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Management of pregnant women with various forms of toxicosis. Toxicosis during early pregnancy: why it occurs and how to alleviate its course

Toxicosis of pregnant women (gestosis) is a pathological condition during pregnancy associated with the development of the fetal egg, disappearing in the postpartum period. This is a complication of pregnancy, which is a consequence of the lack of adaptive capabilities of the mother, in which her body cannot adequately meet the needs of the growing fetus. Gestoses are manifested by various disorders of neurohumoral regulation. There are disorders of the functions of the central and autonomic nervous system, cardiovascular and endocrine systems, as well as a violation of a number of metabolic processes, the immune response, etc. Allocate early and late toxicosis.

Early toxicosis of pregnant women

It develops in the first 20 weeks of pregnancy and is called toxicosis of the first half of pregnancy. Of the existing many theories for the development of early toxicosis (such as neurogenic, corticovisceral, hormonal, allergic, immune), they currently adhere to the theory of violations of neuroendocrine regulation and metabolism, which develop as a result of previous diseases, pregnancy characteristics, and the impact on the body of adverse environmental factors. Early toxicosis of pregnancy is most often accompanied by vomiting and salivation (ptyalism).

Vomit It is typical for about 50–60% of pregnant women, but only 8–10% of them need hospital treatment. The appearance of vomiting is associated with a hormonal imbalance. The onset of vomiting temporarily corresponds to the peak production of human chorionic gonadotropin. With vomiting of pregnant women, the endocrine activity of the adrenal cortex may change in the direction of reducing the production of corticosteroids. Vomiting of pregnant women can also be regarded as an allergization of the body when particles of trophoblast enter the maternal bloodstream. Vomiting is most pronounced in multiple pregnancies and hydatidiform mole.

There are III degrees of severity of vomiting of pregnant women.

I. Mild degree is characterized by vomiting up to 5 times a day, while the condition of the pregnant woman is not disturbed, vomiting may be associated with food intake or odors or appear on an empty stomach.

II. Moderate severity is accompanied by vomiting up to 10-12 times a day, symptoms of intoxication, weakness, weight loss and decreased diuresis.

III. Severe (uncontrollable, or excessive, vomiting) is characterized by repeated vomiting (up to 20 times or more per day), leading to rapid weight loss, exhaustion, metabolic changes and dysfunction of vital organs. Severe vomiting is characterized by severe weakness, agitation or apathy, low-grade fever, tachycardia, lowering blood pressure, the appearance of acetone, protein and cylinders in the urine. Often with severe vomiting, jaundice occurs, in rare cases, toxic liver dystrophy develops.

Treatment of vomiting of pregnant women of the I degree of severity is carried out on an outpatient basis with the control of the dynamics of weight gain of the pregnant woman and regular urine tests for acetone. A diet with frequent, fractional meals, rinsing the mouth with astringents is prescribed, frequent walks in the fresh air are recommended, and acupuncture is prescribed.

Treatment of vomiting of pregnant women II and III severity is carried out in a hospital. A complex treatment is prescribed, the purpose of which is to normalize the functions of the central nervous system, restore the loss of nutrients and fluids, correct electrolyte balance and acid-base balance. Termination of pregnancy is performed in case of treatment failure, with persistent subfebrile body temperature, severe tachycardia, progressive weight loss, proteinuria, cylindruria, acetonuria, jaundice.

hypersalivation often present with vomiting of pregnant women, but sometimes it can be in the form of an independent form of early toxicosis of pregnant women. With severe salivation, the loss of saliva per day can reach 1 liter or more. Abundant salivation has a depressing effect on the psyche of a pregnant woman, leads to dehydration, hypoproteinemia, sleep disturbance, loss of appetite and body weight. Sometimes there is maceration of the skin and mucous membranes of the lips. Treatment of hypersalivation is advisable to carry out in the clinic. In this case, atropine and local infusion of astringent and antiseptic herbs (oak bark, chamomile, sage) are used. Severe hypoproteinemia is an indication for plasma transfusion. Hypnosis and acupuncture are used as auxiliary methods.

A special form of early preeclampsia is jaundice due to cholestasis (cholestatic hepatitis). This form of toxicosis occurs rarely, as a rule, occurs at the beginning of the second trimester of pregnancy and progresses as its duration increases. It is characterized by a predominant lesion of the liver, often accompanied by itching of the skin, an increase in cholesterol and alkaline phosphatase activity in the blood with normal alanine aminotransferase activity. This form of preeclampsia is often complicated by premature termination of pregnancy, bleeding during childbirth, and the formation of fetal malformations. When the pregnancy is terminated, jaundice disappears, but may recur in subsequent pregnancies. The differential diagnosis is carried out with jaundice that occurred during pregnancy due to viral hepatitis, cholelithiasis, intoxication of the body, hemolytic anemia. Treatment is carried out in accordance with the general principles of hepatitis treatment. A diet, vitamins, glucose, protein preparations, etc. are prescribed. Considering the extremely serious significance of liver damage during pregnancy, primarily for a woman, the question of its premature termination is often raised.

Occasionally, dermatosis manifests itself in the form of eczema, herpes, impetigo herpetiformis. With impetigo herpetiformis, the likelihood of perinatal mortality is high. These dermatoses are treated in the same way as in the absence of pregnancy.

Tetany is one of the rare forms of pregnancy toxicosis. Its cause is a violation of calcium metabolism in pregnant women. A manifestation of this form of toxicosis is the occurrence of muscle spasms of the upper and lower extremities, the face. It is also necessary to take into account the possibility of manifestations of hypoparathyroidism in connection with pregnancy. Calcium preparations are used to treat this form of toxicosis. An even rarer form of early toxicosis of pregnant women is bronchial asthma. It should be differentiated from exacerbation of previously existing bronchial asthma. Treatment includes the appointment of calcium preparations, sedatives, a complex of vitamins, general UVI.

Pregnant women who have undergone early toxicosis need careful outpatient monitoring, since they often later develop late toxicosis.

Late toxicosis of pregnant women

Toxicosis that develops after 20 weeks of pregnancy is called late or toxicosis of the second half of pregnancy. In the 1990s this term has been replaced by the term "OPG-preeclampsia" (edema, proteinuria, hypertension). OPG-preeclampsia is a syndrome of multiple organ failure resulting from the development of pregnancy. The causes of this pathology have not yet been clarified enough. The immunological theory explains the occurrence of symptoms of OPG-preeclampsia by the reaction of the body of a pregnant woman to fetal antigens. In this case, the formation of autoimmune complexes that activate the kinin system occurs. Subsequently, arterial hypertension occurs. In addition, hemocoagulation increases, accompanied by the deposition of fibrin, impaired blood supply to the placenta and organs of the pregnant woman. The immune theory of the occurrence of OPG-gestosis is confirmed by the detection of subendothelial complement deposits, immunoglobulins G and M in the kidneys of a pregnant woman.

Generalized vasospasm with subsequent or simultaneous development of hypovolemia is important in the development of OPG preeclampsia. According to most scientists, the primary is a violation of the uteroplacental circulation, after which a spasm of peripheral vessels occurs, as a result of which the volume of the vascular bed decreases, and hypovolemia occurs.

V. N. Sterov and co-authors believe that there are two main reasons for the development of OPG-preeclampsia: diffusion-perfusion insufficiency of uteroplacental circulation and the presence of extragenital pathology in a pregnant woman, primarily circulatory disorders in the kidneys. In both cases, there is a syndrome of multiple organ failure with a different clinic and consequences. Mixed forms of OPG-gestosis are possible, in which several systems are affected simultaneously.

