41 weeks pregnant. Obstetric and gestational periods: how they differ

Gestation is, in fact, the definition of the term pregnancy, with the difference that the gestation period is determined by the number of full weeks of the period when a pregnant woman is carrying a child. The beginning of gestation is calculated from the calendar date from the beginning of the last menstrual cycle, before the onset of the observed pregnancy, and ends with the moment the woman gives birth, or, in more dire options, with an induced abortion or spontaneous miscarriage. If it is not possible to establish correct data on menstruation, then the gestational age of pregnancy can be determined by an obstetrician-gynecologist using other studies, clinically detectable signs and, directly, the method of ultrasound examination.

The beginning of gestation is important to determine by the leading doctor of the antenatal clinic, not only to determine the approximate life span of the fetus, but also to most accurately calculate the date of birth. This point is very significant for the girl who is carrying a child, since she will know the expected time and will have the additional opportunity to think through everything in advance and prepare for the birth of the child.

It is generally accepted that, according to the gestational age assigned, newborn children are divided into the following categories: premature, born within the given period of time are full-term, or those born beyond the given period are post-term.

It is also important to distinguish the obstetric period from the gestational period, which can often not be differentiated, although they differ by approximately a two-week interval.

When does gestational diabetes occur?

An autoimmune disease in which metabolism is disrupted and carbohydrates cease to be properly absorbed and broken down is called diabetes mellitus. There are two types of diabetes, but sometimes two more are added to the list. The result is:

1. Type 1 diabetes. For some reason, endocrine cells that produce insulin die in the pancreas. Without the hormone responsible for the absorption of glucose, this simple sugar accumulates unhindered in the blood. It mainly affects those under 30. The disease is chronic.
2. Type 2 diabetes. There is enough insulin, but the body's cells lose sensitivity to it, so the hormone loses its role as a “regulator” of glucose in the blood. More common in those over 50. Chronic pathology.
3. Secondary diabetes mellitus. It occurs against the background of other diseases - infections, disturbances in the functioning of organs and systems. A failure in carbohydrate metabolism manifests itself as a symptom, and then develops into an independent disease.
4. Gestational diabetes mellitus. An increase in blood glucose concentration, which is characteristic exclusively of pregnancy, is recognized as a type of diabetes and is called gestational.

Gestation is another name for pregnancy, from the Latin gestare, “to carry within oneself.” Unlike other types of diabetes, the one that occurs during pregnancy goes away on its own. After childbirth, as a rule, the symptoms disappear, but if the disease is started, it will have time to:

• cause irreparable harm to a child;
• provoke the development of type 2 diabetes in the mother in the future.

When the first blood or urine tests of a pregnant woman show elevated sugar levels, it is too early to panic: for expectant mothers, such results are considered normal. If the glucose level is high and repeated tests, there is cause for concern. When the following tests do not reveal a decrease in blood sugar, your doctor will most likely diagnose gestational diabetes mellitus - GDM.

Causes of the disease

The mechanism of occurrence of GDM is associated with the new role of female hormones. Estrogen, lactogen and cortisol protect the fetus in the placenta. However, these hormones are insulin antagonists; stimulate the release of glucose into the blood. If previously insulin, which is produced by the pancreas, regulated the supply of glucose, now the process is uncontrollable: hormones stubbornly “push” the monosaccharide into the blood. The pancreas works hard, producing 3 times more insulin than before pregnancy, but it is still not enough to “bind” excess sugar.

Medical statistics say: gestational diabetes mellitus affects four out of a hundred pregnant women (according to some sources, ten out of a hundred). At risk are expectant mothers who give birth after 30 years of age and who have diabetics among their close relatives.

Hormonal changes occur in the body of every woman expecting a child, however, fortunately, GDM is diagnosed in only a few. Normally, a pregnant woman’s pancreas is still able to supply the required amount of insulin, which will not allow glucose to “run wild.” The following factors can push up the rise in blood sugar levels and, consequently, the development of gestational diabetes:

• Autoimmune diseases in women; The functions of the pancreas sharply decrease and insulin production slows down.
• Heredity. If you have diabetes in your family, the risk of GDM in the expectant mother doubles.
• Infections in the early stages that weaken the immune defense.
• Polycystic ovary syndrome is the appearance of benign formations around the ovaries that impair their function. Occurs when there is excess production of the male hormone androgen.
• GDM during previous pregnancies.
• A previous pregnancy that resulted in the birth of a stillborn child.
• The birth of a previous baby weighing more than 4 kg.
• Excess amniotic fluid.
• Obesity or excess weight (exceeding the norm by 20% or more) due to a diet with an excess of easily digestible carbohydrates.

