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Late toxicosis during pregnancy when it begins. Late toxicosis during pregnancy: how to save mom and baby from trouble? How to treat late toxicosis of pregnant women

Gestosis is considered a rather dangerous condition that occurs in girls in position. This term means late toxicosis during pregnancy that occurs in the second or third trimester. If the usual toxicosis does not threaten either the mother or the fetus in any way, then a lot of complications and dangers come from gestosis. A similar condition occurs in about 15% of mothers.

It is necessary to prepare a bag with baby things in advance

Toxicosis of pregnant women is a pathological complex of symptoms that occurs with the negative impact of gestation on a woman. Toxic conditions are at different times. Early toxicity conditions bother mom at 1-12 weeks, and toxicosis in late pregnancy occurs at 26-40 weeks. It is impossible to accurately name the duration of this period, because the terms for each patient are different due to the individuality of the organisms.

Toxic conditions significantly complicate bearing, provoking the creation of an unfavorable atmosphere for fetal growth and development. At times, toxicosis does pose a danger to mom's health or her life. The onset of toxicosis is primarily due to pregnancy. Against the background of a developing and growing embryo, changes in the hormonal status, the activity of the body changes significantly. Experts suggest that toxic manifestations during gestation are due to addiction to the coexistence of the embryo and the mother.

Late toxicosis of pregnant women indicates a profound pathological failure in the functionality of vital organic systems such as endocrine and cardiovascular, hematopoietic or excretory, etc. Sometimes the patient is diagnosed with pretoxicosis, meaning that a woman has a preclinical gestosis form, in which there are no actual symptoms, but already changes in the analyzes appeared, pressure instability is noted, etc.

The reasons

Experts have not yet been able to find out exactly which factors are of paramount importance in the development of gestosis, however, they determined that in late toxicosis during pregnancy, the causes can be caused by several factors.

  1. Endocrine. According to this assumption, the mechanism of development of gestosis is due to changes in hormonal status, which negatively affects vascular tone, fluidity and blood clotting. There is a deterioration in blood supply and material exchange processes are disturbed, cardiovascular regulation is upset, which occurs against the background of changes in the activity of the endocrine glands.
  2. The genetic theory suggests that gestosis occurs more often in girls whose mothers also suffered from similar toxicosis during gestation.
  3. The cortical-visceral theory suggests that the main reason why gestosis occurs is a neurotic disorder, manifested by impaired cortical and subcortical connections, which leads to changes in cardiovascular activity and a deterioration in blood supply.
  4. Placental factor. Scientists argue that late toxicosis occurs against the background of the absence of the necessary vascular changes in the uterine network of vessels that feed the placental tissues. The result is the formation of specific substances that disrupt cardiovascular activity.
  5. Immunological factor. According to this assumption, late toxicosis is accompanied by an abnormal reaction of the mother's body to fetal antigens. As a result, changes occur in the permeability and tone of the vascular channels, and later in the intraorganic tissues and structures.

The vast majority of experts believe that there is no only one cause of gestosis. Usually, the functionality of intraorganic structures is impaired under the influence of a whole complex of factors.

How does late toxicosis manifest

It is very beneficial for expectant mothers to breathe fresh air.

In accordance with the degree of complexity, gestosis can manifest itself in a variety of symptoms. The clinic is divided into typical and atypical symptoms. Typical manifestations include dropsy and preeclampsia, nephropathy and eclampsia. Dropsy suggests that patients have pronounced hyperedema on the extremities and face, abdomen, etc. In fact, dropsy is considered the first stage of gestosis. Usually, the general well-being of a woman is within the normal range, but a feeling of rapid fatigue, heaviness in the limbs may appear, and a strong desire to drink something worries.

There are no signs of spikes in blood pressure, it may even be at a slightly lower level. Approximately 25% of these patients subsequently develop nephropathy against the background of dropsy. This is already a slightly different form of gestosis, in which patients are worried about a complex of several pathological conditions such as hypertension, dropsy and proteinuria. Hypertension can exceed 200/150 mm Hg. Art.

Another degree of typical preeclampsia is preeclampsia, which includes the symptoms of nephropathic syndrome, migraine pains, heaviness in the frontal or occipital area, dizziness and insomnia, veils and midges before the eyes, ear noise and lethargy, apathetic state. Also, preeclampsia is accompanied by gastrointestinal disorders such as nausea and vomiting and abdominal pain.

Eclampsia is considered the most severe form of typical gestosis. It is a state of convulsive seizures against the background of preeclampsia with additional exposure to stimuli in the form of pain syndrome, bright light or loud sounds. The attack begins with twitching of the muscle tissues of the face, turning into tonic convulsive contractions, up to the cessation of breathing. Then involuntary contractions of the limbs occur, breathing stops, the lips and nasolabial triangle turn blue, foam begins to stand out from the mouth. Then the patient takes a deep breath, after which the respiratory functions are gradually restored and the condition is normalized.

In fact, each of the typical gestosis forms represents the severity of late toxicosis. As for the atypical manifestations of gestosis, they are represented by hypertension with nephropathy and non-convulsive eclampsia.

What is the danger

Gestosis is dangerous because it can develop latently.

  • Latent internal edema appears, pressure rises, protein is secreted into the urine. Such symptoms do not cause any discomfort in mommy, therefore they do not attract her attention.
  • Only an obstetrician-gynecologist will be able to detect pathological symptoms, so you need to attend all routine examinations and take all prescribed tests.
  • Late toxicosis provokes material exchange disorders and negatively affects placental functions, which leads to acute hypoxia and nutritional deficiency of the baby.
  • The exchange of salts is also disturbed, water and sodium begin to accumulate in the tissues of the body, the permeability of the vascular walls increases. All this provokes the formation of internal hyper-edema.
  • Due to circulatory disorders, oxygen deficiency of the placenta and uterus, kidneys, liver of the brain develops.
  • Excessive accumulation of fluid in the body provokes degenerative changes, disrupts the functionality of organs and causes hemorrhages.

