Gestosis: symptoms and treatment. Preeclampsia (late toxicosis) in pregnant women: signs, degrees, consequences, treatment

Preeclampsia is a serious complication of late pregnancy, which is why it is also called late "toxicosis". With gestosis, the work of the kidneys, blood vessels and brain of the expectant mother worsens. Its most characteristic signs are an increase in blood pressure and the appearance of protein in urine tests.

An increase in pressure may be imperceptible, but is more often manifested by headache, nausea, blurred vision. Protein in the urine indicates a violation of the kidneys and is often accompanied by edema.

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

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

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

Tendency to gestosis

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

In the second pregnancy, the likelihood of meeting with late toxicosis falls. The easier the first preeclampsia proceeded, and the closer its beginning was to the term of delivery, the less likely it is to repeat. Those mothers who started earlier and had a difficult course, especially if they had to do a caesarean section because of this, are more likely to meet with preeclampsia again.

When the likelihood of gestosis is greater:

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

If preeclampsia was not in the first pregnancy, it is very unlikely that it will be in the second.

Causes of gestosis during pregnancy

Although scientists have not fully established the causes of preeclampsia, it is known that the placenta plays a major role in its development. When there is insufficient blood supply to the uterus (for example, when the uterine arteries are narrowed) or the placenta itself is pathological, it triggers a mechanism for raising pressure to increase blood flow.

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

With edema, water exits the bloodstream into the tissues, which makes the blood thicker and increases the formation of blood clots. Blood clots can clog small vessels and worsen blood flow even more, and thick blood increases pressure. There is a vicious circle.

Signs of preeclampsia

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

The appearance of protein in the urine(proteinuria).
The first and main criterion that indicates kidney damage. Almost never preeclampsia happens without proteinuria, and the stronger it is, the worse. Although the identification of this sign alone does not yet speak of gestosis.

Normally, protein in the urine should be absent.
Small amounts, in the region of 0.033 g / l, in combination with leukocytes, may be a sign of inflammation of the kidneys (pyelonephritis).
0.8 g / l and more rather speak of preeclampsia.
Proteinuria in combination with an increase in pressure over 140/90 always speaks of preeclampsia.

Urine analysis should be taken before each visit to the doctor in the antenatal clinic. If it seems to you that the urine has become cloudy, dark in color or covered with foam, take the test without waiting for the appointed day.

Increase in blood pressure more than 140/90 mm Hg. Art.
This is the second main sign of preeclampsia, which may go unnoticed, or may be manifested by headache, nausea, flies before the eyes, dizziness.

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

In severe cases, untreated high blood pressure can lead to severe damage to the nervous system: loss of consciousness, seizures (eclampsia), and bleeding in the brain (stroke). Such a danger arises when the upper numbers of blood pressure exceed 160, and the lower 110 millimeters of mercury.

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

If you have swelling, it is easy to determine if you do a simple test. With your thumb, press on the inner surface of the lower leg in the region of the bone and hold for a few seconds. If a hole remains at the site of pressure, then there is swelling. Similarly, you can conduct this test on any other part of the body.

Another sure sign of edema is that slippers or shoes have become small, the wedding ring cannot be removed from the finger. In some cases, there are hidden edema. They can be identified by too much weight gain compared to the norm.

Examination for suspected preeclampsia

Analysis of urine . Allows you to identify protein, ketone bodies, leukocytes, bacteria and other elements. This makes it possible to distinguish kidney damage in preeclampsia from pyelonephritis or other diseases.
Blood analysis . Such indicators as hemoglobin play a role (a slight decrease at the end of pregnancy is the norm), hematocrit (blood thickening), platelets, the level of liver enzymes (indicates liver damage in severe preeclampsia).
With . Allows you to assess the development of the baby and recognize his delay in time. Evaluation of blood flow in the uterine arteries using Doppler allows you to give an approximate prognosis for the development of the disease: the worse the blood flow, the greater the likelihood of preeclampsia.
. It is done after the 28th week of pregnancy, at an earlier date it is not significant. Shows the mobility of the baby, the work of his heart and, therefore, the presence or absence of hypoxia (oxygen starvation).

Accurate Diagnosis

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

Video footage

Late toxicosis (preeclampsia), edema during pregnancy.

Preeclampsia or toxicosis is a disease that occurs in women, characterized by a violation of the functions of organs and systems in connection with a developing pregnancy.

Gestoses are the result of a violation of the process of adaptation of the mother's body to a developing pregnancy. Gestoses are fraught with complications for both the mother's body and the fetus.

Gestoses develop only during pregnancy, and disappear after childbirth or termination of pregnancy. Rarely, gestosis causes a pathology that remains even after the end of pregnancy.

Preeclampsia is a fairly common pathology during pregnancy; it develops in 25-30% of expectant mothers. This formidable disease has been the cause of maternal mortality for many years (it ranks second among the causes of death of pregnant women in Russia).

Preeclampsia leads to disruption of the functions of vital organs, especially the vascular system and blood flow.

If preeclampsia develops in a practically healthy woman, in the absence of diseases, it is called pure preeclampsia. Preeclampsia, which has developed against the background of chronic diseases in a woman (kidney disease, liver disease, hypertension, impaired fat metabolism or endocrine pathology), is called combined gestosis.

Preeclampsia can begin both in the first and second half of pregnancy, but most often develops in the third trimester, from 28 weeks of pregnancy.

Causes of gestosis during pregnancy

The causes of preeclampsia are not fully understood and not clarified. Scientists offer more than 30 different theories to explain the causes and mechanism of preeclampsia.

Predisposing factors for the development of preeclampsia may be: insufficiency of adaptive reactions of neuroendocrine regulation; pathology of the cardiovascular system; endocrine diseases; kidney disease; diseases of the liver and biliary tract; obesity; frequent stressful situations; intoxication (alcohol, drugs, smoking); immunological and allergic reactions.

TO risk group on the development of preeclampsia during pregnancy include:

women with overwork, chronic stress (this indicates a weak adaptive ability of the nervous system);
pregnant women under 18 and over 35;
pregnant women who had gestosis during a previous pregnancy;
women with a hereditary predisposition to preeclampsia;
women who gave birth often with short intervals between births or had frequent abortions;
pregnant women with chronic infections or intoxications;
socially unprotected women (malnutrition in pregnant women, poor environmental conditions);
women with genital infantilism (delayed sexual development or underdevelopment of the genital organs and their functions);
women with first pregnancy;
women with multiple pregnancies;
women with bad habits.

