Preeclampsia is preeclampsia. Preeclampsia, eclampsia and HELLP syndrome in pregnant women: what is it Signs of severe preeclampsia

Preeclampsia is a pathological condition that can occur in women during pregnancy, during or after childbirth. The disorder entails a significant increase in the mother's normal blood pressure.

Preeclampsia in pregnancy can be life-threatening for both mother and baby. A severe type of toxicosis is accompanied by the development of convulsions and deterioration of the blood supply to the placenta.

The baby does not receive enough oxygen and nutrients, which has a negative impact on the speed of its intrauterine development. Damage may affect such organs and systems of the mother’s body as:

• brain;
• central nervous system;
• kidneys
• liver.

Classification

The classification of preeclampsia suggests that the toxic condition differs in its course. Depending on the severity of the manifestation, the following degrees of preeclampsia are distinguished:

• mild preeclampsia. The pressure increases to 150/90 mmHg. Art., the level of protein in the urine increases (up to 1 g/l). The level of creatinine and platelets in the blood increases. There is swelling of the legs;
• moderate preeclampsia. The pressure rises to 170/110 mmHg. Art., the amount of protein is up to 5 g/l. Renal dysfunction occurs, swelling moves to the peritoneum and arms;
• severe preeclampsia. The pressure indicator overcomes the mark of 170/110 mm Hg. Art., disorders of the functioning of the visual organs are noted. The patient complains of pain in the abdominal area. A headache occurs. Facial swelling increases. Severe preeclampsia is characterized by the presence of seizures. The activity of liver enzymes increases, the number of platelets in the blood decreases. All of these factors lead to an urgent need to terminate the pregnancy through a cesarean section.

Causes

The risk of toxic disorder during pregnancy occurs in women when:

• severe symptoms of preeclampsia in a pregnant mother, that is, the patient’s hereditary predisposition;
• severe signs of preeclampsia in the patient during previous pregnancies or childbirths;
• multiple pregnancy (carrying 2 or more children at the same time);
• first pregnancy;
• arterial hypertension;
• kidney diseases,
• metabolic disorders;
• severe somatic diseases of a chronic nature;
• cardiovascular pathologies;
• increased body weight;
• pregnant woman over 40 years of age;
• swelling or proliferation of fetal tissue.

Symptoms

The development of a severe form of toxicosis can be suspected by the presence of the following signs of the disease:

• increase in pressure;
• nausea and vomiting;
• swelling of the legs, abdomen, face;
• rapid increase in body weight;
• visual impairment;
• pain in the upper abdomen;
• drowsiness or insomnia;
• irritability;
• headache;
• lethargy and apathy;
• oliguria (decreased amount of urine excreted).

Diagnostics

Help for preeclampsia begins with an accurate diagnosis. The nature of the pathology and its stage can be determined after a comprehensive examination, including:

• study of obstetric and gynecological history, that is, the history of diseases of the pregnant woman, the presence and number of previous pregnancies and births;
• gynecological examination with checking the color of the skin, the level of swelling;
• monitoring the patient's weight gain. An increase in body weight of a pregnant woman from 3.5 kg per week is considered painful;
• blood pressure measurement;
• blood and urine tests;
• Ultrasound of the fetus and internal organs;
• consultation with an ophthalmologist.

Treatment of preeclampsia

Treatment of moderate to severe preeclampsia should occur in a hospital setting. After examining and examining the pregnant woman, the doctor decides on the need for early delivery. Usually this measure is not resorted to without a high risk of pregnancy complications.

Medication and therapeutic assistance

The doctor monitors, analyzes and corrects the patient’s blood pressure. Medication is used to maintain the functioning of internal organs (heart, liver, kidneys and lungs). The patient takes vasodilators and undergoes oxygen therapy, that is, inhalation of oxygen.

Doctors are taking steps to improve fetal survival through hormone therapy. Uterine blood circulation can be enhanced due to vasodilators and oxygen therapy.

Anticonvulsants reduce the risk of seizures in the expectant mother. It is possible to normalize the activity of the central nervous system with the help of psychotropic drugs. Dehydration therapy helps prevent an increase in the amount of fluid in the brain.

Adjuvant therapy

Medical care for the patient consists of bed rest and a special diet. During pregnancy, a woman needs to increase the amount of protein, vitamins and minerals she consumes.

The patient is required to be in a state of complete rest. It is important to completely eliminate visual and auditory stimuli and relieve the pregnant woman from pain.

Complications

The list of dangerous complications after the development of severe toxic damage to the body includes:

• placental abruption;
• bleeding;
• delayed fetal development;
• liver necrosis;
• swelling of the brain or lungs;
• renal failure;
• fetal death.

In the absence of adequate treatment, the serious condition leads to the death of the mother.

Prevention

You can reduce your risk of developing preeclampsia by taking steps to:

• pregnancy planning;
• treatment of diseases during pregnancy;
• registering a pregnant woman with medical records;
• timely visit to an obstetrician-gynecologist.

Preeclampsia- This is a pathological condition characteristic only of pregnant women. Previously, the medical literature used the term OPG-preeclampsia; OPG meant “edema-proteinuria-hypertension.”

The basis of pathological changes in preeclampsia is damage to the endothelium (the internal lining of all blood vessels). This leads, on the one hand, to vasospasm and disruption of nutrition of all organs, and on the other, an increase in the permeability of the vascular wall, the liquid part of the blood sweats through the vessels into the tissue and edema is formed. After part of the plasma is released into the tissues, the blood becomes thicker and less fluid, it is more difficult for the heart to “pump” the thickened blood and, in order to cope, the body reacts by increasing blood pressure. The likelihood of blood clots also increases (thick blood + damaged lining of blood vessels, to which the clotting elements “stick”).

Thus, preeclampsia is a generalized vascular lesion.

The prevalence of preeclampsia, according to various sources, ranges from 5 to 20% among all pregnant women, of which severe preeclampsia accounts for about 1%. Preeclampsia develops after more than 20 weeks, and the earlier the clinical signs of this pathological condition appear, the more serious the prognosis for the mother and fetus.

Causes of preeclampsia

As such, there are no clear causes of preeclampsia. But there are risk factors, so when you register, the obstetrician-gynecologist asks for seemingly extraneous information. However, based on the sum of risk factors, we can conclude that this patient is at risk of developing preeclampsia and take all possible measures to prevent this pregnancy complication.

Risk factors for preeclampsia:

1) Primiparas, especially first births under the age of 18 and over 35 years
2) Preeclampsia, gestational arterial hypertension or eclampsia in the woman’s history or in first-degree relatives (mother, grandmother, sister)
3) Pregnancy with twins
4) Obstetric complications of pregnancy (hydatidiform mole, hydrops fetalis)
5) Chronic diseases of the cardiovascular system with circulatory disorders (untreated arterial hypertension)
6) Metabolic diseases (diabetes mellitus, obesity)
7) Kidney diseases, especially those accompanied by arterial hypertension (chronic pyelonephritis, glomerulonephritis, polycystic kidney disease)
8) Autoimmune and allergic diseases (rheumatoid arthritis, antiphospholipid syndrome, bronchial asthma, various allergies, hay fever)

Symptoms of preeclampsia

Moderate preeclampsia:
- increase in blood pressure from 140/90 mmHg. up to 159/99 mmHg. (even if the increase in blood pressure is noted on one arm)
- moderate swelling (feet, legs, pasty hands)
- moderate proteinuria (0.5-3.0 grams per day)

Pressure marks due to edema

Severe preeclampsia:
- increase in blood pressure to 160/100 mmHg. and higher (even a one-time fixation of such blood pressure figures requires a revision of treatment and, possibly, hospitalization; it should be based on a combination with other clinical manifestations)
- generalized edema (feet and legs, hands, the anterior abdominal wall when folded resembles a lemon peel, hands, swelling of the face, swelling and nasal congestion)
- proteinuria (the appearance of protein in the urine from 0.5 g/day and above)
- thrombocytopenia (decrease in the level of blood clotting platelets - platelets, increases the risk of bleeding; the lower limit of normal according to various sources is considered to be from 150 to 180 * 109 / ml)
- headache and heaviness in the parietotemporal region
- pain and heaviness in the right hypochondrium and in the epigastrium (the area “under the stomach”)
- nausea
- vomit
- decreased amount of urine excreted (indicates impaired renal function)
- visual impairment (flickering “floaters in front of the eyes”, flashes of light, blurred vision)
- hyperreflexia (all reflexes intensify, which indicates convulsive readiness)
- euphoria, insomnia, excitement or, conversely, lethargy, decreased reaction speed
- less often jaundice (the risk of complications with HELLP syndrome increases).

The clinical picture of severe preeclampsia most often consists of several symptoms (almost always including increased blood pressure).

The listed symptoms, especially in combination, are an emergency situation and require emergency diagnosis and assistance to a pregnant woman, and are a reason to call an ambulance team or independently go to the nearest maternity hospital (if it is not possible to call an emergency hospital).

Survey

1) complete blood count (CBC)
In the OAC, we can observe thickening of the blood due to the fact that the liquid part of the blood goes into the tissues (hematocrit increases), manifestations of inflammation (increased levels of leukocytes and ESR), and a decrease in the level of platelets and hemoglobin.

2) general urinalysis (UCA)
In TAM, we are primarily interested in protein; normally, protein is absent; the indicator of 0.033‰ requires monitoring of TAM and more careful observation. The persistent presence of traces of protein in the urine requires further examination.

3) daily proteinuria
- moderate from 0.5 to 3.0 grams per day
- pronounced more than 3.0 grams per day
This measurement of the amount of protein lost by the body in the urine per day indicates a violation of the filtration function of the kidneys (normally large protein molecules do not penetrate into the urine) and helps to suspect the development of preeclampsia.

4) biochemical blood test (BAC)
In the LHC it is necessary to check total protein and its fractions, ALT, AST, bilirubin, urea, sugar. This is the minimum number of indicators that help diagnose/exclude more serious disorders.

