Almost every second person encounters one or another manifestation of toxicosis (gestosis) at different stages of pregnancy. future mom... For many, it is morning sickness that becomes the first news that life has arisen under their hearts. But gestosis can take on a more sinister guise. We are talking about this with Irina Nikolaevna BUZAEVA, head of the department of pathology of pregnant women, State Healthcare Institution "Perinatal Center" (Kaliningrad)

- What is gestosis? What are the symptoms of this diagnosis?

Gestosis (toxicosis) is a complication of pregnancy associated directly with the pregnancy itself. They are early and late. Everyone knows about the early ones: this is nausea, vomiting in the first weeks or months of bearing a child. They are extremely rarely aggressive and lead to changes on the part of the mother's body, but they are visible, tangible, and both the woman and the people around her pay attention to them. Late toxicosis is much more insidious. They can lead to the most serious complications during pregnancy, and, unfortunately, until now, late gestosis is one of the leading causes of maternal mortality in the world.

Late gestosis is less noticeable for a woman and is manifested, as a rule, by three symptoms: the appearance of edema, protein in the urine, and an increase in blood pressure. Late gestosis may contain all three symptoms, but may contain only one. In this case, only edema is visible to the eye. Increases in blood pressure by pregnant women are felt less, and changes in urine tests are not felt at all. That is why at the end of pregnancy, all expectant mothers are forced to regularly weigh themselves, measure blood pressure and take urine tests.

Late gestosis is extremely insidious because they can have an unpredictable course. This toxicosis, I repeat, can manifest itself in the form of edema, and only edema remains until the end of pregnancy. Or toxicosis can be felt exclusively by such a symptom as a moderate increase in blood pressure. And such a scenario is also possible when toxicosis begins to progress very quickly, and then the deterioration of a woman's health goes on for days and even hours. Therefore, this pathology should be treated only in stationary conditions.

- Is gestosis a common problem?

In the department of pregnancy pathology of our maternity hospital about 25-30% of women undergo treatment with gestosis, about 30-50 people per month.

- What are the reasons for the appearance of gestosis?

There are many theories here, but scientists have not yet made a final conclusion about the causes of toxicosis. There are versions, but I would not frighten expectant mothers with medical terms.

- But can we talk about risk groups for the development of preeclampsia?

Yes. Toxicosis rarely develops in absolutely healthy women. Most often, we have combined gestosis, which develop against the background of maternal diseases. This includes kidney disease, high blood pressure, liver dysfunctions, and many other medical conditions.

- Is there a connection between toxicosis in the first third of pregnancy and gestosis in the third trimester?

If at the beginning of pregnancy a woman is sick in the morning, it does not mean that at the end she will develop gestosis. But there is another relationship: in a woman who has health problems before pregnancy, we more often expect the development of late gestosis. And there are situations when we offer women with the second stage of hypertension to terminate the pregnancy, because bearing a child threatens her life.

- Why are gestosis dangerous?

Gestosis can lead to very serious complications: these are severe renal dysfunctions, visual disturbances, and cerebral hemorrhages, and disorders of the blood coagulation system. The latter is one of the most formidable complications: with the developed disseminated intravascular coagulation syndrome, thrombosis of the uterine vessels may begin at first, and after a short-term increase in the blood coagulation system, a decrease occurs, up to a complete loss of blood coagulation ability. This leads to the development of severe obstetric bleeding, which requires serious resuscitation measures, blood transfusions, and which, unfortunately, for a woman, can end with the removal of the uterus if everything is started and help is not provided on time.

In a medical institution, of course, they never bring it to this extreme stage, they try to raise the issue of delivery, because it is almost impossible to cure toxicosis during pregnancy. It is possible to suspend the severity of its course, but the final cure of this pathology occurs only after delivery. Therefore, late toxicosis is often the cause of premature termination of pregnancy. If this is done in a hospital and on time, the risk of negative consequences for the mother and the fetus is minimal.

Eclampsia is a severe form of late gestosis, its extreme stage, when a woman develops seizures, very reminiscent of an epileptic seizure, the pressure rises sharply, and protein appears in the urine. An attack of eclampsia is a life-threatening situation that can lead to impairment or loss of vision, hemorrhage in the brain, and irreversible changes in the kidneys.

Is it necessary and possible to treat early gestosis? And is a situation possible when he becomes the reason for the hospitalization of the expectant mother?

If a woman is worried only about nausea and vomiting no more than once a day, this does not lead to weight loss, such gestosis does not need treatment. Of course, there are also severe forms of early preeclampsia, but they are very rare in comparison with severe forms of late preeclampsia. In this case, the woman is hospitalized, she is given a dropper, if necessary, physiotherapy is carried out, an immunological method of treatment is applied, etc. As a rule, by 12 weeks with the most severe gestosis, the symptoms gradually go away, and by 16 weeks there is no nausea and vomiting and a trace.

- What pressure during pregnancy is considered pathological? Or is its sharp rise more important here?

There is such a rule here: we look at the initial level of pressure in a woman and compare it with the pressure in the second half of pregnancy. If a woman has her normal blood pressure - 90/60, then already 120/90 is a serious problem. Overweight women always have a slightly higher blood pressure, and for them, the norm may be, say, 140/80. Then we again estimate how much this pressure has increased. A special problem is hypertensive patients, whose blood pressure was 150-160 from an early age. Such women are under the close supervision of a doctor.

- Is it possible to say only by the presence of edema that a woman has gestosis?

Yes, edema is definitely gestosis, and such a woman is at risk of developing a more severe form of gestosis. And we begin to fight this gestosis at the stage of edema. The further depends on when the treatment is started, and on the woman's body itself, how healthy it is and how much it resists the problem that has arisen.

- How is edema diagnosed? Is it only because white marks remain on the hands and feet for a long time after pressing?

No, weight gain is necessarily assessed for the entire pregnancy and weekly, monthly. During each visit to the antenatal clinic, the expectant mother must weigh herself. An increase of 300-400 grams per week is considered the norm. If a pathological weight gain begins in the second half, this indicates that there are hidden edema in the body, and therefore, correction of water-salt metabolism is necessary. Treatment begins with nutritional adjustments. The antenatal clinic doctor appoints a fasting day. If this does not lead to any effect, medications are used.

- As for the fluid intake, does a woman need to reduce its amount?

