Causes of eclampsia in pregnant women. Eclampsia and preeclampsia in pregnancy: causes, risks and emergency care. Prevention of preeclampsia in pregnancy

- this is a complication of pregnancy, characterized by the occurrence of arterial hypertension and proteinuria (detection of protein in the urine test) after pregnancy. In some cases, preeclampsia causes dysfunction of the liver, kidneys, lungs, and brain.

In medicine, preeclampsia is called late or arterial hypertension of pregnant women.

Who is at risk

Women who have at least one of the following characteristics are at increased risk of developing preeclampsia:

first pregnancy (without miscarriages and abortions);
chronic arterial hypertension, kidney disease, lupus erythematosus, or diabetes before pregnancy;
multiple pregnancy (for example, twins or triplets);
family history of preeclampsia;
the presence of preeclampsia in the history of the disease;
age up to 20 years, or over 35 years;
obesity.

Causes of preeclampsia during pregnancy

Anomalies in the development of the blood vessels of the uterus and placenta that occur in the early stages of pregnancy activate processes that ultimately lead to preeclampsia. The cause of the symptoms of the disease are changes inside the small arteries, which reduce blood flow to the kidneys, liver, brain and to the placenta itself. What is the trigger mechanism for such violations for physicians remains a mystery.

Maternal preeclampsia

Most pregnant women with preeclampsia have slightly elevated blood pressure and a small amount of excess protein in their urine. Otherwise, the clinical picture of the disease is stable and does not cause concern. However, there are cases when the signs of preeclampsia signal the seriousness of the situation:

strong;
vision problems (blurred or double vision, blind spots, light flashes, loss of vision);
shortness of breath due to the presence of fluid in the lungs;
pain in the epigastric region (like heartburn);
blood pressure >160/110 mmHg st;
poor renal function tests (eg, serum creatinine >1.1 mg/dL);
platelets<100 000/мм3;
abnormal liver function (according to the results of a blood test);
pulmonary edema.

Fetal Preeclampsia

This disease can adversely affect the ability of the placenta to provide the baby with adequate nutrition and oxygen, which can have certain consequences:

unsatisfactory results of the non-stress test and the biophysical profile of the fetus;
slow growth of the child (usually noted with help);
a decrease in the amount of amniotic fluid around the child;
decrease in the intensity of blood flow in the vessels of the umbilical cord (determined using dopplerometry).

Can preeclampsia be prevented during pregnancy?

There are no tests that predict with certainty when to expect complications of this kind, and there are no ways to prevent them. For expectant mothers who are at risk, doctors may recommend low-dose aspirin. You can start taking the drug from the end of the first trimester until the end of the pregnancy.

Treatment of preeclampsia during pregnancy

the only preeclampsia treatment is the birth of a child and a placenta. Bed rest and medications can lower blood pressure and consequently reduce the risk of stroke, but these procedures will not affect the underlying vascular abnormalities in the mother, and thus will not stop the progression of the disease.

Pregnancy management program, complicated by preeclampsia, is formed taking into account the gestational age of the fetus and the presence of severe signs of the disease. Method of delivery, whether vaginal or C-section, depends on a number of factors such as the position of the fetus, the opening and thinning of the cervix, as well as the general condition of the child. In most cases, the baby is born vaginally.

To stimulate the uterus, obstetricians use oxytocin, which is administered intravenously. If labor activity is weak or accompanied by any abnormalities that require a quick extraction of the child, a caesarean section is performed.

With a full-term pregnancy, the appearance of preeclampsia at term no longer poses a threat to the health of a woman or her child. Babies born at term are not at high risk for complications from preterm birth and usually do not need an extra stay in an incubator.

If preeclampsia develops at an earlier date and there are no serious signs of the disease, the possibility of postponing childbirth is allowed. This gives the baby extra time to gain the right weight and complete fetal development. With more serious symptoms of the disease, entailing a threat to the health of the woman in labor and the baby, a delivery operation is performed.

Preeclampsia of pregnant women with delayed delivery

In delayed delivery, the mother and baby are closely monitored, which includes the following:

Help with childbirth

To prevent an attack of eclampsia (a more severe form of preeclampsia), an intravenous injection of a solution of magnesia is given during childbirth and within 24 hours after childbirth. To prevent a stroke in the mother, drugs are administered to relieve high blood pressure.

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Eclampsia and preeclampsia are pathological conditions that occur during pregnancy. Both conditions are not independent diseases, but are syndromes of insufficiency of various organs, combined with various symptoms of damage to the central nervous system of varying severity. Preeclampsia and eclampsia are pathological conditions that develop exclusively during pregnancy. In a non-pregnant woman or man, neither preeclampsia nor eclampsia can develop in principle, since these conditions are provoked by disturbances in the relationship of the mother-placenta-fetus system.

Since the causes and mechanisms of development of eclampsia and preeclampsia have not yet been finally elucidated, the world has not made an unambiguous decision to which particular nosology these syndromes should be attributed. According to scientists from Europe, the USA, Japan and experts from the World Health Organization, preeclampsia and eclampsia are syndromes related to manifestations of hypertension in pregnant women. This means that eclampsia and preeclampsia are considered precisely as varieties of arterial hypertension in pregnant women. In Russia and some countries of the former USSR, eclampsia and preeclampsia are types of preeclampsia, 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 syndrome of multiple organ failure 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 excretion of protein in the urine (proteinuria).

Eclampsia- these are the predominant clinical manifestations of brain damage with convulsions and coma against the background of the general symptoms of preeclampsia. Convulsions 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 classification of the World Health Organization, 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 provoked by the bearing of the fetus;
3. Preeclampsia:

Mild degree of preeclampsia (non-severe);
Severe preeclampsia.

