Eclampsia is a late pregnancy toxicosis characterized by convulsive seizures with a subsequent comatose state.

Etiology eclampsia, as well as water and nephropathy of pregnant women are considered uniform. Eclampsia is the most severe form of the Late (see). With eclampsia, as in the nephropathy of pregnant women, there is a characteristic triad of clinical symptoms - swelling, and; They are joined by the symptoms of the lesions of the CNS - (see), coma (see).

Pathologist changes at eclampsia are observed in the brain, liver, kidneys; Changes from the CNS are the most difficult. Characteristic: Sharp brain swelling, often point hemorrhages; The hemorrhages of large sizes are usually observed with eclampsia against the background of a previously used hypertensive disease. In the liver, on the soil of thrombosis, hemorrhages are observed under its capsule, the decompensation of hepatic cells. Significant degenerative changes arise in the kidneys, less often obstructive lesions of the cortical kidney layer are observed.

Fur and symptoms. Eclampsia seizures are usually preceded by preeclampsia syndrome: a few hours before an ecloptic seal, pregnant complains of headache, sharp pain in the opposite region may appear. There are various changes in view: in some cases, pregnant sees everything "as it were in the fog", in others - the flashes of "flies" before the eyes; It may be temporary complete.

The seal of eclampsia contains three following one after another phase. He begins the loss of consciousness; A pregnant look is fixed at one point, the head deviates aside; Fibrillar twitching of mimic muscles appear. This introductory phase lasts up to 30 seconds.; It follows the phase of tonic convulsions, in which the whole body bends, the head is leaving the joy, jaws are compressed, breathing is delayed. This phase lasts 20-25 seconds. The next, longer phase is the appearance of clonic convulsions - indiscriminate contraction of the muscles of the body and limbs. The seizure ends with a deep whistling breath, a foam appears from the mouth, breathing restores. After the seizure, the woman is in a comatose state. There are cases of eclampsia, in which the woman during the day remains in a comatose state, while it can be up to 10-15 and more seizures (eclaptic status).

They distinguish the eclampsia during pregnancy, in childbirth and postpartum eclampsia. With eclampsia in childbirth, the seizures are not repeated after the women's relatives of the woman. If the eclampsia has developed in recent months of pregnancy, then in connection with the seizures, generic activities, despite the use of drugs, is enhanced.

Often, after stopping eclampsia, the pregnancy can continue, but if the symptoms of the late toxicosis (especially albuminuria, hypertension) continue to remain, which indicates a severe form of toxicosis, then in the coming days the repetition of eclampsia (return eclampsia) should be feared. Especially severe form is nozzy eclampsia; With this form, the pregnant woman flows into a heavy comatose state, often leading to death. Adverse signs at eclampsia are: small jaggility, sharp decrease in blood pressure ().

An atypical forms of eclampsia are observed, more often having a easier flow; There may be an eclampsia without pronounced hypertension; In other cases there is no albuminuria.

The gods who have undergone eclampsia in may be observed a severe complication in the form of acute. As a result of the necrosis of the cortical kidney layer, Anuria is developing; The amount of urine per day is less than 100 ml, urine has a view of a coffee ground.

Eclampsia (Eclampsia; from Greek. Eklampsis - flash, sudden appearance) - Heavy toxicosis of the second half of pregnancy, characterized by the appearance of convulsion.

The development of eclampsia distinguish between four periods: 1) eclampsism characterized by edema, albuminuria and hypertension; 2) Preeclampsia, in which symptoms of intracranial pressure increases (headache, leaping vision, excitation, vomiting) are attached to the phenomena of eclampsism. 3) a convulsion period; 4) recovery period.

A typical eclampsia is characterized by a sudden appearance of convulsion, which sometimes precede pain in the epigastric area - a solar symptom of irritation.

At the beginning, the seal appears small fibrillar twitching, mainly the muscles of the person transmitted in the future to the upper limbs (this period lasts from a few seconds to half a minute). Then the most dangerous for mother and the fetus comes from 20 to 25 seconds, - appear tonic reductions of skeletal muscles, loss of consciousness, stopping the breath, sharp cyanosis of the skin and mucous membranes, the expansion of pupils, sometimes a woman bite tongue. After this period, clonic convulsions appear covering the torso, upper and lower limbs. Breathing becomes difficult, foam protrudes from the mouth (in the case of the bite of the tongue - with an admixture of blood). In the future, convulsions, gradually weakening, disappear. The duration of such a state is from 40 seconds. up to 1.5-2 minutes.

At the end of the seizure, the patient flows into a comatose state: it lies motionless, it does not have a consciousness, the breathing is noisy, hoarse. A comatose state can change the new attack. If this does not happen, the patient gradually comes into consciousness, normal respiration and sensitivity are restored; Usually there are generally brokenness and headache. The duration of the comatose state is different, sometimes it can last for hours, which, of course, impairs the forecast. At the end of the seizure, the patient does not remember anything about what happened. In particularly severe cases, the Eclampsia convulsive stage can fall out at all (eclampsia without convulsion).

With differential diagnosis, it is primarily necessary to distinguish the seizures of eclampsia from epilepsy. Recognition of the latter helps data of the history (seizures to pregnancy, lack of changes in the eye day, the rapid restoration of consciousness after the seplide).

Sometimes it is not easy to differentiate eclampsia from acute hypertensive encephalopathy, in which sudden attacks of tonic and clonic convulsion may also occur with the subsequent state of the deep coma, similar to those in the eclampsia. In these cases, the diagnosis can help know the knowledge of the clinical picture of hypertensive disease (see). The comatose state at eclampsia should be distinguished from the diabetic and uremic cola (see). Finally, it is necessary to keep in mind the possibility of hemorrhage into the brain.

The cause of segregation with eclampsia is considered to increase the reflex excitability of the cortex of the brain. Therefore, everything that can cause its irritation (generic pain, a rude outdoor or internal study, operational interventions without anesthesia, catheterization, etc.), reflexively can cause and convulsions.

The forecast for eclampsia depends on its clinical form and the characteristics of the flow of eclampsia, as well as on the time of its occurrence.

