What is the risk of developing preeclampsia is low. Causes and risk group

This is a severe variant of gestosis, which occurs after the 20th week of gestation, is characterized by multiple organ disorders with predominant damage to the central nervous system, and precedes eclampsia. Manifested by headaches, nausea, vomiting, visual disturbances, hyperreflexia, lethargy, drowsiness or insomnia. Diagnosed on the basis of 24-hour blood pressure monitoring, general urinalysis, coagulogram, and transcranial Doppler ultrasound. For treatment, infusion therapy, anticonvulsants, antihypertensives, anticoagulants, and membrane stabilizing agents are used. If the prescriptions are ineffective, an emergency caesarean section is indicated.

ICD-10

O14 Pregnancy-induced hypertension with significant proteinuria

General information

Preeclampsia often develops after the 28th week of gestation against the background of milder forms of gestosis. Preeclamptic condition is observed in 5% of pregnant women, women in labor and postpartum women. In 38-75% of patients it occurs in the prenatal period, in 13-36% - during childbirth, in 11-44% - after childbirth. In 62% of cases, preeclampsia precedes eclampsia, although, according to some authors, in other patients the disorder remains unrecognized due to the rapid development of convulsive syndrome. More often the disease occurs in predisposed women during their first teenage, late, multiple pregnancy, repeated gestation with a history of preeclampsia, the presence of obesity, extragenital pathology (chronic arterial hypertension, liver disease, kidney disease, collagenosis, diabetes mellitus, antiphospholipid syndrome).

Causes of preeclampsia

The etiology of the disorder, like other forms of gestosis, has not been definitively established to date. A likely factor contributing to the development of preeclampsia is considered to be a pathological reaction of the body of a predisposed woman to physiological changes during pregnancy. Specialists in the field of obstetrics have proposed more than 30 reasoned etiopathogenetic theories of the occurrence of the disease, the main of which are:

• Hereditary. The role of genetic factors in the development of preeclampsia is confirmed by its more frequent diagnosis in patients whose mothers suffered from gestosis. Affected individuals have defects in the 7q36-eNOS, 7q23-ACE, AT2Р1, and C677T genes. The mode of inheritance is presumably autosomal recessive.
• Immune. The penetration of foreign fetal antigens into the maternal bloodstream is accompanied by a response production of antibodies. The deposition of the resulting immune complexes in various tissues triggers complex protective mechanisms, which are manifested by activation of endothelial cells and acute endotheliosis.
• Placental. Some authors associate preeclampsia with impaired cytotrophoblast invasion. As a result, there is no transformation of the smooth muscle layer of the uterine arteries, which subsequently leads to their spasm, deterioration of intervillous blood flow, hypoxia and, as a consequence, damage to the endothelium.
• Corticovisceral. Proponents of the theory view preeclampsia as a neurotic hemodynamic disorder caused by a disruption in the relationship between the cortex and subcortical regions. This approach explains the provoking role of severe stress and is confirmed by functional changes in the EEG.

Since individual theories cannot fully explain all clinical manifestations of the disease, it is justified to consider gestosis as a polyetiological condition with common mechanisms of pathogenesis. The immediate causes of the development of preeclampsia are incorrectly selected therapy for hydrops of pregnancy and nephropathy, the patient’s failure to comply with medical recommendations, and high therapeutic resistance of milder variants of gestosis.

Pathogenesis

The key link in the mechanism of development of preeclampsia is the generalization of acute endotheliosis and vasoconstriction, initially localized in the placenta, with the involvement of brain tissue in the pathological process. Vascular dysfunction leads to damage to cell membranes, disruption of neuronal metabolism with the occurrence of hypersensitivity and increased excitability of nerve cells. Damage to suprasegmental subcortical structures is accompanied by multisystem autonomic disorders, detected in more than 90% of patients with severe forms of gestosis.

In parallel, pregnant and parturient women with preeclampsia develop pyramidal insufficiency, which indicates a disorder at the level of the cortical sections and is manifested by tendon-periosteal hyperreflexia, anisoreflexia, the emergence of pathological reflexes, and increased convulsive readiness. The brainstem regions are the last to be affected. Destructive processes caused by microcirculation disorders also occur in other organs - liver, kidneys, lung tissue. The situation is aggravated by coagulopathic disorders characteristic of gestosis.

Symptoms of preeclampsia

Usually the disorder occurs against the background of previous nephropathy. To existing edema, arterial hypertension, moderately expressed asthenovegetative symptoms (dizziness, weakness, insufficient sleep, meteotropism, emotional lability) are accompanied by signs of damage to the central nervous system and increased intracranial pressure. The patient complains of intense headache, heaviness in the back of the head, fatigue, looks lethargic, lethargic, indifferent, and sometimes answers out of place. There is increased drowsiness or insomnia, trembling of outstretched fingers, sweating of the palms and feet.

In 25% of women with clinical preeclampsia, visual disorders are detected - a feeling of blurred vision, flashing sparks or flies, fear of light, double vision, loss of certain fields of vision. Nausea, vomiting, and pain in the epigastrium and right hypochondrium may occur. In severe cases, muscle twitching, delirium, hallucinations, and a petechial rash occur, indicating a blood clotting disorder. The preeclamptic state is relatively short, lasting no more than 3-4 days, after which it is relieved by proper therapy or develops into eclampsia.

