What is preeclampsia in pregnant women. What is preeclampsia and how is it treated? Laboratory and instrumental examination and consultation with medical specialists

Classification, symptoms, causes and treatment of the disease

Reeclampsia is one of the serious diseases that can significantly harm the health of the child and mother. It often appears in pregnant women in the second and third trimester or in the postpartum period and is based on a strong increase in blood pressure, kidney damage and other health problems.

Recently, the incidence of preeclampsia has increased from approximately 7% to 20%. Most women fail to detect the disease until it actively develops.

Often a woman confuses the signs of preeclampsia with a difficult pregnancy. If you have any doubts, you should immediately consult a doctor. To reduce the risk of this condition, you should undergo diagnosis and prevention before pregnancy.

Risk factors

To protect yourself from the occurrence of preeclampsia, it is worth undergoing regular medical examinations, especially if you belong to those categories of women who are most at risk of developing the disease during pregnancy.

The listed factors do not have a clear impact on the possibility of developing preeclampsia, since each case is individual. But even if a pregnant woman is not at risk, the disease can manifest itself.

Main risk factors:

1. Childbirth for the first time (with concern before age 18, as well as after 35 years);
2. The appearance of preeclampsia earlier in the woman herself or her relatives (mother, grandmother, sister);
3. Multiple pregnancy (twins, triplets, etc.);
4. Obstetric complications (hydatidiform mole, fetal hydrops);
5. Diseases of the cardiovascular system (arterial hypertension);
6. Diabetes;
7. Obesity;
8. Kidney diseases (chronic pyelonephritis, polycystic kidney disease, etc.);
9. Autoimmune and allergic diseases (arthritis, asthma and various allergies).

Symptoms of the disease

If the disease is not treated on time, it can lead to serious consequences. Due to the fact that preeclampsia can be expressed in three conditions, the symptoms for each of them are different.

Mild preeclampsia is characterized by the following symptoms:

• increase in pressure to 160/90 mm Hg;
• mild swelling (feet, legs, hands);
• Moderate proteinuria (urinating with a lot of protein).

Medium form:

• increase in pressure to 170/110 mm Hg. Art.;
• kidney problems occur, urination becomes weaker;
• increased creatinine in the blood;
• spread of edema to the anterior abdominal wall, arms.

Severe degree of disease (most dangerous):

• increased pressure above 170/110 mm Hg;
• severe swelling (swelling of the face, arms and legs, stuffy nose, etc.);
• proteinuria;
• headache and heaviness in the temporal region;
• severe pain in the right hypochondrium;
• nausea, vomiting;
• decreased amount of urine;
• visual disturbances (flashes of light, blurred and blurred vision);
• decreased response or, conversely, overexcitation;
• rarely jaundice.

Pathogenesis of preeclampsia: how the disease progresses

Today, there are more than 30 causes and theories of preeclampsia. In some cases, this disease can cause severe cramps and lead to eclampsia.

Eclampsia is the most dangerous form of the disease, which occurs in the absence of proper treatment. Can lead to death of both the fetus and mother.

Vasospasm is important in the development of preeclampsia. The reason for this is a disruption in the production of hormones that are aimed at regulating vascular tone. In addition, the viscosity and coagulability of blood increases significantly.

Theories of pathogenesis:

1. Hormonal
2. Neurogenic
3. Immunological
4. Placental
5. Genetic

Neurogenic and hormonal theories explain the appearance of pathologies at the organ level. Genetic and immunological are aimed at the cellular and molecular level. However, the theories listed cannot exist alone: ​​they effectively complement each other, but are not mutually exclusive.

Classification

In the international classification of diseases (ICD 10), there are three states of preeclampsia: mild, moderate and severe.

1. Mild (moderate) degree:

   Increased blood pressure, proteinuria up to 1 g/l. In the analysis, the number of platelets increases significantly (from 180x109/l). A mild degree of preeclampsia is often asymptomatic, thereby preventing the pregnant woman from promptly learning about the developing disease. In this regard, throughout pregnancy it is worth visiting your doctor more often.

2. Average degree:

   A large amount of protein in the urine (about 5 g/l). Platelets increase from 150 to 180x109/l. Creatinine also increases from 100 to 300 µmol/l.

3. Severe preeclampsia is the most dangerous type:

   Protein in the urine becomes several times higher (from 5 g/l), the creatinine level exceeds 300 µmol/l. If treatment is ineffective at the last stage, the disease may develop into eclampsia.

Typically, preeclampsia occurs during pregnancy. However, there are cases when the disease appears after childbirth. It manifests itself as follows: blood pressure rises, migraines appear, headaches and pain in the upper abdomen, vision problems begin, etc. Another important factor is that there is rapid weight gain (up to 1 kg per week).

In most cases, symptoms during the postpartum period do not differ from the symptoms of preeclampsia during pregnancy. Having suffered such a disease, it is necessary to undergo a course of recovery. You shouldn’t hope that “everything will go away after giving birth.” Unfortunately, the risk of complications, especially in the first 2 weeks after birth, remains high. Therefore, further treatment is necessary in a hospital, and then on an outpatient basis under the supervision of the attending physician.

