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mild preeclampsia. Preeclampsia in pregnancy - what is it? Preeclampsia in pregnancy: symptoms, causes and treatment

Most women are familiar with such a concept as preeclampsia, that is, toxicosis that occurs on recent months pregnancy. This problem can become more severe and progress to a more severe and health-threatening condition known as preeclampsia in pregnancy. If you know the symptoms of this problem and take timely measures to cure it, you can avoid the development of eclampsia, a more severe form of the disease that poses a danger to the life of the mother and child.

Preeclampsia- This is a pathology that occurs during pregnancy, in which blood pressure rises, and. Every year more and more pregnant women suffer from this disease. To date, the incidence of preeclampsia is 7-15%.

greatest danger exposed to women who are prone to arterial hypertension and predisposed to diseases of the cardiovascular system.

Preeclampsia during pregnancy - consequences and risks

The chance of developing preeclampsia usually increases with increasing gestational age. Most often she occurs in the 2nd or 3rd trimester.

What is dangerous given state for mother and child? High blood pressure leads to the fact that the blood supply to the placenta deteriorates, the fetus and nutrients which adversely affects its normal development. For the mother, preeclampsia is also extremely dangerous - it impairs the performance of the kidneys, liver and central nervous system. nervous system including the brain.

In especially severe cases this disease can cause loss of consciousness against the background of severe convulsions, and sometimes even hemorrhage in the liver. If the convulsions are very severe, seizures may follow one after another, and a pregnant woman may not regain consciousness for hours. This phenomenon is extremely dangerous, since the result of such deep attacks can be a coma, accompanied by swelling of the brain, which often leads to a stroke.

Seizures are not a necessary symptom of preeclampsia. They don't happen to everyone. Some women may experience only blurred vision and headaches. A pregnant woman falls into a coma only with a sharp jump in blood pressure. Exactly because of this reason preeclampsia syndrome should be carefully monitored and take timely measures to prevent seizures.

Causes of Preeclampsia in Pregnancy

At present, science no explanation found for preeclampsia pregnant. It is only known that this disease almost always occurs after.

Were identified risk factors that contribute to the development of this state:

In addition, the likelihood of developing preeclampsia increases if a woman is carrying twins or triplets, and also if this problem has already occurred in a previous pregnancy.

Symptoms of Preeclampsia in Pregnancy

Symptoms of this disease can be:

  • violations of visual function - clouding in the eyes, veil, pupil dilation, black dots before the eyes;
  • sleep problems - insomnia or constant drowsiness;
  • fatigue, dizziness, headaches that do not go away even with
  • the use of analgesics;
  • pressing pains in the chest area;
  • nausea, sometimes vomiting;
  • swelling in the hands or feet, itching, hyperemia;
  • increased temperature of the extremities (hyperthermia);
  • dry cough, runny nose, hearing loss;
  • frequent and shallow breathing.

If two or more of these symptoms appear, urgently seek medical attention. If this problem is not treated with due attention, convulsions will begin to occur, often leading to a coma, which is extremely dangerous for the health of a woman and for the life of a child.

Any woman in position needs see a doctor regularly. At each examination, blood pressure is checked, as well as urine and blood tests.

In order to detect signs of preeclampsia in time, it is necessary to take the following tests:

  • blood test for hemostasis;
  • tests to check the level of liver enzymes;
  • tests indicating the content of uric acid, urea and creatinine in the blood;
  • urinalysis - if it contains protein, then the likelihood of preeclampsia is high.

Unfortunately, preeclampsia is not treatable. You can only keep it under control, as well as prescribe therapy that will alleviate the condition of a sick woman.

With mild forms of the disease the pregnant woman is prescribed bed rest, with regular visits to the doctor. It is recommended to avoid heavy physical work and stress, to minimize walks and walk less, and to completely exclude any sports. Reducing physical activity helps increase blood circulation in the uterus, resulting in improved fetal health.

If preeclampsia occurs in severe form, a pregnant woman is hospitalized and prescribed a course of drugs to reduce blood pressure. Before term, corticosteroid therapy is usually used to help the baby's lungs develop faster.

If pregnancy has exceeded, operative delivery may be indicated for severe preeclampsia. It's already enough long term so that the fetus can exist outside the womb of a woman, without endangering the health of the mother.

If preeclampsia is not treated on time, it can lead to a complication called HELLP syndrome. It is characterized by very high maternal and perinatal mortality.

It is characterized by symptoms such as: vomiting, severe cutting pains in the upper abdomen, aggressive emotional condition, bouts of dizziness, weakness in the body.

The danger of this syndrome is that its signs can only be noticed if the woman is at a gestational age exceeding 35 weeks.

When this HELLP syndrome occurs, the symptoms of preeclampsia increase dramatically, which is fraught with the development of the following disorders in a pregnant woman:

  • destruction of red blood cells in the blood (hemolysis);
  • low platelets (thrombocytopenia);
  • increased activity of liver enzymes.

Sometimes HELLP syndrome may appear after the birth of a child. In this case, the doctor prescribes therapy using pressure-lowering drugs, as well as means to prevent seizures. Sometimes a blood transfusion may be needed. If the syndrome is detected before the onset of childbirth, the only measure to save a woman's life is to terminate the pregnancy by caesarean section.

In one out of two hundred women with preeclampsia, this disease can develop into more severe condition - eclampsia, which is characterized by frequent bouts of convulsive seizures, sometimes turning into a coma. Of course, this condition poses a great danger to both the mother and the developing fetus.

The main symptoms of eclampsia: edema, hypertension, excretion of protein in the urine, symptoms of lesions of the central nervous system - convulsions and coma.

Determine upcoming seizure it is possible for sharp headaches, visual impairment and painful spasms at the top of the abdomen. But it is not always possible to predict the next seizure - more often they occur without any symptoms preceding them.

