Gestosis 2nd half of pregnancy 1st help. Gestosis during pregnancy and its possible consequences. The risk group includes

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

Preeclampsia during pregnancy is a complication of the gestational period. It develops during pregnancy, during childbirth or in the first days after it. Preeclampsia is accompanied by severe disruption of the functioning of vital organs. The basis of this condition is the impaired adaptation of the woman’s body to pregnancy. As a result of a cascade of reactions, vascular spasm occurs in all tissues, their blood supply is disrupted, 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. If this complication develops in the later stages and

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

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

In modern conditions, atypical gestosis is becoming more and more common. They are characterized by the predominance of one symptom, early onset, and early formation of placental insufficiency. Underestimation of the severity of the condition leads to delayed diagnosis, untimely treatment and late delivery.

Classification

The classification of gestosis is not sufficiently developed. In Russia, the disease was most often divided into the following types:

• dropsy of pregnancy (with a predominance of edema);
• mild, moderate and severe nephropathy;
• preeclampsia;
• eclampsia.

The main disadvantage of this classification is the vagueness of the term “preeclampsia”, which does not allow specifying the severity of the condition.

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

• O10: hypertension (high blood pressure), which existed before pregnancy and complicated the course of pregnancy, childbirth, and 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: hypertension arising during pregnancy in combination with a large amount of protein in the urine;
• O15: eclampsia;
• O16: unspecified hypertension.

This classification solves some operational aspects of diagnosis and treatment, but does not reflect the processes occurring 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 pre-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. Gestosis goes away after childbirth, with the exception of severe complications. This suggests that the source of the problems is the fetus and placenta. Preeclampsia occurs only in humans. This disease does not occur in animals, not even monkeys, so it cannot be studied experimentally. Associated with this is a large number of theories and questions regarding the nature of this condition.

Why does gestosis occur?

Let's consider the main modern theories of the development of this condition:

1. Cortico-visceral theory. According to her, gestosis is very similar to a neurotic condition with disruption of the cerebral cortex and a subsequent increase in vascular tone. Confirmation of this theory is the increase in the incidence of the disease in pregnant women after mental trauma, as well as data obtained using electroencephalography.
2. The endocrine theory considers an abnormal pregnancy as a chronic stress that causes overstrain and exhaustion of all endocrine systems of the body, including those that regulate vascular tone.
3. The immunological theory states that trophoblast tissue (the outer membrane of the fetus that forms the placenta) is a weak antigen. The body produces appropriate antibodies, which also interact with the woman’s kidney and liver cells. As a result, the vessels of these organs are affected. However, autoimmune processes are not observed in all women with gestosis.
4. The genetic theory is based on the fact that women whose mothers have suffered gestosis develop the pathological condition 8 times more often than average. Scientists are actively searching for “eclampsia genes.”
5. The placental theory assigns primary importance to disruption of the formation of the placenta.
6. Thrombophilia and antiphospholipid syndrome can cause damage to vascular walls throughout the body, and they also lead to disruption of the formation of the placenta.

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

The following factors significantly increase the risk of gestosis:

1. Extragenital diseases, namely hypertension, metabolic syndrome, kidney and gastrointestinal diseases, frequent colds and endocrine pathology.
2. Multiple pregnancy.
3. Previously suffered gestosis.
4. The woman's age is under 18 and over 30 years old.
5. Poor social conditions.

How the disease develops

The onset of the disease occurs in the very early stages of pregnancy. When the embryo is implanted (introduced) 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 and the inner lining of the blood vessels, the endothelium, is affected. Endothelial dysfunction is the most important triggering factor of gestosis. It leads to the release of powerful vasoconstrictor substances. At the same time, blood viscosity increases, and microthrombi form in spasmed vessels. Disseminated intravascular coagulation syndrome (DIC syndrome) 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 is reduced, including the kidneys, liver, heart, brain and placenta. These disorders cause the clinical picture of gestosis.

Symptoms of gestosis

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

• measuring blood pressure at intervals of 5 minutes with the woman lying on her side, on her back, and again on her side. The test is positive if the diastolic (“bottom”) pressure changes by more than 20 mmHg. Art.;
• disturbance of uteroplacental blood flow according to data;
• decrease in platelet count 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;
• reducing the concentration of anticoagulants, in particular, its own heparin;
• reduction in the relative number of lymphocytes to 18% and below.

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

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

• swelling;
• arterial hypertension;
• proteinuria.

Preeclampsia is characterized by a variety of variants of 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 the patients suffer from protracted forms of the disease.

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

High blood pressure usually occurs at 29 weeks. For a more accurate diagnosis, you should follow all measurement rules, record the pressure on both arms, and select the correct cuff size.

Edema during gestosis is associated with sodium retention, a decrease in the concentration of proteins in the blood, and the accumulation of under-oxidized metabolic products in the tissues. Swelling can be only in 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 volume of fluid consumed;
• excessive weight gain;
• “Ring symptom” - a woman’s engagement ring or other familiar ring becomes insufficient.

Proteinuria is the excretion of protein in the urine. It is caused by damage to the renal glomeruli as a result of lack of oxygen and vasospasm. The release 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

A particular danger for mother and child is a dysfunction of the nervous system - preeclampsia and eclampsia.

Symptoms of preeclampsia:

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

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

Complications

Late gestosis can cause severe complications that can even lead to the death of 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 disseminated intravascular coagulation syndrome.

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

HELLP syndrome includes hemolysis (decomposition of red blood cells), a decrease in the number of platelets responsible for blood clotting, and disruption of the liver 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 the woman and the fetus.

Symptoms develop quickly. The woman begins to complain of headache, vomiting, pain in the abdomen or in the right hypochondrium. Jaundice and bleeding appear, the patient loses consciousness, and begins to have convulsions. A rupture of the liver occurs with bleeding into the abdominal cavity, placental abruption. Even if a woman undergoes urgent surgery, 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. For 2-6 weeks, the woman experiences weakness, lack of appetite, abdominal pain, nausea and vomiting, weight loss, and itchy skin. Then liver and kidney failure develops, which is manifested by jaundice, edema, uterine bleeding and fetal death. Hepatic coma often occurs with disruption of brain function.

Assessing the severity of the condition

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

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

Gestosis 2 degrees characterized by the appearance of edema in the abdomen, proteinuria up to 1 g/l, increased pressure up to 170/110 mm Hg. Art. Grade 1 fetal malnutrition may occur. This form occurs at 30-35 weeks.

Diagnosis of severe form is based on the following signs:

• increase in blood pressure to 170/110 mm Hg. Art. and higher;
• excretion of more than 1 gram of protein per liter of urine;
• decrease in urine volume to 400 ml per day;
• widespread swelling;
• disruption 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, hospital treatment is necessary.

Treatment of gestosis

Main directions of therapy:

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

The woman is prescribed the following medications:

• 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 circulating blood volume using intravenous infusions;
• disaggregants (Curantil) and anticoagulants (Fraxiparin) under strict control of blood clotting;
• antioxidants (vitamins C, E, Essentiale).

Drug treatment for mild cases can be carried out for 10 days, for moderate cases – up to 5 days, for severe conditions – up to 6 hours. If treatment is ineffective, urgent delivery is necessary.

Delivery in case of gestosis is carried out through the natural birth canal or by cesarean section. A woman can give birth on her own if the disease is mild, the fetus is in good condition, there are no other diseases, and the medications are effective. In more severe cases, elective surgery is used. In case of severe complications (eclampsia, renal failure, placental abruption, etc.), 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 stress, get proper rest, and not take medications without a doctor’s prescription. Food should be nutritious and, 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 in food.

The key to preventing gestosis is regular observation by a doctor, monitoring weight, blood pressure, blood and urine tests. If necessary, the woman is hospitalized in a day hospital or in a sanatorium, where preventive treatment is carried out.

If the condition worsens, swelling, headache, or pain in the right hypochondrium appears, 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 mother and child.

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Any woman who has given birth is familiar with some features of the course of pregnancy and the main stages of monitoring it: regular visits to a medical facility, testing, ultrasound examinations, weighing. Some people are surprised by the need for weight control. Like, why should medical workers care about the future figure of a pregnant woman? Any diagnostic procedure has a meaning and is conditioned by something.

How many kilograms should a woman's weight increase during pregnancy? Many will answer the question correctly - about 10 kg. What if it’s 20–25? Such an increase “speaks” of hidden (and not only) edema. And swelling is gestosis. For women, this disease is more commonly known as late toxicosis.

Edema is one of the diagnostic signs of gestosis, but the pathology is not limited to them. Preeclampsia is easier in healthy women. In this case it is called “pure”. This type of disease occurs in 30% of pregnant women. If it develops against the background of existing diseases (hypertension, diabetes, gastrointestinal ailments, kidney diseases), then in this case they speak of “combined” gestosis. It is clear that the latter form is more difficult.

The first signs of possible gestosis

This pathology concerns only pregnant women - after childbirth, gestosis goes away. However, gestosis is classified as a dangerous disease. Its cunning lies in its complications. A quarter of female deaths during pregnancy are due to gestosis. The fetus dies 3-4 times more often than during an uncomplicated pregnancy.

The main cause of gestosis is a dysregulation of blood vessels, resulting in their spasm. Microvessels are mainly affected.

As for the pathogenesis of gestosis: many scientists see its connection with immune factors. Fetal antigens influence maternal antibody production. In turn, antibodies cause the formation of excess immune complexes, which have a negative effect on the pregnant woman’s body.

How does gestosis manifest?

The disease is often called OPG-preeclampsia. OPG – the first letters of the terms: edema, proteinuria, . These are the main signs of pathology. The entire complex is not always noted. Mild gestosis can occur with one or two of the listed symptoms.

OPG complex of symptoms

Swelling is more common in pregnant women. A woman drinks a lot of fluid, which cannot completely leave the body and lingers in the interstitial space. Only the lower extremities may swell, but in more severe forms, the entire body may swell. Swelling is not always noticeable. Sometimes we are talking about a hidden form. It is detected by weighing. A weight gain of more than 0.5 kg per week indicates an emerging problem. Monitoring of fluid intake and amount of urine excreted is prescribed. If, during normal drinking conditions, less than 0.8 liters of urine is excreted, preeclampsia can be suspected.

Hypertension develops against the background of fluid retention. Blood pressure is monitored at every doctor's visit. Pressure during gestosis exceeds the norm by 15–20%. What pressure is considered normal? Usually it is 120/80. However, if a woman had symptoms at the beginning of pregnancy, then even the generally accepted norm for her may already be a signal for further examination.

Proteinuria refers to the excretion of protein in the urine. This sign indicates a violation of renal activity. Therefore, it is important not to skip a diagnostic procedure such as a urine test. After 20 weeks of pregnancy, urine is examined weekly.

If a woman has two of the three signs of this disease, then treatment at home is ineffective - it is better to hospitalize the patient.

Other symptoms include headache, vomiting, nausea, and heaviness in the head. In the most difficult cases - changes in consciousness and convulsions.

The manifestation of pathology in pregnant women is more likely:

• Expecting their first child;
• Having genital tract infections: chlamydia, mycoplasmosis, ureaplasmosis;
• Suffering from chronic diseases: hypertension, diabetes, kidney disease, excess weight and others;
• Expecting twins.

Classification of gestosis

One of the classifications of pathology is divided into types:

1. Early gestosis;
2. Late gestosis.

The disease becomes more severe at the end of pregnancy.

Depending on the signs and form, the disease can be divided into the following degrees of severity:

1st degree

Dropsy of pregnancy is classified as gestosis of the 1st degree. This stage is characterized only by edema of varying severity. Usually they are less pronounced in the morning, and in the evening the condition worsens.

2nd degree

With grade 2 gestosis, all three symptoms of OPG are observed. In diagnosing hypertension, the most important indicators are diastolic pressure. The fact is that it is directly related to placental blood flow: the higher the diastolic pressure, the less oxygen the child receives. It is noteworthy that it is not so much the increase in pressure that is dangerous as its abrupt changes. This stage is especially difficult for pregnant women with concomitant diseases.

Complications develop:

• Placental abruption;
• Bleeding;
• Premature birth.

The main danger is that with complicated gestosis, the fetus is at risk of death.

Nephropathy is diagnosed simply by urine analysis. If things go wrong, it is important to monitor the condition of the fundus. Changes may indicate.

Stage 3, preeclampsia

As the condition worsens, stage 3 of gestosis develops. Pain and heaviness in the head indicate the onset of preeclampsia. Possible blurred vision, vomiting, and pain in the liver area. Memory deterioration, apathy, insomnia, irritability and other signs of changes in blood circulation in the brain are possible. Edema has a damaging effect on the liver, as evidenced by pain on the right side. There are even hemorrhages in this organ. “Floaters” and “veils” before the eyes may indicate problems with the retina.

Main signs of preeclampsia:

1. The amount of urine decreases to 0.4 liters or less;
2. Blood pressure – 160/110 or more;
3. Protein in urine;
4. Blood clotting disorder;
5. Changes in liver function;
6. Nausea, vomiting;
7. Symptoms of brain and visual disorders.