Preventing preeclampsia

To reduce or eliminate the risk of preeclampsia, you should take care of prevention in advance:

1. Preparing for pregnancy (examination by a doctor, diagnosis of existing diseases).
2. Effective treatment of identified diseases before pregnancy.
3. Mandatory registration of a woman at the nearest or selected antenatal clinic.
4. Regular visits to the gynecologist (at least once a month).
5. Follow all doctor's instructions (tests, studies, treatment).

Treatment of the disease

For patients with moderate type of preeclampsia, the doctor prescribes bed rest. A pregnant woman needs to spend as much time as possible lying on her back. In this position, uterine blood flow and cardiac output increase several times, and therefore the mother’s blood pressure begins to normalize.

The supine position helps improve uteroplacental function and has a positive effect on fetal growth and metabolism.

Hospitalization occurs only if the pregnant woman is unable to independently visit a doctor or maintain bed rest at home. However, if the condition worsens and mild preeclampsia develops into severe, patients need to immediately visit a doctor.

As for inpatient conditions, similar treatment is carried out, but normalization of the condition occurs much faster, since with proper monitoring there is less chance of complications.

One of the important indicators of stable vital activity during pregnancy is blood pressure. It is dangerous both, leading to tissue hypoxia due to a lack of oxygen and nutrients supplied to the fetus, and its increase, leading to serious and life-threatening consequences (edema, malfunction of the kidneys and heart muscles, brain tissue), which turn into a state of preeclampsia with possible eclampsia.

These complications significantly affect the condition of both the mother and the baby, and, naturally, without immediate intervention they threaten both with severe complications and even death. Therefore, with the development of alarming signs indicating possible preeclampsia or eclampsia, hospitalization is indicated, and if there are more pronounced and critical symptoms, resuscitation and the entire course of treatment to stabilize the condition, and if this is not possible, delivery according to emergency indications.

What is preeclampsia and eclampsia?

According to all medical canons, the condition of preeclampsia and eclampsia refers to serious pathological conditions that can arise exclusively in connection with pregnancy. These are not independent diseases, but pathological syndromes associated with damage to a group of internal organs of a pregnant woman, combined with varying degrees of severity of damage to the nervous system and brain, which forms convulsive readiness and severe manifestations of multiple organ failure.

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Since these problems are associated only with imbalances in the “mother-placental site-fetus” system, such a diagnosis cannot arise in principle among children, men or non-pregnant women - this is exclusively an obstetric pathology.

To date, the exact causes of such an anomaly and a single and clear mechanism for the development of preeclampsia and then eclampsia have not been clarified; in different countries of the world, a final decision has not yet been made as to which group of pathologies this syndrome should be classified as.

European countries, America and most WHO experts attribute manifestations of preeclampsia with eclampsia to gestation, that is, they are essentially severe degrees of this pathology. But in our country and some countries of the former Union they are traditionally classified as manifestations of gestosis - late toxicosis (complications) of pregnancy, which creates a certain confusion in terms, management and prevention tactics.

Let's take as a basis modern international data on the definition of the world's leading clinics and scientific institutes:

Preeclampsia usually occurs in the last months of gestation, forming high blood pressure numbers, sometimes reaching critical values. In addition, preeclampsia is characterized by the loss of proteins in the urine, as well as the formation, with the spread of edema throughout the body, the addition of painful headaches, leading to vomiting, and the occurrence of visual disturbances.

As preeclampsia develops, signs of renal damage form - nephropathy, and without adequate treatment, preeclampsia can threaten the development of eclampsia - a critical degree of impairment in which convulsive attacks are formed and coma is possible. This threatens the death of mother and baby during gestation, during labor or immediately after birth , especially if the woman was not observed in a hospital and did not receive full and adequate treatment.

The development of severe preeclampsia with the formation of eclampsia threatens to lead to serious disruptions in the functioning of the most important organs - the brain, respiratory system and lungs, excretory system and kidneys, as well as the liver and heart. If these were serious violations, the consequences of such a pregnancy with the development of preeclampsia may then remain for the rest of the woman’s life, and they will affect the health of both the mother herself and the child she gives birth to.

WHO experts say that the development of preeclampsia with its outcome in eclampsia can cause the death of up to 40-45% of all pregnant women and babies around the world. Most often, these complications are typical for the first pregnant woman and young women under 18 years of age, or older women in labor who are over 35 years old.

Preeclampsia: risk factors and exact causes

It is impossible to predict in advance the development of preeclampsia and predict which external or internal factors may provoke it. In the formation of such a complication, numerous external or internal influences may be important, which could be present before conception, or formed later, during gestation. But among them there are those that play leading roles in pathology:

• which was recorded before pregnancy
• Excess weight or clinically significant,

For the development of eclampsia, multiple pregnancies and the development of both the first and second types, the formation or presence, become predisposing already during pregnancy.

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Previous cases of preeclampsia in a previous pregnancy, or the formation of similar gestational complications in close first- and second-degree relatives - mothers, sisters, aunts or nieces - may increase the risk of developing pathology.

Why is preeclampsia dangerous during pregnancy?

