Will the late gestosis go away after childbirth? Gestosis in pregnant women: symptoms, treatment and degree of danger to the fetus and mother. Can pregnant women drink lemon tea

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Gestosis after childbirth

Gestosis after delivery: how to deal with it

Gestosis after pregnancy and during it has symptoms known to doctors: increased blood pressure, edema, and in connection with them a rapid and large weight gain, as well as protein in the urine. With severe preeclampsia, a woman experiences nausea and vomiting, and 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 what organs of the mother he struck.

Gestosis (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 delivery. All that doctors can do is to help prepare the child as much as possible for life outside the womb (with the rapid early progression of pathology, the child is born prematurely) and to prevent (though not in all cases) eclampsia, a formidable complication of gestosis in the mother.

Gestosis that occurs in the mother for a week, as a rule, leads to an emergency caesarean section due to her serious condition and the child to save them. If late toxicosis occurs after a week, there is a chance that gestosis will not have time to harm the mother and child too much. 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 operative, it depends on many factors. However, this situation is always under the control of doctors and anesthesiologists. About half of the 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 on time.

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

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

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

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

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

Postpartum edema is common. And not only for those suffering from gestosis. A sign of preeclampsia is considered to be a rapid increase in swelling of the hands and face. If the ankles are swollen, this is not so scary. It will go away in a few days or weeks. At the same time, women who are breastfeeding 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;
visual impairment, flashing of flies in the eyes;
pain between the ribs or in the right hypochondrium (liver);
rare urination;
increase in pressure.

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

If there was eclampsia, a CT scan of the brain should be done. In addition, donate blood for antiphospholipid antibodies, lupus anticoagulant, and undergo a test for thrombophilia.

At least the supervision of a gynecologist and therapist is required.

The consequences of gestosis for the child and mother

The woman is explained that she is in the risk category for the development of arterial hypertension, renal and hepatic failure, diabetes mellitus in the future. Gestosis after cesarean and childbirth can eventually turn into coronary heart disease, 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 with calcium supplements.

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

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

Toxicosis during pregnancy (gestosis)

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

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. Usually in pregnant women, late toxicosis occurs after 20 weeks of gestation, but clinically it is detected after 26 weeks. 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, blood vessels.

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

All forms of late toxicosis can consistently 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 of pregnant women;
preeclampsia;
eclampsia.

This classification in separate lines puts transient hypertension in pregnant women and preeclampsia superimposed on the existing hypertension. Another classification is based on the differentiation of preemplaxia by degrees (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 direct causes of gestosis are associated with the body's autoimmune response to the release of certain substances by the placenta and the fetus. These substances react with the immune system's own cells to form complex antibody complexes. It is they who damage the walls of blood vessels, make them permeable. In addition, these reasons lead to generalized vasospasm, which disrupts the blood supply to internal organs. Due to angiospasm, blood pressure rises and the total volume of circulating blood decreases. The viscosity of the blood increases, blood clots appear, hypoxia of the tissues of the kidneys, brain, and liver is detected.

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

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

a 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;
overweight;
violations of the structure of the genital organs, their underdevelopment;
poisoning, intoxication;
polyhydramnios, cystic drift.

According to statistics, the symptoms of preeclampsia more often occur in women over the age of 35 and under 18, in socially unprotected women with poor living and nutritional conditions. Gestosis can develop after abortions performed with short time intervals or with multiple pregnancies.

Gestosis in the first half of pregnancy

Gestosis in pregnant women can occur even at the initial stages of gestation. Early toxicosis (gestosis) is more often detected from the first weeks and has a variety of symptoms. The woman notes nausea, vomiting, change in taste and smell, nervousness, tearfulness. Early mild toxicosis can cause vomiting up to 3-5 times a day. The average severity of toxicosis has more severe symptoms: vomiting occurs up to 7-10 times a day, there is a pronounced weight loss. After the development of a severe degree of toxicosis, a woman urgently needs hospitalization, since indomitable vomiting is combined with an increase in body temperature, a drop in pressure, pulse, sharp weight loss, 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 the pathology of internal organs.

Gestosis of the second half of pregnancy

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

Gestosis during the second pregnancy

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

The clinical picture of gestosis

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

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

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

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

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

Treatment for preeclampsia must be urgent, and most often includes artificial childbirth and intravenous drug administration. Otherwise, the likelihood of developing such a pathology as eclampsia is high. 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 stress on the body and face. Foam with blood may come out of the mouth, breathing becomes intermittent, hoarse. During this period, the pregnant woman can quickly die from massive cerebral hemorrhage. After consciousness has returned, the woman may again fall into a seizure state due to the impact of any stimulus (sound, light). If the condition of eclampsia was diagnosed in the late stages of pregnancy, even with successful delivery and saving the woman's life, there are lesions of internal organs and systems. Their treatment in the future will depend on the complexity, size and severity of the course.

Consequences and complications of gestosis

Gestosis is always a serious test for both mother and child. Retinal detachment in preeclampsia leads to irreversible blindness or permanent loss of vision. The functioning of the nervous system, kidneys, 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, dropsy of the brain, pulmonary edema, acute liver dystrophy. The baby can also die due to placental abruption and the resulting hypoxia, suffocation. The overall rate of perinatal mortality in the presence of preeclampsia reaches 30%. Even a mild form of preeclampsia causes disturbances in the physical development of the fetus due to hypoxia, as well as the appearance of mental abnormalities after childbirth. Due to very serious consequences, the prevention of gestosis and its early detection are highly relevant.

Gestosis after childbirth

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

Diagnostics of the gestosis

In the presence of a rapid weight gain (from 400 grams per week), the specialist should examine the pregnant woman to identify signs of preeclampsia. It includes:

general analysis of urine, blood;
blood biochemistry;
urine analysis according to Zimnitsky;
regular weighing and pressure measurements;
fundus examination;
Ultrasound of the fetus;
Ultrasound of internal organs.

