Preeclampsia during pregnancy is a complication in which the functioning of physiological systems and organs is disrupted, and pathological condition disappears after delivery. According to studies, it is formed in the third trimester of pregnancy, but can occur earlier, from 4 to 20 weeks.
Preeclampsia, what is it and how does it manifest?
Preeclampsia has three characteristic symptoms, which are not difficult to make a primary diagnosis:
- . Hidden and obvious, noticeable on the limbs and face.
- Proteinuria. In urine analysis, the protein content is increased.
- Hypertension. Increased blood pressure.
The pathology negatively affects the functioning of the cardiovascular, nervous and endocrine systems, and changes in blood composition occur. Preeclampsia develops after the 18th week and manifests itself by the end of the 27th week.
About a third of pregnant women experience manifestations of this complication. In some cases, it causes the death of the mother or baby.
Clinical manifestations are often consistent, so early gestosis occurs in the first half of pregnancy. The patient notes constant nausea, vomiting, and increased salivation (not to be confused with “normal”).
At a later stage, nephropathy, hydrops of pregnancy, preeclampsia and eclampsia appear. In the presence of a diseased liver, skin and nervous diseases, rare forms of pathology are formed.
Preeclampsia of the combined form appears with hypertension, endocrinopathy, biliary tract and kidney disease, and impaired lipid metabolism in the body.
Reasons for the formation of gestosis
There is not yet a unified theory about what contributes to gestosis during pregnancy, but some theories of the etiology of the disease have been proposed.
The cortico-visceral theory suggests the formation of neurosis in pregnant women, when there is a failure in the interaction between the cortex and the subcortical structure of the brain, leading to reflex changes. In practice, this theory is often confirmed; gestosis occurs as a consequence of nervous tension.
According to the immunological theory, with gestosis there is improper hormonal control of body functions. The immunological conflict between the fetus and mother is considered as the main cause. At the same time, vasospasm increases blood pressure and reduces the amount of blood necessary for the nutrition and functioning of cells.
Genetic theory suggests that women whose mothers suffered from preeclampsia are susceptible to complications. Lack of B vitamins and folic acid increases the content of homocysteine - an amino acid that enhances thrombus formation. From its influence, microholes are formed in the vessels, through which plasma protein and liquid fall into the tissue.
Preeclampsia during pregnancy leads to swelling, the signs of which are not visible at the onset of the disease, but weight increases significantly. Plasma penetrates and stagnates in the tissues, resulting in swelling, increased blood pressure and decreased frequency of urination.
Similar microholes appear in the vascular walls of the kidneys, through which protein penetrates into the urine. Prescribed regularly for pregnant women general analysis urine. This helps in accurate diagnosis and allows treatment to begin immediately after pathology is detected.
When the inner lining of the vessel - the endothelium - is damaged, its permeability increases, which promotes the effusion of fluid into the body tissue. This changes the density of the blood, its thickness and coagulability. The risk of blood clots increases.
Preeclampsia is dangerous due to disorders in the brain. Blood clots and minor hemorrhages form, intracranial pressure increases and nervous tissue degeneration occurs.
The appearance of gestosis in the early stages is difficult to notice; the condition is easily confused and mistaken for a mild ailment in pregnant women. Blood pressure increases slightly, causing headache, weakness, nausea and fatigue.
- , the higher its content, the worse the manifestation of pathology.
- Blood pressure exceeds 140/90 mmHg. Art.
- Edema - when protein is detected in the urine, they indicate gestosis.
The disease affects most organs: kidneys and liver, heart, placenta and nervous system. The formation of constant hypoxia is possible, which leads to intrauterine growth retardation.
IN initial stage gestosis (toxicosis) in women vomits up to several times a day. There is constant nausea, loss of appetite, desire to eat spicy and salty foods. Bouts of vomiting do not affect weight. Temperature is within normal limits. These symptoms appear in the first months of pregnancy and then disappear on their own.
Rarely, vomiting may stop, and then becomes uncontrollable (more than 20 times per day). The patient is weakened, has an aversion to food, the pulse is thready, and the blood pressure drops. Acetone and protein are found in the urine. In serious cases, the temperature rises sharply and arrhythmia is possible.
At the end of pregnancy, gestosis develops gradually. Initially, dropsy forms, over time nephropathy develops, then severe forms: preeclampsia, eclampsia. In cases of dropsy, women experience swelling due to fluid retention. At this time, hidden and visible swelling occurs. Given the slowdown in diuresis, body weight increases very quickly.
The tumor is noticeable in the ankle joint, then spreads higher. Swelling of the face is noticeable. By evening, the limbs and lower abdomen swell.
Three symptoms of gestosis with nephropathy:
- edema;
- protein in urine;
- hypertension.
