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Preeclampsia treatment in pregnant women. Why are gestosis dangerous? Types of gestosis in pregnant women

Preeclampsia, or preeclampsia, is a pathology of pregnancy that occurs in the later stages and is characterized by increased blood pressure, the appearance of edema, and the detection of protein in the urine. Preeclampsia remains one of the most important causes maternal mortality in the world, since its emergence and course are unpredictable, and most effective method treatment is delivery. Child mortality due to gestosis exceeds the average by several times.

Causes and theories of the disease

Preeclampsia occurs only in pregnant women. Doctors believe that in some women the body cannot adapt to new living conditions during pregnancy, all systems are overstrained, and gestosis occurs.

Pregnant women at risk for developing this pathology include:

under 18 years of age;
with multiple pregnancy;
having kidney disease, autoimmune diseases(eg, systemic lupus erythematosus, rheumatoid arthritis, sarcoidosis);
had high blood pressure before pregnancy;
obese (with a body mass index greater than 30);
with mutations in the hemostatic system (PAI-1, Leiden);
with diabetes mellitus, especially uncontrolled.

In the presence of one or more risk factors, the woman’s body ceases to cope with the high load, vasospasm and circulatory disorders occur. Generalized vasospasm leads to failure of all organ systems.

Classification of preeclampsia

To determine treatment tactics, it is advisable to distinguish between moderate and severe gestosis during pregnancy.

Moderate gestosis is characterized by an increase in pressure above 140/90 mm Hg. and detection of protein in urine in amounts from 0.3 to 5 g/l. The diagnosis of severe preeclampsia is made when blood pressure rises above 160/110 mmHg. and detection of protein in daily urine of more than 5 g/l. Additional symptoms may appear:

headache;
visual disturbances (“floaters” before the eyes);
nausea or vomiting;
pain in the stomach, right hypochondrium;
swelling;
lethargy and apathy;
weakness and drowsiness;
fetal growth restriction;
changes in biochemical blood test (increased creatinine, AST, ALT, decreased platelets).

Diagnosis of preeclampsia

The final diagnosis of late gestosis can only be made by the attending physician. The diagnosis is made if a woman has edema, high blood pressure from 140/90 mmHg, and protein is detected in the urine.

It is important to know that most often preeclampsia is accompanied by so-called hidden edema. They can be recognized if they have:

pathological weight gain of more than 350 grams per week;
reducing the daily volume of urine below 900 ml;
nocturia (a condition when the volume of urine excreted at night exceeds the volume during the day);
positive “ring symptom” (rings that were previously freely removed from the fingers become impossible to remove).

Arterial pressure the gynecologist should measure at every visit to a pregnant woman antenatal clinic. IN controversial cases(in some women, for example, blood pressure rises only when visiting a doctor) a pregnant woman is recommended to measure her blood pressure independently every day and keep a diary where morning and evening measurements are entered. If a woman does not have the opportunity to take measurements on her own, the gynecologist can write a referral to a hospital, where 24-hour blood pressure monitoring (ABPM) will be carried out using a special device. This method of diagnosing hypertension in pregnant women is the most accurate.

A general urine test must also be taken before each visit to the doctor. The development of preeclampsia is indicated by the appearance of protein and a decrease in urine density. To avoid errors in the results, women must correctly collect urine for analysis.

On the eve of the test, foods with diuretic properties (watermelon, coffee) are excluded from the pregnant woman’s diet, and consumption is limited. meat dishes, legumes.
The morning portion of urine is used. Urine is collected immediately upon awakening, preferably after 6 hours of uninterrupted sleep.
Urine is collected in a sterile, disposable container.
Before collecting the analysis, the woman toilets the external genitalia without using hygiene products and soap; the entrance to the vagina must be closed with a sterile cotton or gauze swab (to prevent vaginal discharge from getting into the container with urine).
An average portion of urine is collected for analysis.
The container must be delivered to the laboratory within 1-2 hours. If delivery takes longer, the container with urine should be stored in the refrigerator, but no more than 6 hours.

Additionally, the gynecologist prescribes for pregnant women biochemical analysis blood and coagulation test (coagulogram). The development of gestosis may be indicated by:

increased urea and creatinine;
decreased protein in the blood;
decrease in platelets.

Preeclampsia in women with hypertension

In pregnant women with arterial hypertension, the diagnosis of gestosis causes some difficulties. The diagnosis is made in the following cases:

against the background of high blood pressure, protein is detected in general analysis urine;
previously controlled hypertension becomes uncontrolled, blood pressure becomes higher than usual for this woman;
the appearance of signs of cardiovascular or renal failure, that is, the appearance of edema and severe shortness of breath.

It is worth noting that in women with hypertension the risk of developing complicated preeclampsia is very high.

Complications and gestosis

The most dangerous consequences of gestosis include HELLP syndrome and eclampsia.

Eclampsia can occur in a woman with gestosis during late pregnancy. The diagnosis is made when, against the background of clinical preeclampsia, a pregnant woman develops generalized convulsions, that is, involuntary contraction of all muscle groups. Most often, the harbingers of the development of an attack and the most early symptoms is a very severe headache that cannot be relieved by taking painkillers, and involuntary contraction of the facial muscles.

HELLP syndrome is characterized by a rapid course and rapid increase in symptoms. Pathology develops due to liver dysfunction. A pregnant woman develops jaundice skin, vomiting with a small amount of blood, convulsions, hemorrhages at injection sites. The occurrence of the above symptoms is combined with headache, general weakness, nagging pain in the right hypochondrium. For diagnostics HELLP syndrome a pregnant woman must undergo a general and biochemical blood test, which reveals a decrease in platelet levels, an increase in liver enzymes (AST and ALT) and signs of hemolysis.

