Why pulls the lower abdomen and lower back at 40 weeks of pregnancy and what to do?

The fortieth week of pregnancy is the final stretch of a long journey that a woman has gone through to give life to a new person. The expectant mother anxiously awaits the birth, because this is the time when the burden of pregnancy will be resolved and she will see her child. New sensations have appeared: it has become easier to breathe, heartburn has disappeared, and at the same time there is a heaviness in the lower abdomen, trips to the toilet have become more frequent. And then there is also a signal that worries and alarms the expectant mother, the stomach is pulling at 40 weeks of pregnancy, how to treat this?

Epidemiology

The epidemiology of symptoms of late pregnancy shows that almost all women experience some unpleasant signs of impending labor. Thus, more than 20% of pregnant women at 40 weeks of pregnancy experienced bloating, 80% - nagging pain in the back and lumbar region, more than 70% - abdominal stiffness, which is caused by increased uterine tone, some had constipation, and some women noted the appearance of loose stool. Two-thirds of women experiencing nagging sensations in the lower abdomen did not have complications, and for a third they were a potential threat. Thus, placental abruption occurred with one out of 120 pregnant women.

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Causes 40 week abdominal pain in the abdomen

The most likely reason for a pulling sensation in the lower abdomen at 40 weeks of pregnancy is that the fetus has already descended into the pelvis by this time and taken a position from which it will be convenient for it to pass through the birth canal and be born. The load at this time increases on the pelvic bones, lower back, and abdomen. Heaviness in the lower abdomen, and sometimes pain in the groin and sacrum are harbingers of imminent labor. But one should not exclude the occurrence of pathologies at such a late stage of pregnancy. These include the following:

• an inflammatory process occurring in the internal genital organs. Women who suffered from infectious inflammation of the uterine appendages or had ovarian cysts before pregnancy may be more susceptible to this. The infectious focus, spreading to neighboring organs, affects the pain receptors of the peritoneal tissues, causing nagging pain;
• inflammation of the urinary system and kidneys;
• rupture of an ovarian cyst, if present, which can increase in size simultaneously with the growth of the fetus;
• placental abruption;
• increased uterine tone.

There are other reasons for such conditions, so differentiated diagnostics is necessary, designed to provide answers to all the concerns of the expectant mother, and qualified doctors will avert the threat to the life of the mother and child.

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Risk factors

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

• stress;
• hard physical labor;
• hormonal surge;
• inflammatory diseases of the genital organs;
• pathologies of the liver, kidneys, heart, the woman’s age (after 35 years, cases of increased uterine tone become more frequent);
• endocrine diseases;
• frequent abortions;
• bad habits (smoking, alcohol).

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Pathogenesis

The pathogenesis of one of the factors posing a threat to the fetus - increased uterine tone - lies in the occurrence of spasms of the muscles of the middle layer of the uterus (there are three of them) - the myometrium. In a normal state, this muscle is relaxed, which makes it possible to bear a baby. When for one reason or another its tension occurs, 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 long-term state of muscle tone entails the risk of miscarriage. The appearance of such symptoms at 40 weeks of pregnancy may indicate only the approach of labor. With short contractions of the myometrium, the body prepares for contractions. But it is better, in order to avoid complications, to give the doctor the opportunity to assess your condition.

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

Symptoms 40 week abdominal pain in the abdomen

Symptoms of pulling sensations in the lower abdomen at 40 weeks of pregnancy most likely indicate the approach of labor and should be taken calmly, as this is quite normal for this period of pregnancy. If this is the only symptom, then you need to lie on your side, relax, stroking your stomach. Wearing a special bandage that supports the stomach will also help. If there are other signs indicating pathology, you need to raise the alarm.

First signs

Thus, the first signs of inflammation may be elevated body temperature, purulent discharge from the vagina. Cystitis will signal itself not only by frequent urge to urinate, which is typical for pregnancy, but also by cutting pains. The first signs of placental abruption are bloody discharge, dull aching incessant pain in the lower abdomen and during palpation, decreased blood pressure, rapid heartbeat, dizziness, vomiting and even fainting. The latter symptoms may also indicate food poisoning. To correctly assess the condition of the pregnant woman, it is necessary to analyze all the symptoms that occur, and not just a pulling sensation in the lower abdomen.

Complications and consequences

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

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Diagnostics 40 week abdominal pain in the abdomen

When faced with symptoms that cause a certain alertness, anxiety and suspicion, it is necessary to undergo an examination to exclude the presence of pathologies. The timeliness of this step can prevent many complications. Diagnosis of pulling sensations in the lower abdomen at 40 weeks of pregnancy involves laboratory tests of urine and blood, a vaginal smear, as well as an ultrasound examination.

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Tests

Pregnancy is a big burden on the kidneys, so urine analysis is carried out at all stages of pregnancy. It helps to determine the presence of protein, indicating problems with the kidneys, possible pyelonephritis. A general blood test will give a picture of the hemoglobin level, through which oxygen gets into the tissues, and will also detect inflammation in the body. A bacteriological study of a vaginal smear will indicate the presence of red blood cells, white blood cells and key cells. In case of Rh-conflict of parents, an immunological analysis for antibodies is also carried out.