5) 24-hour blood pressure monitoring (ABPM or Holter monitoring)
The study consists of installing a blood pressure measuring device and a recording device for a day; at certain intervals, air is pumped into the cuff, blood pressure is measured and recorded. The patient must lead a normal lifestyle, and also perform several positional and stress diagnostic tests per day (lie for a certain time on your back, on your side, and so on, climb the stairs). All events are recorded in a diary, so that later a specialist in functional diagnostics can compare increases in blood pressure and heart rate with periods of stress or rest.

6) consultation with a therapist, neurologist, ophthalmologist. If you visited a therapist and an ophthalmologist before your health began to deteriorate, you should consult again.
The neurologist will check reflexes, focal neurological symptoms and suspect seizure activity.
The ophthalmologist will examine the fundus of the eye, which shows hypertensive changes and edema.

7) fetal monitoring
- CTG (cardiotocography) – reflects the state of the fetal heartbeat, its movements and contractile activity of the uterus. CTG can be interpreted as normotype, questionable and pathological.

Ultrasound + Doppler is a visual research method; Doppler scanning shows blood flow in the vessels of the uterus, umbilical cord and fetal vessels.

Differential diagnosis of preeclampsia

When making a diagnosis, the following facts are taken into account:
- 30% of pregnant women may have significant edema in the absence of preeclampsia (most often edema has a venous or other cause not related to pregnancy)
- according to various sources, up to 40% of cases of preeclampsia are not accompanied by edema

Sometimes you may not understand why your doctor is so worried and prescribes medications three times a day. To understand the complications of pregnancy accompanied by increased blood pressure, we present this table.

Hypertensive conditions that occur during pregnancy

Clinical manifestations	Chronic arterial hypertension (existing BEFORE pregnancy)	Gestational hypertension	Preeclampsia
Time of onset of blood pressure rise	Up to 20 weeks (usually from early stages)	From 20 weeks	From 20 weeks, the probability increases by the third trimester
Hypertension degree	I-III	I-II	I-III
Proteinuria (protein in urine)	absent	absent	usually observed to varying degrees
Increased urea in blood serum (above 5.5 mmol/l)	absent	absent	usually observed
Blood thickening (determined by hematocrit in the CBC)	absent	absent
Thrombocytopenia	absent	absent	observed in severe preeclampsia
Liver dysfunction (jaundice)	absent	absent	observed in severe preeclampsia

Note:

1. Degrees of arterial hypertension
I BP 140/90-159/99 mmHg.
II BP 160/100-179/109 mmHg.
III BP 180/110 and above
2. Serum urea is taken into account in the absence of serious kidney diseases present before pregnancy (long-term chronic pyelonephritis, glomerulonephritis with the formation of renal failure, and so on)

Complications of preeclampsia

1) mother's side

Eclampsia is a serious complication of preeclampsia, accompanied by cerebral edema, convulsive seizures (one or a series called eclamptic status), coma and acute fetal hypoxia. The mortality rate from eclampsia is trending downward and currently stands at 1 in 2000.

HELLP syndrome. The name of this pathological condition is an abbreviation:
H – Hemolysis – hemolysis, that is, destruction of red blood cells
EL – Elevated liver enzymes – increasing the level of liver tests (ALAT, AST)
LP – Low Platelets – decreased platelet levels.
Acute, massive damage to the liver and blood cells occurs, and liver failure develops. The mortality rate for the development of HELLP syndrome is up to 75%.

Premature placental abruption.

Premature birth (between 22 and 37 weeks).

2) from the fetus
- placental insufficiency (placental dysfunction),
- chronic fetal hypoxia leading to growth retardation, fetal malnutrition,
- acute fetal hypoxia, threatening hypoxic damage to the fetal central nervous system and antenatal fetal death.

Treatment of preeclampsia

If there is a combination of edema and moderate proteinuria, or a combination of moderate and treatable hypertension with swelling of the legs, then treatment can be started on an outpatient basis and in a day hospital. More pronounced pathological manifestations are subject to hospitalization in the obstetric hospital in the pregnancy pathology department for treatment and decision on the issue of delivery.

1)
Physical activity should be measured and not tiring; outdoor walks, swimming, and simple stretching exercises (without bending the body or lifting weights) are suitable. Of course, if pregnancy occurs with threats of miscarriage or premature birth, then physical activity should be limited.
Fatty, spicy foods should be excluded from the diet, salt should be limited to 5 grams per day and liquid to 1-1.2 liters per day (including soups, cereals, juices, fruits and vegetables).

2) Positional therapy.
Knee-elbow position for 3-15 minutes up to 6 times a day, if this does not provoke pain in the lower abdomen and increased blood pressure. Blood pressure should be measured before the procedure and 10-15 minutes after. You can use a ball or other supports for your elbows if that is more convenient for you.

3) Diuretics.
Canephron 2 tablets 3 times a day (an alcoholic solution of the same drug is not recommended during pregnancy since the administration is long-term) is used according to different schemes, from 10-14 days to constant use (10 days on, 10 days off, and so on). The choice of dosage regimen is made by a doctor (antenatal clinic therapist or obstetrician managing your pregnancy) taking into account the test results and the achieved effect.
Brusniver 1 filter bag 3-4 times a day. The dosage regimen and duration are determined by the local obstetrician-gynecologist or therapist.

4) Antihypertensive therapy.
1. 1st line drug: methyldopa (dopegit), this is a drug that is safe to take during pregnancy.
Dopegit 250 mg is used from 1 tablet 2-3 times a day to 2 tablets 4 times a day. The dose is determined by the doctor based on tolerability and effect.
2. 2nd line drugs: beta blockers (metoprolol) and slow calcium channel blockers (nifedipine). Used as an additional drug when methyldopa is ineffective at the maximum allowable dose. The decision to start taking these drugs and the dose will be determined by the doctor, since there are side effects for the mother and fetus.
Egilok (metoprolol tartrate) from 12.5 mg 2 times a day to 50 mg 2 times a day.
Betaloc-ZOK (metoprolol succinate) from 12.5 mg to 50 mg 1 time per day (preferably in the morning).
Nifedipine (Cordaflex, Codipine, Corinfar) 10 mg situationally when blood pressure rises, the tablet should be taken under the tongue and lying down, in order to avoid a sharp decrease in blood pressure and collapse. You can take up to 3 tablets per day.
3. Others: thiazide diuretics (hydrochlorothiazide 12.5-25 mg per day), used in case of ineffectiveness of the above drugs, persistent increase in blood pressure, are used less frequently, since there has not been a multicenter study on the safety of use in pregnant women. Clinical observations did not reveal any adverse effects on the fetus.

5) Magnesium therapy.
Magnesium sulfate (magnesium sulfate) is administered exclusively intravenously in a treatment room or hospital setting. Jet administration is indicated for relief of acute symptoms, then drip administration is prescribed to a saturating dose. The dose is calculated individually. Magnesium sulfate is an anticonvulsant drug and is the gold standard in the prevention of eclampsia (seizures), reducing the likelihood of their occurrence by 60%. Magnesia also has a moderate hypotensive and diuretic effect.

6) Prevention of fetal respiratory distress syndrome (FRS).
If there is a risk of premature birth, prophylaxis of fetal SDD with glucocorticoid drugs is indicated in the period of 24-34 weeks. This event helps the baby's lungs mature a little earlier, which increases the likelihood of his survival and adaptation. Dexamethasone is most often used; the procedure is performed in the day hospital of the antenatal clinic, or during hospitalization in a 24-hour hospital.

7) Delivery.
Preeclampsia is a condition that is inextricably linked with pregnancy and cannot be cured. All of the approaches listed above help stabilize the condition and minimize the risk of complications for the mother and fetus, but sometimes all efforts are ineffective. In such cases, delivery is indicated.
In the case of long-term moderate preeclampsia, possibly in combination with placental dysfunction and fetal malnutrition, independent delivery with prolonged anesthesia (therapeutic epidural anesthesia) is indicated.
In case of severe preeclampsia, emergency delivery by cesarean section is indicated.
The choice of delivery method is strictly individual and depends on many factors: the severity of the mother’s condition, the condition of the fetus and its presentation, the location of the placenta, the readiness of the birth canal, the correspondence of the sizes of the mother’s pelvis and the fetal head, medical history (complicated childbirth/postpartum period, uterine scar after cesarean section or myomectomy, stillbirth or birth trauma, etc.) and others.

Prevention of preeclampsia before and during pregnancy

There is no specific prevention for preeclampsia. However, planning a pregnancy should be approached carefully. Visit the obstetrician-gynecologist with whom you plan to register, and a competent therapist. You need to make sure that you enter your new state healthy. If you know about the presence of chronic diseases or have identified them in the process of pre-conception preparation, then you should achieve stable remission and maximum compensation of functions. If you are obese, consult an endocrinologist, he will help you achieve optimal weight.

Regular observation by a doctor and timely completion of laboratory and instrumental tests (including ultrasound screenings) will help to identify many pathological conditions as early as possible and take the necessary measures.

Forecast

With inadequate treatment/lack of treatment, there is 1 case of eclampsia per 200 cases of preeclampsia, which increases the risk of complications from the fetus and the “fixation” of pathological changes in the mother’s body (maintenance of arterial hypertension and impaired renal function after delivery).

With regular monitoring and disciplined adherence to prescribed prescriptions, the chance of giving birth to a healthy baby and maintaining your own health is significantly increased. The overwhelming majority of observed women who receive full treatment successfully carry and give birth to healthy children.

Take care of yourself and be healthy!

Obstetrician-gynecologist Petrova A.V.

Thank you

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!

Eclampsia and preeclampsia are pathological conditions that occur during pregnancy. Both conditions are not independent diseases, but are syndromes of failure of various organs, combined with various symptoms of damage to the central nervous system of varying degrees of severity. Preeclampsia and eclampsia are pathological conditions that develop exclusively during pregnancy. In principle, a non-pregnant woman or man cannot develop either preeclampsia or eclampsia, since these conditions are provoked by disturbances in the relationship between the mother-placenta-fetus system.

