A pregnant woman lurks a lot of dangers. One of them is preeclampsia and eclampsia - pathological conditions that occur in expectant mothers. In this article, we will not focus on independent diseases, but rather on the syndromes of organ failure, which is accompanied by partial damage to the central nervous system to a greater or lesser extent. You will learn about the causes of eclampsia and preeclampsia, first aid and the likely consequences of this problem right now.
What is this pathology?
In a non-pregnant woman or men, such violations cannot occur. The thing is that the problem arises in the system "pregnant - placenta - fetus." To name the exact causes and describe the pathogenesis of the development of this disease, not a single doctor is still able to, but nevertheless we will talk about the most probable factors provoking the syndrome in the next section.
According to medical scientists from Western countries, preeclampsia and eclampsia are syndromes that arise as a result of the progression of hypertension. In domestic medical science, not so long ago, a slightly different position took place, according to which both syndromes are considered varieties of gestosis.
Eclampsia and preeclampsia develop in pregnant women in the second trimester, usually after the 20th week. Characteristic signs of multiple organ failure typical of preeclampsia are persistent arterial hypertension, swelling of the body and limbs. The presence of protein in the urine may indicate the development of the syndrome - doctors call this proteinuria.
Unlike preeclampsia, eclampsia is accompanied by more serious disorders that lead to damage to the cerebral hemispheres. The patient may have a coma against the background of a hypertensive crisis. Very characteristic for eclampsia are convulsions, confusion. In the absence of proper medical care, a woman is at risk of death.
Disease classification
Based on the typology established by WHO, multiple organ failure syndrome (preeclampsia) can be mild or severe. To the initial stage of development of this pathology include gestational hypertension, which is an exacerbation of the chronic form of the disease, provoked by gestation. Diagnosed preeclampsia in a predominant number of cases precedes eclampsia.
Russian obstetrician-gynecologists divide eclampsia into several varieties, depending on at what point it developed:
- during pregnancy - the most common variant of the course of the syndrome (found in 80% of all cases of eclampsia);
- during childbirth - in the process of obstetric aid, the manifestation of the syndrome is diagnosed in every fifth to sixth woman;
- after childbirth - pathology occurs during the day after labor, is about 2% of cases.
Based on the content of medical protocols, eclampsia and preeclampsia are characterized by exactly the same symptom complexes. In addition, there will be no difference in the treatment of mild and severe multiple organ failure. For this reason, the classification and typology of eclampsia is not critical for the doctor. The only thing that the treatment regimen may depend on when the syndrome occurs is one of the forms of the disease:
- typical, which is characterized by hypertension (blood pressure exceeds 140/90 mm Hg), swelling of the body, increased cerebrospinal fluid pressure and protein content in the urine (an indicator of eclampsia may indicate 0.6 g / l or more);
- atypical, developing in severe childbirth in women with a weakened central nervous system (cerebral edema, non-critical hypertension, increased intracranial pressure);
- uremic - the likelihood of this form of the syndrome is high in expectant mothers who have a history of chronic kidney and urinary system diseases before pregnancy.
Provocative factors
As already noted, almost nothing is known about the causes of eclampsia and preeclampsia, which makes it impossible to name them with accuracy. With absolute certainty, doctors can only say one thing - this condition can develop exclusively in pregnant women and no one else.
There are about three dozen different hypotheses and assumptions regarding the causes of syndromes. The most prognostic and realistic can be called several of them:
- genetic disorders;
- thrombophilia, including antiphospholipid syndrome;
- chronic infectious diseases (Epstein-Barr virus, cytomegalovirus, etc.).
Complicating the situation is the inability to find out exactly whether a woman will have this problem during the period of gestation in the absence or presence of these factors. Doctors also know the fact that fetoplacental insufficiency serves as a starting lever in the development of eclampsia. Other risk factors predisposing to the disease are:
- the presence of references to preeclampsia or eclampsia in the birth and pregnancy management protocols preceding the present;
- the presence of the syndrome in the mother or other blood relatives;
- multiple or first pregnancy;
- age over 40;
- long interval between previous and current ongoing pregnancy (more than 8 years);
- chronic arterial hypertension;
- diabetes;
- cardiovascular diseases.
Symptoms
The main signs of eclampsia and preeclampsia of pregnant women are three manifestations:
- swelling of the limbs and body;
- a significant increase in blood pressure;
- the presence of protein in the urine.
To diagnose a syndrome of multiple organ failure in a future mother, any symptom in combination with hypertension is enough.
Edema with this disease can be localized in different places and have an unequal severity. In some women, swelling can occur only on the face, in others - on the legs, and in others - throughout the body. Unlike edema, which is found in most pregnant women, edema with eclampsia does not become less pronounced after a long stay in a horizontal position. With pathological edema against the background of preeclampsia, the patient rapidly gains weight in the second trimester.
