How do you prevent gestosis?

Preventive measures are carried out in order to prevent the development of severe forms of gestosis in high-risk pregnant women and during the period of remission after their discharge from the hospital.

The high-risk group for developing gestosis includes:

• extragenital pathology;
• multiple pregnancy;
• presence of gestosis in previous pregnancies; age under 17 and over 30 years.

The preventive complex includes a diet, a “strong rest” regimen, vitamins, herbal infusions with a sedative effect and a mechanism that improves kidney function, antispasmodics, drugs that affect metabolism, antiplatelet agents and anticoagulants, antioxidants, membrane stabilizers, as well as treatment of extragenital pathology as indicated.

• A 3500 kcal diet should contain sufficient protein (up to 110–120 g/day), fats (75–80 g), carbohydrates (350–400 g), vitamins, and minerals. Moderately salted foods are used, and spicy and fatty foods that cause thirst are excluded. Pregnant women with extragenital pathology need a diet that takes into account the table recommended for each pathology. It is advisable to use the therapeutic nutrition product "Ekolakt" (up to 200 ml/day).

The drink is prepared on the basis of carrots, white cabbage, and beetroot. It contains carbohydrates, vitamins, amino acids, live lactobacilli of the J. plantarum 8PA-3.0 strain and hasan antioxidant property, affecting various metabolic processes. The drink is used in courses (3-4 courses) of 14 days. The amount of liquid in pregnant women at risk is limited to 1300-1500 ml, salt - to 6-8 g / day.

• Dosed bed rest "strong rest" helps to reduce OPSS, increase stroke volume of the heart and renal blood flow, normalize uteroplacental blood flow; this is an important non-drug measure. The method consists of pregnant women staying in a position mainly on the left side from 10 to 13 and from 14 to 17 hours, during the hours corresponding to increased peaks of arterial pressure.
• All pregnant women should receive vitamins. Vitamin herbal teas or vitamin tablets are prescribed.
• It is necessary to take calcium supplements in a daily dose of up to 2000 mg [a combination of calcium carbonate (calcium 500 mg) and vitamin D is better absorbed
• The preventive complex includes herbal preparations:
  • sedatives (valerian rhizome infusion 30 ml 3 times a day or tablets 1-2 tablets 3 times a day, motherwort herb infusion 30 ml 3-4 times a day), sedative infusions 1/2 tablespoon 3 times a day;
  • improving kidney function ("Kidney tea", birch buds, bearberry leaves, lingonberry leaves, corn fish extract, horsetail grass, blue cornflower flowers), "Phytolysin";
  • normalizing vascular tone (hawthorn flowers, fruits, extract).
• Considering that in the early stages of gestosis development it is important to increase vascular tone, antispasmodics are included in the preventive complex (aminophylline 1 tablet 2 times a day, papaverine 1 tablet 2 times a day, drotaverine 1 tablet 3 times a day, etc.).
• To normalize cellular metabolism of microelements, potassium and magnesium aspartate are used, 1 tablet 3 times a day, and other preparations containing microelements.
• To stabilize microcirculation, one of the disaggregants (pentoxifylline 1 tablet 3 times a day, dipyridamole 2 tablets 3 times a day) or acetylsalicylic acid 60 mg/day daily in the first half of the day after meals is included in the preventive complex. Dipyridamole is approved for use at all stages of pregnancy, including the earliest ones. Contraindications to the use of acetylsalicylic acid are hypersensitivity to salicylates, bronchial asthma, gastric ulcer and duodenal ulcer, blood coagulation disorders, and a history of bleeding.
• Taking into account the importance of lipid peroxidation in the initiation of gestosis, one of the antioxidants is introduced into the prophylactic complex for its normalization: vitamin E (300 mg/day), ascorbic acid (100 mg/day), glutamic acid (3 g/day), folic acid.
• To restore the structural and functional properties of cell membranes, membrane stabilizers are used, preparations containing polyunsaturated essential fatty acids: phospholipids, 2 capsules 3 times a day, and the food supplement omega-3 triglycerides [20%], 1 capsule 1–2 times a day.
• To normalize the hemostatic properties of blood, low-molecular heparin is used - calcium nadroparin, which is prescribed once daily at 0.3 ml (280 IU). Indications for the use of low-molecular heparin: the presence of soluble fibrinogen complexes, a decrease in APTT less than 20 s, hyperfibrinogenemia, a decrease in endogenous heparin below 0.07 U / ml, antithrombin III below 75%. Calcium nadroparin is used from the 16th week of gestation. Treatment is carried out in courses, its duration is 3-4 weeks. Calcium nadroparin is used under the control of blood clotting time, which should not increase more than 1.5 times compared to the initial one. Contraindications to the use of calcium nadroparin during pregnancy are the same as in general pathology.
• Preventive measures are carried out against the background of treatment of extragenital pathology according to indications.

