Women all over the world face the following problems during the pregnancy;
The threat of abortion is the presence of metrorrhagia or uterine contractions in a pregnant woman. In this situation you should visualize the cervix and check that it is closed, the woman will be advised to rest in bed and abstain from physical exertion. A Beta-HCG and an obstetric ultrasound should be ordered to rule out other pathologies. It also allows us to evaluate ovular viability. In any case the pregnancy happens to be of high obstetric risk. If the metrorrhagia was very important, if there were placental remnants or the neck was open, we would be in the presence of an ongoing abortion and the referral to the hospital should be performed urgently.
Premature placental abruption
Premature abruption of the plantation is also called abruptio placentae and it is understood that such placenta that after 22 weeks of gestation and before the third trimester is evident from its normal implantation. Common symptoms include bleeding and painful uterine contractions. In this situation, the patient will be referred to a hospital in order to confirm the diagnosis, assess the degree of detachment and make the differential diagnosis with the placenta previa that can be followed with the same symptoms.
The pregnancy lasts more than 42 weeks. Their actual presence occurs in 1-2% of all pregnancies, most of the possible prolonged pregnancies are due to errors in the date of the last rule. If there is no early ultrasound that allows us to ensure the actual time of gestation, it will be sent to a secondary level for complementary studies (amnioscopy, amniocentesis, oxytocin test, etc.) that allow us to know the degree of fetal maturity and decide between Continue gestation or cause labor.
Physiologically in the last weeks of gestation the amount of amniotic fluid descends. In usual clinical practice and in the absence of symptoms and clinical signs that make us suspect (pain induced with fetal movements or palpation, lower than expected uterine size, etc.), will be determined by ultrasound, and if it is Few weeks of evolution and at the end of gestation, in the absence of other data, may indicate fetal post-maturity.
Premature labor is the presence of uterine contractions at least every 10 minutes before 37 weeks of gestation. Pregnant women at risk of preterm birth should be included in a specific program and referred to a specialized level.
Polyhydramnios: Is the presence of amniotic fluid in an amount greater than 2000 ml. It is usually indicative of fetal pathology or twin pregnancy. Uterine size may be suspected higher than expected, difficulty in palpating the fetus or distant heart tones. Confirmation is obtained by ultrasound and will always be referred to a specialized center for study.
Placenta previa: This pathology is suspected in the presence of bleeding in the third trimester of gestation. It consists of the implantation of the placenta in the inferior segment being able to be marginal, partial or total. Pregnant women with bleeding in the third trimester must be admitted to a hospital for study.
Medical pathologies in pregnancy
Anemia: Anemia is a frequent problem in pregnancy, in the absence of other data that make us suspect other different pathologies, it is usually due to iron deficiency and courses as mild anemia with a hemoglobin between 10 and 11 and a hematocrit between 30 And 33. The recommended treatment is the administration of ferrous sulfate, 500 mg / day, in doses equivalent to 100 Elemental Fe, two or three times daily according to the degree of anemia [A]. It can also be advised as a prophylactic treatment starting at the 21st week of gestation at doses of 100 mg. Of elemental Fe once a day. Asymptomatic Bacteriuria: It is the presence of more than 100,000 bacterial colonies per ml. Of urine, without clinical data of urinary infection. It is a common problem that affects almost 5% of all pregnancies. If untreated, 30% will develop pyelonephritis. All cases should be treated according to antibiogram, never with trimethoprim-sulfamethoxazole. Pregnancies with asymptomatic bacteriuria or urinary tract infection should be followed throughout pregnancy, with urinary cultures frequent between 4 and 6 weeks and at 6 weeks postpartum.
Urinary infection: The presence of dysuria and pollakiuria, in the absence of data indicating high-grade urinary tract infection. Proceed as in asymptomatic bacteriuria. If urinary discomfort is very important, while receiving urine culture and antibiogram treatment can be initiated with cefuroxime axetil 250 mg every 12 hours, Amoxycillin 500 mgr + Clavulanic acid 125 mg every 8 hours, Nitrofurantoin 50 mg every 6 hours , Taken with food remembering that it can produce falsely positive glucosurias and must be used with caution before the birth due to the risk of neonatal hemolysis and also with Fosfomicina 50 mg every 8 hours or Fosfomicina-Trometramol 3 gr in single nocturnal dose.
Are all antibiotics safe in the pregnant woman?