Gestosis after childbirth: causes, symptoms, diagnosis, treatment, recovery period and advice from a gynecologist. Gestosis before and after childbirth

28.07.2019

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Preeclampsia after childbirth

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

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

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

headache;
rare urination;
increase in pressure.

Preeclampsia after childbirth, how to treat preeclampsia after pregnancy

Preeclampsia after delivery: how to cope with it

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

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

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

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

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

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

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

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

Postpartum edema is common. And not only in those suffering from preeclampsia. A sign of preeclampsia is considered to be a rapid increase in swelling of the hands and face. If the ankles are swollen, this is not so scary. It will go away in a few days or weeks. At the same time, women who are breastfeeding should not use diuretics (diuretics), as this will lead to a decrease in lactation - a lack of breast milk.

What to do if gestosis does not go away after childbirth

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

headache;
visual impairment, flashing of flies in the eyes;
pain between the ribs or in the right hypochondrium (liver);
rare urination;
increase in pressure.

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

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

Observation of at least a gynecologist and therapist is required.

The consequences of gestosis for the child and mother

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

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

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

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

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Toxicosis during pregnancy (gestosis)

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

Gestosis and its varieties

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

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

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

arterial hypertension of pregnant women;
preeclampsia;
eclampsia.

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

Why do pregnant women develop gestosis?

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

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

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

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

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

Gestosis in the first half of pregnancy

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

Gestosis of the second half of pregnancy

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

Gestosis during the second pregnancy

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

The clinical picture of gestosis

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

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

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

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

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

Treatment for preeclampsia must be urgent and most often includes artificial childbirth and intravenous drug administration. Otherwise, the likelihood of developing such a pathology as eclampsia is high. Signs of this condition:

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

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

Consequences and complications of gestosis

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

Preeclampsia after childbirth

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

Diagnostics of the gestosis

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

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

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

Mild preeclampsia in pregnant women

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

blood pressure periodically rises to 150/90 mm Hg;
the concentration of protein in the urine is not higher than 1 g / l;
edema on the legs (lower leg, foot) is visualized;
the platelet count reaches 180 * 109 l;
creatinine in the blood is not more than 100 μ mol / l.

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

Moderate preeclampsia in pregnant women

Moderate preeclampsia is characterized by the following indicators:

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

Urgent delivery by caesarean section is indicated at this stage.

Severe preeclampsia

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

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

Features of pregnancy management with gestosis

If the treatment of preeclampsia or observational tactics does not lead to an improvement in the woman's condition, delivery is planned regardless of the timing of pregnancy. On the contrary, if laboratory parameters and clinical signs have improved, then the pregnant woman continues to remain in the hospital under close supervision. A special diet is prescribed, bed rest, pressure control up to 6 times a day. The woman is weighed twice a week, the drinking regime and the amount of urine excreted are monitored. Urine and blood tests are also regularly performed, and examinations are carried out by narrow specialists. Thus, the treatment and prevention of preeclampsia often help bring the pregnancy to the week and safely deliver. Delivery by caesarean section is planned in the absence of the effect of therapy.

Nutrition of the expectant mother with gestosis

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

Treatment of gestosis

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

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

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

Influence of preeclampsia on methods and timing of delivery

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

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

Childbirth in severe late toxicosis is carried out within 2-12 hours, which depends on the period of normalization of the woman's condition after the start of drug therapy. Childbirth with moderate preeclampsia is planned in 2-5 days from the start of treatment in the absence of its effectiveness.

How to prevent gestosis

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

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

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

Useful information

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

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

Gestosis and its varieties

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

dropsy of pregnant women;
preeclampsia;
eclampsia.

arterial hypertension of pregnant women;
preeclampsia;
eclampsia.

Why do pregnant women develop gestosis?

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

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

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

Gestosis in the first half of pregnancy

Gestosis of the second half of pregnancy

Gestosis during the second pregnancy

The clinical picture of gestosis

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

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

Consequences and complications of gestosis

Preeclampsia after childbirth

Diagnostics of the gestosis

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

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

Mild preeclampsia in pregnant women

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

blood pressure periodically rises to 150/90 mm Hg;
the concentration of protein in the urine is not higher than 1 g / l;
edema on the legs (lower leg, foot) is visualized;
the platelet count reaches 180 * 109 l;
creatinine in the blood is not more than 100 μ mol / l.

