Preeclampsia is pathological condition during pregnancy, which is manifested by the appearance of edema, high blood pressure and proteinuria (protein in the urine). Usually this disease develops in the second and third trimester, but sometimes it occurs earlier. According to statistics, the incidence of the disease has recently increased from 7 to 20%.

Preeclampsia is a disease that indicates serious disorders in the mother’s body, so a pregnant woman needs mandatory examination and the necessary therapy. Symptoms of the disease disrupt the normal functioning of the placenta, as a result of which the fetus does not receive sufficient nutrients and oxygen, which entails the development of hypoxia and malnutrition.

Symptoms of preeclampsia

The main symptoms include increased blood pressure, protein in the urine, swelling, weight gain due to fluid retention, headaches, abdominal pain, decreased urine output, dizziness, blurred vision, vomiting and nausea, and changes in reflexes.

The symptoms of preeclampsia depend on its severity. The most severe form of the disease, called eclampsia, in addition to the above symptoms, is characterized by the presence of seizures. Eclampsia requires immediate intervention medical workers and providing timely assistance, as it can lead to life-threatening complications.

Degrees of preeclampsia

There are three degrees of preeclampsia.

1. Mild degree (mild preeclampsia) - characterized by an increase in pressure no higher than 150/90 mm Hg. Art., proteinuria up to 1 g/l. Swelling of the lower extremities is observed. The platelet count in the blood test is not less than 180x109/l, creatinine is up to 100 µmol.

Mild preeclampsia can be asymptomatic, preventing the expectant mother from suspecting the onset of the disease. Therefore, one should not underestimate the importance of examinations and tests throughout pregnancy. This will help the doctor recognize the signs of preeclampsia at the initial stage and take the right measures to eliminate them in time.

2. Moderate degree of preeclampsia – there is an increase in blood pressure to 170/110 mm Hg. Art., protein in the urine is more than 5 g/l, the platelet count ranges from 150 to 180x109/l, creatinine from 100 to 300 µmol/l.

3. Severe preeclampsia - characterized by an increase in pressure above 170/110 mm Hg. Art., protein in urine exceeds 5 g/l, creatinine exceeds 300 µmol/l. There is a headache in the back of the head and forehead, blurred vision, which is manifested by flickering spots, pain in the right side due to swelling of the liver. Severe preeclampsia can develop into eclampsia, one of the most dangerous forms of gestosis, which is characterized by the presence of seizures. Severe preeclampsia and eclampsia are diseases that can pose a threat to the health and life of the mother and child.

Causes of preeclampsia

The exact cause of preeclampsia and eclampsia is not fully known. Some suggestions include poor maternal nutrition, high levels of body fat, and poor blood flow to the uterus. There are certain risk factors for developing this disease.

Risk factors for developing preeclampsia

Most often, this disease develops during the first pregnancy in young women, as well as in pregnant women over forty years old. A risk factor may be arterial hypertension, which was observed in a woman even before pregnancy, preeclampsia during previous pregnancies, excess weight, preeclampsia in a mother or sister. The risk group includes women who have multiple pregnancies, kidney disease, rheumatoid arthritis, diabetes.

Treatment of preeclampsia

Treatment tactics for preeclampsia depend on the severity of the disease and the maturity of the fetus.

Mild preeclampsia requires bed rest at home or in the hospital. In particular, doctors recommend spending time lying on your back. This helps to reduce blood pressure to some extent. Constant monitoring of the condition of the mother and child is carried out with mandatory measurement of blood pressure, weighing, ultrasound and cardiotocography of the fetus, and counting of movements. When the dynamics of the disease increases, drug treatment is used.

To treat preeclampsia, magnesium sulfate is used, which prevents the development of eclampsia, as well as antihypertensive therapy, which is aimed at lowering blood pressure. In the absence of positive dynamics from the applied treatment and an increase in symptoms, artificial stimulation of labor or a cesarean section is performed.

Video from YouTube on the topic of the article:

Preeclampsia (preeclampsia) is a complication that occurs during pregnancy or the postpartum period and affects both mother and child. Preeclampsia is characterized by high blood pressure (hypertension) as well as abnormally high levels of protein in the urine (proteinuria).

What is preeclampsia (preeclampsia)?

Preeclampsia (preeclampsia) is a condition during pregnancy characterized by high blood pressure and availability. Preeclampsia can develop in the second half of pregnancy (after 20 weeks), including during labor or even after childbirth.

There are mild preeclampsia (possible outpatient management), severe preeclampsia and eclampsia. The more severe the preeclampsia, the higher the risk of developing serious complications.

Preeclampsia can pose a serious risk to mother and baby. Therefore, at the slightest suspicion of preeclampsia (preeclampsia), it is recommended to immediately consult a doctor.

Why is preeclampsia (preeclampsia) dangerous?

Most women with preeclampsia do not develop serious complications. But as preeclampsia becomes more severe, many of the pregnant woman's organs can be affected, which can lead to serious and even life-threatening consequences. This is why it is necessary to decide on an emergency delivery if the condition is severe or worsening.

Preeclampsia (preeclampsia) causes blood vessels to narrow, leading to high blood pressure and reduced blood flow. In this case, the liver, kidneys and brain are most affected. Additionally, if less blood flows into the uterus, the baby may experience problems such as slower growth, oligohydramnios, and placental abruption.