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

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 mm Hg;
the concentration of protein in the urine is not higher than 1 g / l;
edema on the legs (lower leg, foot) is visualized;
platelet count reaches 180 * 109 liters;
creatinine in the blood is not more than 100 μ mol / l.

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

Moderate preeclampsia in pregnant women

Moderate preeclampsia is characterized by the following indicators:

blood pressure rises to 170/110 mm Hg;
proteinuria not higher than 5 g / l;
edema is found on the legs, on the front of the peritoneum;
creatinine in the blood - micromole / l.

At this stage, urgent labor is indicated by cesarean section.

Severe preeclampsia

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

blood pressure over 170/110 mm Hg;
proteinuria - from 5 g / l;
edema is found on the legs, front of the peritoneum, on the face, hands;
platelet count - * 109 l;
creatinine - from 300 μ mol / l.

Features of pregnancy management with preeclampsia

If the treatment of gestosis or observational tactics does 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, pressure control up to 6 times a day is mandatory. The woman is weighed twice a week, the drinking regime and the amount of urine excreted are monitored. Urine and blood tests are also regularly performed, and examinations are carried out by narrow specialists. Thus, the treatment and prevention of gestosis often help bring the pregnancy to the week and safely deliver. Childbirth by caesarean section is planned in the absence of the 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, do not exceed the dietary calorie standards established for pregnant women. The diet for gestosis must necessarily include protein of animal origin (fish, meat, dairy food, eggs), which is lost in urine. We must not forget about plant fiber, but sweets and salty, refined, fatty foods are better off. Treatment of gestosis necessarily includes limiting salt and fluid intake (up to a liter per day). Instead of water, the expectant mother is better off drinking diuretic teas, a decoction of lingonberry leaves, 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, a pregnant woman is often prescribed drug treatment:

herbal sedatives (valerian, motherwort);
herbal diuretics (kanephron, cyston), synthetic diuretics (lasix);
magnesium preparations for removing excess fluid from the body (magne B6, magnesium sulfate intravenously);
vitamin and mineral complexes;
medicines to improve placental blood circulation (actovegin, courantil);
drugs of the latest generation that lower blood pressure (valz, physiotens, etc.);
drugs to improve liver function (Hofitol, Essentiale).

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

The influence of gestosis on the methods and timing of delivery

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

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

Childbirth with a severe course 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 in 2-5 days from the start of treatment in the absence of its effectiveness.

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. In order to prevent gestosis, the following measures are performed:

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

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

constant general fatigue;
drowsiness;
malaise;
periodic unreasonable pain in the internal organs;
depressive state

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

GESTOSIS: correction in the postpartum period

Gestosis is a pathology of pregnancy, which is one of the most threatening complications for both the mother and the fetus. Gestosis 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 parturient women, severe forms of preeclampsia occupy one of the first places.

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

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

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

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

It is known that the placenta, liver and kidneys of humans contain common antigens. The emergence of antibodies to the placenta, liver and kidneys of the fetus, due to cross reactions, leads to an immunological alteration of these organs of the maternal organism and a violation of their function, which is observed with late gestosis.

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

Supporters of the placental theory mention humoral factors of placental origin as a trigger for gestosis. In the early stages of gestation, inhibition of trophoblast migration in the artery occurs. At the same time, no transformation of the muscle layer is observed in the convoluted uterine arteries. The indicated 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. Endothelial damage in the development of preeclampsia is currently considered to be one of the essential places.

The main markers of endothelial dysfunction in late gestosis are thromboxane A2, prostacyclin, von Willebrand factor, fibronectin, tissue plasminogen activator and its inhibitor, endothelial relaxing factor, endothelial cells circulating in the blood. The authors came to the conclusion that with an increase in the gestational age, an increase in the 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, a large number of endothelial cells were found, their swelling was noted against the background of increased plasma membrane permeability and signs of cell damage in the form of vacuolization of the cytoplasm, swelling and clearing of the mitochondrial matrix, chromatin condensation.

Endothelial damage contributes to the development of changes underlying preeclampsia - an increase in vascular permeability and their sensitivity to vasoactive substances, the loss of their thromboresistant properties with the formation of hypercoagulation, with the creation of conditions for generalized vasospasm. Generalized vasospasm leads to ischemic and hypoxic changes in vital organs and disruption of their function.

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

Along with vasospasm, impaired rheological and coagulation properties of blood, hypovolemia plays an important role in the development of organ hypoperfusion - mainly due to the low volume of circulating plasma (VCP). Low VCP values \u200b\u200bin gestosis are due to generalized vasoconstriction and a decrease in the vascular bed, increased permeability of the vascular wall with the release of some 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 the tissue partial oxygen tension in the tissues by 1.5–2 times, depending on the severity of the disease.

The authors of some works suggest that the triggering mechanism for the development of multiple organ failure in gestosis (as in sepsis, toxic-allergic dermatitis, postoperative syndrome, etc.) is the systemic inflammatory response syndrome, in the development of which there are three stages. The first stage in response to a damaging factor (immune or non-immune agent) is characterized by local production of cytokines by activated cells, which are numerous mediators (lymphokines, monokines, thymosins, etc.) that mediate intercellular interactions and regulators of hematopoiesis and immune response. The second stage is characterized by the 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 the case of insufficient function of the systems regulating homeostasis of the body, the damaging effect of cytokines and other mediators increases. This entails a violation of the permeability and function of endothelial capillaries, the formation of distant foci of systemic inflammation and the development of organ dysfunction, which is characteristic of the third stage of the systemic inflammatory response syndrome.

