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Vomiting throughout pregnancy. Herbal preparations with choleretic and hepatoprotective effects. Causes associated with pregnancy

Throughout pregnancy, changes are constantly taking place in a woman's body. They relate to hormonal changes, the redistribution of physiological stress and the location of the internal organs of the abdominal cavity. A woman emotionally and physically can experience such changes in different ways. Nausea during late pregnancy is not uncommon. A woman should take the appearance of this symptom very seriously due to the dangerous causes of its occurrence.

Nausea in late pregnancy can be one of the manifestations of late toxicosis (gestosis). If nausea and vomiting in the first trimester of pregnancy are rarely threatening symptoms, then in the later stages this condition requires urgent hospitalization. And that's why. This condition is based on pathological changes in the function of the kidneys, cardiovascular and nervous systems. Such processes are dangerous for the health of the life of the mother and the unborn child. The appearance of gestosis can be indicated not only by nausea in late pregnancy, but also by the following symptoms:

  • increased thirst;
  • dizziness, headache, tinnitus;
  • a rapid increase in body weight due to the appearance of edema;
  • pain in the hypochondrium;
  • detection of protein in urine.


If a woman ignores such "signals" of her own body and does not timely apply to a medical institution for qualified help, then she risks losing a child or even her own life due to pulmonary and cerebral edema. Physicians always pay special attention to pregnant women after 35 years of age, women who have had abortions in the past, kidney pathologies, cardiovascular and endocrine diseases. The likelihood of gestosis in such pregnant women is always higher. Those who have Rh-conflict are also at risk.

Intoxication in the third trimester of pregnancy

The appearance of nausea and vomiting in late pregnancy can be the result of infectious diseases and poisoning. The most common causes of nausea are acute respiratory viral diseases, accompanied by fever, rhinitis, and headache. In such a situation, it would be right for a pregnant woman to consult a doctor for advice. Only a doctor, taking into account all the risks to the fetus and mother, will be able to choose the safest drugs, because most drugs are contraindicated during pregnancy.

There are cases when nausea in the last months of pregnancy is associated with acute intestinal infections or poisoning with toxic products. Such conditions are characterized by vomiting, diarrhea, general malaise, fever and require immediate medical attention. In case of intoxication due to intestinal infections and poisoning, the safest and most effective remedy for is sorbent (, white coal, enterosgel, atoxil), which helps to quickly cleanse the gastrointestinal tract and the body from toxic products.


Nausea due to acute appendicitis

The remedy for nausea during pregnancy should not be used on its own if we are talking about an acute attack of appendicitis. Unfortunately, this disease, which requires immediate intervention by a surgeon, is not uncommon during pregnancy. If a woman feels pain in the lower abdomen, especially on the right, as well as vomiting, diarrhea, general malaise, then we can talk about symptoms of appendicitis. You should not take pain relievers, antispasmodics, as well as drugs for vomiting and diarrhea, even if they are completely safe for the child and the pregnant woman.

Such tactics will only distort the overall clinical picture and complicate the timely and accurate diagnosis of the disease. An acute attack of appendicitis adversely affects the development of the fetus and the health of the expectant mother. There is only one way out in this situation - emergency surgery. The postoperative period requires medical supervision to prevent infectious complications. In general, the forecast is positive. As a rule, women who have undergone an operation associated with the removal of appendicitis give birth to healthy babies without complications in the postpartum period.


Causes of nausea that do not pose a threat to the pregnant woman and the baby

The reasons why nausea may occur in late pregnancy may be associated with physiological changes within the mother's body. The growing fetus and the enlarging uterus gradually squeeze the internal organs: liver, stomach, intestines. This changing position of the uterus can cause discomfort, nausea, and heartburn. Nausea before childbirth is not a pathological symptom.

Overeating, despite the good appetite of a pregnant woman in the second half of pregnancy, does not contribute to a pleasant feeling of satiety. Moreover, such unreasonable eating contributes to the deterioration of the condition, nausea and vomiting appear.


The pressure on the liver interferes with its functions and the outflow of bile, nausea may appear. In this case, it is impractical to take a remedy for nausea during pregnancy due to the fact that the reason for this condition is not only in the distortion of the work of the organs of the gastrointestinal tract, but in their unusual location inside. The throwing of the contents of the stomach and duodenum into the esophagus causes heartburn. This may also cause nausea and vomiting.