A woman may have a combination of any symptoms. Nephropathy occurs simultaneously with dropsy. Increased diastolic pressure is dangerous because it reduces placental blood flow. The fetus does not receive enough oxygen. Later, nephropathy can develop into a serious complication - eclampsia.
With preeclampsia, the central nervous system is affected. In addition to the three main symptoms of gestosis, there is heaviness in the back of the head, pain in the abdomen, head pain, nausea, and vomiting. A pregnant woman experiences visual impairment (flickering of spots), memory, and insomnia.
Symptoms of preeclampsia:
- pressure is more than 160/110 mm Hg. Art.;
- decreased urine output (< 500 мл), свертываемость крови хуже из-за снижения тромбоцитов, заметно нарушение функционирования печени.
Eclampsia is the worst phase of gestosis. The woman may experience attacks of painful cramps. Light and any sharp sounds are irritating; this lasts for several minutes, after which loss of consciousness is possible. There is a danger of developing a deep coma - this threatens placental abruption, bleeding, fetal hypoxia and premature birth. The life of the fetus is in danger.
It should be noted that with gestosis, the pregnant woman feels well for some time, complaining only of minor swelling and weight gain. However, edema does not only form in the extremities. The placenta suffers from it - this impairs the supply of oxygen to the fetus.
Preeclampsia during pregnancy is a serious condition; the first symptoms are the reason for an immediate visit to the doctor.
Diagnostics
Laboratory tests and the patient’s complaints help determine the condition of the pregnant woman. For diagnosis the following is carried out:
- coagulogram, which determines blood clotting time;
- blood test (biochemistry and general);
- changes in body weight;
- urine analysis (biochemistry and general);
- fundus examination;
- blood pressure dynamics;
- the volume of fluid excreted taking into account its consumption;
To determine the condition of the fetus, ultrasound and Doppler ultrasound are prescribed. To clarify the diagnosis, consultations with a nephrologist, therapist, ophthalmologist and neurologist are carried out.
It is advisable to hospitalize a patient at any stage of pregnancy. This is necessary to preserve the functions of the body systems and successful childbirth.
Outpatient observation is allowed only for stage 1 dropsy. In case of development of nephropathy, preeclampsia and eclampsia, hospitalization is required. Termination of pregnancy is carried out early for health reasons.
Therapy is aimed at preventing the development of complications and the formation of intrauterine disorders in the fetus.
To do this, normalize the work:
- nervous system;
- determine the condition of the vascular wall;
- improve blood circulation;
- normalize water-salt metabolism;
- reduce viscosity and increase blood clotting;
- regularly monitor blood pressure dynamics;
- normalizes metabolic processes in the body.
The duration of treatment directly depends on the severity of gestosis. A mild form will require a two-week hospital stay, while a moderate form will require a long stay. In difficult cases, the pregnant woman will have to remain under daily supervision until delivery.
Premature births are carried out, if observed:
- Lack of positive dynamics from therapy for persistent nephropathy (moderate severity).
- If the expected effect is not observed during resuscitation in the first 2 hours.
- Disturbances in the development and growth of the fetus (with nephropathy).
- Eclampsia, risk of complications.
Preeclampsia in the second half of pregnancy requires constant medical supervision. Unattended childbirth is allowed only if the woman’s condition is satisfactory, there are no abnormalities in the fetus and if the results of therapy are positive. In all other cases it is prescribed C-section.
Consequences of gestosis
A pregnant woman is at risk of deteriorating kidney and heart function, and pulmonary edema cannot be ruled out. Hemorrhages in internal organs are possible.
Preeclampsia is dangerous due to placental abruption during pregnancy, lack of oxygen and nutrients to the developing fetus. This threatens developmental delays and dangerous fetal hypoxia.
Prevention of gestosis during pregnancy
If a woman has a disease internal organs, begin preventive measures from the second trimester of pregnancy.
The importance needs to be explained:
- proper rest and sleep;
- balanced diet;
- physical activity;
- daily walks;
- restriction of salt and sometimes fluid.
Women with predisposing factors are required to register with the antenatal clinic at an early stage of pregnancy and follow the doctor's instructions. Be sure to undergo all laboratory tests to monitor your condition. Medicines are prescribed only in the presence of concomitant diseases and individual indicators.
You can plan your next pregnancy after gestosis at any stage, as soon as the woman feels strong and capable. It is impossible to predict how pregnancy will develop. It is worth considering previous experience, assessing risk factors and finding a gynecologist you can trust.
Preeclampsia during pregnancy in the early and late stages is a serious complication. In some cases, delay in diagnosis and treatment threatens the death of mother and child. For this reason, the information from this article will be useful not only to women who have already encountered this diagnosis, but also to other expectant mothers.
