Gestosis or late toxicosis - Causes, symptoms and treatment. MF.

Late toxicosis or gestosis is a complication of pregnancy, leading to the deterioration of vital organs and systems. Late toxicosis develops in the second half of pregnancy and progresses until delivery.

The frequency of gestosis is 10-15% of the total number of pregnant women. Despite many years of research, the exact cause of gestosis development is still unknown. According to some researchers, gestosis develops due to the violation of hormonal regulation in vital organs. According to another version, gestosis arises from the immunological incompatibility of the mother and the fetus.

Recently, the frequency of this complication of pregnancy is growing every year. Most obstetrician-gynecologists associate the growth of gestosis with an increase in the number of late births( after 35 years).Unfortunately, at this age, most women already have several chronic diseases, which significantly burdens the course of pregnancy and childbirth.

The main diseases that cause the development of late toxicosis include:

high blood pressure, obesity, chronic pyelonephritis, diabetes mellitus, heart defects, vegetovascular dystonia.

Symptoms of gestosis

Symptoms of gestosis are diverse. The first symptoms of late toxicosis future mother may notice at 28-29 weeks of pregnancy. In what way are they manifested? First of all, it is swelling of the feet, hands, face. This is the so-called "dropsy of pregnant women" - the easiest manifestation of gestosis. If swelling is not expressed, then a woman may not notice them. In order to determine whether there is edema or not, it is worthwhile to closely monitor the weight gain. Normally, starting from the 28th week of pregnancy, a woman's weight may increase by an average of 350-500 g during the week. If the weight gain exceeds 500 g per week, then it can testify about the fluid retention in the body, which is a sign of dropsy.

A more severe manifestation of gestosis is nephropathy( lesion of the parenchyma and glomerular apparatus of the kidneys), which is characterized by swelling, increased blood pressure and the appearance of protein in the urine( "proteinuria").The more protein in the urine, the worse will be the prognosis of gestosis. How to notice nephropathy? The main symptom of progressive nephropathy is a decrease in the amount of urine released. This is a rather dangerous sign that a woman should pay attention to first. Most often, at first the woman has swelling, then her blood pressure rises and only then there is proteinuria.

To severe manifestations of gestosis include the development of pre-eclampsia and eclampsia. These are the last stages of gestosis. When untimely medical intervention, such conditions pose a threat to the life of the mother and fetus.

In preeclampsia, microcirculation in the central nervous system is impaired. Clinically, preeclamation, as well as nephropathy, manifests itself in the form of the main symptoms - high blood pressure, swelling, and protein in the urine. Only when the pre-eclampsia develops, signs of nervous system damage are added to these symptoms: headaches, visual disturbances, flies, or '"swaddling clothes" before your eyes, nausea, vomiting.

If this process is not stopped in time, then preeclampsia becomes eclampsia - the pregnancy suddenly has seizures with loss of consciousness, lasting 1-2 minutes. Eclamsia can be fatal.

Given the potential danger of gestosis, at any even the minimum manifestations of the disease a woman should immediately contact an obstetrician-gynecologist and tell in detail about her complaints.

Diagnosis of late gestosis

In order to reliably determine whether or not gestosis exists, one visit to a doctor is not enough. Dynamic monitoring of obstetrician-gynecologist is necessary.

At each visit to the pregnant woman, the blood pressure( BP) on both hands, pulse and body weight must be measured. An increase in blood pressure above 135/85 may indicate gestosis. The doctor assesses the weight gain of the pregnant woman, the presence or absence of edema, asks the pregnant woman whether the amount of urine released has decreased.

Also for suspected gestosis, additional tests and studies are prescribed:

- clinical and biochemical blood test;
- general analysis of urine;
- ultrasound of the fetus with dopplerometry, CTG( cardiotocography) of the fetus.

If the analysis and examination data give rise to suspicions of preeclampsia( blood pressure above 135/85, severe swelling and large weight gain, protein in the urine) are additionally prescribed:

- daily monitoring of blood pressure, ECG;
- urine analysis according to Nechiporenko, according to Zimnitsky, daily urine analysis for protein;
- hemostasiogram;
- consultation of an oculist, therapist, nephrologist, neurologist.

Treatment of late gestosis

For mild manifestations of gestosis - edema, treatment is performed on an outpatient basis. With nephropathy and more severe manifestations of the disease, hospitalization of the pregnant woman in the midwife department is indicated.

With minor edema and normal tests, the treatment of gestosis is limited to compliance with lifestyle and nutrition recommendations.

When dropsy with pronounced edema and mild form of nephropathy appoint:

- sedatives( tinctures of motherwort, valerian);
- disaggregants( Trental, Curantil) to improve the rheological properties of the blood;
- antioxidants( vitamin A and E);
- with increasing blood pressure, hypotensive drugs with antispasmodic effect are used( Euphyllin, Dibasol);
- phytogens with a diuretic effect.

