Quite often, pregnancy is accompanied by various pathological conditions. In our article, we will tell you what preeclampsia is, why it occurs, how it develops, describe its signs, talk about the diagnosis, treatment and prevention of this condition.

Preeclampsia during pregnancy is a complication of the gestational period. It develops during childbearing, during childbirth or in the first days after them. Preeclampsia is accompanied by a pronounced disruption of the functioning of vital organs. The basis of this condition is a disturbed adaptation of the woman's body to pregnancy. As a result of a cascade of reactions, vasospasm occurs in all tissues, their blood supply is disturbed, and dystrophy develops. The nervous system, heart and blood vessels, placenta and fetus, kidneys and liver are affected.

Relevance of the problem

Preeclampsia in pregnant women develops in 12-15% of cases. It is the leading cause of death for women in the third trimester of pregnancy. With the development of this complication in the later stages and

up to a third of all children die in childbirth. In women, after a complication, the kidneys suffer, chronic arterial hypertension develops.

What is dangerous preeclampsia for the fetus? It causes intrauterine hypoxia (lack of oxygen) and growth retardation. The consequences of preeclampsia for a child are a lag in physical and mental development.

In modern conditions, atypical gestoses are increasingly common. They are characterized by the predominance of one symptom, early onset, early formation of placental insufficiency. Underestimation of the severity of the condition in this case leads to delayed diagnosis, untimely treatment and late delivery.

Classification

The classification of preeclampsia is not well developed. In Russia, the most commonly used division of the disease into the following types:

• dropsy of pregnant women (with a predominance of edema);
• nephropathy of mild, moderate and severe degree;
• preeclampsia;
• eclampsia.

The main disadvantage of this classification is the vagueness of the term "preeclampsia", which does not allow clarifying the severity of the condition.

Today, preeclampsia is divided into forms in accordance with the International Classification of Diseases 10th revision:

• O10: hypertension (high blood pressure) that existed before pregnancy and complicated the course of gestation, childbirth, the postpartum period;
• O11: Pre-existing high blood pressure with the addition of proteinuria (protein in the urine);
• O12: the appearance of edema and protein in the urine during pregnancy at normal pressure;
• O13: development of high blood pressure during pregnancy in the absence of protein in the urine;
• O14: pregnancy-induced hypertension associated with high protein in the urine;
• O15: eclampsia;
• O16: Unspecified hypertension.

This classification solves some working aspects of diagnosis and treatment, but does not reflect the processes taking place in the body.

With "pure" gestosis, pathology occurs in a previously healthy woman. This type is observed only in 10-30% of women. Combined forms are difficult. They develop against the background of previously existing diseases: hypertension, kidney and liver pathology, metabolic syndrome (obesity, insulin resistance), endocrine pathology (diabetes mellitus, hypothyroidism, and others).

This condition is typical only for the period of gestation. Preeclampsia after childbirth disappears, with the exception of severe complications. This suggests that the source of the problems is the fetus and the placenta. Gestosis occurs only in humans. This disease does not occur in animals, not even in monkeys, so it cannot be studied experimentally. A large number of theories and questions regarding the nature of this condition are associated with this.

Why does gestosis occur

Consider the main modern theories of the development of this state:

1. Cortico-visceral theory. According to her, gestosis is very similar to a neurotic state with disruption of the cerebral cortex and a subsequent increase in vascular tone. Confirmation of this theory is the increase in the frequency of the disease in pregnant women after mental trauma, as well as data obtained using electroencephalography.
2. The endocrine theory considers an improperly proceeding pregnancy as a chronic stress that causes overstrain and exhaustion of all endocrine systems of the body, including those regulating vascular tone.
3. The immunological theory states that the tissue of the trophoblast (the outer membrane of the fetus that forms the placenta) is a weak antigen. The body produces the appropriate antibodies, which also interact with the cells of the woman's kidneys and liver. As a result, the vessels of these organs are affected. However, autoimmune processes are not fixed in all women with preeclampsia.
4. The genetic theory is based on the fact that in women whose mothers suffered preeclampsia, the pathological condition develops 8 times more often than the average. Scientists are actively looking for "eclampsia genes".
5. Placental theory focuses on the violation of the formation of the placenta.
6. Thrombophilia and antiphospholipid syndrome can cause damage to the vascular walls throughout the body, and they also lead to a violation of the formation of the placenta.

Scientists believe that a unified theory of the origin of preeclampsia has not yet been developed. The most promising are the immunological and placental versions.

The following factors significantly increase the risk of preeclampsia:

1. Extragenital diseases, namely hypertension, metabolic syndrome, diseases of the kidneys and gastrointestinal tract, frequent colds and endocrine pathology.
2. Multiple pregnancy.
3. Previously transferred gestosis.
4. The age of the woman is under 18 and over 30 years old.
5. Bad social conditions.

How the disease develops

The onset of the disease occurs even in the earliest stages of pregnancy. During implantation (introduction) of the embryo into the wall of the uterus, the arteries located in the muscle layer do not change, but remain in the "pre-pregnancy" state. Their spasm occurs, the inner lining of the vessels, the endothelium, is affected. Endothelial dysfunction is the most important trigger of preeclampsia. It leads to the release of powerful vasoconstrictor substances. At the same time, blood viscosity increases, microthrombi are formed in spasmodic vessels. The syndrome of disseminated intravascular coagulation (DIC) develops.

Vasospasm leads to a decrease in the volume of blood circulating in the body. As a result, the tone of peripheral vessels reflexively increases. The intensity of blood flow in all organs decreases, including the kidneys, liver, heart, brain and placenta. These violations cause a clinical picture of preeclampsia.

Symptoms of preeclampsia

External signs usually manifest gestosis of the second half of pregnancy. However, we found that the disease develops much earlier. Early preeclampsia is considered a preclinical stage, which can be detected using special tests:

• measurement of pressure with an interval of 5 minutes in the position of a woman lying on her side, on her back, again on her side. The test is positive if the diastolic ("lower") pressure changes by more than 20 mm Hg. Art.;
• violation of uteroplacental blood flow according to;
• decrease in the number of platelets less than 160×10 9 /l;
• signs of increased blood clotting: increased platelet aggregation, decreased activated partial thromboplastin time, increased fibrinogen concentration in the blood;
• decrease in the concentration of anticoagulants, in particular, own heparin;
• a decrease in the relative number of lymphocytes to 18% and below.

If a woman finds two or three of the listed signs, she needs treatment for preeclampsia.

Classic signs of preeclampsia that appear in the second half of pregnancy and especially in the 3rd trimester:

• swelling;
• arterial hypertension;
• proteinuria.

Gestosis is characterized by a variety of options for its course. The classic triad occurs in only 15% of women, and one of the three symptoms occurs in a third of patients. More than half of patients suffer from protracted forms of the disease.

One of the earliest signs of the disease is excessive weight gain. It usually starts at 22 weeks of gestation. Normally, any woman up to 15 weeks should add no more than 300 g weekly. Then, in patients younger than 30 years old, this increase should be no more than 400 grams per week, in older women - 200-300 grams.

An increase in blood pressure usually occurs at 29 weeks. For a more accurate diagnosis, you should follow all the measurement rules, register the pressure on both arms, and choose the right cuff size.

Edema in preeclampsia is associated with sodium retention, a decrease in the concentration of proteins in the blood, and the accumulation of incompletely oxidized metabolic products in the tissues. Edema can be only on the legs, spread to the abdominal wall or cover the entire body. Signs of hidden edema:

• excretion of the main volume of urine at night;
• a decrease in the amount of urine excreted compared to the amount of fluid consumed;
• excessive weight gain;
• “symptom of the ring” - a woman’s wedding or other familiar ring becomes small.

Proteinuria is the excretion of protein in the urine. It is caused by damage to the glomeruli as a result of lack of oxygen and vasospasm. Excretion of more than 1 gram of protein in any portion of urine is a dangerous sign. At the same time, the level of protein in the blood decreases.

