THICKENING OF THE PLEURA
Thickening of the pleura can be observed along the line of the convexity of the chest and sometimes in the area of interlobar fissures.
Radiological signs
Normally, there is no boundary between the inner surface of the chest wall and outer surface the lungs are not observed, but as a result of the inflammatory process in the pleura between the lung and the chest wall, a line of the pleura can be visible. The thickness of the pleural line in patients who have had pleurisy can range from 1 to 10 mm. Thickening of the pleura following an inflammatory process is almost always the result of fibrotic changes in the visceral pleura. Thickening can be local or total. Local thickening of the pleura is most often observed in the lower parts of the chest cavity, since this is where pleural fluid collects. With local thickening of the pleura, the costophrenic sinuses are completely or partially smoothed out. In such cases, the patient should have a radiograph taken in the lateral decubitus position (see previous section of this chapter) to rule out the presence of free pleural fluid. The main diagnostic value of local pleural thickening is that it indicates previous inflammation of the pleura.
After an intense inflammatory process of the pleura, observed in cases of extensive hemothorax, pyothorax or pleurisy of tuberculous etiology, a total thickening of the pleura of the entire hemithorax may occur. This thickening is caused by the development of fibrous tissue in the visceral pleura; the thickness of the pleura can exceed 2 cm. The inner surface of this layer is calcified, which allows its thickness to be accurately determined. If this pleural lesion causes painful sensations, and the function of the lung located under the pleura is not impaired, then the symptoms can be relieved as a result of decortication (see Chapter 22).
Thickening of the apical areas of the pleura. Sometimes there is thickening of the pleura at the apex of the lung. Previously, this phenomenon was associated with the tuberculosis process, but currently they have a different opinion. Renner et al. The apical areas of the pleura were examined at autopsy in 19 patients in whom thickening of these areas was visible on radiographs, and no evidence of new tuberculosis was identified. Because the incidence of apical pleural thickening increases with age, the authors hypothesized that the thickening may be related to the healing process in the lungs under conditions of chronic ischemia. Thickening of the apical portions of the pleura is often bilateral, but can also be observed on one side (193. In the latter case, apical lung cancer or Pancoast tumor should be suspected.
Thickening of the pleura may also result from exposure to asbestos (see Chapter 22). However, unlike other types of pleural thickening, thickening of the parietal, rather than visceral, pleura is observed. It can be either local (such thickenings are called pleural plaques) or total. On average, the period between the onset of exposure to asbestos and the appearance of pleural plaques is 30 years. Pleural thickening or plaques formed as a result of asbestos exposure are usually observed bilaterally and are more pronounced in the lower half of the chest, and the configuration follows the contour of the ribs. Thickened areas are usually calcified. On a radiograph, the severity of calcification varies from small straight or rounded shadows, usually located above the dome of the diaphragm, to complete calcification of the lower parts of the lungs. CT scan is the most sensitive of X-ray methods diagnosis of pleural thickening and calcification of the pleura caused by exposure to asbestos.
PNEUMOTHORAX
Radiological signs of pneumothorax are determined by two factors. Firstly, the air in the pleural cavity collects in its upper part, since it is less dense than lung tissue. Secondly, the lobes of the lung retain their normal shape at any degree of collapse. It should be noted that these are the same factors that influence the accumulation of pleural fluid. The only difference is that in a pneumothorax, air rises into the upper part of the hemithorax and causes the upper lobe of the lung to collapse, while in a pleural effusion, fluid collects in the lower part of the hemithorax and causes the lower lobe to collapse.
Normally, intrapleural pressure is negative, which is due to the balance between the inward movement of the lungs and the outward movement of the chest wall. If air enters the pleural cavity, the lung will shrink, the chest cavity will increase in volume and intrapleural pressure will increase. When introduced into pleural cavity 1000 ml of air, the lung will decrease in volume by 600 ml, and the chest cavity will increase by 400 ml. The intrapleural pressure on this side will become less negative and, since the pressure in the contralateral cavity will remain unchanged, the mediastinum will be shifted to the contralateral side. The ipsilateral dome of the diaphragm will be lowered due to an increase in intrapleural pressure and a resulting decrease in transdiaphragmatic pressure. An increase in the volume of the hemithorax, flattening of the dome of the diaphragm and displacement of the mediastinum mean that the patient has a tension pneumothorax.
