Causes of increased red blood cells in urine during pregnancy

Before giving birth, it is important for a woman to monitor the condition of her body. To do this, she needs to undergo regular examinations, during which she has to give blood or urine tests. When examining such materials, a doctor can often discover various ailments that she did not know she had.

For example, there may be an increased number of red blood cells in the urine. This is a sign that inflammatory processes are occurring in the body and there is an infection in the reproductive system.

Norms for the number of red blood cells during pregnancy

Hematocrit value is a value equal to the total volume of red blood cells.
Their standard number in a woman’s body is from 3.7 to 4.7 million per 1 microliter or 1 cubic meter. mm. In percentage terms, a content of 36 to 42% is considered normal. During pregnancy, another circulatory system is added to the mother's circulatory system - her unborn child. Accordingly, the number of blood cells changes. These changes, unfortunately, do not always have a positive effect on mother and baby. For example, if red blood cells in the blood are elevated during pregnancy, this has a negative effect on

- the blood thickens and its movement slows down. Overcoming the path from easy to

, red blood cells give off a significant amount of oxygen, and the child receives already oxidized products. The situation looks paradoxical - there are a lot of red blood cells, but the unborn child suffers from a lack of oxygen. If a pregnant woman’s hematocrit is over 45%, then the woman urgently needs blood-thinning infusion therapy. The consequences of high red blood cells in women can be disastrous, so the causes of their appearance must be promptly eliminated.

An increase in blood volume leads to a drop in the concentration of red blood cells in early pregnancy with their subsequent increase. In the first trimester, a value of 4.2-5.4 million is considered normal, in the second - 3.5-4.8 million, in the third - 3.7-5.0 million per 1 μl. The presence of toxicosis in a pregnant woman can also cause a decrease in the level of red blood cells in the blood. This is the body's natural reaction to dehydration.

Did you know? A ribbon made up of all the red blood cells of one person will be so long that it could easily encircle the Earth three times along the equator.

As for the erythrocyte sedimentation rate (ESR), a woman’s pregnancy is a condition during which this indicator can either increase or decrease. A decrease in ESR levels in the first two trimesters is considered normal. In absolutely all women who do not have serious health problems, closer to the date of birth, the erythrocyte sedimentation rate triples.

The erythrocyte sedimentation rate during pregnancy is usually increased and is up to 45 mm/h. For non-pregnant women, this figure should not exceed 15 mm/h.

With the presence of red blood cells in the urine, everything is much simpler. Normally they should not be present in it. Despite this, a pregnant woman should not be afraid of a possible diagnosis of hematuria, which means the presence of blood in the urine. This situation can be caused not only by various pathological processes, but also by changes in the body associated with bearing a child.

Red blood cells in the urine of pregnant women are counted using a test, which is given at almost every doctor’s appointment, in order not to miss the onset of the infectious process. The research is done quite quickly and you can find out the results on the same day.

The norm of blood cells in the test material is no more than two per sample. When conducting diagnostics, all parameters are taken into account in order to determine the location of hematuria.

(cervical examination).

Unlike a blood test, when a reduced number of red blood cells can be detected, there is no such parameter in a urine test, since normally there should not be any in the urine. One cell per field of view is allowed. According to statistics, specialists more often detect 3-5 red blood cells in the field of view - this is also not considered an anomaly; the pregnant woman may be asked to take the test again to eliminate possible errors when collecting urine.

A condition in which the number of red blood cells in a biomaterial exceeds the norm is called hematuria. With a slight increase in values, we are talking about microhematuria, and if the urine acquires a red tint, which is explained by the inclusion of a large number of red blood cells, macrohematuria is diagnosed.

Red blood cells found in urine during pregnancy are a symptom of the disease, but not the disease itself. Treatment is prescribed depending on the cause of this condition, after which the urine test results return to normal.

If the appearance of red blood cells in the biomaterial was caused by physical fatigue, minor injury, stress or overheating, rest and taking vitamins prescribed by the doctor will be enough to restore the pregnant woman’s condition. More serious cases require treatment with medication. If a diagnosis of macrohematuria is made, or if protein is detected in the urine along with red blood cells, hospital treatment is recommended to minimize complications. The following are used in therapy:

• antibacterial drugs (Monural, Amoxiclav);
• analgesics (No-shpa);
• anti-inflammatory drugs (Diclofenac, Paracetamol);
• diuretic medications (Canephron, Eufillin, Nephron);
• hemostatics to stop uterine bleeding (Ditsinon, Vikasol);
• a diet with limited consumption of water, salt and protein foods.