Severe forms of the disease

Of particular danger to the mother and child is a violation of the function of the nervous system - preeclampsia and eclampsia.

Symptoms of preeclampsia:

• headache in the back of the head and temples;
• "shroud", "flies" before the eyes;
• pain in the upper abdomen and in the right hypochondrium;
• nausea and vomiting, fever, itchy skin;
• nasal congestion;
• drowsiness or increased activity;
• redness of the face;
• dry cough and hoarseness;
• tearfulness, inappropriate behavior;
• hearing loss, difficulty speaking;
• chills, shortness of breath, fever.

With the progression of this condition, eclampsia develops - a convulsive seizure, accompanied by hemorrhages and swelling of the brain.

Complications

Late preeclampsia can cause severe complications that can even lead to the death of the mother and child:

• eclampsia and coma after it;
• intracerebral hemorrhage;
• acute renal failure;
• respiratory failure;
• retinal detachment and loss of vision in a pregnant woman;
• premature;
• hemorrhagic shock and DIC.

There are more rare forms that complicate preeclampsia. This is the so-called HELLP-syndrome and acute fatty hepatosis of pregnant women.

HELLP syndrome includes hemolysis (breakdown of red blood cells), a decrease in the number of platelets responsible for blood clotting, and abnormal liver function with an increase in its enzymes in the blood. This complication occurs mainly after the 35th week of pregnancy, especially against the background of nephropathy, and often causes the death of a woman and fetus.

Symptoms develop quickly. The woman begins to complain of headache, vomiting, pain in the abdomen or in the right hypochondrium. There is jaundice, bleeding, the patient loses consciousness, she begins to have convulsions. There is a rupture of the liver with bleeding into the abdominal cavity, placental abruption. Even if a woman is urgently operated on, due to blood clotting disorders, she may die in the postoperative period from severe bleeding.

Acute fatty hepatosis of pregnant women develops mainly during the first pregnancy. Within 2-6 weeks, a woman is concerned about weakness, lack of appetite, abdominal pain, nausea and vomiting, weight loss, skin itching. Then liver and kidney failure develops, which is manifested by jaundice, edema, uterine bleeding and fetal death. Often there is a hepatic coma with disruption of the brain.

Assessment of the severity of the condition

According to the Russian classification, the severity of the disease is determined by the condition of the kidneys.

Preeclampsia 1 degree usually accompanied by swelling of the legs, slight proteinuria, increased blood pressure up to 150/90 mm Hg. Art. In this case, the fetus develops normally. This condition usually occurs at 36-40 weeks.

Preeclampsia 2 degrees characterized by the appearance of edema on the abdomen, proteinuria up to 1 g / l, increased pressure up to 170/110 mm Hg. Art. Fetal hypotrophy of the 1st degree may be noted. This form occurs at 30-35 weeks.

Diagnosis of a severe form is based on the following features:

• increase in blood pressure up to 170/110 mm Hg. Art. and higher;
• protein excretion in an amount of more than 1 gram per liter of urine;
• decrease in urine volume to 400 ml per day;
• widespread edema;
• violation of blood flow in the arteries of the uterus, brain and kidneys;
• delayed fetal development;
• blood clotting disorder;
• increased activity of liver enzymes;
• development up to 30 weeks.

With such a serious condition, treatment in a hospital is necessary.

Treatment of preeclampsia

The main directions of therapy:

• medical and protective regime;
• delivery;
• restoration of the functions of internal organs.

A woman is prescribed the following drugs:

• sedatives, sedatives (valerian, motherwort), in severe cases - tranquilizers and antipsychotics (Relanium, Droperidol), barbiturates, anesthetics;
• antihypertensive drugs (mainly calcium antagonists - Amlodipine, beta-blockers - Atenolol, as well as Clonidine, Hydralazine and others);
• magnesium sulfate, which has a hypotensive, anticonvulsant, sedative effect;
• replenishment of the volume of circulating blood with the help of intravenous infusions;
• antiplatelet agents (Kurantil) and anticoagulants (Fraksiparin) under strict control of blood coagulation;
• antioxidants (vitamins C, E, Essentiale).

Drug treatment with a mild degree can be carried out within 10 days, with moderate severity - up to 5 days, with a serious condition - up to 6 hours. If treatment fails, urgent delivery is necessary.

Delivery with preeclampsia is carried out through the natural birth canal or with the help of a caesarean section. A woman can give birth herself with a mild degree of illness, a good condition of the fetus, the absence of other diseases, the effect of medications. In more severe cases, a planned operation is used. In severe complications (eclampsia, renal failure, placental abruption, and so on), an emergency caesarean section is performed.

After a caesarean section, drug treatment is continued until all body functions are fully restored. Women are discharged home no earlier than 7-15 days after birth.

Prevention of gestosis during pregnancy

A pregnant woman should avoid nervous and physical overload, have a good rest, and not take medications without a doctor's prescription. Nutrition should be complete, if possible hypoallergenic. Severe fluid restriction and a low-salt diet are not indicated. Only in severe cases of renal failure is the patient recommended to reduce the amount of protein consumed with food.

The key to preventing preeclampsia is regular medical supervision, weight control, blood pressure, blood and urine tests. If necessary, a woman is hospitalized in a day hospital or in a sanatorium, where preventive treatment is carried out.

If the condition worsens, the appearance of edema, headache, pain in the right hypochondrium, the patient should consult a doctor as soon as possible. Self-medication is unacceptable. Untreated acute gestosis is an immediate threat to the life of the mother and child.

Preeclampsia is a complication that occurs in many pregnant women. It disappears after childbirth. Pathology is considered a formidable disease, as it sometimes causes maternal death. Complication is most often detected in the third semester of pregnancy.

This is an insidious disease that may not cause concern. But at some point, a woman has an attack of convulsions (eclampsia), which threatens the health of the mother and baby.

Currently, doctors are trying to prevent such phenomena. By regularly visiting a gynecologist, you can keep your health under control. Read on for everything about complications during pregnancy: signs of occurrence, nuances of treatment, what prevention and consequences of the disease can be advised.

What are the signs and symptoms of preeclampsia

Main features

• swelling or dropsy (hands and feet swell first);
• the appearance of protein in the urine;
• blood pressure is above normal.

Dangerous symptoms - harbingers of an attack of seizures

• nausea;
• headache;
• stomachache;
• lethargy and drowsiness;
• flashing "flies" before the eyes.

The combination of such symptoms is characteristic of preeclampsia, which is the result of preeclampsia. Against the background of seizures, the following conditions may occur: stroke, heart attack, placental abruption, pulmonary edema, renal failure, placental abruption, retinal detachment. These complications develop very quickly and can be present in pregnant women of any age.

Groups

Edema of pregnant women

They can be overt and covert. The latter appear in the early stages of the disease. Occur due to the retention of fluids in the tissues. Self-medication is not allowed here. Diuretic drugs cannot eliminate the problem, but only worsen the condition of the pregnant woman and the fetus. Not all swelling during pregnancy is associated with a disease. Only a specialist can identify complications.

Preeclampsia

This condition most often occurs after the 20th week of pregnancy. Sometimes preeclampsia occurs at the end of the first week after childbirth. Its symptoms are hypertension, edema and proteinuria. In severe cases, the blood supply to the brain is disrupted. This is manifested by severe headache, vomiting and impaired visual function.

Eclampsia

This is the most severe form. It has a whole range of symptoms, the most dangerous of which is convulsions.

Gestosis can manifest itself in different ways. Some women have minimal symptoms. Others suffer from fulminant attacks that have catastrophic consequences.

The cause of the disease - the opinions of doctors

Doctors cannot accurately name the causes that cause complications. But there is an unequivocal opinion that such a complication rarely occurs in healthy women. Most often, preeclampsia develops against the background of existing diseases of the mother. An increase in pressure, a violation of the functions of the kidneys or liver, as well as other somatic diseases are indirect causes of toxicosis in pregnant women.

