Fetal kidney stones are very rare pathology. In an adult, on scanograms they are defined as oval-shaped hyperechoic formations that give an acoustic shadow if their thickness exceeds 5 mm. In the fetus, due to the small size of the cameos, acoustic leakage is never observed. On scanograms of the fetus, they are defined as oval-shaped hyperechoic formations, the length of which is usually 3-5 mm, thickness - 2-3 mm.

The fetal bladder begins to be detected on scanograms at 12-13 weeks of gestation. On transverse scanograms it is defined as round, and on longitudinal scans it is defined as an echo-negative oval-shaped formation with clear, even contours, completely devoid of internal echo structures.

The size of the bladder is subject to significant individual fluctuations and depends on the degree of its filling. Emptying of the bladder occurs completely or fractionally, i.e. in parts. In some cases, in the amniotic fluid at the location, one can observe the appearance of a turbulent flow, the occurrence of which is caused by emptying the bladder.

Anomalies of the bladder and urethra are rare. In the antenatal period, the following malformations are mainly observed: bladder exstrophy, ureterocele, urethral atresia, posterior urethral valve, pmne-bUy.

Bladder exstrophy - congenital disease, characterized by a defect in the lower abdominal wall and the absence of the anterior wall of the bladder. This malformation is extremely rare - 1:45,000 newborns. In boys, this defect is often combined with total epispadias, and in girls, with anomalies of the uterus and vagina. The main echographic sign of bladder exstrophy is the absence of its image on scanograms, while the size and structure of the kidneys remain normal.

The amount of amniotic fluid is also unchanged. The diagnosis of exstrophy can be made as early as 16-18 weeks. Treatment is only surgical. Taking into account the large number of unsatisfactory long-term results, the question of the advisability of further continuation of pregnancy must be decided together with specialists working in the field of pediatric urology.

Ureterocele is often detected only at the end of pregnancy and mainly with pronounced dilation of the ureter. Due to the fact that this pathology is almost always accompanied by pyelonephritis, urethritis and cystitis. in the immediate period after birth, the child must be sent to a specialized hospital for further examination and treatment.

Urethral atresia is an extremely rare developmental defect. The main echographic sign of this pathology is a pronounced enlargement of the bladder in the complete absence of amniotic fluid. Bladder enlargement begins to be detected from 14-15 weeks of pregnancy.

By the end of the second and beginning of the third trimester of pregnancy bladder increases so much that it can fill the entire abdominal cavity. In turn, this leads to a significant increase in the abdomen.

In most cases, hydronephrotic transformation of the kidneys and dilation of the ureters of varying severity are noted. In case of urethral atresia and bilateral severe hydronephrosis, termination of pregnancy is indicated.

A bladder diverticulum is a blind ending protrusion of its wall. Diverticula can be single or multiple. The wall of the diverticulum consists of the same layers as the bladder, the muscle layer is hypoplastic. The pathogenesis is explained by congenital inferiority of the muscle layer. On scans it is identified as a small round or, less commonly, oval cystic protrusion of the bladder.

The disease is more common in male patients. Small asymptomatic diverticula usually do not require treatment; larger ones must be excised.

In most cases of this malformation, it is possible to identify a dilated proximal part of the urethra, which is depicted on scanograms as a small tubular structure located in the lower parts of the bladder. In many cases, megaureter and hydronephrosis are observed. Considering that the urethral valve causes intravesical obstruction, leading to severe disruption of urodynamics, and in most cases is accompanied by cystic ureteral reflux, in severe forms of the defect, termination of pregnancy should be considered appropriate.

Prune-belly syndrome is a combination of hypoplastic anterior abdominal wall muscles, urinary tract obstruction, and cryptorchidism. It is manifested by hypotension and atrophy of the muscles of the anterior abdominal wall, large atonic bladder, dilatation of the ureters and cryptorchidism.

Frequency of occurrence of the defect: one case per 40,000 newborns. It is observed approximately 15 times more often in boys than in girls.

When diagnosing this pathology, it should be borne in mind that, unlike urethral atresia, with prune-belly syndrome, amniotic fluid is detected. Ultrasound diagnostics syndrome is possible as early as 15 weeks of pregnancy.

The level of urinary tract obstruction below the bladder manifests antenatally as megacystis. An increase in the size of the bladder during antenatal ultrasound may be due to the following reasons: abnormalities in the development of the urethra (atresia, agenesis, strictures, stenosis, posterior urethral valves), prune belle syndrome, megacystis-microcolon-intestinal hypoperistaltic syndrome.

Posterior urethral valve
The posterior urethral valve is a congenital fold of mucosa in the posterior part of the urethra (prostatic or membranous part), it prevents emptying of the bladder.

Epidemiology
Urethral valves are the main causes of bladder outlet obstruction and account for 40% of all obstructive bladder-level uropathies. The frequency of this pathology in men is 1:8000, and in very rare cases, a similar picture in female fetuses can be caused by agenesis (atresia) of the urethra.

Etiology
The source of the membranous form of the valves are the residual folds of the urogenital membrane formed at the border of the anterior and posterior urethra.

The pathogenesis of secondary changes in the urinary system with the posterior urethral valve is a step-by-step, gradually worsening dystrophic process, spreading from the area of the main urethral obstruction to the kidneys. This anomaly of the urethra creates an obstacle to the flow of urine during urination, as a result of which the prostatic part of the urethra expands, trabecularity of the walls and hypertrophy of the bladder neck occurs, and vesicoureteral reflux develops, leading to damage renal parenchyma and renal dysfunction.

Antenatal diagnosis
Antenatal ultrasound picture of bladder outlet obstruction is characterized by persistent dilatation of the bladder, which does not improve with dynamic observation. The walls of the bladder are thickened by more than 2 mm; in most cases, dilatation of the bladder is combined with expansion of the overlying parts of the urinary tract (megaureter, ureterohydronephrosis), and this process is bilateral.

