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The gestosis is a state which is characteristic only for pregnant women. This complication of pregnancy breaks work of a number of systems and bodies in an organism of the pregnant woman. The similar state disappears several days later after the child's birth. According to researches of specialists, the gestosis is in a varying degree characteristic of a third of pregnant women. The disease is often shown during the period between the sixteenth and twentieth week of pregnancy, but the most characteristic of emergence of a gestosis is the third trimester of pregnancy. The reason of display of this pathology – characteristic changes in an organism of future mother because of which in a placenta there is a formation of substances which make mikrosokopichesky holes in vessels. Through these openings protein of plasma, and also liquid gets to fabrics from blood. It promotes formation of hypostases. At the very beginning of a disease hypostases still cannot be seen, however when weighing considerable increase of weight is already observed.
Similar a mikrootvetrstiya are formed also in vessels of kidneys, through them protein gets to urine. The general analysis of urine which the pregnant woman has to pass regularly facilitates diagnosis and gives the chance to begin to treat a gestosis at once after the beginning of a disease.
Types of a gestosis
It is accepted to distinguish several types of gestoses at pregnant women. The gestosis is early, arising in the first half of pregnancy, it is shown by nausea, vomiting, often unrestrained. At the woman strong salivation is observed. The gestosis late is shown on late durations of gestation (the third trimester). Manifestations of a nephropathy, an edema, a preeclampsia, an eclampsia are characteristic of this state. Also rare forms of gestoses which are shown by diseases of a liver, skin, a nervous system, etc. are diagnosed. It is also accepted to allocate "pure" gestoses which arise at the healthy pregnant woman in the absence of background diseases. The "combined" gestoses are shown owing to a disease which preceded this pathology. It can be an arterial hypertension, an endocrinopathy, diseases of kidneys.
Today there is no uniform exact opinion on an origin of gestoses. However there is a number of theories which assume a certain etiology of a gestosis. So, according to the corticovisceral theory the gestosis of pregnant women is represented as a certain neurosis of pregnant women of which disturbance of interaction between bark and subcrustal structures is characteristic. As a result in a hemodynamics reflex changes appear. This theory is confirmed by quite frequent manifestation of gestoses as consequences of nervous stresses.
According to the immunological theory the gestosis arises owing to change of mechanisms which are responsible for ensuring trasplatsentarny immunity in an organism. According to the genetic theory, to a gestosis those women at whose mothers the preeclampsia was observed have predisposition.
One more theory confirms interrelation of a gestosis and deficit in an organism of the woman of vitamins of group B and folic acid. In the third trimest of a beremennota the organism demands much more the mentioned vitamins. At their insufficient receipt in an organism concentration of a gomotsistein in blood becomes higher. Gomotsistein – substance very toxic for an endothelium. Under the influence of this substance there is time in vessels through which plasma passes in fabric. A consequence — hypostases, increase of pressure in vessels and decrease in diuresis.
According to the placental theory at patients with a gestosis, migration of a trophoblast is broken owing to what there is a spasm, lowering of an intervillous blood-groove, a hypoxia. Further owing to a hypoxia the endothelium is surprised, there are disturbances in a hemodynamics, a hormonal background, a metabolism.
At a gestosis of change happen in many bodies: functioning of kidneys and a liver, a placenta, a nervous system is broken. There can be a hypoxia of chronic character, a fruit growth inhibition syndrome.
At an early gestosis (toxicosis) pregnant women, as a rule, have a vomiting which can arise many times day. Constant nausea is observed, the hyporexia, desire is spicy and salty food. Constant vomiting does not influence strongly the pregnant woman's weight: considerably it does not go down. Temperature remains normal. Other described symptoms are characteristic only of the first months of pregnancy, later they disappear independently. In more exceptional cases vomiting at the woman does not stop later, at the same time it becomes unrestrained. At a similar state vomiting can be shown to twenty times a day and, it occurs at any time. The patient sharply grows thin, she develops a resistant fastidium. Pulse becomes more frequent, arterial pressure goes down. At the same time analyses confirm existence in urine of acetone and protein. In especially hard cases body temperature can increase, be shown arrhythmia and a condition of nonsense.
At a late gestosis the disease develops step by step. In the beginning there is edema, passing in a nephropathy, later over time – in a preeclampsia and an eclampsia. When developing dropsy at pregnant women hypostases because of a constant delay in a liquid organism are shown. During this period both the latent, and explicit hypostases can be shown. In view of lower release of urine from an organism the body weight of the pregnant woman increases very quickly, urination more intensively at night. Hypostases, as a rule, originally develop in anklebones, then they begin to extend up. Sometimes at the woman also simultaneous face edemas are observed. At the end of the day more swelled look legs, a stomach bottom.
