Severe preeclampsia treatment. Preeclampsia in pregnancy: what is it? Eclampsia and preeclampsia - principles of treatment

One of the most common complications that occur in late pregnancy is preeclampsia. It is quite dangerous for the health of the mother and the unborn child,

which makes it an important and pressing issue in obstetrics. The greatest threat is posed by severe preeclampsia (code O14.1, according to the ICD), which can provoke seizures in the mother and even coma.

What is this disease?

Preeclampsia is a pathological condition of a pregnant woman, which is accompanied by a multisystem pattern of complications. According to the ICD, these include high blood pressure and the presence of large amounts of protein in the urine, which has the clinical name “proteinuria.” A concomitant symptom of the pathology is a high level of swelling of the body, namely the arms, legs, and face (ICD code O14.0).

Preeclampsia occurs in almost every fifth pregnant woman. However, a severe form of the disease is observed in 5% of women. Such indicators cause obstetricians to sound the alarm, since as a result of this syndrome, the supply of oxygen and nutrients to the child’s body slows down, which can provoke a slowdown in its development.

For the mother, this condition is also considered extremely dangerous, since every second pregnant woman suffering from severe preeclampsia dies as a result of suffocation. This pathology provokes dysfunction of the kidneys, brain, liver and lungs, which is observed not only in the postpartum period. Problems in the functioning of the above organs most often make themselves felt in the mother’s subsequent life.

The risk of developing the disease is especially high in women who had preeclampsia during a previous pregnancy. Patients who previously suffered from hypertension or kidney disease are also under special supervision. Heredity in some cases can also provoke the development of the syndrome in the second or third semester of pregnancy.

There are mild, moderate, and severe forms of preeclampsia. Each of them is characterized by a different complexity of symptoms and possible complications. The mild form is characterized by an inconspicuous course of the disease, which is almost impossible to detect without a special medical examination. Moderate or moderate preeclampsia most often occurs in pregnant women and requires constant medical supervision, as it can develop into a severe stage, which is the most dangerous and can provoke premature placental abruption.

Symptoms of preeclampsia

The main symptoms of preeclampsia are:

- frequent headaches;

- dizziness;

- the appearance of black dots before the eyes;

- blurred vision;

- high blood pressure;

- pain in the abdomen;

- nausea and vomiting;

- excessive swelling of the limbs;

- significant weight gain;

- lack of urge to urinate;

- a sharp decrease in the amount of urine.

In severe cases of pathology, convulsions, loss of consciousness, and suffocation may occur. Also in this condition there is a high level of protein in the urine (from 5g/l).

Causes of pathology

The proven causes of preeclampsia are:

— urolithiasis (UKD) or other disorders of the kidneys;

— mother’s age from 35 years;

- the presence of a severe stage of pathology during a previous pregnancy;

- genetic predisposition on the part of the pregnant mother;

- arterial hypertension;

- overweight;

- multiple pregnancy;

- diabetes mellitus.

Diagnostics

The best way to avoid the development of preeclampsia and its progression to a severe stage is considered to be timely diagnosis. In the early stages of pregnancy, a woman must register with an obstetrician-gynecologist, who will conduct regular examinations.

One of the mandatory research methods that a pregnant woman must undergo every time she is examined by a doctor is measuring blood pressure. As a rule, in the second trimester of pregnancy there is a slight increase. The task of specialists in this case is to timely diagnose the onset of the development of a mild degree of pathology, which, in the absence of proper treatment, can rapidly develop into a more dangerous moderate and severe form.

Another mandatory examination of a pregnant woman is a general urine test. Only it can show the presence of a protein, which signals the development of severe preeclampsia.

Systematic weight measurement is also necessary for timely diagnosis of pathology. After all, an unreasonable and sharp increase in it may indicate water retention in the tissues - one of the main symptoms of preeclampsia.

If a woman notices that in the evening the volume of her legs, arms and fingers increases sharply, while she feels unwell, feels dizzy and has a headache, she should immediately inform the doctor. After all, these symptoms may indicate the development of a mild degree of pathology.

Treatment of preeclampsia

Treatment of preeclampsia can be carried out in several directions. The main determining factor in this process is the degree of the disease. The duration of pregnancy also plays an important role. After all, any medical intervention implies an impact not only on the health of the woman, but also on her unborn child. And the task of doctors is to select methods and drugs that would cause as little harm as possible to the baby.

Therefore, the main thing in the treatment of preeclampsia is considered to be the prevention of a possible attack, which is accompanied by convulsions, difficulty breathing, loss of consciousness and, in some cases, death of the pregnant woman.

Treatment of severe forms

Treatment of severe preeclampsia is a rather complex and at the same time responsible task for obstetricians. Since it is considered the most dangerous to the health and life of the mother. Unlike mild and moderate, severe degree requires a complete examination of the woman’s body. Doctors often prefer hospitalization, which allows for round-the-clock supervision of the pregnant woman.

In most cases, doctors recommend bed rest for the expectant mother, which helps increase blood flow to the placenta. This allows you to avoid its premature detachment.

A prerequisite for treatment is taking medications that lower blood pressure. Naturally, doctors select the medications that are safest for the fetus. Taking diuretic medications is also necessary, especially if excess water provokes significant weight gain.

To reduce swelling in the body, it is recommended that pregnant women limit the consumption of salty, spicy and fried foods. The amount of water you drink should also be reduced, especially at night. But this does not mean that you should avoid liquids altogether. It is necessary for the pregnant woman’s body just like air, food, etc.

If a severe form of preeclampsia occurs at 37-38 weeks of pregnancy, then most likely doctors decide to induce artificial birth. This is necessary in order to avoid the occurrence of eclampsia (code O15, according to the ICD) and save the baby’s life.

Preeclampsia (preeclampsia) is a complication that occurs during pregnancy or the postpartum period and affects both mother and child. Preeclampsia is characterized by high blood pressure (hypertension) as well as abnormally high levels of protein in the urine (proteinuria).

