Doctors call preeclampsia a pathological condition that can occur in pregnant women. It worries 10% of women in the position.

With pathology, blood does not enter the placenta in the right amount. All the symptoms of the disease lead to the fact that the fetus receives an insufficient amount of oxygen and nutrients from the mother. This threatens hypotrophy and hypoxia.

Preeclampsia affects the health of the baby. The baby may have a low birth weight. Modern advances in medicine make it possible to overcome the negative impact of the disease. Therefore, most women in labor successfully cope with a dangerous pathology. They give birth to healthy babies.

Causes of pathology

Experts cannot accurately name the causes of such a pathology. It is likely that preeclampsia develops due to spasm of peripheral vessels. Presumable factors that negatively affect the body are the following:

• malnutrition of a pregnant woman;
• high levels of body fat;
• poor blood flow in the uterus.

In addition, doctors identify risk factors that contribute to the disease:

1. first pregnancy;
2. the age of the pregnant woman is more than 40 years;
3. high blood pressure in a woman before pregnancy;
4. excess weight;
5. autoimmune diseases in women;
6. heredity (preeclampsia in the closest relatives);
7. multiple pregnancy;
8. kidney disease, diabetes, rheumatoid arthritis.

Associated symptoms and signs of the disease

Signs:

• A clear sign of pathology is edema, which grows very quickly. In a pregnant woman, the hands and face are especially swollen. The woman begins to gain excessive weight.
• The second symptom is high blood pressure.
• In some women, biochemical parameters of the blood change and jaundice occurs.
• Headache, abdominal pain, hyperreflexia, blurred vision.
• Protein in urine and reduced amount of urine.
• Nausea and vomiting.

Tests in a pregnant woman with preeclampsia can detect protein in the urine (proteinuria). This indicates pathological disorders. A pregnant woman is examined and treated.

Light degree

The pressure rises from 150/90 mm Hg. An increased number of platelets is found in the blood. Urinalysis shows the presence of protein up to 1 g / l. Pregnant women have swollen legs. Sometimes this disease occurs without any symptoms. Only after passing regular tests, a woman discovers a pathology. Therefore, while waiting for a child, you should not miss planned visits to the doctor. If a mild degree of preeclampsia is detected in time, then possible complications can be prevented.

Average degree

The pressure rises to 170/110 mm Hg. Art. The doctor detects protein in the urine (over 5 g/l). Symptoms of the disease become more pronounced than at the initial stage.

heavydegree

This is the most dangerous state. The pressure rises significantly. Protein in the urine increases. The woman suffers from a headache, which is localized in the forehead. She can flash in her eyes. Vision is disturbed, and pain occurs in the right side due to the swollen liver.

There are hematological disorders. The disease at this stage can develop into eclampsia - the most dangerous preeclampsia. It is accompanied by convulsions. Severe preeclampsia and eclampsia can threaten the health of mother and baby.

Proper condition diagnosis

If a pregnant woman is diagnosed with arterial hypertension (high blood pressure lasts more than 6 hours) and protein is found in the urine, then we are talking about preeclampsia.

Edema and pastosity confirm the diagnosis. If you experience unusual swelling in your face, arms, or legs, you should consult your doctor.

It should be noted that this disease does not have specific symptoms. Sometimes swelling and cramps occur for other reasons. Therefore, an accurate diagnosis can be made only after taking into account the totality of symptoms. Confirmation of the correctness of the diagnosis is the disappearance of symptoms after the birth of the baby.

Preeclampsia during pregnancy

This is preeclampsia, which has a characteristic clinical picture of damage to the nervous system. Most often it develops in the second half of pregnancy. But sometimes it occurs in the early stages. Statistics show that in recent years the frequency of this pathology has increased significantly. It usually occurs during the first pregnancy. With repeated pregnancies, such a pathology is detected less frequently.

Treatment regimen for preeclampsia

Treatment is determined by the doctor after examining the woman. It all depends on the severity of the pathology, as well as on the stage of pregnancy. Mild preeclampsia can be successfully managed at home. It is enough to observe bed rest. Experts advise lying on your back more often, which helps to reduce blood pressure.

In this case, the pregnant woman should be under the supervision of a doctor. She is undergoing ultrasound, constantly measuring blood pressure, cardiotocography and counting fetal movements. If there is no improvement, then they resort to drugs. Doctors prescribe drugs that reduce blood pressure. In addition, a woman should take magnesium sulfate.

If adverse symptoms continue to increase, then the question arises of a caesarean section or artificial induction of labor. In severe cases, the only solution is delivery. Doctors try to prolong the pregnancy as much as possible, but if the pathology endangers the life of the child or mother, then they resort to artificial stimulation of childbirth.

After the birth of a baby, a woman may experience postpartum preeclampsia, which lasts for several weeks. It can threaten the mother's life.

Emergency care for acute form

Dangerous symptoms in which a pregnant woman needs urgent medical attention:

1. arterial pressure rises significantly (more than 170/110 mm Hg);
2. oliguria;
3. violation of cerebral blood flow;
4. severe swelling;
5. strong mental or motor excitement or depression.

In such cases, the patient is urgently hospitalized. She is given sedatives beforehand to prevent convulsions. Pregnant women are usually given Relanium or Droperidol. In severe situations, hypnotics from a series of barbiturates are used. Short-term mask anesthesia is sometimes used before the introduction of sedatives. Specific actions of doctors depend on the severity of the patient's condition.

Complications of uterine prolapse have serious consequences, from the article you will learn how to prevent the development of the disease.

What causes this disease, which is also known as toxemia, is unknown. Diagnosis is when blood pressure is high (greater than 140/90) and there is protein in the urine or swelling of the face, arms, and legs. Many women who get preeclampsia feel fine, but others have symptoms of severe preeclampsia, such as headaches, eye spots, blurred vision, upper abdominal pain, or seizures (known as eclampsia). At risk are women with chronic hypertension, kidney disease, diabetes, and mothers with many children.

Preeclampsia is the most common medical problem in pregnant women. It occurs in the second half of pregnancy in about 6-10% of women. Although there are many different causes of hypertension, the most clinically significant is preeclampsia, which affects 1-3% of pregnant women. Preeclampsia is associated with maternal and fetal complications and an increased mortality rate. There is no other effective intervention, other than delivery, for preeclampsia, which is why it is the cause of about half of artificially induced preterm births with all the ensuing consequences.

At present, the exact cause of preeclampsia is unknown, although it is understood that this disorder is associated with widespread endothelial dysfunction. It is assumed that the violation of invasion (trophoblast) and subsequent restructuring of the maternal spiral arteries in the first trimester of pregnancy lead to a decrease in placental circulation and the release into the maternal circulation of factors that cause damage to endothelial cells. Because each organ is supplied with blood, preeclampsia should be considered a multisystem disease that can present differently in each patient. Therefore, the management of pregnant women with preeclampsia involves more than just treating hypertension.

