Precautions regarding cloudy urine during pregnancy.

Turbid urine with sediment during pregnancy does not always indicate the presence of infectious processes in the body. Quite often, it can be both a variant of the norm and a physiologically justified deviation. In the event of discomfort or suspicious symptoms, one should not delay a visit to a specialist, and even more so self-medicate. This can lead to serious and dangerous complications - fetoplacental insufficiency, hypoxia, malnutrition and intrauterine growth retardation. 

Risks to the fetus and possible prevention in cloudy urine.

The main dangers that cloudy urine can indicate are inflammatory diseases of the urinary tract, the development of urolithiasis and kidney failure. A pregnant woman is responsible not only for her health, but also for the life of her unborn child. These pathologies threaten with serious consequences, since the infection in the acute stage can spread throughout the body with the bloodstream, thereby causing sepsis.

When it enters the circulatory system of the fetus, the risk of underdevelopment of individual organs in the infant, the acquisition of injuries or death at any gestation period increases. If the immune system manages to cope with microorganisms, then there is still a chance of having a child with weakened lungs, kidneys, heart or blood vessels.

If the turbidity of the urine is caused by a hormonal imbalance, it is necessary to re-examine the thyroid gland. A failure in the operation of this system can lead to a miscarriage in the early stages, and to a premature birth of a child in later periods.

The task of every woman is to preserve her own health and give birth to a child without pathological abnormalities. To do this, you must regularly visit a gynecologist and undergo scheduled examinations and examinations. Experts recommend preventive measures that include intimate hygiene, proper drinking regimen, a balanced diet and feasible physical activity not only after conception, but already at the stage of pregnancy planning.

Treatment options for cloudy urine in pregnant women.

If, based on the results of the diagnosis, the doctor determines that the deterioration in the transparency of urine is due to physiological factors, then he will advise you to adjust your lifestyle, diet, and establish a drinking regimen. This is the simplest, but effective measure that will return urine values to normal without the slightest deterioration in the health of the mother and child.

If the dependence of turbid urine on pathological processes and diseases occurring in the body is detected, the woman is prescribed appropriate treatment, taking into account her position, duration, tolerance of drugs and the safety of the latter. Problems related to the female genital area will be dealt with by a gynecologist. Therapy of disorders of the urinary or endocrine system can be carried out by a nephrologist or endocrinologist.

With the initial occurrence or exacerbation of cystitis, pyelonephritis, a course of antibiotic therapy is indicated. It includes the use of the following medications:

• antibiotics (cephalosporins, penicillins) - Ampicillin, Amoxiclav, Monural;

• uroseptics - "Brusniver", "Canephron", "Cyston", "Kidney tea";

• antispasmodics - pills "No-Shpa", candles "Papaverine";

• non-hormonal anti-inflammatory drugs - "Paracetamol", "Nurofen".

When preeclampsia of the second half is detected, therapy is carried out in a day hospital. In this case, drip administration of magnesium sulfate and drugs that affect placental blood flow are indicated. With toxicosis of the initial stage, it is recommended to follow the appointments of the local gynecologist.

Regardless of the impact factor, expectant mothers are shown to follow dietary recommendations, observe a drinking regimen, take mild diuretics to combat edema, and in case of arterial hypertension, antihypertensive drugs, for example, Dopegyt.

Diagnosis of potential pathologies in cloudy urine in pregnant women.

When cloudy urine appears in pregnant women, what this means can only be determined by a doctor after an examination. But women should pay attention to the following symptoms:

• the number of acts of urination during the day and the tendency to increase them;

• the appearance of blood impurities, as well as white sediment after settling;

• discomfort and pain in the lower back and bladder area;

• pain when urinating;

• increased body temperature, fever, weakness and deterioration in general well-being.

After collecting an anamnesis and complaints from the patient, the specialist conducts a visual examination and prescribes an additional diagnostic procedure to find out why the urine is cloudy, because during pregnancy it should be transparent. Of great importance are the following methods of examination:

• general urinalysis;

• research on Nechiporenko;

• daily urine collection (Zimnitsky test);

• bacterial culture of urine with determination of sensitivity to antibiotics;

• ultrasound examination of the kidneys.

Further management of the patient and the choice of treatment regimen depend on the results of the examination and the identified factor that caused the change in urine characteristics.

Dangerous conditions with cloudy urine and additional symptoms.

Among the pathological conditions that can lead to the release of cloudy urine during pregnancy, it should be noted:

• toxicosis in early pregnancy;

• late preeclampsia;

• urolithiasis, accompanied by the formation of stones;

• infectious diseases of the urinary system - cystitis, urethritis, pyelonephritis.

The presence of inflammatory processes in the body of the expectant mother should be reported to the attending physician if the following symptoms are added to the main symptom - cloudy urine:

• violation of urination;

• burning and itching;

• frequent urge to empty the bladder;

• impurities of blood, pus, mucus in the urine, the appearance of flakes;

• discomfort and pain in the lower abdomen, lumbar region and hypochondrium.

It is necessary to undergo a second examination if, according to the results of the first, the following pathologies were identified.

Name. Elements / Increased quantity.

Hematuria Erythrocytes

Leukocyturia and bacteriuria Leukocytes and harmful microorganisms

Proteinuria Proteins and their compounds

Hyluria Lymph

Turbid urine during pregnancy in the morning.

Speaking about the change in urine indicators and its turbidity, it is worth noting the features of the characteristics in the morning immediately after waking up. Due to the high concentration, it changes color, smell, structure, because at night the body rests, therefore, the flow of food and water is temporarily stopped. Therefore, a portion of morning urine is used for analysis.

It should be remembered that the amount of vaginal discharge increases overnight, so before taking material for research, a woman should thoroughly toilet the genitals with baby soap. And while filling the container, use a sterile swab to block the exit of the vagina.

Cloudy urine in the last trimester of pregnancy.

At this time, most women experience heartburn attacks, which they try to neutralize by taking alkaline mineral water or a solution of baking soda in water. Specific elements that are utilized by the mother's kidneys can provoke a change in the transparency of urine - it will become cloudy.

At the same time, in the later stages, the growing uterus presses on the urinary tract, and the ureter suffers from this, first of all. Its patency due to compression of its lumen is disturbed, which causes a deterioration in the quality of urine.

Turbid urine in women during pregnancy in the third trimester may appear against the background of preeclampsia - late toxicosis. This specific condition poses a threat to the health and life of the mother and fetus, and therefore requires medical supervision. It is during this period that the diagnosis becomes the most significant.

Cloudy urine in mid-pregnancy.

From the third to the sixth month, intensive growth and development of the fetus is observed, as a result of which the need for nutrition and the intake of more fluid increases. All waste products are excreted through the maternal urinary system. Therefore, the transparency of urine during this period is a characteristic sign of the health of the mother and fetus. Cloudy urine in a woman during pregnancy in the second trimester can form if dairy products are consumed. Sediment and turbidity in urine appear due to an increase in the amount of phosphates contained in alkaline environments (all types of milk).

Turbid urine during pregnancy in the first three months.

As a rule, cloudy urine during early pregnancy appears with the development of toxicosis, aggravated by bouts of nausea. In severe cases, this condition persists around the clock, intensifying after eating. Episodes of vomiting are bad for a woman's well-being, as they gradually lead to moderate or severe dehydration. As a result, the body cannot make up for the lack of fluid. Toxicosis and dehydration are signs of a change in the structure of urine, the concentration of salt compounds and an increase in turbidity. If during the study of urine in the first weeks an excessive increase in the amount of protein (above 300 mg / day) is detected, then this may indicate pathological changes in the kidneys and their individual structures.

In addition, cloudy urine in the first trimester often indicates the initial latent course of inflammatory processes without the manifestation of specific symptoms - cystitis, urethritis, pyelonephritis. In the presence of a chronic pathology, the likelihood of its exacerbation is high.

Causes of cloudy urine during pregnancy at different times.

As practice shows, cloudy urine in pregnant women appears for various reasons. According to the women themselves, deterioration in the transparency of urine, caused by a change in physiology, occurs in them much more often than in other people. These include factors related to the functional restructuring of the body and arising in connection with this change:

• change in taste perception;

• drinking regimen;

• taking vitamins and medicines;

• physiological and hormonal changes depending on the duration of pregnancy.

Factors that provoke the appearance of cloudy urine during the period of bearing a child can also be due to inflammatory processes, dysfunction of urinary structures, genetic characteristics and hereditary diseases. In the presence of chronic pathologies in the body, one should be attentive to one's health, since pregnancy can exacerbate their course.

Normal urine values in pregnant women.

In healthy women, urine is completely transparent and has a shade of light yellow. Slight changes in shade may be due to restricted drinking regimen, taking a number of medications, or eating certain foods containing a coloring pigment. Experts consider the following data to be optimal indicators of the state of urine:

Color Light yellow

Sediment None

Protein Does not exceed 500 mg/day.

Glucose Permissible provided it is absent in the blood

Erythrocytes No more than 3 per field of view

Leukocytes H6 and less units in the field of view

Density 1012 g/l

Acid-base balance 5-7.4pH

The body of a woman undergoes restructuring during gestation, so many processes occur in it with changes. A slight excess of salts that may be present in the biological fluid under natural conditions is fully used to create the bone and cartilage structures of the baby. This explains the presence of absolutely transparent urine in pregnant women, not clouded by oxalates, phosphates and urates.

How to collect urine for analysis during pregnancy?

How to properly take a urine test for pregnant women should be told by a gynecologist or midwife when registering, and only some women know about this before becoming pregnant.

Preparation for the collection of biological fluid is based not only on the observance of thorough hygiene measures, but also on separate recommendations for women:

• Approximately one day before taking a urine test, it is undesirable for a future mother to expose her body to physical and psycho-emotional stress, as they are fraught with the appearance of protein in the urine. Also during this time, it is important to stop eating spicy, salty and meat dishes. Compliance with these recommendations will allow you to get the correct information when deciphering the general urine test in pregnant women.

• Often a bad urinalysis obtained by a pregnant woman is the result of a carelessly selected container for collecting biological fluid. Currently, a sterile and compact jar for collecting analysis can be bought at a pharmacy.

• It is necessary to collect urine for analysis during pregnancy in the morning, immediately after waking up. In this case, the density of the collected body fluid will be more concentrated, so any abnormalities will be obvious.

• Many pregnant women who are going to study a general urine test are interested in: how much should I put in a jar so that the result is normal? Experts advise filling the container up to half.

