Gestosis
The content of the article:
- Causes and risk factors
- Forms of the disease
- Disease stages
- Symptoms
- Diagnostics
- Treatment
- Potential consequences and complications
- Forecast
- Prevention
Gestosis (late toxicosis of pregnant women, OPG-gestosis) is a disease specific to the second half of pregnancy.
Gestosis is a widespread obstetric pathology. It accompanies up to 30% of pregnancies and is one of the main causes of obstructed labor, maternal and infant mortality.
Gestosis or late toxicosis may occur in the second half of pregnancy
Causes and risk factors
It is generally accepted that the development of gestosis is caused by the combined effect of various factors: placental, genetic, immunological, hormonal and neurogenic.
The pathology is based on a spasm of blood vessels, entailing a violation of the blood supply to organs and tissues, their hypoxia and ischemia. In addition, the consequences of vascular spasm are:
- a decrease in the volume of circulating blood;
- increased blood pressure;
- increased permeability of the vascular wall;
- sweating of fluid from the vessels into the surrounding tissues with the development of edema;
- increased blood viscosity;
- tendency to form blood clots.
In pregnant women, the brain, liver, placenta, and kidneys are most sensitive to hypoxia. Therefore, it is in these organs that functional and structural disorders occur.
At the heart of gestosis is a spasm of blood vessels
Changes in the kidneys are expressed with varying intensity - from mild proteinuria to the formation of acute renal failure. Violation of blood flow in the vessels of the placenta causes intrauterine growth retardation and fetal hypoxia. Focal hemorrhages and necrosis occur in the liver tissues. Violation of the blood supply to the brain leads to dystrophic changes in nerve cells, the formation of blood clots in blood vessels, an increase in intracranial pressure, the occurrence of small-focal or small-point hemorrhages.
Factors predisposing to the development of gestosis are:
- chronic somatic diseases of a pregnant woman;
- hereditary predisposition;
- multiple pregnancy;
- rhesus conflict;
- the age of the pregnant woman is under 18 or over 35;
- large fruit.
Forms of the disease
In clinical practice, two forms of pathology are distinguished:
- Pure gestosis. It develops in pregnant women who are not diagnosed with any extragenital diseases.
- Combined gestosis. It occurs in pregnant women suffering from lipid metabolism disorders, diseases of the endocrine glands (pancreas, thyroid glands, adrenal glands) and biliary tract, liver pathologies (glomerulonephritis, pyelonephritis), arterial hypertension.
Disease stages
There are 4 clinical stages of gestosis:
- Dropsy (gestational edema).
- Nephropathy (there are 3 degrees - mild, moderate, severe).
- Preeclampsia.
- Eclampsia.
Symptoms
The first sign that allows one to suspect a developing gestosis is dropsy. It is characterized by fluid retention in the body, which leads to the appearance of edema. At first, the edema is latent; they are detected by the weekly weight gain of the pregnant woman, exceeding 300 g. If the necessary measures are not taken, the edema becomes clearly visible. With a mild degree of dropsy, they are localized only in the lower extremities. In severe cases, diffuse edema of almost all soft tissues is observed.
Dropsy is the first sign of gestosis
The general condition and well-being with dropsy practically do not suffer. Only with highly developed edema, patients complain of increased thirst, heaviness in the legs, fatigue and weakness.
The next stage in the development of gestosis is nephropathy of pregnant women. Clinically, it is manifested by the triad of V. Zangemeister:
- swelling;
- proteinuria (protein in the urine);
- arterial hypertension (high blood pressure).
One of the names of preeclampsia, OPG-gestosis, reflects the indicated symptoms ("O" - edema, "P" - proteinuria, "G" - hypertension).
In obstetric practice, it is believed that the occurrence of even two symptoms from this triad can be regarded as a manifestation of nephropathy.
With high blood pressure, combined with edema and proteinuria, they speak of nephropathy of pregnant women
The development of arterial hypertension in a pregnant woman is spoken of in case of an increase in diastolic pressure by 15 mm Hg or more. Art., and systolic - by 30 mm Hg. Art. and higher in comparison with indicators of blood pressure in early pregnancy.
With gestosis, the danger is not so much the value of blood pressure, but its sharp fluctuations, which can cause serious complications on the part of both the mother and the fetus - due to the deterioration of blood supply to vital organs and violations of the uteroplacental blood flow.
Proteinuria indicates the progression of nephropathy. At the same time, a decrease in daily urine output to 500-600 ml is often observed.
It is not always possible to assess the severity of the course of nephropathy by the level of protein, blood pressure and the severity of edema. In recent years, in clinical practice, more and more cases have been recorded when in pregnant women with an unexpressed Tsangemeister triad, nephropathy passes into the following clinical stages of gestosis development (preeclampsia, eclampsia).
