Gestosis 2nd half of pregnancy 1st help. Gestosis during pregnancy and its possible consequences

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 child’s development, condition 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, 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), artificial induction of premature birth or C-section- This is the only way to save the life of 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

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.

To prevent this condition from overshadowing the process of expecting a child, each 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 indomitable vomiting provokes dehydration of the female body, and oxygen starvation causes delays in intrauterine mental and physical development 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 edema 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 features Jaundice is 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 start labor activity.
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. Recommended for daily use fresh fruit, compotes, juices and fruit drinks. You should not limit yourself in fluid intake, even taking into account the development of edema.
• Drug therapy. Drug treatment in in this case 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

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 notice close attention, attributing them 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 they join following signs gestosis during pregnancy - 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 real reason the occurrence 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 drugs and medical supervision, severe consequences can be avoided and most often 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 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 to lead healthy image life 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.

(late toxicosis of pregnancy, PTH) - pathological conditions of the second half of pregnancy, characterized by a triad of main symptoms: edema (latent and visible), proteinuria (the presence of protein in the urine), hypertension (persistent increase in blood pressure). Accompanied by disorders of the functions of vital systems: cardiovascular, nervous, endocrine, hemostasis. According to the severity of the disorders, pretoxicosis, hydrops of pregnancy, nephropathy of pregnancy, preeclampsia and eclampsia are distinguished. May cause maternal and child mortality.

General information

Preeclampsia or late toxicosis of pregnant women is a complicated course III trimester pregnancy, characterized by the development of deep disorders in vital organs and systems, especially in the vascular bed and blood circulation. Preeclampsia begins to develop after 18-20 weeks of pregnancy, and is most often detected after 26-28 weeks. Preeclampsia accompanies 20-30% of pregnancies and is one of the most common causes of complicated childbirth (in 13-16% of cases), including maternal mortality and fetal death. According to the clinical forms of gestosis, dropsy, nephropathy, preeclampsia and eclampsia of pregnant women are distinguished. Clinical forms of gestosis can also be successive stages of a single pathological process, starting with edema during hydrops of pregnancy and gradually developing into the most severe form - eclampsia.

Late toxicosis of pregnant women is divided into pure and combined gestosis. Pure gestosis develops during pregnancy in women who do not suffer from concomitant diseases, and combined gestosis develops in women with a history of various diseases. An unfavorable course of gestosis is observed in pregnant women suffering from hypertension, renal pathology (pyelonephritis, glomerulonephritis), diseases of the biliary tract and liver (dyskenesia, previous hepatitis), endocrine glands (adrenal glands, thyroid, pancreas), lipid metabolism disorders.

Causes of gestosis

Complications of gestosis

The development of complications of gestosis is always associated with the death of the pregnant woman and the fetus. The course of gestosis can be complicated by the development of renal and heart failure, pulmonary edema, hemorrhages in the liver, adrenal glands, kidneys, intestines, spleen, and pancreas.

Characteristic complications of gestosis are premature detachment of a normally located placenta, placental insufficiency leading to developmental delay, hypoxia and malnutrition of the fetus. In severe cases of gestosis, HELLP syndrome may develop, the name of which is an abbreviation of the symptoms: H - hemolysis, EL - increased levels of liver enzymes, LP - decreased platelet levels.

Treatment of gestosis

The basic principles of treatment of emerging gestosis are: hospitalization and compliance with medical and protective measures, elimination of disturbances in the functioning of vital organs and systems, careful and quick delivery. Outpatient treatment of gestosis is allowed only for stage I dropsy. Pregnant women with severe gestosis (nephropathy, preeclampsia, eclampsia) are hospitalized in hospitals with an intensive care unit and a department for premature babies. In particularly severe cases of gestosis, early termination of pregnancy is indicated.

Therapeutic measures for gestosis are aimed at the prevention and treatment of complicated pregnancy and intrauterine fetal disorders (hypoxia, malnutrition and developmental delay) by normalizing:

• activity of the central nervous system;
• circulation, coagulability, blood viscosity;
• metabolic processes;
• condition of the vascular wall;
• blood pressure indicators;
• water-salt metabolism.

The duration of treatment for gestosis depends on the severity of its manifestations. With a mild degree of nephropathy, hospitalization is carried out for at least 2 weeks, with a moderate degree - for 2-4 weeks, taking into account the condition of the fetus and the pregnant woman, followed by discharge for observation in the antenatal clinic. Severe forms of gestosis (nephropathy, preeclampsia and eclampsia) are treated in a hospital under the supervision of resuscitators until delivery.

