Late toxicosis: causes, symptoms, complications

What is late toxicosis? The process is considered a pathological condition. In medicine, this phenomenon is called “preeclampsia”. It leads to a failure in the normal functioning of almost all systems.Late toxicosis during pregnancy -this is a serious phenomenon that can be fatal in some cases. In this case, the woman needs to urgently induce labor.

In fact nausea during pregnancylate date not so much a rare event. Approximately 15% of women develop this pathology. If the patient’s sensation sharply worsens, she is urgently hospitalized. The whole difficulty lies in diagnosing similar condition difficult. It does not always manifest itself properly, and the symptoms are very vague.

The danger of late toxicosis

Toxicosis during pregnancy later may be hidden. Symptoms such as racing blood pressure, swelling inside the body, the presence of protein in the urine is almost invisible. In this case, the woman does not feel much discomfort. Only a specialist can determine the presence of toxicosis. This is why it is important to regularly visit the doctor's office.

Why is late toxicosis dangerous?? Heaviness this process It also lies in the fact that it disrupts metabolism. As a result, the baby may develop a lack of oxygen and nutrition.

Often leads to serious disturbances in salt metabolism. Gradually, a lot of fluid and sodium begins to accumulate in the woman’s body. The vessels become permeable. Internal swelling occurs as the tissues quickly fill with water.

Due to circulatory pathology, the woman and fetus experience a lack of nutrients. The brain, kidneys, liver, and, of course, the uterus itself with the placenta are most negatively affected. Soon specific changes are formed, the function of organs is noticeably impaired.

Causes

Why do you feel sick?at a later date? Unfortunately, scientists have still not been able to determine exactly what influences the occurrence of such processes. Even now it has not been revealed what is playing vital role in gestosisin pregnant women. Experts suggest thatcausestoxicosis may be as follows:

• Most doctors are confident that this condition is a kind of manifestation of nervousness. They claim thatwears psychological character. In this case, some physiological abnormalities in the brain may occur. This is what can lead to poor circulation and problems with the vascular system.
• Endocrinologists have a completely different opinion on this matter. They believe thatmanifests itself due to modification of the activity of the glands. Because of this, the cardiac and vascular system begins to suffer, disruptions in blood circulation and work occur. metabolic process. This all happens due to the fact that hormones can affect blood vessels, in particular the fluidity and coagulability of blood.
• Experts who study immunity believe thatlate toxicosis of pregnant women- This is a completely understandable reaction of the body. Thus, the body reacts to fetal antigens. And of course, this process affects blood circulation and the functioning of all organs of the mother.
• From the genetic side, it can be assumed thattoxicosis in late pregnancymay worry the expectant mother if all women had the same problem. As is known, many chronic diseases and pathologies are transmitted genetically, and there is nothing surprising in this phenomenon.
• More recently, experts have put forward the theory that it’s all about the placenta. In this case, the pregnancy does not proceed as expected. If everything is normal, then vascular network The uterus, which nourishes the placenta, must undergo certain transformations. It is because of the disruption of this process that disruptions occur throughout the body.

Late toxicosis during pregnancycan go almost unnoticed, with the exception of nausea, to which pregnant girls are already accustomed. Most experts agree that it is impossible to single out just one cause, usuallyin pregnant womenSuch processes manifest themselves under the influence of several circumstances at once.

Symptoms of pathology

When does it occur late toxicosis, symptomsdepend on the form of pathology. A woman may experience the following symptoms:

1. Dropsy. In this case, almost the entire body becomes covered with edema. Such changes appear in the first stage. In general, the woman feels well, but due to swelling, heaviness, thirst and fatigue may occur.Deadlinessuch states may be different. The pressure does not rise and may only drop slightly. Approximately 25% of women suffer from nephropathy after dropsy.
2. Nephropathy. IN in this case Along with significant edema, hypertension occurs. Some girls have protein in their urine. A clear sign This condition is a sharp increase in blood pressure. Only specialists can determine the degree of pathology. For this, a scale is used that helps to compare several indicators.
3. Preeclampsia. Characterized by all of the above symptoms. Along with this, apathy, migraine, slight dizziness, pressure in the back of the head, and sleep disturbance may occur. Some patients complain of slight retardation, the appearance of midges before the eyes, and tinnitus. In most episodes, women experience disorders such as nausea, vomiting, and pain in the stomach.
4. Eclampsia. This configuration of toxicosis is rare. In this state, the expectant mother may fall into a kind of seizure. It usually happens due to the influence of some external irritants, such as too bright light, loud sound, severe pain.When does it startseizure, the woman’s facial muscles only twitch slightly, then a tremor occurs. In rare cases, patients experience breathing problems, tongue biting, unintentional flexion of limbs, and foaming at the mouth. When the seizure ends, the woman takes a deep breath.

Thus, late toxicosis of pregnant womenpresented by complication phases.

What are the dangers of complications?

Late toxicosis during pregnancyhas not yet been fully studied. Basically, doctors managed to get a large number of information about the processes that occur in a woman’s body during gestosis, but little is known about the causes that cause it. Most often, such processes have Negative influence exactly on vascular system. This leads to impaired blood circulation, and blood flow and coagulation indicators deteriorate.