Since the causes and mechanisms of development of eclampsia and preeclampsia have not yet been fully elucidated, the world has not made an unambiguous decision as to which nosology these syndromes should be classified as. According to scientists from Europe, the USA, Japan and experts from the World Health Organization, preeclampsia and eclampsia are syndromes related to the manifestations of hypertension in pregnant women. This means that eclampsia and preeclampsia are considered precisely as types of arterial hypertension in pregnant women. In Russia and some countries of the former USSR, eclampsia and preeclampsia are considered types of gestosis, that is, they are considered a variant of a completely different pathology. In this article we will use the following definitions of eclampsia and preeclampsia.

Preeclampsia is a multiple organ failure syndrome that occurs only during pregnancy. This syndrome is a condition in which a woman, after the 20th week of pregnancy, develops persistent hypertension, combined with generalized edema and the release of protein in the urine (proteinuria).

Eclampsia– these are the predominant clinical manifestations of brain damage with seizures and coma against the background of the general symptoms of preeclampsia. Seizures and coma develop due to severe damage to the central nervous system by excessively high blood pressure.

Classification of eclampsia and preeclampsia

According to the World Health Organization classification, eclampsia and preeclampsia occupy the following place in the classification of hypertension in pregnant women:
1. Chronic arterial hypertension that existed before pregnancy;
2. Gestational hypertension that occurs during pregnancy and is caused by pregnancy;
3. Preeclampsia:

• Mild preeclampsia (not severe);
• Severe preeclampsia.

4. Eclampsia.

The above classification clearly illustrates that eclampsia and preeclampsia are types of hypertension that develops in pregnant women. Preeclampsia is a condition that precedes the development of eclampsia. However, eclampsia does not necessarily develop against the background of only severe preeclampsia; it can also occur with mild preeclampsia.

In Russian practical obstetrics the following classification is often used:

• Edema of pregnant women;
• Nephropathy 1, 2 or 3 degrees;
• Preeclampsia;
• Eclampsia.

However, according to the instructions of the World Health Organization, nephropathy of any severity is classified as preeclampsia, without being classified as a separate nosological structure. It is precisely because of the presence of nephropathy in the Russian classification that obstetricians-gynecologists consider preeclampsia to be a short-term condition preceding eclampsia. And foreign obstetricians and gynecologists classify preeclampsia as nephropathy of degrees 1, 2 and 3, and therefore believe that it can last for a fairly long period of time. However, as foreign practicing obstetricians note, before an attack of eclampsia, the course of preeclampsia becomes sharply more severe for a short period of time. It is this spontaneous and abrupt deterioration in the course of preeclampsia that is considered an immediate harbinger of eclampsia, and when it occurs, it is necessary to urgently hospitalize the woman in an obstetric hospital.

Foreign experts diagnose preeclampsia if a woman has hypertension (pressure above 140/90 mm Hg), edema and proteinuria (protein content in daily urine more than 0.3 g/l). Domestic experts regard these symptoms as nephropathy. Moreover, the severity of nephropathy is determined by the severity of the three listed symptoms (volume of edema, pressure value, protein concentration in the urine, etc.). But if the three symptoms (Zantgemeister triad) are accompanied by headache, vomiting, abdominal pain, blurred vision (visible “as if in a fog,” “spots before the eyes”), and decreased urine output, then Russian obstetricians make a diagnosis of preeclampsia. Thus, from the point of view of foreign specialists, nephropathy is a serious pathology that must be classified as preeclampsia, and not wait for a sharp deterioration in the condition preceding eclampsia. In the future, we will use the term “preeclampsia”, putting into it an understanding of the essence of foreign obstetricians, since the treatment guidelines used in almost all countries, including Russia, were developed by these specialists.

To summarize, to understand the classifications, you should know that preeclampsia is hypertension in combination with proteinuria (protein in the urine in a concentration of more than 0.3 g/l). Depending on the severity of the Zantgemeister triad, mild and severe preeclampsia are distinguished.

Mild preeclampsia is hypertension in the range of 140 – 170/90 – 110 mmHg. Art. in combination with proteinuria with or without edema. Severe preeclampsia is diagnosed when blood pressure is above 170/110 mmHg. Art. combined with proteinuria. In addition, severe preeclampsia includes any hypertension in combination with proteinuria and any of the following symptoms:

• Strong headache;
• Visual impairment (veil, floaters, fog before the eyes);
• Abdominal pain in the stomach area;
• Nausea and vomiting;
• Convulsive readiness;
• Generalized swelling of the subcutaneous tissue (swelling throughout the body);
• Decreased urine output (oliguria) to less than 500 ml per day or less than 30 ml per hour;
• Pain when palpating the liver;
• The number of platelets in the blood is below 100 * 106 pieces/l;
• Increased activity of liver transaminases (AST, ALT) above 90 IU/l;
• HELLP syndrome (destruction of red blood cells, high activity of liver transaminases, platelet count below 100 * 106 pieces/l);
• IUGR (intrauterine growth retardation).

Severe and mild preeclampsia reflect different degrees of severity of damage to the internal organs of a pregnant woman. Accordingly, the more severe the preeclampsia, the greater the damage to internal organs, and the higher the risk of adverse consequences for the mother and fetus. If severe preeclampsia does not respond to drug therapy, the only treatment option is termination of pregnancy.

The classification of preeclampsia into mild and severe is generally accepted in Europe and the USA, as well as recommended by the World Health Organization. The Russian classification has a number of differences. In the Russian classification, mild preeclampsia corresponds to grades I and II nephropathy, and severe preeclampsia corresponds to grade III nephropathy. Preeclampsia in the Russian classification is actually the initial stage of eclampsia.

Depending on the moment at which eclampsia develops, it is divided into the following types:

• Eclampsia occurring during pregnancy(accounts for 75 - 85% of all cases of eclampsia);
• Eclampsia during childbirth, which occurs directly during labor (approximately 20–25% of all cases of eclampsia);
• Postpartum eclampsia, which occurs within 24 hours after delivery (accounts for approximately 2–5% of all cases of eclampsia).

All of the listed types of eclampsia develop according to exactly the same mechanisms, and therefore have the same clinical manifestations, symptoms and severity. Moreover, even the principles of treatment for any of the above types of eclampsia are the same. Therefore, the classification and distinction of eclampsia depending on the time of its occurrence is of no practical importance.

Depending on the prevailing symptoms and damage to any organ, three clinical forms of eclampsia are distinguished:

• Typical form of eclampsia characterized by severe swelling of the subcutaneous tissue of the entire surface of the body, increased intracranial pressure, severe proteinuria (protein concentration is more than 0.6 g/l in daily urine) and hypertension more than 140/90 mm Hg;
• Atypical form of eclampsia most often develops during prolonged labor in women with a labile nervous system. This form of eclampsia is characterized by cerebral edema without swelling of the subcutaneous tissue, as well as slight hypertension, increased intracranial pressure and moderate proteinuria (protein concentration in daily urine from 0.3 to 0.6 g/l);
• Renal or uremic form of eclampsia develops in women who suffered from kidney disease before pregnancy. The renal form of eclampsia is characterized by mild or completely absent swelling of the subcutaneous tissue, but the presence of a large amount of fluid in the abdominal cavity and amniotic sac, as well as moderate hypertension and intracranial pressure.

Eclampsia and preeclampsia - causes

Unfortunately, the causes of eclampsia and preeclampsia are currently not fully understood. Only one thing is known for certain - these conditions develop exclusively during pregnancy, and therefore are inextricably linked with a disruption of normal relationships in the mother-placenta-fetus system. There are more than thirty different theories of the development of eclampsia and preeclampsia, among which the most complete and prognostically significant are the following:

• Genetic mutations (gene defects eNOS, 7q23-ACE, HLA, AT2Р1, C677T);
• Antiphospholipid syndrome or other thrombophilias;
• Chronic pathologies of non-genital organs;
• Infectious diseases.

Unfortunately, there is currently no test that can determine whether eclampsia will develop in a given case with or without predisposing factors. Many modern scientists believe that preeclampsia is a genetically determined insufficiency in the processes of adaptation of the woman’s body to new conditions. However, it is known that the trigger for the development of preeclampsia is placental insufficiency and the risk factors that a woman has.

Risk factors for preeclampsia and eclampsia include the following:
1. The presence of severe preeclampsia or eclampsia during previous pregnancies;
2. The presence of severe preeclampsia or eclampsia in the mother or other blood relatives (sisters, aunts, nieces, etc.);
3. Multiple pregnancy;
4. First pregnancy (preeclampsia develops in 75–85% of cases during the first pregnancy, and only in 15–25% during subsequent ones);
5. Antiphospholipid syndrome;
6. The pregnant woman is over 40 years old;
7. The interval between the previous and current pregnancy is more than 10 years;
8. Chronic diseases of internal non-genital organs:

• Arterial hypertension;
• Kidney pathology;
• Diseases of the cardiovascular system;

Eclampsia and preeclampsia - pathogenesis

Currently, the leading theories of the pathogenesis of preeclampsia and eclampsia are neurogenic, hormonal, immunological, placental and genetic, explaining various aspects of the mechanisms of development of pathological syndromes. Thus, neurogenic, hormonal and renal theories of the pathogenesis of eclampsia and preeclampsia explain the development of pathologies at the organ level, and genetic and immunological - at the cellular and molecular level. Each theory separately cannot explain the diversity of clinical manifestations of preeclampsia and eclampsia, so they all complement each other, but do not replace.

Currently, scientists believe that the initial link in the pathogenesis of preeclampsia and eclampsia is laid at the time of migration of the cytotrophoblast of the fetal egg. The cytotrophoblast is a structure that provides nutrition and also supports the growth and development of the fetus until the formation of the placenta. It is on the basis of the cytotrophoblast that the mature placenta is formed by the 16th week of pregnancy. Before the formation of the placenta, trophoblast migration occurs. If the migration and invasion of trophoblast into the uterine wall is insufficient, then in the future this will provoke preeclampsia and eclampsia.