Radiological signs
An accurate diagnosis of pneumothorax can be made if the line of the visceral pleura is visible (Fig. 14). The line of the visceral pleura in such cases is dim, but sharply defined; it separates the lung parenchyma from the rest of the chest cavity, which is devoid of a pulmonary pattern. Although one might expect that a partially collapsed lung would have increased density on x-ray, this is not observed on the following reasons. First, blood flow decreases in proportion to the degree of lung collapse, and it is blood flow that largely determines the density of the x-ray image. Second, the chest is a cylinder, and in pneumothorax, air in front and behind the partially collapsed lung reduces the overall radiographic density of the lung. X-ray density does not increase until the lung has lost about 9Q% of its volume. Complete atelectasis of the lung as a result of pneumothorax is characterized by an increase in the pleural cavity and flattening of the dome of the diaphragm on the affected side, displacement of the mediastinum to the contralateral side and
Rice. 14. Anterior direct radiograph for right-sided pneumothorax. The line of the pleura of the collapsed lung is visible. Note the bulla at the apical line of the pleura, likely the cause of the pneumothorax.
Rice. 15. Anterior direct radiograph with pneumothorax and complete atelectasis of the right lung.
the presence of a mass of increased density the size of a fist in the lower part of the hilum of the lung, representing a collapsed lung (Fig. 15).
Pneumothorax is usually easily diagnosed when a line of visceral pleura is detected on a plain radiograph. However, with a small pneumothorax, the line of the visceral pleura may not be visible on a regular radiograph, and then the diagnosis can be established in two ways: 1) make X-ray V vertical position with a full exhalation; the meaning of this is that, although the volume of gas in the pleural cavity is constant, with full exhalation the volume of the lung will decrease, and the part of the pleural cavity occupied by air will increase, which will greatly facilitate the identification of the line of the visceral pleura; 2) take an x-ray in the lateral decubitus position, with the side with the suspected pneumothorax facing upward; in this position, the free air in the pleural cavity rises upward, which increases the distance between the lung and the chest wall; in addition, the number of random shadows near the lateral surface of the chest wall is less than in the apical sections.
Atypical pneumothorax. As with pleural effusion, the radiological appearance of pneumothorax may be atypical. If the lung parenchyma is damaged to such an extent that the lung does not retain its normal shape, then the appearance of the partially collapsed lung will be modified. Adhesions between the visceral and parietal pleura also modify the radiological picture of pneumothorax. Such adhesions often have the appearance of cords between a partially collapsed lung and the chest wall (Fig. 16). Diffuse adhesions between the viscera
Rice. 16. Atypical pneumothorax.
Anterior direct radiograph for chronic pulmonary tuberculosis and secondary spontaneous left-sided pneumothorax. Note that air in the pleural cavity is visible only in the lower part of the hemithorax due to adhesions between the visceral and parietal pleura.
ceral and parietal pleura can prevent collapse of the entire lung lobe. Clinically and radiologically, it is important to distinguish giant bullae from pneumothorax, since their treatment methods are different. In some cases differential diagnosis difficult, since a large bulla may resemble a large pneumothorax with adhesions.
Tension pneumothorax. Tension pneumothorax develops with positive pressure in the pleural cavity. Because increased intrapleural pressure can cause significant disturbances in gas exchange (see Chapter 19), it is necessary to diagnose tension pneumothorax as early as possible in order to begin its treatment immediately. X-ray diagnosis of tension pneumothorax using only x-rays unreliable. Although it is often considered that an increase in the volume of the pleural cavity, flattening of the diaphragm and contralateral displacement of the mediastinum indicate tension pneumothorax, sometimes all these signs are found in the case of non-tension pneumothorax. An accurate radiological diagnosis can only be made by fluoroscopic examination. With tension pneumothorax during inspiration, increased pleural pressure prevents the mediastinum from shifting to the affected side (which is observed with non-tension pneumothorax), in addition, there is a restriction in the movement of the ipsilateral part of the diaphragm. To confirm the presence of a tension pneumothorax, it is usually better to insert a needle into the pleural space rather than waste time x-ray examination(see chapter 19).
4. CLINICAL DATA AND LABORATORY INDICATORS
Normally, the pleural cavity contains only a few milliliters of pleural fluid. If the volume of fluid increases so much that it is visible x-ray, this is a deviation from the norm. The accumulation of pleural fluid can be caused by various pathological processes (see Table 2). If pleural fluid is detected, you should try to determine which of the many listed in the table. 2 conditions were caused by the accumulation of pleural fluid. This chapter discusses clinical picture pleural effusions. The following discusses the different types of laboratory tests used in differential diagnosis pleural effusions. Chapter 5 provides recommendations for a systematic approach to diagnosing pleural effusions.
CLINICAL DATA
The presence of moderate or large amounts of pleural fluid is associated with certain symptoms and characteristic changes that can be detected during physical examination of the patient.
Symptoms
The symptoms of pleural effusion are largely determined by the pathological process that caused it. Many patients have symptoms associated with pleural effusion, are not observed, and if they are present, they can be caused by inflammation of the pleura, impaired breathing or gas exchange. The inflammatory process in the pleura manifests itself in the form of pleural pain in the chest. Since nerve endings are present only in the parietal pleura, pleural pain indicates inflammation of the parietal pleura. Some patients with pleural effusion experience a dull, aching pain in the chest rather than pleural pain. This symptom is typical in cases where the underlying disease directly affects the parietal pleura. pleura, for example, with a metastatic tumor or abscess in the lungs. Thus, pleural pain in the chest or dull pain. It's a dull pain indicate that the process involves the parietal pleura and the resulting effusion is exudative in nature.
