Toxicosis during late pregnancy: symptoms, consequences and treatment. Late toxicosis in pregnant women Can pregnant women develop late toxicosis?

Every pregnant woman knows firsthand that toxicosis is an unpleasant state of the body. It is accompanied by vomiting and nausea. Occurs due to poisoning of the body with harmful substances and toxins.

In principle, toxicosis during pregnancy is not so dangerous if it torments a woman in the early stages of pregnancy. Attacks of nausea and vomiting in the last or mid-second trimester of pregnancy are dangerous for both the health and life of the mother and her unborn child.

Late toxicosis during pregnancy is also called gestosis. Its symptoms can be quite vague, so diagnosing the initial stage can be difficult.

Preeclampsia develops in approximately one in ten women. Its danger lies in the fact that it is accompanied by disorders of the entire body and often leads to serious consequences, emergency childbirth, and sometimes death.

A patient with the first signs of toxicosis in the third trimester of pregnancy is urgently admitted to the hospital. There she is under the supervision of a doctor. In acute cases, labor is accelerated and the mother is transferred from premature baby to the appropriate department.

Complications of the gestational period develop both during pregnancy, at the time of birth, and immediately after them.

Symptoms of gestosis

Late toxicosis has three main symptoms:

1. Swollen body;
2. High blood pressure;
3. There is protein in the urine.

The first sign of gestosis is swelling. They are the first to report a problem. But it also happens that apart from them, nothing expresses pathology. Then the degree of late toxicosis is determined by the severity of these edemas:

• swelling appeared in the arms and legs;
• swelling of the limbs, as well as the abdominal area;
• the swelling reached the neck and covered the face.

At the second stage, the pregnant woman needs to measure her blood pressure. If it is 20% higher than what it was before pregnancy, late toxicosis can be diagnosed.

To finally confirm the diagnosis, a urine test is done. The norm for protein is 0; if it is present, the diagnosis is fully confirmed.

Possible reasons

Late toxicosis of pregnancy is a poorly studied pathology, and therefore it is almost impossible to indicate definitely what causes nausea during pregnancy. There are only obvious factors that provoke pathology. These include:

• immune disorders;
• allergy;
• poisoning with harmful drugs - nicotine, alcohol, drugs;
• endocrine diseases;
• kidney problems;
• overweight;
• nervous environment;
• heart failure;
• weak ability of the pregnant woman to adapt.

The most common toxicosis is later manifests itself in women:

• with the first pregnancy;
• with underdeveloped genitals;
• with the presence of chronic infectious diseases;
• those who terminated pregnancy;
• previously suffered from toxicosis;
• under 18 and over 35 years of age;
• with symptoms of chronic fatigue;
• with multiple pregnancy.

Why is late toxicosis dangerous?

Toxicosis in late pregnancy poses a serious danger to both the unborn child and the pregnant woman herself. For the latter, the presence of vomiting and nausea in the 3rd trimester can have the following consequences:

• birth of a child prematurely;
• dehydration of the body;
• premature placental abruption;
• blood clot formation;
• impaired circulation in the brain;
• spasm of cerebral vessels;
• failure of some organs.

The child's life is also in danger. After all, gestosis provokes:

• slowdown intrauterine development and fetal growth retardation;
• child dementia;
• excessively low fetal weight;
• lack of oxygen;
• premature placental abruption leads to the death of the baby.

Of course, it is categorically not recommended to take the disease to extremes. If for some reason a pregnant woman could not be diagnosed with a disease and it proceeds without treatment, she herself should carefully evaluate her condition. If you have the following symptoms, you should immediately consult a doctor:

1. Fever, chills, or shortness of breath.
2. I suffer from headaches and temporal pain.
3. The pregnant woman is feeling sick.
4. Constantly makes her sleepy or, on the contrary, she is overly active.
5. Disturbing cough, hoarseness, stuffy nose, hearing loss, difficulty speaking.

Ignoring these symptoms of toxicosis in the third trimester of pregnancy will contribute to hemorrhage and swelling of the brain. And this is fraught with death.

Timely diagnosis

Just like that, it’s almost impossible to determine offhand whether a pregnant woman really has late toxicosis. This can only be done by doctors with many years of experience, and even then not always. That is why a thorough diagnosis of gestosis implies:

1. Accounting for pregnant women's complaints.
2. Laboratory research.
3. Amnestic data.

To fully establish the problem, research is needed:

• condition of the fundus;
• dynamics of changes in a pregnant woman’s weight;
• blood pressure measurements;
• determine the ratio of urine excreted and fluid consumed by the patient;
• general and biochemical blood parameters, as well as the level of coagulation;
• general analysis urine.

The patient also needs to undergo Doppler ultrasound and ultrasound.

Observation

To alleviate the general condition and prevent the consequences of gestosis, a patient who feels sick in late pregnancy needs to:

• rest more;
• eat a lot of vegetables, fruits, drink any healthy liquid;
• a balanced diet, in which protein foods predominate and carbohydrates are reduced;
• communication with a psychologist, possibly even taking sedatives, which are acceptable during pregnancy;
• complete elimination of nervous situations, loud noises;
• good sleep;
• relaxing holiday.

Treatment

The basic principles of treating gestosis are:

• hospitalization in the pregnancy pathology department;
• maintaining a calm regime;
• taking appropriate medications;
• eliminating malfunctions of important organs;
• a quick, but most importantly, careful birth of a child.

In the treatment of gestosis, all measures are aimed at normalizing water-salt metabolism, blood pressure, the condition of the walls of blood vessels, metabolic processes, circulation, viscosity, blood clotting, as well as the activity of the central nervous system.