Changes in the blood vessels caused by preeclampsia can cause fluid to "leak" from the capillaries into the tissue, causing. And when the tiny blood vessels in the kidneys leak, protein from the blood leaks into the urine. (A small amount is normal, but if there is a lot, it signals problems.)

What are the signs and symptoms of preeclampsia?

Because the clinical manifestations of preeclampsia (gestosis) are not always obvious, diagnosing preeclampsia is not so easy. Mild preeclampsia may be asymptomatic.

The main features include:

1. High blood pressure. High blood pressure Traditionally, blood pressure (BP) is 140/90 or more measured twice with at least 6 hours between measurements. This is one of the most important indicators that preeclampsia may develop. However, an increase in diastolic (lower) pressure by 15 mm Hg. Art. or more, and/or an increase in systolic (upper) pressure by 30 mm Hg. Art. or more from the initial blood pressure value (measured before 20 weeks of pregnancy), may be a cause for concern and requires a more detailed examination, even if the pressure does not exceed 140/90, that is, it is not a criterion for preeclampsia. This relative increase in blood pressure is of great importance in the presence of other signs of preeclampsia.

   If blood pressure is elevated and there is no protein in the urine, then they speak of arterial hypertension. Arterial hypertension can be caused by pregnancy (high blood pressure diagnosed only after the 20th week of pregnancy) and hypertension not associated with pregnancy (high blood pressure diagnosed before the 20th week of pregnancy).



2. Increased content. The amount of protein in the urine can fluctuate throughout the day, so a 24-hour urine protein test is considered the most accurate.

In most cases future mom does not suspect these signs until the next visit to the doctor. Despite the fact that 10-15% of all pregnant women have high blood pressure, this does not necessarily mean the presence of preeclampsia. To make a diagnosis of preeclampsia, in addition to high blood pressure, the presence of protein in the urine is required.

As preeclampsia progresses, other symptoms may also occur:

• headache;
• visual impairment (increased sensitivity to light, blurred vision, spots before the eyes, etc.);
• sudden severe swelling (significant increase in existing swelling, swelling of the face);
• sharp pain under the ribs;
• nausea, vomiting;
• convulsions (a sign of eclampsia).

They are an integral part of most pregnancies, especially during the third trimester. Usually swells Bottom part body, for example, legs, ankles, swelling is not very pronounced in the morning and intensifies in the evening. With preeclampsia, swelling occurs suddenly and is usually pronounced. without the presence and increased pressure are currently considered normal and do not require special treatment (with the exception of generalized edema).

Who can get preeclampsia?

Any pregnant woman can develop preeclampsia. However, some women are more susceptible to it than others. The most significant risk factors for preeclampsia (preeclampsia) are:

• presence of preeclampsia in previous pregnancies;
• multiple pregnancy;
• chronic hypertension (high blood pressure);
• first pregnancy;
• diabetes;
• kidney diseases;
• obesity, especially with a body mass index (BMI) of 30 or more;
• age over 40 or under 18 years;
• family history of preeclampsia (presence of the disease in mother, sister, grandmother).

How is preeclampsia treated?

When monitoring a woman with preeclampsia (gestosis), the doctor is guided by many factors, including the gestational age and condition of the child, the health and age of the mother, and also carefully monitors the progression of the disease. Blood pressure is measured, the results of laboratory tests are evaluated, which show the condition of the pregnant woman’s kidneys and liver, and the blood’s ability to clot. The doctor also monitors the child’s development and makes sure that the child is not in danger.

If the baby's development does not correspond to the gestational age, or it has stopped developing altogether, then it may be dangerous for it to remain in the uterus, even if the baby is still too small. If the mother develops severe preeclampsia/eclampsia, which may lead to severe consequences, childbirth may be the only solution to save the mother and ensure the survival of the child.

Unfortunately, there are no effective measures to prevent and treat preeclampsia (preeclampsia). Treatment of severe preeclampsia is based on careful assessment, stabilization, continuous monitoring, and delivery at the optimal time for the mother and her baby.

Is it possible to somehow prevent the development of preeclampsia?

On this moment There is no reliable way to prevent the development of preeclampsia. Regular use of low-dose aspirin and calcium supplements may help prevent preeclampsia, according to some studies. Never take aspirin during pregnancy unless prescribed by your doctor.

Today, the best thing you can do to protect yourself and your baby as much as possible is to visit your doctor regularly during pregnancy. At each visit, your doctor should measure your blood pressure and check your urine for protein. It is also important to know the warning signs of preeclampsia (preeclampsia) so that you can inform your doctor about them in time and begin treatment as quickly as possible.

Every woman who is expecting a child would like to have fewer problems with her health during this wonderful period. But a normal (physiological) pregnancy, in which a woman has no difficulties in carrying a baby, accounts for only about 35%. And in other cases, pregnant women experience certain complications during this period. And one such condition that is dangerous to the health and even the life of a pregnant woman and her fetus is preeclampsia (preeclampsia).

