Obstetrics and gynecology. Clinical picture of OPG (preeclampsia, eclampsia) (most important)

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Obstetrics and gynecology. Clinical picture of OPG (preeclampsia, eclampsia) (most important)

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33. Clinical picture of OPG (preeclampsia, eclampsia)

Preeclampsia. It is characterized by signs associated with dysfunction of the central nervous system such as hypertensive encephalopathy (cerebrovascular accident, increased intracranial pressure and cerebral edema). Excitement of patients is noted, less often drowsiness. Against the background of high blood pressure, a woman experiences headaches, dizziness, and blurred vision (flickering spots before her eyes). Some pregnant women experience pain in the epigastric region, nausea, and vomiting. At this time, hemorrhages in the brain and other vital organs are possible. Sometimes premature birth, premature placental abruption, and fetal death occur. As the clinical manifestations of gestosis increase, cerebral circulation is disrupted. As a result, convulsive readiness appears, eclampsia occurs - convulsions and loss of consciousness.

Eclampsia occurs most often against the background of preeclampsia or nephropathy. It is characterized by convulsions and loss of consciousness. A seizure in eclampsia may have a sudden onset, but in most cases it is preceded by symptoms of preeclampsia. It develops in a certain sequence.

The first stage lasts 20-30 s. At this time, small fibrillar contractions of the muscles of the face are noted, which then pass to the upper limbs.

The second stage lasts 15-25 s. It is characterized by the appearance of tonic convulsions of all skeletal muscles, while there is a violation or complete cessation of breathing, cyanosis of the face, dilated pupils, loss of consciousness.

At the onset of the third stage, lasting 1-1,5 minutes, tonic convulsions turn into clonic convulsions of the muscles of the trunk, then the upper and lower extremities. Breathing becomes irregular, hoarse, foam comes out of the mouth, stained with blood due to biting the tongue.

The fourth stage is characterized by the fact that after the cessation of seizures, the patient falls into a coma (usually lasts no more than 1 hour, sometimes several hours or even days). Consciousness returns gradually, amnesia is noted, the patient is worried about headache, fatigue. Sometimes the coma persists until a new seizure. A convulsive seizure may be single, or there is a series of seizures up to several dozen, recurring at short intervals (eclamptic status). The more seizures there were, the more often they were, the longer the period of the patient's coma, the more severe the eclampsia and the worse the prognosis. There may be a sudden loss of consciousness, not accompanied by convulsions. Complications of eclampsia include the development of heart failure, pulmonary edema, acute respiratory failure, aspiration pneumonia. There is also brain damage in the form of edema, ischemia, thrombosis, hemorrhage. Perhaps the development of retinal detachment, an acute form of disseminated intravascular coagulation, hepatic and renal failure. With eclampsia, premature detachment of the placenta, termination of pregnancy is not excluded. During respiratory arrest, fetal death may occur due to hypoxia.

Author: Ivanov A.I.

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