Causes of gestosis in pregnant women. Consequences of gestosis for a child. Inpatient treatment: indications and methodology

All women who have children know about the peculiarities of pregnancy and monitoring it: constant monitoring by a gynecologist, regular checks of tests, weighing and ultrasound. Some girls wonder why they need to step on the scale every time. Excessive weight gain indicates the appearance of edema. And they, in turn, are a sign that gestosis is developing during pregnancy.

This condition is not limited to the development of edema. Preeclampsia occurs most easily in pregnant women who do not have somatic diseases. In the presence of urinary and endocrine, gastrointestinal tract, the course will be more severe.

25% maternal mortality associated precisely with the state of gestosis. The risk of fetal death increases 3-4 times. After childbirth, all manifestations of gestosis disappear.

Causes

To understand what gestosis is in pregnant women, you need to start with the cause of its occurrence.

The main cause of gestosis in pregnant women is disturbances in vascular regulation. As a result, spasms occur. The target of changes is the microcirculatory bed.

Many scientists note that gestosis during pregnancy is associated with immunity and its factors. The fetus produces antigens that lead to the appearance of the mother. As a result, the formation of immune complexes occurs, the number of which exceeds normal. The result will be Negative influence on the mother's body.

Signs of gestosis during pregnancy are quite typical. They are all expressed by the abbreviation OPG. It stands for edema, proteinuria and. The entire symptom complex is not always observed.

The most common symptom is swelling of the hands. Due to an increase in the amount of water consumed, the exit of which is difficult, it is retained in the space between the tissues. Swelling of the arms and legs may occur; in severe cases, the swelling spreads throughout the body. Sometimes there are no obvious manifestations. Any changes can only be detected by weighing.

Normal weight gain per week during the third trimester is 500g. If you get more when weighing, then you should be more careful. Also, urine output should be more than 800 ml per day when drinking 1.5-2 liters of water.

• 5th degree.

Without treatment, the condition continues to worsen. The so-called HELLP syndrome develops. Vomiting of blood begins and jaundice appears. In extremely severe cases, coma is possible. Death is likely in 80% of cases.

Sometimes quite rare forms occur. They manifest themselves in the form of dermatoses, bronchial asthma or itching.

Some pregnant women are affected by other types of gestosis:

• Softening bones. Tooth decay occurs and painful sensations in the bones and joints, gait is disturbed. It develops against the background of a lack of vitamins in the body, and especially calcium.
• Increased saliva production. Excessive salivation occurs before vomiting. As a result, the body suffers from a lack of water, dry mouth appears, as a result of which speech changes and the mucous membrane of the oral cavity is damaged.
• Jaundice. At the same time, its other forms do not develop. Careful diagnosis of these two conditions is necessary to exclude infectious liver damage.
• Hepatic atrophy. Most often occurs in the first trimester. It is not amenable to any therapy. To improve the condition, termination of pregnancy is recommended.

Complications

With a mild course of gestosis, it can proceed unnoticed. Pregnant women think that there is no need to be examined if nothing worries them. But that's not true. We must not forget about the hidden current.

The danger of gestosis during pregnancy lies not in the disease itself, but in its complications:

• Edema of the lungs, brain;
• Hemorrhages in the brain, liver, lungs and other organ systems;
• Disruption of the normal functioning of the heart and blood vessels;
• Placental abruption;
• Impaired kidney function;
• Changes in the course of fetal development, its remaining from the norm;
• Premature birth;
• Disorders of the hepatobiliary system;
• Intrauterine oxygen starvation of a child;
• Changes in vision, its deterioration;
• Infant and maternal mortality.

But all this can be avoided. Regular urination and visiting a doctor once a month with the prescription of appropriate therapy will prevent the development of gestosis.

Diagnostics

All pregnant women constantly test a large number of tests, so diagnosing gestosis during pregnancy is not difficult. If there are any deviations from the norm, some studies may be ordered outside of the plan. Additionally, other diagnostic procedures are used.