At a nephropathy at the woman available already three main symptoms of a gestosis: the expressed hypostases, existence in protein urine, periodically shown high arterial pressure. The combination of any two symptoms can be observed. The nephropathy is shown against an edema. At this state the high rate of diastolic pressure is especially dangerous that influences decrease in a placental blood-groove. Respectively, the fruit receives less oxygen. Later the nephropathy can pass into an eclampsia that is very dangerous state for the pregnant woman. At a preeclampsia microcirculation in the central nervous system is broken. Except three main symptoms of a gestosis at this state the heavy feeling in a nape, a stomach ache, headaches, vomiting, nausea can be shown. At the woman sight and memory can worsen, to be interrupted a sleep. Owing to disturbance of a blood-groove in occipital part of a cerebral cortex "veil" can be always on the mind or be observed flashing of "sparks". Signs of a preeclampsia is high systolic the ABP (from 160 mm of mercury) and diastolic the ABP (from 110 mm of mercury.). Considerably release of urine decreases, in blood the number of thrombocytes decreases, coagulability of blood decreases, work of a liver is broken.
At an eclampsia, the heaviest stage of a gestosis, attacks of spasms are observed, at the same time all functions of systems and bodies are broken. Spasms which are provoked by pain, bright light, sharp sounds, etc. last several minutes. After an attack the woman faints. Also after similar attacks the deep coma can develop. It can provoke placental detachment, bleedings, a hypoxia of a fruit and premature births. This state threatens fruit life.
It is important to consider that at a gestosis a certain span the woman can feel rather well, complaining only of small hypostases, a noticeable increase in weight. However hypostases are characteristic not only of extremities, but also of a placenta that leads to insufficient supply with fruit oxygen. Therefore the described symptoms are an occasion to urgently visit the doctor.
Diagnosis of a gestosis
Reason for the assumption of the similar diagnosis is existence at the pregnant woman of the described symptoms. The doctor performs regular inspection and weighs the patient to exclude existence of hypostases. Diagnosis of a gestosis is carried out taking into account results of the general analyses of urine and blood. Continuous measurement of arterial pressure allows to define existence of problems in this direction. Also for statement of the correct diagnosis the daily urine is defined for what it is necessary to learn a ratio of liquid which was drunk, and that which is allocated. As a rule, the diagnosis "gestosis" is made in the presence of three symptoms – hypostases, protein in urine and the raised ABP.
If the woman has no visible hypostases, but weight grows too quickly, then the doctor can carry out test the Osage apple Aldrich. For this purpose under skin physical solution is entered and is defined for what period the papule will resolve. If it occurred quicker, than in thirty five minutes, in an organism there are obscure edemas.
Treatment of a gestosis
If the specialist defines only insignificant hypostases of legs at the pregnant woman, then in that case treatment can be carried out on an outpatient basis. In the presence of considerable hypostases and protein in urine hospitalization and hospitalization is necessary. At a heavy gestosis there is a threat of life of mother and a fruit. Therefore treatment is carried out in the intensive care unit or in an intensive care unit.
Without fail in a hospital before purpose of treatment the examination of women including blood tests and urine, research of a condition of a fruit by carrying out ultrasonography, a kardiotokografiya and a dopplerometriya is conducted.
In the course of treatment infusional therapy for the purpose of recovery of necessary amount of liquid in a vascular bed and removal of liquid from body tissues is used. It is also important to fill the lost protein. In the presence of the raised ABP hypotensive therapy is applied. Duration of treatment depends on a condition of the woman. If treatment does not give due effect for three days at heavy degree of a gestosis, then operation of Cesarean section is performed.
Prevention of a gestosis
As a rule, the gestosis most often arises at the women pregnant with twin, at those whose age exceeds 35 years, at the women having various chronic diseases (pathology of kidneys, a hypertension, disturbance of a lipometabolism), sexually transmitted infections. To prevent development of a gestosis to pregnant women it is extremely important to watch a body weight constantly. For this purpose it is not necessary to overeat, it is worth eating food which has the high content of protein, it is essential to limit sweet and farinaceous food in the menu. It is very important to use enough cellulose which is in vegetables, bran, fruit, greens. Women who notice that they significantly put on weight have to limit the use acute, salty and liquids. So, it is necessary to drink no more than 1-1,5 liters a day. An important factor of prevention of a gestosis is the full-fledged dream (not less than eight hours a day), a positive emotional background.
As one more method of prevention of a gestosis it is considered to be active lifestyle. Daily walks on foot, swimming, occupations by yoga, and also performance of specially developed exercises for a certain period are recommended to pregnant women.