What is preeclampsia (gestosis)?

is a condition during pregnancy that is characterized by high blood pressure and the presence of... Preeclampsia can develop in the second half of pregnancy (after 20 weeks), including during labor or even after childbirth.

There are mild preeclampsia (possible outpatient management), severe preeclampsia and eclampsia. The more severe the preeclampsia, the higher the risk of developing serious complications.

Preeclampsia can pose a serious risk to mother and baby. Therefore, at the slightest suspicion of preeclampsia (preeclampsia), it is recommended to immediately consult a doctor.

Why is preeclampsia (preeclampsia) dangerous?

Most women with preeclampsia do not develop serious complications. But as preeclampsia becomes more severe, many of the pregnant woman's organs can be affected, which can lead to serious and even life-threatening consequences. This is why it is necessary to decide on an emergency delivery if the condition is severe or worsening.

Preeclampsia (preeclampsia) causes blood vessels to narrow, leading to high blood pressure and reduced blood flow. In this case, the liver, kidneys and brain are most affected. Additionally, if less blood flows into the uterus, the baby may experience problems such as slower growth, oligohydramnios, and placental abruption.

Changes in the blood vessels caused by preeclampsia can cause fluid to "leak" from the capillaries into the tissue, causing. And when the tiny blood vessels in the kidneys leak, protein from the blood leaks into the urine. (A small amount is normal, but if there is a lot, it signals problems.)

What are the signs and symptoms of preeclampsia?

Because the clinical manifestations of preeclampsia (preeclampsia) are not always obvious, diagnosing preeclampsia is not so easy. Mild preeclampsia may be asymptomatic.

The main features include:

1. High blood pressure. High blood pressure is traditionally defined as blood pressure (BP) of 140/90 or more measured twice with at least 6 hours between measurements. This is one of the most important indicators that preeclampsia may develop. However, an increase in diastolic (lower) pressure by 15 mm Hg. Art. or more, and/or an increase in systolic (upper) pressure by 30 mm Hg. Art. or more from the initial blood pressure value (measured before 20 weeks of pregnancy), may be a cause for concern and requires a more detailed examination, even if the pressure does not exceed 140/90, that is, it is not a criterion for preeclampsia. This relative increase in blood pressure is of great importance in the presence of other signs of preeclampsia.

   If blood pressure is elevated and there is no protein in the urine, then they speak of arterial hypertension. Arterial hypertension can be caused by pregnancy (high blood pressure diagnosed only after the 20th week of pregnancy) and hypertension not associated with pregnancy (high blood pressure diagnosed before the 20th week of pregnancy).



2. Increased content. The amount of protein in the urine can fluctuate throughout the day, so a 24-hour urine protein test is considered the most accurate.

In most cases, the expectant mother is not aware of these signs until her next visit to the doctor. Despite the fact that 10-15% of all pregnant women have high blood pressure, this does not necessarily mean the presence of preeclampsia. To make a diagnosis of preeclampsia, in addition to high blood pressure, the presence of protein in the urine is required.

As preeclampsia progresses, other symptoms may also occur:

• headache;
• visual impairment (increased sensitivity to light, blurred vision, spots before the eyes, etc.);
• sudden severe swelling (significant increase in existing swelling, swelling of the face);
• sharp pain under the ribs;
• nausea, vomiting;
• convulsions (a sign of eclampsia).

They are an integral part of most pregnancies, especially during the third trimester. Usually the lower part of the body swells, for example, the legs, ankles; the swelling is not very pronounced in the morning and intensifies in the evening. With preeclampsia, swelling occurs suddenly and is usually pronounced. without the presence and increased pressure are currently considered normal and do not require special treatment (with the exception of generalized edema).

Who can get preeclampsia?

Any pregnant woman can develop preeclampsia. However, some women are more susceptible to it than others. The most significant risk factors for preeclampsia (preeclampsia) are:

• presence of preeclampsia in previous pregnancies;
• multiple pregnancy;
• chronic hypertension (high blood pressure);
• first pregnancy;
• diabetes mellitus;
• kidney diseases;
• obesity, especially with a body mass index (BMI) of 30 or more;
• age over 40 or under 18 years;
• family history of preeclampsia (presence of the disease in mother, sister, grandmother).

How is preeclampsia treated?

When monitoring a woman with preeclampsia (gestosis), the doctor is guided by many factors, including the gestational age and condition of the child, the health and age of the mother, and also carefully monitors the progression of the disease. Blood pressure is measured, the results of laboratory tests are assessed, which show the condition of the pregnant woman’s kidneys and liver, and the blood’s ability to clot. The doctor also monitors the child’s development and makes sure that the child is not in danger.

If the baby's development does not correspond to the gestational age, or it has stopped developing altogether, then it may be dangerous for it to remain in the uterus, even if the baby is still too small. If a mother develops severe preeclampsia/eclampsia, which can lead to serious consequences, childbirth may be the only solution to save the mother and ensure the survival of the baby.

Unfortunately, there are no effective measures to prevent and treat preeclampsia (preeclampsia). Treatment of severe preeclampsia is based on careful assessment, stabilization, continuous monitoring, and delivery at the optimal time for the mother and her baby.

Is it possible to somehow prevent the development of preeclampsia?

There is currently no reliable way to prevent the development of preeclampsia. Regular use of low-dose aspirin and calcium supplements may help prevent preeclampsia, according to some studies. Never take aspirin during pregnancy unless prescribed by your doctor.

Today, the best thing you can do to protect yourself and your baby as much as possible is to visit your doctor regularly during pregnancy. At each visit, your doctor should measure your blood pressure and check your urine for protein. It is also important to know the warning signs of preeclampsia (preeclampsia) so that you can inform your doctor about them in time and begin treatment as quickly as possible.

Preeclampsia cannot be considered an independent disease; it is a pathological condition characterized by malfunctions in the fetus-placenta-mother system. That is why preeclampsia can be observed only during pregnancy, starting from about 20 weeks, and manifest itself with symptoms of disorders of the internal organs and central nervous system of varying degrees of complexity.

What is the cause of this condition, what are its main manifestations and is it possible to avoid preeclampsia during pregnancy?

