Up to the development of convulsive syndrome, cardiovascular, endocrine systems, hemostasis and other systems, which can lead to adverse outcomes for the mother and fetus. But most often it manifests itself as a triad of symptoms: edema, proteinuria, hypertension.

The frequency is 7-16%. The medical examination system allows women to be hospitalized in pregnancy pathology departments when the first signs of the disease appear. However, due to the blurring of clinical manifestations, often observed recently with this complication, there are cases of the development of convulsive syndrome (eclampsia) and other severe clinical manifestations of toxicosis outside the hospital.

Risk groups for the development of late toxicosis (preeclampsia):

• pregnant women with extragenital pathology (kidney diseases, chronic nonspecific lung diseases, endocrinopathies, etc.);
• obese pregnant women;
• pregnant women with heart defects;
• pregnant women who had late toxicosis in previous pregnancies;
• woman's age (over 30 years or under 19 years);
• multiple pregnancy (twins, triplets, etc.);
• anemia of pregnant women;
• intrauterine fetal hypotrophy (delayed fetal development);
• sensitization by Rh factor or blood group;
• if a pregnant woman has an occupational hazard.

Types and manifestations of the disease

There are typical and atypical forms of late toxicosis (preeclampsia).

Typical forms include: dropsy, nephropathy I, II, III degrees, preeclampsia, eclampsia. These forms are considered as different stages of the same pathological process.

Atypical ones include: monosymptomatic nephropathy with hypertension, nephropathy with two symptoms, eclampsia without seizures.

Dropsy is characterized by the appearance of one symptom of edema, which is often widespread: on the lower and upper extremities, on the anterior abdominal wall, in the form of puffiness or swelling of the face. Dropsy is the initial form of late toxicosis of pregnancy. The general condition of a pregnant woman with dropsy is not affected, and only in cases where the swelling is severe do complaints of a feeling of heaviness, fatigue, and increased thirst arise. Blood pressure remains within normal limits or even slightly below it. Hydrops of pregnant women in 20-24% of cases turns into nephropathy.

Nephropathy most often combines the presence of three symptoms: edema, hypertension, and proteinuria (the appearance of protein in the urine). Unlike hydrops of pregnancy, with nephropathy the main symptom is not edema, but arterial hypertension, which in severe cases can reach 200/150 mm Hg. Art. and even higher. The degree of nephropathy is determined using a special Savelyeva scale. The scale characterizes the condition of pregnant women at the time of examination.

Preeclampsia is a more severe form of late toxicosis. Against the background of the appearance of three symptoms (edema, proteinuria, hypertension), new signs appear: dizziness, a feeling of heaviness in the forehead and back of the head, insomnia, apathy, lethargy, blurred vision (“veil” before the eyes, flickering “flies”, sometimes loss of vision ), tinnitus, signs of stomach and liver upset - nausea, vomiting,.

Any irritant can lead to the development of eclampsia (convulsive seizure) - loud sound, bright light, pain. Eclampsia is the most severe form of gestosis. Rarely seen. This is a convulsive contraction with . Has 4 stages:

Stage 1 - lasts about 20-30 seconds and is characterized by twitching of the facial (facial) muscles.

Stage 2 - also lasts about 20-30 seconds and is characterized by tonic (long-term muscle contractions, as a result of which the limbs “freeze” in a position of flexion or extension, the patient’s body is stretched, the head is thrown back or brought to the chest) convulsions up to stopping breathing and biting language.

Stage 3 - lasts about 2 minutes and is characterized by clonic (successive contractions of the flexor and extensor muscles, which is manifested by rapid involuntary movements of the limbs and torso) convulsions, breathing is impaired, cyanosis develops (bluish discoloration of the skin), foamy saliva with an admixture appears blood.

Stage 4 - begins with a deep breath and is characterized by a gradual restoration of breathing; consciousness may still be absent.

Complications of late toxicosis (gestosis)

Treatment of gestosis

Treatment depends on the form preeclampsia.

