Poisoning during pregnancy

introduction

Pregnancy poisoning, also known as gestosis, is a generic term for all diseases that are associated with high blood pressure values ​​during pregnancy.
It is one of the most common pregnancy complications, along with bleeding, and accounts for 20% of perinatal deaths.

The term pregnancy poisoning is widespread, but now out of date and somewhat misleading, as it is with this clinical picture is not a poisoning in the sense. Therefore, the term gestosis is more commonly used nowadays.

The pregnancy poisoning occurs mainly in the last third of the pregnancy up and go with me Water retention in the legs, hands, and face, high blood pressure and increased Excretion of protein in the urine hand in hand. One speaks of an increased blood pressure Values ​​over 140/90 mmHg. Blood pressure values ​​below 130/80 mmHg are normal.

Poisoning during pregnancy can occur under certain circumstances life threatening for mother and child but can usually be recognized in time and treated well become. Only in rare, severe cases is one early delivery of the child is necessary, but usually not before the 28th week of pregnancy, from which the child is already viable.

Read more on the subject below Pregnancy Complications - What Are The Signs?

definition

The pregnancy poisoning (Gestosis) is a collective term for all pregnancy diseases that start with increased blood pressure accompanied. It is mainly expressed in generalized water retention in the body (Edema), Blood pressure values ​​over 140/90 mmHg (hypertension) and increased Protein excretion via the urine (Proteinuria).
The poisoning of pregnancy is further subdivided into five sub-forms:

• pregnancy-related high blood pressure (SIH)
• pre-eclampsia
• Eclampsia
• HELLP syndrome
• Grafting

Pregnancy-related high blood pressure

Under pregnancy-related high blood pressure (SIH) one understands increased blood pressure values ​​for the first time, after the completed 20th week of pregnancy, without protein excretion.

pre-eclampsia

From one pre-eclampsia one speaks of blood pressure values over 160/110 mmHgwhich occurred for the first time after the 20th week of pregnancy and with increased Protein excretion in the urine, Kidney and liver damage, as well as neurological complaints such as a headache and Visual disturbances accompanied. Having preeclampsia can also cause it Growth and development disorders of the child come.

Eclampsia

A Eclampsia is characterized by the same symptoms as preeclampsia plus additional symptoms Seizures. Eclampsia is a life threatening emergencythat sometimes too coma and Multiple organ failure can lead. The Maternal mortality is between 8-27%.

HELLP syndrome

The HELLP syndrome expresses itself mainly through strong Upper abdominal pain, nausea, Vomit, Visual disturbances and a headache, and goes with stronger Liver damage and one impaired blood clotting which can sometimes be life-threatening. The HELLP syndrome is considered a very important one, and very dangerous complication pregnancy poisoning.

Graft gestosis

From one Graft gestosis one speaks when the woman is already before the onset of pregnancy under chronic high blood pressure or one Kidney disease and then develop symptoms of pregnancy poisoning during pregnancy. Women with graft disease have one high risk of preeclampsia.

causes

The exact causes of pregnancy poisoning have not yet been clarified. There are several hypotheses in which the Plaster cake (placenta) plays an important role in the development of the disease. It is believed to be due to a Reduced blood flow of the mother cake to a release of toxic substances come the one Vascular spasm trigger that takes the form of a increased blood pressure in the mother expresses.
This in turn leads to, among other things Kidney damage, with increased protein excretion, one Liver damage, with expression of a HELLP syndrome and to damage the Central nervous system, With Seizures as a result. The chronic reduced blood supply to the mother cake also carries the risk for childhood growth and development disorders.

Proven to be safe Risk factors however, the following apply to pregnancy poisoning: obesity (BMI> 30), Age over 40 years, better known high blood pressure, a pre-existing Diabetes mellitus, one familial accumulation of gestures, existing Kidney disease and certain Autoimmune diseases, among other things Antiphospholipid Syndrome. Also a multiple pregnancy, or genetic disorders, like Trisomies, can increase the risk of developing pregnancy poisoning. Women who have already had pregnancy poisoning also have one increased risk of repetition.

