Itching pregnant women in the last month. Why during pregnancy in the early and later periods it can be felt on the skin, how to cope with him? To which doctor to seek advice

Itch - This is a painful feeling that is caused by constant irritation of nervous endings and manifests itself to a strong need for combing skin and mucous membranes.

Information During pregnancy, many women complain about frequent skin (especially, the skin of the abdomen and chest), which gives them a considerable discomfort. Itching can be permanent or appear from time to time, intensify in the evening and night time or disturbing throughout the day, manifest itself independently or be a symptom of another disease.

Causes of the appearance of the skin

TO basic reasons Believe:

  1. Fast abdomen and breast increase. In the second half of pregnancy, the skin begins to stretch quickly, the breakdowns of connective tissue fibers arise, and a constant desire to comb clearing the skin appears. Especially itching intensifies in the evening and night;
  2. Allergic reactionand. Allergen can be new hygiene products, pollen of plants, food products, etc. In addition to itching for allergies, it is characterized by redness, swelling, the presence of rashes;
  3. Excessive sweating. With neglect of the power of hygiene, the sweat can accumulate in the folds of the body and cause itching;
  4. Cholesteaspregnant women (disorders of the liver and biliary tract caused by hormonal changes). Cholestasis is characterized by a strong itching and redness of the palms and stop, can then spread to the rest of the body;
  5. Diabetes;
  6. Dermatosis of pregnant womenas a manifestation of rare species of toxicosis. This is a group of skin diseases that manifest themselves only during pregnancy. It is often found directly to the itching of pregnant women, which spreads throughout the body and leads to a deterioration of general well-being, irritability, insomnia. More rapid eczema, manifested by a strong itching, burning and happiness on the skin;
  7. Yellowee pregnant women (also a rare type of toxicosis). Characterized by damage to the liver, yellow skin staining, strong itching;

Important In any case, you should not try to independently determine the reason for the appearance of itch and the more self-treatment. At the first signs of the appearance of the skin, immediately apply for a consultation to the doctor.

Treatment of skin ferry during pregnancy

Treatment of skin ferry First of all, it is aimed at eliminating the cause that caused this symptom. Before that, you can use methods that will help temporarily remove itchingor at least facilitate its manifestations:

  1. Regularly ventilate and moisturize the room. The room should be cool (no more than 18 degrees Celsius) to avoid increased sweating;
  2. Compliance with personal hygiene rules. It is recommended to take a warm or contrasting shower several times a day;
  3. Systematically wash itching places medicinal herbs champs (AIR marsh, daisy pharmacy, violet tricolor, a series) or a weak solution of food soda;
  4. Regularly do applications With chamomile and rod. Herbs need to be confused to a cascidious state, put on the item of the skin and cover with a marble napkin. The procedure is performed 2 times a day for several hours.

These methods will help to remove itching for a short time. The main disease remains the treatment of the main disease.

When manifesting skin itch as a symptom allergic reaction It is primarily important to identify and eliminate the action of the allergen, often after this itching immediately stops. An independent reception is categorically prohibited, the treatment should be prescribed only an allergist.

With diabetes It is necessary to strictly monitor blood sugar levels. Perhaps the additional introduction of insulin will be required. Treatment should pass under the permanent control of the endocrinologist.

For pregnant trouts A woman tend to recommend inpatient treatment. Prescribe a gentle diet with the exception of sharp and salty dishes, smoked. Locally, the affected areas impose a row with a solution of potassium permanganate. To reduce itching and burning, vitaminotherapy, calcium preparations are prescribed.

For cholestasy pregnant women Treatment should be carried out only in the hospital. Prescribed preparations to improve bile outflows (,) and hepatoprotectors to maintain the functions of the liver (CARCIL, Essentialy).

Yellowee pregnant women (A rare type of toxicosis) is an extremely dangerous disease and threatens the health and life of a woman. With the diagnosis decree, the pregnant women are emergency and interrupting the pregnancy on any time.