It is impossible to give a more precise reason. A pregnant woman experiences malfunctions in the body, which can lead to serious problems. In some cases, doctors resort to early delivery in order to save the life of the child and mother. Therefore, before conception, a woman must undergo an examination.

Immunological diseases, blood clotting disorders, kidney disease, vegetative-vascular dystonia, anemia, diabetes mellitus - these and many other disorders often lead to preeclampsia

This will allow you to predict possible complications that may arise during the period of bearing a baby. If necessary, a woman is prescribed a course of treatment before pregnancy. Immunological diseases, blood clotting disorders, kidney disease, vegetative-vascular dystonia, anemia, diabetes mellitus - these and many other disorders often lead to the manifestation of the disease.

If you have problems with your kidneys, thyroid, or blood pressure, be sure to visit a doctor.

The risk group includes

• women over 30 and under 18;
• those who often had abortions;
• women who have given birth many times;
• those who have a short break between births.

No one is 100% safe from preeclampsia. Therefore, experts strongly advise to regularly come for a checkup. Control of pressure and weight, blood and urine tests are the measures that allow early detection of complications.

No one is 100% safe from preeclampsia

The excellent health of a pregnant woman is not yet an indicator of good health. Sometimes test results show poor results in the absence of external signs of the disease.

Why gestosis appears in pregnant women

Preeclampsia or toxicosis is a complication that is associated with pregnancy. It may be early or late. Early toxicosis is known to all pregnant women. It shows up at the earliest. Its main symptoms are nausea and vomiting. The early stage is usually non-aggressive.

All its signs are noticed not only by the pregnant woman herself, but also by the people around her. Late toxicoses are more insidious. They lead to dangerous complications. Late preeclampsia is the leading cause of maternal mortality. This complication is less noticeable.

It manifests itself in three main features:

1. swelling;
2. protein in the urine;
3. high blood pressure.

Not all women show the full range of symptoms. Only one of them can tell about the presence of pathology. Visible here are only edema. Pressure rises may not be very significant. In this case, the woman does not feel them. Changes in the composition of urine also do not bother the pregnant woman. Therefore, by the end of the term, doctors measure blood pressure weekly and carry out weighing.

Late gestosis sometimes have an unpredictable development. Sometimes they begin to progress rapidly. In this scenario, the woman's health is rapidly deteriorating. A pregnant woman may feel worse and worse every hour. Pathology in this form is treated only in stationary conditions.

Today, about 27% of pregnant women experience the disease. Its symptoms subside after childbirth. The complication occurs due to the fact that the mother's body cannot optimally adapt to bearing a child. As a result, various violations occur.

The disease is characterized by spasm of the smallest blood vessels. As a result, the amount of blood that carries nutrients and oxygen to the cells is drastically reduced. The work of organs and systems is disrupted. Spasm of small vessels leads to an increase in blood in large vessels. All this leads to an increase in blood pressure.

There are changes in the kidneys, which entails the appearance of protein in the urine. The brain also suffers. This is manifested by nausea, headaches, flashing "flies". If a pregnant woman experiences dry skin and itching, then this is a clear sign of changes in the liver.

A woman has swelling, and the blood becomes thicker. Such processes are reflected in the condition of the fetus. Its growth and development is slowed down. The baby experiences a lack of oxygen (hypoxia).

Diagnostic methods

If the doctor suspected preeclampsia, he prescribes the following procedures:

1. general and biochemical blood tests;
2. urine tests (daily, biochemical and clinical);
3. weighing;
4. measurement of blood pressure;
5. examination of the fundus;
6. Ultrasound and dopplerometry of the fetus.

The patient needs to be examined by a general practitioner, a neurologist, an ophthalmologist and a nephrologist. A serious problem is considered a significant deviation of pressure from the norm.

A special group is made up of hypertensive patients, in whom the pressure is increased initially. They are under constant medical supervision. If a woman has only edema, then she is at risk for a more severe form of preeclampsia.

Doctors must take into account the initial pressure of a woman with blood pressure in the second period of pregnancy

From the moment edema appears, specialists begin to take measures to prevent complications. The success of treatment depends on the body of the pregnant woman.

When diagnosing edema, a specialist evaluates weight gain for the entire duration of pregnancy, as well as for a month and a week. An increase of about 300-400 grams is considered the norm. Pathological increase indicates hidden edema. In this case, measures are taken to correct nutrition and water-salt metabolism.

The gynecologist recommends sticking to a diet and spending fasting days. If this does not help, then the doctor prescribes special drugs. If a pregnant woman has a significant weight gain, but there is no swelling, then she can be given an MCO test (McClure-Aldrich test).

It consists in the fact that a woman is injected with saline under the skin. The doctor notes the time during which the papule resolves. If the interval does not take 35 minutes, then there is swelling in the body.

The first sign of edema is slight numbness of the fingers.. It is difficult for a woman to unbend her fingers, she can hardly put on rings. With small swelling of the legs, the gynecologist prescribes treatment, which is carried out on an outpatient basis. If the arms, legs and face swell, the pressure is increased, and there is also protein in the urine, then you need to go to the hospital.

In this case, the condition of a woman can deteriorate dramatically at any time. Self-medication is not allowed here. Some women start taking diuretics on their own, which worsens the situation even more.

Complication of the second half of pregnancy (starting closer to the third trimester)

Late toxicosis occurs for many reasons. Violation in the endocrine system, obesity, sexual diseases, hypertension - all these factors can contribute to the development of preeclampsia in the second half of pregnancy. Sometimes it is a consequence of the flu or SARS.

Improper nutrition can also give impetus to the development of late toxicosis. It is impossible to cure it at home. The woman needs hospital treatment. She is given droppers and prescribed medications that help to make up for the lack of fluid in the vessels.

The cause of late toxicosis is often a pathology in the placenta. In this case, childbirth is considered the most effective solution to the problem. With formidable complications resort to caesarean section.

The initial symptoms of late toxicosis are detected at the next examination in the antenatal clinic. The doctor evaluates weight gain, measures blood pressure, examines urine analysis and calculates the fetal heartbeat. Based on the data obtained, he can conclude that there is or is no preeclampsia.

If the doctor insists on hospitalization, then you can not refuse. The late degree does not go away on its own. The symptoms will only get worse. If you miss the time, you may experience preeclampsia or more severe complications (seizures).

How is childbirth

The severity of the disease affects the choice of time and method of delivery. The doctor takes into account the condition of the mother and child.

The most favorable births are those that occur through the natural birth canal. This is a truth that all gynecologists and obstetricians have supported for centuries. But for such childbirth, the following conditions are needed: a mature cervix, the proportionality of the mother's pelvis and the fetal head, head presentation of the fetus, the woman's age is not older than 30 years, the absence of diseases in the mother and other factors.

With gestosis, childbirth can be accompanied by complications. Therefore, they are carried out very carefully, using antispasmodics and painkillers. Delivery is considered stressful for the fetus and mother.

With gestosis, childbirth can be accompanied by complications

Studies conducted by specialists have shown that with this disease, the woman and the fetus have reduced anti-stress resistance. Any aggressive impact during childbirth (fatigue, hyperstimulation of the uterus, painful manipulations) can have sad consequences. A woman has every chance of suffering from fulminant and critical hypertension.

As a result, cerebral blood flow may be disturbed, leading to eclampsia. Statistics show that eclampsia in childbirth occurs quite often. It can occur not only during childbirth through the natural birth canal, but also during caesarean section.

Typical complications at the birth of a child

• fetal asphyxia;
• premature detachment of the placenta;
• heavy bleeding in the postpartum period.

Childbirth is considered the main way to save a woman from preeclampsia. But for an immature and premature baby, delivery before the due date is not a very favorable outcome. But in some cases, the baby is more likely to survive outside the mother's body. Then the only strategy of doctors is delivery. It allows you to save the life of the child and mother.

Childbirth in the presence of the disease is carried out against the background of stabilization of laboratory and clinical parameters.

