Toxicosis during late pregnancy: symptoms, consequences and treatment. Late toxicosis of pregnant women

08.07.2019

Most women experience nausea during pregnancy. Despite the fact that it gives the expectant mother a lot of discomfort, this phenomenon is considered normal and in most cases goes away on its own by 12-14 weeks of gestation. If toxicosis appears in the second half of pregnancy, we are talking about a pathological process, ignoring which is fraught with the development of serious consequences for the health of the mother and child. In 30% of cases, toxicosis in late pregnancy ends in fetal death.

Why does pathology occur? By what symptoms can it be identified? How is late toxicosis treated during pregnancy?

Causes of late toxicosis

Scientists have not yet come to a consensus regarding the factors provoking the development of this pathology. Currently, the causes of toxicosis in late pregnancy are interpreted from the standpoint of various theories:

Cortico-visceral. According to its supporters, this pathological phenomenon, which in medicine is called preeclampsia, develops against the background of a malfunction in the nervous system of the future woman in labor. Neurotic disorders lead to disruption of cortical and subcortical connections, as a result of which the cardiovascular system suffers and blood supply worsens.
Endocrine. Adherents of this theory believe that the development of toxicosis in late pregnancy is associated with hormonal changes in the body of a pregnant woman. Such disorders inhibit the state of blood vessels and blood clotting, resulting in deterioration of blood supply to organs, metabolic processes, and cardiovascular regulation.
Immunological. According to this theory, pathology occurs due to the rejection of fetal antigens by the mother's body, as a result of which the permeability and tone of the vascular channels increase. Subsequently, such changes lead to a deterioration in the state of intraorganic tissues and structures.
Genetic. The followers of this theory came to the conclusion that late toxicosis is inherited.
Placental. Preeclampsia develops due to the lack of necessary changes in the vessels of the uterus that feed the placental tissues. This defect eventually leads to the formation of specific substances that aggravate the work of the cardiovascular system.

Among the main factors in the development of late toxicosis are:

abuse of the future mother by alcohol and smoking;
prolonged stress;
disruption of the normal functioning of the immune, endocrine and cardiovascular systems;
overweight;
liver damage;
kidney disease;
biliary dysfunction.

The risk group for developing preeclampsia includes women:

under 18 years old and over 35 years old;
with multiple pregnancy;
with chronic infectious pathologies;
in history of which there are cases of artificial termination of pregnancy.

Types and symptoms of pathology

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Toxicosis that occurs in the second half of gestation is classified according to several criteria:

time of occurrence;
flow form;
degree of damage.

The danger of preeclampsia lies in the fact that for a long period the pathological process may not manifest itself in any way, so in some cases it is difficult to understand when it began. The doctor can suspect signs of the disease only on the basis of the results of clinical studies. The table provides information on the types of late toxicosis and the symptoms by which it can be recognized.

Classification sign	Varieties of preeclampsia	Symptoms
Classification sign	Varieties of preeclampsia	Symptoms
By time of appearance	During pregnancy	pronounced swelling of the face, neck, upper and lower extremities; the presence of protein in the urine; high blood pressure (over 130/80 mm Hg); bouts of dizziness, loss of consciousness, severe nausea and vomiting; noise and ringing in the ears; rapid weight gain (more than 500 g in 7 days).
	During childbirth
	Within the first 48 hours after the baby is born
By the shape of the flow	Dropsy or swelling of pregnancy
	Nephropathy
	Preeclampsia
	Eclampsia
By degree	I (easy)
	II (medium)
	II (heavy)

Complications and consequences

Toxicosis in the 2nd and 3rd trimesters of gestation is dangerous for the health of the future mother and fetus. Complications that may occur in a woman with untimely action:

violation of the normal functioning of the kidneys, lungs and liver;
disorders of the central nervous system;
failure of the visual function;
hepatic coma;
vasospasm and microcirculatory changes in the brain;
the formation of blood clots, which can cause intracerebral hemorrhage, swelling of the brain and lungs, as well as the development of heart, liver and kidney failure;
dehydration against the background of indomitable vomiting;
premature detachment of the placenta.

