Symptoms and treatment of preeclampsia in pregnancy

1 The essence of the pathology of

Pre-eclampsia of pregnant women: what is it? During pregnancy, almost all women are exposed to toxicosis at a late stage of gestation( gestosis), and this is perceived by them as an inevitable phenomenon, without causing much anxiety, but exhausting the body. In its essence, pre-eclampsia during pregnancy is a gestosis that develops in a complicated and more severe variant.

This pathological phenomenon is usually manifested at the end of the 2nd or 3rd trimester of pregnancy in the form of pronounced symptoms( edema, arterial hypertension, proteinuria).Preeclampsia every year more and more affects pregnant women, and the number of diseases is fixed in the range of 8-15% of all examined, and the pathology growth is associated with such diseases as hypertension and vascular diseases.

The disease, gradually acquiring signs of a severe degree, is very dangerous. As a result of its development, placental dysfunctions occur, which causes oxygen starvation of the fetus and a deficiency of necessary nutrients, which are the cause of hypotrophy and hypoxia. The organism of a pregnant woman is also at great risk, especially the liver, kidneys, the nervous system in general, and the brain in particular.

If you do not take timely measures, then severe preeclampsia passes into a particularly severe form - eclampsia, which can cause very serious consequences: convulsions, to whom, and in especially severe cases even death. All this points to the seriousness of the disease in question and the need for timely detection and treatment.

2 Etiology of the disease

Fully etiological mechanism of occurrence of pre-eclampsia has not been established to date, but certain regularities have been revealed that give grounds for presenting the general picture. The following main causes are identified which trigger the mechanism:

• abnormalities in placenta formation;
• hereditary predisposition;
• excessive body weight and obesity;
• arterial hypertension and a tendency to hypertension;
• endocrine pathologies and diabetes mellitus;
• rheumatoid arthritis;
• kidney disease;
• poor-quality food;
• violation of blood flow in the uterus.

The high-risk group includes such pregnant women who had signs of a similar illness during their previous pregnancy;pregnant for the first time;with multiple conception. It is noted that most often women are under 21 years old and older than 38-40 years old.

3 Clinical picture of

When pre-eclampsia develops in pregnant women, the symptoms in many ways resemble the usual intoxication of the pregnant woman's body in the late stages of pregnancy. However, this pathology is more difficult and more intensive. The following main symptoms are distinguished:

• headache, dizziness;
• intense pain syndrome in the upper abdomen;
• accelerated body weight gain( more than 3.6 kg for 7 days);
• unexpected swelling of the lower and upper extremities, as well as face;
• nausea and vomiting;
• appearance of protein in the urine( proteinuria);
• vision impairment( gooseflesh before the eyes, decreased acuity, hypertrophied sensitivity to light exposure);
• arterial hypertension;
• decrease in the volume of excreted urine.

An important symptom of the disease is that it, as a rule, is accompanied by another disease - HELLP-syndrome. Symptoms of this disease: pain in the upper abdomen, vomiting, dizziness, malaise, frequent anger at all. This syndrome clearly manifests itself only on the 36th week of pregnancy, but originates much earlier.

Started preeclampsia passes into eclampsia, which is fraught with serious consequences. This form of pathology is characterized by the following symptoms: severe headaches, cramps, spasms, intense pain in the abdominal region.

4 Degrees of manifestation of the disease

Depending on the neglect of the disease, predisposition and provoking factors, preeclampsia may have varying degrees of severity and danger. The disease is classified into 3 categories:

1. Pre-eclampsia of mild degree. This form of the disease is difficult to detect due to a mild manifestation of symptoms, which practically does not distinguish it from simple intoxication. The main symptoms are: hypertension with a pressure up to 145/95 mm Hg;proteinuria up to 1.2 g protein per liter of urine;swelling of the lower extremities. A blood test shows such changes: creatinine - up to 105 μmol, platelets - more than 175 billion per 1 liter. The mild stage is very difficult to detect independently, and therefore it is important to conduct regular tests.
2. Disease of the middle stage of development. Characteristic features: hypertension up to 175/115 mm Hg;the protein content in the urine is more than 4.5 g / l. Blood composition: creatinine - up to 310 μmol / l, platelets up to 190 billion per 1 liter.
3. Severe preeclampsia. At this stage, the symptoms of pathology become apparent. The general condition of the pregnant woman sharply worsens. The stage is described by such signs: blood pressure rises above 175/115 mm Hg;proteinuria - more than 5.5 g protein per 1 liter;severe headache with localization in the forehead and occiput;swelling of the liver causing painful pain in the right side;impaired vision;increase in the level of creatinine in the blood above 320 μmol / l. Significantly increased risk of HELLP-syndrome with the following manifestations: erythrocyte destruction, anomaly in the production of hepatic enzymes, thrombocytopenia. At the severe stage of the disease, especially when complications arise, the issue of artificial delivery with caesarean section is being considered.

5 Diagnosed

Pre-eclampsia refers to diseases that need to be identified at an early stage, but early diagnosis of external manifestations is difficult. Any pregnant woman should be under constant medical supervision, especially on late pregnancy. Only a periodic analysis of blood and urine, monitoring of weight gain, control of blood pressure can help in the early detection of the disease.

In general, the diagnosis of preeclampsia is based on the following studies:

• total blood test, incl.on hemostasis;
• biochemical blood test with hepatic enzyme level control;
• blood test for the content of creatinine, uric acid and urea;
• urine test for protein.

When should I see a doctor immediately? To this action should result in the following symptoms: pain in the upper abdomen, frequent headaches;swelling of the limbs and face;decrease in the volume of urine output. If in the process of intoxication nausea arterial hypertension is revealed, then a visit to the doctor becomes an urgent necessity.

6 Treatment tactics

Treatment of preeclampsia in pregnant women depends on the stage of the disease and the presence of complicating factors.

Treatment procedures are complicated in many respects by a significant restriction in taking medications to exclude the harmful effects on the fetus.

The treatment scheme in each case has a strictly individual approach, taking into account the age of the woman, the condition, the presence of other diseases. In principle, a complete cure for pathology can not be achieved, which means that the doctor's task is to facilitate the condition and create the safest conditions for the course of pregnancy. In especially severe cases, there is a need for artificial delivery( after 37 weeks).

Treatment of pre-eclampsia in mild form is performed at home and, as a rule, without taking medications. In detecting this stage, bed rest is primarily ensured. It is recommended to lie more often lying on the back or left side, which normalizes the circulation of blood. Maximum physical activity is reduced, any sports activities are excluded. Treatment should be under the control of a doctor, and if there is a clear progression of pathology, a decision is made about the need for drug therapy.

In the severe stage of the disease, the pregnant woman is obligatorily placed in a hospital. To exclude the development of eclampsia, magnesium sulfate is administered. This remedy reliably prevents the occurrence of convulsive phenomena. The drug is administered by intravenous or intramuscular injection. Sometimes such drugs as diazepam and phenytoin are used, but their effectiveness is somewhat lower than that of magnesium sulphate.

The scheme for the treatment of severe preeclampsia includes other areas of medicamentous effects:

1. Hypermagnetism is suppressed by intravenous injection of calcium gluconate solution, as well as by oxygen therapy.
2. Reduction of blood pressure - the safest antihypertensive therapy is provided by drugs Hydralazine, Apressin, Methyldof, and also the appointment of an adrenoblocker - Atenolol and a universal blocker - Labetalol.
3. When treated for less than 34 weeks of gestation, corticosteroids are prescribed - to improve lung function.

Pre-eclampsia in pregnant women is considered quite a dangerous pathology if it can develop to severe form. In order to prevent the progression of the disease, it is necessary to detect the disease at an early stage, and this is achieved by regular examinations at the doctor, even in cases when the symptoms are not clearly manifested.