Influence of gestoses on the development of the intrauterine fetus. What is preeclampsia in pregnant women. When the likelihood of gestosis is greater

Gestosis during early and late pregnancy is a formidable complication. In some cases, delay in diagnosis and treatment threatens the death of the 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 future mothers.

What is late gestosis and why 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, fetal growth retardation and hypoxia in it.

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

Causes of preeclampsia (late toxicosis)

The main cause of 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, disturbances in the formation of the placenta, those vessels that connect it with the uterus, occur. And the longer the gestation period, the more obvious the violations that have arisen as a result of this become. The child lags behind in development, has a small weight, a lack of oxygen is diagnosed on CTG. A woman, on the other hand, has signs of arterial hypertension (increased blood pressure) and kidney problems.

There is more than one theory of the occurrence of gestosis. Often associated with deficiency folic acid(vitamin B9), endocrine pathologies (thyroid diseases, diabetes), weak nervous system, susceptibility to stress. Some honey. the authors generally recommend considering early and late gestosis as a kind of neurosis of pregnant women. Therefore, it is recommended to carry out its prevention with light 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 grandmother, mother had late gestosis of pregnant women, then their daughters and granddaughters will certainly have them);
• age future 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 preeclampsia in the later stages

Often the first "swallow" is a delay in the development of the fetus. 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, less than average. Problems with the placenta can be determined, for example, its premature maturation, as well as circulatory disorders in the vessels of the placenta (according to Doppler sonography).

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

1. Edema. They can be overt and covert. The common ones first appear on the ankles and fingers. However, such swelling may not be a symptom of late preeclampsia, 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 swelling spreads to the whole body, face. And especially if they are already present in the morning, after a night's sleep.

Hidden edema in late pregnancy is manifested by an excessive increase in weight by the expectant mother. That is why doctors carefully weigh the expectant mother at each consultation. They try not to miss gestosis in mommy, as the consequences for the child and herself threaten to be very serious.

If the expectant mother has gained more than 500 grams in 1 week, while she feels good and all tests are normal, the doctor recommends that she conduct 1-2 fasting days, diet and drinking regimen. And carry out a control weighing in 1-2 weeks.
Many mothers know that in order not to frighten the doctor with the numbers on the scales, you need to eat a little less and drink less in the afternoon the day before the visit to him. And, of course, do not eat up and do not drink water immediately before a visit to the doctor. Going to the toilet before weighing also does not hurt. And don't wear more clothes than usual. Otherwise, the resulting figures will not be informative.

Normally, weight gain per week during pregnancy does not exceed 400 grams. Thus, during the entire pregnancy, a woman gains up to 12 kilograms of weight. A greater number of these kilograms is the weight of the child, placenta, amniotic fluid, increased blood volume. Normally, more fluid is retained in the tissues of the expectant mother than before pregnancy. If a woman is not overweight during pregnancy, after childbirth she loses overweight already within 1-2 months.

Often preeclampsia during late pregnancy is manifested not only by edema, but also by reduced diuresis. That is, a woman drinks quite a lot, but goes to the toilet very little. This is a very dangerous symptom. Doctors advise all patients with edema to measure the amount of fluid drunk and excreted. If there is early gestosis or late, and in a rather severe form, the amount of urine is reduced to 500-700 grams.

2. Protein in the urine. He says that there are problems with the kidneys. But not always. If only traces of protein were found, then, most likely, mommy ate a little more than usual protein foods. Or just poorly washed before collecting urine.

If traces of the protein are also present in repeated analyzes, while the gestation period is still short, say, 10-12 weeks, the pressure is normal, there are no edema, gynecologists usually refer such a patient to urologists. They look at the anamnesis, which shows the ultrasound of the kidneys and prescribe treatment if necessary.
It should be noted that kidney problems - cystitis, pyelonephritis are very common during pregnancy.

If the doctor believes that the patient develops preeclampsia, then she is asked to pass the so-called daily urine test. Usually performed in a hospital setting. During the day, a woman urinates in one container. Then he evaluates and tells the doctor the total volume of urine, mixes it and pours a part for laboratory research.

Pregnancy eclampsia, the most formidable consequence of preeclampsia, usually occurs when the numbers are 2 grams of protein in a daily urine test.