The formation of preeclampsia, its progression from mild manifestations to severe and life-threatening ones, creates a condition that then develops a severe disorder of placental circulation. This threatens the birth of a child with organ malformations, severe malnutrition and numerous functional disorders of developing systems and organs. As a result, a situation is created in which children are less well adapted to their new living conditions; they have a slower pace of physical and neuropsychic development, are weakened and painful.

Preeclampsia is no less dangerous for the woman herself - it provokes, in which numerous complications develop, which threatens the birth of newborns with impaired vision or hearing, formed or. This is due to both nutritional deficiency and many other factors.

Doctors in hospitals and clinics often underestimate the danger of preeclampsia for the child and mother, which risks late consultation with a doctor and hospitalization in hospital for care.

A rather superficial attitude towards preeclampsia has been formed among doctors and patients due to the fact that outwardly its symptoms manifest themselves in the form of lesions of individual organs, which, it seems, can be completely corrected. Local doctors pay attention to increased blood pressure, as well as the manifestation of increasing amounts of protein in the urine in parallel with the development of edema, loss of protein in the urine, sometimes without predicting all possible internal processes. And they are quite serious, since all systems and organs in the body of a pregnant woman are closely interconnected.

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Symptoms of preeclampsia, which can be objectively recorded, are just the tip of the iceberg, a visible part of the processes that occur in the body during the formation of multiple organ failure syndrome (that is, almost all organs and tissues are involved).

Manifestations of preeclampsia, which appear externally, make it possible to establish a diagnosis of pathology, but often they do not indicate its nature in any way, and it seems that such a disorder arises almost out of nowhere, in a previously apparently healthy and strong woman. But in reality, such a complication is typical for women who have progressive arterial hypertension with a tendency to a crisis, and accordingly, as a stressful state and increased workload, pregnancy makes holes in the body.

Difficulties in interpreting preeclampsia

Many doctors caring for pregnancy may overestimate the presence of symptoms that are typical for preeclampsia. Thus, they can classify swelling in the area of ​​the arms and legs during gestation, which is quite acceptable as a physiological phenomenon of expectant mothers, as the beginning of pathology. But Only in the presence of edema, without all other symptoms, the diagnosis is not made. And besides this, there is no established clear connection between the phenomenon of arterial hypertension and the appearance of edema against it.

With high blood pressure during gestation, edema may occur, but is often absent; it is not a leading criterion for preeclampsia - it is possible against the background of normal and even low blood pressure. Therefore, they are assessed only as an auxiliary, not the main criterion.

It's a completely different matter - . This is precisely the real symptom of preeclampsia, but it may not appear from the very beginning of the pathology. In approximately 10% of pregnant women, preeclampsia occurs without increased urine protein; seizures may first occur, and only then does a change in protein in the urine appear, and its amount does not depend on the severity of seizures and condition; fluctuations from insignificant to very high volumes are acceptable.

Based on these data, experts came to the conclusion that during gestation against the background of developing preeclampsia, structural renal lesions should form - either sclerotic kidney damage should be revealed.

The appearance of such pathologies increases the likelihood of such a gestational complication.

The release of protein into the urine is preceded by many other problems and pathologies - changes in the blood plasma with creatinine, metabolic products that reflect the functioning of the kidneys. And it is also a known fact that in rare cases, preeclampsia can develop not only in the later stages of gestation, but is also possible in the first 20 weeks. Then the reason for its formation can be considered to be problems of the fertilized egg, this leads to the growth of chorionic villi, they swell and a serious and threatening condition of hydatidiform mole is formed.

Features of the course of preeclampsia: its types and variants

• There are several types of pathology, which have specific manifestations of morphological changes in the body of a pregnant woman: First type
• – formation of low pressure in the area of ​​the pulmonary artery orifice, leading to a decrease in cardiac output. However, the level of vascular resistance is high, which forms hypertension. Second type
• – a typical increase in all indicators, while the systemic increase in pressure is extremely pronounced. Third type
• – hypertension at the mouth of the pulmonary artery is normal, but cardiac output will be increased, and vascular resistance against this background is also high, this forms high blood pressure. Fourth type

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– an increase in the volume of circulating plasma, an increase in pressure in the area of ​​​​the vessels of the right heart and an increase in cardiac output, which ultimately leads to systemic hypertension.

With these variants of the course, there is no need for medications and other methods of correction, but it is important to constantly monitor the pregnant woman, limit her physical activity and strictly monitor her health status, often in confinement.

Eclampsia during gestation: what is it?

If we consider the term itself, it is derived from the Greek term “eclampsis”, which means outbreak, attack. This indicates the main manifestation of eclampsia in the form of muscle spasms throughout the body of the expectant mother with loss of consciousness.

It is extremely important for specialists observing pregnancy to predict eclampsia, since it usually occurs suddenly and seriously threatens the patient’s life. Determining a high risk of seizures is not easy; extensive experience is required. Over many years of research into this pathology and the work of obstetricians, several criteria have been identified that can classify women into different risk groups for eclampsia. During pregnancy, it is important to determine them as accurately as possible, and the role of the expectant mother herself is also important, as she can provide the doctor with important information.

Thus, in the formation of eclampsia, the leading role is given to negative hereditary factors, and eclampsia, unlike many other complications, can threaten during the first pregnancy.

