Gestosis (late toxicosis) in pregnant women: signs, degrees, consequences, treatment

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

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

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

The first signs of possible gestosis

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

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

Regarding the pathogenesis of gestosis: many scientists see its connection with immune factors. Fetal antigens influence maternal antibody production. In turn, antibodies cause the formation of excess immune complexes, which have Negative influence on the pregnant woman's body.

How does gestosis manifest?

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

OPG complex of symptoms

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

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

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

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

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

The manifestation of pathology in pregnant women is more likely:

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

Classification of gestosis

One of the classifications of pathology is divided into types:

1. Early gestosis;
2. Late gestosis.

The disease becomes more severe at the end of pregnancy.

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

1st degree

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

2nd degree

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

Complications develop:

• Placental abruption;
• Bleeding;
• Premature birth.

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

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

Stage 3, preeclampsia

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

Main signs of preeclampsia:

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

Eclampsia

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

HELLP syndrome

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

The most rare forms of gestosis include:

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

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

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

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

Complications of gestosis

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

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

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

Diagnostics

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

TO necessary research relate:

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

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

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

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

How to treat gestosis?

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

Main areas of treatment:

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

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

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

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

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

Principles of hexose prevention

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

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

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

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

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

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

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

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

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

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

Warning signs: diagnosis of gestosis during pregnancy

The main signs of gestosis during pregnancy are high blood pressure, swelling and the appearance of protein in the urine. To make it clear what condition should alert the expectant mother, let’s take a closer look at each of them.

Edema

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

Protein in urine

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

Increased pressure

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

Causes of gestosis in pregnant women

It must be said that, despite numerous studies, the exact cause of the development of gestosis has not yet been identified. This complication is called the “disease of theories” because there are many assumptions about the causes of its occurrence.

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

• Disturbance in brain function. This theory is confirmed by the fact that gestosis occurs most often in women exposed to severe stress. In this case, the balance in the processes of excitation and inhibition is disrupted, and a malfunction occurs in the cerebral cortex, which is responsible for the functioning of all internal organs, and a general vasospasm occurs.
• Endocrine disruption. During pregnancy, the levels of most hormones increase 10–20 times. And if the balance in this system is disturbed, gestosis occurs.
• Immunological reaction to foreign genes of the fetus. As you know, the immune system must come to the defense and reject foreign tissue (which, in fact, is the fetus - after all, 50% of its genes are from the father). This is the cause of toxicosis in the first half of pregnancy, and such situations are also possible in the second half. The body's defenses begin to produce antibodies to the fetus, which affects the blood vessels - they sharply contract.

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

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

Of course, the illness of the expectant mother also affects the baby. After all, the blood vessels of the placenta contract in the same way as all the others. As a result, the amount of blood flowing to the child decreases - the baby begins to lack oxygen and nutrients, and this negatively affects its growth and development. In addition, since the work of the mother’s kidneys is disrupted, they can no longer remove waste products as well as before. Intoxication occurs first in the woman’s body, and then in the child. Of course, in such a situation there is no way to do without treatment. But doctors can only use therapy that supports the functioning of the suffering internal organs, since the disease will subside only after childbirth.

Is hospitalization necessary for gestosis?

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

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

Treatment of gestosis in a pregnant woman in a hospital

In the maternity hospital, the woman undergoes the following tests:

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

In addition, the expectant mother will regularly have her blood pressure measured and the amount of fluid excreted and drunk assessed. Will conduct a consultation and narrow specialists: an ophthalmologist, focusing on the condition of the fundus vessels, will give an opinion on the condition of the brain vessels; a neurologist will evaluate the functioning of the nervous system and, above all, the brain; The nephrologist will give an opinion on the functioning of the kidneys. And finally, the therapist and obstetrician-gynecologist will assess the severity of the disease and decide on further treatment. Usually, medications are prescribed that lower blood pressure, improve the condition of blood vessels and prevent increased blood clotting.

The expectant mother is discharged when there is no protein in the urine, the blood pressure normalizes, swelling decreases and the fetus feels well. However, one must understand that in the future the symptoms of gestosis may reappear, so a pregnant woman should measure her blood pressure every day and carefully monitor whether the swelling increases again.

Is it possible to avoid gestosis during pregnancy?

Fortunately, the expectant mother can prevent the occurrence of gestosis. To do this, she should adhere to the following rules.

