Late gestosis in pregnancy: what is dangerous, causes, emergency care, prevention

Late gestosis is a form of complicated pregnancy, during which there is a metabolic disorder and disruption of the normal functioning of the main organs and systems. It is accompanied by severe nausea, vomiting, edema, and intoxication. Sometimes this disease is called late toxicosis. The main period of development of this pathology is the second half of pregnancy. The progression of the disease occurs until childbirth.

Numerous studies are being conducted, attempts are being made to identify the exact cause of the disease and select the most effective treatment. But so far these attempts have not been crowned with the expected success. Most researchers are inclined to believe that gestosis is a consequence of improper regulation of vital processes by the endocrine system. Others believe that gestosis indicates that the fetus and mother are genetically and immunologically incompatible with each other.

The frequency of this pathology is steadily increasing from year to year. This is explained by the fact that the number of women who give birth at a later age is significantly increasing. More and more women give birth after reaching 35 years of age, which was considered practically unacceptable and extremely unsafe earlier. Such pregnancy is usually complicated by a large number of chronic pathologies, acts as an additional burden on the body.

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Epidemiology

Gestosis affects approximately 10-15% of pregnant women. The consequence of this pathology in most cases is maternal mortality, the percentage of which is 40% of all obstetric causes of death.

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Causes late gestosis

Despite the fact that numerous studies are being conducted, scientists from different countries of the world are trying to find an answer to the question about the nature of the development of gestosis, the exact reasons have not yet been established. It remains only to assume. Various theories are being considered, which in general can explain the origin of toxicosis in the late stages.

The following theories are considered to be the most recognized and significant: corticovisceral, endocrine, immunological, genetic, and placental.

The corticovisceral theory of gestosis is aimed at considering this pathology as a neurotic disorder of a pregnant woman, which is accompanied by a sharp disruption of the normal functioning of the cerebral cortex and the corresponding subcortical structures. The connection between these elements is disrupted, as a result, failures occur in the regulatory processes aimed at controlling the activity of the entire organism. The normal functioning of the circulatory system is disrupted, the process of hematopoiesis itself is disrupted, which entails disruptions in the blood supply to various organs.

If we consider gestosis from the point of view of endocrine theory, it can be represented as a violation of the regulation of the cardiovascular system. As a result, the blood supply to the internal organs is disrupted. Tissues and cells suffer from an excess of waste products and a lack of nutrients and oxygen. Blood circulation continues to deteriorate, toxins and metabolic products accumulate in the body, and intoxication of the entire organism develops. In addition, the necessary hormones, tissue regulators, and biologically active substances cease to be produced. The tone of blood vessels and internal organs is disrupted, as well as the fluidity, coagulability, and basic properties of blood.

From an immunological point of view, gestosis is a change in the state of protective mechanisms, including non-specific protection mechanisms. There is a failure in the body at all its levels: cellular, tissue, organ. Blood elements and mucous membranes also undergo changes. As a result, the immune system becomes disoriented and ceases to recognize the cells of its own body, perceiving them as foreign. Antigens begin to be produced against them, aimed at destroying the latter. This process is called autoimmune. An active struggle between the mother's and the fetus's organism unfolds, their survival is jeopardized. The danger is that the antigen elements produced act both against the pregnant woman's body and against the fetus, leaving neither of them a chance of survival.

The genetic theory is based on statistically confirmed data. Gestosis is more common in women whose mothers also suffered from gestosis. Some scientists even suggest that there is a "preeclampsia gene", the presence of which is fraught with the development of such an extremely dangerous condition as gestosis.

The origins of the placental theory are based on the assumption that the processes typical of a pregnant woman do not occur in the uterus. The uterine vessels do not undergo the required changes. They do not develop the ability to nourish the placenta. Such vessels begin to be perceived as damaged and foreign, and the body starts synthesizing biologically active substances, as a result of which the situation only worsens. First, the placental vessels are damaged, then the vessels that provide blood supply to the uterus and its mucous layer are transformed. Ultimately, the general vascular bed is disrupted, blood and lymph stagnate, and intense edema develops. The danger lies in the damage to both the cavity vessels and the vessels of the internal organs. This entails a disruption in the functioning of the entire organism.

