Gestoses of pregnant women

Description:

Gestoses — the complications of normally proceeding pregnancy which are characterized by frustration of a number of bodies and systems of an organism.

It is considered that the generalized vasospasm and subsequent changes connected with microcirculation disturbance, hypoperfusion, a hypovolemia is the cornerstone of a pathogeny.

Classification:

    * Early gestoses: vomiting and pernicious vomiting (excessive vomiting), hypersalivation
    * Late gestoses: edema, nephropathy, preeclampsia, Eclampsia
    * Rare forms of gestoses: diseases of skin, liver (jaundice of pregnant women), nervous, bone and other systems

Also allocate:

    * "pure" gestoses — arising for lack of background diseases, among full health.
    * the "combined" gestoses evolving from the previous disease (an idiopathic hypertensia, diseases of kidneys, endocrinopathies).

Symptoms of Gestoses of pregnant women:

Early toxicoses.

    * Vomiting and pernicious vomiting of pregnant women.

Carry vomiting of pregnant women which happens not only in the mornings, but also repeats several times a day, even after meal to toxicosis (gestosis). The nausea which is followed by vomiting appetite usually goes down, develops tendency to spicy and salty food. Despite vomiting of considerable decrease in body weight of the pregnant woman it is not observed. Pregnant women complain of weakness, irritability, drowsiness, sometimes of sleeplessness. The general satisfactory condition, temperature normal, pulse can be to 90 уд. in min. Vomiting is observed within the first 2-3 months of pregnancy, will easily respond to treatment or passes spontaneously. only at some women vomiting amplifies and gains character of pernicious vomiting. It is considered that at incubation of the first child early toxicosis is shown stronger.

    * Pernicious vomiting.

Vomiting repeats 20 and more times a day, it happens day and night. The body weight of the woman falls. There is a sharp weight loss, subcutaneously the fatty layer of an ischezayet.kozh becomes flabby and dry, language is laid over, from a mouth an unpleasant smell. There is a fastidium. Temperature is subfebrile, pulse to 100 — 120 beats per minute, the ABP goes down, in urine acetone and protein appears. At especially heavy current high temperature, icteric coloring of skin, sharp increase of pulse and arrhythmia is observed, delirium can develop.

    * Hypersalivation.

It is quite often observed at vomiting of pregnant women, but it can be shown in the form of independent toxicosis. The amount of the emitted saliva can reach 1 liter. The health of the pregnant woman worsens, there is sleeplessness, body weight goes down.

Late toxicoses.

Late toxicoses represent stages of development of uniform pathological process. The initial form — an edema, passes into more severe form — a nephropathy which passes consistently into a nephropathy, a preeclampsia and an eclampsia.

Reasons of Gestoses of pregnant women:

There is no consensus about a gestosis etiology now. However there is a number of theories:

    * The corticovisceral theory — is the cornerstone idea of a gestosis, as about a peculiar neurosis of pregnant women at which relationship between bark and subcrustal structures is broken. It leads to reflex changes in a hemodynamics. This theory is confirmed by frequent emergence of a gestosis at pregnant women against the background of psychological stresses. At EEG functional changes in subcrustal structures come to light.
    * Endocrine theory.
    * The immunological theory — consists in change of the mechanisms providing trasplatsentarny immunity. The essence of the theory is that in a placenta a number of the substances blocking mother's T-cells is produced. Recognition process by T-cells of antigenic distinctions between tissues of mother and a fruit is broken that leads to mother's sensitization placental proteins. The antigenic structure of a placenta is similar to tissues of kidneys and a liver that can be the reason of damage of these bodies at a gestosis. However not all scientists found cell-bound immune complexes in mother's blood.
    * The genetic theory — it is established that at daughters of women with a preeclampsia the gestosis arose by 8 times more often than in normal population. The autosomal and recessive way of inheritance is assumed.
    * The theory of avitaminosis In and folic acid. The need for vitamins of group B and folic acid increases in the third trimester. Intake of these vitamins C a daily diet becomes insufficient. As a result in blood concentration of a gomotsistein increases. Gomotsistein is extremely toxic for an endothelium. Under its influence in an endothelium of vessels there is time through which plasma goes to surrounding fabrics. There are hypostases. In response to decrease in OTsK the hypophysis excretes vasopressin which increases pressure in vessels and reduces a diuresis. This theory is confirmed by practice as appointment to women with a gestosis of vitamins B and folic acid in big dosages within a day leads to disappearance of hypostases, normalization of arterial pressure and the termination of a proteinuria.
    * Placental theory. Possibly, at the women suffering from a gestosis migration of a trophoblast in uterus vessels is broken. Spiral uterine arteries do not change the structure, remain in the same look, as at nonpregnant. Relationship in system a trophoblast — spiral arteries is broken, there is a spasm, decrease in an intervillous blood-groove and a hypoxia. The hypoxia in fabrics of an uteroplacental complex leads to defeat of an endothelium, disturbance of its vasoactive properties, release of the mediators directed to vasoconstriction. Long products of vasoconstrictors cause disturbances in a hemodynamics, TsNS, the hormonal status, a metabolism and acid — the main balance of an organism.

The generalized vasospasm is the cornerstone of a pathogeny that is shown by hypertensia. The spasm happens because of damage of an endothelium. (Damage of an endothelium is confirmed by increase in fibronectin level blood — a glycoprotein of a subendothelial origin.) At damage there is an emission in endothelin blood that leads to a vasospasm, including renal arteries and activation of system a renin — angiotensin — Aldosteronum, and also to emission of adrenaline and noradrenaline and reduction of the threshold of sensitivity to these mediators.

At the same time synthesis of vazodilatator decreases.

At the expense of a vasospasm, a hypoxia, reduction of anticoagulating properties of blood hypercoagulation and DVS develops. Also microcirculation is broken, permeability of a microvascular bed, transuding of plasma in an interstitium increases (that leads to hypostases at decrease in OTsK).

In many bodies there are hypoxemic (dystrophic) changes: the gestosis is almost always followed by a renal failure, function of a liver, a nervous system, placenta is broken. There is a fruit growth inhibition syndrome, a chronic hypoxia.

Treatment of Gestoses of pregnant women:

Prevention of gestoses.

Who enters into risk group?

    * Women who for the first time will become mothers;
    * expecting twin;
    * ladies after 35 years;
    * mummies with chronic diseases (vegeto-vascular dystonia, obesity, a diabetes mellitus, an idiopathic hypertensia or chronic pyelonephritis);
    * the having sexually transmitted infections (clamidiosis, mycoplasmosis, ureaplasmosis).

Women with hypostases, easy and average degree of a gestosis are treated in department of pathology of pregnant women. If a gestosis heavy and furthermore there are preeclampsia signs (a preconvulsive state) or the patient transferred an eclamptic (convulsive) attack, then treatment is carried out in intensive care unit of an intensive care. The plan of inspection usually includes:

    * blood tests (the general, biochemical, a koagulogramma – coagulability definition;
    * analyses of urine (the general, daily loss of protein, Zimnitsky's test);
    * assessment of a condition of a fruit (ultrasonography, kardiotokografiya and dopplerometriya);
    * Consultation of the therapist, oculist is obligatory, at severe forms of a gestosis – the neurologist.

Treatment consists in use of infusional therapy (droppers) which purpose – to fill a lack of liquid of a vascular bed and to bring her out of fabrics, and also to fill protein loss. If supertension, suitable hypotensive drugs select.

Duration of hospitalization depends on severity of a gestosis. At hypostases – about a week, and at a gestosis of easy degree – to two. The best treatment of a gestosis is a delivery as pregnancy, to be exact – the placenta becomes the reason of its development.

Therefore at inefficiency of treatment within 3 days at heavy degree of a gestosis and within 3 hours at a preeclampsia (at emergence of symptoms) do to the pregnant woman operation of Cesarean section.