What tests to take after childbirth. Complications after childbirth: what tests need to be taken. Signs of complications after childbirth

Why do complications occur after childbirth?

The birth of a child and the nine-month gestation that precedes it is the greatest test for the female body, but experts consider the postpartum period to be a much more difficult burden. Pregnancy forces all life-support systems to completely restructure, devoting all their strength to the formation of the fetus and the birth of the baby.

Immediately after giving birth, the rhythm of life of a young mother is subject to the regime of repeated breastfeeding and round-the-clock care for the newborn. There is an accumulation of physiological, mental and emotional fatigue, which almost inevitably causes functional disruptions in the body and the activation of chronic diseases. Without adequate medical supervision, the resulting disorders can lead to serious illness.

On the eve of a cesarean section

The doctor determines the date of the operation after receiving the examination results - the baby is full-term and ready to be born. As a rule, elective surgery is scheduled for the morning. On the eve of the operation, your attending physician and anesthesiologist will talk with you, who will tell you what kind of anesthesia you will be given and the events before, during and after the operation, find out whether you have had anesthesia before, your reaction to them, whether you suffer from allergies to medications . You will certainly be asked to sign a consent to the operation and the proposed method of pain relief. When prescribing the drug, the anesthesiologist must check your body weight and, if necessary, weigh you.

Eating the day before surgery should be light. At 18:00 you are allowed to drink a glass of kefir or tea. And then the usual “nothing by mouth” rule applies - no liquids or food should be consumed

, otherwise, while under anesthesia, the contents of the stomach may enter the respiratory tract.

Before the operation, a set of hygienic measures is carried out: hair on the pubic area and lower abdomen is shaved, the pregnant woman must take a hygienic shower the day before. At night you will be offered a light sedative.

Signs of complications after childbirth

You should contact a gynecologist if you experience the following more than a month after giving birth:

• weakness, fatigue, dizziness;
• pain in the lower abdomen, back, genitals;
• discharge;
• pain, compaction in the mammary glands;
• unpleasant odor from the vagina;
• nausea, vomiting, constipation;
• poor or increased appetite;
• tearfulness, bad mood;
• increased neck volume, pain in the submandibular area, pain when swallowing;
• swelling on the face, legs, etc.;
• increase in abdominal volume;
• increased weight, obesity or, on the contrary, sudden weight loss.

Help mom

Both first-time mothers and experienced mothers soon after the birth of a child understand that caring for a baby on their own is very difficult. Satisfying the constant needs of the newborn, the mother spends a large amount of energy, which is difficult to compensate due to the impossibility of proper rest.

Don't refuse help

There is no need to be shy about asking relatives or friends for help with household chores. Help from grandparents or other relatives will help the mother focus on the needs of the child, and not on laundry or dirty dishes.

If the family budget allows, there is no shame in enlisting the help of a nanny or an au pair, who will take care of the cooking, cleaning, laundry and shopping.

Complications and threats of the postpartum period

Postpartum complications can be local, directly affecting the reproductive organs, or systemic, having clear physiological or psychological manifestations.

Gynecological complications after childbirth

Gynecological pathologies are mainly associated with infection and excessive physical activity:

• Slow recovery of prenatal volumes of the uterus
  , caused by the presence in the organ of parts of the placenta or blood clots that promote inflammation. The problem is identified on .
• Postpartum endometritis
  due to impaired blood flow, a long anhydrous interval during childbirth or sexually transmitted infection. To identify pathology, you need to take it and do it.
• Dehiscence of the perineal seams
  caused by inadequate loads or infection. .
• Uterine bleeding
  can have a critical impact on a woman's life and requires immediate medical attention. A woman will notice uterine bleeding visually; if there is heavy discharge, you need to call an ambulance.

Breast pathologies

Such complications are very common:

• Lactation disturbance
  manifests itself as a consequence of the anatomical features of the gland, the presence of cysts and mastopathy.
• Mastitis
  is caused by congestion, staphylococcal infection and improper breast care.

You can identify pathologies of the mammary glands by going through the test.

Urological diseases and gastrointestinal pathologies

Such complications after childbirth are even more common than gynecological ones:

• Pyelonephritis
  occurs against the background of bacterial infection and renal complications during pregnancy. The disease is detected by, you also need to take a test.
• Chronic constipation
  is typical for women in labor with multiple ruptures in the perineal area or postoperative features of cesarean section. The cause of chronic constipation is clearly visible on.
• Hemorrhoids
  are almost inevitable after a difficult birth and due to the fear of sutures coming apart.
• Urinary incontinence
  due to weakened pelvic floor muscles after difficult childbirth. In case of prolapse (prolapse) of organs, the gynecologist will select and place.

Endocrine complications after childbirth

• Diabetes in pregnant women
  does not always stop after childbirth, so a young mother needs professional help in selecting therapy and diet. Elevated sugar and related postpartum pathologies can be identified by taking a blood test.
• Tumors and functional malfunctions of the thyroid gland
  often appear during the period of restoration of prenatal hormonal levels. In this case, the gynecologist-endocrinologist will prescribe and.
• Morbid obesity
  can be a consequence of a combined disorder of the adrenal glands and the thyroid gland. Diagnostic measures are the same.

Cardiovascular postpartum disorders

• Tachycardia becomes a consequence of severe toxicosis.
• Arterial hypertension can result from complications that arise during pregnancy.

These diseases are identified and treated by a cardiologist.

Psychological disorders

Depression and chronic fatigue, emotional breakdowns.

Problems of this nature are associated with a difficult pregnancy and problematic childbirth, the subsequent addition of the burden of caring for the baby, and the manifestation of phobias in connection with the child’s illnesses. Such phenomena usually go away on their own.

List of tests (for women and men) when planning pregnancy

• having a family history of hereditary diseases (mental illnesses, hemophilia, Duchenne myopathy, diabetes mellitus and others);
• where a man and a woman are in adulthood, because aging chromosome cells increase the risk of pathology during the formation of an embryo;
• whose relatives suffer from delayed mental and physical development for no apparent external reason;
• who have already had two or more regressing pregnancies;
• whose child suffers from a hereditary disease.

