Preeclampsia in the first trimester of pregnancy manifestations. Alarming signs: diagnosis of preeclampsia during pregnancy. The symptoms of this condition are

Gestosis occurs in the second half of pregnancy (in most cases after 30 weeks, but it can be observed earlier - after the 20th week). According to various sources, it develops in 3–20% of expectant mothers. Moreover, the longer the period of pregnancy at which this ailment appears, the better the prognosis, since with earlier vascular changes in the placenta, the fetus will suffer longer from a lack of oxygen and nutrition.

Warning signs: diagnosis of preeclampsia during pregnancy

The main signs of preeclampsia during pregnancy are high blood pressure, edema and the appearance of protein in the urine. To make it clear what state should alert the expectant mother, let's dwell on each of them in more detail.

Edema

Swelling can be overt or latent. The latter are detected in the body by excessive weight gain (more than 300 g per week after 30 weeks of pregnancy). This is the first sign of gestosis. A woman, of course, can already notice obvious swelling herself. They can be light, insignificant - for example, the expectant mother pays attention to the fact that her favorite shoes have become cramped or there is a mark from the ring on her finger. The swelling can be more intense - when the legs and abdomen swell completely. Then a woman can no longer put on her usual shoes. And the swelling is very severe when the legs, stomach and face swell. With the latter, the most significant degree of swelling of the whole body. Moreover, the edema is most clearly visible in the evening, when fluid accumulates in the lower parts of the body due to the vertical position of the body. During the night, it is redistributed evenly, and in the morning the swelling can be almost invisible. In 9 out of 10 women, increased pressure and excretion of protein in the urine join edema.

Protein in urine

Unfortunately, this, like the next symptom, is practically invisible to the expectant mother herself. That is why preeclampsia, in contrast to toxicosis, is easier to miss and more difficult to cure. For this reason, in the last trimester, you need to regularly take a urine test to check if a protein has appeared in it, which should not be normal.

Pressure rise

In a pregnant woman, high blood pressure is considered to be above 135/85 mm Hg. Art. But doctors are always guided by the initial figures of this indicator, measured in the first trimester. Therefore, if the systolic pressure (first digit) rises by 30 mm Hg. Art compared with the original, and diastolic (second digit) - by 15 mm Hg. Art., then doctors are already talking about hypertension. The expectant mother herself may not feel the increase in pressure. That is why in the third trimester, pregnant women are regularly measured at their doctor's appointments and are advised to do this at home every day (if there is suspicion of hypertension).

Causes of gestosis in pregnant women

I must say that, despite numerous studies, the exact cause of the development of gestosis has so far been identified. This complication is called the "disease of theories" because there are many assumptions about the causes of its occurrence.

The main mechanism for the development of the disease, scientists and doctors consider spasm (strong contraction) of all vessels of the mother's body. This is exactly what causes an increase in blood pressure. Protein in the urine appears due to impaired renal function, and edema is due to the fact that, due to vasospasm, fluid flows out of the blood into the tissues through their walls. In addition, the viscosity of the blood rises. It becomes stringy, blood cells can clump together, forming blood clots. They clog the lumens of blood vessels, causing oxygen deficiency of organs (placenta, kidneys), which further disrupts their work and worsens the baby's condition. Why does such a violation occur? There are several theories that try to answer this important question:

• Disturbance in the work of the brain. This theory is confirmed by the fact that gestosis occurs most often in women under severe stress. At the same time, the balance in the processes of excitation and inhibition is disturbed, a failure occurs in the work of the cerebral cortex, which is responsible for the functioning of all internal organs, and a general vasospasm occurs.
• Endocrine disruption. During pregnancy, the level of most hormones rises 10–20 times. And if the balance in this system is disturbed, gestosis occurs.
• Immunological reaction to foreign genes of the fetus. As you know, immunity should stand up and reject foreign tissues (which, in fact, is the fetus - after all, 50% of its genes are from the dad). This is the cause of toxicosis in the first half of pregnancy, and in the second half, such situations are also possible. The body's defenses begin to develop antibodies to the fetus, which is reflected in the vessels - they are sharply reduced.

At the moment, the generally accepted opinion is that vasospasm and preeclampsia occur under the influence of not one, but several factors described above.

Influence of gestosis of a pregnant woman on the child's condition

Of course, the illness of the expectant mother is reflected in the baby. After all, the vessels of the placenta contract in the same way as everyone else. As a result, the amount of blood supplied to the child decreases - the baby begins to lack oxygen and nutrients, and this negatively affects its growth and development. In addition, since the work of mom's kidneys is disrupted, they can no longer excrete waste products as well as before. Intoxication occurs first of the woman's body, and then the child. Of course, in such a situation, treatment is indispensable. But doctors can only use therapy that supports the work of the suffering internal organs, since the disease will recede only after childbirth.

