Encyclopedia of Family Medicine

Chapter 37 Sexual knowledge and eugenics (9)
(5) Early abruption of the placenta

It is characterized by vaginal bleeding accompanied by abdominal pain in the middle and late stages of pregnancy, and those with less bleeding do not pose a serious threat to mother and baby.People with heavy bleeding may have severe abdominal pain or shock, but blood can accumulate in the uterine cavity, and vaginal bleeding may not necessarily be a lot.Pregnant women suffer from vascular diseases such as chronic nephritis, hypertension, and pregnancy-induced hypertension.Or there is a history of abdominal trauma in the third trimester of pregnancy, or sexual life, which can be the cause of this disease.According to the degree of placental detachment, the disease can be divided into two types: ① mild: less vaginal bleeding, accompanied by mild abdominal pain, mostly without fetal heart change; ② severe: mainly intrauterine bleeding.There may not be much vaginal bleeding, severe abdominal pain, and shock may occur.

In terms of treatment, patients with mild symptoms can absolutely rest in bed and observe changes in blood pressure and pulse.Symptomatic treatment such as hemostasis and sedation was given.Severely ill patients should be sent to hospital for treatment immediately.

Special Diseases and Maternity

1. Heart disease complicated with pregnancy

During pregnancy and childbirth, the burden on the heart increases, and healthy pregnant women can handle it.But people with pre-existing heart disease may face many risks.Therefore, married women suffering from heart disease should decide whether to have children according to the opinions of specialist doctors.Usually, if the patient is competent for general physical labor or has slight palpitations, shortness of breath and fatigue after activities, she can be pregnant and give birth.However, patients should be monitored by obstetricians and physicians, avoid physical labor during pregnancy, prevent emotional stress and agitation, pay attention to rest, increase nutrition, and prevent colds and other infections.Check every two weeks for the first 5 months of pregnancy. After 1 months, you will be checked once a week, and you will be hospitalized two weeks before the expected date of delivery, and you will choose the delivery method according to the doctor's advice.

If the patient feels palpitations and shortness of breath after a little exercise, can't lie down at night, and has hemoptysis or bloody sputum, liver enlargement, or lower limb edema, it means that the heart function is very poor, and the risk of pregnancy and childbirth can no longer be taken.Women with viral myocarditis can only conceive after being cured.

2.Hepatitis complicated with pregnancy

The liver is an important organ, and the liver function of hepatitis patients is reduced, which makes it difficult to bear the burden of pregnancy. Pregnancy in the acute stage or active stage of hepatitis may endanger the safety of mother and child.If a pregnant woman is a hepatitis B patient, it is also possible to transmit hepatitis to the newborn.Therefore, after pregnancy, it was found that she had hepatitis.If the pregnancy has not exceeded 3 months, induced abortion is appropriate. If hepatitis is discovered in the middle and late stages, it should be actively treated for hepatitis under the guidance of a specialist, paying attention to rest and eating a high-protein diet.It is not advisable to breastfeed after giving birth to reduce the physical exertion of the mother and the chance of infection to the baby.Newborns of patients with hepatitis B should pay attention to injecting high-efficiency hepatitis B immunoglobulin and hepatitis B vaccine.

3.chronic nephritis with pregnancy

Patients with chronic nephritis should be checked by a specialist to prove that the nephritis has been basically cured (normal blood pressure and renal function, negative or trace amount of urine protein) before pregnancy.Because during pregnancy, the burden on the kidneys is heavy, which can worsen the original condition. In the second half of pregnancy, pregnancy-induced hypertension syndrome is easy to occur, which will aggravate kidney damage, affect the placental function, and endanger the safety of mother and child.

4.diabetes mellitus pregnancy
During pregnancy, diabetic patients are more prone to infection, pregnancy-induced hypertension syndrome and ketoacidosis.Among the babies born to patients, the proportion of deformed, stillbirth or macrosomia is much higher than that of healthy women.Therefore, patients whose diabetes has not been controlled, or who have developed obvious kidney disease or eye retinopathy should not be pregnant.Diabetes has been controlled, blood pressure is not high, renal function and fundus examination are normal.Pregnancy and childbirth are possible, but must be supervised by a specialist.

5. Tuberculosis combined with pregnancy

Patients in the active stage of tuberculosis not only have the risk of infecting others, but also cannot bear the burden of pregnancy, and commonly used anti-tuberculosis drugs have certain harm to the fetus.If pregnancy is found at this time, abortion should be performed as early as possible.

Patients who have been cured of tuberculosis can conceive and give birth, but they still need to pay attention to strengthen nutrition, take adequate rest, and ask a specialist for regular checkups.

6. Uterine fibroids combined with pregnancy
Small fibroids do not have much impact on pregnancy and childbirth.The effects of large uterine fibroids on the fetus are:
(1) Fetal malposition is prone to occur during pregnancy;
(2) Interfering with uterine contraction during childbirth can prolong the labor process and increase bleeding. If it grows in the lower part of the uterus, it may also hinder the delivery of the fetus;
(3) Abdominal pain and fever sometimes occur due to necrosis of the fibroid center.If the uterine fibroids are large, pregnant women need to undergo cesarean section at an appropriate time under the close supervision of an obstetrician.And while the fetus is delivered, the uterine fibroids are treated.