Eclampsia

An even more severe degree of gestosis is eclampsia. In addition to all of the above symptoms, convulsions are present. Typically, attacks are caused by external stimuli: loud sound, bright light, stress, pain. The attack does not last long - about 2 minutes. The danger of this condition is cerebral edema and death. Despite the similarities between gestational seizures and epileptic seizures, they have a number of differences. In epilepsy, urine tests are normal, there is no hypertension, and a characteristic epileptic aura is noted before a seizure.

HELLP syndrome

One of the dangerous forms is called HELLP syndrome. Its signs include bloody vomiting, jaundice, severe coma, and liver failure. Usually observed in women who have given birth frequently. May occur even after childbirth(unlike other forms of gestosis). About 80% of women and the same number of unborn children die from this type of pathology.

The most rare forms of gestosis include:

• Eczema;
• Dermatoses;
• Bronchial asthma;
• Pregnancy itch.

Some researchers suggest that all these forms are exacerbations of pre-existing diseases in women.

With different frequencies, pregnant women may suffer from other types of gestosis:

1. Osteomalacia. Otherwise - softening of the bones. A pronounced form is rare. More often it manifests itself in tooth decay, bone pain, changes in gait, and neuralgia. The reason for this condition lies in the lack of microelements - especially calcium - and vitamins.
2. Ptyalism (salivation). It is often accompanied by vomiting. With excessive saliva production, the body becomes dehydrated, speech is impaired, and the skin and mucous membranes are irritated.
3. Hepatosis. Accompanied by jaundice. It is necessary to differentiate with hepatitis. Therefore, a thorough diagnosis is carried out, and the woman is temporarily isolated from others.
4. Liver atrophy. If such a complication occurs during early gestosis and cannot be treated, then it is recommended to terminate the pregnancy.
5. HELLP syndrome is considered a truly rare form. Still, for most women, pregnancy ends happily - with the birth of a healthy baby.

Complications of gestosis

Mild gestosis can be almost invisible. Why get examined, let alone be hospitalized, if you feel good and don’t hurt anything! But I would like to emphasize that The main danger of the disease is its consequences, such as:

• Pulmonary edema;
• Hemorrhage;
• Pathology of the cardiovascular system;
• Placental abruption;
• Kidney diseases;
• Delay in child development;
• HELLP syndrome;
• Early birth;
• Liver diseases;
• Fetal hypoxia;
• Brain swelling;
• Problems with the retina of the eye;
• Stroke;
• Death of a child;
• Death of a pregnant woman.

Important! The development of dangerous stages of gestosis and their consequences can be prevented by timely diagnosis and correctly prescribed treatment.

Diagnostics

Every woman undergoes regular medical examination during pregnancy; if alarming symptoms appear, such examination is carried out unscheduled, and diagnostic procedures are added.

Required studies include:

1. Weighing. In the second part of pregnancy, weight gain should not exceed 350 g per week. If a woman has gained half a kilogram or more, then additional examinations need to be carried out.
2. The need to control fluid intake. For pregnant women, the rule “2 liters or more of water per day” is not suitable. And when pronounced edema appears, its amount should not be more than 1 liter. It is also necessary to control the volume of urine excreted.
3. Carrying out a blood test. The number of platelets and red blood cells is determined. Particularly important is the indicator of platelet content and coagulation. In addition to the general one, a biochemical analysis is carried out.
4. Blood pressure control, and on each arm. The presence of gestosis can be indicated by a large difference in the indicators on the left and right hands.
5. Analysis of urine. It is necessary to monitor the presence of protein in the urine.
6. Ultrasound of the fetus with. With the help of this study, the degree of fetal development and malnutrition is revealed.
7. Dentist examination.
8. Fundus examination. If the vessels of the fundus are changed, this may indicate problems with the vessels of the brain.

A woman should not ignore medical examinations. This is especially true for mature mothers (after 35 years) and those who are giving birth to their first child. Also, pregnant women with chronic and infectious diseases should be attentive to their health.

Successful diagnosis is the key to a properly structured treatment strategy.

Important! Not a single symptom should escape the attention of a pregnant woman. She must immediately report her suspicions to her doctor.

How to treat gestosis?

Let's say right away that Preeclampsia cannot be completely cured. It goes away with pregnancy. However, it is possible to prevent its development into more severe forms.

Main areas of treatment:

• It is necessary to create a protective treatment regime. A woman should avoid strong emotional stress, be calm and balanced. Bright light, noise, heavy physical activity that does not correspond to her condition are harmful. If gestosis is mild, then remedies such as motherwort and valerian are prescribed, and in more severe forms, they resort to individual selection of sedatives taking into account pregnancy.
• To restore the function of the pregnant woman’s body, as well as to prevent fetal hypoxia, appropriate medications are prescribed. These are medications that have a sedative, hypotensive, antispasmodic, and diuretic effect. Such drugs should improve placental blood flow, preventing fetal hypoxia. In case of exacerbation of existing chronic diseases, appropriate treatment is prescribed aimed at relieving symptoms.
• The birth canal must be prepared so that delivery during gestosis can be carried out in a timely and careful manner. The timing of delivery is determined by the condition of the pregnant woman. For example, a severe form of gestosis requires delivery no later than three days after the condition worsens. If eclampsia develops, delivery should be immediate. Childbirth is safest for the health of the baby at 38 weeks of pregnancy and later, since by this time all the vital systems of the fetus have time to form. Give birth naturally or use a caesarean section? The choice depends on the condition of the fetus and the birth canal of the pregnant woman. In case of severe gestosis, when urgent delivery is necessary, a caesarean section is performed. If childbirth occurs naturally, anesthesia is recommended. And not so much for pain relief, but to improve placental and renal circulation, as well as a slight decrease in pressure. In the case of mild gestosis, treatment is prescribed, and childbirth occurs on time naturally.

In moderate and mild forms of gestosis, women are recommended to be hospitalized in a hospital. Severe gestosis may require resuscitation. The main research procedures carried out in the hospital:

1. Conducting a general urine test, as well as a Zimnitsky test.
2. Study of the condition of the unborn child (Doppler, ultrasound, cardiotocography).
3. Coagulogram and other blood tests.

Infusion therapy is used as treatment, the task of which is to remove tissue fluid, as well as replenish its deficiency in the vessels. For hypertension, individual selection of medications is carried out.

Treatment lasts from several hours to several weeks. It all depends on the severity of the condition. The more dangerous it is, the less time a woman has. Delivery is the main outcome of any treatment. Therefore, in the most severe cases, an immediate caesarean section is performed.

Principles of hexose prevention

The main task of the patient and medical workers is timely detection of the disease and initiation of early treatment. Therefore, it is difficult to avoid gestosis without active prevention.

Avoid obesity. During pregnancy, women sometimes gain a lot of weight. Why is this happening? There are many reasons. Firstly, hormonal changes can cause an increase in appetite. Secondly, a woman begins to allow herself to eat everything, citing the fact that her figure is already deteriorating, it won’t get any worse. Thirdly, some women are sure that you need to eat for two. If she eats as before, the baby will not get many nutrients. Unfortunately, the effect of such eating behavior is sad - obesity and gestosis.

The diet for gestosis is very simple. The fetus needs protein (the cells of the unborn child’s body will be built from it), which means that a pregnant woman’s diet should include dairy products, lean meat, eggs, and fish. An increased protein content in food is also necessary because it migrates from the body.

You need vitamins, minerals, fiber. And they are most abundant in vegetables and fruits. Fiber is especially important: with a minimum of calories, it perfectly satisfies hunger. This diet is also beneficial for the gastrointestinal tract - there will be no constipation or complications such as those that often bother pregnant women. It’s good to forget about the existence of flour and sweet foods. Apart from excess weight, they will give nothing to either mother or child.

The maximum weight gain during the entire pregnancy should be no more than 12 kg. Women with initial underweight may gain a little more. Conversely, plump mothers are allowed to gain a maximum of 10 kg.

Proper drinking regime is very important. Despite the threat of edema, you should not severely limit yourself in water. It is recommended to consume 1 to 1.5 liters of fluid per day, this also includes fruits, soups and other foods. But you cannot retain this water with salt. No matter how much a pregnant woman would like to eat a pickled cucumber or a piece of herring, there is no need to do this. To remove excess fluid, as well as improve renal blood circulation, it is useful to drink a decoction of bearberry, rose hips, cranberry juice, kidney tea (by agreement with your doctor!). For the same purposes, the doctor may prescribe special medications: cystone, canephron, etc.

And one more, and perhaps the most important principle of prevention - active lifestyle. Pregnancy is not a disease. Therefore, a pregnant woman, like any other woman, should walk, swim, do yoga for pregnant women, Pilates, and not forget about special gymnastics. The main thing is not to overdo it. It is necessary to listen to your condition and stop exercising at the slightest suspicion of its deterioration. For your peace of mind, it is better to consult a doctor once again. Physical activity should not harm a woman and her unborn child. The doctor may recommend special exercises to help get rid of certain manifestations of the pathology.

Undiagnosed and untreated gestosis is dangerous. Only careful attention to yourself will allow a woman to give birth to a healthy child and maintain her own health.

Video: gestosis in the cycle “Pregnancy week by week”

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, plasma fluid and protein penetrate into the body tissues. This causes severe swelling. Since the kidney vessels also allow protein to pass through, it is easily detected during a general urine test. Timely testing allows you to identify gestosis in the early stages of development, which greatly facilitates its treatment.

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

OPG-preeclampsia, which is what late toxicosis of pregnancy is increasingly called, got its name due to a triad of characteristic symptoms: edema, proteinuria and hypertension. However, it is not at all necessary that all these signs of the disease will be detected. Sometimes gestosis is mild and is characterized by the presence of one or two symptoms.

Preeclampsia in the second half of pregnancy can develop in the complete absence of any serious pathologies, against the background of a completely prosperous condition of the pregnant woman. This condition is called “pure” gestosis. But more often, gestosis occurs against the background of existing chronic ailments, for example, in cases of impaired fat metabolism, pathology of the endocrine system, hypertension, kidney and liver diseases. Doctors call this disease “combined” gestosis.

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

• Dropsy of pregnancy- the simplest and earliest stage of gestosis 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 a disease. The diagnosis of “OPG-gestosis” can only be made by a qualified specialist based on a preliminary examination and laboratory research methods. Having discovered the characteristic symptoms of mild gestosis, pregnant women should not draw premature conclusions, much less take any actions aimed at self-medication.
• Nephropathy- one of the stages of gestosis, developing against the background of dropsy in pregnancy and 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 develop into another form of gestosis - 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 such a degree of gestosis, a disruption of the blood supply often occurs, causing nausea, vomiting, severe headaches and a feeling of heaviness in the back of the head. Late gestosis can negatively affect the vision of pregnant women and also cause serious mental disorders. Read more about preeclampsia →
• Eclampsia- one of the most severe stages of gestosis 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 gestosis is often accompanied by convulsive attacks, which can cause premature birth, bleeding, fetal hypoxia, and as a result, cause the death of the woman and the unborn child. Moreover, such an attack can provoke pulmonary and cerebral edema, stroke and heart attack, placental and retinal detachment, and the development of liver or kidney failure.

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

• The presence of late toxicosis, manifested in the form of nausea, vomiting and dizziness. Such signs of the disease are usually accompanied by excessive salivation and can be disturbing at any time of the day.
• The appearance of protein in a general urine test. This type of examination is prescribed to pregnant women regularly until childbirth and allows timely recognition of gestosis.
• Increased blood pressure. Due to the loss of fluid, the blood in a pregnant woman’s body thickens, moving it through the vessels becomes more difficult and this increases the pressure.
• The appearance of edema and sudden weight gain.

Preeclampsia 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 timely treatment to begin and prevent serious irreversible consequences.

OPG-gestosis is incurable and you can 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. For mild cases of the disease, treatment can take place at home; for more severe cases, treatment can take place in a hospital, in close proximity to the intensive care unit. The duration of inpatient treatment is largely determined by the severity of the disease. If there is minor swelling, it can last a week, with more serious steppe – up to 2-3 weeks. Since pregnancy itself, or rather the placenta of a pregnant woman, is the main cause of gestosis, the best treatment is natural delivery.

If there are indications, the expectant mother should not refuse hospitalization. There, in any emergency situation, 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 the woman’s health.

To confirm the diagnosis and establish the form of gestosis, the expectant mother will have to undergo a thorough examination. She will only be able to breathe a sigh of relief after giving birth, since for the rest of her pregnancy she will have to adhere to a special diet limiting salt and liquid to 1000 ml per day. For any degree of gestosis in the 3rd trimester, it is necessary to control the accumulation of fluid in the body, as well as constantly monitor the dynamics of body weight gain.

After confirming the diagnosis of gestosis in the second half of pregnancy, the woman will need to undergo a study such as Doppler ultrasound of the fetus, as well as obtain consultations with a therapist, neurologist, ophthalmologist and nephrologist.

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

Treatment of gestosis in pregnant women is not complete without sedatives. Mild symptoms of the disease serve as a reason to prescribe valerian or motherwort tincture; with the development of eclampsia, stronger sedatives are used. At the same time, placental insufficiency is prevented. 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-gestosis is a rather complex disease, the symptoms of which can be sluggish. However, most often gestosis in the second half of pregnancy is characterized by rapid development with a sharp deterioration in the condition of pregnant women.