Prevention

Prevention involves preventing the development of late toxicosis in pregnant women. To achieve this, a pregnant woman needs:

• proper organization of nutrition, rest, physical activity;
• staying in the fresh air;
• low salt and fluid intake;
• monitoring the entire course of pregnancy by a doctor;
• control of blood pressure, urine parameters, weight.

Prevention with medications is prescribed by a doctor. Self-medication is unacceptable, otherwise there is a risk of not only giving birth to a sick child, but also losing him altogether.

So, late toxicosis, the causes of which are intoxication, as well as harmful substances released by the body of a pregnant woman, should not be underestimated and taken lightly. If this pathology is not treated, it may well lead to unpleasant, serious consequences. Starting from difficult and sudden births and ending with death for both participants in the process: the mother and her baby.

That is why, if toxicosis is detected at a late stage or only suspected, it is best for a pregnant woman to consult a doctor and in no case self-medicate.

Late toxicosis or gestosis is a pathological condition. It occurs in the second half of pregnancy. Late toxicosis during pregnancy is accompanied by various dysfunctions of the nervous system. If toxicosis is early stages most often does not pose any threat, then a late diagnosis may be the beginning of serious complications. This condition can develop into a disorder of vital organs and systems for both the expectant mother and the baby. Preeclampsia usually accounts for ten to fifteen percent of all pregnant women.

For toxicosis Counseling Treatment
What does Nausea cause?
not recommended Pregnancy without symptoms

The exact causes of late gestosis are unknown, but the disease often develops under certain conditions. For example, this happens if it is the first pregnancy, or the age of the expectant mother is under eighteen years old and over thirty-five. Preeclampsia can also develop in women who have bad habits, chronic diseases such as diabetes mellitus, hypertension, obesity and much more.

Multiple pregnancy, insufficiency of protein in orgasm, polyhydramnios - these factors can also be the reason for this diagnosis, and also if the interval between births is less than three years.

But even if the factors described above are absent, this does not provide an exact guarantee that a woman will not have late toxicosis during pregnancy. If a pregnant woman is healthy and has no prerequisites for pathology, she may develop a similar diagnosis due to overwork, stress, poor nutrition, or due to a common cold or injury.

Diagnostic features

A later state of vomiting and nausea cannot be called normal. At the first symptoms, you should contact a specialist. Typically, gestosis begins in the third trimester and lasts until childbirth. But what also happens is that a woman is admitted to a hospital and undergoes a course of treatment. The body recovers for some time.

Painful condition in any position

The symptoms of late toxicosis are similar to those that were in the first half of pregnancy. It could be:

• nausea;
• severe vomiting (but more than five times a day);
• weakness in the body;
• ailments.

These symptoms may also include swelling of the limbs and face, increased blood pressure that does not respond to medications, and pre-convulsant symptoms. When tested, a large amount of protein is detected in the urine - this is explained by the fact that the walls of the blood vessels are weakened and the proteins leave the body.

Consultation with a specialist

Other symptoms of gestosis:

• headache;
• dizziness;
• increased fatigue;
• visual or hearing impairment;
• spontaneous pain in the abdomen, stomach area or under the ribs.

The need to contact a specialist

As soon as you begin to experience the first signs of late gestosis, you should immediately consult a doctor. Any sign will be enough. The main symptoms can be expressed by edema, cramps, hypertension. The doctor will be able to alleviate the condition and help not harm the unborn child.

When a woman regularly visits a specialist during pregnancy, it is easier to track late toxicosis. In any case, the doctor will prescribe the following procedures:

• general gynecological examination;
• general urinalysis;
• urine analysis according to Nechiporenko, according to Zimnitsky;
• analysis of 24-hour urine for protein;
• visiting an ophthalmologist to measure the fundus and visual acuity, a nephrologist, a neurologist;
• clinical, biochemical blood test;
• ultrasound examination of the fetus with Doppler ultrasound;
• fetal cardiotocography (CTG);
• hemostasiogram.

After this, the doctor will prescribe the necessary treatment and tell you about following a certain diet. Therefore it will be necessary:

• limit fluid intake to one liter for a day;
• follow a salt-free diet;
• remove all artificial products, preservatives, dyes, etc. from the diet;
• diversify your diet with fruits, vitamins, and vegetables;
• control your weight, there should be a weight gain of no more than 300 g per day, if this norm is exceeded, then these are signs of dropsy, that is, severe swelling;
• it is necessary to eliminate all causes of formation - treatment of colds, other diseases, eliminate stressful situations, normalize the daily routine.

Treatment and recovery after difficult days

If none of this helps, then the pregnant woman is hospitalized to prevent complications from occurring.

What else is dangerous about late toxicosis? Mainly because it can develop into its final stage – eclampsia. When this condition occurs, brain function is disrupted and heart failure develops. A pregnant woman may faint, and cerebral hemorrhages may occur, leading to cardiac arrest.

In order not to lead to such a terrible state, it is necessary to observe preventive measures, adhere to the specialist’s recommendations and conduct healthy image life.

Methods of treatment and prevention

What to do	Description
Sleep and rest	On latest dates During pregnancy, a woman needs proper sleep (at least ten hours) and rest. You cannot overwork or do difficult physical work. You should avoid stressful situations and be less nervous.
Nutrition	Eliminate all canned, unhealthy foods, alcohol, carbonated drinks, and foods with dyes. Gradually reduce the amount of dairy, fermented milk, meat and fish products and replace them with vegetables, fruits, herbs, and legumes. Go on a diet diet. It is recommended to drink water in small sips, every half hour.
Healthy lifestyle	If you are concerned about the symptoms of toxicosis in the later stages, you need to lead an active lifestyle. It is worth doing gymnastics for pregnant women, but first consult with your gynecologist. Spend more time outdoors, avoid tobacco smoke and stuffy rooms. Get as much rest as possible. During outbreaks of epidemics, avoid crowded places.
Nausea, vomiting	If nausea bothers you in the morning, snack on nuts, crackers, crackers, and fruit. Don't overeat. Water and lemon juice help a lot. Any liquids with added ginger.
Medication method	If nothing at home helps, hospitalization is necessary. The doctor will prescribe the necessary medications to restore the body.