3. Increased blood pressure. In this case, the doctor must distinguish preeclampsia from ordinary hypertension, that is, the condition that the woman had before pregnancy, and was not provoked by her.

If at the reception the patient was found to have a pressure above 130 to 90, she is recommended to control it at home. Measure 2-3 times a day, according to all the rules (in the right position, complete calm) and record the result. It often happens that in women the pressure rises exclusively at the doctor's office, the so-called white coat syndrome. In this case, talking about hypertension or preeclampsia is unnecessary.

With gestosis, the pressure usually rises by about 30 units of the upper one. That is, if the pressure of 110 to 70 is normal for a woman, then with gestosis it rests on the numbers 140 to 90 or more.

If there are no other signs of preeclampsia, the patient is referred to a cardiologist, who can prescribe daily monitoring of blood pressure (a special device is attached for a day), an ECG, an ultrasound of the heart, and a pressure-lowering drug approved for use during pregnancy - Dopegit.

Exist different forms preeclampsia. In Russia, four names are used to clarify the diagnosis:

• dropsy (the woman has swelling, hidden or obvious);
• nephropathy (high blood pressure, protein in the urine and swelling);
• preeclampsia (increased intraocular pressure, headaches, vomiting, nausea, fog before the eyes, flashing flies) - at any moment the last, fourth stage of preeclampsia can occur;
• eclampsia (a woman begins to have convulsions, loss of consciousness, the work of various organs and systems is disrupted, a stroke, premature detachment of the placenta can occur).

Research and analysis during pregnancy to detect preeclampsia

1. General analysis of urine. Rented every two weeks, before going to the gynecologist. Or more often if necessary.

2. Blood pressure measurement. At every doctor's appointment, and often at home.

3. Inspection of the fingers and ankles for swelling. The doctor looks to see if there are traces of worn rings, socks.

4. Weighing, dynamic tracking of weight gain. Now almost all antenatal clinics have convenient electronic scales for these purposes.

5. Screening ultrasound and dopplerography. On the first screening ultrasound (11-13 weeks), preeclampsia of the first half of pregnancy (early preeclampsia) is manifested by narrowing of the vessels of the uterus. This indicates a defective formation of the placenta.
At the second ultrasound (20-22 weeks), they look for any lag in the development of the fetus. At 32-34 weeks, the third planned ultrasound is performed, which not only assesses the development of the fetus, but also the condition of the placenta and amniotic fluid.

6. Determination of the concentration of proteins, hormones formed by the placenta. A decrease in the PAPP-A protein and the PIGF hormone at the end of the first trimester of pregnancy indicate placental insufficiency and a probable delay in fetal development. At the same time, obvious violations may not yet be visible on ultrasound.

Prevention and treatment of preeclampsia during pregnancy

If a woman is only concerned about swelling, that is, she still has the so-called dropsy, she is not sent to the hospital, but a diet and a normal drinking regimen are recommended. You don't need to cut back on drinking. You should drink exactly as much as you want. It is also not necessary to limit salt, in the sense that you can add salt to food as before. But from pickles, sausages, chips and others, not too useful products containing a lot of salt, it is better to refuse.

In the pregnancy pathology department, edema is “treated” with diuretics. And in order not to provoke complications of late gestosis, they make droppers with "magnesia". It also serves as a prevention of premature birth.

In addition, the woman is given mild sedatives. plant origin- valerian and motherwort. They are advised to use by expectant mothers in the form of decoctions. But it is also available in tablet form.

Preeclampsia after childbirth gradually subsides, the symptoms disappear. Childbirth is the only cardinal treatment for it. All the rest of the drugs used by doctors are symptomatic therapy aimed at stabilizing the condition of the pregnant woman and monitoring the condition and development of the child. If the doctor sees deterioration, suffering of the child, delivery is performed. Most often, this is an emergency caesarean section. If the pregnancy is premature, the mother is given dexamethasone injections so that the baby's lungs open after birth.

Specific prevention of preeclampsia during pregnancy, which can be carried out among all expectant mothers, as you might guess, is also absent. After all, the cause of occurrence, the reason for the development of late toxicosis, is not exactly known. However, competent pregnancy planning and timely treatment of exacerbations of chronic diseases and infectious diseases will definitely benefit.