  
  Age over 30 and overweight - as a result, a woman risks getting GDM

• High blood pressure.
• Excessive physical activity, psychological fatigue.

  Overwork during pregnancy weakens the body, which disrupts metabolism and creates the threat of GDM.

There is an opinion that GDM occurs more often in some ethnic groups than in others. The risk group consists of indigenous women from Asia, Africa, and Latin America.

Threats to mother and unborn child

“GDM does not last forever, it will disappear after childbirth” - this is how many expectant mothers reassure themselves and are in no hurry to start treatment. Big mistake.

Consequences for a pregnant woman

In 10–15% of cases, after the birth of a child, a mother who has experienced gestational diabetes mellitus develops the disease into the chronic stage—type 2 diabetes. It is generally a "disease of the elderly"; all the more unpleasant for a young woman to receive it. Long-term health consequences are depressing. Among them:

• Heart problems: hypertension, coronary disease, increased risk of heart attacks and strokes.
• Sexual dysfunction: lack of libido.
• Lesions of the skin, nerves and blood vessels of the feet; so-called diabetic foot. When the condition is neglected, ulcers form in the tissues, and in some cases gangrene occurs.

  Diabetic foot is a kind of “passport” of the disease: the diagnosis with such a symptom is obvious

• Cataract is clouding of the eye lens.
• Nephropathy is a disorder of the kidneys. In diabetic nephropathy, sclerosis of the renal vessels occurs, as a result of which the kidneys are unable to excrete insulin.

Sometimes nephropathy affects a woman already during pregnancy: changes in the composition of the blood (constantly high glucose levels) have a detrimental effect on kidney tissue. The main danger is that the pathology initially develops without symptoms. And only then does the woman notice that she has:

• limbs swell, bags form under the eyes;
• dyspnea;
• general weakness;
• nausea, vomiting.

In the early stages, nephropathy can be cured. But because it is difficult to recognize the disease, treatment is often delayed. The result is sad: late-stage nephropathy forces you to terminate your pregnancy. Too much during pregnancy depends on the kidneys, which are no longer able to cope with their tasks.

Risks for the baby

Gestational diabetes in a mother rarely appears in the 1st trimester of pregnancy. However, if it does occur in the early stages, the consequences may include:

• risk of miscarriage;
• congenital defects in the unborn child: as a rule, the brain and cardiovascular system are affected.

At 28–36 weeks of gestation, the opposition between female hormones and insulin reaches its maximum. GDM, as a rule, approaches the expectant mother at this time, under the influence of a malfunction in carbohydrate metabolism. Along with diabetes, the threat of diabetic fetopathy increases, in other words, the effect of “feeding” the fetus. Glucose is delivered in excess from the mother's blood, and the child's pancreas, having barely formed, is already working in an enhanced mode, converting excess sugar into fat. Eventually:

• The fetus increases significantly in size - at birth the weight is more than 4.5 kg.
• The body develops disproportionately: the child’s head and limbs are normal, but the stomach is large and the shoulders are broad.
• Enlarged heart, liver and kidneys. The risk of jaundice increases.
• After birth, the baby has difficulty breathing; in some cases, the newborn has to be connected to a ventilator.

  With diabetic fetopathy, it is difficult for the baby to breathe on his own, he is placed in an incubator and artificial respiration is established

• The blood becomes too viscous, resulting in a risk of blood clots.
• Low levels of magnesium and calcium are observed in the blood of a newborn.
• The risk of premature birth increases, which can result in the death of the child.

Diabetic fetopathy rarely goes away without a trace: even with successful delivery, the baby develops neurological disorders, and the child lags behind in physical development.

Standards and deviations in timing calculations

The most accurate ultrasound indicators are dimensional values. The biparietal size of the embryo's head and its coccygeal-parietal length are taken into account. Here the error is minimal if there are no deviations in the development of the fetus. A disproportionate increase or decrease in the fetal head shows defects in the formation of the cranium and brain development, which causes a general developmental delay.