In pregnant women, it can be associated with changes in hormonal levels and squeezing effects on the intestines. Violation of defecation contributes to the intoxication of the body due to the prolonged presence of feces in the intestines. This condition is characterized by the appearance of nausea. For constipation, the best remedy for nausea during pregnancy is a balanced diet with enough fiber and lactic acid foods. It will be safe on the basis of lactulose, acting in the intestinal lumen and not entering the general bloodstream.

Nausea before childbirth

Nausea before childbirth is a physiological process and is not dangerous. Hormones appear in the blood, which contribute to the normal course of childbirth. In addition, a woman may feel a sense of excitement, which also negatively affects the gastrointestinal tract. Nausea before childbirth, subsequent vomiting, and diarrhea may accompany contractions. This condition does not require treatment and is not a threat to the health of the child and pregnant woman.

A pregnant woman should always be attentive to her body, and if unpleasant sensations and symptoms arise, it is imperative to consult her doctor for advice.

Pregnancy is a welcome and exciting condition for many women. In addition to pleasant emotions, expectant mothers are haunted by unusual sensations. First of all, this is nausea during early pregnancy. However, this symptom is not a harbinger of abnormal fetal development. According to statistics, at 4-7 weeks of pregnancy, 60% of women show signs of toxicosis. And less than 10% of expectant mothers need inpatient treatment.

In most cases, toxicosis proceeds without consequences and complications. In a mild form, it does not require any treatment. If there is a sharp weight loss, severe vomiting or weakness, you cannot do without the help of a specialist.

The most common belief is that weakness, nausea during early pregnancy should be mandatory, and their absence is an alarming signal.

ICD-10 code

R11 Nausea and vomiting

Causes of nausea in early pregnancy

According to most experts, the slightest hormonal changes provoke nausea. Risk factors:

  • pathology of the digestive system;
  • heredity;
  • thyroid or kidney disease;
  • frequent stress;
  • infectious diseases;
  • obesity;
  • poisoning or intoxication.

Also, the cause of severe nausea during early pregnancy can be the smoking of the expectant mother. And in some cases, this is the result of self-hypnosis. Many mothers build on previous experiences or simply pay too much attention to experiences. Perhaps, in this case, the pregnant woman should visit a psychologist.

Although nausea is not indicative of a disorder, it should not be considered normal. Since frequent and strong gagging can negatively affect the health of not only the mother, but also the baby. It is considered acceptable in the morning on an empty stomach.

Pathogenesis

There are many different theories that have tried to explain the causes of nausea in the first trimester of pregnancy. Among them: reflex, hormonal, immune, allergic and others. However, to date, experts have not been able to find out the exact reason.

The body of the expectant mother is exposed to various stimuli from the moment of fertilization. Not all systems and organs are ready to completely resist this, and as a result, a kind of response occurs.

Symptoms of nausea during early pregnancy

A woman finds out about her interesting situation at about 4-5 weeks. At the same time, the first signs of early toxicosis appear. In addition to weakness, a constant desire to sleep and irritability, the expectant mother begins to be bothered by nausea, vomiting and exacerbated sense of smell.

Many pregnant women suffer from nausea in early pregnancy to delay. The reasons for this phenomenon are difficult to explain. Perhaps this is due to fear and anxiety or self-hypnosis.

The main symptoms of nausea during early pregnancy are:

  1. Vomit. Doctors identify several forms of vomiting at once:
  • lightweight. It is characterized by infrequent emetic attacks (up to five per day). Within a week, the expectant mother can lose 1-3 kg. Her general condition is normal. Apathy may develop. Changes in analyzes are not recorded;
  • average. The number of vomiting attacks increases up to 10 times a day, metabolism is disrupted. In seven days, an expectant mother can lose up to 5 kg. Blood pressure may drop and heart rate increases. If you start treatment on time, the prognosis will be favorable;
  • heavy. This form is accompanied by dizziness and nausea in early pregnancy. The frequency of emetic attacks reaches twenty times a day. Sleep disturbance is observed, liquid and water are not retained in the stomach. A pregnant woman suddenly loses weight, experiences dry tongue. A pungent smell of acetone appears from the mouth;
  1. Dermatosis. Cases of its appearance are much less common. It often manifests itself as itchy skin;
  2. Choking or bronchial asthma. The disease is difficult and is accompanied by a dry cough;
  3. Increased salivation. It can appear as an independent pathology or with vomiting.

