Update: February 2019
With the onset of pregnancy in the body of a woman occurs
restructuring of the functions of all organs and systems. According to Russian statistics
70 – eight0% of all pregnant women have pathological disorders,
called preeclampsia, better known as toxicosis.
Gestosis during pregnancy can occur at any time and
manifest in mild and severe forms. Registered in women
Consultations on this subject consist of about 1eight% of pregnant women. eight to
16% – suffer from toxicosis of the second half of pregnancy, and among
pregnant specialized hospitals – up to 30%.
The proportion of mortality due to eclampsia (severe gestosis) –
20 – 25%, child mortality due to gestosis on the terms of the 22nd
weeks of gestation up to 7 days after birth (perinatal
mortality) 3 – four times higher than the average mortality.
What is gestosis
Statistical data in different sources significantly
differ. This is mainly due to three reasons:
- Incomplete coverage by dispensary observation of all pregnant women
- Late appealability of pregnant women in antenatal clinics when
mild forms of preeclampsia become more severe.
(pre-eclampsia and eclampsia).
- Change of the general name and classification of pathological
In connection with the last point, some clarity should be introduced.
This will avoid the substitution of concepts and confusion
Previously, all pathological symptoms throughout
pregnancy and abnormalities in the results of laboratory and
instrumental studies called toxicosis of pregnancy. AT
depending on the time and form, it was divided into toxicosis first and
second half of pregnancy.
AT соответствии с настоящей классификацией термин «токсикоз»
replaced by the term “preeclampsia”. Some experts believe that he can
be early (in the first trimester of pregnancy) and late (in the second
half). Others recognize only preeclampsia of the second half.
pregnancy, and those disorders that appear in the first half,
considered either physiological or not related to etiology
(cause) and pathogenesis (developmental mechanism) of gestosis. More
convenient is the first option to get
ideas of any pathological abnormalities
course of pregnancy.
They are associated with pregnancy and disappear after delivery. it
is the basis for the assumption by all scientists that
the cause of preeclampsia lies in:
- the negative role of the ovum and the fetus;
- disorder of adaptation mechanisms of a woman called
provide the fetus with the possibility of normal development.
the occurrence of preeclampsia during pregnancy, a lot. However, among them
most attention is paid to accompanying explicit or implicit
ongoing endocrine diseases, impaired renal function and
liver, high blood pressure, multiple fetal
pregnancy, the cystic and some others.
ATерсий и теорий о начальных и последующих механизмах развития
There are many pathologies, but all of them, except autoimmune, cause a great
doubt. Rather, they reflect the individual links of the cascade development
Gestosis in early pregnancy
It occurs in the first three months of pregnancy and passes
completely by the beginning of the second trimester. ATедущая роль в его патогенезе
- Functional dysregulation of the central nervous system
by type of neurosis.
- Disadaptation vegetative centers. Pregnancy first
queue requires restructuring of the digestive system,
which is connected via nerve receptors and trunks to
autonomic centers of the hypothalamic region of the brain.
Impulses entering the same centers from a modified uterus or
conductive nerve pathways on the background of nervous system disorders may
wear a perverted character. They trigger feedbacks from
centers, but already to the digestive tract, which leads to nausea and
- Neuroendocrine (neuro-hormonal) disorders and
exchange disorders. They also contribute
the emergence of perverse pathological impulses and development
early gestosis. For example, a coincidence in start time is noted.
vomiting with reduced excretion of corticosteroids by the adrenal cortex and
peak content of human chorionic gonadotropin in the blood.
Clinical manifestations and treatment
Mild preeclampsia is most often manifested by salivation,
nausea and vomiting (50 – 60%), less often – dermatosis in the form of skin
itching and rash, eczema, very rarely – bronchial asthma,
osteomalacia (softening of the bones), acute liver dystrophy,
tonic convulsions of the limbs or muscles of the neck and face.
The earlier vomiting occurs, the harder it is and
accompanied by loss of fluid and impaired water and electrolyte
balance. There are 3 degrees of severity:
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- Fetal heartbeats weekly
- Grade I is a mild form. Vomiting may be on an empty stomach or
due to food intake, unpleasant smell. Its frequency is not more than
5 times a day, and the loss of body weight is no more than 2 to 3 kg per
- II degree – moderate. Vomiting is repeated 6 – 10 times, and
weight loss – 3 kg for 7 – 10 days. ATозникают слабость,
increase the pulse rate to 90 – 100 beats / min at rest,
slight decrease in blood pressure, positive
reaction of urine to the presence of acetone.