For treatment and prevention of eclampsia prescribe rest and no stress on the body and nervous system and minimize the risk of new attacks. The only way to avoid seizures– be constantly under control in a medical institution.

For prevention and treatment eclampsia during pregnancy in women who have preeclampsia, magnesium sulfate is recommended.

Since the risk of developing eclampsia is very high in the case of pre-eclampsia, any pregnant woman with this problem should undergo regular check-ups with a doctor, which will be about. If the condition worsens and the likelihood of developing eclampsia appears, the issue of early delivery will be decided.

Prevention of preeclampsia in pregnancy

There are several things you can do to help reduce your chances of developing preeclampsia. elimination of risk factors this disease. For example, if there is excess weight, before planned pregnancy care should be taken to reduce body weight.

If you have hypertension, get treatment to normalize your blood pressure. Women suffering from diabetes will need to visit an endocrinologist and consult on methods for a successful pregnancy.

  • Regularly visit a gynecologist who monitors the course of pregnancy. If the doctor gave a referral to other specialists, be sure to visit them. In case of deterioration of health, you should consult a doctor outside the next period, i.e. unscheduled.
  • If your doctor has prescribed any medications, do not skip taking them.
  • Follow all the doctor's recommendations and prescriptions regarding the daily routine, diet, rest, etc.
  • According to some studies, a course of taking calcium supplements and small doses of aspirin can reduce the possibility of preeclampsia. But it is highly not recommended to make a decision on such measures on your own - first you need to consult a gynecologist.

Video about preeclampsia in pregnancy

This video explains in detail about preeclampsia during pregnancy, as well as its complication - eclampsia. You will learn about the signs and causes of this condition, risk factors and treatments.

The greatest danger of preeclampsia consists in the fact that in some cases it almost does not manifest itself in any way initial stages. A woman does not feel much discomfort when writing off discomfort on preeclampsia, and meanwhile the disease continues to develop, threatening the transition to a more severe form. Have you met with a similar condition? What sensations did you experience at the same time and what methods of treatment were used? Share your experience in comments.

Classification, symptoms, causes and treatment of the disease

Re-eclampsia is one of serious illnesses, which can significantly harm the health of the child and mother. Often it occurs in pregnant women in the second and third trimester or in the postpartum period and is based on a severe increase in blood pressure, kidney damage and other health problems.

Recently, the increase in the incidence of preeclampsia has increased from approximately 7% to 20%. Most women fail to identify the disease until its active development.

Often a woman confuses the signs of preeclampsia with a difficult pregnancy. If in any doubt, you should immediately consult a doctor. To reduce the risk of similar condition should be diagnosed and prevented before pregnancy.

Risk factors

To protect yourself from the occurrence of preeclampsia, you should regularly undergo medical examination, especially if you belong to those categories of women who are most at risk of developing the disease during pregnancy.

These factors do not have a clear impact on the possibility of developing preeclampsia, since each case is individual. But even if a pregnant woman does not fall into the risk zone, the disease can manifest itself.

Main risk factors:

  1. Childbirth for the first time (with fear of age up to 18, and also after 35 years);
  2. The appearance of preeclampsia earlier in the woman herself or her relatives (mother, grandmother, sister);
  3. Multiple pregnancy(twins, triplets, etc.);
  4. Obstetric complications (cystic drift, fetal dropsy);
  5. Diseases of the cardiovascular system (arterial hypertension);
  6. Diabetes;
  7. Obesity;
  8. Kidney disease (chronic pyelonephritis, polycystic kidney disease, etc.);
  9. Autoimmune and allergic diseases(arthritis, asthma and various allergies).

Symptoms of the disease

If the disease is not treated on time, it can lead to serious consequences. Since preeclampsia can be expressed in three conditions, the symptoms for each of them are different.


Mild preeclampsia is characterized by the following features:

  • pressure increase up to 160/90 mm Hg;
  • mild edema (feet, shins, hands);
  • moderate proteinuria (urination with a lot of protein).

Middle form:

  • increase in pressure up to 170/110 mm Hg. Art.;
  • the occurrence of problems with the kidneys, urination becomes weaker;
  • increased creatinine in the blood;
  • distribution of edema to the anterior abdominal wall, arms.

Severe degree of the disease (most dangerous):

  • pressure increase above 170/110 mm Hg;
  • severe edema(swelling of the face, arms and legs, stuffy nose, etc.);
  • proteinuria;
  • headache and heaviness in the temporal region;
  • strong pain in the area of ​​the right hypochondrium;
  • nausea, vomiting;
  • decrease in the amount of urine;
  • blurred vision (flashes of light, blurred and blurred vision);
  • decrease in reaction or, conversely, overexcitation;
  • rarely jaundice.

The pathogenesis of preeclampsia: how the disease proceeds

To date, there are more than 30 causes and theories of the occurrence of preeclampsia. In some cases, such a disease can cause severe convulsions and lead to eclampsia.

Eclampsia is the most dangerous form disease that occurs in the absence of proper treatment. Can lead to death of both fetus and mother.

In the development of preeclampsia, vasospasm is important. The reason for this is a violation of the production of hormones that are aimed at regulating vascular tone. In addition, the viscosity and coagulability of the blood increases significantly.

Theories of pathogenesis:

  1. Hormonal
  2. neurogenic
  3. Immunological
  4. Placental
  5. genetic

Neurogenic and hormonal theories explain the appearance of pathologies at the organ level. Genetic and immunological are directed to the cellular and molecular level. However, the theories listed alone cannot exist: they effectively complement each other, but are not mutually exclusive.

Classification

In the international classification of diseases (ICD 10), there are three conditions of preeclampsia: mild, moderate and severe.