Moderate preeclampsia in pregnant women

Moderate preeclampsia is characterized by the following indicators:

blood pressure rises to 170/110 mm Hg;
proteinuria not higher than 5 g / l;
edema is found on the legs, on the front of the peritoneum;
platelet count - 150-180 * 109 l;
creatinine in the blood - 100-300 μ mol / l.

Urgent delivery by caesarean section is indicated at this stage.

Severe preeclampsia

blood pressure more than 170/110 mm Hg;
proteinuria - from 5 g / l;
edema is found on the legs, the front of the peritoneum, on the face, arms;
platelet count - 120-149 * 109 l;
creatinine - from 300 μ mol / l.

Features of pregnancy management with gestosis

If the treatment of preeclampsia or observational tactics does not lead to an improvement in the woman's condition, delivery is planned regardless of the timing of pregnancy. On the contrary, if laboratory parameters and clinical signs have improved, then the pregnant woman continues to remain in the hospital under close supervision. A special diet is prescribed, bed rest, pressure control up to 6 times a day. The woman is weighed twice a week, the drinking regime and the amount of urine excreted are monitored. Urine and blood tests are also regularly performed, and examinations are carried out by narrow specialists. Thus, the treatment and prevention of preeclampsia often help bring the pregnancy to 28-38 weeks and safely deliver. Delivery by caesarean section is planned in the absence of the effect of therapy.

Nutrition of the expectant mother with gestosis

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

Treatment of gestosis

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

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

Influence of preeclampsia on methods and timing of delivery

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

How to prevent gestosis

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

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

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

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

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

What are the signs and symptoms of preeclampsia

The main signs

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

Dangerous symptoms - harbingers of a seizure attack

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

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

Groups

Swelling of pregnant women

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

Preeclampsia

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

Eclampsia

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

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

The cause of the disease - the opinions of doctors

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

It is impossible to name the reasons more precisely. A pregnant woman experiences malfunctions in the body, which can lead to serious problems. In some cases, doctors resort to early delivery to keep the baby and mother alive. Therefore, before conception, a woman must undergo an examination.

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

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

If you have kidney, thyroid, or blood pressure problems, be sure to see your doctor.

The risk group includes

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

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

Nobody is 100% insured from gestosis

The great well-being of a pregnant woman is not yet an indicator of good health. Sometimes test results show poor results in the absence of external signs of the disease.

Why does gestosis appear in pregnant women?

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

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

It manifests itself in three main features:

swelling;
protein in the urine;
high blood pressure.

Not all women have the full range of symptoms. Only one of them can tell about the presence of pathology. Only edema is visible here. The pressure rises may not be very significant. In this case, the woman does not feel them. Changes in the composition of urine also do not bother the pregnant woman. Therefore, by the end of the term, doctors measure blood pressure on a weekly basis and carry out weighing.

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

Today, about 27% of pregnant women face the disease. Its symptoms subside after childbirth. A complication arises from the fact that the mother's body cannot optimally adapt to carrying a child. As a result, various violations arise.

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

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

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

Diagnostic methods

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

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

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

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

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

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

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

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

It consists in the fact that a woman is injected with saline under the skin. The doctor marks the time during which the papule resolves. If the interval does not take 35 minutes, then there is edema in the body.

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

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

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

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

Improper nutrition can also give rise to the development of late toxicosis. It is impossible to cure it at home. The woman needs inpatient treatment. She is given droppers and prescribed medications that help fill the lack of fluid in the vessels.

The cause of late toxicosis is often pathology in the placenta. In this case, childbirth is considered the most effective solution to the problem. With formidable complications, they resort to caesarean section.

The initial symptoms of late toxicosis are detected at the next examination in the antenatal clinic. The doctor evaluates the weight gain, measures blood pressure, examines the urinalysis and calculates the fetal heart rate. Based on the data obtained, he can conclude about the presence or absence of gestosis.