Taking into account the peculiarities of the course of pregnancy, in the second half of it, it is imperative to reduce the amount of fluid you drink, otherwise serious violations of water-salt metabolism will lead to the development of edema, that is, you can provoke the development of edema in yourself if you consume fluid uncontrollably. After all, do not forget that pregnancy itself causes a moderate tendency to water retention in the body.

- How much liquid a day can or should the expectant mother drink in the last months of bearing a baby?

No more than 1-1.5 liters per day.

- Does physical activity influence the appearance or reduction of edema?

With fitness, you will not remove the swelling and, sitting in the position of the legs above the head, only redistribute them. Edema is a fluid retention in the intercellular spaces, and it must be removed.

- Is it possible to do it only in a hospital?

Edema is the mildest stage of late gestosis, and they always begin to treat it in antenatal clinics. If within 7-10 days the treatment does not give any effect, then the woman is sent to a hospital. Unfortunately, sometimes mothers come to us who have neglected the advice of obstetricians-gynecologists in antenatal clinics, and all because many simply do not realize the full danger of edema.

How appropriate is the use of drugs for the treatment of preeclampsia? If the metabolism is impaired, won't the situation be aggravated by chemicals that give an additional load on the body?

The use of drugs for gestosis, I believe, is mandatory. The question rests only on what to use, in what quantities and with what symptoms. You cannot cure a serious stage of late gestosis with any diets or herbs. And to use diuretic herbs, if the edema has just begun, it is necessary under the strict supervision of a doctor: the symptoms that can follow the edema - increased pressure and impaired filtration function of the kidneys - the woman herself will not notice, this is seen only by the doctor during the examination.

- Gestosis is an indication for caesarean section? Is it possible natural childbirth with gestosis?

With preeclampsia of mild and moderate severity, women, as a rule, give birth themselves. Indications for cesarean section are only severe forms of gestosis, when delivery must be done very quickly and there are no conditions to carry out childbirth through the vaginal birth canal.

How does gestosis in a mother during pregnancy affect the condition of the newborn? Is there a relationship here?

It is believed that there are no long-term consequences or special threats for children. But we must bear in mind that gestosis themselves often force us to terminate a pregnancy prematurely, and premature birth is a certain risk to the health of the child and its further development. That is why, when a woman comes to us with a preeclampsia clinic at 37-38 weeks, we breathe easier: we have a matured child and we know that the mother's condition will not affect the condition of the fetus.

- Do the symptoms of gestosis go away after childbirth?

Symptoms of gestosis can last up to two months after delivery, and eclampsia can develop in the early postpartum period. But we believe that if within two weeks no complications have developed, then we have avoided the risk.

If you have some kind of somatic illness, you need to undergo serious preparation for pregnancy, be examined by a specialist according to the profile of the disease, to find out whether it is possible to carry a pregnancy in this situation. And I advise expectant mothers to listen to the advice of experts. Yes, our women have become more literate, they read a lot, strive to get as much information as possible, but there are things that only a doctor knows.

Interviewed by Irina Shelygina
Regional Fund for Support of Motherhood and Childhood "Creation"

The site administration does not assess the recommendations and reviews about treatment, drugs and specialists. Remember that the discussion is conducted not only by doctors, but also by ordinary readers, so some advice can be dangerous to your health. Before any treatment or taking medications, we recommend that you contact a specialist!

COMMENTARY

Natalia / 2012-02-24

I gave birth 5 years ago, I was not diagnosed with gestosis, but I had very high blood pressure, severe swelling and I gained about 20 kg in the last 2 months, the gynecologist was not worried about this. I gave birth to a premature baby (8 months), there was a very difficult birth (high blood pressure, increased protein in urine) I think it was gestosis, can gestosis somehow affect my health now? After giving birth, I started having problems with my kidneys (although my kidneys were always healthy), my eyesight worsened and my blood pressure often jumps (this caused headaches) Thank you in advance

Tatiana / 2012-04-14

I was given o-gestosis during pregnancy, the ratio of the liquid drunk and the excreted liquid was 100 to 5-10%. in recent months I have gained 19 kg. The new gynecologist did not advise me anything except to drink less liquid. the protein in my urine was off scale. 7 years have passed since the birth, but my swelling has not gone away. all the liquid drunk enters the tissues - arms, legs and face. The nephrologist did not find anything, the endocrinologist, too, the gynecologist and therapist also say that I have no diseases, I checked my heart and hormones, liver and thyroid gland. how many examinations and analyzes I have not passed over these 7 years and no one can tell me anything how to stop it all. before pregnancy, I did not suffer from edema and kidney disease too. I am now gaining up to 1 kg per day, in a week I can gain up to 5-6 kg, then I drink a diuretic, because I cannot feel normal at the same time, my state of health is greatly deteriorating. tell me, can this be the consequences of gestosis and which doctor would you advise me to contact or what tests do I need to pass in order for them to show specific results?

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Indications for early delivery are:

• moderate preeclampsia in the absence of the effect of therapy for 5 to 6 days;
• severe preeclampsia and preeclampsia with ineffective therapy within 3 to 12 hours;
• eclampsia, HELLP-syndrome, AGBP;
• gestosis, accompanied by severe fetal-placental insufficiency and fetal malnutrition.

It is fundamentally important to treat the intensive care of critical forms of preeclampsia as a preoperative preparation, since spontaneous childbirth is a danger to the life of the mother and the fetus. According to the instructions of obstetricians-gynecologists, severe preeclampsia is treated within 1 day, preeclampsia - up to 8 hours, with the development of eclampsia, immediate delivery is recommended. Depending on the conditions and obstetric situation, a cesarean section or an obstetric forceps is chosen. With severe hypertensive syndrome, even with the use of controlled normotonia, it is not possible to keep blood pressure at a safe level for a long time. At the same time, there is a significant risk of developing complications such as premature detachment of a normally located placenta, intrapartum fetal death, violation cerebral circulation, retinal detachment, pulmonary edema. With the development of convulsive syndrome, it is advisable to carry out intensive therapy for 1-2 hours to stop cerebral edema and the phenomena of multiple organ failure, and only then proceed to operative delivery.

Absolute indications for caesarean section are:

• eclampsia and its complications;
• complications of gestosis - coma, cerebral hemorrhage, HELLP-syndrome, acute fatty hepatosis of pregnant women, premature detachment of the normally located placenta, retinal detachment and hemorrhage into it, anuria (oliguria), etc .;
• severe form of preeclampsia and lack of conditions for rapid delivery;
• combination of gestosis with other obstetric pathology.

