Why pulls the lower abdomen and lower back on the 40th week of pregnancy and what should I do?

The fortieth week of pregnancy is the finish line of the great path that a woman went through to give life to a new person. The future mother in anxious expectation of childbirth, because this is the time when the permission from the burden of pregnancy will come and she will see her child. There were new sensations: it became easier to breathe, heartburn was gone, and at the same time there was a weight in the bottom of a stomach, trips to a toilet became frequent. And then there's the signal, disturbing and alarming future mother, pulling the belly at the 40th week of pregnancy, how to treat it?

Epidemiology

The epidemiology of symptoms of late pregnancy testifies that almost all women experience some or other unpleasant signs of future childbirth. Thus, more than 20% of pregnant women experienced bloating at the 40th week of pregnancy, 80% - pulling pains in the back and waist, more than 70% - stiffness of the abdomen, which was caused by increased tone of the uterus, some had constipation, and some women noticed the appearance of a relaxed stool . Two-thirds of women experiencing the pulling sensation in the lower abdomen had no complications, and for a third they were potentially threatened. Thus, placental abruption occurred with one of 120 pregnant women.

[1], [2], [3]

Causes of the stretching pain in the abdomen at 40 weeks gestation

The most probable cause of the pulling sensations in the lower abdomen at 40 weeks gestation is that the fetus has already fallen into a small pelvis and has taken a position with which it will be convenient for him to pass the birth canal and be born. The load at this time increases on the pelvic bones, lower back, abdomen. The severity of the lower abdomen, and sometimes the pain in the groin, the sacrum - precursors of rapid delivery. But we should not exclude the emergence of pathologies at this late pregnancy. They include the following:

• an inflammatory process that takes place in the internal genital organs. To a greater extent, this can be affected by women who before infection suffered infectious inflammation of the uterine appendages or had ovarian cysts. The infectious focus, spreading to neighboring organs, affects the pain receptors of the peritoneal tissues, causing drawing pains;
• inflammation of the urinary system and kidneys;
• rupture of the ovarian cyst in its presence, which may increase simultaneously with fetal growth;
• exfoliation of the placenta;
• increased tone of the uterus.

There are other causes of such conditions, so a differentiated diagnosis is needed to answer all the fears of the future mother, and qualified doctors will endanger the life of the mother and child.

[4], [5]

Risk factors

Risk factors for the normal course of a woman's pregnancy and the successful course of labor are:

• stress;
• heavy physical labor;
• hormonal splash;
• inflammatory diseases of the genital organs;
• pathology of the liver, kidneys, heart, age of the woman (after 35 years, there are more cases of increased uterine tone);
• endocrine diseases;
• frequent abortions;
• bad habits (smoking, alcohol).

[6]

Pathogenesis

The pathogenesis of one of the factors that pose a threat to the fetus - the increased tone of the uterus, lies in the occurrence of spasms of the muscles of the middle layer of the uterus (there are three of them) - myometrium. In a normal state this muscle is relaxed, which makes it possible to bear the baby. When, for one reason or another, her tension arises, the woman feels heaviness, sometimes painful sensations in the abdomen. Most often this occurs in the first trimester of pregnancy. With a short period of such muscle contraction, there is no threat to the fetus and the woman. A prolonged state of muscle tone leads to the risk of miscarriage. The appearance of such symptoms at the 40th week of pregnancy can only testify to the approach of labor. With short contractions of myometrium, the body prepares for fights. But it is better, in order to avoid complications, to allow the doctor to assess his condition.

The mechanism of another serious threat, characteristic for the 40th week of pregnancy - abruption of the placenta, is that blood accumulates between the placenta and the uterus wall, forming a hematoma. Over time, the hematoma grows, increasing the detachment of the placenta. This is a very dangerous phenomenon, which requires immediate intervention by specialists.

Symptoms of the stretching pain in the abdomen at 40 weeks gestation

Symptoms of the pulling sensations in the lower abdomen at 40 weeks gestation, most likely, testify to the approach of birth and take them calmly, tk. This is quite normal for this period of pregnancy. If this is the only symptom, then you need to lie on your side, relax, while stroking your stomach. A special bandage supporting the abdomen will also help. If there are other signs that indicate a pathology, it is necessary to raise an alarm.