Therefore, the appearance of unusual symptoms, severe malaise and other signs indicating the development of gestosis, it is imperative to consult a gynecologist.

How to relieve a pregnant woman

Mineral water can be drunk in any quantity

To normalize the condition of the patient suffering from preeclampsia and prevent all sorts of complications, the patient needs to follow a half-bed or bed rest, she needs to fully sleep and rest, avoid stressful situations and stimuli such as sharp and loud sounds or too bright light. If there is excessive nervousness, it is best to discuss with your doctor the possibility of taking safe sedatives.

Mom's diet must be strictly balanced and adjusted. Carbohydrates in the diet should be limited, but eat more protein foods. Also, mommy should eat more vegetables and fruits rich in vitamins, drink fruit drinks and juices, preferably freshly squeezed. Even if there is severe puffiness, a pregnant woman should not be limited in drinking drinks.

If the situation is difficult, then the patient is prescribed drug therapy to help prevent fetal hypoxia. Diuretics are usually contraindicated because they lead to a decrease in the volume of circulating blood, which provokes the occurrence of disorders in the placental circulation. Diuretic medications are prescribed only in case of myocardial insufficiency or pulmonary edema. Additionally, you need to take vitamin complexes

If the patient does not get better, then she is hospitalized in order to exclude the development of complications of late toxicosis. The main thing is not to ignore the doctor's recommendations, not to abandon the inpatient stay, otherwise eclampsia may develop, accompanied by serious disorders of cerebral functionality, myocardial insufficiency, deep fainting, cerebral hemorrhages and even cardiac arrest. To prevent this from happening, you must follow the preventive recommendations.

Complications of gestosis

Gestosis conditions are inevitably accompanied by hypertensive symptoms and hyperexia, severe headaches and premature delivery. Late toxicosis has an extremely negative effect on fetal development and on the condition of patients, especially those with hypertension, renal pathologies, myocardial and liver failure. And in severe gestosis, complications develop, manifested by dystrophic changes in intraorganic structures. Against this background, patients may develop complications like:

  • Vascular thrombosis;
  • Chronic hypoxia;
  • Kidney failure;
  • Against the background of severe vomiting, dehydration may develop;
  • Pulmonary activity is impaired;
  • Cerebral hemorrhage occurs;
  • Particularly serious complications are cerebral edema or deep coma;
  • Also, preeclampsia is able to provoke premature delivery or intrauterine death.

For a baby, maternal gestosis can result in intrauterine growth retardation, weight deficit or mental underdevelopment of the child. If gestosis is detected before the 36-week period, it does not cause fetal disorders, then the doctor chooses observational tactics. If the patient develops eclampsia, then an emergency caesarean is performed.

Prevention methods

To avoid gestosis manifestations and complications, mom should take care of the prevention of these conditions in advance, even at the planning stage of conception. It is necessary to undergo a comprehensive examination in advance to identify latent or chronic pathologies. In addition, the patient should stop smoking and drinking any kind of alcohol, even beer. The girl should sleep at least 9 h / d, and also do a little rest in the middle of the day. You should also reconsider physical activity, if there is a risk of developing preeclampsia, then it is better to refuse them altogether.

Psycho-emotional peace should reign in the house, without scandals, petty squabbles and domestic quarrels. It is useful to do swimming or yoga, walk every day before going to bed, practice breathing exercises. You need to eat in small portions, breakfast should be unhurried and you should start it in bed with a slice of lemon. Food should be warm. For the prevention of hyperexia, it is recommended to drink renal preparations, rosehip broth, bearberry tea or lingonberry leaves. It is better to consult a nutritionist about the diet, and throughout the entire gestation it is necessary to monitor body weight in order to prevent too much weight gain.

For the prevention of gestosis, lipoic acid, magnesium preparations, tocopherol or Hofitol, Curantil, which improves placental blood circulation, are sometimes prescribed. Toxic conditions in the second half of pregnancy can complicate the course of gestation in any patient. But if you take care of prevention in advance, responsibly approach the issue of planning and register in a timely manner, following medical prescriptions, then you can minimize the likelihood of developing such a complication.

Late toxicosis (preeclampsia) is a formidable complication of the second half of pregnancy, since it is associated with dysfunction of vital organs.

Previously, gestosis was divided into "pure" and "combined". The "clean" included gestosis, which occurs in pregnant women against the background of full health, that is, in expectant mothers who do not have any chronic diseases. But more often there are combined gestosis, which develop against the background of one or another previous disease. The most unfavorable course of gestosis in pregnant women with hypertension, kidney disease (glomerulonephritis, pyelonephritis), liver and biliary tract (condition after previous hepatitis, impaired motility of the biliary tract), pathology of the endocrine organs (thyroid gland, pancreas, adrenal glands), disorders exchange.

Why does late toxicosis occur?

The cause of gestosis is the developing fetus. With the interruption or termination of pregnancy, gestosis stops, although the disorders caused by it can persist for a long time, and in its severe course lead to serious and persistent disorders of the activity of various organs and systems.

There are more than 30 theories trying to explain the onset and development of late toxicosis during pregnancy, but its true nature remains unclear to date. It is believed that the main cause of gestosis is a violation of the formation of the placenta in the early stages of pregnancy. At the same time, due to unknown reasons, at the stages of formation of the placenta, small vessels grow inadequate into the wall of the uterus, and the vessels themselves retain an increased sensitivity to substances that cause their spasm. In this case, there is a violation of the formation and maturation of the placenta, the uteroplacental and fetal-placental blood flows decrease, gas exchange and metabolism in the placenta are limited, the synthesis of placental hormones decreases. All these changes lead to insufficient supply of oxygen and nutrients to the baby, cause a delay in its growth and development. With gestosis, there are changes in the function of the endocrine organs that produce biologically active substances that regulate vascular tone, fluidity and blood clotting, as well as an incorrect reaction of the immune system of a pregnant woman to a fetus alien to her. All these changes lead to disruption of the cardiovascular system, blood supply to internal organs, metabolism in organs and tissues.

How does late toxicosis manifest during pregnancy?

