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Preeclampsia (late toxicosis) in pregnant women: signs, degrees, consequences, treatment. How to identify late gestosis and why is it dangerous? Rare forms of gestosis

Most often, gestosis occurs in the third trimester: this is the reason for its second name - late toxicosis. However, with toxicosis, in the usual sense of this diagnosis, it has almost nothing in common.

What is gestosis?

Preeclampsia (late toxicosis) is a pathological condition of the second half of pregnancy, accompanied by three distinctive features:

  1. swelling (visible or hidden);
  2. proteinuria (traces of protein in the urine);
  3. hypertension (sustained increase blood pressure).

This ailment greatly affects the well-being of the expectant mother, as it affects the functioning of vital systems: nervous, cardiovascular, hemostasis and endocrine.

The risk group for developing gestosis includes:

  • nulliparous (in particular, women over 35 years old);
  • carrying twins or triplets;
  • persons suffering from chronic diseases diabetes, pyelonephritis, vegetovascular dystonia);
  • overweight women;
  • women with untreated STDs.

How to identify late gestosis?

A pregnant woman can and should track changes in her well-being. But what you definitely should not do is to diagnose yourself. If you suspect that preeclampsia is the cause of your discomfort, consult a doctor. Without timely diagnosis and correction, the disease can lead to miscarriage.

The following medical studies and analyzes will help to identify late toxicosis in the second half of pregnancy:

  • General urine analysis: given every two weeks (if necessary - more often) before a visit to the gynecologist.
  • Ultrasound and dopplerography: helps to assess the development of the child, the condition amniotic fluid and placenta.
  • Measurement of blood pressure. This indicator can be monitored both in the clinic and at home.
  • Control of the level of protein and hormones produced by the placenta. A decrease in PAPP-A protein and PIGF hormone may be a sign of fetal growth retardation and placental insufficiency.
  • Medical examination to detect edema. The doctor watches how the patient's skin reacts to the removal of wearing rings, socks, elastic bands and controls how quickly the dents disappear.
  • Weighing and tracking gradual weight gain. This indicator can also be additionally monitored at home, using electronic scales.

Note! Monitoring of protein and hormone levels complements the results obtained as a result of ultrasound.

Causes of gestosis during pregnancy

In medical circles, preeclampsia has a second name - "the disease of theories." It is quite understandable, because the exact causal relationship of the onset of the disease has not yet been deduced. There are only plausible theories that sound like this:

  • There is a disturbance in the functioning of the brain. This theory is supported by statistical data: preeclampsia is much more likely to occur in women subject to severe stress. In the cerebral cortex, the processes of excitation and inhibition are disturbed, and vasospasm occurs.
  • The endocrine system fails due to a sharp increase in hormone levels.
  • Immunity perceives the fetus as a foreign tissue and the body begins to produce antibodies against it. There is an internal failure, and as a result - a reduction in blood vessels.

Note! At the moment, doctors have come to the consensus that preeclampsia occurs due to the combination of all of the above factors.

What is the danger of preeclampsia in the second half of pregnancy?

Preeclampsia has an extremely negative effect on the well-being of the expectant mother and the health of the fetus, and here's why:

  • Against the background of preeclampsia, a woman may develop side diseases of the nervous system, kidneys, liver and organs of vision.
  • Vasospasm can contribute to the formation of blood clots, cerebral edema, heart failure, and even cause a coma.
  • Bouts of nausea and vomiting dehydrate the mother-to-be and can lead to placental abruption, fetal asphyxia, or premature birth.
  • Sluggish preeclampsia leads to hypoxia and delays prenatal development fetus.
  • Newborns whose mothers suffered from preeclampsia during pregnancy most often have extremely low body weight, delays in physical and mental development and weak immunity.

Important! Perinatal mortality in late gestosis is 32%.

With eclampsia (a severe form of preeclampsia), an artificial induction of premature birth or a caesarean section is the only way save the life of mother and child. Fortunately, the disease rarely progresses to this stage.

Symptoms of preeclampsia in the second half of pregnancy

OPG is another name for gestosis in modern medicine, which is decoded as follows:

  • O - edema;
  • P - proteinuria (traces of protein in the urine);
  • D - hypertension (high blood pressure).

These symptoms are characteristic of preeclampsia in the second half of pregnancy, however, not all expectant mothers who were diagnosed with "late toxicosis" experienced all three.

Most often, women complain only about the very first - swelling.

Reference! All three signs of preeclampsia are found only in 15% of cases out of 100.

Localization and intensity of edema reflects the progress of the disease:

  • First degree- swollen arms and legs.
  • Second degree- Edema covers not only the limbs, but also the abdomen.
  • Third degree- Edema extends not only to the body, but also to the neck and face.

Treatment of preeclampsia in the second half of pregnancy

Treatment of preeclampsia is a difficult task, which only a professional can handle. With any form of late toxicosis, a woman is placed under observation in the maternity ward. This measure is being taken to:

  1. Restoration and normalization of the vital functions of the organism of the expectant mother.
  2. Creation of rest conditions for the preservation of the fetus.
  3. Fast and safe childbirth.

For patients in whom preeclampsia is associated with nervous disorders and stress, doctors prescribe plant-based sedatives (valerian, motherwort, Novopassit). Less often - expectant mothers are prescribed tranquilizers.

An obligatory item in the elimination of preeclampsia is infusion-transfusion therapy, aimed at improving blood circulation and normalizing pressure.

Also, use medicines to normalize blood pressure:

  • Papaverine;
  • Dibazol;
  • Eufillin.

Reference! With a mild form of hypertension, it is enough to take only one drug.

With gestosis, the fetus suffers from a lack of oxygen and nutrients. This problem is solved with the help of the following disaggregants:

  • Aspirin;
  • Trental;
  • Curantyl;
  • Fraxiparine.

If the signs of preeclampsia are not very pronounced and the therapy gives a positive effect, a woman can give birth naturally, but only under painkillers and after hormonal therapy and preparation of the cervix. If late toxicosis occurs in severe form, then a cesarean section is prescribed for the woman in labor. This is the only way to save the health of the mother and the life of the child.