The cost of tests and ultrasounds that need to be completed after childbirth

1. Ultrasound of the pelvis + kidneys - price 1600 rubles.
2. Ultrasound of the abdominal cavity - price 1000 rubles.
3. Ultrasound of the thyroid gland - price 1000 rubles.
4. Ultrasound of the mammary glands + lymph nodes - 1000 rubles.
5. General urine analysis - 325 rubles.
6. Biochemical blood test (extended examination - 17 indicators) - 3720
7. Microflora smear - 465 rubles.
8. Tests for sex hormones: progesterone - 495 rubles, prolactin - 525 rubles, LH - 495 rubles, free testosterone - 1350 rubles.

Decoding the results

A gynecological examination and smear analysis of the flora make it possible to diagnose inflammatory diseases of the reproductive system. A cytology smear is necessary to exclude malignant tumors of the cervix. A blood test for HIV, viral hepatitis and syphilis is required. These infections are very often asymptomatic and cause irreparable harm to the child’s health. If studies reveal diseases or abnormalities, the couple will be prescribed treatment. If the test results in preparation for pregnancy planning are normal, the doctor gives permission to conceive. Spouses need to eat a balanced diet, monitor their lifestyle, and take folic acid. A woman should not take any medications 2–3 months before conception without a doctor’s prescription, drink alcohol, or smoke. You should avoid visiting saunas and baths.

***

Bibliography

• Askhabova JI.M., Makhmudova G.A. Reproductive health and family planning issues. Makhachkala. – 2003.
• Radzinsky V.E., Pustotina O.A. Family planning in the 21st century. M.: GEOTAR-Media, 2020.
• The influence of preconception preparation on the course and outcome of pregnancy with herpetic infection / V.L. Tyutyunnik, T.A. Fedorova, Z.S. Zaidieva, S.A. Aliyeva//Problem. reproductions. 2005. No. 5.
• Radzinsky V.E. Obstetric aggression. M.: Publishing house of the magazine StatusPraesens, 2011.

Where to undergo a comprehensive examination and tests after childbirth in St. Petersburg

The postpartum monitoring program for the mother’s condition helps the patient avoid complications and cope with existing pathologies. You can go through all the necessary diagnostics in.

The diagnostic complex includes laboratory and hardware examinations (ultrasound and various tests), consultations with specialists, and therapeutic measures. All procedures are performed according to a schedule convenient for the patient, which does not interfere with her individual daily routine. You can undergo an examination immediately after discharge from the maternity ward in order to prevent possible complications and illnesses in time.

Benefits of a comprehensive postpartum examination:

• The diagnostic complex includes a balanced set of studies and procedures that allow an objective and timely assessment of a woman’s postpartum condition.
• Considering the lack of time for a nursing mother, all procedures can be completed in one laboratory and diagnostic department by appointment, in a short time.

Patients can receive qualified advice from specialized specialists and undergo the necessary treatment within one medical institution.

A month to a month and a half after giving birth, you will need to undergo a gynecological examination. But if you had a caesarean section, you will need to visit the doctor a week, two and four weeks after giving birth.

Gynecologist after childbirth

should check your physical recovery from pregnancy and childbirth, assess your emotional state, give recommendations on postpartum contraceptive methods, and answer any questions you have during this time.

Write down these questions as they arise, so that later, at the reception, you can ask about everything and not forget anything. So, for example, you may have some problems after childbirth (such as,), and you may also have questions about breastfeeding, resuming sexual activity and preventing unwanted pregnancy, playing sports, etc.

But if postpartum problems bring you serious discomfort or you have pain, bleeding, an unexplained fever, or other serious symptoms, go to the doctor immediately, without waiting for the appointed time!

How will the reception take place?

First, the gynecologist will check if you have any complaints. After this, he will measure your weight and blood pressure. After this, he will check your abdomen to make sure that you do not have any painful sensations when palpating, and will also check the stitch if you had a caesarean section.

Further reception will proceed as follows:

1. A breast exam, during which your doctor will determine whether you have breast tenderness, lumpiness, redness, cracked nipples, or abnormal breast discharge.

2. Examination of the external genitalia and perineum (if you have had an episiotomy, the doctor will check the healing of the sutures).

3. Internal gynecological examination, during which the condition of the vagina and cervix is ​​assessed. The doctor will carefully examine the vagina for damage, bruising, and healing of tears and stitches, if any. After this, the gynecologist will take an oncocytology test (PAP test or Pap smear).

The doctor will palpate the pelvic area to feel the uterus and make sure that it has contracted and returned to its proper place; will palpate the cervix and ovaries to identify any problems with them (for example, the appearance of cysts on the ovaries), and check vaginal muscle tone.

What questions should be discussed with a gynecologist?

We invite you to familiarize yourself with an approximate list of questions that you can ask your gynecologist after childbirth

:

1. If you had any complications during childbirth or pregnancy, find out why this happened and how these problems may affect your future health and your next pregnancy if you decide to have another child.

2. Discuss your physical condition, for example if you still have postpartum bleeding (lochia), if you have pain in your stomach, vagina or perineum, if you suffer from fecal or urinary incontinence, if you have breast pain or have constipation problems. . Don't be shy to talk about anything that's bothering you.

3. If you feel overwhelmed, worried, or depressed, then you definitely need to tell your doctor about all the psycho-emotional problems that you have developed during motherhood.

4. If you are having difficulty establishing breastfeeding, your doctor can give you some good advice on improving lactation. If you do not want to breastfeed, then you may need to take medications to stop lactation and consult a mammologist.

5. If you cannot decide on a method of contraception, then consult your doctor about which methods are compatible with breastfeeding. If you are planning to use a diaphragm, you need to inform your gynecologist so that the doctor can conduct a thorough examination and determine whether you have any contraindications.

6. Find out if you can resume having sex. Most likely, your doctor will allow it, but don’t worry if you have no desire to have sexual intercourse. This is not a sign of frigidity, it’s just that many women after giving birth do not want to have sex until five to six months. Wait until you feel ready.