Pregnancy after preeclampsia may well be the same problem, end at the same time or earlier, the woman is at risk for nephropathy.
If she did not have late preeclampsia - this is the usual preeclampsia of the second half of pregnancy, and the one that is called early, it makes sense to talk with the doctor about the prophylactic use of aspirin in small dosages. This is the only way to date to prevent preeclampsia in the risk group.

30.10.2019 17:53:00

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

Preeclampsia 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. AT recent times this diagnosis is 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 that the woman had not previously known about may become aggravated and manifest. The body due to the presence of certain defects and " weaknesses» can not cope with the load, violations develop in vital organs and systems.

Preeclampsia is usually diagnosed in the third trimester of pregnancy. However, the process of occurrence of pathological changes in the body begins earlier - at the 17-18th week.

Specialists 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 gestosis 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 are already talking about gestosis of the 2nd half of pregnancy. It is he who causes the greatest concern.

Causes of preeclampsia

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 disorders in the circulatory system that provoke gestosis with malfunctions in the regulation between the cortex and subcortex of the brain resulting from the body's addiction to pregnancy;
• the hormonal theory blames the occurrence of a state of disruption in the work of the adrenal glands, deviant 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 alien to it, as a result, the body tries in every possible way to reject the foreign body. There is another immunogenetic version, the proponents of which believe that, on the contrary, the maternal organism, in response to the antigens coming from the placenta into the bloodstream, does not produce antibodies in sufficient quantities, as a result, defective complexes circulate in the bloodstream, which have a negative effect, first of all, on kidneys;
• theory of inheritance: if a woman’s mother and grandmother suffered from a serious condition, then this fate is unlikely to escape her, and therefore it is necessary to pay Special attention disease prevention.

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

The chances of making a diagnosis are greatly increased by conditions such as:

• obesity;
• endocrine pathologies;
• diseases of the liver and kidneys;
• diseases of the cardiovascular system;
• allergic reactions.

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

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

If the expectant mother did not suffer from preeclampsia while carrying her first child, then the chances that he will manifest himself in an existing pregnancy are small. If a pregnant woman has a history of serious illness or belongs to a risk group, attention to her condition by 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 blood vessels decreases, the nutrition of organs and cells is disrupted. This leads to the fact that they begin to cope poorly with their work.

First of all, brain cells, as well as kidneys and liver, suffer from insufficient blood supply. Such a situation turns into a disaster 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 tests indicate that a condition that threatens her health and the life of the fetus develops in the body.

The following stages of development of gestosis are distinguished:

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

Edema during preeclampsia can also be hidden - in this case, the specialist suspects too much weight gain in the patient. And sometimes the woman herself suddenly begins to notice that wedding ring he dresses with difficulty, 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 your thumb on the skin. If a light trace remains in this place for a long time, then swelling is present.

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

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

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

The second stage of preeclampsia, 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 preeclampsia during pregnancy, indicating 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 lower the chances of a successful pregnancy outcome.

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

The symptoms of this condition are:

• flies or fog before 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, diuresis decreases, the proportion of platelets in the blood decreases and its coagulability decreases.

fourth and most dangerous stage late preeclampsia during pregnancy is eclampsia. Most often, this condition is manifested by convulsions - they can be provoked by any stimulus: a 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 convulses, losing consciousness. The non-convulsive form of eclampsia is considered even more dangerous, when a pregnant woman suddenly falls into a coma due to pathological processes occurring in the body and high pressure indicators.

Eclampsia threatens with such serious consequences as:

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

Diagnosis of preeclampsia

If a woman registers in a timely manner and does not miss scheduled visits to the doctor, preeclampsia will not go unnoticed. Modern medical practice provides for regular testing and examination of patients. Based on the results of these research procedures, signs indicating the development of a dangerous condition are revealed.

So, suspicions may arise when abnormalities are detected during such medical events as:

• weighing a pregnant woman (fears cause an increase of more than 400 grams per week, although everything is individual here: you need to take into account both the duration of pregnancy and the weight of a woman when registering);
• urinalysis (even traces of protein are a reason for a more detailed examination);
• examination of the fundus;
• measurement of blood pressure;
• analysis of the ratio "volume of fluid drunk: excreted urine";
• blood coagulation analysis;
• general blood analysis.

