HYDROPS GRAVIDARUM (hydrops gravidarum) — one of early forms of toxicosis of the second half of pregnancy, the main symptom a cut are hypostases. At V. protein in urine is absent, arterial pressure remains normal. The excess increase in weight at the expense of hypostases is noted.
Etiology and pathogeny
Question of an etiology and V.'s pathogeny. it is very difficult and studied insufficiently fully. Emergence of hypostases at V. it is connected with disturbance of a water salt metabolism and blood circulation in system of capillaries and precapillaries as a result of the changed neuroendocrinal regulation. Similar disturbances lead to unevenly accelerated or are more often to the slowed-down blood flow in peripheral network of vessels, to increase in permeability of vascular walls, hypostases and disturbance of exchange in fabrics are a consequence of what.
The clinical picture
the Delay of liquid brings in an organism to hidden in the beginning, and then and to explicit hypostases. Usually at the same time the exudate in a cavity is not observed, seldom or never there can be ascites and a hydrothorax. The general condition of the pregnant woman remains satisfactory. Quite often at the beginning of a disease it is possible to note emergence of alarm symptoms when the woman begins to complain of close footwear, cannot remove a ring from a finger. During the weighing the increase of weight in a week reaches 1 — 2 kg (it is normal — on 300 — 400 g in the second half of pregnancy), the oliguria is observed. Mac-Klyura's test — Aldrich is positive (see. Mac-Klyura-Oldricha test ).
Distinguish four stages in development of a disease: 1) hypostases only of the lower extremities in shins and feet; 2) hypostases of the lower extremities, abdominal wall and lumbosacral area; on the lower half of a trunk prints of linen or a stethoscope (are visible during the listening of heartbeat of a fruit); 3) hypostases of the lower extremities, front abdominal wall, lumbosacral area and person; 4) general hypostasis.
the Diagnosis does not cause difficulties at regular overseeing of the pregnant woman in the conditions of clinic for women. At each visit of consultation (at least once in 2 weeks) the pregnant woman is weighed, make systematically analyses of urine, measure arterial pressure, carry out Mac-Klyura's test — Aldrich.
The differential diagnosis
the Differential diagnosis is carried out more often with hypostases of a cordial and renal origin. At heart diseases usually, in addition to hypostases, there are also other signs of disturbance of cordial activity — cyanosis, developments of stagnation in lungs, the increased liver, exudates in a cavity etc. Renal hypostases usually begin with a face, the increased arterial pressure can be observed, the changes in urine characteristic of a disease of kidneys (cylinders, lixivious erythrocytes), in blood are noted the content of residual nitrogen increases. At V., despite sharply expressed hypostases, usually there is no accumulation of liquid in serous cavities.
At an excess increase in weight it is necessary to begin treatment timely: unloading of an organism from liquid — a balanced diet (polurazgruzochny days — without the first liquid course) with restriction of liquid in days to 800 ml and sodium chloride to 2 g; the milk and vegetable diet with the obligatory content of vitamins, an exception of food of extractives is recommended; appoint magnesium sulfate, 20 g on reception are single-step (to wash down with a glass of water); in the next days — 15% solution of magnesium sulfate on 1 table. l. 3 — 4 times a day within 3 days.
If in the next 1 — 2 day the weight of the pregnant woman is not lost and tends to increase, then is shown, as well as at visible hypostases, treatment in stationary conditions. In a hospital before disappearance of hypostases appoint a bed rest, sedative and diuretic means (control of a diuresis and analyses of urine in dynamics).
At considerable hypostases the electrolyte-deficient diet with restriction of liquid to 300 — 500 ml a day, purpose once a week of fasting days is shown (the pregnant woman receives only 800 g of fresh cottage cheese and 100 — 200 g of sugar or 1 — 1,5 kg of apples). Food in other days shall be rather caloric (2,5 thousand calories a day). The diet shall contain proteins (fish or meat 100 of), creamy or vegetable oil (to 50 g), vegetable dishes, infusion of a dogrose, a cranberry, a citrus etc.
Drug treatment: solution of glucose (40% from 20 to 40 ml) with ascorbic to - that (to 300 — 400 mg) intravenously that increases a diuresis and improves the general condition of the patient; 10%rastvor ammonium chloride (1 table, l. from 3 to 5 times a day) or 15% solution of magnesium sulfate (on 1 table. l. 2 — 4 times a day).
With the purpose to cause the expressed diuretic effect appoint hypothiazid (on 0,025 g of 1 — 2 time a day every other day, 3 — 4 times) along with potassium chloride (on 1 g 3 times a day).
Instead of hypothiazid it is possible to recommend furosemide (lasixum) of 0,04 g or Diacarbum (Fonuritum, Diamoxum, acetazoleamide) of 0,25 g of 1 times a day, 3 — 4 days.
Weight reduction of the pregnant woman and increase in a diuresis along with improvement of overall health of the patient is a favorable sign.
The increase in the weight of 300 — 400 g a week demonstrates the occurred recovery of pregnant women.
Forecast, as a rule, favorable; pregnancy comes to an end with childbirth in time. However at late begun treatment and inaccurate (from the pregnant woman) observance of preventive actions the disease can pass in nephropathy of pregnant women (see).
the Work-rest schedule and a balanced diet would play the main role in V.'s prevention. (see. Pregnancy ). Also overseeing by the woman from first months of pregnancy, its careful inspection at the first visit of consultation and systematic control of dynamics of body weight of the pregnant woman is necessary.
On the special account pervo-pregnant women undertake 30 years which transferred or having diseases of a liver, kidneys and cardiovascular system, and also the woman with polycarpous pregnancy and a hydramnion and povtornoberemenny, having late toxicoses of pregnancy in the anamnesis are more senior.
See also Toxicoses of pregnant women .
Bibliography: Becker S. M. Pathology of pregnancy, page 27, L., 1975; Grishchenko V. I. Late toxicosis of pregnant women, Kiev, 1968, bibliogr.; H and - kolayev A. P. Late toxicoses of pregnant women, M., 1972; Persianinov L. S. Obstetric seminar, t. 2, page 347, Tashkent, 1973, bibliogr.; Petrov - M and with l and to about in M. A. both With about t-N and to about in and L. G. Late toxicosis of pregnant women, L., 1971.
I. F. Perfilyeva.