Mild nausea requires no treatment and will go away over time. Nausea without vomiting may be present during early pregnancy. This often happens on an empty stomach or in the morning. To remove the unpleasant sensation, it is enough to eat a little.

However, a number of symptoms stand out, which indicate the need to go to a medical facility and undergo an examination:

  • vomiting attacks occur more often than 10 times a day;
  • fever and nausea in early pregnancy;
  • heart rate increases;
  • the expectant mother is rapidly losing weight.

If you have these symptoms, you should consult with a specialist and undergo treatment.

Diagnosing nausea in early pregnancy

It is not difficult for specialists to diagnose pregnancy nausea. To establish the degree and severity of the disease, the expectant mother needs to be examined and tested. As a result, the doctor will be able to establish the content of bilirubin in the blood, sodium, potassium, indicators of glucose, nitrogen, protein, as well as protein fractions. In urine, the doctor determines the level of protein, acetone, bile pigments and urobilin. By the level of Ht, you can determine how dehydrated the body of the expectant mother is.

Instrumental diagnostics of nausea includes:

  • Ultrasound. Examination of the abdominal cavity will assess the condition of not only the biliary tract and gallbladder, but also the intestines, kidneys, and pancreas;
  • acidity test. The study will show the level of acidity in the body. If the study showed that the pH of the stomach is not more than 2.0, this indicates the presence of gastroenterological diseases or inflammatory processes;
  • esophagogastroduodenoscopy. It is a procedure that allows a specialist to assess the condition of the surface of the stomach, esophagus and duodenum. For this, a special tool is used - an endoscope. It is carried out in case of urgent need.

Differential diagnosis

Differential diagnostics are also carried out. It is necessary to determine an accurate diagnosis. Since nausea is accompanied by various diseases. For example, pancreatitis, gastritis, food poisoning, stomach cancer.

Treating early pregnancy nausea

Expectant mothers are concerned about the main question of what to do and how to get rid of nausea in early pregnancy. There are many effective ways to deal with this problem. However, do not self-medicate. In order not to harm yourself and the unborn child, it is better to be examined and follow the recommendations of the attending physician.

Treatments for early pregnancy nausea

Treating nausea involves addressing the underlying cause. Its main goal is to restore metabolism, water-salt metabolism, and to establish the work of important organs. Severe and moderate vomiting is treated in a hospital. You can get rid of mild nausea on an outpatient basis.

To eliminate nausea in the evening during early pregnancy, the first step is to review the diet of the pregnant woman. Food should be taken in small portions about 3-4 times a day chilled.

Medication involves the use of medications to help eliminate nausea and vomiting:

  • Motilium. The drug is used for disorders of the motility of the digestive system and severe attacks of nausea. It has an antiemetic and anti-nausea effect by blocking dopamine receptors in neuronal cells. Contraindications for use: internal bleeding, epilepsy, pain in the abdomen, high blood pressure. According to the instructions, the daily dose of the drug is 1-2 tablets, the intake should be divided by 3 times. It is necessary to take Motilium after meals;
  • Cerucalus. Helps relieve persistent nausea during early pregnancy. Used for frequent vomiting, nausea, stomach cramps. The dosage is prescribed by the attending physician individually. Since the drug can adversely affect the condition of the fetus. The average daily dose is 10-15 mg 2-3 times. Side effects: dry mouth, weakness, apathy, muscle spasms. If a woman adhered to the recommendations of a specialist and correctly took the drug, as a result, her general condition will significantly improve, the work of the intestines will accelerate;
  • Regidron. Diarrhea and nausea in early pregnancy lead to the elimination of a large amount of fluid from the body. To restore it, doctors prescribe this drug. The daily dose of the drug is 30/60 ml of solution per kilogram of weight. 1 sachet of the drug is enough for a liter of warm water. It is forbidden to add sugar or its substitutes to the resulting solution, since they will reduce the therapeutic effect. Despite the fact that the drug is safe, it is better to take it under the supervision of a doctor;
  • Polyphepan. It is an enterosorbent agent that helps with diarrhea, nausea and vomiting, and has a detoxifying effect. It is taken one hour before meals. Pregnant women are prohibited from taking the drug on their own. The doctor, after examining, sets the dosage and duration of the course of treatment.