According to the latest data (IS Sidorova et al., 2005), neurospecific proteins of the fetal brain play a leading role in the development of preeclampsia and acute endotheliosis. This is due to the fact that there is no tolerance in the mother's body to these proteins, which have the properties of autoantigens and, when they enter the mother's bloodstream, cause the formation of antibodies. The appearance in the mother's blood of antigens of neurospecific proteins is due to a violation of the permeability of the blood-brain barrier. One of the most important pathogenetic links leading to a violation 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 importance of damage to the central nervous system, kidneys, uterus and other organs, which develops with gestosis, I would like to emphasize the role of liver changes that arise 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 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 should 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 an essential role in the pathogenesis of severe forms of gestosis. At the same time, the change in most parameters can be recorded even at the preclinical stage, which makes it possible to predict the development of liver failure. In addition, observing the physiologically proceeding pregnancy, one should take into account the effect of progesterone on the tone and motility of the biliary tract, which contributes to the occurrence of cholelithiasis and cholestasis even in healthy women.

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

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

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

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

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

In patients with mild forms of preeclampsia, when studying a biopsy material, significant changes in the liver are not detected. In severe forms of gestosis, small-droplet fatty degeneration of hepatocytes develops in the absence of necrosis, cytoplasm swelling, 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 regular change in the protein-forming and detoxification functions of the liver. According to a number of studies, with an increase in the severity of gestosis, hypoproteinemia increases, expressed in a decrease in albumin fractions and an increase in globulin fractions (IgG, IgA, IgE), an increase in the level of circulating immune complexes.

It was found that with gestosis the antitoxic function of the liver, cellular and humoral immunity are sharply suppressed. The pigment and carbohydrate functions are the least affected. An increase in bilirubin is noted only with preeclampsia - mainly due to the fraction of indirect bilirubin. In severe forms of gestosis, hypercholesterolemia and an increase in the activity of transaminases are found.

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

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

The poverty of clinical manifestations of liver pathology in gestosis, according to MA Repina, dictates the need to develop reliable laboratory criteria for assessing the severity of its lesion.

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

Thus, at present there is no consensus on the long-term consequences of the transferred 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), arising as a consequence of the pathogenesis of gestosis, do not stop after delivery and may cause the development of extragenital complications in the future.

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

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

Until now, blood serum parameters are the main criteria for the clinical diagnosis of hepatocellular failure. In this regard, it is necessary to study the biochemical parameters of blood serum. 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, serves as a criterion for assessing the permeability of the plasmolemma and damage to hepatocytes. It is also necessary to determine the 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; the density of the wall of the gallbladder, liver, gallbladder bile, measurement of the volume and thickness of the walls of the gallbladder is determined. Ultrasound diagnostics of fatty hepatosis is performed by registering the ultrasound density of various parts of the hepatic parenchyma by means of echodensitometry, which, based on a pathological change in the 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 the assessment of bilisynthetic and biliexcretory functions of the liver, concentration and motor functions of the gallbladder, patency of the biliary tract. The study is highly informative in patients with inflammatory and metabolic diseases of the liver, gallbladder, cholelithiasis, dyskinesia of the biliary tract, diseases of the gastrointestinal tract, abdominal syndrome of unknown etiology, etc.

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

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

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

From our point of view, the study of liver function indicators will allow diagnosing liver damage in the early stages before clinical symptoms, monitoring the therapy, achieving restoration of the liver functional state in the postpartum period, predicting the course of gestosis, as well as possible complications in repeated pregnancies.

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

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

Long-term lipid-correcting therapy with petroleum jelly-pectin emulsion FISHANT C (PentaMed) once a week for 2-12 months, with the obligatory use of combined herbal hepatotropic drugs: hepabene (Ratsiopharm), in a dose of 1 capsule

3 times a day - and restoration of colon microbiocenosis with probiotics: hilak forte (Ratsiopharm) at a dose of 40-60 drops a day, polibacterin (Alfarm) - 2 tablets 3 times a day for 10 days.

Literature

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Egorova AE Features of the course of the postpartum period in postpartum women who have undergone preeclampsia: author. dis. ... Cand. honey. sciences. M., 2002.
Kantemirova ZR Features of the course of pregnancy, childbirth and the postpartum period with gallbladder cholesterosis: author. dis. ... Cand. honey. sciences. M., 2000.
Clinical lectures on obstetrics and gynecology / ed. A. N. Strizhakova, A. I. Davydova, L. D. Belotserkovtseva. Moscow: Medicine, 2004.620 p.
Kuzmin V.N., Serobyan A.G. Acute fatty hepatosis of pregnant women in the practice of an obstetrician-gynecologist // Attending Doctor. No. 5. 2003. P. 12-19.
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. The modern concept of multiple organ failure in gestosis // Perinatal anesthesiology and intensive care of mother and newborn. Ekaterinburg, 1999.S. 25–32.
Nazarenko G.I., Kishkun A.A. Clinical evaluation 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 - a new domestic activator of immunity with pronounced detoxification properties // Medicines and pharmaceuticals. 1999. No. 3 (23). S. 20-22.
Repina M.A.Gestosis as a cause of maternal mortality // Journal of Obstetrics and Women's Diseases. 2000. T. XLIX. Issue 1.P. 45–50.
Saveliev V.S., Petukhov V.A., Koralkin A.V. Extrahepatic biliary dysfunctions in lipid distress syndrome: etiopathogenesis, diagnosis and treatment principles // Russian Medical Journal. 2002. No. 9. P. 77–84.
Savelyeva G.M., Kulakov V.I., Serov V.N. Modern approaches to the diagnosis, prevention and treatment of gestosis: honey. directions. 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 PD Electron microscopy of endothelial cells circulating in the blood during pregnancy complicated by preeclampsia // Actual problems of physiology and pathology of a woman's reproductive function. SPb., 1999. S. 404–405.
Serov V.N.Eclampsia. M .: MIA, 2002.
Sidorova I.S.Gestosis. Monograph. M .: Medicine, 2003.
Sidorova IS, Dmitrieva TB, Chekhonin VP, et al. The role of fetal neurospecific proteins in the development of preeclampsia // Questions of gynecology, obstetrics and perinatology. 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 reproductive period // Obstetrics and gynecology. 2000. No. 6. P. 37–39.
Chernukha E.A. Generic bloc. M .: Triada-X, 2003.709 p.
Cherny VI, Galolu SI, Kabanko TP and others. Labyrinths of preeclampsia // Health. Kiev, 2001.
Chekhonin VP, Ryabukhin IA, Belopasov VV et al. Immunoassay of antibodies to neurospecific proteins in assessing the state of the BBB function // Immunology. 1997. T. 2. P. 67–69.
Sherlock Sh., 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.
Roberts J. M., Redman C. W. Pre-eclampsia: more than pregnancy-induced hypertension // Lancet. 1996; 341: 1447-1451.
Schwab R. Preeclampsia / Eclampsia // Br. J. Obstet. Gynecol. 1998; 76: 1055-1065.
Saftlas A. F., Olson D. R., Franks A. L. et al. Epidemiology of preeclampsia and eclampsia // Am. J. Obstet. Gynecol. 1998; 163: 460-465.

