Will late gestosis go away after childbirth? Preeclampsia in pregnant women: symptoms, treatment and degree of danger for the fetus and mother. Can pregnant women have tea with lemon?

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Gestosis after childbirth

Gestosis after childbirth: how to cope with it

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

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

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

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

If the pregnancy is less than 32 weeks and there is severe preeclampsia (severe gestosis), the woman has a caesarean section. After 34 weeks, natural birth is possible if the baby has no visible health problems and is in the correct position in the uterus.

During childbirth, as a preventive measure for eclampsia, a woman receives epidural anesthesia, that is, she gives birth only with pain relief, as well as drugs that lower blood pressure.

Doctors are required to prevent protracted labor and severe uterine bleeding after it. Therefore, a drug that contracts the uterus, Oxytocin, is used.

On the first day after childbirth, a woman suffering from severe gestosis is in the intensive care ward, where her condition is closely monitored by resuscitators. At this time, she receives anticonvulsant therapy in the form of “magnesia,” familiar to many women. This drug not only relieves uterine tone, but is also a good preventative against eclampsia. The woman's condition is closely monitored. They take urine and blood tests from her, and often measure her blood pressure.

In the first days after childbirth, women physiologically increase the volume of circulating blood, and for those who suffer from gestosis, this is an additional risk factor for arterial hypertension. Depending on the level of blood pressure and the severity of gestosis, the postpartum woman is prescribed blood pressure medications. If possible, compatible with lactation. For example, “Dopegit”, “Nifedipine”. Treatment of postpartum gestosis continues after discharge from the hospital. Increased blood pressure may persist for up to two months, but normally the condition should gradually return to normal. Discontinuation of the drug occurs by slowly reducing the frequency of administration and dosage.

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

What to do if gestosis does not go away after childbirth

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

headache;
blurred vision, flickering spots in the eyes;
pain between the ribs or in the right hypochondrium (liver);
rare urination;
increase in pressure.

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

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

At a minimum, supervision by a gynecologist and a therapist is required.

Consequences of gestosis for the child and mother

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

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

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

Gestosis in pregnant women also has a negative impact on the child’s body - after childbirth, gestosis in mothers goes away, but problems in the baby may remain. Most often, with the nervous system. Children whose mothers have suffered severe gestosis are almost always born low birth weight, with signs of intrauterine growth retardation and chronic hypoxia.

Toxicosis during pregnancy (gestosis)

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

Gestosis and its varieties

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

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

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

arterial hypertension in pregnant women;
preeclampsia;
eclampsia.

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

Why do pregnant women develop gestosis?

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

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

There are a number of factors whose influence is considered to predispose to the development of gestosis during pregnancy. Among them:

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

According to statistics, symptoms of gestosis more often occur in women aged after 35 years and under 18 years, in socially vulnerable women who have poor living and nutritional conditions. Preeclampsia can develop after abortions performed at short intervals or during multiple pregnancies.

Gestosis in the first half of pregnancy

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

Preeclampsia in the second half of pregnancy

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

Preeclampsia during the second pregnancy

Women who have suffered severe gestosis during pregnancy have high risk development of pathology during repeated pregnancy. If the interval between pregnancies is short, then the risk of gestosis is even higher. Typically, expectant mothers at risk are placed in a hospital in advance, or their health status is monitored on an outpatient basis from the first weeks of pregnancy.

Clinical picture of gestosis

As a rule, in late pregnancy, signs of gestosis are associated with the appearance of edema (dropsy). They can be subtle and are detected by rapid weight gain (more than 400 grams per week). As the pathology develops, swelling becomes noticeable on the legs, feet, abdomen, face, and arms. Swelling is especially visible in the afternoon.

Preeclampsia in pregnant women at the stage of dropsy is caused by a decrease in urine output and impaired fluid outflow. However, other signs of pathology are often absent, and the woman may feel well. Later, thirst, severe fatigue, and heaviness in the legs appear.

At the stage of nephropathy during pregnancy, proteinuria (the presence of protein) is detected in the urine, and blood pressure increases (from 135/85 mmHg). Uneven, spasmodic fluctuations in pressure during the day are diagnosed. The amount of urine excreted in a woman drops significantly, despite consuming a large volume of fluid. If at this stage there is no necessary treatment, the symptoms of gestosis quickly increase and can develop into pathologies such as eclampsia and preeclampsia.

Preeclampsia is a complication of nephropathy in pregnancy, accompanied by severe circulatory disorders and damage to the nervous system. In addition, the patient experiences minor hemorrhages in the retina, liver, and stomach. Preeclampsia has the following clinical signs:

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

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

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

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

Consequences and complications of gestosis

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

Gestosis after childbirth

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

Diagnosis of gestosis

If there is rapid weight gain (from 400 grams per week), a specialist should examine the pregnant woman to identify signs of gestosis. It includes:

general analysis of urine and blood;
blood biochemistry;
urine analysis according to Zimnitsky;
regular weighings and pressure measurements;
fundus examination;
Fetal ultrasound;
Ultrasound of internal organs.

A woman must consult a nephrologist, ophthalmologist, neurologist, and, if necessary, a cardiologist. When hidden edema is detected due to excessive weight gain, an MKO test is performed (subcutaneous injection of saline solution and recording the time during which it resolves).

Mild preeclampsia in pregnant women

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

blood pressure periodically rises to 150/90 mmHg;
protein concentration in urine is not higher than 1 g/l;
swelling is visualized in the legs (lower leg, foot);
platelet count reaches 180*109 l;
creatinine in the blood is no more than 100 µmol/l.

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

Moderate preeclampsia in pregnant women

Moderate preeclampsia is characterized by the following indicators:

blood pressure rises to 170/110 mmHg;
proteinuria not higher than 5 g/l;
swelling is detected in the legs, on the front of the peritoneum;
creatinine in the blood - micromol/l.

At this stage, emergency delivery by cesarean section is indicated.

Severe preeclampsia

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

blood pressure more than 170/110 mmHg;
proteinuria - from 5 g/l;
swelling is detected on the legs, the anterior part of the peritoneum, on the face, hands;
platelet count -*109 l;
creatinine - from 300 µmol/l.

Features of pregnancy with gestosis

If treatment of gestosis or observational tactics do not lead to an improvement in the woman’s condition, delivery is planned regardless of the timing of pregnancy. On the contrary, if laboratory parameters and clinical signs have improved, then the pregnant woman continues to remain in the hospital under close supervision. A special diet, bed rest, and blood pressure monitoring up to 6 times a day are required. The woman is weighed twice a week, her drinking regime and the amount of urine excreted are monitored. Urine and blood tests are also regularly performed, and examinations are carried out by specialized specialists. Thus, treatment and prevention of gestosis often helps to carry the pregnancy to one week and ensure a safe delivery. Childbirth by caesarean section is planned if there is no effect of therapy.

