Gestose

Gestose is a term used in obstetrics to describe a group of hypertensive disorders that arise after 20 weeks of gestation. It commonly includes gestational hypertension, preeclampsia, eclampsia, and related conditions such as HELLP syndrome. In some medical traditions, gestose is used interchangeably with gestosis or toxemia of pregnancy. The category may also include postpartum manifestations in some classifications.

The condition is characterized by abnormal placentation and systemic endothelial dysfunction, leading to elevated blood pressure and varying degrees of organ involvement. It is associated with an imbalance of angiogenic factors, such as increased sFlt-1 and reduced placental growth factor, which contribute to placental and maternal vascular abnormalities.

Diagnosis relies on new-onset hypertension after 20 weeks and either proteinuria or signs of end-organ dysfunction. Proteinuria thresholds commonly include ≥300 mg/24 hours or a protein/creatinine ratio ≥0.3. In the absence of proteinuria, other indicators of organ involvement—such as renal impairment, liver dysfunction, thrombocytopenia, pulmonary edema, or cerebral/visual symptoms—support a diagnosis of preeclampsia with severe features.

Management focuses on monitoring and balancing maternal and fetal health, with delivery as the definitive treatment for preeclampsia. Antihypertensive therapy aims to reduce the risk of stroke (typical targets are lower than 160/110 mmHg). Magnesium sulfate is often used for seizure prophylaxis in preeclampsia with severe features or eclampsia. The timing of delivery depends on gestational age and disease severity, with conservative management possible in select cases to prolong pregnancy when maternal and fetal conditions permit.

Prognosis improves after delivery, but gestose increases maternal and fetal risks, particularly with severe disease. Prevention centers on early identification of high-risk pregnancies, aspirin prophylaxis for selected patients, and meticulous prenatal care.