Gestosis of the 1st half of pregnancy. Life forecast

Preeclampsia in pregnant women usually occurs in the second half of pregnancy. By virtue of physical changes In the body during this crucial period for a woman, the functioning of the most important organs and systems becomes abnormal. Alarm signal The presence of gestosis is caused by edema. The peculiarity of the course of gestosis is that its presence often does not cause harm to the body in the first stages. Early detection this problem is one of the tasks of an obstetrician-gynecologist who monitors a woman’s pregnancy in antenatal clinic. The diagnosis of “preeclampsia” occurs on the basis of rapid weight gain.

Since swelling is quite common among pregnant women, many of them no longer pay attention to it, considering the presence of edema to be normal in their condition. However, indifference during pregnancy is unacceptable: the gradual accumulation of fluid in all tissues of the expectant mother’s body threatens the unborn child, since excess fluid also ends up in the placenta. If protein is present in the urine analysis of a pregnant woman, this becomes evidence of impaired kidney function. This is how gestosis shows its second “face”. Abnormal functioning of organs cannot but have a negative impact on circulatory system. So, the third signal indicating the presence of gestosis is increased blood pressure.

To prescribe treatment, for an experienced gynecologist, the presence of even one symptom is sufficient, because further development Preeclampsia is impossible to predict. Of course, the disease may not progress beyond edema and high blood pressure in its development, but you should not count on this. In some cases, gestosis can provoke convulsive attacks and even completely disrupt work. internal organs. Naturally, this is very dangerous both for the expectant mother and for the fetus developing in her womb. There are different pathological cases: bleeding, detachment of a healthy placenta, hypoxia, fetal death. That is why it is necessary to start fighting this disease as early as possible.

What is gestosis in pregnant women?

Preeclampsia today is understood as a phenomenon previously called late toxicosis. Developing at approximately 16% of total number of all pregnancies, it took 2nd – 3rd place among the various causes of mortality of expectant mothers, thereby becoming the cause of illness and death in newborns. Risk factors for the development of gestosis are:

• the presence of gestosis during a previous pregnancy;
• pregnant woman’s age 20 – 35 years;
• first pregnancy or pregnancy from a new sexual partner;
• multiple pregnancy;
• hereditary predisposition;
• chronic infections, stress, intoxication;
• bad habits.

Preeclampsia in pregnant women

Considering gestosis as a pathology during pregnancy, it is worth highlighting its types. The so-called pure gestosis occurs for no apparent reason, while “combined” gestosis develops against the general background of diseased organs, hypertension, obesity and hormonal disorders. IN medical practice The following division of gestosis also takes place:

1. Early gestosis, observed, as a rule, in the first trimester. It is also called early toxicosis because it is accompanied by vomiting of varying complexity.
2. Late gestosis, starting in the second half of pregnancy, occurs with edema and high blood pressure. Protein is observed in the blood test.
3. A rare form of the disease. Can occur at any stage of pregnancy. In addition to the main symptoms, it is accompanied by dermatosis, asthma, jaundice, psychopathy and other diseases.

Preeclampsia manifests itself in four degrees of severity:

1. Dropsy of pregnancy. Swelling, first appearing on the knees, gradually spreads to the thighs, abdomen, face and body. If your weight gain is more than 300 g per week, or your weight is constantly changing, you should think about the possible formation of edema.
2. Nephropathy. Its nature is an increase in blood pressure, as well as the appearance of protein in the urine during swelling that precedes the development of these pathologies. Often a woman does not complain about anything. In severe cases, nephropathy can progress to the next degree.
3. Preeclampsia. Its manifestations are similar to nephropathy, but complications include damage to the central nervous system. A pregnant woman may notice spots before her eyes, experience abdominal pain and headaches. These symptoms pose a serious threat to a woman’s health, indicating the development of cerebral edema. If appropriate measures are not taken in time, the disease will quickly progress to the next stage.
4. Eclampsia is characterized by the appearance of seizures and loss of consciousness. In this case, it is advisable to resort to emergency delivery for the benefit of the mother and her child.

Symptoms of gestosis

The symptoms of gestosis are quite varied. The first manifestations of late toxicosis can be observed at 28–29 weeks of pregnancy. This is mainly swelling of the limbs and face. This kind of dropsy is considered the most mild manifestation gestosis. In the absence of pronounced expression, a woman may not even pay attention to these changes. In order to determine the presence or absence of edema, it is necessary to carefully monitor your weight gain during pregnancy at all stages. An increase of 350–500 g per week is considered normal, no earlier than from the 28th week of pregnancy. When this range is exceeded, it may indicate fluid retention in the body, causing dropsy.

Nephropathy, affecting the parenchyma and glomerular apparatus of the kidneys, is a more severe manifestation of gestosis. Here, edema is already pronounced, blood pressure is elevated and protein is present in the urine, the amount of which determines the prognosis of the disease. The main symptom of progressive nephropathy is a small amount of urine excreted. On this very danger sign A pregnant woman should pay attention first. An approximate scheme for the development of gestosis here is as follows: edema - blood pressure - proteinuria (protein in the urine). Stages 3 and 4 of gestosis discussed above are the most dangerous. Therefore, having noticed even the most minimal manifestations of the disease, a pregnant woman should contact the gynecologist who is observing her as soon as possible and paint an accurate picture of what is happening.