The main studies include the following:

• Regular weight check. Normal weight gain in the second and third trimester should be no more than 350 g per week. If more than 500 g was collected, then the pregnant woman is examined additionally.
• Monitoring the amount of water consumed. The well-known norm of drinking 1.5-2 liters of water per day is not suitable for pregnant women. If even mild swelling occurs, the amount of fluid should be reduced to 1 liter per day. Plus additional control over the amount of urine excreted.
• . The main indicators are platelets and red blood cells. Based on the platelet count, it is determined how well the blood clots and whether there is a risk of bleeding.
• . The amount of liver enzymes, bilirubin and sugar is checked. This will make it clear how well the liver works and whether there is hidden diabetes.
• . Be sure to measure it on both hands. The difference in the results obtained may indicate the presence of gestosis.
• Clinical examination of urine. A diagnostic sign of gestosis will be the appearance of protein in the analysis results.
• Fetal screening. There are 3 in total, one in each trimester. With gestosis, the latter matters. During the study, the suitability of the fetus for the gestational age, its size and weight are determined.
• Doppler. Using a Doppler study, it is determined how well the blood flow is in the vessels of the placenta. The fetal heartbeat is also recorded.
• Examination by a dentist. Complete sanitation of the oral cavity is one of the main requirements in the antenatal clinic. If there are foci of chronic infection, you may be denied hospitalization. Also, upon examination, you can find out whether there is tooth decay, which indicates a lack of calcium in the pregnant woman’s body.
• Examination by an ophthalmologist. The ophthalmologist checks for any changes in the blood vessels of the fundus, which indicate increased blood pressure and changes in cerebral blood flow.

Skipping doctor's visits and not conducting regular examinations is not allowed. We are talking not only about the health of the pregnant woman, but also the child. Women over 35 years of age, especially in the case of their first pregnancy, are at risk for gestosis. At each visit, it is important not to forget to report all your complaints so that the diagnosis is timely.

Treatment

As such, there is no treatment for gestosis during pregnancy. This condition goes away with delivery. You can only stop its progression and prevent serious complications from developing.

Treatment of gestosis has the following directions:

• Creating a calm atmosphere around the pregnant woman.

Emotional turmoil should be completely excluded. Loud noise, light and excessive exercise can worsen the condition. For mild cases, it is recommended to use valerian or motherwort preparations. If a more severe form occurs, the gynecologist selects the drug based on individual characteristics every patient.

• Improving blood circulation of the placenta and fetus.

Sedatives, hypotensives, diuretics and antispasmodics prevent the development of hypoxia in the child. If this occurs against the background of existing somatic diseases, then they are treated.

• Preparing a pregnant woman for premature birth.

In severe cases, delivery should occur no later than three days after the deterioration. Can be used as natural childbirth, so C-section. The decision is made by an obstetrician-gynecologist based on test results and assessment of the patient’s condition. When choosing the first option, it is necessary to use epidural anesthesia, which allows you to normalize blood circulation in the placenta and kidneys. If eclampsia has already begun, an emergency caesarean section is recommended. In mild cases, corrective therapy is prescribed, and premature birth is not necessary.

With moderate and severe severity of gestosis, the pregnant woman is placed in the antenatal department or pregnancy pathology department. In particularly difficult cases, hospitalization in intensive care is possible.

The following diagnostic procedures are carried out in the hospital:

• Urine examination, including Zimnitsky test;
• Fetal condition examination;
• Study of blood parameters.

Since swelling of the extremities during gestosis is an excessive accumulation of fluid in the space between the tissues, their treatment consists of removing it. Infusion solutions are used for these purposes. With everything medications are selected individually.

Treatment may last several weeks. Its main goal is to stabilize the condition and carry the child to term. due date. In severe conditions, the only treatment is an emergency caesarean section.

Prevention of gestosis during pregnancy should be mandatory. Self-monitoring of your health is the basis of the entire pregnancy.

What should not be allowed:

• Obesity.

Compliance during pregnancy is very important. Proper nutrition, including the supply of all necessary vitamins and microelements. The diet must include milk and its products, lean meat and fish, and eggs. It is necessary to eat foods high in protein, as this is the main building element.

• Limit your intake of vitamins and fiber.

Vegetables and fruits should form the basis of the diet. Fiber is beneficial for the body because it improves intestinal motility, which is sometimes not so effective during pregnancy. It also satisfies the feeling of hunger well.

• A large number of flour products and sweets.