If there is the slightest suspicion of gestosis in the 3rd trimester, you should immediately seek qualified help. Self-treatment in this case is unacceptable, since gestosis can lead to the rapid development of a 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 premature labor or perform a caesarean section.

Prevention of such a disease as gestosis in the second half of pregnancy should be of interest, first of all, to women included in the so-called risk group:

• pregnant women over 35 years of age;
• primiparous or having multiple pregnancies;
• carriers of sexually transmitted infections (mycoplasmosis, chlamydia, ureaplasma, etc.);
• pregnant women suffering from chronic diseases (diabetes mellitus, obesity, hypertension, pyelonephritis, vegetative-vascular dystonia, etc.).

To prevent gestosis, from the first months of pregnancy until childbirth, women should carefully monitor their diet and body weight. The expectant mother needs good nutrition, 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, sweets 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 gestosis 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 can occur due to compression of the ureters by the uterus, which increases in size. In this case, in order to restore the impaired outflow of urine, doctors recommend that expectant mothers take the knee-elbow position for 10 minutes every day.

With a tendency to edema, the prevention of gestosis cannot do without drugs that have a weak diuretic effect. Decoctions of lingonberry, rosehip, bearberry leaves, as well as berry fruit drinks and kidney teas are perfect for this. A special decongestant mixture can be purchased at the pharmacy. However, you should pay attention that it does not contain woolly erva, which can destroy tooth enamel, kidney stones and liver stones.

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

Degrees of gestosis in pregnant women

Late gestosis (toxicosis) in pregnant women is a pathological condition when all systems of a woman’s body cannot cope with the fetal needs for nutrients and oxygen.

This condition begins after the twentieth week of pregnancy and may last several weeks after delivery. The main symptoms of gestosis are: edema, high blood pressure and proteinuria. Late toxicosis in pregnant women can manifest itself as one symptom, but sometimes the symptoms are combined. In this regard, four forms of gestosis are distinguished:

These forms of late toxicosis are typical and are considered by doctors as different stages of the same process.

This is the earliest stage of gestosis, which is characterized by the manifestation of only one symptom - edema. They are usually widespread: swelling of the lower and upper extremities, the anterior abdominal wall, and puffiness or swelling of the face may also appear. With dropsy, the general condition of pregnant women is not disturbed; only in cases where the swelling is too pronounced, women may experience a slight feeling of heaviness. It is quite difficult to diagnose edema as the first stage of gestosis, since they also appear during a normally ongoing pregnancy. You need to weigh yourself regularly in order to notice rapid weight gain (more than 0.5 kg per week) in time, since swelling can also appear inside the body.

In 20-24% of cases, dropsy develops into nephropathy, a stage characterized by a combination of several symptoms: edema, hypertension and proteinuria. The main symptom of nephropathy is high blood pressure (hypertension), which can sometimes reach 200/150 mmHg. Art., and sometimes higher. The degree of this stage of gestosis is determined according to the Savelyeva scale, which characterizes the condition of pregnant women during examination. There are three main degrees of nephropathy.

Edema appears slightly, mainly in the lower extremities. Mild hypertension appears - about 150/90 mm Hg. Art., protein appears in the urine - up to 1.0 g/l.

Edema spreads to the lower extremities and abdominal cavity. Blood pressure rises to 170/100 mm Hg. Art., protein in urine – 1.0-3.0 g/l.

The legs, abdomen, and face swell. Blood pressure – more than 170/100 mm Hg. Art., protein in urine – more than 3.0 g/l. Hemorrhages and degenerative changes may appear in the fundus.

Preeclampsia is a more severe form of late toxicosis. To the three symptoms of nephropathy (edema, hypertension, proteinuria), others are added: dizziness, headache, insomnia, apathy, blurred vision (small “spots”, “veil” before the eyes, sometimes complete loss of vision), lethargy, tinnitus and sensation heaviness in the back of the head or forehead. There are also signs of digestive tract and liver disorders: nausea, abdominal pain, vomiting. In this condition, a pregnant woman can experience eclampsia (convulsive seizure) from any irritant (bright light, loud sound, pain).

This stage of gestosis is the most dangerous for the pregnant woman and the fetus, but its cases are rare. Whole body seizures are accompanied by severe fluctuations in blood pressure, which can lead to cerebral hemorrhage (stroke), placental abruption, and fetal death. Also, a pregnant woman may experience acute respiratory failure (difficulty breathing, agitation, shortness of breath). Eclampsia leads to loss of consciousness and occurs in four main stages:

Stage 1 – seconds twitching of the facial muscles is observed.

Stage 2 – tonic convulsions are observed for 2-30 seconds (prolonged muscle contraction, as a result of which the limbs “freeze” in the position of extension or flexion, the head is brought to the chest or thrown back, the patient’s body is stretched). This stage can lead to biting the tongue and even stopping breathing.

Stage 3 – for about two minutes, the pregnant woman experiences clonic convulsions (repeated contraction of the flexor and extensor muscles), cyanosis develops (blue discoloration of the skin), breathing is impaired, and foamy saliva with blood appears.

Stage 4 is the final stage, which begins with a deep breath. The pregnant woman may not yet regain consciousness.

Preeclampsia in pregnant women can occur slowly, with mild symptoms, or it can progress very quickly and develop into eclampsia within a few days. In both cases, fetal hypoxia occurs.

Source: called the brightest, most fabulous period in a woman’s life.

However, in reality, it happens that the main character of this fairy tale has to endure a lot of suffering and trials on the way to her main goal.

The pregnancy does not have to be carried to term, but literally “stayed” in the hospital in order for its outcome to be successful. One of the common reasons for a woman’s poor health and her “imprisonment” in the department of pathology of pregnant women is gestosis.

Doctors call gestosis a complicated course of pregnancy that occurs at any stage and is directly related to the pregnancy itself, or rather to the difficulty in the process of adaptation of the mother’s body to a new state for it, which threatens with serious negative consequences for the health and life of the mother and baby.

A loose translation of the term “gestosis” from Latin means “painful pregnancy.”

Obstetricians-gynecologists characterize gestosis according to various criteria: by the time of occurrence, by the degree of severity, by the presence of concomitant diseases, by symptoms, etc.

As a rule, when diagnosing “gestosis,” doctors mean the pathology of late pregnancy as causing a disruption in the functioning of the mother’s vital organs and the normal development of the fetus.

Whereas gestosis in the first weeks after conception is less insidious and extremely rarely threatens the health of the expectant mother and her baby after the symptoms cease.

Depending on the period, early and late gestosis are distinguished.

Early gestosis in pregnant women begins before 12 weeks and can continue until the middle of the second trimester

Most often, this condition manifests itself in the expectant mother in the form of symptoms of body intoxication (toxicosis):

• nausea, vomiting and other unpleasant symptoms from the digestive system;
• intolerance to certain smells and foods;
• loss of appetite;
• dizziness;
• salivation (sometimes more than 1 liter per day).

More or less pronounced manifestations of toxicosis in the first weeks of pregnancy worry about 60% of expectant mothers. By the 20th week, by the time the placenta forms, the unpleasant manifestations of toxicosis, as a rule, disappear.

However, there are also special, extremely rare forms of early gestosis:

“Jaundice” of pregnant women (cholestasis) - usually develops after the 12th week from the moment of conception and is manifested in the coloring of the skin and mucous membranes in a yellow color, often accompanied by itching throughout the body.

In most cases, it is benign, but can mask serious damage to the liver and kidneys, gallbladder, and pancreas. Test results and medical supervision will help you figure it out.

Dermatosis during pregnancy causes a lot of unpleasant sensations due to incessant itching of a local nature (usually in the external genitalia) or general.

Dermatoses can appear both as a result of the process of adaptation of a woman’s body to the state of pregnancy, and as a result of exacerbation of diseases that cause itching (from allergic to infectious).

Manifestations of dermatoses occur in the form of urticaria, eczema, herpes and other skin lesions.

It manifests itself in the form of convulsions that occur due to calcium metabolism disorders, as well as due to certain mental disorders and a tendency to convulsive syndromes.

It occurs due to calcium-phosphorus deficiency, means softening of bone tissue and manifests itself in the form of pain in the joints and limbs, aggravated by movement.

Particularly dangerous is gestosis in the second half of pregnancy (late gestosis), in which the layer of endothelial cells lining the internal walls of blood vessels is damaged, resulting in vascular spasm.

This leads to difficulty in blood circulation in the body, which leads to degenerative changes in organs and tissues, including their death.

The kidneys, liver, brain and placenta are most affected by hypoxia.

Most often, late gestosis occurs against the background of an existing disease, which worsens during pregnancy.

This form of pathological pregnancy is called “combined” gestosis.

Complications of pregnancy are much less common in mothers who are not at risk for health reasons, but, nevertheless, in approximately 10-30% of cases this happens, is called “pure” preeclampsia and has a more favorable prognosis in treatment.

The processes that occur during the development and progression of gestosis in a woman’s body have been studied by doctors much better than the causes of its occurrence.

Since this pathological condition occurs only during pregnancy and goes away after its end (or 2 days after birth), its connection with pregnancy is unambiguous and this is perhaps the only thing about which there is no doubt.

Followers of several theories are trying to substantiate the causes of gestosis.

Because of this, the mother’s body is unable to adapt to the stressful state of bearing a fetus. In addition, the hormonal relationship in the “mother-placenta-fetus” system is disrupted, which also leads to hormonal imbalance.

However, there are opinions that such hormonal disorders are not a cause, but a consequence of gestosis.

Explains the occurrence of gestosis by the fact that the immune defense of the maternal body is activated, perceiving the introduction of the embryo as a foreign formation with the production of appropriate antibodies to fetal antigens.

Autoimmune compounds of maternal antibody molecules and fetal antigens lead to blood clotting in the vessels of the placenta, obstruction of blood flow in it, causing vasospasm. This leads to dysfunction of the placenta.

Similar processes involving complexes of antibodies and antigens also occur in the kidneys and liver, disrupting the adaptation of these organs and, subsequently, their performance.

The theory is based on the results of studies that have proven that the tendency to gestosis is inherited. This leads scientists to believe that there is a gene that causes gestosis.

The theory states that gestosis develops due to dysfunction of the central nervous system, possibly due to frequent and prolonged stress.

This leads to an adaptation failure during pregnancy on the part of neuroendocrine interactions and ultimately leads to vascular spasms and impaired circulation in the organs.

Preeclampsia in early pregnancy usually has quite vivid manifestations and causes a lot of unpleasant sensations for the expectant mother.

However, apart from poor health and some discomfort in everyday life, in most cases it does not pose a serious danger and usually does not require treatment.

In rare cases, when attacks of vomiting are repeated more than 7-10 times a day, are accompanied by weight loss, and the general condition of the mother calls into question the successful course and outcome of pregnancy, the woman is hospitalized and prescribed special treatment aimed at increasing immunity, vitamin therapy, and physical therapy. And, as a rule, by the 16th week of pregnancy, attacks of nausea and vomiting disappear.

The insidiousness of late gestosis is that its course and development can be asymptomatic, and the consequences can be serious complications of pregnancy.

Pathological changes in a woman’s body during gestosis have a wide scope of action. The most pronounced functional disorders are in the kidneys, liver, uteroplacental system, brain, and lungs of the patient.

The danger to the fetus of gestosis is indirect, through the mother’s body, in extremely severe forms. This is a risk of fetal hypoxia and intrauterine growth retardation, therefore, during gestosis, constant monitoring of the fetal condition is carried out.

We also must not forget that the progression of gestosis always carries the risk of an unfavorable outcome of pregnancy and forces doctors to make a decision to terminate it early, which cannot pass without leaving a mark on the health of the baby.

The mechanism of development of late gestosis is quite clear, therefore, the signs of pathology in the second half of pregnancy are clearly defined:

• edema arising due to impaired renal function as a consequence of gestosis;
• increased blood pressure due to fluid retention in the body and cerebral vascular spasms;
• protein in the urine due to kidney damage in combination with a violation of the filtration functions of the liver, inhibition of its synthesizing functions.

In honor of this triad (edema, proteinuria, hypertension), gestosis in late pregnancy is called OPG-gestosis.

All symptoms detected in a woman are assessed according to severity on a three-digit scale. Based on the totality of the results, the level of severity of gestosis itself is determined.

As a rule, gestosis is expressed through a combination of two symptoms of varying severity.

Whereas to diagnose gestosis, the manifestation of one, the very first symptom, for example, swelling of the extremities, is sufficient.

The simultaneous manifestation of all three symptoms to any degree is rare and means an increase in the severity of gestosis, called nephropathy.

The severity of preeclampsia and nephropathy is assessed in a similar way and depends on the degree of manifestation of OPG symptoms (for nephropathy) and pathological changes in the fundus (for preeclampsia).

The mild form is characterized by the following symptoms:

• swelling in the lower extremities;
• Blood pressure is not higher than 150/90 mm. rt. Art.;
• Protein in urine or traces of protein.