This pathological phenomenon, which appeared in late pregnancy, is dangerous for the fetus with the following consequences:

birth before the due time;
antenatal asphyxia;
death as a result of too early detachment of the placenta;
hypoxia, subsequently leading to a slowdown in intrauterine development;
low birth weight;
weakened immune system;
delayed mental and physical development.

Diagnostic methods

An accurate diagnosis is made only after a thorough analysis of the patient's complaints and research results. Diagnosis involves specialists such as an ophthalmologist, therapist, neurologist and nephrologist.

The table provides general information about the manipulations that are used to confirm suspicions of late toxicosis.

Diagnostic procedure	Description of the method	The purpose of the
Collection of anamnesis	Obtaining and analyzing information about what symptoms are present, whether the patient had bad habits and artificial termination of pregnancy in the past, whether her mother suffered from a similar pathology. Study of medical history.	Making a preliminary diagnosis, developing a plan for further diagnostic measures.
Laboratory research	General urine analysis	Determination of the presence of protein and the level of density
	Urinalysis according to Zimnitsky	Finding out the amount of biomaterial released at night
	Clinical and biochemical blood test	Determination of the number of red blood cells and platelets
	Coaculogram	Checking the state of the convolution function
Instrumental examinations	Measurement of blood pressure, including after increased physical activity	Detection of hypotension
	Analysis of the ratio of the volume of fluid consumed and urine output	Finding out the cause of edema
	Tracking the dynamics of weight change	Finding out the cause of edema
	Examination of the condition of the fundus	Checking the status of visual function
	dopplerography	Checking the condition of the fetus
	KTG
	ultrasound

How is pathology treated?

When a pregnant woman is diagnosed with the initial stage of preeclampsia - dropsy, the elimination of its symptoms is carried out on an outpatient basis. For other manifestations of the disease, the future woman in labor is subject to mandatory hospitalization. Pathology is not treatable, because there is no way to accurately determine the causes of its occurrence. If late toxicosis is detected in a future woman in labor, measures are taken to alleviate her condition, prevent the aggravation of symptoms and maintain the normal functioning of the fetus.

With the development of the disease at 29-36 weeks, in the event of a deterioration in the well-being of a pregnant woman, she is prepared for childbirth before the due date. In situations where the applied therapeutic measures were ineffective, and the form of the disease is severe, delivery is carried out using a caesarean section.

Form of the disease	Methods of treatment	Duration of therapy, days
Light	Medications are prescribed: sedatives; antispasmodic - for the relief of spasms; antiplatelet agents - to normalize the rheological properties of blood; antioxidants; hypotensive - to normalize pressure; to prevent the formation of blood clots - improve blood circulation; diuretics - normalize the process of urination and stop swelling.	10-14
Medium and heavy	Infusion therapy is carried out, aimed at eliminating the failure of metabolic and electrolyte processes. For this, fresh frozen plasma and reopoliglyukin are introduced. Anticoagulants are also used. Diuretics are used to normalize water-salt metabolism.	14-28

Prevention measures

The words "pregnancy" and "toxicosis" in the minds of most people are inextricably linked. And toxicosis itself is just as firmly associated with dizziness and even throughout the day. It is because of this stereotype that women are so surprised when they are told about late toxicosis of pregnant women. Of course, because a woman, most often, does not experience nausea at this time. However, preeclampsia, this is how this disease has been called since 1996, has a slightly different nature and symptoms than early toxicosis.

Unfortunately, toxicosis of the second half of pregnancy often proceeds completely unnoticed for a woman, while it can have simply catastrophic consequences and flow into a very severe form. There are 4 forms of gestosis:

Edema. They can be overt and covert. Hidden swelling of the internal organs is called, they can only be detected at a doctor's appointment. The reason for the appearance of edema is fluid retention in the body. Later limbs begin to swell. However, it is not at all necessary that edema indicates preeclampsia, a consultation with a gynecologist is necessary.

