The earliest evidence of gestosis is the appearance. Gestosis of pregnant women: signs of early and late gestosis. Gestosis: what happens in the body

Gestosis during early and late pregnancy is a formidable complication. In some cases, delay in diagnosis and treatment can lead to the death of the mother and child. For this reason, the information from this article will be useful not only for women who have already encountered this diagnosis, but also for other future mothers.

What is late gestosis and how is it dangerous? This complication is typical for the second half of pregnancy, more often occurs after the 30th week, and is characterized by disruption of the work of various maternal organs, placental insufficiency, delayed fetal development and hypoxia in it.

Despite the name, which often includes the word "toxicosis", the mechanism of this pathology and risk factors are different. Moreover, late toxicosis that occurs during pregnancy is much more dangerous than early. The second, most terrible, can lead to dehydration and loss of pregnancy. And the first, the one that is late, in severe cases, provokes the strongest seizures in a woman, which often end in strokes, cerebrovascular accident, coma.

Causes of gestosis (late toxicosis)

The main reason for this pathology is directly pregnancy, the fetus, or rather the placenta. In some women, for reasons unknown to science, in the early stages of pregnancy, there are disturbances in the formation of the placenta, those vessels that connect it to the uterus. And the longer the gestation period, the more obvious the violations that have arisen as a result of this become. The child is lagging behind in development, has a small weight, a lack of oxygen is diagnosed on CTG. The woman, on the other hand, 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 disease, diabetes mellitus), 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. And therefore, its prevention is recommended to be carried out with mild sedatives.

The cause of early preeclampsia, when it begins to develop at a period of 13-15 weeks, is often a tendency to thrombosis in a woman due to genetic abnormalities - thrombophilia. This is one of the potential risks of developing late toxicosis.

In addition, a negative role is definitely played by:

• heredity (if the grandmother, mother had late gestosis of pregnant women, then their daughters and granddaughters will certainly have them);
• the age of the expectant mother (more often 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 the later stages

Often, fetal growth retardation becomes the first "swallow". 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, is less 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 (by Doppler ultrasonography).

In general, the diagnosis of gestosis during pregnancy is carried out by a gynecologist leading the pregnancy, based on the following symptoms.

1. Swelling. They can be overt and covert. 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 on the legs, and they appear in the afternoon.

It is bad if the edema spreads to the whole body, face. And especially if they are present already in the morning, after a night's sleep.

The consequences of gestosis during pregnancy can be very serious: up to placental abruption and fetal death. Therefore, women carrying a baby so often have to be tested. The purpose of these research procedures is to identify signs of a serious condition in the early stages in order to correct the situation in a timely manner, while the pathological changes have not yet had time to harm the health of the mother and child.

Gestosis during pregnancy is a complication that significantly increases the risk of perinatal death, threatens the life and health of a woman and practically guarantees problems in childbirth. Recently, this diagnosis has been made by about 30% of expectant mothers.

The period of bearing a child is a kind of test of the state of the body. At this time, hereditary characteristics and chronic diseases, which the woman did not previously suspect, may become aggravated and manifest. The body, due to the presence of certain defects and "weak points", cannot cope with the load, disorders develop in vital organs and systems.

Usually gestosis is diagnosed in the third trimester of pregnancy. However, the process of occurrence of pathological changes in the body begins earlier - at 17-18 weeks.

Experts distinguish 2 types of gestosis:

• clean. It develops in expectant mothers who do not have a history of serious diseases;
• combined. It is diagnosed in women suffering from hypertension, kidney and liver diseases, various pathologies of the endocrine system and other chronic ailments.

Early preeclampsia during pregnancy, or the so-called early toxicosis, is considered the norm, a kind of adaptation of the body to a new state, but still requires special control from the woman herself and doctors. If the pathology develops after 20 weeks, they already talk about preeclampsia in 2 half of pregnancy. It is he who causes the greatest concern.

Causes of gestosis

There are several opinions explaining the causes of the onset of the disease. There is no single explanation yet. Most likely, in each case, one of the theories or a combination of several versions is correct:

• the cortico-visceral version connects disturbances in the circulatory system provoking preeclampsia with malfunctions in the regulation between the cortex and the subcortex of the brain, resulting from the body's habituation to pregnancy;
• the hormonal theory blames the onset of a state of disturbance in the work of the adrenal glands, deviating production of estrogens or hormonal insufficiency of the placenta;
• the immunogenetic theory suggests that gestosis in late pregnancy is nothing more than an inadequate response of the mother's immune system to fetal proteins that are alien to it, as a result of which the body tries in every possible way to reject the foreign body. There is another immunogenetic version, the supporters of which believe that, on the contrary, the maternal organism, in response to antigens coming from the placenta into the vascular bed, produces antibodies in insufficient quantities, as a result, inadequate complexes circulate in the bloodstream, which have a negative effect, first of all, on kidneys;
• inheritance theory: if a woman's mother and grandmother suffered from a serious condition, then this fate is unlikely to pass her, and therefore special attention should be paid to the prevention of the disease.

If experts have not yet come to a common opinion about the causes of gestosis during pregnancy, then they are unanimous about the risk factors.

Conditions such as:

• obesity;
• endocrine pathologies;
• liver and kidney disease;
• diseases of the organs of the cardiovascular system;
• allergic reactions.

There are special categories of women who are at risk. The onset of gestosis is most likely in:

• pregnant women under 17-18 and over 33 years old;
• women carrying more than one child;
• women whose nervous system is exhausted by frequent stress;
• women who have suffered from preeclampsia during previous pregnancies;
• pregnant women, abuse of alcohol, smoking and drugs;
• pregnant women from a social risk group who are malnourished and living in unfavorable conditions;
• women whose pregnancies have not passed at least 2 years;
• women who have frequent abortions or have a history of pre-conception miscarriages.

If the expectant mother did not suffer from preeclampsia, carrying the first child, then the chances that he will manifest himself in the existing pregnancy are small. If a pregnant woman has a history of serious diseases or belongs to a risk group, attention to her condition from specialists should be increased.

