Emergency (first) aid for gestosis. Emergency care for preeclampsia, eclampsia. First aid for preeclampsia, eclampsia.

What is preeclampsia (preeclampsia)?

Preeclampsia (gestosis) is a condition during pregnancy that is characterized by high blood pressure and the presence of protein in the urine.
Preeclampsia can develop in the second half of pregnancy (after 20 weeks), including during labor or even after childbirth. There are mild preeclampsia (possible outpatient management), severe preeclampsia and eclampsia. The more severe the preeclampsia, the higher the risk of developing serious complications.

Preeclampsia can pose a serious risk to mother and baby. Therefore, at the slightest suspicion of preeclampsia (preeclampsia), it is recommended to immediately consult a doctor.

Causes of eclampsia in pregnant women

Since eclampsia is a dysfunction of the “mother-placenta-fetus” system, the causes are diseases that the woman already had before conceiving the child. During pregnancy, these pathologies can be a trigger for the onset of severe gestosis. Among the causes of eclampsia are the following:

1. Fetoplacental insufficiency (FPI) is a condition in which the blood flow of the placenta begins to function poorly. Only a doctor can assess the condition of the arteries using a Doppler examination.
2. Thrombophilia is a genetic disease that involves a special mutation of genes that provoke thrombus formation. During pregnancy, thrombophilia becomes active and in later stages is the cause of the development of FPN.
3. Mutations of the eNOS gene affect the functioning of blood vessels. If there is a genetic defect, a woman’s body may perceive the fetus as a foreign body and try to get rid of it.
4. Defects in the attachment of the placenta to the walls of the uterus cause deterioration in fetal nutrition and provoke the appearance of FPN. With this pathology, blood flow disturbances can develop either gradually or suddenly.

In addition to the causes, there are risk factors for eclampsia and preeclampsia. At the very beginning of pregnancy, when registering, the gynecologist should pay attention to their presence and prescribe the patient appropriate therapy so that risk factors do not provoke the onset of severe gestosis.

• Chronic hypertension;
• Multiple pregnancy;
• Presence of eclampsia or preeclampsia in obstetric history;
• The presence of eclampsia or preeclampsia in the obstetric history of the mother, grandmother, aunt or sister;
• Old-time women (over 40 years of age at the time of pregnancy).

Particularly close attention to the patient’s condition should be paid if one or more risk factors for the development of gestosis are combined with the fact that the woman is carrying her first pregnancy.

Types and stages

The disease has two degrees of severity: moderate and severe. There are several types of eclampsia:

1. Typical – blood pressure increases to 140/90 mmHg, severe swelling appears and protein in the urine increases.
2. Atypical - most often observed in patients with a weakened central nervous system.
3. Uremic – at risk for women with kidney and urinary system diseases.

Pathologies are divided according to the time of occurrence; preeclampsia and eclampsia are:

1. In a pregnant woman.
2. In a woman in labor.
3. At the parent's.

Moderate

Moderate preeclampsia occurs after mild preeclampsia, in the first stage there are practically no symptoms and therefore it quickly passes into the next stage without being noticed. The moderate form is accompanied by the following symptoms:

• blood pressure is elevated and does not fall below 150/110 mmHg;
• the level of protein in the urine increases, which indicates a violation of the kidneys;
• When examining blood, a clotting problem is observed;
• swelling in the legs, arms, hands and abdomen.

The pathology negatively affects the woman: she experiences severe fatigue, apathy, migraines and heaviness in her legs. The fetus suffers - it does not receive enough oxygen, metabolism is disrupted and gradual poisoning occurs.

Moderate preeclampsia requires urgent hospital treatment; in some cases, the woman in labor undergoes a cesarean section to prevent death.

Heavy

Severe form – the beginning of the development of eclampsia. One of the most dangerous complications of pregnancy. Blood pressure does not fall below 179/110 mmHg, swelling even extends to the face, and protein in the urine rarely increases. The body cannot cope with bearing a child. The woman’s health deteriorates greatly, her vision decreases and the first convulsive contractions begin, usually on the face.

This stage is difficult to treat and it is rapidly gaining momentum and provokes HELLP syndrome, which stands for:

• N - red blood cells are destroyed and substances that stimulate intravascular coagulation penetrate into the blood;
• ELL – liver dysfunction. Liver enzymes are not synthesized and accumulate, damaging the organ tissue. As a result, the pressure in the vessels increases, which leads to dystrophy and hemorrhage;
• LP – platelet count drops sharply.

The syndrome develops rapidly, causing dizziness, nausea, jaundice, bloody vomiting, and then convulsions and coma.

