1. Treatment of preeclampsia. Prevention of attacks of eclampsia. Relieving attacks of eclampsia.
3. Indications for caesarean section for gestosis. Tactics of labor management in women with gestosis. Postpartum period with gestosis.
4. Premature birth. Definition, classification of premature birth.
5. Frequency (epidemiology) of premature birth. Causes (etiology) of premature birth.
6. Pathogenesis (development) of premature birth. The mechanism of action of bacteria in causing premature birth.
7. Clinical picture (clinic) of premature birth. Threatened premature birth. Beginning, beginning premature labor. Course of premature birth.
8. Diagnosis of threatening and beginning premature labor. Baumgarten tocolysis index.
9. Transvaginal ultrasound examination for premature birth. Biochemical markers of infection. Fruit fibronectin.
10. Tactics for managing premature birth. Conservative wait-and-see tactics.
Treatment of eclampsia must be carried out together with a resuscitator in the intensive care unit with monitoring of the condition of vital organs.
During attack of eclampsia the patient is kept from possible injuries and bruises, falls, the head is turned to the side so that the patient does not bite her tongue, a spatula or mouth dilator is inserted, the tongue is grabbed with a tongue holder and pulled forward, freeing the airways, and the contents of the upper respiratory tract are aspirated if necessary. During pregnancy, after an attack of eclampsia, assisted ventilation with a mask is started or the patient is transferred to mechanical ventilation. Sibazon (seduxen) - 4 ml of a 0.5% solution, droperidol - 2 ml of a 0.25% solution, or diprazine - 2 ml of a 2.5% solution or promedol - 1 ml of a 2% solution - are administered intravenously.
For relief of ongoing attacks of eclampsia carry out short-term inhalation of fluorotane in combination with nitrous oxide and oxygen in a ratio of 1:1 or 2:1 using a mask method. In order to relieve attacks of eclampsia, it is possible to use barbiturates: hexenal, sodium thiopental (on average 250 mg as a 1% solution intravenously). The therapeutic and protective regimen can be carried out by repeated administration of seduxen or diprazine in reducing doses.
Indicated during pregnancy emergency delivery by cesarean section, which is part of the complex treatment of gestosis.
With the development of eclampsia during childbirth, depending on the readiness of the birth canal, the woman is delivered by caesarean section or by applying obstetric forceps (extraction of the fetus during breech presentation).
In the postpartum period, after restoration of spontaneous breathing, anticonvulsant therapy is carried out and oxygen is prescribed.
Intravenous drip administration of magnesium sulfate is indicated.. The first dose should be a shock dose (at the rate of 5 g of dry matter per 200 ml of rheopolyglucose); this dose is administered intravenously over 20-30 minutes under blood pressure monitoring. Then the administration is carried out at a rate of 1-2 g/h under the control of blood pressure, respiratory rate, knee reflexes, and diuresis.
When HELLP syndrome develops during treatment of preeclampsia it is necessary to carry out plasmapheresis, transfusion of fresh frozen plasma, correction of hemostasis, and the use of immunosuppressants.
Eclampsia most often develops at the end of pregnancy (44%), less often during childbirth (33%) and the postpartum period (23%).
Development of a seizure in pregnant women should be considered as eclampsia with subsequent differential diagnosis.
After an attack of eclampsia the number of respirations increases to 50 per minute, it can be difficult (wheezing), cyanosis is often observed. Usually there is reduced diuresis (anuria), proteinuria, and hemoglobinuria.
After an attack of eclampsia Pulmonary edema may develop, caused by aspiration pneumonitis or heart failure caused by infusion therapy.
Due to an attack of eclampsia cerebral hemorrhage may occur, which is manifested by hemiplegia. It is most often observed in older women with chronic hypertension, ruptured aneurysms or arteriovenous abnormalities. A comatose state may be due to cerebral edema, which can be confirmed using nuclear magnetic resonance. The cause of death may be brain damage, or the cause of vision loss may be retinal detachment. The prognosis is usually favorable, vision is restored within a week (Cunningham F.J. et al, 1995). Less commonly, eclampsia is accompanied by psychosis, which lasts from several days to 2 weeks; the prognosis is usually favorable.
Maternal mortality due to eclampsia, according to C.R. Leitch et al. (1997), is 3.9%, perinatal mortality is 168.7%.
Eclampsia Study Group(Eclampsia Trial Collaborative Group, 1995) on a large sample (1687 women) conducted a comparative assessment of the frequency of recurrence of eclampsia attacks during treatment with magnesium sulfate, diazepam and phenytoin. When using magnesium sulfate, repeated attacks were observed in 5.7-13.2%, when using diazepam - in 27.9%, when prescribing phenytoin - in 17.1% of cases.
Maternal and perinatal mortality when using magnesium sulfate and diazepam was almost the same, there were no differences in the frequency of induced labor and cesarean section.
