The author - Sozinova AV practicing obstetrician-gynecologist. Experience in the specialty since 2001.
Pre-eclampsia and eclampsia - a serious stage preeclampsia and are a serious complication of pregnancy. According to statistical data, a percentage of 5-10% of pre-eclampsia and eclampsia 0.5% among the total number of births, pregnancy and postpartum.
Preeclampsia - a preconvulsive condition characterized by significant rise blood pressure, high protein in the urine and severe edema (not the main prognostic sign).
Eclampsia - a seizure that is either allowed or goes into a coma.
Kinds
Preeclampsia and eclampsia are classified according to the period associated with pregnancy:
- pre-eclampsia and eclampsia of pregnancy;
- pre-eclampsia and eclampsia mothers;
- pre-eclampsia and eclampsia puerperal.
Preeclampsia has two degrees of severity: mild and severe.
Eclampsia depending on the prevailing manifestations divided into brain, coma, liver and kidney.
Causes
The causes of preeclampsia and eclampsia is still not determined. 30 and more is known theories explaining the causes and mechanisms of development of pre-eclampsia and eclampsia. But the general opinion of all doctors is the presence of placental pathology, formation of which is broken in the early stages of pregnancy.
When placental tackle (surfactant introduced placenta) or deficit for the placental receptor proteins, the placenta begins to synthesise substances which cause constriction vessels (vasoconstrictors), which leads to generalized spasm of blood vessels in the body to increase the pressure therein and increase the supply of oxygen and nutrients to the fetus. This leads to hypertension and multiple organ damage (primarily affects the brain, liver, kidneys).
Not the least role in the development of pre-eclampsia and eclampsia played by heredity and chronic diseases.
The symptoms of pre-eclampsia and eclampsia
Symptoms of preeclampsia
Preeclampsia is a short interval between nephropathy and seizures. Preeclampsia - a violation of the functions of the vital organs of the body, leading syndrome, which is a central nervous system:
- the emergence of flies before his eyes, flickering, blurred objects;
- tinnitus, headache, feeling of heaviness in the neck;
- nasal congestion;
- memory disorders, drowsiness or insomnia, irritability or apathy.
Also for pre-eclampsia is characterized by pain in the upper abdomen ( "the stomach"), in the right upper quadrant, nausea, vomiting.
Adverse prognostic factor is the strengthening of tendon reflexes (this symptom indicative of seizure and a high likelihood of developing eclampsia).
When picking preeclampsia swelling, sometimes within a few hours, but the severity of edema in the evaluation of severity of the condition values have not pregnant. The severity of pre-eclampsia is set based on complaints, proteinuria and hypertension (increased blood pressure to normotensive above 140/90 mm Hg. Art. cause for concern). If hypertension is 160/110 and more talk about the severe pre-eclampsia.
Kidney damage is manifested as a reduction in urine output (oliguria and anuria) and high protein content in the urine (0.3 grams in the daily amount of urine).
Symptoms of eclampsia
Eclampsia - a bout of seizures, which consists of several phases:
- The first phase. The duration of the first (input) phase is 30 seconds. At this stage there are small facial muscle contractions.
- The second phase. Tonic seizures - generalized spasm of muscles of the body, including the respiratory muscles. The second phase lasts for 10-20 seconds and is the most dangerous (death can occur woman).
- The third phase. The third phase - a stage-clonic seizures. Motionless and tense patients ( "as a string") begins to beat in seizures. Seizures come from the top down. The woman is no pulse and respiration. The third stage lasts 30-90 seconds and allowed deep breath. Then breathing becomes rare and deep.
- The fourth phase. Fit permitted. Characteristically allocation of foam mixed with blood from the mouth, there is a pulse, the person loses cyanosis, returning to normal color. Sick or regains consciousness, or falls into a coma.