Prevention

Prevention of preeclampsia should be started at the stage of planning a baby. To reduce the likelihood of late toxicosis, you need to:

  • Cure all existing diseases- this must be done before conception.
  • Find physical activity to your liking and do not forget about sports even during pregnancy. Daily walks to fresh air- required.
  • Monitor your diet and take vitamin and mineral supplements prescribed by your doctor.
  • Reset excess weight before pregnancy and also ensure that no more than 12 kg was gained during it.
  • Limit sugar and salt intake so as not to retain water in the body.
  • Drink enough clean drinking water without gas - this will help to avoid dehydration.

Conclusion

Unfortunately, it is impossible to insure against the development of preeclampsia, however, you can minimize the likelihood of its occurrence if you prepare for conception, register in the hospital in a timely manner and follow all medical recommendations.

Especially for- Maria Dulina

Preeclampsia during pregnancy is a complication in which there is a malfunction physiological systems and organs, and the pathological condition disappears after delivery. According to studies, it forms in the third trimester of pregnancy, but can occur earlier, from 4 to 20 weeks.

Gestosis, what is it and how is it manifested?

Gestosis has three characteristic symptom for which it is not difficult to make a primary diagnosis:

  1. . Hidden and overt, noticeable on the limbs and face.
  2. Proteinuria. In the analysis of urine, the protein content is increased.
  3. Hypertension. Elevated BP.

Pathology negatively affects the work of the cardiovascular, nervous and endocrine systems, there is a change in the composition of the blood. Preeclampsia develops after 18 weeks, manifests itself by the end of 27 weeks.

About a third of pregnant women experience manifestations of this complication. In some cases, it causes the death of a woman in labor or a baby.

Clinical manifestations are often consistent, so early preeclampsia is formed in the first half of pregnancy. The patient notes constant nausea, vomiting, increased salivation (not to be confused with "normal").

At a later stage, nephropathy, dropsy of pregnancy, preeclampsia and eclampsia appear. In the presence of a diseased liver, skin and nervous diseases, rare forms of pathology are formed.

Gestoses of the combined form appear with hypertension, endocrinopathy, diseases of the biliary tract and kidneys, and impaired lipid metabolism in the body.

Reasons for the formation of gestosis

There is no unified theory about what contributes to preeclampsia during pregnancy, but some theories of the etiology of the disease have been proposed.

The cortico-visceral theory suggests the formation of neurosis in pregnant women, with a failure in the interaction between the cortex and the subcortical structure of the brain, leading to reflex changes. In practice, this theory is often confirmed, preeclampsia occurs as a result of nervous tension.

According to the immunological theory, with gestosis, there is an incorrect hormonal control of body functions. Immunological conflict between the fetus and mother is considered as the main cause. At the same time, vasospasm increases blood pressure and reduces the amount of blood necessary for the nutrition and functioning of cells.

The genetic theory suggests that women whose mothers suffered from preeclampsia are susceptible to complications. Deficiency of B vitamins and folic acid increases the content of homocysteine ​​- an amino acid that enhances thrombosis. From its impact, micro-holes are formed in the vessels, through which plasma protein and liquid fall into the tissue.

Preeclampsia during pregnancy leads to swelling, the signs of which are not visible at the beginning of the disease, but the weight increases significantly. Plasma penetrates and stagnates in the tissues, resulting in edema, increased pressure and decreased frequency of urination.

Such micro-holes appear in the vascular walls of the kidneys, through which the protein penetrates into the urine. Regularly a pregnant woman is prescribed a general urine test. This helps accurate diagnosis and allows you to start treatment immediately after the discovery of pathology.

With damage to the inner lining of the vessel - the endothelium - its permeability increases, which contributes to the effusion of fluid into the tissue of the body. This changes the density of blood, its density and coagulability. The risk of thrombosis increases.

Preeclampsia is dangerous disorders in the brain. Blood clots, small hemorrhages are formed, intracranial pressure and dystrophy of the nervous tissue increase.

The appearance of preeclampsia at an early stage is difficult to notice, the condition is easy to confuse and take for a slight malaise in pregnant women. Slightly increased blood pressure, causing headache, weakness, nausea and fatigue.

  1. the higher its content, the worse the manifestation of pathology.
  2. Blood pressure exceeds 140/90 mm Hg. Art.
  3. Edema - when protein is found in the urine, they indicate preeclampsia.

The disease affects most organs: kidneys and liver, heart, placenta and nervous system. Perhaps the formation of permanent hypoxia, which leads to intrauterine growth retardation.

In the initial stage of gestosis (toxicosis), women vomit up to several times a day. There is constant nausea, loss of appetite, desire to eat spicy and salty foods. Bouts of vomiting do not affect weight. The temperature is within normal limits. These symptoms appear in the first months of pregnancy, then disappear on their own.

Rarely, vomiting may stop and then become indomitable (more than 20 times per day). The patient is weakened, has aversion to food, the pulse is thready, the blood pressure drops. Acetone and protein are found in the urine. IN serious cases temperature rises sharply, arrhythmia is possible.

At the end of pregnancy, preeclampsia develops gradually. Initially, dropsy is formed, over time, nephropathy develops, then severe forms: preeclampsia, eclampsia. In the case of dropsy, women develop swelling due to fluid retention. At this time, latent and visible edema occurs. Given the slowdown in diuresis, body weight increases very quickly.

The tumor is noticeable in the ankle joint, then spreads higher. Noticeable swelling of the face. By evening, limbs swell and Bottom part belly.

Three symptoms of preeclampsia with nephropathy:

  • edema;
  • protein in the urine;
  • hypertension.

A woman may have any combination of symptoms. Nephropathy occurs simultaneously with dropsy. Elevated diastolic pressure is dangerous, it reduces placental blood flow. The fetus does not receive oxygen. Later, nephropathy can turn into a serious complication - eclampsia.

Preeclampsia affects the central nervous system. In addition to the three main symptoms of preeclampsia, there is heaviness in the back of the head, pain in the abdomen, head, nausea, and vomiting. A pregnant woman experiences visual impairment (flying flies), memory, insomnia.

Symptoms of preeclampsia:

  • pressure more than 160/110 mm Hg. Art.;
  • decreased urine output (< 500 мл), свертываемость крови хуже из-за снижения тромбоцитов, заметно нарушение функционирования печени.