Complications

The most dangerous complication of preeclampsia is considered to be eclampsia - the most severe type of gestosis with high rates of maternal and perinatal mortality. 1-3% of patients experience vision loss (amaurosis) caused by edema, vascular changes, retinal detachment or ischemia of the occipital lobe of the cortex due to circulatory disorders in the posterior cerebral artery basin. It is possible to develop a hypertensive crisis, cerebral edema, stroke, HELLP syndrome, abruption of a normally located placenta, the occurrence of postpartum coagulopathic hemorrhage and DIC syndrome. Fetoplacental insufficiency usually worsens, and signs of intrauterine fetal hypoxia increase.

Women who have had preeclampsia are 4 times more likely to develop cardiovascular diseases in the future (hypertension, angina, heart attacks, strokes, congestive heart failure), and the risk of developing type 2 diabetes mellitus doubles. In a third of patients, gestosis is diagnosed in subsequent pregnancies.

Diagnostics

Timely diagnosis of preeclampsia usually does not present any particular difficulties if the pregnant woman has been under the supervision of an obstetrician-gynecologist for a long time for previous nephropathy. At the initial visit of a patient with characteristic complaints, an examination plan is recommended to identify specific markers of gestosis:

• Blood pressure control. Daily monitoring with automatic blood pressure measurement using a special device is shown. In patients with preeclampsia, blood pressure usually exceeds 180/110 mmHg. Art. with a pulse amplitude of more than 40 mm Hg. Art. The arterial hypertension index is 50% or higher.
• Assessment of the hemostasis system. Preeclampsia is characterized by consumption coagulopathy and activation of the fibrinolytic system. It is recommended to study the content of fibrinogen, its degradation products (RFMC), antithrombin III, endogenous heparin, evaluate APTT, prothrombin (MHO), thrombin time.
• General urine analysis. Proteinuria is considered an important sign of preeclampsia. The protein content in the urine exceeds 5 g/l, granular casts and leukocyturia may be detected. Hourly diuresis often decreases to 40 ml or less. To assess the severity of kidney damage, the daily amount of protein in the urine is determined.
• TCDG of cerebral vessels. Used for objective assessment of cerebral blood flow. Transcranial Doppler ultrasound confirms the presence of signs of increased cerebral perfusion pressure and decreased vascular resistance characteristic of preeclampsia.

Taking into account possible obstetric complications, the patient is shown ultrasound of the uterus and placenta, Dopplerography of uteroplacental blood flow, CTG, fetometry, and fetal phonocardiography. Differential diagnosis is carried out with diseases of the brain (thrombosis of the dural sinuses, meningitis, tumors, stroke), non-convulsive forms of epilepsy, retinal detachment. A pregnant woman is consulted by an anesthesiologist-resuscitator, therapist, neurologist, ophthalmologist, cardiologist, nephrologist.

Treatment of preeclampsia

The patient is urgently hospitalized in the intensive care unit of the nearest hospital with a delivery room. The main therapeutic goal is to reduce reflex and central hyperreactivity, prevent seizures, stabilize vital functions, and correct multiple organ disorders. A pregnant woman with preeclampsia is prescribed a strict medical and protective regimen. The treatment regimen includes the following groups of drugs:

• Anticonvulsants. The “gold standard” is the administration of magnesium sulfate through an infusion pump. The drug has a sedative, anticonvulsant, antispasmodic, hypotensive effect, and effectively reduces intracranial pressure. Simultaneously with the improvement of cerebral hemodynamics, the myometrium relaxes and increases the intensity of blood flow in the uterus. If necessary, tranquilizers are additionally used.
• Antihypertensive drugs. Imidazoline derivatives are preferred, which have a central α2-adrenomimetic effect, stimulate I1-imadazoline receptors in the nucleus of the solitary tract and thereby enhance the parasympathetic effect on the myocardium. Parenteral administration of peripheral vasodilators, hybrid β- and α1-blockers with a rapid antihypertensive effect is possible.
• Infusion formulations. To normalize oncotic and osmotic pressure, colloidal, protein, and balanced crystalloid solutions are administered intravenously. Infusion therapy can improve the rheological properties of blood, central and peripheral hemodynamics, tissue perfusion, reduce the severity of multiple organ disorders, and restore water and electrolyte balance.

According to indications, sedatives, direct anticoagulants, antioxidants, membrane stabilizers, and drugs to improve blood flow in tissues and prevent fetal respiratory distress syndrome are used. If intensive care is ineffective within 24 hours of hospitalization, emergency delivery by cesarean section is recommended. For patients with rapidly increasing symptoms of preeclampsia, surgery is performed within 2-4 hours. Natural childbirth with high-quality anesthesia (long-term epidural anesthesia), perineotomy or episiotomy is possible only with a significant improvement in the patient’s well-being, stable stabilization of blood pressure, and laboratory parameters.

Prognosis and prevention

Gestational outcome in pregnant women with symptoms of preeclampsia depends on availability medical care and the correct choice of tactics. In any case, the prognosis for the mother and fetus is considered serious. Maternal mortality rate in last years managed to reduce to 0.07 per 1000 births, perinatal mortality ranges from 21 to 146 per 1000 observations. Preventing preeclampsia involves regular check-ups antenatal clinic, monitoring of pressure and laboratory parameters in patients with hydrops of pregnancy, nephropathies, careful implementation of all medical prescriptions, normalization of sleep and rest, psycho-emotional peace, control of weight gain, protein-enriched diet with low salt content.

