Ministry of Health of Uzbekistan
TASHKENT MEDICAL ACADEMY
ANEMIA AND PREGNANCY
KIDNEY DISEASE AND PREGNANCY
(The text of the lecture)
For the 4th year students of medical and
medical and pedagogical faculties
Compiled by:
since of medicine Associate – L.M. Abdullaeva
Tashkent-2013
Plan of the lecture. The concept of anemia, classification, incidence, etiology,
pathogenesis, clinical features. Diagnosis, differential diagnosis, and management
during pregnancy, childbirth and the postpartum period, the rehabilitation of women
with anemia.
The concept of pyelonephritis, classification, incidence, etiology, pathogenesis,
clinical features. Diagnosis, differential diagnosis, and management during
pregnancy, childbirth and the postpartum period, the rehabilitation of women in
pelonefrite.
The purpose of the students to form knowledge about anemia, pyelonephritis, their
etiology, pathogenesis, clinical picture, diagnosis, differential diagnosis: the course
and management of pregnancy, childbirth and the postpartum period in this
pathology.
Expected results: listening lectures will
Enables learners:
- To get an idea of the anemia and pyelonephritis;
- To get an idea on how to diagnose anemia and pyelonephritis
- To get an idea about the tactics of management in pregnancy, childbirth and
postpartum anemia and pyelonephritis
Anemia - one of the most important health problem not only in our country but also
all over the world because of the scale of its distribution, otritsatelnmh effects on
human health and the huge economic EVENTUAL DAMAGES.
According to WHO, iron deficiency anemia (IDA) in the world are affected more than
800 million people - out of a hundred patients ninety-five - are women.
According to the observations Nabiyeva MA (1984), JK Jabbarov (1990) and HK
Farmankulova (1994) of extragenital pathology beremenngh IDA takes first place.
IDA beremenngh is 75-95% of all anemia (Kassirskii IA Alekseev, 1970, Miterev JG
1983).
The relevance of IDA by a high frequency of this disease, which in Uzbekistan have
zhenvschin bearing age is 70%, and in pregnant women - 91.2% (Hamzaliev BH et al
1990, Asimov, DA 1994, Karimov SH.I . 1994 Bakhramov SM Farmankulov HK,
1996, Zakirov IZ 1997).
Extreme ecological situation in the Aral Sea (Karakalpakstan and Khorezm region) is
a high risk to public health. One of the diseases that have a progressive growth in the
last EXP is anemia among pregnant women, which increased by 5 times in the last 10
years (Ataniyazova O., 1997). According to the Institute of Uz AIG pervorodyavdih
even in young (17-20 years), the frequency of anemia exceeds 80%, and according to
Suleymanova DN, Khasenova GH (1998) - at 95-97% (and almost 95% of them
suffered from anemia in childhood and did not receive specific therapy and
prevention).
By dannnm WHO (1996), women with anemia is 5-10 times more likely to die in
childbirth than women with normal hemoglobin level. Hemoglobin level less than 80
g / l reduced tolerance to blood loss pregnant childbirth. When hemoglobin 60 g / l of
circulatory decompensation becomes apparent when shortness of breath and increased
cardiac output at rest. Childbirth, abortion, bleeding and other complications can lead
to maternal deaths (PMASO, 1989, A). In the fall of hemoglobin below 40 g / l of a
high probability of maternal deaths are due to anemic heart failure and acute hypoxia.
Even the loss of 100 ml of blood in pregnant women with hemoglobin levels below
40 g / l at birth can cause circulatory shock and death (PCHASO, 1989, A).
On the recommendation of Ministry of Health of the Republic of Uzbekistan, severe
anemia should be considered a contraindication to pregnancy and childbirth (1999).
However, in practical obstetrics in obstetric facilities continue to be a woman with a
hemoglobin level 70 - 30 g / l, often with preeclampsia and obstetric pathology, most
often primiparous, before birth or during labor, which puts an obstetriciangynecologist in an extreme situation, requires a definition organizing service
highspecialized obstetric, hematology and anesthesia-intensive care.
