Often during pregnancy, various pathological conditions occur. Gestosis is one of them. The disease in the early stages of pregnancy is called toxicosis. It is accompanied by intolerance to certain odors, nausea, vomiting, drowsiness and weakness, but does not pose a danger to the fetus and mother. Late gestosis can develop in the third trimester, at the time of delivery or after. With this disease, vital organs are affected: the heart, blood vessels, liver and kidneys, as well as the placenta and the fetus.
Causes of gestosis
Until now, doctors do not know the exact causes of gestosis. However, there is an opinion that the disease occurs against the background of high blood pressure, impaired liver and kidney function, and other somatic diseases in pregnant women. There are several theories that explain the formation of gestosis:
- Endocrine - during pregnancy, the heart and blood vessels are disturbed due to poor metabolism and insufficient blood supply to organs with nutrients. Such failures are a consequence of changes in the functioning of the endocrine system, which is responsible for the composition of the blood and vascular tone.
- Cortico-visceral - explains the disease by the development of neurosis in a pregnant woman. The cerebral cortex, thanks to conditioned reflexes, affects the state of internal organs, and this upsets the balance of inhibition and excitation in it.
- Placental - most likely the uterine arteries due to genetic and immunological features do not change their structure, as in the normal development of pregnancy, and they do not transform the muscle layer. As the fetus grows, spasm of the vessels occurs, leading to a decrease in blood flow and the occurrence of hypoxia.
- Immunological - an immunological mismatch occurs between the tissues of the fetus and the mother. As a result of this, the female body does not accept a foreign body or there is insufficient production of antibodies, which disrupts blood circulation and causes gestosis after childbirth.
- Genetic - the disease is often transmitted by inheritance. Studies have confirmed that fetal genes play a role in the development of gestosis.
With the disease, the heart function deteriorates, which means that the blood circulation worsens, its coagulability increases. Organs and tissues are no longer supplied with enough oxygen and nutrition. The lack of blood circulation affects the brain, liver, kidneys and placenta most of all. The fetus has oxygen starvation and its development is stopped, which gives rise to very serious consequences after gestosis.
Symptoms of gestosis
The disease can be asymptomatic for a long time. The clinical picture is characterized by special signs at each stage of the disease:
- Edema, or dropsy - there is swelling of the soft tissues in different places. There are four degrees: first - feet; the second - legs and stomach; the third - lower and upper limbs, abdomen, face; the fourth is the whole body.
- The appearance of protein in urine - there is a violation of the functioning of the kidneys, the daily urine norm decreases. During the study, protein is found in it, its rapid increase is a sign of the rapid progression of the disease.
- Increased blood pressure - a malfunction in the kidneys and swelling cause an increase in pressure. In severe cases, high blood pressure leads to loss of consciousness, hemorrhage, and the occurrence of postpartum gestosis is also possible.
- Preeclampsia - headaches occur, eyesight worsens, inadequate reactions appear, irritability (or indifference occurs), the condition may be sleepy, or, conversely, insomnia torments.
- Eclampsia is the most severe and dangerous stage of the disease, which can develop both before childbirth and after them. The condition is accompanied by seizures, convulsions. During this period, the functions of all organs and systems of the body are violated: severe renal failure, possible liver rupture, pulmonary edema, stroke or heart attack, placental abruption, fetal hypoxia, and premature birth are possible. Gestosis after childbirth can cause the death of the mother and baby.
Who is at risk?
No one is safe from gestosis, but its manifestation is most likely in the following female category:
- women in labor under the age of 18 and over 30;
- giving birth repeatedly;
- with multiple pregnancy;
- having a short break between pregnancies, when the body is weakened, gestosis can occur in the baby after birth;
- often aborting an artificial pregnancy;
- with a hereditary predisposition;
- with diseases of the kidneys, liver, cardiovascular and endocrine system.
The well-being of a woman carrying a child does not always indicate her health. Test results may indicate malfunctions in the body with external well-being. Specialists strongly recommend visiting a gynecologist regularly throughout pregnancy, so as not to miss serious complications.
Diagnosis of the disease
If suspected of gestosis, the doctor conducts the following activities:
- Medical history - during a conversation with a pregnant woman or a woman who has already given birth, the doctor listens to complaints, finds out all the ailments that the woman feels, specifies the time when the symptoms of the disease started, and whether the gestosis was in close relatives.
