The author - Sozinova AV practicing obstetrician-gynecologist. Experience in the specialty since 2001.
One of the complications of pregnancy - a preeclampsia, which is characterized by dysfunction of vital organs. Another name for preeclampsia - late toxicosis.
Preeclampsia is diagnosed after 20 weeks of pregnancy, but more often in the 25-28 weeks, although signs of complications can occur a few days before giving birth.
Late preeclampsia is diagnosed in approximately 10-15% of all pregnant women.
degrees
Depending on the flow gestosis isolated grade 4:
- I degree - swelling (edema of pregnancy);
- II degree (nephropathy);
- Grade III (preeclampsia);
- IV degree (eclampsia).
Also distinguish between pure preeclampsia and match preeclampsia.
- About pure preeclampsia say, if a woman has no chronic extragenital diseases (non-genital)
- A combined gestosis, on the contrary, takes place on the background of common chronic diseases (hypertension, renal disease, obesity, and others).
Causes
At the present time we have not yet been identified the causes of preeclampsia, but no doubt one - this complication of pregnancy is a fruit that comes into conflict with the mother.
In the mechanism of the development of preeclampsia pregnant lies generalized vasospasm, which leads to hypertension (increased blood pressure).
Threatening factors for the development of preeclampsia:
- age (younger than 18 and older than 30 years);
- pregnancy is not a fruit;
- heredity (women whose mothers suffered from preeclampsia);
- first pregnancy;
- preeclampsia in previous pregnancy;
- the presence of extragenital pathologies (obesity, hypertension, kidney and liver pathology, etc.).
symptoms of preeclampsia
First diagnose preclinical stage preeclampsia - pregestoz (no clear signs). Diagnosis pregestoza placed in the evaluation of laboratory and other research methods:
- measurement of blood pressure three times with an interval of 5 min in different positions (increased diastolic, i.e. lower values by 20 mm Hg. Art. and more);
- increasing thrombocytopenia (Platelet lowering);
- decrease in lymphocytes (lymphopenia);
- increase platelet aggregation (increased blood clotting).
preeclampsia itself manifested the classic triad of symptoms (Tsangemeystera triad):
- swelling,
- proteinuria (Protein in urine)
- increased blood pressure.
Symptoms of powers
I degree gestosis
Swelling (edema of pregnancy)
Distinguish 4 degrees of swelling in pregnant women.
The first degree is characterized by swelling of the feet and lower leg, a second lower leg edema and rise on the front abdominal wall, the third level of - a swelling of the feet, the hands, the front wall of the abdomen and face. And the last stage - a generalized edema or anasarca.
Besides the fact that the swelling may be visible, do not forget about the hidden edema. The idea of hidden edema induces abnormal weight gain (more than 300 grams. in Week). Also on said latent edema oliguria (urine output reduction amount to 600-800 ml per day).
Indirect sign is the ratio of the discharged liquid and drunk (dedicated less than 2/3). Also, a characteristic feature of edema in pregnancy is considered a "symptom ring" (difficult to be removed or put to the usual ring finger) and the tightness of everyday shoes.
II degree gestosis
nephropathy
Nephropathy (OPG-gestosis) occurs as a triad Tsangeymestera:
- swelling, in varying degrees of severity,
- proteinuria (protein in urine),
- arterial hypertension.
When evaluating the increase in arterial pressure are guided to the original (before pregnancy) pressure. On hypertension say at higher systolic (upper) pressure over 30 mm Hg. v., and diastolic increases by 15 or more mm Hg. Art.
The average (normal pressure in pregnant tend 110/70). Hypertension - is to increase the pressure to 140/100 mm Hg. Art.
Proteinuria indicates renal vascular wall lesion, through which the urine protein misses.
In case of detection of traces of protein in the urine (0.033 g / l) is either deleted pyelonephritisOr there is a failure to comply with hygiene rules at the time of urine. On say with proteinuria in the urine protein indicators reaching 0.3 g / l and more.
III degree gestosis
preeclampsia
State prior eclampsia
IV degree
Eclampsia
A serious condition, the last degree of preeclampsia. Characterized by seizures.
Diagnostics
In addition to the clinical manifestations and additional laboratory testing methods used for the diagnosis of preeclampsia:
- pressure measurement three times a day and after minor physical activities (squatting, climbing stairs) - diagnosed lability of blood pressure;
- general urine analysis (Identification of the protein, increasing the density of urine);
- CBC (reducing platelet increase in hematocrit, Which means thickening of the blood);
- urinalysis for Zimnitskiy (oliguria and nocturia - increase urine volume at night);
- control drunk and allocated liquid daily;
- weight measurement every week;
- biochemical blood tests (increase creatinine, Urea, liver enzymes, decrease in total protein);
- blood clotting (Increase of all indicators).
Treatment of preeclampsia during pregnancy
Preeclampsia at home
Treatment of preeclampsia appoints and monitors its effectiveness obstetrician. Swelling of the first degree may be treated as outpatients. All other degrees of preeclampsia treated in a hospital.
First of all, pregnant create emotional and physical rest. Recommended longer lie on the left side (position «Bed rest»), since in this position improves blood flow to the uterus, and therefore the fetus.
The second step is to dietetic therapy (therapy table must contain a sufficient amount of protein, the amount of fluid intake depends on diuresis, and the food itself should be salted insufficiently).
When abnormal weight gain 1-2 times a week appointed fasting days (cheese, apple, fish).
sedatives (motherwort, valerian, novopassit) are assigned to the normalization of the brain and prevent seizures. In some cases showing weak tranquilizers (Phenazepamum).
Treatment of preeclampsia in a hospital
The main place in the treatment of preeclampsia take intravenous drip of magnesium sulfate. The dose depends on the extent and severity manifestation of preeclampsia. Magnesium sulfate has hypotensive, spasmolytic and anticonvulsive effects.
When hypertension prescribed drugs that reduce pressure (atenolol, Corinfar).
Also shown holding infusion therapy salt solutions (saline, and the solution glucose), colloids (reopoligljukin, Infukol - starch), blood products (fresh frozen mass, albumen).
To improve the rheology (flow) of blood prescribed Antiplatelet agents (pentoxifylline) and anticoagulants (heparin, enoxaparin).
Normalization uteroplacental blood flow, and Membrane carried antioxidants (aktovegin, vitamin E, glutamic acid).
mild gestosis treatment continues for at least 2 weeks, moderate 2-4 weeks severe preeclampsia and requires constant finding pregnant hospital until delivery.
Complications and prognosis
Possible complications of preeclampsia:
- liver pathology, kidney, heart;
- pulmonary edema, bleeding in vital organs;
- premature detachment of the placenta;
- Fetal hypotrophy;
- coma;
- intrauterine fetal death.
The prognosis depends on the degree of preeclampsia, its symptoms and the timeliness and effectiveness of treatment. In most cases, the prognosis is favorable.
prevention
Specific prevention of preeclampsia does not exist. In the women's clinic when registering carefully collected history of women and the survey is conducted, after which the risk of developing preeclampsia (low, medium or high).
Women at risk, low-salt diet is recommended protein with periodic unloading days and adherence of the day and relax.
Preventive treatments are also conducted (sedatives, anti-oxidants, diuretic charges).
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.