For all the reasons for the development of OPG-gestosis, there is a violation of the functions of the placenta. Uteroplacental perfusion sharply decreases: with full-term physiological pregnancy it is 162 ml/min per 100 g of placental tissue, with OPG preeclampsia it is only 59 ml/min per 100 g of placental tissue. This is mainly due to a decrease in pulse blood pressure and deterioration of venous outflow. With a mild course of OPG-gestosis, perfusion disturbance is eliminated by increased cardiac activity of the pregnant woman and an increase in blood pressure. With an increase in the symptoms of OPG-preeclampsia, hypoxia and acidosis develop in the mother's body. They lead to a continued decrease in uteroplacental perfusion, which can have consequences such as hypoxia, malnutrition and fetal death. Obesity, multiple pregnancies, polyhydramnios, stress, physical stress are additional factors contributing to an increase in uteroplacental perfusion disorders. In the position of a woman lying on her back, the uterus presses the inferior vena cava, which impairs perfusion. Vascular disorders resulting from the development of OPG-gestosis disrupt the diffusion capacity of the placenta. The process is also enhanced by the activation of lipid peroxidation. The products of incomplete breakdown of fats cause damage to cell membranes, which leads to a sharp deterioration in gas exchange, disruption of the barrier, filtration and purification, endocrine, immune and metabolic functions of the placenta, in which areas of thrombosis, ischemia, hemorrhages and edema begin to form. As a result of these changes in the placenta, the needs of the fetus are not fully met, and its development is delayed. In the placenta, the synthesis of estrogens and progesterone, which contribute to the normal development of pregnancy, decreases. Basically, violations of perfusion and diffusion functions are associated with each other. Expressed perfusion-diffusion insufficiency of the placenta in severe form of OPG-preeclampsia V. N. Sterov and co-authors call shock placenta syndrome.

There is a more frequent development of OPG-gestosis during repeated births, if signs of it were observed in previous pregnancies, as well as in women with urinary system disease, hypertension, and diabetes mellitus.

Clinical picture and diagnosis. The clinical manifestations of OPG-preeclampsia are as follows: a significant increase in body weight, the appearance of edema, proteinuria, increased blood pressure, convulsions and coma.

OPG-preeclampsia manifests itself in four clinical forms. These are dropsy, nephropathy, preeclampsia and eclampsia.

Dropsy pregnant women is expressed in the appearance of pronounced persistent edema in the absence of proteinuria and normal blood pressure. Initially, edema may be hidden (positive symptom of the ring, McClure-Aldrich test), there is an excessive increase in body weight. Further, visible edema appears on the lower extremities, in the vulva, torso, upper extremities and face. The general condition of a pregnant woman usually does not suffer. Pregnancy in most cases ends with delivery on time. Sometimes nephropathy of pregnant women develops.

Nephropathy pregnant women are three main symptoms: proteinuria, edema, increased blood pressure.

Allocate III severity of nephropathy.

I. Edema of the lower extremities, blood pressure up to 150–90 mm Hg. Art., proteinuria up to 1 g / l - I degree.

II. Edema of the lower extremities and anterior abdominal wall, blood pressure up to 170/100 mm Hg. Art., proteinuria up to 3 g / l - II degree.

III. Severe edema of the lower extremities, anterior abdominal wall and face, blood pressure above 170/100 mm Hg. Art., proteinuria more than 3 g / l - III degree. The onset of preeclampsia and eclampsia can occur with II and even with I degree of severity of nephropathy.

When prescribing treatment for nephropathy in pregnant women, it is also necessary to take into account the degree of impairment of the state of the cardiovascular, urinary systems, kidneys, and liver function. The severity of nephropathy is characterized by an increase in diastolic and a decrease in pulse pressure, as well as asymmetry in blood pressure. Further development of preeclampsia leads to an increase in hemodynamic disorders: the volume of circulating blood decreases, central and peripheral venous pressure decreases, the value of cardiac output decreases, peripheral vascular resistance increases, and metabolic changes in the myocardium increase. To accurately determine the degree of proteinuria, the daily excretion of protein in the urine is determined. It increases with the progression of preeclampsia and in severe nephropathy exceeds 3 g. A violation of the concentration function of the kidneys can be assumed from stable hypoisosthenuria (urine specific gravity - 1010-1015) in the study according to Zimnitsky. With worsening preeclampsia, diuresis decreases, the nitrogen excretion function of the kidneys decreases (the urea content in the blood reaches 7.5 mmol / l or more).

At the same time, there is a decrease in the amount of protein in the blood plasma (up to 60 g / l or less). The development of hypoproteinemia is associated with several reasons, one of them is a violation of the protein-forming and antitoxic functions of the liver and a decrease in the colloid-oncotic pressure of the blood plasma. An increase in the permeability of the vascular wall and, as a result, the appearance of protein in the extracellular space can also be the causes of hypoproteinemia. The more severe the gestosis, the lower the protein content in the blood plasma. The severity of preeclampsia is indicated by its early onset and prolonged course, as well as severe thrombocytopenia and fetal malnutrition. In severe nephropathy, there is a high probability of premature detachment of the placenta, premature birth, intrauterine death of the fetus. Nephropathy can result in preeclampsia and eclampsia.

Preeclampsia. It is characterized by signs associated with dysfunction of the central nervous system. according to the type of hypertensive encephalopathy (impaired cerebral circulation, increased intracranial pressure and cerebral edema). Excitation of patients is noted, drowsiness is more rare. Against the background of increased blood pressure, a woman has a headache, dizziness, blurred vision (flies before the eyes). The phenomena of hypertensive angiopathy of the retina are noted. Some pregnant women experience pain in the epigastric region, nausea, and vomiting. At this time, hemorrhages in the brain and other vital organs are possible. Sometimes there are premature births, premature detachment of the placenta, fetal death. As the clinical manifestations of gestosis increase, cerebral circulation is disturbed. As a result, convulsive readiness appears, eclampsia occurs - convulsions and loss of consciousness.

Eclampsia occurs most often against the background of preeclampsia or nephropathy. It is characterized by convulsions and loss of consciousness. A seizure in eclampsia may have a sudden onset, but in most cases it is preceded by symptoms of preeclampsia. It develops in a certain sequence.

The first stage lasts 20–30 s. At this time, small fibrillar contractions of the muscles of the face are noted, which then pass to the upper limbs.

The second stage lasts 15–25 s. It is characterized by the appearance of tonic convulsions of all skeletal muscles, while there is a violation or complete cessation of breathing, cyanosis of the face, dilated pupils, loss of consciousness.

At the onset of the third stage, lasting 1–1.5 minutes, tonic convulsions turn into clonic convulsions of the muscles of the trunk, then the upper and lower extremities. Breathing becomes irregular, hoarse, foaming at the mouth, stained with blood due to biting the tongue.

The fourth stage is characterized by the fact that after the cessation of seizures, the patient falls into a coma (usually lasts no more than 1 hour, sometimes several hours or even days). Consciousness returns gradually, amnesia is noted, the patient is worried about headache, weakness. Sometimes the coma persists until a new seizure. A convulsive seizure may be single, or a series of seizures up to several tens is observed, recurring at short intervals (eclamptic status). The more seizures there were, the more often they were, the longer the period of the patient's coma, the more severe the eclampsia and the worse the prognosis. There may be a sudden loss of consciousness, not accompanied by convulsions. Complications of eclampsia include the development of heart failure, pulmonary edema, acute respiratory failure, aspiration pneumonia. There is also brain damage in the form of edema, ischemia, thrombosis, hemorrhage. Perhaps the development of retinal detachment, an acute form of disseminated intravascular coagulation, hepatic and renal failure. With eclampsia, premature detachment of the placenta, termination of pregnancy is not excluded. During respiratory arrest, fetal death may occur due to hypoxia.

Therapy of preeclampsia depends on its severity. Treatment of dropsy of pregnancy is based on diet. Limit fluid intake to 700–800 ml and salt to 3–5 g per day. Diets are used in the form of unloading apple or cottage cheese days no more than once a week. In case of nephropathy in pregnant women, sedatives are additionally prescribed (motherwort tincture, Relanium (2.0 ml intramuscularly), phenobarbital (0.05 at night)), desensitizing agents (diphenhydramine 0.1 2 times a day). Antihypertensive drugs are used taking into account individual sensitivity and under regular control of A / D (2.4% eufillin - 10.0 ml intramuscularly, no-shpa - 2.0 ml intramuscularly, clonidine - 0.000075 each, 25% magnesium sulfate - 5.0–10.0 ml intramuscularly). In order to normalize the permeability of the vascular wall, askorutin is prescribed - 1 tablet 3 times a day, calcium gluconate - 0.5, 5% ascorbic acid - 2.0 ml intravenously.

Reflexotherapy, electrotranquilization have a good effect.