Typically, pain associated with pleural disease is clearly localized and coincides with the location of the pleural lesion, since the parietal pleura is innervated mainly by intercostal nerves. However, sometimes pleural pain radiates to the abdominal area, since the intercostal innervation extends to the abdominal cavity. A clear exception in the localization of pain are cases of involvement of the central part of the diaphragmatic pleura. Since this part of the parietal pleura is innervated by the phrenic nerve, when the central part of the diaphragm is inflamed, pain radiates to the ipsilateral shoulder. Pleural pain, simultaneously experienced in the lower chest and ipsilateral shoulder, is characteristic of lesions of the diaphragm.
The second symptom of pleural effusion is a dry, nonproductive cough. The mechanism of cough is unclear. It may be associated with an inflammatory process in the pleura; or [compression lung fluid promotes contact between the opposite walls of the bronchi, which causes a cough reflex.
The third symptom of pleural effusion is shortness of breath. Pleural effusion is a space-occupying process in the chest cavity and therefore leads to a decrease in the volume of all parts of the lung. A small pleural effusion causes displacement rather than compression of the lung and does not have a significant effect on pulmonary function. Massive pleural effusion undoubtedly causes a significant decrease in lung volume, but pulmonary function improves less than might be expected after therapeutic thoracentesis. When examining 9 patients, the average amount of aspirated pleural fluid was 1100 ml, and their lung vital capacity increased by an average of only 150 ml. It is likely that the explanation for this slight improvement in pulmonary function after thoracentesis is concomitant parenchymal damage. The degree of dyspnea is often not proportional to the size of the pleural effusion. This is usually associated with restriction of chest movement due to pleural pain or parenchymal damage. Gas composition arterial blood usually remains at an acceptable physiological level even when the entire hemithorax is darkened, since there is a reflex decrease in perfusion of the unventilated lung.
Physical research methods
When examining a patient with suspected pleural effusion, special attention should be paid to the relative sizes of both halves of the chest and the intercostal spaces. With an increase in intrapleural pressure on the side of the effusion, this half of the chest will increase in size, and the usually concave surface of the intercostal spaces will be smoothed out or may even become convex. And, conversely, with a decrease in intrapleural pressure on the side of the effusion, which is observed in cases of obstructive lesions of the main bronchus or with armored lung, the size of the ipsilateral hemithorax will decrease, and normally the concave surface of the intercostal spaces will become more in-depth. In addition, when you inhale, the intercostal spaces will decrease. An increase in hemithorax with protrusion of the intercostal spaces is an indication for therapeutic thoracentesis, which is performed in order to reduce intrapleural pressure. Signs of decreased intrapleural pressure are a relative contraindication for thoracentesis, since decreased intrapleural pressure can cause pulmonary edema as a result of its expansion. Undoubtedly, in many patients with pleural effusion, the size of the chest on the side of the effusion and the outlines of the intercostal spaces do not change.
2) the ratio of the LDH level in the pleural fluid to its level in the blood serum exceeds 0.6;
3) the level of LDH in the pleural fluid exceeds 2/3 of the value upper limit normal level LDH in serum
Specific gravity (relative density)
In the past the magnitude specific gravity pleural fluid measured by a hydrometer was used to separate pleural effusions into transudates and exudates. Recently, many institutions use refractometers to determine the specific gravity of pleural fluid. Unfortunately, the scale of commercially available refractometers is calibrated using the specific gravity of urine, not pleural fluid, so on this scale a value of 1.020 corresponds to a pleural fluid protein level of 3.0 g/100 mL. Since the refractometer scale is also suitable for determining the level of protein in pleural fluid, and since the only reason for measuring the specific gravity of pleural fluid is to determine the protein content, then with a refractometer, measuring specific gravity becomes unnecessary, unreliable and should no longer be recommended. Protein content can be quickly determined at the bedside using a refractometer scale.
Other characteristics of transudates
Most transudates are transparent, straw-colored, non-viscous, and odorless. In approximately 15% of cases, the number of red blood cells exceeds 10,000/mm3; however, the detection of blood in the pleural fluid does not mean that the pleural effusion is not a transudate. Since red blood cells contain large amounts of LDH, one would expect that pleural fluid with a large admixture of blood would meet the criteria for exudative pleural effusion in terms of LDH levels. However, in reality this is not observed. Red blood cells contain the LDH isoenzyme - LDH-1. In one study, in 23 patients with pleural effusion, despite a pronounced admixture of blood in the pleural fluid (the number of red blood cells exceeded 100,000/mm3), a significant increase in the LDH-1 fraction in the pleural fluid was not observed.
