Gestosis during pregnancy later: signs and consequences

Gestosis during pregnancy is a complication of gestation that occurs in the later stages. The 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.

Let's consider in more detail: toxicosis during pregnancy - what it is, why it occurs in the later stages, its signs and consequences (for the pregnant woman herself and for the baby).

1. What is gestosis during late pregnancy?
2. Causes of late toxicosis
3. Signs of gestosis in late pregnancy
4. Laboratory signs
5. Severity
6. How does severe gestosis manifest in the third trimester?
7. Prevention
8. Treatment
9. How to treat in a hospital and when a pregnant woman needs hospitalization
10. Consequences for the mother
11. Consequences of gestosis in late pregnancy for a child
12. Can gestosis happen again during the next pregnancy?

Preeclampsia during pregnancy - what is it?

Preeclampsia during late pregnancy is pathological condition which some pregnant women experience, its outdated name is late toxicosis. It is accompanied by a distortion of the functioning of interconnected organs and systems.

Treatment of gestosis in the second half of pregnancy

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.

Inpatient treatment: indications and methodology

Hospitalization is indicated for a woman with any degree of gestosis that is higher than the first. Also hospital treatment it is assumed when outpatient care 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.

Consequences for mom

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 consequence of gestosis during pregnancy 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, clinical picture and the patient’s initial health status.

Consequences of gestosis during pregnancy for a child

Medical practice shows that the closer to childbirth gestosis begins, the more favorable its prognosis will be. Women whose problem appeared at 35 weeks have more likely successful resolution than pregnant women with gestosis that began at 20 weeks. The main danger for the baby is oxygen starvation. Hypoxia can lead to irreversible consequences:

• cerebral circulatory disorders;
• fetal malnutrition;
• intrauterine death.

The likelihood of recurrence of gestosis in later stages in subsequent pregnancies

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 signs of late toxicosis just before giving birth, the likelihood of a relapse is reduced significantly.

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Preeclampsia during pregnancy - what is it, symptoms

Maria Sokolova

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Preeclampsia is a complication of important organs and systems of a pregnant woman’s body. The disease is very serious and dangerous. It can disrupt the functioning of the liver, kidneys, heart, vascular, and endocrine systems. In the world, gestosis manifests itself in a third of expectant mothers, and it can develop both against the background of a chronic disease and in healthy woman.

Types and degrees of gestosis in pregnant women

Early gestosis

The disease begins to manifest itself already in the first stages of pregnancy. It often occurs from the first days and ends in the 20th week. Early gestosis does not pose a great threat to mother and child. There are three degrees of severity of the disease:

1. Easy. Toxicosis occurs in the morning. In total, it can appear 5 times a day. You may lose your appetite. A pregnant woman will lose 2-3 kg. The general condition of the body is normal - the temperature is normal. Blood and urine tests are also normal.
2. Average. Toxicosis increases up to 10 times a day. The time of manifestation is any and does not depend on nutrition. You can also lose 2-3 kg in 2 weeks. Body temperature usually rises and varies from 37 to 37.5 degrees. The pulse quickens - 90-100 beats per minute. Urine tests are distinguished by the presence of acetone.
3. Heavy. Toxicosis is observed constantly. Vomiting can happen up to 20 times a day, or even more. The general state of health deteriorates sharply. A pregnant woman loses up to 10 kg due to poor appetite. The temperature will rise to 37.5 degrees. A rapid pulse is also noted - 110-120 beats per minute, sleep disturbance, low blood pressure. Mommy will constantly want to drink, as the body will suffer from dehydration. The tests will be bad: acetone and protein are observed in the urine, which is washed out of the body; in the blood - increased hemoglobin, bilirubin, creatinine.

Late gestosis

In the case when the disease lasts longer than 20 weeks, it is called late gestosis. There are several stages of late gestosis:

• At stage 1, swelling occurs. A pregnant woman will notice them by numbness and thickening of the toes and hands.
• Stage 2 – nephropathy. U expectant mother pressure rises. This may result in bleeding or placental abruption.
• At stage 3, preeclampsia occurs. A protein indicator appears in urine tests. The body does not accept protein and removes it. A pregnant woman may have headache, toxicosis, insomnia, abdominal pain, memory and vision impairment.
• Stage 4 – eclampsia. Convulsions and loss of consciousness appear. In the acute form, a woman may fall into a coma.

