Arterial hypertension during gestosis of the 2nd half of pregnancy. Gestosis of the second half of pregnancy, symptoms

Preeclampsia in pregnant women

is a syndrome of multiple organ functional failure that develops as a result of a mismatch in the capabilities of the mother’s body’s adaptive systems to adequately meet the needs of the developing fetus. This discrepancy is realized through placental insufficiency. The fetoplacental complex is the main etiological factor in the occurrence of gestosis (pregnancy does not occur outside of pregnancy and after its interruption, clinical manifestations cease).

Late toxicosis (gestosis)

The main links of pathogenesis:

1) generalized vasoconstriction,

2) hypovolemia,

3) violation of the rheological properties of blood (changes in blood viscosity, aggregation properties of blood cells),

4) development of disseminated intravascular coagulation syndrome (DIC syndrome).

There are 2 stages in pathogenesis:

1- formation of placental ischemia and local endothelial dysfunction, primary and secondary placental insufficiency;

2- formation of systemic endothelial dysfunction and multiple organ disorders.

Classically, gestosis is characterized by a triad of symptoms: edema, hypertension, proteinuria (Zangemeister triad). In pregnant women with gestosis, the types of central hemodynamics are determined: hyperkinetic, hypokinetic, eukinetic.

Classification of gestosis:

• Pregestosis,
• Dropsy of pregnant women,
• Nephropathy (preeclampsia),
• Preeclampsia,
• Eclampsia,

Atypical form of gestosis:

• HELLP syndrome,

• Acute fatty hepatosis.

Pregestosis is a complex of pathological changes in the body of a pregnant woman preceding the clinical picture of gestosis. To diagnose pregestosis, tests are used that are based on identifying pathological reactions of the cardiovascular system, changes in urine and blood. For this purpose, simple, fairly informative methods that do not require special equipment can be used:

- vascular asymmetry when measuring blood pressure in both arms,

- reduction in pulse pressure to 30 mm Hg. Art. (norm 40-50)

- a change in peripheral blood flow, which can be detected by raising your arms above your head and clenching your hands into a fist for 3-5 seconds, after which the arms are lowered with unclenched hands, paleness of the hands or the appearance of parasthesia in them indicates a violation of peripheral blood circulation,

- increase in the temporobrachial coefficient (the ratio of blood pressure in the temporal artery to the brachial artery at a norm of 0.5),

- narrowing of arterial vessels during fundus examination,

- increased specific gravity of blood,

— dysproteinemia (decrease in albumin, increase in gamma globulin fractions),

— decrease in the number of platelets over time.

The presence of hidden edema can be judged by the following signs:

- tight shoes at the end of the day,

- positive ring sign,

- pathological weight gain (more than 350-400 g),

- decrease in daily diuresis,

- positive McClure-Aldrich test.

Dropsy of pregnant women - there are 4 degrees of dropsy:

1. degree - swelling of the lower extremities
2. degree - swelling of the lower extremities and anterior abdominal wall
3. degree - swelling of the lower extremities, abdominal wall and face
4. degree - anasarca

Mild nephropathy:

- increase in blood pressure no higher than 25-30% of the initial level, 150/90,

— proteinuria up to 1 g/l,

— deficit of daily diuresis 15%.

Moderate nephropathy:

- increase in blood pressure to 40% of the initial level, 170/100,

— proteinuria up to 3 g/l,

— deficit of daily diuresis 25%.

Severe nephropathy:

- increase in blood pressure above 40% of the initial level, more than 170/100,

- proteinuria more than 3 g/l,

- deficit of daily diuresis over 25%.

In practice, G.M. Savelyeva’s scale is used. (1989), which also takes into account background diseases, the period of pregnancy at which gestosis is diagnosed: mild gestosis - up to 7 points, moderate stage - up to 11 points, severe gestosis 12 or more points.

In diagnosis, they also focus on average blood pressure (SBP) = (systolic pressure + 2 x diastolic): 3. Normal SBP is 100.

Preeclampsia

Symptoms appear associated with circulatory disorders in the central nervous system and the autonomic nervous system, increased intracranial pressure and cerebral edema developing against the background of nephropathy: visual disturbances, headache, epigastric pain, dizziness, a feeling of fullness in the head and limbs, nasal congestion, hoarseness. , hearing loss, hyperthermia.

Eclampsia

This is a clinically pronounced syndrome of multiple organ failure, characterized by: severe cerebrovascular accidents, cerebral edema, and the development of 1 or more convulsive seizures.

An attack of eclampsia develops in 4 stages:

1 – preconvulsive – small fibrillary twitching of the facial muscles with further spread to upper limbs, duration 20-30 seconds.

2 – tonic convulsions – tonic contractions of all skeletal muscles, the body stretches and tenses, the spine bends, loss of consciousness, pale face, apnea, cyanosis, tongue bite, jaw closing, “eye rolling”, duration 30 seconds;

3 - clonic convulsions, with a contraction of individual muscle groups, duration from several seconds to 2 minutes;

4 - resolution of the seizure - the convulsions stop, take a deep breath, intermittent noisy breathing appears, foam mixed with blood appears at the mouth; constriction of the pupils, breathing is gradually restored, the woman regains consciousness, remembers nothing about what happened, amnesia.

Complications of eclampsia:

• hypertensive encephalopathy,
• hemorrhagic stroke,
• subarachnoid hemorrhages,
• PONRP,
• DIC - syndrome,
• intrauterine fetal death,
• pulmonary edema,
• acute pulmonary injury syndrome,
• aspiration syndrome,
• visual impairment, acute hepatic-renal failure,
• postpartum psychoses.

HELLP syndrome.

This form of gestosis is characterized by:

H – hemolysis

EL - increased levels of liver enzymes

LP - low platelet count

HELLP syndrome is characterized by high maternal mortality (up to 75%) and perinatal mortality.

