Heartburn in pregnant women in the third trimester

With heartburn during gestation, most women are familiar, 60-70 percent. Someone she begins to torment already in the first months, while others complain of an unpleasant burning sensation in the chest only at the last stretch. The closer to childbirth, the more causes and predisposing factors of heartburn, the more women note this very uncomfortable symptom.

Heartburn during pregnancy in the third trimester is very common. It is characterized as a burning sensation in the zone of the upper abdomen and the center of the chest( behind the sternum), that is, along the esophagus, which can be combined with soreness, weakness, and other dyspeptic manifestations: nausea, flatulence( bloating), sour taste, belching. Often, a short dry cough that accompanies the condition of a woman is added.

The main causes of

The mechanism of the sensation of heat behind the sternum is explained by the onset of the process of irritation of the mucosa of the esophagus. This happens, since foreign bodies that have an acidity index( pH), which is unfavorable for the esophagus, enter the lumen of the organ, namely, gastric contents. Food masses, appearing in the stomach, mix with gastric juice and begin to be exposed to chemical attack of hydrochloric acid, that is, they acquire a sharp acid reaction.

During pregnancy, there are several such predisposing moments, and each of them can explain why the cardiac sphincter loses its functionality. In general, the process of casting gastric juice into the esophagus is called gastroesophageal reflux, and this symptom is a manifestation of very many diseases of the gastrointestinal tract, as well as neurological, endocrine and psychiatric pathologies.

The mucosa of the esophagus, in contact with acidic gastric contents, perceives this environment as aggressive and foreign. Hydrochloric acid really begins to destroy the epithelium of the esophagus, signals about which the nerve fibers enter the cortex of the woman's brain, where a feeling of heartburn is formed. If such a mechanical and chemical contact of hydrochloric acid with the esophagus occurs frequently, then it can begin the inflammatory process( esophagitis), the formation of deeper mucosal defects( erosions and ulcers).

The irritation of the esophagus occurs when it gets into the stomach contents of the

. During the period of gestation, the causes of heartburn are most often physiological, that is, they are explained by the changes that occur in the body of a future mother. So, cardinally changes the hormonal background, which is necessary for bearing the baby and preparing for childbirth. The hormone progesterone acts most effectively in the first half of gestation, relaxing the smooth muscles of the uterus and eliminating the occurrence of a threat of miscarriage. But, at the same time, there is a relaxing effect on the smooth muscles of other internal organs, in particular, the intestine and the cardiac sphincter. As a result, constipation and gastroesophageal reflux, the main mechanism of heartburn formation, are often formed.

However, in the last months of gestation, the hormone progesterone begins to lose its leading influence on the woman's body. Gradually, its level decreases and, as we approach the birth, it practically reduces to zero. And this is natural, because before birth the uterus should not be too relaxed, it should begin to prepare for active and long cuts.

Therefore, the role of progesterone in the mechanism of burning in the chest at the end of pregnancy is not leading, heartburn in the third trimester is largely due to another natural process. This gradual increase in pressure in the abdominal cavity, resulting from an increase in the size and mass of the uterus and fetus. The closer to childbirth, the higher the intra-abdominal pressure, the stronger the internal organs are pushed back, and the stomach is pressed by the uterus to the diaphragm and to the lower third of the esophagus. Naturally, in such conditions, the casting of gastric contents into the esophagus occurs much more often.

In addition, the increase in pressure in the abdominal cavity is affected not only by the increase in weight of the fetus. Pregnancy can be many-water or multi-fruit, which becomes an additional factor provoking the appearance of heartburn in the last months of gestation.

To short-term increase in pressure in the abdominal cavity, the opening of the cardiac sphincter and, consequently, the ingestion of stomach contents into the esophagus, various predisposing factors can also lead. Their presence can be found in the lives of almost every pregnant woman:

• overeating, even if a woman consumes light meals;
• preference for heavy meals, fatty, smoked, spicy dishes;
• a one-time use of a large volume of liquid;
• the use of carbonated drinks;
• excessive physical load( lifting and carrying heavy loads, homework, work with slopes on the backyard);
• too tight bandage on the abdomen.

Rest immediately after meals can cause heartburn

The effect of these factors is not permanent and natural, they can be quickly disposed of without difficulty, and heartburn during pregnancy in the third trimester will become much less likely to appear and will not be so painful. But in some cases a woman needs qualified medical care.