Most current versions explaining the reasons for the development of gestosis:
1. The cortico-visceral theory explains the development of gestosis by disturbances in the nervous regulation between the cerebral cortex and the subcortex as a result of the adaptation of the mother's body to a developing pregnancy. As a result of these violations, a failure occurs in the circulatory system.
2. The endocrine (hormonal) theory considers dysfunction of the endocrine system to be the root cause of preeclampsia. But some scientists believe that these endocrine disorders occur already with preeclampsia, i.e. are secondary.
According to this theory, some researchers call the cause of preeclampsia a dysfunction of the adrenal cortex, others - a violation of the production of estrogen hormones (produced by the ovaries), others see the cause of preeclampsia in insufficient hormonal activity of the placenta.
3. Supporters of the placental theory point to changes in the vessels in the uterus and placenta, their tendency to spasms and subsequent disruption of blood flow, leading to hypoxia. The placenta is formed along with the fetus. Up to 16 weeks, it is not sufficiently developed and does not protect the woman from the products formed during the metabolism of the fetus. These substances enter the bloodstream and cause intoxication in a woman, which can manifest itself in the form of vomiting, nausea, and intolerance to odors. After 16 weeks of pregnancy, when the placenta is already sufficiently developed, these phenomena disappear.
4. The immunogenetic theory seems to be the most likely. According to this theory, preeclampsia develops as a result of an inadequate immune response of the mother's body to antigens (foreign proteins) of the fetus: the mother's body tries to reject the fetus, as it were. According to another immunocompetent theory, in the mother's body, on the contrary, antibodies are not produced enough in response to placental antigens constantly entering the bloodstream. As a result, these defective complexes circulate in the blood, which cause circulatory disorders, especially in the kidneys, characteristic of gestosis.
5. The genetic predisposition to preeclampsia is confirmed by the fact that the risk of developing preeclampsia is higher in those women in whom other women in the family (mother, sister, grandmother) suffered from preeclampsia.

The risk of developing preeclampsia is 8 times higher in women whose mothers had preeclampsia compared to other women whose mothers did not have preeclampsia. Studies have shown that daughters develop eclampsia in 48.9% of cases (the eldest daughter more often than the youngest), and sisters develop it in 58% of cases.

Even manifestations of early gestosis or toxicosis, according to the observations of gynecologists, develop in those women whose mothers suffered from toxicosis. If it did not manifest itself in the mother, then the daughter can only slightly rock in the transport, or her sense of smell may become somewhat aggravated.

Most scientists are inclined to believe that when preeclampsia occurs, a combination of several of these causes matters.

The metabolic products of the embryo are not neutralized in the first trimester by the placenta (it is formed from the 9th to the 16th week of pregnancy), they enter the blood of the pregnant woman and cause nausea and vomiting in response.

Due to changes in the woman's body (including hormonal ones), the permeability of the vascular wall increases, and as a result of this, the liquid part of the blood "leaves" the bloodstream and accumulates in the tissues - this is how edema occurs. Both the uterus and the placenta swell, which impairs blood supply and oxygen supply to the fetus.

Due to the thickening of the blood, its ability to form blood clots increases. In order to "push" this thickened blood through the vessels, the body has to increase blood pressure - another manifestation of preeclampsia.

The increased permeability of the vascular wall in the kidneys leads to the ingress of protein into the urine and excretion from the body - proteinuria is also a symptom of preeclampsia.

What is the danger of preeclampsia during pregnancy (consequences of preeclampsia)?

The development of gestosis adversely affects the health of both mother and fetus, and can cause very serious consequences. A woman may experience impaired functioning of the kidneys, lungs, nervous system, liver, visual impairment. Vasospasm and microcirculation disorders, the formation of microthrombi can lead to cerebral hemorrhage, vascular thrombosis, cerebral edema and the development of a coma, pulmonary edema, heart failure, kidney or liver failure.

Indomitable vomiting with gestosis can cause dehydration of a woman's body. Preeclampsia can lead to premature detachment of the placenta, to premature birth, to fetal asphyxia. With preeclampsia of mild and moderate severity, premature births are observed in 8-9%, and with severe preeclampsia - in 19-20% of cases. If preeclampsia passes into the stage of eclampsia, then 32% of children are born prematurely.

The consequences of late preeclampsia in any form are extremely unfavorable for the child. The acute form of gestosis with premature detachment of the placenta can even cause the death of the child. Perinatal mortality in preeclampsia reaches 32%.

Slow preeclampsia leads to fetal hypoxia (insufficient oxygen supply), which, in turn, is likely to cause intrauterine growth retardation. 30-35% of children born from mothers with manifestations of preeclampsia have low body weight. Hypoxia of the fetus subsequently leads to a delay in the physical and mental development of the child. Many children often get sick.

With the most severe form of preeclampsia - eclampsia - urgent delivery (or termination of pregnancy) is the only way to save the life of a woman and a child. Preterm delivery is not always a favorable outcome for a preterm immature baby. Although in some cases, the child is more likely to survive outside the womb.

Ptyalism, or drooling, may occur on its own or may accompany vomiting. Salivation can reach a volume of 1 liter or more per day. At the same time, general well-being worsens, appetite decreases, there may be weight loss, sleep disturbance. With pronounced ptyalism, signs of dehydration may appear.

Usually, early gestoses rarely show an aggressive course. Regardless of the severity of early gestosis, its manifestations should disappear by 12-13 weeks of pregnancy. If the manifestations of toxicosis continue, it is necessary to conduct an examination of the pregnant woman in order to exclude the exacerbation of any chronic disease of the internal organs.

Preeclampsia in the second half of pregnancy (late preeclampsia)

Gestosis of the second half of pregnancy is also called late gestosis (toxicosis). They pose a great danger, because. can lead to serious complications. Most often they develop from the 28th week of pregnancy, but may appear at the end of the first and beginning of the second half of pregnancy. In modern medicine, sometimes late gestosis is called OPG-gestosis: O - edema, P - proteinuria (protein in the urine), G - hypertension (increased blood pressure).

The characteristic triad of symptoms ( edema, protein in the urine, increased blood pressure) may not occur in all women. One of them may also indicate the development of gestosis. Visible for a woman, a manifestation of preeclampsia is only one symptom - swelling. And an increase in blood pressure and protein in the urine can only be detected by a doctor. Therefore, it is so important for a pregnant woman to register for pregnancy in a timely manner and regularly attend a doctor's appointment.

The combination of symptoms in gestosis may be different. Currently, all 3 signs of late gestosis are observed only in 15% of cases, edema with increased pressure - in 32% of cases, protein in the urine and increased pressure - in 12% of cases, edema and protein in the urine - in 3% of cases. Moreover, obvious edema is noted in 25%, and hidden (they are indicated by pathological weight gain) - in 13% of cases.

The first stage of late gestosis – edema, or dropsy pregnant. A woman can notice the appearance of edema by feeling a slight numbness in her fingers. With swelling, it becomes difficult to unbend your fingers and put rings on your fingers.

Puffiness does not always mean the development of preeclampsia. Swelling can be the result of increased production of progesterone (the so-called pregnancy hormone). Edema can also appear as a result of an exacerbation of a chronic disease (varicose veins, heart disease, kidney disease). But to figure out whether edema is a common manifestation of pregnancy, a symptom of a chronic disease, or a symptom of preeclampsia, only a doctor can.

If there is an excessive weight gain in a pregnant woman, and there are no visible edema, then a McClure-Aldrich test can be performed to check the woman: saline is injected subcutaneously and the time it takes for the button to resolve is observed. If it does not become less than in 35 minutes, then there are hidden edema.