The most common is the triad of symptoms: edema, protein in the urine, and high blood pressure. However, the degree of their severity is different. A combination of two of the three classic symptoms is possible.

Edema is manifested by excessive weight gain after 20 weeks of pregnancy. In a normal pregnancy, body weight gain is 350-400 g per week and 10-12 kg for the entire pregnancy. With gestosis, weight gain is more than 400-500 g per week, fluid retention is accompanied by a decrease in the amount of urine excreted.

Arterial hypertension - an increase in the level of blood pressure up to 135/85 mm Hg. Art. and higher.

The appearance of protein in the urine is the most constant and reliable sign of gestosis. In normal pregnancy, no protein is detected in the urine. The amount of protein depends on the degree of kidney damage and the severity of gestosis.

The appearance of other clinical symptoms, as a rule, indicates the development of critical forms and complications of gestosis.

Are there stages of gestosis?

Previously, doctors identified four stages of gestosis.

The first stage - edema of pregnant women - manifested itself only by the appearance of edema, the second stage was called nephropathy - at this stage, kidney damage of a pregnant woman was added, protein appeared in the urine, swelling in the pregnant woman increased, blood pressure increased, while the amount of urine excreted decreased.

The third stage, preeclampsia, is a critical but reversible condition that precedes the most severe fourth, stage of gestosis - eclampsia.

The main clinical manifestation of this severe complication of pregnancy is the attachment of symptoms of brain damage. Typical and alarming symptoms of preeclampsia are headache, dizziness, visual impairment (flickering in the eyes, fog in the eyes, temporary loss of vision, etc.), tinnitus, nasal congestion and shortness of breath, drowsiness, pain in the upper abdomen, nausea, and vomiting. A woman is worried about a feeling of heaviness in the back of the head or headaches, nausea, vomiting, visual impairment, possibly inadequate perception of what is happening, that is, changes in the mental sphere.

Preeclampsia is a very dangerous state of increased convulsive readiness of the body, when any stimulus (loud sound, bright light, pain, vaginal examination) can provoke a convulsive seizure (eclampsia) with all possible adverse consequences for the mother and fetus.

Now the first three stages of gestosis are more and more often combined by one concept - preeclampsia.

What happens in a woman's body with gestosis?

The changes occurring in a woman's body during gestosis have been studied much better than their cause. They are based on a spasm of all blood vessels, a decrease in the volume of circulating blood, a change in blood coagulability and fluidity, a violation of microcirculation. In addition, with gestosis, there is a weakening of the heart. All this leads to a significant decrease in the blood supply to tissues up to their death.

The kidneys, liver and brain are most sensitive to lack of blood supply. The placenta does not cope with work, and the so-called placental insufficiency develops. In fact, it consists in a deterioration of blood circulation in the mother - placenta - fetus system, in a violation of the exchange of oxygen and nutrients between mother and baby, which causes oxygen starvation of the fetus and intrauterine growth retardation.

Diagnostics of the gestosis

It is almost impossible to treat an already begun gestosis, therefore doctors are trying to identify pregnant women with a high risk of placental malfunction and the development of preeclampsia in late pregnancy.

For early diagnosis of preeclampsia, it is necessary to register with the antenatal clinic in a timely manner, be sure to regularly visit a gynecologist, take tests, in some cases, you may need to consult a therapist, cardiologist and neurologist.

First of all, when registering for pregnancy, the most significant risk factors are identified - smoking, previous abortions, burdened heredity (low birth weight of the previous child, tendency to thrombosis), the presence of chronic heart disease, blood vessels,.

Prenatal screening, which is performed at 11-14 weeks of gestation, provides significant assistance in assessing the risk of developing preeclampsia. It is performed to detect Down syndrome, Edwards syndrome and other chromosomal diseases in the fetus.

Determination of proteins produced by the placenta. First of all, the determination of the PAPP-A protein is carried out, a decrease in its concentration in the blood at 11-14 weeks of pregnancy occurs in pregnant women who have a high risk of placental insufficiency and fetal growth retardation. The second placental hormone that helps in assessing the risks of placental insufficiency and gestosis is PIGF (placental growth factor). Its concentration in the blood decreases long before the first manifestations of placental insufficiency. Its definition is not as widely used as PAPP-A, but nevertheless many laboratories have already included this protein in prenatal first trimester screening. Measurement of blood flow in the vessels of the uterus during the first screening ultrasound scan at 11-14 weeks is extremely important in the first trimester screening. It has been proven that the narrowing of the vessels of the uterus, determined during the study, indicates the inferiority of the formation of the placenta, which will worsen with increasing gestational age and will lead to a decrease in the baby's nutrition and oxygen supply, that is, to placental insufficiency, preeclampsia and fetal growth retardation. With normal sizes of uterine vessels at 11-14 weeks of pregnancy, the risk of developing severe late toxicosis is negligible.

Currently, a comprehensive early screening has been developed to predict the risk of developing placental insufficiency, preeclampsia and intrauterine growth retardation. Unfortunately, it is not yet included in the list of services provided in the antenatal clinic under the compulsory medical insurance (compulsory medical insurance), but is available to everyone in the prenatal diagnostic centers.

The next compulsory screening is carried out at 20-21 weeks of pregnancy. In this case, it is imperative that the fetus is measured to assess whether there is a growth retardation. Indeed, with oxygen starvation, the baby grows more slowly, its size begins to lag behind the norm for each stage of pregnancy. In addition, the doctor must assess the condition and maturity of the placenta. During ultrasound, dopplerometry of the vessels of the uterus is also carried out to identify early changes that precede the manifestations of preeclampsia.

In expectant mothers belonging to a high-risk group, in addition to ultrasound and dopplerometry, they also check pressure fluctuations during the day, determine the amount of protein in the urine sample collected per day, evaluate the indicators of the blood coagulation system.