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

How is childbirth going?

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

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

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

With gestosis, childbirth may be accompanied by complications

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

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

Typical complications of childbirth

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

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

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

Indications for early birth (regardless of the gestational age)

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

Doctors carry out a gentle and fast delivery. Preference is given to giving birth through the birth canal. This avoids the stress of surgery and anesthesia. The woman is given pain relief.

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

Illness after childbirth

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

Degrees and classifications

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

Late gestosis usually does not have severe complications.

Severity:

easy,
average,
heavy,
eclampsia.

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

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

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

degree I - edema of the lower extremities;

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

grade III - edema extends to internal organs.

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

Early

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

The main manifestations of toxicosis:

dizziness,
nausea,
salivation,
vomit.

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

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

The mechanisms of development of the early form have not been studied. Experts believe that it is a woman's pathological reaction to pregnancy. The development of toxicosis involves the immune, allergic, toxic, reflex and neurogenic mechanisms.

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

Late gestosis

This is a complication that occurs in the second half of pregnancy. It develops until the very birth. Such toxicosis leads to a breakdown of the systems and organs of a woman.

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

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

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

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

Light

A mild degree of the disease is characterized by a slight increase in blood pressure. It exceeds the norm by 20%. Protein in urine is 1.0 g / l. Of the signs, edema is present. The woman is given outpatient treatment.

Heavy

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

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

Pathogenesis of gestosis

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

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

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

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

What is the danger of a disease during pregnancy

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

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

Any form of late onset of the disease is dangerous to the fetus. In the vessels of the placenta, blood circulation is disturbed. The acute form causes its detachment, premature birth or death of the child. Sluggish gestosis causes a delay in the intrauterine development of the baby.

What are the principles of treatment

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

Basic principles of treatment:

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

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

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

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

If after a week the woman's condition has not improved, then she is sent to the hospital. Medicines in the presence of a disease are used without fail. It is impossible to cure it with herbs and diets.

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

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

Prophylaxis

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

Diet

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

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

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

The food of a pregnant woman should be saturated with vitamins and minerals. You should drink purified water, excluding coffee, strong tea and carbonated drinks. Doctors usually prescribe special vitamin complexes for pregnant women. They must be accepted without fail.

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

What can be the consequences

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

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

How to avoid the occurrence of this ailment

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

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24.10.2008

Gestosis of pregnant women (also called late toxicosis) is a complication of pregnancy that occurs in its second half and is characterized by dysfunction of vital organs and systems. Unfortunately, gestosis is one of the most common problems: its signs are detected in 13-16% of expectant mothers.

Gestosis is divided into dropsy of pregnancy, nephropathy of pregnancy, preeclampsia and eclampsia. Gestosis, which develops in pregnant women against the background of visible well-being and in the absence of any diseases, qualifies as "pure gestosis" and occurs in 20-30% of pregnant women. When gestosis occurs against the background of an existing disease (hypertension, kidney, liver disease, endocrine system pathology, lipid metabolism disorders), it qualifies as a combined one.

Manifestations of preeclampsia

Dropsy of pregnant women is characterized by persistent edema due to fluid retention in the body and is one of the early symptoms of preeclampsia. Distinguish between latent and overt edema. Latent edema is evidenced by pathological (more than 300-400 g per week) or uneven weekly weight gain.

Due to a decrease in urine excretion and fluid retention in the body, body weight rapidly increases, and there is a predominance of night urination over daytime. Swelling usually begins in the ankle area and gradually spreads upward. In some cases, the face begins to swell at the same time. In the morning, the swelling is less noticeable because the fluid is evenly distributed throughout the body during the night's rest. During the day, the swelling descends to the legs and lower abdomen. Even with severe edema, the general condition and well-being of pregnant women, as a rule, remains good. Diagnosis of dropsy in pregnant women is based on the detection of edema, weighing results, comparing the amount of fluid drunk and excreted per day - a woman should excrete no less than she drinks.