Why not gestosis

Nowadays, modern doctors in their work make maximum use of the principles of evidence and reliability in examination methods, treatment and their formulations. In 2013 in the USA, after a large scientific work on the study of preeclampsia and its complications, it was recommended to apply new methods and criteria for diagnosis, treatment and prevention of this condition in practice. The obstetrics and gynecology community around the world supported these changes. Therefore, in 2016, clinical recommendations (treatment protocols) “Hypertensive disorders during pregnancy, childbirth and the postpartum period” were proposed for Russian obstetricians-gynecologists, anesthesiologists and therapists. Preeclampsia. Eclampsia". And all the terminology, methods and approaches to diagnosis, treatment, and prevention of complications of gestosis that were previously used were replaced with new ones. Therefore, from now on, according to the latest classification, the term gestosis is not used in medical documentation and literature, but is replaced by the concept of preeclampsia.

What is preeclampsia

To begin with, let’s determine that preeclampsia, as gestosis was previously called, is not an independent disease, but a pathological condition that is classified as a hypertensive disorder, that is, disturbances in a woman’s well-being against the background of high blood pressure. Preeclampsia develops in pregnant women after the 20th week and is always accompanied by an increase in blood pressure, which is combined with a high protein content in urine analysis (0.3 g/l in daily urine), often, swelling and disturbances in the functioning of organs and systems in the woman’s body (multiple organ failure).

Some statistics indicate the seriousness of the problem:

Classification of preeclampsia and evaluation criteria

According to the international classification of diseases (ICD-10) there are:

• moderately severe preeclampsia;
• severe preeclampsia.

To determine the degree of development of pathological symptoms, severity assessment criteria are used.

Criteria for assessing preeclampsia:

Causes and mechanisms of its occurrence

Preeclampsia is caused by:

• initial disturbances of hemostasis, i.e. disturbances of processes in the pregnant woman’s body that preserve blood in the bloodstream, prevent vascular bleeding, help restore blood flow when blood vessels are blocked by blood clots, against the background of:
  • genetic predisposition;
  • hormonal disorders;
  • various diseases internal organs that are not gynecological diseases and obstetric complications;
  • infections;
• at 12–16 weeks of pregnancy, the muscular layer of the spiral arteries of the uterus does not soften, the vessels of the placenta cannot be embedded in them, which causes insufficiency of its blood supply (placental ischemia), and as a result unborn child does not receive enough oxygen and nutrients (fetal hypoxia, delayed fetal development);
• in the body of a pregnant woman, processes are activated that contribute to the formation of blood clots in the vessels, and this changes the blood supply to tissues and organs (endothelial dysfunction), first locally, then systemically (the functioning of organs and systems is disrupted).

The process of embedding the surface layer of placental villi into the muscular layer of the spiral arteries of the uterus (diagram)

Mechanisms of development of preeclampsia

The formation of preeclampsia is based on vascular spasm as a result of high blood pressure.
Stages:

• the regulation of vascular tone is disrupted, which leads to spasm of blood vessels throughout the body - generalized spasm;
• the permeability of the vascular wall increases and sodium salts, proteins, and liquid come out of the blood into the tissues - edema forms;
• the volume of circulating blood inside the vessels decreases;
• this leads to changes in the properties of the blood: viscosity increases, formed elements (mainly red blood cells) stick together - the blood thickens;
• As a result, metabolic processes and oxygen saturation of cells in organs and tissues are disrupted, this entails their damage to such an extent that they are subsequently unable to maintain the vital functions of the body, and multiple organ failure develops.

Blood thickening disrupts the normal functioning of organs and systems in the body of a pregnant woman

What happens to a woman’s body and the unborn child with preeclampsia

In a pregnant woman, the functioning of all vital organs and systems is disrupted.

Symptoms of multiple organ failure

System/organ	Manifestations of disorders (dysfunctions)
central nervous system	Headache, flickering of “floaters” before the eyes (photopsia), feeling of “pins and needles” (paresthesia), muscle twitching and convulsions.
The cardiovascular system	Arterial hypertension, decrease in the volume of circulating blood in the bloodstream (hypovolemia), heart failure.
Kidneys	Protein in the urine (proteinuria), decreased amount of urine output (oliguria), acute renal failure(OPN).
Liver	Low protein content in the blood plasma (hypoproteinemia), metabolic disorders in liver cells and their damage (hepatosis), HELLP syndrome, necrosis and rupture of the liver.
Digestive system	Pain in the epigastric region, heartburn, nausea, vomiting.
Lungs	acute damage to lung tissue (acute respiratory distress syndrome), pulmonary edema.
Blood system, hemostasis	Low platelet count, increased bleeding (thrombocytopenia), blood clotting disorder, risk of developing blockage of large and small vessels with blood clots (thrombophilia, disseminated intravascular coagulation), pathological destruction of red blood cells (hemolytic anemia).
Mother-placenta-fetus (fetoplacental complex)	Intrauterine growth restriction, oligohydramnios, premature separation of the normally located placenta from the uterus (normally occurs after childbirth).

Dangerous consequences of preeclampsia

Severe complications of preeclampsia in pregnant women

• HELLP syndrome, hematoma or liver rupture.
• Acute renal failure.
• Pulmonary edema.
• Stroke.
• Myocardial infarction.
• Hemorrhage and retinal detachment.
• Placental abruption.
• Antenatal fetal death.

Danger of eclampsia

Eclampsia is attacks of individual seizures or a series of seizures. A convulsive state develops against the background of preeclampsia in the absence of other causes. This threatens the life of not only the expectant mother, but also her fetus. Eclampsia occurs at any degree of preeclampsia, and not just at its critical form. It can develop during pregnancy, during childbirth, and after childbirth for 4 weeks.