Eclampsia is observed during pregnancy (ECLAMPSIA GRAVIDARUM), childbirth (Eclampsia sub partu) and after them (Eclampsia Puerperalis). Began during pregnancy, Eclampsia can cause childbirth and end with them. It can meet the so-called intercurrent form of eclampsia, when the seizures began during pregnancy under the influence of treatment are stopped, pregnancy is preserved, then urgent delivery comes, and the seizures of the eclampsia are not repeated. In some cases, Eclampsia during pregnancy, the seizures stopped at first appear again (the recurrent form of eclampsia of pregnant women). Starting during pregnancy, the seizures can continue in childbirth and the postpartum period. Eclampsia Sub Partu can spread to the postpartum period.

There are three clinical forms of eclampsia.
1. Typical form. It occurs more often in pregnant hyperstatenic type, accompanied by large edema of subcutaneous fiber and tissues of internal organs, as well as an increase in intracranial pressure, severe albuminuria; At the same time, hypertension is observed.
2. Not quite a typical form. It is more common when protracted childbirth is predominantly in women with a laby nervous system; It is usually observed only by swelling of the brain, the edema of subcutaneous fiber does not happen. In such cases, only symptoms of increased intracranial pressure with moderate and changing hypertension are observed; Albuminuria, especially at the beginning, is missing at all.
3. The uremic form of eclampsia, which is based on nephritis, former to pregnancy or developing during pregnancy. More often occurs in pregnant asthenic physique. With this form of swelling of subcutaneous fiber and the tissues of internal organs, there are no or are weakly pronounced, which indicates the insufficient barrier function of the connective tissue. At the same time, free fluid can be accumulated in the abdominal and chest cavities, as well as in the fruit bubble.

In the liver there are severe degenerative changes to necrosis and hemorrhage inclusive. This liver and renal failure is due to general heavy intoxication, the depression of the CNS, high hypertension, and sometimes jaundice.

Eclampsia - Dangerous Mother and Fetal Disease. The causes of the death of the mother with it can be: asphyxia and circulatory disruption during convulsion; intoxication; hemorrhage into the brain; infection to which the body of a pregnant woman with eclampsia is particularly susceptible; pulmonary edema. Eclampsia occurs the harder, the longer the time passes from the start of seizures before delivery; Therefore, the earlier during pregnancy develops eclampsic cramps, the worse the forecast for the mother and the fetus. The recurrent form of eclampsia of pregnant women is especially dangerous; A more favorable forecast gives an intercurrent form that began close to the expulsion period of the fetus.

The most favorable forecast for a typical but not fully developed eclampsia in cases where the process is limited to the sphere of the CNS. More than such a "brain" form of eclampsia is observed in childbirth; Her seizures will be stopped immediately at the end of childbirth. Mortality with it, as a rule, is not observed. The typical, quite developed eclampsia proceeds. If it develops during pregnancy, then with proper and rational therapy can be cured, the pregnancy will develop further, and the eclampsia will flow according to the type of "interco-terrestrial" form. More rare cases of recurring eclampsia (during pregnancy), which proceeds extremely difficult.

Frequent causes of death with typical eclampsia are swelling of light and developing in this soil, and septic postpartum processes. As a result of the prolonged stage, the convulsion can appear asphyxia and cardiac arrest (the convulsive stage of the eclampsia goes into paralytic).

If, with a typical eclampsia, a cure, changes caused by an edema and blood circulation disorder, RESP occurs. Hypertension, soon disappear, the functional state of the organs is returned to the norm after a while. Thus, the forecast for typical eclampsia is relatively favorable. The exceptions are cases of eclampsia, developed in early pregnancy and shortly after delivery.

A less favorable forecast for an atypical uremic form of eclampsia, in which heavier damage to parenchymal organs, especially kidney and liver, is observed. With the same form of eclampsia, hemorrhages are more often observed in the brain, leading to death, as well as the "eclampsia without convulsion", in which the convulsive stage falls and immediately comes the paralysis stage. Changes in organs arising from the uremic form of eclampsia (nephritis, retinit et al.) Are almost not amenable to reverse development, the functional state of the organs for a long time remains disturbed. Therefore, the uremic form of eclampsia more often gives relapses for both this and the next pregnancy. The recurrent shapes of the eclampsia are extremely severe. The severity is also determined by the number of seizures, the duration of the intervals between them and the state of the patient at this time. All other things being equal, the eclampsia is harder in cases where the number of seizures becomes more when they are longer, the intervals between them are shorter, and the patient outside the seizures is unconscious.

To characterize the condition of the patient, the assessment of the tone of the cardiovascular system is of great importance. Frequent weak filling of the pulse serves as a sign of the occurrence of the paralytic stage. Often, the temperature rises.

Eclampsia is a severe complication of pregnancy, childbirth and postpartum period. It is characterized by a significant lifting of blood pressure and the appearance of convulsion against hypertension. In the absence of treatment, the eclampsia may cause the death of the mother and the child. No connection with pregnancy, the eclampsia does not develop.

The reasons

Eclampsia is a severe complication of gestosis and occurs in late pregnancy. In most cases, the emergence of this pathology is associated with the inadequate diagnosis of the gestosis of the average and serious degree and the absence of necessary therapy. Refusal of medical care and ignoring the recommendations of the doctor may cause the deterioration of the state of the woman against the background of gestosis until the development of the eclampsia and all its complications.

The exact cause of the gestosis and the accompanying eclampsia is still not known. There are several theories of this pathology. Most modern specialists adhere to the versions that Eclampsia is nothing but the absence of a normal adaptation of the woman's body to coming pregnancy. This theory cannot fully explain the entire variety of clinical manifestations of gestosis and eclampsia, but it allows you to at least assume the cause of the problem and thereby try to prevent its development.

Other versions of the development of eclampsia:

• The pathology of the trophoblast is the predecessor of Chorion (the absence of changes in the uterine arteries necessary for pregnancy and the accompanying violation of blood flow in the placenta).
• Genetic theory (the development of eclampsia in women predisposed to this).
• Immunity impairment.

Risk factors:

• endocrine pathology (obesity, diabetes mellitus.);
• preceding arterial hypertension and other cardiovascular pathology;
• violations in the hemostasis system;
• antiphospholipid syndrome;
• kidney disease;
• multiple pregnancy;
• infectious diseases transferred during pregnancy;
• harmful habits (smoking);
• age older than 40 and under 18 years old.

