Preeclampsia is a pathology of pregnancy, which is one of the most threatening complications for both the mother and the fetus. Preeclampsia is characterized by a deep disorder of the functions of vital organs and systems. According to various authors, the incidence of preeclampsia in pregnant women in our country ranges from 7 to 16%.

In the structure of mortality of pregnant women, women in childbirth and puerperas, severe forms of gestosis occupy one of the first places.

Childbirth, eliminating the cause of the disease, does not prevent the preservation and progression of changes in the organs and systems of a woman after pregnancy. This increases the risk of complications in the postpartum period, the occurrence of preeclampsia during repeated pregnancy, the formation of extragenital pathology.

Currently, gestosis in 70% of cases develops in pregnant women with extragenital pathology.

Preeclampsia is a syndrome of multiple organ functional failure that occurs or worsens in connection with pregnancy. It is based on a violation of the mechanisms of adaptation of a woman's body to pregnancy.

In our opinion, speaking about the development of gestosis, one should agree with the conclusion of the majority of scientists about the combined effect of a number of factors on the body of a pregnant woman: neurogenic, hormonal, immunological, placental, genetic.

Human placenta, liver and kidneys are known to contain common antigens. The emergence of antibodies to the placenta, liver and kidneys of the fetus due to cross-reactions leads to immunological alteration of these organs of the mother's body and disruption of their function, which is observed in late gestosis.

The genetic theory of gestosis suggests an autosomal recessive way of inheritance of the disease. It has been noted that among the daughters of women with preeclampsia, the number of gestosis diseases is 8 times higher than in the normal population.

As a trigger for gestosis, supporters of the placental theory mention humoral factors of placental origin. In the early stages of gestation, trophoblast migration into the arteries is inhibited. At the same time, no transformation of the muscle layer is observed in the tortuous uterine arteries. These morphological features of spiral vessels, as gestation progresses, predispose them to spasm, decreased intervillous blood flow, and hypoxia. Hypoxia, which develops in the tissues of the uteroplacental complex against the background of impaired blood flow, causes local damage to the endothelium, which later becomes generalized. Damage to the endothelium in the development of preeclampsia is currently accepted to take one of the significant places.

The main markers of endothelial dysfunction in late gestosis are thromboxane A2, prostacyclin, von Willebrand factor, fibronectin, tissue plasminogen activator and its inhibitor, endothelial relaxing factor, endothelial cells circulating in the blood. The authors came to the conclusion that with an increase in the gestation period, an increase in the severity of late gestosis, the number of endotheliocytes circulating in the blood increases.

When conducting electron microscopy in blood smears in patients with eclampsia, a large number of endothelial cells were found, their swelling against the background of increased plasmolemma permeability and signs of cell damage in the form of cytoplasm vacuolization, swelling and clarification of the mitochondrial matrix, and chromatin condensation were noted.

Damage to the endothelium contributes to the development of changes underlying preeclampsia - an increase in vascular permeability and their sensitivity to vasoactive substances, the loss of their thrombotic properties with the formation of hypercoagulation, with the creation of conditions for generalized vasospasm. Generalized vasospasm leads to ischemic and hypoxic changes in vital organs and disruption of their function.

Against the background of spasm of the microcirculation vessels, the rheological and coagulation properties of the blood change, and a chronic form of the syndrome of disseminated intravascular coagulation (DIC) of the blood develops. One of the reasons for the development of DIC is the deficiency of anticoagulants - endogenous heparin and antithrombin III, the decrease of which, according to a number of authors, corresponds to the severity of preeclampsia. The basis of the chronic course of DIC in preeclampsia is widespread intravascular coagulation with impaired microcirculation in the organs.

Along with vasospasm, impaired rheological and coagulative properties of blood, hypovolemia plays an important role in the development of organ hypoperfusion, mainly due to low circulating plasma volume (CVV). Low values ​​of VCP in preeclampsia are due to generalized vasoconstriction and a decrease in the vascular bed, increased permeability of the vascular wall with the release of part of the blood into the tissues. Vascular and extravascular changes lead to a decrease in tissue perfusion and the development of hypoxic changes in tissues, as evidenced by a decrease in tissue partial oxygen tension in tissues by 1.5-2 times, depending on the severity of the disease.

The authors of some works suggest that the trigger for the development of multiple organ failure in preeclampsia (as in sepsis, toxic-allergic dermatitis, postoperative syndrome, etc.) is a systemic inflammatory response syndrome, in the development of which there are three stages. The first stage, in response to a damaging factor (immune or non-immune agent), is characterized by local production of cytokines by activated cells, which are numerous mediators (lymphokines, monokines, thymosins, etc.), which are mediators of intercellular interactions and regulators of hematopoiesis, immune response. The second stage is characterized by activation of macrophages and platelets by cytokines, an increase in the production of growth hormone. At the same time, an acute phase reaction develops, which is controlled by anti-inflammatory mediators and their endogenous antagonists.

In case of insufficient function of the systems regulating homeostasis of the body, the damaging effect of cytokines and other mediators increases. This entails a violation of the permeability and function of endothelial capillaries, the formation of distant foci of systemic inflammation and the development of organ dysfunction, which is typical for the third stage of the systemic inflammatory response syndrome.

According to the latest data (I. S. Sidorova et al., 2005), neurospecific proteins of the fetal brain play a leading role in the development of preeclampsia and acute endotheliosis. This is due to the fact that in the mother's body there is no tolerance to these proteins, which have the properties of autoantigens and, when they enter the mother's bloodstream, cause the formation of antibodies. The appearance of antigens of neurospecific proteins in the mother's blood is due to a violation of the permeability of the blood-brain barrier. One of the most important pathogenetic links leading to impaired permeability of the blood-brain barrier is autoimmune brain damage, which leads to the development of severe forms of the disease during pregnancy and childbirth, and also causes the development of complications during the three-year postpartum period.

Without denying the significance of the defeat of the central nervous system, kidneys, uterus and other organs that develops with gestosis, I would like to emphasize the role of liver changes that occur in connection with the development of hepatosis or HELLP syndrome. The relevance of the study of these pathological conditions is due to the fact that there are still no definitively developed criteria for their diagnosis and therapy, and in 50-70% they lead to death.

The liver is an organ in which numerous metabolic reactions take place. It occupies a central place not only in the processes of intermediate metabolism of carbohydrates, proteins, nitrogen, etc., but also in the synthesis of proteins, redox reactions, and the neutralization of foreign substances and compounds.

The dynamic development of the gestational process, leading to an increase in the load on the organ, exposes the liver to functional stress, which does not lead to any special changes in it. However, it must be borne in mind that the liver, depleting its reserve capacity as pregnancy progresses, becomes vulnerable.

During this period, it is advisable to pay special attention to the functional state of the hepatobiliary system, which plays a significant role in the pathogenesis of severe forms of preeclampsia. At the same time, a change in most parameters can be recorded even at the preclinical stage, which makes it possible to predict the development of liver failure. In addition, when observing a physiologically proceeding pregnancy, one should take into account the effect of progesterone on the tone and motility of the biliary tract, which contributes to the occurrence of cholelithiasis and cholestasis even in healthy women.

During a physiologically proceeding pregnancy, as the authors point out, certain changes are observed in the liver, which are purely functional in nature and do not cause disturbances in the general condition of pregnant women.

Pregnant women with a physiological course of gestation are characterized by an increase in the activity of alkaline phosphatase due to additional synthesis of the enzyme by the placenta, an increased content of cholesterol, triglycerides. On the 6th day of the postpartum period in healthy puerperas, regardless of the method of delivery, all indicators of the functional state of the liver return to normal.

In pregnant women with preeclampsia, there is a violation of the functional activity of the liver, manifested by hyperenzymemia, changes in pigment, lipid, protein, carbohydrate metabolism and thrombocytopenia, immunodeficiency phenomena, the severity of which corresponds to the severity of the disease. Changes in indicators of the state of the liver in most pregnant women with preeclampsia are not accompanied by clinical signs of her disease.

The data available in the literature indicate that the violation of the functional state of the liver in severe forms of preeclampsia reaches a maximum and persists for 24-48 hours after delivery.

