Gestosis during pregnancy: what it is, causes, signs and how to treat
What is gestosis during pregnancy?
Gestosis is when you have high blood pressure and protein in the urine during pregnancy. This can occur at any time after the 20th week of pregnancy, although in some cases it occurs earlier, the second half of pregnancy. You may also have low platelet levels, kidney or liver problems. This condition is also called toxemia (poisoning of the body) or hypertension caused by pregnancy. Eclampsia is a serious complication of preeclampsia. Eclampsia includes high blood pressure, leading to convulsions during pregnancy.
Approximately 5-10% of all pregnant women suffer from preeclampsia.
As it has already become clear to you, preeclampsia is a disruption of the work of organs important for life. The phenomenon arises in the developmental period in the female body of the embryo, fetus, and therefore passes away independently after birth, leaving only unpleasant memories. All organs involved are usually fully restored. Late toxicosis is another name for this pathology. But, unlike the usual toxicosis in the first part of pregnancy, which is considered a variant of the norm, late toxicosis should be treated. He is fraught with serious complications that threaten the life of the expectant mother and unborn child.
Causes of preeclampsia in pregnant women
There is no exact explanation of the causes of the development of late toxicosis, but there are several theories trying to explain this and the causes of this pathology. Each of these theories has its supporters, but it is generally recognized that the development of preeclampsia contributes to a number of factors that violate the work of internal organs.
Popular theories such as:
Cortico-visceral. It is based on the assumption that the physiological connection is broken between the cortex and the subcortex of the brain, which leads to pathological changes in the vascular system.
Endocrine theory. Based on this theory, it is believed that preeclampsia develops on the background of endocrine disruption. But there is another opinion: such violations develop already during late toxicosis, and do not provoke it.
Immunological theory. Gestosis occurs due to inadequate response of the mother's immune system to fetal antigens. The body of a pregnant woman is trying to reject the developing fetus.
Genetic theory has a basis: preeclampsia is more common in women, among whose relatives there have already been cases of late toxicosis of pregnant women.
Placental theory. The theory is based on the fact that in the placenta and uterus pathological changes occur in the vessels, they are subject to spasm. As a result, the blood flow is disturbed and hypoxia (oxygen starvation) occurs.
None of the theories explains to the end how gestosis develops. Most often several factors are involved in the occurrence of this pathology.
There are also risk factors that increase the chances of developing pre-eclampsia. These include:
multiple pregnancy (pregnancy with more than one fetus);
those who decide to become pregnant after the age of 35;
or being in early teens;
being pregnant for the first time;
with a history of high blood pressure
having a history of diabetes;
having a history of kidney disease.
Nothing can finally prevent this disorder. Early and consistent prenatal care can help your doctor diagnose the condition more quickly and avoid complications. Having a diagnosis will allow your doctor to ensure proper control before delivery.
Symptoms of gestosis during pregnancy
Obvious signs of preeclampsia in the 3rd trimester:
swelling of the legs, hands, and face;
protein in the urine;
Edema: at the initial stage, preeclampsia is manifested by edema. This condition is called dropsy of pregnant women. Not always this condition is obvious, there are internal edema. They become obvious during weighing, as they are manifested by a large increase in weight in a short period of time.
Do not be afraid of edema: they do not always talk about preeclampsia. May indicate the exacerbation of chronic diseases - kidney or heart, varicose veins. Or be a normal companion of pregnancy due to changes in hormonal levels. But it is up to the specialist to establish the exact cause, so it is important to inform him of any changes.
In the early stages, edema is latent, but as the disease progresses, it becomes pronounced (see photo below). Edema rises from the bottom up - first touching the feet, and over time the swelling spreads and affects the whole body and face.
Protein in the urine: the second sign, proteinuria, or the appearance of protein in the urine, says kidney damage. Protein should not be detected, so its appearance is always alarming to doctors. And this is the reason why pregnant women are prescribed to pass an urinalysis regularly.
If 0.033 g / l of protein is detected in the urine, and in the clinical analysis of the blood, an increased level of white blood cells is indicated, rather, pyelonephritis. But the figures from 0.8 g / l are evidence of preeclampsia.
Hypertension: the third sign indicates the development of late toxicosis (increased blood pressure). Doctors pay attention to the increase of more than 140/90 mm Hg. Art. There are "flies", or dark spots, in front of the eyes, headache, nausea, dizziness. But high pressure may not manifest itself, and the future mother will find out about her condition when it is measured at a doctor's office.