Treatment of dropsy in pregnant women is most often carried out in the day hospital of the antenatal clinic.

All other forms of gestosis require treatment in a hospital department of pathology of pregnant women or the intensive care unit of a maternity hospital.

Indications for cesarean section for late toxicosis (preeclampsia):

• eclampsia;
• preeclampsia and severe nephropathy in the absence of effect from intensive therapy within 24 hours;
• coma;
• anuria (lack of urine, which most often indicates the development of acute);
• retinal detachment;
• retinal hemorrhage;
• hemorrhage in the brain or spinal cord.
• combination of gestosis with concomitant pathology: PONRP (premature abruption of a normally located placenta), large fetus, narrow pelvis, anomaly of labor, lack of effect from induction of labor, acute fetal hypoxia, breech presentation of the fetus.

What can you do?

It is necessary to register at the antenatal clinic at the first suspicion of pregnancy. The best results always come from a preventive approach to any medical problem. Be sure to inform your doctor about chronic diseases (if any).

It is advisable to be observed by one gynecologist during pregnancy. Then he will know everything about the state of health, the course of previous pregnancies, concomitant diseases, and how this pregnancy proceeded. This will help to suspect late toxicosis in time and prevent its complications.

What can a doctor do?

Late toxicosis is established by fluid retention: excessive weight gain, edema, increased blood pressure, convulsions. With late toxicosis, protein is detected in urine tests. upon examination notices changes in the fundus and decreased visual acuity.

Therefore, systematic and careful monitoring of the pregnant woman for the timely detection of early signs of gestosis is of extreme importance. To do this, every time you visit a pregnant woman, you must:

• weigh her (preferably at the same time of day and in the same clothes);
• measure blood pressure in both arms;
• conduct a urine test;
• Carry out a thorough obstetric examination.

Toxicosis can rightfully be called the most common complication of pregnancy. Pathology occurs due to impaired adaptation of the female body to a new position. Both the mother and the child under her heart suffer from this disease. We will talk about the causes, development mechanisms and methods of treatment of late toxicosis during pregnancy below.

About 25–30% of expectant mothers suffer from toxicosis. Pathology should never be underestimated: toxicosis has not left the list of causes of death among pregnant women for many years (it ranks second among the factors that cause the death of Russian women expecting a child). Toxicosis poses the greatest danger to the cardiovascular system and blood flow. The complication develops both at the beginning of pregnancy and in the second half. Most often, doctors have to deal with expectant mothers whose toxicosis began in the 3rd trimester, after 28 weeks of pregnancy.

Causes of late toxicosis during pregnancy

Today, there are about 30 different theories, the authors of which have tried to explain the causes and methods of development of the disease, but the reliable causes of the pathology have not been fully clarified and studied.

Let us list the most obvious factors that can provoke the appearance of late toxicosis in a pregnant woman:

• low adaptive ability of the maternal body;
• disturbances in the functioning of the cardiovascular system;
• excessive excess weight;
• constant exposure to a stressful environment;
• kidney dysfunction;
• disorders of the liver and biliary tract;
• diseases of the endocrine system;
• the presence of the maternal body in a state of poisoning due to the use of alcoholic beverages, drugs or smoking;
• allergy;
• immunological disorders.

Late toxicosis during pregnancy: who is at risk

Pregnant women who:

• have bad habits;
• got pregnant for the first time;
• have multiple pregnancies;
• suffer from chronic fatigue;
• are in a stressful state;
• under 18 or over 35 years of age;
• suffered from toxicosis during a previous pregnancy;
• often gave birth with short intervals between pregnancies;
• often had abortions;
• have chronic infectious diseases;
• socially unprotected (have food problems and live in poor conditions);
• have genital infantilism (underdevelopment of the genital organs).