With gestosis in the liver, as in an organ with a developed capillary system, to one degree or another, a deep violation of microcirculation and chronic tissue hypoxia always develop. At the same time, according to the author, her condition, according to clinical and biological indicators, is characterized by a syndrome of hepatocellular insufficiency.

In patients with mild forms of gestosis, no significant changes in the liver are found in the study of biopsy material. In severe forms of gestosis, small droplet fatty degeneration of hepatocytes develops in the absence of necrosis, swelling of the cytoplasm, and changes in the hepatic parenchyma. However, even in the mildest cases, there are signs of a violation of the functional state of the liver. First of all, there is a regular change in the protein-forming and detoxifying functions of the liver. According to a number of studies, with an increase in the severity of preeclampsia, hypoproteinemia increases, expressed in a decrease in albumin fractions and an increase in globulin (IgG, IgA, IgE), an increase in the level of circulating immune complexes.

It has been established that with gestosis, the antitoxic function of the liver, cellular and humoral immunity are sharply suppressed. Pigment and carbohydrate functions are disturbed least of all. An increase in bilirubin is noted only with preeclampsia - mainly due to the fraction of indirect bilirubin. In severe forms of gestosis, hypercholesterolemia and an increase in transaminase activity are found.

Studies show that the activity of indicator liver enzymes in preeclampsia can both increase and significantly decrease. At the same time, according to the author, various systems of hepatocytes are damaged to varying degrees, some can continue to function even with a very severe course of preeclampsia. Apparently, it depends on the initial state of the body.

According to most authors, clinically, liver damage is asymptomatic or develops only with a developed picture of severe preeclampsia (acute fatty hepatosis or HELLP syndrome), while milder degrees go unnoticed.

The poverty of the clinical manifestations of liver pathology in preeclampsia, according to M. A. Repina, dictates the need to develop reliable laboratory criteria for assessing the severity of its damage.

The question of whether the transferred preeclampsia really increases the likelihood of developing various diseases in the future is of interest to many researchers. However, the results of clinical and epidemiological studies are very contradictory (G. M. Savelyeva, 2003; V. L. Pecherina et al., 2000).

Thus, there is currently no consensus on long-term consequences transferred preeclampsia and the occurrence or progression of any extragenital diseases in the future. Nevertheless, it can be assumed that profound changes in organs and systems (multiple organ failure), arising as a result of the pathogenesis of preeclampsia, do not stop after delivery and may cause the development of extragenital complications in the future.

Diagnosis of liver diseases in pregnant women presents certain difficulties. This is due to the fact that the clinical picture of the disease in pregnant women with preeclampsia often changes, the disease can proceed atypically. In the second half of pregnancy, the definition of the boundaries of the liver and its palpation are difficult due to the filling of the abdominal cavity with a growing uterus; during pregnancy, biochemical blood parameters also change, as a result of which the interpretation of liver function tests in pregnant women requires some correction. The most modern research methods (radionuclide liver scan, splenoportography, laparoscopy, puncture liver biopsy) are unsafe for pregnant women, and we can perform them only after delivery.

Based on the above pathogenetic features of gestosis, the algorithm for diagnosing liver disorders consists of determining its morphological and functional changes.

Until now, blood serum indicators have been the main criteria for the clinical diagnosis of hepatocellular insufficiency. In this regard, it is necessary to study the biochemical parameters of blood serum. The criterion for assessing the permeability of the plasma membrane and damage to hepatocytes is the determination of the level of enzymatic activity of alanine aminotransferase, a cytosolic enzyme of hepatocytes, as well as enzymes associated with various cell structures: aspartate aminotransferase, alkaline phosphatase, lactate dehydrogenase. It is also necessary to determine indicators of cellular (subpopulations of T-lymphocytes, B-lymphocytes) and humoral immunity (IgG, IgA, IgM, IgE) to assess the severity of immunodeficiency.

The study of morphological changes is an assessment of the results of ultrasound examination of the liver and gallbladder; at the same time, the density of the wall of the gallbladder, liver, gallbladder bile is determined, the volume and thickness of the walls of the gallbladder are measured. Ultrasound diagnosis of fatty hepatosis is performed by recording the ultrasonic density of various sections of the hepatic parenchyma by echodensitometry, which, based on a pathological change in a specially introduced attenuation coefficient, makes it possible to diagnose fatty hepatosis.

Hepatobiliary scintigraphy is a comprehensive study of the functional and organic state of the hepatobiliary system, including the assessment of bilisynthetic and biliary excretory functions of the liver, concentration and motor functions of the gallbladder, biliary tract patency. The study is highly informative in patients with inflammatory and metabolic diseases of the liver, gallbladder, cholelithiasis, biliary tract dyskinesia, diseases of the gastrointestinal tract, abdominal syndrome of unclear etiology, etc. .

Undoubtedly, the state of the phagocytic system of the liver attracts great attention of scientists, since a serious influence of the function of the reticuloendothelial system on the course of various diseases has been noted.

Thus, the data available in the literature on the functional state of the liver in women who have undergone preeclampsia are contradictory, since they were obtained from the analysis of a small and heterogeneous number of clinical observations and, in addition, are often limited to the characteristics of one of the functions of the liver.

Based on a comprehensive analysis of the identified modern methods studies of morphological and functional changes in qualitative and quantitative indicators can most accurately diagnose morphological and functional changes in the liver in women who have undergone nephropathy, which will solve some controversial issues of practical obstetrics in the management of women with this pathology in the postpartum period.

From our point of view, the study of liver function indicators will allow diagnosing liver damage in the early stages before clinical symptoms, monitoring ongoing therapy, restoring the functional state of the liver in the postpartum period, predicting the course of preeclampsia, as well as possible complications in repeated pregnancies.

In this regard, it is necessary to correct treatment regimens in the postpartum period with the inclusion of pathogenetically substantiated simple and safe efferent methods.

In order to correct the immune status in women who have undergone gestosis, therapy is carried out with the immunomodulatory drug polyoxidonium (Immafarma), which has immunocorrective, detoxifying, membrane-stabilizing activity and promotes physiological and reparative regeneration of the liver. It is used at a dose of 6 mg in saline, one injection per day for 8 days, then at a maintenance dose of 6 mg once a week for 1 month (depending on the severity of the pathological process).

The most promising direction in the treatment of metabolic disorders of the liver can be considered long-term lipid-correcting therapy with vaseline-pectic emulsion Fishant S (PentaMed) once a week for 2-12 months, with the obligatory use of combined herbal hepatotropic drugs: hepabene (Ratiopharm), at a dose of 1 capsule

3 times a day - and restoration of colon microbiocenosis with probiotics: hilak forte (Ratiopharm) at a dose of 40-60 drops per day, polybacterin (Alpharm) - 2 tablets 3 times a day for 10 days.

Literature

V. A. Kakhramanova
A. M. Torchinov, doctor of medical sciences, professor
V. K. Shishlo, Candidate of Medical Sciences, Associate Professor
MGMSU, RMAPO, Moscow

Often during pregnancy, various pathological conditions occur. Gestosis is one of them. The disease at an early stage of pregnancy is called toxicosis. It is accompanied by intolerance to certain odors, nausea, vomiting, drowsiness and weakness, but does not pose a danger to the fetus and mother. Late preeclampsia can develop in the third trimester, during delivery or after. With this disease, vital organs are affected: the heart, blood vessels, liver and kidneys, as well as the placenta and fetus.

Reasons for the development of gestosis

Until now, doctors do not know the exact causes of gestosis. However, there is an opinion that the disease occurs against the background of high blood pressure, disorders in the liver and kidneys, and other somatic diseases in pregnant women. There are several theories explaining the formation of gestosis:

1. Endocrine - during pregnancy, the work of the heart and blood vessels is disturbed due to poor metabolism and insufficient blood supply to the organs with nutrients. Such failures are the result of a change in the functioning of the endocrine system, which is responsible for the composition of the blood and vascular tone.
2. Cortico-visceral - explains the disease by the development of neurosis in a pregnant woman. The cerebral cortex, due to conditioned reflexes, affects the state internal organs, and this upsets the balance of inhibition and excitation in it.
3. Placental - most likely, the uterine arteries, due to genetic and immunological characteristics, do not change their structure, as in the normal development of pregnancy, and the muscle layer is not transformed in them. As the fetus grows, vasospasm occurs, leading to a decrease in blood flow and the occurrence of hypoxia.
4. Immunological - there is an immunological discrepancy between the tissues of the fetus and mother. As a result, the female body does not accept a foreign body or there is an insufficient production of antibodies, which disrupts blood circulation and preeclampsia occurs after childbirth.
5. Genetic - the disease is often inherited. Studies have confirmed that fetal genes play a role in the development of preeclampsia.

