In short: Preeclampsia (gestosis) is a serious complication of the second half of pregnancy, manifested by high blood pressure (≥140/90), protein in the urine and often edema. It occurs in 2–8% of pregnant women. Without treatment, it can turn into eclampsia (convulsions) - a threat to the life of the mother and fetus. At the first symptoms, immediately consult a doctor.
What is gestosis (preeclampsia)
The term "gestosis" in Russian medicine unites conditions previously described as "late toxicosis of pregnancy". In international practice, the term "preeclampsia" is used. This is a specific complication of pregnancy, characterized by impaired function of the vascular endothelium (the inner lining of vessels) throughout the body.
Preeclampsia develops after the 20th week of pregnancy (most often after 32-34 weeks, but it can be earlier - "early" preeclampsia) and does not go away on its own. The only way to "cure" preeclampsia is delivery. This complication is one of the leading causes of maternal and perinatal mortality in the world.
What is the difference between gestosis and early toxicosis
Early toxicosis is nausea and vomiting in the first trimester associated with hormonal changes. It is unpleasant, but in most cases it is safe. Late toxicosis (gestosis, preeclampsia) is a fundamentally different condition: it is a systemic vascular disorder that threatens the life of the mother and fetus. There is no pathogenetic connection between them.
Symptoms of preeclampsia
Increased blood pressure. BP ≥ 140/90 mm Hg. With two measurements with an interval of at least 4 hours, the main diagnostic criterion is the main diagnostic criterion. Severe preeclampsia: BP ≥ 160/110.
Protein in the urine (proteinuria). ≥ 0.3 g in daily urine or a value of ++ and higher on the test strip. Reflects kidney damage.
Edema. Suddenly increasing swelling, especially of the face and hands, appearing in the morning after sleep is an alarming sign. It should be emphasized: swelling of the legs itself is not a criterion for preeclampsia - their combination with blood pressure and protein is important.
Alarming symptoms of severe preeclampsia:
Severe headache that is not relieved by paracetamol.
Eye disorders: floaters, shroud, double vision, darkening.
Pain in the epigastrium or right hypochondrium ("liver" pain).
Nausea and vomiting in the second half of pregnancy.
A sharp decrease in urination (oliguria).
Shortness of breath at rest.
Severe headache that is not relieved by paracetamol.
Eye disorders: floaters, shroud, double vision, darkening.
Pain in the epigastrium or right hypochondrium ("liver" pain).
Nausea and vomiting in the second half of pregnancy.
A sharp decrease in urination (oliguria).
Shortness of breath at rest.
Risk factors for preeclampsia
Preeclampsia is more likely to develop with:
First pregnancy (primiparous women at risk).
Multiple pregnancies.
Preeclampsia in a previous pregnancy or in close relatives.
Chronic arterial hypertension, diabetes mellitus, kidney disease.
Obesity (BMI over 30 before pregnancy).
Over 35 years of age.
The interval between pregnancies is more than 10 years.
First pregnancy (primiparous women at risk).
Multiple pregnancies.
Preeclampsia in a previous pregnancy or in close relatives.
Chronic arterial hypertension, diabetes mellitus, kidney disease.
Obesity (BMI over 30 before pregnancy).
Over 35 years of age.
The interval between pregnancies is more than 10 years.
What is the danger of preeclampsia
Without treatment, preeclampsia progresses. Possible complications:
Eclampsia is a convulsive seizure (analogous to epileptic) in a pregnant woman. Threatens the life of the mother.
HELLP syndrome is a severe form of preeclampsia: hemolysis, increased liver enzymes, decreased platelets. Requires emergency delivery.
Placental abruption is an acute violation of uteroplacental blood flow.
Fetal growth retardation is chronic placental insufficiency.
Premature birth is often an emergency cesarean section.
Eclampsia is a convulsive seizure (analogous to epileptic) in a pregnant woman. Threatens the life of the mother.
HELLP syndrome is a severe form of preeclampsia: hemolysis, increased liver enzymes, decreased platelets. Requires emergency delivery.
