Symptoms of gestosis (preeclampsia)

• Edema
• Protein in urine
• Increased blood pressure

Risks of preeclampsia

Treatment of gestosis (preeclampsia)

• For swelling
• If kidney function is impaired
• For spasms
• When blood thickens

When to go to the hospital?

One of the most dangerous pathologies of pregnancy is gestosis ( read more here: « » ). However, with timely diagnosis and proper treatment, serious consequences can be avoided. What happens in the body during gestosis, what is its danger and how to treat it, Alina Vladimirovna tellsCZAPLOUCKA, gynecologist at the multidisciplinary medical center "EuroMed Clinic".

What happens during gestosis?

The exact cause - the trigger that provokes the development of symptoms of gestosis in the body of a pregnant woman - is still not known. The following is clear: the complication begins when the lining of the blood vessels becomes permeable and the liquid part of the blood, plasma, begins to leak through it.

This phenomenon has several unpleasant consequences: internal swelling of tissues and organs begins, the blood becomes thicker, its volume decreases, which leads to a deterioration in the blood supply to vital organs and the uterus. The body reacts by turning on the “emergency mode” of high blood pressure by spasming blood vessels, which further aggravates the situation and gives a new round to the development of complications. That is why, at the first signs of gestosis, it is so important to take urgent measures to stabilize this condition.

Expert commentary

With gestosis, the inner lining of small vessels of capillaries and precapillaries is damaged, their permeability increases, the liquid part of the blood leaves the vascular bed and accumulates in organs and tissues. Changes in blood supply to the vascular bed are accompanied by hypovolumia, chronic vascular spasm, i.e. contraction of small vessels leads to hypoxia (oxygen starvation) of the pregnant woman and fetus, thickening of the blood, which also forms a vicious circle, disrupting the blood supply to the kidneys, heart, liver, and other important organs, including the placenta.

Symptoms of gestosis (preeclampsia)

Preeclampsia has three main clinical symptoms, each of which individually can be caused by a number of other pathologies. However, if the patient has at least two of the three signs of gestosis, this may be the basis for a diagnosis.

The first sign is swelling

Edema often occurs in absolutely healthy pregnant women, so doctors do not make a diagnosis based on this symptom alone. However, the presence of severe edema is the basis for closely monitoring blood pressure levels and regularly taking a urine test. Swelling in combination with high blood pressure or protein in the urine is a sign of gestosis.

If there is a sudden weight gain and suspected edema, doctors often recommend that pregnant women undergo a special test - McClure-Aldrich test . To do this, the pregnant woman is injected with saline solution subcutaneously. A small blister forms at the injection site, which normally should dissolve slowly and remain visible for at least an hour. If the blister disappears earlier or does not form at all, this indicates hidden edema.

You can determine obvious swelling yourself: you need to press your finger on the inner surface of the shin. If there is a small hole left on the skin that does not go away within a few seconds, this is severe swelling.

The second sign is protein in the urine (proteinuria)

In almost any form of gestosis, proteinuria is recorded - a sign of kidney damage. If, apart from this symptom, there are no other signs of gestosis, protein in the urine may indicate other serious diseases.

Normally, there should be no protein in the urine. Values ​​above 0.3 g/l may be a sign of gestosis, especially in combination with high blood pressure.

The third sign is increased blood pressure (hypertension)

It is not without reason that doctors insist on constant monitoring of blood pressure levels in pregnant women. After the 20th week of pregnancy, a slight increase in blood pressure (no more than 5-10 mm Hg) relative to the “working” pressure of the pregnant woman is a physiological norm, this is due to the appearance of an additional circle of blood circulation.

However, an increase in pressure to values ​​of 140/90 and above is a rather alarming sign that requires urgent medical attention!

Signs of high blood pressure:

• Headache;
• Dizziness;
• Noise in ears;
• Nausea, vomiting;
• "Floaters" before the eyes;
• Redness of the skin or the appearance of red spots on the face and chest.

All three signs indicate preeclampsia. If such symptoms appear in a pregnant woman, it is important to immediately consult a doctor.

Expert commentary

Clinical manifestations:

Edema syndrome - edema can be hidden, manifested by pathological weight gain, or obvious, visible to the naked eye. They are usually localized on the feet, legs, hands, face, and anterior abdominal wall.

Proteinuria is the presence of protein in the urine, a significant excess - more than 0.3 g/l in daily urine.

Increased blood pressure - the criterion for hypertension is an increase in blood pressure of 140 or higher for systolic and 90 or higher millimeters of mercury for diastolic.

The borderline pressure is 130 and 80 mmHg. and requires careful monitoring.

Risks of preeclampsia

In rare cases, if the course is unfavorable, gestosis can develop into a severe form - eclampsia. According to statistics, preeclampsia occurs in 5-10%, and eclampsia in 0.5% of the total number of pregnant women and women in labor.