Mechanism of development of gestosis

Since the causes of gestosis are quite diverse, scientists have developed several theories for the development of this pathology. According to one of them, the disease is caused by disharmony of the cerebral cortex and subcortical formations. This is manifested by reflex changes vascular system and impaired blood circulation. An important prerequisite for the development of gestosis is a violation of the hormonal regulation of functions important for human life organs and systems. Plays a significant role in the development of gestosis immunological incompatibility maternal tissues with fetal tissues. Most scientists agree with the opinion about the role of hereditary predisposition in the occurrence of gestosis. But most researchers have a different opinion, from which it follows that there is no single mechanism for the development of gestosis. But the combined effect of various damaging factors on the development of this pathology is quite possible.

Considering all possible mechanisms for the development of gestosis, importance must also be given to the spasm of all blood vessels, leading to impaired circulation in tissues and organs with a disorder of their functions. High blood pressure just reflects vasospasm. Damage to the endothelium, the inner layer of blood vessels, also deserves special attention. This phenomenon causes a decrease in the endothelium of the synthesis of substances that affect vascular tone, as well as the blood coagulation system, with a simultaneous change in the sensitivity of the vascular wall to them.

Preeclampsia is accompanied by severe kidney disorders, which manifest themselves in different ways - from the appearance of protein in the urine to acute renal failure. With gestosis, the liver also ceases to perform its functions normally: circulatory disorders in the liver tissues occur, dead areas appear, and hemorrhages occur. The brain of a pregnant woman undergoes structural and functional changes for the worse:

• microcirculation is disrupted;
• blood clots appear in the vessels, accompanied by the development of dystrophic changes in nerve cells;
• pinpoint or small focal hemorrhages occur;
• edema is accompanied by increased intracranial pressure.

With gestosis in pregnant women, pronounced changes in the placenta are also observed, which are the cause of the development chronic form hypoxia and delayed fetal development. All these changes are accompanied by a decrease in fetal-placental blood flow.

Diagnosis of gestosis

If gestosis is suspected, in order to make an accurate diagnosis, the pregnant woman must undergo general and biochemical urine tests to determine the protein in her urine. daily norm, as well as to check the number of platelets and the condition of the entire blood coagulation system. The detection of edema is facilitated by continuous monitoring of body weight, and the state of the vascular system and the level of blood pressure are judged by pressure, which must be measured on both arms. Of particular value to diagnostic study involves an examination of the fundus by an ophthalmologist, as well as an ultrasound of the fetus to detect hypoxia. Pregnancy requires every woman to regularly donate urine and blood, weigh herself and measure blood pressure. However, women who are at risk deserve close attention from doctors: primiparas, carrying multiple fetuses, over 35 years of age, carriers of sexually transmitted infections and those suffering from chronic diseases.

Treatment of gestosis

The essence of treatment for gestosis is to restore normal condition women's health. In the second half of pregnancy, if gestosis develops, the main rule of behavior is to contact a specialist in a timely manner without trying self-treatment. Correct treatment gestosis can only be prescribed by a doctor, taking into account the fact that some medications as a result of their use, they can further aggravate the condition of the pregnant woman and the fetus she is carrying. An example is a situation where a pregnant woman, wanting to get rid of edema, on the advice of relatives, begins to take diuretic pills. However positive result she will not be able to achieve this, since the cause of edema here is pathological vascular permeability. This incorrect approach to treatment worsens the condition even more.

All doctor's instructions can be easily followed in home environment if gestosis is mild. However, severe forms require observation by hospital specialists, where they will promptly provide any medical care. An important stage Timely delivery also serves as a treatment for gestosis. If the pregnant woman’s condition does not improve, fetal hypoxia is detected, and there is no effect of therapy, childbirth becomes the only way out in this situation. With mild forms of gestosis, the birth of a child naturally quite realistic, however, there is a risk of deterioration of the woman’s condition during pushing with an increase in the load on the mother’s body. In most cases it is carried out C-section, especially with renal or liver failure, stroke, eclampsia and retinal detachment.

Carrying out preventive measures for gestosis is important point, since complete recovery from of this disease does not seem possible. The goal here is to prevent the condition from getting worse. The main thing is timely detection. Pregnant women should approach all tests and examinations in the office responsibly in order to monitor the progress of pregnancy.

While in " interesting position“, even if it proceeds normally, it is important to properly develop a diet and stick to it. So, fiber and proteins should predominate in food products, but it is advisable to reduce the consumption of fatty and floury foods. Pregnant women should stay as long as possible fresh air, but walking should not be tiring. A “gestational” pregnant woman will help not only herself, but also the baby growing inside her, since these measures help improve blood supply to tissues and reduce hypoxia.

From all of the above it follows that no one is immune from the development of gestosis. expectant mother, however, protection from its formidable complications is quite possible. To do this, you just need to take good care of your health, listening to the slightest changes in it, and also feel full responsibility for both your own and the health of the unborn baby.