Symptoms of preeclampsia and its causes

The insidiousness of preeclampsia in pregnant women lies in the absence of any specific external manifestations or clear symptoms that can make it clear to a pregnant woman that her condition requires urgent medical intervention. The first indicator of the onset of preeclampsia is considered to be a combination of factors such as:

a significant increase in a pregnant woman’s blood pressure (arterial hypertension);

the presence of protein in the urine (proteinuria) and a sharp decrease in the amount excreted.

Over time, these symptoms are accompanied by swelling of the arms, legs and face. It is important not to confuse this with swelling, which can accompany the normal course of pregnancy and be its constant companion. Such swelling is almost unnoticeable at the beginning of the day, but can increase significantly in the evening. Edema with preeclampsia always occurs suddenly and is much more serious.

The manifestations listed above are enough for the doctor to diagnose preeclampsia. However, over time, the symptoms already described may intensify or, conversely, become less pronounced. New manifestations of preeclampsia may also occur, namely:

severe headaches that provoke poor health, heaviness in the back of the head, blurred vision, “fog” before the eyes;

rapid gain of excess weight, which is caused by fluid retention in the body of a pregnant woman;

liver dysfunction, which causes nagging pain in the right hypochondrium, nausea, and sometimes vomiting;

sleep disturbance – insomnia or, on the contrary, drowsiness;

frequent mood swings, irritability or apathy towards everything around you;

a decrease in platelet levels, which is determined using a clinical blood test.

Modern medicine has not yet come to a consensus regarding the causes of such a disorder in pregnant women as preeclampsia. One of the most widespread and accepted in scientific circles is the opinion that preeclampsia is caused by a violation of the process of formation of placental vessels, which, in turn, leads to limited blood flow in the placenta.

When determining the main causes of preeclampsia, scientists identify several factors that can affect its manifestation:

Genetic factors and predispositions.

Problems with the mother’s immune system that existed before pregnancy and worsened during pregnancy.

Injuries or damage to blood vessels, including the placenta, of various origins.

Types of preeclampsia

Depending on the time of occurrence, preeclampsia can be divided into three types:

1. Preeclampsia in pregnant women.

   Preeclampsia in parturient women.

   Postpartum (or postpartum) preeclampsia.

Preeclampsia during pregnancy is observed on average in 5-10% of women and occurs after the 20th week of pregnancy. With insufficient attention to this dangerous condition, a woman may develop eclampsia, which, in turn, is fraught not only with health, but also with the life of the mother and child.

Regardless of the quality of the course of the entire period of pregnancy, symptoms of preeclampsia can arise unexpectedly during labor that has already begun (preeclampsia in parturient women). This can be expressed in a sharp increase in blood pressure or problems in the functioning of the kidneys, liver, nervous system, even convulsive attacks.

In some cases, symptoms of preeclampsia, which directly threaten the life and health of the mother, may persist for 2-3 days after birth (postpartum preeclampsia).

Based on the severity and manifestation of symptoms of preeclampsia, we can talk about two forms of its course:

moderate form;

severe form.

Despite the seemingly insignificant manifestation of symptoms of moderate preeclampsia, ignoring them can lead to serious consequences for the mother and child, even death. That is why such attention is paid to adhering to the schedule of visiting specialists and conducting all necessary tests and studies.

With the development of a severe form of preeclampsia, more threatening symptoms are added to the already indicated manifestations, indicating a violation of cerebral circulation. Doctors believe that the main reasons for this condition are a decrease in cerebral blood flow, leading to hypoxia of the brain (its neurons) and a significant increase in the sensitivity of neurons to external stimuli.

Treatment and prevention



The difficulty in treating preeclampsia is that drugs that can be used, for example, to lower blood pressure or normalize kidney function and liver function in pregnant women, can cause significant harm to the unborn baby. In this situation, the doctor weighs the risks posed by possible treatment or refusal of it. Doctors are often inclined to start treatment, since failure to take any measures can lead to a rapid and irreversible process of preeclampsia transitioning into such an extremely life-threatening condition for the mother and fetus as eclampsia.

If the situation, in the opinion of doctors, requires mandatory intervention, the pregnant woman is offered hospitalization, during which she will:

therapy was carried out aimed at reducing edema and fluid retention in the woman’s body;

medications are prescribed to lower blood pressure and bring it to normal levels;

treated with anticonvulsants if any occur;

Corticosteroids have been prescribed to normalize liver function and bring platelet levels back to normal.

If measures to eliminate the manifestations of preeclampsia were taken in a timely manner, then, most likely, neither the expectant mother nor her child will be in danger of complications.

If we talk about the prevention of preeclampsia, then its main steps can be considered:

Strict control of fluid intake.

Complete exclusion or limitation of salt intake.

Complete refusal of strong black or green tea, as well as coffee, replacing them with compotes and herbal infusions.

Refusal of fried, fatty, hot or spicy foods.

Regular feasible physical activity and walks.

And, of course, mandatory and complete rest for a pregnant woman.

Preeclampsia, or preeclampsia, is a pregnancy complication that develops after the 20th week of pregnancy. Preeclampsia is based on disorders of the general blood circulation with the development of multiple organ failure.

Preeclampsia is not an independent disease, it is a syndrome caused by the inability of the mother's adaptive systems to meet the needs of the growing fetus, which is manifested by perfusion-diffusion insufficiency of the placenta, expressed to varying degrees.

As the duration of pregnancy increases, and, accordingly, the needs of the fetus, gestosis also progresses, manifesting itself in a clinical triad of symptoms: proteinuria, hypertension and edema (excessive weight gain).

According to statistics, the frequency of gestosis in pregnant women on average across the country has increased in recent years and ranges from 7% to 20%. In the structure of causes of maternal mortality in the Russian Federation, gestosis consistently ranks third and ranges from 11.8% to 14.8%. Some authors note that women who have suffered gestosis may develop chronic kidney pathology and hypertension. The high incidence of maternal and perinatal morbidity and mortality is based on the lack of accurate knowledge about the pathogenesis of the disease, which depends on many predisposing factors, as well as underestimation of the severity and reliable diagnostic criteria, which leads to inadequate therapy and various complications depending on the timeliness and method of delivery and volume anesthesiological and resuscitation care.