Prevention itch

Skin itching delivers a pregnant mass of unpleasant moments, affects her well-being, worsens sleep. The treatment is not always effective and often manifestations can be renewed. For this reason, extremely important are directly preventive actions:

  • Weight control. With an excess or uneven weight set, there is a high probability of stretching the skin and the appearance of stretch marks, which leads to the appearance of itching;
  • Comply with Hygiene Rules. It should take at least once a day to take a warm shower (not hot), a reception during pregnancy is contraindicated;
  • Avoid drying the skin. After water procedures, it is necessary to apply a lotion on the skin or body cream;
  • Massage With alternating strokes and rubbing. It helps well as a prophylactic agent from the appearance of stretch marks, and, accordingly, the occurrence of the skin itching;
  • Give preference clothes only from natural fabrics (cotton, wool, flax).

Many pregnant women say that their skin raises the desire to scratch much stronger than usual, especially around the chest and abdomen. This is a common consequence of pregnancy, which is most often concerned about in the second and third trimesters.

Easy itch is common due to hormonal changes and increase blood supply to the skin. As the pregnancy and growth of your child, the belly leather is stretched, which can also cause. A minor desire to scratch should not be anxious, but if itching becomes strong, it can be a sign of a liver disease called intrachnoral cholestasis of pregnant women (VCB). It meets less than 1 out of 100 pregnancies, but requires medical care.

There are many options for treating itching skin during this period, but they will depend on the root causes. In most cases, itching disappears immediately after the child's birth.

Itching during pregnancy is it normal or not?

This is a common phenomenon that in most cases should not cause anxiety. Estrogen levels can lead to the fact that the skin blues and itches, in particular on the palms and soles of the stop. Since the skin on the belly is stretched to adapt to your growing child, it often causes her dryness and itching. In addition, those who had a tendency to dry skin, psoriasis or other dermatological problems earlier, may notice that their symptoms deteriorate during pregnancy. All these "side effects" must subscribe as soon as you give. States that are accompanied by a rash during pregnancy should be appreciated by the doctor.

Statistics

The Polish study conducted in 2017 showed that the overall prevalence of itching among pregnant women was almost 40% at certain periods of pregnancy. It is also interesting that in the course of this study, most of the women from 292 attracted women did not manage to establish the cause. In a few older studies and sources, the frequency of about 20% is more common.

The reasons

There are several factors that can affect the skin during pregnancy and lead to itching or high sensitivity, until your child is born.

Cause

Description

Dermatosis Often itch is a sign of any dermatosis (skin disease), which accidentally coincided with a period of tooling a child or previously existed and could break back during pregnancy. In some cases, this is due to a group of specific dermatosis pregnancy.

Various factors can cause redness or rashes on the skin during pregnancy. Women are often encountered with the Padel, because the increase in hormones during pregnancy affects sweat glands. In addition, urticaria may develop due to improving sensitivity to insect bites, some products, etc. Most rash is harmless, but if they are accompanied by breathing disorders, you should consult a doctor to make sure that you do not have an allergic reaction.

High estrogen levels Pregnancy increases estrogen level in the body, which can cause temporary itching on hand and legs. This may be accompanied by redness.

Prevalence: up to 2/3 of pregnancies (not very reliable source)

Dry skin In order for your child to be accommodated in the stomach, this part of the body needs to be stretched. This means that the glands under the skin becomes more difficult to maintain it moistened. When your body faces such changes, you can experience dryness that is accompanied by itching or discomfort.
Sealing Upholstered Papulas and Balaxes of Pregnant women (English Puppp) Upholstered papulas and pregnant plaques are a rash that affects about 0.5% of women with unionless pregnancy, 2.9% of those who are carrying twins and 14% - triple. This rash is manifested in the form of itching redness on the stomach. There may be several small or large spots that apply to buttocks, hips and hands. Most often, this is found in the third trimester. The rash is not hazardous and should disappear a few days after childbirth, but if it causes serious discomfort during pregnancy, it can be treated with steroid tools for local application (after the doctor's prescription!).

Prevalence: 1 to 160 pregnant women (average frequency that depends on the number of external fruits)

Pregnancy cholestasis (HB) If a strong itch appeared in the third trimester, it may be a sign of a liver disease, known as pregnant cholestasis. It causes blocking of bile ducts, which prevents it from leakage from the liver into the intestine and leads to a cluster in the blood of bile salts. Some of the symptoms of such a serious pathology are redness and strong itching of the skin, especially palms and soles, but can manifest themselves throughout the body.

Prevalence: 1 of 140 pregnant women (0.7%), in women from India and Pakistan above - 1-2%.