In prenatal diagnosis, unfavorable signs include: oligohydramnios, increased volume of the bladder with thickening of its walls, bilateral expansion of the renal collecting system, dilation of the posterior urethra. The situation is especially aggravated if these signs appeared before the 24th week of gestation and progress rapidly. The prognosis is more favorable if the signs of bladder outlet obstruction are moderate, appear no earlier than the 24th week of gestation, progress slowly and at the same time a normal or slightly reduced amount of amniotic fluid remains, slight hypertrophy of the bladder walls, normal size and structure of the kidneys, or unilateral ureterohydronephrosis.

Fetal interventions
Currently, during the antenatal diagnosis of megacystis, some specialists have begun to use vesico-amniotic shunting for treatment. According to them (G. Bernaschek), this procedure allows for fetal survival of up to 70%. However, it is noted that the final cause of the development of obstruction, which determines the prognosis of the disease, cannot be identified antenatally. Because the presence of obstructive uropathy increases the risk of detecting chromosomal abnormalities, prenatal karyotyping should be performed before shunt placement. To determine kidney function, a puncture of the enlarged bladder or renal pelvis is performed, followed by biochemical analysis the resulting urine. Installation of a vesico-amniotic shunt is advisable no later than 20-22 weeks of gestation. However, even despite timely and correctly performed intrauterine intervention, there remains a high probability unfavorable outcome due to the development of pulmonary hypoplasia. The main advantage of antenatal diagnosis is that it provides the opportunity early treatment immediately after the birth of the child, before a secondary infection occurs.

Clinical picture
The posterior urethral valve is characterized by an abundance of various symptoms, among which there are local ones, indicating a urethral obstruction, and general ones, resulting from additional complications. Clinical manifestations in newborns include: urinary retention, full bladder, enlarged kidneys ( volumetric formations palpable in the lateral regions abdominal cavity). When urinating, urine is released in the form of a sluggish stream or drops. It is possible that a secondary infection can occur very quickly.

Diagnostics
The diagnosis of posterior urethral valve can be confirmed by voiding cystourethrography. It reveals: enlargement of the prostatic part of the urethra, an increase in the volume of the bladder with signs of trabecularity of its walls, massive one- or two-sided active-passive vesicoureteral reflux; when urinating, emptying occurs inadequately; the urethra cannot be traced along its entire length. At the valve level, the hourglass symptom is determined.

Treatment
Treatment begins with eliminating the obstruction. First of all, a urethral catheter is installed, and water-electrolyte imbalance and acidosis are corrected. After the child’s condition has been stabilized, electroresection of the valve is performed using endourethral access (as a rule, this manipulation can be performed at the age of 1 to 2 months). In patients with a posterior urethral valve, one of the causes of urinary dysfunction is neurogenic bladder dysfunction, and one should not expect complete restoration of lower urinary tract functions without conservative treatment. Even with a successful operation of destruction of the posterior urethral valves, there is no complete restoration of the functional ability of the urinary tract, although their stabilization without further deterioration is noted.

Prune-Belli syndrome
Prune belle syndrome (Eagle-Barrette syndrome, plum belly syndrome, etc.) is characterized by three main signs: hypoplasia or complete absence of the muscles of the anterior abdominal wall, a large atonic bladder (often combined with bilateral megaureter) and bilateral cryptorchidism.

Epidemiology
The disease is rare, its frequency is 1 case per 35,000-50,000 newborns. In girls, although rare (about 5% of all cases), an incomplete form of the syndrome occurs. Most cases of prune belle syndrome are sporadic; in the literature there are references to its combination with chromosomal abnormalities (trisomy of chromosomes 13, 18 and 45).

Etiology
There are several theories regarding the etiology of prune belle syndrome, but none of them explains all of its manifestations. According to one version, obstruction of the lower urinary tract in the prenatal period leads to a sharp expansion of the ureters and pyelocaliceal system of the kidneys, and under the influence of prolonged pressure, atrophy of the muscles of the anterior abdominal wall occurs. In addition, prune belle syndrome can be caused by disturbances in the embryogenesis of the yolk sac and allontois.

Antenatal diagnosis
Ultrasound diagnosis of prune belle syndrome is possible from 14-15 weeks of pregnancy. At the beginning of the second trimester, the main echographic sign is megacystis, while the bladder can occupy most of the fetal abdominal cavity. In the II-III trimester, the echographic picture shows a sharply dilated, non-emptying bladder with hypertrophy of its walls and thinning of the anterior abdominal wall. With a pronounced process, a picture of bilateral ureterohydronephrosis and oligohydramnios appears. As a result of the progression of pathological changes, urinary ascites may develop.

Prenatal examination should include karyotyping and careful ultrasound with detailed assessment of the anatomy of the internal organs and the fetal face. The detection of prune belle syndrome, combined with severe oligohydramnios, indicates complete atresia of the urinary tract (if there is no obstruction of the urinary duct), renal failure develops already in utero. This most severe form of pathology often causes intrauterine fetal death (up to 20%) and another 50% of children die in the first days of life from acute respiratory failure associated with pulmonary hypoplasia due to oligohydramnios. Therefore, if this situation is identified, termination of pregnancy should be offered at any time, since the prognosis for this combination is extremely unfavorable. Intrauterine bladder decompression can prevent the development of the full picture of the syndrome. However, the success rate of antenatal interventions is low.

Clinical picture
The first thing that catches the eye when examining a newborn with prune belle syndrome is the folded, wrinkled anterior abdominal wall, reminiscent of a prune. When a child begins to stand and walk, a protrusion of the abdomen is noted due to muscle weakness. It is difficult for such children to maintain balance, so their motor activity is sharply limited. In addition, weakness of the muscles of the anterior abdominal wall leads to frequent infections respiratory tract and constipation. The prognosis depends mainly on the severity of the urinary tract lesion. Ultrasound and X-ray examination reveals sharply dilated, tortuous ureters, an overstretched bladder with a thinned wall, and a patent urinary duct. The ureters are hypotonic and peristalt very weakly. In 70% of patients, bilateral vesicoureteral reflux is detected. The posterior urethra is sharply dilated, the prostate gland is hypoplastic or absent. All patients with prune belle syndrome are infertile, which is likely due to abnormalities of the epididymis, seminal vesicles, and vas deferens.

