Gestoses

To Gestoses carry a number of morbid conditions which arise at pregnancy, complicate its flow and disappear after its terminal.

Gestoses part on two big bunches:

• early (vomiting of pregnant women, excessive vomiting, a ptyalism) arise usually in 4 - 12 weeks of pregnancy
• serotinal (the hydrops gravidarum, a nephropathy, a preeclampsia and an eclampsia) - arise last 2-3 months

Aetiology

Modern researches allow to consider, that the basic etiological factor is the incompetence of mechanisms of acclimatisation to the arisen pregnancy. It is known, that almost in all systems of an organism of the pregnant woman there are the physiological changes promoting normal flow of pregnancy and a correct fetation. Development of these changes having adaptive character, is regulated by the excitatory system at active participation of the hormones formed in hemadens and in a placenta. To occurrence of Gestoses contribute congenital and acquired insufficiency of system of neuroendocrinal regulation of adaptive reactions (a hypoxia, infection contaminations, intoxications, an oligotrophy in the antenatal season, hereditary factors etc.).

Occurrence of Gestoses is promoted also by influence of the pathogenic factors conducting to disturbance of adaptic processes. It descends at diseases warmly ¦ vascular system (an idiopathic hypertensia, rheumatic heart diseases), disturbance of activity of hemadens (diabetes, a hyperthyroidism), nephroses (a nephritis, a pyelonephritis), hepatobiliary systems (a hepatitis, a cholecystitis), the disbolism (adiposity), the expressed stressful situations, intoxications (smoking, etc.), allergic and immunologic reactions.

Pathogenesis

Immunogenetic theory surveys serotinal Gestoses as implication of the immunological havoc arising on the basis of genetical caused antigenic heterogeneity of an organism of mother and a foetus. At normal development of pregnancy antigenic heterogeneity does not show owing to complex immunobiological communications between an organism of mother, a foetus and a placenta. Gestoses can arise at changes in a placenta, antigens of a foetus defining penetration into blood of mother, in the presence of the factors causing production of antibodies, in its organism there are reactions an antigen - an antibody. The immunologic alterations arising under specified conditions, are surveyed as a releaser causing changes in excitatory, vascular, endocrine and other systems.

Hormonal theory of Gestoses of pregnant women has received appreciable development. One authors considered as the cause of their occurrence disturbance of function of a cortex of adrenals, others - change of secretion of estrogenic hormones, the third - insufficient hormonal activity of a placenta. Disturbance of function of hemadens has great value in a pathogenesis of Gestoses of pregnant women, but is not a primary factor. Endocrine disturbances, apparently, arise at a toxicosis of pregnant women again.

Renal theory. The growing uterus can cause a prelum and ischemisation nephroses, thus in nephroses the renin which, arriving in blood, contacts gamma-globulins is formed and forms Hypertensinum causing rising of arterial pressure. However occurrence of toxicoses of pregnant women is known at size of the uterus excluding a prelum of nephroses.

Early Gestoses

Vomiting of pregnants is accompanied by change of gustatory and olfactory sensations, appetite dropping, happens not only in the mornings, and repeats some times in day. According to gravity and degree of the arisen changes in an organism of the pregnant woman distinguish following degrees:

• easy vomiting
• moderate (moderately severe)
• excessive vomiting (the serious form)

Easy vomiting - repeats some times (2-4) in day, mainly after meal. The general condition usually is not broken, the temperature normal, sphygmus can be speeded a little up (90 impacts in a minute), a BP within norm, a diuresis sufficient. To treatment gives in easily, or passes spontaneously. In some cases passes in the following phase.

Moderate vomiting - arises irrespective of food intake, to 10 times a day. It is quite often accompanied by a hypersalivation. The pregnant woman grows thin, there comes attrition. Temperature subfebrile (to 37.5), sphygmus with predilection to a tachycardia (100 impacts in a minute). A skin dryish. There is an appreciable delicacy and apathy. The diuresis goes down, there can be a transient acetonuria.

Excessive vomiting. Will repeat to 20 and more times a day, not only in the afternoon, but also at night. A condition of the pregnant woman serious, an adynamia, a sharp decline of forces, a sharp fastidium, excessive irritability. Quite often vomiting will join a hypersalivation that burdens a condition. Attrition is characteristic, the skin becomes dry and flabby, tongue is densely imposed, from a mouth the acetone odour becomes perceptible.

Gaste painful at a palpation, a subcutaneously-fatty layer drawn.

The body temperature subfebrile, but can raise to 38 and above. Arise the expressed tachycardia (120 and more impacts in a minute) and a hypotension. The daily urine is lowered, in urine acetone is found, there is a protein and cylinders. In blood the filtrate nitrogen maintenance accrues, the quantity of Sodium chloridums decreases, the metabolic acidosis accrues. The lethal outcome is possible.

Treatment. It is necessary to frame conditions of full emotional and physical rest, good leaving, silence and a long sleep. With success the psychotherapy, acupuncture is applied. Sedative therapy includes appointment of sodium of Bromidum. Also prescribe caffeine (if the patient keeps nutrition, it is possible inside). From antiemetic preparations prescribe neuroleptics (aminazine, an ethaperazine, Droperidolum).

Spend struggle against starvation and a dehydration. To the patient give various, readily assimilable nutrition, vitamin-rich. If the nutrition is not acquired, prescribe a glucose intravenously (20-40 % solution) or together with sodium Sodium chloridum introduce by means of clysters. For metabolic acidosis elimination it is recommended introduces Natrii hydrocarbonas intravenously or in a clyster. At appreciable attrition - a hemotransfusion and plasmas.