Other reasons Those who suffered from allergies or poor skin condition to pregnancy may notice the deterioration of their problems during its flow. Talk to your doctor before using your usual treatments, since some drugs are unsafe during pregnancy.

Examples of itching rash during pregnancy

Urticaria is an allergic reaction to food, insect bites, drugs, chemicals, etc. With increasing hormones and changes that occur in your body, it is possible that you become more sensitive to pathogens and encounter the urticaries during pregnancy
Itchy urctural papulas and pregnant plaques are found in some women. Despite the fact that they are very annoying (because of the itch), but do not represent long-term risk for the mother or fetus. Papulas and plaques are usually beginning to appear on the abdominal cavity (although not on the navel), and often apply to feet, chest, armpits, etc. The face is usually also not affected.

How to calm the itchy skin during pregnancy?

1. Use soft bathing tools.

If you are tested, try to avoid what can worsen your problem. Use only soft soaps and means that do not contain stimuli, such as pH regulators and flavors (fragrances).

2. Avoid overheating

Too hot weather can strengthen your itching, so try to wear breathable clothes and avoid getting out on hot days to prevent excessive skin irritation. Also avoid hot baths or shower. Overheating can be dangerous for your child.

3. Apply a soft moisturizer

If your dry skin, try using soft moisturizers to relieve. Adding oatmeal, and even better - flour (colloidal oatmeal), in a bath or application of a Kalamin's children's lotion - famous methods for removing the skin to serpen, which are safe for pregnant women. You can also consult a doctor in order for him to advise you a moisturizing cream or ointment that can be used during this period.

4. Use air humidifier

Sometimes itching is associated with dry skin. You can try to use a humidifier of air to solve this problem, especially in winter. But you must be careful because the device can distribute allergens and microbes if used incorrectly. Before starting work, read all the instructions from the manufacturer and before turning on, make sure that the humidifier is maximum clean. Also avoid the constant impact of the humidifier, as it can cause irritation.

Skin itching during pregnancy - the phenomenon is not particularly common. Most often, the skin begins to be unbearable (like after mosquito bites) in the evening, closer to the night, which can provoke insomnia and in general worsen the mood of a woman. Usually itching does not harm the baby and itself goes after childbirth. However, it is still worth consulting with a gynecologist and a dermatologist.

What does he happen from?

The reason for the occurrence of itching during pregnancy in most cases is a liver failure: the production and outflow of bile, the overall increase in the level of bilirubin in the blood. This is due to the hormonal failure in the body of the future mother - disorders of estrogen synthesis, as well as due to the pressure of the fetus on the bile ducts. Generating in large fatty acids fall with blood flow into the skin of a woman and irritate the nerve endings, causing an agonizing itch. Such phenomena associated with bile in the body can make themselves felt in the third trimester of pregnancy. Sometimes it is accompanied by such dangerous diseases such as diabetes.

Who is predisposed?

Usually itching during pregnancy is observed in women with chronic diseases of biliary tract and with a high level of cholesterol in the blood. Such future mothers needed regularly (at least once a month) to make a biochemical blood test to eliminate toxic effects on liver cells.

How to deal?

About discomfort associated with skin itch, pregnant need to tell his gynecologist. In some cases, itching may be a sign of the development of such a dangerous disease as hepatitis. The doctor will hold appropriate surveys. If it does not represent any danger according to an objective survey, it is not necessary to get rid of discomfort, it allows simple adherence to a diet aimed at reducing cholesterol levels, to limit the use of oily, acute and salty food, which prevents liver to cope with the function of the selection of bile, and abundant drinking - It is necessary to eliminate dry skin. If the diet does not help, the doctor can prescribe appropriate bile preparations suitable for pregnant women.

It is important to find the cause of the disturbing itch, eliminating the whole group of skin diseases that may be observed during pregnancy.

Itching in the area of \u200b\u200bbelly and chest

About such a itching should be said separately. As a rule, the skin on the stomach or chest is itches in the second and third trimesters due to its stretching, because these parts of the body increase in the amount during pregnancy. In this case, it is very important not to comb the skin - this will lead to the appearance of stretch marks, which, unlike itching, will not pass after delivery. We regularly use moisturizing creams, special means against Striy, make a lightweight breast massage and belly with a circular movement of fingers and do not take a hot shower.

