Signs of gestosis in the 2nd trimester. Gestosis of the second half of pregnancy, symptoms

During pregnancy, it would seem that a woman should be happy and peaceful. But in fact, this is a very important period, nine months long before the baby arrives. The body of a pregnant woman does a tremendous amount of work, in which almost all organs and systems are involved. Even the slightest failure in this process can provoke serious complications, and therefore the expectant mother needs to be very attentive to her health. Indeed, during pregnancy, many diseases that a woman might not even know about before can worsen; complications may appear and ailments may develop. But the most serious complication of pregnancy is gestosis. They always scare pregnant women, justifying the need to undergo endless tests throughout pregnancy and not miss consultations with obstetricians and gynecologists and monitor their weight.

Gestosis in pregnant women is a late toxicosis. Normally, gestosis appears in the third trimester of pregnancy after 35 weeks and proceeds in a mild form for 1-3 weeks (the so-called “pure gestosis”). In more severe cases, second trimester gestosis may also develop, appearing at 20-24 weeks and lasting 4-6 weeks (“combined gestosis”). And even after childbirth, late gestosis can be observed within 2-3 weeks.

The main symptoms of gestosis during pregnancy are:

• the occurrence of edema (the so-called dropsy of pregnancy);
• protein is detected in a urine test;
• an increase in blood pressure is observed.

Preeclampsia creeps up unnoticed. Against the background of general good health, swelling occurs, which a woman may not immediately pay close attention to, attributing it to the heat or to the herring and pickled cucumber eaten the day before. And then, for some reason, a test came from the laboratory with the conclusion that protein was found in the urine. But she feels good until her blood pressure starts to rise. And the following signs of gestosis during pregnancy are added: sleep disturbances and headaches, cramps and nausea. This condition requires medical attention.

Oddly enough, despite many different theories and opinions, medicine still does not know the true cause of gestosis, which is why it is also called the “disease of theories.” It is believed that the manifestation of this disease is facilitated by a combination of various factors, chronic diseases and genetic characteristics of the body.

There is a risk group of pregnant women who are more likely to develop gestosis than others:

• the age of the pregnant woman is up to 18 and from 35 years;
• complications in the first trimester of pregnancy;
• burdened somatic, gynecological and obstetric history;
• neuroendocrine pathologies, diabetes, problems with kidneys, liver, etc.;
• Preeclampsia is more common in the first pregnancy, preeclampsia in the second pregnancy is observed much less frequently;
• There is also a high probability of gestosis during multiple pregnancies.

And many other factors. However, even a pregnant woman who does not belong to any of the risk groups may develop gestosis as a result of past infections or immune complex pathology.

The fact is that it is precisely the theory of the vascular cause of gestosis that official medicine leans towards. That is, a malfunction in the functioning of blood vessels, or more precisely in their inner lining - the endothelium - leads to microthrombosis in the woman’s organs - kidneys, brain, etc., as well as the placenta.

Why is gestosis dangerous during pregnancy?

Don’t panic, be afraid, diagnose yourself with “preeclampsia” and start self-medicating. Trust your doctor to diagnose your condition. At the initial stage, the disease is quite easily controlled with medications under the supervision of a doctor. If it is started, more severe degrees of pregnancy gestosis may develop. Their severe course is fraught with danger to the life of both mother and child, therefore, in some cases, if the duration of pregnancy allows, a decision is made on emergency delivery. Swelling of visible parts of the body is not such a problem compared to the fact that the placenta swells along with all organs. This causes oxygen starvation of the fetus, up to its death in especially severe cases. The pregnant woman herself may develop cerebral edema. That is why, at the slightest suspicion of the occurrence of gestosis, you should immediately inform your doctor about it.

Stages of gestosis during pregnancy

There are four stages or degrees of gestosis during pregnancy:

1. The so-called dropsy of pregnancy. It flows quite easily. The only visible symptoms are swelling of the hands or swelling of the legs. But you shouldn’t judge gestosis based on this sign alone; you just need to voice this to the doctor at the next scheduled visit.
2. Nephropathy, which can affect the kidneys. A sharp increase in pressure is added to the swelling. Nephropathy can quickly develop into eclampsia - the most severe degree of gestosis. This stage requires immediate treatment and medical supervision.
3. Preeclampsia, which impairs the blood supply to the central nervous system. Accompanied by symptoms such as protein in the urine and high blood pressure. Nausea and vomiting, severe headaches, and visual disturbances are possible. Against the background of preeclampsia, mental disorders of varying degrees even occur.
4. Eclampsia is the most severe condition in which convulsions occur, even a stroke, brain swelling can occur, and the functioning of many organs is disrupted. Rapid aging is observed, placental abruption, fetal hypoxia and even death are possible.