It is noted that Eclampsia is more often developing in the first pregnancy. If preceding pregnancy proceeded without complications, the likelihood of gestosis and its complications are not too high. In a situation where the first pregnancy was against the background of the gestosis, the risk of developing eclampsia is very high in the next child's conception.

A large interval between childbirth (10 or more years) also increases the likelihood of eclampsia. In this situation, the body "forgets" about how to enter the child, and adaptation occurs again. An additional risk factor in this situation is the age of a woman. As a rule, such a large gap between birth is found in women who decide to the birth of a second child after 35 years.

Development mechanisms

In the occurrence of gestosis and the subsequent eclampsia, the endothelium of vessels suffers. In the inner layer of the vascular wall, specific changes are developing:

• reduction of vessel elasticity;
• reduction of tone;
• activation of intravascular inflammation;
• increased risk of blood clots inside vessels.

All this leads to a violation of microcirculation, including in the uterine and placental vessels. Against this background, blood viscosity increases, its coagulation increases. Growing blood pressure, which leads to a violation of the functioning of vital organs: kidneys, liver, hearts. A polyorgan deficiency is developing, in the future, capable of leading the death of a woman and the fetus.

During pregnancy, changes in the placenta are always noted during pregnancy. The thrombosis of small vessels occurs, the foci of necrosis and hemorrhage occur. All this leads to a violation of hemodynamics in the placenta and the development of its functional failure. The pathology of the placenta in turn leads to insufficient admission of oxygen and nutrients to the fetus. The hypoxia of the fetus occurs, accompanied by the delay of its development and other complications. With the development of severe gestosis and eclampsia, the state of the fetus becomes critical, which often requires emergency delivery.

Eclampsia and gestosis

Eclampsia is a complication of gestosis and is always considered in connection with it. Without previous gestosis, the eclampsia does not occur. Knowing, as gestosis proceeds, you can notice pathology in time and take the necessary measures to prevent eclampsia.

Signs of gestosis:

• swelling;
• an increase in blood pressure;
• proteinuria.

Edema during pregnancy does not always talk about the development of gestosis. The moderate swelling of the hands and legs is considered the usual phenomenon in future mothers and does not require special treatment. If the blood pressure and well-being of a woman remains normal, only the dynamic observation of the doctor is shown. Daily blood pressure control, pulse attentive attitude to their health will allow you to notice the first signs of gestosis on time and take the necessary measures.

Arterial hypertension is a key symptom of gestosis. During pregnancy, clinical significance has an increase in systolic pressure by 30 mm Hg. Art., and diastolic - by 15 mm Hg. Art. from the source. Anxious signs are sharp blood pressure drops. Heavy complications of gestosis (including eclampsia) are often related precisely with rapid changes in blood pressure.

Proteinuria is the appearance of a protein in the urine. Such a symptom appears late and speaks about the defeat of the kidneys. A repeated increase in protein in the urine of more than 0.033 g / l and above requires special surveillance of a specialist.

The treatment of gestosis is carried out outpatient or in the hospital (depending on the stage of the disease). If the help was not provided on time, preeclampsia develops.

Preeclampsia is manifested by such symptoms:

• violation of vision (flashes of flies, appearance of pellets before eyes, weakening vision);
• headache;
• severity in the occipital region;
• nausea;
• vomiting;
• pain and discomfort in the epigastric region;
• insomnia or pathological drowsiness;
• excitation or apathy;
• memory disorders.

If any of these signs occur, a woman should be hospitalized as soon as possible to the obstetric hospital under the clock observation of doctors.

Special attention deserves the emergence of the following symptoms during pregnancy:

• enhance arterial pressure above 160/110 mm Hg. st.;
• violation of consciousness;
• reducing the volume of urine (oligulia) up to 400 g per day and less;
• proteinuria more than 5 g per day;
• hypercoagulating changes (according to a coagulogram or hemostasiogram);
• platelet reduction;
• liver lesion.

The emergence of at least one symptom of this list indicates a serious flow of gestosis and indicates a high risk of developing eclampsia.

Symptoms of eclampsia

A typical symptom of eclampsia is muscle cramps arising against the background of signs of heavy gestosis and preeclampsia. During childbirth and in the postpartum period, the eclampsia may arise suddenly without pronounced previous manifestations. In this situation, minor signs of gestosis are not taken into account during pregnancy, which leads to an inadequate assessment of the situation and the late formulation of the diagnosis.

The attack of convulsion with eclampsia lasts about 2 minutes and several stages passes:

The first stage

It lasts about 30 seconds. Accompanied by the appearance of small twitching muscles of the face, eyelids, limbs.

Second stage

The period of tonic convulsion. There is a reduction in all muscles of the body. Breathing is broken or missing. Consciousness is absent. There is cyanosis of the skin. This stage lasts only 15-20 seconds, but it can end the death of a woman as a result of hemorrhage into the brain.

Third stage

The period of clonic cramps. A convulsions are continuously running over each other. The convulsive wave applies to the body from top to bottom. There is no breathing, the pulse is not felt. The entire stage lasts 30-90 seconds, after which the convulsions gradually subscribe and stop. Breathing is restored, but remains rare and deep.

Fourth Stage

The way out of a convulsive seizure is accompanied by the appearance of foam from the mouth. Foam painted with blood. Cyanosis falls, skin spokes are pink. Breathing is gradually restored, pulse appears.

After the end of the attack, a woman can return to consciousness or go to whom. The memory of what happened is not saved. Even with the preserved consciousness, severe complications often occur:

• asphyxia;
• bruises and fractures;
• aspiration pneumonia;
• renal and liver failure.

Coma with eclampsia is associated with edema brain. If the comatose state continues more than a day, the forecast is considered unfavorable.

Dismissed eclampsia

A rare form of eclampsia. The future mother complains of a strong headache, darkening in the eyes and other violations of vision. Perhaps the onset of full blindness. Against the background of high blood pressure, the woman flows into a whom. Causes do not develop. This form of eclampsia is usually associated with hemorrhage to the brain and in most cases ends with a fatal outcome.

Consequences for fruit

High blood pressure, disruption of microcirculation in the placenta and insufficiency of vital organs - all this leads to pronounced fetal hypoxia. Symptoms grow together with the deterioration of the state of the woman. If the help is not rendered on time, the fruit dies intrauterine. The only way to save the child is an emergency delivery.