Eclampsia is the worst phase of preeclampsia. A woman may experience painful seizures. Light and any sharp sounds are annoying, it lasts for several minutes, after which loss of consciousness is possible. There is a danger of developing a deep coma - this threatens placental abruption, bleeding, fetal hypoxia and premature birth. The life of the fetus is in danger.

It should be noted that with preeclampsia, for some time, the pregnant woman feels good, complaints only of slight swelling, weight gain. Nevertheless, edema is formed not only in the limbs. The placenta suffers from it - this worsens the supply of oxygen to the fetus.

Preeclampsia during pregnancy is a serious condition, the first symptoms are the reason for an immediate visit to the doctor.

Diagnostics

Laboratory tests and patient complaints help determine the condition of the pregnant woman. For the diagnosis is carried out:

  • coagulogram, which determines the time of blood clotting;
  • blood test (biochemistry and general);
  • changes in body weight indicators;
  • urinalysis (biochemistry and general);
  • fundus examination;
  • blood pressure dynamics;
  • the volume of the allocated liquid, taking into account its consumption;

To determine the condition of the fetus, ultrasound and dopplerography are prescribed. Clarification of the diagnosis is carried out by consultations with a nephrologist, therapist, ophthalmologist and neurologist.

It is advisable to hospitalize the patient at any stage of pregnancy. This is necessary to maintain the functions of the body systems and successful childbirth.

Outpatient observation is allowed only with stage 1 dropsy. In the case of the development of nephropathy, preeclampsia and eclampsia, hospitalization is mandatory. Termination of pregnancy ahead of schedule is carried out according to vital indications.

Therapy is aimed at preventing the development of complications and the formation of intrauterine disorders in the fetus.

To do this, normalize the work:

  • nervous system;
  • determine the state of the vascular wall;
  • improve blood circulation;
  • normalize water-salt metabolism;
  • reduce viscosity and increase blood clotting;
  • regularly monitor the dynamics of blood pressure;
  • normalizes metabolic processes in the body.

The duration of treatment directly depends on the severity of gestosis. A mild form will require a two-week stay in a hospital, an average degree requires a long stay. In difficult cases, the pregnant woman will have to remain under daily supervision until delivery.

Preterm birth is carried out if observed:

  1. Lack of positive dynamics from therapy with persistent nephropathy (moderate severity).
  2. If the expected effect is not noted during resuscitation in the first 2 hours.
  3. Violations in the development and growth of the fetus (with nephropathy).
  4. Eclampsia, the risk of complications.

Preeclampsia of the second half of pregnancy requires constant medical supervision. Independent childbirth is allowed only if the woman is in a satisfactory condition, there are no disorders in the fetus and if positive results therapy. In all other cases, a caesarean section is prescribed.

Consequences of preeclampsia

A pregnant woman is threatened with a deterioration in the work of the kidneys and heart, do not exclude pulmonary edema. Hemorrhages in the internal organs are possible.

Preeclampsia is dangerous placental abruption during pregnancy, lack of oxygen and nutrients to developing fetus. This threatens developmental delay, dangerous fetal hypoxia.

Prevention of gestosis during pregnancy

If a woman has diseases of the internal organs, they begin preventive measures from the second trimester of pregnancy.

The importance of:

  • proper rest and sleep;
  • balanced diet;
  • physical activity;
  • daily walks;
  • restriction of salt, and sometimes fluids.

Women with predisposing factors are required to be registered with women's consultation at an early stage of pregnancy and follow the doctor's instructions. Be sure to undergo all laboratory tests to monitor the condition. Medicines are prescribed only if there is concomitant diseases and individual scores.

To plan next pregnancy after preeclampsia, it is possible at any time, as soon as the woman feels strength and opportunity in herself. It is impossible to predict how the pregnancy will develop. Worth considering previous experience, evaluate risk factors and find a gynecologist you can trust.

In pregnant women, edema often appears on the body. This occurs against the background of a violation of the removal of excess fluid from the body and may not be a serious pathology. But in some cases, swelling indicates serious illness, which is called gestosis of pregnant women. If the patient or the doctor does not sound the alarm in time, preeclampsia can be complicated by conditions that end in death.

Gestosis and its varieties

Preeclampsia (late toxicosis) is a disease that develops only during pregnancy and is characterized by the appearance of serious organic and functional disorders in many body systems, but most often in the cardiovascular system. Usually, in pregnant women, late toxicosis occurs after the 20th week of gestation, but is clinically detected after the 26th week. Up to a third of all pregnancies are accompanied by gestosis of one degree or another, and the woman's condition returns to normal only after childbirth has occurred. The most severe preeclampsia is observed in women suffering from endocrine pathologies, diseases of the kidneys, liver, heart, blood vessels.

The classification of preeclampsia is primarily based on the forms of its course:

  1. dropsy of pregnant women;
  2. preeclampsia;
  3. eclampsia.

All forms of late toxicosis can sequentially flow into one another, ending in the most severe of them - eclampsia. Preeclampsia can be concomitant (in women with a history of severe pathologies) and pure (in healthy pregnant women). Foreign classification divides gestosis into 3 forms:

  • arterial hypertension of pregnant women;
  • preeclampsia;
  • eclampsia.

This classification puts in separate lines transient hypertension in pregnant women and preeclampsia, layered on existing hypertension. Another classification is based on the differentiation of preemplaxia by degrees (mild, moderate, severe).

Why do pregnant women develop preeclampsia

Late toxicosis is a syndrome of multiple organ failure, which is caused by a violation of the mechanisms of adaptation of the body to pregnancy. It is believed that the immediate causes of gestosis are associated with an autoimmune reaction of the body to the release of certain substances by the placenta and fetus. These substances, reacting with their own cells immune system form complex antibody complexes. They damage the walls of blood vessels, making them permeable. In addition, these causes lead to generalized vasospasm, which disrupts the blood supply to internal organs. Due to angiospasm, blood pressure rises and the total volume of circulating blood decreases. The viscosity of the blood increases, blood clots appear, hypoxia of the tissues of the kidneys, brain, and liver is detected.

