Obstetrics and Gynecology - A.M. Hromova 2000

Early pregnancy toxicoses. Late gestosis
Late gestosis
Prevention of late gestosis

The primary role in addressing this issue belongs to the antenatal clinic. To prevent the onset of late gestosis, antenatal clinics should implement the following measures:

1. During routine clinical check-ups, identify pregnant women who are at high risk for developing late gestosis. This high-risk group should include women with extragenital pathologies (Hypertension, neurocirculatory dystonia, Diabetes Mellitus, hemorrhagic vasculitis, diencephalic-endocrine syndrome, Kidney disease, Blood Coagulation and fibrinolytic system deficiencies, Epilepsy, etc.); young primigravidas (under 19 years of age) and older primigravidas (over 30); women who experienced late gestosis during previous pregnancies; and pregnant women with polyhydramnios, multiple gestations, macrosomia, Rh-immunization, or ABO blood group incompatibility between the fetus and the mother.

2. The management of Pregnancy in women with extragenital pathologies should be carried out in cooperation with specialists in relevant fields to promptly determine the feasibility of carrying the pregnancy to term and to administer corrective therapy.

3. To predict a pregnant woman's predisposition to late gestosis, the renal Water-excretion function should be assessed in the first trimester. This is performed following a one-hour compression of the lower legs and thighs using a pneumatic pressure of 50–70 mm Hg via an anti-G suit. A typical response to this intervention is a drop in diuresis. Women in whom diuresis increases after the test in the first trimester should be classified as being at risk for developing late gestosis in the future.

4. Pregnant women in the gestosis risk groups should undergo two courses of prophylactic Treatment (at 26–28 and 32–34 weeks of gestation). These courses include stimulating the synthesis of ANP (atrial natriuretic peptide) through the daily intravenous administration of 10% riboxin 10 ml, potassium orotate 0.5 g three times a day, Methionine at the same dosage, nicotinic acid 0.3 g per day, Folic acid 0.009 g per day, and daily stimulation of low-pressure volume receptors using an anti-G suit. Each treatment course lasts for 10–12 days.

5. Every pregnant woman must be thoroughly examined for the earliest possible detection and correction of pre-toxicosis signs.

6. Early Diagnosis of clinically apparent forms of late gestosis, accompanied by mandatory hospitalization of patients for appropriate treatment, serves as a method to prevent mild forms of the disease from progressing into more severe ones.

Control Questions

1. What conditions in pregnant women are referred to as gestoses?

2. Which conditions are classified as early gestoses (toxicoses) of pregnancy?

3. Which conditions are classified as Late Gestoses?

4. Which conditions are grouped under the category of "rare forms of gestosis"?

5. Explain the mechanism behind the onset of early toxicosis.

6. Under what circumstances is vomiting considered to be a pregnancy-related toxicosis?

7. Clinical presentation of mild and excessive vomiting in pregnant women.

8. Under what conditions is the treatment of pregnancy-related vomiting carried out?

9. Nutritional management for a pregnant woman experiencing vomiting.

10. Treatment of pregnancy-related vomiting.

11. Ptyalism (salivation) in pregnancy as an early toxicosis: clinical signs and treatment.

12. Dermatoses of pregnancy and their treatment.

13. Jaundice in pregnancy: Clinical Features, diagnosis, and Differential diagnosis.

14. What are the symptoms of late gestoses?

15. What is PIH (edema-proteinuria-hypertension) gestosis, and how did this term originate?

16. Describe the mechanism underlying The Development of PIH gestoses.

17. The Mechanism of hypoproteinemia

18. What are the symptoms of edema in pregnant women?

19. How does weight gain progress during a normal pregnancy?

20. Main principles of treatment for pregnant women with edema.

21. On what basis is the diagnosis of Preeclampsia in pregnancy established?

22. Classification of preeclampsia According to the severity of its course.

23. Management and treatment of pregnant women with preeclampsia.

24. What is the therapeutic effect of magnesium sulfate in the treatment of preeclampsia?

25. What are the characteristic signs of preeclampsia?

26. What is the mechanism underlying the symptoms of preeclampsia?

27. Emergency care for preeclampsia.

28. Signs and symptoms of Eclampsia.

29. Stages in the progression of an eclamptic seizure.

30. Under what circumstances do eclamptic seizures occur postpartum?

31. Modern approach to the treatment of pregnant women with eclampsia.

32. Emergency care for eclampsia.

33. Obstetrical management in late gestosis.

34. Principles of labor management in late gestosis.

35. Prevention of late gestosis.