In addition to swelling, increased blood pressure and proteinuria, the likelihood of additional symptoms of the disease is not ruled out. Due to damage to the central nervous system caused by hypertension, symptoms such as:
- Strong headache;
- blurry vision, veil, flies before the eyes;
- epigastric pain;
- dyspeptic disorders (nausea, vomiting, diarrhea);
- muscle hypertonicity;
- reduction in urine output (less than 400 ml per day);
- pain on palpation of the liver;
- thrombocytopenia;
- intrauterine growth retardation.
The first symptoms of severe preeclampsia are an unconditional reason for hospitalization of the patient in an obstetric hospital. A pregnant woman is shown treatment whose goal is to normalize blood pressure, relieve swelling of the brain, and prevent the development of eclampsia.
Toxicosis with preeclampsia does not pose a particular threat and does not affect the nature of the course of the syndrome. Eclampsia, in contrast to preeclampsia, is manifested by convulsive seizures, the cause of which is brain damage due to swelling of the hemispheres and increased cerebrospinal fluid pressure. Thus, the main sign of eclampsia can be considered convulsions, which can be:
- single;
- serial
- provoke coma after a seizure.
Sometimes, loss of consciousness in patients is not preceded by convulsive attacks. An impending worsening of the condition is signaled by a suddenly intensifying headache, insomnia, a sharp jump in pressure.
Cramps often begin with visually imperceptible twitches of the facial muscles, which gradually pass to the muscles of the whole body. Most often, after the end of a seizure, consciousness returns, but the patient is not able to tell about her feelings, because she does not remember anything. Convulsions against the background of eclampsia are repeated when exposed to any stimulus, be it a bright light, a loud sound, pain or internal experiences. The reason in this case is the increased excitability of the brain, provoked by swelling and high intracranial pressure.
How to diagnose a syndrome
In obstetrics, pre-eclampsia and eclampsia of pregnant women are some of the most serious problems. To prevent deterioration of health, it is important to monitor blood pressure and periodically undergo clinical trials:
- general urine test (for proteinuria);
- blood test to determine the level of hemoglobin, platelet and red blood cell count, coagulation period;
- electrocardiogram;
- biochemical blood test for the concentration of urea, creatinine, bilirubin in it;
- CTG and ultrasound of the fetus;
- Ultrasound of the vessels of the uterus and placenta.
All of these diagnostic procedures allow timely detection of preeclampsia and eclampsia. The woman will have emergency care in the clinic, regardless of the severity and severity of the symptoms. However, people from the close environment of the pregnant woman also need to know how to act in case of an eclampsic attack.
Before the arrival of the ambulance crew
The emergency care algorithm for eclampsia and preeclampsia is of particular importance to the patient. First of all, a woman needs to be laid on her left side - this minimizes the risk of choking with vomit, as well as blood and stomach contents entering the airways and lungs. The patient should be carefully placed on a soft surface (bed, mattress or sofa) so that during the next convulsive attack she does not inflict accidental injuries on herself. During a seizure, hold the patient, squeeze her arms and legs is not necessary. If possible, during seizures, it is important to provide oxygen through the mask (optimal speed 4-6 l / min). As soon as the cramp is completed, it is necessary to clean the mouth and nasal passages from mucus, vomit, blood.
Anticonvulsant treatment
Providing first aid for eclampsia and preeclampsia is not enough to alleviate the patient's condition. Without drugs for this syndrome, it is impossible to stop convulsive attacks.
Ambulance specialists immediately bring in sick magnesium sulfate upon arrival. Moreover, the manipulation should be carried out in stages, in compliance with the correct sequence. A solution of magnesia of 25% concentration in an amount of 20 ml is injected intravenously. The medicine is supplied dropwise for 10-15 minutes, after which the dosage is reduced. For maintenance therapy, 320 ml of saline is diluted with 80 ml of 25% magnesium sulfate. The optimal speed of drug administration is 11-22 drops per minute. The drug is administered continuously throughout the day. Replenishment of magnesium deficiency in the body of a pregnant woman will prevent subsequent bouts of seizures.
With the introduction of the solution at a rate of 22 drops per minute, 2 g of dry matter every hour will enter the woman's body. Simultaneously with the introduction of the drug, it is necessary to monitor whether symptoms of an overdose of magnesium occur, which include the following manifestations:
- intermittent breathing (less than 16 breaths per minute);
- oppression of reflexes;
- reduction in daily urine output to 30 ml per hour.
In case of an overdose of magnesium-containing drugs, their use is stopped and a pregnant antidote is administered to the pregnant woman in the near future - 10 ml of calcium gluconate in 10% concentration. Anticonvulsant treatment is carried out for the remaining period of pregnancy until there is a risk of developing eclampsia.
If, after the administration of magnesia, the convulsions are repeated again, the patient is given another, stronger drug - most often “Diazepam". On average, 10 mg of the drug is injected into the body for two minutes. With the resumption of convulsive attacks, the drug is repeated in the same dosage. If the convulsions do not recur over the next 15-20 minutes, proceed with maintenance therapy: 500 ml of saline are used for 40 mg of Diazepam. Drugs are administered for 6-8 hours.