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Many people are associated with irritability, but sometimes future mothers face strong susceptibility not only their psyche, but also the body. Skin itching can occur in any period of gestation. No matter why it appears, this symptom delivers a lot of inconvenience and requires immediate action. The problem is that pregnant women have many signs eliminate exclusively by gentle methods.

Why maybe a skin itching may appear during pregnancy?

Itching during pregnancy can be a variant of the norm. It is explained by hormonal changes in the future mothers who make it the ideal "incubator" for the fetus. Estrogens produced in the female body affect the work of all its systems. The skin becomes more dry and sensitive, she sensibly reacts to any stimuli and already at the very beginning of gestation can be sealing for completely different reasons.

With the development of pregnancy, discomfort can either enhance or completely disappear. All women have this happens in different ways: the whole body is unicked, other unpleasant sensations are localized in some specific place. Most often, pregnant women worries discomfort in the abdomen, chest and crotch.

In early terms

In 1 trimester, the culprit of all the troubles of the future mother is toxicosis. Due to the fact that many "garbage" is thrown into the blood, the woman appears itching, which is most felt in places, where the epidermis is the thinnest.

Another physiological reason that the skin is covered is its dryness. This is normal if there are no rashes on it.

In the first months of the baby to wear a frequent reason that the zudis leather, there is an increased sweating. Under the influence of hormones, a woman starts sweating stronger than before. The skin is not accustomed to this, so reacts with annoyance and itching where the moisture accumulates: in the area of \u200b\u200bthe armpits, under the breast, in the crotch area, etc.


Itching in the abdomen and chest area in pregnant women in 1 trimester is explained by the processes occurring inside the abdominal cavity and the mammary glands. When a woman has nipples and skin near them, her breast is preparing for the beginning of lactation.

If there are cracks on the skin on the skin, legs and hands began to get it, perhaps in her body lack vitamins A and E. Vitamin E deficiency is dangerous for the fetus, so it is often prescribed by pregnant women.

In later terms

The skin can also be in the late duration of the baby (more in the article: itchies belly in late pregnancy). In 3 trimester, many future mothers complain about itching in the abdomen area and the appearance of stretch marks. Strya is often accompanied by a very strong itch, causing discomfort to a woman.

The cause of the unpleasant sensations in the last months of the baby tooling is often the weight gained weight. The epidermis is stretched, not soying to adapt to new body sizes, and it is zudit.


In the 3 trimester, the body sometimes begins to hide because of the nervous overvoltage. In this case, itching is not very pronounced, but manifests itself to a greater extent during the appearance of thoughts about the upcoming births. Especially sensitive women who are very worried about how they will be cope with one of the most difficult moments in life, it is necessary to make sedative teas for pregnant women. As a rule, such funds are well removing the itching of different localization.

Pathological processes accompanied by itching and related symptoms

In most cases, the toddler is not very pronounced during the bearings, which takes place in itself. If the condition is accompanied by a beam on the skin, a change in body temperature and other signs, it is associated with any pathology. The pathological causes of itching in the future mother may be as follows:

Localization itch

The skin in pregnant women can get into different places depending on the cause that caused discomfort. For example, the presence of fungal lesions explains why the skin of the legs is called. Hormonal changes are responsible for discomfort in the abdomen and chest area during pregnancy. In varicose veins, legs are very often scratched. Itching throughout the body is observed less often and, as a rule, is a sign of pathological processes in the body.

Diagnostic methods

To accurately determine for what reason the future mother suffers from itching of different parts of the body in the early and late periods of pregnancy, the doctor must collect a complete history of disorder. He conducts a visual inspection, allowing him to understand whether there is signs of irritation on the skin.

If there are visible foci of defeat with them the scraping is taken. If the skin of the zudit without rashes, additional surveys are appointed - blood and urine tests, ultrasound of internal organs.

How to get rid of itching during pregnancy depending on its reasons?

The discomfort caused by the internal disease should be treated only in the hospital. Serious disorders of the liver, kidneys, pancreas, causing itching of the body, carry a clear threat to the health of the fetus, so treatment should pass under the strict control of the doctor.

If itching appeared as a side reaction to the baby tooling, you can use various methods to combat it. The main thing is that they cannot harm the child.

Conservative therapy

Doctors recommend to remove the sensation of the skin with regular hygiene. Future Mama needs a shower or bath at a comfortable water temperature. In no case should it be hot - it will strengthen the discomfort. For washing, it is desirable to use hypoallergenic agents. After taking the soul on the skin it is useful to apply a children's cream.