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Instrumental diagnostics

In case of complaints of pulling and painful sensations in the lower abdomen, in order to exclude intrauterine pathology at 40 weeks of pregnancy, an ultrasound is prescribed. With the help of this examination, the doctor will determine the condition of the placenta, whether the fetus is at risk of oxygen starvation, since this can provoke a violation of the brain, cardiac activity of the fetus, and sometimes lead to its death. The ultrasound will show the condition of the uterus, amniotic fluid, whether the baby's neck is entangled with the umbilical cord, the readiness of the cervix for childbirth, the weight of the fetus, which will make it possible to determine the method of delivery. According to the indications of the ultrasound, another type of this study can be prescribed - Doppler. Its purpose is to determine disorders in the functions of the placenta and examine the blood flow of the umbilical cord, uterus and vessels of the fetus. If abnormalities in fetal development are observed (hypoxia, placental insufficiency), cardiotocography is performed to clarify the diagnosis and condition of the fetus, which determines the tone of the uterus, the motor activity of the child, and the frequency of its heart contractions.

Differential diagnosis

The main task of differential diagnostics is to separate physiological pain from pathological pain with pulling sensations in the lower abdomen. This is necessary to exclude urgent conditions.

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Treatment 40 week abdominal pain in the abdomen

Treatment of pulling sensations in the lower abdomen at 40 weeks of pregnancy is prescribed in the case when a pathology requiring intervention is diagnosed. Indications for therapy include, for example, identifying foci of infection. For example, inflammation of the urinary tract: cystitis and pyelonephritis. Treatment for these diseases is prescribed in a complex, consisting of antispasmodics, antipyretics and approved antibacterial drugs: aminopenicillins and cephalosporins. In case of inflammation of the ovaries and appendages, antibiotics cannot be avoided. If the increased tone of the uterus, expressed in cramping pulling pains, does not go away after taking a horizontal position and taking an antispasmodic, then labor may begin. The child is already fully formed and ready to be born, and in order to avoid such dangerous consequences as oxygen starvation and placental abruption, it is necessary to go to the maternity hospital. If placental abruption does occur, measures are taken depending on its area. If the abruption is small, doctors stimulate labor, otherwise a cesarean section is performed.

Medicines

The safest antispasmodics for pregnant women include No-shpa, Papaverine, Baralgin, Spazgan, Trigan and Maxigan.

No-shpa is an antispasmodic drug, the active substance of which is dratoverine. It is produced in the form of yellow tablets, convex on both sides, with the inscription spa on one of the surfaces. Eliminates spasms of smooth muscles. It has contraindications for renal, heart failure, low blood pressure and intolerance to the active substance. Side effects include increased heart rate, dizziness, headache, nausea, vomiting. You can take no more than two tablets at a time 2-3 times a day. The daily dose should not exceed 6 tablets.

Among the antipyretics, paracetamol may be prescribed for pregnant women.

Paracetamol is a non-narcotic analgesic that is available in different forms: tablets, capsules, suspensions, syrups. It has contraindications for use in case of allergy to the drug and in case of renal and hepatic insufficiency. Side effects may arise from the circulatory, urinary systems, nervous system - in the form of increased excitability or drowsiness, cardiovascular system - decreased heart contractions, digestive system - in the form of nausea. The recommended single dose of tablets is no more than 1.5 g, and the maximum daily dose is 3-4 g, evenly distributed over 3-4 doses. Syrup for adults is recommended in a dose of 20-40 ml 3-4 times a day.

From the aminopenicillin group, if necessary, you can use amoxin - white tablets of broad-spectrum antibacterial action, the active substance is amoxicillin. Contraindicated in case of allergy to the components of the drug, diseases of the gastrointestinal tract, kidneys, liver. Use with caution in pregnant women and during lactation. Amoxin can cause side effects in the form of nausea, vomiting, diarrhea, stomatitis, dizziness, anxiety, insomnia. The dose is 0.5 g three times a day, regardless of food intake.

Cephalosporins are bactericidal drugs or beta-lactam antibiotics, the mechanism of action of which is the destruction of bacterial cell walls. There are 5 generations of them, depending on the spectrum of action, structure and resistance to the action of bacterial enzymes on the antibiotic, as well as the method of administration into the body. Here are some of them: cephaloridine, cefazolin, cefoxitin, cefotaxime, cefpodoxime, cefodox, cefepime, ceftobiprole, ceftolozane, etc.

Cefodox is a 3rd generation drug that can be used by pregnant women for cystitis and pyelonephritis. It is available in powders and tablets. It is contraindicated in case of allergy to the components of the drug. 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 of pregnancy, as well as at other times, expectant mothers need vitamins A, C, D, and iron (30-60 mg per day). Iron deficiency can lead to muscle weakness. You can replenish your body with this element by eating meat, fish, and eggs. Iron found in plant foods is absorbed worse than in animal products. It is not recommended to drink tea or coffee with food, as they interfere with its absorption. Therefore, it is best to drink juice or compote after eating. Vitamin C is necessary to strengthen the immune system. Its need for an expectant mother is 100 mg per day. Currants, sweet peppers, lemon, orange, strawberries, kiwi are foods rich in this vitamin. Vitamin D forms a healthy cardiovascular system of the child, prevents the occurrence of rickets. The daily requirement for it is 400 mg. It is not possible to provide the body with this vitamin completely through food, because It is found in small quantities in egg yolk, cod liver, some types of fish, butter, and milk.