Apart from increasing the level of carbohydrates in the blood and storing fat, they do nothing. It is better to replace them with more complex products, such as cereals and whole grain bars.

• Violation of the drinking regime.

The average volume of fluid per day should be at least 1 liter. This figure includes fruit juices, teas, soups. Avoid increased consumption of salt and salty foods.

Good effect on pregnancy physical activity. Yoga, swimming pool, Pilates have a positive effect on vitality. In addition, trained muscles will endure the birth process much easier. But don't overuse it. For any state changes, all loads are canceled.

Preeclampsia in pregnant girls and women is a fairly common disease. Preventing it is much easier than treating it. Monitoring your condition and visiting a doctor will prevent complications from developing.

It disrupts the functioning of a number of systems and organs in the body of a pregnant woman. This condition disappears a few days after the birth of the child. According to research by specialists, gestosis to one degree or another is typical for a third of pregnant women. The disease often manifests itself between the sixteenth and twentieth weeks of pregnancy, but the third trimester of pregnancy is most typical for the occurrence of gestosis. The reason for the manifestation of this pathology is characteristic changes in the body of the expectant mother, due to which substances are formed in the placenta that make microscopic holes in the vessels. It is through these holes that protein and fluid enter the tissue from the blood. It promotes education swelling . At the very beginning of the disease, edema cannot yet be seen, but when weighed, a significant increase in weight is already observed.

Similar microperiods also form in the vessels of the kidneys, through which protein enters the urine. A general urine test, which a pregnant woman should undergo regularly, facilitates diagnosis and makes it possible to begin treating gestosis immediately after the onset of the disease.

Types of gestosis

It is customary to distinguish several types of gestosis in pregnant women. Early gestosis , which occurs in the first half of pregnancy, is manifested by nausea, vomiting, often uncontrollable. The woman has heavy salivation.Late gestosis appears on later pregnancy (third trimester). This condition is characterized by symptoms nephropathy , dropsy , preeclampsia , eclampsia . Rare forms of gestosis are also diagnosed, which manifest themselves liver diseases , skin , nervous system etc. It is also customary to highlight “pure” gestosis , which occur in a healthy pregnant woman in the absence of underlying diseases. "Combined" gestosis manifest themselves as a result of a disease that preceded this pathology. It could be , endocrinopathy , .

Causes of gestosis

To date, there is no single exact opinion about the origin of gestosis. However, there are a number of theories that suggest a certain etiology of gestosis. Yes, according to cortico-visceral theory Pregnancy gestosis is presented as a specific pregnancy, which is characterized by a violation of the interaction between the cortex and subcortical structures. As a result, reflex changes appear in hemodynamics. This theory is confirmed by the fairly frequent manifestation of gestosis as a consequence of nervous stress.

According to immunological theory gestosis occurs due to changes in the mechanisms that are responsible for ensuring transplacental immunity in the body. By genetic theory , those women whose mothers had preeclampsia are predisposed to gestosis.

Another theory indicates the relationship between gestosis and deficiency in a woman’s body B vitamins And . It is in the third trimester of pregnancy that the body requires significantly more of the mentioned vitamins. If their intake into the body is insufficient, the concentration in the blood becomes higher. Homocysteine ​​is a very toxic substance for the endothelium. Under the influence of this substance, pores appear in the vessels through which the plasma passes into the tissue. The consequence is swelling, increased pressure in blood vessels and decreased blood pressure.

According to placental theory in patients with gestosis, trophoblast migration is disrupted, resulting in spasm , decreased intervillous blood flow , . Further, due to hypoxia, the endothelium is affected, hemodynamic disturbances occur, hormonal background, metabolism .

Symptoms of gestosis

With gestosis, changes occur in many organs: the functioning of the kidneys and liver, placenta, and nervous system is disrupted. May occur hypoxia chronic, fetal growth restriction syndromeA .

At early gestosis() Pregnant women usually experience vomiting, which can occur many times a day. There is constant nausea, decreased energy levels, and a desire to eat spicy and salty foods. Constant vomiting does not greatly affect the weight of a pregnant woman: it does not decrease noticeably. The temperature remains normal. The remaining symptoms described are typical only for the first months of pregnancy; later they disappear on their own. In more rare cases, a woman’s vomiting does not stop later, and she becomes indomitable. In this condition, vomiting can occur up to twenty times a day, and this occurs at any time of the day. The patient loses weight sharply and develops a persistent aversion to food. The pulse becomes more frequent, blood pressure decreases. In this case, tests indicate the presence in the urine acetone And squirrel . In especially severe cases, body temperature may rise and and a state of delirium.

