Why is there an acute stomach during pregnancy? Who will be a boy or a girl if there is an acute form of the abdomen during pregnancy?

The term " acute stomach" brings together a large group of organ diseases abdominal cavity, acute and life-threatening, from which most patients can be cured only with emergency surgery. The frequency of certain diseases of the mentioned group in pregnant women is similar or slightly higher than that outside pregnancy. “Acute abdomen” is not uncommon in obstetric practice. Operations for it are performed in approximately 0.2% of pregnant women.

Most common organ damage gastrointestinal tract: appendix (accounts for up to 90% of the causes of “acute abdomen” during pregnancy), gallbladder and pancreas, stomach, intestines. The clinical picture of an “acute abdomen” can be caused by gynecological diseases (torsion of the legs of changed and unchanged appendages, malnutrition of fibroids, internal bleeding, etc.), various complications of pregnancy, childbirth and the postpartum period (premature abruption of a normally located placenta, threatened and completed uterine rupture , septic complications), as well as diseases of organs located outside the abdominal cavity (kidneys, lungs, heart).

The variety of causes of “acute abdomen” makes its diagnosis difficult. During late pregnancy and childbirth, diagnostic difficulties increase, which inevitably affects the timeliness of the operation and plays a decisive role in worsening the prognosis for the mother and fetus.

Mortality in various diseases of the “acute abdomen” group is significantly higher than in non-pregnant women, although there is almost no statistically reliable modern information about this. Comparing the data of foreign authors, we can come to the conclusion that in acute appendicitis it is 2.5-3 times, and in certain types of intestinal obstruction it is 2-4 times higher than that in non-pregnant women.

In addition to the increased danger for the mother, acute diseases of the abdominal cavity adversely affect the course of pregnancy, causing premature termination, death of fetuses, and death of newborns. Similar complications, according to various authors, are observed in 5-7% of women with acute appendicitis, in 50-70% with certain forms of intestinal obstruction, and with peritonitis, the death of children reaches 90%. The cause of these losses is not only infection of the fetus, placenta, uterus, but also intoxication (including drugs), hyperthermia, and disruption of homeostasis in the mother.

The prognosis for the mother and fetus in any acute diseases of the abdominal organs worsens significantly with increasing pregnancy and childbirth, which is associated with increasing diagnostic difficulties and, consequently, with a delay in surgery.

The symptoms of any disease during pregnancy are the same as outside of it. The manifestation of symptoms, usually typical in the early stages of pregnancy, can become quite blurred in late dates and during childbirth. This is explained not only by a significant change in the topography of the abdominal organs, stretching of the abdominal wall, and the inaccessibility for palpation of individual organs pushed aside by the uterus. The main reason for the blurred clinical picture lies in changes in the reactivity of a woman’s body during pregnancy. It is known that reflex activity largely depends on hormonal levels, which in pregnant women are very different from non-pregnant women. In addition, this background is not constant and varies in different terms pregnancy, which cannot but affect the formation of clinical manifestations of diseases. Therefore, it is natural that different pathological processes, developing against a similar background, often acquire common features. One of them is the erasure of clinical manifestations of diseases in late pregnancy and childbirth. The difficulties of differential diagnosis are similar various forms groups of “acute abdomen” with the same diseases: food intoxication, pyelonephritis, colic, as well as in different forms obstetric pathology (started contractions, preeclampsia, abruption of a normally located placenta, or even uterine rupture).

A particular difficulty for diagnosis is the fact that during pregnancy, pyelonephritis or the mentioned obstetric pathology may actually occur, provoked by surgical diseases or accompanying them.

The world literature contains many reports of how patients with surgical diseases (appendicitis, cholecystitis, pancreatitis, intestinal obstruction, etc.) were operated on for obstetric indications, most often due to suspected abruption of a normally located placenta. The reason for such an error was the unusual tension of the uterus (hypertonicity) in combination with its soreness and deterioration in the general condition of the patient, which sometimes appear in the late stage of development of any abdominal catastrophe.