Precursor symptoms that precede the development of eclampsia:

• headache intensifies, dizziness and general weakness appear;
• vision is impaired - “flickering of flies”, “scorching and fog” before the eyes, loss of vision is even possible;
• severe pain in the stomach and right hypochondrium;
• girdle pain (due to hemorrhage in the roots of the spinal cord);
• twitching of muscles throughout the body (clonic contractions);
• pupil dilation.

If help is not provided, convulsions appear, the pregnant woman loses consciousness, and falls into a coma.

Typical clinical picture of a convulsive state:

• Preconvulsive period (20–30 sec) - facial muscles twitch, consciousness switches off, and a frozen gaze appears.
• Tonic convulsions (10–20 sec) – they begin from the muscles of the head, neck, arms, and spread to the muscles of the torso and legs. Breathing stops. The head is thrown back, the spine is arched. Pulse is difficult to determine. The skin appears blue (cyanosis). Possible cerebral hemorrhage and death.
• Clonic convulsions (0.5–2 min) - spastic contractions and relaxations of all muscle groups occur (twitching).
• Result: resolution of the seizure or coma.

Clinical forms of eclampsia:

• isolated attacks;
• a series of convulsive seizures (eclamptic status);
• coma.

There is “eclampsia without eclampsia,” that is, a pregnant woman suddenly loses consciousness without an attack of convulsions and falls into a coma.
The extreme manifestation of eclampsia is coma

What is HELLP syndrome

HELLP syndrome is a deadly complication that develops in 4–12% of pregnant women with severe preeclampsia. With this syndrome, serious blood clotting disorders, necrosis and rupture of the liver, and intracerebral hemorrhage occur.

The diagnosis is made based on the following criteria:

• H (hemolisis) – hemolysis - pathological destruction of red blood cells and the release of free hemoglobin into the blood serum and urine (increase in LDH, bilirubin).
• EL (elevated liver enzymes) - increased levels of liver enzymes (ALAT, AST).
• LP (low platelet count) - low platelet count.

HELLP syndrome manifests itself:

• pain in the stomach on the right, nausea, vomiting with blood;
• headache;
• jaundice;
• hemorrhages in the skin;
• an increase in diastolic (lower) blood pressure above 110 mm Hg. Art.;
• arterial hypertension;
• swelling;
• high protein content in urine.

HELLP syndrome is complicated by:

• liver failure;
• eclampsia (convulsions);
• coma;
• liver rupture;
• massive swelling;
• edema of the brain, lungs;
• intracerebral hemorrhage;
• ischemic stroke;
• premature detachment of a normally located placenta.

As soon as minimal signs of this syndrome are identified, the pregnant woman is urgently given delivery and intensive care.
Pregnant women with HELLP syndrome are observed only in intensive care and intensive care units

How to suspect preeclampsia

The diagnosis of preeclampsia is made by an obstetrician-gynecologist.

Risk factors for preeclampsia

Tests have not yet been created that detect pre-elampsia in early stages pregnancy and make it possible to minimize the development of its complications. Therefore, all women, already at the stage of planning to conceive a child, should undergo an assessment of risk factors.

Women are at high risk of developing preeclampsia if:

• preeclampsia was present in at least one of the previous pregnancies;
• have chronic kidney disease;
• autoimmune diseases: systemic lupus erythematosus, antiphospholipid syndrome;
• hereditary thrombophilia;
• diabetes mellitus type 1 or 2;
• chronic hypertension.

You are less likely to develop preeclampsia if:

• first pregnancy;
• the interval between pregnancies is more than 10 years;
• assisted reproductive technologies (IVF) are used;
• family history of cardiovascular disease and preeclampsia (grandmother, mother or sister);
• excessive weight gain during pregnancy;
• body mass index 35 or more at the first visit (obesity 1 or 2 degrees);
• infections during pregnancy;
• multiple pregnancies;
• age 40 years or more;
• Ethnicity: Scandinavian, African, South Asian or Pacific Islander;
• systolic blood pressure more than 130 mm Hg. Art. or diastolic blood pressure more than 80 mm Hg. Art.;
• increased levels of triglycerides (fats) before pregnancy;
• low socioeconomic status;
• drug use: cocaine, methamphetamine.

Examination of pregnant women for the diagnosis of preeclampsia

To identify the possible development of preeclampsia, all women must have their blood pressure measured from the first visit to the doctor and then at each visit.

If the numbers of these measurements exceed normal values, and there were no problems with hypertension before, the pregnant woman is at risk and under the close supervision of an obstetrician-gynecologist. Women who already had arterial hypertension fall into this group from the first visit to the doctor. Increases in blood pressure are monitored especially closely after the 20th week of pregnancy.

The following are taken as normal blood pressure:

• systolic blood pressure - less than 140 mm Hg. Art.;
• diastolic blood pressure - less than 90 mm Hg. Art.

The control process occurs according to certain rules:

• Blood pressure is measured while sitting, in a comfortable, relaxed position, with the hand at heart level. Pregnant women with diabetes must have their blood pressure measured both while sitting and lying down.
• The pregnant woman should be at rest, after at least a 5-minute rest.
• The study is carried out 2 times with an interval of at least a minute. If the result differs by more than 5 mm Hg. Art., then an additional third measurement is carried out, and the figures of the last two measurements are averaged.
• Be sure to measure blood pressure in both arms and, at different pressures, take higher readings as a basis.
• The results are recorded with an accuracy of 2 mmHg. Art.