Hypovolemia is corrected using infusion therapy (10-20% albumin - 100.0 ml intravenously, hemodez - 400.0 ml intravenously). To restore water-salt metabolism, diuretics are used in the form of herbs (decoction of bearberry leaves), veroshpiron - 1 tablet 2-3 times a day, lasix - 40 mg intravenously. Methionine, folic acid, asparcam are used to normalize metabolism. For prophylactic and therapeutic purposes, in the event of intrauterine hypoxia and fetal hypotrophy, nootropic drugs are prescribed - piracetam - 5.0 ml intravenously, ambrobene, hormones, tocolytics. To improve the rheological and coagulation properties of blood, antiplatelet agents are prescribed: chimes 1 tablet 2-3 times a day, as well as reopoliglyukin - 400.0 ml intravenously, trental - 2.0 ml intravenously, antioxidants (vitamin E - 200 mg 1 time, Essentiale - 1 capsule 3 times a day).

The immunomodulator Derinat is administered in the form of 10.0 ml of a 0.25% solution, 1 drop into the nose up to 8 times a day for 3-5 days, or 5.0 ml of a 1.5% solution intramuscularly from 3 to 5 -8 injections.

Therapy of preeclampsia and eclampsia requires a special approach.

The basic principles were developed by V. V. Stroganov.

1. Creation of a medical and protective regimen, including rest, sleep and rest.

2. Carrying out activities aimed at normalizing the functions of the most important organs.

3. The use of medications to eliminate the main manifestations of eclampsia.

4. Fast and gentle delivery.

All activities are carried out in the intensive care unit by an obstetrician-gynecologist together with an anesthesiologist-resuscitator. All manipulations (injections, measurement of blood pressure, catheterization, vaginal examination) are carried out under anesthesia.

Eclamptic status, eclampsia in combination with large blood loss, the development of symptoms of cardiopulmonary insufficiency, eclamptic coma are regarded as absolute indications for mechanical ventilation. In these cases, it is necessary to prescribe glucocorticoids: hydrocortisone hemisuccinate (500-800 mg per day) or prednisolonehemisuccinate (90-150 mg per day) with a gradual dose reduction. Artificial ventilation of the lungs is carried out in the hyperventilation mode until, without anticonvulsant therapy, there is no convulsive readiness for 2–3 days, the patient is in contact, blood pressure stabilizes, and there are no complications from the respiratory system. To prevent the occurrence and development of acute renal and renal-hepatic insufficiency, inflammatory and septic diseases, blood loss is mandatory to be replenished during childbirth (with caesarean section - in the early postpartum period). In addition, it is advisable to conduct active antibiotic therapy. In renal and hepatic insufficiency, extracorporeal detoxification methods (hemodialysis, hemosorption, plasmapheresis), hemoultrafiltration are carried out. Delivery at term and the use of complex therapeutic effects can reduce the incidence of mortality in eclampsia.

Forecast depends on the severity of OPG-gestosis. The prognosis can be very doubtful in eclampsia, especially with the development of eclamptic coma against the background of cerebral edema, the appearance of ischemia and cerebral hemorrhages. Mortality in eclamptic coma can be 50%.

Prevention consists in the early detection of diseases of various organs and systems, especially the cardiovascular, urinary and endocrine systems before pregnancy, timely treatment and careful monitoring of a pregnant woman with the above diseases throughout the entire period of pregnancy. Particularly noteworthy are women at risk for OPG-preeclampsia on an outpatient basis. An obstetrician-gynecologist should examine these patients at least once every 2 weeks in the first half of pregnancy and once a week in the second half.

One of the important preventive measures is the timely detection and treatment of pretoxicosis. It is characterized by such features as asymmetry of blood pressure in the arms (difference of 10 mm Hg or more in the sitting position), pulse pressure of 30 mm Hg. Art. and less, a decrease in the oncotic density of urine, a decrease in daily diuresis to 900 ml, slight proteinuria and excessive weight gain.

Early toxicosis during pregnancy is a woman's health disorder associated with the adaptation of her body to bearing a fetus.

Toxicosis in the early stages is experienced by 6 out of 10 women, but gynecologists do not always consider this condition to be a disease that necessarily requires treatment. Early toxicosis of pregnant women still has no clearly established causes, and there are no ways to prevent it. The absence of early toxicosis also does not indicate any pathology, some women do not experience it at all.

Causes of early toxicosis

The causes of early toxicosis during pregnancy have not yet been fully studied, they are trying to explain it with several theories, but all researchers agree on only one thing, it is the presence of a fetus in the uterus that causes pregnancy symptoms in the early stages. Removal of the fetal egg leads to an instant cessation of complaints.

Most likely, the causes of early toxicosis of pregnant women are due to neuro-reflex shifts at the level of the diencephalic region of the brain, the discoordination of the processes of excitation and inhibition in which occurs due to a violation of neuro-reflex impulses due to the embryo developing in the uterus and rapidly progressive ingrowth of chorionic villi into the endometrium.

It is known that after the end of the formation of the placenta by 11-13 weeks, the unpleasant first symptoms during pregnancy subside, and the condition of the pregnant woman returns to normal.

Signs of early toxicosis

Toxicosis in early pregnancy, the treatment of which requires medical intervention, should pose a threat to the woman's health.

Signs of pregnancy in the early stages due to gastroenterological discomfort must be distinguished from real early toxicosis during pregnancy, which is a serious functional disorder of the nervous system that occurs in response to the presence of a fetal egg.

How does early toxicosis manifest itself?

Early toxicosis of pregnant women can have a wide variety of symptoms, but nausea, heartburn are the leading manifestations in the vast majority of women. In the early stages, vomiting, dizziness and nausea during pregnancy are the most common forms of toxicosis, salivation is quite common, and other, rare signs of early toxicosis, such as dermatosis, pruritus, osteomalacia or bronchial asthma, are much less common.

Pregnancy vomiting occurs in 6 out of 10 women, but only 10% of them are treated. Heartburn and nausea are considered by doctors only as natural symptoms during pregnancy, and only recommendations on diet and nutrition are given to the pregnant woman.

Vomiting is graded according to severity, there are three of them in total. The timing is important when nausea appears during pregnancy, vomiting, and other signs of early toxicosis, the earlier, the more severe the vomiting takes.

1 severity
Vomiting and nausea occur after meals, up to 5 times a day, a pregnant woman can lose up to 3 kg of body weight. Despite the general disturbance of health, loss of appetite, her condition remains relatively satisfactory. The skin remains moist, pulse and blood pressure are within normal limits. How to deal with early toxicosis during pregnancy with such manifestations - of course, without drugs. Obstetricians do not treat this, you need to try to survive the troubles of the first trimester, using only folk remedies for early toxicosis.

2 severity
Severe nausea during pregnancy occurs already in the first days and quickly develops into vomiting, which occurs regardless of food intake, up to 10 times a day. There may be a slight temperature, acetone is found in the urine of half of the pregnant women, the pressure decreases, the pulse accelerates to 100 per minute, the general condition of the woman is greatly impaired, many have thoughts of terminating the pregnancy, it is so difficult to endure. Starting from the second degree of severity, toxicosis at an early stage of pregnancy is subject to medical treatment.

3 severity
This is already a life-threatening condition for a pregnant woman, excessive vomiting. It repeats up to 25 times a day, and can be triggered even by movement. The pregnant woman does not want to move, lies all the time, cannot sleep, food and water are not retained, vomiting immediately occurs, and a loss of up to 10 kg of body weight is possible. The skin and tongue become dry, the temperature rises, the pulse rises to 120 per minute, and the blood pressure is low. In the urine, acetone is found in all women, there is often protein, hemoglobin is increased, there are changes in the biochemical blood test.

When does early toxicosis begin and end?

Early toxicosis begins in most cases as early as 5-6 weeks of pregnancy, some not particularly happy women may feel the first symptoms even before the delay in menstruation. This earliest toxicosis is associated with a woman's high sensitivity to pregnancy hormones and proceeds very hard in the future.

The timing when early toxicosis ends depends on the severity of its course and what kind of pregnancy you have, singleton or multiple. With a singleton pregnancy, early toxicosis lasts up to 11-12 weeks, and with a multiple pregnancy, it disappears by the 14-16th week of pregnancy.

Treatment of early toxicosis

With a mild degree of nausea and vomiting, treatment of early toxicosis of pregnancy is carried out on an outpatient basis, with a moderate and even more severe degree, hospitalization may be required. It often happens that the very fact of excluding a pregnant woman from a stressful situation at home and at work already leads to an improvement in her condition.