This especially applies to situations where the heat behind the breastbone becomes a manifestation of not only pregnancy, but also serious co-morbidities. Then the woman needs timely diagnostics and complex treatment of pathologies( gastritis, gastroduodenitis, enterocolitis, peptic ulcer, liver and gallbladder diseases).

Methods of treatment

If burning sensation in the chest is felt rarely and quickly disappears, the future mother, as a rule, does not seek medical help. But often heartburn during pregnancy in later terms becomes almost a constant companion of a woman, tortures her, disturbs sleep and appetite, worsens the mood, negatively affects her overall condition.

In most situations, doctors observe a woman's pregnancy, already aware of the presence of background diseases. However, the manifestation of a pathology can occur in the gestation period, as evidenced by the appearance of certain clinical signs, including severe heartburn. In such cases it is necessary to diagnose and prescribe to the woman such treatment that would be most effective and, at the same time, safe for the unborn child.

If the presence of heartburn in the third trimester is due solely to physiological causes and the internal organs of the woman are healthy, then the treatment of this condition will consist of the following directions:

• medications according to indications;
• compliance with the diet;
• recommendations on lifestyle.

Drug therapy

Any drug at any time of pregnancy should be taken very carefully. In cases of heartburn, many know that it is necessary to reduce the acidity of gastric juice. This will make the contents of the stomach the least invasive of the mucosa of the esophagus. Therefore, many people think that baking soda, like alkali, can help with heartburn, including during pregnancy. However, it is not necessary to use soda to treat burning sensation in the chest. A short-term positive result will be, as the acidity will drop for a short while, but during the chemical reaction of soda and hydrochloric acid a large amount of gas is released, which will activate the stomach, gall bladder, pancreas. Therefore, after an improvement in the condition of heartburn must return, and it becomes even more intense.

Antacids are used only with the permission of the doctor

The most acceptable late gestation are antacid agents that rapidly reduce the level of acidity of the gastric contents, while very slightly absorbed into the bloodstream. They do not restore the efficiency of the cardiac sphincter, and gastroesophageal reflux still occurs under certain conditions, but the "aggressive" effect on the esophagus is much reduced.

Typically, a doctor recommends any drug from the following antacids:

• Rennie , used in the 3rd trimester most often. It consists of mineral salts, which actively interact with hydrochloric acid, in just 3-5 minutes, suppressing heartburn. In addition to it, eructations, flatulence, nausea are eliminated. It is enough to chew 1 tablet at an attack of heartburn, but the maximum amount per day - 11 tablets.
• Maalox , contains magnesium and aluminum, thus can affect the mineral metabolism. In addition, magnesium reduces the activity of uterine musculature, therefore, 1 month before the birth, this drug is not recommended. Antatsidny effect occurs due to a decrease in the activity of pepsin gastric juice.
• Almagel can be consumed no more than 3 days. It contains aluminum and magnesium, can cause allergic reactions and intensify dyspeptic symptoms.
• Gaviscon forms a protective layer, including in the area of ​​the cardiac sphincter. Due to this, the functionality of the sphincter is partially restored, the possibility of reflux is eliminated, the acidity of the gastric masses decreases. It is recommended to drink no more than 7 days.

In some cases, antacids have to be combined with other drugs. For example, sorbents( Smekta, Enterosgel), histamine blockers( Ranitidine).If heartburn badly gives in to therapy, then the gastroenterologist begins to examine and treat a woman.

Recommendations on diet and lifestyle

In the last months and weeks of pregnancy, it is very important to follow the doctor's recommendations, which relate to the diet and behavior of women. To heartburn as rarely as possible, you need to use a higher pillow to sleep, do not go to bed or just lie down right after eating, do not wear tight clothes and clothes. It is important to carry out every day a feasible complex of gymnastic exercises, often walking outdoors.

Cottage cheese and milk naturally reduce acidity in the stomach

In the diet, the following rules should be adhered to:

• organize a split meal( 5-7 times a day), in small portions;
• eat slowly, not hurrying;
• drink fluid between meals;
• not gorge on before going to bed and not overeat;
• to exclude fatty, pickled, spicy, smoked;
• to exclude baking pastries, coffee, chocolate, soda;
• more often use milk and cottage cheese, which reduce the manifestations of heartburn;
• exclude corn and barley cereals, which increase the production of gastric juice.

In most cases, only dietary recommendations are already able to significantly help a pregnant woman. If the heartburn is of significant intensity and duration, then you have to resort to drug therapy.