With late gestosis, the disease develops in stages. First there is dropsy , over time passing into nephropathy , later - in preeclampsia And eclampsia . When dropsy occurs in pregnant women, swelling occurs due to constant fluid retention in the body. During this period, both hidden and obvious swelling may appear. Due to lower urine output from the body, a pregnant woman’s body weight increases very quickly, and urination is more intense at night. Swelling, as a rule, initially appears in the ankle area, then it begins to spread upward. Sometimes a woman experiences simultaneous swelling of the face. At the end of the day, the legs and lower abdomen look more swollen.

With nephropathy, a woman already has three main symptoms of gestosis: severe swelling, the presence of protein in the urine, and periodically manifested high blood pressure. A combination of any two symptoms may occur. Nephropathy manifests itself against the background of dropsy. In this condition, a high level of diastolic pressure, which affects the decrease in placental blood flow. Accordingly, the fetus receives less oxygen. Later, nephropathy can develop into eclampsia, which is a very dangerous condition for a pregnant woman. With preeclampsia, microcirculation in the central nervous system is disrupted. In addition to the three main symptoms of gestosis, this condition may include a feeling of heaviness in the back of the head, stomach pain, headaches, vomiting, and nausea. A woman’s vision and memory may deteriorate and her sleep may be disrupted. Due to impaired blood flow in the occipital part of the cerebral cortex, there may be a “veil” before the eyes or the flickering of “sparks” may be observed. Signs of preeclampsia include high systolic Blood pressure (from 160 mm Hg) and diastolic blood pressure (from 110 mm Hg). Urine excretion is significantly reduced, the number of platelets in the blood decreases, blood clotting decreases, and liver function is disrupted.

With eclampsia, the most severe stage of gestosis, seizures are observed, while all functions of systems and organs are disrupted. Convulsions, which are provoked by pain, bright light, sharp sounds, etc., last several minutes. After the attack, the woman loses consciousness. Also, after such seizures, deep seizures may develop. This may provoke placental abruption , fetal hypoxia And premature birth . This condition threatens the life of the fetus.

It is important to take into account that with gestosis, a woman can feel quite well for a certain period of time, complaining only of slight swelling and noticeable weight gain. However, edema is characteristic not only of the extremities, but also of the placenta, which leads to insufficient oxygen supply to the fetus. Therefore, the symptoms described are a reason to immediately visit a doctor.

Diagnosis of gestosis

The reason for assuming such a diagnosis is the presence of the described symptoms in a pregnant woman. The doctor conducts regular examinations and weighs the patient to exclude the presence of edema. Diagnosis of gestosis is carried out taking into account the results general analyzes urine and blood. Constant measurement of blood pressure allows you to determine the presence of problems in this area. Also, to make a correct diagnosis, it is determined daily diuresis , for which it is necessary to find out the ratio of the liquid that was drunk and the one that is released. As a rule, the diagnosis of “preeclampsia” is made in the presence of three symptoms: swelling , protein in urine And high blood pressure .

If a woman does not have visible swelling, but the weight is gaining too quickly, then the doctor may perform McClure-Aldrich test . To do this, a saline solution is injected under the skin and it is determined how long it will take for the papule to resolve. If this happens faster than thirty-five minutes, there is hidden swelling in the body.

Treatment of gestosis

If a specialist determines only minor swelling of the legs in a pregnant woman, then treatment can be carried out on an outpatient basis. If there is significant edema and protein in the urine, hospitalization and inpatient treatment are necessary. With severe gestosis, there is a threat to the life of the mother and fetus. Therefore, treatment is carried out in the intensive care unit or intensive care unit.

Before prescribing treatment, a mandatory examination of women is carried out in the hospital, including blood and urine tests, examination of the condition of the fetus by Ultrasound , cardiotocography And dopplerometry .

