Отеки при беременности – состояние, возникающее у большинства женщин. По статистике, только 20 % беременных не сталкиваются с ними. Зачастую отеки никак не влияют на организм будущей мамы и ее ребенка, однако порой они могут сопровождать достаточно опасные состояния, требующие обследования и лечения. Какими бывают отеки при беременности и нужно ли лечить любое их проявление?
Изабелла Чарчян
Акушер-гинеколог, г. Москва
Отек – это избыточное скопление жидкости в межтканевом пространстве какой-либо части организма. Во время беременности количество жидкости, циркулирующей в теле женщины, увеличивается почти вдвое, так как она содержится в околоплодных водах, плаценте, а также нужна растущему малышу и его кровеносной системе. При этом меняется водно-солевой обмен (в сосудах накапливается натрий, который задерживает выведение жидкости), а растущая матка давит на сосуды и органы, что замедляет кровообращение и способствует задержке жидкости. Помимо всего этого, смена гормонального фона в этот период вызывает ощущение жажды, что также приводит к отекам.
Отек как синдром сопровождает многие заболевания разных органов и систем организма: эндокринных, сердечно-сосудистых, почечных и других воспалительных процессов.
Отеки (особенно большие) – это не просто симптом, который неэстетично выглядит и доставляет дискомфорт. Они могут быть достаточно опасными. Из-за сильной отечности мамы у ребенка может возникнуть гипоксия (кислородное голодание), а сама будущая мама может пострадать от отеков внутренних органов и, как следствие, нарушения их работы. Отек также может быть одним из симптомов гестоза – состояния, при тяжелой степени которого может встать вопрос даже о досрочных родах. Поэтому появление (и даже возможное их появление) важно отследить на самой ранней стадии.
Однако иногда даже сильные отеки не беспокоят беременную женщину, и ее самочувствие остается удовлетворительным. Даже в такой ситуации лучше обратиться к врачу, так как более чем в 90 % таких случаев состояние ухудшается (появляется белок в моче, повышается давление) и переходит в гестоз.
Как правило, отеки начинают беспокоить будущую маму примерно с 30-й недели (а при гестозе – с 20-й недели) беременности.
Выраженные отеки могут сопровождать беременных, ожидающих двойню или просто вынашивающих крупный плод.
Скрытые отеки при беременности – что это такое?
Кажется, что отечность – это всегда очевидная проблема. Однако это не cовсем так. Помимо явных отеков существуют так называемые скрытые (отеки внутренних органов и тканей). Помочь обнаружить их может наблюдающий вас акушер-гинеколог, проведя несколько обследований:
- Регулярное взвешивание. Очень часто на скрытые отеки указывает слишком сильная прибавка в весе – более 300 г в неделю.
- Регулярное измерение окружности ног. Об осложненных скрытых отеках свидетельствует увеличение размера окружности голени на 1 см и более (замеры проводятся раз в неделю).
- Исследование показателей суточного диуреза. Диурез – это объем мочи, образуемой за конкретный период времени. С его помощью сравнивается количество жидкости, которое было выпито, с объемом выделенной мочи. В норме в день выделяется 3⁄4 от всей выпитой жидкости (сюда входят и вода, и другие напитки, и фрукты, и супы).
Как правило, о том, склонна ли женщина к отекам, врач может узнать уже на первых неделях беременности. Данные об этом он получает из осмотра пациентки, изучения ее конституции, наследственности, истории болезней, а также из анализа крови на биохимию. Чем раньше будет известно о том, возможно ли у вас появление отеков, тем быстрее вы сможете принять меры по их профилактике.
Физиология и патология отеков при беременности
Отеки могут быть физиологическими и патологическими. Физиологические отеки обычно не вызывают осложнений и доставляют беременной лишь чувство недовольства своим внешним видом. Их происхождение связано с тем, что растущая матка сдавливает сосуды – это препятствует нормальному оттоку крови. Матка давит и на мочеточники, отчего возникает задержка жидкости при беременности и, как следствие этого, отечность. Отеки физиологического типа могут быть связаны и с конституцией самой беременной – у женщин невысокого роста и с повышенной массой тела они возникают чаще.
