From what week of pregnancy can preeclampsia begin. Preeclampsia of moderate severity in pregnant women. Degrees and classifications

Gestosis is one of the most severe complications second half of pregnancy. Unfortunately, it is almost impossible to predict the occurrence of this condition; there are no guaranteed ways to prevent the development of preeclampsia today either.

The only effective way to "treat" preeclampsia is to terminate the pregnancy at any time. It is known that gestosis is based on a massive vasospasm, which threatens the life of both the mother and the baby. Let's try to figure out what gestosis is and why it is so dangerous.

What is gestosis?

Spasm (or narrowing) of blood vessels leads to an increase in blood pressure, which in itself can dramatically worsen the condition of a woman. But the main problem is that the vascular crisis occurs simultaneously in many organs and seriously disrupts their work.

The greatest danger in preeclampsia is the inability of the kidneys to fulfill their main job- remove metabolic products from the body of a woman.

This leads to the accumulation in the body of a pregnant woman of unnecessary, waste (in fact - poisonous!) Substances. Naturally, these substances also get to the baby.

On the other hand, vasospasm in the placenta significantly disrupts the supply of oxygen and nutrients to the baby.

Sometimes vasoconstriction occurs instantly and the condition future mother worsens literally before our eyes. Sometimes this is a “veiled”, stretched out process in time, almost imperceptible to either the expectant mother or medical workers.

In the latter case, the child is more or less long time experiencing oxygen starvation, nutrient deficiency, "attack" by toxic metabolic products, so its growth and development slow down.

There are several other extremely problematic moments of gestosis. In constricted vessels, blood circulation slows down, blood clots can form, which finally “turn off” the vessel from work. Depending on the localization of the blocked vessel(s) in a particular zone (area) of the body, the blood supply is disrupted.

In medical parlance, this is called "ischemic stroke." The most severe manifestations ischemic stroke are convulsions and loss of consciousness. By nature, the human body is a self-regulating system. Therefore, as soon as blood clots begin to form in narrowed vessels, the “protection” - the anti-coagulant system - comes into play. The viscosity of the blood decreases, the blood becomes more fluid and stops clotting. At this stage of development of preeclampsia, the risk of heavy bleeding increases dramatically.

It is hardly necessary to explain to anyone that massive bleeding is a direct threat to human life.

Given the insidiousness of preeclampsia, from the moment of diagnosis to the moment of delivery of a woman, ideally, no more than three days should pass. If preeclampsia occurs, delivery is carried out at any stage of pregnancy. Even if it is still far from the intended one, in conditions of preeclampsia, the life and health of the child are under direct threat. Therefore, it is better to “pick up” the baby from the aggressive environment of the mother’s body, and go out in an incubator.

We emphasize once again that when it comes to the life of the mother and child, the gestational age at the time of delivery does not matter. In modern conditions, even very early born children have the opportunity to be healthy, and their mothers - happy. As a rule, the development of preeclampsia falls on fairly long gestation periods - after 30-32 weeks. But there are, of course, exceptions.

The earlier in pregnancy gestosis develops, the more severe it is, and the more rehabilitation measures will be shown to both mother and baby.

Gestosis during pregnancy. Who is at risk?

As the observations of specialists show, gestosis occurs more often in spring or autumn. Perhaps, changes in atmospheric pressure, spring beriberi, or the autumn tendency of some women to a depressive perception of life play a role.

Of course, in order to reduce the number of cases of manifestation of preeclampsia, doctors are trying to identify the so-called "risk group" for the development of preeclampsia. For this, specialists, literally from the very first appointment in antenatal clinic, trying to "paint a portrait" of the expectant mother, asking her a lot of questions about her health and lifestyle.

More high risk compared to other pregnant women have:

overweight or obese women;
women with initially high blood pressure figures or those suffering from hypertension;
women with kidney disease;
expectant mothers suffering from diabetes (including) or other diseases of the endocrine system;
women with autoimmune diseases(antiphospholipid syndrome, systemic lupus erythematosus, rheumatic diseases, connective tissue diseases, etc.)
women with a labile psyche, disorders in the work of the nervous system;
single moms-to-be and older moms-to-be;
women, near blood relatives which were strokes, heart attacks, thrombosis;
women who had previously given birth, had large children or had stillbirths. Also those women who have suffered preeclampsia in previous pregnancies;
women who have had spontaneous abortions(especially a few).

But even this “risk group” is very conditional. Most women with the above problems, with a full examination and proper treatment of the underlying disease (preferably BEFORE the planned pregnancy!) Safely endure their children and will never know what preeclampsia is. On the other hand, this dangerous complication can develop in an initially completely healthy woman who does not have any risk factors.

This once again emphasizes the unpredictability and insidiousness of preeclampsia.

How to determine the onset of gestosis during pregnancy?

Only a doctor establishes the appearance of late toxicosis. He can diagnose the onset of the disease by dangerous symptom, - the presence of protein in urine tests.

Do not forget that the urinalysis must be collected correctly, otherwise vaginal discharge may falsely show the presence of protein in the urine.

For the result to be correct, it is necessary to wash the perineum, and then close the entrance to the vagina with a cotton swab and collect a medium portion of urine. Dishes for analysis should be clean (you can boil for 2-3 minutes), and it is even better to buy a sterile glass at the pharmacy.

Also, during each visit to the doctor, blood pressure measurements are not in vain. Indicators above 130/80 mm Hg also indicate the onset of gestosis.