Classification of gestosis

There are many classifications of gestosis, of which it seems advisable for an obstetrician clinician to use the classification proposed by the International Society for the Study of Hypertension in Pregnancy (V. Pipkin, H. S. Wallenberg, 1998):

hypertension in pregnancy (GP);

preeclampsia (HD with proteinuria);

chronic hypertension or kidney disease;

chronic hypertension with the addition of preeclampsia;

unclassified hypertension and/or proteinuric disorders, eclampsia.

According to the terminology of the American Society of Obstetricians and Gynecologists (1972), the classification of gestosis includes the following nosological units:

edema of pregnant women;

proteinuria;

arterial hypertension;

preeclampsia;

eclampsia.

Most foreign authors diagnose preeclampsia with a combination of edema, proteinuria and hypertension, regardless of their severity. On the recommendation of WHO and in accordance with the requirements of the ICD 10th revision, the following classification of late gestosis in pregnant women was approved (1998).

Hypertension during pregnancy.

Swelling during pregnancy.

Proteinuria during pregnancy.

Mild preeclampsia (corresponds to grade I nephropathy).

Preeclampsia of moderate severity (corresponds to stage II nephropathy).

Severe preeclampsia (corresponds to grade III nephropathy and/or preeclampsia).

Eclampsia.

There are pure and combined forms of late gestosis. Combined gestosis in pregnant women develops against the background of extragenital diseases. Features of combined gestosis are the early onset of the disease (before 20 weeks of pregnancy), a more severe course compared to pure forms.

The etiology of gestosis depends on two main factors:

placental factor;

maternal factor.

Placental factor - it is known that the development of gestosis begins after the formation and functioning of the placenta. Placental factor is associated with incomplete trophoblast invasion of the maternal spiral arteries, resulting in insufficient perfusion of the placenta with subsequent ischemia.

At this stage, the production of vasoactive (mediators and markers of inflammation, tumor necrosis factor (TNF-alpha), interleukins) substances begins that perform a compensatory function, eventually leading to disruption of the integrity of the vascular endothelium, with the transition of these substances into the vascular bed of the mother and the further development of vascular dysfunction in the maternal bloodstream, which is expressed by multiple organ failure in the mother. Due to placental ischemia and cytokine-mediated oxidative stress, low-density lipoprotein (LDL) levels increase, which promotes the accumulation of triglycerides in the endothelium, further exacerbating the process of endothelial damage.

The maternal factor includes extragenital diseases present in the mother (arterial hypertension (HTN), kidney disease, lipid metabolism disorders (LDM), diabetes mellitus (DM), etc.), which are directly related to endothelial damage. For example, elevated serum lipid levels in diabetes mellitus or NJO may increase lipid peroxidation and predispose to endothelial damage. Among maternal factors, one should also note an increased level of homocysteine, a product of the conversion of the essential amino acid methionine. Excess homocysteine ​​accumulates in the blood and has a toxic effect on the endothelial cell. During a normal pregnancy, homocysteine ​​levels decrease. With a deficiency of B vitamins and folic acid, as well as in women who smoke, with a sedentary lifestyle, diabetes and renal pathology, and impaired methionine metabolism, the level of homocysteine ​​increases.

Pathogenesis. An obligatory component of the pathogenesis of gestosis is endothelial dysfunction. The endothelium, or the internal cellular lining of blood vessels, ensures the integrity of the vascular wall and selective permeability for various substances between the intravascular and interstitial space, which is ensured by the specific structure of the endothelium. The trigger for endothelial dysfunction is hypoxia, which develops in the tissues of the uteroplacental system. Local damage to the endothelium leads to the release of toxic endothelin, a decrease in the synthesis of vasodilators, cellular disaggregants (bradykinin, prostacyclin). Damage to the endothelium increases its sensitivity to vasoactive substances, hypercoagulation and generalized vasospasm, which results in hypoxia and ischemia of vital organs. Markers of endothelial dysfunction are substances synthesized by the endothelium or being elements of the endothelium. These are von Willebrand factor, tissue plasminogen activator, thromboxane A2, fibronectin, prostacyclin deficiency in the vascular bed, endothelial cells circulating in the blood.

As is known, an increase in von Willebrand factor and fibronectin is responsible for the development of hypercoagulation and an increase in the thrombogenic properties of the endothelium. In turn, the level of prostacyclin, which provides antiplatelet and vasodilatory function, decreases. The level of nitric oxide also decreases, which during a normal pregnancy tends to increase and has a relaxing effect on blood vessels. The level of endothelin, a powerful vasoconstrictor, increases, antiphospholipid antibodies are detected, which have a damaging effect on the vascular endothelium, as proven by many authors. The study of these factors makes it possible to assess the degree of vascular damage and remains a promising direction in the study of gestosis.

Recently, studies have appeared aimed at studying the significance of mediators of endothelial dysfunction, which are produced when the integrity of the endothelium is damaged, which is quite informative for determining the severity and outcome of gestosis. These are pro- and anti-inflammatory cytokines, on the basis of which it is possible to establish the severity and degree of the systemic inflammatory response of the vascular system - TNF-alpha, interleukins-1 (8), intercellular adhesion molecules, the mononuclear phagocyte system (neutrophils, monocytes, lymphocytes), quantitative indicators which grow in proportion to the severity of gestosis. Pathomorphological processes during gestosis in vital organs, as a result of vascular dysfunction:

Circulatory system:

increased total peripheral vascular resistance, decreased cardiac output;

arterial hypertension;

impaired vascular permeability and hypovolemia. Constriction of peripheral vessels and centralization of blood circulation;

increased blood viscosity and osmolarity, thrombocytopenia and intravascular hemolysis (in severe forms).

Central nervous system: due to decreased cerebral blood flow due to vasospasm, there is increased excitability of the central nervous system (CNS), pinpoint hemorrhages, hypertensive encephalopathy and cerebral edema in severe cases.

