What is preeclampsia in pregnancy. Symptoms, signs, consequences

Preeclampsia during pregnancy is a complication in which there is a disruption in the functioning of physiological systems and organs, and the pathological condition disappears after delivery. According to studies, it forms in the third trimester of pregnancy, but can occur earlier, from 4 to 20 weeks.

Gestosis, what is it and how is it manifested?

Preeclampsia has three characteristic symptoms, according to which it is not difficult to make a primary diagnosis:

. Hidden and overt, noticeable on the limbs and face.
Proteinuria. In the analysis of urine, the protein content is increased.
Hypertension. Elevated BP.

Pathology negatively affects the work of the cardiovascular, nervous and endocrine systems, there is a change in the composition of the blood. Preeclampsia develops after 18 weeks, manifests itself by the end of 27 weeks.

About a third of pregnant women experience manifestations of this complication. In some cases, it causes the death of a woman in labor or a baby.

Clinical manifestations are often consistent, so early preeclampsia is formed in the first half of pregnancy. The patient notes constant nausea, vomiting, increased salivation (not to be confused with "normal").

At a later stage, nephropathy, dropsy of pregnancy, preeclampsia and eclampsia appear. In the presence of a diseased liver, skin and nervous diseases, rare forms of pathology are formed.

Gestoses of the combined form appear with hypertension, endocrinopathy, diseases of the biliary tract and kidneys, and impaired lipid metabolism in the body.

Reasons for the formation of gestosis

There is no unified theory about what contributes to preeclampsia during pregnancy, but some theories of the etiology of the disease have been proposed.

The cortico-visceral theory suggests the formation of neurosis in pregnant women, with a failure in the interaction between the cortex and the subcortical structure of the brain, leading to reflex changes. In practice, this theory is often confirmed, preeclampsia occurs as a result of nervous tension.

According to the immunological theory, with gestosis, there is an incorrect hormonal control of body functions. The immunological conflict between the fetus and the mother is considered as the main cause. At the same time, vasospasm increases blood pressure and reduces the amount of blood necessary for the nutrition and functioning of cells.

The genetic theory suggests that women whose mothers suffered from preeclampsia are susceptible to complications. The lack of B vitamins and folic acid increases the content of homocysteine, an amino acid that increases blood clots. From its impact, micro-holes are formed in the vessels, through which plasma protein and liquid fall into the tissue.

Preeclampsia during pregnancy leads to swelling, the signs of which are not visible at the beginning of the disease, but the weight increases significantly. Plasma penetrates and stagnates in the tissues, resulting in edema, increased pressure and decreased frequency of urination.

Such micro-holes appear in the vascular walls of the kidneys, through which the protein penetrates into the urine. Regularly a pregnant woman is prescribed a general urine test. This helps accurate diagnosis and allows you to start treatment immediately after the discovery of pathology.

With damage to the inner lining of the vessel - the endothelium - its permeability increases, which contributes to the effusion of fluid into the tissue of the body. This changes the density of blood, its density and coagulability. The risk of thrombosis increases.

Preeclampsia is dangerous disorders in the brain. Blood clots, small hemorrhages are formed, intracranial pressure and dystrophy of the nervous tissue increase.

The appearance of preeclampsia at an early stage is difficult to notice, the condition is easy to confuse and take for a slight malaise in pregnant women. Slightly increased blood pressure, causing headache, weakness, nausea and fatigue.

the higher its content, the worse the manifestation of pathology.
Blood pressure exceeds 140/90 mm Hg. Art.
Edema - when protein is found in the urine, they indicate preeclampsia.

The disease affects most organs: kidneys and liver, heart, placenta and nervous system. Perhaps the formation of permanent hypoxia, which leads to intrauterine growth retardation.

In the initial stage of gestosis (toxicosis), women vomit up to several times a day. There is constant nausea, loss of appetite, desire to eat spicy and salty foods. Bouts of vomiting do not affect weight. The temperature is within normal limits. These symptoms appear in the first months of pregnancy, then disappear on their own.

Rarely, vomiting may stop and then become indomitable (more than 20 times per day). The patient is weakened, has aversion to food, the pulse is thready, the blood pressure drops. Acetone and protein are found in the urine. In serious cases, the temperature jumps sharply, arrhythmia is possible.