For dropsy with severe swelling and mild form, the following is usually prescribed:

• sedatives, these can be tinctures, herbal decoctions;
• antioxidants – vitamins A, E;
• the use of antihypertensive drugs that have an antispasmodic effect;
• herbal infusions that have a diuretic effect.

What does the diagnosis mean?

What does the disease lead to?

Late toxicosis or gestosis in the second half of pregnancy occurs no earlier than after the twentieth to twenty-fifth week. The development of vomiting and nausea in late pregnancy negatively affects the health of the expectant mother and child. It can also cause serious illness. A pregnant woman may experience disturbances in the functioning of the kidneys, lungs, nervous system, liver, and dehydration may begin. Vascular spasms, impaired microcirculation, cerebral edema, and coma are often observed. This diagnosis can also lead to early placental abruption, early labor or fetal asphyxia.

When gestosis forms, fluid leaves the vessels, blood pressure rises - this is necessary so that the blood does not thicken and circulate freely throughout the body, therefore, due to the fact that coagulability increases, there is a risk of blood clots.

Another unpleasant side of this symptom is that changes occur in the woman’s body, pregnant for a long time may not notice anything. And after they begin to appear, it may already be too late. Any irritant can cause convulsions; against this background, heart attack, stroke, retinal detachment, and swelling of the lungs occur. Therefore, timely diagnosis is necessary, and subsequently prevention of such a phenomenon as late toxicosis in a woman who is pregnant.

: Borovikova Olga

gynecologist, ultrasound doctor, geneticist

For pregnant women, the word “toxicosis” is usually associated with the first months of pregnancy. Although nausea, vomiting and drowsiness are quite inconvenient, in most cases they are not dangerous for the development of the fetus and the condition of the mother.

The main changes in gestosis are associated with disturbances in the functioning of the circulatory system. This causes oxygen starvation and fluid retention in the tissues.

The kidneys are very vulnerable. During their normal functioning, there should be no protein in the urine, but disruption of the blood supply to the vessels leads to a malfunction of the organs, and as a result, the appearance of protein in unacceptable quantities. Late toxicosis negatively affects the functioning of the nervous system. In severe cases, cerebral edema may develop.

There are several forms of the pathological condition: dropsy, nephropathy, preeclampsia, eclampsia. They are all different stages of the disease.

Dropsy

It belongs to the most common pathologies that occur in late gestation. It develops especially often with. The first signs are swelling of the feet and legs, worsening in the morning. Gradually, swelling spreads to the arms, sacrum and lower back, and face. A woman may notice that she has difficulty removing a ring from her finger or putting on previously loose shoes.

Another common sign of dropsy is a decrease in the total amount of urine produced per day. There is a sharp increase in weight, sometimes a feeling of heaviness in the body, shortness of breath, and tachycardia are felt. But in general, the general condition remains normal, there are no disturbances in the functioning of the liver or kidneys. After childbirth, the symptoms of dropsy disappear without treatment.

In the early stages of the disease, you can combat the symptoms of dropsy at home. This must be done, even if you feel generally satisfactory, since lack of treatment can lead to the transition of late toxicosis to the next stage of development.

Nephropathy

Occurs as a complication of dropsy. In addition to pronounced swelling of the whole body, a significant increase in blood pressure, dizziness, severe thirst, insomnia, a feeling of heaviness, pain in the sacrum and lower back are noted. Often there are disturbances in the functioning of the liver, which leads to an increase in its size, painful sensations in the right hypochondrium, and jaundice. The risk of developing nephropathy increases if the pregnant woman has other diseases, such as diabetes, hypertension, nephritis.

Nephropathy belongs to severe lesions that lead to the development and delay of its development, or complicated childbirth, bleeding.

Preeclampsia

The pathology is associated with dropsy and nephropathy of pregnancy. At this stage of late toxicosis, a significant increase in the amount of protein in the urine is noted. It can reach 0.5-1 g/l per day and higher. The woman experiences severe swelling throughout the body, pain in the temples and right hypochondrium, nausea and vomiting.

Patients complain of blurred vision, an unstable psychological state - from euphoria and excitement to lethargy and apathy. Pathological changes are also noticeable in a blood test: red blood cells are destroyed and the number of platelets decreases.

The woman’s condition poses a danger both to herself and to the unborn child, who does not receive the necessary nutrients due to impaired blood supply through the vessels of the placenta. As a result, the risk of fetal death or the development of diseases such as epilepsy or cerebral palsy increases.

Eclampsia

Accompanied by fainting, seizures and coma. Eclampsia develops rapidly; in some cases, after convulsive seizures, hemorrhage in the brain can occur, followed by irreversible coma. Seizures, despite their short duration, are also very dangerous because they can lead to sudden death.

Convulsive attacks of eclampsia begin with small tremors of the facial muscles. Then there is a sharp deterioration in the condition with the spread of seizures to the upper and lower limbs and torso. The duration of the seizure is about a minute, they can be repeated so often that the woman does not have time to regain consciousness.

The most severe and dangerous form of the disease is a coma, which can occur abruptly, often without preliminary convulsions.

When the woman regains consciousness, she complains of severe headaches, general weakness and weakness. In most cases (70%), eclampsia develops during pregnancy, but it may occur during childbirth (30% of cases) and in the postpartum period (about 2% of cases).

