Preeclampsia or late toxicosis - causes and methods of treatment. What is late toxicosis of pregnant women? One of the forms of late toxicosis

What's happened toxicosis during pregnancy? There are early and late toxicosis during pregnancy. Pregnancy is a joyful event, especially if it is planned in advance and is long-awaited. But the joy of the first realization that a woman will soon become a mother can be overshadowed by the appearance of toxicosis. Well, what joy can you experience from nausea, vomiting, increased salivation and a decrease, or even a complete lack of appetite?

What is toxicosis

Toxicosis during pregnancy a frequent phenomenon, which is characterized by nausea, vomiting, aversion to food, intolerance to odors, general weakness. Often with toxicosis there is profuse salivation, drowsiness, weight loss.

A woman's self-hypnosis plays a significant role in toxicosis, which enhances the discomfort.

Who is at risk?

Any pregnant woman may be prone to early or late toxicosis. There are several factors that can cause toxicosis:

• heredity;
• multiple pregnancy;
• unstable psyche and through dimensional emotionality.
• the presence in a woman of diseases of the kidneys, endocrine system, hypertension, digestive system;
• age up to 18 and after 35 years;
• genital infections;
• excess weight;

The severity of toxicosis

Toxicosis can be mild, moderate and severe. The first two types can be somewhat relieved in a fairly safe way, but still be sure to tell your doctor about the sensations you are experiencing - this is necessary in any case.

Toxicosis of varying severity is characterized by:

In the first degree of severity, the urge to vomit is infrequent, maximum 5 times a day, weight loss is within the normal range;

The second degree of toxicosis is manifested by frequent urge to vomit, weight is lost within 5 kg;

In the third degree of severity, vomiting torments a woman up to 20 times a day, while the general well-being of the woman worsens, the temperature often rises, and the heartbeat quickens. Often a pregnant woman loses weight by 10 or more kg. With such severe toxicosis, mandatory hospitalization is indicated, otherwise a miscarriage may occur.

Types of toxicosis

Toxicosis in pregnant women are divided into early and late. The first type of toxicosis is more common and carries much fewer complications. Toxicosis in the last months of pregnancy is called. It is manifested by increased intracranial pressure, appears, and rapid weight gain. This can lead to premature and difficult births and is generally dangerous to the health of both the mother and the baby. Gestosis is divided into four types:

Early toxicosis: when it starts, causes and symptoms

When does toxicosis begin in pregnant women

Early toxicosis can occur simultaneously with pregnancy and lasts approximately sixteen weeks, during this period the placenta is fully formed and assumes the role of a protector of the fetus. At what week of pregnancy does toxicosis begin?? Most women begin to experience morning sickness at 7-8 weeks pregnant.

In 1-2% of cases, early toxicosis is very difficult.

In a severe form of early toxicosis, weakness, high fever, weight loss and tachycardia (more than 90 beats per minute) are observed.

It happens that pregnancy proceeds without manifestations of toxicosis. This indicates the ideal health of a woman, her body has completely adjusted to the new conditions and is ready to bear a baby.

Causes of early toxicosis

The causes of early toxicosis can be of a different nature:

• heredity;
• the presence of multiple pregnancy;
• diseases of the digestive system;
• unstable psyche and overwhelming emotions.

The reason for the manifestations of toxicosis in the early stages may be the adaptation of the body to the presence of the embryo. The female body begins to rebuild at the biochemical level, while many new organic substances are produced. The hormonal background of a woman changes completely immediately after conception. Also, in the first stages of pregnancy, the placenta is formed, which later, starting from the second trimester of pregnancy, takes on the protective functions of the fetus from toxins.

Symptoms and treatment of early toxicosis

The main (clinical) symptoms are nausea and vomiting. Non-clinical include:

• jaundice is damage to the liver, which leads to a yellowish color of the skin. In this case, emergency hospitalization is required.
• dermatoses - itching all over the body, eczema may appear;
• asthma (suffocation attacks);
• ptyalism is increased salivation (up to 1 liter per day, can cause maceration of the mucous membranes and skin);
• seizures and osteomalacia (softening of the bones) occur due to a decrease in calcium levels in the blood.

Toxicosis during early pregnancy, how to deal with it?

When these symptoms are detected, it is shown:

• Physical and emotional peace;
• Taking vitamins;
• antiemetic therapy;
• Reception of solutions from dehydration;
• Taking sedatives;
• Taking protective drugs for the liver.