  1. Mild (moderate) degree:

    Increased pressure, proteinuria up to 1 g / l. In the analysis, the number of platelets significantly increases (from 180x109 / l). Weak degree preeclampsia is often asymptomatic, thereby preventing the pregnant woman from promptly learning about developing disease. In this regard, throughout the pregnancy, it is worth visiting your doctor more often.

  2. Average degree:

    A large number of protein in urine (about 5 g/l). Platelets increase from 150 to 180x109/l. Creatinine also increases from 100 to 300 µmol/L.

  3. Severe preeclampsia is the most dangerous view:

    The protein in the urine becomes several times more (from 5 g / l), the creatinine level exceeds 300 μmol / l. If on last stage it is ineffective to resort to treatment, the disease can go into eclampsia.


Preeclampsia usually occurs during pregnancy. However, there are cases when the disease appears after childbirth. It manifests itself as follows: pressure rises, migraines appear, headaches and pains in the upper abdomen, vision problems begin, etc. It is also an important factor that there is a rapid weight gain (up to 1 kg per week).

In most cases, the symptoms in the postpartum period do not differ from the symptoms of preeclampsia during pregnancy. Having suffered such a disease, it is necessary to undergo a course of recovery. You should not hope that "after giving birth everything will pass." Unfortunately, the risk of complications, especially in the first 2 weeks after birth, remains high. Therefore, it is necessary further treatment in the hospital, and then on an outpatient basis under the supervision of the attending physician.


Prevention of preeclampsia

To reduce or eliminate the risk of preeclampsia, it is worth taking care of prevention in advance:

  1. Preparation for pregnancy (examination by a doctor, diagnosis of existing diseases).
  2. Effective treatment diagnosed diseases before pregnancy.
  3. Mandatory registration of a woman in the nearest or selected antenatal clinic.
  4. Regular visits to the gynecologist (at least once a month).
  5. Fulfillment of all instructions of the doctor (tests, studies, treatment).

Treatment of the disease

For patients with moderate preeclampsia, the doctor prescribes bed rest. A pregnant woman needs to spend as much time as possible lying on her back. In this position, uterine blood flow and cardiac output increase several times, and therefore the pressure in the mother begins to normalize.

The supine position improves uteroplacental function, has a positive effect on fetal growth and metabolism.

Hospitalization occurs only if the pregnant woman is not able to visit a doctor on her own or observe bed rest at home. However, if the condition worsens and mild preeclampsia develops into severe, patients need to see a doctor immediately.

As for stationary conditions, a similar treatment is carried out, however, the normalization of the condition occurs much faster, since with proper control less chance get complications.

Preeclampsia is a condition that occurs in pregnant women and is characterized by increased, as well as the presence of protein in the urine. In most cases, preeclampsia appears in the second half of pregnancy, closer to the third trimester. Therefore, preeclampsia is referred to as late toxicosis of pregnant women. In exceptional cases, the manifestation of preeclampsia at an earlier date is possible.

Preeclampsia is followed by the most severe form late toxicosis() - eclampsia. Eclampsia is accompanied by convulsions and loss of consciousness. Convulsions begin suddenly and cover the whole body. The danger is that eclampsia can cause coma and even death for both the mother and her mother. born child. What can develop eclampsia before, during, and after childbirth.

Causes of Preeclampsia in Pregnancy

Despite the fact that eclampsia was described in ancient medical treatises, what exactly causes it is not known. In the same way, it is quite difficult to say what exactly led to the development of preeclampsia preceding it, since the exact cause of this condition has also not been completely established. Some experts cite malnutrition and malnutrition among the causes of preeclampsia, high level fat in female body or insufficient blood flow in the uterus.

Main features

Signs of preeclampsia include:

  • main:, protein in the urine, arterial hypertension;
  • additional: rapid weight gain, dizziness, severe headaches, severe nausea and vomiting, abdominal pain, reflex changes, decreased urine volume, visual disturbances, pain in the epigastric region.

But do not be afraid when reading these lines, since swelling during pregnancy does not mean the presence of preeclampsia at all. Pregnancy is characterized by some swelling. But, if the edema remains even after a long rest and, moreover, is combined with the described symptoms and is accompanied by high blood pressure, this is an alarming bell.

Who can develop preeclampsia?

Women at risk for developing preeclampsia include:

  • pregnant for the first time;
  • very pregnant young age(up to 16 years old) or over 40 years old;
  • with the presence of arterial hypertension before pregnancy;
  • with a strong stage of obesity;
  • with diseases: diabetes mellitus, lupus erythematosus, rheumatoid arthritis;
  • with kidney disease;
  • with multiple pregnancy;
  • who have experienced preeclampsia in previous pregnancies;
  • whose mother or sister also had preeclampsia.

Does preeclampsia in pregnancy put the baby in the womb at risk?

Unfortunately yes. With preeclampsia, placental blood flow is disturbed, which leads to the birth of an underdeveloped baby. Moreover, pregnancy complicated by preeclampsia in most cases ends in premature birth. There is also a high risk of having a baby with a variety of pathologies. For example, epilepsy, cerebral palsy, impaired vision and hearing.

How to treat preeclampsia in pregnancy?

There is no specific treatment for preeclampsia. But, in connection with the threat of the transition of this condition into eclampsia, the pregnant woman needs urgent hospitalization. In a hospital, a woman, in order to prevent the occurrence of seizures and lower blood pressure, may be prescribed magnesium sulfate preparations (). The use of magnesium sulfate has been found to halve the risk of developing eclampsia in women with symptoms of preeclampsia. Hydralazine or similar drugs may be used to lower blood pressure. It is also possible to prescribe drugs with anticonvulsant and sedative effects. Especially carefully during this period, the consumption of fluid by a pregnant woman and the volume of urine she excretes are monitored. Also, a pregnant woman is advised to rest as much as possible. During rest, you need to be either lying on your left side, or sitting straight.

