Now 40 years old, the elderly mother Xiao A, who had intussusception surgery at the age of 1, was found to have uterine fibroids 10 years ago, when there was no special treatment, last year, the fibroids have grown to nearly 8 cm in size, and in the same year, she was found to have subclinical hypothyroidism (hereinafter referred to as "hypothyroidism"). Due to unexplained infertility, she chose to go to IVF, but nutritional screening at 9 weeks of pregnancy found hyperhomocysteinemia, elevated glycosylated albumin, high folic acid, vitamin D deficiency problems... Advanced age, test tubes, uterine fibroids, hypothyroidism, these keywords each need pregnant mothers to be highly vigilant, today, Peking Union Medical College Hospital obstetrics experts on these situations are analyzed, hoping to give the majority of pregnant mothers some inspiration.
About the author: Ma Liangkun
Chief Physician of the Department of Obstetrics, Peking Union Medical College Hospital, specializes in perinatal health care, obstetric complications and comorbidities, prenatal diagnosis and genetic counseling.
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With the liberalization of the three-child policy, more and more families choose to have another baby, and many pregnant mothers are already in an advanced state of age at this time. All pregnant women over the age of 35 in the expected date of delivery are considered to be pregnant at an advanced age, and the advanced age itself increases the risk of embryonic discontinuation in the first trimester, the risk of fetal chromosomal abnormalities and deformities in the second trimester, and the risk of pregnancy complications and complications of pregnant women suffering from gestational diabetes and gestational hypertension, as well as contractions during childbirth, dystocia, postpartum hemorrhage, etc., which will make the pregnancy process more difficult.
Little A is now 40 years old, belongs to the orange risk of pregnancy risk grading, then it is necessary to do "manage their own things, regardless of God's affairs", age is already an immutable factor, rather than worrying about these risks, lamenting that the years are not easy, it is better to strengthen the learning of pregnancy knowledge, manage their own lifestyle, do their best to reduce the risk that can be reduced, and at the same time treat the results that cannot be changed with an accepting attitude. (Specific operation strategies we will be launched in the follow-up, welcome pregnant mothers to continue to pay attention to ~~)
IVF
At present, there are not a few couples who achieve pregnancy through assisted reproductive means such as IVF for various reasons, but compared with the natural pregnancy process, IVF pregnancy is more likely to bring psychological pressure to pregnant mothers.
If there is tension and anxiety, the couple can seek psychological counseling, and it is necessary to relieve tension through mindfulness meditation. Pregnant mothers with symptoms such as anxiety, depression, and insomnia in IVF pregnancy or poor maternal history are recommended to go to the perinatal psychological counseling clinic, and can also participate in balint group, sculpture, group counseling and other experiential classes for pregnant women.
Hypothyroidism
Subclinical hypothyroidism is becoming more common in the general population, and pregnant women are also prone to fluctuations in thyroid function due to changes in hormone levels during pregnancy. Little A had subclinical hypothyroidism before pregnancy and began to take Eucalyptus therapy, coupled with increased thyroxine requirements in the first trimester, requiring regular monitoring and review of thyroid function, as well as the need to know the nutritional status of iodine, including serum iodine and urinary iodine creatinine levels.
Some families with thyroid disease patients will blindly choose uniodized salt, resulting in the whole family being in a state of iodine deficiency, but the demand for iodine during pregnancy will rise from 160 micrograms per day before pregnancy to 230 micrograms, and severe iodine deficiency in pregnant mothers will lead to infantile insignia, affecting the growth and development of children and intelligence. Therefore, during pregnancy, normal thyroid function and reasonable iodine nutrition status should be guaranteed to reduce the impact on pregnancy and fetus, of course, if the corresponding prevention and treatment is carried out before pregnancy, such as thyroid function and iodine nutrition status assessment and adjustment, it is more ideal.
Uterine fibroids
Uterine fibroids are the most common gynecological benign tumors, occurring in about 20% to 30%, mainly in women of childbearing age. With the development and popularization of medical imaging technology, especially ultrasound technology, the actual incidence of uterine fibroids may be higher, which means that more and more women may find uterine fibroids before giving birth. So what is the impact of uterine fibroids on pregnant mothers who are pregnant and have uterine fibroids?
Taking Small A as an example, her uterine fibroids are 7.6 * 4.9 cm, located in the lower part of the posterior wall, the size is close to a medium-sized apple, belonging to the intermuscular fibroids, growing in the uterus will have many effects on pregnancy and childbirth, if the fibroids are too large or located in the lower part of the uterus, it may cause the following effects on pregnancy, childbirth and the postpartum stages.