The leading diagnosis of an “acute abdomen” in pregnant women is the sudden appearance of pain, accompanied by nausea and vomiting (the latter usually does not occur during pregnancy over 16 weeks), pain in the entire abdomen or its parts, protective muscle tension, local or general bloating, increased intestinal motility , dullness of percussion sound in sloping areas, symptoms of peritoneal irritation, etc. Additional research methods are of great importance, although some of them (for example, X-ray, laparoscopy) have limited use during pregnancy.

When the process is neglected, in almost all forms of “acute abdomen,” the individual features of the disease are erased, and manifestations of peritonitis and intoxication become predominant. As a rule, they are accompanied by already expressed signs of a threat or the beginning of termination of pregnancy. In such cases, the need for surgery becomes obvious, but it is already belated and associated with significant technical difficulties, which often predetermines an unfavorable outcome.

Any disease of the “acute abdomen” group should be considered as a direct threat to the life of the mother and fetus and all measures should be taken to eliminate it.

Preoperative preparation, necessary for many diseases, should be especially complete and thorough in pregnant women. Corrective infusion therapy should be carried out long-term, rationally, and include blood transfusions and blood substitutes, the introduction of proteins, electrolytes, and vitamins.

Endotracheal anesthesia, as it provides optimal conditions for the mother and fetus with regard to oxygenation, as well as minimal invasiveness of the operation, is preferably used in the early stages of pregnancy. In its second half, its use should become mandatory. The operation must be performed with a second assistant, as carefully as possible, through a sufficient incision.

The course of surgery in pregnant women can be complicated due to altered topography of organs, fragility and increased bleeding of tissues. The intervention itself on the abdominal organs is performed in a typical manner; the indications for drainage or tamponade are similar. Attitude towards pregnancy is one of the most controversial issues in the case of an “acute abdomen”.

The need for preliminary emptying of the uterus is most often justified by fair fears for the fate of the child, the impossibility of performing the main operation, fear of generalization of peritonitis in the postoperative period due to the onset of labor, as well as uncertainty about the outcome of the disease for the mother, which may be adversely affected by progressive pregnancy (cases of pancreatitis , paralytic ileus).

Many authors consider termination of pregnancy not indicated, even if the operation is performed during childbirth. The onset of childbirth after surgery is considered a lesser evil than production caesarean section with an infected abdominal cavity. Fears of the development of metroendometritis and peritonitis, even with the use of timely and massive treatment with broad-spectrum antibiotics, are sufficient grounds for removal of the uterus in those rare cases when a cesarean section is forced to resort to conditions of generalized peritonitis.

In case of any acute diseases of the abdominal organs, it should be remembered that when dire situations arise, concern for the safety of the woman should prevail over all other considerations, including fears for the fate of the fetus.

In the following presentation, the issues raised are discussed in more detail in relation to individual diseases of the “acute abdomen” group.

• Obstetric peritonitis after childbirth
  Inflammation of the peritoneum - peritonitis, is the most dangerous complication acute diseases of the abdominal organs. By definition, obstetric peritonitis is the body’s reaction to a conflict...
• Peritonitis after cesarean section
  Peritonitis after cesarean section in its clinical course can manifest itself in several ways, depending on the route of infection. Option 1: a cesarean section was performed against the background of an existing infection, most often
• Torsion of the pedicle of an ovarian tumor during pregnancy
  Ovarian tumors are common during pregnancy - in 1.2-1.3% of cases. Their histological structure is varied: descriptions of almost all tumors, including malignant ones, are found.
• 
  Women with metabolic disorders are more likely to suffer from acute cholecystitis; during pregnancy, developing hypercholesterolemia becomes of particular importance. Significant role in the development of cholecystitis and...
• Acute pancreatitis and pregnancy
  Among acute diseases of the abdominal organs, pancreatitis ranks 3rd [Savelyev V.S. et al., 1983]. According to summary world statistics given by I. P. Ivanov et al. (1980), pancreatic frequency...
• Acute intestinal obstruction during pregnancy
  Acute intestinal obstruction (AIO) is one of the most serious and common diseases of the abdominal organs. Patients with this pathology occupy 1.2-3.5% of surgical hospital beds
• Perforation of gastric and duodenal ulcers and pregnancy
  Perforation of gastroduodenal ulcers during pregnancy is extremely rare. This is explained not only by the rarity of the combination of peptic ulcer with pregnancy (from 1:25,000 to 1:75,000), but also
• Prevention of some complications in “acute abdomen”
  Prevention of complications of acute diseases of the abdominal organs during pregnancy should begin long before its onset. Active identification and planned treatment of women with reproductive disorders

Signs and folk signs pregnancy with a boy.