Classification. By the term iron deficiency anemia means a state of pregnant women,
to the diagnostic criteria which include hemoglobin 110 g / L or less, erythrocytes 3,5-1012 / L or less, the color indicator - to 0.85, lower hematocrit to 33% and
Moreover, serum iron levels below 10.746 mmol / l Up to now there is no uniform
classification of anemia in pregnant women. The most comprehensive and widely
considered among clinicians and classification I.A.Kassirskogo GA Alekseev
(1962.1970).
1. Hemorrhagic anemia.
2. Anemia due to impaired blood formation:-iron deficiency;
-Zhelezorefrakternye;
-B12 (folic acid) deficient;
-B12 (folic acid) refractory - due to impaired assimilation of vitamin B12
(folic acid), bone marrow;
-Dizeritropoeticheskie - due to ineffective erythropoiesis;
3. Hypoplastic.
4. Hemolytic anemia.
Pregnant women are all forms of anemia, but is prevalent in most cases, iron.
Iron deficiency anemia is characterized by reduction of iron in the blood
serum, bone marrow, and the depot, resulting in the formation of hemoglobin
is broken, there are hypochromic anemia and trophic disorders in the tissues
(Idelson LI, 1977.1979). Taken to distinguish between IDA in pregnant
women and chronic IDA, which took place prior to pregnancy. IDA is
characterized by reduction in the number of red blood cells (eritropeniya) and
decreased hemoglobin (hypochromia) per unit volume of blood. IDA is
developing in pregnant women with exhaustion of stored iron and its unmet
due to a number of reasons. Emergence of IDA during pregnancy contribute
to: chronic gastritis, enterocolitis, cholecystitis, pancreatitis, worm
infestations, hypothyroidism, latent foci of infection (tonsillitis,
pyelonephritis, etc.) under which interfere with the absorption of iron. A value
of iron deficiency, minerals, protein and vitamins in the diet. By the
development of this disease predispose frequent childbirth, viral infections
during pregnancy, blood loss (menorrhagia in labor, etc.).
Pregnancy poses a number of preconditions for the emergence of IDA. Thus, under
the influence of neurohormonal restructuring develops hyperplasia of bone marrow.
In this case, there is a state of physiological hypervolemia, changes in blood cells. All
these changes are aimed at providing a physiological pregnancy and create favorable
conditions for the development of the fetus.
Includes an increase in the state of hypervolemia bcc (blood volume), OTSE
(circulation of red blood cells), CGO (volume circulation plasma).
The second precondition for the emergence of IDA in pregnant women is the process
of blood near the fetus. He begins with a 19-day intrauterine and goes through three
stages: in the yolk sac, fetal liver, bone marrow of the fetus. In addition, for the
formation of hemoglobin fetus uses the resources of the parent body: iron, protein,
vitamins, salts, trace elements. Furthermore, he not only uses iron maternal organism,
but in the last three months intensively they are designed its own reserves in the liver,
utilizing up to 200-400mg of iron.
The third prerequisite for the emergence of IDA in pregnant women is a developing
iron deficiency due to the need for it is greater than the intake of the normal diet, and
in violation of the diet iron deficiency increases many times.
Fourth predposshkoy are frequent pregnancy and childbirth, as a result of which the
body does not have time to make up iron stores. For pregnant woman loses 700-800
mg of iron. This is the amount it can recover (including lactation) for only 2-3 years.
None of the existing classifications ischerpivayuschego does not answer the question
about the causes of anemia in pregnancy. Yu.K.Dzhabbarova offers its classification
of iron-deficiency anemia, gestational period, which allows midwives to better
identify pathogenetically substantiated therapy for anemia during pregnancy,
childbirth and the postpartum period.
The studies found that chronic IDA occurs in 83% of pregnant women. In
primigravidas anemia is often the result of insufficient iron production, if the patient
was born a premature baby or her mother suffered from iron deficiency anemia.