Late toxicosis: when it starts, causes and symptoms

When does late toxicosis begin?

At what stage of pregnancy does toxicosis begin?(late)? It manifests itself from the 18th week of pregnancy and lasts until the very birth.

In late pregnancy, especially if it is the first, as a rule, the symptoms of toxicosis are much stronger.

Causes of late toxicosis

The causes of late toxicosis may be:

• a woman has kidney disease, hypertension;
• age up to 18 and after 35 years;
• multiple pregnancy;
• genital infections;
• toxicosis in previous pregnancies;
• overweight;
• smoking and harmful working conditions before pregnancy.

As a result of increased pressure, the blood thickens, clotting increases, so blood clots can form. Due to edema, fetal hypoxia occurs, cerebral edema can lead to eclampsia, which is fatal. To save the life of mother and child resort to caesarean section.

Symptoms and treatment of late toxicosis

Doctors distinguish three main (clinical) symptoms:

• The main symptom is swelling in different parts of the body, as well as swelling inside the body;
• Increased protein content in the urine;
• Weight gain as a result of water retention in the body.

When these symptoms are detected, hospital treatment. It includes:

• Bed rest (full);
• A special diet, mainly plant and dairy foods. Restriction of fats, water and salt;
• Reduction of edema with diuretics;
• Decreased blood pressure.

How to relieve the symptoms of toxicosis?

And do not think that toxicosis is the lot of all pregnant women. If you assure yourself that you will be able to avoid it, you will not experience such unpleasant symptoms. The main thing is to tune in to a positive result. Trust me it will help.

Factors that can provoke the appearance of discomfort, it is better to exclude. Of course, neither the sounds that cause irritation, nor the foods and smells that cause vomiting can be completely ignored or avoided. But keeping them to a minimum is a good thing. And always be in a calm state, breathe correctly and be distracted by something else. How to get rid of toxicosis during pregnancy?

Preeclampsia or late toxicosis during pregnancy is a pathological condition that is accompanied by disorders from various body systems. It is dangerous for its consequences, in severe cases there is a risk of death and an emergency delivery is required.

Late toxicosis develops in about 10-15 women out of 100. At the first sign of a complication, the patient is hospitalized in the pregnancy pathology department.

The difficulty is that it is not always possible to identify preeclampsia at the beginning of its development, the symptoms can be blurred.

What is the danger of late toxicosis?

The danger of late toxicosis is in a gradual latent development: internal edema, protein in the urine, an increase in blood pressure often do not cause any discomfort in a pregnant woman and go unnoticed.

A doctor can identify this condition, which is why regular visits to him are so important. Preeclampsia disrupts metabolic processes and affects the state of the placenta: the child develops a lack of oxygen and nutrition.

With late toxicosis, violations of salt metabolism occur, sodium and water accumulate in the body, and the walls of blood vessels become more permeable. This leads to the filling of tissues and organs with fluid and internal edema.

Blood circulation is disturbed, tissues receive insufficient oxygen and nutrients. The brain, liver, kidneys, uterus and placenta suffer. Hyperhydration leads to dystrophic changes, hemorrhages, dysfunctions of organs.

Causes of late toxicosis

Clinical studies aimed at studying the causes of preeclampsia have not revealed what plays a primary role in its development.

To date, there are several assumptions:

1. Proponents of the corticovisceral theory believe that toxicosis during late pregnancy is a kind of neurosis, expressed in violation of the physiological cortical-subcortical connections. As a result, the work of the vascular system changes, blood supply worsens.
2. The endocrine theory states that a change in the activity of the glands leads to dysregulation of the cardiovascular system, deterioration of blood circulation and metabolism in organs. This is because hormones affect vascular tone, clotting and blood flow.
3. Adherents of the immunological theory say that with gestosis, an inadequate reaction of the mother's body to the child's antigens occurs. This leads to changes in vascular tone and permeability, and then to disturbances in organs and tissues.
4. The genetic theory is based on the assumption that the frequency of late toxicosis is higher in pregnant women whose mothers also suffered from this complication. Perhaps there are "preeclampsia" genes.
5. The placental theory claims that the main cause of preeclampsia is the absence of changes in the vascular network of the uterus that feeds the placenta, which are characteristic of a normal pregnancy. Therefore, substances are formed that disrupt the mother's cardiovascular system.