In a comparative evaluation of the use of magnesium sulfate and phenytoin, it was found that maternal mortality was 2 times lower when magnesium sulfate was prescribed (2.6 and 5.2%, respectively). Newborns treated with magnesium sulfate by the mother were less likely to require intubation and intensive care.
Occurs in women at the end of pregnancy or during activity. This is the most extreme degree of manifestation of complications that arose during. It is characterized by a disorder in the functioning of certain systems and organs -.
What is eclampsia
Eclampsia is the most severe form of gestosis in a critical form, accompanied by convulsions, loss of consciousness and a state of coma, called post-eclamptic.
The rapidity of development of these conditions gave the disease its name. "Eclampsia" is a Greek word meaning "lightning flash." 
The pathology is dangerous because there is a high probability of occurrence severe complications, For example:
- cerebral hemorrhage;
- premature placental abruption;
- pulmonary edema;
- liver and kidney failure;
- fetal death.
The diagnosis is made based on the clinical picture and results. Treatment consists of providing the patient with rest, stopping seizures, restoring vital functions and maintaining them. Eclampsia is direct to women.
Important! The form that develops in the absence of seizures is fraught with cerebral hemorrhage.
Did you know? Cases of preeclampsia are not that rare; it occurs in approximately 5% of pregnant women. From this group, one out of two hundred patients suffers a complication in the form of eclampsia, and may well die if they do not receive qualified medical care.
As a rule, eclampsia is preceded by nephropathy or preeclampsia, which cannot be treated. Non-compliance by a pregnant woman simple rules: doctor’s appointments, eating and resting, conservation bad habits play a role in the development of the condition. The risk group includes:
- too young primiparas;
- women of Balzac age (), carrying their first child;
- patients who have:
- arterial hypertension;
- glomerulonephritis;
- gastritis;
- colitis;
- systemic lupus erythematosus;
- rheumatoid arthritis;
- The risk group also includes patients:
- having toxicosis in previous pregnancies;
- those whose mothers or other close relatives also had eclampsia or preeclampsia.
Clinical forms
Eclampsia has three clinical forms.
- Typical. It is characterized by the fact that it is characterized by extensive subcutaneous tissue and tissues that make up the internal organs, in addition, intracranial and blood pressure increases, and the protein content in the urine increases greatly.
- Atypical. It develops more often during prolonged labor and is characterized by cerebral edema; the subcutaneous tissue does not swell. There are symptoms of increased intracranial and blood pressure; There is no protein in the urine, especially in the first stages.
- Uremic. This is a form of eclampsia in pregnant women, the basis of which is the presence of a disease such as nephritis in the patient, which was previously present or developed during pregnancy. Swelling of the fiber and organ tissues is weakly expressed, which indicates the failure of the connective tissues that serve as a barrier. Free fluid accumulates in the amniotic sac, chest or abdominal cavities. The liver undergoes degenerative changes, including hemorrhages and necrosis. It is renal-liver failure that causes severe general intoxication of the body, depression nervous system, high blood pressure, sometimes jaundice.
Depending on the moment at which the development of eclampsia occurs, they distinguish three varieties:
- Developing during pregnancy - from 75 to 85% of all episodes.
- In childbirth, namely during the birth act - from 20 to 25%.
- Postpartum, which can occur in the next day, less often - two days - ranges from 2 to 5% of cases.
According to clinically manifested characteristics, eclampsia is divided into:
- renal - the presence of convulsive syndrome and falling into a coma when urine does not enter the bladder;
- cerebral - the main symptom is a jump in blood pressure;
- hepatic - a metabolic disorder, a decrease in protein levels in the blood, a pathological change in the inner layer of blood vessels.
Symptoms and course of the disease
As a rule, preeclampsia precedes the development of eclampsia. Its characteristic features:
- head ;
- nausea;
- visual impairment;
- pain in the area;
- excitability;
- convulsive readiness.
Typical for eclampsia is loss of consciousness and seizures. Features of seizures characteristic of the disease:
- within 15-30 seconds, the facial muscles contract finely;
- they are replaced by a spasm of the skeletal muscles - tonic convulsions lasting for 15-20 seconds;
- Finally, convulsions of the muscles of the limbs and torso occur.
Did you know? The patient of obstetricians-gynecologists is a woman; in case of danger, the doctor does not face the ethical task of choosing whom to save-mother or child. The mother's life always comes first.
The seizure may be a single seizure, or a series of seizures may occur; they may be accompanied by the following symptoms:
- short-term episode of apnea;
- cyanosis;
- pupil dilation;
- tongue biting;
- foaming from the mouth.
The convulsions last about 2 minutes, after which a coma occurs. Consciousness is gradually restored if no new attacks follow. In some cases, the patient cannot come out of a coma. An attack can be triggered by:
- bright light;
- sudden loud sound.