The leukocyte count in most transudates is less than 1000/mm3, but in approximately 20% of cases it exceeds 1000/mm3. For transudates, a leukocyte count exceeding 10,000/mm3 is rare. Of the total number of leukocytes, the predominant cells may be polymorphonuclear leukocytes, lymphocytes, or other mononuclear cells. In a study of 47 transudates, in 6 cases (13%) more than 50% of the cells were polymorphonuclear leukocytes, in 16 cases (34%) small lymphocytes predominated, and in 22 cases (47%) other mononuclear cells predominated. The glucose content in pleural fluid is the same as in blood serum, and the amylase content is low. The pH value of the transudate is higher than the simultaneously measured blood pH value. This is probably due to the active transport of bicarbonate from the blood into the pleural cavity.
Thickening of the wall of the main reproductive organ - the uterus - occurs in women of various age groups. Cause of myometrial thickening various localizations and length is hormonal imbalance, in the etiology of which several factors are considered. Thickening of the uterine layers is associated with certain clinical symptoms, which significantly change general state the beautiful half of the population. Various medical fields are busy searching for the most effective method of eliminating this gynecological problem.
Physiological aspects
Thickening of the uterine wall occurs periodically in women due to the characteristics menstrual cycle. Each phase of the cycle is accompanied by the production of certain hormones in varying concentrations. Estrogen and progesterone are produced in the female body by the genital organs and directly affect the lining of the uterus.
The uterine lining thickens monthly in every woman who has reached reproductive age. Each cycle the endometrium prepares for the expected pregnancy and implantation of the fertilized egg. In the absence of this event, the endometrium is forced to be rejected and evacuated from the uterine cavity. Hormonal compactions occur due to estrogen, while progesterone controls their growth.
The release of the egg from the membranes, called ovulation, continues as it moves along fallopian tubes where fertilization should take place. If this does not happen, the unfertilized female reproductive cell enters the uterus, which is accompanied by a drop in hormonal levels. This also mediates menstruation - the shedding of the uterine lining and unfertilized egg through the blood.
Normally, the menstrual cycle has approximately equal frequency and duration of discharge. Malfunctions in the female body, one of which may be thickening of the uterine wall, may be indicated by following symptoms:
- Menstruation becomes too frequent or too infrequent. The duration of the discharge itself changes.
- Women begin to suffer from premenstrual syndrome, which is accompanied by headaches and increased irritability.
- The onset of menstruation is also marked by severe pain. The woman describes the pain as pulling, spread throughout the lower abdomen.
There is more than one reason that can cause thickening of the uterus due to the inability to shed endometrial cells. The etiology of the pathological condition is determined by the doctor during examination and laboratory and instrumental tests.
Etiology of the condition
A dense uterus, if detected during a gynecological examination, is an indication for use. ultrasound examination. Thickenings of the walls of the uterus are called clinical practice endometrial hyperplasia and are exclusively instrumental indicators. Hyperplasia can be detected on the posterior wall of the uterus or in any other part of it when:
- the following diseases
Uterine fibroids. Tubercles in the muscular layer of the uterus occur in almost every woman who has crossed the threshold of 30 years. They vary significantly in size and location and can be located both in the body and in the cervix. Seals in the uterus in the form of nodes are of myomatous origin, but can grow into both the serous and mucous layers of the uterus. Any subserous node is dangerous because it grows into the abdominal cavity. When myomatous compaction in the uterus reaches a certain size, it is clinically manifested by menstrual cycle disorder, dysfunctional uterine bleeding
, severe pain syndrome. If these symptoms are ignored and there is no treatment, there is a risk of urination and defecation problems, and there is a high probability of infertility.
- With small nodules, gynecologists usually do nothing, but only observe for some time. Small tubercles in the myometrium or on the surface of the uterus are prone to self-resorption. Endometritis is an inflammatory process. The pathology begins with minor tingling in the abdomen, which is then joined by discharge from the genitals with an unpleasant putrid smell . Further symptoms of general intoxication increase: fibrile temperature,, dyspeptic disorders. Gynecological bimanual examination reveals fibrous dense areas on the anterior wall of the uterus or in other areas, a painful organ on palpation, and its significant enlargement.
- Adenomyosis of the uterus is also called internal endometriosis. Signs of the disease are detected during examination using an ultrasound wave, and some symptoms indicate it. Upon palpation examination, the uterus is uneven; it may be lumpy or unevenly enlarged. Menstruation in women is scanty and spotting. Patients complain about bad feeling, constant desire to drink, pronounced weight loss. Sexual relations do not bring pleasure to women; sexual contacts are accompanied by pain.
Adenomyosis affects the inner lining of the uterus, it takes on a cellular appearance and becomes abnormally thick. Thickening of the posterior wall of the uterus compresses the genital appendages and disrupts their function.