In addition to dropsy, all forms of gestosis require treatment in a hospital setting in the pathology department. In case of renal failure, premature placental abruption, acute fetal hypoxia, it is indicated.

Diagnostics

Knowing the dangers of late toxicosis, it is necessary to regularly visit an obstetrician-gynecologist throughout the entire gestation period. Every pregnant woman should regularly undergo a number of general activities:

• measuring blood pressure, especially important after exercise;
• passing a general urine test to detect protein, as well as tests according to Nechiporenko and Zemnitsky;
• conducting general and biochemical blood tests;
• controlling the amount of liquid you drink;
• weekly measurement of weight gain;
• visiting an ophthalmologist to measure fundus and visual acuity;
• consultation with a nephrologist and neurologist;
• Ultrasound of the kidneys and adrenal glands;
• conducting an electrocardiogram.

With minor swelling of the extremities and a generally satisfactory condition, they are limited to following the doctor’s general recommendations on lifestyle and dietary adjustments.

Diagnosis of nephropathy, especially its severe forms does not present any difficulties, but in some cases it must be distinguished from diabetic and uremic coma.

Treatment

For mild nephropathy, drug therapy is prescribed, which includes:

• sedatives (tinctures of motherwort, valerian);
• antispasmodics (Papaverine, No-shpa);
• means for normalizing blood pressure (Eufillin, Dibazol, Clonidine);
• drugs to reduce the risk of blood clots and normalize blood circulation;
• diuretics to improve urination and eliminate swelling.

The duration of treatment in the hospital department is from 10 to 14 days. Complete normalization of the condition is a rather long process, usually it is completed only after the birth of the child. The woman’s blood pressure stabilizes, urine analysis returns to normal, and swelling disappears.

If there are symptoms of preeclampsia, the pregnant woman is hospitalized in the intensive care unit for antihypertensive and anticonvulsant treatment. The main task is to stabilize the condition and stop the seizures. Only after this can the question of delivery be raised. It can be performed either naturally or by caesarean section, if there are additional indications for this.

In the absence of immediate treatment, the consequences of severe late toxicosis may include:

• pulmonary edema;
• acute heart failure;
• stroke or paralysis;
• mental disorders;
• liver necrosis;
• cerebral edema and coma;
• death of the fetus and death for the mother.

Anticonvulsant therapy involves intravenous administration of magnesium sulfate (magnesia). But the only way to relieve a woman from the severe symptoms of late toxicosis is to induce labor.

For mild forms of preeclampsia, they are performed at 36-37 weeks of pregnancy. In severe forms of eclampsia, immediate delivery is necessary immediately after the seizures are relieved, regardless of the stage of pregnancy. If there are no additional indications () natural birth in this situation is more preferable.

Prevention

Nutrition and daily routine

It is impossible to completely eliminate the risk of developing late toxicosis, but following the rules of a balanced diet and a healthy lifestyle will allow women at risk to avoid severe forms of the disease.

In the second half of pregnancy, the expectant mother needs to minimize or completely abandon the consumption of smoked foods, dishes with a lot of spices and seasonings, and sweets. It is better to steam food or bake it in the oven.

If you are prone to edema, you need to limit your salt intake (no more than 3-4 g per day). A salt-free diet helps remove fluid and reduce swelling.

In the second half of pregnancy the following are useful:

• lean boiled meat and fish;
• cottage cheese and fermented milk products;
• liver, low-fat cheeses;
• vegetables (carrots, cabbage, beets), fruits (apples, apricots, lemons), nuts;
• porridge (except semolina);
• lingonberry or cranberry fruit drinks, dried fruit decoctions.

If you are prone to edema and excessive weight gain, your daily calorie intake should not exceed 3000. Careful adherence to the rules of balanced nutrition will help you not exceed the norm for weight gain per week - 350 grams. It is also necessary to monitor the amount of liquid consumed. It should be no more than 1-1.5 liters per day, including soups, compotes, teas.

An important condition for preventing the development of late toxicosis is adherence to a daily routine. You need to sleep at least 7-9 hours a day, of which 1 hour is a daytime nap. Slow walks in the fresh air are very beneficial.

The pathological condition can negatively affect the activity of the fetus. Therefore, it is important for the expectant mother to monitor the number of movements of the child throughout the day. Starting from week 25, the tremors should be clearly noticeable. If the child's activity is reduced, the doctor should be notified.

Other preventive measures

The risk of developing late toxicosis can be reduced if a woman pays close attention to her health. A prerequisite for every pregnant woman is timely registration at the antenatal clinic. The expectant mother must take all tests on time and adhere to the timing of visits to the doctor. During pregnancy, it is important to closely monitor your weight and lead a healthy lifestyle.

Pregnant women at risk should especially carefully follow the doctor’s instructions. These are women with kidney and liver diseases, endocrine pathologies, pregnant with twins, over 35 years old, who have had sexually transmitted infections. Any signs of poor health should be reported to the doctor who will prescribe necessary tests and appropriate treatment.

When talking about toxicosis in pregnancy, we usually mean nausea and vomiting in the first weeks of pregnancy. Even men and young unmarried girls know about this condition. But not everyone knows that there are other types of toxicosis that lie in wait for some pregnant women already at advanced stages - these are the so-called late toxicosis of pregnancy.

Since 1996, it has been customary in medicine to call late toxicosis gestosis in pregnant women. These are quite serious conditions that arise as a result of deep and severe metabolic disorders in a woman’s body caused by pregnancy. Gestosis ranks second in obstetrics among the causes of maternal and infant mortality; it can affect the future health of a woman and lead to problems in the health of the children she gives birth to. Today, gestosis in pregnant women is common - from 12 to 18 percent of expectant mothers experience gestosis of varying degrees of severity during pregnancy.