If a woman's mother had eclampsia or its threat during childbirth or pregnancy, the probability of its development is up to 50% or higher. If siblings have it, the risks may exceed 60%.

In addition, multiple pregnancy and the presence of hypertension before conception are also included in the risk factors, and young age and pregnancy after 35-40 years also play a role. The presence of arterial hypertension during pregnancy and preeclampsia are the most threatening conditions during gestation, which can at any time lead to eclampsia, therefore these pregnant women are monitored under special supervision.

In its development, eclampsia has certain mechanisms and typical manifestations. Against this background, convulsive contractions develop in the respiratory muscles, leading to disruption of the ventilation functions of the bronchi and lungs, retraction of the tongue and a state of acute hypoxia of tissues with vital organs. This threatens to increase the permissible volumes of CO2 in tissues and red blood cells, which, when it exceeds certain concentrations, leads to stimulation of the glandular organs. As a result, saliva and bronchial mucus, stomach and intestinal juices are intensely released, but all this occurs against the background of loss of consciousness, which means that the cough reflex disappears, due to which, under normal conditions, excess mucus could be removed from the respiratory tract. The accumulation of saliva and mucus in the bronchi leads to a narrowing of the lumen of the respiratory tract, which disrupts the ventilation of the lungs even more, increasing the manifestations of hypoxia. If the accumulation of mucus leads to a complete blockage of the lumen of the bronchi, this threatens sudden changes in gas exchange and the accumulation of toxic concentrations of CO2 in the blood, which dramatically increases the chances of adverse outcomes for the mother and child. In high concentrations, this gas suppresses the activity of the respiratory center of the brain, which leads not to an increase, but to a slowdown in respiratory movements, disrupts the process of gas exchange in tissues and the removal of metabolic products, and threatens irreversible hypoxic damage to vital tissues and organs. In this situation, reflex irritation of the vasomotor center occurs with stimulation of receptors, which leads to spasm of small vessels and a reflex increase in pressure.

As eclampsia progresses, vascular spasm intensifies, which threatens the progression of eclampsia; excess blood enters the area of ​​large-diameter blood vessels. It leads to excessive stress on the pregnant woman’s myocardium. Such loads on the heart muscle under conditions of hypoxia with an excess of carbon dioxide are dangerous; they can also lead to pronounced and serious changes according to the data. High loads on the myocardium lead to an increase in the frequency of heart contractions, which creates a strong, and in addition to this, the cavities of the heart expand, which threatens to disrupt normal blood circulation inside the vessels, which again leads to increased hypoxia and accumulation of CO2 in the tissues. Due to disturbances in cardiac activity, such a phenomenon as is formed, the formation of which further worsens the prognosis.

Prolonged, severe attacks of eclampsia are possible, against the background of which hypoxia of an exorbitant level is formed, which leads to a sharp increase in the concentration of CO2 in the blood, which threatens a negative effect on the vasomotor center and peripheral arterioles. Circulatory failure occurs in the area of ​​both the central and main vessels and the peripheral area of ​​microcirculation: the blood flow of all organs and tissues, which tolerate hypoxia to varying degrees, suffers.

Most pregnant women who develop an attack of eclampsia have serious disorders in the functionality of the kidneys and liver, for which hypoxia is most significant and sensitive. Problems with their blood supply lead to a decrease in functionality, which leads to a breakdown of neutralizing functions with the accumulation of toxins and intermediate metabolic products in the tissues.

If kidney function is impaired, it is possible to restore their normal function only by increasing ventilation, but if the airways are blocked by viscous sputum and saliva, this is extremely difficult to do. In addition, the kidneys and liver can function adequately only in conditions of intact brain tissue. If the damage to the renal tissue is significant, this threatens, it forms an increase in seizures and an increase in cerebral edema.

Why is eclampsia especially dangerous for pregnant women?

In some cases, there are such variants of the course that even experienced resuscitators cannot stop an attack of eclampsia, which leads to intracerebral hemorrhages and paralysis of the respiratory center. The result of all this will be cardiac arrest in the diastole phase. Against the background of a serious condition, pulmonary edema forms, which threatens the formation of acidosis (respiratory and due to metabolic failures) - this is severe acidification of the blood due to intermediate metabolic products. In this condition, even against the background of resuscitation measures and full assistance, the death of the woman and fetus can occur within a period of several hours to two days from the onset of the attack.

If, as a result of such severe eclampsia, the mother survives, irreversible, disabling health consequences will remain for the rest of her life. These include paralysis and various kinds of autonomic disorders, severe headaches and memory loss, severe psychosis and epilepsy, and disruption of the functioning of all internal organs.

That is why it is important to manage pregnant women with any manifestations of gestosis; they always have a risk of eclampsia - this is a reason for maximum attention to her condition and hospitalization at the slightest deterioration of the condition.

Provocateur of seizures in eclampsia: hypertension

Often, arterial hypertension during gestation leads to the formation (or in other words, late toxicosis of pregnant women). Against the background of such conditions, dangerous complications that threaten the fetus and mother may develop:

• Premature placental abruption, bleeding, fetal death
• Miscarriage, premature labor with birth
• Delays in fetal development by weight and height
• Formation of eclampsia with the death of both.