Preeclampsia is a preconvulsive condition, which is characterized by clinical signs of gestosis: high blood pressure, a large amount of protein in the urine, severe edema. Preeclampsia can lead to dire consequences for the mother and fetus, so this condition requires urgent hospitalization.

Eclampsia is a complicated form of preeclampsia: a severe seizure caused by an excessive increase in blood pressure. In the absence of urgent measures, it can, unfortunately, go into a coma.

Expert commentary

Preeclampsia is a multisystem pathological condition that occurs in the second half of pregnancy, after 20 weeks, characterized by arterial hypertension in combination with proteinuria more than 0.3 g per liter in daily urine, edema, and manifestations of insufficiency of the function of other organs and systems.

Complications of preeclampsia - eclampsia. Clinical manifestations are headache, blurred vision, hypertension and seizure alertness or generalized seizures.

Other complications of preeclampsia are edema, hemorrhage or retinal detachment, pulmonary edema, stroke, placental abruption, antenatal, intrauterine fetal death.

Treatment of gestosis

For mild forms of gestosis, individual supportive treatment is prescribed, aimed at stopping the development of complications. When treating gestosis, there is no general scheme for all; treatment can only be prescribed by a doctor, in accordance with the clinical picture of the complication.

For swelling:

• following a diet rich in proteins and vitamins;
• limiting fluid intake (no more than 800-1000 ml per day) and salt.

Sudden, sharp weight gain (more than 3 kg per week)

In a hospital setting, complex therapy is carried out to reduce blood pressure, remove spasms, improve blood supply to the uterus and placenta, and stabilize the nervous system. If the symptoms of gestosis worsen, emergency delivery is performed - through stimulation of natural labor or cesarean section, depending on the situation.

(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 of the third trimester of 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 fetal malnutrition. 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 examinations. 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, physical activity, and stay in the fresh air. Even with the normal development of pregnancy, it is necessary to limit the intake of liquid and salt, especially in the second half. An important component of the prevention of gestosis is the management of pregnancy throughout the entire period: early registration, regular visits, monitoring body weight, blood pressure, laboratory tests of urine, etc. The prescription of drug prevention for gestosis depends on concomitant diseases and is carried out according to individual indications.

One of the complications of pregnancy is gestosis, which is characterized by dysfunction of vital organs. Another name for gestosis is late toxicosis.

Preeclampsia is diagnosed after 20 weeks of pregnancy, but more often at 25-28 weeks, although signs of this complication may appear several days before birth.

Late gestosis is diagnosed in approximately 10-15% of all pregnant women.

Degrees

Depending on the severity of gestosis, there are 4 degrees:

• I degree - edema (edema of pregnant women);
• II degree (nephropathy);
• III degree (preeclampsia);
• IV degree (eclampsia).

There is also a distinction between pure gestosis and combined gestosis.

• Pure gestosis is spoken of if a woman does not have chronic extragenital diseases (not related to the genital area)
• Combined gestosis, on the contrary, occurs against the background of chronic general diseases (arterial hypertension, kidney disease, obesity, etc.).

Causes

At present, the causes of gestosis have not yet been identified, but one thing is certain - this complication of pregnancy is caused by the fetus, which comes into conflict with the mother’s body.

The mechanism of development of gestosis in pregnant women is a generalized vasospasm, which leads to hypertension (increased blood pressure).

Threat factors for the development of gestosis:

• age (under 18 and over 30 years old);
• pregnancy with more than one fetus;
• heredity (women whose mothers suffered from gestosis);
• first pregnancy;
• gestosis in previous pregnancies;
• the presence of extragenital pathology (obesity, arterial hypertension, renal and hepatic pathology, etc.).

Symptoms of gestosis

First, the preclinical stage of gestosis is diagnosed - pregestosis (there are no obvious signs). The diagnosis of pregestosis is made by evaluating laboratory and additional research methods:

• measuring blood pressure three times with a 5-minute break in different positions (increasing diastolic, i.e., lower values ​​by 20 mm Hg or more);
• increasing thrombocytopenia (decreased platelets);
• decrease in lymphocytes (lymphopenia);
• increased platelet aggregation (increased blood clotting).

Preeclampsia itself is manifested by a classic triad of symptoms (Zangemeister triad):

• swelling,
• proteinuria (protein in urine)
• increased blood pressure.

Symptoms by degree

I degree of gestosis
Edema (dropsy of pregnancy)

There are 4 degrees of edema in pregnant women.

The first degree is characterized by swelling of the feet and legs, in the second the swelling of the legs and rises to the anterior abdominal wall, the third degree is swelling of the legs, hands, anterior abdominal wall and face. And the last degree is generalized edema or anasarca.

In addition to the fact that swelling can be visible, do not forget about hidden swelling. Pathological weight gain (more than 300 grams per week) suggests hidden edema. Oligouria (reduction in the amount of urine excreted to 600-800 ml per day) also indicates hidden edema.