Rare types of gestosis

Doctors also distinguish some other forms of manifestation of gestosis. These include:

1. Jaundice. May occur in the 2nd trimester due to viral hepatitis.
2. Dermatosis. Manifests in different forms– there may be urticaria, eczema, herpes, allergic manifestations on the skin.
3. Liver dystrophy. This disease is also called fatty hepatosis. It significantly reduces the activity of the kidneys and liver.
4. Tetany of pregnant women. Due to a lack of calcium and vitamin D, and thyroid dysfunction, seizures may occur.
5. Osteomalacia – softening of bones. It also appears due to a lack of calcium, phosphorus, vitamin D, and improper functioning of the thyroid gland.
6. Arthropathy. For the same reasons, the bones of the pelvis and joints may not heal properly.
7. Chorea. Develops against the background of mental disorders. A pregnant woman may involuntarily begin to move parts of her body and may have difficulty speaking or swallowing.

Signs of early and late gestosis during pregnancy - diagnosis

You can notice early gestosis by the following symptoms:

• Nausea.
• Loss of appetite.
• Dizziness.
• Tearfulness.
• Changes in taste and smell.
• Drooling.

Late gestosis is characterized by the following symptoms:

• Edema.
• High blood pressure.
• Indicator of protein in urine.
• Cramps.
• Emotional disturbance.
• Fever.
• Stomach ache.
• Toxicosis.
• Anemia.
• Visual impairment.
• Fainting.
• Memory loss.

The main causes of gestosis during pregnancy

Doctors still do not come to a common opinion about the causes of gestosis. Here are the main causes of the disease:

1. Hormonal effects manifested through the destruction of the placenta.
2. Toxic poisoning of the body. Moreover, both the mother and the unborn child can release toxins.
3. An allergic manifestation expressed through vomiting or miscarriage. Allergies occur due to tissue incompatibility ovum parents.
4. The body's immunological reaction. Due to violations immune system The mother's body rejects the fetus.
5. Neuroreflex effect. A growing person can irritate endometrial receptors and provoke a negative reaction of the autonomic nervous system.
6. Mental perception. Mommy may be afraid of pregnancy, future birth and will set herself up in such a way that the processes of inhibition and excitation of the central nervous system begin to be disrupted in her body.
7. Genetic reaction of the body.

Risks of gestosis in pregnant women - how dangerous is the disease for mother and baby?

The risk of gestosis in a pregnant woman is high. The main factors that may cause the disease are:

1. Extragenital pathology. Cardiovascular diseases, kidney and liver diseases develop. The endocrine system and metabolism are disrupted.
2. Bad habits – alcoholism, smoking, drug addiction.
3. Ecological problems.
4. Unfavorable social and living conditions.
5. Wrong diet.
6. Diseases that depend on the hazards of labor production.
7. Violation of rest and sleep schedules.
8. Age – under 18 years and over 35.
9. Multiple births.
10. Genital infantilism.
11. Hereditary gestosis.
12. Chronic infections.
13. Poor immune system.
14. Anomalies of the internal organs of the pelvis.
15. Obesity.
16. Diabetes.
17. Lupus erythematosus.
18. Personal attitude towards pregnancy, expressed in negativity.
19. Thyroid diseases.
20. Cold.

The disease should be taken seriously. If there is a risk to life or a complication, the mother should immediately consult a doctor.

Preeclampsia is dangerous during pregnancy.

The expectant mother may experience:

• Headaches, dizziness.
• Vision will deteriorate.
• Acute respiratory failure.
• Kidney damage.
• Coma.
• Stroke.
• Cramps.
• Damage to the central nervous system.
• Destruction of brain cells.

Of course, gestosis affects the development little man. He may experience developmental delay and hypoxia.

In addition, the placenta may detach and a miscarriage may occur.

The website warns: the information is provided for informational purposes only and does not constitute medical advice. Do not self-medicate under any circumstances! If you have any health problems, consult your doctor!