As a result of such phenomena, the heart begins to become weak. The blood supply to tissues is much worse, and such processes in some situations lead to fetal rejection. All of these processes especially affect the functioning of the brain, liver and kidneys.

Late toxicosis in severe form can cause great harm not only for the mother, but also for her child. As you know, the placenta consists almost entirely of blood vessels. With such violations, they cannot properly provide for the fetus nutrients and oxygen. This is what leads to the child being delayed in development.

Nausea in late pregnancycould really be a red flag. This pathology often causes pulmonary edema, heart and kidney failure.

For an unborn baby, this condition poses a great danger, because there is a possibility of placental abruption, which in turn will lead to oxygen breathing and premature birth.

Not in all casesnausea during pregnancylate can signal such frightening diagnoses. Sometimes the whole reason lies in excessive worries, stress, and sudden climate change. A woman can simply be poisoned, consume a product of poor quality, she will experience nausea, vomiting, and she will mistake it for late toxicosis. In this case, you cannot do without consulting a doctor.

Preventive measures

There is no remedy yet that would help completely eliminate the possibility of toxicosis. But if you follow some rules, you can reduce the occurrence of nausea to a minimum. First of all, you need to eat right and follow a routine. You should exclude from your diet all fried, smoked, fatty foods, various semi-finished products, pickles and sweets.

Sometimes they are the ones that cause nausea. In addition, it is worth understanding that not only the woman, but also the child eats this food. It is best to boil food, steam it, stew it, or bake it without using oil. If a woman is worried about swelling, it is better not to drink a lot of water. Wherein daily norm should be approximately 1-1.5 liters, which includes not only water in pure form, but also various teas, compotes, broths.

Of course, you should refuse bad habits. Very often alcohol and nicotine provoke unpleasant symptoms and pathology. At the same time, it is necessary to follow a daily routine, rest, get enough sleep, and not stay up late. Walking at a slow pace is recommended, at least twice a day for 30 minutes.

Late toxicosis during pregnancy does not always mean that it is time to sound the alarm, but you cannot ignore such a reaction of the body. Sometimes such processes can lead to death, and not only the mother, but also the child can die. To avoid the worst and give birth healthy baby, at the first signs of late toxicosis, you should consult a doctor.

One of the most difficult and dangerous complications In pregnant women, late toxicosis during pregnancy is considered. This pathology characterized by functional disorders of organs that have vital important. Toxicosis occurs along with the development of pregnancy and causes disastrous consequences not only for the mother, but also for the fetus.

Concept and definition of late toxicosis

Pregnancy is complicated by late toxicosis in approximately 13% of pregnant women. Most often it appears after the 30th week. Symptoms of toxicosis increase gradually. Therefore, with timely registration, regular visits to the doctor and tests, you can significantly reduce the risk of pathology and prevent a threat to the life of the mother and unborn child.

When late toxicosis occurs, the functioning of the endocrine, cardiovascular and nervous system. Preventing death in severe cases becomes possible only through emergency caesarean section. The danger of such a condition manifests itself in acute heart failure, coma, pulmonary edema, premature detachment placenta, the occurrence of acute hypoxia in the fetus. The pathology occurs in several stages, the most severe and dangerous of which are the last.

Late toxicosis during pregnancy is also known as gestosis. It goes away completely within a period of several hours to several days after delivery. However high pressure, caused not by gestosis, but by hypertension, cannot go away on its own and requires the adoption of separate therapeutic measures.

The following categories of women are at risk:

• Age less than 18 and over 35 years old.
• The presence of gestosis during previous pregnancies.
• Development of multiple pregnancy.
• Diseases such as heart defects, hypertension, chronic kidney disease, etc.

In most cases, the cause of late toxicosis remains unknown. In general, this is not of decisive importance, since all efforts are aimed at combating the severe consequences of the pathology.

Causes of late toxicosis

The exact causes of late toxicosis have not yet been established. From a medical point of view, a number of factors are considered that can give rise to the appearance of this pathology. First of all, they are related to various diseases and disruption of vital organs and systems - heart, liver, kidneys, as well as endocrine diseases. The cause of gestosis can be frequent stress, obesity, intoxication of the body with alcohol, smoking, drugs, the presence of allergic and immunological reactions.

There are several versions of the causes of the occurrence and development of late toxicosis:

• According to the corticovisceral theory, neural regulation is disrupted between the subcortex and the cerebral cortex. As a result, the mother's body begins to adapt to the onset of pregnancy. This condition leads to a malfunction in the circulatory system and the further occurrence of gestosis.
• The hormonal or endocrine version is associated with impairment of basic functions in endocrine system. However, there are opinions that these disorders appear already during the period of gestosis and serve as secondary signs. They affect the adrenal cortex and ovaries, which produce estrogen. In some cases, the disorder is insufficient hormonal activity of the placenta.
• Sometimes the blood vessels in the placenta and uterus change, spasms occur, and blood flow is disrupted, causing hypoxia. These deviations relate to placental disorders. Their essence lies in the formation of the placenta simultaneously with the fetus. Its insufficient development in the initial stage does not protect the female body from fetal metabolic products. The entry of these substances into the bloodstream of the female body leads to intoxication, accompanied by nausea, vomiting, and odor intolerance. After sufficient development of the placenta, these phenomena gradually disappear.
• WITH most likely The immunogenetic version is being considered. In this case, the development of gestosis occurs as a result of a negative immune reaction of the woman’s body to foreign proteins or antigens of the fetus. There is an attempt to reject it. In another situation, antibodies are produced by the female body in insufficient quantities. Therefore, they cannot cope with placental antigens entering the bloodstream. Thus, inferior complexes circulate in the blood, which lead to circulatory disorders.