As a result of processing all available data and analyzing existing theories and assumptions, scientists come to the general conclusion that the cause of gestosis is not limited to one factor, but implies the combined action of several factors. Together, they disrupt the normal functioning of not only the uterus and placenta, but also the mother and fetus.

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Risk factors

Women giving birth for the first time and giving birth late, as well as those expecting twins and underage pregnant women are at a significant risk of getting gestosis. Those suffering from chronic diseases, having genitourinary and venereal infections, giving birth every 2 years are at a higher risk. Such diseases as chlamydia, ureaplasmosis, mycoplasmosis are especially dangerous. Any concomitant diseases are an additional risk factor.

Previous colds, viral diseases, stress and nervous strain increase the risk of gestosis. Women with a family history of gestosis (their mother or grandmother had similar problems) are subject to special monitoring.

Those at risk include those who have polyhydramnios, multiple pregnancies, women with a large fetus, anemia, a history of miscarriage, and those who have Rh incompatibility and have had severe early toxicosis.

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Pathogenesis

Unlike the causes, which have not been studied enough, the pathogenesis of the disease is known in full. The main pathology is spasm, which affects blood vessels. Moreover, the spasm affects all blood vessels of the body: vessels of the large and small circle of blood circulation, the brain, the placenta and even the coronary vessels of the brain.

The heart becomes weak, the speed and volume of blood circulating through the vessels decreases. As a result, the internal organs, and especially the cells and tissues, receive less blood. This significantly worsens the metabolic processes in the body, contributes to the accumulation of toxins and metabolic products in the blood. Also, the cells stop receiving the substances they need. Ultimately, dystrophic processes occur in the cells and tissues, they are subject to degenerative processes. It can end in the death of cells and tissues.

The cells most sensitive to lack of blood circulation are the brain, as well as the kidneys and liver. The placenta, which largely consists of blood vessels, undergoes the most severe changes, since it is very sensitive.

In gestosis, it does not supply the fetus with the necessary amount of oxygen and nutrients, does not provide a full exchange between the mother and child, and does not completely remove metabolic products. The consequence is high intoxication of the body, oxygen starvation.

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Symptoms late gestosis

Late gestosis is not a single disease, but a whole complex of pathologies and critical conditions that develop in the second half of pregnancy. Signs of gestosis can be very diverse, and sometimes it is difficult to immediately make the correct diagnosis. Additional research and systematic observation are required.

The main symptom is the appearance of nausea and severe swelling in the second and third trimesters, heaviness in the legs, severe headache. Gradually, these symptoms increase, the condition worsens. It becomes difficult to walk, the load on the heart and legs increases.

The first signs that indicate gestosis make themselves known at about 28-29 weeks. Situations in which arms and legs swell, and severe swelling of the face should cause concern. This condition is often called "dropsy". In this condition, the face and body seem to be filled with water and become waxy. Pressing leaves a mark, a depression is formed, which takes a long time to smooth out.

Constant control over the situation is important, since the situation progresses quite quickly. If the swelling is not pronounced enough, the disease may not be noticed and timely measures may not be taken, which is fraught with consequences. It is necessary to closely monitor the condition, since if the swelling is not pronounced enough, the woman may not notice it. Also, ensure constant weight control, especially in dynamics. On average, weekly weight gain is 350-500 grams. These indicators can significantly exceed the norm, this may indicate that fluid is retained in the body, which results in the development of gestosis.

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Stages

Stage 1 is called hydrocele of pregnant women. This is the condition in which the first signs of the disease appear.

The second stage is nephropathy, which causes severe kidney damage and other deep lesions of the viscera. The parenchyma and glomerular apparatus are damaged. This is manifested by edema. It becomes difficult to breathe, difficult to walk. Blood pressure increases sharply. An alarming sign is the appearance of protein in the blood and urine. High protein content indicates a serious condition of the body and an unfavorable prognosis. Gradually, more and more fluid is retained in the body, and the amount of urine excreted decreases.

The third stage is an even more severe stage, in which preeclampsia develops. At this stage, urgent measures are already required. Preeclampsia is accompanied by the development of nephropathy, severe kidney damage. Edema is added to all this. Vision is impaired, various circles appear, which are often called "flies" by the people, a veil appears. If urgent measures are not taken, the final stage - eclampsia - occurs.

The fourth stage is eclampsia. There is a loss of consciousness, frequent dizziness, convulsions. This stage usually ends in death.