Two more important symptom, which should not be overlooked - a sharp increase in body weight and the appearance of edema. But not every swelling is diagnosed as preeclampsia. An enlarged uterus puts pressure on all internal organs, including blood vessels. Naturally, due to excessive pressure, this process contributes to fluid retention in the body. But, if the edema occurs abruptly and begins to progress, this may indicate the actual onset of preeclampsia.

You must remember that undiagnosed preeclampsia in time causes the following complications:

bleeding during childbirth caused by a violation of the coagulation system;
retinal detachment;
fetal oxygen deficiency, developmental delay.

Signs of preeclampsia during pregnancy

To summarize all of the above, then the main signs of gestosis are:

the appearance of protein in the urine,
increase in pressure
pathological,
abrupt appearance edema.

Symptoms can appear all at once or in a different sequence, it depends on which internal organ of the woman suffers the most. "Inventing preeclampsia for yourself" is not worth it on your own, but any of the above signs is an obligatory reason to talk with your doctor.

Treatment of preeclampsia during early pregnancy

adopt a protein-rich diet.
avoid fried, spicy and salty foods.
if at the beginning of pregnancy a woman suffered, for more later dates she needs to remove from the diet foods that previously cause vomiting.
replace concentrated broths with light vegetable soups.
. This does not mean that you need to drink little, no, such abstinence, on the contrary, causes even more fluid stagnation. 30 ml per kilogram of weight - calculated sufficient norm. You must control the work excretory system body and then make sure that the amount of fluid you drink is not less than the amount allocated. The question of how much to drink, what exactly to drink, how to drink, and so on, is quite voluminous, so it is placed in a separate article. .

Unfortunately, if those given by a pregnant woman do not show improvement in dynamics, she will be hospitalized in a maternity hospital.

Under any circumstances and problems, it is necessary to eat properly and efficiently throughout pregnancy and try to play sports (even just walking). To do this, in the Mom's Store you should pay attention to specialized ones for pregnant and lactating women, as well as buy comfortable clothes and accessories, and for travel or moderate exercise.

Note. Return of food and cosmetics possible only with undamaged packaging.

Consequences of gestosis during pregnancy

Preeclampsia causes a very dangerous condition for a pregnant woman, which in medicine is called eclampsia. Eclampsia is characterized by a critical increase in blood pressure and the appearance of a convulsive seizure, which begins with twitching of the facial muscles. Then convulsions of the whole body join, swelling of the brain and lungs occurs, coma occurs. A woman risks dying from a cerebral hemorrhage, and a child from oxygen deficiency.

When diagnosing eclampsia, doctors urgently send a woman to a hospital and perform early delivery () in order to save both mother and baby.

Complications of preeclampsia that can harm the child

We wrote a lot about how the manifestations of late toxicosis - preeclampsia are dangerous for a pregnant woman, however, this does not mean that the baby does not suffer. In this situation, the most important system fails: Mom - Placenta - Baby.

Preeclampsia causes a spasm of small vessels of all organs, as a result, the amount of blood that carries the baby is narrowed. nutrients. The function of the placenta also deteriorates, it becomes thinner, its area increases, areas with hemorrhages appear. In such a situation, the placenta can no longer protect the fetus from negative influences and provide it with oxygen.

The baby becomes vulnerable, his systems and internal organs begin to lag behind in development. In severe cases, gestosis causes premature birth, and in critical situations - the death of the fetus.

During pregnancy, you must remember that now you and the baby are one, so if late gestosis is detected, keep calm, follow all the recommendations of doctors and do not refuse hospitalization. There are many examples when, even with such a complex and dangerous diagnosis as late toxicosis, after delivery, both mother and baby felt absolutely healthy.

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During the period of expectation of a child, the female body is very vulnerable, because it is at this moment that any dormant disease can return with a strong exacerbation, and already at the very beginning of pregnancy. In the second half of pregnancy very often (about a third of women) gestosis develops - a rather dangerous complication, which is often accompanied by impaired functioning vascular system and blood flow.

Causes of preeclampsia in pregnant women.
Over the past few years, this disease has topped the list of causes of maternal death in our country. As a rule, preeclampsia begins to develop at the seventeenth to twentieth week of pregnancy, but in most cases it is diagnosed only after twenty-eight weeks. Some changes occur in the woman's body, the result of which is the formation in the placenta of substances that can make micro-holes in the walls of blood vessels through which plasma protein and fluid from the blood enter the tissues, contributing to the appearance of edema. At first, it is difficult to visually see the swelling, except that the arrows on the scales deviate upwards during weighing. Similar micro-holes later appear in the vessels of other organs, most often the kidneys, as a result of which protein appears in the urine. Since the vessels were left without fluid, the body must increase blood pressure to pump the remaining fluid through the body. Hence the high blood pressure. Against the background of thickening of the blood, an increase in its coagulability is observed, which contributes to the development of blood clots. An increase in the number of holes in the vessels worsens the course of the disease and becomes dangerous for a pregnant woman. Early diagnosis of preeclampsia (in particular urinalysis) and timely treatment play a key role.