From the fundus side: uneven caliber of retinal vessels.

Moderate severity is characterized by the following symptoms:

• swelling in the lower extremities, anterior abdominal wall, upper extremities
• Blood pressure from 150/90 mm. rt. Art. up to 170/100 mm. rt. Art.
• protein in urine more than 3 g/l.
• from the fundus of the eye: retinal edema.

A severe form of late gestosis can be recognized when:

• swelling spreads to the entire body and face.
• Blood pressure is higher than 170/100 mm. rt. Art.
• protein in urine: 1-3 g/l.
• from the fundus side, retinal hemorrhages and degenerative changes in the fundus are possible.

A woman’s self-perception in a state of preeclampsia can be different: headache of varying intensity and localization, blurred vision, confusion, symptoms of toxicosis, rhinitis, sinusitis, etc. and so on.

If medical measures are not taken in a timely manner to stop the development of severe forms of gestosis, there is a risk of its most dangerous stage: eclampsia.

Attacks of eclampsia are manifested by convulsions similar to epileptic ones, pallor of the skin, stopping of the pulse, followed by a coma, after emerging from which the woman, as a rule, does not remember what happened.

A series of attacks following one another is characterized as “eclamptic status.” The severity of eclampsia is assessed by the number, duration of seizures and length of coma. Of course, the higher the degree, the less favorable the prognosis for the life of the mother and fetus.

Fortunately, the risk of developing eclampsia is now minimal (less than 1% of all pregnancies). Thanks to modern methods for diagnosing gestosis, a life-threatening condition can be predicted and prevented in a timely manner.

Diagnosis of gestosis is carried out on the basis of clinical observations and laboratory data on the woman’s tests.

An appointment with a gynecologist for a pregnant woman always includes several diagnostic methods to rule out gestosis.

Regular weight measurements are needed to determine the dynamics of changes in body weight over a period. If the growth exceeds the norm of 300 g per week and at the same time there is a pronounced puffiness of the limbs, body, face, we can talk about the appearance of edema.

This is not the norm, but a fairly common occurrence that can accompany a woman throughout her pregnancy.

Blood pressure is measured in both arms, because... with vasospasm, a difference occurs in the indicators. Current values ​​are also compared with previous values ​​to monitor hypertension (especially important for hypotensive patients).

Analysis of data on the composition of urine donated the day before, because even minor traces of protein in the urine require clarification of the reasons for its appearance.

Nausea, vomiting, headache, dizziness, etc. may hide preclinical manifestations of gestosis.

If gestosis is suspected, the doctor will refer the woman for additional tests and examinations.

Some blood clotting indicators require attention: platelets, red blood cells, the number of which decreases with the development of gestosis, and fibrin/fibrinogen degradation products (FDP), the number of which increases in severe forms of gestosis and indicates the risk of DIC syndrome.

The indicators of the concentration of electrolytes (especially sodium) in the plasma, which are responsible for water metabolism in tissues, the amount of total protein and its composition of its fractions in the blood serum, which differ from normal, should be alarming.

As well as increased levels of nitrogen metabolism: urea and creatinine, which signal a violation of renal function.

The presence of bilirubin in the urine determines the dysfunction of the liver and gallbladder.

It is carried out when traces of protein are detected in a general urine test. It consists of collecting the entire volume of diuresis per day in one container, followed by laboratory analysis to determine the total loss of protein.

• McClure-Aldrich test to detect hidden edema.

It is carried out if the weight gain over the period steadily exceeds the permissible norms, and no obvious edema is observed. Then 0.2 ml is injected under the skin of the forearm. saline solution and time of resorption of the papule (“bump” at the injection site) is recorded.

If after half an hour no papules are detected when palpating, a conclusion is drawn about the presence of hidden edema.

Timely diagnosis of late gestosis in the early stages of its manifestation makes it possible to prevent large-scale damage to the woman’s organs and maintain the pregnancy or carry out a careful delivery in time to save the life of the mother and child.

Special observation and more detailed and thorough examination during pregnancy are required by women who are at increased risk of gestosis:

• by age:
  • under 18 years old,
  • over 35 years old;

• according to social and living conditions:
  • working in hazardous industries,
  • living in conditions of increased stress,
  • having bad habits;
  • lack of weight due to poor nutrition;

• according to the presence of extragenital diseases:
  • having kidney and liver diseases;
  • having endocrine disorders;
  • having cardiovascular diseases, etc.;

• according to obstetric and gynecological predisposition:
  • multiple pregnancy;
  • polyhydramnios;
  • genetic predisposition (severe gestosis in the patient’s mother);
  • previously experienced gestosis (regardless of the outcome of pregnancy);
  • infantilism of the genital organs, etc.

• infectious diseases.

Special observation must be taken without irritation and especially without panic, remembering that all the actions of doctors are aimed at the benefit of her health and the future baby.

The measures prescribed by doctors when identifying signs of gestosis in a woman can only be called treatment conditionally.

Since a complete cure is possible only after getting rid of the culprit of the disease - pregnancy itself. Therefore, the mutual efforts of the expectant mother and medical staff are aimed at stabilizing the condition, preventing the progression of gestosis and the development of its severe forms.

For mild forms of gestosis (excessive weight gain due to swelling of the legs), treatment is carried out on an outpatient basis, under the supervision of a doctor managing the pregnancy. The patient is prescribed a protein-vegetable diet with feasible salt limitation and a quiet lifestyle.

If the severity of edema has not decreased or has increased to grade 2-3, the woman is admitted to a hospital, and herbal diuretics, vitamins that strengthen blood vessels and drugs that improve blood flow are added to the previous treatment.

When treating grade 1-2 nephropathy, in addition to the above measures, medications that lower blood pressure are prescribed, as well as herbal-based sedatives such as motherwort, valerian, etc., and rarely tranquilizers.

And also to improve the functioning of the liver, kidneys, heart, brain activity, uteroplacental blood flow.

When grade 3 nephropathy degenerates into preeclampsia and eclampsia, the efforts of doctors are aimed at relieving the symptoms of these conditions, after which it is recommended to prepare the woman for immediate delivery, as the only possible measure to preserve the life of the mother and fetus.

Preventive measures should be carried out primarily in patients at risk.

The main methods of preventing late gestosis include:

• full sleep (at least 8 hours);
• regular walks in the fresh air;
• absence of stress and creation of a pleasant emotional background;
• proper nutrition with the addition of a minimum amount of salt;
• treatment and prevention of chronic diseases of the cardiovascular system, liver, kidneys;
• normalization of metabolism;
• ensuring normal blood clotting.

It is advisable to start a course of preventive treatment during the week of pregnancy. The duration of a course of preventive drug treatment (taking antiplatelet agents and hepatoprotectors) lasts on average 3-4 weeks.

Childbirth is the only way to cure gestosis, but even after the birth of the baby, mothers who have suffered gestosis are in no hurry to be discharged from the maternity hospital. Their recovery after childbirth is closely monitored, tests are taken, and medications are prescribed.

You should not be upset, because it is much easier to prevent possible complications after suffering gestosis than to deal with an aggravated disease. And the baby, who also had a hard time, will be under round-the-clock supervision. Very soon all the troubles associated with pregnancy and childbirth will be forgotten and they will be replaced by memories of the first long-awaited meeting with your child.

When I was pregnant, my fingers swelled quite a bit. The wedding ring had to be removed. It's good that it didn't turn into gestosis.

When I was carrying my first son, I did not take the diagnosis of gestosis as seriously as I should have. Although there were symptoms: the swelling was very strong, the weight was growing rapidly. But it seemed to me that my obstetrician simply didn’t want to bother with me and was trying to put me in the hospital. And when I was carrying the second one, I was really scared for the baby and me: my blood pressure (always 120/80) rose to 165 and higher, there was swelling - it wasn’t the legs, but some kind of cakes, again I gained more weight than normal. This time I flew to the doctor myself in fear. Indeed, the only true treatment is childbirth.

Source: during pregnancy - what is it? Symptoms and signs late in the 3rd trimester

Preeclampsia is a complication of pregnancy that occurs in the later stages. This condition significantly disrupts the functions of the mother’s body and brings suffering to the child.

Therefore, at the first manifestations of pathology, it is necessary to do an examination, and if the problem is confirmed, take measures to eliminate it.

Preeclampsia during pregnancy - what is it?

Preeclampsia is a pathological condition that some pregnant women experience; its outdated name is late toxicosis. It is accompanied by a distortion of the functioning of interconnected organs and systems. If early toxicosis in a pregnant woman is considered a natural condition for most women and does not cause concern among doctors, then gestosis of the 2nd half of gestation is recognized as a deviation from the norm. Even to a mild extent, it can harm the mother's body.

Statistical data show that perinatal mortality during the formation of toxicosis in the second half of gestation exceeds standard indicators by at least 5 times. There are several classifications of gestosis, each of which takes the symptoms of the disease as a reference point.

There is no clear reason why late toxicosis begins in some pregnant women. Each symptom of pathology is explained in its own way. The question of the cause of the disease remains open to this day. The main assumption is that the placenta plays a major role in the formation of the problem.

The child's place is necessary for the nutrition and protection of the embryo. If for some reason the blood vessels of the placenta narrow or pathologies occur, the blood supply becomes insufficient. In this case, the baby's place begins to regulate processes in the pregnant woman's body, increasing pressure to obtain a larger portion of blood. As a result of increased blood pressure in the mother, vasoconstriction occurs in her body. This process leads to disruption of nutrition of vital organs: the brain, kidneys and heart. It is quite natural that the performance of these structures is deteriorating.

When edema forms, fluid leaves the bloodstream, causing the formation of blood clots and an increase in blood pressure. A vicious circle arises, since these pathological conditions inevitably cause physiological disturbances in the functioning of the placenta. This issue is actively studied by a science called pathophysiology.

There are also opinions about the reasons for the formation of pathology: endocrine, genetic, immunological and others.

Signs of the formation of a pathological condition are quite difficult to miss. With gestosis in women, the general well-being is disrupted, since the dangerous process affects all parts of the body, and due to the appearance of hidden edema, weight increases. That is why every appointment with a pregnant gynecologist begins with measuring body weight.

Toxicosis of the second half of pregnancy begins by the 35th week. There are cases when the deterioration of the expectant mother’s well-being occurred already at 20 weeks, but under such circumstances the prognosis will be disappointing. The second and third trimester are accompanied by the active functioning of the placenta. Characteristic signs of disturbances in its function and the onset of gestosis will be the following symptoms:

• urine analysis shows protein - proteinuria is defined as more than 0.8 g/l;
• high blood pressure - a woman’s blood pressure readings are at least 140/90, which in the initial stages can manifest as headaches, spots before the eyes, and nausea;
• swelling - easily recognized by a sharp increase in body weight, when the usual shoes become small, and the ring no longer fits on the finger.

Single manifestations do not yet indicate the onset of gestosis. The pathology usually combines high blood pressure and proteinuria or edema and hypertension. Diagnostics will reliably help identify gestosis.

In order to prevent the onset of pathology in time, the expectant mother regularly undergoes tests and examinations. The following studies will help confirm the problem:

• urine analysis (helps in differentiating pyelonephritis from gestosis);
• blood test (shows thickening, increased platelet count and decreased hemoglobin);
• Ultrasound with Doppler (detects the risk of toxicosis based on the state of blood flow in the placenta);
• cardiotocography (helps to timely identify hypoxia and malnutrition of the embryo).

Domestic obstetrics distinguishes 4 degrees of the disease:

1. dropsy (edema forms in the expectant mother);
2. nephropathy (impaired kidney function);
3. preeclampsia (pre-convulsive condition);
4. eclampsia (convulsions that can lead to coma).

According to statistics, the last 2 degrees develop less frequently than the first. Timely treatment helps to avoid dangerous complications. To understand the scale of development of gestosis, it should be said that out of 100% of women experiencing dropsy and nephropathy, only 0.5% undergo eclampsia.

According to the form, the pathological condition associated with late toxicosis can be distinguished:

• combined (when a woman has concomitant diseases such as hypertension, obesity, kidney disease);
• pure (when gestosis develops in a healthy patient).

Severe gestosis in the second half of pregnancy is a dangerous condition that can be fatal for both the mother and the unborn baby. The pathology is characterized by a strong increase in blood pressure to critical levels.

At the same time, the woman has a high concentration of protein in her urine and brain function is seriously impaired. The main manifestation of eclampsia is convulsive syndrome. A pregnant woman may feel a severe headache and discomfort in the epigastric region in advance. Characteristic signs of seizures will be:

• contractions of the facial muscles in the form of tremors that spread to the limbs;
• the skin turns blue, loss of consciousness occurs with dilation of the pupils;
• foam pours out of the mouth, which can be bloody in color due to injury to the tongue by the teeth;
• the culmination of a convulsive seizure is coma or death, and the fetus, as a rule, dies due to severe hypoxia.

It is necessary to treat gestosis from its very first manifestations. One of them is blood pressure. Every appointment with a gynecologist begins with measuring his indicators. A dangerous condition is considered when the tonometer shows 135/90. This factor becomes decisive for prescribing further diagnostics and therapy for a woman.