Etiology and pathogenesis of HELLP syndrome

It is based autoimmune mechanism damage to the vascular endothelium, hypovolemia with blood thickening and the formation of microthrombi, followed by fibrinolysis.

The occurrence of the disease is associated with a decrease in prostacyclin, which causes vasoconstriction in the placenta. This leads to microangiopathic changes in the endothelium, the release of placental thromboplastin and its entry into the maternal bloodstream. The consequence of this is adhesion and aggregation of platelets, and thrombocytopenia occurs. When red blood cells pass through altered microvessels, hemolysis occurs. Impaired perfusion in the liver leads to the development of toxic hepatosis with necrosis of the liver parenchyma, in some cases to the formation of subcapsular hematomas. As a result, the level of blood enzymes increases.

MAIN SYMPTOMS OF HELLP SYNDROME

With HELLP syndrome there is a clear clinical picture. Initial manifestations of the disease may be nonspecific and include:

• headache,
• increased fatigue,
• malaise,
• flu-like symptoms

As the disease progresses, pain appears in the epigastric region, a feeling of heaviness and pain in the right hypochondrium, nausea, vomiting as a result of irritation of the peritoneum and irritation of the Glissonian capsule. If intrahepatic pressure increases, this can lead to periportal bleeding, which progresses with the subsequent formation of hematomas under the Glissonian capsule and their fusion. With mechanical damage (increased intra-abdominal pressure during vaginal delivery), the subcapsular hematoma may rupture.

Sometimes HELLP syndrome manifests itself as a clinical picture of PONRP with massive coagulopathic bleeding, jaundice, vomiting mixed with blood, hemorrhage at injection sites, rapid formation of hepatic-renal failure, convulsions, coma.

LABORATORY INDICATORS OF HELLP SYNDROME

• Increased transaminase levels (AST >200 units/l, ALT >70 units/l, LDH >600 units/l;
• Thrombocytopenia less than 100 x 109 thousand;
• Decrease in antithrombin III level below 70%;
• Intravascular hemolysis and increased bilirubin concentration, both due to direct and indirect
• Increased prothrombin time and activated partial thromboplastin time (aPTT)
• Decrease in fibrinogen concentration,
• An increase in the content of nitrogenous waste in the blood,
• Reduced blood glucose levels.
• Morphological examination of the liver indicates that the pathological process is based on intravascular coagulation syndrome and liver necrosis. The most accurate diagnosis is possible using computed tomography of the liver.

Acute fatty hepatosis of pregnant women is an atypical form of gestosis and poses a particular danger to the pregnant woman and the fetus.

Clinic: the disease develops more often in primigravidas in the third trimester, under the age of 25, but can also occur at an older age.

During acute gastrointestinal tract infection, two periods are distinguished: anicteric and icteric.

The first anicteric period can last from several days to 5-6 weeks, is characterized by various complaints, and has few objective symptoms.

The second period is a short period with a stormy clinical course, a rapid progressive course (from several hours to several days) rich in both subjective and objective signs. Within 2-4 days, the jaundice intensifies and becomes more intense. The increase in jaundice is accompanied by the appearance of vomiting, and the vomit acquires an admixture of blood and becomes the color of “coffee grounds.” Belching with rotten eggs appears, hiccups, heartburn, the tongue is coated with a dirty gray coating, bloating, more in the epigastric region, liver odor from the mouth, loose, discolored stool. The size of the liver is reduced or unchanged. Signs of heart failure are increasing: tachycardia, arrhythmia, ECG shows diffuse changes in the myocardium, ischemia, respiratory failure, hemorrhagic diathesis, acute renal failure, peripheral edema, fluid accumulation in the serous cavities, antenatal fetal death.

Examination scheme for pregnant women with gestosis

1. Careful collection of anamnesis for the purpose of diagnosing long-term forms (time of appearance of pathological weight gain, instability of blood pressure).

2.Measurement of blood pressure in both arms, calculation of pulse and average blood pressure, detection of hidden and obvious edema, measurement of ankle circumference, monitoring of daily weight gain, measurement of daily diuresis. Peripheral blood examination: complete blood count (hemoglobin, red blood cells, platelets, hematocrit).

3. Study of venous blood:

• total protein and protein fractions
• blood electrolytes,
• urea and residual nitrogen,
• bilirubin (total, direct, indirect)
• transaminases,
• blood sugar,
• serum iron,
• coagulogram

4.General analysis urine, Nechiporenko test, Zimnitsky test, with

kidney pathology, Rehberg test, urine culture for flora and sensitivity to antibiotics.

5.Diagnostics of the intrauterine condition of the fetus

6. Consultations with specialists: therapist, ophthalmologist (fundus eye), neurologist, infectious disease specialist, and other specialists if necessary.

Complications of gestosis

With gestosis, complications are possible from both the mother and the fetus. Maternal complications include: cardiovascular failure, pulmonary edema, cerebral hemorrhage, cerebral hypoxia, edema, coma, retinal detachment and retinal hemorrhage, acute renal failure, anuria, acute liver failure, premature abruption of the normally located placenta

Fetal complications include: acute fetal hypoxia, intrauterine growth retardation, intrauterine fetal death, spontaneous premature birth.

THERAPY OF GESTOSES

Basic principles of therapy for gestosis:

1. Creation of a therapeutic and protective regime
2. Elimination of hypovolemia
3. Antihypertensive therapy
4. Normalization of rheological and coagulation properties of blood
5. Normalization of vascular permeability
6. Regulation of water-salt metabolism
7. Prevention and treatment of multiple organ failure
8. Prevention and treatment of placental insufficiency
9. Antioxidant therapy.

The therapeutic and protective regime is ensured by taking drugs that have a sedative effect.