There are some other reasons why the uterine wall thickens, but they are directly related to physiological state pregnancy.
Pathology during pregnancy
Ultrasound examinations during pregnancy are performed at least three times. In the early stages of gestation, the doctor may identify a discrepancy between the disproportionately enlarged posterior and anterior walls. The gynecologist can interpret this as two cases:
- This picture is a variant of the norm if the gestational age does not exceed 5 weeks. Until this time, active implantation of the fertilized egg into the endometrium occurs, which mediates thickening of the place where this occurs. In this case, the embryo with its membranes must have a strictly even, oval shape.
- If there is local thickening of the uterus during pregnancy and a change in the shape of the fertilized egg, the doctor suspects a threat spontaneous abortion. The embryo may be visualized in an abnormal form, scaphoid, drop-shaped.
In this case, a woman may complain of nagging, transient pain in the groin area or lower back, scanty discharge from the genital tract, feelings of weakness and fatigue. Abortion in progress is visualized on ultrasound in the form of a subchorionic hematoma in any place of the uterus. In this case, pregnancy cannot be maintained; to prevent bleeding, curettage and hemostatic therapy are resorted to.
Hypertonicity of the uterus, assessed during ultrasound examination as dense lesions on the surface of the organ, may occur due to the woman’s excitement, due to the pathological action of the sensor. If, together with such an ultrasound picture, a woman feels well, this is not regarded as signs of a threat of miscarriage.
Competent specialists determine the cause of thickening of the uterine wall with high accuracy. It is important for every woman to be attentive to her reproductive health and not miss a single symptom that would indicate a malfunction in its operation.
Contraction of the uterus is a normal condition, just like for any other muscle. When muscle fibers contract, the uterus is in good shape, that is, in tension, and the pressure on its internal cavity increases. observed in most women and does not cause harm to health, but in some cases this condition is dangerous when carrying a child and requires special examination and treatment.
Myometrial hypertonicity during pregnancy requires increased attention, because the supply of oxygen and beneficial nutrients to the fetus depends on the condition of the uterus. Along the anterior and posterior walls, hypertonicity of the myometrium causes compressed vessels through which oxygen flows to the child.
Causes
During a routine examination in a gynecologist's office, a diagnosis such as frequent uterine contractions is made very often. The course of this symptom can be harmless or, conversely, dangerous for the health of the expectant mother and child. The reasons for tone can be very different. Female body during pregnancy, it is rebuilt and works differently, not as always. The behavior of the uterus is influenced by both external and internal factors:
- diseases of the uterus;
- presence of chronic diseases;
- abnormal shape of the uterus;
- hormonal deficiency;
- repeated abortions or uterine surgeries;
- bad habits;
- poor sleep, stressful situations;
- multiple ovarian cysts;
- polyhydramnios.
- infantilism, size, underdevelopment).
A more precise cause can be determined after an ultrasound examination. The doctor writes a referral for blood tests to determine hormone levels.
In early pregnancy
Myometrial hypertonicity at the beginning of pregnancy indicates that the woman’s body does not produce enough progesterone or there is an excess of male hormones.
Reason increased tone uterus in the second trimester is:
- impaired fat metabolism;
- constant stress;
- inflammatory diseases of the reproductive system;
- magnesium deficiency;
- large fetal size;
- multiple pregnancy.
Severe toxicosis, accompanied by profuse vomiting, leads to frequent contractions of many muscles, including the uterus. The most dangerous phenomenon that can accompany pregnancy is Rh conflict, which causes fetal rejection; a clear symptom of this is the tone of the uterine myometrium.
There are reasons that cause increased tone that are not at all dangerous, for example, severe gas formation in the intestines. Painful sensations are associated with gases that press on the walls of the uterus. In this case, you need to exclude celery, garlic and salty foods from your diet.
Symptoms of increased tone
Any woman will be able to determine uterine hypertonicity, especially in early stages pregnancy. You don’t need a paid gynecologist for this:
- nagging pains similar to those that occur during menstruation;
- heaviness in the very bottom of the abdomen;
- pain in the lower back, radiating to the sacrum;
- bloody issues, but not always.
At later stages, in addition to all the listed reasons, abdominal hardness is added.
Treatment of myometrium
If during the examination it turns out that the tone of the uterine myometrium does not pose a direct threat to the life and health of the woman and fetus, treatment is carried out at home. In critical situations future mom is sent for hospitalization. For outpatient treatment the following are prescribed:
- "Papaverine";
- "No-Shpa";
- "Magne B 6";
- sedatives;
- products containing magnesium: “Partusisten”, “Bricanil” and “Ginipral”.
All medications are prescribed by a doctor; during their use, the condition is monitored, blood pressure, blood sugar levels and heartbeat are checked. All these drugs are used to eliminate pain symptoms and alleviating the condition of the pregnant woman.