In this regard, mommy needs to pay close attention to any ailments and seemingly trivial headaches if they develop against the background of increased blood pressure. It is important to immediately inform your doctor about this, and if you have high blood pressure, call an ambulance and be admitted to a hospital.

If problems develop in the area of ​​internal organs, this threatens to provoke convulsive attacks, which may not be related to circulatory disorders in the brain area.

Convulsions in pregnant women can occur in the form of single attacks, or in series that follow one after another, and in this case, doctors are talking about a serious complication - eclamptic status.

After an attack of convulsions occurs, the woman may completely lose consciousness, which subsequently leads to the development of a coma. It is also worth knowing that In the presence of eclampsia, loss of consciousness is possible even without the presence of convulsive attacks. The seizures themselves may not occur against the background of complete health; they have a number of special precursors that are important for the woman and her family to take into account.

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Convulsions are usually preceded by a severe and sharp headache, the formation of attacks and a sharp increase in blood pressure, against the background of which the pregnant woman can become very restless, followed by the convulsive attack itself, which can last up to two minutes.

A seizure in its course can also have several successive stages:

During pregnancy, the excitability of the nervous system is high, and to provide emergency care for such attacks, complete rest and resuscitation conditions are important, and then long and intensive treatment will follow, which will not end even after childbirth.

Treatment of preeclampsia and eclampsia in pregnant women

If a threat arises against the background of preeclampsia and eclampsia, this leads to the need for specific, sometimes long-term treatment only in a hospital and only in the intensive care unit.

Under the strict supervision of obstetricians and resuscitators, the woman is placed in a hospital before giving birth.

At a later date, if there is a real threat to the health and life of both, a decision is made to induce labor or emergency . If a woman exhibits signs indicating gestosis and preeclampsia - kidney damage, problems with the placenta, fetal hypoxia, protein in the urine, edema, pressure, this should be regarded as a special danger and a critical pathology requiring immediate treatment.

The first thing doctors do to reduce pressure and improve tissue nutrition is the introduction of magnesium, which relaxes the walls of blood vessels and reduces pressure; it also has diuretic properties. It is administered intravenously at a certain speed, which helps in preventing seizures, and then against the background of this, treatment with antihypertensive drugs and additional drugs is carried out. If no treatment helps in this condition, immediate delivery is necessary, otherwise it threatens to turn into convulsions and death of both the woman and her child.

Alena Paretskaya, pediatrician, medical columnist

Any doctor will tell you that during pregnancy, patients may experience a variety of conditions that would otherwise indicate serious illness. Preeclampsia in pregnant women stands apart here, the symptoms, causes and treatment of which doctors have yet to study. But even what is already known allows us to talk about some danger to the health of both mother and child. Blood pressure may rise and fall, swelling may appear, but you should not take this lightly - all this can lead to very sad consequences without proper treatment. So what is it?

Preeclampsia in pregnancy

In the process of bearing a child, a woman’s body experiences serious changes and overloads. It is not always possible to maintain health, which is why every expectant mother needs constant monitoring by doctors. Even so, she may end up with a condition called pregnancy preeclampsia. What it is?

It can be expressed in different ways, a woman may not even feel any discomfort and believe that her pregnancy is proceeding completely normally. Most doctors call this gestosis, using the term “preeclampsia” only in relation to a fairly acute condition characterized by a number of other symptoms. But it all starts with fairly harmless signs.

Causes

If doctors are absolutely clear about what preeclampsia in pregnant women is, then why it occurs is difficult to say. There are certain risk factors that can increase the likelihood of its occurrence, but they do not always work. And if a woman may encounter this phenomenon during her first pregnancy, then not in subsequent ones. Doctors tend to say that the cause is a high level of disruption of the proper functioning of the vascular system, as well as poor nutrition. But even eliminating all this, it cannot be guaranteed that such a problem will not arise.

By the way, preeclampsia can also occur immediately after childbirth, so there is a possibility that malfunctions in the hormonal or several systems at once are to blame. In any case, if you have ever experienced signs of preeclampsia during pregnancy, when planning your next one, you should consult with several specialists at once, including a hematologist, endocrinologist and, of course, an obstetrician-gynecologist.

Origin and course

A woman experiences a fairly large number of unpleasant symptoms, which should alert her even before serious preeclampsia in pregnant women begins. What it is?

Firstly, it is a rise in blood pressure to fairly high values. This may not be felt at all, especially if the expectant mother neglects regular visits to the doctor and does not measure this indicator herself.

Secondly, this is serious swelling, which is almost impossible to get rid of. A sharp weight gain and swelling by the end of the day - this can to some extent be considered as normal phenomena for pregnancy, which you can try to stop with a more balanced diet and the introduction of cranberry juice into the diet. But if such measures do not help, and the condition only worsens, combined with high blood pressure, it makes sense to talk about gestosis - the so-called toxicosis of the second half of pregnancy.

The third sign that mild preeclampsia may soon occur in pregnant women is the presence of protein in a urine test. This means that the kidneys are seriously affected; they simply cannot cope with the load and begin to fail. If the disease is further ignored, other, more dangerous signs of preeclampsia in pregnant women appear.