Do I need hospitalization for gestosis?

Unfortunately, gestosis often proceeds in a rapid and rather serious form, when the body of the expectant mother itself cannot cope with the disease. And then the woman needs the help of doctors in the hospital.

If the expectant mother has only first-degree edema (swelling of the legs), then there is no need to go to the hospital and the antenatal clinic will treat her. The doctor will prescribe a salt-free diet, give recommendations on how to control the amount of fluid drunk and secreted (a woman will need to draw up a schedule - how much fluid she drinks, including first courses, and how many times she urinates), and also prescribes diuretics, drugs that strengthen the vascular wall, and improving blood circulation in tissues. But if swelling of the arms and abdomen joins the edema of the legs, you will have to go to the hospital - in this case, gestosis poses a serious threat to the health of the expectant mother and baby, since the condition can rapidly deteriorate.

Treatment of gestosis of a pregnant woman in a hospital

In the maternity hospital, a woman is given the following tests:

• General blood analysis will allow you to estimate the amount of hemoglobin (oxygen carrier), platelets responsible for blood viscosity.
• General urine analysis will show the presence or absence of protein in the urine.
• Fetal ultrasound with dopplerometry allows you to understand the condition of the fetus and find out if it is lagging behind in growth, to assess the intensity of blood flow in the vessels of the placenta and umbilical cord (this will indicate a possible oxygen deficiency).
• CTG of the fetus will allow you to track the rhythm of heart contractions and identify if the baby is suffering from a lack of oxygen.

In addition, the expectant mother will regularly measure blood pressure and assess the amount of fluid excreted and drunk. Specialists will also consult: an ophthalmologist, focusing on the state of the vessels of the fundus, will give an opinion on the state of the vessels of the brain; a neurologist will assess the work of the nervous system and, above all, the brain; the nephrologist will give an opinion on the work of the kidneys. Finally, the therapist and obstetrician-gynecologist will assess the severity of the disease and decide on further treatment. Usually, drugs are prescribed that lower blood pressure, improve the condition of blood vessels and prevent increased blood clotting.

The expectant mother is discharged when there is no protein in the urine, the pressure normalizes, the swelling decreases and the fetus will feel good. However, it must be understood that in the future, the reappearance of symptoms of gestosis is possible, therefore, a pregnant woman should measure pressure every day and carefully monitor whether the swelling does not increase again.

Is it possible to avoid gestosis during pregnancy?

Fortunately, the expectant mother is able to prevent the appearance of preeclampsia. To do this, she should adhere to the following rules.

• Monitor the amount of fluid and salt entering the body. No matter how much you want to eat a lot of salty and drink a lot of water, after 25-26 weeks it is worth controlling the amount of fluid you drink. The expectant mother should drink about 1.5 liters of water a day (including soup, tea, fruit drink, etc.). Do not eat foods that are too salty - they cause fluid retention and make you more thirsty.
• To live an active lifestyle. The veins of the legs deposit a large volume of blood. Accumulating there, it begins to thicken, which threatens the appearance of blood clots and edema (since the fluid begins to escape into the tissues) - all this predisposes to the development of gestosis. When the muscles of the legs are actively contracting, they prevent blood from stagnating in the veins, pushing it into the general bloodstream. Therefore, doctors advise all pregnant women in the second and third trimesters to lead a moderately active lifestyle: walking a lot in the fresh air, swimming, doing yoga, etc.
• Maintain a calm emotional background. The cerebral cortex coordinates many processes in the body of the expectant mother, including the state and functioning of the cardiovascular system. If a persistent focus of arousal associated with stress forms in the brain, this “distracts” it from coordinating the pregnancy processes. Therefore, it is worth protecting yourself as much as possible from possible stress and anxiety.
• In the presence of chronic diseases(hypertension, chronic inflammation of the kidneys) it is important that the entire pregnancy be observed by a general practitioner or a specialized specialist in order to prevent the exacerbation of diseases and the appearance of gestosis in time.
• Be sure to follow all the advice of the gynecologist, come to the appointment on time and take all the prescribed tests, since preeclampsia appears imperceptibly.

