How to prevent gestosis?

Preventative measures are carried out to exclude the development of severe forms of gestosis in pregnant high-risk groups and during remission after discharge from the hospital.

The group of high risk of gestosis include:

• extragenital pathology;
• multiple fertility;
• presence of preeclampsia in previous pregnancies; age younger than 17 years and over 30 years.

The preventive complex includes a diet, a regime of "stronged rest", vitamins, herbal sedatives and a mechanism that improves kidney function, antispasmodics, drugs that affect metabolism, disaggregants and anticoagulants, antioxidants, membrane stabilizers, and treatment of extragenital pathology according to indications.

• Diet caloric content of 3500 kcal should contain a sufficient amount of protein (up to 110-120 g / day), fats (75-80 g), carbohydrates (350-400 g), vitamins, minerals. Use moderately salty foods, exclude hot and fatty foods that cause thirst. Pregnant with extragenital pathology requires a diet with a table recommended for each pathology. It is advisable to use the product of therapeutic nutrition "Ecolact" (up to 200 ml / day).

The drink is prepared on the basis of carrots, white cabbage, table beet. It contains carbohydrates, vitamins, amino acids, live lactobacillus strain J. plantarum 8PA - 3,0 and has antioxidant properties, affecting various metabolic processes. Drink apply courses (3-4 courses) for 14 days. The amount of fluid in pregnant women at risk is limited to 1300-1500 ml, salt - up to 6-8 g / day.

• Dosirovanny bed rest regime "stronged rest" helps to reduce OPSS, increase the shock volume of the heart and kidney blood flow, normalize utero-placental circulation; this is an important non-drug event. The method consists in staying pregnant in a position predominantly on the left side from 10 to 13 and from 14 to 17 hours, at hours corresponding to elevated blood pressure peaks.
• All pregnant women should receive vitamins. Assign vitamins or vitamins in tablets.
• It is necessary to take calcium preparations in a daily dose up to 2000 mg [a better combination of calcium carbonate (calcium 500 mg) and vitamin D
• In the preventive complex enter phytosols:
  • sedative (valerian rhizome infusion of 30 ml 3 times a day or tablets of 1-2 tablets 3 times a day, motherwort infusion of 30 ml of infusion 3-4 times a day), soothing for 1/2 tablespoon 3 times a day ;
  • improving kidney function ("Kidney tea", birch buds, bearberry leaves, cowberry leaves, corn fishes extract, horsetail grass field, cornflower blue flowers), "Phytolysin";
  • normalizing vascular tone (hawthorn flowers, fruits, extract).
• Given that in the early stages of the development of gestosis is important to increase the tone of the vessels, the preventive complex includes antispasmodics (aminophylline 1 tablet 2 times a day, papaverine 1 tablet 2 times a day, drotaverin 1 tablet 3 times a day, etc.).
• To normalize the cellular metabolism of trace elements, potassium and magnesium aspartate 1 capsule 3 times a day and other preparations containing trace elements are used.
• To stabilize the microcirculation in the preventive complex include one of the disaggregants (pentoksifillin 1 tablet 3 times a day, dipyridamole 2 tablets 3 times a day) or acetylsalicylic acid at 60 mg / day daily in the morning after meals. Dipiridamole is approved for use at all stages of pregnancy, including at the earliest. Contraindications to the use of acetylsalicylic acid - increased sensitivity to salicylates, bronchial asthma, peptic ulcer of the stomach and duodenum, disorders of the blood coagulation system, bleeding in the anamnesis.
• Taking into account the importance of lipid peroxidation in the initiation of gestosis, one of the antioxidants is introduced into the preventive complex: 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 food supplement omega-3 triglycerides [20%] 1 capsule 1-2 times a day.
• To normalize the haemostatic properties of the blood, low molecular weight heparin, calcium supraparin, is administered, which is administered once daily with 0.3 ml (280 IU). Indications for the use of low molecular weight heparin: the presence of soluble complexes of fibrinogen, a decrease in APTT less than 20 s, hyperfibrinogenemia, a decrease in endogenous heparin below 0.07 U / ml, antithrombin III below 75%. Nadroparin calcium is used from the 16th week of gestation. Treatment is carried out by courses, its duration is 3-4 weeks. Nadroparin calcium is used under the control of clotting time, which should not be increased by more than 1.5 times compared with the original. Contraindications to the use of calcium supra-paparin during pregnancy are the same as in general pathology.
• Preventive measures are performed against the background of treatment of extragenital pathology according to indications.