Most researchers agree that it is impossible to single out one cause of late toxicosis. Violation of the function of internal organs occurs due to the combined effects of various factors.\

Signs of pathology

Symptoms of toxicosis in late pregnancy depend on the form of pathology. According to this criterion, typical and atypical manifestations are distinguished. The first group includes:

1. Dropsy. Its only symptom is swelling that appears on the arms, legs, abdomen and face. This form is the first stage of late toxicosis of pregnant women. The woman's well-being does not worsen, only with pronounced edema there is a feeling of heaviness, fatigue, excessive thirst. There are no changes in blood pressure, it is either normal or slightly below it. Nearly a quarter of pregnant women with dropsy subsequently develop nephropathy. Read more about dropsy of pregnancy→
2. Nephropathy. This form is manifested by a combination of edema, hypertension and proteinuria (the appearance of protein in the urine). The main symptom is arterial hypertension, in some cases reaching 200/150 mm Hg. Art. and more. Gynecologists determine the degree of nephropathy on a special Savelyeva scale, she evaluates a combination of various indicators during the examination.
3. Preeclampsia. It includes symptoms of nephropathy, as well as other manifestations: headache, dizziness, a feeling of heaviness in the occipital and frontal parts, insomnia, apathy, lethargy, visual disturbances in the form of "midges", "shroud" or blindness, tinnitus. There are disorders of the gastrointestinal tract (vomiting, nausea, pain in the abdomen).
4. Eclampsia. The most severe and rare form of late toxicosis of pregnant women. It is a convulsive seizure that develops against the background of preeclampsia when exposed to a strong stimulus: loud sound, bright light, pain. First, twitching of the muscles of the face appears, then tonic convulsions develop, sometimes with respiratory arrest and biting of the tongue. After - clonic convulsions (involuntary flexion and extension of the limbs), respiratory arrest, cyanosis, foam from the mouth. The seizure ends with a deep breath, restoration of breathing.

Thus, all typical forms of late toxicosis of pregnant women represent different stages of this complication. Atypical include nephropathy with hypertension and non-convulsive eclampsia.

Possible Complications

The processes that occur in the female body with late toxicosis have been studied much better than the causes that cause them. Changes occur due to spasm of the entire vascular system, a decrease in blood circulation, a violation of its coagulability and fluidity.

The heart muscle becomes weaker. As a result, there is a decrease in the blood supply to tissues, dystrophic processes develop in them, leading to death. The lack of blood supply most strongly affects the work of the kidneys, liver and brain.

The placenta consists mainly of vessels that change during preeclampsia and cannot provide the exchange of oxygen and nutrients between a pregnant woman and her child. There is fetal hypoxia and intrauterine growth retardation.

Toxicosis in late pregnancy can lead to heart failure, pulmonary edema, acute renal failure, coma, and the appearance of the HELLP syndrome (destruction of liver cells, thrombocytopenia, hemolysis of red blood cells).

For the fetus, this condition is dangerous for premature placental abruption, the development of fetoplacental insufficiency, which leads to acute and chronic oxygen starvation, intrauterine growth retardation, and premature birth.

Prevention of late toxicosis

A reliable remedy that prevents the development of late toxicosis does not yet exist. But it is in the power of a woman to reduce the risk of pathology and serious consequences to a minimum.

Consider measures to monitor the condition of the expectant mother and not miss the moment to provide medical care.

Nutrition and daily routine

Prevention of late toxicosis is based on adherence to the regimen and diet. In the second half of pregnancy, every woman needs to stop eating smoked and canned foods, excessively spicy and salty foods, and chocolate.

It is better to cook food for a couple or bake, you should refrain from frying. The volume of fluid consumed is monitored, its total amount should be about 1 liter (+/- a glass), including soups, compotes, tea.

Juices from some fruits and vegetables are also taken into account (watermelons, oranges and cucumbers contain a lot of water).

Do not forget that one of the first signs of preeclampsia is a feeling of thirst, forcing a woman to drink a lot of fluids, while the volume of urine is much less than expected.

Water fills the tissues and lingers in them, hidden edema appears. Therefore, you need to constantly monitor the amount of incoming fluid and salt.

It is necessary to minimize the consumption of flour products, sweets.

The diet should consist of vegetables, a variety of cereals (preferably oatmeal and buckwheat), cottage cheese, dairy products. Meat and fish are chosen from lean varieties and boiled or steamed.

Useful will be a fruit drink of lingonberries and cranberries, a decoction of dried fruits. These drinks help to remove excess water and serve as a prophylactic for inflammatory diseases of the urinary system.