Indications for preterm birth (regardless of gestational age)

1. non-convulsive or convulsive eclampsia, seizures;
2. preeclampsia, which progresses even with hospital treatment;
3. the rapid deterioration of a woman's health;
4. retinal disinsertion;
5. placental insufficiency, which progresses;
6. placental abruption;
7. signs of hepatopathy.

Doctors carry out a gentle and quick delivery. Preference is given to childbirth through the natural birth canal. This avoids the stress that surgery and anesthesia cause. The woman is given anesthesia.

Caesarean section is performed if there are absolute indications: preeclampsia and eclampsia, placental abruption, oliguria, coma.

Illness after childbirth

After childbirth, some women have symptoms of pathology. Such patients are prescribed appropriate treatment, which is continued until their condition stabilizes. The treatment regimen is determined individually.

Degrees and classifications

Specialists distinguish between early and late gestosis. The first occurs at a period of 22-24 weeks and lasts quite a long time. The second may appear when the period is 36 weeks. The late form of the disease usually does not have severe complications. During this period, the baby has already formed and delivery is not accompanied by dangerous symptoms.

Late preeclampsia usually does not have severe complications.

Severity:

1. light,
2. average,
3. heavy
4. eclampsia.

Doctors also distinguish pregestosis or the preclinical stage of the disease. There is also a division into combined and pure gestosis. This is where comorbidities matter. Pregnant women with extragenital ailments that were not detected in time are included in the group of women suffering from a pure form of the disease.

If complications arose against the background of an existing disease, then we are talking about a combined form. In practice, 70% of women have exactly the combined form. The most adverse symptoms are observed in pregnant women who have liver disease, kidney disease, endocrine disorders, hypertension and metabolic syndrome.

Edema plays an important role in the diagnosis. They may vary in severity.:

grade I - edema of the lower extremities;

degree II - swelling of the lower and upper extremities, as well as the abdominal wall;

degree III - edema extends to the internal organs.

Edema may be hidden. They may be accompanied by proteinuria and arterial hypertension. The course of the disease is determined by conducting a study of blood and urine. In this case, the doctor monitors the condition of the fetus. The severity of the pathology can be judged by the number of heartbeats of the baby.

Early

Early preeclampsia or toxicosis worries many pregnant women. It occurs in the first half of the term. Doctors cannot name the reasons for it.

The main manifestations of toxicosis:

1. dizziness,
2. nausea,
3. salivation,
4. vomit.

They can be expressed with different strengths. If the disease manifests itself too brightly, then doctors prescribe treatment. Toxicosis is so widespread that its symptoms are considered normal during pregnancy.

In fact, the phenomenon has a pathological basis. Normally, pregnancy in a healthy woman should not be accompanied by nausea and vomiting. Pregnancy is a physiological normal state of the body. This is not a pathology.

The mechanisms of development of the early form have not been studied. Experts believe that it is a pathological reaction of a woman to pregnancy. Immune, allergic, toxic, reflex and neurogenic mechanisms are involved in the development of toxicosis.

In some cases, the disease in early pregnancy takes the form of asthma, dermatosis, tetany or osteomalacia.

Late preeclampsia

This is a complication that occurs in the second half of pregnancy. It develops until birth. Such toxicosis leads to a breakdown of the systems and organs of a woman.

Many obstetricians associate the occurrence of preeclampsia with an increased number of late births.

The reasons for the development of late getosis have not been studied by science. According to some versions, preeclampsia occurs due to the immunological incompatibility of the fetus and mother. Other experts believe that hormonal processes are to blame. Late form in recent years is detected very often.

Many obstetricians attribute this to the increased number of late births. Women who give birth after the age of 35 have chronic diseases that complicate the course of pregnancy and childbirth.

A woman may notice the first signs of a late disease at the 28th week. Usually pregnant women find edema. This is the mildest manifestation of the disease. Edema is also called "dropsy of pregnancy." In more severe cases, the complication is manifested by nephropathy.

Easy

A mild degree of the disease is characterized by a slight increase in blood pressure. It exceeds the norm by 20%. Protein in urine is 1.0 g/l. Of the signs, edema is present. The woman is undergoing outpatient treatment.

Heavy

Blood pressure exceeds the norm by 40% and more. Protein content - 3.0 g/l. The health of the pregnant woman worsens. She develops a headache, swelling increases and protein in the urine increases.

Sleep may also be disturbed and vision may be impaired. The patient is admitted to the hospital. If the condition is very serious, then the pregnant woman is sent to intensive care. The tactics of treatment depends on the condition of the woman and the fetus.

The pathogenesis of preeclampsia

The basis of the pathogenesis of the disease is a generalized spasm of blood vessels. This is manifested by an increase in pressure. Spasm occurs due to damage to the endothelium. Dystrophic changes occur in the organs and tissues of the patient. The functions of the liver, kidneys and nervous system are impaired, and the fetus and placenta also suffer.

The mechanism of development of pathology is a controversial issue. Many experts adhere to the hormonal theory. The cause of complications in this case is considered a violation of the functions of the adrenal glands, a change in the production of estrogens or the hormonal status of the placenta.

There are doctors who support the renal theory of the occurrence of gestosis. The kidneys are squeezed by the growing uterus, which entails a number of disorders in the body. But this theory is refuted by facts that claim that toxicosis occurs in pregnant women and without squeezing the kidneys.

There is also an immunogenetic theory, which states that placentation is disturbed in some pregnant women due to genetic characteristics.

What is the danger of the disease during pregnancy

Gestosis is dangerous for its complications. If it is accompanied by vomiting, then the pregnant woman may be dehydrated. The functions of many organs and systems are impaired. The kidneys, liver and heart suffer. The most severe complication is acute yellow liver atrophy, which can be fatal. But this pathology develops very rarely. If preeclampsia is extremely severe, then the pregnancy is terminated.

With a favorable course of early toxicosis, its symptoms disappear by the 12th week. If it continues, then doctors talk about pathology. This may be caused by an exacerbation of chronic diseases or any obstetric pathology.

Any form of late onset of the disease is dangerous to the fetus. In the vessels of the placenta, blood circulation is disturbed. The acute form causes its detachment, premature birth or death of the child. Sluggish preeclampsia causes a delay in intrauterine development of the baby.

What are the principles of treatment

Modern doctors cannot completely eliminate the disease. In many cases, they control this complication. Timely treatment helps to prevent the development of serious complications. Self-medication is an unacceptable measure. Without the help of a professional, preeclampsia goes into a difficult stage.

Basic principles of treatment:

• maintaining a medical and protective regime;
• taking sedative drugs (valerian, motherwort or stronger drugs);
• drug treatment of internal organs;
• careful and timely delivery.

If the treatment does not lead to positive changes, and the condition of the mother and child worsens, then the question of childbirth arises.

If preeclampsia is treatable and does not progress, then labor induction is not used. Premature birth is a forced measure that is used in severe cases. If the treatment does not lead to positive changes, and the condition of the mother and child worsens, then the question of childbirth arises.

The treatment regimen for toxicosis is developed individually. Doctors take into account many nuances: the severity of the disease, concomitant diseases, the condition of the fetus, etc. A mild degree of toxicosis begins to be treated in the antenatal clinic.

If after a week the woman's condition has not improved, then she is sent to the hospital. Medicines in the presence of a disease are used necessarily. It is impossible to cure it with herbs and diets.

Pregnant women with edema that accompany moderate and mild preeclampsia are treated in a hospital (department of pathology of pregnant women). In severe form with signs of preeclampsia, the woman is placed in the intensive care unit and resuscitation.

The duration of treatment depends on the severity of the disease. The best treatment for a severe form is delivery. Therefore, three hours after an unsuccessful treatment for preeclampsia, the patient is given a caesarean section.