If an accurate diagnosis is made, it is necessary to monitor the condition of the fetus, carried out by means of ultrasound + Doppler. For periods after 29-30 weeks - CTG. At the same time, the woman is additionally observed by narrow specialists: a nephrologist, a neurologist, an oculist.

Treatment of preeclampsia

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

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

In the absence of improvement on the background of treatment or, moreover, the progression of a dangerous condition, we are talking about early delivery. In this case, the presence of a child in the womb becomes more dangerous than its birth 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 preeclampsia

Women at risk should pay special attention to the prevention of preeclampsia during pregnancy. And it is necessary to start acting 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 pregnancy occurs, it is necessary to register as soon as possible. When the condition of the pregnant woman is under the control of specialists, many problems can be identified and eliminated even at initial stages. Patients often have to take tests and visit a antenatal clinic, where they are weighed and pressure is measured every time.

The following simple measures are excellent prevention of preeclampsia:

• limiting the amount of fluid you drink and salt consumed (especially in the second half of pregnancy);
• full sleep for at least 8 hours;
• adequate physical exercise;
• walks in the open air;
• avoidance of stress;
• a full-fledged vitamin-rich food and the right diet (better little by little, but often).
• fatty, salty and spicy foods 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.

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

Fortunately, a timely visit to the doctor leading the pregnancy is a guarantee of recognizing the disease at an early stage. With a competent approach, pregnancy after the treatment of preeclampsia and further childbirth proceed without complications.

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Preeclampsia, or preeclampsia, is a pathology of pregnancy that occurs in the later stages and is characterized by an increase in blood pressure, the appearance of edema, and the detection of protein in the urine. Preeclampsia remains one of the most important causes of maternal death in the world, since its occurrence and course is unpredictable, and the most effective method of treatment is delivery. Child mortality in preeclampsia exceeds the average by several times.

Causes and theories of the disease

Preeclampsia occurs only in pregnant women. Doctors believe that in some women the body cannot adapt to the new conditions of existence for it during pregnancy, there is an overstrain of all systems, preeclampsia occurs.

At risk for the development of this pathology are pregnant women:

• under 18 years of age;
• With multiple pregnancy;
• those with kidney disease, autoimmune diseases (eg, systemic lupus erythematosus, rheumatoid arthritis, sarcoidosis);
• had high blood pressure before pregnancy;
• obese (body mass index greater than 30);
• with mutations in the hemostasis system (PAI-1, Leiden);
• with diabetes mellitus, especially uncontrolled.

In the presence of one or more risk factors, a woman's body ceases to cope with a high load, vasospasm and circulatory disorders occur. Generalized vasospasm leads to failure of all organ systems.

Classification of preeclampsia

To determine the tactics of treatment, it is advisable to distinguish between moderate and severe preeclampsia during pregnancy.

Moderate preeclampsia is characterized by an increase in pressure above 140/90 mm Hg. and the detection of protein in the urine in an amount of 0.3 to 5 g / l. The diagnosis of severe preeclampsia is made when the pressure rises above 160/110 mmHg. and detection of protein in daily urine more than 5 g/l. In this case, additional symptoms may be detected:

• headache;
• visual disturbances ("flies" before the eyes);
• nausea or vomiting;
• pain in the stomach, right hypochondrium;
• swelling;
• lethargy and apathy;
• weakness and drowsiness;
• fetal growth retardation;
• changes in the biochemical blood test (increased creatinine, AST, ALT, decreased platelets).

Diagnosis of preeclampsia

The final diagnosis of late gestosis can only be made by the attending physician. The diagnosis is made when a woman has edema, high blood pressure from 140/90 mm Hg, when protein is detected in the urine.

It is important to know that most often preeclampsia is accompanied by so-called latent edema. They can be recognized if they have:

• pathological weight gain of more than 350 grams per week;
• decrease in daily urine volume below 900 ml;
• nocturia (a condition where the volume of urine excreted at night exceeds the daily volume);
• a positive “ring symptom” (rings that were previously freely removed from the fingers become impossible to remove).