Acquired anemia in 71% of pregnant women tested was associated with frequent
delivery. In history, 21% of these patients were found indicate various kinds of
bleeding (miscarriages, hypotonic bleeding, etc.). With the progression of pregnancy
increases the severity of anemia and clinical manifestations are more pronounced: A
woman worries dizziness, blackouts, headaches, weakness, fatigue with mild exertion,
shortness of breath and palpitations. Clinically, these patients can be set pale skin, low
blood pressure, tachycardia, cardiac auscultation - a functional systolic murmur.
Based on laboratory studies to a significant reduction of serum iron, hypovolemia,
hypoproteinemia, severe hypoxia. 0 duration of the disease showed different trophic
changes: spoon shaped depressions nails, their fragility, brittleness and loss of light
hair, dry skin.
Anemia is a symptom ekstragenitalnyh diseases (rheumatic fever, heart disease,
kidney damage, liver, gastrointestinal tract) is found quite often - at 47-60% of
pregnant women. The iron content in the blood snvorotke thus - within limits.
Before anemia occurs without obvious symptoms klicheskih and, to our knowledge, is
found in 61% of pregnant women who considered themselves healthy. Latent iron
deficiency is established by studying the contents of transferrin and transferrin
saturation with iron. Pregnant women with anemia were identified before us at
increased risk of anemia. Before anemia is more common in pregnant women who
have had a lot of abortions, recent significant blood loss, and those suffering from
extra genital pathology, the frequency and multiparous and pregnancy, which came in
the lactation period.
Are pregnant complain of fatigue, loss of appetite, taste perversion, the tendency to
prstudnym diseases. Patients often mistakenly attribute the symptoms of iron
deficiency to early toxicosis. Iron deficiency in untreated pregnant women - one of the
risk factors for the development not only of anemia, and preeclampsia. This
contingent pregnant shown holding of preventive measures. Timely administration of
iron supplements to pregnant, vitamins (A, B, C, E and folic acid), cobalt and glucose
in combination with a balanced nutrition can cut lechebnm Before anemia, prevent its
transfer to clear.
Classification of IDA in women of reproductive age.
Before pregnancy
during pregnancy
Zhelezofetsitnaya chronic
anemia (due to iron
deficiency at birth,
untreated blood loss
Chronic infectious and
inflammatory extra genital
diseases associated with
hypochromic anemia
Mixed form.
Previous anemia
kasai
Hemorrhagic anemia
(subacute)
anemia of pregnancy
in the postpartum
period
Acute hemorrhagic anemia
Worsening anemia that
was available during
pregnancy
Immune anemia
Nutritional anemia in 13% of pregnant women is the result of dyspeptic symptoms
(heartburn, regurgitation, nausea), non-myasngh dishes izvrasheniya taste, vomiting,
that is, early manifestations of toxicity, and acute exacerbations gastroenterocolitis.
Feature for its prevention and treatment - parenteral iron preparations, minerals,
vitamins, glucose, protein environments (alvezin, Aminona etc.), detoxication and
desensibiliziruyuvdih funds.
Hemorrhagic anemia in pregnancy as a result of blood loss during an ectopic
pregnancy, which began abortion, hydatidiform mole, premature placental abruption,
uterine rupture. Depending on the availability of iron stores in the body, the extent,
duration and frequency of blood loss anemia can develop acutely or gradually. This
form of anemia was observed in 3%.
Subacute hemorrhage in the form of spotting, krovovydeleny small portions of
patients usually do not show the other complaints, although the dynamics of
hematology they are steadily declining. Acute blood loss anemia is more than 0.30.5% of body weight is accompanied by hemorrhagic shock and requires immediate
and fluid homeostasis korrigiruyushey intensive care.
Anemia of pregnancy is established in the event that prior to pregnancy or in one
trimester hemoglobin was 120 g / l and above. Most often develop anemia from 20
weeks of pregnancy, due to the feature of fetal blood and functional state of the
fetoplacental complex in general.