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Forms

The types of late gestosis correspond to its stages of development. Accordingly, 4 main forms of gestosis can be distinguished:

• dropsy of pregnant women;
• nephropathy;
• preeclampsia;
• eclampsia.

Pure gestosis is also distinguished, in which the health condition is satisfactory, pathologies are not detected and the pregnancy proceeds normally. In combined gestosis, a large number of concomitant pathologies and diseases are recorded, a high level of neuropsychic overstrain.

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Complications and consequences

The consequences are premature birth. This is due to both the natural premature birth of the baby and the need to induce artificial labor. In many cases, urgent delivery is the only correct option that allows you to save the life and health of the mother and child. In some cases, there is a need to induce premature labor, in others there is a need for an urgent cesarean section.

The consequences also include placental abruption with its normal location. This ends in fetal death and hypoxia, intrauterine death. A frequent consequence is hemorrhage. Gestosis can end in a convulsive seizure, bleeding, and the development of DIC syndrome.

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Diagnostics late gestosis

Confirmation or refutation of the presence of gestosis is not limited to a simple visit to the doctor and examination. The doctor must prescribe laboratory and instrumental studies. Systematic observation by an obstetrician-gynecologist is also necessary. Observations are recorded dynamically.

It is necessary to have a picture of changes in dynamics. It is necessary to clearly know how blood pressure changes. Moreover, the pressure must be measured on both arms. It is important to know how the pulse changes. It is also necessary to monitor changes in body weight in dynamics. An increase in pressure above 135/85 may indicate the presence of gestosis. Weight gain should not exceed 500 g per week. Large weight may indicate fluid retention. It is necessary to know how much urine is excreted per day, whether there have been changes towards a decrease in daily diuresis. It is also necessary to monitor the presence or absence of protein in the urine. In addition, consultation with specialists such as an ophthalmologist, neurologist, and nephrologist is necessary.

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Tests

If a woman is diagnosed with gestosis, a fairly large number of tests will be required. First of all, blood is taken and a general clinical examination is conducted. The number of red blood cells and platelets in the blood can provide significant information. A biochemical blood test determines the amount of protein, which is an important diagnostic sign. The concentration of electrolytes is also important, indicating the general condition of the body, the state of metabolism. Urea and creatinine levels are important.

Additionally, the coagulation and fluid properties of the blood are examined. One of the main ones is urine analysis. In this case, a regular clinical urine analysis is carried out, as well as a biochemical and daily urine analysis. The amount of protein in the urine is necessarily taken into account. Strict diuresis control is carried out. If the doctor has an idea of how the fluid is distributed in the body, what the dynamics of its distribution and excretion are, many important conclusions can be made and an adequate solution can be chosen. It is important to know the ratio between the amount of liquid drunk daily and the excreted liquid. This information can be obtained by tracking changes in body weight over time.

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Instrumental diagnostics

To obtain additional information, if necessary, such studies as fetal ultrasound with Doppler, fetal cardiotocography are carried out. Important information can be provided by daily blood pressure monitoring and daily electrocardiogram. If necessary, a hemostasiogram can be performed.

An examination of the fundus is mandatory. This is due to the fact that gestosis affects all vessels, including the vessels of the eye. The condition of the vessels of the eye is similar to the condition of the vessels of the brain and the vascular system as a whole. A mandatory additional consultation with an ophthalmologist, therapist, nephrologist, and neurologist is also prescribed.

Differential diagnosis

Late gestosis of pregnancy must be differentiated from hypertension, kidney diseases. The closest clinical picture is observed in glomerulonephritis and pyelonephritis. However, these diseases can be distinguished by the onset of the disease and the current anamnesis. Gestosis first appears at 28 weeks of pregnancy. Other diseases can manifest at any time, including before pregnancy. A distinctive feature of gestosis is spasm of the eyeball. Such pathology is not observed in other diseases. Edema and decreased diuresis are observed only in gestosis and glomerulonephritis.

In order to make an accurate differential diagnosis, the results of the tests, as well as the urine test according to Nechiporenko, will be required. If necessary, a bacteriological test can be carried out, which allows the development of bacterial infections to be excluded. Most often, urine is subjected to this test. In case of excessive bacterial contamination, additional antibacterial therapy can be carried out.