Sometimes, for medical reasons, it is necessary to perform a caesarean section or terminate the pregnancy. But then all factors are summed up, including the gestational period of pregnancy, the results of hardware and laboratory tests.

The calculation is carried out using the formula: W = 52.687-0.6? 7810.011-76.7756 x H

To pre-calculate the PDA (estimated date of birth), after an ultrasound scan it is recalculated differently: Ш = ? 13.9646 KTR – 4.1993 + 2.155 (W – gestation, KTR – coccygeal-parietal size or replaced by BPR – biparietal size of the fetus), calculated in millimeters.

Doctors also use the “Dubovich scale”, when newborns are assessed based on external and neurological signs in points (from 0 to 5). Calculations confirm the baby's gestational age in weeks and confirm its developmental norms.

Attention: Do not worry if what the doctor says and your assumptions do not coincide. Doctors have their own parameters and “norms”. Calendar, obstetric and gestational periods of pregnancy do not coincide; they are needed for medical indicators.

There are slight deviations in timing if a woman has a multiple pregnancy (twins, triplets or more):

1. A singleton pregnancy lasts from 38 to 43 obstetric weeks (from 36 to 41 in the embryonic or gestational period).
2. Carrying twins lasts up to 38 obstetric weeks or up to 36 embryonic weeks.
3. Pregnancy with triplets lasts up to 34 obstetric weeks or up to 32 weeks of embryonic period.

The more embryos are carried at the same time, the smaller they will be, but this will not affect their further development. The obstetric period differs from the embryonic period in that it is determined by menstruation, while the embryonic period is determined by the expected date of conception.

Determining the gestational age of the fetus or gestational age by week is standard medical practice. Never make hasty conclusions or get confused with these deadlines. Count your pregnancy period by week, as the doctor says. To prevent your doctor from making a mistake, mark the start dates of your periods on a calendar. Have an easy pregnancy and safe birth!

Source: EmpireMam.com

How to recognize gestational diabetes

The disease does not have clear symptoms. It happens that the clinical picture is so blurred that the expectant mother feels as before and is not aware of diabetes. If mild negative sensations appear, she chalks it up to pregnancy. Indeed, one can be mistaken: GSD seems to be “masquerading” as an “interesting situation.” Here are the signs of the disease:

• constant thirst, the quenching of which results in a frequent urge to urinate;
• nausea, vomiting;
• increased blood pressure;
• slowly healing wounds;
• inflammation in the genitourinary system (candidiasis and others);
• weight loss due to increased appetite;
• sometimes the appetite suddenly disappears;
• feeling of numbness or tingling in the limbs;
• constant fatigue;
• decreased visual acuity.

In fact, it’s either diabetes or pregnancy with normal sugar levels. When several symptoms appear at once, this is a reason to visit a gynecologist. Only a thorough examination of a woman will reveal the disease with one hundred percent accuracy.

Diagnostics

If you suspect you have hereditary diabetes or have suffered from GDM before, be sure to tell your doctor. Most likely, you will have to go to an endocrinologist and take an unscheduled test for GDM. And according to the plan, expectant mothers are examined at 24–28 weeks. The purpose of the test is to find out how the pregnant woman’s body copes with the absorption of glucose.

You will have to take tests on an empty stomach. Procedure for doctors:

1. The patient's blood is taken from a vein. The received data becomes the initial one.
2. The woman is given a liquid to drink in which 50 grams of sugar have been dissolved.
3. After 1 hour, blood is drawn again.
4. After 2 hours - the final blood draw.

It would seem - why such difficulties, and for the patient, in addition, unpleasant sensations? Let's look at the results obtained as an example. If there is no GDM, a blood test will show:

1. The initial blood draw is a sugar level of 5.49 mmol/L (millimoles per liter).
2. Blood sampling after drinking sweet liquid - 11.49 mmol/l.
3. The last sample was 7.79 mmol/l.

That is, the body, having received sweets, first splashed glucose into the blood, and then a natural decrease occurred. This means insulin knows its stuff. When the pancreatic hormone does not cope with the task and the patient develops GDM, the analysis will show:

1. Initial blood sampling - 5.49–6.69 mmol/l.
2. The next one, after taking the syrup, is less than 11.09 mmol/l.
3. The third sample is more than 11.09 mmol/l.