Symptoms and signs of preeclampsia in pregnancy

central nervous system

• Eclamptic convulsions
• Cerebral hemorrhages (intraventricular or subarachnoid)
• Cerebral infarction: micro- or macroinfarction (cortical blindness caused by infarction of the occipital zone)

Clotting system

• Thrombocytopenia
• Microhemangiopathic hemolysis
• HELLP syndrome (hemolysis, elevated liver enzymes, decreased platelet count)
• Disseminated intravascular coagulation

Eyes

• Retinal disinsertion
• retinal edema

kidneys

• Acute tubular necrosis
• Acute cortical necrosis
• Nonspecific renal failure

Liver

• Capsule rupture
• heart attack
• Jaundice
• Decreased synthesis of soluble coagulation factors
• HELLP syndrome

Respiratory system

• Pulmonary edema
• Laryngeal edema
• Adult Respiratory Distress Syndrome

Abnormalities suggestive of preeclampsia that may be found on examination

mother

• Increase in urea and creatinine
• Increased liver function tests (aspartate aminotransferase, alanine aminotransferase)
• Hemolysis
• Hyperuricemia
• hypocalcemia
• Increase in total cell volume
• Proteinuria
• Increased plasma antithrombin III
• Increased plasma fibronectin
• Increased plasma von Willebrand factor
• Thrombocytopenia

In the fetus

• Intrauterine growth retardation
• Abnormal blood flow in the umbilical artery on Doppler ultrasound
• Abnormal fetal cardiac activity (with cardiotocography)

Classification of hypertension in pregnancy

• Chronic hypertension
• Hypertension due to pregnancy (gestational hypertension)
• Preeclampsia
• Preeclampsia due to chronic hypertension

The blood pressure of the expectant mother decreases in the first half of a normal pregnancy and again reaches or exceeds the pre-pregnancy level by the 30th week. Hypertension during pregnancy is considered to be pressure > 140/90 mm Hg. Art., if these figures are obtained twice with an interval between measurements of at least 4 hours or if the diastolic pressure exceeds PO mm Hg. Art. If this occurs before the 20th week, it is assumed that chronic hypertension is present. If hypertension first occurs after the 20th week of pregnancy and is not accompanied by proteinuria, it is called "pregnancy-induced hypertension". Pre-eclampsia is defined as new onset hypertension with proteinuria (> 300 mg/day or ++ on the dipstick) in the absence of a urinary tract infection after 20 weeks of gestation. If a patient with pre-existing hypertension develops proteinuria (> 300 mg/day or ++), this is called superimposed pre-eclamia. Eclampsia is defined as tonic-clonic seizures that occur against the background of preeclampsia.

Efforts in the care of pregnant women in the UK are aimed at detecting preeclampsia. There is no reliable screening test for this purpose, so regular blood pressure and urine screening is done. It is shown that this reduces mortality in childbirth by 7 times. In addition, women are identified at an increased risk of developing hypertension. The incidence of preeclampsia is higher in the first pregnancy (or first pregnancy from a new partner), multiple pregnancies, in the presence of first-degree relatives with a history of hypertension, and at the beginning and end of childbearing years. Important risk factors are chronic kidney disease, chronic hypertension (particularly poorly managed), diabetes mellitus, and thrombophilia. Patients with burdened anamnesis are referred to the high-risk group; they are observed in special obstetric clinics and examined more often than low-risk women. Women who have previously suffered from preeclamisia are also considered to be at high risk, since relapses of the disease in the same form occur in 20-40% of cases, depending on the studied population.

It is important to note that preeclampsia is a heterogeneous condition, and the diagnosis can be made by the clinical features listed above in combination with hypertension and proteinuria.

Despite significant cardiovascular problems, cardiologists are rarely involved in the management of hypertension in pregnancy, except in cases of severe or resistant hypertension or other unusual manifestations, such as secondary hypertension in aortic coarctation. Thus, most cardiologists have little experience in the management of hypertension in pregnancy. This may be a particular problem in counseling women with hypertension who are planning a pregnancy, in the prevention of preeclampsia, the use of pharmacological agents in pregnancy, and in the care of patients with a history of preeclampsia.

Measuring blood pressure during pregnancy

When measuring blood pressure in pregnant women, the doctor faces the same problems as when examining other patients, namely: the choice of a suitable place to apply the cuff, possible measurement errors, and systematic errors in the evaluation of readings by blood pressure fluctuation devices. All this can affect the final measurement results. Particular attention when measuring pressure in a pregnant woman should be given to the posture of the patient. In the second half of pregnancy, blood pressure is lower if the patient lies on her back. The reason for this is that the pregnant uterus prevents venous outflow from the lower extremities and reduces cardiac preload. Therefore, pressure should be measured when the patient is lying on her left side or sitting. Since the cuff is difficult to maintain at heart level with the patient in the left lateral position, the sitting position is preferred.

In the UK (but not in the US), a fourth Korotkoff sound (K4) was previously considered to be more preferable than K5 for measuring diastolic blood pressure. The reason for this is that K5 is audible at zero cuff pressure. However, a study in which 250 patients participated showed that diastolic blood pressure always exceeded 50 mm Hg. Art. K5 is closer to intra-arterial diastolic than K4 and can be determined more consistently than K4. K5 is currently recommended for measuring diastolic blood pressure in the UK.

"White coat hypertension", when a patient's high blood pressure is associated with a medical setting, is more of a problem for pregnant women than for non-pregnant women. This factor is minimized by using devices that allow blood pressure to be measured frequently and outside the clinic, such as 24/7 ambulatory BP monitoring.

Automated blood pressure monitors, whether inpatient or outpatient, widely used in antenatal, maternity and other wards require special calibration for use in pregnant women and especially in pre-eclampsia. Many devices currently in use are not suitable for pregnant women. In particular, in preeclampsia, the physical characteristics of the vessels change. The pattern of pressure changes between systole and diastole analyzed by the oscillometric instrument changes, and the algorithm used by the instrument to calculate diastolic pressure is no longer accurate. In severe preeclampsia, devices that rely on oscillometric measurements may give an inaccurate estimate of diastolic pressure with an error of 15 mmHg. Art. compared to conventional sphygnomanometry. This can lead to inadequate treatment of hypertension. Even instruments that use a microphone to pick up Korotkoff sounds are not free from this problem. We recommend the SpaceLabs 90207 and SpaceLabs Scout as the only automated blood pressure monitors that have been proven accurate in severe preeclampsia.

Diagnosis of preeclampsia in pregnant women

Although researchers have been trying for years to come up with strategies to prevent preeclampsia, such as aspirin for children, a low-sodium diet, and megavitamins, nothing has yet been found to work. Diagnosis is all that modern medicine can offer. Therefore, weekly visits to the doctor are necessary.

Treatment of preeclampsia in pregnant women

The only treatment is childbirth. If the disease is very severe, the doctor may recommend giving birth, even if the baby is premature. If the symptoms are moderate, the doctor will likely decide what to do based on the results of blood and urine tests; he may also recommend induced labor if the baby is full term.

Prevention of preeclampsia

Prevention of preeclampsia is especially important, since the only effective way to treat it is the birth of a child. Two groups of women are particularly at risk of developing preeclampsia: those who have had preeclampsia during a previous pregnancy and those who have kidney disease or hypertension.

Early clinical trials of antiplatelet agents, in particular low-dose aspirin (60-150 mg/day), showed encouraging results - the risk of preeclampsia was reduced by 70%. Other studies, notably the CLASP (Cooperative Study of Low-Dose Aspirin in Pregnancy), did not show any risk reduction. However, a subsequent analysis of the CLASP data showed that the number of cases of early-onset preeclampsia (before 34 weeks of gestation) can be reduced by 50%, and this is important, since it is earlier onset of preeclampsia that is associated with the highest rates of complications in childbirth. A subsequent meta-analysis of 32 clinical trials of antiplatelet agents showed that they reduced the risk of developing preeclampsia by 15%. The risk decreases regardless of the gestational age at which a woman starts taking aspirin at the prescribed dose. In the UK, the usual prophylactic dose of aspirin is 75 mg per day; reception should be started in the first trimester of pregnancy, since the main pathological changes leading to the development of preeclampsia occur during this period.

Attempts have been made to prescribe a special diet to reduce the risk of preeclampsia. There was no benefit from reducing salt intake or supplementing magnesium. However, calcium supplementation of at least 1 g/day reduced the risk of developing hypertension by 19% and preeclampsia by 30%. These effects were most pronounced in women at high risk for preeclampsia. A study of 283 pregnant women at high risk of preeclampsia found that taking antioxidants such as vitamins C and E reduced the risk from 26% to 8%.