Photo - photobank Lori

What is gestosis?

Preeclampsia is divided into hydrops of pregnancy (when severe swelling predominates), nephropathy of pregnancy (when symptoms of kidney damage predominate), preeclampsia and eclampsia (when damage to the nervous system and convulsions predominate). Gestosis can develop even in women who were absolutely healthy before pregnancy, against the backdrop of the first months going well. Such gestosis is called “pure gestosis”; it occurs in approximately 25-30% of women. Preeclampsia can also occur against the background of maternal pathology - kidney damage, hypertension, liver damage, fat metabolism disorders or endocrine disorders. Such gestoses are classified as combined.

Dropsy of pregnancy

When a woman develops hydrops of pregnancy, persistent and severe swelling appears first of all. They occur due to pathological fluid retention in the body, and edema is usually considered the very first sign of impending gestosis. Edema can be hidden and obvious, while latent edema is called a pathological increase in body weight per week (more than 500 g) or uneven weight gain over weeks. This occurs due to a decrease in the amount of urine excreted, fluid retention by body tissues and, as a result, an increase in body weight due to water. In addition, nocturia may occur (when much more urine is excreted at night than during the day).

First of all, swelling begins to form in the ankles and legs, gradually the swelling rises up the body, but in some cases, swelling on the face may form simultaneously with the legs. In the morning, swelling is not so noticeable, since during night sleep the liquid is relatively evenly distributed throughout the woman’s body. During the day, due to the vertical position of the body, the swelling usually falls to the limbs and lower abdomen with the perineum.

According to the severity and prevalence, edema can be divided into four degrees:

• first degree, in which swelling is expressed only on the feet and legs,
• second degree, in which swelling is expressed in the legs and lower abdomen,
• third degree of edema, in which swelling is located on the legs, face and anterior abdominal wall,
• quadruple degree of edema with its distribution throughout the body.

However, even with fairly severe edema, the general condition and well-being of pregnant women remains satisfactory. The doctor determines the presence of dropsy in pregnancy by visually detecting edema, palpating the lower legs, weighing and recording weight gain, and also by comparing the amount of fluid consumed and excreted. Normally, a woman should excrete at least 3/4 of the fluid she drinks.

Nephropathy in pregnancy

Nephropathy (kidney damage due to gestosis) is manifested by the presence of three main symptoms - edema, the appearance of protein in the urine, and increased blood pressure. Only two of the three symptoms may occur in different combinations. Typically, nephropathy occurs as a progressive condition with dropsy, the pressure rises above 135/85 against the background of severe edema and changes in urine, and a disturbance in the general condition.

Why is high blood pressure dangerous in a pregnant woman?

High blood pressure is the most obvious and most dangerous sign of gestosis. In this case, the blood pressure numbers themselves will be especially important - an increase in the upper pressure by 30 mmHg or more from normal, and an increase in the lower pressure by 15 mmHg or more. When taking pressure into account, an increase in lower pressure is more dangerous than upper pressure, since lower pressure has a stronger effect on the baby - it reduces blood flow in the placenta and reduces the supply of oxygen to the fetus.

The development of nephropathy can be dangerous for the health of expectant mothers because this condition, without proper treatment, can develop into a state of preeclampsia and eclampsia (severe seizures with disruption of all organs and systems). In addition, the development of nephropathy in pregnant women can disrupt the functioning of vital organs - the liver, heart, brain, since they are all closely interconnected. Among other things, nephropathy can create the preconditions for such serious complications of pregnancy as (normally located), the development of bleeding, fetal hypoxia and premature birth, fetal death as a result of acute hypoxia. All these complications arise as a result of sharp fluctuations in blood pressure.

Why is protein in the urine of a pregnant woman dangerous?

The appearance of protein in the urine, which is called proteinuria, is one of the typical signs of gestosis. Moreover, if the amount of protein in the urine gradually increases, this indicates a deterioration in the woman’s condition and requires immediate medical attention. Simultaneously with the appearance of protein in the urine and an increase in pressure, the volume of urine excreted per day decreases; its amount can decrease to 500 ml or less. The less urine a pregnant woman excretes, the worse the course of the disease and the prognosis for pregnancy will be. Particularly dangerous is long-term nephropathy, which can lead to dangerous complications for the mother and fetus.

Preeclampsia and eclampsia

The main complications in the development of gestosis are preeclampsia And eclampsia, these are severe, progressive and life-threatening conditions for the pregnant woman.

At preeclampsia progressive circulatory disorders develop in small vessels of organs and tissues, especially in nervous system. Against the background of detecting protein in the urine, high blood pressure and edema, preeclampsia gives a feeling of heaviness in the back of the head, stomach pain, headaches, nausea, pain in the right side, vomiting and visual disturbances. In addition to these symptoms, drowsiness or insomnia, memory problems, indifference or irritability, severe lethargy may occur, weakened vision with flickering spots or sparks in the eyes, blurred vision, which is caused by problems with blood circulation in the retina and brain stem.

Preeclampsia is characterized by an increase in pressure of more than 160/110 with the appearance of protein in the urine of more than 5 g/l, with a sharp decrease in urine volume to 400 ml or less, and a severe general condition. Preeclampsia causes severe problems with brain function, visual impairment and blood clotting problems, which causes bleeding and liver function is affected.

Eclampsia- this is an extreme manifestation of gestosis, a life-threatening condition in which all the symptoms described above appear, and to them are added attacks of severe and prolonged convulsions. Typically, the occurrence of convulsive seizures is provoked by external stimuli - bright light, pain, sharp sounds; Typically, convulsions during such attacks last no more than two minutes. After a seizure, the pregnant woman is unconscious, and it gradually returns with loss of memory for the duration of the attack. Severe headaches and general weakness occur. In some cases, the unconscious state remains unchanged until the next attack of convulsions, and there can be many such attacks.

