Preeclampsia: correction in the postpartum period. Gestosis before and after childbirth. Preeclampsia in pregnant women - symptoms and prevention. Treatment of preeclampsia in pregnant women women's health

In vitro fertilization (IVF) is a modern technology of artificial insemination, with the help of which many couples have a chance to have a child. Even 10 - 15 years ago people.

Now there are many clinics in the country that can provide such services.

To operation C-section was successful, it is necessary to prepare for it accordingly. In this article, we will talk about preparing for a caesarean section.

comments on the article

© Site about pregnancy, childbirth and baby health BIRTH-INFO.RU,

All articles on the site are for informational purposes only. Only a doctor can prescribe a specific treatment!

Gestosis after childbirth

Preeclampsia after delivery: how to deal with it

Preeclampsia after pregnancy and during it has symptoms known to doctors: an increase blood pressure, swelling, and in connection with them a rapid and large weight gain, as well as protein in the urine. In severe preeclampsia, a woman experiences nausea and vomiting, a severe headache. Since pathology can cause a lot of problems, more than one doctor decides how to treat preeclampsia after childbirth. It all depends on which organs of the mother he hit.

Preeclampsia (late toxicosis) is one of the most severe pathologies in expectant mothers. It is directly related to pregnancy. It begins in the second, and more often the third trimester, and is the main cause of maternal and child mortality. It is not treated with medication, only by delivery. All that doctors can do is to help prepare the child as much as possible for life outside the womb (with the rapid early progression of the pathology, the child is born prematurely) and prevent (though not in all cases) eclampsia, a formidable complication of preeclampsia in the mother.

Preeclampsia that occurs in the mother for a period of weeks, as a rule, leads to an emergency caesarean section due to her serious condition and the child in order to save them. If late toxicosis occurs after weeks, there is a chance that preeclampsia will not have time to harm the body of the mother and child too much. Light preeclampsia rarely has consequences. Usually, all its symptoms go away in the first 1-2 days after the baby is born.

Childbirth with gestosis can be natural or operative, it depends on many factors. However, this situation is always under the control of doctors and anesthesiologists. Approximately half of the cases of eclampsia (severe convulsive seizures) occur in the postpartum period, in the first 28 days after birth. And more often eclampsia is diagnosed in women who gave birth at term.

With a period of less than 32 weeks and severe preeclampsia (severe preeclampsia), a woman is given a caesarean section. After 34 weeks, natural childbirth is possible if the baby does not show any health problems and is in the correct position in the uterus.

During childbirth, as a prevention of eclampsia, a woman receives epidural anesthesia, that is, she gives birth only with anesthesia, as well as drugs that reduce blood pressure.

Doctors are required to prevent prolonged labor and severe uterine bleeding after them. Therefore, a uterine contracting drug is used - "Oxytocin".

On the first day after childbirth, a woman suffering from severe preeclampsia is in the intensive care unit, where her condition is closely monitored by resuscitators. At this time, she receives anticonvulsant therapy in the form of "magnesia" familiar to many women. This drug not only relieves the tone of the uterus, but is also a good prophylactic from eclampsia. The condition of the woman is closely monitored. They take urine and blood samples from her, and often measure her blood pressure.

In the first days after childbirth, women physiologically increase the volume of circulating blood, and for those who suffer from preeclampsia, this is an additional risk factor for arterial hypertension. Depending on the level of blood pressure and the severity of preeclampsia, the puerperal is prescribed drugs for pressure. If possible, compatible with lactation. For example, Dopegit, Nifedipine. Treatment postpartum preeclampsia continues after discharge from the hospital. The increase in pressure can last up to about two months, but normally the condition should gradually return to normal. Withdrawal of the drug occurs by slowly reducing the frequency of administration and dosage.

Edema after childbirth - frequent occurrence. And not only in those suffering from gestosis. A sign of preeclampsia is considered a rapid increase in swelling of the hands and face. If the ankles are swollen - it's not so scary. It will pass within a few days or weeks. At the same time, breastfeeding women should not use diuretic (diuretic) drugs, as this will lead to a decrease in lactation - a lack of breast milk.

What to do if preeclampsia does not go away after childbirth

You need to know the symptoms that require urgent medical attention:

• headache;
• blurred vision, flies in the eyes;
• pain between the ribs or in the right hypochondrium (liver);
• infrequent urination;
• increase in pressure.

If the protein in the urine remains after 6-8 weeks after childbirth, a consultation with a urologist or nephrologist is required.

If there was eclampsia, it is necessary to do a CT scan of the brain. In addition, donate blood for antiphospholipid antibodies, lupus anticoagulant, undergo a test for thrombophilia.

Supervision at least of the gynecologist and the therapist is required.

Consequences of gestosis for the child and mother

The woman is explained that she is at risk for developing arterial hypertension, kidney and liver failure, and diabetes in the future. Preeclampsia after cesarean and childbirth can eventually turn into coronary heart disease, cause a stroke.

As for the new pregnancy, there is a risk of repeating the scenario of the previous one. For prevention, a woman is prescribed aspirin in small doses from 12 weeks of pregnancy until its end. Sometimes together with calcium preparations.

The interval between pregnancies should not be more than 10 years, as this is also a risk factor for the development of eclampsia when carrying a child.

Preeclampsia in pregnant women also has a negative effect on the child's body - after childbirth, preeclampsia in mothers disappears, but problems in the baby may remain. Most often, with the nervous system. Children whose mothers have suffered severe preeclampsia are almost always born small, with signs of intrauterine growth retardation and chronic hypoxia.

Toxicosis during pregnancy (gestosis)

In pregnant women, edema often appears on the body. This occurs against the background of a violation of the removal of excess fluid from the body and may not be a serious pathology. But in some cases, edema indicates a serious illness called gestosis of pregnant women. If the patient or the doctor does not sound the alarm in time, preeclampsia can be complicated by conditions that end in death.

Gestosis and its varieties

Preeclampsia (late toxicosis) is a disease that develops only during pregnancy and is characterized by the appearance of serious organic and functional disorders in many body systems, but most often in the cardiovascular system. Usually, in pregnant women, late toxicosis occurs after the 20th week of gestation, but is clinically detected after the 26th week. Up to a third of all pregnancies are accompanied by gestosis of one degree or another, and the woman's condition returns to normal only after childbirth has occurred. The most severe preeclampsia is observed in women suffering from endocrine pathologies, diseases of the kidneys, liver, heart, blood vessels.

The classification of preeclampsia is primarily based on the forms of its course:

All forms of late toxicosis can sequentially flow into one another, ending in the most severe of them - eclampsia. Preeclampsia can be concomitant (in women with a history of severe pathologies) and pure (in healthy pregnant women). Foreign classification divides gestosis into 3 forms:

• arterial hypertension of pregnant women;
• preeclampsia;
• eclampsia.

This classification in separate lines puts transient hypertension in pregnant women and preeclampsia, layered on existing hypertension. Another classification is based on the differentiation of preemplaxia by degrees (mild, moderate, severe).

Why do pregnant women develop preeclampsia

Late toxicosis is a syndrome of multiple organ failure, which is caused by a violation of the mechanisms of adaptation of the body to pregnancy. It is believed that the immediate causes of gestosis are associated with an autoimmune reaction of the body to the release of certain substances by the placenta and fetus. These substances, reacting with their own cells immune system form complex antibody complexes. They damage the walls of blood vessels, making them permeable. In addition, these causes lead to generalized vasospasm, which disrupts the blood supply to internal organs. Due to angiospasm, blood pressure rises and the total volume of circulating blood decreases. The viscosity of the blood increases, blood clots appear, hypoxia of the tissues of the kidneys, brain, and liver is detected.

Presumably, the above processes in the body of a pregnant woman can be combined with a change in the hormonal regulation of the functioning of vital organs. There is also a genetic predisposition to gestosis. The causes of preeclampsia are also associated with a failure of the nervous regulation of the activity of organs and systems.

There are a number of factors, the impact of which is considered predisposing to the development of preeclampsia during pregnancy. Among them:

• diseases of pregnant women in anamnesis, including pathologies of the heart, liver, nervous system, metabolism, gallbladder, kidneys;
• the presence of autoimmune diseases and allergic reactions at the time of pregnancy;
• bad habits;
• severe stress;
• excess body weight;
• violations of the structure of the genital organs, their underdevelopment;
• poisoning, intoxication;
• polyhydramnios, hydatidiform drift.

According to statistics, the symptoms of preeclampsia often occur in women over the age of 35 and under 18, in socially unprotected women who have poor living conditions and nutrition. Preeclampsia can develop after abortions performed at short intervals or during multiple pregnancies.

Gestosis in the first half of pregnancy

Preeclampsia in pregnant women can occur even on early stages bearing a fetus. Early toxicosis (preeclampsia) is more often detected from the first weeks and has a variety of symptoms. The woman notes nausea, vomiting, changes in taste and smell, nervousness, tearfulness. Early mild toxicosis can cause vomiting up to 3-5 times a day. The average severity of toxicosis has more severe symptoms: vomiting is observed up to 7-10 times a day, there is a pronounced weight loss. After the development of a severe degree of toxicosis, a woman urgently needs hospitalization, since indomitable vomiting is combined with an increase in body temperature, a drop in pressure, pulse, a sharp weight loss, the appearance of acetone and protein in the urine. If early preeclampsia has not disappeared by the end of the 1st trimester, a comprehensive examination of the woman for pathology of the internal organs should be carried out.

Gestosis in the second half of pregnancy

If early preeclampsia is dangerous due to dehydration and impaired fetal development, then late toxicosis is an even more serious condition. Already by the presence of rapid weight gain, the appearance of edema and protein in the urine, the doctor may suspect preeclampsia in pregnant women. Later, as a complication, an increase in blood pressure is added, which occurs in about 30% of women with preeclampsia. The danger of toxicosis in the second half of pregnancy is that its signs can quickly turn into a serious condition - eclampsia, which is very dangerous for the life of the mother and child. Late toxicosis often develops during the first pregnancy, and its symptoms can increase hourly and have a very aggressive course. Sometimes only an emergency birth can save the life of an expectant mother.

Gestosis during the second pregnancy

Women who have experienced severe preeclampsia during pregnancy have high risk development of pathology during repeated gestation of the fetus. If the interval between pregnancies is small, then the risk of preeclampsia is even higher. Usually, expectant mothers from the risk group are placed in a hospital in advance, or their health status is monitored on an outpatient basis from the first weeks of pregnancy.

Clinical picture of preeclampsia

As a rule, in late pregnancy, signs of preeclampsia are associated with the appearance of edema (dropsy). They can be implicit and are detected by rapid weight gain (more than 400 grams per week). As the pathology develops, edema becomes noticeable on the legs, feet, abdomen, face, hands. Edema is especially visible in the second half of the day.

Preeclampsia in pregnant women at the stage of dropsy is due to a decrease in urine output and a violation of the outflow of fluid. At the same time, other signs of pathology are often absent, and the woman may feel well. Later, thirst, severe fatigue, heaviness in the legs join.

At the stage of nephropathy during pregnancy, proteinuria (the presence of protein) is detected in the urine, blood pressure increases (from 135/85 mm Hg). An uneven, spasmodic fluctuation of pressure during the day is diagnosed. The amount of urine excreted by a woman falls sharply, despite the consumption of a large volume of fluid. If at this stage there is no necessary treatment, the symptoms of gestosis increase rapidly and can develop into pathologies such as eclampsia and preeclampsia.

Preeclampsia is a complication of nephropathy in pregnant women, accompanied by severe circulatory disorders and damage to the nervous system. In addition, the patient has small hemorrhages in the retina, liver, stomach. Preeclampsia has the following clinical features:

• heaviness in the head, pain, dizziness;
• nausea, vomiting;
• pain in the abdomen, stomach, ribs;
• sleep disorders;
• visual dysfunction due to damage to the retina.

Treatment for preeclampsia must be urgent and most commonly includes induced labor and intravenous administration medicines. Otherwise, there is a high probability of developing a pathology such as eclampsia. Signs of this condition:

• severe pain in the body without a clear localization;
• headache;
• convulsive seizures;
• loss of consciousness;
• coma.

Eclampsia is often expressed in convulsions that last for several minutes and cause severe tension in the body, face. Foam with blood may come out of the mouth, breathing becomes intermittent, hoarse. During this period, a pregnant woman can quickly die from a massive cerebral hemorrhage. After consciousness has returned, the woman may again fall into a state of seizure due to exposure to any stimulus (sound, light). If the state of eclampsia was diagnosed in late pregnancy, even with successful delivery and saving the life of a woman, internal organs and systems are damaged. Their treatment in the future will depend on the complexity, magnitude and severity of the course.