In addition, gestosis can be accompanied by retinal detachment, cerebral hemorrhage, pulmonary and cerebral edema, placental abruption, and fetal death.

Basic principles of treatment of gestosis

Since the cause of gestosis is the mother’s body’s failure to accept the fetus, the most effective treatment for preeclampsia is delivery. With gestosis of moderate severity, a woman is indicated for hospitalization in a hospital. Her condition and the condition of the child are monitored there. In most cases, continuation of pregnancy is possible. Delivery is indicated when there is a significant deterioration in the condition of the mother and fetus.

In severe preeclampsia, delivery is carried out immediately after stabilization of the mother's condition and, if possible, after prevention of fetal RDS (respiratory distress syndrome) up to 34 weeks of pregnancy. Delivery should take place in institutions high level. Prevention of fetal respiratory disorders involves the administration of corticosteroids according to special regimens.

According to WHO recommendations ( World Organization health care), if gestosis occurs before the 24th week of gestation, it is advisable to interrupt dangerous pregnancy. When gestosis occurs at 25-34 weeks, attempts are made to maintain and prolong the pregnancy. If gestosis occurs after the 35th week, delivery is possible. In this case, delivery may be an emergency in the following cases:

bleeding from the birth canal;
acute hypoxia fetus (by CTG results);
eclampsia;
constant severe headache and changes in vision;
uncontrollable vomiting;
untreatable arterial hypertension;
marked decrease in platelets;
oligohydramnios.

In other cases, planned delivery is acceptable.

Drug treatment of preeclampsia

Drugs are used to treat gestosis various groups- blood pressure lowering agents, drugs for the treatment of seizures, diuretics, infusion therapy.

It should be remembered that only a gynecologist can select the drug and its dosage. With an excessive decrease in blood pressure in a pregnant woman, blood circulation in the placenta may be impaired, and this can cause deterioration in the condition of the fetus, hypoxia, or even its death.

To prevent and relieve seizures, a woman may be prescribed magnesium sulfate (magnesium). After birth, magnesium administration should continue for 24 hours. As infusion therapy, intravenous administration of a special saline solution in moderate volumes (about one liter per day). Diuretics are used only for incipient pulmonary edema.

Features of childbirth in women with preeclampsia

During the second stage of labor (pushing), an episiotomy is often performed to shorten the duration of this stage.

In the third stage of labor (the period of separation of the placenta), oxytocin is administered to the postpartum woman to prevent bleeding to reduce the risk of massive bleeding. To prevent convulsions during childbirth, epidural anesthesia is indicated for the woman in labor.

Prevention of gestosis

Women from the group high risk development of preeclampsia, low-dose aspirin (75 mg per day) is recommended. This is done with written informed voluntary consent pregnant woman, since in accordance with the instructions the intake acetylsalicylic acid Contraindicated in the first trimester of pregnancy.

Pregnant women are advised to take additional vitamins containing calcium (1 mg per day). Calcium, acting on blood vessels, prevents the development arterial hypertension in a pregnant woman. Positive influence the intake of omega-3 unsaturated substances also has an effect on the vascular wall fatty acids. Prevention methods such as resting on the left side in the morning and evening, limiting salt intake, using heparin, taking diuretics, and garlic have not proven effective.

The period of bearing a baby is a stressful time for every woman. After all, the expectant mother always worries whether everything is okay with her baby. In this article we'll talk about what gestosis is during pregnancy.

Designation of the concept

At the very beginning, you need to understand the concepts that will be used in the article. So, gestosis during pregnancy can also be called late toxicosis. If we talk medical language, that is pathological condition, which develops precisely in the second half of pregnancy (III trimester). It is important to note that this disease can be accompanied by a disorder of many body systems: nervous, endocrine, cardiovascular, etc. In the most severe cases this disease can lead to the death of not only the child, but even the mother.

Symptoms

How can you recognize gestosis during pregnancy? Symptoms of this disease are the first bells indicating that a woman should definitely seek treatment. medical assistance. How can a pregnant woman feel about this?

Symptoms may be the same as with early toxicosis: nausea, vomiting, dizziness. However, all this can appear not only in morning hours, but also at any time throughout the day.
With this disease, protein is found in the urine of pregnant women.
Swelling occurs. The legs (feet, ankles, calves) and arms (hands) may swell.
Another important symptom is that sudden weight gain may occur.
Observed high blood pressure.

If a woman has gestosis during pregnancy, not all symptoms may be present. There may be several of them (2-3 of the above).

At-risk groups

It must also be said that there are special categories of women who are most susceptible to this disease.

Ladies over 35 years old.
Primipara, i.e. those women who are pregnant for the first time.
Women who have multiple pregnancies (twins, triplets).
Ladies who are carriers of various sexually transmitted infections (chlamydia, ureaplasma, etc.).
Pregnant women who have various types of chronic diseases ( diabetes, obesity, hypertension, pyelonephritis, etc.).

Types of disease

IN medical practice Preeclampsia during pregnancy is classified according to various criteria. So, it can be either pure or combined late toxicosis.

Pure gestosis. It develops in those pregnant women who do not suffer from concomitant diseases.
Combined gestosis. It occurs in women who have some problems with various body systems.

Stages of the disease

Doctors also distinguish four main stages of this disease.

Dropsy.
Nephropathy.
Preeclampsia.
Eclampsia.