Nutrition of the expectant mother with gestosis

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

Treatment of gestosis

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

sedatives of plant origin (valerian, motherwort);
herbal diuretics (canephron, cystone), synthetic diuretics (Lasix);
magnesium preparations to remove excess fluid from the body (magne B6, magnesium sulfate intravenously);
vitamin and mineral complexes;
medications to improve placental blood circulation (Actovegin, Kurantil);
latest generation drugs that lower blood pressure (Valz, Physiotens, etc.);
drugs to improve liver function (chofitol, essentiale).

Outpatient treatment is carried out only for the initial degree of gestosis - dropsy. All other stages of the pathology require hospitalization of the pregnant woman. In severe cases, the woman is prescribed emergency therapy with medications that lower blood pressure and anticonvulsants, and after stabilization of the condition, immediate delivery is carried out.

The influence of gestosis on methods and timing of delivery

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

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

Childbirth in severe cases of late toxicosis is carried out within 2-12 hours, which depends on the period of normalization of the woman’s condition after the start of drug therapy. Childbirth with moderate gestosis is planned 2-5 days after the start of treatment if it is not effective.

How to prevent gestosis

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

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

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

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

The materials presented are general information and cannot replace medical advice.

GESTOSIS: correction in the postpartum period

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

In the structure of mortality among pregnant women, women in labor and postpartum, severe forms of gestosis occupy one of the first places.

Childbirth, while eliminating the cause of the disease, does not prevent the persistence and progression of changes in a woman’s organs and systems after pregnancy. At the same time, the risk of developing complications in the postpartum period, the occurrence of gestosis during repeated pregnancy, and the formation of extragenital pathology increases.

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

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

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

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

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

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

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

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

Damage to the endothelium contributes to the development of changes that underlie preeclampsia - increased vascular permeability and sensitivity to vasoactive substances, loss of their thromboresistant properties with the formation of hypercoagulation, creating conditions for generalized vasospasm. Generalized vasospasm leads to ischemic and hypoxic changes in vital organs and disruption of their function.

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

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

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

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

According to the latest data (I. S. Sidorova et al., 2005), neurospecific proteins of the fetal brain play a leading role in the development of gestosis and acute endotheliosis. This is due to the fact that the mother’s body lacks tolerance to these proteins, which have the properties of autoantigens and, when they penetrate into the mother’s bloodstream, cause the formation of antibodies. The appearance of neurospecific protein antigens in the mother's blood is caused by a violation of the permeability of the blood-brain barrier. One of the most important pathogenetic links leading to disruption of the permeability of the blood-brain barrier is autoimmune brain damage, which leads to the development of severe forms of the disease during pregnancy and childbirth, and also causes the development of complications during the three-year postpartum period.

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

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

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

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

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

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

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

Data available in the literature indicate that impairment of the functional state of the liver in severe forms of gestosis reaches a maximum and persists for 24–48 hours after birth.

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

In patients with mild forms of gestosis, examination of biopsy material does not reveal significant changes in the liver. In severe forms of gestosis, small-droplet fatty degeneration of hepatocytes develops in the absence of necrosis, swelling of the cytoplasm, and changes in the hepatic parenchyma. However, even in the mildest cases there are signs of impaired liver function. First of all, there is a natural change in the protein-forming and detoxification functions of the liver. According to a number of studies, with increasing severity of gestosis, hypoproteinemia increases, expressed in a decrease in albumin fractions and an increase in globulin fractions (IgG, IgA, IgE), and an increase in the level of circulating immune complexes.

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

Research suggests that the activity of liver indicator enzymes during gestosis can either increase or significantly decrease. At the same time, according to the author, various hepatocyte systems are damaged to varying degrees, some can continue to function even with very severe gestosis. Apparently, this depends on the initial state of the organ.

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

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

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

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

Diagnosis of liver diseases in pregnant women presents certain difficulties. This is due to the fact that the clinical picture of the disease in pregnant women with gestosis often changes, and the disease may have an atypical course. In the second half of pregnancy, determining the boundaries of the liver and palpating it is difficult due to the filling of the abdominal cavity with the growing uterus; During pregnancy, biochemical blood parameters also change, as a result of which the interpretation of liver function tests in pregnant women requires certain correction. The most modern research methods (radionuclide liver scanning, splenoportography, laparoscopy, liver puncture biopsy) are unsafe for pregnant women, and we can perform them only after delivery.

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

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

The study of morphological changes is an assessment of the results of ultrasound examination of the liver and gallbladder; in this case, the density of the wall of the gallbladder, liver, gallbladder bile is determined, measurement of the volume and thickness of the walls of the gallbladder is determined. Ultrasound diagnosis of fatty hepatosis is carried out by recording the ultrasonic density of various sections of the liver parenchyma using echodensitometry, which, based on the pathological change in a specially introduced attenuation coefficient, makes it possible to diagnose fatty hepatosis.

Hepatobiliscintigraphy is a comprehensive study of the functional and organic state of the hepatobiliary system, including assessment of bisynthetic and biliary excretory functions of the liver, concentration and motor functions of the gallbladder, and patency of the bile ducts. The study is highly informative in patients with inflammatory and metabolic diseases of the liver, gall bladder, cholelithiasis, biliary dyskinesias, diseases of the gastrointestinal tract, abdominal syndrome of unknown etiology, etc.

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

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

Based on a comprehensive analysis of those identified using modern methods studies of morphological and functional changes in qualitative and quantitative indicators can most accurately diagnose morphofunctional changes in the liver in women who have suffered nephropathy, which will resolve some controversial issues of practical obstetrics in the management of women with this pathology in the postpartum period.

From our point of view, the study of liver function indicators will make it possible to diagnose liver damage in the early stages before clinical symptoms, monitor ongoing therapy, achieve restoration of the functional state of the liver in the postpartum period, predict the course of gestosis, as well as possible complications with repeated pregnancies.

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

In order to correct the immune status of women who have suffered gestosis, they are treated with the immunomodulatory drug polyoxidonium (Immapharma), which has immunocorrective, detoxifying, membrane-stabilizing activity and promotes physiological and reparative regeneration of the liver. Used at a dose of 6 mg in saline solution, one injection per day for 8 days, then at a maintenance dose of 6 mg once a week for 1 month (depending on the severity of the pathological process).

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

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

Literature

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

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

MGMSU, RMAPO, Moscow

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There are standard lengths of stay in the maternity hospital if the postpartum period passes without complications. During vaginal delivery, it can be 4-6 days, and during surgical delivery - 7-9 days. It is at this time that the doctor monitors the mother and baby daily.