What is late gestosis and why is it dangerous? This complication is typical for the second half of pregnancy, most often occurs after the 30th week, and is characterized by disruption of the functioning of various maternal organs, fetoplacental insufficiency, delayed fetal development and hypoxia.
Despite the name, which often includes the word “toxicosis,” the mechanism of occurrence of this pathology and the risk factors are different. Moreover, late toxicosis that occurs during pregnancy is much more dangerous than early toxicosis. The second, worst thing, can lead to dehydration and loss of pregnancy. And the first, the late one, in severe cases provokes severe seizures in a woman, which often end in strokes, cerebrovascular accident, and coma.
Causes of gestosis (late toxicosis)
The main cause of this pathology is pregnancy itself, the fetus, or rather the placenta. In some women, for reasons unknown to science, early stages pregnancy, there are disturbances in the formation of the placenta, those vessels that connect it to the uterus. And the longer the pregnancy, the more obvious the disorders that arise as a result become. The child is developmentally delayed, has low weight, and CTG reveals a lack of oxygen. The woman develops signs of arterial hypertension (increased blood pressure) and kidney problems.
There is more than one theory of the occurrence of gestosis. It is often associated with a deficiency of folic acid (vitamin B9), endocrine pathologies (thyroid diseases, diabetes), a weak nervous system, and exposure to stress. Some honey The authors generally recommend considering early and late gestosis as a kind of neurosis of pregnant women. That is why it is recommended to prevent it with mild sedatives.
The cause of early gestosis, when it begins to develop at 13-15 weeks, is often a woman’s tendency to thrombosis due to genetic abnormalities - thrombophilia. This is one of the potential risks of developing late toxicosis.
In addition, the following definitely play a negative role:
- heredity (if a grandmother or mother had late gestosis in pregnancy, then their daughters and granddaughters will certainly have them);
- the age of the expectant mother (more often the pathology occurs in pregnant women under 20 years old and over 35 years old);
- diseases of the kidneys, heart, blood vessels, especially complicated during pregnancy;
- high blood pressure.
Signs of gestosis in later stages
Often the first “swallow” is a delay in fetal development. At the second, and more often the third screening (ultrasound), the doctor notes that the size of the fetus does not correspond to the gestational age, it is smaller than average. Problems with the placenta can be determined, for example, its premature maturation, as well as impaired blood circulation in the vessels of the placenta (using Doppler ultrasound).
In general, the diagnosis of gestosis during pregnancy is carried out by a gynecologist managing the pregnancy, based on the following symptoms.
1. Edema. Can be obvious or hidden. Common ones first appear on the ankles and fingers. However, such swelling may not be a symptom of late gestosis, but a variant of the norm. Especially if the swelling is only in the legs, and they appear in the afternoon.
It’s bad if swelling spreads to the whole body and face. And especially if they are present in the morning, after a night’s sleep.
Preeclampsia in pregnant women is a condition of malfunction of some vital organs, which manifests itself mainly late in the 2nd-3rd trimester. What to do when it appears, causes, symptoms and preventive measures will be discussed in the article.
What is gestosis
Gestosis during pregnancy corresponds to a number of manifestations, knowing which, you can initially diagnose the disorder:
- The presence of subtle and noticeable swelling in the arms, legs, and face
- Increased levels of protein compounds in the urine, called proteinuria
- Increase in blood pressure (hypertension)
The development of gestosis negatively affects the functioning of the heart, blood vessels, thyroid gland, and central nervous system. As a result, the composition of the blood even changes. The usual timing of the disease is 18-27 weeks, which is late.
Pregnancy with gestosis occurs in almost 30% of women. Sometimes it leads to the death of a newborn or expectant mother, so the disease must be taken seriously.
In order to identify gestosis in time, it is necessary to monitor its characteristic manifestations, which appear sequentially during the first half of gestation. During this period, the expectant mother constantly experiences nausea, vomiting, and increased salivation. It is important to understand the extent of these symptoms, as the signs “ normal toxicosis"are normal for a pregnant woman.
At a later stage, manifestations are supplemented by nephropathy (renal damage), dropsy, preeclampsia and eclampsia. The last two points are severe forms of toxicosis. The presence of such internal disorders is reflected externally - the skin suffers, and in addition, deviations appear due to the nervous system.
Combined gestosis call the situation of manifestation of signs of hypertension, deviations in endocrine system, dysfunction of bile excretion and urine excretion. After childbirth, gestosis completely disappears.
Causes of gestosis
The disease has not yet been fully studied; the exact reasons why gestosis occurs in the early and late stages of pregnancy have not been identified. However, there are a number of hypotheses that help to understand it and how unpleasant sensations and fatal consequences can be avoided.