Many women, even before they find out the gender of the child on an ultrasound, try to predict whether a son or daughter will be born. People have come up with a lot of signs and superstitions regarding the gender of the unborn child. Below, we will try to figure this out.

There are a lot of features that indicate that you will be born a hero. This is both the shape of the tummy and the cleanliness of the skin.

Signs of pregnancy with son:

• Round belly
• Increased hairiness of the skin
• Dark stripe on belly
• Clean skin
• Thick and beautiful hair

It is worth noting that bearing a hero is much easier. The woman is almost not bothered by toxicosis and feels well. The gait, despite pregnancy, is graceful and light. There is practically no swelling. Varicose veins are rarely a concern.

There are many parameters that indicate pregnancy with a male baby:

• Sharp belly, which is dropped quite low
• Pigmentation on the abdomen and appearance age spots on hands
• Pointed nose tip
• Darkening of hair on legs
• There may be dark fuzz under the nose
• Beautiful hair

Many people note that a woman pregnant with her son seems to blossom. Facial features become soft, skin cleanses. It is pleasant to the touch and velvety.

While expecting a son, most women note some changes in behavior. In general, the woman becomes calmer and more balanced. She rarely gets nervous or worried. Performance increases significantly. Employers note that a woman works for two and is completely focused on tasks.

How does a pregnant woman feel about having a boy?

It is worth noting that many women are able to determine the gender of their unborn child based on their feelings. When pregnant with a male representative, the pregnant woman is often hot all the time. At the same time, the lower extremities are cold all the time. The skin on your palms may dry out.

The woman’s appetite is very good, this is due to the absence of toxicosis. In this case, preference is given to salty foods and meat. The woman practically does not want sweets. Constantly wants kefir and cottage cheese.

Pregnant belly shape with a boy

Many people can predict pregnancy by the shape of their tummy. Usually the belly is pronounced, convex and slightly sharp. If you look at a woman from behind, it is difficult to say that she is in position, since the waist line is distinct. The sides are not covered in fat. The tummy is located quite low.

At the first ultrasound, that is, at 12 weeks, it is quite difficult to determine the sex of the child. This is due to the fact that sexual characteristics are poorly visible. Although already from the 8th week, secondary sexual characteristics begin to form in boys. By the 12th week, with a good ultrasound machine, you can see a tubercle in the genital area. Only by the 20th week will the child’s reproductive system be fully formed and the gender can be accurately determined.

First ultrasound: signs of the birth of boys

There are many signs that indicate pregnancy with a hero or princess.

List:

• There are many warriors in the world, a hero will be born
• The country is experiencing economic growth, a baby is born
• If you want salty food and meat, then a protector will be born
• Constantly want sweets - wait for a girl
• The face is covered with acne, a princess is born
• The waist and sides are swimming with fat - a baby will be born
• Insomnia and toxicosis - a beauty will be born
• Blows at the top of the abdomen - for a girl, if below - for a boy

Differences between pregnancy with a boy and a girl

Doctors note that pregnancy is better tolerated by a hero. During pregnancy with the princess, the woman becomes irritable and nervous, and suffers from toxicosis. It is worth noting that on latest dates Pregnant with her son, the woman’s legs become very swollen and hurt.

Signs:

• IN interesting position future mommy wants sex all the time, then there will be a princess.
• You can find out who is going to be born by looking at their tummy. Directed to the right is a sign of a son, and to the left is a sign of a daughter.
• If you look closely at the shade around the nipples of pregnant women, then when carrying a princess they should become lighter than before fertilization, and when carrying a male child they should become darker.
• Boys knock in the lower part of the tummy, and princesses push from above, in the solar plexus area.

Toxicosis during pregnancy, boy or girl

Doctors note that toxicosis affects women who are expecting a daughter. Women expecting a boy usually feel good.