One of the main causes of maternal and child mortality is preeclampsia in pregnant women. This is a serious complication in pregnant women, occurring in women against the background of a significant increase in blood pressure. Poor circulation has a detrimental effect on the mother’s brain and the condition of the fetus.

Causes and course

Eclampsia and preeclampsia do not have clearly defined causes. One of the theories for the occurrence of toxicosis during pregnancy is adaptogenic. According to her, a woman’s body fails to reconfigure and accept the changes associated with the development of another life in her. Superficial implantation of the placenta can also cause the development of toxicosis. With insufficient oxygenation, hypoxia occurs, to which the woman’s immune system reacts, trying to reject the “wrong” tissues of the developing embryo. Whatever the reason for the development of the pathological condition, its course always poses a danger to the mother and child. Risk factors have been identified based on clinical studies and observations. Among them are:

• the woman's age is less than 15 and more than 35 years;
• history of abortion;
• endocrine diseases;
• problems with excess weight;
• chronic infectious and inflammatory diseases.

Splash on hormonal level When pregnancy occurs, it provokes an exacerbation of existing diseases and changes in the vascular system. Transformation of the vascular membranes leads to a decrease in their functionality, the appearance of lesions in the kidneys, brain and liver, and pinpoint hemorrhages. Persistent hypertension and multiple organ deficiency develop.

The risk of developing preeclampsia increases several times with a hereditary predisposition, unhealthy lifestyle and multiple pregnancies.

Degrees of preeclampsia

The severity of the condition is classified based on the severity of the main three symptoms: high blood pressure, edema and proteinuria. In practice, obstetricians-gynecologists use two scales that determine the complexity of the disease: Wittlinger and Savelyeva. According to the first of them, the following signs of preeclampsia are determined: the level of deviation in blood pressure, weight, diuresis, the presence of protein, edema and general complaints from the pregnant woman are assessed. The second scale additionally determines the period of onset of gestosis, the level of fetal developmental delay and the presence of underlying diseases. The severity of indicators is assessed in points, based on the sum of which a conclusion is made about the severity of preeclampsia. The table provides this information in detail:

Symptoms of different degrees of toxicosis

Preeclampsia is characterized by a triad of classic symptoms, the severity of which depends on the severity of the condition. Thus, with a mild degree, blood pressure rises to 150/90, urine protein is less than 1 g/l, and swelling is minimal and localized in the ankle area. Moderate preeclampsia is diagnosed when blood pressure rises to 170/100, edema spreads to the anterior abdominal wall and proteinuria up to 3 grams/liter. In the severe form, when the body becomes convulsive, blood pressure exceeds the threshold of 180/110, and generalized edema of the entire body and face is expressed. Other symptoms of preeclampsia include:

• increased heart rate;
• low diuresis up to 400 ml per day;
• fetal hypoxia;
• headaches and dizziness;
• noise in ears;
• visual impairment;
• nausea and vomiting;
• yellowness of the skin and sclera.

Diagnostics

Regular measurement of blood pressure, urine testing, determination of edema and weight gain allows you to respond in time to the onset of preeclampsia. If there is a suspicion of the development of pathology, the patient must be hospitalized in a hospital and monitored around the clock. It is recommended to monitor blood pressure every 2 hours, the level of daily diuresis, and the rate of increase in edema. For differential diagnosis of the disease, MRI, CT, ultrasound of the uterus, detailed and biochemical blood tests are indicated. To early identify the risk of developing pathology, screening is performed to determine placental growth factor. Based on its data, attempts can be made to prevent the progression of pathology.

Early diagnosis of gestosis begins with the woman’s vigilance and her regular visits to the woman’s doctor.

What is the treatment?

Treating toxicosis with medication is not effective. The only solution for severe preeclampsia is delivery. The earlier the pathology appears, the more difficult its course and treatment. Progressive gestosis early pregnancy requires its interruption. With moderate late-onset preeclampsia, they try to maintain the pregnancy at least until the 37th week. To do this, measures are taken aimed at reducing peripheral vascular resistance, reducing edema, restoring blood pressure levels and kidney function. Medicines are not effective for treating this condition. You can relieve symptoms and lower blood pressure by administering magnesium sulfate, anticonvulsants and sedatives. Bed rest is advisable.

Complications of gestosis

Severe preeclampsia is dangerous for the mother and her baby. Impaired blood supply to the placenta leads to hypoxia, developmental delay and intrauterine fetal death. As for the mother, the following frequent consequences can be noted:

• increased intracranial pressure;
• swelling of the brain and lungs;
• respiratory and heart failure;
• visual impairment and blindness;
• cerebral hemorrhage;
• placental abruption;
• attack of eclampsia.

Severe preeclampsia can result in a seizure, which can be triggered by the slightest irritant. The result can be coma and death of the woman. Another consequence of preeclampsia is HELP syndrome, accompanied by hemolysis, increased activity of liver enzymes and thrombopenia. Its diagnosis before birth requires early delivery, and after birth - blood transfusion.

Preeclampsia is a condition that occurs in pregnant women and is characterized by increased blood pressure and the presence of protein in the urine. In most cases, preeclampsia appears in the second half of pregnancy, closer to the third trimester. Therefore, preeclampsia is classified as a late toxicosis of pregnancy. In exceptional cases, preeclampsia may manifest for more than early stages.