In most cases, late toxicosis occurs and develops under the influence of several factors. Changes in female body cause an increase in the permeability of vascular walls. Because of this, the liquid component of the blood penetrates the tissues, leading to the appearance of edema. They arise in the uterus and placenta, disrupting blood supply and impairing oxygen supply to the fetus.

Symptoms of late toxicosis

The main sign of gestosis is swelling. Liquid consumed by a woman in large quantities is not completely removed from the body, but remains in the space between the tissues. Typically, swelling occurs only in the lower extremities, but in severe cases the entire body may swell. There is a so-called hidden form edema, detected only when weighed. This is evidenced by a weight gain of over 500 g within a week. There is a need to control the amount of fluid consumed and, accordingly, urine excreted. If, while maintaining a normal drinking regime, urine output is less than 0.8 l, this may be the most likely manifestation of gestosis.

Along with fluid retention comes the development of hypertension. Therefore, pressure must be constantly monitored. As a rule, pressure during late toxicosis becomes approximately 15-20% higher than normal. Some women experience hypotension during the initial period of pregnancy, when the blood pressure level is below normal. This factor must be taken into account during the examination.

A serious symptom is proteinuria, when protein is excreted in the urine. This sign indicates impaired kidney function. IN similar situation great importance has a urine test that should not be skipped. After 20 weeks of pregnancy, such a study is carried out weekly. If a woman has several symptoms of pathology at once, treatment at home becomes ineffective, and such patients are recommended to be hospitalized.

Other symptoms manifest themselves in the form of headache, nausea and vomiting, heaviness in the head, and in the more severe form, convulsions and altered consciousness are observed.

Main types of gestosis

Symptoms and forms of the disease make it possible to divide gestosis into several degrees of severity:

• The first degree of gestosis in pregnant women manifests itself in the form of dropsy. The woman becomes noticeable with swelling, which decreases in the morning and increases again in the evening.
• The second degree is characterized by the presence of all the main symptoms. First of all, this is diastolic pressure, which is directly related to the blood flow of the placenta. As pressure increases, the supply of oxygen to the fetus decreases. The greatest danger comes from changes in pressure in the form of regular surges. This stage is complicated by the presence concomitant diseases. The most serious complications are considered to be bleeding, fetal hypoxia, placental abruption, and the onset of premature birth. They all create real threat fetal death.
• With the third degree of gestosis, preeclampsia develops, manifested by pain and heaviness in the head. At the same time, vomiting, pain in the liver area, and blurred vision may occur. Apathy sets in, memory deteriorates. All this is accompanied by insomnia, irritability and other symptoms indicating altered blood circulation in the brain. The liver may be injured severe swelling, up to hemorrhage.

Eclampsia is considered the most severe form of late toxicosis. In addition to the symptoms already listed, seizures appear. Seizures can be triggered by external stimuli - painful sensations, loud sounds, stress, bright light. They last about two minutes. The danger of this condition is cerebral edema and cerebral hemorrhage, which can be fatal.

Diagnosis and treatment of toxicosis

The most complete diagnosis of gestosis is carried out using general and laboratory methods research. Blood pressure is measured at least three times a day, including after exposure to light physical activity. Carrying out general analysis urine allows you to detect protein and increased density of urine. A special urine analysis according to Zimnitsky determines its volume excreted at night.

A general and biochemical blood test, as well as a coagulation test, are mandatory. The amount of fluid drunk and excreted is monitored daily. Weight is measured every week. The data obtained allow us to develop the most optimal set of therapeutic measures.

As a rule, late toxicosis is treated in a hospital setting. It is recommended to start treatment at an early stage, when symptoms are manifested only by the presence of edema. First of all, a protective regime is prescribed with a diet and special drugs, influencing the desired blood parameters. Droppers help improve blood circulation, kidney and liver functions. Sedative and calming therapeutic measures are carried out. It is impossible to completely cure gestosis, since the exact causes of the disease cannot be determined.

In the presence of late toxicosis in the period from 29 to 36 weeks, in case of increasing clinical manifestations, a woman is preparing for childbirth a little earlier deadline. If intensive care measures are ineffective and the form of gestosis is severe, a cesarean section is performed. With a time reserve of 3-4 days, the cervix is ​​prepared using a special gel containing prostaglandins. In this case, the woman can give birth on her own. However, in the absence of complications, a threat to life and health, and the possibility of treating gestosis, it is recommended to delay childbirth until the due date.