Symptoms

After the appearance of edema, which, by the way, may not be felt at all, but has a significant effect on the fetus, as well as protein in a urine test, other signs of progression of gestosis can appear quite quickly. There may be a decrease in diuresis and further fluid retention in the body. In this case, a woman may experience abdominal pain, dizziness, vomiting, and nausea. Reflexes may then change due to swelling of the brain.

You need to understand that timely consultation with a doctor will help you avoid all these troubles. Currently, treatment tactics have already been developed, and in extreme cases, maximum inhibition of the progression of the disease. It is often possible to significantly prolong pregnancy and sometimes even carry the child to term, having been safely delivered with the help of surgeons.

Degrees

Preeclampsia in pregnant women varies in severity and the need for urgent measures. Traditionally, there are three, and based on the blood pressure norm of 120/80, they look like this:

• Mild preeclampsia in pregnant women. Minor swelling may be observed, and the blood pressure value does not rise above 150/90. There are changes in the biochemical blood test; protein in the urine is no more than 1 gram per liter.
• Moderate preeclampsia in pregnancy. The pressure is at 170/110, resulting in a headache. The level of protein in urine is up to 5 grams per liter. The number of platelets changes and
• Severe preeclampsia in pregnant women. The indicators exceed the above figures. Additional symptoms appear and progress: abdominal pain, dizziness and lightheadedness, blurred vision.

The danger also lies in the fact that preeclampsia can progress very quickly. Therefore, even a single increase in pressure to sufficiently high values ​​can be a reason for an emergency visit to the doctor, and in severe cases, calling an ambulance. It is not necessary to remember the name “preeclampsia in pregnant women”; doctors will understand what it is themselves. You just need to remember that doctors simply won’t be able to help if they arrive too late.

Diagnostics

At each appointment with the gynecologist, blood pressure is measured and weighed. In addition, the urine is analyzed for the presence of protein. If there is a predisposition to the occurrence of preeclampsia in pregnant women, symptoms or suspicions, it makes sense to regularly carry out a number of additional tests.

Firstly, it allows you to detect the activity of liver enzymes and changes in their levels. Secondly, this is a blood test for hemostasis, that is, blood clotting. This test can identify problems such as blood clots. The third test, which helps monitor the condition of a pregnant woman, is blood testing for creatinine and urea levels. It allows you to evaluate kidney function.

As a rule, simpler and more visual tests are carried out in a hospital setting - for example, an analysis of daily protein loss or showing the functioning of the excretory system.

Treatment of preeclampsia

From the point of view of doctors, pregnant women have one serious drawback - most medications cannot be used for them. Of course, the arsenal of medications for maintaining a more or less stable state during preeclampsia is quite wide, but still they are not always effective, because each organism is unique in its reactions. What complicates the situation is that this condition can progress from about the twentieth week of pregnancy, and in this case there is practically no chance of independent pregnancy.

Combination therapy is usually used to reduce blood pressure and excess fluid in the body, as well as improve blood flow to the fetus. For the most part, timely treatment of preeclampsia in pregnant women allows one to get rid of problems for a period sufficient for a successful pregnancy. But in Russian practice, a woman suffering from hypertension will most likely not be allowed to give birth on her own for medical reasons, so in this case you need to psychologically prepare for a caesarean section.

Consequences for the mother

Eclampsia can occur if preeclampsia in pregnancy is ignored for a long time. What is it and how is this condition characterized? This is a very dangerous complication that can threaten not only the health, but also the life of a woman.

HELLP syndrome develops, that is, liver damage is observed, red blood cells are destroyed and the number of platelets decreases. Convulsions may begin, and even coma may occur. Sometimes there is death. However, the disease affects not only the mother.

Consequences for the fetus

The negative impact on the child begins even when blood pressure rises. The blood vessels narrow, blood flow in the placenta is disrupted, and the baby does not receive enough oxygen and nutrients. The fetus grows worse; abnormalities may be observed on CTG and during ultrasound. If preeclampsia begins early enough, low birth weight, bleeding disorders, and other problems may occur. So do not neglect medical help.

Preeclampsia in pregnancy is a condition that occurs only in pregnant women (usually after 20 weeks) or immediately after childbirth. This condition is also characterized by protein in the urine sample.

Most women who develop preeclampsia give birth to healthy children, but the condition can pose serious problems for the woman herself. Without treatment, this condition can cause kidney damage (particularly) and brain damage. It can also cause blood clots (thrombi) and serious problems with blood formation (thrombophilia).

In rare cases, preeclampsia can develop into a life-threatening condition called eclampsia. Eclampsia is characterized by seizures in a pregnant woman and can even lead to coma.

Symptoms of preeclampsia

Signs and symptoms of preeclampsia include:

• high blood pressure;
• presence of traces of protein in the urine;
• pain in the right upper abdomen;
• severe headaches;
• sudden weight gain (from 1 to 2.5 kg per week);
• vision problems (blurred, spots in the eyes, eye sensitivity to light);
• dizziness;
• swelling in the legs, arms and face.

Many of these symptoms are common during a normal pregnancy. But if you have blurred vision, a severe headache, or severe pain in the upper abdomen, call a doctor immediately!