Infusion therapy is used to eliminate hypovolemia, restore tissue perfusion, blood flow in vital organs, eliminate hemoconcentration and hypoproteinemia, and correct electrolyte and metabolic disorders. IT is carried out by the method of controlled hemodilution by introducing colloid and crystalloid solutions, carried out under the control of diuresis, hematocrit and hemodynamic parameters. IT begins with the introduction of colloid solutions, and then crystalloid ones.

Antihypertensive therapy should be selected individually, taking into account the type of central maternal hemodynamics and the clinical characteristics of preeclampsia. For this purpose, drugs of different mechanisms of action are used: vasodilators, antispasmodics, blockers, and stimulators of adrenergic receptors, ganglion blockers.

Magnesium sulfate is prescribed taking into account mean arterial pressure. With SBP up to 110 mm Hg. Art. 25% -20 ml is administered with 400 ml of isitonic solution intravenously.

Calcium antagonists can be used simultaneously with magnesium sulfate: verapamil 80 mg, Norvasc 5-10 mg per day, Corinfar 10 mg 2 times a day.

Ganglion blockers are prescribed during controlled antihypertensive therapy: pentamin 5% - 0.5 ml, benzohexonium 1.0-1.5 ml of a 2.5% IV solution in an isotonic solution or in a 5% glucose solution.

Antispasmodic drugs in combination with antihypertensive drugs make it possible to long-term and persistently prevent arterial hypertension and maintain blood pressure at a normal level.

Diuretics are prescribed only after replenishment of the circulating plasma volume:

• with severe generalized edema
• at a diastolic blood pressure level of 120 mm Hg. Art. and more
• with diuresis less than 50 ml/hour
• with a central venous pressure of more than 60 mm water column.
• with complications in the form of acute left ventricular failure
• with pulmonary edema

Prevention and treatment of DIC syndrome: chimes, trental, fresh frozen plasma, cryoprecipitate, protease inhibitors.

First aid for eclampsia

The patient is placed on a flat surface and her head is turned to the side. The airways are cleared by carefully opening the mouth with a spatula, pulling the tongue forward and aspirating the contents of the oral cavity and airways. When spontaneous breathing is restored after a seizure, oxygen is given. In case of prolonged apnea, auxiliary ventilation is immediately started or the patient is transferred to mechanical ventilation. When cardiac activity stops, closed cardiac massage is performed in parallel with mechanical ventilation using cardiovascular resuscitation techniques. To prevent seizures, neuroleptanalgesia is administered: Relanium 2 ml., Promedol 2% -1 ml., Pipolfen 2 ml.; droperidol 4-6 ml if repeated administration is necessary, the same drugs in half the dose no earlier than after 2 hours. Further treatment according to the basic principles of treatment of severe gestosis.

Indications for mechanical ventilation:

1. Intractable attacks of eclampsia,
2. Impaired external respiration, tachypnea more than 40 bpm, apnea, arrhythmia,
3. Coma,
4. Acute disturbances of vital functions.

Features of labor management in women with gestosis

The birth should be conducted by an obstetrician-gynecologist together with an anesthesiologist. Monitoring the condition of the mother and fetus; lateral position, gradual pain relief during labor, antispasmodics, antihypoxants, antihypertensive drugs, drugs that improve uteroplacental blood flow.

The method of choice for labor anesthesia for severe gestosis is long-term epidural anesthesia. Antihypertensive therapy is carried out under the control of blood pressure, with blood pressure over 160/100 mm Hg. controlled relative normotension is indicated. In order to reduce intrauterine pressure when the cervix is ​​dilated by 3-4 cm, an early amniotomy is performed. In the third and early postpartum periods - prevention of bleeding IV oxytocin 5 units in an isotonic solution 0.9% - 400 ml.

Indications for early delivery:

• severe gestosis with no effect from treatment for 1-2 days;
• preeclampsia with no effect of treatment within 6 hours
• eclampsia
• HELLP syndrome,
• complications of gestosis
• severe fetoplacental insufficiency.

Indications for caesarean section

eclampsia,

preeclampsia in the absence of treatment effect,

complications of gestosis,

PONRP (even non-progressive),

pronounced FPN, IUGR with the possibility of nursing a premature newborn,

combination of gestosis with other obstetrics. pathology (breech presentation, infertility),

lack of effect from labor induction,

HELLP syndrome, acute headache.

Prevention of severe forms of gestosis

Identification of pregnant women into risk groups for gestosis.

Early diagnosis of mild forms of gestosis, pathogenetically based therapy, timely solution to the issue of early delivery.

Specific drug prevention

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 nervous system, kidneys, liver and organs of vision.
• 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, delays in physical and mental development, as well as 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.
• Reset overweight 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

Preeclampsia in the second half of pregnancy is a more severe and complex pathology with all sorts of manifestations. Late toxicosis, or gestosis, is a complication of the second half of pregnancy, characterized by disruption of the normal functioning of many organs and systems of the pregnant woman’s body. Characteristic of gestosis is a complex of basic symptoms (laws, detection of protein in urine during examination, rise in blood pressure. The prevalence of gestosis is on average 10%. Currently, the more frequent development of gestosis in the second half of pregnancy is observed in women with various diseases of internal organs, Moreover, in primigravidas the frequency of gestosis is higher. It is also noted that age plays a certain role in the occurrence of complications in the second half of pregnancy. Thus, in young girls (under 18 years of age) and, conversely, in pregnant women over 30 years of age, the likelihood of developing gestosis is much higher.

There are certain groups of women with an increased risk of developing gestosis in the second half of pregnancy:

1. pregnant women with Rh conflict between mother and fetus: in mother negative Rh factor, and in the fetus and, accordingly, in the genetic father of the child - positive;
2. women with a serious disease - antiphospholipid syndrome;
3. women who suffer from arterial hypotension (persistent decrease in pressure) before pregnancy in combination with hydatidiform mole (spread of membrane tissue into the uterine wall);
4. women suffering from overweight (obesity), etc.