Complications and consequences of late toxicosis

Most often, the development of late toxicosis occurs after the 20th week of pregnancy. He calls serious complications which become the main causes of death.

As a rule, late toxicosis during pregnancy can cause the following complications:

• Spasms of small arteries occur, which are detected by ophthalmologists when examining the fundus.
• The permeability of the vascular walls increases, the outflow of blood in the veins worsens. As a result, obvious or hidden swelling occurs, and protein appears in the urine.
• The liquid component of the blood leaks into adjacent tissues. Because of this, the blood thickens and its coagulability increases.
• Lower blood pressure decreases and upper blood pressure increases.

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

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

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

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

Dropsy

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

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

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

Nephropathy

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

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

Preeclampsia

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

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

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

Eclampsia

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

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

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

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

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

Diagnostics

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

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

At minor swelling limbs and general satisfactory condition are limited to compliance general recommendations lifestyle and nutritional adjustment doctor.

Diagnosis of nephropathy, especially its severe forms, is not difficult, but in some cases it must be distinguished from diabetic and uremic coma.

Treatment

At mild form nephropathy is prescribed drug therapy, which includes:

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

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

If there are symptoms of preeclampsia, the pregnant woman is hospitalized in the intensive care unit for antihypertensive and anticonvulsant treatment. the main task– stabilization of the condition and cessation of seizures. Only after this can the question of delivery be raised. It can be produced as naturally, and by caesarean section, if there are additional indications for this.

With absence immediate treatment the consequences of severe late toxicosis can be:

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

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

For mild forms of preeclampsia, they are performed at 36-37 weeks of pregnancy. In severe forms of eclampsia, immediate delivery is necessary immediately after the seizures are relieved, regardless of the stage of pregnancy. If not additional indications() natural birth in this situation is more preferable.

Prevention

Nutrition and daily routine

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

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

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

In the second half of pregnancy the following are useful:

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

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

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

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

Other preventive measures

The risk of developing late toxicosis can be reduced by careful attention women to their health. A prerequisite for every pregnant woman is timely registration at the antenatal clinic. The expectant mother must take all tests on time and adhere to the timing of visits to the doctor. During pregnancy, it is important to closely monitor your weight, healthy image life.

Pregnant women at risk should especially carefully follow the doctor’s instructions. These are women with kidney and liver diseases, endocrine pathologies, pregnant with twins, over 35 years old, who have had sexually transmitted infections. About any signs feeling unwell you need to notify the doctor who will prescribe necessary tests and appropriate treatment.

Sudden attacks of nausea, debilitating vomiting - many pregnant women are familiar with the symptoms of toxicosis that occurs in the early stages. The woman stoically endures the torment, knowing that it will soon end. When toxicosis suddenly manifests itself in the 2nd or 3rd trimester, the expectant mother does not know what to think; however, there is no time to think - you need to urgently go to the doctor. Late toxicosis - serious pathology, neglecting which will cost too much.

How does late toxicosis differ from normal toxicosis?

The most common complication during pregnancy it is toxicosis. On initial stages fetal development, the female body adapts to new conditions; immune defense is reduced so that the mother’s antibodies do not get rid of the embryo, which they see as a foreign object (half of the DNA cells in the unborn child are from the father’s). The weakened body of a pregnant woman is attacked by toxins, causing a response in the form of nausea and vomiting.

According to statistics from the World Health Organization, 9 out of 10 expectant mothers suffer from toxicosis in the 1st trimester varying degrees heaviness; advanced medicine of the 21st century is not able to reduce these indicators. Late toxicosis is diagnosed in approximately every 7 pregnant women.

If a complication occurs in the 1st trimester, it usually goes away without consequences by 12–16 weeks of pregnancy. It’s a different matter when late toxicosis appears - otherwise this condition is called gestosis; pathology threatens to disrupt the functions of vital body systems. Unlike early toxicosis, late toxicosis does not proceed easily and often ends tragically. Preeclampsia is the main cause of female mortality in the 3rd trimester.

In 30% of cases, pregnancy with this pathology ends in premature birth.

When does gestosis begin and end?

Signs of pathology usually appear at 28 weeks of gestation, but sometimes a woman detects toxicosis in the middle of the 2nd trimester - which is much more dangerous for the expectant mother and fetus. Preeclampsia stops after childbirth or termination of pregnancy, since the development of pathology is associated exclusively with the presence of an embryo in the female body. The consequences, however, will be felt for a long time by disorders in the functioning of organs.

The following factors complicate the situation with gestosis:

• late toxicosis is difficult to recognize: at the initial stage, the symptoms are erased, and the woman attributes the malaise to pregnancy;
• the pathology is difficult to treat;
• It is not always possible to identify the causes of gestosis.

Why does gestosis occur and how does it manifest itself?

To find out the true nature of gestosis, clinical researches, however, the main “culprits” of the pathology were never found. Until now, doctors are struggling in search of a clear answer to the question - what provokes a terrible disease; So far we have only been able to formulate hypotheses.