Compliance with the daily routine is the second important component in the prevention of late toxicosis. You need to sleep at night and at least 8 hours. In the last trimester, it is desirable to find the opportunity to lie down during the day for at least 1 hour.

Eliminate physical and emotional stress. If you feel internal tension and anxiety, you need to seek help from a psychologist (for example, in a antenatal clinic).

Weight gain control

In order not to miss the first symptoms of late toxicosis during pregnancy, from the middle of the term it is worth starting to keep a self-control diary. It records weight gain, for greater clarity - in the form of a graph.

Normal weight gain is 350 grams per week.

Thus, it is possible to track the appearance of internal edema, with this complication, weight increases faster due to the accumulation of water in the tissues.

By keeping a diary, the problem can be detected at an early stage and quickly corrected by adjusting diet and medication without resorting to hospitalization.

Monitoring fetal activity

Another indicator that is useful to record is the number of movements of the unborn child. For several days, you need to listen to his movements and mark them.

Tremors should be well felt from 25 weeks. Then, when the approximate amount is known, the control can be carried out twice a week, in the morning and in the evening for half an hour.

Since the activity and general condition of the fetus are completely dependent on the well-being of the mother, with the development of late toxicosis, the number of movements changes. If the child began to move rarely or, on the contrary, is too active, you must definitely inform the gynecologist about this.

Late toxicosis of pregnant women or gestosis is a very serious complication, the consequences of which can be life-threatening for the mother and unborn child. But with the prevention and timely detection of this problem, the correction of the condition is quick and successful.

Therefore, starting from the 20th week, a pregnant woman should carefully consider her diet and daily routine, as well as not to miss visits to the doctor and taking tests.

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Children are our everything. Therefore, when a woman is diagnosed with "toxicosis in late pregnancy, or late toxicosis", this means that the woman needs urgent medical care from specialists in order to save the life of the child and her own.

Late toxicosis during pregnancy

Late toxicosis during pregnancy, or gestosis is serious complication which can have dire consequences. This term is understood as a disorder of all vital functions of the female body, which occurs as a result of the development of pregnancy and can lead to fatal consequences for the mother and fetus. Late toxicosis of pregnant women develops over long periods, starting from the second half of pregnancy, most often at 36-40 weeks.

Late toxicosis: causes

The causes of toxicosis in the later stages have not yet been precisely established, however, among the possible factors affecting the development of this disease, experts distinguish the following:

• hereditary predisposition;
• disruption of the endocrine system;
• as a result of an incorrect immune response of the female body to the fetus (rejection by the body);
• the presence of abortions;
• insufficient interval between pregnancies, when the female body does not have time to fully recover after the last birth (approximately 2 years);
• the influence of the age factor (the risk group includes women under 18 and over 35);
• chronic diseases of internal organs, diabetes mellitus, hypertension;
• nervous tension, stress, unrest;
• lack of sleep.

Degrees of toxicosis in the later stages

Symptoms of late toxicosis depend on the stage of development of the disease. Depending on the severity in modern medicine, there are several degrees of toxicosis in the later stages:

1. Dropsy (edema)

Fluid accumulates in the body cavities of a pregnant woman. Dropsy is the initial stage of late toxicosis, which is manifested by an excessive increase in the body weight of a woman (up to 400 g per week). As a rule, at this stage it is not required to resort to any medical treatment. It is necessary to limit the amount of liquid and salt consumed. If the edema is clearly expressed, then the woman must be hospitalized and prescribed diuretics.

2. Nephropathy

It can develop both against the background of dropsy, and due to a number of chronic diseases. Characterized by:

• the presence of protein in the urine of a woman;
• pressure increase;
• edema.

It affects the kidneys and the cardiovascular system of the body. If nephropathy is detected, the woman is hospitalized and prescribed medication.

3. Preeclampsia

The third stage of gestosis, in which there is:

• increased blood pressure;
• the appearance of edema and protein in the urine;
• disruption of the heart, liver, lungs, kidneys;
• headaches and blurred vision.

In this case, hospitalization is mandatory. The most important thing that needs to be done at this stage is to prevent the transition of toxicosis to the last stage.

4. Eclampsia

The most severe and dangerous stage of late toxicosis. It is characterized by convulsions and loss of consciousness. The consequences of eclampsia are sad:

• serious disorders of the brain;
• pulmonary edema;
• heart failure;
• hemorrhage in the brain;
• the death of a woman and the death of a fetus.