A meta-analysis of the treatment of hypertension before conception or during pregnancy concluded that the number of patients with severe hypertension is reduced, but the risk of developing preeclampsia and fetal and newborn complications is not reduced. Therefore, patients who have hypertension should be properly evaluated and adequately treated before pregnancy. Antihypertensive agents have not been shown to be teratogenic, although ACE inhibitors may be associated with skull defects and kidney dysfunction. Thus, when choosing drugs for non-pregnant patients, future pregnancy can not be taken into account. However, if a woman is planning a pregnancy, it is better to prescribe antihypertensive drugs, which can be continued throughout the pregnancy, than to change the drug in the first trimester, when the placenta is formed. There are no levels of blood pressure at which pregnancy is unacceptable. Patients should receive counseling about the possible risk of preeclampsia and possible preventive treatment.

Management of pregnant patients with hypertension

There are two important differences between the management of hypertension during and outside of pregnancy. Most cases of hypertension outside of pregnancy are idiopathic, or essential, that is, they occur chronically. In this case, the main goal of treatment is to prevent such long-term complications as stroke or myocardial infarction. Outside of pregnancy, few patients present with severe acute hypertension, which should be treated immediately because of the risk of hypertensive encephalopathy or cerebral hemorrhage. It has been established that a sharp decrease in pressure outside of pregnancy is associated with a high risk for the patient. At the same time, hypertension in pregnancy stops after childbirth, so there is no need for its treatment to provide for the prevention of long-term complications. Preeclampsia is associated with a high risk of eclampsia and cerebral hemorrhage. The latter complication is the most common cause of maternal death in preeclampsia. In pregnant women with severe preeclampsia, a sharp decrease in blood pressure is often necessary.

The most important difference in the management of hypertension in pregnant and non-pregnant patients is the multisystem nature of preeclampsia, as well as the consequences of endothelial dysfunction on the cardiovascular system, including a tendency to thrombosis, a decrease in intravascular blood volume, and increased endothelial permeability. The manifestations of preeclampsia are highly variable, and patients with severe disease may have little or no hypertension. It is necessary to identify other signs of this syndrome and carry out appropriate treatment. They can be expressed in varying degrees and progress at different rates. However, they develop continuously, and, as shown, no intervention other than delivery can stop this process.

Since the manifestations of the disease are variable, the division of hypertension in pregnancy and preeclampsia into mild, moderate and severe is difficult and may not correspond to clinical manifestations. Therefore, to determine the severity of the disease, an assessment of the clinical picture as a whole is required, taking into account complaints, objective signs, data from laboratory and other examinations, and the condition of the fetus.

Patients with asymptomatic hyperthecia without proteinuria or without impaired renal, hepatic or blood coagulation function, with blood pressure not exceeding 150/95 mm Hg. Art., can be successfully carried out on an outpatient basis. If possible, a day hospital is preferred, where the doctor can prescribe medication and monitor response to therapy. More than 40% of patients with existing hypertension subsequently develop preeclampsia. Therefore, they should be followed up with regular blood pressure, urine, blood, liver and kidney function, and blood clotting tests.

With blood pressure exceeding 160/100 mm Hg. Art., without proteinuria, the patient should be immediately examined by an obstetrician-gynecologist. In the presence of proteinuria, hospitalization is required. The latter is needed not because it prevents the development of preeclampsia, but because it allows intensive monitoring of the mother and fetus, consisting of measuring blood pressure every 4 hours, collecting daily urine, a complete blood count, assessing the function of the kidneys, liver and blood coagulation, as well as assessment of the water balance. Since delivery is currently the only treatment, monitoring has a dual purpose: first, to assess the need for delivery, prescribe antihypertensive therapy and assess response to it in order to keep the pregnancy as long as possible, until the maximum possible fetal maturity is reached; secondly, such observation allows you to correctly determine the time when delivery is necessary.

The specific aim of antihypertensive therapy is the prevention of brain disorders and eclampsia, as well as the prolongation of pregnancy and the administration of corticosteroids to promote the maturation of the lungs of the fetus if it is less than 34 weeks old. It is not necessary to strive to reduce blood pressure to normal levels, as this can further impair the function of the placenta. The goal is to achieve a pressure of the order of 140/90 mm Hg. Art.

Management of patients with mild to moderate hypertension

A meta-analysis of the Cochrane database of all clinical trials of antihypertensive agents in mild to moderate hypertension concludes that treatment of mild hypertension (where there is no risk to the mother) does not improve fetal prognosis but reduces the incidence of severe hypertension. However, patients with chronic hypertension, who are at high risk of developing preeclampsia, were more likely to have received antihypertensive agents early in pregnancy and were excluded from most clinical trials in the Cochrane database. It is doubtful that pregnancy can be prolonged by symptomatic treatment of preeclampsia with careful monitoring of blood pressure and appropriate biochemical and hematological tests, since blood pressure control does not prevent worsening of preeclampsia or complications in childbirth. Therefore, an important factor for deciding on symptomatic treatment is the maturity of the fetus. Symptomatic treatment can be given to a woman at 26 weeks' gestation, while at 38 weeks' gestation, there is little benefit in continuing the pregnancy.

Methyldopa

Despite lacking efficacy as an antihypertensive agent, methyldopa is still the most commonly used for long-term control of blood pressure during pregnancy. Compared with placebo, fetal outcome was shown to improve, and 7-year follow-up did not reveal any abnormalities in children whose mothers received methyldopa. Later it was shown that methyldopa is the only antihypertensive agent that does not affect the fetoplacental circulation, although this may be due to a slight hypotensive effect. Usually the dose ranges from 250 mg to 1 g three times a day. At a high dose, sedative and depressive effects are expressed. Methyldopa should not be given if the pregnant woman is at risk of developing depression. In this case, β-blockers and calcium antagonists would be more appropriate.

β-blockers

In clinical practice in the UK, labetalol (α, β-blocker) is used. β-blockers are associated with a reduction in the incidence of severe hypertension, probably due to a decrease in cardiac output and a decrease in peripheral resistance. Other β-blockers have been tested. Specifically, oxprenolol was compared with methyldopa and atenolol was compared with placebo. They had different effects on reducing the risk of developing preeclampsia. However, there are concerns that β-blockers, in particular atenolol, may cause intrauterine growth retardation due to a decrease in uteroplacental perfusion; since the weight of newborns and placentas after therapy with atenolol decreases. It is unclear whether the risk of fetal growth retardation is specific to atenolol. Since atenolol does not exhibit intrinsic sympathomimetic activity (unlike oxprenolol) or mixed α,β blocker activity (labetalol), it is important to consider the pharmacological profile of each β-blocker. Despite the relatively weak β-blocking effect of labetalol, it should not be prescribed to patients with asthma.

Nifedipine

Nifedipine is the only calcium antagonist for which there is any experience in pregnancy, based on individual observations rather than full-fledged clinical trials. A retrospective study has shown it to be a useful antihypertensive agent given either as monotherapy or together with methyldopa or labetalol. It has been shown that nifedipine effectively lowers blood pressure and reduces spasm of the cerebral arteries. The use of long-acting nifedipine preparations is especially useful in facilitating adherence to medication regimens and in women with labile blood pressure.

Diuretics

Diuretics were officially widely used to "treat" or prevent preeclampsia. Meta-analysis showed that they reduce edema but do not affect perinatal survival. Theoretically, diuretics are contraindicated, as circulating blood volume is already low in severe preeclampsia and further reduction may impair placental perfusion. Diuretics also increase serum urate levels, which are measured to monitor the progression of preeclampsia. For these reasons, and because of their ineffectiveness as an antihypertensive agent, diuretics are not used to control blood pressure during pregnancy.

ACE inhibitors

These medicines should not be given after the first trimester of pregnancy. They cause renal failure in the fetus, which manifests itself before childbirth with oligohydramnios, and after childbirth with oliguria and anuria. The outcome for the fetus can be fatal, this applies to both captopril and enalapril.