The causes of this disease are not fully understood, but there are several scientific assumptions about how it starts. According to one of them, the disease has neurological roots, when the relationship between parts of the brain is disrupted, which leads to a deterioration in the state of blood vessels and disruption of the blood supply to all organs and systems. According to another version, the cause of the disease is endocrine disorders, when, against the background of a malfunction of the endocrine glands, the functions of the heart and blood vessels are disrupted, blood flow is disturbed, and the composition and properties of the blood deteriorate. The third version is the immunological theory, when defense mechanism The body produces antibodies that cause vasoconstriction. Scientists also put forward versions that preeclampsia has genetic roots, or the clue lies in the vessels of the placenta. But still, most of the scientific community is inclined to believe that the disease provokes a whole range of various disorders and chronic diseases.

Women should remember that preeclampsia is an extremely insidious thing. Often, an increase in blood pressure, which greatly exceeds the norm during pregnancy, as well as protein in the urine of women, do not bother, but for quite a long time they feel great, there are no pains or ailments. However, we must not forget that not only, say, parts of the body are exposed to edema, but also the placenta itself (fetal hypoxia), and later the brain. All this in the end can easily provoke an attack of seizures (eclampsia). Often symptoms (preeclampsia) of impending seizures (nausea, headache, drowsiness, "flies", weakening of the reactions of the body, pain in the stomach) occur literally a few minutes or hours before an attack, which often ends in death, both for the mother and the fetus. This happens because in this preconvulsive state, a pregnant woman develops pulmonary edema, heart attack, detachment of the placenta and retina, stroke, kidney and liver failure. That's why obstetricians and gynecologists this disease and its prevention are given increased attention.

Symptoms and types of preeclampsia in pregnant women.
About thirty percent of cases in women who are expecting a child develop the so-called "pure preeclampsia", when the woman's condition is generally normal and there are no diseases. If preeclampsia develops in the presence of any disease (be it kidney disease, hypertension, etc.), then they speak of "combined preeclampsia."

There are several stages of the disease:

dropsy pregnant is early stage disease and is expressed in the appearance of edema of the upper and lower extremities, while at first the edema appears in a latent form, and only then they become visible to the naked eye. It should be noted that edema is not always evidence of preeclampsia; only a specialist can accurately diagnose the condition.
Against the background of dropsy, nephropathy occurs in combination with a violation of the functioning of the kidneys. The beginning of this stage of the disease can be said if a pregnant woman has an increase in blood pressure. In this situation, the danger lies in the fact that this condition easily acquires the most difficult stage in the development of preeclampsia - eclampsia. In this case, timely diagnosis and prompt treatment are of priority, since complications are the most terrible.
The next stage of the disease is preeclampsia, which is expressed in the appearance of several signs (edema, high blood pressure, protein in the urine). There may also be disruptions in the blood supply to the central nervous system, which is manifested by headache, nausea, weakness, inhibition of reactions, visual impairment, and mental disorders.
As noted above, the most severe stage of preeclampsia is eclampsia. At this stage of the development of the disease, seizures appear, the functioning of organs and systems is impaired, heart attacks and strokes often occur. At this stage of the disease, placental abruption, premature birth, heavy bleeding, as well as a lack of oxygen in the fetus and its death.

Diagnosis of gestosis.
The diagnosis of "preeclampsia" and the assessment of its degree is carried out according to the results of urine tests (which are done before each visit by a woman to a doctor), the value of blood pressure, an intensive increase in the weight of the pregnant woman, and also according to her complaints.

If the weight gain in a pregnant woman is significant, but at the same time we see no signs of swelling, they may prescribe a Maclure-Aldrich test (MCO). The essence of the method lies in the subcutaneous injection of saline, as a result of which a kind of papule is formed. Next, the doctor notes the time during which this papule will resolve. In the case of hidden edema, the papule resolves faster than in half an hour.

If minor swelling of the legs is detected, outpatient treatment is usually recommended, in more serious cases- hospital. Remember, the condition of a pregnant woman with preeclampsia can worsen significantly in just a couple of hours.

It should be noted that self-medication in such cases can only be harmful and aggravate the situation. Very often, when edema appears, women themselves prescribe diuretics (diuretics) in the hope that they will easily remove excess fluid from the body. And in this main mistake, because all the liquid has gone into the tissues, and so it is not in the vessels. Diuretics only aggravate the disease.

Prevention of gestosis.
The risk group for developing the disease is primiparous women, those who are expecting twins, the fair sex after thirty-five years, as well as those who have chronic diseases (vegetative-vascular dystonia, diabetes, hypertension, obesity, chronic pyelonephritis) and sexually transmitted infections (chlamydia, mycoplasmosis, ureaplasmosis).

Prevention of the disease should begin at the planning stage of the baby. It is important to cure all existing ailments, start a healthy lifestyle (nutrition, physical activity (swimming, Pilates and yoga are the most effective), regular walks on fresh air healthy and quality sleep). It is also necessary to take vitamins, and this reception will continue throughout pregnancy and after childbirth.

The main method of prevention of gestosis is the fight against overweight! The norm during pregnancy is an increase in weight by 12 kg, with an initial lack of weight, a woman can recover by another three kilograms, with an initial body weight exceeding the norm, weight gain at the end of pregnancy should not exceed 10 kg. Therefore healthy balanced diet should be the number one rule in a pregnant woman. No need to think that your daily "eating" will benefit the child. No! All this has one result - obesity and preeclampsia. It is important that the diet of a woman in position is rich in protein (lean meat, fish, eggs, cottage cheese), because it is vital for building the cells of the baby's body. If preeclampsia has already been diagnosed, the use of protein becomes even more important, because it is washed out of the body with urine and “flows” into the tissues.