Consequences and complications of preeclampsia

Preeclampsia is always a serious test for both mother and child. Retinal detachment in preeclampsia leads to irreversible blindness or permanent visual impairment. The functioning of the nervous system, kidneys, liver worsens, blood clots form, heart failure develops. Preeclampsia and eclampsia can cause complications that threaten a woman's life - severe dehydration, stroke, hemorrhages in internal organs, dropsy of the brain, pulmonary edema, acute liver dystrophy. The baby can also die due to placental abruption and hypoxia and suffocation developing in connection with this. The overall rate of perinatal mortality against the background of preeclampsia reaches 30%. Even a mild form of gestosis causes disturbances in the physical development of the fetus due to hypoxia, as well as the appearance of mental abnormalities after childbirth. Due to the very serious consequences, the prevention of preeclampsia and its early detection are of high relevance.

Gestosis after childbirth

As a rule, childbirth quickly alleviates the condition of the pregnant woman. Preeclampsia most often improves symptoms within 48 hours after delivery, but eclampsia may develop within the same period. In this regard, after childbirth, drug prevention of further complications is carried out. If the signs of preeclampsia do not disappear 14 days after delivery, this means the presence of damage to the internal organs and systems. Such patients need long-term, sometimes life-long treatment of emerging pathologies.

Diagnosis of preeclampsia

If there is a rapid weight gain (from 400 grams per week), the specialist should conduct an examination of the pregnant woman in order to identify signs of preeclampsia. It includes:

• general analysis of urine, blood;
• blood biochemistry;
• urinalysis according to Zimnitsky;
• regular weighing and pressure measurements;
• fundus examination;
• fetal ultrasound;
• Ultrasound of internal organs.

A woman must consult a nephrologist, ophthalmologist, neuropathologist, and, if necessary, a cardiologist. If latent edema is detected due to excessive weight gain, an MCO test is performed (subcutaneous injection of saline and fixing the time during which it resolves).

Mild Preeclampsia in Pregnancy

Preeclampsia in late pregnancy can present with varying degrees of severity. With a mild degree, a woman has the following indicators:

1. arterial pressure periodically rises to 150/90 mm Hg;
2. the concentration of protein in the urine is not higher than 1 g / l;
3. visualized swelling on the legs (lower leg, foot);
4. the platelet count reaches 180 * 109 l;
5. creatinine in the blood is not more than 100 μmol / l.

At this stage, the pregnant woman is placed in a hospital, her movement is strictly limited, and drug treatment is performed. When the condition worsens, an operation is performed - childbirth by caesarean section.

Preeclampsia of moderate severity in pregnant women

Moderate preeclampsia is characterized by the following indicators:

1. blood pressure rises to 170/110 mm Hg;
2. proteinuria not higher than 5 g/l;
3. edema is found on the legs, on the anterior part of the peritoneum;
4. creatinine in the blood - mk.mol / l.

At this stage, urgent delivery by caesarean section is indicated.

Severe preeclampsia

Severe preeclampsia occurs with severe symptoms (vomiting, headache, etc.). At any moment, this condition turns into eclampsia, but sometimes the last degree of preeclampsia develops atypically, when there are no visible causes and signs of it. Therefore, if moderate edema does not disappear after treatment within 3 weeks, the disease qualifies as severe preeclampsia. Her diagnostic criteria are:

1. blood pressure over 170/110 mm Hg;
2. proteinuria - from 5 g / l;
3. edema is found on the legs, anterior part of the peritoneum, on the face, hands;
4. platelet count - * 109 l;
5. creatinine - from 300 micromol / l.

Features of pregnancy management with preeclampsia

If the treatment of preeclampsia or observational tactics do not lead to an improvement in the woman's condition, delivery is planned, regardless of the duration of pregnancy. On the contrary, if laboratory parameters and clinical signs have improved, then the pregnant woman continues to remain in the hospital under close supervision. Be sure to appoint a special diet, bed rest, pressure control up to 6 times a day. A woman is weighed twice a week, the drinking regimen and the amount of urine excreted are monitored. Urine and blood tests are also regularly performed, examinations are carried out by narrow specialists. Thus, the treatment and prevention of preeclampsia often help to bring the pregnancy to a week and safely carry out delivery. Childbirth by caesarean section is planned in the absence of the effect of therapy.

Nutrition of the expectant mother with gestosis

The diet of a pregnant woman should provide her and the baby with all the necessary nutrients, but the amount of food should be limited. In other words, you should not exceed the norms for the caloric content of the diet established for pregnant women. The diet for preeclampsia must necessarily include animal protein (fish, meat, dairy products, eggs), which is lost in the urine. We must not forget about vegetable fiber, but it is better to exclude sweets and salty, refined, fatty foods. Treatment of preeclampsia necessarily includes limiting salt and fluid intake (up to a liter per day). Instead of water, it is better for a future mother to drink diuretic teas, a decoction of lingonberry leaves, bearberry. The pregnant diet excludes the consumption of pickles, marinades, salted fish, etc.

Treatment of preeclampsia

In addition to dietary nutrition, fluid restriction and bed rest, a pregnant woman is often prescribed medication:

1. sedative preparations of plant origin (valerian, motherwort);
2. herbal diuretics (canephron, cystone), synthetic diuretics (lasix);
3. magnesium preparations for removing excess fluid from the body (magne B6, magnesium sulfate intravenously);
4. vitamin and mineral complexes;
5. drugs to improve placental circulation (actovegin, chimes);
6. drugs of the latest generation that lower blood pressure (valz, physiotens, etc.);
7. preparations to improve the functioning of the liver (chophytol, Essentiale).

Outpatient treatment is carried out only in the initial degree of preeclampsia - dropsy. All other stages of the pathology require the placement of a pregnant woman in a hospital. In severe cases, a woman is prescribed emergency therapy with drugs that reduce blood pressure, anticonvulsants, and after stabilization of the condition, immediate delivery is performed.

The influence of preeclampsia on the methods and timing of delivery

Independent childbirth is allowed if the treatment of preeclampsia was successful, the condition of the fetus and the pregnant woman herself is not satisfactory, and there are no prerequisites for the development of acute preeclampsia during childbirth. In other cases, operative delivery is indicated. Indications for preterm birth are:

• persistent nephropathy of moderate, severe degree;
• failure of gestosis therapy;
• preeclampsia, eclampsia (including complications of eclampsia).

Childbirth in severe cases of late toxicosis is carried out within 2-12 hours, which depends on the period of normalization of the woman's condition after the onset drug therapy. Childbirth with moderate preeclampsia is planned in 2-5 days from the start of treatment in the absence of its effectiveness.

How to prevent gestosis

Prevention of preeclampsia should be carried out in every pregnant woman after the end of the first trimester. Particular attention should be paid to women with multiple pregnancy, women over 35 years of age and with a history of chronic diseases of internal organs. To prevent gestosis, the following measures are taken:

• organization of the daily routine and proper nutrition;
• regular but moderate physical activity;
• frequent exposure to the open air;
• limiting salt intake;
• observation by an obstetrician-gynecologist during the entire period of pregnancy;
• treatment, correction of chronic pathologies;
• rejection of bad habits.

At the first sign of fluid retention in the body, you need to notify the doctor about this, who will do everything necessary to maintain the health of the mother and the birth of a strong baby!

• constant general fatigue;
• drowsiness;
• malaise;
• periodic causeless pain in the internal organs;
• depression

The presented materials are general information and cannot replace the advice of a doctor.

GESTOSIS: correction in the postpartum period

Preeclampsia is a pathology of pregnancy, which is one of the most threatening complications for both the mother and the fetus. Preeclampsia is characterized by a deep disorder of the functions of vital organs and systems. According to different authors

Preeclampsia is a pathology of pregnancy, which is one of the most threatening complications for both the mother and the fetus. Preeclampsia is characterized by a deep disorder of the functions of vital organs and systems. According to various authors, the incidence of preeclampsia in pregnant women in our country ranges from 7 to 16%.

In the structure of mortality of pregnant women, women in childbirth and puerperas, severe forms of gestosis occupy one of the first places.

Childbirth, eliminating the cause of the disease, does not prevent the preservation and progression of changes in the organs and systems of a woman after pregnancy. This increases the risk of complications in the postpartum period, the occurrence of preeclampsia with repeated pregnancy, formation extragenital pathology.

Currently, gestosis in 70% of cases develops in pregnant women with extragenital pathology.

Preeclampsia is a syndrome of multiple organ functional failure that occurs or worsens in connection with pregnancy. It is based on a violation of the mechanisms of adaptation of a woman's body to pregnancy.

In our opinion, speaking about the development of gestosis, one should agree with the conclusion of the majority of scientists about the combined effect of a number of factors on the body of a pregnant woman: neurogenic, hormonal, immunological, placental, genetic.

Human placenta, liver and kidneys are known to contain common antigens. The emergence of antibodies to the placenta, liver and kidneys of the fetus due to cross-reactions leads to immunological alteration of these organs of the mother's body and disruption of their function, which is observed in late gestosis.

The genetic theory of gestosis suggests an autosomal recessive way of inheritance of the disease. It has been noted that among the daughters of women with preeclampsia, the number of gestosis diseases is 8 times higher than in the normal population.

As a trigger for gestosis, supporters of the placental theory mention humoral factors of placental origin. In the early stages of gestation, trophoblast migration into the arteries is inhibited. At the same time, in twisted uterine arteries no transformation of the muscle layer is observed. These morphological features of spiral vessels, as gestation progresses, predispose them to spasm, decreased intervillous blood flow, and hypoxia. Hypoxia, which develops in the tissues of the uteroplacental complex against the background of impaired blood flow, causes local damage to the endothelium, which later becomes generalized. Damage to the endothelium in the development of preeclampsia is currently accepted to take one of the significant places.

The main markers of endothelial dysfunction in late gestosis are thromboxane A2, prostacyclin, von Willebrand factor, fibronectin, tissue plasminogen activator and its inhibitor, endothelial relaxing factor, endothelial cells circulating in the blood. The authors came to the conclusion that with an increase in gestational age, an increase in the severity late preeclampsia the number of endotheliocytes circulating in the blood increases.

When conducting electron microscopy in blood smears in patients with eclampsia, it was found a large number of endothelial cells, their swelling against the background of increased plasmolemma permeability and signs of cell damage in the form of cytoplasm vacuolization, swelling and clarification of the mitochondrial matrix, and chromatin condensation were noted.

Damage to the endothelium contributes to the development of changes underlying gestosis - an increase in vascular permeability and their sensitivity to vasoactive substances, the loss of their thrombotic properties with the formation of hypercoagulability, with the creation of conditions for generalized vasospasm. Generalized vasospasm leads to ischemic and hypoxic changes in vital organs and disruption of their function.

Against the background of spasm of the microcirculation vessels, the rheological and coagulation properties of the blood change, and a chronic form of the syndrome of disseminated intravascular coagulation (DIC) of the blood develops. One of the reasons for the development of DIC is the deficiency of anticoagulants - endogenous heparin and antithrombin III, the decrease of which, according to a number of authors, corresponds to the severity of preeclampsia. The basis of the chronic course of DIC in preeclampsia is widespread intravascular coagulation with impaired microcirculation in the organs.

Along with vasospasm, impaired rheological and coagulation properties of blood, hypovolemia plays an important role in the development of organ hypoperfusion, mainly due to low circulating plasma volume (VCV). Low values ​​of VCP in preeclampsia are due to generalized vasoconstriction and a decrease in the vascular bed, increased permeability of the vascular wall with the release of part of the blood into the tissues. Vascular and extravascular changes lead to a decrease in tissue perfusion and the development of hypoxic changes in tissues, as evidenced by a decrease in tissue partial oxygen tension in tissues by 1.5–2 times, depending on the severity of the disease.

The authors of some works suggest that the trigger for the development of multiple organ failure in preeclampsia (as in sepsis, toxic-allergic dermatitis, postoperative syndrome, etc.) is a systemic inflammatory response syndrome, in the development of which there are three stages. The first stage, in response to a damaging factor (immune or non-immune agent), is characterized by local production of cytokines by activated cells, which are numerous mediators (lymphokines, monokines, thymosins, etc.), which are mediators of intercellular interactions and regulators of hematopoiesis, immune response. The second stage is characterized by activation of macrophages and platelets by cytokines, an increase in the production of growth hormone. At the same time, an acute phase reaction develops, which is controlled by anti-inflammatory mediators and their endogenous antagonists.

In case of insufficient function of the systems regulating homeostasis of the body, the damaging effect of cytokines and other mediators increases. This entails a violation of the permeability and function of endothelial capillaries, the formation of distant foci of systemic inflammation and the development of organ dysfunction, which is typical for the third stage of the systemic inflammatory response syndrome.