Caesarean section for severe forms of preeclampsia is performed only under endotracheal anesthesia. In less severe forms, surgery can be performed under epidural anesthesia. After removing the fetus, for the prevention of bleeding, it is advisable to administer an intravenous bolus of 20 thousand units of contrikal followed by the introduction of 5 IU of oxytocin. Intraoperative blood loss is compensated for with fresh frozen plasma, infucol solution (HES 6% or 10%), and crystalloids.

The indication for blood transfusion is a decrease in Hb below 80 g / l, Ht below 0.25. Given the high risk of developing a clinically expressed disseminated intravascular coagulation syndrome and respiratory distress syndrome in severe forms of preeclampsia, erythrocyte mass is used to replenish blood loss for no more than 3 days of storage. With vaginal delivery, childbirth is carried out with maximum anesthesia - stage-by-stage long-term analgesia using fentanyl, stadol. Sacral, epidural anesthesia, which also has an antihypertensive effect, is effective.

24.10.2008

Gestosis of pregnant women (also called late toxicosis) is a complication of pregnancy that occurs in its second half and is characterized by dysfunction of vital organs and systems. Unfortunately, gestosis is one of the most common problems: its signs are detected in 13-16% of expectant mothers.

Gestosis is divided into dropsy of pregnancy, nephropathy of pregnancy, preeclampsia and eclampsia. Gestosis, which develops in pregnant women against the background of visible well-being and in the absence of any diseases, qualifies as "pure gestosis" and occurs in 20-30% of pregnant women. When gestosis occurs against the background of an existing disease (hypertension, kidney, liver disease, endocrine system pathology, lipid metabolism disorders), it qualifies as a combined one.

Manifestations of preeclampsia

Dropsy of pregnant women is characterized by persistent edema due to fluid retention in the body and is one of the early symptoms of preeclampsia. Distinguish between latent and overt edema. Latent edema is evidenced by pathological (more than 300-400 g per week) or uneven weekly weight gain.

Due to a decrease in urine excretion and fluid retention in the body, body weight rapidly increases, and there is a predominance of night urination over daytime. Swelling usually begins in the ankle area and gradually spreads upward. In some cases, the face begins to swell at the same time. In the morning, the swelling is less noticeable because the fluid is evenly distributed throughout the body during the night's rest. During the day, the swelling descends to the legs and lower abdomen. Even with severe edema, the general condition and well-being of pregnant women, as a rule, remains good. Diagnosis of dropsy in pregnant women is based on the detection of edema, weighing results, comparing the amount of fluid drunk and excreted per day - a woman should excrete no less than she drinks.

Nephropathy is characterized by a combination of three symptoms: edema, increased blood pressure, and protein in the urine. There may also be two symptoms in various combinations. Nephropathy of pregnant women usually develops against the background of dropsy preceding it. Increase in blood pressure up to 135/85 mm Hg. Art. and above is one of the important clinical signs of nephropathy. Baseline blood pressure is important. Arterial hypertension in pregnant women is evidenced by an increase in systolic blood pressure (first digit) by 30 mm Hg. Art. from the original, and the diastolic (second digit) - by 15 mm Hg. Art. and higher. Special meaning has an increase in diastolic pressure, which is directly proportional to a decrease in placental blood flow and a decrease in the supply of oxygen to the fetus.

Nephropathy poses a danger to the health of pregnant women, women in labor and postpartum women due to the fact that it can turn into eclampsia (a seizure with impaired function of all organs and systems), cause severe dysfunctions of vital organs, and also creates preconditions for complications such as premature detachment of a normally located placenta, premature birth, bleeding, fetal hypoxia (insufficient oxygen supply), fetal death.

Severe complications of gestosis (bleeding, premature detachment of a normally located placenta, fetal death) are largely due not to high blood pressure, but to its sharp fluctuations.

The presence of protein in the urine (proteinuria) is one of the most characteristic signs of preeclampsia. A progressive increase in protein in the urine indicates a worsening of the course of the disease. Simultaneously with the presence of the listed symptoms in pregnant women, the volume of urine excreted decreases. The daily amount of urine is reduced to 400-600 ml or less. The less urine is excreted, the worse the prognosis of the disease. The longer the nephropathy lasts, the worse the prognosis of the condition of pregnant women and the outcomes of pregnancy.

Preeclampsia is manifested by a predominant violation of microcirculation in the central nervous system. This type of gestosis, in addition to the typical triad of symptoms, is characterized by a feeling of heaviness in the back of the head, headaches, pain in the stomach, in the right hypochondrium, nausea, vomiting, and visual impairment. Along with the listed signs, memory impairment, insomnia or drowsiness, irritability, indifference, lethargy may occur. There is also a weakening of vision, the flickering of "flies" or sparks, a "veil" in front of the eyes, which is a consequence of circulatory disorders in the occipital cortex and retinal damage.

Preeclampsia is characterized by the following symptoms: systolic blood pressure of 160 mm Hg. Art. and higher; diastolic blood pressure 110 mm Hg. Art. and higher; protein content in urine 5 g per day or more); a decrease in the volume of urine excreted (less than 400 ml); cerebral and visual disturbances, nausea, vomiting, a decrease in the number of platelets (blood cells responsible for blood clotting), a decrease in the activity of the blood coagulation system, impaired liver function.

Eclampsia- a severe stage of gestosis, in which, in addition to the symptoms characteristic of nephropathy and preeclampsia, seizures develop. The appearance of a convulsive seizure of eclampsia is most often provoked by external stimuli (bright light, sharp sound, pain, stressful situation). The seizure usually lasts 1 to 2 minutes.

After the seizure, the patient lies unconscious. After a while, consciousness returns, but she does not remember anything about what happened, complains of a headache and general fatigue. In some cases, the unconscious state is not interrupted and after some time passes into the next seizure. There may be several seizures. The prognosis is unfavorable when developing after a seizure of deep coma (a state in which there is no consciousness, the coordinating function of the brain is partially lost), which indicates cerebral edema, as well as possible hemorrhages. In some cases, a non-convulsive form of eclampsia may occur. In this case, the patient complains of severe headache, darkening in the eyes. Suddenly she falls into a coma with high blood pressure.

Explicit visible edema, in terms of their prevalence, differ in degrees:

• I degree - swelling of the legs;
• II degree - swelling of the legs and abdomen;
• III degree - edema of the legs, anterior abdominal wall and face;
• IV degree - generalized - common to the legs, trunk, arms, face.

