MCO test during pregnancy, resorption rate. Preeclampsia in the second half of pregnancy. How can you resist gestosis?

Most often, gestosis occurs in the third trimester: this explains its second name - late toxicosis. However, it has almost nothing in common with toxicosis, in the usual understanding of this diagnosis.

What is gestosis?

Gestosis (late toxicosis) is a pathological condition of the second half of pregnancy, accompanied by three distinctive signs:

swelling (visible or hidden);
proteinuria (traces of protein in urine);
hypertension (sustained increase in blood pressure).

This disease greatly affects the well-being of the expectant mother, as it affects the functioning of vital systems: nervous, cardiovascular, hemostasis and endocrine.

Those at risk for developing gestosis include:

primigravidas (in particular, women over 35 years old);
carrying twins or triplets;
persons suffering from chronic diseases (diabetes mellitus, pyelonephritis, vegetative-vascular dystonia);
overweight women;
women with untreated STDs.

How to identify late gestosis?

A pregnant woman can and should monitor changes in her health. But what you definitely shouldn’t do is diagnose yourself. If you suspect that the cause of your discomfort is gestosis, consult a doctor. Without timely diagnosis and correction, the disease can lead to miscarriage.

The following medical studies and tests will help identify late toxicosis in the second half of pregnancy:

General urine analysis: taken every two weeks (more often if necessary) before visiting a gynecologist.
Ultrasound examination and Dopplerography: helps assess the development of the child, the condition of the amniotic fluid and placenta.
Blood pressure measurement. This indicator can be monitored both in the clinic and at home.
Control of the level of protein and hormones produced by the placenta. A decrease in PAPP-A protein and the hormone PIGF may be a sign of fetal growth restriction and placental insufficiency.
Medical examination to detect edema. The doctor watches how the patient’s skin reacts to the removal of rings, socks, and elastic bands and controls how quickly the dents disappear.
Weighing and tracking gradual weight gain. This indicator can also be further monitored at home using electronic scales.

Note! Monitoring protein and hormone levels complements the results obtained from ultrasound.

Causes of gestosis during pregnancy

In medical circles, gestosis has a second name - “the disease of theories.” It is quite understandable, because the exact cause-and-effect relationship of the occurrence of the disease has not yet been deduced. There are only plausible theories that sound like this:

There is a disruption in the functioning of the brain. This theory is supported by statistical data: gestosis occurs much more often in women exposed to severe stress. In the cerebral cortex, the processes of excitation and inhibition are disrupted and vascular spasm occurs.
The endocrine system fails due to a sharp increase in hormone levels.
The immune system perceives the fetus as foreign tissue and the body begins to produce antibodies against it. An internal failure occurs, and as a result, blood vessels contract.

Note! At the moment, doctors have come to a consensus that gestosis occurs due to a combination of all of the above factors.

Why is gestosis dangerous in the second half of pregnancy?

Preeclampsia has an extremely negative effect on the well-being of the expectant mother and the health of the fetus, and here’s why:

Against the background of gestosis, a woman may develop side diseases of the nervous system, kidneys, liver and visual organs.
Vascular spasms can contribute to the formation of blood clots, cerebral edema, heart failure, and even cause a coma.
Attacks of nausea and vomiting dehydrate the expectant mother's body and can lead to placental abruption, fetal asphyxia, or premature birth.
Sluggish gestosis leads to hypoxia and delays in intrauterine development of the fetus.
Newborns whose mothers suffered from gestosis during pregnancy most often have extremely low body weight, delayed physical and mental development, and weak immunity.

Important! Perinatal mortality in late gestosis is 32%.

In case of eclampsia (severe form of gestosis), an artificial induction of premature birth or cesarean section is the only way to save the life of the mother and child. Fortunately, the disease rarely progresses to this stage.

Symptoms of gestosis in the second half of pregnancy

OPG is another name for gestosis in modern medicine, which stands for as follows:

O - swelling;
P - proteinuria (traces of protein in urine);
G - hypertension (high blood pressure).