Kidneys: decreased renal blood flow and glomerular filtration, increased serum creatinine concentrations. Protein permeability increases, sodium and water are retained.

Liver: Liver damage is characteristic of eclampsia, the cause of which is still unclear. Characteristic changes in the liver during gestosis: periportal necrosis, hemorrhages, decreased synthesis of albumin, procoagulants, increased levels of transaminases, hemolysis, activation of proteolysis. The development of fatty hepatosis, acute steatosis or jaundice of mixed origin is possible.

Respiratory organs: the vital capacity of the pulmonary capillaries and hydrostatic pressure in the pulmonary vessels decreases.

Placenta: in the endothelium of placental vessels during gestosis, massive deposits of immune complexes and cytokines IL-8 and IL-1 occur, which disrupt immune homeostasis and the integrity of the endothelium, contributing to the development of placental insufficiency.

Factors predisposing to gestosis:

Women with chronic stress (psychosocial stress characteristic of the late 20th - early 21st centuries), fatigue, which indicates inertia of the central nervous system and weak adaptive ability.

Hereditary predisposition: the presence of gestosis on the maternal side, congenital and acquired insufficiency of the system of neuroendocrine regulation of adaptive reactions (hypotrophy in the antenatal period), allergic and immunological reactions, general genital infantilism, as well as age under 17 years. This also includes the predisposition of “candidate” genes to thrombophilic complications (mutation of cystathione beta synthetase, prothrombin gene G20210).

Pregnancy due to diseases: cardiovascular system (hypertension, rheumatic heart disease), disruption of the endocrine glands (diabetes, hyperthyroidism), kidney (nephritis, pyelonephritis), hepatobiliary system (hepatitis, cholecystitis), vegetative-vascular dystonia, obesity, arterial hypertension.

Women who have experienced gestosis during previous pregnancies.

Chronic intoxication (smoking, etc.) and infections.

Environmental factors (chronic hypoxia, poor nutrition).

Diagnostics

The diagnosis can be made based on a combination of clinical and laboratory criteria.

Basic:

urinalysis (determination of protein in urine more than 0.3 g/l; oliguria - urine volume per day less than 400 ml);

Blood pressure is above 135/85 mm Hg. Art. (in the presence of hypotension, an increase in systolic blood pressure of 30 mm Hg from the original; diastolic blood pressure by 15 mm Hg);

biochemical blood parameters (liver transaminases, bilirubin and its fractions (characteristically increased values), total protein, urea, creatinine);

hemostasis parameters (thromboelastography, activated partial thromboplastin time (aPTT), platelet count and aggregation, fibrinogen, its degradation products, endogenous heparin concentration, antithrombin III);

blood concentration indicators (hematocrit, hemoglobin, number of erythrocytes and platelets (characteristic thrombocytopenia ≥ 100).

Additional:

measurement of central venous pressure (CVP);

assessment of the condition of the fundus;

determination of mediators of systemic inflammation in the blood and markers of endothelial dysfunction in the blood;

non-invasive instrumental determination of the state of water sectors (method of integral rheography, integral impedancemetry);

ultrasound examination of vital organs of the mother and fetus;

Dopplerometry of maternal and fetal hemodynamics.

When studying maternal hemodynamics, four main pathogenetic variants of systemic circulatory disorders are identified.

Hyperkinetic type of central uterine hemodynamics (CMH), regardless of the values ​​of total peripheral vascular resistance (TPVR) and eukinetic type with normal values ​​of TPVR. With this type, moderate disorders of cerebral (in 9%), renal (in 9%), utero-placental- fetal (7.2%) and intraplacental (69.4%) blood circulation. In 11% there is intrauterine growth retardation. In 91%, mild severity of gestosis is clinically detected. The therapy for gestosis is effective in most cases. The prognosis for mother and fetus is favorable.

Eukinetic type of CMG with increased values ​​of TPSS and hypokinetic type of CMG with normal values ​​of TPSS. With this type, blood flow disorders are recorded, mainly of the second degree in the system of renal arteries, utero-placental-fetal and intraplacental blood flow. Moderate forms of gestosis prevail. Intrauterine growth restriction (IUGR) is detected in 30%, decompensated placental insufficiency - in 4.3%, preeclampsia - in 1.8%. The therapy for gestosis has an effect of 36%.

Hypokinetic type of CMG with increased peripheral vascular resistance. Disturbances of the renal, uteroplacental and intraplacental blood flow, mainly II and III degrees of severity, are detected in 100%. In 42%, a bilateral disturbance of blood flow in the uterine arteries is determined. This type is characterized by moderate and severe forms of gestosis, IUGR in 56%, decompensated fetoplacental insufficiency (FPI) in 7%, preeclampsia in 9.4%. There is no improvement in hemodynamic and clinical parameters during therapy, and half experience a deterioration. The prognosis for the mother and fetus is unfavorable, since with this type of hemodynamics the highest percentage of severe forms of gestosis, decompensated placental insufficiency, as well as premature delivery and perinatal losses are observed.

Severe cerebral hemodynamic disturbances (increased pulsation index in the internal carotid artery (ICA) more than 2.0 and/or retrograde blood flow in the supratrochlear arteries). With this type, forms of gestosis are detected with rapid progression of the clinical picture (within 2–3 days). Regardless of the indicators of central, renal, uteroplacental and intraplacental hemodynamics, preeclampsia develops in 100% of cases with this type. The maximum period from registration of pathological blood flow values ​​in the internal carotid arteries to the development of the clinical picture of preeclampsia does not exceed 48 hours.

Therapy for gestosis is based on treating symptoms and preventing complications. At the same time, one should strive for a pathogenetically substantiated, comprehensive and individually selected treatment regimen depending on the clinical form and laboratory parameters.