Diagnostics
Differential diagnosis of pre-eclampsia and eclampsia in the first place should be carried out with an epileptic seizure ( "aura" before the attack, seizures). Also, the data should be distinguished from the complications of uremia and brain diseases (meningitis, encephalitis, Hemorrhage, tumors).
The diagnosis of pre-eclampsia and eclampsia set jointly instrumental and laboratory data:
- Measurement of blood pressure. Increase in blood pressure of 140/90 prior to and maintaining these figures for 6 hours increased systolic pressure units 30 and 15 diastolic.
- proteinuria. Identification of 3 or more grams of protein in the daily urine quantity.
- Blood chemistry. Increased nitrogen, creatinine, urea (kidney damage), increased bilirubin (decay of erythrocytes and liver damage), the rise in liver enzymes (AST, ALT) - abnormal liver function.
- General blood analysis. Increase in hemoglobin (decrease in the volume of fluid in the bloodstream, ie blood clots) increasing hematocrit (Viscous, "ropy" blood), decrease platelet.
- General urine analysis. Detection of protein in urine in large amounts (normally absent), identifying albumin (severe preeclampsia).
Treatment of pre-eclampsia and eclampsia
Patients with pre-eclampsia and eclampsia necessarily hospitalized in a hospital. Treatment should be started immediately, on the spot (in the waiting room, the house in case of a call an ambulance brigade in the department).
In the treatment of complications of pregnancy data involved a doctor - an obstetrician-gynecologist and the doctor-resuscitator. A woman hospitalized in the intensive care unit, where he created a health-protective syndrome (sharp sound, light, touch can trigger a seizure). Additionally appointed sedatives.
Gold standard for treatment of these forms of preeclampsia is intravenous solution of magnesium sulfate (under the control of blood pressure, respiratory rate and heart rate). To prevent seizures and relanium appointed droperidol intravenously, possibly in combination with dimedrolom and promedolom.
At the same time compensate for the volume of circulating blood (intravenous infusion colloids, blood products and saline solutions: plasma, reopoligljukin, Infukol, glucose solution, isotonic saline, and etc.).
blood pressure control is performed purpose antihypertensive agents (clonidine, dopegit, Corinfar, atenolol).
In pregnancies up to 34 weeks of the therapy directed on fetal lung maturation (corticosteroids).
Emergency delivery is indicated without positive effect on the therapy for 2-4 hours, during the development of eclampsia and its complications, with placental abruption, or suspected it, in acute lack of oxygen (hypoxia) fetus.
First aid in a fit of eclampsia:
Turn a woman on the left side (to prevent airway aspiration), to create the conditions, reduce trauma patient not to use physical force to stop seizures, after the attack to clear the mouth of vomit, blood and mucus. Call an ambulance.
Drug cupping the eclampsia:
Intravenous administration of 2.0 ml of droperidol, 2.0 ml and 1.0 ml relanium promedola. After closure attack carried ventilation mask (oxygen), and in the case of coma trachea is intubated with a further ventilator holding device.
Complications and prognosis
Prognosis after myocardial attack (coma) eclampsia and preeclampsia depends on the severity of the patient's condition, the presence extragenital disease, age and complication.
complications:
- placental abruption;
- severe intrauterine fetal hypoxia;
- bleeding in the brain (paresis, paralysis);
- acute liver and renal failure;
- HELLP-syndrome (hemolysis, increased liver enzymes, platelet reduction);
- DIC;
- lung edema, brain edema;
- heart failure;
- coma;
- the death of the woman and / or fetus.
Some studies in pregnancy
- Smears during pregnancy.
- Tests during pregnancy by trimester.
- Ultrasound during pregnancy.
- Urinalysis in pregnancy.
- Coagulation.
- Installing pessary.
- Glucose tolerance test.
- Homocysteine in pregnancy.
- Amniocentesis.
- Anesthesia during childbirth.
- Fetal CTG (cardiotocography)
- Cordocentesis.
- Epidural anesthesia during childbirth.