Патологические отеки, как правило, сопровождают гестоз (поздний токсикоз) – осложнение беременности, которое может возникнуть в третьем триместре. Его симптомы – повышенное артериальное давление, выделение с мочой белка (в норме он отсутствует), тошнота, рвота, головные боли, судороги (эклампсия), лихорадка, сонливость или, наоборот, сильное возбуждение, плюс сильные отеки. Однако гестоз может и не сопровождаться отеками, и такой, «сухой» гестоз считается более тяжелым случаем. Также гестоз не обязательно сопровождается всеми вышеперечисленными симптомами. Самое опасное – наличие судорог. В любом случае гестоз почти всегда требует помощи врача и нахождения беременной в стационаре. Чем раньше начать его лечить, тем меньше шансов, что он перейдет в тяжелую форму.
Отеки ног при беременности
Отеки ног при беременности – это самый часто встречающийся вид отеков. Особенно они беспокоят тех, кто проводит на ногах много времени, или просто после долгой ходьбы. Отеки обычно заметны на стопах и голенях. Любимая обувь при этом становится мала или сильно давит. Важно выбрать такую, которая не будет доставлять дискомфорт, из хорошо тянущихся материалов, чтобы ее было удобно носить во второй половине дня. Также стоит отказаться от высоких каблуков, отдав предпочтение невысоким и устойчивым. Если вас беспокоят отеки ног при беременности, постарайтесь отказаться от длительных прогулок, не стойте на ногах в течение длительного времени, дома принимайте лежачее положение и поднимайте ноги кверху, а также регулярно делайте массаж стоп.
Отеки рук при беременности
Отеки рук при беременности, как правило, появляются у тех женщин, которые работают за компьютером, занимаются рукоделием и любой другой монотонной работой, – застой жидкости образуется по причине однообразных движений. В таком случае необходимо регулярно делать гимнастику для пальцев. Также, начиная со второй половины беременности, врачи советуют не носить на руках кольца. Если не убрать их вовремя, можно дождаться такой степени отечности, при которой снять их будет очень сложно или невозможно.
Отеки лица при беременности
Отек лица при беременности легко заметить – лицо становится круглым и одутловатым. Особенный дискомфорт доставляет отечность век, под глазами появляются мешки. Это связано со специфическими анатомическими особенностями век – в этой области находится рыхлая клетчатка, сильно впитывающая жидкость. Уменьшить отеки на лице можно, соблюдая общие правила по профилактике отечности тела.
Отеки носа при беременности
Нос может отекать как следствие общего отека лица, а также из-за возможных аллергических реакций, которые в период ожидания ребенка сильно обостряются. Желательно не допускать заложенности и отечности носа, потому что из-за проблем с дыханием затрудняется доступ кислорода к ребенку. Устранить отек можно с помощью капель, однако не забывайте, что беременным запрещено применять целый ряд из привычных препаратов, поэтому лучше, если лекарство вам выпишет врач, который точно знает, какие средства разрешены.
Профилактика и лечение отеков при беременности
Беременным с отеками уделяется повышенное внимание на этапе ведения в женской консультации. Будущую маму регулярно взвешивают, измеряют артериальное давление и следят за работой почек при помощи анализов мочи. Все направлено на предупреждение (профилактику) осложнений. Советы, которые дают врачи:
- Наладьте питание. Исключите жареное и копченое (еда, приготовленная такими способами, плохо влияет на сосуды), мясо и овощи варите, готовьте на пару, запекайте. Пища должна содержать достаточное количество белка (чтобы избежать его недостатка, который может возникнуть при гестозе). Также лучше не употреблять жирные, острые, маринованные, сладкие продукты, сдобу. А вот нежирные бульоны, каши, фрукты и овощи стоит есть регулярно. Для профилактики отечности полезно проводить и разгрузочные дни, но, не увлекаясь, не чаще одного раза в неделю и обязательно после согласования с врачом.