A characteristic feature of anemia - anemia, often found itself unexpectedly
pregnancy with nutrition and without visible blood loss, and the disease is slowly but
steadily progressing. On examination fails to detect extragenital diseases (pathology
blood, kidneys, liver, lungs, gastrointestinal tract, cardiovascular system). Most
vnrazhennaya extent of disease observed in the 28-34 weeks of pregnancy.
Undoubtedly, the development of anemia in pregnant women the primary role belongs
to reduce the iron content, some vitamins (A, B, C, D, E), minerals (cobalt,
manganese,
zinc, selenium, nickel), metabolic disturbance, decreased plasma proteins svyazannnh
with increased spending on growth and development of the motherplodovoplatsentarno complex. We also believe that the inhibition of erythropoiesis
during pregnancy contribute to dysregulation of the nervous system, the excess steroid
hormones, especially estradiol and estrone, reduction of gastric secretion. However, it
should be emphasized that a certain role in the violation of hematopoiesis is owned
and immunological shifts proiskhodyashim during pregnancy.
When studying the history of patients tshatelnom often found preceding anemia
pathological conditions involving immunological changes - acute viral and infectious
diseases (influenza, tonsillitis, etc.), the threat of termination of pregnancy, twins, Rh
immunization, dermatitis, chronic foci of infection. Moved increased antigenic load
with active immunological response accompanied by the development of iron
deficiency anemia and T-immunodeficiency.
In such a complex treatment of anemia, we've included antihistamines,
desensibiliziruyushie, detoxification and immunostimuliruyushie funds.
The primary cause of IDA in primiparous usually a combination of factors,
vklyuchayushy shortfall of iron from the mother at birth, anemic, unbalanced diet
(less than 120-150 grams of protein a day), and processes of absorption in the
gastrointestinal tract as a result of the transferred and untreated acute gastritis ,
enteritis, intestinal dysbiosis, with are also important environmental factors, such as
high salinity water, contamination of food with pesticides, herbicides, nitrates, etc.
Determining the causes of IDA should be excluded helminth infestation, chronic
gastrointestinal bleeding {ulcers, hemorrhoids, giperpolimenoreya). In multiparous,
besides the above factors, the main cause of IDA is the extension of bleeding due to
abortion, birth, operations, Navy.
Clinically proven the need to distinguish between anemia in pregnant women to
reduce the degree of hematological parameters, as the progression of an increasing
threat to the mother and fetus.
Classification by severity of anemia
The severity
hemoglobin
g/l
one light
110-91
2 medium
90-71
3 heavy
70-51
4 very heavy (extreme)
50 and pass
Red blood cells, 1012 / L
3,6-3,2
3,3-2,6
2,8-1,8
2,2-1,5
Laboratory Methods
Main methods of diagnosis and monitoring the treatment of iron deficiency anemia
- CBC;
- Hematocrit, reticulocytes, platelets;
- Iron content;
- Serum transferrin, the calculation of percent transferrin saturation.
Additional methods for the differential diagnosis of iron deficiency anemia:
- Morphology of the bone marrow (in hemoglobin of 60 g / L or less)
- Osmotic resistance of erythrocytes;
- Ferritin blood; '
- Common protein and protein fractions of blood;
- Enzymes and bilirubin levels (ALT, AST, cholinesterase);
- Revmoproby;
- Electrocardiogram;
- Cholesterol, beta-lipoproteins, blood sugar, carbohydrate curve;
- Electrolyte levels (potassium, calcium, sodium);
- Urea, creatinine of blood;
- Coagulation (prothrombin index, recalcification time, tolerance to heparin,
fibrinogen);
- Gas composition and acid - base balance of blood
- A general analysis of urine samples Nechiporenko, Zimnitsky, Rehberg;
- Fecal helminth eggs and fecal occult blood.