Prevention of severe forms of gestosis begins at 8–9 weeks of gestation. Preventive measures are carried out in stages, taking into account the background pathology:

• from the 8th–9th week, all pregnant women who are at risk are prescribed an appropriate diet, the “Bed rest” regimen, a vitamin complex, and treatment for extragenital pathology;
• from the 16th-17th week, patients with chronic cholecystitis, cholangitis, and lipid metabolism disorders of the I-II degree are additionally given herbal preparations in the preventive complex: herbal preparations with a sedative mechanism and one that improves liver and kidney function;
• from the 16th–17th week, in patients with hypertension, chronic pyelonephritis, glomerulonephritis, lipid metabolism disorder grades II–III, endocrinopathies, combined extragenital pathology, in addition to the previous measures, antiplatelet agents or anticoagulants, antioxidants, and membrane stabilizers are included.

Pregnant women at risk should take preventive measures on a regular basis. Herbal teas and metabolic preparations are prescribed in alternation on a regular basis. Against this background, antiplatelet agents or anticoagulants, membrane stabilizers together with antioxidants are used in courses of 30 days with a break of 7-10 days.

Similar measures are carried out simultaneously to prevent recurrence of gestosis in pregnant women after discharge from the maternity hospital.

When initial clinical symptoms of gestosis appear, hospitalization and inpatient treatment are necessary.

Despite intensive study of the pathophysiology of gestosis, there is still no scientifically substantiated data on the etiology of the disease, which does not allow developing effective methods for the prevention and treatment of gestosis. However, dynamic observation, consistent complex therapy and timely delivery allow obtaining positive results.

Modern principles of gestosis prevention. Preventive measures are taken to exclude the development of severe forms of gestosis and placental insufficiency in high-risk pregnant women. According to our data, along with anamnesis data, the high-risk group for gestosis development includes patients with impaired uteroplacental blood flow detected at 14-16 weeks (SDO in the uterine arteries is more than 2.4, SDO in the spiral arteries is more than 1.85).

The preventive complex includes: diet, “Bed rest” regimen, vitamins, drugs that normalize cellular metabolism, disaggregants, restoration of structural and functional properties of cell membranes, antioxidants.

1. A diet with a caloric content of 3000-3500 kcal should contain 110-120 g/day of protein. The amount of liquid is limited to 1300-1500 ml, table salt - 6-8 g per day.
2. Dosed bed rest "strong rest" (the method involves keeping pregnant women in a position mainly on their left side from 10:00 to 13:00 and from 14:00 to 17:00) helps to reduce total peripheral vascular resistance, increase stroke volume and renal perfusion, and normalize uteroplacental blood flow.
3. Pregnant women at high risk of developing gestosis should receive vitamins throughout the entire gestation period in tablet form (Vitrum-Prenatal, Materna, Pregnavit).
4. In order to stabilize microcirculation, one of the disaggregants is included in the prophylactic complex (Trental, 1 tablet 3 times a day, Curantil, 2 tablets 3 times a day, Aspirin, 60 mg per day daily).
5. To normalize lipid peroxidation, one of the antioxidants is used (vitamin E 300 mg per day, vitamin C 100 mg per day, glutamic acid 3 g per day).
6. To restore the structural and functional properties of cell membranes, Essentiale Forte (2 capsules 3 times a day) and Lipostabil (2 capsules 3 times a day) are used.
7. Preventive measures are carried out against the background of treatment of extragenital pathology.

Prevention of gestosis in high-risk pregnant women should begin at 8-10 weeks of gestation.

From 8-9 weeks, all pregnant women in the high-risk group are prescribed a diet, the “Bed rest” regimen, a vitamin complex, and treatment for extragenital pathology.

From 16-19 weeks, patients are additionally prescribed antiplatelet agents or anticoagulants, antioxidants and membrane stabilizers. Antiplatelet agents are especially indicated in cases of uteroplacental hemodynamic disorders (Trental 100 mg 3 times a day or aspirin 250 mg per day for 3 weeks). Repeated courses of drug correction of uteroplacental hemodynamic disorders should be carried out at critical times (24-27 and 32-35 weeks).

Based on the analysis of data obtained during the examination of more than 2,000 patients at high risk of developing gestosis, the proposed prevention regimen made it possible to reduce the incidence of gestosis by 1.5 times, its severe forms by 2 times, and placental insufficiency by 2.5 times.

Thus, at present, the only real way to reduce the incidence of gestosis, especially severe forms, is the timely identification of a high-risk group for the development of this pathology and the implementation of preventive measures. Treatment of gestosis should be started at the preclinical stage. In the treatment of the developed disease, it is necessary to adhere to active pregnancy management tactics, which allows preventing the development of severe complications in the mother and fetus.

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