These symptoms are characteristic of gestosis in the second half of pregnancy, however, not all expectant mothers who were diagnosed with “late toxicosis” experienced all three.

Most often, women complain only about the very first thing - swelling.

Reference! All three signs of gestosis occur only in 15% of 100 cases.

The localization and intensity of swelling reflects the progress of the disease:

First degree- arms and legs swell.
Second degree- swelling covers not only the limbs, but also the abdomen.
Third degree- swelling spreads not only to the body, but also to the neck and face.

Treatment of gestosis in the second half of pregnancy

Treatment of gestosis is a difficult task that only a professional can cope with. For any form of late toxicosis, the woman is placed under observation in the maternity ward. This measure is taken to:

Restoration and normalization of the vital functions of the expectant mother’s body.
Creating resting conditions for preserving the fetus.
A quick and safe birth.

For patients whose gestosis is associated with nervous disorders and stress, doctors prescribe herbal-based sedatives (valerian, motherwort, Novopassit). Less commonly, the expectant mother is prescribed tranquilizers.

An obligatory point in eliminating gestosis is infusion-transfusion therapy aimed at improving blood circulation and normalizing blood pressure.

Also, medications are used to normalize blood pressure:

Papaverine;
Dibazol;
Eufillin.

Reference! For mild hypertension, taking only one drug is sufficient.

With gestosis, the fetus suffers from a lack of oxygen and nutrients. This problem is solved with the help of the following disaggregants:

Aspirin;
Trental;
Chime;
Fraxiparine.

If the signs of gestosis are not very pronounced and the therapy has a positive effect, the woman can give birth naturally, but only under painkillers and after hormonal therapy and preparation of the cervix. If late toxicosis occurs in a severe form, then the woman in labor is prescribed a cesarean section. This is the only way to preserve the health of the mother and the life of the child.

Prevention

Prevention of gestosis should begin at the planning stage of the baby. To reduce the likelihood of late toxicosis you need:

Cure all existing diseases- this must be done before conception.
Find physical activity to your liking and don’t forget about sports even during pregnancy. Daily walks in the fresh air are a must.
Watch your diet and take vitamin and mineral supplements as prescribed by your doctor.
Lose excess weight before pregnancy, and also make sure that no more than 12 kg are gained during it.
Limit your intake of sugar and salt, so as not to retain water in the body.
Drink enough clean drinking water without gas - this will help avoid dehydration.

Conclusion

Unfortunately, you cannot insure against the development of gestosis, however, you can minimize the likelihood of its occurrence if you prepare for conception, register with the hospital in a timely manner and follow all medical recommendations.

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If a pregnant woman has gained a lot of weight, obstetricians are not worried about her appearance, but about the health of the expectant mother and her baby. Preeclampsia during pregnancy is a serious disease; it is in order to recognize it in the early stages that doctors weigh expectant mothers at every examination. Of course, this causes a lot of indignation, the question is, what difference does it make to the doctor whether I add 10-12 kilograms (this is the norm) or 20, is it my figure? So doctors have to explain that pathological weight gain is one of the symptoms of a serious pathology of gestosis in pregnant women.

This disease is insidious and occurs only in expectant mothers. Almost a third of expectant mothers suffer from gestosis; it is difficult to detect in the early stages and poses a threat to the mother and fetus. The first signs of gestosis can be noticed only from the 20th week; most often, many doctors begin to notice changes only in the third trimester, from the 28th week. The reason that gestosis occurs in pregnant women is a change in the body of the expectant mother; substances are produced in the placenta that are capable of making small holes in the vessels, it is through them that liquid and plasma penetrate from the blood into the tissue, which leads to swelling. The more holes are formed in the vessels, the more protein a woman loses, and, accordingly, the disease worsens. Doctors often prescribe a general urine test to understand whether there is protein there and, based on this, determine whether gestosis occurs during pregnancy or not.

Symptoms of gestosis in pregnant women

Since fluid disappears from the vessels, the body increases blood pressure in order to quickly pump the remaining fluid through the body; it is not without reason that the symptoms of gestosis do not exclude high blood pressure.

