Gestosis is a pregnancy disorder accompanied by hypertension. It occurs in various forms and its cause is still largely unknown. Gestosis should be treated as early as possible, otherwise it can lead to a life-threatening condition.
What is gestosis?
Gestosis is a condition that occurs only during pregnancy (gestatio in Latin). The hallmark of gestosis is, among other things, elevated blood pressure (hypertensive = increasing blood pressure). Originally, all diseases triggered by pregnancy were referred to as gestoses and divided into early and late gestoses according to the time of their occurrence. Thus, morning sickness belonged to the early gestoses, preeclampsia and hypertension to the late gestoses. Today, the term gestosis is used exclusively for diseases during pregnancy that cause increased blood pressure. The different forms of gestosis are eclampsia and preeclampsia, hypertension, HELLP syndrome, and graft-eclampsia. The former name “EPH-gestosis,” which was based on the symptoms of edema, increased protein excretion (proteinuria), and increased blood pressure (hypertension), is no longer commonly used.
Causes
The exact triggers for gestosis are not yet clearly understood. In the past, people suspected some kind of poisoning of the body and therefore called gestosis pregnancy poisoning. However, this approach has not been confirmed. Today, it is assumed that the uterus sends impulses to the body during pregnancy that cause blood pressure to rise. However, it is not yet known exactly what triggers this process and how it takes place. It is assumed that the body is unable to adjust to pregnancy and is overwhelmed by the many changes. However, there are also some factors whose presence increases the risk of gestosis. These are, for example, various pre-existing conditions such as diabetes], renal dysfunction or antiphospholipid syndrome. However, pregnant women who are severely overweight or older than 40 also have an increased risk of gestosis.
Symptoms, complaints, and signs
Symptoms of gestosis include high blood pressure, increased protein excretion in the urine, nausea, vomiting, headache, edema, seizures, pain in the right upper abdomen, or vision problems. However, gestosis can be divided into early and late gestosis. Early gestosis is usually harmless and occurs in the first trimester of pregnancy. It is mainly noticeable by nausea and vomiting and subsides by the 12th week of pregnancy. After a gestosis-free period, late gestosis with very severe symptoms may occur in a few women in the last third of pregnancy. Up to ten percent of pregnant women suffer from so-called preeclampsia, a late gestosis characterized by increased protein concentrations in the urine, edema and severely elevated blood pressure. Preeclampsia can develop into so-called eclampsia with life-threatening complications such as cerebral edema, thrombosis or acute kidney failure. Since the complications are life-threatening for both mother and child, immediate emergency medical attention is required. There is no cure for gestosis during pregnancy. However, after the birth of the child, the symptoms regress. An even more severe form of pre-eclampsia is the so-called HELLP syndrome. HELLP syndrome is characterized by severe pain in the upper abdomen as well as nausea and vomiting. In extreme cases, it can lead to death in a few hours. But again, the condition of mother and child quickly returns to normal after birth.
Diagnosis and course
The typical symptom of gestosis is increased blood pressure, which usually occurs after the 20th week of pregnancy. Gestosis is said to occur when in consecutive measurements the systolic value is higher than 140 mmHg and the diastolic value is higher than 90 mmHg. In single measurements, gestosis is suspected from a level of 160 mmHg. There are usually other signs as well, such as increased excretion of protein (proteinuria) in the urine and water retention (edema) in the legs, feet, hands or even the face. Proteinuria occurs when one liter of urine contains more than 300 mg of protein.To measure this accurately, the pregnant woman must collect the excreted urine over 24 hours. If gestosis is not treated, it can lead to a life-threatening condition for both mother and child. Eclampsia can occur with nausea and vomiting, stomach pain, headaches, seizures and impaired consciousness. To prevent such a severe course, early diagnosis is important. At the first sign of hypertension, the physician should measure the protein concentration in the urine as well as perform a comprehensive blood test. Other possible examinations include sonography (ultrasound) and cardiotocography (CTG, recording the baby’s heart sounds).
Complications
The most common complication of hypertensive pregnancy disease that is not recognized or treated too late is premature birth – even if this can be averted, in some cases impaired growth or liver and kidney damage occur in the unborn baby. A severe form of gestosis – also called eclampsia – causes seizures, as a result of which the placenta can detach. In this case, the life of mother and child is acutely endangered. Other possible consequences include acute kidney failure, cerebral edema, thrombosis or severe bleeding. Lack of oxygen during a seizure can lead to impairment of the mother’s brain function and even coma or death. HELLP syndrome is a rare complication of gestosis that is also life-threatening to both mother and child: Due to a decline in liver function, liver enzymes in the blood rise sharply and blood clotting worsens. HELLP syndrome can develop within a few hours and is manifested by severe upper abdominal pain, often accompanied by nausea and visual disturbances. If the pregnancy is not terminated as soon as possible by cesarean delivery, liver rupture, cerebral hemorrhage, or detachment of the placenta may result. Surviving gestosis increases the risk of recurrent complications in a subsequent pregnancy.