It is necessary to take timely measures to prevent the transition of toxicosis to severe degrees. To do this, you need to systematically visit your doctor, listen to his advice and instructions.

Remember that your negligence can cause a disastrous outcome. Take care of your health and listen to your heart!

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

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

Why does late toxicosis occur?

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

There are more than 30 theories trying to explain the occurrence and development of late toxicosis during pregnancy, but its true nature remains unclear to date. It is believed that the main cause of preeclampsia is a violation of the formation of the placenta in early pregnancy. At the same time, due to unknown reasons, at the stages of placenta formation, incomplete ingrowth of small vessels into the uterine wall occurs, and the vessels themselves remain hypersensitive 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 flow decreases, gas exchange and metabolism in the placenta are limited, and the synthesis of placental hormones decreases. All these changes lead to an insufficient supply of oxygen and nutrients to the baby, causing a delay in its growth and development. With preeclampsia, there are changes in the function of the endocrine organs that produce biologically active substances that regulate vascular tone, fluidity and blood clotting, and there is also an incorrect reaction of the immune system of a pregnant woman to a fetus that is foreign 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 itself during pregnancy?

The most typical is the triad of symptoms: edema, the appearance of protein in the urine and increased blood pressure. However, their severity varies. 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, weight gain is 350-400 g per week and 10-12 kg for the entire pregnancy. With preeclampsia, 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 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 preeclampsia. During normal pregnancy, protein in the urine is not detected. The amount of protein depends on the degree of kidney damage and the severity of preeclampsia.

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

Are there stages of gestosis?

Previously, doctors identified four stages of preeclampsia.

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

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

The main clinical manifestation of this severe complication of pregnancy is the addition of symptoms of brain damage. The characteristic and alarming symptoms of preeclampsia are headache, dizziness, blurred vision (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 vomit. A woman is worried about a feeling of heaviness in the back of her head or headaches, nausea, vomiting, blurred vision, perhaps 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 irritant (loud sound, bright light, pain, vaginal examination) can provoke a seizure (eclampsia) with all possible adverse consequences for the mother and fetus.

Now the first three stages of preeclampsia are increasingly united by one concept - preeclampsia.

What happens in a woman's body with gestosis?

The changes that occur in a woman's body during preeclampsia are much better studied 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 clotting and fluidity, and a violation of microcirculation. In addition, with gestosis, the work of the heart is weakened. All this leads to a significant decrease in blood supply to tissues up to their death.

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

Diagnosis of preeclampsia

It is almost impossible to treat preeclampsia that has already begun, so doctors are trying to identify pregnant women with a high risk of placental dysfunction and the development of preeclampsia in late pregnancy.

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

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

Significant assistance in assessing the risk of developing preeclampsia is provided by prenatal screening, which is carried out at 11-14 weeks of pregnancy. 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 preeclampsia 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 many laboratories have already included this protein in first trimester prenatal screening. The measurement of blood flow in the vessels of the uterus during the first screening ultrasound 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 lead to a decrease in the nutrition of the baby and its oxygen supply, that is, to placental insufficiency, preeclampsia and fetal growth retardation. With normal sizes of uterine vessels at 11–14 weeks of gestation, the risk of developing severe late toxicosis is negligible.

At present, 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 within the framework of compulsory medical insurance (mandatory medical insurance), but is available to everyone in prenatal diagnostic centers.

The next mandatory screening is carried out at 20-21 weeks of pregnancy. In this case, measurements of the fetus must be carried out in order to assess whether there is a lag in growth. After all, with oxygen starvation, the baby grows more slowly, its size begins to lag behind the norm for each period of pregnancy. In addition, the doctor necessarily evaluates the condition and maturity of the placenta. During ultrasound, Doppler uterine vessels are also performed to detect early changes that precede manifestations of preeclampsia.

In expectant mothers belonging to the 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, and 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 head and abdomen of the crumbs, the length of the bones of his arms and legs, and calculates the estimated weight of the fetus. These measurements allow the doctor to make sure 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 disturbed. During ultrasound, the amount and type of amniotic fluid is assessed, which can also change with intrauterine fetal suffering.

Doppler. Dopplerometry of the vessels of the placenta and 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 blood supply deficiency. Doplerometry is carried out 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.

Gynecological examinations. Regular examinations by a gynecologist help to identify hidden or obvious swelling. At an early stage of gestosis, it is precisely hidden edema that appears associated with fluid retention in the tissues. To identify them, you must carefully monitor the weight of a pregnant woman. In some cases, the doctor may recommend monitoring the amount of fluid drunk and excreted.