If you suffered from anemia (lack of iron) while you were pregnant, or lost a lot of blood during childbirth, then you will definitely be prescribed a blood test for anemia. If you have had gestational diabetes, you will need to have a blood glucose test or a glucose tolerance test.

Don’t neglect visiting a gynecologist after childbirth

! There are situations when you do not feel any symptoms that could indicate problems, but there is a problem, it’s just hidden. It happens that a woman comes back a few months later and is diagnosed with polycystic ovary syndrome or endometriosis, and this can cause infertility in the future.

Childbirth can be carried out in several ways:

• through the natural birth canal, that is, through the vagina.
• by caesarean section.

For each method of delivery there are standards for examination in the postpartum period, which must be complied with. Tests after childbirth before discharge are a basic set of studies that should be performed for every woman who gives birth to a baby.

If the process of delivery was carried out through the natural birth canal without any complications, then the volume of research is minimal. Postpartum tests for the mother include:

• clinical blood test;
• clinical urine analysis;
• conducting fluorography or x-ray examination of the chest organs.

• placental dysfunction with or without slowing blood flow;
• utero-fetal infection;
• chorioamnionitis;
• fetal distress;
• a history of miscarriage;
• antenatal fetal death;
• home birth;
• premature and;
• pregnancy due to the use of assisted reproductive technologies (IVF);

Histological examination is carried out by a histologist. In the material being examined, the doctor can detect calcifications, degenerative tissue changes due to chronic hypoxia (lack of oxygen), and inflammatory elements due to an existing uterine-fetal infection.

Poor analysis of the placenta after childbirth allows us to identify the cause of pregnancy complications, calculate the risks for the mother and child in the postpartum period, and also prevent these factors in subsequent pregnancies.

Hormone analysis after childbirth

A healthy woman does not need any specific testing for hormone levels after childbirth.

If there are diseases of the thyroid gland (hypo-, hyperthyroidism, diffuse toxic goiter), an analysis of the levels of the hormones TSH (thyroid-stimulating hormone), T3 and T4 is mandatory. If there is a pituitary adenoma, a test is performed to determine the level.

Preparation and procedure for taking a general blood test for a newborn and infant

If the child has been prescribed a clinical blood test, then the day before parents need to familiarize themselves with the general rules for taking this test:

• OAC is usually taken in the morning (except in urgent cases).
• The general rule for everyone is to donate blood on an empty stomach. But for newborns and infants, this condition is not at all necessary, because feeding regimes for all babies are different (a child can eat at night or early in the morning).
• The laboratory technician must always work in protective rubber gloves, using only disposable sterile instruments. Therefore, it is best to purchase disposable gloves, a special scarifier and alcohol wipes (or cotton wool and alcohol) at the pharmacy before taking the test.
• Currently, special automatic scarifiers have been developed for small children, delivering a minimum of pain and discomfort to the baby during the procedure.
• Blood is taken from the ring finger on the left hand. The finger is first wiped with alcohol; after the puncture, the first drop of blood is removed with an alcohol wipe.
• After collecting the required amount of blood, the puncture area must be covered with a cotton swab moistened with alcohol. Since the baby is small, the mother must hold the cotton swab for some time.

It is important for young parents to know that the procedure is quite unpleasant and painful for the child, so the baby (especially over the age of six months) will be capricious and try to remove the handle. Therefore, you need to hold the baby tightly and, of course, calm him down.

Tests one month after birth

A month after giving birth, women must return to their local obstetrician-gynecologist. The range of tests during this period during the normal course of the postpartum period is quite narrow (provided there are no complications after childbirth, as well as the absence of extragenital pathology). Mandatory studies include a smear from the genital organs for flora.

Many people believe that after childbirth, an HIV test is included in the list of mandatory ones. This opinion is wrong. If a woman is examined twice during pregnancy, there is no point in taking it immediately after childbirth. After consulting the woman, the therapist must prescribe a clinical blood test and a general urine test. If there are any concomitant diseases, the woman needs consultation with related specialists and an individual examination.

Tests after childbirth by a gynecologist

After being discharged from the maternity hospital, new mothers must visit an obstetrician-gynecologist at the antenatal clinic. The main purpose of the appointment is to assess the woman’s condition in the postpartum period, and if there are any symptoms indicating an unfavorable course, prescribe the necessary examinations and therapy.

After a gynecological examination, if there are signs of colpitis (inflammation of the vagina), exocervicitis (inflammation of the vaginal part of the cervix), endometritis (inflammation of the endometrium of the uterus), the doctor can take an analysis of the genitourinary tract for flora. This analysis will determine:

• the flora that inhabits the vagina (normally, most representatives of the flora are Doderlein bacilli),
• the number of leukocytes - cells, an increase in the number of which indicates an inflammatory process (the norm is up to 10),
• the amount of epithelium, which in the vagina is represented by stratified squamous non-keratinizing epithelium (in a normal smear its amount should be moderate).

If the doctor suspects the presence of endometritis, then the right decision would be to send the woman for an ultrasound examination of the pelvic organs and a clinical blood test to identify inflammatory changes.

Palpation of the mammary glands is mandatory. Since many mothers encounter the problem of lactostasis, and, sometimes, mastitis. If there is congestion in the mammary glands, milk can be analyzed for the presence of infectious agents.

Irina Drozdova, obstetrician-gynecologist, especially for the site

Useful video

After giving birth, in the hustle and bustle of daily worries with a newborn, many mothers forget about their own health, especially if in fact nothing bothers them. However, it is better not to postpone a planned visit to the gynecologist, because literally a couple of hours will help a young mother make sure that everything is in order with her health. Agree, it is better to prevent problems in advance than to deal with their consequences later.

When and where to go

A woman is warned about the need and timing of visiting a gynecologist after childbirth even within the walls of the maternity hospital. usually recommended to visit a gynecologist 1-1.5 months after birth

, at the end of the late postpartum period. Of course, if health problems arise, you should consult a doctor sooner.

: “If a woman has pain in the lower abdomen, the temperature rises, there are symptoms of lactostasis, there is discharge with an unpleasant odor, bleeding or suppuration of the suture, you should immediately contact the place of birth (in the first 6 weeks) or an antenatal clinic. Women in labor after a cesarean section, as a rule, come to the gynecologist at the site of the operation to remove the stitches. If this is not necessary, then 1-1.5 months after birth you should visit an antenatal clinic.”

