What is preeclampsia in pregnancy. Symptoms, signs, consequences. Dangerous changes: gestosis of pregnant women

Preeclampsia occurs in the second half of pregnancy (in most cases after 30 weeks, but can also be observed earlier - after the 20th week). According to various sources, it develops in 3-20% of expectant mothers. Moreover, the longer the gestation period at which this disease appears, the better the prognosis, since with earlier vascular changes in the placenta, the fetus will suffer from a lack of oxygen and nutrition for a longer time.

Alarming signs: diagnosis of preeclampsia during pregnancy

The main signs of preeclampsia during pregnancy are high blood pressure, swelling and the appearance of protein in the urine. To make it clear what condition should alert the expectant mother, let's dwell on each of them in more detail.

Edema

Edema can be obvious and hidden. The latter in the body are detected by excessive weight gain (more than 300 g per week after 30 weeks of pregnancy). This is the first sign of preeclampsia. A woman, of course, can already notice obvious swelling herself. They can be light, insignificant - for example, the expectant mother pays attention to the fact that her favorite shoes have become cramped or there is a trace of the ring on her finger. Edema can be more intense - when the legs and stomach swell completely. Then the woman can no longer put on her usual shoes. And edema is very strong when the legs, stomach and face swell. At the last, most significant degree, the whole body swells. Moreover, swelling is most visible in the evening, when fluid accumulates in its lower sections due to the vertical position of the body. During the night, it is redistributed evenly, and in the morning swelling can be almost invisible. In 9 out of 10 women, edema is accompanied by an increase in pressure and the excretion of protein in the urine.

Protein in the urine

Unfortunately, this, like the next symptom, is almost invisible to the expectant mother herself. That is why preeclampsia, unlike toxicosis, is easier to miss and more difficult to cure. For this reason, in the last trimester, you need to regularly take a urine test to check if a protein has appeared in it, which should not be normal.

Increasing pressure

In a pregnant woman, blood pressure above 135/85 mm Hg is considered elevated. Art. But doctors always focus on the initial figures of this indicator, measured in the first trimester. Therefore, if the systolic pressure (the first digit) rises by 30 mm Hg. st compared with the original, and diastolic (second digit) - by 15 mm Hg. Art., then doctors are already talking about hypertension. The expectant mother herself may not feel the increase in pressure. That is why in the third trimester, pregnant women regularly measure it at doctor's appointments and are advised to do this at home daily (if there is a suspicion of hypertension).

Causes of gestosis in pregnant women

I must say that, despite numerous studies, the exact cause of the development of preeclampsia has so far been identified. This complication is called the "disease of theories" because there are many assumptions about the causes of its occurrence.

Scientists and doctors consider spasm (strong contraction) of all vessels of the mother's body to be the main mechanism for the development of the disease. This is what causes an increase in blood pressure. Protein in the urine appears due to a malfunction of the kidneys, and edema is due to the fact that, due to a spasm of the vessels, the fluid through their walls leaves the blood into the tissues. In addition, blood viscosity increases. It becomes viscous, blood cells can stick together, forming blood clots. They clog the lumen of the vessels, causing oxygen deficiency of the organs (placenta, kidneys), which further disrupts their work and worsens the condition of the baby. Why does such a violation occur? There are several theories that attempt to answer this important question:

Violation in the work of the brain. This theory is confirmed by the fact that preeclampsia occurs most often in women subject to severe stress. In this case, the balance in the processes of excitation and inhibition is disturbed, the cerebral cortex, which is responsible for the functioning of all internal organs, malfunctions, and a general vasospasm occurs.
Endocrine disruption. During pregnancy, the level of most hormones increases 10-20 times. And if the balance in this system is disturbed, preeclampsia occurs.
Immunological reaction to foreign genes of the fetus. As you know, immunity should stand up for defense and reject foreign tissues (which, in fact, is the fetus - after all, 50% of its genes are from its father). This is the cause of toxicosis in the first half of pregnancy, and such situations are also possible in the second half. The body's defenses begin to produce antibodies to the fetus, which is reflected in the vessels - they are sharply reduced.

At the moment, it is generally accepted that vasospasm and preeclampsia occur under the influence of not one, but several factors described above.

The influence of preeclampsia in a pregnant woman on the condition of the child

Of course, the illness of the expectant mother is reflected in the baby. After all, the vessels of the placenta are reduced in the same way as all the others. As a result, the amount of blood supplied to the child decreases - the baby begins to lack oxygen and nutrients, and this negatively affects its growth and development. In addition, since the work of the mother's kidneys is disrupted, they can no longer excrete waste products as well as before. There is intoxication first of the body of a woman, and then of a child. Of course, in such a situation, treatment is indispensable. But doctors can only apply therapy that supports the work of suffering internal organs, since the disease will recede only after childbirth.

Is hospitalization necessary for gestosis?

Unfortunately, preeclampsia often occurs in a quick and rather serious form, when the body of the expectant mother cannot cope with the disease itself. And then the woman needs the help of doctors in a hospital.

If the expectant mother has only edema of the first degree (swelling of the legs), then there is no need to go to the hospital and the antenatal clinic doctor will treat her. The doctor will prescribe a salt-free diet, give recommendations on how to control the amount of fluid drunk and excreted (the woman will need to draw up a schedule - how much fluid she drinks, including first meals, and how many times she urinates), and will also prescribe diuretics, drugs that strengthen the vascular wall and improving tissue blood supply. But if swelling of the arms and abdomen joins the swelling of the legs, you will have to go to the hospital - in this case, preeclampsia is a serious threat to the health of the expectant mother and baby, since the condition can rapidly worsen.

Treatment of preeclampsia in a pregnant woman in a hospital

In the maternity hospital, a woman is given the following tests:

General blood analysis will allow you to estimate the amount of hemoglobin (oxygen carrier), platelets responsible for blood viscosity.
General urine analysis will show the presence or absence of protein in the urine.
Doppler ultrasound of the fetus allows you to understand the condition of the fetus and find out if it is lagging behind in growth, to assess the intensity of blood flow in the vessels of the placenta and umbilical cord (this will indicate a possible oxygen deficiency).
Fetal CTG will allow you to track the rhythm of heart contractions and determine if the baby is suffering from a lack of oxygen.

In addition, the expectant mother will regularly measure blood pressure and evaluate the amount of fluid excreted and drunk. Specialists will also consult: an ophthalmologist, focusing on the state of the fundus vessels, will give an opinion on the state of the cerebral vessels; a neurologist will evaluate the work of the nervous system and, above all, the brain; the nephrologist will give an opinion on the work of the kidneys. And finally, the therapist and obstetrician-gynecologist will assess the severity of the disease and decide on further treatment. Usually prescribe drugs that reduce blood pressure, improve the condition of blood vessels and prevent increased blood clotting.