Dropsy

If a woman has gestosis during pregnancy, its first manifestation will be dropsy. This stage is characterized by fluid retention in the body and the appearance of edema. It is also worth mentioning that at the very beginning, swelling can be hidden. They can be recognized by weight gain (more than 300 g per week) or uneven distribution. Dropsy also has several stages of development:

Stage 1. Swelling of the legs. The legs and feet suffer.

Stage 2. Along with the legs, the anterior abdominal wall also swells.

Stage 3. In addition to the abdomen and legs, the face and hands also swell.

Stage 4. These are universal, or, as doctors call them, generalized edema.

The cause of edema is diuresis and fluid retention in the body. At the very beginning, the ankles are affected, then the accumulation of fluid spreads higher. Also, in parallel, swelling can occur on the face. In the morning, these symptoms are less visible, since the fluid is distributed evenly throughout the body (after all, the body long time was in vertical position). In the evening, the legs and lower abdomen swell greatly as the fluid gradually “drops.” In this case, pregnant women most often do not feel any inconvenience. At severe swelling possible fast fatiguability, heaviness in the legs. The doctor will be able to identify this disease immediately after examining the patient. Dropsy is also indicated by an excessive increase in the pregnant woman’s body weight and negative diuresis (an analysis whose results indicate that the amount of fluid consumed exceeds the amount excreted).

Nephropathy

So, gestosis. Signs during pregnancy, if a woman has the second stage of this disease: hypertension (i.e., high blood pressure) is added to edema, as well as proteinuria (protein in the urine). Even two symptoms that are observed in the expectant mother may indicate that the woman has nephropathy. In this case, pressure readings can increase to 135/85 mm Hg. Art. and higher (however, it is important to know the initial pressure data). We can talk about a pathological increase in pressure if:

Systolic readings (the so-called “upper” pressure) increased by more than 30 units (mm Hg).
Diastolic readings (“lower” pressure) increased by 15 units (mm Hg).

However, diastolic pressure is especially important, since it is responsible for placental circulation and saturation of the fetus with oxygen. Here it is worth saying that a more dangerous indicator is a fluctuation in pressure, and not its one-time jump.

When protein appears in the urine (proteinuria occurs), this indicates that the condition is progressing. In this case, the patient’s daily urine volume (diuresis) decreases to 0.5 liters. Important: the lower the daily diuresis, the more dangerous condition and so worse prognosis regarding pregnancy outcome.

Preeclampsia

If the lady late gestosis During pregnancy, the third stage of the disease is preeclampsia. It appears against the background of severe nephropathy. This disease is characterized by disorders of the circulatory and central nervous system. The main symptoms in this case: severe headaches, nausea, possible vomiting, also pain in the right hypochondrium and epigastric region, heaviness in the back of the head. A pregnant woman may also have insomnia or drowsiness, memory impairment, visual disturbances, irritability, indifference, and lethargy.

All this suggests that the patient has a cerebral circulatory disorder, which can lead to retinal damage. Important indicators preeclampsia in a pregnant woman:

Increased amount of protein in urine (from 5 g per day).
Increased blood pressure (about 160/110 mm Hg and higher).
The daily volume of urine is reduced to 400 ml.
The level of platelets in the blood decreases, blood clotting indicators change.
Liver dysfunction may occur.

Eclampsia

Preeclampsia during pregnancy can reach its last, fourth stage, which is called eclampsia. In this case, convulsions with loss of consciousness may also be added to the above symptoms of nephropathy and preeclampsia. These seizures can be provoked by the following external factors:

Bright light.
Sharp pain.
Stress.
Loud sharp sound.

The seizure itself lasts on average one to two minutes.

At the same time, at the very beginning, the pregnant woman will feel twitching of her eyelids, then this will spread to her hands and lower limbs. A woman’s eyes may roll back under her moving eyelid, and her fists will clench.
After about 30 seconds, tonic convulsions will develop. The woman’s body tenses, the spine arches, and the skin becomes bluish. Breathing may stop at this point. Brain hemorrhage may also occur at this time.
After another 20 seconds, so-called clonic convulsions occur. At this time, the woman will convulse, as if jumping on the bed. By the end of the attack they weaken. However, foam may appear at the mouth, and breathing becomes hoarse.
After another half a minute, breathing will gradually level out, the skin will become natural shade, the pupils will constrict.

Important: the woman most often does not remember the seizure itself. After it, you feel weak throughout the body and tired. Also, any external irritants (injections, loud conversations) can cause another seizure in a woman. The symptoms of a seizure are similar to epileptic ones.

Diagnostics

How can late gestosis be diagnosed during pregnancy? So, at the first symptoms (even if they don’t bother the woman), you should seek medical help. At the very beginning, the doctor will examine the patient and collect anamnesis. Next, he may refer the woman for examinations:

Coagulogram (blood test for clotting).
Blood test: general and biochemical.
Urinalysis: general and biochemical.
Collection of daily urine output.
Blood pressure measurement.
Weight measurement.
Examination of the fundus by an ophthalmologist.

The doctor should also clarify the condition of the fetus. To do this, the lady will be sent for an ultrasound or Doppler ultrasound. The doctor can also redirect the woman to the following specialists: ophthalmologist, therapist, nephrologist and neurologist.

Complications of the disease

What can a woman expect if she is diagnosed with gestosis during pregnancy? The consequences can even be dire. Thus, the development of complications of gestosis is fraught with the death of not only the fetus, but even the mother herself. Moreover, the development of this disease can be complicated by the occurrence of heart and kidney failure, pulmonary edema, hemorrhages in the liver, kidneys, adrenal glands, pancreas, spleen and even the brain. Among characteristic complications may be the following:

Placental abruption.
Placental insufficiency (which can lead to fetal hypoxia).
The development of HELLP syndrome, when the level of platelets decreases, the level of kidney enzymes increases and hemolysis occurs (destruction of red blood cells in the blood).