Most scientific sources say that gestosis is accompanied by blood pressure 140/90. However, each patient’s body is individual. You can't evaluate everyone according to the same parameters. It is necessary to take into account the initial blood pressure of the pregnant woman. We can talk about pathology when the systolic pressure limit exceeds normal values ​​for a pregnant woman by 30 mmHg. Diastolic pressure is directly proportional to the oxygen supply to the embryo. Therefore, its increase by 15 mmHg or more is a dangerous condition.

There are no specific methods of prevention. The main point in preventing the consequences of pathology is regular examinations. If a woman is prone to gestosis, then she is prescribed a daily routine, a certain menu, moderate physical activity, and also drinking diuretics.

Predisposition to complications is determined by concomitant diseases:

• pancreatitis;
• hepatitis;
• arterial hypertension;
• kidney diseases (even if they were suffered in childhood);
• autoimmune diseases;
• age after 40 years;
• late toxicosis and preeclampsia in previous gestation and in family history (in close relatives).

In these cases, it is necessary to take preventive measures at the preconception stage - a more thorough examination, treatment of concomitant diseases. Also, more careful monitoring should be carried out by the doctor and the woman should be wary already during the gestation period.

The diet of an expectant mother prone to edema and high blood pressure should exclude salty foods and spices, alcohol in any form, fatty and sweet foods.

In a pregnant woman's diet, it is necessary to focus on protein foods, eat small portions and drink enough clean water. Protein helps retain fluid in the bloodstream. If there are risks, for example, diabetes, then an individual diet is suggested that excludes the intake of sugar and insulin levels are regulated.

With the first degree of toxicosis in the second half of pregnancy, the patient is prescribed outpatient treatment. It is recommended to lie more on your left side so that the uterus is better supplied with blood and oxygen. To normalize brain function, herbal sedatives are prescribed. In certain cases, mild tranquilizers, such as Phenazepam, may be needed.

Hospitalization is indicated for a woman with any degree of gestosis that is higher than the first. Also, inpatient treatment is suggested when outpatient treatment does not bring positive dynamics.

The hospital therapy technique involves the injection into a vein of drugs (magnesium sulfate, pentoxifylline, aminophylline) that relieve spasms, lower blood pressure and prevent the occurrence of convulsive syndrome. Medicines to lower blood pressure, as well as blood thinners, are prescribed as complementary agents. The treatment period for mild and moderate gestosis is variable and ranges from 2 to 4 weeks. The patient is in serious condition in the hospital until delivery.

The main danger of gestosis for a woman is the disruption of the functioning of vital organs. Hepatic, renal and cardiac dysfunction threatens subsequent distortion of the functioning of other systems. The most serious thing that can happen to an expectant mother is death or eclamptic coma. There is a risk of pulmonary edema and hemorrhages in organs. The prognosis depends on the degree of the disease, the clinical picture and the initial health status of the patient.

Medical practice shows that the closer to childbirth gestosis begins, the more favorable its prognosis will be. Women whose problem appeared at 35 weeks are more likely to have a successful resolution than expectant mothers with gestosis at 20 weeks. The main danger for the baby is oxygen starvation. Hypoxia can lead to cerebral circulatory disorders, fetal malnutrition and result in intrauterine death.

Preeclampsia may recur during the next pregnancy. Moreover, the likelihood of relapse is directly proportional to the time of onset of symptoms. If a woman’s gestosis began at 20 weeks, then recurrence is almost guaranteed. When an expectant mother encounters symptoms just before giving birth, the likelihood of a relapse decreases significantly.

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Source: a woman who has given birth is familiar with some of the features of pregnancy and the main stages of monitoring it: regular visits to a medical facility, tests, ultrasound examinations, weighing. Some people are surprised by the need for weight control. Like, why should medical workers care about the future figure of a pregnant woman? Any diagnostic procedure has a meaning and is conditioned by something.

Edema is one of the diagnostic signs of gestosis, but the pathology is not limited to them. Preeclampsia is easier in healthy women. In this case it is called “pure”. This type of disease occurs in 30% of pregnant women. If it develops against the background of existing diseases (hypertension, diabetes, gastrointestinal ailments, kidney diseases), then in this case they speak of “combined” gestosis. It is clear that the latter form is more difficult.

The main cause of gestosis is a dysregulation of blood vessels, resulting in their spasm. Microvessels are mainly affected.

Swelling is more common in pregnant women. A woman drinks a lot of fluid, which cannot completely leave the body and lingers in the interstitial space. Only the lower extremities may swell, but in more severe forms, the entire body may swell. Swelling is not always noticeable. Sometimes we are talking about a hidden form. It is detected by weighing. A weight gain of more than 0.5 kg per week indicates an emerging problem. Monitoring of fluid intake and amount of urine excreted is prescribed. If, during normal drinking conditions, less than 0.8 liters of urine is excreted, preeclampsia can be suspected.

Hypertension develops against the background of fluid retention. Blood pressure is monitored at every doctor's visit. Pressure during gestosis exceeds the norm by 15–20%. What pressure is considered normal? Usually it is 120/80. However, if a woman had hypotension at the beginning of pregnancy, then even the generally accepted norm for her may already be a signal for further examination.

• Expecting their first child;
• Expecting twins.

With grade 2 gestosis, all three symptoms of OPG are observed. In diagnosing hypertension, the most important indicators are diastolic pressure. The fact is that it is directly related to placental blood flow: the higher the diastolic pressure, the less oxygen the child receives. It is noteworthy that it is not so much the increase in pressure that is dangerous as its abrupt changes. This stage is especially difficult for pregnant women with concomitant diseases.

The main danger is that with complicated gestosis, the fetus is at risk of death.

1. Blood pressure – 160/110 or more;
2. Protein in urine;
3. Blood clotting disorder;
4. Changes in liver function;
5. Nausea, vomiting;

One of the dangerous forms is called HELLP syndrome. Its signs include bloody vomiting, jaundice, severe coma, and liver failure. Usually observed in women who have given birth frequently. It can appear even after childbirth (unlike other forms of gestosis). About 80% of women and the same number of unborn children die from this type of pathology.

Mild gestosis can be almost invisible. Why get examined, let alone be hospitalized, if you feel good and don’t hurt anything! But I would like to emphasize that the main danger of the disease lies in its consequences, such as:

• Pulmonary edema;
• Hemorrhage;
• Placental abruption;
• Kidney diseases;
• Delay in child development;
• HELLP syndrome;
• Early birth;
• Liver diseases;
• Fetal hypoxia;
• Brain swelling;
• Problems with the retina of the eye;
• Stroke;
• Death of a child;
• Death of a pregnant woman.

Important! The development of dangerous stages of gestosis and their consequences can be prevented by timely diagnosis and correctly prescribed treatment.

1. Dentist examination.

Important! Not a single symptom should escape the attention of a pregnant woman. She must immediately report her suspicions to her doctor.

Let us say right away that it is impossible to completely cure gestosis. It goes away with pregnancy. However, it is possible to prevent its development into more severe forms.

Main areas of treatment:

Avoid obesity. During pregnancy, women sometimes gain a lot of weight. Why is this happening? There are many reasons. Firstly, hormonal changes can cause an increase in appetite. Secondly, a woman begins to allow herself to eat everything, citing the fact that her figure is already deteriorating, it won’t get any worse. Thirdly, some women are sure that you need to eat for two. If she eats as before, the baby will not get many nutrients. Unfortunately, the effect of such eating behavior is sad - obesity and gestosis.

You need vitamins, minerals, fiber. And they are most abundant in vegetables and fruits. Fiber is especially important: with a minimum of calories, it perfectly satisfies hunger. This diet is also beneficial for the gastrointestinal tract - there will be no constipation and complications such as hemorrhoids, which often bother pregnant women. It’s good to forget about the existence of flour and sweet foods. Apart from excess weight, they will give nothing to either mother or child.

Proper drinking regime is very important. Despite the threat of edema, you should not severely limit yourself in water. It is recommended to consume 1 to 1.5 liters of fluid per day, this also includes fruits, soups and other foods. But you cannot retain this water with salt. No matter how much a pregnant woman would like to eat a pickled cucumber or a piece of herring, there is no need to do this. To remove excess fluid, as well as improve renal blood circulation, it is useful to drink a decoction of bearberry, rosehip, cranberry juice, kidney tea (in consultation with your doctor!). For the same purposes, the doctor may prescribe special medications: cystone, canephron, etc.

And one more, and perhaps the most important principle of prevention is an active lifestyle. Pregnancy is not a disease. Therefore, a pregnant woman, like any other woman, should walk, swim, do yoga for pregnant women, Pilates, and not forget about special gymnastics. The main thing is not to overdo it. It is necessary to listen to your condition and stop exercising at the slightest suspicion of its deterioration. For your peace of mind, it is better to consult a doctor once again. Physical activity should not harm a woman and her unborn child. The doctor may recommend special exercises to help get rid of certain manifestations of the pathology.

Undiagnosed and untreated gestosis is dangerous. Only careful attention to yourself will allow a woman to give birth to a healthy child and maintain her own health.

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

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

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. If this complication develops in the later stages and

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

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

In modern conditions, atypical gestosis is becoming more and more common. They are characterized by the predominance of one symptom, early onset, and early formation of placental insufficiency. Underestimation of the severity of the condition leads to delayed diagnosis, untimely treatment and late delivery.

The classification of gestosis is not sufficiently developed. In Russia, the disease was most often divided into the following types:

• dropsy of pregnancy (with a predominance of edema);
• mild, moderate and severe nephropathy;
• preeclampsia;
• eclampsia.

The main disadvantage of this classification is the vagueness of the term “preeclampsia”, which does not allow specifying the severity of the condition.

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

• O10: hypertension (high blood pressure), which existed before pregnancy and complicated the course of pregnancy, childbirth, and 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: hypertension arising during pregnancy in combination with a large amount of protein in the urine;
• O15: eclampsia;
• O16: unspecified hypertension.

This classification solves some operational aspects of diagnosis and treatment, but does not reflect the processes occurring 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 pre-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. Gestosis goes away after childbirth, with the exception of severe complications. This suggests that the source of the problems is the fetus and placenta. Preeclampsia occurs only in humans. This disease does not occur in animals, not even monkeys, so it cannot be studied experimentally. Associated with this is a large number of theories and questions regarding the nature of this condition.

Let's consider the main modern theories of the development of this condition:

1. Cortico-visceral theory. According to her, gestosis is very similar to a neurotic condition with disruption of the cerebral cortex and a subsequent increase in vascular tone. Confirmation of this theory is the increase in the incidence of the disease in pregnant women after mental trauma, as well as data obtained using electroencephalography.
2. The endocrine theory considers an abnormal pregnancy as a chronic stress that causes overstrain and exhaustion of all endocrine systems of the body, including those that regulate vascular tone.
3. The immunological theory states that trophoblast tissue (the outer membrane of the fetus that forms the placenta) is a weak antigen. The body produces appropriate antibodies, which also interact with the woman’s kidney and liver cells. As a result, the vessels of these organs are affected. However, autoimmune processes are not observed in all women with gestosis.
4. The genetic theory is based on the fact that women whose mothers have suffered gestosis develop the pathological condition 8 times more often than average. Scientists are actively searching for “eclampsia genes.”
5. The placental theory assigns primary importance to disruption of the formation of the placenta.
6. Thrombophilia and antiphospholipid syndrome can cause damage to vascular walls throughout the body, and they also lead to disruption of the formation of the placenta.

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

The following factors significantly increase the risk of gestosis:

1. Extragenital diseases, namely hypertension, metabolic syndrome, kidney and gastrointestinal diseases, frequent colds and endocrine pathology.
2. Multiple pregnancy.
3. Previously suffered gestosis.
4. The woman's age is under 18 and over 30 years old.
5. Poor social conditions.

The onset of the disease occurs in the very early stages of pregnancy. When the embryo is implanted (introduced) 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 and the inner lining of the blood vessels, the endothelium, is affected. Endothelial dysfunction is the most important triggering factor of gestosis. It leads to the release of powerful vasoconstrictor substances. At the same time, blood viscosity increases, and microthrombi form in spasmed vessels. Disseminated intravascular coagulation syndrome (DIC syndrome) 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 is reduced, including the kidneys, liver, heart, brain and placenta. These disorders cause the clinical picture of gestosis.

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

• measuring blood pressure at intervals of 5 minutes with the woman lying on her side, on her back, and again on her side. The test is positive if the diastolic (“bottom”) pressure changes by more than 20 mmHg. Art.;
• disturbance of uteroplacental blood flow according to Doppler ultrasound;
• decrease in platelet count less than 160× 109/l;
• signs of increased blood clotting: increased platelet aggregation, decreased activated partial thromboplastin time, increased fibrinogen concentration in the blood;
• reducing the concentration of anticoagulants, in particular, its own heparin;
• reduction in the relative number of lymphocytes to 18% and below.

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

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

• swelling;
• arterial hypertension;
• proteinuria.

Preeclampsia is characterized by a variety of variants of 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 the patients suffer from protracted forms of the disease.