Treatment
Treatment is selected individually, depending on the severity of the syndrome. Initially, the main efforts are aimed at maintaining kidney function and preventing infections. Despite the dilation of the urinary tract, due to the absence of obstruction, the pressure in it is usually low, so surgery can be postponed until later in life. Newborns are operated on only when symptoms of obstruction appear and renal function deteriorates. Interventions are aimed at temporary diversion of urine, for which an epicystostomy or nephrostomy is performed. Later, such patients require reconstructive surgery. The volume and stages of treatment are determined in each specific case.

Bladder exstrophy
Bladder exstrophy is a congenital absence of the anterior wall of the bladder and the corresponding part of the abdominal wall with eversion (inversion) of the posterior wall of the bladder through the resulting hole. Incomplete exstrophy is the absence of the anterior wall of the bladder, with preservation of the sphincters of the bladder and urethra.

Epidemiology
The frequency of this defect is on average 1 case per 40,000-50,000 newborns. Bladder exstrophy is more common among boys, with a ratio of 5:1 or 6:1. The defect is typical for children of young mothers and women who have given birth many times.

Pathophysiology
Bladder exstrophy affects the urinary tract, genitals, pelvic musculoskeletal system, and sometimes the gastrointestinal tract.

There is a divergence of the pubic symphysis associated with improper formation of the innominate bones. Generally bony pelvis turned downwards and the sacrum has a larger volume and a larger surface. A defect of the anterior abdominal wall, as a rule, starts from the navel, which is located lower than usual, and to the articulation pubic bones. The distance between the navel and anus is shortened. In boys, the short and wide penis is split along the dorsal surface. The urethra is located in front of the prostate. There are no testicles in the scrotum, but they are developed normally. In girls with bladder exstrophy, the vagina is shorter than normal, but has a normal width. The clitoris is bifurcated, the labia and pubis are separated. Incorrect development pelvic floor creates the preconditions for genital prolapse. At birth, the bladder mucosa may be normal or with hamartomatous polyps. The exstrophied bladder can have different sizes, distensibility and neuromuscular regulation, which is important for performing reconstructive interventions.

Prenatal diagnosis
The main echographic prenatal signs of bladder exstrophy are as follows:
- lack of visualization of the bladder with unchanged kidney structure and normal quantity amniotic fluid;
- low umbilical cord attachment;
- additional low-lying echo of a formation outside the abdominal cavity, which is an exstrophied bladder;
- expansion of the arches of the pubic bones;
- abnormalities of the genitals.

Differential diagnosis antenatally should primarily be carried out with such congenital defects as omphalocele, gastroschisis, cloacal exstrophy.

Associated developmental anomalies
Combined defects in bladder exstrophy are rare and are represented by anomalies of the heart, lungs, lumbar region spine. Bladder exstrophy can be combined with such anomalies as unilateral or bilateral inguinal hernias, weakness of the anal sphincter and rectal prolapse, vaginal duplication, anomalies of the sigmoid colon, ureterohydronephrosis, unilateral or bilateral cryptorchidism, anorectal defects, underdevelopment of the sacrum and coccyx, myelodysplasia.

Lead tactics
After prenatal diagnosis, various tactics are possible: termination of pregnancy or timely preparation for immediate surgical intervention after the birth of the child. Accurate prenatal diagnosis is important for detailed recommendations to the family, and decision-making rests entirely with the expectant parents. If a decision is made to prolong pregnancy, an accurate prenatal diagnosis of the main defect and accompanying malformations is necessary for appropriate perinatal management of the pregnant woman and the fetus by obstetricians, pediatric surgeons, urologists, neurosurgeons and neonatologists. Currently, there is no convincing data on the need caesarean section with exstrophy of the bladder in the fetus. Infants with bladder exstrophy should be born in a perinatal center where emergency neonatal care is available.

Helping a newborn in the delivery room
After the baby is born, the bladder mucosa should be covered with a sterile plastic bag to prevent contact with the diaper or clothing. Immediately after birth, the child’s condition and the size of the bladder platform are assessed to decide whether it is possible to perform primary reconstructive surgery.

Clinical picture
The clinical picture of bladder exstrophy is characteristic and consists of the following signs: in the lower abdomen there is a defect in the anterior abdominal wall, into which the posterior wall of the bladder opens in the form of a bright red formation. There is a divergence of the rectus abdominis muscles with a splitting of the umbilical ring, which is adjacent to the upper edge of the defect. The mucous membrane of the bladder is easily vulnerable, often covered with papillomatous growths and bleeds easily. The diameter of the vesical plate can vary from 3 to 7 cm. In the lower part of the mucous membrane of the bladder there are the orifices of the ureters, from which urine is constantly secreted. Boys almost always have epispadias, the penis is underdeveloped and shortened, pulled up to the anterior abdominal wall, the cleft urethra is in contact with the mucous membrane of the bladder, and the scrotum is undeveloped. In girls, cleft of the clitoris, cleft or absence of the urethra, and adhesions of the labia majora and minora are detected.

Diagnostics
Exposed bladder and deformed genitals are visible immediately after the birth of the child. Diagnostics is mainly aimed at identifying concomitant malformations, determining the condition of the urinary tract and the presence of infection. Treatment
In case of birth of a child with bladder exstrophy in accordance with international standards It is advisable to correct this defect in the early stages (the first 1-2-3 days after birth). So early operations are caused by the possibility of reducing the bones of the pubis in patients with exstrophy of the bladder without osteotomy (intersection iliac bones) - while the bones remain plastic. IN recent years More and more specialists are inclined towards early plastic surgery of the bladder with local tissue. This was largely facilitated by reports of numerous complications after operations to divert urine into the intestines. However, it is not always technically possible to perform adequate primary repair and achieve urinary continence in most patients with bladder exstrophy. Creating a bladder from local tissue is possible with a diameter of the vesical plate of at least 3 cm. Smaller dimensions of the posterior wall of the bladder are an indication for transplantation of the ureters into the sigmoid colon or an isolated intestinal segment. The most common technique now is step-by-step correction with early restoration of the integrity of the bladder, posterior urethra and anterior abdominal wall and performing osteotomy of the pelvic bones. Epispadias are eliminated between the ages of 6 months and 1 year; reconstruction of the bladder neck with reimplantation of the ureters - at the age of 4-5 years.