Currently, a pattern has been identified - the occurrence of gestosis in the second half of pregnancy is determined by hereditary predisposition.

In medical and obstetric practice, it is customary to divide gestosis into pure and mixed forms. In this case, the emergence of mixed, or complicated, forms is facilitated by various diseases of the internal organs: hypertension - a persistent increase in blood pressure, diseases of the kidneys, liver, and heart.

In turn, pure forms of gestosis occur in four stages:

1. swelling;
2. mild, moderate, severe renal dysfunction;
3. preeclampsia - increased blood pressure in combination with impaired renal function;
4. eclampsia - loss of consciousness, limb cramps, blue discoloration, breathing problems.

WHO (World Health Organization) presents the following classification:

1. arterial hypertension of pregnant women without proteinuria (no protein in the urine);
2. proteinuria of pregnant women (detection of protein in the urine);
3. preeclampsia - a combination of arterial hypertension in pregnancy with proteinuria;
4. eclampsia;
5. latent arterial hypertension (high blood pressure), latent kidney disease and other diseases that appear only during pregnancy;
6. previously known diseases accompanied by arterial hypotension (low blood pressure);
7. preeclampsia and eclampsia, complicating previously known diseases: a) arterial hypertension; b) kidney disease.

Thanks to this classification, each specified species, depending on the time of occurrence, can be divided according to the beginning of its occurrence:

1. during pregnancy;
2. during childbirth;
3. during the first 48 hours of the postpartum period.

Scientists-pathophysiologists together with obstetricians-gynecologists currently agree that the cause of gestosis consists of several components, disorders of varying degrees of severity.

Causes of gestosis during pregnancy

There are many theories about the occurrence of gestosis, but there is no exact answer about the causes of this condition yet.

The main cause of gestosis in the second half is systemic vascular spasm, leading to an increase in total peripheral vascular resistance, a decrease in cardiac output, a decrease in blood flow and glomerular filtration of the kidneys. This determines the signs of gestosis. The characteristic complex of symptoms of gestosis - edema, increased blood pressure, the presence of protein in the urine - is due to the interconnection of a number of successive chains of a mechanism triggered as a result of vasospasm. Vascular spasm of the arterial circulation leads to an increase in intravascular pressure, stagnation of blood flow in small vessels increases the permeability of small vessels. This results in an increase in the general peripheral vascular resistance to blood flow, and as a consequence of this, an increase in pressure and circulatory disturbances occur in vital organs (brain, liver, kidneys, heart, etc.). The severity of this process directly depends on the severity of gestosis in each specific case. Further disorders are associated with prolonged vascular spasm, which leads to deterioration of myocardial activity (ischemic myocardiopathy), ischemia of the renal cortex and an even greater increase in blood pressure, spasm of cerebral vessels, spasm of the uterine and spiral arteries - disorders of the uteroplacental and fetal placental blood flow. Such changes are very dangerous due to a decrease in the functions of neutralizing toxins and the formation of proteins in the liver. A number of studies have noted that with gestosis, despite changes in the circulatory system, compensatory and adaptive mechanisms are formed, aimed primarily at the normal functioning of the “mother-placenta-fetus” system. And only with significant depletion of these mechanisms and the body as a whole, fetoplacental insufficiency and intrauterine growth retardation of the fetus develop, so the appearance of signs of gestosis indicates the low efficiency of individual compensatory mechanisms.

Symptoms and signs of gestosis during pregnancy

With gestosis, there are 3 symptoms:

• presence of edema;
• the appearance of protein in the urine.
• increase in blood pressure.

Swelling is the earliest symptom of gestosis, so at each appointment the doctor carefully feels the woman’s lower limbs and asks her if she notices the appearance of edema during the day. If a woman wears wedding ring constantly, then she can observe the so-called “ring symptom” - previously it moved freely on the finger, but now it is removed with great difficulty.

The doctor learns about the presence of proteinuria (protein in the urine) from regular laboratory tests that he prescribes for a pregnant woman. You shouldn’t neglect this research and be lazy and take a jar. Proteinuria is a serious symptom.

An increase in blood pressure (BP) is also important feature development of gestosis. That is why at each appointment the doctor measures the pregnant woman’s blood pressure on both arms, writes down the readings, and compares them with previous values. If suspicions arise, the doctor may ask the woman to measure her blood pressure at home. It is advisable to do this in the morning, afternoon and evening. Measure the pressure on both hands. The first result corresponds to the blood pressure values ​​obtained when measuring on the right hand, the second - on the left.

The symptoms (manifestations) of gestosis in the second half of pregnancy have long been known. Despite this, the variations in the course of the disease are somewhat broader than these symptoms. Each pregnant woman with a complicated pregnancy has her own special variant of gestosis.

At an early stage of the disease, a woman, as a rule, does not complain of feeling unwell; swelling may be minor, and increases in blood pressure may not be felt or may be explained by fatigue; a mild headache is rarely noted. However, modern doctors distinguish an additional, so-called preclinical, stage of gestosis. In this case, there are still no signs of the disease, but laboratory data already shows changes in the blood and urine. Signs of the preclinical stage of development of gestosis are a progressive decrease in the number of platelets, an increase in blood coagulation ability in the cellular and plasma components of homeostasis, a decrease in blood factors that prevent excessive blood clotting, and the flow of lymph into the interstitial spaces, due to which hidden edema occurs. Also at the preclinical stage there may be disturbances in the uteroplacental blood flow. To examine women, they also conduct a special test to identify manifestations of pregestosis. To do this, blood pressure is measured three times with an interval of 5 minutes in the position of the woman on her side, on her back and again on her side. The likelihood of gestosis occurring is high if there is an increase in diastolic (lower) pressure by more than 20 mmHg. Art. As a rule, the initial manifestations of gestosis in the second half of pregnancy are promptly diagnosed in the antenatal clinic, since they constantly monitor the woman’s weight gain at each consultation visit, systematically measure blood pressure in both arms, conduct urine and blood tests and assess the intrauterine condition of the fetus.