Probability theories

Over the years of research, about 30 different theories have emerged that more or less plausibly explain the origin of late toxicosis. Here are the most popular:

Another observation: if the pregnant mother suffered from late toxicosis, the pathology is highly likely to manifest itself in her daughter. The presence of a gene responsible for the inheritance of gestosis is suspected.

However, in some cases, doctors can only guess about the causes of gestosis: nothing is certain. Such a mysterious, deadly disease.

Stages of pathology development

Depending on how late toxicosis develops, several stages are distinguished, each of which is marked by characteristic symptoms.

Dropsy - the first stage of gestosis

A pregnant woman is surprised to notice that swelling appears in the most unexpected places: on the face, stomach, limbs. Swelling of the legs and feet increases in the morning. The rings are difficult to remove and put on your fingers. In general, the expectant mother’s well-being does not deteriorate; her blood pressure remains normal.
One of the first signs of gestosis is swelling of the legs and feet, which is especially noticeable in the morning.

But when fluid retention in the body is significant and swelling is pronounced, the woman notices with alarm:

More often, dropsy is diagnosed when the expectant mother is carrying two or more children.

After childbirth, swelling goes away - if treatment is started on time. But in every fourth woman, dropsy develops into nephropathy during pregnancy.

Nephropathy - second stage

This is a serious complication of dropsy. The condition of the expectant mother is rapidly deteriorating. To the swelling already existing throughout the body are added:

If the expectant mother is suffering diabetes mellitus, nephritis or hypertension, the risk of developing nephropathy increases.

Stage three - preeclampsia

At this stage of gestosis, the pregnant woman’s condition is critical, but so far reversible. The symptoms are extremely alarming:

During preeclampsia, any irritant - a sharp sound, bright light, an attack of pain - can provoke seizures.

Stage four - eclampsia

Translated from Greek, the word “eclampsia” means an outbreak, a sudden appearance. This life-threatening stage of gestosis is extremely rare, usually in women who are pregnant for the first time. It is the same convulsive seizure that occurs due to an unexpected stimulus.

Here's how eclampsia develops:

1. The facial muscles begin to tremble slightly.
2. Cramps spread to the body, upper and lower extremities. In some cases, breathing stops and the patient may bite the tip of her tongue. Foam appears at the mouth.
3. The woman loses consciousness.

The duration of the seizure is about a minute. One follows another, the pregnant woman does not have time to wake up. After a series of convulsive seizures, cerebral hemorrhage often occurs; the woman falls into an irreversible coma. Sometimes a coma occurs suddenly, without convulsions.

A deep breath, gradual restoration of breathing - this means that after convulsions the patient regains consciousness. The woman feels unbearable headaches and weakness.

In 70% of cases, eclampsia occurs during pregnancy; in 30% - already during childbirth.

What does late toxicosis threaten for mother and fetus?

Only in case of dropsy is a pregnant woman allowed to stay at home; if there are signs of nephropathy or preeclampsia, the woman is admitted to the hospital, to the pathology department. It cannot be otherwise - the threats to life and health with late toxicosis are so serious.

Initiating a pathology is as easy as shelling pears, since it is not always possible to immediately recognize it; increased blood pressure, swelling, nausea - whatever you want, pregnancy. Few people will be suspicious of the first signs of gestosis. Meanwhile, the disease develops latently.

Only thorough examination The doctor reveals late toxicosis: due to metabolic disorders in the female body, the fetus begins to experience a lack of oxygen. During an ultrasound, a dangerous symptom is easily detected.

In a pregnant woman, advanced gestosis causes severe consequences:

• salt metabolism is disrupted, sodium and water accumulate in the organs;
• the walls of blood vessels allow more fluid to pass through than usual, as a result it fills the tissues and organs, which leads to internal edema- in particular, to pulmonary edema;
• the heart muscle weakens, so blood flow slows down, not enough nutrients enter the tissues; heart failure develops, stroke and paralysis are possible;
• overhydration results in hemorrhages and degenerative processes leading to tissue death; the functions of the uterus and placenta deteriorate, liver cells are destroyed (necrosis occurs), acute renal failure appears;
• disruption of brain function; convulsive seizures, coma cause irreparable harm women's health lead to mental disorders, and often end in death.

The critical condition of the mother is already becoming a threat to the life of the fetus. Even when it doesn't come to eclampsia, unborn child as a result of preeclampsia developing in a pregnant woman, it is highly likely that she will receive:

Already at the stage of nephropathy, the risks of developing oxygen starvation in the fetus are high; in some cases, premature birth.

Which expectant mothers are at risk?

Observations of pregnant women have shown that the following women suffer from late toxicosis most often:

The list is approximate, since gestosis can threaten even healthy to the expectant mother without bad habits, if a woman:

• overtired;
• experienced stress;
• got injured;
• does not eat properly;
• caught a cold.

Preeclampsia during second pregnancy

Sometimes signs of late toxicosis, which should disappear after the birth of the child, persist - Furthermore, begin to progress. In such a situation, if a woman decides to become pregnant a second time, she is at high risk of getting gestosis again.