The next stage is called nephropathy. At this stage, it begins. It is expressed in three symptoms: edema, increased blood pressure and the appearance of protein in the urine. Nephropathy can be mild, moderate or severe.

The next stage, preeclampsia, develops only in 5%. This stage is characterized, in addition to the already indicated symptoms, disorders of the nervous system, manifested in pain in the back of the head, nausea, dizziness, sometimes even psychological changes and inappropriate behavior.

The most severe stage is called eclampsia. At this stage, late toxicosis has very unpleasant manifestations, the most characteristic of which are spasms of the skeletal muscles of the whole body. Such an attack can result in a stroke. In addition, there is a possibility of placental abruption, and this can lead to fetal death.

The reasons for the development of late toxicosis have not yet been identified, there are a lot of theories. However, most scientists believe that it is impossible to single out any one reason for the development of preeclampsia. But the processes occurring in the body of pregnant women during preeclampsia are well studied. First of all, gestosis is a spasm of blood vessels, which leads to a decrease in blood volume, its thinning. All this negatively affects the blood supply to organs and tissues. Tissue degeneration occurs, sometimes leading to their death. The lack of oxygen has a particularly strong effect on the brain, liver, and circulatory system. In addition, preeclampsia can lead to fetal hypoxia.

In parallel with these processes, the permeability of tissues increases, as a result of which the accumulation of fluid in the body begins. This is what causes the edema characteristic of late toxicosis. And the reason is vasospasm.

As can be seen from all of the above, late toxicosis is a serious disease that requires timely treatment. However, it is rather difficult to diagnose gestosis in time. First of all, every woman should know if she is one of the risk groups. Unfortunately, late toxicosis can also develop in a perfectly healthy woman, however, in women suffering from certain diseases, the risk of developing preeclampsia is much higher.

These diseases include hypertension, chronic diseases of the stomach, kidneys, biliary tract, thyroid disease and obesity. Women suffering from these diseases need to take care of themselves and the child even before conception. It is necessary to undergo a course of treatment, and during pregnancy, monitor your condition very carefully, and specifically for changes in weight and pressure.

In addition, you need to register at the antenatal clinic on time and visit your doctor regularly. In the first half of pregnancy at least once every two weeks, and in the last trimester even every week. With the normal development of pregnancy, a weekly weight gain should be about 500 g.

In case of suspicion of late toxicosis of pregnant women, the woman will be asked to take a series of tests and, possibly, be hospitalized. You should not refuse, as preeclampsia sometimes develops very quickly and the consequences can be irreversible.

But now, the woman has confirmed Treatment in this case is simply necessary. Unfortunately, it will not be possible to completely cure preeclampsia, however, it is quite possible to control the condition of a woman with this diagnosis. To do this, you need to observe the diet and fluid intake, possibly taking sedatives. In addition, with the help of medicines, the work of internal organs is normalized.

Usually, they try not to carry out stimulation with gestosis. A woman is observed before the start of independent childbirth. However, if there is a threat to the life and health of a woman in labor or a child, it may be necessary to induce labor by stimulation.

Up to the development of convulsive syndrome, cardiovascular, endocrine systems, hemostasis and other systems, which can lead to adverse outcomes for the mother and fetus. But most often it is manifested by a triad of symptoms: edema, proteinuria, hypertension.

The frequency is 7-16%. The medical examination system allows women to be hospitalized in the pregnancy pathology departments when the first signs of the disease appear. However, due to the blurring of clinical manifestations, often observed recently with this complication, there are cases of the development of convulsive syndrome (eclampsia) and other severe clinical manifestations of toxicosis outside the hospital.

