Mom Life

Topic 5 Pregnancy complications

    Complications of pregnancy: toxaemia, ectopic pregnancy.spontaneous abortion, anemia, placenta previa, premature placental abruption.Causes and clinical symptoms.Principles of diagnosis, treatment, and prophylaxis of first aid in eclampsia and Classification of gestosis By date of occurrence: early and late. Early gestosis (I half of pregnancy): * vomiting of pregnant women; • salivation; * indomitable vomiting of pregnant women. Late gestosis (II half of pregnancy): * dropsy of pregnant women, * nephropathy of pregnant women; •eclampsia. Rare forms of gestosis: * bronchial asthma of pregnant women; * anemia of pregnant women; * hypotension of pregnant women; * hypertension of pregnant women; * jaundice of pregnant women; * dermatoses of pregnant women; * osteomalacia, etc Gestoses that have one symptom are called monosymptomatic,and two or more are called polysymptomatic. Early gestosis Vomiting of pregnant women is the most common form of early gestosis of a pregnant woman. Causes: metabolic disorders, changes in the reaction of the pregnant woman's body to irritation coming from the external and internal environment. Clinical picture: vomiting occurs up to 5 times a day, on an empty stomach or associated with food intake and unpleasant odors; the General condition is not significantly disturbed. Treatment: outpatient or inpatient under the control of the dynamics of the body weight of the pregnant woman and with repeated tests of urine for acetone. Frequent fractional nutrition, mouthwash with astringents, recommend frequent change of environment (walking), effective reflexotherapy In \ m splenin 2 ml 1 time a day, the course is 7-10 days. Salivation(ptyalism)-excessive flow of saliva. Causes: violation of the interaction of the Central nervous system and internal organs as a result of infectious diseases, intoxication, inflammatory processes in the endometrium, medabots, and extragenital pathology. Clinical picture: the amount of saliva released up to 1 liter per day or more, the pregnant woman's psyche is depressed, maceration of the skin around the mouth and lip mucosa, reduced appetite, pale skin,deterioration of health, weight loss, signs of dehydration. Inpatient treatment. Mental and physical rest, restorative therapy. Atropine 0.0005 g 2 times a day. The skin of the face is smeared with vaseline. Rinsing the mouth with a solution of menthol, extract of sage, chamomile. Indomitable vomiting of pregnant women — the most severe form of early gestosis-leads to a marked deterioration in the General condition of the pregnant woman. Vomiting can be repeated more than 10 times a day, occurs at any time of the day. As a result of dehydration and starvation, the patient's metabolism is disrupted. Excessive vomiting leads to a progressive loss of body weight, which can reach 715 kg or more and make up 10-15 % of the original body weight, dry skin develops, the pulse increases, blood pressure decreases, and the smell of acetone from the mouth appears. Sharply decreases the amount of power, it appears protein, cylinders, acetone. In the absence of treatment or its ineffectiveness, comatose state and death of the patient may occur. In a hospital setting, the lack of effect of treatment is an indication for termination of pregnancy. Within a few hours after the instrumental removal of the fetal egg, the patient's condition improves, she has an appetite, food begins to be retained, and soon a full recovery occurs. Treatment is aimed at regulating the relationship between the cortex and its subcortical parts.Sedative therapy, infusion, therapy, antiemetics, vitamin therapy. Late gestosis of pregnant women Dropsy of pregnant women-characterized by the development of edema. The accumulation of liquid is caused by a violation of water-salt exchange and increased capillary permeability. The diagnosis of dropsy of pregnant women is made in the presence of hidden and visible edema. Hidden edema is detected by the following tests: a positive ring symptom, a McClure-Aldrich test, an increase in the circumference of the ankle joint by more than 1 cm during the week, a pathological weight gain (for a week should not exceed 250-300 g). When dropsy first occurs pasty, and then swelling of the feet and shins. In the future, edema spreads to the thighs, the front wall of the abdomen, the torso and face. The body weight of a pregnant woman increases rapidly. Blood pressure remains normal, protein in the urine is absent, changes in the heart, kidneys, liver and other organs are not observed. Treatment: indicated hospitalization in OPB (Department of pathology of pregnant women). It is necessary to appoint a diet: table 7 with a restriction of salt to 3-4 g per day and liquid to 1 liter. Assign fasting days (Apple, cottage cheese), it is necessary to normalize the volume of circulating blood(BCC), followed by the