How else to take a urine test during pregnancy: it is not recommended to shake and shake the sample, filter the urine through cheesecloth (some pregnant women do this in the hope of getting a good test result), the collected sample must be delivered to the laboratory within the next hour - only if all these conditions are met the result will be as correct and correct as possible.

During pregnancy, every woman should know how to take a general and daily urine test. This is important to protect yourself and your unborn baby from health problems.

Compliance with the rules on nutrition on the eve of the collection of biomaterial, the use of a sterile container is one of the conditions for a correct assessment of the result. With a responsible approach, a woman's pregnancy will end safely, and the birth itself will take place without complications.

Indicators of urine analysis during pregnancy are an important aspect to ensure its normal course.

Physiological changes in the urinary system during pregnancy.

During pregnancy, the kidneys of the expectant mother work more intensively, since they are faced with the task of evacuating from the body not only the products of their metabolic processes, but also the metabolic products of the fetus. Many women ask if a urine test shows pregnancy. Unfortunately, it is impossible to determine the presence of pregnancy by a general urine test; there are other methods for this, such as a test for hCG.

In the first 12 weeks of pregnancy, blood flow increases, and therefore all organs begin to receive a larger volume of circulating blood. Glomerular filtration increases, and tubular reabsorption does not change throughout pregnancy, which causes the development of edema, fluid retention in the body.

As the uterus grows, the position of the internal organs changes. In the third trimester, the bladder moves upwards outside the pelvis, its walls thickening to withstand increased uterine pressure. In rare cases, a hydroureter occurs - a violation of the patency of the ureter, usually the right one. This is due to its compression at the level of the pelvic bone.

Under the influence of progesterone, the tone of the urinary tract decreases, they expand, as a result of which the infection penetrates the bladder more easily with the subsequent development of pyelonephritis.

If the urine test is bad?

A poor urine test in pregnant women may indicate asymptomatic bacteriuria, early and late toxicosis, pyelonephritis, cystitis and other pathological conditions that threaten the normal course of pregnancy. Depending on what the study shows - proteinuria, hematuria, etc., a woman is recommended to undergo an additional examination (Nechiporenko analysis, ultrasound, etc.).

If a poor urine test is detected in late pregnancy, and this is accompanied by increasing edema and arterial hypertension, we can talk about preeclampsia. This condition is dangerous for the mother and fetus. The woman is urgently admitted to the hospital. 

If a urine test in the presence of pregnancy shows poor results, while the woman complains of fever, back pain and weakness, most likely we are talking about an infectious lesion of the kidneys. This condition is also treated in stationary conditions.

What to do if the urine test turned out to be bad pi pregnancy? There is no need to worry, it is important to follow all the recommendations of the doctor and not refuse additional diagnostic methods and inpatient treatment.

Urine analysis for culture.

What kind of urine tests are not taken by pregnant women, and an analysis for bakposev is also included in this number. What is it for? With this analysis, you can determine the bacteria that are in the body of a woman. That is, the biological fluid of a pregnant woman is used as a nutrient medium for growing pathogenic microflora in it.

If a woman is sick, a urine test will show not only the presence of bacteria, but also their sensitivity to certain drugs, which is important during pregnancy. As a result, the doctor will be able to prescribe the most gentle treatment that is safe for the mother and unborn child.

During pregnancy, for bacteriological culture, a urine sample is usually collected with a catheter, then the resulting liquid is taken to the laboratory and placed in a nutrient medium. After that, urine, saturated with pathogenic microorganisms, is placed in different test tubes and cleaned in a heating cabinet, where favorable conditions are created for the growth and reproduction of bacteria.

At the end of the study, on about 5-10 days, the doctor finds out what kind of microflora was in the woman's urine. If necessary, she is prescribed treatment.

Is it possible to determine on your own that urine does not signal a problem?

You can determine the signs of “good” urine using your own observations if you pay attention to the following factors:

• Color of collected urine. Normally, its shade should vary from straw yellow to amber yellow. The saturation of the color can be given by taking multivitamin preparations prescribed for expectant mothers. However, the shade should in no case be dark.

• Smell. It may not be at all, or it will not be pronounced. No harsh flavors. If some acidity is felt, and the smell has an obsession, it is necessary to inform the doctor about this.

• Transparency. Urine should be clear, there can be no talk of any turbid impurities. If the collected liquid is cloudy, that is, it is impossible to see anything else through the container, most likely there are bacteria and epithelium in the urine in large quantities, which is not a good sign.

Urinalysis according to Nicheporenko.

If the expectant mother has swelling, pain in the lower back and lower abdomen, it is necessary to exclude infectious and inflammatory processes. For this purpose, during pregnancy, a urine test according to Nechiporenko is prescribed, which will show the presence or absence of pathologies.

When conducting this urine test in pregnant women, two indicators are taken into account - the rate of leukocytes and erythrocytes in 1 ml of biological fluid. For leukocytes, it is 2000 in 1 ml, for erythrocytes - 1000. If the result is higher than normal, most likely it is an infection of the bladder, urethra and kidneys.

If the number of leukocytes is exceeded, then this may indicate pyelonephritis - inflammation of the kidneys. If the indicators are slightly increased, we can talk about the errors that the woman made during the collection of urine.

In order not to worry once again what a urine test shows during an existing pregnancy and how correct these results will be, the biological fluid for the study should be collected correctly.

Normal indicators of general clinical analysis.

Below are the characteristics and numbers that are typical for analyzes of healthy women.

Indicators. Meaning.

Amount of urine 150-250 ml

Color Straw yellow, amber yellow

Transparency Full

Density 1.010-1.030

pH 5.0-7.0

Protein Up to 0.033 g/l

Glucose Absent

Bilirubin Absent

Urobilinogen Traces

Ketone bodies

Erythrocytes 1-2 in p. sp.

Leukocytes Up to 5 in p.

Epithelium Single cells of squamous and transitional epithelium

Cylinders Single hyaline cylinders

Salts Single urates and oxalates

Deciphering the analysis of urine during pregnancy.

When deciphering the urine test of a pregnant woman, the following normal indicators are evaluated:

• The color depends on the allocated volume of the biological fluid and the presence of dyes-pigments in it. Normally, urine should be colored straw-yellow due to the content of urochrome.

• The transparency of a liquid characterizes all the properties of the biological components present in it. Normally, urine should be clear.

• Specific gravity refers to the content of dissolved components in urine, such as salts, sugar, urea, etc.

• pH, or acidity, is determined by the concentrated content of hydrogen ions formed in the liquid as a result of the dissociation of organic and inorganic acids.

• Normal protein should not be detected in the urine of a pregnant woman, and if urine analysis showed its presence, this is proteinuria, which can be physiological (against a background of severe mental shock, physical activity, consuming a large amount of protein) and pathological (diseases of the genitourinary system or allergies).

• Sugar is not normally detected, but if glucose is detected in the urine of a pregnant woman, there are suspicions of diabetes mellitus, the woman is recommended to additionally take a blood test for sugar.

• Bilirubin in the urine should not be detected. If it is found, we can talk about jaundice, hepatitis and other pathologies that disrupt the outflow of bile. Urine will have the color of dark beer.

• Ketone bodies are not normally detected, a urine test with the presence of acetone during pregnancy can show early toxicosis, anemia and gestational diabetes mellitus.

• Nitrites are normally absent, their detection in the urine of pregnant women indicates the presence of inflammation in the organs of the urinary tract.

• Hemoglobin detected in the urine is a clear indicator of pathology that indicates anemia.

• Erythrocytes are normally detected singly (1-2 in the field of view). If there are more of them, we are talking about hematuria associated with infections of the renal system and urinary tract.

• Leukocytes in the analysis of urine in a pregnant woman should not exceed 0-5 in the field of view, otherwise we are talking about an inflammatory process in the kidneys - glomerulonephritis and pyelonephritis, as well as diseases of the urinary system - cystitis.

• Epithelial cells in urine should not exceed 0-3 per field of view. If their number exceeds this value, most likely, we are talking about kidney diseases - pyelonephritis, urolithiasis.

• The cylinders are absent in the urine of a healthy person, their presence in the analysis of urine during pregnancy indicates various kidney diseases.

• Bacteria and fungi diagnosed in the urine indicate infectious diseases of the genitourinary system, such as urethritis, vaginal thrush, etc.

• Salts indicate a change in urine pH response. Normally, urine contains oxalates and urates in single amounts. An excess of salts indicates the development of urolithiasis.

• Normal mucus in the analysis of a pregnant woman can be detected in a small amount. Its presence in large quantities indicates inflammatory diseases of the genitourinary system.

Mucus in the urine of a pregnant woman.

The inner lining of the organs of the urinary system constantly secretes mucus. Normally, mucus is absent or found in small quantities.

Increased secretion of mucus indicates insufficient hygiene of the genital organs during the sampling or an inflammatory disease of the urinary system, but in the presence of other signs of pathology.

Salts in the urine of a pregnant woman.

Urine is an aqueous solution of the breakdown products of protein substances and various salts that precipitate. The presence of a certain type of salt crystals in the urine indicates a change in pH in one direction or another. An acidic environment causes the formation of urates, an alkaline environment - phosphates. With normal other indicators of urine, the presence of salts is not considered a sign of any disease.

An excess of salts (urates, phosphates or oxalates) leads to the appearance of stones and, as a result, to the development of urolithiasis.

This happens due to metabolic disorders, unbalanced nutrition.

Precipitation of urates occurs when the body is dehydrated (for example, during a period of heat and insufficient drinking regime, due to profuse vomiting, diarrhea, etc.) or when meat food predominates in the diet.

Phosphates appear when eating foods rich in phosphorus (fish, sour milk, oatmeal, buckwheat, etc.).

Oxalates occur in any pH reaction, but with excessive consumption of products containing large amounts of oxalic acid.

Bacteria and fungi in the urine of a pregnant woman.

In the analysis of a healthy person, bacteria and fungi should be absent, their presence indicates an infection of the genitourinary system (cystitis, urethritis, candidiasis, etc.).

If bacteria are found in the urine, additional urine is taken for bakposev to determine the type of bacteria and their titer (quantity). If necessary, antibiotic treatment is prescribed, to which this type of bacteria is sensitive.

Cylinders in the urine of a pregnant woman.

In case of kidney diseases, protein accumulates in the renal tubules, leukocytes, erythrocytes, exfoliated epithelial cells and other particles “stick” to it. This plastic mass envelops the tubules, cylindrical in shape, from the inside, and thus makes, as it were, their cast. When urinating, these cylindrical casts are washed out and determined by the laboratory assistant during analysis.