Causes of preeclampsia

The exact reason why a woman developed this condition is almost impossible to establish. However, there are several risk factors that may make you more likely than other women to develop preeclampsia:

• if this is the first pregnancy;
• if you had preeclampsia in a previous pregnancy;
• if similar cases have already occurred in the family;
• if you had problems before or developed during pregnancy such as diabetes, kidney disease, gestational hypertension and other types of high blood pressure, blood clotting problems, lupus and other autoimmune disorders;
• if the pregnancy is multiple;
• if you are over 35 years old;
• if you are overweight or obese.

Pregnancy complications caused by preeclampsia

Pregnant women with preeclampsia often experience the following complications during pregnancy:

1. Premature birth. Even after treatment, you will likely have to give birth early to avoid serious problems with your own health and the health of your baby.

2. Complete or partial placental abruption. If the placenta separates from the uterus, the baby will not receive enough oxygen and nutrients. The most common symptom of abruption is uterine bleeding, so if you experience any vaginal bleeding, rush to the doctor immediately!

3. Insufficient baby weight at birth. This complication is caused by the fact that high pressure causes a narrowing of the blood vessels of the placenta and uterus, as a result of which the baby does not receive sufficient food and oxygen, which leads to a delay in its growth.

If you have preeclampsia, your healthcare provider can help you prevent most complications, but only if you follow the prenatal care guidelines completely!

Diagnosis and treatment of preeclampsia

At each visit to the gynecologist, you will undergo mandatory weighing, blood pressure measurement and urine testing. Thanks to these simple manipulations, the doctor will be able to monitor your condition and detect the first signs of preeclampsia in time!

The best “cure” for preeclampsia is, of course, having a baby. Drug treatment depends on the length of your pregnancy and the severity of preeclampsia. Even if you have mild preeclampsia, you still need treatment to prevent the condition from getting worse.

Let's look at how preeclampsia of varying severity is treated at different stages of pregnancy:

1. Mild pre-eclampsia up to 37 weeks - some women with this condition can stay at home, but some will have to stay in hospital. Your doctor will check your blood pressure regularly and routinely order urine tests to make sure your preeclampsia is not getting worse.

If the condition worsens, the doctor will most likely decide to induce labor - by administering oxytocin or amniotomy (opening the amniotic sac). Induction of labor in this case is the best way to prevent possible problems.

In addition to monitoring the woman, the doctor will monitor the child’s health using the following monitoring methods:

• Ultrasound examination - necessary to ensure that the baby's growth meets the norms for a particular gestational age. Ultrasound also allows you to examine the placenta and assess the amount of amniotic fluid to ensure that the pregnancy is progressing normally;
• non-stress test – monitoring the child’s pulse;
• biophysical profile - this study combines a non-stress test with ultrasound examination.

2. Mild preeclampsia at 37 weeks or more - most women at this stage do not have serious health problems and can safely wait until labor begins, but they definitely need careful monitoring from doctors!

3. Severe pre-eclampsia at 34 weeks or more - at this stage you will definitely need to be in the hospital, and if the condition worsens, you will immediately undergo induction of labor.

4. Severe preeclampsia up to 34 weeks - requires the woman to be constantly in the hospital for careful monitoring. The woman is given corticosteroids to speed up the development of the fetus's lungs. If the condition worsens, the woman is immediately induced to induce labor. Most babies born at this stage of pregnancy will require a stay in the intensive care unit (usually for 4 to 6 weeks).

5. Severe preeclampsia complicated by HELLP syndrome - this combination occurs in 2 out of 1000 pregnancies, and HELLP syndrome most often (20% of cases) develops in women with severe preeclampsia. If you develop HELLP syndrome, you will have to give birth early, no matter how many weeks pregnant you are, to prevent serious health problems.

Unfortunately, there is no way to prevent preeclampsia during pregnancy. But if you're overweight or obese, getting your weight under control before you get pregnant can significantly reduce your risk of developing preeclampsia!

Preeclampsia is a complicated degree of toxicosis that occurs in women during pregnancy in the second or third trimester. Characterized by a significant increase in blood pressure and the presence of protein in the urine. Almost every fourth pregnant woman shows signs of this disease. The risk group consists of young girls who are giving birth to their first child, and women over forty years old, provided that the first pregnancy occurs at this age.

Such a disease, depending on the general condition of the woman and the degree of manifestation of symptoms, has its own classification. Preeclampsia in pregnant women can sometimes be complicated by a disease such as, during which the same symptoms appear as during the first disease, only they are accompanied by severe convulsions, which can lead to the death of the woman and the newborn. Doctors note that out of two hundred pregnant women who express preeclampsia, only one will have eclampsia.

The main danger with such a disease is the placenta not performing its functions correctly. Such a disorder in work leads to the fact that the fetus does not receive enough oxygen and nutrients, which can cause improper development of the unborn baby.

It is important to know that after giving birth, all symptoms and signs of preeclampsia in a woman will go away over time. But, if medical assistance is not provided in time, the disease can lead to many complications and disastrous consequences.