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

High blood pressure usually occurs at 29 weeks. For a more accurate diagnosis, you should follow all measurement rules, record the pressure on both arms, and select the correct cuff size.

Edema during gestosis is associated with sodium retention, a decrease in the concentration of proteins in the blood, and the accumulation of under-oxidized metabolic products in the tissues. Swelling can be only in 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 volume of fluid consumed;
• excessive weight gain;
• “Ring symptom” - a woman’s engagement ring or other familiar ring becomes insufficient.

Proteinuria is the excretion of protein in the urine. It is caused by damage to the renal glomeruli as a result of lack of oxygen and vasospasm. The release 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.

A particular danger for mother and child is a dysfunction of the nervous system - preeclampsia and eclampsia.

Symptoms of preeclampsia:

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

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

Late gestosis can cause severe complications that can even lead to the death of 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 placental abruption;
• hemorrhagic shock and disseminated intravascular coagulation syndrome.

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

HELLP syndrome includes hemolysis (decomposition of red blood cells), a decrease in the number of platelets responsible for blood clotting, and disruption of the liver 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 the woman and the fetus.

Symptoms develop quickly. The woman begins to complain of headache, vomiting, pain in the abdomen or in the right hypochondrium. Jaundice and bleeding appear, the patient loses consciousness, and begins to have convulsions. A rupture of the liver occurs with bleeding into the abdominal cavity, placental abruption. Even if a woman undergoes urgent surgery, 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. For 2-6 weeks, the woman experiences weakness, lack of appetite, abdominal pain, nausea and vomiting, weight loss, and itchy skin. Then liver and kidney failure develops, which is manifested by jaundice, edema, uterine bleeding and fetal death. Hepatic coma often occurs with disruption of brain function.

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

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

Gestosis 2 degrees characterized by the appearance of edema in the abdomen, proteinuria up to 1 g/l, increased pressure up to 170/110 mm Hg. Art. Grade 1 fetal malnutrition may occur. This form occurs at 30-35 weeks.

Diagnosis of severe form is based on the following signs:

• increase in blood pressure to 170/110 mm Hg. Art. and higher;
• excretion of more than 1 gram of protein per liter of urine;
• decrease in urine volume to 400 ml per day;
• widespread swelling;
• disruption 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, hospital treatment is necessary.

Main directions of therapy:

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

The woman is prescribed the following medications:

• 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 circulating blood volume using intravenous infusions;
• disaggregants (Curantil) and anticoagulants (Fraxiparin) under strict control of blood clotting;
• antioxidants (vitamins C, E, Essentiale).

Drug treatment for mild cases can be carried out for 10 days, for moderate cases – up to 5 days, for severe conditions – up to 6 hours. If treatment is ineffective, urgent delivery is necessary.

Delivery in case of gestosis is carried out through the natural birth canal or by cesarean section. A woman can give birth on her own if the disease is mild, the fetus is in good condition, there are no other diseases, and the medications are effective. In more severe cases, elective surgery is used. In case of severe complications (eclampsia, renal failure, placental abruption, etc.), 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.

A pregnant woman should avoid nervous and physical stress, get proper rest, and not take medications without a doctor’s prescription. Food should be nutritious and, 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 in food.

The key to preventing gestosis is regular observation by a doctor, monitoring weight, blood pressure, blood and urine tests. If necessary, the woman is hospitalized in a day hospital or in a sanatorium, where preventive treatment is carried out.

If the condition worsens, swelling, headache, or pain in the right hypochondrium appears, 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 mother and child.

Any woman who has given birth is familiar with some features of the course of pregnancy and the main stages of monitoring it: regular visits to a medical facility, testing, ultrasound examinations, weighing. Some people are surprised by the need for weight control. Like, why should medical workers care about the future figure of a pregnant woman? Any diagnostic procedure has a meaning and is conditioned by something.

How many kilograms should a woman's weight increase during pregnancy? Many will answer the question correctly - about 10 kg. What if it’s 20–25? Such an increase “speaks” of hidden (and not only) edema. And swelling is gestosis. For women, this disease is more commonly known as late toxicosis.

Edema is one of the diagnostic signs of gestosis, but the pathology is not limited to them. Preeclampsia is easier in healthy women. In this case it is called “pure”. This type of disease occurs in 30% of pregnant women. If it develops against the background of existing diseases (hypertension, diabetes, gastrointestinal ailments, kidney diseases), then in this case they speak of “combined” gestosis. It is clear that the latter form is more difficult.

The first signs of possible gestosis

This pathology concerns only pregnant women - after childbirth, gestosis goes away. However, gestosis is classified as a dangerous disease. Its cunning lies in its complications. A quarter of female deaths during pregnancy are due to gestosis. The fetus dies 3-4 times more often than during an uncomplicated pregnancy.

The main cause of gestosis is a dysregulation of blood vessels, resulting in their spasm. Microvessels are mainly affected.

As for the pathogenesis of gestosis: many scientists see its connection with immune factors. Fetal antigens influence maternal antibody production. In turn, antibodies cause the formation of excess immune complexes, which have a negative effect on the pregnant woman’s body.

The disease is often called OPG-preeclampsia. OPG – the first letters of the terms: edema, proteinuria, hypertension. These are the main signs of pathology. The entire complex is not always noted. Mild gestosis can occur with one or two of the listed symptoms.

OPG complex of symptoms

Swelling is more common in pregnant women. A woman drinks a lot of fluid, which cannot completely leave the body and lingers in the interstitial space. Only the lower extremities may swell, but in more severe forms, the entire body may swell. Swelling is not always noticeable. Sometimes we are talking about a hidden form. It is detected by weighing. A weight gain of more than 0.5 kg per week indicates an emerging problem. Monitoring of fluid intake and amount of urine excreted is prescribed. If, during normal drinking conditions, less than 0.8 liters of urine is excreted, preeclampsia can be suspected.

Hypertension develops against the background of fluid retention. Blood pressure is monitored at every doctor's visit. Pressure during gestosis exceeds the norm by 15–20%. What pressure is considered normal? Usually it is 120/80. However, if a woman had hypotension at the beginning of pregnancy, then even the generally accepted norm for her may already be a signal for further examination.

Proteinuria refers to the excretion of protein in the urine. This sign indicates a violation of renal activity. Therefore, it is important not to skip a diagnostic procedure such as a urine test. After 20 weeks of pregnancy, urine is examined weekly.

If a woman has two of the three signs of this disease, then treatment at home is ineffective - it is better to hospitalize the patient.

Other symptoms include headache, vomiting, nausea, and heaviness in the head. In the most difficult cases - changes in consciousness and convulsions.

The manifestation of pathology in pregnant women is more likely:

• Expecting their first child;
• Having genital tract infections: chlamydia, mycoplasmosis, ureaplasmosis;
• Suffering from chronic diseases: hypertension, diabetes, kidney disease, vegetative-vascular dystonia, excess weight and others;
• Expecting twins.

One of the classifications of pathology is divided into types:

1. Early gestosis;
2. Late gestosis.

The disease becomes more severe at the end of pregnancy.

Depending on the signs and form, the disease can be divided into the following degrees of severity:

Dropsy of pregnancy is classified as gestosis of the 1st degree. This stage is characterized only by edema of varying severity. Usually they are less pronounced in the morning, and in the evening the condition worsens.

With grade 2 gestosis, all three symptoms of OPG are observed. In diagnosing hypertension, the most important indicators are diastolic pressure. The fact is that it is directly related to placental blood flow: the higher the diastolic pressure, the less oxygen the child receives. It is noteworthy that it is not so much the increase in pressure that is dangerous as its abrupt changes. This stage is especially difficult for pregnant women with concomitant diseases.

Complications develop:

• Placental abruption;
• Fetal hypoxia;
• Bleeding;
• Premature birth.

The main danger is that with complicated gestosis, the fetus is at risk of death.

Nephropathy is diagnosed simply by urine analysis. If things go wrong, it is important to monitor the condition of the fundus. Changes may indicate a violation of cerebral circulation.

As the condition worsens, stage 3 of gestosis develops. Pain and heaviness in the head indicate the onset of preeclampsia. Possible blurred vision, vomiting, and pain in the liver area. Memory deterioration, apathy, insomnia, irritability and other signs of changes in blood circulation in the brain are possible. Edema has a damaging effect on the liver, as evidenced by pain on the right side. There are even hemorrhages in this organ. “Floaters” and “veils” before the eyes may indicate problems with the retina.

Main signs of preeclampsia:

1. The amount of urine decreases to 0.4 liters or less;
2. Blood pressure – 160/110 or more;
3. Protein in urine;
4. Blood clotting disorder;
5. Decreased platelet count;
6. Changes in liver function;
7. Nausea, vomiting;
8. Symptoms of brain and visual disorders.

An even more severe degree of gestosis is eclampsia. In addition to all of the above symptoms, convulsions are present. Typically, attacks are caused by external stimuli: loud sound, bright light, stress, pain. The attack does not last long - about 2 minutes. The danger of this condition is cerebral hemorrhage, cerebral edema, and death. Despite the similarities between gestational seizures and epileptic seizures, they have a number of differences. In epilepsy, urine tests are normal, there is no hypertension, and a characteristic epileptic aura is noted before a seizure.

One of the dangerous forms is called HELLP syndrome. Its signs include bloody vomiting, jaundice, severe coma, and liver failure. Usually observed in women who have given birth frequently. May occur even after childbirth(unlike other forms of gestosis). About 80% of women and the same number of unborn children die from this type of pathology.

The most rare forms of gestosis include:

• Eczema;
• Dermatoses;
• Bronchial asthma;
• Pregnancy itch.

Some researchers suggest that all these forms are exacerbations of pre-existing diseases in women.

With different frequencies, pregnant women may suffer from other types of gestosis:

1. Osteomalacia. Otherwise - softening of the bones. A pronounced form is rare. More often it manifests itself in tooth decay, bone pain, changes in gait, and neuralgia. The reason for this condition lies in the lack of microelements - especially calcium - and vitamins.
2. Ptyalism (salivation). It is often accompanied by vomiting. With excessive saliva production, the body becomes dehydrated, speech is impaired, and the skin and mucous membranes are irritated.
3. Hepatosis. Accompanied by jaundice. It is necessary to differentiate with hepatitis. Therefore, a thorough diagnosis is carried out, and the woman is temporarily isolated from others.
4. Liver atrophy. If such a complication occurs during early gestosis and cannot be treated, then it is recommended to terminate the pregnancy.
5. HELLP syndrome is considered a truly rare form. Still, for most women, pregnancy ends happily - with the birth of a healthy baby.

Mild gestosis can be almost invisible. Why get examined, let alone be hospitalized, if you feel good and don’t hurt anything! But I would like to emphasize that The main danger of the disease is its consequences, such as:

• Pulmonary edema;
• Hemorrhage;
• Pathology of the cardiovascular system;
• Placental abruption;
• Kidney diseases;
• Delay in child development;
• HELLP syndrome;
• Early birth;
• Liver diseases;
• Fetal hypoxia;
• Brain swelling;
• Problems with the retina of the eye;
• Stroke;
• Death of a child;
• Death of a pregnant woman.

Important! The development of dangerous stages of gestosis and their consequences can be prevented by timely diagnosis and correctly prescribed treatment.

Every woman undergoes regular medical examination during pregnancy; if alarming symptoms appear, such examination is carried out unscheduled, and diagnostic procedures are added.

Required studies include:

1. Weighing. In the second part of pregnancy, weight gain should not exceed 350 g per week. If a woman has gained half a kilogram or more, then additional examinations need to be carried out.
2. The need to control fluid intake. For pregnant women, the rule “2 liters or more of water per day” is not suitable. And when pronounced edema appears, its amount should not be more than 1 liter. It is also necessary to control the volume of urine excreted.
3. Carrying out a blood test. The number of platelets and red blood cells is determined. Particularly important is the indicator of platelet content and coagulation. In addition to the general one, a biochemical analysis and a coagulogram are performed.
4. Blood pressure control, and on each arm. The presence of gestosis can be indicated by a large difference in the indicators on the left and right hands.
5. Analysis of urine. It is necessary to monitor the presence of protein in the urine.
6. Fetal ultrasound with Doppler. With the help of this study, the degree of fetal development and malnutrition is revealed.
7. Dentist examination.
8. Fundus examination. If the vessels of the fundus are changed, this may indicate problems with the vessels of the brain.

A woman should not ignore medical examinations. This is especially true for mature mothers (after 35 years) and those who are giving birth to their first child. Also, pregnant women with chronic and infectious diseases should be attentive to their health.

Successful diagnosis is the key to a properly structured treatment strategy.

Important! Not a single symptom should escape the attention of a pregnant woman. She must immediately report her suspicions to her doctor.

Let's say right away that Preeclampsia cannot be completely cured. It goes away with pregnancy. However, it is possible to prevent its development into more severe forms.

