Preeclampsia is a pregnancy-specific disease. Counts among the so-called pregnancy poisonings (gestoses). Leading symptoms are increased blood prere (more than 140 /90 mmHg), increased excretion of protein through the urine and retention of fluid in the ties of pregnant women (edema formation). However, the symptoms mentioned do not necessarily have to herald pre-eclampsia. Edema, in particular, is seen in most pregnant women toward the end of pregnancy, even without another underlying condition. High blood prere occurs in about 10% of pregnant women, pre-eclampsia in 2%.
High blood prere during pregnancy
High blood prere ( ≥ 140/90 mmHg) in pregnancy means an increased risk of complications. Nevertheless, the majority of pregnant women who have high blood prere or develop it during pregnancy give birth to their child in good health. A distinction is made between pregnancy-independent hypertension, which already exists before the start of pregnancy or until the 20th week of pregnancy. Pregnancy-related hypertension, which occurs after the 20th week of pregnancy (1-5% of pregnancies), and pregnancy-related hypertension, which occurs after the 20th week of pregnancy (1-5% of pregnancies). SSW developed (in 5-10% of cases). The latter form, pregnancy hypertension, which is usually uncomplicated, usually normalizes within 6 weeks after birth.
However, if the increase in blood prere during pregnancy is accompanied by increased protein excretion in the urine (> 300 mg/24 h) are associated with rapid weight gain (> 0.5 kg/week) and swelling of the face and hands, we speak of preeclampsia, and in the most severe form of eclampsia, d.h. life-threatening conditions for mother and child.
If the placenta is no longer able to supply the child adequately, this is called placental insufficiency. This can be caused, for example, by pregnancy poisoning or nicotine abuse. The undersupply can lead to consequential damage to the unborn child.
Diabetes during pregnancy (gestational diabetes)
If the mother is diagnosed with a disorder of the sugar metabolism during pregnancy, this is referred to as "gestational diabetes" (Gestation = pregnancy) – regardless of whether there is already known diabetes mellitus which is only detected during pregnancy or whether the diabetes has only developed as a result of pregnancy.
Basically, it is the most frequent concomitant disease in pregnancy with about 2% – 8% frequency, which can lead to serious complications for the mother and especially for the child before and during birth . The disease results in recurrent, briefly elevated blood glucose levels in the mother and eventually in the child. Pregnant women are at increased risk for infections, high blood prere and preterm birth because of it. Further health risks can arise for the child, such as malformations or fetal macrosomia. In this case, too much of the growth hormone insulin can lead to weight gain and, in some cases, enlargement of the skull and bones, which can make delivery more difficult, necessitate a Caesarean section and lead to birth injuries. Affected newborns often later become overweight children and adults and are more prone to diabetes and the late complications associated with the metabolic disease. It is therefore very important that the disease is detected and treated as early as possible.
Insulin plays a decisive role in the development of gestational diabetes. It is responsible for transferring sugar (glucose) from the blood into the cells and thus ensures a reduction in blood sugar levels. During pregnancy, there is usually an increase in blood glucose levels, which is caused on the one hand by various pregnancy hormones (e.g.B. The placental insufficiency can be caused by the presence of estrogen, human placental lactogen (HPL) and, on the other hand, often by nutritional factors (malnutrition and overeating). This also increases the maternal organism's need for insulin. If the pancreas is unable to supply this increased demand for insulin, diabetes develops. After the birth, the mother needs less insulin, which is why the disease disappears again in most cases. In a small proportion of those affected, the diabetes persists after pregnancy or leads to diabetes mellitus after five years.
Between the 24. and the 28. From the second week of pregnancy, all pregnant women who do not already have diagnosed, manifest diabetes can receive a blood glucose-based screening test for the early detection of gestational diabetes (GDM). Risk factors for developing gestational diabetes include:
– Malnutrition and the resulting overweight or obesity. obesity in the family – gestational diabetes during a previous pregnancy – excessive weight gain during pregnancy – impaired glucose tolerance (precursor of type II diabetes) before pregnancy
In pregnant women who are at increased risk of diabetes, a screening test for elevated blood glucose levels can be performed as early as the first trimester of pregnancy. However, it should be tested in high-risk patients with negative results in the 24. up to 28. The blood glucose level should be checked at the 32nd week of pregnancy and also at the 32nd week if the results are negative again. to 34. SSW to be repeated.