Diagnostics

For timely identification of gestosis and eclampsia:

1. Common blood test (the value has a decrease in platelets and an increase in hematocrit).
2. General urine analysis (pay attention to the presence of protein).
3. Coagulogram and hemostasiogram (to assess the condition of the coagulation system of blood).
4. Ultrasound (determination of the state of the fetus, the number of oily water, the degree of maturity of the placenta).
5. Dopplerometry (clinical significance has a violation of blood flow in uterine and fruit arteries).
6. KTG (to assess the heart activities of the fetus and the timely detection of hypoxia).
7. Control of blood pressure.
8. Control Diurea (Reducing the daily volume of urine is an unfavorable sign).
9. Weight control (fast weight gain can talk about the development of hidden edema and gestosis).

The recognition of the eclampsia on typical symptoms of difficulty is not available. Problems arise at the preeclampsia stage, as well as in the event of an inconsistent form. Pregnant women from the high risk group should be warned about the possible development of gestosis and eclampsia. With the appearance of the first signs of the disease, it is necessary to consult a doctor or call "ambulance".

Principles of treatment

Treatment of severe gestosis and eclampsia is carried out only in the hospital. With the development of preeclampsia and eclampsia, therapy begins immediately, where pathology has been identified: at home, in women's consultation, in the ambulance car or in the reception room of the maternity hospital. The actions of the doctor are aimed at restoring the functions of the internal organs and the prevention of complications.

The treatment of pregnant women with eclampsia is carried out under conditions of separation of intensive therapy at the same time as preparation for emergency delivery. Pregnancy at eclampsia is not prolonged. You can save the woman and her baby only with timely delivery and providing all necessary resuscitation assistance.

At the stage of preparation for the operation shows:

• monitoring the condition of the function of the heart, lungs, kidneys, nervous system and other organs;
• control over the state of the fetus;
• the relief of the seizures of eclampsia;
• prevention of new seizures seizures;
• decrease in blood pressure;
• intensive therapy for restoring the function of the nervous system and internal organs.

The binding scheme of the attack and the stages of intensive measures are developed by the Ministry of Health. Only with strict adherence to all events and constant monitoring for the state of women and the fetus can be hoped for a favorable outcome.

Treatment scheme includes:

• hypotensive therapy (magnesium sulfate and other means);
• anticonvulsant drugs.

The choice of medicines will depend on the severity of the state of the woman and the presence of concomitant pathology. With a breakdown, the woman is translated into IVL.

Rostroduction with eclampsia must pass within 2 hours from the moment of diagnosis. Priority is given to Cesarean section.

Intensive therapy continues in the postpartum period, ensuring vital bodies, prevention of convulsion. According to the testimony, antibacterial therapy is carried out, funds are assigned to reduce the risk of thrombosis.

Prevention

Specific medical prevention of eclampsia has not been developed. The following recommendations will help reduce the risk of severe complications of gestosis:

1. Regular observation of the gynecologist and the passage of all the necessary surveys in the deadlines.
2. Weight control (weekly).
3. Evaluation of daily diuresis.
4. Control of overall urine analysis and detection of proteinuria (before each appearance to the doctor or more often if there is indications).
5. Control of blood pressure (weekly at the doctor's reception and daily at home - women from a high risk group).
6. Treatment of all concomitant pathology to pregnancy or during nursing the fetus (special attention is paid to heart disease, vessels, kidneys, liver).
7. Timely therapy of the initial stages of gestosis and preeclampsia.
8. Starting hospitalization in the hospital for childbirth (if there is indications).
9. Evaluation of the hemostasis system and timely correction of violations identified.
10. Rational dating: inclusion in fatty fish, vegetable products, salt limit and sharp, spicy, fried dishes.
11. Refusal of bad habits (smoking, addiction to alcohol).
12. Moving lifestyle (daily walks, yoga for pregnant women, gymnastics, swimming).
13. Prevention of stress.
14. Reception of vitamins and sedatives (by testimony).

If the first signs of severe gestosis and eclampsia shows the hospitalization in the hospital. The fulfillment of all the recommendations of the doctor will help solve the problem, retaining the life and health of a woman and her baby.

Eclampsia is the heaviest stage of toxicosis of the second half of pregnancy (gestosis), which characterizes the pervasive seizures and sudden loss of consciousness. This is an extremely dangerous state that without treatment can lead to the loss of a child and the death of a pregnant woman.

Causes of eclampsia

The eclampsia of pregnant women is characterized by unexplained generalized convulsions against the background of preeclampsia. As a rule, it develops not earlier than the twentieth week of pregnancy. For 7-10 days after delivery, the development of postpartum eclampsia is possible.

The diagnosis is usually established according to the results of blood test and protein in the daily amount of urine. Also analyze clinical data, investigate the liver functions, determine the number of platelets, urates, measured electrolytes in serum. Most often, Eclampsia is found at primary women, if there is arterial hypertension or vascular disorders in the history. Also, risk factors are age up to 20 years, preeclampsia in a family history, an unfavorable outcome in previous pregnancies, obesity, multiple pregnancy and thromboembolic violations.

The reasons for the occurrence of eclampsia doctors are not established. They may be placental ischemia, heart attack or poorly developed uterine placental spiral arterioles. As a result, the fetus growth limit may be observed. A multicoping or diffuse spasm of vessels can lead to the development of ischemia, which ultimately causes multiple damage to various organs, including brain, kidney and liver.

Eclampsia is dangerous to the life of the fetus and mother of the state. The cause of mother death can be:

• Intoxication;
• Circulatory disorder and asphyxia during convulsion;
• Infection, which is particularly susceptible to the body of pregnant in the presence of eclampsia;
• Hemorrhage into the brain;
• Pulmonary edema.

The course of eclampsia of pregnant women depends on how much time has passed from the start of seizures before the delivery. Therefore, the earlier there are eclamps of convulsions, the worse the forecast for the fetus and mother.

Symptoms of eclampsia

The characteristic symptoms of the eclampsia are hypertension, albuminuria, swelling and signs of lesion of the central nervous system (convulsions, coma). Turning pathologist changes affect brain, kidneys and liver, but the most severe changes from the CNS, which occur in the form of a sharp edema of the brain and point hemorrhages are the most difficult. With a previously had hypertension, hemorrhages of large sizes may occur.