An indirect sign is the ratio of the liquid drunk and excreted (less than 2/3 excreted). Also a characteristic sign of edema in pregnant women is the “ring symptom” (it is difficult to remove or put on a ring on a familiar finger) and tightness of everyday shoes.

II degree of gestosis
Nephropathy

Nephropathy (OPG-gestosis) occurs as the Zangheimester triad:

• swelling, to varying degrees of severity,
• proteinuria (protein in urine),

When assessing an increase in blood pressure, they are guided by the initial (pre-pregnancy) pressure. Arterial hypertension is said to occur when systolic (upper) pressure increases by 30 mm Hg or more. Art., and diastolic increases by 15 or more mm Hg. Art.

On average (normal blood pressure in pregnant women is usually 110/70). Arterial hypertension is an increase in blood pressure up to 140/100 mmHg. Art.

Proteinuria indicates damage to the walls of the kidney vessels, through which protein enters the urine.

If traces of protein are detected in the urine (0.033 g/l), it is necessary to either exclude pyelonephritis, or there is non-compliance with hygienic rules when donating urine. Proteinuria is said to occur when protein levels in the urine reach 0.3 g/l or more.

III degree of gestosis
Preeclampsia

Condition preceding eclampsia

IV degree
Eclampsia

Serious condition, last degree of gestosis. Characterized by convulsive attacks.

Diagnostics

In addition to clinical manifestations, additional and laboratory research methods are used to diagnose gestosis:

• measuring blood pressure three times a day and after minor physical exertion (squatting, climbing stairs) - lability of blood pressure is diagnosed;
• general urinalysis (detecting protein, increasing urine density);
• general blood test (decrease in platelets, increase in hematocrit, which means blood thickening);
• urine analysis according to Zimnitsky (oliguria and nocturia - an increase in the volume of urine excreted at night);
• control of fluids drunk and excreted daily;
• weight measurement weekly;
• biochemical blood test (increased creatinine, urea, liver enzymes, decreased total protein);
• blood clotting (increase in all indicators).

Treatment of gestosis during pregnancy

Preeclampsia at home

Treatment of gestosis is prescribed and monitored by an obstetrician-gynecologist. For first degree edema, outpatient treatment is allowed. All other degrees of gestosis are treated in a hospital.

First of all, the pregnant woman is given emotional and physical peace. It is recommended to lie more on the left side (the “Bed rest” position), since in this position the blood supply to the uterus, and, consequently, to the fetus, improves.

Secondly, therapeutic nutrition is necessary (the treatment table must contain a sufficient amount of protein, the volume of liquid drunk depends on diuresis, and the food itself must be under-salted).

In case of pathological weight gain, fasting days (cottage cheese, apple, fish) are prescribed 1-2 times a week.

To normalize brain function and prevent convulsive attacks, sedatives (motherwort, valerian, novopassit) are prescribed. In some cases, weak tranquilizers (phenazepam) are indicated.

Treatment of gestosis in a hospital

The main place in the treatment of gestosis is occupied by intravenous drip administration of magnesium sulfate. The dose depends on the degree of gestosis and the severity of manifestations. Magnesium sulfate has hypotensive, anticonvulsant and antispasmodic effects.

For arterial hypertension, blood pressure-lowering drugs (atenolol, Corinfar) are prescribed.

Infusion therapy with saline solutions (saline and glucose solution), colloids (reopolyglucin, infucol - starch), blood products (fresh frozen mass, albumin) is also indicated.

To improve the rheology (fluidity) of blood, antiplatelet agents (pentoxifylline) and anticoagulants (heparin, enoxaparin) are prescribed.

Normalization of uteroplacental blood flow is carried out by membrane stabilizers and antioxidants (actovegin, vitamin E, glutamic acid).

Treatment of mild gestosis lasts for at least 2 weeks, moderate severity 2-4 weeks, and severe gestosis requires the pregnant woman to remain in the hospital continuously until delivery.

Complications and prognosis

Possible complications of gestosis:

• pathology of the liver, kidneys, heart;
• pulmonary edema, hemorrhages in vital organs;
• premature placental abruption;
• fetal hypotrophy;
• coma;
• intrauterine fetal death.

The prognosis depends on the degree of gestosis, its manifestations and the timeliness and effectiveness of treatment. In most cases, the prognosis is favorable.

Prevention

There is no specific prevention of gestosis. In the antenatal clinic, when registering, a woman’s medical history is carefully collected and an examination is carried out, after which the risk group for the development of gestosis is determined (low, medium or high).

Preventive courses of treatment are also carried out (sedatives, antioxidants, diuretics).

Some studies during pregnancy

Any woman who has given birth is familiar with some features of the course of pregnancy and the main stages of monitoring it: regular visits to a medical facility, testing, ultrasound examinations, weighing. Some people are surprised by the need for weight control. Like, why should medical workers care about the future figure of a pregnant woman? Any diagnostic procedure has a meaning and is conditioned by something.