For the fetus, gestosis is dangerous due to oxygen starvation, since blood circulation in the placenta is disrupted. All three last stages are very dangerous and flow from one to another very quickly.

In fact, no one is immune from the manifestation of gestosis. To one degree or another, its course is noticed in almost 30% of pregnant women, but, thanks to modern medications and the supervision of doctors, serious consequences can be avoided and most often it passes almost unnoticed.

Prevention of gestosis during pregnancy

Unfortunately, there is no recipe that can be used to prevent the occurrence of gestosis in the second half of pregnancy. However, general recommendations must be followed. And this: do not overwork, do not be nervous, follow a daily routine, get enough sleep, walk more in the fresh air, eat right. You need to limit salty, smoked and sweets, and monitor weight gain. You don't have to eat for two, but you don't have to starve either. There should be moderation in everything. Physical activity is good, but only in the form of walking, swimming in the pool and exercises only under the supervision of an instructor for pregnant women. And in the event that there are no contraindications from the doctor who is managing the pregnancy.

For a pregnant woman, a simple seasonal infection or flu can turn into big troubles. You need to make every effort not to get sick. To do this, you should avoid crowded rooms, especially during an epidemic.

If the expectant mother works, there is no need to risk her health and work after 30 weeks of pregnancy. Until this date, it is also advisable to work in a more gentle mode.

Treatment of gestosis during pregnancy

The most important thing is to immediately consult a doctor at the first suspicion of gestosis! At the initial stage of late gestosis during pregnancy, it is quite possible to get by with treatment at home, provided you follow all the doctor’s recommendations. However, you need to be prepared for the fact that the doctor will insist on hospitalization. There is no need to be stubborn and question the appropriateness of this appointment.

Most likely, first you will have to undergo a large number of tests and be examined by several specialists to assess the condition of the body. After which treatment will be more accurately prescribed.

However, in advanced cases of the appearance of gestosis, they can be admitted to the hospital immediately and closer to the intensive care unit. Therefore, there is no need to delay treatment in the early stages.

When diagnosed with gestosis, a woman should drink no more than one liter per day and follow a diet. The diet should contain a sufficient amount of proteins and vitamins; salty and smoked foods are prohibited. All this is aimed at controlling the accumulation of fluid in the body.

The practice of treating gestosis during pregnancy most often consists of prescribing sedatives; depending on the patient’s condition, it is possible to prescribe diuretics and blood pressure-lowering drugs. Placental insufficiency is also prevented, and medications are used that improve blood flow in the vessels and directly in the placenta.

The main task of every pregnant woman is to follow the general recommendations of doctors, not miss consultations and take prescribed tests on time. And also lead a healthy lifestyle and eat right according to your situation. But, the most important thing is to be attentive to your well-being and report any ailments to your doctor. And then, even if gestosis in pregnant women does not bypass, its serious consequences can be avoided. And along with the end of pregnancy, gestosis will definitely pass.

Severe gestosis in the second half of pregnancy is characterized by serious changes in the body of the expectant mother. The severity of this condition is individual for each pregnant woman.

In order for this condition not to overshadow the process of expecting a child, every expectant mother should become familiar with the peculiarities of its course and methods of combating the manifestations of toxicosis.

Preeclampsia in the second half of pregnancy is a severe form, which includes a whole range of disorders of organs and systems. This condition occurs against the background of a developing pregnancy. Severe toxicosis is caused by a violation of the adaptive ability of the female body. This condition is very complex and can pose a great threat to the body of the mother and fetus.

Symptoms of gestosis in the second half of pregnancy disappear on their own after the birth of a child or an artificial termination of pregnancy. However, when carrying a fetus, a woman with severe toxicosis needs close attention and adequate treatment.

In terms of prevalence, gestosis occurs in 25-30% of women during pregnancy. This pathology continues to occupy a leading position in the list of causes of high maternal mortality.