If protein is found in the urine, and the pressure indicators exceed the norm, the diagnosis is unequivocal: it is preeclampsia.
When measuring blood pressure, it is important to focus on its dynamics, since in women who had low blood pressure before pregnancy, with preeclampsia, the values may not exceed the normal range. An important criterion is diastolic pressure - it reflects the presence of vasospasm. Its increase indicates hypoxia (oxygen starvation) of the fetus and impaired placental circulation.
A large role than the increase in pressure, have its fluctuations. They cause dangerous complications, such as placental abruption, bleeding, and failure to provide timely medical care - fetal death.
Stages of gestosis in pregnant women
Depending on the presence, combination and severity of symptoms of preeclampsia, four stages of the disease are distinguished:
The first stage can go unnoticed, and to indicate edema - only an increase in weight of more than 0.5 kilogram per week. To identify hidden edema using Maclura Aldrich test. For this pregnant saline is injected subcutaneously. If the “button” disappears in less than half an hour, then there are hidden edemas.
Early detection of preeclampsia improves the prognosis and reduces the risk of serious complications.
Nephropathy is a disease of the kidneys. In nephropathy, in addition to edema, protein is found in the urine. This condition develops after the 20th week of pregnancy. By itself, the allocation of protein is not dangerous, after pregnancy, all the symptoms disappear. But if nephropathy is not treated, then it goes into a more serious condition - preeclampsia.
Preeclampsia in pregnant women is characterized by an increase in blood pressure and the accompanying symptoms - headache, nausea, the occurrence of dark spots before the eyes. The situation is complicated by the development of a violation of cerebral circulation, there is a feeling of heaviness in the back of the head, a very severe headache, vision suffers. Possible impaired memory and the manifestation of mental disorders, and the pressure reaches 160/110 mm Hg. Art. and higher.
Eclampsia is the fourth and most dangerous stage, which is characterized by the appearance of convulsions in a pregnant woman. The cause of cramps can be at first glance a minor event - a loud sound, bright light, stress. The cramps last for about two minutes, first there are tonic convulsions, in which the woman’s body straightens and stretches out, and then the clonic ones - the limbs constantly twitch, the woman seems to bounce in bed. After the attack, the woman is unconscious:
At this time, serious complications that threaten the life of the mother and fetus can develop:
swelling of the brain
Another type of eclampsia is non-convulsive. Against the background of high blood pressure, a woman suddenly falls into a coma. With this form, there is a high risk of death.
These are manifestations of various kinds of symptoms (nausea, vomiting, salivation) in the first half of pregnancy. They occur due to the violation of all types of metabolism, adaptation of the woman’s body, changes in the immune system and the functioning of the brain. At the same time there is a maximum increase in hCG (pregnancy hormone). Early preeclampsia with multiple pregnancies and gallbladder is most severe. Risk factors include:
Disruption of the systems responsible for the adaptation of the body (neuroendocrine disorders, high or low pressure, rheumatic heart defects).
Diseases of the liver, kidneys (hepatitis, nephritis, pyelonephritis).
Bad habits (alcohol, smoking, drugs).
Postponed diseases of the genital organs.
Manifestations of early preeclampsia
Vomiting occurs in about 50-80% of all pregnant women. This is a manifestation of a violation of the adaptation of a woman's body to pregnancy. Vomiting 1-2 times a day without disturbing the general condition of the woman does not apply to gestosis. When vomiting occurs (10-12 times a day), it manifests itself in general weakness, low blood pressure, fever up to 38 ° C, and an increase in heart rate, this is considered a sign of preeclampsia. Prolonged vomiting is accompanied by loss of water, vitamins, exhaustion, and blood clots. Such vomiting is observed in 15%.
Mild vomiting occurs up to 3-5 times a day (usually on an empty stomach), accompanied by nausea, decreased appetite and normal general condition, blood pressure and urination.
This form, in 90% of cases, passes on its own and is easily treatable.
For a moderate degree, vomiting up to 10 times a day is typical, regardless of eating, as well as nausea, salivation, dehydration, low blood pressure, tachycardia, decreased diuresis (urination) and body weight. Also present adynamia, apathy, mental lability. In 5% of women can experience abnormal liver function.
In severe vomiting occurs up to 20 or more times a day, food does not hold, there is a weak pulse up to 120 per minute, very low pressure (80/40), a woman can lose 3-5 pounds a week. The woman is exhausted, the skin and mucous membranes of the tongue, lips are dry, the skin and eyes are yellow, there is bad breath, poor sleep, fast fatigue, loss of appetite.