If swelling becomes visible, it means that 3 liters of excess fluid is retained in the body. First, the feet swell, then the edema spreads upward, capturing the shins, thighs, abdomen, neck and face. Even if a woman does not experience discomfort, urgent measures must be taken so that preeclampsia does not worsen. It is dangerous to self-medicate and take diuretics, because. this will worsen the situation even more. The condition may worsen at any moment.

The second stage of gestosis – nephropathy- usually develops against the background of dropsy. Its first symptom is increased blood pressure. For a pregnant woman, not only an increase in pressure is important, but also its sharp fluctuations, which can cause placental abruption and fetal death or sudden bleeding.

The third stage of preeclampsia – preeclampsia- is characterized by the fact that in addition to edema and increased pressure, there is also protein in urine. At this stage, severe disorders of the blood supply to the brain can develop, which is manifested by the appearance of a severe headache, a feeling of heaviness in the back of the head, flashing flies before the eyes, nausea and vomiting, visual impairment, memory impairment, and sometimes even mental disorders. There are also irritability, insomnia, lethargy, pain in the abdomen and in the right hypochondrium. Arterial pressure is increased - 160/110 mm Hg. Art. and higher.

The fourth, most severe stage of preeclampsia – eclampsia. Sometimes it, bypassing preeclampsia, develops very quickly after nephropathy. With eclampsia, the function of many organs is impaired, convulsions may appear. Seizures can be triggered by various factors: a sharp sound, bright light, a stressful situation, pain. The attack of spasms proceeds 1-2 minutes. There may be tonic ("pulling" convulsions) and clonic (small muscle twitches). The convulsive attack comes to an end with a loss of consciousness. But there is also a non-convulsive form of eclampsia, in which, against the background of increased pressure, a woman suddenly falls into a coma (loses consciousness).

Eclampsia is fraught with serious complications: placental abruption, premature birth, bleeding, fetal hypoxia, and even fetal death. It is not excluded at this stage the occurrence of a heart attack, pulmonary edema, stroke, renal failure.

Eclampsia is more common in women with their first pregnancy. When predicting the risk of developing eclampsia, genetic factors should also be taken into account. With a mole and multiple pregnancies, the risk of developing eclampsia increases significantly.

In some cases, an asymptomatic or oligosymptomatic course of preeclampsia is possible. But the rapid development of this complication of pregnancy is also possible. Therefore, at the slightest suspicion of preeclampsia in a pregnant woman, delay in examination and treatment is dangerous for the life of the mother and child.

Late preeclampsia can have an unpredictable development. It can progress dramatically, while the deterioration of the woman's condition will rapidly increase every hour. The earlier preeclampsia develops, the more aggressive it is, and the more severe consequences it will have, especially with untimely treatment.

Rare forms of gestosis

Rare forms of gestosis include:

Jaundice of pregnancy: it occurs more often in the second trimester, is accompanied by itching, is usually progressive; can be the cause of miscarriage, fetal development disorders, bleeding. It resumes at the next pregnancy and is an indication for termination of pregnancy. The cause of its occurrence may be transferred in the past viral hepatitis.
Dermatoses: eczema, urticaria, herpetic eruptions; there can only be excruciating skin itching (local or total), causing irritability and insomnia. It occurs more often in people with allergic manifestations and liver pathology.
Acute fatty degeneration of the liver (fatty liver): characterized by the appearance of bleeding, bruising, vomiting, swelling, a decrease in the amount of urine and convulsions. The cause of occurrence is unclear; may be the outcome of other types of gestosis. May be associated with fatty degeneration of the kidneys. It is characterized by a gradual decrease in kidney and liver function.
Tetany of pregnant women: frequent occurrence of muscle cramps, mainly in the limbs. Occurs when there is a lack of calcium due to its consumption by the fetus, in violation of the function of the parathyroid gland, in violation of the absorption of calcium in the intestine and with a lack of vitamin D.
Osteomalacia(softening of the bones of the skeleton) and arthropathy(impaired articulation of the pelvic bones and joints): also associated with impaired calcium and phosphorus metabolism and a decrease in the function of the parathyroid gland. Contributes to the occurrence of this type of gestosis lack of vitamin D.
Chorea of pregnancy: uncoordinated and involuntary movements, emotional instability, mental disorders, some difficulty in swallowing and speech. Occurs with organic lesions of the brain. In mild cases, pregnancy continues and ends in childbirth. In severe cases, termination of pregnancy. After pregnancy, the manifestations of chorea gradually disappear.

Gestosis during the second pregnancy

It is known that with the termination of pregnancy, the manifestations of preeclampsia disappear after a few days. However, after childbirth, it is possible to preserve and even progress the changes that have occurred in the organs and systems of the woman's body. In this regard, the risk of developing gestosis during repeated pregnancy increases.

Women who have undergone preeclampsia during pregnancy are at risk for the development of preeclampsia. The risk increases if the interval between pregnancies is short. Such women should monitor the course of pregnancy and health from the first weeks of pregnancy, regularly and carefully.

However, there are cases when, during the second pregnancy, preeclampsia did not develop at all or proceeded in a milder form.

Management of pregnancy with gestosis

With a gestation period of up to 36 weeks and moderate preeclampsia, the continuation of pregnancy is possible, and it depends on the effectiveness of the treatment. In such a situation, a thorough examination and monitoring of the pregnant woman is carried out in the hospital for 1-2 days. If laboratory data or clinical manifestations worsen in the mother, or if the condition of the fetus worsens, delivery is necessary, regardless of the gestational age. If the dynamics is positive, then treatment and dynamic monitoring of the state of the mother and fetus in a hospital continues.
This observation includes:

bed or semi-bed rest;
control of blood pressure 5-6 times a day;
body weight control (1 time in 4 days);
daily monitoring of the received (drank and administered intravenously) and excreted fluid;
control of protein content in the urine (in a single portion every 2-3 days and in the daily amount of urine every 5 days);
general analysis of blood and urine every 5 days;
oculist examinations;
monitoring the condition of the fetus daily.

With the effectiveness of the treatment of preeclampsia, pregnancy is continued until the very term of delivery or until the period in which a viable fetus is born.

In severe preeclampsia, a more active tactic of pregnancy management is currently being carried out. Indications for early delivery are not only eclampsia (convulsive or non-convulsive) and complications of eclampsia, but also preeclampsia in the absence of the effect of treatment within 3-12 hours, and moderate preeclampsia in the absence of the effect of treatment within 5-6 days. The rapid increase in the severity of a woman's condition or the progression of placental insufficiency are also indications for early delivery.

The severity of preeclampsia and the condition of the woman and fetus determine the choice of method and time of delivery. Preferably childbirth through natural birth canal. But for this, the following conditions are necessary: cephalic presentation of the fetus, the proportionality of the fetal head and the mother's pelvis, the maturity of the cervix, the age of the pregnant woman is not older than 30 years, etc.

