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Late Toxemia of Pregnancy (Preeclampsia)

What is the late toxemia of pregnancy?

Late toxemia (preeclampsia) pregnant - is a pathological condition that occurs in the second half of pregnancy and is accompanied by a variety of disorders of the nervous system until the development of seizures, cardiovascular and endocrine systems, hemostasis, and other systems, which may lead to adverse outcomes for mother and fetus. But most often manifested by a triad of symptoms: edema, proteinuria, hypertension.
The frequency of 7-16%. The system allows medical examination of women hospitalized in the department of pathology of pregnancy at the first signs of the disease. However, due to the wear of the clinical manifestations are often observed in recent years in this complication, there are cases of seizures (eclampsia), and other severe clinical signs of toxicity outside the hospital.

Risk of developing late toxicity (preeclampsia)

1) pregnant women with extragenital pathology (kidney disease, hypertension, chronic nonspecific lung diseases, endocrinopathies, etc).;
2) pregnant women with obesity;
3) pregnant women with heart disease;
4) pregnant women who have had late toxicosis in previous pregnancies;
5) The age of the woman (aged 30 years or younger than 19 years)
6) multiple pregnancy (twins, triplets, etc.)
7) anemia of pregnant women;
8) intrauterine fetal malnutrition (growth retardation)
9) sensitization by the Rh factor or group of blood
10) If a pregnant woman has an occupational hazard.

Forms and manifestations of the disease

Allocate typical and atypical forms of late toxemia (preeclampsia).

The typical forms include: dropsy, nephropathy I, II, III degree, pre-eclampsia, eclampsia. These forms are considered as different stages of the same disease process.

By atypical include: monosemeiotic nephropathy with hypertension, nephropathy, with the presence of two symptoms, eclampsia without convulsions.

Edema characterized by the appearance of the symptoms of edema, which often have a common character: on the lower and upper extremities, the abdominal wall, in the form of puffiness or swelling of the face. Hydrops is the initial form of late toxemia of pregnancy. The general condition of the pregnant with edema is not broken, and only in those cases where the swelling are severe, there are complaints about the heaviness, fatigue, increased thirst. Blood pressure is within the normal range or slightly below it. Dropsy pregnant in 20-24% of cases becomes nephropathy.

Nephropathy often combines the presence of three symptoms of edema, hypertension, proteinuria (the appearance of protein in the urine). Unlike dropsy pregnant nephropathy main symptom is not swelling, and hypertension, which in severe cases can reach 200/150 mm Hg. Art. and even higher. The degree of nephropathy is defined by a special scale Savelevoj. The scale describes the state of pregnant at the time of the inspection.

Pre-eclampsia refers to more severe forms of late toxicosis. Amid the three symptoms (edema, proteinuria, hypertension) there are new signs: headache, dizziness, feeling of heaviness in the forehead and nape of the neck, insomnia, lethargy, confusion, blurred vision ("veil" in front of his eyes, flashing, "flies", sometimes loss of vision), tinnitus, the symptoms of indigestion and liver - nausea, vomiting, abdominal pain.

Any stimulus can lead to eclampsia (convulsive seizure) - a loud noise, bright lights, and pain. Eclampsia is the most severe form of preeclampsia. Is rare. It is twitching with loss of consciousness. It has 4 stages

Stage 1 - lasts about 20-30 seconds and is characterized by facial twitching (facial) muscles.

2 stage - and lasts for about 20-30 seconds and is characterized by tonic (prolonged muscle contractions that result in limb "freeze" in flexion or extension, the patient's body is pulled, throws back his head back or brought to the breast) until convulsions and respiratory arrest biting tongue.

3 stage - less than 2 minutes and is characterized by clonic (successive reductions flexor and extensor muscles, which manifests rapid involuntary movements of the limbs and trunk), convulsions, breathing while impaired, develops cyanosis (bluish skin color), there is a frothy saliva from mixed with blood.

4 stage - begins with a deep breath, and is characterized by a gradual recovery of breath, the mind can still missing.

Complications of late toxemia (preeclampsia)

1) heart failure
2) pulmonary edema;
3) acute renal failure
5) coma;
6) premature detachment of placenta;
7) the development of placental insufficiency:
- Acute and chronic hypoxia
- Intrauterine fetal development
- Premature birth.
- The development of HELLP syndrome: hemolysis of red blood cells, degeneration of the liver cells, thrombocytopenia.

Treatment of preeclampsia

The treatment depends on the form of preeclampsia.

Treatment of hydrocephalus pregnant produce more often in outpatient prenatal.

All other forms of preeclampsia require treatment in a hospital pathology department pregnant or maternity hospital intensive care unit.

Indications for cesarean section in late toxemia (preeclampsia)

1) eclampsia;
2) pre-eclampsia and severe nephropathy in the absence of the effect of intensive care within days;
3) coma;
4) anuria (absence of urine, which usually indicates the development of acute renal failure)
5) detachment of the retina;
6) bleeding in the retina of the eye;
7), bleeding in the brain or spinal cord.
8) A combination of preeclampsia with comorbidities: PONRP (premature detachment of placenta), large fruit, narrow pelvis, abnormal labor, lack of effect of induction of labor, acute hypoxia, breech fetus.

What can you do?

This is necessary at the first suspicion of pregnancy to be registered in the antenatal clinic. The best results are always gives a preventive approach to any medical problem. Be sure to inform the board doctor about chronic diseases (if any).

It is desirable to be observed during pregnancy in a gynecologist. Then he will know all about the health status of the flow of previous pregnancies, concomitant diseases, such as leaking this pregnancy. This will help in time to suspect late toxicosis and prevent its complications.

What can a doctor do?

Late toxicosis is set by fluid retention: excessive weight gain, edema, increased blood pressure, seizures. In case of late toxicosis in the urine protein is detected. Optometrist during the inspection notice changes in the fundus and decreased visual acuity.

Therefore, the extreme importance is the systematic and thorough monitoring of pregnant for the timely detection of early signs of preeclampsia. To do this each time you visit a pregnant consultation is necessary:

1) weigh it (preferably at the same time and in the same clothes)
2) to measure blood pressure in both arms;
3) to carry out research of urine.