The danger of late toxicosis increases significantly when less than two years pass between the first and second pregnancies.

However, the expectant mother already knows - forewarned means forearmed. From the very first weeks of pregnancy, you should register with the antenatal clinic; Doctors are obliged to carefully monitor the condition of a patient who has experienced gestosis in order to promptly detect the re-development of the pathology and prevent preeclampsia and eclampsia.

How to diagnose and treat gestosis

Since gestosis in the initial stages is “masked” as normal pregnancy With her standard set of ailments, a woman needs to be regularly examined by a doctor and undergo tests on time. Alarm signals will be:

• increased blood pressure, especially after exercise;
• detection of protein in urine;
• decrease in the number of red blood cells and platelets in the blood;
• too rapid weight gain;
• decreased visual acuity (diagnosed during examination by an ophthalmologist);
• malfunctions of the kidneys and adrenal glands detected on ultrasound;
• unsatisfactory electrocardiogram readings.

During the first screening ultrasound, which is performed at 11–14 weeks of pregnancy, blood flow in the vessels of the uterus is measured; if the blood flow is normal and the vessels are not narrowed, the risk of late toxicosis is extremely low.

Fetal examinations (CTG, ultrasound, Doppler) easily detect hypoxia based on the following signs: insufficient height and weight of the unborn child, narrowed blood vessels of the placenta and umbilical cord.

When a woman experiences minor swelling of her legs and arms, the doctor will limit herself to advice to lead a healthy lifestyle and eat right. At the stage of nephropathy, the pregnant woman is admitted to a hospital.

Will medications help?

The onset of gestosis is practically untreatable; There are no pills that will relieve the expectant mother of the pathology.

However, doctors have the opportunity to prevent the onset of preeclampsia and seizures and save the lives of the mother and fetus. Despite the fact that taking medications during pregnancy is undesirable (substances from medications penetrate through into the child’s body), sometimes doctors are forced to resort to drug therapy to alleviate the patient’s condition. So, those suffering from gestosis are prescribed:

• sedatives (as an option - tinctures, herbal decoctions) to normalize the functioning of the nervous system; medicinal plants you should choose carefully, since many are allergens;
• medications with antispasmodic effects - to improve blood flow in the uterus and placenta, reduce the threat of fetal hypoxia;
• magnesia (administered intravenously) - in severe stages of gestosis, to prevent the occurrence of seizures;
• antioxidants - vitamins A, E, C, group B.

Photo gallery: medications used for gestosis

Motherwort tincture has a calming (sedative) effect. No-shpa is an effective antispasmodic, but should be used with caution during pregnancy.
Magnesium sulfate solution (Magnesia) prevents seizures

Diuretics are prescribed only for heart failure or pulmonary edema, when such drugs cannot be avoided. In other cases, they are avoided because they reduce the volume of blood flow and slow blood circulation between the uterus and placenta.

How to manage pregnancy with late toxicosis

In severe forms of gestosis, the woman is closely monitored in the hospital. If the patient's condition worsens despite treatment, premature birth is caused. And when it was revealed positive dynamics, the pregnant woman still has a chance to carry the fetus to term. Here are the main things doctors pay attention to:

• strict bed rest;
• at least 6 times a day - measuring blood pressure; if the increase is significant, reduce it with medication;
• weighing - once every 3–4 days;
• diet with minimum quantity salt;
• correct drinking regime(it is possible to limit fluid intake to 1 liter - but only for one day);
• control of the volume of fluid excreted from the body in the form of urine;
• control of protein levels in urine;
• monitoring the condition of the fetus.

If symptoms of preeclampsia occur, the pregnant patient is placed in the intensive care unit and a set of measures is taken to prevent seizures.

One hundred percent guarantee that a woman carries a child to term due date and the child will be born viable, no.

If the circumstances are successful, doctors prefer a natural method of delivery. But when there is a threat of eclampsia right during childbirth or intrauterine suffering of the fetus is detected, one has to resort to a caesarean section.

In the initial stages of gestosis, when a woman is treated at home, the following is required:

• create a calm environment around; avoid loud sounds, quarrels, nervous breakdowns;
• exclude from the diet food with chemical additives - dyes, thickeners, preservatives;
• eat foods high in protein and low in carbohydrates;
• weigh yourself daily;
• if you have a cold or other illness, treat it.

To normalize the functioning of the nervous system, conversations with a psychologist will help.

Prevention of gestosis

Despite the fact that the causes of toxicosis in late pregnancy medical science It is difficult to determine, risk groups have been identified more or less accurately. To minimize the threat of pathology, the expectant mother needs to:

• do not drink alcohol, do not smoke;
• exclude from the menu harmful products- smoked meats, canned food, spices, chocolate;
• limit the consumption of fried and salty foods;
• if present overweight, limit your daily calorie intake (no more than 3000);
• drink water in small sips, at intervals of half an hour;
• sleep at least 8–9 hours; in the 3rd trimester, in addition to nighttime sleep, an hour’s sleep during the day is useful;
• walk 2–3 hours daily in the fresh air (with rest on a bench);
• move actively, do swimming or yoga, do gymnastics for pregnant women (with the approval of a doctor);
• avoid heavy physical activity;
• do not get nervous over trifles, ask your family to behave with restraint, and not provoke conflicts;
• control weight gain (normally no more than 350 grams per week);
• listen to the movements of the fetus in the womb in order to detect hypoxia in time; a small number of movements or, conversely, excessive activity is a reason to immediately consult a doctor.