Causes and mechanisms of development of preeclampsia

The causes of gestosis are very diverse. In this regard, several theories have been proposed for the development of this complication. So, according to one of the theories, gestosis is caused by a violation of the relationship between the cerebral cortex and subcortical formations, which is expressed by reflex changes in the vascular system and impaired blood circulation.

Of great importance for the development of gestosis is a violation of hormonal regulation of the functions of vital organs and systems. A significant role in the development of preeclampsia is assigned to the immunological incompatibility of the tissues of the mother and the fetus. A number of scientists are of the opinion about the possibility of a hereditary predisposition in the onset of preeclampsia. However, most researchers believe that there is no single mechanism for the development of gestosis, but there is a combined effect of various damaging factors in the development of this pathology.

From the point of view of possible mechanisms for the development of gestosis, great importance is assigned to the spasm of all vessels, which leads to impaired blood circulation in organs and tissues and a disorder of their function. A reflection of vasospasm is an increase in blood pressure. Equally important is the defeat of the inner layer of blood vessels - the endothelium. Damage to the endothelium leads to a decrease in the synthesis of substances in it that affect the tone of blood vessels and the blood coagulation system, and a change in sensitivity to them on the part of the vascular wall.

The body also synthesizes a number of other substances that regulate vascular tone. Under the influence of damaging factors, the balance between the substances is disturbed, which ensure the expansion and contraction of the vessels in favor of the latter, which leads to vasospasm. Against the background of the ongoing changes, the process of intravascular coagulation of blood is activated, the properties of blood flow are disrupted, and its viscosity increases. Blood circulation in the vessels becomes difficult, which is accompanied by the formation of blood clots, and there is a decrease in the supply of oxygen to the tissues of the mother and fetus.

Along with the changes occurring, the indicators of the function of the cardiovascular system of the pregnant woman decrease. Due to the increased permeability of the vascular wall against the background of damage to the vascular endothelium, the liquid part of the blood is released into the tissue, which manifests itself in the form of edema.

Gestosis is accompanied by severe renal dysfunction, which has various manifestations, ranging from the appearance of protein in the urine and ending with acute renal failure - a condition in which the kidneys cannot cope with their work. With gestosis, the function of the liver is also disturbed, which is accompanied by a disorder of blood circulation in its tissues, focal necrosis (areas of necrosis) and hemorrhages. There are also functional and structural changes in the brain: microcirculation disorders, the appearance of blood clots in the vessels with the development of dystrophic changes in nerve cells, punctate or focal hemorrhages, edema with increased intracranial pressure. With gestosis in pregnant women, there are also pronounced changes in the placenta, which are the cause of the development of chronic hypoxia and delayed fetal development. These changes are accompanied by a decrease in fetal-placental blood flow.

How is gestosis detected?

Diagnosis of preeclampsia is based on the assessment of anamnestic data (data on the woman's diseases, the course of this pregnancy), the patient's complaints, the results of a clinical objective study and laboratory data. To clarify the situation and objectively assess the patient's condition, they must evaluate:

• clotting properties of blood;
• general analysis blood;
• biochemical blood parameters;
• general and biochemical urine analysis;
• the ratio of consumed and released fluid;
• blood pressure value;
• change in body weight over time;
• concentration function of the kidneys;
• fundus condition.

If preeclampsia is suspected, ultrasound and Doppler measurements are performed. Additional consultations of a therapist, nephrologist, neuropathologist, ophthalmologist are also required.

Treatment of gestosis

The basic principles of the treatment of preeclampsia include: the creation of a therapeutic and protective regimen, restoration of the function of vital organs, fast and gentle delivery.

With dropsy I degree, it is possible to carry out treatment in the conditions of antenatal clinics. With dropsy of II-IV degree, treatment is carried out in a hospital setting. Pregnant women with severe nephropathy, preeclampsia, eclampsia should be hospitalized in hospitals at multidisciplinary hospitals that have an intensive care unit and a unit for nursing premature babies.

Treatment of gestosis includes a set of measures:

• a diet with fluid restriction (800-1000 ml per day) and salt, enriched with proteins and vitamins;
• creation of a therapeutic and protective regime (including sedatives);
• infusion, or intravenous, therapy (its purpose is to improve blood circulation in small vessels, including in the vessels of the placenta). The volume of infusions is up to 1400 ml per day (using Reopolyglucin, plasma preparations, etc.);
• antihypertensive therapy - treatment aimed at lowering blood pressure (dibazol, magnesia, nitrates, ganglion blockers for controlled hypotension, calcium antagonists, apressin);
• prevention of placental insufficiency (actovegin, vitamins E, B6, B12, C, methionium).

Sedatives, diuretics, and medicines that lower blood pressure and improve blood flow are prescribed.

The duration of treatment is determined by the severity of gestosis and the condition of the fetus. With mild nephropathy, the duration of inpatient treatment should be at least 2 weeks, with an average - from 2 to 4 weeks, depending on the condition of the fetus. The patient can be discharged from the hospital with recommendations to continue treatment under the supervision of a antenatal clinic. In severe nephropathy and the presence of an effect of treatment, observation and treatment in a hospital setting before delivery is optimal. Treatment of severe nephropathy, preeclampsia and eclampsia is carried out in conjunction with resuscitators in the intensive care unit.

Indications for early delivery (usually by caesarean section) are:

• moderate nephropathy with no effect of treatment within 7-10 days;
• severe forms of preeclampsia with failure of intensive therapy for 2-3 hours;
• nephropathy, regardless of severity, with delayed fetal development and lack of growth during treatment;
• preeclampsia, eclampsia and its complications.

Delivery through the vaginal birth canal is carried out in the presence of appropriate conditions: with a satisfactory condition of the patient and the effect of treatment, in the absence of intrauterine fetal suffering according to ultrasound and cardiomonitoring studies.

Prevention of gestosis

Measures aimed at preventing the development of gestosis should be carried out in patients at risk for the development of this pathology. Risk factors include: violation of fat metabolism, hypertension, kidney pathology, diseases of the endocrine system, infectious diseases, combined pathology internal organs(that is, the presence of several diseases).