It can be seen that the syrup provoked a stable increase in blood sugar; Over time, the indicator moves further and further from the norm, which means that glucose is poorly absorbed.

A test that determines glucose tolerance allows you to accurately diagnose GDM

Mistakes are possible: a woman came for tests having had a light snack or was very worried - which does not happen. To confirm the diagnosis, the endocrinologist will prescribe a repeat procedure in 10–12 days.

A routine blood sugar test is also taken on an empty stomach. Glucose levels above 7.1 mmol/l give reason to suspect GDM.

If sugar is detected in the urine during pregnancy, there is little doubt: the woman has gestational diabetes. Moreover, it is neglected, since the kidneys can no longer cope with their tasks.

Degrees of gestation

The degree of gestation, which is actually the age of the embryo and fetus in the mother’s womb from the time of fertilization, corresponds to the gestational age in the modern classification, this degree is correlated with the degrees of full term of children and prematurity, and according to previously accepted degrees of gestational age, they are divided into the following subtypes:

- The first degree of gestation, which corresponds to 37-35 weeks of gestation and often such babies are born with a preliminary weight of 2500-2001 grams and their height reaches 45-41 cm.

- Second degree of gestation, which corresponds to 34-32 weeks of gestational age and with an estimated weight of 2000-1501 grams and a body length of about 40-36 cm.

- Third degree of gestation, with a time limit of 31-29 weeks and a weight in the range of 1500-1001 grams and 35-30 cm of height.

- And the last, fourth degree of gestation with a borderline value of up to a weekly gestational value of 29, and a borderline weight of the born baby of 1000 or less, a length of less than 30 cm. They are also called the term “premature babies with extremely low weight.”

Today, the degrees of gestation still fade into the background, and in the modern medical community it is customary to formulate a diagnosis of gestation according to instrumental indicators and the baby’s weight at birth. The borderline weight in such observed newborns has a margin of error for weight loss of up to 12% by the newborn week; recovery occurs significantly late in comparison with full-term ones, approximately by the end of the newborn period, that is, by the 28th day of the child.

The fact of prematurity, with proper care, does not have a particularly strong impact on the development of the child. By the age of two or three, such children catch up with their same-year-old peers, both in all standard indicators, and quite possibly even surpass them, but provided that they have been involved with the children and given them due attention and care.

According to different degrees of gestation, the approach to such children is also different. They are nursed either at home (with mild prematurity) or in conditions specially created for them, in several successive stages (deep prematurity). Thus, in children with an initial weight of over 2300 grams, this complex is limited to special procedures and upon discharge the weight is already sufficiently normalized for home monitoring. When born with a lower weight, discharge may take up to three to four months, since nursing and recovery of such babies is more labor-intensive and takes three stages: 1) maternity hospital; 2) a specialized department of the hospital; 3) home care.

How to treat GDM

Strict control over sugar levels and eliminating the causes for its rise are the principles of therapy for gestational diabetes. Expectant mothers are recommended to buy a glucometer and use the device 4–6 times a day:

1. On an empty stomach.
2. An hour after eating.

A glucometer is a necessary device for a pregnant woman when symptoms of GDM appear.
Visits to the clinic for tests are also a mandatory measure. As for medications, only insulin is allowed during pregnancy, and only if other methods of combating diabetes have proven useless. Insulin therapy is entirely the responsibility of the attending physician: he prescribes the dosage and determines the duration of the course. The drug is administered by injection using disposable syringes.

Let's switch to proper nutrition

The first place in the treatment of GDM is diet. It is important for a woman to remember: food restrictions are needed not to lose excess weight, but to restore normal glucose levels in the body. You should choose low-calorie but nutritious foods; then the fetus will not suffer from a lack of nutrients.

Strongly exclude from the menu:

• confectionery, baked goods - due to the abundance of easily digestible carbohydrates;
• certain fruits - bananas, cherries, grapes, persimmons - as they contain “light” carbohydrates;
• butter;
• fatty sauces;
• smoked meats;
• sausages, sausages;
• pork;
• mayonnaise;
• semi-finished products;
• instant food - soups, cereals, noodles.