What procedures and manipulations await a young mother after childbirth?

The doctor and midwife will periodically check:

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

You will also be asked:

whether you urinate regularly and do not experience discomfort or burning;
whether you have had a bowel movement (if you stay in the maternity hospital for more than one or two days) and whether regular bowel movements have been restored.

You may be assigned:

tablets that promote uterine contraction - to prevent postpartum hemorrhage;
injections or tablets of painkillers and antispasmodics in the presence of painful postpartum contractions (such drugs are received by multiparous women and patients after cesarean section);
antibacterial drugs (they may be prescribed after surgical delivery).

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

The reasons for a woman's delay in the maternity hospital can be different. Let's tell you more about them.

Complications of pregnancy and childbirth

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

Infectious complications of the postpartum period

Endometritis - inflammation of the uterine mucosa. This disease is manifested by an increase in body temperature to 38-40°C, depending on the severity of the disease, pain in the lower abdomen (it should be noted that this is normal, especially after repeated births, during this period cramping pain may be observed - more often during feeding). This is due to contraction of the uterus. Pain due to endometritis is constant, it is nagging in nature and can spread to the lumbar region. Discharge from the genital tract with endometritis is profuse and has an unpleasant odor. If normally, 2-3 days after birth, the discharge becomes bloody in nature, then with endometritis, bloody discharge may resume. With inflammation, the uterus contracts poorly. It is necessary to say about the so-called subinvolution of the uterus. This is a borderline state between endometritis and normal: the uterus does not contract enough, which can “prepare the ground” for inflammation.
Inflammatory complications that can lead to a woman’s delay in the maternity hospital also include divergence and infection of perineal sutures and sutures after cesarean section. With these complications, redness of the skin is observed in the area of the rupture or incision, pus may be released from the wound, and the suture area is painful.

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

In case of uterine subinvolution, the patient remains in the postpartum department, where she is additionally prescribed contracting drugs. If this therapy is effective, ultrasonography uterus on the 4-5th day after birth to avoid retained placenta and blood accumulation. After this, the woman is discharged. If the treatment is ineffective or other signs of endometritis occur, as well as in case of infection and suture divergence, the woman is transferred to a special second obstetric department. Here, if necessary, antibacterial therapy, uterine lavage, uterine contractions, and dressings in the area of a purulent wound when the sutures diverge are prescribed. In doubtful cases, after the baby is discharged, the young mother can be transferred to the gynecological department of the hospital for further treatment.

During the postpartum period, complications such as thrombophlebitis - inflammatory complication of varicose veins of the lower extremities. As a result of this disease, the wall of the vein becomes inflamed in the area of the previously formed blood clot. In this case, the patient is bothered by pain in the area of the affected limb, redness of the skin over the affected vessel. In case of thrombophlebitis, after consultation with a surgeon, depending on the severity of the condition, the patient is transferred to the second obstetric department or a specialized vascular department of the hospital. The complex of therapeutic measures for this disease includes elastic bandaging of the affected limb, the use of antibacterial, anti-inflammatory, and painkillers. At a certain stage of the disease, blood thinning drugs are prescribed.

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

Chronic diseases

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

To the hospital - at your own request

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

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

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

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

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

There are now many clinics open across the country that can provide similar services.

In order for a caesarean section to be successful, it is necessary to prepare for it accordingly. In this article we will talk about preparing for a caesarean section.

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Gestosis after childbirth

Doctors are required to prevent protracted labor and severe uterine bleeding after it. Therefore, a drug that contracts the uterus, Oxytocin, is used.

headache;
rare urination;
increase in pressure.

Preeclampsia after childbirth, how to treat preeclampsia after pregnancy

Gestosis after childbirth: how to cope with it

During childbirth, as a preventive measure for eclampsia, a woman receives epidural anesthesia, that is, she gives birth only with pain relief, as well as drugs that lower blood pressure.

Doctors are required to prevent protracted labor and severe uterine bleeding after it. Therefore, a drug that contracts the uterus is used - &Oxytocin&.

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

What to do if gestosis does not go away after childbirth

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

headache;
blurred vision, flickering spots in the eyes;
pain between the ribs or in the right hypochondrium (liver);
rare urination;
increase in pressure.

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

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

At a minimum, supervision by a gynecologist and a therapist is required.

Consequences of gestosis for the child and mother

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

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Toxicosis during pregnancy (gestosis)

Gestosis and its varieties

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

arterial hypertension in pregnant women;
preeclampsia;
eclampsia.

Why do pregnant women develop gestosis?

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

There are a number of factors whose influence is considered to predispose to the development of gestosis during pregnancy. Among them:

history of diseases of pregnant women, including pathologies of the heart, liver, nervous system, metabolism, gall bladder, kidneys;
the presence of autoimmune diseases and allergic reactions during pregnancy;
bad habits;
severe stress;
excess body weight;
violations of the structure of the genital organs, their underdevelopment;
poisoning, intoxication;
polyhydramnios, hydatidiform mole.

Gestosis in the first half of pregnancy

Preeclampsia in the second half of pregnancy

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

Preeclampsia during the second pregnancy

Women who have suffered severe gestosis during pregnancy have a high risk of developing pathology during repeated pregnancy. If the interval between pregnancies is short, then the risk of gestosis is even higher. Typically, expectant mothers at risk are placed in a hospital in advance, or their health status is monitored on an outpatient basis from the first weeks of pregnancy.

Clinical picture of gestosis

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

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

Consequences and complications of gestosis

Gestosis after childbirth

Diagnosis of gestosis

If there is rapid weight gain (from 400 grams per week), a specialist should examine the pregnant woman to identify signs of gestosis. It includes:

general analysis of urine and blood;
blood biochemistry;
urine analysis according to Zimnitsky;
regular weighings and pressure measurements;
fundus examination;
Fetal ultrasound;
Ultrasound of internal organs.

Mild preeclampsia in pregnant women

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

blood pressure periodically rises to 150/90 mmHg;
protein concentration in urine is not higher than 1 g/l;
swelling is visualized in the legs (lower leg, foot);
platelet count reaches 180*109 l;
creatinine in the blood is no more than 100 µmol/l.

Moderate preeclampsia in pregnant women

Moderate preeclampsia is characterized by the following indicators:

blood pressure rises to 170/110 mmHg;
proteinuria not higher than 5 g/l;
swelling is detected in the legs, on the front of the peritoneum;
creatinine in the blood - micromol/l.

At this stage, emergency delivery by cesarean section is indicated.

Severe preeclampsia

blood pressure more than 170/110 mmHg;
proteinuria - from 5 g/l;
swelling is detected on the legs, the anterior part of the peritoneum, on the face, hands;
platelet count -*109 l;
creatinine - from 300 µmol/l.

