The document discusses classifications and management of gestational disorders including vomiting of pregnancy, preeclampsia, edema, and eclampsia. It classifies vomiting based on severity from mild to severe hyperemesis gravidarum. Preeclampsia is classified based on symptoms and can range from mild to severe. Edema is classified based on the extent of edema from the feet to generalized anasarca. Eclampsia is a severe condition involving seizures that requires immediate delivery and intensive medical care in a specialized unit. Management involves hospitalization, monitoring, supportive care, and often early delivery to treat the condition and protect the health of the mother and fetus.

1. The lecture of docent of the chair ofThe lecture of docent of the chair of
obstetrics and gynecology No 1obstetrics and gynecology No 1
KUSHCHKUSHCH
Vladymyr NykolaevychVladymyr Nykolaevych
GESTOSISGESTOSIS
((part II)part II)
The main principals of diagnostics andThe main principals of diagnostics and
treatmenttreatment

2. Classification of GESTOSISClassification of GESTOSIS dependingdepending
on:on:
 incidenceincidence (frequent and rare forms)(frequent and rare forms)
 term of pregnancyterm of pregnancy (forms of early(forms of early
forms and late forms of pregnancy)forms and late forms of pregnancy)
 clinical pictureclinical picture (the degree of process)(the degree of process)
Frequent formsFrequent forms of gestosis are following:of gestosis are following:
 Early pregnancy toxemia (till 20 weeksEarly pregnancy toxemia (till 20 weeks
of gestation)of gestation)
 Vomiting of pregnancy (mild, moderate,Vomiting of pregnancy (mild, moderate,
severe)severe)
 Hypersalivation (ptyalism)Hypersalivation (ptyalism)
 Dermatosis of pregnancyDermatosis of pregnancy

3. SimpleSimple VOMITINGVOMITING
Less than 5 times dailyLess than 5 times daily and withoutand without
any impairment of health andany impairment of health and
metabolismmetabolism
ManagementManagement
 The main principal –The main principal – correction ofcorrection of
diet regimendiet regimen
 No specific medicationNo specific medication treatmenttreatment
 Mild sedative medicationMild sedative medication
 HospitalizationHospitalization is notis not requiredrequired

4. ModerateModerate VOMITINGVOMITING
5 – 10 times a day5 – 10 times a day, loss of body weight, failure of, loss of body weight, failure of
metabolism,metabolism,
tachycardia, subfebrile conditiontachycardia, subfebrile condition
ManagementManagement
 HospitalizationHospitalization is requiredis required
 Treatment and protective regimenTreatment and protective regimen
 AntiemeticsAntiemetics medicationsmedications
 Transfusion therapy forTransfusion therapy for compensation the liquorcompensation the liquor
lossloss (hypovolemia)(hypovolemia)
- Glucose solution, Trisol, Rheopolyglucin- Glucose solution, Trisol, Rheopolyglucin
 Correction ofCorrection of hepatic metabolismhepatic metabolism
- Hofitol, Essentiale- Hofitol, Essentiale
 GestagentherapyGestagentherapy (the prevention of prematurtly)(the prevention of prematurtly)
 Desensitizing therapyDesensitizing therapy
 Vitamins (B1, B12, E, C)Vitamins (B1, B12, E, C)

5. Severe form ofSevere form of VOMITINGVOMITING
(HYPEREMESIS GRAVIDARUM)(HYPEREMESIS GRAVIDARUM)
More thanMore than 10 times10 times a daya day
 High temperatureHigh temperature
 TachycardiaTachycardia
 HypotensionHypotension
 Icterus (yellowness) of skinIcterus (yellowness) of skin
 Acetone smell is very significantAcetone smell is very significant
 All kind of metabolism are disturbedAll kind of metabolism are disturbed

6. Severe form ofSevere form of VOMITINGVOMITING (cont’d)(cont’d)
Diagnosis depends on determination of:Diagnosis depends on determination of:
 billirubinbillirubin
 ketosisketosis
 electrolyte’s levelelectrolyte’s level
 acetoneacetone
 billiary pigmentsbilliary pigments
 control of body weight and diuresiscontrol of body weight and diuresis