Management of patients with severe hypertension

As a result of an increase in blood pressure to 170/110 mm Hg. Art. direct damage to the endothelium occurs, and at a pressure level of 180-190 / 120-130 mm Hg. Art. cerebral autoregulation is disturbed, which can lead to cerebral hemorrhage. In this case, there is a risk of placental abruption or fetal asphyxia. Therefore, at a blood pressure of 170/110 mm Hg. Art. urgent treatment is required. Currently, hydralazine or labetalol are most often used, although it is not known which of these antihypertensive agents is more effective in such cases. Physicians should prescribe a drug that they are familiar with, as the spectrum of side effects of these drugs can mimic symptoms of preeclampsia (eg, cause headaches). It is necessary to reduce the pressure level to safe levels without further reduction in blood pressure, which can lead to a deterioration in uteroplacental perfusion and, in turn, cause fetal hypoxia. Therefore, during intravenous therapy with antihypertensive agents, continuous monitoring of fetal heart rate is necessary. Management of severe acute hypertension should be undertaken where individual patient observation and BP monitoring can be performed at least every 15 minutes.

Hydralazine

In the past, hydralazine has been the most widely used treatment for severe acute hypertension. An intravenous bolus (10-20 mg over 10-20 minutes) lowers blood pressure to a safe level. During intravenous injection of hydralazine, blood pressure should be checked every 5 minutes. Then hydralazine can be administered intravenously at 1-5 mg / h. Side effects: headache, facial flushing, dizziness and palpitations.

Labetalol

Labetalol is a combined α, (3-adrenergic antagonist) that has become the most commonly used in severe acute hypertension. Initially, 200 mg orally can be given. 20 mg / h, which can be increased by 20 mg / h until a maximum dose of 160 mg / h is reached. If there is a history of asthma or heart disease, labetalol is not prescribed because of its (3-blocker activity.

Nifedipine

Nifedipine is a calcium antagonist. Its oral administration is effective in acute severe hypertension. During pregnancy, you should not prescribe the drug in sublingual form, as this can cause a sharp drop in blood pressure and lead to fetal hypoxia. In acute severe hypertension, 10 mg of the standard drug can be prescribed (without prolonging the effect). Side effects: headache, dizziness and palpitations. Recent studies have shown that the combination of nifedipine with magnesium sulfate does not enhance the effects of either of these drugs, so the fear that the simultaneous administration of both drugs will cause a sharp drop in blood pressure is not justified.

Anticonvulsants

Patients with severe preeclampsia have an increased risk of developing seizures, which are dangerous for both mother and fetus. In the United States for the treatment of eclampsia for a long time prescribed and prescribed parenterally magnesium sulfate. Lucas et al. showed that magnesium sulfate was significantly more effective than phenytoin in preventing seizures. A placebo-controlled randomized clinical trial in 10,110 women with hypertension and proteinuria showed that the risk of eclampsia in women who received magnesium was reduced by 58% compared with the placebo group. Fetal mortality rates do not change, although the incidence of placental abruption decreases. A subsequent meta-analysis of this and other randomized trials showed that the risk of eclampsia in patients treated with magnesia was 0.33 compared with the risk when taking placebo. In addition, magnesium sulfate was found to be more effective than phenytoin in preventing eclampsia.

Magnesium sulfate (10%) is administered at a loading dose of 4 g intravenously over 10 minutes, and then intravenously at 1 g / h around the clock. This treatment is continued until childbirth. If respiratory rate > 16/min, urine output > 25 ml/h, and deep reflexes (knee and elbow) are preserved, there is no need to check the concentration of magnesium in the blood. If deep reflexes disappear (magnesium concentration is about 5 mmol / l), the drug should be discontinued. In case of respiratory and cardiac arrest (magnesium concentration> 10 mmol / l), it is necessary to take measures to restore breathing and cardiac activity, stop the infusion and inject 10 ml of 10% calcium gluconate intravenously.

Fluid balance

In severe preeclampsia, fluid balance monitoring is required. In patients, the amount of extracellular fluid may be increased, which is manifested by edema and a decrease in the volume of fluid inside the vessels due to increased endothelial permeability. With water overload, fluid penetrates the tissues, which can lead to pulmonary edema. Therefore, a urinary catheter should be placed and urine output and fluid intake should be checked every hour, which should not exceed 80 ml/h or 1 mg/kg. If urine output is low, careful assessment of fluid balance with invasive monitoring of central venous pressure and pulmonary capillary pressure is required. If there are no signs of pulmonary edema, 250 ml of a colloidal solution should be given. If there are signs of pulmonary edema, 20 mg of furosemide is administered intravenously. In severe condition, invasive monitoring of arterial or central venous pressure is necessary. Sometimes measurement of pulmonary capillary wedge pressure is required in order to decide whether to continue the infusion or reduce cardiac preload and afterload.

Eclampsia

Although eclampsia can develop in the presence of pre-eclampsia, 11% of patients have no proteinuria or significant hypertension at the time of the first seizure, and 43% of cases do not have a combination of these features. Eclampsia can occur either before childbirth (38%), or during childbirth (18%), or in the postpartum period (44%). In the UK, the incidence of eclampsia is 1 in 2000 births. Mortality - 2%. When managing eclampsia, first of all, it is necessary to maintain normal breathing and circulation and stop convulsions.

For seizure prevention, magnesium sulfate is clearly more effective than phenytoin and diazepam, with a relative risk of 67% and 52%, respectively. In addition, both maternal and fetal outcomes are better when magnesium is used. Therefore, all doctors dealing with eclampsia should know how to use magnesium sulfate. A loading dose of 10% magnesium sulfate (4 mg) is administered intravenously or intramuscularly. In the absence of intravenous access, an infusion of 1 g / h is carried out to prevent further convulsions. Respiratory rate and deep tendon reflexes should be constantly monitored as described previously.

Secondary hypertension in pregnancy

The earlier hypertension occurs in a pregnant woman, the less likely it is due to pregnancy. As in the absence of pregnancy, in most cases there is no obvious cause (essential hypertension), it can be established only in 5% of cases. However, some forms of secondary hypertension present special problems that need to be kept in mind and ruled out in the differential diagnosis.

Pheochromocytoma

Nearly every report of maternal mortality has a death from pheochromocytoma. This disease can simulate preeclampsia. If the diagnosis is not established, the mortality rate is 50%. As in the absence of pregnancy, in most cases there are no typical signs, so all patients with severe hypertension should be examined for the presence of pheochromocytoma by the method that is accepted in this medical institution: direct determination of the level of catecholamines or their metabolite, vanillylmandelic acid. Since the results of biochemical tests for pheochromocytoma are affected by methyldopa, the examination should be carried out before starting treatment. If tests suggest the presence of this tumor, treatment with α- and β-blockers should be started immediately. Phenoxybenzamine and propranolol can be given despite any concerns regarding the use of (3-blockers during pregnancy. Once an effective 3-blocker is given, the risk to the mother is eliminated. Tumor localization can be determined before delivery by ultrasound or MRI, which are safe in pregnancy. If the localization of the tumor is established reliably, it can be removed by a combined approach at the time of delivery or later.If the tumor is not localized before delivery (which is more likely if it is located outside the adrenal glands), delivery is safe with a combined blockade of a- and 8-adrenergic receptors.After delivery, you can determine the location of the tumor and remove it.

Coarctation of the aorta

Most patients with severe coarctation of the aorta undergo surgical treatment before pregnancy. If surgery is not done, there is an increased risk of aortic dissection due to increased cardiac output during pregnancy. Patients with coarctation of the aorta should receive β-blockers to control blood pressure, despite the risk to the fetus. The use of (3-blockers is preferred, as they reduce myocardial contractility and thus reduce the load on the aorta.

kidney disease

Renal vascular hypertension does not cause specific problems in pregnancy, but this is not the case in renal parenchymal disease. Hypertension and renal failure interact in a way that is not well understood, which increases the risk of preeclampsia and acute or chronic fetal distress, i.e. kidney disease in the presence of hypertension increases the incidence of intrauterine fetal growth retardation from 2 to 16%, and the incidence of preterm birth from 11 to 20%. In women with impaired renal function, the frequency of fetal death increases 10 times. Additional studies of kidney function are required, since during pregnancy the load on them increases, which in healthy pregnant women is compensated by an increase in the glomerular filtration rate. Some women experience an irreversible decline in kidney function during pregnancy.