The first hypothesis is called Cortico-visceral. She claims that due to the incomplete relationship between the cortex and subcortical tissues in the brain, a pregnant woman develops a neurosis that affects some reflex functions. Many practical studies confirm this point of view, since the appearance of gestosis often correlates with severe nervous strain.
The second point of view is called immunological. Judging by it, the strong hormonal shocks experienced by a woman during pregnancy lead to the emergence of an immunological conflict between the organisms of the fetus and mother. Because of this, the blood vessels are partially subject to spasms, which leads to an increase in blood pressure above normal and reduces the ability to supply the body’s cells with blood.
A third look examines gestosis with genetic point of view. Based on this, the complication more often appears in expectant mothers who have a mother who suffered from preeclampsia. This disorder leads to a lack of vitamin B and other microelements, which results in increased blood clot formation.
As a result, vascular microholes are formed, through which plasma protein compounds enter the blood. The endothelium, the inner lining of the vascular wall, becomes permeable, causing fluid to leak into the tissue structures. This leads to thickening of the blood, which increases clotting due to excessive thrombus formation.
The plasma that has penetrated into the vessels stagnates in them, forming edema, increasing blood pressure, and so on. At the initial stages of the development of gestosis, these symptoms are invisible, but over time, after the second trimester or earlier, they begin to appear.
The vascular walls of the kidneys also suffer from the formation of the microholes described above. Through them, the urine is saturated with protein, which can be detected by conducting an appropriate analysis. Moreover, one of the first signs is a slight decrease in the frequency of trips to the toilet by a pregnant woman.
With gestosis, brain dysfunction increases, since due to a blood clot and minor hemorrhages, growth and deficiency of nerve tissue is observed.
First signs
Preeclampsia in early development is hardly noticeable; its symptoms are very similar to ordinary ailments, which is not uncommon during pregnancy. It is possible to track the pathology by periodically checking the pressure (it increases slightly). Other signs include headaches in women, a state of weakness, and the urge to vomit.
Early gestosis in pregnant women has the following symptoms:
- A urine test reveals elevated protein levels. An increase in the indicator in the future means the progress of the disease.
- Increase in blood pressure above 140 to 90
- The first manifestations of edema
Symptoms of gestosis during pregnancy
At a later stage, the disease affects a significant part of the internal organs, as a result the picture of symptoms becomes clearer and more varied. Preeclampsia affects the kidneys, liver, cardiovascular and central nervous systems. Hypoxia often occurs, due to which the fetus does not develop fully under conditions of oxygen deficiency.
With gestosis (toxicosis), the first thing that occurs is vomiting, which occurs several times a day. Due to periodic nausea, there is no appetite, but there is a tendency to eat spicy and salty foods. Body weight does not change, temperature is normal. The existence of these symptoms is typical for the first months of pregnancy, after which they disappear.
However, sometimes vomiting occurs again, becoming continuous (15-20 times). After this, the patient becomes very weak, blood pressure drops below normal, and the veins become thread-like. Urinalysis shows high content acetone and protein. An increase in temperature and severe arrhythmia are often observed.
Photo. Symptoms of gestosis in pregnant women
In pregnant women at a late stage, in the 2nd and 3rd trimester, the development of gestosis is gradual. The disease begins with dropsy, progressing first to preeclampsia and then to eclampsia. Dropsy has symptoms of swelling due to the accumulation of fluid in the body. Edema can be hidden or visible. They are localized in the ankle area, moving upward. The face, lower abdomen, arms, and legs are susceptible to swelling. Body weight is growing at an accelerated pace.
Preeclampsia can lead to kidney nephropathy, the symptoms in this case are the same:
- Presence of edema
- Increased protein in urine
Some of the symptoms may be absent. Dropsy with nephropathy often complement each other, increasing symptoms. The whole situation threatens to insufficient oxygen supply to the fetus.
Eclampsia
This is the name of the most severe phase of gestosis. At this time, painful cramps and an acute reaction to bright light and loud sound are likely for 1-5 minutes. Further, the pregnant woman may lose consciousness, even to the point of coma. It is clear that this does not bode well. In extreme cases, the placenta detaches, internal bleeding and premature birth develop. During this period, the fetus is in a state of oxygen deficiency and is in serious danger.
The condition of eclampsia is preceded by preeclampsia when the above symptoms of gestosis are supplemented by heaviness in the back of the head, pain in the abdomen, blurred vision, an increase in blood pressure above 150/105, a decrease in the amount of urine excreted, and abnormalities in the functioning of the liver.
Preeclampsia during pregnancy is a dangerous condition, the first symptoms of which are few and in general the pregnant woman feels well. Increased swelling and increased pressure in the later stages should be alarming. If these signs appear, you should definitely visit a gynecologist.