Even if the child is born after 20. If the baby's blood glucose level is significantly higher than his or her developmental age during the first week of pregnancy, it should be checked whether gestational diabetes may be present.
A mild form of gestational diabetes can be treated by diet, with several small, low-calorie meals per day and sufficient exercise. In particular, rapidly available sugars, such as those found in white flour products, confectionery or soft drinks, should generally be avoided, as they lead to a rapid rise in blood sugar levels. Instead, whole-grain products should be preferred as a source of carbohydrates. In 85% of all cases, a wholesome, healthy diet is sufficient for therapy; in 15% of cases, insulin must also be administered . If a good adjustment of the blood glucose values is not possible by diet, a medicinal treatment must be carried out. This treatment takes place in diabetology practices in cooperation with the gynecologist. After pregnancy, gestational diabetes usually disappears, but those affected should have their blood glucose levels checked regularly by their gynecologist even after delivery.
Because of the possible complications, it is recommended for women with gestational diabetes to give birth in a clinic with neonatal intensive care. It is not uncommon for their babies to have an increased birth weight of over 4 kg, which necessitates a cesarean section or forceps delivery. can make a suction cup birth necessary.
To be on the safe side, blood glucose levels should also be checked again after birth – preferably at regular intervals in the future as well. Studies have shown that more than half of all women with gestational diabetes develop diabetes within 10 years. Pregnant women who develop diabetes that requires insulin injections have an even worse prognosis – 61% of them will develop type II diabetes within the next three years. Among expectant mothers who were adequately treated by dietary changes alone, only 15% later became ill. This form of diabetes can also be well controlled with medication and dietary changes.
The risk of deep vein thrombosis in the legs or pelvic veins is about 6 times higher in pregnant women and women who have recently given birth than in non-pregnant women. This is caused by the physical changes during pregnancy: the composition of the blood and the hormone balance change, the vein walls become more elastic and dilate due to the increased production of the progesterone hormone. This slows down the blood flow. In addition, changes in venous prere – especially in the last months of pregnancy, when the growing fetus and uterus put increasing prere on the veins in the abdomen – favor the formation of blood clots.
In the case of thrombosis, a blood clot (thrombus) forms in a healthy or previously damaged blood vessel and constricts or blocks the vessel. Blood clots of this type can form when "used" blood is pumped into the body, deoxygenated blood no longer flows adequately toward the heart. Most frequently, thromboses form in the veins and here preferentially in the veins of the lower half of the body (deep leg veins, not infrequently also pelvic veins). In principle, the frequency of thrombosis is significantly higher in the veins than in the arteries. This is due to the more delicate anatomical structure of the vein walls. The lower flow velocity of the venous blood compared to the arteries is responsible.
If a thrombosis has already occurred in a previous pregnancy, the risk of a new thrombosis is considerably increased. If other risk factors are added, these multiply together and dramatically increase the risk of thrombosis. In addition, the risk of thrombosis after a caesarean section is significantly higher than after a vaginal delivery. Only consistent thrombosis prevention can help here. In order to support the vein function and prevent secondary diseases, heparin administration and the wearing of well-fitted compression stockings can be helpful.
Expectant mothers should always consult a doctor if a leg swells painfully, turns bluish and the superficial veins are filled with more blood. The doctor is able to detect thrombosis by palpating the thrombosis prere points and with the help of ultrasound or magnetic resonance imaging and, if necessary, treat it with blood-thinning medication.
If a fertilized egg does not nest in the uterus but outside (extrauterine) in the fallopian tube, this is called an ectopic pregnancy. Abdominal cavity pregnancies are another form of extrauterine pregnancy. In this case, the hormonal effects typical of pregnancy would be present, but no fetal sac or embryo would be visible in the uterus. Most extrauterine pregnancies end by themselves without complications. Otherwise, there may be severe, life-threatening bleeding, or. Rupture of the fallopian tube, which requires immediate surgery.