Additional methods to assess the state of pregnant women:
- Measurement of blood pressure in both arms;
- Consideration of drunk and parenterally administered fluids and measuring daily
urine;
- Check weighing and recording of weight gain;
- Analysis of vaginal discharge for purity;
- Bacteriological examination of secretions from the nose and the cervix to detect
pathogenic microorganisms and antibiotic susceptibility testing;
- Determination of the degree of maturity of the cervix and body ready for labor (from
38 weeks).
- Blood for chlamydia, toxoplasmosis, rubella, ureoplazmoz, flu
Additional methods for the assessment of fetoplacental complex:
- Ultrasound of the fetus and placenta;
- CTG fetus.
In a study of pregnant women with anemia should also eliminate syphilis,
tuberculosis, brucellosis. Patients should bgg examined therapist, ENT, dental, if
necessary, involve a hematologist, optometrist and other specialists. Pregnant women
made in the dynamics of treatment every 10 days to assess its effectiveness.
Treatment of anemia are mild (I degree), conducted in a clinic. Hospitalization of
pregnant women with anemia is shown when expressed forms (II - IV extent) of the
disease in conjunction with extra genital pathology, there is no effect of the therapy
with otyagoshennym obstetric history and the presence of other obstetric pathology.
At discharge, these pregnancies are transferred to clinical examination in the high-risk
group.
Tactics of the doctor for chronic anemia! The most serious attention should be
patients who have anemia was found in the I trimester of pregnancy at the first visit to
the antenatal clinic. Physician should clarify the etiology of anemia, the duration and
severity of the disease, the effect of the previously held antianemic therapy.
In identifying pregnant anemia grade III - IV disease is a thrombocytopenic purpura,
bone marrow hypoplasia, hemolytic anemia. Anemia is often a symptom of chronic
liver disease (cancer gepatolienalny syndrome) or kidneys (glomerulonephritis,
pyelonephritis, tumor), so this group of pregnant women should be subject to in-depth
clinical examination.
Women suffering from chronic anemia, pregnancy usually aggravates its course - the
severity increases. In anemia II - III degree women concerned dizziness, blackouts,
headaches, weakness, fatigue with mild exertion, shortness of breath and palpitations.
For these patients, characterized by pale skin, low blood pressure, functional systolic
murmur. A significant limitation of the disease can be judged by the presence of
trophic changes - spoon shaped nails impressions, their fragility, brittleness and loss
of light, sekuchest hair, dry skin.
Pregnancy is contraindicated in hemolytic anemia, hypo - and aplasia of the bone
marrow, leukemia, thrombocytopenic purpura disease, protekayushey heavy or
frequent exacerbations. To recommend termination of pregnancy up to 12 weeks, and
patients with severe iron deficiency anemia.
When pregnancy is over 12 weeks in patients with anemia III - IV severity of the
issue of abortion must be addressed with great caution, as this may pro-radiate
significant blood loss. Therefore, abortion should be recommended only if
otyagoschayushih factors: age over 40 years, bleeding in the previous delivery, the
active phase of rheumatic fever, endocarditis, and aortic stenosis, mitral valve, severe
heart failure, chronic hepatitis in the active phase, liver cirrhosis, chronic renal failure
and acute renal failure, hyperthyroidism III degree. In the hospital immediately before
termination of pregnancy is necessary to cure the underlying disease, the prevention
of bleeding.
Pregnant women with anemia II degree registered at high risk, make plans
examination and treatment - preventive measures, including 2-4 courses of hospital
treatment for 20 - 30 days each at intervals of 4 weeks. After being discharged from
the hospital outpatient pregnancy continues.
Complications of pregnancy and childbirth are in direct proportion to the severity of
anemia and the development of them in grade III - IV disease threatens the lives of
mother and fetus. In addition, please note that in cases of operative delivery women
with anemia increases the degree of operational risk, the volume resuscitation and
anesthesia pomoschi.Chasto voznikayushie shock and collapse characterized speed
and depth of a relatively small loss of blood and the difficulty removing the patient
from this state. Given this, it is recommended mandatory antenatal care for women
with anemia for 2 -3 weeks. inpatient (hospital is in the 37 - 38 weeks).