7. Severe form ofSevere form of VOMITINGVOMITING (cont’d)(cont’d)
TreatmentTreatment
To beTo be intensiveintensive,, urgenturgent andand complexcomplex::
1. Treatment and protective regimen1. Treatment and protective regimen
2. Antiemetics medications2. Antiemetics medications
3. Transfusion therapy –3. Transfusion therapy – daily volume of infusion isdaily volume of infusion is
about 30 ml/kg of body weight (or about 2500,00about 30 ml/kg of body weight (or about 2500,00
ml).ml).
4. Desensitizing therapy4. Desensitizing therapy
5. Vitamins (B1, B12, E, C)5. Vitamins (B1, B12, E, C)
6. Symptomatic6. Symptomatic
If the therapy is not effective during 24If the therapy is not effective during 24
hours it is thehours it is the indication for artificialindication for artificial
abortionabortion..

8. PREGESTOSISPREGESTOSIS (subclinical forms)(subclinical forms)
The clinical signs of pregestosis areThe clinical signs of pregestosis are
followingfollowing::
 ↓↓ progressive decreasing the platelets quantityprogressive decreasing the platelets quantity
((trombocytopeniatrombocytopenia) – less than) – less than 160.000160.000
 ↑↑ increasing ofincreasing of blood coagulationblood coagulation
 ↑↑ increasing of body weight – more thanincreasing of body weight – more than 350 g a350 g a
weekweek
 ≠≠ instability and asymmetry of arterial bloodinstability and asymmetry of arterial blood
pressurepressure
 ≠≠ diuresis disturbancesdiuresis disturbances
The clinical assessment of the signs should beThe clinical assessment of the signs should be
repeated atrepeated at least two times a months during theleast two times a months during the
pregnancypregnancy..

9. PREGESTOSISPREGESTOSIS (cont’d)(cont’d)
ManagementManagement
 Control of body weightControl of body weight
 Control of blood pressure on the bothControl of blood pressure on the both
handshands
 Urine analysisUrine analysis
 Oldridge’s test (for diagnosticOldridge’s test (for diagnostic
internal edemas)internal edemas)
 Detailed obstetrics examinationDetailed obstetrics examination

10. CLASSIFICATION OF PREGNANCYCLASSIFICATION OF PREGNANCY
INDUCED HYPERTENSIONINDUCED HYPERTENSION
(according to recommendation of World Health(according to recommendation of World Health
Organization (1989)Organization (1989)
 Hypertensive disorders duringHypertensive disorders during
pregnancypregnancy
 Edema during pregnancyEdema during pregnancy
 Proteinuria during pregnancyProteinuria during pregnancy
 Mild preeclampsiaMild preeclampsia
 Moderate preeclampsiaModerate preeclampsia
 Severe preeclampsiaSevere preeclampsia
 EclampsiaEclampsia

11. EDEMAEDEMA (Dropsy)(Dropsy)
Characterized by more persistent edemaCharacterized by more persistent edema
 TheThe 1-st1-st degree - the edema ofdegree - the edema of feetfeet andand
legslegs
 TheThe 2-nd2-nd degree – the edema ofdegree – the edema of feetfeet,, legslegs
andand abdomenabdomen
 TheThe 3-rd3-rd degree - the edema ofdegree - the edema of feetfeet,, legslegs,,
abdomenabdomen andand faceface
 TheThe 4-th4-th degree –degree – anasarcaanasarca (general(general
edema)edema)

12. EDEMAEDEMA (contn’d)(contn’d)
ManagementManagement
 HospitalizationHospitalization is extremely requiredis extremely required
The main principal of medical care:The main principal of medical care:
–bad restbad rest
–adequate dietadequate diet
–control of fetal intrauterine conditioncontrol of fetal intrauterine condition
–prophylaxis of intrauterine hypoxiaprophylaxis of intrauterine hypoxia
of fetusof fetus