The expectant mother is discharged when there is no protein in the urine, pressure normalizes, swelling decreases and the fetus feels good. However, it must be understood that in the future, the symptoms of preeclampsia may reappear, so a pregnant woman should measure her pressure every day and carefully monitor whether swelling is increasing again.

Is it possible to avoid preeclampsia during pregnancy?

Fortunately, the expectant mother is able to prevent the appearance of preeclampsia. To do this, she should adhere to the following rules.

Monitor the amount of fluid and salt entering the body. No matter how much you would like to eat a lot of salty foods and drink plenty of water, after 25–26 weeks, you should control the amount of fluid you drink. The expectant mother should drink about 1.5 liters of water per day (including soup, tea, juice, etc.). You should not eat too salty foods - they cause fluid retention and make you even more thirsty.
To live an active lifestyle. The veins of the legs deposit a large volume of blood. Accumulating there, it begins to thicken, which threatens with the appearance of blood clots and edema (since the liquid begins to leak into the tissues) - all this predisposes to the development of preeclampsia. When the leg muscles are actively contracting, they do not allow blood to stagnate in the veins, pushing it into the general circulation. Therefore, doctors advise all pregnant women in the second and third trimesters to lead a moderately active lifestyle: walk a lot in the fresh air, swim, do yoga, etc.
Maintain a calm emotional background. The cerebral cortex coordinates many processes that occur in the body of a future mother, including the state and functioning of the cardiovascular system. If a persistent focus of excitation associated with stress is formed in the brain, this “distracts” it from coordinating the processes of pregnancy. Therefore, it is worth protecting yourself to the maximum from possible stresses and worries.
In the presence of chronic diseases(hypertension, chronic inflammation of the kidneys) it is important to observe the entire pregnancy with a general practitioner or a specialized specialist in order to prevent exacerbation of diseases and the appearance of preeclampsia in time.
Be sure to follow all the advice of a gynecologist, come to the appointment on time and take all the prescribed tests, since preeclampsia appears imperceptibly.

The most severe degrees of preeclampsia during pregnancy

If a pregnant woman has heaviness in the back of her head, headaches, flies before her eyes, nausea, vomiting, lethargy or irritability, then these may be signs of a severe degree of gestosis - preeclampsia, which requires immediate hospitalization. After all, this condition indicates the convulsive readiness of the woman's body. This means that any stimulus, be it a bright light, a loud sound, or a routine vaginal examination, can lead to the development of a seizure - eclampsia. This is the most severe form of preeclampsia and it is very rare. The condition can occur during pregnancy, childbirth, and even after the baby is born. The main manifestation of eclampsia is convulsions of the whole body with loss of consciousness and respiratory arrest, during which the fetus may die from a growing lack of oxygen.

With mild preeclampsia, treatment can be carried out in the conditions of antenatal clinics. Pregnant women with moderate and severe gestosis, preeclampsia and eclampsia should be hospitalized in obstetric hospitals located in multidisciplinary hospitals with an intensive care unit and a department for nursing premature babies, or in perinatal centers.

Therapy of pregnant women is based on the treatment of symptoms and signs of secondary manifestations of gestosis, while the goal is to reduce the incidence of complications from the mother and fetus.

The principles of gestosis therapy are to create a therapeutic and protective regimen; restoration of the function of vital organs; fast and safe delivery.

The creation of a therapeutic and protective regimen is carried out by normalizing the function of the central nervous system.

Restoration of the function of vital organs along with hypotensive, infusion-transfusion (ITT) and detoxification therapy, normalization of water-salt metabolism, rheological and coagulation properties of blood, improvement of uteroplacental blood flow includes normalization of the structural and functional properties of cell membranes.

Therapy of preeclampsia should now be carried out under the control of CVP (within 5-10 cm of water column), diuresis (at least 35 ml / h), concentration (hemoglobin at least 70 g / l, hematocrit at least 0.25 l / l, the number of erythrocytes is at least 2500000000000 / l and platelets is at least 100000000000 / l) and biochemical blood parameters (total protein not less than 60 g/l, alkaline phosphatase, ACT, ALT, total bilirubin, creatinine within the physiological norm depending on the method of determination), electrolytes (K+ not more than 5.5 mmol/l, Na+ not more than 130-159 mmol/l).

Normalization of the function of the central nervous system is carried out by sedative and psychotropic therapy.

In patients with mild and moderate preeclampsia without extragenital pathology, preference is given to sedatives of plant origin (valerian, tablets or infusion 3 times a day; motherwort extract 20 drops 3-4 times; peony tincture 1 teaspoon 3 times) in combination with hypnotics (nitrazepam 1 tablet at night) or tranquilizers (diazepam, phenazepam, oxaz epam) in doses, depending on the condition.

With moderate preeclampsia and preeclampsia, all initial manipulations are carried out against the background of inhalation anesthesia using benzodiazepane tranquilizers, neuroleptics, analgesics, antihistamines, barbiturates according to indications.

Indications for intubation and mechanical ventilation are eclampsia and its complications, the need for abdominal delivery. In the postoperative or postpartum periods, the transfer of the puerperal to spontaneous breathing is possible no earlier than 2 hours after delivery and only with stabilization of systolic blood pressure (not higher than 140-150 mm Hg), normalization of CVP, heart rate, diuresis rate (more than 35 ml / h) against the background of recovery of consciousness.

The use of y-hydroxybutyric acid preparations is contraindicated due to their ability to cause arterial hypertension and psychomotor agitation.

Antihypertensive therapy is carried out at the level of systolic blood pressure, which exceeds the initial level before pregnancy by 30 mm Hg, and diastolic by 15 mm Hg. Art. Currently, calcium antagonists are recommended (magnesium sulfate up to 12 g / day, verapamil 80 mg 3 r / day, amlodipine 5 mg 1 r / day), blockers and stimulants of adrenergic receptors (clonidine 150 mg 3 r / day, atenolol 50-100 mg 1 r / day, labetalol up to 300 mg / day, betaxolol 2 0 mg 1 r / day, nebivolol 2.5 mg 2 r / day), vasodilators (hydralazine 10-25 mg 3 r / day, sodium nitroprusside 50-100 mcg, prazosin 1 mg 1-2 r / day), ganglion blockers (azamethonium bromide 5% 0.2-0.75 ml, hexamethonium benzosulfonate 2, 5% 1-1.5 ml).

With mild preeclampsia, monotherapy is used (calcium antagonists, antispasmodics), with an average degree - complex therapy for 5-7 days, followed by a switch to monotherapy if there is an effect.

The following combinations are most effective: calcium antagonists + clonidine (85%); vasodilators + clonidine (82%).