The blood thickens, its coagulability decreases, which can cause blood clots.

The insidiousness of gestosis in pregnant women lies in the fact that a woman feels healthy for a long time. Well, just think, protein in tests and excess weight – is this really an indicator? After all, the kidneys don’t bother me, and my head doesn’t hurt, and there’s no visible swelling. But swelling can manifest itself not only in the arms and legs, but also in the placenta, which means that the fetus simply does not have enough oxygen, which will later manifest itself as an attack of convulsions. Symptoms shortly before an attack of convulsions appear instantly: nausea, flashing “spots” before the eyes, headache, drowsiness, abdominal pain. This condition of a woman is called preeclampsia, and the attack of seizures itself is called eclampsia. This condition can trigger the development of stroke, heart attack, pulmonary edema, liver and kidney failure. And this happens quite quickly even in a young and seemingly healthy woman. It is precisely because the symptoms of gestosis are unpredictable that doctors devote a lot of time to the prevention and timely diagnosis of this disease in expectant mothers.

How is the diagnosis made?

If the expectant mother has gained a lot of weight, but no visible edema has appeared, then the doctor may do an MCO or MacLure-Aldrich test. The procedure is simple: a saline solution is injected under the skin and the time is measured to determine how long it takes for the papule to resolve. If faster than 35 minutes, then the pregnant woman has hidden swelling. Also, many people notice that it is more difficult for them to bend their fingers, and they swell, this is swelling.

If the doctor reveals only slight swelling of the legs, then it is enough to limit yourself to outpatient treatment, but if this is also accompanied by swelling of the face, hands, and protein appears in the urine, then you need to go to the hospital. Symptoms of gestosis can appear in just a few days. Taking certain medications can only worsen the situation, especially diuretics. Many women naively believe that such pills will help remove excess fluid from the body. The fact is that there is already not enough of it in the vessels, because it is in the tissues, which means that diuretics can aggravate the course of gestosis.

It is worth recalling that gestosis during pregnancy has risk groups, which include:

women who are pregnant for the first time;
those who are expecting twins;
women over 35 years of age;
expectant mothers who have chronic diseases: diabetes mellitus, hypertension, pyelonephritis or vegetative-vascular dystonia.
ladies who have been diagnosed with sexually transmitted infections: ureaplasmosis, chlamydia, mycoplasmosis.

Prevention and treatment of gestosis

To avoid gestosis, try to eat right; the basis of every growing organism is protein, so try to include fish, cottage cheese, chicken, and eggs in your diet. If doctors have already diagnosed gestosis in pregnant women, then the need for protein foods increases, because protein is lost in the urine and goes into the tissues. It is advisable to limit yourself to sweets; try to replace them with fruits and vegetables, preferably rich in fiber.

If you notice a lot of weight gain, limit your intake of salty foods and liquids. Also, do not forget about an active lifestyle: swimming, hiking or yoga are the best activities for expectant mothers. To avoid swelling, drink a decoction of rose hips, bearberry, cranberry juice or kidney tea.

If you have been diagnosed with a mild or moderate degree of gestosis, then this is treated in the hospital, the pathology department. For more serious symptoms, treatment of gestosis is transferred to the intensive care unit. It is necessary to take blood and urine tests, and also do an ultrasound to assess the condition of the fetus. Consultation with specialists is required: therapist, neurologist, ophthalmologist. Treatment of gestosis mainly consists of infusion therapy to replenish the lack of fluid, and at the same time, medications are prescribed that lower blood pressure. The duration of inpatient treatment depends on the severity of the disease, usually a week or two. If treatment for gestosis does not produce the desired results and it continues to worsen, the pregnant woman undergoes a cesarean section.

Toxicosis in the last trimester, called gestosis, is one of the most serious complications of pregnancy.

Despite this, gestosis is by no means considered a rare phenomenon: approximately every third expectant mother has to deal with it, for whom it threatens with problems in the kidneys, cardiovascular system, blood flow disorders and other unpleasant consequences for both the woman herself and her baby.