If a child with bladder exstrophy was born in a serious condition due to concomitant pathology or is not fully term, early surgical intervention is postponed. In this case, it is necessary to direct therapeutic measures to prevent or reduce inflammation of the bladder area and maceration of the surrounding skin. Once the child’s condition has stabilized, one should return to the question of the possibility of performing primary plastic surgery of the bladder, but with an osteotomy. The bladder is closed, but no attempts are made to tighten the bladder neck. After successfully undergoing the first stage of correction of bladder exstrophy, the patient at an older age will have to undergo several more surgical interventions on plastic surgery of the external genitalia, formation of the urethra and navel, lengthening of the penis.

Forecast
Despite the treatment, patients continue to have partial or complete urinary incontinence due to the small volume of the bladder and underdevelopment of the sphincter mechanisms.

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The bladder puts pressure on the fetus

Why does the fetus put pressure on the bladder during pregnancy?

Literally from the first days of pregnancy, changes begin to occur in a woman’s body aimed at preparing her body for long-term gestation and childbirth.

Pregnancy

This is a psychological restructuring, a change in hormonal background, which affect the functioning of almost all organs and systems, anatomical changes.

As pregnancy progresses, the fetus grows, and the enlarging uterus puts pressure on all nearby organs, especially the bladder.

The structure of the female genitourinary system

The functions of filtering blood plasma and producing urine are performed by the kidneys. On the outside they are covered with a capsule of connective tissue, and under it there is the so-called parenchyma.

It consists of functional cells - nephrons. Plasma passes through their system of glomeruli and tubules, and toxic metabolic products are filtered out.

As a result, urine is formed. It enters the ureter through the system of the calyces and renal pelvis.

Then, thanks to reflex periodic contractions of its walls, urine from the kidney enters the bladder, and from it is released from the body through the urethra.

The bladder is an organ for storing urine. Its average volume is 700 ml. It is located in the lower abdomen, in the pelvic cavity.

In women, the back surface of the bladder is in contact with the uterus and vagina.

The anatomical structure of the bladder includes the following sections:

the apex, which is located in front at the top;
body – the middle and largest part;
bottom located at the bottom at the back;
the neck (or bladder triangle), which is located at the bottom of the bladder and connects to the ureter.

The wall of the bladder consists of three layers. Inside it is lined with a mucous membrane, which is covered with cells transitional epithelium.

On average, there are three layers of smooth muscle muscles - two longitudinal and one circular. And the outer layer partly consists of connective tissue.

On the inner surface of the bladder, with the exception of the neck, the epithelium forms well-defined folds. As they fill, they straighten out, and the shape of the bladder becomes oval or pear-shaped.

Changes during pregnancy

During fetal development, a number of factors affect the organs of the urinary system.

She now works with increased load, removing from the mother’s body not only the products of her metabolism, but also the products of the fetus’s metabolism.

A special period in a woman's life

Expansion of the renal calyces and pelvis, spasm, or vice versa, atony of the ureters and bladder are due to several reasons.

The placenta surrounding the fetus additionally produces progesterone. The concentration of this hormone is tens of times higher than its amount before pregnancy.

It affects the functioning of smooth muscle muscles of organs gastrointestinal tract and genitourinary system.

In addition, due to the anatomical location of the uterus, as the fetus increases in size, it puts pressure on the bladder and ureters located in close proximity.

With mechanical compression, the outflow of urine is disrupted, and the pressure in the renal calyces and pelvis increases. Since the uterus puts pressure on the bladder, urine can be “thrown” back into the kidneys.

Diseases of the urinary system

As the fetus develops and grows, the uterus puts more and more pressure on nearby organs.

Problems in pregnant women

The risk of developing an inflammatory process in the kidneys increases. This is especially dangerous for women with previous or chronic diseases urinary system.

The source of infection can be localized in the kidney parenchyma (glomerulonephritis) or in the collecting system (pyelonephritis).

Symptoms of these diseases:

increased temperature, low-grade is observed with glomerulonephritis, high - with pyelonephritis;
aching pain in the lumbar region;
general deterioration of condition, fatigue, low performance, drowsiness;
frequent urination;
increased blood pressure;
swelling.

Changes also appear in clinical analysis urine. Bacteria, leukocytes, protein, and possibly red blood cells appear.

Urinalysis

For the treatment of these diseases it is prescribed antibacterial drugs, which do not harm the fetus, restoratives, immunostimulating agents, vitamins.

Particular attention should be paid to bacterial inflammation of the bladder - cystitis. In women, this disease occurs quite often.

The infection enters the bladder through the urethra. During pregnancy, the risk of this disease is very high, since the fetus in the uterus puts pressure on the bladder, as a result of which urodynamics are disrupted.

The main symptom of cystitis is a sharp stabbing pain in the lower abdomen, frequent, sometimes false, urge to urinate. A slight increase in temperature is possible.

In a laboratory study of urine, in addition to bacteria and leukocytes, transitional epithelial cells appear, which cover the inner surface of the bladder.

Sometimes taking uroseptics is enough to treat cystitis. Antibiotics are prescribed only in severe cases. The main thing in treatment is its timely start. Advanced cystitis will cause the infection to rise up into the kidneys.

When an enlarged uterus puts pressure on the bladder, urolithiasis may worsen. Stones can vary in shape, size, and composition.

Before pregnancy, a woman may not have been aware of her illness. But changes in the contours and size of the bubble as the fetus grows will definitely make it known.

Large stones are more often found in the kidneys. Small fragments or crystals reach the bladder. But with their sharp edges they injure its walls, as well as the inner mucous membrane of the urethra.

This causes severe burning and sharp pain. They are especially intensified during urination. In a urine test, blood appears (sometimes it is visible to the naked eye), epithelial cells of the bladder and urethral mucosa, and salt.

The situation is worse when the fetus puts pressure on the ureter and the stones are in the kidneys. In such cases, due to blockage or spasm of the ureter, renal colic.

Acute pain

To facilitate the passage of stones from the bladder, antispasmodic drugs are prescribed (for example, no-spa is absolutely safe for the fetus) and painkillers.

To monitor and timely diagnose pathological processes in the bladder during fetal development, it is imperative to regularly undergo a general urine test. Bacterial culture is also done several times during pregnancy.