With incomplete invasion of the migrating trophoblast, the uterine arteries do not develop and grow, as a result of which they are unprepared to ensure further life, growth and development of the fetus. As a result, as pregnancy progresses, the uterine arteries spasm, which reduces blood flow to the placenta and, accordingly, to the fetus, creating conditions for chronic hypoxia. With severe insufficiency of blood supply to the fetus, its development may even be delayed.

Spasmed uterine vessels become inflamed, which leads to swelling of the cells that form their internal lining. Fibrin is deposited on the inflamed and swollen cells of the inner layer of blood vessels, forming blood clots. As a result, blood flow in the placenta is further disrupted. But the pathological process does not stop there, since inflammation of the cells of the inner lining of the vessels of the uterus spreads to other organs, primarily to the kidneys and liver. As a result, the organs are poorly supplied with blood and their function becomes insufficient.

Inflammation of the inner lining of the vascular wall leads to their severe spasm, which reflexively increases the woman’s blood pressure. Under the influence of inflammation of the internal lining of blood vessels, in addition to hypertension, the formation of pores, small holes in their walls, through which fluid begins to seep into the tissue, forming edema. High blood pressure increases the sweating of fluid into the tissue and the formation of edema. Therefore, the higher the hypertension, the stronger the swelling during preeclampsia in a pregnant woman.

Unfortunately, the vascular wall is damaged as a result of the inflammatory process, and therefore insensitive to various biologically active substances that relieve spasms and dilate blood vessels. Therefore, hypertension appears to be constant.

In addition, due to damage to the vascular wall, blood clotting processes are activated, which consume platelets. As a result, the supply of platelets is exhausted, and their number in the blood decreases to 100 * 106 pieces/l. After the platelet pool is depleted, a woman experiences partial hemophilia, when the blood clots poorly and slowly. Low blood clotting combined with high blood pressure creates a high risk of stroke and cerebral edema. While a pregnant woman does not have cerebral edema, she suffers from preeclampsia. But as soon as the development of cerebral edema begins, this indicates the transition of preeclampsia to eclampsia.

The period of increased blood clotting and subsequent development of hemophilia in eclampsia is a chronic DIC syndrome.

Eclampsia and preeclampsia - symptoms and signs

The main symptoms of preeclampsia are edema, hypertension and proteinuria (the presence of protein in the urine). Moreover, to be diagnosed with preeclampsia, a woman does not have to have all three symptoms; only two are sufficient - a combination of hypertension with edema or hypertension with proteinuria.

Edema with preeclampsia can be of varying severity and prevalence. For example, some women experience swelling only on the face and legs, while others experience swelling all over the body. Pathological edema in preeclampsia differs from normal swelling characteristic of any pregnant woman in that it does not decrease or go away after an overnight rest. Also, with pathological edema, a woman gains weight very quickly - more than 500 g per week after the 20th week of pregnancy.

Proteinuria is considered to be the detection of protein in an amount of more than 0.3 g/l in a daily portion of urine.

Hypertension in a pregnant woman is considered to be an increase in blood pressure above 140/90 mm Hg. Art. At the same time, the pressure is in the range of 140 – 160 mm Hg. Art. for systolic value and 90 – 110 mmHg. Art. for diastolic it is considered moderate hypertension. Pressure above 160/110 mm Hg. Art. considered severe hypertension. The division of hypertension into severe and moderate is important in determining the severity of preeclampsia.

In addition to hypertension, edema and proteinuria, severe preeclampsia is accompanied by symptoms of damage to the central nervous system and cerebrovascular disorders, such as:

• Severe headache;
• Visual impairment (the woman indicates blurred vision, a feeling of spots running before the eyes and fog, etc.);
• Abdominal pain in the stomach area;
• Nausea and vomiting;
• Convulsive readiness;
• Generalized edema;
• Reducing urination to 500 ml or less per day or less than 30 ml per hour;
• Pain when palpating the liver through the anterior abdominal wall;
• Decrease in total platelet count less than 100 * 106 pieces/l;
• Increased activity of AST and ALT more than 70 U/l;
• HELLP syndrome (destruction of red blood cells, low levels of platelets in the blood and high activity of AST and ALT);
• Intrauterine growth retardation (IUGR).

The above symptoms appear against the background of increased intracranial pressure and associated moderate cerebral edema.

Mild preeclampsia characterized by the obligatory presence of hypertension and proteinuria in a woman. Swelling may or may not be present. Severe preeclampsia characterized by the obligatory presence of severe hypertension (pressure above 160/110 mm Hg) in combination with proteinuria. In addition, preeclampsia is considered severe, in which a woman experiences any level of hypertension in combination with proteinuria and any one of the symptoms of cerebrovascular accident or central nervous system damage listed above (headache, blurred vision, nausea, vomiting, abdominal pain, decreased urination, etc.).

If symptoms of severe preeclampsia appear, the woman must be urgently hospitalized in an obstetric hospital and begin antihypertensive and anticonvulsant treatment aimed at normalizing blood pressure, eliminating cerebral edema and preventing eclampsia.

Eclampsia is a seizure that develops against the background of swelling and brain damage due to previous preeclampsia. That is, the main symptom of eclampsia is convulsions in combination with a woman’s comatose state. Convulsions during eclampsia can be different:

• Single convulsive seizure;
• A series of convulsive seizures following one after another at short intervals (eclamptic status);
• Loss of consciousness after a seizure (eclamptic coma);
• Loss of consciousness without a seizure (eclampsia without eclampsia or coma hepatica).

Immediately before eclamptic convulsions, a woman may experience increased headaches, worsened sleep up to the point of insomnia, and a significant increase in blood pressure. One convulsive seizure during eclampsia lasts from 1 to 2 minutes. At the same time, it begins with twitching of the facial muscles, and then convulsive contractions of the muscles of the whole body begin. After the end of the violent spasms of the body muscles, consciousness slowly returns, the woman comes to her senses, but does not remember anything, and therefore is not able to talk about what happened.

Eclamptic seizures develop due to deep damage to the central nervous system during cerebral edema and high intracranial pressure. The excitability of the brain is greatly increased, so any strong irritant, for example, bright light, noise, sharp pain, etc., can provoke a new attack of seizures.

Eclampsia - periods

A seizure in eclampsia consists of the following successive periods:
1. Pre-convulsant period lasting for 30 seconds. At this time, the woman begins to have small twitches in her facial muscles, her eyes close with her eyelids, and the corners of her mouth droop;
2. Period of tonic convulsions , also lasting on average about 30 seconds. At this moment, the woman’s torso stretches, the spine bends, the jaw clenches tightly, all muscles contract (including the respiratory muscles), the face turns blue, the eyes look at one point. Then, when the eyelids tremble, the eyes roll upward, as a result of which only the whites become visible. The pulse stops being palpable. Due to contraction of the respiratory muscles, the woman does not breathe during this period. This phase is the most dangerous, because due to respiratory arrest, sudden death can occur, most often from a cerebral hemorrhage;
3. Period of clonic convulsions , lasting from 30 to 90 seconds. With the beginning of this period, lying motionless with tense muscles, the woman begins to literally convulse. The spasms pass one after another and spread throughout the body from top to bottom. The convulsions are violent, the muscles of the face, torso and limbs twitch. During convulsions, the woman does not breathe, and the pulse cannot be felt. Gradually the convulsions weaken, become less frequent and finally stop completely. During this period, the woman takes her first loud breath, begins to breathe noisily, foam comes out of her mouth, often stained with blood due to a bitten tongue. Gradually breathing becomes deep and rare;
4. Seizure resolution period lasts several minutes. At this time, the woman slowly regains consciousness, her face turns pink, her pulse begins to be felt, and her pupils slowly constrict. There is no memory of the seizure.

The total duration of the described periods of an attack of eclamptic convulsions is 1 – 2 minutes. After a seizure, a woman's consciousness may recover, or she may fall into a coma. A comatose state develops in the presence of cerebral edema and continues until it goes away. If a coma during eclampsia continues for hours and days, then the prognosis for the woman’s life and health is unfavorable.

Eclampsia and preeclampsia - principles of diagnosis

To diagnose eclampsia and preeclampsia, the following studies must be performed regularly:

• Detection of edema and assessment of its severity and localization;
• Blood pressure measurement;
• Urine analysis for protein content;
• Blood test for hemoglobin concentration, platelet count and hematocrit;
• Blood during clotting;
• Electrocardiogram (ECG);
• Biochemical blood test (total white blood, creatinine, urea, ALT, AST, bilirubin);
• Coagulogram (APTT, PTI, INR, TV, fibrinogen, coagulation factors);
• Fetal CTG;
• Fetal ultrasound;
• Doppler analysis of the vessels of the uterus, placenta and fetus.

The simple examinations listed above allow you to accurately diagnose preeclampsia and eclampsia, as well as assess their severity.

Emergency care for eclampsia

For eclampsia, it is necessary to place the pregnant woman on her left side to reduce the risk of vomit, blood and gastric contents entering the lungs. The woman should be placed on a soft bed so that during convulsions she does not accidentally injure herself. It is not necessary to forcibly restrain during a convulsive eclamptic seizure.

During convulsions, it is recommended to supply oxygen through a mask at a rate of 4 - 6 liters per minute. After the convulsions are completed, it is necessary to clean the oral and nasal cavities, as well as the larynx, with suction from mucus, blood, foam and vomit.

Immediately after the end of the seizure, magnesium sulfate should be administered intravenously. First, 20 ml of a 25% magnesia solution is administered over 10–15 minutes, then switch to a maintenance dosage of 1–2 g of dry matter per hour. For maintenance magnesium therapy, 80 ml of 25% magnesium sulfate is added to 320 ml of saline. The prepared solution is administered at 11 or 22 drops per minute. Moreover, 11 drops per minute corresponds to a maintenance dose of 1 g of dry matter per hour, and 22 drops - respectively, 2 g in a maintenance dosage of magnesium sulfate should be administered continuously for 12 - 24 hours. Magnesium therapy is necessary to prevent possible subsequent seizures.