Treatment

If a lady has gestosis during pregnancy, treatment will be carried out in special medical institutions. That is, the woman will definitely be hospitalized and placed in a hospital. Outpatient treatment is possible only in the first stage of gestosis, when expectant mother dropsy. If the patient has a severe form of late toxicosis, she should be hospitalized in an institution where there is an intensive care unit, as well as a department for premature babies. If the case is particularly severe, the woman may be advised to terminate the pregnancy.

If the patient is diagnosed with gestosis during pregnancy, treatment will last at least two weeks (average: 2-4 weeks). IN mandatory Not only the woman, but also her baby will be observed. If the patient has a severe form of gestosis, the woman is placed in a hospital for the entire period of bearing the baby until delivery.

Edema. Mild swelling can be treated on an outpatient basis, sometimes in a day hospital. First of all, the doctor will correct the diet (diet No. 7 or No. 10). The doctor may also prescribe diuretics: Furosemide, Diacarb. To improve blood circulation, you can take the drugs “Curantil” or “Eufilin”. Vitamin E or the drug “Methionine” will help optimize metabolic processes. To combat stress, the following medications can be prescribed: Phenobarbital, Phenazepam.
Nephropathy. Treatment depends on the occurrence of specific symptoms and their severity. Without fail, the patient will be prescribed medications that relieve spasms - “Papaverine”, “No-shpa”. The doctor may also prescribe medications that will improve blood microcirculation: Curantil, Piracetam. Infusion therapy (intracellular fluid replenishment): drugs “Reopoliglyukin”, “Hemodez”. Antihypertensives (drugs that lower blood pressure): Anaprilin, Pentamin, etc.
Preeclampsia. First of all, it is necessary to create a regime for the patient in which the patient will not be disturbed by unnecessary noises and sounds. The patient may be prescribed magnesium therapy (administration of magnesium sulfate) or alternative drugs: Lasix, Eufilin. Painkillers will also be relevant: the drug “Frotoran” or nitrous oxide. The patient can be given Diazepam as an anticonvulsant and sedative.
Eclampsia. If the patient has an attack, she must be protected from possible injury, and patency must also be monitored respiratory tract. After an attack, the doctor will prescribe artificial ventilation lungs, and will also begin the process of giving birth to the baby (by caesarean section).

Premature birth with gestosis

So, the patient has gestosis (second pregnancy or first - it doesn’t matter). When can early birth be indicated?

Most often, with gestosis, a woman is recommended to deliver by cesarean section. However, if the condition of the woman in labor is satisfactory, the fetus has developed normally, and there are no complications, the woman may be recommended to give birth independently.

Preventive measures

Prevention of gestosis during pregnancy is also important. It is especially necessary for those women who have chronic diseases, whose older relatives experienced this problem (hereditary factor), if there is an Rh conflict between the mother and the fetus, multiple pregnancy etc. Preventive measures it should be started from the beginning of the second trimester, after the end of early toxicosis. What is important in this case:

A woman must correctly adjust her daily routine. You need to sleep at least 8 hours a day, visit as often as possible fresh air, moderately load the body.
We need to adjust our diet. To do this, you should limit your salt and liquid intake.
You need to take basic tests regularly: blood and urine. It is also necessary to visit a gynecologist in a timely manner.

Will it be normal? next pregnancy after gestosis? Of course! If during the first pregnancy a woman had this state, this does not mean that it will definitely happen again. It is enough to follow preventive measures and follow all the recommendations of your local gynecologist.

Quite often, pregnancy is accompanied by various pathological conditions. In our article we will tell you what gestosis is, why it occurs, how it develops, we will describe its signs, and we will talk about the diagnosis, treatment and prevention of this condition.

Preeclampsia during pregnancy is a complication of the gestational period. It develops during pregnancy, during childbirth or in the first days after it. Preeclampsia is accompanied by severe disruption of the functioning of vital organs. The basis of this condition is the impaired adaptation of the woman’s body to pregnancy. As a result of a cascade of reactions, vascular spasm occurs in all tissues, their blood supply is disrupted, and dystrophy develops. The nervous system, heart and blood vessels, placenta and fetus, kidneys and liver are affected.

Relevance of the problem

Preeclampsia in pregnant women develops in 12-15% of cases. This main reason deaths of women in the third trimester of pregnancy. If this complication develops in the later stages and

Up to a third of all children die in childbirth. In women, after suffering a complication, the kidneys suffer and chronic arterial hypertension develops.

How dangerous is gestosis for the fetus? He calls intrauterine hypoxia(lack of oxygen) and growth retardation. The consequences of gestosis for a child are delays in physical and mental development.

IN modern conditions Atypical gestosis is becoming more common. They are characterized by the predominance of one symptom, early onset, early formation placental insufficiency. Underestimation of the severity of the condition leads to delayed diagnosis, untimely treatment and late delivery.

Classification

The classification of gestosis is not sufficiently developed. In Russia, the disease was most often divided into the following types:

dropsy of pregnancy (with a predominance of edema);
mild, moderate and severe nephropathy;
preeclampsia;
eclampsia.

The main disadvantage of this classification is the vagueness of the term “preeclampsia”, which does not allow specifying the severity of the condition.