The disease may develop suddenly during birth process, if the nature of labor is not sufficiently anesthetized or the nature of labor is difficult: a narrow pelvis in the woman in labor, excessive labor, its hyperstimulation. After surgery, the risk of eclampsia exists if the patient is extubated before independent function has been restored.
Important! The further prognosis depends on the number and duration of attacks and the duration of the coma.
The disease is manifested by the following symptoms:
- impairment of consciousness or loss of consciousness;
- visual impairment, a sign of which is “spots” flashing before the eyes;
- persistent increase in pressure;
- convulsions;
- swelling;
- headaches and pain under the right lower rib;
- blockage of blood vessels - thrombosis;
- nausea;
- increased excitability.
Eclampsia is characterized by the following manifestations:
- cerebral circulatory disorders and swelling;
- hemorrhages in the brain and membranes of the brain;
- liver and kidney failure;
- disorder of the endocrine and nervous systems.
Diagnostics
Diagnostic value There is no traditional examination of pregnant women: examination, Doppler, since the condition of eclampsia is acute and it develops suddenly and rapidly. Diagnosis of this disease is based on recording typical clinical manifestations, observation of which allows us to distinguish the form of gestosis in question from other brain lesions.
A typical circumstance is that eclampsia is associated with pregnancy and occurs closer to the third trimester, during or immediately after childbirth. The condition is preceded by severe gestosis and symptoms inherent in preeclampsia.
Important! The aura, that is, the warning symptoms characteristic of epilepsy, is absent in the case of eclampsia.
X-ray allows you to exclude pulmonary edema, computer and magnetic resonance imaging - assess the condition of the brain.
Diagnosis of the disease consists of the following procedures and activities.
- The doctor analyzes complaints and anamnesis of the disease - the time of onset of headaches, blurred vision and consciousness, increased blood pressure, swelling and similar symptoms.
- History of the patient’s life - what diseases have been suffered, surgical operations performed, injuries suffered, whether there are pathologies of the body systems: urinary, respiratory, vascular.
- Family history - the presence of gestosis during pregnancy in close relatives.
- Obstetric and gynecological history - number, course, features and complications of previous pregnancies and.
- Visual examination of the patient - the presence and location of edema, its severity.
- Control of blood pressure, since severe hypertension is an invariable companion and precursor to eclampsia.
- Monitoring the condition of urine and blood.
- Ophthalmological examination of the fundus.
- Ultrasound at the required time or as prescribed by the doctor.
First aid
First aid for developing eclampsia consists of: next events:
- Call an ambulance immediately.
- Lay the patient on her left side on a flat surface.
- Inserting a mouth speculum or a spoon wrapped in gauze into her mouth between the molars.
- Capturing the tongue and bringing it out, if there is a tongue holder.
- Covering a woman with blankets or pillows to protect her from injury.
- Removing foam, vomit and mucus from the mouth with a napkin moistened with a solution at the end of the attack.
- Performing closed cardiac massage in case of cardiac arrest.
Important! Cardiac massage, other resuscitation measures, as well as the prescription of ANY medications can only be performed by specialists who are performing medical duties and are responsible for the patient.
Upon rendering the first first aid the patient should be transported to the intensive care unit using a stretcher positioned so that the upper half of the body is elevated. 
How is the treatment carried out?
If a pregnant woman develops eclampsia, she should be taken to the hospital as quickly as possible, where she will receive emergency medical care. She is placed in an individual room to prevent exposure to extraneous irritants and is examined under general anesthesia. The ambulance mobilizes the main veins, catheterizes the bladder, and aspirates the gastric contents.
Treatment of eclampsia in pregnant women is carried out according to the following algorithm:
- They stop seizures and provide their prevention.
- Delivery is carried out as soon as possible.
- The gynecologist and resuscitator constantly monitor the condition of the woman and child.
- Restore vital functions of body systems.
- Normalizes blood pressure.
- They provide oxygen therapy - treatment with oxygen.
- Complete rest is prescribed.
Important! During a convulsive attack, resuscitation measures are indicated.
During the development of the disease, the patient’s condition must be monitored using hardware monitoring of blood pressure, heart rate, electrocardiography, and electroencephalography.
Using laboratory tests, platelet counts, electrolytes, hemoglobin, acid-base status, and blood gas composition are monitored.
Diuresis is monitored hourly using bladder catheterization. 
To saturate the blood with oxygen, long-term ventilation of the lungs is carried out, the following is administered:
- Magnesium sulfate drip - lowering blood pressure and preventing seizures.
- Dextran solution - normalization of blood properties.
- Glucose - improves metabolic processes in the brain.
- Diuretics - removal of edema.
To prevent recurrence of attacks, sedatives or narcotics are prescribed.
Women who have had eclampsia need rehabilitation, which consists of:
- monthly examinations by a therapist and gynecologist;
- taking tests;
- carrying out symptomatic treatment of blood vessels, kidneys, the state of the central nervous system and pressure;
- reception of the complex and;
- diet;
- The minimum period of contraception is 3 years.