With gestosis, anti-stress resistance decreases in both the mother and the fetus. Childbirth with gestosis is stressful for both of them. And at any moment (with fatigue in childbirth, painful sensations, etc.), a woman can suffer from pressure that has risen sharply to critical numbers. This can lead to the development of eclampsia in childbirth, and to impaired cerebral circulation. Therefore, with preeclampsia, childbirth is often carried out by caesarean section (although eclampsia can develop in this case as well).

Indications for delivery by caesarean section with preeclampsia are currently expanded:

eclampsia and complications of eclampsia;
various complications of preeclampsia: acute renal failure, coma, retinal detachment or retinal hemorrhage, cerebral hemorrhage, premature placental abruption, AFGB (acute fatty hepatosis of pregnancy), HELLP syndrome (combined liver damage and hemolytic anemia in nephropathy), etc .;
preeclampsia, severe preeclampsia with an immature cervix;
preeclampsia in combination with other obstetric pathology;
preeclampsia for a long time (more than 3 weeks).

With gestosis in pregnancy after 36 weeks, the continuation of pregnancy already loses its meaning, we are talking only about the choice of method of delivery.

Treatment of preeclampsia during pregnancy

Treatment of early preeclampsia

Nausea, increased salivation and vomiting - the main manifestations of early gestosis during pregnancy - can simply be endured. Some women manage to get rid of nausea and vomiting in the morning if they drink water with lemon on an empty stomach in the morning.

If nausea worries constantly, and vomiting occurs occasionally, then you can try to reduce nausea with tea (with mint, lemon balm or lemon), fruit drinks and juices. In the morning it is better to eat cottage cheese or sour-milk products, cheese - every woman will be able to find acceptable ways to deal with nausea. You can apply mouthwash with infusion of chamomile, sage.

With strong salivation, rinsing with oak bark infusion will also help, taking yarrow infusion 10 minutes before meals and 2 hours after meals.

If the vomiting is indomitable, constant, then you should definitely consult a doctor, as this can threaten the health of both the woman and the fetus. Vomiting occurs in 50-60% of pregnant women, and only 8-10% of them need treatment. We must not forget about a sufficient amount of drinking to make up for the loss of fluid with vomiting.

Medicamentous treatment, including homeopathic remedies, can be used only as prescribed by a doctor and under the supervision of a doctor.

In the case of a severe general condition of a woman (development of acute renal failure or acute yellow liver dystrophy), with preeclampsia in the first half of pregnancy and in the absence of the effect of treatment within 6-12 hours, termination of pregnancy is indicated. And since most often early gestosis develops in the period of 6-12 weeks of pregnancy, the pregnancy is terminated by artificial abortion.

Treatment of late gestosis

Creation of a medical-protective regime. Depending on the severity of the course of preeclampsia, a bed or semi-bed rest is prescribed, sufficient for the duration of sleep. Loud sounds, emotional experiences are excluded. Psychotherapeutic work with a woman is recommended as an obligatory component of treatment. If necessary, the doctor prescribes sedatives (valerian, motherwort with a mild degree of gestosis or more potent drugs with a severe degree).
Proper diet for a pregnant woman: varied, fortified, easily digestible food; restriction of carbohydrates and a sufficient amount of proteins in products; the use of a sufficient amount of fruits and vegetables, juices and fruit drinks. Sometimes it is recommended to eat food lying in bed, in small portions, chilled. Fasting days are not recommended. Limiting fluid, even with severe edema, should not be (contrary to many recommendations on the Internet) - because, on the contrary, it is necessary to replenish the volume of the bloodstream.
Medical treatment is prescribed for the purpose of normalizing the functions of organs and systems of a pregnant woman and preventing or treating fetal hypoxia. Diuretic drugs are practically not used, because. their use additionally reduces the volume of blood flow, thereby disrupting (or further aggravating existing disorders) placental circulation. The only indications for their appointment are pulmonary edema and heart failure, but after replenishing the volume of circulating blood. Vitamins of group B, C, E are prescribed; drugs that improve uteroplacental circulation and reduce the permeability of the vascular wall, lowering blood pressure, and others.
Early delivery. Indications for early delivery and its methods are described in the section "Management of pregnancy with gestosis".

The duration of treatment is determined individually depending on the severity of preeclampsia, the condition of the pregnant woman and the fetus. Treatment for dropsy of pregnant women of the 1st degree is carried out on an outpatient basis, all other cases should be treated in a hospital.

The main condition for the success of treatment is timeliness and professionalism.

Prevention of gestosis during pregnancy

Prevention of preeclampsia (toxicosis) should be taken care of even when planning pregnancy. It is necessary to conduct an examination and consultations of specialists in order to identify the pathology and (if necessary) to carry out treatment. It is also necessary to eliminate bad habits, i.e. prepare in advance for conception.

During the onset of pregnancy, the following measures will serve as prevention of preeclampsia:

Sufficient sleep (8-9 hours a day), proper rest, limitation of physical activity, exclusion of stressful situations and a positive psycho-emotional climate in the family are the most important conditions for the prevention of preeclampsia.
Breathing exercises, special physiotherapy exercises for pregnant women, massage of the neck and collar region and head will balance the processes of inhibition and excitation in the centers of the brain and improve blood oxygen saturation. Will help prevent preeclampsia (toxicosis) swimming, Pilates, yoga, long walks (hiking) in the fresh air.
It is important that the family understand the condition of the pregnant woman and try to alleviate it. For example, if a woman during this period is irritated by pungent odors (husband's toilet water, coffee, garlic, onions, etc.), then you should stop using them.
You should wake up slowly, without making sudden movements. Even in the supine position (even if there is still no nausea), you can eat a piece of black bread or a cracker, kiwi or a slice of lemon, drink a decoction of chamomile.
Nutrition should be complete, but this does not mean that you can eat everything and in unlimited quantities. During the day, food should be eaten often, but in small portions. Food should not be very hot and not very cold.

It is necessary to exclude fried, fatty foods, smoked products, canned food, pickles, chocolate. It is also necessary to limit, and it is better to exclude sweets, muffins, ice cream altogether. It is important to limit your salt intake.

It is useful to use cereals (buckwheat, oatmeal).

A growing fetus needs protein, so a pregnant woman should eat protein-rich foods: lean meats (beef, chicken, veal), eggs, fish, cottage cheese. And if gestosis has already appeared, then the need for proteins is even higher, because. proteins are lost in the urine.

Vitamins will provide the body with fruits and berries, decoctions of dried fruits and rose hips, cranberry juice. We should not forget about fiber - it will cause a feeling of fullness, and will serve as a prevention of constipation. Most fiber in vegetables (carrots, beets), fruits and dried fruits, mushrooms, bran, sea kale, greens.

