Gestosis is a pathological symptom complex that occurs exclusively against the background of pregnancy. Sometimes this syndrome is called "late toxicosis", which, in fact, is not entirely correct from the point of view of the officially accepted specialists classification, which are diagnosed with "toxicosis" and "gestosis."
Nevertheless, specialists may call gestosis a late toxicosis in communication, which in no way indicates their incompetence, since in the obsolete classification of toxicoses there were only two of its definitions - early and late.
For patients, it is not the definitions that are important, but their essence, so they need to know the main thing:
- Emerging complications in the first half (early) pregnancy are called toxicosis, and in the second (late) - gestosis;
- unlike early toxicosis, late (gestosis) is always associated with profound pathological disorders capable of provoking dangerous complications;
- gestosis in pregnant women never passes by itself;
- if the pregnant woman is diagnosed with toxicosis , this does not imply the mandatory appearance of her gestosis, although there is a physiological relationship between these conditions;
- it is not always possible to predict the development of gestosis, since pathology has a peculiarity of appearing sometimes suddenly without accompanying precursors;
- Timely diagnosed gestosis can be suppressed, and if left unattended, the pregnant woman may die.
Clinic gestosis can not be missed. "Classic" gestosis in pregnancy is diagnosed relatively simply by the characteristic triad of pathological symptoms: impaired renal function, arterial hypertension and edematous syndrome. These signs are not always equally expressed, but almost always present simultaneously, since each of these symptoms is not an independent pathological process, but a link of a single chain.
Gestosis now still refers to "disease theories". The origin of gestosis has not yet been reliably studied, only the most important factors provoking it are known. Most gestoses are diagnosed in pregnant women with extragenital pathology, which are at the root of endocrine and vascular disorders: diabetes , vascular pathology, hypertension , renal pathology and the like. Developing against the background of a similar pathology, gestosis is called a combination, or secondary. It is the secondary gestosis that is diagnosed more often (80%). In initially healthy pregnant gestosis is classified as primary.
There is also the concept of pre-toxicity. It is used to identify pre-clinical gestosis, when there are deviations in the absence of obvious clinical manifestations in the analyzes of the pregnant woman. Pre-toxicity is not a stage of gestosis, as its transformation into a more serious condition does not always happen.
Four forms of gestosis are officially recognized: edema (edematous syndrome), nephropathy (renal dysfunction), preeclampsia and eclampsia proper (terminal state bordering on coma). They are also regarded as the stage of gestosis.
Regardless of the form of gestosis, it is always considered a threatening condition, and therefore requires emergency hospitalization and inpatient treatment.
The consequences of gestosis depend on many factors:
- from the stage of gestosis;
- on how timely it is diagnosed;
- from the presence of concomitant extragenital pathology in pregnant women;
- on its degree of influence on the fetus;
- on the adequacy of the therapy.
It should be clarified that the terms "early gestosis", "gestosis of the second half of pregnancy" and "late gestosis" are incorrect, since the true gestosis occurs late, and the pathological symptom complex related to the first half of gestation is called toxicosis.
What is gestosis?
Gestosis is the form of late toxicosis of pregnant women. To early toxicosis are several states that appeared in the first half of pregnancy:
- Pathological vomiting. Each second pregnant woman, due to a change in the hormonal background, has nausea or vomiting, which is considered as a temporary physiological condition during the period of adaptation of the organism to the conditions of pregnancy. As a rule, in the natural course of pregnancy, nausea and vomiting often occur in the morning (usually on an empty stomach), repeated no more than 3 times a day and, in addition to clinical inconvenience, do not cause significant harm. When the placentation process ends (12th - 13th week), uncomfortable symptoms pass without a drug correction.
As an early complication of pregnancy only pathological vomiting is considered. It is observed in 8-10% of pregnancies and is classified as an early toxicosis. Episodes of vomiting for a day occur repeatedly, do not depend on food intake, its quality and quantity. The pregnant woman stops eating correctly and loses weight, and her well-being worsens considerably.
- Jaundice of pregnant women. It develops because of the same hormonal adjustment on the background of cholestasis, when bile is delayed and not transported to the small intestine. It provokes heartburn, periodic nausea, local or total (generalized) itching of the skin . Some people have a slight and unstable icterus. The phenomena of cholestasis, like physiological vomiting, are observed in mild form in many pregnant women, but they are not always elevated to the rank of toxicosis.