In case of severe toxicosis in the body of a pregnant woman, the blood supply to vital organs is disrupted. If a woman has no concomitant diseases, then we are talking about pure gestosis. In the presence of chronic diseases of organs and systems, gestosis is combined.

Severe toxicosis occurs in women with the same frequency throughout pregnancy.

How to identify late gestosis and why is it dangerous?

In order to reliably determine the presence of late gestosis, a pregnant woman should be under the close attention of an obstetrician-gynecologist. The doctor performs a dynamic assessment of the woman’s condition. At each visit, a healthcare professional will measure your blood pressure, count your pulse, and estimate your body weight. Blood pressure readings above 135/85 may indicate the development of a late form of gestosis.

Lower extremities, weight gain, as well as a decrease in the frequency of urination can inform about the development of a pathological condition.

Late development of severe toxicosis is fraught with the following consequences:

• and displacement of the placenta, leading to fetal death;
• premature birth;
• hepatic coma and renal and hepatic failure;
• cerebral and pulmonary edema, stroke and heart failure;
• retinal detachment and hemorrhage;
• oxygen starvation (), followed by fetal death.

Constant and uncontrollable vomiting provokes dehydration of the female body, and oxygen starvation causes delays in the intrauterine mental and physical development of the fetus. Children born to mothers with signs of gestosis may have various malformations and low body weight.

In rare cases, severe toxicosis can result in the death of a woman. To avoid this, doctors raise the question of urgent delivery.

Reasons

Various circumstances can serve as an impetus for the occurrence of gestosis in the second half of pregnancy.

The list of predisposing factors includes:

• the presence of constant stress, chronic fatigue;
• age over 35 and under 18 years;
• a history of severe toxicosis during pregnancy;
• hereditary predisposition;
• primary or multiple pregnancy;
• drinking alcohol or smoking during pregnancy;
• a history of a large number of abortions;
• infectious damage to the body of a pregnant woman;
• social vulnerability of the expectant mother;
• underdevelopment of a woman’s reproductive system organs.

The most likely causes of gestosis in the second half of pregnancy include:

1. Disruption of nervous regulation between the subcortical structures of the brain and its cortex. Such dysfunction provokes circulatory disorders.
2. Pathological changes in the vessels of the placenta and uterus. Insufficiency of blood circulation in the uteroplacental circle causes the development of oxygen starvation in the fetus.
3. Disruption of the endocrine system. In some cases, the development of gestosis may be caused by disruption of the adrenal cortex, ovaries or placenta.
4. The most likely cause of the development of severe toxicosis is an inadequate immune response of the maternal body to foreign proteins of the developing fetus.
5. Hereditary predisposition is an equally likely cause of late gestosis. If the mother of a pregnant woman showed signs of severe toxicosis, then this woman has a much higher risk of developing abnormalities.

Those women who have a combination of several of the above reasons are at particular risk.

Signs

Preeclampsia in the second half of pregnancy has a number of characteristic signs, among which are:

• Edema syndrome. Depending on the severity of the pathological process, there are 1st degree (swelling of the extremities), 2nd degree (edema of the abdomen and extremities), and 3rd degree (widespread edema).
• Increased blood pressure levels. An increase in diastolic pressure by 20% of the existing norm may indicate the development of gestosis.
• The appearance of protein in urine analysis. If this symptom was detected in a pregnant woman, this indicates the development of damage to the renal apparatus due to gestosis.

A severe form of toxicosis makes itself felt at 28 weeks of pregnancy. The development of this pathology can be indicated by the combination of the above symptoms or the presence of at least one of them.

Preeclampsia in the second half of pregnancy is divided into several stages, among which are:

1. The stage of the appearance of edema. A pregnant woman can recognize edema by symptoms such as slight numbness in the fingertips, as well as difficulty bending her hand into a fist. Edema during pregnancy does not always indicate the development of toxicosis. In some cases, this is a manifestation of excessive progesterone production. Another cause of swelling of the lower extremities may be venous insufficiency.
2. Nephropathic stage. The cause of this condition is the retention of excess fluid in the body of a pregnant woman. During nephropathy, a persistent increase in blood pressure is observed.
3. Stage of appearance of protein in urine (). During the entire period of preeclampsia, a woman may experience circulatory disorders, a feeling of heaviness in the back of the head, headache, memory and vision disorders, as well as vomiting and nausea.
4. The most serious stage is eclampsia, characterized by disruption of the functioning of many organs and systems. A characteristic symptom of this condition is seizures. Convulsive syndrome can be triggered by bright light, sharp sound or pain. Some women may not have seizures during eclampsia. Instead, cases of short-term loss of consciousness are observed. With eclampsia, displacement and abruption of the placenta may occur.