Management of Pregnancy in IDA
When mild IDA treatment on an outpatient basis in a clinic, a day hospital. In
moderate severity is shown, with no effect on patient treatment, the presence of
concomitant extragenital diseases and obstetric pathology, routine and preventive
hospitalization of pregnant women with IDA carries out 28-32 weeks and for
antenatal care at 38 weeks.
Hospitalization of pregnant women 28-32 weeks provides treatment or prevention of
IDA, as well as therapy to improve the utero-placental blood flow, preventive
measures to prevent the occurrence of preeclampsia.
Treatment of IDA in both outpatient and inpatient should be comprehensive,
including diet therapy, drug therapy, treatment of comorbidity, the exclusion of
harmful factors and normalization of work and leisure.
Nutrition of pregnant with IDA should be high (3000-3500 kcal) and include all vital
substances.
It should be noted that the most easily digestible iron is in beef, liver, egg yolk, bread,
beans, and soy, dried apricots, raisins, dill, parsley, lettuce, beets, carrots and apples.
Although it should be noted that it is not possible to ensure fully the lack of iron in
these products. Therefore, you should use iron supplements are mandatory.
Ferropreparaty are actively stimulates the bone marrow, increases the number of red
blood cells and their content of hemoglobin, increased color index. Treatment with
oral medication should be prolonged (4-6 weeks).
Treatment of pregnant women with IDA I extents in a clinic. It should bgg complex,
including a long of drugs and diet therapy. We offer the following principles of
pathogenetic therapy.
To make up for iron deficiency nazanachayut one zhelezosoderzhayushih drugs.
Ginotardiferron contains iron sulfate (II), mukoproteozu, folic acid, ascorbic acid. An
important property of the drug is a long slow release of iron from the drug and its
slow absorption, ie achieved the greatest therapeutic effect - 1 table. a day.
Globex contains ferrous fumarate (II) 304 mg (100 mg of iron), folic acid 1.5 mg,
vitamin B12 10 mcg of elemental zinc (sulfate) 15 mg 1kapsule 2 times daily for 15
days
Treatment of severe IDA to 20 weeks held in the hematology department (in the
absence of obstetric pathologies), after 20 weeks - in the maternity complex: - when
HB 70-60 g / l - in OPB - when HB 50 g / l or less - in the ICU .
Particular threat is increasing the share of severe disease (hemoglobin level of 70
g / L or less), which has increased over the last 20 years with 3% to 20-23% in some
areas / districts (2,3,4).
Ministry of Health of the Republic of Uzbekistan on the recommendations of severe
anemia should be considered a contraindication to pregnancy and childbirth (1999).
However, in practical obstetrics in obstetric facilities continue to be a woman with a
hemoglobin level 70 - 30 g / l, often with pre-eclampsia and other obstetric pathology,
most often primiparous, before birth or during labor, which puts an obstetriciangynecologist in an extreme situation requires Definition organization providing
tertiary obstetric, hematology, anesthesia, intensive care and laboratory services. Due
to the deterioration of ecological conditions in some regions of the country has been
an increase in the detection rate of severe IDA in pregnant women from 6.7% in 1983
to 10% in 1998 to 20-23% in 2008 (2,3,5 and 6).
Severe anemia is a major cause and trigger the development of complications that
lead to maternal mortality and perinatal pathology. Among the dead mothers IDA
noted mostly moderate (20%), severe (60%) and very severe (20%). Marked by a
large proportion of maternal deaths with anemia of moderate to severe (55.7%),
pregnancy and childbirth which is 2/3 of the cases were complicated pathologic
hemorrhage (Zakirova NI, 1999).
In pregnant women with severe anemia, the risk of delivery increases with a
decrease in hemoglobin and deeper organs and tissue hypoxia due to the development
of profuse, hypo-and atonic bleeding, severe coagulopathy and postpartum septic
diseases (8).