- Increased salivation (ptyalism) against the background of a temporary increase in the function of the salivary glands.
All of the listed conditions in toxicosis can exist simultaneously or in the singular.
In later terms, complications of pregnancy occur in the form of serious violations and differ from those in the early stages. Allocate:
- Edema syndrome (dropsy). The fluid retention has a different degree of severity, but tends to progress.
- Renal dysfunction (nephropathy), diagnosed by the presence of protein in the urine (proteinuria) and its number.
- Pre - eclampsia . Inevitably follows severe nephropathy due to disruption of the processes of blood supply to the brain.
- Eclampsia . The most severe, terminal, phase of gestosis, threatening the lives of all participants in the pathological process.
Why is gestosis as a form of toxicosis isolated in a separate clinical group?
First of all, it should be noted that in the case of early toxicosis, all arising disorders have a functional character, that is, they are temporary, pass quickly and independently, as soon as the mother organism adapts to the new conditions. With gestosis, violations are of an organic nature, that is, there are changes in the organs that violate their function.
Toxicosis of early terms does not interfere with the development of the fetus and does not affect its vital functions, and with gestosis, the fetus does not just experience discomfort - as a result, it develops conditions that do not allow it to maintain proper vital functions.
Most of the early toxicoses stop spontaneously. When the placenta finally "ripens" and begins to secrete progesterone, the temporary hormonal dysfunction of the initial gestation period is compensated, and the symptoms of toxicosis are eliminated.
Gestosis never passes without medication from outside. There is a direct relationship between the time of gestosis and its outcome. The earlier the diagnosis is made, the higher the success of therapy and the less likely the negative consequences.
Causes of Gestosis
At the heart of the pathological process with gestosis is a generalized vascular spasm, as a result of which the volume of circulating blood ( hypovolemia ) decreases, there are changes in blood coagulability and the microcirculation process in organs is disrupted. As a result, in the tissues appear dystrophic changes of varying severity - from mild dystrophy to local necrosis (dying).
None of the existing theories of the origin of gestosis can fully explain the formation of pathology, but each of them has the right to exist, since it contains reliable facts.
It is believed that the prerequisites for the development of gestosis appear even at the stage of implantation of a fertilized egg into the endometrium. In conditions of physiologically developing pregnancy, the fetal egg, overcoming the fallopian tube, falls into the area of the uterine fundus and is implanted into the mucous membrane. The outer shell of the embryo (chorion), like the branching roots of the tree, plunges deeply into the endometrium with the help of peculiar outgrowths - the villi. The outgrowths form a close connection with the adjacent uterine vessels to ensure the full development of the embryo. Subsequently, the placenta (a child's place) is formed in the chorionic villus zone, and the place of attachment of the villi to the uterus is called the "placental area". Perhaps when a certain structural failure occurs during the ingrowth of villi, the blood supply of the fetal egg is not physiological, and when the load on the vascular system increases significantly in the second half of pregnancy, gestosis appears.
Gestosis may have a neurological cause, when dysfunction occurs in the central nervous system, and the process of normal neurovegetative regulation of pregnancy formation is disrupted.
The immunological theory of the origin of gestosis states that at the heart of the pathology there is an inadequate response of the mother's organism to the fetal tissues, which are perceived as "alien" and rejected.
Often, gestosis in pregnant women is diagnosed in parallel with the pathology of the placenta, namely with impaired blood supply to the child's place. It is believed that the placenta begins to suffer because of gestosis, but in some patients the primary is placental pathology.
It is logical to assume that the health of the pregnant woman can also cause gestosis, when it appears against the background of the already existing pathology of the endocrine or cardiovascular system, as well as kidney disease.
Symptoms and signs of gestosis
Prerequisites for the formation of gestosis appear at different times, but a full-fledged clinic often develops after the 20th week of gestation.
It is extremely important for a specialist to detect precursors of gestosis as early as possible, so they are trying to find them already from the 13th - 15th week. More often in the preclinical stage of gestosis (pregestosis), there is the earliest symptom - swelling. The difficulty in diagnosing prehistoric disease is associated with the differentiation of the usual edema of a pregnant woman from a pathological fluid retention. It is believed that the physiological edema disappears after a night's sleep and does not imply a decrease in diuresis, nor does it provoke laboratory changes.