- Grade III – involuntary vomiting of pregnant women. It occurs when
any movements, eating or water up to 20 – 25 times / day. The loss
weight – eight – 10 kg and more. Signs are pronounced
dehydration, weakness, fever, dry skin
and mucous membranes. Pulse exceeds 120 beats / min, decreases
blood pressure, decreases the allocation of the daily volume of urine,
In urine tests, a pronounced positive reaction to
acetone. AT анализах крови – нарушения белкового, солевого и
If you experience symptoms of gestosis in the form of vomiting of pregnant women
correction is required only in eight – 12%. Mild treatment
carried out on an outpatient basis in the form of recommendations regarding nutrition
and mode, the appointment of sedative drugs in the form of tinctures
medicinal herbs. Frequent control of weight dynamics is required,
blood and urine tests, blood pressure (normal).
When II and III degrees are assigned rest, sedatives
(sedative) drugs, corrective therapy using
intravenous drip injections of water-salt solutions, vitamins,
protein loss recovery. With adequate therapy
condition is quickly restored.
AT тяжелых случаях лечение осуществляется только в стационаре.
With the progression of symptoms during treatment is shown
artificial interruption of pregnancy.
Preeclampsia in late pregnancy is accompanied by a violation
all types of metabolism, total damage to all systems (see
calculating the duration of pregnancy). This changes
properties of blood, vascular walls, dystrophy of organs and
There are neurogenic, hormonal, renal theories of mechanisms
developmental pathology. AT настоящее время отдается предпочтение
immunological. It has several varieties that differ
by some elements. Its general meaning is tissue
incompatibility at the cellular level. AT результате этого не
vascular changes of the uterus occur, necessary to form
placental blood flow.
it подтверждает тот факт, что гестоз возникает с самого начала
of pregnancy. Therefore, the use of the term “late” to it
ATозникшие нарушения приводят к снижению кровотока в ворсинах
chorion, deterioration of oxygen delivery to tissues (hypoxia). it
causes local damage to the inner lining of blood vessels
(endothelium), becoming common due to
release of toxic biologically active substances.
The consequence is an increase in vascular permeability and the occurrence
edema, increased sensitivity to vasoconstrictor hormones.
ATозникает распространенный спазм кровеносных сосудов с повышением
blood pressure. Reduced ability to counteract
endothelial cells of the inner vascular wall of thrombus formation,
Physical and chemical properties of blood are disturbed (thickening, fluidity and
ATследствие этих процессов образуются микротромбы, нарушается
microcirculation and nutrition of tissues, damaged liver structure,
lungs, kidneys, which is manifested in the corresponding changes in overall
status and results of laboratory diagnostic and
AT классификации различают «чистые» гестозы и возникшие на фоне
associated diseases. The main clinical signs of late
- High blood pressure. More удобно ориентироваться
in terms of average pressure. It is determined by
apparatus or formula by dividing by 3 the amount of systolic and
double diastolic pressure. AT норме оно не должно
exceed 100 mm. Hg Art. The beginning of the disease indicates
exceeding this figure by 15 mm.
- The presence of edema.
- Increased urine protein content.
Some women may have only two of the three main
symptom. AT зависимости от их выраженности и с учетом субъективной
symptoms and other indicators distinguish the following forms
gestosis in late pregnancy:
- ATодянка беременных.
it наиболее легкая форма позднего гестоза. Its main symptom
– swelling of varying degrees:
- 1st – only shins;
- 2nd – anterior abdominal wall and legs;
- 3rd – joins another swelling of the face;
- fourth – anasarca (total swelling).
Edemas are accompanied by a decrease in the amount of daily urine (up to 30 –
60% and more) and weight gain of more than 350 grams over of the week.
It can develop independently or as a result.
ineffective treatment of dropsy, as evidenced by the accession
high blood pressure or / and protein in the urine. AT
Depending on the symptoms, there are four degrees of nephropathy, which
convenient to determine, focusing on the presented eight-point scale
ATиттлингера. The estimated amount is determined by the degree
severity of nephropathy:
- Easy – 2 – 10 points.
- Average – 11 – 20 points.