Early delivery for gestosis is indicated for persistent nephropathy of moderate severity, if the effect of treatment is absent within 7-10 days; severe forms of gestosis in cases of failure of intensive care measures for 2-3 hours; nephropathy, accompanied by delayed development and growth of the fetus during treatment; eclampsia and its complications.

Independent childbirth during gestosis in pregnant women is allowed if the condition of the mother in labor is satisfactory, the therapy is effective, and there are no intrauterine disorders of fetal development according to the results of cardiac monitoring and ultrasound research. Negative dynamics in the condition of a pregnant woman with gestosis (increased blood pressure, the presence of brain symptoms, increased fetal hypoxia) serves as an indication for surgical delivery.

Prevention of gestosis

Factors predisposing to the development of gestosis are: hereditary predisposition, chronic pathology of internal organs in a pregnant woman (kidneys, heart, liver, blood vessels), Rh conflict, multiple pregnancy, large fetus, pregnancy in a woman over 35 years old. Prevention of gestosis in women with risk factors should be carried out from the beginning of the second trimester of pregnancy.

In order to prevent the development of gestosis in pregnant women, it is recommended to organize a rational regimen of rest, nutrition, motor activity, spending time in the fresh air. Even with normal development Pregnancy requires restriction of fluid and salt intake, especially in the second half. An important component of the prevention of gestosis is pregnancy management throughout the entire period: early production registration, regular visits, control of body weight, blood pressure, laboratory tests of urine, etc. The prescription of drug prophylaxis for gestosis depends on concomitant diseases and is carried out according to individual indications.

Lecture No. 5

Topic 1.112. Nursing care for pathological pregnancy: gestosis, extragenital pathology

Lecture outline:

1. Updating the topic

2. Definition of the concept: “gestosis in pregnant women”, causes, clinical manifestations, principles of treatment and prevention;

3. Various types extragenital pathology during pregnancy;

4. Principles of treatment and prevention of gestosis and extragenital pathology in pregnant women.

5. Use of medications in accordance with the rules for their use;

6. Nursing care for pathological pregnancy: gestosis, extragenital pathology

Educational goals:

• Introduce students to the definition of “gestosis in pregnant women”;
• To develop knowledge about the causes, clinical manifestations, principles of treatment and prevention of gestosis and extragenital pathology.

Relevance of the topic: In recent years, the role of the nurse has increased significantly, which places special demands on her education, knowledge and practical skills. The nurse transforms from a technical executor of doctor’s orders into an independently thinking worker, capable of analyzing the purpose and results of any procedure, as well as predicting possible complications.

During pregnancy, a woman’s body undergoes significant functional changes, which normally do not go beyond the physiological. In case of non-compliance with hygiene, diet or extragenital diseases of a woman, pregnancy often becomes pathological.

Lecture notes

Main types of obstetric pathology.

1. Diseases of the maternal body arising in connection with the pregnancy itself (developing fertilized egg) - early and late gestosis.

2. Diseases caused by improper development of a fertilized egg - bleeding in the first and second half of pregnancy.

Bleeding in the first half of pregnancy is associated with abortion or miscarriage , violation ectopic pregnancy, chorionepithelioma .

Bleeding in the second half of pregnancy is associated with pathology of the placenta

ü placenta previa (lateral or marginal placenta previa - the placenta is located in the lower segment of the uterus, close to the pharynx; complete placenta previa - the placenta completely covers the pharynx)

ü premature abruption of the normally located placenta (PONRP)

3. Diseases that are not causally related to pregnancy and that arose during pregnancy (hepatitis, influenza, anemia), or worsen during pregnancy (exacerbation of chronic pyelonephritis) - extragenital pathology.

4. Obstetric pathology is treated the same way anomalies of the bony pelvis (its various forms and degrees of narrowing).

5. Abnormal fetal positions (transverse and oblique).

6. Malpresentation of the fetus (pelvic)

7. Complications of childbirth :

Anomalies of labor – primary and secondary labor weakness, discoordinated labor activity, excessive or violent labor.

Untimely rupture of amniotic fluid:

ü premature;

ü early;

ü belated.

8. Bleeding during childbirth (in the 1st, 2nd, 3rd and early postpartum periods) may be associated with pathology of the placenta, poor contractile activity of the uterus, ruptures of the uterus, cervix, vagina, perineum, vulva.

9. Pathological conditions of the fetus and newborn:

Fetal hypotrophy;

Fetal hypoxia;

Hemolytic disease newborn

Preeclampsia – there is a disease of adaptation of the mother's body to the presence of a growing fertilized egg in the uterine cavity. This is a disease that occurs during pregnancy and goes away with the end of pregnancy.

