Striae Gravidarum

STRIAE GRAVIDARUM, stretch marks of pregnant women, which form in the second half of pregnancy in approximately 80% of all pregnant women. They are usually located on both lower quadrants of the abdominal wall in parallel concentric lines with the concavity facing the linea alba; further on the outer and partly on the anterior surface of the thighs in their upper half, as well as on the buttocks; and finally, on the mammary glands, radiating from the nipple to the periphery of the gland. Until very recently, the formation of pregnancy scars was explained purely by the mechanical stretching of the skin due to the growth of the pregnant uterus and mammary glands, and on the thighs and buttocks due to rapid fat deposition. However, arguments raised against this explanation included the fact that with rapidly growing abdominal tumors and rapid fluid accumulation in the abdominal cavity, such bands on the abdominal wall as a rule do not form despite sometimes very strong stretching. It was noted that the skin and underlying tissues in the indicated areas during pregnancy not only stretch, but also undergo drastic changes in their biochemical structure. These changes affect both the underlying muscle layers and especially the subcutaneous adipose tissue, in which a large amount of fat is deposited simultaneously with strong loosening. According to modern views, these local processes specific to pregnancy lead to the tearing of the skin in its deep layers; at the sites of the tears, the underlying expanded vascular network shines through the superficial layers of the epidermis, which is why during pregnancy the scars have the appearance of red bands with a violet tint of various shades; upon termination of pregnancy, the skin defects are filled with scar tissue and then become white, even brilliantly white, sometimes with a pearlescent tint. From the foregoing, it is obvious that pregnancy scars can have diagnostic value during pregnancy to clarify the diagnosis of pregnancy itself, and outside of pregnancy as one of the additional signs of a previously carried pregnancy. However, in both cases, especially if it concerns forensic medical examination, great caution is nevertheless necessary, since formations analogous to pregnancy scars are sometimes observed in women who have never been pregnant, and even in men. Here and there, however, the medical history invariably indicates rapidly developing obesity, moreover, obesity of the pituitary type. Individual observers tried to figure out the dependence of the formation of pregnancy scars on a particular constitution of the woman, but the data published so far are unconvincing and contradictory. Equally unconvincing are those observations where authors try to clarify the relationship between the formation of pregnancy bands and the further course of pregnancy and labor (for example, with perineal ruptures). Standing apart is Mayer's attempt to attribute a special photochemical significance to pregnancy bands in the sense of the effect of light on the skin and especially on the blood circulating in it. The excessive development of pregnancy scars undoubtedly negatively affects the nutrition and elasticity of the abdominal wall, leads to its flabbiness, and in connection with this, to the instability of the abdominal organs (enteroptosis). In this regard, it is necessary to take care of preventing the formation of pregnancy bands. This is achievable to a certain extent by reasonable physical culture in the non-pregnant state and during pregnancy, as well as by the use of rational bandages and massage of the abdominal wall both during pregnancy and in the postpartum period.