Early gestosis in pregnant women: symptoms and treatment. Severe forms of the disease

(late toxicosis of pregnancy, PTH) - pathological conditions of the second half of pregnancy, characterized by a triad of main symptoms: edema (latent and visible), proteinuria (the presence of protein in the urine), hypertension (persistent increase in blood pressure). Accompanied by disorders of the functions of vital systems: cardiovascular, nervous, endocrine, hemostasis. According to the severity of the disorders, pretoxicosis, hydrops of pregnancy, nephropathy of pregnancy, preeclampsia and eclampsia are distinguished. May cause maternal and child mortality.

General information

Preeclampsia or late toxicosis of pregnant women is a complicated course of the third trimester of pregnancy, characterized by the development of deep disorders in vital organs and systems, especially in the vascular bed and blood circulation. Preeclampsia begins to develop after 18-20 weeks of pregnancy, and is most often detected after 26-28 weeks. Preeclampsia accompanies 20-30% of pregnancies and is one of the most common reasons complicated births (in 13-16% of cases), including maternal mortality and fetal death. According to the clinical forms of gestosis, dropsy, nephropathy, preeclampsia and eclampsia of pregnant women are distinguished. Clinical forms of gestosis can also be successive stages of a single pathological process, starting with edema due to dropsy in pregnancy and gradually developing into the most severe form - eclampsia.

Late toxicosis of pregnant women is divided into pure and combined gestosis. Pure gestosis develops during pregnancy in women who do not suffer from concomitant diseases, and combined - in women with a history of various diseases. An unfavorable course of gestosis is observed in pregnant women suffering from hypertension, renal pathology (pyelonephritis, glomerulonephritis), diseases of the biliary tract and liver (dyskenesia, previous hepatitis), endocrine glands (adrenal glands, thyroid, pancreas), lipid metabolism disorders.

Causes of gestosis

Complications of gestosis

The development of complications of gestosis is always associated with the death of the pregnant woman and the fetus. The course of gestosis can be complicated by the development of renal and heart failure, pulmonary edema, hemorrhages in the liver, adrenal glands, kidneys, intestines, spleen, and pancreas.

Characteristic complications of gestosis are premature detachment of a normally located placenta, placental insufficiency leading to developmental delay, hypoxia and fetal malnutrition. In severe cases of gestosis, HELLP syndrome may develop, the name of which is an abbreviation of the symptoms: H - hemolysis, EL - increased levels of liver enzymes, LP - decreased platelet levels.

Treatment of gestosis

The basic principles of treatment of emerging gestosis are: hospitalization and compliance with medical and protective measures, elimination of disturbances in the functioning of vital organs and systems, careful and quick delivery. Outpatient treatment of gestosis is allowed only for stage I dropsy. Pregnant women with severe gestosis (nephropathy, preeclampsia, eclampsia) are hospitalized in hospitals with an intensive care unit and a department for premature babies. In particular severe cases preeclampsia, early termination of pregnancy is indicated.

Therapeutic measures for gestosis are aimed at the prevention and treatment of complicated pregnancy and intrauterine fetal disorders (hypoxia, malnutrition and developmental delay) by normalizing:

• activities of the central nervous system;
• circulation, coagulability, blood viscosity;
• metabolic processes;
• condition of the vascular wall;
• blood pressure indicators;
• water-salt metabolism.

The duration of treatment for gestosis depends on the severity of its manifestations. At mild degree nephropathy, hospitalization is carried out for at least 2 weeks, with an average degree - for 2-4 weeks, taking into account the condition of the fetus and the pregnant woman, followed by discharge for observation in the antenatal clinic. Severe forms gestosis (nephropathy, preeclampsia and eclampsia) are treated in a hospital under the supervision of resuscitators until delivery.

Early delivery for gestosis is indicated for persistent nephropathy of moderate severity, if the effect of treatment is absent within 7-10 days; severe forms of gestosis in cases of failure of intensive care measures for 2-3 hours; nephropathy, accompanied by delayed development and growth of the fetus during treatment; eclampsia and its complications.

Independent childbirth during gestosis in pregnant women is allowed if the condition of the mother in labor is satisfactory, the therapy is effective, and there are no intrauterine disorders of fetal development according to the results of cardiac monitoring and ultrasound examinations. Negative dynamics in the condition of a pregnant woman with gestosis (increased blood pressure, presence brain symptoms, increasing fetal hypoxia) serves as an indication for operative delivery.

Prevention of gestosis

Factors predisposing to the development of gestosis are: hereditary predisposition, chronic pathology of internal organs in a pregnant woman (kidneys, heart, liver, blood vessels), Rh conflict, multiple pregnancy, large fetus, pregnancy in a woman over 35 years old. Prevention of gestosis in women with risk factors should be carried out from the beginning of the second trimester of pregnancy.

In order to prevent the development of gestosis in pregnant women, it is recommended to organize a rational regimen of rest, nutrition, physical activity, and stay on fresh air. Even with normal development Pregnancy requires restriction of fluid and salt intake, especially in the second half. An important component of the prevention of gestosis is the management of pregnancy throughout the entire period: early registration, regular visits, control of body weight, blood pressure, laboratory research urine, etc. Prescription of drug prophylaxis for gestosis depends on concomitant diseases and is carried out according to individual indications.

Any of the long-standing diseases can make themselves felt by exacerbation. Even something that has never bothered you before may well show its face now. Many ailments “come out” already in the first trimester. But in the second half of pregnancy, one of the most dangerous complications can develop - gestosis.

Preeclampsia in pregnant women is accompanied by dysfunction of vital organs, including to a greater extent — vascular system and blood flow.