Women with mild degree preeclampsia requires careful care and a significant limitation of activity.

If there is a risk premature birth, doctors will do everything possible to prolong the pregnancy and so that the baby will survive. If the gestational age is already approaching the expected date of birth, childbirth is induced artificially. In the case of a very severe form of preeclampsia, immediate delivery is carried out, despite the gestational age, since the slightest delay in this case is fraught with death.

Fortunately, not every case of preeclampsia ends badly. According to statistics, today there is only one in two hundred cases, which turns out to be tragic.

Prevention of occurrence

There is no 100% reliable way to prevent preeclampsia in pregnancy. However, in order to prevent its development, doctors advise during the period of bearing a baby (especially if a woman is at risk) to be as attentive as possible to her body: rest more, not overstrain, eat right and undergo medical examinations on time. It is necessary to regularly take all tests, even such, at first glance, simple as blood and urine tests. Constant monitoring of the level of protein in the urine, as well as blood pressure, will help determine preeclampsia in its early stages. And this, in turn, will ensure the most favorable outcome.

Especially for Olga Rizak

After the 20th week. It is generally accepted that preeclampsia occurs more often in primiparas, but it can also occur in multiparas, especially if there are predisposing factors [twin pregnancies, diabetes, chronic hypertension or change of husband (sexual partner)]. With the development of preeclampsia at the beginning of the 2nd trimester (14-20 weeks), it is necessary to exclude hydatidiform mole and choriocarcinoma.

There are two criteria for preeclampsia:

  1. - the occurrence of hypertension (systolic pressure more than 140 mm Hg, diastolic pressure - more than 90 mm Hg) after the 20th week of pregnancy against the background of previously normal blood pressure;
  2. - the occurrence of proteinuria after the 20th week of pregnancy.

Proteinuria is defined as the presence of 0.3 g or more of protein in 24-hour urine or 30 mg/dL (“+” on the test strip) or more in a properly collected urine sample.

Previously, an increase in systolic pressure by 30 mm Hg was considered a criterion for preeclampsia. or diastolic - by 15 mm Hg. Since a physiological increase in pressure in the third trimester has already been proven, and often there is no data on the exact indicator of pressure before pregnancy, which could be taken as the initial one, at present, an increase to 140/90 mm Hg. is not considered a diagnostic criterion for preeclampsia. Despite this, an increase in pressure should attract attention, it may precede the onset of a full-blown preeclampsia syndrome. Also, preeclampsia is often preceded (accompanied by) generalized. Congestive edema (swelling of the lower extremities) is often noted in normal pregnancy. Edema of the hands and face is more characteristic of preeclampsia, but in the absence of hypertension and proteinuria, they are not considered. diagnostic features preeclampsia.

Depending on the degree of hypertension and proteinuria, as well as the severity of damage to other organ systems, two forms of preeclampsia are distinguished: mild and severe.

A variant of severe preeclampsia is the HELLP syndrome. It develops in women with preeclampsia and manifests as hemolysis, a decrease in the number of platelets, an increase in liver enzymes and a decrease in their number (thrombocytopenia). Unlike typical preeclampsia, HELLP syndrome occurs more often in multiparous women over the age of 25 before the 36th week of pregnancy.

Initially, in 20% of cases, hypertension may not be present, in 30% there is a slight increase in blood pressure, in 50% - a significant increase.

Eclampsia

Eclampsia is the occurrence of tonic-clonic seizures in a woman with preeclampsia, not associated with other causes. Patients with severe preeclampsia are at high risk of developing seizures. However, they can also occur with mild preeclampsia. In addition, eclamptic seizures sometimes precede the classic signs of preeclampsia. The frequency and timing of the development of eclamptic seizures vary significantly, depending on clinical approaches, including the appointment of magnesium sulfate in childbirth to prevent seizures, timely diagnosis and delivery in severe preeclampsia. According to the latest data, 38-53% of eclamptic seizures occur before childbirth, 18-36% during childbirth, and 11-44% after them (usually within 24 hours). When evaluating atypical cases of eclampsia (eg, onset of signs of mild preeclampsia 48 hours postpartum or earlier), it is important to rule out other possible reasons seizures, such as diseases accompanied by convulsive syndrome, hypertensive encephalopathy, metabolic disorders (including hypoglycemia and hyponatremia), CNS hemorrhages, thrombosis, neoplasms and infectious diseases.

pathological anatomy

There are three main pathoanatomical disorders characteristic of preeclampsia and eclampsia:

  1. - insufficient decidualization of the myometrial segments of the spiral arteries;
  2. — endotheliosis of glomerular capillaries;
  3. - ischemia, hemorrhages in many organs as a result of constriction of arterioles.

Normally, trophoblast invasion leads to the replacement of the muscular and elastic layers of the spiral arteries with fibrinoid tissue, which results in the formation of large, tortuous, low-resistance channels penetrating the entire myometrium. In preeclampsia, these changes are limited only to the decidual segments of the vessels, which is expressed by a decrease in the diameter of the myometrial segments of the spiral arteries by 60%. The prevalence of placental infarcts in preeclampsia is much higher.

Typical for preeclampsia (eclampsia) damage to the kidneys is glomerular capillary endotheliosis, which is easiest to detect with electron microscopy. This disorder is characterized by marked edema of the glomerular capillary endothelium and fibrinoid deposition within and beneath the endothelial cells. Light microscopy reveals an increase in the diameter of the glomeruli with their protrusion into the base of the proximal tubules, as well as endothelial and mesangial cellular edema of varying degrees.