The prognosis for such a condition is extremely unfavorable, since seizures can lead to the development of a coma - a lack of consciousness with a partial loss of control over the functions of the body by the brain. During convulsions, cerebral hemorrhages or edema and swelling of the brain may develop. Sometimes eclampsia can be non-convulsive with headache, darkness in the eyes and the gradual formation of a coma against the background of sharply increased blood pressure.

Why and how do gestosis develop?

Doctors identify many reasons for the development of gestosis, but today the direct influence of any one specific factor has not been clearly clarified. In this regard, several theories of the origin of gestosis have been put forward.

According to one version, gestosis occurs as a disruption of the connection between the cerebral cortex and subcortical formations, which causes disturbances in vascular tone and leads to circulatory disorders, increased pressure and problems in organs.

Other experts attach great importance in the development of gestosis to disturbances in hormonal metabolism and its effect on vital organs. Also played a role are immunological conflicts between the body of the mother and the fetus, and, as it were, the rejection of the child by the mother’s body. Many are also confident in the role of heredity in the development of gestosis. Most scientists have formed the opinion that there is no single mechanism in the development of gestosis, and there is an interaction of several factors in the development of this pathology.

With the development of gestosis, a pronounced spasm of small vessels occurs in all organs and tissues, which leads to disorders in their functioning. As a result of spasm of small vessels, a sharp increase in blood pressure occurs. With gestosis, damage to the inner wall of blood vessels (endothelium) also occurs, which disrupts the formation of special substances in it that help the vessels stay in good shape, and substances that affect blood clotting. As a result, blood circulation and blood viscosity suffer, which also increases blood pressure and affects kidney function. The nutrition of the fetus also suffers; less blood flows to it than necessary.

The vessels become more permeable to fluid, and then the liquid part of the blood plasma goes into the tissue, which causes swelling. The kidneys cannot cope with excretion excess water, begin to malfunction and leak protein into the urine. Loss of protein only increases swelling. All problems, one after another, grow like a snowball in a woman’s body, the brain and everything suffer. internal organs, convulsions occur. With convulsions and coma, the placenta and fetus are seriously affected.

How are gestosis detected?

To identify gestosis, the doctor will carefully ask about the well-being of the pregnant woman and take into account all her complaints. A thorough examination is necessary to identify edema, measure weight and pressure. To make a diagnosis, a number of tests and studies are necessary:

• general blood test,
• general urinalysis,
• urine test for daily protein excretion,
• coagulogram (blood for infusion),
• biochemical analysis of blood and urine,
• daily urine volume,
• fundus examination.

Ultrasound examination of the fetus and placenta, Doppler measurements are also carried out; it is necessary to consult a therapist, nephrologist, ophthalmologist and neurologist.

How is gestosis treated?

Gestosis is treated exclusively in a hospital, since this condition is progressive and threatens health and even life. The basis of treatment is the creation of a gentle regime for the woman, restoration of the functioning of all vital organs and the most delicate delivery possible. It is only permissible to treat in a antenatal clinic under the supervision of an obstetrician-gynecologist.

Treatment requires adherence to a diet with fluid restriction to 1000 ml per day, strict control of salt intake, enriched with proteins and vitamins. Complete rest and taking sedatives, infusion therapy with blood plasma preparations, rheopolyglucin, and saline solution with drugs are required. The volume of incoming fluid is calculated by the doctor. It is necessary to carry out therapy to lower blood pressure with magnesium preparations, dibazole and other drugs, based on the level of pressure and indications. Diuretics, a drug to improve blood circulation, and placental blood flow, vitamins, etc.

The duration of treatment depends on the degree of gestosis and its severity, as well as the condition of the fetus and the mother’s body. Nephropathy is treated in a hospital for at least two weeks, in severe cases up to a month, constantly assessing the condition of the fetus. This may be followed by follow-up treatment in a antenatal clinic, and sometimes women remain in the hospital until the birth. If there is no effect of treatment or there is a threat of preeclampsia, the issue of early caesarean section is decided.

Late toxicosis during pregnancy or gestosis is a very dangerous pathology that includes a group of symptoms: hypertension, proteinuria and edema, occurring together or separately. Preeclampsia occurs only in pregnant women. In special cases, the disease can seriously threaten the life of the mother and fetus. Read what late toxicosis is, what are its causes, symptoms and consequences. How to prevent and what to do if you notice signs of this disease.

Preeclampsia is a late toxicosis in pregnant women. As a rule, it occurs in the third trimester of pregnancy. Most often it affects women preparing to become mothers for the first time.

The pathology is closely related to hypertension while expecting a child. High blood pressure during this period determines all the symptoms of this disease.

The name “toxicosis” is a relic of the past, when it was mistakenly believed that this anomaly was caused by a toxin produced by the body of a pregnant woman. Today, experts have concluded that this is not the case.

Causes of late toxicosis during pregnancy

To date, the reasons have not been fully studied. Some doctors consider high blood pressure to be the main culprit, while other doctors see the cause as metabolic disorders.

However, there are factors that contribute to the occurrence of this phenomenon. Toxicosis in the third trimester most often threatens pregnant women over 35 years of age, especially if they are expecting their first child.

Mothers with multiple pregnancies are more susceptible to gestosis than when carrying a single fetus.

Sometimes late toxicosis may be associated with diabetes, hypertension, excess weight, chronic kidney, liver or cardiovascular diseases.

In addition, the occurrence of pathology can be provoked by poor nutrition, as well as genetic predisposition.