The recommended amount of fluid per day is at least 2 liters. This volume also includes milk, soups, juicy fruits. You can use alkaline mineral water without gas, tea with lemon balm or mint.
You need to constantly monitor your weight and keep records. After 28 weeks of pregnancy, weekly weight gain should average 350 g, and not more than 500 g. During the entire pregnancy, a woman should gain no more than 12 kg in weight. Excessive or too rapid weight gain may indicate the development of edema.
Difficulties in the outflow of urine contribute to the occurrence of edema and the development of preeclampsia. The uterus in a standing position compresses the ureters and thereby interferes with the outflow of urine. Therefore, doctors recommend that pregnant women stand in the knee-elbow position 3-4 times a day for 10 minutes. You can put a pillow under your chest for comfort. The outflow of urine is improved.
In order to prevent edema, it is recommended to drink kidney tea, a decoction of lingonberry leaves, wild rose, bearberry. You can take herbal preparations such as Cyston, Canephron, Cystenal.
Sometimes doctors prescribe magnesium preparations (Magnerot, Magne-B6), lipoic acid, vitamin E, Hofitol (contributes to the inactivation of substances that destroy blood vessels in the liver), Curantil (improves blood supply to the placenta and is a prophylactic for the development of preeclampsia) for the prevention of preeclampsia.

Preeclampsia: causes, symptoms, consequences, treatment, prevention - video

Pregnancy after gestosis

If a woman's pregnancy proceeded with gestosis, then it is very difficult to predict whether gestosis will occur during the next pregnancy. In each case, you should consult a doctor and analyze the possible causes of preeclampsia.

A woman in this situation is at risk for preeclampsia and needs careful medical supervision from the very first weeks of a new pregnancy.

But the occurrence of preeclampsia in subsequent pregnancies is not inevitable.

Violates the work of a number of systems and organs in the body of a pregnant woman. This condition disappears a few days after the birth of the child. According to research by experts, preeclampsia is more or less typical for a third of pregnant women. The disease often manifests itself between the sixteenth and twentieth weeks of pregnancy, but the third trimester of pregnancy is most characteristic for the onset of preeclampsia. The reason for the manifestation of this pathology is the characteristic changes in the body of the expectant mother, due to which the formation of substances occurs in the placenta that make microscopic holes in the vessels. It is through these holes in the tissue from the blood that protein enters, as well as fluid. It promotes education edema . At the very beginning of the disease, edema cannot yet be seen, however, when weighing, a significant increase in weight is already observed.

Similar micro-openings are also formed in the vessels of the kidneys, through which the protein enters the urine. A general urine test, which a pregnant woman should undergo regularly, facilitates diagnosis and makes it possible to start treating gestosis immediately after the onset of the disease.

Types of preeclampsia

It is customary to distinguish between several types of gestosis in pregnant women. Preeclampsia early , which occurs in the first half of pregnancy, is manifested by nausea, vomiting, often indomitable. The woman has a strong salivation. Preeclampsia late manifests itself in late pregnancy (third trimester). This condition is characterized by manifestations nephropathy , dropsy , preeclampsia , eclampsia . Rare forms of gestosis are also diagnosed, which manifest themselves liver disease , skin , nervous system and others. It is also customary to single out "pure" gestoses that occur in a healthy pregnant woman in the absence of background diseases. "Combined" gestoses manifest as a result of a disease that preceded this pathology. It could be , endocrinopathy , .

Causes of preeclampsia

To date, there is no single exact opinion about the origin of gestosis. However, there are a number of theories that suggest a specific etiology of preeclampsia. Yes, according to cortico-visceral theory gestosis of pregnant women is presented as a certain pregnant, which is characterized by a violation of the interaction between the cortex and subcortical structures. As a result, reflex changes appear in hemodynamics. This theory is confirmed by the fairly frequent manifestation of gestosis as a consequence of nervous stress.

According to immunological theory preeclampsia occurs due to changes in the mechanisms that are responsible for providing transplacental immunity in the body. By genetic theory , those women whose mothers had preeclampsia are predisposed to preeclampsia.

Another theory indicates the relationship between preeclampsia and deficiency in a woman's body. b vitamins And . It is in the third trimester of pregnancy that the body requires much more of the vitamins mentioned. With insufficient intake of them in the body, the concentration in the blood becomes higher. Homocysteine is a very toxic substance for the endothelium. Under the action of this substance, pores appear in the vessels through which the plasma passes into the tissue. The result is swelling, increased pressure in the vessels and a decrease.

According to placental theory in patients with preeclampsia, trophoblast migration is disrupted, resulting in spasm , decrease in intervillous blood flow , . Further, due to hypoxia, the endothelium is affected, there are disturbances in hemodynamics, hormonal background, metabolism .

Symptoms of preeclampsia

With preeclampsia, changes occur in many organs: the functioning of the kidneys and liver, the placenta, and the nervous system are disrupted. May occur hypoxia chronic nature, fetal growth retardation syndromeA .

With early gestosis () in pregnant women, as a rule, vomiting occurs, which can occur many times a day. There is constant nausea, decreased appetite, desire to eat spicy and salty foods. Constant vomiting does not greatly affect the weight of the pregnant woman: it does not noticeably decrease. The temperature remains normal. The rest of the described symptoms are typical only for the first months of pregnancy, later they disappear on their own. In more rare cases, a woman's vomiting does not stop later, while she becomes indomitable. In this condition, vomiting can occur up to twenty times a day, and this happens at any time of the day. The patient loses weight sharply, she develops a persistent aversion to food. The pulse becomes more frequent, blood pressure decreases. At the same time, the analyzes indicate the presence in the urine acetone And squirrel . In especially severe cases, body temperature may rise, manifest and state of delirium.

With late gestosis, the disease develops in stages. First there is dropsy , with time passing into nephropathy , later in preeclampsia And eclampsia . When dropsy occurs in pregnant women, edema appears due to the constant retention of fluid in the body. During this period, both latent and obvious edema can appear. Due to the lower excretion of urine from the body, the body weight of the pregnant woman increases very quickly, urination is more intense at night. Edema, as a rule, initially appears in the ankles, then they begin to spread upwards. Sometimes a woman also has simultaneous swelling of the face. At the end of the day, the legs and lower abdomen look more swollen.

With nephropathy, a woman already has three main symptoms of preeclampsia: pronounced edema, the presence of protein in the urine, periodically manifesting high blood pressure. A combination of any two symptoms may occur. Nephropathy manifests itself against the background of dropsy. In this condition, a high rate is especially dangerous. diastolic pressure, which affects the decrease in placental blood flow. Accordingly, the fetus receives less oxygen. Later, nephropathy can turn into eclampsia, which is a very dangerous condition for a pregnant woman. With preeclampsia, microcirculation in the central nervous system is disturbed. In addition to the three main symptoms of preeclampsia in this condition, there may be a feeling of heaviness in the back of the head, stomach pain, headaches, vomiting, and nausea. A woman's eyesight and memory may deteriorate, sleep may be disturbed. Due to a violation of blood flow in the occipital part of the cerebral cortex, a “veil” may stand before the eyes or a flicker of “sparks” can be observed. Signs of preeclampsia are high systolic BP (from 160 mm Hg) and diastolic blood pressure (from 110 mm Hg). Urine excretion is significantly reduced, the number of platelets in the blood decreases, blood clotting decreases, and liver function is disrupted.