Gestosis: what happens in the body?

The basis for the occurrence of preeclampsia during pregnancy is vascular spasm. As a result, the total volume of blood circulating in the bed of blood vessels decreases, the nutrition of organs and cells is disturbed. This leads to the fact that they begin to poorly cope with their work.

First of all, the cells of the brain, as well as the kidneys and liver, suffer from insufficient blood supply. This situation turns into a catastrophe for the placenta. It cannot function normally, which threatens the fetus with hypoxia and, accordingly, developmental delay.

Symptoms and stages of gestosis

It should be borne in mind that signs of preeclampsia during pregnancy can have varying degrees of severity. It happens that a woman feels great, but analyzes indicate that a condition threatening her health and the life of the fetus develops in the body.

There are the following stages in the development of gestosis:

• dropsy (or swelling);
• nephropathy;
• preeclampsia;
• eclampsia.

Edema during preeclampsia can be hidden - a specialist suspects in this case too much weight gain in the patient. And sometimes the woman herself suddenly begins to notice that the wedding ring is difficult to put on, and the elastic bands of the socks leave rather deep grooves on the ankles.

There is a simple method for detecting edema - you need to press on the skin with your thumb. If a light trace remains in this place for a long time, it means that swelling is present.

The ankles are usually the first to swell. The dropsy then spreads upward. Sometimes swelling even reaches the face, changing its features beyond recognition.

Dropsy, depending on the prevalence, is classified into stages:

• Stage 1 - only feet and legs swell;
• Stage 2 - edema of the anterior abdominal wall is added;
• Stage 3 - swelling of the legs, abdomen, face and hands;
• Stage 4 - generalized edema (throughout the body).

The second stage of gestosis, nephropathy, is manifested by such signs as:

• swelling;
• protein in the urine;
• increase in blood pressure to 130/80 and above.

The rise, and especially sharp fluctuations in blood pressure, is an alarming symptom of gestosis during pregnancy, indicating an insufficient blood supply to the placenta, which leads to oxygen starvation of the fetus and threatens its death, premature detachment, and bleeding.

The appearance of protein in the urine indicates the progression of nephropathy. The kidneys cease to cope with the load, diuresis decreases. The longer the period of nephropathy, the less chances of a successful pregnancy outcome.

In the absence of proper treatment, nephropathy flows into the next stage of gestosis, characterized by a generalized disorder of the blood supply to the central nervous system - preeclampsia.

The symptoms of this condition are:

• flies or fog in front of the eyes;
• diarrhea;
• vomit;
• pain in the head and abdomen;
• heaviness in the back of the head;
• sleep and memory disorders;
• lethargy and apathy, or, conversely, irritability and aggression.

Along with this, the pressure continues to rise (up to 155/120 and above), the amount of protein in the urine increases, urine output decreases, the proportion of platelets in the blood decreases and the rates of its coagulation decrease.

The fourth and most dangerous stage of late gestosis during pregnancy is eclampsia. Most often, this condition is manifested by convulsions - they can be provoked by any stimulus: loud sound, light, awkward movement.

It all starts with twitching of the eyelid and facial muscles. Then the seizure gains momentum and reaches its climax, when the patient literally beats in convulsions, losing consciousness. Even more dangerous is the non-convulsive form of eclampsia, when a pregnant woman suddenly falls into a coma due to the pathological processes occurring in the body and high pressure indicators.

Eclampsia threatens with such serious consequences as:

• stroke;
• retinal disinsertion;
• suffocation of the fetus;
• hemorrhages in internal organs (primarily in the liver and kidneys);
• edema of the lungs and brain;
• coma and death.

Diagnostics of the gestosis

If a woman registers on time and does not miss the appointments to the doctor, gestosis will not go unnoticed. Modern medical practice provides for regular testing and examination of patients. According to the results of these research procedures, signs are revealed that indicate the development of a dangerous condition.

So, suspicions can arise when deviations from the norm are detected during medical events such as:

• weighing a pregnant woman (fears are raised by more than 400 grams per week, although everything is individual here: you need to take into account both the gestational age and the woman's weight when registering);
• urine analysis (even traces of protein are the reason for a more detailed examination);
• fundus examination;
• blood pressure measurement;
• analysis of the ratio "the volume of liquid drunk: excreted urine";
• blood clotting analysis;
• general blood analysis.

If an accurate diagnosis is made, it is necessary to monitor the condition of the fetus, carried out using the ultrasound + Doppler method. For periods after 29-30 weeks - CTG. In this case, a woman is additionally monitored by narrow specialists: a nephrologist, a neurologist, an ophthalmologist.

Treatment of gestosis

Timely treatment of gestosis during pregnancy increases the chances of its successful outcome and natural delivery. Patients with nephropathy of any severity, preeclampsia and eclampsia are placed in a hospital setting.

At the same time, therapeutic measures are aimed at normalizing the water-salt balance of the pregnant woman, as well as harmonizing metabolic processes, the activity of the cardiovascular and central nervous systems.

The complex of medical procedures includes:

• bed and half-bed rest;
• elimination of stressful situations;
• vitamin-enriched food;
• physiotherapy with a calming effect;
• drug treatment, carried out in order to normalize the functions of organs and systems of the pregnant woman and support the fetus suffering from hypoxia.

In the absence of improvement during treatment or, even more so, the progression of a dangerous condition, we are talking about early delivery. In this case, finding a child in the womb becomes more dangerous than being born prematurely.

As for mild preeclampsia during pregnancy, accompanied only by edema and mild symptoms, it is treated on an outpatient basis. In other cases, the patient needs round-the-clock supervision of specialists, because at any time the disease can begin to progress rapidly.

Prevention of gestosis

Women at risk need to pay special attention to the prevention of preeclampsia during pregnancy. And it is necessary to begin to act even at the stage of planning a child, that is, before conception: to be examined in order to identify and eliminate pathologies, give up bad habits, drink special vitamin complexes, etc.

