Gestosis, toxaemia of pregnancy

Gestosis refers to pregnancy disorders whose symptoms often include high blood pressure and cloudy urine.

1 May 2021 | 5 Min. Reading Time

Overview

Gestosis refers to pregnancy disorders whose symptoms often include high blood pressure and cloudy urine. These are presumably caused by pregnancy-related changes combined with various risk factors, such as obesity, smoking or high blood pressure. Pregnancy check-ups are important to ensure early detection of such problems.

Symptoms

In early pregnancy (early gestosis)

Nausea and vomiting in the morning (morning sickness)
- From 2nd to 4th months of pregnancy
- Common, mostly harmless
- Disappears on its own
Rarely: excessive and dangerous vomiting
- Dehydration, fever
- Disturbance of kidney and liver function, disorientation
Sometimes, increase in salivation

Gestosis is rare during the second trimester of pregnancy

Gestosis during the third trimester of pregnancy (late gestosis)

Main symptom: high blood pressure (hypertension), higher than 140/90 mm Hg
- Indications: headaches and visual disturbances (flickering, hazy vision)
Excretion of protein in urine (proteinuria)
- Indicates disturbance of kidney function
Oedema (general swelling)
- In particular in legs
- Combined with excessive weight gain
- Can also happen to pregnant women who are otherwise healthy
Other symptoms: nausea and vomiting as well as abdominal pain, anxiety, disorientation

Pre-eclampsia

Main symptoms: hypertension and proteinuria
Potentially threatening condition for mother and child
If not treated, this can lead to eclampsia (see below)

Eclampsia

Immediately life-threatening, most severe form of late gestosis
Seizures with loss of consciousness
- Before, during or after the birth
- Attack is similar to an epileptic seizure (lasts approx. 1 minute)
- Followed by unconsciousness (hours to days)

HELLP syndrome

Comes as a total surprise or as part of eclampsia
- Can also occur after the birth
Acute kidney and liver failure with jaundice, bleeding and thrombosis
Loss of placental function is possible
- Consequence: premature birth or stillborn child

Causes and treatment

Causes

The exact causes aren’t known

Various factors are believed to play a role (list is not exhaustive):

Pregnancy as a physically and mentally “abnormal situation”
First pregnancy (specifically very young or older women)
Multiple pregnancy
Gestosis during a previous pregnancy
Family predisposition
Pre-existing disorders
- High blood pressure
- Diabetes mellitus (diabetes)
- Disturbance of pancreatic, liver and kidney function
- Vascular and other damage
Malnutrition or nutritional deficiency
Obesity

Further treatment by your doctor / in hospital

Possible tests

24-hour blood pressure monitoring
Urine analysis
Blood test (liver and kidney function, blood count)
Ultrasound (sonography)
CTG (cardiotocography ) to assess the foetal heartbeat

Possible therapies

Admission to hospital
Treatment of blood pressure
Magnesium (to prevent eclampsia)
Premature delivery
- Only way to treat the causes
- Depending on condition of mother and child
- From induction of labour to emergency Caesarian section

What can I do myself?

Go for regular pregnancy check-ups
Balanced diet
Sufficient vitamin and mineral supplements (in particular calcium and iron)
For high blood pressure: low-salt diet, no reduction in fluid intake
Avoid stress, take regular rest breaks
No alcohol and nicotine (generally during pregnancy)
To elevate the legs, raise the foot of the bed
Weight control:
- Weight gain is individual
- Underweight women gain proportionately more weight than overweight women
- Generally avoid losing weight during pregnancy

When to see a doctor?

For regular pregnancy check-ups (to ensure early detection of complications)
In between regular check-ups if problems occur such as:
- High blood pressure
- Headaches
- Visual disorders
- Cloudy urine
- Vaginal bleeding
Weight gain of more than 600g/week
- Primarily visible as oedema (swelling) in the legs