The classification looks like this:

• Early gestosis.
• Late gestosis (mild, moderate, severe preeclampsia and eclampsia).

Let's look specifically at each type of toxicosis.

Early gestosis

These are manifestations various kinds symptoms (nausea, vomiting, salivation) in the first half of pregnancy. They arise due to disorders of all types of metabolism, adaptation of the woman’s body, changes in immunity and brain functioning. In this case, there is a maximum increase in hCG(pregnancy hormone). Early gestosis is most severe when multiple pregnancy and hydatidiform mole. Risk factors include:

• Disturbances in the functioning of systems responsible for adaptation of the body (neuroendocrine disorders, high or low blood pressure, rheumatic heart defects).
• Diseases of the liver, kidneys (hepatitis, nephritis, pyelonephritis).
• Diabetes.
• Mental disorders.
• Obesity.
• Infectious diseases.
• Bad habits (alcohol, smoking, drugs).
• Allergies.
• Past diseases of the genital organs.

Manifestations of early gestosis

Vomit

Vomiting occurs in approximately 50-80% of all pregnant women. This is a manifestation of a violation of the woman’s body’s adaptation to pregnancy. Vomiting 1-2 times a day without disturbing the general condition of the woman does not apply to gestosis. When vomiting occurs (10-12 times a day), it is manifested by general weakness, low blood pressure, an increase in temperature to 38 C, an increase in heart rate, this is considered a sign of gestosis. Prolonged vomiting is accompanied by loss of water, vitamins, exhaustion, and blood thickening. Such vomiting is observed in 15%.

Light form vomiting occurs up to 3-5 times a day (usually on an empty stomach), accompanied by nausea, loss of appetite and normal general condition, blood pressure and urination.

This form goes away on its own in 90% of cases and is easy to treat.

For medium degree Characterized by vomiting up to 10 times a day, regardless of food intake, as well as nausea, salivation, dehydration, low blood pressure, tachycardia, decreased diuresis (urination) and body weight. There is also adynamia, apathy, and mental lability. 5% of women may experience liver dysfunction.

In severe forms, vomiting occurs up to 20 or more times a day, food is not retained, there is a weak pulse of up to 120 per minute, very low blood pressure (80/40), a woman can lose 3-5 kilograms per week. The woman is emaciated, the skin and mucous membranes of the tongue, lips are dry, the skin and eyes are yellow color, there is an unpleasant odor from the mouth, bad dream, fast fatiguability, loss of appetite.

Salivation

Can occur in all pregnant women. This is a relatively rare type of gestosis. Based on the amount of saliva, mild and severe forms are distinguished, and according to the nature - constant (day and night) and intermittent (it disappears, then it appears). The mild form does not lead to any impairment. Severe may cause dehydration, bad feeling and mental disorders.

Late gestosis

These are profound disturbances in the functioning of vital organs in the second half of pregnancy, which is manifested by the classic triad of symptoms - increased blood pressure, protein in the urine and edema. Occur more often after 28 weeks of pregnancy.

Preeclampsia

Causes:

• General vasospasm (the intensity of the liver and kidneys decreases, which leads to changes in protein, carbohydrate and fat metabolism, antitoxic function and kidney filtration);
• Changes in rheological characteristics and blood coagulation (thickening, increased coagulability);
• Decreased blood volume;
• Impaired blood circulation in organs and water-salt balance.

Risk factors include:

• Pathologies of extragenital organs (liver, heart, lungs).
• Presence of preeclampsia in a previous pregnancy.
• Age of the pregnant woman (less than 19 and more than 30 years).
• Maternal obesity, anemia, bad habits, unbalanced diet.
• Multiple births, large fetus, its hypotrophy.

Eclampsia

This is a severe form of preeclampsia. It is characterized by the development of a convulsive attack (maybe even several) and loss of consciousness. There is prenatal (75%) and postnatal. Before the convulsions there may be a sharp headache, abdominal pain, vomiting, blurred vision and cerebral circulation. There is also a risk of stroke and paralysis of half the body.

Pathogenesis of eclampsia

The mechanism of development is not well understood. Now it is considered as the failure of adaptive maternal systems to meet the needs of fetal development. When under the influence negative factors(diseases of the liver, lungs, heart defects, obesity, genetic disorders, psycho-emotional stress, infection) spasm of small vessels occurs in all organs, their function is disrupted and tissue hypoxia develops (lack of oxygen). The load on the heart increases, blood volume decreases, the inner lining of blood vessels is injured, which increases blood clotting. As a result, nephropathy and insufficiency of blood flow in the uterus and placenta occur.

How is gestosis diagnosed?

Establishing diagnosis early toxicosis no difficulties. A typical clinical picture (vomiting a certain number of times, salivation), the onset of symptoms in the first half of pregnancy, risk factors may be present. In the blood, the level of bilirubin and leukocytes is increased, the level of protein is decreased, the amount of urine excreted per day is present, acetone is present in the urine, the water-electrolyte balance is disturbed - hypokalemia, hypernatremia.