Many medications are contraindicated for pregnant women, so doctors try to avoid using any medications until an accurate diagnosis is made. If there are kidney stones that require surgical removal, surgery is postponed until after delivery, while the woman is provided with supportive care.

The presence of red blood cells in the urine of the expectant mother may indicate the presence of pathological processes in the body, but the presence of three to five red blood cells in the analysis may be allowed.

If the number of red blood cells in urine significantly exceeds the norm, the patient is diagnosed with gross hematuria. In this case, the urine takes on a scarlet tint, which may be a symptom of diseases of the urinary system.

The rate of red blood cells in urine during pregnancy should not exceed one red body in the field of view.

Additional diagnostic methods to identify the causes of increased red blood cells in the urine

Scarlet color of urine can be caused by the following factors:

• excessive physical activity;
• lifting weights;
• hot baths and saunas;
• frequent exposure to the sun;
• consumption of alcoholic beverages;
• unbalanced diet with a predominance of spicy foods.

Uterine bleeding can also cause an increase in the level of red blood cells in urine. It is quite difficult to identify it right away, since the color of the urn does not change in this case. The prevailing number of women with uterine erosion also have a high number of red blood cells.

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Advanced colpitis (inflammation of the vaginal mucosa) can cause red blood cells to enter the urine through cell membranes.

An increase in the size of the uterus can also cause the appearance of red blood cells in the urine. This is explained by the constant pressure of the enlarged uterus on the urinary organs. As a result of such processes, circulatory disorders and kidney failure occur.

Other natural reasons for the presence of red blood cells in the urine include hormonal changes during pregnancy. In such a situation, the number of red blood cells in urine is insignificant, so there is no danger to the mother and unborn child.

Women who are actively involved in sports before pregnancy should avoid strength training while pregnant.

A high concentration of red blood cells in the urine indicates the presence of hematuria. A balanced diet and proper daily routine can help you get rid of this syndrome in a short time.

If a woman has red blood cells in her urine during pregnancy, the gynecologist will insist on a repeat analysis and examination of the vagina, for which a gynecological speculum and colposcope are used. During the procedure, the specialist will take a smear for bacterial culture from the cervix and urethra.

To clarify the diagnosis, additional studies may be prescribed:

• urine analysis according to Nechiporenko (similar to the general analysis, but determines the presence of cells in 1 ml of biomaterial);
• three-glass sample;
• Ultrasound of the pelvic organs and peritoneum;
• coagulogram to assess blood clotting;
• cystoscopy (prescribed in exceptional cases when there is a threat to the mother’s life).

CT scans, X-rays with contrast, thyroid scans and other tests may be needed to detect diseases, but because they can harm the baby, they try to postpone them until the postpartum period. The use of one or another diagnostic method will depend on the results of a urine test and the nature of the woman’s symptoms.

Macrohematuria is the presence of blood in the urine in a significant amount, when its presence is determined visually. The main physiological reasons for this phenomenon are changes in the woman’s hormonal levels and the growth of the uterus. Gradually increasing during pregnancy, it begins to put pressure on the bladder and ureters.

In addition to physiological factors and the presence of diseases, the growth of red blood cells can also be provoked by external factors:

• severe overheating;
• physical overload;
• alcohol abuse, which causes vasoconstriction of the kidneys with subsequent penetration of red blood cells into the urine;
• past stress, which provokes an increase in steroid levels;
• injuries of the kidneys, ureters, bladder.

Hematuria can be caused by many reasons, but, if we ignore possible diseases and pathologies, then in most cases this process in pregnant women is physiological in nature. The reason for this is a significant enlargement of the uterus, which puts pressure on the bladder, causing minor damage to it.

Also, pregnant women often experience idiopathic hematuria caused by hormonal changes. If red blood cells in urine are elevated during pregnancy for the above reasons, then all that needs to be done in this situation is to wait for successful delivery and subsequent normalization of test results.

Important! The accuracy of urine test results and compliance with the rules for its collection are closely related. The containers for collecting samples must be sterile, and the liquid itself must be stored for no more than two hours at a temperature not exceeding 18 °C.