When you become pregnant, you need to register as soon as possible. When the condition of a pregnant woman is under the supervision of specialists, many problems can be identified and eliminated at the initial stages. Patients often have to undergo tests and attend antenatal clinics, where they are weighed and measured every time.

The following simple measures are excellent prevention of gestosis:

• limiting the volume of fluid and salt consumed (especially in the second half of pregnancy);
• full sleep lasting at least 8 hours;
• adequate physical activity;
• walks in the open air;
• avoidance of stress;
• full-fledged vitamin-rich food and the correct diet (better in small quantities, but often).
• fatty, salty and spicy should be excluded from the diet - this is an additional and completely unnecessary load on the liver.

According to individual indications, drug prophylaxis can also be prescribed.

Gestosis is a condition that threatens the life and health of the mother and fetus. The danger is that there may not be visible signs of the disease. The woman feels great, and at this time pathological changes occur in her body.

Fortunately, a timely visit to the leading pregnancy doctor is a guarantee of early recognition of the disease. With the right approach, pregnancy after treatment of preeclampsia and further childbirth proceed without complications.

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(EARLY GESTOSIS)

Etiology. Toxicosis of pregnant women, or gestosis, are pathological conditions that occur during and in connection with pregnancy. The etiological factor contributing to the onset of gestosis is the ovum. Distinguish between early and late gestosis.

Early preeclampsia is usually observed in the first trimester of pregnancy and passes by the second trimester. For most forms of early preeclampsia, disorders of the functions of the digestive system are characteristic.

Pathogenesis. There were many theories trying to explain the mechanism of development of early preeclampsia: reflex, neurogenic, hormonal, allergic, immune, cortico-visceral. The leading role in the pathogenesis of early preeclampsia (vomiting) is currently assigned to a violation of the functional state of the central nervous system. A number of clinical symptoms (vomiting, salivation, skin rash) are similar to those of experimental neurosis. In the early stages of pregnancy, the symptoms of neurosis are manifested mainly by a disorder of the function of the gastrointestinal tract, since the onset of pregnancy necessitates a restructuring of activities, primarily of the food stereotype. It is known that food reflexes are associated with the autonomic centers of the diencephalic region. The afferent signals arriving here from the periphery can be perverted (either due to changes in the receptor apparatus of the uterus, or in the pathways). There may be changes in the very centers of the diencephalic region. All this affects the nature of the response efferent impulses. With an altered sensitivity of the nervous system, a violation of reflex reactions, a violation of nutritional functions occurs quickly: loss of appetite, nausea, salivation (salivation), vomiting.

An important role in the onset of early preeclampsia is played by neuroendocrine and metabolic disorders, which can lead to the manifestation of pathological reflex reactions. Violation of hormonal relationships in the body also causes pathological reflex reactions and, as a consequence, the development of early preeclampsia. It is known that pronounced forms of early preeclampsia often occur with multiple pregnancies, with cystic drift. With vomiting of pregnant women, there is a temporary coincidence of the onset of vomiting with the peak in the content of chorionic gonadotropin, and there is often a decrease in the secretion of corticosteroids in the adrenal cortex.

Clinical course. There are common (vomiting of pregnant women, salivation) and rare forms of early preeclampsia (dermatoses of pregnant women, tetany, osteomalacia, acute yellow atrophy of the liver, bronchial asthma of pregnant women).

Vomiting of pregnant women (emesis gravidarum) occurs in about 50-60% of pregnant women, but no more than 8-10% of them need treatment. There are 3 degrees of severity of vomiting in pregnant women. The earlier the vomiting of pregnant women occurs, the more severe it is.

Idegree- mild form of vomiting of pregnant women. The general condition remains satisfactory. The frequency of vomiting does not exceed 5 times a day. Vomiting occurs on an empty stomach and can be caused by food intake or unpleasant odors. Weight loss does not exceed 2-3 kg. Body temperature, moisture content of the skin and mucous membranes remains normal. The pulse rate does not exceed 80 beats / min. Blood pressure does not change. Clinical urine and blood counts remain normal.

IIdegree- vomiting of moderate severity. With this form of preeclampsia, the general condition of the woman is disturbed. Patients complain of weakness, sometimes dizziness. Vomiting is repeated 6 to 10 times a day. Body weight loss exceeds 3 kg in 1-1.5 weeks. Some women may have subfebrile body temperature. The moisture content of the skin and mucous membranes remains normal. The pulse quickens up to 90-100 beats / min. Blood pressure may be slightly lowered. In the study of urine, a positive reaction to acetone (+, ++ and less often +++) is revealed.

IIIdegree- severe (excessive) vomiting of pregnant women. The general condition of women is deteriorating sharply. Vomiting is repeated up to 20-25 times a day. In some cases, vomiting can occur from any movement of a pregnant woman. Due to the fact that vomiting continues at night, sleep is disturbed. There is marked weight loss (weight loss reaches 8-10 kg or more). Pregnant women do not retain food or water, which leads to significant dehydration and metabolic disorders. All types of metabolism are severely disrupted. The skin and mucous membranes become dry. The body temperature rises (37.2-37.5 ° C, sometimes 38 ° C). The pulse quickens to 120 beats / min, blood pressure decreases, urine output is reduced. In the study of urine, a positive reaction to acetone (+++ or ++++) is found, protein and casts are often detected. In blood tests, hypo- and dysproteinemia, hyperbiliru-binemia, an increase in creatinine content are determined. Excessive vomiting of pregnant women is now very rare.

Treatment of mild vomiting of pregnant women, as a rule, is outpatient under the control of the dynamics of the body weight of the pregnant woman and mandatory repeated urine tests for the content of acetone. Vomiting of pregnant women of moderate severity and severe require hospital treatment.

Complex therapy of vomiting in pregnant women includes drugs that affect the central nervous system, normalizing endocrine and metabolic disorders (in particular, water and electrolyte balance), antihistamines, vitamins. During treatment, it is necessary to observe the medical and protective regime. You cannot place two such patients in one ward, since a recovering woman may have a relapse of the disease under the influence of a patient with ongoing vomiting.