A gynecologist should measure blood pressure at each visit to a pregnant antenatal clinic. In controversial cases (in some women, for example, the pressure rises only at a doctor's appointment), it is recommended that a pregnant woman measure blood pressure on her own every day and keep a diary, where morning and evening measurements are entered. If a woman does not have the opportunity to take measurements on her own, the gynecologist can write out a referral to a hospital where blood pressure monitoring will be carried out during the day (ABPM) with a special device. This method of diagnosing hypertension in pregnant women is the most accurate.

A urinalysis is also required before each visit to the doctor. The development of preeclampsia is indicated by the appearance of protein and a decrease in the density of urine. To avoid errors in the results, women must correctly collect urine for analysis.

1. On the eve of the test, products with diuretic properties (watermelon, coffee) are excluded from the diet of a pregnant woman, the use of meat dishes and legumes is limited.
2. The morning portion of urine is used. Urine is collected immediately upon waking, preferably after an uninterrupted 6-hour sleep.
3. Urine is collected in a sterile disposable container.
4. Before collecting the analysis, the woman spends the toilet of the external genitalia without using hygiene products and soap, the entrance to the vagina must be closed with a sterile cotton or gauze swab (to prevent vaginal discharge from entering the urine container).
5. An average portion of urine is collected for analysis.
6. The container must be delivered to the laboratory within 1-2 hours. If delivery takes longer, then the urine container should be stored in the refrigerator, but not more than 6 hours.

Additionally, the gynecologist prescribes a biochemical blood test and a coagulation test (coagulogram) for pregnant women. The development of gestosis may indicate:

• increased urea and creatinine;
• decrease in protein in the blood;
• decrease in platelets.

Preeclampsia in women with hypertension

In pregnant women with arterial hypertension, the diagnosis of preeclampsia causes some difficulties. The diagnosis is made in the following cases:

• against the background of high blood pressure, protein is detected in the general urine test;
• previously controlled hypertension becomes uncontrolled, blood pressure becomes higher than usual for this woman;
• the appearance of signs of cardiovascular or renal failure, that is, the appearance of edema, severe shortness of breath.

It is worth noting that in women with hypertension, the risk of developing complicated preeclampsia is very high.

Complications and gestosis

The most formidable consequences of preeclampsia include HELLP-syndrome and eclampsia.

Eclampsia can occur in a woman with preeclampsia during late pregnancy. The diagnosis is made when, against the background of a preeclampsia clinic, a pregnant woman develops generalized convulsions, that is, an involuntary contraction of all muscle groups. Most often, the harbingers of the development of an attack and the most early symptoms is a very severe headache, not relieved by taking painkillers, and involuntary contraction of the muscles of the face.

HELLP-syndrome is characterized by a rapid course and a rapid increase in symptoms. Pathology develops due to a violation of the liver. A pregnant woman develops yellowness of the skin, vomiting with a small amount of blood, convulsions, hemorrhages at the injection sites. The occurrence of the above symptoms is combined with headache, general weakness, pulling pains in the right hypochondrium. To diagnose the HELLP syndrome of a pregnant woman, it is necessary to pass a general and biochemical blood test, in which a decrease in the level of platelets, an increase in liver enzymes (AST and ALT) and signs of hemolysis are detected.

In addition, preeclampsia may be accompanied by retinal detachment, cerebral hemorrhage, pulmonary and cerebral edema, placental abruption, and fetal death.

Basic principles of treatment of preeclampsia

Since the cause of preeclampsia is the mother's rejection of the fetus, the most effective treatment for preeclampsia is delivery. With gestosis of moderate severity, a woman is shown hospitalization in a hospital. There is monitoring of her condition and the condition of the child. In most cases, continuation of the pregnancy is possible. Delivery is indicated with a significant deterioration in the condition of the mother and fetus.

In severe preeclampsia, delivery is carried out immediately after the stabilization of the mother's condition and, if possible, after the prevention of RDS (respiratory distress syndrome) of the fetus with a gestational age of up to 34 weeks. Delivery should be carried out in institutions high level. Prevention of respiratory disorders of the fetus involves the introduction of corticosteroids according to special schemes.