Popular versions of the development of late toxicosis during pregnancy

Scientists identify several of the most relevant theories for the emergence of late toxicosis:

1. According to the hormonal theory, late toxicosis develops due to dysfunction of the endocrine system. The pathology may be based on a dysfunction of the adrenal cortex or insufficient synthesis of estrogens produced by the ovaries. However, opponents of the theory believe that problems with hormones arise after the development of toxicosis, that is, they are secondary.
2. The placental theory suggests that late toxicosis develops due to circulatory problems in the pregnant uterus, which leads to severe oxygen deficiency. Against this background, intoxication begins in the woman’s body, the external signs of which are nausea, vomiting and odor intolerance.
3. According to the immunogenetic theory, late toxicosis occurs due to an inadequate response of the maternal immune system to foreign proteins in the child’s body. In other words, the body tries to reject the fetus, as a result of which toxicosis occurs.

Today, many scientists agree that late toxicosis during pregnancy appears due to a combination of the above reasons.

Consequences of toxicosis in late pregnancy

Late toxicosis causes serious complications for the mother and her unborn baby. Here are the consequences a pregnant woman suffering from this pathology can expect:

• disorders of the kidneys, lungs, liver, nervous system and visual organs;
• spasm of cerebral vessels, disruption of microcirculation in the brain;
• the formation of blood clots, which can cause hemorrhage in the brain, vascular thrombosis and edema of the brain or lungs, heart, liver and kidney failure;
• dehydration of the body of the expectant mother due to vomiting, which cannot be stopped;
• premature placental abruption;
• premature delivery (in 19 - 20% of cases);
• fetal suffocation.

For a child, late toxicosis is also very dangerous, as it provokes the development of the following conditions:

• fetal death due to placental abruption (in 32% of cases);
• oxygen starvation, which leads to retardation of intrauterine growth and development;
• low body weight (in 30–35% of children);
• mental and physical retardation;
• soreness.

Signs of late toxicosis during pregnancy

The presence of late toxicosis is indicated by 3 symptoms:

• swelling;
• high blood pressure;
• the presence of protein in the urine.

Edema develops before other symptoms. By the way, they may be the only sign of pathology. Based on the severity of edema, doctors determine the degree of late toxicosis:

• I degree – swelling of the upper and lower extremities;
• II degree – swelling of the limbs and abdominal area;
• III degree – extensive swelling that covers the neck and face.

If the expectant mother’s blood pressure is increased by 20% compared to the initial pressure before pregnancy, then there is reason to talk about the presence of late toxicosis. The same can be said about the presence of protein compounds in the urine - normally there is no protein in the urine.

Features of the condition of a pregnant woman with late toxicosis

There is no exact answer to the question at what time late toxicosis may appear during pregnancy. But most often the pathology makes itself felt from the 28th week of the “interesting” position. The set of symptoms characteristic of late toxicosis is not expressed in all women. The most telling sign of the disease is swelling, while hypertension and protein in the urine can only be confirmed by a doctor. That is why it is so important for the expectant mother to register on time and regularly come for scheduled examinations. There are 4 stages in the development of late toxicosis during pregnancy:

Initial stage of late toxicosis expressed by edema, or dropsy of pregnancy. The development of swelling is indicated by a feeling of slight numbness in the fingers of a woman in position. In addition, the rings do not fit on the fingers, and straightening them becomes very painful. However, swelling does not always indicate the development of toxicosis. Quite often, this symptom occurs due to active synthesis of progesterone or as a result of exacerbation of a chronic form of the disease (for example, varicose veins). Only a qualified specialist can determine the nature of swelling in an expectant mother. In some cases, doctors are dealing with hidden edema that needs to be confirmed.

If the expectant mother has gained a lot of weight, but has no visible swelling, a Maclure-Aldrich test is performed: a 0.9% sodium chloride solution is injected under the pregnant woman’s skin and the time is noted. If the “button” after the injection does not disappear within 35 minutes, the woman has hidden swelling. Visible swelling is localized first on the feet, and then slowly “creeps” upward - to the legs, thighs, abdomen, back, neck and face. In no case should the expectant mother take diuretics, relying on chance, as this will further aggravate her condition.