With skin, caused by skin diseases, a special ointment is prescribed, which removes unpleasant sensations. For example, the phenolic gel helps with allergies.

Many mothers who complain about skin itching suffered by dermatological disorders before pregnancy. They are accustomed to using certain therapeutic ointment and creams for the treatment. To make sure that the tool does not harm the baby when used during gestation, you must first consult with the gynecologist. Knowing about the tendency of his body to such reactions, the use of drugs for internal and outdoor use should be discussed with an obstetrician in the early deadlines until the disease has escaped.

Folk remedies

Many women who are contraindicated by pharmacy ointments from itching, recipes recipes of traditional medicine. All of them are safe for the future mother and quickly remove skin irritation:

  1. Warm bath with chamomile decoction or turn. For her preparation, you need to boil in 3 liters of water 100 g of grass, give the brave to cool and pour it into a prepared bath. Sitting in such a healing mixture follows at least 15 minutes.
  2. Oatmeal compress. It is necessary to carry out such a procedure with the addition of kefira or prostruck in flakes. Apply compress recommended for 20-30 minutes.
  3. Capported leaf. With itching it is recommended to do a cabbage leaf, operated in an apple vinegar. If you need to remove the feeling of itching from the site where there are cracks, the application should be made without using vinegar. Capported leaf before use you need to stretch in your hands.


Is it possible to prevent the appearance of itching during pregnancy?

Preventive measures that can warn dermatological problems during pregnancy:


During pregnancy, a woman may experience various sensations. Some future mothers celebrate the appearance of skin itching. Many are inclined to consider it a harmless phenomenon that will be held in itself. But sometimes itching can be a symptom of dangerous diseases.

Skin itch

Itching during pregnancy can manifest in different ways. Sometimes he worries a woman only in the morning or evening, but it is able to disappear throughout the day.

The symptoms are erased, but more often the future mother clearly feels how the body is drawn during pregnancy. It delivers her certain discomfort and inconvenience. If itching is very pronounced, on the skin of the patient you can see combs, sometimes before the blood.

In addition to this symptom, others may appear:

  • Stretching on the stomach and chest.
  • Severe dry skin.
  • The appearance of rams on the chest, abdomen, hands or legs.
  • Changing the color of the skin and scool, their yellowing.
  • Dimming urine.

All of these changes must be reported to the doctor, since it is from the complete clinical picture that the correct diagnosis depends.

Why does it appear itch during pregnancy?

The reasons

Itching during pregnancy can appear for many reasons. Sometimes it is a sign of physiological processes, natural changes in the body of the future mother. In such situations after delivery, all unpleasant sensations independently disappear.

But if itch is a symptom of the disease, you need to make a diagnosis as soon as possible and begin treatment. This is not just a sense of discomfort, it is a threat to the health of a woman and her child.

The most common causes of skin ferry during pregnancy include:

  • An increase in abdomen and mammary glands.
  • Excessive dry skin.
  • Vitamin deficiency.
  • Allergy.
  • Skin diseases.
  • Liver diseases and biliary tract.
  • Kidney defeat.

Increase abdomen and mammary glands

During pregnancy, the stomach and chest increase significantly in size for a rather short period of time. The skin is stretched and often starts to hide. The faster these changes occur, the time will be itching.


In the early periods, in the first trimester, the unpleasant sensations arise in the chest area, because it is the breasts that are the first to react to the birth of a new life. Due to the increased products of prolactin, the chest increases by 1-3 size.

Itching in the abdomen is usually appearing in late pregnancy - in the third trimester, closer to the intended date of birth. Besides him, stretch marks can appear on the body of the future mother. As a rule, they are well noticeable on lactic glands, abdomen, in the hips and buttocks.

If the woman does not enter twins or triple, itching in the abdomen area is noted much more often like skin changes.

Assist to get rid of unpleasant sensations throughout the pregnancy special cosmetics from stretch marks.

Excessive dry skin

Some women have increased dry skin from birth. During pregnancy, this feature of the body can enhance and manifest themselves to painful itching.

Often, dry skin itches after a hot bath, as well as in the unrecoverable rooms, where the temperature reaches 24-25 °.