The most severe degrees of gestosis during pregnancy

If a pregnant woman develops heaviness in the back of the head, headaches, flashing of flies before the eyes, nausea, vomiting, lethargy or irritability, then these may be signs of a severe degree of gestosis - preeclampsia, which requires immediate hospitalization. After all, such a state indicates the convulsive readiness of the woman's body. This means that any stimulus, be it a bright light, a loud sound, or a routine vaginal examination, can lead to the development of a convulsive seizure - eclampsia. This is the most severe form of gestosis and it is very rare. The condition can occur during pregnancy and childbirth, and even after the baby is born. The main manifestation of eclampsia is seizures of the whole body with loss of consciousness and respiratory arrest, during which the fetus may die from an increasing lack of oxygen.

Before starting the treatment of gestosis, you should decide on the stage, degree and clinic in a particular case and in a particular woman. For this, it is worth recalling the main characteristics of this disease.

Treatment of early preeclampsia

The main manifestations of early preeclampsia: nausea, vomiting in the morning, excessive salivation (salivation), insomnia - can be treated without medication. Some women are able to rub the initial signs, and a glass of water with lemon on an empty stomach helps them to cope with the symptoms. If vomiting is intermittent, and nausea constantly bothers, then you can try to brew tea with lemon balm, mint or lemon. It is better to eat dairy products for breakfast: cottage cheese, kefir or cheese. You can also use fruit and berry juices, fruit drinks, compotes, or try to rinse your mouth with infusions of sage, chamomile. With abundant salivation, rinsing with yarrow and oak bark will help 10-15 minutes before meals.

If vomiting is constant, indomitable, then be sure to contact your doctor, as this condition can threaten both your health and the health of the child.

In the early stages of toxicosis, water intake should not be neglected. Due to profuse vomiting, dehydration of the body will increase, therefore, it is necessary to consume sufficient fluid.

In case of renal failure, liver dystrophy in the first half of pregnancy and if treatment is ineffective during the day, termination of pregnancy is indicated. The way to terminate pregnancy at such an early stage (usually 6-12 weeks) is an induced abortion.

Late form therapy

By itself, preeclampsia in the later stages occurs quite rarely, according to statistics, about 8% of all pregnancies.

During the treatment of late gestosis, strict bed rest, prolonged sleep, absence of irritants and worries are prescribed. Treatment with sedatives is recommended: motherwort, valerian, sedative preparations. In addition, it is necessary to observe the correct diet: food should be easily digestible, rich in vitamins, balanced with proteins and carbohydrates. Eating fruits, vegetables, a sufficient amount of fruit drinks and juices. Sometimes it is recommended to eat directly in bed and chilled.

It is not worth, contrary to many advice on the Internet, to neglect the use of water with pronounced edema, since it is necessary, on the contrary, to replenish the volume of the bloodstream.

Hospital treatment

Ultrasound is one of the ways to diagnose problems

With late gestosis, the main type of treatment is inpatient. All medications prescribed at the hospital stage are aimed at reducing fetal hypoxia and normalizing the functions of the internal systems of the pregnant woman's body.

In the course of treatment, in no case are diuretics prescribed, since they reduce the volume of total circulating blood in the body, thereby aggravating the existing deviations and disrupting the placental circulation.

An exception is heart failure and pulmonary edema, although diuretics are sometimes used in these conditions (but only on one condition that the patient's condition is stable).

While the patient is in the hospital, she is closely monitored, which includes:

• bed rest;
• blood pressure control 4-5 times a day;
• body weight check (once every 4 days);
• monitoring the drunk and excreted fluid during the day;
• control of protein in the urine (the daily portion of urine is checked every 5 days, the daily number of times every 2-3 days, depending on the patient's condition);
• general urine analysis every 4-5 days;
• complete blood count platelets, hematocrit 1 time in 7-10 days;
• examination by an ophthalmologist;
• urine analysis according to Nechiporenko once;
• ECG once;
• controlling the vital functions of the fetus every day;

The doctor may prescribe a number of drugs, but self-medication in such a situation is unacceptable.

Drugs for the treatment of preeclampsia in the later stages:

• Antispasmodics (drotaverine, papaverine)
• Sedatives (valerian inside 1 tablet 2-3 times a day)
• Antihypertensive drugs (methyldopa; metoprolol only from the second trimester of pregnancy, amlodipine only from the second trimester of pregnancy)
• Antiarrhythmics (Verapamil)
• Hormone therapy (estrogens from 5 to 10 weeks of pregnancy; gestagens from 7 to 8 weeks of pregnancy)
• Glucocorticosteroids (administered under the supervision of 17-corticosteroids in the urine until 25-36 weeks of gestation)
• Antiplatelet (within 3-4 weeks)
• Ascorutin (first 3 months of pregnancy; 16-18, 24-26 and 30-32 weeks of pregnancy)
• Iron preparations