At the end of pregnancy, preeclampsia develops gradually. Initially, dropsy is formed, over time, nephropathy develops, then severe forms: preeclampsia, eclampsia. In the case of dropsy, women develop swelling due to fluid retention. At this time, latent and visible edema occurs. Given the slowdown in diuresis, body weight increases very quickly.

The tumor is noticeable in the ankle joint, then spreads higher. Noticeable swelling of the face. By evening, the limbs and lower abdomen swell.

Three symptoms of preeclampsia with nephropathy:

edema;
protein in the urine;
hypertension.

A woman may have any combination of symptoms. Nephropathy occurs simultaneously with dropsy. Elevated diastolic pressure is dangerous, it reduces placental blood flow. The fetus does not receive oxygen. Later, nephropathy can turn into a serious complication - eclampsia.

Preeclampsia affects the central nervous system. In addition to the three main symptoms of preeclampsia, there is heaviness in the back of the head, pain in the abdomen, head, nausea, and vomiting. A pregnant woman experiences visual impairment (flying flies), memory, insomnia.

Symptoms of preeclampsia:

pressure more than 160/110 mm Hg. Art.;
decreased urine output (< 500 мл), свертываемость крови хуже из-за снижения тромбоцитов, заметно нарушение функционирования печени.

Eclampsia is the worst phase of preeclampsia. A woman may experience painful seizures. Light and any sharp sounds are annoying, it lasts for several minutes, after which loss of consciousness is possible. There is a danger of developing a deep coma - this threatens placental abruption, bleeding, fetal hypoxia and premature birth. The life of the fetus is in danger.

It should be noted that with preeclampsia, for some time, the pregnant woman feels good, complaints only of slight swelling, weight gain. Nevertheless, edema is formed not only in the limbs. The placenta suffers from it - this worsens the supply of oxygen to the fetus.

Preeclampsia during pregnancy is a serious condition, the first symptoms are the reason for an immediate visit to the doctor.

Diagnostics

Laboratory tests and patient complaints help determine the condition of the pregnant woman. For the diagnosis is carried out:

coagulogram, which determines the time of blood clotting;
blood test (biochemistry and general);
changes in body weight indicators;
urinalysis (biochemistry and general);
fundus examination;
blood pressure dynamics;
the volume of the allocated liquid, taking into account its consumption;

To determine the condition of the fetus, ultrasound and dopplerography are prescribed. Clarification of the diagnosis is carried out by consultations with a nephrologist, therapist, ophthalmologist and neurologist.

It is advisable to hospitalize the patient at any stage of pregnancy. This is necessary to maintain the functions of the body systems and successful childbirth.

Outpatient observation is allowed only with stage 1 dropsy. In the case of the development of nephropathy, preeclampsia and eclampsia, hospitalization is mandatory. Termination of pregnancy ahead of schedule is carried out according to vital indications.

Therapy is aimed at preventing the development of complications and the formation of intrauterine disorders in the fetus.

To do this, normalize the work:

nervous system;
determine the state of the vascular wall;
improve blood circulation;
normalize water-salt metabolism;
reduce viscosity and increase blood clotting;
regularly monitor the dynamics of blood pressure;
normalizes metabolic processes in the body.

The duration of treatment directly depends on the severity of gestosis. A mild form will require a two-week stay in a hospital, an average degree requires a long stay. In difficult cases, the pregnant woman will have to remain under daily supervision until delivery.

Preterm birth is carried out if observed:

Lack of positive dynamics from therapy with persistent nephropathy (moderate severity).
If the expected effect is not noted during resuscitation in the first 2 hours.
Violations in the development and growth of the fetus (with nephropathy).
Eclampsia, the risk of complications.

Preeclampsia of the second half of pregnancy requires constant medical supervision. Independent childbirth is allowed only if the woman is in a satisfactory condition, there are no disorders in the fetus and with positive results of therapy. In all other cases, a caesarean section is prescribed.

Consequences of preeclampsia

A pregnant woman is threatened with a deterioration in the work of the kidneys and heart, do not exclude pulmonary edema. Hemorrhages in the internal organs are possible.

Preeclampsia is dangerous placental abruption during pregnancy, lack of oxygen and nutrients to the developing fetus. This threatens developmental delay, dangerous fetal hypoxia.

Prevention of gestosis during pregnancy

If a woman has diseases of the internal organs, preventive measures begin from the second trimester of pregnancy.

The importance of:

proper rest and sleep;
balanced diet;
physical activity;
daily walks;
restriction of salt, and sometimes fluids.