A relatively short-term spasm of arterioles (within an hour) can cause necrosis of sensitive parenchyma cells. Prolonged vascular spasm (3 hours) leads to heart attacks in important organs such as the liver, placenta, and brain. The liver may develop periportal necrosis, rare complications of which are subcapsular hematoma and liver rupture. Hemorrhage and necrosis may also occur in the brain. During an ophthalmological examination, narrowing of the retinal vessels is detected, which serves as an indicator of the state of the arterial bed as a whole. An extremely unfavorable sign is retinal hemorrhage, since it may precede similar disorders in other organs.

Symptoms of preeclampsia and eclampsia

Many of the features of preeclampsia and eclampsia can be explained by endothelial dysfunction, vasospasm, and activation of the coagulation system.

sensitivity to angiotensin

One of the first signs of developing preeclampsia is a decrease in the effective dose of angiotensin II administered. In normal pregnancy, the angiotensin concentration required to increase blood pressure by 20 mmHg is increased, while in incipient preeclampsia, the effective dose is reduced.

Weight gain and swelling

Abnormal weight gain and edema occur early and indicate extravascular fluid retention. It is associated with damage to the endothelium and increased vascular permeability, which allows fluid to diffuse through the vascular wall into the interstitial space. Thus, with preeclampsia, fluid retention in the body of a woman often occurs against the background of a decrease in intravascular volume. Hematocrit also increases, which is reflected by hypovolemia and hemoconcentration. That is why the appointment of diuretics is recommended only for pulmonary edema.

Increase in blood pressure

An important symptom is an increase in pressure, especially diastolic, which more accurately reflects changes in peripheral vascular resistance. In the prenatal period, changes in blood pressure may occur several days after onset pathological delay liquids.

Proteinuria

In the antenatal period, proteinuria occurs a few days after the development of hypertension. If the complication first manifests itself in childbirth or immediately after them, proteinuria develops after a few hours or even minutes. Proteinuria in preeclampsia is caused by narrowing of the afferent arterioles and an increase in glomerular permeability.

Kidney Functions

The first sign of kidney dysfunction is an increase in uric acid in the blood. Further, the creatinine clearance decreases and the content of creatinine and urea in the blood increases. Kidney damage can progress to severe oliguria and renal failure.

blood clotting system

The most common disorder is thrombocytopenia.

The number of platelets also decreases during normal pregnancy, but a decrease in their content of less than 100 * 10 * 9 / l is considered pathological, which, with signs of preeclampsia, indicates its severe form. Perhaps the development of DIC-syndrome (especially with premature detachment of the placenta). The combination of hemolysis (H), increased liver function tests (EL) and low platelet levels (LP) - HELLP syndrome may not be accompanied by signs of DIC and indicates severe preeclampsia even with normal blood pressure or a slight increase.

liver function

Vascular spasm in the liver leads to focal hemorrhages and heart attacks, which causes under the ribs or epigastric region against the background of increased liver enzymes (alanine aminotransferase and aspartate aminotransferase). Rarely, liver ruptures are considered an unfortunate complication of preeclampsia, often associated with HELLP syndrome. With severe hemolysis, the concentration of bilirubin usually increases. The activity of alkaline phosphatase is often increased during normal pregnancy, so its increase has no clinical significance, since it is due to the activity of the placenta.

Function of the placenta

Vascular spasm in the uteroplacental complex can lead to placental infarction and decreased uteroplacental blood flow. As a result of this, the fetus develops oligohydramnios or a violation of the heart rate. Widespread placental infarcts can cause retroplacental hemorrhage or placental abruption, which significantly affects perinatal mortality.

Influence on the central nervous system

Various degrees of spasm of retinal vessels manifest visual impairment in the form of clouding, spots in front of the eyes and cattle. Due to ischemia of the optic lobe, sudden loss of vision (cortical blindness) can occur. If the woman's condition is quickly stabilized and delivery is carried out, it is possible full recovery vision. and an increase in reflex excitability (hyperreflexia) indicate involvement in pathological process CNS and may precede seizures.

Diagnosis of preeclampsia

When examining a woman with preeclampsia, it is necessary to clarify the severity of the latter, the condition of the fetus (developmental delay, oligohydramnios, changes in heart rate) and its maturity.

The initial examination should include a thorough history taking, objective examination and laboratory research. In the anamnesis, it is necessary to pay attention to the increase in pressure and the presence of kidney disease in the past, before pregnancy or during previous pregnancies. The woman should be asked about symptoms of severe preeclampsia or its complications, such as headache, visual disturbances, nausea, vomiting, abdominal pain (especially in the epigastrium), and vaginal bleeding. It is necessary to study the data of the exchange card and find out when the first increase in pressure occurred and proteinuria occurred.

Physical examination should focus on assessing blood pressure and weight gain, detecting edema, measuring fundal height, checking reflexes, and qualitative dipstick urine protein testing. In addition, attention is paid to signs of severe preeclampsia, such as pain in the epigastric region or hypochondrium, uterine tenderness, petechiae (associated with a decrease in platelet count), and pulmonary edema. With a severe headache, visual impairment, an examination is recommended.

Laboratory Standard for Preeclampsia

  • , determination of platelet count and LDH activity.
  • With pathological changes - determination of D-dimers in the blood, coagulogram and calculation of the leukocyte formula.
  • Examination of kidney function: determination of the concentration of urea, creatinine, uric acid in the blood; general analysis urine, determination of protein and creatinine content in daily urine.
  • Liver tests: determination of the activity of aspartate aminotransferase, alanine aminotransferase and bilirubin concentration.
  • It is also necessary to assess the condition of the fetus. Evaluation begins with determining his gestational age based on clinical, ultrasound data (if possible). carried out to determine the size of the fetus and IAI, Doppler recording of the resistance index of the umbilical artery and the systolic-diastolic ratio. For diagnostics acute disorders fetal status perform a non-stress test.