Placental abruption is an acute violation of uteroplacental blood flow.
Fetal growth retardation is chronic placental insufficiency.
Premature birth is often an emergency cesarean section.
Prevention of preeclampsia
For women at high risk of preeclampsia, the WHO and ACOG recommend taking low-dose aspirin (75–150 mg/day) from 12–16 weeks of pregnancy to 36 weeks. This reduces the risk of developing preeclampsia by about 10-20%. It is prescribed strictly by a doctor after assessing the risks.
Calcium (1–2 g/day) with a low dietary calcium intake also reduces the risk of preeclampsia, according to the WHO. Adequate levels of vitamins during pregnancy and maintaining a normal weight before pregnancy also reduce the risk.
Treatment of gestosis (preeclampsia)
Treatment is carried out exclusively in a hospital. Mild preeclampsia up to 37 weeks – close monitoring, antihypertensive therapy (reduction of blood pressure to safe values), prevention of convulsions with magnesium sulfate. Severe preeclampsia is an urgent delivery regardless of the term.
Lowering blood pressure with antihypertensive drugs does not "cure" preeclampsia – it only reduces the risk of stroke in the mother. The pathological process in the placenta continues. That is why the decision to give birth is made taking into account the term of pregnancy, the condition of the mother and the fetus.
When to see a doctor
Call an ambulance or go to the hospital immediately if:
BP ≥ 140/90 (measured twice).
A severe headache, visual impairment, abdominal pain appeared.
A sharp increase in swelling, especially of the face.
Convulsions.
Reduced fetal movements.
BP ≥ 140/90 (measured twice).
A severe headache, visual impairment, abdominal pain appeared.
A sharp increase in swelling, especially of the face.
Convulsions.
Reduced fetal movements.
Frequently Asked Questions
Can preeclampsia be cured without childbirth?
No. The only radical treatment for preeclampsia is delivery. Medications allow you to control blood pressure and prevent seizures, but do not eliminate the cause - a pathologically implanted placenta. After childbirth, preeclampsia usually disappears within a few days to weeks.
Will preeclampsia recur in the next pregnancy?
The risk of recurrence is higher than in women without a history of preeclampsia. With severe or early preeclampsia, the risk of recurrence is 20-40%. In the next pregnancy, careful observation and preventive intake of aspirin are recommended.
Conclusion
Preeclampsia (gestosis) is a serious but preventable and controllable complication of pregnancy. Regular scheduled visits to the doctor, blood pressure control and urine tests can detect it at an early stage. High blood pressure, swelling of the face or a severe headache in the second half of pregnancy is a reason to immediately seek medical help.
Bibliography
- WHO. WHO recommendations for prevention and treatment of pre-eclampsia and eclampsia. WHO, 2011. https://www.who.int/publications/i/item/9789241548335
- ACOG Practice Bulletin No. 222. Gestational Hypertension and Preeclampsia. Obstet Gynecol. 2020. https://pubmed.ncbi.nlm.nih.gov/32443079/
- NICE Guideline NG133. Hypertension in pregnancy: diagnosis and management. 2019. https://www.nice.org.uk/guidance/ng133
- Rolnik DL, et al. Aspirin versus Placebo in Pregnancies at High Risk for Preterm Preeclampsia. N Engl J Med. 2017;377:613-622. https://pubmed.ncbi.nlm.nih.gov/28657417/
- Ministry of Health of the Russian Federation. Clinical guidelines: Preeclampsia. Eclampsia. Ministry of Health of the Russian Federation, 2021. https://cr.minzdrav.gov.ru/
- Steegers EA, et al. Pre-eclampsia. Lancet. 2010;376(9741):631-644. https://pubmed.ncbi.nlm.nih.gov/20598363/
This material is for informational purposes only and does not constitute medical advice and is not a substitute for medical advice. If a child's sleep is accompanied by alarming symptoms, a pronounced deterioration in health, problems with breathing, feeding or weight gain, it is necessary to consult a qualified medical specialist as soon as possible, and not rely only on information from the Internet.