Women with predisposing factors are required to register with the antenatal clinic at an early stage of pregnancy and follow the doctor's instructions. Be sure to undergo all laboratory tests to monitor the condition. Medications are prescribed only in the presence of concomitant diseases and individual indicators.

It is possible to plan the next pregnancy after preeclampsia at any time, as soon as the woman feels strength and opportunity in herself. It is impossible to predict how the pregnancy will develop. It is worth taking into account previous experience, assessing risk factors and finding a gynecologist you can trust.

Preeclampsia is one of the most severe complications of the second half of pregnancy. Unfortunately, it is almost impossible to foresee the occurrence of this condition; there are no guaranteed ways to prevent the development of gestosis today either.

The only effective way to "treat" preeclampsia is to terminate the pregnancy at any time. It is known that gestosis is based on a massive vasospasm, which threatens the life of both the mother and the baby. Let's try to figure out what gestosis is and why it is so dangerous.

What is gestosis?

Spasm (or narrowing) of blood vessels leads to an increase in blood pressure, which in itself can dramatically worsen a woman's condition. But the main problem is that the vascular crisis occurs simultaneously in many organs and seriously disrupts their work.

The greatest danger in preeclampsia is the inability of the kidneys to perform their main job - to remove metabolic products from the woman's body.

This leads to the accumulation in the body of a pregnant woman of unnecessary, waste (in fact - poisonous!) Substances. Naturally, these substances also get to the baby.

On the other hand, vasospasm in the placenta significantly disrupts the supply of oxygen and nutrients to the baby.

Sometimes vasoconstriction occurs instantly and the condition of the expectant mother worsens literally “before our eyes”. Sometimes this is a “veiled”, stretched out process in time, almost imperceptible to either the expectant mother or medical workers.

In the latter case, the child experiences oxygen starvation for more or less a long time, a lack of nutrients, an “attack” with toxic metabolic products, so his growth and development slow down.

There are several other extremely problematic moments of gestosis. In constricted vessels, blood circulation slows down, blood clots can form, which finally “turn off” the vessel from work. Depending on the localization of the blocked vessel(s) in a particular zone (area) of the body, the blood supply is disrupted.

In medical parlance, this is called "ischemic stroke." The most severe manifestations of ischemic stroke are convulsions and loss of consciousness. By nature, the human body is a self-regulating system. Therefore, as soon as blood clots begin to form in narrowed vessels, the “protection” - the anti-coagulant system - comes into play. The viscosity of the blood decreases, the blood becomes more fluid and stops clotting. At this stage of development of preeclampsia, the risk of heavy bleeding increases dramatically.

It is hardly necessary to explain to anyone that massive bleeding is a direct threat to human life.

Given the insidiousness of preeclampsia, from the moment of diagnosis to the moment of delivery of a woman, ideally, no more than three days should pass. If preeclampsia occurs, delivery is carried out at any stage of pregnancy. Even if it is still far from the intended one, in conditions of preeclampsia, the life and health of the child are under direct threat. Therefore, it is better to “pick up” the baby from the aggressive environment of the mother’s body, and go out in an incubator.

We emphasize once again that when it comes to the life of the mother and child, the gestational age at the time of delivery does not matter. In modern conditions, even very early born children have the opportunity to be healthy, and their mothers - happy. As a rule, the development of preeclampsia falls on fairly long gestation periods - after 30-32 weeks. But there are, of course, exceptions.

The earlier in pregnancy gestosis develops, the more severe it is, and the more rehabilitation measures will be shown to both mother and baby.

Gestosis during pregnancy. Who is at risk?

As the observations of specialists show, gestosis occurs more often in spring or autumn. Perhaps, changes in atmospheric pressure, spring beriberi, or the autumn tendency of some women to a depressive perception of life play a role.

Of course, in order to reduce the number of cases of manifestation of preeclampsia, doctors are trying to identify the so-called "risk group" for the development of preeclampsia. To do this, specialists, literally from the very first appointment at the antenatal clinic, are trying to "paint a portrait" of the expectant mother, asking her a lot of questions about her health and lifestyle.

A higher risk than other pregnant women are:

overweight or obese women;
women with initially high blood pressure figures or those suffering from hypertension;
women with kidney disease;
expectant mothers suffering from diabetes (including) or other diseases of the endocrine system;
women with autoimmune diseases (antiphospholipid syndrome, systemic lupus erythematosus, rheumatic diseases, connective tissue diseases, etc.)
women with a labile psyche, disorders in the work of the nervous system;
single moms-to-be and older moms-to-be;
women whose closest blood relatives had strokes, heart attacks, thrombosis;
women who had previously given birth, had large children or had stillbirths. Also those women who have suffered preeclampsia in previous pregnancies;
women who have had spontaneous abortions (especially several).