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

V.K.Shishlo, candidate of medical sciences, associate professor

MGMSU, RMAPO, Moscow

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There are standard periods of stay in a maternity hospital if the postpartum period passes without complications. When giving birth through a vaginal birth canal, they can be 4-6 days, with operative delivery - 7-9 days. It was at this time that the doctor monitors mom and baby every day.

What procedures and manipulations await a young mother after childbirth?

The doctor and midwife will periodically check:

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

You may be assigned:

pills that promote uterine contraction - for the prevention of postpartum hemorrhage;
injections or tablets of analgesic and antispasmodic drugs in the presence of painful postpartum contractions (such drugs are received by multiparous and patients after a caesarean section);
antibacterial drugs (they can be prescribed after surgical delivery).

If one or another indicator deviates 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 illness. There can be no trifles here. Each symptom must be taken seriously and responsibly.

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

Complications of pregnancy and childbirth

Severe forms of gestosis in pregnant women. Gestosis is manifested by edema, the appearance of protein in the urine, and increased blood pressure. An extreme form of preeclampsia is eclampsia - seizures due to spasm of the cerebral vessels. In severe forms of preeclampsia, a woman stays in the hospital until blood pressure stabilizes and urine analyzes normalize. With mild forms of preeclampsia, when blood pressure does not increase after childbirth, there is no edema, one normal urine test is enough to discharge the patient 5-6 days after childbirth. If at least one of the symptoms of gestosis persists, then, depending on its severity, treatment can be carried out in the intensive care unit or in the postpartum department. For treatment, sedatives, antihypertensive, diuretics are prescribed. Since gestosis is a risk factor for postpartum bleeding, 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, immunity is reduced, so there is a high likelihood of other complications, such as infectious ones. After bleeding, antianemic, reducing therapy is carried out, the hemoglobin content in the blood is controlled. If the postpartum period is not accompanied by repeated bleeding, then the patient is discharged 1 day later than other women who gave birth on the same day.
Traumatic childbirth with the formation of large ruptures or vesicovaginal or rectovaginal fistulas. Fistulas are passages that form between two organs: the vagina and the bladder, or the vagina and the rectum. This happens when the head of the fetus does not move along the birth canal for a long time. This forms a pressure ulcer that connects the vagina to other organs. Childbirth with deep tears of the vagina, perineum, when the tears of the perineum reach the muscles of the rectum, are also considered traumatic. In the described cases, after childbirth, a longer observation of the restored tissues is necessary, since the extensive wound surface formed after ruptures predisposes to inflammatory complications, suture divergence. Sometimes a woman needs re-hospitalization for the next surgery, during which fistulas are sutured or the muscles of the pelvic floor are strengthened. In the absence of complications with the healing of sutures, the postpartum woman is in the postpartum ward 1-2 days longer than other women.

Infectious complications of the postpartum period

Endometritis - inflammation of the lining of the uterus. This disease is manifested by an increase in body temperature to 38-40 ° C, depending on the severity of the disease, pain in the lower abdomen (it should be noted that normally, especially after repeated childbirth, cramping pains can be observed during this period - more often during feeding). This is due to the contraction of the uterus. Endometritis pains are persistent, they are pulling in nature and can spread to the lumbar region. Discharge from the genital tract with endometritis abundant, with an unpleasant odor. If normally, 2-3 days after childbirth, the discharge acquires a bloody character, then with endometritis, spotting 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 the norm: 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 hospital should also include divergence and infection of the sutures of the perineum and the suture after cesarean section. With these complications, reddening of the skin is observed in the area of \u200b\u200bthe rupture or incision, pus can be released from the wound, and the seam area is painful.

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

With subinvolution of the uterus, the patient remains in the postpartum ward, where she is additionally prescribed contraction drugs. With the effectiveness of this therapy, an ultrasound examination of the uterus is performed on the 4-5th day after childbirth to exclude retention of placenta residues and blood accumulation. After that, the woman is discharged. If the treatment is ineffective or other signs of endometritis have joined, as well as in case of infection and divergence of the seams, the woman is transferred to a special second obstetric department. Here, if necessary, antibiotic therapy is prescribed, washing of the uterus, uterine-reducing agents, dressings in the area of \u200b\u200ba purulent wound when seams are diverging. In doubtful cases, after the baby is discharged, the young mother can be transferred to the gynecological department of the hospital for follow-up care.

In the postpartum period, a complication such as thrombophlebitis - an inflammatory complication of varicose veins of the lower extremities. As a result of this disease, the vein wall in the area of \u200b\u200ba previously formed thrombus becomes inflamed. In this case, the patient is worried about pain in the area of \u200b\u200bthe affected limb, redness of the skin over the affected vessel. With thrombophlebitis, after consulting a surgeon, depending on the severity of the condition, the patient is transferred to the second obstetric department or a specialized vascular department of the hospital. The complex of therapeutic measures for this disease includes elastic bandaging of the affected limb, the use of antibacterial, anti-inflammatory, analgesic drugs. At a certain stage of the disease, blood thinners are prescribed.