Types of gestosis in pregnant women

Preeclampsia is also called late toxicosis of pregnancy. It is impossible to accurately determine what causes the development of gestosis and what the mechanism of this process is. Doctors say that a whole complex is always involved in the development of gestosis. But most often its appearance is provoked by chronic illnesses.

If gestosis develops against the background of the visible well-being of the pregnant woman and in the absence of any diseases, experts call it “pure gestosis.” This phenomenon occurs in 20-30% of pregnant women. In case of development of gestosis against the background of an existing disease ( hypertonic disease, kidney disease, liver disease, pathology endocrine system, disorders of fat metabolism) we are talking about “combined gestosis”.

Depending on the form in which gestosis manifests itself and the symptoms accompanying it, there are types of gestosis, which are, as it were, its stages or degrees of severity:

• Hydrops of pregnancy is the earliest stage at which the legs and hands appear, first hidden and only then obvious. However, swelling does not yet mean the appearance of gestosis. Only a specialist can judge this. Therefore, never draw premature conclusions and especially do not take any therapeutic actions.
• Nephropathy develops against the background of dropsy and is accompanied by impaired renal function. The first sign is increased. Nephropathy can quickly develop into the most severe form of gestosis - eclampsia, and therefore requires immediate treatment. Complications and consequences of nephropathy can be the most terrible.
• Preeclampsia is characterized by swelling, increased blood pressure, and protein in the urine. Disturbances in the blood supply to the central nervous system may occur, which causes a feeling of heaviness in the back of the head or nausea, vomiting, blurred vision, and possible mental disorders.
• Eclampsia is the most severe stage of gestosis. Convulsive attacks appear, the functions of organs and systems are disrupted, and a stroke may even occur. Eclampsia is also dangerous due to the risk of premature placenta, premature birth, hemorrhage, and fetal death.

Treatment methods for gestosis during pregnancy

Regardless of what form of gestosis develops in a woman, she must definitely tell the doctor about it and begin treatment, since gestosis in all its manifestations is very dangerous for the child and mother.

It is impossible to cure gestosis. But in most cases it is quite possible and very necessary to alleviate its course. Mild forms of gestosis can be treated at home, more severe ones - in a hospital setting, often in close proximity to the intensive care unit.

If the doctor suspects that you have developed gestosis, the first thing you will have to do is take many tests and undergo mandatory examinations to confirm the diagnosis and establish its form. The accumulation of fluid in a woman’s body is also monitored and the dynamics of body weight are monitored. Pregnant women with gestosis are prescribed a diet with limited fluid (800-1000 ml per day) and salt, enriched with proteins and. An examination by an ophthalmologist, consultation with a therapist, nephrologist and neurologist are required. Mandatory ultrasonography, including fetal Doppler.

As a rule, a woman is prescribed drugs to calm the nervous system, for example, motherwort or valerian for mild symptoms and strong sedatives in case of eclampsia. If organ dysfunction requires drug treatment, appropriate medications are prescribed: diuretics, as well as medications that lower blood pressure and improve blood flow in small vessels, including the placenta. At the same time, prevention is carried out placental insufficiency(Actovegin, vitamins E, B6, B12, C).

In general, it all depends on the manifestations of gestosis and the condition of the pregnant woman. However, it is extremely important not to self-medicate, as this can lead to rapid development of complications and sad consequences. If therapeutic measures do not bring relief, or the condition of the mother or child worsens, premature birth is stimulated.

Preeclampsia can be characterized by both an asymptomatic course without any special complaints, or rapid development with a sharp deterioration in the condition. Therefore, delaying in case of suspected gestosis can be dangerous. And treatment can only be carried out under the supervision and prescription of professional doctors.

Especially for- Elena Kichak

From Guest

I was diagnosed with gestosis at 28 weeks, based on urine tests, and was immediately admitted to the hospital without further investigation. They did an ultrasound and a CTG, and everything in the world, I had to lie there for a long time. But she carried it to term and gave birth to a healthy baby.

What it is? Gestosis during pregnancy is pathological condition an organism in which the functions of vital organs are disrupted and which is extremely difficult to control if it has entered an advanced stage.

The disease occurs mainly in the third trimester and has another name - late toxicosis. However, it differs from the classic ailment in the form of nausea and vomiting in that it entails dysfunction of the cardiovascular and endocrine systems, damage to the central nervous system as a result of spasm blood vessels.

The prevalence reaches 30%, the situation is further complicated by the fact that gestosis in the first half of pregnancy is very difficult to detect on initial stages development. For example, late toxicosis, which began at 20 weeks, is detected only by 27–28 weeks.

What is the danger of gestosis?

Until now, despite the development of medicine, gestosis remains one of the main causes of maternal and infant mortality in antenatal and postpartum period. It does not kill instantly, but contributes to the rapid decline of the body over several days.

The patient may lose vision, the ability to move independently, and one by one important organs stop functioning: liver, kidneys, heart, brain. The more serious the stage of gestosis, the less chance remains with the doctors to save the patient and (or) her child.

Only close attention to a deterioration in your health and timely examination will help identify late toxicosis on early stages its development and avoid mortal risk.

Causes of gestosis

Scientists have not yet reliably determined what exactly causes the development of late toxicosis. There are only some assumptions about this:

• Pathological changes in the central nervous system. The relationship between the cerebral cortex and subcortical structures is disrupted, which leads to pathology. Trigger are psychological stresses that a woman could be exposed to while carrying a child.
• Immune disorders, in particular, failures in the recognition of maternal tissue and fetal tissue. This process involves special T cells, which are regulators of the immune response.
• Disruptions in the endocrine system. Pregnancy involves dramatic changes in hormonal status, which can result in disruptions in the functioning of a woman’s entire body.
• Flaw folic acid. This provokes an increase in the level of non-proteinogenic amino acids, which are extremely toxic to the body.