In the treatment process, infusion therapy is used to restore required quantity fluid in the vascular bed and removal of fluid from body tissues. It is also important to replace lost protein. In the presence of high blood pressure, it is used sexually transmitted infections. To prevent the development of gestosis, it is extremely important for pregnant women to constantly monitor their own weight. To do this, you should not overeat, you should eat food that has a high protein content, and significantly limit sweets and starchy foods in the menu. It is very important to consume a sufficient amount of fiber, which is found in vegetables, bran, fruits, and herbs. Women who notice that they have gained significant weight should limit their intake of spicy, salty and liquid foods. So, you should drink no more than 1-1.5 liters per day. An important factor Prevention of gestosis is full sleep (at least eight hours a day), a positive emotional background.

Another method of preventing gestosis is considered to be active image life. Pregnant women are recommended to take daily walks, swimming, yoga, and perform specially designed exercises for a certain period.

(late toxicosis of pregnancy, PTH) - pathological conditions of the second half of pregnancy, characterized by a triad of main symptoms: edema (latent and visible), proteinuria (the presence of protein in the urine), hypertension (persistent increase in blood pressure). Accompanied by disorders of the functions of vital systems: cardiovascular, nervous, endocrine, hemostasis. According to the severity of the disorders, pretoxicosis, hydrops of pregnancy, nephropathy of pregnancy, preeclampsia and eclampsia are distinguished. May cause maternal and child mortality.

General information

Preeclampsia or late toxicosis of pregnant women is a complicated course of the third trimester of pregnancy, characterized by the development of deep disorders in vital organs and systems, especially in the vascular bed and blood circulation. Preeclampsia begins to develop after 18-20 weeks of pregnancy, and is most often detected after 26-28 weeks. Preeclampsia accompanies 20-30% of pregnancies and is one of the most common reasons complicated births (in 13-16% of cases), including maternal mortality and fetal death. According to the clinical forms of gestosis, dropsy, nephropathy, preeclampsia and eclampsia of pregnant women are distinguished. Clinical forms of gestosis can also be successive stages of a single pathological process, starting with edema during hydrops of pregnancy and gradually developing into the most severe form - eclampsia.

Late toxicosis of pregnant women is divided into pure and combined gestosis. Pure gestosis develops during pregnancy in women who do not suffer from concomitant diseases, and combined gestosis develops in women with a history of various diseases. An unfavorable course of gestosis is observed in pregnant women suffering from hypertension, renal pathology (pyelonephritis, glomerulonephritis), diseases of the biliary tract and liver (dyskenesia, previous hepatitis), endocrine glands (adrenal glands, thyroid, pancreas), lipid metabolism disorders.

Causes of gestosis

Complications of gestosis

The development of complications of gestosis is always associated with the death of the pregnant woman and the fetus. The course of gestosis can be complicated by the development of renal and heart failure, pulmonary edema, hemorrhages in the liver, adrenal glands, kidneys, intestines, spleen, and pancreas.

Characteristic complications of gestosis are premature detachment of a normally located placenta, placental insufficiency, leading to developmental delay, hypoxia and malnutrition of the fetus. In severe cases of gestosis, HELLP syndrome may develop, the name of which is an abbreviation of the symptoms: H - hemolysis, EL - increased levels of liver enzymes, LP - decreased platelet levels.

Treatment of gestosis

The basic principles of treatment of emerging gestosis are: hospitalization and compliance with medical and protective measures, elimination of disturbances in the functioning of vital organs and systems, careful and quick delivery. Outpatient treatment of gestosis is allowed only for stage I dropsy. Pregnant women with severe gestosis (nephropathy, preeclampsia, eclampsia) are hospitalized in hospitals with an intensive care unit and a department for premature babies. In especially severe cases of gestosis, early termination of pregnancy is indicated.

Therapeutic measures for gestosis are aimed at the prevention and treatment of complicated pregnancy and intrauterine fetal disorders (hypoxia, malnutrition and developmental delay) by normalizing:

• activity of the central nervous system;
• circulation, coagulability, blood viscosity;
• metabolic processes;
• condition of the vascular wall;
• blood pressure indicators;
• water-salt metabolism.