7.Ovarian tumor with pregnancy

The impact of ovarian tumors on pregnancy and childbirth depends on the nature, location and complications of the tumor.Ovarian tumors are often located on both sides or behind the uterus. With the growth of uterine months of pregnancy, the tumor position rises to the abdominal cavity, which is prone to torsion and necrosis and rupture.If the ovarian tumor remains in the pelvis, it can prevent the fetus from being delivered vaginally, or rupture due to uterine contractions and pressure on the baby's head.In the case of ovarian cancer, the main concern is the increased likelihood of metastasis over time.

Whether to terminate pregnancy after ovarian tumors are found depends on the nature of the tumor and the duration of pregnancy.Benign ones can be surgically removed at 16 to 20 weeks of gestation, and surgery during this period is less likely to cause miscarriage.If it is discovered in the third trimester of pregnancy, as long as there is no malignant manifestation or obstruction of the birth canal, the tumor can be resected after natural delivery.The tumor can also be removed at the same time as the cesarean section; such as torsion, rupture and infection of the ovarian tumor, surgical resection should be performed at any time.If the ovarian tumor is malignant, immediate surgery is required, and the survival of the fetus should not be considered.However, if it is found in the third trimester of pregnancy, cesarean section can be performed according to the patient's request to remove the tumor at the same time.

8.Hyperthyroidism with pregnancy
Pregnancy has no major direct effect on patients with hyperthyroidism (hyperthyroidism).However, pregnancy increases the burden on the heart, which can increase the cardiovascular burden in patients with hyperthyroidism.If pregnant women use antithyroid drugs, the fetus can also have congenital hypothyroidism.Although patients can be pregnant and give birth, they must take medication under the guidance of a specialist physician, and the dose of antithyroid drugs should be small.If you continue to take antithyroid drugs after giving birth, you should not breastfeed, and abortion should be considered in the following two situations: (1) You have received radioisotope iodine or taken high-dose antithyroid drugs in the early stage of pregnancy, or have undergone total thyroidectomy or subtotal thyroidectomy. Those who did not supplement thyroxine in time; (2) those with hyperthyroidism accompanied by heart disease and hypertension.

Babies born to patients with hyperthyroidism should consult their doctor within 3 months of birth whether they need thyroxine supplementation.

childbirth
1.signs of labor

The fundus of the uterus descends.About 2 weeks before labor, as the fetal head descends into the pelvis, the pregnant woman feels that the height of the uterus drops, the chest feels relaxed, the breathing is smooth, and the pressure on the stomach is relieved.

Frequent urination.As the fetal head descends into the pelvic cavity, it compresses the bladder and increases the frequency of urination.

Lower abdominal pain.A few days before labor, pregnant women may experience slight backache and a sense of paroxysmal tightening in the lower abdomen.

"See Red".There is a small amount of bloody mucus out of the vagina before labor, commonly known as "seeing red".This is a normal physiological phenomenon, suggesting that delivery will take place in 2 to 3 days, and no treatment is required.

Regular uterine contractions.Uterine contractions every 5 to 6 minutes, lasting more than 1 seconds each time, and the degree of abdominal pain gradually intensifies, the interval becomes shorter and longer, and the duration becomes longer and longer.This is the main sign that a pregnant woman can feel the imminent labor.

It should be noted that some women do not have the above signs of labor, but the water breaks first. At this time, there is a slightly turbid yellow amniotic fluid flowing out of the vagina. They should go to the hospital immediately for examination and waiting for labor.

2.labor

The whole process of childbirth is called the labor process, which is divided into 3 stages.

The first stage of labor.From the regular contraction of the uterus to the full dilation of the cervix.At the beginning of this stage, the strength of uterine contraction is weak, and the interval time is long. After a few hours, the uterine contraction becomes frequent and regular, and the strength of uterine contraction gradually increases. The duration of contraction is extended by about 50 seconds, and the interval time between uterine contraction is shortened. Once every 2 to 3 minutes.The cervix gradually expands to full dilation (that is, the cervix expands by about 1 cm).The puerpera feels pain in the lower abdomen, and some feel unbearable soreness in the waist.

Second stage of labor.From the full dilation of the cervix to the delivery of the fetus, this is the delivery period of the fetus.Primiparas need l~2 hours.At this stage, as the fetal head gradually descends, translucent fluid flows out of the vagina.And there is a feeling of needing to defecate, and at the same time, I can't help but hold my breath downward.This accelerates the further descent of the fetal head until it is pushed towards the vaginal opening.At this time, the mother should hold her breath correctly and use abdominal pressure under the guidance of medical staff until the fetus is delivered smoothly.

The third stage of labor.It takes about 15 minutes from the delivery of the fetus to the delivery of the placenta, generally no more than 30 minutes.

(End of this chapter)