To normalize the function of the central nervous system, electrosleep or electroanalgesia is used. The duration of exposure is 60-90 minutes. The course of treatment consists of 6-8 sessions. In order to influence the central nervous system, hypnosuggative therapy can be used. A good effect is given by various options for reflexology, oxybarotherapy, endonasal electrophoresis with vitamin B g

To combat dehydration of the body, to detoxify and restore KOS, infusion therapy is used in an amount of 2-2.5 liters per day.

Ringer-Locke's solution (1000-1500 ml), 5% glucose solution (500-1000 ml) with ascorbic acid (5% solution 3-5 ml) and insulin (based on 1 U of insulin per 4.0 g of dry matter glucose). For the correction of hypoproteinemia, albumin is used (10 or 20% solution in an amount of 100-150 ml). In case of violation of CBS, intravenous administration of sodium bicarbonate (5% solution) is recommended. As a result of the elimination of dehydration and loss of salts, as well as the deficiency of albumin, the condition of patients is rapidly improving.

Antiemetic drugs should be used with great caution because of their adverse effects on pregnancy. From drugs in the complex therapy of vomiting of pregnant women include vitamins (B r B 6, B 12, C), coenzymes (cocarboxylase), hepatoprotectors (Essentiale). Until a lasting effect is achieved, all drugs must be administered parenterally.

The effectiveness of the therapy is judged by the cessation of vomiting, weight gain, normalization of urine and blood tests. The ineffectiveness of the therapy requires termination of pregnancy. Indications for termination of pregnancy are:

1) incessant vomiting;

2) an increase in the level of acetone in urine tests;

3) progressive decrease in body weight;

4) severe tachycardia;

5) dysfunction of the nervous system;

6) icteric staining of the sclera and skin;

7) change in CBS, hyperbilirubinemia.

Drooling (ptyalismus) can accompany vomiting of pregnant women, less often it occurs as an independent form of early toxicosis. With severe salivation, a pregnant woman can lose 1 liter of fluid per day. Excessive salivation leads to dehydration of the body, hypoproteinemia, maceration of the facial skin, negatively affects the psyche.

Treatment of severe salivation should be carried out in a hospital. Rinse the mouth with infusion of sage, chamomile, oak bark, menthol solution. With a large loss of fluid, Ringer-Locke's solution, 5% glucose solution is prescribed intravenously. With significant hypoproteinemia, an infusion of albumin solution is indicated. Atropine is administered orally or subcutaneously 2 times a day. A good effect is achieved with hypnosis, acupuncture. To prevent and eliminate maceration of the facial skin with saliva, use its lubrication with zinc paste or Lassar paste.

Dermatoses of pregnant women - rare forms of early preeclampsia. This group of various skin diseases that occur during pregnancy and disappear after its termination. The most common form of dermatoses is pruritus gravidarum (pruritus gravidarum). It can be limited to the vulva, it can spread throughout the body. Itching can be excruciating, irritable, and sleep disturbances. Itching of pregnant women it is necessary to differentiate from pathological conditions accompanied by itching (diabetes mellitus, fungal skin diseases, trichomoniasis, allergic reactions).

For treatment, sedatives, antihistamines, vitamins B x and B 6, general ultraviolet irradiation are used.

Rarely found eczema (eczema gravidarum), diseases caused by herpetic viruses (herpes zoster, herpes simplex).

The most dangerous, but rare is impetigo herpetiformis. This disease can be fatal. Its etiology is unknown. It is manifested by a pustular rash. In most cases, the disease is associated with endocrine disorders, especially with dysfunction of the parathyroid glands. Characterized by severe general phenomena - prolonged or intermittent fever of the septic type, chills, vomiting, diarrhea, delirium, convulsions. Itching is usually absent. The disease can be fatal in a few days or weeks, but it can be prolonged.

For treatment, calcium preparations, vitamin D 2, dihydrotachi-sterol, glucocorticoids are used; locally - warm baths with potassium permanganate solution, opening of pustules, disinfecting ointments. In the absence of success or insufficient effectiveness of treatment, pregnancy should be terminated.

Tetania pregnant (tetania gravidarum) is manifested by muscle cramps of the upper extremities ("obstetrician's hand"), less often of the lower extremities ("ballerina's leg"), face ("fish mouth"). At the heart of the disease is a decrease or loss of the function of the parathyroid glands and, as a consequence, a violation of calcium metabolism. In case of severe course of the disease or exacerbation of latent tetany during pregnancy, the pregnancy should be terminated. For treatment, parathyroidin, calcium, dihydrotachysterol, vitamin D are used.

Osteomalacia of pregnant women (osteomalatia gravidarum) in pronounced form is extremely rare. Pregnancy in these cases is absolutely contraindicated. An erased form of osteomalacia (symphysiopathy) is more often observed. The disease is associated with impaired phosphorus-calcium metabolism, decalcification and softening of the bones of the skeleton. The main manifestations of symphysiopathy are pain in the legs, pelvic bones, and muscles. General weakness, fatigue, paresthesia appear; gait changes ("duck"), tendon reflexes increase. Palpation of the pubic joint is painful. An X-ray and ultrasound examination of the pelvis sometimes reveals a divergence of the bones of the pubic joint, however, unlike true osteomalacia, there are no destructive changes in the bones. The erased form of osteomalacia is a manifestation of hypovitaminosis D.

Hence the treatment of the disease. A good effect is given by the use of vitamin D, fish oil, general ultraviolet radiation, progesterone.

Acute yellow pigenia atrophy (atrophia hepatis flava acuta) is extremely rare and may result from excessive vomiting of pregnant women or occur independently of it. As a result of fatty and protein transformation of liver cells, the size of the liver decreases, jaundice appears, then severe nervous disorders, coma, and the patient dies. The whole process lasts 2-3 weeks. Pregnancy must be terminated immediately. And even in the case of termination of pregnancy, recovery does not always occur.