• Monitor the amount of fluid and salt entering the body. No matter how much you would like to eat a lot of salty foods and drink a large number of water, after 25–26 weeks it is worth monitoring the amount of liquid you drink. The expectant mother should drink about 1.5 liters of water per day (including soup, tea, fruit juice, etc.). You should not eat too salty foods - they cause fluid retention and make you want to drink even more.
• News active image life. The veins of the legs deposit a large volume of blood. Accumulating there, it begins to thicken, which threatens the appearance of blood clots and edema (as the fluid begins to leak into the tissues) - all this predisposes to the development of preeclampsia. When the leg muscles actively contract, they prevent blood from stagnating in the veins, pushing it into the general bloodstream. Therefore, doctors advise all pregnant women to lead a moderately active lifestyle in the second and third trimesters: walk a lot fresh air, swim, do yoga, etc.
• Maintain a calm emotional background. The cerebral cortex coordinates many processes occurring in the body of the expectant mother, including condition and work of cardio-vascular system. If a persistent focus of excitation associated with stress forms in the brain, this “distracts” it from coordinating the processes of pregnancy. Therefore, it is worth protecting yourself as much as possible from possible stress and anxiety.
• In the presence of chronic diseases(hypertension, chronic kidney inflammation) it is important to be observed by a general practitioner or specialized specialist throughout pregnancy in order to prevent exacerbation of diseases and the appearance of gestosis in time.
• Be sure to follow all the advice of the gynecologist, come to your appointment on time and take all prescribed tests, since gestosis appears unnoticed.

The most severe degrees of gestosis during pregnancy

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

Preeclampsia or late toxicosis during pregnancy is a pathological condition that poses an immediate threat to the life of the mother and child. When the first signs of the possible development of gestosis appear, you should consult a doctor who, if necessary, will suggest hospitalization.

Now let's look at this in more detail.

What is "gestosis"?

The term gestosis defines a pathological condition that develops in pregnant women during later more than 28 weeks. It is characterized by an increase in a woman's weight and an increase in systemic blood pressure, which can lead to placental abruption. The mechanism of development of the pathological condition remains reliably unknown today. It is believed that the main pathophysiological link is an increase in the permeability of the walls of small vessels, which is the cause of the development of several complications:

• The development of edema of peripheral soft tissues, which is a consequence of the release of plasma (the liquid part of the blood) from the vessels into the intercellular substance.
• Violation of the functional state of the kidneys - increased permeability affects the glomeruli, in which “filtration” of blood occurs and the formation of primary urine. This leads to protein compounds (albumin and globulins) from the blood entering the urine.
• An increase in the level of systemic blood pressure - the development of edema leads to a decrease in the volume of circulating blood due to the release of plasma into the intercellular substance of tissues. This causes a reflex increase in the synthesis of biologically active compounds (angiotensins), which lead to arterial spasm and an increase in systemic blood pressure.

Arterial hypertension against the background of gestosis during pregnancy increases the risk of placental abruption with a sharp deterioration in the nutrition of the fetus, which can cause its death. Also, the pathological condition poses an immediate threat to the life of the mother. This is due to swelling of the brain tissue with a violation of its functional state, which is manifested by the development of seizures and loss of consciousness.

Features of gestosis during pregnancy

Preeclampsia in pregnant women is a fairly common condition and one of the main causes maternal mortality. Stands out separately early toxicosis, which is also mistakenly called gestosis. It develops in and is characterized by intoxication of the woman’s body with nausea and periodic symptoms. Early toxicosis does not directly pose a danger to the life of the child and mother. Late toxicosis or gestosis develops in and is characterized by the presence of certain features, which include:

• Primary damage to blood vessels, which is accompanied by an increase in the permeability of their walls.
• A change in the functional state of the cardiovascular system, it is accompanied by an increase in the level of systemic blood pressure, an increase in heart contractions, as well as a decrease in the volume of blood that is pushed out of the heart during its contraction (cardiac output).
• Malnutrition of the fetus, as a change in the functional state of the woman’s cardiovascular system is reflected on the placenta. Usually a spasm of the arterial vessels of the placenta develops with a high probability of its detachment.
• Deterioration functional activity kidneys, which is accompanied by the development of renal failure and an increase in the concentration of metabolic products in the blood. In particular, the level of creatinine, nitrogenous compounds that have a negative effect on the brain, increases.
• Intoxication with damage to the structures of the central and peripheral nervous system. Against the background of increased permeability of the walls of microvasculature vessels, swelling of the brain tissue occurs, their compression in the cranium, which initiates sharp functional disorders. They are manifested by tonic-clonic convulsions, as well as loss of consciousness.

A feature of the clinical course of late gestosis is a sharp, sometimes sudden deterioration of the condition against the background of relatively satisfactory health. Therefore, if a pathological condition is suspected, women must be hospitalized in a medical hospital.