- Heavy – more than 21 points.
|Number of points||Показатели артериального давления (мм. Hg Art.)||The amount of protein in the urine g / day||Edema||Daily urine output (diuresis) in liters||The increase in mass (kg) of the body from the onset of pregnant.||Subjective symptoms|
|0||120 and eight0||not||not||More than 1.0||Up to 12||not|
|2||1four0 and 90||up to 1.0||limited||–||13 – 15||weakness, increased thirst, slight shortness of breath when walking and
|four||160 and 100||2 – 3||common||0.9 – 0.6||16 or more||–|
|6||–||four и более||–||Less than 0.5||–||–|
|eight||1eight0 и 110||–||–||No urine more than 6 hours||–||–|
When it, in addition to symptoms of nephropathy, there are more signs
circulatory disorders in the vessels of the brain, swelling of his
shells and increase intracranial pressure:
- lethargy, drowsiness, sometimes unmotivated good mood
(euphoria) and arousal;
- nausea, vomiting, pain in the epigastric region;
- increased or, conversely, reduced response to external
stimuli (bright light, loud sound, air movement);
- ухудшение зрения, фотопсии – мелькание «мушек», темных или
multicolored circles and spots before eyes.
The duration of preeclampsia can range from minutes to
a few hours.
Пример из практики – Pre-eclampsia
AT палату патологии поступила первобеременная женщина с
Diagnosis: Pregnancy 36 weeks. Nephropathy 2 – 3 степени. On the face
the classic triad of Tsangamemester: swelling of the legs, hands and
anterior abdominal wall, protein in the urine to 0.5 g / l, pressure 150/100.
Жалоб при поступлении not. I, (obstetrician-gynecologist Sozinova
Anna) prescribed her treatment in full and thorough
наблюдение, в частности, контроль АД каждые 2 часа, пока не усnot.
Late in the evening I was urgently called to work. The pressure jumped
up to 190/120.
I began to actively ask her about complaints. Woman
describes the classic symptoms of preeclampsia: both the headache and
flies before the eyes, and the nose is stuffed up. According to the rules need to be treated 2
hours, after which the question of operative delivery.
We are trying to create a therapeutic and protective regime as much as we can:
the patient is alone in the ward, the overhead light is extinguished and only burns
table lamp, we say, almost a whisper. At the same time
we call the resuscitator-anesthesiologist, because the cesarean section in
this case is inevitable. And, of course, there was a caesarean section, to
Happily, both mom and baby felt after all
Eclampsia является результатом выраженного поражения всех систем
and manifests itself as a syndrome of multiple organ failure. More often she
develops after the previous form, but may occur
suddenly with any severity of nephropathy.
Eclampsia протекает с судорогами, которым могут предшествовать
increased headache, blurred vision, twitching of the eyelids and
facial muscles, anxiety, and mental
violations. Seizures can be triggered by bright light
slight pain or harsh sound, but often
alone or as a series of seizures.
Их длительность – 1 – 2 минуты, после чего наступает потеря
consciousness, which returns slowly with subsequent amnesia.
Sometimes loss of consciousness occurs without seizures.
Пример из практики – Eclampsia
One woman was operated for preeclampsia.
The patient must be in the intensive care unit for 3 days,
but already in the second she is transferred to the hospital. And here comes for me
ambulance. My patient survey, “What are we complaining about?”, Replies that
my head hurts. I wrote off everything for the postoperative period (pressure
was perfect – 110/70), without focusing on the rest
(it was operated on for pre-eclampsia), I appoint promedol
for pain relief and leaving home.
I did not have time to go far, as the driver of the ambulance on the radio gets:
�“Urgently back! Eclampsia!» ATыясняется, что при попытке сделать
intravenous injection the woman begins to twitch (there were mimic
convulsions), the midwife did not lose her head, “did not come out of the vein” and introduced
magnesia. I’m in a panic, because my fault, I tell you to prick, all that
there is in the maternity hospital (and there was little and only in the “stash”). What kind
scheme? What kind дозировки? Just to remove the convulsive attack. AT ход
went and droperidol, and Relanium, and the same magnesia. ATызвали
an anesthesiologist, but before his arrival, it was not that the attack was stopped, but
the patient was deeply asleep and even snored. Ok that’s all good
The effects of eclampsia can be severe:
- cerebrovascular accident and subarachnoid
- respiratory and cardiac arrest;
- renal-hepatic failure;
- development of intravascular coagulation with life-threatening
bleeding or thrombosis and pulmonary distress syndrome.
Treatment of preeclampsia during pregnancy with mild dropsy
or nephropathy possible on an outpatient basis, with average and
Severe – in the hospital.
Help for preeclampsia and eclampsia is carried out only in
resuscitation and intensive care units using
epidural analgesia, anesthesia, mechanical ventilation,
long-term infusion therapy under strict laboratory control
the functions of all organs and systems. In late periods with severe
Emergency caesarean section is indicated in the condition, since sometimes
only surgery saves the life of a woman and child.