4. Eclampsia.

The above classification clearly illustrates that eclampsia and preeclampsia are varieties of hypertension that develops in pregnant women. Preeclampsia is a condition that precedes the development of eclampsia. However, eclampsia does not necessarily develop with 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 separated into a separate nosological structure. It is precisely because of the presence of nephropathy in the Russian classification that obstetricians and gynecologists consider preeclampsia a short-term condition preceding eclampsia. And foreign obstetrician-gynecologists refer to preeclampsia as nephropathy of the 1st, 2nd and 3rd degrees, and therefore they believe that it can last for quite a long period of time. However, as noted by foreign practicing obstetricians, before an attack of eclampsia, the course of preeclampsia is sharply aggravated for a short period of time. It is this spontaneous and abrupt worsening of the course of preeclampsia that is considered a direct precursor of eclampsia, and when it occurs, it is necessary to urgently hospitalize a 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 is 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 symptoms listed (the volume of edema, the magnitude of the pressure, the concentration of protein in the urine, etc.). But if the three symptoms (Zantgemeister triad) are joined by headache, vomiting, abdominal pain, blurred vision (visible "as in a fog", "flies before the eyes"), a decrease in urine output, then Russian obstetricians diagnose preeclampsia. Thus, from the point of view of foreign experts, nephropathy is a serious pathology that must be attributed to preeclampsia, and not wait for a sharp deterioration in the condition preceding eclampsia. In the future, we will use the term "preeclampsia", investing in 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.

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

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

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

Severe and mild preeclampsia reflect the varying severity of damage to the internal organs of a pregnant woman. Accordingly, the more severe the preeclampsia, the greater the damage to the internal organs, and the higher the risk of developing adverse consequences for the mother and fetus. If severe preeclampsia is not amenable to drug therapy, then the only treatment is abortion.

The classification of preeclampsia into mild and severe is generally accepted in Europe and the United States, 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 grade I and II nephropathy, and severe preeclampsia is 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 varieties:

Eclampsia occurring during pregnancy(accounts for 75 - 85% of all cases of eclampsia);
Eclampsia in childbirth, arising directly in the process of childbirth (approximately 20 - 25% of all cases of eclampsia);
postpartum eclampsia that occurs within a day after delivery (approximately 2 - 5% of all cases of eclampsia).

All of the listed varieties 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 of any of the above varieties 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 edema 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 subcutaneous tissue edema, 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 with kidney disease before pregnancy. The renal form of eclampsia is characterized by slight or no edema of the subcutaneous tissue, but the presence of a large amount of fluid in the abdominal cavity and fetal bladder, 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 violation of normal relationships in the mother-placenta-fetus system. There are more than thirty different theories for the development of eclampsia and preeclampsia, among which the following are the most complete and prognostically significant:

Genetic mutations (defects in the eNOS, 7q23-ACE, HLA, AT2P1, C677T genes);
Antiphospholipid syndrome or other thrombophilias;
Chronic pathologies of non-genital organs;
Infectious diseases.

Unfortunately, at present there is no test that allows you to find out whether eclampsia will develop in this particular case with or without predisposing factors. Many modern scientists believe that preeclampsia is genetically determined by the insufficiency of 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 fetoplacental insufficiency and the risk factors that a woman has.

Risk factors for preeclampsia and eclampsia include the following:
1. 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 age of the pregnant woman is over 40;
7. The interval between previous and present 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 whole variety 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 placenta is formed. It is on the basis of cytotrophoblast that a 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 the 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 do not grow, as a result of which they are not ready 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 chronic hypoxia conditions for it. With severe insufficiency of the blood supply to the fetus, there may even be a delay in its development.

Spasmodic uterine vessels become inflamed, which leads to swelling of the cells that form their inner lining. Fibrin is deposited on the inflamed and swollen cells of the inner layer of blood vessels, forming blood clots. As a result, the blood flow in the placenta is even more disturbed. 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 develop a failure of their function.

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

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

In addition, due to damage to the vascular wall, blood clotting processes are activated, for which platelets are consumed. 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 has partial hemophilia, when the blood clots poorly and slowly. Low blood clotting against the background of high blood pressure creates a high risk of stroke and cerebral edema. As long as 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 the subsequent development of hemophilia in eclampsia is a chronic DIC.

Eclampsia and preeclampsia - symptoms and signs

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

Edema in preeclampsia can be of varying severity and prevalence. For example, some women have only swelling on the face and legs, while others have it all over the body. Pathological edema in preeclampsia differs from normal, characteristic of any pregnant woman, in that they do not decrease and do not disappear after a night's 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 the detection of protein in an amount of more than 0.3 g / l in the daily portion of urine.

Hypertension in a pregnant woman is considered to be an increase in blood pressure above 140/90 mm Hg. Art. In this case, the pressure is in the range of 140 - 160 mm Hg. Art. for systolic value and 90 - 110 mm Hg. 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, in severe preeclampsia, symptoms of damage to the central nervous system and disorders of cerebral circulation are added, such as:

Severe headache;
Visual impairment (a woman indicates blurred vision, a feeling of flies running in front of her eyes and fog, etc.);
Pain in the abdomen in the region of the stomach;
Nausea and vomiting;
Convulsive readiness;
Generalized edema;
Decreased urination to 500 ml or less per day or less than 30 ml per hour;
Soreness when probing the liver through the anterior abdominal wall;
Decrease in the total number of platelets less than 100 * 106 pieces / l;
Increased activity of AST and ALT more than 70 IU / 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. Edema 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 classified as severe, in which a woman has any level of hypertension in combination with proteinuria and any one of the symptoms of cerebrovascular accident or CNS damage listed above (headache, blurred vision, nausea, vomiting, abdominal pain, decreased urination, etc.).