Features of pregnancy with gestosis

Nutrition of the expectant mother with gestosis

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

Treatment of gestosis

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

sedatives of plant origin (valerian, motherwort);
herbal diuretics (canephron, cystone), synthetic diuretics (Lasix);
magnesium preparations to remove excess fluid from the body (magne B6, magnesium sulfate intravenously);
vitamin and mineral complexes;
medications to improve placental blood circulation (Actovegin, Kurantil);
latest generation drugs that lower blood pressure (Valz, Physiotens, etc.);
drugs to improve liver function (chofitol, essentiale).

The influence of gestosis on methods and timing of delivery

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

How to prevent gestosis

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

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

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

Helpful information

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

The materials presented are general information and cannot replace medical advice.

Preeclampsia is a complication that occurs in many pregnant women. It disappears after childbirth. Pathology is considered a serious disease, as it sometimes causes maternal mortality. The complication is most often detected in the third semester of pregnancy.

This is an insidious disease that may not cause concern. But at a certain point, a woman experiences an attack of convulsions (eclampsia), which threatens the health of the mother and baby.

Currently, doctors are trying to prevent such phenomena. By regularly visiting a gynecologist, you can keep your health under control. Read on to learn everything about complications during pregnancy: signs of occurrence, nuances of treatment, what prevention can be recommended and the consequences of the disease.

What are the signs and symptoms of gestosis?

Main features

swelling or dropsy (first the hands and feet swell);
the appearance of protein in the urine;
blood pressure is higher than normal.

Dangerous symptoms - harbingers of a seizure attack

nausea;
headache;
stomach ache;
lethargy and drowsiness;
flashing “flies” before the eyes.

The combination of such symptoms is characteristic of preeclampsia, which is the result of gestosis. The following conditions may occur against the background of seizures: stroke, heart attack, placental abruption, pulmonary edema, renal failure, placental abruption, retinal detachment. Such complications develop very quickly and can be present in pregnant women of any age.

Groups

Edema of pregnant women

They can be obvious or hidden. The latter appear in the early stages of the disease. They arise due to fluid retention in tissues. Self-medication is unacceptable here. Diuretic medications cannot eliminate the problem, but only worsen the condition of the pregnant woman and the fetus. Not all swelling during pregnancy is associated with illness. Only a specialist can identify complications.

Preeclampsia

This condition most often occurs after the 20th week of pregnancy. Sometimes preeclampsia occurs at the end of the first week after birth. Its signs are hypertension, edema and proteinuria. In severe cases, the blood supply to the brain is disrupted. This is manifested by severe headache, vomiting and visual impairment.

Eclampsia

This is the most severe form. It has a whole range of symptoms, the most dangerous of which are seizures.

Gestosis can manifest itself in different ways. Some women have minimal symptoms. Others suffer from fulminant attacks that have catastrophic consequences.

The cause of the disease - the opinions of doctors

Doctors cannot accurately name the causes of complications. But there is a clear opinion that such a complication rarely occurs in healthy women. Most often, gestosis develops against the background of existing diseases of the mother. Increased blood pressure, impaired renal or liver function, as well as other somatic diseases are indirect causes of toxicosis in pregnant women.

It is impossible to name the reasons more precisely. A pregnant woman experiences disruptions in her body that can lead to serious problems. In some cases, doctors resort to early delivery to save the life of the child and mother. Therefore, before conceiving, a woman needs to undergo examination.

Immunological diseases, blood clotting disorders, kidney disease, vegetative-vascular dystonia, anemia, diabetes- these and many other disorders often lead to gestosis

This will allow you to predict possible complications that may arise during pregnancy. If necessary, a woman is prescribed a course of treatment even before pregnancy. Immunological diseases, blood clotting disorders, kidney diseases, vegetative-vascular dystonia, anemia, diabetes mellitus - these and many other disorders often lead to the manifestation of the disease.

If you have problems with your kidneys, thyroid gland or blood pressure, be sure to visit your doctor.

The risk group includes

women over 30 years of age and under 18 years of age;
those who frequently had abortions;
women who have given birth many times;
those who have a short break between births.

No one is 100% immune from gestosis. Therefore, experts strongly advise you to regularly come for examination. Monitoring blood pressure and weight, blood and urine tests are measures that allow timely detection of complications.

No one is 100% immune from gestosis

The excellent health of a pregnant woman is not yet an indicator of good health. Sometimes test results show poor results in the absence of external signs diseases.

Why does gestosis appear in pregnant women?

Preeclampsia or toxicosis is a complication associated with pregnancy. It may be early or late. Early toxicosis is known to all pregnant women. It manifests itself at the earliest stages. Its main symptoms are nausea and vomiting. Early stage usually not aggressive in nature.

All its signs are noticed not only by the pregnant woman herself, but also by the people around her. Late toxicosis is more insidious. They are the ones who lead to dangerous complications. Late gestosis is the leading cause of maternal mortality. This complication is less noticeable.

It manifests itself in three main signs:

swelling;
protein in urine;
high blood pressure.

Not all women experience the full range of symptoms. Only one of them can indicate the presence of pathology. Only swelling is visible here. Pressure rises may not be very significant. In this case, the woman does not feel them. Changes in the composition of urine also do not bother the pregnant woman. Therefore, towards the end of the term, doctors measure blood pressure and weigh in weekly.

Late gestosis sometimes has an unpredictable development. Sometimes they begin to progress dramatically. In this case, the woman’s health condition rapidly deteriorates. A pregnant woman may feel worse and worse every hour. Pathology in this form is treated only in an inpatient setting.

Today, about 27% of pregnant women experience the disease. Its symptoms subside after childbirth. The complication arises due to the fact that the mother’s body cannot optimally adapt to bearing a child. As a result, various violations arise.

The disease is characterized by spasm of the smallest blood vessels. As a result, the amount of blood that carries nutrients and oxygen to the cells is sharply reduced. The functioning of organs and systems is disrupted. Spasm of small vessels leads to an increase in blood in large vessels. All this leads to increased blood pressure.

Changes occur in the kidneys, which leads to the appearance of protein in the urine. The brain also suffers. This is manifested by nausea, headaches, and flashing “sights”. If a pregnant woman experiences dry skin and itching, this is a clear sign of changes in the liver.

The woman experiences swelling and the blood becomes thicker. Such processes also affect the condition of the fetus. Its growth and development slows down. The baby experiences a lack of oxygen (hypoxia).

Diagnostic methods

If the doctor suspects gestosis, he prescribes the following procedures:

general and biochemical blood tests;
urine tests (24-hour, biochemical and clinical);
weighing;
blood pressure measurement;
fundus examination;
Ultrasound and Dopplerometry of the fetus.