You will find out 100% results during an ultrasound at 20-22 weeks of pregnancy. As practice shows, folk signs can be wrong and have a 50% chance.

The easiest way is to observe changes in your diet and behavior. There are many ways to determine the gender of a baby. All of them are based on physiological changes in the mother.

Ways to determine gender:

• Look at your stomach. If it is vague - to the princess, if it is sharp and sticks out - to the boy
• Food. Those who are expecting a daughter want fruits and sweets, and those who are expecting a son want meat and spicy food
• Cold feet - for a boy, swelling at the end of pregnancy - for a son
• Dark stripe on the stomach - for a boy
• Soft and soft skin- to the girl

Many people can determine gender by the shape and location of the abdomen.

Signs:

• Boy. The tummy during pregnancy is sharp and downward. The waist is visible from behind and it is not clear that the woman is in position
• Girl. The tummy is vague. Fat appears in the sides and lower back. The stomach is located high

Signs of a boy or girl during pregnancy

Signs in an interesting position can be seen in the video.

VIDEO: Signs for determining the sex of a child

In fact, it is very rare that all the signs of a boy or girl are present at once. Mixed eating and behavioral preferences are common. Pregnant women are prone to mood swings, so a woman can be either nervous or calm. You can tell by the chest. If the areola is dark, it will be a boy, if it is light, it will be a girl.

What is the difference between being pregnant with a boy and being pregnant with a girl?

You can find out more about this in the video.

VIDEO: Differences during pregnancy with a son and daughter

Below is a table by which you can determine whether you will have a son or daughter. Data calculated using fertilization period.

Acute stomach during pregnancy, boy or girl

If a woman has a sharp belly, she will have a boy. It resembles a soccer ball hidden under a dress. Very neat and sticks out forward.

This table is based on the age of the future parents.

Signs of a boy during early pregnancy

On early stages, when an ultrasound cannot yet determine the sex of the baby, you can do this yourself. Most often, the condition of the pregnant woman and her eating habits are monitored. If a woman feels sick and vomits, she will be a princess. In a pregnant woman good mood and there is no nausea - a protector will be born.

By the heartbeat you can determine the gender of the baby. If the baby's number of beats is more than 140, wait for the princess. If there are less than 140 blows, a hero will be born. Doctors note that the girl’s heart beats much faster and less orderly. There are often malfunctions of the heart muscle. The boy's heartbeat is more rhythmic.

Differences between pregnancy with a girl and a boy

The differences when pregnant with a boy or a girl can be seen in the video.

VIDEO: Differences

First signs of pregnancy with a boy

The gender of the fetus can also be determined by what the woman eats. If you want salty, spicy and meat, then a boy will be born.

Signs of a girl:

• Bad mood and bloated stomach
• Acne on the face
• Nausea

Signs of a boy:

• Acute stomach
• Good mood
• Clean face

Diagnosing an acute abdomen in a pregnant woman is complicated by her position, since the syndrome can be mistaken for physiological feature gestational period.

The causes of acute abdomen in expectant mothers are very diverse. Below, in order of frequency of diagnosis in pregnant women, we name the main diseases that are accompanied by this syndrome.

• Acute appendicitis. Most often it develops in the second trimester of pregnancy. A feature of appendicitis during gestation is the difficulty of diagnosing it due to changes in the localization of pain and the impossibility of carrying out informative diagnostic methods.
• Acute intestinal obstruction. In expectant mothers, it most often occurs in a mechanical form. The disease is especially dangerous in the 12-16th week of pregnancy and 2-3 weeks before birth.
• Acute cholecystitis and choledocholithiasis. Diseases of the urinary system are widespread among pregnant women, most often they have physiological causes.
• Acute pancreatitis occupies a leading position in the list of causes of perinatal mortality.
• Peptic ulcer of the stomach and duodenum. In the early stages of pregnancy, the protective function of the gastrointestinal tract increases due to high level estrogens. However, in the last trimester and postpartum period exacerbations of the disease and manifestation of acute abdomen syndrome are possible.
• Spontaneous rupture of the spleen or liver is very rare, only with pathological gestosis and injuries incompatible with the integrity of the internal organs.
• Torsion of the pedicle of an ovarian tumor is diagnosed late. Removal is possible in the 2nd trimester or immediately after delivery.
• Malnutrition of the uterine fibroid node is often physiological deviation, which involutions after childbirth and with the onset of menstruation.