Basic principles that should be followed when treating gestosis:

provision of medical and protective regime;

relieving generalized vascular spasm, normalizing blood pressure, adequate magnesium therapy in the absence of intolerance to it;

infusion correction of hypovolemia;

improving blood circulation and functioning of the most sensitive organs (kidneys, liver). Improving uteroplacental circulation to prevent hypoxia and fetal malnutrition;

correction of water-salt, protein and carbohydrate metabolism, as well as acid-base state (ABS);

during childbirth, providing adequate pain relief, preventing massive blood loss and coagulation disorders during childbirth and the postpartum period;

continuation of therapy for gestosis and residual effects in the postpartum period, to prevent the development of chronic pathology of the kidneys and cardiovascular system.

Today, most authors consider it unacceptable to treat gestosis on an outpatient basis. It is important to provide first aid at home, in a antenatal clinic and during transportation of a pregnant woman to a hospital, which requires the availability of the necessary drugs to normalize blood pressure, normalize the function of the central nervous system, and the cardiovascular system. The ambulance must be equipped with equipment for administering nitrous-oxygen anesthesia if necessary. Treatment of a pregnant woman (parturient, postpartum woman) with gestosis is carried out by an obstetrician-gynecologist, together with an anesthesiologist-resuscitator.

Normalization of central nervous system function is carried out through sedative and psychotropic therapy.

In patients with dropsy, mild to moderate nephropathy without extragenital pathology, preference should be given to sedatives of plant origin (valerian, motherwort extract) in combination with hypnotics (Eunoctin or Radedorm at night) or tranquilizers (Relanium, Seduxen, Phenazepam, Nozepam) in doses depending on the condition.

In case of moderate nephropathy and preeclampsia, all initial manipulations are carried out against the background of inhalation anesthesia using benzodiazepane tranquilizers, neuroleptics, analgesics, antihistamines, barbiturates as indicated.

The indication for intubation and artificial pulmonary ventilation (ALV) is currently eclampsia and its complications, the need for abdominal delivery.

In the postoperative or postpartum periods, transferring a parturient woman to spontaneous breathing is possible no earlier than 2 hours after delivery, only with stabilization of systolic blood pressure (not higher than 140–150 mm Hg), normalization of central venous pressure, heart rate, diuresis rate (more than 35 ml/hour) against the background of restoration of consciousness.

At low CVP values ​​(less than 3 cm H2O), antihypertensive therapy should be preceded by infusion-transfusion therapy. The drug of choice is magnesium sulfate. The relevance of magnesium therapy remains unchanged. In addition to the anticonvulsant effect, magnesium sulfate has a noticeable hypotensive and diuretic effect. It also promotes the production of prostacyclin, which is a mediator of vascular relaxation, reduces endothelin levels, suppresses platelet aggregation, and prolongs bleeding time. Limitations in the use of the drug are its ability to easily cross the placenta, ineffectiveness in renal failure and the possibility of cardiogenic shock and pulmonary edema. Intramuscular administration of the drug has a weak narcotic, noticeable sedative effect, relieves spasm of peripheral vessels, which in the kidneys leads to an increase in diuresis and a decrease in proteinuria.

The initial dose is 2.5 g of dry matter. The total daily dose of magnesium sulfate is at least 12 g intravenously under the control of respiratory rate, hourly diuresis and knee reflex activity. For severe gestosis, magnesium therapy is carried out using perfusers and infusion pumps, which limits the introduction of crystalloids into the pregnant woman's body.

Along with magnesium, you can use calcium antagonists such as Verapamil 80 mg per day or Norvasc 5-10 mg per day. If there is no effect from the presented antihypertensive therapy, short-acting ganglion blockers (Pentamine) or nitrate derivatives (sodium nitroprusside) are used.

The following are currently recommended as antihypertensive therapy:

calcium antagonists (Verapamil, Norvasc);

blockers and stimulants of adrenergic receptors (Clonidine, Atenolol);

vasodilators (hydralazine, sodium nitroprusside, prazosin);

ganglion blockers (Pentamine, atracurium besilate).

For mild nephropathy, monotherapy (calcium antagonists, antispasmodics) is used; for moderate nephropathy, complex therapy is used for 5–7 days, followed by a transition to monotherapy if there is an effect.

Infusion-transfusion therapy (ITT) is used to correct hypovolemia, in order to replenish circulating blood volume (CBV), plasma colloid-osmotic pressure, rheological and coagulation properties of blood, macro- and microhemodynamics.

Infusion therapy begins with the use of crystalloids (saline solution, Mefusol, Chlosol, Ringer-Lactate solution) for the primary replacement of bcc and continues with colloids (6% and 10% solutions of hydroxylated starch (HES) - Refortan, Infucol, Tetraspan, Voluven, etc.) , to attract fluid from the interstitial space into the bloodstream. The ratio of colloids and crystalloids is from 1:1 to 2:1. Cardiotropic drugs (Corglicon, Cocarboxylase, vitamins C, B) are prescribed simultaneously with crystalloids to prevent possible cardiovascular failure. The volume of ITT is determined by the values ​​of hematocrit (not lower than 0.27 l/l and not higher than 0.35 l/l), diuresis (50–100 ml/h), central venous pressure (not less than 6–8 cm water column), indicators hemostasis (antithrombin III not less than 70%, endogenous heparin not less than 0.07 units ml), blood pressure figures, protein content in the blood (not less than 60 g/l). It should be noted that the more severe the hypertension, the less ITT should be performed.

If colloids predominate in the ITT composition, complications such as colloid nephrosis and worsening hypertension are possible; with an overdose of crystalloids, hyperhydration develops. The infusion of protein-containing drugs in severe forms of gestosis is important, since the infusion of concentrated solutions of plasma, protein and especially albumin normalizes the protein composition of the blood and promotes the movement of fluid from the intercellular extravascular space into the bloodstream.

When performing ITT, the rate of fluid administration and its ratio to diuresis are important. To prevent congestive heart failure and pulmonary edema, at the beginning of the infusion, the rate of solution administration is 2–3 times higher than diuresis; subsequently, against the background or at the end of fluid administration, the amount of urine per hour should exceed the volume of injected fluid by 1.5–2 times.