1. Threatened miscarriage in the first and second trimesters of pregnancy.
2. Threatened preterm birth in the third trimester, fetal position is not correct, membrane rupture, as well as dystocia during childbirth, caesarean section, midwifery and postpartum hemorrhage.
3. Menorrhagia, secondary anemia and iron deficiency caused by uterine fibroids will also increase the risk of anemia during pregnancy and postpartum.
4. Pregnancy also has an impact on fibroids, and some pregnant women may develop red degeneration of uterine fibroids during pregnancy, which is manifested by rapid enlargement of fibroids, abdominal pain, fever and elevated blood picture.
Once the above situation occurs, I believe that many doctors and pregnant mothers will be worried, so they choose bed rest and reduce activity to avoid or reduce risk. However, it should be noted that the impact of bed rest and braking will be greater, such as:
1. Negative emotions. Pregnant mothers will frequently brush their mobile phones on long-term bed rest, and once they see negative news, it is easy to fall into a vicious circle of negative emotions such as anxiety.
2. Negative emotions often affect appetite, resulting in normal weight increase during pregnancy, increasing the risk of multiple malnutrition such as anemia and low protein. Lack of sun exposure can cause vitamin D deficiency or even depletion, increase the risk of fetal calcium deficiency, and affect fetal bone and dental health.
3. Atrophy of muscles throughout the body. Pregnant mothers who have been hospitalized for several months are so weak that they fall and cannot walk when they get out of bed for the first time, and at the same time, they will also cause bloating discomfort in the lower abdomen and increased feelings of contractions due to insufficient strength of the core muscles, resulting in threatened premature birth or the need for medical intervention.
4. Immobilization and hypercoagulable state during pregnancy will also increase the risk of deep vein thrombosis of the lower extremities. This refers to the abnormal coagulation of blood in the deep vein, the formation of a blood clot (blood clot), so that the lumen of the vein is partially or completely occluded, and the lower extremities are the most common site of deep vein thrombosis. If a blood clot breaks off into the circulatory system and embolizes (blocks) the pulmonary artery, it can cause respiratory and circulatory dysfunction or even death.
After pregnancy, the gradually enlarged uterus compresses the inferior vena cava and iliac veins, making the venous return flow worse and the blood flow of the lower limbs slows down. The placenta produces a large amount of estrogen during pregnancy, which promotes the liver to produce various coagulation factors, resulting in a hypercoagulable state of blood. Coupled with the decrease in the amount of activity caused by braking, the blood flow in the lower limbs is slowed down, so pregnant women who are bedridden and immobilized are prone to deep vein thrombosis of the lower limbs. If the pregnant mother's lower limbs suddenly appear swollen in a short period of time, it is necessary to be careful, because the thrombosis blocking the venous return will cause edema of the affected limb and require immediate examination in the hospital.
5. Women secrete a large amount of progesterone after pregnancy, and these progesterones will reduce the motivation of gastrointestinal peristalsis. When the gastrointestinal tract is not enough water and food residues are more, it is easy to lead to fecal dry knots are not easy to excrete, the ever-enlarging uterus will cause mechanical compression of the gastrointestinal tract, bedridden pregnant mothers will also increase the risk of constipation because of insufficient dietary fiber intake, insufficient activity, insufficient drinking water, and constipation, coupled with insufficient abdominal wall muscle contractility at this time, it will be easier to cause constipation. Long-term constipation can lead to varicose veins around the rectum, the formation of hemorrhoids, due to difficulty in defecation, pregnant mothers often need to spend more effort to excrete feces, which in the long run will lead to fissures and generate bad emotions.
Constipation is also a manifestation of the microecological imbalance of pregnant mothers, that is, the state of harmful bacteria exceeding that of beneficial bacteria. Recent studies have shown that mothers and newborns share bifidobacterium colonies, the state of the mother's intestinal flora affects the establishment and health of the microflora in newborns, and the abnormal microbiota of pregnant women increases the risk of offspring obesity, allergies, autism and other diseases.
6. Pregnant mothers on bed rest may reduce the amount of water they drink because they are not accustomed to urinating in bed or getting out of bed to go to the toilet, thereby increasing the risk of urinary tract infection, which in turn will increase the risk of fever, uterine contractions, and premature birth.
These are all problems that may occur after bed rest is immobilized, and various relevant literature does not support "bed rest can reduce the probability of threatened miscarriage and threatened preterm birth".
So, there are so many risks of elderly women with uterine fibroids, how should we prevent it? Stay tuned to "Doctor Concordia Says" this Friday and we'll continue to answer your questions.
Image/Courtesy of the author
Editor/Hong Chengwei
Editor-in-Chief/Chen Mingyan
Producer/Wu Peixin