Since protein and other elements are excreted in the urine only in a pathological condition of the kidneys, then in a healthy person there should be no cylinders in the sample, only hyaline cylinders and no more than 1-2 in the field of view, an increased content of this species or the presence of others (granular , waxy, erythrocyte, leukocyte, epithelial) is possible only with various renal diseases.

Epithelial cells in the urine of a pregnant woman.

The epithelium lines the mucous membrane of all internal organs. Squamous epithelium is almost always present in the urine sediment of a healthy person in an amount of up to 3 cells per field of view. Their number increases with an infectious disease of the urinary tract.

Another type of cells, transitional epithelium, appears in the urine with cystitis, pyelonephritis, and nephrolithiasis. Permissible presence of the 1st cell of transitional epithelium in the field of view.

The renal epithelium is found in the sediment with an infectious lesion of the kidney parenchyma - pyelonephritis, kidney glomeruli - glomerulonephritis, etc. In a healthy person, the renal epithelium is absent in the urine sediment.

Leukocytes in the urine of a pregnant woman.

To combat pathogens of various diseases, the body produces leukocytes. Normally, in the urine of a woman, 0-5 leukocytes are found in the field of view.

An increased content of leukocytes (leukocyturia) always indicates inflammatory processes in the kidneys - pyelonephritis, in the urinary tract - cystitis, urethritis or genital organs.

An erroneously positive result is obtained by women who neglect personal hygiene and other rules when taking an analysis.

An excessive increase in leukocytes (pyuria) can be detected even with the naked eye: the urine is cloudy, “flakes” and “threads” float in it. This indicates the accession to the inflammatory process of the purulent.

Nitrites in the urine of a pregnant woman.

They are not found in the urine of a healthy person. A positive result indicates the presence of an infection in the urinary tract.

Hemoglobin.

Normally, there is no hemoglobin in the urine. Usually its presence indicates hemolytic anemia.

Erythrocytes.

In a healthy person, erythrocytes in the urine are either absent, or 1-2 cells are found in the field of view.

An increase in the number of red blood cells (hematuria) occurs with kidney diseases and diseases of the urinary system.

Ketone bodies in the urine of a pregnant woman.

It is generally accepted that ketone bodies in a healthy person should be absent.

During pregnancy, these bodies can be identified in the urine, which indicates dehydration with early toxicosis. But this is not a trifle, ketone bodies poison the body with acetone, so it is necessary to be examined to exclude other possible diseases (in particular, diabetes mellitus).

Acetone is most often found in the urine with anemia or gestational diabetes in pregnancy. In such cases, a doctor at the hospital prescribes a dropper and a special diet. The main goal is to drink more alkaline mineral water, exclude sweet, fatty, reduce protein intake, and vice versa, include more carbohydrate foods in the diet.

Bilirubin in the urine of a pregnant woman.

In a healthy person, bilirubin is not found in the urine. But with obstructive jaundice, viral hepatitis and other diseases that cause difficulty in the outflow of bile, the appearance of bilirubin is observed, and the urine turns dark, “the color of beer”.

Sugar in the urine of a pregnant woman.

Normally, sugar in the urine of a healthy person is absent or found in a small amount up to 0.083 mmol / l.

During pregnancy, "traces" of glucose can be detected in the urine. This happens due to heredity (especially in late pregnancy - after 35 years), with obesity, eating high-carbohydrate foods, or with severe stress.

In the second trimester of pregnancy, physiological glucosuria is observed, which is due to the normal processes occurring in the body of a pregnant woman. It does not require drug treatment, but nutrition should be adjusted to reduce the amount of carbohydrate food in the diet of a pregnant woman (limit the intake of sweets and starchy foods).

Detection of glucose (glucosuria) is observed in diabetes, kidney and other types of diabetes.

Protein in the urine of a pregnant woman.

 Protein in the urine of a pregnant woman.

• Normally, there is no protein in the urine, but during pregnancy a slight increase to 0.033 g / l is allowed, which is caused by strong emotional feelings for the health of the fetus, possible overheating in the summer or hypothermia in the cold season, the intake of undenatured protein foods (raw eggs and home-made unboiled milk), the presence of allergies at the time of the test, and indeed, a strong burden on the kidneys.

• Toward the end of the second trimester, a small amount of protein may appear due to mechanical compression of the kidneys by a pregnant growing uterus, but this phenomenon is not permanent, and is not dangerous only if there are no other signs of kidney disease.

• Also, the protein can get into the urine along with vaginal discharge, therefore, in order for the result of the analysis to be as accurate as possible, it is necessary to follow all the rules for sampling urine.

The appearance of protein (proteinuria) indicates diseases of the kidneys (pyelonephritis, glomerulonephritis, nephropathy of pregnant women, etc.), urinary tract (cystitis, ureteritis) or preeclampsia (late toxicosis).

pH of urine in a pregnant woman.

The reaction of urine in humans ranges from 5.0 (acidic) to 8.0 (slightly alkaline) depending on the diet. The acidity of urine is increased by protein (in particular, meat) products and fats, and the alkalinization of urine is promoted by vegetable products (fruits, vegetables) and dairy foods.

The reaction of urine in a healthy person with a balanced diet is slightly acidic (pH=6.0 and >) or neutral (pH=7.0).

An acidic environment is a good environment for the development of bacteria, so the presence of such an environment all the time is undesirable.

Kidney failure, urinary tract infections, and other diseases affect the pH increase.

Diabetes mellitus, tuberculosis, fever, severe diarrhea, and other ailments will affect the pH by lowering it.

The specific gravity of urine in a pregnant woman.

This indicator depends on the amount of substances dissolved in the urine and the water drunk per day.

The relative density (or specific gravity) of the urine of a healthy person is 1003-1035 g / l.

An increase in density occurs with dehydration of the body, toxicosis, uncontrolled diabetes mellitus, glomerulonephritis, etc., and a decrease occurs with heavy drinking, nephritis, and renal failure.

Transparency of urine in a pregnant woman.

Freshly collected normal urine is ideally clear, possibly slightly cloudy due to the presence of epithelium and mucus.

It also becomes slightly cloudy due to the long standing of the sample, so the collected sample must be delivered to the laboratory as soon as possible so as not to distort the result of the analysis. A small amount of water drunk can also cause cloudy urine in a healthy person.

Severe turbidity of urine is caused by erythrocytes, leukocytes, bacteria, mucus, a significant amount of salts or epithelial cells, etc.

The color of urine in a pregnant woman.

In a healthy person, urine can be straw to deep yellow in color. Often, pregnant women have a bright yellow or orange color of urine, which is due to the intake of vitamins on the eve of the test.

When drinking heavily, the urine dilutes and becomes colorless, and, conversely, when drinking a small amount of fluid or when it is lost (vomiting, diarrhea), the urine becomes more concentrated, dark yellow.

A sign of the disease is most often considered if the urine has a color:

• strong tea ("beer" color) - pathology of the liver and gallbladder, such as parenchymal (hepatic) jaundice or viral hepatitis;

• pink-red (the color of "meat slops") - inflammation of the kidneys, such as acute glomerulonephritis;

• greenish-yellow ("lemon" color) - obstructive jaundice (ie cholelithiasis), the presence or entry of pus into the urinary system;

• dark brown (dark brown) - hemolytic anemia;

• whitish - the presence of a large number of phosphates or lipids, such as renal lymphostasis, fatty degeneration of the kidneys;

• dairy - urinary tract infection, cystitis, pyelonephritis.

How to take urine for analysis?

It is necessary to collect the average portion of the morning (immediately after sleep) urine in a special sterile container for analysis with a plastic lid.

On the eve of sampling, exclude the use of medications (vitamins, diuretics, hormones, antibiotics and other medicines) and coloring foods (carrots, beets, asparagus, cranberries, blueberries, etc.).

The last sexual intercourse should be at least 12 hours before the collection of the urine sample.

First of all, before collecting urine, it is necessary to carefully hygiene the external genital organs. To prevent the vaginal environment from entering the urine sample, it is necessary to cover the entrance to the vagina with a piece of cotton wool or insert a swab. Avoid touching the urine collection container with your body.

When urinating, flush the first portion of urine (1-2 seconds) into the toilet, and then, without interrupting urination, collect the second part of the urine, interrupting at the end of the process and finishing urinating into the toilet. For analysis, you need about 50 ml of biomaterial.

The collected urine must be delivered to the laboratory within 1-1.5 hours. On the jar with the analysis, clearly indicate your last name, initials, date of collection of the analysis and time.

If a urine test in a pregnant woman is bad.

With a poor urine test in pregnant women, the doctor order a re-examination. If it shows the same results, they will find out the causes of the pathology. For this, laboratory, instrumental studies are prescribed. It is impossible to carry out therapy on your own. It is dangerous for a pregnant woman, a fetus.

Urinalysis can be done manually or with using automated analyzers. To choose the right test, consult with your doctor. For pregnant women, it is important to conduct studies in a timely manner in order to identify deviations in the early stages.

If they are eliminated, there will be no risk to her, the child.

Explanation of clinical analysis results urine in pregnant women.

Depending on the area of change in the urine index, the doctor suggests the causes of deviations from the norm. More often he looks at the number of red blood cells, white blood cells, epithelium. With their slight change, one can suspect the disease in the early stages of development.

The amount of urine.

Volume should be medium. If it is lowered this is indicative of inflammatory kidney disease. When the level of biological fluid is exceeded, water-salt metabolism is disturbed.

Color.

The color of urine depends on the amount of pigments. In a healthy person, it is yellow. If there are many pigments in inflammatory diseases of the liver, biliary system, it darkens. Dark urine is observed in the morning, and light urine during the day.

Transparency.

A healthy woman should have clear urine. If turbidity appears in it, this indicates bacteriuria. For example, Escherichia coli in the urine during pregnancy.

Density.

Density or specific gravity of urine refers to the amount of substances contained in urine. If the value exceeds the norm, the kidneys do not work enough, passing substances. Decreased levels indicate a lack of substances in the body.

Ph urine.

Normally, the acid-base state of the urine of a pregnant woman is less than 7 units. PH in the urine is increased in violation acid-base state in the body or inflammatory diseases of the kidneys, bladder, and other departments.

Protein.

Normally, a person has traces of protein. If a large amount of protein is formed, this indicates an inflammatory diseases of the urinary system, serious renal pathologies. The amount of protein can increase with prolonged fasting.

Glucose.

Glucose is found in the urine with glucosuria, diabetes during pregnancy. Normally, a small amount of the substance is observed.