After the vomiting termination it is necessary to continue fortifying treatment.

Ptyalism (hypersalivation). It can be observed as at vomiting of pregnant women, and it is independent. The daily sialosis can reach 1 l and more. At the expressed hypersalivation there is a maceration of a skin and mucous labiums, appetite goes down, the state of health worsens. The pregnant woman grows thin, the sleep is broken. Owing to appreciable loss of fluid there are dehydration signs. Treatment basically is similar to that at vomiting. The gargle of a mouth infusion of a sage, a camomile, menthol solution Is recommended. For the prevention of a maceration a face skin grease with Vaselinum. Usually well gives in to treatment and after the termination of a hypersalivation pregnancy educes normally.

Serotinal Gestoses

Hydrops gravidarum is characterised by occurrence of the puffiness having nonperishable character. Begins in second half of pregnancy, is closer to sorts. In the beginning there is pastosis, and then a puffiness of autopodiums and anticnemions; at the further development hips, outside generative organs, a gaste swell. In serious cases there is a general puffiness. Fluid collects mainly in subcutaneously-fatty tissue, the fluid clump in serous lumens usually does not happen. A BP the normal. Protein in urine is absent. At an irregular regimen the edema can pass in the following form - a nephropathy.

Treatment consists in fluid restriction (700-800 ml a day) and salts (3-5). At appreciable edemas the confinement to bed, strict restriction of fluid are necessary (to 500 ml), "unloading" days, prescribe a hydrochlorthiazide (also Sodium chloridum of a potassium for hypopotassemia prevention), intravenously a glucose, inside ammonium Sodium chloridum. Preparations of Valeriana, Leonurus and sedatives (under indications) are recommended.

Nephropathy of pregnants educes against an edema. The triad is characteristic: edemas, BP rising, a proteinuria. Distinguish three severity levels of a nephropathy.

The first degree is characterised by small edemas, a moderate hypertensia (a systolic BP not above 150 mm. Hg) and protein presence in urine to 1 g/l.

The second severity level: the expressed edemas, a BP raises on 40 % from initial digits (a systolic BP to 170 mm. Hg), protein in urine to 2-3 g/l.

The third degree: sharply expressed edemas, a BP than 170 mm raise more. Hg, the expressed proteinuria (over 3 g/l), a cylindruria and oliguria.

Flow of sorts at patients with a nephropathy can be complicated a foetus asphyxia, anomaly of patrimonial forces, a bleeding, etc. During sorts transition threat in the following stage - a preeclampsia is enlarged.

Treatment: hypochloride and a rastitelno-milk diet, are recommended unloading dynes. For enriching of an albuminous metabolism prescribe methionine, and also parenteral introduction of albuminous preparations. Sedative therapy. In the presence of the expressed edemas - diuretic (hydrochlorthiazide). Apply magnesium Zinci sulfas (hypotensive, sedative, diuretic action). Prescribe vitamins.

Preeclampsia. The signs bound to disturbance of functions a CNS join a clinical picture: a headache, heavy feeling in the field of forehead and a nucha, a veil before eyes, a flicker of front sights. The preeclampsia can pass at any moment in an eclampsia. There can be a premature placental detachment and other complications dangerous to pregnancy and a foetus.

Treatment is based on the principles accepted for therapy of an eclampsia.

Eclampsia. The higher stage of development of a serotinal gestosis. The brightest symptom - cramps with (clod) loss of sight. Arises during sorts is more often, is rarer - during pregnancy and after sorts. Before the beginning of attacks headache intensifying, sight deterioration, a sleeplessness, disturbing, BP rising are quite often observed. Each attack proceeds 1-2 mines and develops of the consecutive seasons.

1. The preconvulsive season. There are fine twitchings of face muscles, eyelids are occluded, squirrels of eyes are visible only. 20-30 seconds last
2. The season of tonic cramps. There is a tetanic reduction of muscles of all body, the trunk exerts, breath stops, a cyanosis of the person. Duration same. It is most dangerous to mother and a foetus.
3. The season of clonic cramps. Rough convulsive twitchings of face muscles, trunks, extremities. Duration 20-30 seconds of the Cramp gradually weaken, there is a rhonchial breath, from a mouth the foam imbued by blood owing to an occlusion of tongue is excreted.
4. The season of the permission of an attack. The patient some time is in a coma, the consciousness comes back gradually, about happened remembers nothing. This season can last some hours.

The main causes of lethal outcomes are hematencephalons, an asphyxia, disturbance of warm activity, a fluid lungs. After an attack there can be an aspiration pneumonia, disturbance of function of nephroses, psychoses are possible.

Principles of treatment an eclampsia:

1. Elimination of visual, acoustical and tactile stimuluses
2. Cupping of attacks (a narcotic analgetic + Chlorali hydras)
3. Accelerated, but not forced delivery
4. Maintenance of correct activity of lungs, nephroses, etc. organs.
5. An exsanguination

Proceeding their principles, the patient place in the separate blacked out, well aired chamber where hum and superfluous locomotions of the personnel is not supposed. Intramusculary introduce 25 % solution of Zinci sulfas of magnesium on 20 ml each 6 hours per flow of days. Clinical researches, manipulations and so forth spend under an easy inhalation narcosis. Apply neuroleptics, to elimination of a vascular spastic stricture - an Euphyllinum. Dehydrational and infusional therapy. It is necessary to observe a principle of moderate doses of medicamental preparations in certain sequence. A prime priority are given to neurotropic therapy, and also depression of a BP and diuresis rising. An exsanguination now do not apply in a kind of possibility of development of a vascular shock.