According to the latest data (I. S. Sidorova et al., 2005), neurospecific proteins of the fetal brain play a leading role in the development of preeclampsia and acute endotheliosis. This is due to the fact that in the mother's body there is no tolerance to these proteins, which have the properties of autoantigens and, when they enter the mother's bloodstream, cause the formation of antibodies. The appearance of antigens of neurospecific proteins in the mother's blood is due to a violation of the permeability of the blood-brain barrier. One of the most important pathogenetic links leading to impaired permeability of the blood-brain barrier is autoimmune brain damage, which leads to the development of severe forms of the disease during pregnancy and childbirth, and also causes the development of complications during the three-year postpartum period.

Without denying the significance of damage to the central nervous system, kidneys, uterus and other organs that develops with gestosis, I would like to emphasize the role of liver changes that occur in connection with the development of hepatosis or HELLP syndrome. The relevance of the study of these pathological conditions is due to the fact that there are still no definitively developed criteria for their diagnosis and therapy, and in 50–70% they lead to death.

The liver is an organ in which numerous metabolic reactions take place. It occupies a central place not only in the processes of intermediate metabolism of carbohydrates, proteins, nitrogen, etc., but also in the synthesis of proteins, redox reactions, and the neutralization of foreign substances and compounds.

The dynamic development of the gestational process, leading to an increase in the load on the organ, exposes the liver to functional stress, which does not lead to any special changes in it. However, it must be borne in mind that the liver, depleting its reserve capacity as pregnancy progresses, becomes vulnerable.

During this period, it is advisable Special attention pay attention to the functional state of the hepatobiliary system, which plays a significant role in the pathogenesis of severe forms of preeclampsia. At the same time, a change in most parameters can be recorded even at the preclinical stage, which makes it possible to predict the development of liver failure. In addition, when observing a physiologically proceeding pregnancy, one should take into account the effect of progesterone on the tone and motility of the biliary tract, which contributes to the occurrence of cholelithiasis and cholestasis even in healthy women.

During a physiologically proceeding pregnancy, as the authors point out, certain changes are observed in the liver, which are purely functional in nature and do not cause disturbances in the general condition of pregnant women.

Pregnant women with a physiological course of gestation are characterized by an increase in the activity of alkaline phosphatase due to additional synthesis of the enzyme by the placenta, an increased content of cholesterol, triglycerides. On the 6th day of the postpartum period in healthy puerperas, regardless of the method of delivery, all indicators of the functional state of the liver return to normal.

In pregnant women with gestosis, there is a violation of the functional activity of the liver, manifested by hyperenzymemia, changes in pigment, lipid, protein, carbohydrate metabolism and thrombocytopenia, immunodeficiency phenomena, the severity of which corresponds to the severity of the disease. Changes in indicators of the state of the liver in most pregnant women with preeclampsia are not accompanied by clinical signs of her disease.

The data available in the literature indicate that the violation of the functional state of the liver in severe forms of preeclampsia reaches a maximum and persists for 24–48 hours after childbirth.

With gestosis in the liver, as in an organ with a developed capillary system, to one degree or another, a deep violation of microcirculation and chronic tissue hypoxia always develop. At the same time, according to the author, her condition, according to clinical and biological indicators, is characterized by a syndrome of hepatocellular insufficiency.

In patients with mild forms of gestosis, no significant changes in the liver are found in the study of biopsy material. In severe forms of gestosis, small droplet fatty degeneration of hepatocytes develops in the absence of necrosis, swelling of the cytoplasm, and changes in the hepatic parenchyma. However, even in the mildest cases, there are signs of a violation of the functional state of the liver. First of all, there is a regular change in the protein-forming and detoxifying functions of the liver. According to a number of studies, with an increase in the severity of preeclampsia, hypoproteinemia increases, expressed in a decrease in albumin fractions and an increase in globulin (IgG, IgA, IgE), an increase in the level of circulating immune complexes.

It has been established that with gestosis, the antitoxic function of the liver, cellular and humoral immunity are sharply suppressed. Pigment and carbohydrate functions are disturbed least of all. An increase in bilirubin is noted only with preeclampsia - mainly due to the fraction of indirect bilirubin. In severe forms of gestosis, hypercholesterolemia and an increase in transaminase activity are found.

Studies show that the activity of indicator liver enzymes in preeclampsia can both increase and significantly decrease. At the same time, according to the author, various systems of hepatocytes are damaged to varying degrees, some can continue to function even with a very severe course of preeclampsia. Apparently, it depends on the initial state of the body.

According to most authors, clinically, liver damage is asymptomatic or develops only with a developed picture of severe preeclampsia (acute fatty hepatosis or HELLP syndrome), while milder degrees go unnoticed.

The poverty of the clinical manifestations of liver pathology in preeclampsia, according to M. A. Repina, dictates the need to develop reliable laboratory criteria for assessing the severity of its damage.

The question of whether the transferred preeclampsia really increases the likelihood of developing various diseases in the future is of interest to many researchers. However, the results of clinical and epidemiological studies are very contradictory (G. M. Savelyeva, 2003; V. L. Pecherina et al., 2000).

Thus, at present there is no consensus on the long-term consequences of preeclampsia and the occurrence or progression of any extragenital diseases in the future. Nevertheless, it can be assumed that profound changes in organs and systems (multiple organ failure), arising as a result of the pathogenesis of preeclampsia, do not stop after delivery and may cause the development of extragenital complications in the future.

Diagnosis of liver diseases in pregnant women presents certain difficulties. This is due to the fact that the clinical picture of the disease in pregnant women with preeclampsia often changes, the disease can proceed atypically. In the second half of pregnancy, the definition of the boundaries of the liver and its palpation are difficult due to the filling of the abdominal cavity with a growing uterus; during pregnancy, biochemical blood parameters also change, as a result of which the interpretation of liver function tests in pregnant women requires some correction. The most modern research methods (radionuclide liver scan, splenoportography, laparoscopy, puncture liver biopsy) are unsafe for pregnant women, and we can perform them only after delivery.

Based on the above pathogenetic features of gestosis, the algorithm for diagnosing liver disorders consists of determining its morphological and functional changes.

Until now, blood serum indicators have been the main criteria for the clinical diagnosis of hepatocellular insufficiency. In this regard, it is necessary to study the biochemical parameters of blood serum. The criterion for assessing the permeability of the plasma membrane and damage to hepatocytes is the determination of the level of enzymatic activity of alanine aminotransferase, a cytosolic enzyme of hepatocytes, as well as enzymes associated with various cell structures: aspartate aminotransferase, alkaline phosphatase, lactate dehydrogenase. It is also necessary to determine indicators of cellular (subpopulations of T-lymphocytes, B-lymphocytes) and humoral immunity (IgG, IgA, IgM, IgE) to assess the severity of immunodeficiency.

The study of morphological changes is an assessment of the results of ultrasound examination of the liver and gallbladder; at the same time, the density of the wall of the gallbladder, liver, gallbladder bile is determined, the volume and thickness of the walls of the gallbladder are measured. Ultrasound diagnostics fatty hepatosis is produced by recording the ultrasonic density of various sections of the hepatic parenchyma by echodensitometry, which, based on a pathological change in a specially introduced attenuation coefficient, makes it possible to diagnose fatty hepatosis.

Hepatobiliary scintigraphy is a comprehensive study of the functional and organic state of the hepatobiliary system, including an assessment of bilisynthetic and biliary excretory functions of the liver, concentration and motor functions of the gallbladder, biliary tract patency. The study is highly informative in patients with inflammatory and metabolic diseases of the liver, gallbladder, cholelithiasis, biliary tract dyskinesia, diseases gastrointestinal tract, abdominal syndrome of unclear etiology, etc. .

Undoubtedly, the state of the phagocytic system of the liver attracts great attention of scientists, since a serious influence of the function of the reticuloendothelial system on the course of various diseases has been noted.

Thus, the data available in the literature on the functional state of the liver in women who have undergone preeclampsia are contradictory, since they were obtained from the analysis of a small and heterogeneous number of clinical observations and, in addition, are often limited to the characteristics of one of the liver functions.

Based on a comprehensive analysis of the morphological and functional changes in qualitative and quantitative indicators identified using modern research methods, it is possible to most accurately diagnose morphological and functional changes in the liver in women who have undergone nephropathy, which will allow solving some controversial issues of practical obstetrics in the management of women with this pathology in the postpartum period.

From our point of view, the study of liver function indicators will allow diagnosing liver damage in the early stages before clinical symptoms, monitoring ongoing therapy, restoring the functional state of the liver in the postpartum period, predicting the course of preeclampsia, and also possible complications with repeated pregnancies.

In this regard, it is necessary to correct treatment regimens in the postpartum period with the inclusion of pathogenetically substantiated simple and safe efferent methods.

In order to correct the immune status in women who have undergone preeclampsia, therapy is carried out with the immunomodulatory drug polyoxidonium (Immafarma), which has immunocorrective, detoxifying, membrane-stabilizing activity and promotes physiological and reparative regeneration of the liver. It is used at a dose of 6 mg in saline, one injection per day for 8 days, then at a maintenance dose of 6 mg once a week for 1 month (depending on the severity of the pathological process).

The most promising direction in the treatment of metabolic disorders of the liver can be considered long-term lipid-correcting therapy with vaseline-pectic emulsion Fishant S (PentaMed) once a week for 2–12 months, with the obligatory use of combined herbal hepatotropic drugs: hepabene (Ratiopharm), at a dose of 1 capsule

3 times a day - and restoration of colon microbiocenosis with probiotics: hilak forte (Ratiopharm) at a dose of 40–60 drops per day, polybacterin (Alpharm) - 2 tablets 3 times a day for 10 days.

Literature

1. Glukhova G. N., Salov N. A., Chesnokova I. I. Mechanisms of impaired humoral and hormonal regulation of basal vascular tone in preeclampsia//Problems of pregnancy. 2004. No. 8. S. 19–23.
2. Egorova A.E. Features of the course of the postpartum period in puerperas who have undergone preeclampsia: author. dis. . cand. honey. Sciences. M., 2002.
3. Kantemirova Z. R. Features of the course of pregnancy, childbirth and the postpartum period in cholesterosis of the gallbladder: author. dis. . cand. honey. Sciences. M., 2000.
4. Clinical lectures on obstetrics and gynecology / ed. A. N. Strizhakova, A. I. Davydova, L. D. Belotserkovtseva. Moscow: Medicine, 2004. 620 p.
5. Kuzmin V. N., Serobyan A. G. Acute fatty hepatosis of pregnant women in the practice of an obstetrician-gynecologist / / Attending Doctor. No. 5. 2003. P. 12–19.
6. Kulakov V. I., Murashko L. E., Burlev V. A. Clinical and biochemical aspects of the pathogenesis of preeclampsia//Obstetrics and gynecology. 1995. No. 6. S. 3–5.
7. Medvedinsky ID, Yurchenko LN, Pestryaeva LA et al. Modern concept of multiple organ failure in gestosis//Perinatal anesthesiology and intensive care of mother and newborn. Yekaterinburg, 1999, pp. 25–32.
8. Nazarenko G. I., Kishkun A. A. Clinical evaluation of laboratory results. M.: Medicine, 2002.
9. Pecherina VL, Mozgovaya EV Prevention of late preeclampsia// Russian Medical Journal. 2000. No. 3. S. 52–56.
10. Polyoxidonium - a new domestic immunity activator with pronounced detoxification properties // Medicines and Pharmaceuticals. 1999. No. 3 (23). pp. 20–22.
11. Repina M.A. Preeclampsia as a cause of maternal mortality // Journal of Obstetrics and Women's Diseases. 2000. Vol. XLIX. Issue. 1. P. 45–50.
12. Savelyev V.S., Petukhov V.A., Koralkin A.V. Extrahepatic biliary dysfunction in lipid distress syndrome: etiopathogenesis, diagnosis and principles of treatment//Russian Medical Journal. 2002. No. 9. S. 77–84.
13. Savelyeva G. M., Kulakov V. I., Serov V. N. Modern approaches to the diagnosis, prevention and treatment of preeclampsia: honey. instructions. No. 99/80. M., 1999.
14. Savelyeva G. M., Shalina R. I. Preeclampsia in modern obstetrics// Russian Medical Journal. 2000. No. 6. S. 50–53.
15. Sveshnikov PD Electron microscopy of endothelial cells circulating in the blood during pregnancy complicated by preeclampsia//Current issues of physiology and pathology of the reproductive function of women. SPb., 1999. S. 404–405.
16. Serov V. N. Eclampsia. M.: MIA, 2002.
17. Sidorova I. S. Gestosis. Monograph. M.: Medicine, 2003.
18. Sidorova I. S., Dmitrieva T. B., Chekhonin V. P. et al. The role of neurospecific fetal proteins in the development of preeclampsia//Issues of gynecology, obstetrics and perinatology. 2005. V. 4. No. 3. S. 24–30.
19. Torchinov A. M., Khashukoeva A. Z., Petukhov V. A. et al. Possible risk factors for cholesterol cholecystolithiasis in women of the reproductive period//Obstetrics and gynecology. 2000. No. 6. S. 37–39.
20. Chernukha E. A. Generic block. M.: Triada-X, 2003. 709 p.
21. Cherny V. I., Galolu S. I., Kabanko T. P. and others. Labyrinths of preeclampsia//Health. Kyiv, 2001.
22. Chekhonin V. P., Ryabukhin I. A., Belopasov V. V. et al. Enzyme immunoassay of antibodies to neurospecific proteins in assessing the state of the BBB function//Immunology. 1997. V. 2. S. 67–69.
23. Sherlock S., Dooley J. Diseases of the liver and biliary tract. Moscow: Geotar, Medicine, 1999.
24. Shekhtman M. M. Guidelines for extragenital pathology in pregnant women. Moscow: Triada-X, 1999. 815 p.
25. Song C., Song J. C., Han J. et al. Preeclampsia - eclampsia. Pathogenesis, diagnosis and treatment//Br. J. Obstet. Gynecol. 1998; 74:1065–1071.
26. Fadigan A. B., Sealy D. P., Schneider E. F. Preeclampsia: progress and puzzle//Am. fam. Physician. 1996; 49:849–856.
27. Friedman S. A. Preeclampsia, eclampsia and HELLP-syndrome//Br. J. Obstet. Gynecol. 1998; 71:1244–1247.
28. Roberts J. M., Redman C. W. Pre-eclampsia: more than pregnancy-induced hypertension//Lancet. 1996; 341: 1447–1451.
29. Schwab R. Preeclampsia/Eclampsia//Br. J. Obstet. Gynecol. 1998; 76:1055–1065.
30. Saftlas A. F., Olson D. R., Franks A. L. et al. Epidemiology of preeclampsia and eclampsia//Am. J. Obstet. Gynecol. 1998; 163:460–465.