May be observed in all pregnant women. This is a relatively rare type of preeclampsia. According to the amount of saliva, they emit a light and heavy form, and behind a character - constant (day and night) and intermittent (either disappears, then appears). The mild form does not lead to any violation. Severe can cause dehydration, feeling unwell and mental disorder.
These are deep violations of the activity of vital organs in the second half of pregnancy, which is manifested by the classic triad of symptoms - high blood pressure, protein in the urine and edema. More often after 28 weeks of pregnancy.
General vasospasm (decreases the intensity of the liver and kidneys, which leads to changes in protein, carbohydrate and fat metabolism, antitoxic function and filtration of the kidneys);
Changes in rheological characteristics and blood coagulation (thickening, increased clotting);
Decreased blood volume
Impaired circulation of organs and water-salt balance.
Risk factors include:
Pathologies of extragenital organs (liver, heart, lungs).
The presence of preeclampsia during past pregnancy.
Pregnant age (less than 19 and over 30 years).
Maternal obesity, anemia, bad habits, unbalanced nutrition.
Plurality, large fruit, its hypotrophy.
This is a severe form of preeclampsia. It is characterized by the development of convulsive attacks (maybe even a few) and loss of consciousness. It happens prenatal (75%) and postpartum. Before seizures, there may be a sharp headache, abdominal pain, vomiting, impaired vision and cerebral circulation. There is also a risk of stroke and half body paralysis.
Pathogenesis of eclampsia
The mechanism of development is insufficiently studied. Now it is viewed as the failure of adaptive maternal systems to provide for the developmental needs of the fetus. When under the influence of negative factors (liver disease, lungs, heart defects, obesity, genetic disorders, psychoemotional stress, infection) there is a spasm of small vessels in all organs, their function is disturbed and tissue hypoxia (oxygen deficiency) develops. The load on the heart increases, the blood volume decreases, the inner lining of the vessels is injured, which increases blood clotting. As a result, nephropathy and blood flow insufficiency occur in the uterus, placenta.
How is gestosis diagnosed?
The diagnosis of early toxicosis is not difficult. Characteristic clinic (vomiting a certain number of times, salivation), the occurrence of symptoms in the first half of pregnancy, risk factors may be present. In the blood, the level of bilirubin, leukocytes is increased, the protein level is lowered, the amount of urine released per day, acetone is present in the urine, the water-electrolyte balance is disturbed - hypokalemia, hypernatremia.
With late gestosis there are some difficulties. Before the onset of symptoms, it is difficult to diagnose. It is necessary to pay attention to the risk factors of occurrence and to detect early signs (pressure increase of more than 140/90, edema, protein in the urine more than 1 g / l., Increase in body weight). The main role is assigned to continuous monitoring of pregnant women, in which they systematically measure pressure, protein in the urine, body weight and observe when the edema appears.
For treatment it is very important to determine the severity of pre-eclampsia. There are 3 degrees:
Easy form. Typical blood pressure is from 130 to 150, there is little protein in the urine (up to 0.3 g / l), edema is observed only on the lower limbs, normal platelet count (a sign of normal blood clotting) and creatinine (an indicator of kidney function).
Medium shape. Pressure from 150 to 170, protein in the urine can rise to 5 g / l, swelling is already on the face, platelets are below normal, creatinine rises (the kidneys are disturbed).
Heavy form. Pressure from 170 and higher, protein more than 5 g / l, swelling throughout the body (especially in the nasal passages, which complicates breathing), headache, stomach ache, in the liver, in the eyes of the flies, the amount of urine, platelets ( risk of bleeding), impaired kidney function up to their failure.
What is dangerous gestosis?
Early gestosis rarely pose any danger to the mother or fetus. But if vomiting is long-lasting and is not treatable, irreversible changes in the body can occur, even lethality. But this happens very rarely. It should be noted that repeated and prolonged vomiting of pregnant women can lead to the threat of termination of pregnancy, pre-eclampsia, fetal hypoxia, increased blood loss during childbirth and weakness of labor activity. Also, the threat of termination of pregnancy may occur when refractory salivation and depression of the mental state of the pregnant woman.
Late gestosis represent a high risk for the mother and the fetus - renal, adrenal and hepatic insufficiency develops, and fetal development and its intrauterine death are delayed. In the absence of treatment for eclampsia, an eclampic coma develops.