How many kilograms should a woman's weight increase during pregnancy? Many will answer the question correctly - about 10 kg. What if it’s 20–25? Such an increase “speaks” of hidden (and not only) edema. And swelling is gestosis. For women, this disease is more commonly known as late toxicosis.

Edema is one of the diagnostic signs of gestosis, but the pathology is not limited to them. Preeclampsia is easier in healthy women. In this case it is called “pure”. This type of disease occurs in 30% of pregnant women. If it develops against the background of existing diseases (hypertension, diabetes, gastrointestinal ailments, kidney diseases), then in this case they speak of “combined” gestosis. It is clear that the latter form is more difficult.

The first signs of possible gestosis

This pathology concerns only pregnant women - after childbirth, gestosis goes away. However, gestosis is classified as a dangerous disease. Its cunning lies in its complications. A quarter of female deaths during pregnancy are due to gestosis. The fetus dies 3-4 times more often than during an uncomplicated pregnancy.

The main cause of gestosis is a dysregulation of blood vessels, resulting in their spasm. Microvessels are mainly affected.

As for the pathogenesis of gestosis: many scientists see its connection with immune factors. Fetal antigens influence maternal antibody production. In turn, antibodies cause the formation of excess immune complexes, which have a negative effect on the pregnant woman’s body.

How does gestosis manifest?

The disease is often called OPG-preeclampsia. OPG – the first letters of the terms: edema, proteinuria, . These are the main signs of pathology. The entire complex is not always noted. Mild gestosis can occur with one or two of the listed symptoms.

OPG complex of symptoms

Swelling is more common in pregnant women. A woman drinks a lot of fluid, which cannot completely leave the body and lingers in the interstitial space. Only the lower extremities may swell, but in more severe forms, the entire body may swell. Swelling is not always noticeable. Sometimes we are talking about a hidden form. It is detected by weighing. A weight gain of more than 0.5 kg per week indicates an emerging problem. Monitoring of fluid intake and amount of urine excreted is prescribed. If, during normal drinking conditions, less than 0.8 liters of urine is excreted, preeclampsia can be suspected.

Hypertension develops against the background of fluid retention. Blood pressure is monitored at every doctor's visit. Pressure during gestosis exceeds the norm by 15–20%. What pressure is considered normal? Usually it is 120/80. However, if a woman had symptoms at the beginning of pregnancy, then even the generally accepted norm for her may already be a signal for further examination.

Proteinuria refers to the excretion of protein in the urine. This sign indicates a violation of renal function. Therefore, it is important not to skip a diagnostic procedure such as a urine test. After 20 weeks of pregnancy, urine is examined weekly.

If a woman has two of the three signs of this disease, then treatment at home is ineffective - it is better to hospitalize the patient.

Other symptoms include headache, vomiting, nausea, and heaviness in the head. In the most difficult cases - changes in consciousness and convulsions.

The manifestation of pathology in pregnant women is more likely:

• Expecting their first child;
• Having genital tract infections: chlamydia, mycoplasmosis, ureaplasmosis;
• Suffering from chronic diseases: hypertension, diabetes, kidney disease, excess weight and others;
• Expecting twins.

Classification of gestosis

One of the classifications of pathology is divided into types:

1. Early gestosis;
2. Late gestosis.

The disease becomes more severe at the end of pregnancy.

Depending on the signs and form, the disease can be divided into the following degrees of severity:

1st degree

Dropsy of pregnancy is classified as gestosis of the 1st degree. This stage is characterized only by edema of varying severity. Usually they are less pronounced in the morning, and in the evening the condition worsens.

2nd degree

With grade 2 gestosis, all three symptoms of OPG are observed. In diagnosing hypertension, the most important indicators are diastolic pressure. The fact is that it is directly related to placental blood flow: the higher the diastolic pressure, the less oxygen the child receives. It is noteworthy that it is not so much the increase in pressure that is dangerous as its abrupt changes. This stage is especially difficult for pregnant women with concomitant diseases.

Complications develop:

• Placental abruption;
• Bleeding;
• Premature birth.

The main danger is that with complicated gestosis, the fetus is at risk of death.

Nephropathy is diagnosed simply by urine analysis. If things go wrong, it is important to monitor the condition of the fundus. Changes may indicate.

Stage 3, preeclampsia

As the condition worsens, stage 3 of gestosis develops. Pain and heaviness in the head indicate the onset of preeclampsia. Possible blurred vision, vomiting, and pain in the liver area. Memory deterioration, apathy, insomnia, irritability and other signs of changes in blood circulation in the brain are possible. Edema has a damaging effect on the liver, as evidenced by pain on the right side. There are even hemorrhages in this organ. “Floaters” and “veils” before the eyes may indicate problems with the retina.

Main signs of preeclampsia:

1. The amount of urine decreases to 0.4 liters or less;
2. Blood pressure – 160/110 or more;
3. Protein in urine;
4. Blood clotting disorder;
5. Changes in liver function;
6. Nausea, vomiting;
7. Symptoms of brain and visual disorders.