The characteristic symptoms of gestosis in the second half of pregnancy can be varied. Pregnant women with this pathology need constant monitoring and monitoring of their health.

Rare forms of gestosis

A small percentage of pregnant women suffer from rare forms of severe toxicosis. In this case, the pathology may be accompanied by:

1. Dermatosis (urticaria, eczema). A woman may experience severe itching that interferes with sleep.
2. Jaundice. This condition is more often observed in pregnant women in the second half of pregnancy. Characteristic signs of jaundice are itchy skin, yellowing of the skin, as well as the mucous membrane of the eye sclera. The development of jaundice can cause fetal malformations and early onset of labor.
3. Fatty hepatosis. This pathology is characterized by the appearance of convulsive syndrome, increased bleeding and frequent vomiting. Fatty liver degeneration can occur in combination with fatty kidney degeneration.
4. Chorea. This type of gestosis in the second half of pregnancy is characterized by the appearance of involuntary movements, mental and emotional instability, difficulty speaking and swallowing.
5. Muscle tetany. This rare form of gestosis is characterized by involuntary contraction of individual muscle groups.
6. Osteomalacia. When calcium metabolism is disturbed in the body of a pregnant woman, pathological softening of bone tissue occurs.

Treatment

The treatment plan for gestosis in the second half of pregnancy consists of the following points:

• Organizing the correct regimen for a pregnant woman. Taking into account the severity of the pathological process, the expectant mother is prescribed semi-bed rest or bed rest. For the entire period of bearing a child, a woman should be protected from excessive emotional stress and stress.
• Diet selection. A pregnant woman should eat fortified, varied and light foods. The restriction includes carbohydrate and fatty foods. It is recommended to consume fresh fruits, compotes, juices and fruit drinks daily. You should not limit yourself in fluid intake, even taking into account the development of edema.
• Drug therapy. Drug treatment in this case is aimed at correcting the functioning of internal organs and systems. With the help of drugs, oxygen starvation in the fetus is prevented. A pregnant woman is prescribed vitamin therapy (B vitamins, and), drugs that simulate uteroplacental circulation, as well as antihypertensive drugs.
• Early birth. This method is used according to strict indications.

Prevention

In order to prevent the occurrence of severe toxicosis during pregnancy, you must follow these recommendations:

• A pregnant woman should sleep at least 9 hours a day. Adequate rest and the absence of physical and mental stress ensure a comfortable pregnancy.
• Every woman should master the techniques of physical therapy. To prevent gestosis in the second half of pregnancy, walking, swimming in the pool, and massage of the head and collar area are useful.
• A calm environment should reign in the family of a pregnant woman. There should be no strong odors, loud noise or too bright light in the house.
• After waking up, a woman should remain in bed for some time, without making sudden movements. A sudden awakening can trigger an attack of toxicosis.
• It is important to follow a diet, avoiding overeating. You need to eat food in small portions, 4-5 times a day.

No expectant mother is immune from the occurrence of this pathology. After confirming the fact of pregnancy, each woman must promptly register with the antenatal clinic, where she will be provided with the necessary assistance if such a pathology is detected.

Useful video about gestosis

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 undergo 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, threatening the life and health of a woman and practically guaranteeing problems during childbirth. Recently, this diagnosis has been made to approximately 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 appear. Due to the presence of certain defects and “weak points,” the body cannot cope with the load, and disorders develop in vital organs and systems.

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

Experts distinguish 2 types of gestosis:

• clean. Develops in expectant mothers who do not have a history of serious illnesses;
• combined. 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 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 the 20th week, they already speak of gestosis of the 2nd half of pregnancy. It is he who causes the greatest concern.