First signs

So, the first signs of the presence of inflammation can be fever, purulent discharge from the vagina. Cystitis signals about itself not only frequent urge to urinate, which is typical for pregnancy, but also with cutting pains. The first signs of placental detachment are spotting, dull aching incessant pain in the abdomen and during palpation, lowering of blood pressure, palpitation, dizziness, vomiting and even fainting. The last symptoms can indicate food poisoning. To properly assess the condition of a pregnant woman, it is necessary to analyze all the occurring symptoms, and not just a pulling sensation in the lower abdomen.

Complications and consequences

The consequences and complications depend on the cause and speed of its elimination. Thus, placental abruption is a great risk to the life of both mother and child. It is fraught with severe uterine bleeding, which carries a serious threat to the life of a woman. For a child this is also a big risk, because Through the placenta, the fetus receives everything necessary for its existence: oxygen, nutrients. At 25% of the detachment area, suffocation begins, at 30% - a direct threat to life, and with 50% or more - the death of the fetus. According to statistics, every sixth child with this diagnosis dies in the womb of the mother. With timely treatment in a medical institution, such a late pregnancy, like 40 weeks, gives every chance of the birth of a healthy child.

[7], [8]

Diagnostics of the stretching pain in the abdomen at 40 weeks gestation

Faced with symptoms that cause certain alertness, anxiety and suspicion, it is necessary to undergo a checkup to exclude the presence of pathologies. Timeliness of this step can prevent many complications. Diagnosis of the pulling sensations in the abdomen at 40 weeks of gestation consists in carrying out laboratory tests of urine and blood, a smear from the vagina, and carrying out an ultrasound.

[9], [10]

Analyzes

Pregnancy is a big burden on the kidneys, so urinalysis is performed at all stages of pregnancy. With its help, the presence of protein, indicating violations in the work of the kidneys, a possible pyelonephritis, is determined. A general blood test will give a picture of the level of hemoglobin through which oxygen enters the tissues, and also reveals inflammation in the body. A bacteriological study of a vaginal smear will indicate the presence of red blood cells, leukocytes and key cells. In case of Rh-parasite conflict, an immunological assay for antibodies is performed.

[11], [12]

Instrumental diagnostics

When complaints of pulling and painful sensations in the lower abdomen to exclude intrauterine pathology at 40 weeks of pregnancy, ultrasound is prescribed. With the help of this study, the doctor will establish the placenta condition, if the fetus does not threaten oxygen starvation, tk. This can provoke a violation of the brain, cardiac activity of the fetus, and sometimes lead to his death. Ultrasound will show the condition of the uterus, amniotic fluid, whether the neck of the baby is wrapped by the umbilical cord, the willingness of the cervix to give birth, the weight of the fetus, which will make it possible to determine the method of delivery. According to the testimony of ultrasound, another type of this study - dopplerometry - can be prescribed. Its goal is to identify abnormalities in the functions of the placenta and to investigate the blood flow of the umbilical cord, uterus and vessels of the fetus. If violations in the development of the fetus (hypoxia, placental insufficiency) are noticed, cardiography is performed to determine the diagnosis and condition of the fetus, which determines the tone of the uterus, the motor activity of the child, and the frequency of his heartbeat.

Differential diagnosis

The main task of differential diagnosis is the separation of physiological pain from the pathological with the pulling sensations in the lower abdomen. This is necessary to exclude urgent states.

[13], [14]

Treatment of the stretching pain in the abdomen at 40 weeks gestation

Treatment of pulling sensations in the abdomen at 40 weeks of pregnancy is prescribed in the case when a pathology requiring intervention is diagnosed. Indication for therapy is, for example, the detection of foci of infection. For example, inflammation of the urinary tract: cystitis and pyelonephritis. Treatment for these diseases appoint a complex, consisting of antispasmodics, antipyretic and permitted antibacterial drugs: aminopenicillin and cephalosporins. With inflammation of the ovaries and appendages, antibiotics can not be avoided. If the increased tone of the uterus, expressed in cramping pulling pains, does not pass after taking a horizontal position and taking an antispasmodic, it is possible that labor begins. The child has fully formed and is ready to be born, and in order to avoid such dangerous consequences as oxygen starvation and detachment of the placenta, it is necessary to go to the hospital. If the detachment of the placenta does occur, the measures are taken depending on its area. With a small detachment, doctors stimulate labor, otherwise a caesarean section is performed.