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

Chronic diseases

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

To the hospital - at your own request

Sometimes situations arise when a young mother is not confident in herself, she “did not have time to look around” and is afraid to be 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 childbirth - no more than 6 days, after a cesarean section - no more than 10.

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

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

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

In Vitro Fertilization (IVF) is a modern artificial insemination technology that allows many couples to have a chance to have a baby. Even 10 - 15 years ago people.

Many clinics are now open in the country that can provide such services.

For a cesarean section to be successful, you need to prepare for it accordingly. In this article, we'll talk about getting ready for a cesarean section.

comments on the article

All articles on the site are for informational purposes only. A specific treatment can only be prescribed by a doctor!

Gestosis after childbirth

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

headache;
rare urination;
increase in pressure.

Gestosis after childbirth, how to treat gestosis after pregnancy

Gestosis after delivery: how to deal with it

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

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

On the first day after childbirth, a woman suffering from severe gestosis is in the intensive care unit, where resuscitators are closely monitoring her condition. At this time, she is receiving anticonvulsant therapy in the form of "magnesia", which is familiar to many women. This drug not only relieves the tone of the uterus, but is also a good preventive measure against eclampsia. The woman's condition is closely monitored. They take urine and blood tests from her, and often measure 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 mother is prescribed drugs for pressure. If possible, compatible with lactation. For example, & Dopegit &, & Nifedipine &. Treatment of postpartum gestosis continues after discharge from the hospital. The increase in pressure can persist for about two months, but normally the condition should gradually return to normal. Cancellation 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;
visual impairment, flashing of flies in the eyes;
pain between the ribs or in the right hypochondrium (liver);
rare urination;
increase in pressure.

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

If there was eclampsia, a CT scan of the brain should be done. In addition, donate blood for antiphospholipid antibodies, lupus anticoagulant, and undergo a test for thrombophilia.

At least the supervision of a gynecologist and therapist is required.

The consequences of gestosis for the child and mother

The interval between pregnancies should not be more than 10 years, since this is also a risk factor for developing 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 of pregnant women;
preeclampsia;
eclampsia.

Why do pregnant women develop gestosis?

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

a 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;
overweight;
violations of the structure of the genital organs, their underdevelopment;
poisoning, intoxication;
polyhydramnios, cystic drift.

Gestosis in the first half of pregnancy

Gestosis of the second half of pregnancy

Gestosis during the second pregnancy

The clinical picture of gestosis

heaviness in the head, pain, dizziness;
nausea, vomiting;
pain in the abdomen, stomach, ribs;
sleep disorders;
dysfunction of vision 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

Diagnostics of the gestosis

In the presence of a rapid weight gain (from 400 grams per week), the specialist should examine the pregnant woman to identify signs of preeclampsia. It includes:

general analysis of urine, blood;
blood biochemistry;
urine analysis according to Zimnitsky;
regular weighing and pressure measurements;
fundus examination;
Ultrasound of the fetus;
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 mm Hg;
the concentration of protein in the urine is not higher than 1 g / l;
edema on the legs (lower leg, foot) is visualized;
platelet count reaches 180 * 109 liters;
creatinine in the blood is not more than 100 μ mol / l.

Moderate preeclampsia in pregnant women

Moderate preeclampsia is characterized by the following indicators:

blood pressure rises to 170/110 mm Hg;
proteinuria not higher than 5 g / l;
edema is found on the legs, on the front of the peritoneum;
creatinine in the blood - micromole / l.

At this stage, urgent labor is indicated by cesarean section.

Severe preeclampsia

blood pressure over 170/110 mm Hg;
proteinuria - from 5 g / l;
edema is found on the legs, front of the peritoneum, on the face, hands;
platelet count - * 109 l;
creatinine - from 300 μ mol / l.

Features of pregnancy management with preeclampsia

Nutrition of the expectant mother with gestosis

Treatment of gestosis

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

herbal sedatives (valerian, motherwort);
herbal diuretics (kanephron, cyston), synthetic diuretics (lasix);
magnesium preparations for removing excess fluid from the body (magne B6, magnesium sulfate intravenously);
vitamin and mineral complexes;
medicines to improve placental blood circulation (actovegin, courantil);
drugs of the latest generation that lower blood pressure (valz, physiotens, etc.);
drugs to improve liver function (Hofitol, Essentiale).

The influence of gestosis on the methods and timing of delivery

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

How to prevent gestosis

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

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

Useful information

constant general fatigue;
drowsiness;
malaise;
periodic unreasonable pain in the internal organs;
depressive state

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

Gestosis is a complication that occurs in many pregnant women. It disappears after childbirth. Pathology is considered a formidable disease, as it sometimes becomes the cause of maternal death. The complication is most often detected in the third semester of pregnancy.

It is an insidious disease that may not be a cause for concern. But at some point, a woman has a seizure attack (eclampsia), which threatens the health of the mother and baby.

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

What are the signs and symptoms of gestosis

Key features

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

Dangerous symptoms - harbingers of a seizure attack

nausea;
headache;
stomachache;
lethargy and drowsiness;
flashing "flies" before the eyes.

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

Groups

Swelling of pregnant women

They can be explicit or hidden. The latter appear in the early stages of the disease. They arise due to the retention of fluids in the 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 edema during pregnancy is associated with a disease. 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 is convulsions.

Gestosis can manifest itself in different ways. Some women have minimal symptoms. Others suffer from lightning attacks, which are disastrous.

The cause of the disease - the opinions of doctors

Doctors cannot accurately name the causes of complications. But there is an unequivocal opinion that such a complication rarely occurs in healthy women. Most often, gestosis develops against the background of the existing diseases of the mother. Increased 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 malfunctions in the body, which can lead to serious problems. In some cases, doctors resort to early delivery to keep the baby and mother alive. Therefore, before conception, a woman must be examined.