This is necessary, since some inflammatory processes can be asymptomatic. Also, during a fetal ultrasound, an ultrasound of the bladder and kidneys is usually performed to assess their condition.

Pregnant women with a history of urinary system diseases are given special attention. For them, the list of mandatory tests is much wider.

Prevention

During normal pregnancy, when the enlarged uterus puts pressure on the bladder, the woman feels a constant urge to urinate.

At the same time, the volume of urine excreted is very small. This is especially felt when the fetus has grown, in the third trimester.

Preventive examinations

If the uterus is very enlarged (with polyhydramnios, multiple pregnancies, large fetuses), it puts so much pressure on the bladder that this can even lead to urinary incontinence.

You may also experience irregular pain in the bladder area. It can be aching, or, conversely, sharp and strong, but short-lived.

The fetus is constantly moving, turning, pressing harder or weaker on nearby organs.

To prevent inflammatory processes, you should never try to endure the urge to urinate.

Since the size of the uterus after 27-30 weeks is significantly increased, it puts more and more pressure on the bladder. Its volume decreases as pregnancy progresses.

When urine accumulates, the risk of developing bacterial inflammation increases.

In addition, you should strictly adhere to the recommendations of the gynecologist and undergo all tests and examinations in a timely manner.

And of course, if disturbing symptoms appear, you should not postpone going to the doctor.

It is also necessary to follow a balanced diet and monitor the amount of salt. And the most important thing is a sufficient amount of fluid consumed.

It is necessary to limit the consumption of coffee and other drinks containing caffeine. Beyond harm cardiovascular system, it removes calcium from the body, increases diuresis and dulls the feeling of thirst. The best choice is clean drinking water; mineral water promotes the deposition of salts and the formation of stones. It is also worth introducing compotes, freshly squeezed vegetable and fruit juices into your diet.

Rosehip decoction is very useful (due to its high vitamin C content and immune-strengthening effect) and cranberry juice(it has a strong antibacterial effect).

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Bladder pain during pregnancy

The fact that during pregnancy a woman’s body undergoes various changes is an absolute norm and even a necessity. After all, now his main task is to create the most favorable conditions for bearing a baby, so that he develops on time and as best as possible. In addition, changes occur in the body of the expectant mother associated with the growth of the fetus. For example, a growing baby puts pressure on the mother’s bladder, often causing her a lot of inconvenience. By the way, let's talk about this more specifically.

A little anatomy

The bladder can be called a bag. It is very elastic and contains smooth muscle. In simple words, the bladder is a reservoir where urine collects. Urine is discharged from the bladder through the urethra. This is made possible thanks to special muscles called sphincters, which are functionally connected to the muscles of the bladder. When the bladder muscles begin to contract involuntarily and the sphincters relax, urine is released. Metabolic products leave the body along with it.

Bladder changes during pregnancy

During the period of bearing a baby, every woman sooner or later notices the changes that occur in her genitourinary system and, in particular, the bladder. For example, on early stages During pregnancy, almost everyone experiences an increased frequency of urination. This is such a common occurrence that some people tend to attribute this symptom to signs of pregnancy. Further, the woman also notes increased frequency of urination. This is due to the fact that the growing uterus and the fetus in it put pressure on the bladder. A pregnant woman may also experience an accumulation of mucus in the bladder.

In addition, during pregnancy, a woman experiences changes in other organs related to the urinary system. These are, in particular, the kidneys and ureters.

Separately, I would like to talk about such an unpleasant phenomenon as inflammation of the bladder. This disease is called cystitis. It is characterized severe pain and pain during urination, after which there is often a feeling of incomplete emptying of the bladder. A woman suffering from cystitis feels a frequent urge to urinate, but when she goes to the toilet, she realizes that this is a false call.

Cystitis is usually caused by bacteria. In addition, inflammation of the bladder is possible as a result of damage to its inner lining. An acute urinary stone can act as an “aggressor”, chemicals, as well as, as a result of medical procedures, thermal and chemical burns. During pregnancy, cystitis can be either chronic or acute, that is, occurring for the first time. If the necessary measures are not taken, the inflammation can rise upward and affect the ureters and kidneys, thereby creating a real threat to the life of both the fetus and the woman carrying it.

To treat cystitis during pregnancy, certain measures must be followed. For example, a woman will be prescribed rest (not just sexual rest, but with a complete ban on moving around the apartment). The next step is a special diet and taking medications (uroseptics, antispasmodics and, in especially severe cases, antibiotics). Pregnant women need to be very careful about their health, because early stages the disease can be defeated with the help of grandmother’s recipes: a warm bath, cranberry and lingonberry fruit drinks, and so on. It is very important to protect yourself from hypothermia so as not to provoke the onset and development of the disease. Do not forget that during pregnancy not every medication is indicated for a woman, as it can adversely affect the health of the child. For example, sulfa drugs or tetracyclines should not be taken during pregnancy. Therefore, it is very important not to self-medicate, but to contact a competent specialist who will provide qualified assistance in a short time.

Especially for beremennost.net – Elena Kichak

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How the fetus puts pressure on the bladder

Causes of uterine pressure on the bladder

Myoma

The uterus has several important functions. In addition to the conception of the embryo and gestation of the fetus, it performs menstrual and endocrine functions, producing the sex hormone - relaxin.

Everything related to the female genital organs should be under personal close attention and under the supervision of doctors.

One of the unhealthy situations that causes discomfort in the female body, as well as a lot of ensuing issues related to the pressure of the uterus on the bladder.

There are only two reasons for this phenomenon. The first is directly related to the period of pregnancy, and the second to the fact that fibroids have formed in the uterus.

Myoma is benign tumor, fibrous nodules that form from muscle tissue uterus.

Myomas can be completely different in size, number, and location. They can be located on the walls of the uterus, inside them and even grow into the cavity if there is a leg.

The size of a fibroid tumor can be completely different, ranging from 1 mm and reaching more than twenty centimeters in diameter.

Such large fibroids can completely fill the uterus, as a result of which the uterus increases in size and reaches almost the size that corresponds to a six-month pregnancy.

Fibroids, located on the walls of the uterus, or having a huge size, provoke effects on neighboring organs and begin to put pressure on the bladder.