Preeclampsia, a complication of pregnancy, involves spasm of all blood vessels - this is what causes the failure of vital organs.

Symptoms of gestosis during pregnancy by stage

There are several classifications of late toxicosis, but doctors in Russia distinguish 4 main stages in the development of the disease, each of which is characterized by certain clinical manifestations.

Dropsy

It is characterized by insufficient removal of fluid from the body, resulting in swelling. This stage is divided into 4 stages, which are characterized by the ascending direction of localization of edema:

1. The feet swell, and there is slight swelling of the legs.
2. The legs swell completely, the lower third of the abdomen swells.
3. The swelling rises higher and affects the face, in addition to the legs and body.
4. Edema affects the entire body and is observed in internal organs.

Characteristic signs of edema

• When you press your finger on the surface of the skin, a dent remains. The longer it takes to disappear, the more severe the swelling becomes.
• Tingling and numbness are felt in the swollen limb.
• Severe swelling causes a feeling of fatigue in a pregnant woman.

These are the most early symptoms gestosis during pregnancy - if doctors prescribe the necessary therapy to a woman, then late toxicosis will not develop further.

Nephropathy

If no therapeutic measures were taken when edema appeared, then the disease progresses and enters the stage of nephropathy. In addition to fluid retention, hypertension appears in the body, and urine tests indicate an increase in protein.

All these symptoms will be noticeable to the doctor if the patient visits the antenatal clinic at least once every 2 weeks and regularly tests necessary tests. Nephropathy has several degrees, which have certain symptoms:

1. I degree - the pressure does not exceed 150/90, and the distance from the upper to the lower limit should be normal. A urine test reveals protein of no more than 1 g/l. There is swelling of the lower extremities.
2. II degree - pressure does not exceed 170/100, protein in the urine increases and begins to reach 3 g/l. Edema extends not only to lower limbs, but also on the lower third of the abdominal wall.
3. III degree – pressure is above 170/110, protein in the urine exceeds 3 g/l, swelling spreads throughout the body, swelling of the internal organs is detected.

Nephropathy, especially its severe degree, cannot go unnoticed, and the pregnant woman will be forced to go to the hospital due to the deterioration of her condition.

Preeclampsia

In some cases, stage III nephropathy, despite treatment, develops into preeclampsia. The main difference between this condition and nephropathy is that the pregnant woman has a circulatory disorder in the brain.

Created real threat for the life of the mother and fetus, which requires immediate hospitalization. Among the signs of severe gestosis during pregnancy are the following:

• Confusion
• Headache
• Loss of vision and/or hearing
• Feeling of heaviness in the back of the head
• Manifestations of sclerosis
• Hemorrhages in the walls of vital organs
• Vomit

If a woman in this condition is left without medical care, she will die. Preeclampsia involves placing the patient in an intensive care unit, since her well-being must be monitored around the clock.

Eclampsia

It is considered the most severe degree of gestosis of pregnancy, in which even emergency and highly qualified care does not guarantee that the woman will survive. Some doctors are inclined to consider preeclampsia the initial stage of eclampsia.

Eclampsia involves worsening the manifestations of nephropathy and a rather weak response of the body to the measures taken to save the patient’s life.

Characteristic signs of eclampsia

• Loss of consciousness
• Tonic convulsions
• Clonus
• Severe weakness
• Strong headache
• Extensive swelling of internal organs (most often the brain)
• Blood pressure above 170/110

Eclampsia does not occur suddenly, so if you respond promptly to worsening health and test results, you can successfully prevent this condition.

Treatment of gestosis in stages - drugs, regimens

For each stage of gestosis in the third trimester of pregnancy, the doctor selects appropriate therapy. For diagnosis, the results of urine and blood tests, blood pressure indicators, body weight indicators (over several weeks), and fundus examinations are used.

Treatment of stage I of gestosis (edema)

The main reason for the appearance of edema is the delay in the removal of fluid from the body. Traditionally, Russian obstetricians and gynecologists practice strict control over fluid intake and significant limitation of its volume.

• The results of such a “diet” are not always noticeable: the pregnant woman is constantly thirsty, and existing swelling goes away too slowly. However, no new ones are formed.

Gradually, our doctors began to adopt the experience of Western specialists: a pregnant woman is allowed to drink as much as she wants, but with one condition - all the liquid consumed must have a pronounced diuretic effect. This could be cranberry juice or brewed lingonberry leaves. This method of treating gestosis is much easier to tolerate, and it gets rid of edema much faster.

In addition to natural remedies, the doctor may prescribe diuretics:

• Canephron is available in the form of drops, as well as in the form of dragees. Dilates renal vessels, prevents excess fluid absorption. Reduces protein excretion in urine.
• Cyston - increases blood supply to the epithelial tissue of the urinary system, has an antibacterial and diuretic effect. Available in tablet form.
• Phytolysin – promotes relaxation of smooth muscles, has an anti-inflammatory and diuretic effect. Available in the form special paste from which a suspension must be made.

At severe swelling For a pregnant woman, hospitalization and treatment in a hospital are indicated.

Treatment of stage II gestosis (nephropathy)

Nephropathy involves a combination of edema and increased blood pressure. Consequently, therapy that helps normalize blood pressure is added to the treatment of fluid retention in the body.