Prevention

1. proper nutrition;
2. active lifestyle (it is useful for pregnant women to do yoga, swimming, fitness);
3. frequent walks in the fresh air;
4. lack of bad habits and stress;
5. taking prophylactic drugs as prescribed by a doctor (Magne-B6, vitamin E, chimes, etc.);

Diet

Proper nutrition can improve the condition of a pregnant woman. On the table, a woman should have useful products. Emphasis should be placed on food rich in protein. These are lean meat, cottage cheese, fish and eggs. Sweet, fatty, fried, smoked and salty should be excluded.

Under the strictest ban fast food. The daily menu should include fresh vegetables, fruits, juices and herbs. Eat more fiber foods to relieve constipation.

If there is swelling, then the doctor makes a diet. He recommends monitoring the amount of fluid you drink and excrete. Pregnant women need to control the amount of food they eat. Otherwise, there will be a strong weight gain, which can lead to a number of complications.

Pregnant food should be rich in vitamins and minerals. You should drink purified water, excluding coffee, strong tea and carbonated drinks. Doctors usually prescribe special vitamin complexes for pregnant women. They must be accepted without fail.

Pregnancy food should be rich in vitamins and minerals

What could be the consequences

Preeclampsia is a dangerous condition that can lead to sad consequences. It ranks second among the causes of death of mothers (the first place is given to bleeding). A complication is perinatal mortality (its rate reaches 32%).

Women suffering from the disease get endocrine disorders, hypertension, kidney pathology. Children born to such mothers experience problems with psycho-emotional and physical development. Many babies often get sick in early childhood.

How to avoid this disease

In order for this pathology to bypass you, its prevention must begin even before conception. All chronic diseases should be identified and treated. Hidden infections can be detected if you undergo an examination. It is very important to lead a healthy lifestyle.

Preeclampsia after delivery: how to deal with it

Preeclampsia after pregnancy and during it has symptoms known to doctors: increased blood pressure, swelling, and in connection with them a quick and large weight gain, as well as protein in the urine. In severe preeclampsia, a woman experiences nausea and vomiting, a severe headache. Since pathology can cause a lot of problems, more than one doctor decides how to treat preeclampsia after childbirth. It all depends on which organs of the mother he hit.

Preeclampsia (late toxicosis) is one of the most severe pathologies in expectant mothers. It is directly related to pregnancy. It begins in the second, and more often the third trimester, and is the main cause of maternal and child mortality. It is not treated with medication, only by delivery. All that doctors can do is to help prepare the child as much as possible for life outside the womb (with the rapid early progression of the pathology, the child is born prematurely) and prevent (though not in all cases) eclampsia, a formidable complication of preeclampsia in the mother.

Preeclampsia that occurs in the mother for a period of 24-28 weeks, as a rule, leads to an emergency caesarean section due to her serious condition and the child in order to save them. If late toxicosis occurs after 30-32 weeks, there is a chance that gestosis will not have time to harm the body of the mother and child too much. Mild preeclampsia rarely has consequences. Usually, all its symptoms go away in the first 1-2 days after the baby is born.

Childbirth with gestosis can be natural or operative, it depends on many factors. However, this situation is always under the control of doctors and anesthesiologists. Approximately half of the cases of eclampsia (severe convulsive seizures) occur in the postpartum period, in the first 28 days after birth. And more often eclampsia is diagnosed in women who gave birth at term.

With a period of less than 32 weeks and severe preeclampsia (severe preeclampsia), a woman is given a caesarean section. After 34 weeks, natural childbirth is possible if the baby does not show any health problems and is in the correct position in the uterus.
During childbirth, as a prevention of eclampsia, a woman receives epidural anesthesia, that is, she gives birth only with anesthesia, as well as drugs that reduce blood pressure.

Doctors are required to prevent prolonged labor and severe uterine bleeding after them. Therefore, a uterine contracting drug is used - "Oxytocin".

On the first day after childbirth, a woman suffering from severe preeclampsia is in the intensive care unit, where her condition is closely monitored by resuscitators. At this time, she receives anticonvulsant therapy in the form of "magnesia" familiar to many women. This drug not only relieves the tone of the uterus, but is also a good prophylactic against eclampsia. The condition of the woman is closely monitored. They take urine and blood samples from her, and often measure her blood pressure.

In the first days after childbirth, women physiologically increase the volume of circulating blood, and for those who suffer from preeclampsia, this is an additional risk factor for arterial hypertension. Depending on the level of blood pressure and the severity of preeclampsia, the puerperal is prescribed drugs for pressure. If possible, compatible with lactation. For example, Dopegit, Nifedipine. Treatment of postpartum preeclampsia continues after discharge from the hospital. The increase in pressure can last up to about two months, but normally the condition should gradually return to normal. Withdrawal of the drug occurs by slowly reducing the frequency of administration and dosage.

Edema after childbirth is a common occurrence. And not only in those suffering from gestosis. A sign of preeclampsia is considered a rapid increase in swelling of the hands and face. If the ankles are swollen - it's not so scary. It will pass within a few days or weeks. At the same time, breastfeeding women should not use diuretic (diuretic) drugs, as this will lead to a decrease in lactation - a lack of breast milk.

What to do if preeclampsia does not go away after childbirth

You need to know the symptoms that require urgent medical attention:

• headache;
• blurred vision, flies in the eyes;
• pain between the ribs or in the right hypochondrium (liver);
• infrequent urination;
• increase in pressure.

If the protein in the urine remains after 6-8 weeks after childbirth, a consultation with a urologist or nephrologist is required.
If there was eclampsia, it is necessary to do a CT scan of the brain. In addition, donate blood for antiphospholipid antibodies, lupus anticoagulant, undergo a test for thrombophilia.
Supervision at least of the gynecologist and the therapist is required.

Consequences of gestosis for the child and mother

The woman is explained that she is at risk for developing arterial hypertension, kidney and liver failure, and diabetes in the future. Preeclampsia after cesarean and childbirth can eventually turn into coronary heart disease, cause a stroke.

As for the new pregnancy, there is a risk of repeating the scenario of the previous one. For prevention, a woman is prescribed aspirin in small doses from 12 weeks of pregnancy until its end. Sometimes together with calcium preparations.

The interval between pregnancies should not be more than 10 years, as this is also a risk factor for the development of eclampsia when carrying a child.

Preeclampsia in pregnant women also has a negative effect on the child's body - after childbirth, preeclampsia in mothers disappears, but problems in the baby may remain. Most often, with the nervous system. Children whose mothers have suffered severe preeclampsia are almost always born small, with signs of intrauterine growth retardation and chronic hypoxia.

Preeclampsia (late toxicosis) is a set of symptoms that is characteristic only for pregnant women with a period of more than 24 weeks, but often occurs in the third trimester of pregnancy (from 28 weeks). The reasons are still not exactly clear. According to one theory, ethology is the hormones and substances that the placenta secretes. Once in the blood, they bind to the cells of the immune system, forming a complex that is aimed at damaging the vascular wall and promotes the release of excess fluid into the soft tissues (edema). After damage occurs, the response of the body and the vessels narrow, which causes a persistent and significant increase in blood pressure and a decrease in the volume of circulating blood in the vessels.

Risk groups and genetic predisposition

Predisposing factors in gestosis can serve as chronic diseases of the cardiovascular, endocrine and excretory systems. Do not forget about constant stress, which leads to overstrain; intoxication of the body of the expectant mother; allergic reactions.

Experts concluded that a certain category of women is at risk, namely:

• future mothers under the age of 18 and over 35;
• pregnant women who have suffered preeclampsia in the past;
• frequent abortions and childbirth in short intervals;
• bad habits of the mother and the people around her;
• multiple and first pregnancy, especially at a late or immature age.