But even this “risk group” is very conditional. Most women with the above problems, with a full examination and proper treatment of the underlying disease (preferably BEFORE the planned pregnancy!) Safely endure their children and will never know what preeclampsia is. On the other hand, this dangerous complication can develop in an initially completely healthy woman who does not have any risk factors.

This once again emphasizes the unpredictability and insidiousness of preeclampsia.

How to determine the onset of gestosis during pregnancy?

Only a doctor establishes the appearance of late toxicosis. He can diagnose the onset of the disease by a dangerous symptom - the presence of protein in urine tests.

Do not forget that the urinalysis must be collected correctly, otherwise vaginal discharge may falsely show the presence of protein in the urine.

For the result to be correct, it is necessary to wash the perineum, and then close the entrance to the vagina with a cotton swab and collect a medium portion of urine. Dishes for analysis should be clean (you can boil for 2-3 minutes), and it is even better to buy a sterile glass at the pharmacy.

Also, during each visit to the doctor, blood pressure measurements are not in vain. Indicators above 130/80 mm Hg also indicate the onset of gestosis.

Two more important symptoms that should not be overlooked are a sharp increase in body weight and the appearance of edema. But not every swelling is diagnosed as preeclampsia. An enlarged uterus puts pressure on all internal organs, including blood vessels. Naturally, due to excessive pressure, this process contributes to fluid retention in the body. But, if the edema occurs abruptly and begins to progress, this may indicate the actual onset of preeclampsia.

You must remember that undiagnosed preeclampsia in time causes the following complications:

bleeding during childbirth caused by a violation of the coagulation system;
retinal detachment;
fetal oxygen deficiency, developmental delay.

Signs of preeclampsia during pregnancy

To summarize all of the above, then the main signs of gestosis are:

the appearance of protein in the urine,
increase in pressure
pathological,
sudden onset of edema.

Symptoms can appear all at once or in a different sequence, it depends on which internal organ of the woman suffers the most. "Inventing preeclampsia for yourself" is not worth it on your own, but any of the above signs is an obligatory reason to talk with your doctor.

Treatment of preeclampsia during early pregnancy

adopt a protein-rich diet.
avoid fried, spicy and salty foods.
if a woman suffered at the beginning of pregnancy, at a later date she needs to remove foods that previously caused vomiting from the diet.
replace concentrated broths with light vegetable soups.
. This does not mean that you need to drink little, no, such abstinence, on the contrary, causes even more fluid stagnation. 30 ml for every kilogram of weight is considered a sufficient norm. You must control the work of the excretory system of the body and then make sure that the amount of fluid you drink is not less than that allocated. The question of how much to drink, what exactly to drink, how to drink, and so on, is quite voluminous, so it is placed in a separate article. .

Unfortunately, if those given by a pregnant woman do not show improvement in dynamics, she will be hospitalized in a maternity hospital.

Under any circumstances and problems, it is necessary to eat properly and efficiently throughout pregnancy and try to play sports (even just walking). To do this, in the Mom's Store you should pay attention to those specialized for pregnant and lactating women, as well as buy comfortable clothes and accessories, and for travel or moderate sports.

Note. Return of food and cosmetics is possible only if the packaging is intact.

Consequences of gestosis during pregnancy

Preeclampsia causes a very dangerous condition for a pregnant woman, which in medicine is called eclampsia. Eclampsia is characterized by a critical increase in blood pressure and the appearance of a convulsive seizure, which begins with twitching of the facial muscles. Then convulsions of the whole body join, swelling of the brain and lungs occurs, coma occurs. A woman risks dying from a cerebral hemorrhage, and a child from oxygen deficiency.

When diagnosing eclampsia, doctors urgently send a woman to a hospital and perform early delivery () in order to save both mother and baby.

Complications of preeclampsia that can harm the child

We wrote a lot about how the manifestations of late toxicosis - preeclampsia are dangerous for a pregnant woman, however, this does not mean that the baby does not suffer. In this situation, the most important system fails: Mom - Placenta - Baby.