With the disease, the work of the heart worsens, which means that blood circulation worsens, its coagulability increases. Organs and tissues are no longer supplied with enough oxygen and nutrition. The brain, liver, kidneys and placenta suffer most from lack of blood circulation. The fetus has oxygen starvation and its development is suspended, which gives rise to very serious consequences after preeclampsia.

Symptoms of preeclampsia

The disease can be asymptomatic for a long time. The clinical picture is characterized by special signs at each stage of the disease:

• Edema, or dropsy - swelling of soft tissues is observed in different places. There are four degrees: the first - the feet; the second is the legs and stomach; the third - lower and upper limbs, stomach, face; the fourth is the whole body.
• The appearance of protein in urine - there is a violation of the functioning of the kidneys, the daily rate of urine decreases. During the study, a protein is found in it, its rapid increase is a sign of the rapid progression of the disease.
• Increased blood pressure - failure of the kidneys and swelling cause an increase in pressure. In severe cases, high blood pressure leads to loss of consciousness, hemorrhages, and the occurrence of postpartum preeclampsia is also possible.
• Preeclampsia - headaches occur, vision deteriorates, inadequate reactions appear, irritability (or indifference sets in), the condition may be drowsy or, conversely, insomnia torments.
• Eclampsia is the most severe and dangerous stage of the disease, which can develop both before and after childbirth. The condition is accompanied by seizures, convulsions. During this period, the functions of all organs and systems of the body are disrupted: severe renal failure, possible liver rupture, pulmonary edema, stroke or heart attack, placental abruption, fetal hypoxia and premature birth. Preeclampsia after childbirth can cause the death of the mother and child.

Who is at risk?

No one is safe from the disease of preeclampsia, but its manifestation is most likely in the following female category:

• women in labor under 18 and over 30;
• having given birth many times;
• with multiple pregnancy;
• having a short break between pregnancies, when the body is weakened, gestosis may occur in the child after birth;
• often interrupting pregnancy artificially;
• with hereditary predisposition;
• with diseases of the kidneys, liver, cardiovascular and endocrine systems.

The well-being of a woman bearing a child does not always indicate her health. The test results may show malfunctions in the body with external well-being. Experts strongly recommend regular visits to the gynecologist throughout pregnancy, so as not to miss serious complications.

Diagnosis of the disease

If gestosis is suspected, the doctor takes the following measures:

• History taking - during a conversation with a pregnant woman or a woman who has already given birth, the doctor listens to complaints, finds out all the ailments that the woman feels, specifies the time when the symptoms of the disease began, asks if close relatives had preeclampsia.
• Visual examination - it turns out if there is swelling on the legs and body, blood pressure is measured, the pulse is felt, the heart sounds of the mother and fetus are heard.
• A general analysis and biochemistry of blood is prescribed.
• Urine is being studied - a clinical, daily and biochemical analysis is taken.
• The fundus is checked.
• The pressure is constantly monitored.
• Body weight is determined.
• Ultrasound and dopplerometry of the fetus is done.

Additional consultations of a therapist, neurologist, nephrologist, ophthalmologist are prescribed. Based on the data obtained, a diagnosis is made, and a course of treatment for preeclampsia is prescribed after or before childbirth.

Development of the disease

According to the severity of the course and the severity of the manifestations, late preeclampsia is divided into three degrees:

• First, it is called dropsy. Light initial manifestations in the form of edema spread throughout the body. They significantly increase the body weight of a woman in position, and often remain after childbirth. Edema appears on the limbs, gradually spreading to the stomach and face. They progress rapidly, increasing in the evening, and are poorly corrected. Nephropathy joins dropsy. The kidneys stop functioning normally.
• The second - an increase in edema, the appearance of protein in urine, the further development of nephropathy, an increase in pressure are manifestations of severe preeclampsia. The body of a pregnant woman ceases to cope with stress and begins to malfunction.
• Third - all processes gradually progress and an extremely serious condition sets in. The nervous system is damaged, which threatens the life of the fetus and woman. A severe form of the disease is diagnosed according to the following signs: protein excretion in the urine of more than 1 g / l, a decrease in the daily volume of urine to 400 ml, pressure reaches 170/110 and above, severe swelling of the whole body, blood flow is disturbed, blood clotting and fetal development, increases activity of liver enzymes. Urgent resuscitation and the birth of a baby are required, often with the help of an operation. In this condition, the child may develop preeclampsia after cesarean.

Treatment of preeclampsia

The main areas of therapy include:

• childbirth;
• medical and protective regime;
• treatment of postpartum preeclampsia;
• restoration of the activity of internal organs.

For pharmacotherapy, the following medicines are used:

• tincture of "Valerian", "Motherwort", in severe conditions, antipsychotics and tranquilizers are indicated - "Droperidol", "Relanium".
• Medications to relieve pressure - Amlodipine, Atenolol, Hydralazine.
• Magnesium sulfate is used as an anticonvulsant drug.
• Intravenous infusions are carried out to replenish blood volume.
• Anticoagulants and antiplatelet agents - Fraxiparin, Curantil.
• Antioxidants - "Essentiale", vitamins E and C.

A mild degree of the disease is treated for no more than ten days, an average one - five, and a serious condition - six hours. If there is no effect, urgent delivery is prescribed, which is carried out naturally with a mild degree of the disease. The consequences of preeclampsia after childbirth in this case are minimal for both the fetus and the mother. In severe cases, a planned operation is prescribed. The occurrence of eclampsia and placental abruption requires emergency delivery by caesarean section. Further, pharmacotherapy lasts until the normal functioning of all body systems. The woman in labor is discharged from the hospital in one to two weeks.

Gestosis after childbirth

The disease during and after pregnancy is marked by three well-known symptoms: edema, protein in the urine, and increased blood pressure. Late toxicosis is always associated with pregnancy. It can be in the second trimester, and most often in the third. Gestoses are pathological changes during pregnancy associated with hormonal disruptions and various pathologies. The disease in a mild form, as a rule, has no consequences, and preeclampsia after childbirth disappears in the first two days. The onset of the disease at 24-28 weeks requires an emergency caesarean section to save the life of the baby and mother. If late toxicosis occurs at 30-32 weeks of gestation, the mother and baby suffer slightly.

A woman can give birth herself or by surgery. After 34 weeks, in the absence of health problems for the baby, childbirth can be natural. To prevent eclampsia, a woman is given drugs that reduce blood pressure and anesthetize childbirth. Doctors monitor the duration of labor and uterine bleeding, using the drug "Oxytocin", which promotes the woman is placed - under the supervision of resuscitators - in the intensive care unit. For the prevention of eclampsia, magnesium sulfate is prescribed and blood and urine are constantly taken for analysis, blood pressure readings are monitored.

How to treat preeclampsia after childbirth?

Therapy of preeclampsia continues at home. High blood pressure can be observed for up to two months, so a woman should systematically monitor it and take drugs to reduce it. During the period of breastfeeding, it is recommended to take Dopegit and Nifedipine. Over time, the pressure returns to normal. Cancellation of drugs should be done gradually, by reducing the dosage and frequency of administration. In addition to high blood pressure, edema appears in women after childbirth. First of all, they form at the ankles. Over time, they pass. Worse, if there is an increasing swelling of the hands and face - these are signs of preeclampsia. It is urgent to visit a doctor who will prescribe the right treatment gestosis after childbirth. It should be noted that about half of the cases of severe convulsive seizures (eclampsia) occur in the first four weeks after childbirth. Often the disease occurs in women who gave birth at term. In this case, urgent health care.

How is childbirth going?