Today, gestosis is divided into forms in accordance with the International Classification of Diseases, 10th revision:

O10: hypertension ( high pressure), existing before pregnancy and complicating the course of pregnancy, childbirth, and the postpartum period;
O11: pre-existing high blood pressure with the addition of proteinuria (protein in the urine);
O12: the appearance of edema and protein in the urine during pregnancy at normal pressure;
O13: development of high blood pressure during pregnancy in the absence of protein in the urine;
O14: hypertension arising during pregnancy in combination with a large amount of protein in the urine;
O15: eclampsia;
O16: unspecified hypertension.

This classification solves some operational aspects of diagnosis and treatment, but does not reflect the processes occurring in the body.

With “pure” gestosis, pathology occurs in previously healthy woman. This type is observed only in 10-30% of women. Combined forms are difficult. They develop against the background of pre-existing diseases: hypertension, kidney and liver pathology, metabolic syndrome (obesity, insulin resistance), endocrine pathology(diabetes mellitus, hypothyroidism and others).

This condition is typical only for the period of gestation. Gestosis goes away after childbirth, with the exception of severe complications. This suggests that the source of the problems is the fetus and placenta. Preeclampsia occurs only in humans. This disease does not occur in animals, not even monkeys, so it cannot be studied experimentally. Related to this a large number of theories and questions regarding the nature of this condition.

Why does gestosis occur?

Let's consider the main modern theories of the development of this condition:

Cortico-visceral theory. According to her, gestosis is very similar to a neurotic condition with disruption of the cerebral cortex and a subsequent increase in vascular tone. Confirmation of this theory is the increase in the incidence of the disease in pregnant women after mental trauma, as well as data obtained using electroencephalography.
The endocrine theory considers an abnormal pregnancy as a chronic stress that causes overstrain and exhaustion of all endocrine systems of the body, including those that regulate vascular tone.
The immunological theory states that trophoblast tissue (the outer membrane of the fetus that forms the placenta) is a weak antigen. The body produces appropriate antibodies, which also interact with the woman’s kidney and liver cells. As a result, the vessels of these organs are affected. However, autoimmune processes are not observed in all women with gestosis.
The genetic theory is based on the fact that women whose mothers have suffered gestosis develop the pathological condition 8 times more often than average. Scientists are actively searching for “eclampsia genes.”
The placental theory assigns primary importance to disruption of the formation of the placenta.
Thrombophilia and antiphospholipid syndrome may cause damage vascular walls throughout the body, and they also lead to disruption of the formation of the placenta.

Scientists believe that a unified theory of the origin of gestosis has not yet been developed. The most promising are the immunological and placental versions.

The following factors significantly increase the risk of gestosis:

Extragenital diseases, namely hypertonic disease, metabolic syndrome, kidney disease and gastrointestinal tract, frequent colds and endocrine pathology.
Multiple pregnancy.
Previously suffered gestosis.
The woman's age is under 18 and over 30 years old.
Poor social conditions.

How the disease develops

The onset of the disease occurs as early as early dates pregnancy. When the embryo is implanted (introduced) into the wall of the uterus, the arteries located in the muscle layer do not change, but remain in the “pre-pregnancy” state. Their spasm occurs and the inner lining of the blood vessels, the endothelium, is affected. Endothelial dysfunction is the most important triggering factor of gestosis. It leads to the release of powerful vasoconstrictor substances. At the same time, blood viscosity increases, and microthrombi form in spasmed vessels. Disseminated intravascular coagulation syndrome (DIC syndrome) develops.

Vasospasm leads to a decrease in the volume of blood circulating in the body. As a result, the tone of peripheral vessels reflexively increases. The intensity of blood flow in all organs is reduced, including the kidneys, liver, heart, brain and placenta. These disorders cause clinical picture gestosis.

Symptoms of gestosis

External signs usually manifest themselves as gestosis in the second half of pregnancy. However, we found that the disease develops much earlier. Early gestosis is considered a preclinical stage, which can be identified using special tests:

measuring blood pressure at intervals of 5 minutes with the woman lying on her side, on her back, and again on her side. The test is positive if the diastolic (“bottom”) pressure changes by more than 20 mmHg. Art.;
disturbance of uteroplacental blood flow according to data;
decrease in platelet count less than 160× 10 9 /l;
signs of increased blood clotting: increased platelet aggregation, decreased activated partial thromboplastin time, increased fibrinogen concentration in the blood;
reducing the concentration of anticoagulants, in particular, its own heparin;
reduction in the relative number of lymphocytes to 18% and below.

If a woman has two or three of the listed signs, she needs treatment for gestosis.

Classic signs of gestosis that appear in the second half of pregnancy and especially in the 3rd trimester:

swelling;
arterial hypertension;
proteinuria.

Preeclampsia is characterized by a variety of variants of its course. The classic triad occurs in only 15% of women, and one of the three symptoms occurs in a third of patients. More than half of the patients suffer from protracted forms of the disease.

One of the most early signs diseases – excessive weight gain. It usually begins at 22 weeks of gestation. Normally, any woman up to 15 weeks should gain no more than 300 grams per week. Then, for patients under 30 years of age, this increase should be no more than 400 grams per week, for older women - 200-300 grams.

High blood pressure usually occurs at 29 weeks. For a more accurate diagnosis, you should follow all measurement rules, record the pressure on both arms, and select the correct cuff size.

Edema during gestosis is associated with sodium retention, a decrease in the concentration of proteins in the blood, and the accumulation of under-oxidized metabolic products in the tissues. Swelling can be only in the legs, spread to the abdominal wall, or cover the entire body. Signs of hidden edema:

excretion of the main volume of urine at night;
a decrease in the amount of urine excreted compared to the volume of fluid consumed;
excessive weight gain;
“Ring symptom” - a woman’s engagement ring or other familiar ring becomes insufficient.