Edemas not only are harbingers of gestosis, they are also its initial stage. Only 8% of pregnant women have edematous syndrome with an isolated course, and in all others it inevitably aggravates and provokes the next stage of gestosis.
Any gestosis has a classic triad of symptoms:
- swelling of any severity (latent / obvious) - (O);
- protein excretion in the urine (proteinuria) - (P);
- arterial hypertension - (D).
According to the name of the symptoms in this triad, pathology by specialists is sometimes called "OPG - gestosis". Symptoms of gestosis can be expressed unequally and are not always present "threesomes".
Classification gestozov implies the presence of the severity of one of its forms. Allocate:
- Vodian with varying degrees of swelling. Swelling may appear in the first trimester for quite innocuous reasons, so when they continue at a later date, the pregnant woman may not give due importance to this symptom, especially since dropsy practically does not worsen the state of health. As a rule, the pregnant woman begins to think about the unhappiness in the case of very pronounced edema, and in the early stages the dropsy should be suspected by the observing physician.
When swelling is well pronounced, it is not difficult to diagnose them. Sometimes, with the so-called "hidden" swelling, an inexplicable weight gain is evidence of their presence. If the dietary intake of a pregnant woman has not changed, but the weight gain is higher than the accepted norm, ascertain the presence of hidden swelling, when the accumulated intercellular fluid increases the weight.
- Renal dysfunction (nephropathy). Throughout the entire period of gestation, the kidneys work in an enhanced mode, using all the backup capabilities. Against the background of edemas, hidden or obvious, the additional burden on the kidneys, therefore, in the absence of proper treatment at the initial stages of gestosis, there are signs of renal dysfunction: increased edema, lability of blood pressure (then high, then normal) and proteinuria. The appearance of protein in the urine is a kind of marker for the stage of gestosis, and its concentration indicates the depth of the lesion.
Another important feature of nephropathy is the change in blood pressure, namely, its increase, and the greatest danger is not simply augmentation of BP numbers, but its significant fluctuations.
- Pre-eclampsia. The shortest period of gestosis, which appears against the background of pronounced nephropathy as an intermediate state between it and proper eclampsia. Pre-eclampsia is said to be associated with neurological disorders associated with severe nephropathy: headaches, lethargy and drowsiness, eye changes and the like.
- Eclampsia. Terminal, the heaviest stage of gestosis. Against the backdrop of ongoing polyorganism, convulsive syndrome and coma are developing.
In contrast to early toxicosis, late toxicosis, especially in the beginning, does not always provoke negative symptoms, so the gestosis is usually not identified by the pregnant woman. This is precisely the insidiousness of gestosis: the patient feels quite well, and the gestosis is masked under completely "harmless" manifestations, which are taken for the usual malaise of pregnant women. Initially, gestosis in pregnant women is identified by a change in the composition of blood, urine, as well as by the unusual "behavior" of blood pressure.
In such a situation, the paramount importance is the presence of a trusting relationship between the pregnant woman and the doctor who watches her. Unfortunately, often pregnant women in assessing the severity of their condition rely solely on their own well-being and do not agree with the recommendations of a specialist for preventive hospitalization.
It should be noted that the division of toxicosis according to the timing of occurrence is very conditional and relies on statistics, which only indicates the most common occurrence of signs of complication of pregnancy. There are situations when prolonged early toxicosis continues in the second half of pregnancy, or when gestosis starts already in the first half.
Degrees of gestosis
Classification of gestosis is very conventional. She identifies several forms of gestosis, which were described above, but each of them is both a form and a degree simultaneously. The brighter the clinic of gestosis, the higher the degree of its severity. In fact, gestosis is a single pathogenetic process that consists of successively developing conditions - dropsy, nephropathy and preeclampsia / eclampsia.
When they say about the degree of gestosis, they usually mean only one of its forms - dropsy of pregnant women. According to the visual expression of edematic syndrome, dropsy is classified according to the degrees (or stages):
- 1 degree - not expressed edema only on feet and legs, having unstable character;
- 2 degree - the swelling of the legs becomes more obvious, they do not pass for a long time, the swelling of the abdominal wall joins them;
- 3 degree - edema of the 1st and 2nd degree is associated with swelling of the hands (more often brushes) and face;
- 4 degree (most severe) - edema becomes ubiquitous (generalized).