- Visual inspection - it is found out if there is swelling on the legs and body, blood pressure is measured, the pulse is felt, the heart sounds of the mother and fetus are heard.
- A general analysis and blood biochemistry are prescribed.
- A study of urine is carried out - a clinical, daily and biochemical analysis is taken.
- The fundus is checked.
- Constantly monitored pressure.
- Body weight is determined.
- Ultrasound and dopplerometry of the fetus are done.
Additional consultations of a therapist, neurologist, nephrologist, optometrist are prescribed. Based on the data obtained, a diagnosis is made and a course of treatment for preeclampsia is prescribed after childbirth or before.
Disease development
By the severity of the course and severity of manifestations, late gestosis is divided into three degrees:
- First, it is called dropsy. Mild initial manifestations in the form of edema spread throughout the body. They significantly increase the woman’s body weight in position, and often remain after childbirth. Edema appears on the extremities, gradually spreading to the stomach and face. They progress rapidly, increasing towards evening, and are poorly adjusted. Nephropathy joins dropsy. The kidneys stop functioning normally.
- The second - an increase in edema, the appearance of protein in urine, the further development of nephropathy, increased pressure are manifestations of severe gestosis. The body of a pregnant woman ceases to cope with the loads and disruptions in his work begin.
- Third, all processes gradually progress and an extremely serious state of gestosis sets in : preeclampsia and eclampsia. There is a damage to the nervous system, which threatens the life of the fetus and woman. A serious form of the disease is diagnosed by the following symptoms: urinary protein excretion of more than 1 g / l, urine daily volume is reduced to 400 ml, pressure reaches 170/110 and higher, severe swelling of the whole body, blood flow, blood clotting and fetal development are impaired, and it increases activity of liver enzymes. Urgent resuscitation and the birth of a baby are required, often with the help of an operation. In this condition, the child may develop gestosis after cesarean.
Gestosis treatment
The main areas of therapy include:
- childbirth;
- medical and protective regimen;
- postpartum gestosis treatment;
- restoration of the activity of internal organs.
The following medicines are used for pharmacotherapy:
- tincture "Valerian", "Motherwort", in severe conditions, antipsychotics and tranquilizers - "Droperidol", "Relanium" are shown.
- Medicines for relieving pressure - Amlodipine, Atenolol, Hydralazine.
- As an anticonvulsant drug, Magnesium Sulfate is used.
- Intravenous infusions are performed to replenish the volume of blood.
- Anticoagulants and antiplatelet agents - "Fraksiparin", "Curantil."
- Antioxidants - Essential, Vitamins E and C.
A mild disease can be treated for no more than ten days, an average of five, and a severe condition of six hours. In the absence of effect, an urgent delivery is prescribed, which is carried out naturally with a mild disease. The consequences of gestosis after childbirth in this case are minimal for both the fetus and the mother. In severe cases, a scheduled operation is prescribed. The occurrence of eclampsia and placental abruption requires emergency delivery by cesarean section. Further, pharmacotherapy lasts until the normal functioning of all body systems. An expectant mother is discharged from the hospital in one to two weeks.
Gestosis after childbirth
The disease during and after pregnancy is noted by three known symptoms: edema, protein content in urine, and increased pressure. Late toxicosis is always associated with pregnancy. He may be in the second trimester, and most often in the third. Gestosis is a pathological change during pregnancy associated with hormonal disruptions and various pathologies. The disease in a mild form, as a rule, has no consequences and preeclampsia after childbirth occurs in the first two days. The occurrence of the disease in 24–28 weeks requires an emergency caesarean section to save the life of the baby and mother. In case of late toxicosis in 30–32 weeks of pregnancy, the mother and baby suffer slightly.
A woman can give birth by herself or by surgery. After 34 weeks in the absence of health problems of the baby, childbirth can be natural. To prevent eclampsia, a woman is injected with drugs that lower blood pressure and anesthetize labor. Doctors monitor the duration of labor and uterine bleeding using the medication Oxytocin, which helps to reduce the uterus. After giving birth, the woman is placed - under the supervision of resuscitators - in the intensive care unit. To prevent eclampsia, “Magnesium sulfate” is prescribed and blood and urine are constantly taken for analysis, and blood pressure readings are monitored.
How to treat gestosis after childbirth?