With the development of preeclampsia, the symptoms of nephropathy are joined by manifestations of the onset of hypertensive encephalopathy and cerebrovascular accidents:
- dizziness;
- heaviness in the back of the head;
- headache;
- lethargy, lethargy, drowsiness (or, conversely, insomnia, euphoria, agitation);
- visual impairment ("flies" or fog in front of the eyes, double vision);
- noise in ears;
- increased severity of reflexes (hyperreflexia).
In addition, with preeclampsia, signs of liver dysfunction appear:
- pain in the epigastric region;
- nausea;
- vomiting;
- disorders of the blood coagulation system;
- increased activity of liver enzymes.
The onset of preeclampsia symptoms indicates a high convulsive readiness, when any irritation (loud sound, bright light, pain) can lead to eclampsia, the main clinical manifestations of which are convulsions with loss of consciousness.
In the course of a convulsive seizure with eclampsia, several consecutive periods are distinguished:
- Fibrillar twitching of the muscles of the face, and then of the upper limbs. The gaze is fixed to the side. Duration is about 30 seconds.
- Tonic convulsions. They start in the upper muscle groups and extend downward. The patient stops breathing, develops cyanosis of the mucous membranes and skin, dilates the pupils. The pulse is difficult to determine. The duration of tonic seizures is 25-35 seconds.
- Clonic seizures. The pulse is not detected, there is no breathing. Lasts about 2 minutes.
- Resolution. The seizure ends, the patient takes a deep breath, foam appears from the mouth, which, due to biting the tongue, may contain an admixture of blood. Cyanosis disappears. The patient regains consciousness, does not remember the seizure.
Eclampsia attack with gestosis
An attack of eclampsia can result in a post-eclampsic coma. In very rare cases, the patient falls into a coma without a previous seizure. The non-convulsive form is observed against the background of massive hemorrhage in the brain tissue and is usually fatal.
Diagnostics
Diagnosis of gestosis is carried out taking into account the history, complaints of the pregnant woman, physical examination data and the results of objective studies. To assess the severity of gestosis, as well as to identify the patient's existing disorders, laboratory tests are shown:
- general analysis of blood and urine;
- coagulogram;
- blood chemistry.
In addition, they regularly monitor blood pressure, monitor the amount of urine and its ratio with the volume of fluid consumed, and the dynamics of body weight.
To assess the condition of the fetus and the characteristics of the uteroplacental blood flow, dopplerography and ultrasound are performed.
Doppler ultrasound allows you to assess the condition of the fetus in pregnant women with gestosis
The patient is consulted by an ophthalmologist (fundus examination is required), a nephrologist, a therapist and a neurologist.
Treatment
The main elements of gestosis therapy:
- Hospitalization and creation of a medical and protective regime. The patient is protected from strong stimuli (sound, light). All necessary manipulations are performed as accurately and carefully as possible. They use physiotherapeutic procedures, herbal medicine (tincture of valerian, motherwort), psychotropic and hypnotics (droperidol, sibazon).
- Therapeutic diet. Meals should be fractional - eating 5-6 times a day in small portions. The basis of the diet is dairy and plant products. The amount of table salt is limited to 6-8 g per day, and the amount of liquid consumed is limited to 1500 ml.
- Normalization of vascular tone and blood pressure. For this purpose, antispasmodic and antihypertensive drugs are used. Drug therapy is carried out under the control of blood pressure and other hemodynamic parameters.
- Therapy of placental insufficiency, intrauterine hypotrophy and fetal hypoxia.
With severe preeclampsia, eclampsia and eclampsic coma, early delivery is indicated
Indications for early delivery with gestosis are:
- lack of effect from nephropathy therapy within 14 days;
- lack of effect from intensive therapy of preeclampsia, carried out for 2-4 hours;
- eclampsia and eclampsic coma.
Potential consequences and complications
The main danger of gestosis lies precisely in the development of severe complications, such as:
- intrauterine hypoxia and fetal death;
- Disseminated intravascular coagulation and hemorrhagic shock;
- acute renal failure;
- premature detachment of a normally located placenta;
- HELLP syndrome (decreased platelet count, increased transaminase activity, erythrocyte hemolysis);
- subcapsular hematomas or ruptures of the liver;
- acute pulmonary injury syndrome;
- hypertensive encephalopathy;
- retinal disinsertion;
- hemorrhage in the brain.
Forecast
The outcome in gestosis is determined by the severity of the disease, the clinical picture, and the time of occurrence. In most cases, with timely started therapy, the prognosis is favorable.
Prevention
Prevention of gestosis should begin at the stage of pregnancy planning: medical examination, active treatment of identified gynecological and extragenital diseases are recommended.
During the entire period of pregnancy, you should adhere to a sleep and rest regimen, and devote time to moderate physical activity. In the diet, you need to limit fried, fatty, spicy foods, increase the proportion of fresh vegetables and fruits.
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Elena Minkina Doctor anesthesiologist-resuscitator About the author
Education: graduated from the Tashkent State Medical Institute, specializing in general medicine in 1991. Repeatedly passed refresher courses.
Work experience: anesthesiologist-resuscitator of the city maternity complex, resuscitator of the hemodialysis department.
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