The degree of dropsy is assessed visually, that is, as soon as swelling becomes visible, therefore this classification is not an absolutely reliable evaluation criterion. For more detailed diagnosis of the degree of pathology, laboratory and instrumental methods are required.
As already mentioned, early gestosis does not exist by definition. Speaking such a phrase probably confuses gestosis with an early toxicosis or has in mind the early manifestations of gestosis, which will be discussed in this chapter.
The earliest evidence of gestosis is the appearance of dropsy of any stage. Feeling of pregnant swelling does not worsen, and the emerging fatigue, thirst and heaviness in the legs to the end of the day are regarded as the consequences of pregnancy. Therefore, initially the diagnosis of dropsy and the onset of gestosis, respectively, for the first time ascertained by a specialist.
Edema with dropsy have several differences from those with a physiological pregnancy. As a rule, usual swelling appears in connection with any particular circumstance and passes after its elimination. These often include:
- a large amount of drunk fluids;
- Long stay in the "standing" position (therefore, swelling intensifies closer to the end of the day);
- too hot weather, increasing the load on the vessels;
- salty foods;
- taking medications that cause water retention in tissues.
It is very important not only to ascertain the swelling, but also to establish their relationship with diuresis - the amount of fluid released. Water drop is distinguished by a significant fluid retention in the tissues, so the amount of fluid released from the urine is always less than what the pregnant woman drank. In this situation, they speak of a negative diuresis. Self-assessment diuresis is simple enough, so pregnant women after the preliminary recommendations of a doctor can cope with this task well.
If the swelling ceases to disappear on their own after a long rest, the kidney function is under threat, since they are working at the limit of possibilities. In the absence of the necessary treatment, edema inevitably provokes renal dysfunction and the next stage of gestosis - nephropathy.
The pathological condition preceding the early manifestations of gestosis is classified as pre-toxoid (pre-gestosis). It differs in the inconstancy of symptoms, as well as in that it does not necessarily translate into a full-fledged gestosis. Pre-toxicity has the following symptoms:
- Unexplained weight gain, when the amount of food and liquid used by the pregnant woman is the same, and edema is not visualized.
- Lability of blood pressure: a decrease in pulse to 30 or less, an increase in diastolic over 90 mm. gt; st;
- Decrease in daily diuresis measured to 900 and less ml;
- There may be "traces of protein" in the urine;
- Change in laboratory indicators (hemoglobin, hematocrit and the like).
The use of the term "late gestosis" is incorrect, since gestosis already means the appearance of pathology in later terms. For the same reason, it is illiterate to say "gestosis of the second half of pregnancy". The term "late toxicosis" is still sometimes used, but is considered obsolete, and therefore incorrect in terms of formulating the diagnosis.
Whatever the term denoting pathology, it is much more important to determine the onset of a serious condition in a timely manner and to begin adequate therapy as soon as possible.
So, in the previous chapters it has already been said about the first, initial, stage of gestosis - dropsy. On its background often more severe forms of gestosis - nephropathy and pre-eclampsia.
Persistent, tending to increase, swelling signal about the maximum burden on the kidneys. Edema is considered to be the first alarming harbinger of gestosis, they can appear by the 13th-14th week and classified as pre-stest. In the absence of the necessary drug intervention, after a short period of time, the kidneys lose the opportunity to compensate for the load, therefore, against a background of renal decompensation, a full-fledged clinic of gestosis develops. It is distinguished by a classical triad (edema, hypertension and proteinuria), which is almost always present in severe forms of gestosis (95%).
Arterial hypertension is considered an important marker of gestosis, because it reflects the severity of vascular spasm, and the amount of proteins in the urine indicates the degree of renal decompensation.
And again a little terminology. "Arterial hypertension" is a term used to refer to a temporarily conditioned rise in blood pressure, if the patient's pressure has not been increased beyond pregnancy. As a rule, after birth, the pressure indicators return to the original figures again. Arterial hypertension should not be confused with hypertension, or hypertension, which is not dependent on the presence of pregnancy and is a chronic extragenital pathology. As a rule, pregnant women with a history of hypertension are included in the group of high risk for gestosis, since their vascular system is already working incorrectly and more often does not cope with the load during gestation.