A. M. Torchinov, Doctor of Medical Sciences, Professor

V. K. Shishlo, Candidate of Medical Sciences, Associate Professor

MGMSU, RMAPO, Moscow

on the same topic

news

Specializations

fresh issue#02/18

Mass media www.lvrach.ru Founder: Open Systems Publishing House LLC Editor-in-chief: Akhmetova I.B. Address Email editions:

Editorial phone number: 7 Age marking: 16+ Certificate of registration of the mass media of the online publication El. No. FSot dated July 14, 2015 issued by Roskomnadzor.

Preeclampsia or toxicosis is a disease that occurs in women, characterized by a violation of the functions of organs and systems in connection with a developing pregnancy.

Gestoses are the result of a violation of the process of adaptation of the mother's body to a developing pregnancy. Gestoses are fraught with complications for both the mother's body and the fetus.

Gestoses develop only during pregnancy, and disappear after childbirth or termination of pregnancy. Rarely, gestosis causes a pathology that remains even after the end of pregnancy.

Preeclampsia is a fairly common pathology during pregnancy; it develops in 25-30% of expectant mothers. This formidable disease has been the cause of maternal mortality for many years (it ranks second among the causes of death of pregnant women in Russia).

Preeclampsia leads to disruption of the functions of vital organs, especially the vascular system and blood flow.

If preeclampsia develops in a practically healthy woman, in the absence of diseases, it is called pure preeclampsia. Preeclampsia, which has developed against the background of chronic diseases in a woman (kidney disease, liver disease, hypertension, impaired fat metabolism or endocrine pathology), is called combined gestosis.

Preeclampsia can begin both in the first and second half of pregnancy, but most often develops in the third trimester, from 28 weeks of pregnancy.

Causes of gestosis during pregnancy

The causes of preeclampsia are not fully understood and not clarified. Scientists offer more than 30 different theories to explain the causes and mechanism of preeclampsia.

Predisposing factors for the development of preeclampsia may be: insufficiency of adaptive reactions of neuroendocrine regulation; pathology of the cardiovascular system; endocrine diseases; kidney disease; diseases of the liver and biliary tract; obesity; frequent stressful situations; intoxication (alcohol, drugs, smoking); immunological and allergic reactions.

TO risk group on the development of preeclampsia during pregnancy include:

• women with overwork, chronic stress (this indicates a weak adaptive ability of the nervous system);
• pregnant women under 18 and over 35;
• pregnant women who had gestosis during a previous pregnancy;
• women with a hereditary predisposition to preeclampsia;
• women who gave birth often with short intervals between births or had frequent abortions;
• pregnant women with chronic infections or intoxications;
• socially unprotected women (malnutrition in pregnant women, poor environmental conditions);
• women with genital infantilism (delayed sexual development or underdevelopment of the genital organs and their functions);
• women with first pregnancy;
• women with multiple pregnancies;
• women with bad habits.

Most current versions explaining the reasons for the development of gestosis:
1. The cortico-visceral theory explains the development of gestosis by disturbances in the nervous regulation between the cerebral cortex and the subcortex as a result of the adaptation of the mother's body to a developing pregnancy. As a result of these violations, a failure occurs in the circulatory system.
2. The endocrine (hormonal) theory considers dysfunction of the endocrine system to be the root cause of preeclampsia. But some scientists believe that these endocrine disorders occur already with preeclampsia, i.e. are secondary.
According to this theory, some researchers call the cause of preeclampsia a dysfunction of the adrenal cortex, others - a violation of the production of estrogen hormones (produced by the ovaries), others see the cause of preeclampsia in insufficient hormonal activity of the placenta.
3. Supporters of the placental theory point to changes in the vessels in the uterus and placenta, their tendency to spasms and subsequent disruption of blood flow, leading to hypoxia. The placenta is formed along with the fetus. Up to 16 weeks, it is not sufficiently developed and does not protect the woman from the products formed during the metabolism of the fetus. These substances enter the bloodstream and cause intoxication in a woman, which can manifest itself in the form of vomiting, nausea, and intolerance to odors. After 16 weeks of pregnancy, when the placenta is already sufficiently developed, these phenomena disappear.
4. The immunogenetic theory seems to be the most likely. According to this theory, preeclampsia develops as a result of an inadequate immune response of the mother's body to antigens (foreign proteins) of the fetus: the mother's body tries to reject the fetus, as it were. According to another immunocompetent theory, in the mother's body, on the contrary, antibodies are not produced enough in response to placental antigens constantly entering the bloodstream. As a result, these defective complexes circulate in the blood, which cause circulatory disorders, especially in the kidneys, characteristic of gestosis.
5. The genetic predisposition to preeclampsia is confirmed by the fact that the risk of developing preeclampsia is higher in those women in whom other women in the family (mother, sister, grandmother) suffered from preeclampsia.

The risk of developing preeclampsia is 8 times higher in women whose mothers had preeclampsia compared to other women whose mothers did not have preeclampsia. Studies have shown that daughters develop eclampsia in 48.9% of cases (the eldest daughter more often than the youngest), and sisters develop it in 58% of cases.

Even manifestations of early gestosis or toxicosis, according to the observations of gynecologists, develop in those women whose mothers suffered from toxicosis. If it did not manifest itself in the mother, then the daughter can only slightly rock in the transport, or her sense of smell may become somewhat aggravated.

Most scientists are inclined to believe that when preeclampsia occurs, a combination of several of these causes matters.

The metabolic products of the embryo are not neutralized in the first trimester by the placenta (it is formed from the 9th to the 16th week of pregnancy), they enter the blood of the pregnant woman and cause nausea and vomiting in response.

Due to changes in the woman's body (including hormonal ones), the permeability of the vascular wall increases, and as a result of this, the liquid part of the blood "leaves" the bloodstream and accumulates in the tissues - this is how edema occurs. Both the uterus and the placenta swell, which impairs blood supply and oxygen supply to the fetus.

Due to the thickening of the blood, its ability to form blood clots increases. In order to "push" this thickened blood through the vessels, the body has to increase blood pressure - another manifestation of preeclampsia.

The increased permeability of the vascular wall in the kidneys leads to the ingress of protein into the urine and excretion from the body - proteinuria is also a symptom of preeclampsia.

What is the danger of preeclampsia during pregnancy (consequences of preeclampsia)?

The development of gestosis adversely affects the health of both mother and fetus, and can cause very serious consequences. A woman may experience impaired functioning of the kidneys, lungs, nervous system, liver, visual impairment. Vasospasm and microcirculation disorders, the formation of microthrombi can lead to cerebral hemorrhage, vascular thrombosis, cerebral edema and the development of a coma, pulmonary edema, heart failure, kidney or liver failure.

Indomitable vomiting with gestosis can cause dehydration of a woman's body. Preeclampsia can lead to premature detachment of the placenta, to premature birth, to fetal asphyxia. With preeclampsia of mild and moderate severity, premature births are observed in 8-9%, and with severe preeclampsia - in 19-20% of cases. If preeclampsia passes into the stage of eclampsia, then 32% of children are born prematurely.

The consequences of late preeclampsia in any form are extremely unfavorable for the child. The acute form of gestosis with premature detachment of the placenta can even cause the death of the child. Perinatal mortality in preeclampsia reaches 32%.

Slow preeclampsia leads to fetal hypoxia (insufficient oxygen supply), which, in turn, is likely to cause intrauterine growth retardation. 30-35% of children born from mothers with manifestations of preeclampsia have low body weight. Hypoxia of the fetus subsequently leads to a delay in the physical and mental development of the child. Many children often get sick.

With the most severe form of preeclampsia - eclampsia - urgent delivery (or termination of pregnancy) is the only way save the life of a woman and a child. Preterm delivery is not always a favorable outcome for a preterm immature baby. Although in some cases, the child is more likely to survive outside the womb.

Ptyalism, or drooling, may occur on its own or may accompany vomiting. Salivation can reach a volume of 1 liter or more per day. At the same time, it worsens general well-being, appetite decreases, there may be weight loss, sleep disturbance. With pronounced ptyalism, signs of dehydration may appear.

Usually early gestosis rarely show an aggressive course. Regardless of the severity of early gestosis, its manifestations should disappear by 12-13 weeks of pregnancy. If the manifestations of toxicosis continue, it is necessary to conduct an examination of the pregnant woman in order to exclude the exacerbation of any chronic disease of the internal organs.

Preeclampsia in the second half of pregnancy (late preeclampsia)

Gestosis of the second half of pregnancy is also called late gestosis (toxicosis). They pose a great danger, because. can lead to serious complications. Most often they develop from the 28th week of pregnancy, but may appear at the end of the first and beginning of the second half of pregnancy. In modern medicine, sometimes late gestosis is called OPG-gestosis: O - edema, P - proteinuria (protein in the urine), G - hypertension (increased blood pressure).

The characteristic triad of symptoms ( edema, protein in the urine, increased blood pressure) may not occur in all women. One of them may also indicate the development of gestosis. Visible for a woman, a manifestation of preeclampsia is only one symptom - swelling. And an increase in blood pressure and protein in the urine can only be detected by a doctor. Therefore, it is so important for a pregnant woman to register for pregnancy in a timely manner and regularly attend a doctor's appointment.

The combination of symptoms in gestosis may be different. Currently, all 3 signs of late gestosis are observed only in 15% of cases, edema with increased pressure - in 32% of cases, protein in the urine and increased pressure - in 12% of cases, edema and protein in the urine - in 3% of cases. Moreover, obvious edema is noted in 25%, and hidden (they are indicated by pathological weight gain) - in 13% of cases.

The first stage of late gestosis – edema, or dropsy pregnant. A woman can notice the appearance of edema by feeling a slight numbness in her fingers. With swelling, it becomes difficult to unbend your fingers and put rings on your fingers.

Puffiness does not always mean the development of preeclampsia. Swelling can be the result of increased production of progesterone (the so-called pregnancy hormone). Edema can also appear as a result of an exacerbation of a chronic disease (varicose veins, heart disease, kidney disease). But to figure out whether edema is a common manifestation of pregnancy, a symptom of a chronic disease, or a symptom of preeclampsia, only a doctor can.

If there is an excessive weight gain in a pregnant woman, and there are no visible edema, then a McClure-Aldrich test can be performed to check the woman: saline is injected subcutaneously and the time it takes for the button to resolve is observed. If it does not become less than in 35 minutes, then there are hidden edema.

If swelling becomes visible, it means that 3 liters of excess fluid is retained in the body. First, the feet swell, then the edema spreads upward, capturing the shins, thighs, abdomen, neck and face. Even if a woman does not experience discomfort, it is necessary to take Urgent measures so that gestosis does not worsen. It is dangerous to self-medicate and take diuretics, because. this will worsen the situation even more. The condition may worsen at any moment.

The second stage of gestosis – nephropathy- usually develops against the background of dropsy. Its first symptom is increased blood pressure. For a pregnant woman, not only an increase in pressure is important, but also its sharp fluctuations, which can cause placental abruption and fetal death or sudden bleeding.