As a rule, the development of eclampsia is preceded by preeclampsia syndrome, in which headache is observed, vomiting, sharp pain in the opposite region. Various violations of vision can also occur - from bolding and flickering flies in front of the eyes to the temporary complete blindness.

Symptoms of eclampsia are manifested in several stages:

• Loss of consciousness after fixing the view at one point, the deviation of the head to the side, the appearance of fibrillar twitching of the mimic muscles (up to 30 seconds);
• The appearance of tonic convulsion, during which the head is leaving for the post, the whole body bends, breathing is delayed, jaws are compressed (up to 20-25 seconds);
• The appearance of clonic convulsions manifested by random contractions of the muscles of the body and limbs. This is a longer phase that ends with a whistling in-depth breath, the appearance of the mouth of foam and respiratory recovery.

They distinguish the eclampsia during pregnancy, in childbirth and postpartum eclampsia. If attacks are developing during childbirth, in most cases they are no longer repeated. Often, after the relief of the eclampsia, the predorance is delayed by medicines. However, with the ongoing symptoms of late toxicosis (especially albuminuria, hypertension), attacks can be repeated, resulting in postpartum eclampsia.

Dismaying eclampsia is a particularly difficult form at which a pregnant woman can fall into a severe comatose state, which subsequently leads to a fatal outcome. The most unfavorable symptoms of eclampsia are tachycardia, small jaggility and hypotension. Also there are sometimes atypical eclampsia forms with an easier flow (without pronounced hypertension or albuminuria).

In women who have undergone postpartum eclampsia, a severe complication may occur in the form of acute renal failure. At the same time, as the result of the necrosis of the cortex layer of the kidneys can develop Anuria.

Treatment of eclampsia pregnant women

The main method of treating eclampsia is a browser. Immediate birth at diligent pregnancy are carried out after stabilizing the state of the woman. If the term is less than 37 weeks, the risk of premature delivery must be balanced with the threat of preeclampsia and the reaction to the therapy conducted.

The treatment of eclampsia and preeclampsia is primarily aimed at improving the health of the mother, which is positively reflected in the state of the fetus. With a light manifestation of eclampsia and preeclampsia symptoms, an outpatient treatment is possible, including a strict bed mode, (lying on the left side), an increase in fluid intake, normal salt consumption and assessment of the state every 2-3 days.

Against the background of a poorly corrected moderate eclampsia, a woman, as a rule, is hospitalized. At first, for several hours, a stabilization treatment is carried out by the intravenous administration of 1 g of calcium gluconate.

Magnesium sulfate is administered intravenously (4 g for 20 minutes), after which it is necessary to carry out additional intravenous infusion of the medication. The dose of magnesium sulfate is calculated individually and varies depending on the reflexes, blood pressure and level of magnesium in serum.

Magnesium infusion intravenously can cause hypotension, lethargy or temporary oppression of breathing in a newborn, although serious complications are observed quite rarely. With the ineffectiveness of therapy with magnesium sulfate to stop the attacks of the eclampsia of pregnant women, valium or phenytoin and intravenous hydralazine infusion are prescribed.

The method of delivery must be chosen based on the state of the woman. With a mature cervix, rapid natural genera are possible to accelerate which oxytocin solution is injected intravenously. If the natural delivery is impossible, cesarean cross-section is carried out.

After delivery every 1-2 weeks it is necessary to undergo a survey. If blood pressure is not normalized after 2 months, doctors prescribe additional research for the diagnosis of chronic arterial hypertension.

Since the eclampsia is a very dangerous state, women from the risk group must be found in advance from the doctor about the possible symptoms of its occurrence and when developing late toxicosis, carefully refer to their health. If you do not carry out the treatment of eclampsia, a fatal outcome is possible, so when the first alarming symptoms appear, it is necessary to immediately apply for medical help.

From the earliest time of pregnancy, a special system of interaction between the mother of the mother with the embryo is formed. In gynecology, she was named "System of the Placenta Fruit System. Thanks to her, the body of a woman does not rejected the embryo, but on the contrary: contributes to its preservation and development.

However, a part of pregnant women can have a violation of this system, which leads to an eclampsia - a state at which there is a dysfunction of vital organs of the mother, carrying a direct threat of both the life of a woman and the life of the fetus.

To date, there is no consensus about why this ailment begins, but it is reliably known that its appearance is characteristic only for pregnant women, feminine and herds. In obstetric practice, two states of late gestosis are distinguished: preeclampsia and eclampsia, but what is such a simple language?

Preeclampsia - This is a condition in which the defeat of the nervous system, liver, kidneys occurs, arterial hypertension is developing.

- This is a state requiring emergency hospitalization, it can develop in patients with preeclampsia, as well as exist as an independent form of severe disease.

Causes of eclampsia in pregnant women

Because the eclampsia is a violation of the functioning of the system of the Mother Placenta Fruit, then the diseases are the diseases that have already had a woman before the conception of the child. During pregnancy, these pathologies can be a starting mechanism by the beginning of a severe degree of gestosis. Among the reasons for the eclampsia, the following is distinguished:

1. Fetoplacentage insufficiency (FPN) is a condition in which the placenta bleeding begins to function badly. Evaluate the condition of the arteries can only doctor during doppler-research.
2. Thrombophilia is a genetic disease involving a special mutation of genes that provoke thrombosis. During pregnancy, thrombophilia becomes active and in late terms is the cause of the development of FPN.
3. Mutations of the Enos gene - influence the work of the vessels. If there is a genetic defect, the woman's body can perceive the fruit as a foreign body and try to get rid of it.
4. Defects attaching placenta to the walls of the uterus - determine the deterioration in the nutrition of the fetus, provoke the appearance of FPN. With this pathology, the circulation of blood flow can be formed both gradually and suddenly.

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

• Chronic hypertension;
• Multiple pregnancy;
• The presence of eclampsia or preeclampsia in an obstetric history;
• The presence of eclampsia or preeclampsia in the obstetric history of mother, grandmother, aunt or sisters;
• Comborn women (age for over 40 at the time of pregnancy).