Presumably, the above processes in the body of a pregnant woman can be combined with a change in the hormonal regulation of the functioning of vital organs. There is also genetic predisposition to gestosis. The causes of preeclampsia are also associated with a failure of the nervous regulation of the activity of organs and systems.

There are a number of factors, the impact of which is considered predisposing to the development of preeclampsia during pregnancy. Among them:

  • diseases of pregnant women in history, including pathologies of the heart, liver, nervous system, metabolism, gallbladder, kidneys;
  • having autoimmune diseases and allergic reactions at the time of pregnancy;
  • bad habits;
  • severe stress;
  • excess body weight;
  • violations of the structure of the genital organs, their underdevelopment;
  • poisoning, intoxication;
  • polyhydramnios, hydatidiform drift.
According to statistics, symptoms of preeclampsia often occur in women over the age of 35 and under 18, in socially unprotected women with poor living conditions and nutrition. Preeclampsia can develop after abortions performed at short intervals or during multiple pregnancies.

Gestosis in the first half of pregnancy

Preeclampsia in pregnant women can occur even on early stages bearing a fetus. Early toxicosis (preeclampsia) is more often detected from the first weeks and has a variety of symptoms. The woman notes nausea, vomiting, changes in taste and smell, nervousness, tearfulness. Early mild toxicosis can cause vomiting up to 3-5 times a day. The average severity of toxicosis has more severe symptoms: vomiting is observed up to 7-10 times a day, there is a pronounced weight loss. After the development of a severe degree of toxicosis, a woman urgently needs hospitalization, since indomitable vomiting is combined with an increase in body temperature, a drop in pressure, pulse, a sharp weight loss, the appearance of acetone and protein in the urine. If early preeclampsia has not disappeared by the end of the 1st trimester, a comprehensive examination of the woman for pathology of the internal organs should be carried out.

Gestosis in the second half of pregnancy

If early preeclampsia is dangerous due to dehydration and impaired fetal development, then late toxicosis is an even more serious condition. Already by the presence of rapid weight gain, the appearance of edema and protein in the urine, the doctor may suspect preeclampsia in pregnant women. Later, as a complication, an increase in blood pressure is added, which occurs in about 30% of women with preeclampsia. The danger of toxicosis in the second half of pregnancy is that its signs can quickly turn into a serious condition - eclampsia, which is very dangerous for the life of the mother and child. Late toxicosis often develops during the first pregnancy, and its symptoms can increase hourly and have a very aggressive course. Sometimes only an emergency birth can save the life of an expectant mother.

Gestosis during the second pregnancy

Women who have experienced severe preeclampsia during pregnancy have high risk development of pathology during repeated gestation of the fetus. If the interval between pregnancies is small, then the risk of preeclampsia is even higher. Usually, expectant mothers from the risk group are placed in a hospital in advance, or their health status is monitored on an outpatient basis from the first weeks of pregnancy.

Clinical picture of preeclampsia

As a rule, on later dates Pregnancy signs of preeclampsia are associated with the appearance of edema (dropsy). They can be implicit and are detected by rapid weight gain (more than 400 grams per week). As the pathology develops, edema becomes noticeable on the legs, feet, abdomen, face, hands. Edema is especially visible in the second half of the day.

Preeclampsia in pregnant women at the stage of dropsy is due to a decrease in urine output and a violation of the outflow of fluid. At the same time, other signs of pathology are often absent, and the woman may feel well. Later, thirst, severe fatigue, heaviness in the legs join.

At the stage of nephropathy during pregnancy, proteinuria (the presence of protein) is detected in the urine, blood pressure increases (from 135/85 mm Hg). An uneven, spasmodic fluctuation of pressure during the day is diagnosed. The amount of urine excreted by a woman falls sharply, despite the consumption of a large volume of fluid. If at this stage there is no necessary treatment, the symptoms of gestosis increase rapidly and can develop into pathologies such as eclampsia and preeclampsia.

Preeclampsia is a complication of nephropathy in pregnant women, accompanied by severe circulatory disorders and damage to the nervous system. In addition, the patient has small hemorrhages in the retina, liver, stomach. Preeclampsia has the following clinical features:

  • heaviness in the head, pain, dizziness;
  • nausea, vomiting;
  • pain in the abdomen, stomach, ribs;
  • sleep disorders;
  • visual dysfunction due to damage to the retina.

Treatment for preeclampsia must be urgent and most often includes artificial childbirth and intravenous administration medicines. Otherwise, there is a high probability of developing a pathology such as eclampsia. Signs of this condition:

  • severe pain in the body without a clear localization;
  • headache;
  • convulsive seizures;
  • loss of consciousness;
  • coma.

Eclampsia is often expressed in convulsions that last for several minutes and cause severe tension in the body, face. Foam with blood may be released from the mouth, breathing becomes intermittent, hoarse. During this period, a pregnant woman can quickly die from a massive cerebral hemorrhage. After consciousness has returned, the woman may again fall into a state of seizure due to exposure to any stimulus (sound, light). If the state of eclampsia was diagnosed in late pregnancy, even with successful delivery and saving the life of a woman, internal organs and systems are damaged. Their treatment in the future will depend on the complexity, magnitude and severity of the course.

Consequences and complications of preeclampsia

Preeclampsia is always a serious test for both mother and child. Retinal detachment in preeclampsia leads to irreversible blindness or permanent visual impairment. The functioning of the nervous system, kidneys, liver worsens, blood clots form, heart failure develops. Preeclampsia and eclampsia can cause complications that threaten a woman's life - severe dehydration, stroke, bleeding during internal organs, dropsy of the brain, pulmonary edema, acute liver dystrophy. The baby can also die due to placental abruption and hypoxia and suffocation developing in connection with this. General indicator perinatal mortality against the background of preeclampsia reaches 30%. Even mild form gestosis causes disturbances physical development fetus due to hypoxia, as well as the appearance of mental abnormalities after childbirth. Due to the very serious consequences, the prevention of preeclampsia and its early detection are of high relevance.

Gestosis after childbirth

As a rule, childbirth quickly alleviates the condition of the pregnant woman. Preeclampsia most often improves symptoms within 48 hours after delivery, but eclampsia may develop within the same period. In this regard, after childbirth, drug prophylaxis further complications. If the signs of preeclampsia do not disappear 14 days after delivery, this means the presence of damage to the internal organs and systems. Such patients need long-term, sometimes life-long treatment of emerging pathologies.