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

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

In the diagnosis of vascular disorders and preeclampsia, examination of the fundus by an ophthalmologist 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 preeclampsia during pregnancy

As noted above, it is currently impossible to completely cure preeclampsia, unfortunately. 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 regimen for the nervous system of a woman, depending on the degree of the disease, various sedatives are prescribed. With an increase in pressure, you will definitely need to take medications that reduce it. Drugs aimed at improving the fluid properties of blood are widely used.

The only effective treatment for severe forms of preeclampsia is delivery. It is clear that they resort to it only in cases where it is necessary to preserve the health of the mother and the life of the baby. Independent childbirth is permissible under the appropriate conditions: a satisfactory condition of the woman, the effect of treatment, the absence of intrauterine suffering of the fetus. With a deterioration in the condition of the expectant mother (increase in pressure, the appearance of brain symptoms) and the fetus, a caesarean section is indicated.

Late preeclampsia 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 state

Eclampsia is the most dangerous manifestation of severe preeclampsia. It occurs against the background of preeclampsia and is characterized by disruption of almost all systems and organs. Seizures are the main symptom of preeclampsia.

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

Toxicosis can rightly be called the most common complication of pregnancy. Pathology arises on the basis of impaired adaptation of the female body to a new position. Both the mother and the child under her heart suffer from this disease. We will talk about the causes, mechanisms of development and methods of treating late toxicosis during pregnancy below.

About 25 - 30% of expectant mothers suffer from toxicosis. Pathology should by no means be underestimated: for many years, toxicosis has not left the list of causes of death among pregnant women (it ranks second among the factors that cause the death of Russian women expecting a baby). The greatest danger of toxicosis is for the cardiovascular system and blood flow. The complication develops both at the beginning of pregnancy and in its second half. Most often, doctors have to deal with expectant mothers whose toxicosis began in the 3rd trimester, after the 28th week of pregnancy.

Causes of late toxicosis during pregnancy

Today, there are about 30 different theories, the authors of which tried to explain the causes and methods of the development of the disease, however, the reliable causes of the onset of the pathology have not been fully elucidated and not studied.

We list the most obvious factors that can provoke the appearance of late toxicosis in a pregnant woman:

• low adaptive capacity of the maternal organism;
• disorders in the work of the cardiovascular system;
• excessive excess weight;
• constant stay in a stressful environment;
• kidney dysfunction;
• disorders in the liver and biliary tract;
• diseases of the endocrine system;
• the stay of the mother's body in a state of poisoning due to the use of alcoholic beverages, drugs or smoking;
• allergy;
• immunological disorders.

Late toxicosis during pregnancy: who is at risk

From a dangerous disease, women in the position who:

• have bad habits;
• got pregnant for the first time;
• have multiple pregnancies;
• suffer from chronic fatigue;
• are under stress;
• under 18 or over 35;
• suffered from toxicosis during a previous pregnancy;
• often gave birth with short intervals between pregnancies;
• often had abortions;
• have chronic infectious diseases;
• socially unprotected (have problems with nutrition and live in poor conditions);
• have genital infantilism (underdevelopment of the genital organs).

Popular versions of the development of late toxicosis during pregnancy

Scientists identify several of the most relevant theories for the appearance of late toxicosis:

1. According to the hormonal theory, late toxicosis develops on the basis of dysfunction of the endocrine system. The pathology may be based on a disorder of the function of the adrenal cortex or insufficient synthesis of estrogens that produce the ovaries. However, opponents of the theory believe that problems with hormones arise after the development of toxicosis, that is, they are secondary.
2. The placental theory suggests that late toxicosis develops due to circulatory disorders in the pregnant uterus, which leads to a serious oxygen deficiency. Against this background, intoxication begins in the woman's body, the external signs of which are nausea, vomiting and intolerance to odors.
3. According to the immunogenetic theory, late toxicosis occurs due to an inadequate response of the maternal immune system to foreign proteins in the child's body. In other words, the body tries to reject the fetus, as a result of which toxicosis occurs.

Today, many scientists agree that late toxicosis during pregnancy appears due to the combination of the above reasons.