When iron deficiency anemia secondary to severe shows therapy with parenteral
iron preparations:
FERROFER - iron sucrose + + + 100 mg of iron in one vial.
Intravenous bolus injection of 100 mg of iron, stream, slowly, not less than 5
minutes in a day number 3 (+ HB 15-20 g / l).
Intravenous drip infusion of 100 mg of iron, drip, in 100 ml of saline, no less than
15 minutes in a day number 3 (+ HB 15-20 g / l).
In / in 200 mg of iron as effective as transfusion
1 unit (420 mL) ermassy.
Intravenous iron therapy have a rapid effect and does not cause unwanted side effects
and poor tolerability, and therefore recommended.
Diet therapy is important in the prevention and the treatment of anemia in pregnant
women, their diet should bnt expanded by increasing the content of protein, vitamins,
minerals and iron. In the first half of pregnancy, the daily intake of protein should be
110 g, fat - 80 g, carbohydrates - 350 g (shared calorie food -2800-3000 kcal). In the
second half of pregnancy, the amount of protein should be increased to 120 g, fat - up
to 90 g, carbohydrates - to 400g (shared calorie piodi -3100-3200 kcal).
The main sources of protein - meat, liver, tongue, kidney, fish, poultry, eggs and dairy
products. Found that when taking animal food than plant iron absorption increases by
8.5 times.
The human body gets fat at the expense of meat, cheese, milk, cottage cheese, sour
cream, cream, eggs, etc. It is advisable to include in the diet of patients with AgroFood butter and vegetable oil (cottonseed, sunflower, corn, soybean oil - 25 grams a
day).
Carbohydrates should make up for the expense of foods rich in plant
fiber: rye bread, ovoshey (tomatoes, carrots, squash, potatoes, beets, cabbage, radish),
watermelons, melons, fruits (pomegranate, apple, cherry, quince, apricot, Alchan,
figs, lemons, tangerines, oranges and etc.), dried fruit (apricots, raisins, prunes), nuts
(pistachios, almonds, etc.), which are also rich in fat (75%) and protein (25%), fruits
(hips, currants, mulberries, raspberries, strawberries, gooseberries, etc.), bobovk
(beans, corn, peas, etc.), cereal (oatmeal, buckwheat, rice). Micronutrient rich in fungi
and yeast. Mandatory inclusion in the diet of pregnant fresh greens - lettuce, spinach,
green onions, Shavel, dill, parsley, etc. In cases where the fruit is not enough, you
need to consume juices (apple, plum, tomato, carrot) or stewed fruit and jelly. Fruits,
vegetables, bahchevne culture and greens occupy an important place in the diet. Some
of them are a source of starch, the other - the protein, and others - sugar. Plant foods
rich in mineral salts, trace elements and vitamins. The fiber contained in it, promotes
intestinal peristalsis, which is especially important during pregnancy.
Transfusion of blood and its components are made in the following order:
- Replacement to fill the globular and plasma blood volume;
- Elimination of hemic, circulatory and tissue hypoxia body by oxygen transport and
disposal of carbon dioxide;
- Improve maternal - placental circulation and condition of the fetus, including
increased oxygen delivery to ensure its components of blood, which is the treatment
and prevention of hypoxia and asphyxia, anemia at birth;
- Improving the contractility of the uterus during labor and the postpartum period,
therefore, the prevention of the weakness of labor, hypotonic and atonic bleeding
subinvolution lohiometry uterus and in the postpartum period;
- Correction of the hemostatic system by filling the number of red blood cells, and
trobotsitov all plasma clotting factors in speaker to - first, to minimize the loss of
blood followed, in - secondly, to prevent the development of coagulopathy and
thrombocytopenia consumption;
- Mana immune protective properties of the body, which is an effective measure to
prevent purulent - inflammatory disease in the postpartum period;
- Prevention hypogalactia, improving the quantity and quality of breast milk in the
lactation period.