The second stage of late toxicosis called nephropathy. This disease occurs, as a rule, due to dropsy. Its main symptom is high blood pressure. It is important for the expectant mother to know that she can suffer not only from increased blood pressure, but also from its sharp jumps, which will lead to placental abruption and the death of the child.

At the third stage of toxicosis , which is called preeclampsia, protein appears in the urine. This condition is fraught with a disorder of the blood supply to the brain and, accordingly, a number of associated symptoms, including the following:

• headache;
• dull pain or feeling of heaviness in the back of the head;
• “flies” before the eyes;
• nausea and vomiting;
• visual disturbances;
• memory lapses;
• irritability;
• problems falling asleep;
• high blood pressure (160/110 and above);
• rarely – mental disorders.

Eclampsy I– the last and most dangerous stage of late toxicosis. Against this background, the expectant mother often experiences convulsions, which can be caused by a loud sound, blinding light or a feeling of pain. The attack lasts about 1 - 2 minutes, and it ends with loss of consciousness. Eclampsia threatens a pregnant woman with the following serious complications:

• placental abruption;
• premature birth;
• intrauterine oxygen starvation of the baby;
• death of a child;
• heart attack, stroke;
• pulmonary edema;
• renal failure.

More often than others, women who are pregnant for the first time experience eclampsia.

Late toxicosis during second pregnancy

All signs of late toxicosis disappear a few days after the birth of the child. In especially severe cases, some pathological changes in the woman’s organs and systems remain and even progress after childbirth. In this regard, the risk of toxicosis during pregnancy with a second child increases. Mothers who had to fight late toxicosis during their first pregnancy are definitely at risk for developing toxicosis if they decide to have another child. By the way, this risk increases significantly if the time interval between the first and second pregnancies is short. Such expectant mothers should take this problem very seriously and register from the first weeks of pregnancy. Fortunately, there are often cases when, during a second pregnancy, late toxicosis did not manifest itself at all or was mild.

Specifics of management of pregnancy complicated by late toxicosis

If late toxicosis is present during pregnancy up to 36 weeks, whether a woman brings her baby to term depends solely on the tactics and effectiveness of treatment. In this case, the expectant mother is carefully examined and then left under the supervision of doctors for 1 - 2 days. If the mother's condition continues to deteriorate, then delivery is indicated for her in any case, regardless of the gestational age. However, if the dynamics are positive, the expectant mother is monitored in a hospital setting. Here are the factors that doctors pay attention to first:

• compliance with bed rest;
• blood pressure control up to 6 times a day;
• checking body weight once every 3–4 days;
• drinking regime;
• the volume of fluid excreted from the body in the form of urine;
• the presence of protein in the urine;
• general blood and urine tests every 4 to 5 days;
• the condition of the baby in the womb.

With a successful combination of circumstances and properly selected treatment, pregnancy due to late toxicosis can be extended until the period when the fetus can be safely called viable. The method of delivery in this case is preferably natural. However, doctors opt for a cesarean section if there is a risk of developing eclampsia during childbirth.

Methods to combat late toxicosis during pregnancy

To alleviate the condition of a pregnant woman with late toxicosis and prevent the development of complications, the following measures should be taken:

1. Maintaining bed or semi-bed rest.
2. Complete rest and sleep.
3. Eliminate loud noises and stressful situations.
4. Regular psychotherapeutic conversations with a psychologist. If necessary, take sedatives approved for pregnant women.
5. Balanced diet and varied menu. The predominance of foods high in protein and limited in carbohydrates.
6. Regular consumption of fruits, vegetables, natural juices and fruit drinks. The expectant mother cannot be limited in fluids even with severe swelling.

To stabilize the condition of a pregnant woman suffering from late toxicosis, they also resort to drug treatment, which helps prevent fetal hypoxia. Diuretic drugs are rarely used, since taking these drugs causes a decrease in blood flow, which in turn leads to serious disturbances in placental circulation. Diuretics are indicated for the expectant mother only if she has diseases such as pulmonary edema and heart failure. Pregnant women with late toxicosis are prescribed vitamins B, C and E, as well as medications that improve blood flow in the uterus and placenta and reduce the permeability of vascular walls.