Risk groups for the development of late toxicosis (preeclampsia):

1) pregnant women with extragenital pathology (kidney disease, chronic non-specific lung disease, endocrinopathies, etc.);

2) pregnant women with obesity;

3) pregnant women with heart defects;

4) pregnant women who had late toxicosis in previous pregnancies;

5) the woman's age (over 30 or under 19);

6) multiple pregnancy (twins, triplets, etc.);

7) anemia of pregnant women;

8) intrauterine fetal malnutrition (fetal growth retardation);

9) sensitization by Rh factor or blood group;

10) if a pregnant woman has occupational hazards.

Types and manifestations of the disease

There are typical and atypical forms of late toxicosis (gestosis).

Typical forms include: dropsy, nephropathy I, II, III degree, preeclampsia, eclampsia. These forms are considered as different stages of the same pathological process.

Atypical ones include: monosymptomatic nephropathy with hypertension, nephropathy with two symptoms, eclampsia without seizures.

Dropsy is characterized by the appearance of one symptom of edema, which is more common: on the lower and upper limbs, on the anterior abdominal wall, in the form of puffiness or swelling of the face. Dropsy is the initial form of late toxicosis of pregnant women. The general condition of a pregnant woman with dropsy is not disturbed, and only in those cases when the edema is very pronounced, there are complaints of a feeling of heaviness, fatigue, increased thirst. Blood pressure remains within normal limits or even slightly below it. Dropsy of pregnant women in 20-24% of cases turns into nephropathy.

Nephropathy most often combines the presence of three symptoms of edema, hypertension, proteinuria (the appearance of protein in the urine). Unlike dropsy of pregnant women with nephropathy, the main symptom is not edema, but arterial hypertension, which in severe cases can reach 200/150 mm Hg. Art. and even higher. The degree of nephropathy is determined by a special Savelyeva scale. The scale characterizes the state of pregnant women at the time of examination.

Preeclampsia refers to more severe forms of late toxicosis. Against the background of the appearance of three symptoms (edema, proteinuria, hypertension), new signs appear: dizziness, a feeling of heaviness in the forehead and back of the head, insomnia, apathy, lethargy, visual impairment (“veil” before the eyes, flashing “flies”, sometimes loss of vision ), tinnitus, signs of indigestion and liver - nausea, vomiting,.

Any irritant can lead to the development of eclampsia (convulsive seizure) - a loud sound, bright light, pain. Eclampsia is the most severe form of preeclampsia. Occurs rarely. This is a convulsive contraction with. Has 4 stages:

Stage 1 - lasts about 20-30 seconds and is characterized by twitching of mimic (facial) muscles.

Stage 2 - also lasts about 20-30 seconds and is characterized by tonic (prolonged muscle contractions, as a result of which the limbs "freeze" in the position of flexion or extension, the patient's body is extended, the head is thrown back or brought to the chest) convulsions up to respiratory arrest and biting language.

Stage 3 - lasts about 2 minutes and is characterized by clonic (following contractions of the flexor and extensor muscles, which is manifested by rapid involuntary movements of the limbs and trunk) convulsions, breathing is disturbed, cyanosis develops (bluish coloration of the skin), foamy saliva appears with an admixture of blood.

Stage 4 - begins with a deep breath and is characterized by a gradual restoration of breathing, consciousness may still be absent.

Complications of late toxicosis (gestosis)

2) pulmonary edema;

3) acute renal failure;

6) premature detachment of a normally located placenta;

7) development of placental insufficiency:

Acute and chronic hypoxia,

intrauterine growth retardation,

premature birth.

Development of HELLP syndrome: hemolysis of erythrocytes, degeneration of liver cells, thrombocytopenia.

Treatment of preeclampsia

Treatment depends on the form preeclampsia.

Treatment of dropsy of pregnant women is carried out most often in the day hospital of the antenatal clinic.

All other forms of preeclampsia require treatment in a hospital in the department of pathology of pregnant women or in the intensive care unit of a maternity hospital.