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Symptoms of gestosis during pregnancy

visible swelling on the woman’s face and limbs;
excessive weight gain;
the appearance of protein in the urine;
increased blood pressure;
swelling of the placenta detected during ultrasound examination.

Most of these signs can go unnoticed for a long time, and when a woman feels changes in her health, the disease can already lead to serious consequences. Therefore, it is important not to miss preventive appointments with a gynecologist and undergo prescribed tests on time.

Specialists

Preeclampsia in the second half of pregnancy (preclampsia)

Preeclampsia can occur as early as 20 weeks after your last menstrual period. Its additional signs are dizziness, nausea, headaches, and in complicated cases - changes in mental state and visual impairment.

They indicate that in the absence of effective treatment, eclampsia can occur - a very dangerous convulsive attack for the expectant mother, which often results in pulmonary edema, kidney failure, stroke, placental abruption and other life-threatening conditions and the continuation of pregnancy.

Diagnostics

Preventive examinations and laboratory diagnostics during pregnancy make it possible to recognize gestosis in time. During each visit to the doctor, the expectant mother is weighed, her blood pressure is measured, and she is regularly given directions for a urine test.

If there is a suspicion of gestosis, and its signs in a woman are questionable, the gynecologist may prescribe her an MKO test. During this study, the resorption time of subcutaneously injected saline is calculated. If it is less than thirty minutes, this indicates the presence of hidden edema.

Treatment of gestosis during pregnancy

If gestosis is detected in the second half of pregnancy, it is necessary to undergo a course of treatment in a hospital. The woman will be prescribed special medications, as well as droppers to restore protein losses and lack of fluid in the blood vessels.

The duration of treatment for gestosis during pregnancy depends on the severity of symptoms and some other factors. If therapy does not bring the desired results and the disease threatens the life of the expectant mother or her child,

It is in the late stages of pregnancy (so from 18 to 36 weeks). This is a real complication, which, by the way, unlike early toxicosis, can subsequently actually harm the health of the unborn child, and about a third of absolutely all pregnant women are susceptible to it. And of course, with gestosis, some kind of circulatory disturbance occurs, and the tissues simply do not receive enough of the much-needed amount of oxygen, and thus the water-salt balance is disturbed. And all the walls of the vessels weaken somewhat, and a certain dose of liquid enters the tissues.

Symptoms of such gestosis are significant swelling of the face, arms and legs, as well as high blood pressure, then protein in the urine, frequent headaches, severe headaches, and some mental disorders are also possible. In addition, with gestosis, edema of the placenta also develops, which may then well lead to oxygen starvation of the fetus itself, and this, of course, also affects the nervous system of the child himself. The danger of this pathology also lies in the fact that it is not at all easy to recognize immediately, and seeking medical help is often too late, when gestosis itself is already developing. But the consequences of such late toxicosis may well be extremely severe - even up to a stroke, as well as a heart attack, or pulmonary edema, and sometimes even kidney failure. The most dangerous stage of such gestosis is called eclampsia. But with it there is a real threat of retinal detachment, convulsions or fainting may occur. Therefore, absolutely all pregnant women, without exception, need to regularly undergo appropriate examinations, because such complications can only be identified with the help of special laboratory tests. But if there are simply no real external signs of swelling, a special MKO test is prescribed: this is how a special saline solution is injected subcutaneously and the full time of its resorption is recorded. And if this time is less than 30 minutes, then there is some hidden swelling.

In addition, among the real ones there may be pathologies of the endocrine system, as well as obesity, hypertension, and some serious sexual diseases. Preeclampsia may well also be a consequence of an acute respiratory viral infection, or the flu, or even just poor nutrition. But those at risk of suffering complex gestosis are, first of all, expectant mothers suffering from certain chronic diseases. These are all those who are often exposed to various stresses, and those who give birth with a very short interval of less than 2 years, and in addition to this, also pregnant women under 18 and also over 35 years old.

