In the final third trimester of pregnancy, women are often faced with such a phenomenon as increased tone of the uterine muscles. In the last three months of gestation, the uterus is large, it occupies almost all the space in the abdominal cavity, and therefore its tension, which was sometimes indistinguishable in the early stages, is now perfectly felt by a woman, and is also easily diagnosed by an obstetrician-gynecologist by palpation.
Is hypertonicity dangerous in the late stages, this article will tell.
What it is?
Hypertonicity is a state of increased excitability of the myometrium (middle layer of the uterus). After conception, the smooth muscles of the female reproductive organ are maintained in a relaxed state by the hormone progesterone. Due to this, it becomes more elastic, loose, which makes it possible for it to grow unhindered. The soft uterus ensures the normal functioning of the placenta, while the tension of the myometrium sections can adversely affect the state of the uteroplacental blood flow, as a result of which the baby may receive less nutrients and oxygen.
The tone of the uterus in the third trimester can be both physiological, natural, and pathological.... In the first case, we are talking about such a mysterious and insufficiently studied phenomenon as Braxton-Hicks contractions, or false contractions. In the second case, the tension is prolonged, unhealthy, threatening a woman with the onset of premature birth.
Obstetricians have long noticed that tone in the third trimester is most common in expectant mothers who have not reached the age of 19, as well as in women who become pregnant after 35 years.
In the former, the uterus is not sufficiently mature and ready for childbirth, the latter have an impressive obstetric anamnesis, in which there is a place for abortion, and difficult childbirth, and infectious and inflammatory gynecological diseases.
Pathological hypertonicity
Most often, pathological hypertonia develops due to hormonal progesterone deficiency. The level of this hormone should be quite high throughout the entire period of gestation. Only in the last weeks, its concentration begins to gradually decrease, yielding the dominant right to estrogens and oxytocin. This is what becomes the biochemical basis for the onset of labor.
Among other reasons that can lead to the development of an increased tone of the uterus in the late stages, the following situations can be called:
- the woman is very nervous, experiencing chronic stress, is in a state of depression;
- the expectant mother has bad habits (smoking, drinking alcohol, dependence on caffeine);
- pregnancy proceeds against the background of endometriosis or with an existing uterine myoma;
- the expectant mother has thyroid diseases;
- in the first trimester or the first half of the second trimester, the woman had influenza, a viral infection.
Pathological hypertonia has two degrees.
- The first - the emergence of tension on the back wall of the reproductive female organ. This tone is less dangerous, especially if contractile activity is not observed in the area of attachment of the placenta. In the early stages, women usually do not feel this kind of hypertonia. But in the third trimester, the tone of the first degree is manifested by pulling sensations in the lumbar region with extension to the sacrum.
- Second degree of hypertension - tone of the anterior wall of the reproductive organ or the entire myometrium. Feels like a breaking pain in the lower abdomen, tension in the abdomen, its "petrification". The pathology is easily visible even to the woman herself - the stomach rises higher, becomes dense, hard, urination becomes more frequent, often women experience false urges to defecate, but it does not happen.
Hypertonicity in the late stages is dangerous not only with the likelihood of premature birth. In a state of tension, the work of the vessels of the uterus is disrupted, which leads to fetal hypoxia, and sometimes to its death. The possibility of placental abruption is not excluded.
It is impossible to ignore the violation, a woman needs qualified assistance and special treatment.
Treatment
With a pathological tone to a woman it is recommended to observe bed or half-bed rest... If the degree is first, then home treatment may be allowed. In the second degree with severe symptoms, and sometimes brownish or bloody discharge from the vagina, hospitalization is recommended.
It is important for a woman to reduce physical activity, calm down and stop being nervous.
For treatment, drugs are used - antispasmodics. "No-Shpa" helps not only to reduce the tone of the smooth muscles of the uterus, but also helps to prepare the cervix for the upcoming birth.
If the gestational age has reached 34 weeks, progesterone preparations can be used for treatment in case of progesterone deficiency. After 34 weeks, a decrease in progesterone in the body is considered normal, and they try to refuse drugs based on it so as not to lead to hormonal disruption.
Often the tone in the later stages develops against the background of a lack of magnesium. Therefore, the pregnant woman is shown taking magnesium preparations and injections of "Magnesia" intramuscularly. To normalize the emotional background, sedatives of herbal origin, for example, motherwort tincture, can be recommended.
When an obvious psychogenic factor is identified, a psychotherapist, a psychologist should work with a woman. The sooner the source of chronic stress is eliminated, the more likely it is that the tone will decrease.
With the development of pathological hypertonia for up to 34 obstetric weeks, doctors can prescribe a woman tocolytic drugs ("Ginipral", "Salgim" and others). They allow you to buy time to start administering betamethasone-based drugs to the pregnant woman, which will help the baby's lungs to mature at an accelerated rate. So the baby is prepared for birth ahead of time. If he is born with a small amount of surfactant in the alveoli of the lungs, then the development of distress syndrome, acute respiratory failure is possible.
Training contractions
False contractions do not occur in all women in the third trimester. They are felt as a short-term tension of the uterine muscles. The uterus tenses for no apparent reason, remains in this position for several seconds or minutes, and then relaxes. The next episode of tension can repeat itself completely spontaneously - and after a few hours, and after a few days. There is no systematicity in such contractions, which distinguishes them from generic ones.
Some women the first such contractions appear as early as the 20th week of pregnancy, but in the majority - only in the third trimester of pregnancy... As the gestation period increases, the intensity of the training contractions may increase. Moreover, their complete absence is also an absolute norm.
Brexton-Hicks contractions do not affect the fetus, do not harm its development, do not bring the moment of onset of labor closer, do not have any effect on the condition of the cervix, do not lead to its opening, do not increase the likelihood of premature birth and therefore should not frighten a woman. They are considered a manifestation of the preparatory activity of the uterus before the difficult process of childbirth.
There is also a theory that false contractions are the result of disturbances in the work of the woman's nervous system... During pregnancy, the uterine tissue grows, and in the third trimester the number of nerve fibers in the uterus naturally begins to decrease - this is part of the prenatal preparation of the female body. Part of the appearance of nerve impulses straining the uterus may be associated with this process.
How to make it easier?
Symptoms of training contractions in the 3rd trimester of pregnancy help to facilitate a warm shower, change in body position, adequate physical activity, taking an antispasmodic pill, if agreed with the attending physician, a cup of warm herbal tea and a positive attitude. Sometimes it's enough to just lie down a little and breathe right., as taught in the courses of expectant mothers, and the tension of the uterus goes away. Yoga classes, walks in the fresh air are useful.
False contractions do not need treatment, but if they appear often and cause severe inconvenience and anxiety, a woman must definitely inform her obstetrician-gynecologist about them at a scheduled appointment at a antenatal clinic.