Diagnosis of preeclampsia

If there is a rapid weight gain (from 400 grams per week), the specialist should conduct an examination of the pregnant woman in order to identify signs of preeclampsia. It includes:

  • general analysis of urine, blood;
  • blood biochemistry;
  • urinalysis according to Zimnitsky;
  • regular weighing and pressure measurements;
  • fundus examination;
  • fetal ultrasound;
  • Ultrasound of internal organs.

A woman must consult a nephrologist, ophthalmologist, neuropathologist, and, if necessary, a cardiologist. If latent edema is detected due to excessive weight gain, an MCO test is performed (subcutaneous injection of saline and fixing the time during which it resolves).

Mild Preeclampsia in Pregnancy

Preeclampsia in late pregnancy can present with varying degrees of severity. With a mild degree, a woman has the following indicators:

  1. arterial pressure periodically rises to 150/90 mm Hg;
  2. the concentration of protein in the urine is not higher than 1 g / l;
  3. visualized swelling on the legs (lower leg, foot);
  4. the platelet count reaches 180 * 109 l;
  5. creatinine in the blood is not more than 100 μmol / l.

At this stage, the pregnant woman is placed in a hospital, her movement is strictly limited, and drug treatment is performed. If the condition worsens, an operation is performed - childbirth by caesarean section.

Preeclampsia of moderate severity in pregnant women

Moderate preeclampsia is characterized by the following indicators:

  1. blood pressure rises to 170/110 mm Hg;
  2. proteinuria not higher than 5 g/l;
  3. edema is found on the legs, on the anterior part of the peritoneum;
  4. platelet count - 150-180 * 109 l;
  5. creatinine in the blood - 100-300 micromol / l.

At this stage, urgent delivery by caesarean section is indicated.

Severe preeclampsia

Severe preeclampsia occurs with severe symptoms (vomiting, headache, etc.). At any moment, this condition turns into eclampsia, but sometimes the last degree of preeclampsia develops atypically, when there are no visible causes and signs of it. Therefore, if moderate edema does not disappear after treatment within 3 weeks, the disease qualifies as severe preeclampsia. Her diagnostic criteria are:

  1. blood pressure over 170/110 mm Hg;
  2. proteinuria - from 5 g / l;
  3. edema is found on the legs, anterior part of the peritoneum, on the face, hands;
  4. platelet count - 120-149 * 109 l;
  5. creatinine - from 300 micromol / l.

Features of pregnancy management with preeclampsia

If the treatment of preeclampsia or observational tactics do not lead to an improvement in the woman's condition, delivery is planned, regardless of the duration of pregnancy. On the contrary, if laboratory parameters and clinical signs have improved, then the pregnant woman continues to remain in the hospital under close observation. Mandatory appointment special diet, bed rest, pressure control up to 6 times a day. A woman is weighed twice a week, control drinking regime and the amount of urine excreted. Urine and blood tests are also regularly performed, examinations are carried out by narrow specialists. Thus, the treatment and prevention of preeclampsia often help to bring the pregnancy to 28-38 weeks and safely carry out delivery. Childbirth by caesarean section is planned in the absence of the effect of therapy.

Nutrition of the expectant mother with gestosis

The diet of a pregnant woman should provide her and the baby with all the necessary nutrients, but the amount of food should be limited. In other words, you should not exceed the norms for the caloric content of the diet established for pregnant women. The diet for preeclampsia must necessarily include animal protein (fish, meat, dairy products, eggs), which is lost in the urine. We must not forget about vegetable fiber, but sweets and salty, refined, fatty foods better to exclude. Treatment of preeclampsia necessarily includes limiting salt and fluid intake (up to a liter per day). Instead of water, it is better for a future mother to drink diuretic teas, a decoction of lingonberry leaves, bearberry. The pregnant diet excludes the consumption of pickles, marinades, salted fish, etc.

Treatment of preeclampsia

Except diet food, fluid restrictions and bed rest pregnant women are often prescribed medication:

  1. sedative preparations of plant origin (valerian, motherwort);
  2. herbal diuretics (canephron, cystone), synthetic diuretics (lasix);
  3. magnesium preparations for removing excess fluid from the body (magne B6, magnesium sulfate intravenously);
  4. vitamin and mineral complexes;
  5. medicines to improve placental circulation(actovegin, chimes);
  6. drugs of the latest generation that lower blood pressure (valz, physiotens, etc.);
  7. preparations to improve the functioning of the liver (chophytol, Essentiale).

Outpatient treatment is carried out only in the initial degree of preeclampsia - dropsy. All other stages of the pathology require the placement of a pregnant woman in a hospital. In severe cases, a woman is prescribed emergency therapy with drugs that reduce blood pressure, anticonvulsants, and after stabilization of the condition, immediate delivery is performed.

The influence of preeclampsia on the methods and timing of delivery

Independent childbirth is allowed if the treatment of preeclampsia was successful, the condition of the fetus and the pregnant woman herself is not satisfactory, and there are no prerequisites for development acute preeclampsia during childbirth. In other cases, operative delivery is indicated. Indications for preterm birth are:

  • persistent nephropathy of moderate, severe degree;
  • failure of gestosis therapy;
  • preeclampsia, eclampsia (including complications of eclampsia).

Childbirth in severe cases of late toxicosis is carried out within 2-12 hours, which depends on the period of normalization of the woman's condition after the onset drug therapy. Childbirth with gestosis moderate are planned in 2-5 days from the start of treatment in the absence of its effectiveness.

How to prevent gestosis

Prevention of preeclampsia should be carried out in every pregnant woman after the end of the first trimester. Particular attention should be paid to women with multiple pregnancies, women over 35 years of age and with a history of chronic diseases of the internal organs. To prevent gestosis, the following measures are taken:

  • organization of the daily routine and proper nutrition;
  • regular but moderate physical activity;
  • frequent exposure to the open air;
  • limiting salt intake;
  • observation by an obstetrician-gynecologist during the entire period of pregnancy;
  • treatment, correction of chronic pathologies;
  • rejection bad habits.