Since a surge in pressure can occur repeatedly and within a short period of time, the pregnant woman should be admitted to the hospital to monitor her blood pressure around the clock, as well as monitor her kidney function. To stabilize the condition, the following will be prescribed:

• Complete peace. Physical effort provokes a rise in blood pressure, so a woman needs to observe bed rest.
• Taking sedatives. They help lower blood pressure, however, during pregnancy, some of them can have an abortifacient effect, so you should not choose a sedative yourself.
• A diet whose goal is to reduce salt and fluid intake, as well as normalize the ratio of proteins, fats and carbohydrates in the diet.
• Taking antispasmodics. Since late toxicosis is based on vasospasm, it is important to prevent it. Otherwise, the symptoms of placental gestosis will worsen. During pregnancy, drugs such as No-shpa and papaverine are allowed.
• Taking protein drugs. Nephropathy involves increased leaching of protein from the body, so the doctor’s task is to increase its levels.

Comprehensive timely treatment of gestosis during pregnancy at the stage of nephropathy, in most cases gives positive effect and stops further progression of late toxicosis.

Treatment of stages III and IV of gestosis (preeclampsia and eclampsia)

Both of these diseases involve serious dysfunction of the kidneys, liver, heart, brain, as well as large blood vessels of the placenta, so this stage of gestosis most often has consequences for the child.

If the pregnancy has reached the period at which the fetus can be born viable, then the mother undergoes an emergency caesarean section.

To stabilize the patient's condition, the following measures are taken:

• Intravenous drip administration of magnesium, rheopolyglucin, glucose and diuretics, which should relieve the woman of edema.
• Complete rest and strict bed rest. As a rule, with eclampsia the patient feels so weak that she is unable to get out of bed on her own.
• Administration of anticonvulsants if the patient experiences tonic seizures.
• Hourly monitoring of protein levels in urine. Since the woman is not able to take the test herself, a catheter is inserted into the urethra.
• Connection to the system artificial ventilation lungs.
• Taking strong sedatives to normalize blood pressure and prevent new seizures.

Emergency delivery should be carried out only when convulsive contractions have been stopped and relative stabilization of blood pressure has been achieved.

Pregnancy after mild forms of gestosis should proceed under close medical supervision. Since the exact causes of late toxicosis are unknown, it is difficult to determine specific preventive measures that would protect a pregnant woman from developing this disease.

• Most the right way protect yourself from preeclampsia and eclampsia - timely treatment for early stages gestosis.

One of the complications of pregnancy is gestosis, which is characterized by dysfunction of vital organs. Another name for gestosis is late toxicosis.

Preeclampsia is diagnosed after 20 weeks of pregnancy, but more often at 25-28 weeks, although signs of this complication may appear several days before birth.

Late gestosis is diagnosed in approximately 10-15% of all pregnant women.

Degrees

Depending on the severity of gestosis, there are 4 degrees:

• I degree - edema (edema of pregnant women);
• II degree (nephropathy);
• III degree (preeclampsia);
• IV degree (eclampsia).

There is also a distinction between pure gestosis and combined gestosis.

• They speak of pure gestosis if a woman does not have chronic extragenital diseases(not related to the sexual sphere)
• Combined gestosis, on the contrary, occurs against the background of chronic general diseases (arterial hypertension, kidney disease, obesity, etc.).

Causes

At present, the causes of gestosis have not yet been identified, but one thing is beyond doubt - this complication pregnancy is caused by the fetus, which comes into conflict with the mother’s body.

The mechanism of development of gestosis in pregnant women is a generalized vasospasm, which leads to hypertension (increased blood pressure).

Threat factors for the development of gestosis:

• age (under 18 and over 30 years old);
• pregnancy with more than one fetus;
• heredity (women whose mothers suffered from gestosis);
• first pregnancy;
• gestosis in previous pregnancies;
• the presence of extragenital pathology (obesity, arterial hypertension, renal and hepatic pathology, etc.).

Symptoms of gestosis

First, the preclinical stage of gestosis is diagnosed - pregestosis ( obvious signs are missing). The diagnosis of pregestosis is made by assessing laboratory and additional methods research:

• measuring blood pressure three times with a 5-minute break in different positions (increasing diastolic, i.e., lower values ​​by 20 mm Hg or more);
• increasing thrombocytopenia (decreased platelets);
• decrease in lymphocytes (lymphopenia);
• increased platelet aggregation (increased blood clotting).

Preeclampsia itself is manifested by a classic triad of symptoms (Zangemeister triad):

• swelling,
• proteinuria (protein in urine)
• increased blood pressure.

Symptoms by degree

I degree of gestosis
Edema (dropsy of pregnancy)

There are 4 degrees of edema in pregnant women.

The first degree is characterized by swelling of the feet and legs, in the second the swelling of the legs and rises to the anterior abdominal wall, the third degree is swelling of the legs, hands, anterior abdominal wall and face. And the last degree is generalized edema or anasarca.

In addition to the fact that swelling can be visible, do not forget about hidden swelling. Pathological weight gain (more than 300 grams per week) suggests hidden edema. Oligouria (reduction in the amount of urine excreted to 600-800 ml per day) also indicates hidden edema.

An indirect sign is the ratio of the fluid drunk and excreted (less than 2/3 excreted). Also characteristic feature edema in pregnant women is considered a “ring symptom” (difficulty removing or putting a ring on a familiar finger) and tightness of everyday shoes.

II degree of gestosis
Nephropathy

Nephropathy (OPG-gestosis) occurs as the Zangheimester triad:

• swelling, to varying degrees of severity,
• proteinuria (protein in urine),

When assessing an increase in blood pressure, they are guided by the initial (pre-pregnancy) pressure. Arterial hypertension is said to occur when systolic (upper) pressure increases by 30 mmHg or more. Art., and diastolic increases by 15 or more mm Hg. Art.