For severe nephropathy, pre-eclampsia and eclampsia, treatment is performed with the intensive care unit in the intensive care unit. Carry out infusion therapy to correct metabolic and electrolyte disorders - inject fresh-frozen plasma, reopolyglucin. In addition to the above groups of drugs, in severe forms of gestosis, anticoagulants are also used( Heparin).To quickly regulate water-salt metabolism diuretics( Furosemide) are used instead of phytospores.

For all forms of gestosis, to prevent the threat of premature birth and fetal hypoxia, selective sympathomimetics( Ginipral)

are used. The question of the method of delivery in gestosis is no less relevant.

If the condition of the pregnant is satisfactory and the fetus does not suffer from this, based on the data from ultrasound and CTG, the delivery is carried out through the natural birth canal. In the absence of the effect of therapy, with severe forms of gestosis and chronic hypoxia of the fetus, a caesarean section is indicated.

Treatment of gestosis is carried out not only before birth, but also during childbirth and in the postpartum period until the woman's condition is fully stabilized.

Nutrition and diet for gestosis

Lifestyle and nutrition in gestosis are very important for successful treatment. In the presence of edema and abnormal weight gain pregnant should adhere to a special diet. It is necessary to exclude from the diet acute, salted and fried foods. Less to consume salt. Preference should be given to boiled dishes, slightly under-salted. Try to consume foods of both vegetable and animal origin, as well as sour-milk products, fruits and vegetables. On average, a pregnant woman with a tendency to swelling should consume no more than 3000 calories per day. It is necessary to limit not only consumption of food, but also liquid. It is necessary to drink no more than one and a half liters of liquid per day. You should pay attention to diuresis - the amount of fluid allocated should be more than drunk.

An uneasy lifestyle, stress also provokes gestosis. In the second half of pregnancy a woman should sleep at least 8-9 hours a day. If you want to sleep in the daytime, it's also better to lie down for a rest. But at the same time, a sedentary image can also provoke gestosis. Therefore, a woman is recommended to take daily walks in the fresh air for at least an hour, to engage in special fitness for pregnant women.

Folk remedies for gestosis

Traditional medicine in the treatment of gestosis is very relevant, especially with dropsy, many medicinal plants have a diuretic effect. When gestosis appoint kidney tea, cranberry or cowberry mors, decoction of dogrose. You can use herbal preparations, such as Kanefron or Cyston. Sedative tinctures from motherwort or valerian can be used starting from the 13-14 weeks of pregnancy for the prevention and treatment of gestosis. With severe forms of gestosis, folk remedies are ineffective, so only medicines are used.

Complications of preeclampsia:

- premature delivery;
- detachment of the normally located placenta, leading to fetal death;
- fetal hypoxia, which also leads to intrauterine fetal death;
- hemorrhage and detachment of the retina;
- heart failure, pulmonary and brain edema, heart attacks and strokes;
- development of renal-hepatic insufficiency, hepatic coma.

Prevention of preeclampsia:

- reproductive function up to 35 years;
- timely treatment of chronic diseases that provoke gestosis;
is a healthy lifestyle.

Consultation of an obstetrician-gynecologist for the topic of late gestosis:

1. I am 38 weeks pregnant. I found a small protein in the urine and prescribed a dropper. But I do not have swelling and pressure. Do I need treatment in my case?
Treatment in this case is necessary to prevent the development of nephropathy. It is not necessary that there is pressure or swelling.

2. I have 37 weeks of pregnancy. I have been hospitalized for 2 weeks because of edema and protein in the urine. Despite the treatment, swelling increased and protein as was so left. What to do?
In your case, most likely, gestosis will only occur after childbirth, but treatment should be continued until childbirth to save the fetus. For you, the main thing now is under the supervision of doctors.

3. Do I have to go to hospital with a big weight gain?
If there is no pronounced edema, pressure and protein in the urine, then it is not necessary.

4. Normally I have a pressure of 120/80.When it rises to 130/90, the head is very sore. What to do, what to take?
This pressure is the upper limit of the norm, but if it hurts your head, this may indicate a complication of gestosis, so I recommend that you consult your gynecologist on-site and if advised, go to the hospital.

5. Is it possible to have cesarean delivery with gestosis or do you have to do it yourself?
Gestosis is not an indication for caesarean section. The operation is done only in emergency cases with progression of the disease.

6. By the 28th week has already added 10 kg. The doctor appointed Euphyllin, but I do not want to drink it. All my tests are normal. Can you do without Euphillin?
You can not use Euphyllinum only if you strictly adhere to diet and other recommendations to reduce gestosis.

7. What is the risk of protein in the urine? How does this affect the fetus?
Protein in urine indicates the loss of protein and impaired renal function. The fruit in this case does not have enough material for building its own cells. This can lead to a delay in the development of the fetus.

8. How much you can drink fluids per day for gestosis?
In the presence of edema - no more than one and a half liters per day.

9. I have swelling of my legs. The doctor appointed Trental. But the instructions say many side effects of this drug, I'm afraid to drink. How does Trental affect the fetus?
Trental is safe for the child.

10. What is the acceptable protein norm in urine?
Normally, there should not be any protein in the urine.

Obstetrician-gynecologist, Ph. D.Christina Frambos