There are some difficulties with late gestosis. It is difficult to make a diagnosis before symptoms appear. It is necessary to pay attention to risk factors and identify early signs(increased blood pressure more than 140/90, edema, protein in urine more than 1 g/l., weight gain). The main role is given to constant monitoring of pregnant women, in which blood pressure, protein in the urine, body weight are systematically measured and the appearance of edema is observed.

Determining the severity of preeclampsia is very important for treatment. There are 3 degrees:

• Light form. Typical blood pressure is from 130 to 150, there is little protein in the urine (up to 0.3 g/l), swelling is observed only in the lower extremities, a normal number of platelets (a sign of normal blood clotting) and creatinine (an indicator of kidney function).
• Medium shape. Blood pressure is from 150 to 170, protein in the urine can rise to 5 g/l, swelling is already on the face, platelets are below normal, creatinine increases (kidney function is impaired).
• Severe form. Blood pressure of 170 and above, protein more than 5 g/l, swelling throughout the body (especially in the area of ​​the nasal passages, which complicates breathing), headache, stomach ache, in the liver area, in the eyes of the spot, the amount of excreted urine and platelets is greatly reduced ( risk of bleeding), kidney function is disrupted up to kidney failure.

Why are gestosis dangerous?

Early gestosis rarely poses any danger to the mother or fetus. But if vomiting is long-term and cannot be treated, irreversible changes in the body can occur, including mortality. But this happens very rarely. It should be noted that repeated and prolonged vomiting in pregnant women can lead to the threat of miscarriage, preeclampsia, fetal hypoxia, increased blood loss during childbirth and weakness labor activity. Also, the threat of miscarriage may arise due to untreatable salivation and depression mental state pregnant.

Late gestosis represents high risk for mother and fetus - renal, adrenal and liver failure develops, there is a delay in the development of the fetus and its fetal death. If eclampsia is left untreated, eclamptic coma develops.

Treatment of early gestosis

Mild forms are treated at home, while moderate and severe forms must be treated in a hospital. It is necessary to ensure long sleep, a calm environment, proper care, and proper diet. Diet food should be fortified and easily digestible. Take in small portions chilled. If food is not retained, intravenous administration of amino acids, proteins, glucose, and vitamins is prescribed. It is recommended to drink alkaline mineral waters 5-6 times a day. After eliminating vomiting, the diet can be expanded. Must be prescribed physical therapy(walking, self-massage of the muscles of the upper half of the body, deep breathing). It is also necessary to carry out psychotherapy, which makes it possible to convince the pregnant woman that vomiting is reversible and pregnancy will pass Fine. You can use electrosleep, reflexology and acupuncture, acupuncture, herbal medicine, aromatherapy (inhalation of pleasantly smelling substances).

At increased salivation You should rinse your mouth with infusion of chamomile, oak bark, and menthol solution. The skin around the mouth needs to be smeared protective creams, eat food in small portions.

Drug therapy

• Drug treatment is based on the administration of antiemetic drugs. They inhibit the vomiting center in the medulla oblongata. Such substances include chlorpromazine, metoclopramide, etaprazine (does not reduce blood pressure, which has a positive effect on the body during prolonged vomiting), droperidol (also has a sedative effect).
• To eliminate dehydration, glucose solutions and physiological solutions are prescribed.
• To improve uteroplacental circulation and fetal gas exchange, oxygen therapy should be used and drugs that dilate the vessels of the uterus and fetus (potassium orotate, pentoxifylline) should be administered.
• To reduce saliva secretion, atropine sulfate solution is administered intramuscularly.

Every day, your body weight and the amount of fluid you drink and excrete are monitored. In severe cases, protein and amino acid preparations are added. Pour in about 2-2.5 liters. In the most severe cases, hormones (hydrocortisone, ACTH) are administered. If there is a threat of miscarriage, progesterone is administered subcutaneously for 7 days. An indicator of the effectiveness of treatment will be an increase in diuresis, stopping vomiting, improving the patient’s condition and increasing body weight. If there is no effect from therapy (vomiting does not stop, the skin turns yellow, the temperature rises without infection, tachycardia appears, weight loss) termination of pregnancy is indicated.

Treatment of late gestosis

The goal of therapy is to restore the functions of vital organs and the fetoplacental system, eliminate symptoms, and prevent the development of a convulsive state. In case of late gestosis, the patient should always be hospitalized.

It is important to adhere to the following provisions:

• Normalization of blood pressure and blood volume.
• Elimination of general vasospasm.
• Improving blood flow in the kidneys.
• Regulation of water-salt balance, metabolism, rheological characteristics of blood (thickness, coagulability).
• Prevention of hypoxia and fetal malnutrition, bleeding in the pre- and postpartum period.
• Carrying out normal birth with adequate anesthesia.

Diet. A pregnant woman should eat about 2900-3500 kcal per day, food should contain a high percentage of protein, a reduced amount of animal fats, cholesterol, and foods that cause thirst. You need to include rest during the day, about 2-3 hours, which improves blood flow in the placenta and kidneys.