Average ( normal pressure in pregnant women, usually 110/70). Arterial hypertension is an increase in blood pressure up to 140/100 mmHg. Art.

Proteinuria indicates damage to the walls of the kidney vessels, through which protein enters the urine.

If traces of protein are detected in the urine (0.033 g/l), it is necessary to either exclude pyelonephritis, or there is non-compliance with hygienic rules when donating urine. Proteinuria is said to occur when protein levels in the urine reach 0.3 g/l or more.

III degree of gestosis
Preeclampsia

Condition preceding eclampsia

IV degree
Eclampsia

Serious condition, last degree of gestosis. Characterized by convulsive attacks.

Diagnostics

Besides clinical manifestations To diagnose gestosis, additional and laboratory methods research:

• measuring blood pressure three times a day and after minor physical activity(squatting, climbing stairs) - lability of blood pressure is diagnosed;
• general urinalysis (detecting protein, increasing urine density);
• general blood test (decrease in platelets, increase in hematocrit, which means blood thickening);
• urine analysis according to Zimnitsky (oliguria and nocturia - an increase in the volume of urine excreted at night);
• control of fluids drunk and excreted daily;
• weight measurement weekly;
• biochemical analysis blood (increased creatinine, urea, liver enzymes, decreased total protein);
• blood clotting (increase in all indicators).

Treatment of gestosis during pregnancy

Preeclampsia at home

Treatment of gestosis is prescribed and monitored by an obstetrician-gynecologist. For first degree edema, outpatient treatment is allowed. All other degrees of gestosis are treated in a hospital.

First of all, the pregnant woman is given emotional and physical peace. It is recommended to lie more on the left side (the “Bed rest” position), since in this position the blood supply to the uterus, and, consequently, to the fetus, improves.

Secondly, it is necessary therapeutic nutrition(the treatment table must contain a sufficient amount of protein, the volume of liquid drunk depends on diuresis, and the food itself must be under-salted).

At pathological increase weight, fasting days (cottage cheese, apple, fish) are prescribed 1-2 times a week.

To normalize brain function and prevent convulsive attacks, sedatives (motherwort, valerian, novopassit) are prescribed. In some cases, weak tranquilizers (phenazepam) are indicated.

Treatment of gestosis in a hospital

The main place in the treatment of gestosis is occupied by intravenous drip administration of magnesium sulfate. The dose depends on the degree of gestosis and the severity of manifestations. Magnesium sulfate has hypotensive, anticonvulsant and antispasmodic effects.

For arterial hypertension, blood pressure-lowering drugs (atenolol, Corinfar) are prescribed.

Infusion therapy is also indicated saline solutions (saline and glucose solution), colloids (reopolyglucin, infucol - starch), blood products (fresh frozen mass, albumin).

To improve the rheology (fluidity) of blood, antiplatelet agents (pentoxifylline) and anticoagulants (heparin, enoxaparin) are prescribed.

Normalization of uteroplacental blood flow is carried out by membrane stabilizers and antioxidants (actovegin, vitamin E, glutamic acid).

Treatment of mild severity of gestosis continues for at least 2 weeks, moderate severity - 2-4 weeks, and severe gestosis requires the pregnant woman to remain in the hospital continuously until delivery.

Complications and prognosis

Possible complications of gestosis:

• pathology of the liver, kidneys, heart;
• pulmonary edema, hemorrhages in vital organs;
• premature placental abruption;
• fetal hypotrophy;
• coma;
• intrauterine fetal death.

The prognosis depends on the degree of gestosis, its manifestations and the timeliness and effectiveness of treatment. In most cases, the prognosis is favorable.

Prevention

There is no specific prevention of gestosis. In the antenatal clinic, when registering, a woman’s medical history is carefully collected and an examination is carried out, after which the risk group for the development of gestosis is determined (low, medium or high).

Preventive courses of treatment are also carried out (sedatives, antioxidants, diuretics).

Some studies during pregnancy

Gestosis is a late toxicosis in women, during the period of intrauterine formation of the unborn baby.

The following symptoms and signs of gestosis appear closer to the middle of pregnancy, or later:

• Hidden or visible swelling;
• Pathology in which protein is diagnosed in urine - proteinuria;
• A constantly increasing blood pressure index is the pathology of hypertension.

There are disturbances in the functioning of the following body systems:

• Vascular systems;
• Nervous system;
• Endocrine organ systems;
• Hemostasis systems.

What is gestosis?

Preeclampsia is a complicated pregnancy that begins at the end of the second trimester and the peak of complications occurs in the third trimester of the baby’s formation in utero.

Late toxicosis disrupts the functioning of many organs, especially the functionality of the blood flow system, as well as deviations in the state of the vascular and nervous systems.

The development of gestosis begins from the 18th week of pregnancy, and this pathology is detected only at the 26th week.

Preeclampsia develops in almost every third pregnant woman, and complications during pregnancy that result in the loss of the child or the death of the pregnant woman herself lead to up to 16.0% of all cases.

The clinical form of severe pregnancy may have the following pathologies:

• Swelling, or dropsy;
• Pathology nephropathy;
• Complication of preeclampsia;
• Eclampsia during pregnancy.

All these pathologies can form gradually, with a single progressive process and develop from swelling and end with eclampsia, which leads to dangerous consequences.

Risk of development in late gestation

Late toxicosis (preeclampsia) during pregnancy is divided into:

• Pure type of toxicosis;
• Combined type of gestosis.