After preeclampsia comes the most severe form of late toxicosis () - eclampsia. Eclampsia is accompanied by convulsions and loss of consciousness. Convulsions begin suddenly and cover the entire body. The danger is that eclampsia can cause coma and even death of both the mother and her mother. born child. Eclampsia can develop before, during, and after childbirth.

Causes of preeclampsia in pregnant women

Despite the fact that eclampsia was described in ancient medical treatises, what exactly causes it is not known. In the same way, it is quite difficult to say what exactly led to the development of preeclampsia that preceded it, since exact reason This condition has also not been completely established. Some experts cite insufficient and unsatisfactory nutrition, high levels of fat in the female body, or insufficient blood flow in the uterus among the causes of preeclampsia.

Main features

Signs of preeclampsia include:

• main: protein in urine, arterial hypertension;
• additional: rapid weight gain, dizziness, severe headaches, severe nausea and vomiting, abdominal pain, changes in reflexes, decreased urine volume, visual disturbances, pain in the epigastric region.

But don’t be scared when reading these lines, since edema during pregnancy does not at all mean the presence of preeclampsia. Pregnancy is characterized by some swelling. But, if swelling remains even after a long rest and is also combined with the described symptoms and is accompanied by high blood pressure, this is an alarm bell.

Who is likely to develop preeclampsia?

Women at risk for developing preeclampsia include:

• pregnant for the first time;
• those who became pregnant at a very young age (under 16 years old) or over 40 years old;
• with the presence of arterial hypertension even before pregnancy;
• with severe obesity;
• with diseases: diabetes mellitus, lupus erythematosus, rheumatoid arthritis;
• with kidney diseases;
• during multiple pregnancy;
• who have had cases of preeclampsia in previous pregnancies;
• whose mother or sister also had cases of preeclampsia.

Does preeclampsia in pregnancy pose a risk to the baby in the womb?

Unfortunately yes. With preeclampsia, placental blood flow is disrupted, which leads to the birth of an underdeveloped baby. Moreover, pregnancy complicated by preeclampsia in most cases ends in premature birth. There is also a high risk of having a baby with various pathologies. For example, epilepsy, cerebral palsy, visual and hearing impairment.

How to treat preeclampsia in pregnant women?

There is no specific treatment for preeclampsia. But, due to the threat of this condition turning into eclampsia, the pregnant woman needs urgent hospitalization. In a hospital, a woman may be prescribed magnesium sulfate (magnesium sulfate) in order to prevent seizures and lower blood pressure. It has been established that the use of magnesium sulfate halves the risk of developing eclampsia in women with symptoms of preeclampsia. To lower blood pressure, you can use hydralazine or similar drugs. It is also possible to prescribe drugs with anticonvulsant and sedative effects. During this period, the pregnant woman’s fluid intake and the volume of urine excreted are especially carefully monitored. It is also recommended that a pregnant woman get as much rest as possible. During rest, you need to be either lying on your left side or sitting upright.

Women with mild preeclampsia need gentle care and significant limitation of activity.

If there is a risk premature birth, doctors will do everything possible to prolong the pregnancy and ensure that the born baby survives. If the pregnancy is already approaching the expected date of birth, labor is induced artificially. In the case of a very severe form of preeclampsia, immediate delivery is carried out, despite the stage of pregnancy, since the slightest delay in this case is fraught with death.

Fortunately, not every case of preeclampsia ends badly. If you believe the statistics, today there is only one out of two hundred cases, which turns out to be tragic.

Prevention of occurrence

There is no 100% reliable way to prevent preeclampsia in pregnant women. However, in order to prevent its development, doctors advise that during the period of bearing a baby (especially if the woman is at risk) to be as attentive as possible to your body: rest more, not overexert yourself, eat right and undergo medical examinations on time. It is necessary to regularly take all tests, even such seemingly simple ones as blood and urine tests. Constant monitoring of the level of protein in the urine, as well as blood pressure, will help determine preeclampsia for its early stages. And this, in turn, will ensure the most favorable outcome.

Especially for Olga Rizak

Every woman who is expecting a child would like to have fewer problems with her health during this wonderful period. But a normal (physiological) pregnancy, in which a woman has no difficulties in carrying a baby, accounts for only about 35%. And in other cases, pregnant women experience certain complications during this period. And one such condition that is dangerous to the health and even the life of a pregnant woman and her fetus is preeclampsia (preeclampsia).

Why not gestosis

Nowadays, modern doctors in their work make maximum use of the principles of evidence and reliability in examination methods, treatment and their formulations. In 2013 in the USA, after extensive scientific work on the study of preeclampsia and its complications, it was recommended to apply new methods and criteria for diagnosis, treatment and prevention of this condition in practice. The obstetrics and gynecology community around the world supported these changes. Therefore, in 2016, clinical recommendations (treatment protocols) “Hypertensive disorders during pregnancy, childbirth and the postpartum period” were proposed for Russian obstetricians-gynecologists, anesthesiologists and therapists. Preeclampsia. Eclampsia". And all the terminology, methods and approaches to diagnosis, treatment, and prevention of complications of gestosis that were previously used were replaced with new ones. Therefore, from now on, according to the latest classification, the term gestosis is not used in medical documentation and literature, but is replaced by the concept of preeclampsia.

