pancreatitis diagnostics as sounding, angiography, retrograde pancreatography in pregnant women can not be applied, therefore there are some difficulties in diagnosing
On ultrasound it is possible to notice fluid in the abdomen, peripanercatic hematoma, abscess, pseudocysts, but with a gestation period of more than 30 weeks, the uterus closes the gland and can visualize only her body. The disease is dangerous for the child, because pancreatic enzymes are able to penetrate the placental barrier, as well as due to hypocalcemia and electrolyte imbalance.
Conservative treatment involves a refusal to eat, infusion therapy, the removal of gastric contents through the probe, the taking of analgesic, antispasmodics, and drugs that inhibit the activity of enzymes. This treatment helps 90% of patients, the improvement or deterioration of the disease occurs within 3-5 days.
Intestinal obstruction
Surgical intervention is required if a pregnant woman develops intestinal obstruction. Violation of the movement of stools and gases can occur during pregnancy due to:
- squeezing the enlarged uterus of the intestinal adhesions( in 55% of the cases of obstruction, of which 45% is in the third trimester);
- torsion of the intestinal loops( in 25% of cases);
- hernia( in 10% of cases);
- is a benign or malignant tumor.
If there are spikes, then there are three periods when there is a risk of development of pathology: raising the uterus from the small pelvis( I trimester), lowering the head of the child into a small pelvis( III trimester), a sharp decrease in the uterus after the birth of the child with abnormal intra-abdominal pressure.
Suspension of a woman who has undergone removal of appendicitis or other operations in the abdominal cavity
is predisposed. If the intestine is obstructed, diffuse abdominal pain occurs, it is constant or intermittent( the interval between attacks is 4-5 minutes if the pathology in the small intestine and 10-15, if in thick).Stool and gas retention is noted, vomiting begins in 80% of cases.
At the initial stage of the disease, abdominal muscles are not strained. As the disease develops, fever, a decrease in the amount of urine released by the kidneys, a shock state. Therefore, if a pregnant woman has clinical symptoms of obstruction and there have been surgical interventions in anamnesis, then an X-ray examination is necessary.
Moreover, the X-ray in the beginning is not informative, but as the pathology develops quickly, a repeated picture taken after 5-6 hours indicates intestinal dysfunction. Before the diagnosis is made, symptomatic therapy is carried out: intestinal stimulation, gastric lavage, siphon enema, medicines. After determining the disease, an operation is performed.
Ulcer
Gastric ulcer in pregnant women occurs extremely rarely. In the literature, less than a hundred cases of complications of pathology are described( most occur after the 28th week of gestation).When a child is pregnant, the woman's gastric motility decreases and the secretion of gastric juice decreases, but the production of mucin increases.
There is an assumption that such protection of the mucosa is caused by the action of estrogen. Exacerbation of peptic ulcer disease( dyspeptic disorder, abdominal pain) can be regarded by a woman as typical signs of pregnancy. When the ulcer is perforated, there is a pain syndrome, signs of peritonitis are noted, shock develops.
Such a clinic requires surgical treatment. Diagnosis of the disease with the help of gastroscopy. In the third trimester, a cesarean section is performed to reduce the harmful effects on the fetus of hypoxemia and maternal hypotension.
Consequences of operation for the fetus
Modern drugs that are used for anesthesia are safe enough for the fetus, but at the same time they increase the risk of miscarriage at an early pregnancy. The use of an anesthetic by a pregnant woman does not have significant side effects on the baby.
Aspirin may be prescribed, but its duration and dosage should be shortened. Pregnant women should take antibacterial drugs. The safest are considered to be cephalosporins, penicillins, macrolides, sulfonamides and aminoglycosides should be avoided, tetracyclines should not be used.
Antibacterial agents are selected individually
X-rays are only made if the risk from unrecognized pathology exceeds the risk of exposure to the fetus. This method of research is mainly used if there is an assumption about intestinal obstruction.
For the fetus, hypoxia is the greatest danger in surgical intervention, therefore it is necessary to check the pO2 values and the oxygenation of the mother's blood throughout the treatment. The outcome of pregnancy is affected not so much by the very surgical intervention, but by the severity of the inflammatory process that arose after the operation.
Pain that does not threaten the health of a woman and a child, as a rule, passes quickly enough, they have a pulling character, and their intensity does not increase. If the discomfort continues for two hours, the pain intensifies, the body temperature rises or if even the sensations simply make the pregnant nervous, then it is necessary to consult a doctor who will inspect and, if necessary, prescribe an examination.