Proteinuria is the excretion of protein in the urine. It is caused by damage to the renal glomeruli as a result of lack of oxygen and vasospasm. Excretion of more than 1 gram of protein in any portion of urine – danger sign. At the same time, the level of protein in the blood decreases.

Severe forms of the disease

A particular danger for mother and child is a dysfunction of the nervous system - preeclampsia and eclampsia.

Symptoms of preeclampsia:

headache in the back of the head and temples;
“veil”, “flies” before the eyes;
pain in the upper abdomen and right hypochondrium;
nausea and vomiting, fever, itchy skin;
nasal congestion;
drowsiness or increased activity;
facial redness;
dry cough and hoarseness;
tearfulness, inappropriate behavior;
hearing loss, difficulty speaking;
chills, shortness of breath, fever.

As this condition progresses, eclampsia develops - a convulsive seizure accompanied by hemorrhages and swelling of the brain.

Complications

Late gestosis can cause severe complications that can even lead to the death of mother and child:

eclampsia and coma after it;
intracerebral hemorrhage;
acute renal failure;
respiratory failure;
retinal detachment and loss of vision in a pregnant woman;
premature;
hemorrhagic shock and disseminated intravascular coagulation syndrome.

There are more rare forms, complicating gestosis. This is the so-called HELLP syndrome and acute fatty hepatosis of pregnancy.

HELLP syndrome includes hemolysis (decomposition of red blood cells), a decrease in the number of platelets responsible for blood clotting, and disruption of the liver with an increase in its enzymes in the blood. This complication occurs mainly after the 35th week of pregnancy, especially against the background of nephropathy, and often causes the death of the woman and the fetus.

Symptoms develop quickly. The woman begins to complain about headache, vomiting, pain in the abdomen or right hypochondrium. Jaundice and bleeding appear, the patient loses consciousness, and begins to have convulsions. Liver rupture occurs with bleeding in abdominal cavity, placental abruption. Even if a woman undergoes urgent surgery, she may die due to blood clotting disorders. postoperative period from severe bleeding.

Acute fatty hepatosis of pregnant women develops mainly during the first pregnancy. For 2-6 weeks, the woman experiences weakness, lack of appetite, abdominal pain, nausea and vomiting, weight loss, itchy skin. Then liver and kidney failure develops, which is manifested by jaundice, edema, uterine bleeding and fetal death. Hepatic coma often occurs with disruption of brain function.

Assessing the severity of the condition

According to the Russian classification, the severity of the disease is determined by the condition of the kidneys.

Preeclampsia 1st degree usually accompanied by swelling of the legs, slight proteinuria, and an increase in blood pressure up to 150/90 mmHg. Art. In this case, the fetus develops normally. This condition usually occurs at 36-40 weeks.

Gestosis 2 degrees characterized by the appearance of edema in the abdomen, proteinuria up to 1 g/l, increased pressure up to 170/110 mm Hg. Art. Grade 1 fetal malnutrition may occur. This form occurs at 30-35 weeks.

Diagnosis of severe form is based on the following signs:

increase in blood pressure to 170/110 mm Hg. Art. and higher;
excretion of more than 1 gram of protein per liter of urine;
decrease in urine volume to 400 ml per day;
widespread swelling;
disruption of blood flow in the arteries of the uterus, brain and kidneys;
delayed fetal development;
blood clotting disorder;
increased activity of liver enzymes;
development up to 30 weeks.

With such a serious condition, hospital treatment is necessary.

Treatment of gestosis

Main directions of therapy:

medical and protective regime;
delivery;
restoration of functions of internal organs.

The woman is prescribed the following medications:

sedatives, sedatives (valerian, motherwort), in severe cases - tranquilizers and antipsychotics (Relanium, Droperidol), barbiturates, anesthetics;
antihypertensive drugs (mainly calcium antagonists - Amlodipine, beta blockers - Atenolol, as well as Clonidine, Hydralazine and others);
magnesium sulfate, which has a hypotensive, anticonvulsant, sedative effect;
replenishment of circulating blood volume using intravenous infusions;
disaggregants (Curantil) and anticoagulants (Fraxiparin) under strict control of blood clotting;
antioxidants (vitamins C, E, Essentiale).

Drug treatment for mild degree can be carried out for 10 days, for moderate severity – up to 5 days, for severe condition – up to 6 hours. If treatment is ineffective, urgent delivery is necessary.

Delivery during gestosis is carried out through natural birth canal or by caesarean section. A woman can give birth on her own if the disease is mild, the fetus is in good condition, there are no other diseases, and the medications are effective. In more severe cases, elective surgery is used. In case of severe complications (eclampsia, renal failure, placental abruption, etc.), an emergency caesarean section is performed.

After caesarean section drug treatment continue until all body functions are completely restored. Women are discharged home no earlier than 7-15 days after birth.

Prevention of gestosis during pregnancy

A pregnant woman should avoid nervous and physical stress, get proper rest, and not take medications without a doctor’s prescription. Food should be nutritious and, if possible, hypoallergenic. Severe fluid restriction and a low-salt diet are not indicated. Only in severe cases of renal failure is the patient recommended to reduce the amount of protein consumed in food.

The key to preventing gestosis is regular observation by a doctor, monitoring weight, blood pressure, blood and urine tests. If necessary, the woman is hospitalized in a day hospital or in a sanatorium, where preventive treatment is carried out.