Bronchial asthma of pregnant women (asthma bronchialis gravidarum) is very rare. It is assumed that the cause of it is the hypofunction of the parathyroid glands with impaired calcium metabolism.

Treatment includes calcium supplements, D vitamins, and sedatives. Bronchial asthma of pregnant women should be differentiated with exacerbation of bronchial asthma that existed before pregnancy.

Prevention. Prevention of early preeclampsia consists in the timely treatment of chronic diseases, the fight against abortion, the provision of emotional peace to the pregnant woman, and the elimination of the adverse effects of the external environment. Early diagnosis and treatment of the initial (mild) manifestations of gestosis is of great importance, which makes it possible to prevent the development of more severe forms of the disease.

Gestosis, or late toxicosis,- one of the most severe complications of pregnancy, characterized by dysfunction of many organs. This pathology is very dangerous: according to statistics, it is one of the first three diseases leading to maternal mortality. For this reason, the occurrence of gestosis must be taken seriously and all the doctor's recommendations must be carefully followed.

Classification and severity of gestosis

Today there is several classifications of preeclampsia:

1. In combination with other diseases;
2. By stages of severity(mutually replace each other);
3. By the time of occurrence.

In combination with other diseases:

• Pure late gestosis(occurs against the background of a woman's complete health and well-being, is not combined with other diseases);
• Combined gestosis: more severe because proceeds against the background of other serious diseases (arterial hypertension, endocrine pathologies, obesity, and others).

By stages of severity:

• Dropsy of pregnant women: occurs with fluid retention in the body, which is characterized by the occurrence of edema;
• NephropathiI am... This gestosis in pregnant women is characterized by an increase in blood pressure, edema and the appearance of protein in the urine. It should be noted that these signs do not always appear simultaneously, but only one of them may exist (for example, arterial hypertension);
• PreeclampsyI am: characterized by an increase in intracranial pressure and changes in cerebral circulation, which is manifested by headaches, visual impairment, nausea, vomiting and other signs;
• Eclampsia: the final and extremely dangerous stage of gestosis, in the absence of emergency assistance, inevitably leads to the death of the mother and child. The woman's condition deteriorates significantly, up to loss of consciousness, severe convulsions begin.

By the time of occurrence:

• Early preeclampsia during pregnancy: occurs immediately after 20 weeks (usually at 22-24 weeks) and is more malignant, difficult to respond to treatment;
• Late gestosis: occurs after 30 weeks (usually at 35-36), proceeds quite favorably.

Symptoms

Gestosis during pregnancy has different symptoms depending on the stage of the course.

Dropsy of pregnant women

Signs of preeclampsia of this stage are manifested by edema of various prevalence:

1. Mild preeclampsia: swelling of the legs appears (if you press on the front surface of the leg, there are pronounced pits - depressions);
2. Moderate degree: edema progresses, spreading to the trunk;
3. Severe degree: edema covers a large surface of the body. The general condition of the woman worsens, there is shortness of breath, tachycardia.

Nephropathy

Nephropathy in most cases occurs as a result of the lack of timely treatment for dropsy in pregnant women. This stage of gestosis is manifested triad of symptoms:

1. Increased blood pressure;
2. Worsening of edema;
3. The appearance of protein in the urine(proteinuria).

Gestosis in the second half of pregnancy at the stage of nephropathy can include all of the listed symptoms, or manifest itself with only one symptom.

Preeclampsia

With preeclampsia, intracranial pressure begins to increase, which is manifested by severe headaches, flashing of flies before the eyes, severe weakness. If untreated, this stage quickly turns into eclampsia.

Eclampsia

With the development of eclampsia, seizure attack, after which the woman falls into a coma:

1. First step(20-30 seconds). Convulsive contractions of the muscles of the face and upper limbs appear;
2. Second phase(25 seconds). Convulsions affect all muscles, including the respiratory one. There is a cessation of breathing, the woman loses consciousness;
3. Third stage(1-1.5 minutes). The woman falls into a coma, the convulsions stop. When the patient regains consciousness, she does not remember anything about the attack.

Treatment

information Gestosis of any severity is dangerous for the course of pregnancy and the condition of the woman herself, therefore it is important to identify it in a timely manner and begin treatment.

Treatment of dropsy in pregnant women

• Compliance with a diet with the strict exclusion of salt, spicy and smoked foods;
• Limiting fluid to 1.5 liters per day;
• removing excess fluid from the body(furosemide and others);
• Preparations to improve the functions of the placenta( , vitamin C).

Treatment of dropsy begins on an outpatient basis, in the absence of effect within 10-14 days, the woman is hospitalized in the department of pregnancy pathology.

Nephropathy treatment

Treatment of nephropathy should be carried out only in a hospital setting:

• Bed rest with complete exclusion of psycho-emotional and physical stress;
• Eating a fluid and salt-restricted diet... Fasting days are recommended once a week;
• Diuretic drugs;
• Mild sedatives ( , );
• Antihypertensive drugs to lower blood pressure;
• Consultation of a therapist, ophthalmologist, urologist.

If the condition of a woman or a child worsens, and there is no effect of the treatment being carried out, it is recommended to carry out an early delivery, regardless of the duration of pregnancy.

Preeclampsia treatment

Treatment of preeclampsia is carried out by analogy with nephropathy, but it should be borne in mind that inflicting pain on a woman can provoke an attack of eclampsia. For this reason, all manipulations, including injections and, should be carried out only with anesthesia (the best option is nitrous oxide).

Eclampsia treatment

Eclampsia is a very dangerous condition that can quickly lead to the death of a child and a woman. Treatment should be started immediately and must be carried out in conjunction with resuscitators in the intensive care unit:

1. Introduction of a woman into anesthesia;
2. Relief of seizures;
3. Administration of drugs to lower blood pressure;
4. Medication sleep for 1-2 days.

In the absence of the effect of treatment, emergency delivery is indicated at any stage of pregnancy.