When should you see a doctor?
Pregnant women should always attend the checkups and preventive examinations offered during pregnancy. To ensure the health of mother and child and to check the developmental progress, it is advisable to take advantage of the available offer. If the expectant mother has a diffuse feeling of an abnormality or abnormality, it is recommended to make an appointment with a doctor. If there is palpitations, elevated blood pressure, or an unusual increase in internal body heat, a visit to the doctor is required. In case of seizures or severe pain, an emergency physician should be called. Until the ambulance arrives, the instructions and directions of the ambulance service should be followed. An emergency physician is also needed if there are disturbances of consciousness or lapses of consciousness. If fainting occurs, the pregnant woman should sit down immediately and then call 911. If the expectant mother suffers from unusually heavy water retention in the legs, hands or face, she should consult a doctor. If the water retention increases to such an extent that mobility is impaired or the visual blemish causes psychological problems, a visit to the doctor is necessary. If irregularities can be perceived during urination, a doctor should also be consulted.
Treatment and therapy
The therapy of gestosis depends on its severity and any existing diseases of the pregnant woman. In the early stages and with mild symptoms, bed rest and sparing are often enough to help. The primary goal of treatment is to prevent life-threatening eclampsia. To lower blood pressure, antihypertensive drugs are usually administered, but these are only used for values above 170/110 mmHg. To counteract proteinuria, the pregnant woman must increase her protein intake. Magnesium sulfate is prescribed to prevent possible seizures. Accompanying bed rest should be observed in any case. If the symptoms are already advanced, the patient is usually admitted to the hospital to be permanently monitored. As an inpatient, a permanent urinary catheter is often placed to monitor urine output, and a continuous blood pressure monitor is installed to record readings at specific short time intervals. In very severe cases of gestosis, early delivery by cesarean section may be necessary.
Outlook and prognosis
Gestosis is most common in the first and last trimesters of pregnancy. The second trimester, known as the tolerance stage, is often very calm and without gestoses. During the first trimester, however, they can cause the pregnancy as a whole to be at risk if they are particularly severe. In the last trimester, in the worst case, they can lead to premature induction of labor and the birth of a premature baby who needs medical support in the first weeks of life. Most gestoses are now detected at an early stage through prenatal care, and there are also effective treatment options so that the risks for mother and child can be kept low and the pregnant woman does not suffer unnecessarily. A distinction must be made between gestoses and so-called graft gestoses. The latter already existed as a disease before pregnancy and their symptoms have now been aggravated by it. If the woman was treated with medication for an underlying disease before pregnancy, the active ingredient or dose may have to be adjusted, because not all medications and active ingredients are suitable for pregnant women. Gestoses usually disappear quickly after the birth of the child, as soon as the woman’s hormone balance returns to normal. Some also disappear after just a few weeks, such as morning sickness at the beginning of pregnancy.
Prevention
One can successfully prevent gestosis by having regular checkups from the beginning if there are existing conditions or factors that pose an increased risk. If gestosis is detected early, it can be treated more easily and reliably.
Follow-up
In most cases of gestosis, the options for follow-up care are severely limited. The focus is on early detection and treatment of this condition to prevent further complications. If gestosis is detected or treated late in the process, the worst case scenario can result in the death of both the mother and the child. In most cases, the disease is treated with the help of medications designed to lower the blood pressure of those affected. Therefore, these medications should also be taken properly and regularly to relieve these symptoms completely. The patient should also check her blood pressure regularly in case of gestosis. In case of doubt, it is advisable to consult a doctor. Furthermore, those affected are dependent on strict bed rest. Exertion or other stressful activities should be avoided in order to speed up the healing process. Furthermore, regular check-ups by the doctor are also advisable in order to regularly monitor the child’s condition. If gestosis is diagnosed and treated early, there are usually no further complications or discomforts and thus no change in the life expectancy of the mother and child. In some cases, however, those affected may have to have a cesarean section.
What you can do yourself
If gestosis has been diagnosed, the affected woman must take it easy. Especially in the early stages, bed rest and relaxation help to relieve symptoms and prevent eclampsia. To lower blood pressure, moderate exercise, a change in diet, and avoidance of stress are recommended in addition to the use of medication. A high-protein diet is recommended for proteinuria. Seizures can be prevented by taking magnesium preparations. Alternatively, preparations from homeopathy can be tested, for example Schüßler salts or the preparation Cuprum metallicum C 200. However, before alternative remedies are used, the doctor should be consulted. Accompanying this, the body should not be excessively strained. In the case of advanced gestosis, the patient must go to a hospital. In most cases, permanent monitoring is then required. Gestosis is also a great psychological burden for most women. Therefore, therapeutic help should be sought after the end of the pregnancy in order to cope with the difficult phase of life. Some women are also helped by contact with others affected. The doctor in charge can answer questions about the possibilities for self-help groups and the like.