If the condition worsens, swelling, headache, or pain in the right hypochondrium appears, the patient should consult a doctor as soon as possible. Self-medication is unacceptable. Untreated acute gestosis is an immediate threat to the life of mother and child.

Unfortunately, every second expectant mother has to deal with manifestations of toxicosis to a greater or lesser extent, and for many it is morning sickness that becomes the happy news that something has now arisen under the heart. new life and in about nine months a baby will appear in the family. Early toxicosis, which torments pregnant women during the first ten weeks, is considered normal occurrence, accompanying the restructuring of the body, and it does not pose any danger. But late toxicosis is a completely different matter; this deviation often has an ominous appearance and severe consequences, and this pathology is called gestosis.

Today this complication pregnancy is considered as serious illness, which threatens the life of the expectant mother and her baby (this is the main reason why gestosis is dangerous). If you find it on early stage, then the pathology will pass in mild form and it will be possible to eliminate it even without a hospital. The first “bells” about approaching danger are swelling, and this seemingly harmless phenomenon - a clear sign development the most dangerous complication pregnancy. Specific symptoms of pathology in the later stages require taking urgent measures both from doctors and from expectant mother, which will avoid serious consequences.

Preeclampsia is diagnosed in approximately 20% of pregnant women, so how to treat it? actual question for many: some women are faced with a problem and want to know more about it in order to speed up recovery as much as possible; others are scared and want to protect themselves, knowing that prevention is the most rational and correct solution.

Preeclampsia in the third trimester of pregnancy and what provokes its development

So, gestosis is a complication late dates pregnancy, it develops in the third trimester and is usually diagnosed in women bearing their first children. Symptoms of pathology may appear for no apparent reason, and may also develop against the background of certain chronic diseases(obesity, hypertension, diseases thyroid gland) and intoxications. According to doctors, the development of gestosis in most cases is observed:

in young mothers (under 18 years of age);
at late pregnancies(in women over 35 years old);
against the background of bad habits;
with hereditary predisposition;
during multiple pregnancy;
as a result of numerous abortions;
when immunological incompatibility tissues of the expectant mother and fetus.

Preeclampsia is a disease during pregnancy that occurs in later months. This complication, which can be called “late toxicosis”, is now renamed gestosis.

Why are there different premature birth
Treatment traditional methods development
inside plan shot

With this disease it is vital important functions the entire body operates in a weakened mode. Preeclampsia usually appears in the second half of pregnancy. With this complication, the functioning of the kidneys, brain, and blood vessels significantly deteriorates.

Don’t think that gestosis in the second half of pregnancy is a joke. It occurs in one third of women. In contrast of ordinary toxicosis– deadlines. Early toxicosis occurs in the first weeks of pregnancy. And late gestosis occurs after the 35th week of pregnancy and later. If this happens earlier, for example, from 21 weeks, this is an alarm, because the treatment will be long.

Reasons for pregnancy

What causes this problem?

Let's consider the causes of this pathology.

Much depends on the placenta. During pregnancy, very small holes form in it, allowing blood plasma and fluid to enter the tissue. This leads to swelling and weight gain.
Kidneys. Microholes also form in them, through which protein escapes along with urine. And the more protein goes away, the worse your condition. The doctor takes a urine test, thanks to which the correct diagnosis can be established.
The relationships between the cortex formations of the brain are disrupted. This leads to violations of cardio-vascular system, as well as poor blood circulation. As a result, the pressure will jump, and you will feel nausea and headaches.
Heredity. If anyone in your family has had gestosis, you may be at risk for this disease.
The influence of hormones.

You may have several reasons together. Which people can be susceptible to gestosis during pregnancy?

With pathologies of the cardiovascular system.
With endocrine diseases.
With kidney and liver diseases.
Women susceptible to depression and stress.
Smoking, drinking.
Obese people.
Girls under 18 years old.
Women over 35.
Girls who often had abortions, or those who give birth too often.
If you have already had this disease.
If you are expecting twins.
Poor environmental conditions.
Women having their first pregnancy.

Symptoms of toxicosis may vary

Main signs of pathology

What are the signs of gestosis during pregnancy? There are 5 main manifestations.

Protein in the urine or proteinuria. From the kidneys, through the vessels, the protein enters the urine. Due to blockage of some vessels, blood stops flowing through them and the vessels narrow. The result is high blood pressure. Narrow vessels provoke oxygen starvation the whole body and organs. This especially affects the liver, kidneys, brain, and placenta. As a result, the fetus cannot develop normally and the mother’s body suffers.
Swelling. How can you notice or distinguish gestosis during pregnancy from ordinary normal swelling? If you notice swelling in your legs or anywhere else, don't panic right away. The main difference between gestosis is rapid weight gain. More than half a kilogram in a week. Swelling may not be visible to the eye, so try to weigh yourself regularly. However, we advise you not to immediately sound the alarm, but to consult a doctor so that he can diagnose you and prescribe treatment. If you start drinking a diuretic yourself to get rid of edema, this can harm the fetus.
Nephropathy. When the disease occurs, the kidneys are affected, swelling appears, and the urine contains protein. This is very dangerous; if you do not see a doctor, you can lose your child.
Preeclampsia. With this type of disease, symptoms appear similar symptoms, as with nephropathy - swelling, high blood pressure and protein in the urine. Damage to the cells of the nervous system is added, which is very dangerous. This occurs in 5-6% of women. In this case, you will feel severe headaches, nausea, and heaviness in the back of your head. Further symptoms: vomiting, lack of understanding of what is happening. May prevent blood from flowing to the brain. Therefore, always consult a doctor.
Most rare case– eclampsia. Includes all of the above symptoms. Convulsions of the whole body are added, which can lead to cerebral hemorrhage and stroke. May lead to the death of a child.