- Ограничьте употребление соли (в идеале до 1–1,5 г в сутки). В ее состав входит натрий, благодаря которому она задерживает в организме жидкость. Важно не только недосаливать (или вовсе не солить) пищу во время приготовления, но также убрать из рациона соленья, квашеную капусту, селедку, чипсы, сухарики, колбасы и сосиски, консервы.
- Больше пейте. Достаточное количество жидкости ускорит водно-солевой обмен в вашем организме. Если пить мало, можно довести организм до обезвоживания, что не менее опасно. В день стоит выпивать до 1,5 л воды (не считая супов, компотов), причем большую часть жидкости выпейте до обеда, оставив на вечер поменьше. Пить лучше не большими стаканами, а маленькими глотками, часто, но понемногу. Однако злоупотреблять жидкостью тоже не стоит – это чревато появлением еще большей отечности. Можно пить не только воду, но и соки (лучше несладкие и свежевыжатые), морсы, чай с молоком. При этом черным чаем и кофе лучше не увлекаться, они могут повлиять на сосуды и давление. Зеленый чай также не столь полезен, как многие считают: он содержит большое количество кофеина и тоже может подействовать на состояние сосудов. В день можно выпивать не более двух чашек. Забудьте о газировке, тем более сладкой. Помимо задержки жидкости она также провоцирует изжогу. Если вы собираетесь начать пить так называемые мочегонные чаи, обязательно проконсультируйтесь с врачом – не все подобные напитки могут пойти на пользу, и принимать их нужно очень осторожно.
- Двигайтесь и занимайтесь гимнастикой по силам. При активных движениях риск появления отеков снижается вполовину. Занимайтесь специальной гимнастикой для беременных, йогой, посещайте бассейн. Главное, не переусердствуйте и занимайтесь по мере сил. Нагрузка должна быть равномерной и дозированной.
- Давайте отдыхать ногам. Постарайтесь не стоять на месте и не ходить слишком долго. Если вы сидите, положите ноги на специальную подставку или табуретку. При этом категорически нельзя сидеть, закинув одну ногу на другую. При длительном сидении примерно раз в час делайте гимнастику стоп – крутите ими в разные стороны. Вставайте поочередно на пятки и полупальцы. Не сидите долго в одной позе. Лежа, кладите под ноги валик. Делайте прохладные ванночки для ног и массаж.
- Старайтесь не находиться долго на жаре или в душных помещениях.
- По рекомендации врача носите специальное компрессионное белье. Отеки ног могут сопровождаться варикозным расширением вен. Лечением этой проблемы должен заниматься флеболог, он же и назначит вам белье необходимой степени компрессии. Главное, выбрать его по размеру, оно не должно давить.
Отеки – симптом, сопутствующий почти каждой беременности. Небольшие отеки практически неизбежны, но в них и нет ничего опасного. Поэтому волноваться не нужно. Главное, вовремя проявить ответственность и не забывать о правилах их профилактики, чтобы не доводить до тяжелой степени. При этом после родов отеки достаточно быстро исчезают, ведь организм женщины покидает около 8 л лишней жидкости. И вы быстро забудете об этой проблеме.
Признаки отеков: когда обращаться к врачу
Самый простой способ определить, отек у вас или нет – надавить пальцем на кожу. Если отека нет, на коже не останется и следа, если есть – вы увидите ямку, которая будет выравниваться достаточно медленно, а сама кожа при отеках становится бледной и напряженной.
Небольшая отечность не принесет вреда беременной, однако существуют признаки, заметив которые лучше не медлить с обращением к врачу:
- Резкий набор веса. Если вы набираете более 300 г за неделю, это говорит о сильных отеках и большом количестве лишней жидкости в организме.
- Проявление отеков в утренние часы. Как правило, отечность носит временный характер и усиливается к вечеру, а утром от нее не остается и следов. Если она беспокоит вас уже с утра, значит, она может перейти в опасную степень.
- Жжение, покалывание пальцев ног и рук, их онемение. Это происходит по причине сдавливания нервов. При сильных отеках также могут появиться и трудности в сгибаниях пальцев, а на ноги становится больно наступать.