Nutrition in the treatment of early toxemia of pregnant women is of great importance, the correct use of food in itself can reduce nausea during pregnancy. You need to eat in small portions, every 2 hours, lying down, food should be chilled, mineral water is shown, alkaline and not carbonated.

Toxicosis in the early stages, treatment

The first trimester of pregnancy is characterized by the fact that the fetus is vulnerable, and many drugs can adversely affect its development, this limits the range of drugs used. Of course, you can’t prescribe anything yourself without consulting a doctor, how to alleviate early toxicosis should be decided only with his help.

The most commonly prescribed drugs:

Cerucal (metoclopromide) refers to anemetics, it is prescribed in extreme cases, with indomitable vomiting of pregnant women due to the ability to increase the tone of the uterus and thereby provoke miscarriages. In general, this drug is prohibited in the first trimester, and only in exceptional cases can you be prescribed it.

Torekan, has a similar effect to cerucal and is also prescribed for health reasons.

Hofitol, this herbal remedy, which is an artichoke extract. The drug has an antioxidant effect and improves liver function, which can significantly remove nausea during pregnancy.

B vitamins. During pregnancy, the need for B vitamins increases by 40%, they are an active participant in many metabolic processes in the mother's body and are needed by the developing fetus. With their shortage, nausea in early pregnancy is more pronounced, and their appointment reduces the unpleasant symptoms of toxicosis. However, the use of injectable forms increases the risk of developing an allergy to these drugs.

Droperidol, a drug that acts directly on the nervous system of the mother, can be used only when absolutely necessary. Although no teratogenic effect on the fetus has been identified, this medicine is still considered to be prescribed only when the benefit to the mother outweighs the risks to the fetus.

Diphenhydramine, pipolfen. These drugs are usually prescribed for allergic reactions, however, due to their sedative, calming effect and normalization of the immune system, they help when nausea occurs during pregnancy. It must be warned that these drugs should also not be prescribed to everyone in a row, and are indicated in the first trimester only with an obvious benefit to the mother that outweighs the risk to the fetus.

Herbal teas and herbal infusions. Herbs for early toxicosis help to safely relieve nausea during pregnancy, and can be used independently by the expectant mother, even if she is just worried about nausea and heartburn during pregnancy. However, what to do with early toxicosis specifically, which herbs to drink, also needs to be agreed with the doctor, since many of them are dangerous during pregnancy, we wrote about this.

Splenin, is a drug that is made from the spleens of cattle. Nausea during pregnancy in the treatment of splenin is reduced by normalizing nitrogen metabolism and improving liver function.

Polyphepan, it is an adsorbent that collects toxins in the stomach and intestines. Everything would be fine, but at the same time, the necessary, useful substances are also removed.

As you can see, any drug treatment, all pills for nausea during pregnancy, injections have a negative side and carry a certain risk. So, you need to try to do without them. Only herbs are relatively safe and help fight early toxicosis without risk.

Often, all treatment in a hospital is limited to infusions of glucose and ascorbic acid, and this is correct, although it does not allow you to completely get rid of early toxicosis.

And most importantly, do not forget that early nausea during pregnancy is more likely an indicator that everything is fine with you and is going according to plan. Your pregnancy is progressing and soon you will become a mother. Already by 11-13 weeks you will enjoy your condition, and what is happening now, you just need to try to survive.

clinical picture. Vomiting of pregnant women is one of the most common forms of toxicosis. It usually occurs due to the progression of morning vomiting of pregnant women and differs from it in that it is observed not only in the morning and not only after eating, but also on an empty stomach, and throughout the day. Appearing from the very first days of pregnancy, it can be observed for 2-3 months, and sometimes more, and cause first painful symptoms, and then a significant deterioration in the general condition of the pregnant woman.
In the development of this form of toxicosis, three stages can be traced: mild, moderate and severe, or excessive, vomiting.

mild vomiting- the initial form of the disease, the main symptom of which is vomiting, repeated several times daily, mainly after eating. Appetite is usually reduced or completely absent; the patient willingly eats spicy and salty dishes. Part of what is eaten, despite vomiting, is retained.

The general condition of the patient is satisfactory, although there is general weakness, insomnia (or, conversely, excessive drowsiness), irritability, constipation. Body temperature, moisture content of the skin and tongue are normal, the pulse is slightly increased (up to 90 beats per minute); blood pressure is unstable, but usually keeps on average (120/70 mm Hg). The patient gradually loses weight. Blood and urine test data are normal.
In the vast majority of cases, these phenomena are eliminated through proper care and treatment or disappear spontaneously.
Sometimes the cure occurs after a few days, and in some cases it drags on for several weeks.
However, such a favorable course is not always observed. In some pregnant women (15%), toxicosis continues to develop and reaches the second stage of its development - moderate vomiting.

moderate vomiting already bears clear features of toxicosis. Vomiting increases up to 20 times a day and appears regardless of food - often from the smell of food or even from the idea of ​​\u200b\u200bit. The patient cannot keep not only solid food, but also water. She loses weight due to tissue dehydration, aggravated by salivation (ptyalism), which is usually associated with vomiting. Saliva flows from the mouth almost continuously and causes irritation and then maceration of the skin of the lower part of the face. The amount of saliva lost daily can reach 1.5 liters or more in especially severe cases. The patient is weakening. The temperature rises by a few fractions of a degree (up to 37.5°); The skin becomes dry, the subcutaneous fat layer decreases. The patient is losing weight. The pulse quickens to 100-120 beats per minute. Arterial pressure decreases, hypotension appears.
Careful observation of the patient, rational care and proper treatment allow, even with a moderate degree of vomiting, to bring the patient to 16-20 weeks of pregnancy. After that, almost as a rule, vomiting stops, the patient's health is gradually restored and the pregnancy is completed. Often, healing occurs much earlier than this period. Very rarely, the disease passes into the third stage - in severe, or excessive, vomiting of pregnant women (hyperemesis gravidarum).

excessive vomiting proceeds with the phenomena of severe intoxication of the body. Vomiting becomes extremely frequent, almost incessant. The smell of acetone comes from the mouth. The patient comes into a state of severe exhaustion. Body temperature reaches 38 degrees or higher. With the progression of the disease, the patient becomes more and more indifferent to the environment, there is euphoria, delirium, and then a coma and death.

Previously, due to the timely identification of patients and the provision of rational medical care to them, deaths from indomitable vomiting are almost never observed. Even the most seriously ill patients, unless irreversible phenomena incompatible with life have occurred in their most important organs and systems, recover as a result of conservative treatment or (in exceptional cases) after an artificial miscarriage.
Recognition vomiting of pregnant women in general and each of the three stages of its development is not difficult.
Treatment should be carried out in a hospital, always with a systematic determination of the weight of a pregnant woman.
Attention should be paid to the organization of the correct medical and protective regimen in the hospital. In this regard, the word (including psychotherapy), the attitude of medical personnel to the patient, prolonged sleep, silence, the absence of other patients with symptoms of vomiting or salivation in the ward, and the treatment of diseases associated with vomiting are of great importance.
Of the medications, daily injections of progesterone at 0.005-0.01 are used for a week, hypnotics are administered orally - Medinal at 0.3 or Barbamil (amytal-sodium) at 0.1-0.2 twice a day. If patients do not retain the medication taken orally, the latter is prescribed in the same doses in the form of an enema (in 30 ml of saline).
At the same time, starvation and dehydration are being fought. For this purpose, patients are allowed to eat any food. Food should be cold, concentrated, rich in vitamins. It is given by a nurse in small portions, regularly and often, at least every 2-3 hours. Daily injected with a drip enema or better intravenous drip method up to 2-3 liters of physiological saline solution or 5% glucose solution, 10 ml of 10% calcium chloride solution and 5 ml of 5% ascorbic acid solution.
Donor blood transfusions are also useful 1-2 times a week for! ° 0-150 ml.
In severe cases, nutritional enemas are prescribed and insulin injections are made, which increases oxidative processes in the body. Insulin is administered subcutaneously for 3-4 days, once a day in the amount of 10-15 units per injection 15-20 minutes before meals or before the administration of glucose (or simultaneously with the latter).
An essential part of the treatment aimed at restoring the impaired function of the central nervous system is the administration of bromine and caffeine to patients. This combination, proposed by I. P. Pavlov for the treatment of patients with neuroses, was used by N. V. Kobozeva in the treatment of patients with early toxicosis of pregnancy.
These funds should not be used all at once; you need to follow a certain sequence when moving from one to another.
After the cure, the pregnant woman remains for some time in the hospital to consolidate the results of treatment. In the future, after discharge, she should be under the constant supervision of the antenatal clinic.
Timely and correct treatment of patients with vomiting of pregnant women almost always leads to a cure. Therefore, resorting to artificial miscarriage to prevent the development of irreversible changes in the most important organs of the patient is necessary only in exceptional cases.