With pure toxicosis, gestosis occurs during pregnancy, when there are no concomitant diseases.

The reasons for the development of a combined type of gestosis occur in those women in whom the following pathologies were identified during examination:

• High blood pressure index - hypertension;
• Inflammation of the kidneys - pyelonephritis;
• Disease of the kidney organ - glomerulonephritis;
• Pathologies in the biliary tract;
• Liver dyskinesia disease;
• Past hepatitis;
• Disease of the endocrine organ of the adrenal glands;
• Disorders of the thyroid gland;
• Damage to the organ of the endocrine system - the pancreas;
• Disorders in lipid metabolism.

ICD-10 code

When diagnosing gestosis, doctors use the classification according to the international system ICD-10.

According to this system, there is a clear distinction between the causes of complicated pregnancy and the pathologies that develop during gestosis:

• O10.9 - pre-existing hypertension, which complicates pregnancy, the birth process and the period after childbirth, unspecified;
• O11.0 - pre-existing hypertension with associated proteinuria;
• O12.0 - edema caused by pregnancy without hypertension;
• O12.1 - proteinuria caused by pregnancy;
• O12.2 - swelling caused by pregnancy with proteinuria;
• O13.0 - pregnancy-induced hypertension and mild preeclampsia;
• O14—pregnancy-induced hypertension and moderate proteinuria;
• O14.0 - moderate preeclampsia;
• O14.1 - severe form of preeclampsia;
• O15.0 - pathology eclampsia during pregnancy;
• O15.1 - eclampsia of the hearth process;
• O15.2 - eclampsia disease during the period after childbirth;
• O16.0 - hypertension in a pregnant woman, unspecified.

Division of pathology by forms and degrees

Preeclampsia is divided into degrees of progression of the pathology according to its forms, as well as depending on the symptoms and signs:

• The first degree of development of the pathology of gestosis. This stage of the disease can be determined when it is mild, and is marked only by the symptoms of swelling. In the morning the dropsy is less, and in the evening the swelling becomes more pronounced;
• The second degree of pathology has more complex symptoms and high blood pressure is noted, including increased diastolic pressure and proteinuria develops;
• The third stage of progression of gestosis- this is the stage of deterioration and development of preeclampsia;
• Fourth degree of gestosis- this is eclampsia. These are severe forms of complicated pregnancy;
• Stage HELLP syndrome. This is the most severe degree of complications during the period of intrauterine formation of the baby.

During the period when gestosis occurs in the second degree, pressure increases when the cardiac organ is in diastole.

The development of this type of hypertension affects the quality of blood flow in the small placental circle - the higher the pressure during diastole, the fewer oxygen molecules enter the placental circle of blood flow, this leads to the fact that the developing fetus does not receive the required amount of oxygen and it develops hypoxia.

A sharp increase or decrease in pressure is also dangerous.

The second stage of late toxicosis is characterized by the following complications:

• Detachment of placental cells;
• Hypoxia of the developing child;
• Uterine bleeding;
• Artificial termination of pregnancy by the body.

Nephropathy in the second degree is diagnosed by a general urine analysis.

Complicated form of pregnancy - preeclampsia

At the third stage of progression of gestosis, improvement occurs general condition pregnant. Manifestations of headaches indicate that complications are developing in the body - preeclampsia.

The following symptoms may also appear:

• Impaired blood flow in the brain;
• Memory is impaired;
• Pathologies of the visual organ develop;
• Apathetic state;
• Nervousness and irritability;
• Liver stroke;
• The amount of urine output is reduced to 400 milliliters;
• Blood pressure index - 160/100 mm. rt. Art.;
• Protein in urine is diagnosed;
• Disturbance in the hemostasis system;
• The number of platelet molecules decreases.

Complicated form of pregnancy - preeclampsia

Severe degrees of progression of gestosis

Severe degrees of progression of the pathology of gestosis in a pregnant woman include eclampsia and HELLP syndrome.

As eclampsia progresses, symptoms of preeclampsia appear, but seizures also increase.

An attack of eclampsia can be provoked by the following irritants:

• Loud and sharp sound;
• A bright, suddenly flashing light;
• Stressful state;
• Soreness.

The attack lasts no more than 2 minutes. A seizure begins with a twitching facial muscles, then the twitching spreads to the limbs, and then to all the muscle tissues of the body.

A reaction of the eye organ also occurs - the gaze stops and becomes clouded, the pupils quickly roll up. The lips move down, the fingers clench into a hard fist.

After 30 - 35 seconds, a convulsive state of the whole body occurs:

• The muscles of the body become very tense;
• The head falls back;
• The jaw clenches stylishly;
• The skin shows signs of cyanosis (blue discoloration);
• Breathing stops;
• A pregnant woman loses consciousness.

After another 10-25 seconds, a sign of clonic convulsion occurs:

• The woman thrashes violently in a fit of convulsion;
• Moves limbs continuously and uncontrollably;
• Bouncing on the bed.

The convulsions weaken after one and a half to two minutes and stop altogether.

After an attack, the following symptoms appear:

• Breathing is hoarse;
• Foam comes out of the mouth; if there is biting of the tip of the tongue, then the foam is red.

Recovery after an attack - breathing becomes even and calm, skin gain natural color, the visual pupils constrict, and the pregnant woman fully gains consciousness.

After the attack, the woman does not remember the seizure and any irritants are not allowed in this moment, because they can trigger a new, more severe seizure. The residual sign of an attack is weakness of the body and strong pain in my head.

Danger this state is that it can cause hemorrhage in the cerebral vessels, and also lead to swelling of the brain, which provokes death.