Preeclampsia is a complication that occurs in many pregnant women. It disappears after childbirth. Pathology is considered a dangerous disease, as it sometimes causes maternal mortality. The complication is most often detected in the third semester of pregnancy.

This is an insidious disease that may not cause concern. But at a certain point, a woman experiences an attack of convulsions (eclampsia), which threatens the health of the mother and baby.

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

What are the signs and symptoms of gestosis?

Main features

• swelling or dropsy (first the hands and feet swell);
• the appearance of protein in the urine;
• blood pressure is higher than 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. The following conditions may occur against the background of seizures: stroke, heart attack, placental abruption, pulmonary edema, renal failure, placental abruption, retinal detachment. Such complications develop very quickly and can be present in pregnant women of any age.

Groups

Edema of pregnant women

They can be obvious or hidden. The latter appear on early stages diseases. They arise due to fluid retention in 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 swelling during pregnancy is associated with illness. Only a specialist can identify complications.

Preeclampsia

This condition most often occurs after the 20th week of pregnancy. Sometimes preeclampsia occurs at the end of the first week after birth. 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 are seizures.

Gestosis can manifest itself in different ways. Some women have minimal symptoms. Others suffer from fulminant attacks that have catastrophic consequences.

The cause of the disease - the opinions of doctors

Doctors cannot accurately name the causes of complications. But there is a clear opinion that such a complication rarely occurs in healthy women. Most often, gestosis develops against the background of existing diseases of the mother. Increased blood 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 disruptions in her body that can lead to serious problems. In some cases, doctors resort to early delivery to save the life of the child and mother. Therefore, before conceiving, a woman needs to undergo 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 us to predict possible complications that may occur during pregnancy. 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 problems with your kidneys, thyroid gland or blood pressure, be sure to visit your doctor.

The risk group includes

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

No one is 100% immune from gestosis. Therefore, experts strongly advise you to regularly come for examination. Monitoring blood pressure and weight, blood and urine tests are measures that allow timely detection of complications.

No one is 100% immune from gestosis

The excellent health of a pregnant woman is not yet an indicator of good health. Sometimes test results show poor results in the absence of external signs diseases.

Why does gestosis appear in pregnant women?

Preeclampsia or toxicosis is a complication associated with pregnancy. It may be early or late. Early toxicosis is known to all pregnant women. It manifests itself at the most early stages. Its main symptoms are nausea and vomiting. Early stage 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 are the ones who lead to dangerous complications. Late gestosis is the leading cause of maternal mortality. This complication is less noticeable.

It manifests itself in three main signs:

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

Not all women experience the full range of symptoms. Only one of them can indicate the presence of pathology. Only swelling is visible here. 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, towards the end of the term, doctors measure blood pressure and weigh in weekly.

Late gestosis sometimes has an unpredictable development. Sometimes they begin to progress dramatically. In this case, the woman’s health condition rapidly deteriorates. A pregnant woman may feel worse and worse every hour. Pathology in this form is treated only in an inpatient setting.

Today, about 27% of pregnant women experience the disease. Its symptoms subside after childbirth. The complication arises due to the fact that the mother’s body cannot optimally adapt to bearing a child. As a result, various violations arise.

The disease is characterized by 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 functioning of organs and systems is disrupted. Spasm of small vessels leads to an increase in blood in large vessels. All this leads to increased 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, and flashing “sights”. If a pregnant woman experiences dry skin and itching, this is a clear sign of changes in the liver.

The woman experiences swelling and the blood becomes thicker. Such processes also affect the condition of the fetus. Its growth and development slows down. The baby experiences 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 (24-hour, biochemical and clinical);
3. weighing;
4. blood pressure measurement;
5. fundus examination;
6. Ultrasound and Dopplerometry of the fetus.

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

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

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

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

When diagnosing edema, a specialist evaluates weight gain over the entire period of pregnancy, as well as over 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 sticking to a diet and fasting days. If this does not help, the doctor prescribes special medications. If a pregnant woman has a significant weight gain, but there is no edema, then she may be given an MCO test (McLure-Aldrich test).