In severe forms of preeclampsia, including preeclampsia and eclampsia, complex antihypertensive therapy is carried out. The most optimal condition for conducting antihypertensive therapy in severe forms of gestosis is the value of the CVP of at least 5-8 cm of water. With low CVP numbers (less than 3 cm of water column), antihypertensive therapy should be preceded by ITT. Magnesium sulphate is the drug of choice. The initial dose is 2.5 g of dry matter. The total daily dose of magnesium sulphate is at least 12 g / in under the control of respiratory rate, hourly diuresis and activity of knee jerks. Simultaneously with magnesia, calcium antagonists can be used: verapamil 80 mg / day or amlodipine 5-10 mg / day. Calcium antagonists can be combined with clonidine at an individual dose. In the absence of the effect of antihypertensive therapy, short-acting ganglioblockers (azamethonium bromide) or nitrate derivatives (sodium nitroprusside) are used.

ITT is used to normalize the volume of circulating blood, colloid osmotic pressure of plasma, rheological and coagulation properties of blood, indicators of macro- and microhemodynamics.

In the composition of ITT, along with fresh frozen plasma, albumin, dextran [cf. they say weight 30,000-40,000] (rheopolyglucin) include 6 and 10% starch solution, mafusol (potassium chloride + magnesium chloride + sodium chloride + sodium fumarate), chlosol (sodium acetate + sodium chloride + potassium chloride), Ringer's lactate solution. The ratio of colloids and crystalloids, the volume of ITT are determined by the values of hematocrit (not lower than 0.27 l / l and not higher than 0.35 l / l), diuresis (50-100 ml / h), CVP (at least 6-8 cm of water column), hemostasis indicators (antithrombin III level is not less than 70%, endogenous heparin is not lower than 0.07 U / ml), blood pressure, content protein in the blood (at least 60 g / l).

With the prevalence of colloids in the composition of ITT, complications such as colloid nephrosis and aggravation of hypertension are possible; with an overdose of crystalloids, hyperhydration develops.

When conducting ITT, the rate of fluid administration and its ratio with diuresis are important. At the beginning of the infusion, the rate of administration of solutions is 2-3 times higher than that of diuresis, subsequently, against the background or at the end of fluid administration, the amount of urine in 1 hour should exceed the volume of fluid administered by 1.5-2 times.

Normalization of water-salt metabolism is carried out by prescribing diuretics, which remains controversial in preeclampsia. To normalize diuresis in mild to moderate preeclampsia, in the absence of the effect of bed rest, diuretic phytocollections are used (juniper fruits, 1 tablespoon 3 times a day, bearberry leaves - bear ears, 30 ml 3 times a day, horsetail herb, kidney tea - stamen orthosiphon, lingonberry leaves, blue cornflower flowers, birch buds) and vegetable diuretic drugs (lespedeza capitate tincture, lespedeza two-color shoots) 1-2 teaspoon per day, kanefron 2 tablets - 50 drops 3 times a day, and in the absence of the effect of the latter - potassium-sparing diuretics (hydrochlorothiazide + triamterene 1 tablet for 2-3 days).

Saluretics (furosemide) are administered for moderate and severe preeclampsia with restoration of CVP to 5-6 cm of water column, total protein content in the blood of at least 60 g / l, hyperhydration phenomena, with diuresis of less than 30 ml / h. In the absence of the effect of the introduction of furosemide at the maximum dose (500 mg / day fractionally), isolated ultrafiltration is used to dehydrate. With the development of acute renal failure, the patient is transferred to a specialized nephrology department for hemodialysis.

Normalization of the rheological and coagulation properties of blood should include one of the antiplatelet agents: along with pentoxifylline (1 tablet 3 times), dipyridamole (2 tablets 3 times), xanthinol nicotinate (1 tablet 3 times), acetylsalicylic acid, anticoagulants are used: low molecular weight heparins (nadroparin calcium, enoxaparin sodium, dalteparin sodium). Disaggregants are initially used in the form of intravenous solutions, subsequently - tablets, for at least 1 month.

Therapeutic doses of acetylsalicylic acid are selected individually depending on the indicators of thromboelastogram: with I.T.P. equal to 40-58 c.u., g + k = 24 mm, platelet aggregation in the range of 70-80%, aspirin is prescribed at 300 mg / day (100 mg 3 r / day, course 7 days); with I.T.P. equal to 35-40 c.u., g + k = 25 mm and platelet aggregation in the range of 60-70%, the dose of acetylsalicylic acid is 180 mg / day. With the normalization of the general condition and hemostatic parameters of the blood, the dose of acetylsalicylic acid is reduced to 60 mg / day.

Indications for the use of low molecular weight heparins (nadroparin calcium, enoxaparin sodium, dalteparin sodium) are a decrease in the level of endogenous heparin to 0.07-0.04 U / ml and below, antithrombin III to 85.0-60.0% and below, chronometric and structural hypercirculation according to thromboelastogram, an increase in platelet aggregation to 60% and above. Low molecular weight heparin is used when dynamic laboratory monitoring of blood coagulation properties is possible. It should not be used in thrombocytopenia, severe hypertension (BP 160/100 mm Hg and above), since there is a risk of hemorrhage.

Normalization of the structural and functional properties of cell membranes and cell metabolism is carried out by antioxidants (alpha-tocopherol acetate (vitamin E), solcoseryl), membrane stabilizers containing polyunsaturated fatty acids (essential phospholipids, soybean oil + triglycerides, omega-3 triglycerides). Correction of violations of structural and functional cell membranes in pregnant women with mild preeclampsia is achieved by including tablets in the treatment complex (vitamin E up to 600 mg / day, essential phospholipids, 2 drops 3 r / day); with moderate and severe preeclampsia, membrane-active substances are administered intramuscularly and intravenously until the effect is obtained, followed by the transition to tablets, the course is up to 3-4 weeks. In patients with moderate preeclampsia and the presence of IUGR with a gestation period of up to 30-32 weeks or less, soybean oil + triglycerides are administered 100 ml every 2-3 days and solcoseryl 1 ml for 15-20 days.

At the same time, to normalize cellular metabolism, a complex of vitamins, sigetin is administered, and oxygen therapy is carried out.

The ongoing complex therapy of gestosis is simultaneously aimed at normalizing the uteroplacental circulation.

Immunotherapy with husband's allogeneic lymphocytes (immunocytotherapy) and immunoglobulin. The mechanism of the therapeutic effect of immunocytotherapy with allogeneic lymphocytes is associated with the normalization of the processes of immune recognition of fetal alloantigens by the maternal organism and the strengthening of suppressor mechanisms. Immunization of the mother with her husband's allogeneic lymphocytes, reactivating the weakened local immune response, activates the synthesis of interleukins and growth factors, the secretion of placental proteins, which ensure the normal development of pregnancy. Immunocytotherapy is carried out once a month. The optimal gestation periods for immunocytotherapy are 15-20, 20-24, 25-29 and 30-33 weeks.

Control is carried out by weekly general clinical examination for 1 month. The frequency of administration of lymphocytes depends on the clinical effect, proteinuria, hemodynamic parameters, body weight and the level of placental proteins in the blood serum.