Nephropathy is characterized by a combination of three symptoms: edema, increased blood pressure, and protein in the urine. There may also be two symptoms in various combinations. Nephropathy of pregnant women usually develops against the background of dropsy preceding it. Increase in blood pressure up to 135/85 mm Hg. Art. and above is one of the important clinical signs of nephropathy. Baseline blood pressure is important. Arterial hypertension in pregnant women is evidenced by an increase in systolic blood pressure (first digit) by 30 mm Hg. Art. from the original, and the diastolic (second digit) - by 15 mm Hg. Art. and higher. Of particular importance is an increase in diastolic pressure, which is directly proportional to a decrease in placental blood flow and a decrease in the supply of oxygen to the fetus.

Nephropathy poses a danger to the health of pregnant women, women in labor and postpartum women due to the fact that it can turn into eclampsia (a seizure with impaired function of all organs and systems), cause severe dysfunctions of vital organs, and also creates preconditions for complications such as premature detachment of a normally located placenta, premature birth, bleeding, fetal hypoxia (insufficient oxygen supply), fetal death.

Severe complications of gestosis (bleeding, premature detachment of a normally located placenta, fetal death) are largely due not to high blood pressure, but to its sharp fluctuations.

The presence of protein in the urine (proteinuria) is one of the most characteristic signs of preeclampsia. A progressive increase in protein in the urine indicates a worsening of the course of the disease. Simultaneously with the presence of the listed symptoms in pregnant women, the volume of urine excreted decreases. The daily amount of urine is reduced to 400-600 ml or less. The less urine is excreted, the worse the prognosis of the disease. The longer the nephropathy lasts, the worse the prognosis of the condition of pregnant women and the outcomes of pregnancy.

Preeclampsia is manifested by a predominant violation of microcirculation in the central nervous system. This type of gestosis, in addition to the typical triad of symptoms, is characterized by a feeling of heaviness in the back of the head, headaches, pain in the stomach, in the right hypochondrium, nausea, vomiting, and visual impairment. Along with the listed signs, memory impairment, insomnia or drowsiness, irritability, indifference, lethargy may occur. There is also a weakening of vision, the flickering of "flies" or sparks, a "veil" in front of the eyes, which is a consequence of circulatory disorders in the occipital cortex and retinal damage.

Preeclampsia is characterized by the following symptoms: systolic blood pressure of 160 mm Hg. Art. and higher; diastolic blood pressure 110 mm Hg. Art. and higher; protein content in urine 5 g per day or more); a decrease in the volume of urine excreted (less than 400 ml); cerebral and visual disturbances, nausea, vomiting, a decrease in the number of platelets (blood cells responsible for blood clotting), a decrease in the activity of the blood coagulation system, impaired liver function.

Eclampsia- a severe stage of gestosis, in which, in addition to the symptoms characteristic of nephropathy and preeclampsia, seizures develop. The appearance of a convulsive seizure of eclampsia is most often provoked by external stimuli (bright light, sharp sound, pain, stressful situation). The seizure usually lasts 1 to 2 minutes.

After the seizure, the patient lies unconscious. After a while, consciousness returns, but she does not remember anything about what happened, complains of a headache and general fatigue. In some cases, the unconscious state is not interrupted and after some time passes into the next seizure. There may be several seizures. The prognosis is unfavorable when developing after a seizure of deep coma (a state in which there is no consciousness, the coordinating function of the brain is partially lost), which indicates cerebral edema, as well as possible hemorrhages. In some cases, a non-convulsive form of eclampsia may occur. In this case, the patient complains of severe headache, darkening in the eyes. Suddenly she falls into a coma with high blood pressure.

Explicit visible edema, in terms of their prevalence, differ in degrees:

I degree - swelling of the legs;
II degree - swelling of the legs and abdomen;
III degree - edema of the legs, anterior abdominal wall and face;
IV degree - generalized - common to the legs, trunk, arms, face.

Causes and mechanisms of development of preeclampsia

The causes of gestosis are very diverse. In this regard, several theories have been proposed for the development of this complication. So, according to one of the theories, gestosis is caused by a violation of the relationship between the cerebral cortex and subcortical formations, which is expressed by reflex changes in the vascular system and impaired blood circulation.