At the first sign of fluid retention in the body, you need to notify the doctor about this, who will do everything necessary to maintain the health of the mother and the birth of a strong baby!

Lecture #5

Topic 1.112. Nursing care in the pathological course of pregnancy: preeclampsia, extragenital pathology

Lecture plan:

1. Topic update

2. Definition of the concept: "preeclampsia of pregnancy", causes, clinical manifestations, principles of treatment and prevention;

3. Different kinds extragenital pathology during pregnancy;

4. Principles of treatment and prevention of preeclampsia and extragenital pathology in pregnant women.

5. Application medications in accordance with the rules for their use;

6. Nursing care in the pathological course of pregnancy: preeclampsia, extragenital pathology

Educational goals:

  • To acquaint students with the definition of the concept of "preeclampsia of pregnancy";
  • Build knowledge about the causes clinical manifestations, principles of treatment and prevention of preeclampsia and extragenital pathology.

Relevance of the topic: IN last years significantly increased the role of the nurse, which makes special requirements to her education, knowledge and practical skills. A nurse from a technical executor of doctor's prescriptions turns into an independent thinker, able to analyze the purpose and results of any procedure, as well as to predict possible complications.

During pregnancy, a woman's body undergoes significant functional changes that normally do not go beyond the physiological. In case of non-compliance with hygiene, diet or extragenital diseases of a woman, pregnancy often becomes pathological.

Lecture summary

Main types obstetric pathology.

1. Diseases of the maternal organism arising in connection with the pregnancy itself (developing fetal egg) - early and late gestoses.

2. Diseases caused wrong development fertilized egg - bleeding I and II half of pregnancy.

Bleeding in the first half of pregnancy associated with abortion or miscarriage , violation ectopic pregnancy, chorionepithelioma .

Bleeding in the second half of pregnancy is associated with pathology of the placenta

ü placenta previa (lateral or marginal placenta previa - the placenta is located in the lower segment of the uterus, close to the pharynx; full presentation placenta - the placenta completely covers the pharynx)

ü premature detachment of a normally located placenta (PONRP)

3. Diseases that are not causally related to pregnancy and that occur during pregnancy (hepatitis, influenza, anemia), or become aggravated during its development (exacerbation of chronic pyelonephritis) - extragenital pathology.

4. Obstetric pathology also includes pelvic anomalies (its various forms and degrees of narrowing).

5. Wrong positions fetus (transverse and oblique).

6. Incorrect presentation of the fetus (pelvic)

7. Complications of childbirth :

Anomalies of labor activity - primary and secondary generic weakness, discoordinated generic activity, excessive or violent labor activity.

Untimely outpouring amniotic fluid:

ü premature;

ü early;

o belated.

8. Bleeding during childbirth (in 1,2,3 and earlier postpartum periods) may be associated with pathology of the placenta, poor contractile activity of the uterus, ruptures: of the uterus, cervix, vagina, perineum, vulva.

9. Pathological conditions fetus and newborn:

Fetal hypotrophy;

Fetal hypoxia;

Hemolytic disease newborn

Preeclampsia - there is a disease of adaptation of the maternal organism to the presence of a growing gestational sac in the uterine cavity. This is a disease that occurs during pregnancy and goes away with its end.

Gestosis of pregnant women occurs only in humans and is the result of one reason - the presence of a fetal egg in the uterus. Clinically, gestosis manifests itself in various forms. This is due to the fact that the adaptive abilities of everyone are different: in some women, the adaptation of the body to new conditions (pregnancy) occurs quickly and completely, in others it is slow and imperfect.

Classification of gestoses.

By date of occurrence:

  1. Early gestosis(toxicosis) (I half of pregnancy):

Salivation

Vomiting of pregnant women

Uncontrollable vomiting of pregnant women

  1. Late gestosis(second half of pregnancy):

Dropsy

Nephropathy

Preeclampsia

Exlampsia

rare forms gestoses:

  • Bronchial asthma pregnant women
  • Jaundice in pregnancy
  • Dermatoses of pregnant women
  • Osteomalacia in pregnancy

Factors predisposing to the occurrence of gestosis are:

1) factors contributing to a decrease in the reactivity of the body;

2) extragenital pathology;

3) pregnancy under the age of 18 and age primiparous after 35 years;

4) overweight;

5) multiple pregnancy;

6) genital infantilism;

7) unbalanced nervous system;

8) early preeclampsia during this pregnancy;

9) preeclampsia of the 1st and 2nd half of pregnancy in history;

10) genetically determined vascular pathology.

All women with these factors are allocated to the group increased risk by gestosis.

Gestosis of the first half of pregnancy.

Drooling (ptyalism) appears in the first 2-3 months of pregnancy and often resolves without treatment by the end of the 3rd month of pregnancy. In more severe cases, a woman loses up to 500-1000 ml. saliva per day. Profuse salivation leads to dehydration of the body, a depressing effect on the psyche of a pregnant woman, causes moceration of the skin of the lips and corners of the mouth.

Problems:

1) constant flow of saliva;

2) violation of a comfortable state;

3) sleep disturbance;

4) disability;

5) change in the skin of the lips.

Treatment: in mild cases, treatment is possible on an outpatient basis, in severe cases, the pregnant woman is hospitalized.

  1. Careful care for oral cavity: rinsing with a decoction of oak bark, sage, chamomile;
  2. The skin in the corners of the mouth is smeared with petroleum jelly;
  3. Sucking mints - reduces salivation;
  4. With significant dehydration - infusion therapy, vitamin therapy.

Vomiting pregnant(in the morning on an empty stomach), from 5-10 times a day or more.

Distinguish:

1. mild degree vomiting - up to 5 times a day. The pregnant woman retains most of the food, general state almost does not suffer, sleep is not disturbed, blood pressure and pulse are normal. Weight and diuresis are not significantly reduced.

2. Vomit medium degree gravity- 5 - 10 times a day. The pregnant woman retains part of the food, there is a moderate weight loss, weakness, fatigue, decreased blood pressure, tachycardia, subfebrile condition, sleep disturbance.