The severity of the disease, the condition of the mother and child affect the method of choosing childbirth and the time of their delivery. The most favorable births are those that occur naturally. For them, it is necessary: ​​the absence of diseases in the mother, the correct diligence of the fetus and the proportions of the fetal head, pelvis, normal cervix, and the age of the woman in labor is not more than 30 years. Childbirth for a woman is a stressful condition, and with preeclampsia, women in labor are especially sensitive to pain, fatigue, so doctors use painkillers and antispasmodics. Otherwise, a sharp jump in pressure may occur at any time, which will lead to disruption of brain activity and the occurrence of eclampsia. The disease occurs both during natural childbirth and after surgery. In this case, the following complications are possible:

• fetal asphyxia;
• bleeding in the postpartum period;
• placental abruption.

Childbirth helps a woman get rid of preeclampsia. Sometimes for premature baby birth - the most the best option. Sometimes the birth of a baby before term gives him a better chance of surviving than staying in the womb. In this case, doctors decide on an early delivery, operative or natural.

What to do if the disease does not go away after childbirth?

Will late preeclampsia go away after childbirth? This question worries women who have been discharged from the hospital, and they have the following symptoms:

• visual impairment;
• pain in the right hypochondrium;
• high blood pressure;
• headache;
• infrequent urination.

In this case, you should immediately consult a doctor. After eclampsia, a gynecologist or therapist will prescribe a CT scan of the brain, blood biochemistry. If the protein content in the urine is up to two months after childbirth, you should seek advice from a urologist and nephrologist. Preeclampsia will pass, but serious complications may remain after it if the treatment and strict adherence to all the recommendations of doctors are neglected.

The consequences of the disease for women

The consequences of preeclampsia for the mother after childbirth can manifest itself in the following:

• renal and liver failure;
• headache;
• hypertension;
• stroke development;
• visual impairment;
• brain damage;
• ischemia of the heart;
• severe postpartum bleeding.

With a new pregnancy, a repetition of the situation is possible.

Consequences for the child

The severe condition of the mother negatively affects the health of the baby. The most dangerous consequence is intrauterine fetal death due to nutritional deficiencies and lack of oxygen as a result of placental damage. But even after childbirth, the consequences of preeclampsia for the child are very serious. Children are very weak, have a small weight, often and for a long time get sick, lag behind in development and growth. Because of the illness of the mother, they are born prematurely, are not adapted to independent living, require special care and assistance in development. Health problems in a baby can remain for life.

Indications for preterm birth, regardless of the gestational age

These include:

• seizures and eclampsia;
• premature detachment placenta;
• rapid progression of the disease;
• retinal disinsertion;
• malfunction of the liver and kidneys.

Doctors try to conduct a quick and gentle birth using painkillers and sedatives. With preeclampsia after childbirth or caesarean section, the necessary treatment and careful monitoring of the state of health are prescribed for the woman and the baby. The treatment regimen is selected individually.

Caesarean section with gestosis

With a threat to life for the fetus or woman and the inability to give birth on their own, a caesarean section is used. This method is used for complicated gestosis, when the condition of the woman in labor begins to deteriorate rapidly, and the child experiences oxygen starvation. The operation is performed using endotracheal combined anesthesia. The uterus is opened and the baby is released if he has problems with breathing or circulation, and resuscitation is carried out. The woman is sutured and after the operation is transferred to the ICU (intensive care unit), where she is given sedatives for a day and is constantly monitored for pressure, edema, liver and kidney function. It is believed that the first two days with preeclampsia after cesarean are the most critical. During this period, severe complications can occur that threaten the health and life of the woman in labor. The child and mother are under the supervision of doctors until the full normalization of health. After examination and satisfactory condition, they are discharged from the hospital. When a child is born on time and there is no oxygen starvation, he will develop normally and keep up with his peers. Otherwise, various complications and disorders of mental and physical health are possible. Some symptoms last for two months, so the treatment of preeclampsia after cesarean continues at home under the supervision of a medical professional.

Complications

Late preeclampsia is dangerous with severe consequences that can begin both during pregnancy and after the birth of a child. The most common of them:

• stroke;
• placental abruption;
• insufficiency of respiratory activity;
• retinal detachment;
• eclampsia and coma;
• hemorrhagic shock;
• acute renal failure;
• oxygen starvation of the fetus can occur with preeclampsia after cesarean section.

More rare forms that complicate preeclampsia are:

• HELP-syndrome - red blood cells decay, the number of platelets decreases, which affect blood clotting, in addition, liver function is disrupted. The disease is transient. The woman has headaches and liver pain, jaundice, vomiting. She loses consciousness, convulsions are possible. There is a rupture of the liver, the abdominal cavity is filled with blood, the placenta exfoliates. The death of the fetus and mother occurs.
• Acute fatty hepatosis - often occurs during the first pregnancy. First, a woman is tormented by severe weakness, abdominal pain, nausea, weight loss, vomiting, itching of the skin. Subsequently, liver and kidney failure appears, jaundice develops, severe edema, uterine bleeding and fetal death occurs. A woman may have a coma and a malfunction in the brain.

About contraception

After suffering preeclampsia, a woman is advised not to become pregnant for at least two years, since time is needed for the body to recover. Young parents should remember that even breastfeeding does not provide a full guarantee of protection against pregnancy. Menstruation may well occur after childbirth in four weeks. But the cycle is still unstable, so it is not recommended to use the calendar method of contraception after severe preeclampsia. Hormonal tablets during lactation enter the milk, which is undesirable for a weakened baby. It turns out that barrier contraception in this case is the most optimal method. It must be remembered that until the bleeding stops, until the uterus is completely contracted, vaginal contraceptives should not be used. The ointment and fatty base of the funds can enter the uterus. Gynecologists recommend using a condom during this period.

Recovery period

Effective recovery after preeclampsia is influenced by proper nutrition, the help of relatives and friends, normal rest, and intimate hygiene. The main task of the recovery period is to eliminate the malfunction of the kidneys and water-salt metabolism. These reasons reduce the ability of patients to work and are considered contraindications for subsequent pregnancy. Recovery is carried out in stages, depending on the severity of preeclampsia:

The first one is galvanization, ultrasonic treatment, microwave therapy. Physiotherapy improves renal hemodynamics, enhance their excretory ability.

How to treat preeclampsia after childbirth with the second degree of severity? Drug therapy is carried out with the use of sedatives: tincture of "Valerian", "Motherwort", "Corvalol"; antihypertensive drugs: "Dibazol", "Papaverin", "Eufillin"; drugs with a diuretic effect: Triampur, Hypothiazid. To increase the absorption of drugs, collar galvanization is used.

The third - a complex of drugs used in the second degree of severity, is supplemented by the introduction of "Albumin" and "Rausedil".

Weakened by preeclampsia after childbirth, a woman's body is prone to various infections, so a woman needs to restore her immune system and return to normal life faster. Gynecologists advise:

• observe the hygiene of the genitals: wash yourself after using the toilet with clean hands from front to back;
• do not use sponges and washcloths;
• use baby soap for washing;
• use individual towels for the chest and perineum;
• use disposable pads;
• underwear should be made of simple fabrics, well breathable;
• it is recommended to sleep on the stomach to improve the outflow of secretions from the uterus;
• it is recommended to visit a gynecologist two weeks after discharge from the hospital;
• in the absence of spotting, you can return to intimate life.

Prevention of preeclampsia

It is impossible to cure preeclampsia, so measures must be taken to prevent it. To do this, you need to visit a gynecologist in a timely manner, measure blood pressure, monitor weight gain, and take tests. A pregnant woman needs to find time for daily walks on fresh air. In food, eat more animal proteins, cottage cheese, vegetables, fruits, greens. With a predisposition to edema, drink herbal teas, cranberry juice. The diagnosis of "preeclampsia" obliges a woman to monitor her well-being with a vengeance. Experts advise women to give birth before the age of 35 to reduce the risk of complications.

Usually, early gestosis is called toxicosis of pregnant women, these are its classic signs with nausea and vomiting, intolerance to strong odors, weakness and severe drowsiness. However, doctors consider toxicosis not as dangerous for the fetus as the development of so-called late gestosis.

Pregnancy gestosis or toxicosis are painful changes during pregnancy caused by hormonal fluctuations, various pathologies and diseases. According to the time when a problem may arise, early gestosis during pregnancy and late are distinguished.

Causes of gestosis in pregnant women

Although the manifestations of gestosis have been studied for a long time, but until today it has not been possible to identify the exact causes of this pathology. Often, pregnant women with disorders of the nervous system and brain, with problems with the heart and pressure suffer from gestosis. Relationships with kidney pathologies and the development of preeclampsia, with the presence of allergies, endocrine and metabolic failures, as well as the presence of bad habits before conception, were revealed.