Another consequence of severe preeclampsia is eclampsia. The pathology causes seizures, which increase each time, accompanied by a sharp increase in blood pressure and deterioration of vision. The disease can bypass the stage of seizures and immediately cause a coma.

What should a pregnant woman and her family pay attention to?

How does preeclampsia manifest?

In the area of ​​the nervous system, the following manifestations are possible:

• headache,
• fear of light,
• convulsions,
• tingling feeling,
• crawling sensation;

In the field of the cardiovascular system:

• heart failure,
• high blood pressure,
• critically low level of blood volume in the body;

Symptoms from the urinary system include:

• decreased amount of urine during urination or its absence,
• presence of protein in urine tests.

In the area of ​​the circulatory system, symptoms such as:

• decrease in hemoglobin level in the blood,
• a significant decrease in platelet count and impaired hemostasis;

In fetal development, possible symptoms are:

• fetal death during pregnancy,
• intrauterine fetal hypoxia;

In the gastrointestinal tract, symptoms may include:

• pain in the stomach area,
• urge to vomit, release of vomit;

The consequences of suffering severe PE, which determine the most unfavorable outcome: kidney pathologies, abruption of a properly formed placenta, pulmonary edema, HELLP syndrome, pneumonia, cerebral hemorrhage and others.

Is it possible to somehow prevent the development of preeclampsia?

There is currently no reliable way to prevent the development of preeclampsia. Regular use of low-dose aspirin and calcium supplements may help prevent preeclampsia, according to some studies. Never take aspirin during pregnancy unless prescribed by your doctor.

Today, the best thing you can do to protect yourself and your baby as much as possible is to visit your doctor regularly during pregnancy. At each visit, your doctor should measure your blood pressure and check your urine for protein. It is also important to know the warning signs of preeclampsia (preeclampsia) so that you can inform your doctor about them in time and begin treatment as quickly as possible.

Unfortunately yes. With preeclampsia, placental blood flow is disrupted, which leads to the birth of an underdeveloped baby. Moreover, pregnancy complicated by preeclampsia in most cases ends in premature birth. There is also a high risk of having a baby with various pathologies. For example, epilepsy, cerebral palsy, visual and hearing impairment.

Since the exact causes of the development of pathology have not yet been clarified, there are also no precisely defined methods of prevention. You can reduce the risk of its occurrence by planning and preparing for pregnancy. Timely treatment of infectious, inflammatory, urogenital and other diseases, elimination of hormonal and endocrine dysfunctions will have a positive effect on the course of future pregnancy.

As for drug prevention of preeclampsia, several methods have been proposed, for example, the use of heparin or calcium supplements, but studies have shown that none of them gives the desired result. The only possible and justified option is to take acetylsalicylic acid in small doses throughout pregnancy.

Prevention

Although preeclampsia cannot be completely prevented, there are a number of steps a woman can take to mitigate some of the factors that contribute to high blood pressure.

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These include:

1. drink 6 to 8 glasses of water daily
2. avoid fried or processed foods
3. eliminate salt from the diet
4. regular exercise
5. avoid alcohol and caffeine
6. keep your legs elevated several times a day
7. rest
8. supplements and medications prescribed by the doctor

This helps maintain healthy blood pressure and reduce the risk of preeclampsia.

How is preeclampsia treated?

When monitoring a woman with preeclampsia (gestosis), the doctor is guided by many factors, including the gestational age and condition of the child, the health and age of the mother, and also carefully monitors the progression of the disease. Blood pressure is measured, the results of laboratory tests are evaluated, which show the condition of the pregnant woman’s kidneys and liver, and the blood’s ability to clot. The doctor also monitors the child’s development and makes sure that the child is not in danger.

If the baby's development does not correspond to the gestational age, or it has stopped developing altogether, then it may be dangerous for it to remain in the uterus, even if the baby is still too small. If a mother develops severe preeclampsia/eclampsia, which can lead to serious consequences, childbirth may be the only solution to save the mother and ensure the survival of the baby.

Unfortunately, there are no effective measures to prevent and treat preeclampsia (preeclampsia). Treatment of severe preeclampsia is based on careful assessment, stabilization, continuous monitoring, and delivery at the optimal time for the mother and her baby.

Specifics of first aid

Considering that the severe condition of gestosis is based on a convulsive syndrome, it is impossible to do without qualified assistance from medical personnel. Treatment methods will also be prescribed by the doctor, and the emergency care algorithm for eclampsia will be as follows:

• Call an emergency medical team, informing the dispatcher about the extremely serious condition of the pregnant woman;
• It is necessary to place the patient on her left side;
• Cover the woman with soft things: blankets, pillows, rugs. This way you can prevent injury during a seizure;
• If necessary, fix the tongue so that it does not stick;
• Between attacks of convulsions, carefully remove accumulated vomit from the mouth.