The third stage of preeclampsia – preeclampsia- is characterized by the fact that in addition to edema and increased pressure, there is also protein in urine. At this stage, severe disorders of the blood supply to the brain can develop, which is manifested by the appearance of a severe headache, a feeling of heaviness in the back of the head, flashing flies before the eyes, nausea and vomiting, visual impairment, memory impairment, and sometimes even mental disorders. There are also irritability, insomnia, lethargy, pain in the abdomen and in the right hypochondrium. Arterial pressure is increased - 160/110 mm Hg. Art. and higher.

The fourth, most severe stage of preeclampsia – eclampsia. Sometimes it, bypassing preeclampsia, develops very quickly after nephropathy. With eclampsia, the function of many organs is impaired, convulsions may appear. Seizures can be triggered by various factors: a sharp sound, bright light, a stressful situation, pain. The attack of spasms proceeds 1-2 minutes. There may be tonic ("pulling" convulsions) and clonic (small muscle twitches). The convulsive attack comes to an end with a loss of consciousness. But there is also a non-convulsive form of eclampsia, in which, against the background of increased pressure, a woman suddenly falls into a coma (loses consciousness).

Eclampsia is fraught with serious complications: placental abruption, premature birth, bleeding, fetal hypoxia, and even fetal death. It is not excluded at this stage the occurrence of a heart attack, pulmonary edema, stroke, renal failure.

Eclampsia is more common in women with their first pregnancy. When predicting the risk of developing eclampsia, genetic factors should also be taken into account. At hydatidiform mole and multiple pregnancies, the risk of developing eclampsia is significantly increased.

In some cases, an asymptomatic or oligosymptomatic course of preeclampsia is possible. But the rapid development of this complication of pregnancy is also possible. Therefore, at the slightest suspicion of preeclampsia in a pregnant woman, delay in examination and treatment is dangerous for the life of the mother and child.

Late preeclampsia can have an unpredictable development. It can progress dramatically, while the deterioration of the woman's condition will rapidly increase every hour. The earlier preeclampsia develops, the more aggressive it is, and the more severe consequences it will have, especially with untimely treatment.

Rare forms of gestosis

Rare forms of gestosis include:

• Jaundice of pregnancy: it occurs more often in the second trimester, is accompanied by itching, is usually progressive; can be the cause of miscarriage, fetal development disorders, bleeding. It resumes at the next pregnancy and is an indication for termination of pregnancy. The cause of its occurrence may be transferred in the past viral hepatitis.
• Dermatoses: eczema, urticaria, herpetic eruptions; there can only be excruciating skin itching (local or total), causing irritability and insomnia. It occurs more often in people with allergic manifestations and liver pathology.
• Acute fatty degeneration of the liver (fatty liver): characterized by the appearance of bleeding, bruising, vomiting, swelling, a decrease in the amount of urine and convulsions. The cause of occurrence is unclear; may be the outcome of other types of gestosis. May be associated with fatty degeneration of the kidneys. It is characterized by a gradual decrease in kidney and liver function.
• Tetany of pregnant women: frequent occurrence of muscle cramps, mainly in the limbs. Occurs when there is a lack of calcium due to its consumption by the fetus, in violation of the function of the parathyroid gland, in violation of the absorption of calcium in the intestine and with a lack of vitamin D.
• Osteomalacia(softening of the bones of the skeleton) and arthropathy(impaired articulation of the pelvic bones and joints): also associated with impaired calcium and phosphorus metabolism and a decrease in the function of the parathyroid gland. Contributes to the occurrence of this type of gestosis lack of vitamin D.
• Chorea of ​​pregnancy: uncoordinated and involuntary movements, emotional instability, mental disorders, some difficulty in swallowing and speech. Occurs with organic lesions of the brain. In mild cases, pregnancy continues and ends in childbirth. In severe cases, termination of pregnancy. After pregnancy, the manifestations of chorea gradually disappear.

Gestosis during the second pregnancy

It is known that with the termination of pregnancy, the manifestations of preeclampsia disappear after a few days. However, after childbirth, it is possible to preserve and even progress the changes that have occurred in the organs and systems of the woman's body. In this regard, the risk of developing gestosis during repeated pregnancy increases.

Women who have undergone preeclampsia during pregnancy are at risk for the development of preeclampsia. The risk increases if the interval between pregnancies is short. Such women should monitor the course of pregnancy and health from the first weeks of pregnancy, regularly and carefully.

However, there are cases when, during the second pregnancy, preeclampsia did not develop at all or proceeded in a milder form.

Management of pregnancy with gestosis

With a gestation period of up to 36 weeks and moderate preeclampsia, the continuation of pregnancy is possible, and it depends on the effectiveness of the treatment. In such a situation, a thorough examination and monitoring of the pregnant woman is carried out in the hospital for 1-2 days. If laboratory data or clinical manifestations worsen in the mother, or if the condition of the fetus worsens, delivery is necessary, regardless of the gestational age. If the dynamics is positive, then treatment and dynamic monitoring of the state of the mother and fetus in a hospital continues.
This observation includes:

• bed or semi-bed rest;
• control of blood pressure 5-6 times a day;
• body weight control (1 time in 4 days);
• daily monitoring of the received (drank and administered intravenously) and excreted fluid;
• control of protein content in the urine (in a single portion every 2-3 days and in the daily amount of urine every 5 days);
• general analysis of blood and urine every 5 days;
• oculist examinations;
• monitoring the condition of the fetus daily.

With the effectiveness of the treatment of preeclampsia, pregnancy is continued until the very term of delivery or until the period in which a viable fetus is born.

In severe preeclampsia, a more active tactic of pregnancy management is currently being carried out. Indications for early delivery are not only eclampsia (convulsive or non-convulsive) and complications of eclampsia, but also preeclampsia in the absence of the effect of treatment within 3-12 hours, and moderate preeclampsia in the absence of the effect of treatment within 5-6 days. The rapid increase in the severity of a woman's condition or the progression of placental insufficiency are also indications for early delivery.

The severity of preeclampsia and the condition of the woman and fetus determine the choice of method and time of delivery. Preferably childbirth through natural birth canal. But for this, the following conditions are necessary: ​​cephalic presentation of the fetus, the proportionality of the fetal head and the mother's pelvis, the maturity of the cervix, the age of the pregnant woman is not older than 30 years, etc.

With gestosis, anti-stress resistance decreases in both the mother and the fetus. Childbirth with gestosis is stressful for both of them. And at any moment (with fatigue in childbirth, painful sensations, etc.), a woman can suffer from pressure that has risen sharply to critical numbers. This can lead to the development of eclampsia in childbirth, and to a violation cerebral circulation. Therefore, with preeclampsia, childbirth is often carried out by caesarean section (although eclampsia can develop in this case as well).

Indications for delivery by caesarean section with preeclampsia are currently expanded:

• eclampsia and complications of eclampsia;
• various complications of preeclampsia: acute renal failure, coma, retinal detachment or retinal hemorrhage, cerebral hemorrhage, premature placental abruption, AFGB (acute fatty hepatosis of pregnancy), HELLP syndrome (combined liver damage and hemolytic anemia in nephropathy), etc .;
• preeclampsia, severe preeclampsia with an immature cervix;
• preeclampsia in combination with other obstetric pathology;
• preeclampsia for a long time (more than 3 weeks).

With preeclampsia in the gestational age after 36 weeks, the continuation of pregnancy already loses its meaning, it is only a question of choosing a method of delivery.

Treatment of preeclampsia during pregnancy

Treatment of early preeclampsia

Nausea, increased salivation and vomiting - the main manifestations of early gestosis during pregnancy - can simply be endured. Some women manage to get rid of nausea and vomiting in the morning if they drink water with lemon on an empty stomach in the morning.

If nausea worries constantly, and vomiting occurs occasionally, then you can try to reduce nausea with tea (with mint, lemon balm or lemon), fruit drinks and juices. In the morning it is better to eat cottage cheese or dairy products, cheese - every woman will be able to find acceptable ways to deal with nausea. You can apply mouthwash with infusion of chamomile, sage.

With strong salivation, rinsing with oak bark infusion will also help, taking yarrow infusion 10 minutes before meals and 2 hours after meals.

If the vomiting is indomitable, constant, then you should definitely consult a doctor, as this can threaten the health of both the woman and the fetus. Vomiting occurs in 50-60% of pregnant women, and only 8-10% of them need treatment. We must not forget about a sufficient amount of drinking to make up for the loss of fluid with vomiting.

Medical treatment, including homeopathic remedies, can be used only as prescribed by a doctor and under the supervision of a doctor.

In the case of a severe general condition of a woman (development of acute renal failure or acute yellow liver dystrophy), with preeclampsia in the first half of pregnancy and in the absence of the effect of treatment within 6-12 hours, termination of pregnancy is indicated. And since most often early gestosis develops in the period of 6-12 weeks of pregnancy, the pregnancy is terminated by artificial abortion.

Treatment of late gestosis

• Creation of a medical-protective regime. Depending on the severity of the course of preeclampsia, a bed or semi-bed rest is prescribed, sufficient for the duration of sleep. Loud sounds, emotional experiences are excluded. Psychotherapeutic work with a woman is recommended as an obligatory component of treatment. If necessary, the doctor prescribes sedatives (valerian, motherwort with a mild degree of gestosis or more potent drugs with a severe degree).
• Proper diet for a pregnant woman: varied, fortified, easily digestible food; restriction of carbohydrates and a sufficient amount of proteins in products; the use of a sufficient amount of fruits and vegetables, juices and fruit drinks. Sometimes it is recommended to eat food lying in bed, in small portions, chilled. Fasting days not recommended. Limiting fluid, even with severe edema, should not be (contrary to many recommendations on the Internet) - because, on the contrary, it is necessary to replenish the volume of the bloodstream.
• Medical treatment is prescribed for the purpose of normalizing the functions of organs and systems of a pregnant woman and preventing or treating fetal hypoxia. Diuretic drugs are practically not used, because. their use additionally reduces the volume of blood flow, thereby disrupting (or further aggravating existing disorders) placental circulation. The only indications for their appointment are pulmonary edema and heart failure, but after replenishing the volume of circulating blood. Vitamins of group B, C, E are prescribed; drugs that improve uteroplacental circulation and reduce the permeability of the vascular wall, lowering blood pressure, and others.
• Early delivery. Indications for early delivery and its methods are described in the section "Management of pregnancy with gestosis".

The duration of treatment is determined individually depending on the severity of preeclampsia, the condition of the pregnant woman and the fetus. Treatment for dropsy of pregnant women of the 1st degree is carried out on an outpatient basis, all other cases should be treated in a hospital.

The main condition for the success of treatment is timeliness and professionalism.

Prevention of gestosis during pregnancy

Prevention of preeclampsia (toxicosis) should be taken care of even when planning pregnancy. It is necessary to conduct an examination and consultations of specialists in order to identify the pathology and (if necessary) to carry out treatment. It is also necessary to eliminate bad habits, i.e. prepare in advance for conception.

During the onset of pregnancy, the following measures will serve as prevention of preeclampsia:

• Sufficient sleep duration (8-9 hours a day), good rest, restriction physical activity, exception stressful situations and a positive psycho-emotional climate in the family are the most important conditions for the prevention of preeclampsia.
• Breathing exercises, special physiotherapy exercises for pregnant women, massage of the neck and collar region and head will balance the processes of inhibition and excitation in the centers of the brain and improve blood oxygen saturation. Will help prevent preeclampsia (toxicosis) swimming, Pilates, yoga, long walks (hiking) on fresh air.
• It is important that the family understand the condition of the pregnant woman and try to alleviate it. For example, if a woman during this period is irritated by strong odors ( toilet water husband, coffee, garlic, onions, etc.), then you should stop using them.
• You should wake up slowly, without making sudden movements. Even in the supine position (even if there is still no nausea), you can eat a piece of black bread or a cracker, kiwi or a slice of lemon, drink a decoction of chamomile.
• Nutrition should be complete, but this does not mean that you can eat everything and in unlimited quantities. During the day, food should be eaten often, but in small portions. Food should not be very hot and not very cold.

It is necessary to exclude fried, fatty foods, smoked products, canned food, pickles, chocolate. It is also necessary to limit, and it is better to exclude sweets, muffins, ice cream altogether. It is important to limit your salt intake.

It is useful to use cereals (buckwheat, oatmeal).

A growing fetus needs protein, so a pregnant woman should eat protein-rich foods: lean meats (beef, chicken, veal), eggs, fish, cottage cheese. And if gestosis has already appeared, then the need for proteins is even higher, because. proteins are lost in the urine.