Diagnostics
Diagnosis begins with a survey. If the doctor suspects gestosis, the diagnosis is refuted or confirmed:
- Coagulogram - testing blood for clotting
- Biochemical and general analysis of blood and urine
- Tracking changes in weight and volume of urine excreted, taking into account fluid intake
- Checking the condition of the fundus
- Measuring blood pressure in dynamics
To clarify the well-being of the embryo during pregnancy, ultrasound examination and Dopplerography are prescribed. It is possible to involve third-party doctors, including:
- Nephrologist
- Oculist
- Neurologist
Treatment of gestosis
Regardless of whether gestosis occurs early or late in pregnancy, the best treatment option is hospitalization. Only in this case there are high chances of preserving the functionality of the mother’s body and successful childbirth. Treatment at home is allowed only in the first stage of dropsy. Nephropathy and preeclampsia require mandatory hospitalization of the pregnant woman. Emergency termination of pregnancy is performed when the patient's life is in danger.
Treatment consists of determining the condition of the vessel walls, improving blood supply and circulation by reducing its viscosity, and normalizing water-salt metabolism. You should also monitor your blood pressure and respond with medication to its fluctuations in any direction. The result of treatment is consolidated by the general normalization of metabolic processes.
The duration of treatment depends on the depth of gestosis. For mild forms, 12-15 days of inpatient therapy are sufficient. With moderate severity, the hospital stay will be longer. Late gestosis of severe form requires daily treatment until the baby is born.
Early birth
Premature birth is indicated in the following situations:
- When the condition fails to improve despite therapy
- If in the case of resuscitation procedures after two hours there is no expected effect
- There are disturbances in the intrauterine formation of the fetus
- Increased likelihood of severe consequences
After pregnancy equator late gestosis needs constant monitoring. Independent birth is allowed only when the woman in labor is in normal condition, when there is no doubt that she has enough strength for this. Otherwise, a caesarean section is used to avoid the risk.
Consequences
If pregnant women are not treated, gestosis can lead to dysfunction of the kidneys and heart muscle. In addition, the lungs swell and internal hemorrhages occur.
The main danger to the fetus is placental abruption, which causes it to receive less nutrients and oxygen. Even with successful resolution of pregnancy, this results in delayed development.
Prevention
If a woman in labor has diseases of internal organs, in the second trimester and later, it is important for her to adhere to the following preventive measures:
- Get enough rest and sleep
- Eat a balanced diet
- Get minimal physical activity
- Take a walk every day
- Limit salt and liquid intake
If there are factors favorable to the disease, you should register with gynecology at an early stage and follow all the instructions of the gynecologist. In order not to miss the moment when the situation worsens, you will have to undergo tests periodically. Drugs are prescribed individually only for concomitant diseases.
Late toxicosis or gestosis is a complication of pregnancy, leading to disruption of vital organs and systems. Late toxicosis develops in the second half of pregnancy and progresses until childbirth.
The frequency of gestosis is 10-15% of the total number of pregnant women. Despite many years of research, the exact cause of the development of gestosis is still unknown. According to some researchers, gestosis develops due to a violation of hormonal regulation in vital organs. According to another version, gestosis occurs due to immunological incompatibility between mother and fetus.
Recently, the frequency of this pregnancy complication is increasing every year. Most obstetricians and gynecologists associate the increase in gestosis with an increase in the number of late births (after 35 years). Unfortunately, by this age, most women already have several chronic diseases, which significantly complicates the course of pregnancy and childbirth.
The main diseases that provoke the development of late toxicosis include:
high blood pressure, obesity, chronic pyelonephritis, diabetes mellitus, heart defects, vegetative-vascular dystonia.
Symptoms of gestosis
Signs of gestosis are varied. The first symptoms of late toxicosis expectant mother may notice at 28-29 weeks of pregnancy. How do they manifest themselves? First of all, this is swelling of the legs, hands, and face. This is the so-called “hydropsis of pregnant women” - the mildest manifestation of gestosis. If the swelling is not pronounced, then the woman may not notice it. In order to determine whether there is swelling or not, you should carefully monitor your weight gain. Normally, starting from the 28th week of pregnancy, a woman’s weight can increase by an average of 350-500 g per week. If weight gain exceeds 500 g per week, then this may indicate fluid retention in the body, which is a sign of dropsy.
A more severe manifestation of gestosis is nephropathy (damage to the parenchyma and glomerular apparatus of the kidneys), which is characterized by edema, increased blood pressure and the appearance of protein in the urine (“proteinuria”). The more protein in the urine, the worse the prognosis of gestosis. How to notice nephropathy? The main symptom indicating progressive nephropathy is a decrease in the amount of urine excreted. This is a rather dangerous sign that a woman should pay attention to first. Most often, a woman first develops edema, then her blood pressure rises, and only then does proteinuria appear.