13. EDEMAEDEMA (contn’d)(contn’d)
Treatment:Treatment:
 limitation of using liquorlimitation of using liquor
 non-salt dietnon-salt diet
 spasmolytic medicationsspasmolytic medications
 Vitamin EVitamin E
 normalization of microcirculationnormalization of microcirculation
 infusion therapy (Rheopolyglucin, Glucose)infusion therapy (Rheopolyglucin, Glucose)
 diuretics if necessarydiuretics if necessary

14. PREECLAMPSIAPREECLAMPSIA
The main clinical signs:The main clinical signs:
 Edema, proteiuria, hypertensionEdema, proteiuria, hypertension
Important pointImportant point –– monosymptomatic formsmonosymptomatic forms
Scale of severity evoluationScale of severity evoluation –– Vittlinger’s scaleVittlinger’s scale
Based on symptoms presence:Based on symptoms presence:
edemaedema
gains in weightgains in weight
proteinuriaproteinuria
blood pressureblood pressure
diuresisdiuresis
subjective symptomssubjective symptoms
Summary of marks (bySummary of marks (by Vittlinger’s scaleVittlinger’s scale))::
Index scoreIndex score 2-102-10 –– mildmild form (1-st degree)form (1-st degree)
Index scoreIndex score 11-2011-20 –– moderatemoderate form (2-nd degree)form (2-nd degree)
Index scoreIndex score 21 and more21 and more –– severesevere form (3-rd degree)form (3-rd degree)

15. PREECLAMPSIAPREECLAMPSIA (contn’d)(contn’d)
ManagementManagement::
 HospitalizationHospitalization
ObligateObligate examinationexamination::
 ultrasound diagnosticsultrasound diagnostics
 placentographyplacentography
 cardiotocographycardiotocography
 controls of hematology and biochemicalcontrols of hematology and biochemical
parameters, including serum electolytes,parameters, including serum electolytes,
blood urie nitrogen, creatinin, uric acid,blood urie nitrogen, creatinin, uric acid,
platelet count, parameters of liver functionplatelet count, parameters of liver function
 control blood pressurecontrol blood pressure

16. ECLAMPSIAECLAMPSIA
This is theThis is the high stagehigh stage of EPH-complex,of EPH-complex,
characterized by general convulsions (toniccharacterized by general convulsions (tonic
or clonic) following to the state of comaor clonic) following to the state of coma
 TheThe 1-st stage1-st stage – transitory stage about– transitory stage about
20-30 sec (mild partial convulsions)20-30 sec (mild partial convulsions)
 TheThe 2-nd stage2-nd stage – tonic convulsions– tonic convulsions
 TheThe 3-rd stage3-rd stage – clonic convulsions– clonic convulsions
 TheThe 4-th stage4-th stage – coma– coma
EclampsiaEclampsia usuallyusually causes maternal andcauses maternal and
fetalfetal death.death.

17. ECLAMPSIAECLAMPSIA (contn’d)(contn’d)
Treatment:Treatment:
All case to be treated in specialized medicalAll case to be treated in specialized medical
departments – Emergency care units ordepartments – Emergency care units or
Reanimation’s department.Reanimation’s department.
The medical care to be directed on following:The medical care to be directed on following:
 prevention of Mendelson’s syndromeprevention of Mendelson’s syndrome
(regurgitation)(regurgitation)
 intubation of breath waysintubation of breath ways
 neurolepanalgesia (i.v.)neurolepanalgesia (i.v.)
 infusion therapy: hypotensive therapy, correctioninfusion therapy: hypotensive therapy, correction
of hypovolemia and desintoxication (the rule ofof hypovolemia and desintoxication (the rule of 33
catheterscatheters –– 22 i.v. andi.v. and 11 urinal bladder)urinal bladder)
 extremely delivery (depends on obstetrics status)extremely delivery (depends on obstetrics status)