Etiology

The causes of preeclampsia in pregnant women are not fully understood, but doctors agree that this disease has its own specific causes, including:

• age during pregnancy. Girls under 22 years of age who are giving birth for the first time and women over forty are more susceptible to this condition;
• internal pathological processes in the body that prevent the normal flow of blood into the uterus;
• poor nutrition and unhealthy lifestyle during pregnancy;
• hereditary factor. If a close relative of a pregnant woman also suffered from such a disease at one time, then the risk of preeclampsia increases;
• previous pregnancies - provided that the father of the children is the same man;
• bearing two, three or more fruits;
• compaction of the placenta;
• various kidney lesions;
• deviation from the norm in the amount of fluid around the fetus.

Varieties

Preeclampsia in pregnant women can be divided depending on the individual pathogenesis of the disease. This classification consists of several degrees:

• mild preeclampsia - pressure increases to 150 to 90, protein is not detected in the urine;
• moderate preeclampsia - pressure 170 over 110, the amount of protein in the urine is at least 5 grams per liter of fluid, swelling appears;
• severe preeclampsia - the pressure is the same as in moderate preeclampsia, the amount of protein in the urine is more than 5 grams, vision deteriorates, severe swelling.

In order to prevent the development of the second and third degrees of preeclampsia, it is necessary to diagnose the mildest degree in a timely manner. To do this, a woman during pregnancy must take monthly and. Severe preeclampsia poses a danger to the health of the woman and the life of the baby.

This classification is always used in medical practice; doctors can use it to determine whether to induce labor artificially or not, since this is what will allow, in some cases, to save the lives of both mother and baby.

Symptoms

In addition to the main symptoms of the disease - increased blood pressure and the presence of protein in the urine, preeclampsia can be expressed by the following symptoms:

• swelling of the arms, legs and face (of varying intensity), depending on the severity;
• weight gain, which is associated with stopping the removal of excess fluid from the body;
• decreased visual acuity;
• severe headaches;
• discomfort in the lower abdomen;
• intoxication of the body;
• fast fatiguability;
• increased irritability and apathy;
• decreased performance;
• inattention and forgetfulness;
• acquiring a yellowish tint to the skin (appears due to liver dysfunction).

If you provide a woman with proper help in time, then after childbirth all signs of the disease will disappear within a few weeks. But in the case when seizures are added to one or more of the above symptoms, this means that this disease has become complicated to the level of eclampsia and urgent treatment is needed in the hospital. If this is not done, after the next attack of convulsions, the woman may fall into a coma or die.

Complications

If you delay the treatment of preeclampsia, this can have a detrimental effect on the health of not only the mother, but also the newborn. The consequences of such a disorder for the mother:

• the appearance of eclampsia;
• increase in pressure to a critical level;
• premature birth;
• placental abruption;
• disruption of internal organs;
• internal bleeding;
• death.

Complications that threaten the baby:

• fetal underdevelopment;
• pathologies in the structure or functioning of certain organs;
• low body weight;
• consequences typical for a premature baby;
• stillbirth;
• death within a few days after birth.

In order to prevent such serious consequences from occurring, you need to consult a doctor in a timely manner so that he can diagnose and begin treatment for preeclampsia at an early stage, and, if necessary, immediately induce labor, after which the patient and her baby will feel better.

Diagnostics

Preeclampsia can only be diagnosed by a qualified specialist in a clinical setting. To do this, the doctor, first of all, collects a complete list of the patient’s complaints, finds out what symptoms caused discomfort and how long they lasted, determines the degree of the disease, according to the above classification, and finds out the possible causes. Conducts an examination to confirm swelling. In addition, the patient must undergo tests:

• blood - to study the composition and determine coagulability;
• urine collected per day to detect protein.

After this, you need to undergo examinations using ultrasound of the fetus and organs located in close proximity to the uterus. Consult an ophthalmologist.

Treatment

Treatment of preeclampsia depends on the pathogenesis of the disease. So, the mildest type is treated by observing rest in the clinic or at home, measuring the woman’s weight and blood pressure. You also need to monitor the composition of urine and the number of movements that the fetus performs. If this degree was diagnosed in the last stages, then the best method of therapy will be childbirth, after which the health of the new mother will become much better. If preeclampsia was detected in the sixth or seventh month, treatment will also be aimed at prolonging the pregnancy in order to avoid premature birth.

Second and third degrees of preeclampsia are treated only in a clinical setting, because there is a risk of complications. During the time spent in the hospital, right up to the birth, the patient is monitored around the clock by an anesthesiologist-resuscitator.

The main thing in the treatment of severe forms of preeclampsia is to normalize vital signs and reduce the intensity of signs of the disease. If a woman is less than thirty weeks pregnant at this time, but drug treatment does not help her, doctors are forced to artificially induce labor and perform a caesarean section - the life of the child cannot always be saved. Within up to two weeks after birth, all symptoms of preeclampsia should subside.

Prevention

Prevention of preeclampsia consists of:

• pregnancy planning;
• undergoing examinations and tests before planning the birth of children;
• treatment of diseases that can cause preeclampsia;
• monthly visits to doctors during pregnancy;
• avoiding highly salty and fatty foods;
• a balanced diet, including a large amount of vitamins and nutrients;
• constant monitoring of blood pressure;
• maintaining a healthy lifestyle not only during pregnancy, but also after childbirth.

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