It must be said that it is simply impossible to cure gestosis completely or tolerate it at home. After all, only with inpatient and adequate treatment are special necessary drugs and droppers prescribed directly to increase protein levels and also to replenish the lack of necessary fluid in the vessels. And since it is the placenta that is initially the cause of such late toxicosis, childbirth is considered the most effective and possibly safest treatment for this particular pathology. However, in case of severe complications (so-called eclampsia), the pregnant woman will need to have a cesarean section.

And some simple actions can also help to avoid gestosis. So, first of all, get regular and high-quality examinations from your doctor. Secondly, simply eliminate unhealthy foods from your daily diet (everything fried, smoked, as well as canned food, and even chocolate) and try to add more vegetables and fruits, as well as cereals and various decoctions to your diet. Once a week it will be possible to arrange a special event. And, of course, physical activity is required (for example, walks in the fresh air, as well as gymnastics for pregnant women, possibly swimming) and restful sleep, at least 8 hours a day.

Very rarely gold is used in its pure form. Usually the product we call gold consists of the precious metal itself and the so-called alloy, that is, an admixture of other metals. Additives are included in the composition of gold to improve endurance and density, because gold in its pure form is very soft. Pure metal wears out quickly, and products made from it are very easy to scratch or break. High-quality products have a mark on the gold, which we will discuss later.

Even in ancient times, it was calculated that the best impurities for gold were silver and copper. Well, samples began to be used to indicate the gold content in the alloy.

Sample is the main indicator of impurities in a product, but stamps also serve this purpose - marks that are placed in control institutions and guarantee the presence of precious metal in the alloy. In France, the first mark was placed in 1275, but in Russia the first mark appeared on a product in Moscow in 1651-1652. It looked like a double-headed eagle with a date written in Slavic letters, and its purpose was to demonstrate the silver standard. Assays in the modern sense were introduced by Peter the Great in his decree of February 13, 1700, which established 4 assays each for gold and silver.

Gold hallmark systems

In the world there are metric, carat and spool systems for gold hallmarks. The most popular are carat and metric, of which the second is most often used. According to the British carat system, which is used in the USA, Switzerland and a number of other countries, a carat is equal to 1/24 of the mass of the entire alloy. Thus, 24 carat gold is a pure substance without additives, but 18 carat means 18 parts of gold in the total proportion of the mixture of metals. In the jewelry industry, you can most often find samples: 9, 10, 14, 18 and 24.

In Russia, since 1711, a spool sampling system has been in use for silver alloys, and in 1733 it was introduced for gold. This measure was invented on the basis of the Russian pound, which contains 96 spools, and the standard itself was expressed by the weight of gold in 96 alloy units. Pure gold had a 96th hallmark, and at the end of the 19th - early 20th centuries the 56th, 72nd, 82nd, 92nd and 94th hallmarks were in use.

In 1927, the USSR switched to the metric calculation system; all manufactured products that previously had a spool marking changed it to metric. The new system was identical to the German one, and the sample number ranged from 0 to 1000 and demonstrated the presence of gold in the alloy.

Today, many countries use metric quality standards (the most accurate system). In them, the highest standard is the 1000th, but in fact it is not found, and the mark on gold can be a number up to 999.9.

In connection with the problem of calculation errors in the glory of gold, a so-called remedium is established, in other words, a deviation from the norm. In compounds of silver and gold, gold and copper, and all three components together, the remedium is usually set to 3 units. For example, a 583-carat alloy should have a remedium of 3 units, therefore, the gold content will be approximately 580-586 g/1 kg of alloy. Gold alloys with an admixture of nickel have a remedium of 5 units.

In Russia, jewelry for sale can have hallmarks from 375 to 958. The Union also had gold of the 583rd standard, but in Europe there was a standard of 14 carats, which had indicators higher than the Soviet one. To avoid a lower price for our gold in Europe, the standard was changed to 585.

In the modern Russian system, 23-karat gold corresponds to the 958th hallmark, 18-karat gold to the 750th, and so on. To convert from metric to carat, you need to multiply the sample by 0.024.

Popular gold samples

In our country there are five levels of quality of gold products.

375th sample is an alloy containing 38 percent metal (impurities - silver and copper), having a color range from yellow to reddish; over time, this mixture fades.