The severity of edema can vary; there are 3 degrees of severity.

I degree - localization of edema only in the lower extremities.
II degree - their spread to the abdominal wall.
III degree - spread of edema throughout the body up to edema of internal organs.

Objective criteria for the severity of severe kidney damage are as follows:

1. systolic (upper) blood pressure 150 mm Hg. Art. and higher, diastolic (lower) blood pressure 100 mm Hg. Art. and above;
2. oliguria - small amount of urine (daily diuresis - urine output per day - less than 400 ml);
3. proteinuria - protein content in urine up to 5 g/l or more;
4. hypoxic (low oxygen content in the blood) type of central maternal hemodynamics with increased total peripheral vascular resistance;
5. severe disturbances of blood flow in the uterine arteries, as well as in the arteries of the kidneys;
6. severe disturbances of cerebral blood flow (dizziness, weakness, visual disturbances, headaches, etc.);
7. lack of improvement or deterioration of the blood system in the mother’s body against the background of complex active therapy for preeclampsia;
8. decreased platelet count, decreased blood viscosity, increased activity of liver enzymes, increased amount of bilirubin in the blood.

Treatment of gestosis during pregnancy

Treatment of gestosis is very labor-intensive and complex. It is important to remember that if there are symptoms of gestosis, you should always monitor the woman’s condition and the results of treatment. For any form of gestosis in the second half of pregnancy, it is advisable to carry out treatment in a specialized hospital - the maternity ward. In severe forms, in addition to intensive therapy of gestosis, resuscitation measures are necessary.

Therapy for gestosis is aimed at the following:

1. quick and gentle delivery;
2. creation of a therapeutic and protective rest regime for the patient;
3. restoration of the function of vital organs and body systems of a pregnant woman.

The creation of a therapeutic and protective regime implies not only being in a hospital and maintaining bed rest, but also the use of sedative and psychotropic (affecting the nervous system) therapy. Preference in women with gestosis in the second half of pregnancy is given to herbal preparations that calm the nervous system, such as valerian, motherwort extract, novopassit, sometimes in combination with tranquilizers: diazepam, elenium, aminazine. There have been cases of use of narcotic substances (phenozepam, etc.). The next point in treatment is mandatory therapy that improves blood flow: infusion-transfusion therapy, which allows you to normalize the volume of circulating blood, normalize plasma pressure, improve the supply of nutrients to tissues and blood clotting abilities, etc. As a result, hydroxylated starch (refortan, infucol), as well as magnesium sulfate (magnesia), if necessary, transfusion of plasma and whole blood. When blood pressure increases, drugs that normalize blood pressure are used: dibazol, papaverine, aminophylline. Currently, other groups of drugs are also recommended. In mild cases, monotherapy is quite effective - the use of one drug; moderate severity often requires a complex selection of drugs - two or several drugs together. To normalize the supply of nutrients and oxygen to the fetus and improve blood clotting properties, disaggregants are used - trental, chimes, fraxiparin, aspirin.

Today, efferent methods of treating gestosis are extremely relevant, including the use of extracorporeal methods of detoxification and dehydration: plasmapheresis and ultrafiltration (exposure to ultraviolet radiation and electromagnetic waves).

With mild forms of gestosis, a positive effect of therapy, the absence of pronounced disturbances in uteroplacental blood flow and the absence of other problems (such as a narrow pelvis, a large fetus, etc.), a woman can give birth on her own. In this case, in order to maximize the preparation of the birth canal, in particular the cervix, hormonal therapy is carried out and prostaglandins are used, preferably topically. With the cervix prepared, the amniotic sac is opened, followed by induction of labor with appropriate medications. It is also mandatory to use adequate pain relief for the woman in labor.

Severe gestosis of the second half requires surgical delivery - caesarean section, this route of delivery is also chosen in case of developing complications of this disease: in case of hemorrhage in the brain against the background of increased pressure, retinal detachment that has occurred or is threatening, acute renal-liver failure. In the above cases, these organs and systems do not cope with their work, and metabolic products (metabolism) accumulate in the body,
which can lead to the development of coma or premature abruption of a normally located placenta.

Due to possible severe consequences, it is necessary to separately distinguish severe forms of gestosis in the second half of pregnancy - these are preeclampsia and eclampsia.

Preeclampsia is a severe form of gestosis, for which, along with all the above symptoms of gestosis, there are signs of a deep disruption of the nervous system and the brain in particular, as the impact of a persistent increase in blood pressure and, as a consequence, an increase in edema of brain structures. The symptom complex of preeclampsia may include the appearance of severe constant headache, dizziness, visual disturbances (“flickering spots”, double vision), inhibited awareness of what is happening around, tinnitus, workload.

Often, a pregnant woman who has developed gestosis is hospitalized to provide inpatient care, the task of which is to normalize the functions of vital organs, prevent seizures and prevent the transition of gestosis to more severe (critical) conditions.

Prevention of gestosis during pregnancy

If there is a suspicion that this condition is possible during advanced pregnancy, it is better to take precautions in advance

• adhere to a special diet recommended by a doctor;
• maintain a water regime (the amount of daily fluid should be clarified);
• monitor weight gain, avoiding large increases in body weight;
• rest during the day for 2-3 hours in a horizontal position (helps improve blood flow to the kidneys and placenta).

• The condition is the main danger of the second half of pregnancy and poses a serious threat to the life of the expectant mother.