Consequences of toxicosis in late pregnancy

Late toxicosis causes serious complications for the mother and her baby, who has not yet been born. Here are the consequences that a pregnant woman suffering from this pathology can expect:

• disorder of the kidneys, lungs, liver, nervous system and organs of vision;
• spasm of cerebral vessels, impaired microcirculation in the brain;
• the formation of blood clots, which can cause cerebral hemorrhage, vascular thrombosis and swelling of the brain or lungs, heart, liver and kidney failure;
• dehydration of the body of the expectant mother due to vomiting, which cannot be appeased;
• premature detachment of the placenta;
• premature delivery (in 19 - 20% of cases);
• fetal suffocation.

For a child, late toxicosis is also very dangerous, as it provokes the development of the following conditions:

• fetal death due to placental abruption (in 32% of cases);
• oxygen starvation, which leads to a delay in intrauterine growth and development;
• low body weight (in 30 - 35% of children);
• mental and physical retardation;
• soreness.

Signs of late toxicosis during pregnancy

The presence of late toxicosis is evidenced by 3 symptoms:

• puffiness;
• high blood pressure;
• the presence of protein in the urine.

Edema develops before other symptoms. By the way, they may be the only sign of pathology. According to the severity of edema, doctors determine the degree of late toxicosis:

• I degree - swelling of the upper and lower extremities;
• II degree - swelling of the limbs and the abdomen;
• III degree - extensive swelling that covers the neck and face.

If the blood pressure of the expectant mother is increased by 20% compared to the initial pressure before pregnancy, then there is reason to talk about the presence of late toxicosis. The same can be said about the presence of protein compounds in the urine - normally there is no protein in the urine.

Features of the state of a pregnant woman with late toxicosis

There is no exact answer to the question of how long late toxicosis may appear during pregnancy. But most often the pathology makes itself felt from the 28th week of an “interesting” situation. The set of symptoms characteristic of late toxicosis is not expressed in all women. The most eloquent sign of the disease is swelling, while hypertension and protein in the urine can only be confirmed by a doctor. That is why it is so important for the expectant mother to register on time and regularly come for scheduled examinations. In the development of late toxicosis during pregnancy, 4 stages are distinguished:

The initial stage of late toxicosis expressed by edema, or dropsy of pregnant women. The development of puffiness is evidenced by a feeling of slight numbness of the fingers in a woman in position. In addition, rings do not fit on the fingers, and it becomes very painful to unbend them. However, edema does not always indicate the development of toxicosis. Quite often, this symptom occurs due to the active synthesis of progesterone or as a result of an exacerbation of the chronic form of the disease (for example, varicose veins). Only a qualified specialist can determine the nature of puffiness in a future mother. In some cases, doctors deal with latent edema that needs to be confirmed.

If the expectant mother has recovered greatly, but she does not have visible swelling, the Maclure-Aldrich test is performed: a 0.9% sodium chloride solution is injected under the skin of a pregnant woman and the time is noted. If the "button" after the injection does not disappear within 35 minutes, the woman has hidden edema. Visible puffiness is localized first on the feet, and then slowly "creeps" up - on the legs, hips, abdomen, back, neck and face. In no case should the expectant mother drink diuretics, relying on chance, as this will further aggravate her condition.

The second stage of late toxicosis called nephropathy. This disease occurs, as a rule, on the basis of dropsy. Its main symptom is high blood pressure. It is important for the expectant mother to know that she can suffer not only from increased pressure, but also from its sharp jumps, which will lead to placental abruption and the death of the child.

At the third stage of toxicosis called preeclampsia, protein appears in the urine. This condition is fraught with a disorder of the blood supply to the brain and, accordingly, a number of associated symptoms, including the following:

• headache;
• dull pain or feeling of heaviness in the back of the head;
• "flies" before the eyes;
• nausea and vomiting;
• visual disturbances;
• memory losses;
• irritability;
• sleep problems;
• high blood pressure (160/110 and above);
• rarely - mental disorders.

Eclampsi I- the last and most dangerous stage of late toxicosis. Against its background, the expectant mother often has convulsions, which can be caused by a loud sound, a blinding light, or a feeling of pain. The attack lasts about 1 - 2 minutes, and it ends with a loss of consciousness. Eclampsia threatens a pregnant woman with the following serious complications:

• detachment of the placenta;
• premature birth;
• intrauterine oxygen starvation of the baby;
• the death of a child;
• heart attack, stroke;
• pulmonary edema;
• kidney failure.

More often than others, women who are pregnant for the first time experience eclampsia.