If after the administration of magnesia the convulsions recur after 15 minutes, then you should switch to Diazepam. Within two minutes, 10 mg of Diazepam should be administered intravenously. If seizures recur, the same dose of Diazepam is re-administered. Then, for maintenance anticonvulsant therapy, 40 mg of Diazepam is diluted in 500 ml of saline, which is administered over 6 to 8 hours.

Regardless of the stage of pregnancy, eclampsia is not an indication for emergency delivery, since it is first necessary to stabilize the woman’s condition and stop the seizures. Only after the convulsive seizures have been relieved can the question of delivery be considered, which can be done either through the natural birth canal or through a cesarean section.

Eclampsia and preeclampsia - principles of treatment

Currently, there is only symptomatic treatment for preeclampsia and eclampsia, which consists of two components:
1. Anticonvulsant therapy (prevention or relief of seizures due to eclampsia);
2. Antihypertensive therapy – reducing and maintaining blood pressure within normal limits.

It has been proven that only antihypertensive and anticonvulsant therapy is effective for the survival and successful development of the fetus and woman. The use of antioxidants, diuretics to eliminate edema and other treatment options for preeclampsia and eclampsia are ineffective, do not benefit either the fetus or the woman and do not improve their condition. Therefore, today, for eclampsia and preeclampsia, only symptomatic therapy is carried out to prevent seizures and reduce blood pressure, which, in most cases, is effective.

However, symptomatic therapy for preeclampsia and eclampsia is not always effective. After all, the only remedy that can completely cure preeclampsia and eclampsia is getting rid of pregnancy, since it is carrying a child that causes these pathological syndromes. Therefore, if symptomatic hypotensive and anticonvulsant treatment is ineffective, emergency delivery is performed, which is necessary to save the life of the mother.

Anticonvulsant therapy

Anticonvulsant therapy for eclampsia and preeclampsia is carried out using intravenous administration of magnesium sulfate (magnesia). Magnesium therapy is divided into loading and maintenance doses. As a loading dose, a woman is given 20 ml of 25 magnesium solution (5 g in terms of dry matter) once intravenously over 10–15 minutes.

Then a magnesium solution in a maintenance dose of 1–2 g of dry matter per hour is administered continuously for 12–24 hours. To obtain magnesium in a maintenance dosage, it is necessary to combine 320 ml of physiological solution with 80 ml of 25% magnesium sulfate solution. Then the finished solution is injected at a rate of 11 drops per minute, which is equivalent to 1 g of dry matter per hour. If the solution is administered at a rate of 22 drops per hour, this will correspond to 2 g of dry matter per hour.

When continuously administering magnesium, monitor for symptoms of magnesium overdose, which include the following:

• Breathing less than 16 per minute;
• Decreased reflexes;
• Reducing the amount of urine less than 30 ml per hour.

If the described symptoms of magnesium overdose appear, you should stop the magnesium infusion and immediately administer an antidote intravenously - 10 ml of a 10% calcium gluconate solution.

Anticonvulsant therapy is administered periodically throughout pregnancy as long as preeclampsia or the risk of eclampsia persists. The frequency of magnesium therapy is determined by the obstetrician.

Antihypertensive therapy

Antihypertensive therapy for preeclampsia and eclampsia consists of bringing the pressure to 130 – 140/90 – 95 mm Hg. Art. and keeping it within specified limits. Currently, for eclampsia or preeclampsia in pregnant women, the following antihypertensive drugs are used to reduce blood pressure:

• Nifedipine– take 10 mg (0.5 tablets) once, then after 30 minutes another 10 mg. Then during the day, if necessary, you can take one tablet of Nifedipine. The maximum daily dose is 120 mg, which corresponds to 6 tablets;
• Sodium nitroprusside – administered intravenously slowly, the initial dosage is calculated from the ratio of 0.25 mcg per 1 kg of body weight per minute. If necessary, the dose can be increased by 0.5 mcg per 1 kg of weight every 5 minutes. The maximum dosage of Sodium nitroprusside is 5 mcg per 1 kg of body weight per minute. The drug is administered until normal pressure is achieved. The maximum duration of sodium nitroprusside infusion is 4 hours.

The above drugs are fast-acting and are used only for a one-time reduction in blood pressure. To subsequently maintain it within normal limits, drugs containing as an active substance methyldopa(for example, Dopegit, etc.). Methyldopa should be started at 250 mg (1 tablet) once a day. Every 2–3 days, the dosage should be increased by another 250 mg (1 tablet), bringing it to 0.5–2 g (2–4 tablets) per day. At a dosage of 0.5 - 2 g per day, methyldopa is taken throughout pregnancy until delivery.

If a sudden attack of hypertension occurs, the pressure is normalized with Nifedipine or Sodium nitroprusside, after which the woman is again transferred to methyldopa.

After childbirth, it is necessary to carry out magnesium therapy for 24 hours, consisting of loading and maintenance dosages. Antihypertensive drugs after childbirth are used on an individual basis, gradually being discontinued.

Rules of delivery for eclampsia and preeclampsia

In case of eclampsia, regardless of the duration of pregnancy, delivery is carried out within 3 to 12 hours after the seizures have stopped.

For mild preeclampsia, delivery is performed at 37 weeks of pregnancy.

In case of severe preeclampsia, regardless of the stage of pregnancy, delivery is carried out within 12 to 24 hours.

Neither eclampsia nor preeclampsia are absolute indications for cesarean section; moreover, vaginal delivery is preferable. Delivery by cesarean section is performed only in case of placental abruption or unsuccessful attempts to induce labor. In all other cases, women with preeclampsia or eclampsia undergo vaginal delivery. In this case, they do not wait for the natural onset of labor, but carry out its induction (labor induction). Childbirth with eclampsia or preeclampsia must be carried out with the use of epidural anesthesia and against the background of careful monitoring of the fetal heartbeat using CTG.

Complications of eclampsia

An attack of eclampsia can provoke the following complications:

• Pulmonary edema;
• Aspiration pneumonia;
• Brain hemorrhage (stroke) followed by hemiplegia or paralysis;
• Retinal detachment followed by temporary blindness. Vision is usually restored within a week;
• Psychosis, lasting from 2 weeks to 2 – 3 months;
• Coma;
• Brain swelling;
• Sudden death due to strangulation of the brain due to its swelling.

Prevention of eclampsia and preeclampsia

Currently, the effectiveness of the following drugs for the prevention of eclampsia and preeclampsia has been proven:

• Taking small doses of Aspirin (75 – 120 mg per day) from the beginning to the 20th week of pregnancy;
• Taking calcium supplements (for example, calcium gluconate, calcium glycerophosphate, etc.) at a dosage of 1 g per day throughout pregnancy.

Aspirin and calcium for the prevention of eclampsia and preeclampsia should be taken by women who have risk factors for the development of these pathological conditions. Women who are not at risk of developing eclampsia or preeclampsia can also take Aspirin and calcium as preventatives.

The following measures are not effective for the prevention of eclampsia and preeclampsia:

• Diet with limited salt and liquid in pregnant women;
• Addition or limitation of proteins and carbohydrates in the diet of a pregnant woman;
• Taking supplements of iron, folic acid, magnesium, zinc, vitamins E and C.

Before use, you should consult a specialist.

Every woman who is expecting a child would like to have fewer problems with her health during this wonderful period. But a normal (physiological) pregnancy, in which a woman has no difficulties in carrying a baby, accounts for only about 35%. And in other cases, pregnant women experience certain complications during this period. And one such condition that is dangerous to the health and even the life of a pregnant woman and her fetus is preeclampsia (preeclampsia).

Why not gestosis

Nowadays, modern doctors in their work make maximum use of the principles of evidence and reliability in examination methods, treatment and their formulations. In 2013 in the USA, after extensive scientific work on the study of preeclampsia and its complications, it was recommended to apply new methods and criteria for diagnosis, treatment and prevention of this condition in practice. The obstetrics and gynecology community around the world supported these changes. Therefore, in 2016, clinical recommendations (treatment protocols) “Hypertensive disorders during pregnancy, childbirth and the postpartum period” were proposed for Russian obstetricians-gynecologists, anesthesiologists and therapists. Preeclampsia. Eclampsia". And all the terminology, methods and approaches to diagnosis, treatment, and prevention of complications of gestosis that were previously used were replaced with new ones. Therefore, from now on, according to the latest classification, the term gestosis is not used in medical documentation and literature, but is replaced by the concept of preeclampsia.

What is preeclampsia

To begin with, let’s determine that preeclampsia, as gestosis was previously called, is not an independent disease, but a pathological condition that is classified as a hypertensive disorder, that is, disturbances in a woman’s well-being against the background of high blood pressure. Preeclampsia develops in pregnant women after the 20th week and is always accompanied by an increase in blood pressure, which is combined with a high protein content in urine analysis (0.3 g/l in daily urine), often, swelling and disturbances in the functioning of organs and systems in the woman’s body (multiple organ failure).

Some statistics indicate the seriousness of the problem:

Classification of preeclampsia and evaluation criteria

According to the international classification of diseases (ICD-10) there are:

• moderately severe preeclampsia;
• severe preeclampsia.

To determine the degree of development of pathological symptoms, severity assessment criteria are used.