In winter, this symptom is more pronounced due to sudden temperature differences on the street and in the apartment. In addition, not many are resorted to the humidification of air in the apartment, although this method is excellent prevention not only itching, but also sharp respiratory diseases.

In the case of overheating, a pregnant woman can develop a regular passman, because of which the back, chest or belly will be hung. Often it is accompanied by redness of the skin and characteristic rashes.

Prevention of itching with excessive dry skin is the use of special creams and humidification.

Vitamin deficiency

When entering the child, the need for vitamins increases, and their consumption is growing. If the future mother has previously observed hypovitaminosis, during pregnancy, clinical manifestations of this pathology will be noticeable.

Vitamins A and E are responsible for the health of the skin. Their disadvantage leads to dryness of mucous membranes and skin, painful tooth, appearance of small cracks.

Often, the palms and feet are brought primarily. Future mothers can notice how legs are scratching during pregnancy. The skin in these areas begins to peel, especially between fingers. Then cracks are formed there.

The untreated hypovitaminosis is able to cause a woman a lot of torment, so it is important before conception and in the first trimester take appropriate drugs. They are prescribed only by the doctor.

Allergy

Allergy is a very frequent cause of the skin with a pregnancy. It can be a reaction to consumable food - for example, exotic fruits. But allergic to washing powder, detergents, body cosmetics occur. In such a situation, the body and hands are usually affected.

This pathology is easy to suspect. Allergic reactions are accompanied by not only itching, but also to redness of the skin and the appearance of various rashes on it - from ordinary urticaria to huge blisters. In addition, with a detailed survey, it is almost always possible to find out the connection of unpleasant symptoms with a causal factor.

Treatment with allergic reactions is selecting only a specialist.

Skin diseases

During pregnancy, you should not forget about skin diseases. They are found both in the early and later. Most often, the following pathologies lead to the appearance of the skin:

  • A variety of dermatitis.
  • Dermatosis.
  • Eczema.
  • Fungal leather damage.
  • Scabies.

Each of these diseases is manifested by a number of unpleasant symptoms. Therefore, when any rashes on skin, erosion or cracks, wet, blisters should urgently turn to a dermatologist.


Some skin diseases have characteristic features, which makes it possible to suspect the diagnosis before the campaign to the doctor.

So, the fungus stops most often settled between your fingers. If redness, unpleasant smell and pronounced itching appeared in this zone, most likely, it is a fungal infection.

Itching during scabies is difficult to confuse with any other. It is very strong, patients with this disease can comb body to blood. However, the thought of scabies brings his appearance in the evening, before bedtime, when the future mother is in bed.

In fact, the scaffold tick reacts to change the ambient temperature. Heat (when a person is under the blanket) its activity increases significantly, and itching increases. In addition, at the same time characteristic - pair - rash appear on the skin.

Self-medication during skin diseases is unacceptable, a dermatologist is needed.

Liver and biliary diseases

In pregnancy, it is often observed a phenomenon called intrahepatic cholestasis. In this case, stagnation of bile in hepatic ducts is noted. You can diagnose pathology in three criteria:

  • Skin tooth.
  • Raising bile acids.
  • The disappearance of all the symptoms after the child appears.

Interested cholestasis is observed in 0.5-1.5% of cases. Sometimes he is manifested by a jaundice, but, as a rule, its intensity is not expressed.

Usually with this pathology itch has characteristic features. It begins after 25-26 gestation weeks and first of all is celebrated in the field of feet and brushes. Then the unpleasant sensations move on the stomach, back and shoulders. At night, discomfort is enhanced.

In more rare cases, these symptoms are evidence of inflammatory processes in the digestive system - hepatitis and cholecystitis.

Light forms of internal cholestasis do not require treatment, with severe - antihistamine drugs, antioxidants, vitamin C are prescribed.

Defeat kidney

With severe kidney damage with the development of their insufficiency, the future mother may also note that the whole body itchs. This is due to the accumulation of toxic exchange products and deposit them in the skin. Feelings at the same time unpleasant and often painful.

However, such pathology is rare, it may be a consequence of chronic pyelonephritis, polycystic or amyloidosis of the kidneys. Nephrologists are treated with the treatment of these diseases.

Itching pregnant women does not apply to independent diseases. It is only a consequence of the main pathology, the diagnosis of which can only be established by the doctor.