Of great importance for the development of gestosis is a violation of hormonal regulation of the functions of vital organs and systems. A significant role in the development of preeclampsia is assigned to the immunological incompatibility of the tissues of the mother and the fetus. A number of scientists are of the opinion about the possibility of a hereditary predisposition in the onset of preeclampsia. However, most researchers believe that there is no single mechanism for the development of gestosis, but there is a combined effect of various damaging factors in the development of this pathology.

From the point of view of possible mechanisms for the development of gestosis, great importance is assigned to the spasm of all vessels, which leads to impaired blood circulation in organs and tissues and a disorder of their function. A reflection of vasospasm is an increase in blood pressure. Equally important is the defeat of the inner layer of blood vessels - the endothelium. Damage to the endothelium leads to a decrease in the synthesis of substances in it that affect the tone of blood vessels and the blood coagulation system, and a change in sensitivity to them on the part of the vascular wall.

The body also synthesizes a number of other substances that regulate vascular tone. Under the influence of damaging factors, the balance between the substances is disturbed, which ensure the expansion and contraction of the vessels in favor of the latter, which leads to vasospasm. Against the background of the ongoing changes, the process of intravascular coagulation of blood is activated, the properties of blood flow are disrupted, and its viscosity increases. Blood circulation in the vessels becomes difficult, which is accompanied by the formation of blood clots, and there is a decrease in the supply of oxygen to the tissues of the mother and fetus.

Along with the changes occurring, the indicators of the function of the cardiovascular system of the pregnant woman decrease. Due to the increased permeability of the vascular wall against the background of damage to the vascular endothelium, the liquid part of the blood is released into the tissue, which manifests itself in the form of edema.

Gestosis is accompanied by severe renal dysfunction, which has various manifestations, ranging from the appearance of protein in the urine and ending with acute renal failure - a condition in which the kidneys cannot cope with their work. With gestosis, the function of the liver is also disturbed, which is accompanied by a disorder of blood circulation in its tissues, focal necrosis (areas of necrosis) and hemorrhages. There are also functional and structural changes in the brain: microcirculation disorders, the appearance of blood clots in the vessels with the development of dystrophic changes in nerve cells, punctate or focal hemorrhages, edema with increased intracranial pressure. With gestosis in pregnant women, there are also pronounced changes in the placenta, which are the cause of the development of chronic hypoxia and delayed fetal development. These changes are accompanied by a decrease in fetal-placental blood flow.

How is gestosis detected?

Diagnosis of preeclampsia is based on the assessment of anamnestic data (data on the woman's diseases, the course of this pregnancy), the patient's complaints, the results of a clinical objective study and laboratory data. To clarify the situation and objectively assess the patient's condition, they must evaluate:

clotting properties of blood;
general blood analysis;
biochemical blood parameters;
general and biochemical urine analysis;
the ratio of consumed and released fluid;
blood pressure value;
change in body weight over time;
concentration function of the kidneys;
fundus condition.

If preeclampsia is suspected, ultrasound and Doppler measurements are performed. Additional consultations of a therapist, nephrologist, neuropathologist, ophthalmologist are also required.

Treatment of gestosis

The basic principles of the treatment of preeclampsia include: the creation of a therapeutic and protective regimen, restoration of the function of vital organs, fast and gentle delivery.

With dropsy I degree, it is possible to carry out treatment in the conditions of antenatal clinics. With dropsy of II-IV degree, treatment is carried out in a hospital setting. Pregnant women with severe nephropathy, preeclampsia, eclampsia should be hospitalized in hospitals at multidisciplinary hospitals that have an intensive care unit and a unit for nursing premature babies.

Treatment of gestosis includes a set of measures:

a diet with fluid restriction (800-1000 ml per day) and salt, enriched with proteins and vitamins;
creation of a therapeutic and protective regime (including sedatives);
infusion, or intravenous, therapy (its purpose is to improve blood circulation in small vessels, including in the vessels of the placenta). The volume of infusions is up to 1400 ml per day (using Reopolyglucin, plasma preparations, etc.);
antihypertensive therapy - treatment aimed at lowering blood pressure (dibazol, magnesia, nitrates, ganglion blockers for controlled hypotension, calcium antagonists, apressin);
prevention of placental insufficiency (actovegin, vitamins E, B6, B12, C, methionium).

