- Physiological changes
- How the pathology of the gastrointestinal tract manifests itself in late pregnancy
- Signs of surgical pathology
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At the fortieth week of pregnancy, the stomach can ache not only due to the onset of labor. Pain can be caused both by natural processes that occur during childbearing, as well as pathological, provoked by organic or physiological disorders.
In late pregnancy, the enlarged uterus presses on neighboring organs, so their location is somewhat biased. Since there is pressure on the intestine and its muscles are relaxed due to the action of hormones, often there are stool disorders that can manifest as constipation or diarrhea.
Stool retention may be troubling for some time after delivery. In some cases, diarrhea is a harbinger of beginning labor. If it hurts the bottom of the abdomen for 40 weeks of pregnancy, then this is considered normal, since the stomach is lowered by this time, the hormonal background changes, the body is preparing to push out the baby.
A woman experiences a heaviness in the abdomen, headaches, weakness, it becomes difficult to walk because of a heavy load on the spine. At this time the child has already sunk to the bottom of the pelvis, which can also cause pain in the lower abdomen and an increased need for urination.
Should alert the discharge from the genitals
For 40 weeks of pregnancy, it can periodically pull and hurt the stomach due to training fights. The abdomen becomes firm, this indicates that the uterus is toned. This phenomenon can occur after physical activity, emotional stress.
They differ from real fights by force, as well as the interval of appearance. If the birth process has begun, then the interval between contractions decreases, and their intensity increases.
How the pathology of the gastrointestinal tract manifests itself in late pregnancy
The aching pains in the abdomen at 40 weeks of gestation, in most cases, are caused by physiological processes that provide the possibility of natural delivery or are provoked by the pressure of the enlarged uterus. But there is a possibility that the pain is caused not by pregnancy, but by pathological processes occurring in the body.
First of all, you need to pay attention to the intensity of pain and duration. Normal is considered if the pain in the lower abdomen is pulling and not too strong, such that it allows you to lead a habitual way of life.
Generic activity began if there is a strong cramping pain in the lower abdomen every 7 minutes. At the same time, the interval between contractions is reduced, and the intensity of pain sensations increases. Unlike training fights, the pain does not go away when you change your posture, taking a sedative.
In case of spasmodic pain caused by pathology, a fight occurs at unequal intervals( they can either lengthen or shorten).In a disease that requires urgent medical intervention, a woman takes a forced position of the body.
Body temperature increases with the inflammatory process of
. Although disturbance of the stool during pregnancy is normal, but the woman is troubled by the pains in the lower abdomen, then one should pay attention to the stool masses. If you notice blood, mucus, undigested food or fat( steatorrhea), then this indicates a disruption of the intestine or pancreas.
With a violation of the motility of the gastrointestinal tract, a belch appears with an unpleasant aftertaste. Bitterness in the mouth occurs if bile is thrown from the stomach into the esophagus. The smell of rot is felt if the food begins to rot already in the stomach. Sour taste is observed with increased acidity of gastric juice, and also if fermentation occurs in the stomach.
Signs of surgical pathology
The risk of developing a surgical pathology during pregnancy is small, but if you allow delay in setting the right diagnosis and do not start adequate therapy in time, it threatens the life of both the pregnant woman and the child.
Emergency help is needed for any pathology that causes the "acute stomach" syndrome. This symptom complex includes a violation of the motor function of the intestine, abdominal wall tension and severe cutting pain in the abdomen. Similar signs appear, if the inflammatory process is rapidly developing, and also if blood circulation in the mesentery vessels is disturbed.
"Acute abdomen" during pregnancy can develop with the following pathologies:
- diseases of the digestive tract( inflammation of the appendix, cholecystitis, perforation of the ulcer, ischemia and intestinal infarction);
- gynecological disorders( torsion of the cysts or cyst rupture);
- complications of pregnancy and childbirth( rupture of the uterus, placental abruption, septic complications);
- dysfunction of organs located outside of the abdominal cavity( lungs, kidneys, heart).
According to statistics, if the operation is performed within the first 6 hours after the appearance of the "acute abdomen," the probability of complications is reduced by a factor of 5-8.