Complications

important Gestosis is a really dangerous pathology, in which sometimes doctors have to forget about the child and do everything to save the life of at least the mother. Gestosis in the second half of pregnancy is not a condition that is worth joking with: severe forms (preeclampsia, eclampsia) can develop in a matter of hours and lead to extremely serious complications.

Possible complications of gestosis:

• Premature termination of pregnancy;
• Delayed intrauterine development of the fetus;
• Premature detachment of a normally located placenta;
• Renal, heart, liver failure;
• Heart attack;
• Retinal detachment;
• Hemorrhage into internal organs, including the brain (strokes);
• Thrombosis of large vessels;
• Edema of the brain followed by a coma;
• Fetal death;
• The death of a woman.

Never refuse hospitalization if the doctor strongly recommends it to you: remember that your life and the life of your child are the most precious thing!

Pregnancy is called the brightest, fabulous period in a woman's life.

However, in reality it happens that the main character of this tale has to endure a lot of suffering and trials on the way to her main goal.

Pregnancy does not have to be carried, but literally "lied" in the hospital, so that its outcome was successful. One of the most common reasons for the poor health of a woman and her “confinement” to the department of pathology of pregnant women is gestosis.

Doctors call preeclampsia a complicated course of pregnancy that occurs at any time and is directly related to the pregnancy itself, or rather, with the difficulty of adapting the mother's body to a new state for it, which threatens with serious negative consequences for the health and life of the mother and baby.

Free translation of the term "gestosis" from Latin means "painful pregnancy".

Normally, pregnant women should not have any gestosis, and the development of a pathological condition at any time can.

Obstetricians-gynecologists characterize gestosis according to various signs: by the time of occurrence, by the severity, by the presence of concomitant diseases, by symptoms, etc.

As a rule, when diagnosing "gestosis", doctors mean the pathology of late pregnancy, as causing disruption of the vital organs of the mother and the normal development of the fetus.

Whereas gestosis in the first weeks after conception is less insidious and extremely rarely threatens the health of the expectant mother and her baby after the symptoms stop.

Classification by the period of occurrence

Depending on the period, early and late gestosis is distinguished.

Early preeclampsia in pregnant women

Early gestosis of pregnant women begins before 12 weeks and can continue until the middle of the second trimester

Most often, this condition manifests itself in the expectant mother in the form of symptoms of body intoxication (toxicosis):

• nausea, vomiting and other unpleasant manifestations from the digestive system;
• intolerance to some smells and food;
• loss of appetite;
• dizziness;
• drooling (sometimes more than 1 liter per day).

More or less expressed concern about 60% of expectant mothers. By the 20th week, by the time the placenta forms, the unpleasant manifestations of toxicosis, as a rule, disappear.

However, there are also special, extremely rare forms of early preeclampsia:

• "Jaundice" of pregnant women

"Jaundice" of pregnant women (cholestasis) - usually develops after the 12th week from the moment of conception and manifests itself in the staining of the skin, mucous membranes in yellow, often accompanied by itching throughout the body.

In most cases, it is benign, but it can mask serious damage to the liver and kidneys, gallbladder, and pancreas. The test results and medical supervision will help to understand.

• Dermatosis.

Dermatosis during pregnancy delivers a lot of unpleasant sensations due to incessant itching of a local nature (usually in the external genitals) or general.

Dermatoses can appear both as a result of the process of adaptation of the woman's body to the state of pregnancy, and as a result of exacerbation of diseases that cause itching (from allergic to infectious).

The manifestations of dermatoses occur in the form of urticaria, eczema, herpes and other skin lesions.

• Tetania of pregnant women.

It manifests itself in the form of seizures arising from a violation of calcium metabolism, as well as due to certain mental disorders and a tendency to convulsive syndromes.

• Osteomalacia.

It occurs due to calcium-phosphorus deficiency, means softening of bone tissue and manifests itself in the form of pain in the joints, limbs, aggravated by movement.

In most cases, early gestosis can be dealt with with the help of modern methods of exposure and absolutely avoid unpleasant consequences for the course of pregnancy and fetal development.

Particularly dangerous is gestosis in the second half of pregnancy (late gestosis), in which the layer of endothelial cells lining the inner walls of blood vessels is damaged, as a result of which vascular spasm occurs.

This leads to difficulty in blood circulation in the body, which entails degenerative changes in organs and tissues, up to their death.

The kidneys, liver, brain and placenta suffer the most from hypoxia.

Dysfunction of the placenta leads to oxygen starvation of the fetus and its lag in intrauterine development.

Most often, late gestosis occurs against the background of an already existing disease, which is exacerbated during pregnancy.

This form of pathological pregnancy is called "combined" preeclampsia.

Complications of pregnancy are much less common in mothers who are not at risk for health reasons, but, nevertheless, in about 10-30% of cases this happens, it is called "pure" gestosis and has a more favorable prognosis in treatment.

Causes of occurrence

The processes occurring during the development and progression of gestosis in a woman's body have been studied by physicians much better than the reasons for its occurrence.

Since this pathological condition occurs only during pregnancy and passes after its end (or 2 days after childbirth), its connection with pregnancy is unambiguous and this is perhaps the only thing that is beyond doubt.

The causes of preeclampsia are trying to substantiate the followers of several theories.

• Endocrine theory.

Because of this, the mother's body is unable to adapt to a stressful state - bearing a fetus. In addition, the hormonal relationship in the mother-placenta-fetus system is disrupted, which also leads to hormonal imbalance.

However, there are opinions that such hormonal disorders are not a cause, but a consequence of gestosis.

• Immunological theory.

Explains the occurrence of gestosis by the fact that the immune defense of the mother's body is activated, perceiving the introduction of the embryo as a foreign formation with the production of appropriate antibodies to the antigens of the fetus.

Autoimmune compounds of maternal antibody molecules and fetal antigens lead to blood clotting in the placenta vessels, obstructing blood flow in it, causing vasospasm. This leads to dysfunction of the placenta.