Important! In severe forms of eclampsia, it is necessary to involve “narrow” specialists: a neurosurgeon or neurologist.
Childbirth with eclampsia
Eclampsia is a direct indication for termination of pregnancy, which is performed in the coming hours after the convulsive syndrome has stopped, blood pressure has normalized and the patient’s electrolyte and fluid balance has been restored to the maximum possible extent.
Did you know? Caesarean section is a very ancient operation. There is a legend that Julius Caesar himself was born in this way, after which a law appeared requiring that a child be removed from the womb of a deceased pregnant woman in this way. Ancient Chinese engravings confirm the considerable age of the manipulation. In them, the woman being operated on was depicted as alive, although, of course, many women died from such an intervention, but at least the child was saved.
The absolute indication for caesarean section eclampsia is not. On the contrary, it is preferable natural childbirth through the birth canal. 
Caesarean section is performed in case of:
- unsuccessful attempts to induce labor;
- placental abruption.
Complication and consequences
Eclampsia is a very dangerous condition that can be fatal if caused by:
- pulmonary edema;
- cerebral hemorrhage;
- suffocation;
- disruption of the activity of the heart muscle.
After the seizures end, the following often occurs:
- renal failure;
- pneumonia;
- psychosis;
- memory impairment.
Eclampsia occurring before the expected delivery date leads to premature birth. However, children born at term are also not insured against signs of immaturity:
- lethargy;
- decreased muscle tone;
- decreased immunity;
- sluggish or absent sucking reflex;
- thermoregulation disorders;
- problems of the body systems: digestive, vascular, excretory.
Important! Fetal death during an attack cannot be ruled out.
Prevention
To prevent the extreme form of gestosis - eclampsia, it is necessary to prevent the development of late toxicosis during pregnancy, as well as promptly identify and treat dropsy, nephropathy and preeclampsia.
To prevent this condition, which is dangerous to the health and life of the woman and fetus, as much as possible the following is required:
- Regular visits of the expectant mother to the gynecologist.
- Registration at the antenatal clinic before 12 weeks.
- Daily monitoring and, if necessary, normalization of blood pressure in pregnant women with arterial hypertension.
- Control of urine analysis in order to detect or not detect protein in it.
- Identification and timely treatment of manifestations of gestosis.
- Timely normalization of central nervous system functions if indicated.
- Rational.
- Moderate.
- Lack of emotional and physical stress.
- Sufficient.
- Competent pregnancy planning.
The more time at the time of development of the disease remains until the date of expected birth, the more severe it is and the worse the prognosis for the woman and the fetus. The most dangerous is the recurrent form; the most favorable prognosis is for eclampsia, which began close to the resolution period.
The uremic atypical form leaves little hope for favorable prognosis, because with its development, damage to internal organs is most severe. It is also “famous” for cerebral hemorrhages, which most likely leads to a sad outcome. It will take a very long time to restore the functions of the affected organs.
This form most often recurs both during the current and subsequent pregnancies, representing a huge and very likely danger for both organisms - the mother and.
Medicine, unfortunately, is not able to save a woman from the likelihood of developing eclampsia, but she can help cope with it, if, of course, the woman takes care of it herself. The sooner she sees a doctor and gets registered, the more diligently she follows the recommendations and the sooner she ends up in a hospital at a dangerous moment, the more favorable the prognosis will be for her and the child.
Eclampsia and preeclampsia - causes, symptoms, consequences - in pregnant women Stars flashed before their eyes. My head ached in the temple area. appeared in the body. Somehow I felt unwell and had a strange feeling in my stomach. The baby suddenly became quiet. On the display of the measuring device the numbers 160 to 100 are frozen. Lie down, lie down, maybe it will go away little by little. Under no circumstances should you waste time. Only an immediate emergency call can save the baby and the woman, because eclampsia spares no one.
Eclampsia: what is it?
- pain in the upper abdomen.
2. Objective manifestations or what the doctor will notice
During each standard examination at the antenatal clinic, the doctor checks weight gain, blood pressure and the presence of edema. Among the tests, a general urine test taken the day before is evaluated. Using these data, it is possible to identify manifestations of gestosis and preeclampsia:
- - increased blood pressure;
- pronounced weight gain;
- presence of tissue swelling;
- the appearance of protein in the urine.
Even if there is a woman’s subjective sensations and high blood pressure, it is necessary to call an ambulance and provide emergency assistance to the pregnant woman. If there is swelling and protein in the urine, then this further aggravates the severity of gestosis.
Eclampsia: how does it manifest?
One of the most life-threatening complications during pregnancy for the mother and fetus is manifested by all the symptoms of preeclampsia, which are accompanied by loss of consciousness and convulsive syndrome, expressed as an attack of convulsions at a period of more than 20 weeks in the absence of epilepsy in the woman before pregnancy. As a rule, this extreme version of pregnancy complications occurs in cases where a woman is not seen in the antenatal clinic and is extremely irresponsible towards herself and her baby.