Very young future mothers or age-related ones often suffer from gestosis - this is explained either by immaturity or age-related changes in the body, as well as those who carry twins, who are overweight and pressure, or who also had gestosis in the female line.

According to the severity of manifestations and severity of the course, it is customary to distinguish three degrees in late gestosis.

Preeclampsia 1 degree during pregnancy

Usually, mild gestosis during pregnancy is called dropsy of pregnant women. These are the initial, relatively mild manifestations. At the same time, pronounced, rather serious edemas are formed throughout the body; they give a large increase in body weight. Edema is visible on the limbs, on the body and even on the face, they increase in the evening, progress and are difficult to correct. Against the background of dropsy, the phenomena of nephropathy can join - kidney damage when they do not cope with their tasks.

Preeclampsia of the 2nd degree during pregnancy

It is the development of nephropathy (kidney damage) with the progression of edema and increased blood pressure, the manifestation of protein in the urine that is already referred to as severe preeclampsia. Such changes indicate that the body cannot cope with the loads that pregnancy imposes on it, and it malfunctions. Gradually, with the progression of the process, extremely severe manifestations of preeclampsia - preeclampsia and eclampsia can occur. These are serious lesions of the nervous system against the background of all the ongoing changes - swelling, pressure, loss of protein by the kidneys. These changes give the most severe and life-threatening consequences of preeclampsia during pregnancy.

What is dangerous gestosis in late pregnancy

Gestoses develop exclusively in pregnant women - they are directly related to the bearing of the fetus. After childbirth, gestosis usually disappears, but often, in severe cases, the consequences of gestosis remain even after childbirth. However, gestosis is dangerous during pregnancy, especially in the third trimester. They can lead to eclampsia, severe seizures that are life-threatening. With them, the pressure goes off scale, the kidneys fail, the whole body swells. This condition requires immediate resuscitation and the birth of a baby to save both lives.

The consequences of preeclampsia for the mother

But often, even after delivery, as a result of severe complications of pregnancy, there are serious consequences of preeclampsia for the mother after childbirth. These can be severe postpartum hemorrhage leading to anemia, as well as complications such as the development of strokes or brain damage due to seizures, irreversible kidney damage with the development of their failure, visual impairment, persistent headaches due to high blood pressure, and much more.

The consequences of gestosis for a child

Naturally, in a difficult condition of the mother, the developing baby will suffer along with her. The development of preeclampsia during pregnancy is no less dangerous and the consequences for the child. Naturally, the most dangerous complication will be intrauterine death of the fetus as a result of hypoxia and nutritional deficiency. This is due to severe placental edema or placental abruption, bleeding and premature birth.

The influence of preeclampsia in the mother on the development of the fetus is expressed. Such children are weakened, they suffer from chronic hypoxia, lag behind in growth and development, and can often and for a long time get sick after birth.

Given the need for the development of pathology to give birth ahead of time, you can add another answer here - what is the danger of gestosis for the fetus. When a child is born much earlier than the due date, he is completely unprepared for an independent life and requires special care, may have deviations in health and developmental delay.

In vitro fertilization (IVF) is modern technology artificial insemination, through which many couples have a chance to have a child. Even 10 - 15 years ago people.

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Gestosis after childbirth

Doctors are required to prevent prolonged labor and severe uterine bleeding after them. Therefore, a uterine contracting drug is used - "Oxytocin".

On the first day after childbirth, a woman suffering from severe preeclampsia is in the intensive care unit, where her condition is closely monitored by resuscitators. At this time, she receives anticonvulsant therapy in the form of "magnesia" familiar to many women. This drug not only relieves the tone of the uterus, but is also a good prophylactic against eclampsia. The condition of the woman is closely monitored. They take urine and blood samples from her, and often measure her blood pressure.

In the first days after childbirth, women physiologically increase the volume of circulating blood, and for those who suffer from preeclampsia, this is an additional risk factor for arterial hypertension. Depending on the level of blood pressure and the severity of preeclampsia, the puerperal is prescribed drugs for pressure. If possible, compatible with lactation. For example, Dopegit, Nifedipine. Treatment of postpartum preeclampsia continues after discharge from the hospital. The increase in pressure can last up to about two months, but normally the condition should gradually return to normal. Drug withdrawal occurs by slow decline frequency of administration and dosage.

• headache;
• infrequent urination;
• increase in pressure.

Preeclampsia after childbirth, how to treat preeclampsia after pregnancy

Preeclampsia after delivery: how to deal with it

Preeclampsia after pregnancy and during it has symptoms known to doctors: increased blood pressure, swelling, and in connection with them a rapid and large weight gain, as well as protein in the urine. In severe preeclampsia, a woman experiences nausea and vomiting, a severe headache. Since pathology can cause a lot of problems, more than one doctor decides how to treat preeclampsia after childbirth. It all depends on which organs of the mother he hit.

Preeclampsia (late toxicosis) is one of the most severe pathologies in expectant mothers. It is directly related to pregnancy. It begins in the second, and more often the third trimester, and is the main cause of maternal and child mortality. It is not treated with medication, only by delivery. All that doctors can do is to help prepare the child as much as possible for life outside the womb (with the rapid early progression of the pathology, the child is born prematurely) and prevent (though not in all cases) eclampsia, a formidable complication of preeclampsia in the mother.

Preeclampsia that occurs in the mother for a period of weeks, as a rule, leads to an emergency caesarean section due to her serious condition and the child in order to save them. If late toxicosis occurs after weeks, there is a chance that preeclampsia will not have time to harm the body of the mother and child too much. Mild preeclampsia rarely has consequences. Usually, all its symptoms go away in the first 1-2 days after the baby is born.

Childbirth with gestosis can be natural or operative, it depends on many factors. However, this situation is always under the control of doctors and anesthesiologists. Approximately half of the cases of eclampsia (severe convulsive seizures) occur in the postpartum period, in the first 28 days after birth. And more often eclampsia is diagnosed in women who gave birth at term.

With a period of less than 32 weeks and severe preeclampsia (severe preeclampsia), a woman is given a caesarean section. After 34 weeks, natural childbirth is possible if the baby does not show any health problems and is in the correct position in the uterus.

During childbirth, as a prevention of eclampsia, a woman receives epidural anesthesia, that is, she gives birth only with anesthesia, as well as drugs that reduce blood pressure.

Doctors are required to prevent prolonged labor and severe uterine bleeding after them. Therefore, a drug that reduces the uterus is used - "Oxytocin".

On the first day after childbirth, a woman suffering from severe preeclampsia is in the intensive care unit, where her condition is closely monitored by resuscitators. At this time, she receives anticonvulsant therapy in the form of "magnesia", familiar to many women. This drug not only relieves the tone of the uterus, but is also a good prophylactic against eclampsia. The condition of the woman is closely monitored. They take urine and blood samples from her, and often measure her blood pressure.

In the first days after childbirth, women physiologically increase the volume of circulating blood, and for those who suffer from preeclampsia, this is an additional risk factor for arterial hypertension. Depending on the level of blood pressure and the severity of preeclampsia, the puerperal is prescribed drugs for pressure. If possible, compatible with lactation. For example, &Dopegit&, &Nifedipin&. Treatment of postpartum preeclampsia continues after discharge from the hospital. The increase in pressure can last up to about two months, but normally the condition should gradually return to normal. Withdrawal of the drug occurs by slowly reducing the frequency of administration and dosage.

Edema after childbirth is a common occurrence. And not only in those suffering from gestosis. A sign of preeclampsia is considered a rapid increase in swelling of the hands and face. If the ankles are swollen - it's not so scary. It will pass within a few days or weeks. At the same time, breastfeeding women should not use diuretic (diuretic) drugs, as this will lead to a decrease in lactation - a lack of breast milk.

What to do if preeclampsia does not go away after childbirth

You need to know the symptoms that require urgent medical attention:

• headache;
• blurred vision, flies in the eyes;
• pain between the ribs or in the right hypochondrium (liver);
• infrequent urination;
• increase in pressure.

If the protein in the urine remains after 6-8 weeks after childbirth, a consultation with a urologist or nephrologist is required.