What is preeclampsia

To begin with, let’s determine that preeclampsia, as gestosis was previously called, is not an independent disease, but a pathological condition that is classified as a hypertensive disorder, that is, disturbances in a woman’s well-being against the background of high blood pressure. Preeclampsia develops in pregnant women after the 20th week and is always accompanied by an increase in blood pressure, which is combined with a high protein content in urine analysis (0.3 g/l in daily urine), often, swelling and disturbances in the functioning of organs and systems in the woman’s body (multiple organ failure).

Some statistics indicate the seriousness of the problem:

Classification of preeclampsia and evaluation criteria

According to the international classification of diseases (ICD-10) there are:

• moderately severe preeclampsia;
• severe preeclampsia.

To determine the degree of development of pathological symptoms, severity assessment criteria are used.

Criteria for assessing preeclampsia:

Causes and mechanisms of its occurrence

Preeclampsia is caused by:

• initial disturbances of hemostasis, i.e. disturbances of processes in the pregnant woman’s body that preserve blood in the bloodstream, prevent vascular bleeding, help restore blood flow when blood vessels are blocked by blood clots, against the background of:
  • genetic predisposition;
  • hormonal disorders;
  • various diseases internal organs that are not gynecological diseases and obstetric complications;
  • infections;
• at 12–16 weeks of pregnancy, the muscular layer of the spiral arteries of the uterus does not soften, the vessels of the placenta cannot be embedded in them, which causes insufficiency of its blood supply (placental ischemia), and as a result, the unborn child does not receive enough oxygen and nutrients (fetal hypoxia, delayed fetal development) ;
• in the body of a pregnant woman, processes are activated that contribute to the formation of blood clots in the vessels, and this changes the blood supply to tissues and organs (endothelial dysfunction), first locally, then systemically (the functioning of organs and systems is disrupted).

Mechanisms of development of preeclampsia

The formation of preeclampsia is based on vascular spasm as a result of high blood pressure.
Stages:

• the regulation of vascular tone is disrupted, which leads to spasm of blood vessels throughout the body - generalized spasm;
• the permeability of the vascular wall increases and sodium salts, proteins, and liquid come out of the blood into the tissues - edema forms;
• the volume of circulating blood inside the vessels decreases;
• this leads to changes in the properties of the blood: viscosity increases, formed elements (mainly red blood cells) stick together - the blood thickens;
• As a result, metabolic processes and oxygen saturation of cells in organs and tissues are disrupted, this entails their damage to such an extent that they are subsequently unable to maintain the vital functions of the body, and multiple organ failure develops.

What happens to a woman’s body and the unborn child with preeclampsia

In a pregnant woman, the functioning of all vital organs and systems is disrupted.

Symptoms of multiple organ failure

Dangerous consequences of preeclampsia

Severe complications of preeclampsia in pregnant women

• HELLP syndrome, hematoma or liver rupture.
• Acute renal failure.
• Pulmonary edema.
• Stroke.
• Myocardial infarction.
• Hemorrhage and retinal detachment.
• Placental abruption.
• Antenatal fetal death.

Danger of eclampsia

Eclampsia is attacks of individual seizures or a series of seizures. A convulsive state develops against the background of preeclampsia in the absence of other causes. This threatens the life of not only the expectant mother, but also her fetus. Eclampsia occurs at any degree of preeclampsia, and not just at its critical form. It can develop during pregnancy, during childbirth, and after childbirth for 4 weeks.

Precursor symptoms that precede the development of eclampsia:

• headache intensifies, dizziness and general weakness appear;
• vision is impaired - “flickering of flies”, “scorching and fog” before the eyes, loss of vision is even possible;
• severe pain in the stomach and right hypochondrium;
• girdle pain (due to hemorrhage in the roots of the spinal cord);
• twitching of muscles throughout the body (clonic contractions);
• pupil dilation.

If help is not provided, convulsions appear, the pregnant woman loses consciousness, and falls into a coma.

Typical clinical picture of a convulsive state:

• Preconvulsive period (20–30 sec) - facial muscles twitch, consciousness switches off, and a frozen gaze appears.
• Tonic convulsions (10–20 sec) – they begin from the muscles of the head, neck, arms, and spread to the muscles of the torso and legs. Breathing stops. The head is thrown back, the spine is arched. Pulse is difficult to determine. Blueness appears skin(cyanosis). Possible cerebral hemorrhage and death.
• Clonic convulsions (0.5–2 min) - spastic contractions and relaxations of all muscle groups occur (twitching).
• Result: resolution of the seizure or coma.

Clinical forms of eclampsia:

• isolated attacks;
• a series of convulsive seizures (eclamptic status);
• coma.

There is “eclampsia without eclampsia,” that is, a pregnant woman suddenly loses consciousness without an attack of convulsions and falls into a coma.
The extreme manifestation of eclampsia is coma

What is HELLP syndrome

HELLP syndrome is a deadly complication that develops in 4–12% of pregnant women with severe preeclampsia. With this syndrome, serious blood clotting disorders, necrosis and rupture of the liver, and intracerebral hemorrhage occur.

The diagnosis is made based on the following criteria:

• H (hemolisis) – hemolysis - pathological destruction of red blood cells and the release of free hemoglobin into the blood serum and urine (increase in LDH, bilirubin).
• EL (elevated liver enzymes) - increased levels of liver enzymes (ALAT, AST).
• LP (low platelet count) - low platelet count.

HELLP syndrome manifests itself:

• pain in the stomach on the right, nausea, vomiting with blood;
• headache;
• jaundice;
• hemorrhages in the skin;
• an increase in diastolic (lower) blood pressure above 110 mm Hg. Art.;
• arterial hypertension;
• swelling;
• high protein content in urine.