Criteria for assessing preeclampsia:

Causes and mechanisms of its occurrence

Preeclampsia is caused by:

• initial disturbances of hemostasis, i.e. disturbances of processes in the pregnant woman’s body that preserve blood in the bloodstream, prevent vascular bleeding, help restore blood flow when blood vessels are blocked by blood clots, against the background of:
  • genetic predisposition;
  • hormonal disorders;
  • various diseases of internal organs that are not gynecological diseases and obstetric complications;
  • infections;
• at 12–16 weeks of pregnancy, the muscular layer of the spiral arteries of the uterus does not soften, the vessels of the placenta cannot be embedded in them, which causes insufficiency of its blood supply (placental ischemia), and as a result, the unborn child does not receive enough oxygen and nutrients (fetal hypoxia, delayed fetal development) ;
• in the body of a pregnant woman, processes are activated that contribute to the formation of blood clots in the vessels, and this changes the blood supply to tissues and organs (endothelial dysfunction), first locally, then systemically (the functioning of organs and systems is disrupted).

The process of embedding the surface layer of placental villi into the muscular layer of the spiral arteries of the uterus (diagram)

Mechanisms of development of preeclampsia

The formation of preeclampsia is based on vascular spasm as a result of high blood pressure.
Stages:

• the regulation of vascular tone is disrupted, which leads to spasm of blood vessels throughout the body - generalized spasm;
• the permeability of the vascular wall increases and sodium salts, proteins, and liquid come out of the blood into the tissues - edema forms;
• the volume of circulating blood inside the vessels decreases;
• this leads to changes in the properties of the blood: viscosity increases, formed elements (mainly red blood cells) stick together - the blood thickens;
• As a result, metabolic processes and oxygen saturation of cells in organs and tissues are disrupted, this entails their damage to such an extent that they are subsequently unable to maintain the vital functions of the body, and multiple organ failure develops.

Blood thickening disrupts the normal functioning of organs and systems in the body of a pregnant woman

What happens to a woman’s body and the unborn child with preeclampsia

In a pregnant woman, the functioning of all vital organs and systems is disrupted.

Symptoms of multiple organ failure

System/organ	Manifestations of disorders (dysfunctions)
central nervous system	Headache, flickering of “floaters” before the eyes (photopsia), feeling of “pins and needles” (paresthesia), muscle twitching and convulsions.
The cardiovascular system	Arterial hypertension, decrease in the volume of circulating blood in the bloodstream (hypovolemia), heart failure.
Kidneys	Protein in the urine (proteinuria), decreased amount of urine excreted (oliguria), acute renal failure (ARF).
Liver	Low protein content in the blood plasma (hypoproteinemia), metabolic disorders in liver cells and their damage (hepatosis), HELLP syndrome, necrosis and rupture of the liver.
Digestive system	Pain in the epigastric region, heartburn, nausea, vomiting.
Lungs	acute damage to lung tissue (acute respiratory distress syndrome), pulmonary edema.
Blood system, hemostasis	Low platelet count, increased bleeding (thrombocytopenia), blood clotting disorder, risk of developing blockage of large and small vessels with blood clots (thrombophilia, disseminated intravascular coagulation), pathological destruction of red blood cells (hemolytic anemia).
Mother-placenta-fetus (fetoplacental complex)	Intrauterine growth restriction, oligohydramnios, premature separation of the normally located placenta from the uterus (normally occurs after childbirth).

Dangerous consequences of preeclampsia

Severe complications of preeclampsia in pregnant women

• HELLP syndrome, hematoma or liver rupture.
• Acute renal failure.
• Pulmonary edema.
• Stroke.
• Myocardial infarction.
• Hemorrhage and retinal detachment.
• Placental abruption.
• Antenatal fetal death.

Danger of eclampsia

Eclampsia is attacks of individual seizures or a series of seizures. A convulsive state develops against the background of preeclampsia in the absence of other causes. This threatens the life of not only the expectant mother, but also her fetus. Eclampsia occurs at any degree of preeclampsia, and not just at its critical form. It can develop during pregnancy, during childbirth, and after childbirth for 4 weeks.

Precursor symptoms that precede the development of eclampsia:

• headache intensifies, dizziness and general weakness appear;
• vision is impaired - “flickering of flies”, “scorching and fog” before the eyes, loss of vision is even possible;
• severe pain in the stomach and right hypochondrium;
• girdle pain (due to hemorrhage in the roots of the spinal cord);
• twitching of muscles throughout the body (clonic contractions);
• pupil dilation.

If help is not provided, convulsions appear, the pregnant woman loses consciousness, and falls into a coma.

Typical clinical picture of a convulsive state:

• Preconvulsive period (20–30 sec) - facial muscles twitch, consciousness switches off, and a frozen gaze appears.
• Tonic convulsions (10–20 sec) – they begin from the muscles of the head, neck, arms, and spread to the muscles of the torso and legs. Breathing stops. The head is thrown back, the spine is arched. Pulse is difficult to determine. The skin appears blue (cyanosis). Possible cerebral hemorrhage and death.
• Clonic convulsions (0.5–2 min) - spastic contractions and relaxations of all muscle groups occur (twitching).
• Result: resolution of the seizure or coma.

Clinical forms of eclampsia:

• isolated attacks;
• a series of convulsive seizures (eclamptic status);
• coma.

There is “eclampsia without eclampsia,” that is, a pregnant woman suddenly loses consciousness without an attack of convulsions and falls into a coma.
The extreme manifestation of eclampsia is coma

What is HELLP syndrome

HELLP syndrome is a deadly complication that develops in 4–12% of pregnant women with severe preeclampsia. With this syndrome, serious blood clotting disorders, necrosis and rupture of the liver, and intracerebral hemorrhage occur.

The diagnosis is made based on the following criteria:

• H (hemolisis) – hemolysis - pathological destruction of red blood cells and the release of free hemoglobin into the blood serum and urine (increase in LDH, bilirubin).
• EL (elevated liver enzymes) - increased levels of liver enzymes (ALAT, AST).
• LP (low platelet count) - low platelet count.

HELLP syndrome manifests itself:

• pain in the stomach on the right, nausea, vomiting with blood;
• headache;
• jaundice;
• hemorrhages in the skin;
• an increase in diastolic (lower) blood pressure above 110 mm Hg. Art.;
• arterial hypertension;
• swelling;
• high protein content in urine.

HELLP syndrome is complicated by:

• liver failure;
• eclampsia (convulsions);
• coma;
• liver rupture;
• massive swelling;
• edema of the brain, lungs;
• intracerebral hemorrhage;
• ischemic stroke;
• premature detachment of a normally located placenta.

As soon as minimal signs of this syndrome are identified, the pregnant woman is urgently given delivery and intensive care.
Pregnant women with HELLP syndrome are observed only in intensive care and intensive care units

How to suspect preeclampsia

The diagnosis of preeclampsia is made by an obstetrician-gynecologist.

Risk factors for preeclampsia

Tests have not yet been created that detect pre-eclampsia in the early stages of pregnancy and make it possible to minimize the development of its complications. Therefore, all women, already at the stage of planning to conceive a child, should undergo an assessment of risk factors.

Women are at high risk of developing preeclampsia if:

• preeclampsia was present in at least one of the previous pregnancies;
• have chronic kidney disease;
• autoimmune diseases: systemic lupus erythematosus, antiphospholipid syndrome;
• hereditary thrombophilia;
• diabetes mellitus type 1 or 2;
• chronic hypertension.

You are less likely to develop preeclampsia if:

• first pregnancy;
• the interval between pregnancies is more than 10 years;
• assisted reproductive technologies (IVF) are used;
• family history of cardiovascular disease and preeclampsia (grandmother, mother or sister);
• excessive weight gain during pregnancy;
• body mass index 35 or more at the first visit (obesity 1 or 2 degrees);
• infections during pregnancy;
• multiple pregnancies;
• age 40 years or more;
• Ethnicity: Scandinavian, African, South Asian or Pacific Islander;
• systolic blood pressure more than 130 mm Hg. Art. or diastolic blood pressure more than 80 mm Hg. Art.;
• increased levels of triglycerides (fats) before pregnancy;
• low socioeconomic status;
• drug use: cocaine, methamphetamine.

Examination of pregnant women for the diagnosis of preeclampsia

To identify the possible development of preeclampsia, all women must have their blood pressure measured from the first visit to the doctor and then at each visit.

If the numbers of these measurements exceed normal values, and there were no problems with hypertension before, the pregnant woman is at risk and under the close supervision of an obstetrician-gynecologist. Women who already had arterial hypertension fall into this group from the first visit to the doctor. Increases in blood pressure are monitored especially closely after the 20th week of pregnancy.

The following are taken as normal blood pressure:

• systolic blood pressure - less than 140 mm Hg. Art.;
• diastolic blood pressure - less than 90 mm Hg. Art.

The control process occurs according to certain rules:

• Blood pressure is measured while sitting, in a comfortable, relaxed position, with the hand at heart level. Pregnant women with diabetes must have their blood pressure measured both while sitting and lying down.
• The pregnant woman should be at rest, after at least a 5-minute rest.
• The study is carried out 2 times with an interval of at least a minute. If the result differs by more than 5 mm Hg. Art., then an additional third measurement is carried out, and the figures of the last two measurements are averaged.
• Be sure to measure blood pressure in both arms and, at different pressures, take higher readings as a basis.
• The results are recorded with an accuracy of 2 mmHg. Art.

When measuring blood pressure, you need to be as relaxed as possible.

To detect arterial hypertension in a pregnant woman, at least two measurements are taken on one arm with an interval of 15 minutes, and the results are averaged. At the same time, it is important to exclude “white coat” hypertension, when when measuring pressure in a doctor’s office, the pressure numbers are higher than normal values, but at home they are within normal limits. And to identify hidden hypertension, when normal pressure is recorded in the doctor’s office, and high pressure when measured at home.

If blood pressure results are questionable, the pregnant woman undergoes 24-hour blood pressure monitoring. The readings are recorded on a special device throughout the day. At the same time, a pregnant woman’s daily routine does not change. Next, the results obtained are analyzed, the average blood pressure value per day is calculated, and the issue of the possibility of developing arterial hypertension and preeclampsia in the future is decided.
When recording diastolic pressure values ​​greater than 110 mm. rt. Art., measurements are carried out once

In the doctor’s office, not only blood pressure numbers are assessed, but also obvious and hidden edema is identified. And although edema in pregnant women does not in all cases reflect the severity of preeclampsia, when they suddenly appear and sharply increase, they become a prognostic sign of a severe form of preeclampsia.