Lowering blood pressure
Another important direction in the provision of emergency care for eclampsia and preeclampsia is the antihypertensive drug effect. Scientists were able to prove that the use of other medicines does not play a significant role in stabilizing a woman’s condition and developing a fetus. Neither antioxidants nor diuretics can help with this syndrome in pregnant women. Such treatment will not bring any benefit. Eclampsia and preeclampsia are treated only symptomatically, that is, the use of anticonvulsants and antihypertensive drugs.
In obstetrics, preeclampsia and eclampsia are direct indications for antihypertensive therapy, the goal of which is to lower blood pressure to 140/90 mm Hg. Art. and preventing its subsequent increase. For pregnant women suffering from multiple organ failure syndrome against hypertension, such drugs as Nifedipine, Sodium Nitroprusside, Dopegit are used.
The maximum daily dose of drugs is calculated by the attending obstetrician-gynecologist individually for each patient, depending on weight, severity of the disease. Some of the drugs are available in tablet form, others in injectable form. In the first days of treatment, specialists prescribe medications in the minimum dosage, gradually increasing the daily amount of active substances. Any changes in therapeutic tactics should be reflected in the treatment protocol. Preeclampsia and eclampsia in pregnant women require prolonged supportive antihypertensive therapy (taking methyldopa-based drugs) until delivery. In the event of a sudden deterioration in the condition caused by a pressure surge, such drugs as Nifedipine, Naniprus and their analogues are recommended for urgent use.
It is impossible to complete magnesia and antihypertensive treatment immediately after childbirth. A woman in labor is prescribed the minimum dosage of drugs over the next day, which is especially important to maintain her blood pressure. As soon as the condition of the newly minted mother is stabilized, the drugs are gradually withdrawn.
Delivery Rules
These clinical recommendations for eclampsia and preeclampsia are not always effective. In severe cases, the only way to cure this pathological condition is to get rid of the fetus, since it is pregnancy and processes associated with the formation and nutrition of the placenta that cause the syndrome. If the anticonvulsant and hypotensive symptomatic treatment does not give the desired results, the woman is prepared for emergency delivery, otherwise no specialist can guarantee the safety of her life.
It is important to understand that eclampsia or preeclampsia alone cannot be called a direct indication for urgent delivery. Before proceeding to the stimulation of labor, it is necessary to achieve a cessation of seizures and stabilize the pregnant woman. Removing a baby from the womb can be done either through a cesarean section or through the birth canal.
The date of birth for multiple organ failure syndrome is prescribed by the doctor based on the severity and severity of the pathology. With mild preeclampsia, a woman has every chance of bringing the baby to the due date. If a woman is diagnosed with a severe form of pathology, then childbirth is carried out within 12 hours after the relief of convulsive attacks.
Neither eclampsia nor preeclampsia are considered absolute indications for cesarean section. Even with a severe form of pathology, natural childbirth is preferable. About cesarean section, we start only in complicated cases - for example, with placental abruption or inefficiency of labor stimulation. Induction, that is, labor stimulation can also be considered a type of indirect treatment for eclampsia and preeclampsia. A pregnant woman is required to use epidural anesthesia, control the fetal heartbeat throughout the process.
What threatens the syndrome of multiple organ failure
An attack of eclampsia can provoke unexpected complications. In the absence of antihypertensive and anticonvulsant treatment, the pregnant woman is threatened by:
- pulmonary edema;
- aspiration pneumonia;
- the development of acute heart failure;
- cerebrovascular accident (hemorrhagic stroke followed by paralysis of one or both sides);
- retinal disinsertion;
- cerebral edema;
- coma;
- death.
Short-term vision loss is not ruled out. In the postpartum period, eclampsia or preeclampsia can leave its mark in the form of psychosis, whose duration on average reaches 2-12 weeks.
Is it possible to prevent a problem
Treatment of eclampsia and preeclampsia in pregnant women, as already noted, is purely symptomatic. At the moment, it is impossible to accurately predict whether this syndrome will develop in a pregnant woman or not, therefore, most experts recommend taking during pregnancy as a prophylaxis of these pathological conditions:
- aspirin (not more than 75-120 mg per day), up to 20-22 weeks;
- calcium preparations (calcium gluconate, calcium glycerophosphate).
These drugs reduce the likelihood of eclampsia in pregnant women at risk. Meanwhile, in small doses, aspirin is also recommended for patients who do not have risks of developing pathology.
The opinion that the following are effective measures for the prevention of eclampsia is erroneous:
- salt-free diet and minimal fluid intake;
- restriction in the diet of proteins and carbohydrates;
- taking iron-containing preparations, vitamin-mineral complexes with folic acid, magnesium, zinc.