Extra genital pathology and pregnancy
1. Extra genital pathology and pregnancy
2. ContentThe course of pregnancy and childbirth in diseases of
the cardiovascular system.
Kidney diseases and pregnancy
The course of pregnancy and childbirth in diseases of
the endocrine system
The course of pregnancy and childbirth in diseases of
the respiratory and digestive system
3. CARDIOVASCULAR DISEASESCardiovascular diseases hold first place out of all
extragenital pathology among pregnant women.
Pregnant women heart disease detection frequency
varies from 0,4 to 4,7%.
Pregnancy worsens the cardiovascular diseases and can
lead to extreme conditions that require immediate
actions, not only from an obstetrician, but also from the
therapist, cardiologist, surgeon.
4. Among heart diseases, most commonly encountered are:Rheumatism
acquired and congenital heart diseases
anomalies of great vessels
surgical heart arrhythmias
5. RheumatismRheumatism among pregnant women occurs in the 2,3
- 6,3%. While rheumatism aggravation appears in 2,5 25% of cases, usually within the first 3 and last 2
months of pregnancy, as well as during first year after
Acquired rheumatic heart diseases account for 75-90%
of all heart lesions in pregnant women.
Of all forms of rheumatic origin defects the most often
are observed mitral valvular insufficiency and a
combination of stenosis of the left atrioventricular
6. To predict the outcomes of pregnancy and childbirthThe following factors are important:
Activity of rheumatoid process
Form and stageof rheumatic defects
Compensation or decompensation of blood circulation
The degree of pulmonary hypertension
Joining (Zdes ne uveren, no moget luchshe slovo
“Addition” vstavit vmesto “joining”?) obstetrics
7. Risk classification of adverse pregnancy outcome in patients with heart defects1 degree - Pregnancy in heart defects without marked
signs of heart failure and acute rheumatic process.
2 degree - Pregnancy with heart defects with initial
symptoms of heart failure (shortness of breath,
tachycardia), evidence rheumatism active phase
symptoms (A.I. Nesterov,degree A 1)
signs of the predominance of right heart failure, presence
of the active phase of rheumatism (A 2), atrial fibrillation,
4 degree - Pregnancy in decompensated heart defect
with signs of left ventricular failure, atrial fibrillation,
thromboembolic manifestations of pulmonary
According to this scheme continuation of the
pregnancy is permissible, with 1 and 2 degree of risk,
only under the supervision of an outpatient and
cardioobsterical facility and with a 3 time
9. Pregnancy and childbirth in arterial hypertensionArterial hypertension detected in 5% of pregnant women:
70% of hypertension in pregnant women
15-25% - hypertensive disease
2-5% - secondary hypertension
Violations of the functions of the placenta:
leads to hypoxia
Syndrome of intrauterine growth retardation
10. TherapyHypertension treatment includes the creation of
emotional rest for a patient
strict observance of day regimen
11. Kidney diseaseKidney disease and urinary tract infections hold
second place after diseases of the cardiovascular
system among extragenital pathology of pregnant
women and pose a risk for both mother and fetus.
During pregnancy: hypotension and increased
pyelocaliceal system and ureters is observed
uterus is deflected to the right
12. Infection enters the urinary tract:ascending path (from the bladder)
descending - lymphogenous (from the intestine, especially
haematogenous (for various infectious diseases)
fungi such as Candida.
13. Clinical formsCommon clinical forms should be noted-pyelonephritis,
hydronephrosis, asymptomatic bacteriuria
Rarely-glomerulonephritis, tuberculosis kidney,
urolithiasis, developmental anomalies of the urinary tract.
Pyelonephritis - is the most frequent disease during
pregnancy (from 6 to 12%), its when concentrating ability
of the kidneys suffers.
Pyelonephritis has a negative effect on pregnancy and the
14. Diabetes and pregnancyThe problem of pregnancy in women with diabetes is
relevant throughout the world.
The course of pregnancy and childbirth in
It adversely affects:
-Utero fetal development
-Increased frequency of malformations
-High perinatal morbidity and mortality
15. Types of diabetesType I diabetes - Insulin dependent diabetes mellitus
Type II diabetes - insulin-independent diabetes
Type III diabetes - gestational diabetes (GD), which
develops after 28 weeks. pregnancy and is transient
violation of glucose utilization in women during
mellitus (IDDM). The disease is usually diagnosed in
girls in childhood, during puberty.
Insulin-independent diabetes mellitus (INSD) occurs
in older women (after 30 years), and it proceeds less
Gestational diabetes is diagnosed very rarely.
majority of pregnant women remains unchanged.
II half of pregnancy. Worsens carbohydrate tolerance,
amplified diabetic complaints.
by the end of pregnancy carbohydrate tolerance
improves again, blood glucose levels and insulin doses
18. At childbirthHigh hypergikemiya, the state of acidosis and
hypoglycemic state is possible in pregnant women with
Obstetric complications in the second half of
hypertension of pregnant
risk of preterm birth
urinary tract infections
19. The flow of labor is complicated by:presence of a large fetus
increase of fetal hypoxia
development of functional-narrow pelvis
shortness of birth shoulder girdle
development of endometritis in childbirth
birth injuries of mother and fetus
20. Contraindications to pregnancy in diabetesThe presence of rapidly progressive vascular complications:
Labile forms of diabetes
Presence of diabetes mellitus in both parents, which
dramatically increases the possibility of disease in children
The combination of diabetes and Rh-sensitized mother
Combination of diabetes mellitus and active pulmonary
21. TreatmentInsulin therapy during pregnancy is required even
under mild forms of diabetes
22. Thyroid disease and pregnancyThe thyroid gland - is an endocrine organ that
produces hormones essential for organism - thyroxine
(or tetraiodothyronine - T4) and triiodothyronine
23. Toxic goiterGraves disease (GD) occurs most frequently during
pregnancy (from 0,2 to 8%). It’s mandatory symptoms
are hyperplasia and hyper function of the thyroid
The course of pregnancy
In the I half-all women have a disease escalation
In the II half-due to blockade of excess hormones in
some patients with mild thyrotoxicosis there is
24. The course of pregnancyHypertension pregnant
At childbirth decompensation of the circulatory system can
often occur, and in the postpartum and early postpartum
period - bleeding.
In the postpartum period
The sharp worsening of postpartum thyrotoxicosis requires:
treatment using merkazalil (it passes through the milk to
suppression of lactation.
25. Tactics obstetrician-gynecologist and endocrinologistHospitalization in the early period to 12 weeks for
examination and decision on the possibility of
carrying out the pregnancy.
Pregnancy is contraindicated:
Pregnancy is contraindicated in the average severity of
diffuse goiter and nodular goiter, if a woman does not
intend to does not intend to have surgery?) in a period
of 14 weeks.
Pregnancy is possible to bear only a mild degree of
thyrotoxicosis a diffuse goiter and positive treatment
26. Active pulmonary tuberculosisIndications for abortion to 12 weeks:
Common destructive process in the lungs, poorly
amenable to treatment;
aggravation of the process during a previous
pregnancy less than 2 years after suffering miliary
27. Prevention of extra genital diseasesPreventive measures of complications of pregnancy
and childbirth during the extra genital diseases regular monitoring of pregnant women in antenatal
clinic by the obstetrician-gynecologist, a physician, an
endocrinologist, a mandatory three times
hospitalization and effective outpatient therapy.