Confectionery (sweets, ice cream, muffins, etc.) should be completely excluded or severely limited. Of course, during pregnancy, you crave sweets terribly (I know from my own experience!), but it can be replaced with sweet fruits. Fiber should also be present in the diet, because it prevents the development of constipation. A sufficient amount of it is found in mushrooms, dried fruits, vegetables, sea kale, greens and bran.

You should not lean on salt during pregnancy and drink plenty of fluids. The maximum amount of liquid per day should be no more than one and a half liters (along with first courses and juicy fruit varieties).

I must say that there is an opinion that a violation of the outflow of urine leads to the appearance of gestosis. This is due to the fact that in a standing position, the uterus presses on the ureters, causing a violation of the outflow of urine. To prevent the development similar condition experts recommend expectant mothers to occupy the knee-elbow position for ten minutes several times throughout the day.

Various kidney teas, rosehip decoction, cranberry juice, as well as a decoction of bearberry or lingonberry leaves are a good prophylactic. Herbal preparations, such as Canephron, Cyston, Cystenal can be an excellent means of preventing edema. For the same purpose, pregnant women are often prescribed magnesium supplements (Magne B6), calcium, omega-3 and omega-6 fatty acids (fish oil, linseed oil), vitamin E, lipoic acid, Hofitol (to facilitate liver function), Curantil ( In addition, it improves blood circulation in the placenta).

Treatment of gestosis.
It is important to know that this disease cannot be completely cured, but it is possible to alleviate its course. In the presence of edema of the lungs And medium degree a woman is referred for treatment in the department of pathology of pregnant women. In the case of a severe degree of preeclampsia with symptoms of preeclampsia or a convulsive attack already suffered, treatment is carried out in the intensive care unit. In this case, a series of mandatory tests are carried out, according to which the condition of the woman and the fetus is assessed. Among these tests, it is worth noting blood and urine tests, determining the level of body weight, ultrasound of the fetus with Doppler, cardiotocography. In addition, examinations by a general practitioner, an ophthalmologist, and in severe cases a neurologist and a nephrologist are required.

In the treatment of preeclampsia, infusion therapy (droppers) is used, due to which the lack of protein and fluid in the vessels is replenished and the latter is removed from the tissues. With high blood pressure, as a rule, antihypertensive drugs are prescribed, as well as drugs, blood flow in small vessels, including the placenta. IN complex therapy appoint also medications with a sedative effect (motherwort, valerian, as well as potent drugs in case of eclampsia). In addition, means are prescribed to prevent the development placental insufficiency(Actovegin, vitamins C, E and group B). Also, pregnant women with gestosis need to create conditions for absolute rest, excluding any experiences.

In general, treatment directly depends on the condition of the pregnant woman and the severity of preeclampsia. If the treatment does not help and there is no improvement (within seven to ten days with moderate severity, after one to three days - with severe), but on the contrary, there is a deterioration in the condition of the pregnant woman or the fetus, in which case premature birth is caused. In case of eclampsia, intensive treatment is allowed for no more than three hours.

The method of delivery is selected taking into account the condition of the fetus. If the situation allows, natural childbirth with epidural anesthesia is preferred, in case of immediate delivery, a caesarean section is performed.

At timely diagnosis And proper treatment preeclampsia, a woman successfully carries the pregnancy to physiological birth or until the appointment of a planned caesarean section. Today, in the case of eclampsia and severe preeclampsia, a caesarean section is performed. It is also prescribed for complications of the disease with other pathologies of pregnancy. Even after a successful delivery, the mother is observed by doctors in the maternity hospital for five days in order to prevent the development of complications after childbirth.

All women who have children know about the peculiarities of the course of pregnancy and monitoring it: constant monitoring by a gynecologist, regular checks of tests, weighing and ultrasound. Some girls have a question, why get on the scales every time. Excessive weight gain indicates the appearance of edema. And they, in turn, are a sign that preeclampsia develops during pregnancy.

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

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

Causes

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

The main cause of preeclampsia in pregnant women is a violation in the regulation of blood vessels. As a result, spasm occurs. The target of changes is the microvasculature.

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

Signs of preeclampsia during pregnancy are quite characteristic. They are all expressed by the abbreviation OPG. It stands for edema, proteinuria and. The whole symptom complex is not always noted.

by the most common symptom are swelling of the hands. Due to the increase in the amount of water consumed, the exit of which is difficult, it is retained in the space between the tissues. There may be swelling of the hands and feet, with severe swelling spread throughout the body. Sometimes there are no clear signs. You can find any changes only when weighing.

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

5 degree.

If left untreated, the condition continues to worsen. The so-called HELLP syndrome develops. Vomiting begins with blood, jaundice appears. In extremely severe cases, coma is possible. Lethal outcome is likely in 80% of cases.

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

Some pregnant women are affected by other types of gestosis:

Softening of the bones. There is a destruction of the teeth, pain in the bones and joints, gait is disturbed. It develops against the background of a lack of vitamins in the body, and especially calcium.
Increased production of saliva. Excess salivation appears before vomiting. As a result, the body suffers from a lack of water, dry mouth appears, as a result of which speech changes and the oral mucosa is damaged.
Jaundice. At the same time, its other forms do not develop. Careful diagnosis of these two conditions is necessary to rule out liver infection.
hepatic atrophy. Most often occurs in the first trimester. No therapy is available. To improve the condition, termination of pregnancy is recommended.