Unfortunately, the reasons for the increase in the number of red blood cells in the urine are not always so harmless. Very often they are provoked by various diseases. Most often these are diseases of the genitourinary system and various infections (the most common are cystitis and pyelonephritis), kidney stones and sexually transmitted diseases. These diseases are not asymptomatic; they are manifested by pain and burning when urinating, fever, nagging pain in the lower abdomen and lower back, nausea and vomiting.

With a diagnosis of hematuria, the influence of gynecological diseases, fibroids, and uterine bleeding due to cervical erosion cannot be completely excluded. If the expectant mother had chronic nephritis, urolithiasis, or blood diseases before pregnancy, then pregnancy provokes an exacerbation of these diseases.

To make an accurate diagnosis, the patient needs to take a “three-glass sample” of urine. This method involves collecting the initial, median and final doses. Biomaterial is collected in different containers.

The analysis technique is based on differentiation:

• if red blood cells are found in the initial stream, then a conclusion is made about the localization of the source of inflammation in the urethra. This may be caused by mechanical trauma, cancer, polyp growth, or a sexually transmitted disease;
• the presence of red blood cells in the median stream indicates problems with the neck of the bladder or urethra;
• the detection of red blood cells in all samples indicates pathology of the kidneys, parenchyma or bladder.

Increased red blood cells in the urine during early pregnancy are most often rare in a healthy woman. The appearance of red blood cells in the urine can usually be observed in the second or third trimester, when all provoking factors are activated, if pathologies are excluded.

Methods that have no contraindications for the mother and unborn child are used as diagnostics:

• three-glass sample;
• Ultrasound of the kidneys;
• urine analysis (clinical and according to Nechiporenko and Amburge).

That is, increased red blood cells in the urine are most often observed during pregnancy in the later stages.

Physiological causes of gross hematuria

The type of hematuria is determined by the cause that led to the development of this syndrome:

1. Extrarenal: the appearance of blood in the urine is not associated with diseases of the urinary system and injuries.
2. Renal: hematuria is caused by kidney pathology.
3. Postrenal: the syndrome occurs as a result of diseases of the urinary tract and bladder.

Classification of hematuria according to the degree of development of the syndrome:

1. Terminal: blood is contained in the last portion of urine.
2. Initial: blood is detected in the first portion of urine.
3. Total: a portion of urine has a scarlet tint.

If the patient's urine is completely red, we can judge the presence of gross hematuria.

It is quite difficult to determine the presence of microhematuria by any characteristic signs, since most often it is asymptomatic, therefore, for the purpose of prevention, pregnant women need to have their urine analyzed monthly. Timely completion of the necessary laboratory tests allows us to identify the presence of the syndrome in the early stages, which greatly simplifies the treatment process.

Discomfort and pain during urination may indicate pathology of the kidneys or organs of the genitourinary system. Most often, such ailments are accompanied by unilateral lumbar pain.

A patient with hematuria may experience symptoms such as:

• loss of appetite;
• nausea;
• vomit;
• deterioration in general health;
• headache;
• lack of weight gain during pregnancy.

The absence of characteristic signs of a high content of red blood cells in the urine significantly complicates the process of identifying the presence of the syndrome in a patient.

If hematuria is suspected, a woman should undergo a urine test. When collecting urine, you must strictly follow the prescribed rules to avoid distortion of the results.

Urine collection algorithm:

1. In the morning after bathing procedures, you need to prepare a gauze swab.
2. Next, you need to place the tampon in the vagina and release the first portion of urine.
3. It is necessary to collect the remaining urine in a previously purchased container, making sure that the container body does not touch the skin.
4. For analysis, you need to collect 70 milliliters of urine.
5. If the test result shows that the expectant mother's urine contains a large number of red blood cells, she will need to undergo a repeat laboratory test and visit a gynecologist.

The results of the examination allow the doctor to determine the exact cause of the content of red blood cells in the urine of the expectant mother and prescribe appropriate treatment. Regular laboratory tests help prevent pregnancy pathologies, miscarriages and diseases of the urinary system.

Prevention

You can reduce the risk of hematuria by following the recommendations:

• to live an active lifestyle;
• eat less salt;
• do not smoke or drink alcohol;
• drink enough water per day;
• use high-quality intimate hygiene products;
• don't get too cold.