Preeclampsia is considered sufficient dangerous condition, which occurs in pregnant girls. This term refers to late toxicosis during pregnancy, occurring in the second or third trimester. If habitual toxicoses do not threaten either the mother or the fetus, then gestosis poses a lot of complications and dangers. This condition occurs in approximately 15% of mothers.

It is necessary to prepare a bag with children's things in advance

Toxicosis of pregnant women is a pathological complex of symptoms that occurs when negative impact gestation on a woman. Toxic conditions occur in different terms. Early toxic conditions bother the mother at 1-12 weeks, and toxicosis in late pregnancy occurs at 26-40 weeks. Can't say the exact duration of this period, because the timing is different for each patient due to the individuality of organisms.

Toxic conditions significantly complicate pregnancy, causing the creation of an unfavorable atmosphere for fetal growth and development. At times, toxicosis even poses a danger to the mother’s health or her life. The appearance of toxicosis is primarily due to pregnancy. Against the background of a developing and growing embryo and changes in hormonal status, the activity of the body changes seriously. Experts suggest that toxic manifestations during pregnancy are due to adaptation to the coexistence of the embryo and mother.

Late toxicosis of pregnant women indicates a profound pathological failure in the functionality of vital organic systems such as endocrine and cardiovascular, hematopoietic or excretory, etc. Sometimes the patient is diagnosed with pretoxicosis, which means that the woman has a preclinical gestosis form, in which there are no actual symptoms, but already changes have appeared in the tests, pressure instability is noted, etc.

Causes

Experts have not yet been able to find out exactly which factors are of paramount importance in the development of gestosis, however, they have determined that the causes of late toxicosis during pregnancy can be determined by several factors.

1. Endocrine. According to this assumption, the mechanism of development of gestosis is due to changes in hormonal status, which negatively affects vascular tone, fluidity and blood clotting. Blood supply deteriorates and metabolic processes are disrupted, cardiovascular regulation is disrupted, which occurs against the background of changes in the activity of the endocrine glands.
2. Genetic theory suggests that gestosis occurs more often in girls whose mothers also suffered from similar toxicosis during pregnancy.
3. The corticovisceral theory suggests that the main reason why gestosis occurs is a neurotic disorder, manifested by disturbances in cortical and subcortical connections, which leads to changes in cardiovascular activity and deterioration of blood supply.
4. Placental factor. Scientists claim that late toxicosis occurs due to the lack of necessary vascular changes in the uterine network of vessels feeding placental tissues. As a result, specific substances are formed that disrupt cardiovascular activity.
5. Immunological factor. According to this assumption, late toxicosis is accompanied by an abnormal reaction of the mother’s body to fetal antigens. As a result, changes occur in the permeability and tone of vascular channels, and later in intraorganic tissues and structures.

The vast majority of experts believe that there is not only one cause of gestational conditions. Typically, the functionality of intraorganic structures is disrupted under the influence of a whole complex of factors.

How does late toxicosis manifest?

It is very useful for expectant mothers to breathe fresh air

Depending on the degree of complexity, gestosis can manifest itself with a variety of symptoms. The clinic is divided into typical and atypical symptoms. The category of typical manifestations includes dropsy and preeclampsia, nephropathy and eclampsia. Dropsy suggests that patients have pronounced hyperedema on the limbs and face, abdomen, etc. In fact, dropsy is considered the first stage of gestosis. Usually general health women is within normal limits, but there may be a feeling of rapid fatigue, heaviness in the limbs, and anxiety desire drink something.

Signs of surges blood pressure are absent, it may even be at a slightly reduced level. Approximately 25% of such patients subsequently develop nephropathy due to dropsy. This is a slightly different form of gestosis, in which patients are worried about a complex of several pathological conditions such as hypertension, hydrops and proteinuria. Hypertension may exceed 200/150 mmHg. Art.

Another degree of typical gestosis is preeclampsia, which includes symptoms of nephropathic syndrome, migraine pain, heaviness in the frontal or occipital area, dizziness and insomnia, blurred vision and midges before the eyes, ringing in the ear and lethargy, and an apathetic state. Preeclampsia is also accompanied by gastrointestinal disorders such as nausea and vomiting reactions and abdominal pain.

Eclampsia is considered the most severe form of typical gestosis. It is a state of convulsive attacks against the background of preeclampsia with additional exposure to irritants in the form pain syndrome, bright lights or loud sounds. The attack begins with twitching of the muscle tissues of the face, turning into tonic convulsive contractions, until breathing stops. Then involuntary contractions of the limbs occur, breathing stops, the lips and nasolabial triangle turn blue, and foam begins to emerge from the mouth. Then the patient takes a deep breath, after which respiratory functions are gradually restored and the condition returns to normal.