Prevention of gestosis in the risk group begins in the second trimester of pregnancy. At the same time, it is necessary to organize a rational regimen of rest and nutrition: adequate sleep (about 8 hours a day), regular walks, it is important to maintain Have a good mood creating a calm emotional background. Regular monitoring of the condition of the mother and the fetus is important to identify the earliest signs indicating the onset of preeclampsia. Drug prophylaxis is aimed at optimizing the function of the nervous system, liver, kidneys, and metabolic processes. It is important to ensure the normal state of the blood coagulation system. The duration of the course of drug prophylaxis is on average 3-4 weeks.

Gestosis is a complication that occurs in many pregnant women. It disappears after childbirth. Pathology is considered a formidable disease, as it sometimes becomes the cause of maternal death. The complication is most often detected in the third semester of pregnancy.

It is an insidious disease that may not be a cause for concern. But at some point, a woman has a seizure attack (eclampsia), which threatens the health of the mother and baby.

Currently, doctors are trying to prevent such phenomena. By regularly visiting your gynecologist, you can keep your health under control. Read on for everything about complications during pregnancy: signs of occurrence, nuances of treatment, what prevention and consequences of the disease can be advised.

What are the signs and symptoms of preeclampsia

The main signs

• edema or dropsy (hands and feet swell first);
• the appearance of protein in the urine;
• blood pressure is above normal.

Dangerous symptoms - harbingers of a seizure attack

• nausea;
• headache;
• stomach ache;
• lethargy and drowsiness;
• flashing "flies" before the eyes.

The combination of such symptoms is characteristic of preeclampsia, which is the result of gestosis. Against the background of seizures, the following conditions may occur: stroke, heart attack, placental abruption, pulmonary edema, renal failure, placental abruption, retinal detachment. These complications develop very quickly and can be present in pregnant women of any age.

Groups

Swelling of pregnant women

They can be overt and covert. The latter appear in the early stages of the disease. They arise due to the retention of fluids in the tissues. Self-medication is unacceptable here. Diuretic medications cannot eliminate the problem, but only worsen the condition of the pregnant woman and the fetus. Not all edema during pregnancy is associated with a medical condition. Only a specialist can identify complications.

Preeclampsia

This condition most often occurs after the 20th week of pregnancy. Sometimes preeclampsia also occurs at the end of the first week after childbirth. Its signs are hypertension, edema and proteinuria. In severe cases, the blood supply to the brain is disrupted. This is manifested by severe headache, vomiting and visual impairment.

Eclampsia

This is the most severe form. It has a whole range of symptoms, the most dangerous of which is convulsions.

Gestosis can manifest itself in different ways. Some women have minimal symptoms. Others suffer from lightning attacks, which are disastrous.

The cause of the disease - the opinions of doctors

Doctors cannot accurately name the causes of complications. But there is an unequivocal opinion that such a complication rarely occurs in healthy women. Most often, preeclampsia develops against the background of the existing diseases of the mother. Increased pressure, impaired renal or liver function, as well as other somatic diseases are indirect causes of toxicosis in pregnant women.

It is impossible to name the reasons more precisely. A pregnant woman experiences malfunctions in the body, which can lead to serious problems. In some cases, doctors resort to early delivery to keep the baby and mother alive. Therefore, before conception, a woman must undergo an examination.

Immunological diseases, blood clotting disorders, kidney diseases, vegetative-vascular dystonia, anemia, diabetes mellitus - these and many other disorders often lead to gestosis

This will allow you to predict possible complications that may occur during the period of gestation. If necessary, a woman is prescribed a course of treatment even before pregnancy. Immunological diseases, blood clotting disorders, kidney diseases, vegetative-vascular dystonia, anemia, diabetes mellitus - these and many other disorders often lead to the manifestation of the disease.

If you have kidney, thyroid, or blood pressure problems, be sure to see your doctor.

The risk group includes

• women over 30 and under 18;
• those who frequently had abortions;
• women who have given birth many times;
• those who have a short break between childbirth.

Nobody is 100% insured from gestosis. Therefore, experts strongly advise that you regularly come for an examination. Monitoring pressure and weight, blood and urine tests are those measures that allow you to identify complications in time.

Nobody is 100% insured from gestosis

The great well-being of a pregnant woman is not yet an indicator of good health. Sometimes test results show poor results in the absence of external signs of the disease.

Why does gestosis appear in pregnant women?

Gestosis or toxicosis is a complication associated with pregnancy. It can be early or late. Early toxicosis is known to all pregnant women. It manifests itself at the earliest possible date. Its main symptoms are nausea and vomiting. The early stage is usually not aggressive in nature.

All its signs are noticed not only by the pregnant woman herself, but also by the people around her. Late toxicosis is more insidious. They lead to dangerous complications. Late preeclampsia is the leading cause of maternal mortality. This complication is less noticeable.

It manifests itself in three main features:

1. swelling;
2. protein in the urine;
3. high blood pressure.

Not all women have the full range of symptoms. Only one of them can tell about the presence of pathology. Only edema is visible here. The pressure rises may not be very significant. In this case, the woman does not feel them. Changes in the composition of urine also do not bother the pregnant woman. Therefore, by the end of the term, doctors measure blood pressure on a weekly basis and carry out weighing.

Late gestosis sometimes has an unpredictable development. Sometimes they start to progress dramatically. In this case, the woman's health condition is rapidly deteriorating. A pregnant woman may feel worse and worse by the hour. Pathology in this form is treated only in stationary conditions.

Today, about 27% of pregnant women face the disease. Its symptoms subside after childbirth. A complication arises from the fact that the mother's body cannot optimally adapt to carrying a child. As a result, various violations arise.

The disease is characterized by a spasm of the smallest blood vessels. As a result, the amount of blood that carries nutrients and oxygen to the cells is sharply reduced. The work of organs and systems is disrupted. A spasm of small vessels leads to an increase in blood in large vessels. All this leads to an increase in blood pressure.

Changes occur in the kidneys, which leads to the appearance of protein in the urine. The brain also suffers. This is manifested by nausea, headaches, flashing "flies". If a pregnant woman experiences dry skin and itching, then this is a clear sign of changes in the liver.

The woman develops swelling, and the blood becomes thicker. Such processes are reflected in the condition of the fetus. Its growth and development slows down. The baby is experiencing a lack of oxygen (hypoxia).

Diagnostic methods

If the doctor suspects gestosis, he prescribes the following procedures:

1. general and biochemical blood tests;
2. urine tests (daily, biochemical and clinical);
3. weighing;
4. blood pressure measurement;
5. fundus examination;
6. Ultrasound and dopplerometry of the fetus.