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

Eclampsia is a seizure that develops against the background of edema and brain damage due to previous preeclampsia. That is, the main symptom of eclampsia is convulsions in combination with a woman's coma. Convulsions in 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 an increase in headache, worsening sleep up to insomnia, and a significant increase in pressure. One seizure in eclampsia lasts 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 violent convulsions of the muscles of the body are over, consciousness slowly returns, the woman comes to her senses, but does not remember anything, therefore she is not able to tell about what happened.

Eclamptic seizures develop due to deep CNS damage during cerebral edema and high intracranial pressure. The excitability of the brain is greatly increased, so any strong stimulus, such as bright light, noise, sharp pain, etc., can provoke a new attack of seizures.

Eclampsia - periods

A convulsive seizure in eclampsia consists of the following consecutive periods:
1. Preconvulsive period lasting for 30 seconds. At this time, the woman begins to have small twitches of the facial muscles, her eyes are covered with eyelids, and the corners of her mouth are lowered;
2. Period of tonic convulsions , which also lasts an average of about 30 seconds. At this moment, the woman's torso is stretched, the spine is bent, the jaws are tightly compressed, all the muscles are contracting (including the respiratory ones), the face turns blue, the eyes look at one point. Then, when the eyelids tremble, the eyes roll up, as a result of which only the whites become visible. The pulse stops being felt. Due to the contraction of the respiratory muscles, the woman does not breathe during this period. This phase is the most dangerous, because sudden death can occur due to respiratory arrest, most often from 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. Convulsions pass one after another and spread through the body from top to bottom. The convulsions are violent, the muscles of the face, trunk and limbs twitch. During convulsions, the woman does not breathe, and the pulse is not felt. Gradually, the convulsions weaken, become less frequent and, finally, completely stop. 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, the pulse begins to be felt, and the pupils slowly narrow. There is no memory of the seizure.

The total duration of the described periods of eclamptic convulsions is 1-2 minutes. After the seizure, the woman's consciousness may recover, or she may fall into a coma. A coma develops in the presence of cerebral edema and continues until the moment when it subsides. If a coma during eclampsia lasts for hours and days, then the prognosis for the life and health of a woman is unfavorable.

Eclampsia and preeclampsia - principles of diagnosis

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

Identification of edema and assessment of their severity and localization;
Measurement of blood pressure;
Urinalysis for protein content;
Blood test for hemoglobin concentration, platelet count and hematocrit;
Blood at the time of clotting;
Electrocardiogram (ECG);
Biochemical blood test (total white, creatinine, urea, AlAT, AsAT, bilirubin);
Coagulogram (APTT, PTI, INR, TV, fibrinogen, coagulation factors);
fetal CTG;
fetal ultrasound;
Dopplerometry of the vessels of the uterus, placenta and fetus.

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

Emergency care for eclampsia

With eclampsia, it is necessary to lay the pregnant woman on her left side to reduce the risk of vomit, blood and gastric contents entering the lungs. The woman should be laid on a soft bed so that during convulsions she does not inflict accidental injuries on herself. It is not necessary to hold by force during a convulsive eclamptic seizure.

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

Immediately after the end of the seizure, magnesium sulfate should be administered intravenously. First, 20 ml of a 25% solution of magnesia is injected within 10-15 minutes, then they 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 finished 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, magnesium sulfate should be administered continuously for 12 to 24 hours. Magnesia therapy is necessary to prevent possible subsequent seizures.

If, after the introduction of magnesia, convulsions recur after 15 minutes, then you should switch to Diazepam. Within two minutes, 10 mg of diazepam should be administered intravenously. With the resumption of seizures, the same dose of Diazepam is re-introduced. 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 gestational age, eclampsia is not an indication for emergency delivery, since it is first necessary to stabilize the woman's condition and achieve cessation of seizures. Only after the relief of convulsive seizures can the question of delivery be considered, which is carried out both through the natural birth canal and through caesarean 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 against the background of eclampsia);
2. Antihypertensive therapy - lowering 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, with eclampsia and preeclampsia, only symptomatic therapy is carried out to prevent seizures and reduce pressure, which, in most cases, is effective.

However, symptomatic therapy of 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 the bearing of a child that is the cause of these pathological syndromes. Therefore, if symptomatic antihypertensive and anticonvulsant treatment is ineffective, an urgent delivery is performed, which is necessary to save the mother's life.

Anticonvulsant therapy

Anticonvulsant therapy for eclampsia and preeclampsia is performed using intravenous administration of magnesium sulfate (magnesia). Magnesia therapy is divided into loading and maintenance doses. As a loading dose, 20 ml of 25 magnesia solution (5 g in terms of dry matter) is injected intravenously within 10-15 minutes for a woman once.

Then a solution of magnesia in a maintenance dose, which is 1 - 2 g of dry matter per hour, is injected continuously for 12 - 24 hours. To obtain magnesia in a maintenance dosage, it is necessary to combine 320 ml of saline with 80 ml of a 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 injected at a rate of 22 drops per hour, then this will correspond to 2 g of dry matter per hour.

With continuous administration of magnesium, symptoms of magnesium overdose should be monitored, 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 an overdose of magnesium appear, the infusion of magnesium should be stopped and an antidote should be immediately administered intravenously - 10 ml of a 10% solution of calcium gluconate.

Anticonvulsant therapy is given intermittently 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 is to bring the pressure to 130 - 140/90 - 95 mm Hg. Art. and keeping it within the specified limits. Currently, the following antihypertensive drugs are used to reduce pressure in eclampsia or preeclampsia of pregnant women:

Nifedipine- take 10 mg (0.5 tablets) once, then 30 minutes later 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 - is 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 body 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 reached. The maximum duration of sodium nitroprusside infusion is 4 hours.