Vitamins will provide the body with fruits and berries, decoctions of dried fruits and rose hips, cranberry juice. We should not forget about fiber - it will cause a feeling of fullness, and will serve as a prevention of constipation. Most fiber in vegetables (carrots, beets), fruits and dried fruits, mushrooms, bran, sea kale, greens.

• The recommended amount of fluid per day is at least 2 liters. This volume also includes milk, soups, juicy fruits. You can use alkaline mineral water without gas, tea with lemon balm or mint.
• You need to constantly monitor your weight and keep records. After 28 weeks of pregnancy, weekly weight gain should average 350 g, and not more than 500 g. During the entire pregnancy, a woman should gain no more than 12 kg in weight. Excessive or too rapid weight gain may indicate the development of edema.
• Difficulties in the outflow of urine contribute to the occurrence of edema and the development of preeclampsia. The uterus in a standing position compresses the ureters and thereby interferes with the outflow of urine. Therefore, doctors recommend that pregnant women stand in the knee-elbow position 3-4 times a day for 10 minutes. You can put a pillow under your chest for comfort. The outflow of urine is improved.
• In order to prevent edema, it is recommended to drink kidney tea, a decoction of lingonberry leaves, wild rose, bearberry. You can take herbal preparations such as Cyston, Canephron, Cystenal.
• Sometimes doctors prescribe magnesium preparations (Magnerot, Magne-B6), lipoic acid, vitamin E, Hofitol (contributes to the inactivation of substances that destroy blood vessels in the liver), Curantil (improves blood supply to the placenta and is a prophylactic for the development of preeclampsia) for the prevention of preeclampsia.

Preeclampsia: causes, symptoms, consequences, treatment, prevention - video

Pregnancy after gestosis

If a woman's pregnancy proceeded with gestosis, then it is very difficult to predict whether gestosis will occur during the next pregnancy. In each case, you should consult a doctor and analyze possible reasons preeclampsia.

A woman in this situation is at risk for preeclampsia and needs careful medical supervision from the very first weeks of a new pregnancy.

But the occurrence of preeclampsia in subsequent pregnancies is not inevitable.

There are standard terms of stay in the maternity hospital in the event that the postpartum period passes without complications. With childbirth through the natural birth canal, they can be 4-6 days, with operative delivery - 7-9 days. It is at this time that the doctor watches the mother and baby every day.

What procedures and manipulations await a young mother after childbirth?

The doctor and midwife will periodically check:

• pulse, blood pressure and respiration;
• temperature (on the first day after birth, it may be slightly increased);
• location of the uterine fundus (during the first day it will be above the level of the navel, and then it will begin to fall);
• uterine fundus tone (if it is soft, it may be massaged to help expel blood clots);
• lochia (discharge from the uterus) - their number, color (if they are unusually abundant, they will be checked very often - several times during the day);
• mammary gland, to determine if you have milk and what condition your nipples are in;
• legs - for thrombosis;
• the seam, if you had a caesarean section;
• crotch - for the color and condition of the sutures, if any (if there are sutures on the perineum or on the anterior abdominal wall, they are treated daily with antiseptic solutions, more often with a solution of brilliant green);
• side effects drugs, if you receive them.

You will also be asked:

• whether you urinate regularly and do not experience discomfort or burning;
• whether you had a stool (if you lie in the hospital for more than one or two days) and whether regular defecation has returned.

You may be assigned:

• pills that promote uterine contraction - for the prevention of postpartum hemorrhage;
• injections or tablets of painkillers and antispasmodics in the presence of painful postpartum contractions (such drugs are given to multiparous and patients after a cesarean section);
• antibacterial drugs (they may be prescribed after surgical delivery).

If some indicators deviate from the norm, it may be necessary to detain the mother in the maternity hospital. For example, the slightest increase in temperature will alert your doctor, since hyperthermia is the first symptom of any infectious disease whether it is an infection of a surgical obstetric wound, a breast infection, or an acute respiratory illness. There can be no trifles here. Each symptom must be taken seriously, with full responsibility.

The reasons for the delay of a woman in the hospital may be different. Let's talk about them in more detail.

Complications of pregnancy and childbirth

• Severe forms of preeclampsia in pregnant women. Preeclampsia is manifested by edema, the appearance of protein in the urine, and an increase in blood pressure. An extreme form of preeclampsia is eclampsia - convulsions due to spasm of cerebral vessels. In severe forms of preeclampsia, a woman lingers in the hospital until blood pressure stabilizes and urine tests normalize. In mild forms of gestosis, when blood pressure does not increase after childbirth, there are no edema, one normal urine test is enough to discharge the patient on the 5-6th day after childbirth. If at least one of the symptoms of gestosis persists, then, depending on its severity, treatment can be carried out in the intensive care unit or in the postpartum unit. For treatment, sedative, antihypertensive, diuretic drugs are prescribed. Since preeclampsia is a risk factor for postpartum hemorrhage, they give injections of oxytocin, a drug that contracts the uterus.
• Massive bleeding during childbirth and in the early postpartum period. After such complications, the woman is weakened, immunity is reduced, so there is a high probability of other complications, such as infectious ones. After bleeding, antianemic, reducing therapy is carried out, hemoglobin content in the blood is controlled. If the course of the postpartum period is not accompanied by repeated bleeding, then the patient is discharged 1 day later than other women who gave birth on the same day.
• Traumatic childbirth with the formation of large tears or vesicovaginal or rectovaginal fistulas. Fistulas are passages that form between two organs: the vagina and the bladder or the vagina and the rectum. This happens when the fetal head does not move along the birth canal for a long time. In this case, a bedsore is formed that connects the vagina with other organs. Childbirth with deep ruptures of the vagina, perineum, when perineal ruptures reach the muscles of the rectum, is also considered traumatic. In the described cases, after childbirth, a longer observation of the restored tissues is necessary, since the extensive wound surface formed after ruptures predisposes to inflammatory complications and suture divergence. Sometimes a woman needs to be readmitted to the hospital for the next operation, during which the fistulas are closed or the pelvic floor muscles are strengthened. In the absence of complications with the healing of sutures, the puerperal stays in the postpartum department 1-2 days longer than other women.

Infectious complications of the postpartum period

• endometritis - inflammation of the lining of the uterus. This disease is manifested by an increase in body temperature up to 38-40 ° C, depending on the severity of the disease, pain in the lower abdomen (it should be noted that it is normal, especially after repeated births, during this period, cramping pains can be observed - more often during feeding). This is due to the contraction of the uterus. Pain with endometritis is persistent, they are pulling in nature and can spread to the lumbar region. Discharge from the genital tract with endometritis is abundant, with an unpleasant odor. If normally, after 2-3 days after childbirth, the discharge becomes bloody in nature, then with endometritis, bloody discharge may resume. With inflammation, the uterus does not contract well. It is necessary to say about the so-called subinvolution of the uterus. This is a borderline condition between endometritis and the norm: the uterus is not contracting enough, which can “prepare the ground” for inflammation.
• Inflammatory complications that can lead to a woman's delay in the maternity hospital should also include divergence and infection of the sutures of the perineum and the suture after caesarean section. With these complications, redness of the skin is observed in the area of ​​\u200b\u200bthe rupture or incision, pus may be released from the wound, and the suture area is painful.

With any inflammatory complications of the postpartum period, the temperature rises to 38-40 degrees C, chills, weakness, decreased appetite, and headaches are observed.

With subinvolution of the uterus, the patient remains in the postpartum department, where she is additionally prescribed reducing drugs. With the effectiveness of this therapy, ultrasonography uterus on the 4th-5th day after birth to exclude retention of placental remnants and accumulation of blood. After that, the woman is discharged. If the treatment is ineffective or other signs of endometritis have joined, as well as infection and divergence of the sutures, the woman is transferred to a special second obstetric department. Here, if necessary, antibiotic therapy is prescribed, uterine lavage, uterine contractions, dressings in the area of ​​​​a purulent wound when the sutures diverge. In doubtful cases, after the baby is discharged, the young mother can be transferred to the gynecological department of the hospital for aftercare.

• In the postpartum period, complications such as thrombophlebitis - inflammatory complication of varicose veins of the lower extremities. As a result of this disease, the wall of the vein becomes inflamed in the area of ​​​​the thrombus that formed earlier. In this case, the patient is concerned about pain in the area of ​​the affected limb, redness of the skin over the affected vessel. With thrombophlebitis, after consulting a surgeon, depending on the severity of the condition, the patient is transferred to the second obstetric department or a specialized vascular department of the hospital. The complex of therapeutic measures for this disease includes elastic bandaging of the affected limb, the use of antibacterial, anti-inflammatory, painkillers. At a certain stage of the disease, drugs that thin the blood are prescribed.

Since factors predisposing to endometritis are manual examination of the uterus, a long anhydrous period (when from the moment of outflow amniotic fluid more than 12 hours pass before the birth of the child), low contractile activity of the uterus, manifested by weakness of labor activity, hypotonic postpartum bleeding, childbirth with a large fetus and other conditions leading to a deterioration in uterine contractility after childbirth, then in these cases, contracting drugs are prescribed, ultrasound is also performed to exclude the delay of parts of the placenta and blood clots. Before discharge, a general blood test is prescribed, since an increased content of leukocytes in the blood is a sign of inflammation. These measures help prevent complications.

chronic diseases

Chronic diseases of the mother are the reason for extending the period of hospitalization in cases of exacerbation of the disease in the postpartum period. More often it is hypertension, as well as diseases of other organs: kidneys, liver, heart. With their exacerbation, a specialist is invited to the postpartum department - a therapist, a cardiologist, etc. Before this, in accordance with the capabilities of the maternity hospital, a number of additional tests and examinations are carried out (blood, urine, ECG, etc.). If the specialist confirms the need for treatment in a specialized hospital, then the woman is transferred to a therapeutic, urological or any other department - as directed.

In the hospital - at your own request

Sometimes situations arise when a young mother is not self-confident, she “did not have time to look back” and is afraid to be left without qualified help. Can she count on the support of doctors? Yes, in this case, it is possible to extend the stay in the hospital by 1-2 days, but within the established norms: after spontaneous childbirth - no more than 6 days, after cesarean section - no more than 10.

If the mother is transferred to the observational department, the baby "moves" with her. The issue of feeding in this case is decided individually. If a woman is transferred to a gynecological department or another hospital, then if the baby is in a satisfactory condition, he can be discharged home.

After discharge, the woman goes under the supervision of a gynecologist from the district antenatal clinic, as well as the attending physicians from the clinic. They continue the treatment they have started, make further appointments and monitor the results.

Even if you had to stay in the hospital longer than you planned, do not worry. After all, your health in the future will depend on how well you are examined and treated during this period. It should also be said that if any complications occur during the first month of the postpartum period (the appearance of profuse bloody or foul-smelling discharge from the genital tract, fever, problems with the breast, with sutures), a young mother can go to the maternity hospital where childbirth took place.

Preeclampsia (late toxicosis) is a set of symptoms that is characteristic only for pregnant women with a period of more than 24 weeks, but often occurs in the third trimester of pregnancy (from 28 weeks). The reasons are still not exactly clear. According to one theory, ethology is the hormones and substances that the placenta secretes. Once in the blood, they bind to the cells of the immune system, forming a complex that is aimed at damaging the vascular wall and promotes the release of excess fluid into the soft tissues (edema). After damage occurs, the response of the body and the vessels narrow, which causes a persistent and significant increase in blood pressure and a decrease in the volume of circulating blood in the vessels.

Risk groups and genetic predisposition

Predisposing factors in gestosis can serve as chronic diseases of the cardiovascular, endocrine and excretory systems. Do not forget about constant stress, which leads to overstrain; intoxication of the body of the expectant mother; allergic reactions.

Experts concluded that a certain category of women is at risk, namely:

• future mothers under the age of 18 and over 35;
• pregnant women who have suffered preeclampsia in the past;
• frequent abortions and childbirth in short intervals;
• bad habits of the mother and the people around her;
• multiple and first pregnancy, especially at a late or immature age.

First symptoms and correct diagnosis

In order to save the life of mother and child, a woman should pay attention to the smallest deviations in her body. Namely, in the third trimester, the appearance of edema is not always sure sign preeclampsia, a symptom may indicate an exacerbation of a chronic disease. The right conclusion can only be made by a specialist who needs to be contacted immediately. Self-medication should not be engaged, the consequences are not reversible. If edema was followed by a persistent increase in blood pressure, this clear sign late toxicosis. For a diagnostic purpose, it is necessary to pass a clinical urine test, the appearance of a significant amount of protein in it indicates a violation of the vascular wall, and this means that the diagnosis of preeclampsia is correct. Additional studies should include clinical and biochemical blood tests, Doppler study, consultation of other specialists (neurologist, ophthalmologist, nephrologist, therapist).