This is explained by the fact that the uterus is in close proximity to the bladder, located directly below it, and at one point they even come into close contact.

Naturally, the enlarged uterus does not have enough space and it begins to put pressure on neighboring organs in order to get the necessary space.

For this reason, there is a risk of uncontrolled urine output, and the urge to urinate significantly increases.

Even strong laughter and coughing can trigger uncontrollable urination, which in medicine is called stress urinary incontinence. It occurs precisely because one organ puts pressure on the second.

Pregnancy

During pregnancy, the uterus also has to increase in size in order to create adequate conditions for bearing a fetus. Having increased, it presses on the bladder with the same force as the fibroid.

The result of pressure exerted by the growing uterus on the neighboring urinary organs is a frequent urge to urinate, which during gestation is not considered a pathological disorder.

The growing uterus requires additional space to avoid squeezing itself, which could cause irreparable harm to the fetus.

Frequent bladder urges are considered by most doctors to be the very first symptoms of pregnancy.

Prolonged retention of urine in the bladder, despite frequent urges, is undesirable, so pregnant women are advised to visit the toilet every twenty minutes, even in the absence of urges.

Otherwise, a reverse reaction may occur when the urinary organ puts pressure on the reproductive organ, increasing its tone, and provoking the threat of miscarriage.

Frequent bladder urges are also explained by the fact that the sphincter, which controls the excretion of urine, very often relaxes under the influence of progesterone, a hormone released in the body of a pregnant woman that is responsible for maintaining pregnancy.

Frequent urge to urinate

A woman is obliged to monitor her well-being and the symptoms that may appear.

Frequent urination without discharge, without pain, without discomfort in the bladder area should not cause concern, because it is a natural change.

But if alarming symptoms appear, the woman is obliged to notify the doctor of her suspicions. The outcome of pregnancy fully depends on systematic monitoring of health status.

Diagnosis and treatment

When a woman complains that something is pressing on the area where the bladder is located, the doctor will definitely refer her for a consultation with a gynecologist and diagnostic test.

If pregnancy is confirmed and there are no other symptoms, the pregnant woman is not prescribed any treatment.

If pregnancy is excluded, then a diagnosis is made for the presence of tumors in the uterus.

If it is detected, an endometrial biopsy is required to take samples of uterine tissue for research.

Such types of studies as hysteroscopy, hysterosalpingography and laparoscopy also have positive reviews for diagnostics.

Laparoscopy already belongs to the category of surgical interventions that allow a gentle method to remove fibroids, if there are indications for this.

Removal of uterine fibroids is extremely rare. Many ladies can live their entire lives without any idea that they have it until it begins to put pressure on neighboring organs.

Only a third of women resort to invasive therapy.

To reduce the risk of fibroids in the uterus, a woman should control her body weight because overweight provokes an increase in estrogen, which is one of the reasons for the occurrence of such formations.

Estrogen subsequently favors their growth, as a result of which they begin to put pressure on the organs of the genitourinary system.

Visiting a gynecologist, observing and following all recommendations will allow a woman to avoid serious problems.

What does it feel like when the uterus grows during pregnancy?

You should immediately take into account the fact that the uterus itself stretches and grows painlessly, that is, you do not feel pain when it enlarges. The receptors that are responsible for pain are located on the inner surface of the organ and signal a pathological process, for example, when placental abruption begins, or the receptors can be irritated by the inflammatory process during pregnancy pathology. You may experience strange sensations when the uterus spasms and enters a state of hypertonicity. In this case, you may feel both mild insignificant pain and severe cramping. Feeling the abdomen will help you distinguish this condition of the uterus; if it is hard and you feel pain, then you need to seek help from a doctor.

Increasing in size, the uterus puts pressure on nearby organs. In the first months of pregnancy, you will feel discomfort in the bladder, which will be accompanied by a frequent and sudden urge to urinate. Such symptoms will go away by the end of the first trimester of pregnancy and will appear again in the last stages, when the fetal head begins to descend into the pelvis and put pressure on the bladder. A uterus with a large fetus may not be positioned quite correctly and may put pressure on the ureter, the organ that connects the kidney and bladder. In this case, you will feel aching pain on the right or left side of your back. Accurate diagnosis and a specialist will be able to determine the cause of such pain after you pass everything necessary tests, then he will prescribe the appropriate treatment for you.

Gradually increasing, the uterus puts pressure on the intestines, and then on other organs of the gastrointestinal tract. Your intestinal function may be impaired - its peristalsis will slow down and constipation may begin. In this case, be sure to include in your daily diet foods that are rich in fiber - fruits, vegetables, cereals. If your condition has not improved, you can take pharmacological preparations safe for pregnant women, for example, Duphalac or Normolakt.

During pregnancy, the uterus grows, and its weight increases unusually quickly for the body. The back muscles and spine do not have time to get used to the increased load, and you feel aching pain in the lower back. Typically, these sensations intensify with each month of pregnancy and cause great discomfort, especially if you have scoliosis or osteochondrosis of the spine. You can strengthen your muscles during pregnancy special exercises, just don’t overdo it so as not to harm your condition.

In the last months of pregnancy, the fundus of the uterus with a large fetus rises very high and begins to put pressure on the diaphragm. At the same time, it becomes difficult for you to take a deep breath and a feeling of lack of air appears. Try to walk more, while the weight of the abdomen naturally shifts down and the fetus puts less pressure, blood circulation also improves and it becomes easier for you to breathe.

Cystitis during pregnancy: causes, complications, treatment

Pain when emptying the bladder #8212; very unpleasant condition. And during pregnancy, this problem, in addition to all other inconveniences, creates a danger for the baby. Cystitis during pregnancy: why does it occur, what is the threat to the mother and the fetus?

It would seem that it is just unpleasant to go to the toilet: often, little by little, and at the end of urination a pain occurs. This has happened before, and before, before pregnancy, it went away on its own. It seems like nothing, maybe you shouldn’t pay attention to it? But inflammatory process in the bladder can cause serious complications. Cystitis may occur for the first time during pregnancy, or an exacerbation of a pre-existing dormant infection may occur. In any case, if symptoms of cystitis occur, you must tell your doctor about it in order to identify the cause in time and begin treatment.