So, if your birth went without complications and nothing worries you, then the first examination after birth is carried out by a gynecologist at the antenatal clinic

at your place of residence or the doctor who observed you before the birth of the child.

Of course, emergency doctor visits for nursing mothers are not provided in district clinics, so plan your visit so that it falls between feedings of the baby. The actual appointment itself rarely takes more than 30 minutes, which cannot be said about the time spent outside the office doors in line.

What happens if you postpone your appointment?

Of course, we all visited the gynecologist more than once before pregnancy and regularly visited the treasured office for a long 9 months. However, after giving birth, many people have questions about the advisability of visiting a doctor. Actually, what is there to see there? Pregnancy is over, childbirth is over, what problems may arise? It turns out that not everything is as simple as it seems at first glance.

A gynecological examination after childbirth is not just prescribed so that the gynecologist checks your weight, blood pressure, or listens to a detailed story about your childbirth experience. Unfortunately, it happens that during the delivery process

and during
the postpartum period
, women
experience certain complications
, and if they are not treated on time, they can develop into serious diseases.

For example, if after childbirth the uterus does not contract well enough, blood clots and placental debris may linger in its cavity and cause inflammation, and an enlarged uterus may indicate the development of endometritis.

Among the complications of the postpartum period, the following main types can be distinguished:

:

• postpartum purulent-inflammatory diseases (peritonitis, endometritis, obstetric surgical wound infections (infiltration);
• venous (superficial thrombophlebitis, deep vein thrombosis);
• breast infections associated with childbirth (mastitis, abscess);
• in the early and late postpartum period, one of the serious complications is bleeding.

Our g_s_k tells

: “I think the sooner you go to the doctor, the better. I went after 2 weeks, the doctor prescribed me a small treatment, because... the uterus contracted poorly, and postpartum erosion was discovered.”

What to expect at your appointment

Many women who have recently given birth put off visiting a doctor not only because they are very busy or they have no one to leave the baby with. They are afraid of pain

during the inspection.

Let's not hide it, it is quite possible, especially if the birth was natural, that you will have to endure several unpleasant minutes in the examination chair. However, if you do not go to the doctor at all and do not treat possible postpartum complications, they can become chronic.

, and dealing with them will be much more difficult.

Our mother HelenaRam tells

: “I was at an appointment after giving birth, I was already preparing to clench my teeth in pain, and the doctor looked at me so carefully that it didn’t even hurt. He said everything is ok, come back in three months. So it’s not always as scary as we think.”

Before the examination, the doctor will definitely clarify whether the birth was natural or a caesarean section, and whether an episiotomy took place. The gynecologist will also check the condition of the walls of the vagina and cervix, it is important that after childbirth they take the correct shape. In case of any suspicions, for example, inflammation in the cervix (cervicitis), which often occurs in the postpartum period, the gynecologist can take a smear from the vagina and cervix.

Gynecologist at the Dobrobut clinic, Irina Valerievna Yarovaya, tells

: “At the first visit to the gynecologist after childbirth, the doctor finds out how the postpartum period went, looks at the vagina, during colposcopy examines the cervix for erosion, and also gives recommendations on contraception during breastfeeding and restoring the menstrual cycle.”

Our YARULYA tells

: “I went to my first appointment with a gynecologist two months after giving birth. True, after that I had been gone for two years already... And I wouldn’t have gone any further, but I had to go; without a gynecologist’s visa, they didn’t want to close my sick leave. In general, as my therapist said, you need to love yourself, i.e. visit a gynecologist once every six months. So don’t delay going to the doctor, even though you don’t want to!”

After being discharged from the maternity hospital, parents have many new tasks and responsibilities. The whole world of a young mother is now focused on her baby, time is scheduled minute by minute, and she cannot get enough sleep. Therefore, some mothers postpone the necessary visit to the gynecologist after childbirth indefinitely. In vain. Even if nothing worries you, you should definitely see a doctor to rule out possible health problems in the future.

Interpretation of a newborn's blood test

The composition of the blood of a newborn baby differs from the composition of the blood of older children. This is explained by the specific development of the hematopoietic organs and circulatory system during the period of intrauterine development. In the first months after the birth of a child, there is a rapid formation of blood cells in the bone marrow of all his bones. The amount of blood relative to the weight of the newborn is 14%, while in infants this figure is 11%, in adults – 7%.

Hemoglobin

The main feature of a newborn’s blood test is the content of a significant amount of fetal hemoglobin, which is formed in the red blood cells of the fetus. Fetal hemoglobin is necessary for a child during intrauterine development, as it is able to bind oxygen particularly strongly and is resistant to alkalis. Even before the baby is born, the gradual replacement of fetal hemoglobin with adult hemoglobin begins.

In the first day of a baby’s life, the content of fetal hemoglobin in the blood is 70–80%. In the future, this type of hemoglobin should be more actively replaced by adult hemoglobin. A condition in which such replacement does not occur is called hemoglobinopathy. Fetal hemoglobin very slowly releases oxygen to organs and tissues, which significantly slows down the development of the child's body.

In a newborn's blood test, the normal hemoglobin content is 145–225 g/l. The level of red blood cells in the baby's blood immediately after birth is higher than in older children. This is due to hypoxia (insufficient oxygen supply), which occurs during fetal development. Normally, the level of red blood cells is 4.4–7.7 × 10 12 /l.

Red blood cells

An increased content of red blood cells in the blood leads to a higher level of color index and hematocrit. The color index of a newborn baby's blood reaches 1.2. Hematocrit (the percentage of red blood cells in the total blood volume) in the first day of a baby’s life reaches 45–65%.

Red blood cells in the blood of newborn children have different shapes, colors, and sizes. In addition, their life expectancy is significantly shorter. According to the transcript of the blood test for a newborn, it is 12 days, and for a one-year-old child this figure is 120 days.

High levels of reticulocytes (young forms of red blood cells) indicate increased regenerative abilities of newborn blood cells. This figure is 28%.