Bilirubin, urobilinogen.

Not present in a healthy woman. An increase in the rate occurs with an inflammatory disease of the liver or biliary system.

Ketone bodies.

Normally, ketone bodies in a healthy woman are practically not detected. They occur when the pH shifts to the acid side, this happens with diabetes mellitus in the decompensated stage.

Erythrocytes.

Normally, single cells are absent or appear. They are determined in the urine with mechanical damage to any part of the urinary system. RBCs should not exceed 2 cells per entire smear microscopy specimen.

Leukocytes.

Leukocytes in the urinary tract appear in the urine with pyelonephritis, nephrolithiasis, and other inflammatory diseases of the urinary system. Urinary tract infection in a pregnant woman is dangerous, it can lead to the spread of bacteria through the placenta. Normally, there are a small number of leukocytes in the urine, as they destroy penetrating bacteria.

Epithelium.

The presence of epithelium indicates mechanical damage to the mucous membrane, inflammatory diseases of any department urinary system during pregnancy with urine. Flat cellular elements in a healthy person are slightly present.

Cylinders.

Normally single cylinders can be detected in urine. A large number appears in inflammatory diseases of the kidneys, hepatitis, scarlet fever, lupus erythematosus, and other diseases.

Salt.

Normally, a small amount of salts is determined. The indicator is detected because urolithiasis or kidney stones appear.

 Table of normal indicators of a general urine test for pregnant women.

In the form of the study are the values of the patient, normal values. She can independently compare them to identify deviations. But the doctor should deal with the decoding, it is impossible to make a diagnosis on your own. The norm of the results of a general clinical analysis of urine in the table.

Options. Norm for women.

Color yellow, straw yellow

Transparency transparent

The smell is not sharp

Density 1.012-1.024 g/l

Acid pH less than 7

Protein up to 0.033 g/l

Sugar up to 0.8 mmol/l

Bilirubin absent

No ketone bodies

Organic sediment / Inorganic sediment - Normally, single squamous epithelial cells may be present in the urine

Erythrocytes 0-3 in the field of view

Leukocytes 0-6 in the field of view

Hyaline cylinders single

No granular cylinders

No wax cylinders

No bacteria

Mushrooms None

Salts None

Bacteriological analysis of urine, urine culture tank during pregnancy.

If the doctor suspects an infection, the patient gives urine for bacteriological analysis. The laboratory assistant inoculates the sample on a nutrient medium. The study is carried out for 5-7 days, since the growth of bacteria can be long. With the help of the test, bacteria and fungi, antibiotics, to which they have sensitivity, are detected.

Often the analysis determines escherichia coli in the urine during pregnancy. It should be observed only in the intestines. Your doctor will advise you not to take antibiotics during pregnancy unless absolutely necessary. Therapy is carried out after childbirth or in the presence of complications due to e. coli in urine.

Urinalysis according to Zimnitsky, Zimnitsky test during pregnancy.

If the patient's filtration capacity of the kidneys is impaired, a large amount of substances enter the urine. It can be protein, glucose, minerals. They increase the specific gravity. It should be 1012-1035 g / l. If the concentration ability is impaired, the indicator will increase.

If the substances are excreted in the urine, they become deficient in the body.

Unlike other studies, for the Zimnitsky sample, a sample is collected during the day (daily urine). The bladder is emptied according to the following rules:

• the first morning portion goes down the toilet;

• all subsequent portions of urine are collected in containers, handing over for analysis.

The doctor determines the density of each urine sample, revealing a tendency to increase or decrease in values per day. The highest concentration of substances should be observed immediately after waking up. At night it is minimal.

If a woman has poor performance according to Zimnitsky, there may be a pathology in the form of glomerulonephritis, pyelonephritis, diabetes mellitus during pregnancy.

Urinalysis according to Sulkovich, Sulkovich's test during pregnancy.

Testing is used if the presence of urolithiasis in the early period. Stones must contain calcium. The study is also applicable to patients who have a reduced amount of vitamin D, there is a prerequisite for the development of rickets. With an increase in oxalate, the doctor may suspect the following diseases:

• pyelonephritis;

• colitis;

• urolithiasis disease;

• diabetes;

• Crohn's disease.

Oxalates appear in the urine if they are poorly absorbed in the body. They gradually accumulate in the urinary system, large conglomerates of stones appear, which injure the mucous membrane with their edges.

Urinalysis according to Nechiporenko, Nechiporenko test during pregnancy.

If erythrocytes, leukocytes, cylinders are increased in a clinical study, the doctor needs confirmation of the data. Since the results appear using microscopy, visual inspection of the mask, it is recommended to conduct a test according to Nechiporenko. With it, a semi-automatic analyzer is used, with the help of which accurate data are obtained, down to each cell.

Normally, testing should give the following data per 1 ml of urine:

• leukocytes up to 2000;

• erythrocytes up to 1000;

• cylinders up to 20 units.

Unlike the previous study, for the Nechiporenko test, not the entire portion of urine is collected, but only the middle part.

General analysis of urine during pregnancy.

General urinalysis during pregnancy includes the following indicators:

• Physical criteria (color, smell, density, presence or absence of foam, sediment);

• Protein, sugar, bile pigments, ketone bodies, erythrocytes, hemoglobin are determined on a semi-automatic analyzer;

• Bacteria, fungi, salts, cylinders, epithelium, erythrocytes, leukocytes are visually determined by sediment microscopy.

The doctor may suspect the presence of inflammation if the white blood cells are enlarged. With an infection, bacteria, leukocytes increase. If the uterus compresses the organs of the urinary system, red blood cells increase in the urine of a pregnant woman.

A general urine test during pregnancy is required. It is delivered every 2 weeks. But if the patient has a disease, the frequency of studies is increased.

Rules for collecting urine for analysis.

To obtain reliable data, the patient should know how to properly collect urine for a general analysis.

• On the eve of urine collection, you should not eat fatty, spicy, fried, sweet foods. If there are many products, they will affect the result.

• Do not use new drugs for 3-4 days. The exception is drugs on which the life and health of a woman depends. But they warn the attending physician, laboratory assistant.

• Immediately after waking up in the morning, they begin to collect urine, but before that you can not eat food or drink large amounts of water.

• Urine is collected in a sterile container, which is bought from a pharmacy. Do not use jars, bottles or other contaminated containers. Even if you clean and disinfect them yourself, foreign substances will remain inside. They affect the received data.

• Before emptying the bladder, the opening of the vagina is closed with a cotton swab. This is necessary so that foreign bacteria, discharge during pregnancy do not get into the sample.

• For general clinical examination of urine, the first portion of the liquid is lowered into the toilet, the middle one is collected in a container. After collection, the container is closed with a lid.

• The urine sample is immediately delivered to the laboratory. But there are times when it can be collected early in the morning when the clinic is closed. Then the liquid is placed on the door in the refrigerator. Do not put it in the freezer or the coldest parts of the refrigerator. The sample is left in the cold for no more than 2-3 hours. After this time, uncontrolled biochemical processes will begin that change the result.

With the growth of the uterus, the state of the internal organs. The liver, kidneys, digestive tract are compressed. Therefore, during pregnancy, clinical tests are constantly taken in order to detect deviations in a timely manner.

The purpose of a general urine test during pregnancy.

Urinalysis in pregnant women is intended for

the following goals:

• clarification of the condition of the kidneys, bladder, urinary canal;

• identification of foreign substances that should not be detected (protein, glucose),

• determination of the state of the liver;

• detection of compression of internal organs by the uterus, fetus, which leads to inflammation.

If the patient has abnormal urinalysis, the doctor prescribes a urinalysis every 2 weeks during pregnancy.

How long does it take to get urinalysis results?

As a rule, a general urine test is prepared for 1-2 days. Most often, a woman gives urine before an appointment with a gynecologist and comes to the doctor with the finished result of the analysis.

An exception is bacterial urine culture, which takes up to two weeks to prepare. This test is done after 14 weeks of pregnancy and is required to diagnose asymptomatic bacteriuria.

Do I need to take a urine test when planning a pregnancy?

When planning a pregnancy, a general urine test is not mandatory, but it is recommended to take it if possible, as it helps to detect kidney pathology before pregnancy.

If a woman has not given urine for a long time and does it for the first time during pregnancy, then when receiving an abnormal result, it may be difficult to interpret it: did the woman have a pathology before pregnancy or are these changes caused directly by pregnancy?

Therefore, it is better to visit a doctor and take tests at the stage of preparation for conception.

Do screenings include urinalysis?

Outside of pregnancy, a urinalysis is not a necessary screening test and is given as indicated or as part of a medical examination.

But during pregnancy, a woman must pass urine at least 5 times. This simple test allows you to detect pathological changes in the mother's body at the initial stages (protein, bacteria, leukocytes, salts).

In addition to a general urine test, an additional tank must be taken after 14 weeks of pregnancy. urine culture to exclude asymptomatic carriage of bacteria in the bladder (during pregnancy, asymptomatic bacteriuria requires treatment).

If some complaints arise, a pregnant woman must pass a urine test without waiting for a gynecologist. These include:

• pain and discomfort in the lower back,

• chills, fever,

• painful urination, the appearance of streaks of blood in the urine,

• bad or strange/unusual smell of urine,

• feeling of incomplete emptying of the bladder.

Poor urinalysis during pregnancy.

Some possible indicators in the results of a general analysis of urine should be paid special attention.

• Acetone (ketone bodies) in the urine indicate a change in the acidity of the urine. This can be observed with toxicosis of the first half of pregnancy. With timely detection and detoxification therapy, pregnant women begin to feel better, vomiting attacks go away or their frequency decreases, and appetite returns.

• Salt/sediment in the urine indicate the possible presence of urolithiasis, metabolic disorders.

• Protein in the urine is the most alarming sign. In a healthy person, there is no protein in the urine; in late pregnancy, traces of protein (up to 0.09 g / l) are acceptable due to the peculiarities of the kidneys during pregnancy. However, any increase in protein above these figures (especially if there are edema and increased blood pressure) indicates the development of such a serious complication as preeclampsia. It can lead to convulsions in a pregnant woman, impaired development and growth of the fetus, and in severe cases, death of the woman and / or fetus.

• Glucose in the urine can be a sign of developing diabetes in pregnancy. Such patients must additionally pass blood glucose (on an empty stomach), as well as a glucose tolerance test and visit an endocrinologist to get detailed advice and necessary recommendations.

• White blood cells in the urine indicate the presence of an inflammatory process in the urinary system. It is imperative for such patients to pass a urine test according to Nechiporenko to determine an ascending infection and identify the possible development of an inflammatory process in the kidneys.