Preeclampsia causes a spasm of small vessels of all organs, as a result, the amount of blood that carries nutrients to the baby narrows. The function of the placenta also deteriorates, it becomes thinner, its area increases, areas with hemorrhages appear. In such a situation, the placenta can no longer protect the fetus from negative influences and provide it with oxygen.

The baby becomes vulnerable, his systems and internal organs begin to lag behind in development. In severe cases, preeclampsia causes premature birth, and in critical situations, fetal death.

During pregnancy, you must remember that now you and the baby are one, so if late gestosis is detected, keep calm, follow all the recommendations of doctors and do not refuse hospitalization. There are many examples when, even with such a complex and dangerous diagnosis as late toxicosis, after delivery, both mother and baby felt completely healthy.

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

Preeclampsia is diagnosed after 20 weeks of pregnancy, but more often at 25-28 weeks, although signs of this complication may occur a few days before delivery.

Late preeclampsia is diagnosed in about 10-15% of all pregnant women.

Degrees

Depending on the severity of the course of gestosis, 4 degrees are distinguished:

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

There are also pure preeclampsia and combined preeclampsia.

They say about pure gestosis if a woman does not have chronic extragenital diseases (not related to the genital area)
Combined preeclampsia, on the contrary, occurs against the background of chronic general diseases (arterial hypertension, kidney disease, obesity, and others).

Causes

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

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

Threatening factors for the development of preeclampsia:

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

Symptoms of preeclampsia

First, the preclinical stage of gestosis is diagnosed - pregestosis (obvious signs are absent). The diagnosis of pregestosis is made by evaluating laboratory and additional research methods:

measurement of blood pressure three times with a break of 5 minutes in different positions (increase in diastolic, i.e. lower values by 20 mm Hg or more);
increasing thrombocytopenia (decrease in platelets);
decrease in lymphocytes (lymphopenia);
increased platelet aggregation (increased blood clotting).

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

swelling,
proteinuria (protein in the urine)
increase in blood pressure.

Symptoms by degree

I degree of preeclampsia
Edema (dropsy of pregnancy)

There are 4 degrees of edema in pregnant women.

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

In addition to the fact that swelling can be visible, do not forget about hidden swelling. The thought of latent edema is suggested by pathological weight gain (more than 300 grams per week). Also, oliguria speaks of latent edema (a decrease in the amount of urine excreted to 600-800 ml per day).

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

II degree of preeclampsia
Nephropathy

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

edema, in varying degrees of severity,
proteinuria (protein in the urine),

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

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

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

If traces of protein are found in the urine (0.033 g / l), it is necessary either to exclude pyelonephritis, or there is a non-compliance with hygiene rules when passing urine. Proteinuria is spoken of when protein in the urine reaches 0.3 g / l or more.

III degree of preeclampsia
Preeclampsia

Condition prior to eclampsia

IV degree
Eclampsia

Severe condition, the last degree of preeclampsia. Characterized by seizures.

Diagnostics

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

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

Treatment of preeclampsia during pregnancy

Gestosis at home

The treatment of preeclampsia is prescribed and controlled by an obstetrician-gynecologist. With edema of the first degree, outpatient treatment is allowed. All other degrees of preeclampsia are treated in a hospital.

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

Secondly, therapeutic nutrition is necessary (the treatment table must contain a sufficient amount of protein, the amount of fluid drunk depends on diuresis, and the food itself must be undersalted).

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

To normalize the work of the brain and prevent convulsive seizures, sedatives are prescribed (motherwort, valerian, novopassitis). In some cases, mild tranquilizers (phenazepam) are indicated.

Treatment of preeclampsia in a hospital

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

With arterial hypertension, drugs that reduce pressure (atenolol, corinfar) are prescribed.

It is also shown to carry out infusion therapy with saline solutions (physiological saline and glucose solution), colloids (rheopolyglucin, infucol - starch), blood products (freshly frozen mass, albumin).

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

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

Treatment of mild severity of preeclampsia lasts at least 2 weeks, moderate severity of 2-4 weeks, and severe preeclampsia requires a permanent stay of the pregnant woman in the hospital until childbirth.

Complications and prognosis

Possible complications of preeclampsia:

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

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

Prevention

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

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

Some research on pregnancy

Preeclampsia is a serious complication of late pregnancy, which is why it is also called late "toxicosis". With gestosis, the work of the kidneys, blood vessels and brain of the expectant mother worsens. Its most characteristic signs are an increase in blood pressure and the appearance of protein in urine tests.

