Obstetrics and Gynecology - A.M. Hromova 2000

Early toxicosis of pregnant women. Late gestosis
Late gestosis
Preeclampsia

Mild preeclampsia is characterized by:

1) an increase in Blood pressure up to 150/90 mmHg;

2) pulse pressure of at least 50 mmHg;

3) proteinuria up to 1 g/L;

4) edema of the lower extremities;

5) platelet count of at least 180x10⁹/L;

6) hematocrit 36-38;

7) fibrinogen B - negative reaction;

8) blood creatinine up to 100 µmol/L.

Moderate preeclampsia is characterized by:

1) an increase in blood pressure up to 170/110 mmHg;

2) pulse pressure of at least 40 mmHg;

3) proteinuria up to 5 g/L;

4) edema of the lower extremities and anterior abdominal wall;

5) hourly diuresis of at least 40 mL/h;

6) platelet count 150-180x10⁹/L;

7) hematocrit 39-42;

8) fibrinogen B - weakly positive (+);

9) creatinine from 100 to 300 µmol/L.

Severe preeclampsia is characterized by:

1) blood pressure exceeding 170/110 mmHg;

2) pulse pressure less than 110 mmHg;

3) proteinuria over 5 g/L;

4) generalized edema;

5) hourly diuresis less than 40 mL/h;

6) platelet count 120-150×10⁹/L;

7) hematocrit over 42;

8) fibrinogen B - positive (++) or markedly positive (+++);

9) creatinine over 300 µmol/L.

Against the Background of these signs, frontal and occipital headaches appear, which are resistant to analgesics. Visual disturbances range from flashing scotoma and blurred Vision to complete blindness. Epigastric or right upper quadrant pain indicates excessive stretching or tearing of the Liver capsule due to its edema and may be a harbinger of seizures. Preeclampsia can progress to Eclampsia at any time.

In obstetric practice, it is rare to observe all symptoms simultaneously. Usually, women present with a combination of several signs, and the severity of preeclampsia should be determined by the most pronounced one. Nowadays, atypical (mild or masked) forms of preeclampsia are quite common, and accurately assessing their severity can be quite challenging. The time factor is of primary importance here: even if the signs of gestosis are moderate but persist for more than three weeks despite adequate Treatment, the condition should be considered severe.