Late gestosis during pregnancy

Late gestosis during pregnancy refers to an obstetric pathology, which is characterized by a severe course and a high risk of unfavorable outcome for the pregnant woman and the unborn child. The condition develops in the third trimester. It is important not to confuse late gestosis and early toxicosis. With early toxicosis, intoxication develops in the body of a pregnant woman, in which nausea develops, accompanied by periodic nausea. Despite the discomfort for a woman, early toxicosis does not pose an immediate threat to life. Late toxicosis can lead to a sharp deterioration in the condition of a pregnant woman. At the beginning, the level of systemic blood pressure changes, kidney function worsens, but this is not reflected in changes in well-being. Due to the absence of obvious changes in the general condition, a woman may not apply for medical care up to the point of development of convulsions, during which the likelihood of complications significantly increases.

The first signs of gestosis during pregnancy

The first signs of the possible development of gestosis in a pregnant woman include several changes in the functional activity of the cardiovascular system and kidneys, these include:

• Weight gain - during pregnancy, all women gain weight, but a noticeable tendency to become overweight is the first sign of the possible development of preeclampsia.
• The appearance of edema of peripheral tissues - the very first (hidden) edema is difficult to determine. Usually the skin of the face area increases in volume ("bags under the eyes" appear), and the lower extremities. As the pathological process progresses, the swelling increases. The appearance of edema does not always indicate gestosis, however, it is better to consult a doctor if they appear.
• Protein in the urine is the first sign of deterioration in kidney function, which can only be determined with the help of laboratory analysis urine. In order not to miss a possible disruption of the functional activity of the kidneys, as planned, the woman periodically donates urine to determine the presence of protein (normally there is no protein in the urine).
• Increased systemic blood pressure (arterial hypertension) – characteristic feature gestosis. Subjectively, the woman does not feel arterial hypertension. To determine this, you should periodically measure your pressure using a tonometer (at home it is better to use modern electronic tonometers).

The appearance of the first signs of the development of gestosis is a reason to consult a doctor, since a sudden and sharp deterioration in a woman’s condition with the development of severe, sometimes irreversible, changes cannot be ruled out.

Symptoms of gestosis

Depending on the severity of the pathological process, several clinical forms of gestosis are distinguished (according to the classification), which are characterized by various manifestations:

• Arterial hypertension in pregnant women - the main manifestation of the pathological process is an increase in the level of systemic blood pressure above the age norm (pressure levels increase by 30 mm Hg).
• Proteinuria is the appearance of protein in the urine, which indicates a violation of the functional state of the kidneys.
• Edema during pregnancy is an indicator of a violation of the functional state of the vascular walls with an increase in their permeability, during which a large volume of plasma enters the intercellular substance of tissues. Edema is predominantly localized in the face and lower extremities.
• Preeclampsia is a severe stage of the pathological process, which is recorded in 5% of pregnant women, more often in primiparous women. It is characterized by the fact that against the background of proteinuria, arterial hypertension and tissue edema, signs of disruption of the functional state of the structures of the central nervous system appear. These include a feeling of heaviness in the back of the head, headaches of varying severity, nausea accompanied by periodic nausea, which brings virtually no relief, decreased visual acuity, changes in behavior (a woman may react inadequately to external stimuli).
• – a critically severe clinical stage of gestosis in pregnant women, against the background of a sharp disturbance in the functional state of the brain, convulsions of striated skeletal muscles develop, which are accompanied by a sharp and pronounced increase in blood pressure (hypertensive crisis).

Causes and prevention of gestosis

The exact cause of the development of gestosis during pregnancy in women remains unclear today. There are theories about the etiology of the disease, which include changes in the immune system, genetic defects, disorders in the brain or placenta. There are several predisposing factors, the impact of which increases the risk of developing gestosis:

• Burdened heredity caused by the transmission of certain altered genes.
• The presence of chronic somatic pathology in the body of a pregnant woman, which usually worsens during pregnancy (vegetative-vascular dystonia, obesity, diseases of the endocrine system, metabolic disorders).
• Chronic stress.
• Exposure of a pregnant woman’s body to adverse environmental factors (toxic compounds, radiation, infections).
• Availability bad habits(smoking, alcohol), poor nutrition with insufficient intake of vitamins and mineral salts.

If previous pregnancies occurred with gestosis, this increases the likelihood of a pathological condition in the future several times. Prevention comes down to the implementation of simple measures aimed at eliminating the effects of provoking factors. It is very important for a pregnant woman to register with an obstetrician-gynecologist and visit him in a disciplined manner throughout her pregnancy. Medical specialist prescribes routine examinations aimed at early diagnosis possible development of gestosis and other complications of pregnancy.