• Bacteria in the urine also indicate the presence of an inflammatory process. To determine the type of bacteria, their quantity, an additional bacterial culture of urine is carried out. Here it should be taken into account that if a large number of bacteria are detected, even in the absence of complaints in a pregnant woman, antibiotic therapy is necessary, since asymptomatic bacteriuria is a condition that threatens the development of the inflammatory process and intrauterine infection of the fetus.

If the deviations revealed in the analysis of urine are insignificant, the repeated analysis is necessary. If there are more significant deviations, an additional examination is required without re-taking a general urine test, sometimes even in a hospital setting.

The norm of values in the analysis of urine during pregnancy.

It is important to remember that the norms of laboratory parameters of a general urine test in women in position are the same as in non-pregnant women. However, even small changes or deviations in these indicators may indicate the beginning of the development of any pathology. That's why it's important to keep an eye on the numbers and see a doctor if, for example, your protein levels are elevated.

In each urinalysis, physical properties are evaluated, such as:

• color,

• density,

• specific gravity,

• acidity,

• the presence of protein, salts, glucose and other substances.

They allow us to conclude that there are possible pathological processes in the body of a woman.

How to take a urine test during pregnancy?

Every expectant mother should know how to collect urine for analysis. Compliance with the rules will allow you to correctly determine the presence of possible pathologies and save time by eliminating repeated retakes in case of incorrect collection of biological fluid.

You can donate urine for research in a clinic or in a private laboratory. For this, the gynecologist issues a special form to the pregnant woman, which indicates the data of the woman, the expected gestational age and the type of analysis. The referral is attached to the container with urine upon delivery to the laboratory.

Observe hygiene.

Some future mothers neglect the thorough hygiene of the external genital organs immediately before collecting urine for analysis. And in vain: you can get distorted results. For example, a lab may detect an increased number of white blood cells, which actually enter the urine from the vagina and not from the urinary tract. Therefore, before collecting urine, it is important to thoroughly rinse the external genitalia with warm tap water, dry with a towel and insert a tampon into the vagina.

Adjust diet if necessary.

Before collecting urine for analysis, it is not recommended to eat brightly colored foods, such as beets or strawberries. This can hinder the study or distort its results. In general, it is recommended to take the biomaterial on an empty stomach so that the pH of the urine is in the physiological range. It is also desirable to limit the intake of salt and certain medications. For the latter, you should consult your doctor.

Use a special container.

Biomaterial should be collected in a special sterile container. Do not use washed glass jars for this, for example, from baby food, as the results of the study may be distorted. Now in any pharmacy you can buy a container for analyzes with a screw cap. It has the right size, and the lid allows you not to worry that the biomaterial will spill during transportation.

Take the middle portion.

It is recommended to collect an average portion of urine for analysis. To do this, urinate into the toilet for 2-3 seconds and then 一 into the container. Most often, 50-70 ml of urine is enough for research.

Deliver analysis on time.

It is not worth storing urine at home for a long time, even in the refrigerator. According to the general rules, it is desirable to deliver it to the laboratory within 3 hours after collection in order to avoid obtaining unreliable results.

Prevent foam formation.

Try not to shake the urine container during transport. This can lead to foam formation and incorrect test results.

When should I take a urine test during pregnancy?

A general urine test is prescribed at least 5 times during pregnancy. However, in practice, the doctor sends the expectant mother for research at each visit. This analysis allows you to identify possible pathologies in time and prescribe treatment. Other types of urine tests are prescribed if necessary - depending on the individual health of the woman and the course of pregnancy.

In the first trimester.

The expectant mother gives a general urine test before the first visit to the gynecologist. Then 一 every 4 weeks.

In the second trimester.

In the second trimester, a urine test is given more often than in the first. At least 一 once every 2 weeks in the second and early third trimester.

In the third trimester.

At the beginning of the third trimester, urine is taken every 2 weeks. From 35 weeks 一 weekly.

What does a urine test show during pregnancy?

Urinalysis allows you to evaluate many parameters of the functioning of the body and prevent the possible development of serious diseases. Important: only a doctor should decipher the indicators.

Urine color.

During the normal course of pregnancy, urine has a yellow color in various shades. Color change can be caused by several factors.

• Taking medication. For example, aspirin can give a pinkish tint, and vitamins - orange.

• Diseases of the kidneys and bladder (cystitis, renal colic) can lead to blood in the urine. It is she who gives the secretions a reddish-brown hue.

• In some liver diseases, urine acquires the so-called "color of beer."

Transparency.

Normally, urine should be completely clear. Cloudiness usually indicates the presence of mucus, protein, microbes, or white blood cells in the urine.

Protein.

May be present in very small amounts in normal pregnancy. However, high blood pressure and edema combined with high protein can be a sign of preeclampsia.

Glucose.

The presence of sugar in the urine can be a sign of a number of diseases, including diabetes. In this case, all pregnant women are prescribed blood glucose control - to exclude possible pathologies or timely prescribing therapy.

Leukocytes.

An increased number of leukocytes most often indicates the presence of an inflammatory process. Moreover, the more leukocytes, the stronger the inflammation. A slight increase can be observed if the urine was not collected according to the rules. For example, with a poor toilet of the external genitalia or ingestion of discharge from the vagina.

Erythrocytes.

The detection of more than two erythrocytes in the field of view - a deviation from the norm. This usually manifests itself in the presence of stones in the urinary tract or kidneys, trauma and inflammation of the kidneys.

Bacteria.

The appearance of bacteria in the urine may not affect the well-being of a pregnant woman. However, almost always this indicates a risk of inflammation from the genitourinary system and requires mandatory therapy. Also, bacteria can get into the urine with poor toileting of the external genitalia.

Reberg's test during pregnancy.

Allows you to evaluate the function of the kidneys to purify the blood, as well as their excretory ability. During the day, urine is collected in one container, which is stored in the refrigerator. After the volume of urine must be measured and mixed. 70-100 ml of biomaterial are delivered to the laboratory, poured into a special container. In this case, the specialist must also report the total volume of urine. At the same time, blood is taken from a vein for creatinine (a protein that is excreted in the urine, it allows you to evaluate the work of the kidneys).

Before the analysis, complete physical and emotional rest is recommended, the use of coffee and strong tea is excluded.

Urinalysis for sterility during pregnancy.

As a rule, it is prescribed by a nephrologist for the diagnosis of kidney diseases caused by microorganisms. It is considered a rather rare type of research.

Urinalysis according to Zimnitsky during pregnancy.

Rented by expectant mothers suffering from kidney disease. It is usually carried out in a hospital, where the woman is kept. This makes research easier. Urine is collected in 8 separate containers, every 3 hours during the day, then it is mixed and sent to the laboratory. If the analysis is performed at home, the pregnant woman will need to record the total volume of urine, the amount of daily urine and the amount of liquid drunk.

Urinalysis according to Nechiporenko during pregnancy.

It is prescribed if any deviations from the norm are found in the general analysis of urine. Allows you to assess the state of the urinary system, in particular, to identify the presence of hidden inflammatory processes. The collection rules are the same as for general analysis.

Bacterial culture of urine during pregnancy.

It is mandatory to carry out at 14 weeks of pregnancy, as well as when bacteria are found in a general urine test. This study is necessary in order to determine the presence of asymptomatic bacteriuria. Timely detection of the inflammatory process allows you to prescribe therapy in time and prevent the development of serious complications, such as pyelonephritis and glomerulonephritis.

For analysis, you need to collect the first morning urine. Before this, a thorough toilet of the external genital organs is required, it is recommended to close the vagina for the duration of the procedure with a swab. The sterile container with the material must be tightly closed and quickly brought to the laboratory - no later than 1.5-2 hours. Results should be expected in about a week.

Protein analysis during pregnancy.

Helps to identify disorders in the work of the kidneys, as well as concomitant diseases of internal organs, including the cardiovascular system. If the disease is mild, only traces of protein are found in the urine, and severe pathologies can cause high proteinuria. Usually this symptom occurs with gestosis, which most often appears in the third trimester, less often - at 20-22 weeks of gestation.

Daily urinalysis during pregnancy.

It is prescribed when severe edema appears in a pregnant woman. The analysis allows you to assess the degree of violation of metabolic processes and identify many hidden pathologies of the kidneys.

It is necessary to collect urine strictly on time, while it is necessary to fill out a special form: a pregnant woman must record the number and time of urination. A special container with a screw cap is used to collect the biomaterial. After the procedure, it must be tightly closed and placed in the refrigerator (daily urine is stored exclusively at low temperatures). It is enough to bring 80-100 ml of urine to the laboratory - this is enough for the study. In this case, it is necessary to inform the laboratory assistant of the amount of the total volume of the collected material.

General analysis of urine during pregnancy.

This study awaits every woman carrying a child. With its help, possible pathologies that may occur at each stage of pregnancy are identified. Also, thanks to the study, the doctor can evaluate the work of the kidneys and urinary system.

What you need to know about taking a urine test during pregnancy?

It is important to collect biomaterial in the morning. It is preferable to collect for analysis the average portion of the first morning urine. If this fails for some reason, it is recommended to wait at least 4 hours since the last urination

You will need to adjust your diet. In order to avoid unreliable results of the study, on the eve of the test, it is recommended to exclude brightly colored foods, dietary supplements and medicines from the menu (after consulting a doctor)

Hygiene must be observed. Incorrect hygiene of the external genital organs can lead to a distortion of the results of the study

Psychological support after a miscarriage.

After a miscarriage, a woman often goes through psychological trials. It is especially difficult with habitual miscarriage. Often a sense of false guilt develops, which is not justified in the vast majority of cases, and it is necessary to get rid of it. Sometimes maintaining a pregnancy is simply impossible, and a woman should not blame herself for this. Sometimes, to improve the psychological state of a woman, you can resort to the help of a psychologist and group therapy. Usually in such a situation, the help and support of loved ones and relatives, especially the spouse, is very important.

Misconceptions about miscarriage.

It is often misunderstood that a miscarriage can be caused by exercise, constipation, stress, sex, eating spicy food, and so on. Usually, all these factors in the normal course of pregnancy cannot provoke a spontaneous abortion. On the contrary, doctors often recommend light physical activity, swimming and specialized yoga for the normal course of pregnancy. Nevertheless, it is important to coordinate with the doctor the level of physical activity and lifestyle during pregnancy.

Miscarriage prevention.

