Angina in pregnant women is rare. This is due to the fact that atherosclerosis, which often becomes the cause, usually makes itself felt in patients who are already out of child-bearing age. Nevertheless, it happens that a woman give birth, who had previously been diagnosed with angina; It is also manifested angina during pregnancy in the first principle.

Angina and pregnancy

Man with stable angina Stable angina - one of the manifestations of coronary heart disease   - The most common form of the disorder - can live for years, maintaining the usual quality of life, but for a pregnant woman and her unborn child is a very dangerous disease. Unstable angina is due to the unpredictability of its attacks and the difficulties associated with its treatment, is even more dangerous: women with this diagnosis can be recommended abortion. However, the question of whether it is safe to keep the pregnancy is under any form of angina in the expectant mother. The fact that this disturbance attack begins when the heart is not enough oxygen. The body of a pregnant woman must provide oxygen not only herself, but also to the child, which is why the attacks may become more frequent and / or become more severe.

Changes in one way or another affect the heart muscle begin 5-8 weeks of pregnancy, and reach the peak at the end of the second trimester. The blood volume in the body of a pregnant woman is increased by 40-50%. The concentration of red blood cells and hemoglobin is usually slightly lower than before pregnancy. Cardiac output, or cardiac output - an indicator of the volume of blood that the heart emits for one minute - increases by 30-50%, and during childbirth by 50%. Heart rate increases by 10-15 beats per minute, and the blood pressure is reduced on average by 10 mm / Hg. Art. (millimeters of mercury).

It is highly recommended to be surveyed and those who are the factors that increase the risk of strokes, such as high blood pressure, heart disease, family history, sedentary lifestyle, prolonged abuse of fatty foods, smoking, diabetes type 1 or 2, age over 45 years. It is also recommended to be screened for all women who have previously occurred at times weak pains in the chest, that they did not seek medical attention.

Women who are overweight before pregnancy is recommended to bring the weight back to normal, and smokers - to quit (though it should be done to any woman who wants to get pregnant). Those who have raised blood pressure, you should take medication to allow him to keep within limits.

Genera of women suffering from angina pectoris, typically tested using analgesics - it reduces the workload on the heart and reduce the risk of angina attack. There is quite a strong likelihood that a woman will be scheduled caesarean section.

As for the treatment of angina births associated with increased risk, late in the third trimester, they need to very carefully monitor their state of health, and to go to the hospital as soon as they will have the very first signs of starting labor.

Symptoms of angina at pregnancy

Symptoms of angina pectoris in pregnant women, in general, does not differ from its symptoms in other patients. The main feature of symptom onset - pain or tightness in the chest. Sometimes the pain radiates to other parts of the body - arms, neck, jaw, shoulders. During an attack may occur, and symptoms such as nausea, weakness or dizzy, shortness of breath, sweating.

In stable angina symptoms appear after a certain physical or emotional stress. Attacks of this type of angina is usually each time have the same intensity and do not last more than five minutes. The pain goes almost immediately after taking nitroglycerin.

Typically, the pain of angina, this species is stronger than in stable angina; it remains to half an hour or more, and does not pass after taking the medication. Moreover, unstable angina attack Unstable angina - alarm organism   It may be a precursor of myocardial infarction (although a heart attack during pregnancy - a rare phenomenon, according to various estimates, it occurs in one in 10,000 or even 30,000 pregnant women).

Prinzmetal angina attacks Prinzmetal angina - a rare disease with serious consequences   typically start at rest and often very strong, but stopped after taking medication (usually nitroglycerin). Prinzmetal angina - a rare disease; it is diagnosed in only 2% of patients suffering from angina.

Pain or tightness in the chest during pregnancy can also be caused by:

• Heartburn. Pregnant women in particular often suffer from severe heartburn as a hormone produced during the whole period of pregnancy, relax the sphincter muscle at the back of the esophagus, and the probability of getting gastric juices into the esophagus increases significantly. However, chest pain that occurs when heartburn, usually can not be given into the hands, neck, and other parts of the body;
• Upset stomach and indigestion in some cases, can cause very severe pain in the chest Chest pain is one symptom - a lot of diseases . For many women, the symptoms of heartburn and indigestion compounded after 27 weeks of pregnancy;
• The pressure of the uterus. As soon as the baby grows, the uterus increases in size, begins to put pressure on the diaphragm and ribs, and can cause pain in the chest. This pain is rarely sudden nature of the attacks, and even more often and long, but not very strong, but it happens that it is taken as a symptom of angina attack started;
• Heart attack. Although the risk of a heart attack during pregnancy is minimal, this possibility can not be completely ruled out. Its main symptom is a strong, dull or sharp pain in the chest. Other possible symptoms - dizziness, shortness of breath, numbness in the extremities, cold sweat. Nitroglycerin during a heart attack does not bring relief. If you suspect a heart attack immediately call an ambulance or ask someone from the family to drive you to the hospital, but in any case, do not drive yourself.