Preeclampsia and eclampsia: what are the complications?
1. From the fetus
The first thing you need to understand is that the baby suffers very much in this situation. In fact, an increase in blood pressure is a spasm of all blood vessels in the body. The blood that carries oxygen to the child stops flowing to him. The baby experiences severe oxygen starvation, which could cause:
- — fetoplacental insufficiency and fetal hypoxia;
- threatening fetal asphyxia;
- intrauterine death.
2. Mother's side
The organs and systems of a pregnant woman during acute vascular spasm experience no less oxygen. Depending on where in the body blood circulation is disrupted, the following serious complications can be identified:
- — disturbance of cerebral blood flow with the development of stroke;
- visual impairment up to retinal detachment;
- change in blood flow in the region and lungs with the development of cardiac and respiratory failure;
- impaired liver function with the occurrence of jaundice, destruction of liver cells and the development of liver failure;
- changes in kidney function, leading to renal failure and a sharp decrease in the amount of urine produced;
- disruption of blood flow in the placenta, which causes premature placental abruption and bleeding from the uterus;
- the development of total intravascular coagulation, which will cause the formation of blood clots anywhere in the body.
Any of these complications can lead to severe pathology and death of the woman, which is why it is so important to notice and respond to the minimal symptoms of preeclampsia in time.
Preeclampsia and eclampsia: what are the tactics?
1. Help before the obstetric hospital
If a pregnant woman, while at home, feels a headache or spots appear before her eyes, then her blood pressure should be measured. For any readings exceeding the norm (120 to 80), you must call an ambulance. You don't need to take a blood pressure pill. This will be lost time, which is so necessary to save health and life.
If a woman comes to an appointment at the antenatal clinic with complaints, and the doctor finds it, then the woman will not be allowed to go home. A resuscitation ambulance team will be called. Before emergency help arrives, a woman with preeclampsia should be provided with strict bed rest and treatment aimed at lowering blood pressure. A team of resuscitators will provide emergency care on the spot, then on a stretcher (a pregnant woman with preeclampsia must absolutely not be moved to an upright position or led to the car with her legs) taken to the intensive care unit and taken to the perinatal center.
If convulsions suddenly begin, then, regardless of who is next to the woman, the following measures must be taken:
- — immediately call emergency medical assistance;
- try to protect the woman as much as possible from injury and damage, without actively trying to restrain her;
- turn the woman to the left to prevent the tongue from retracting with breathing problems and vomit getting into the body;
- after the convulsions have ended, use a napkin or handkerchief to clear the woman’s mouth of vomit so that she can breathe normally.
2. Help in the perinatal center
When a pregnant woman with preeclampsia is admitted to a perinatal center, the first step is to ensure stable blood pressure. Some medications have already been administered by the emergency resuscitator, so treatment is prescribed taking this into account.
Next, you need to quickly assess the condition of the woman and the fetus in order to decide on the method of delivery. It is necessary to understand that the only way to save the life of a woman and baby is to quickly rid the woman’s body of pregnancy. The decision on management tactics is made jointly by the obstetrician and the anesthesiologist-resuscitator.
If a woman has a full-term pregnancy, the birth canal is ready, the fetus is in good condition and blood pressure remains stable, then it is possible. Although this favorable combination of factors is very rare.
In case of a premature pregnancy and the ability to keep blood pressure within normal limits, the medical council may decide to delay delivery in order to try to prepare the fetal lungs as much as possible with the help of special drugs that accelerate the maturation of lung tissue.
If unfavorable conditions are created, then an emergency procedure is performed. Indications for surgical delivery include:
- - presence of at least one convulsive seizure;
— placental abruption with bleeding;
- threatening asphyxia or severe fetal suffering according to the results ultrasound examination or according to cardiotocography data;
- swelling and hemorrhages in the fundus during examination by an ophthalmologist;
- symptoms of preeclampsia that do not go away within 6-12 hours intensive treatment;
- complications of gestosis with the development of renal and liver failure.
In addition to delivery, it is necessary to carry out the entire range of therapeutic measures aimed at preserving the health and life of the woman. This assistance is provided by an anesthesiologist-resuscitator. If a convulsive syndrome occurs with loss of consciousness, the development of severe complications from vital organs (heart, lungs, brain), the woman is transferred to artificial pulmonary ventilation (ALV) with the entire complex of resuscitation medical care.
Preeclampsia and eclampsia: what will happen in the postpartum period?
After the birth of the child, it is necessary to continue treatment, because even in the absence of pregnancy, a seizure can occur. And this risk remains in the near future. The first week of treatment is carried out in the intensive care unit or in the intensive care ward. Then transfer to the postpartum ward is possible, subject to positive dynamics.