First symptoms and correct diagnosis

In order to save the life of mother and child, a woman should pay attention to the smallest deviations in her body. Namely, in the third trimester, the appearance of edema is not always a reliable sign of preeclampsia, a symptom may indicate an exacerbation of a chronic disease. The right conclusion can only be made by a specialist who needs to be contacted immediately. Self-medication should not be engaged, the consequences are not reversible. If the edema was followed by a persistent increase in blood pressure, this is a clear sign of late toxicosis. For a diagnostic purpose, it is necessary to pass a clinical urine test, the appearance of a significant amount of protein in it indicates a violation of the vascular wall, and this means that the diagnosis of preeclampsia is correct. Additional studies should include clinical and biochemical blood tests, Doppler study, consultation of other specialists (neurologist, ophthalmologist, nephrologist, therapist).

Treatment and possible complications

After a reliable diagnosis, the doctor is obliged to put the patient in a hospital for detailed observation and additional research. If blood pressure exceeds the norm by 40%, and the protein is over 3.0 g / l, the general condition worsens, urgent hospitalization is indicated in the intensive care unit, where appropriate therapy is prescribed. Treatment consists in preventing the development of complications, this is taking sedatives, vitamins and minerals in the complex, reducing the intake of water (up to 1 liter) and salt, drugs that improve blood circulation, both for the pregnant woman and the fetus. The protein deficiency in the body, which came out through the vascular wall, is also filled. If we turn to traditional medicine, treatment is aimed at removing excess fluid from the body through diuretic infusions and decoctions, such as wild rose, chamomile and calendula decoction.

Bloody, brown and white discharge before period

If the symptoms do not progress and the condition is stable, they do not come to urgent obstetric care, but if the above therapy is ineffective, the only way out is surgery - caesarean section.

According to the vital indications of the fetus and mother, further management tactics are determined, therefore, if hypoxia of the body occurs, which leads to irreversible consequences, it is necessary to act quickly in order to avoid an undesirable outcome. But there are not always indications for physiological childbirth, then they resort to surgical interventions. According to many experts, the best treatment for this disease is timely delivery, after which improvement and stabilization of the condition can be expected.

Doctors always give preference to the natural passage of the child through the birth canal, and therefore they try to extend the therapeutic treatment until the appointed time (38-42 weeks). But it all depends on the severity of preeclampsia (mild, moderate, severe and eclampsia), which are classified from disruption of the organs and systems of the body. Childbirth is stressful for the child and mother with this pathology. Therefore, from the beginning of childbirth to their end, blood pressure figures should be monitored, since under the action of a painful stimulus, it can rise sharply and provoke eclampsia during childbirth, which in turn leads to impaired cerebral circulation. In this case, surgical intervention is indicated.

A caesarean section is a method of urgent delivery when there is a threat to the life of the fetus or woman in labor, as well as the impossibility of natural childbirth. One of the indications is the increase in multiple organ failure against the background of high blood pressure and vascular wall permeability. The method of the operation is as follows: under combined endocardial anesthesia, the uterus is opened and the newborn child is released. Assessing its vital functions, namely respiration and blood circulation, if necessary, resuscitation is carried out, then the tissues of the surgical field are sutured in layers. After completion of the operation, after 30-50 minutes, sedatives are administered endotracheally.

After the operation, the woman is sent to the intensive care unit or intensive care unit, observation and administration of drugs continues throughout the day. Then, within 48 hours after childbirth or surgery, they continue the necessary monitoring of the state of the vital functions of the woman who gave birth, since this period can be the most critical for the health of the mother. Unfortunately, there are a lot of complications after childbirth, some of them lead to death. Difficult childbirth is the basis for further observation of specialists.

Be sure to process the seams, examine the perineum. The introduction of drugs continues until the complete disappearance of edema, normalization and stabilization of blood pressure, the disappearance of protein in the urine. After a repeated detailed examination, the mother and child can be discharged from the hospital.

Postpartum hemorrhoids in a nursing mother: causes, diet, treatment

Against the background of gestosis, the course of the postpartum period and stress passes, but increases several times, therefore it requires additional treatment and correction of the complications that have arisen. It is on rehabilitation that the future life of the mother and the possibility of re-pregnancy depend. Symptoms of preeclampsia can last up to 2 months, but with adequate therapy and observation, there is nothing to fear. If in the first two days after childbirth there are no complications and deterioration of the condition, the crisis is stopped and the likelihood of exacerbation is minimal. After the transferred and timely untreated preeclampsia, complications are observed in the kidneys, constant swelling of the lower and upper extremities, a persistent rise in blood pressure and disturbances in the endocrine system - an imbalance of hormones.

The treatment of which is not always possible, because often doctors cannot determine any pathology, therefore there is no adequate therapy.

For a child born with such a diagnosis on time, the complications are minimal and often such children often get sick at an early age and do not lag behind their peers in development. But if complications, for some reason, led to oxygen starvation (hypoxia) of the fetus, the consequences are violations of physical and mental development.

If you are planning a second child after Gestosis in your first pregnancy, the approach must be very serious and require special preparation.

Preventive measures to prevent complications during pregnancy

Preventive measures should be started even before the conception of a child, since all environmental factors, ecology, bad habits and stress affect the female body unfavorably. Maintain a healthy lifestyle, prevent chronic diseases. All unexamined and latent infectious processes should be identified and, if possible, stopped. The reproductive function should be carried out from 18 to 35 years, because at an early age, female organs and systems are not formed and are not capable of bearing a child, and in the late period, on the contrary, they all decrease and cannot work adequately.

During pregnancy, questions arise about proper nutrition, which a pregnant woman must definitely observe, since her body gives all the reserve forces to build a new body. The diet should be enriched with trace elements and vitamins. Preference is given to the calcium element, because most of it is spent on building a new skeleton. Daily intake of fermented milk products will ensure a full intake and make up for the calcium deficiency in the body of the mother and the growing fetus. Vitamin E contributes to the nutrition of the placenta, which is important for the unborn child. With proper treatment, the symptoms of toxicosis disappear and the body of the mother and child functions normally.
Preventing all possible complications during pregnancy and after childbirth or Caesarean section, constant monitoring by an obstetrician-gynecologist and other related specialists is necessary. Timely detection of pathologies of organs and systems, as well as chronic diseases, can prevent possible complications. As for the environment and relatives of the expectant mother, they must also undergo examinations to detect a latent infection. If it was found in someone around, it should be eliminated if possible. That this person would not serve as a source of a chronic infectious process. Since the immunity of a pregnant woman is vulnerable and the addition of pathology is fraught with an effect on her well-being.

What to do with constipation after cesarean and what medications can be used

After complicated and physiological childbirth, constant monitoring is required, both for the mother and for the development of the child (especially if he was born out of time and prematurely). This is a prerequisite, because with the initial detection of a pathology, it is easier to treat than a complicated disease that will lead to significant disturbances in other systems.

Often during pregnancy, various pathological conditions occur. Gestosis is one of them. The disease at an early stage of pregnancy is called toxicosis. It is accompanied by intolerance to certain odors, nausea, vomiting, drowsiness and weakness, but does not pose a danger to the fetus and mother. Late preeclampsia can develop in the third trimester, during delivery or after. With this disease, vital organs are affected: the heart, blood vessels, liver and kidneys, as well as the placenta and fetus.

Reasons for the development of gestosis

Until now, doctors do not know the exact causes of gestosis. However, there is an opinion that the disease occurs against the background of high blood pressure, disorders in the liver and kidneys, and other somatic diseases in pregnant women. There are several theories explaining the formation of gestosis:

1. Endocrine - during pregnancy, the work of the heart and blood vessels is disturbed due to poor metabolism and insufficient blood supply to organs with nutrients. Such failures are the result of a change in the functioning of the endocrine system, which is responsible for the composition of the blood and vascular tone.
2. Cortico-visceral - explains the disease by the development of neurosis in a pregnant woman. The cerebral cortex, due to conditioned reflexes, affects the state of internal organs, and this upsets the balance of inhibition and excitation in it.
3. Placental - most likely, the uterine arteries, due to genetic and immunological characteristics, do not change their structure, as in the normal development of pregnancy, and the muscle layer is not transformed in them. As the fetus grows, vasospasm occurs, leading to a decrease in blood flow and the occurrence of hypoxia.
4. Immunological - there is an immunological discrepancy between the tissues of the fetus and mother. As a result, the female body does not accept a foreign body or there is an insufficient production of antibodies, which disrupts blood circulation and preeclampsia occurs after childbirth.
5. Genetic - the disease is often inherited. Studies have confirmed that fetal genes play a role in the development of preeclampsia.