It involves injecting a woman with a saline solution under her skin. The doctor records the time it takes for the papule to resolve. If the interval does not take 35 minutes, then there is swelling in the body.

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

In this case, the woman’s condition can deteriorate sharply at any moment. Self-medication is not allowed here. Some women begin to take diuretics on their own, which further worsens the situation.

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

Late toxicosis occurs for many reasons. Violation in endocrine system, obesity, sexually transmitted diseases, hypertension - all these factors can contribute to the development of gestosis in the second half of pregnancy. Sometimes it is a consequence of the flu or acute respiratory viral infection.

Poor nutrition can also give impetus to the development of late toxicosis. It is impossible to cure it at home. The woman requires hospital treatment. She is given IV drips and prescribed medications that help replenish the lack of fluid in the vessels.

The cause of late toxicosis is often pathology in the placenta. In this case, the most effective solution problems are considered childbirth. In case of serious complications, a caesarean section is resorted to.

The initial symptoms of late toxicosis are detected during the next examination in antenatal clinic. The doctor evaluates weight gain, measures blood pressure, examines urine samples and counts the fetal heartbeat. 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. Late degree doesn't go away on its own. The symptoms will only get worse. If you miss time, you may experience preeclampsia or more severe complications (seizures).

How does childbirth go?

The severity of the disease affects the choice of time 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 a truth that has been supported by all gynecologists and obstetricians from time immemorial. But for such childbirth the following conditions are needed: a mature cervix, proportionality between the mother’s pelvis and the fetal head, cephalic presentation fetus, woman's age not older than 30 years, absence of illnesses in the mother and other factors.

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

With gestosis, childbirth may be accompanied by complications

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

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

Typical complications during childbirth

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

The main way to relieve a woman of gestosis is childbirth. But for an immature and premature baby, delivery before due date- this is not a completely 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 becomes 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 delivery (regardless of gestational age)

1. nonconvulsive or convulsive eclampsia, seizures;
2. gestosis, which progresses even with hospital treatment;
3. rapid deterioration in the woman’s health;
4. retinal disinsertion;
5. placental insufficiency, which progresses;
6. placental abruption;
7. signs of hepatopathy.

Doctors perform a gentle and quick delivery. Preference is given to childbirth through the natural birth canal. This avoids the stress that surgery and anesthesia cause. 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 childbirth, some women experience 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 22–24 weeks and lasts quite a long time. The second may appear 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 delivery is not accompanied by dangerous symptoms.

Late gestosis usually does not have severe complications

Severity:

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

Doctors also distinguish pregestosis or the preclinical stage of the disease. There is also a division into combined and pure gestosis. Concomitant conditions are important here. Pregnant women with extragenital ailments that were not detected in time are included in the group of women suffering from pure look diseases.

If complications arise against the background of an existing disease, then we are talking about a combined form. In practice, 70% of women have 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 diagnosis. They can have different degrees of severity:

grade I - swelling of the lower extremities;

degree II - swelling of the lower and upper extremities, as well as the abdominal wall;

degree III - swelling spreads to internal organs.

Edema may be hidden. They may be accompanied by proteinuria and arterial hypertension. The course of the disease is determined by conducting blood and urine tests. At the same time, the doctor monitors the condition of the fetus. The severity of the pathology can be judged by the number of baby’s heartbeats.

Early

Early gestosis or toxicosis worries many pregnant women. It occurs in the first half of the term. 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 different strengths. If the disease manifests itself too clearly, doctors prescribe treatment. Toxicosis is so widespread that its symptoms are considered normal occurrence during pregnancy.

In fact, the phenomenon has a pathological basis. Normally, pregnancy in a healthy woman should not be accompanied by nausea and vomiting. Pregnancy is a 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 pathological reaction of a woman to pregnancy. Immune, allergic, toxic, reflex and neurogenic mechanisms are involved in the development of toxicosis.

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 childbirth. Such toxicosis leads to disruption of a woman’s systems and organs.

Many obstetricians attribute the occurrence of gestosis to the increased number of late births

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

Many obstetricians attribute this to the increased incidence of late births. Women who give birth after 35 years have chronic diseases complicating the course of pregnancy and childbirth.