With eclampsia, the most severe stage of gestosis, seizures are observed, while all the functions of systems and organs are disturbed. Convulsions that provoke pain, bright lights, harsh sounds, etc., last for several minutes. After an attack, the woman loses consciousness. Also, after such seizures, a deep one can develop. This may provoke placental abruption , fetal hypoxia And premature birth . This condition threatens the life of the fetus.

It is important to consider that with gestosis for a certain period of time, a woman can feel quite well, complaining only of slight swelling, a noticeable weight gain. However, edema is characteristic not only of the limbs, but also of the placenta, which leads to insufficient oxygen supply to the fetus. Therefore, the described symptoms are an occasion to visit a doctor without delay.

Diagnosis of preeclampsia

The reason for the assumption of such a diagnosis is the presence of the described symptoms in a pregnant woman. The doctor conducts regular examinations and weighs the patient to exclude the presence of edema. Diagnosis of gestosis is carried out taking into account the results of general urine and blood tests. Constant measurement of blood pressure allows you to determine the presence of problems in this direction. Also, in order to make a correct diagnosis, daily diuresis , for which it is necessary to know the ratio of the liquid that was drunk and the one that is released. As a rule, the diagnosis of "preeclampsia" is made in the presence of three symptoms - edema , protein in urine And high blood pressure .

If a woman does not have visible swelling, but the weight is gaining too quickly, then the doctor may Maclure-Aldrich test . To do this, a saline solution is injected under the skin and it is determined over what period the papule will resolve. If this happened faster than thirty-five minutes, there are hidden edema in the body.

Treatment of preeclampsia

If a specialist determines only slight swelling of the legs in a pregnant woman, then treatment can be carried out on an outpatient basis. In the presence of significant edema and protein in the urine, hospitalization and inpatient treatment are necessary. In severe preeclampsia, there is a threat to the life of the mother and fetus. Therefore, treatment is carried out in the intensive care unit or in the intensive care unit.

Without fail, in a hospital, before prescribing treatment, an examination of women is carried out, including blood and urine tests, a study of the condition of the fetus by conducting ultrasound , cardiotocography And dopplerometry .

In the process of treatment, infusion therapy is used to restore the required amount of fluid in the vascular bed and remove fluid from body tissues. It is also important to replace the lost protein. In the presence of elevated blood pressure, apply genital infections. To prevent the development of preeclampsia in pregnant women, it is extremely important to constantly monitor their own weight. To do this, you should not overeat, you should eat food that has a high protein content, significantly limit sweet and starchy foods in the menu. It is very important to consume a sufficient amount of fiber, which is found in vegetables, bran, fruits, and greens. Women who notice that they have gained significant weight should limit their intake of spicy, salty, and liquid foods. So, you should drink no more than 1-1.5 liters per day. An important factor in the prevention of preeclampsia is a good sleep (at least eight hours a day), a positive emotional background.

Another method of preventing preeclampsia is considered to be an active lifestyle. Pregnant women are recommended daily walks, swimming, yoga classes, as well as the implementation of specially designed exercises for a certain period.

The first months of pregnancy are most often accompanied by early toxicosis (gestosis). Nausea and dizziness for many are symptoms of the conception of the fetus. This pathology is quite safe, but still should be under the supervision of a doctor.

Late preeclampsia during pregnancy is a more dangerous disorder that threatens fetal hypoxia and premature birth. If your feet are swollen and your rings are getting small, be sure to check your urine for protein. Treatment of toxicosis in the third trimester takes place permanently.

Causes of gestosis during pregnancy

The reasons for the appearance of signs of preeclampsia throughout pregnancy have not been accurately identified. Scientists offer at least 30 theories about the factors that provoke early and late toxicosis.

Modern gynecologists tend to trust the following versions:

Cortico-visceral. Toxicosis is provoked by disturbances in the work of the cerebral cortex and circulatory disorders. As a result of getting used to pregnancy, late preeclampsia develops.

The second theory links preeclampsia with pathologies of the endocrine system. Due to the lack of hormones, improper functioning of the adrenal glands, ovaries and pathology of the vessels of the placenta, violations of the normal course of pregnancy occur.

immunological version. Proponents of this theory see the root cause of gestosis in the rejection of the mother's body of a foreign fetal protein.

Genetic. If the mother and grandmother had gestosis during pregnancy, there is a high probability of developing pathology.

Placental. Early gestosis of pregnancy develops due to the underdevelopment of the placenta and the ingestion of the waste products of the fetus into the woman's body.

Also, the pathology occurs in women who have become pregnant before the age of 17, who are obese, have kidney and liver diseases. If a pregnant woman abuses alcohol and smokes, is often nervous or does not receive enough vitamins, she will have complications.

Signs of preeclampsia in the later stages

Preeclampsia, which appears at 30-35 weeks, has obvious signs. On examination by a gynecologist, the legs and arms of a woman are necessarily examined, pressure is measured. The main symptoms of toxicosis in late pregnancy:

Edema of the extremities.
The pressure is constantly elevated, increased by 20% of the normal pressure of a woman.
Detection of protein in the urine (proteinuria).

All three symptoms practically do not occur, the presence of only one sign of preeclampsia indicates a pathological course of pregnancy. If even in the first trimester there is an excessive increase in body weight, there is a risk of late toxicosis.

A severe form of preeclampsia is accompanied by fever, general weakness, headaches, nausea, swelling of the limbs, abdomen, face. In this case, the woman needs urgent hospitalization and treatment.

Diagnostics

A pregnant woman must be registered and visit a gynecologist at least once a month. On examination, the doctor notes any changes in health, sends for testing. The main procedures by which gestosis is detected:

general blood and urine tests;
weighing and measuring the volume of the abdomen;
examination of the limbs with pressure on the skin;
pressure measurement, comparison with initial indicators;
blood clotting test.

If the presence of protein in the urine is detected, and the legs and arms become swollen, the woman is sent for an ultrasound of the fetus. When confirming the diagnosis, it is necessary to undergo inpatient treatment, as well as register with a neurologist and nephrologist.

How to treat late gestosis

It is impossible to ignore hypostases of the lower extremities. The pathological condition disrupts the course of pregnancy and threatens premature birth.

Treatment of preeclampsia during pregnancy includes the following medical procedures:

Therapeutic mode. A woman needs to spend more time lying down or reclining, resting and sleeping at least 8 hours a day. Stressful situations are excluded.

Proper diet. The daily menu should contain dishes rich in useful trace elements. Vitamin complexes are prescribed. The amount of fluid consumed is not reduced.

Medical therapy. The drugs are aimed at improving blood circulation in the uterus and placenta, lowering blood pressure. Diuretics are used in extreme cases: diseases of the cardiovascular system, pulmonary edema.

Delivery. In some cases, there is no time to treat preeclampsia, and delay threatens the health of the mother and child.

Depending on the condition of the patient, the obstetrician-gynecologist determines the duration of therapy. If preeclampsia of the 1st degree is detected, the pregnant woman can stay at home, provide herself with bed rest and proper nutrition.

Medical

If a mild degree of severity of preeclampsia is detected, a course of drug therapy is prescribed, which lasts up to 10 days. In case of complicated development of toxicosis, treatment is carried out immediately before delivery and can last from 5 hours to 4 days.

