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22 декабря 2013, 14:37 132 +1

Эклампсия 

Группа заболеваний: осложнения беременности и родов
Смежные болезни: диабет сахарный, преэклампсия
Врач в каталоге: акушер-гинеколог
Пораженный орган: организм беременной
 

Факторы риска

  • Первая беременность;
  • Многоплодная беременность;
  • Возраст беременной старше 35 лет;
  • Аутоимуннаяе заболевания;
  • Диабет;
  • Дисфункция почек.

Описание

Эклампсия (от греч. ἔκλαμψις — вспышка, внезапное возникновение)  это одно из тяжелейших осложнений беременности, при котором у женщины внезапно начинаются судороги, она теряет сознание, а иногда впадает в коматозное состояние.

В США от эклампсии ежегодно умирают примерно три из каждых 100 тысяч беременных (то есть 0,003%). Обычно к смерти женщины приводят обусловленный эклампсией инсульт, кровотечение, дисфункция печени, поражение почек, а также слепота и внезапное отслоение плаценты (преждевременное отделение плаценты от стенки матки). Плод также подвергается риску вследствие преждевременного появления на свет (недоношенности), чреватого респираторным дистрессом (угнетение дыхания) и другими опасными состояниями.

Причины

Эклампсии почти всегда предшествует преэклампсия  состояние, для которого характерны повышение артериального давления, отеки, наличие белка в моче. Развитие этого тяжелого состояния можно предупредить при своевременном мониторинге. К сожалению, причины эклампсии и преэклампсии пока точно не известны. При сроке беременности 20 недель и больше приблизительно у 6% женщин развивается преэклампсия, а у 0,1% это состояние позже переходит в эклампсию.

К высоким факторам риска по преэклампсии относятся первая беременность, беременность в возрасте до 20 и старше 45 лет, беременность двойней или тройней, повышенное артериальное давление, преэклампсия при предыдущей беременности, диабет, болезни почек или аутоиммунное нарушение. Тем не менее и в отсутствие всех перечисленных факторов риска у некоторых беременных все равно развивается преэклампсия. Чем тяжелее симптомы преэклампсии, тем выше вероятность ее перехода в эклампсию.

Симптомы

Главный симптом эклампсии во время беременности, родовых схваток, родов или после рождения ребенка  судороги. У некоторых женщин их бывает всего несколько, а у некоторых, еслиих не лечить, судороги повторяются часто. Причем судорожные припадки могут быть настолько сильными, что пациентка теряет сознание или впадает в кому. В самых тяжелых случаях наступает смерть.

Примерно у половины всех женщин с эклампсией судорожные припадки возникают до родов. Вскоре после них начинаются родовые схватки, причем, как правило, они продолжаются недолго. Однако примерно четверть женщин, подверженных эклампсии, ощущают первые судорожные припадки не раньше начала родовых схваток или родов. Иногда судороги возобновляются на следующий день после родов. Еще четверть женщин с эклампсией ощущают первые судорожные припадки только после родов, обычно это происходит в течение первых суток после появления младенца на свет.

Диагностика

Если у беременной начались судорожные припадки, она потеряла сознание или впала в коматозное состояние, врачи диагностируют эклампсию. 

Лечение

После начала судорожных припадков женщину с эклампсией доставляют в больницу, где ей обычно вводят сульфат магния для снятия судорог или другие противосудорожные средства. Помимо этого беременной дают перорально или вводят инъекционно гипотензивные медикаментозные препараты, чтобы снизить артериальное давление.

Если ребенок еще не родился, гинекологи стараются (по возможности) задержать роды до нормализации состояния пациентки. Однако, как это ни странно прозвучит, самый эффективный способ борьбы с эклампсией  рождение ребенка. После родов за пациенткой, пережившей приступ эклампсии, устанавливают пристальное врачебное наблюдение, чтобы исключить рецидив. Поскольку повторные судорожные припадки обычно возникают в течение первых суток после родов, в этот период женщине с профилактической целью вводят сульфат магния. Одновременно врачи следят за балансом жидкости в организме.

Большинство обусловленных эклампсией ос-ложнений поддается медикаментозному лечению. Исключение составляет, пожалуй, лишь такое тяжелое осложнение как инсульт, вследствие которого мозг может быть необратимо поврежден.

Профилактика

Главным средством предупреждения эклампсии является постоянное врачебное наблюдение за беременными женщинами с симптомами преэклампсии  своевременная диагностика и лечение данного состояния. Для этого в первую очередь необходимы качественная дородовая помощь квалифицированных специалистов, регулярные профилактические осмотры в третьем триместре беременности, постоянный контроль массы тела, измерение артериального давления, анализы мочи.

При развитии симптомов преэклампсии могут потребоваться искусственно стимулированные роды, чтобы ускорить рождение ребенка и таким образом предотвратить эклампсию. Правда, некоторым беременным удается «вылежать», в буквальном смысле слова, еще несколько недель в состоянии преэклампсии при наличии полноценного постельного режима и пристального врачебного контроля.

Не гарантирует успеха в профилактике эклампсии и применение сильнодействующих противосудорожных или седативных препаратов. Среди врачей нет также единого мнения о повышенном риске гипертензии в последующей жизни для тех женщин, у кого во время беременности была преэклампсия или эклампсия. Пациенткам с преэклампсией в анамнезе рекомендуется постоянно следить за артериальным давлением.

 
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