Complications

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

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

Edema of the lungs, brain;
Hemorrhages in the brain, liver, lungs and other organ systems;
Violation of the normal functioning of the heart and blood vessels;
Placental abruption;
Violation of the kidneys;
Changes in the course of fetal development, its remaining from the norm;
premature birth;
Violations of the hepatobiliary system;
Intrauterine oxygen starvation of the child;
Changes in vision, its deterioration;
Infant and maternal mortality.

But all this can be avoided. Regular, urine and a visit to the doctor once a month with the appointment of appropriate therapy will not allow preeclampsia to develop.

Diagnostics

All pregnant women constantly take a large number of analyzes, so the diagnosis of preeclampsia during pregnancy is not difficult. If there are any deviations from the norm, some studies may be scheduled outside the plan. In addition, other diagnostic procedures are used.

The main studies include the following:

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

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

Treatment

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

Treatment of gestosis has the following directions:

Creation calm atmosphere around the pregnant woman.

Emotional shocks should be completely excluded. Loud noise, light, and excessive exercise can make the condition worse. With a mild course, the use of valerian or motherwort preparations is recommended. If there is a more severe form, then the gynecologist selects the drug based on the individual characteristics of each patient.

Improvement of blood circulation of the placenta and fetus.

Sedative, antihypertensive, diuretic drugs and antispasmodics prevent the development of hypoxia in the child. If this happens against the background of already existing somatic diseases, then they are treated.

Preparing a pregnant woman for preterm birth.

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

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

The following diagnostic procedures are carried out in the hospital:

Urinalysis, including a Zimnitsky test;
Study of the condition of the fetus;
Study of blood parameters.

Since swelling of the extremities with gestosis is an excessive accumulation of fluid in the space between the tissues, their treatment consists in removing it. For these purposes, infusion solutions are used. With all drugs are selected individually.

Treatment may continue for several weeks. Its main goal is to stabilize the condition and carry the child to due date. In severe conditions, the only treatment will be an emergency caesarean section.

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

What should not be allowed:

Obesity.

Compliance during pregnancy is very important. Proper nutrition, including the intake of all essential vitamins and micronutrients. The diet must contain milk and its products, lean meat and fish, eggs. It is necessary to eat foods high in protein, as this is the main building block.

Limiting vitamin and fiber intake.

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

A large number of flour products and sweets.

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

Violation of the drinking regime.

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

Good for pregnancy physical activity. Yoga, swimming pool, Pilates have a positive effect on vitality. In addition, trained muscles will endure the process of childbirth much easier. But don't overuse it. Any state changes cancel all loads.

Preeclampsia in pregnant girls and women is a fairly common disease. Prevention is much easier than cure. Monitoring your condition and visiting a doctor will not allow complications to develop.

Preeclampsia in pregnant women is called the state of malfunction of some vital important organs, which manifests itself mainly in the late period in the 2-3rd trimester. What to do when it appears, we will consider the causes, symptoms and preventive measures in the article

What is gestosis

Preeclampsia during pregnancy corresponds to a number of manifestations, knowing which, you can initially diagnose the disorder:

The existence of implicit and noticeable edema on the arms, legs, in the face
Increased levels of proteins in the urine, called proteinuria
Increase in blood pressure (hypertension)

The development of gestosis negatively affects the work of the heart, blood vessels, thyroid gland s, CNS. As a result, even the composition of the blood changes. The usual timing of the disease is 18-27 weeks, which refers to the late period.

Pregnancy with preeclampsia occurs in almost 30% of women. Sometimes it leads to the death of a newborn or expectant mother, so the disease must be taken seriously.

In order to identify preeclampsia in time, it is necessary to monitor its characteristic manifestations that appear sequentially during the first half of gestation. During this period, the expectant mother constantly has nausea, the urge to vomit, there is an increased separation of saliva. It is important to understand the extent of these symptoms, as the signs of " normal toxicosis” are the norm for a pregnant woman.

In the later period, manifestations are supplemented by nephropathy (kidney damage), dropsy, preeclampsia and eclampsia. The last two points are severe forms of toxicosis. The presence of such internal disorders is reflected outside - the skin suffers, in addition, there are deviations on the basis of nerves.

Combined preeclampsia call the situation of manifestation of signs of hypertension, deviations in endocrine system, violations of the functional output of bile and urine output. After childbirth, gestosis completely disappears.

Causes of preeclampsia

The disease has not yet been fully studied, the exact reasons why preeclampsia is taken in early and late pregnancy have not been identified. However, there are a number of hypotheses that help to understand it and how to avoid it. discomfort and fatal consequences.

The first hypothesis is called Cortico-visceral. She claims that due to the incomplete relationship between the cortex and subcortical tissues in the brain, a neurosis is formed in a pregnant woman, affecting some reflex functions. Many practical studies confirm this point of view, since the appearance of preeclampsia often correlates with strong nervous strains.

The second point of view is called immunological. Judging by it, the strong hormonal shocks experienced by a woman during pregnancy lead to the emergence of an immunological conflict between the organisms of the fetus and mother. Because of this, the vessels are partially subjected to spasms, which leads to an increase in blood pressure above normal and reduces the ability of the cells of the body to be fed with blood.