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

This will allow you to predict possible complications that may arise during the period of bearing a baby. 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 kidney, thyroid, or blood pressure problems, be sure to see your doctor.

The risk group includes

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

Nobody is 100% insured from gestosis. Therefore, experts strongly advise you to regularly come for an examination. Monitoring pressure and weight, blood and urine tests are those measures that allow you to identify complications in time.

Nobody is 100% insured from gestosis

The great 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 of the disease.

Why does gestosis appear in pregnant women?

Gestosis or toxicosis is a complication associated with pregnancy. It can be early or late. Early toxicosis is known to all pregnant women. It manifests itself at the earliest possible date. Its main symptoms are nausea and vomiting. The early stage is 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 that lead to dangerous complications. Late gestosis is the leading cause of maternal mortality. This complication is less noticeable.

It manifests itself in three main features:

swelling;
protein in the urine;
high blood pressure.

Not all women have the full range of symptoms. Only one of them can tell about the presence of pathology. Only edema is visible here. The 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, by the end of the term, doctors measure blood pressure and weigh them weekly.

Late gestosis sometimes has an unpredictable development. Sometimes they start to progress dramatically. In this case, the woman's health condition is rapidly deteriorating. A pregnant woman can feel worse and worse every hour. Pathology in this form is treated only in stationary conditions.

Today, about 27% of pregnant women face the disease. His symptoms subside after childbirth. A complication arises from the fact that the mother's body cannot optimally adapt to carrying 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 dramatically reduced. The work of organs and systems is disrupted. A spasm of small vessels leads to an increase in blood in large vessels. All this leads to an increase in 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, flashing "flies". If a pregnant woman experiences dry skin and itching, then this is a clear sign of changes in the liver.

The woman develops swelling, and the blood becomes thicker. Such processes are reflected in the condition of the fetus. Its growth and development slows down. The baby is experiencing a lack of oxygen (hypoxia).

Diagnostic methods

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

general and biochemical blood tests;
urine tests (daily, biochemical and clinical);
weighing;
blood pressure measurement;
fundus examination;
Ultrasound and dopplerometry of the fetus.

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

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

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

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

When diagnosing edema, a specialist evaluates weight gain over the entire period of pregnancy, as well as for 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 adhering to a diet and fasting days. If this does not help, then the doctor prescribes special drugs. 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 lies in the fact that a woman is injected with saline under the skin. The doctor marks the time during which the papule resolves. If the interval does not take 35 minutes, then the body has edema.

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

In this case, the woman's condition can deteriorate sharply at any time. Self-medication is not allowed here. Some women start taking diuretics on their own, which further aggravates the situation.

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

Late toxicosis occurs for many reasons. Violation of the endocrine system, obesity, sexual diseases, hypertension - all these factors can contribute to the development of preeclampsia in the second half of pregnancy. Sometimes it is a consequence of the transferred flu or SARS.

Improper nutrition can also give rise to the development of late toxicosis. It is impossible to cure it at home. The woman needs inpatient treatment. She is given droppers and prescribed medications that help fill 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. With formidable complications, they resort to caesarean section.

The initial symptoms of late toxicosis are detected at the next examination in the antenatal clinic. The doctor evaluates the weight gain, measures blood pressure, examines the urinalysis and calculates the fetal heart rate. 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. A late degree does not go away on its own. The symptoms will only get worse. If you lose time, you may experience preeclampsia or more severe complications (seizures).

How is labor going

The severity of the disease affects the timing 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 the truth that from time immemorial has been supported by all gynecologists and obstetricians. But for such childbirth, the following conditions are needed: a mature cervix, the proportionality of the mother's pelvis and the head of the fetus, cephalic presentation of the fetus, the woman's age not older than 30 years, the absence of diseases in the mother and other factors.

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

With gestosis, childbirth may be accompanied by complications

Studies carried out by specialists have shown that with this disease, the anti-stress resistance of the woman and the fetus is reduced. Any aggressive effect during childbirth (fatigue, uterine hyperstimulation, painful manipulations) can have sad consequences. A woman has every chance of suffering from fulminant and critical hypertension.

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

Typical complications during childbirth

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

The main way that relieves a woman from gestosis is childbirth. But for an immature and premature baby, delivery before the due date is not a very favorable outcome. But in some cases, the baby is more likely to survive outside the mother's body. Then the only strategy of doctors is 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 birth (regardless of the gestational age)

non-convulsive or convulsive eclampsia, seizures;
preeclampsia, which progresses even with hospital treatment;
the rapid deterioration in a woman's health;
retinal disinsertion;
placental insufficiency, which is progressing;
placental abruption;
signs of hepatopathy.

Doctors carry out a gentle and fast delivery. Preference is given to giving birth through the natural birth canal. This avoids the stress caused by surgery and anesthesia. 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 have 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 a period of 22-24 weeks and lasts quite a long time. The second can occur 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 the delivery is not accompanied by dangerous symptoms.

Late gestosis usually has no severe complications.

Severity:

easy,
average,
heavy,
eclampsia.

Doctors also distinguish pregestosis or preclinical stage of the disease. There is also a division into combined and pure gestosis. Here the accompanying conditions are of importance. Pregnant women with extragenital ailments that were not identified in time are classified as a group of women suffering from a pure form of the disease.

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

Edema plays an important role in the diagnosis. They can vary in severity.:

degree I - edema of the lower extremities;

grade II - edema of the lower and upper extremities, as well as the abdominal wall;

grade III - edema extends to internal organs.

Swelling can be hidden. They can be accompanied by proteinuria and arterial hypertension. The course of the disease is determined by examining blood and urine. In this case, the doctor monitors the condition of the fetus. The severity of the pathology can be judged by the number of heartbeats of the baby.

Early

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

The main manifestations of toxicosis:

dizziness,
nausea,
salivation,
vomiting.

