Obstetrics and Gynecology - A. M. Gromova 2000

Early pregnancy toxicosis. Late gestosis
Late gestosis
Gestational edema (edema gravidarum)

They begin In the second half of Pregnancy and are characterized by peripheral edema. There are four degrees of severity of gestational edema:

Grade I - edema of the lower extremities;

Grade II - spread to the abdominal wall;

Grade III - edema extends to the upper extremities and face;

Grade IV - generalized edema, progressing to anasarca.

Due to fluid retention, the pregnant woman's weight increases rapidly. Diuresis fluctuates: at the onset of the condition, it is slightly reduced, then increases, and subsequently decreases again against the Background of increasing edema. Neither protein nor formed Blood elements are detected in the urine. Blood pressure remains within normal limits. The clinical course of edema is protracted. They periodically subside and then worsen again. In most cases, gestational edema does not progress to a more severe form of the disorder. However, in 20-24% of patients, progression to Preeclampsia is still possible.

Treatment of gestational edema

I. Supportive and protective regimen.

II. A rational, high-calorie, predominantly protein-plant diet with restricted salt intake (up to 3-5g per day). Weekly fasting days are advisable. Fluid restriction is not recommended, as it contributes to worsening hypovolemia.

III. Pharmacotherapy:

1. Sedative and desensitizing therapy, improvement of blood rheology and vascular wall condition, antioxidant agents as in the treatment of pre-toxemia.

2. Antispasmodics: aminophylline 1 ml of 24% solution intramuscularly, no-spa 2 ml of 2% solution intramuscularly or in 0.04g tablets twice daily.

3. Medications that intensify myocardial METABOLISM (riboxin 10% - 10 ml intravenously, essentiale 5-10 ml pre-diluted with the patient's blood, Folic acid 0.003g three times a day).

4. Measures ensuring:

a) increased production of atrial natriuretic peptide (ANP) by cardiomyocytes (potassium orotate and Methionine 0.5 g, nicotinic acid 0.1 g, and folic acid 0.0003g three times a day);

b) stimulation of ANP release from cardiomyocytes into the bloodstream through daily stimulation of thoracic volume receptors via redistribution of blood in the body using an anti-G suit (compression of the pregnant woman's lower legs and thighs with a pneumatic pressure of 50-60 mmHg for one hour) or Water-immersion compression (submerging the patient in a water bath (t - 34°C) up to the level of the sixth cervical vertebra for two hours).

5. Diuretics (furosemide, hydrochlorothiazide) under the control of diuresis with the simultaneous administration of potassium supplements.

6. Agents that improve uteroplacental blood flow and help prevent Fetal Hypoxia. Discharge from the hospital is possible after the complete disappearance of edema.