The culprit of toxicosis during pregnancy may be hormonal changes in the body. This is especially common in the first trimester after conceiving a child.

Let's sum it up possible reasons late-stage toxicosis:

first pregnancy;

age under 18 and over 35 years;

the appearance of preeclampsia, eclampsia or toxicosis in previous pregnancies;

family history, that is, cases of occurrence in close relatives;

vascular disease;

systemic diseases;

metabolic diseases such as diabetes;

kidney disease;

multiple pregnancy, which provokes a large distension of the uterus and, of course, an increased need for protein;

1. improper nutrition of a pregnant woman.

How to recognize the symptoms of late toxicosis

Preeclampsia is indicated by three main symptoms, which are: edema, proteinuria and hypertension. Below we will analyze each of them in detail. These signs may not always appear all at once. Some women experience one or two symptoms. In the most severe cases, they can appear simultaneously.

Usually the first symptom is high blood pressure. Normal blood pressure in pregnant women should not exceed 135/85. Above 140/90 mm may be the first sign of gestosis.

Late toxicosis during pregnancy can affect every woman. At the first signs of this phenomenon, the expectant mother should immediately consult a doctor. If the pathology is detected on time and the doctor takes appropriate measures, then there is a high probability that the mother will give birth to a healthy child.

Severe late toxicosis can lead to premature birth. If gestosis is detected too late or not detected at all, it can lead to death of the mother and fetus. This happens rarely and is mainly typical for developing countries.

Normal hypertension during pregnancy should not pose any danger, but only if it is temporary and is not accompanied by any alarming symptoms.

As a rule, in such a situation, medications for hypertension help, and the disease itself goes away a few weeks after birth.

Forms and degrees of gestosis

Doctors distinguish between early and late toxicosis. Early toxicosis occurs in the first trimester of pregnancy. Most often it is characterized by vomiting and nausea. In most cases, symptoms disappear by 12 weeks after conception. Usually it does not affect the mother and child, that is, it is not dangerous.

Much more dangerous is the late form of toxicosis, which occurs in the last third of pregnancy. It is characterized by swelling, protein in the urine and high blood pressure. If one of these signs occurs, a woman should consult a doctor. Preeclampsia in a pregnant woman has varying degrees of severity (see below).

Preeclampsia

Severe degree associated with high blood pressure. Most often develops after the 20th week of pregnancy. If left untreated, it can have very negative consequences. If preeclampsia is diagnosed after 34 weeks, for the safety of mother and baby, the doctor considers the option of early delivery. The pathology is characterized by:

swelling of the body (arms, legs, face, abdomen) that does not go away after sleep;

presence of protein in urine, more than 300 mg per day. Healthy women have no protein in their urine;

blood pressure exceeds 140/90.

This condition is typical for typical gestosis and requires quick medical care.
Swelling is a symptom that, unfortunately, is often ignored because it affects many pregnant women.

Swelling occurs due to water retention in the body. Common cases include swelling of the lower extremities. While with gestosis, in addition to the lower extremities, the arms, face and abdomen swell.

Important! A woman with late toxicosis does not necessarily have to experience all the symptoms at the same time. Therefore, in each case, high blood pressure requires control.

Once a diagnosis is made, appropriate treatment must be implemented. This is important. Since complications may arise already at this stage. For example, a slowdown in blood flow through the placenta, which disrupts fetal nutrition and oxygen deficiency. This can lead to fetal malnutrition (growth retardation).

Timely treatment, sometimes in a hospital setting, is quite effective and normalizes the blood pressure of a pregnant woman.

Eclampsia

If measures are not taken in time for preeclampsia, then there is a high probability of the most dangerous degree of late toxicosis - eclampsia.

In addition to the signs listed above, a pregnant woman experiences additional symptoms, such as:

severe headaches;

dizziness;

anxiety;

disturbance of consciousness;

double vision;

vomiting and abdominal pain.

In severe cases (eclampsia), severe seizures may occur. Complications may include thrombosis, cerebral edema and acute renal failure. These are serious threats to the life of mother and child.

The consequence of a severe progressive form of gestosis can be HELLP syndrome, in which liver function and blood clotting are disrupted. This is an extremely dangerous condition. With this complication, severe pain appears in the upper abdomen, most often on the right under the ribs, nausea and vomiting.

Unfortunately, HELLP syndrome is not always immediately detectable, since in most cases the initial signs of this pathology are perceived by the woman as an acceptable deterioration in the condition that occurs in all mothers expecting a child.

Important to know! Help syndrome develops very quickly, one might say, with lightning speed. And if it is not detected quickly, it can lead to death within a few hours.

In cases where eclampsia threatens a pregnant woman or child, doctors decide to premature birth.

How is late toxicosis treated?

Mild to moderate forms of high blood pressure often do not require special treatment. Changing your lifestyle, diet, limiting salt to reduce the risk of gestosis and its complications.

If you suspect you have signs of it, you need to inform your doctor as soon as possible so that timely treatment can be implemented that will prevent the occurrence of dangerous complications.

In order to determine toxicosis in late pregnancy, a number of studies are performed. After that to the expectant mother appropriate medications are prescribed.
Most often, medications that lower blood pressure are administered, as well as drugs that reduce uterine contractions in order to prevent premature birth and regulate the water-salt balance.

In many cases, a woman diagnosed with gestosis is hospitalized to prevent possible complications.

The expectant mother should rest as much as possible and lie on her left side. This will improve blood circulation.

If late toxicosis is not treated, placental abruption, premature birth can occur, and can also lead to failure of the kidneys and cardiovascular system.
In addition to drug treatment, rest and an appropriate diet are necessary.

