gestosi

Gestosi, or gestosis, is the umbrella term for hypertensive disorders that develop during pregnancy, typically after 20 weeks of gestation. It includes gestational hypertension, preeclampsia (with or without severe features), and can progress to eclampsia or HELLP syndrome as severe complications. Chronic hypertension can be present with superimposed preeclampsia, which is sometimes treated as a distinct category in guidelines.

Pathophysiology involves abnormal placental development and impaired placental perfusion, leading to systemic endothelial dysfunction, inflammation, and in some cases multi-organ involvement. The condition can affect both mother and fetus and may worsen rapidly in the presence of risk factors or complications.

Key risk factors include first pregnancy, multiple gestation, preexisting hypertension or kidney disease, diabetes, obesity, autoimmune disorders, advanced maternal age, and a family history of hypertensive disorders in pregnancy.

Clinical features and diagnosis rely on blood pressure measurements and assessment for organ involvement. Hypertension is typically defined as a persistent systolic blood pressure of 140 mmHg or higher, or diastolic of 90 mmHg or higher, on two occasions at least four hours apart after 20 weeks of gestation. Proteinuria (usually ≥300 mg/24 hours) is one diagnostic criterion for preeclampsia, but its absence does not exclude the condition if there is evidence of organ dysfunction such as renal impairment, elevated liver enzymes, thrombocytopenia, cerebral or visual symptoms, or pulmonary edema. Severe features may include very high blood pressure, severe headaches, epigastric or right upper quadrant pain, or seizures.

Management is guided by severity and gestational age. For mild disease remote from term, close monitoring and delivery planning are common; for severe disease or preterm cases, maternal stabilization and fetal assessment are priorities, with antihypertensives (such as labetalol or nifedipine) used to control blood pressure and magnesium sulfate given for seizure prophylaxis. Corticosteroids may be used to accelerate fetal lung maturity if preterm delivery is anticipated. Delivery remains the definitive treatment for preeclampsia. Postpartum monitoring continues as hypertension often resolves after delivery but can persist for weeks.

Prognosis depends on timely recognition and management; with appropriate care, maternal and fetal outcomes have improved, though gestosis remains a leading cause of obstetric morbidity worldwide. Recurrence risk is higher in women with prior hypertensive disorders in pregnancy.