The third ultrasound is performed for all expectant mothers at 30–34 weeks of pregnancy. The doctor measures the circumference of the baby's head and abdomen, the length of the bones of its arms and legs, and calculates the estimated weight of the fetus. These measurements allow the doctor to verify that the baby is developing normally. The structure of the placenta is also important, the presence of signs of aging in it, as a result of which it usually ceases to fully supply the fetus with blood, which means that it ceases to have enough oxygen and nutrients, and the development of the child is impaired. During an ultrasound scan, the amount and type of amniotic fluid is assessed, which can also change during intrauterine fetal suffering.

Dopplerometry. Dopplerometry of the vessels of the placenta and the umbilical cord (a method for studying the speed of blood flow in these vessels) also allows you to assess the well-being of the baby and identify the initial stages of a deficiency in blood supply. Dopplerometry is performed at 20-21 weeks and at 30-32 weeks of pregnancy, if there are changes, control is carried out at least every two weeks, and sometimes much more often.

Examination by a gynecologist. Regular check-ups by a gynecologist can help reveal hidden or obvious swelling. At the early stage of gestosis, it is the latent edema associated with fluid retention in the tissues that appears. To identify them, you must carefully monitor the weight of the pregnant woman. In some cases, the doctor may recommend monitoring the amount of fluid you drink and secreted.

Not all edema in pregnant women is associated with gestosis. But when they appear, you must definitely contact your doctor.

In the second half of pregnancy, independent pressure control is also necessary, since its increase is not always accompanied by any manifestations.

In the diagnosis of vascular disorders and gestosis, an examination by an ophthalmologist of the fundus helps, since the state of the vessels of the eye is similar to the state of the vessels of the brain and the vascular system of a woman as a whole.

Treatment of gestosis during pregnancy

As noted above, it is, unfortunately, impossible to completely cure gestosis at the moment. However, in most cases, timely and correct treatment can prevent the development of severe forms of late toxicosis in pregnant women. An important point is the creation of a therapeutic and protective regime for the woman's nervous system, depending on the degree of the disease, various sedatives are prescribed. When the pressure rises, you will definitely need to take medications that lower it. Medicines aimed at improving the flowing properties of blood are widely used.

The only effective method of treating severe forms of gestosis is delivery. It is clear that they resort to it only in cases when it is necessary to preserve the health of the mother and the life of the baby. Spontaneous childbirth is permissible if there are appropriate conditions: a satisfactory condition of the woman, the effect of treatment, the absence of intrauterine fetal suffering. When the condition of the expectant mother deteriorates (pressure build-up, the appearance of brain symptoms) and the fetus, a cesarean section is indicated.

Late gestosis is a formidable complication of the second half of pregnancy. Since this condition is poorly treatable, it is much easier to take timely measures to prevent its development.

The most dangerous condition

Eclampsia is the most dangerous manifestation of severe gestosis. It occurs against the background of preeclampsia and is characterized by disruption of the work of almost all systems and organs. The main symptom of preeclampsia is the onset of seizures.

After a convulsive seizure, the woman is in a coma for some time, consciousness returns gradually, she does not remember anything about what happened. The seizures may recur at short intervals. During an attack, due to a sharp rise in blood pressure, a cerebral vessel may rupture, which causes a stroke - intracranial hemorrhage. There is also a high risk of premature placental abruption, which can lead to fetal death.

Late toxicosis or preeclampsia is a serious disease that occurs late in pregnancy. With this disease, the presence of severe failures in the work of the main systems and organs is noted.

Gestosis: what is it?

The disease in question occurs mainly in the later stages.

Gestosis is a complication of pregnancy, due to which there is a disorder in the performance of vital organs and blood flow. It is characterized by malfunctions in the work of the brain, blood vessels, kidneys and other organs of a woman.

In more than 90% of situations, toxicosis develops by the end of the term, after the 34th week. Girls with the first pregnancy are most susceptible to illness. The emergence of the same disease at a later date is an alarming signal. In general, the later the disease occurs, the more favorable the prognosis.

Types of gestosis:

Vodyanka. The main symptom is fluid retention in the body, which manifests itself in the form of edema and weight gain. Especially you should be alerted by swelling of the ankles, scanty urination.

Nephropathy. In this type of gestosis, swelling, increased pressure, and the presence of protein in the urine are also observed. The danger of this ailment is that it can move to the next stage - a convulsive attack - to cause disturbances in the work of internal organs, and even the death of a child.

Preeclampsia. This term is called a type of gestosis, in which there is a violation of the central nervous system. Typical symptoms: heaviness in the back of the head, pain in the head, stomach, under the ribs, nausea, vomiting. In advanced cases, memory impairment, impaired vision, "sparks" or a veil before the eyes are possible due to circulatory disorders and damage to the retina.

Eclampsia - This is the worst type of gestosis. Its symptoms are a mixture of nephropathy and preeclampsia, convulsions are possible with harsh sounds, stress, and bright light.

Symptoms of gestosis

Usually:

  • pressure rises,
  • protein is detected in the urine analysis,
  • visual disturbances appear,
  • nausea, vomiting, headache.

Toxicosis can manifest itself in different ways.

  • The first signs of the disease are most often found around the 29th week.

First of all, swelling occurs in the area of \u200b\u200bthe face and limbs - "Dropsy of pregnant women." This manifestation is the least severe of all existing symptoms. Unexpressed swelling of the patient is often not even noticed. To establish the presence of puffiness, the girl should regularly monitor her body weight.

Under normal conditions, body weight after the 28th week increases by 300-500 grams within 7 days. If a girl grows heavier by more than half a kilogram in 7 days, this is most often due to insufficient effective removal of fluid from her body.

  • A more serious sign of late toxicosis in pregnant women is nephropathy.

With this violation, there is a failure of kidney function, against the background of which edema is formed, protein is detected in the urine analysis, and the pressure increases. It is very important to control the concentration of protein in the urine - as it increases, the chances of successful maturity and natural childbirth decrease.

The main sign of nephropathy is a decrease in urine volume. This symptom is extremely alarming. It is to him that the patient should first of all pay her attention. Usually the situation develops like this:

Edema occurs;

Pressure rises;

The volume of urine excreted decreases.

  • Also severe signs include preeclampsia and eclampsia.