When measuring blood pressure, you need to be as relaxed as possible.

To detect arterial hypertension in a pregnant woman, at least two measurements are taken on one arm with an interval of 15 minutes, and the results are averaged. It is important to exclude hypertension " white coat"when, when measuring blood pressure in a doctor's office, the pressure numbers are higher normal indicators, and in a home environment - within normal limits. And to identify hidden hypertension, when normal pressure is recorded in the doctor’s office, and high pressure when measured at home.

If blood pressure results are questionable, the pregnant woman undergoes 24-hour blood pressure monitoring. The readings are recorded on a special device throughout the day. At the same time, a pregnant woman’s daily routine does not change. Next, the results obtained are analyzed, the average blood pressure value per day is calculated, and the issue of the possibility of developing arterial hypertension and preeclampsia in the future is decided.
When recording diastolic pressure values ​​greater than 110 mm. rt. Art., measurements are carried out once

In the doctor’s office, not only blood pressure numbers are assessed, but also obvious and hidden edema is identified. And although edema in pregnant women does not in all cases reflect the severity of preeclampsia, when they suddenly appear and sharply increase, they become a prognostic sign of a severe form of preeclampsia.

To do this, monitor body weight gain, measure the circumference of the ankle joint, evaluate the ring symptom, and measure the daily or hourly volume of urine (diuresis).
Obvious swelling of the ankle joints does not always indicate the presence of preeclampsia

Laboratory and instrumental examination and consultation with medical specialists

Studies of blood and urine readings of a pregnant woman help in making a diagnosis of preeclampsia.

When studying a general urine test in pregnant women, the presence of protein and casts is assessed, which normally, except for hyaline ones, are not detected. Protein in the urine (proteinuria) of 0.3 g/L or more in combination with high blood pressure confirms the diagnosis of preeclampsia until proven otherwise. The presence of casts, protein formations that have formed in the renal tubules, indicates kidney damage.

The amount of lost protein is confirmed and specified in the daily urine sample. And if its value is 0.3 g/l or more, and there are other signs of preeclampsia, then the diagnosis of moderate preeclampsia is clarified based on the presence of other criteria. If the level of protein in the urine per day is greater than or equal to 5 g/l, or in two portions of urine, which is collected at intervals of 6 hours, is equal to or greater than 3 g/l, or a test strip value of 3+ is determined, then we speak of severe preeclampsia.

But if there are symptoms of a critical condition in a pregnant woman (severe hypertension, extremely low platelet count, liver and kidney failure, pulmonary edema, etc.), detecting protein in the urine is not necessary to determine severe preeclampsia.

If preeclampsia is suspected in pregnant women, kidney function is studied in laboratory tests using additional urine tests. In the Zimnitsky analysis, the ability of the kidneys to concentrate and excrete urine is assessed, and with the help of the Roberg test they are assessed excretory function kidney
An important test to determine the amount of protein in your daily serving

A general blood test looks at the number of red blood cells, hemoglobin, and hematocrit. Their sharp increase reflects signs of blood thickening. And platelet numbers, especially their low content (below 100*10/l), indicate increased bleeding and severe preeclampsia.

In a biochemical blood test, total protein and its fractions are important, low levels of which indicate the permeability of the vascular wall, a sign of preeclampsia. Severe preeclampsia is also indicated by an increase in creatinine, especially in combination with oliguria, a symptom in which a pregnant woman produces a small amount of urine (less than 500 ml/day). Increased bilirubin and uric acid indicate liver damage. High values ​​of liver tests (ALT, AST, LDH) also indicate severe preeclampsia.

In the coagulogram, a decrease in indicators (APTT, fibrinogen and PDF, PTI, TV, antithrombin III) is also an assessment of the severity of preeclampsia.
Blood counts indicate changes in a pregnant woman's body

Pregnant women undergo an ECG (electrocardiography) and monitor the condition of the heart.

An ultrasound of the vital organs of the mother and fetus, Doppler ultrasound of the umbilical cord arteries are performed and the utero-fetal blood flow is assessed.

An ophthalmologist examines the condition of the fundus of a pregnant woman. Papilledema is a result of arterial hypertension.

Pregnant women undergo CT and MRI of the brain to clarify the diagnosis of eclampsia.
Using ultrasound examination, the condition of the internal organs of the mother and fetus is assessed

Help with preeclampsia

Care for pregnant women with preeclampsia and eclampsia is provided only in a specialized obstetric hospital (maternity hospital) of at least regional or republican significance, where there is a department of obstetrics and gynecology, or in perinatal centers.

Treatment depends on:

• from the duration of pregnancy;
• severity of preeclampsia;
• condition of the pregnant woman and the fetus.

With moderate preeclampsia, the woman must be hospitalized. In the hospital, her diagnosis is clarified, treatment is prescribed and the fetal activity is assessed. They are trying to prolong her pregnancy, with constant monitoring of her well-being and the development of the unborn baby. Delivery is carried out if the condition of the mother and fetus worsens or when the period reaches 34–36 weeks.