Essential hypertension

This diagnosis is made for most women with hypertension that occurs before 20 weeks of gestation. It has now become clear that essential hypertension as such does not pose a risk to the fetus, and antihypertensive therapy may worsen the condition of the fetus. The only risk is the development of preeclampsia. Women with pre-pregnancy essential hypertension have a 20% risk of developing preeclampsia compared with a 4% risk in the absence of hypertension. The goal of managing patients with essential hypertension in early pregnancy is to prevent the development of severe life-threatening hypertension.

Very rarely, an early termination of pregnancy may be required due to severe hypertension, which, otherwise, will put the woman's life at risk.

Management of the patient with hypertension postpartum

Hypertensive disorders that occur during pregnancy usually resolve after the baby is born. But treatment should not be interrupted abruptly, as this is associated with the risk of recurrence of symptoms. There are no hypertensive drugs that are contraindicated during breastfeeding. Women who have had hypertension during pregnancy, especially severe, should be monitored up to 6 weeks after delivery with blood pressure measurements and urine tests. By this time, in 90% of women, the pressure reaches normal numbers. The remaining 10% of patients are subject to further routine examination to ensure that there are no causes of high blood pressure, such as pheochromocytoma or heart disease, such as left ventricular hypertrophy.

Women who have preeclampsia during pregnancy are twice as likely to develop coronary heart disease over the next 20 years as they are after a normal pregnancy. In addition, women who have had hypertensive disorders during pregnancy are at increased risk of metabolic syndrome and hypertension up to 7 years after the onset of preeclampsia. This can be explained by the fact that preeclampsia and the metabolic syndrome have common features: hyperinsulinemia, hyperlipidemia, and impaired vascular function. Further prospective studies are required to elucidate the association between preeclampsia and metabolic syndrome. In any case, women who have had hypertensive disorders during pregnancy should be informed that they are at risk of developing cardiovascular disease and should take care to reduce risk factors related to diet and body mass index. In addition, they need long-term follow-up with these factors in mind to reduce the risk of developing cardiovascular disease in the future.

Treatment of hypertension in pregnancy - delivery

In the famous maternity hospital in Chicago, there is a place on the wall where the names of famous discoverers are engraved. The place for the name of someone who discovers the cause of preeclampsia (hypertension in pregnancy) is still empty. It's safe to bet that it won't be me, but it's equally safe to say it won't be any one particular person. This is such a complex condition that a definitive answer to this question would take a very thick book covering such disparate disciplines as immunology, biochemistry, genetics, and embryology. It will be a whole brick problem to put the names of thousands of researchers who have combined their knowledge in order to establish the cause. It will be easier to build a new wall or two.

If gestational hypertension is "pre" eclampsia, and you think that if "pre" is no good, and eclampsia, whatever it is, is definitely worse, then you are absolutely right. Before modern prenatal care protocols were adopted, women were often

This is a severe variant of preeclampsia, which occurs after the 20th week of gestational age, is characterized by multiple organ disorders with a primary lesion of the central nervous system, preceded by eclampsia. Manifested by headaches, nausea, vomiting, visual disturbances, hyperreflexia, lethargy, drowsiness or insomnia. It is diagnosed on the basis of data from daily monitoring of blood pressure, urinalysis, coagulogram, transcranial dopplerography. For treatment, infusion therapy, anticonvulsant, antihypertensive, anticoagulant, membrane stabilizing agents are used. With the ineffectiveness of appointments, an emergency caesarean section is indicated.

ICD-10

O14 Pregnancy-induced hypertension with significant proteinuria

General information

Often, preeclampsia develops after the 28th week of gestation against the background of milder forms of preeclampsia. The preeclamptic state is observed in 5% of pregnant women, women in labor and puerperas. In 38-75% of patients, it occurs in the prenatal period, in 13-36% - in childbirth, in 11-44% - after childbirth. In 62% of cases, preeclampsia precedes eclampsia, although, according to some authors, in other patients, the disorder remains unrecognized due to the rapid development of convulsive syndrome. More often, the disease occurs in predisposed women during the first teenage, late, multiple pregnancy, repeated gestation with a history of preeclampsia, the presence of obesity, extragenital pathology (chronic arterial hypertension, diseases of the liver, kidneys, collagenoses, diabetes mellitus, antiphospholipid syndrome).

Causes of preeclampsia

The etiology of the disorder, as well as other forms of gestosis, has not been finally established to date. A likely factor contributing to the development of preeclampsia is the pathological reaction of the body of a predisposed woman to physiological changes during pregnancy. More than 30 reasoned etiopathogenetic theories of the onset of the disease have been proposed by specialists in the field of obstetrics, the main of which are:

• hereditary. The role of genetic factors in the development of preeclampsia is confirmed by its more frequent diagnosis in patients whose mothers suffered from preeclampsia. Patients have defects in the genes 7q36-eNOS, 7q23-ACE, AT2P1, C677T. The mode of inheritance is presumably autosomal recessive.
• immune. Penetration into the maternal circulation of foreign antigens of the fetus is accompanied by the response production of antibodies. The deposition of the formed immune complexes in various tissues triggers complex protective mechanisms, which are manifested by the activation of endothelial cells and acute endotheliosis.
• Placental. Some authors associate preeclampsia with impaired cytotrophoblast invasion. As a result, there is no transformation of the smooth muscle layer of the uterine arteries, which subsequently leads to their spasm, deterioration of intervillous blood flow, hypoxia and, as a result, damage to the endothelium.
• Cortico-visceral. Proponents of the theory consider preeclampsia as a neurotic hemodynamic disorder caused by a violation of the relationship between the cortex and subcortical regions. This approach explains the provoking role of severe stress and is confirmed by functional changes in the EEG.

Since individual theories cannot fully explain all the clinical manifestations of the disease, it is justified to consider preeclampsia as a polyetiological condition with common mechanisms of pathogenesis. The immediate causes of the development of preeclampsia are improperly selected therapy for dropsy of pregnancy and nephropathy, non-compliance by the patient with medical recommendations, high therapeutic resistance of milder variants of gestosis.

Pathogenesis

The key link in the mechanism of development of preeclampsia is the generalization of acute endotheliosis and vasoconstriction, initially localized in the placenta, with the involvement of brain tissues in the pathological process. Vascular dysfunction leads to damage to cell membranes, impaired metabolism of neurons with the occurrence of hypersensitivity and increased excitability of nerve cells. The defeat of suprasegmental subcortical structures is accompanied by polysystemic autonomic disorders, detected in more than 90% of patients with severe forms of preeclampsia.

In parallel, pregnant women and women in labor with preeclampsia develop pyramidal insufficiency, which indicates a disorder at the level of the cortical sections and is manifested by tendon-periosteal hyperreflexia, anisoreflexia, the occurrence of pathological reflexes, and an increase in convulsive readiness. The last to be affected are the brain stem regions. Destructive processes caused by microcirculation disorders also occur in other organs - the liver, kidneys, lung tissue. The situation is aggravated by coagulopathic disorders characteristic of gestosis.

Symptoms of preeclampsia

Usually, the disorder occurs against the background of previous nephropathy. Existing edema, arterial hypertension, moderate asthenovegetative symptoms (dizziness, weakness, insufficient sleep, meteotropism, emotional lability) are accompanied by signs of CNS damage and increased intracranial pressure. The patient complains of intense headache, heaviness in the back of the head, fatigue, looks lethargic, lethargic, indifferent, sometimes responds inappropriately. There is increased drowsiness or insomnia, trembling of outstretched fingers, sweating of the palms and feet.

In 25% of women with a clinic of preeclampsia, visual disorders are detected - a feeling of blurred vision, flickering of sparks or flies, fear of light, double vision, loss of individual fields of vision. Perhaps the appearance of nausea, vomiting, pain in the epigastrium and the right hypochondrium. In severe cases, there are muscle twitches, delirium, hallucinations, petechial rash, indicating a violation of blood clotting. The pre-eclamptic state is relatively short, lasting no more than 3-4 days, after which it is stopped by the correct therapy or passes into eclampsia.