Treatment and possible complications

After a reliable diagnosis, the doctor is obliged to put the patient in a hospital for detailed observation and additional research. If blood pressure exceeds the norm by 40%, and protein is over 3.0 g / l, general state worsens, urgent hospitalization is indicated in the intensive care unit, where appropriate therapy is prescribed. Treatment consists in preventing the development of complications, this is taking sedatives, vitamins and minerals in the complex, reducing the intake of water (up to 1 liter) and salt, drugs that improve blood circulation, both for the pregnant woman and the fetus. The protein deficiency in the body, which came out through the vascular wall, is also filled. If you turn to traditional medicine, treatment, is aimed at removing excess fluid from the body through diuretic infusions and decoctions, such as rose hips, decoction of chamomile and calendula.

Is it possible to take mezim for young mothers while breastfeeding

If the symptoms do not progress and the condition is stable, they do not come to urgent obstetric care, but if the above therapy is ineffective, the only way out is surgery - caesarean section.

According to the vital indications of the fetus and mother, further management tactics are determined, therefore, if hypoxia of the body occurs, which leads to irreversible consequences, it is necessary to act quickly in order to avoid an undesirable outcome. But there are not always indications for physiological childbirth, then they resort to surgical interventions. According to many experts, the best treatment with this disease, timely delivery is necessary, after which improvement and stabilization of the condition can be expected.

Doctors always give preference to the natural passage of the child through the birth canal, and therefore they try to extend the therapeutic treatment until the appointed time (38-42 weeks). But it all depends on the severity of preeclampsia (mild, moderate, severe and eclampsia), which are classified from disruption of the organs and systems of the body. Childbirth is stressful for the child and mother with this pathology. Therefore, from the beginning of childbirth to their end, blood pressure figures should be monitored, since under the action of a painful stimulus it can rise sharply and provoke eclampsia during childbirth, which in turn leads to impaired cerebral circulation. In this case, surgical intervention is indicated.

A caesarean section is a method of urgent delivery when there is a threat to the life of the fetus or woman in labor, as well as the impossibility natural childbirth. One of the indications is the increase in multiple organ failure against the background of high blood pressure and vascular wall permeability. The method of the operation is as follows: under combined endocardial anesthesia, the uterus is opened and the newborn child is released. Assessing its vital functions, namely respiration and blood circulation, if necessary, resuscitation is carried out, then the tissues of the surgical field are sutured in layers. After completion of the operation, after 30-50 minutes, sedatives are administered endotracheally.

After the operation, the woman is sent to the intensive care unit or intensive care unit, observation and administration of drugs continues throughout the day. Then, within 48 hours after childbirth or surgery, they continue the necessary monitoring of the state of the vital functions of the woman who gave birth, since this period can be the most critical for the health of the mother. Unfortunately, there are a lot of complications after childbirth, some of them lead to death. Difficult childbirth is the basis for further observation of specialists.

Be sure to process the seams, examine the perineum. The introduction of drugs continues until the complete disappearance of edema, normalization and stabilization of blood pressure, the disappearance of protein in the urine. After a repeated detailed examination, the mother and child can be discharged from the hospital.

When to go to the gynecologist for an appointment after childbirth?

Against the background of gestosis, the course of the postpartum period and stress passes, but increases several times, therefore it requires additional treatment and correction of the complications that have arisen. It is on rehabilitation that the future life of the mother and the possibility of re-pregnancy depend. Symptoms of preeclampsia can last up to 2 months, but with adequate therapy and observation, there is nothing to fear. If in the first two days after childbirth there are no complications and deterioration of the condition, the crisis is stopped and the likelihood of exacerbation is minimal. After suffering and not treated in a timely manner, complications are observed in the kidneys, constant swelling of the lower and upper extremities, a persistent rise in blood pressure and disorders in the endocrine system - an imbalance of hormones.

The treatment of which is not always possible, because often doctors cannot determine any pathology, therefore there is no adequate therapy.

For a child born with such a diagnosis on time, the complications are minimal and often such children get sick more often in early age and do not lag behind their peers in development. But if complications, for some reason, led to oxygen starvation (hypoxia) of the fetus, the consequences are violations of physical and mental development.

If you are planning a second child after Gestosis in your first pregnancy, the approach must be very serious and require special preparation.

Preventive measures to prevent complications during pregnancy

Preventive measures should be started even before the conception of a child, since all environmental factors, ecology, bad habits and stress affect the female body unfavorably. Maintain a healthy lifestyle, prevent chronic diseases. All unexamined and latent infectious processes should be identified and, if possible, stopped. The reproductive function should be carried out from 18 to 35 years, because at an early age, female organs and systems are not formed and are not capable of bearing a child, and in the late period, on the contrary, they all decrease and cannot work adequately.

During pregnancy, questions arise about proper nutrition, which a pregnant woman must definitely observe, since her body gives all the reserve forces to build a new body. The diet should be enriched with trace elements and vitamins. Preference is given to the calcium element, because most of it is spent on building a new skeleton. Daily intake of fermented milk products will ensure a full intake and make up for the calcium deficiency in the body of the mother and the growing fetus. Vitamin E contributes to the nutrition of the placenta, which is important for the unborn child. With proper treatment, the symptoms of toxicosis disappear and the body of the mother and child functions normally.
Preventing all possible complications during pregnancy and after childbirth or Caesarean section, constant monitoring by an obstetrician-gynecologist and other related specialists is necessary. Timely detection of pathologies of organs and systems, as well as chronic diseases, can prevent possible complications. As for the environment and relatives of the expectant mother, they must also undergo examinations to detect a latent infection. If it was found in someone around, it should be eliminated if possible. That this person would not serve as a source of a chronic infectious process. Since the immunity of a pregnant woman is vulnerable and the addition of pathology is fraught with an effect on her well-being.

Discharge with an unpleasant odor after childbirth

After complicated and physiological childbirth, constant monitoring is required, both for the mother and for the development of the child (especially if he was born out of time and prematurely). This is prerequisite, because with the initial detection of pathology, it is easier to treat than a complicated disease that will lead to significant disturbances in other systems.

Popular

Gestosis before and after childbirth. Preeclampsia in pregnant women - symptoms and prevention. Treatment of preeclampsia in pregnant women

Preeclampsia of pregnant women or late toxicosis is a complication inherent in the second half of pregnancy, which is associated with disruption of the functioning of vital organs and systems in a woman's body. Only pregnant women can suffer from preeclampsia, and it passes preeclampsia after childbirth, over time. Signs of this disease are detected in 13-16% of women in position. Its seriousness is evidenced by the fact that for enough long period preeclampsia is called one of the three main causes of maternal mortality in our country.

Preeclampsia can develop only from the 16-20th week of pregnancy. But most often - in the third trimester, that is, after 28 weeks. This is a very insidious disease - at first, a woman may not have any manifestations of gestosis at all. And even after the discovery of its main symptoms, the well-being of the expectant mother can remain normal. But in no case should preeclampsia be ignored, because the untimely provision of medical care is fraught with serious consequences for the health of the mother and the unborn baby.

What happens in a woman's body with gestosis? Water-salt metabolism is disturbed and water and sodium retention occurs. The permeability of the walls of blood vessels increases, due to which the liquid from them enters the tissues. Blood circulation is disturbed and the supply of tissues with oxygen and nutrients is reduced. The placenta, kidneys and brain are the first to react to insufficient blood supply in the body of the expectant mother. Because of all these changes, the baby also suffers - poor blood supply to the placenta causes placental insufficiency, and it, in turn, delays intrauterine development of the fetus.

Gestosis develops in stages. Persistent edema due to fluid retention in the body of the expectant mother - its early symptom. They mean it's started dropsy, the first stage of gestosis. Depending on the extent of edema, there are different degrees dropsy. Edema is not only obvious, that is, visible to the eye, but also hidden. They are indicated by uneven or pathological (more than 300-400 g per week) weight gain in the expectant mother. In the morning, swelling is not so noticeable - at night, excess fluid is evenly distributed over the woman's body. But towards the end of the day, swelling begins to appear on the legs and lower abdomen.

If edema in a pregnant woman is added high blood pressure, and analyzes show the presence of protein in the urine- it's about development nephropathy, which usually begins after dropsy, if its treatment was not started in time. The expectant mother's blood pressure is 135/85 mm Hg. Art. and above is a clear sign of nephropathy. However, the starting point is always the baseline blood pressure of the pregnant woman. Complications of preeclampsia in pregnant women no longer arise due to high blood pressure, but due to its sharp fluctuations.

Nephropathy is very dangerous state, because it can flow into eclampsia - a convulsive attack, as well as provoke bleeding in the expectant mother, placental abruption, onset premature birth, fetal hypoxia or even death.

The next stage of preeclampsia - preeclampsia. With it, the pregnant woman experiences a feeling of heaviness in the back of her head, headaches and pains in the stomach, nausea, vomiting, impaired vision, memory. She may be tormented by insomnia or, conversely, drowsiness, lethargy and irritability. The expectant mother feels a veil before her eyes, flickering & flies & sparks - these are consequences of damage to the retina and circulatory disorders of the occipital part of the cerebral cortex. The blood pressure indicator can reach 160/110 mm Hg. Art. and higher. Here it is important to respond very quickly to the condition of the woman in order to prevent the development of the next stage of preeclampsia, which can take the life of both mother and baby.

At the most severe stage of gestosis, eclampsia, seizures lasting 1-2 minutes are added to the symptoms of nephropathy and preeclampsia. In some cases, eclampsia proceeds without convulsions, then the expectant mother complains of a headache, darkening in the eyes and may fall into a coma.

In order to avoid the severe consequences of preeclampsia and to save the life of mother and baby, in some cases, doctors have to resort to an extreme method - premature delivery.

Which of the expectant mothers is most at risk of preeclampsia? - Women who are preparing to become mothers for the first time, pregnant women under the age of 18 and over 35 years (due to aging of the tissues of the reproductive system), with chronic diseases (VVD, diabetes, obesity, hypertension, pyelonephritis) or genital infections, inflammatory diseases of the genital area, endocrine disorders.

There is a high probability of developing preeclampsia also with multiple pregnancies, large fetuses and polyhydramnios, if the interval between births is less than two years, as well as with previous abortions. If the expectant mother is constantly overtired, is in a state of chronic stress, she is also at risk.

However, preeclampsia can also occur in an absolutely healthy pregnant woman. This usually happens at 34-36 weeks of pregnancy. The reason for this may be a failure of adaptive mechanisms due to an increased load on the body, improper nutrition of a pregnant woman, lack of a regimen, and even a banal SARS.

With a mild form of gestosis (dropsy of the first degree), the doctor may limit himself to outpatient treatment. If severe dropsy is found in a pregnant woman, she will be treated in a hospital. With nephropathy, preeclampsia and eclampsia, the expectant mother is hospitalized in a hospital where there is an intensive care unit and a department for premature babies. If the doctor, upon detection of preeclampsia, insists on treating the expectant mother in a hospital, she should not refuse. Because in this way she endangers the health and life of the baby and her own.

While hospitalized, the expectant mother usually undergoes a series of examinations - she takes blood tests (general, for biochemistry, for coagulation), urine tests (general, which determines the daily loss of protein, Zimnitsky's test). The attending physician will definitely assess the condition of the fetus using ultrasound, cardiotocography and dopplerometry. If necessary, the pregnant woman is examined by an ophthalmologist and a neurologist.

Treatment of gestosis involves several areas:

- a diet with fluid restriction (up to 1 liter per day) and salt, enriched with proteins and vitamins;

- intravenous therapy to improve blood circulation in small vessels, including placental vessels;

– therapy aimed at lowering blood pressure;

- the introduction of drugs for the prevention of placental insufficiency;

The expectant mother will also be prescribed sedatives, diuretic drugs and bed rest. The duration of treatment in the hospital depends on how severe the form of preeclampsia was found in the pregnant woman. If the treatment of severe forms is ineffective for a certain period of time, the doctor may decide to perform a caesarean section.

To resist gestosis

The expectant mother is able to follow some simple rules, and then there is a chance that the diagnosis "Preeclampsia" will not appear in her medical record. What do we have to do?

1. Watch your weight. Starting from the 28th week, the weekly weight gain of the pregnant woman should not exceed 350 g, maximum - 500 g.

2. Follow a diet. At the same time, lean on foods rich in protein, limit (or rather refuse) flour and sweets.

3. Limit fluid intake (1-1.5 liters during the day, along with liquid food and juicy fruits) and salty foods.

4. Lead an active lifestyle. Hiking in the fresh air, and if there are no contraindications, yoga, swimming for pregnant women is what you need to keep fit.

5. Engage in self-control. Start, for example, a diary where the expectant mother can record daily weight gain, as well as the number of movements of the crumbs over a certain period of time.