Symptoms

Diagnosis of acute abdomen

Diagnosis of some diseases of expectant mothers is complicated by the impossibility of conducting a number of informative studies at a specific period of study. The diagnosis is complicated by the confusion of the syndrome with the symptoms of pregnancy itself (including abdominal pain), and differences in the clinical picture between pregnant women and ordinary adults. The main manifestations of an acute abdomen in expectant mothers are: painful sensations in the abdominal area and symptoms of intoxication of the body. Each disease has additional symptoms:

• Acute appendicitis - displacement of the pain location to the upper abdomen, the presence of vomiting and nausea, increased body temperature.
• Acute intestinal obstruction - retention of gases and feces, abdominal pain different types, duration and intensity.
• Acute cholecystitis and choledocholithiasis - subferal body temperature, loss of appetite, weight loss.
• Acute pancreatitis - bloating, nausea, frequent vomiting, painful sensations of a different nature.
• Peptic ulcer of the stomach and duodenum - vomiting, possibly mixed with blood.
• Spontaneous rupture of the spleen or liver - sharp pain, development of peritonitis and shock.
• Torsion of the pedicle of an ovarian tumor - gradually increasing pain, often in the right side.
• Malnutrition of the uterine fibroid node - local spasmodic abdominal pain.

Complications

An acute abdomen and its underlying cause can significantly complicate the condition of the mother and her baby. The main consequences that pain syndrome can lead to if left without timely diagnosis and treatment:

• miscarriage,
• intrauterine fetal death,
• artificial termination of pregnancy in order to preserve a woman’s life,
• death of a newborn within a short time after birth,
• infection of the genital organs and parts of the uterus,
• placental infection of the child,
• developmental delay of the child,
• obstetric difficulties during childbirth,
• death of a pregnant woman.

Treatment

What can you do

The expectant mother should not attribute all painful sensations to the course of pregnancy. In case of severe or recurring pain with manifestations of other signs of an acute abdomen, it is necessary to immediately call ambulance.

Calling emergency help is necessary both in case of severe pain and in cases where a dull, aching pain persists for an hour.

You should not self-medicate under any circumstances, especially in your situation. Taking any medications and even food can change the symptoms and will not allow the doctor to make a correct diagnosis.

Traditional medicine is contraindicated for pregnant women. Its methods can be especially destructive in acute surgical diseases.

Agree to hospitalization and prescribed treatment (often surgical). Before choosing a treatment method, doctors assess all the risks to the health and life of mother and baby.

What does a doctor do

Most effective way Treatment of acute diseases is surgery. Sometimes any delay in front of them can be lethal. However, before surgery, the doctor must make sure that the diagnosis is correct.

To perform the operation, the pregnant woman must have appropriate anesthesia.

If an acute abdomen and the underlying disease are caused by physiological changes (primarily the growth of the uterus and an increase in its pressure on other organs), the doctor may prescribe conservative therapy in a hospital setting.

The specialist must determine in advance the date of birth and the method of delivery in the event of an emergency.

Prevention

The best prevention of pain during pregnancy is to identify all health problems and eliminate them during pregnancy planning.

In preparation for conception important point should be given to strengthening the immune system, preparing female body to an increase in load. Elimination of unfavorable factors that may influence the development of diseases can also be considered measures to prevent acute abdomen.

Expectant mothers should regularly visit a gynecologist, take all tests, and not ignore any changes in the condition, especially if they are associated with abdominal pain, frequent vomiting and fever.

According to the shape of the abdomen, as some expectant mothers and their relatives still believe, one can determine the gender of the unborn child. In their opinion, a more “sharp” tummy, which is also practically invisible if you look at a pregnant woman from the back, indicates that a boy will be born. A rounded belly, on the contrary, indicates that a girl will be born.

However, modern obstetrician-gynecologists use more reliable methods for diagnosing the sex of the baby and give their opinion using ultrasound. But you shouldn’t ignore the shape of your belly at all, because it can indicate peculiarities during pregnancy or even its dangerous complications.