Complications

The most formidable complication of preeclampsia is eclampsia, the most severe type of preeclampsia with high rates of maternal and perinatal mortality. In 1-3% of patients, there is a loss of vision (amaurosis) caused by edema, vascular changes, retinal detachment or ischemia of the occipital lobe of the cortex due to circulatory disorders in the posterior cerebral artery basin. Perhaps the development of a hypertensive crisis, cerebral edema, stroke, HELLP syndrome, detachment of a normally located placenta, the occurrence of postpartum coagulopathic bleeding and DIC. Fetoplacental insufficiency is usually aggravated, signs of intrauterine fetal hypoxia are growing.

Women who have had preeclampsia are 4 times more likely to develop cardiovascular diseases in the future (hypertension, angina pectoris, heart attacks, strokes, congestive heart failure), and the risk of developing type 2 diabetes mellitus doubles. In a third of patients, gestosis is diagnosed in subsequent pregnancies.

Diagnostics

Timely diagnosis of preeclampsia is usually not particularly difficult if the pregnant woman has been under the supervision of an obstetrician-gynecologist for a long time about previous nephropathy. At the initial visit of a patient with characteristic complaints, an examination plan is recommended with the identification of specific markers of preeclampsia:

• Blood pressure control. Daily monitoring with automatic measurement of blood pressure using a special device is shown. In patients with preeclampsia, blood pressure usually exceeds 180/110 mm Hg. Art. with a pulse amplitude of more than 40 mm Hg. Art. The arterial hypertension index is 50% or more.
• Assessment of the hemostasis system. Preeclampsia is characterized by coagulopathy of consumption and activation of the fibrinolytic system. It is recommended to study the content of fibrinogen, its degradation products (RFMK), antithrombin III, endogenous heparin, to evaluate APTT, prothrombin (MHO), thrombin time.
• General urine analysis. Proteinuria is an important symptom of preeclampsia. The protein content in the urine exceeds 5 g / l, granular casts, leukocyturia can be detected. Hourly urine output is often reduced to 40 ml or less. To assess the severity of kidney damage, the daily amount of protein in the urine is determined.
• TCDH of cerebral vessels. It is used for an objective assessment of cerebral blood flow. In the course of transcranial Doppler sonography, the presence of signs of an increase in cerebral perfusion pressure and a decrease in vascular resistance, characteristic of preeclampsia, is confirmed.

Taking into account possible obstetric complications, the patient is shown ultrasound of the uterus and placenta, dopplerography of the uteroplacental blood flow, CTG, fetometry, fetal phonocardiography. Differential diagnosis is carried out with diseases of the brain (thrombosis of the sinuses of the hard shell, meningitis, tumors, stroke), non-convulsive forms of epilepsy, retinal detachment. A pregnant woman is consulted by an anesthesiologist-resuscitator, therapist, neuropathologist, ophthalmologist, cardiologist, nephrologist.

Treatment of preeclampsia

The patient is urgently admitted to the intensive care unit of the nearest hospital with a delivery room. The main therapeutic task is to reduce reflex and central hyperreactivity, prevent convulsive syndrome, stabilize vital functions, and correct multiple organ disorders. A pregnant woman with preeclampsia is shown a strict medical and protective regimen. The treatment regimen includes the appointment of the following groups of drugs:

• Anticonvulsants. The “gold standard” is the introduction of magnesium sulfate through an infusomat. The drug has a sedative, anticonvulsant, antispasmodic, hypotensive effect, effectively reduces intracranial pressure. Simultaneously with the improvement of cerebral hemodynamics, it relaxes the myometrium and increases the intensity of blood flow in the uterus. If necessary, tranquilizers are additionally used.
• Antihypertensive drugs. Imidazoline derivatives are preferred, which have a central α2-adrenomimetic effect, stimulate I1-imadazoline receptors in the nucleus of the solitary tract and thereby enhance the parasympathetic effect on the myocardium. Perhaps parenteral administration of peripheral vasodilators, hybrid β- and α1-blockers with a rapid antihypertensive effect.
• Infusion formulations. To normalize oncotic and osmotic pressure, colloidal, protein, balanced crystalloid solutions are injected intravenously. Infusion therapy improves the rheological properties of blood, central and peripheral hemodynamics, tissue perfusion, reduces the severity of multiple organ disorders, and restores water and electrolyte balance.

According to indications, sedatives, direct-acting anticoagulants, antioxidants, membrane stabilizers, drugs to improve blood flow in tissues, and prevent fetal respiratory distress syndrome are used. With the ineffectiveness of intensive therapy within a day from the moment of hospitalization, an emergency delivery by caesarean section is recommended. Patients with rapidly increasing symptoms of preeclampsia undergo surgery within 2-4 hours. Natural childbirth with high-quality anesthesia (long-term epidural anesthesia), perineotomy or episiotomy is possible only with a significant improvement in the patient's well-being, stable stabilization of blood pressure, and laboratory parameters.

Forecast and prevention

The outcome of gestation in pregnant women with symptoms of preeclampsia depends on the availability of medical care and the correct choice of management tactics. In any case, the prognosis for the mother and fetus is considered serious. The level of maternal mortality in recent years has been reduced to 0.07 per 1000 births, perinatal mortality ranges from 21 to 146 per 1000 observations. Prevention of preeclampsia involves regular examinations at the antenatal clinic, monitoring of blood pressure and laboratory parameters in patients with dropsy of pregnancy, nephropathies, careful implementation of all medical prescriptions, normalization of sleep and rest, psycho-emotional peace, control of weight gain, protein-enriched diet with low salt content.

Preeclampsia is a condition in pregnant women characterized by high blood pressure, fluid retention (edema) and protein in the urine (proteinuria). The disease is diagnosed most often between the 20th week of pregnancy and the first after childbirth, that is, in the second and third trimesters. However, preeclampsia can develop earlier.

Eclampsia is a severe form of preeclampsia that is accompanied by convulsions or coma. The danger of the disease lies in the early detachment of the placenta from the uterine wall. In 0.5% of cases, in the absence of timely treatment, eclampsia is fatal.

Preeclampsia affects about 20% of pregnant women, and previously this figure was only 5%, which indicates the progression of the incidence. The disease occurs during the first pregnancy, as well as in women who complained of high blood pressure or blood vessel disease before pregnancy.

Causes of preeclampsia

To date, it is impossible to say exactly what leads to the development of preeclampsia, since the causes are not yet fully understood. But still, there are risk factors that can affect the incidence of women:

• First pregnancy;
• Preeclampsia in relatives;
• The age of the pregnant woman is over 40;
• Diabetes;
• Multiple pregnancy;
• Obesity;
• Arterial pressure;
• Arterial hypertension before pregnancy;
• Pathology of the kidneys;
• Systemic lupus erythematosus;
• Rheumatoid arthritis and some others.

Symptoms of preeclampsia

This disease is characterized by symptoms such as an increase in pressure over 140 to 90 mm. rt. Art., swelling of the hands and face, the presence of protein in the urine, which is confirmed only by the appropriate analysis. Sometimes a woman's pressure rises during pregnancy, but does not reach the aforementioned mark, however, if there are other signs, they talk about the diagnosis of "preeclampsia".

Children born to sick mothers are 5 times more susceptible to various disorders and diseases in the first days after birth than those born to women without preeclampsia. These newborns are often underweight or born prematurely.

In addition to the main symptoms of preeclampsia, the following changes in the condition of a woman are observed:

• Stomach ache;
• Rapid weight gain that does not correspond to the norm;
• Dizziness;
• Changing reflexes;
• Severe nausea and vomiting, atypical for the second and third trimesters;
• Decreased amount of urine;
• Severe headaches due to high blood pressure.

In severe preeclampsia, the following complications are observed:

• Destruction of red blood cells;
• A decrease in the number of platelets, which indicates a violation of blood clotting, is the greatest danger to the mother and baby;
• An increase in the content of liver enzymes, which indicates damage to this organ.