It is important to follow all prescriptions

From physiotherapy:

• Central electroanalgesia - exposure to high-frequency impulse current on the cortex and subcortex of the brain, the average duration of the procedure is up to 30 minutes
• Electrosleep - a procedure is prescribed, on average, lasting from 30 minutes to 2 hours, its essence lies in the introduction of the patient into the phase of therapeutic sleep under the influence of a pulsed current
• Endonasal galvanization - electrophoresis with turunda through the nasal sinuses, improves blood circulation in the brain
• Non-invasive hemomagnetotherapy - designed to enhance the effect and effectiveness of drug therapy

The main goal of inpatient treatment for this type of pathology is to replenish the lack of fluid in the bloodstream. Additionally, individual doses of antihypertensive drugs are selected and compensate for the loss of protein in the body.

The length of hospital stay depends on the severity of gestosis and the presence of its complications. The average length of stay in the hospital ranges from 1 to 2 weeks.

One of the complications of pregnancy is gestosis, which is characterized by dysfunction of vital organs. Another name for gestosis is late toxicosis.

Gestosis is diagnosed after 20 weeks of pregnancy, but more often at 25-28 weeks, although signs of this complication may occur several days before delivery.

Late gestosis is diagnosed in about 10-15% of all pregnant women.

Degrees

Depending on the severity of the course of gestosis, 4 degrees are distinguished:

• I degree - edema (dropsy of pregnant women);
• II degree (nephropathy);
• III degree (preeclampsia);
• IV degree (eclampsia).

Also distinguish between pure gestosis and combined gestosis.

• They say about pure gestosis if a woman does not have chronic extragenital diseases (not related to the genital area)
• Concomitant gestosis, on the contrary, proceeds against the background of chronic general diseases (arterial hypertension, kidney disease, obesity, and others).

Causes

Currently, the causes of gestosis have not yet been identified, but one thing is beyond doubt - this complication of pregnancy causes a fetus that comes into conflict with the mother's body.

The mechanism of development of preeclampsia in pregnant women is generalized vasospasm, which leads to hypertension (increased blood pressure).

Threatening factors for the development of gestosis:

• age (under 18 and over 30);
• pregnancy with more than one fetus;
• heredity (women whose mothers suffered from preeclampsia);
• first pregnancy;
• preeclampsia in past pregnancies;
• the presence of extragenital pathology (obesity, arterial hypertension, renal and hepatic pathology, and others).

Symptoms of gestosis

First, the preclinical stage of gestosis is diagnosed - pregestosis (there are no obvious signs). The diagnosis of pregestosis is made when evaluating laboratory and additional research methods:

• measurement of blood pressure three times with a break of 5 minutes in different positions (increase in diastolic, i.e. lower values ​​by 20 mm Hg and more);
• increasing thrombocytopenia (decreased platelets);
• decreased lymphocytes (lymphopenia);
• increased platelet aggregation (increased blood clotting).

Gestosis itself is manifested by the classic triad of symptoms (Zangemeister's triad):

• swelling
• proteinuria (protein in the urine)
• increased blood pressure.

Symptoms by degrees

I degree of gestosis
Edema (dropsy of pregnancy)

There are 4 degrees of edema in pregnant women.

The first degree is characterized by swelling of the feet and legs, in the second, swelling of the legs and rise to the anterior abdominal wall, the third degree is swelling of the legs, hands, anterior abdominal wall and face. And the last degree is generalized edema or anasarca.

In addition to the fact that edema may be visible, one should not forget about hidden edema. Pathological weight gain (more than 300 grams per week) suggests hidden edema. Also, oliguria speaks about hidden edema (a decrease in the amount of excreted urine to 600-800 ml per day).

An indirect symptom is the ratio of drunk and discharged fluid (allocated less than 2/3). Also, a characteristic sign of edema in pregnant women is considered a "ring symptom" (it is difficult to remove or put on a ring on a familiar finger) and tightness of everyday shoes.

II degree of gestosis
Nephropathy

Nephropathy (OPG-gestosis) proceeds as the Tsangeimeter triad:

• swelling, in varying degrees of severity,
• proteinuria (protein in the urine),

When assessing an increase in blood pressure, they are guided by the initial (before pregnancy) pressure. Arterial hypertension is spoken of when the systolic (upper) pressure rises by 30 mm Hg or more. Art., and the diastolic increases by 15 mm Hg or more. Art.

On average (normal blood pressure in pregnant women is usually 110/70). Arterial hypertension is an increase in pressure up to 140/100 mm Hg. Art.