Actively include in your diet:

• foods high in fiber - porridge, rice, whole grain bread, legumes;
• lean meat - chicken, rabbit, also lean beef;
• fish;
• vegetables with “correct” carbohydrates - carrots, broccoli, pumpkin;
• cucumbers, tomatoes;
• cabbage;
• zucchini;
• bell pepper (a little at a time, because it’s sweet);
• citrus fruits (if there are no allergies).

Photo gallery: products for women with GDM

Choosing products is half the battle. To reduce blood glucose levels, you will have to eat following the following standards:

• avoid fried foods, prefer boiled, stewed, baked foods;
• sit at the table 3 times a day, at the same time, between main meals you can have two snacks;
• the portion on a plate should not exceed 200–250 grams;
• If you feel sick in the morning, you can eat a few crackers.

Do not disdain arithmetic: patiently count the number of calories in your daily diet, find out the ratio of nutrients. Here's the norm:

• proteins - 20–25%;
• fats - 35–40%;
• carbohydrates - 35%.

Let's remember about physical education

Lying in bed and suffering is a sure way to aggravate your condition and, in addition, gain even more pounds. Reasonable physical activity, on the contrary, will alleviate the symptoms of GDM because:

• certain muscles that do not depend on insulin consume glucose during warm-up, thereby helping to reduce its level;
• metabolism improves;
• The overall tone of the body increases and the mood improves.

Of course, abdominal exercises will have to be excluded, since stress on the abdomen during pregnancy is unacceptable. Also avoid sudden movements. Suitable for expectant mothers:

• light gymnastics;
• walking;
• swimming, exercises in water.

Smooth, measured movements - exercise will regulate metabolism and even lower blood sugar levels.
A set of exercises for pregnant women will be suggested by a specialist in physical therapy at the clinic or during courses for pregnant women.

Exercise 3 times a week, for 20 minutes - that's enough. You can walk in the fresh air, away from the roadway, without restrictions.

How to give birth with gestational diabetes

If the condition of the expectant mother is severe or complications are noticeable in the fetus, they resort to early birth - usually at the 37th week of pregnancy. In other cases, the best time for delivery is the 38th week: the baby’s lungs are already formed, and there are no risks of breathing problems yet.

During labor, a woman's sugar levels are checked every 2-3 hours. Since this level fluctuates, prompt measures are needed, so when it increases, insulin is administered, and when it decreases, glucose is administered. The child’s breathing and heartbeat are closely monitored. In emergency situations, a caesarean section is performed.

A large baby, with large shoulders and a belly, can injure the mother when passing through the birth canal, and he himself will suffer dislocations. In such cases, cesarean section is also possible.

If the mother has GDM, the newborn is born with low glucose levels, but when fed with breast milk or formula, the sugar returns to normal.

After the placenta, which produced hormones “hostile” to insulin, leaves the body, the amount of sugar in the mother is normalized. This could be called a happy ending, if not for the possible complications for those whose diabetes turned out to be advanced.

Video: doctor on diagnosis and treatment of GDM

Pregnancy Calendar

Reducing the risk of GDM

The disease does not respect logic and often appears in healthy women, avoiding those who are at risk. Therefore, every expectant mother needs precautions. Here are some:

• Monitor your glucose levels and get tested regularly.
• Avoid excess weight gain.
• Eat right.
• Stay physically active.

If a woman has already dealt with GDM during a previous pregnancy, even tighter blood sugar control is needed. And after giving birth, keeping in mind the possibility of type 2 diabetes, you should avoid medications that cause insulin resistance, for example:

Reviews

Gestational diabetes mellitus, although not a chronic disease, usually disappears without a trace after childbirth. However, if you ignore the pathology, it will bring with it a trail of complications that threaten the health of mother and baby. The main danger is disturbances in the development of the unborn child, the unwitting culprit of which is the mother. It is possible that GDM will disappear on its own during pregnancy, but it is better not to hope for chance, but to take measures to prevent the development of the disease. You have to follow a diet - to be honest, not too strict - move more and get tested regularly. It turns out that you just need to lead a healthy lifestyle, and in this case, diabetes will leave you in peace, freeing you from unpleasant consequences.

A professional television journalist, she worked for many years as a special correspondent and commentator on federal television channels (VGTRK, TVC). Author of documentaries. I have awards, including state ones. In recent years, he has been the editor-in-chief of the private television company PUL.