Therapy of gestosis continues at home. High blood pressure can be observed for up to two months, so a woman should systematically monitor it and take drugs to reduce it. During the period of breastfeeding, it is recommended to take "Dopegit" and "Nifedipine." Over time, the pressure returns to normal. Drug withdrawal should be done gradually, by reducing the dosage and frequency of administration. In addition to high blood pressure, edema appears in women after childbirth. First of all, they form on the ankles. Over time, they pass. Worse, if there is an increasing swelling of the hands and face, these are signs of preeclampsia. It is urgent to visit a doctor who will prescribe the right treatment for preeclampsia after childbirth. It should be noted that about half of cases of severe convulsive seizures (eclampsia) occur in the first four weeks after childbirth. Often the disease occurs in women who have given birth on time. In this case, urgent medical attention is needed.
How is the birth?
The severity of the disease, the condition of the mother and child, affect the method of choosing the birth and the time of their delivery. The most favorable births are those that occur naturally. For them it is necessary: the absence of diseases in the mother, the proper diligence of the fetus and the proportions of the fetal head, pelvis, normal cervix, and the age of the woman in labor is no more than 30 years. Childbirth for a woman is a stressful condition, and with gestosis, women in labor are especially sensitive to pain, fatigue, so doctors use painkillers and antispasmodics. Otherwise, at any moment, a sharp jump in pressure may occur, which will lead to impaired brain activity and the occurrence of eclampsia. The disease occurs both during childbirth in a natural way and after surgery. The following complications are possible:
- fetal asphyxiation;
- postpartum haemorrhage;
- placental abruption.
Childbirth helps to get rid of a woman from gestosis. Sometimes for a premature baby a birth is the best option. Sometimes giving birth to a baby before the deadline gives him more chances to survive than to stay in the womb. In this case, doctors decide on an early delivery operatively or naturally.
What if the disease after childbirth does not go away?
Will late gestosis pass after childbirth? This question worries women who were discharged from the hospital, and they have the following symptoms:
- visual impairment;
- pain in the right hypochondrium;
- high blood pressure;
- headache;
- rare urination.
In this case, you should immediately consult a doctor. After eclampsia, a gynecologist or therapist will prescribe a CT scan of the brain, blood biochemistry. If urine contains protein up to two months after birth, you should seek the advice of a urologist and nephrologist. Gestosis will pass, but serious complications can remain after it, if you neglect treatment and strict adherence to all the recommendations of doctors.
The consequences of the disease for women
The consequences of gestosis for the mother after childbirth can manifest itself in the following:
- renal and liver failure;
- headache;
- hypertension;
- stroke development;
- impaired vision;
- brain damage;
- heart ischemia;
- severe postpartum hemorrhage.
With a new pregnancy, a repetition of the situation is possible.
Consequences for the child
Severe condition of the mother negatively affects the health of the baby. The most dangerous consequence is the fetal death of the fetus due to malnutrition and lack of oxygen as a result of damage to the placenta. But even after childbirth, the consequences of gestosis for a child are very serious. Children are very weak, have little weight, are often ill for a long time, and lag behind in development and growth. Due to mother’s illness, they are born prematurely, are not adapted to independent life, require special care and development assistance. Health problems in a baby can remain for life.
Indications for premature birth, regardless of gestational age
These include:
- seizures and eclampsia;
- premature placental abruption;
- rapid progression of the disease;
- retinal disinsertion;
- malfunction of the liver and kidneys.
Doctors try to have a quick and gentle birth using painkillers and sedatives. With gestosis after childbirth or cesarean section, the necessary treatment and careful monitoring of the state of health are prescribed for the woman and the baby. The treatment regimen is selected individually.
Caesarean section for gestosis
In case of a life threat to the fetus or woman and the inability to give birth, a cesarean section is used. This method is used for complicated gestosis, when the state of the woman in labor begins to deteriorate rapidly, and the child experiences oxygen starvation. The operation is performed using endotracheal combined anesthesia. They open the uterus and release the baby, if he has problems with breathing or circulation, conduct resuscitation. The woman is sutured and after surgery transferred to the ICU (intensive care unit), where she is injected with sedatives during the day and is constantly monitored for pressure, swelling, liver and kidney function. It is believed that the first two days with gestosis after cesarean are the most critical. During this period, severe complications can occur that threaten the health and life of the woman in childbirth. The child and mother are under the supervision of doctors until the normalization of health. After examination and a satisfactory condition, they are discharged from the hospital. When a child is born on time and in the absence of oxygen starvation, it will develop normally and not lag behind peers. Otherwise, various complications and disorders of mental and physical health are possible. Some symptoms last for two months, so treatment for gestosis after cesarean continues at home under the supervision of a medical professional.