A woman may notice the first signs of late disease at 28 weeks. Pregnant women usually experience swelling. This is the mildest manifestation of the disease. Edema is also called “edema of pregnancy.” In more severe cases, the complication manifests itself as nephropathy.

Easy

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. Signs include swelling. The woman is undergoing outpatient treatment.

Heavy

Blood pressure exceeds the norm by 40% and more. Protein content - 3.0 g/l. The pregnant woman's health is deteriorating. She develops a headache, swelling increases, and protein in her urine increases.

Sleep may also be disrupted and vision may deteriorate. The patient is admitted to the hospital. If the condition is very serious, 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 patient’s organs and tissues. The functions of the liver, kidneys and nervous system are impaired, and the fetus and placenta are also affected.

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

There are doctors who support the renal theory of the occurrence 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 even without compression of the kidneys.

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

How dangerous is the disease during pregnancy?

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

If the course is favorable early toxicosis its symptoms disappear by the 12th week. If it continues, then doctors talk about pathology. This may be caused by exacerbation of chronic diseases or some obstetric pathology.

Any form of late onset of the disease poses a danger to the fetus. Blood circulation in the blood vessels of the placenta is disrupted. Acute form causes its detachment, premature birth or death of the child. Sluggish gestosis causes a delay intrauterine development 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, gestosis enters a severe stage.

Basic principles of treatment:

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

If 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 induction of labor is not used. Premature birth is a forced measure that is used in severe cases. If treatment does not lead to positive changes, and the condition of the mother and child worsens, 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, she is sent to the hospital. Medications If there is a disease, they must be used. It cannot be cured with herbs and diets.

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

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

Prevention

1. proper nutrition;
2. active lifestyle (pregnant women benefit from yoga, swimming, fitness);
3. frequent walks in the fresh air;
4. absence bad habits and stress;
5. taking preventive medications as prescribed by a doctor (Magne-B6, vitamin E, chimes, etc.);

Diet

Proper nutrition can improve the condition of a pregnant woman. A woman should have on her table healthy foods. The emphasis should be on foods rich in protein. This includes lean meat, cottage cheese, fish and eggs. Sweet, fatty, fried, smoked and salty foods should be excluded.

Fast food is strictly prohibited. The daily menu should include fresh vegetables, fruits, juices and greens. You should eat more fiber foods to relieve constipation.

If there is swelling, the doctor will create a diet. He recommends monitoring the amount of fluid you drink and excrete. Pregnant women must control the amount of food they eat. IN otherwise there will be a strong weight gain, which can lead to a number of complications.

Pregnant food should be rich in vitamins and microelements. 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.

Pregnant food should be rich in vitamins and microelements

What could be the consequences?

Preeclampsia 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 suffer from endocrine disorders, hypertension, and kidney pathologies. Children born to such mothers experience problems with psycho-emotional and physical development. Many children often get sick in early childhood.

How to avoid this disease

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

For mild gestosis, treatment can be carried out in antenatal clinics. It is advisable to hospitalize pregnant women with moderate and severe gestosis, preeclampsia and eclampsia in obstetric hospitals located in multidisciplinary hospitals with an intensive care unit and a department for nursing premature babies, or in perinatal centers.

Therapy for pregnant women is based on the treatment of symptoms and signs of secondary manifestations of gestosis, with the goal of reducing the incidence of complications from the mother and fetus.

The principles of therapy for gestosis are to create a therapeutic and protective regime; restoration of the function of vital organs; quick and gentle delivery.

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

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

Therapy of gestosis should currently be carried out under the control of central venous pressure (within 5-10 cm water column), diuresis (at least 35 ml/h), concentration (hemoglobin at least 70 g/l, hematocrit at least 0.25 l /l, the number of erythrocytes is not less than 2500000000000/l and platelets is not less than 100000000000/l) and biochemical blood parameters (total protein not less than 60 g/l, alkaline phosphatase, AST, ALT, total bilirubin, creatinine within physiological norm depending on the determination method), electrolytes (K+ no more than 5.5 mmol/l, Na+ no more than 130-159 mmol/l).