About arterial hypertension testify:
- an increase in systolic pressure by 30 and above mm Hg. Art. (in relation to the initial), and diastolic - at 15 and above mm Hg;
- an increase in diastolic and a decrease in pulse blood pressure (in normal terms, it is on average 40 mm Hg).
Nephropathy is indicated by arterial pressure 135/85 and above mmHg. The conditional "norm" always assumes the initial, "working", pressure of the patient, as, as you know, its figures in healthy people have a wide range.
Renal failure is also indicated by an unjustified increase in body weight against the background of a decrease in diuresis, as well as proteinuria. In healthy pregnant women, the protein in the urine is not determined. It appears if the function of the kidneys decreases, and they stop filtering the fluid correctly by letting the proteins in. The higher the degree of proteinuria, the heavier the gestosis.
Sometimes a lab technician can write in conclusion - "traces of protein", which does not mean the onset of gestosis in the absence of other symptoms, but requires specialist attention and re-examination.
Nephropathy in somatically healthy pregnant women is considered primary. In contrast, secondary (combined) nephropathy always appears against the background of the existing pathology (pyelonephritis, glomerulonephritis, heart diseases, hypertension and the like).
Nephropathy is diagnosed in 2-15% of pregnant women. This wide range is explained by the different degree of severity of the pathology on which the outcome of gestosis depends.
Pregnant nephropathy is classified according to the severity of the disease:
- I degree of nephropathy. It differs with small edema with predominant localization on the legs, the appearance in urine of not more than 1 g / l of protein, an increase in pressure up to 150/90 mm Hg. st and initial signs of changes in the vessels of the retina (uneven caliber).
- II degree of nephropathy. The arterial pressure rises to 170/110 mm Hg. Art. (with an obligatory pulse difference of at least 40 ka), proteinuria up to 3 g / l, not only the lower extremities swell, but also the abdominal wall in front, due to pronounced edematous syndrome, the amount of urine released is markedly reduced, and the retina is often diagnosed.
III degree of nephropathy. It is the final stage of this form of gestosis on the background of pronounced deficiency of renal function. Edema becomes widespread, hypertension is increasing (over 170/100), proteinuria is expressed (more than 3 g / g), dystrophic changes and minor hemorrhages in the eye-fund zone.
The state of health of a pregnant woman worsens as the disease progresses. There is thirst, sleep disorder, dizziness , weakness, shortness of breath, dyspepsia , visual disturbances.
With a severe degree of nephropathy, dystrophic changes in the liver and ischemia of the heart muscle are observed.
The severity of nephropathy in pregnant women is indicated not only by the severity of these symptoms, but also by their duration. Even with moderate signs, nephropathy is classified as severe if symptoms do not go away with therapy for two weeks.
Vascular spasm in gestosis is non-local, generalized. Therefore, from its effects, brain tissue is affected. In conditions of increasing gestosis, the brain tissue also begins to swell, which provokes the beginning of the next phase - pre-eclampsia.
The consequences of gestosis are also diagnosed in the fetus. Spasm of vessels in the placental area causes intermittent blood flow between the uterus and placenta. As a result, dystrophic processes begin in the placenta tissues, the fetus lacks oxygen and nutrients necessary for proper development. Diagnosis of fetal hypotrophy and hypoxia , as well as premature detachment of a child's place.
In somatically healthy patients the probability of severe forms of gestosis is very small - they are diagnosed only in 10%. The probability of gestosis increases if the patient had chronic pathologies associated with the work of the heart, vessels, endocrine glands and kidneys outside of pregnancy. It was also noted that a serious leaking early toxicosis may become a predisposing factor for subsequent gestosis.
In whatever form the gestosis occurs during pregnancy, it always tends to increase symptoms and worsen the clinical situation.
It is impossible to classify gestosis as "easy" and "heavy", because gestosis is already a serious complication of pregnancy. More often, when they say about the severity of gestosis, they mean the last, third, degree of nephropathy or the most dangerous, terminal, stage - eclampsia.
The severity of gestosis is determined by the combination of symptoms and the degree of their severity. For evaluation, common clinical criteria are used, but sometimes gestosis does not have a clearly defined sequence of symptoms and immediately becomes severe.
Eclampsia is considered an extremely severe form of gestosis. Its causes remain poorly understood, but with timely measures, the condition can be suppressed, so the severe form of gestosis is now diagnosed infrequently (1%).