Treatment of early gestosis
Mild forms are treated at home, and medium and heavy - always in the hospital. It is necessary to ensure a long sleep, a calm atmosphere, proper care, the right diet. Food in the diet should be fortified, easily digestible. Take in small portions when chilled. If the food is not retained, intravenous administration of amino acids, proteins, glucose, vitamins is prescribed. It is recommended to use alkaline mineral water 5-6 times a day. After eliminating vomiting, the diet can be expanded. Be sure to appoint physical therapy (walks, self-massage of the muscles of the upper half of the body, deep breathing). You also need to carry out psychotherapy, which makes it possible to convince the pregnant woman that vomiting is reversible and the pregnancy will go well. Electric, reflex and acupuncture, acupuncture, phytotherapy, aromatherapy (inhalation of pleasantly smelling substances) can be used.
With increased salivation should rinse the mouth with infusion of chamomile, oak bark, menthol solution. The skin around the mouth should be smeared with protective creams, food should be consumed in small portions.
Drug treatment is based on the introduction of antiemetic drugs. They inhibit the vomiting center in the medulla. Such substances include chlorpromazine, metoclopramide, epotarazin (does not reduce pressure, which has a positive effect on the body with prolonged vomiting), droperidol (it also has a calming effect).
To eliminate dehydration prescribed glucose solutions, physiological solutions.
To improve the uteroplacental blood circulation and fetal gas exchange, it is necessary to use oxygen therapy and administer drugs that expand the uterus and fetus vessels (potassium orotate, pentoxifylline).
To reduce the secretion of saliva injected atropine sulfate solution intramuscularly.
Every day, control body weight, the amount of drunk and excreted fluid. In severe form, add protein and amino acid preparations. Pour in about 2-2.5 liters. In the most severe cases, hormones are injected (hydrocortisone, ACTH). With the threat of miscarriage, progesterone is injected subcutaneously for 7 days. An indicator of the effectiveness of treatment will be an increase in diuresis, stopping vomiting, improving the patient's condition and an increase in body weight. If there is no effect from therapy (vomiting does not stop, the skin turns yellow, the temperature rises without infection, tachycardia appears, weight loss), an abortion is indicated.
Treatment of late gestosis
The goal of therapy is the restoration of the functions of vital organs and the placental system, the elimination of symptoms, and the prevention of the development of a convulsive state. With late gestosis, the patient should always be hospitalized.
It is important to adhere to such provisions:
Normalization of blood pressure and blood volume.
Elimination of generalized vascular spasm.
Improving blood flow in the kidneys.
Regulation of water-salt balance, metabolism, rheological characteristics of blood (thickness, clotting).
Prevention of hypoxia and malnutrition of the fetus, bleeding in the pre-and postpartum period.
Normal labor with adequate anesthesia.
Diet. A pregnant woman should eat about 2900-3500 Kcal per day, food should contain a high percentage of protein, a reduced amount of animal fats, cholesterol, foods that cause thirst. You need to include a rest in the afternoon, about 2-3 hours, which improves blood flow in the placenta and kidneys.
Treatment of mild late gestosis
For mild severity, medication is not always prescribed. The consumption of water and salt is not limited. If the gestational age is up to 37 weeks, observation in the day hospital facilities is possible. Main indicators are monitored (pressure, fluid balance, edema, registration of fetal movements). In the case of a stable state - waiting tactics. If there is at least one sign of a moderate degree - the woman is hospitalized.
Treatment of moderate late gestosis
With a moderate degree of pre-eclampsia, they prescribe a semi-bed regimen, a limitation of physical and mental stress, a diet, a complex of vitamins and microelements.
Antihypertensive therapy. With a pressure of more than 160, antihypertensive drugs are administered (metoprolol, methyldopa, nifedipine — others are contraindicated). But pressure must be controlled because low pressure affects the blood flow to the fetus and placenta.
Infusion therapy. The goal - the normalization of blood volume, rheological properties and hemodynamics. Introduce physiological solutions (Ringer, 0.9% sodium chloride), protein preparations.
In the absence of the effect of therapy for 7–10 days, an abortion is indicated.
Treatment of severe late gestosis
Severe pre-eclampsia. A pregnant woman is hospitalized in the intensive care unit, a separate ward is allocated with round-the-clock monitoring, and a catheterized vein is used for long-term infusion therapy.
Assign strict bed rest. The pressure is maintained at the level of 150-160 for the prevention of hemorrhage in the brain (the preparations are the same as for the average form). They use magnesia therapy by administering magnesium sulfate to maintain magnesium concentrations in the blood and prevent seizure conditions. Infusion therapy under strict control.