Treatment late gestosis

In case of mild manifestations, in the early stages of the disease, outpatient treatment is carried out. In case of severe manifestations, it is necessary to hospitalize the pregnant woman. This is necessary in order to conduct daily monitoring, track changes in the main indicators in dynamics, and also makes it possible to apply full and comprehensive treatment. In addition, the patient will be under constant supervision of medical personnel, which will help to avoid complications and, if necessary, take urgent measures. The patient is hospitalized in the obstetric department.

Treatment of the initial stages mainly includes drug therapy. Sedatives, antioxidants, and drugs that help control blood pressure are prescribed. In case of severe edema, antihistamines or antispasmodics may be required to help relax muscles and relieve tension. Disaggregants may be required to improve the rheological properties of the blood. Diuretics are prescribed for severe edema. It is better to use herbal and homeopathic remedies.

In severe nephropathy, especially at the stage of preeclampsia and eclampsia, treatment is carried out in the intensive care unit with the participation of a resuscitator. Infusion therapy is carried out, which allows correcting metabolic and electrolyte disorders. Fresh frozen plasma and rheopolyglucin are administered. In addition to these drugs, anticoagulants may be required. Diuretics can be prescribed to control the daily amount of urine. In order to quickly restore the water-salt balance, herbal infusions can be used.

In any form of gestosis, selective sympathomimetics are used, which make it possible to prevent the threat of premature birth and fetal hypoxia. Also, any form of gestosis implies the need to resolve the issue of delivery. If the condition is satisfactory, delivery occurs through the natural birth canal. If the condition is severe, it is necessary to think over alternative routes. If therapy is ineffective, a cesarean section is performed. Sometimes planned, sometimes emergency.

A feature of gestosis is that its treatment is carried out both before and during childbirth. In most cases, treatment continues even after childbirth, until the woman's condition is completely stabilized.

Treatment regimens for late gestosis

The main principles of treating gestosis are the need to create a therapeutic and protective regimen for the woman. Depending on the severity of the disease, any treatment regimen should include sedatives. The choice of drugs depends on the specific treatment regimen and the severity of the disease. For example, at the initial stage, sedatives of plant origin may be sufficient. Whereas at the stage of eclampsia, strong drugs are needed.

Any scheme includes medicinal restoration of the function of vital organs, depending on which organ is affected. An important stage in determining the treatment scheme is the choice of the method of delivery: natural childbirth or cesarean section, timely or emergency, premature delivery.

There is no universal treatment regimen for gestosis. In each case, it will be strictly individual. It depends on many factors. In no case should you self-medicate, as this can be dangerous for both the mother and the child and lead to serious consequences. It is necessary to strictly follow the doctor's recommendations.

Medicines

Magnesium therapy is often prescribed, which is a course of magnesium sulfate. This method has proven itself well and has been used in many countries for a long time. For this, 24 ml of 25% magnesium sulfate is taken and administered parenterally. The drug is administered 4 times a day, approximately every 4-5 hours.

In case of severe edema and high blood pressure, euphyllin is used. 10 ml of a 2.4% solution of euphyllin diluted in 10 ml of physiological solution is administered. It has a hypotensive, diuretic effect, improves blood microcirculation and improves blood clotting properties. The drug is administered slowly, since rapid administration can cause numerous side effects, including nausea and dizziness.

For spasms and high blood pressure, 2-4 ml of 1% dibazol and 2 ml of 2% papaverine solution are administered. These drugs also have an additional immunostimulating effect.

If the pressure is at a consistently high level and is not reduced by dibazol and other light means, pentamine is used. 0.5-1 ml of a 5% solution of the drug is administered.

Vitamins

In case of gestosis, as in any other condition, the pregnant woman's body needs vitamins. It is recommended to take vitamins in the following daily concentration:

• vitamin PP – 60 mg
• vitamin H – 150 mcg
• Vitamin C – 500 mg
• Vitamin D – 45 mcg.

Physiotherapy treatment

Physiotherapeutic treatment is used in obstetric pathology, during periods of exacerbation of diseases, and in infectious and inflammatory processes. In gestosis, it can be used to reduce nausea, to prevent the threat of miscarriage or premature birth. In some cases, on the contrary, to stimulate labor and prepare the body for childbirth. It is used to relieve the symptoms of gestosis, to accelerate the healing of postoperative wounds after cesarean section, perineal injuries, to enhance the repair of cracks in the nipples, to stimulate contractions of the uterus during its subinvolution after childbirth. It can help preserve the developing fetus or accelerate its development if it lags.