Drugs that will eliminate the signs of pathology:

sedatives to calm the nervous system;
drugs that lower blood pressure;
a dropper with magnesia, to eliminate convulsions, lower pressure;
intravenous blood infusions;
antioxidants that protect the body from toxins;

During treatment, doctors monitor the condition of the fetus, if something threatens his life or health, an emergency caesarean section is performed. Childbirth in a natural way is possible with the effect of therapy and sufficient intrauterine development of the baby.

Folk remedies for gestosis

Treatment of late gestosis at home is possible only in the first two stages of the disease. Folk recipes are used in combination with drug therapy.

Herbal teas. During the day it is useful to drink tea from chamomile and mint.

Decoctions from medicinal collections. Pharmacy fees with sedative and diuretic properties are brewed in the following proportion: 2 tablespoons of grass per liter of boiling water.

Tinctures. A medicine is being prepared on the water, with the addition of coltsfoot, mountain ash, mint, motherwort, plantain, geranium, string.

Traditional medicine prescriptions should be taken with caution. Be sure to consult with your doctor and monitor your health. In any case, the pregnant woman should undergo a medical course of treatment.

Prevention of gestosis during pregnancy

Late toxicosis not only leaves the expectant mother uncomfortable, but also threatens fetal hypoxia and premature birth. To prevent preeclampsia and its negative consequences, doctors recommend taking preventive measures: you can not drink a lot of fluids, as well as salty foods; physical activity should be moderate; full sleep; balanced diet; ensure a calm pregnancy without stress and nervous breakdowns.

For the correct course of pregnancy, it is necessary to lead a moderately active lifestyle. Walk in the fresh air, do gymnastics for pregnant women. Also strictly monitor weight gain, weekly no more than 400 grams.

Complications and prognosis

Mandatory treatment of preeclampsia is associated with possible serious complications that it causes.

If you ignore the symptoms of dropsy, a woman has the following complications:

a sharp increase in blood pressure, coma;
intracerebral bleeding;
manifestations of respiratory failure;
rapid development of renal failure;
placental abruption, premature birth;
failure of the vital systems of the body, coma.

There are also visual impairments, up to complete loss of vision. Deadly complications - HELLP-syndrome and acute fatty hepatosis. Sharp pains in the abdomen, vomiting and nausea in the last months of pregnancy are symptoms of a dangerous condition.

Nephropathy

Nephropathy is the second stage of gestosis and is treated with medication in a hospital. In addition to swelling of the legs and arms, there is an increase in pressure, proteinuria is diagnosed.

The presence of protein in the urine is combined with its decrease in the blood. Proteinuria indicates a violation of kidney function, spasm of the vessels of the placenta and uterus, lack of oxygen to the body of a woman and fetus. Due to constantly elevated pressure or sharp jumps in performance, placental abruption is provoked, which threatens premature birth or death of the child.

Preeclampsia

If left untreated, nephropathy quickly flows into the next degree of preeclampsia - preeclampsia.

In addition to the main symptoms of late gestosis, there are:

signs of intoxication;
headache;
flies before the eyes, dizziness;
lack of air;
insomnia, memory impairment;
behavioral disorder: aggressiveness or indifference.

The woman feels sharp pains in the abdomen and neck. With the appearance of bleeding and pain in the lower back, you need to call an ambulance. Treatment is carried out permanently, depending on the duration of pregnancy, it takes up to 5 to 10 days.

Eclampsia

Eclampsia is the last stage of preeclampsia, in which a pregnant woman has convulsive seizures, the pressure rises to 160/120. Any loud noise or sudden movement can provoke this symptom. Pathology can lead to fetal hypoxia, maternal stroke, internal bleeding, swelling of internal organs, coma, death.

Eclampsia without seizures is also sometimes observed. In this case, the woman immediately falls into a coma. Treatment should be urgent, intramuscular and intravenous drugs are used.

Gestosis during early and late pregnancy is a formidable complication. In some cases, delay in diagnosis and treatment threatens the death of the mother and child. For this reason, the information from this article will be useful not only to women who have already encountered this diagnosis, but also to other future mothers.

What is late gestosis and why is it dangerous? This complication is typical for the second half of pregnancy, more often occurs after the 30th week, and is characterized by disruption of the functioning of various maternal organs, placental insufficiency, fetal growth retardation and hypoxia in it.

Despite the name, in which the word "toxicosis" often appears, the mechanism of occurrence of this pathology and risk factors are different. Moreover, late toxicosis that occurs during pregnancy is much more dangerous than early. The second, the worst, can lead to dehydration and loss of pregnancy. And the first one, the one that is late, in severe cases provokes severe seizures in a woman, which often end in strokes, cerebrovascular accident, coma.

Causes of preeclampsia (late toxicosis)

The main cause of this pathology is directly pregnancy, the fetus, or rather the placenta. In some women, for reasons unknown to science, in the early stages of pregnancy, disturbances in the formation of the placenta, those vessels that connect it with the uterus, occur. And the longer the gestation period, the more obvious the violations that have arisen as a result of this become. The child lags behind in development, has a small weight, a lack of oxygen is diagnosed on CTG. A woman, on the other hand, has signs of arterial hypertension (increased blood pressure) and kidney problems.

There is more than one theory of the occurrence of gestosis. Often it is associated with a deficiency of folic acid (vitamin B9), endocrine pathologies (thyroid diseases, diabetes mellitus), a weak nervous system, and susceptibility to stress. Some honey. the authors generally recommend considering early and late gestosis as a kind of neurosis of pregnant women. Therefore, it is recommended to carry out its prevention with light sedatives.

The cause of early preeclampsia, when it begins to develop at a period of 13-15 weeks, is often a tendency to thrombosis in a woman due to genetic abnormalities - thrombophilia. This is one of the potential risks of developing late toxicosis.

In addition, a negative role is definitely played by:

heredity (if grandmother, mother had late gestosis of pregnant women, then their daughters and granddaughters will certainly have them);
the age of the future mother (more often the pathology occurs in pregnant women under 20 years old and over 35 years old);
diseases of the kidneys, heart, blood vessels, especially complicated during pregnancy;
high blood pressure.

Signs of preeclampsia in the later stages

Often the first "swallow" is a delay in the development of the fetus. At the second, and more often the third screening (ultrasound), the doctor notes that the size of the fetus does not correspond to the gestational age, less than average. Problems with the placenta can be determined, for example, its premature maturation, as well as circulatory disorders in the vessels of the placenta (according to Doppler sonography).

In general, the diagnosis of gestosis during pregnancy is carried out by a gynecologist who leads the pregnancy, based on the following symptoms.

1. Edema. They can be overt and covert. The common ones first appear on the ankles and fingers. However, such swelling may not be a symptom of late preeclampsia, but a variant of the norm. Especially if the swelling is only on the legs, and they appear in the afternoon.

It is bad if the swelling spreads to the whole body, face. And especially if they are already present in the morning, after a night's sleep.