You can consult a doctor about the use of rosehip decoction, cranberry juice, kidney tea, which have a weak diuretic effect and help prevent edema. For the same purpose, the doctor may also prescribe a number of medications to the pregnant woman.

Also, one should not forget about the organization of the diet and rest of the pregnant woman, sufficient night sleep, regular walks in the fresh air. The expectant mother should be in a good mood and be in a calm environment.

Preeclampsia in pregnant women - symptoms and treatment

Most women endure pregnancy easily, but there are those for whom bearing a child is associated with the risk of losing health, and sometimes even life. This is observed in approximately 12 - 27% of expectant mothers.

The functional discrepancy between all systems of a woman's body to the needs of the fetus in late pregnancy is called preeclampsia, i.e. the woman's body cannot cope with the task of providing the fetus with nutrients and oxygen, and this condition is associated precisely with the onset of pregnancy.

Preeclampsia of pregnant women used to be called late toxicosis or dropsy. It is observed after the 20th week of pregnancy and may continue for another 2-3 weeks after delivery.

The mechanism of development of preeclampsia

To date, the causes of preeclampsia in pregnant women have not been fully studied, there are several theories: endocrine (the effect of hormones), immunological (reaction of the mother's body to the fetus), genetic and corticovisceral. None of these theories can 100% explain all the processes that occur during gestosis of pregnant women.

But the changes that occur in the body during gestosis are well studied. Under the influence of toxic substances, damage to the walls of blood vessels is observed, the liquid part of the blood, together with the protein, "leaves" into the tissues, so edema occurs.

The kidneys are an organ where there are a lot of blood vessels, protein through them enters the urine. This phenomenon is called proteinuria.

As a result of a decrease in the amount of circulating blood in the vessels, their narrowing (spasm) occurs, which leads to an increase in blood pressure.

With vasospasm, oxygen starvation of all organs is observed, the kidneys, liver and brain are the most "in need" of it, in a pregnant woman, the placenta should be added to this list. As a result, not only the mother's body suffers, but also the fetus, hypoxia and developmental delay occur.

To date, there are several classifications of preeclampsia in pregnant women, all of them are designed for the convenience of doctors. The tactics of management and treatment depend on the correct diagnosis and determination of the severity of the course of preeclampsia during pregnancy.

There are three main symptoms of preeclampsia: edema, proteinuria and increased blood pressure. Preeclampsia in a pregnant woman can be manifested by one symptom, but their combination is also possible.

The presence of all three symptoms doctors call nephropathy. And in the classifications it is called preeclampsia (divided into 3 degrees of severity).

There are pure gestoses and combined ones, that is, those that have arisen against the background of another disease (pyelonephritis, diabetes mellitus, obesity, hypertension), moreover, combined forms appear up to 20 weeks (early gestosis), proceeding more difficult compared to late gestosis.

The most severe and formidable condition is eclampsia - a convulsive condition that doctors try to prevent.

Edema is the earliest symptom of preeclampsia that a woman herself can notice. They can be mild, affecting only the legs, or they can be noticeable on the face. Edema is also observed during a normal pregnancy, so do not panic from the very beginning.

It is necessary to weigh yourself regularly, too fast weight gain (more than 0.5 kg per week) should alert you, because edema can be not only obvious, but also hidden (the abdominal wall swells, and the increase in the abdomen is interpreted incorrectly).

PRE-ECLAMPSIA (nephropathy) - preeclampsia during pregnancy, which combines edema, proteinuria (protein in the urine) and increased blood pressure. There is a mild degree (BP - 150/90 mm Hg, protein in the urine - up to 1.0 g / l, edema is noticeable only on the legs), an average degree (BP - 170/100 mm Hg, protein in urine - 1.0-3.0 g / l, swelling of the legs and abdominal wall occurs), severe (BP - more than 170/100 mm Hg, protein in the urine - more than 3.0 g / l, legs swell, abdominal wall and face) nephropathy.

Objectively, a woman feels a headache, nausea, there may be vomiting, heaviness in the occipital region and a mental disorder.

The level of blood pressure must be measured in dynamics and compared with the initial value, and, moreover, you need to pay attention to diastolic pressure, it is it that displays vasospasm. A small difference between systolic and diastolic blood pressure (less than 30 mmHg) is a poor prognostic sign and requires hospitalization.

Eclampsia is the most severe manifestation of preeclampsia in a pregnant woman, in which convulsions of the whole body are observed. Sharp fluctuations in blood pressure at this moment are dangerous, because this leads to rupture of cerebral vessels (stroke), placental abruption, followed by hypoxia and fetal death. A pregnant woman may experience acute respiratory failure (shortness of breath, shortness of breath, agitation).

The course of preeclampsia can be long with minor symptoms, but sometimes it develops over several days to the state of eclampsia. In both cases, fetal hypoxia occurs.

Symptoms of preeclampsia In order to diagnose preeclampsia in pregnant women, it is necessary to pass a general analysis and a biochemical analysis of urine to determine the protein, determine the protein in daily urine, check the number of platelets and the state of the entire blood coagulation system.

Control over body weight will help to identify edema, normally, if there is no preeclampsia, in the second half of pregnancy a woman adds 350 grams per week (no more than 500 grams). You can also track the amount of fluid drunk and excreted (in the form of urine).

The level of blood pressure and the state of the vascular system can be judged by the pressure measured on both hands (with gestosis, a difference is possible on two limbs). A valuable diagnostic study will be an examination by an oculist of the fundus and an ultrasound examination of the fetus to detect hypoxia.

Each pregnant woman donates blood and urine, is weighed and regularly measures blood pressure. But women from the risk group for the development of preeclampsia are subject to the closest attention from physicians, these include primiparous women, women with multiple pregnancies, late pregnancy- over 35 years old, women with sexually transmitted infections and chronic diseases(obesity, diabetes mellitus, pyelonephritis, arterial hypertension).

Treatment of preeclampsia is to restore the normal state of health of a woman. The most important rules for the development of preeclampsia in the second half of pregnancy is the timely visit to the doctor and the absence of any self-treatment. Only a doctor knows how to treat preeclampsia, because taking certain medications can only aggravate the already difficult condition of a pregnant woman and fetus. For example, to get rid of edema, some begin to drink diuretic pills, but the cause of edema in preeclampsia is pathological vascular permeability, and not excess fluid, so the condition worsens even more.

With mild forms of preeclampsia, you can follow all the prescriptions of the doctor at home. But with a severe course of preeclampsia, it is better to be under the supervision of specialists in a hospital, where they will provide medical assistance in a timely manner (reduce pressure, relieve convulsions).

Timely delivery is also important in the treatment of preeclampsia, because preeclampsia is a condition caused by pregnancy. If the condition of a pregnant woman worsens or severe fetal hypoxia, the absence of the effect of therapy, childbirth is the only right decision. With mild gestosis, it is possible to have a child naturally, but in this case there is a risk of deterioration during attempts, when the load on the woman's body increases greatly.

Most often, a caesarean section is performed, especially when there is eclampsia, stroke, retinal detachment, kidney or liver failure in a woman in labor.

Prevention of preeclampsia is an important point during pregnancy, since it is not possible to cure the disease completely, it remains only to prevent the condition from worsening. The most important thing is to find out in time.

Every responsible woman should regularly be weighed, control blood pressure measurement, and give urine for protein content. Even with a normal pregnancy, proper nutrition is important with a predominance of proteins and fiber, a reduced content of fat and starchy foods, as well as a long stay in the fresh air, walking. And with preeclampsia, these activities are vital not only for the expectant mother, but also for the little man inside her, because this improves the blood supply to the tissues and reduces hypoxia.

Thus, no one is immune from the development of preeclampsia, but you can protect yourself from formidable complications. To do this, it is enough to take care of yourself and feel responsible for your health and the health of the child.

Treatment of preeclampsia in pregnant women

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

Control of blood pressure - prevention of preeclampsia At each visit to the doctor of a pregnant woman, blood pressure (BP) in both arms, pulse and body weight must be measured. An increase in blood pressure above 135/85 may indicate preeclampsia. The doctor evaluates the weight gain of the pregnant woman, the presence or absence of edema, asks the pregnant woman if the amount of urine excreted has decreased.

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

– clinical and biochemical analysis of blood;

- general urine analysis;

– Ultrasound of the fetus with dopplerometry, CTG (cardiotocography) of the fetus.

If the obtained tests and examination data raise suspicions of preeclampsia (BP above 135/85, pronounced edema and large weight gain, protein in the urine), additionally appoint:

- daily monitoring of blood pressure, ECG;

- urine analysis according to Nechiporenko, according to Zimnitsky, analysis of daily urine for protein;

– consultation of an ophthalmologist, therapist, nephrologist, neurologist.

Treatment of late gestosis

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

For minor swelling and normal tests treatment of preeclampsia is limited to compliance with recommendations on lifestyle and nutrition.

With dropsy with severe edema and a mild form of nephropathy, the following is prescribed:

- sedatives (tinctures of motherwort, valerian);

- antiplatelet agents (Trental, Curantil) to improve the rheological properties of blood;

- antioxidants (vitamin A and E);

- with an increase in blood pressure, antihypertensive drugs with an antispasmodic effect are used (Eufillin, Dibazol);

- herbal teas with a diuretic effect.

In severe 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 disorders - fresh frozen plasma, reopoliglyukin are administered. In addition to the above groups of drugs, in severe forms of gestosis, anticoagulants (Heparin) are also used. For rapid regulation of water-salt metabolism, diuretics (Furosemide) are used instead of herbal teas.

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

No less relevant is the question of the method of delivery in preeclampsia.

If the condition of the pregnant woman is satisfactory and the fetus does not suffer, based on the data of ultrasound and CTG, then the birth is carried out through the natural birth canal. In the absence of the effect of therapy, in severe forms of preeclampsia and chronic fetal hypoxia, a caesarean section is indicated.

Treatment of preeclampsia 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 in gestosis are very importance for successful treatment. In the presence of edema and pathological weight gain, a 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 undersalted. 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. It is necessary to limit not only the consumption of food, but also liquids. You need to drink no more than one and a half liters of fluid per day. Attention should be paid to diuresis - the amount of liquid excreted should be greater than that drunk.

Hectic lifestyle, stress also provokes 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 image can also provoke preeclampsia. Therefore, a woman is recommended to take daily walks in the fresh air for at least an hour, to 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. With gestosis, kidney tea, cranberry or lingonberry juice, rosehip broth are prescribed. You can use herbal preparations such as Canephron or Cyston. Sedative tinctures from motherwort or valerian can be used starting from the 13-14th week of pregnancy for the prevention and treatment of gestosis. In severe forms of gestosis, folk remedies are not effective, therefore, only drugs are used.

- Detachment of a normally located placenta, leading to fetal death;

- fetal hypoxia, which also leads to intrauterine death of the fetus;

- hemorrhage and retinal detachment;

- heart failure, pulmonary and cerebral edema, heart attacks and strokes;

- development of renal and hepatic insufficiency, hepatic coma.

- implementation of reproductive function up to 35 years;

- timely treatment of chronic diseases that provoke preeclampsia;

- healthy lifestyle.

Gestosis - what is it?

Preeclampsia is a complication of pregnancy that develops after 20 weeks and can be observed within 2 or 3 days after childbirth. The cause of preeclampsia has not been fully established. Signs of preeclampsia are the appearance of edema (dropsy of pregnancy), protein in the urine and increased blood pressure. If the disease progresses, preeclampsia occurs, in which the central nervous system is affected.

The woman has a headache, flies before her eyes, abdominal pain, nausea or vomiting. This indicates the development of cerebral edema. Without treatment, the disease progresses to the next stage, and eclampsia occurs (convulsions against the background of loss of consciousness).

Preeclampsia is a dangerous condition that can lead to fetal death due to oxygen starvation, since normal blood circulation in the placenta is disturbed. The disease also threatens the life of the mother. Usually, the development of eclampsia is an indication for emergency delivery before the due date in the interests of both the woman and the child.

Preeclampsia occurs in about 13-16% of all pregnancies. The disease develops due to the fact that during pregnancy there are substances that can damage blood vessels. As a result, plasma fluid and protein seep into the tissues, resulting in severe edema. The woman is gaining weight, despite the usual diet. In addition, through the vessels of the kidneys, the protein enters the urine. Due to vasospasm, blood pressure rises.

Preeclampsia is more common in women who are carrying their first child or twins, women over 35 years of age and suffering from chronic diseases. For the timely detection of preeclampsia, it is necessary to regularly weigh the expectant mother, conduct urine tests and measure blood pressure.

Gestosis is divided into two main types. Pure preeclampsia occurs if a woman has no other background diseases. The disease appears after 35 weeks of pregnancy and lasts 1-2 weeks. Combined preeclampsia develops in women with other chronic diseases. It occurs at 20-22 weeks of pregnancy and lasts up to 6 weeks.