The above drugs are fast-acting and are used only for a single pressure reduction. For its subsequent maintenance within normal limits, preparations containing as an active substance methyldopa(for example, Dopegyt, 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 sharp attack of hypertension occurs, the pressure is normalized with Nifedipine or Sodium nitroprusside, after which the woman is again transferred to methyldopa.

After childbirth, magnesium therapy should be carried out during the day, consisting of loading and maintenance dosages. Antihypertensive drugs after childbirth are used individually, canceling gradually.

Rules for delivery in eclampsia and preeclampsia

With eclampsia, regardless of the gestational age, delivery is performed within 3 to 12 hours after the relief of seizures.

With mild preeclampsia, delivery is carried out at 37 weeks of gestation.

In severe preeclampsia, regardless of the gestational age, delivery is performed within 12 to 24 hours.

Neither eclampsia nor preeclampsia are absolute indications for caesarean section Moreover, childbirth through natural ways is preferable. Delivery by caesarean section is performed only with placental abruption or with unsuccessful attempts to induce labor. In all other cases, women with preeclampsia or eclampsia have vaginal delivery. At the same time, they do not wait for the natural onset of childbirth, but carry out their induction (induction). Childbirth with eclampsia or preeclampsia is necessarily carried out with the use of epidural anesthesia and against the background of careful monitoring of the fetal heart rate using CTG.

Complications of eclampsia

An attack of eclampsia can provoke the following complications:

Pulmonary edema;
aspiration pneumonia;
Cerebral hemorrhage (stroke) followed by hemiplegia or paralysis;
Retinal detachment followed by temporary blindness. Usually vision is restored within a week;
Psychosis, lasting from 2 weeks to 2 - 3 months;
Coma;
swelling of the brain;
Sudden death due to infringement of the brain against the background of its edema.

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 preparations (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 and preeclampsia can also take aspirin and calcium as a preventive measure.

Preeclampsia and eclampsia are severe stages of preeclampsia and are a formidable complication of pregnancy. According to statistics, the percentage of preeclampsia is 5-10%, and eclampsia 0.5% among the total number of women in labor, pregnant women and puerperas.

Preeclampsia is a preconvulsive condition characterized by a significant rise in blood pressure, high protein content in the urine, and severe edema (not a major prognostic sign).

Eclampsia is a seizure that either resolves or progresses to a coma.

Kinds

Preeclampsia and eclampsia are classified according to the period associated with pregnancy:

preeclampsia and eclampsia of the pregnant;
preeclampsia and eclampsia of the mother;
preeclampsia and eclampsia of the puerperal.

Preeclampsia has 2 levels of severity: moderate and severe.

Eclampsia, depending on the prevailing manifestations, is divided into cerebral, coma, hepatic and renal.

The reasons

The causes of preeclampsia and eclampsia are still not exactly established. There are 30 or more theories that explain the causes and mechanisms of development of preeclampsia and eclampsia. But the general opinion of all doctors is the presence of placental pathology, the formation of which is disturbed in the early stages of pregnancy.

When placental attachment is disturbed (superficially implanted placenta) or there is a deficiency of receptors for placental proteins, the placenta begins to synthesize substances that cause vasoconstriction (vasoconstrictors), which leads to a generalized spasm of all blood vessels in the body to increase pressure in them and increase the supply of oxygen and nutrients. substances to the fetus. This leads to arterial hypertension and multiple organ damage (first of all, the brain, liver, kidneys are affected).

An important role in the development of preeclampsia and eclampsia is played by heredity and chronic diseases.

Symptoms of eclampsia and preeclampsia

Signs of preeclampsia

Preeclampsia is only a short interval between nephropathy and a seizure. Preeclampsia is a violation of the functions of the vital organs of the body, the leading syndrome of which is damage to the central nervous system:

the appearance of flies before the eyes, flickering, vagueness of objects;
tinnitus, headache, feeling of heaviness in the back of the head;
nasal congestion;
memory disorders, drowsiness or insomnia, irritability or apathy.

Also, preeclampsia is characterized by pain in the upper abdomen (“under the spoon”), in the right hypochondrium, nausea, and vomiting.

An unfavorable prognostic sign is an increase in tendon reflexes (this symptom indicates convulsive readiness and a high likelihood of developing eclampsia).

With preeclampsia, edema increases, sometimes within a few hours, but the severity of edema in assessing the severity of the condition of the pregnant woman does not matter. The severity of preeclampsia is established on the basis of complaints, proteinuria and arterial hypertension (an increase in blood pressure for normotonic patients above 140/90 mm Hg should be alarming). If arterial hypertension is 160/110 or more, they speak of severe preeclampsia.

Kidney damage manifests itself in the form of a decrease in the amount of urine excreted (oliguria and anuria), as well as a high protein content in the urine (0.3 grams per daily amount of urine).

Signs of eclampsia

Eclampsia is an attack of seizures, which consists of several phases:

First phase. The duration of the first (introductory) phase is 30 seconds. In this stage, small contractions of the muscles of the face appear.
Second phase. Tonic convulsions are a generalized spasm of all the muscles of the body, including the respiratory muscles. The second phase lasts 10-20 seconds and is the most dangerous (the death of a woman may occur).
Third phase. The third phase is the stage of clonic convulsions. The motionless and tense patient ("like a string") begins to beat in a convulsive fit. Convulsions go from top to bottom. The woman is without a pulse and breathing. The third stage lasts 30-90 seconds and is resolved with a deep breath. Then breathing becomes rare and deep.
Fourth phase. Seizure is allowed. Characterized by the release of foam with an admixture of blood from the mouth, a pulse appears, the face loses its cyanosis, returning to normal color. The patient either regains consciousness or falls into a coma.