Eclampsia is similar in symptoms to epilepsy, but there are differences.

In epilepsy there are no such signs as in eclampsia:

• There are no signs of hypertension;
• Indicators in urine are within the standards;
• Before an epileptic seizure occurs, an epileptic-type aura is detected.

HELLP syndrome is a complicated form of Gestosis

HELLP syndrome is the most dangerous form of complicated pregnancy, which has serious consequences.

Clinical symptom of late gestosis:

• Signs of jaundice;
• Vomiting with bloody clots;
• Liver organ failure;
• Coma.

HELLP syndrome occurs most often in women who have frequent pregnancy. This type gestosis manifests itself even after childbirth. Complications of HELLP syndrome are fatal in 80.0% of pregnant women and their unborn children.

Types of gestosis that have rare form manifestations:

• Skin eczema;
• Dermatosis disease;
• Disease of bronchial type asthma;
• Skin itching and mucous membrane itching.

These types of gestosis are a complicated form of existing diseases in the body of a pregnant woman, which worsen during this period.

Rare types of gestosis in pregnant women

The types of gestosis during pregnancy are:

• Pathology osteomalacia. This type of gestosis is marked by softening of cells bone tissue. This pathology manifests itself quite sharply in severe symptoms. Most often, teeth are destroyed, pain appears in the bones and joints, a limping gait appears, and neuralgia develops. The cause of osteomalacia is a deficiency of vitamins in a pregnant woman and calcium;
• Signs of ptyalism. Often drooling occurs together with vomit from the body. With a large volume of saliva secreted, dehydration of the body cells occurs, a disturbance in the speech apparatus occurs, and irritation occurs on the mucous membrane and skin;
• Hepatosis disease. This type of disease has signs of jaundice. A pregnant woman must be urgently isolated from those around her. A diagnosis is carried out, which is aimed at differentiating hepatosis from hepatitis and starting the correct therapy;
• Pathology: atrophy of the liver organ. If this complication of pregnancy occurs during early period If the disease is gestosis, and it cannot be cured, then it is necessary to artificially interrupt the development of the fetus.

Causes of gestosis in pregnant women

Before today The reasons for the formation of gestosis during pregnancy by a pregnant woman have not been precisely studied. In studies of obstetrics and gynecology, there are only theories of the etiology of gestosis.

The theory of the cortico-visceral type implies its origin from a violation of the relationship of brain organs. The connection between the cerebral cortex and the subcortical substance disappears, which radically changes the reflexes in the vascular membranes, as well as in the blood flow system itself.

There is also a theory of hormonal imbalance and regulation hormonal levels vital organs, leading to an immunological conflict to the fetus.

One of the reasons is a woman’s predisposition to gestosis. Preeclampsia is hereditary and genetic in nature, and if there are women in the family who have experienced preeclampsia during pregnancy, then the pregnant woman high risk formation of this pathology.

During the first pregnancy, gestosis is possible in the first half of pregnancy, from the second pregnancy and in subsequent ones - development occurs from the 2nd half.

Most often, doctors come to the consensus that gestosis does not develop from one cause; the formation of pathology occurs through a combined method from various factors impact.

Pathogenesis of pathology

The mechanism of action of gestosis occurs from the fact that a generalized spasmodic state is formed in the walls of blood vessels, which provokes disturbances in the blood flow system and the supply of blood to the tissue cells of vital organs.

Especially noticeable this violation in the peripheral sphere of blood supply - these are cerebral vessels, as well as vessels with a small diameter of the limbs.

The spasmodic state of blood vessels increases the blood pressure index and reduces the volume of circulating blood in the bloodstream system.

This mechanism prevents the organs from receiving nutrients and oxygen molecules, and a gestational set of seizure symptoms is formed during the disease, which can have a negative impact on the fetus during its development, as well as on the pregnant woman herself.

If damage to the cells of the vascular membranes occurs, then:

• High permeability of the choroid;
• The release of biological fluid from the membranes of blood vessels into the muscle tissue - bruising occurs;
• A change occurs in the hemostatic system - the coagulability of blood plasma is disrupted;
• The consistency of the blood is disturbed, the liquid becomes more viscous, which threatens the occurrence of a pathology in the body of a pregnant woman - arterial thrombosis.

The following organs are most often affected by changes and disturbances in the blood flow system:

• Cells of all brain organs, especially cerebral vessels;
• Kidney organ cells;
• Liver tissue cells;
• A disorder occurs in the small placental blood supply and in the integrity of the placental cells.

Why is gestosis dangerous?

With the pathology of gestosis in pregnant women, a disturbance begins in the structural cells, as well as in the functional abilities of brain cells:

• Cerebral microcirculation is disrupted;
• Formation of blood clots in the cerebral arteries;
• Increased pressure index inside the cranium;
• Brain swelling and hemorrhage, which leads to death;
• Changes in cells nerve fibers dystrophic nature;
• Small focal type cerebral hemorrhages (micro strokes).

If kidney function is impaired, the development of:

• Inflammation of the kidney organ;
• Increased protein concentration in urine;
• Kidney organ failure in the acute phase of development.

If gestational changes have occurred in the liver cells, then there is a danger of developing:

• Foci of organ tissue necrosis;
• Effusion of blood into the liver tissue.

During the period of disruption of the blood supply to the placenta, hypoxia of the developing child occurs, provoking:

• Not the full development of the child - physically and intellectually;
• Development congenital pathologies organs and systems in utero;
• To freezing, or miscarriage of an unborn baby.

Basics clinical picture

What pressure is typical for late toxicosis?