Similar processes involving complexes of antibodies and antigens also occur in the kidneys and liver, disrupting the adaptation of these organs and, subsequently, their performance.

• Genetic theory.

The theory is based on the results of studies that have proven that the tendency to gestosis is inherited. This leads scientists to believe that there is a gene that causes preeclampsia.

• Kortikovisceral theory.

The theory claims that gestosis develops due to dysfunction of the central nervous system, possibly due to frequent and prolonged stress.

This leads to an adaptive failure during pregnancy on the part of neuroendocrine interactions and ultimately leads to vascular spasms and circulatory disorders in organs.

The danger of gestosis for a woman and a fetus

Preeclampsia of early pregnancy usually has rather vivid manifestations and delivers a lot of unpleasant sensations to the expectant mother.

However, in addition to feeling unwell and some discomfort in everyday life, in most cases it does not carry a serious danger and usually does not need treatment.

In rare cases, when bouts of vomiting are repeated more than 7-10 times a day, accompanied by weight loss, and the general condition of the mother casts doubt on the successful course and outcome of pregnancy, the woman is hospitalized and prescribed special treatment aimed at increasing immunity, physiotherapy. And, as a rule, by the 16th week of pregnancy, attacks of nausea and vomiting disappear.

The insidiousness of late gestosis is that their course and development may be asymptomatic, and the consequences may be serious complications of pregnancy.

Complications of late gestosis - preeclampsia, eclampsia, disseminated intravascular coagulation syndrome. Among the causes of maternal mortality, preeclampsia ranks second.

Pathological changes in a woman's body with gestosis have a wide scope of their action. The most pronounced functional disorders are in the kidneys, liver, uteroplacental system, brain, lungs of the patient.

The danger to the fetus is gestosis mediated, through the mother's body, in extremely severe forms. This is the risk of fetal hypoxia, delayed intrauterine development, therefore, with gestosis, the state of the fetus is constantly monitored.

Also, we must not forget that the progression of gestosis always carries the risk of an unfavorable outcome of pregnancy and forces doctors to decide on an early termination of it, which cannot pass without leaving a trace for the health of the baby.

Symptoms

The mechanism of development of late gestosis is quite clear, therefore, the signs of pathology in the second half of pregnancy are clearly defined:

• arising from impaired renal function as a result of gestosis;
• due to fluid retention in the body and cerebrovascular spasms;
• due to kidney damage in combination with impaired filtration functions of the liver, inhibition of its synthesizing functions.

In honor of this triad (edema, proteinuria, hypertension), gestosis of late pregnancy was called OPG-gestosis.

All symptoms detected in a woman are assessed according to the severity on a three-digit scale. According to the totality of the results, the level of severity of the gestosis itself is determined.

As a rule, gestosis is expressed through a combination of two symptoms of varying severity.

Whereas for the diagnosis of preeclampsia, the manifestation of one, the very first of the symptoms, for example, edema of the extremities, is sufficient.

The simultaneous, to some extent, pronounced manifestation of all three symptoms is rare and means an aggravation of the severity of gestosis, called nephropathy.

If signs of increased intracranial pressure, which are revealed during the examination of the fundus of the eye by an ophthalmologist, are added to the symptoms of OPH-gestosis, they speak of the development of a complicated form of nephropathy: preeclampsia.

The severity of preeclampsia and nephropathy is assessed in a similar way and depends on the degree of manifestation of OPG symptoms (for nephropathy) and pathological changes in the fundus (for preeclampsia).

1 degree of severity

The mild form is characterized by the following features:

• swelling in the lower extremities;
• HELL is not higher than 150/90 mm. rt. Art .;
• Protein in urine or traces of protein.

From the fundus side: uneven calibers of the retinal vessels.

Preeclampsia 2 degrees of severity

Moderate severity is characterized by the following symptoms:

• swelling of the lower limbs, anterior abdominal wall, upper limbs
• BP from 150/90 mm. rt. Art. up to 170/100 mm. rt. Art.
• protein in urine more than 3 g / l.
• fundus side: retinal edema.

Third degree of severity

A severe form of late gestosis can be recognized when:

• edema spreads to the whole body, face.
• HELL is higher than 170/100 mm. rt. Art.
• protein in urine: 1-3 g / l.
• from the fundus side, retinal hemorrhages, degenerative changes in the fundus are possible.

The self-perception of a woman in a state of preeclampsia can be different: of varying intensity and localization, visual impairment, confusion, symptoms of toxicosis, sinusitis, etc. etc.

With untimely medical measures taken to stop the development of severe forms of preeclampsia, there is a risk of its most dangerous stage: eclampsia.

Eclampsia is a serious dysfunction of the central nervous system due to vasospasm of the cerebral vessels, pathological changes in the functioning of vital organs and a condition fraught with disability or often fatal for the mother and baby.

Attacks of eclampsia are manifested by convulsions similar to epileptic seizures, pallor of the skin, stopping the pulse, followed by a coma, after coming out of which, the woman, as a rule, does not remember what happened.

A series of seizures following one after another is characterized as "eclamptic status". According to the number, duration of seizures and the length of the coma, the severity of eclampsia is assessed. Of course, the higher the degree, the less favorable the prognosis for the life of the mother and fetus.

Fortunately, the risk of developing eclampsia is now minimized (less than 1% of all pregnancies). Thanks to modern methods of diagnosing preeclampsia, a life-threatening condition can be predicted and prevented in time.

Diagnostics

Diagnosis of preeclampsia is carried out on the basis of clinical observations and laboratory data on the analysis of a woman.

An appointment with a gynecologist for a pregnant woman always includes several diagnostic methods to exclude preeclampsia.

• Weighing.

Regular weight measurements are needed to determine over a period. If the increase exceeds the norm of 300 g per week and at the same time there is a pronounced puffiness of the limbs, body, face, we can talk about the appearance of edema.

This is not the norm, but a fairly common occurrence that can accompany a woman during the entire period of pregnancy.

• Measurement of blood pressure.