The patient must be examined by a therapist, neuropathologist, ophthalmologist and nephrologist. A significant deviation of pressure from the norm is considered a serious problem.

A special group is made up of hypertensive patients, whose blood pressure is increased initially. They are under constant medical supervision. If a woman has only edema, then she is at risk for a more severe form of preeclampsia.

Doctors must take into account the initial pressure of a woman with blood pressure in the second stage of pregnancy.

From the moment edema appears, specialists begin to take measures to prevent complications. The success of treatment depends on the body of the pregnant woman.

When diagnosing edema, a specialist evaluates weight gain over the entire period of pregnancy, as well as for a month and a week. An increase of about 300-400 grams is considered normal. A pathological increase indicates hidden edema. In this case, measures are taken to correct nutrition and water-salt metabolism.

The gynecologist recommends adhering to a diet and fasting days. If this does not help, then the doctor will prescribe special medications. If a pregnant woman has significant weight gain, but there is no edema, then she can be given an MCO test (McLure-Aldrich test).

It consists in the fact that a woman is injected with saline under the skin. The doctor marks the time during which the papule resolves. If the interval does not take 35 minutes, then there is edema in the body.

The first sign of edema is slight numbness in the fingers.... It is difficult for a woman to unbend her fingers; she can hardly put on rings. With small swelling of the legs, the gynecologist prescribes treatment, which is carried out on an outpatient basis. If the arms, legs and face swell, the pressure is increased, and there is also protein in the urine, then you need to go to the hospital.

In this case, the woman's condition can deteriorate sharply at any time. Self-medication is not allowed here. Some women start taking diuretics on their own, which further aggravates the situation.

Complication of the second half of pregnancy (starting closer to the third trimester)

Late toxicosis occurs for many reasons. Disorders in the endocrine system, obesity, sexual diseases, hypertension - all these factors can contribute to the development of preeclampsia in the second half of pregnancy. Sometimes it is the result of a previous flu or ARVI.

Improper nutrition can also give rise to the development of late toxicosis. It is impossible to cure it at home. The woman needs inpatient treatment. She is given droppers and prescribed medications that help fill the lack of fluid in the vessels.

The cause of late toxicosis is often pathology in the placenta. In this case, childbirth is considered the most effective solution to the problem. With formidable complications, they resort to caesarean section.

The initial symptoms of late toxicosis are detected at the next examination in the antenatal clinic. The doctor evaluates the weight gain, measures blood pressure, examines the urinalysis and calculates the fetal heart rate. Based on the data obtained, he can conclude about the presence or absence of gestosis.

If the doctor insists on hospitalization, then you cannot refuse. A late degree does not go away on its own. The symptoms will only get worse. If you lose time, you may experience preeclampsia or more severe complications (seizures).

How is childbirth going?

The severity of the disease affects the timing and method of delivery. The doctor takes into account the condition of the mother and child.

The most favorable births are those that occur through the natural birth canal. This is the truth, which from time immemorial has been supported by all gynecologists and obstetricians. But for such childbirth, the following conditions are needed: a mature cervix, the proportionality of the mother's pelvis and the head of the fetus, cephalic presentation of the fetus, the woman's age not older than 30 years, the absence of diseases in the mother and other factors.

With gestosis, childbirth may be accompanied by complications. Therefore, they are carried out very carefully, using antispasmodics and pain relievers. Delivery is considered stressful for the fetus and mother.

With gestosis, childbirth may be accompanied by complications

Studies carried out by specialists have shown that with this disease, the anti-stress resistance of the woman and the fetus is reduced. Any aggressive effect during childbirth (fatigue, uterine hyperstimulation, painful manipulations) can have dire consequences. A woman has every chance of suffering from fulminant and critical hypertension.

As a result, cerebral blood flow can be disrupted, leading to eclampsia. Statistics show that eclampsia during childbirth occurs quite often. It can occur not only during vaginal delivery, but also during cesarean section.

Typical complications of childbirth

• fetal asphyxia;
• premature placental abruption;
• heavy bleeding in the postpartum period.

The main way that relieves a woman of gestosis is childbirth. But for the immature and premature baby delivery before the due date is not a very favorable outcome. But in some cases, the baby has a better chance of surviving outside the mother's body. Then the only strategy of doctors is delivery. It allows you to save the life of the child and mother.

Childbirth in the presence of the disease is carried out against the background of stabilization of laboratory and clinical parameters.

Indications for early childbirth (regardless of the gestational age)

1. non-convulsive or convulsive eclampsia, seizures;
2. preeclampsia, which progresses even with hospital treatment;
3. the rapid deterioration in a woman's health;
4. retinal disinsertion;
5. placental insufficiency, which is progressing;
6. placental abruption;
7. signs of hepatopathy.

Doctors carry out a gentle and fast delivery. Preference is given to giving birth through the birth canal. This avoids the stress of surgery and anesthesia. The woman is given pain relief.

Caesarean section is performed if there are absolute indications: preeclampsia and eclampsia, placental abruption, oliguria, coma.

Illness after childbirth

After giving birth, some women have symptoms of pathology. Such patients are prescribed appropriate treatment, which is continued until their condition stabilizes. The treatment regimen is determined individually.

Degrees and classifications

Experts distinguish between early and late gestosis. The first occurs at a period of 22-24 weeks and lasts a long time. The second can occur when the period is 36 weeks. The late form of the disease usually does not have severe complications. During this period, the baby has already formed and the delivery is not accompanied by dangerous symptoms.

Late gestosis usually does not have severe complications.

Severity:

1. easy,
2. average,
3. heavy,
4. eclampsia.

Doctors also distinguish pregestosis or preclinical stage of the disease. There is also a division into combined and pure gestosis. Here the accompanying conditions are important. Pregnant women with extragenital ailments that were not identified in time are considered to be among the group of women suffering from a pure form of the disease.

If complications arose against the background of an existing disease, then we are talking about a combined form. In practice, 70% of women have exactly the combined form. The most unfavorable symptoms are observed in pregnant women who have liver disease, kidney disease, endocrine disorders, hypertension and metabolic syndrome.

Edema plays an important role in the diagnosis. They can vary in severity.:

degree I - edema of the lower extremities;

grade II - edema of the lower and upper extremities, as well as the abdominal wall;

grade III - edema extends to internal organs.