Severe manifestations of gestosis include the development of preeclampsia and eclampsia. These are the last stages of gestosis. Without timely medical intervention, such conditions pose a threat to the life of the mother and fetus.
With preeclampsia, microcirculation in the central nervous system is disrupted. Clinically, preeclampsia, as well as nephropathy, manifests itself in the form of the main symptoms - high blood pressure, edema, protein in the urine. Only with the development of preeclampsia, signs of damage to the nervous system are added to these symptoms: headaches, blurred vision, a feeling of flickering "flies" or " “veils” before the eyes, nausea, vomiting.
If this process is not stopped in time, preeclampsia turns into eclampsia - the pregnant woman suddenly develops seizures with loss of consciousness, lasting 1-2 minutes. Eclamsia can be fatal.
Considering the potential danger of gestosis, with any, even the most minimal manifestations of the disease, a woman should immediately contact an obstetrician-gynecologist and tell in detail about her complaints.
Diagnosis of late gestosis
In order to reliably determine whether or not gestosis is present, one visit to the doctor is not enough. Dynamic observation by an obstetrician-gynecologist is necessary.
At every visit to the doctor, a pregnant woman must measure blood pressure (BP) in both arms, pulse and body weight. An increase in blood pressure above 135/85 may indicate gestosis. The doctor evaluates the pregnant woman’s weight gain, the presence or absence of edema, and asks the pregnant woman whether the amount of urine excreted has decreased.
Also, if gestosis is suspected, additional tests and studies are prescribed:
Clinical and biochemical blood test;
- general urine analysis;
- Fetal ultrasound with Doppler, CTG (cardiotocography) of the fetus.
If the obtained tests and examination data raise suspicions of gestosis (blood pressure above 135/85, severe edema and large weight gain, protein in the urine), the following is additionally prescribed:
Daily monitoring of blood pressure, ECG;
- urine analysis according to Nechiporenko, according to Zimnitsky, analysis of daily urine for protein;
- hemostasiogram;
- consultation with an ophthalmologist, therapist, nephrologist, neurologist.
Treatment of late gestosis
For mild manifestations of gestosis - dropsy, treatment is carried out on an outpatient basis. In case of nephropathy and more severe manifestations of the disease, hospitalization of the pregnant woman in the obstetric department is indicated.
With minor swelling and normal tests, treatment of gestosis is limited to following lifestyle and nutrition recommendations.
For dropsy with severe edema and mild nephropathies, the following is prescribed:
Sedatives (tinctures of motherwort, valerian);
- disaggregants (Trental, Curantil) to improve the rheological properties of blood;
- antioxidants (vitamin A and E);
- when blood pressure increases, antihypertensive drugs with an antispasmodic effect are used (Eufillin, Dibazol);
- herbal infusions with a diuretic effect.
In severe forms of nephropathy, preeclampsia and eclampsia, treatment is carried out with the participation of a resuscitator in the intensive care unit. Infusion therapy is carried out to correct metabolic and electrolyte disturbances - fresh frozen plasma and rheopolyglucin are administered. In addition to the above groups of drugs, anticoagulants (Heparin) are also used for severe forms of gestosis. To quickly regulate water-salt metabolism, diuretics (Furosemide) are used instead of herbal infusions.
For all forms of gestosis, to prevent the threat of premature birth and fetal hypoxia, selective sympathomimetics (Ginipral) are used.
No less relevant is the question of the method of delivery for gestosis.
If the condition of the pregnant woman is satisfactory and the fetus does not suffer, based on ultrasound and CTG data, then the birth is carried out through the natural birth canal. If there is no effect of therapy, in severe forms of gestosis and chronic fetal hypoxia, a cesarean section is indicated.
Treatment of gestosis is carried out not only before childbirth, but also during childbirth and in the postpartum period until the woman’s condition is completely stabilized.
Nutrition and diet for gestosis
Lifestyle and nutrition during gestosis are very important for successful treatment. If there is edema and pathological weight gain, the pregnant woman should follow a special diet. It is necessary to exclude spicy, salty and fried foods from the diet. Consume less salt. Preference should be given to boiled dishes, slightly under-salted. Try to eat foods of both plant and animal origin, as well as dairy products, fruits and vegetables. On average, a pregnant woman with a tendency to edema should consume no more than 3,000 calories per day. You should limit not only your food intake, but also your liquid intake. You need to drink no more than one and a half liters of fluid per day. You should pay attention to diuresis - the amount of fluid excreted should be more than drunk.