Particularly close attention to the state of the patient should be given if one or more risk factors of the development of gestosis are combined with the fact that the woman puts the first pregnancy in the account.

Types of disease

In general, the eclampsia can be divided into two types: according to the severity of the disease and the time of its occurrence. Depending on this, the treatment regimen will be determined and the risk to mother and fetus health is evaluated.

The Russian classification of the stages of the development of gestosis is somewhat different from the one that is adopted in Europe. According to domestic specialists, Preeclampsia is the initial stage of the eclampsia.

Severity of the disease

• Easy preeclampsia - implies blood pressure in the range of 140-170/90 - 110 mm Hg. Art. At the same time, in the analysis of urine, proteinuria will be determined - (more than 0, 3 g / l).
• Heavy preeclampsia - implies blood pressure above the border of 170/110 mm RT. Art. Proteinuria is pronounced.

Disease occurrence time

• Eclampsia during pregnancy - meets most often, rushes a threat to the life of the mother and child. Treatment is complicated by the fact that the fruit may not transfer certain preparations to relocate attacks.
• Eclampsia for childbirth - occurs about 20% of all cases, rushes a threat to the life of a woman and child. In this case, the provocative of attacks is a generic activity.
• Eclampsia after childbirth - arises very rarely, develops within a day after the child's appearance.

Signs of eclampsia and symptoms

Despite the variety of species, signs of eclampsia have a certain similarity, so they can be allocated in a general list:

• Increased arterial pressure - depending on how much it has increased, the doctor will determine the severity of the disease.
• Evenkers - the heavier condition of the patient, the more powerful is the delay in the fluid in its body. Swells, mainly the upper part of the body (face, hands).
• A series of convulsive seizures - numerous, lasts 1-2 minutes. The gaps between the cramps are small. Loss of consciousness is short-lived.
• Eclampsic status - a series of convulsive seizures in which the patient is in a coma and does not come into consciousness.

Characteristic of a convulsive segment

The attack begins with involuntary contractions of the facial muscles. After a short period of time, the whole muscles of the body is involved in the process. The woman loses consciousness, the clones of the limbs appear. After a series of clonus comes coma.

Diagnostics

The diagnosis is complicated by the fact that eclampsia has no specific symptoms that would only meet it. Cramps, swelling and proteinuria can be symptoms of other diseases that do not have any relationship to pre-pre-predose.

Currently, the problem of determining the eclampsia is actively studied, and for the diagnosis, doctors apply special surveys and analyzes that reveal the initial stage of the disease - preeclampsia:

• Systematic measurement of blood pressure. Moreover, to confirm the eclampsia, it is necessary to monitor the state of blood pressure in the dynamics.
• Urine analysis to determine the amount of protein. The daily sample () is important here.

If the indicators say the presence of preeclampsia, then subsequent convulsive seizures will indicate that the pathological processes in the body of a woman entered into the most serious stage of their development - eclampsia.

Since severe degrees of gestosis assume the presence of convulsive seizures, then self-examination must be completely eliminated. The first aid for eclampsia will be reduced to the following actions:

1. Call an ambulance (most likely to send reanomobil).
2. Woman to put on the left side, around her the rollers from the blankets around it. This precaution will help the patient to avoid injury before the doctors arrival. In addition, such a pose will provide free outflow of foam distinguished during an attack.
3. Language to fix in order to avoid its blur in the cavity of the pharynka.
4. In the intervals between the attacks, remove the variest masses and foam.

You can stop the repeat series of seizures using intravenous administration of magnesia (20 ml of 25% solution for 30 minutes).

It is important to remember - in emergency cases you can call the number 03 and ask the doctor's duty to give you instructions to the actions that need to be taken until the ambulance team is on the way.

Treatment of eclampsia pregnant women

Heavy gestosis therapy consists of two stages. First you need to stop convulsions, and then reduce blood pressure. At the same time, it is necessary to eliminate edema to facilitate the state of the woman.

However, this is only auxiliary measure in the treatment of eclampsia. The main actions should be pressure normalization and anticonvulsant therapy. It is important to adhere to a certain sequence in the appointment of treatment.

Thus, the reduction in pressure without eliminating seizures will not give the expected effect and will generally be difficult, as the pregnant woman will not be able to take tablets or medicine due to the high tone of the muscles, which occurs during convulsive seizures.

Anticonvulsant therapy

All medicines designed to relieve seizures can be divided into three categories:

1. Preparations intended for emergency exposure: 25% Magnesia solution, Droperidol, diazepam.
2. Preparations intended for supporting therapy: 25% magnesia solution in dosage 2 g per hour, Fulged, Seduksen, Andaxin.
3. Preparations that enhance the sedation effect: Dimedrol, glycine.

Dosage should be prescribed a doctor. All anticonvulsant drugs have a property to significantly relax muscles and cause excessive drowsiness. If the attacks of the eclampsia managed to stop and the rootorization did not take place, then the therapy should be repeated for the entire period of pregnancy to avoid new manifestations of gestosis.

Hypotensive therapy

It is carried out after the convulsion relief. It is important not to immediately reduce the high blood pressure, but also to keep it within the normal range is not easy if, with eclampsia, it was decided not to make an emergency delivery.

• Preparations intended for emergency exposure: nifedilin, sodium nitroprusside (intravenous, maximum - 5 μg per 1 kg of weight per minute.)
• Preparations intended for supporting therapy: methyldop.

Tools against high pressure should be made before the end of pregnancy, so that the attacks do not repeat. Hypotensive therapy must be carried out primarily only if the patient has a threat of hemorrhage into the brain.

In severe cases, the eclampsia is shown in the quality of treatment, regardless of the period of pregnancy and the state of the fetus. In this case, the life of the mother is worth the life of the mother, so all possible measures should be taken to rescue. However, the following conditions must be complied with the organization of labor:

• Cramps must be stopped. It is only a few hours after the termination of the binding to start starting the delivery procedures.
• If possible, childbirth must be made through natural ways. Cesarean section involves general anesthesia, which can provoke a new wave of convulsion after exiting anesthesia.
• Generic activity must be stimulated by artificially. It is important to meet during the period when the attack retreated - when it renewed the muscle of the whole body will come to the tone and the birth of the child will become difficult.