Indications for caesarean section with late toxicosis (gestosis):

1) eclampsia;

2) preeclampsia and severe nephropathy in the absence of the effect of intensive therapy within a day;

3) coma;

It is advisable to be observed during pregnancy by one gynecologist. Then he will know everything about the state of health, about the course of previous pregnancies, concomitant diseases, how this pregnancy proceeded. This will help to suspect late toxicosis in time and prevent its complications.

What can a doctor do?

Late toxicosis is established with fluid retention: excessive weight gain, edema, increased blood pressure, convulsions. With late toxicosis, protein is detected in urine tests. on examination, he notices changes in the fundus and a decrease in visual acuity.

Therefore, systematic and careful monitoring of a pregnant woman for the timely detection of early signs of preeclampsia is of utmost importance. To do this, at each visit to a pregnant consultation, you must:

1) weigh it (preferably at the same time of day and in the same clothes);
2) measure blood pressure on both arms;
3) conduct a urine test;
4) to carry out a thorough obstetric examination.

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

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

Causes of late toxicosis during pregnancy

Today, there are about 30 different theories, the authors of which tried to explain the causes and ways of developing the disease, but the reliable causes of the pathology have not been fully elucidated and not studied.

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

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

Late toxicosis during pregnancy: who is at risk

From a dangerous disease, women in the position who:

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

Popular versions of the development of late toxicosis during pregnancy

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

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

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

Consequences of toxicosis in late pregnancy

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

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

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

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

Signs of late toxicosis during pregnancy

The presence of late toxicosis is evidenced by 3 symptoms:

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

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

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

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

Features of the state of a pregnant woman with late toxicosis

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

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

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

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

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

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

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

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

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

Late toxicosis during the second pregnancy

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

The specifics of the management of pregnancy complicated by late toxicosis

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

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

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

Methods of dealing with late toxicosis during pregnancy

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

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

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

Prevention of the development of late toxicosis during pregnancy

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

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

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

Causes and treatment of late toxicosis during pregnancy. Video

Content:

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

The concept and definition of late toxicosis

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

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

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

The risk group includes the following categories of women:

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

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

Causes of late toxicosis

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

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

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

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

Symptoms of late toxicosis

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

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

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

Other symptoms include headache, nausea and vomiting, heaviness in the head, and, in severe cases, convulsions and altered consciousness.

The main types of gestosis

Symptoms and forms of the disease allow us to divide preeclampsia into several degrees of severity:

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

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

Diagnosis and treatment of toxicosis

The most complete diagnosis of preeclampsia is carried out using general and laboratory research methods. Pressure is measured at least three times a day, including after exposure to small physical exertion. Conducting a general urine test reveals protein and increased urine density. A special analysis of urine according to Zimnitsky determines its volume allocated at night.

It is mandatory to carry out a general and biochemical blood test, as well as a clotting test. The amount of fluid drunk and excreted is monitored daily. Weight is measured every week. The data obtained allow us to develop the most optimal set of therapeutic measures.

As a rule, late toxicosis is treated in stationary conditions. Treatment is recommended to start already at an early stage, when symptoms are manifested only by the presence of edema. First of all, a protective regime is prescribed with the appointment of a diet and special drugs that affect the desired blood parameters. Droppers contribute to the improvement of blood circulation, kidney and liver functions. Sedative sedative therapeutic measures are carried out. It is impossible to completely cure preeclampsia, since it is impossible to establish the exact causes of the disease.

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

Complications and consequences of late toxicosis

Most often, the development of late toxicosis occurs after the 20th week of pregnancy. It causes serious complications, which are the main causes of death.

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

There are spasms of small arteries, detected by ophthalmologists when examining the fundus.
The permeability of the vascular walls increases, the outflow of blood in the veins worsens. As a result, there are obvious or hidden edema, protein appears in the urine.
The liquid component of the blood is released into adjacent tissues. Because of this, the blood thickens, its clotting increases.
The lower blood pressure is lowered and the upper arterial pressure is increased.