Diagnostics

Differential diagnosis of preeclampsia and eclampsia should first of all be carried out with an epileptic seizure (“aura” before an attack, convulsions). Also, these complications should be distinguished from uremia and brain diseases (meningitis, encephalitis, hemorrhages, neoplasms).

The diagnosis of preeclampsia and eclampsia is established by a combination of instrumental and laboratory data:

Measurement of blood pressure. An increase in blood pressure to 140/90 and maintaining these numbers for 6 hours, an increase in systolic pressure by 30 units, and diastolic pressure by 15.
Proteinuria. Detection of 3 or more grams of protein in the daily amount of urine.
Blood chemistry. An increase in nitrogen, creatinine, urea (kidney damage), an increase in bilirubin (erythrocyte breakdown and liver damage), an increase in liver enzymes (AST, ALT) - a violation of liver function.
General blood analysis. An increase in hemoglobin (a decrease in the volume of fluid in the vascular bed, that is, a thickening of the blood), an increase in hematocrit (viscous, "viscous" blood), a decrease in platelets.
General urine analysis . Detection of protein in urine in large quantities (normally absent), detection of albumin (severe preeclampsia).

Treatment of eclampsia and preeclampsia

A patient with preeclampsia and eclampsia must be hospitalized in a hospital. Treatment should be started immediately, on the spot (in the emergency room, at home in case of an ambulance call, in the department).

An obstetrician-gynecologist and a resuscitator are involved in the treatment of these complications of pregnancy. The woman is hospitalized in the intensive care unit, where a therapeutic-protective syndrome is created (a sharp sound, light, touch can provoke a seizure). Additionally, sedatives are prescribed.

The gold standard for the treatment of these forms of gestosis is the intravenous administration of a solution of magnesium sulfate (under the control of blood pressure, respiratory rate and heart rate). Also, to prevent seizures, droperidol and relanium are prescribed intravenously, possibly in combination with diphenhydramine and promedol.

At the same time, the volume of circulating blood is replenished (intravenous infusions of colloids, blood products and saline solutions: plasma, reopoliglyukin, infucol, glucose solution, isotonic solution, etc.).

Blood pressure is controlled by prescribing antihypertensive drugs (clophelin, dopegyt, corinfar, atenolol).

In pregnancy up to 34 weeks, therapy is carried out aimed at maturation of the fetal lungs (corticosteroids).

Emergency delivery is indicated in the absence of a positive effect from therapy within 2-4 hours, with the development of eclampsia and its complications, with placental abruption or suspicion of it, with acute oxygen deficiency (hypoxia) of the fetus.

First aid for an attack of eclampsia:

Turn the woman on her left side (to prevent aspiration of the respiratory tract), create conditions that reduce the trauma of the patient, do not use physical force to stop convulsions, after an attack, clean the oral cavity from vomit, blood and mucus. Call an ambulance.

Medical relief of an attack of eclampsia:

Intravenous administration of 2.0 ml of droperidol, 2.0 ml of relanium and 1.0 ml of promedol. After the end of the attack, the lungs are ventilated with a mask (oxygen), and in the case of a coma, the trachea is intubated, followed by a ventilator.

Complications and prognosis

The prognosis after an attack (coma) of eclampsia and preeclampsia depends on the severity of the patient's condition, the presence of extragenital diseases, age and complications.

Complications:

placental abruption;
acute intrauterine fetal hypoxia;
hemorrhages in the brain (paresis, paralysis);
acute liver and kidney failure;
HELLP syndrome (hemolysis, increased liver enzymes, decreased platelets);
pulmonary edema, cerebral edema;
heart failure;
coma;
death of a woman and / or fetus.

Some research on pregnancy

Preeclampsia - symptoms and treatment

What is preeclampsia? We will analyze the causes of occurrence, diagnosis and treatment methods in the article of Dr. A. A. Dubova, an obstetrician with an experience of 12 years.

Definition of disease. Causes of the disease

Preeclampsia- a complication of the second half of pregnancy, in which, due to an increase in the permeability of the vascular wall, disorders develop in the form of arterial hypertension, combined with the loss of protein in the urine (proteinuria), edema and multiple organ failure.

In fact, the cause of preeclampsia is pregnancy: it is during it that pathological events occur, ultimately leading to the clinic of preeclampsia. Preeclampsia does not occur in non-pregnant women.

The scientific literature describes more than 40 theories of the origin and pathogenesis of preeclampsia, and this indicates the lack of common views on the causes of its occurrence. It has been established that young and nulliparous women are more likely to suffer from preeclampsia (from 3 to 10%). In pregnant women with a planned second birth, the risk of its occurrence is 1.4-4%.

The starting point in the development of preeclampsia in modern obstetrics is a violation of placentation. If the pregnancy proceeds normally, from the 7th to the 16th week, the endothelium (the inner lining of the vessel), the inner elastic layer and the muscular plates of the spiral artery section, are replaced by the trophoblast and fibrin-containing amorphous matrix (components of the precursor of the placenta - the chorion). Because of this, the pressure in the vascular bed decreases and additional blood flow is created to meet the needs of the fetus and placenta. Preeclampsia is associated with the absence or incomplete invasion of the trophoblast into the region of the spiral arteries, which leads to the preservation of sections of the vascular wall, which has a normal structure. In the future, the impact on these vessels of substances that cause vasospasm leads to a narrowing of their lumen to 40% of the norm and the subsequent development of placental ischemia. In the normal course of pregnancy, up to 96% of the 100-150 spiral arteries of the uterus undergo physiological changes, while in preeclampsia, only 10%. Studies confirm that the outer diameter of the spiral arteries in pathological placentation is half that of normal.

If you experience similar symptoms, consult your doctor. Do not self-medicate - it is dangerous for your health!