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 III 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 a deterioration in your well-being and timely examination will help to identify late toxicosis in the early stages of its development and avoid the fatal risk.

Causes of gestosis

Scientists have not yet reliably found out what exactly is the cause of the development of late gestosis. 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 gestosis, 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 of gestosis 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 finds herself without medical care, then she will die. Preeclampsia involves placing the patient in an intensive care unit, since her well-being must be monitored around the clock.

Eclampsia

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

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

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

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

Except natural remedies Your doctor may prescribe diuretics:

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

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

Treatment of stage II (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 (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.

• Most the right way protect yourself from preeclampsia and eclampsia - timely therapy in the early stages of gestosis.

In short, gestosis is one of the complications that can occur during pregnancy. The concept of gestosis describes a large complex of symptoms that manifests itself in cases when the body of a pregnant woman cannot meet the needs of the growing fetus.

This condition is a big problem in modern gynecology, since it can cause serious complications and is quite difficult for a woman. In developed countries, due to the active development of obstetric practice, as well as a high standard of living, only 6% of pregnancies occur against the background of gestosis. In Russia, according to studies published in journals, the incidence rate is growing and amounts to 19% of all pregnancy cases.

This means that at this stage of development of obstetrics in Russia, it is not possible to completely eliminate all risk factors that lead to the development of this disease. A careful study of medical histories allows us to speak with confidence about the relationship of risk factors with this condition.

Determining the disease should not be a problem for a qualified gynecologist. The classic complaints of a pregnant woman, as well as the characteristic clinical picture, make it possible to relatively quickly make a correct diagnosis and begin treatment measures.

Difficulty in pregnant women

Classification of gestosis according to ICD-10

In the international classification of diseases, gestosis belongs to the section “Swelling, proteinuria and hypertensive disorders during pregnancy, childbirth and the postpartum period” under codes O10-O16.

In Russia, a new classification of gestosis according to clinical course is used to a greater extent.

So, according to this, the following types of disease are distinguished.

1. Clean. The classic form of the disease, which is not complicated by other somatic pathologies.
2. Combined. It occurs in pregnant women who previously suffered from pathologies that cause hypertension.
3. Unclassified. There is a characteristic clinical picture, but there is not enough data to establish the cause.

If we talk about classification specifically according to the ICD, the following types of gestosis are distinguished:

The ICD classification does not represent a refined diagnosis that takes into account absolutely all the characteristics of the condition. The International Classification of Diseases is necessary to simplify the work of doctors around the world.

Forms and stages of gestosis by severity

In addition to classification according to the clinical course (pure, combined and unclassified gestosis), classification is also used according to the severity of the patient’s condition.

So, according to the degree of severity, the following types are distinguished.

1. Easy. The duration of gestosis is relatively short, about two weeks. It manifests itself as swelling in the lower legs, as well as a slight increase in body weight. Proteinuria is insignificant or absent. Pressure up to 150/90. It is usually diagnosed in the last weeks of pregnancy.
2. Average. Lasts up to one month. It is necessary to carry out therapeutic measures. Swelling appears in the abdomen. Pressure up to 170/110. Most often occurs between 30 and 35 weeks. Accompanied by exacerbation of chronic somatic diseases.
3. Heavy. The duration of the condition is more than a month. Often requires immediate delivery to preserve the health of the pregnant woman.

Often, all forms of gestosis are accompanied by oligohydramnios or problems with the placenta. It is the disruption of blood circulation between the uterus and placenta that becomes a common cause of the formation of mild forms of the disease.

Carefully!
Separately from the forms of gestosis, according to the degree of severity, preeclampsia and eclampsia should be distinguished. These two conditions require immediate medical intervention, with the aim of providing emergency medical care and subsequent hospitalization in a hospital.

In the early stages

Preeclampsia does not occur during such a period. If manifestations of this condition are observed before the 20th week, that is, in the first trimester, it is customary to say that the woman had a chronic disease, against the background of which an increase in blood pressure was detected. That is, we cannot talk about the classic form of gestosis.

Some women mistake toxicosis for an early form of gestosis, but this is completely wrong. Toxicosis is a condition in a pregnant woman that develops in the first half of pregnancy and is manifested by nausea and vomiting. The condition does not pose a risk to the health of the pregnant woman and fetus and does not require emergency medical intervention.

If there is an increase in blood pressure early stages, you must immediately seek help from a specialist to avoid exacerbation of somatic diseases and timely initiation of treatment measures.

In the later stages

Preeclampsia develops precisely in this period of pregnancy, starting from 20-22 weeks. For a long time, this condition occurs without visible changes. It begins with the stage of formation of edematous syndrome. A pregnant woman's body experiences significant fluid retention, which leads to pathological weight gain.

Swelling also appears in stages.

1. Swelling of the legs.
2. Swelling of the abdomen.
3. Swelling of the face.
4. Widespread swelling.

To determine whether there is swelling or not, you need to carry out a simple manipulation. Press on a free area of ​​skin with one finger. If the white mark remains for more than a few seconds, then there is swelling in this area.

Observation
Further progression of gestosis leads to the appearance of protein in the urine and the development of nephropathy. This usually occurs at 30-32 weeks, but can be earlier, depending on when the symptom complex began to develop. If the condition is not treated, preeclampsia develops, requiring immediate medical attention.

Severe form

It develops against the background of other serious pathologies, such as diabetes.

It has been proven that the disease is often one of the reasons for the development of such forms of gestosis as.

1. HELLP syndrome. With this pathology, there is pronounced hemolysis of red blood cells, a decrease in platelet levels, and an increase in liver enzymes.
2. Yellow atrophy of the liver. In this case, liver cells are replaced by adipose tissue. There are no signs of organ inflammation. As a result, significant impairment of liver function occurs, up to the formation of failure.
3. Liver failure. Against the background of prolonged eclampsia, as well as the addition of other complications, such as bleeding, infectious processes, serious dysfunction of the organ is possible, up to its failure.