Causes of cystitis

1. Infection

A small proportion of bladder inflammation may be toxic or allergic in nature. But in the vast majority of cases, cystitis occurs when an infection occurs. Microbes enter the bladder and cause inflammation there. In women, microorganisms are carried up the urethra more easily than in men, because its length is only about 4 cm. An additional predisposing factor is the proximity of the entrance to the urethra (that is, the urethra) to the vagina and rectum, where microorganisms are always present . Exactly coli most often it becomes the cause of cystitis.

2. Contributing factors

Just the presence of infection does not always lead to illness. We also need factors that create conditions for the proliferation of microbes in the bladder. The most common of them:

hypothermia, when a woman gets wet and frozen in the rain or sits on a cold stone for a long time. This is sometimes quite enough to cause painful and frequent urination;
weakened immunity due to physical fatigue or poor nutrition;
inflammation in the vagina caused by any infection or caused by bacterial vaginosis;
diseases of the pelvic organs, in which blood flow in the bladder area is disrupted;
any medical interventions on the bladder (cystoscopy, insertion of a catheter, use of medications that irritate the inner surface of the bladder).

3. Pregnancy

Carrying a fetus itself can contribute to the occurrence of cystitis. The causal connection is simple: against the background of changes in hormonal status and a mandatory decrease in immunity, microbes can easily and simply make their way up the urethra into the bladder. The growing uterus can put pressure on the bladder, impairing blood flow in its wall. During long periods of pregnancy, the uterus begins to compress the ureters, leading to congestion in the urinary tract. Against this background, microbes begin to multiply, which leads to an ascending infection and the development of pyelonephritis.

Read about pyelonephritis in expectant mothers here

How does cystitis manifest?

The symptoms of inflammation in the bladder are well known:

frequent desire to visit the toilet;
painful sensations of any nature ( sharp pain, discomfort, burning) associated with urination;
a small amount of urine every time you go to the toilet;
unusual-looking urine (cloudy, dark, unpleasant smell or with blood);
dull or pressing pain in the lower abdomen.

Quite often, a pregnant woman will not have significant symptoms of cystitis. During advanced pregnancy, when the fetal head is already pressing on the lower abdomen, the woman will explain all manifestations of cystitis by her condition. And in this case, only by analysis will the doctor be able to find out about the presence of an inflammatory process in the bladder.

How is cystitis diagnosed?

If in general analysis urine, which a pregnant woman tests before each visit to the doctor, will reveal signs of inflammation (protein in the urine, increased amount leukocytes, the presence of red blood cells, large number epithelium, mucus and bacteria), then the doctor will first suspect an infection in the urinary tract. For full examination Before prescribing treatment, the following tests must be done:

vaginal smear to determine the degree of purity;
urine analysis according to Nechiporenko;
urine culture to determine sensitivity to antibacterial agents;
Ultrasound examination of the kidneys.

Read about all the examination methods that may be needed for conception and throughout pregnancy here

The main task of additional examination is to make sure that the inflammation has not spread higher up the urinary tract towards the kidneys. Most often, it is cystitis that causes inflammation in the kidneys #8212; pyelonephritis.

How to treat cystitis during pregnancy

For treatment acute inflammation antibiotics must be used in the bladder. The safest and most effective medicine is Amoxiclav or Amoxicillin, which the doctor will prescribe in the required doses based on the results of the examination. Besides antibacterial agent, it is necessary to use herbal uroseptics, which include drugs such as Canephron or Zhuravit. Herbal remedies have a good effect on the urinary tract - lingonberry leaf, birch buds, kidney tea. You can use Fitolysin paste, but not everyone will like the taste of this medicine. Most optimal for cystitis #8212; strictly and correctly follow the doctor’s recommendations.

For chronic cystitis, the main thing #8212; prevent exacerbation of the inflammatory process. If you do everything correctly, you can safely carry out your entire pregnancy. preventive measures and prevent manifestations of the disease. In particular, you need to take herbal uroseptic remedies. We should not forget about the basic rules of personal hygiene. Starting from 25 weeks, you need to perform positional therapy: stand in the knee-elbow position 5-6 times a day for 10-15 minutes. In this position, the growing uterus sags and does not put pressure on the urinary tract, preventing congestion that contributes to aggravation.

Read on ipregnancy in detail about medications approved for use for the treatment of cystitis in pregnant women: Canephron during pregnancy

Amoxicillin during pregnancy

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Bladder during pregnancy

Organs and systems female body V varying degrees react to his preparation for motherhood. Discomfort in the bladder area during pregnancy is one of the first to be felt and manifests itself more or less intensely throughout the entire gestation period. The expectant mother needs to distinguish between such symptoms, since some of them are purely physiological, but others may indicate the presence of serious health problems.

Why does the bladder hurt during pregnancy?

At the very beginning of the gestation period, the fertilized egg is still very small. However, the uterus is already preparing for future changes: it increases in size and thickens. At this time, the reproductive organ is located in the pelvic area and puts pressure on surrounding organs. In addition, the sphincter (locking muscle) of the bladder partially relaxes under the influence of progesterone, the pregnancy hormone. The woman experiences a feeling of discomfort and urination becomes more frequent. If there is no inflammatory process, all this happens painlessly. The expectant mother is simply forced to go to the toilet more often.

As the fetus grows, the uterus begins to rise and partially extends into the abdominal cavity. The pressure on the bladder is reduced. In addition, the woman gets a little used to frequent urination and perceives it as normal. Bladder pain during pregnancy indicates a completely different situation. The reason may be:

Inflammatory process (cystitis). The development of the disease is provoked by pathogenic microorganisms (staphylococci, streptococci, E. coli) that have penetrated the urinary organs. Infection occurs quite often, since the woman’s immunity is weakened. Less commonly, exacerbations of cystitis are caused by mechanical factors that injure the walls of the bladder (for example, sharp stones during urolithiasis). The symptoms of cystitis are well known. A woman complains of pain and burning when urinating, frequent ineffective urges, and a feeling of incomplete emptying. Urine becomes cloudy; analysis shows the presence of red blood cells, white blood cells and other abnormalities;
Cystalgia. The disease is associated with dysfunction of the urinary system due to improper innervation. The symptoms are similar to those of cystitis, but urine characteristics remain normal, indicating the absence of an inflammatory process;
Bladder fullness later. During pregnancy of more than 28 weeks, the bladder changes its location and even shape under the pressure of the growing uterus. It bends slightly and its base rises above the level pelvic bones. The ureters stretch slightly in length. These changes cause discomfort and pain in the suprapubic area.