Preconditions of eclampsia are formed already in the initial stages of gestosis. This condition is characterized by convulsive syndrome, loss of consciousness followed by coma. The consequences of gestosis in severe form are extremely unfavorable, as they can provoke irreversible disorders in the brain, parenchymal organs (kidneys, liver) of the pregnant woman, premature births against the background of placental abruption and, finally, death of all participants in the pathological scenario.
The pathology name is of Greek origin and means "a flash like lightning". Indeed, the symptoms of eclampsia develop rapidly, in rare cases even against the background of apparent well-being.
It should be noted that eclampsia does not always happen in the second half of pregnancy. Also, it is diagnosed in labor (27-30%) or in the first day / two after their completion (1-2%). Very rarely pathology develops until the 21st week of gestation.
Eclampsia develops against the background of unoccupied nephropathy, so among its symptoms there is hypertension with pronounced edema and proteinuria. The fact that nephropathy has been transformed into a more serious condition is indicated by the appearance of a convulsive syndrome.
Convulsive seizures can happen quite suddenly, but more often between nephropathy and eclampsia there is a short period - pre-eclampsia, it is also considered one of the forms of gestosis. Preeclampsia precursors hide in severe nephropathy.
Symptoms of preecampia are very characteristic. A few hours before the onset of seizures in the pregnant woman, vision is disturbed - "eyes" or "veils" appear before your eyes, and vision can be lost for a short time. Also there is a headache, heaviness in the nape of the neck, discomfort in the epigastric zone, nausea with vomiting, lethargy and memory disorders.
Following the pre-eclampsia follows the terminal phase of gestosis - eclampsia. To confuse this state with any other is impossible because of a typical, classical, clinic, namely, a sudden loss of consciousness and a seizure attack. A seizure attack has an important feature - a wave of convulsive contractions passes from the facial muscles to the musculature of the body and passes through several successive phases:
- Introductory phase. Against the background of loss of consciousness, the facial muscles twitch no longer than 30 seconds.
- Tonic convulsions. The body of the pregnant woman bends because of the maximum tension, the head reclines, the breath stops. After about 25 seconds, the next phase begins.
- The phase of clonic convulsions. The musculature of the body and limbs diminishes.
After an attack, the pregnant woman falls into a coma. If subsequent seizures are absent, consciousness returns to it.
A fit of eclampsia may be the only, or may consist of several, following one after another, seizures.
According to the leading clinical sign, several forms of eclampsia are distinguished:
- cerebral, flowing with severe hypertension;
- Renal, when besides cramps and coma there is anuria;
- Hepatic, in the case of dystrophic disorders in the hepatic tissue;
- one of the most insidious forms of eclampsia is considered to be non-convulsive, or comatose, when the pathology immediately transforms into a coma, bypassing the convulsive period, this form of the disease is very difficult to diagnose on time, so it often leads to the death of the patient.
Diagnosis of gestosis
Initially, the characteristic clinic helps diagnose gestosis, and the degree of its severity is determined according to the severity of the leading symptoms: swelling, proteinuria, parameters of hypertension, the degree of delay in normal fetal development, background pathologies and the period of appearance of the first signs of gestosis. Each of the criteria is evaluated by a certain number of points, which are summed up. Thus, for mild cases, this amount does not exceed 7, with an average of 8 -11, and 12 or more points indicate a severe form of pathology.
Laboratory diagnostics is of great importance. If it is carried out on time, when the symptoms of gestosis are not fully discharged, the transformation of gestosis into more severe forms can be stopped.
The preclinical stage of gestosis is diagnosed by the presence of hidden and obvious edema, urine test parameters (diuresis, protein level) and arterial hypertension. It is important not so much a single measurement of blood pressure, and its fluctuations during the day.
At any degree of gestosis, it is necessary to ascertain the condition of the placenta and its blood flow, and also to determine how much the pathology "harms" the developing fetus. Produced dopplerography, cardiotocography, ultrasound scanning. Additionally, according to indications, kidney and liver are scanned, an ECG is recorded.
Biochemical research helps to present pathological processes in the liver and kidneys, as well as assess the degree of their severity.
Gestosis provokes specific changes in the liver tissues, united by the concept of "HELLP-syndrome", which combines several pathological conditions:
H - hemolysis;
EL - high enzymatic activity;
LP - low number of platelets ( thrombocytopenia ).