Eclampsia

An even more severe degree of gestosis is eclampsia. In addition to all of the above symptoms, convulsions are present. Typically, attacks are caused by external stimuli: loud sound, bright light, stress, pain. The attack does not last long - about 2 minutes. The danger of this condition is cerebral edema and death. Despite the similarities between gestational seizures and epileptic seizures, they have a number of differences. In epilepsy, urine tests are normal, there is no hypertension, and a characteristic epileptic aura is noted before a seizure.

HELLP syndrome

One of the dangerous forms is called HELLP syndrome. Its signs include bloody vomiting, jaundice, severe coma, and liver failure. Usually observed in women who have given birth frequently. May occur even after childbirth(unlike other forms of gestosis). About 80% of women and the same number of unborn children die from this type of pathology.

The most rare forms of gestosis include:

• Eczema;
• Dermatoses;
• Bronchial asthma;
• Pregnancy itch.

Some researchers suggest that all these forms are exacerbations of pre-existing diseases in women.

With different frequencies, pregnant women may suffer from other types of gestosis:

1. Osteomalacia. Otherwise - softening of the bones. A pronounced form is rare. More often it manifests itself in tooth decay, bone pain, changes in gait, and neuralgia. The reason for this condition lies in the lack of microelements - especially calcium - and vitamins.
2. Ptyalism (salivation). It is often accompanied by vomiting. With excessive saliva production, the body becomes dehydrated, speech is impaired, and the skin and mucous membranes are irritated.
3. Hepatosis. Accompanied by jaundice. It is necessary to differentiate with hepatitis. Therefore, a thorough diagnosis is carried out, and the woman is temporarily isolated from others.
4. Liver atrophy. If such a complication occurs during early gestosis and cannot be treated, then it is recommended to terminate the pregnancy.
5. HELLP syndrome is considered a truly rare form. Still, for most women, pregnancy ends happily - with the birth of a healthy baby.

Complications of gestosis

Mild gestosis can be almost invisible. Why get examined, let alone be hospitalized, if you feel good and don’t hurt anything! But I would like to emphasize that The main danger of the disease is its consequences, such as:

• Pulmonary edema;
• Hemorrhage;
• Pathology of the cardiovascular system;
• Placental abruption;
• Kidney diseases;
• Delay in child development;
• HELLP syndrome;
• Early birth;
• Liver diseases;
• Fetal hypoxia;
• Brain swelling;
• Problems with the retina of the eye;
• Stroke;
• Death of a child;
• Death of a pregnant woman.

Important! The development of dangerous stages of gestosis and their consequences can be prevented by timely diagnosis and correctly prescribed treatment.

Diagnostics

Every woman undergoes regular medical examination during pregnancy; if alarming symptoms appear, such examination is carried out unscheduled, and diagnostic procedures are added.

Required studies include:

1. Weighing. In the second part of pregnancy, weight gain should not exceed 350 g per week. If a woman has gained half a kilogram or more, then additional examinations need to be carried out.
2. The need to control fluid intake. For pregnant women, the rule “2 liters or more of water per day” is not suitable. And when pronounced edema appears, its amount should not be more than 1 liter. It is also necessary to control the volume of urine excreted.
3. Carrying out a blood test. The number of platelets and red blood cells is determined. Particularly important is the indicator of platelet content and coagulation. In addition to the general one, a biochemical analysis is carried out.
4. Blood pressure control, and on each arm. The presence of gestosis can be indicated by a large difference in the indicators on the left and right hands.
5. Analysis of urine. It is necessary to monitor the presence of protein in the urine.
6. Ultrasound of the fetus with. With the help of this study, the degree of fetal development and malnutrition is revealed.
7. Dentist examination.
8. Fundus examination. If the vessels of the fundus are changed, this may indicate problems with the vessels of the brain.

A woman should not ignore medical examinations. This is especially true for mature mothers (after 35 years) and those who are giving birth to their first child. Also, pregnant women with chronic and infectious diseases should be attentive to their health.

Successful diagnosis is the key to a properly structured treatment strategy.

Important! Not a single symptom should escape the attention of a pregnant woman. She must immediately report her suspicions to her doctor.

How to treat gestosis?

Let's say right away that Preeclampsia cannot be completely cured. It goes away with pregnancy. However, it is possible to prevent its development into more severe forms.