In this form, if the treatment does not have an effect for 24 hours, the pregnant woman is prepared for an artificial abortion, regardless of the duration of the pregnancy. The advantage of giving birth through the natural genital tract with adequate anesthesia. If the genital tract is ready (the cervix is mature enough and preparation is done by the introduction of prostacyclin) delivery is performed through the genital tract. Otherwise, with cervical immaturity, progression of elevated pressure and pre-eclampsia, deterioration of the fetus, risk of convulsive attack, a cesarean section is performed.
Eclampsia is treated right on the spot where the cramps happened. The pregnant woman is placed on a flat surface on the left side, the upper airways are freed, and the content of the oral cavity is eliminated. With self-preserved breathing, oxygen is inhaled. In the opposite case - artificial respiration. At the same time, a vein is catheterized and therapy with magnesium sulfate is started. After elimination of seizures, they normalize the water-electrolyte balance, metabolism, and acidity of the blood by infusion therapy.
Artificial termination of pregnancy begin as a matter of urgency, regardless of which week of pregnancy (if there is a possibility through the natural genital tract, if not - a cesarean section).
It is very important to adequately provide medical care for pregnant women with pre-eclampsia. The help of a psychologist is also important, since after such complications stress disorders arise.
After childbirth, treatment of late gestosis is continued, depending on the state of the woman, symptoms, and data of blood tests. Magnesia therapy is prescribed for at least 24 hours after delivery or the last attack of seizures. They measure blood pressure, ECG, blood and urine tests, stabilize the condition. If everything is in order, the woman is discharged.
Women who are at risk of pre-eclampsia, it is very important to plan a pregnancy so that its development falls in the summer-autumn period. It is necessary to look around at the doctor 1 time in 2 weeks in the first half of pregnancy and 1 time a week for the second. There should be a calm atmosphere in everyday life, at work, it is important to adhere to the principles of a balanced diet, since the need for vitamins and microelements increases during pregnancy.
An increase in blood pressure by 30–40% of the initial level and body weight, especially after 30 weeks, by more than 400 grams is a risk factor that requires special attention. If at least one symptom of preeclampsia appears, an urgent need to hospitalize a woman in the obstetric department.
Nutrition and Supplements
Some supplements may help prevent preeclampsia. But they will not help with the already existing state, they should be consumed before conceiving a child. If you are pregnant, do not take anything without the approval of your doctor. All supplements have side effects. And some may be unsafe for women with certain illnesses.
Prevent preeclampsia will help:
Calcium. If you have low calcium or high blood pressure, some studies show that 2,000 mg of calcium per day may reduce the risk of pre-eclampsia.
Vitamin D. Some studies show that having low levels of vitamin D increases the risk of preeclampsia in a pregnant woman. One preliminary study showed that taking vitamins D seems to reduce the risk of preeclampsia. However, women in the study also consumed high levels of omega-3 fatty acids. Therefore, scientists are not sure that this is caused by vitamin D, but rather Omega 3 fatty acids, or a combination of 2 of these supplements, have affected.
Folic acid, vitamin B6, vitamin C and vitamin E. These vitamins can also help prevent the development of preeclampsia in women.
Lycopene. Additional studies are needed to confirm the results.
Coenzyme Q10 (CoQ10). In one study of women with a high risk of pre-eclampsia, those who took CoQ10 were less likely to suffer from preeclampsia than those who took placebo. CoQ10 can increase blood clotting and create complications during pregnancy. Talk to your doctor.
A small dose of aspirin. Studies published in the Journal of the American Medical Association show that taking small doses of aspirin daily reduces the risk of developing gestosis during pregnancy. Also, before you start taking aspirin, talk to your doctor, maybe it is contraindicated to you.
To prevent preeclampsia during pregnancy, you need to take care of its prevention before it occurs. In the presence of chronic diseases, consult with experts, conduct treatment or supportive therapy. Rejection of bad habits, good nutrition and taking care of your health before pregnancy will significantly reduce the risk of preeclampsia.
In the period of childbearing a woman should pay attention to proper sleep and rest, to avoid stress. Walking outdoors and practicing suitable sports should become a habit. Throughout pregnancy, you need to fully eat, eliminating or reducing the use of flour, fried, fatty and smoked.
A regular visit to the doctor in the antenatal clinic, regular measurement of blood pressure, weight control and timely analysis of urine will help in time to detect the presence of pathology and take measures.