500th - an alloy with 50.5 percent gold (impurities - silver and copper).

585th is a mixture of 58.5 percent gold with silver, copper, palladium and nickel. This combination makes the product hard, durable, and resistant to air, which is why it is often used in production.

750 is an alloy with a 75.5 percent precious metal content mixed with silver, platinum, copper, nickel and palladium. It can range in color from green and yellow to pink and reddish. Quite durable, but well processed and polished. Very popular for making jewelry, used for high-precision work.

958 is an alloy with a gold content of 95.38 percent, which is rarely used due to its softness and inexpressive color.

Alloys higher than 750 standard are not susceptible to tarnishing when interacting with air, and 999 standard is not used due to poor reliability indicators. For works of art, the 958th standard is best suited, the 900th is used for minting, and for jewelry purposes the 585th standard is used.

Hallmarks on gold

In all countries, the metal content in alloys is controlled by government agencies, and if jewelry is produced by a jewelry corporation, then verification is carried out internally. For example, in Holland the production of silver and gold products of any quality is completely permitted.

In the Russian Federation, the share of gold in the alloy is determined by the state and is indicated in the decree “On the procedure for testing and marking products made of precious metals.” Products made from such metals must have a state mark and comply with Russian standards.

The testing and hallmarking procedure is carried out by the Russian State Assay Office, located under the Ministry of Finance. And compliance with gold hallmarks and their compliance with reality is monitored by specialists from the Federal Assay Supervision.

In Turkey, Egypt, Greece and the USA, gold and silver products are not controlled. In this regard, Russian jewelers say that 90% of Turkish gold does not correspond to the declared quality: often, with the specified 585th standard, it actually barely reached 500th. But recently, trust in Turkish hallmarks has completely disappeared, the fact is that in any store in this country you can choose an unmarked gold product, after which the seller will put the desired number on it using a special machine.

Usually, the image of the mark combines a certain design and a digital designation of the sample, and the sample itself, as mentioned earlier, is set by government services.

Types of stamps

Different designs and shapes are used to mark products in different countries, so what marks are depicted on gold in different countries? For example, in Belarus, products are marked with a bison.

Until 1896, in Russia they placed “tees” - stamps on which the hallmark number, coat of arms, the first letters of the inspector’s name and the year the stamp was placed were combined into one pattern. And if before 1897 the signs themselves had a convex shape, then after this year they acquired a depressed appearance.

Already in 1899, one brand was introduced in Russia - the “sign of identification”, which looked like a female head in a kokoshnik, depicted in profile on the left.

From 1908 to 1927, other brands worked with the same head in a kokoshnik, but turned in the other direction, moreover, accompanied by a Greek letter, varying depending on the region of Russia.

In 1927, a new brand appeared in Russia - the head of a worker with a hammer, and the calculation itself was converted to metric. Since July 1, 1958, for products made from all precious metals, a mark in the form of a five-pointed star, inside of which there was a sickle and a hammer, began to be used.

Now Russian jewelry is also branded with a woman’s head in a kokoshnik. The mark can be either combined or placed separately. On the stamp of the combined type in the frame there is a head in a kokoshnik looking to the right and numbers indicating the sample, and to the left of the head there is a small letter indicating the State Inspectorate, which put the stamp.

To stamp separate or easily separated items, a separate type stamp is used, the head is placed on one, and the hallmark numbers are placed on the other part of the product.

Jewelry made in Russia must have the imprint of the State Inspectorate and the manufacturer's mark with an encrypted year of branding and the encrypted name of the enterprise.

Fake gold standard

Not every swindler will decide to counterfeit a gold sample, since it is difficult and involves huge risks. Typically, fraud involves putting a high standard on a low-quality product that still contains gold. Similar products can be bought in small shops around the world, but by chance they can also be sold in decent jewelry stores. A well-made counterfeit sample is almost impossible to detect by eye, which is why it is necessary to check the alloy itself.

A portable device, a gold detector, that you can carry with you while shopping, can help with this. It is worth remembering that the device may have its limitations and errors, so you should not trust it completely.