At the same time, the listed deviations are the final stages of the disease. If they are found, it is extremely important to consult a doctor in time and take the required measures, because these conditions directly threaten the life of the child and the woman herself.

Preeclampsia is characterized by microcirculation failures in the nervous system. The main signs of such a deviation are standard manifestations - the detection of protein in the urine, swelling, an increase in pressure. Vision problems are added, as well as nausea, severe headaches, "veil" or "flies" before the eyes.

In the absence of timely assistance, preeclampsia turns into a more dangerous state - eclampsia. A woman has sudden convulsions, often accompanied by loss of consciousness. Eclampsia is very dangerous, sometimes it even ends with the death of the patient.

Thus, toxicosis is an extremely dangerous ailment.

Even with mild symptoms such as headaches and pressure, you should immediately go to the hospital.

and tell the specialist in detail about all the disturbing moments, because the sooner the required measures are taken, the more likely it is to preserve the pregnancy and give birth to a full-fledged baby.

Why is gestosis dangerous?

The disease negatively affects the condition of the woman and the fetus. Malfunctions in the functioning of organs and systems may occur. Vascular spasms occur, microcirculation is interrupted, microthrombi appear, which can cause cerebral hemorrhage, vascular thrombosis, edema of the brain and lungs, problems with the kidneys, heart and liver appear, the patient may fall into a coma.

Due to constant vomiting, a woman's body becomes dehydrated. Placental abruption may occur, asphyxia and premature birth are not excluded.

When diagnosing a severe degree of the disease, premature birth occurs in about 20% of situations. If the disease progresses to eclampsia, almost every third baby is born prematurely.

Regardless of the form of the disease, it causes many problems for the fetus. In the event of a detachment of the placenta, the fetus may even die - this happens in almost every third situation.

Due to the sluggish toxicosis, oxygen deficiency occurs, against the background of which there is a delay in the development of the baby. More than a third of children born to patients with toxicosis are underweight.

Due to oxygen deficiency, the development of the baby is delayed in mental and psychological terms. Such children are more likely to get sick.

In the case of the progression of the disease to eclampsia - the most severe form - they resort to either termination of pregnancy or urgent delivery. At the same time, provoked delivery is not always safe for a premature fetus.

Rarely, but sometimes a very serious complication still appears, known as acute liver dystrophy. Because of him, a woman can die.

Also, toxicosis can lead to profuse bleeding after childbirth.

Why does late toxicosis appear?

The exact causes of the pathology in question have not been determined. Among the predisposing moments are:

  • insufficient fitness of the woman's body;
  • disruptions from the endocrine, as well cardiovascular systems;
  • vasospasm, circulatory disorders;
  • hormonal imbalance, incompatibility between the fetus and the mother;
  • diseases of the liver, kidneys, biliary tract;
  • constant stress;
  • excessive weight;
  • intoxication with nicotine, alcohol and drugs;
  • manifestations of an allergic and immunological nature.
  • factor of heredity. An unproven factor, but practice shows that such cases also exist.

There are many theories of the onset of toxicosis, among which the following are the most relevant:

1. Cortico-visceral ... In accordance with its provisions, gestosis occurs against the background of disorders from the brain, as well as the nervous system. The female body is trying to adapt to pregnancy. As a result of the listed and additional associated failures, the circulatory system stops working correctly and the disease in question begins to develop.

2. Hormonal, it is endocrine. In accordance with this theory, toxicosis appears due to various kinds of endocrine disruptions. Along with this, many researchers are sure that such failures occur already against the background of toxicosis.

3. Placental... The adherents of this theory see the root causes of the disease as violations in the work of the placenta and uterus.

4. Immunogenetic... It is considered the closest to the truth. In accordance with its provisions, an incorrect immunity response to fetal proteins leads to the appearance of the disease in question. The female body regards them as foreign bodies and tries to destroy them.

5. Genetic... Studies confirm that patients whose closest relatives suffered from late toxicosis are 7-8 times more likely to develop the disease.

Risk factors for the development of late toxicosis

Among the risk factors that can provoke the onset of the disease are:

  • constant stress and overwork;
  • pregnancy under the age of 18 and over 35;
  • frequent abortions;
  • intoxication;
  • infectious diseases;
  • poor environmental situation around;
  • poor quality food;
  • bad habits.

Diagnosis of toxicosis

You must regularly attend antenatal clinics

To confirm or deny the presence of the disease, it is not enough just to go to the doctor and tell him about the disturbing circumstances. First of all, you need to undergo regular examination by a gynecologist.

At each visit, the woman's body weight, heart rate and blood pressure are compulsorily measured. During pregnancy, even a relatively small increase in pressure may be a sign of the disease in question.

The doctor evaluates the dynamics of weight gain by the patient, checks her for edema, and is interested in changes in the volume of urine output.

If there is a suspicion of gestosis, the pregnant woman is sent for more detailed studies and analyzes. The list is standard:

  • analysis of urine;
  • a blood test for biochemistry;
  • ultrasound procedure;
  • kidney function, fundus condition;
  • dynamics of weight change;
  • cardiotocography and dopplerometry.

The following events are also usually assigned:

  • analysis of urine for protein content. Additionally, analyzes are carried out according to Zimnitsky and Nechiporenko;
  • regular measurements of heart rate and blood pressure;
  • hemostasiogram.

Methods for treating preeclampsia

The procedure for treatment is established only after the patient undergoes the required examinations and the necessary tests. Remember: a course of therapy can only be prescribed by a qualified specialist.

Self-medication in such cases is unacceptable, because by doing so, you only risk harming yourself and your child.

Treatment of mild manifestations of toxicosis, as a rule, is carried out on an outpatient basis. In case of nephropathy and more serious problems, the pregnant woman is hospitalized and taken under constant supervision in the obstetric department.

If the edema is insignificant and the conclusions on the analyzes, in this case, in the norm, no therapeutic measures, except for recommendations for adjusting the diet and lifestyle, are not used.