Treatment of preeclampsia and eclampsia

The only effective way for the mother to deal with preeclampsia is delivery, but the fetus may be premature. The goals of treatment are to reduce the risk and prevent complications of severe eclampsia in the mother and complications associated with prematurity in the fetus. In mild preeclampsia and a stable condition of a woman without signs of fetal distress, delivery is not performed until the 37th week of pregnancy, while in severe preeclampsia and eclampsia, delivery is performed immediately after stabilization of the condition, regardless of the gestational age of the fetus.

With a preliminary diagnosis of preeclampsia, it is advisable to hospitalize a woman to assess the severity of the disease and the stability of the mother and fetus. If a mild degree of preeclampsia is diagnosed as a result of the initial examination and the condition of the fetus is stable, treatment consists of limiting physical activity and constant monitoring. There is no evidence that chronic use of antihypertensive or diuretic agents prevents the progression of mild to severe preeclampsia and improves fetal outcome. Depending on the circumstances, treatment can be carried out in a hospital or on an outpatient basis. The woman should be monitored with weekly blood pressure monitoring and proteinuria quantification in addition to standard laboratory research. Fetal condition requires monitoring of activity, heart rate and volume amniotic fluid. If the condition of the woman or fetus worsens before the 38th week of pregnancy, delivery is recommended.

If severe preeclampsia is diagnosed at the initial examination, the patient should remain in the hospital until the end of the pregnancy. After the 32-34th week, with stabilization of the condition, delivery is performed. In severe preeclampsia before 32 weeks, the decision to deliver is made on an individual basis after assessing the risk to the fetus associated with prematurity and the potential risk to the mother and fetus if the pregnancy is prolonged. The mother and fetus should be monitored with daily or more frequent monitoring of laboratory parameters and the condition of the fetus. In some cases, stabilization of the condition with the help of bed rest, the appointment of antihypertensive drugs and glucocorticoids for the maturation of the lungs of the fetus softens the course of the disease and allows you to delay delivery in order to prolong pregnancy. If the clinical condition worsens (eg, uncontrolled hypertension, pulmonary edema, signs of HELLP syndrome or coagulopathy, CNS symptoms, placental abruption, or fetal deterioration), delivery is recommended.

Birth management in preeclampsia

In the absence of obstetric indications for caesarean section (weakness labor activity, deterioration of the fetus, headless presentation of the fetus) it is necessary to induce labor. The mother and fetus during childbirth should be under constant supervision. Simultaneously with the control of blood pressure, prevention of seizures is carried out. The risk of developing oliguria, pulmonary edema and thrombocytopenia or HELLP syndrome should be considered.

With fetal IUGR or placental abruption on CTG, decelerations, bradycardia, or other signs of fetal deterioration requiring caesarean section may occur. In most cases, epidural anesthesia is preferred for labor pain relief or caesarean section in the absence of signs of coagulopathy.

Prevention of seizures

Given the risk of seizures and their impact on morbidity, attention should be paid to the degree of CNS excitation. Increased lability of the nervous system is assessed by peripheral reflexes, in particular, knee and ankle reflexes. Prodromal signs of eclampsia in preeclampsia are severe headache and prolonged clonic convulsions.

Prevention of convulsions with magnesium sulfate is prescribed in almost all cases of preeclampsia during childbirth and continues during the first day of the postpartum period (the validity of the use for mild preeclampsia has not been proven). In severe preeclampsia, seizure prevention begins from the moment the woman enters the hospital and continues until the condition stabilizes. If delivery is not planned, the infusion can be stopped, and then resumed in labor and continued within a day after them until the signs of preeclampsia disappear. RCTs have confirmed that magnesium sulfate is the drug of choice for eclamptic seizures because it is effective and results in a reduction in perinatal morbidity. For prevention, both intramuscular and intravenous administration are equally effective, but intramuscular injections are very painful.

Therapeutic concentrations of magnesium in the blood are in the range of 4.8-9.6 mg / dl, but in order to avoid the development of a toxic effect, the dose should not exceed 7-8 mg / dl. Magnesium ions are excreted mainly by the kidneys, therefore diuresis control is recommended. An overdose of magnesium sulfate can have severe and even fatal consequences. To prevent errors during bolus administration, the drug should be administered using an infusion pump. To control the occurrence of a toxic effect, it is necessary to monitor diuresis, deep reflexes and respiratory movements. Clinical assessment is supplemented by regular monitoring of magnesium concentration in the blood (every 6 hours) and blood oxygen saturation using oximetry. With oliguria or an increase in the concentration of creatinine in the blood, the dose of the drug should be halved, and the magnesium content should be monitored every 2 hours. The toxic effect of magnesium sulfate can occur even with normal kidney function. To stop magnesium toxicity, 10% calcium gluconate is administered intravenously at a dose of 10 ml and, if necessary, resuscitation measures are started.

Water balance correction

Accurate records of fluid intake and diuresis must be kept to determine fluid requirements. These patients experience vasoconstriction, interstitial edema, and varying degrees of intravascular volume depletion, resulting in decreased diuresis. In addition, they may be prescribed various infusions, such as magnesium sulfate and oxytocin, which have a direct or indirect effect on diuresis.

Most common mistakes in treatment, fluid overload and excessive salt restriction. Water intoxication is currently rarely recorded. A conservative approach aims to compensate for fluid loss by administering appropriate electrolyte solutions. Due to the versatility of the pathophysiological nature of the disease in the case of refractory oliguria or pulmonary edema, monitoring of central hemodynamics using pulmonary artery catheterization is recommended.