- Обувь жмет и становится тесноватой, кольца с трудом снимаются с пальцев или совсем не снимаются.
- Сильное округление лица, опухание носа и губ.
- Учащенное сердцебиение, одышка, повышение давления.
Беременность представляет собой серьезную нагрузку на женский организм. Изменения гормонального фона, увеличение потребностей растущего организма и физическое воздействие плода на близлежащие органы часто сопровождается неприятными последствиями. Так, отеки при беременности являются спутниками практически каждой беременной женщины, что делает проблему весьма актуальной.
Почему у беременных часто возникают отеки
Отечность у беременных может появляться как следствие неблагоприятных условий или в результате нарушения нормальной работы организма. Физиологические отеки появляются при:
- слишком жаркой погоде;
- длительной интенсивной физической нагрузке, например, сидение в неудобной позе или многочасовое нахождение на ногах;
- неправильно подобранной обуви, которая слишком сдавливает стопы.
В этом случае страдает та область, которая подвергается непосредственному негативному воздействию. Так, тесная обувь приведет к тому, что отекут ноги, многочасовая работа за компьютером вызовет отечность в руках. После устранения провоцирующих факторов, отеки спадают самостоятельно.
Особенно часто отеками страдают женщины при многоплодной беременности, так как плоды быстро растут и начинают интенсивно давить на почки и другие находящиеся рядом органы.
Но, помимо физиологических отеков, у беременной женщины могут наблюдаться и другие, которые вызваны развитием различных заболеваний.
Так, чтобы ответить на вопрос, почему у беременных отекают ноги или другие части тела, специалисту предстоит проверить работы следующих органов и систем:
Начинать борьбу с этим неприятным явлением можно только после достоверно установленной причины.
Какое влияние отеки оказывают на плод
Когда отекают руки, ноги, пальцы и другие части тела, женщина испытывает дискомфорт. Ей тяжело передвигаться, нет возможности носить привычную обувь, кольца. Все это доставляет массу неудобств. Но эстетические проявления, далеко не все, чем опасны отеки во время беременности. Длительное состояние отечности может оказать следующее влияние на плод:
- нарушить кислородное снабжение;
- ухудшается кровоснабжение;
- малыш не имеет возможности получать все необходимые элементы, а значит, начнет отставать в развитии.
Серьезной опасностью для женщины является гестоз, который также может помимо прочих симптомов вызывать застой жидкости в организме. Отекают руки, ноги, плацента. В данной ситуации для сохранения беременности, женщине требуется госпитализация.
Чтобы избавиться от негативных последствий, важно снимать не только саму отечность, но и проходить корректное лечение причины, которая поспособствовала скоплению лишней жидкости в организме.
Узнаем причину по локализации отеков
Существует несколько видов отеков. Они разделяются в зависимости от места проявления. По ним можно во многом судить о том, какой орган или система дали сбой.
При этом следует понимать, что если отечность появляется после ночи и быстро проходит утром, то повода для беспокойства нет. Это физиологическая особенность женского организма во время вынашивания ребенка.
Волноваться следует в том случае, когда отеки не спадают. Так как в этом случае следует незамедлительно обратиться за помощью к специалисту для обследования.
Во время беременности отекать могут не только ноги и руки, часто застой жидкости обнаруживается и в других местах:
- Отек ног провоцирует рост плода. Также причиной может стать нарушение работы почек.
- Пальцы рук. Могут проявляться при нарушении работы сердца, почек.
- Лицо. Отек носа при беременности часто наблюдается у женщины после сна. Это также может свидетельствовать о чрезмерном потреблении жидкости, сбоях в работе почек, патологическом насморке беременных.
- Половых губ. Наблюдается в сложных ситуациях, когда требуется срочная госпитализация для введения лишней жидкости. Несет угрозу для плода.
Особую опасность представляют собой, так называемые внутренние отеки. Внешне их обнаружить сложно, но при этом внутренние органы и самое главное плод подвергается колоссальной нагрузке.
Чтобы распознать их, нужно знать, симптомы скрытых отеков:
- чувство тяжести в конечностях;
- дискомфорт;
- сложность передвигаться;
- чрезмерный набор веса.