According to the recommendations of the WHO (World Health Organization), if preeclampsia occurs before the 24th week of gestation, it is advisable to terminate a dangerous pregnancy. When preeclampsia occurs at a period of 25-34 weeks, they try to maintain and prolong the pregnancy. If preeclampsia occurs after the 35th week, delivery is possible. In this case, delivery can be emergency in the following cases:

• bleeding from the birth canal;
• acute fetal hypoxia (according to the results of CTG);
• eclampsia;
• persistent severe headache and vision changes;
• indomitable vomiting;
• untreated arterial hypertension;
• pronounced decrease in platelets;
• oligohydramnios.

In other cases, planned delivery is acceptable.

Medical treatment for preeclampsia

For the treatment of preeclampsia, drugs of various groups are used - reducing pressure, drugs for the treatment of seizures, diuretics, infusion therapy.

It should be remembered that only a gynecologist can select the drug and its dosage. With an excessive decrease in blood pressure in a pregnant woman, circulatory disorders in the placenta are possible, and this can cause a deterioration in the condition of the fetus, hypoxia, or even death.

For the prevention and relief of seizures, a woman can be prescribed magnesium sulfate (magnesia). After childbirth, the administration of magnesium should continue for 24 hours. As infusion therapy, intravenous administration of a special saline solution in moderate volumes (about one liter per day) is used. Diuretics are used only when pulmonary edema begins.

Features of delivery of women with preeclampsia

In the second stage of labor (the pushing period), an episiotomy is often performed to shorten the duration of this stage.

In the third stage of labor (the period of separation of the placenta), oxytocin is administered to the puerperal to prevent bleeding to reduce the risk of massive bleeding. Epidural anesthesia is indicated for the prevention of convulsions during childbirth.

Prevention of preeclampsia

For women at high risk of developing preeclampsia, low-dose aspirin (75 mg daily) is recommended. This is done with the written informed voluntary consent of the pregnant woman, since, in accordance with the instructions, taking acetylsalicylic acid in the first trimester of pregnancy is contraindicated.

Pregnant women are shown an additional intake of vitamins containing calcium (1 mg per day). Calcium, acting on the vessels, prevents the development of arterial hypertension in a pregnant woman. Positive influence on the vascular wall has the intake of omega-3 unsaturated fatty acids. Prevention methods such as resting on the left side in the morning and evening, limiting salt intake, using heparin, taking diuretics, garlic, have not proven effective.

Weight gain, swelling - many women who have been pregnant have experienced these unpleasant manifestations. But when body weight begins to become critical, and edema appears not only on the arms and legs, but also on the face, doctors can make an unpleasant diagnosis - preeclampsia. In professional language, preeclampsia is preeclampsia.

Preeclampsia this is a rather dangerous complication of a normal pregnancy, which may not manifest itself, or it may manifest itself as edema, increased pressure, loss of protein in the urine, and convulsions. This complication is in second place in Russia as a cause of maternal mortality.

Fortunately, this is not a chronic disease that can overcome a woman all her life. A complication during pregnancy that occurs with its onset disappears after childbirth. Worldwide, about a third of all expectant mothers suffer from this.

What is gestosis during pregnancy

Gestoses are divided into two groups:

1. Signs of preeclampsia (toxicosis) in the early stages are manifested in increased salivation, loss of taste and smell after vomiting. It can be not only in the morning, but repeated several times a day, mainly after meals. Usually, these symptoms begin from the 4th and last until the 12th-14th week of pregnancy. If toxicosis is with complications, then vomiting occurs regardless of whether the woman ate or not. The patient loses weight, exhaustion sets in, the temperature may be slightly elevated. This form of pathology is easily treatable.
2. Preeclampsia during late pregnancy can begin from the 16th week and continue until childbirth. It is characterized by a large increase in weight, over 20 kg. Against the background of poor kidney function, edema appears not only in the arms and legs, but also in the face. At further development possible swelling of the thighs, abdomen, external genitalia. This dangerous swelling also affects the place in which the child is located.