The patient needs to be examined by a therapist, neurologist, ophthalmologist and nephrologist. A significant deviation of pressure from the norm is considered a serious problem.

A special group consists of hypertensive patients, whose blood pressure is initially elevated. They are under constant medical supervision. If a woman only has edema, then she is at risk for a more severe form of gestosis.

Doctors must take into account the initial blood pressure of a woman with blood pressure in the second period of pregnancy

From the moment edema appears, specialists begin to take measures to prevent complications. The success of treatment depends on the pregnant woman’s body.

When diagnosing edema, a specialist evaluates weight gain over the entire period of pregnancy, as well as over a month and a week. An increase of about 300–400 grams is considered normal. A pathological increase indicates hidden edema. In this case, measures are taken to correct nutrition and water-salt metabolism.

The gynecologist recommends sticking to a diet and fasting days. If this does not help, the doctor prescribes special medications. If a pregnant woman has a significant weight gain, but there is no edema, then she may be given an MCO test (McLure-Aldrich test).

It involves injecting a woman with a saline solution under her skin. The doctor records the time it takes for the papule to resolve. If the interval does not take 35 minutes, then there is swelling in the body.

The first sign of edema is slight numbness in the fingers. It is difficult for a woman to straighten her fingers; she can hardly put on rings. For minor swelling of the legs, the gynecologist prescribes treatment, which is carried out on an outpatient basis. If your arms, legs and face swell, your blood pressure is high, and there is protein in your urine, then you need to go to the hospital.

In this case, the woman’s condition can deteriorate sharply at any moment. Self-medication is not allowed here. Some women begin to take diuretics on their own, which further worsens the situation.

Complication of the second half of pregnancy (starting closer to the third trimester)

Late toxicosis occurs for many reasons. Disorders in the endocrine system, obesity, sexually transmitted diseases, hypertension - all these factors can contribute to the development of gestosis in the second half of pregnancy. Sometimes it is a consequence of the flu or acute respiratory viral infection.

Poor nutrition can also give impetus to the development of late toxicosis. It is impossible to cure it at home. The woman requires hospital treatment. She is put on IVs and prescribed medications that help replenish the lack of fluid in the vessels.

The cause of late toxicosis is often pathology in the placenta. In this case, childbirth is considered the most effective solution to the problem. In case of serious complications, a caesarean section is resorted to.

The initial symptoms of late toxicosis are detected during the next examination at the antenatal clinic. The doctor evaluates weight gain, measures blood pressure, examines urine samples and counts the fetal heartbeat. Based on the data obtained, he can conclude about the presence or absence of gestosis.

If the doctor insists on hospitalization, then you cannot refuse. The late stage does not go away on its own. The symptoms will only get worse. If you miss time, you may experience preeclampsia or more severe complications (seizures).

How does childbirth go?

The severity of the disease affects the choice of time and method of delivery. The doctor takes into account the condition of the mother and child.

The most favorable births are those that occur through the natural birth canal. This is a truth that has been supported by all gynecologists and obstetricians from time immemorial. But for such a birth, the following conditions are needed: a mature cervix, proportionality of the mother’s pelvis and the fetal head, cephalic presentation of the fetus, the woman’s age is not older than 30 years, the absence of illnesses in the mother and other factors.

With gestosis, childbirth may be accompanied by complications. Therefore, they are carried out very carefully, using antispasmodics and painkillers. Childbirth is considered stressful for the fetus and mother.

With gestosis, childbirth may be accompanied by complications

Research conducted by specialists has shown that with this disease, the woman and fetus have reduced anti-stress resistance. Any aggressive influence during childbirth (fatigue, hyperstimulation of the uterus, painful manipulations) can have dire consequences. A woman has every chance of suffering from fulminant and critical hypertension.

As a result, cerebral blood flow may be impaired, leading to eclampsia. Statistics show that eclampsia during childbirth occurs quite often. It can occur not only during vaginal delivery, but also during caesarean section.

Typical complications during childbirth

fetal asphyxia;
premature placental abruption;
heavy bleeding in the postpartum period.

The main way to relieve a woman of gestosis is childbirth. But for an immature and premature baby, delivery before due date- this is not a completely favorable outcome. But in some cases, the baby has a better chance of surviving outside the mother's body. Then the only strategy of doctors becomes delivery. It allows you to save the life of the child and mother.

Childbirth in the presence of the disease is carried out against the background of stabilization of laboratory and clinical parameters.

Indications for early delivery (regardless of gestational age)

nonconvulsive or convulsive eclampsia, seizures;
gestosis, which progresses even with hospital treatment;
rapid deterioration in the woman’s health;
retinal disinsertion;
placental insufficiency, which progresses;
placental abruption;
signs of hepatopathy.

Doctors perform a gentle and quick delivery. Preference is given to childbirth through the natural birth canal. This avoids the stress that surgery and anesthesia cause. The woman is given pain relief.

Caesarean section is performed if there are absolute indications: preeclampsia and eclampsia, placental abruption, oliguria, coma.

Illness after childbirth

After childbirth, some women experience symptoms of pathology. Such patients are prescribed appropriate treatment, which is continued until their condition stabilizes. The treatment regimen is determined individually.

Degrees and classifications

Experts distinguish between early and late gestosis. The first occurs at 22–24 weeks and lasts quite a long time. The second may appear when the period is 36 weeks. The late form of the disease usually does not have severe complications. During this period, the baby has already formed and delivery is not accompanied by dangerous symptoms.

Late gestosis usually does not have severe complications

Severity:

light,
average,
heavy,
eclampsia.

Doctors also distinguish pregestosis or the preclinical stage of the disease. There is also a division into combined and pure gestosis. Concomitant conditions are important here. Pregnant women with extragenital ailments that were not detected in time are classified as a group of women suffering from a pure type of disease.

If complications arise against the background of an existing disease, then we are talking about a combined form. In practice, 70% of women have the combined form. The most unfavorable symptoms are observed in pregnant women who have liver disease, kidney disease, endocrine disorders, hypertension and metabolic syndrome.

Edema plays an important role in diagnosis. They can have different degrees of severity:

grade I - swelling of the lower extremities;

degree II - swelling of the lower and upper extremities, as well as the abdominal wall;

degree III - swelling spreads to internal organs.

Edema may be hidden. They may be accompanied by proteinuria and arterial hypertension. The course of the disease is determined by conducting blood and urine tests. At the same time, the doctor monitors the condition of the fetus. The severity of the pathology can be judged by the number of baby’s heartbeats.

Early

Early gestosis or toxicosis worries many pregnant women. It occurs in the first half of the term. Doctors cannot name the reasons for it.

The main manifestations of toxicosis:

dizziness,
nausea,
salivation,
vomit.