Treatment of mild late gestosis

For mild degree gravity drug treatment not always prescribed. The consumption of water and salt is not limited. If pregnancy is up to 37 weeks, observation in a hospital is possible day stay. Monitor key indicators (pressure, fluid balance, edema, registration of fetal movements). In the case of a stable condition, wait-and-see tactics are used. If at least one moderate sign appears, the woman is hospitalized.

Treatment of moderate late gestosis

For moderate preeclampsia, semi-bed rest, limitation of physical and mental stress, diet, and a complex of vitamins and microelements are prescribed.

Antihypertensive therapy. If the pressure is more than 160, antihypertensive drugs are administered (metoprolol, methyldopa, nifedipine - others are contraindicated). But you need to control your blood pressure because low blood pressure negatively affects the blood flow of the fetus and placenta.

Infusion therapy. The goal is to normalize blood volume, rheological properties and hemodynamics. Saline solutions (Ringer's, 0.9% sodium chloride) and protein preparations are administered.

If there is no effect of therapy for 7-10 days, termination of pregnancy is indicated.

Treatment of severe late gestosis

Severe preeclampsia. The pregnant woman is hospitalized in the intensive care unit, allocated a separate room with round-the-clock monitoring, and a vein is catheterized for long-term infusion therapy.

Strict bed rest is prescribed. The pressure is maintained at 150-160 to prevent cerebral hemorrhage (the drugs are the same as for the moderate form). Magnesium therapy is used by administering magnesium sulfate to maintain the concentration of magnesium in the blood and prevent convulsive conditions. Infusion therapy is under strict supervision.

With this form, if treatment does not have an effect within 24 hours, the pregnant woman is prepared for artificial interruption pregnancy, regardless of gestational age. The advantage is given to childbirth through the natural reproductive tract with adequate pain relief. If the genital tract is ready (the cervix is ​​sufficiently mature and preparation has been carried out with the introduction of prostacyclin), delivery is performed through the genital tract. Otherwise, if the cervix is ​​immature, high blood pressure and preeclampsia are progressing, fetal condition is deteriorating, or there is a risk of a convulsive attack, a cesarean section is performed.

Eclampsia is treated directly at the site where the seizures occurred. The pregnant woman is placed on a flat surface on her left side, the upper respiratory tract is freed, the contents are eliminated oral cavity. If spontaneous breathing is maintained, oxygen inhalation is performed. Otherwise - artificial ventilation lungs. At the same time, the vein is catheterized and therapy with magnesium sulfate is started. After eliminating the seizures, the water-electrolyte balance, metabolism, and blood acidity are normalized with infusion therapy.

Artificial termination of pregnancy is started urgently, regardless of what week the pregnancy is (if possible through the natural reproductive tract, if not - cesarean section).

It is very important to adequately provide medical care to pregnant women with preeclampsia. The help of a psychologist is also important, since stress disorders arise after such complications.

Postpartum period

After childbirth, treatment of late gestosis continues depending on the woman’s condition, symptoms and blood test data. Magnesium therapy is prescribed for at least 24 hours after childbirth or the last attack of convulsions. They measure blood pressure, ECG, blood and urine tests, and stabilize the condition. If everything is in order, the woman is discharged.

Prevention of toxicosis

For women who are at risk of preeclampsia, it is very important to plan their pregnancy so that its development occurs in the summer-autumn period. You need to be examined by a doctor once every 2 weeks in the first half of pregnancy and once a week in the second. There should be a calm environment at home and at work, it is important to adhere to the principles balanced nutrition, since during pregnancy the need for vitamins and microelements increases.

Increase in blood pressure by 30-40% of entry level and body weight, especially after 30 weeks, by more than 400 grams - a risk factor that requires special attention. If at least one symptom of preeclampsia appears, the woman must be urgently hospitalized in the obstetric department.

The period of bearing a baby is a stressful time for every woman. After all, it's always future mom worries whether everything is okay with her baby. This article will discuss 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 the morning, but 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.
• Increased blood pressure is observed.

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.

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

Types of disease

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

1. Pure gestosis. It develops in those pregnant women who do not suffer from concomitant diseases.
2. 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.

1. Dropsy.
2. Nephropathy.
3. Preeclampsia.
4. 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. With severe swelling, rapid fatigue and heaviness in the legs are possible. 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 oxygen saturation of the fetus. 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 systems. 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 of preeclampsia in a pregnant woman:

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

1. Bright light.
2. Sharp pain.
3. Stress.
4. Loud sharp sound.

The seizure itself lasts on average one to two minutes.

1. At the same time, at the very beginning, the pregnant woman will feel twitching of the eyelids, then this will spread to the arms and lower limbs. A woman’s eyes may roll back under her moving eyelid, and her fists will clench.
2. 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.
3. 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.
4. 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:

1. Coagulogram (blood test for clotting).
2. Blood test: general and biochemical.
3. Urinalysis: general and biochemical.
4. Collection of daily urine output.
5. Blood pressure measurement.
6. Weight measurement.
7. 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:

1. Placental abruption.
2. Placental insufficiency (which can lead to fetal hypoxia).
3. 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 the expectant mother has 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). Not only the woman, but also her baby will be monitored without fail. 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.