Proteinuria indicates damage to the walls of the vessels of the kidneys, through which protein enters the urine.

If traces of protein are found in the urine (0.033 g / l), it is necessary either to exclude pyelonephritis, or there is non-compliance with hygiene rules when passing urine. Proteinuria is spoken of when protein levels in urine reach 0.3 g / l or more.

III degree of gestosis
Preeclampsia

Pre-eclampsia

IV degree
Eclampsia

Severe condition, the last degree of gestosis. It is characterized by seizures.

Diagnostics

In addition to clinical manifestations, additional and laboratory research methods are used to diagnose preeclampsia:

• measuring pressure three times a day and after minor physical exertion (squatting, climbing stairs) - blood pressure lability is diagnosed;
• general urine analysis (protein detection, increased urine density);
• a general blood test (a decrease in platelets, an increase in hematocrit, which means thickening of the blood);
• urine analysis according to Zimnitsky (oliguria and nocturia - an increase in the volume of urine excreted at night);
• control of drunk and discharged fluid daily;
• weight measurement weekly;
• biochemical blood test (increase in creatinine, urea, liver enzymes, decrease in total protein);
• blood clotting (an increase in all indicators).

Treatment of gestosis during pregnancy

Gestosis at home

Treatment of gestosis is prescribed and monitored by an obstetrician-gynecologist. For edema of the first degree, treatment is allowed on an outpatient basis. All other degrees of preeclampsia are treated in a hospital.

First of all, emotional and physical peace is created for the pregnant woman. It is recommended to lie more on the left side (“Bed rest” position), as this position improves the blood supply to the uterus and, consequently, to the fetus.

In the second place, medical nutrition is necessary (the medical table should contain a sufficient amount of protein, the volume of fluid drunk depends on the diuresis, and the food itself should be undersalted).

With a pathological weight gain 1-2 times a week, fasting days (cottage cheese, apple, fish) are prescribed.

To normalize the brain and prevent seizures, sedatives are prescribed (motherwort, valerian, novopassit). In some cases, mild tranquilizers (phenazepam) are indicated.

Treatment of gestosis in the hospital

The main place in the treatment of preeclampsia is occupied by intravenous drip administration of magnesium sulfate. The dose depends on the degree of preeclampsia and the severity of manifestations. Magnesium sulfate has antihypertensive, anticonvulsant and antispasmodic effects.

With arterial hypertension, drugs are prescribed that reduce blood pressure (atenolol, corinfar).

It is also shown to carry out infusion therapy with saline solutions (saline and glucose solution), colloids (rheopolyglucin, infukol - starch), blood preparations (fresh frozen mass, albumin).

To improve the rheology (fluidity) of the blood, antiplatelet agents (pentoxifylline) and anticoagulants (heparin, enoxaparin) are prescribed.

The normalization of the uteroplacental blood flow is carried out by membrane stabilizers and antioxidants (Actovegin, vitamin E, glutamic acid).

Treatment of mild preeclampsia lasts at least 2 weeks, moderate preeclampsia 2-4 weeks, and severe preeclampsia requires the constant presence of the pregnant woman in the hospital until delivery.

Complications and prognosis

Possible complications of gestosis:

• pathology of the liver, kidneys, heart;
• pulmonary edema, hemorrhage in vital organs;
• premature placental abruption;
• fetal malnutrition;
• coma;
• intrauterine fetal death.

The prognosis depends on the degree of gestosis, its manifestations and the timeliness and effectiveness of treatment. In most cases, the prognosis is good.

Prophylaxis

There is no specific prophylaxis for preeclampsia. In the antenatal clinic, when registering, the woman's history is carefully collected and an examination is carried out, after which the risk group for the development of preeclampsia is determined (low, medium or high).

Also, preventive courses of treatment are carried out (sedatives, antioxidants, diuretic fees).

Some studies during pregnancy

A complication of pregnancy, which is characterized by a triad of main symptoms: hypertension (high blood pressure), proteinuria (protein in the urine), edema (visible or latent), is called gestosis. According to statistics, in 20% of women expecting a child, this condition develops after 32 weeks of an interesting position (3rd trimester).

Causes

Late gestosis of pregnant women is called a disease of theories, since the exact causes of their occurrence are unknown.

The development of pathology is triggered by vasospasm, which is the beginning of an increase in blood pressure. As a result of these processes, the kidneys are disrupted, which is why protein appears in the urine. An increase in blood pressure leads to the fact that through the walls of blood vessels blood fluid flows into the tissues, provoking swelling.