Causes of gestosis

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

• the cortico-visceral version associates disturbances in the circulatory system that provoke gestosis with problems in the regulation between the cortex and subcortex of the brain that arise as a result of the body’s adaptation to pregnancy;
• the hormonal theory blames the occurrence of the condition on disorders of the adrenal glands, abnormal estrogen production or hormonal insufficiency of the placenta;
• The immunogenetic theory suggests that gestosis in late pregnancy is nothing more than an inadequate reaction of the mother’s immune system to foreign fetal proteins, 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 body, in response to antigens coming from the placenta into the blood vessels, produces antibodies in insufficient quantities, as a result, defective complexes circulate in the bloodstream, which have a negative impact, first of all, on kidneys;
• theory of inheritance: if a woman’s mother and grandmother suffered from a serious condition, then she is unlikely to escape this fate, 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, they are unanimous about the risk factors.

Conditions that significantly increase your chances of getting a diagnosis include:

• obesity;
• endocrine pathologies;
• liver and kidney diseases;
• 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 years old;
• women carrying more than one child;
• women whose nervous system is exhausted by frequent stress;
• women who suffered from gestosis during previous pregnancies;
• pregnant women who abuse alcohol, smoking and drugs;
• pregnant women from a social risk group who are undernourished and living in unfavorable conditions;
• women with at least 2 years between pregnancies;
• women who frequently have abortions or have a history of miscarriages prior to conception.

If the expectant mother did not suffer from gestosis while carrying her first child, then the chances that it will manifest itself in the existing pregnancy are low. If a pregnant woman has a history of serious illnesses or belongs to a risk group, specialists should pay increased attention to her condition.

Preeclampsia: what happens in the body?

The basis for the occurrence of gestosis during pregnancy is vascular spasm. As a result, the total volume of blood circulating in the blood vessels decreases, and the nutrition of organs and cells is disrupted. This leads to them not being able to do their job well.

First of all, brain cells, as well as kidneys and liver, suffer from insufficient blood supply. This situation also 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 is worth keeping in mind that signs of gestosis during pregnancy can have varying degrees of severity. It happens that a woman feels great, but tests indicate that a condition is developing in her body that threatens her health and the life of the fetus.

The following stages of development of gestosis are distinguished:

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

Swelling during gestosis can also be hidden - the specialist’s suspicion in this case is caused by the patient’s excessive weight gain. 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 quite deep grooves on the ankles.

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

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

Dropsy, depending on its 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 arms swell;
• Stage 4 – generalized edema (over the entire body).

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

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

A rise, and especially sharp fluctuations in blood pressure, is an alarming symptom of gestosis 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 can no longer cope with the load, and 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 gestosis, characterized by a generalized disorder of the blood supply to the central nervous system - preeclampsia.

Symptoms of this condition are:

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

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

The fourth and most dangerous stage of late gestosis during pregnancy is eclampsia. Most often, this condition manifests itself as convulsions - they can be provoked by any irritant: 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 and loses consciousness. The nonconvulsive 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 blood pressure.

Eclampsia threatens with such serious consequences as:

• stroke;
• retinal detachment;
• fetal strangulation;
• hemorrhages in internal organs (primarily in the liver and kidneys);
• pulmonary and cerebral edema;
• coma and death.

Diagnosis of gestosis

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

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

• weighing a pregnant woman (an increase of more than 400 grams per week raises concerns, although everything is individual here: both the gestational age and the woman’s weight must be taken into account when registering);
• urine analysis (even traces of protein are a reason for a more detailed examination);
• fundus examination;
• blood pressure measurement;
• analysis of the ratio “volume of liquid drunk: urine excreted”;
• blood clotting test;
• general blood test.

If an accurate diagnosis is made, monitoring of the fetal condition is necessary, carried out using the ultrasound + Doppler method. After 29-30 weeks - CTG. In this case, the woman is additionally observed by specialized specialists: nephrologist, neurologist, ophthalmologist.

Treatment of gestosis

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

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 range of medical procedures includes:

• bed and semi-bed rest;
• exclusion of stressful situations;
• vitamin-enriched nutrition;
• physiotherapy, which has a calming effect;
• drug treatment carried out with the aim of normalizing the functions of the organs and systems of the pregnant woman and supporting the fetus suffering from hypoxia.

If there is no improvement during treatment or, moreover, progression of a dangerous condition, we are talking about early delivery. In this case, being a child in the womb becomes more dangerous than being born prematurely.

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

Prevention of gestosis

Women at risk need to pay special attention to the prevention of gestosis during pregnancy. And you need to start acting at the stage of planning a child, that is, before conception: get examined to identify and eliminate pathologies, give up bad habits, take special vitamin complexes, etc.