1. 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.
2. 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.
3. 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.
4. Eclampsia. If the patient has an attack, she must be protected from possible injury, and the airway must also be monitored. After the attack, the doctor will prescribe artificial ventilation of the 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 pregnancies, 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:

1. A woman must correctly adjust her daily routine. You need to sleep at least 8 hours a day, spend time in the fresh air as often as possible, and exercise your body moderately.
2. We need to adjust our diet. To do this, you should limit your salt and liquid intake.
3. 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.

Preeclampsia is serious complication late dates pregnancy, which is why it is also called late “toxicosis”. With gestosis, the functioning of the kidneys, blood vessels and brain of the expectant mother deteriorates. His most characteristic features– this is an increase in blood pressure and the appearance of protein in urine tests.

The increase in pressure may not be noticeable, but is more often manifested by headache, nausea, and blurred vision. Protein in the urine indicates kidney dysfunction and is often accompanied by edema.

In severe cases, gestosis can lead to convulsive seizures, placental abruption, developmental delay and death of the baby.

In 90% of cases, gestosis begins after 34 weeks, most often in pregnant women with their first baby. More early start(from 20 weeks) – a sign of a severe course. The closer to the expected date of birth gestosis begins, the better its prognosis.

Unlike early toxicosis, which is considered “normal” by many doctors, gestosis disrupts the course of pregnancy and must be treated. In case of severe gestosis that threatens the development of the baby, it is often necessary to resort to stimulation of early labor or caesarean section.

Tendency to gestosis

Gestosis of varying degrees occurs on average in 10–15% of expectant mothers, much more often it appears in the first pregnancy. The timing of its onset is from 20 weeks and up to several days after birth. In multiple pregnancies, gestosis can begin earlier (from 16 weeks) and be more severe.

During the second pregnancy, the likelihood of encountering late toxicosis decreases. The easier the first gestosis was, and the closer its onset was to the due date, the less likely repeat. Those mothers for whom it began earlier and had a difficult course, especially if they had to have a caesarean section because of this, have a greater chance of encountering gestosis again.

When the likelihood of gestosis is greater:

• During the first pregnancy;
• If you already had chronic diseases before pregnancy: kidney problems, high blood pressure or overweight. In this case, gestosis is called “combined”, in contrast to “pure” gestosis, which develops against the background of complete health;
• Pregnancy with twins and triplets;
• Heredity, that is, parents or siblings suffered from gestosis;
• Age less than 20 and over 35 years.

If there was no gestosis in the first pregnancy, it is very unlikely that it will occur in the second.

Causes of gestosis during pregnancy

Although scientists have not fully established the causes of gestosis, it is known that the placenta plays a major role in its development. If there is insufficient blood supply to the uterus (for example, due to narrowing of the uterine arteries) or pathology of the placenta itself, it triggers a pressure rise mechanism to increase blood flow.

The rise in pressure is achieved by narrowing the blood vessels of the mother's body, but this leads to a deterioration in the blood supply to her vital organs - the kidneys and brain. They receive less blood, and their work deteriorates.

With edema, water comes out of the bloodstream into the tissue, which makes the blood thicker and increases the formation of blood clots. Blood clots can clog small vessels and further impair blood flow, and thick blood increases blood pressure. A vicious circle arises.

Signs of gestosis

There are three main signs of gestosis, which usually appear together or in pairs: swelling, protein in the urine and increased blood pressure.

The appearance of protein in the urine(proteinuria).
The first and main criterion that indicates kidney damage. Preeclampsia almost never occurs without proteinuria, and the stronger it is, the worse it is. Although the identification of this sign alone does not indicate gestosis.

Normally, there should be no protein in the urine.
Small amounts, around 0.033 g/l, in combination with leukocytes may be a sign of kidney inflammation (pyelonephritis).
0.8 g/l or more is more likely to indicate gestosis.
Proteinuria in combination with an increase in blood pressure over 140/90 always indicates gestosis.

A urine test must be taken before each visit to the doctor at the antenatal clinic. If you feel that your urine has become cloudy, dark in color, or covered with foam, get tested without waiting until the appointed day.

Increased blood pressure more than 140/90 mm Hg. Art.
This is the second main sign of gestosis, which may go unnoticed, or may manifest itself as headache, nausea, flashing spots before the eyes, and dizziness.

The combination of high blood pressure with protein in the urine is called preeclampsia, and indicates the initial stage of brain damage to the expectant mother. This is why your blood pressure needs to be measured at every doctor's visit.

In severe cases, untreated high pressure can cause serious damage to the nervous system such as loss of consciousness, seizures (eclampsia) and bleeding in the brain (stroke). This danger occurs when the upper figures of blood pressure exceed 160 and the lower 110 millimeters of mercury.

Edema.
Often found during normal pregnancy, and in themselves are not a sign of gestosis, but only in combination with proteinuria or high blood pressure. Moreover, gestosis without edema (“dry”) is more severe.

Whether you have swelling can be easily determined by performing a simple test. Use your thumb to press inner surface shin in the bone area and hold for a few seconds. If a hole remains at the point of pressure, then there is swelling. This test can also be performed on any other part of the body.