Treatment of eclampsia

Eclampsia is a medical emergency in obstetrics. All professionals caring for pregnant women should be able to recognize eclamptic seizures, promptly initiate resuscitation, and attempt to stabilize the condition. Assistance should be provided by a team of doctors and experienced nurses in a separate delivery room with minimal noise and lighting. As with any seizure, efforts should be made to protect the patient from injury, to release Airways and to eliminate hypoxia, start supplying oxygen through a mask. Every 10 minutes in the lateral position, it is necessary to monitor blood pressure and conduct pulse oximetry. For blood sampling and administration of infusion solutions, a catheter of size 16-18 is installed in one of the veins. The bladder is also catheterized.

Pharmacological stabilization consists of preventing the recurrence of seizures and controlling hypertension. An RCT confirmed that magnesium sulfate is the most effective remedy prevention of recurrent eclamptic seizures and the safest drug for mother and fetus. Intravenous administration of magnesium sulfate for the relief of seizures in eclampsia is similar to the prophylactic use of the drug, but the saturation dose is 4-6 g. The maintenance dose with normal kidney function is also 2 g / h. If diazepam is given in addition to magnesium sulfate, personnel trained in intubation should be prepared to assist in maternal respiratory depression. In general, polypharmacy is undesirable.

Eclamptic seizures often cause fetal bradycardia, which usually disappears after stabilization of the mother's condition and correction of hypoxia. It is extremely important to stabilize the woman's condition before any attempts at delivery. Induction of labor or caesarean section during an attack can exacerbate eclampsia. Delivery (preferably conservative) is carried out after correcting hypoxia, stopping seizures and reducing diastolic pressure to 100 mm Hg.

Prevention

There are no proven methods to prevent preeclampsia. Theoretically, the role of a nutritional factor is assumed, therefore, before conception, it is recommended to change the diet and reduce body weight. The main goals are early diagnosis of the disease, observation of its effect on the condition of the mother and fetus, stabilization of the condition in severe form and delivery in case of high risk maternal or fetal morbidity.

Consequences and outcome

Uncomplicated mild preeclampsia during full-term pregnancy in primiparas has no long-term consequences for the mother. In such patients, the risk of developing hypertension in the future is higher than in any other person. However, if preterm pregnancy is complicated by preeclampsia, the risk of future development cardiovascular disease higher and during subsequent pregnancy, the risk of recurrence of preeclampsia is very high (up to 40%). Women with gestational hypertension are more likely to develop chronic hypertension. Their daughters have a higher risk of developing preeclampsia during pregnancy, suggesting a hereditary predisposition to this pathological condition.

Pregnancy does not affect long-term prognosis in patients with chronic hypertension. Some of the more severe complications of preeclampsia, such as stroke and kidney failure, can be long-term effects for mother. In general, the mortality of women with gestational hypertension depends on the severity of the disease, socioeconomic level and quality of care provided. Currently no effective method prevention of preeclampsia, but high-quality monitoring of pre-eclampsia can prevent its severe complications.

The consequences for the fetus and newborn are the most difficult to predict, since the morbidity and mortality associated with hypertensive syndromes are associated with IUGR, prematurity, acute and chronic RDS of the fetus. All of these complications can have long-term consequences for the central nervous system.

The article was prepared and edited by: surgeon

Eclampsia and preeclampsia - causes, symptoms, consequences - in pregnant women

Stars flashed before my eyes. The head in the temples ached. appeared in the body. Somehow it became bad, and the sensations are strange in the stomach. The kid suddenly fell silent. On the display of the measuring device, the numbers 160 by 100 froze. Lie down, lie down, maybe it will slowly pass. Under no circumstances should you waste your time. Only immediate call emergency assistance can save the baby and the woman, because eclampsia spares no one.

Eclampsia: what is it?

- Pain in the upper abdomen.

2. Objective manifestations or what the doctor will notice

At each standard examination in the antenatal clinic, the doctor checks weight gain, blood pressure and the presence of edema. From the analyzes, the general urine test given the day before is evaluated. According to these data, it is possible to identify manifestations of preeclampsia and preeclampsia:

    - increased blood pressure;

    - pronounced weight gain;

    - the presence of tissue swelling;

    - the appearance of protein in the urine.

Even if only subjective feelings women and high blood pressure it is necessary to call an ambulance and provide emergency assistance to a pregnant woman. If there are edema and protein in the urine, then this further aggravates the severity of preeclampsia.

Eclampsia: how does it manifest itself?

One of the most life-threatening complications for the mother and fetus during pregnancy is manifested by all the symptoms of preeclampsia, which are accompanied by loss of consciousness and convulsive syndrome, expressed as a seizure of convulsions for a period of more than 20 weeks in the absence of epilepsy in a woman before pregnancy. As a rule, this extreme variant of pregnancy complications occurs in cases where a woman is not observed in the antenatal clinic and is extremely irresponsible towards herself and her baby.

Preeclampsia and eclampsia: what are the complications?

1. From the side of the fetus

The first thing to understand is that the baby in this situation suffers very much. In fact, an increase in blood pressure is a spasm of all blood vessels in the body. The blood that carries oxygen to the child ceases to flow to him. The baby is experiencing oxygen starvation which can cause:

    - fetoplacental insufficiency and fetal hypoxia;

    - threatening fetal asphyxia;

    - intrauterine death.

2. On the mother's side

The organs and systems of a pregnant woman with acute vascular spasm experience no less oxygen. Depending on where the blood circulation is disturbed in the body, the following formidable complications can be distinguished:

    - violation of cerebral blood flow with the development of a stroke;

    - visual impairment up to retinal detachment;

    - changes in blood flow in the area and lungs with the development of heart and respiratory failure;

    - violation of liver function with the occurrence of jaundice, destruction of liver cells and the development of liver failure;

    - a change in the functioning of the kidneys, leading to kidney failure and a sharp decrease in the amount of urine produced;

    - violation of blood flow in the placenta, which causes premature detachment placenta and bleeding from the uterus;

    - the development of total intravascular coagulation, which will cause the formation of blood clots anywhere in the body.