Symptoms

Symptoms of pregnancy poisoning in the mother are mainly:

• Water retention in the body
• increased proteinuria
• up to acute kidney failure
• severe upper right abdominal pain
• nausea
• Vomit
• a headache
• Visual disturbances
• Sensitivity to light and noise
• Seizures as a result of CNS damage.

Due to the chronic reduced blood flow and dysfunction of the placenta, growth and development disorders can occur in the child, premature placental detachment, with premature birth or miscarriage as a result.
If you have one of these symptoms of pregnancy poisoning, you should see a doctor as soon as possible in order to take countermeasures.

Read more on the topic: Placental insufficiency

Diagnosis

Pregnancy poisoning can usually be detected and treated in good time as part of preventive medical check-ups. The mother's blood pressure and weight are regularly checked and the urine is checked for possible urinary tract infections and proteinuria using a urine stix.
Furthermore, an ultrasound is performed, in which the child's growth can be assessed, as well as the placenta and the amount of amniotic fluid.

You might also be interested in: Protein in the urine during pregnancy

If there are any abnormalities in the ultrasound that indicate pregnancy poisoning, Doppler sonography is performed. This involves a special ultrasound examination of the uterine and placenta vessels, as well as the child's cerebral vessels, in which the risk of preeclampsia can be assessed, as well as any reduced blood flow and functional disorders of the placenta.

Read more on the topic: Doppler sonography

The CTG monitors the child's heart functions. Ophthalmological examinations are also indicated in order to rule out retinal hemorrhages and papillary edema, which can be an early indication of increased intracranial pressure as a result of the increased blood pressure. A blood test can also be used to determine elevated liver values ​​and blood clotting disorders in the context of a HELLP syndrome.

therapy

The mildest form of pregnancy poisoning, pregnancy-induced hypertension (SIH) should only be treated with medication if the blood pressure is elevated above 160/110 mmHg. The drug of choice here would be alpha-methydopa in tablet form, alternatively also with nifedipine or urapidil. The most important thing here, however, is avoiding stress, as well as getting enough exercise and a balanced, protein-rich diet.
Read more about the topic here: Lowering blood pressure during pregnancy

In the case of preeclampsia, hospitalization should always be carried out, with bed rest, controlled lowering of blood pressure with medication and careful flushing out of the edema.
If the child is threatened with premature birth, lung maturation should be carried out. In the case of a severe form of preeclampsia, admission and monitoring is carried out in the intensive care unit, with continuous CTG and thrombosis prophylaxis. Depending on the mother's condition, the earliest possible delivery of the child should be considered, in an emergency even if the child is immature, because the only causal treatment for pregnancy poisoning is termination of the pregnancy.

Complications and consequences

The consequences of any pregnancy poisoning can Eclampsia be those with life threatening Seizures, up to unconsciousness and coma, goes hand in hand and to Blindness, heart- and Kidney failure, and ultimately to Death of mother and child can lead. The mortality rate lies between 8-27%.

Another consequence of pregnancy poisoning can be HELLP syndrome be where it is especially to life-threatening bleeding disorders that can come in the form of a Consumption Coagulopathy express where it is for Multiple organ failure and life-threatening bleeding can occur.

Forecast and danger

The pregnancy poisoning is one of the leading causes of death for mother and child during pregnancy.
When full screen an eclamspy is the risk to the Maternal mortality about 8-27%, The full picture of a HELLP syndrome is at risk for the Lethality of the child at approx. 30%. However, if the disease is recognized and treated in time, it is Forecast very favorable.

Prevention and prevention

The most important thing to prevent pregnancy poisoning is regular Prenatal checkups, routine Urine and blood pressure controls.
In addition, pregnant women should also pay attention to themselves whether Water in their legs, hands or in yours face stores. It often helps with swollen legs To sit legs up, as well as being sufficient too move,to the Blood circulation to improve.
If no improvement is achieved, it is important to see a doctor immediately. One is also important balanced and healthy nutrition. Pregnant women who are at risk of pregnancy poisoning should be careful sufficient proteins to take in. Protein foods are for example Cheese, milk, meat, fish and nuts.
Another important measure to avoid high blood pressure is above all Avoiding stress and sufficient Relaxation.