They can be expressed with different strengths. If the disease manifests itself too brightly, then 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 the 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 woman's pathological reaction to pregnancy. The development of toxicosis involves the immune, allergic, toxic, reflex and neurogenic mechanisms.

In some cases, the ailment 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 the very birth. Such toxicosis leads to a breakdown of the systems and organs of a woman.

Many obstetricians associate the occurrence of gestosis with an increased number of late births

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

Many obstetricians attribute this to an increased number of late births. Women who give birth after 35 years of age have chronic diseases that complicate pregnancy and childbirth.

A woman can notice the first signs of a late illness at the 28th week. Usually pregnant women find edema. This is the mildest manifestation of the disease. Edema is also called "dropsy of pregnant women." In more severe cases, the complication is manifested by 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. Of the signs, edema is present. The woman is given outpatient treatment.

Heavy

Blood pressure exceeds the norm by 40% and further. Protein content - 3.0 g / l. The state of health of the pregnant woman worsens. She develops a headache, swelling builds up and protein in the urine increases.

Sleep and vision can also be impaired. The patient is admitted to the hospital. If the condition is very serious, then 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. A spasm occurs due to damage to the endothelium. Dystrophic changes occur in the organs and tissues of the patient. The functions of the liver, kidneys and nervous system are impaired, and the fetus and placenta also suffer.

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

There are doctors who support the renal theory 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 the facts, which claim that toxicosis occurs in pregnant women without squeezing the kidneys.

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

What is the danger of a disease during pregnancy

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

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

Any form of late onset of the disease is dangerous to the fetus. In the vessels of the placenta, blood circulation is disturbed. The acute form causes its detachment, premature birth or death of the child. Sluggish gestosis causes a delay in the intrauterine development of 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 to prevent the development of severe complications. Self-medication is an unacceptable measure. Without the help of a professional, preeclampsia passes into a difficult stage.

Basic principles of treatment:

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

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

If gestosis is treatable and does not progress, then labor stimulation is not used. Premature birth is a compulsory measure that is used in severe cases. If the treatment does not lead to positive changes, and the condition of the mother and child deteriorates, 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, the condition of the fetus, etc. A mild degree of toxicosis begins to be treated in the antenatal clinic.

If after a week the woman's condition has not improved, then she is sent to the hospital. Medicines are used in the presence of a disease. It is impossible to cure it with herbs and diets.

Pregnant women with edema, which accompany moderate and mild gestosis, are treated in a hospital (department of pathology of pregnant women). In severe form with signs of preeclampsia, a woman is placed in the intensive care unit and intensive care unit.

The duration of treatment depends on the severity of the disease. The best treatment for severe disease is delivery. Therefore, three hours after the undertaken ineffective treatment for preeclampsia, the patient undergoes a caesarean section.

Prevention

proper nutrition;
an active lifestyle (it is useful for pregnant women to do yoga, swimming, fitness);
frequent walks in the fresh air;
lack of bad habits and stress;
taking prophylactic drugs as prescribed by a doctor (Magne-B6, vitamin E, courantil, etc.);

Diet

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

Under the strictest ban on fast food. The daily menu should contain fresh vegetables, fruits, juices and herbs. Eat more fiber foods to relieve constipation.

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

The food of a pregnant woman should be saturated with vitamins and minerals. 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.

Food of a pregnant woman should be saturated with vitamins and minerals

What can be the consequences

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

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

How to avoid the occurrence of this ailment

In order for this pathology to bypass you, its prevention must be started even before conception. All chronic diseases should be identified and treated. Latent infections can be detected if tested. It is very important to lead a healthy lifestyle.

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

Gestosis during pregnancy is a complication of the gestational period. It develops during gestation, during childbirth or in the first days after them. Gestosis is accompanied by a pronounced disruption of the work of vital organs. This condition is based on the impaired adaptation of the woman's body to pregnancy. As a result of a cascade of reactions, vasospasm 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.

The urgency of the problem

Gestosis in pregnant women develops in 12-15% of cases. It is the leading cause of death for women in the third trimester of pregnancy. With the development of this complication at a later date and

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

Why is gestosis dangerous for the fetus? It causes intrauterine hypoxia (lack of oxygen) and growth retardation. The consequences of gestosis for a child are a lag in physical and mental development.

In modern conditions, atypical gestosis is increasingly common. They are characterized by the predominance of one symptom, early onset, early formation of placental insufficiency. Underestimation of the severity of the condition in this case leads to delayed diagnosis, delayed treatment and late delivery.

Classification

The classification of gestosis has not been developed enough. In Russia, the division of the disease into the following types was most often used:

dropsy of pregnant women (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 10 revision:

О10: hypertension (high blood pressure) that existed before pregnancy and complicated the course of gestation, childbirth, and the postpartum period;
О11: pre-existing high blood pressure with addition of proteinuria (protein in the urine);
О12: the appearance of edema and protein in the urine during pregnancy at normal pressure;
A13: development of high blood pressure during pregnancy in the absence of protein in the urine;
A14: hypertension during pregnancy in combination with a large amount of protein in the urine;
O15: eclampsia;
O16: unspecified hypertension.

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

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

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

Why does gestosis occur?

Consider the main modern theories of the development of this condition:

Cortico-visceral theory. According to her, gestosis is very similar to a neurotic state with disruption of the cerebral cortex and a subsequent increase in vascular tone. Confirmation of this theory is the increase in the frequency of the disease in pregnant women after mental trauma, as well as data obtained using electroencephalography.
The endocrine theory considers an abnormally proceeding pregnancy as a chronic stress that causes overstrain and depletion of all endocrine systems of the body, including those that regulate vascular tone.
Immunological theory states that trophoblast tissue (the outer shell of the fetus that forms the placenta) is a weak antigen. The body produces the corresponding antibodies, which also interact with the cells of the woman's kidneys and liver. As a result, the vessels of these organs are affected. However, autoimmune processes are not recorded in all women with gestosis.
The genetic theory is based on the fact that women whose mothers have had preeclampsia develop a pathological condition 8 times more often than on average. Scientists are actively looking for “eclampsia genes”.
The placental theory assigns the main importance to the violation of the formation of the placenta.
Thrombophilia and antiphospholipid syndrome can cause damage to the vascular walls throughout the body, and they also lead to a violation 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 tract diseases, frequent colds and endocrine pathology.
Multiple pregnancy.
Previously postponed gestosis.
The age of the woman is under 18 and over 30.
Poor social conditions.

