Preeclampsia (late toxemia of pregnancy)

Edema, preeclampsia in pregnancy.  Photo from http://creative.gettyimages.com

The word "morning sickness" is not often heard every woman who gave birth to at least one child. Complication of pregnancy, for many years, which bears the name of late toxicosis, since 1996, became known by the term "preeclampsia." This condition is characterized by deep frustration function of vital organs and systems.

Gestoses is a distinction between 'pure' and 'fit'. By "clean" referred gestoses that occur in pregnant women who previously did not suffer from any diseases. But more often observed sochetannye gestoses that develop on the background of the preceding disease. Most adversely flows preeclampsia in pregnant women with hypertension, renal disease (glomerulonephritis, pyelonephritis), liver and biliary tract (conditions after earlier hepatitis, biliary dysmotility), disorders of endocrine glands (thyroid, pancreas, adrenal glands), lipid disorders exchange.

Causes

Despite numerous studies, the causes and mechanism of Gestoses still not finalized.

Valid now considered a number of theories:

  • Kortikivistseralnaya theory considering preeclampsia as a kind of neurosis pregnant in violation of the physiological relationship between the cortex and subcortical structures of the brain, leading to changes in the vascular system and circulatory problems.
  • According to supporters endocrine theory, dysregulation of the cardiovascular system, circulatory organs, metabolism in tissues and organs is due to changes in the function of the endocrine organs that produce biologically active substances that regulate vascular tone, flow and blood clotting.
  • Supporters immunological theory believe that changes in the blood vessels, tissues and organs characteristic of preeclampsia, arising from the inadequate response of the immune system of the mother to certain antigens of fetal tissue, there was no in normal pregnancy.
  • Nomination genetic theory based on the statistics confirmed increase in the frequency of Gestoses those pregnant mothers who suffered from preeclampsia during pregnancy. Do not reject the existence of "genes of preeclampsia."
  • The provisions placental theory based on the fact that in typical no gestosis physiological pregnancy changes in uterine vessels feeding the placenta. As a result, releases the active substances, resulting in the disruption of the entire vascular system of the mother.
  • Currently, most researchers have concluded that a single mechanism of Gestoses not exist, and there is the combined effect of various factors, eventually leading to disruption of internal organs.

What's going on?

The changes occurring in women with preeclampsia have been studied much better than their reason. Their foundation is the spasm of blood vessels, decrease in blood volume, changes in blood flow and clotting, impaired microcirculation. In addition, gestosis is weakened cardiac performance and reducing the circulating blood volume. All this leads to a significant reduction in blood supply to the tissues with the development of degenerative changes in them until the death of tissue. The organs most sensitive to a lack of blood supply, are the kidneys, liver and brain. The placenta, mostly consisting of vessels that have undergone changes characteristic of preeclampsia, is not doing its primary function of ensuring the exchange of oxygen and nutrients between mother and fetus, which causes oxygen starvation of the fetus and its intrauterine development.

What are the symptoms?

Depending on the symptoms gestoses divided into 4 stages: edema during pregnancy, nephropathy, pre-eclampsia and eclampsia.

Swelling there are implicit and explicit. In the early stages of preeclampsia there is hidden edema associated with fluid retention in the tissues. Understand this is very important as an attempt to self-medication with diuretic drugs not only reduce the amount of swelling, and will only worsen the overall condition of the pregnant woman and the fetus. It should be remembered that not all the swelling, it was noted during pregnancy are associated with preeclampsia. Do not be put off too soon, and be sure to check with your doctor.

Nephropathy — kidney disease — develops after 20th week of pregnancy. Can be mild, moderate and severe. It manifests itself in three main symptoms: edema, hypertension, proteinuria. Hypertension — high blood pressure, systolic ("top") to 30 mm Hg. Art. from baseline to pregnancy and diastolic ("lower") — 15 mm Hg. Art. above. Hypertension is one of the most important manifestations of preeclampsia, because reflect the severity of vasospasm. Proteinuria — is the appearance of protein in the urine.

Preeclampsia — severe stage of preeclampsia, which develops in 5% of pregnant women, most first-time mothers. In this case, against the background of severe nephropathy (edema, proteinuria, hypertension) there are signs of damage to the central nervous system. A woman worried about a feeling of heaviness in the neck or head pain, nausea, vomiting, blurred vision, perhaps inadequate perception of what is happening, ie changes in mental health. Severe pre-eclampsia is expressed predominantly in circulatory disorders of the central nervous system, particularly brain cells.

Eclampsia— The most severe stage of preeclampsia, reflected a complex set of symptoms, the most characteristic of which are convulsive seizures striated (skeletal) muscles of the body. During the attack because of abrupt rise in blood pressure could rupture of cerebral vessels, causing a stroke — intracranial hemorrhage. Also may be premature detachment of the placenta, which can cause fetal death.

The manifestations of preeclampsia could range from a stretched into months malosimptomno form, which may not even bother woman to lightning and catastrophic in its consequences.

Diagnosis and treatment

The diagnosis of "preeclampsia," based on clinical and laboratory data. For the early diagnosis of the disease requires timely registration with the women's clinic, required regular routine gynecological examinations and those professionals to whom you sent for consultation. Here is a list of activities that await you in the event that you have a doctor suspected preeclampsia:

  1. CBC with the definition of the absolute number of red blood cells and platelets;
  2. blood biochemical determination of protein concentration of electrolytes, BUN, and creatinine;
  3. study of clotting and fluid properties of blood;
  4. urine tests: clinical, daily urine with the definition of the quantity of protein chemistry;
  5. control diuresis, proper understanding of the accumulation of fluid in the body can be obtained by comparing the number of daily drunk and discharged liquid and measuring the dynamics of body weight;
  6. measurement of blood pressure in the dynamics on both hands, as if widespread vascular spasm can be a significant difference in terms of blood pressure on the left and the right, which will also indicate the depth of the violations;
  7. control of body weight;
  8. fundus examination, as the state of the vessels of the eye similar to cerebrovascular and cardiovascular system, women in general;
  9. ultrasound, including fetal Doppler velocimetry;
  10. consulting physician, nephrologist, neurologist.

As for treatment, it can be said that modern medicine is not able to fully heal from preeclampsia, but in most cases is possible to control this condition. Timely and appropriate treatment helps prevent severe forms of preeclampsia. Self-treatment is unacceptable, because without a professional individual treatment possible weighting of preeclampsia, which will lead to a deterioration of a pregnant woman and fet
us.

The principles of treatment Gestoses are as follows:

  • creation health-protective regime for the nervous system, women, depending on the extent of the disease are assigned different sedatives from motherwort and valerian with minimal manifestations of preeclampsia to potent sedatives for eclampsia;
  • drug recovery of function of vital organs;
  • timely and careful delivery. When preeclampsia is treatable doctors do not encourage holding of premature birth. Premature delivery is carried out with the ineffectiveness of the treatment, with the deterioration of a pregnant woman, and child.

Treatment Gestoses enough individually, and it can prevent the timely start of the development of serious complications. Once again: do not self! If your doctor has prescribed you medication, you need discipline to perform all of his appointment.

Alexander Gavrylenko

Magazine "9 months» № August 2002

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