Extracorporeal methods of detoxification and dehydration - plasmapheresis and ultrafiltration - are used in the treatment of severe forms of preeclampsia.

Indications for plasmapheresis:

severe preeclampsia with gestation periods up to 34 weeks and the absence of the effect of ITT in order to prolong pregnancy;
complicated forms of gestosis (HELLP-syndrome and AFGB) for the relief of hemolysis, DIC, the elimination of hyperbilirubinemia.

Indications for ultrafiltration:

posteclamptic coma;
swelling of the brain;
intractable pulmonary edema;
anasarka.

Discrete plasmapheresis and ultrafiltration are carried out by a specialist trained in the department of extracorporeal detoxification methods.

Recent studies have shown that calcium supplements can reduce the incidence of hypertension, preeclampsia, and preterm birth. It is interesting to note that in pregnant women with a transplanted kidney during treatment with glucocorticoids (methylprednisolone) and immunosuppressive therapy with cytostatics (cyclosporine), preeclampsia did not develop, and the existing dropsy did not turn into a more severe form.

In addition, when preventing distress syndrome with glucocorticoids in women with severe preeclampsia, there was an improvement in the condition of pregnant women and the possibility of prolonging their pregnancy for more than 2 weeks. There is also no convincing evidence of the benefits of using acetylsalicylic acid in preeclampsia.

Detailed treatment regimens for preeclampsia, depending on the severity and the drugs used, are presented in the book "Drugs used in obstetrics and gynecology."

In the treatment of preeclampsia, the duration of therapy in pregnant women is important. With mild and moderate preeclampsia, inpatient treatment should be carried out for 14 days, with an average - 14-20 days. Subsequently, measures are taken to prevent the recurrence of gestosis in the conditions of the antenatal clinic. With a severe degree of preeclampsia, inpatient treatment is carried out before delivery.

Ed. IN AND. Kulakova

What it is? Preeclampsia during pregnancy is a pathological condition of the body in which the functions of vital organs are disrupted and which is extremely difficult to control if it has entered an advanced stage.

The disease occurs mainly in the third trimester and has another name - late toxicosis. However, it differs from the classic malaise in the form of nausea and vomiting in that it entails dysfunction of the cardiovascular and endocrine systems, damage to the central nervous system as a result of spasm of blood vessels.

The degree of spread reaches 30%, the situation is further complicated by the fact that preeclampsia in the first half of pregnancy is very difficult to detect at the initial stages of development. So, for example, late toxicosis, which began at 20 weeks, is detected only by 27-28 weeks.

What is the danger of gestosis?

Until now, despite the development of medicine, preeclampsia remains one of the main causes of maternal and infant mortality in the prenatal and postnatal period. It does not kill instantly, but contributes to the rapid extinction of the body within a few days.

The patient may lose her sight, the ability to move independently, one after another, important organs stop working: the liver, kidneys, heart, brain. The more serious the stage of preeclampsia, the less chance doctors have to save the patient and (or) her child.

Only close attention to the deterioration of one's well-being and timely examination will help to identify late toxicosis in the early stages of its development and avoid mortal risk.

Causes of gestosis

Scientists have not yet found out for certain what exactly is the cause of the development of late toxicosis. There are only a few assumptions about this:

Pathological changes in the central nervous system. The relationship between the cerebral cortex and subcortical structures is disrupted, which leads to pathology. The trigger mechanism is the psychological stress that a woman could be exposed to while carrying a child.
Immune disorders, in particular, failures in the recognition of maternal and fetal tissues. This process involves special T cells that are regulators of the immune response.
Disruptions in the endocrine system. Pregnancy involves cardinal changes in the hormonal status, as a result of which malfunctions in the functioning of the entire body of a woman can begin.
Folic acid deficiency. This provokes an increase in the level of non-proteinogenic amino acids, which are extremely toxic to the body.

A complication of pregnancy with preeclampsia involves a spasm of all vessels - this is the reason for the failure of vital organs.

Symptoms of preeclampsia during pregnancy by stages

There are several classifications of late toxicosis, but doctors in Russia distinguish 4 main stages in the development of the disease, each of which is characterized by certain clinical manifestations.

Dropsy

It is characterized by insufficiently good excretion of fluid from the body, resulting in edema. This stage is divided into 4 stages, which are characterized by an upward direction of edema localization:

The feet swell, slight swelling of the legs is observed.
The legs swell completely, the lower third of the abdomen swells.
The swelling rises higher and affects the face, in addition to the legs and body.
Edema affects the whole body, observed on the internal organs.

Characteristic signs of edema

When pressed with a finger on the surface of the skin, a dent remains. The longer it disappears, the more severe the swelling.
In the edematous limb, tingling, numbness is felt.
Severe swelling provokes a feeling of fatigue in a pregnant woman.

These are the earliest symptoms of preeclampsia during pregnancy - if doctors prescribe the necessary therapy to a woman, then late toxicosis will not develop further.

Nephropathy

If no therapeutic measures were taken when edema appeared, then the disease progresses and passes into the stage of nephropathy. In addition to fluid retention, hypertension appears in the body, and urine tests indicate an increase in protein.

All these symptoms will be noticeable to the doctor if the patient visits the antenatal clinic at least once every 2 weeks and regularly passes the necessary tests. Nephropathy has several degrees that have certain symptoms:

I degree - the pressure does not exceed 150/90, and the distance from the upper to the lower border should be normal. Urine analysis reveals protein no more than 1 g / l. There is swelling of the lower extremities.
II degree - the pressure does not exceed 170/100, the protein in the urine increases and begins to reach 3 g / l. Edema extends not only to the lower limbs, but also to the lower third of the abdominal wall.
III degree - pressure above 170/110, protein in urine exceeds 3 g / l, edema spreads throughout the body, edema of internal organs is detected.

Nephropathy, especially its severe degree, cannot go unnoticed, and the pregnant woman will be forced to go to the hospital due to the deterioration of her condition.

Preeclampsia

In some cases, the III degree of nephropathy, despite the treatment, goes into preeclampsia. The main difference between this condition and nephropathy is that a pregnant woman has a violation of blood circulation in the brain.

There is a real threat to the life of the mother and fetus, which requires immediate hospitalization. Among the signs of severe preeclampsia during pregnancy, the following can be distinguished:

Confusion
Headache
Loss of vision and/or hearing
Feeling of heaviness in the back of the head
Manifestations of sclerosis
Hemorrhages in the walls of vital organs
Vomit

If a woman in this condition is without medical care, she will die. Preeclampsia involves the placement of the patient in the intensive care unit, since her well-being must be monitored around the clock.

Eclampsia

It is considered the most severe degree of preeclampsia of pregnancy, in which even emergency and highly qualified care does not guarantee that a woman will survive. Some doctors tend to consider preeclampsia as the initial stage of eclampsia.