Complications
Late gestosis is dangerous with serious consequences that can begin both during pregnancy and after the birth of a baby. The most common ones are:
- stroke;
- placental abruption;
- respiratory failure;
- retinal detachment;
- eclampsia and coma;
- hemorrhagic shock;
- acute renal failure;
- fetal oxygen starvation can occur with gestosis after cesarean section.
More rare forms complicating gestosis are:
- HELP syndrome - red blood cells break down, the number of platelets that affect blood coagulation decreases, in addition, the liver is disturbed. The disease is fleeting. The woman has head and liver pains, jaundice, vomiting. She loses consciousness, cramps are possible. Liver rupture occurs, the abdominal cavity is filled with blood, the placenta exfoliates. The death of the fetus and mother.
- Acute fatty hepatosis - often occurs during the first pregnancy. First, a woman is tormented by severe weakness, abdominal pain, nausea, weight loss, vomiting, itching of the skin. Subsequently, hepatic and renal failure appears, jaundice, severe edema, uterine bleeding develops and fetal death occurs. A woman may have a coma and a malfunction of the brain.
About contraception
After a gestosis, a woman is recommended not to become pregnant for at least two years, since time is needed to restore the body. Young parents should remember that even breastfeeding does not fully guarantee pregnancy protection. Menstruation may well occur after delivery in four weeks. But the cycle is still unstable, therefore it is not recommended to use the calendar method of contraception after severe gestosis. Hormonal tablets during lactation pass into milk, which is undesirable for a weakened baby. It turns out that barrier contraception in this case is the most optimal way. It must be remembered that until the bleeding stops, until the uterus contracts completely, vaginal contraceptives should not be used. Ointment and fatty basis of funds can enter the uterus. Gynecologists recommend using a condom during this period.
Recovery period
Effective recovery after gestosis is affected by proper nutrition, help of relatives and friends, normal relaxation, intimate hygiene. The main objective of the recovery period is to eliminate the malfunction of the kidneys and water-salt metabolism. These reasons reduce the ability to work of patients and are considered contraindications for subsequent pregnancy. Recovery is carried out in stages, depending on the severity of gestosis:
The first - conduct galvanization, ultrasonic exposure, microwave therapy. Physiotherapy improves renal hemodynamics, enhances their excretory ability.
How to treat gestosis after childbirth with a second degree of severity? Drug therapy is carried out using sedatives: tincture "Valerian", "Motherwort", "Corvalol"; antihypertensive drugs: "Dibazol", "Papaverine", "Eufillin"; medicines with a diuretic effect: Triampur, Hypothiazide. To increase the assimilation of drugs using collar galvanization.
The third - a complex of drugs used for the second degree of severity, is supplemented by the introduction of "Albumin" and "Rausedil."
Gynecologist's advice
Weakened by gestosis after childbirth, the woman’s body is prone to attach various infections, so a woman needs to restore her immune system and return to normal life faster. Gynecologists advise:
- observe genital hygiene: wash off after using the toilet with clean hands from front to back;
- do not use sponges and washcloths;
- for washing use baby soap;
- use individual towels for the chest and crotch;
- apply disposable pads;
- underwear must be made of simple fabrics, allow air to pass through well;
- sleep is recommended on the stomach to improve the outflow of discharge from the uterus;
- it is recommended to visit a gynecologist two weeks after discharge from the hospital;
- in the absence of bloody discharge, you can return to intimate life.
In addition to these recommendations, every woman should eat well, eat foods rich in vitamins and minerals.
Prevention of gestosis
It is impossible to cure gestosis, therefore, measures must be taken to prevent it. To do this, you need to visit a gynecologist in a timely manner, measure blood pressure, monitor weight gain, and take tests. Pregnant need to find time for daily walks in the fresh air. Eat more animal proteins, cottage cheese, vegetables, fruits, greens. With a predisposition to edema, drink herbal teas, cranberry juice. The diagnosis of gestosis obliges a woman to monitor her health with a vengeance. Specialists advise women to give birth before age 35 to reduce the risk of complications.