As a rule, if there are complications from a woman’s organs and systems, further treatment is necessary in a specialized hospital (cardiology, nephrology or neurology). Subsequently, rehabilitation is carried out on an outpatient basis under the supervision of an obstetrician-gynecologist, local therapist and specialized specialist.
Preeclampsia and eclampsia: what are the outcomes and consequences?
1. For the fetus
The consequences for the child largely depend on the speed of medical care, which is why it is so important to respond promptly to the first manifestations of preeclampsia. The chances of preserving the life of the fetus are very high if you immediately call ambulance and end up in an obstetric hospital. The baby has an extremely low chance of survival if a seizure occurs far from the maternity hospital, when it is impossible to perform in the next few minutes.
2. For the mother
The consequences for a woman can affect the rest of her life. This is especially true for the consequences of the most severe variant - eclampsia. Circulatory disorders, even short-term, will affect the functions of organs and systems, causing the following diseases:
- — hypertension with constant use of antihypertensive pills;
— kidney pathology with the presence of protein and leukocytes in urine analysis;
— pathology of the nervous system caused by cerebral hypoxia;
— pathology of the cardiovascular system with an increased risk of thrombosis in any part of the body;
- liver pathology with the development of endocrine diseases.
The difficulty is that after suffering from preeclampsia and eclampsia, some of the problems in the body cannot be detected. Latent failure in any organ may gradually manifest itself over at least the next five years. Therefore, one of the strict recommendations for a woman is mandatory contraception, so that the next desired pregnancy occurs no earlier than in five years. And all this time you should be monitored by a therapist with regular examination using laboratory and diagnostic methods for detecting pathology.
Preeclampsia, manifested by certain complaints and increased blood pressure, is a reason to call emergency help, regardless of the stage of pregnancy. The occurrence of a convulsive seizure with loss of consciousness, which are signs of eclampsia, sharply reduces the ability of doctors to save the life of the mother and fetus. Only timely medical care can guarantee a woman’s continued health and life, and will also give her baby a real chance of survival.
Not a single medical scientist, even the most titled one, can name the exact cause of this disease. Therefore, we can only talk about factors whose presence can affect the development of the disease. It is assumed that the leading role is played by the pathology of brain cells, which occurs against the background of:
- hypertension that has reached a critical level;
- narrowing of blood vessels (their vasoconstriction);
- loss of the BBB’s ability to qualitatively fulfill its role as a barrier protecting nervous tissue from toxins in the blood and microorganisms that perceive the brain as foreign tissue;
- disorders of cerebral circulation and potassium-calcium balance.
The risk group includes:
- young primigravidas and those over 35;
- ladies suffering from a number of diseases (hypertension, diabetes, obesity, lupus erythematosus);
- those who have close relatives who have had eclampsia;
- with multiple pregnancy.
Depending on the predominant manifestations, eclampsia is divided into:
- cerebral (severe form of hypertension);
- hepatic (deep metabolic disorders);
- comatose (without convulsions);
- renal (development of anuria).
The most severe form of the disease is considered to be comatose, which is accompanied by cerebral hemorrhage.
Preeclampsia in pregnant women is a severe degree of gestosis (complications normal pregnancy, occurring in the second and third trimester), characterized by increased blood pressure, proteinuria (detection of protein in the urine), edema and disruption of the functioning of the central nervous system and other vital organs.
Symptoms
A characteristic triad of indicators that appear when there is a threat of illness are:
- swelling;
- high blood pressure (hypertension);
- the appearance of protein in the urine (albuminuria).
At the last stage, these symptoms are joined by convulsions and coma, indicating damage to the central nervous system. Pathological changes are also present:
- in the brain (edema, pinpoint and extensive hemorrhages);
- in the kidneys (anatomical damage, necrosis of the cortical layer);
- in the liver (hemorrhages under the capsule, disruption of the liver cells).
The following signs are unfavorable for this disease:
- hypotension,
- tachycardia,
- yellowing of the skin.
Usually this disease is preceded by preeclampsia with the following symptoms:
- headache,
- visual impairment,
- pain in the right hypochondrium and epigastric region,
- nausea,
- overexcitement.
The course of eclampsia itself is conventionally divided into four phases, each of which is characterized by the presence of certain symptoms and lasts approximately the same time in all patients:
Loss of consciousness, facial muscles contract (30 sec.).
Spasm of the muscles of the whole body, including respiratory muscles (10-20 sec.).
Seizure (convulsions), lack of breathing and pulse (30-90 sec.).
The seizure ends, foam with blood is released from the mouth, a pulse and breathing appear, the face acquires a natural color.
At the end of the last phase, the patient either comes to her senses or falls into a coma. If she remains in this state for a long time, she may not come out of it. The second phase is also deadly. With difficult labor, hyperstimulation of labor, or if it is excessively strong, the development of eclampsia can begin right during the process of delivery.
