Gestosis is a complication of pregnancy, which is manifested by swelling of tissues, an increase in a woman’s blood pressure, and in severe cases can lead to convulsive seizures. Sometimes gestosis is also called late toxicosis. This pathology usually manifests itself at the end of the second or third trimester of pregnancy.
According to statistics, gestosis occurs in 7-20% of Russian women and ranks third in the list of causes of maternal mortality in the country (from 11.8% to 14.8%)1. Perinatal mortality with such a complication is 5-7 times higher than the average values.2
As you can see, gestosis is a rather serious disease, the symptoms of which many women, unfortunately, consider normal manifestations of pregnancy. The causes of gestosis have not been fully studied, but the widespread spread of this disease has allowed us to develop a reliable methodological basis for the timely detection of pathology.
CLASSIFICATION OF GESTOSIS
There are two main classifications of gestosis, the most relevant for Russian medicine.
Domestic distinguishes four forms of the disease, which can manifest separately or flow into each other: dropsy, nephropathy (impaired kidney function), preeclampsia and eclampsia (increased blood pressure, seizures, loss of consciousness).
In ICD-10, such violations are listed in paragraphs O10-O16.
SYMPTOMS OF GESTOSIS
Swelling of tissues.
Edema does not immediately manifest visually. Most often, in the initial stages, fluid retention in tissues is detected by weighing. But other manifestations are also possible: for example, a pregnant woman cannot wear her rings or shoes that fit her in size.
Weight gain exceeding the permissible norm.
Weight gain during gestosis is usually a consequence of edema. Body weight increases due to fluid. At the same time, obesity is a provoking factor for the development of gestosis, so the weight of a pregnant woman doubly requires careful monitoring.
It is considered normal to add 10-12 kg for the entire period of pregnancy. For women with a reduced body mass index, the gain may be 2-3 kg higher than this norm, with an increased BMI, it should not exceed 10 kg. Starting from the 28th week of pregnancy, the normal weight gain is about 350 g per week, but not more than 500 g.
Increased blood pressure.
High blood pressure (hypertension) is the main sign of developing gestosis. Pregnant women need to regularly measure blood pressure. At values above 140/90 mm Hg, medical consultation is mandatory.
In cases where blood pressure was constantly elevated before pregnancy, it is necessary to conduct careful monitoring of this and other parameters for determining gestosis. Compared with pre-pregnancy pressure, the risk zone begins on average with an increase of 30 mmHg systolic and 15 mmHg diastolic pressure (“upper” and “lower”, respectively).
Thirst, increased fatigue, decreased diuresis, a feeling of “heaviness” in the legs.
Headache, lethargy, drowsiness, “flies” in front of the eyes, pain in the stomach area. (Attention! These symptoms may indicate a pre-convulsive condition, in case of their occurrence, urgent medical consultation is necessary and, possibly, hospitalization of a pregnant woman.)
Proteinuria (loss of protein in the urine).
EDEMA: PATHOLOGY OR NORM?
Most women “in the old–fashioned way” are of the opinion that edema is a normal phenomenon during pregnancy. In some cases, a woman does not even consider it necessary to inform the attending physician about this symptom.
Indeed, fluid retention may not be a manifestation of gestosis, however, with increased swelling, it is necessary to pay increased attention to the analysis of urine and blood pressure.
The fact is that the accumulation of fluid in the tissues can be caused by vascular damage. The liquid flows through small “holes” into the tissues, which manifests as edema. If you use diuretics (diuretics) at the same time, you can aggravate the situation, since there is already very little fluid in the vessels. It is because of the lack of fluid that the body increases blood pressure. That is, the use of diuretics can bring blood pressure values to a critical level and even provoke a convulsive seizure.
We draw your attention to the danger of self-medication! To eliminate puffiness, diuretics can be used: both soft natural (decoction of lingonberry leaves, rosehip tea, cranberry juice) and stronger medicines. The first ones can be used independently, but you should definitely inform your doctor about it. But we strictly do not recommend “prescribing” any pills to yourself.
Remember that edema during gestosis affects not only the limbs, but also the internal organs. In particularly severe cases, placental edema (and, accordingly, fetal hypoxia) or its detachment are possible.
DIAGNOSIS OF GESTOSIS
Since most of the symptoms of gestosis are individually manifested in almost all pregnant women, diagnosis involves constant monitoring of all factors that may indicate this disease. The combination of the two symptoms already indicates an increased danger.
To prevent severe forms of gestosis, the following clinical studies are conducted:
blood test (general, biochemical, additionally – liver tests);
urine analysis (general, including determination of the amount of protein, additionally – according to the systems of Zimnitsky and Nechiporenko);
blood pressure monitoring;
control of the dynamics of changes in body weight.
In case of suspicion of gestosis, additional tests are carried out:
ophthalmological examination (the condition of the fundus is being studied);
consultation of a therapist;
consultation with a neurologist;
consultation of a nephrologist;
dopplerography and ultrasound (to determine the level of placental blood flow).
WHICH DOCTOR SHOULD I CONTACT FOR SYMPTOMS OF GESTOSIS
First of all, you should state your complaints to the gynecologist who is leading your pregnancy. In the event that you do not trust the specialist enough, it is possible to consult with another doctor of the same profile (provide him with the data established during the previous examination). Be responsible, do not diagnose yourself and do not prescribe treatment yourself.
In addition, you can consult with a therapist. Consultations of other specialists are required only in a special direction.
TREATMENT OF GESTOSIS
Treatment of gestosis is carried out in a hospital. Lighter forms are treated in the department of pathology of pregnant women, severe forms are treated in the intensive care unit and intensive care unit.
Droppers are used to restore fluid balance. In addition, it is necessary to make up for the loss of protein. In case of high blood pressure, antihypertensive drugs are used.
If medication is ineffective for 3 days or there is a 3-hour preeclampsia, a cesarean section may be performed.