Salivation of pregnant women

This complication, as already noted, usually joins the vomiting of pregnant women, but can also be observed as an independent manifestation of early toxicosis.
Treatment no different from the treatment for vomiting of pregnant women. To prevent irritation of areas of the skin abundantly irrigated with saliva, the latter should be lubricated with vaseline oil or Lassar paste. Subjective relief can be achieved by frequent rinsing of the mouth with 1% menthol solution, infusion of sage or chamomile, and other astringents.

Toxic hypertension in pregnancy

Toxic hypertension in pregnant women should be understood as an increase in blood pressure that began during pregnancy in a woman who had not previously had hypertension. Everyday observations show that such hypertension occurs relatively often in the first half of pregnancy and can therefore be attributed to monosymptomatic early toxicosis.
clinical picture. The basis of the disease is a disorder of the function of the vascular system. It can be found in most women in the first weeks of pregnancy. However, a temporary and slight increase or decrease in blood pressure in most women is eliminated within a few weeks. In some pregnant women, hypertension lasts until the end of pregnancy and even longer. In some cases, hypertension progresses as pregnancy progresses and later turns into late toxicosis - nephropathy. In other cases, hypertension remains the only symptom of the disease until the end of pregnancy and is eliminated in the very first days of the postpartum period. Finally, in very rare cases, hypertension in pregnant women as a monosymptomatic toxicosis becomes persistent and continues after childbirth in the form of hypertension.
Pregnant hypertension can cause changes in the placenta and related complications (anomalies of its detachment, etc.), as well as cerebral hemorrhages during childbirth.

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At the first visit to a pregnant antenatal clinic, it is necessary to measure her blood pressure and inquire about its height in the time preceding pregnancy. If a woman with normal blood pressure before pregnancy has even slight (above 135/85 mm Hg) hypertension, the pregnant woman should be taken under special supervision; if during the first weeks of observation the blood pressure does not decrease, she should be placed in the maternity hospital. An increase in diastolic pressure with normal systolic pressure should also be considered as gestational hypertension.
It is necessary to conduct a differential diagnosis between toxic hypertension of pregnant women, nephropathy of pregnant women and hypertension. With nephropathy and with hypertension that began long before pregnancy, characteristic changes in the urine are found - protein, cylinders and other uniform elements that are absent in the initial period of hypertension in pregnant women.
Treatment is the same as for other types of early toxicosis (see above), you should only limit the amount of fluid consumed. If symptoms associated with secondary changes in organs, especially in the kidneys (protein, casts in the urine), which can be observed in a number of women in the last months of pregnancy, join the hypertension of pregnant women, treatment is carried out according to the principles adopted for the treatment of late pregnancy toxicosis.

Dermatoses of pregnant women

Dermatoses of pregnant women are called skin diseases that occur during pregnancy and in connection with it. Itching of pregnant women appears from the very beginning of pregnancy or at the end of it, first in the vulva and in the vagina, and then can spread throughout the body. Itching causes insomnia, fatigue and irritability, complicating pregnancy. After childbirth, it stops on its own.
Treatment of all forms of dermatoses of pregnant women is the same as for other early toxicoses (see above). Good results are also obtained by subcutaneous administration of the blood serum of a healthy pregnant woman (15-20 ml).
The exception is impetigo herpetiformis, the most severe and rare form of dermatosis of pregnant women. Starting with the appearance of several pustules with an intense red base, it spreads throughout the body and quickly leads to the death of the patient if the pregnancy is not immediately terminated.

Hepatopathy of pregnancy (jaundice of pregnancy)

It should be borne in mind that some infectious disease or intoxication that has accidentally joined may in some cases be the cause of the transition of hepatopathy in pregnant women to one of the most serious diseases - acute liver dystrophy.
When making a diagnosis of hepatopathy in pregnant women, the fever-free period of Botkin's disease, which can join pregnancy, should be excluded. Botkin's disease is characterized by an acute (feverish) onset of the disease, weakness, intestinal dysfunction (constipation or diarrhea), vomiting, pain in the legs, etc. Botkin's disease, which complicates pregnancy, can also turn into acute liver dystrophy.
Acute liver dystrophy (dystrophia hepatis acuta) is one of the rarest and most severe complications of pregnancy. Occurs in any period of pregnancy.
A slight icteric coloration of the skin in 2-3 days turns into saffron-yellow.
Treatment consists in immediate termination of pregnancy, but this rarely saves the patient.

Neuro- and psychopathy of pregnant women

This group of toxicosis of pregnancy includes a number of diseases caused by dysfunction of the central and peripheral nervous system. These include various kinds of neuritis and neuralgia, as well as tetany - cramps of the upper and lower extremities, sometimes spreading to the whole body. Seizures are accompanied by pain. Spasms of the hand ("obstetrician's hand") and foot ("ballerina's foot") are characteristic. In very rare cases, with frequent repetitions, the prevalence and duration of seizures, the general condition of the pregnant woman worsens: the body temperature rises, breathing becomes difficult (laryngo-spasm), urination and defecation are upset, etc.
Women who had chorea in childhood may get it again during pregnancy, but the disease in such cases is mild. Chorea can be severe if it occurs for the first time during and in connection with pregnancy. This disease is called chorea pregnant (chorea gravidarum); this is one of the manifestations of toxicosis. The disease begins with acute convulsive, erratic
and unrestrained twitches, capturing the entire skeletal muscles. Convulsions recurring during the day and at other times quickly exhaust the patient. The body temperature rises, the pulse quickens, the psyche is often upset.
Treatment of mild neuropathies is the same as other forms of early pregnancy toxicosis. In 15 severe cases, not amenable to conservative treatment, the patient has to resort to artificial termination of pregnancy to save the life of the patient.
Psychoses can appear in the first weeks of pregnancy or later, as well as during childbirth, but most often they occur in the postpartum period (postpartum psychosis), often after eclampsia. Psychoses that occurred during pregnancy, in most cases, disappear soon after childbirth, while postpartum psychoses can become protracted.
The treatment of these forms of diseases of the nervous system is described in the courses of neurology and psychiatry.

Other forms of early toxicosis of pregnancy

Worthy of mention are the lesions of the bones and joints that occur in some women during pregnancy (osteo-et arthropathia gravidarum). Bone damage is expressed in the destruction of teeth (caries), softening of the bones of the skeleton (osteomalacia), excessive growth of bones, especially the facial part of the skull and limbs (acromegaly), etc. Of the lesions of the statutes, pathological (excessive) softening of the joints of the pelvic bones, especially pubic articulation, predisposing to their rupture and excessive stretching during childbirth.
Of the blood diseases associated with pregnancy (haematopathia gravidarum), it is important to remember the possibility of developing anemia in a pregnant woman, sometimes rapidly progressing and endangering the life of the pregnant woman and the fetus. This disorder appears to be due to an Rh incompatibility between mother and fetus, and is seen in some Rh-negative women who carry a fetus that has inherited Rh-positive blood from their father. This disease is recognized on the basis of the results of a blood test of a pregnant woman, in particular on the Rh factor.
Treatment consists of transfusions of pregnant compatible blood - by group and by Rh factor. Every day, 2 ml of campolone or antianemin are injected under the skin. A good effect is given by folic acid (orally 5 mg 3 times a day or parenterally 10-15 mg daily for some time). In cases not amenable to conservative treatment, artificial termination of pregnancy is indicated.
Finally, a number of other pregnancy complications should also be attributed to pregnancy toxicosis, in particular, pyelitis of pregnant women and varicose veins of the pelvic organs and lower extremities. The basis of these complications is a decrease in the tone of the walls of the ureter (with pyelitis) and veins (with varicose veins), apparently under the influence of progesterone. In the first case, the atonic state of the ureters contributes to stagnation in them and in the renal pelvis of urine and their associated infection, which causes pyelitis (high body temperature, pain in the lumbar region and other symptoms). Varicose veins can cause thrombophlebitis, sometimes complicating pregnancy, especially the postpartum period.
Treatment should be carried out in such cases according to the same principles as in other forms of early toxicosis of pregnancy. Inflammatory processes accompanying pyelitis and varicose veins (pyelitis, thrombophlebitis) require treatment according to the method described in the courses of private surgery. Termination of pregnancy in such cases has to be resorted to only in exceptional cases.