Another sure sign swelling - slippers or shoes become too small, wedding ring does not come off the finger. In some cases, there is hidden swelling. They can be identified by too much weight gain compared to the norm.

Examination for suspected gestosis

• Analysis of urine . Allows you to identify proteins ketone bodies, leukocytes, bacteria and other elements. This makes it possible to distinguish kidney damage during gestosis from pyelonephritis or other diseases.
• Blood analysis . Indicators such as hemoglobin (a slight decrease at the end of pregnancy is normal), hematocrit (blood thickening), platelets, and the level of liver enzymes (indicates liver damage in severe gestosis) play a role.
• With . Allows you to assess the development of the baby and recognize his delay in time. Assessment of blood flow in uterine arteries using Doppler allows you to give an approximate prognosis of the development of the disease: the worse the blood flow, the more likely gestosis.
• . Done after 28 weeks of pregnancy, for more early stages not indicative. Shows the baby’s mobility, the functioning of his heart and, therefore, the presence or absence of hypoxia (oxygen starvation).

Accurate diagnosis

All of these symptoms are characteristic not only of gestosis, and they must be distinguished from signs of other diseases, especially if the expectant mother had them before pregnancy. Therefore, only a doctor can make an accurate diagnosis of gestosis.

Video materials

Late toxicosis (gestosis), edema during pregnancy.

All women who have children know about the peculiarities of pregnancy and monitoring it: constant monitoring by a gynecologist, regular checks of tests, weighing and ultrasound. Some girls wonder why they need to step on the scale every time. Excessive weight gain indicates the appearance of edema. And they, in turn, are a sign that gestosis is developing during pregnancy.

This condition is not limited to the development of edema. Preeclampsia occurs most easily in pregnant women who do not have somatic diseases. If present, urinary and endocrine, gastrointestinal tract, the flow will be more severe.

25% maternal mortality associated precisely with the state of gestosis. The risk of fetal death increases 3-4 times. After childbirth, all manifestations of gestosis disappear.

Causes

To understand what gestosis is in pregnant women, you need to start with the cause of its occurrence.

The main cause of gestosis in pregnant women is disturbances in vascular regulation. As a result, spasms occur. The target of changes is the microcirculatory bed.

Many scientists note that gestosis during pregnancy is associated with immunity and its factors. The fetus produces antigens that lead to the appearance of the mother. As a result, the formation of immune complexes occurs, the number of which exceeds normal. The result will be Negative influence on the mother's body.

Signs of gestosis during pregnancy are quite typical. They are all expressed by the abbreviation OPG. It stands for edema, proteinuria and. The entire symptom complex is not always observed.

The most common symptom are swelling of the hands. Due to an increase in the amount of water consumed, the exit of which is difficult, it is retained in the space between the tissues. Swelling of the arms and legs may occur; in severe cases, the swelling spreads throughout the body. Sometimes there are no obvious manifestations. Any changes can only be detected by weighing.

Normal increase weight per week during the third trimester – 500g. If you get more when weighing, then you should be more careful. Also, urine output should be more than 800 ml per day when drinking 1.5-2 liters of water.

• 5th degree.

Without treatment, the condition continues to worsen. The so-called HELLP syndrome develops. Vomiting of blood begins and jaundice appears. In extremely severe cases, coma is possible. Death is likely in 80% of cases.

Sometimes there are quite rare forms. They manifest themselves in the form of dermatoses, bronchial asthma or itching.

Some pregnant women are affected by other types of gestosis:

• Softening bones. Tooth decay occurs and painful sensations in the bones and joints, gait is disturbed. It develops against the background of a lack of vitamins in the body, and especially calcium.
• Increased saliva production. Excessive salivation occurs before vomiting. As a result, the body suffers from a lack of water, dry mouth appears, as a result of which speech changes and the mucous membrane of the oral cavity is damaged.
• Jaundice. At the same time, its other forms do not develop. Careful diagnosis of these two conditions is necessary to exclude infectious liver damage.
• Hepatic atrophy. Most often occurs in the first trimester. It is not amenable to any therapy. To improve the condition, termination of pregnancy is recommended.

Complications

With a mild course of gestosis, it can proceed unnoticed. Pregnant women think that there is no need to be examined if nothing worries them. But that's not true. We must not forget about the hidden current.

The danger of gestosis during pregnancy lies not in the disease itself, but in its complications:

• Edema of the lungs, brain;
• Hemorrhages in the brain, liver, lungs and other organ systems;
• Disruption of the normal functioning of the heart and blood vessels;
• Placental abruption;
• Impaired kidney function;
• Changes in the course of fetal development, its deviation from the norm;
• Premature birth;
• Disorders of the hepatobiliary system;
• Intrauterine oxygen starvation of a child;
• Changes in vision, its deterioration;
• Infant and maternal mortality.

But all this can be avoided. Regular urination and visiting a doctor once a month with the prescription of appropriate therapy will prevent the development of gestosis.

Diagnostics

All pregnant women constantly undergo a large number of tests, so diagnosing gestosis during pregnancy is not difficult. If there are any deviations from the norm, some studies may be ordered outside of the plan. Additionally, other diagnostic procedures are used.