HELLP syndrome is complicated by:

• liver failure;
• eclampsia (convulsions);
• coma;
• liver rupture;
• massive swelling;
• edema of the brain, lungs;
• intracerebral hemorrhage;
• ischemic stroke;
• premature detachment of a normally located placenta.

As soon as minimal signs of this syndrome are identified, the pregnant woman is urgently given delivery and intensive care.
Pregnant women with HELLP syndrome are observed only in intensive care and intensive care units

How to suspect preeclampsia

The diagnosis of preeclampsia is made by an obstetrician-gynecologist.

Risk factors for preeclampsia

Tests have not yet been created that detect pre-eclampsia in the early stages of pregnancy and make it possible to minimize the development of its complications. Therefore, all women, already at the stage of planning to conceive a child, should undergo an assessment of risk factors.

Women are at high risk of developing preeclampsia if:

• preeclampsia was present in at least one of the previous pregnancies;
• have chronic kidney disease;
• autoimmune diseases: systemic lupus erythematosus, antiphospholipid syndrome;
• hereditary thrombophilia;
• diabetes mellitus type 1 or 2;
• chronic hypertension.

You are less likely to develop preeclampsia if:

• first pregnancy;
• the interval between pregnancies is more than 10 years;
• assisted reproductive technologies (IVF) are used;
• family history of cardiovascular disease and preeclampsia (grandmother, mother or sister);
• excessive weight gain during pregnancy;
• body mass index 35 or more at the first visit (obesity 1 or 2 degrees);
• infections during pregnancy;
• multiple pregnancies;
• age 40 years or more;
• Ethnicity: Scandinavian, African, South Asian or Pacific Islander;
• systolic blood pressure more than 130 mm Hg. Art. or diastolic blood pressure more than 80 mm Hg. Art.;
• increased levels of triglycerides (fats) before pregnancy;
• low socioeconomic status;
• drug use: cocaine, methamphetamine.

Examination of pregnant women for the diagnosis of preeclampsia

To identify the possible development of preeclampsia, all women must have their blood pressure measured from the first visit to the doctor and then at each visit.

If the numbers of these measurements exceed normal values, and there were no problems with hypertension before, the pregnant woman is at risk and under the close supervision of an obstetrician-gynecologist. Women who already had arterial hypertension fall into this group from the first visit to the doctor. Increases in blood pressure are monitored especially closely after the 20th week of pregnancy.

The following are taken as normal blood pressure:

• systolic blood pressure - less than 140 mm Hg. Art.;
• diastolic blood pressure - less than 90 mm Hg. Art.

The control process occurs according to certain rules:

• Blood pressure is measured while sitting, in a comfortable, relaxed position, with the hand at heart level. In pregnant women with diabetes mellitus Be sure to measure blood pressure both while sitting and lying down.
• The pregnant woman should be at rest, after at least a 5-minute rest.
• The study is carried out 2 times with an interval of at least a minute. If the result differs by more than 5 mmHg. Art., then an additional third measurement is carried out, and the figures of the last two measurements are averaged.
• Be sure to measure blood pressure in both arms and, at different pressures, take higher readings as a basis.
• The results are recorded with an accuracy of 2 mmHg. Art.

To detect arterial hypertension in a pregnant woman, at least two measurements are taken on one arm with an interval of 15 minutes, and the results are averaged. It is important to exclude hypertension " white coat“when, when measuring blood pressure in a doctor’s office, the pressure numbers are higher than normal values, but at home they are within normal limits. And to identify hidden hypertension, when normal pressure is recorded in the doctor’s office, and high pressure when measured at home.

If blood pressure results are questionable, the pregnant woman undergoes 24-hour blood pressure monitoring. The readings are recorded on a special device throughout the day. At the same time, a pregnant woman’s daily routine does not change. Next, the results obtained are analyzed, the average blood pressure value per day is calculated, and the issue of the possibility of developing arterial hypertension and preeclampsia in the future is decided.
When recording diastolic pressure values ​​greater than 110 mm. rt. Art., measurements are carried out once

In the doctor’s office, not only blood pressure numbers are assessed, but also obvious and hidden edema is identified. And although edema in pregnant women does not in all cases reflect the severity of preeclampsia, when they suddenly appear and sharply increase, they become a prognostic sign of a severe form of preeclampsia.

To do this, monitor body weight gain, measure the circumference of the ankle joint, evaluate the ring symptom, and measure the daily or hourly volume of urine (diuresis).
Obvious swelling of the ankle joints does not always indicate the presence of preeclampsia

Laboratory and instrumental examination and consultation with medical specialists

Studies of blood and urine readings of a pregnant woman help in making a diagnosis of preeclampsia.

When studying a general urine test in pregnant women, the presence of protein and casts is assessed, which normally, except for hyaline ones, are not detected. Protein in the urine (proteinuria) of 0.3 g/L or more in combination with high blood pressure confirms the diagnosis of preeclampsia until proven otherwise. The presence of casts, protein formations that have formed in the renal tubules, indicates kidney damage.

The amount of lost protein is confirmed and specified in the daily urine sample. And if its value is 0.3 g/l or more, and there are other signs of preeclampsia, then the diagnosis of moderate preeclampsia is clarified based on the presence of other criteria. If the level of protein in the urine per day is greater than or equal to 5 g/l, or in two portions of urine, which is collected at intervals of 6 hours, is equal to or greater than 3 g/l, or a test strip value of 3+ is determined, then we speak of severe preeclampsia.