Prevention of late toxicosis during pregnancy

To protect yourself from the appearance of symptoms of late toxicosis during pregnancy, a woman needs to take the necessary measures at the stage of planning a child. To do this, they undergo a full examination and consult with specialists in various fields to identify pathologies (if any) that in the future may cause the development of this disease during pregnancy. You also need to familiarize yourself with the general set of recommendations regarding the correct lifestyle of a pregnant woman and follow these tips:

1. Get rid of nicotine addiction before conception.
2. Avoid drinking alcohol before pregnancy.
3. Sleep about 9 hours a night and be sure to take rest breaks during the day.
4. Reduce the degree of physical activity or abandon it altogether.
5. Create a favorable psycho-emotional climate in your family.
6. Learn the basics of breathing exercises during pregnancy. The necessary information can be obtained from your attending physician.
7. Take a massage course for the neck-collar area and head.
8. Swimming or yoga (with your doctor's permission).
9. Be outdoors every day.
10. Eat often in small portions.
11. Wake up slowly and eat the first piece of food of the day (a slice of lemon, a cracker) before getting out of bed.
12. Work with a nutritionist to create an individual nutrition program that would fully satisfy a woman in a situation complicated by late toxicosis.
13. Always eat food at room temperature.
14. Monitor your body weight throughout pregnancy.

Late toxicosis can complicate the pregnancy of any woman. However, responsible pregnancy planning, timely registration of pregnancy and cooperation with a doctor in the form of regular examinations will help to significantly reduce the risk of developing this dangerous pathology.

Causes and treatment of late toxicosis during pregnancy. Video

t for mothers, the site has already talked about such a complication of pregnancy as toxicosis in the article “”. Today's topic of conversation is

Late toxicosis, or as it is also called “preeclampsia,” is a very insidious disease of pregnant women. It is insidious because a pregnant woman may not even suspect that she has toxicosis. After all, she may not feel nausea, bouts of vomiting and malaise, as with toxicosis in the early stages. The fact is that toxicosis in late pregnancy may not have external signs.

But this does not make the disease any less serious or dangerous.

Late toxicosis: causes

As noted earlier, it is very difficult to determine the cause of both early and late toxicosis. But doctors suggest that the following reasons lead to such a complication as late toxicosis:

• Neurosis
• Endocrine diseases
• Immunological causes
• Heredity
• Poor nutrition
• Colds
• Increased physical stress on the body
• Overwork

Most often, late toxicosis of pregnant women is a consequence of several reasons.

Late toxicosis during pregnancy: signs

Usually late toxicosis is observed in pregnant women in the third trimester. It is usually discovered by a doctor, since it is often hidden from the pregnant woman herself.

The main signs of late toxicosis:

• Fast weight gain. The doctor is picky about excess weight gain not on a whim. This sign may indicate presence of hidden edema. And also excess weight can lead to increased stress on the kidneys, heart and other organs, which also leads to gestosis.
• Obvious swelling of the legs, arms, face
• Ringing in the ears, floaters in front of the eyes
• Protein in urine
• High blood pressure, as well as different pressure readings in different arms
• With advanced toxicosis, vomiting, headaches, fainting, and convulsions appear.

Late toxicosis during pregnancy: stages

1. Edema (dropsy). At this stage, edema can be hidden or obvious, protein is not detected in the urine, and there are no changes in blood pressure. The presence of this disease can be indicated by excessive weight gain - more than 300 grams per week.
2. Nephropathy. At this stage, the vascular system and kidneys are affected. Characterized by edema, hypertension, and the presence of protein in the urine. At this stage, hospitalization of the pregnant woman, prescription of a salt-free diet, restriction of fluid intake and drug treatment are necessary. If late toxicosis of pregnant women is not treated at this stage, this can lead to fetal death, disruption of its development, or transition of toxicosis to a more serious stage.
3. Preeclampsia characterized by very severe edema, the presence of protein in the urine, and increased blood pressure. A pregnant woman feels a headache, tinnitus, and dizziness. Vision may be impaired. This stage is very dangerous for the child, since the pregnant woman experiences disturbances in the functioning of all the most important organs: kidneys, heart, liver. Urgent hospitalization is required.
4. Eclampsia. At this stage of late toxicosis during pregnancy, convulsions and loss of consciousness appear due to disturbances in the functioning of the pregnant woman’s brain. The consequences of this stage are pulmonary edema, cerebral hemorrhage. Death of the fetus and death of the pregnant woman may occur. Fortunately, this stage of late toxicosis practically never occurs during pregnancy due to constant monitoring of the condition of the expectant mother by doctors.