The problem is that it is difficult to determine the surgical pathology during pregnancy, which is explained by the following factors:
- abdominal organs displaced;
- can not palpate organs due to enlarged uterus;
- changes in immunity and reflexes of the abdominal wall;
- atypical picture of the course of the disease;
- nausea, vomiting, stool discomfort, back pain and abdominal pain can be perceived as features of the course of pregnancy.
All this provokes diagnostic errors and delays in providing adequate medical care. To correctly establish the cause of the pathology of a pregnant woman should be examined by a surgeon and gynecologist, only in this way can exclude obstetric or gynecological disease.
Inflammation of the appendix
In 9 out of 10 cases in pregnant women, the "sharp abdomen" is caused by an inflammation of the appendix of the cecum. Appendicitis are difficult to diagnose because there is no specific symptomatology. Determine it when palpating the abdominal area, what to do in a pregnant woman, especially at this time, is quite difficult.
Clinical manifestation of acute appendicitis with pain in the right side( at the beginning of the inflammatory process, pain can be felt in the lower abdomen), pulse rate up to 100 beats per minute, hyperthermia, frequent vomiting, belching, bloating, tummy of the uterus. Symptoms of irritation of the peritoneum are weak or absent altogether.
If the disease develops at 40 weeks of gestation, then first deliver and then appendectomy. If there are indications for cesarean section, then the operations are carried out simultaneously.
Inflammation of the gallbladder
During pregnancy, women often develop stones in the gallbladder, which is due to a change in the composition of the bile, as well as impairment of the motor activity of the bile ducts, which is why the secret stagnates.
In case of cholecystitis caused by motion of the calculus, surgical therapy of
may be required. The symptoms of the disease include:
- abdominal pain that can last minutes or hours, as a rule, it occurs after eating;
- nausea and vomiting;
- lack of appetite;
- increase in temperature to 38 ° C.
Conservative treatment involves refusing to eat for two days, infusion therapy, taking antispasmodics, analgesics, antibacterial and antihistamines. Indications for surgical treatment are:
- presence of symptoms of diffuse peritonitis;
- no effect of conservative therapy;
- complications in the form of pancreatitis, cholangitis, mechanical jaundice, dystrophy of the gallbladder tissue.
Inflammation of the pancreas
The pathology is caused by the presence in the gland of activated enzymes, which act aggressively and injure tissues. During pregnancy, the disease develops due to violation of gallbladder motility, increased secretion of enzymes( proteases, lipases, amylases), increasing intra-abdominal pressure.
- with increasing pain in the abdomen( especially after oily or spicy food);
- with nausea;
- vomiting, not bringing relief;
- high temperature;
- blood pressure, which varies depending on whether the pregnant woman lies or is standing;
- straining the muscles of the peritoneum.
The disease is mainly treated in a conservative way. Surgical intervention is necessary if an abscess develops, secondary pancreatitis, pseudocyst fracture occurs.
If the lumen of the intestine is blocked and stool and gases stagnate in the intestine, surgical intervention is necessary. In intestinal pregnancy, the obstruction develops as a result of:
- atonia( due to the action of hormones);
- compression of the intestines and adhesions of the uterus;
- torsion of bowel loops;
In 45% of cases, the obstruction occurs in the third trimester of pregnancy, which is due to the lowering of the child's head in the small pelvis
. When the lumen of the intestine is closed, pain occurs throughout the abdomen. It can be permanent or periodic. In the second case, the seizures are repeated every 4-5 minutes if the obstruction is in the small intestine, or 10 minutes later, if in thick.
There is a delay in stool and gas, vomiting begins. With the development of abdominal muscle pathology in a relaxed state. When the disease progresses, a fever begins, possibly a shock state.
Exacerbation of peptic ulcer during pregnancy is extremely rare, as decreased gastric motility and hydrochloric acid secretion, and the production of protective mucus is increased.
Symptoms of perforation of ulcers during pregnancy:
- acute abdominal pain spreads to the right hypochondrium and into the scapula area;
- absence of vomiting;
- forced position of the body;
- muscles of the abdominal wall are tense( how strongly pronounced the symptom depends on the site of the ulcer).
If pathological conditions of the gastrointestinal tract have developed that require the use of potent medicines or surgical intervention, then stimulation of labor or cesarean section is performed with obstetric indications. The child is ready to be born, so it is more dangerous for him intoxication, the consequences of hyperthermia or intrauterine infection.