Leukocytes

A newborn's blood test normally indicates physiological leukocytosis. On the first day of a newborn’s life, the level of leukocytes in his blood is in the range of 10–33 × 10 9 / L, then their level decreases to 7 × 10 9 / L. The main number of leukocytes is represented by segmented neutrophils (about 50–80%).

Band neutrophils

Band neutrophils make up 6–10%, lymphocytes – 20–25%, eosinophils – 1–4%, monocytes – 10–12%, basophils – 0–1%.

Increased blood viscosity affects ESR (erythrocyte sedimentation rate). Based on the interpretation of the newborn’s blood test, the normal ESR is 0–2 mm/hour.

Bilirubin

Bilirubin (yellow pigment) is an intermediate product that occurs during the breakdown of hemoglobin in the liver, bone marrow, and spleen. Free bilirubin cannot be excreted from the body because it is insoluble. In order for it to become soluble, specific proteins must transport it to the liver. There, under the influence of liver enzymes as a result of biochemical reactions, bilirubin becomes soluble and is excreted in the urine. Sometimes newborn babies lack specific proteins that are needed to transfer bilirubin to the liver. Then they develop the so-called physiological jaundice of newborns.

At the birth of a child, the bilirubin content in the umbilical cord blood should not exceed 51–60 µmol/l. On days 3–7, the normal content of bilirubin in the baby’s blood is up to 205 µmol/l, in a premature baby – up to 170 µmol/l. After two to three weeks, bilirubin in children should return to normal and be 8.5–20.5 µmol/l.

If the content of bilirubin in the blood of a newborn exceeds these indicators, his condition is considered pathological. In this case, the child undergoes additional tests, based on the results of which the necessary treatment is prescribed.

Appointment!

Even in the maternity hospital, every woman is warned about the need to visit a gynecologist.

The doctor usually recommends abstaining from sexual activity for the same amount (or a little more). However, some violate both the first and second prohibitions.

A visit to the gynecologist is postponed “until better times,” and abstinence lasts less than the doctor prescribed. Both are fraught with serious health problems. The most common of these is endometritis - inflammation of the inner layer of the uterus (endometrium).

If you are putting off an appointment with a gynecologist because you don’t want to be separated from your child even for a few hours, remember that a healthy mother can give her baby much more care and love. Unfortunately, the district antenatal clinic does not provide out-of-turn appointments for nursing mothers. Therefore, if you are worried that you will have to miss a feeding because of a visit to the doctor, a commercial medical center is a good option. You can sign up for any hour convenient for you and not waste precious time in line. The appointment and examination itself rarely takes more than 40 minutes. In addition, before going to the doctor, you can express milk for your baby or take your baby with you, asking one of your relatives to accompany you.

Procedures to prepare for the day of birth

If a woman enters the maternity hospital with contractions or broken waters, the algorithm of actions and all procedures before childbirth are described in the previous paragraph.

But a pregnant woman may be in the pregnancy pathology department and her delivery may be planned, or contractions may begin at any time. In this case, she expects the following:

• Examination by the attending or duty doctor, and, if necessary, by the head of the department.
• CTG recording - fetal heartbeat.
• Cleansing enema and shower.
• Transfer to an observational or physiological maternity ward.

If a woman is planning a caesarean section, the procedure is the same. A light dinner is allowed the night before; in the morning you can only drink a little clean water.

Also, the pregnant woman must collect all her things if she was previously in the pathology department. Some can be taken with you to the delivery room, the other will need to be put in a storage room.

Watch this video about preparatory procedures before childbirth:

In the delivery room

The maternity room includes an examination room (usually several), prenatal wards where women are during contractions, as well as the maternity rooms (halls) themselves - they contain special chairs, a table for treating a newborn, as well as equipment and tools that may be needed during childbirth, everything is sterile, and consumables are disposable (diapers, etc.).

The delivery room also includes an operating room, where, if necessary, a woman can be sent urgently during childbirth.

After admission to the delivery room, the woman is assigned to one of the prenatal wards, where she will be monitored (including video), and CTG monitoring of the fetal condition is carried out. The doctor, who is in charge of the delivery room at this time, clarifies the woman’s complaints and medical history, studies the birth chart and, if necessary, conducts an examination in a gynecological chair.

If childbirth proceeds without complications, then the frequency of vaginal examinations is as follows:

• every four hours during labor;
• after the rupture of amniotic fluid;
• if complications are suspected.

The woman is in the prenatal ward throughout the contractions; she is also allowed to move along the corridor and take a shower (as a method of pain relief).

With the beginning of the pushing period, the issue of transfer to the delivery room itself is decided. Here the woman lies down on a chair, the doctor monitors the condition of the fetus by heart rate (listened to with a stethoscope or CTG monitor).

After the birth of the child, the birth canal is examined for rupture. If necessary, the doctor performs suturing, as well as additional manipulations. For another two hours, the woman is under close supervision of medical personnel for timely detection of complications. After which the postpartum woman is transferred to a ward with the baby.

If an emergency or planned caesarean section is performed, then immediately after the operation the woman is transferred to the intensive care unit for observation - for at least two hours, most often for 12-24 hours. After this, she is also transferred to the postpartum ward.

Watch this video on how to care for a suture after a caesarean section:

Take a notepad

During your first visit to the gynecologist after giving birth, you may be confused, so it is better to write down all the questions in a notebook in advance. Don't forget to ask your doctor about contraception (breastfeeding mothers are limited in their choice of contraceptives), when to resume intimate relationships with your husband, when you can go to the gym or start doing housework. Feel free to ask any questions you have. Believe me: you are not the first and you will not be the last to wonder whether it is possible to get pregnant if you are breastfeeding and when menstruation will resume. These are quite expected questions, and the doctor has had to answer them more than once in his practice. Yes, there are, of course, standard recommendations. Sexual activity can be resumed no earlier than 8 weeks after birth; the next pregnancy should be planned after 2-3 years; the best contraceptive method for nursing mothers is barrier (namely, condoms). But every case is individual. This is why you go to see a doctor to hear his recommendations for you personally.