The third view considers preeclampsia with genetic point of view. Based on this, the complication often appears in expectant mothers who have a mother who suffered from preeclampsia. This disorder leads to a lack of vitamin B and other trace elements, which is expressed by an increased formation of a blood clot.

As a result, the formation of vascular micro-holes occurs, through which plasma protein compounds enter the blood. The endothelium - the inner lining of the vascular wall - becomes permeable, which causes the effusion of fluids into tissue structures. This leads to thickening of the blood, which increases clotting due to excessive thrombus formation.

The plasma that has penetrated into the vessels stagnates in them, forming edema, increasing blood pressure, and so on. On early stages the development of preeclampsia, these symptoms are invisible, but over time, after the second trimester or earlier, they begin to appear.

The vascular walls of the kidneys also suffer from the formation of micro-holes described above. Through them, urine is saturated with protein, which can be detected by conducting an appropriate analysis. At the same time, one of the first signs is a decrease in the frequency of trips for a pregnant woman to the toilet in a small way.

With preeclampsia, brain dysfunction increases, since due to a blood clot and small hemorrhages, there is an increase and a lack of nerve tissues.

First signs

Preeclampsia on early development hardly noticeable, with its signs it is very similar to the usual malaise, which is not uncommon during pregnancy. It is possible to track the pathology by periodically checking the pressure (it increases slightly). Other signs include headaches in women, a state of weakness, the urge to vomit.

Early preeclampsia in pregnant women has the following symptoms:

Urinalysis reveals an increased protein content. An increase in the indicator in the future means the progress of the disease.
Increased blood pressure above 140 to 90
The first manifestations of edema

Symptoms of gestosis during pregnancy

At a later stage, the disease affects a significant part of internal organs, as a result, the picture of symptoms becomes clearer and more diverse. Preeclampsia affects the kidneys, liver, cardiovascular and central nervous system. Often there is hypoxia, due to which the fetus develops inadequately in conditions of oxygen deficiency.

With gestosis (toxicosis), the first thing that happens is vomiting, repeated several times a day. Due to periodic nausea, there is no appetite, but there is a tendency to eat spicy and salty things. Body weight does not change, temperature is normal. The existence of these symptoms is typical for the first months of pregnancy, after which they disappear.

However, sometimes vomiting occurs again, turning into incessant (15-20 times). After that, the patient is greatly weakened, blood pressure drops below normal, the bullet becomes threadlike. Urinalysis shows high levels of acetone and protein. Often there is an increase in temperature and severe arrhythmias.

Photo. Symptoms of gestosis in pregnant women

In pregnant women at a late stage, in the 2nd, 3rd trimester, the development of preeclampsia is gradual. The disease begins with dropsy, passing first to preeclampsia, and then to eclampsia. Dropsy has symptoms of swelling due to the accumulation of fluid in the body. Edema is hidden and visible. They are localized in the ankle area, moving up. The face, lower abdomen, arms, legs are subject to edema. Body weight is growing at an accelerated pace.

Preeclampsia can lead to kidney nephropathy, the symptoms in this case are the same:

The presence of edema
Increased protein in the urine

Some of the symptoms may be absent. Dropsy with nephropathy often complement each other, increasing the symptoms. The whole situation threatens with insufficient supply of oxygen to the fetus.

Eclampsia

This is the name of the most severe phase in preeclampsia. At this time, painful convulsions, an acute reaction to bright light and loud sound are likely for 1-5 minutes. Further, a pregnant woman may lose consciousness, up to a coma. It is clear that this does not bode well. In extreme cases, the placenta exfoliates, internal bleeding and premature birth develop. The fetus during this period is in a state of oxygen deficiency and is in serious danger.

The state of eclampsia is preceded by preeclampsia when the above symptoms of preeclampsia are supplemented by heaviness in the back of the head, painful sensations in the abdomen, visual impairment, an increase in blood pressure above 150/105, a decrease in the amount of urine excreted, abnormalities in the functioning of the liver.

Gestosis during pregnancy is dangerous state, the first symptoms of which are little manifested and, in general, the pregnant woman feels well. Increased swelling and increased pressure in the later stages should alert. When these signs appear, you should definitely visit a gynecologist.

Diagnostics

Diagnosis begins with a survey. If the doctor suspects preeclampsia, then the diagnosis is denied or confirmed:

Coagulogram - blood clotting test
Biochemical and general analysis of blood and urine
Tracking changes in weight and volume of urine excreted, taking into account the consumed fluid
Checking the condition of the fundus
Measurement of blood pressure in dynamics

To clarify the well-being of the embryo during pregnancy, an ultrasound examination and dopplerography are prescribed. It is possible to attract third-party doctors, including:

Nephrologist
Optometrist
Neurologist

Treatment of preeclampsia

Regardless of whether gestosis occurs in early or late pregnancy, the best option treatment is hospitalization. Only in this case there are high chances of preserving the functionality of the mother's body and successful delivery. It is allowed to be treated at home only at the first stage of dropsy. Nephropathy and preeclampsia require the mandatory placement of a pregnant woman in a hospital. Emergency termination of pregnancy is carried out when the life of the patient is threatened.

Treatment consists in determining the state of the walls of blood vessels, improving blood supply and circulation by reducing its viscosity, and normalizing water-salt metabolism. You should also monitor blood pressure and respond with medication to its jumps in any direction. The result of treatment is fixed by the general normalization of metabolic processes.