Prevention of severe forms of gestosis begins with the 8-9th week of gestation. Preventive measures are carried out in stages, taking into account the background pathology:

• from 8th to 9th weeks, all pregnant women at risk are assigned the appropriate diet, "Ved rest" regimen, vitamin complex, treatment of extragenital pathology;
• with 16-17th week patients with chronic cholecystitis, cholangitis, violation of fat metabolism of I-II degree in addition to the preventive complex are added phytosorts: plant doses with sedative and improving the function of the liver and kidney mechanism;
• from 16-17th week to patients with essential hypertension, chronic pyelonephritis, glomerulonephritis, violation of lipid metabolism of II-III degree, endocrinopathies, combined extragenital pathology in addition to previous activities include disaggregants or anticoagulants, antioxidants, membrane stabilizers.

In pregnant women at risk, preventive measures must be carried out continuously. Phytosets and metabolic drugs, alternating, appoint permanently. Against this background, disaggregants or anticoagulants, membrane stabilizers together with antioxidants are applied for 30 days with a break of 7-10 days.

Similar activities are conducted simultaneously with the goal of preventing the recurrence of gestosis in pregnant women after discharge from the maternity hospital.

When there are initial clinical symptoms of gestosis, hospitalization and treatment in hospital are necessary.

Despite intensive study of the pathophysiology of gestosis, up to the present time there is no scientifically substantiated data on the etiology of the disease, which does not allow to develop effective methods of prophylaxis and treatment of gestosis. However, dynamic observation, consistent complex therapy and timely delivery allow us to obtain positive results.

Modern principles of the prevention of gestosis. Preventative measures are taken to exclude the development of severe forms of gestosis and placental insufficiency in pregnant high-risk groups. According to our data, along with the history data, patients with a violation of utero-placental blood flow, identified at the period of 14-16 weeks (SDO in the uterine arteries more than 2.4, SDO in the spiral arteries more than 1.85) belong to the group of high risk of gestosis development. .

The preventive complex includes: a diet, a "Ved rest" regime, vitamins, drugs that normalize the cellular metabolism, disaggregants, restore the structural and functional properties of cell membranes, antioxidants.

1. Diet 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. Dosirovanny bed rest "stronged rest" (the method consists in the stay of pregnant women in a position predominantly on the left side from 10 to 13 and from 14 to 17 hours) contributes to a decrease in OPSS, an increase in the shock volume of the heart and renal perfusion, the normalization of uteroplacental blood flow.
3. Pregnant groups at high risk of gestosis development Should receive vitamins throughout the gestation period in a tablet form (vitrum-prenatal, materna, pregnavit).
4. In order to stabilize the microcirculation in the preventive complex include one of the disaggregants (trental 1 tablet 3 times a day, curetil 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, Essential-forte (2 capsules 3 times a day), lipostabil (2 capsules 3 times a day) are used.
7. Preventive measures are performed against the background of treatment of extragenital pathology.

Preventive maintenance gestozov at pregnant women of a group of high risk should begin with 8-10 weeks gestation.

From 8-9 weeks all pregnant women at high risk are assigned a diet, "Ved rest" regime, a complex of vitamins, treatment of extragenital pathology.

From 16-19 weeks, patients are additionally prescribed disaggregants or anticoagulants, antioxidants and membrane stabilizers. Especially shown antiaggregants in the violation of utero-placental hemodynamics (trental 100 mg 3 times a day or aspirin 250 mg per day for 3 weeks). Repeated courses of medicamentous correction of disorders of utero-placental hemodynamics 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 for gestosis, the proposed prevention regimen reduced the rate of gestosis 1.5 times, its severe forms 2 times, and placental insufficiency 2.5 times.

Thus, at present the only real way to reduce the frequency 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 preeclampsia must begin at the preclinical stage. In the treatment of the developed disease, it is necessary to adhere to active tactics of pregnancy management, which helps prevent the development of severe complications in the mother and fetus.

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