Symptoms of preeclampsia

Previously, in domestic obstetrics, what is now called the term "preeclampsia" was called "late preeclampsia", and directly under preeclampsia they understood a severe degree of late preeclampsia. Today, in most regions of Russia, they switched to the classification adopted by WHO. Previously, they talked about the so-called OPG-gestosis (edema, proteinuria and hypertension).

1. Arterial hypertension

Preeclampsia is characterized by systolic blood pressure>140 mm Hg. Art. and / or diastolic blood pressure> 90 mm Hg. Art., measured twice with an interval of 6 hours. At least two elevated blood pressure values are the basis for the diagnosis of hypertension during pregnancy. If in doubt, ambulatory blood pressure monitoring (ABPM) is recommended.

2. Proteinuria

To diagnose proteinuria, it is necessary to identify the quantitative determination of protein in the daily portion (normal during pregnancy - 0.3 g / l). Clinically significant proteinuria during pregnancy is defined as the presence of protein in the urine ≥ 0.3 g/l in a daily sample (24 hours) or in two samples taken with an interval of 6 hours; when using a test strip (protein in urine) - indicator ≥ "1+".

Moderate proteinuria is a protein level > 0.3 g/24 hours or > 0.3 g/l, determined in two portions of urine taken 6 hours apart, or a "1+" value on a test strip.

Severe proteinuria is a protein level > 5 g/24 hours or > 3 g/L in two urine samples taken 6 hours apart, or a 3+ dipstick value.

To assess the true level of proteinuria, it is necessary to exclude the presence of a urinary tract infection, and abnormal proteinuria in pregnant women is the first sign of multiple organ lesions.

3. Edema syndrome

The triad of signs described by Wilhelm Zangemeister in 1912 (OPG preeclampsia) is found today in only 25-39%. The presence of edema in modern obstetrics is not considered a diagnostic criterion for preeclampsia, but it is important when you need to assess its severity. When the pregnancy is normal, edema occurs in 50-80% of cases, outpatient management is safe for a mild edematous symptom. However, generalized, recurrent edema is often a sign of combined preeclampsia (often against the background of kidney pathology).

The American surgeon and illustrator Frank Henry Netter, who was rightly nicknamed the "Michelangelo of Medicine", very clearly depicted the main manifestations of preeclampsia.

The pathogenesis of preeclampsia

In response to ischemia in violation of implantation (see figure), placental factors, including anti-angiogenic factors and inflammatory mediators that damage endothelial cells, begin to be actively produced. When the compensatory mechanisms of blood circulation are running out, the placenta, with the help of pressor agents, actively “adjusts” the blood pressure of the pregnant woman to itself, while temporarily increasing blood circulation. As a result of this conflict, endothelial dysfunction occurs.

With the development of placental ischemia, a large number of mechanisms are activated, leading to damage to endothelial cells throughout the body, if the process is generalized. As a result of systemic endothelial dysfunction, the functions of vital organs and systems are disrupted, and as a result, we have clinical manifestations of preeclampsia.

Violation of placental perfusion due to pathology of the placenta and vasospasm increases the risk of fetal death, intrauterine growth retardation, the birth of children small for term and perinatal mortality. In addition, the condition of the mother often causes early pregnancy termination - which is why children born to mothers with preeclampsia have a higher incidence of respiratory distress syndrome. Placental abruption is very common among preeclamptic patients and is associated with high perinatal mortality.

Classification and stages of development of preeclampsia

Moderate preeclampsia	Combination of two main symptoms: I. Systolic blood pressure 141-159 mm Hg. Art. and / or diastolic blood pressure, 91-99 mm Hg. Art. at double measurement with an interval of 6 hours II. Protein content in daily urine 0.3 g. and more
heavy preeclampsia	I. BP numbers 160/100 mm Hg. Art. and above, measured at least twice with an interval of 6 hours in a horizontal position of a pregnant woman and/or II. Proteinuria 5 grams per day or more or 3 grams in separate portions of urine obtained twice with a difference of 4 hours or more and / or joining the symptoms of moderate preeclampsia at least one of the following: - oliguria, 500 ml per day or less; - pulmonary edema or respiratory failure (cyanosis); - pain in the epigastrium or right hypochondrium, nausea, vomiting, deterioration of liver function; - cerebral disorders (headache, impaired consciousness, visual impairment - photopsy); - thrombocytopenia (below 100x109/ml); - severe fetal growth retardation; - beginning before 32-34 weeks and the presence of signs of fetoplacental insufficiency.
The diagnosis of severe preeclampsia is established by the presence of: - two main criteria for severe (AH and proteinuria) or - one main criterion of any degree and an additional criterion. Eclampsia is a condition in which the clinical manifestations of preeclampsia are dominated by brain lesions, accompanied by a convulsive syndrome that cannot be explained by other causes, and the period of resolution following it. Eclampsia can develop against the background of preeclampsia of any severity, and is not a manifestation of the maximum severity of preeclampsia.

Complications of preeclampsia

The main complications of preeclampsia are:

hypertensive encephalopathy;
hemorrhagic stroke;
subarachnoid hemorrhage;
premature detachment of the placenta (7-11%);
DIC (8%);
acute fetal hypoxia (48%) and intrauterine fetal death;
pulmonary edema (3-5%);
pulmonary heart failure (2-5%);
aspiration pneumonia (2-3%);
visual impairment;
acute renal failure (5-9%);
liver hematoma (1%);
HELLP syndrome (10-15%);
postpartum psychosis.

Diagnosis of preeclampsia

Diagnosis of preeclampsia is primarily to establish the presence of the above symptoms. In some cases, the differential diagnosis of preeclampsia and arterial hypertension that existed before pregnancy is difficult.