Changes in a woman's body cause substances that occur in the placenta and make microscopic holes in the vessels. Through these holes, plasma, protein, liquid penetrate into the organs, causing edema. Hostile substances attack the kidneys, and the urine becomes filled with protein. The more gaps there are, the more protein is lost.

Assessment of the degree of preeclampsia according to Savelyeva G.M.

What is dangerous gestosis during pregnancy

When the liquid disappears from the vessels, increased pressure appears in order to pump the liquid that remains through the body. Dehydration of the vessels also threatens with blood clots due to the fact that the blood has thickened.

That is why doctors at each appointment prescribe a urine test. Thus, deviations from the norm can be detected in time, a correct, timely diagnosis can be made and life-saving treatment can be started.

A woman can feel great for a long time, not complain about anything, not pay attention to weight, pressure and swelling. But preeclampsia during pregnancy, as an insidious enemy, is able to manifest itself a few hours, minutes, before the main blow.

Due to placental edema and lack of oxygen, hypoxia may form in the fetus. Because edema covers the entire body of a pregnant woman, the brain suffers - there is a high probability of an attack of seizures.

Against the background of such a condition, a heart attack, stroke, exfoliation of the "children's place" and the retina of the eye, pulmonary edema, pathologies in the kidneys and liver can develop.

The sudden onset of symptoms (nausea, headache, "flies" before the eyes, drowsiness, painful spasm in the stomach) are a signal that a convulsive attack is starting.

This can lead to the death of the mother and child. That is why consulting doctors pay so much attention to monitoring, prevention and timely diagnosis of gestosis.

To alleviate the patient's condition, doctors must eliminate visual, tactile, auditory stimuli. Maintain the proper functioning of the lungs and kidneys, stop a possible seizure. If the condition is critical, then apply emergency delivery.

How to identify gestosis?

If a woman, putting on rings, notices that they are small, it is difficult to bend her fingers into a fist - this is a reason to suspect swelling. The doctor, seeing such a pathology during the examination, may offer to make a sample from saline. The drug, penetrating into the subcutaneous adipose tissue, forms a "button". The doctor notes the time and if the papule resolves in 35 minutes, then suspicion of latent edema may occur.

The presence of the entire "set" of edema in different parts of the body, poor urine tests, hypertension - this is a reason to go to the hospital! It is not necessary to have all the symptoms, there may be 1-2.

The condition of a pregnant woman can deteriorate very quickly. Self-medication is inappropriate here, and delay in such a situation is dangerous.

In no case should you take any diuretic drugs, the vessels are already dehydrated, all the liquid has gone into the tissues.

Risk group

• women over 35
• primiparous,
• those who bear 2 or more children,
• ladies suffering from chronic diseases (obesity, diabetes, kidney disease, hypertension),
• having sexually transmitted infections.

Prevention of preeclampsia - the fight against excess weight

A pregnant woman is shown a complete, balanced diet. But this does not mean that she should eat everything and how much she wants. Otherwise, the result can be disastrous - obesity and preeclampsia.

The diet of the expectant mother should include the protein necessary for the development of the child's body. This construction material is in meat, eggs, fish, cottage cheese. Saturated protein food is especially important if there are manifestations of preeclampsia, because through the micro-holes the protein goes into the urine.

Plant foods must be present in the diet of a pregnant woman. A large amount of fiber is the prevention of constipation. All kinds of vegetables and herbs are desirable on the table, it is recommended to include mushrooms, seaweed, bran.

Sweet and fatty foods are undesirable at all, in extreme cases, make restrictions. Exclude pastries, ice cream, sweets. It is better to add fruits to your diet. Sometimes you can eat marshmallows and marmalade, they have a lot of pectin.

For the entire pregnancy, a woman should gain 10-15 kg, depending on whether she was overweight before pregnancy or was thin.

If there is a swimming pool near the house - swim. Before starting classes, it is advisable to consult with your doctor leading the pregnancy.

To prevent swelling, you can drink herbal teas. Rosehip, lingonberry leaf, bearberry, cranberry are weak diuretic herbal remedies. They will not harm the body and can help not to bring the condition to the point where you need to take drastic measures.

Good preparation for pregnancy, compliance comfort mode day and proper nutrition, sufficient rest and physical activity, following the recommendations of doctors - there is a guarantee of a normal course of pregnancy and the successful appearance of a long-awaited baby.