Treatment

The website does not advise treating toxicosis in late pregnancy on your own. Remember, this disease is very serious and can greatly affect the condition and health of your child. As you know, the best treatment for any disease is prevention.

These simple rules can be very effective in the fight against late toxicosis:

• Tell your doctor about any changes in your health.
• Tell your doctor about your chronic and hereditary diseases.
• Follow your doctor's recommendations.
• Get examined by specialists and get tested in a timely manner.
• Rest more often, get full sleep.
• Try to eat right and avoid eating food with added preservatives, dyes, and GMOs.
• Drink an infusion of rosehip and rowan.
• Swim.
• Avoid stress and anxiety.
• Enjoy the upcoming event.

We hope that this article will help you avoid such a dangerous complication as late toxicosis during pregnancy. Well, if you are given such a diagnosis, do not be upset and do not refuse the recommendations of your doctor. After all, late toxicosis detected at an early stage can be treated quickly and without consequences.

Late toxicosis or gestosis is a complication of pregnancy, leading to disruption of vital organs and systems. Late toxicosis develops in the second half of pregnancy and progresses until childbirth.

The frequency of gestosis is 10-15% of the total number of pregnant women. Despite many years of research, the exact cause of the development of gestosis is still unknown. According to some researchers, gestosis develops due to a violation of hormonal regulation in vital organs. According to another version, gestosis occurs due to immunological incompatibility between mother and fetus.

Recently, the frequency of this pregnancy complication is increasing every year. Most obstetricians and gynecologists associate the increase in gestosis with an increase in the number of late births (after 35 years). Unfortunately, by this age, most women already have several chronic diseases, which significantly complicates the course of pregnancy and childbirth.

The main diseases that provoke the development of late toxicosis include:

high blood pressure, obesity, chronic pyelonephritis, diabetes mellitus, heart defects, vegetative-vascular dystonia.

Symptoms of gestosis

Signs of gestosis are varied. The expectant mother may notice the first symptoms of late toxicosis at 28-29 weeks of pregnancy. How do they manifest themselves? First of all, this is swelling of the legs, hands, and face. This is the so-called “hydropsis of pregnant women” - the mildest manifestation of gestosis. If the swelling is not pronounced, then the woman may not notice it. In order to determine whether there is swelling or not, you should carefully monitor your weight gain. Normally, starting from the 28th week of pregnancy, a woman’s weight can increase by an average of 350-500 g per week. If weight gain exceeds 500 g per week, then this may indicate fluid retention in the body, which is a sign of dropsy.

A more severe manifestation of gestosis is nephropathy (damage to the parenchyma and glomerular apparatus of the kidneys), which is characterized by edema, increased blood pressure and the appearance of protein in the urine (“proteinuria”). The more protein in the urine, the worse the prognosis of gestosis. How to notice nephropathy? The main symptom indicating progressive nephropathy is a decrease in the amount of urine excreted. This is a rather dangerous sign that a woman should pay attention to first. Most often, a woman first develops edema, then her blood pressure rises, and only then does proteinuria appear.

Severe manifestations of gestosis include the development of preeclampsia and eclampsia. These are the last stages of gestosis. Without timely medical intervention, such conditions pose a threat to the life of the mother and fetus.