With the disease, the work of the heart worsens, which means that blood circulation worsens, its coagulability increases. Organs and tissues are no longer supplied with enough oxygen and nutrition. The brain, liver, kidneys and placenta suffer most from lack of blood circulation. The fetus has oxygen starvation and its development is suspended, which gives rise to very serious consequences after preeclampsia.

Symptoms of preeclampsia

The disease can be asymptomatic for a long time. The clinical picture is characterized by special signs at each stage of the disease:

• Edema, or dropsy - swelling of soft tissues is observed in different places. There are four degrees: the first - the feet; the second is the legs and stomach; the third - lower and upper limbs, stomach, face; the fourth is the whole body.
• The appearance of protein in urine - there is a violation of the functioning of the kidneys, the daily rate of urine decreases. During the study, a protein is found in it, its rapid increase is a sign of the rapid progression of the disease.
• Increased blood pressure - failure of the kidneys and swelling cause an increase in pressure. In severe cases, high blood pressure leads to loss of consciousness, hemorrhages, and the occurrence of postpartum preeclampsia is also possible.
• Preeclampsia - headaches occur, vision deteriorates, inadequate reactions appear, irritability (or indifference sets in), the condition may be drowsy or, conversely, insomnia torments.
• Eclampsia is the most severe and dangerous stage of the disease, which can develop both before and after childbirth. The condition is accompanied by seizures, convulsions. During this period, the functions of all organs and systems of the body are disrupted: severe renal failure, liver rupture, pulmonary edema, stroke or heart attack, placental abruption, fetal hypoxia and premature birth are possible. Preeclampsia after childbirth can cause the death of the mother and child.

Who is at risk?

No one is safe from the disease of preeclampsia, but its manifestation is most likely in the following female category:

• women in labor under 18 and over 30;
• having given birth many times;
• with multiple pregnancy;
• having a short break between pregnancies, when the body is weakened, gestosis may occur in the child after birth;
• often interrupting pregnancy artificially;
• with hereditary predisposition;
• with diseases of the kidneys, liver, cardiovascular and endocrine systems.

The well-being of a woman bearing a child does not always indicate her health. The test results may show malfunctions in the body with external well-being. Experts strongly recommend regular visits to the gynecologist throughout pregnancy, so as not to miss serious complications.

Diagnosis of the disease

If gestosis is suspected, the doctor takes the following measures:

• History taking - during a conversation with a pregnant woman or a woman who has already given birth, the doctor listens to complaints, finds out all the ailments that the woman feels, specifies the time when the symptoms of the disease began, asks if close relatives had preeclampsia.
• Visual examination - it turns out if there is swelling on the legs and body, blood pressure is measured, the pulse is felt, the heart sounds of the mother and fetus are heard.
• A general analysis and biochemistry of blood is prescribed.
• Urine is being studied - a clinical, daily and biochemical analysis is taken.
• The fundus is checked.
• The pressure is constantly monitored.
• Body weight is determined.
• Ultrasound and dopplerometry of the fetus is done.

Additional consultations of a therapist, neurologist, nephrologist, ophthalmologist are prescribed. Based on the data obtained, a diagnosis is made, and a course of treatment for preeclampsia is prescribed after or before childbirth.

Development of the disease

According to the severity of the course and the severity of the manifestations, late preeclampsia is divided into three degrees:

• First, it is called dropsy. Light initial manifestations in the form of edema spread throughout the body. They significantly increase the body weight of a woman in position, and often remain after childbirth. Edema appears on the limbs, gradually spreading to the stomach and face. They progress rapidly, increasing in the evening, and are poorly corrected. Nephropathy joins dropsy. The kidneys stop functioning normally.
• The second - an increase in edema, the appearance of protein in urine, the further development of nephropathy, an increase in pressure are manifestations of severe preeclampsia. The body of a pregnant woman ceases to cope with stress and begins to malfunction.
• Third - all processes gradually progress and an extremely serious condition sets in. The nervous system is damaged, which threatens the life of the fetus and woman. A severe form of the disease is diagnosed according to the following signs: protein excretion in the urine of more than 1 g / l, a decrease in the daily volume of urine to 400 ml, pressure reaches 170/110 and above, severe swelling of the whole body, blood flow is disturbed, blood clotting and fetal development, increases activity of liver enzymes. Urgent resuscitation and the birth of a baby are required, often with the help of an operation. In this condition, the child may develop preeclampsia after cesarean.

Treatment of preeclampsia

The main areas of therapy include:

• childbirth;
• medical and protective regime;
• treatment of postpartum preeclampsia;
• restoration of the activity of internal organs.

For pharmacotherapy, the following medicines are used:

• tincture of "Valerian", "Motherwort", in severe conditions, antipsychotics and tranquilizers are indicated - "Droperidol", "Relanium".
• Medications to relieve pressure - Amlodipine, Atenolol, Hydralazine.
• Magnesium sulfate is used as an anticonvulsant drug.
• Intravenous infusions are carried out to replenish blood volume.
• Anticoagulants and antiplatelet agents - Fraxiparin, Curantil.
• Antioxidants - "Essentiale", vitamins E and C.

A mild degree of the disease is treated for no more than ten days, an average one - five, and a serious condition - six hours. If there is no effect, urgent delivery is prescribed, which is carried out naturally with a mild degree of the disease. The consequences of preeclampsia after childbirth in this case are minimal for both the fetus and the mother. In severe cases, a planned operation is prescribed. The occurrence of eclampsia and placental abruption requires emergency delivery by caesarean section. Further, pharmacotherapy lasts until the normal functioning of all body systems. The woman in labor is discharged from the hospital in one to two weeks.

Gestosis after childbirth

The disease during and after pregnancy is marked by three well-known symptoms: edema, protein in the urine, and increased blood pressure. Late toxicosis is always associated with pregnancy. It can be in the second trimester, and most often in the third. Gestoses are pathological changes during pregnancy associated with hormonal disruptions and various pathologies. The disease in a mild form, as a rule, has no consequences, and preeclampsia after childbirth disappears in the first two days. The onset of the disease at 24-28 weeks requires an emergency caesarean section to save the life of the baby and mother. If late toxicosis occurs at 30-32 weeks of gestation, the mother and baby suffer slightly.

A woman can give birth herself or by surgery. After 34 weeks, in the absence of health problems for the baby, childbirth can be natural. To prevent eclampsia, a woman is given drugs that reduce blood pressure and anesthetize childbirth. Doctors monitor the duration of labor and uterine bleeding, using the drug "Oxytocin", which promotes the woman is placed - under the supervision of resuscitators - in the intensive care unit. For the prevention of eclampsia, magnesium sulfate is prescribed and blood and urine are constantly taken for analysis, blood pressure readings are monitored.

How to treat preeclampsia after childbirth?

Therapy of preeclampsia continues at home. High blood pressure can be observed for up to two months, so a woman should systematically monitor it and take drugs to reduce it. During the period of breastfeeding, it is recommended to take Dopegit and Nifedipine. Over time, the pressure returns to normal. Cancellation of drugs should be done gradually, by reducing the dosage and frequency of administration. In addition to high blood pressure, edema appears in women after childbirth. First of all, they form at the ankles. Over time, they pass. Worse, if there is an increasing swelling of the hands and face - these are signs of preeclampsia. It is urgent to visit a doctor who will prescribe the necessary treatment for preeclampsia after childbirth. It should be noted that about half of the cases of severe convulsive seizures (eclampsia) occur in the first four weeks after childbirth. Often the disease occurs in women who gave birth at term. In this case, urgent medical attention is needed.

How is childbirth going?