Physiotherapy treatment

Physiotherapeutic treatment is widely used in gynecology, along with medication and homeopathic treatment. Even during early pregnancy, physical therapy is used, since they can sometimes replace harmful medications for the fetus in their effect on the focus of pathology. But at 40 weeks of pregnancy, you should not expose yourself and your child to magnetic, electrical, or ultrasound effects.

Folk remedies

If it is time to give birth, then traditional medicine will not help and the only prescription is to go to the maternity hospital. But if a pathology is diagnosed, then you can carefully resort to some recipes that will not harm the fetus. So, in case of inflammatory processes of the urinary tract, intestines, you can drink herbs that have an antiseptic effect, but in no case douching should be done so as not to provoke premature birth.

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Herbal treatment

Well-known and widely used herbs in urology: bear's ears, corn silk, pol-pala, horsetail, birch buds, which have a diuretic and disinfectant effect, are not all recommended for pregnant women. Some of them irritate the muscles of the uterus, causing its increased tone. Before preparing decoctions and infusions, you should still familiarize yourself with the contraindications or consult a doctor, and it is also advisable to make them single-component. Alcohol tinctures should not be taken. Here are some decoction recipes:

• Pour 10g of corn silk into a glass of hot water, bring to a boil and keep on the fire for several minutes. Drink a third of a glass 30 minutes before meals;
• 2 teaspoons of half-pala per glass of water are brought to a boil and boiled for 5 minutes, then infused for several hours. Taken warm through a straw, 50 g half an hour before meals.

For intestinal discomfort, flatulence, which can also cause a pulling sensation in the lower abdomen, chamomile is a good choice. It is prepared simply:

• Pour 1 tablespoon into a glass of boiling water and leave for an hour, it is good to use a thermos for this. Take a third of a glass before meals.

But herbs such as bearberry, birch buds, horsetail, wild strawberries, parsley root, and juniper berries are contraindicated for pregnant women due to their ability to provoke uterine contractions.

Homeopathy

If inflammatory processes are detected in the genital area, which is the source of pulling sensations in the lower abdomen at 40 weeks of pregnancy, a homeopathic remedy such as Kanefron can be used for treatment.

Canephron - thanks to the components of plant origin included in it (lovage root, centaury, rosemary), the drug affects the foci of inflammation, is an anti-edematous and antispasmodic agent. Available in tablets. There are practically no contraindications. Side effects are possible with an allergy to the component of the drug. Patients with diabetes should take it with caution, since the product contains carbohydrates. Drink without chewing three times a day for two weeks to a month.

Viburkol suppositories are widely used during pregnancy to treat inflammation of the genitals, to reduce uterine tone, and to eliminate flatulence.

Viburcol is a safe homeopathic remedy that not only eliminates infection, but also activates the body's defenses. It is available in the form of suppositories that are inserted deep into the rectum, after which it is necessary to lie on your side for 10 minutes. Two suppositories are recommended per day, in the morning and in the evening. The drug has virtually no contraindications. Side effects include the urge to empty the bowels. It can be used along with other treatments.

Medicines such as caulophyllum and pulsatilla will help prepare for childbirth and soften the cervix.

Caulophyllum is considered a female root, taken twice a day, three balls, starting two weeks before the expected birth.

Pulsatilla - the drug is based on dilutions of rubbings of the pasque flower herb. The spectrum of action of the drug is quite wide, so the doctor's prescription will determine the dose and frequency of administration. There are practically no contraindications, except for individual intolerance to the herb. It is produced in granules (dilutions D3, D6, D12, D30, D200).

Surgical treatment

Surgical treatment at 40 weeks of pregnancy may be necessary if acute appendicitis is diagnosed. In this case, the appendix is removed and a cesarean section is performed at the same time. This type of delivery is also used for uterine bleeding caused by placental abruption. Surgical intervention cannot be avoided if the ovarian cyst stalk is twisted or ruptured.

Prevention

It is impossible to predict and prevent all the complications that may lie in wait for a woman on the way to becoming a mother. But every expectant mother should do everything in her power to go through this path feeling good and in a good mood and to give her baby a healthy start. The best prevention of all possible troubles will be a healthy lifestyle, consisting of proper nutrition, walks in the fresh air, giving up bad habits, reducing physical and emotional stress.

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Forecast

With a timely response to failures in the functioning of the complex "woman-fetus" system and competent intervention of specialists, the prognosis for childbirth is favorable. It is worth remembering that at 40 weeks of pregnancy, the fetus is already full-term, ready to leave the mother's womb and exist outside her body.

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