Obstetrics and Gynecology - A. M. Hromova 2000

Early toxicosis in pregnant women. Late gestosis
Late gestosis
Pretoxicosis

Pretoxiphosis is a preclinical form of Late gestosis characterized by the absence of overt clinical pathology, while laboratory and instrumental findings already indicate physiological shifts specific to gestosis. Although pretoxiphosis does not inevitably progress to clinically manifest gestosis, it frequently does. Therefore, careful and systematic monitoring of pregnant women is essential in antenatal care clinics for the early detection of pretoxiphosis signs. To achieve this, the following measures must be carried out at each visit:

1. Weekly weighing of the woman to monitor excessive weight gain. Normally, a pregnant woman's weight should increase by 50 g per day, 350-400 g per week, or no more than 1.6 to 2 kg per month. An abnormal weight gain suggests the presence of occult edema.

2. Detection of occult edema using specific tests:

- determination of relative Blood density using the Phillips-Van Slyke-Barashkov method (an increase to 1060-1062 indicates occult edema);

- McClure-Aldrich tissue hydrophilicity test — a papule formed by the intradermal injection of an isotonic sodium chloride solution resolves in less than 40 minutes (normally around 60 minutes);

- an increase in ankle circumference of more than 1 cm over the course of a week;

- a positive "ring" sign.

3. Measurement of blood pressure to identify pregnant women with unstable vascular tone who are prone to late gestosis. Indications of pretoxiphosis include a 15-20% increase in systolic blood pressure or a 10% increase in diastolic blood pressure compared to baseline values, as well as an Asymmetry of 10-15 mmHg between the arms. The calculation of mean arterial pressure is particularly informative.

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Normally, this value is 100 mmHg; a 25 mmHg increase from baseline indicates the onset of the condition. Assessment of the temporobrachial coefficient provides insight into cerebral Circulation. In the presence of vascular spasm, this value rises to 0.7-0.8 (normally not exceeding 0.5). Functional tests (such as the roll-over test and exercise test) also assist in detecting vascular tone lability.

4. Urinalysis. A decrease in daily diuresis to 900 ml and a drop in osmotic urine density indicate The Development of pretoxiphosis. The detection of even the smallest amount of protein in the urine should prompt the physician to conduct a more detailed examination. Repeated detection of even minimal proteinuria is an indication for hospital admission.

5. Evaluation of blood test results. The hematocrit level in pregnant women with pretoxiphosis may be slightly elevated, indicating hypovolemia and hemoconcentration. Impaired blood rheology results in a decreased platelet count and enhanced platelet aggregation, accompanied by reduced fibrinogen levels, accumulation of fibrin degradation products, and peripheral blood hypercoagulation, which is manifested by a shortened Lee-White coagulation time. These changes may precede the Clinical symptoms of gestosis by several weeks. Lymphocytopenia in a pregnant woman with pretoxiphosis indicates an impaired immune status. Biochemical blood analysis should focus on total protein and its fractions, as well as Liver enzyme levels (ALT, AST, bilirubin).

6. Detection of peripheral circulation disorders via capillaroscopy or functional diagnostic tests.

7. Calculated determination of circulating blood volume and interstitial fluid volume to identify hypovolemia and intercellular hyperhydration (V.K. Likhachev, 1981):

CBV = 1851.0 + 17.3 x X₁ + 80.0 x X₂ - 13.0 x X₃, where X₁ is Heart rate (bpm); X₂ is venous hematocrit (%); X₃ is the patient's weight (kg). In healthy pregnant women, CBV ranges from 5350 to 5400 ml.

EIV = 17.35 + 6.7 x X₁ - 0.0334 x X₂ - 0.011 x X₃, where X₁ is urinary sodium excretion (mmol/min); X₂ is daily diuresis (ml); X₃ is mean arterial pressure (mmHg). In healthy pregnant women, this parameter exceeds 14.5 L. To establish a Diagnosis of pretoxiphosis, identifying changes in 2-3 of the aforementioned parameters is sufficient. Once women with pretoxiphosis are identified, they must be placed on a special register and undergo a course of prophylactic Treatment.

Treatment of pretoxiphosis

I. An appropriate daily routine featuring adequate Sleep (9-10 hours), fresh-air walks, and regulated Physical Exercise. Eliminating sources of emotional stress at home and in the workplace is extremely important.

II. A balanced diet rich in Proteins, Vitamins, and micronutrients, with restricted table salt intake and strict adherence to a fluid regimen (up to 1 L of fluid per day).

III. Pharmacological management, which includes:

1. Sedatives (valerian tablets 0.2 g three times a day or motherwort tincture 20 drops 3 times a day).

2. Desensitizing agents (calcium chloride 1 tablespoon 3-5 times a day, Suprastin 2% - 1.0 ml intramuscularly or 0.025 three times a day).

3. Spasmolytics for blood pressure asymmetry or an upward trend (dibazol 0.3 g three times a day, aminophylline 0.5 g suppositories, papaverine 2% - 2.0 ml intramuscularly).

4. Multivitamins and agents that improve protein assimilation (glutamic acid, Methionine 1.5 g per day).

5. Normalization of redox processes (ascorbic acid 200 mg, vitamin E 100 mg per day).

6. Regulation of vascular wall permeability and Cell membrane stabilization (galascorbin 0.5 g three times a day, calcium gluconate at the same dosage).

7. Antiplatelet agents (curantyl 0.025 g or trental 0.2 g three times a day under coagulogram monitoring).

8. Selective inhibition of thromboxane synthesis (aspirin 50 mg daily or nitroglycerin 0.0005 g three times a day).

9. In the presence of latent edema or abnormal weight gain — diuretic tea (birch leaves, rose hips), potassium supplements (potassium orotate 0.5 g three times a day).

10. 70% oxygen-air mixture for 10 min. once a day.