If you become pregnant, you must register as soon as possible. When a pregnant woman’s condition is under the control of specialists, many problems can be identified and eliminated in the initial stages. Patients often have to undergo tests and visit antenatal clinics, where they are weighed and blood pressure measured every time.

An excellent prevention of gestosis are the following simple measures:

• limiting the amount of fluid you drink and salt consumed (especially in the second half of pregnancy);
• adequate sleep lasting at least 8 hours;
• adequate physical activity;
• walks in the fresh air;
• avoiding stress;
• nutritious food rich in vitamins and proper diet (preferably 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 may be prescribed.

Preeclampsia is a condition that threatens the life and health of the mother and fetus. The dangerous thing is that there may be no visible signs of the disease. The woman feels great, but 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 treatment of gestosis and further childbirth proceed without complications.

Useful video about gestosis

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

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

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

What is the danger of gestosis?

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

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

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

Causes of gestosis

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

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

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

Symptoms of gestosis during pregnancy by stage

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

Dropsy

It is characterized by insufficient removal of fluid from the body, resulting in swelling. This stage is divided into 4 stages, which are characterized by the ascending direction of localization of edema:

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

Characteristic signs of edema

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

These are the earliest symptoms of gestosis during pregnancy - if doctors prescribe the woman the necessary therapy, then late toxicosis will not develop further.

Nephropathy

If no therapeutic measures were taken when edema appeared, then the disease progresses and enters the stage of nephropathy. In addition to fluid retention, hypertension appears in the body, and urine tests indicate an increase in protein.

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

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

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

Preeclampsia

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

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

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

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

Eclampsia

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

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

Characteristic signs of eclampsia

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

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

Treatment of gestosis in stages - drugs, regimens

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

Treatment of stage I of gestosis (edema)

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

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

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

In addition to natural remedies, the doctor may prescribe diuretics:

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

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

Treatment of stage II gestosis (nephropathy)

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

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

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

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

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

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

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

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

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

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

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

• The surest way to protect yourself from preeclampsia and eclampsia is timely therapy in the early stages of gestosis.

Most often, gestosis occurs in the third trimester: this explains its second name - late toxicosis. However, it has almost nothing in common with toxicosis, in the usual understanding of this diagnosis.

What is gestosis?

Gestosis (late toxicosis) is a pathological condition of the second half of pregnancy, accompanied by three distinctive signs:

1. swelling (visible or hidden);
2. proteinuria (traces of protein in urine);
3. hypertension (sustained increase in blood pressure).

This disease greatly affects the well-being of the expectant mother, as it affects the functioning of vital systems: nervous, cardiovascular, hemostasis and endocrine.

Those at risk for developing gestosis include:

• primigravidas (in particular, women over 35 years old);
• carrying twins or triplets;
• persons suffering from chronic diseases (diabetes mellitus, pyelonephritis, vegetative-vascular dystonia);
• overweight women;
• women with untreated STDs.

How to identify late gestosis?

A pregnant woman can and should monitor changes in her health. But what you definitely shouldn’t do is diagnose yourself. If you suspect that the cause of your discomfort is gestosis, consult a doctor. Without timely diagnosis and correction, the disease can lead to miscarriage.

The following medical studies and tests will help identify late toxicosis in the second half of pregnancy:

• General urine test: taken every two weeks (more often if necessary) before visiting a gynecologist.
• Ultrasound examination and Dopplerography: helps assess the development of the child, the condition of the amniotic fluid and placenta.
• Blood pressure measurement. This indicator can be monitored both in the clinic and at home.
• Control of the level of protein and hormones produced by the placenta. A decrease in PAPP-A protein and the hormone PIGF may be a sign of fetal growth restriction and placental insufficiency.
• Medical examination to detect edema. The doctor watches how the patient’s skin reacts to the removal of rings, socks, and elastic bands and controls how quickly the dents disappear.
• Weighing and tracking gradual weight gain. This indicator can also be further monitored at home using electronic scales.

Pay attention! Monitoring protein and hormone levels complements the results obtained from ultrasound.