Unfortunately, miscarriage is not always preventable. Exceptions include cases when a doctor detects certain diseases in a woman that cause spontaneous abortion (for example, a malfunction of the thyroid gland or a bleeding disorder). If no specific causes of miscarriage are found, then the doctor usually limits himself to the standard recommendations for the prevention of miscarriage:

• In the presence of chronic diseases, ensuring their control before conception is required.

• Maintain body weight within a normal range.

• Taking prenatal vitamins. Studies show that some women have difficulty conceiving or carrying a pregnancy due to a lack of vitamin B12 and folic acid.

• Transformation and prevention of possible transmission of infections, such as STDs.

• Avoiding tobacco and alcohol use.

• Taking any medications only under the strict supervision of a doctor.

After a spontaneous abortion, before planning a pregnancy, the doctor may recommend the following examinations:

• blood test for hormones;

• chromosome analysis;

• examination of the uterus and cervix.

Depending on the woman's health, the specialist may recommend waiting a certain amount of time before trying to get pregnant again. During a new pregnancy, regular testing may be required to ensure that its normal course is monitored.

If the pregnancy is the first, then the priority for the prevention of miscarriage is to improve the general health of the expectant mother before conception. During pregnancy, it is required to exclude the use of alcohol and tobacco products, as well as to minimize the consumption of caffeinated products. Special vitamins for those planning pregnancy help improve the diet of the expectant mother, and light physical activity, agreed with the doctor, can contribute to the viability of the fetus.

Vacuum aspiration of a miscarriage.

This surgical procedure is used when the above treatment approaches have not worked. This procedure is performed to completely cleanse the uterus. This is achieved by opening the cervix and inserting a narrow suction tube, followed by aspiration of tissue associated with miscarriage. In general, the procedure takes about 10 minutes. Sometimes it can be performed without general anesthesia. Some women may develop an infection after these procedures. If the temperature rises, vaginal discharge acquires an unpleasant odor and abdominal pain appears, you should promptly consult a doctor.

Medical treatment for miscarriage.

Often, a woman is offered medical treatment for a miscarriage. This may be an oral remedy or a drug injected into the vagina. These drugs will contribute to the complete cleaning of the uterus and are similar in their action to a surgical operation.

Medical treatment usually does not require hospitalization. Bleeding may continue up to three weeks after drug treatment. However, residual bleeding should not be too intense. If the bleeding does not stop even after a few days, surgery may be suggested.

Many women prefer this form of treatment because it does not require hospitalization or surgery. 3 weeks after these procedures, a pregnancy test should be performed. If it is positive, then you should visit a doctor.

Conservative therapy after a miscarriage.

A number of women prefer to "let nature take its course." In most cases, the sloughing tissue comes out naturally and the bleeding stops after a few days. This may take up to 14 days. However, this approach is not used if spontaneous abortions have been observed before, a bleeding disorder is present, or infection is suspected. If the bleeding does not stop or increases, the woman may be offered an alternative form of treatment.

In the event that bleeding and pain subside, a pregnancy test should be performed after 3 weeks. If the test shows the presence of pregnancy, then it is necessary to visit a doctor for further assessment of the situation.

Visiting a doctor for miscarriage.

It is necessary to immediately notify the attending physician about any facts of bleeding. A diagnosis is required, as miscarriage is not the only cause of vaginal bleeding during pregnancy. With intense bleeding and severe pain in the lower abdomen, you should immediately seek emergency help. Operative ultrasound will help determine what exactly is causing the bleeding:

• threatened miscarriage (fetal heartbeat is noted inside the uterus);

• miscarriage (no fetal heartbeat);

• another cause of bleeding (eg ectopic pregnancy);

• there may be bleeding, for example, from cervical erosion, or from a cervical polyp (a polyp in the cervical canal).

If the ultrasound does not allow to establish how viable the fetus is, then a second examination may be required after 1 or 2 weeks.

Consequences of miscarriage.

If cervical dilatation has begun, the doctor may diagnose cervical incompetence and apply stitches (cerclage) to prevent late miscarriage. In the case when a miscarriage did occur, it is likely that it was complete, that is, not only the fetus was rejected, but also the placenta and the upper layer of the endometrium. Complete elimination of these tissues can take up to 2 weeks. If this does not happen, then emptying of the uterus is required so that the body can normalize the menstrual cycle. Therefore, in some cases of incomplete miscarriage, medications or surgery (curettage) may be prescribed to help the body cleanse the uterine cavity. Also, in the near future after a spontaneous abortion, additional precautions are required to avoid the development of infection.

In rare cases, it is possible to misdiagnose miscarriage. Sometimes bleeding is observed, the fetal heartbeat is not fixed, and the fetus itself can develop. It is important to understand that this is possible only in the early stages, and if the heartbeat during this pregnancy has not yet been seen before. However, when bleeding stops and pregnancy symptoms return, a second ultrasound may clarify the situation.

Diagnosis of miscarriage.

In case of development of symptoms characteristic of miscarriage, you should consult a specialist. The doctor will assess the symptoms of bleeding and, possibly, prescribe an analysis of the level of chorionic gonadotropin, check the condition of the cervix, send for an ultrasound scan and analyze the fetal heartbeat. The results of these tests will help the specialist determine if a miscarriage has occurred.

Causes of miscarriage in the early and late stages.

Miscarriage usually presents with vaginal bleeding and abdominal pain. Vaginal discharge may resemble blood clots. In many situations, bleeding will gradually stop. The time it may take to do this may vary from case to case. This usually takes a few days, but can take 2 weeks or more. In most women, bleeding is profuse, with the presence of clots resembling heavy periods. However, in some situations, heavy bleeding may occur.

On the other hand, a number of cases of miscarriage are not accompanied by the development of symptoms. The fetus stops developing and dies, but remains in the uterus. This is the so-called non-developing pregnancy. There may be no pain or bleeding. Also, toxicosis and soreness of the glands sometimes disappear. In some situations, this type of miscarriage is diagnosed only at the next scheduled ultrasound.

In some women, the symptoms of miscarriage are characterized by very little bleeding and no or little pain. Then the pregnancy begins to proceed normally. This is the so-called threatened miscarriage. In threatened miscarriage, rest and restriction of physical activity is usually recommended until pain is minimized and bleeding stops.

Usually, with spontaneous abortion, pain is localized in the lower abdomen and is spasmodic in nature. Acute and severe pain, localized on one side of the abdomen, often indicates an ectopic pregnancy. In this case, the bleeding is extremely small or the blood has an almost black color. If an ectopic pregnancy is suspected, an urgent referral to a specialist is necessary, since this condition is often life-threatening. Minor short-term bleeding is a variant of the norm. You should consult a doctor immediately with any amount of discharge, their number does not always reflect the true picture, and if the pads are not enough for an hour, call an ambulance.

Some early miscarriages are diagnosed only during a routine check-up of the condition of a pregnant woman. In this case, an ultrasound examination does not detect a fetus in the uterus. Sometimes the level of progesterone drops so much that nausea and soreness of the mammary glands disappear. It should be remembered that after about 12-13 weeks, these pregnancy symptoms often become less pronounced or disappear altogether, which is a variant of the norm.

Late miscarriage is the most difficult to tolerate, as it is accompanied by heavy bleeding, and sometimes rupture of the fetal bladder. Also, in a number of situations, intense cramping pains are noted, which require the use of painkillers prescribed by a doctor. However, miscarriage due to a weak cervix is sometimes painless.

Forecast and prevention of habitual miscarriage.

The prognosis depends on the cause of the pathology. Thus, habitual miscarriage associated with thrombophilia, endocrine disorders and anatomical defects in some cases can be successfully treated, and methods for correcting conditions associated with alloimmune factors are still under study. On average, subject to timely identification of the causes, adequate treatment both outside and during pregnancy, it is possible to achieve the birth of viable children in 70-95% of cases.

In most cases, the methods of treatment allowed during pregnancy are ineffective, so prevention should be given great importance. Preventive measures include a thorough examination of women who are at risk or already have episodes of miscarriage in history, as well as their spouses, correction of violations at the stage of preconception preparation, rational management of pregnancy.

Treatment of habitual miscarriage.

Treatment is carried out both in the process of gestation and outside it. Therapeutic measures during pregnancy are aimed at preventing premature expulsion of the fetus, maintaining its further development. Outside the gestation period, correction of pathological changes leading to miscarriage is carried out using methods that cannot be applied during pregnancy.

Symptomatic treatment of threatened and incipient miscarriage includes bed rest, sedative, antispasmodic and hemostatic drugs, in case of premature birth, tocolytic agents are additionally used. With ICI, the external cervical os is sutured or a pessary ring is installed. In the case of a missed pregnancy and incomplete abortion, curettage is performed; in the later stages, the expulsion of the fetus is carried out by excitation of the contractile activity of the uterus. Methods of etiotropic treatment depend on the cause of the pathology:

• Hormone therapy. In case of ovarian insufficiency, leading to a deficiency of the corresponding hormones, estrogen, progesterone, chorionic gonadotropin preparations are prescribed; in case of impaired adrenal function, APS, and other autoimmune processes - glucocorticoids; in case of hypothyroidism - thyroxine preparations.

• Antithrombotic treatment. Produced with established genetically determined thrombophilia, APS. Low molecular weight heparins, antiplatelet agents are used, with hyperhomocysteinemia - vitamins B6, B12, folates. Outside of pregnancy, long-term use of indirect anticoagulants is indicated.

• Antibacterial therapy. During pregnancy, it is prescribed to combat intrauterine infection in the detection of foci in the genitourinary tract, tonsillitis, chorioamnionitis, but at this stage it does not contribute to the adequate formation of the gravid endometrium and normal implantation. Treatment of endometritis to prevent pregnancy should be carried out before gestation.

• Surgery. Surgical intervention is recommended for anatomical defects, it is carried out outside of pregnancy. Metroplasty, removal of an additional uterine horn, conservative myomectomy, vaginoplasty are performed.

Diagnosis of habitual miscarriage.

Considering the multifactorial nature of recurrent miscarriage and insufficient knowledge of etiopathogenesis, it is possible to establish the root cause of this obstetric pathology only in 50-60% of patients. The study is conducted under the guidance of an obstetrician-gynecologist. If a pregnant woman applied with complaints of pain, spotting, the diagnosis of abortion is first clarified, after which the causes of the complication are clarified. Diagnostic search is carried out using the following methods:

• Physical examination. In the course of a gynecological examination, according to the state of cervical mucus and cervix, uterine tone, threatening, incipient preterm labor or miscarriage can be diagnosed. An analysis of the anamnestic data and the results of a general examination suggests the cause of the pathological condition.