Gestosis in pregnant women occurs only in humans and is a consequence of one reason - the presence of a fertilized egg in the uterus. Clinically, gestosis manifests itself in various forms. This is due to the fact that everyone’s adaptive abilities are different: in some women, the body’s adaptation to new conditions (pregnancy) occurs quickly and completely, in others it occurs slowly and imperfectly.

Classification of gestosis.

By date of occurrence:

1. Early gestosis(toxicosis) (I half of pregnancy):

· Drooling

· Vomiting of pregnant women

Uncontrollable vomiting of pregnant women

1. Late gestosis(II half of pregnancy):

Dropsy

Nephropathy

Preeclampsia

Exlampsia

Rare forms of gestosis:

• Bronchial asthma pregnant women
• Jaundice of pregnancy
• Dermatoses of pregnant women
• Osteomalacia in pregnancy

Factors predisposing to the occurrence of gestosis are:

1) factors that help reduce the body’s reactivity;

2) extragenital pathology;

3) pregnancy before the age of 18 and age-old primigravidas after 35 years;

4) excess body weight;

5) multiple births;

6) genital infantilism;

7) unbalanced nervous system;

8) early gestosis during this pregnancy;

9) history of gestosis of the 1st and 2nd half of pregnancy;

10) genetically determined vascular pathology.

All women with these factors are identified as an increased risk group for gestosis.

Gestosis in the first half of pregnancy.

Drooling (ptialism) appears in the first 2-3 months of pregnancy and often resolves without treatment by the end of the 3rd month of pregnancy. In more severe cases, a woman loses up to 500-1000 ml. saliva per day. Excessive salivation leads to dehydration of the body, has a depressing effect on the psyche of a pregnant woman, and causes moceration of the skin of the lips and corners of the mouth.

Problems:

1) constant flow of saliva;

2) violation of a comfortable state;

3) sleep disturbance;

4) disability;

5) changes in the skin of the lips.

Treatment: in mild cases, treatment is possible on an outpatient basis; in severe cases, the pregnant woman is hospitalized.

1. Careful oral care: rinsing with a decoction of oak bark, sage, chamomile;
2. The skin in the corners of the mouth is lubricated with Vaseline;
3. Sucking on mints reduces salivation;
4. In case of significant dehydration - infusion therapy, vitamin therapy.

Vomiting of pregnancy(in the morning on an empty stomach), from 5-10 times a day or more.

There are:

1. Mild vomiting – up to 5 times a day. The pregnant woman retains most of her food, her general condition is almost unaffected, sleep is not disturbed, blood pressure and pulse are normal. Weight and urine output are not significantly reduced.

2. Moderate vomiting– 5 – 10 times a day. The pregnant woman retains part of the food, moderate weight loss, weakness, increased fatigue, decreased blood pressure, tachycardia, low-grade fever, and sleep disturbance are observed.

3. Severe (excessive, uncontrollable) vomiting-occurs after every meal. A pregnant woman cannot retain food, there is an aversion to food, progressive weight loss, the skin is flabby, dry - the skin turgor decreases, the tongue is coated, the mouth is clogged bad smell, blood pressure is reduced, tachycardia 100-120 beats per minute, low-grade fever, sleep disturbance, protein and acetone in the urine.

Problems and impaired needs will depend on the clinical form:

2) vomiting + insomnia;

3) vomiting + insomnia + anxiety;

4) violated need to be clean.

As a rule, after the 12th week of pregnancy, manifestations early gestosis either disappear completely or decrease significantly.

Treatment: for grade 1 vomiting – outpatient, for grades 2 and 3 – in hospital.

1. Therapeutic and protective regime and psychotherapy;
2. Electrosleep - regulates the relationship between the cerebral cortex and subcortical centers, where the vomiting center is located;
3. Diet – thermal, chemical and mechanical sparing is observed and fractional meals in 2 hours. For grade 3 – parenteral nutrition.
4. Impact on nervous system(sedative therapy)
5. Fighting dehydration, intoxication (infusion therapy, antiemetics)
6. Restoration of metabolism and functions of the most important organs (vitamin therapy).

When conducting drug treatment Pregnant women with gestosis in the first half of pregnancy should exercise caution, taking into account the possible embryotoxic effect. The recovery time depends on the thoroughness of following the doctor’s orders and the completeness of the care. The test that determines the effectiveness of treatment is stabilization or increase in body weight, normalization of body temperature and blood pressure, positive daily diuresis, decrease or disappearance of vomiting, decrease and disappearance of acetone in the urine. Upon recovery, the pregnant woman should be specially registered, as relapses are possible.