Swelling can be hidden. They may be accompanied by proteinuria and arterial hypertension. The course of the disease is determined by examining blood and urine. In this case, the doctor monitors the condition of the fetus. The severity of the pathology can be judged by the number of heartbeats of the baby.

Early

Early preeclampsia or toxicosis worries many pregnant women. It occurs in the first half of the term. The doctors cannot name the reasons for it.

The main manifestations of toxicosis:

1. dizziness,
2. nausea,
3. salivation,
4. vomit.

They can be expressed with varying strengths. If the disease manifests itself too clearly, then doctors prescribe treatment. Toxicosis is so widespread that its symptoms are considered normal during pregnancy.

In fact, the phenomenon has a pathological basis. Normal pregnancy in healthy woman should not be accompanied by nausea and vomiting. Pregnancy is the physiological normal state of the body. This is not a pathology.

The mechanisms of development of the early form have not been studied. Experts believe that it is a woman's pathological reaction to pregnancy. The development of toxicosis involves the immune, allergic, toxic, reflex and neurogenic mechanisms.

In some cases, the disease in early pregnancy takes the form of asthma, dermatosis, tetany, or osteomalacia.

Late gestosis

This is a complication that occurs in the second half of pregnancy. It develops until the very birth. Such toxicosis leads to a breakdown of the systems and organs of a woman.

Many obstetricians associate the occurrence of gestosis with an increased amount of late childbirth

The reasons for the development of late ghetosis have not been studied by science. According to some versions, gestosis occurs due to the immunological incompatibility of the fetus and the mother. Other experts believe that hormonal processes are to blame. The late form has been revealed very often in recent years.

Many obstetricians attribute this to an increased number of late births. Women who give birth after 35 years of age have chronic diseases that complicate the course of pregnancy and childbirth.

A woman can notice the first signs of a late illness at the 28th week. Usually, pregnant women find edema. This is the mildest manifestation of the disease. Edema is also called "dropsy of pregnant women." In more severe cases, the complication is manifested by nephropathy.

Light

A mild degree of the disease is characterized by a slight increase in blood pressure. It exceeds the norm by 20%. Protein in urine is 1.0 g / l. Of the signs, edema is present. The woman is given outpatient treatment.

Heavy

Blood pressure exceeds the norm by 40% and further. Protein content - 3.0 g / l. The well-being of the pregnant woman worsens. She develops a headache, swelling builds up and protein in the urine increases.

Sleep and vision can also be impaired. The patient is admitted to the hospital. If the condition is very serious, then the pregnant woman is sent to intensive care. Treatment tactics depend on the condition of the woman and the fetus.

Pathogenesis of gestosis

The basis of the pathogenesis of the disease is a generalized spasm of blood vessels. This is manifested by an increase in pressure. Due to damage to the endothelium, spasm occurs. Dystrophic changes occur in the organs and tissues of the patient. The functions of the liver, kidneys and nervous system are impaired, and the fetus and placenta also suffer.

The mechanism of development of pathology is a controversial issue. Many experts adhere to hormonal theory. In this case, the cause of complications is considered to be a violation of the functions of the adrenal glands, a change in the production of estrogen or the hormonal status of the placenta.

There are doctors who support the renal theory of gestosis. The kidneys are compressed by the growing uterus, which entails a number of disorders in the body. But this theory is refuted by facts that claim that toxicosis occurs in pregnant women without squeezing the kidneys.

There is also an immunogenetic theory, which states that some pregnant women have a placentation disorder due to genetic characteristics.

What is the danger of a disease during pregnancy

Gestosis is dangerous for its complications. If it is accompanied by vomiting, then the pregnant woman may be dehydrated. The functions of many organs and systems are impaired. Kidneys, liver and heart suffer. The most serious complication is acute yellow atrophy of the liver, which can lead to lethal outcome... But this pathology develops very rarely. If preeclampsia is extremely severe, then the pregnancy is terminated.

With a favorable course early toxicosis his symptoms disappear by 12 weeks. If it continues, then doctors talk about pathology. This can be caused by an exacerbation of chronic diseases or any obstetric pathology.

Any form of late onset of the disease is dangerous to the fetus. In the vessels of the placenta, blood circulation is disturbed. Acute form causes its detachment, premature birth or death of the child. Sluggish gestosis causes a delay in the intrauterine development of the baby.

What are the principles of treatment

Modern doctors cannot completely eliminate the disease. In many cases, they control this complication. Timely treatment helps prevent the development of severe complications. Self-medication is an unacceptable measure. Without the help of a professional, preeclampsia passes into a severe stage.

Basic principles of treatment:

• maintaining a medical and protective regime;
• taking sedatives (valerian, motherwort, or stronger drugs);
• drug treatment internal organs;
• gentle and timely delivery.

If the treatment does not lead to positive changes, and the condition of the mother and child worsens, then the question of childbirth arises.

If gestosis is treatable and does not progress, then labor stimulation is not used. Premature birth is a compulsory measure that is used in severe cases. If the treatment does not lead to positive changes, and the condition of the mother and child deteriorates, then the question of childbirth arises.

The treatment regimen for toxicosis is developed individually. Doctors take into account many nuances: the severity of the disease, concomitant diseases, the condition of the fetus, etc. Mild toxicosis begins to be treated in the antenatal clinic.

If after a week the woman's condition has not improved, then she is sent to the hospital. Medications in the presence of a disease, they are used without fail. It is impossible to cure it with herbs and diets.

Pregnant women with edema that accompany moderate and mild preeclampsia are treated in a hospital (department of pathology of pregnant women). In a severe form with signs of preeclampsia, a woman is placed in the intensive care unit and intensive care unit.

The duration of treatment depends on the severity of the disease. The best treatment severe form - delivery. Therefore, three hours after the undertaken ineffective treatment for preeclampsia, the patient undergoes a caesarean section.

Prophylaxis

1. proper nutritious nutrition;
2. an active lifestyle (it is useful for pregnant women to do yoga, swimming, fitness);
3. frequent walks in the fresh air;
4. absence bad habits and stress;
5. taking prophylactic drugs as prescribed by a doctor (Magne-B6, vitamin E, courantil, etc.);

Diet

Proper nutrition can improve the condition of a pregnant woman. Healthy foods should be present on the woman's table. The emphasis should be on foods rich in protein. These are lean meat, cottage cheese, fish and eggs. Sweet, fatty, fried, smoked and salty foods should be avoided.

