What is gestosis?

by Claudia Ravaldi

curated by Valentina Pontello

Valentina Pontello , gynecologist and counselor talks about gestosis, and what it is important to know.

What is gestosis?

Gestosis or preeclampsia is a condition characterized by hypertension (blood pressure above 140/90 mmHg) and proteinuria (i.e. the presence of protein in the urine), which develops after 20 weeks of gestation . Some cases have a lightning-fast onset, while others have a subtle course and are difficult to diagnose.

The possible complications (sometimes lethal) for the health of the mother and the child make it one of the most feared pathologies by those involved in obstetrics. It is therefore very important that mothers are also sensitized to be able to recognize the early signs of this pathology in order to be able to promptly report any changes deemed suspicious to the doctor.

What is eclampsia?

Eclampsia is the most severe and rare form of gestosis: it manifests itself with convulsions and requires prompt intervention because it can be lethal for the mother and the baby. This usually occurs in patients with serious overt gestosis and therefore already undergoing hospitalization. The HELLP syndrome consists of a condition in which gestosis is combined with hemolysis (ie the destruction of red blood cells), an increase in liver enzymes and a reduction in the number of platelets, a sign that the disease has spread to the whole maternal organism and is no longer confined to the placenta alone.

In these particularly severe forms, delivery must be carried out quickly at any gestational period, to prevent irreversible damage to the mother’s health. On the other hand, in other milder forms of gestosis, especially if arisen in the preterm period, it is preferred to buy time, to improve the survival and health prospects of the child.

Can a good and thorough family and personal medical history (gathering all the information on our health and that of our family) during the obstetric visit exclude the risk of gestosis?

No, in no case is it possible to exclude a priori the future appearance of gestosis, and it is good to always remain alert. Doctors and midwives must always be ready to recognize the symptoms of this pathology, even in pregnancies considered ” physiological ” up to that moment.

Are there women who are more at risk than others of developing gestosis?

Women who have had gestosis in a previous pregnancy, chronic hypertensive patients (some discover they are pregnant only when they are already pregnant) and in general those suffering from type I diabetes (insulin-dependent) or from kidney or kidney diseases are particularly at risk. of the immune system, which compromise the function of the placenta. Gestosis often complicates the child’s growth retardation, especially in early onset cases (around 20-24 weeks), which are the most difficult to manage, given the child’s extreme prematurity. However, it should be remembered that gestosis can also affect a full-term, healthy pregnancy considered “physiological”.

So how to recognize the first signs of gestosis?

  • Check for weight gain . Gestational diabetes and excessive weight gain are associated with gestosis risk . A rapid and excessive weight gain of the mother (from the kilo upwards in a few days) can be a sign of water retention . Reduce your dietary intake of salt and follow a proper diet to reduce the risk of this complication.
  • Check for peripheral edema , and always bring them to the attention of the gynecologist during the monthly visit. The signs of edema are: swollen hands with difficulty in removing the ring, swollen ankles, with socks that leave deep marks. Water retention is common in pregnancy, especially in term and alone does not diagnose gestosis, but it is still important to be aware of the associated signs.

Regularly perform the examinations required by the pregnancy protocol. In particular it is important the urinalysis , scheduled monthly, which may show the presence of proteinuria. Proteinuria, if mild, can also be associated with urinary tract infections and is not necessarily a sign of gestosis. Always show your doctor the tests as soon as they are ready.

  • The most important thing is to take your blood pressure often: a couple of times a week from 20 weeks, intensifying checks at the end of pregnancy. If you don’t have the device at home, go to the pharmacy, and write down the results on a card, to be presented to the doctor at the time of the check-up. Ask your doctor to take your blood pressure every time you visit. Normal values are those equal to or less than 120/80 . In fact, pregnancy in itself causes a reduction in blood pressure and viscosity levels, which are functional to correct placental circulation.

What blood pressure values can indicate hypertension in pregnancy?

Values of 130-135 for systolic and 85 for diastolic sound the first alarm bell and must be kept under strict control. Values equal to or greater than 140/90 may require a series of tests, to be performed in hospital. If you have persistently altered blood pressure levels, contact your doctor urgently or go to the local gynecological emergency room.

To find out more, see http://www.medicinamaternofetale.it/medicina-materna/gestosi

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