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

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

In case of moderate gestosis and preeclampsia, all initial manipulations are carried out against the background of inhalation anesthesia using benzodiazepane tranquilizers, neuroleptics, analgesics, antihistamines, barbiturates as indicated.

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

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

Antihypertensive therapy is carried out when the level of systolic blood pressure exceeds the initial level before pregnancy by 30 mm Hg, and diastolic blood pressure by 15 mm Hg. Art. Currently, calcium antagonists are recommended (magnesium sulfate up to 12 g/day, verapamil 80 mg 3 times/day, amlodipine 5 mg 1 time/day), blockers and stimulants of adrenergic receptors (clonidine 150 mg 3 times/day, atenolol 50-100 mg 1 time / day, labetalol up to 300 mg / day, betaxolol 20 mg 1 time / day, nebivolol 2.5 mg 2 times / day), vasodilators (hydralazine 10-25 mg 3 times / day, sodium nitroprusside 50-100 mcg , prazosin 1 mg 1-2 times a day), ganglion blockers (azamethonium bromide 5% 0.2-0.75 ml, hexamethonium benzosulfonate 2.5% 1-1.5 ml).

For mild gestosis, monotherapy (calcium antagonists, antispasmodics) is used; for moderate gestosis, complex therapy is used for 5-7 days, followed by a transition to monotherapy if there is an effect.

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

In severe forms of gestosis, including preeclampsia and eclampsia, complex antihypertensive therapy is carried out. The most optimal condition for carrying out antihypertensive therapy for severe forms of gestosis is a CVP value of at least 5-8 cm of water column. At low CVP values ​​(less than 3 cm H2O), antihypertensive therapy should be preceded by ITT. The drug of choice is magnesium sulfate. The initial dose is 2.5 g of dry matter. The total daily dose of magnesium sulfate is at least 12 g IV under the control of respiratory rate, hourly diuresis and knee reflex activity. Calcium antagonists can be used simultaneously with magnesium: verapamil 80 mg/day or amlodipine 5-10 mg/day. Calcium antagonists can be combined with clonidine at an individual dose. If there is no effect from antihypertensive therapy, short-acting ganglion blockers (azamethonium bromide) or nitrate derivatives (sodium nitroprusside) are used.

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

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

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

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

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

Saluretics (furosemide) are administered for moderate and severe gestosis when the central venous pressure is restored to 5-6 cm water column, the total protein content in the blood is at least 60 g/l, symptoms of hyperhydration, and diuresis is less than 30 ml/h. If there is no effect from the administration of furosemide at the maximum dose (500 mg/day in fractions), isolated ultrafiltration is used for the purpose of dehydration. If acute renal failure develops, the patient is transferred to a specialized nephrology department for hemodialysis.

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

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

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

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

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

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

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

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

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

Indications for plasmapheresis:

• severe gestosis with gestation up to 34 weeks and no effect of ITT to prolong pregnancy;
• complicated forms of gestosis (HELLP syndrome and acute gastrointestinal tract) to relieve hemolysis, disseminated intravascular coagulation, and eliminate hyperbilirubinemia.

Indications for ultrafiltration:

• post-eclamptic coma;
• cerebral edema;
• intractable pulmonary edema;
• anasarca.

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

Research recent years Calcium supplements have been shown to reduce the incidence of hypertension, preeclampsia, premature birth. It is interesting to note that in pregnant women with a transplanted kidney, during treatment with glucocorticoids (methylprednisolone) and immunosuppressive therapy with cytostatics (cyclosporine), preeclampsia did not develop, and the existing dropsy did not develop into a more severe form.

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

Detailed treatment regimens for gestosis, depending on the severity and drugs used, are presented in the book “Medicines used in obstetrics and gynecology.”

In the treatment of gestosis important has a duration of therapy in pregnant women. For mild and moderate degrees of gestosis, it is advisable to carry out inpatient treatment for 14 days, for moderate degrees - 14-20 days. Subsequently, measures are taken to prevent the recurrence of gestosis in the conditions of the antenatal clinic. In severe cases of gestosis, inpatient treatment is carried out until delivery.

Ed. IN AND. Kulakova