An increase in pressure may be imperceptible, but is more often manifested by headache, nausea, blurred vision. Protein in the urine indicates a violation of the kidneys and is often accompanied by edema.

In severe cases, preeclampsia can lead to seizures, placental abruption, developmental delay and death of the baby.

In 90% of cases, preeclampsia begins after 34 weeks, most often in pregnant women with their first baby. An earlier start (from 20 weeks) is a sign of a severe course. The closer to the expected date of birth, gestosis began, the better its prognosis.

Unlike early toxicosis, which is considered “normal” by many doctors, preeclampsia disrupts the course of pregnancy and must be treated. With severe preeclampsia that threaten the development of the baby, it is often necessary to resort to stimulation of preterm labor or caesarean section.

Tendency to gestosis

Preeclampsia of varying degrees occurs on average in 10-15% of expectant mothers, much more often it appears in the first pregnancy. The timing of its onset is from 20 weeks and up to several days after childbirth. With multiple pregnancies, preeclampsia can begin earlier (from 16 weeks) and is more severe.

In the second pregnancy, the likelihood of meeting with late toxicosis falls. The easier the first preeclampsia proceeded, and the closer its beginning was to the term of delivery, the less likely it is to repeat. Those mothers who had it started earlier and had a difficult course, especially if they had to do a caesarean section because of this, are more likely to meet with preeclampsia again.

When the likelihood of gestosis is greater:

In the first pregnancy;
If you already had chronic diseases before pregnancy: kidney problems, high blood pressure or overweight. In this case, gestosis is called “combined”, in contrast to “pure” gestosis, which develops against the background of complete health;
Pregnancy with twins and triplets;
Heredity, that is, parents or sisters suffered from preeclampsia;
Age less than 20 and over 35 years.

If preeclampsia was not in the first pregnancy, it is very unlikely that it will be in the second.

Causes of gestosis during pregnancy

Although scientists have not fully established the causes of preeclampsia, it is known that the placenta plays a major role in its development. When there is insufficient blood supply to the uterus (for example, when the uterine arteries are narrowed) or the placenta itself is pathological, it triggers a mechanism for raising pressure to increase blood flow.

The rise in pressure is achieved due to the narrowing of the vessels of the mother's body, but this leads to a deterioration in the blood supply to her vital organs - the kidneys and brain. They receive less blood, and their performance deteriorates.

With edema, water exits the bloodstream into the tissues, which makes the blood thicker and increases the formation of blood clots. Blood clots can clog small vessels and impair blood flow even more, and thick blood increases pressure. There is a vicious circle.

Signs of preeclampsia

There are three main signs of gestosis that usually appear together or in pairs: edema, protein in the urine and increased blood pressure.

The appearance of protein in the urine(proteinuria).
The first and main criterion that indicates kidney damage. Almost never preeclampsia happens without proteinuria, and the stronger it is, the worse. Although the identification of this sign alone does not yet speak of gestosis.

Normally, protein in the urine should be absent.
Small amounts, in the region of 0.033 g / l, in combination with leukocytes, may be a sign of inflammation of the kidneys (pyelonephritis).
0.8 g / l and more rather speak of preeclampsia.
Proteinuria in combination with an increase in pressure over 140/90 always speaks of preeclampsia.

Urine analysis should be taken before each visit to the doctor in the antenatal clinic. If it seemed to you that the urine became cloudy, dark in color or covered with foam, take the test without waiting for the appointed day.

Increase in blood pressure more than 140/90 mm Hg. Art.
This is the second main sign of preeclampsia, which may go unnoticed, and may be manifested by headache, nausea, flies before the eyes, dizziness.

The combination of high blood pressure with protein in the urine is called preeclampsia, and speaks of the initial stage of brain damage to the expectant mother. This is why blood pressure must be measured at every visit to the doctor.

In severe cases, untreated high blood pressure can lead to severe damage to the nervous system: loss of consciousness, seizures (eclampsia), and bleeding in the brain (stroke). Such a danger arises when the upper numbers of blood pressure exceed 160, and the lower 110 millimeters of mercury.

Edema.
Often found during normal pregnancy, and in themselves are not a sign of preeclampsia, but only in combination with proteinuria or high blood pressure. Moreover, preeclampsia without edema (“dry”) is more difficult.