To eliminate nausea and vomiting in the early stages of pregnancy, physical procedures are performed. Physiotherapy treatments include:

  1. Endonasal electrophoresis. For the procedure, B vitamins are used;
  2. Electrosleep;
  3. Galvanization of the brain.

Carrying out these procedures helps to suppress the activity of the vomiting center in the brain.

The effectiveness of traditional medicine for nausea

To get rid of unpleasant symptoms, many resort to alternative treatment. The most effective remedies for early pregnancy nausea in the morning or evening are:

  • cranberry juice. To prepare fruit drink, you need to wash and grind about 150-200 grams of cranberries. The grated berries are poured with boiling water, and boil for ten minutes. You can add lemon juice and sugar to the fruit drink. Drink the remedy when the first vomiting appears;
  • potato juice. Grind the potatoes with a blender or meat grinder. The resulting liquid is taken with nausea after eating in the early stages of pregnancy, about 2 tablespoons;
  • to get rid of heartburn and nausea in early pregnancy, it is recommended to use pumpkin juice or seeds.

Nausea at night during early pregnancy leads to sleep disturbance and irritability. To get rid of the discomfort, you can turn to herbal treatment. The most effective and safest lemon balm broth. For 1 liter of water, 6 tbsp is used. l. herbs. Melissa should be poured with boiling water and insisted for 3 hours. Take a decoction of 0.5 cups 4-5 times a day.

Tea made from mint (20 g), valerian root (15 g), marigold flowers (20 g) and millennial (20 g) also helps. Pour the mixture of herbs with boiling water (0.5 l) and leave for 3 hours. After the tea, you need to strain and take three tablespoons 6 times a day.

Another good remedy that helps to forget about nausea and vomiting in the first trimester of pregnancy is fennel. It improves digestion and soothes the stomach. To prepare the broth, you need to brew 1 teaspoon in a glass of boiling water. After 10 minutes, the broth should be thoroughly filtered. You can add honey or lemon juice.

Homeopathic remedies for nausea

Many experts prefer to prescribe homeopathic remedies that reduce vomiting and alleviate the general condition of the expectant mother. Today, the following drugs are most popular from homeopathy:

  1. Kokkulin. The tablets eliminate nausea and prevent vomiting, improve appetite. Two tablets are taken three times a day per day. The drug has no side effects. Contraindications include individual intolerance;
  2. Sepia. The drug is developed on the basis of dried pharmaceutical cuttlefish ink. The remedy is prescribed for vomiting, persistent nausea, constipation and pain. The duration of the course of treatment and the dose is determined by the attending physician;
  3. Ipecacuanha. The remedy helps to relieve severe nausea and increased salivation. The drug is taken three times a day. Doses are determined by a specialist;
  4. Colchicum. With nausea from food and chills, the drug is recommended to be taken three times a day, three balls (grains).

Prophylaxis

In order not to have to suffer from vomiting and nausea during the period of carrying a child, you should carefully prepare for pregnancy. A planned pregnancy will help avoid the appearance of various unpleasant symptoms.

Also, we must not forget about nutrition. The diet of a pregnant woman should be varied. Meals are small 3-4 times a day.

It is advisable not to get involved in physical activity. In this case, it is necessary to walk in the fresh air for at least three hours a day, if weather conditions permit. In winter, you should dress warmly so as not to freeze.

Herbal teas are suitable to combat vomiting and nausea. Before taking them, you should consult a specialist.

It is worth noting that nausea follows almost all expectant mothers. However, if you listen to your body and adhere to the doctor's recommendations, a woman can easily overcome this stage and be able to fully enjoy the joy of motherhood.

It's important to know!