With severe edema and mild nephropathy, the doctor may prescribe:

  • sedative medications (usually mild, such as valerian, motherwort, etc.);
  • antioxidants;
  • antiplatelet agents that help normalize blood rheological parameters;
  • diuretics (usually on a natural herbal basis).

If headaches and an increase in pressure are present, antispasmodic antihypertensive drugs are prescribed.

Treatment of severe forms

Severe complications are treated intensively, with the assistance of a resuscitator. To normalize electrolyte and metabolic processes, infusion therapy techniques are used, during which the patient receives rheopolyglucin and fresh frozen plasma.

For the treatment of severe forms of the disease, anticoagulants are used. If necessary, the rapid normalization of water-salt metabolic processes, phyto-assemblies are replaced by diuretics.

Regardless of the form of toxicosis, the doctor prescribes selective sympathomimetics to prevent the development of hypoxia and premature birth.

It is not uncommon to make decisions about the safest and most optimal method of delivery. So, if the patient is in a relatively normal state and there is no threat to the child, judging by CTG and ultrasound, the childbirth is carried out without cesarean. If therapy does not give the desired result, in the presence of chronic hypoxia and other serious complications, they resort to cesarean section.

Treatment methods are used not only before childbirth, but also after pregnancy, until the patient's body condition is completely normalized.

The girl should make every effort to prevent the development of toxicosis.

  • First, she needs to adhere to the optimal sleep and rest patterns, stay at rest, avoid stress and other situations that can negatively affect the baby's condition.
  • Secondly , you can't be nervous... She should be outdoors more often and walk. It is important to prevent hypothermia of the body and to fight any stool disorders in a timely manner.

The most important preventive tool against gestosis is correct, balanced, regular and nutritious nutrition... The diet must include the required amount of protein. It is best obtained from fresh dairy products, meat and eggs. You can eat boiled fish. Read more about proper nutrition during pregnancy.

Even with the appearance of edema, you cannot limit yourself in fluid intake, because with its deficiency, the blood thickens, which promises many problems for the patient and her baby. The recommended rate of fluid intake is from 2 liters per day.

During pregnancy, you can not lean on salt-free diets, but an excessive amount of salty is also unacceptable. Salt consumption rate is up to 6-8 g per day.

You can take diuretics only as directed by your doctor.

You can take any kind of diuretic to eliminate edema only as directed by your doctor.

With the uncontrolled intake of such drugs, important trace elements will be washed out of the body. Also diuretics help to thicken the blood. Even the relatively safe herb bear ears is contraindicated in the presence of toxicosis.

Late toxicosis is an extremely dangerous and rather insidious disease, so

self-medicate and take any kind of action without first discussing with your doctor is prohibited.

Remember: your health and the life of an unborn baby directly depends on how responsibly you approach compliance with medical prescriptions, adhere to a rest regimen, follow a diet.

If you find the first signs of an illness, see your doctor. Toxicosis left unattended can not only badly affect your well-being, but even lead to death. Health to you and your baby!

Content:

One of the most severe and dangerous complications in pregnant women is late toxicosis during pregnancy. This pathology is characterized by functional disorders of organs that are of vital importance. Toxicosis occurs along with the development of pregnancy and cause disastrous consequences not only for the mother, but also for the fetus.

Concept and definition of late toxicosis

Pregnancy is complicated by late toxicosis in about 13% of pregnant women. Most often it appears after the 30th week. Symptoms of toxicosis increase gradually. Therefore, with timely registration, regular visits to the doctor and the delivery of tests, you can significantly reduce the risk of pathology and prevent a threat to the life of the mother and the unborn child.

When late toxicosis occurs, the work of the endocrine, cardiovascular and nervous systems is disrupted. Prevention of death in severe cases becomes possible only with the help of an emergency caesarean section. The danger of such a condition is manifested in acute heart failure, coma, pulmonary edema, premature placental abruption, and acute hypoxia in the fetus. Pathology proceeds in several stages, the most severe and dangerous of which are the latter.

Late toxicosis during pregnancy is also known as gestosis. It completely resolves in the period from several hours to several days after delivery. However, high pressure, caused not by gestosis, but by hypertension, cannot pass on its own and requires the adoption of separate therapeutic measures.

The following categories of women are at risk:

  • Age less than 18 and over 35 years old.
  • The presence of preeclampsia during previous pregnancies.
  • The development of multiple pregnancies.
  • Diseases in the form of heart defects, hypertension, chronic kidney disease, etc.

In most cases, the cause of the onset of late toxicosis remains unknown. In general, this is not decisive, since all efforts are directed to combating the severe consequences of pathology.

Causes of late toxicosis

The exact causes of late toxicosis have not yet been established. From a medical point of view, a number of factors are considered that can give rise to the appearance of this pathology. First of all, they are associated with various diseases and disorders of the vital organs and systems - heart, liver, kidneys, as well as endocrine diseases. The cause of gestosis can be frequent stress, obesity, intoxication of the body with alcohol, smoking, drugs, the presence of allergic and immunological reactions.

There are several versions of the causes of the onset and development of late toxicosis:

  • According to the cortico-visceral theory, nerve regulation is impaired between the subcortex and the cerebral cortex. As a result, the mother's body begins to adapt to the onset of pregnancy. This condition leads to a failure in the circulatory system and the further occurrence of gestosis.
  • The hormonal or endocrine version is associated with violations of the basic functions in the endocrine system. However, there are opinions that these violations appear already during the period of gestosis and serve as secondary signs. They affect the adrenal cortex, the ovaries, which produce estrogens. In some cases, the disorder is insufficient hormonal activity of the placenta.
  • Sometimes in the placenta and uterus, vessels change, spasms occur, blood flow is disturbed, causing hypoxia. These deviations refer to placental disorders. Their essence lies in the formation of the placenta simultaneously with the fetus. Its insufficient development at the initial stage does not provide protection of the female body from the metabolic products of the fetus. The entry of these substances into the bloodstream of the female body leads to intoxication, accompanied by nausea, vomiting, and intolerance to odors. After sufficient development of the placenta, these phenomena gradually disappear.
  • An immunogenetic version is most likely considered. In this case, the development of gestosis occurs as a result of a negative immune response of the woman's body to foreign proteins or fetal antigens. There is an attempt to reject it. In another situation, antibodies are produced by the female body in insufficient quantities. Therefore, they cannot cope with placental antigens entering the bloodstream. Thus, the circulation of defective complexes occurs in the blood, which lead to circulatory disorders.