Eclampsia implies an aggravation of the manifestations of nephropathy and a rather weak response of the body to ongoing measures to save the patient's life.

Characteristic signs of eclampsia

Loss of consciousness
tonic convulsions
Clonuses
severe weakness
Strong headache
Extensive swelling of the internal organs (most often the brain)
Blood pressure above 170/110

Eclampsia does not occur suddenly, so if you respond in time to a deterioration in well-being and test results, you can successfully prevent this condition.

Treatment of preeclampsia in stages - drugs, schemes

For each stage of preeclampsia in the third trimester of pregnancy, the doctor selects the appropriate therapy. For diagnosis, the results of urine and blood tests, blood pressure indicators, body weight indicators (in dynamics over several weeks), and fundus examinations are used.

Treatment of stage I preeclampsia (edema)

The main reason for the appearance of edema is the delay in the removal of fluid from the body. Traditionally, Russian obstetrician-gynecologists practice strict control over fluid intake and a significant limitation of its volume.

The results of such a “diet” are not always noticeable: the pregnant woman is constantly thirsty, and the already existing swelling goes away too slowly. However, no new ones are formed.

Gradually, our doctors began to adopt the experience of Western experts: a pregnant woman is allowed to drink as much as she likes, but with one condition - all the liquid consumed must have a pronounced diuretic effect. It can be cranberry juice or brewed lingonberry leaves. This method of treating preeclampsia is much easier to tolerate, and it relieves edema much faster.

In addition to natural remedies, the doctor may prescribe diuretics:

Kanefron - is available in the form of drops, as well as in the form of dragees. Expands the renal vessels, prevents excessive absorption of fluid. Reduces the excretion of protein in the urine.
Cyston - enhances the blood supply to the epithelial tissue of the urinary system, has an antibacterial and diuretic effect. Produced in the form of tablets.
Phytolysin - promotes relaxation of smooth muscles, has anti-inflammatory and diuretic effects. Produced in the form of a special paste from which you need to make a suspension.

With severe edema for a pregnant woman, hospitalization and treatment in a hospital are indicated.

Treatment of stage II preeclampsia (nephropathy)

Nephropathy involves a combination of edema and increased blood pressure. Consequently, therapy is added to the treatment of fluid retention in the body, contributing to the normalization of blood pressure.

Since the pressure surge can occur repeatedly and within a short time, the pregnant woman must be admitted to the hospital to monitor blood pressure indicators around the clock, as well as monitor kidney function. To stabilize the state, the following will be written:

Complete peace. Physical effort provokes a rise in pressure, so a woman needs to stay in bed for several days.
Taking sedatives. They help lower blood pressure, but during pregnancy, some of them can have an abortive effect, so you should not choose a sedative yourself.
Diet, the purpose of which is to reduce the intake of salt and fluid, as well as the normalization of the ratio of proteins, fats and carbohydrates in the diet.
Taking antispasmodics. Since late toxicosis is based on vasospasm, it is important to prevent it. Otherwise, the symptoms of placental preeclampsia will worsen. During pregnancy, drugs such as No-shpa and papaverine are allowed.
Taking protein supplements. Nephropathy involves increased leaching of protein from the body, so the task of the doctor is to increase its performance.

Complex timely treatment of preeclampsia during pregnancy at the stage of nephropathy, in most cases, has a positive effect and stops the further progression of late toxicosis.

Treatment of III and IV stages of preeclampsia (preeclampsia and eclampsia)

Both of these diseases involve serious impairment of the functioning of the kidneys, liver, heart, brain, and large blood vessels of the placenta, so this stage of preeclampsia most often has consequences for the child.

If the pregnancy has reached the period at which the fetus can be born viable, then the mothers do an emergency caesarean section.

To stabilize the patient's condition, the following measures are taken:

Drip intravenous administration of magnesium preparations, rheopolyglucin, glucose and diuretics, which should save the woman from edema.
Complete rest and strict bed rest. As a rule, with eclampsia, the patient feels such a strong weakness that she is not able to get out of bed herself.
The introduction of anticonvulsants, if the patient has tonic convulsions.
Hourly monitoring of protein in the urine. Since the woman is not able to take the test herself, a catheter is inserted into the urethra.
Connection to the artificial lung ventilation system.
Taking strong sedatives to normalize pressure and prevent new seizures.

Emergency delivery should be carried out only when it was possible to stop convulsive contractions and achieve relative stabilization of blood pressure.

Pregnancy after mild forms of gestosis should proceed under enhanced medical supervision. Since the exact causes of late toxicosis are unknown, it is difficult to determine specific preventive measures that would save a pregnant woman from developing this disease.

The surest way to protect yourself from preeclampsia and eclampsia is timely therapy in the early stages of preeclampsia.

Quite often, pregnancy is accompanied by various pathological conditions. In our article, we will tell you what preeclampsia is, why it occurs, how it develops, describe its signs, talk about the diagnosis, treatment and prevention of this condition.

Preeclampsia during pregnancy is a complication of the gestational period. It develops during childbearing, during childbirth or in the first days after them. Preeclampsia is accompanied by a pronounced disruption of the functioning of vital organs. The basis of this condition is a disturbed adaptation of the woman's body to pregnancy. As a result of a cascade of reactions, vasospasm occurs in all tissues, their blood supply is disturbed, and dystrophy develops. The nervous system, heart and blood vessels, placenta and fetus, kidneys and liver are affected.

Relevance of the problem

Preeclampsia in pregnant women develops in 12-15% of cases. It is the leading cause of death for women in the third trimester of pregnancy. With the development of this complication in the later stages and

up to a third of all children die in childbirth. In women, after a complication, the kidneys suffer, chronic arterial hypertension develops.

What is dangerous preeclampsia for the fetus? It causes intrauterine hypoxia (lack of oxygen) and growth retardation. The consequences of preeclampsia for a child are a lag in physical and mental development.

In modern conditions, atypical gestoses are increasingly common. They are characterized by the predominance of one symptom, early onset, early formation of placental insufficiency. Underestimation of the severity of the condition in this case leads to delayed diagnosis, untimely treatment and late delivery.

Classification

The classification of preeclampsia is not well developed. In Russia, the most commonly used division of the disease into the following types:

dropsy of pregnant women (with a predominance of edema);
nephropathy of mild, moderate and severe degree;
preeclampsia;
eclampsia.

The main disadvantage of this classification is the vagueness of the term "preeclampsia", which does not allow clarifying the severity of the condition.

Today, preeclampsia is divided into forms in accordance with the International Classification of Diseases 10th revision:

O10: hypertension (high blood pressure) that existed before pregnancy and complicated the course of gestation, childbirth, the postpartum period;
O11: Pre-existing high blood pressure with the addition of proteinuria (protein in the urine);
O12: the appearance of edema and protein in the urine during pregnancy at normal pressure;
O13: development of high blood pressure during pregnancy in the absence of protein in the urine;
O14: pregnancy-induced hypertension associated with high protein in the urine;
O15: eclampsia;
O16: Unspecified hypertension.