Diagnosis of eclampsia during pregnancy
There is not a single study or test whose results could help predict the occurrence of this disease. It is sudden and develops very rapidly, so a traditional examination, consisting of:
- gynecological examination,
- ultrasound diagnostics (Doppler),
- Ultrasound research.
All that can, with a certain degree of probability, predict the occurrence of this disease is observing the typical manifestations of symptoms and taking into account laboratory data, including the following parameters:
- high blood pressure persists for several hours;
- an increased amount of urea, creatine and nitrogen indicates kidney damage;
- increased bilirubin and increased levels of liver enzymes - liver problems;
- an increase in hematocrit and hemoglobin in the blood, a decrease in platelets in it;
- detection of albumin and protein in urine.
Complications
The likelihood of serious complications occurring after an attack of the disease is very high. Its consequences may be:
- premature placental abruption;
- cerebral hemorrhage;
- swelling of the brain, lungs;
- intrauterine fetal death as a result of hypoxia;
- renal, liver, heart failure;
- death of a pregnant woman.
Treatment
What can you do
During an attack of eclampsia in pregnant women, the necessary first aid involves the following actions:
- to prevent vomit from entering the respiratory tract, turn the patient on her side;
- remove dangerous objects so that she does not get hurt;
- do not use force to control seizures;
- clean the mouth after the attack ends;
- call an ambulance. Attacks of eclampsia in pregnant women can be repeated, so emergency medical care is important and necessary!
What does a doctor do
Since the causes and conditions for the occurrence of the disease are unknown, the only method of treating it is considered to be early birth. During a seizure, the resuscitator carries out resuscitation measures. After the patient has regained consciousness, she is provided with:
- complete peace;
- eliminating vasospasm to avoid raising blood pressure to a critical level;
- carrying out dehydration therapy (removing fluid to prevent cerebral edema);
- oxygen therapy.
Further treatment is carried out in a hospital with the involvement of a neurosurgeon and neurologist.
Prevention
To minimize the possibility of the occurrence of extreme forms of gestosis, it is necessary:
- carry out preventive measures to prevent late toxicosis;
- promptly diagnose and eliminate symptoms of nephropathy, dropsy and preeclampsia;
- control blood pressure.
During the period of bearing a child, a number of complications may develop that are dangerous to the life of the mother and fetus. One of these complications is eclampsia - a severe form of gestosis in pregnant women, accompanied by a sharp jump in blood pressure to critical values. This condition is very dangerous and threatens both the course of pregnancy and the life of the woman.
Preeclampsia is called toxicosis of pregnant women, which manifests itself on later. Preeclampsia is the main cause of death among women during pregnancy in all developed countries. Preeclampsia or preeclampsia in pregnant women is characterized by a sudden increase in blood pressure with shortness of breath and the development of edema.
Eclampsia is the most severe form of gestosis. Despite the fact that the mechanism of development of gestosis has been fairly well studied, methods for preventing it are still not known, which makes this condition an urgent problem for women carrying a child.
Eclampsia after childbirth, at the end of pregnancy and during delivery is a dangerous condition that requires emergency care. The dangers of eclampsia during pregnancy include risks to the life of the woman and the fetus.
Eclampsia in pregnant women occurs in approximately 3% of cases of late toxicosis after 20 weeks of gestation.
In later stages, the body may not cope well with increased loads. In severe cases, this results in gestosis and eclampsia
Reasons for development
There are more than thirty theories about the causes and mechanisms of development of eclampsia, but none of them have been confirmed or refuted. Factors predisposing to the development of this complication include:
- woman's age;
- severe form of arterial hypertension;
- diabetes, including pregnancy diabetes;
- systemic diseases;
- thromboembolism;
- vascular disorders;
- obesity;
- multiple pregnancy;
- bad habits.
Despite the fact that the role of these factors in the development of eclampsia has not been precisely confirmed, they increase the risk of gestosis, and therefore eclampsia in pregnant women.
According to statistics, this disorder occurs in women who are too young – under 17 years of age. Women who become pregnant for the first time over the age of 35-37 are also at risk of developing eclampsia.
The risks of developing a dangerous complication increase if the pregnancy is difficult. In cases where a woman has high blood pressure, aggravated by vascular disorders, throughout the entire period of bearing a child, there is a high risk of developing preeclampsia and its complications.
Systemic diseases that can potentially cause eclampsia in late pregnancy or after childbirth include diabetes mellitus, endocrine disorders, lupus erythematosus and a number of autoimmune diseases.
An important role in the development of a dangerous complication is played by the course of previous pregnancies and family history. If previous births were accompanied by preeclampsia, and there have been cases of eclampsia and other forms of severe gestosis among close relatives, there is a high probability of developing this complication.
Precise Impact multiple pregnancy the development of eclampsia and other complications has not been proven, but this factor should be taken into account by the doctor when managing the patient’s pregnancy.