Medications

The safest antispasmodics for pregnant women include but-shpu, papaverine, baralgin, spazgan, trigan and maxigan .

But-spa is an antispasmodic drug whose active ingredient is dravetoverin. Produced in the form of convex on both sides tablets yellow, with the inscription of the spa on one of the surfaces. Eliminates spasms of smooth muscles. Has contraindications in renal, heart failure, with low blood pressure and intolerance to the active substance. Side effects include rapid heartbeat, dizziness, headache, nausea, vomiting. For one reception you can drink no more than two tablets 2-3 times a day. The daily dose should not exceed 6 tablets.

Among the antipyretic drugs, paracetolol can be administered to pregnant women.

Paracetomol is a non-narcotic analgesic, which is available in various forms: tablets, capsules, suspensions, syrups. Has contraindications for admission for allergies to the drug and for renal and hepatic insufficiency. Side effects can arise from the side of the circulatory system, the urinary system, the nervous system - in the form of increased excitability or drowsiness, cardiovascular - reduce heart contractions, digestive system - in the form of nausea. The recommended single dose of taking tablets is not more than 1.5 g, and the maximum daily intake is 3-4 g, evenly distributed for 3-4 doses. Syrup for adults is recommended in a dose of 20-40 ml 3-4 times a day.

From the group of aminopenicillins, if necessary, amoxin-white tablets of antibacterial broad-spectrum antibodies can be used, the active substance amoxicillin. Contraindicated with allergies to drug components, diseases of the gastrointestinal tract, kidneys, liver. Use with caution in pregnant women and during lactation. Amosin can cause adverse reactions in the form of nausea, vomiting, diarrhea, stomatitis, dizziness, anxiety, insomnia. Dose intake - 0.5 g three times a day, regardless of food intake.

Cephalosporins are bactericidal preparations or beta-lactam antibiotics, the mechanism of action of which is to destroy cells of the bacterial wall. There are 5 generations, depending on the spectrum of the action, structure and resistance to the action of bacterial enzymes on the antibiotic, as well as the way of administration. Here are some of them: cephaloridine, cefazolin, cefoxitin, cefotaxime, cefpodoxime, cefodox, cefepime, ceftobiprol, ceftolozan, and others.

Cefodox is a 3rd generation drug, it can be used for pregnant women with cystitis and pyelonephritis. Produced in powders and tablets. Contraindicated in case of allergy to the components of the remedy. Side effects are possible in the form of nausea, vomiting, headache, diarrhea, changes in the blood formula. The daily dose is 200 mg.

Vitamins

At 40 weeks gestation, as in other terms, future mothers require vitamins A, C, D, as well as iron (30-60 mg per day). Deficiency of iron can lead to muscle weakness. Replenish the body with this element is possible due to the consumption of meat, fish, eggs. Iron, found in plant products, is digested worse than in products of animal origin. Drink food with tea or coffee is not recommended, tk. They interfere with its assimilation. Therefore, after eating, it is best to drink juice or compote. Vitamin C is necessary to strengthen immunity. His need for a future mother is 100mg a day. Currant, sweet pepper, lemon, orange, strawberry, kiwi - these are the foods rich in this vitamin. Vitamin D forms a healthy cardiovascular system of the child, prevents the emergence of rickets. The daily requirement for it is 400 mg. To provide an organism with this vitamin with the help of food products will not be completely possible, because It contains in small amounts in egg yolk, cod liver, some varieties of fish, butter, milk.

Physiotherapeutic treatment

In gynecology, physiotherapy is widely used, along with medication, homeopathic. Even with pregnancy in the early stages of resorting to fizmethods, tk. They sometimes at their impact on the focus of pathology can replace harmful to the fetus drugs. But for 40 weeks of pregnancy, you should not expose yourself and your child to magnetic, electrical, ultrasonic effects.