If a woman has severe preeclampsia, then delivery is performed by caesarean section, as it is the fastest and most affordable method.

Degrees of preeclampsia

In total, there are three degrees of preeclampsia:

• Mild pre-eclampsia - an increase in pressure not higher than 150/90 mm Hg. Art. and the concentration of protein in the urine up to 1 g / l. The patient has swelling of the legs. With mild preeclampsia, the platelet count does not fall below 180x109 / l, creatinine - up to 100 µmol. This stage can occur without any pronounced symptoms, so expectant mothers sometimes do not know about the disease. It is not for nothing that gynecologists recommend to undergo scheduled examinations before pregnancy in a timely manner and to be registered in gynecology as early as possible. It is the timely delivery of all the necessary tests that allows you to identify preeclampsia at an easy stage;
• The average degree of preeclampsia is characterized by an increase in pressure up to 170/110 mm Hg. Art., protein content in urine - more than 5 g / l, platelets in the blood - from 150 to 180x109 / l, creatinine - 100-300 μmol / l. At this stage, swelling of the lower extremities and the anterior abdominal wall is observed, headaches are possible;
• Severe preeclampsia - an increase in blood pressure above 170/110 mm Hg. Art., the concentration of protein in the urine - more than 5 g / l, creatinine - more than 300 μmol / l. Patients suffer from pain in the back of the head and forehead, visual impairment, which is manifested by the flashing of lights or flies. Also, for severe preeclampsia, pain in the liver area is characteristic, which indicates its edema.

A severe degree of preeclampsia often turns into eclampsia, the most dangerous form of preeclampsia, in which convulsions can occur. Advanced stages of the disease pose a threat to the health of both mother and child.

Diagnosis and treatment of preeclampsia

To determine the presence and degree of preeclampsia, it is necessary to regularly carry out the following activities as part of gynecological control:

• Regularly measure blood pressure;
• Track weight gain once a month;
• Take a blood test for hemostasis;
• Take a urine test for protein content;
• Take a blood test for uric acid, urea and creatinine;
• Monitor liver enzyme levels with a blood chemistry test.

Preeclampsia is treated with medication, diet therapy, and bed rest. After the birth of a child, the signs of the disease disappear, but a number of measures must be observed during and after pregnancy so that there are no complications for the baby and mother in the future.

Treatment of preeclampsia is beneficial when diuretics are used to remove excess fluid from the body. It is also recommended to reduce your intake of salt, which is known to retain fluid.

During pregnancy with a diagnosis of preeclampsia, bed rest must be observed. Most of all, you should lie on your left side, because in this position the pressure on the large vein in the abdominal cavity, which carries blood to the heart, is minimal. As a result, blood circulation improves and the manifestation of symptoms decreases.

To reduce blood pressure, the introduction of magnesium sulfate intravenously is indicated. Even in the presence of mild preeclampsia, treatment may be needed in case of a sharp deterioration in the condition, from which no one is immune. In this case, the patient is placed in a hospital and is constantly monitored for all indicators.

If the disease becomes severe, and treatment is ineffective, the pregnancy is terminated surgically. Delivery is carried out only when it was possible to normalize the pressure with the help of medications.

In 25% of cases, eclampsia as a type of preeclampsia manifests itself after childbirth during the first days. Then they use drugs that normalize blood pressure and sedatives. Patients stay in the hospital from several days to several weeks, depending on the indicators of their condition.

After discharge, it is necessary to take blood pressure medications for some time, as well as visit a doctor every two weeks. If the pressure remains high after 2 months after delivery, then the cause of this phenomenon is not associated with preeclampsia.

During pregnancy, in addition to the happy expectation of the baby, there are certain risks. It is important to study in advance information about possible complications and diseases during this period in order to be ready to act in an unforeseen situation. Despite the study and close attention to preeclampsia, it has not yet been possible to thoroughly study this disease.

What is preeclampsia?

During pregnancy and preeclampsia, pressure drops and swelling are characteristic. In the presence of preeclampsia, these symptoms are greatly enhanced. Often this disease develops at a later date, at the end of the second or third trimester. However, sometimes the disease occurs in the first half of pregnancy.

How much is it dangerous for a pregnant woman and fetus? An increase in blood pressure affects the flow of blood to the placenta and the beneficial substances and trace elements contained in it. Due to poor blood supply, the child receives not only less oxygen, but also less nutrition.

The worst option for the development of the fetus is an insufficient amount of oxygen and nutrients. In addition to slow development, various pathological diseases may appear. Preeclampsia also greatly affects the mother, worsens the functioning of the liver, kidneys, nervous system, but most importantly, the deterioration of the brain.

There are three stages or three varieties of the disease:

• Easy stage;
• Medium;
• Severe - can develop into eclampsia.

A severe stage is a serious reason for hospitalization, as there is a risk to the fetus. The pregnant woman may faint, with convulsions and loss of consciousness.

Classification

As described above, there are three types of preeclampsia: mild, moderate, and severe. In addition to the listed varieties, there is a classification recognized by the World Health Organization:

• Chronic hypertension that existed and bothered the woman before pregnancy;
• During pregnancy, gestational hypertension began, which arose due to the bearing of the fetus;
• Preeclampsia (dividing in turn into mild, moderate and severe);
• Eclampsia.

According to the above classification, we conclude that the symptoms of the disease in a pregnant woman are a consequence of an already existing disease. Preeclampsia and eclampsia are diseases belonging to the groups of hypertension. It is important to have time to see a doctor in time, with mild stages or even before pregnancy. Eclampsia can develop even as a result of a mild stage of preeclampsia, so you need to be careful and attentive.

Reasons for development

Unfortunately, at the moment, the causes of preeclampsia in pregnant women are not fully understood. There are more than 30 different theories about the causes of this disease in a pregnant woman.

Among the 30 theories stand out and confirmed by many doctors the following:

• The presence of genetic mutations with defects in the eNOS, C677T, 7q23-ACE, AT2P1 and HLA genes;
• The presence of infectious diseases;
• Various types of thrombophilia, and especially antiphospholipid syndrome;
• Chronic pathologies of organs (except genital).

At risk fall into the following categories:

• Young women under 22;
• Women over the age of 35;
• Pregnant women with placental diseases;
• Patients with hypertension, having problems with the kidneys;
• Pregnant for the second time, while preeclampsia was detected in the first pregnancy;
• obese women;
• Primiparous;
• Women with multiple pregnancies;
• With a history of hereditary diseases.

There is no test to determine whether a woman will get 100% preeclampsia or eclampsia during pregnancy. Many scientists believe that preeclampsia is a genetically determined insufficiency of the processes of adaptation of a woman's body to new conditions. However, it is important to ensure that the risk factors listed above do not become the trigger for the onset of the disease.

Symptoms

During the mild stage of the disease, there are often no symptoms at all. Sometimes it happens that a woman's legs or fingers swell, sometimes the pressure rises. But against the background of pregnancy, this does not seem strange, and therefore doctors do not particularly pay attention to it.

The main reasons for visiting a doctor are high blood pressure, edema and the presence of protein in the urine. In this case, for suspicion, the presence of only two symptoms is sufficient.

Edema in a pregnant woman is of varying degrees: only on the face, on the limbs or throughout the body. Edema characteristic of preeclampsia is one that does not go away with time or after a night's sleep. It is also important to correctly pass all the necessary urine tests, then the doctor will be able to detect the presence of 0.3 g / l of protein in the urine and more in time, which means that he will immediately prescribe treatment. Blood pressure above 140/90 mm Hg. Art. is also considered a reason to visit a doctor with a risk of developing eclampsia.

In addition to the above symptoms the following often occur:

• Headache;
• WZRP;
• Blurred vision, "goosebumps" before the eyes, fog, etc .;
• HELLP syndrome;
• Pain in the stomach;
• The activity of AsAt and Alat rises above 70 IU/l;
• vomiting or nausea;
• Platelets become less than 100x106 pieces / l;
• convulsions;
• Pain when probing the liver;
• Generalized edema;
• Urination decreased to 500 ml per day.