Physiotherapy can also be used to treat colds and inflammatory diseases of the upper respiratory tract, to stimulate intestinal activity, improve peristalsis, and for various concomitant diseases.

Despite the numerous positive effects of physiotherapy, it should be used with caution during pregnancy. Not all types of physiotherapy can be useful. Incorrect dosage or incorrect choice of procedure can harm both the mother and the unborn child. Some types of exposure are prohibited for pregnant women. For example, magnetic exposure is contraindicated at any stage of pregnancy. Even local exposure to limited areas of the body is prohibited.

Microwave therapy is also harmful to the body of a pregnant woman. In this type of therapy, the body is exposed to microwaves that penetrate deep into the layers of internal tissues and can even affect the developing fetus. The consequences of such influence are not fully known to science.

Cryotherapy is one of those types of treatments that are contraindicated for pregnant women. It is not recommended to expose the body to extremely low temperatures.

The most effective impact is physiotherapy as part of complex therapy. Any method can be used only on the recommendation of a doctor.

Folk remedies

Traditional medicine should be used as part of a comprehensive therapy. Before starting treatment, it is better to consult a doctor.

Aromatic medicinal baths have proven themselves to be effective in treating gestosis. To prepare such a bath, it is recommended to make a decoction of herbs and add essential oils. Immortelle and chamomile have a positive effect on the condition. To prepare a bath, make a decoction separately. To do this, pour boiling water over a small amount of herbs. Prepare a rich decoction in a 1-2 liter container. After that, strain the decoction and pour it hot into a bath filled with water. Make the temperature comfortable. Take a bath for 15-20 minutes, several times a week. Decoctions penetrate the pores into the skin, promote relaxation, and relieve the main symptoms of gestosis. You can add a few drops of essential oil, choosing the aroma that will be most pleasant for the woman.

Aromatherapy is an effective means of combating edema, signs of gestosis. It promotes relaxation, calmness, helps a woman find a sense of harmony, balance. To conduct an aromatherapy session at home, you need to create a favorable atmosphere, choose a secluded room, and air it out in advance.

It is recommended to use an aroma lamp. It will distribute the aroma throughout the room, will facilitate its uniform distribution and flow. To do this, light a candle in the lamp, which heats the upper container with water. Add a few drops of essential oil to this water. The water begins to boil, evaporate and the room is filled with a subtle aroma. After the lamp is lit, you need to sit in a comfortable position, or lie down, relax as much as possible. You need to try not to move, not to think about anything, drive away all thoughts. It is important to feel only harmony, calm and the subtle aroma of essential oil that fills the room. It is better to close your eyes, listen to your inner feelings.

This helps to relax muscles, the nervous system, relieve swelling and eliminate the main symptoms. The procedure lasts as long as it brings comfort and pleasure. But it is recommended to do it for at least 30 minutes, since a shorter time will be ineffective. A person begins to relax after at least 20 minutes, and complete relaxation usually occurs only after 30 minutes. It is necessary to take precautions - control the amount of water in the aroma lamp. Water constantly evaporates, and the aroma lamp should not be empty. Firstly, if there is no evaporation, the aroma will stop emitting. Secondly, the lamp is constantly heated from below by a candle. Without water, a hot lamp can crack. Therefore, it is better to put it nearby, and periodically, without losing the state of harmony and relaxation, add a small amount of water as it evaporates. It is recommended to take a course of aromatherapy, every day or every other day for 21-28 days, with a noticeable positive effect, you can do it for a longer period.

An effective folk remedy is lemongrass juice therapy. It is used in tea or water. Add about 15 ml of juice to a glass of tea, stir and drink. You can add honey or sugar to taste. It has a positive effect on the body, has antioxidant properties, helps to relax muscles, relieve tension. Lemongrass juice is especially effective after an aromatherapy session, as it enhances relaxation.

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Herbal treatment

Ginseng root has a positive effect in the treatment of gestosis. Stimulates immunity, eliminates nausea. It is used as a tincture. It can be used in pure form, or added to tea or water. The daily dose is 60 drops, they must be divided into several doses.

Ellecuterococcus also has an immunostimulating effect, normalizes hormonal levels. It is recommended for early and late toxicosis. It helps eliminate edema and congestion. The plant extract is taken 2 ml several times a day before each meal.