Alternative treatment

If the time has come to give birth, then alternative medicine will not help and the only recipe is to go to the hospital. But if the pathology is diagnosed, you can carefully resort to some recipes that can not cause harm to the fetus. So, in the inflammatory processes of the urinary tract, the intestine, you can drink the herbs that have antiseptic effects, but in no case should you do douching, so as not to provoke premature births.

[15], [16], [17], [18], [19]

Herbal Treatment

Known and widely used in urology grass: bear ears, corn stigmas, half-pala, field horsetail, birch buds, which have a diuretic and disinfectant effect, not all are recommended for pregnant women. Some of them irritate the musculature of the uterus, causing an increased tone of the uterus. Before preparing decoctions and infusions, you should still get acquainted with contraindications or consult a doctor, and it is desirable to make them one-component. Alcohol tinctures should not be taken. Here are some recipes for broth:

• 10 g corn stigmas pour a glass of hot water, bring to a boil and hold on the fire for several minutes. Drink in 30 minutes. Before eating one third of the glass;
• 2 teaspoons of a half-pail on a glass of water are brought to a boil and boiled for 5 minutes, after which several hours are infused. It is taken in a warm form through a tube 50 g for half an hour before meals.

With discomfort in the intestine, flatulence, which can also cause a pulling sensation in the lower abdomen, a camomile chamomile is good. It is prepared simply:

• 1 tablespoon pour a glass of boiling water and insist an hour, it is good to use a thermos for this. Take a third of the glass before eating.

But such herbs as bear ears, birch buds, field horsetail, strawberry berries, parsley root, juniper fruits are contraindicated for pregnant women because of the ability to provoke uterine contractions.

Homeopathy

When revealing inflammatory processes in the genital area, which is the source of the pulling sensations in the lower abdomen at the 40th week of pregnancy, a homeopathic remedy like kanefron can be used for treatment.

Kanefron - due to the components of plant origin (lover's root, centaury, rosemary), the drug acts on inflammatory foci, is a decongestant and antispasmodic agent. Produced in tablets. There are practically no contraindications. Adverse reactions are possible with allergies to the drug component. Take cautiously to patients with diabetes mellitus. The composition of the drug is carbohydrates. Drink not chewing three times a day lasting from two weeks to a month.

Widely used in pregnancy for the treatment of inflammation of the genital organs, to reduce the tone of the uterus, to eliminate the flatulence of the suppository of viburkol.

Viburkol is a safe homeopathic remedy, not only eliminating the infection, but also activating the body's defenses. Produced in the form of candles that are placed deep into the rectum, after which it is necessary to lie down for 10 minutes on the side. Two candles are recommended per day, in the morning and in the evening. The drug has virtually no contraindications. Of the adverse reactions, the urge to empty the intestine is noted. Can be used along with other medications.

Such drugs as caulophyllum, pulsatilla help prepare for childbirth, soften the cervix.

Kaulofillum - is considered a female root, it is taken twice a day for three balls, it is necessary to start two weeks before the expected delivery.

Pulsatilla - at the heart of the drug lie the dilution of grits of lumbago grass. The spectrum of the action of the remedy is quite wide, therefore the doctor's appointment will determine the dose and frequency of admission. There are practically no contraindications, except that there is an individual intolerance to the herb. It is produced in granules (dilutions D3, D6, D12, D30, D200).

Operative treatment

Operative treatment at 40 weeks of pregnancy may be necessary in diagnosing acute appendicitis. In this case, the appendix is removed and a caesarean section is simultaneously performed. It is resorted to such delivery and with uterine bleeding caused by abruption of the placenta. Do not avoid surgical intervention when twisting the leg of the ovarian cyst or its rupture.

Prevention

To anticipate and prevent all the complications that can lie in wait for a woman on the way to obtaining the status of a mother is impossible. But every future mother should do everything in her power to go this way with good health and mood and give a healthy start to your baby. The best prevention of all possible troubles will be a healthy lifestyle, consisting of proper nutrition, walks in the fresh air, the rejection of bad habits, reducing physical and emotional stress.

[20], [21], [22]

Forecast

With timely response to malfunctions in the functioning of the complex female-fetus system and the competent intervention of specialists, the delivery prognosis is safe. It is worth remembering that at the 40th week of pregnancy the fetus is already full, ready to leave the womb of the mother and exist outside her body.

[23], [24], [25]