3. Severe (excessive, uncontrollable) vomiting Occurs after every meal. The pregnant woman does not hold food, there is an aversion to food, weight progressively decreases, the skin is flabby, dry - skin turgor decreases, the tongue is lined, from the mouth bad smell, blood pressure is reduced, tachycardia 100-120 beats per minute, subfebrile temperature, sleep disturbance, protein and acetone in the urine.

Problems and violated needs will depend on clinical form:

2) vomiting + insomnia;

3) vomiting + insomnia + anxiety;

4) a disturbed need to be clean.

As a rule, after the 12th week of pregnancy, the manifestations of early preeclampsia either completely disappear or significantly decrease.

Treatment: with 1 degree of vomiting - outpatient, with 2 and 3 degrees - in a hospital.

  1. Therapeutic-protective regimen and psychotherapy;
  2. Electrosleep - regulates the relationship between the cerebral cortex and the subcortical centers, where the vomiting center is located;
  3. Diet - thermal, chemical and mechanical sparing and fractional nutrition In 2 hours. At 3 degrees - parenteral nutrition.
  4. Effects on the nervous system (sedative therapy)
  5. Fight against dehydration, intoxication (infusion therapy, antiemetics)
  6. Restoration of metabolism and functions of the most important organs (vitamin therapy).

When conducting drug treatment pregnant women with gestosis in the first half of pregnancy should be careful, given the possible embryotoxic effect. The terms of recovery depend on the thoroughness of the implementation of the doctor's prescriptions and the usefulness of the care. The test that determines the effectiveness of treatment is the stabilization or increase in body weight, normalization of body temperature and blood pressure, positive daily diuresis, decrease or disappearance of vomiting, decrease and disappearance of acetone in the urine. Upon recovery, the pregnant woman should be on special records, as relapses are possible.

The consequences of preeclampsia during pregnancy can be very serious: up to placental abruption and fetal death. Therefore, women who are carrying a baby so often have to take tests. The purpose of these research procedures is to identify signs of a serious condition on early stages for timely correction of the situation, while pathological changes have not yet had time to harm the health of the mother and child.

Preeclampsia during pregnancy is a complication that significantly increases the risk of perinatal death, threatens the life and health of a woman and practically guarantees problems in childbirth. IN Lately this diagnosis is made by about 30% of expectant mothers.

The period of bearing a child is a kind of test of the state of the body. At this time, hereditary features and chronic diseases about which the woman had no idea before. The body due to the presence of certain defects and " weaknesses» can not cope with the load, violations develop in vital organs and systems.

Preeclampsia is usually diagnosed in the third trimester of pregnancy. However, the process of occurrence pathological changes in the body begins earlier - at the 17-18th week.

Specialists distinguish 2 types of gestosis:

  • clean. It develops in expectant mothers who do not have a history of serious diseases;
  • combined. Diagnosed in women suffering from hypertension, kidney and liver diseases, various pathologies endocrine system and other chronic ailments.

Early gestosis during pregnancy, or the so-called early toxicosis, is considered the norm, a kind of adaptation of the body to a new state, but still requires special control by the woman herself and the doctors. If the pathology develops after 20 weeks, they are already talking about gestosis of the 2nd half of pregnancy. It is he who causes the greatest concern.

Causes of preeclampsia

There are several opinions explaining the causes of the onset of the disease. There is no single explanation yet. Most likely, in each specific case one of the theories or a combination of several versions is correct:

  • the cortico-visceral version connects disorders that provoke gestosis in the circulatory system with malfunctions in the regulation between the cortex and subcortex of the brain, resulting from the body getting used to pregnancy;
  • the hormonal theory blames the occurrence of a state of disruption in the work of the adrenal glands, deviant production of estrogens or hormonal insufficiency of the placenta;
  • immunogenetic theory suggests that preeclampsia in late pregnancy is nothing more than an inadequate response of the mother's immune system to fetal proteins alien to it, as a result, the body tries in every possible way to reject foreign body. There is another immunogenetic version, the proponents of which believe that, on the contrary, the maternal organism, in response to the antigens coming from the placenta into the bloodstream, does not produce antibodies in sufficient quantities, as a result, defective complexes circulate in the bloodstream, which have Negative influence, first of all, on the kidneys;
  • theory of inheritance: if a woman’s mother and grandmother suffered from a serious condition, then this fate is unlikely to escape her, and therefore special attention should be paid to disease prevention.


If experts have not yet come to a common opinion about the causes of preeclampsia during pregnancy, then they are unanimous about risk factors.

The chances of making a diagnosis are greatly increased by conditions such as:

  • obesity;
  • endocrine pathologies;
  • diseases of the liver and kidneys;
  • diseases of the cardiovascular system;
  • allergic reactions.

There are special categories of women who are at risk. The occurrence of gestosis is most likely in:

  • pregnant women under 17-18 and over 33;
  • women bearing more than one child;
  • women whose nervous system is exhausted by frequent stress;
  • women who suffered from preeclampsia during previous pregnancies;
  • pregnant women, abusing alcohol, smoking and drugs;
  • pregnant women from a social risk group who receive malnutrition and live in unfavorable conditions;
  • women whose pregnancies have not passed at least 2 years;
  • women who frequently have abortions or have a history of pre-conception miscarriages.

If future mom did not suffer from preeclampsia, bearing her first child, then the chances that he will manifest himself in an existing pregnancy, are small. If a pregnant woman has a history of serious illness or belongs to a risk group, attention to her condition by specialists should be increased.

Gestosis: what happens in the body?

The basis for the occurrence of preeclampsia during pregnancy is vascular spasm. As a result, the total volume of blood circulating in the blood vessels decreases, the nutrition of organs and cells is disrupted. This leads to the fact that they begin to cope poorly with their work.

First of all, brain cells, as well as kidneys and liver, suffer from insufficient blood supply. Such a situation turns into a disaster for the placenta. It cannot function normally, which threatens the fetus with hypoxia and, accordingly, developmental delay.

Symptoms and stages of gestosis

It should be borne in mind that signs of preeclampsia during pregnancy can have varying degrees of severity. It happens that a woman feels great, but tests indicate that a condition that threatens her health and the life of the fetus develops in the body.