Differential diagnosis of hypertensive complications of pregnancy

Clinical signs	Chronic hypertension	Preeclampsia
Age	often age (more than 30 years)	often young (years)
Parity pregnancy	multi-pregnant	primigravida
The emergence of clinical signs	up to 20 weeks	≥ 20 weeks
Degree of hypertension	moderate or heavy	moderate or heavy
Proteinuria	missing	usually available
increase body weight	gradual	significant in a short time period of time
Serum urea blood more than 5.5g/l (0.33mmol/l)	rarely	there is practically always
Hemoconcentration	missing	present in severe degrees
Thrombocytopenia	missing	present in severe degrees
Hepatic dysfunction	missing	present in severe degrees
Ophthalmoscopic painting	arteriovenous crossovers, exudates	spasm, swelling
Myocardial hypertrophy left ventricle	Often	rarely

Treatment of preeclampsia

1. Delivery- the most effective and the only pathogenetically substantiated method of treatment.

With moderate preeclampsia, the pregnant woman should be hospitalized to clarify the diagnosis and carefully monitor her condition and the fetus, but it is possible to continue gestation up to 37 weeks. With a deterioration in the condition of the mother and fetus, delivery is indicated.
In severe preeclampsia, you must first stabilize the mother's condition, and then decide on delivery, preferably after the prevention of fetal respiratory distress syndrome, if the pregnancy is less than 34 weeks.

2. Antihypertensive therapy

Purpose of treatment- maintain blood pressure within the limits that maintain normal levels of utero-fetal blood flow and reduce the risk of developing eclampsia.

Antihypertensive therapy should be carried out, constantly monitoring the condition of the fetus, because a decrease in placental blood flow provokes the progression of functional disorders in it. The criterion for initiating antihypertensive therapy is BP ≥ 140/90 mm Hg. Art.

The main drugs used to treat hypertension during pregnancy:

Methyldopa (dopegyt)- antihypertensive drug of central action, α2-adrenergic agonist (first-line drug);
Nifedipine- calcium channel blocker (second-line drug);
β-blockers: metoprolol, propranolol, sotalol, bisoprolol;
According to indications: verapamil, clonidine, amlodipine.

3. Prevention and treatment of seizures

For the prevention and treatment of seizures, the main drug is magnesium sulfate (MgSO 4). The indication for anticonvulsant prophylaxis is severe preeclampsia if there is a risk of developing eclampsia. With moderate preeclampsia - in some cases, the council decides, because this increases the risk of caesarean section and there are a number side effects. The mechanism of action of magnesium is explained by a violation of the flow of calcium ions into the smooth muscle cell.

In addition, it is necessary to control the water balance, pay attention to the treatment of oliguria and pulmonary edema when they occur, normalize the function of the central nervous system, the rheological properties of blood, and improve fetal blood flow.

Forecast. Prevention

Today, up to 64% of deaths from preeclampsia are preventable.

The main factors of high-quality and timely assistance:

identifying women at high risk;
quality management of pregnancy until clinical complications of pregnancy;
adequate tactics after the clinical manifestation of an obstetric complication.

Unfortunately, today there are no sufficiently sensitive and specific tests that would provide early diagnosis/detection of the risk of developing preeclampsia.

Risk factors for developing preeclampsia:

1. antiphospholipid syndrome;

2. kidney disease;

3. history of preeclampsia;

4. forthcoming first birth;

5. chronic hypertension;

6. diabetes mellitus;

7. residents of highland areas;

8. multiple pregnancy;

9. cardiovascular diseases in the family (strokes / heart attacks in close relatives);

10. systemic diseases;

11. obesity;

12. history of preeclampsia in the patient's mother;

13. age 40 and older;

14. weight gain during pregnancy over 16 kg.

It has been established that preeclampsia is characterized by insufficient angiogenesis - the process of vessel formation. It involves about 20 stimulating and 30 angiogenesis-inhibiting factors, their list is constantly updated. The most studied and of particular interest from the point of view of studying the pathogenesis of preeclampsia are two proangiogenic factors: vascular endothelial growth factor (VEGF) and placental growth factor (PlGF), antiangiogenic factor - Fms-like tyrosine kinase (Flt-1) and its soluble form (sFlt -one).

An increase in the content of this sFlt-1 with a simultaneous decrease in VEGF and PlGF begins 5-6 weeks before the clinical manifestations of preeclampsia. This fact allows predicting the development of preeclampsia in women at risk in the first trimester of pregnancy. However, other researchers noted that despite the high sensitivity of the test (96%), the isolated determination of sFlt-1 cannot be used in the diagnosis of preeclampsia due to low specificity. Thus, detection of changes in the ratio of PlGF and sFlt-1 levels during pregnancy may play an important supporting role in confirming the diagnosis of preeclampsia.

Today, there are commercial kits that allow you to conduct an enzyme immunoassay to determine the likelihood of developing preeclampsia, based on the determination of the content of PlGF (DELFIA Xpress PlGF kit, PerkinElmer; USA), screening tests have been proposed to predict and early diagnosis pre-eclampsia based on the determination of the ratio of sFlt-1 and PlGF (Elecsys sFlt-1/PlGF, Roche, Switzerland).

Due to impaired trophoblast invasion, vascular resistance in the uterine artery increases and placental perfusion decreases. An increase in uterine artery pulse index and systole-diastolic ratio at 11-13 weeks of gestation is the best predictor of preeclampsia and is highly recommended for use in clinical practice in pregnant women at risk.

Due to the lack of comprehensive information on the etiology and pathophysiology of preeclampsia, the development of effective preventive measures presents certain difficulties.

Only proven acceptance today 2 groups of drugs for the prevention of preeclampsia:

Aspirin at low doses (75 mg per day) from 12 weeks before delivery. In this case, it is necessary to take the written informed consent of the patient, since according to the instructions for use, taking aspirin is contraindicated in the first trimester.