Prevention

Preventive measures to prevent the eclampsia are appointed either those patients who had this a history of the previous pregnancies, or those whom the attacks have already happened and there is a need to prevent new ones.

Gynecologist can assign calcium preparations or aspirin. Depending on the state of the woman and the fetus, these drugs are prescribed for the entire period, or at some specific period of time until the doctor is convinced that the patient is out of danger.

The treatment of eclampsia in a pregnant woman requires an immediate intervention of a specialist, so all the actions of its relatives should only be reduced to the first aid before the arrival of the Medical Brigade.

Eclampsia is the most severe stage of the late toxicosis (gestosis). Unlike early toxicosis, eclampsia syndrome pays a huge danger not only for the health of the fetus and the future mother, but also the lives of both of them.

Pathology wears a spontaneous sudden character, develops very quickly, so it is very difficult to predict its consequences. The emergence of eclampsia is preceded by the appearance of edema, the presence of protein in the urine, an increase in blood pressure.

The state does not belong to independent diseases and occurs only during the period of tooling the child, during the delivery, in the postpartum period. It is usually associated with severe disorders in the pregnant system - a placenta - the fruit and is a combination of strong lesions of the central nervous system, which in the most severe cases manifest itself by the development of convulsion and coma.

In more than 90% of cases, Eclampsia occurs after 28 weeks of pregnancy, very rarely (not more than 1%) to 20 weeks. Diagnosis is not difficult, so modern medicine extremely rarely notes heavy complications after the attack.

The reasons

Definitely determine why eclampsia occurs in pregnant women, it is impossible. There are many theories, but none of them is 100% reliable. Doctors allocate a number of predisposing factors, whose ignoring can lead to the development of pathology. These include:

• hypertensive states;
• the presence of similar attacks in previous pregnancy;
• chronic internal organs (severe kidney lesions, heart disease and vessels, diabetes, severe obesity form);
• the first birth in the early (up to 18 years) or later (after 35 years old);
• bad uterine blood flow;
• disorders in the placenta;
• eclampsia near the nearest relatives.

The risk of a pathological state increases if the time interval between pregnancies exceeds ten years. Most often, eclampsia is observed during pregnancy (up to 70% of cases). During childbirth, the indicator is about 25%, after delivery - no more than 2-3%.

Symptoms

The emergence of pathology precedes the state. For him are characterized by such signs: protein in the urine, hypertension, swelling. Eclampsia syndrome can develop if there are even one or two of the above factors.

The most common manifestation of late toxicosis is swelling. Usually they arise on the legs and arms, in the future spreading to the area of \u200b\u200bthe face and neck, as well as the whole body. Edema has a pathological character, they not only do not decrease after night rest, but also lead to a rapid weight gain (more than 500 g per week).

Normally, there is no protein in the urine. In pregnant women, a permissible indicator can be 0.333 g / l per day. If the indicators exceed this norm, we are talking about proteinuria, a woman in this case should be under the strict observation of the doctor.

The protein in the urine is present in more than half of women with symptoms of preeclampsia. However, in 14% of pregnant women analyzing the urine analysis correspond to the norm.

The risk of pathology is rising in arterial pressure of 140/90 mm. RT. Art. (moderate form of illness), 160/110 mm. RT. Art. (severe form).

Other threatening factors are:

• sharp headache, dizziness;
• nausea and vomiting;
• pain in the area of \u200b\u200bthe stomach and liver;
• problems with urination;
• strong swelling of the whole body;
• impairment of vision, the appearance of "flies" before the eyes

It is noted a pathological change in blood composition - a decrease in the number of platelets, the destruction of the erythrocytes. The presence of edema, increased pressure and elevated protein concentration in the urine allows you to diagnose "moderate eclampsia". In severe cases, the development of a convulsive filling and fetal death is possible.

The main signs are convulsive seizures that end with fainting, and in severe cases. The eclampsia is characterized by increasing headaches, chronic sleep disorders, sharp leap of blood pressure. Deep lesions of the nervous system organs increase brain excitability. Exposing cramps can external irritants of various intensity: bright light, sharp movements, strong noise.

Several stages can be distinguished in a convulsive fit:

1. Voltage and fine face shakes, general condition deteriorates sharply.
2. Stretching the entire body, external bend of the spine, cutting muscles. Convulsices are noted, eye rigging, change of pulse, respiratory disorders. This stage of a convulsive seizure is the most dangerous because it leads to the risk of a complete stopping of breathing, hemorrhage into the brain and to possible death.
3. The body of a pregnant woman is exposed to strong convulsions that replace each other. The convulsive fit lasts about a minute. A sharp disorders of breathing and pulse are characteristic, the appearance of foam from the mouth, the selection of blood from the bite of the tongue. Gradually, convulsions are weakening, breathing is normalized, skin covers acquire their natural color.
4. Return of consciousness. Within a few minutes, the woman comes to himself, her pulse and breathing normal is normal, pupils are narrowed. Memories of the transferred is not preserved.

After the seizure, the condition gradually stabilizes, but there are often cases when convulsions are completed. This condition can continue from a few hours to several days. It presents a real threat to mother and fetus health.

The classification of the disease, depending on the main symptoms and the degree of their severity, includes:

1. A typical form - there is a high pressure, skin swelling, a high amount of protein in the urine.
2. The atypical form is the most often symptoms appear with a long-term delivery. With this form of the disease, the brain swelling is diagnosed, while other symptoms are expressed slightly or absent.
3. Radishes - arises with severe kidney pathologies.

When glomerulonephritis, an acute inflammatory process in the kidneys, skin swelling can be insignificant with excessive accumulation of fluid in the abdominal cavity and fetal bubble.

Diagnosis and treatment

As already noted, the disease is vividly pronounced, so its diagnosis does not represent much difficulty. The situation is often exacerbated by the fact that a convulsive fit arises sharply and leaves no time to gynecological examination or conducting an ultrasound. Typical signs help to distinguish the eclampsia from the epileptic seal, as well as from the diabetic coma.

Before doctors there is a task in time to identify the forerunners of the late toxicosis and prevent their transition to the hardest form.

Preliminary diagnostic, they are preventive measures include:

• survey of the patient about the time of the appearance of the first symptoms, such as swelling, headache, pressure jumps;
• analysis of possible diseases of the internal organs that arose both before and during pregnancy;
• general blood and urine tests;
• fetus and state of internal organs;
• regular control of blood pressure;
• identification of edema, evaluation of their severity and location;
• electrocardiogram.