But if a pregnant woman has symptoms of a critical condition (severe hypertension, extreme low content platelets, liver and kidney failure, pulmonary edema, etc.) detection of protein in the urine is not necessary to determine severe preeclampsia.

If preeclampsia is suspected in pregnant women, kidney function is studied in laboratory tests using additional urine tests. The Zimnitsky test evaluates the ability of the kidneys to concentrate and excrete urine, and the Roberg test evaluates the excretory function of the kidneys.
An important test to determine the amount of protein in your daily serving

IN general analysis blood, look at the number of red blood cells, hemoglobin, hematocrit. Their sharp increase reflects signs of blood thickening. And platelet numbers, especially their low content (below 100*10/l), indicate increased bleeding and severe preeclampsia.

In a biochemical blood test, total protein and its fractions are important, low levels of which indicate the permeability of the vascular wall, a sign of preeclampsia. Severe preeclampsia is also indicated by an increase in creatinine, especially in combination with oliguria, a symptom in which a pregnant woman produces a small amount of urine (less than 500 ml/day). Increased bilirubin and uric acid indicate liver damage. High values ​​of liver tests (ALT, AST, LDH) also indicate severe preeclampsia.

In the coagulogram, a decrease in indicators (APTT, fibrinogen and PDF, PTI, TV, antithrombin III) is also an assessment of the severity of preeclampsia.
Blood counts indicate changes in a pregnant woman's body

Pregnant women undergo an ECG (electrocardiography) and monitor the condition of the heart.

An ultrasound of the vital organs of the mother and fetus, Doppler ultrasound of the umbilical cord arteries are performed and the utero-fetal blood flow is assessed.

An ophthalmologist examines the condition of the fundus of a pregnant woman. Papilledema is a result of arterial hypertension.

Pregnant women undergo CT and MRI of the brain to clarify the diagnosis of eclampsia.
Using ultrasound examination, the condition of the internal organs of the mother and fetus is assessed

Help with preeclampsia

Care for pregnant women with preeclampsia and eclampsia is provided only in a specialized obstetric hospital (maternity hospital) of at least regional or republican significance, where there is a department of obstetrics and gynecology, or in perinatal centers.

Treatment depends on:

• from the duration of pregnancy;
• severity of preeclampsia;
• condition of the pregnant woman and the fetus.

With moderate preeclampsia, the woman must be hospitalized. In the hospital, her diagnosis is clarified, treatment is prescribed and the fetal activity is assessed. They are trying to prolong her pregnancy, with constant monitoring of her well-being and the development of the unborn baby. Delivery is carried out if the condition of the mother and fetus worsens or when the period reaches 34–36 weeks.

With severe preeclampsia, a pregnant woman is admitted to the intensive care unit. After normalization of the mother's condition, delivery is performed. At a period of less than 34 weeks, if the well-being of the pregnant woman and the fetus allows, then prevention of possible severe breathing disorders (respiratory distress syndrome) of the unborn child is carried out (with glucocorticoids). And the woman herself is transferred to a specialized maternity ward for observation and further highly qualified care.

Basic treatment for preeclampsia includes:

• anticonvulsant therapy;
• hypertensive therapy;
• delivery.

Moreover, delivery is the main and only method of treating preeclampsia and eclampsia.

Hypertensive and anticonvulsant therapy reduces the risk of developing the consequences of these conditions.

Anticonvulsant therapy

To relieve seizures in preeelampsia and eclampsia, use magnesium sulfate 25%; tranquilizers (diazepam, seduxen).

The use of these drugs is carried out according to strict indications.

Antihypertensive therapy

To reduce blood pressure during arterial hypertension in a pregnant woman, use:

• central adrenoreceptor stimulants (methyldopa, dopegit) - 1st line;
• cardioselective β-blockers (metoprolol, labetolol);
• calcium channel blockers (nifedipine, verapamil);
• antispasmodics (dibazole, papaverine);
• peripheral vasodilators (nitroglycerin, sodium nitroprusside).

Combinations of drugs are not used to correct blood pressure. Since it is dangerous to quickly reduce blood pressure - this leads to a lack of oxygen supply (hypoxia) to the fetus.

The following is not used for the treatment of hypertension in preeclampsia:

• ACE inhibitors;
• angiotensin II receptor antagonists;
• spironolactone.

Diuretics are used only for swelling of the lungs and brain.

The only timely and adequate way to eliminate preeclampsia and eclampsia is delivery.

Indications for emergency delivery (counting by minutes):

• bleeding from the birth canal;
• suspicion of placental abruption;
• acute hypoxia (distress syndrome) of the fetus.

For urgent delivery (counting the clock):

• constant headache and visual manifestations - “flickering spots” before the eyes, “fog in the eyes”;
• persistent abdominal pain, nausea or vomiting;
• high blood pressure that cannot be treated with medication;
• progressive deterioration of liver and/or kidney function;
• eclampsia - convulsions or a series of convulsive attacks;
• platelets less than 100 x 10⁹/l and their progressive decrease;
• abnormal condition of the fetus (CTG, ultrasound, severe oligohydramnios).

Indications for caesarean section:

• all severe complications of preeclampsia, except fetal death;
• deterioration of the condition of the mother (BP more than 160/110 mm Hg) or fetus (acute hypoxia) during childbirth.