The following stages of development of gestosis are distinguished:

  • dropsy (or swelling);
  • nephropathy;
  • preeclampsia;
  • eclampsia.

Edema during preeclampsia can also be hidden - in this case, the specialist suspects too much weight gain in the patient. And sometimes the woman herself suddenly begins to notice that wedding ring he dresses with difficulty, and the elastic bands of the socks leave rather deep grooves on the ankles.

There is a simple method for detecting edema - you need to press your thumb on the skin. If a light trace remains in this place for a long time, then swelling is present.

The ankles are usually the first to swell. Then dropsy spreads upwards. Sometimes swelling even reaches the face, changing its features beyond recognition.

Dropsy, depending on the prevalence, is classified into stages:

  • Stage 1 - only the feet and legs swell;
  • Stage 2 - swelling of the anterior abdominal wall is added;
  • Stage 3 - legs, stomach, face and hands swell;
  • Stage 4 - generalized edema (all over the body).

The second stage of preeclampsia, nephropathy, is manifested by such signs as:

  • swelling;
  • protein in the urine;
  • increase in blood pressure to 130\80 and above.

Rise, and especially sharp fluctuations in blood pressure - alarm symptom preeclampsia during pregnancy, indicating insufficient blood supply to the placenta, which leads to oxygen starvation fetus and threatens its death, premature detachment, the occurrence of bleeding.

The appearance of protein in the urine indicates the progression of nephropathy. The kidneys cease to cope with the load, diuresis decreases. How longer period nephropathy, those less chance for a successful pregnancy outcome.

In the absence of proper treatment, nephropathy flows into the next stage of preeclampsia, characterized by a generalized disorder of the blood supply to the central nervous system - preeclampsia.

The symptoms of this condition are:

  • flies or fog before the eyes;
  • diarrhea;
  • vomit;
  • pain in the head and abdomen;
  • heaviness in the back of the head;
  • sleep and memory disorders;
  • lethargy and apathy, or, conversely, irritability and aggression.

Along with this, the pressure continues to rise (up to 155/120 and above), the amount of protein in the urine increases, diuresis decreases, the proportion of platelets in the blood decreases and its coagulability decreases.

The fourth and most dangerous stage of late gestosis during pregnancy is eclampsia. Most often, this condition is manifested by convulsions - they can be provoked by any stimulus: a loud sound, light, awkward movement.

It all starts with twitching of the eyelid and facial muscles. Then the seizure gains momentum and reaches its climax, when the patient literally convulses, losing consciousness. The non-convulsive form of eclampsia is considered even more dangerous, when a pregnant woman is due to pathological processes And high performance pressure suddenly falls into a coma.

Eclampsia threatens with such serious consequences as:

  • stroke;
  • retinal disinsertion;
  • strangulation of the fetus;
  • hemorrhages in the internal organs (primarily in the liver and kidneys);
  • swelling of the lungs and brain;
  • coma and death.

Diagnosis of preeclampsia

If a woman registers in a timely manner and does not miss scheduled visits to the doctor, preeclampsia will not go unnoticed. Modern medical practice provides for regular testing and examination of patients. Based on the results of these research procedures, signs indicating the development of a dangerous condition are revealed.

So, suspicions may arise when deviations from the norm are detected during such medical events, How:

  • weighing a pregnant woman (fears cause an increase of more than 400 grams per week, although everything is individual here: you need to take into account both the duration of pregnancy and the weight of a woman when registering);
  • urinalysis (even traces of protein are a reason for a more detailed examination);
  • examination of the fundus;
  • measurement of blood pressure;
  • analysis of the ratio "volume of fluid drunk: excreted urine";
  • blood coagulation analysis;
  • general blood analysis.

If an accurate diagnosis is made, it is necessary to monitor the condition of the fetus, carried out by means of ultrasound + Doppler. For periods after 29-30 weeks - CTG. At the same time, the woman is additionally observed by narrow specialists: a nephrologist, a neurologist, an oculist.

Treatment of preeclampsia

Timely treatment of preeclampsia during pregnancy increases the chances of a successful outcome and delivery naturally. Patients with nephropathy of any severity, preeclampsia and eclampsia are placed in a hospital.

At the same time, therapeutic measures are aimed at normalizing the water-salt balance of the pregnant woman, as well as harmonizing metabolic processes, the activity of the cardiovascular and central nervous systems.

Complex medical procedures includes:

  • bed and semi-bed rest;
  • exclusion of stressful situations;
  • food enriched with vitamins;
  • physiotherapy with a calming effect;
  • drug treatment carried out in order to normalize the functions of organs and systems of a pregnant woman and support a fetus suffering from hypoxia.

In the absence of improvement during treatment or, moreover, the progression of a dangerous condition, we are talking about early delivery. In this case, the presence of a child in the womb becomes more dangerous than its birth prematurely.

As for mild preeclampsia during pregnancy, accompanied only by edema and weak pronounced signs he is being treated on an outpatient basis. In other cases, the patient needs round-the-clock supervision of specialists, because at any time the disease can begin to progress rapidly.

Prevention of preeclampsia

Women at risk should pay special attention to the prevention of preeclampsia during pregnancy. And you need to start acting even at the stage of planning a child, that is, before conception: to be examined in order to identify and eliminate pathologies, give up bad habits, drink special vitamin complexes etc.

When pregnancy occurs, it is necessary to register as soon as possible. When the condition of the pregnant woman is under the control of specialists, many problems can be identified and eliminated even at initial stages. Patients often have to take tests and visit a antenatal clinic, where they are weighed and pressure is measured every time.

The following simple measures are excellent prevention of preeclampsia:

  • limiting the amount of fluid you drink and salt consumed (especially in the second half of pregnancy);
  • full sleep for at least 8 hours;
  • adequate physical activity;
  • walks in the open air;
  • avoidance of stress;
  • complete food rich in vitamins and correct mode nutrition (better little by little, but often).
  • fatty, salty and spicy should be excluded from the diet - this is an additional and not at all required load on the liver.

According to individual indications, drug prophylaxis can also be prescribed.

Preeclampsia is a condition that threatens the life and health of the mother and fetus. It is dangerous that there may not be visible signs of the disease. A woman feels great, and at this time pathological changes occur in her body.