Together with other diseases

All of the above forms are extremely dangerous for both the mother and her unborn child. It is extremely important to be hospitalized in a timely manner and begin specific treatment.

Rare forms of gestosis

All severe types of the disease are rare.

In addition to them, the following can be included:

• jaundice of pregnant women;
• chorea;
• tetany;
• dermatosis

The above types of disease are not always life-threatening for the fetus and mother, but also require immediate treatment.

The exact factors have not been identified

Causes

The pathogenesis of the development of gestosis during pregnancy is not fully understood.

According to experts, this condition can develop due to several reasons, namely.

1. Corticovisceral factor. According to this theory, changes leading to gestosis occur against the background of disruptions in connections between cortical and subcortical structures.
2. Hormonal background. Changes in the endocrine background during pregnancy can also lead to a number of disorders, against the background of which the formation of late gestosis occurs.
3. Immune theory. According to these data, changes in the body and the development of gestosis are facilitated by an incorrect reaction of the immune system to tissue antigens secreted by the fetus.
4. Placental theory. With insufficient development of the placenta, nutritional deficiency may occur and the development of this condition.

Expert opinion
Borovikova Olga
The genetic factor also plays a major role in the formation of late gestosis. According to studies, if there is a family history of cases of gestosis, the risk of developing this condition increases significantly.

Psychosomatics plays a role in the formation of many diseases and gestosis is no exception. Constant stressful situations also significantly increase the risk of developing this condition.

At-risk groups

The main goal of the antenatal clinic is to prevent the formation of gestosis. This requires preventive measures. Not all women are subject to this, but only those who are at risk for the development of gestosis.

This group includes those who have one or more risk factors from the following list:

• gestosis during a previous pregnancy;
• complicated heredity (preeclampsia in the mother or grandmother);
• age 40 and older;
• long interval between births;
• diabetes mellitus and other endocrine diseases;
• cardiac pathology and other somatic diseases;
• early first birth.

The likelihood of developing gestosis is not always present, even in the presence of several risk factors. Such women simply have a higher chance of developing this condition.

The main thing is to start treatment on time

Symptoms

Preeclampsia is a complex disease that manifests itself as a triad of symptoms. The first manifestation is high blood pressure. In addition to changes in the tonometer readings, the patient may complain of headache, deterioration in health, dizziness, and weakness. Some patients experience joint pain.

During an attack of high blood pressure, a serious sign is a significant increase in symptoms, as well as the lack of effect from the use of antihypertensive drugs.

The second sign that the disease manifests itself is the appearance of protein in the urine. Outwardly it is not possible to distinguish this. This symptom can only be confirmed after a urine test. The appearance of protein in the urine is an alarming sign that may indicate not only gestosis, but also severe inflammatory kidney diseases.

The last sign is swelling. The first thing you need to understand is that edema syndrome occurs in most women whose pregnancy proceeds physiologically.

If a doctor diagnoses late gestosis, a bad prognostic sign is the following:

• no swelling;
• increased swelling in the lumbar region.

Knowing how the disease manifests itself is important to remember. If its signs appear, you should immediately seek help from a specialist. Only timely initiation of treatment can avoid complications.

Diagnosis of gestosis

In most cases, clinical manifestations of the disease are sufficient, as well as routine examination methods and further evaluation of the results.

The first routine examination that a doctor should conduct if gestosis is suspected is measuring blood pressure. Normally, it should not exceed 130/90. It is recommended to take measurements twice with an interval of several minutes. The next test to confirm the presence of gestosis is a general urine test. The main indicator that a specialist can determine for this disease is the appearance of protein in the urine.

To assess the severity of gestosis, doctors use the so-called Savelyeva scale. In this scale, depending on the results of the examination and tests, scores are assigned that determine the severity of the pathology.

How to get tested

To properly prepare for testing, you must follow the following rules.

1. Blood must be donated on an empty stomach.
2. It is not recommended to drink tea, coffee and natural juices.
3. A few days before the examination, completely eliminate fatty foods.
4. 24 hours before taking a general urine test, do not consume food that is colored, alcohol, or drinks containing caffeine.
5. Urine should be collected in special containers.
6. When collecting urine at home, the container must be delivered to the laboratory no later than 2 hours later.

By following these rules, you can significantly reduce the risk of false results in tests. This will allow the doctor to make a more accurate diagnosis and correctly determine the severity of the disease.

What's happening, symptoms

Decoding

Urine, normally, should be characterized by the following indicators:

• color yellow;
• transparent;
• no pungent odor;
• sugar and protein should normally not exceed 0.085 µmol/l and 0.033 g/l, respectively;
• leukocytes 0-5;
• red blood cells 0-1;
• cylinders 1-2.

With gestosis, there will be a significant increase in the level of protein in the urine. So-called proteinuria is detected.

In the blood during gestosis, we are interested in the level of hemoglobin, as well as liver tests.

Normally, the following values ​​should be:

• Hb 120-140;
• Platelets 180-320;
• AST until 10-40;
• ALT up to 31;
• alkaline phosphatase up to 240.

Expert review
Borovikova Olga
In case of gestosis, specialists are more interested in the ALT and AST indicators. In severe cases of the disease, a significant increase in their level is noted. A general blood test is not decisive in making a diagnosis, but a drop in platelet levels below 100 also indicates a severe course of the disease.

Treatment of gestosis in pregnant women

The protocol for the treatment and diagnosis of late gestosis includes two main activities.

1. Anticonvulsant therapy.
2. Therapy aimed at lowering blood pressure.

Preeclampsia does not always require hospital treatment. In some cases, it is possible to manage the disease on an outpatient basis.