In this article, we will consider issues related to toxicosis, as well as tips on how to deal with it: what may be the signs and degree of toxicosis, methods of treatment and prevention.

Early toxicosis is a pathological condition that occurs during and in connection with pregnancy. The presence of toxicosis does not depend on the sex of the fetus.

Clinic of toxicosis

Early toxicosis usually occurs in the first 12 weeks of pregnancy, but in some cases it can disturb a woman up to 16, and sometimes even up to 20 weeks. Toxicosis is most often manifested by poor health, nausea and vomiting, some have profuse salivation (up to 1.5 liters of saliva per day can be released).

Due to vomiting and salivation, dehydration of the body can occur, which is manifested by dry skin and mucous membranes, an increase in body temperature, a decrease in blood pressure and an increase in heart rate.

There are 3 degrees of vomiting of pregnant women:

1. Light degree. The general condition remains satisfactory, the frequency of vomiting is not more than 3-4 times a day, weight loss does not exceed 2 kg. Moisture of the skin and mucous membranes remains normal. Blood and urine tests remain normal. Treatment is carried out on an outpatient basis.

2. Medium severity. Vomiting 5 to 10 times a day, weight loss exceeds 2 kg per week. There may be a slight increase in body temperature. Often observed. Urinalysis revealed a positive reaction to acetone. Treatment takes place at a day hospital or a woman is hospitalized.

3. Severe degree. Vomiting more than 10 times a day. At night, vomiting continues, which disturbs sleep. Marked weight loss is noted. Arterial pressure decreases. Severe, slow condition. In the analysis of urine - a positive reaction to acetone, there may be protein. In the blood test, the content of bilirubin and creatinine increases, the amount of protein decreases. In this case, hospitalization is necessary. With excessive vomiting (more than 20 times a day for several days in a row), in some cases, the question of termination of pregnancy is raised.

Salivation may accompany vomiting, rarely occurs as an independent disease. Excessive salivation leads to dehydration, it also negatively affects the psyche of a woman.

There are also rare forms of early toxicosis: osteomalacia (softening of the bones) of pregnant women, acute yellow liver atrophy (as a result, liver cells begin to die quickly, the liver decreases in size), tetany of pregnant women (muscle cramps of the upper and lower extremities). In these cases, termination of pregnancy is necessary. Once again I want to emphasize: they are extremely rare!

Treatment

With a mild degree of toxicosis, medications are dispensed with. Required. In addition, a pregnant woman should avoid the presence of strong odors: it is not recommended to use perfume (if a deodorant is needed, then choose an odorless one), to be in a room where repairs are underway, passive smoking should be avoided (and even more so smoke yourself). Stuffiness in the room also increases nausea, so it needs to be ventilated periodically.

Nausea is stronger on an empty stomach, so it should not be empty. You can keep unsweetened cookies or crackers on the nightstand near the bed to have a snack before breakfast without getting out of bed. You can even snack at night if you wake up, as according to some reports, toxicosis worsens in the morning due to the fact that blood sugar levels decrease overnight. When you wake up, do not get up immediately, lie down for another 20 minutes, then get up smoothly, do not abruptly jump off the bed.

It is better to take food in small portions, every 2-3 hours. Food should be boiled or steamed, fried foods should be avoided. You can eat baby food, as it is better absorbed. For breakfast, it is better to choose cold food, because it smells less. Crackers save many people, only they need to be prepared by yourself, because various flavorings are added to factory-made crackers, which will only increase nausea. After eating, do not make sudden movements and do not bend over.

It's important to listen to your body, since what you really want to eat at the moment will not harm you, even if it is some kind of "bad" food.

Good for relieving nausea taste and smell of lemon. It is recommended to suck on a slice of lemon when nausea occurs. It is good to take a shower using lemon-scented shower gels. It is also an effective ginger. It should be added to tea or just chewed.

Calming effect on the digestive system mint products(for example, mint tea). You can chew mint gum. However, at a later date, mint can cause heartburn.

Nausea can be overcome by sucking lollipops. Sucking helps a lot pieces of ice or frozen fruit juice(preferably citrus).

You need to drink plenty of water to avoid dehydration. Mineral water is useful for restoring the water-salt balance in the body. You can also drink water with lemon or weak green tea. You need to drink often, but in small portions. This is very important, as dehydration has a negative effect on the fetus, as the flow of nutrients is sharply reduced.

Prevention

A pregnant woman needs to provide emotional peace. It is necessary to be sympathetic to the new food addictions of a woman, to understand that these are not just whims. You also need to help her avoid unpleasant pungent odors.

Often an attack of nausea can be provoked by riding in transport, especially in public. Therefore, if you need to travel only 2-3 stops, then it is better to walk. Moreover, it is useful for pregnant women to walk a lot.

If possible, try to get out into the fresh air for a week or two, for example, to the country house. Especially in the warm season.

Of great importance is the treatment of initial (mild) manifestations of toxicosis, which makes it possible to prevent the development of more severe forms of the disease.

Some women are so tormented by toxicosis that they begin to doubt whether the birth of a baby is worth all these torments. Get rid of such thoughts! The most important thing is, despite temporary difficulties, to remember the child that is in the tummy, and try to make him feel that he is the most desirable.

TOXICOSIS OF PREGNANT WOMEN

Toxicosis of pregnant women are diseases that occur in connection with the development of the fetal egg and are characterized by very diverse symptoms, of which the most constant and pronounced are dysfunction of the central nervous system, vascular disorders, and metabolic disorders. By the time of occurrence and clinical manifestations, it is customary to subdivide toxicosis into 2 groups: early (vomiting of pregnant women, hypersalivation, dermatosis, hepatopathy, neuro- and psychopathy, etc.) and late - gestosis (dropsy of pregnancy, nephropathy, preeclampsia, eclampsia). Rare forms of toxicosis are distinguished into a special group - hepatopathy (toxic jaundice), acute liver dystrophy, tetany of pregnant women, chorea of ​​pregnant women, osteomalacia, arthropathy. Early toxicosis is usually characterized by dehydration of the body. late toxicosis (OPG gestosis) - excessive accumulation of fluid in the tissues. The problem of toxicosis remains an urgent problem due to the fact that the frequency of this complication does not decrease, but even increases due to a decrease in the health indices of the current generation of girls and women and a significant frequency of immaturity of the reproductive system in them. And, in addition, the clinical course of toxicosis has changed somewhat, when, against the background of a long course, an explosive acceleration of clinical manifestations occurs with the development of irreversible shock manifestations in systems and organs that ensure the correct course of pregnancy (placenta, kidneys, liver, lungs, heart, brain). The features of the clinical course of toxicosis include polysystemic, multi-organ damage with a pronounced damaging effect on the fetus.

MANAGEMENT OF PREGNANT WOMEN WITH TOXICOSIS

The first meeting between a doctor and a pregnant woman takes place, as a rule, in the antenatal clinic. During the first visit, it is important to find out if the woman is at risk for the development of toxicosis.

Risk factors for the development of toxicosis:

    extragenital diseases before pregnancy of the vascular system, kidneys, endocrine and immunological disorders

    general and genital infantilism

    complications of previous pregnancies, childbirth and the postpartum period

    chronic inflammatory processes in the endometrium

    chronic intoxication with nicotine and alcohol

    the presence of late toxicosis in the mother and sisters

    early (before 18 years) or late (after 27 years) age of first pregnancy

    unfavorable time of conception 15.04 - 15.08 and 15.11 - 10.08.

    pregnancy when staying in the north for less than 5 years

    early complications of pregnancy: toxicosis, threat of miscarriage, arterial hypotension, vegetative-vascular dystonia.

    latent iron deficiency (hemoglobin content less than 118 gl in the first trimester)

    detection of extragenital pathology during pregnancy

    hemoconcentration (an increase in hemoglobin over 5 gl at 28-32 weeks, leukopenia, thrombocytopenia

All women who are likely to develop preeclampsia are registered in the antenatal clinic and carefully examined. Women who are not included in the risk group are also regularly monitored. It is important to identify the onset of toxicosis as early as possible (at the stage of pretoxicosis) and treat it.