The question of blood transfusion in each case should be decided individually. Instead
ermassy transfusion before delivery and efficient use of labor in / infusion Ferrofera
to avoid massive blood loss, in DIC, hemorrhagic shock, and need for massive
transfusion in a volume of 1 liter or more, which most often occur transfusion
complications , homologous blood syndrome, acute renal failure, and others OPPN
Pyelonephritis
Pyelonephritis-nonspecific inflammatory process porazhayushy inetrstitsialnuyu
kidney tissue and the renal pelvis system.
The agents of the cup 70% (are enterobacteria) (Escherichia coli, klebsiela, Proteus),
less-enetrokokk (15%) and Pseudomonas aeruginosa (10%). Infection in the kidney
and pelvis gets hematogenous or voskhodyashim way. Its primary focus is most often
located in the tonsils, carious teeth, urinary or genital organs sistemm.
In the period after childbirth can be the source of the uterus.
During pregnancy, there predraspolagayushie factors for the development of
pyelonephritis:
- Rupture of the uro-, hemodynamics.
In the early stages it is associated with changes in the concentration of hormones
(estrogen, progesterone, chronic gonadotropin kortikosteroidm).
The predominance of progesterone reduces tone ureters and bladder, which leads to
stagnation of urine. Develop vesicoureteral reflux-junction (reverse reflux of urine,
which increases the pressure and scored vnutrilohanochnogo microbial toxins in
higher-lying sections and kidney tissue.
- Starting from the 20th week of pregnancy the uterus compresses the ureters
increases and as a result in the urogenital tract is stagnant urine. On the one hand,
leads to the expansion of pelvis, the other creates an environment for bacterial growth.
- If in pregnant a purulent inflammatory foci nahodyaishesya they microorganisms by
hematogenous fall in the renal parenchyma, pelvis and cause pyelonephritis or cups
can be a factor in the development of pyelonephritis.
In practice, the following classification of pyelonephritis:
I Pyelonephritis of pregnancy (one-way or two-way
affected kidney).
II Chronic pyelonephritis of pregnancy (single or
bilateral lesions of the kidney).
Adrift pyelonephritis divided into sleduyushie fazm:
1. Phase of active inflammation;
2. Latent phase of inflammation;
3. Phase of remission.
Clinical course: ostrmy pyelonephritis appears tyazhelmm obshim state bolnmh,
vmsokoy temperature, fever, wrong type of headache, sweating silnsh postepennmm
decrease temperaturm body. Uchashayutsya dmhanie and pulse. There tupme pain,
Kotormo distributed in the groin. When palpatsiisimptom Pasternatskogo
polozhitelnmy. In cases tyazhelmh vospalitelnmy process extending to the kidney
capsule and okruzhayuiduyu adipose tissue, which may vmzvat septic shock.
In chronic pyelonephritis, there is a slight pain, usilivayushiesya motion, Bistro
fatigue, loss of appetite, fever and subfebrialnaya obshee malaise.
For the clinical course of chronic pyelonephritis is characteristic fuzzy povpnenie
blood pressure and symptomatic chronic renal failure.
It should be noted that in the prevailing circumstances sovremennmh
latentnoprotekayushie formm chronic pyelonephritis, Cawthorne accompanied by
relapses during pregnancy.
It can be asymptomatic, but the study of urine vnyavlyaetsya bacteriuria and pyuria.
The introduction of labor, and postpartum pyelonephritis.
Childbirth preferably carried out under anesthesia: No-spa 2 ml baralgin-0, 5 ml
electro analgesia, epidural anesthesia.
. In the postpartum period to continue the treatment of pyelonephritis (antibiotics,
nitrofurans, desensibiliziruyushie preparatm, vitamins, immune modulators.)
Females undergoing rehabilitation pyelonephritis.
After vshiski from the hospital to outpatient observation by a doctor obshey practice,
during which performed urinalysis, urine testing for Zimnitskiy and Nechiporenko.
Rehabilitation performed with an obstetrician-gynecologist and therapist.
Women who have had pyelonephritis, you can use all the methods of contraception.