This classification solves some working aspects of diagnosis and treatment, but does not reflect the processes taking place in the body.

With "pure" gestosis, pathology occurs in a previously healthy woman. This type is observed only in 10-30% of women. Combined forms are difficult. They develop against the background of previously existing diseases: hypertension, kidney and liver pathology, metabolic syndrome (obesity, insulin resistance), endocrine pathology (diabetes mellitus, hypothyroidism, and others).

This condition is typical only for the period of gestation. Preeclampsia after childbirth disappears, with the exception of severe complications. This suggests that the source of the problems is the fetus and the placenta. Gestosis occurs only in humans. This disease does not occur in animals, not even in monkeys, so it cannot be studied experimentally. A large number of theories and questions regarding the nature of this condition are associated with this.

Why does gestosis occur

Consider the main modern theories of the development of this state:

Cortico-visceral theory. According to her, gestosis is very similar to a neurotic state with disruption of the cerebral cortex and a subsequent increase in vascular tone. Confirmation of this theory is the increase in the frequency of the disease in pregnant women after mental trauma, as well as data obtained using electroencephalography.
The endocrine theory considers an improperly proceeding pregnancy as a chronic stress that causes overstrain and exhaustion of all endocrine systems of the body, including those regulating vascular tone.
The immunological theory states that the tissue of the trophoblast (the outer membrane of the fetus that forms the placenta) is a weak antigen. The body produces the appropriate antibodies, which also interact with the cells of the woman's kidneys and liver. As a result, the vessels of these organs are affected. However, autoimmune processes are not fixed in all women with preeclampsia.
The genetic theory is based on the fact that in women whose mothers suffered preeclampsia, the pathological condition develops 8 times more often than the average. Scientists are actively looking for "eclampsia genes".
Placental theory focuses on the violation of the formation of the placenta.
Thrombophilia and antiphospholipid syndrome can cause damage to the vascular walls throughout the body, and they also lead to a violation of the formation of the placenta.

Scientists believe that a unified theory of the origin of preeclampsia has not yet been developed. The most promising are the immunological and placental versions.

The following factors significantly increase the risk of preeclampsia:

Extragenital diseases, namely hypertension, metabolic syndrome, diseases of the kidneys and gastrointestinal tract, frequent colds and endocrine pathology.
Multiple pregnancy.
Previously transferred gestosis.
The age of the woman is under 18 and over 30 years old.
Bad social conditions.

How the disease develops

The onset of the disease occurs even in the earliest stages of pregnancy. During implantation (introduction) of the embryo into the wall of the uterus, the arteries located in the muscle layer do not change, but remain in the "pre-pregnancy" state. Their spasm occurs, the inner lining of the vessels, the endothelium, is affected. Endothelial dysfunction is the most important trigger of preeclampsia. It leads to the release of powerful vasoconstrictor substances. At the same time, blood viscosity increases, microthrombi are formed in spasmodic vessels. The syndrome of disseminated intravascular coagulation (DIC) develops.

Vasospasm leads to a decrease in the volume of blood circulating in the body. As a result, the tone of peripheral vessels reflexively increases. The intensity of blood flow in all organs decreases, including the kidneys, liver, heart, brain and placenta. These violations cause a clinical picture of preeclampsia.

Symptoms of preeclampsia

External signs usually manifest gestosis of the second half of pregnancy. However, we found that the disease develops much earlier. Early preeclampsia is considered a preclinical stage, which can be detected using special tests:

measurement of pressure with an interval of 5 minutes in the position of a woman lying on her side, on her back, again on her side. The test is positive if the diastolic ("lower") pressure changes by more than 20 mm Hg. Art.;
violation of uteroplacental blood flow according to;
decrease in the number of platelets less than 160×10 9 /l;
signs of increased blood clotting: increased platelet aggregation, decreased activated partial thromboplastin time, increased fibrinogen concentration in the blood;
decrease in the concentration of anticoagulants, in particular, own heparin;
a decrease in the relative number of lymphocytes to 18% and below.

If a woman finds two or three of the listed signs, she needs treatment for preeclampsia.

Classic signs of preeclampsia that appear in the second half of pregnancy and especially in the 3rd trimester:

swelling;
arterial hypertension;
proteinuria.

Gestosis is characterized by a variety of options for its course. The classic triad occurs in only 15% of women, and one of the three symptoms occurs in a third of patients. More than half of patients suffer from protracted forms of the disease.

One of the earliest signs of the disease is excessive weight gain. It usually starts at 22 weeks of gestation. Normally, any woman up to 15 weeks should add no more than 300 g weekly. Then, in patients younger than 30 years old, this increase should be no more than 400 grams per week, in older women - 200-300 grams.

An increase in blood pressure usually occurs at 29 weeks. For a more accurate diagnosis, you should follow all the measurement rules, register the pressure on both arms, and choose the right cuff size.

Edema in preeclampsia is associated with sodium retention, a decrease in the concentration of proteins in the blood, and the accumulation of incompletely oxidized metabolic products in the tissues. Edema can be only on the legs, spread to the abdominal wall or cover the entire body. Signs of hidden edema:

excretion of the main volume of urine at night;
a decrease in the amount of urine excreted compared to the amount of fluid consumed;
excessive weight gain;
“symptom of the ring” - a woman’s wedding or other familiar ring becomes small.

Proteinuria is the excretion of protein in the urine. It is caused by damage to the glomeruli as a result of lack of oxygen and vasospasm. Excretion of more than 1 gram of protein in any portion of urine is a dangerous sign. At the same time, the level of protein in the blood decreases.

Severe forms of the disease

Of particular danger to the mother and child is a violation of the function of the nervous system - preeclampsia and eclampsia.

Symptoms of preeclampsia:

headache in the back of the head and temples;
"shroud", "flies" before the eyes;
pain in the upper abdomen and in the right hypochondrium;
nausea and vomiting, fever, itchy skin;
nasal congestion;
drowsiness or increased activity;
redness of the face;
dry cough and hoarseness;
tearfulness, inappropriate behavior;
hearing loss, difficulty speaking;
chills, shortness of breath, fever.

With the progression of this condition, eclampsia develops - a convulsive seizure, accompanied by hemorrhages and swelling of the brain.

Complications

Late preeclampsia can cause severe complications that can even lead to the death of the mother and child:

eclampsia and coma after it;
intracerebral hemorrhage;
acute renal failure;
respiratory failure;
retinal detachment and loss of vision in a pregnant woman;
premature;
hemorrhagic shock and DIC.