PRETOXICOSIS.

It is characterized by the condition of a pregnant woman preceding gestosis, although pretoxicosis does not necessarily develop into toxicosis. It is important to identify pretoxicosis as early as possible before it becomes more severe.

Signs of pretoxicosis:

    pathological weight gain after the 20th week of pregnancy in the absence of visible edema.

    Increase in diastolic pressure over 90 mm Hg

decrease in pulse pressure to 30 or less.

    Asymmetry of blood pressure on two arms (it is always necessary to measure on two arms) more than 10 mm Hg.

    functional tests for measuring blood pressure: a test with a turn - turn the woman on the left side, on the right, and if after that the change in blood pressure is more than 20 mm Hg, then this woman will be at risk.

    Decreased daily diuresis to 900 ml/day or less. In this case, a decrease in the specific gravity of urine is determined.

    Slight proteinuria.

    Higher mean BP. The norm of average blood pressure is 90-100 mm Hg, if more than 105, then this is a pathology.

    Laboratory indicators (hemoglobin, hematocrit, etc.).

1. Diet with restriction of sodium salts and moderate fluid restriction (1000 - 1200 ml per day). There are currently no delivery days scheduled.

2. Mode. Physical activity and good sleep must be regulated. Required to take sedatives.

3. Psychoprophylactic preparation. Pregnancy and childbirth are always stressful, so conversations with a pregnant woman, exercise, swimming, reflexology are shown).

4. Taking antiplatelet agents to improve uteroplacental circulation (trental tablets 0.1 each, chimes tablets 0.025 each, complamin).

5. Oxygen therapy with electroanalgesia for the regulation of cortical neurodynamics, vascular tone.

6. Vitamins to improve tissue metabolism: gindevit, vitamin E, methionine, glutamic acid, vitamin C, riboflavin, nicotinic acid.

7. To reduce the permeability of the vascular wall - ascorutin, galascorbin, calcium gluconate.

8. With pathological weight gain: diuretic teas, potassium orotate, antispasmodics (dibazole, papaverine), antihistamines.

9. Aspirin preparations 60 mg / day starting from the 13th week of pregnancy in women at risk for the development of preeclampsia. The use of such a dose is based on the fact that aspirin promotes the release of prostacyclin (a natural vasodilator and antiaggregant). The prevalence of prostacyclin over thromboxanes is the prevention of vasospasm.

10. Calcium preparations. In women with arterial hypertension, there is an increase in the content of calcium in the cells, which leads to vasoconstriction, and in plasma the concentration of calcium decreases. Therefore, taking 2 g of calcium salt per day from 20 weeks of gestation is widely used in the United States. You can use fish oil that contains a large amount of vitamins and calcium

EARLY TOXICOSIS OF PREGNANT WOMEN.

They occur in 60-50% of all pregnant women, but require correction in only 10%. Early toxicosis of pregnant women is manifested by dyspeptic disorders in the form of vomiting, salivation; rare forms - dermatosis of pregnant women, bronchial asthma of pregnant women, hepatosis of pregnant women (up to fatty hepatosis of pregnant women). The most common form of hypertension is vomiting, and depending on the frequency of vomiting, the degree of deterioration and laboratory parameters, there are:

1. light degree

2. moderate degree

3. severe vomiting

In order to determine the severity of vomiting of pregnant women, it is necessary to conduct the following studies:

1. Clinical blood test (increase in hematocrit, hemoglobin, erythrocytes, increase in ESR).

2. Biochemical blood test (total protein content and protein fractions, fibrinogen, platelet counts, liver enzymes).

3. Urinalysis (increase in specific gravity, daily urine output, urea, creatinine in order to identify the degree of involvement of the kidneys in the process).

4. With all the mechanisms of pathogenesis, the development of early toxicosis of pregnant women violates the ECG, which also shows the degree of electrolyte imbalance, EEG.

5. Strict calculation of the frequency of vomiting per day compared with daily diuresis.

6. Assessment of the general condition: complaints, pulse, dry skin, etc.

Mild vomiting may not be treated. Treatment requires severe and moderate vomiting in women at risk of developing into a severe degree. Treatment is carried out only in a hospital.

1. Regulation of the central nervous system: droperidol is a neuroleptic with a pronounced antiemetic effect (intravenously, intramuscularly, 1 ml of a 0.25% solution of Droperidol). With intravenous administration, the effect is very fast, with intramuscular administration, the effect occurs after 3-4 hours. Aminazine is now used less frequently, as it has a negative effect on the liver. Herbal infusions, Relanium tablets (40-50 mg, or Relanium 0.5% 2 ml), Nozepam (10 mg).

2. Fight against dehydration. In severe vomiting, infusion therapy of at least 1.5-3 liters compared with diuresis: saline solutions (crystalloids), proteins and plasma preparations, 10-20% glucose, vitamins B and C. In severe vomiting, prednisolone (hydrocortisone), estrogens.

3. Antihistamines: dimedrol (Sol. Dimedroli 1% 1ml), pipolfen (0.025 tablets), suprastin (2% 1 ml, in tablets of 0.025), diprazine (2.5% 1 ml in ampoules).

4. In the presence of metabolic acidosis - sodium bicarbonate 200 ml. Can be used - acesol, orthosol, chlosol, potassium, sodium asparginate. Bromine preparations are very rarely used. Polyglucin is used less often, reopoliglyukin - hyperoncotic drugs with high hematocrit numbers are not recommended.

Severe vomiting requires emergency care. Indications for termination of pregnancy will be:

    severe general condition

    failure of treatment in the next 6-12 hours

    development of acute yellow liver dystrophy

    development of OPN

Since early toxicosis of pregnancy most often develops at 6-12 weeks of gestation, the method of terminating a pregnancy is artificial abortion.

LATE TOXICOSIS OF PREGNANT WOMEN (OPG-gestoses).

OPG-gestoses include water, nephropathy, preeclampsia and eclampsia. Incorrect adaptation of the body to the development of the ovum is most often characterized by spasm of blood vessels. violation of their permeability. the development of edema, thickening of the blood, a violation of the state of the liver and nervous system. Clinical forms of gestosis often represent certain stages in the development of a single pathological process. Nephropathy occurs in 2.1-27%, eclampsia - in 0.05-0.1% of pregnant women and women in childbirth.

To assess the severity of preeclampsia, various scales have been proposed: based on the Zantgemeister triad, where each symptom is scored. Some include daily diuresis, subjective complaints, fetal malnutrition in indicators. The index of toxicosis is determined. The most common is the Peller scale: the severity of edema, weight gain, proteinuria, blood pressure, daily diuresis, subjective complaints. Points are counted. Repin scale: the same + condition of the fundus. With mild preeclampsia - angiopathy with dilated veins and narrowed arteries. Severe preeclampsia - narrowing of the arteries and veins, preeclamptic condition - swelling of the retina. Weight gain is not more than 12 kg, but depending on the type of physique: with a normal physique, an increase of 9-10 kg, for hyposthenics - 11-12 kg, for hypersthenics no more than 8-9 kg. Thus, the diagnosis of toxicosis is based on the Zantgemeister triad and laboratory data (decreased diuresis, the presence of protein and a cylinder in the urine, an increase in creatinine and urea, changes in liver tests; impaired uteroplacental circulation, ultrasound data - malnutrition, platelet count - as a prognostic criterion ).

Risk groups for the development of OPG-preeclampsia:

    Women with kidney disease.

    Women with diseases of the cardiovascular system - hypertension, vegetovascular dystonia, heart defects.

    Women with endocrinopathies and especially obesity and diabetes.

An examination that every woman must undergo to clarify the severity of preeclampsia:

    Clinical blood test: pay attention to hemoglobin, hematocrit, ESR, the number of red blood cells, platelets.

    Determination of kidney function: daily diuresis, with severe preeclampsia - determination of hourly diuresis, Zimnitsky, Nechiporenko test. Pay attention to the specific gravity, the amount of protein, the presence of hyaline cylinders.

    Checking liver function based on a biochemical blood test: coagulogram, protein amount, liver enzymes.