There are three main versions of why late gestosis occurs during pregnancy:

1. Failure of brain function. According to statistics, late gestosis is observed in patients who have experienced severe stress.
2. Endocrine Disorders. During pregnancy, the level of hormones rises many times over, which provokes these symptoms.
3. Immunological reaction. In the third trimester, the immune system begins to produce antibodies, which often leads to vasoconstriction.

There are certain factors that predispose to the development of late gestosis. The risk group includes pregnant women who have:

• hereditary predisposition;
• excess body weight;
• bad habits;
• chronic infections;
• prolonged stress;
• multiple pregnancy.

Stages

There are several stages of gestosis (late toxicosis). The severity of this complication in the third trimester can be said, depending on which of them is identified in the woman. So, preeclampsia during late pregnancy develops in the following sequence:

1. Dropsy. From this stage, the pathological process begins. A pregnant woman develops swelling, which is dangerous for the fetus. Due to edema, the child does not receive oxygen in full, which leads to the development of problems with the central nervous system.
2. Nephropathy. The second stage of the disease, which is characterized by malfunctioning of the kidneys. At this stage, the pregnant woman's blood pressure rises and remains high.
3. Preeclampsia. Protein is detected in the urine. A woman has headaches, mental disorders, vision problems.
4. Eclampsia. At the fourth stage of the pathological process, a pregnant woman has seizures. The fruit is in great danger. The child may die, but if he survives, he will be born with a whole bunch of various congenital pathologies.

Symptoms

In most cases of gestosis in the third trimester of pregnancy, symptoms of nephropathy are characteristic. Among them:

• dropsy (swelling of the abdomen, legs, face, arms);
• high blood pressure;
• rapid pulse;
• dizziness;
• protein in urine;
• nausea;
• lethargy;
• excessive sweating;
• headache;
• anxiety;
• fatigue.

What is the danger of gestosis in the later stages

Symptoms of gestosis in the third stage are dangerous for both the mother and the fetus. For a woman, this condition threatens:

• Severe postpartum haemorrhage that leads to anemia.
• The development of strokes or brain damage that occur against the background of seizures.
• Edema, which leads to pulmonary edema.
• Irreversible kidney damage that leads to kidney failure.
• Visual impairment due to high blood pressure.

In a serious condition of the mother, the child will suffer no less. The most dangerous complication for the fetus is its intrauterine death. This occurs as a result of hypoxia or nutritional deficiency due to severe intoxication. Also, preeclampsia in the third trimester is dangerous with growth retardation, which threatens with a lag behind the child after birth in mental and physical development.

Establishing diagnosis

The doctor diagnoses preeclampsia based on the results of several laboratory tests. Among them:

• Urine tests. Research will show if there is protein in urine. A general analysis will help to distinguish the impairment of kidney function caused by pregnancy from other diseases of the urinary system.
• Blood fluid analyzes. They will help to assess blood viscosity, hemoglobin level, liver enzymes. The results of these analyzes allow you to determine the stage of gestosis.
• CT scan of the fetus. The child's mobility and heart rate are monitored. According to the indicators, fetal hypoxia is diagnosed.
• Doppler ultrasound. Assess the fetal blood flow in the vessels of the placenta, umbilical cord. The study helps to assess the development of the baby in the womb.

Treatment

As a rule, gestosis in the third trimester is treated in a hospital under the supervision of doctors. The activities carried out are aimed at getting rid of negative factors that can affect the development or life of the fetus. In severe forms of the pathological process, the woman will be monitored until the very birth. The main methods of treatment:

• bed rest;
• light, balanced diet (food rich in proteins);
• physiotherapy (magnetotherapy of the kidney area, galvanization of the collar zone, electrosleep therapy);
• medications;
• premature birth.

With the development of the above symptoms, doctors decide whether to deliver (natural or operative) or prolong the pregnancy. At the third and fourth stages of gestosis, with its positive dynamics, full therapy is possible up to delivery at the due date. In a state of preeclampsia or exclampsia with negative dynamics of pathology, the most effective treatment is operative delivery (cesarean section). Drug therapy includes:

Group of drugs	Action	Name of drugs
Tranquilizers, antipsychotics, sedatives	Calming, relaxing	Relanium, Droperidol
Antispasmodics	Relieve spasms of smooth muscles	No-shpa, Papaverine, Curantil
Tocolytics	Relaxation of the uterus, normalization of blood circulation	Magnesia sulfate, Partusisten
Antibiotics	Elimination of intrauterine infection	Erythromycin, Sumamed
Hypotensive

In this article:

Gestosis is one of the most dangerous complications that occurs during pregnancy and passes after childbirth. This serious disease is one of the top three leading causes of death for expectant mothers and is diagnosed in almost 30% of pregnant women.