There are more rare forms that complicate preeclampsia. This is the so-called HELLP-syndrome and acute fatty hepatosis of pregnant women.

HELLP syndrome includes hemolysis (breakdown of red blood cells), a decrease in the number of platelets responsible for blood clotting, and abnormal liver function with an increase in its enzymes in the blood. This complication occurs mainly after the 35th week of pregnancy, especially against the background of nephropathy, and often causes the death of a woman and fetus.

Symptoms develop quickly. The woman begins to complain of headache, vomiting, pain in the abdomen or in the right hypochondrium. There is jaundice, bleeding, the patient loses consciousness, she begins to have convulsions. There is a rupture of the liver with bleeding into the abdominal cavity, placental abruption. Even if a woman is urgently operated on, due to blood clotting disorders, she may die in the postoperative period from severe bleeding.

Acute fatty hepatosis of pregnant women develops mainly during the first pregnancy. Within 2-6 weeks, a woman is concerned about weakness, lack of appetite, abdominal pain, nausea and vomiting, weight loss, skin itching. Then liver and kidney failure develops, which is manifested by jaundice, edema, uterine bleeding and fetal death. Often there is a hepatic coma with disruption of the brain.

Assessment of the severity of the condition

According to the Russian classification, the severity of the disease is determined by the condition of the kidneys.

Preeclampsia 1 degree usually accompanied by swelling of the legs, slight proteinuria, increased blood pressure up to 150/90 mm Hg. Art. In this case, the fetus develops normally. This condition usually occurs at 36-40 weeks.

Preeclampsia 2 degrees characterized by the appearance of edema on the abdomen, proteinuria up to 1 g / l, increased pressure up to 170/110 mm Hg. Art. Fetal hypotrophy of the 1st degree may be noted. This form occurs at 30-35 weeks.

Diagnosis of a severe form is based on the following features:

increase in blood pressure up to 170/110 mm Hg. Art. and higher;
protein excretion in an amount of more than 1 gram per liter of urine;
decrease in urine volume to 400 ml per day;
widespread edema;
violation of blood flow in the arteries of the uterus, brain and kidneys;
delayed fetal development;
blood clotting disorder;
increased activity of liver enzymes;
development up to 30 weeks.

With such a serious condition, treatment in a hospital is necessary.

Treatment of preeclampsia

The main directions of therapy:

medical and protective regime;
delivery;
restoration of the functions of internal organs.

A woman is prescribed the following drugs:

sedatives, sedatives (valerian, motherwort), in severe cases - tranquilizers and antipsychotics (Relanium, Droperidol), barbiturates, anesthetics;
antihypertensive drugs (mainly calcium antagonists - Amlodipine, beta-blockers - Atenolol, as well as Clonidine, Hydralazine and others);
magnesium sulfate, which has a hypotensive, anticonvulsant, sedative effect;
replenishment of the volume of circulating blood with the help of intravenous infusions;
antiplatelet agents (Kurantil) and anticoagulants (Fraksiparin) under strict control of blood coagulation;
antioxidants (vitamins C, E, Essentiale).

Drug treatment with a mild degree can be carried out within 10 days, with moderate severity - up to 5 days, with a serious condition - up to 6 hours. If treatment fails, urgent delivery is necessary.

Delivery with preeclampsia is carried out through the natural birth canal or with the help of a caesarean section. A woman can give birth herself with a mild degree of illness, a good condition of the fetus, the absence of other diseases, the effect of medications. In more severe cases, a planned operation is used. In severe complications (eclampsia, renal failure, placental abruption, and so on), an emergency caesarean section is performed.

After a caesarean section, drug treatment is continued until all body functions are fully restored. Women are discharged home no earlier than 7-15 days after birth.

Prevention of gestosis during pregnancy

A pregnant woman should avoid nervous and physical overload, have a good rest, and not take medications without a doctor's prescription. Nutrition should be complete, if possible hypoallergenic. Severe fluid restriction and a low-salt diet are not indicated. Only in severe cases of renal failure is the patient recommended to reduce the amount of protein consumed with food.

The key to preventing preeclampsia is regular medical supervision, weight control, blood pressure, blood and urine tests. If necessary, a woman is hospitalized in a day hospital or in a sanatorium, where preventive treatment is carried out.

If the condition worsens, the appearance of edema, headache, pain in the right hypochondrium, the patient should consult a doctor as soon as possible. Self-medication is unacceptable. Untreated acute gestosis is an immediate threat to the life of the mother and child.

In this article:

Preeclampsia is one of the most dangerous complications that occurs during pregnancy and disappears after childbirth. This serious disease is one of the top three causes of death for expectant mothers and is diagnosed in almost 30% of pregnant women.

Preeclampsia during pregnancy is often called late toxicosis and is usually detected in the 3rd trimester. It can be accompanied by dysfunction of any vital organs, however, most often, the vascular system suffers.

The placenta of pregnant women with gestosis begins to produce special substances that provoke the formation of micropores on the walls of blood vessels. Thanks to them, fluid and plasma protein penetrate into the tissues of the body. This causes severe swelling. Since the vessels of the kidneys also pass the protein, it is easily detected in a general urine test. Timely delivery of tests allows you to identify gestosis in the early stages of development, which greatly facilitates its treatment.

Gestosis in the second half of pregnancy- a very insidious disease in which a pregnant woman can feel completely healthy for a long time. Preeclampsia can be suspected by rapid weight gain in the 3rd trimester, resulting from latent edema of internal organs, including the placenta, which can cause fetal hypoxia.

OPG - preeclampsia, and this is how late toxicosis of pregnant women is increasingly called, got its name due to the triad of characteristic signs: edema, proteinuria and hypertension. At the same time, it is not at all necessary that all these signs of the disease will be detected. Sometimes preeclampsia is mild and is characterized by the presence of one or two symptoms.

The main types and severity of preeclampsia in pregnant women

Preeclampsia of the second half of pregnancy can develop in the complete absence of any serious pathologies, against the background of a completely prosperous state of the pregnant woman. This condition is called "pure" preeclampsia. But more often preeclampsia occurs against the background of existing chronic ailments, for example, in violation of fat metabolism, pathology of the endocrine system, hypertension, diseases of the kidneys and liver. Doctors call such a disease "combined" preeclampsia.