Modern methods of managing pregnant women with gestosis determine the following indications for hospitalization:

• severe preeclampsia;
• gestosis complicated by liver pathology or HELLP syndrome.

In these conditions, emergency hospitalization of the pregnant woman is necessary. Otherwise, serious complications may develop, including death.

Drugs

The following drugs can be used in the treatment of gestosis:

• magnesia (necessary for the relief of convulsive syndrome);
• nifedipine and urapidil (drugs of choice for lowering blood pressure in pregnant women);
• vitamins C and E (occasionally used as preventive treatment, but their effectiveness has not been proven).

If an infectious process has developed against the background of gestosis, it is possible to prescribe antibacterial drugs such as Ceftriaxone or Josamycin. They do not have a teratogenic effect, therefore they are absolutely safe for use during pregnancy.

Extremely serious condition

Early gestosis

The concept implies ordinary toxicosis. No specific activities are required. In this case, the body will cope on its own. In case of severe toxicosis, you can consult a specialist to identify concomitant diseases that may require treatment. Typically, toxicosis goes away on its own and is rarely severe.

Severe gestosis

Develops from 34 to 39 weeks of the disease. It must be remembered that while mild preeclampsia can be treated on an outpatient basis, the development of eclampsia requires emergency hospital treatment.

In addition to administering medications, emergency delivery may be necessary.

It is carried out in the presence of the following indications:

• severe eclampsia, difficult to treat with medication;
• deterioration of the fetus;
• a sharp increase in the manifestation of the disease.

If the pregnancy has reached 37 weeks, delivery is mandatory. If after stimulation there is no effect, a caesarean section is performed.

Severe gestosis is an extremely serious condition that can be fatal. Therefore, it is a mistake to believe that gestosis and toxicosis are the same thing. Toxicosis does not require serious treatment measures and extremely rarely leads to serious complications.

How to treat gestosis during pregnancy at home

It is important to remember that you should never self-medicate. The first thing to do is to immediately seek help from a doctor. If proper treatment is started quickly, complications can be avoided.

There is no specific first aid that can be provided to a patient at home.

If gestosis is complicated, the following must be done.

1. Call an ambulance.
2. Place the patient on the bed.
3. Ensure a sufficient flow of oxygen (open the window, remove the pregnant woman from restrictive clothing.
4. Try to calm the woman down.

After the ambulance arrives, the pregnant woman will be provided with all the necessary assistance, and if indicated, she will be hospitalized.

The diet is prescribed based on examination

Care

The most important thing is to carefully monitor her condition and measure her blood pressure. This will allow you to notice deterioration in a timely manner.

It is also necessary to reduce the stress component and make the woman’s life more comfortable. Normalizing the psychological component of a pregnant woman’s life can reduce the risk of complications significantly.

To ensure that a pregnant woman receives proper and nutritious nutrition. It cannot be said that the diet can cure gestosis, but it reduces the risk of complications.

Diet

There is no specific nutrition for gestosis. There are rules that every pregnant woman at increased risk of this condition must adhere to.

To reduce the risk, you must adhere to the following rules.

1. Eat small portions. In total, there should be 5-6 meals in one day.
2. Avoid foods with strong odors.
3. Do not drink a lot of fluids and refrain from drinking liquids 20 minutes before meals.
4. Monitor weight changes carefully. If a woman gains more weight in a week than necessary, fasting days should be arranged.
5. The menu must include soups made with chicken and vegetable broths, as well as stewed or steamed dishes. It is better to avoid fried and fatty foods.

The diet is always individual and should be prepared under the supervision of the attending physician. To ensure proper nutrition It is better to consult a specialist.

Complications

Preeclampsia is a serious pathology that, if severe, can lead to serious complications for both the mother and the fetus.

A pregnant woman may experience the following complications:

• thrombosis;
• stroke;
• formation of DIC syndrome;
• kidney damage;
• retinal detachment;
• pulmonary edema;
• coma.

Such serious complications arise in cases where a pregnant woman does not follow the recommendations of a specialist and does not treat the disease. To reduce the risk of complications, it is important to carry out preventive measures, as well as treat manifestations of gestosis.

A very serious complication of this condition is HELLP syndrome. This syndrome includes hemolysis of red blood cells, elevated liver enzymes, and thrombocytopenia.

The occurrence of this condition is possible only if gestosis is accompanied by DIC syndrome, as well as liver and kidney failure. Main problem- high mortality. Only with timely diagnosis and immediate delivery can the prognosis of complications be improved.

Early prevention

Consequences for the child

Preeclampsia also affects the fetus. It is dangerous for the fetus not so much due to its consequences during pregnancy as in the postpartum period.

The following complications are possible in newborns:

• respiratory distress syndrome;
• severe hypoxia;
• malnutrition;
• underdevelopment of internal organs.

All these conditions develop against the background of the fact that during gestosis, the function of the placenta is disrupted and there is an insufficient supply of nutrients to the fetus.

Can gestosis recur during a second pregnancy?

One of the risk factors is the presence of this condition in a previous pregnancy. If there is a case of gestosis in the gynecological history, the risk of developing this condition during a future pregnancy increases significantly.

To reduce the risk of recurrence, it is recommended to carry out preventive measures, as well as register with the antenatal clinic in a timely manner.

Prevention

Women at risk must be identified.

To prevent the formation of gestosis, the following recommendations must be followed:

• sleep at least 8 hours;
• frequent walks in the fresh air;
• reduction of stress factor;
• careful monitoring of the pregnant woman's condition.

Drug prevention includes taking acetylsalicylic acid from 12 to 36 weeks. The use of this drug is recommended in low doses in women at risk.

Prevention does not completely avoid gestosis. However, it reduces the risk of its formation and facilitates its course. ABOUT preventive measures Any woman planning a pregnancy should know.