The timely conduct of diagnostic measures at the preeclampsia stage will not allow the state of the future mother to move into the easter eclampsia. If this is not done, the risk of complications is increasing, such as severe heart failure, stroke or paralysis, mental disorders, coma and sudden death.

Very often an attack of elampsia occurs when a woman is away from a medical institution, where immediate assistance will be provided. First of all, it is necessary to cause ambulance without delay. In anticipation of physicians should be rendered attendance.

Promotional and urgent help

Pregnant need to be put on the left side to prevent ingestion of vomit masses and blood. It is better if it will be on a soft surface that will help avoid extra injury. It is not necessary to hold the patient during convulsion.

After the seizure, it is necessary to clean the mouth and nose from mucus, foam, vomit and blood. When a woman comes to himself, it will take to make all the strength to calm it and prevent additional emotional stress.

Emergency care at eclampsia is, first of all, anticonvulsant therapy. Patient intravenously introduced magnesium sulfate (magnesia). After the first primary dose, the maintenance dosage is prescribed in the form of a solution of magnesia and saline. Such therapy is necessary for the entire time while the danger of eclampsia is preserved.

Therapy

The treatment of eclampsia should be directed to the normalization of blood pressure, the correction of the brain, the restoration of circulation and blood coagulation. Prescribed medication therapy, the purpose of which is to bring blood pressure to the norm. Preparations of nifedipine, nitroprusside sodium, operated. Accurate dosages identifies the doctor.

Preparations used in eclampsia therapy

Diuretics are prescribed to remove strong edema, and to improve brain metabolism - glucose. Since after an attack, a patient may have a severe psychological state, it is prescribed sedatives (soothing) drugs. The treatment of eclampsia implies the attraction of a neurologist and neurosurgeon.

The convulsive condition carries danger and for the future child. There is a risk of premature detachment of placenta and lack of oxygen intake for the fetus. The forecast of the disease is not always favorable and depends on several factors: the severity of the seizure, the period of pregnancy, the timeliness of the provision of qualified medical care.

Rhodework

After the end of the convulsion, doctors decide on the delivery. With a moderate form of pathology, pregnancy is possible to 37 weeks. Heavy forms pose a threat to the life of a woman and child, so the delivery is carried out, regardless of the period during the day.

There is an erroneous opinion that the eclampsia syndrome requires exclusively a delivery by means. However, if the condition is not complicated by or some other medical records, there is no need for a cesarean section. On the contrary, childbirth naturally in this state is more preferred. It is necessary to accelerate labor produced by the gentle methods: opening the fruit bubble, turning the fetus.

Although the typical period for the development of eclampsia is the time of having a child, sometimes there is a rapid eclampsia in childbirth. Such a state occurs with the prolonged fights, inappropriate to anesthesia, strong generic activity, when the process of opening the cervix and expulsion of the fetus occur too quickly. Symptoms of syndrome similar to similar signs arising during pregnancy.

Eclampsia after childbirth is developing, as a rule, in the first two days after the birth of a child (there are cases of late eclampsia, which occurred in a few weeks after delivery) and happens quite rarely. Treatment of pathological condition is carried out with the help of the same therapeutic methods as during pregnancy.

Treatment in Stroganov

For successful treatment with eclampsia, Principles of Strogan are used. Thanks to the use of these methods, mortality decreased by 5-6 times.

Principles of Stroganov include the following measures:

1. Women's room in a darkened room, where there are no noise or visual stimuli. Treatment (injections, catheterization) are carried out with inhalation anesthesia.
2. Getting rid of seizures with morphine hydrochloride and chloralhydrate, the introduction of which was carried out according to a specially developed scheme.
3. Rhodework with the assignment of obstetric forceps, the rupture of the fetal shells.
4. Medical therapy aimed at maintaining the normal functioning of the lungs, heart and kidneys.
5. Blooding 300-400 ml.

Over time, some principles of Strogan have undergone certain changes. Thus, the drug morphine and chloralhydrate, which inhibitively act on the central nervous system, were replaced with magnesium sulfate and oxygen ester. In order to prevent oxygen starvation of mother and child, inhalation of oxygen is carried out.

Blooding reduces vessel spasms, which allows pressure indicators to normal, improve the functioning of the kidneys and lungs. Blooding does not produce if urgent delivery is planned.

Due to the optimal combination of traditional and modern treatment methods, the state today belongs to rare pathologies, and mothers mortality and fetal death occurs only in the most extreme cases.

Women who suffered eclampsia during pregnancy or childbirth should be under thorough medical supervision of the entire postpartum period. Regular blood pressure measurements are needed, conducting overall urine analysis every two to three days in order to track the presence of protein. Special attention is paid to the activities of the cardiovascular system, respiratory and sexual areas.

Children need in very careful care. In such kids, there is a tendency to infectious and viral diseases, allergic reactions, diseases of the nervous system and other pathologies.

Prevention

Preventive measures aimed at minimizing the risk of development of pathology are as follows:

1. Registration registration no later than 12 weeks.
2. Regular observation by a gynecologist, visiting consultation monthly in the first half of pregnancy and every two weeks in the second.
3. Treatment of chronic diseases of the internal organs at the pregnancy planning stage.
4. Control over blood pressure.
5. Delivery of general analysis of urine at least once a month in the first 20 weeks of pregnancy and two times a month in the subsequent period.
6. Timely identification and elimination of the first signs, fighting edema.
7. Compliance with the principles of proper nutrition (inclusion in the diet of nonostic food, rich in vitamins, fresh vegetables, fruits and greens, restriction of oily food and salt).
8. Exception of excessive physical exertion, psychological peace.
9. Sufficient stay in the fresh air, regular walk in the fresh air, moderate sports load, sleep at least 8-9 hours per day.

The prevention of the development of eclampsia contributes to the receipt of minor doses of aspirin from the moment of detection and until the 20th week of gestation and calcium drugs throughout the entire period of the child's dentition. Receiving these medicines should become the norm for those women who are included in the risk group. Also, for prevention, iron preparations are recommended, folic acid, magnesium, vitamins E and C.