Blood pressure is measured on both hands, because with vasospasm, there is a difference in indicators. Current values ​​are also compared with previous values ​​to track hypertension (especially important for hypotensive patients).

• Analysis of urine

Analysis of data on the composition of the urine handed over the day before, tk. even minor traces of protein in the urine require clarification of the reasons for its appearance.

• Patient complaints.

Nausea, vomiting, headache, dizziness, etc. can hide preclinical manifestations of preeclampsia.

If gestosis is suspected, the doctor will refer the woman for additional tests and examinations.

• General blood analysis.

Some indicators of blood clotting require attention: platelets, erythrocytes, the number of which decreases with the development of preeclampsia and degradation products of fibrin / fibrinogen (PDF), the number of which increases in severe forms of preeclampsia and indicates the risk of disseminated intravascular coagulation.

• Blood chemistry.

Alarming should be indicators of the concentration of electrolytes (especially sodium) in the plasma, which are responsible for water metabolism in tissues, the amount of total protein and its composition of its fractions in the blood serum, which differ from normal.

As well as increased indicators of nitrogen metabolism: urea and creatinine, which signal impaired renal functions.

• Biochemical analysis of urine.

The presence of bilirubin in urine determines a malfunction of the liver and gallbladder.

• Daily urine analysis for protein.

It is carried out when traces of protein are found in the general analysis of urine. It consists in collecting the entire volume of diuresis per day in one container, followed by laboratory analysis to determine the total loss of protein.

• McClure-Aldrich test to detect latent edema.

It is carried out if the weight gain over the period steadily exceeds the permissible norms, and no obvious edema is observed. Then 0.2 ml is injected under the skin of the forearm. saline and the time of papule resorption ("tubercle" at the injection site) is noted.

If after half an hour the papules are not found when probing, they conclude that there are hidden edema.

Timely diagnosis of late gestosis in the early stages of its manifestation allows you to prevent large-scale damage to the organs of a woman and to preserve the pregnancy or to carry out a careful delivery on time in order to save the life of the mother and child.

Risk groups for the occurrence of gestosis

Special observation and a more detailed and thorough examination during pregnancy are required by women who are in groups at increased risk of gestosis:

• by age:
  • under 18 years old,
  • over 35 years old;

• according to social conditions:
  • working in hazardous production,
  • living in high stress conditions,
  • having bad habits;
  • lack of weight due to poor nutrition;

• by the presence of extragenital diseases:
  • having kidney, liver disease;
  • having endocrine disorders;
  • having cardiovascular diseases, etc .;

• by obstetric and gynecological predisposition:
  • multiple pregnancy;
  • polyhydramnios;
  • genetic predisposition (severe gestosis in the patient's mother);
  • previously experienced gestosis (regardless of the outcome of pregnancy);
  • infantilism of the genitals, etc.

• infectious diseases.

If, at the first visit to the gynecologist, the expectant mother finds out that for some reason she falls into the group of increased risk of preeclampsia, then she should be ready for increased attention from medical specialists throughout the pregnancy.

Special observation should be treated without irritation and even more so without panic, remembering that all the actions of doctors are aimed at the benefit of her health and the future baby.

Treatment of gestosis during pregnancy

The measures prescribed by doctors when signs of gestosis in a woman are detected can be called treatment only conditionally.

Since a complete cure is possible only after getting rid of the culprit of the disease - the pregnancy itself. Therefore, the mutual efforts of the expectant mother and the medical staff are aimed at stabilizing the condition, preventing the progression of gestosis and the development of its severe forms.

The choice of treatment methods, its intensity, duration depend on the severity of preeclampsia and the forms of its manifestation.

In milder forms of preeclampsia (excess weight gain due to edema of the legs), treatment is carried out on an outpatient basis, under the supervision of a physician leading the pregnancy. The patient is prescribed a protein-plant diet with feasible salt restriction and adherence to a calm lifestyle.

If the severity of edema has not decreased, or has increased to 2-3 degrees, the woman is placed in a hospital, and herbal diuretics, vitamins that strengthen blood vessels and drugs that improve blood flow are added to the previous treatment.

In the treatment of grade 1-2 nephropathy, in addition to the above measures, drugs are prescribed that lower blood pressure, as well as herbal sedatives, such as motherwort, valerian, etc., rarely - tranquilizers.

The state of nephropathy of the 3rd degree requires adherence to bed rest and intensive therapy with the use of a set of measures aimed at smoothly reducing and stabilizing blood pressure, relieving vascular spasm and hypovolemia.

And also to improve the functioning of the liver, kidneys, heart, brain activity, uteroplacental blood flow.

With the degeneration of grade 3 nephropathy into preeclampsia and eclampsia, the efforts of doctors are aimed at relieving the symptoms of these conditions, after which it is recommended to prepare a woman for immediate delivery, as the only possible measure to preserve the life of the mother and fetus.

Prophylaxis

Preventive measures should be carried out, first of all, in patients at risk.

The main methods of preventing late gestosis include:

• full sleep (at least 8 hours);
• regular walks in the fresh air;
• lack of stress and the creation of a pleasant emotional background;
• proper nutrition with the addition of a minimum amount of salt;
• treatment and prevention of chronic diseases of the cardiovascular system, liver, kidneys;
• normalization of metabolism;
• ensuring normal blood clotting.

It is advisable to start the course of preventive treatment at 14-16 weeks of pregnancy. The duration of the course of medical preventive treatment (taking antiplatelet agents and hepatoprotectors) lasts on average 3-4 weeks.

Childbirth is the only way to cure preeclampsia, but even after the birth of a baby, mothers who have undergone preeclampsia are in no hurry to be discharged from the hospital. Their recovery after childbirth is closely monitored, tests are taken, and drugs are prescribed.

You should not be upset, because it is much easier to prevent possible complications after suffering gestosis than to deal with an exacerbated disease. And the baby, who also had a hard time, will be under round-the-clock supervision. Very soon, all the troubles associated with pregnancy and childbirth will be forgotten and replaced by memories of the first long-awaited meeting with your child.