If there was eclampsia, it is necessary to do a CT scan of the brain. In addition, donate blood for antiphospholipid antibodies, lupus anticoagulant, undergo a test for thrombophilia.

Supervision at least of the gynecologist and the therapist is required.

Consequences of gestosis for the child and mother

The woman is explained that she is at risk for the development of arterial hypertension, kidney and liver failure, diabetes in future. Preeclampsia after cesarean and childbirth can eventually turn into coronary heart disease, cause a stroke.

As for the new pregnancy, there is a risk of repeating the scenario of the previous one. For prevention, a woman is prescribed aspirin in small doses from 12 weeks of pregnancy until its end. Sometimes together with calcium preparations.

The interval between pregnancies should not be more than 10 years, as this is also a risk factor for the development of eclampsia when carrying a child.

Preeclampsia in pregnant women also has a negative effect on the child's body - after childbirth, preeclampsia in mothers disappears, but problems in the baby may remain. Most often, with the nervous system. Children whose mothers have suffered severe preeclampsia are almost always born small, with signs of intrauterine growth retardation and chronic hypoxia.

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Toxicosis during pregnancy (gestosis)

In pregnant women, edema often appears on the body. This occurs against the background of a violation of the removal of excess fluid from the body and may not be a serious pathology. But in some cases, edema indicates a serious illness called gestosis of pregnant women. If the patient or the doctor does not sound the alarm in time, preeclampsia can be complicated by conditions that end in death.

Gestosis and its varieties

Preeclampsia (late toxicosis) is a disease that develops only during pregnancy and is characterized by the appearance of serious organic and functional disorders in many body systems, but most often in the cardiovascular system. Usually, in pregnant women, late toxicosis occurs after the 20th week of gestation, but is clinically detected after the 26th week. Up to a third of all pregnancies are accompanied by gestosis of one degree or another, and the woman's condition returns to normal only after childbirth has occurred. The most severe preeclampsia is observed in women suffering from endocrine pathologies, diseases of the kidneys, liver, heart, blood vessels.

The classification of preeclampsia is primarily based on the forms of its course:

All forms of late toxicosis can sequentially flow into one another, ending in the most severe of them - eclampsia. Preeclampsia can be concomitant (in women with a history of severe pathologies) and pure (in healthy pregnant women). Foreign classification divides gestosis into 3 forms:

• arterial hypertension of pregnant women;
• preeclampsia;
• eclampsia.

This classification in separate lines puts transient hypertension in pregnant women and preeclampsia, layered on existing hypertension. Another classification is based on the differentiation of preemplaxia by degrees (mild, moderate, severe).

Why do pregnant women develop preeclampsia

Late toxicosis is a syndrome of multiple organ failure, which is caused by a violation of the mechanisms of adaptation of the body to pregnancy. It is believed that the immediate causes of gestosis are associated with an autoimmune reaction of the body to the release of certain substances by the placenta and fetus. These substances, reacting with their own cells of the immune system, form complex complexes of antibodies. They damage the walls of blood vessels, making them permeable. In addition, these causes lead to generalized vasospasm, which disrupts the blood supply to internal organs. Due to angiospasm, blood pressure rises and the total volume of circulating blood decreases. The viscosity of the blood increases, blood clots appear, hypoxia of the tissues of the kidneys, brain, and liver is detected.

Presumably, the above processes in the body of a pregnant woman can be combined with a change in the hormonal regulation of the functioning of vital organs. There is also a genetic predisposition to gestosis. The causes of preeclampsia are also associated with a failure of the nervous regulation of the activity of organs and systems.

There are a number of factors, the impact of which is considered predisposing to the development of preeclampsia during pregnancy. Among them:

• diseases of pregnant women in history, including pathologies of the heart, liver, nervous system, metabolism, gallbladder, kidneys;
• the presence of autoimmune diseases and allergic reactions at the time of pregnancy;
• bad habits;
• severe stress;
• excess body weight;
• violations of the structure of the genital organs, their underdevelopment;
• poisoning, intoxication;
• polyhydramnios, hydatidiform drift.

According to statistics, the symptoms of preeclampsia often occur in women over the age of 35 and under 18, in socially unprotected women who have poor living conditions and nutrition. Preeclampsia can develop after abortions performed at short intervals or during multiple pregnancies.

Gestosis in the first half of pregnancy

Preeclampsia in pregnant women can occur even in the initial stages of gestation. Early toxicosis (preeclampsia) is more often detected from the first weeks and has a variety of symptoms. The woman notes nausea, vomiting, changes in taste and smell, nervousness, tearfulness. Early mild toxicosis can cause vomiting up to 3-5 times a day. The average severity of toxicosis has more severe symptoms: vomiting is observed up to 7-10 times a day, there is a pronounced weight loss. After the development of a severe degree of toxicosis, a woman urgently needs hospitalization, since indomitable vomiting is combined with an increase in body temperature, a drop in pressure, pulse, a sharp weight loss, the appearance of acetone and protein in the urine. If early preeclampsia has not disappeared by the end of the 1st trimester, a comprehensive examination of the woman for pathology of the internal organs should be carried out.

Gestosis in the second half of pregnancy

If early preeclampsia is dangerous due to dehydration and impaired fetal development, then late toxicosis is an even more serious condition. Already by the presence of rapid weight gain, the appearance of edema and protein in the urine, the doctor may suspect preeclampsia in pregnant women. Later, as a complication, an increase in blood pressure is added, which occurs in about 30% of women with preeclampsia. The danger of toxicosis in the second half of pregnancy is that its signs can quickly turn into a serious condition - eclampsia, which is very dangerous for the life of the mother and child. Late toxicosis often develops during the first pregnancy, and its symptoms can increase hourly and have a very aggressive course. Sometimes save a life expectant mother only emergency births.

Gestosis during the second pregnancy

Women who have experienced severe preeclampsia during pregnancy have a high risk of developing pathology during repeated gestation. If the interval between pregnancies is small, then the risk of preeclampsia is even higher. Usually, expectant mothers from the risk group are placed in a hospital in advance, or their health status is monitored on an outpatient basis from the first weeks of pregnancy.

Clinical picture of preeclampsia

As a rule, on later dates Pregnancy signs of preeclampsia are associated with the appearance of edema (dropsy). They can be implicit and are detected by rapid weight gain (more than 400 grams per week). As the pathology develops, edema becomes noticeable on the legs, feet, abdomen, face, hands. Edema is especially visible in the second half of the day.

Preeclampsia in pregnant women at the stage of dropsy is due to a decrease in urine output and a violation of the outflow of fluid. At the same time, other signs of pathology are often absent, and the woman may feel well. Later, thirst, severe fatigue, heaviness in the legs join.

At the stage of nephropathy during pregnancy, proteinuria (the presence of protein) is detected in the urine, blood pressure increases (from 135/85 mm Hg). An uneven, spasmodic fluctuation of pressure during the day is diagnosed. The amount of urine excreted by a woman falls sharply, despite the consumption of a large volume of fluid. If at this stage there is no necessary treatment, the symptoms of gestosis increase rapidly and can develop into pathologies such as eclampsia and preeclampsia.

Preeclampsia is a complication of nephropathy in pregnant women, accompanied by severe circulatory disorders and damage to the nervous system. In addition, the patient has small hemorrhages in the retina, liver, stomach. Preeclampsia has the following clinical features:

• heaviness in the head, pain, dizziness;
• nausea, vomiting;
• pain in the abdomen, stomach, ribs;
• sleep disorders;
• visual dysfunction due to damage to the retina.

Treatment of preeclampsia must be urgent and most commonly includes induced labor and intravenous administration. medicines. Otherwise, there is a high probability of developing a pathology such as eclampsia. Signs of this condition:

• severe pain in the body without a clear localization;
• headache;
• convulsive seizures;
• loss of consciousness;
• coma.

Eclampsia is often expressed in convulsions that last for several minutes and cause severe tension in the body, face. Foam with blood may come out of the mouth, breathing becomes intermittent, hoarse. During this period, a pregnant woman can quickly die from a massive cerebral hemorrhage. After consciousness has returned, the woman may again fall into a state of seizure due to exposure to any stimulus (sound, light). If the state of eclampsia was diagnosed in late pregnancy, even with successful delivery and saving the life of a woman, internal organs and systems are damaged. Their treatment in the future will depend on the complexity, magnitude and severity of the course.