Lightly digestible, low-salt foods are recommended, rich in calcium.
In addition, constant monitoring of weight and blood pressure is required. In some cases on recent months pregnancy, when the woman’s condition does not improve despite the introduction medicines and following the doctor's recommendations, a caesarean section is performed.

If a woman of childbearing age suffers from hypertension, then she should prepare for pregnancy in advance in order to avoid possible complications in the form of toxicosis in late pregnancy and its complications. Especially if this is your second pregnancy.

Cases of gestosis in the first pregnancy increases the risk of development in subsequent ones. Not all blood pressure-lowering medications can be used during pregnancy.

In addition, you should pay close attention to risk factors. Often diabetes, obesity, high level cholesterol, smoking cigarettes or bad eating habits.

By the way, smoking, poor diet or obesity can cause not only hypertension, but also many other serious complications.

In women at risk, ultrasound is performed more often than in other women, as well as a study of protein levels in the urine.

Women with hypertension, chronic diseases and risk factors increase the likelihood of developing:

intrauterine fetal growth restriction;

fetal mortality;

preeclampsia and eclampsia;

premature separation of the placenta;

premature birth.

The only way to treat preeclampsia is to give birth. In patients at the end of 37 weeks of pregnancy, childbirth occurs as in normal cases. By this time, the child is already mature enough to live outside the mother’s body. In pregnant women with severe preeclampsia, delivery is carried out between 35 and 37 weeks.

At 24-34 weeks, preference is given to drug treatment, and early birth is postponed as long as possible.

At up to 24 weeks, a decision is made about a possible termination of pregnancy. The main focus here is to prevent the pregnant woman from being in mortal danger.

If premature birth is necessary, and the child’s pulmonary maturation has not yet been completed, doctors first accelerate it with medication.

With HELLP syndrome, delivery is often performed immediately. Otherwise, the situation may become life-threatening for mother and baby.

Consequences of gestosis

Preeclampsia can have many consequences. Therefore, after diagnosis, continuous monitoring of the mother and fetus is crucial. Various types Hypertensive diseases during pregnancy may partially overlap with each other.

Thus, from gestational hypertension, preeclampsia can develop first, and then eclampsia or Help syndrome.

Eclampsia can occur suddenly and become life-threatening to a pregnant woman within a few hours without any prior symptoms.

Preeclampsia can limit the amount of oxygen and nutrition the placenta provides to the baby. This can lead to decreased fetal weight and many other complications that are associated with preterm birth and prematurity.

Danger that may threaten the mother:

development of eclampsia;

bleeding problems. The blood may not clot at all;

possible premature placental abruption;

liver rupture;

However, these complications occur rarely and with severe gestosis. Eclampsia occurs in approximately one in 1,500 pregnant women. Most often this happens because the signs of preeclampsia have been suppressed or ignored.

The symptoms of this pathology, as already written, are convulsions, coma, severe headaches, blurred vision and consciousness, pain in the right hypochondrium, and even complete loss of consciousness.

This is a condition that directly threatens the life and health of mother and baby. It can cause permanent damage to a woman's brain, liver or kidneys. The condition of eclampsia requires a special, individually selected method of treatment.

Life after gestosis

Typically, high blood pressure, protein in the urine, and other symptoms of preeclampsia disappear by six weeks after delivery. In some cases, blood pressure may increase for several days after childbirth.

If a woman had preeclampsia during pregnancy, then in subsequent pregnancies the risk of occurrence is high. However, usually it is not so acute.

In addition, in those women who had high blood pressure during pregnancy. The risk of developing hypertension increases in later life.

Prevention

Each expectant mother may help reduce the risk of preeclampsia. First of all, she should undergo preventive examinations. Regular visits to the gynecologist help identify the first symptoms of pathology, which can be life-threatening for mother and baby.

To prevent pregnancy-related illnesses, many doctors recommend taking 450 mg of magnesium per day daily.

This drug is believed to have a positive effect on blood pressure and provide some protection against preeclampsia.

Besides, important role plays balanced and healthy eating. Lots of fresh fruits and vegetables, high quality is not enough and whole grain products should certainly be present in the diet of the expectant mother.

During the period when the mother is expecting a baby, it is useful to reduce the amount of salt to about three to four grams per day. This will help reduce swelling. There is a salt-free diet, which implies a complete abstinence from salt in any form. Helps remove excess fluid from the body, which means getting rid of edema.

It should be remembered that this diet can only be used for a short time, usually two weeks, and only with the approval of a doctor.

It is necessary to control fluid intake. The daily norm should not exceed one and a half liters. This includes first courses, teas, juices.

The expectant mother should monitor her weight. It would be correct to adhere to a diet where daily norm calories will not exceed 3000. A pregnant woman should gain weight no more than 350 grams per week.

Carbohydrates help transport amino acids, which are formed due to the breakdown of proteins. Therefore, without carbohydrates, the body will not receive proteins adequately and will not absorb them. But there must be moderation in everything. A large amount of carbohydrates is also harmful to the body.

Excess glucose, which occurs when carbohydrates are broken down, is stored as fat and causes hunger. This leads to overeating and excess weight gain, and also provokes diabetes.

It has long been believed that during pregnancy, the mother's body produces some kind of poison that causes various symptoms. However, this opinion is outdated. Most likely, there are various reasons that make changes in a woman’s body at this stage. As a result, some mothers have complaints. New research suggests that an unknown factor X may be involved, which affects blood vessel walls. Other scientists have not ruled out a connection with the mother's placenta, too low blood volume, malnutrition or poor nutrition during pregnancy. The exact reasons have not yet been studied or proven.

Attention! The information is for informational purposes only and should not be construed as a substitute for professional advice or treatment. Any self-medication is dangerous to health!

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Late toxicosis during pregnancy: symptoms, causes, consequences from 12 Feb 2019