Features before discharge from the hospital

Depending on the condition of the postpartum woman, the doctor determines the time of her discharge. The day before you need to undergo a minimum examination and examination. Procedures before leaving the hospital include the following:

• blood and urine analysis, if necessary - a broader study, including biochemical examination, in-depth urine tests;
• inspection of seams and their treatment;
• vaginal examination on a chair - the rate of uterine contraction and the nature of discharge from the genital tract are determined;
• examination of the mammary glands;

The newborn undergoes separate examinations and examinations. If any abnormalities or complications are discovered in the baby, mother and child may be left in the maternity hospital for some more time. In some hospitals, in such cases it is assumed that the patient will be transferred to another department (rehabilitation) or even a children's hospital.

As soon as the mother and baby are ready for discharge, all documents are drawn up - discharge summary, documents for the child, and others, if necessary. The woman should subsequently provide some of them to the pediatrician, and the other to the gynecologist at her place of residence.

Preparation for childbirth is universal and is performed in all maternity hospitals, but each medical institution has its own approaches and nuances. For example, in some places visiting relatives is allowed during the entire stay in the maternity hospital and even during childbirth. In others, this is strictly prohibited and even wearing your own clothes is not allowed. Therefore, when sending to a hospital on a scheduled basis, you should find out such nuances in advance.

Will it hurt?

Some women put off visiting the doctor for another reason. They're scared. If the birth occurred naturally, the first examination after it in the chair may indeed seem quite unpleasant. But if postpartum complications are not detected in time, they will become chronic, and correcting the situation will be much more difficult: prevention is always more effective than treatment. To cope with fear, think that everyone goes through this, that it will only take a few minutes, and that your health is worth it.

If a woman experiences too much discomfort during the examination, the doctor may spray the birth canal with an anesthetic.

How is the inspection carried out? Was the birth natural? In this case, the gynecologist looks at the condition of the external genitalia and checks how the stitches are healing if you have had an episiotomy. It is mandatory to take a smear from the vagina and cervix. This test will help identify inflammation in the cervix (cervicitis), which often occurs during the postpartum period.

Also during the examination, the doctor checks the condition of the walls of the vagina and cervix. If the cervix is ​​irregularly shaped, it is usually because the stitches have come apart or the doctor missed a tear during delivery. In any case, stitches will need to be stitched again. Yes, it is a little painful, but it is extremely necessary, otherwise chronic inflammation of the cervix may occur, which leads to infertility.

Preparing a baby for a blood test

No matter how prepared the medical staff is, first of all the baby’s parents need to “savvy” themselves in advance: the more serene and confident the mother of a small patient feels, the calmer the procedure for taking blood from an infant will be.

The warmth of the mother will calm the baby in an unknown environment (otherwise the nervous state of the parents, their excessive anxiety or fear willy-nilly be passed on to the baby).

But many mothers and fathers need to be prepared for the fact that they will have to entrust the baby to experienced laboratory assistants, since in some clinics adults are not allowed to be present in the manipulation room. There should be no place for fear, panic and negative emotions: doctors and nurses who know their stuff will quickly and more or less painlessly carry out the necessary diagnosis.

Some doctors lubricate the child's hand with a special anesthetic ointment, then the child does not feel anything.

Qualified personnel prepares instruments for analysis in advance. In turn, the venipuncture needle must be washed with heparin.

Most mothers and fathers refuse to give up the child and require personal presence when taking the test.

But many psychologists are unanimous in the following opinion: it’s better if other people’s aunties and uncles do everything “bad” to the child, and a calm and smiling mother will come out and “save” her baby, calm him down, distract him with toys and feed him.

But if the parents are standing next to them or holding them in their arms, then the child may be “offended” and receive permanent psychological trauma, since the people closest to him do not “protect” him at an extremely unpleasant and painful moment.

If the mother is allowed to hold the baby in her arms, then it will be possible to distract the baby with a new or his favorite toy, as well as bright rattles. Better yet, come to the manipulation room in advance and allow the child to master the new environment.

The main thing in pediatric venipuncture is the common sense of adults: no matter how scary or sorry the infant may be, parents should always remember that the health of their baby is more important.

>Postpartum tests for mom: nuances of the postpartum period

After cesarean

If the birth ended surgically, a visit to the doctor should also under no circumstances be postponed. And besides, mothers after a cesarean section have nothing to fear. For them, the examination on the chair will be the same as dozens of previous ones, to which one could already get used to over the past 9 months. Mothers of caesarean babies undergo an ultrasound in the maternity hospital, during which the condition of the uterus is assessed: they look at how it contracts, whether there are any clots or remnants of the placenta in its cavity. In case of any problems, the gynecologist prescribes treatment. But, unfortunately, sometimes complications begin after discharge from the maternity hospital, when the doctor is not around. If you have had a caesarean section, you need to take extra care of your health. Your uterus does not contract as well as those who gave birth vaginally, which means blood clots and placental debris can become trapped in the uterus and cause inflammation. In order for the uterus to contract faster, doctors recommend applying ice to the lower abdomen and breastfeeding the newborn as often as possible. Natural feeding stimulates the production of the hormone oxytocin, which perfectly promotes uterine contractions.

After a cesarean section, the risk of endometritis is significantly higher than after a natural birth.

For this reason, it is very important to monitor uterine contractions during the postoperative period. The doctor feels the body of the uterus and assesses its size. An enlarged uterus indicates the presence of endometritis. In this case, the patient is sent for a repeat ultrasound. After this, she is prescribed complex treatment with mandatory antibacterial therapy. Sometimes a woman has to do curettage. But do not be afraid, this procedure is done under anesthesia.

Also, for women who have found the joy of motherhood through a cesarean section, it is important to monitor their suture very carefully and carefully observe its hygiene.

• try to wet the seam as little as possible, take a shower briefly and carefully;
• forget about the bath for at least 6 weeks;
• after a shower, lubricate the seam with brilliant green or iodine;
• wear loose underwear made from natural fabrics;
• Have a separate towel for wiping the seam.

Caesarean section, like any abdominal operation, is a serious test for the body. Sometimes, despite all precautions, operated mothers begin to have problems with women's health.