Hematuria in pregnant women is diagnosed quite often, but in most cases it is not dangerous for the mother and child. But it can also indicate serious pathologies, so it is necessary to undergo all studies for timely detection and treatment.

Risk to the fetus

Physiological hematuria is not associated with risks to the fetus. Just like most diseases of the genitourinary system, which can be treated during pregnancy with drugs that are safe for the woman and the fetus. The danger for the unborn child is uterine bleeding, when bloody discharge through the reproductive canals flows into urine during urination.

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Significantly aggravates the risks to the fetus caused by the appearance of a significant number of red blood cells in the urine and an increase in red blood cells in the blood in pregnant women. Treatment in such cases should be comprehensive and immediate.

Reference values

The normal concentration of red blood cells in pregnant women does not exceed one cell in the field of view under a microscope

If red blood cells in the urine are elevated, doctors first make sure the data is accurate. A woman should have no more than one red blood cell excreted in her urine, and a man should have up to three. In the second trimester of pregnancy, the content of red blood cells should not change, even against the background of an increase in blood flow to provide the growing fetus with the necessary nutrition and oxygen. In the third trimester, the risk of developing preeclampsia, a severe complication of pregnancy characterized by the presence of edema, protein in the urine and hypertension, increases due to iron deficiency anemia.

Normally, the urine of pregnant women should not contain red blood cells. Even a slight increase should alert clinicians. They will definitely prescribe a repeat or clarifying study. The norm is characterized by a complete absence of red blood cells, therefore, if one cell is detected in the field of view, an additional analysis is performed.

Red blood cells often increase against the background of complicated leukocytosis, proteinuria (with protein in the urine). In many cases, doctors diagnose nephrourological diseases of an infectious and non-inflammatory nature, gestosis, and secondary arterial hypertension.

Analysis of urine

When a pregnant woman registers with a gynecologist, she is regularly sent to the laboratory for a urine sample for a general analysis. This study includes various testing methods:

• inspection of the biomaterial for its transparency, shade and quantity;
• study of the chemical composition to determine pH and the presence of metabolic products (bilirubin, glucose, protein, etc.);
• identification of microbes;
• checking the test liquid under a microscope for the presence of red blood cells, leukocytes, salts and other inclusions.

Why do a urine test during pregnancy? Urine is formed in the kidneys as a result of blood filtration - with it, metabolic products, excess water, salts and other substances are removed from the body. The study allows you to assess the quality of the kidneys and liver, suggest the presence of inflammation and infection, and during pregnancy, identify abnormalities of the genital organs or disruptions in the development of the fetus.

To avoid erroneous release of red blood cells into the urine, you must adhere to the rules for preparing and collecting biomaterial. One day before, you need to exclude bright berries, beets, and spicy foods from your diet.

Urine collection must be carried out in compliance with the following rules:

• urine is collected in the morning after washing without the use of antimicrobial hygiene products (douching is prohibited);
• It is recommended to use a pharmacy container for collection - such devices are inexpensive, sterile and equipped with a tightly screwed lid;
• urination should begin and end past the container, collecting only the average portion of urine;
• It is advisable to collect biomaterial by weight, without touching the container to the body, which will reduce the likelihood of foreign impurities getting into the urine;
• the container should be delivered to the laboratory within 1–2 hours.

Erythrocyturia is the presence of more than 10 units of red blood cells in the field of view. It is possible to correctly interpret the appearance and growth of red blood cells in urine by resorting to quantitative analysis of urine sediment according to Nechiporenko. An excessive number of casts in the urine, according to this study, exclusively indicates kidney damage.

Important! To make an accurate diagnosis, it is extremely important to determine the specific type of red blood cells found in the urine - fresh or leached.

The presence of fresh red blood cells indicates a destroyed renal barrier or damage to the mucous membrane of the urinary tract caused by toxic damage to the kidneys, the presence of stones in the kidneys, bladder and ureters, disintegrating tumors of these organs.

The localization of the disease directly in the kidney is indicated by the presence of leached red blood cells in a urine test. Also, this type of red blood cells indicates prolonged bleeding from the mucous membranes of the urinary tract.

There are several tests that can help detect elevated red blood cells during pregnancy.

Your doctor may order the following tests.