    Determination of the state of the cardiovascular system - numbers of blood pressure, pulse, ECG (signs of myocardiopathy).

    Examination of the fundus (to establish the degree of retinal angiopathy).

    Dopplerography, ultrasound (determination of the thickness of the placenta, the degree of maturity (with gestosis, the gestation period is exceeded), small-point hemorrhages in the placenta, determination of the degree of fetal hypotrophy.

The diagnosis is made on the basis of laboratory data, clinical manifestations, and the severity of preeclampsia is judged according to these criteria. Treatment of gestosis is carried out only in a hospital due to the possibility of a rapid transition to more severe forms.

Principles of treatment:

    Therapeutic and protective regime: reduced doses of neuroleptics (droperidol), ataractics (seduxen, diazepam), antihistamines (diphenhydramine, pipolfen), analgesics with physiotherapy (IRT, electroanalgesia).

    Hypotensive: better ganglion blockers (pentamine, benzohexonium, hygronium), taking into account the duration of their action, 8% magnesia sulfate IV drip.

    Detoxification: correction of KOS, electrolytes, rheological properties of blood - hemodez, rheopolyglucin, rheoglunam, crystalloids.

    Diuretics against the background of adequate infusion therapy with control of water and electrolyte balance, since unreasonable use of diuretics reduces BCC and increases the risk of DIC.

Treatment of preeclampsia is always carried out under the control of: * AD numbers. * Daily diuresis, hourly diuresis in severe cases. * Biochemical parameters, especially platelets.

The ineffectiveness of the treatment of late toxicosis is determined by: 1) negative diuresis; 2) sharp fluctuations in blood pressure throughout the day (falling to normal numbers); 3) high mean blood pressure; 4) tachycardia; 5) continued suffering of the fetus.

The main thing is to decide on the time and speed of delivery. In 15% of pregnant women with preeclampsia, therapy is ineffective. That is, the need for early delivery:

    with prolonged sluggish toxicosis, not amenable to therapy

    severe preeclampsia, not amenable to therapy during the day.

    violation of the vital activity of the fetus (intrauterine hypoxia)

If there is a mature birth canal and if there is preeclampsia, then it is necessary to carry out labor induction with early amniotomy: an amniotomy is performed, the woman is transferred to the maternity ward and a management plan is outlined. If the birth canal is immature, the course of gestosis is sluggish or, on the contrary, bright - delivery by caesarean section. Cesarean section is indicated for: Abdominal delivery in PTB reaches 5-25% and is shown:

    intractable eclampsia (more than a day)

    prolonged (more than 24 hours) coma after eclampsia;

    aneurosis, retinal detachment and hemorrhage in the fundus;

    cerebral hemorrhage and its threat;

    critical uncontrolled hypertension;

    disorder of cerebral circulation with the failure of therapy within 2-3 hours;

    oliguria and anuria due to SNP and AKI for more than 24 hours;

    combination with obstetric pathology (age of a woman, incorrect position of the fetus and insertion of the head, scar on the uterus, narrow pelvis, placenta previa and premature detachment, breech presentation, severe fetal hypoxia with a neck unprepared for childbirth);

    eclampsia in the first stage of labor in the absence of conditions for rapid delivery;

    lack of effect from labor induction (opening less than 4 cm in 6 hours);

    combination with combined heart disease with a predominance of stenosis, coarctation of the aorta II-III degree;

    intractable acute SSN; intractable acute respiratory failure

Features of conducting labor through the natural birth canal: the presence of painful contractions always leads to an exacerbation of preeclampsia in childbirth, so the following tactics should be used: FIRST PERIOD. 1. Pain relief (promedol, fentanyl), epidural anesthesia - hypotensive effect, relaxes the cervix, improves uteroplacental circulation. 2. Antihypertensive therapy intravenously - dibazol, papaverine, fractional intramuscular pentamine, clonidine (sedation, hypotensive, analgesic effect), sublingual nitroglycerin.

SECOND PERIOD. Greatest chance of seizures and other complications. Ganglioblockers are administered intravenously by drip-controlled normotonia (imechin, pentamine). Depending on the condition of the fetus and mother, the second period should be shortened by perineotomy or by the imposition of exit or cavitary obstetric forceps.

THIRD PERIOD. With careful prevention of bleeding. Since there is already a chronic stage of DIC. Intravenously drip oxytocin, methylergometrine, at the time of head eruption.

REGRESSION OF LATE TOXICOSIS

The reverse development of the main clinical manifestations of PTB lasts up to 3 weeks, pathogenetic disorders are especially persistent during the 1st week, therefore, convulsive readiness and the possibility of eclampsia remain. However, the residual effects of PTB, especially severe and complicated forms, increase sharply after 1-2 years. These are kidney diseases up to 30%, hypertension up to 25%, diencephalic syndrome up to 20%. Only 30% of women who have had severe forms of PTB remain healthy. The rest have disorders of the immune and endocrine systems, cardiovascular diseases, and kidney diseases. This requires a phased rehabilitation under the supervision of a local obstetrician-gynecologist, internist, neuropathologist, endocrinologist, nephrologist. As for reproduction, it is possible no earlier than 2 years and no later than 5 years after PTB, and only after a thorough systematic examination in a hospital setting.

PREVENTION MEASURES FOR TOXICOSIS

Firstly, this is the rehabilitation of girls, girls, women of reproductive age by a therapist with extragenital pathology.

Secondly, early diagnosis and treatment of delayed physical and sexual development is the task of a pediatrician.

Thirdly, the obligatory function of an obstetrician-gynecologist is the early detection and treatment of sexual infantilism, the fight against unwanted pregnancy, the active detection and treatment of chronic endometritis and cervicitis.

Prevention of toxicosis immediately before the onset of pregnancy and during it are:

    intensive dispensary monitoring of pregnant women at risk for PTB - 1 time in 2 weeks in the first half and once a week in the second;

    rational mode of work and rest with walks 2 times a day in the fresh air;

    exercise therapy, physiopsychoprophylactic preparation;

    rationally constructed diet: wide use of vegetables, fruits, vegetable oil, boiled meat and fish, cottage cheese, replacing salt with sonasol, fasting days under weight and diuresis control, magnesium diet;

    vitamin preparations: C, retinol, PP, haloscorbin, glutamic acid, calcium gluconate, gendevit;

    central electroanalgesia, massage or galvanization of the collar zone, electrosleep for the regulation of cortical neurodynamics and vascular tone, ultrasound or microwave therapy on the kidney area to normalize general and regional hemodynamics, endonasal galvanization, ultraviolet irradiation;

    improvement of uteroplacental circulation: electrorelaxation of the uterus according to Khasin, magnesium iontophoresis, xanthinol nicotinate, sigetin with fenoterol, eufilin in suppositories, oxygen therapy;

    herbal medicine: motherwort, valerian root, rose hips, mint, immortelle, chamomile, cudweed, St. John's wort, bearberry, lingonberry leaves;

    if pretoxicosis is detected, hospitalization in a day hospital with an in-depth examination, treatment with preformed physical factors (central electroanalgesia, electrosleep, galvanization of the cervicofacial, collar zones, endonasal, ultrasound or microwave therapy in the kidney area). Complex vitamin therapy: biotin 3-5 mg, pyridoxine 10 mg, calcium pantothenate 100 mg, calcium panganate 100 mg, E 0.5 mg, riboflavin 5 mg, B12 10 mcg, nicotinic acid 20 mg, C 200 mg 2 times a day, fasting diet. If there is no effect, hospitalization in an obstetric hospital is necessary, since this is already PTB.

The main condition for the prevention of PTB is the continuity in the work of the w / c and obstetric hospital, early diagnosis and treatment of initial forms of PTB with mandatory correction of the feto-placental and utero-placental complex.

REHABILITATION

    3 weeks daily: blood pressure, diuresis, urine and blood tests; samples of Zemnitsky, Nechiporenko, Reberg, determination of urea and blood proteins; therapy that improves the functional state of the central nervous system, water-electrolyte and protein balance, elimination of hypovolemia.

    In the clinic up to 1 year: a therapist once a month, blood pressure, urine and blood tests. Symptomatic treatment of the central nervous system, blood pressure, kidneys, in case of pathology - treatment.

    With an increase in blood pressure and proteinuria within 6 months after birth - hospitalization in a specialized department, and then

1 year after the hospital - examination and observation by a specialist in the field.