To eliminate the recurrence of serial seizures, you can administer a magnesium solution intravenously.

The possibilities of transportation are determined by the arriving doctors, and assistance to the expectant mother should be carried out in an emergency vehicle, since artificial ventilation may be necessary to restore breathing. They also carry out emergency measures to reduce blood pressure.

Therapeutic measures

At the initial stage of treatment for pregnant women and women in labor, it is advisable to use drugs that relieve seizures and reduce blood pressure. At the same time, swelling is relieved, which worsens the woman’s general condition.

Note!

The use of any one direction of therapy will only worsen the patient’s condition: the use of anticonvulsants without normalizing blood pressure is pointless.

Carrying out sulfate infusion therapy includes the use of such drugs.

• Medicines that relieve seizures:

1. Emergency (Droperidol, Magnesia);
2. Supporters (Fulsed, Andakin);
3. Strengthening the sedative effect (Glycine, Diphenhydramine).

• Drugs that lower blood pressure:

1. Emergency (Nifediline);
2. Supportive (Methyldopa).

Note!

You need to control your blood pressure by taking medications throughout your pregnancy. All medications are used intravenously or intramuscularly.

If the attacks are severe and difficult to treat, emergency delivery is indicated. Indications for its implementation include the following symptoms:

• Bleeding from the birth canal;
• Placental abruption;
• Fetal hypoxia.

At the same time, they begin to stimulate labor after stopping the attack of convulsions, choosing a natural method of delivery, since anesthesia for caesarean section can provoke another attack.

In all other cases, therapy is carried out with magnesia and prescribed medications until the severity of the pathology and the general health of the mother and baby are clarified.

Prevention rules

Prevention of dangerous conditions is an important component of maintaining the health of the expectant mother. Preventive measures are used in the following cases:

• The pregnant woman has already had a history of attacks of eclampsia and preeclampsia;
• The attacks occurred in close relatives of the woman: mother or sister.

Preventive measures include the use of Aspirin from the middle of the second trimester (from 75 to 120 mg daily as prescribed by a doctor) and products containing calcium (1 g per day).

How is preeclampsia treated?

There is no specific treatment for preeclampsia. But, due to the threat of this condition turning into eclampsia, the pregnant woman needs urgent hospitalization. In a hospital, a woman may be prescribed magnesium sulfate (magnesia) to prevent seizures and lower blood pressure.

It has been established that the use of magnesium sulfate halves the risk of developing eclampsia in women with symptoms of preeclampsia. To lower blood pressure, you can use hydralazine or similar drugs. It is also possible to prescribe drugs with anticonvulsant and sedative effects.

Women with mild preeclampsia require careful care and significant restriction of activity.

If there is a risk of premature birth, doctors will do everything possible to prolong the pregnancy and ensure that the born baby survives. If the pregnancy is already approaching the expected date of birth, labor is induced artificially. In the case of a very severe form of preeclampsia, immediate delivery is carried out, despite the stage of pregnancy, since the slightest delay in this case is fraught with death.

Fortunately, not every case of preeclampsia ends badly. If you believe the statistics, today there is only one out of two hundred cases, which turns out to be tragic.

There is no 100% reliable way to prevent preeclampsia in pregnant women. However, in order to prevent its development, doctors advise that during the period of bearing a baby (especially if the woman is at risk) to be as attentive as possible to your body: rest more, not overexert yourself, eat right and undergo medical examinations on time.

It is necessary to regularly take all tests, even such seemingly simple ones as blood and urine tests. Constant monitoring of protein levels in the urine, as well as blood pressure, will help identify preeclampsia in its early stages. And this, in turn, will ensure the most favorable outcome.

Diagnostics

Making a diagnosis is complicated by the fact that eclampsia does not have specific symptoms that would correspond only to it. Cramps, edema and proteinuria may be symptoms of other diseases that have nothing to do with gestosis.

Currently, the problem of determining eclampsia is being actively studied, and to make a diagnosis, doctors use special examinations and tests that reveal the initial stage of the disease - preeclampsia:

• Systematic blood pressure measurement. Moreover, to confirm eclampsia, it is necessary to monitor the state of blood pressure over time.
• Urine analysis to determine the amount of protein. A daily test (Zimnitsky test) is important here.

If the indicators indicate the presence of preeclampsia, then subsequent convulsive seizures will indicate that the pathological processes in the woman’s body have entered the most severe stage of their development - eclampsia.