"Magne B 6" take 1-2 tablets daily, during meals, with plenty of water. The drug should be taken under the supervision of a doctor. The medicine reduces the level of iron in the blood, which leads to anemia. Side effects are expressed in the form of nausea, constipation, flatulence, vomiting.
In case of progesterone deficiency in the initial stages of pregnancy, to preserve it, hormonal drugs- "Dufostan" or "Utrozhestan". It is important to remember that only a doctor can prescribe and cancel treatment, since stopping treatment hormonal drugs it needs to be done gradually.
Treatment in the second and third semesters
In the second trimester, stronger and more effective drugs are prescribed, for example Ginipral. If there is a risk of placental abruption, the medicine is not used. By the third trimester, the fetus is sufficiently mature, but pregnancy pathology such as excessive placental abruption occurs. Here an emergency decision is made to induce labor or caesarean section so as not to lose the child and save the life of the mother.
You can ease the pain by kneeling on a chair and slowly arching your back on all fours. The head is raised up. Next, you need to carefully bend over like a cat, as far as your stomach will allow, with your chin pulled towards your chest. After this exercise, you need to sit down in a comfortable position, stretch your legs and relax.
Hospital treatment and diagnosis
Increased tone of the uterus is easily determined when the doctor usually feels the fossilization of the uterus. The woman lies on her back during palpation (examination), bending her legs at the hips and knees to relieve tension in the abdomen.
But the most accurate and widespread way is ultrasound examination(ultrasound). The scan will determine the degree of development of the pathology. There are special drugs, myometers or tonometers. Such equipment is rarely used for more than difficult cases, because pathology is easy to identify by other methods.
The decision to hospitalize is made as a last resort, when the pregnancy is initially difficult or all attempts have been made to relax the muscle, but the myometrial hypertonicity does not change. The woman is provided with absolute peace in the hospital, the doctor monitors the condition of the expectant mother and child and takes measures for any changes in the behavior of the uterus.
In the hospital, "Magnesia" is prescribed for intramuscular injection. Treat orally:
- magnesium gluconate;
- magnesium lactate;
If there are problems with the kidneys, medications are not prescribed or are used as carefully as possible.
How to help yourself with sudden pain?
Sudden myometrial hypertonicity: what to do? First of all, you need to take the most comfortable position and relax, breathe evenly and calmly. It is recommended to drink a sedative, such as motherwort. Accept medicines from increased uterine tone, the pain should go away within 15-20 minutes. If this does not happen, you need to call an ambulance.
Consequences of uterine hypertonicity
In some cases, uterine hypertonicity is a real pathology of pregnancy, which can lead to premature birth or miscarriage. Compressed vessels often cause hypoxia (lack of oxygen) or malnutrition (stunted growth) of the fetus.
Myometrial hypertonicity can also lead to the following consequences:
- long labor;
- indication for caesarean section;
- postpartum bleeding.
The uterus cannot contract on its own, so in the maternity hospital the doctor monitors its tone. If a woman is exhausted and cannot give birth on her own, a decision is made to have a caesarean section to save the baby.
If it so happens that the myometrium is heterogeneous, it causes a lot of problems, so it is important to monitor your health and the behavior of the abdomen. If it often becomes hard and pain is felt, you should definitely seek help from a doctor. This will save you from many troubles and allow you to carry a healthy baby.
Complications:
- pathology can cause miscarriage;
- inhibit fetal development;
- premature placental abruption.
Heterogeneous myometrium
Clear signs that a woman has heterogeneous myometrium are a painful sensation in the lower abdomen, bleeding. This condition appears due to the influence of the following factors:
- hormonal disbalance;
- abortions and other intrauterine curettages;
- having multiple pregnancies;
- trauma to the inner lining of the uterus.
Preventive actions
To avoid many problems associated with bearing a child, pregnancy should be planned. It is important to prepare for it in a timely manner, undergo examination, and undergo a course of treatment for chronic diseases.
Every woman should register with an antenatal clinic before 12 weeks of pregnancy and regularly visit an obstetrician-gynecologist; it would be a good idea to visit private clinic, where the examination will be carried out by a paid gynecologist.
It is important to ensure yourself adequate sleep and quality rest, switch from hard work to easier work, and eliminate emotional overstrain and physical activity.
The main condition for preventing the appearance of uterine hypertonicity is careful attention to your health and a routine examination by a gynecologist. This condition is regarded as therefore it is very important to seek medical help promptly.
The female body is a complex system, in which all organs and systems are interconnected. For example, lack female hormones estrogen leads to a number of diseases that affect overall well-being and fertility.
Thickening of the uterine wall is a common disease that occurs for a number of reasons and entails serious consequences.