Gestosis during pregnancy is often called late toxicosis and is usually detected in the 3rd trimester. It can be accompanied by a disorder of the functions of any vital organs, however, most often, the vascular system suffers.

The placenta of pregnant women with gestosis begins to produce special substances that provoke the formation of micropores on the walls of blood vessels. Thanks to them, liquid and plasma protein penetrate into the tissues of the body. This causes severe swelling. Since the vessels of the kidneys also pass protein, it is easily detected in the general analysis of urine. Timely delivery of tests allows you to identify gestosis in the early stages of development, which greatly facilitates its treatment.

Gestosis of the second half of pregnancy- a very insidious disease in which a pregnant woman can feel quite healthy for a long time. Gestosis can be suspected by the rapid weight gain in the 3rd trimester, resulting from latent edema of internal organs, including the placenta, which can cause fetal hypoxia.

OPG - gestosis, and this is how the late toxicosis of pregnant women is increasingly called, got its name due to the triad of characteristic signs: edema, proteinuria and hypertension. Moreover, it is not at all necessary that all these signs of the disease will be detected. Sometimes gestosis is mild and is characterized by the presence of one or two symptoms.

The main types and severity of gestosis in pregnant women

Gestosis in the second half of pregnancy can develop in the complete absence of any serious pathologies, against the background of a completely safe state of a pregnant woman. This condition is called "pure" gestosis. But more often gestosis occurs against the background of existing chronic ailments, for example, in violation of fat metabolism, pathology of the endocrine system, hypertension, kidney and liver diseases. Doctors call this disease "combined" gestosis.

Gestosis in the 3rd trimester can manifest itself in different forms and have different causes, symptoms and consequences. Experts identify several types of gestosis, which can become a stage or severity of this disease.

• Dropsy of pregnant women- the simplest and earliest stage of gestosis in the 3rd trimester, which is characterized by swelling of the legs and hands. Moreover, the presence of edema does not always indicate the presence of a disease. The diagnosis of "OPG-gestosis" can only be made by a qualified specialist on the basis of a preliminary examination and laboratory research methods. Having found in themselves the characteristic symptoms of mild preeclampsia, pregnant women should not draw premature conclusions, and even more so take any actions aimed at self-medication.
• Nephropathy- one of the stages of gestosis, which develops against the background of dropsy of pregnant women and is accompanied by impaired renal function. The main symptom of this condition is a sharp increase in blood pressure. Treatment for nephropathy should be immediate, since this condition can quickly turn into another form of preeclampsia - eclampsia, the consequences of which can pose a danger to the life and health of pregnant women.
• Preeclampsia- a later stage of gestosis, which has such serious signs as edema, high blood pressure, protein in urine tests. Moreover, with such a degree of gestosis, blood supply is often disturbed, provoking the appearance of nausea, vomiting, severe headaches and a feeling of heaviness in the back of the head. Late gestosis can negatively affect the vision of pregnant women, as well as cause serious mental disorders.
• Eclampsia- one of the most severe stages of gestosis during the second half of pregnancy. The consequences of this degree of the disease are very dangerous, both for the expectant mother and for the baby. Late gestosis is often accompanied by convulsive seizures, which can cause premature birth, bleeding, fetal hypoxia, and as a result, cause the death of a woman and an unborn child. Moreover, such an attack can provoke pulmonary and cerebral edema, stroke and heart attack, placental and retinal detachment, the development of hepatic or renal failure.

How to recognize a dangerous ailment?

Every pregnant woman should know all the symptoms of gestosis in order to recognize a dangerous ailment as early as possible. What should alert the expectant mother?

• The presence of late toxicosis, manifested in the form of nausea, vomiting and dizziness. Such signs of the disease are usually accompanied by profuse salivation and can be disturbing at any time of the day.
• The appearance of protein in the general analysis of urine. This type of study is prescribed for pregnant women regularly until the very birth and allows you to recognize preeclampsia in time.
• Increased blood pressure. Due to the loss of fluid, the blood in the body of a pregnant woman thickens, it becomes more difficult to move it through the vessels, and this increases the pressure.
• The appearance of edema and a sharp increase in weight.

Treatment of gestosis in pregnant women

Gestosis in all its manifestations is extremely dangerous. If you suspect you have any signs of this disease, you should immediately tell your doctor about them. This will allow you to start timely treatment and prevent serious irreversible consequences.