• Ultrasonography. Ultrasound of the uterus makes it possible to diagnose a missed pregnancy, to detect congenital and acquired defects. Outside of gestation, an ultrasound of the ovary (folliculometry) is performed to detect violations of ovarian function.

• Laboratory blood tests. To detect endocrine pathology, studies of the general hormonal status, the level of sex and placental hormones are performed. For the diagnosis of APS and hereditary thrombophilia, a coagulogram, enzyme immunoassay, and PCR analysis are performed. By the method of DNA sequencing of spouses, typing of HLA class II genes, genetic abnormalities in parents are determined, their histocompatibility is assessed.

• Research on infections. During pregnancy, a vaginal smear is examined, outside of gestation - an endometrial biopsy. Cultural analysis allows to identify a nonspecific bacterial infection, to clarify the sensitivity of the pathogen to antibiotics. PCR research is used to diagnose viral and specific bacterial infections.

Additionally, MRI of the pelvic organs, hysteroscopy can be prescribed. Diagnosis is carried out with the involvement of an endocrinologist, immunologist and medical geneticist. Incipient pregnancy loss is differentiated with uterine tumors, ectopic pregnancy, trophoblastic disease, and placenta previa.

Complications after habitual miscarriage.

Preterm birth poses a threat to the life and health of the unborn child. Most early neonatal (70%) and childhood (65-75%) deaths occur in premature babies. Stillbirth in preterm birth is 9-13 times higher than in urgent. In surviving children, complications are registered ten times more often than in full-term ones: blindness, deafness, cerebral palsy, mental disorders and chronic pulmonary pathologies. For the mother, a particular danger is incomplete abortion, non-developing pregnancy, the complications of which are bleeding, infection of the uterus and membranes, DIC.

Symptoms of habitual miscarriage.

Signs of spontaneous interruption of the gestation process with habitual miscarriage do not differ from those with sporadic pregnancy losses. Threatened abortion or premature birth are manifested by minor pelvic pain, as their intensity increases as they progress, bleeding from the vagina joins. With a non-developing pregnancy, body weight gain stops, signs of toxicosis disappear, the mammary glands soften, and there is no motor activity of the fetus.

There are no significant differences in the clinical picture in miscarriage caused by one or another causative factor, but some features can be noted. So, with ovarian insufficiency, pregnancy loss usually occurs in the first trimester (at the sixth or eighth week), interruption is preceded by frequent urination, separation of mucus from the vagina. With adrenal hyperandrogenism, the loss occurs in the second or third trimester, manifested by bloody discharge of varying intensity without other signs of interruption.

With ICI, usually from the second trimester, scanty mucous discharge with bloody streaks, a feeling of pressure, fullness, and stabbing pains in the vaginal area can be noted. Miscarriage associated with APS and hyperhomocysteinemia is characterized by an early (from the twentieth week) onset of gestosis, accompanied by persistent edema, thirst, headaches, nausea, vomiting, and deterioration in general well-being.

Classification of recurrent miscarriage.

The outcome of miscarriage is usually the expulsion of the fetus (viable or not), less often the dead fetus remains in the uterus. A non-developing pregnancy in such cases is classified as a failed miscarriage or failed birth. In modern obstetrics, the following division of pregnancy loss according to the timing of the episode (according to the WHO classification) is accepted:

• Spontaneous abortion (miscarriage). Interruption of the gestation process up to 21 completed weeks. In Russia, early (up to 12 full weeks) miscarriage and late - from the thirteenth week are distinguished.

• Premature birth. Interruption from the 22nd to the full 37th week (with a fetal weight of 500 grams), including very early (at 22-27 weeks) and early (at 28-33 weeks) preterm birth. In Russia, pregnancy loss before the full 27th week does not apply to preterm birth, and perinatal mortality is counted from the 28th week.

Pathogenesis of recurrent miscarriage.

Habitual losses associated with the chromosomal factor are due to the abnormal initiation of the embryo and its initial non-viability. Other factors create an unfavorable background for implantation, the formation and normal functioning of the placenta, and the further development of the embryo. As a result of alloimmune disorders, the mother's immune system attacks the "foreign" antigens of the embryo received from the father, the mother's body rejects the fetal egg. Autoimmune reactions lead to damage to maternal tissues, which has an indirect adverse effect on the embryo.

A deficiency or imbalance of sex hormones provokes an inferior gravid transformation of the endometrium, a lack of progesterone leads to impaired immune restructuring. Latent infections potentiate an increase in the activity of local immunity. As a result of thrombophilia (including APS), the balance between the processes of fibrin formation and fibrinolysis during implantation is disturbed, thrombosis of the vascular bed occurs and uteroplacental blood flow is disturbed. All these changes become the causes of inferior trophoblast invasion, impaired placentogenesis and fetoplacental insufficiency.

Causes of habitual miscarriage.

Recurrent miscarriage is most often associated with long-term adverse endogenous effects. The etiological factors of this obstetric pathology are in many respects similar to those in infertility or sporadic interruption of gestation and differ only in lesser severity compared to infertility and a permanent nature, in contrast to the transient effect with spontaneous losses. The main causes of habitual miscarriage include:

• Autoimmune diseases. The proportion of immunological factors in the etiology of pregnancy loss is up to 80%. The most significant autoimmune disorders include antiphospholipid syndrome (APS), sensitization to human chorionic gonadotropin, thyroid hormones, and nuclear antigens. The risk group includes mothers suffering from autoimmune diseases, viral infections (hepatitis C, HIV).

• Alloimmune disorders. Among the alloimmune causes of miscarriage are high histocompatibility of spouses, the predominance of pro-inflammatory cytokines in the blood of the mother and endometrium, and a deficiency of the progesterone-induced blocking factor. The risk group includes women who are married to a blood relative, who have endocrine pathologies with progesterone deficiency.

• Congenital thrombophilia. In a third of pregnant women, recurrent miscarriage is provoked by mutations in factor V Leiden and the prothrombin gene, deficiency of antithrombin III, proteins C and S, and hyperhomocysteinemia. Risk factors: early (up to forty years) thromboembolism, recurrent thrombosis in a woman and her close relatives, thrombotic complications associated with gestation, childbirth and the use of hormonal contraceptives.

• Endocrine disorders. In 8-20% of patients, the cause of losses is luteal phase deficiency, increased secretion of luteinizing hormone, hyperandrogenism, hypothyroidism and decompensated diabetes mellitus. The risk group consists of women with obesity, signs of virilization, late menarche, sharp fluctuations in body weight, oligo- and amenorrhea, menstrual irregularities.

• Endometrial infections. In 87% of patients with miscarriage, persistence in the endometrium of several types of obligate anaerobic flora and viral agents (herpes simplex, cytomegalovirus, Coxsackie, enteroviruses) is noted. The likelihood of endometritis is increased in patients with chronic lower genital tract infection, bacterial vaginosis, induced abortions, and previous uterine surgery.

• Anatomical defects of the uterus. Congenital (duplication of the uterus, saddle-shaped, unicornuate uterus, intrauterine septum) and acquired (submucosal myomatous nodes, intrauterine adhesions) anatomical disorders are the cause of abortion in 10-16% of women. Risk factors for acquired pathologies: endometritis, artificial abortions, surgical interventions on the uterus.

• Pathology of the cervix. Isthmic-cervical insufficiency (ICI) can be anatomical or functional in nature and is involved in recurrent interruptions of gestation in 13-20% of cases. It often develops with hyperandrogenism of any genesis, cervicitis, after a difficult birth (accompanied by ruptures, the use of obstetric forceps), conization of the cervix, hyperovulation induction.

• Genetic abnormalities of the fetus. Usually these are chromosomal aberrations that lead to habitual miscarriage in 3-6% of cases. Among them, monosomy X0 (Shereshevsky-Turner syndrome), various trisomies, polyploidy. Risk factors: closely related marriage, hereditary diseases in the families of the patient and her spouse, the presence of children with congenital defects in a married couple, mental retardation.

General information about miscarriage.

According to the definition of the World Health Organization, recurrent miscarriage is a consecutive three-fold spontaneous interruption of gestation (including the cessation of development). However, according to many clinicians, the presence of two episodes of pregnancy loss should be considered as the criteria for recurrent miscarriage. The prevalence of pathology is 2-5%, a significant part of the habitual losses are recorded before the viability of the fetus (22 weeks). The probability of subsequent spontaneous interruption increases significantly with an increase in the number of previous episodes: if after the first loss the risk of the next one is 15%, then after two failures in a row this figure more than doubles - up to 36-38%.

What is recurrent miscarriage?

Recurrent miscarriage is a polyetiological reproductive pathology characterized by repeated consecutive episodes of spontaneous interruption of gestation up to the 38th (full 37) weeks. The main signs of a miscarriage include pelvic pain and spotting from the genital tract. Diagnosis includes history taking, physical examination, ultrasonography, coagulogram, bacteriological and PCR analysis for infections, spouse karyotyping, HLA II typing. Treatment is usually conservative; surgery may be required for anatomical abnormalities.

Forecast. Prevention of miscarriage.

Women with preterm labor, spontaneous miscarriages, missed pregnancies, as well as with threatened miscarriage and spotting during this pregnancy should be allocated to a high risk group for miscarriage for the timely administration of vaginal progesterone. Progesterone is prescribed from early pregnancy or from the moment of the threat of termination of pregnancy. The use of progesterone is also indicated to support the luteal phase after IVF. The route of administration of progesterone does not matter.

You can judge the favorable development of pregnancy by the indicators of hCG and progesterone. Until 6-7 weeks of pregnancy, the level of hCG should increase by 2 times every 1.5-2 days. If the hCG level is low or it goes down, then the pregnancy is not progressing.

With an ultrasound examination with a vaginal probe, the fetal egg should normally be visualized at a period of 4 weeks. The diameter of the ovum in this case is 3-5 mm, which corresponds to the hCG levels of 1500-2000 IU / l. In case of discrepancy with these criteria, the prognosis for the development of pregnancy is doubtful.

The level of progesterone can indirectly also be a predictor of pregnancy outcome:

• > 60 nmol/l - indicates the normal course of pregnancy;

• < 25 nmol / l - portends an unfavorable outcome of pregnancy.