Consequences and complications of preeclampsia

Preeclampsia is always a serious test for both mother and child. Retinal detachment in preeclampsia leads to irreversible blindness or permanent visual impairment. The functioning of the nervous system, kidneys, liver worsens, blood clots form, heart failure develops. Preeclampsia and eclampsia can cause complications that threaten a woman's life - severe dehydration, stroke, hemorrhages in internal organs, dropsy of the brain, pulmonary edema, acute liver dystrophy. The baby can also die due to placental abruption and hypoxia and suffocation developing in connection with this. The overall rate of perinatal mortality against the background of preeclampsia reaches 30%. Even a mild form of gestosis causes disturbances in the physical development of the fetus due to hypoxia, as well as the appearance of mental abnormalities after childbirth. Due to the very serious consequences, the prevention of preeclampsia and its early detection are of high relevance.

Gestosis after childbirth

As a rule, childbirth quickly alleviates the condition of the pregnant woman. Preeclampsia most often improves symptoms within 48 hours after delivery, but eclampsia may develop within the same period. In this regard, after childbirth, drug prevention of further complications is carried out. If the signs of preeclampsia do not disappear 14 days after delivery, this means the presence of damage to the internal organs and systems. Such patients need long-term, sometimes life-long treatment of emerging pathologies.

Diagnosis of preeclampsia

If there is a rapid weight gain (from 400 grams per week), the specialist should conduct an examination of the pregnant woman to identify signs of preeclampsia. It includes:

• general analysis of urine, blood;
• blood biochemistry;
• urinalysis according to Zimnitsky;
• regular weighing and pressure measurements;
• fundus examination;
• fetal ultrasound;
• Ultrasound of internal organs.

A woman must consult a nephrologist, ophthalmologist, neuropathologist, and, if necessary, a cardiologist. If latent edema is detected due to excessive weight gain, an MCO test is performed (subcutaneous injection of saline and fixing the time during which it resolves).

Mild Preeclampsia in Pregnancy

Preeclampsia in late pregnancy can present with varying degrees of severity. With a mild degree, a woman has the following indicators:

1. arterial pressure periodically rises to 150/90 mm Hg;
2. the concentration of protein in the urine is not higher than 1 g / l;
3. visualized swelling on the legs (lower leg, foot);
4. the platelet count reaches 180 * 109 l;
5. creatinine in the blood is not more than 100 μmol / l.

At this stage, the pregnant woman is placed in a hospital, her movement is strictly limited, and drug treatment is performed. When the condition worsens, an operation is performed - childbirth by caesarean section.

Preeclampsia of moderate severity in pregnant women

Moderate preeclampsia is characterized by the following indicators:

1. blood pressure rises to 170/110 mm Hg;
2. proteinuria not higher than 5 g/l;
3. edema is found on the legs, on the anterior part of the peritoneum;
4. creatinine in the blood - mk.mol / l.

At this stage, urgent delivery by caesarean section is indicated.

Severe preeclampsia

Severe preeclampsia occurs with severe symptoms (vomiting, headache, etc.). At any moment, this condition turns into eclampsia, but sometimes the last degree of gestosis develops atypically, when there are no visible causes and signs of it. Therefore, if moderate edema does not disappear after treatment within 3 weeks, the disease qualifies as severe preeclampsia. Her diagnostic criteria are:

1. blood pressure over 170/110 mm Hg;
2. proteinuria - from 5 g / l;
3. edema is found on the legs, anterior part of the peritoneum, on the face, hands;
4. platelet count - * 109 l;
5. creatinine - from 300 micromol / l.

Features of pregnancy management with preeclampsia

If the treatment of preeclampsia or observational tactics do not lead to an improvement in the woman's condition, delivery is planned, regardless of the duration of pregnancy. On the contrary, if laboratory parameters and clinical signs have improved, then the pregnant woman continues to remain in the hospital under close supervision. Be sure to appoint a special diet, bed rest, pressure control up to 6 times a day. A woman is weighed twice a week, the drinking regimen and the amount of urine excreted are monitored. Urine and blood tests are also regularly performed, examinations are carried out by narrow specialists. Thus, the treatment and prevention of preeclampsia often help to bring the pregnancy to a week and safely carry out delivery. Childbirth by caesarean section is planned in the absence of the effect of therapy.

Nutrition of the expectant mother with gestosis

The diet of a pregnant woman should provide her and the baby with all the necessary nutrients, but the amount of food should be limited. In other words, you should not exceed the norms for the caloric content of the diet established for pregnant women. The diet for preeclampsia must necessarily include animal protein (fish, meat, dairy products, eggs), which is lost in the urine. We must not forget about vegetable fiber, but it is better to exclude sweets and salty, refined, fatty foods. Treatment of preeclampsia necessarily includes limiting salt and fluid intake (up to a liter per day). Instead of water, it is better for a future mother to drink diuretic teas, a decoction of lingonberry leaves, bearberry. The pregnant diet excludes the consumption of pickles, marinades, salted fish, etc.

Treatment of preeclampsia

In addition to dietary nutrition, fluid restriction and bed rest, a pregnant woman is often prescribed medication:

1. sedative preparations of plant origin (valerian, motherwort);
2. herbal diuretics (canephron, cystone), synthetic diuretics (lasix);
3. magnesium preparations for removing excess fluid from the body (magne B6, magnesium sulfate intravenously);
4. vitamin and mineral complexes;
5. drugs to improve placental circulation (actovegin, chimes);
6. drugs of the latest generation that lower blood pressure (valz, physiotens, etc.);
7. preparations to improve the functioning of the liver (chophytol, Essentiale).

Outpatient treatment is carried out only in the initial degree of preeclampsia - dropsy. All other stages of the pathology require the placement of a pregnant woman in a hospital. In severe cases, a woman is prescribed emergency therapy with drugs that reduce blood pressure, anticonvulsants, and after stabilization of the condition, immediate delivery is performed.

The influence of preeclampsia on the methods and timing of delivery

Independent childbirth is allowed if the treatment of preeclampsia was successful, the condition of the fetus and the pregnant woman herself is not satisfactory, and there are no prerequisites for the development of acute preeclampsia during childbirth. In other cases, operative delivery is indicated. Indications for preterm birth are:

• persistent nephropathy of moderate, severe degree;
• failure of gestosis therapy;
• preeclampsia, eclampsia (including complications of eclampsia).

Childbirth in severe cases of late toxicosis is carried out within 2-12 hours, which depends on the period of normalization of the woman's condition after the start of drug therapy. Childbirth with moderate preeclampsia is planned in 2-5 days from the start of treatment in the absence of its effectiveness.

How to prevent gestosis

Prevention of preeclampsia should be carried out in every pregnant woman after the end of the first trimester. Particular attention should be paid to women with multiple pregnancy, women over 35 years of age and with a history of chronic diseases of internal organs. To prevent gestosis, the following measures are taken:

• organization of the daily routine and proper nutrition;
• regular but moderate physical activity;
• frequent exposure to the open air;
• limiting salt intake;
• observation by an obstetrician-gynecologist during the entire period of pregnancy;
• treatment, correction of chronic pathologies;
• rejection of bad habits.

At the first sign of fluid retention in the body, you need to notify the doctor about this, who will do everything necessary to maintain the health of the mother and the birth of a strong baby!

Useful information

• constant general fatigue;
• drowsiness;
• malaise;
• periodic causeless pain in the internal organs;
• depression

The presented materials are general information and cannot replace the advice of a doctor.

There are standard terms of stay in the maternity hospital in the event that the postpartum period passes without complications. With childbirth through the natural birth canal, they can be 4-6 days, with operative delivery - 7-9 days. It is at this time that the doctor watches the mother and baby every day.

What procedures and manipulations await a young mother after childbirth?

