Obstetrics and gynecology. Clinical picture of OPG (dropsy, nephropathy) (the most important)

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Obstetrics and gynecology. Clinical picture of OPG (dropsy, nephropathy) (the most important)

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32. Clinical picture of OPG (dropsy, nephropathy)

Clinical picture and diagnosis. Clinical manifestations of OPG gestosis are as follows: significant increase in body weight, the appearance of edema, proteinuria, increased blood pressure, convulsions and coma.

Dropsy pregnant women is expressed in the appearance of pronounced persistent edema in the absence of proteinuria and normal blood pressure. Initially, edema may be hidden (positive symptom of the ring, McClure-Aldrich test), there is an excessive increase in body weight. Further, visible edema appears on the lower extremities, in the vulva, torso, upper extremities and face. Pregnancy in most cases ends with delivery on time. Sometimes nephropathy of pregnant women develops.

Nephropathy pregnant women are three main symptoms: proteinuria, edema, increased blood pressure.

There are three degrees of severity of nephropathy:

1) swelling of the lower extremities, blood pressure up to 150-90 mm Hg. Art., proteinuria up to 1 g / l - I degree;

2) swelling of the lower extremities and anterior abdominal wall, blood pressure up to 170/100 mm Hg. Art., proteinuria up to 3 g / l - II degree;

3) pronounced edema of the lower extremities, anterior abdominal wall and face, blood pressure above 170/100 mm Hg. Art., proteinuria more than 3 g / l - III degree. The onset of preeclampsia and eclampsia can occur with II and even with I degree of severity of nephropathy.

When prescribing treatment for nephropathy in pregnant women, it is also necessary to take into account the degree of impairment of the state of the cardiovascular, urinary systems, kidneys, and liver function. The severity of nephropathy is characterized by an increase in diastolic and a decrease in pulse pressure, as well as asymmetry in blood pressure. Further development of preeclampsia leads to increased hemodynamic disturbances. To accurately determine the degree of proteinuria, the daily excretion of protein in the urine is determined. It increases with the progression of preeclampsia and in severe nephropathy exceeds 3 g. A violation of the concentration function of the kidneys can be assumed from stable hypoisosthenuria (urine specific gravity - 1010-1015) in the study according to Zimnitsky. With worsening preeclampsia, diuresis decreases, the nitrogen excretion function of the kidneys decreases (the urea content in the blood reaches 7,5 mmol / l or more).

At the same time, there is a decrease in the amount of protein in the blood plasma (up to 60 g / l or less). The development of hypoproteinemia is associated with several reasons, one of them is a violation of the protein-forming and antitoxic functions of the liver and a decrease in the colloid-oncotic pressure of the blood plasma. An increase in the permeability of the vascular wall and, as a result, the appearance of protein in the extracellular space can also be the causes of hypoproteinemia. The severity of preeclampsia is indicated by its early onset and prolonged course, as well as severe thrombocytopenia and fetal malnutrition. In severe nephropathy, there is a high probability of premature detachment of the placenta, premature birth, intrauterine death of the fetus. Nephropathy can result in preeclampsia and eclampsia.

Author: Ivanov A.I.

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