They can be expressed with different strengths. If the disease manifests itself too clearly, doctors prescribe treatment. Toxicosis is so widespread that its symptoms are considered normal during pregnancy.

In fact, the phenomenon has a pathological basis. Normally, pregnancy in a healthy woman should not be accompanied by nausea and vomiting. Pregnancy is a physiological normal state of the body. This is not a pathology.

The mechanisms of development of the early form have not been studied. Experts believe that it is a pathological reaction of a woman to pregnancy. Immune, allergic, toxic, reflex and neurogenic mechanisms are involved in the development of toxicosis.

In some cases, the disease in early pregnancy takes the form of asthma, dermatosis, tetany or osteomalacia.

Late gestosis

This is a complication that occurs in the second half of pregnancy. It develops until childbirth. Such toxicosis leads to disruption of a woman’s systems and organs.

Many obstetricians attribute the occurrence of gestosis to the increased number of late births

The reasons for the development of late gestosis have not been studied by science. According to some versions, gestosis occurs due to immunological incompatibility of the fetus and mother. Other experts believe that hormonal processes are to blame. The late form has been detected very often in recent years.

Many obstetricians attribute this to the increased incidence of late births. Women who give birth after 35 years have chronic diseases complicating the course of pregnancy and childbirth.

A woman may notice the first signs of late disease at 28 weeks. Pregnant women usually experience swelling. This is the mildest manifestation of the disease. Edema is also called “edema of pregnancy.” In more severe cases, the complication manifests itself as nephropathy.

Easy

A mild degree of the disease is characterized by a slight increase in blood pressure. It exceeds the norm by 20%. Protein in urine is 1.0 g/l. Signs include swelling. The woman is undergoing outpatient treatment.

Heavy

Blood pressure exceeds the norm by 40% and more. Protein content - 3.0 g/l. The pregnant woman's health is deteriorating. She develops a headache, swelling increases, and protein in her urine increases.

Sleep may also be disrupted and vision may deteriorate. The patient is admitted to the hospital. If the condition is very serious, the pregnant woman is sent to intensive care. Treatment tactics depend on the condition of the woman and the fetus.

Pathogenesis of gestosis

The basis of the pathogenesis of the disease is a generalized spasm of blood vessels. This is manifested by an increase in pressure. Due to damage to the endothelium, spasm occurs. Dystrophic changes occur in the patient’s organs and tissues. The functions of the liver, kidneys and nervous system are impaired, and the fetus and placenta are also affected.

The mechanism of development of pathology is a controversial issue. Many experts adhere to the hormonal theory. The cause of complications in this case is considered to be dysfunction of the adrenal glands, changes in the production of estrogen or the hormonal status of the placenta.

There are doctors who support the renal theory of the occurrence of gestosis. The kidneys are compressed by the growing uterus, which entails a number of disorders in the body. But this theory is refuted by facts that claim that toxicosis occurs in pregnant women even without compression of the kidneys.

There is also an immunogenetic theory, which states that some pregnant women have disrupted placentation due to genetic characteristics.

How dangerous is the disease during pregnancy?

Gestosis is dangerous due to its complications. If it is accompanied by vomiting, then the pregnant woman may be dehydrated. The functions of many organs and systems are impaired. The kidneys, liver and heart suffer. The most severe complication is yellow acute liver atrophy, which can be fatal. But this pathology develops very rarely. If gestosis is extremely severe, the pregnancy is terminated.

If the course of early toxicosis is favorable, its symptoms disappear by the 12th week. If it continues, then doctors talk about pathology. This may be caused by exacerbation of chronic diseases or some obstetric pathology.

Any form of late onset of the disease poses a danger to the fetus. Blood circulation in the blood vessels of the placenta is disrupted. The acute form causes detachment, premature birth or death of the child. Sluggish gestosis causes intrauterine growth retardation in the baby.

What are the principles of treatment?

Modern doctors cannot completely eliminate the disease. In many cases they control this complication. Timely treatment helps prevent the development of severe complications. Self-medication is an unacceptable measure. Without the help of a professional, gestosis enters a severe stage.

Basic principles of treatment:

maintaining a medical and protective regime;
taking sedative medications (valerian, motherwort or stronger drugs);
drug treatment of internal organs;
careful and timely delivery.

If treatment does not lead to positive changes, and the condition of the mother and child worsens, then the question of childbirth arises

If gestosis is treatable and does not progress, then induction of labor is not used. Premature birth- This is a forced measure that is used in severe cases. If treatment does not lead to positive changes, and the condition of the mother and child worsens, then the question of childbirth arises.

The treatment regimen for toxicosis is developed individually. Doctors take into account many nuances: the severity of the disease, concomitant diseases, condition of the fetus, etc. Mild toxicosis begins to be treated in the antenatal clinic.

If after a week the woman’s condition has not improved, she is sent to the hospital. Medications If there is a disease, they must be used. It cannot be cured with herbs and diets.

Pregnant women with edema that accompanies middle and mild degree gestosis, are treated in a hospital (department of pathology of pregnant women). In severe cases with signs of preeclampsia, the woman is admitted to the intensive care unit.

The duration of treatment depends on the severity of the disease. Best treatment severe form - delivery. Therefore, three hours after ineffective treatment for preeclampsia, the patient undergoes a cesarean section.

Prevention

proper nutrition;
active lifestyle (pregnant women benefit from yoga, swimming, fitness);
frequent walks in the fresh air;
absence of bad habits and stress;
taking preventive medications as prescribed by a doctor (Magne-B6, vitamin E, chimes, etc.);

Diet

Proper nutrition can improve the condition of a pregnant woman. A woman should have on her table healthy foods. The emphasis should be on foods rich in protein. This includes lean meat, cottage cheese, fish and eggs. Sweet, fatty, fried, smoked and salty foods should be excluded.

Fast food is strictly prohibited. The daily menu should include fresh vegetables, fruits, juices and herbs. You should eat more fiber foods to relieve constipation.

If there is swelling, the doctor will create a diet. He recommends monitoring the amount of fluid you drink and excrete. Pregnant women must control the amount of food they eat. Otherwise, there will be a strong weight gain, which can lead to a number of complications.

Pregnant food should be rich in vitamins and microelements. You should drink purified water, excluding coffee, strong tea and carbonated drinks. Doctors usually prescribe special vitamin complexes for pregnant women. They must be accepted without fail.

Pregnant food should be rich in vitamins and microelements

What could be the consequences?

Preeclampsia is a dangerous condition that can lead to dire consequences. It ranks second among the causes of death of mothers (the first place is given to bleeding). A complication is perinatal mortality (its rate reaches 32%).