Gynecologists advise immediately consult a doctor or even call an ambulance if you have:

• painful sensations appeared in the lower abdomen;
• bleeding does not stop for more than 6 weeks or has become more profuse and acquired an unpleasant odor;
• suppuration appeared in the suture area;
• the temperature suddenly rose.

All these are alarm bells, harbingers of serious inflammatory processes.

What will happen immediately after admission to the maternity hospital?

A maternity hospital is for many a medical institution full of mysteries, because since Soviet times it has been customary for pregnant women and women in labor not to be allowed out even to relatives from the moment of admission until discharge, but to communicate “through the glass window.” In order to feel calm and be prepared for all manipulations, it is useful to know what procedures are carried out in the maternity hospital at different stages.

Pregnant women enter the maternity hospital for two reasons:

• by referral from a antenatal clinic doctor;
• on your own or in an ambulance with some complaints.

If a pregnant woman is “in labor”

This means that the woman arrived either with contractions or with broken amniotic fluid and will have to give birth in the next few hours. In this case, the sequence of procedures that will be performed upon admission to the maternity hospital is as follows:

• conversation with the midwife, and then with the doctor on duty, who fills out the documentation - the birth chart;
• examination by a doctor, listening to the fetal heartbeat;
• measuring the abdominal circumference and the height of the uterine fundus;
• determining the weight of a pregnant woman;
• blood pressure measurement.

1. The pregnant woman changes into clothes (robe, slippers, underwear) from the maternity hospital or her own clothes - depending on the institution.
2. A cleansing enema is performed. If a pregnant woman is admitted while pushing, an enema is not performed and she is immediately transferred to the delivery room.
3. If necessary, the genital area is treated (shaving), then you should take a shower.
4. The pregnant woman is sent to the department - physiological or observational, based on the clinical situation.

Expert opinion

Daria Shirochina (obstetrician-gynecologist)

If bleeding or other conditions that are life-threatening and require immediate delivery are detected, the pregnant woman can be sent to the operating room directly from the emergency room with only minimal or no treatment.

If there are signs of labor or other problems

In this case, the pregnant woman is sent to the pathology department or home (for example, if she refuses hospitalization or her condition does not require inpatient care). The procedures that are carried out in this case are as follows:

• Conversation with the midwife and doctor, preparation of the necessary documentation.
• Examination on a gynecological chair.
• Measuring weight, blood pressure, parameters of a pregnant woman.
• If the pregnant woman is not hospitalized, she is given an advisory report on her condition with further recommendations.
• If necessary, the woman is sent to the pathology department or the delivery room for observation.

In hospital?

Unfortunately, some postpartum complications may require mommy to be hospitalized. Of course, I don’t want to part with the baby. But you have no right to risk your health: now you have double responsibility. By the way, breastfeeding can be established even after discharge from the hospital, provided that you regularly express milk.

If you gave birth under a contract, then in case of postpartum complications you can seek medical help at the same maternity hospital. There they are required to provide you with a free luxury ward for up to 7 days (most contracts stipulate this) and free treatment.

If you gave birth without a contract, it would still be more advisable to go to the maternity hospital where your baby was born. They know you there, and doctors are one way or another responsible for your condition after childbirth.

General blood test in a newborn and infant: normal, interpretation

As you know, clinical blood test indicators make it possible to assess the state of child health, make a preliminary diagnosis or exclude the presence of pathological processes. It is worth noting that the norms of analysis in children differ from those in adults, and gradually change with age:

On the first day after birth, the baby’s first tests are taken. With their help, the doctor assesses the baby’s health status and his adaptive abilities. So, immediately after birth, blood from the umbilical cord is tested for HIV infection, hepatitis B and C, and syphilis. If necessary, conduct a blood test for bilirubin.

On the fourth day, the newborn's blood is tested for genetic diseases. On the fifth day, the child is given a blood sample for a general (clinical) analysis. A blood test is usually taken from the newborn's heel. This is a more convenient way to collect blood, since the baby’s fingers are still very small to carry out this procedure.

Symptoms of hormonal imbalance

Signs of hormonal imbalance in the postpartum period depend on the level of hormones that are produced in excess or insufficient quantities. The most common symptoms of the pathology are:

• weight gain or loss;
• menstrual irregularities, heavy and painful menstruation;
• decreased performance, deterioration of a woman’s psychological state;
• mood disorders (outbursts of aggression followed by periods of apathy, etc.);
• decreased libido;
• dizziness;
• swelling;
• sweating;
• sudden changes in blood pressure, disruption of the cardiovascular system;
• dissomnia;
• disturbance of the deep sleep phase;
• alopecia;
• active hair growth in various parts of the body;
• dermatological pathologies, skin rashes;
• disturbances in breast milk production;
• postpartum depression, lack of attachment to the newborn, etc.

Underweight or overweight in a woman can be associated not only with changes in diet, but also with hormonal imbalances. The following endocrine factors contribute to weight gain:

1. Increased ghrelin concentration. The balance of ghrelin and leptin regulates feelings of hunger and satiety. With intense ghrelin production or impaired cell sensitivity to leptin, a woman constantly feels hungry and is forced to strictly control her diet in order to slow down weight gain. Increased production of ghrelin can be associated both directly with hormonal imbalance and with lack of sleep during the period of caring for the baby: reducing the daily sleep requirement to 4-5 hours leads to an increase in ghrelin concentration by 15% and a corresponding decrease in leptin synthesis.
2. Decreased production of thyroid hormones. Pathologies of the thyroid gland associated with a decrease in the synthesis of iodine-containing hormones T3 and T4 (hypothyroidism) lead to the appearance of edema, a slowdown in metabolism and a rapid increase in body weight. Against the background of breastfeeding and postpartum hormonal imbalance, many characteristic signs of thyroid disease (menstrual irregularities, mood changes) may not be noticeable.
3. Increased cortisol synthesis. An increase in appetite with increased ghrelin synthesis is not the only cause of excess weight in young mothers. Insufficient sleep, physical and psycho-emotional stress stimulate the production of the stress hormone - cortisol, which provokes swelling and accumulation of fat in the abdomen and thighs. Reducing the amount of sleep by 2-3 hours a day leads to an increase in cortisol production by 50%.