Uterine hyperplasia
During ovulation, the released egg moves through the fallopian tubes, where fertilization can occur. If this does not happen, it enters the uterine cavity, which leads to hormonal imbalance. It is for this reason that particles of the uterine mucosa and female germ cells are released through the blood.
The uterus is a round cavity whose walls consist of three layers. Outer layer, covering the uterus in the pelvis, is called serous.
Considered the thickest middle layer– myometrium: it allows the uterus to contract during labor activity, during the menstrual cycle. Endometrium - internal slime layer, with which some changes occur during menstruation.
During hormonal imbalance or the development of any disease, any of the layers of the uterus may thicken. Most often, women are diagnosed with thickening of the inner layer of the organ.
The main factors provoking these changes include:
- Threat of spontaneous miscarriage.
The reasons for termination of pregnancy can be bad habits, excessive exercise. But thickening of the walls in some cases does not affect the duration of pregnancy and proper development fetus
- Benign tumor of the uterus caused by higher level estrogens.
Myoma is the most common disease in which cramping pain is observed, pressing sensations in the lower abdomen, causeless bleeding, which sometimes leads to anemia. Very rarely, a patient may complain of intestinal problems and bladder. Advanced cases of pathology lead to infertility.
- Growth in the structures of the muscle layer.
A woman complains of frequent pain, unusual discharge and menstrual irregularities. When examining, thickening of the uterus can be detected both on the anterior and posterior walls. Untimely treatment can lead to tumors of various types and infertility.
- Inflammatory process in the endometrium.
The disease is characterized by elevated body temperature, purulent discharge, nausea, general weakness, periodic pain and vomiting. As the lining of the uterus thickens, fibrosis and calcification develop. The menstrual cycle is disrupted.
The main reasons for hormonal imbalance, which should cause concern for a woman, include age, excess weight, taking hormonal medications, diabetes.
Symptoms of the disease
The uterus is internal organ, so it is very often impossible to detect any problems or changes associated with it. But there are a number of symptoms that you need to pay attention to. When contacting a gynecologist, a woman should tell her about them in as much detail as possible, which will make it easier to make a preliminary diagnosis:
- various pains in the lower abdomen;
- the appearance of cramps during the menstrual cycle;
- discharge with blood particles or bleeding during absence of menstruation;
- the menstrual cycle is painful or its duration has increased;
- the discharge has acquired an unpleasant odor;
- a surge of warmth is periodically felt in the lower abdomen;
- sudden changes in mood, depression.
A visit to specialists should not be postponed if the pain does not subside after taking painkillers, and there is a rapid heartbeat even during rest.
Diagnostics
An appointment with a gynecologist most often begins with an oral history of the patient. The woman should tell the doctor in detail about the symptoms that worried her, when they began.
Laboratory tests begin with a cytological smear, which allows you to determine any changes in the cervix, followed by analysis of the condition of the uterus itself and the internal mucous layer.
In addition, at the discretion of the attending physician, a number of diagnostic measures can be carried out:
Also, diagnosis does not exclude a general and biochemical blood test. This helps prevent excessive bleeding during treatment or infection.
Treatment for thickening of the uterine wall
Treatment of uterine hyperplasia directly depends on the cause of the disease. For example, for adenomyosis, painkillers are prescribed and contraceptives to reduce pain and bleeding. The symptoms of the disease can be partially eliminated with the help of a spiral, which is placed for a short time. But after its removal, the signs of the disease return again.
In advanced cases, adenomyosis requires immediate surgical intervention. If heavy bleeding is observed, there is a suspicion of fibroids, it is recommended complete removal uterus.
Doctor's prescriptions for hyperplasia
When diagnosing a benign neoplasm, hormonal drugs are prescribed, which only temporarily stop the growth of pathological nodes. Combined oral contraceptives are most often prescribed to young and nulliparous girls in whom hyperplasia is accompanied by heavy bleeding.
Thickening of the uterine wall often occurs due to hormonal imbalance, so synthetic analogues are used to restore balance. The duration of treatment is not more than three months. The patient may complain of occasional bleeding, which is considered normal.
Often drug therapy does not help, so the attending physician prescribes surgery:
- Curettage of the uterine cavity is carried out to remove the problem area of the mucous membrane and stop bleeding. Deleted biological materials V mandatory sent to the laboratory for testing.
- Cryodestruction is carried out to expose the affected area to low temperatures. As a result, the thickened part of the uterus is rejected.
- Thickening of the mucous membrane can be removed using a laser or high temperatures. The endometrium recovers in a short time after surgery.
Prognosis and complications
The consequences of thickening the uterine wall can be different and depend on the disease that caused this pathology. For example, advanced cases of adenomyosis can lead to iron deficiency, frequent headaches and fainting, decreased performance and memory impairment. Advanced cases of the disease most often become the cause of malignant tumors.
