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For practical use of ICD-10 is inconvenient, so for clinical use (for writing the
history of childbirth), we recommends adapted Russian Society of
Obstetricians and Gynecologists classification match ICD-10 (Prof., Acad.
RAMS GM Saveleva, prof. L . E. Murashko, prof. Radzinsky VE).
Classification of
Russian Society of
ICD
Obstetricians and
Gynecology
O11 Existing previously hypertension with Combined/Associated
acceding proteinuria gestosis*
O12.2 Induced pregnant edema with proteinuria Gestosis*
O13 Induced pregnant hypertension without Mild degree of
significant proteinuria. Mild pre-ecclampsia (Mild gestosis*
stages of nephropathy)
O14 Pregnancy-induced hypertension with Gestosis*
significant proteinuria
O14.0 Pre-ecclampsia (nephropathy) of medium Medium degree of
severity Gestosis
O14.1 Severe Pre-ecclampsia Severe degree of
gestosis
O14.9 Pre-ecclampsia (nephropathy) unspecified
Pre-ecclampsia
O15 Eclampsia (Same)
O15.0 Eclampsia during pregnancy (Same)
O15.1 Eclampsia during birth (Same)
O15.2 Eclampsia during post-partum period (Same)
O15.9 Eclampsia with unspecified period (Same)
O16 Hypertension of mother is not unspecified (Same)
O16 Transient Hypertension during pregnancy (Same)
Note. *Degree of severity of gestosis is divided in point scale
What is Nephropathy?
Nephropathy - the next stage of development of dropsy state of gestosis,
which lead to a pronounced pathological change in the body of a pregnant
woman. Leading role in the pathogenesis of nephropathy is disorder of
vascular system, disruption microcirculation, hypovolemia (decrease in
volume of circulating plasma) with involvement in the process of all vital
organs and fetoplacental system.
SCALE OF VITTLINGERA
SCALE OF GOEKA
Points
Symptoms
0 1 2 3
Edema No On leg or On leg, Generalized
pathological anterior
increase abdominal
weight cavity
Proteinuria, g/day No 0.033 – 0.132 0.132 – 1.0 1 or more
Systolic arterial Less 130 - 150 150 - 170 170 and
pressure, mmHg than more
130
Diastolic arterial Until 85 - 95 90 - 110 More than
pressure, mmHg 85 110
Duration of No 36 – 40 or 35 - 30 24 – 30 or
manifestation of during labour earlier
gestosis
ЗРП, weeks No – Gap from 1 Gap from 3
-2 -4 and more
Background of No Manifestation Manifestation Manifestation
disease of disease of disease of disease
before during before and
pregnancy pregnancy during
pregnancy
Vascular changes are reflected in the picture fundus. In the study of eye
fundus noted phenomenon hypertonic angiopathy: a spasm of retinal
arteries and veins with precapillary edema, hemorrhages in the retina and
swelling.
To identify proteinuria in pregnancy after 32 weeks is to produce a urine
sample daily. In the presence of proteinuria in the early stages of urine
sample is repeated every 3-4 days. When collection protein in the urine, the
appearance of the cylinders to divide the blood content to residual nitrogen,
urea, to produce a sample of Zomnitski, analysis of blood electrolytes.
Increase number of units of residual nitrogen in the blood, even if his
figures are within the physiological, is an unfavorable sign, is evidence of
the disorder of nitrogen excretory kidney function.
Nephropathy I degree - Up to 12 g
Nephropathy II degree - Up to 18 g
Nephropathy III degree - Up to 25 g
Preeclampsia – Up to 25g
Eclampsia - Up to 50 g
Of these, 4 g in the first hour, the rest - for 23 hours in equal shares. With
intravenous drip of magnesium sulfate is necessary to monitor urine output,
tendon reflexes and frequency of respiration, which must not be less than
14 per minute.
To normalize oncotic pressure and treatment of hypoproteinemia use
intravenous drip 400 ml Hydroxyethylstarch, 200-250 ml one group of fresh
frozen plasma or 10-20% albumin solution. Also use the solution dextran
(reopoliglukin). At the present time to deal with hypovolemia and impaired
microcirculation preference to give preparation of Hydroxyethylstarch,
which is able to bind and retain water in the intravascular space in internal
vessels.
Deliveries are constant monitoring mother, fetus and activity of the uterus,
requiring a partogramm. Non rational management of pregnancy and
childbirth, absent treatment or its inefficiency can lead to the development
of the next phase of gestosis - preeclampsia.
There is a rise of all symptoms: blood pressure increased to 180 and 110
mmHg and more, increased proteinuria, and increased edema. Blood
pressure is characterized by rapid rise with a simultaneous decrease in its
amplitude. When examining eyeball, there is a sharp angiospasm of
arterioles, hemorrhage, and edema and detachment of retina. Azotemia
increases, hypoxia develops until severe acidosis, deteriorating function of
all critically important organs, reduces utero-placental blood flow,
progresses to chronic DIC. Any stimulus can lead to the development of
convulsive seizure - eclampsia.
What is eclampsia?
Eclampsia - the most dangerous stage of gestosis, characterized by rapid
growth of cerebral symptoms and the appearance of seizures. The danger of
an attack of eclampsia is the fact that during the attack, bleeding may occur
in the retina of the eye and the brain or other vital organs, and therefore the
possibility of loss of vision and a fatal outcome. The fetus may die from
hypoxia due to disturbance of utero-placental circulation, which can be
acute (premature placenta abruptio) or chronic (and worsening angiospasm
and progressive DIC syndrome).
In the second period, labor ends with the operation with obstetric forceps.
Intensive therapy is continued until there is a persistent improvement
(achievement of stable hemodynamics, normalization of liver function and
kidney).
This pathology, as gestosis can not affect the condition of the fetus. As a
result of disturbance of utero-placental blood circulation and gas exchange
in the fetus, chronic hypoxia may developed and, as a consequence -
placental insufficiency. Chronic hypoxia has often become the cause of
asphyxia in the birth of children. Therefore, during childbirth is necessary to
prevent fetal hypoxia, and after the birth, to be ready to provide newborn
with intensive care benefits.