Hormonal changes
Two thirds of all pregnant women suffer from different degrees of urinary retention. In most cases, the ureters and renal pelvis are affected. On the one hand, the cause is the hormonal change that causes the ureters to dilate, on the other hand, the growing uterus presses on the ureters.
In most cases, the urinary retention is only slightly pronounced and does not cause any symptoms. However, it can also promote inflammation of the renal pelvis. If the kidneys are heavily congested, the outflow can be improved by inserting ureteral stents.
Normally, the urinary retention is reduced within 3 months after birth. If this is not the case, further clarification should be carried out. Gestational diabetes refers to the first occurrence of a diabetic metabolic condition during pregnancy and does not refer to type 1 or type 2 diabetics whose disease was already known before pregnancy.
Due to hormonal changes, the sugar concentration in the blood is increased during pregnancy. At the same time, the secretion of insulin (one of the main hormones of sugar metabolism) is increased because the pancreas produces more of it. However, if the extent of the increased sugar concentration exceeds the pancreas‘ ability to produce insulin, gestational diabetes occurs.
This disease causes more frequent urinary tract infections and pre-eclampsia. The disturbed metabolic situation also has a negative effect on the unborn child. Very often the children are “macrosomal” (very large) with a birth weight over 4 kilograms.
The malformation rate increases with poorly adjusted sugar levels. Developmental disorders are also possible, especially of the lungs and liver. Other effects are a lot of amniotic fluid and an increased rate of premature births and deaths of the child in the womb.
In order to detect as many pregnant women with gestational diabetes as possible, the urine is checked for sugar during screening and, in cases of doubt, an OGTT (oral glucose tolerance test) is performed.The therapy of gestational diabetes consists of an adapted diet, exercise and sport. Insulin therapy may have to be started if these measures are not sufficient. The hormonal changes during pregnancy increase the tendency of the blood to form clots.
Therefore, the number of leg vein thromboses or pulmonary embolism increases during pregnancy. The risk is six times higher compared to a non-pregnant woman. About 0.13% of pregnancies are affected by a thromboembolic event.
Treatment is based on inhibition of blood clotting by means of heparin, which is not passed on to the unborn child via the placenta. The bladder mole represents a vesicular malformation of the chorionic villi, which actually serve to ensure the exchange of substances between mother and fetus. Chorionic villi are cells of the placenta, which have protrusions to increase their surface area.
The bladder mole occurs in one in 1. 500 pregnancies and causes the following symptoms: vaginal bleeding in early pregnancy, pronounced morning sickness, significantly enlarged uterus, pregnancy poisoning and respiratory disorders. The treatment is carried out by a complete scraping of the uterus.
A placenta praevia refers to an incorrect position of the placenta after the 24th week of pregnancy, with the placenta lying completely or partially in front of the inner cervix. The frequency is 0.5% of all pregnancies. If the inner cervix is completely closed by the placenta, a caesarean section must be performed.
If the placenta praevia touches the inner cervix only at the edges, a normal delivery attempt must not be attempted. The symptom of a placenta praevia is painless bleeding, which occurs particularly in the last trimester of pregnancy and can be very dangerous for mother and child, depending on its extent. If there is bleeding in the placenta praevia, the pregnant woman is admitted to hospital and closely monitored.
Depending on the age of the pregnancy and the degree of risk to mother and child, delivery is carried out by caesarean section or medication is administered to control the bleeding. Placental insufficiency, also known as placenta weakness, affects about 2-5% of all pregnancies. It can be either acute or gradual and describes a functional disorder of the placenta with a decrease in its ability to supply the child with nutrients.
It can occur at any stage of pregnancy. Acute placental insufficiency occurs when the uterus undergoes permanent contractions, a lump in the umbilical cord, a placental abruption or pregnancy poisoning. Chronic placental insufficiency is often caused by maternal diseases (e.g. high blood pressure, diabetes, collagenosis), maternal smoking or infectious diseases.
The consequences of placenta weakness can be the death of the unborn child, delayed growth or an early resolution of the placenta. By ultrasound examination of the unborn child and the blood vessels that supply the placenta and child with blood, the extent of placental insufficiency can be determined and the best time of birth can be determined. Depending on the cause of the placenta weakness, a different procedure may be necessary.
Too much amniotic fluid (so-called polyhydramnion) occurs in up to 3% of all pregnancies; too little amniotic fluid (oligohydramnion) in up to 7%. Too much amniotic fluid has no cause in 60% of cases, in 20% of cases the mother suffers from diabetes mellitus and in up to 20% of cases the child has malformations, which can affect the digestive tract, for example. Too much amniotic fluid can trigger contractions, a feeling of tension in the abdomen or shortness of breath.
The therapy of the polyhydramnion depends on the cause, possibly an early delivery is necessary. Too little amniotic fluid in the last third of the pregnancy may have been triggered by an early rupture of the bladder or be an indication of a beginning placental insufficiency. The prognosis for too little amniotic fluid in the last third of the pregnancy is good.
However, if a lack of amniotic fluid occurs earlier, this can be an indication of malformations of the urinary tract in the unborn child. If the bladder bursts prematurely, the pregnancy should be prolonged to a maximum of the 34th week of pregnancy in order to keep the risk of infection or compression of the umbilical cord lower than the risk of premature birth.