The main studies include the following:

• Regular weight check. Normal weight gain in the second and third trimester should be no more than 350 g per week. If more than 500 g was collected, then the pregnant woman is examined additionally.
• Monitoring the amount of water consumed. The well-known norm of drinking 1.5-2 liters of water per day is not suitable for pregnant women. If even mild swelling occurs, the amount of fluid should be reduced to 1 liter per day. Plus additional control over the amount of urine excreted.
• . The main indicators are platelets and red blood cells. Based on the platelet count, it is determined how well the blood clots and whether there is a risk of bleeding.
• . The amount of liver enzymes, bilirubin and sugar is checked. This will make it clear how well the liver works and whether there is hidden diabetes.
• . Be sure to measure it on both hands. The difference in the results obtained may indicate the presence of gestosis.
• Clinical examination of urine. A diagnostic sign of gestosis will be the appearance of protein in the analysis results.
• Fetal screening. There are 3 of them in total, one in each trimester. With gestosis, the latter matters. During the study, the suitability of the fetus for the gestational age, its size and weight are determined.
• Doppler. Using a Doppler study, it is determined how well the blood flow is in the vessels of the placenta. The fetal heartbeat is also recorded.
• Examination by a dentist. Complete sanitation of the oral cavity is one of the main requirements in the antenatal clinic. If there are foci of chronic infection, you may be denied hospitalization. Also, upon examination, you can find out whether there is tooth decay, which indicates a lack of calcium in the pregnant woman’s body.
• Examination by an ophthalmologist. The ophthalmologist checks for any changes in the vessels of the fundus that indicate increased blood pressure and changes in cerebral blood flow.

Skipping doctor's visits and not conducting regular examinations is not allowed. We are talking not only about the health of the pregnant woman, but also the child. Women over 35 years of age, especially in the case of their first pregnancy, are at risk for gestosis. At each visit, it is important not to forget to report all your complaints so that the diagnosis is timely.

Treatment

As such, there is no treatment for gestosis during pregnancy. This condition goes away with delivery. You can only stop its progression and prevent serious complications from developing.

Treatment of gestosis has the following directions:

• Creating a calm atmosphere around the pregnant woman.

Emotional turmoil should be completely excluded. Loud noise, light and unnecessary physical exercise may lead to worsening of the condition. For mild cases, it is recommended to use valerian or motherwort preparations. If a more severe form occurs, the gynecologist selects the drug based on individual characteristics every patient.

• Improving blood circulation of the placenta and fetus.

Sedatives, hypotensives, diuretics and antispasmodics prevent the development of hypoxia in the child. If this occurs against the background of existing somatic diseases, then they are treated.

• Preparing a pregnant woman for premature birth.

In severe cases, delivery should occur no later than three days after the deterioration. Can be used as natural childbirth, and caesarean section. The decision is made by an obstetrician-gynecologist based on test results and assessment of the patient’s condition. When choosing the first option, it is necessary to use epidural anesthesia, which allows you to normalize blood circulation in the placenta and kidneys. If eclampsia has already begun, an emergency caesarean section is recommended. In mild cases, corrective therapy is prescribed, and premature birth is not necessary.

With moderate and severe severity of gestosis, the pregnant woman is placed in the antenatal department or pregnancy pathology department. In particularly difficult cases, hospitalization in intensive care is possible.

The following diagnostic procedures are carried out in the hospital:

• Urine examination, including Zimnitsky test;
• Fetal condition examination;
• Study of blood parameters.

Since swelling of the extremities during gestosis is an excessive accumulation of fluid in the space between the tissues, their treatment consists of removing it. Infusion solutions are used for these purposes. All medications are selected individually.

Treatment may last several weeks. Its main goal is to stabilize the condition and carry the child to term. due date. For severe conditions the only treatment There will be an emergency caesarean section.

Prevention of gestosis during pregnancy should be mandatory. Self-monitoring of your health is the basis of the entire pregnancy.

What should not be allowed:

• Obesity.

Compliance during pregnancy is very important. Proper nutrition, including the supply of all necessary vitamins and microelements. The diet must include milk and its products, lean meat and fish, and eggs. It is necessary to eat foods with high content protein, as it is the main building element.

• Limit your intake of vitamins and fiber.

Vegetables and fruits should form the basis of the diet. Fiber is beneficial for the body because it improves intestinal motility, which is sometimes not so effective during pregnancy. It also satisfies the feeling of hunger well.

• A large number of flour products and sweets.

Apart from increasing the level of carbohydrates in the blood and storing fat, they do nothing. It is better to replace them with more complex products, such as cereals and whole grain bars.

• Violation of the drinking regime.

The average volume of fluid per day should be at least 1 liter. This figure includes fruit juices, teas, soups. Avoid increased consumption of salt and salty foods.

Good effect on pregnancy physical activity. Yoga, swimming pool, Pilates have a positive effect on vitality. In addition, trained muscles will endure the birth process much easier. But don't overuse it. Any change in state causes all loads to be cancelled.

Preeclampsia in pregnant girls and women is a fairly common disease. Preventing it is much easier than treating it. Monitoring your condition and visiting a doctor will prevent complications from developing.