It is worth noting that hydroxyethyl starch (HES) preparations are the drugs of choice for plasma replacement in the treatment of gestosis. Starch for the production of HES is obtained from potatoes or corn. The structural similarity of HES to glycogen provides them with the following properties:

replenishment of vascular volume due to the ability to bind water;

influence on the rheological properties of blood (plasma viscosity and APTT increases, microcirculation and oxygen supply to tissues improves);

restoration of damaged endothelium, reduction in the level of circulating adhesion molecules, cytokines, inhibition of von Willebrand factor release.

Normalization of water-salt metabolism is carried out by prescribing diuretics, the use of which in gestosis remains controversial.

To normalize diuresis in nephropathy of mild and moderate severity in the absence of effect from bed rest, diuretic herbal preparations are used, and in the absence of effect from the latter, potassium-sparing diuretics (Triampur compositum, 1 tablet for 2-3 days).

Saluretics (Lasix) are administered for nephropathy of moderate severity and for severe forms of gestosis, when the central venous pressure is restored to 5–6 cm of water. Art., values ​​of total protein in the blood of at least 60 g/l, symptoms of hyperhydration, with diuresis less than 30 ml/hour. It should be borne in mind that a decrease in diuresis during gestosis is not associated with kidney damage, but is a consequence of vascular spasm and a decrease in renal blood flow. Therefore, diuretics are used only after achieving at least a partial hypotensive effect.

Normalization of the rheological and coagulation properties of blood should include one of the disaggregants: along with Trental, Curantyl, xanthinol nicotinate, Aspirin and the anticoagulant Fraxiparine Forte are used. Disaggregants are initially administered intravenously in the form of solutions, subsequently in tablet form for at least one month.

Therapeutic doses of Aspirin are selected individually depending on the thromboelastogram parameters.

Normalization of the structural and functional properties of cell membranes and cellular metabolism is carried out by antioxidants (vitamin E, Solcoseryl), membrane stabilizers containing polyunsaturated fatty acids (PUFAs) (Lipostabil, Essentiale forte, Lipofundin, Eikonol). Correction of disturbances in the structural and functional cell membranes in pregnant women with mild nephropathy is achieved by including tablets in the treatment complex (vitamin E, Essentiale Forte, Lipostabil); for moderate and severe nephropathy, membrane active substances should be administered intravenously until the effect is obtained, followed by switching to tablet preparations for up to 3–4 weeks.

In patients with moderate nephropathy and the presence of FGR with a gestation period of up to 30–32 weeks or less, it is necessary to administer lipofundin 2–3 times a day for 15–20 days and Solcoseryl.

The complex therapy of gestosis is simultaneously aimed at normalizing the uteroplacental circulation. Additionally, beta mimetics (Ginipral, Bricanil in individually tolerated dosages) can be used for this purpose.

Extracorporeal methods of detoxification and dehydration, plasmapheresis and ultrafiltration are used in the treatment of severe forms of gestosis.

Plasmapheresis:

severe nephropathy with gestation up to 34 weeks and the absence of effect from infusion-transfusion therapy to prolong pregnancy;

in complicated forms of gestosis (HELLP syndrome and acute fatty hepatosis of pregnancy (AFPH)) to relieve hemolysis, disseminated intravascular coagulation, and eliminate hyperbilirubinemia.

Indications for ultrafiltration are post-eclamptic coma, cerebral edema, intractable pulmonary edema, anasarca.

Discrete plasmapheresis and ultrafiltration are performed by a trained physician trained in the department of extracorporeal detoxification methods.

When treating gestosis, not only the composition of therapy is important, but also its duration in pregnant women with gestosis of varying degrees of severity.

For mild severity, it is advisable to carry out inpatient treatment for up to 14 days, for moderate severity - up to 14–20 days. Subsequently, measures are taken to prevent relapse of gestosis in the antenatal clinic. In severe cases of gestosis, inpatient treatment is carried out until delivery.

Urgent abdominal delivery is carried out against the background of complex intensive care. Infusion-transfusion therapy, if necessary, is supplemented with hepatoprotectors - 10% glucose solution in combination with macrodoses of ascorbic acid (up to 10 g/day), fresh frozen plasma of at least 20 ml/kg per day, transfusion of platelet concentrate (at least two doses) if the platelet level is lower 50 × 10 9 /l.

In the postoperative period, complex therapy continues against the background of careful clinical and laboratory monitoring.

Tactics of pregnancy and childbirth

If there is an effect from the therapy for gestosis, pregnancy continues until a period that guarantees the birth of a viable fetus or until labor occurs.

Currently, in severe forms of gestosis, more active pregnancy management tactics are used. Indications for early delivery are not only eclampsia and its complications, but also severe nephropathy, preeclampsia in the absence of effect from therapy within 3–12 hours, as well as moderate nephropathy in the absence of effect from therapy within 5–6 days.

Currently, the indications for caesarean section have been expanded:

eclampsia and its complications;

complications of gestosis: coma, cerebral hemorrhage, acute renal failure, HELLP syndrome, acute abdominal pain, retinal detachment and hemorrhages into it, premature abruption of a normally located placenta, etc.;

severe nephropathy and preeclampsia with an unprepared cervix and indications for early delivery;

combination of gestosis with other obstetric pathology.

It should be emphasized that cesarean section for severe forms of gestosis is performed only under endotracheal anesthesia. For less severe forms of nephropathy, surgery can be performed under epidural anesthesia. After extraction of the fetus, to prevent bleeding, it is advisable to administer an intravenous bolus of Contrikal followed by the administration of oxytocin. Intraoperative blood loss is compensated with fresh frozen plasma, Infucol solution (HES 6% or 10%) and crystalloids. The indication for blood transfusion is a decrease in hemoglobin below 80 g/l and hematocrit below 0.25 l/l. Blood is used for no more than three days of storage.

If it is possible to conduct childbirth through the natural birth canal, a prostaglandin gel is first introduced into the cervical canal or into the posterior vaginal fornix to improve the functional state of the uterus and prepare the cervix instead of estrogens. With the cervix prepared, amniotomy is performed followed by induction of labor.