In most cases, late toxicosis occurs and develops under the influence of several factors at once. Changes in the female body cause an increase in the permeability of the vascular walls. Because of this, the liquid component of the blood penetrates into the tissues, leading to the appearance of edema. They occur in the uterus and placenta, disrupting blood supply and impairing oxygen supply to the fetus.

Symptoms of late toxicosis

Edema is considered the main sign of gestosis. The liquid consumed by a woman in large quantities is not completely excreted from the body, but remains in the space between the tissues. As a rule, edema occurs only in the lower extremities, however, in severe form, the entire body can swell. There is a so-called latent form of edema, which is only detected by weighing. This is evidenced by the weight gain of over 500 g within a week. It becomes necessary to control the amount of fluid consumed and, accordingly, urine output. If, while observing the normal drinking regimen, urine output is lower than 0.8 liters, this may become the most likely manifestation of gestosis.

Along with fluid retention, hypertension develops. Therefore, the pressure must be constantly monitored. As a rule, the pressure with late toxicosis becomes higher than normal by about 15-20%. In some women, hypotension is noted in the initial period of pregnancy, when the pressure level is below the norm. This factor must be taken into account during the examination.

Proteinuria, when protein is excreted in the urine, is a serious symptom. This symptom indicates impaired kidney function. In such a situation, urine analysis is of great importance, which should not be missed. After 20 weeks of pregnancy, such a study is carried out weekly. If a woman has several symptoms of pathology at once, treatment at home becomes ineffective, it is recommended to hospitalize such patients.

Other symptoms are manifested in the form of headache, nausea and vomiting, heaviness in the head, and in more severe forms, convulsions and altered consciousness are observed.

The main types of gestosis

Symptoms and forms of the disease make it possible to divide gestosis into several degrees of severity:

  • The first degree of gestosis in pregnant women manifests itself in the form of dropsy. The woman becomes noticeable swelling, which decreases in the morning and increases again in the evening.
  • The second degree is characterized by the presence of all the main symptoms. First of all, it is diastolic pressure, which is directly related to the blood flow of the placenta. With increasing pressure, the supply of oxygen to the fetus decreases. The greatest danger is represented by pressure changes in the form of regular surges. This stage is complicated by the presence of concomitant diseases. The most severe complications are considered such as bleeding, fetal hypoxia, placental abruption, the onset of premature birth. All of them pose a real threat of fetal death.
  • With the third degree of gestosis, the development of preeclampsia occurs, manifested by pain and heaviness in the head. At the same time, vomiting, pain in the liver region, and visual impairment may appear. Apathy sets in, memory worsens. All this is accompanied by insomnia, irritability, and other symptoms that indicate altered blood circulation in the brain. The liver can be injured by severe edema, even hemorrhage.

The most severe form of late toxicosis is eclampsia. In addition to the symptoms already listed, convulsions appear. Attacks can be triggered by external stimuli - pain, loud sounds, stress, bright light. They last about two minutes. The danger of this condition is cerebral edema, cerebral hemorrhage, which can be fatal.

Diagnosis and treatment of toxicosis

The most complete diagnosis of gestosis is carried out using general and laboratory research methods. Pressure is measured at least three times a day, including after exposure to light physical exertion. A general urinalysis can detect protein and increased urine density. A special analysis of urine according to Zimnitsky establishes its volume excreted at night.

A general and biochemical blood test, as well as a coagulation test, is mandatory. The amount of liquid drunk and excreted is monitored daily. Weight is measured every week. The data obtained make it possible to develop the most optimal set of therapeutic measures.

As a rule, late toxicosis is treated in an inpatient setting. It is recommended to start treatment at an early stage, when symptoms are manifested only by the presence of edema. First of all, a protective regime is prescribed with the appointment of a diet and special drugs that affect the desired blood parameters. Drops help improve blood circulation, kidney and liver function. Sedative sedative therapeutic measures are performed. It is impossible to completely cure gestosis, since the exact causes of the disease cannot be established.

In the presence of late toxicosis in the period from 29 to 36 weeks, in the case of increasing clinical manifestations, the woman prepares for childbirth a little earlier than the established date. If the intensive care measures are ineffective, and the form of gestosis is severe, a caesarean section is performed. With a time reserve of 3-4 days, the cervix is \u200b\u200bprepared using a special gel containing prostaglandins. In this case, the woman can give birth on her own. However, in the absence of complications, threats to life and health, the possibility of treating preeclampsia, it is recommended to delay childbirth until the prescribed time.

Complications and consequences of late toxicosis

Most often, the development of late toxicosis occurs after the 20th week of pregnancy. It causes serious complications that become the leading causes of death.

As a rule, late toxicosis during pregnancy can cause the following complications:

  • Spasms of small arteries occur, which are detected by ophthalmologists when examining the fundus.
  • The permeability of the vascular walls increases, the outflow of blood in the veins worsens. As a result, there are obvious or latent edema, protein appears in the urine.
  • The liquid component of the blood is released into the adjacent tissues. Because of this, the blood thickens, its coagulability increases.
  • The lower and the upper blood pressure rises.

Every pregnant woman knows firsthand that toxicosis is an unpleasant condition of the body. It is accompanied by vomiting, nausea. It occurs due to poisoning of the body with harmful substances and toxins.

In principle, toxicosis during pregnancy is not so dangerous if it torments a woman in the early period of gestation. Attacks of nausea and vomiting in the last or in the middle of the second trimester of pregnancy are dangerous to both the health and life of the mother and her unborn child.

Late toxicosis during pregnancy is also called gestosis. Its symptoms can be rather vague, so it can be difficult to diagnose the initial stage.