Women suffering from the disease suffer from endocrine disorders, hypertension, and kidney pathologies. Children born to such mothers experience problems with psycho-emotional and physical development. Many children often get sick in early childhood.

How to avoid this disease

In order for this pathology to bypass you, its prevention must begin even before conception. All chronic diseases should be identified and treated. Hidden infections can be detected if you undergo testing. It is very important to lead healthy image life.

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Quite often, pregnancy is accompanied by various pathological conditions. In our article we will tell you what gestosis is, why it occurs, how it develops, we will describe its signs, and we will talk about the diagnosis, treatment and prevention of this condition.

Preeclampsia during pregnancy is a complication of the gestational period. It develops during pregnancy, during childbirth or in the first days after it. Preeclampsia is accompanied by severe disruption of the functioning of vital organs. The basis of this condition is the impaired adaptation of the woman’s body to pregnancy. As a result of a cascade of reactions, vascular spasm occurs in all tissues, their blood supply is disrupted, and dystrophy develops. The nervous system, heart and blood vessels, placenta and fetus, kidneys and liver are affected.

Relevance of the problem

Preeclampsia in pregnant women develops in 12-15% of cases. It is the leading cause of death for women in the third trimester of pregnancy. If this complication develops in the later stages and

Up to a third of all children die in childbirth. In women, after suffering a complication, the kidneys suffer and chronic arterial hypertension develops.

How dangerous is gestosis for the fetus? He calls intrauterine hypoxia(lack of oxygen) and growth retardation. The consequences of gestosis for a child are delays in physical and mental development.

IN modern conditions Atypical gestosis is becoming more common. They are characterized by the predominance of one symptom, early onset, early formation placental insufficiency. Underestimation of the severity of the condition leads to delayed diagnosis, untimely treatment and late delivery.

Classification

The classification of gestosis is not sufficiently developed. In Russia, the disease was most often divided into the following types:

dropsy of pregnancy (with a predominance of edema);
mild, moderate and severe nephropathy;
preeclampsia;
eclampsia.

The main disadvantage of this classification is the vagueness of the term “preeclampsia”, which does not allow specifying the severity of the condition.

Today, gestosis is divided into forms in accordance with the International Classification of Diseases, 10th revision:

O10: hypertension (high blood pressure), which existed before pregnancy and complicated the course of pregnancy, childbirth, and the postpartum period;
O11: pre-existing high blood pressure with the addition of proteinuria (protein in the urine);
O12: the appearance of edema and protein in the urine during pregnancy at normal pressure;
O13: development during pregnancy high pressure in the absence of protein in the urine;
O14: hypertension arising during pregnancy in combination with big amount protein in urine;
O15: eclampsia;
O16: unspecified hypertension.

This classification solves some operational aspects of diagnosis and treatment, but does not reflect the processes occurring in the body.

With “pure” gestosis, pathology occurs in a previously healthy woman. This type is observed only in 10-30% of women. Combined forms are difficult. They develop against the background of pre-existing diseases: hypertension, kidney and liver pathology, metabolic syndrome (obesity, insulin resistance), endocrine pathology (diabetes mellitus, hypothyroidism and others).

This condition is typical only for the period of gestation. Gestosis goes away after childbirth, with the exception of severe complications. This suggests that the source of the problems is the fetus and placenta. Gestosis occurs only in humans. This disease does not occur in animals, not even monkeys, so it cannot be studied experimentally. Associated with this is a large number of theories and questions regarding the nature of this condition.

Why does gestosis occur?

Let's look at the main modern theories development of this condition:

Cortico-visceral theory. According to her, gestosis is very similar to neurotic state with disruption of the cerebral cortex and subsequent increase in vascular tone. Confirmation of this theory is the increase in the incidence of the disease in pregnant women after mental trauma, as well as data obtained using electroencephalography.
The endocrine theory considers an abnormal pregnancy as a chronic stress that causes overstrain and exhaustion of all endocrine systems of the body, including those that regulate vascular tone.
The immunological theory states that trophoblast tissue (the outer membrane of the fetus that forms the placenta) is a weak antigen. The body produces appropriate antibodies, which also interact with the woman’s kidney and liver cells. As a result, the vessels of these organs are affected. However, autoimmune processes are not observed in all women with gestosis.
The genetic theory is based on the fact that women whose mothers have suffered gestosis develop the pathological condition 8 times more often than average. Scientists are actively searching for “eclampsia genes.”
The placental theory assigns primary importance to disruption of the formation of the placenta.
Thrombophilia and antiphospholipid syndrome can cause damage to vascular walls throughout the body, and they also lead to disruption of the formation of the placenta.

Scientists believe that a unified theory of the origin of gestosis has not yet been developed. The most promising are the immunological and placental versions.

The following factors significantly increase the risk of gestosis:

Extragenital diseases, namely hypertension, metabolic syndrome, kidney and gastrointestinal diseases, frequent colds and endocrine pathology.
Multiple pregnancy.
Previously suffered gestosis.
The woman's age is under 18 and over 30 years old.
Poor social conditions.

How the disease develops

The onset of the disease occurs as early as early dates pregnancy. When the embryo is implanted (introduced) into the wall of the uterus, the arteries located in the muscle layer do not change, but remain in the “pre-pregnancy” state. Their spasm occurs and the inner lining of the blood vessels, the endothelium, is affected. Endothelial dysfunction is the most important triggering factor of gestosis. It leads to the release of powerful vasoconstrictor substances. At the same time, blood viscosity increases, and microthrombi form in spasmed vessels. Disseminated intravascular coagulation syndrome (DIC syndrome) develops.

Vasospasm leads to a decrease in the volume of blood circulating in the body. As a result, the tone of peripheral vessels reflexively increases. The intensity of blood flow in all organs is reduced, including the kidneys, liver, heart, brain and placenta. These disorders cause the clinical picture of gestosis.

Symptoms of gestosis

External signs usually manifest themselves as gestosis in the second half of pregnancy. However, we found that the disease develops much earlier. Early gestosis is considered a preclinical stage, which can be identified using special tests:

measuring blood pressure at intervals of 5 minutes with the woman lying on her side, on her back, and again on her side. The test is positive if the diastolic (“bottom”) pressure changes by more than 20 mmHg. Art.;
disturbance of uteroplacental blood flow according to data;
decrease in platelet count less than 160× 10 9 /l;
signs of increased blood clotting: increased platelet aggregation, decreased activated partial thromboplastin time, increased fibrinogen concentration in the blood;
reducing the concentration of anticoagulants, in particular, its own heparin;
reduction in the relative number of lymphocytes to 18% and below.

If a woman has two or three of the listed signs, she needs treatment for gestosis.

Classic signs of gestosis that appear in the second half of pregnancy and especially in the 3rd trimester:

swelling;
arterial hypertension;
proteinuria.