What determines the shape of the abdomen in pregnant women?

The belly of expectant mothers grows during pregnancy due to the growth of the baby, the enlargement of the uterus and the number amniotic fluid. Typically, the first changes in abdominal volume become noticeable by the 12th week of pregnancy, and they become more obvious by the 20th week. During the first pregnancy, when the muscles of the anterior abdominal wall are not stretched, or if the woman has well-pumped abs, the abdomen may be almost invisible even at the 20th week.

Normally, at this stage, the fundus of the uterus is located just below the navel, at 24 weeks - at its level, at 28 weeks - 2-3 centimeters higher. By the 38th week of pregnancy, the uterus reaches the lower process of the sternum and costal arches - this is its highest level. Then the uterus will drop a little - and the baby will be a little lower and closer to the pelvic cavity.

These changes shouldn't be scary. expectant mother, because they are physiological and prepare the baby for childbirth. Interestingly, with almost the same height of the uterine fundus at the 32nd and 40th weeks, the abdominal circumference at the 40th week will be 8-10 centimeters larger than it was at 32 weeks. This is explained by the growth of the baby and the fact that the uterus has dropped down a little along with him.

Only a doctor during an appointment can correctly assess the height of the uterine fundus and compare it with the volume of the abdomen and the gestational age, - this is how the head of the organizational and methodological department of the Yekaterinburg Clinical Hospital comments on the topic that we are discussing. perinatal center, obstetrician-gynecologist Olga Vladimirovna Perevozkina.

Olga Vladimirovna also drew our attention to the fact that there is no scientific basis for determining the sex of a baby based on the shape of the mother’s belly, and what medicine can discuss today from an evidence-based position concerns only the size of a pregnant woman’s abdomen and their deviations up or down.

What signs in the shape and size of the tummy should the expectant mother pay attention to and, if necessary, discuss her concerns with a doctor:

Belly seems too big

It makes no sense to give norms for abdominal volumes here, because each woman has her own initial volumes, but there are certain conventional guidelines: if at 20 weeks of pregnancy the abdominal volume was 70-75 cm, then at 30 weeks - 82-87 cm and 95-100 cm by the 40th week. An increased abdominal size may indicate:

Multiple pregnancy (twins or triplets),

Polyhydramnios (can be caused by an infection, endocrine diseases and Rhesus conflict),

Large fetus (the most common reason here is endocrine diseases of the mother and the high growth of its parents)

Fetal development abnormalities,

Chorionepithelioma, or hydatidiform mole (this is a malignant neoplasm from the cells of the chorion, that is, the embryo),

Breech presentation of the fetus (when the pelvic end of the baby is below his head). In this case, it is important to timely and competently decide the question of how best to give birth - by yourself or by caesarean section.

Belly is too small

There could also be several reasons:

Ectopic pregnancy (this reason is relevant only at the very beginning of pregnancy and requires immediate surgical intervention),

Oligohydramnios (among its causes are malfunction or rupture of the membranes, serious illnesses of the mother, malformations of the baby, infections),

Delayed fetal development (causes: disruption of the placenta, intrauterine infections, toxicosis of pregnancy, poor nutrition of the expectant mother),

Developmental defects of the baby

Non-developing or frozen pregnancy.

If the expectant mother feels that her belly is growing too slowly, she should pay attention to the baby’s movements and her own sensations - weakness, nausea, bloody issues, temperature increase. And immediately seek help from a doctor. Most likely, the doctor, after taking his own measurements of the location of the uterine fundus and listening to the baby’s heartbeat, will refer the expectant mother for an ultrasound, and based on its results, a decision will be made on the necessary treatment and the prospects for pregnancy.

It is important to consider that the condition of the abdominal muscles affects the size of the expectant mother's belly. With repeated pregnancies, especially multiple pregnancies, and also if the mother did not use a postpartum bandage and the muscles were stretched, the stomach will look less compact. There is one more factor that expectant mothers need to take into account - this is the work of the intestines, because with its overflow, decreased tone and increased gas formation The volume of the abdomen will objectively and subjectively appear larger.

We wish you happy pregnancy, easy birth and great joy from meeting the baby!