The duration of treatment depends on the depth of gestosis. At mild form 12-15 days of inpatient therapy is enough. With an average degree, the stay in the hospital will be longer. Late severe gestosis needs daily treatment until the baby is born.

Preterm birth

Preterm delivery is indicated in the situation:

When the condition fails to improve despite therapy
If in the case of resuscitation procedures after two hours there is no expected effect
There are violations of intrauterine fetal formation
Increased likelihood of severe consequences

After the equator of pregnancy late preeclampsia needs constant monitoring. Independent birth is allowed only under normal conditions of the woman in labor, when there is no doubt that she has enough strength for this. Otherwise, in order to avoid the risk, they resort to a caesarean section.

Consequences

If pregnant women are not treated, then preeclampsia threatens with dysfunction of the kidneys and heart muscle. In addition, the lungs swell, internal hemorrhages occur.

The main danger to the fetus is the detachment of the placenta, because of which it receives less nutrients and oxygen. Even with a successful resolution of pregnancy, this turns into a slow development.

Prevention

If a woman in labor has diseases of internal organs, in the second trimester and later, it is important for her to adhere to the following preventive measures:

Enough rest and sleep
Balanced Eat
Get minimal physical activity
walk daily
Limit salt and fluid intake

If there are favorable factors for the disease, you should register in gynecology at an early stage and follow all the instructions of the gynecologist. In order not to miss the moment of aggravation of the situation, it will be necessary to periodically undergo tests. The appointment of drugs occurs individually only with concomitant diseases.

Preeclampsia (late toxicosis of pregnant women, OPG-gestosis) is a disease specific to the second half of pregnancy.

Gestosis - widespread obstetric pathology. It accompanies up to 30% of pregnancies and is one of the main causes of complicated delivery, maternal and infant mortality.

Causes and risk factors

It is generally accepted that the combined effect of various factors leads to the development of preeclampsia: placental, genetic, immunological, hormonal and neurogenic.

The pathology is based on a spasm of blood vessels, which leads to a violation of the blood supply to organs and tissues, their hypoxia and ischemia. In addition, the consequences of vascular spasm are:

decrease in the volume of circulating blood;
increased blood pressure;
increased permeability of the vascular wall;
exudation of fluid from the vessels into the surrounding tissues with the development of edema;
increase in blood viscosity;
tendency to form blood clots.

In pregnant women, the brain, liver, placenta, and kidneys are most sensitive to hypoxia. Therefore, it is in these organs that functional and structural disorders occur.

Changes in the kidneys are expressed with varying intensity - from slight proteinuria to the formation of acute renal failure. Violation of blood flow in the vessels of the placenta causes intrauterine delay development and fetal hypoxia. Focal hemorrhages and necrosis occur in the liver tissues. Violation of the blood supply to the brain leads to dystrophic changes in nerve cells, the formation of blood clots in blood vessels, increased intracranial pressure, the occurrence of small-focal or small-point hemorrhages.

Factors predisposing to the development of gestosis are:

chronic somatic diseases of a pregnant woman;
hereditary predisposition;
multiple pregnancy;
Rhesus conflict;
the age of the pregnant woman is under 18 or over 35;
large fruit.

Forms of the disease

IN clinical practice There are two types of pathology:

Pure gestosis. It develops in pregnant women who are not diagnosed with any extragenital diseases.
Combined gestosis. It occurs in pregnant women suffering from lipid metabolism disorders, diseases of the endocrine glands (pancreas, thyroid glands, adrenal glands) and biliary tract, liver pathologies (glomerulonephritis, pyelonephritis), arterial hypertension.

Stages of the disease

There are 4 clinical stages of preeclampsia:

Dropsy (gestational edema).
Nephropathy (there are 3 degrees - mild, moderate, severe).
Preeclampsia.
Eclampsia.

The outcome of gestosis is determined by the severity of the disease, clinical picture, the period of occurrence.

Symptoms

The first sign that allows you to suspect developing preeclampsia is dropsy. It is characterized by fluid retention in the body, which leads to edema. Initially, edema is latent; they are detected by the weekly weight gain of a pregnant woman, exceeding 300 g. If the necessary measures are not taken, the edema becomes clearly visible. With a mild degree of dropsy, they are localized only in the region of the lower extremities. In severe cases, diffuse swelling of almost all soft tissues is observed.

The general condition and well-being with dropsy practically do not suffer. Only with highly developed edema, patients complain of increased thirst, heaviness in the legs, fatigue and weakness.

The next stage in the development of gestosis is nephropathy of pregnant women. Clinically, it is manifested by the W. Zangemeister triad:

edema;
proteinuria (protein in the urine);
arterial hypertension (high blood pressure).

One of the names of gestosis, OPG-gestosis, reflects indicated symptoms("O" - edema, "P" - proteinuria, "G" - hypertension).

In obstetric practice, it is believed that the occurrence of even two symptoms from this triad can be regarded as a manifestation of nephropathy.

About development arterial hypertension in a pregnant woman, they say in case of an increase in diastolic pressure by 15 or more mm Hg. Art., and systolic - by 30 mm Hg. Art. and higher than blood pressure early dates pregnancy.

With preeclampsia, the danger is not so much the magnitude of blood pressure as its sharp fluctuations, which can cause serious complications for both the mother and the fetus - due to a deterioration in the blood supply to vital organs and disorders of the uteroplacental blood flow.