Чтобы подтвердить наличие внутренних отеков, следует обратиться к доктору, который направит на исследование.
Учимся определять
Чтобы выявить у себя отеки женщине совершенно необязательно обращаться за помощью специалистов. Существует простой и быстрый способ подтвердить данный факт. Он заключается в том, чтобы надавить пальцем руки на ту часть тела, в которой предполагается отечность. В норме кожа должна в течение нескольких секунд вернуться в исходное положение. Долго не проходящая ямка говорит о скоплении жидкости под кожей.
Кроме этого существуют и другие более точные способы, как определить отеки:
- Подсчет количества мочи. При отсутствии проблем с выведением из организма жидкости, женщина должна вывести посредством мочеиспускания ¾ от общего объема выпитой за сутки жидкости. Остальное выводится с помощью пота и дыхания. Меньшее количество также свидетельствует о проблемах.
- Контроль набора веса. Иногда акушер-гинеколог может заподозрить развитие отечности по избыточному набору веса. При этом рацион женщины остается прежним, а прибавка в массе увеличивается. Отклонением считается прибавка более чем 400 г в неделю.
- Тест Макклюра-Олдрича. Самый точный метод, которые проводится в условиях лечебного заведения. Для этого под кожу беременной женщины вводят 0,25 мл обычного физраствора. Если пуговка рассасывается более чем за 45 минут, значит, на лицо переизбыток жидкости в организме.
Один из основных гормонов беременности прогестерон, способен задерживать натрий в организме женщины, что способствует образованию отеков.
В любом случае, контролировать развитие отеков необходимо на каждом этапе беременности. При этом особый контроль начинается с 3 триместра беременности.
Специальные средства в борьбе с проблемой
Борьба с отеками должна начинаться при появлении первых признаков. Определить степень тяжести ситуации и назначить корректное лечение под силу только специалисту. Сделать это возможно после тщательного осмотра, сдачи анализов и выявления точных причин задержки жидкости в организме.
Вот несколько рекомендаций, как избавиться от отеков при беременности с помощью специальных средств:
- Хофитол. Один из самых часто назначаемых препаратов. Он основан на листьях артишока. Помогает улучшить выведение жидкости и исключает ее застой.
- Канефрон. Также относится к безопасным природным средствам. Выпускается в форме спиртовой настойки и таблеток. Для беременных женщин допустим прием таблеток. Они окажут мочегонное действие и разгрузят почки.
- Фитозилин. Специальная мазь, на основе лечебных трав, которая принимается вовнутрь. Дарит диуретический и антисептический эффект.
Прием лекарственных препаратов требует строго соблюдения рекомендаций по количеству и кратности употребления средства.
Борьба с недугом с помощью правильного рациона
От того, что и когда употребляет женщина, во многом зависит ее состояние. Так, нередко, чтобы избавиться от отечности женщине достаточно всего лишь пересмотреть свой ежедневный рацион.
Даже в том случае, если явление будет вызвано патологическими изменениями, правильное питание позволит значительно облегчить ситуацию и самочувствие женщины.
Для начала следует полностью исключить пищу, которая способствует задержке жидкости в организме:
- пряности;
- копчености;
- чрезмерное употребление соли;
- жирные блюда.
Особое значение следует уделять и питьевому режиму. Во время беременности привычную норму в 1,5-2 л воды, следует сократить до 1,2-1,5 л.
Если женщину постоянно мучает жажда, тогда ей необходимо обратиться к специалисту для выяснения причин данного явления.
На время вынашивания малыша имеет место перейти на здоровую пищу, которая будет готовиться на пару или путем варки. Особой эффективностью при борьбе с отечностью у беременных обладают разгрузочные дни. Они помогут организму восстановить силы и отдохнуть. Примерный алгоритм разгрузочного дня при беременности при отеках может выглядеть следующим образом:
- Кефир с низким процентом жирности – 1 литр.
- Нежирный творог – 100 г.
- Отварное филе курицы – 200 г.
- Курага, изюм, чернослив – 150 г.