Nausea, an unpleasant feeling of urge to vomit is an afferent autonomic impulse (including an increase in parasympathetic tone) of the medullary vomiting center. Vomiting - forced removal of gastric contents due to inadvertent contraction of the muscles of the abdominal wall during lowering of the fundus of the stomach and relaxation of the esophageal sphincter


If a young woman suddenly vomits, the first thing the witnesses think about is pregnancy. Indeed, vomiting during pregnancy is not uncommon. Most often, it occurs in the very early stages and is one of the signs of toxicosis, but it happens that pregnant women vomit in the last trimester, when they develop. In most cases, vomiting during pregnancy is a temporary symptom and goes away on its own, but less optimistic forecasts are also possible.

Toxicosis of pregnant women

More than half of all pregnant women experience nausea and vomiting during pregnancy. In this case, most often expectant mothers vomit in the morning, but the rest of the day also happens. Morning vomiting during pregnancy along with salivation is the most common manifestation of toxicosis. The phenomenon, of course, is the most unpleasant, but, according to the results of American studies, it can be considered as a good sign: vomiting during pregnancy indicates its normal course, American scientists say. Their studies have shown that women who experience nausea and vomiting during pregnancy have a great chance of a successful gestation, while expectant mothers who do not suffer from toxicosis are often worried. Just in case, I note that if you do not vomit, then this does not mean that things are bad. Rather, on the contrary: vomiting during pregnancy is not yet a cause for concern, more precisely, it is far from always.

There are several degrees of severity of vomiting during pregnancy. In the overwhelming majority of cases, women are faced with the mildest degree, when vomiting occurs up to 4 times a day. At the same time, despite the obvious discomfort, the expectant mother does not experience obvious health problems associated with vomiting. This condition does not harm the future baby either.

It would seem that this unpleasant phenomenon has been studied well enough. However, it is not known for certain why pregnant women vomit. Doctors only suggest some reasons, the most probable of which seems to be hormonal changes in a woman's body.

How to relieve the condition?

And even though they have not been studied enough, every woman is interested in how to stop vomiting during pregnancy? It can often be alleviated by making slight changes in your daily habits. Start with the awakening itself. It is the morning for many pregnant women that can be the most difficult to survive. If you vomit violently in the morning, learn to placate your stomach before getting out of bed. It can be dry biscuits or crackers and a few sips of water - cook them in the evening for a snack in the morning without getting out of bed. Rise only after some time has passed so that everything "settles down". And it is better to lie in a half-sitting position, lifting the upper body.

In general, when vomiting during pregnancy, it is extremely important not to starve and drink enough fluids. But with the use of water and food, there are often problems: everything immediately comes back. Doctors urge pregnant women in such cases to eat only the desired dishes, but certainly fractional: literally a little bit, but quite often. It is better to exclude all fried, smoked and other aggressive foods (although, most likely, it already disgusts you) and choose something light as snacks: vegetables, fruits, fermented milk drinks. For breakfast, protein (an egg or a piece of boiled lean meat) is good. Try to include B vitamins in your diet, especially vitamin B6 (or pyridoxine) - it can eliminate nausea and prevent vomiting. Pyridoxine is found in whole grains, buckwheat, sprouted wheat, potatoes, carrots, cabbage, bananas, hazelnuts, peanuts, sunflower seeds, chicken, and fish. Vitamin B6 is also sold as a drug in a pharmacy. However, before using it, be sure to consult your doctor (the recommended dose for pregnant women is no more than 25 mg 3-4 times a day).

For toxicosis, first courses are useful - light soups and broths. Liquid warm food, as a rule, is accepted with gratitude by the stomach.

If drinking during pregnancy makes you vomit every time, try sucking on ice cubes. Drinking in this case is best between meals, and not during, in small sips and portions. Find a way to get fluids into your body as it is so important! Many pregnant women are helped to relieve vomiting by adding lemon to tea or mineral water. Special solutions (for example, Regidron) will help to compensate for the electrolyte deficiency; add-on chicken broth is also suitable.

Aromatherapy can also help. The easiest, fastest and most harmless way is to slice the lemon and enjoy the citrus aroma. It is believed to be good at eliminating nausea and is able to stop vomiting attacks. Citrus essential oils can also be used, but it's best to consult with a knowledgeable practitioner here.