Main areas of treatment:

• It is necessary to create a protective treatment regime. A woman should avoid strong emotional stress, be calm and balanced. Bright light, noise, heavy physical activity that does not correspond to her condition are harmful. If gestosis is mild, then remedies such as motherwort and valerian are prescribed, and in more severe forms, they resort to individual selection of sedatives taking into account pregnancy.
• To restore the function of the pregnant woman’s body, as well as to prevent fetal hypoxia, appropriate medications are prescribed. These are medications that have a sedative, hypotensive, antispasmodic, and diuretic effect. Such drugs should improve placental blood flow, preventing fetal hypoxia. In case of exacerbation of existing chronic diseases, appropriate treatment is prescribed aimed at relieving symptoms.
• The birth canal must be prepared so that delivery during gestosis can be carried out in a timely and careful manner. The timing of delivery is determined by the condition of the pregnant woman. For example, a severe form of gestosis requires delivery no later than three days after the condition worsens. If eclampsia develops, delivery should be immediate. Childbirth is safest for the health of the baby at 38 weeks of pregnancy and later, since by this time all the vital systems of the fetus have time to form. Give birth naturally or use a caesarean section? The choice depends on the condition of the fetus and the birth canal of the pregnant woman. In case of severe gestosis, when urgent delivery is necessary, a caesarean section is performed. If childbirth occurs naturally, anesthesia is recommended. And not so much for pain relief, but to improve placental and renal circulation, as well as a slight decrease in pressure. In the case of mild gestosis, treatment is prescribed, and childbirth occurs on time naturally.

In moderate and mild forms of gestosis, women are recommended to be hospitalized in a hospital. Severe gestosis may require resuscitation. The main research procedures carried out in the hospital:

1. Conducting a general urine test, as well as a Zimnitsky test.
2. Study of the condition of the unborn child (Doppler, ultrasound, cardiotocography).
3. Coagulogram and other blood tests.

Infusion therapy is used as treatment, the task of which is to remove tissue fluid, as well as replenish its deficiency in the vessels. For hypertension, individual selection of medications is carried out.

Treatment lasts from several hours to several weeks. It all depends on the severity of the condition. The more dangerous it is, the less time a woman has. Delivery is the main outcome of any treatment. Therefore, in the most severe cases, an immediate caesarean section is performed.

The main task of the patient and medical workers is timely detection of the disease and initiation of early treatment. Therefore, it is difficult to avoid gestosis without active prevention.

Avoid obesity. During pregnancy, women sometimes gain a lot of weight. Why is this happening? There are many reasons. Firstly, hormonal changes can cause an increase in appetite. Secondly, a woman begins to allow herself to eat everything, citing the fact that her figure is already deteriorating, it won’t get any worse. Thirdly, some women are sure that you need to eat for two. If she eats as before, the baby will not get many nutrients. Unfortunately, the effect of such eating behavior is sad - obesity and gestosis.

The diet for gestosis is very simple. The fetus needs protein (the cells of the unborn child’s body will be built from it), which means that a pregnant woman’s diet should include dairy products, lean meat, eggs, and fish. An increased protein content in food is also necessary because it migrates from the body.

You need vitamins, minerals, fiber. And they are most abundant in vegetables and fruits. Fiber is especially important: with a minimum of calories, it perfectly satisfies hunger. This diet is also beneficial for the gastrointestinal tract - there will be no constipation and complications such as hemorrhoids, which often bother pregnant women. It’s good to forget about the existence of flour and sweet foods. Apart from excess weight, they will give nothing to either mother or child.

The maximum weight gain during the entire pregnancy should be no more than 12 kg. Women with initial underweight may gain a little more. Conversely, plump mothers are allowed to gain a maximum of 10 kg.

Proper drinking regime is very important. Despite the threat of edema, you should not severely limit yourself in water. It is recommended to consume 1 to 1.5 liters of fluid per day, this also includes fruits, soups and other foods. But you cannot retain this water with salt. No matter how much a pregnant woman would like to eat a pickled cucumber or a piece of herring, there is no need to do this. To remove excess fluid, as well as improve renal blood circulation, it is useful to drink a decoction of bearberry, rosehip, cranberry juice, kidney tea (in consultation with your doctor!). For the same purposes, the doctor may prescribe special medications: cystone, canephron, etc.

And one more, and perhaps the most important principle of prevention - active lifestyle. Pregnancy is not a disease. Therefore, a pregnant woman, like any other woman, should walk, swim, do yoga for pregnant women, Pilates, and not forget about special gymnastics. The main thing is not to overdo it. It is necessary to listen to your condition and stop exercising at the slightest suspicion of its deterioration. For your peace of mind, it is better to consult a doctor once again. Physical activity should not harm a woman and her unborn child. The doctor may recommend special exercises to help get rid of certain manifestations of the pathology.

Undiagnosed and untreated gestosis is dangerous. Only careful attention to yourself will allow a woman to give birth to a healthy child and maintain her own health.

Often, women in the second half of pregnancy develop a pathological condition called OPG - gestosis, which means: swelling; protein, or protein in urine; high blood pressure, or hypertension. Previously, this condition was called toxicosis of the second half, or late toxicosis, of pregnancy.

Moreover, a triad of symptoms is not necessarily detected - there may be two, or even one symptom. This condition is based on diseases of small vessels, which leads to impaired kidney function, increased blood pressure and edema.

During pregnancy, especially in the second half, the load on the kidneys increases sharply. That is why a pregnant woman should regularly submit her urine for analysis, which can be used to detect OPG - preeclampsia in the early stages.

If left untreated, pregnancy can end tragically for both mother and child. This disease is insidious. The woman usually feels well and does not pay attention to the doctor’s concern about sudden “jumps” in her body weight - yesterday she was alone, and today she is 2 kg more.

Meanwhile, you need to be wary - the kidneys do not cope well with the load. Protein appears in the urine - another serious warning of trouble. Protein metabolism in OPG-preeclampsia is the first to suffer.

If urgent measures are not taken, other disturbances in the functioning of the kidneys will occur (excretion of salts, concentration of urine). Women's blood pressure increases. And finally, OPG - gestosis develops into a formidable complication - eclampsia: cerebral circulation is disrupted, the permeability of the walls of the capillaries of the brain increases. As a result, the pressure of the cerebrospinal fluid increases sharply.

The seizure begins suddenly - severe convulsions occur, covering the entire body, and at the same time a coma develops. A seizure can result in either the death of the woman or the fetus. But even in this case, if a woman in labor can be saved, she often has complications for the rest of her life after suffering from eclampsia - for example, blindness.

Therefore, it is important to monitor your kidney function very carefully: if you don’t put on your wedding ring in the morning, or yesterday’s loose shoes have become tight today, you should immediately consult a doctor and follow all his recommendations.

If the doctor sends you to the hospital for OPG - gestosis, you need to go to the hospital. There the necessary treatment will be carried out: normal kidney function will be restored and blood pressure will decrease.

Diet is of great importance for improving the condition of the woman and the fetus.. Usually the doctor prescribes dairy and plant foods; in addition, you are allowed to eat boiled meat or fish 1-2 times a week. The amount of animal protein can be increased on the advice of a doctor if a woman loses a lot of protein in the urine.

The sooner OPG - gestosis is eliminated, the better for the unborn child. With this disease, there is insufficiency of placental circulation, and consequently intrauterine hypoxia and fetal malnutrition. A serious complication is miscarriage, the frequency of which increases with increasing duration of the pathological condition and its severity: with mild and moderate severity of OPG-preeclampsia, 8-9% of children will be born prematurely, with severe 19-20%, with the transition of OPG-preeclampsia to preeclampsia - up to 32% of children. If OPG-gestosis lasts 2-3 weeks, 11-13% of children are born premature, and if up to 4 weeks - up to 20%. 30-35% of newborns have low body weight. Such children have to be nursed, they grow up neuropathic, eat poorly, and cause a lot of trouble for their parents.

A woman should be aware of the factors that contribute to the disease. First of all, these include any kidney disease, even suffered in childhood and not making itself felt. Pregnancy can activate a stalled pathological process. In addition, excessive nutrition during pregnancy can lead to OPG - gestosis.

Almost all expectant mothers are familiar with this phenomenon, which torments them in the first trimester of pregnancy. But all the discomfort suffered from attacks of nausea, vomiting and poor health is nothing in comparison with gestosis in the second half of pregnancy, which poses a huge threat to the life and health of not only the fetus, but also the pregnant woman herself. It is not surprising that most women, after listening to the stories of more experienced friends and the opinions of specialists, wonder how to avoid gestosis during pregnancy.

Symptoms of gestosis in the second half of pregnancy

It is no secret that any disease is much easier to prevent than to treat. But in fairness, it is worth noting that a disease detected at an early stage is also more treatable than an advanced disease. In contrast to the relatively harmless toxicosis of the first half of pregnancy, early detection is perhaps the only opportunity for a woman to avoid serious consequences.

Analyzing reviews of women who have suffered gestosis in the second half of pregnancy, we can identify several symptoms that accompany the disease. For example, the first signs of gestosis in the 3rd semester are swelling of the face and limbs. If a woman ignores these symptoms or the disease is asymptomatic, then headaches, nausea, blurred vision and mental disorders may occur. Gestosis of the 2nd half of pregnancy at the last stage, called eclampsia, can cause kidney failure, heart attack, stroke, convulsions and fainting. In this case, swelling of the placenta most often occurs, which causes oxygen starvation and fetal death.

Treatment of gestosis in the second half of pregnancy

Treatment of pathology must be carried out in a medical facility or under the supervision of a physician. Self-medication and the use of alternative medicine are strictly prohibited. As a rule, the doctor prescribes special medications that increase protein levels and replenish the lack of fluid in the blood vessels.

If treatment does not bring tangible results and the disease continues to progress, the only option to solve the problem is childbirth. Most often, women diagnosed with gestosis in the second half of pregnancy, especially in its last stage, are given birth by cesarean section.

Causes and prevention

The reasons for the development of gestosis in the second half of pregnancy can be very diverse. As a rule, these are improper functioning of the endocrine system, excess weight, high blood pressure, stress, past infectious diseases, poor lifestyle and nutrition. Women who give birth with a short interval (up to two years) are also at risk. as well as women in labor under the age of 17 and over 35 years old.

To prevent gestosis, doctors recommend excluding fried and smoked foods, canned foods and sweets from the diet, giving preference to vegetables and fruits. The daily routine is also important - healthy sleep, gymnastics, walks in the fresh air. Since gestosis in the second half of pregnancy at the first stage can be asymptomatic, the main condition for preventing the development of the disease is periodic examination by the attending physician, who will be able to conduct a number of special tests. In any case, at the first unfavorable changes in your health, you should immediately seek medical help.

Preeclampsia in pregnant women

is a syndrome of multiple organ functional failure that develops as a result of a mismatch in the capabilities of the mother’s body’s adaptive systems to adequately provide for the needs of the developing fetus. This discrepancy is realized through placental insufficiency. The fetoplacental complex is the main etiological factor in the occurrence of gestosis (pregnancy does not occur outside of pregnancy and after its interruption, clinical manifestations cease).

Late toxicosis (gestosis)

The main links of pathogenesis:

1) generalized vasoconstriction,

2) hypovolemia,

3) violation of the rheological properties of blood (changes in blood viscosity, aggregation properties of blood cells),

4) development of disseminated intravascular coagulation syndrome (DIC syndrome).

There are 2 stages in pathogenesis:

1- formation of placental ischemia and local endothelial dysfunction, primary and secondary placental insufficiency;

2- formation of systemic endothelial dysfunction and multiple organ disorders.

Classically, gestosis is characterized by a triad of symptoms: edema, hypertension, proteinuria (Zangemeister triad). In pregnant women with gestosis, the types of central hemodynamics are determined: hyperkinetic, hypokinetic, eukinetic.

Classification of gestosis:

• Pregestosis,
• Dropsy of pregnant women,
• Nephropathy (preeclampsia),
• Preeclampsia,
• Eclampsia,

Atypical form of gestosis:

• HELLP syndrome,

• Acute fatty hepatosis.

Pregestosis is a complex of pathological changes in the body of a pregnant woman preceding the clinical picture of gestosis. To diagnose pregestosis, tests are used that are based on identifying pathological reactions of the cardiovascular system, changes in urine and blood. For this purpose, simple, fairly informative methods that do not require special equipment can be used:

- vascular asymmetry when measuring blood pressure in both arms,

- reduction in pulse pressure to 30 mm Hg. Art. (norm 40-50)

- a change in peripheral blood flow, which can be detected by raising your arms above your head and clenching your hands into a fist for 3-5 seconds, after which the arms are lowered with unclenched hands, paleness of the hands or the appearance of parasthesia in them indicates a violation of peripheral blood circulation,

- increase in the temporobrachial coefficient (the ratio of blood pressure in the temporal artery to the brachial artery at a norm of 0.5),

- narrowing of arterial vessels during fundus examination,

- increased specific gravity of blood,

— dysproteinemia (decrease in albumin, increase in gamma globulin fractions),

— decrease in the number of platelets over time.

The presence of hidden edema can be judged by the following signs:

- tight shoes at the end of the day,

- positive ring sign,

- pathological weight gain (more than 350-400 g),

- decrease in daily diuresis,

- positive McClure-Aldrich test.