With severe preeclampsia, a pregnant woman is admitted to the intensive care unit. After normalization of the mother's condition, delivery is performed. At a period of less than 34 weeks, if the well-being of the pregnant woman and the fetus allows, then prevention of possible severe breathing disorders (respiratory distress syndrome) of the unborn child is carried out (with glucocorticoids). And the woman herself is transferred to a specialized maternity ward for observation and further highly qualified care.

Basic treatment for preeclampsia includes:

• anticonvulsant therapy;
• hypertensive therapy;
• delivery.

Moreover, delivery is the main and only method of treating preeclampsia and eclampsia.

Hypertensive and anticonvulsant therapy reduces the risk of developing the consequences of these conditions.

Anticonvulsant therapy

To relieve seizures in preeelampsia and eclampsia, use magnesium sulfate 25%; tranquilizers (diazepam, seduxen).

The use of these drugs is carried out according to strict indications.

Antihypertensive therapy

To reduce blood pressure during arterial hypertension in a pregnant woman, use:

• central adrenoreceptor stimulants (methyldopa, dopegit) - 1st line;
• cardioselective β-blockers (metoprolol, labetolol);
• calcium channel blockers (nifedipine, verapamil);
• antispasmodics (dibazole, papaverine);
• peripheral vasodilators (nitroglycerin, sodium nitroprusside).

Combinations of drugs are not used to correct blood pressure. Since it is dangerous to quickly reduce blood pressure - this leads to a lack of oxygen supply (hypoxia) to the fetus.

The following is not used for the treatment of hypertension in preeclampsia:

• ACE inhibitors;
• angiotensin II receptor antagonists;
• spironolactone.

Diuretics are used only for swelling of the lungs and brain.

The only timely and adequate way to eliminate preeclampsia and eclampsia is delivery.

Indications for emergency delivery (counting by minutes):

• bleeding from the birth canal;
• suspicion of placental abruption;
• acute hypoxia (distress syndrome) of the fetus.

For urgent delivery (counting the clock):

• constant headache and visual manifestations - “flickering spots” before the eyes, “fog in the eyes”;
• persistent abdominal pain, nausea or vomiting;
• high blood pressure that cannot be treated with medication;
• progressive deterioration of liver and/or kidney function;
• eclampsia - convulsions or a series of convulsive attacks;
• platelets less than 100 x 10⁹/l and their progressive decrease;
• abnormal condition of the fetus (CTG, ultrasound, severe oligohydramnios).

Indications for caesarean section:

• all severe complications of preeclampsia, except fetal death;
• deterioration of the condition of the mother (BP more than 160/110 mm Hg) or fetus (acute hypoxia) during childbirth.

Childbirth is the only way to cure preeclampsia and eclampsia

Infusion therapy

Infusion therapy is not included in the basic treatment of preeclampsia and eclampsia. Because to prevent pulmonary edema, the flow of fluid into the pregnant woman’s body must be limited. It is carried out only if there are physiological and pathological losses of fluid due to blood loss, vomiting, diarrhea, and as a slow and constant delivery to the vascular bed medicines. More often they prefer to use polyelectrolyte balanced crystalloids (Ringer-Lock solution). Synthetic solutions (plasma substitutes and gelatin solutions), natural colloids (albumin), blood products are used only for absolute indications: with a sharp decrease in circulating blood volume, shock, blood loss.

Prevention and prediction of preeclampsia

Prediction factors for preeclampsia in the first trimester of pregnancy:

• Carrying out, if possible, 3D echography and Doppler ultrasound of the uterine arteries.
• blood pressure control (average value);
• control of the level of placental growth factor (PIGF), protein that is associated with pregnancy (PAPP-A), a decrease in the concentration of which indicates the early onset of preeclampsia.

To prevent preeclampsia and if risk factors are present, according to the recommendations of the World Health Organization (WHO), acetylsalicylic acid is used from the 12th to the 36th week of pregnancy.

If there is a deficiency of calcium intake from food and the risk of developing preeclampsia, calcium supplements are used (Kalcemin, Calcium D3-nycomed, etc.).

The sooner the doctor suspects the symptoms of preeclampsia and begins treatment, the higher the chance of avoiding serious complications. And there is less likelihood of disability for the mother and her baby, as well as their death.

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Preeclampsia in pregnant women is not only one of the most formidable, but also one of the most confusing complications of pregnancy. When doctors diagnose preeclampsia, what does it mean, what are the dangers of this condition and what can be done? Our expert Marina Mikhailovna CHERNIKOVA, leading obstetrician-gynecologist at the ERA Medical Center, tells the story.

What is preeclampsia in pregnancy?

There is confusion regarding the definition of the term “preeclampsia” in our country. For a long time in Russia there was a diagnosis “ ", including a wide range of pregnancy complications: edema, nephropathy (kidney damage), increased blood pressure (hypertension). Preeclampsia, according to this classification, is a short-term intermediate state that precedes a severe convulsive attack that threatens the life of the mother and fetus - eclampsia. Some obstetricians and gynecologists still use the term “preeclampsia” in this meaning.

However, today a different classification has been adopted, which is valid throughout the world. In accordance with it, preeclampsia is divided into 3 degrees of severity - according to the severity of symptoms, and includes, among other things, nephropathy and hypertension. Mild forms of preeclampsia are treated at home; moderate and severe forms require urgent treatment in a hospital, as this condition poses a threat to the life of the woman and child. Today, preeclampsia and eclampsia in pregnant women are serious problems in obstetrics. The incidence of preeclampsia is 5-10%, and eclampsia - 0.05% in world statistics. In Russia, these diagnoses rank third among the causes of maternal mortality and range from 11.8% to 14.8%.