Impact of the disease on the child

One of the consequences is premature birth

Preeclampsia, which occurs in the second half of pregnancy, affects the development of the fetus.

Let's consider the main consequences:

premature birth;
lack of oxygen supplied to the child;
developmental delay.

The very first thing to do is consult a doctor. If you notice symptoms of gestosis, go to the doctor immediately. You must understand the seriousness of the disease.
You don't have to ever eat everything you want. Try to minimize your consumption of salty, fatty, fried foods.
Try to move more.
Follow your doctor's recommendations.

To identify gestosis during pregnancy, you need to know your symptoms. You will need to pass a general and biochemical urine test, because it is by the protein content that you can determine gestosis, and also pay attention to blood clotting.

Be sure to measure your weight to notice significant weight gain, which will also indicate violations. Typically, a woman should gain weight up to 350-370 grams.

You need to constantly measure your blood pressure. As scientists note, with this disorder there will be different pressures on the two hands. And it will be increased. Blood pressure will help you see the condition of your blood vessels.

The main thing is to regularly donate blood, urine, and go to the antenatal clinic.

Methods of treatment and prevention

Treatment of gestosis during pregnancy consists of using droppers with medicines, which will help restore the necessary fluid in the body, as well as restore lost protein. If you just have swelling, then you can take medications prescribed by your doctor at home.

Only a doctor should prescribe treatment for you

Sedatives are prescribed. With the help of medications, the functioning of all important organs of a woman is restored.

And with other forms, you need to stay in a hospital, where, if necessary, you will be provided urgent help. Doctors will also ensure that the birth is carried out on time. Perhaps it will be premature birth. In order not to expose either the woman or the child to danger, a caesarean section is performed.

But always remember, only a doctor can prescribe treatment for you, never self-medicate. How can prevention of gestosis help during pregnancy? You can try to prevent this disease by following a few rules.

Don't eat too much. No need to eat fatty, too salty, fried foods. Don't think that the more you eat, the better it is for your baby, it's not true. This can lead to gestosis or obesity.
Eat protein foods - this is extremely important. It is best if it is veal or chicken. Try to boil them. And also eat eggs, cottage cheese, various varieties fish.
Remember that salt during pregnancy is very dangerous. If you constantly want pickles, humble yourself so as not to harm either yourself or your child. This includes salted nuts and herring.
Eat plenty of fruits instead of sweets. Try to give up sweets, especially baked goods. On the contrary, fruits will enrich your body with vitamins and strengthen your immune system.
Fiber is very important for pregnant women. It can be bought in the store in dry form and added to kefir. It is found in the following products: carrots, beets, mushrooms, fruits, seaweed, bran.
Walk, walk in the fresh air, it is very good for your body. Ventilate the room as often as possible, but be careful not to let it get drafty.

With these tips, you can prevent complications.

Traditional methods of treatment

Recipes help with problems traditional medicine. Let's look at the most effective of them.

Before use traditional methods, consult

For the first recipe you will need:

cranberry;
semolina;
sugar.

Cooking method.

Take 70 grams of cranberries and wash them.
Press through a strainer.
Pour boiling water – 200 ml.
Place on the fire and cook for 7 minutes. We filter.
Add 1 spoon of semolina and boil for 20 minutes.
Add 3 tablespoons of sugar to the resulting broth and bring to a boil.
Let cool and drink the mousse.

Helps against swelling of dried apricots.

Cooking method.

Take a small amount of dried apricots.
Pour boiling water over it and let it brew overnight in a warm place.
You need to drink half an hour before breakfast.

Very good method avoid swelling - legs up.

Every day you need to lie on your back and raise your legs up.
Lie like this for 15 minutes. Thanks to this, blood circulation improves and there will be no swelling of the legs.

What's next? You may think that the next pregnancy after gestosis will proceed the same way. But not necessarily!
Before getting pregnant again, try to rest, boost your immunity, take vitamins, eat more vegetables and fruits. Get tested.

And, most importantly, during pregnancy, from the first days, consult a doctor on every issue, try to monitor your weight, and regularly take blood and urine tests. Watch your diet, take vitamins, not too much liquid, less salt, fatty foods, and sweets. Walk, breathe fresh air. Take medications that lower blood pressure and cope with swelling.

Let's look at the reviews of people who suffered from gestosis.

Lena Marinkova:

Towards the end of my pregnancy I was diagnosed with gestosis. I was terrified because I had read all sorts of scary things on the Internet. My arms and legs were very swollen. The doctor prescribed me a diuretic, put on a bunch of IVs, and the doctor also told me to eat everything without salt. This of course was torture for me. Labor had to be started using stimulation. Everything went well, I gave birth to a normal, healthy baby. My daughter’s weight was 2,800, so they kept us in the hospital for a little while. I'm so glad everything turned out okay. So don't be afraid if they tell you gestosis.

Alisa Mironova:

At week 38, my blood pressure was very high, my legs were swelling, and tests showed protein. I was immediately put on safekeeping. Well it was a little easier. They gave me IVs there, gave me some kind of drug, and constantly measured my blood pressure. I gained a lot of weight, although I tried not to eat a lot of flour and limited salty foods. I gave birth on time, by cesarean section, so that there would be no complications, and that everything would be fine with me and the baby. The weight was wonderful - 3300, I couldn’t believe my luck.

Be healthy, always monitor your condition so that there are no complications. Best wishes! Also find out why and what the norm is.