When to sound the alarm?

Experts say that only 8-10% of women experiencing nausea and vomiting during pregnancy need medical attention. These are pregnant women who develop moderate and especially severe vomiting. In addition to the fact that the expectant mother cannot eat and provide the growing fetus with the necessary substances, she is still rapidly losing the resources accumulated by the body, which do not have time to be replenished. The water-electrolyte balance is disturbed, intoxication and dehydration occurs, which is very dangerous for both.

You should definitely see a doctor if:

  • vomiting is repeated more than 6 times a day or does not stop at all;
  • you started to lose weight (more than 3 kg in 10-14 days);
  • decreased amount of urine, and it darkened;
  • you have dry mouth and constant feeling of thirst;
  • the skin, mucous membranes of the eyes and mouth became dry;
  • the reaction has become inhibited;
  • you feel tired and powerless all the time;
  • you pass out;
  • you smell acetone from your mouth;
  • body temperature is elevated;
  • reduced;
  • rapid heartbeat (more than 80 beats per minute).

In this case, the doctor will refer you to inpatient treatment. In most cases, a woman's condition is alleviated by intravenous administration of drugs that stop intoxication and compensate for the loss of fluid and nutrients. Antiemetics are used less often due to the high likelihood of their teratogenic effects on the fetus.

If the measures taken by the medical staff do not help and the vomiting does not stop, the doctor may decide to terminate the pregnancy. But in practice, this is extremely rare. As a rule, all expectant mothers cope with toxicosis on their own. However, if you are not feeling well, then notifying the leading gynecologist about this will not be superfluous, even if the condition is not critical. It should also be noted that vomiting during pregnancy is not always a sign of toxicosis. We can talk about, for example, or some kind of disease of internal organs (gastritis, ulcers, cholelithiasis, pancreatitis and others). Therefore, in any case, notify your doctor that you are not feeling well - he will help establish the correct diagnosis and alleviate your condition.

Of course, you probably don't have the strength to endure bouts of vomiting and exhausting nausea. But after 12 weeks, things should get better. Take time off from work or take sick leave if pregnancy vomiting interferes with your duties. Do not be afraid to ask for support and help from loved ones: let them take care of all household chores and cooking if you cannot do this due to feeling unwell.

Remember: More than 50% of all women experience vomiting during pregnancy. And this is not the worst "side effect". Be patient and courageous: very soon it will become easier - and you can enjoy this wonderful period of your life! Keep your nose up!

Specially for- Elena Kichak

Nausea during pregnancy worries a fairly large number of women, out of ten, about 6 learn what it is and are looking for a remedy - how at least to alleviate this condition.
It can occur as a manifestation of early toxicosis of pregnant women, due to diseases, and as a functional indigestion in the later stages.

Vomiting during early pregnancy

In most cases, vomiting occurs after nausea, along with heartburn, lack of appetite, sensitivity to odors - this is collectively called early toxicosis.

When does vomiting start during pregnancy?

Most often, this happens for the first time after 5-6 weeks. Most often, it becomes bad in the morning, although symptoms are also possible in the evening, as a rule, they are a manifestation of the fact that you are too tired during the day and you need to get more rest. If you feel relatively well in the morning, and when you return home after a working day, and feel so tired that you cannot even eat, after eating, you are worried about nausea, you definitely need to fight this. Work during pregnancy should fade into the background, if you do not feel well, complain to the gynecologist in the antenatal clinic, they will help you.

A painful sensation can occur after eating, it is provoked by strong odors, sudden movements. It is caused by many products, each future moment has its own, and it often happens that it seems that you yourself want this particular food, and very much, feeling real hunger, but your body categorically does not accept this, and a gag reflex arises.

Constant, severe vomiting during pregnancy in the first weeks leads to dehydration, electrolyte imbalance, weight loss and deterioration of the woman's condition. Feeling terrible, the duration of this suffering and the discomfort that it causes, make us look for ways to stop this side effect.

During pregnancy, early toxicosis is treated only if eruptions from the stomach occur more often than 5 times a day. You can read in detail about what early toxicosis is, what medicines for vomiting during pregnancy can be prescribed to you.