Preeclampsia is characterized by a variety of variants of its course. The classic triad occurs in only 15% of women, and one of the three symptoms occurs in a third of patients. More than half of the patients suffer from protracted forms of the disease.

One of the earliest signs of the disease is excessive weight gain. It usually begins at 22 weeks of gestation. Normally, any woman up to 15 weeks should gain no more than 300 grams per week. Then, for patients under 30 years of age, this increase should be no more than 400 grams per week, for older women - 200-300 grams.

High blood pressure usually occurs at 29 weeks. For a more accurate diagnosis, you should follow all measurement rules, record the pressure on both arms, and select the correct cuff size.

Edema during gestosis is associated with sodium retention, a decrease in the concentration of proteins in the blood, and the accumulation of under-oxidized metabolic products in the tissues. Swelling can be only in the legs, spread to the abdominal wall, or cover the entire body. Signs of hidden edema:

excretion of the main volume of urine at night;
a decrease in the amount of urine excreted compared to the volume of fluid consumed;
excessive weight gain;
“Ring symptom” - a woman’s engagement ring or other familiar ring becomes insufficient.

Proteinuria is the excretion of protein in the urine. It is caused by damage to the renal glomeruli as a result of lack of oxygen and vasospasm. Excretion of more than 1 gram of protein in any portion of urine – danger sign. At the same time, the level of protein in the blood decreases.

Severe forms of the disease

A particular danger for mother and child is a dysfunction of the nervous system - preeclampsia and eclampsia.

Symptoms of preeclampsia:

headache in the back of the head and temples;
“veil”, “flies” before the eyes;
pain in the upper abdomen and right hypochondrium;
nausea and vomiting, fever, itchy skin;
nasal congestion;
drowsiness or increased activity;
facial redness;
dry cough and hoarseness;
tearfulness, inappropriate behavior;
hearing loss, difficulty speaking;
chills, shortness of breath, fever.

As this condition progresses, eclampsia develops - a convulsive seizure accompanied by hemorrhages and swelling of the brain.

Complications

Late gestosis can cause severe complications that can even lead to the death of mother and child:

eclampsia and coma after it;
intracerebral hemorrhage;
acute renal failure;
respiratory failure;
retinal detachment and loss of vision in a pregnant woman;
premature;
hemorrhagic shock and disseminated intravascular coagulation syndrome.

There are more rare forms that complicate gestosis. This is the so-called HELLP syndrome and acute fatty hepatosis of pregnancy.

HELLP syndrome includes hemolysis (decomposition of red blood cells), a decrease in the number of platelets responsible for blood clotting, and disruption of the liver with an increase in its enzymes in the blood. This complication occurs mainly after the 35th week of pregnancy, especially against the background of nephropathy, and often causes the death of the woman and the fetus.

Symptoms develop quickly. The woman begins to complain of headache, vomiting, pain in the abdomen or in the right hypochondrium. Jaundice and bleeding appear, the patient loses consciousness, and begins to have convulsions. Liver rupture occurs with bleeding in abdominal cavity, placental abruption. Even if a woman undergoes urgent surgery, due to blood clotting disorders, she may die in the postoperative period from severe bleeding.

Acute fatty hepatosis of pregnant women develops mainly during the first pregnancy. For 2-6 weeks, the woman experiences weakness, lack of appetite, abdominal pain, nausea and vomiting, weight loss, and itchy skin. Then liver and kidney failure develops, which is manifested by jaundice, edema, uterine bleeding and fetal death. Hepatic coma often occurs with disruption of brain function.

Assessing the severity of the condition

According to the Russian classification, the severity of the disease is determined by the condition of the kidneys.

Preeclampsia 1st degree usually accompanied by swelling of the legs, slight proteinuria, and an increase in blood pressure up to 150/90 mmHg. Art. In this case, the fetus develops normally. This condition usually occurs at 36-40 weeks.

Gestosis 2 degrees characterized by the appearance of edema in the abdomen, proteinuria up to 1 g/l, increased pressure up to 170/110 mm Hg. Art. Grade 1 fetal malnutrition may occur. This form occurs at 30-35 weeks.

Diagnosis of severe form is based on the following signs:

increase in blood pressure to 170/110 mm Hg. Art. and higher;
excretion of more than 1 gram of protein per liter of urine;
decrease in urine volume to 400 ml per day;
widespread swelling;
disruption of blood flow in the arteries of the uterus, brain and kidneys;
delayed fetal development;
blood clotting disorder;
increased activity of liver enzymes;
development up to 30 weeks.

With such a serious condition, hospital treatment is necessary.

Treatment of gestosis

Main directions of therapy:

medical and protective regime;
delivery;
restoration of functions of internal organs.

The woman is prescribed the following medications:

sedatives, sedatives (valerian, motherwort), in severe cases - tranquilizers and antipsychotics (Relanium, Droperidol), barbiturates, anesthetics;
antihypertensive drugs (mainly calcium antagonists - Amlodipine, beta blockers - Atenolol, as well as Clonidine, Hydralazine and others);
magnesium sulfate, which has a hypotensive, anticonvulsant, sedative effect;
replenishment of circulating blood volume using intravenous infusions;
disaggregants (Curantil) and anticoagulants (Fraxiparin) under strict control of blood coagulation;
antioxidants (vitamins C, E, Essentiale).

Drug treatment for mild cases can be carried out for 10 days, for moderate cases – up to 5 days, for severe conditions – up to 6 hours. If treatment is ineffective, urgent delivery is necessary.

Delivery in case of gestosis is carried out through the natural birth canal or by cesarean section. A woman can give birth on her own if the disease is mild, the fetus is in good condition, there are no other diseases, and the medications are effective. In more severe cases, elective surgery is used. In case of severe complications (eclampsia, renal failure, placental abruption, etc.), an emergency caesarean section is performed.

After a caesarean section, drug treatment is continued until all body functions are fully restored. Women are discharged home no earlier than 7-15 days after birth.

Prevention of gestosis during pregnancy

A pregnant woman should avoid nervous and physical stress, get proper rest, and not take medications without a doctor’s prescription. Food should be nutritious and, if possible, hypoallergenic. Severe fluid restriction and a low-salt diet are not indicated. Only in severe cases renal failure The patient is advised to reduce the amount of protein consumed in food.

The key to preventing gestosis is regular observation by a doctor, monitoring weight, blood pressure, blood and urine tests. If necessary, the woman is hospitalized in a day hospital or in a sanatorium, where preventive treatment is carried out.

If the condition worsens, swelling, headache, or pain in the right hypochondrium appears, the patient should consult a doctor as soon as possible. Self-medication is unacceptable. Untreated acute gestosis is an immediate threat to the life of mother and child.