If you have swelling, it is easy to determine if you do a simple test. With your thumb, press on the inner surface of the lower leg in the area of \u200b\u200bthe bone and hold for a few seconds. If a hole remains at the site of pressure, then there is swelling. Similarly, you can conduct this test on any other part of the body.

Another sure sign of edema is that slippers or shoes have become small, the wedding ring cannot be removed from the finger. In some cases, there are hidden edema. They can be identified by too much weight gain compared to the norm.

Examination for suspected preeclampsia

Analysis of urine . Allows you to identify protein, ketone bodies, leukocytes, bacteria and other elements. This makes it possible to distinguish kidney damage in preeclampsia from pyelonephritis or other diseases.
Blood test . Such indicators as hemoglobin play a role (a slight decrease at the end of pregnancy is the norm), hematocrit (blood thickening), platelets, the level of liver enzymes (indicates liver damage in severe preeclampsia).
from . Allows you to assess the development of the baby and recognize his delay in time. Evaluation of blood flow in the uterine arteries using Doppler allows you to give an approximate prognosis for the development of the disease: the worse the blood flow, the greater the likelihood of preeclampsia.
. It is done after the 28th week of pregnancy, at an earlier date it is not significant. Shows the mobility of the baby, the work of his heart and, therefore, the presence or absence of hypoxia (oxygen starvation).

Accurate Diagnosis

All of these symptoms are characteristic not only for preeclampsia, and they must be distinguished from signs of other diseases, especially if the expectant mother had them before pregnancy. Therefore, only a doctor can make an accurate diagnosis of gestosis.

Video footage

Late toxicosis (preeclampsia), edema during pregnancy.

The concern of obstetricians with a large increase in the weight of a pregnant woman is not related to concern about her appearance, but about the health of the mother and baby.

Often to the question: “How much can and should a woman gain weight during pregnancy?” Many answer correctly, about 10-12 kg. But it happens that some add 20 kg or more. Women are indignant: “Why are we constantly weighed in the antenatal clinic, what difference does it make to the doctor, what kind of figure will I have after childbirth? And in general, a woman during pregnancy should eat whatever she wants. And then the baby will not receive the necessary nutrients. So you often have to explain to doctors that pathological weight gain is one of the early symptoms of a serious pathology called preeclampsia.

What is gestosis?

Preeclampsia is a disease that occurs only in pregnant women and usually disappears a few days after childbirth. Preeclampsia affects about a third of expectant mothers. Statistics show how formidable this disease is: for many years it has been firmly among the top three causes of maternal death in Russia.

Preeclampsia begins only after the 16-20th week of pregnancy, and is most often detected in the third trimester (after 28 weeks). It occurs due to changes in the body of a pregnant woman, as a result of which substances are formed in the placenta that can make microholes in the vessels. Through these "holes" from the blood, plasma protein and fluid penetrate into the tissues, so edema is formed. They, at first still invisible to the eye, can be detected when weighing.

"Holes" are also formed in the vessels of the kidneys, so protein enters the urine through them. The more "holes", the more a woman loses protein, the more serious the disease. Therefore, so often the doctor prescribes a general urine test to the expectant mother. This allows you to make a diagnosis and start treatment as early as possible.

Since the fluid has left the vessels, the body has to increase blood pressure in order to pump the remaining fluid through the body. The third symptom of preeclampsia appears - high blood pressure. Due to the thickening of the blood, its coagulability increases, which can lead to the formation of blood clots.

Gestosis is insidious. A woman feels healthy for a very long time. Well, just think, I gained excess weight, they found protein in my urine, for some reason the pressure rose. But the head does not hurt, and the kidneys do not bother either. So everything is ok? And in fact it is not. After all, not only the arms, legs, face swell, but also the placenta (which leads to a lack of oxygen in the fetus), and ultimately the brain (which can lead to seizures).

At the same time, symptoms (headache, nausea, flashing of "flies" before the eyes, drowsiness, lethargy, pain in the stomach) appear several hours, and sometimes minutes before an attack of convulsions that can take the life of both the mother and the child.

This condition is called preeclampsia, and the seizure itself is called eclampsia. The danger is that against the background of such a convulsive state, a heart attack, stroke, pulmonary edema, detachment of the placenta and retina, kidney and liver failure develop. And all this very quickly and - in a seemingly healthy and young woman.

That is why doctors of antenatal clinics devote so much time to the prevention and timely diagnosis of gestosis in pregnant women.

We make a diagnosis: gestosis

18.12.2019 21:09:00
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