Too young expectant mother, as well as late pregnancy, increase the likelihood of eclampsia
Classification and forms
Eclampsia is characterized by severity and forms of manifestation. The disorder develops in several stages:
- arterial hypertension before pregnancy;
- hypertension in pregnancy;
- mild to severe preeclampsia;
- eclampsia in pregnancy.
These stages indicate that eclampsia is a direct consequence of a blood pressure disorder, which occurred even before pregnancy and worsened during pregnancy, against the background of increased stress on the woman’s body.
There is another classification used in domestic clinics to assess the condition of a pregnant woman. It also includes 4 stages of increasing symptoms:
- severe swelling during pregnancy;
- gestational nephropathy;
- preeclampsia;
- eclampsia.
However, preeclampsia is diagnosed already at the stage of a sustained increase in blood pressure with the appearance of edema and impaired renal function. This condition is a reason to prescribe therapy to stabilize the woman’s well-being.
Severe swelling may be a sign of preeclampsia
Based on severity, eclampsia is divided into moderate and severe. There are several types of pathological conditions, depending on the period of onset of symptoms:
- postpartum eclampsia;
- eclampsia during childbirth;
- eclampsia in late pregnancy.
Regardless of the period of onset of symptoms, in case of severe eclampsia, urgent hospitalization of the woman is indicated.
Symptoms of pathology
Symptoms of preeclampsia, as a condition preceding the development of a convulsive state against the background of high blood pressure, include:
- visual impairment – decreased sharpness, appearance of blind spots, flickering of flies;
- headache characteristic of hypertension;
- difficulty breathing and swelling of the nasal mucosa (stuffiness);
- impairment of cognitive functions of the brain (memory impairment);
- worsening sleep, loss of strength.
More pronounced symptoms of high blood pressure and circulatory disorders may appear - pain in the heart, tachycardia, nausea.
A dangerous symptom is increased reflexes. This sign indicates a risk of rapid development of eclampsia with convulsions.
Signs of eclampsia are convulsive seizures that occur in several stages:
- small contractions of facial muscles;
- development of tonic seizures;
- clonic seizures;
- seizure resolution.
An attack of eclampsia begins with rapid contractions of the facial muscles. This condition indicates an impending seizure and lasts no more than a minute. Then tonic convulsions appear. This is manifested by a sudden strong spasm of all the muscles of the body. Due to the contraction of the respiratory muscles at this stage, there is a risk of sudden death. This stage of the attack rarely lasts longer than 30 seconds.
In the third stage, the whole body tenses due to increased tone muscles, the woman cannot move, and at this moment a convulsive attack begins. The cramps are increasing, starting from the lower part of the body. During a seizure, breathing stops and the heartbeat stops. The seizure lasts up to two minutes.
At the stage of resolution of the attack, breathing returns, it becomes deep, but rare. There may be bloody foam coming from the mouth. There are two options for the outcome of a seizure - the woman either regains consciousness or falls into a coma.
An attack of eclampsia is similar to an attack of epilepsy and may result in coma
Diagnostics
The method or algorithm for diagnosing eclampsia is based on the exclusion of epileptic seizures. For this purpose, blood pressure measurements are taken. The vascular nature of convulsive seizures is confirmed by a stable increase in pressure over 140 to 100 for more than six hours.
Laboratory tests necessary to make a diagnosis:
- biochemical blood test;
- urine test for protein content;
- general urinalysis;
- blood pressure measurements.
Usually these tests are enough to diagnose the pathology.
Treatment of eclampsia is carried out exclusively in a hospital. First aid for eclampsia is aimed at reducing the risk of injury to a woman during a seizure. The patient is turned onto her side and held during convulsions. During a convulsive attack during eclampsia, it is necessary to monitor the woman’s condition. After the attack resolves, the oral cavity should be cleared of foam and vomit.
After emergency care for eclampsia has been provided, a team of doctors should immediately be called to the house and transport the patient to the hospital. Taking any medications to relieve eclamptic seizures at home is strictly prohibited.
Therapy is carried out in a hospital
Postpartum eclampsia is treated directly in maternity hospital. The woman is transported to the intensive care ward, where she is under constant observation.
If symptoms of eclampsia appear late in pregnancy, treatment is carried out with anticonvulsants. If the pregnancy is less than 34 weeks, measures are taken to prevent premature birth.
It is important to remember that eclampsia is a dangerous condition in which a woman needs emergency medical care.
Complications after eclampsia
Complications after an attack depend on the severity of symptoms and the general condition of the patient. The potential risks of eclampsia are assessed by the nature of the complications for the mother. These include:
- pulmonary edema;
- acute liver failure;
- cerebral edema;
- to whom;
- death.
With eclampsia during pregnancy, there is a high risk of developing acute fetal hypoxia with a fatal outcome for the child.
Prevention of eclampsia comes down to precise implementation of the recommendations of the obstetrician-gynecologist who monitors the woman during pregnancy, and timely treatment of late toxicosis.