A hectic lifestyle and stress also provoke gestosis. In the second half of pregnancy, a woman should sleep at least 8-9 hours a day. If you want to sleep during the day, it is also better to lie down to rest. But at the same time, a sedentary lifestyle can also provoke gestosis. Therefore, a woman is recommended to take walks every day. fresh air for at least an hour, do special fitness for pregnant women.
Folk remedies for gestosis
Traditional medicine in the treatment of gestosis is very relevant, especially with dropsy, many medicinal plants have a diuretic effect. For gestosis, kidney tea, cranberry or lingonberry juice, and rose hip decoction are prescribed. You can use herbal preparations such as Canephron or Cyston. Sedative tinctures from motherwort or valerian can be used starting from 13-14 weeks of pregnancy for the prevention and treatment of gestosis. For severe forms of gestosis folk remedies are not effective, so only medications are used.
Complications of gestosis:
Premature birth;
- detachment of a normally located placenta, leading to fetal death;
- fetal hypoxia, which also leads to intrauterine fetal death;
- hemorrhage and retinal detachment;
- heart failure, pulmonary and cerebral edema, heart attacks and strokes;
- development of renal and hepatic failure, hepatic coma.
Prevention of gestosis:
Implementation reproductive function up to 35 years old;
- timely treatment of chronic diseases that provoke gestosis;
- healthy image life.
Consultation with an obstetrician-gynecologist on the topic of late gestosis:
1. I'm 38 weeks pregnant. They found a small amount of protein in my urine and prescribed IVs. But I have no swelling or pressure. Is treatment necessary at all in my case?
Treatment in in this case necessary to prevent the development of nephropathy. It is not necessary that there be pressure or swelling.
2.I'm 37 weeks pregnant. I have been in the hospital for 2 weeks now due to swelling and protein in my urine. Despite the treatment, the swelling increased and the protein remained as it was. What to do?
In your case, most likely, gestosis will go away only after childbirth, but treatment must be continued until childbirth in order to save the fetus. The main thing for you now is under the supervision of doctors.
3. Do I need to go to the hospital if I gain a lot of weight?
If there is no pronounced swelling, pressure and protein in the urine, then it is not necessary.
4. Normally my blood pressure is 120/80. When it rises to 130/90, my head hurts a lot. What to do, what to take?
This pressure is the upper limit of normal, but if you have a headache, this may indicate a complication of gestosis, so I recommend consulting with your gynecologist in person and, if he recommends, going to the hospital.
5. Is it possible to give birth on your own with preeclampsia or do you have to have a caesarean section?
Preeclampsia is not an indication for caesarean section. The operation is performed only in emergency cases when the disease progresses.
6. By week 28 I had already gained 10 kg. The doctor prescribed Eufillin, but I don’t want to take it. All my tests are normal. Maybe you can do without Eufillin?
You can avoid using Eufillin only if you strictly adhere to the diet and other recommendations to reduce the manifestations of gestosis.
7. Why is protein in urine dangerous? How does this affect the fetus?
Protein in the urine indicates protein loss and impaired kidney function. In this case, the fetus does not have enough material to build its own cells. This can lead to delayed fetal development.
8. How much fluid can you drink per day with gestosis?
In the presence of edema - no more than one and a half liters per day.
9. I have swelling in my legs. The doctor prescribed Trental. But the instructions say a lot side effects I'm afraid to take this drug. How does Trental affect the fetus?
Trental is safe for children.
10. What is the acceptable level of protein in urine?
Normally, there should be no protein in the urine at all.
Obstetrician-gynecologist, Ph.D. Christina Frambos
Preeclampsia is a serious complication late dates pregnancy, which is why it is also called late “toxicosis”. With gestosis, the functioning of the kidneys, blood vessels and brain of the expectant mother deteriorates. Its most characteristic signs are an increase in blood pressure and the appearance of protein in urine tests.
The increase in pressure may not be noticeable, but is more often manifested by headache, nausea, and blurred vision. Protein in the urine indicates kidney dysfunction and is often accompanied by edema.
In severe cases, gestosis can lead to convulsive seizures, placental abruption, developmental delay and death of the baby.
In 90% of cases, gestosis begins after 34 weeks, most often in pregnant women with their first baby. An earlier onset (from 20 weeks) is a sign of a severe course. The closer to the expected date of birth gestosis begins, the better its prognosis.
Unlike early toxicosis, which is considered “normal” by many doctors, gestosis disrupts the course of pregnancy and must be treated. In case of severe gestosis that threatens the development of the baby, it is often necessary to resort to stimulation of early labor or caesarean section.
Tendency to gestosis
Gestosis of varying degrees occurs on average in 10–15% of expectant mothers, much more often it appears in the first pregnancy. The timing of its onset is from 20 weeks and up to several days after birth. In multiple pregnancies, gestosis can begin earlier (from 16 weeks) and be more severe.