The duration of treatment for gestosis depends on the severity of its manifestations. For mild nephropathy, hospitalization is carried out for at least 2 weeks, with medium degree– for 2-4 weeks, taking into account the condition of the fetus and the pregnant woman, followed by discharge for observation in the antenatal clinic. Severe forms of gestosis (nephropathy, preeclampsia and eclampsia) are treated in a hospital under the supervision of resuscitators until delivery.

Early delivery for gestosis is indicated for persistent nephropathy of moderate severity, if the effect of treatment is absent within 7-10 days; severe forms of gestosis in cases of failure of intensive therapy measures for 2-3 hours; nephropathy, accompanied by delayed development and growth of the fetus during treatment; eclampsia and its complications.

Independent childbirth during gestosis in pregnant women is allowed if the condition of the mother in labor is satisfactory, the therapy is effective, and there are no intrauterine disorders of fetal development according to the results of cardiac monitoring and ultrasound examinations. Negative dynamics in the condition of a pregnant woman with gestosis (increased blood pressure, the presence of brain symptoms, increased fetal hypoxia) serves as an indication for surgical delivery.

Prevention of gestosis

Factors predisposing to the development of gestosis are: hereditary predisposition, chronic pathology internal organs in a pregnant woman (kidneys, heart, liver, blood vessels), Rh conflict, multiple pregnancy, large fetus, pregnancy in a woman over 35 years old. Prevention of gestosis in women with risk factors should be carried out from the beginning of the second trimester of pregnancy.

In order to prevent the development of gestosis in pregnant women, it is recommended to organize a rational regimen of rest, nutrition, motor activity, stay on fresh air. Even with normal development Pregnancy requires restriction of fluid and salt intake, especially in the second half. An important component of the prevention of gestosis is pregnancy management throughout the entire period: early registration, regular visits, monitoring body weight, blood pressure, laboratory research urine, etc. Prescription of drug prophylaxis for gestosis depends on concomitant diseases and is carried out according to individual indications.

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 pathological condition, which develops in pregnant women in the later stages of 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 of 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.
• Change in functional status of cardio-vascular system, it is accompanied by an increase in systemic blood pressure, an increase in heart contractions, and 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 in the functional activity of the 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's 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 seek medical help until the development of seizures, 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 possible violation 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, in 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. 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 tissue edema of 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.

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

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

The prevalence reaches 30%; the situation is further complicated by the fact that gestosis in the first half of pregnancy is very difficult to detect in the initial stages of development. For example, late toxicosis, which began at 20 weeks, is detected only by 27–28 weeks.

What is the danger of gestosis?

Until now, despite the development of medicine, gestosis remains one of the main causes of maternal and infant mortality in the prenatal and postpartum period. It does not kill instantly, but contributes to the rapid decline of the body over several days.

The patient may lose vision, the ability to move independently, and one by one important organs stop functioning: liver, kidneys, heart, brain. The more serious the stage of gestosis, the less chance doctors have to save the patient and (or) her child.

Only close attention to the deterioration of your health and timely examination will help identify late toxicosis in early stages its development and avoid mortal risk.

Causes of gestosis

Scientists have not yet reliably determined what exactly causes the development of late toxicosis. There are only some assumptions about this:

• Pathological changes in the central nervous system. The relationship between the cerebral cortex and subcortical structures is disrupted, which leads to pathology. The trigger is the psychological stress that a woman may have been exposed to while carrying a child.
• Immune disorders, in particular, failures in the recognition of maternal tissue and fetal tissue. This process involves special T cells, which are regulators of the immune response.
• Crashes in endocrine system. Pregnancy involves dramatic changes in hormonal status, which can result in disruptions in the functioning of a woman’s entire body.
• Lack of folic acid. This provokes an increase in the level of non-proteinogenic amino acids, which are extremely toxic to the body.

Preeclampsia, a complication of pregnancy, involves spasm of all blood vessels - this is what causes the failure of vital organs.

Symptoms of gestosis during pregnancy by stage

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

Dropsy

Not characterized enough good hatching fluids from the body resulting in swelling. This stage is divided into 4 stages, which are characterized by the ascending direction of localization of edema:

1. The feet swell, and there is slight swelling of the legs.
2. The legs swell completely, the lower third of the abdomen swells.
3. The swelling rises higher and affects the face, in addition to the legs and body.
4. Edema affects the entire body and is observed in internal organs.