Proteinuria indicates the progression of nephropathy. At the same time, a decrease in daily diuresis to 500-600 ml is often observed.

It is not always possible to assess the severity of the course of nephropathy by the level of protein, blood pressure and the severity of edema. IN last years In clinical practice, cases are increasingly being recorded when in pregnant women with an unexpressed Zanggemeister triad, nephropathy passes into the following clinical stages of the development of preeclampsia (preeclampsia, eclampsia).

With the development of preeclampsia, the symptoms of nephropathy are joined by manifestations of the onset of hypertensive encephalopathy and cerebrovascular accidents:

dizziness;
heaviness in the back of the head;
headache;
lethargy, lethargy, drowsiness (or, conversely, insomnia, euphoria, agitation);
visual disturbances ("flies" or fog before the eyes, double vision);
noise in ears;
increased severity of reflexes (hyperreflexia).

In addition, with preeclampsia, signs of impaired liver function appear:

pain in the epigastric region;
nausea;
vomit;
disorders of the blood coagulation system;
increased activity of liver enzymes.

The occurrence of symptoms of preeclampsia indicates a high convulsive readiness, when any irritation (loud sound, bright light, pain) can lead to eclampsia, the main clinical manifestations of which are convulsions with loss of consciousness.

Prevention of preeclampsia should begin at the stage of pregnancy planning: it is recommended medical examination, active treatment of identified gynecological and extragenital diseases.

During a seizure during eclampsia, several consecutive periods are distinguished:

Fibrillar twitching of the muscles of the face, and then of the upper limbs. The gaze is fixed to the side. Duration about 30 seconds.
Tonic convulsions. They start from the upper muscle groups and spread down. The patient stops breathing, develops cyanosis of the mucous membranes and skin pupils dilate. The pulse is difficult to determine. The duration of tonic convulsions is 25-35 seconds.
Clonic convulsions. The pulse is not determined, there is no breathing. Lasts approximately 2 minutes.
Permission. The convulsive seizure ends, the patient takes a deep breath, foam appears from the mouth, which, due to biting the tongue, may contain an admixture of blood. The cyanosis disappears. The patient wakes up and has no memory of the seizure.

An attack of eclampsia may end in a post-eclamptic coma. In very rare cases, the patient falls into a coma without a previous convulsive seizure. The non-convulsive form is observed against the background of massive hemorrhage in the brain tissue and usually ends in death.

Diagnostics

Diagnosis of preeclampsia is carried out taking into account the anamnesis, complaints of the pregnant woman, physical examination data and results. objective research. To assess the severity of preeclampsia, as well as to identify the patient's violations, laboratory tests are shown:

general analysis of blood and urine;
coagulogram;
blood chemistry.

In addition, they regularly monitor blood pressure, monitor the amount of urine separated and its relationship with the volume of fluid consumed, body weight dynamics.

Dopplerography and ultrasound are performed to assess the condition of the fetus and the characteristics of the uteroplacental blood flow.

The patient is consulted by an ophthalmologist (an examination of the fundus is necessary), a nephrologist, a general practitioner and a neurologist.

Treatment

The main elements of gestosis therapy:

Hospitalization and the creation of a medical-protective regime. The patient is protected from strong stimuli (sound, light). All necessary manipulations are performed as carefully and carefully as possible. Physiotherapeutic procedures, herbal medicine (tincture of valerian, motherwort), psychotropic and hypnotic drugs (droperidol, sibazon) are used.
Therapeutic diet. Nutrition should be fractional - eating 5-6 times a day in small portions. The basis of the diet is dairy and vegetable products. The amount of table salt is limited to 6-8 g per day, and the amount of fluid consumed is up to 1500 ml.
Normalization of vascular tone and blood pressure. For this purpose, antispasmodic and antihypertensive drugs are used. Medical therapy carried out under the control of blood pressure and other hemodynamic parameters.
Therapy of placental insufficiency, intrauterine malnutrition and fetal hypoxia.

Indications for early delivery with gestosis are:

lack of effect from the therapy of nephropathy within 14 days;
lack of effect from intensive therapy for preeclampsia, carried out for 2-4 hours;
eclampsia and eclamptic coma.

Preeclampsia accompanies up to 30% of pregnancies and is one of the main causes of complicated delivery, maternal and infant mortality.

Possible consequences and complications

The main danger of preeclampsia lies precisely in the development of severe complications, such as:

intrauterine hypoxia and fetal death;
DIC and hemorrhagic shock;
acute renal failure;
premature detachment of a normally located placenta;
HELLP-syndrome (decrease in the number of platelets, increased activity of transaminases, hemolysis of erythrocytes);
subcapsular hematomas or ruptures of the liver;
syndrome of acute pulmonary injury;
hypertensive encephalopathy;
retinal disinsertion;
hemorrhage in the brain.

Forecast

The outcome of preeclampsia is determined by the severity of the disease, the clinical picture, the time of occurrence. In most cases, with timely therapy, the prognosis is favorable.

Prevention

Prevention of preeclampsia should begin at the stage of pregnancy planning: a medical examination is recommended, active treatment of identified gynecological and extragenital diseases.

During the entire period of pregnancy, you should adhere to a sleep and rest regimen, devote time to moderate physical activity. In the diet, you need to limit fried, fatty, spicy foods, increase the proportion of fresh vegetables and fruits.

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