With preeclampsia, microcirculation in the central nervous system is disrupted. Clinically, preeclampsia, as well as nephropathy, manifests itself in the form of the main symptoms - high blood pressure, edema, protein in the urine. Only with the development of preeclampsia, signs of damage to the nervous system are added to these symptoms: headaches, blurred vision, a feeling of flickering "flies" or " “veils” before the eyes, nausea, vomiting.

If this process is not stopped in time, preeclampsia turns into eclampsia - the pregnant woman suddenly develops seizures with loss of consciousness, lasting 1-2 minutes. Eclamsia can be fatal.

Considering the potential danger of gestosis, with any, even the most minimal manifestations of the disease, a woman should immediately contact an obstetrician-gynecologist and tell in detail about her complaints.

Diagnosis of late gestosis

In order to reliably determine whether or not gestosis is present, one visit to the doctor is not enough. Dynamic observation by an obstetrician-gynecologist is necessary.

At every visit to the doctor, a pregnant woman must measure blood pressure (BP) in both arms, pulse and body weight. An increase in blood pressure above 135/85 may indicate gestosis. The doctor evaluates the pregnant woman's weight gain, the presence or absence of edema, and asks the pregnant woman whether the amount of urine excreted has decreased.

Also, if gestosis is suspected, additional tests and studies are prescribed:

Clinical and biochemical blood test;
- general urine analysis;
- Fetal ultrasound with Doppler, CTG (cardiotocography) of the fetus.

If the obtained tests and examination data raise suspicions of gestosis (blood pressure above 135/85, severe edema and large weight gain, protein in the urine), the following is additionally prescribed:

Daily monitoring of blood pressure, ECG;
- urine analysis according to Nechiporenko, according to Zimnitsky, analysis of daily urine for protein;
- hemostasiogram;
- consultation with an ophthalmologist, therapist, nephrologist, neurologist.

Treatment of late gestosis

For mild manifestations of gestosis - dropsy, treatment is carried out on an outpatient basis. In case of nephropathy and more severe manifestations of the disease, hospitalization of the pregnant woman in the obstetric department is indicated.

With minor swelling and normal tests, treatment of gestosis is limited to following lifestyle and nutrition recommendations.

For dropsy with severe edema and mild nephropathies, the following is prescribed:

Sedatives (tinctures of motherwort, valerian);
- disaggregants (Trental, Curantil) to improve the rheological properties of blood;
- antioxidants (vitamin A and E);
- when blood pressure increases, antihypertensive drugs with an antispasmodic effect are used (Eufillin, Dibazol);
- herbal infusions with a diuretic effect.

In severe forms of nephropathy, preeclampsia and eclampsia, treatment is carried out with the participation of a resuscitator in the intensive care unit. Infusion therapy is carried out to correct metabolic and electrolyte disturbances - fresh frozen plasma and rheopolyglucin are administered. In addition to the above groups of drugs, anticoagulants (Heparin) are also used for severe forms of gestosis. To quickly regulate water-salt metabolism, diuretics (Furosemide) are used instead of herbal infusions.

For all forms of gestosis, selective sympathomimetics (Ginipral) are used to prevent the threat of premature birth and fetal hypoxia.

No less relevant is the question of the method of delivery for gestosis.

If the condition of the pregnant woman is satisfactory and the fetus does not suffer, based on ultrasound and CTG data, then the birth is carried out through the natural birth canal. If there is no effect of therapy, in severe forms of gestosis and chronic fetal hypoxia, a cesarean section is indicated.

Treatment of gestosis is carried out not only before childbirth, but also during childbirth and in the postpartum period until the woman’s condition is completely stabilized.

Nutrition and diet for gestosis

Lifestyle and nutrition for gestosis are very important for successful treatment. If there is edema and pathological weight gain, the pregnant woman should follow a special diet. It is necessary to exclude spicy, salty and fried foods from the diet. Consume less salt. Preference should be given to boiled dishes, slightly under-salted. Try to eat foods of both plant and animal origin, as well as dairy products, fruits and vegetables. On average, a pregnant woman with a tendency to edema should consume no more than 3,000 calories per day. You should limit not only your food intake, but also your liquid intake. You need to drink no more than one and a half liters of fluid per day. You should pay attention to diuresis - the amount of fluid excreted should be more than drunk.