If severe signs of symptoms are detected, the pregnant woman should be urgently hospitalized. All of the above symptoms indicate that the woman has CNS disorders, brain circulatory disorders, cerebral edema, etc.

What is dangerous for pregnant women?

Moderate and severe forms of preeclampsia, as well as eclampsia itself, are very dangerous not only for a pregnant woman, but also for the fetus. Not all women pay attention to symptoms and agree to treatment. It is best to drink medicines during a moderate form of the disease, as prescribed by a doctor. Do not bring the disease to a serious condition.

The severe form is very dangerous for the body of a pregnant woman and for the body of a child. Blood pressure above 170/110 and severe edema not only make you feel worse, but greatly interfere with life. Wherein kidneys and liver can't do their job, which means that toxins are not removed from the body, it begins tissue hypoxia. This form of the disease is very difficult to treat, accompanied by severe convulsions, sometimes reaching a coma, often with a fatal outcome for the fetus.

Eclampsia, on the other hand, can lead to severe heart failure, strokes and paralysis, psychosis, coma, cerebral edema, and sudden death. That is why moderate and mild preeclampsia should not be taken lightly.

Diagnostics

To detect preeclampsia and eclampsia, it is necessary to periodically diagnose these diseases. If the doctor has prescribed certain tests or studies to the pregnant woman, it is recommended not to postpone them, since if found in time, such a disease can be 100% curable. The more time passes, the less chance of recovery.

The following analyzes and studies should be carried out:

• Regularly measure blood pressure and record any changes;
• Observation of changes in the weight of a pregnant woman, fix changes and monitor the dynamics;
• General analysis of urine and blood (for the content of protein, hemoglobin, platelets and hematocrit, for the time of blood clotting);
• Identification of the number of edema, their location and strength;
• Electrocardiogram (ECG);
• Fetal ultrasound and fetal CTG;
• Biochemistry of blood;
• Coagulogram;
• Dopplerometry of the fetus, uterus and placenta.

These studies can allow the doctor to determine the presence of diseases of the pregnant woman and the fetus and prescribe treatment in time. In addition, the gynecologist can prescribe preventive consultations with an ophthalmologist, endocrinologist, rheumatologist and cardiologist.

Modern medicine makes it possible to identify specific markers of preeclampsia. They are detected only with certain tests that are prescribed to all pregnant women who are at risk.

Treatment

If the doctor detects preeclampsia in a pregnant woman, then the patient must be transferred to a hospital in order to monitor her condition. At the hospital, the woman is placed in a special intensive care unit, with minimal noise and dim lighting. The main thing for the attending physician is to reduce and weaken the convulsions of the pregnant woman and normalize the pressure.

Pre-eclampsia and eclampsia currently cannot be completely cured. Diseases can only be controlled and their effects reduced. Treatment consists in taking medication, in the correct sleep, rest and nutrition regimen, and in the correct delivery of the woman. Medicines and the correct regimen should help reduce the amount of water in the body, normalize blood pressure, and reduce seizures.

Medical therapy

In the medical treatment of the disease, magnesium sulfate, Eufillin and Papaverine are used, which help the pregnant woman prevent convulsions and normalize blood pressure. Furosemide is used to expel excess fluid, Albumin (protein) is administered intravenously, and Nifedipine and Dopegyt are used to reduce pressure. Also, pregnant women are often prescribed sedatives.

First aid in the event of a seizure in a pregnant woman:

• The pregnant woman is laid on a soft surface on her side. The head is slightly thrown back so that the tongue does not sunk during convulsions;
• It is better to put an expander in your mouth, it can be an ordinary spoon. However, it is important to wrap it with gauze or a thin soft cloth so that the woman does not injure her jaw;
• To protect the pregnant woman from injury, it is necessary to lay her around with pillows or blankets;
• After an attack, the woman's oral cavity should be thoroughly cleaned of the mucous, vomit and blood masses that appeared there;
• If necessary, conduct a heart massage;
• Often, after an attack, a pregnant woman does not remember what happened, so you should be calm, confident, courteous and caring. It is necessary to reassure and support the expectant mother.

The main thing is to call an ambulance after first aid or during it. Ambulance doctors will administer magnesium sulfate to the pregnant woman, which stops seizures. If convulsions recur, then diazepam should be administered to the woman. Any other treatment is possible only in a hospital.

delivery

It happens that the cause of preeclampsia is the pregnancy itself, so the way out of the situation is to terminate the pregnancy or early delivery. An indication for preterm birth is fetal hypoxia and its possible death. If complications arise, then an urgent caesarean section is prescribed.

The solution to the problem depends on the gestational age. With a mild stage and the least symptoms, childbirth is prescribed for 37 weeks. If the disease proceeds with severe complications and symptoms, then the operation is prescribed within 10-12 hours. In such cases, they do not pay attention to the term, since with complications, regardless of the term, the survival and development of the fetus is impossible.

Catering

An important role in the relief of preeclampsia is played by the right diet. Many women are afraid to drink enough fluids because they are afraid of swelling. But it is not the quantity of liquid that matters, but the quality and origin. Carbonated drinks, coffee, packaged juices from stores and other sugary drinks with additives are strictly prohibited.

Drinking drinks that are healthy for the body, rich in vitamins and minerals and have a sufficient diuretic effect should be consumed. These include:

• Mineral water without gas, better containing additional minerals and vitamins;
• Freshly squeezed and natural juices, which are better to prepare yourself at home;
• Morses;
• Rosehip decoctions;
• Natural green tea.

When calculating the amount of liquid that has entered the body, one should remember about the liquid contained in food, first courses, vegetables, fruits, etc.

The second condition is the use of less salt and carbohydrates, which retain water in the body. Pickled vegetables, smoked meats, seasonings, ketchup, mayonnaise, sweets and spicy dishes are excluded from the menu.

The following products must be included in the menu:

• Dairy and sour-milk products of a low percentage of fat content;
• Lean meat and fish;
• A small amount of fruit;
• Cereals:,;
• Baked, boiled or steamed vegetables;
• Products with a diuretic effect (watermelon, melon, celery, cucumbers, etc.);
• A couple of slices of whole grain bread a day.

Possible Complications

If preeclampsia was during the first pregnancy, there is a high probability of recurrence of the disease in the second, so women are afraid to have a child again. If, nevertheless, the couple decided on a second child, the entire pregnancy should be carefully checked and registered with a doctor.

In the absence of proper treatment and urgent hospitalization, the following may occur: complications:

• Serious violations of the work of blood vessels and the heart;
• Asphyxia and fetal death;
• Pulmonary edema;
• Premature detachment of the placenta;
• Cerebral hemorrhage, stroke and paralysis;
• Anemia;
• Renal failure.

Prophylactic treatment prescribed by the attending physician should be carried out. Also, throughout the pregnancy, every week it is necessary to take a urine test, and measure the pressure every day and record the results.

Consequences and prevention

After childbirth, you should not relax, you should continue treatment, as convulsive seizures may continue. Medical assistance continues after delivery for another 2 weeks. The first week the patient should be in the intensive care unit. With positive dynamics, you can transfer her to the postpartum ward.

Unfortunately, prevention of this disease does not guarantee that it will not return. Women with hypertension, endocrine disorders, or kidney and liver failure should be treated before pregnancy.

The following tips may help during pregnancy:

• Register with the LCD as soon as possible to monitor symptoms;
• Prophylactic intake of vitamins, calcium and aspirin;
• Be sure to visit the gynecologist frequently;
• Walks in the open air;
• Careful and strict adherence to all doctor's recommendations;
• Favorable psychological and emotional atmosphere;
• Consultation visits to a general practitioner, cardiologist, endocrinologist and rheumatologist;
• Regular weighing and monitoring of nutrition.

It is strictly forbidden to take medicines on your own. Before any change in medication, you should consult your doctor.

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