Preeclampsia in the 3rd trimester can manifest itself in various forms and have different causes, symptoms and consequences. Specialists identify several types of preeclampsia, which can become the stage or severity of this disease.

dropsy pregnant- the simplest and earliest stage of preeclampsia in the 3rd trimester, which is characterized by swelling of the legs and hands. However, the presence of swelling does not always indicate the presence of the disease. The diagnosis of "OPG-gestosis" can only be made by a qualified specialist on the basis of a preliminary examination and laboratory research methods. Having discovered the characteristic symptoms of mild preeclampsia, pregnant women should not draw premature conclusions, and even more so take any action aimed at self-treatment.
Nephropathy- one of the stages of gestosis, which develops against the background of dropsy of pregnant women and is accompanied by impaired renal function. The main symptom of this condition is a sharp increase in blood pressure. Treatment for nephropathy should be immediate, since this condition can quickly turn into another form of preeclampsia - eclampsia, the consequences of which can pose a danger to the life and health of pregnant women.
Preeclampsia- a later stage of gestosis, which has such serious signs as edema, high blood pressure, protein in urine tests. Moreover, with this degree of preeclampsia, there is often a violation of the blood supply, provoking the appearance of nausea, vomiting, severe headaches and a feeling of heaviness in the back of the head. Late preeclampsia can adversely affect the vision of pregnant women, as well as cause serious mental disorders.
Eclampsia- one of the most difficult stages of preeclampsia during the second half of pregnancy. The consequences of this degree of the disease are very dangerous, both for the expectant mother and for the baby. Late preeclampsia is often accompanied by convulsive seizures, which can cause premature birth, bleeding, fetal hypoxia, and as a result, cause the death of a woman and an unborn child. Moreover, such an attack can provoke pulmonary and cerebral edema, stroke and heart attack, detachment of the placenta and retina, the development of liver or kidney failure.

How to recognize a dangerous disease?

Every pregnant woman should know all the symptoms of gestosis in order to recognize a dangerous illness as early as possible. What should alert the expectant mother?

The presence of late toxicosis, manifested in the form of nausea, vomiting and dizziness. Such signs of the disease are usually accompanied by profuse salivation and can disturb at any time of the day.
The appearance of protein in the general analysis of urine. This type of study is prescribed to pregnant women regularly until the very birth and allows you to recognize preeclampsia in time.
Increase in blood pressure. Due to the loss of fluid, the blood in the body of a pregnant woman thickens, it becomes more difficult to move it through the vessels and this increases the pressure.
The appearance of edema and a sharp weight gain.

Treatment of preeclampsia in pregnant women

Gestosis in all its manifestations is extremely dangerous. If you suspect any signs of this disease, you should immediately tell your doctor about them. This will allow you to start timely treatment and prevent serious irreversible consequences.

Opg-preeclampsia is incurable and it is possible to get rid of it only after childbirth. However, it is quite possible to significantly alleviate the condition of a pregnant woman in the 3rd trimester. With a mild degree of the disease, treatment can occur at home, with a more severe one, in a hospital, in the immediate vicinity of the intensive care unit. The duration of inpatient treatment is largely determined by the severity of the disease. In the presence of small edema, it can be a week, with a more serious steppe - up to 2-3 weeks. Since pregnancy itself, or rather the placenta of a pregnant woman, is the main cause of preeclampsia, natural delivery is the best treatment.

If there is evidence, the expectant mother should not refuse hospitalization. There, in any emergency, she will be able to receive qualified medical care and undergo a course of treatment that will significantly improve her condition. With the help of droppers, doctors will quickly replenish the loss of fluid and protein in the blood vessels and normalize a woman's health.

To confirm the diagnosis and establish the form of preeclampsia, the expectant mother will have to undergo a thorough examination. It will be possible to breathe a sigh of relief only after childbirth, because until the end of pregnancy she will have to adhere to a special diet with restriction of salt and liquid to 1000 ml per day. With any degree of preeclampsia in the 3rd trimester, it is necessary to control the accumulation of fluid in the body, as well as constantly monitor the dynamics of weight gain.

After confirming the diagnosis of "preeclampsia of the second half of pregnancy", the woman will need to undergo such a study as fetal Doppler, as well as get advice from a therapist, neuropathologist, ophthalmologist and nephrologist.

Drug treatment of toxicosis of the second half of pregnancy depends on the dysfunction of the internal organs. The causes and symptoms of preeclampsia during pregnancy in different women may differ, so all medications are prescribed individually. These can be diuretics or drugs that lower blood pressure and improve blood flow in small vessels.

Treatment of preeclampsia in pregnant women is not complete without sedatives. Weak symptoms of the disease are the reason for the appointment of valerian or motherwort tincture, with the development of eclampsia, stronger sedatives are used. At the same time, prevention of placental insufficiency is carried out. For this, the drug Actovegin and a number of vitamins are prescribed, which will have to be taken in the second half of pregnancy until the birth itself.

Opg-preeclampsia is a rather complex disease, the signs of which can be sluggish. However, most often gestosis of the second half of pregnancy is characterized by rapid development with a sharp deterioration in the condition of pregnant women.

In case of the slightest suspicion of preeclampsia in the 3rd trimester, you should immediately seek qualified help. Self-treatment in this case is unacceptable, since preeclampsia can lead to the rapid development of a wide variety of complications with very sad consequences. In exceptional cases, when the prescribed treatment does not bring the slightest relief, and the condition of the expectant mother and her child worsens, doctors may decide to induce preterm labor or perform a caesarean section.

How to resist the insidious disease?

Prevention of such an ailment as gestosis of the second half of pregnancy should be of interest, first of all, to women who are part of the so-called risk group:

pregnant women over the age of 35;
nulliparous or having multiple pregnancies;
carriers of sexually transmitted infections (mycoplasmosis, chlamydia, ureaplasma, etc.);
pregnant women suffering from chronic diseases (diabetes mellitus, obesity, hypertension, pyelonephritis, vegetovascular dystonia, etc.).

To prevent preeclampsia, from the first months of pregnancy until the very birth, women should carefully monitor their diet and their own weight. The expectant mother needs a nutritious diet, the basis of which should be food enriched with protein: eggs, cottage cheese, fish, lean meats, etc. You should not get carried away with pickles, sweet and flour dishes. It is better to give preference to fresh fruits and vegetables, which are enriched with fiber and are the best way to prevent constipation.

Prevention of preeclampsia of varying severity should include an active lifestyle and moderate physical activity. To do this, you can visit the pool, do yoga or take daily walks.

Sometimes it is quite difficult to identify the main causes of gestosis. Preeclampsia may occur due to compression of the ureters by the uterus, which is increasing in size. In this case, in order to restore the disturbed outflow of urine, doctors recommend expectant mothers to take a knee-elbow position daily for 10 minutes.

With a tendency to edema, the prevention of preeclampsia cannot do without funds that have a weak diuretic effect. For this, decoctions of lingonberry leaves, wild rose, bearberry, as well as berry fruit drinks and kidney teas are perfect. A special decongestant collection can be purchased at a pharmacy. However, at the same time, attention should be paid to the fact that it does not contain woolly erva, which can destroy tooth enamel, kidney and liver stones.

An excellent alternative to herbal teas against edema can be herbal preparations such as cystenal, kanefron, cystone, and so on. Treatment and prevention of edema can also be carried out with the help of drugs: Magne-B6, magnerot, vitamin E, lipoic acid, hofitol or chimes.