Dangerous and pathological surges in blood pressure during pregnancy, especially in late gestosis, look like an increase in systolic pressure of more than 30 mm. rt. Art., and diastolic pressure - from 15 units.

A sharp and spasmodic increase in blood pressure in the arteries during cardiac diastole is quite dangerous. This leads to fetal hypoxia, as well as to an artificial pregnancy by the body.

During pregnancy, blood pressure is 135/85 mm. rt. Art. - this is a sign of nephropathy during gestosis.

It is very important for a woman, when planning a pregnancy, to monitor the blood pressure index systematically in order to know the trend of its fluctuations.

Initial blood pressure indicators before pregnancy and in the 1st trimester of pregnancy can become the main individual indicators of a pregnant woman.

Diagnosis of gestosis

During pregnancy planning, as well as during pregnancy, a woman should do a diagnostic examination of the body to identify hidden pathologies that may cause the development of gestosis.

During pregnancy, you must systematically undergo the following examination procedures:

• Constantly weigh yourself and avoid being overweight. In the 3rd trimester, you cannot gain more than 350.0 grams in 7 days;
• Maintain fluid balance and constantly check the body for signs of swelling. If there is swelling, drink water - no more than 1000 milliliters per day;
• Constant control of urine output from the body;
• Constant monitoring of the blood pressure index. The pressure is measured in both arms. If there is a large discrepancy in blood pressure indices right hand and left hand, then this is a sign of gestosis.

Also, these types of laboratory clinical tests are also carried out systematically in each trimester to identify developing pathologies in the body, as well as identifying gestosis:

• General and biochemical analysis of urine. This study helps to identify the concentration of protein in urine, as well as ketone bodies. Leukocytes in urine may indicate possible infection and viruses entering the body of a pregnant woman. Based on urine analysis, kidney pathology is distinguished: pyelonephritis with late gestosis;
• Blood composition analysis - general and biochemistry;
• A blood test method - a coagulogram - will show changes in the hemostasis system and the clotting properties of blood plasma;
• Ultrasound of the uterus, as well as the fetus with the instrumental Doppler technique. Timely detection of delayed development of the baby;
• Cardiotocography technique developing fetus. Held this technique after 28 calendar week during pregnancy. Allows this method identify the performance of the cardiac organ of the unborn child, as well as its mobility and identify possible fetal hypoxia.

Also, the pregnant woman is systematically examined by an ophthalmologist, dentist, neurologist and nephrologist.

A pregnant woman who is predisposed to gestosis is examined weekly by a therapist, as well as a gynecologist.

How is gestosis treated during the fetal development period?

IN modern medicine no methods have been developed for complete healing from the pathology of gestosis during pregnancy.

Treatment is aimed at:

• The main direction in treatment is to help preserve the child and the health of the mother in labor. There is ongoing support drug therapy life-supporting organs;
• With the help of the sedative effect of drugs, the fibers of the nervous system are strengthened.

Early stages of gestosis, only in the presence of minor swelling, are treated on an outpatient basis, the remaining stages of development and progression of gestosis are treated only in a clinical hospital.

Also used in treatment is a salt-free diet and the use of herbal teas and decoctions in treatment.

Drug therapy

Medications that a doctor prescribes to a pregnant woman for the treatment of gestosis belong to the following pharmacological groups of drugs:

• Sedatives;
• Means for lowering blood pressure index;
• Medicines of the anticoagulant group;
• Antiplatelet drugs;
• Diuretics for swelling.

Also appointed vitamin complexes group of vitamins B, as well as vitamin C.

Drugs of 2 forms are used in the treatment of gestosis - in the form of oral tablets, or in the form of solutions for infusion.

Drugs used in treatment:

• The drug Actovegin is prescribed in the 2nd and 3rd trimester of pregnancy to increase blood circulation in the placenta and prevent its insufficiency;
• To replenish magnesium in the body and to strengthen the heart muscle - Magnesium B6 is used in the treatment of preeclampsia;
• The drug Curantil prevents placental hypoxia and insufficiency, increases the functioning of the placental circle of the blood flow system, and this drug also prevents vascular thrombosis;
• The drug Hofitol is a herbal medicine that can restore cells and liver functionality.

If gestosis progresses and cannot be stopped by everyone available methods, then a caesarean section is prescribed in order to save the newborns and the health of the mothers in labor.

Prevention of gestosis

The main prevention during pregnancy is the compatibility of Rh factors in both parents in order to avoid Rh conflict between the mother and the unborn baby.

The following rules should also be followed during complicated pregnancies:

• A diet with a minimum of salt and excluding smoked, pickled, and flour dishes from the diet;
• Drink at least 1200 milliliters of water per day;
• Active lifestyle;
• Avoid stress;
• Give up bad habits;
• Control your weight to prevent obesity;
• Go through systematically diagnostic examination condition.

Video: Late toxicosis (preeclampsia), edema.

Life forecast

With timely diagnosis of the pathology of gestosis at the initial mild stage of swelling, outpatient treatment brings positive results - the prognosis is favorable.

At the stage of preeclampsia, treatment in a hospital is necessary. Drug treatment can correct the blood pressure index and improve the condition of the pregnant woman - the prognosis is more favorable.

During the stage of gestosis eclampsia, changes occur not only in the blood flow system, but also in the cerebral vessels. Great chance miscarriage, as well as a high probability of death from cerebral hemorrhage in a pregnant woman - the prognosis is unfavorable.

HELLP syndrome in 80.0% of cases ends in the death of the mother in labor and in almost 100.0% of fetal death during its development - the prognosis is unfavorable.