appointment of diuretics(lasix, hypothyazid) Diuretics must be prescribed in combination with potassium preparations. Nephropathy of pregnant women is characterized by a triad of symptoms: edema, increased blood pressure and protein in the urine. In the atypical form, two of the following symptoms are expressed. The diagnosis is made on the basis of clinical data, laboratory examination, consultations of a therapist and an optometrist.The disease should be differentiated with hypertension, glomerulonephritis, pyelonephritis.. Treatment of nephropathy of pregnant women should be complex, differentiated depending on the stage of the disease. Intensive therapy of severe forms of late gestosis of pregnant women is carried out in a modern modification of the principles of treatment according to Stroganov: * ensuring a strict medical and protective regime; * normalization of the Central nervous system, * antihypertensive therapy; * reducing the permeability of vessel walls; * fight against edema; * improvement of microcirculation and detoxification by administration of protein preparations, plasma and blood substitutes. Children born to women who have suffered from late gestosis are at high risk and need appropriate care. Preeclampsia is a transitional stage from nephropathy to eclampsia. Reasons: incorrect treatment of late gestosis or its absence, non-compliance with the regime and diet of preneuropathy of pregnant women. Clinical picture: against the background of symptoms of nephropathy of pregnant women, headache, visual impairment, pain in the epigastric region appear. Sometimes vomiting, insomnia, and depressed mood are possible. The functions of the circulatory system, kidneys, liver, and metabolism are disrupted. Tissue hypoxia and acidosis increase. Complications: transition to eclampsia, hemorrhage in vital organs, premature detachment of the normally located placenta, fetal asphyxia Treatment: the pregnant woman is not transportable. Emergency care: give raushanesthesia, call the medical team, contact with the vein (introduction of reopoliglyukin), then hospitalization in the PIT (intensive care unit), individual post, continuation of treatment according to the principles of Stroganov. ~ Eclampsia is a convulsive seizure with loss of consciousness — severe late gestosis of pregnancy. Clinical picture. Seizures begin with a fibrillar twitching of the facial muscles, then tonic convulsions occur, turning into clonic convulsions. The convulsions weaken, there is a hoarse breathing, foam on the lips, stained with blood due to the bite of the tongue. The number of seizures from 1-2 to 10 and higher. Pain, noise, light, any stimulus can cause a new seizure. The circulatory disorder increases, there is swelling of the brain, hemorrhage in the brain, liver and other organs. Oxygen starvation increases, acidosis increases. The last phase of the seizure is comatose. Each seizure lasts for 1-2 minutes. Consciousness returns gradually, sometimes a new seizure may resume when the patient has not yet regained consciousness. The most common seizures are during childbirth and at the end of pregnancy, rarely after birth. Eclampsia is dangerous for the mother and fetus. During a seizure, there may be tongue biting, fractures, and bruises. Sometimes there are anuria, aspiration pneumonia, psychosis. A pregnant woman can die even during the first seizure. Causes of death: brain hemorrhage, asphyxia, pulmonary edema, cardiac arrest, Eclampsia should be differentiated from epilepsy, hysteria, etc. Treatment. Emergency. During a seizure between the molars, you must insert a mouth expander, a spatula, or a spoon handle covered with gauze to avoid biting the tongue. Then the tongue holder, so that the tongue does not fall, turn the head to the side to prevent aspiration of vomit. As soon as the first breath appears, saliva is removed from the mouth and oxygen is inhaled. In case of respiratory disorders, it is recommended to switch to auxiliary breathing or artificial ventilation (only the doctor). Then a complex medical treatment is performed, and a quick and gentle delivery is shown.If there are conditions, delivery is carried out through the natural birth canal (the imposition of obstetric forceps, fetal extraction for the pelvic end). Indications for cesarean section are: eclampsia, preeclampsia with failure of intensive care, comatose state,anuria, amovrosis, retinal detachment, suspected brain hemorrhage. Toilet the patient on admission, vaginal examination, catheterization, injections and other manipulations should be performed under light ether or ftorotanovy anaesthesia. The patient is located in the pit, where an individual post is established (anesthesiologist, obstetrician-gynecologist, midwife, nurse-anesthetist) After childbirth, women who have suffered eclampsia need special attention and subsequent long-term follow-up in a women's clinic.