Main areas of treatment:

• It is necessary to create a protective treatment regime. A woman should avoid strong emotional stress, be calm and balanced. Bright light, noise, heavy physical activity that does not correspond to her condition are harmful. If gestosis is mild, then remedies such as motherwort and valerian are prescribed, and in more severe forms, they resort to individual selection of sedatives taking into account pregnancy.
• To restore the function of the pregnant woman’s body, as well as to prevent fetal hypoxia, appropriate medications are prescribed. These are medications that have a sedative, hypotensive, antispasmodic, and diuretic effect. Such drugs should improve placental blood flow, preventing fetal hypoxia. In case of exacerbation of existing chronic diseases, appropriate treatment is prescribed aimed at relieving symptoms.
• The birth canal must be prepared so that delivery during gestosis can be carried out in a timely and careful manner. The timing of delivery is determined by the condition of the pregnant woman. For example, a severe form of gestosis requires delivery no later than three days after the condition worsens. If eclampsia develops, delivery should be immediate. Childbirth is safest for the health of the baby at 38 weeks of pregnancy and later, since by this time all the vital systems of the fetus have time to form. Give birth naturally or use a caesarean section? The choice depends on the condition of the fetus and the birth canal of the pregnant woman. In case of severe gestosis, when urgent delivery is necessary, a caesarean section is performed. If childbirth occurs naturally, anesthesia is recommended. And not so much for pain relief, but to improve placental and renal circulation, as well as a slight decrease in pressure. In the case of mild gestosis, treatment is prescribed, and childbirth occurs on time naturally.

In moderate and mild forms of gestosis, women are recommended to be hospitalized in a hospital. Severe gestosis may require resuscitation. The main research procedures carried out in the hospital:

1. Conducting a general urine test, as well as a Zimnitsky test.
2. Study of the condition of the unborn child (Doppler, ultrasound, cardiotocography).
3. Coagulogram and other blood tests.

Infusion therapy is used as treatment, the task of which is to remove tissue fluid, as well as replenish its deficiency in the vessels. For hypertension, individual selection of medications is carried out.

Treatment lasts from several hours to several weeks. It all depends on the severity of the condition. The more dangerous it is, the less time a woman has. Delivery is the main outcome of any treatment. Therefore, in the most severe cases, an immediate caesarean section is performed.

Principles of hexose prevention

The main task of the patient and medical workers is timely detection of the disease and initiation of early treatment. Therefore, it is difficult to avoid gestosis without active prevention.

Avoid obesity. During pregnancy, women sometimes gain a lot of weight. Why is this happening? There are many reasons. Firstly, hormonal changes can cause an increase in appetite. Secondly, a woman begins to allow herself to eat everything, citing the fact that her figure is already deteriorating, it won’t get any worse. Thirdly, some women are sure that you need to eat for two. If she eats as before, the baby will not get many nutrients. Unfortunately, the effect of such eating behavior is sad - obesity and gestosis.

The diet for gestosis is very simple. The fetus needs protein (the cells of the unborn child’s body will be built from it), which means that a pregnant woman’s diet should include dairy products, lean meat, eggs, and fish. An increased protein content in food is also necessary because it migrates from the body.

You need vitamins, minerals, fiber. And they are most abundant in vegetables and fruits. Fiber is especially important: with a minimum of calories, it perfectly satisfies hunger. This diet is also beneficial for the gastrointestinal tract - there will be no constipation or complications such as those that often bother pregnant women. It’s good to forget about the existence of flour and sweet foods. Apart from excess weight, they will give nothing to either mother or child.

The maximum weight gain during the entire pregnancy should be no more than 12 kg. Women with initial underweight may gain a little more. Conversely, plump mothers are allowed to gain a maximum of 10 kg.

Proper drinking regime is very important. Despite the threat of edema, you should not severely limit yourself in water. It is recommended to consume 1 to 1.5 liters of fluid per day, this also includes fruits, soups and other foods. But you cannot retain this water with salt. No matter how much a pregnant woman would like to eat a pickled cucumber or a piece of herring, there is no need to do this. To remove excess fluid, as well as improve renal blood circulation, it is useful to drink a decoction of bearberry, rose hips, cranberry juice, kidney tea (by agreement with your doctor!). For the same purposes, the doctor may prescribe special medications: cystone, canephron, etc.

And one more, and perhaps the most important principle of prevention - active lifestyle. Pregnancy is not a disease. Therefore, a pregnant woman, like any other woman, should walk, swim, do yoga for pregnant women, Pilates, and not forget about special gymnastics. The main thing is not to overdo it. It is necessary to listen to your condition and stop exercising at the slightest suspicion of its deterioration. For your peace of mind, it is better to consult a doctor once again. Physical activity should not harm a woman and her unborn child. The doctor may recommend special exercises to help get rid of certain manifestations of the pathology.

Undiagnosed and untreated gestosis is dangerous. Only careful attention to yourself will allow a woman to give birth to a healthy child and maintain her own health.

Video: gestosis in the cycle “Pregnancy week by week”

Late toxicosis or gestosis is a complication of pregnancy, leading to disruption of vital organs and systems. Late toxicosis develops in the second half of pregnancy and progresses until childbirth.

The frequency of gestosis is 10-15% of the total number of pregnant women. Despite many years of research, the exact cause of the development of gestosis is still unknown. According to some researchers, gestosis develops due to a violation of hormonal regulation in vital organs. According to another version, gestosis occurs due to immunological incompatibility between mother and fetus.