Treatment of gestosis during pregnancy

Treatment of gestosis during pregnancy is carried out only in a gynecological hospital. In the absence of significant hemodynamic disturbances, dynamic medical observation is performed. If functional changes in the cardiovascular, nervous system, or kidneys are detected, complex treatment is prescribed, including several areas:

• Normalization of systemic blood pressure levels.
• Improving blood circulation in the brain.
• Prevention of swelling of tissues of the nervous system structures.
• Intravenous drip infusion of special saline solutions, which makes it possible to restore the volume of fluid and salts in the bloodstream.

Adequate pain relief is used during childbirth. The implementation of therapeutic measures continues after the birth of the child. The choice of drugs is made by an obstetrician-gynecologist, based on their effectiveness for a pregnant woman and safety for the body developing fetus. In case of development, treatment is carried out in the intensive care unit using various means.

The prognosis for gestosis in a pregnant woman depends on the early detection of the pathological condition, as well as on the timely initiation of therapeutic measures. The danger of the disease cannot be underestimated. If a doctor suggests hospitalization, then even if the woman’s general condition is normal, it is not recommended to refuse.

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

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

Relevance of the problem

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

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

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

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

Classification

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

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

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

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

• O10: hypertension (high blood pressure), which existed before pregnancy and complicated the course of pregnancy, childbirth, and the postpartum period;
• O11: pre-existing high blood pressure with the addition of proteinuria (protein in the urine);
• O12: the appearance of edema and protein in the urine during pregnancy at normal pressure;
• O13: development of high blood pressure during pregnancy in the absence of protein in the urine;
• O14: hypertension arising during pregnancy in combination with a large amount of protein in the urine;
• O15: eclampsia;
• O16: unspecified hypertension.

This classification solves some operational aspects of diagnosis and treatment, but does not reflect the processes occurring in the body.

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

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

Why does gestosis occur?

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

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

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

The following factors significantly increase the risk of gestosis:

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

How the disease develops

The onset of the disease occurs as early as early dates pregnancy. When the embryo is implanted (introduced) into the wall of the uterus, the arteries located in the muscle layer do not change, but remain in the “pre-pregnancy” state. Their spasm occurs and the inner lining of the blood vessels, the endothelium, is affected. Endothelial dysfunction is the most important triggering factor of gestosis. It leads to the release of powerful vasoconstrictor substances. At the same time, blood viscosity increases, and microthrombi form in spasmed vessels. Disseminated intravascular coagulation syndrome (DIC syndrome) develops.

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

Symptoms of gestosis

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

• measuring blood pressure at intervals of 5 minutes with the woman lying on her side, on her back, and again on her side. The test is positive if the diastolic (“bottom”) pressure changes by more than 20 mmHg. Art.;
• disturbance of uteroplacental blood flow according to data;
• decrease in platelet count less than 160× 10 9 /l;
• signs of increased blood clotting: increased platelet aggregation, decreased activated partial thromboplastin time, increased fibrinogen concentration in the blood;
• reducing the concentration of anticoagulants, in particular, its own heparin;
• decrease relative number lymphocytes up to 18% and below.

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

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

• swelling;
• arterial hypertension;
• proteinuria.

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

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

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

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

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

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

Severe forms of the disease

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

Symptoms of preeclampsia:

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

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

Complications

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

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

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

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

Symptoms develop quickly. The woman begins to complain about headache, vomiting, pain in the abdomen or right hypochondrium. Jaundice and bleeding appear, the patient loses consciousness, and begins to have convulsions. Liver rupture occurs with bleeding in abdominal cavity, placental abruption. Even if a woman undergoes urgent surgery, she may die due to blood clotting disorders. postoperative period from severe bleeding.

Acute fatty hepatosis of pregnant women develops mainly during the first pregnancy. For 2-6 weeks, the woman experiences weakness, lack of appetite, abdominal pain, nausea and vomiting, weight loss, itchy skin. Then liver and kidney failure develops, which is manifested by jaundice, edema, uterine bleeding and fetal death. Hepatic coma often occurs with disruption of brain function.

Assessing the severity of the condition

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

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

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

Diagnosis of severe form is based on the following signs:

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

With such a serious condition, hospital treatment is necessary.

Treatment of gestosis

Main directions of therapy:

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

The woman is prescribed the following medications:

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

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

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

After caesarean section drug treatment continue until all body functions are completely restored. Women are discharged home no earlier than 7-15 days after birth.

Prevention of gestosis during pregnancy

A pregnant woman should avoid nervous and physical stress, get proper rest, and not take medications without a doctor’s prescription. Food should be nutritious and, if possible, hypoallergenic. Severe fluid restriction and a low-salt diet are not indicated. Only in severe cases of renal failure is the patient recommended to reduce the amount of protein consumed in food.

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

If the condition worsens, swelling, headache, or pain in the right hypochondrium appears, the patient should consult a doctor as soon as possible. Self-medication is unacceptable. Untreated acute gestosis– direct threat to the life of mother and child.