Characteristic signs of edema

• When you press your finger on the surface of the skin, a dent remains. The longer it takes to disappear, the more severe the swelling becomes.
• There is tingling and numbness in the swollen limb.
• Severe swelling causes a feeling of fatigue in a pregnant woman.

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

Nephropathy

If, when swelling appears, no therapeutic measures was not accepted, then the disease progresses and enters the stage of nephropathy. In addition to fluid retention, hypertension appears in the body, and urine tests indicate an increase in protein.

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

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

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

Preeclampsia

In some cases, stage III nephropathy, despite treatment, develops into preeclampsia. The main difference between this condition and nephropathy is that the pregnant woman has a circulatory disorder in the brain.

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

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

If a woman in this condition finds herself without medical care, then she will die. Preeclampsia involves placing the patient in an intensive care unit, since her well-being must be monitored around the clock.

Eclampsia

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

Eclampsia involves worsening the manifestations of nephropathy and a rather weak response of the body to the measures taken to save the patient’s life.

Characteristic signs of eclampsia

• Loss of consciousness
• Tonic convulsions
• Clonus
• Severe weakness
• Strong headache
• Extensive swelling of internal organs (most often the brain)
• Blood pressure above 170/110

Eclampsia does not occur suddenly, so if you respond promptly to worsening health and test results, you can successfully prevent this condition.

Treatment of gestosis by stages - drugs, regimens

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

Treatment of stage I of gestosis (edema)

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

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

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

Except natural remedies Your doctor may prescribe diuretics:

• Canephron is available in the form of drops, as well as in the form of dragees. Dilates renal vessels, prevents excess fluid absorption. Reduces protein excretion in urine.
• Cyston - increases blood supply to the epithelial tissue of the urinary system, has an antibacterial and diuretic effect. Available in tablet form.
• Phytolysin – promotes relaxation of smooth muscles, has an anti-inflammatory and diuretic effect. It is produced in the form of a special paste from which a suspension must be made.

In case of severe edema, hospitalization and treatment in a hospital setting are indicated for a pregnant woman.

Treatment of stage II gestosis (nephropathy)

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

Since the pressure surge can occur repeatedly and within short term, the pregnant woman should be admitted to the hospital to monitor her blood pressure around the clock, as well as monitor her kidney function. To stabilize the condition, the following will be prescribed:

• Complete peace. Physical effort provokes a rise in blood pressure, so the woman needs to remain in bed for several days.
• Taking sedatives. They help lower blood pressure, however, during pregnancy, some of them can have an abortifacient effect, so you should not choose a sedative yourself.
• A diet whose goal is to reduce salt and fluid intake, as well as normalize the ratio of proteins, fats and carbohydrates in the diet.
• Taking antispasmodics. Since late toxicosis is based on vasospasm, it is important to prevent it. IN otherwise the symptoms of placental gestosis will worsen. During pregnancy, drugs such as No-shpa and papaverine are allowed.
• Taking protein drugs. Nephropathy involves increased leaching of protein from the body, so the doctor’s task is to increase its levels.

Comprehensive timely treatment of gestosis during pregnancy at the stage of nephropathy, in most cases, gives a positive effect and stops further progression of late toxicosis.

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

Both of these diseases involve serious dysfunction of the kidneys, liver, heart, brain, as well as large blood vessels of the placenta, so this stage of gestosis most often has consequences for the child.

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

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

• Intravenous drip administration of magnesium, rheopolyglucin, glucose and diuretics, which should relieve the woman of edema.
• Complete rest and strict bed rest. As a rule, with eclampsia the patient feels so weak that she is unable to get out of bed on her own.
• Administration of anticonvulsants if the patient experiences tonic seizures.
• Hourly monitoring of protein levels in urine. Since the woman is not able to take the test herself, a catheter is inserted into the urethra.
• Connection to the artificial lung ventilation system.
• Taking strong sedatives to normalize blood pressure and prevent new seizures.

Emergency delivery should be carried out only when convulsive contractions have been stopped and relative stabilization of blood pressure has been achieved.

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

• Most the right way protect yourself from preeclampsia and eclampsia - timely treatment for early stages gestosis.