Recently, the frequency of this pregnancy complication is increasing every year. Most obstetricians and gynecologists associate the increase in gestosis with an increase in the number of late births (after 35 years). Unfortunately, by this age, most women already have several chronic diseases, which significantly complicates the course of pregnancy and childbirth.

The main diseases that provoke the development of late toxicosis include:

high blood pressure, obesity, chronic pyelonephritis, diabetes mellitus, heart defects, vegetative-vascular dystonia.

Symptoms of gestosis

Signs of gestosis are varied. The expectant mother may notice the first symptoms of late toxicosis at 28-29 weeks of pregnancy. How do they manifest themselves? First of all, this is swelling of the legs, hands, and face. This is the so-called “hydropsis of pregnant women” - the mildest manifestation of gestosis. If the swelling is not pronounced, then the woman may not notice it. In order to determine whether there is swelling or not, you should carefully monitor your weight gain. Normally, starting from the 28th week of pregnancy, a woman’s weight can increase by an average of 350-500 g per week. If weight gain exceeds 500 g per week, then this may indicate fluid retention in the body, which is a sign of dropsy.

A more severe manifestation of gestosis is nephropathy (damage to the parenchyma and glomerular apparatus of the kidneys), which is characterized by edema, increased blood pressure and the appearance of protein in the urine (“proteinuria”). The more protein in the urine, the worse the prognosis of gestosis. How to notice nephropathy? The main symptom indicating progressive nephropathy is a decrease in the amount of urine excreted. This is a rather dangerous sign that a woman should pay attention to first. Most often, a woman first develops edema, then her blood pressure rises, and only then does proteinuria appear.

Severe manifestations of gestosis include the development of preeclampsia and eclampsia. These are the last stages of gestosis. Without timely medical intervention, such conditions pose a threat to the life of the mother and fetus.

With preeclampsia, microcirculation in the central nervous system is disrupted. Clinically, preeclampsia, as well as nephropathy, manifests itself in the form of the main symptoms - high blood pressure, edema, protein in the urine. Only with the development of preeclampsia, signs of damage to the nervous system are added to these symptoms: headaches, blurred vision, a feeling of flickering "flies" or " “veils” before the eyes, nausea, vomiting.

If this process is not stopped in time, preeclampsia turns into eclampsia - the pregnant woman suddenly develops seizures with loss of consciousness, lasting 1-2 minutes. Eclamsia can be fatal.

Considering the potential danger of gestosis, with any, even the most minimal manifestations of the disease, a woman should immediately contact an obstetrician-gynecologist and tell in detail about her complaints.

Diagnosis of late gestosis

In order to reliably determine whether or not gestosis is present, one visit to the doctor is not enough. Dynamic observation by an obstetrician-gynecologist is necessary.

At every visit to the doctor, a pregnant woman must measure blood pressure (BP) in both arms, pulse and body weight. An increase in blood pressure above 135/85 may indicate gestosis. The doctor evaluates the pregnant woman's weight gain, the presence or absence of edema, and asks the pregnant woman whether the amount of urine excreted has decreased.

Also, if gestosis is suspected, additional tests and studies are prescribed:

Clinical and biochemical blood test;
- general urine analysis;
- Fetal ultrasound with Doppler, CTG (cardiotocography) of the fetus.

If the obtained tests and examination data raise suspicions of gestosis (blood pressure above 135/85, severe edema and large weight gain, protein in the urine), the following is additionally prescribed:

Daily monitoring of blood pressure, ECG;
- urine analysis according to Nechiporenko, according to Zimnitsky, analysis of daily urine for protein;
- hemostasiogram;
- consultation with an ophthalmologist, therapist, nephrologist, neurologist.

Treatment of late gestosis

For mild manifestations of gestosis - dropsy, treatment is carried out on an outpatient basis. In case of nephropathy and more severe manifestations of the disease, hospitalization of the pregnant woman in the obstetric department is indicated.

With minor swelling and normal tests, treatment of gestosis is limited to following lifestyle and nutrition recommendations.

For dropsy with severe edema and mild nephropathies, the following is prescribed:

Sedatives (tinctures of motherwort, valerian);
- disaggregants (Trental, Curantil) to improve the rheological properties of blood;
- antioxidants (vitamin A and E);
- when blood pressure increases, antihypertensive drugs with an antispasmodic effect are used (Eufillin, Dibazol);
- herbal infusions with a diuretic effect.

In severe forms of nephropathy, preeclampsia and eclampsia, treatment is carried out with the participation of a resuscitator in the intensive care unit. Infusion therapy is carried out to correct metabolic and electrolyte disturbances - fresh frozen plasma and rheopolyglucin are administered. In addition to the above groups of drugs, anticoagulants (Heparin) are also used for severe forms of gestosis. To quickly regulate water-salt metabolism, diuretics (Furosemide) are used instead of herbal infusions.