Weight loss in the postpartum period is observed less frequently than the opposite phenomenon. Weight loss can be caused by elevated levels of leptin or thyroid hormones (hyperthyroidism). Excess leptin leads to loss of sensitivity to hunger. A woman who is busy caring for a baby may forget to eat when she is not hungry, which causes nutritional deficiencies.

With increased production of thyroid hormones, weight loss occurs even if the woman ate properly and followed a normal sleep schedule.

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Painful menstruation and intense premenstrual syndrome (algomenorrhea) may be associated with the following factors:

1. Increased production of prostaglandins. Prostaglandins are hormone-like substances that are not conductors (mediators) of pain and inflammation, but significantly increase the sensitivity of pain receptors to inflammatory mediators (bradykinin and histamine).
2. The development of endometriosis due to damage to the cervix, vagina and anterior abdominal wall during normal or complicated childbirth. The introduction of uterine endometrial cells into lesions in a woman’s birth canal or a suture after a cesarean section leads to complications of menstruation. The most common type of cancer to develop is endometriosis that was not treated before pregnancy.
3. Decreased estrogen production in the body. Insufficient concentration of estrogen and a change in its ratio with another female hormone (progesterone) provokes prolonged painful menstruation and intense premenstrual syndrome. PMS with a lack of estrogen and excess progesterone is manifested by severe swelling, dizziness, hot flashes, decreased performance, weakness and changes in heart rate and blood pressure.

Prolonged bleeding during menstruation can also be caused by the opposite phenomenon - an increase in the concentration of estrogen, which occurs with obesity.

Hair loss

Hair loss after childbirth is normal. During pregnancy, the level of female hormones increases, which leads to increased blood supply to the hair follicles and rapid hair growth. After the birth of a child, estrogen levels decrease, so there may be some deterioration in the condition of the curls. Stress, poor nutrition and metabolic disorders aggravate the unpleasant situation.

Pathological causes of hair loss in the postpartum period are:

• increased weakness and dryness of hair due to hypothyroidism;
• alopecia areata caused by excess androgens (dihydrotestosterone).

Signs of the pathological etiology of alopecia are not only its focal nature, but also its combination with the active growth of coarse dark hair in other parts of the body (on the chest, chin, abdomen, above the upper lip, etc.), acne and obesity.

The most active hair loss is observed 3-5 months after childbirth.

Acne on the face and body

Acne on the body and face of a young mother is often a consequence of hormonal imbalance. The pathogenesis of this phenomenon may be associated with the following factors:

• violation of water-salt balance and metabolism of proteins, fats and carbohydrates (glucocorticoids and mineralocorticoids are responsible for these processes);
• excess subcutaneous fat and its improper distribution (changes in the level of estrogen and androgens);
• stimulation or inhibition of the gonads and adrenal glands due to an imbalance of hormones of other glands, incl. pituitary gland

Active production of progesterone against the background of reduced estrogen concentrations, chronic fatigue, stress and postpartum depression cause various psychological disorders. New mothers may experience the following symptoms:

• tearfulness;
• increased irritability;
• suspiciousness;
• apathy;
• depressed state;
• decreased libido;
• short-term outbursts of aggression;
• guilt;
• auto-aggressive behavior and suicidal thoughts.

Disruption of oxytocin production during and after the birth of a child, as well as difficult childbirth and painful long-term rehabilitation can lead to rejection towards the child.

Today, hormonal disorders are quite common. It is especially common in women who have had a caesarean section or had a protracted labor with complications.

What symptoms indicate the presence of hormonal problems:

• The appearance of dizziness and headaches;
• Sleep disturbance;
• Decreased libido;
• Blood pressure surges;
• Irritability and depression.

Increased fatigue and excessive sweating may also indicate hormonal changes.

Sometimes, as a result of hormonal changes, external signs may appear:

• Excess weight with a normal diet;
• Hair loss;
• The appearance of excess hair on the body.

If you have a coincidence of several symptoms, you need to contact an endocrinologist or gynecologist.

Babies up to 1 year

I showed up on the 3rd day, and then as the doctor said, then after half a year I was already in the chair.
because when after an episiotomy there are internal stitches, there is also the possibility of erosion, and it must be treated. In addition, on the 3rd day the doctor looked at how my uterus was contracting and what was going on with my breasts. I took tests half a year later. If you didn’t look at the ultrasound when you were discharged, go for it yourself, sometimes tissues rarely remain in the uterus. needs to be cleaned. This is of course on the conscience of the doctor and uzist. but I personally know in RD 7 in 2 weeks. After me, a girl gave birth without tears or stitches. and then after 2 weeks the outing began. She was rotten inside for 2 weeks. She had a cleaning done 2 weeks after giving birth, you shouldn’t be afraid just because no one will take care of your health except you. I made an appointment with the gynecologist and ran to the appointment.. We smile and wave. Smile and wave :))))))

I had episio both times, but I’ll make a reservation: I have my own doctor, so to speak, that’s why she insists on an examination, she looked at the stomach, how the uterus contracts, and looked at the chest. Both times my threads dissolved on their own, the suture if necessary, she can look on the couch if anything bothers me, but when the daub ends, then the examination is on the chair, but my doctor looks carefully

Smile and wave. Smile and wave :))))))

I showed up on the 3rd day, and then as the doctor said, then after half a year I was already in the chair. because when after an episiotomy there are internal stitches, there is also the possibility of erosion, and it must be treated. In addition, on the 3rd day the doctor looked at how my uterus was contracting and what was going on with my breasts. I took tests half a year later. If you didn’t look at the ultrasound when you were discharged, go for it yourself, sometimes tissues rarely remain in the uterus. needs to be cleaned. This is of course on the conscience of the doctor and uzist. but I personally know in RD 7 in 2 weeks. After me, a girl gave birth without tears or stitches. and then after 2 weeks the outing began. She was rotten inside for 2 weeks. She had a cleaning done 2 weeks after giving birth, you shouldn’t be afraid just because no one will take care of your health except you. I made an appointment with the gynecologist and ran to the appointment..