1. General urine analysis.
2. Urine analysis according to Nechiporenko. Using this analysis, the number of leukocytes, red blood cells and casts per 1 ml of urine is determined. Normally, the number of red blood cells should not exceed 1000. In serious diseases, their number exceeds 4500.
3. Biochemical composition of urine. It is not used to determine the level of red blood cells, but may be needed by a specialist to clarify the cause of hematuria.

Additional examinations may be needed when a specialist wants to clarify the true cause of blood in the urine. In this case, an ultrasound of the abdominal organs may be performed.

What to do first
The first thing that all pregnant women with suspected diseases of the urinary system or hematuria do is a general urine test.

Normally, it is characterized by the following indicators.

1. Color. Normally it should be light yellow.
2. Transparency. Must be completely transparent. Cloudiness, normally, can only be present if the collection rules are violated.
3. Smell. Normally, the smell is not pronounced.
4. Density. The normal density is 1010-1025.
5. Protein. Normally it does not exceed 0.033.
6. Leukocytes. Up to 6 in sight.

In the case of a urine test according to Nechiporenko, the following indicators should be present:

• leukocytes no more than 2000;
• cylinders no more than 20;
• red blood cells no more than 1000.

Observation Changes in normal values ​​do not always indicate the presence of pathology. In some cases, the reason for the change may be a violation of the rules for collecting urine.

Pathology

The following changes in the general analysis of urine indicate violations.

1. Color. When red blood cells appear in the urine, it changes its color. Usually dark brown. It acquires a bright red color with false hematuria, when the cause is certain medications, as well as food.
2. Transparency. Muddy.
3. Smell. Doesn't change.
4. Reaction. If the causes of hematuria are renal in nature, then the urine reaction shifts to the acidic side. If the cause is bladder pathology, it is alkaline.
5. Leukocytes. Against the background of kidney inflammation, the number of leukocytes exceeds 6 in the field of view.

In addition to a general analysis of urine, a urine test according to Nechiporenko is mandatory.

With pathology, the following changes will occur.

1. Leukocytes. If there is inflammation in the urinary system, the indicator exceeds 2000.
2. Red blood cells. We can talk about the presence of blood in the urine if the number of red blood cells exceeds 1000. In severe diseases, the number of red blood cells in 1 ml of urine can reach 45,000.
3. Cylinders. The presence of more than 20 cylinders indicates pathology.

Having assessed the analysis, the doctor may prescribe additional examinations or send you for examination to a urologist.

Even if hematuria appears in the first weeks of pregnancy, it is necessary to begin treatment in a timely manner.

Otherwise, serious problems with fetal development may occur.

Frequently asked questions to the doctor

Importance of Red Blood Cells

Good afternoon. Explain why red blood cells and their absence in urine are so important? These are blood cells, shouldn't they be in the body?

Hello. Red blood cells are the largest group of blood cells, 1 ml of blood contains about 5 million red blood cells, they are necessary for transporting oxygen and nutrients to the cells, and in urine, as we know, there are no cells, because it is a liquid that the body secretes. The presence of blood cells in the urine occurs due to various disorders and is not the norm.

Diseases contributing to the development

Often hematuria becomes a consequence of the development of concomitant infections and inflammation of various organs of the human body.

Inflammatory processes in the genitourinary system often lead to an increase in the level of red blood cells in urine. During pregnancy, women may experience exacerbation of diseases such as cystitis (inflammation of the bladder) and pyelonephritis (nonspecific inflammatory disease of the kidneys of bacterial etiology). Scarlet color of urine may be a symptom of one of these diseases.

Urolithiasis during pregnancy can also cause an increase in the number of red blood cells in urine. This occurs as a result of damage to the mucous membrane by sand and stones. In this case, hematuria is accompanied by severe pain.

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The red color of urine may indicate the presence of malignant tumors in a woman’s body. The difficulty of diagnosis lies in the fact that discomfort and pain do not appear immediately. In the presence of oncological diseases, the entry of red blood cells into urine is caused by the destruction of the walls of blood vessels and malfunctions in the functioning of the affected body systems.

Other diseases

During pregnancy, the expectant mother may encounter pathology of the renal vein, which occurs as a result of its compression. The disease often causes red blood cells to leak into the urine.