Signs of preeclampsia are:

• Protein in urine.

Edema is an indirect indicator of preeclampsia. However, extensive, rapidly growing swelling (especially in the lumbar region) may indicate an increased risk of developing a severe form of this complication.

Expert commentary

Preeclampsia is a syndrome of multiple organ failure (multiple body systems are involved) that occurs only during pregnancy. It develops after the 20th week of pregnancy and is characterized by the following symptoms: increased blood pressure, edema, and the presence of protein in the urine (proteinuria).

Causes of preeclampsia

As with preeclampsia, the causes of preeclampsia are unknown. With this complication, the pregnant woman’s body finds it difficult to adapt to the developing pregnancy, as a result of which various systems and organs begin to suffer.

Expert commentary

Unfortunately, today the exact causes of preeclampsia and eclampsia are not fully known. Only one thing is known for certain - this condition develops exclusively during pregnancy and is inextricably linked with a disruption of normal relationships in the system: mother-placenta-fetus.
Many scientists believe that preeclampsia is a genetically determined disorder of a woman’s body’s adaptation to pregnancy. The trigger for the development of preeclampsia is the risk factors a woman has. This:

• the age of the pregnant woman is under 18 years and over 30;
• preeclampsia during previous pregnancies;
• fetal loss syndrome (recurrent miscarriage);
• multiple births;
• anemia of pregnant women;
• sexual infantilism.

The presence of extragenital pathology, such as kidney disease, cardiovascular disease, diabetes mellitus, thyroid disease, obesity, arterial hypertension, chronic diseases lungs can also lead to the development of this dangerous complication of pregnancy. Such women are taken into groups high risk on the development of preeclampsia, more frequent examinations of the pregnant woman are carried out, observation is carried out jointly with doctors of related specialties: therapist, endocrinologist, nephrologist.

Time frame for the development of preeclampsia

Preeclampsia is a complication of the second half of pregnancy. If a woman is at risk, then monitoring blood pressure and monitoring urine tests is especially important starting from 26-28 weeks. If the expectant mother has extragenital pathology (diseases of the cardiovascular system, kidneys, endocrine pathology), preeclampsia may develop at an earlier date (20 weeks). This form of preeclampsia is called combined and is more severe than usual.

Symptoms of preeclampsia

• Increased blood pressure;
• the presence of protein in the urine;
• headaches, dizziness;
• abdominal pain, nausea and vomiting;
• swelling and weight gain;
• decrease in the required amount of urine;
• changes in reflexes and visual impairment.

The severity of the symptoms of the disease depends on its severity.

Severity of preeclampsia

Preeclampsia has 3 degrees of severity: mild, moderate, severe. The severity is determined by the severity of clinical manifestations.

Expert commentary

In mild cases, the following signs are noted: weakness, poor sleep, swelling of the legs, the appearance of protein in the urine in small quantities (up to 0.3 g), increased pressure to 130-140 mm Hg, increased diastolic pressure to 90-99 mm Hg. .

Moderate preeclampsia is characterized by edema of the lower extremities, anterior abdominal wall, and face. The pressure rises to 140-160 mm Hg (diastolic up to 100-109 mm Hg), severe headaches and nausea appear. Protein in the urine increases to 5 g per day. The platelet count decreases to 140-150 x10v9/l.

Severe preeclampsia is manifested by generalized edema, severe headache, blurred vision, flickering spots in the eyes, pain in the epigastric region, nausea, and vomiting. The pressure rises above 160 mmHg, diastolic pressure exceeds 110 mmHg. Protein in the urine is more than 5 g, a sharp decrease in platelets to 90. This degree of severity of preeclampsia has the most unfavorable prognosis.

Risks of Preeclampsia

According to statistics, the national average incidence of preeclampsia in pregnant women has increased in recent years and ranges from 7% to 20%; unfortunately, this is one of the most common causes of severe complications of pregnancy and childbirth. According to some reports, women who have had preeclampsia during pregnancy may develop kidney pathologies and hypertension. But one of the main risks of preeclampsia is the development of a serious condition - eclampsia in pregnant women.

” Eclampsia is a seizure disorder. Eclamptic seizures develop against the background of preeclampsia due to damage to the central nervous system, which is caused by cerebral edema and high intracranial pressure. Any irritant can provoke convulsions in this state: bright light, loud sounds, pain.

During an attack there may be one or more convulsive seizures in a row. After the seizures are over, consciousness is gradually restored. In some cases, eclamptic coma develops.

Harbingers of eclampsia:

• headache;
• insomnia;
• increased blood pressure;
• convulsive readiness, convulsions.

Eclampsia is not the most severe form of preeclampsia, as many people believe. Unfortunately, in some cases, this condition can develop against the background of mild preeclampsia. The appearance of symptoms of severe preeclampsia or eclampsia requires emergency measures!

One of the most common complications that occurs in later pregnancy should be called preeclampsia. It is quite dangerous for the health of the mother and the unborn child,

which makes it an important and pressing issue in obstetrics. The greatest threat is posed by severe preeclampsia (code O14.1, according to the ICD), which can provoke seizures in the mother and even coma.