Any of these complications can lead to severe pathology and death of a woman, so it is so important to notice and respond to the minimal symptoms of preeclampsia in time.

Preeclampsia and eclampsia: what is the tactic?

1. Help to the obstetric hospital

If a pregnant woman, while at home, feels a headache, flies appear before her eyes, then blood pressure should be measured. For any indicators exceeding the norm (120 to 80), it is necessary to call an ambulance. You don't need to take a blood pressure pill. This will be lost time, which is so necessary to save health and life.

If a woman comes to the appointment women's consultation with complaints, and the doctor discovered that the woman would not be allowed to go home. An ambulance will be called. Before the arrival of emergency help, a woman with preeclampsia must be provided with strict bed rest and treatment to lower blood pressure. The resuscitation team will provide emergency care on the spot, then on a stretcher (a pregnant woman with preeclampsia should absolutely not be moved to a vertical position and led to the car with her own feet) will be taken to the intensive care unit and taken to the perinatal center.

If convulsions suddenly begin, then regardless of who is next to the woman, the following measures must be taken:

    - immediately call for emergency medical assistance;

    - try to protect the woman as much as possible from injuries and injuries, without trying to actively hold her;

    - turn the woman to the left, to prevent the tongue from falling back with respiratory failure and the ingestion of vomit into;

    - at the end of convulsions, use a napkin or handkerchief to clean oral cavity women from vomit so that she can breathe normally.

2. Help in the perinatal center

When a pregnant woman with preeclampsia is admitted to the perinatal center, the first step is to ensure stable blood pressure. Part medicines has already been introduced by the ambulance resuscitator, so treatment is prescribed taking this into account.

Next, you need to quickly assess the condition of the woman and the fetus in order to decide on the method of delivery. It must be understood that the only way to save the life of a woman and a baby is a quick deliverance of a woman's body from pregnancy. The decision on management tactics is made jointly by the obstetrician and the anesthesiologist-resuscitator.

If a woman has a full-term pregnancy, the birth canal is ready, the fetus is in good condition, and blood pressure is stable, then it is possible. Although this favorable combination of factors is very rare.

With a premature pregnancy and the ability to keep blood pressure within normal limits, the medical council may decide to postpone delivery in order to try to prepare the lungs of the fetus as much as possible with the help of special drugs that accelerate the maturation of the lung tissue.

If they are created unfavourable conditions, then the emergency is performed. Indications for operative delivery include:

    - the presence of at least one convulsive seizure;

    - placental abruption with bleeding;

    - threatening asphyxia or severe suffering of the fetus according to the results of ultrasound or according to cardiotocography;

    - edema and hemorrhages in the fundus when examined by an ophthalmologist;

    - symptoms of preeclampsia that do not go away within 6-12 hours of intensive treatment;

    - complications of preeclampsia with the development of renal and hepatic insufficiency.

In addition to delivery, it is necessary to carry out the whole complex of therapeutic measures aimed at preserving the health and life of a woman. This assistance is provided by an anesthesiologist-resuscitator. In the event of a convulsive syndrome with loss of consciousness, the development of severe complications from the vital important organs(heart, lungs, brain) woman is translated into artificial ventilation lungs (IVL) with the implementation of the entire complex of resuscitation medical care.

Preeclampsia and eclampsia: what will happen in the postpartum period?

After the birth of a child, it is necessary to continue treatment, because even in the absence of pregnancy, a seizure can occur. And this risk persists in the coming after. The first week of therapeutic measures are carried out in the intensive care unit or in the intensive care unit. Then it is possible to transfer to the postpartum ward, subject to positive dynamics.

As a rule, if there are complications from the organs and systems of a woman, further treatment is necessary in a specialized hospital (in cardiology, nephrology or neurology). In the future, rehabilitation is carried out on an outpatient basis under the supervision of an obstetrician-gynecologist, a local therapist and a specialized specialist.

Pre-eclampsia and eclampsia: what are the outcomes and consequences?

1. For the fetus

The consequences for the child largely depend on the speed of medical care, which is why it is so important to respond in a timely manner to the first manifestations of preeclampsia. The chances of saving the life of the fetus are very high if, immediately at the first symptoms, ambulance and end up in an obstetric hospital. The baby has an extremely low chance of survival if a seizure occurs away from the maternity hospital, when it is impossible to produce in the next few minutes.

2. For mother

The consequences for a woman can have an impact for the rest of her life. This is especially true of the consequences of the most severe option - eclampsia. Circulatory disorders, even short-term ones, will affect the functions of organs and systems, causing the following diseases:

    - hypertension with constant intake of antihypertensive pills;

    - pathology of the kidneys with the presence of protein and leukocytes in the analysis of urine;

    - pathology of the nervous system due to cerebral hypoxia;

    - pathology of the cardiovascular system with increased risk thrombosis in any part of the body;

    - pathology of the liver with the development of endocrine diseases.

The difficulty is that after undergoing preeclampsia and eclampsia, some of the problems in the body cannot be detected. Latent insufficiency in any organ may gradually manifest itself over at least the next five years. Therefore, one of the strict recommendations for a woman is mandatory contraception, so that the next desired pregnancy occurred no earlier than five years later. And all this time you should be registered with a general practitioner with regular examinations using laboratory and diagnostic methods detection of pathology.

Pre-eclampsia, manifested by certain complaints and increased blood pressure, is a reason to call for emergency help, regardless of the gestational age. The occurrence of a convulsive seizure with loss of consciousness, which are signs of eclampsia, sharply reduces the ability of doctors to save the life of the mother and fetus. Only rendered in a timely manner health care can guarantee a woman the preservation of health and life, and will also give a real chance for the survival of the baby.