An important role during pregnancy play a size of the pelvis. The presence of a narrow pelvis during pregnancy may affect the process of delivery, be the cause of injury of the fetus, or childbirth is completed by cesarean section. Therefore, one of the moments when registering at the antenatal clinic is to measure the size of the pelvis and further prognosis for pregnancy and childbirth.

What is the pelvis

Bone pelvis consists of two iliac two ischial pubic bone and two. During birth the baby passes through the bony pelvic ring in the structure of which involved more sacrum and coccyx.

Classification narrow pelvis

There are anatomically and clinically narrow pelvis (functionally), narrow pelvis.

• Anatomically narrow pelvis - a basin in which at least one of the main dimensions of less than 1, 5-2 cm. Depending on the restriction of a certain size is isolated obscheravnomernosuzhenny, poperechnosuzhenny simple flat and ploskorahitichesky pelvis. Also, there are rare form of narrow pelvis: kososuzhenny, kosopostavlenny and others.
• Reduced pelvis - all sizes are reduced uniformly.
• A simple flat pelvis - only direct reduced size.
• Poperechnosuzhenny pelvis - reduced lateral dimensions.

Depending on how strongly narrowed pelvis are four degrees of constriction.

Clinically narrow basin - a mismatch of the fetal head and the mother's pelvis, regardless of its size. That is, clinically narrow pelvis can be diagnosed only in labor, even in the absence of his anatomical narrowing. Functionally narrow pelvis is also divided into three degrees of severity of symptoms.

Reasons anatomically narrow pelvis

The reasons for narrowing the pelvis much they are likely to be found in childhood or adolescence:

• childhood diseases associated with metabolic disorders Metabolism: The basis of life of all living things   (rickets, polio);
• hormonal disorders (menstrual disorders Menstrual cycle and its characteristics , Hyperandrogenism);
• active sports during childhood and adolescence;
• poor diet in childhood;
• injuries and pelvic fractures, tuberculosis Tuberculosis - a full recovery is not guaranteed   pelvic bones;
• tumors of the pelvis;
• deformity of the spine (kyphosis, scoliosis);
• acceleration.

Causes clinically narrow pelvis

Since clinically narrow pelvis can only speak in childbirth, and the reason most often associated with the passage of birth:

• incorrect insertion of the head;
• anomalies of labor activity;
• large fruit;
• prolonged pregnancy (fetal skull bone is too dense and unable to be configured);
• anatomically narrow pelvis;
• tumors of the uterus;
• congenital malformations of the fetus Fetal development - week after week .

Diagnostics

When a woman gets in the registration of pregnancy, the doctor evaluates the set of indicators and data. If any of the narrow pelvis pregnant entered in the high risk group, and carefully observed the entire pregnancy and childbirth:

• medical history (chronic diseases, deferred childhood diseases, the emergence of menstrual function, puberty);
• external examination (presence of lameness, gait disturbance, the curvature of the limbs);

measurement of the size of the pelvis:

• mezhostny size - normal is 25-26 cm;
• the distance between the most distant points of the iliac crests - is 28-29 cm;
• the distance between the trochanter - 30-31 cm;
• external conjugate (distance from suprasacral pit to the top of the pubic symphysis) - 20-21 cm.
• Recording dispensary map pregnant with normal pelvic dimensions would look like: 26-29-31-21.

additional tests:

• measurement of anthropometric data (narrowing of the pelvis indicate: growth below 160 cm, shoe size is less than 36, the length of the brush is less than 16 cm);
• measurement index Solovyov (wrist circumference) when the size of more than 14 cm, it shows massive contraction of the pelvic bone and pelvis;
• vaginal examination;
• X-ray of the pelvis (if indicated) and ultrasound.

Prenatal care and childbirth in women with narrow pelvis

During pregnancy is not particularly differences only in the later stages of the fetal head is not pressed against the entrance to the pelvis and a woman appears dyspnea. Sometimes beremennostoslozhnyaetsya malposition (lateral or oblique). The birth in women with narrow hips are active-expectantly, carefully monitoring contractions and fetal heart rate behavior of women. It is mandatory to carry out prevention of intrauterine fetal hypoxia and skin therapy. If you deviate from the normal course of doing a cesarean birth.

Complications

Complications during childbirth are numerous and depend on the degree of narrowing, the nature of labor and size of the fetus:

• prenatal outpouring of water;
• prolapse of the umbilical cord loops;
• injury of the fetus;
• weakness of labor activity;
• postpartum infection;
• intrauterine fetal hypoxia;
• hypotonic bleeding in the postpartum period;
• threat or uterine rupture.

Currently, more often erased form of narrowing of the pelvis, which in no vigorous labor than not manifest itself, and childbirth end in quite well.

Anna Sozinova