Sedatives, diuretics, and medicines that lower blood pressure and improve blood flow are prescribed.

The duration of treatment is determined by the severity of gestosis and the condition of the fetus. With mild nephropathy, the duration of inpatient treatment should be at least 2 weeks, with an average - from 2 to 4 weeks, depending on the condition of the fetus. The patient can be discharged from the hospital with recommendations to continue treatment under the supervision of a antenatal clinic. In severe nephropathy and the presence of an effect of treatment, observation and treatment in a hospital setting before delivery is optimal. Treatment of severe nephropathy, preeclampsia and eclampsia is carried out in conjunction with resuscitators in the intensive care unit.

Indications for early delivery (usually by caesarean section) are:

moderate nephropathy with no effect of treatment within 7-10 days;
severe forms of preeclampsia with failure of intensive therapy for 2-3 hours;
nephropathy, regardless of severity, with delayed fetal development and lack of growth during treatment;
preeclampsia, eclampsia and its complications.

Delivery through the vaginal birth canal is carried out in the presence of appropriate conditions: with a satisfactory condition of the patient and the effect of treatment, in the absence of intrauterine fetal suffering according to ultrasound and cardiomonitoring studies.

Prevention of gestosis

Measures aimed at preventing the development of gestosis should be carried out in patients at risk for the development of this pathology. Risk factors include: violation of fat metabolism, hypertension, kidney pathology, diseases of the endocrine system, infectious diseases, combined pathology of internal organs (that is, the presence of several diseases).

Prevention of gestosis in the risk group begins in the second trimester of pregnancy. At the same time, it is necessary to organize a rational regimen of rest and nutrition: adequate sleep (about 8 hours a day), regular walks, it is important to maintain a good mood, create a calm emotional background. Regular monitoring of the condition of the mother and the fetus is important to identify the earliest signs indicating the onset of preeclampsia. Drug prophylaxis is aimed at optimizing the function of the nervous system, liver, kidneys, and metabolic processes. It is important to ensure the normal state of the blood coagulation system. The duration of the course of drug prophylaxis is on average 3-4 weeks.

There are standard periods of stay in the maternity hospital in the event that the postpartum period passes without complications. During vaginal delivery, they can be 4-6 days, with operative delivery - 7-9 days. It was at this time that the doctor monitors the mother and baby every day.

What procedures and manipulations await a young mother after childbirth?

The doctor and midwife will periodically check:

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

You will also be asked:

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

You may be assigned:

pills that help to contract the uterus - for the prevention of postpartum hemorrhage;
injections or tablets of anesthetic and antispasmodic drugs in the presence of painful postpartum contractions (such drugs are received by multiparous and patients after a cesarean section);
antibacterial drugs (they can be prescribed after surgical delivery).

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

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

Complications of pregnancy and childbirth

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

Infectious complications of the postpartum period

Endometritis - inflammation of the lining of the uterus. This disease is manifested by an increase in body temperature up to 38-40 ° C, depending on the severity of the disease, pain in the lower abdomen (it should be noted that normally, especially after repeated childbirth, cramping pains can be observed during this period - more often during feeding). This is due to the contraction of the uterus. Endometritis pains are persistent, they are pulling in nature and can spread to the lumbar region. Discharge from the genital tract with endometritis abundant, with an unpleasant odor. If normally, 2-3 days after childbirth, the discharge acquires a bloody character, then with endometritis, spotting may resume. With inflammation, the uterus contracts poorly. It is necessary to say about the so-called subinvolution of the uterus. This is a borderline state between endometritis and the norm: the uterus does not contract enough, which can "prepare the ground" for inflammation.
Inflammatory complications that can lead to a woman's delay in the hospital should also include divergence and infection of the sutures of the perineum and the suture after cesarean section. With these complications, reddening of the skin is observed in the area of the rupture or incision, pus can be released from the wound, and the seam area is painful.

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

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

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

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

Chronic diseases

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

To the hospital - at your own request

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

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

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

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

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