Dropsy of pregnant women - there are 4 degrees of dropsy:

1. degree - swelling of the lower extremities
2. degree - swelling of the lower extremities and anterior abdominal wall
3. degree - swelling of the lower extremities, abdominal wall and face
4. degree - anasarca

Mild nephropathy:

- increase in blood pressure no higher than 25-30% of the initial level, 150/90,

— proteinuria up to 1 g/l,

— deficit of daily diuresis 15%.

Moderate nephropathy:

- increase in blood pressure to 40% of the initial level, 170/100,

— proteinuria up to 3 g/l,

— deficit of daily diuresis 25%.

Severe nephropathy:

- increase in blood pressure above 40% of the initial level, more than 170/100,

- proteinuria more than 3 g/l,

- deficit of daily diuresis over 25%.

In practice, G.M. Savelyeva’s scale is used. (1989), which also takes into account background diseases, the period of pregnancy at which gestosis is diagnosed: mild stage gestosis - up to 7 points, moderate stage - up to 11 points, severe degree 12 or more points.

In diagnosis, they also focus on average blood pressure (SBP) = (systolic pressure + 2 x diastolic): 3. Normal SBP is 100.

Preeclampsia

Symptoms appear associated with circulatory disorders in the central nervous system and the autonomic nervous system, increased intracranial pressure and cerebral edema developing against the background of nephropathy: visual disturbances, headache, epigastric pain, dizziness, a feeling of fullness in the head and limbs, nasal congestion, hoarseness. , hearing loss, hyperthermia.

Eclampsia

This is a clinically pronounced syndrome of multiple organ failure, characterized by: severe cerebrovascular accidents, cerebral edema, and the development of 1 or more convulsive seizures.

An attack of eclampsia develops in 4 stages:

1 – preconvulsive – small fibrillary twitching of the facial muscles with further spread to the upper limbs, duration 20-30 seconds.

2 – tonic convulsions – tonic contractions of all skeletal muscles, the body stretches and tenses, the spine bends, loss of consciousness, pale face, apnea, cyanosis, tongue bite, jaw closing, “eye rolling”, duration 30 seconds;

3 - clonic convulsions, with a contraction of individual muscle groups, duration from several seconds to 2 minutes;

4 - resolution of the seizure - the convulsions stop, take a deep breath, intermittent noisy breathing appears, foam mixed with blood appears at the mouth; constriction of the pupils, breathing is gradually restored, the woman regains consciousness, remembers nothing about what happened, amnesia.

Complications of eclampsia:

• hypertensive encephalopathy,
• hemorrhagic stroke,
• subarachnoid hemorrhages,
• PONRP,
• DIC - syndrome,
• intrauterine fetal death,
• pulmonary edema,
• acute pulmonary injury syndrome,
• aspiration syndrome,
• visual impairment, acute hepatic-renal failure,
• postpartum psychoses.

HELLP syndrome.

This form of gestosis is characterized by:

H – hemolysis

EL - increased levels of liver enzymes

LP - low platelet count

HELLP syndrome is characterized by high maternal mortality (up to 75%) and perinatal mortality.

Etiology and pathogenesis of HELLP syndrome

It is based on an autoimmune mechanism of damage to the vascular endothelium, hypovolemia with blood thickening and the formation of microthrombi, followed by fibrinolysis.

The occurrence of the disease is associated with a decrease in prostacyclin, which causes vasoconstriction in the placenta. This leads to microangiopathic changes in the endothelium, the release of placental thromboplastin and its entry into the maternal bloodstream. The consequence of this is adhesion and aggregation of platelets, and thrombocytopenia occurs. When red blood cells pass through altered microvessels, hemolysis occurs. Impaired perfusion in the liver leads to the development of toxic hepatosis with necrosis of the liver parenchyma, in some cases to the formation of subcapsular hematomas. As a result, the level of blood enzymes increases.

MAIN SYMPTOMS OF HELLP SYNDROME

With HELLP syndrome there is a clear clinical picture. Initial manifestations of the disease may be nonspecific and include:

• headache,
• increased fatigue,
• malaise,
• flu-like symptoms

As the disease progresses, pain appears in the epigastric region, a feeling of heaviness and pain in the right hypochondrium, nausea, vomiting as a result of irritation of the peritoneum and irritation of the Glissonian capsule. If intrahepatic pressure increases, this can lead to periportal bleeding, which progresses with the subsequent formation of hematomas under the Glissonian capsule and their fusion. With mechanical damage (increased intra-abdominal pressure during vaginal delivery), the subcapsular hematoma can rupture.

Sometimes HELLP syndrome manifests itself as a clinical picture of PONRP with massive coagulopathic bleeding, jaundice, vomiting mixed with blood, hemorrhage at injection sites, rapid formation of hepatic-renal failure, convulsions, coma.

LABORATORY INDICATORS OF HELLP SYNDROME

• Increased transaminase levels (AST >200 units/l, ALT >70 units/l, LDH >600 units/l;
• Thrombocytopenia less than 100 x 109 thousand;
• Decrease in antithrombin III level below 70%;
• Intravascular hemolysis and increased bilirubin concentration, both due to direct and indirect
• Increased prothrombin time and activated partial thromboplastin time (aPTT)
• Decrease in fibrinogen concentration,
• An increase in the content of nitrogenous waste in the blood,
• Reduced blood glucose levels.
• Morphological examination of the liver indicates that the pathological process is based on intravascular coagulation syndrome and liver necrosis. The most accurate diagnosis is possible using computed tomography of the liver.

Acute fatty hepatosis of pregnant women is an atypical form of gestosis and poses a particular danger to the pregnant woman and the fetus.

Clinic: the disease develops more often in primigravidas in the third trimester, under the age of 25, but can also occur at an older age.

During acute gastrointestinal tract infection, two periods are distinguished: anicteric and icteric.

The first anicteric period can last from several days to 5-6 weeks, is characterized by various complaints, and has few objective symptoms.

The second period is a short period with a stormy clinical course, a rapid progressive course (from several hours to several days) rich in both subjective and objective signs. Within 2-4 days, the jaundice intensifies and becomes more intense. The increase in jaundice is accompanied by the appearance of vomiting, and the vomit acquires an admixture of blood and becomes the color of “coffee grounds.” Belching with rotten eggs appears, hiccups, heartburn, the tongue is coated with a dirty gray coating, bloating, more in the epigastric region, hepatic odor from the mouth, liquid discolored stool. The size of the liver is reduced or unchanged. Signs of heart failure are increasing: tachycardia, arrhythmia, ECG shows diffuse changes in the myocardium, ischemia, respiratory failure, hemorrhagic diathesis, acute renal failure, peripheral edema, fluid accumulation in the serous cavities, antenatal fetal death.

Examination scheme for pregnant women with gestosis

1. Careful collection of anamnesis for the purpose of diagnosing long-term forms (time of appearance of pathological weight gain, instability of blood pressure).

2.Measurement of blood pressure in both arms, calculation of pulse and average blood pressure, detection of hidden and obvious edema, measurement of ankle circumference, monitoring of daily weight gain, measurement of daily diuresis. Peripheral blood examination: complete blood count (hemoglobin, red blood cells, platelets, hematocrit).

3. Study of venous blood:

• total protein and protein fractions
• blood electrolytes,
• urea and residual nitrogen,
• bilirubin (total, direct, indirect)
• transaminases,
• blood sugar,
• serum iron,
• coagulogram

4. General urine analysis, Nechiporenko test, Zimnitsky test, with

kidney pathology, Rehberg test, urine culture for flora and sensitivity to antibiotics.

5.Diagnostics of the intrauterine condition of the fetus

6. Consultations with specialists: therapist, ophthalmologist (fundus eye), neurologist, infectious disease specialist, and other specialists if necessary.

Complications of gestosis

With gestosis, complications are possible from both the mother and the fetus. Maternal complications include: cardiovascular failure, pulmonary edema, cerebral hemorrhage, cerebral hypoxia, edema, coma, retinal detachment and retinal hemorrhage, acute renal failure, anuria, acute liver failure, premature abruption of the normally located placenta

Fetal complications include: acute fetal hypoxia, intrauterine growth retardation, intrauterine fetal death, spontaneous premature birth.

THERAPY OF GESTOSES

Basic principles of therapy for gestosis:

1. Creation of a therapeutic and protective regime
2. Elimination of hypovolemia
3. Antihypertensive therapy
4. Normalization of rheological and coagulation properties of blood
5. Normalization of vascular permeability
6. Regulation of water-salt metabolism
7. Prevention and treatment of multiple organ failure
8. Prevention and treatment of placental insufficiency
9. Antioxidant therapy.

The therapeutic and protective regime is ensured by taking drugs that have a sedative effect.

Infusion therapy is used to eliminate hypovolemia, restore tissue perfusion, blood flow in vital organs, eliminate hemoconcentration and hypoproteinemia, and correct electrolyte and metabolic disorders. IT is carried out by the method of controlled hemodilution by introducing colloid and crystalloid solutions, carried out under the control of diuresis, hematocrit and hemodynamic parameters. IT begins with the introduction of colloid solutions, and then crystalloid ones.

Antihypertensive therapy should be selected individually, taking into account the type of central maternal hemodynamics and the clinical characteristics of preeclampsia. For this purpose, drugs of different mechanisms of action are used: vasodilators, antispasmodics, blockers, and stimulators of adrenergic receptors, ganglion blockers.

Magnesium sulfate is prescribed taking into account mean arterial pressure. With SBP up to 110 mm Hg. Art. 25% -20 ml is administered with 400 ml of isitonic solution intravenously.

Calcium antagonists can be used simultaneously with magnesium sulfate: verapamil 80 mg, Norvasc 5-10 mg per day, Corinfar 10 mg 2 times a day.

Ganglion blockers are prescribed during controlled antihypertensive therapy: pentamin 5% - 0.5 ml, benzohexonium 1.0-1.5 ml of a 2.5% IV solution in an isotonic solution or in a 5% glucose solution.

Antispasmodic drugs in combination with antihypertensive drugs make it possible to long-term and persistently prevent arterial hypertension and maintain blood pressure at a normal level.

Diuretics are prescribed only after replenishment of the circulating plasma volume:

• with severe generalized edema
• at a diastolic blood pressure level of 120 mm Hg. Art. and more
• with diuresis less than 50 ml/hour
• with a central venous pressure of more than 60 mm water column.
• with complications in the form of acute left ventricular failure
• with pulmonary edema

Prevention and treatment of DIC syndrome: chimes, trental, fresh frozen plasma, cryoprecipitate, protease inhibitors.

First aid for eclampsia

The patient is placed on a flat surface and her head is turned to the side. The airways are cleared by carefully opening the mouth with a spatula, pulling the tongue forward and aspirating the contents of the oral cavity and airways. When spontaneous breathing is restored after a seizure, oxygen is given. In case of prolonged apnea, auxiliary ventilation is immediately started or the patient is transferred to mechanical ventilation. When cardiac activity stops, closed cardiac massage is performed in parallel with mechanical ventilation using cardiovascular resuscitation techniques. To prevent seizures, neuroleptanalgesia is administered: Relanium 2 ml., Promedol 2% -1 ml., Pipolfen 2 ml.; droperidol 4-6 ml if repeated administration is necessary, the same drugs in half the dose no earlier than after 2 hours. Further treatment according to the basic principles of treatment of severe gestosis.

Indications for mechanical ventilation:

1. Intractable attacks of eclampsia,
2. Impaired external respiration, tachypnea more than 40 bpm, apnea, arrhythmia,
3. Coma,
4. Acute disturbances of vital functions.

Features of labor management in women with gestosis

The birth should be conducted by an obstetrician-gynecologist together with an anesthesiologist. Monitoring the condition of the mother and fetus; lateral position, gradual pain relief during labor, antispasmodics, antihypoxants, antihypertensive drugs, drugs that improve uteroplacental blood flow.

The method of choice for labor anesthesia for severe gestosis is long-term epidural anesthesia. Antihypertensive therapy is carried out under the control of blood pressure, with blood pressure over 160/100 mm Hg. controlled relative normotension is indicated. In order to reduce intrauterine pressure when the cervix is ​​dilated by 3-4 cm, an early amniotomy is performed. In the third and early postpartum periods - prevention of bleeding IV oxytocin 5 units in an isotonic solution 0.9% - 400 ml.

Indications for early delivery:

• severe gestosis with no effect from treatment for 1-2 days;
• preeclampsia with no effect of treatment within 6 hours
• eclampsia
• HELLP syndrome,
• complications of gestosis
• severe fetoplacental insufficiency.

Indications for caesarean section

eclampsia,

preeclampsia in the absence of treatment effect,

complications of gestosis,

PONRP (even non-progressive),

pronounced FPN, IUGR with the possibility of nursing a premature newborn,

combination of gestosis with other obstetrics. pathology (breech presentation, infertility),

lack of effect from labor induction,

HELLP syndrome, acute headache.

Prevention of severe forms of gestosis

Identification of pregnant women into risk groups for gestosis.

Early diagnosis of mild forms of gestosis, pathogenetically based therapy, timely solution to the issue of early delivery.

Specific drug prevention