What is this disease?

Preeclampsia is a pathological condition of a pregnant woman, which is accompanied by a multisystem pattern of complications. According to the ICD, these include high blood pressure, the presence of large quantities protein in the urine, which is clinically known as proteinuria. A concomitant symptom of the pathology is a high level of swelling of the body, namely the arms, legs, and face (ICD code O14.0).

Preeclampsia occurs in almost every fifth pregnant woman. However, a severe form of the disease is observed in 5% of women. Such indicators cause obstetricians to sound the alarm, since as a result of this syndrome, the supply of oxygen and nutrients to the child’s body slows down, which can provoke a slowdown in its development.

For the mother, this condition is also considered extremely dangerous, since every second pregnant woman suffering from severe preeclampsia dies as a result of suffocation. This pathology provokes dysfunction of the kidneys, brain, liver and lungs, which is observed not only in the postpartum period. Problems in the functioning of the above organs most often make themselves felt in the mother’s subsequent life.

The risk of developing the disease is especially high in women who had preeclampsia during a previous pregnancy. Patients who previously suffered from hypertension or kidney disease are also under special supervision. Heredity in some cases can also provoke the development of the syndrome in the second or third semester of pregnancy.

There are mild, moderate, and severe forms of preeclampsia. Each of them is characterized by a different complexity of symptoms and possible complications. The mild form is characterized by an inconspicuous course of the disease, which is almost impossible to detect without a special medical examination. Moderate or moderate preeclampsia most often occurs in pregnant women and requires constant medical supervision, as it can develop into a severe stage, which is the most dangerous and can provoke premature placental abruption.

Symptoms of preeclampsia

The main symptoms of preeclampsia are:

- frequent headaches;

- dizziness;

- the appearance of black dots before the eyes;

- blurred vision;

- high blood pressure;

- pain in the abdomen;

- nausea and vomiting;

- excessive swelling of the limbs;

- significant weight gain;

- lack of urge to urinate;

- a sharp decrease in the amount of urine.

In severe cases of pathology, convulsions, loss of consciousness, and suffocation may occur. Also in this condition there is a high level of protein in the urine (from 5g/l).

Causes of pathology

The proven causes of preeclampsia are:

— urolithiasis (UKD) or other disorders of the kidneys;

— mother’s age from 35 years;

- the presence of a severe stage of pathology during a previous pregnancy;

- genetic predisposition on the part of the pregnant mother;

- arterial hypertension;

— overweight;

- multiple pregnancy;

- diabetes.

Diagnostics

The best way to avoid the development of preeclampsia and its progression to a severe stage is considered to be timely diagnosis. In the early stages of pregnancy, a woman must register with an obstetrician-gynecologist, who will conduct regular examinations.

One of the mandatory research methods that a pregnant woman must undergo every time she is examined by a doctor is measuring blood pressure. As a rule, in the second trimester of pregnancy there is a slight increase. The task of specialists in this case is to timely diagnose the onset of the development of a mild degree of pathology, which, in the absence of proper treatment, can rapidly develop into a more dangerous moderate and severe form.

Another mandatory examination of a pregnant woman is a general urine test. Only it can show the presence of a protein, which signals the development of severe preeclampsia.

Systematic weight measurement is also necessary for timely diagnosis of pathology. After all, an unreasonable and sharp increase in it may indicate water retention in the tissues - one of the main symptoms of preeclampsia.

If a woman notices that in the evening the volume of her legs, arms and fingers increases sharply, and she feels unwell, dizzy and has a headache, she should immediately inform the doctor. After all, these symptoms may indicate the development of a mild degree of pathology.

Treatment of preeclampsia

Treatment of preeclampsia can be carried out in several directions. The main determining factor in this process is the degree of the disease. The duration of pregnancy also plays an important role. After all, any medical intervention implies an impact not only on the health of the woman, but also on her unborn child. And the task of doctors is to select methods and drugs that would cause as little harm as possible to the baby.

Therefore, the main thing in the treatment of preeclampsia is considered to be the prevention of a possible attack, which is accompanied by convulsions, difficulty breathing, loss of consciousness and, in some cases, death of the pregnant woman.

Treatment of severe forms

Treatment of severe preeclampsia is a rather complex and at the same time responsible task for obstetricians. Since it is considered the most dangerous to the health and life of the mother. Unlike mild and moderate, severe degree requires a complete examination of the woman’s body. Doctors often prefer hospitalization, which allows for round-the-clock supervision of the pregnant woman.

In most cases, doctors recommend bed rest for the expectant mother, which helps increase blood flow to the placenta. This allows you to avoid its premature detachment.

A prerequisite for treatment is taking medications that lower blood pressure. Naturally, doctors select the medications that are safest for the fetus. Taking diuretic medications is also necessary, especially if excess water provokes significant weight gain.

To reduce swelling in the body, it is recommended that pregnant women limit the consumption of salty, spicy and fried foods. The amount of water you drink should also be reduced, especially at night. But this does not mean that you should avoid liquids altogether. It is necessary for the pregnant woman’s body just like air, food, etc.

If a severe form of preeclampsia occurs at 37-38 weeks of pregnancy, then most likely doctors decide to induce artificial birth. This is necessary in order to avoid the occurrence of eclampsia (code O15, according to the ICD) and save the baby’s life.