Causes of gestosis during pregnancy

In medical circles, gestosis has a second name - “the disease of theories.” It is quite understandable, because the exact cause-and-effect relationship of the occurrence of the disease has not yet been deduced. There are only plausible theories that sound like this:

• There is a disruption in the functioning of the brain. This theory is supported by statistical data: gestosis occurs much more often in women exposed to severe stress. In the cerebral cortex, the processes of excitation and inhibition are disrupted and vascular spasm occurs.
• The endocrine system fails due to a sharp increase in hormone levels.
• The immune system perceives the fetus as foreign tissue and the body begins to produce antibodies against it. An internal failure occurs, and as a result, blood vessels contract.

Pay attention! At the moment, doctors have come to a consensus that gestosis occurs due to a combination of all of the above factors.

Why is gestosis dangerous in the second half of pregnancy?

Preeclampsia has an extremely negative effect on the well-being of the expectant mother and the health of the fetus, and here’s why:

• Against the background of gestosis, a woman may develop side diseases of the nervous system, kidneys, liver and visual organs.
• Vascular spasms can contribute to the formation of blood clots, cerebral edema, heart failure, and even cause a coma.
• Attacks of nausea and vomiting dehydrate the expectant mother's body and can lead to placental abruption, fetal asphyxia, or premature birth.
• Sluggish gestosis leads to hypoxia and delays in intrauterine development of the fetus.
• Newborns whose mothers suffered from gestosis during pregnancy most often have extremely low body weight, delayed physical and mental development, and weak immunity.

Important! Perinatal mortality in late gestosis is 32%.

In case of eclampsia (severe form of gestosis), an artificial induction of premature birth or cesarean section is the only way to save the life of the mother and child. Fortunately, the disease rarely progresses to this stage.

Symptoms of gestosis in the second half of pregnancy

OPG is another name for gestosis in modern medicine, which stands for as follows:

• O - swelling;
• P - proteinuria (traces of protein in urine);
• G - hypertension (high blood pressure).

These symptoms are characteristic of gestosis in the second half of pregnancy, however, not all expectant mothers who were diagnosed with “late toxicosis” experienced all three.

Most often, women complain only about the very first thing - swelling.

Reference! All three signs of gestosis occur only in 15% of 100 cases.

The localization and intensity of swelling reflects the progress of the disease:

• First degree- arms and legs swell.
• Second degree- swelling covers not only the limbs, but also the abdomen.
• Third degree- swelling spreads not only to the body, but also to the neck and face.

Treatment of gestosis in the second half of pregnancy

Treatment of gestosis is a difficult task that only a professional can cope with. For any form of late toxicosis, the woman is placed under observation in the maternity ward. This measure is taken to:

1. Restoration and normalization of the vital functions of the expectant mother’s body.
2. Creating resting conditions for preserving the fetus.
3. A quick and safe birth.

For patients whose gestosis is associated with nervous disorders and stress, doctors prescribe herbal-based sedatives (valerian, motherwort, Novopassit). Less commonly, the expectant mother is prescribed tranquilizers.

An obligatory point in eliminating gestosis is infusion-transfusion therapy aimed at improving blood circulation and normalizing blood pressure.

Also, medications are used to normalize blood pressure:

• Papaverine;
• Dibazol;
• Eufillin.

Reference! For mild hypertension, taking only one drug is sufficient.

With gestosis, the fetus suffers from a lack of oxygen and nutrients. This problem is solved using the following disaggregants:

• Aspirin;
• Trental;
• Chime;
• Fraxiparine.

If the signs of gestosis are not very pronounced and the therapy has a positive effect, the woman can give birth naturally, but only under painkillers and after hormonal therapy and preparation of the cervix. If late toxicosis occurs in a severe form, then the woman in labor is prescribed a cesarean section. This is the only way to preserve the health of the mother and the life of the child.

Prevention

Prevention of gestosis should begin at the planning stage of the baby. To reduce the likelihood of late toxicosis you need:

• Cure all existing diseases- this must be done before conception.
• Find physical activity to your liking and don’t forget about sports even during pregnancy. Daily walks in the fresh air are a must.
• Watch your diet and take vitamin and mineral supplements as prescribed by your doctor.
• Lose excess weight before pregnancy, and also make sure that no more than 12 kg are gained during it.
• Limit your intake of sugar and salt, so as not to retain water in the body.
• Drink enough clean drinking water without gas - this will help avoid dehydration.

Conclusion

Unfortunately, you cannot insure against the development of gestosis, however, you can minimize the likelihood of its occurrence if you prepare for conception, register with the hospital in a timely manner and follow all medical recommendations.

Especially for- Maria Dulina