It can also be caused by necrotizing papillitis (ischemic infarction of the renal papilla and the adjacent renal medulla). Most often, this disease develops as a result of exacerbation of pyelonephritis or if a woman has diabetes mellitus.

An increased content of red blood cells in the urine can be observed in pregnant women with the following diseases:

• hypertension;
• anemia;
• thrombosis;
• vascular aneurysm.

Various diseases can cause changes in the number of red blood cells in the urine. Only laboratory tests and medical diagnostics can identify the exact cause.

Stabilization methods

Of course, if we are talking about the physiological causes of hematuria, then it is impossible to select stabilization methods in this case. You just have to wait until the pregnancy is resolved by childbirth, and the red blood cells in the urine will disappear on their own.

If the cause of hematuria is the presence of various pathologies in the pregnant woman that provoke the appearance of red blood cells in the urine, then in this case, stabilization methods should be aimed primarily at eliminating the causes of the appearance of red blood cells.

Taking into account the indications, the following are used:

• antibacterial therapy;
• strict diet;
• taking anti-inflammatory drugs;
• taking diuretics;
• Limiting fluid intake to minimize stress on the kidneys.

We should not forget that only a doctor can prescribe adequate treatment.

Did you know? In the 17th century, urine baths became fashionable in France. Their fans sincerely believed that such bathing could restore youth to the skin, make it beautiful and elastic.

What uterine bleeding can be confused with hematuria

When a woman notices bloody inclusions in her urine, she cannot independently distinguish between uterine bleeding and hematuria. This is very important for making a correct diagnosis and timely treatment. Therefore, if you find traces of blood, you should immediately consult a doctor.

At the beginning of pregnancy, bleeding from the uterus means:

• threat of interruption or a process that has already begun;
• ectopic pregnancy.

At this moment, the girl most often only guesses about pregnancy and experiences acute pain. You can save your child only if you immediately consult a doctor.

Bleeding also occurs when placental abruption or uterine rupture occurs. Therefore, the presence of blood cells in urine requires a thorough examination, which is necessary to maintain the health of the mother and child.

Treatment of pathology

Hematuria requires treatment regardless of the duration of pregnancy and the causes of the syndrome. Since a high level of red blood cells in urine signals the presence of pathology, the main goal of treatment is to eliminate it.

After undergoing diagnostics and laboratory tests, the doctor determines the treatment method and prescribes the necessary medications to the patient. Self-administration of medications can lead to serious consequences, including the loss of a child.

To increase the effectiveness of the medications taken, the expectant mother is recommended to pay special attention to a proper diet. It is necessary to minimize the consumption of too fatty, spicy, salty and sweet foods.

You also need to maintain the correct daily routine, avoid heavy physical activity and monitor the quality and quantity of sleep. During pregnancy, it is recommended to spend a lot of time outdoors, avoid stressful situations and overexertion.

After the first trimester, pregnant women need to regularly take the knee-elbow position. The benefit of this exercise is to restore blood circulation to the pelvic organs, the load on which increases significantly during gestation.

Following all the recommendations allows you not only to speed up the treatment of hematuria, but also to prevent the development of this syndrome and possible complications.

An increase in the level of blood cells involves, first of all, diagnosing urinary tract diseases and identifying the primary source of the cause that affected hematuria. Treatment for infection involves the use of antibacterial drugs, which are allowed at the stage of intrauterine fetal formation. If stones are found, hospitalization and antispasmodics will be required.

Medicines based on herbal components will help reduce the slight appearance of blood in urine tests. For the same purpose, you can use decoctions of lingonberry leaves, cranberries or special mixtures, but only after medical consultation.

If hematuria appears, after the doctor makes a diagnosis, treatment for the disease must be started immediately. Depending on the cause, treatment may vary. Most often, the cause of true hematuria is kidney disease.

In this case, the following treatment measures are prescribed:

• diuretics;
• antihypertensive drugs;
• antibiotics.

Antibacterial agents are prescribed only if the bacterial nature of the disease is confirmed. Cephalosporins and macrolides are considered absolutely safe for a pregnant woman. Treatment should be prescribed only by the attending physician.

In the early stages

Expert opinion Olga BorovikovaThe treatment does not stand out in anything special. The goal in this case is to maintain the pregnancy. They can put it on hold only in particularly difficult situations. Treatment is mainly carried out on an outpatient basis.

In the later stages