The uterus has a more favorable prognosis. Untimely treatment can lead to anemia, miscarriage, infertility, and heavy bleeding after childbirth. Complications of endometritis are characterized by pain in the pelvic region, inflammation of the appendages, infertility or menstrual irregularities.
Thickening of the uterine wall is considered benign education, but women with this diagnosis are more susceptible to cancer. That's why timely diagnosis and proper therapy will help get rid of the disease and restore the woman’s health.
Useful video about endometriosis:
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IN local thickening the myometrium can be either on the anterior or posterior wall. Why is this factor dangerous for pregnancy, and what are the acceptable deviations?
Why does the myometrium thicken?
In some pregnant women, when undergoing diagnostic studies thickening of the myometrium is detected. In gynecology, the muscular layer of the uterus is called the myometrium. Its thickness varies depending on what stage of the menstrual cycle a woman is at or during pregnancy. To prevent development pathological processes, you need to know what caused the thickening of the myometrium.
Quite often, local thickening occurs on the anterior wall of the uterus. This is due to hormonal disorders or gynecological, obstetric and even endocrinological diseases of the woman.
Changes can be detected during menstruation, which gradually disappears. The levels of progesterone and estrogen change, which contributes to normal fluctuations in myometrial thickness. Thus, phase 2 of the menstrual cycle can affect local thickening of the myometrium up to one and a half centimeters, and after the end of the menstrual cycle the thickness can be only a couple of millimeters.
The myometrium may also become tense due to the duration of pregnancy. This is due to the fact that the fetus is enlarged and hormonal and physiological changes occur. Using ultrasound, you can detect not only normal thickening, but also identify pathologies such as:
- uterine fibroids;
- threat of miscarriage;
- adenomyosis;
- endometriosis.
Why is there a threat of miscarriage?
After an ultrasound examination, which is performed in the first trimester of pregnancy, the specialist records local thickening of the myometrium along the anterior wall of the uterus. ABOUT pathological disorders thickening indicates after 5 weeks; before this period, thickening indicates implantation of the fertilized egg, which is not a pathological process.
The threat of miscarriage may arise due to the following reasons:
- if the embryo has a drop-shaped or scaphoid shape;
- if the uterus is in a state of hypertonicity;
- if the external contours of the uterus are greatly changed.
Adenomyosis and endometriosis
Quite often when inflammatory processes Adenomyosis develops in the uterus. With this disease, the endometrium is able to grow into the layers of the uterine walls. This disease can be identified in the presence of such signs as: discharge, spotting, menstrual irregularities, pain - the study can reveal both local thickening of the anterior wall of the uterus and the posterior one. Adenomyosis is a form of endometriosis in which there is significant impairment of the muscular layer of the uterus.
The endometrium is the lining layer of the uterus. During inflammatory processes, endometrial cells are damaged and endometriosis develops. Earlier medical specialists believed that this disease was a sign of some gynecological diseases. Modern medicine identified it as an independent nosological unit. One of the forms of this disease is the internal form of endometriosis, which indicates the location of inflammatory foci in the thickness of the endometrium. With endometriosis, there is often local thickening of the myometrium along the posterior wall. This form of thickening can lead to the development malignant neoplasms uterus. In this case, not only thickening is observed, but also a pronounced asymmetry of the uterus due to the development of a lesion in its wall.
What are the dangers of uterine hypertonicity?
Hypertonicity of the uterus during pregnancy requires maximum attention. This is due to the fact that the fetus needs a normal supply nutrients and oxygen. This significantly affects the further course of pregnancy. Most often, hypertonicity is accompanied by vascular compression, and the importance of these vessels lies in the fact that they contribute to the nutritional and oxygen supply of the fetus. This factor adversely affects the fetus. However, premature birth or miscarriage are not always provoked due to myometrial hypertonicity.
What are the reasons for the development of myometrial hypertonicity? Often these factors include the following:
How to properly prevent myometrial hypertonicity is a question that interests many pregnant women.
To prevent this condition, even when planning a pregnancy, a woman should be fully examined for everything. infectious diseases and eliminate existing ones.
Infections during pregnancy are dangerous not only due to hypertension, but also due to much more dangerous actions (during childbirth, a child can acquire many quite unpleasant diseases which cause blindness or even death). In addition to hypertonicity, there is also a condition of uterine hypotonicity, which during pregnancy may not cause any inconvenience, but problems may arise during childbirth.
During pregnancy, a woman should be as nervous and physically overexerted as possible. She better learn not to worry. If the first signs of increased myometrial tone occur, you should not panic, but consult with an endocrinologist and gynecologist.
You should not think that thickening is a consequence of factors only due to the threat of pregnancy; often the cause may be a hormonal surge, which remains within the normal range. Hormonal levels are corrected when visiting a gynecologist or endocrinologist. These doctors prescribe correct treatment, thanks to which a woman does not have to worry about pregnancy.