Gestosis develops in about one in ten women. Its danger lies in the fact that it is accompanied by disorders of the whole organism and often leads to serious consequences, urgent childbirth, and sometimes even death.

The patient with the first signs of toxicosis in the third trimester of pregnancy is urgently admitted to the hospital. There she is under the supervision of a doctor. In acute cases, childbirth is accelerated and the mother with the premature baby is transferred to the appropriate department.

Complications of the gestational period develop both during gestation, at the time of childbirth, and immediately after them.

Symptoms of gestosis

Late toxicosis has three main symptoms:

  1. Swollen body;
  2. High blood pressure;
  3. There is protein in the urine.

The first sign of gestosis is edema. They are the first to report the problem. But it also happens that, apart from them, nothing expresses pathology. Then the degree of late toxicosis is determined by the severity of these edema:

  • swelling in the arms and legs;
  • swollen limbs, as well as the abdomen;
  • swelling reached the neck, covered the face.

At the second stage, it is necessary for the pregnant woman to measure the pressure. If it is 20% higher than the indicator that was before pregnancy, it is possible to diagnose late toxicosis.

To finally make sure of the diagnosis, a urinalysis is done. The normal protein indicator is considered 0, if it is present, the diagnosis is fully confirmed.

Possible reasons

Late toxicosis of pregnant women is a poorly understood pathology, and therefore it is almost impossible to indicate definitely what causes nausea during pregnancy. There are only obvious factors provoking pathology. These include:

  • immune disorders;
  • allergy;
  • poisoning with harmful drugs - nicotine, alcohol, drugs;
  • endocrine diseases;
  • kidney problems;
  • overweight;
  • nervous environment;
  • failures of the heart;
  • poor ability of a pregnant woman to adapt.

Most often, toxicosis in the later stages is manifested in women:

  • with the first pregnancy;
  • with underdeveloped genitals;
  • with the presence of chronic infectious diseases;
  • who terminated pregnancy;
  • suffered from toxicosis earlier;
  • under the age of 18 and later than 35;
  • with a symptom of chronic fatigue;
  • with multiple pregnancies.

Why is late toxicosis dangerous?

Toxicosis in late pregnancy poses a serious danger to both the unborn child and the pregnant woman herself. For the latter, the presence of vomiting and nausea in the 3rd trimester can have the following consequences:

  • premature birth of a child;
  • dehydration of the body;
  • premature detachment of the placenta;
  • the formation of blood clots;
  • violation of circulation in the brain;
  • cerebral vasospasm;
  • failure of some organs.

The life of the child is also in danger. After all, gestosis provokes:

  • retardation of intrauterine development and fetal growth retardation;
  • dementia of the child;
  • excessively small fetal weight;
  • lack of oxygen;
  • premature detachment of the placenta leads to the death of the baby.

Of course, it is strongly discouraged to take the disease to the extreme. If, for some reason, the pregnant woman could not be diagnosed with the disease and it proceeds without treatment, she herself should carefully assess her condition. If you have the following symptoms, you should see a doctor urgently:

  1. Fever, chills, or shortness of breath.
  2. Head and temporal pains torment.
  3. The pregnant woman is sick.
  4. Constantly tends to sleep, or vice versa, she is overly active.
  5. Disturbing cough, hoarseness, stuffy nose, hearing impairment, difficulty speaking.

Ignoring these symptoms of toxicosis in the third trimester of pregnancy will contribute to hemorrhage and cerebral edema. And this is fraught with death.

Timely diagnosis

It is almost impossible to determine at a glance whether a pregnant woman really has late toxicosis. This can only be done by doctors with many years of experience, and even then not always. That is why a thorough diagnosis of gestosis implies:

  1. Accounting for complaints of a pregnant woman.
  2. Laboratory research.
  3. Amnestic data.

Research is needed to fully establish the problem:

  • fundus condition;
  • dynamics of changes in the weight of a pregnant woman;
  • blood pressure measurements;
  • determine the ratio of urine excreted to the fluid consumed by the patient;
  • general and biochemical blood count, as well as the level of coagulation;
  • general urine analysis.

Also, the patient needs to undergo Doppler ultrasound and ultrasound.

Observation

For a patient who is nauseous in late pregnancy, in order to alleviate the general condition and prevent the consequences of gestosis, it is necessary:

  • rest more;
  • eat a lot of vegetables, fruits, use any healthy liquid;
  • a balanced diet in which protein foods predominate and carbohydrates are reduced;
  • communication with a psychologist, possibly even with the use of sedatives, acceptable during pregnancy;
  • complete elimination of nervous situations, loud noises;
  • good dream;
  • calm rest.

Treatment

The basic principles for the treatment of gestosis are:

  • hospitalization in the department of pregnancy pathology;
  • compliance with a calm regime;
  • taking appropriate medications;
  • elimination of malfunctions of important organs;
  • fast, but most importantly, careful childbirth.

In the treatment of gestosis, all measures are aimed at normalizing water-salt metabolism, blood pressure indicators, the state of the walls of blood vessels, metabolic processes, circulation, viscosity, blood clotting, as well as the activity of the central nervous system.

Prevention

Prevention means preventing the development of late toxicosis in pregnant women. To achieve this, a pregnant woman needs:

  • proper organization of nutrition, rest, physical activity;
  • stay in the fresh air;
  • low salt and liquid intake;
  • observation of the entire course of pregnancy by a doctor;
  • control of blood pressure, urine indicators, weight.

Prophylaxis with medicines is prescribed by a doctor. Self-medication is unacceptable, otherwise there is a risk not only of giving birth to a sick child, but also of losing it altogether.

So, late toxicosis, the causes of which are intoxication, as well as harmful substances that the body of a pregnant woman secretes, should not be underestimated and taken lightly. If this pathology is not treated, it may well lead to unpleasant, serious consequences. Starting from difficult and sudden childbirth and ending with a fatal outcome for both participants in the process: the mother and her baby.

That is why, if toxicosis is detected at a later date, or just a suspicion of it, it is most reasonable for a pregnant woman to consult a doctor and in no case self-medicate.