For all forms of gestosis, selective sympathomimetics (Ginipral) are used to prevent the threat of premature birth and fetal hypoxia.

No less relevant is the question of the method of delivery for gestosis.

If the condition of the pregnant woman is satisfactory and the fetus does not suffer, based on ultrasound and CTG data, then the birth is carried out through the natural birth canal. If there is no effect of therapy, in severe forms of gestosis and chronic fetal hypoxia, a cesarean section is indicated.

Treatment of gestosis is carried out not only before childbirth, but also during childbirth and in the postpartum period until the woman’s condition is completely stabilized.

Nutrition and diet for gestosis

Lifestyle and nutrition for gestosis are very important for successful treatment. If there is edema and pathological weight gain, the pregnant woman should follow a special diet. It is necessary to exclude spicy, salty and fried foods from the diet. Consume less salt. Preference should be given to boiled dishes, slightly under-salted. Try to eat foods of both plant and animal origin, as well as dairy products, fruits and vegetables. On average, a pregnant woman with a tendency to edema should consume no more than 3,000 calories per day. You should limit not only your food intake, but also your liquid intake. You need to drink no more than one and a half liters of fluid per day. You should pay attention to diuresis - the amount of fluid excreted should be more than drunk.

A hectic lifestyle and stress also provoke gestosis. In the second half of pregnancy, a woman should sleep at least 8-9 hours a day. If you want to sleep during the day, it is also better to lie down to rest. But at the same time, a sedentary lifestyle can also provoke gestosis. Therefore, a woman is recommended to take at least an hour of walks in the fresh air every day and engage in special fitness for pregnant women.

Folk remedies for gestosis

Traditional medicine in the treatment of gestosis is very relevant, especially with dropsy; many medicinal plants have a diuretic effect. For gestosis, kidney tea, cranberry or lingonberry juice, and rose hip decoction are prescribed. You can use herbal preparations such as Canephron or Cyston. Sedative tinctures from motherwort or valerian can be used starting from 13-14 weeks of pregnancy for the prevention and treatment of gestosis. For severe forms of gestosis, folk remedies are not effective, so only medications are used.

Complications of gestosis:

Premature birth;
- detachment of a normally located placenta, leading to fetal death;
- fetal hypoxia, which also leads to intrauterine fetal death;
- hemorrhage and retinal detachment;
- heart failure, pulmonary and cerebral edema, heart attacks and strokes;
- development of renal and hepatic failure, hepatic coma.

Prevention of gestosis:

Reproductive function up to 35 years of age;
- timely treatment of chronic diseases that provoke gestosis;
- healthy lifestyle.

Consultation with an obstetrician-gynecologist on the topic of late gestosis:

1. I'm 38 weeks pregnant. They found a small amount of protein in my urine and prescribed IVs. But I have no swelling or pressure. Is treatment necessary at all in my case?
Treatment in this case is necessary to prevent the development of nephropathy. It is not necessary that there be pressure or swelling.

2.I'm 37 weeks pregnant. I have been in the hospital for 2 weeks now due to swelling and protein in my urine. Despite the treatment, the swelling increased and the protein remained as it was. What to do?
In your case, most likely, gestosis will go away only after childbirth, but treatment must be continued until childbirth in order to save the fetus. The main thing for you now is under the supervision of doctors.

3. Do I need to go to the hospital if I gain a lot of weight?
If there is no pronounced swelling, pressure and protein in the urine, then it is not necessary.

4. Normally my blood pressure is 120/80. When it rises to 130/90, my head hurts a lot. What to do, what to take?
This pressure is the upper limit of normal, but if you have a headache, this may indicate a complication of gestosis, so I recommend consulting with your gynecologist in person and, if recommended, going to the hospital.

5. Is it possible to give birth on your own with gestosis or is it necessary to have a caesarean section?
Preeclampsia is not an indication for caesarean section. The operation is performed only in emergency cases when the disease progresses.

6. By week 28 I had already gained 10 kg. The doctor prescribed Eufillin, but I don’t want to take it. All my tests are normal. Maybe you can do without Eufillin?
You can avoid using Eufillin only if you strictly adhere to the diet and other recommendations to reduce the manifestations of gestosis.

7. Why is protein in urine dangerous? How does this affect the fetus?
Protein in the urine indicates protein loss and impaired kidney function. In this case, the fetus does not have enough material to build its own cells. This can lead to delayed fetal development.

8. How much fluid can you drink per day with gestosis?
In the presence of edema - no more than one and a half liters per day.

9. I have swelling in my legs. The doctor prescribed Trental. But the instructions say there are many side effects of this drug, I’m afraid to drink it. How does Trental affect the fetus?
Trental is safe for children.

10. What is the acceptable level of protein in urine?
Normally, there should be no protein in the urine at all.

Obstetrician-gynecologist, Ph.D. Christina Frambos