How does the disease develop

The onset of the disease occurs at the earliest stages of pregnancy. When the embryo is implanted (implanted) into the wall of the uterus, the arteries located in the muscle layer do not change, but remain in a "pre-pregnant" state. Their spasm occurs, the inner lining of the vessels - the endothelium - is affected. Endothelial dysfunction is the most important triggering factor for gestosis. It leads to the release of powerful vasoconstrictor substances. At the same time, the viscosity of the blood increases, microthrombi are formed in the spasmodic vessels. Disseminated intravascular coagulation syndrome (DIC) develops.

Vascular spasm 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 decreases, including the kidneys, liver, heart, brain and placenta. These disorders cause a clinical picture of gestosis.

Symptoms of gestosis

External signs are usually manifested by gestosis in the second half of pregnancy. However, we found out that the disease develops much earlier. Early preeclampsia is considered a preclinical stage, which can be detected using special tests:

measurement of pressure with an interval of 5 minutes in the position of a woman lying on her side, on her back, again on her side. The test is positive if the diastolic ("lower") pressure changes by more than 20 mm Hg. Art .;
violation of uteroplacental blood flow according to the data;
a decrease in the number of platelets less than 160 × 10 9 / l;
signs of increased blood clotting: increased platelet aggregation, decreased activated partial thromboplastin time, increased concentration of fibrinogen in the blood;
decrease in the concentration of anticoagulants, in particular, own heparin;
decrease in the relative number of lymphocytes to 18% and below.

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

The classic signs of preeclampsia that appear in the second half of pregnancy and especially in the 3rd trimester:

swelling;
arterial hypertension;
proteinuria.

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

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

An increase in blood pressure usually occurs at 29 weeks. For a more accurate diagnosis, all measurement rules should be followed, the pressure on both arms should be recorded, and the size of the cuff should be correctly selected.

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 only be on the legs, spread to the abdominal wall or cover the whole body. Signs of hidden edema:

excretion of the bulk of urine at night;
a decrease in the amount of urine excreted in comparison with the volume of fluid consumed;
excess weight gain;
"Ring symptom" - a woman becomes not enough of her wedding or other familiar ring.

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. The release of more than 1 gram of protein in any portion of urine is a danger sign. At the same time, the level of protein in the blood decreases.

Severe forms of the disease

Dysfunction of the nervous system - preeclampsia and eclampsia - poses a particular danger to mother and child.

Preeclampsia symptoms:

headache in the back of the head and temples;
"Veil", "flies" before the eyes;
pain in the upper abdomen and in the right hypochondrium;
nausea and vomiting, fever, itching of the skin;
nasal congestion;
drowsiness or increased activity;
redness of the face;
dry cough and hoarseness;
tearfulness, inappropriate behavior;
hearing impairment, difficulty speaking;
chills, shortness of breath, fever.

With the progression of this condition, eclampsia develops - a convulsive seizure, accompanied by hemorrhages and cerebral edema.

Complications

Late gestosis can cause serious complications that can even lead to the death of the 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.

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

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

Symptoms develop quickly. The woman begins to complain of headache, vomiting, pain in the abdomen or in the right hypochondrium. Jaundice, bleeding appears, the patient loses consciousness, she starts having convulsions. There is a rupture of the liver with bleeding into the abdominal cavity, placental abruption. Even if a woman is urgently operated on, 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. Within 2-6 weeks, a woman is worried about weakness, lack of appetite, abdominal pain, nausea and vomiting, weight loss, itching. Then liver and kidney failure develops, which is manifested by jaundice, edema, uterine bleeding and fetal death. Hepatic coma often occurs with impaired brain function.

Assessment of the severity of the condition

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

Preeclampsia 1 degree usually accompanied by edema of the legs, slight proteinuria, an increase in blood pressure up to 150/90 mm Hg. 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 on the abdomen, proteinuria up to 1 g / l, an increase in pressure up to 170/110 mm Hg. Art. There may be grade 1 fetal malnutrition. This form occurs at 30-35 weeks.

Diagnosis of a severe form is based on the following symptoms:

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 up to 400 ml per day;
widespread edema;
violation 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.

In such a serious condition, treatment in a hospital is necessary.

Treatment of gestosis

The main directions of therapy:

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

The following drugs are prescribed for a woman:

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

Medication with a mild degree can be carried out for 10 days, with moderate severity - up to 5 days, with a serious condition - up to 6 hours. If the treatment is ineffective, urgent delivery is necessary.

Delivery with gestosis is carried out through the natural birth canal or by means of a cesarean section. A woman can give birth herself with a mild illness, good condition of the fetus, the absence of other diseases, the effect of medication. In more severe cases, a planned operation is used. In case of severe complications (eclampsia, renal failure, placental abruption, and so on), an emergency caesarean section is performed.

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

Prevention of gestosis during pregnancy

A pregnant woman should avoid nervous and physical overload, fully rest, and not take medications without a doctor's prescription. Nutrition should be complete, as hypoallergenic as possible. Severe fluid restriction and reduced salt diets are not indicated. Only in severe cases of renal failure is the patient recommended to reduce the amount of protein consumed with food.

The key to preventing preeclampsia is regular observation by a doctor, weight control, 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, the appearance of edema, headache, pain in the right hypochondrium, 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 the mother and child.