To do this, monitor body weight gain, measure the circumference of the ankle joint, evaluate the ring symptom, and measure the daily or hourly volume of urine (diuresis).
Obvious swelling of the ankle joints does not always indicate the presence of preeclampsia

Laboratory and instrumental examination and consultation with medical specialists

Studies of blood and urine readings of a pregnant woman help in making a diagnosis of preeclampsia.

When studying a general urine test in pregnant women, the presence of protein and casts is assessed, which normally, except for hyaline ones, are not detected. Protein in the urine (proteinuria) of 0.3 g/L or more in combination with high blood pressure confirms the diagnosis of preeclampsia until proven otherwise. The presence of casts, protein formations that have formed in the renal tubules, indicates kidney damage.

The amount of lost protein is confirmed and specified in the daily urine sample. And if its value is 0.3 g/l or more, and there are other signs of preeclampsia, then the diagnosis of moderate preeclampsia is clarified based on the presence of other criteria. If the level of protein in the urine per day is greater than or equal to 5 g/l, or in two portions of urine, which is collected at intervals of 6 hours, is equal to or greater than 3 g/l, or a test strip value of 3+ is determined, then we speak of severe preeclampsia.

But if there are symptoms of a critical condition in a pregnant woman (severe hypertension, extremely low platelet count, liver and kidney failure, pulmonary edema, etc.), detecting protein in the urine is not necessary to determine severe preeclampsia.

If preeclampsia is suspected in pregnant women, kidney function is studied in laboratory tests using additional urine tests. The Zimnitsky test evaluates the ability of the kidneys to concentrate and excrete urine, and the Roberg test evaluates the excretory function of the kidneys.
An important test to determine the amount of protein in your daily serving

A general blood test looks at the number of red blood cells, hemoglobin, and hematocrit. Their sharp increase reflects signs of blood thickening. And platelet numbers, especially their low content (below 100*10/l), indicate increased bleeding and severe preeclampsia.

In a biochemical blood test, total protein and its fractions are important, low levels of which indicate the permeability of the vascular wall, a sign of preeclampsia. Severe preeclampsia is also indicated by an increase in creatinine, especially in combination with oliguria, a symptom in which a pregnant woman produces a small amount of urine (less than 500 ml/day). Increased bilirubin and uric acid indicate liver damage. High values ​​of liver tests (ALT, AST, LDH) also indicate severe preeclampsia.

In the coagulogram, a decrease in indicators (APTT, fibrinogen and PDF, PTI, TV, antithrombin III) is also an assessment of the severity of preeclampsia.
Blood counts indicate changes in a pregnant woman's body

Pregnant women undergo an ECG (electrocardiography) and monitor the condition of the heart.

An ultrasound of the vital organs of the mother and fetus, Doppler ultrasound of the umbilical cord arteries are performed and the utero-fetal blood flow is assessed.

An ophthalmologist examines the condition of the fundus of a pregnant woman. Papilledema is a result of arterial hypertension.

Pregnant women undergo CT and MRI of the brain to clarify the diagnosis of eclampsia.
Using ultrasound examination, the condition of the internal organs of the mother and fetus is assessed

Help with preeclampsia

Care for pregnant women with preeclampsia and eclampsia is provided only in a specialized obstetric hospital (maternity hospital) of at least regional or republican significance, where there is a department of obstetrics and gynecology, or in perinatal centers.

Treatment depends on:

• from the duration of pregnancy;
• severity of preeclampsia;
• condition of the pregnant woman and the fetus.

With moderate preeclampsia, the woman must be hospitalized. In the hospital, her diagnosis is clarified, treatment is prescribed and the fetal activity is assessed. They are trying to prolong her pregnancy, with constant monitoring of her well-being and the development of the unborn baby. Delivery is carried out if the condition of the mother and fetus worsens or when the period reaches 34–36 weeks.

With severe preeclampsia, a pregnant woman is admitted to the intensive care unit. After normalization of the mother's condition, delivery is performed. At a period of less than 34 weeks, if the well-being of the pregnant woman and the fetus allows, then prevention of possible severe breathing disorders (respiratory distress syndrome) of the unborn child is carried out (with glucocorticoids). And the woman herself is transferred to a specialized maternity ward for observation and further highly qualified care.

Basic treatment for preeclampsia includes:

• anticonvulsant therapy;
• hypertensive therapy;
• delivery.

Moreover, delivery is the main and only method of treating preeclampsia and eclampsia.

Hypertensive and anticonvulsant therapy reduces the risk of developing the consequences of these conditions.

Anticonvulsant therapy

To relieve seizures in preeelampsia and eclampsia, use magnesium sulfate 25%; tranquilizers (diazepam, seduxen).

The use of these drugs is carried out according to strict indications.

Antihypertensive therapy

To reduce blood pressure during arterial hypertension in a pregnant woman, use:

• central adrenoreceptor stimulants (methyldopa, dopegit) - 1st line;
• cardioselective β-blockers (metoprolol, labetolol);
• calcium channel blockers (nifedipine, verapamil);
• antispasmodics (dibazole, papaverine);
• peripheral vasodilators (nitroglycerin, sodium nitroprusside).

Combinations of drugs are not used to correct blood pressure. Since it is dangerous to quickly reduce blood pressure - this leads to a lack of oxygen supply (hypoxia) to the fetus.

The following is not used for the treatment of hypertension in preeclampsia:

• ACE inhibitors;
• angiotensin II receptor antagonists;
• spironolactone.

Diuretics are used only for swelling of the lungs and brain.

The only timely and adequate way to eliminate preeclampsia and eclampsia is delivery.

Indications for emergency delivery (counting by minutes):

• bleeding from the birth canal;
• suspicion of placental abruption;
• acute hypoxia (distress syndrome) of the fetus.

For urgent delivery (counting the clock):

• constant headache and visual manifestations - “flickering spots” before the eyes, “fog in the eyes”;
• persistent abdominal pain, nausea or vomiting;
• high blood pressure that cannot be treated with medication;
• progressive deterioration of liver and/or kidney function;
• eclampsia - convulsions or a series of convulsive attacks;
• platelets less than 100 x 10⁹/l and their progressive decrease;
• abnormal condition of the fetus (CTG, ultrasound, severe oligohydramnios).

Indications for caesarean section:

• all severe complications of preeclampsia, except fetal death;
• deterioration of the condition of the mother (BP more than 160/110 mm Hg) or fetus (acute hypoxia) during childbirth.

Childbirth is the only way to cure preeclampsia and eclampsia

Infusion therapy

Infusion therapy is not included in the basic treatment of preeclampsia and eclampsia. Because to prevent pulmonary edema, the flow of fluid into the pregnant woman’s body must be limited. It is carried out only if there are physiological and pathological losses of fluid due to blood loss, vomiting, diarrhea, and as a slow and constant delivery of drugs into the vascular bed. More often they prefer to use polyelectrolyte balanced crystalloids (Ringer-Lock solution). Synthetic solutions (plasma substitutes and gelatin solutions), natural colloids (albumin), blood products are used only for absolute indications: with a sharp decrease in circulating blood volume, shock, blood loss.

Prevention and prediction of preeclampsia

Prediction factors for preeclampsia in the first trimester of pregnancy:

• Carrying out, if possible, 3D echography and Doppler ultrasound of the uterine arteries.
• blood pressure control (average value);
• control of the level of placental growth factor (PIGF), protein that is associated with pregnancy (PAPP-A), a decrease in the concentration of which indicates the early onset of preeclampsia.

To prevent preeclampsia and if risk factors are present, according to the recommendations of the World Health Organization (WHO), acetylsalicylic acid is used from the 12th to the 36th week of pregnancy.

If there is a deficiency of calcium intake from food and the risk of developing preeclampsia, calcium supplements are used (Kalcemin, Calcium D3-nycomed, etc.).

The sooner the doctor suspects the symptoms of preeclampsia and begins treatment, the higher the chance of avoiding serious complications. And there is less likelihood of disability for the mother and her baby, as well as their death.

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Preeclampsia- a complication of pregnancy, in which there is a persistent increase in blood pressure and the appearance of protein in the urine. Sometimes these symptoms are accompanied by other signs - the development of edema and organ dysfunction (liver, brain, kidneys).

Preeclampsia threatens the life and health of the unborn child and mother. This complication is a factor in the development of oxygen starvation of the fetus, leading to growth retardation and intrauterine death of the baby. Preeclampsia can cause pathologies in the female body - eclampsia (convulsive seizure), HELLP syndrome, liver and kidney failure.

Epidemiology

Preeclampsia does not develop until the 20th week of pregnancy. Most often, this complication of the gestation period occurs in the middle or at the end of the third trimester. In the old medical literature, preeclampsia was called “preeclampsia” or “late toxicosis of pregnancy.”

Preeclampsia is a fairly common complication of pregnancy, it observed in 5-10% of expectant mothers. However, in most cases, the pathology is asymptomatic and does not cause severe disorders in the body.

The incidence of preeclampsia is uneven and depends on environmental and economic living conditions. The disease is most rarely observed in developed countries with a calm climate. Much more often, this pathology occurs among poor people living in hot or mountainous areas.

Pre-eclampsia is a risk factor for the development of HELLP syndrome, rupture of the liver capsule, seizures and other pathologies. The listed complications occur in 0.01% -0.3% of expectant mothers.

Classification

Arterial hypertension in pregnant women is a pathology accompanied by a persistent increase in blood pressure above 140/90. If proteinuria (the appearance of protein in the urine) is associated with this disease, the expectant mother is diagnosed with preeclampsia.

According to the modern classification, there are two types of preeclampsia. They reflect the stages of the pathological process. Moderate preeclampsia characterized by the development of arterial hypertension above 140/90 and proteinuria more than 300 milligrams per day.