Frequent urination during pregnancy can be considered normal in the absence of other unpleasant signs. If pain occurs, body temperature rises or changes appearance urine, the woman should consult a doctor immediately.

The dangers of bladder discomfort during pregnancy

The most common cause of problems in the urinary system of a pregnant woman is cystitis. Under no circumstances should its symptoms be ignored. If the disease is not treated, the inflammatory process can spread to the kidneys, and a situation will arise that is life-threatening for the woman and her unborn child. In addition, infectious agents can penetrate directly into the uterus, which can lead to abnormalities in the development of the fetus.

The urgency of a visit to the doctor is also determined by the specifics of the disease: cystitis in initial stage can be cured with the help of relatively safe herbal preparations, without resorting to sulfonamides, antibiotics and other drugs that can harm the baby. Having asked for help, a woman will receive recommendations on drug treatment inflammation of the bladder during pregnancy, as well as precise instructions regarding compliance with the daily routine and diet, which is extremely important for such a disease. Exactly following the doctor’s advice will help get rid of the disease and prevent serious complications.

The bladder is hollow internal organ a person who performs the function of collecting and removing urine from the body. Its dimensions depend on the degree of fullness and may vary. The bladder capacity of women is slightly smaller than that of men, on average it varies from 200 to 500 ml. However, sometimes the size of this organ changes - an enlarged bladder occurs.

Enlarged bladder causes

Upon examination, an enlarged bladder may be perceived as a cyst, intestinal volvulus, or abdominal tumor. In order to eliminate errors, before examining patients with urinary retention, they undergo bladder catheterization, as well as rectal examination posterior wall of the bladder.

An enlarged bladder is one of the symptoms of urological diseases (for example, hydronephrosis, ischuria - urinary retention), therefore, to clarify the diagnosis, a number of studies are carried out: chromocystoscopy, excretory urography, cystoscopy.

Megacystis in the fetus

In addition, an enlarged bladder occurs in children during fetal development. As a rule, the diagnosis of megacystis is made in the early stages of pregnancy. This anomaly occurs in 0.06% of fetuses. An enlarged bladder (or, otherwise, megacystis) is said to occur when its longitudinal size exceeds 8 mm.

Megacystis in the fetus - causes

Most often, megacystis is a sign of obstructive urinary tract damage. Also, an enlarged bladder can signal undercut belly syndrome. The prognosis for this disease is unfavorable in most cases. It can be diagnosed starting from the second trimester of pregnancy. As a rule, if this diagnosis is established for medical reasons, the pregnancy is terminated.

Megacystis in the fetus - treatment

However, sometimes an enlarged bladder can be transient. In a number of cases (from 5 to 47 according to different researchers), the bladder spontaneously returns to normal sizes. As a rule, in these cases the perinatal outcome is favorable.

If an enlarged bladder is diagnosed in the fetus in the early stages of pregnancy, sometimes an additional study is performed - vesicocentesis. This is a puncture of the fetal bladder wall. Thus, his urine is obtained for analysis. This study is carried out in cases of developmental defects urinary system and a number serious illnesses. In addition, statistics claim that the loss of fetuses with megacystis during vesicocentesis in early pregnancy is significantly reduced.

Diseases and defects of the fetal urinary system threaten its further normal development and health, therefore timely prenatal diagnosis, establishment of prognosis and appropriate treatment tactics are relevant and important.

Megacystis is an increase in the fetal bladder in longitudinal size (more than 8 mm) during intrauterine development. In addition, the ratio of this parameter to the coccygeal-parietal size increases (more than 10.4%, with the norm being 5.4%). Megacystis is most often detected in the early stages of pregnancy (10-15 weeks) in 0.06-0.19% of cases.

The bladder begins to form on days 25–27 of gestation, with the maturation of the urogenital sinus from the inner lobe of the embryo. The organ is fully formed after 21 weeks of fetal development. Normally its size is 8 mm.

Abnormalities of the urinary system develop most often due to chromosomal abnormalities. With ultrasound examination (ultrasound), it is possible to visualize the ureter at the 12th week of pregnancy in 80% of cases, and in 100% with ultrasound at the 13th week.

Causes of pathology

Some researchers argue that if an enlarged bladder is detected in the fetus in the first trimester of pregnancy, determine the real reason its occurrence will not succeed. Scientists identify two main etiological reasons for the development of megacystis in the fetus:

In the early stages of pregnancy, the diagnosis of an enlarged bladder can be established only by some echographic signs, because during this period there are still no specific indicators with which to differentiate intrauterine malformations.

The diagnosis of "megacystis-megaureter-microcolon" is more often diagnosed in female embryos (4:1), and urethral obstruction and Prune-Belly syndrome - in males.

In the early stages (11-13 weeks), dilated upper urinary tracts do not always indicate megacystis syndrome and are most clearly visualized only after 14 weeks.

What is the pathology prognosis?

Various studies (5-47 cases) show that an enlarged organ can spontaneously return to its normal size. Megacystis regresses on its own, which may result in a favorable perinatal outcome.

Researchers explain this by the fact that formation in the bladder smooth muscle and nerve endings continues after the 13th week of embryo development. This does not exclude certain chances for a positive resolution of the problem in the future. You can read about the symptoms and treatment of cystitis in newborns.

However, most researchers predict a negative prognosis for this pathology, which threatens various perinatal defects due to dysplasia (especially cystic). The lethal prognosis for the fetus with these disorders ranges from 20-50% of cases due to the occurrence of insufficiency respiratory system in the neonatal period or early childhood renal failure.

Taking into account that megacystis syndrome in 25–40% of cases is combined with chromosomal abnormalities, the results of studying the fetal karyotype and genetic research will be of primary importance when deciding whether to terminate or prolong pregnancy.