Obstetrics and gynecology. Treatment of gestosis (the most important)

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Obstetrics and gynecology. Treatment of gestosis (the most important)

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34. Treatment of preeclampsia

Therapy of preeclampsia depends on its severity. Treatment of dropsy of pregnancy is based on diet. Limit fluid intake to 700-800 ml and salt to 3-5 g per day. Diets are used in the form of unloading apple or cottage cheese days no more than once a week. In case of nephropathy in pregnant women, sedatives are additionally prescribed (motherwort tincture, Relanium (2,0 ml intramuscularly), phenobarbital, desensitizing agents. Antihypertensive drugs are used taking into account individual sensitivity and under regular blood pressure monitoring. In order to normalize the permeability of the vascular wall, askorutin is prescribed - ascorbic acid.

Reflexotherapy, electrotranquilization have a good effect.

Hypovolemia is corrected with infusion therapy. To restore water-salt metabolism, diuretics are used in the form of herbs (decoction of bearberry leaves), veroshpiron, lasix. Methionine, folic acid, asparcam are used to normalize metabolism. For preventive and therapeutic purposes, in the event of intrauterine hypoxia and fetal hypotrophy, nootropic drugs - piracetam - are prescribed. To improve the rheological and coagulation properties of blood, antiplatelet agents are prescribed: chimes, as well as reopoliglyukin.

Therapy of preeclampsia and eclampsia requires a special approach.

The basic principles were developed by V. V. Stroganov.

1. Creation of a medical and protective regimen, including rest, sleep and rest.

2. Carrying out activities aimed at normalizing the functions of the most important organs.

3. The use of medications to eliminate the main manifestations of eclampsia.

4. Fast and gentle delivery.

Eclamptic status, eclampsia in combination with large blood loss, the development of symptoms of cardiopulmonary insufficiency, eclamptic coma are regarded as absolute indications for mechanical ventilation. In these cases, it is necessary to prescribe glucocorticoids: hydrocortisone hemisuccinate (500-800 mg per day) or prednisolone-hemisuccinate (90-150 mg per day) with a gradual dose reduction. Artificial ventilation of the lungs is carried out in the hyperventilation mode until, without anticonvulsant therapy, there is no convulsive readiness for 2-3 days, the patient is in contact, blood pressure stabilizes, and there are no complications from the respiratory system. To prevent the onset and development of acute renal and renal-hepatic insufficiency, inflammatory-septic diseases, blood loss is mandatory during childbirth (with caesarean section - in the early postpartum period). In addition, it is advisable to conduct active antibiotic therapy. In renal and hepatic insufficiency, extracorporeal detoxification methods (hemodialysis, hemosorption, plasmapheresis), hemoultrafiltration are carried out. Delivery at term and the use of complex therapeutic effects can reduce the incidence of mortality in eclampsia.

Author: Ivanov A.I.

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