In fact, each of the typical gestosis forms represents the severity of late toxicosis. As for the atypical manifestations of gestosis, they are represented by hypertension with nephropathy and nonconvulsive eclampsia.

What is the danger

Preeclampsia is dangerous because it can develop latently.

• Hidden internal swelling appears, pressure rises, and protein is released into the urine. Such symptoms do not cause any discomfort to the mother, and therefore do not attract her attention.
• Only an obstetrician-gynecologist can detect pathological symptoms, so you need to visit all routine examinations and take all prescribed tests.
• Late toxicosis provokes metabolic disorders and negatively affects placental functions, which leads to acute hypoxia and nutritional deficiency in the baby.
• The exchange of salts is also disrupted, water and sodium begin to accumulate in the tissues of the body, and the permeability of the vascular walls increases. All this provokes the formation of internal hyperedema.
• Due to circulatory disorders, oxygen deficiency of the placenta and uterus, kidneys, liver and brain develops.
• Excessive accumulation of fluid in the body provokes dystrophic changes, disrupts the functionality of organs and causes hemorrhages.

Therefore, the appearance of unusual symptoms, severe malaise and other signs indicating the development of gestosis, it is necessary to consult a gynecologist.

How to relieve a pregnant woman's condition

Mineral water can be drunk in any quantity

To normalize the condition of a patient suffering from gestosis and prevent any complications, the patient must follow semi-bed rest or bed rest, she needs to sleep and rest fully, avoid stressful situations and irritants such as sudden and loud sounds or excessively bright light. If you experience excessive nervousness, it is better to discuss with your doctor the possibility of taking safe sedatives.

Mommy's diet must be strictly balanced and adjusted. Carbohydrates in the diet should be limited, but you should eat more protein foods. Also, mommy should eat more vitamin-rich vegetables and fruits, drink fruit drinks and juices, preferably freshly squeezed ones. Even if there is severe swelling, a pregnant woman should not limit her consumption of drinks.

If the situation is complex, then the patient is prescribed drug therapy, helping to prevent fetal hypoxia. Diuretics are usually contraindicated because they lead to a decrease in circulating blood volume, which provokes disorders in the placental circle blood circulation Diuretic medications are prescribed only in cases of myocardial insufficiency or pulmonary edema. Additionally, it is necessary to take vitamin complexes

If the patient does not get better, she is hospitalized to exclude the development of complications of late toxicosis. The main thing is not to ignore the doctor’s recommendations, do not refuse hospital stay, otherwise eclampsia may develop, accompanied by serious disorders of cerebral functionality, myocardial insufficiency, deep fainting states, cerebral hemorrhages and even cardiac arrest. To prevent this from happening, it is necessary to follow preventive recommendations.

Complications of gestosis

Preeclampsia is inevitably accompanied by hypertensive symptoms and hyperedema, severe headaches and premature delivery. Late toxicoses have an extremely negative impact on fetal development and on the condition of patients, especially those with hypertension, renal pathologies, myocardial and liver failure. And with severe gestosis forms, complications develop, manifested by dystrophic changes in intraorganic structures. Against this background, patients may develop complications such as:

• Vascular thrombosis;
• Chronic hypoxia;
• Kidney failure;
• Against the background of severe vomiting, dehydration may develop;
• Pulmonary activity is impaired;
• Cerebral hemorrhage occurs;
• Particularly severe complications are cerebral edema or deep coma;
• Preeclampsia can also provoke premature delivery or intrauterine death.

For a baby, maternal gestosis can result in a delay intrauterine development, underweight or mental retardation of the child. If gestosis is detected before 36 weeks and does not cause fetal abnormalities, then the doctor chooses observational tactics. If the patient develops eclampsia, she undergoes an emergency cesarean section.

Prevention methods

To avoid gestational manifestations and complications, mothers should take care in advance to prevent these conditions, even at the stage of planning conception. It is necessary to undergo a comprehensive examination in advance to identify hidden or chronic pathologies. In addition, the patient should give up smoking and drinking any types of alcohol, even beer. A girl should sleep at least 9 hours a day, and also take a short rest in the middle of the day. You should also reconsider physical activity; if there is a risk of developing gestosis, then it is better to abandon it altogether.

Psycho-emotional peace should reign in the house, without scandals, petty squabbles and domestic quarrels. It is useful to do swimming or yoga, walk every day before bed, practice breathing exercises. You need to eat in small portions, breakfast should be leisurely and you should start it in bed with a slice of lemon. Food should be warm. To prevent hyperedema, it is recommended to drink kidney infusions, rosehip decoction, bearberry tea or lingonberry leaves. It is better to consult a nutritionist about your diet, and throughout pregnancy you need to monitor your body weight in order to prevent excessive large set weight.

To prevent gestosis, lipoic acid, magnesium preparations, tocopherol or Chofitol, Curantil, which improves placental circulation. Toxic conditions in the second half of pregnancy can complicate the course of pregnancy in any patient. But if you take care of prevention in advance, approach the issue of planning responsibly and register in a timely manner, following medical instructions, then you can minimize the likelihood of developing such a complication.