All women who have children know about the peculiarities of the course of pregnancy and monitoring it: constant monitoring by a gynecologist, regular checks of tests, weighing and ultrasound. Some girls have a question, why get on the scales every time. Excessive weight gain indicates the appearance of edema. And they, in turn, are a sign that preeclampsia develops during pregnancy.

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

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

The reasons

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

The main cause of preeclampsia in pregnant women is a violation in the regulation of blood vessels. As a result, spasm occurs. The target of changes is the microvasculature.

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

Signs of preeclampsia during pregnancy are quite characteristic. They are all expressed by the abbreviation OPG. It stands for edema, proteinuria and. The whole symptom complex is not always noted.

The most common symptom is swelling of the hands. Due to the increase in the amount of water consumed, the exit of which is difficult, it is retained in the space between the tissues. There may be swelling of the hands and feet, with severe swelling spread throughout the body. Sometimes there are no clear signs. You can find any changes only when weighing.

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

• 5 degree.

If left untreated, the condition continues to worsen. The so-called HELLP syndrome develops. Vomiting begins with blood, jaundice appears. In extremely severe cases, coma is possible. Lethal outcome is likely in 80% of cases.

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

Some pregnant women are affected by other types of gestosis:

• Softening of the bones. There is a destruction of the teeth, pain in the bones and joints, gait is disturbed. It develops against the background of a lack of vitamins in the body, and especially calcium.
• Increased production of saliva. Excess salivation appears before vomiting. As a result, the body suffers from a lack of water, dry mouth appears, as a result of which speech changes and the oral mucosa is damaged.
• Jaundice. At the same time, its other forms do not develop. Careful diagnosis of these two conditions is necessary to rule out liver infection.
• hepatic atrophy. Most often occurs in the first trimester. No therapy is available. To improve the condition, termination of pregnancy is recommended.

Complications

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

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

• Edema of the lungs, brain;
• Hemorrhages in the brain, liver, lungs and other organ systems;
• Violation of the normal functioning of the heart and blood vessels;
• Placental abruption;
• Violation of the kidneys;
• Changes in the course of fetal development, its remaining from the norm;
• premature birth;
• Violations of the hepatobiliary system;
• Intrauterine oxygen starvation of the child;
• Changes in vision, its deterioration;
• Infant and maternal mortality.

But all this can be avoided. Regular, urine and a visit to the doctor once a month with the appointment of appropriate therapy will not allow preeclampsia to develop.

Diagnostics

All pregnant women constantly take a large number of tests, so the diagnosis of preeclampsia during pregnancy is not difficult. If there are any deviations from the norm, some studies may be scheduled outside the plan. In addition, other diagnostic procedures are used.

The main studies include the following:

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

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

Treatment

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

Treatment of gestosis has the following directions:

• Creating a calm atmosphere around the pregnant woman.

Emotional shocks should be completely excluded. Loud noise, light, and excessive exercise can make the condition worse. With a mild course, the use of valerian or motherwort preparations is recommended. If there is a more severe form, then the gynecologist selects the drug based on the individual characteristics of each patient.

• Improvement of blood circulation of the placenta and fetus.

Sedative, antihypertensive, diuretic drugs and antispasmodics prevent the development of hypoxia in the child. If this happens against the background of already existing somatic diseases, then they are treated.

• Preparing a pregnant woman for preterm birth.

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

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

The following diagnostic procedures are carried out in the hospital:

• Urinalysis, including a Zimnitsky test;
• Study of the condition of the fetus;
• Study of blood parameters.

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

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

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

What should not be allowed:

• Obesity.

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

• Limiting vitamin and fiber intake.

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

• A large number of flour products and sweets.

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

• Violation of the drinking regime.

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

Physical activity has a good effect on the course of pregnancy. Yoga, pool, Pilates have a positive effect on vitality. In addition, trained muscles will endure the process of childbirth much easier. But don't overuse it. Any state changes cancel all loads.

Preeclampsia in pregnant girls and women is a fairly common disease. Prevention is much easier than cure. Monitoring your condition and visiting a doctor will not allow complications to develop.