Opg-gestosis is incurable and you can get rid of it only after childbirth. However, it is quite possible to significantly alleviate the condition of a pregnant woman in the 3rd trimester. With a mild degree of the disease, treatment can take place at home, with a more severe one - in a hospital, in the immediate vicinity of the intensive care unit. The duration of inpatient treatment is largely determined by the severity of the disease. In the presence of small edema, it can be a week, with a more serious steppe - up to 2-3 weeks. Since pregnancy itself, or rather the placenta of a pregnant woman, is the main cause of gestosis, the best treatment is natural delivery.

If there is evidence for the expectant mother, you should not refuse hospitalization. There, in any emergency, she will be able to receive qualified medical care and undergo a course of treatment that will significantly improve her condition. With the help of droppers, doctors will quickly replenish the loss of fluid and protein in the blood vessels and normalize the woman's health.

To confirm the diagnosis and establish the form of preeclampsia, the expectant mother will have to undergo a thorough examination. It will be possible to breathe a sigh of relief only after childbirth, since until the end of pregnancy she will have to adhere to a special diet with restriction of salt and liquid up to 1000 ml per day. With any degree of gestosis in the 3rd trimester, it is necessary to control the accumulation of fluid in the body, as well as constantly monitor the dynamics of body weight gain.

After confirming the diagnosis of preeclampsia in the second half of pregnancy, a woman will need to undergo a study such as fetal Doppler, as well as consult a therapist, neuropathologist, ophthalmologist and nephrologist.

Drug treatment of toxicosis in the second half of pregnancy depends on the dysfunction of internal organs. The causes and symptoms of gestosis during pregnancy may differ from woman to woman, so all medications are prescribed individually. These can be diuretics or drugs that lower blood pressure and improve blood flow in small vessels.

Treatment of gestosis in pregnant women is not complete without sedatives. Mild symptoms of the disease are the reason for the appointment of valerian or motherwort tincture, with the development of eclampsia, stronger sedatives are used. At the same time, placental insufficiency is prevented. For this, the drug Actovegin and a number of vitamins are prescribed, which will have to be taken in the second half of pregnancy until the birth itself.

Opg-gestosis is a rather complex disease, the signs of which may be of a sluggish nature. However, most often, gestosis in the second half of pregnancy is characterized by rapid development with a sharp deterioration in the condition of pregnant women.

In case of the slightest suspicion of gestosis in the 3rd trimester, you should immediately seek qualified help. Self-treatment in this case is unacceptable, since gestosis can lead to the rapid development of a variety of complications with very sad consequences. In exceptional cases, when the prescribed treatment does not bring the slightest relief, and the condition of the expectant mother and her child is deteriorating, doctors may decide to stimulate premature birth or perform a cesarean section.

How to resist an insidious disease?

Prevention of such an ailment as preeclampsia in the second half of pregnancy should be of interest, first of all, to women in the so-called risk group:

• pregnant women over the age of 35;
• primiparous or having multiple pregnancies;
• carriers of sexually transmitted infections (mycoplasmosis, chlamydia, ureaplasma, etc.);
• pregnant women suffering from chronic diseases (diabetes mellitus, obesity, hypertension, pyelonephritis, vegetative-vascular dystonia, etc.).

To prevent preeclampsia, from the first months of pregnancy to the very birth, women should carefully monitor their diet and their own weight. The expectant mother needs good nutrition, the basis of which should be food enriched with protein: eggs, cottage cheese, fish, low-fat meats, etc. You should not get carried away with pickles, sweet and flour dishes. It is better to give preference to fresh fruits and vegetables, which are rich in fiber and are the best way to prevent constipation.

Prevention of gestosis of varying severity should include an active lifestyle and moderate physical activity. To do this, you can visit the pool, do yoga or take daily walks.

Sometimes it is quite difficult to identify the main causes of the appearance of preeclampsia. Gestosis can occur due to squeezing of the ureters by the uterus, which increases in size. In this case, in order to restore the disturbed outflow of urine, doctors recommend that expectant mothers take a knee-elbow position every day for 10 minutes.

With a tendency to edema, the prevention of preeclampsia cannot do without funds with a weak diuretic effect. For this, decoctions of lingonberry leaves, rose hips, bearberry, as well as berry fruit drinks and kidney teas are perfect. A special decongestant charge can be purchased at the pharmacy. However, it should be noted that it does not contain woolly erva that can destroy tooth enamel, kidney and liver stones.

An excellent alternative to herbal teas against edema can be such herbal preparations as cystenal, kanefron, cyston, etc. Treatment and prevention of edema can also be carried out with the help of drugs: Magne-B6, Magnerot, vitamin E, lipoic acid, chophytol or curantil.

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