Echinacea is useful for both the mother's body and the fetus. Reduces intoxication, helps remove toxins from the body, reduces swelling. Take 2-3 ml before meals. Can be used in a mixture with eleutherococcus extract. Together, these two products enhance each other's action, providing a more powerful effect.

Homeopathy

Homeopathic remedies are effective in treating gestosis. But they should be taken with caution and after prior consultation with a doctor. Not all homeopathic remedies are indicated for pregnant women. Some of them can have a negative effect on the mother's body, others - on the fetus. In addition, homeopathic remedies may not be compatible with other drugs and their components. The dosage is determined strictly individually. It should be remembered that homeopathic remedies can have a cumulative effect, so their effect may not appear immediately. Some substances begin to act only after the entire course of treatment has been completed. Therefore, despite the relative safety of these drugs and a small number of side effects, it is recommended to take precautions. The best precaution is a preliminary consultation with a doctor.

• Tea "Altai Bouquet"

To prepare the tea, you need to take bergenia, rose root, kopeck root and lingonberry leaves in a ratio of 2:1:1:1. Mix these herbs and take about 30-45 g of the mixture to prepare the decoction. Pour boiling water over it and leave for about 30 minutes. Then strain and drink 2-3 glasses a day warm. You can add honey or sugar to the tea to taste.

• Hibiscus tea

Regular hibiscus tea, which is sold in stores, can be an excellent homeopathic remedy that has a positive effect on the condition of a pregnant woman suffering from gestosis. The tea has a calming effect, helps to relax the nervous system and muscles. At the same time, it is a rich source of vitamins and microelements. The tea is brewed in a teapot and drunk throughout the day. If desired, you can add sugar and honey to the tea to taste. In case of severe swelling, it is recommended to add nettle leaves to the tea. An approximately equal ratio is made. You can also add viburnum berries or lemon to taste.

• Elixir "Siberian Herbalist"

The elixir helps to harmonize the activity of internal organs, stabilizes the nervous and vascular systems. It has a positive effect on both the mother's body and the child's body.

The elixir can be purchased ready-made in pharmacies. Take it according to the instructions. You can also make the elixir yourself. To do this, take lingonberries, cedar resin, milk thistle seeds, honey or bee bread, mix and pour in alcohol or vodka. The solid contents should fill the container by about a quarter. The product should be left to brew for 3-7 days. Then you can drink it in its pure form or add it to tea. The daily dose is 40-50 ml.

• Medicinal collection. For hypotension and edema

It is recommended to take it as a decoction. To do this, take rose hips and hawthorn fruits in a ratio of about 2: 1.5. Make a decoction. To do this, pour boiling water over the mixture in an amount of about 1 liter, bring to a light boil, set aside, and let it brew. Drink like tea. You can add sugar and honey to taste. It is recommended to drink the entire decoction during the day, and make a new decoction the next day. Drink warm.

• Herbal collection. For late gestosis

To prepare the decoction, take lingonberry leaves, blueberry leaves and fireweed in approximately equal quantities. Mix, take 2-3 tablespoons of this mixture, pour boiling water over it. Let it brew for about 30 minutes, then drink like tea. You can add honey, sugar. If desired, you can add blueberries or lingonberries, or jam from them.

Surgical treatment

If treatment is ineffective within 3 days in severe gestosis and within 3 hours in preeclampsia, a mandatory cesarean section is performed.

Prevention

Prevention comes down to the implementation of reproductive function at the age of up to 35 years. It is also necessary to promptly diagnose and treat concomitant diseases, not to allow diseases to become chronic. It is also important to lead a healthy lifestyle, eat well, exercise, and avoid stress.

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Forecast

In the early stages, with the necessary treatment and strict adherence to all doctor's instructions, the prognosis can be favorable. It is possible to maintain the pregnancy, give birth to the baby on time and in a natural way.

Severe late toxicosis is a life-threatening condition, and the prognosis can be extremely unfavorable. The only and main method of treatment in this case is delivery, since late gestosis leads to damage to the placenta and further maintenance of pregnancy becomes dangerous for both the mother's life and the life of the fetus. If treatment is ineffective within 3 days, an emergency cesarean section is performed. When the first symptoms of preeclampsia appear, an urgent cesarean section is also performed.

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