Uterine prolapse is a lowering of the uterus into the small pelvis The lowering causes a bulging of the vaginal wall. This is often due to a pelvic floor insufficiency (for example, after childbirth) or a slackening of the ligamentous and retaining apparatus. The affected person experiences a feeling of prere or foreign bodies. The bladder function, and u. U. also defecation, may be impaired. If a slight uterine prolapse leads to a (new) pregnancy, the symptoms – especially urinary incontinence – may be intensified. There is no danger to the child or the mother during pregnancy or at birth. However, pelvic floor exercises should be learned during pregnancy to relieve discomfort.
Back pain during pregnancy
During pregnancy, low back pain can often occur in the lower thoracic spine, or. Lumbar spine occur. The causes are different. Depending on the gestational age. The causes are different. Depending on the gestational age. The pain usually disappears in the course of pregnancy or at the latest after birth. If the pain is accompanied by muscular weakness in the legs, or. If nerve disorders occur, medical clarification should be sought urgently . Possible causes of back pain in the course of a normal pregnancy are: a rapid and strong weight gain, in early pregnancy a uterus bent backwards (retroflexio uteri) or, in the case of persistent bleeding, abortions. Later in pregnancy, back pain may occur for the following reasons:
– Kidney disease with congestion of the urinary tract – prere of the fetal head and uterus on the sensitive nerve endings of the lesser pelvis – change in posture due to pregnancy (hollow back) – loosening of the pelvic ring due to pregnancy hormones, joints, ligamentous connections and muscles in preparation for birth
After one out of ten deliveries, so-called postpartum depression or nerve disorders may occur. postnatal depression may occur. The course of disease of postpartum depression is usually gradual. Symptoms include frequent crying, feelings of inferiority and guilt, restlessness, listlessness, and difficulty feeling emotions such as love . Such complaints are often regarded by the affected women and their relatives merely as a side effect of the stress caused by the new living situation, but are not perceived as an illness. Another problem is that mothers are ashamed to talk about their fears and complaints. Therefore, the partner or other close people should approach the affected person, offer talks and encourage and support the mother to seek professional help. The first contact person can be the attending gynecologist. He can arrange further therapy offers. Physical symptoms such as sleep disturbances, loss of appetite and headaches also accompany depression. Contact with a doctor (gynecologist, psychiatrist, or psychotherapist) should definitely be made if the mother is suffering from the symptoms or even if the relationship with the child is disturbed.
Depression lasts longer than baby blues
Postpartum depression can begin immediately after delivery, but it typically occurs six to 12 weeks later. Postnatal depression must be distinguished from the so-called "crying days" or "baby blues", which usually occurs shortly after delivery in the first 3 to 5 days. Crying days are characterized by rapid mood changes, high emotional sensitivity and a tendency to cry, which is why they are quite similar to the symptoms of real depression. The crucial difference, however, is that the symptoms pass after a few days and do not endanger the relationship between mother and child in that. Postnatal depression is usually accompanied by a disturbance in the mother-child relationship, which carries the risk of long-term developmental disorders in the child. In the case of postpartum depression, therefore, not only the mother needs therapy, but the disturbed relationship with the child must also be treated.
The treatment of postnatal depression depends on the severity of the condition. Depending on the symptomatology, a combined psychotherapeutic and drug treatment is offered, whereby for severe depression the use of drugs, so-called antidepressants, is usually essential. Since many drugs pass into breast milk, the choice of medication must take into account whether the mother wishes to continue breastfeeding. However, we can also help those affected to cope better with the symptoms of the illness with psychotherapeutic measures in talk, psychotherapy or body therapy. Partners and family members should also be included in the process so that they can also learn how to deal with the disease appropriately, develop more understanding for the patient and thus provide her with better overall support.
In 1 to 2 out of 1000 births psychosis occurs in the puerperium. The term is applied to all cases that occur in the postpartum period, without distinguishing by cause. Postpartum psychosis usually begins 2 weeks after birth, rarely after 6 to 12 weeks. Symptoms vary and often change suddenly. Depressive or manic moods may occur. Strong restlessness, confusion, anxiety, hallucinations and delusions can also occur. Those affected often suffer from sleep disorders. The outlook for recovery is good in the short term, but relapses may occur. Treatment like "normal" Psychosis.