The doctor and midwife will periodically check:

• pulse, blood pressure and respiration;
• temperature (on the first day after birth, it may be slightly increased);
• location of the uterine fundus (during the first day it will be above the level of the navel, and then it will begin to fall);
• uterine fundus tone (if it is soft, it may be massaged to help expel blood clots);
• lochia (discharge from the uterus) - their number, color (if they are unusually abundant, they will be checked very often - several times during the day);
• milk glands, to determine if you have milk and what condition your nipples are in;
• legs - for thrombosis;
• the seam, if you had a caesarean section;
• crotch - for the color and condition of the sutures, if any (if there are sutures on the perineum or on the anterior abdominal wall, they are treated daily with antiseptic solutions, more often with a solution of brilliant green);
• side effects drugs, if you receive them.

You will also be asked:

• whether you urinate regularly and do not experience discomfort or burning;
• whether you had a stool (if you lie in the hospital for more than one or two days) and whether regular defecation has returned.

You may be assigned:

• pills that promote uterine contraction - for the prevention of postpartum hemorrhage;
• injections or tablets of painkillers and antispasmodics in the presence of painful postpartum contractions (such drugs are given to multiparous and patients after a cesarean section);
• antibacterial drugs (they may be prescribed after surgical delivery).

If some indicators deviate from the norm, it may be necessary to detain the mother in the maternity hospital. For example, the slightest increase in temperature will alert your doctor, since hyperthermia is the first symptom of any infectious disease, whether it is an infection of a surgical obstetric wound, a breast infection, or an acute respiratory illness. There can be no trifles here. Each symptom must be taken seriously, with full responsibility.

The reasons for the delay of a woman in the hospital may be different. Let's talk about them in more detail.

Complications of pregnancy and childbirth

• Severe forms of preeclampsia in pregnant women. Preeclampsia is manifested by edema, the appearance of protein in the urine, and an increase in blood pressure. An extreme form of preeclampsia is eclampsia - convulsions due to spasm of cerebral vessels. In severe forms of preeclampsia, a woman lingers in the hospital until blood pressure stabilizes and urine tests normalize. In non-severe forms of preeclampsia, when blood pressure does not increase after childbirth, there are no edema, one normal urine test is enough to discharge the patient on the 5-6th day after childbirth. If at least one of the symptoms of preeclampsia persists, then, depending on its severity, treatment can be carried out in the intensive care unit or in the postpartum unit. For treatment, sedative, antihypertensive, diuretic drugs are prescribed. Since preeclampsia is a risk factor for postpartum hemorrhage, they give injections of oxytocin, a drug that contracts the uterus.
• Massive bleeding during childbirth and in the early postpartum period. After such complications, the woman is weakened, immunity is reduced, so there is a high probability of other complications, such as infectious ones. After bleeding, antianemic, reducing therapy is carried out, hemoglobin content in the blood is controlled. If the course of the postpartum period is not accompanied by repeated bleeding, then the patient is discharged 1 day later than other women who gave birth on the same day.
• Traumatic childbirth with the formation of large tears or vesicovaginal or rectovaginal fistulas. Fistulas are passages that form between two organs: the vagina and the bladder or the vagina and the rectum. This happens when the fetal head does not move along the birth canal for a long time. In this case, a bedsore is formed that connects the vagina with other organs. Childbirth with deep ruptures of the vagina, perineum, when perineal ruptures reach the muscles of the rectum, is also considered traumatic. In the described cases, after childbirth, a longer observation of the restored tissues is necessary, since the extensive wound surface formed after ruptures predisposes to inflammatory complications and suture divergence. Sometimes a woman needs to be readmitted to the hospital for the next operation, during which the fistulas are closed or the pelvic floor muscles are strengthened. In the absence of complications with the healing of sutures, the puerperal stays in the postpartum department 1-2 days longer than other women.

Infectious complications of the postpartum period

• endometritis - inflammation of the lining of the uterus. This disease is manifested by an increase in body temperature up to 38-40 ° C, depending on the severity of the disease, pain in the lower abdomen (it should be noted that it is normal, especially after repeated births, during this period, cramping pains can be observed - more often during feeding). This is due to the contraction of the uterus. Pain with endometritis is persistent, they are pulling in nature and can spread to the lumbar region. Discharge from the genital tract with endometritis is abundant, with an unpleasant odor. If normally, after 2-3 days after childbirth, the discharge becomes bloody in nature, then with endometritis, bloody discharge may resume. With inflammation, the uterus does not contract well. It is necessary to say about the so-called subinvolution of the uterus. This is a borderline condition between endometritis and the norm: the uterus is not contracting enough, which can “prepare the ground” for inflammation.
• Inflammatory complications that can lead to a woman's delay in the maternity hospital should also include divergence and infection of the sutures of the perineum and the suture after caesarean section. With these complications, redness of the skin is observed in the area of ​​\u200b\u200bthe rupture or incision, pus may be released from the wound, and the suture area is painful.

With any inflammatory complications of the postpartum period, the temperature rises to 38-40 degrees C, chills, weakness, decreased appetite, and headaches are observed.

With subinvolution of the uterus, the patient remains in the postpartum department, where she is additionally prescribed reducing drugs. With the effectiveness of this therapy, an ultrasound examination of the uterus is performed on the 4-5th day after childbirth to exclude retention of placental remnants and accumulation of blood. After that, the woman is discharged. If the treatment is ineffective or other signs of endometritis have joined, as well as infection and divergence of the sutures, the woman is transferred to a special second obstetric department. Here, if necessary, antibiotic therapy is prescribed, uterine lavage, uterine contractions, dressings in the area of ​​​​a purulent wound when the sutures diverge. In doubtful cases, after the baby is discharged, the young mother can be transferred to the gynecological department of the hospital for aftercare.

• In the postpartum period, complications such as thrombophlebitis - inflammatory complication of varicose veins of the lower extremities. As a result of this disease, the wall of the vein becomes inflamed in the area of ​​​​the thrombus that formed earlier. In this case, the patient is concerned about pain in the area of ​​the affected limb, redness of the skin over the affected vessel. With thrombophlebitis, after consulting a surgeon, depending on the severity of the condition, the patient is transferred to the second obstetric department or a specialized vascular department of the hospital. The complex of therapeutic measures for this disease includes elastic bandaging of the affected limb, the use of antibacterial, anti-inflammatory, painkillers. At a certain stage of the disease, drugs that thin the blood are prescribed.

Since factors predisposing to endometritis are manual examination of the uterus, a long anhydrous period (when from the moment of outflow amniotic fluid more than 12 hours pass before the birth of the child), low contractile activity of the uterus, manifested by weakness of labor activity, hypotonic postpartum bleeding, childbirth with a large fetus and other conditions leading to a deterioration in uterine contractility after childbirth, then in these cases, contracting drugs are prescribed, ultrasound is also performed to exclude the delay of parts of the placenta and blood clots. Before discharge, a general blood test is prescribed, since an increased content of leukocytes in the blood is a sign of inflammation. These measures help prevent complications.

chronic diseases

Chronic diseases of the mother are the reason for extending the period of hospitalization in cases of exacerbation of the disease in the postpartum period. More often it is hypertension, as well as diseases of other organs: kidneys, liver, heart. With their exacerbation, a specialist is invited to the postpartum department - a therapist, a cardiologist, etc. Before this, in accordance with the capabilities of the maternity hospital, a number of additional tests and examinations are carried out (blood, urine, ECG, etc.). If the specialist confirms the need for treatment in a specialized hospital, then the woman is transferred to a therapeutic, urological or any other department - as directed.

In the hospital - at your own request

Sometimes situations arise when a young mother is not self-confident, she “did not have time to look back” and is afraid to be left without qualified help. Can she count on the support of doctors? Yes, in this case, it is possible to extend the stay in the hospital by 1-2 days, but within the established norms: after spontaneous childbirth - no more than 6 days, after cesarean section - no more than 10.

If the mother is transferred to the observational department, the baby "moves" with her. The issue of feeding in this case is decided individually. If a woman is transferred to a gynecological department or another hospital, then if the baby is in a satisfactory condition, he can be discharged home.

After discharge, the woman goes under the supervision of a gynecologist from the district antenatal clinic, as well as the attending physicians from the clinic. They continue the treatment they have started, make further appointments and monitor the results.

Even if you had to stay in the hospital longer than you planned, do not worry. After all, your health in the future will depend on how well you are examined and treated during this period. It should also be said that if any complications occur during the first month of the postpartum period (the appearance of profuse bloody or fetid discharge from the genital tract, fever, problems with the chest, with stitches), a young mother can go to the maternity hospital where childbirth took place.