Prevention of miscarriage includes:

• prevention of inflammatory diseases of the small pelvis, rehabilitation of foci of chronic inflammation;

• normalization of the biocenosis of the vagina;

• rejection of bad habits;

• healthy lifestyle;

• control of body weight;

• examination and treatment of general somatic pathology, correction of hormonal disorders;

• prevention of abortion;

• pregnancy planning;

• screening for sexually transmitted diseases and their timely treatment;

• diagnosis and treatment of TORCH infections, if any;

• avoidance of a large number of sexual partners.

Non-specific preconception preparation of the patient (preparation before pregnancy):

• psychological assistance to a patient who had an abortion;

• anti-stress therapy;

• normalization of the regime of work and rest, diet (it is recommended that 3 months before the intended conception, a woman should be given folic acid intake of 400 mcg per day);

• rejection of bad habits;

• medical genetic counseling for women with recurrent miscarriage.

If the cause of recurrent miscarriage is anatomical, surgical treatment is indicated: elimination of the intrauterine septum, synechia, myomatous nodes, endometrial polyps. After the elimination of the anatomical causes of miscarriage, the patient is prescribed a combined estrogen-gestagen preparation for a period of at least three months.

After the third miscarriage (recurrent miscarriage), with the exclusion of genetic and anatomical causes of miscarriage, a woman should be examined for possible coagulopathy (family history, determination of lupus anticoagulant and anticardiolipin antibodies, D-dimer, antithrombin 3, homocysteine, folic acid, antisperm antibodies).

Carrying out pathogenetically substantiated preconception preparation contributes to a significant reduction in gestational complications by 6-8 times, the overall frequency of adverse pregnancy outcomes by 4 times, spontaneous miscarriages by 4.5 times.

Treatment of miscarriage.

Termination threat therapy.

Pathogenetic therapy for miscarriage of endocrine genesis includes taking progesterone preparations for at least 12 weeks.

If hypothyroidism (insufficient functioning of the thyroid gland) was identified among the causes of miscarriage, then treatment is carried out in conjunction with an endocrinologist. In this case, it is necessary to take thyroid hormones throughout the pregnancy, such as L-Thyroxine, Euthyrox.

If the cause of miscarriage was an infection, then antibiotic therapy is carried out, taking into account the isolated flora.

In case of problems in the hemostasis system, anticoagulants are prescribed that inhibit the activity of the blood coagulation system (Fraxiparin, Kleksan) from the moment of conception to childbirth. Antiplatelet agents that prevent thrombosis ("Kurantil"), B vitamins, metafolin (the active form of folic acid).

With an immunological factor, some medical institutions use lymphocytotherapy (LIT) - the introduction of a partner's lymphocytes to a woman.

In a hospital, antispasmodics (No-shpa, drotaverine, papaverine), calcium channel blockers, magnesium solution intravenously are used to treat the threat of miscarriage.

With ICI, when the cervix is shortened by less than 25 mm and / or the cervical canal is opened by 10 mm, a suture is applied to the cervix up to 23 weeks, or an obstetric pessary is used for a period of more than 23 weeks. In parallel, bacteriological vaginal discharge is monitored, progesterone support is required.

If it is no longer possible to maintain a pregnancy in a medical institution, a therapeutic and diagnostic curettage of the uterine cavity and removal of the remnants of the fetal egg or placenta are performed.

In the future, the prophylactic use of antibiotics is mandatory. All Rh-negative women who do not have anti-Rh antibodies are given anti-D immunoglobulin.

To prevent miscarriage in case of a threat, it is necessary to take vitamins and trace elements. They improve the quality of oocytes (sex cells) involved in fertilization, contribute to the proper laying of organs in the embryo, in particular the formation of the neural tube, contribute to the harmonious development of the fetus and placenta, and are components for the synthesis of hormones that maintain pregnancy.

• Folate 3 months before pregnancy + the first 12 weeks - 400-800 mcg / day.

• Iodine preparations - 250 mcg / day 3 months before pregnancy + during the entire gestation period.

Desirable:

• Vitamin D: 3 months before pregnancy 600-800 IU/day and 800-1200 IU/day during pregnancy.

• PUFA - 200-300 mg / day (Omega-3 preparations).

An integrated approach in the management of severe patients is very important, since most of them require the participation of related specialists.

Diagnosis of miscarriage.

Examination stages:

1. Anamnesis - collection of information. Risk groups for preterm birth include:

• women with a history of preterm labor in the absence of symptoms;

• women who have a shortening of the cervix less than 25 mm are detected during transvaginal examination;

• women who have a history of premature birth, who have lost 2 or more pregnancies;

• pregnant women who had a threat of miscarriage, spotting and retrochorial hematoma in the early stages.

2. An objective examination - an examination is performed, weight, height are measured.

3. Gynecological examination, flora smear, cytology smear, colposcopy.

4. Ultrasound of the pelvic organs. During pregnancy, the threat of loss is evidenced by: shortening of the cervix to 25 mm or less according to transvaginal cervicometry in the period of 17-24 weeks. The length of the cervix is clearly correlated with the risk of preterm birth, this is one of the prognostic signs of preterm birth. Transvaginal ultrasound measurement of the length of the cervix is a necessary standard in risk groups for miscarriage.

5. Examination for infections (sexually transmitted diseases, TORCH infections, HIV, hepatitis B and C, syphilis).

6. Hormonal screening:

• on the 2nd-5th day of the menstrual cycle with a regular cycle or in the absence of menstruation any day in the morning on an empty stomach;

• Prolactin, FSH (follicle-stimulating hormone), LH (luteinizing hormone), TSH (thyroid-stimulating hormone), estradiol, free testosterone, DGA-sulfate, cortisol are determined.

7. Ultrasound of the mammary glands.

8. Ultrasound of the thyroid gland and adrenal glands.

According to indications: hysterosalpingography, hysteroscopy, laparoscopy, CT or MRI of the skull and sella turcica, spiral CT of the pelvis / MRI.

Examination of a man:

1. Consultation with an andrologist - a male doctor who specializes in diseases of the male genitourinary system. Often, miscarriage is associated with a male factor in the form of chronic inflammatory diseases of the genitourinary system of a man, the carriage of STDs, and abnormalities in the spermogram.

2. Spermogram + MAR test. The MAR test is a study aimed at detecting antisperm antibodies of the IgG and IgA classes for diagnosing the immunological causes of infertility in men. The MAR test shows the ratio (percentage) of normal, actively motile spermatozoa coated with antisperm antibodies to the total number of spermatozoa with the same characteristics. It also allows you to estimate the percentage of spermatozoa excluded from fertilization. A positive MAR test is a conditional criterion for immunological infertility in men (more than 50%). It is important to remember the rules for taking a spermogram: do not drink alcoholic beverages for 3-5 days, refrain from sexual intercourse, do not visit saunas and baths.

3. Infectious screening.

Complications of miscarriage.

Miscarriage is a rather severe multifactorial pathology. Therefore, it is not easy to predict the outcome of subsequent pregnancies. First of all, among the complications, one can note a pronounced depressive syndrome in a woman who has lost her desired pregnancy. Particularly severe psycho-emotional state in patients suffering from habitual miscarriage.

If an out-of-hospital spontaneous miscarriage occurs, and no follow-up and treatment is carried out, the woman may develop pelvic inflammatory disease, since the remnants of the ovum are an excellent breeding ground for microorganisms.

The formation of isthmic-cervical insufficiency (ICI) can also be considered a complication of an interrupted pregnancy. This is an anatomical or functional defect in the circular muscles of the cervix, which subsequently leads to the opening of the cervix, prolapse of the ovum (protrusion into the cervix) and habitual loss of pregnancy.

In the case of a frozen pregnancy, when the fetus dies and stays inside the uterus for a long time (over 4-6 weeks), especially in the 2nd trimester, bleeding may occur due to the development of DIC (disseminated intravascular coagulation) - a condition characterized by disorders in the blood coagulation system. In this case, depending on the stage of DIC, the formation of multiple blood clots in the vessels of various organs occurs, or bleeding occurs.

A pregnant woman with a history of miscarriage belongs to the high risk group for preterm birth.

A threat to a woman's life in case of miscarriage exists only in case of massive bleeding and hemorrhagic shock (a critical condition caused by acute rapid single blood loss) or in case of infectious complications. When the remains of the fetal egg are infected, inflammatory diseases of the pelvic organs may develop, such as endometritis (inflammation of the uterus), parametritis (inflammation of the periuterine tissue), peritonitis (inflammation of the peritoneum), complicated by blood poisoning (sepsis) and infectious toxic shock.

Classification and stages of development of miscarriage.

Classification according to ICD-10 (International Classification of Diseases 10th revision):

• O03 - Spontaneous abortion - spontaneous pathological termination of pregnancy.

• O02.1 - Miscarriage - a condition in which intrauterine fetal death occurs without expulsion of the fetal egg from the uterus.

• O20.0 - Threatened abortion is a threatened abortion, manifested by increased uterine tone and/or bloody discharge from the uterus before 22 weeks of gestation.

• N 96 - Habitual miscarriage - loss of pregnancy three times or more.

• O60 - Premature birth - delivery that occurred at a period of 22 to 37 completed weeks and with a fetal weight of more than 500 g.

The stages of the disease are:

• Threatening abortion - there are sensations of heaviness or slight pulling pains in the lower abdomen and in the sacrum. Bleeding is usually absent. The uterus is enlarged according to the delay in menstruation, there are no changes in the vaginal part of the cervix.

• Spontaneous miscarriage that has begun - the severity of the pain symptom increases, bloody discharge from the genital tract appears. The size of the uterus corresponds to the gestational age. The cervix is preserved, its canal is closed or slightly open.

• Abortion in progress - the appearance of cramping pain, increased bloody discharge. The cervix is shortened, the cervical canal is open. An abortion in progress may result in an incomplete abortion, when the fetal egg is partially expelled from the cavity. And in the uterus, the fetal membranes, chorionic tissue, placenta are retained.

• Failed spontaneous miscarriage (missed pregnancy) - after the death of the fetal egg, there is no contractile activity of the uterus, the dead fetal egg is not expelled from the uterus, but undergoes secondary changes (autolysis, mummification, resorption of amniotic fluid).

• With isthmic-cervical insufficiency (inability of the muscles of the cervix to hold the fetus and its membranes), abortion most often begins with premature rupture of amniotic fluid (due to infection and violation of the integrity of the membranes). A miscarriage occurs fairly quickly and painlessly.

• Premature birth - begins with an increase in the tone of the myometrium, dull pain in the lower abdomen, which then develop into cramping. The smoothing of the cervix and the opening of the uterine os progresses.

The disease does not always go through all stages. It can stop at one of them with timely treatment or when the factor that provoked the threat is not so strong.