A hectic lifestyle and stress also provoke gestosis. In the second half of pregnancy, a woman should sleep at least 8-9 hours a day. If you want to sleep during the day, it is also better to lie down to rest. But at the same time, a sedentary lifestyle can also provoke gestosis. Therefore, a woman is recommended to take at least an hour of walks in the fresh air every day and engage in special fitness for pregnant women.

Folk remedies for gestosis

Traditional medicine in the treatment of gestosis is very relevant, especially with dropsy; many medicinal plants have a diuretic effect. For gestosis, kidney tea, cranberry or lingonberry juice, and rose hip decoction are prescribed. You can use herbal preparations such as Canephron or Cyston. Sedative tinctures from motherwort or valerian can be used starting from 13-14 weeks of pregnancy for the prevention and treatment of gestosis. For severe forms of gestosis, folk remedies are not effective, so only medications are used.

Complications of gestosis:

Premature birth;
- detachment of a normally located placenta, leading to fetal death;
- fetal hypoxia, which also leads to intrauterine fetal death;
- hemorrhage and retinal detachment;
- heart failure, pulmonary and cerebral edema, heart attacks and strokes;
- development of renal and hepatic failure, hepatic coma.

Prevention of gestosis:

Reproductive function up to 35 years of age;
- timely treatment of chronic diseases that provoke gestosis;
- healthy lifestyle.

Consultation with an obstetrician-gynecologist on the topic of late gestosis:

1. I'm 38 weeks pregnant. They found a small amount of protein in my urine and prescribed IVs. But I have no swelling or pressure. Is treatment necessary at all in my case?
Treatment in this case is necessary to prevent the development of nephropathy. It is not necessary that there be pressure or swelling.

2.I'm 37 weeks pregnant. I have been in the hospital for 2 weeks now due to swelling and protein in my urine. Despite treatment, the swelling increased and the protein remained as it was. What to do?
In your case, most likely, gestosis will go away only after childbirth, but treatment must be continued until childbirth in order to save the fetus. The main thing for you now is under the supervision of doctors.

3. Should I go to the hospital if I gain a lot of weight?
If there is no pronounced swelling, pressure and protein in the urine, then it is not necessary.

4. Normally my blood pressure is 120/80. When it rises to 130/90, my head hurts a lot. What to do, what to take?
This pressure is the upper limit of normal, but if you have a headache, this may indicate a complication of gestosis, so I recommend consulting with your gynecologist in person and, if he recommends, going to the hospital.

5. Is it possible to give birth on your own with gestosis or is it necessary to have a caesarean section?
Preeclampsia is not an indication for caesarean section. The operation is performed only in emergency cases when the disease progresses.

6. By week 28 I had already gained 10 kg. The doctor prescribed Eufillin, but I don’t want to take it. All my tests are normal. Maybe you can do without Eufillin?
You can avoid using Eufillin only if you strictly adhere to the diet and other recommendations to reduce the manifestations of gestosis.

7. Why is protein in urine dangerous? How does this affect the fetus?
Protein in the urine indicates protein loss and impaired kidney function. In this case, the fetus does not have enough material to build its own cells. This can lead to delayed fetal development.

8. How much fluid can you drink per day with gestosis?
In the presence of edema - no more than one and a half liters per day.

9. I have swelling in my legs. The doctor prescribed Trental. But the instructions say there are many side effects of this drug, I’m afraid to drink it. How does Trental affect the fetus?
Trental is safe for children.

10. What is the acceptable level of protein in urine?
Normally, there should be no protein in the urine at all.

Obstetrician-gynecologist, Ph.D. Christina Frambos

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 and premature baby are transferred 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 performed. 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.

Toxicosis most often occurs in women in the later stages:

• 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:

• intrauterine growth retardation 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 urinalysis.

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 under no circumstances self-medicate.