Severe preeclampsia is accompanied by an increase in blood pressure above 160/110 and loss of protein in the urine above 5 grams per day. Also, this diagnosis is made in the presence of at least one of the following signs, regardless of blood pressure and proteinuria:

• loss of consciousness; loss of vision;
• narrowing of visual fields;
• pain in the upper abdomen;
• increase in liver enzymes in the blood by more than 2 times in a biochemical blood test;
• decrease in urine volume less than 500 milliliters per day;
• decrease in the number of platelets in a general blood test.

According to another classification, three types of pathology are distinguished. They reflect the clinical picture of the various stages of preeclampsia.

Mild preeclampsia is characterized by an asymptomatic course. That is why expectant mothers should not skip routine examinations by a gynecologist.

Moderate preeclampsia is accompanied by the development of edema. First they are localized on the ankles and feet, then rise to the lower leg area. Over time, the expectant mother experiences swelling on her eyelids, lips, hands, and in the area of ​​the anterior abdominal wall.

Severe preeclampsia is characterized by a vivid clinical picture. The expectant mother may complain of headaches, blurred vision, and discomfort in the upper abdomen. Also, a pregnant woman notices the appearance of “spots” before her eyes and bruises on the skin.

Violetta Frolova: methods for diagnosing and predicting preeclampsia

Causes of the disease

The development of arterial hypertension in pregnant women is associated with the abnormal course of the second wave of invasion of the membranes. This phenomenon occurs on, it is accompanied by the introduction of placental vessels into the wall of the uterus.

Abnormal invasion leads to oxygen starvation of the fetus. To eliminate this condition, the central nervous system of the female body increases blood pressure by reducing the lumen of blood vessels.

As a result of arterial spasm, intravascular fluid leaves the bloodstream, migrating into the tissues and causing edema. The kidneys lose their normal filtering ability, causing protein to leak into the urine.

At the present stage of development of medicine, the exact mechanism of abnormal invasion of placental vessels has not been identified. Some scientists suggest that the cause of preeclampsia is an inadequate response of the mother's immune system to the process of pregnancy.

Proponents of the toxic theory believe that preeclampsia is the mother’s body’s response to the release of placental metabolic products into the blood. Some researchers focus on hereditary predisposition to the disease. Deficiencies or increases in enzymes and other proteins may contribute to the development of preeclampsia.

Risk factors

Certain diseases and conditions increase your chances of developing preeclampsia:

• absence of childbirth in obstetric history;
• diabetes;
• chronic kidney pathologies;
• arterial hypertension before pregnancy;
• the presence of preeclampsia in close relatives;
• mother's age is less than 18 and more than 40 years;
• increased body weight;
• thrombophilia;
• hereditary connective tissue diseases;
• carrying twins;
• pathologies of the placenta.

Effect on the fetus and woman

Preeclampsia is a severe pathology of the gestation period, worsening the prognosis of pregnancy. The disease has a negative effect on the condition of the fetus by reducing the supply of oxygen to it.

Macronutrient deficiency causes retarded growth and development of the unborn child, hypofunction of the central nervous system, and abnormal tissue division. With a severe lack of oxygen, intrauterine fetal death occurs.

Preeclampsia is a risk factor for a severe pregnancy complication - premature abruption of a normally located placenta. This pathology leads to the development of spontaneous childbirth and the death of the unborn child.

Preeclampsia increases the baby's risk of developing certain congenital abnormalities. These include epilepsy, cerebral palsy, pathologies of hearing, vision and smell. Another consequence of the disease is polyhydramnios due to delayed outflow of amniotic fluid.

The disease interferes with the normal functioning of the expectant mother. Preeclampsia in pregnant women contributes to deterioration of well-being and decreased performance. Pathology can cause disruption of the blood supply to vital organs. Due to this, complications of preeclampsia arise - strokes, liver failure, decreased kidney function. In severe cases, the pathology can cause the death of a woman.

Symptoms of preeclampsia

Clinical manifestations of the disease are varied and depend on the stage of the pathological process. Mild forms of preeclampsia may not be accompanied by severe symptoms. The most common symptom of the pathology is swelling.

Preeclampsia during pregnancy is accompanied by swelling that does not go away in the morning. They can be located in any part of the body - on the feet, legs, arms, face. This disease is also characterized by the development of hidden edema in the abdominal and thoracic cavity. For a long time they are not visible to the human eye. Fluid retention can be detected by monitoring the amount of water you drink and excrete, or by constantly measuring your body weight.

From the central nervous system, symptoms such as “floaters” before the eyes, blurred vision, headaches, and fainting may appear. In rare cases, the expectant mother develops seizures.

Complications in the gastrointestinal tract are associated with stretching of the liver capsule due to stagnation of fluid in it. Due to this phenomenon, a pregnant woman may feel dull pain in the upper abdomen.

Sometimes, against the background of preeclampsia, symptoms associated with a violation of the hemostatic system occur. These include the appearance of bruises on the skin, a drop in blood pressure, and hemolytic anemia (accompanied by jaundice).

Cardiac symptoms of preeclampsia include rhythm disturbances and chest pain. The disease can also contribute to pathologies of renal function - a decrease in the amount of urine excreted or its complete absence.

Diagnosis of the disease

To be diagnosed with preeclampsia, pregnancy must be more than 20 weeks. The main screening method for detecting the disease is measuring blood pressure. With values ​​above 140/90, a pregnant woman is considered sick. To confirm preeclampsia, the doctor evaluates a complete urinalysis; daily protein loss should exceed 300 milligrams.

To confirm the diagnosis, doctors resort to additional research methods. Specialists can conduct an ultrasound scan with a Doppler sensor. This study helps to assess the condition of the uterine and placental vessels.

Attention! For timely detection of preeclampsia, the expectant mother should not skip routine examinations by an obstetrician-gynecologist, during which the doctor evaluates blood pressure and filtering function of the kidneys.

An indirect sign of preeclampsia is the detection of an increased amount of urea in a biochemical blood test. It is a marker of improper functioning of the urinary system.

To diagnose complications of the disease, a complete blood count is assessed. It may show a decrease in platelets below 100,000/microliter. Assessment of liver and kidney function is possible based on the results of a biochemical blood test.

In cases of kidney dysfunction, an increase in creatinine levels is observed. An increase in liver enzymes in the blood indicates the development of liver failure. In case of vision pathologies, a woman may be referred for examination to an ophthalmologist.

Treatment of preeclampsia

Treatment tactics for preeclampsia depend on the stage of the disease. With a moderate course of the pathology, it is possible to prolong pregnancy with the prevention of complications. To do this, doctors prescribe medications that help lower blood pressure.

Methyldopa is considered the safest drug in this group. The drug does not contribute to the development of complications in the fetus. If Methyldopa is ineffective, doctors prescribe other drugs - Nifedipine and Netoprolol. These medications may contribute to the birth of low birth weight babies.

If severe preeclampsia is detected, a woman requires prompt medical attention aimed at normalizing blood pressure. For these purposes, the drugs Clonidine, Nifedipine and Nitroglycerin are used.

To prevent the development of seizures in the expectant mother, intravenous administration of magnesium sulfate is indicated. Within 24 hours of the diagnosis of severe preeclampsia, the pregnant woman should have a caesarean section.

Prevention

At the present stage of medicine, the prevention of preeclampsia is a serious problem, since scientists do not know the exact pathogenesis of this disease. Increased intake of calcium in the diet has been proven to prevent high blood pressure. That is why expectant mothers should consume dairy products, soy, almonds, broccoli, and fish.

Acetylsalicylic acid is a means of preventing preeclampsia. However, taking this drug is not indicated for all women, and only for pregnant women who are at risk. It includes expectant mothers with arterial hypertension diagnosed before pregnancy, diabetes mellitus, and a history of preeclampsia.

Possible complications

Severe preeclampsia can cause a variety of maternal and fetal complications. Pathology is a factor in the development of infarctions of various organs - the brain, heart, kidneys, and intestines.

The disease can provoke rupture of the liver capsule, which is manifested by pallor of the skin, a sharp drop in blood pressure, and sharp pain in the upper abdomen.

The most dangerous complications of preeclampsia are eclampsia and HELLP syndrome. These conditions threaten the life of the mother and child and require immediate hospital treatment and delivery through surgery.

Eclampsia

Eclampsia- development of a seizure in a pregnant woman against the background of arterial hypertension. This complication poses a serious threat to the life of the fetus and mother. The pathology dissipates against the background of existing severe preeclampsia.

During a seizure, the woman loses consciousness and falls to the ground. It usually lasts about 2-3 minutes and ends with a broken breath. Eclampsia is a factor in the development of severe complications - disseminated intravascular coagulation syndrome, cerebral hemorrhage, and heart failure. Pathology can also lead to the death of a child and a woman.

Treatment of eclampsia is to prevent complications and death of the woman. To do this, those around you should put the expectant mother on her back, turn her head to the side, and release her tongue. During an eclampsia attack, doctors administer anticonvulsants in a medical facility.

If a seizure occurs outside of a hospital, people around you should call 911 immediately. After the woman’s condition normalizes, specialists perform an emergency delivery.

HELLP syndrome

HELLP syndrome is a complication of preeclampsia or eclampsia, accompanied by the breakdown of red blood cells, liver failure and a decrease in platelet count. This condition is very dangerous for the life of the expectant mother and child.

The clinical picture of the pathology is extremely varied, most often it includes the main symptoms of preeclampsia - pain in the upper abdomen, malaise, swelling in the arms and face. More specific signs of pathology are bruising on the body, jaundice, vomiting "coffee grounds", seizures and coma.

To diagnose HELLP syndrome, it is necessary to take the blood of the expectant mother for general and biochemical analysis. Once the diagnosis is made, doctors perform an immediate caesarean section. To treat the pathology, anti-inflammatory drugs and infusion therapy are used to replenish red blood cells and platelets.