The severity of the disease, the condition of the mother and child affect the method of choosing childbirth and the time of their delivery. The most favorable births are those that occur naturally. For them, it is necessary: ​​the absence of diseases in the mother, the correct diligence of the fetus and the proportions of the fetal head, pelvis, normal cervix, and the age of the woman in labor is not more than 30 years. Childbirth for a woman is a stressful condition, and with preeclampsia, women in labor are especially sensitive to pain, fatigue, so doctors use painkillers and antispasmodics. Otherwise, a sharp jump in pressure may occur at any time, which will lead to disruption of brain activity and the occurrence of eclampsia. The disease occurs both during natural childbirth and after surgery. In this case, the following complications are possible:

• fetal asphyxia;
• bleeding in the postpartum period;
• placental abruption.

Childbirth helps a woman get rid of preeclampsia. Sometimes, for a premature baby, the birth of a baby is the best option. Sometimes the birth of a baby before term gives him a better chance of surviving than staying in the womb. In this case, doctors decide on an early delivery, operative or natural.

What to do if the disease does not go away after childbirth?

Will late preeclampsia go away after childbirth? This question worries women who have been discharged from the hospital, and they have the following symptoms:

• visual impairment;
• pain in the right hypochondrium;
• high blood pressure;
• headache;
• infrequent urination.

In this case, you should immediately consult a doctor. After eclampsia, a gynecologist or therapist will prescribe a CT scan of the brain, blood biochemistry. If the protein content in the urine is up to two months after childbirth, you should seek advice from a urologist and nephrologist. Preeclampsia will pass, but serious complications may remain after it if the treatment and strict adherence to all the recommendations of doctors are neglected.

The consequences of the disease for women

The consequences of preeclampsia for the mother after childbirth can manifest itself in the following:

• renal and liver failure;
• headaches;
• hypertension;
• stroke development;
• visual impairment;
• brain damage;
• ischemia of the heart;
• severe postpartum bleeding.

With a new pregnancy, a repetition of the situation is possible.

Consequences for the child

The severe condition of the mother negatively affects the health of the baby. The most dangerous consequence is intrauterine fetal death due to nutritional deficiencies and lack of oxygen as a result of placental damage. But even after childbirth, the consequences of preeclampsia for the child are very serious. Children are very weak, have a small weight, often and for a long time get sick, lag behind in development and growth. Because of the illness of the mother, they are born prematurely, are not adapted to independent living, require special care and assistance in development. Health problems in a baby can remain for life.

Indications for preterm birth, regardless of the gestational age

These include:

• seizures and eclampsia;
• premature detachment of the placenta;
• rapid progression of the disease;
• retinal disinsertion;
• malfunction of the liver and kidneys.

Doctors try to conduct a quick and gentle birth using painkillers and sedatives. With preeclampsia after childbirth or caesarean section, the necessary treatment and careful monitoring of the state of health are prescribed for the woman and the baby. The treatment regimen is selected individually.

Caesarean section with gestosis

With a threat to life for the fetus or woman and the inability to give birth on their own, a caesarean section is used. This method is used for complicated gestosis, when the condition of the woman in labor begins to deteriorate rapidly, and the child experiences oxygen starvation. The operation is performed using endotracheal combined anesthesia. The uterus is opened and the baby is released if he has problems with breathing or circulation, and resuscitation is carried out. The woman is sutured and after the operation is transferred to the ICU (intensive care unit), where she is given sedatives for a day and is constantly monitored for pressure, edema, liver and kidney function. It is believed that the first two days with preeclampsia after cesarean are the most critical. During this period, severe complications can occur that threaten the health and life of the woman in labor. The child and mother are under the supervision of doctors until the full normalization of health. After examination and satisfactory condition, they are discharged from the hospital. When a child is born on time and there is no oxygen starvation, he will develop normally and keep up with his peers. Otherwise, various complications and disorders of mental and physical health are possible. Some symptoms last for two months, so the treatment of preeclampsia after cesarean continues at home under the supervision of a medical professional.

Complications

Late preeclampsia is dangerous with severe consequences that can begin both during pregnancy and after the birth of a child. The most common of them:

• stroke;
• placental abruption;
• insufficiency of respiratory activity;
• retinal detachment;
• eclampsia and coma;
• hemorrhagic shock;
• acute renal failure;
• oxygen starvation of the fetus can occur with preeclampsia after cesarean section.

More rare forms that complicate preeclampsia are:

• HELP-syndrome - red blood cells decay, the number of platelets decreases, which affect blood clotting, in addition, liver function is disrupted. The disease is transient. The woman has headaches and liver pain, jaundice, vomiting. She loses consciousness, convulsions are possible. There is a rupture of the liver, the abdominal cavity is filled with blood, the placenta exfoliates. The death of the fetus and mother occurs.
• Acute fatty hepatosis - often occurs during the first pregnancy. First, a woman is tormented by severe weakness, abdominal pain, nausea, weight loss, vomiting, itching of the skin. Subsequently, liver and kidney failure appears, jaundice develops, severe edema, uterine bleeding and fetal death occurs. A woman may have a coma and a malfunction in the brain.

About contraception

After suffering preeclampsia, a woman is advised not to become pregnant for at least two years, since time is needed for the body to recover. Young parents should remember that even breastfeeding does not provide a full guarantee of protection against pregnancy. Menstruation may well occur after childbirth in four weeks. But the cycle is still unstable, so it is not recommended to use the calendar method of contraception after severe preeclampsia. Hormonal tablets during lactation enter the milk, which is undesirable for a weakened baby. It turns out that barrier contraception in this case is the most optimal method. It must be remembered that until the bleeding stops, until the uterus is completely contracted, vaginal contraceptives should not be used. The ointment and fatty base of the funds can enter the uterus. Gynecologists recommend using a condom during this period.

Recovery period

Effective recovery after preeclampsia is influenced by proper nutrition, the help of relatives and friends, normal rest, and intimate hygiene. The main task of the recovery period is to eliminate the malfunction of the kidneys and water-salt metabolism. These reasons reduce the ability of patients to work and are considered contraindications for subsequent pregnancy. Recovery is carried out in stages, depending on the severity of preeclampsia:

The first one is galvanization, ultrasonic treatment, microwave therapy. Physiotherapy improves renal hemodynamics, enhance their excretory ability.

How to treat preeclampsia after childbirth with the second degree of severity? Drug therapy is carried out with the use of sedatives: tincture of "Valerian", "Motherwort", "Corvalol"; antihypertensive drugs: "Dibazol", "Papaverin", "Eufillin"; drugs with a diuretic effect: Triampur, Hypothiazid. To increase the absorption of drugs, collar galvanization is used.

The third - a complex of drugs used in the second degree of severity, is supplemented by the introduction of "Albumin" and "Rausedil".

Weakened by preeclampsia after childbirth, a woman's body is prone to various infections, so a woman needs to restore her immune system and return to normal life faster. Gynecologists advise:

• observe the hygiene of the genitals: wash yourself after using the toilet with clean hands from front to back;
• do not use sponges and washcloths;
• use baby soap for washing;
• use individual towels for the chest and perineum;
• use disposable pads;
• underwear should be made of simple fabrics, well breathable;
• it is recommended to sleep on the stomach to improve the outflow of secretions from the uterus;
• it is recommended to visit a gynecologist two weeks after discharge from the hospital;
• in the absence of spotting, you can return to intimate life.

Prevention of preeclampsia

It is impossible to cure preeclampsia, so measures must be taken to prevent it. To do this, you need to visit a gynecologist in a timely manner, measure blood pressure, monitor weight gain, and take tests. A pregnant woman needs to find time for daily walks in the fresh air. In food, eat more animal proteins, cottage cheese, vegetables, fruits, greens. With a predisposition to edema, drink herbal teas, cranberry juice. The diagnosis of "preeclampsia" obliges a woman to monitor her well-being with a vengeance. Experts advise women to give birth before the age of 35 to reduce the risk of complications.