Obstetrics and gynecology. Late toxicosis of pregnant women (most important)

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Obstetrics and gynecology. Late toxicosis of pregnant women (most important)

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31. Late toxicosis of pregnant women

Toxicosis that developed after 20 weeks of pregnancy is called late or toxicosis of the second half of pregnancy. OPG-preeclampsia is a syndrome of multiple organ failure resulting from the development of pregnancy. The causes of this pathology have not yet been clarified enough. The immunological theory explains the occurrence of symptoms of OPG-preeclampsia by the reaction of the body of a pregnant woman to fetal antigens. This theory of the occurrence of OPG-gestosis is confirmed by the detection of subendothelial complement deposits, immunoglobulins G and M in the kidneys of a pregnant woman.

Generalized vasospasm with subsequent or simultaneous development of hypovolemia is important in the development of OPG preeclampsia. According to most scientists, the primary is a violation of the uteroplacental circulation, after which a spasm of peripheral vessels occurs, as a result of which the volume of the vascular bed decreases, and hypovolemia occurs.

V. N. Sterov and co-authors believe that there are two main reasons for the development of OPG-preeclampsia: diffusion-perfusion insufficiency of uteroplacental circulation and the presence of extragenital pathology in a pregnant woman, primarily circulatory disorders in the kidneys. In both cases, there is a syndrome of multiple organ failure with a different clinic and consequences. Mixed forms of OPG-gestosis are possible, in which several systems are affected simultaneously.

For all the reasons for the development of OPG-gestosis, there is a violation of the functions of the placenta. Uteroplacental perfusion is sharply reduced. This is mainly due to a decrease in pulse blood pressure and deterioration of venous outflow. With a mild course of OPG-gestosis, perfusion disturbance is eliminated by increased cardiac activity of the pregnant woman and an increase in blood pressure. With an increase in the symptoms of OPG-preeclampsia, hypoxia and acidosis develop in the mother's body. They lead to a continued decrease in uteroplacental perfusion, which can have consequences such as hypoxia, malnutrition and fetal death. Obesity, multiple pregnancies, polyhydramnios, stress, physical stress are additional factors contributing to an increase in uteroplacental perfusion disorders.

Vascular disorders resulting from the development of OPG-gestosis disrupt the diffusion capacity of the placenta. The process is also enhanced by the activation of lipid peroxidation. The products of incomplete breakdown of fats cause damage to cell membranes, which leads to a sharp deterioration in gas exchange, disruption of the barrier, filtration and purification, endocrine, immune and metabolic functions of the placenta, in which areas of thrombosis, ischemia, hemorrhages and edema begin to form. As a result of these changes in the placenta, the needs of the fetus are not fully met, and its development is delayed. In the placenta, the synthesis of estrogens and progesterone, which contribute to the normal development of pregnancy, decreases.

Author: Ivanov A.I.

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