During the second pregnancy, the likelihood of encountering late toxicosis decreases. The easier the first gestosis was, and the closer its onset was to the due date, the less likely it is to recur. Those mothers for whom it began earlier and had a difficult course, especially if they had to have a caesarean section because of this, have a greater chance of encountering gestosis again.
When the likelihood of gestosis is greater:
- During the first pregnancy;
- If you already had chronic diseases before pregnancy: kidney problems, high blood pressure or overweight. In this case, gestosis is called “combined”, in contrast to “pure” gestosis, which develops against the background of complete health;
- Pregnancy with twins and triplets;
- Heredity, that is, parents or siblings suffered from gestosis;
- Age less than 20 and over 35 years.
If there was no gestosis in the first pregnancy, it is very unlikely that it will occur in the second.
Causes of gestosis during pregnancy
Although scientists have not fully established the causes of gestosis, it is known that the placenta plays a major role in its development. If there is insufficient blood supply to the uterus (for example, due to narrowing of the uterine arteries) or pathology of the placenta itself, it triggers a pressure rise mechanism to increase blood flow.
The rise in pressure is achieved by narrowing the blood vessels of the mother's body, but this leads to a deterioration in the blood supply to her vital organs - the kidneys and brain. They receive less blood, and their work deteriorates.
With edema, water comes out of the bloodstream into the tissue, which makes the blood thicker and increases the formation of blood clots. Blood clots can clog small vessels and further impair blood flow, and thick blood increases blood pressure. A vicious circle arises.
Signs of gestosis
There are three main signs of gestosis, which usually appear together or in pairs: swelling, protein in the urine and increased blood pressure.
The appearance of protein in the urine(proteinuria).
The first and main criterion that indicates kidney damage. Preeclampsia almost never occurs without proteinuria, and the stronger it is, the worse it is. Although the identification of this sign alone does not indicate gestosis.
Normally, there should be no protein in the urine.
Small amounts, around 0.033 g/l, in combination with leukocytes may be a sign of kidney inflammation (pyelonephritis).
0.8 g/l or more is more likely to indicate gestosis.
Proteinuria in combination with an increase in blood pressure over 140/90 always indicates gestosis.
A urine test must be taken before each doctor's visit. antenatal clinic. If you feel that your urine has become cloudy, dark in color, or covered with foam, get tested without waiting until the appointed day.
Increased blood pressure more than 140/90 mm Hg. Art.
This is the second main sign of gestosis, which may go unnoticed, or may manifest itself as headache, nausea, flashing spots before the eyes, and dizziness.
The combination of high blood pressure with protein in the urine is called preeclampsia, and indicates initial stage brain damage to the expectant mother. This is why your blood pressure needs to be measured at every doctor's visit.
In severe cases, untreated high blood pressure can cause serious damage to the nervous system such as loss of consciousness, seizures (eclampsia) and bleeding in the brain (stroke). This danger occurs when the upper figures of blood pressure exceed 160 and the lower 110 millimeters of mercury.
Edema.
They often occur during normal pregnancy, and in themselves are not a sign of gestosis, but only in combination with proteinuria or high blood pressure. Moreover, gestosis without edema (“dry”) is more severe.
Whether you have swelling can be easily determined by performing a simple test. Use your thumb to press inner surface shin in the bone area and hold for a few seconds. If a hole remains at the point of pressure, then there is swelling. This test can also be performed on any other part of the body.
Another sure sign of edema is that slippers or shoes have become too small, wedding ring does not come off the finger. In some cases, there is hidden swelling. They can be identified by too much weight gain compared to the norm.
Examination for suspected gestosis
- Urinalysis. Allows you to identify protein, ketone bodies, leukocytes, bacteria and other elements. This makes it possible to distinguish kidney damage during gestosis from pyelonephritis or other diseases.
- Blood test. Indicators such as hemoglobin (a slight decrease at the end of pregnancy is normal), hematocrit (blood thickening), platelets, and the level of liver enzymes (indicates liver damage in severe gestosis) play a role.
- With . Allows you to assess the development of the baby and recognize his delay in time. Assessment of blood flow in the uterine arteries using Doppler allows us to give an approximate prognosis of the development of the disease: the worse the blood flow, the greater the likelihood of gestosis.
- . It is done after the 28th week of pregnancy; it is not indicative at earlier stages. Shows the baby’s mobility, the functioning of his heart and, therefore, the presence or absence of hypoxia (oxygen starvation).
Accurate diagnosis
All of these symptoms are characteristic not only of gestosis, and they must be distinguished from signs of other diseases, especially if the expectant mother had them before pregnancy. That's why accurate diagnosis Only a doctor can diagnose gestosis.
Video materials
Late toxicosis (gestosis), edema during pregnancy.
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