During vaginal delivery:

in the first stage of labor, along with the use of classical methods (early opening of the membranes; adequate antihypertensive therapy, infusion-transfusion therapy of no more than 500 ml), gradual long-term analgesia is carried out, including epidural anesthesia;

in the second stage of labor - the most optimal is to continue epidural anesthesia.

When managing childbirth in pregnant women with gestosis, it is necessary to prevent bleeding in the second period and adequately replace blood loss in the third and early postpartum period.

In the postpartum period, infusion-transfusion therapy is carried out in full and lasts for at least 3–5 days, depending on the regression of symptoms of the pathological process under the control of clinical and laboratory data.

The most common mistakes in the treatment of severe forms of gestosis are:

underestimation of the severity of the condition;

inadequate therapy and/or its untimely implementation;

uncontrolled infusion and transfusion therapy, which contributes to overhydration;

incorrect delivery tactics - management of childbirth through the natural birth canal in severe forms of gestosis and their complications;

inadequate prevention of bleeding.

Modern principles of prevention of severe forms of gestosis

Preventive measures are carried out in order to exclude the development of severe forms of gestosis in high-risk pregnant women and during the period of remission after their discharge from the hospital.

The preventive complex includes: diet, Bed rest regimen, vitamins, herbal mixtures with a sedative effect and a mechanism that improves kidney function, antispasmodics, drugs that affect metabolism, disaggregants and anticoagulants, antioxidants, membrane stabilizers, as well as treatment of extragenital pathology according to indications.

A caloric diet of 3500 kcal should contain a sufficient amount of protein (up to 110–120 g/day), fats 75–80 g, carbohydrates 350–400 g, vitamins, and minerals. Moderately salted foods are used, with the exception of spicy, fatty foods that cause a feeling of thirst. The amount of liquid in pregnant women at risk is limited to 1300–1500 ml, salt to 6–8 g per day.

Dosed bed rest Bed rest helps to reduce the total peripheral vascular resistance, increase the stroke volume of the heart and renal blood flow, normalize the uteroplacental circulation and is an important non-drug measure. The method involves pregnant women staying in a position predominantly on the left side from 10 a.m. to 1 p.m. and from 2 p.m. to 5 p.m., during the hours corresponding to high peaks in blood pressure.

All pregnant women should receive vitamins. Vitamin herbal preparations or vitamins are prescribed (taken in tablet form (Gendevit)).

The following herbal preparations are included in the preventive complex:

sedatives (valerian infusion, motherwort infusion), sedative preparations, Novopassit;

improving kidney function (kidney tea, birch buds, bearberry leaves, lingonberries, corn silk, horsetail grass, blue cornflower flowers), Phytolysin;

normalizing vascular tone (hawthorn).

5. Use of antispasmodics.

Considering that in the early stages of the development of gestosis, increasing vascular tone is important, antispasmodics (Eufillin, Papaverine, No-shpa) are included in the preventive complex.

6. Drugs that affect metabolism. To normalize the cellular metabolism of microelements, Asparkam, Panangin and other preparations containing microelements are used.

7. In order to stabilize microcirculation, one of the disaggregants Trental, Curantil, Agapurin) or Aspirin is included in the preventive complex daily in the first half of the day after meals. Contraindications to the use of Aspirin are hypersensitivity to salicylates, bronchial asthma, peptic ulcer of the stomach and duodenum, disorders of the blood coagulation system, and a history of bleeding.

8. Taking into account the importance of lipid peroxidation in the initiation of gestosis, to normalize it, one of the antioxidants is introduced into the preventive complex: vitamin E, ascorbic acid, glutamic acid.

9. To restore the structural and functional properties of cell membranes, membrane stabilizers and preparations containing polyunsaturated essential fatty acids are used: Essentiale Forte, Lipostabil.

10. Normalization of hemostasis. To normalize the hemostatic properties of blood, low molecular weight heparin is used - Fraxiparine, which is prescribed once daily in a dose of 0.3 ml (280 IU). Indications for the use of heparin are: the presence of soluble fibrinogen complexes, a decrease in aPTT of less than 20 seconds, hyperfibrinogenemia, a decrease in endogenous heparin below 0.07 units/ml, antithrombin III below 75%. Fraxiparine is used under the control of blood clotting time, which should not increase more than 1.5 times compared to the initial data. When using heparin, antiplatelet agents are not used. Contraindications for the use of Fraxiparine during pregnancy are the same as in general pathology.

11. Preventive measures are carried out against the background of treatment of extragenital pathology, according to indications.

Prevention of severe forms of gestosis should begin at 8–9 weeks of gestation. Preventive measures are carried out in stages, taking into account the background pathology:

from 8–9 weeks, all pregnant women at risk are prescribed an appropriate diet, Bed rest regimen, a complex of vitamins, and treatment of extragenital pathology;

from 16–17 weeks, for patients with chronic cholecystitis, cholangitis, and stage I–II disorders of fat metabolism, herbal infusions are additionally added to the preventive complex: herbal infusions with a sedative mechanism that improves liver and kidney function;

from 16–17 weeks, patients with hypertension, chronic pyelonephritis, glomerulonephritis, stage II–III fat metabolism disorders, endocrinopathies, extragenital pathology, in addition to the previous measures, are given antiplatelet agents or anticoagulants, antioxidants, and membrane stabilizers.

In pregnant women at risk, preventive measures should be carried out constantly. Herbal infusions and metabolic preparations, alternating, are prescribed continuously. Against this background, disaggregants or anticoagulants, membrane stabilizers, together with antioxidants, are used in courses of 30 days with a break of 7–10 days. Similar measures are carried out simultaneously to prevent relapse of gestosis in pregnant women after discharge from the maternity hospital.

When initial clinical symptoms of gestosis appear, hospitalization and inpatient treatment are necessary.

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 at an earlier stage.

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 for both the mother and her unborn 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 the exact cause of this condition is also not 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 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 found 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 require careful care and significant restriction of activity.

If there is a risk of 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 protein levels in the urine, as well as blood pressure, will help identify preeclampsia in its early stages. And this, in turn, will ensure the most favorable outcome.

Especially for Olga Rizak