Pregnant women with low calcium intake (<600 мг в день) назначают calcium preparations- not less than 1 gr. in a day. The average calcium intake in Russia is 500-750 mg/day, and the current physiological daily intake for pregnant women is at least 1000 mg.

Doctors call preeclampsia a pathological condition that can occur in pregnant women. It worries 10% of women in the position.

With pathology, blood does not enter the placenta in the right amount. All the symptoms of the disease lead to the fact that the fetus receives an insufficient amount of oxygen and nutrients from the mother. This threatens hypotrophy and hypoxia.

Preeclampsia affects the health of the baby. The baby may have a low birth weight. Modern advances in medicine make it possible to overcome the negative impact of the disease. Therefore, most women in labor successfully cope with a dangerous pathology. They give birth to healthy babies.

Causes of pathology

Experts cannot accurately name the causes of such a pathology. It is likely that preeclampsia develops due to spasm of peripheral vessels. Presumable factors that negatively affect the body are the following:

malnutrition of a pregnant woman;
high levels of body fat;
poor blood flow in the uterus.

In addition, doctors identify risk factors that contribute to the disease:

first pregnancy;
the age of the pregnant woman is more than 40 years;
high blood pressure in a woman before pregnancy;
excess weight;
autoimmune diseases in women;
heredity (preeclampsia in the closest relatives);
multiple pregnancy;
kidney disease, diabetes, rheumatoid arthritis.

Associated symptoms and signs of the disease

Signs:

A clear sign of pathology is edema, which grows very quickly. In a pregnant woman, the hands and face are especially swollen. The woman begins to gain excessive weight.
The second symptom is high blood pressure.
In some women, biochemical parameters of the blood change and jaundice occurs.
Headache, abdominal pain, hyperreflexia, blurred vision.
Protein in urine and reduced amount of urine.
Nausea and vomiting.

Tests in a pregnant woman with preeclampsia can detect protein in the urine (proteinuria). This indicates pathological disorders. A pregnant woman is examined and treated.

Light degree

The pressure rises from 150/90 mm Hg. An increased number of platelets is found in the blood. Urinalysis shows the presence of protein up to 1 g / l. Pregnant women have swollen legs. Sometimes this disease occurs without any symptoms. Only after passing regular tests, a woman discovers a pathology. Therefore, while waiting for a child, you should not miss planned visits to the doctor. If a mild degree of preeclampsia is detected in time, then possible complications can be prevented.

Average degree

The pressure rises to 170/110 mm Hg. Art. The doctor detects protein in the urine (over 5 g/l). Symptoms of the disease become more pronounced than at the initial stage.

heavydegree

This is the most dangerous state. The pressure rises significantly. Protein in the urine increases. The woman suffers from a headache, which is localized in the forehead. She can flash in her eyes. Vision is disturbed, and pain occurs in the right side due to the swollen liver.

There are hematological disorders. The disease at this stage can develop into eclampsia - the most dangerous preeclampsia. It is accompanied by convulsions. Severe preeclampsia and eclampsia can threaten the health of mother and baby.

Proper condition diagnosis

If a pregnant woman is diagnosed with arterial hypertension (high blood pressure lasts more than 6 hours) and protein is found in the urine, then we are talking about preeclampsia.

Edema and pastosity confirm the diagnosis. If you experience unusual swelling in your face, arms, or legs, you should consult your doctor.

It should be noted that this disease does not have specific symptoms. Sometimes swelling and cramps occur for other reasons. Therefore, an accurate diagnosis can be made only after taking into account the totality of symptoms. Confirmation of the correctness of the diagnosis is the disappearance of symptoms after the birth of the baby.

Preeclampsia during pregnancy

This is preeclampsia, which has a characteristic clinical picture of damage to the nervous system. Most often it develops in the second half of pregnancy. But sometimes it occurs in the early stages. Statistics show that in recent years the frequency of this pathology has increased significantly. It usually occurs during the first pregnancy. With repeated pregnancies, such a pathology is detected less frequently.

Treatment regimen for preeclampsia

Treatment is determined by the doctor after examining the woman. It all depends on the severity of the pathology, as well as on the stage of pregnancy. Mild preeclampsia can be successfully managed at home. It is enough to observe bed rest. Experts advise lying on your back more often, which helps to reduce blood pressure.

In this case, the pregnant woman should be under the supervision of a doctor. She is undergoing ultrasound, constantly measuring blood pressure, cardiotocography and counting fetal movements. If there is no improvement, then they resort to drugs. Doctors prescribe drugs that reduce blood pressure. In addition, a woman should take magnesium sulfate.

If adverse symptoms continue to increase, then the question arises of a caesarean section or artificial induction of labor. In severe cases, the only solution is delivery. Doctors try to prolong the pregnancy as much as possible, but if the pathology endangers the life of the child or mother, then they resort to artificial stimulation of childbirth.

After the birth of a baby, a woman may experience postpartum preeclampsia, which lasts for several weeks. It can threaten the mother's life.

Emergency care for acute form

Dangerous symptoms in which a pregnant woman needs urgent medical attention:

arterial pressure rises significantly (more than 170/110 mm Hg);
oliguria;
violation of cerebral blood flow;
severe swelling;
strong mental or motor excitement or depression.

In such cases, the patient is urgently hospitalized. She is given sedatives beforehand to prevent convulsions. Pregnant women are usually given Relanium or Droperidol. In severe situations, hypnotics from a series of barbiturates are used. Short-term mask anesthesia is sometimes used before the introduction of sedatives. Specific actions of doctors depend on the severity of the patient's condition.

Complications of uterine prolapse have serious consequences, from the article you will learn how to prevent the development of the disease.