Перечисленные продукты следует разделить на небольшие порции и употребить в течение всего дня. Проводить такую чистку необходимо 1 раз в неделю. Такой частоты будет достаточно, чтобы не ограничить поступление питательных и необходимых для роста малыша элементов и при этом существенно снизить нагрузку на организм.
Будущие мамы сильнее ощущают на себе излишки жидкости. Это происходит по многим причинам. Во-первых, объем циркулирующей крови во время беременности увеличивается почти в 2 раза, а мелкие кровеносные сосуды (капилляры) начинают пропускать жидкость сквозь стенки. Еще у женщин «в положении» часто нарушается водно-солевой обмен, в организме скапливаются соли натрия, которые мешают воде выходить наружу. Плюс к этому повышается уровень гормона прогестерона, который задерживает жидкость. Вам должно быть знакомо это ощущение, потому что то же обычно случается перед менструацией: непонятно откуда берется пара лишних килограммов, немного отекают лицо и руки.
Кстати, чем больше срок беременности, тем больше у вас шансов узнать, что такое отек. Почему? С одной стороны, меняется водный баланс тела, с другой – вес ребенка. Малыш растет, становится больше, тяжелее и с каждым днем все сильнее сдавливает окружающие его органы, в том числе и вены малого таза мамы. Движение крови в них замедляется, зато увеличивается кровяное давление в ногах, появляются отеки и ощущение тяжести.
Мнения зарубежных и российских специалистов в этом вопросе расходятся: первые относятся к отекам как к обычному явлению, особенно если будущую маму не беспокоит гестоз (поздний токсикоз). Но именно это последнее замечание не позволяет российским медикам принять точку зрения западных коллег: только у 1 из 10 будущих мам отеки не приводят к гестозу. У остальных 9 через некоторое время начинает повышаться давление, в моче появляется белок, что и говорит о начале гестоза.
Существует 2 вида отеков: скрытые и явные. О скрытых отеках женщину «предупреждают» весы (за неделю стрелка отклоняется в сторону увеличения больше чем на 300 г), явные же видны сами по себе. Сначала у будущей мамы начинаются проблемы с ногами (к вечеру они «наливаются»), затем отекают руки, живот (после того как врач выслушает сердцебиение малыша, на животе остается след от трубочки) и лицо. Правда, чувствует себя женщина хорошо, ее давление и анализ мочи не выходят за пределы нормы. Несмотря на кажущееся благополучие, пора принимать меры.
- Следите за своим весом: каждый день в одно и то же время – на весы.
- Количество выпитой жидкости должно быть меньше вышедшей.
- Устраивайте себе разгрузочные дни.
- Если эти меры подействуют, постарайтесь до конца беременности соблюдать диету: не увлекайтесь соленым, острым, маринованным, жирным, не ешьте наваристые супы, отдавайте предпочтение отварному мясу или рыбе, молочным продуктам, овощам, фруктам и пейте не больше 1,5 л жидкости в день. А если проблемы останутся, доктор посоветует отправиться на лечение в роддом.
Кстати, сейчас отеки не лечат мочегонными средствами: по некоторым данным, они небезопасны для здоровья будущей мамы и малыша. Вне запрета остаются легкие растительные средства: отвар толокнянки, мочегонный чай.
- Даже если вы заметили небольшие отеки, обратитесь к доктору, чтобы проверить работу почек.
- Не забывайте класть ноги на табуретку, когда присядете отдохнуть.
- Следите, сколько вы пьете: «законная» норма – 1,5 литра воды в день.
- Ешьте слабосоленую (или несоленую) пищу, обходитесь без острых, соленых, жирных продуктов.
- Не сидите долго без движения за столом, в машине, самолете.
Внимание! Все эти замечания особенно актуальны для тех, кто уже начал отсчет III триместра.
После 20-й недели беременности вызывайте «Скорую», если:
- повысилось артериальное давление;
- началась сильная головная боль;
- появились странные зрительные ощущения: мушки в глазах или яркие точки;
- возникла слабость, звон в ушах, болезненная тяжесть в желудке, тошнота, рвота.
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