This syndrome with severe form of gestosis is pronounced in 4-12%.
Treatment of Gestosis
The therapy of gestosis depends on the severity of the pathology, the time of its appearance, the condition of the fetus and the pregnant woman herself. The goal of all activities is timely restoration of the functions of vital organs and preservation of life to the fetus.
Inpatient treatment is allowed only with edema of the 1st degree, with pronounced gestosis, hospitalization is necessary, since the condition can worsen in a short time and requires immediate assistance. The success of all ongoing activities is largely determined by the qualification of the doctor who observes pregnancy , because the earlier the gestosis is diagnosed, the more successful the subsequent therapy. The most favorable situation is when the pathology is detected at the preclinical stage (pre-gestosis), and irreversible changes have not yet occurred.
Therapeutic measures include not only medical correction. It is very important to correctly orient the pregnant woman in the current situation, so that she not only understands the essence of what is happening, but also correctly treats the therapy. If the pregnant woman does not trust the specialist and is panic-stricken in terms of the outcome of pregnancy and the preservation of the fetus, it only aggravates the course of gestosis. Therefore, in addition to classical sedative therapy, and it is necessary to restore its emotional balance. It is recommended to have a bed or half-bed regime, exclusion of physical exertion and emotional overstrain, as well as a positive attitude towards a successful outcome of therapy.
An important stage at any stage of gestosis is the preparation of a proper diet based on digestible products. Contrary to common (including on the Internet) incorrect information, the amount of liquid can not be limited. Edema in gestosis is not associated with excessive fluid intake, but have a different cause, therefore, due to disorders in the circulatory system in gestosis, it is necessary to replenish the liquid volume, and not to limit it.
The plan for drug correction of gestosis is made individually according to a specific situation. It implies the restoration of the proper functioning of all organs involved in the pathological process, treatment or prevention of fetal hypoxia.
The issue of prolonging pregnancy against gestosis depends on how well the treatment is performed. If therapy is not able to stop dangerous pathological changes in the body, pregnancy, as the main cause of gestosis, has to be interrupted. Also, to prompt early delivery should be resorted to if gestosis threatens the life of the fetus.
Of course, gestosis is extremely serious condition, but their presence should not provoke panic in pregnant women. Each of them should know:
- Severe forms of gestosis are not diagnosed infrequently.
- Most gestosis refers to predictable conditions, so their development can not only be foreseen, but also prevented.
- More often the pathology is found out on a preclinical stage, and pregestosis is well stopped.
- Even expressed nephropathy can be cured by observing the regimen and proper therapy.
- Timely diagnosed gestosis on the background of therapy does not threaten the life of the developing fetus, and all the negative consequences can be corrected medically.
- Sometimes gestosis requires an early delivery. However, more often it develops shortly before the natural termination of pregnancy, when the fetus is already "adult", and is able to function normally outside the uterus. If the diagnosis is made on time, the children born in this way certainly need special treatment, but subsequently have all chances to be healthy.
The full development of the fetal lungs is completed by the 34th week. If the condition of the pregnant woman requires delivery until this time, when the fetal lungs are still "not open" and are not ready for existence in the oxygen environment, the technique of preliminary medicamental stimulation of "ripening" of the lungs is used.
Separately it is necessary to stop on the most severe form of gestosis - eclampsia. Its development can be predicted by the appearance of symptoms - precursors - signs of nephropathy and / or preeclampsia. It is very important how quickly after the appearance of threatening symptoms the pregnant woman is hospitalized. Unfortunately, a fit in a pregnant woman can happen at a prehospital stage, and its outcome is determined by the quality of pre-hospital care. While the "ambulance" is going to help, simple actions are necessary:
- Put the pregnant woman on her left side and, if possible, soothe her so that she does not hurt herself.
- A seizure is often accompanied by vomiting, so that the pregnant woman does not choke, it is necessary to ensure the evacuation of the contents of the oral cavity.
- If possible, it is necessary to protect the patient from sharp sound and light stimuli, as they are capable of provoking the next attack.
- It is inadmissible to "help" a pregnant woman to overcome a seizure - to try to keep her and so on. Convulsions pass independently, and with the external effect of their intensity can only increase.