Late toxicosis during the second pregnancy

All signs of late toxicosis disappear a few days after the birth of the child. In especially severe cases, some pathological changes in the organs and systems of a woman remain and even progress after childbirth. In this regard, the risk of toxicosis during pregnancy with a second child increases. Moms who were forced to fight late toxicosis during their first pregnancy are definitely at risk for the appearance of toxicosis if they decide to have another child. By the way, this risk increases significantly if the time interval between the first and second pregnancies is small. Such future mothers should take this problem very seriously and be registered from the first weeks of pregnancy. Fortunately, there are cases when, during repeated pregnancy, late toxicosis did not manifest itself at all or proceeded in a mild form.

The specifics of the management of pregnancy complicated by late toxicosis

If late toxicosis is present during pregnancy for up to 36 weeks, whether a woman delivers a baby for the prescribed period depends solely on the tactics and effectiveness of treatment. In this case, the expectant mother is carefully examined, and then left under the supervision of doctors for 1 - 2 days. If the mother's condition continues to deteriorate, then in any case, delivery is indicated to her, despite the gestational age. However, with positive dynamics, the expectant mother is observed in stationary conditions. Here are the factors that doctors pay attention to in the first place:

• compliance with bed rest;
• control of blood pressure up to 6 times a day;
• body weight check 1 time in 3-4 days;
• drinking regime;
• the volume of fluid excreted from the body in the form of urine;
• the presence of protein in the urine;
• general analysis of blood and urine every 4-5 days;
• condition of the baby in the womb.

With a successful combination of circumstances and properly selected treatment, pregnancy due to late toxicosis can be extended until the period when the fetus can be safely called viable. The method of delivery in this case is preferably natural. However, doctors opt for a caesarean section if there is a risk of developing eclampsia during childbirth.

Methods of dealing with late toxicosis during pregnancy

To alleviate the condition of a pregnant woman with late toxicosis and prevent the development of complications, the following measures should be taken:

1. Compliance with bed or semi-bed rest.
2. Complete rest and sleep.
3. Eliminate loud sounds and stressful situations.
4. Regular psychotherapeutic conversations with a psychologist. If necessary, taking sedatives allowed for pregnant women.
5. Balanced diet and varied menu. The predominance of food with a high content of proteins and a limited amount of carbohydrates.
6. Regular consumption of fruits, vegetables, natural juices and fruit drinks. It is impossible to limit the expectant mother in liquid even with severe puffiness.

To stabilize the condition of a pregnant woman suffering from late toxicosis, they also resort to drug treatment, which helps prevent fetal hypoxia. Diuretic drugs are rarely used in this case, since taking these drugs causes a decrease in blood flow, which in turn leads to serious violations of the placental circulation. Diuretics are shown to the expectant mother only if she has diseases such as pulmonary edema and heart failure. Pregnant women with late toxicosis are shown vitamins B, C and E, as well as drugs that improve blood flow in the uterus and placenta and reduce the permeability of vascular walls.

Prevention of the development of late toxicosis during pregnancy

To protect herself from the appearance of symptoms of late toxicosis during pregnancy, a woman needs to take the necessary measures at the stage of planning a child. To do this, they undergo a complete examination and consult with specialists of various profiles in order to identify pathologies (if any) that may cause the development of this disease during pregnancy in the future. You also need to familiarize yourself with the general set of recommendations regarding the correct lifestyle of a woman in position and follow these tips:

1. Get rid of nicotine addiction before conception.
2. Stop drinking alcohol before pregnancy.
3. Sleep about 9 hours a night and be sure to take rest breaks during the day.
4. Reduce the degree of physical activity or abandon them altogether.
5. Create a favorable psycho-emotional climate in your family.
6. Learn the basics of breathing exercises during pregnancy. The necessary information can be obtained from the attending physician.
7. Take a course of massage of the cervical-collar zone and head.
8. Go swimming or yoga (with the permission of a doctor).
9. Be outdoors daily.
10. Eat small meals often.
11. Waking up slowly and eating the first piece of food of the day (a slice of lemon, a cracker) before getting out of bed.
12. To draw up with a nutritionist an individual nutrition program that would completely satisfy a woman in a position complicated by late toxicosis.
13. Always eat food at room temperature.
14. During the entire pregnancy, control body weight.

Late toxicosis can complicate the pregnancy of any woman. However, responsible pregnancy planning, timely registration for pregnancy and cooperation with a doctor in the form of regular examinations will help to significantly reduce the risk of developing this dangerous pathology.

Causes and treatment of late toxicosis during pregnancy. Video