Infusion therapy

Infusion therapy is not included in the basic treatment of preeclampsia and eclampsia. Because to prevent pulmonary edema, the flow of fluid into the pregnant woman’s body must be limited. It is carried out only if there are physiological and pathological losses of fluid due to blood loss, vomiting, diarrhea, and as a slow and constant delivery of drugs into the vascular bed. More often they prefer to use polyelectrolyte balanced crystalloids (Ringer-Lock solution). Synthetic solutions (plasma substitutes and gelatin solutions), natural colloids (albumin), blood products are used only for absolute indications: with a sharp decrease in circulating blood volume, shock, blood loss.

Prevention and prediction of preeclampsia

Prediction factors for preeclampsia in the first trimester of pregnancy:

• Carrying out, if possible, 3D echography and Doppler ultrasound of the uterine arteries.
• blood pressure control (average value);
• control of the level of placental growth factor (PIGF), protein that is associated with pregnancy (PAPP-A), a decrease in the concentration of which indicates the early onset of preeclampsia.

To prevent preeclampsia and if risk factors are present, according to the recommendations of the World Health Organization (WHO), acetylsalicylic acid is used from the 12th to the 36th week of pregnancy.

If there is a deficiency of calcium intake from food and the risk of developing preeclampsia, calcium supplements are used (Kalcemin, Calcium D3-nycomed, etc.).

How formerly a doctor suspects symptoms of preeclampsia and begins treatment, the higher the chance of avoiding serious complications. And there is less likelihood of disability for the mother and her baby, as well as their death.

The process of bearing a child rarely goes completely smoothly. And experience certain painful sensations during the gestational period is natural. However, when the pain affects the left side, the expectant mother should show increased...

A frozen pregnancy is a difficult test for a woman. It is difficult to survive and impossible to forget. It’s even harder to overcome the fear of a new pregnancy, which could end just as sadly. Therefore it is important...

Thrush is a common disease of the female genital organs. According to statistics, 44% of women on earth suffer from this disease. Young girls are especially often interested in the question of whether it can affect...

Preeclampsia is a well-known toxicosis in the last trimester. It can cause complications and then preeclampsia develops. For the expectant mother, the problems associated with this pathology should be clarified in advance. How terrible are the consequences directly for the woman and child.

What is preeclampsia in pregnancy

So, what is preeclampsia in pregnancy? This is a kind of late toxicosis, manifested by the presence.

In rare cases, these symptoms may bother the expectant mother in the early stages.

The disease may worsen and develop into a more serious stage of eclampsia. The disease is life-threatening for mother and child.

Its symptoms develop rapidly both before, during and after childbirth. Convulsions begin throughout the body, which can lead to coma and death.

Over a short period of time, relapses of typical muscle contractions are possible.

Causes

The exact reasons why this disease develops have not been established, but there are some substantiated versions:

• fetal rejection due to immunological changes in the woman’s body;
• abnormal in the uterus with enlargement of the spiral arteries
• violation ;
• tendency to form in the blood in a latent form. The process develops with a large amount of the hormone thromboxane 2;
• an imbalance between the cerebral cortex and subcortical structures, which contributes to poor blood flow through the vessels;
• in the last stages of pregnancy, edema often occurs, which is associated with a lack of folic acid and B vitamins;
• genetics on the female line.

There are experts who note preeclampsia developing in women due to insufficient...

Symptoms

At a mild stage, the symptoms of preeclampsia may not appear, and the pregnant woman will feel fine.

But a severe form of the disease has the following symptoms:

Having such symptoms, we can say that the prognosis is not good for both the mother and the unborn child.

Subsequently, complications may develop that are close to irreversible consequences.

Why is preeclampsia dangerous?

Any serious illness is fraught with consequences, especially if a woman is pregnant. Accordingly, the fetus suffers. It could happen to a child and even him.

For the mother, the disease can result in:

All these manifestations are individual. They can occur either collectively or individually.

Classification

The classification of preeclampsia is conventionally divided into three types: mild, moderate and severe stages of the disease.

Light form

This degree is characterized by a slight increase in blood pressure, mild malaise and weakness of the whole body. Visible swelling of the extremities plus weight gain.

Average

Along with the disease, symptoms increase. Arterial pressure becomes above 160, and diastolic 100-109. I have a constant headache and my weight doesn’t stop increasing. Swelling of the face, legs and arms.

Severe stage

In addition to the feet and legs, the face and upper limbs swell significantly, and fluid begins to accumulate inside the natural cavities.

The pressure of the upper and lower indicators reaches the critical norm. They appear, feel nauseous, feel dizzy and have a headache.

The organs of vision suffer.

Therapy

Treatment of preeclampsia in pregnant women depends on the stage of development of the disease and the duration of pregnancy.

At a mild stage, a woman does not need to be monitored. It is enough to take tests a couple of times a week that are necessary, in particular for the amount of protein in the urine. This is the most accurate indicator of the development of the disease.

In this case, it is necessary to monitor the pressure and record it daily.

Also future mom must watch your physical health, do not overwork, reduce the activity of movements.

Hospitalization is indicated for moderate severity. The pregnant woman may need bed rest. At this stage, the main thing is not to allow high blood pressure. For this purpose, special medications are used.

Severe preeclampsia requires surgery only after relief of seizures or other symptoms.

If placental abruption occurs, perform.