Treatment

Treating toxicosis with medication is not effective. The only solution for severe preeclampsia is delivery. The earlier the pathology appears, the more difficult its course and treatment. Progressive gestosis of early pregnancy requires its termination. With moderate late-onset preeclampsia, they try to maintain the pregnancy at least until the 37th week.

To do this, measures are taken aimed at reducing peripheral vascular resistance, reducing edema, restoring blood pressure levels and kidney function. Medicines are not effective for treating this condition. You can relieve symptoms and lower blood pressure by administering magnesium sulfate, anticonvulsants and sedatives. Bed rest is advisable.

Treatment requires a stay in a hospital, where special conditions are created: there is no harsh light, no noise, the woman in labor needs complete rest so as not to provoke convulsions. The patient must be examined by an obstetrician and resuscitator.

To extinguish the symptom use:

• sedatives to relieve anxiety;
• intravenous solution of magnesium sulfate;
• to prevent seizures, the drugs Droperidol, Diphenhydramine, Relanium are used intravenously;
• replenishment of circulating blood is required;
• blood pressure control, medications Dopegit, Clonidine, Atenolol;
• if the pathology appeared before the 34th week of pregnancy, then therapy is necessary for the maturation of the fetal lungs;
• in the absence of improvement and progression of the disease, a decision is made on urgent delivery.

Stages of formation by severity

In medicine, it is customary to distinguish preeclampsia by severity in order to understand which strategy to choose for subsequent treatment:

1. A mild degree is determined by the presence of blood pressure up to 150/100 mm Hg, protein in urine up to 1 g/l and the appearance of swelling of the lower extremities;
2. Moderate preeclampsia is characterized by a pressure not higher than 170/110 mm Hg, the appearance of protein in the urine of about 5 g/l and creatinine up to 300 µmol/g. In addition to swelling of the legs, an edematous reaction in the arms and in the abdominal wall area is added.
3. A severe form of the pathology is caused by high blood pressure (above 170/110), a significant appearance of protein and creatinine in the urine, as well as swelling of the facial part (nose, eyelids). There is a deterioration in the functioning of the optic nerve, the patient complains of more frequent migraines.

Moderate preeclampsia can quickly progress to a severe form of the disease. In this case, the kidneys and liver will not be able to cope with the processing of incoming fluid, and there is a risk of intoxication and hypoxia. In the absence of early diagnosis and adequate treatment, the pathological process can result in a coma for the woman and death for the baby.

Complications of gestosis

In an expectant mother, severe pathology can cause complications in the brain in the form of edema.
Severe preeclampsia is dangerous for the mother and her baby. Impaired blood supply to the placenta leads to hypoxia, developmental delay and intrauterine fetal death. As for the mother, the following frequent consequences can be noted:

• increased intracranial pressure;
• swelling of the brain and lungs;
• respiratory and heart failure;
• visual impairment and blindness;
• cerebral hemorrhage;
• placental abruption;
• attack of eclampsia.

Severe preeclampsia can result in a seizure, which can be triggered by the slightest irritant. The result can be coma and death of the woman. Another consequence of preeclampsia is HELP syndrome, accompanied by hemolysis, increased activity of liver enzymes and thrombopenia. Its diagnosis before birth requires early delivery, and after birth - blood transfusion.

Algorithm of actions for symptoms of pathology

Emergency care must be provided strictly in a certain order. Since the pathology gives serious complications and poses a threat to the mother and fetus, at the first signs of seizures, call an ambulance. Before doctors arrive, you must:

1. Place the patient on a pillow with her left side and cover her with blankets.
2. Open your mouth and fix the position of your tongue, preventing it from swallowing and choking.
3. Wipe your mouth to remove vomit, foam and mucus.
4. If necessary, perform a heart massage.

The main focus in treating the disease is to eliminate seizures.

Next, the patient is transported to the intensive care unit. The room should be soundproof, with darkened windows and dim lighting. Diagnostic measures are carried out under anesthesia to eliminate additional irritating factors. Ensuring the vital functions of the body during convulsive seizures is ensured by the following resuscitation measures:

• artificial ventilation to maintain breathing;
• administration of intravenous diuretics;
• catheterization of the bladder to ensure the excretory functions of the body;
• intravenous administration of glucose to lower intracranial pressure and stabilize cardiac activity;
• drip or intravenous administration of drugs to improve the activity of the hematopoietic system;
• the use of sedatives to relieve stimulation of the central nervous system.

Emergency care for pathology is aimed at maintaining the functioning of all organs and systems of the body, especially the kidneys, liver, heart and brain. When providing first aid, the following indicators are constantly monitored:

• blood pressure;
• heart rate;
• completeness of breathing;
• functioning of the urinary system.

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