Under the strictest ban on fast food. The daily menu should contain fresh vegetables, fruits, juices and herbs. Eat more fiber foods to relieve constipation.

If there is swelling, then the doctor makes a diet. He recommends keeping track of the amount of fluid you drink and secreted. Pregnant women should definitely control the amount of food they eat. Otherwise, there will be a strong weight gain, which can lead to a number of complications.

The food of a pregnant woman should be saturated with vitamins and minerals. You should drink purified water, excluding coffee, strong tea and carbonated drinks. Doctors usually prescribe special vitamin complexes for pregnant women. They must be accepted without fail.

The food of a pregnant woman should be saturated with vitamins and minerals.

What can be the consequences

Gestosis is a dangerous condition that can lead to dire consequences. It ranks second among the causes of death of mothers (the first place is given to bleeding). A complication is perinatal mortality (its rate reaches 32%).

Women suffering from the disease get endocrine disorders, hypertension, kidney pathology. Children born to such mothers experience problems with psycho-emotional and physical development. Many babies are often sick during early childhood.

How to avoid the occurrence of this ailment

In order for this pathology to bypass you, its prevention must be started even before conception. All chronic diseases should be identified and treated. Latent infections can be detected if tested. It is very important to lead healthy image life.

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, describe its symptoms, talk about the diagnosis, treatment and prevention of this condition.

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

The urgency of the problem

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

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

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

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

Classification

The classification of preeclampsia has not been sufficiently developed. In Russia, the division of the disease into the following types was most often used:

• dropsy of pregnant women (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 10 revision:

• О10: hypertension (high blood pressure) that existed before pregnancy and complicated the course of gestation, childbirth, and the postpartum period;
• О11: preexisting high blood pressure with addition of proteinuria (protein in the urine);
• О12: the appearance of edema and protein in the urine during pregnancy at normal pressure;
• A13: development of high blood pressure during pregnancy in the absence of protein in the urine;
• A14: hypertension during pregnancy in combination with a large amount of protein in the urine;
• O15: eclampsia;
• O16: unspecified hypertension.

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

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

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

Why does gestosis occur?

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 state with disruption of the cerebral cortex and a subsequent increase in vascular tone. This theory is confirmed by an increase in the incidence of illness in pregnant women after mental trauma, as well as data obtained using electroencephalography.
2. Endocrine theory considers an abnormally proceeding pregnancy as a chronic stress that causes overstrain and depletion of all endocrine systems of the body, including those that regulate vascular tone.
3. Immunological theory states that trophoblast tissue (the outer shell of the fetus that forms the placenta) is a weak antigen. The body produces the corresponding antibodies, which also interact with the cells of the kidney and liver of the woman. As a result, the vessels of these organs are affected. However, autoimmune processes are not recorded in all women with preeclampsia.
4. The genetic theory is based on the fact that in women whose mothers have had preeclampsia, the pathological condition develops 8 times more often than on average. Scientists are actively looking for "eclampsia genes."
5. The placental theory assigns the main importance to a violation of the formation of the placenta.
6. Thrombophilia and antiphospholipid syndrome can cause damage to the vascular walls throughout the body, and they also lead to a violation of the formation of the placenta.

Scientists believe that a unified theory of the origin of 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 tract diseases, frequent colds and endocrine pathology.
2. Multiple pregnancy.
3. Previously postponed gestosis.
4. The woman's age is under 18 and over 30 years old.
5. Poor social conditions.

How does the disease develop?

The onset of the disease occurs at the earliest stages of pregnancy. When the embryo is implanted (implanted) into the wall of the uterus, the arteries located in the muscle layer do not change, but remain in a "pre-pregnant" state. Their spasm occurs, the inner lining of the vessels - the endothelium - is affected. Endothelial dysfunction is the most important triggering factor for preeclampsia. It leads to the release of powerful vasoconstrictor substances. At the same time, the viscosity of the blood rises, microthrombi are formed in the spasmodic vessels. Disseminated intravascular coagulation syndrome (DIC syndrome) develops.

Vascular spasm 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 decreases in all organs, including the kidneys, liver, heart, brain and placenta. These disorders cause a clinical picture of gestosis.

Symptoms of gestosis

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

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

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

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

• swelling;
• arterial hypertension;
• proteinuria.

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

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

An increase in blood pressure usually occurs at 29 weeks. For a more accurate diagnosis, all measurement rules should be followed, the pressure on both arms should be recorded, and the size of the cuff should be correctly selected.

Edema during preeclampsia 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 only be on the legs, spread to the abdominal wall, or cover the entire body. Signs of hidden edema:

• excretion of the bulk of urine at night;
• a decrease in the amount of urine excreted in comparison with the volume of fluid consumed;
• excess weight gain;
• "Ring symptom" - a woman becomes not enough of her wedding or other familiar ring.

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

Severe forms of the disease

Dysfunction of the nervous system - preeclampsia and eclampsia - poses a particular danger to the mother and child.

Preeclampsia symptoms:

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

With the progression of this condition, eclampsia develops - a seizure, accompanied by hemorrhages and cerebral edema.

Complications

Late gestosis can cause serious complications that can even lead to the death of the mother and child:

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

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

HELLP syndrome includes hemolysis (breakdown of red blood cells), a decrease in the number of platelets responsible for blood clotting, and a malfunction of the liver with an increase in its enzymes in the blood. This complication occurs mainly after 35 weeks 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, bleeding appears, the patient loses consciousness, she begins to have convulsions. There is a rupture of the liver with bleeding into the abdominal cavity, placental abruption. Even if a woman is urgently operated on, due to blood clotting disorders, she may die in the postoperative period from severe bleeding.

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

Assessment of the severity of the condition

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

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

Preeclampsia 2 degrees characterized by the appearance of edema on the abdomen, proteinuria up to 1 g / l, an increase in pressure up to 170/110 mm Hg. Art. There may be degree 1 fetal malnutrition. This form occurs at 30-35 weeks.

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

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

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

Treatment of gestosis

The main directions of therapy:

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

The following drugs are prescribed for a woman:

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

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

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

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

Prevention of gestosis during pregnancy

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

The key to preventing preeclampsia is regular observation by a doctor, weight control, 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, the appearance of edema, headache, pain in the right hypochondrium, the patient should consult a doctor as soon as possible. Self-medication in this case is unacceptable. Untreated acute preeclampsia is an immediate threat to the life of the mother and child.