Hidden edema in late pregnancy is manifested by an excessive increase in weight by the expectant mother. That is why doctors carefully weigh the expectant mother at each consultation. They try not to miss gestosis in mommy, as the consequences for the child and herself threaten to be very serious.

If the expectant mother has gained more than 500 grams in 1 week, while she feels good and all tests are normal, the doctor recommends that she spend 1-2 unloading days, follow a diet and drink regimen. And carry out a control weighing in 1-2 weeks.
Many mothers know that in order not to frighten the doctor with the numbers on the scales, you need to eat a little less and drink less in the afternoon the day before the visit to him. And, of course, do not eat up and do not drink water immediately before a visit to the doctor. Going to the toilet before weighing also does not hurt. And don't wear more clothes than usual. Otherwise, the resulting figures will not be informative.

Normally, weight gain per week during pregnancy does not exceed 400 grams. Thus, during the entire pregnancy, a woman gains up to 12 kilograms of weight. A greater number of these kilograms is the weight of the child, placenta, amniotic fluid, increased blood volume. Normally, more fluid is retained in the tissues of the expectant mother than before pregnancy. If a woman does not have excess weight during pregnancy, after childbirth she loses extra pounds within 1-2 months.

Often preeclampsia during late pregnancy is manifested not only by edema, but also by reduced diuresis. That is, a woman drinks quite a lot, but goes to the toilet very little. This is a very dangerous symptom. Doctors advise all patients with edema to measure the amount of fluid drunk and excreted. If there is early gestosis or late, and in a rather severe form, the amount of urine is reduced to 500-700 grams.

2. Protein in the urine. He says that there are problems with the kidneys. But not always. If only traces of protein were found, then, most likely, mommy ate a little more than usual protein foods. Or just poorly washed before collecting urine.

If traces of the protein are also present in repeated analyzes, while the gestation period is still small, say, 10-12 weeks, the pressure is normal, there are no edema, gynecologists usually refer such a patient to urologists. They look at the anamnesis, which shows the ultrasound of the kidneys and prescribe treatment if necessary.
It should be noted that kidney problems - cystitis, pyelonephritis are very common during pregnancy.

If the doctor believes that the patient develops preeclampsia, then she is asked to pass the so-called daily urine test. Usually performed in a hospital setting. During the day, a woman urinates in one container. Then he evaluates and tells the doctor the total volume of urine, mixes it and pours a part for laboratory research.

Pregnancy eclampsia, the most formidable consequence of preeclampsia, usually occurs when the numbers are 2 grams of protein in a daily urine test.

3. Increased blood pressure. In this case, the doctor must distinguish preeclampsia from ordinary hypertension, that is, the condition that the woman had before pregnancy, and was not provoked by her.

If at the reception the patient was found to have a pressure above 130 to 90, she is recommended to control it at home. Measure 2-3 times a day, according to all the rules (in the right position, complete calm) and record the result. It often happens that in women the pressure rises exclusively at the doctor's office, the so-called white coat syndrome. In this case, talking about hypertension or preeclampsia is unnecessary.

With gestosis, the pressure usually rises by about 30 units of the upper one. That is, if the pressure of 110 to 70 is normal for a woman, then with gestosis it rests on the numbers 140 to 90 or more.

If there are no other signs of preeclampsia, the patient is referred to a cardiologist, who can prescribe daily blood pressure monitoring (a special device is attached for a day), an ECG, an ultrasound of the heart, and a pressure-lowering drug approved for use during pregnancy - Dopegit.

There are different forms of gestosis. In Russia, four names are used to clarify the diagnosis:

dropsy (the woman has swelling, hidden or obvious);
nephropathy (high blood pressure, protein in the urine and swelling);
preeclampsia (increased intraocular pressure, headaches, vomiting, nausea, fog before the eyes, flashing flies) - at any moment the last, fourth stage of preeclampsia can occur;
eclampsia (a woman begins to have convulsions, loss of consciousness, the work of various organs and systems is disrupted, a stroke, premature detachment of the placenta can occur).

Research and analysis during pregnancy to detect preeclampsia

1. General analysis of urine. Rented every two weeks, before going to the gynecologist. Or more often if necessary.

2. Blood pressure measurement. At every doctor's appointment, and often at home.

3. Inspection of the fingers and ankles for swelling. The doctor looks to see if there are traces of worn rings, socks.

4. Weighing, dynamic tracking of weight gain. Now almost all antenatal clinics have convenient electronic scales for these purposes.

5. Screening ultrasound and dopplerography. On the first screening ultrasound (11-13 weeks), preeclampsia of the first half of pregnancy (early preeclampsia) is manifested by narrowing of the vessels of the uterus. This indicates a defective formation of the placenta.
At the second ultrasound (20-22 weeks), they look for any lag in the development of the fetus. At 32-34 weeks, the third planned ultrasound is performed, which not only assesses the development of the fetus, but also the condition of the placenta and amniotic fluid.

6. Determination of the concentration of proteins, hormones formed by the placenta. A decrease in the PAPP-A protein and the PIGF hormone at the end of the first trimester of pregnancy indicate placental insufficiency and a probable delay in fetal development. At the same time, obvious violations may not yet be visible on ultrasound.

Prevention and treatment of preeclampsia during pregnancy

If a woman is only concerned about swelling, that is, she still has the so-called dropsy, she is not sent to the hospital, but a diet and a normal drinking regimen are recommended. You don't need to cut back on drinking. You should drink exactly as much as you want. It is also not necessary to limit salt, in the sense that you can add salt to food as before. But it is better to refuse pickles, sausages, chips and other not very healthy products containing a lot of salt.

In the pregnancy pathology department, edema is “treated” with diuretics. And in order not to provoke complications of late gestosis, they make droppers with "magnesia". It also serves as a prevention of premature birth.

In addition, a woman is given light sedatives of plant origin - valerian and motherwort. They are advised to use by expectant mothers in the form of decoctions. But it is also available in tablet form.

Preeclampsia after childbirth gradually subsides, the symptoms disappear. Childbirth is the only cardinal treatment for it. All the rest of the drugs used by doctors are symptomatic therapy aimed at stabilizing the condition of the pregnant woman and monitoring the condition and development of the child. If the doctor sees deterioration, suffering of the child, delivery is performed. The most common is an emergency caesarean section. If the pregnancy is premature, the mother is given dexamethasone injections so that the baby's lungs open after birth.

Specific prevention of preeclampsia during pregnancy, which can be carried out among all expectant mothers, as you might guess, is also missing. After all, the cause of occurrence, the reason for the development of late toxicosis, is not exactly known. However, competent pregnancy planning and timely treatment of exacerbations of chronic diseases and infectious diseases will definitely benefit.

Pregnancy after preeclampsia may well be the same problem, end at the same time or earlier, the woman is at risk for nephropathy.
If she did not have late preeclampsia - this is the usual preeclampsia of the second half of pregnancy, and the one that is called early, it makes sense to talk with the doctor about the prophylactic use of aspirin in small dosages. This is the only way to date to prevent preeclampsia in the risk group.