In a hospital, the pregnant woman is placed in an isolated resuscitation ward, where necessary light and sound isolation is created, as well as the necessary monitoring of the state of basic vital functions. The purpose of further measures is to prevent another seizure and prevent serious damage to important organs and systems. Conducted:
- Administration of sedatives.
- Elimination of generalized vasospasm, which is the source of hypertension. "Gold standard" for the realization of this goal is believed to be sulfate magnesia, introduced by means of a dropper.
- Replenishment of the circulating bloodstream (blood products, isotonic solutions and other liquids).
- Medication control of blood pressure level (Clopheline, Dopegit and analogues).
- Stimulation of diuresis (Lasix, Furosemide and others) in order to eliminate the growing swelling of the brain.
If the measures taken are ineffective, and the condition of the pregnant woman is aggravated, she is transferred to the artificial ventilation of the lungs.
Complications after gestosis
The negative consequences and the degree of their severity in gestosis are determined, first of all, by the form of gestosis, the effectiveness of the treatment, and also its timeliness.
Consequences of gestosis:
- with improperly conducted therapy or its absence, pulmonary edema is formed (the result of a shock lung);
- Numerous hemorrhages in the tissue of the kidneys and local necrosis provoke the clinic of acute renal failure;
- a cerebral coma on the background of edema of brain structures;
- multiple life-threatening hemorrhages in the adrenal glands and any other significant organs;
- untimely detachment of the placenta , provoking the fetus acute shortage of oxygen (hypoxia), capable of provoking its death, as well as massive uterine bleeding ;
- violation of blood circulation in the placental area and, as a consequence, poor functioning of the placenta;
chronic fetal hypoxia, caused by placental dysfunction, and even intrauterine death.
After the carried gestosis, an adequate rehabilitation is necessary, since complications can appear in more distant from the past pregnancy period. Therefore, the birth of a prescribed monthly examination throughout the year. Controls blood pressure, the state of the central nervous system. Laboratory monitoring of kidney function (urinalysis) is also required. If within six months after childbirth, hypertension and changes in urine are still present, the patient is examined in more detail by a nephrologist.
Prevention of gestosis
Preventive maintenance of gestosis begins with the first visit to a pregnant specialist's office. Observers of pregnancy specialists have the concept of a "risk group". They are formed according to the likelihood of certain complications in pregnant women. As a rule, pregnant women with unsuccessful first births, with chronic diseases and complicated course of this pregnancy get to such groups.
A certain risk of gestosis is found in somatically healthy pregnant women with severe forms of early toxicosis, especially if it continues throughout the first half of pregnancy. One of the explanatory reasons for the gestosis of the theories asserts that early toxicosis creates prerequisites for the formation of gestosis, when it is still impossible to diagnose it.
If the pregnant woman was at risk for gestosis, a personal plan of preventive measures is drawn up. Its content depends on the risk of gestosis, which can be low, medium and high. High is the risk of gestosis, if the pregnant woman has overcome the 35-year-old age barrier, has a chronic somatic pathology, multiple pregnancies and the presence of gestosis in previous pregnancies. As a rule, the risk of gestosis increases with repeated gestations, since the compensatory mechanisms with each subsequent delivery are depleted.
The higher the risk of gestosis, the longer and more extensive the preventive measures. There are no standard schemes for drug prevention of gestosis, since the list of drugs is determined individually. About all risks of complications of pregnancy and the volume of preventive treatment, a pregnant woman can find out from her gynecologist.
The most favorable is the situation when a woman who wants to become a mother comes to a specialist with the purpose of assessing her body's readiness for the forthcoming event. If the examination reveals any deviations, timely treatment allows later to avoid both early and late toxicosis. It is especially important to do this in a similar way to patients with chronic diseases.
Even against the background of a normal pregnancy, one should not forget that the organism that functions beyond its limits should be protected. The most simple preventive measures are:
- Appropriate pregnancy rhythm. Even under the condition of normal state of health, it is necessary to remember the increase in the time of sleep, rest, change in the plan for physical activity and the right emotional mood.
- Food. Certainly, from some food addictions it is necessary to refuse, having replaced favorite products on useful.
- Psychological rest. Stressful situations must be leveled.
The opinion that gestoses inevitably repeat in subsequent pregnancies is wrong. Despite being at risk, survivors of gestosis may not have it in the future.