Vomiting during late pregnancy

In the later stages, there are also precedents of toxicosis, and at the same time it sometimes happens completely unexpectedly. You can feel great, nothing portends even a hint of nausea, you are happy to eat, for example, very ripe sweet plums and suddenly ... your stomach rebelles and is instantly freed from both the plums and everything that you ate a little earlier. Vomiting in the second half of pregnancy easily occurs when eating poor quality food from the point of view of your stomach. Pregnancy makes the gastrointestinal tract very sensitive to this, nature so protects the child. Apparently, the plums were too ripe and if there were no vomiting, everything would have ended with diarrhea.

Vomiting in the second trimester of pregnancy can also occur with normal overeating. This is especially true before childbirth. The enlarged uterus left too little room for the stomach.

And there is another very important reason: many women before childbirth and in the first stage of childbirth have very big problems, both with the intestines and with the stomach. The body knows that hard work is best done light and is freed from any load. So, if you suddenly became ill in the last month of pregnancy, this may indicate that labor is starting.

Treatment is reduced to proper nutrition, often in small portions, an elevated position during sleep, and the use of the knee-elbow position. Medicines are rarely needed. You can read in detail about the measures to combat nausea.

Dangerous causes of vomiting in pregnant women

Nausea is a symptom that can occur with a variety of medical conditions that have nothing to do with pregnancy. There may even be diseases that require urgent help from a surgeon and threaten your life.

Vomiting during pregnancy can be dangerously combined with:

Temperature. It occurs in case of poisoning, intestinal infection, in acute surgical diseases of the abdominal organs. For example, pregnancy and appendicitis occur together, one does not exclude the other, and even if you are in a position, an urgent operation is needed for appendicitis.

Diarrhea. Most often it happens with intestinal infections. Salmonellosis. Dysentery, acute gastroenteritis of various origins may well manifest itself with symptoms such as fever, vomiting and diarrhea. During pregnancy These diseases are, of course, very dangerous and require immediate medical attention.

Bile occurs in cases where it is either too frequent, or if there is a reflux of the contents of the duodenum into the stomach (duodeno-gastric reflux, a gastroenterological disease, which usually worsens during pregnancy). If the substance is yellow or even green, see a doctor immediately.

Pain in the abdomen. It happens at the beginning of labor, with surgical diseases, with intestinal infections and many other diseases. Abdominal pain definitely requires urgent medical advice, call an ambulance without hesitation.

Blood. This is a manifestation of a surgical disease, Melory-Weiss syndrome. If the symptom is repeated many times, as a result of vomiting, cracks in the gastric mucosa appear in the place where it passes into the esophagus. This is a dangerous condition. In addition, vomiting during pregnancy with blood occurs with gastric ulcer, varicose veins of the esophagus and some other dangerous diseases.

From the foregoing, it is clear that the causes of vomiting in pregnant women are not always so harmless, and it is always worth deciding what to do if you are worried about this unpleasant symptom with your doctor.

ETIOLOGY (CAUSES) VOMITING DURING PREGNANCY

The etiology has not been determined. An important role in the development of the disease is played by violations of the relationship between the activity of the central nervous system and internal organs. Of great importance is the predominance of excitation in the subcortical structures of the central nervous system (reticular formation, centers of regulation of the medulla oblongata). In these areas, the vomiting center and the chemoreceptor trigger zone are located, which regulate the emetic act, the respiratory, vasomotor and salivary centers, as well as the nuclei of the olfactory system of the brain. The close location of these centers determines the sensations of nausea preceding the emetic act and a number of concomitant autonomic disorders (increased salivation, deepening breathing, tachycardia, pallor of the skin due to spasm of peripheral vessels).

In the subcortical structures, the predominance of brain excitement with the emergence of a vegetative response is associated with pathological processes in the genitals (inflammatory diseases, intoxication) that disrupt the functioning of the receptor apparatus of the uterus (it is also possible damage to the ovum), which is most likely possible when physiological relationships are disturbed the maternal organism and trophoblast in the early stages of gestation.

At the beginning of pregnancy, autonomic disorders can simultaneously be caused by hormonal disorders, in particular, an increase in the level of hCG in the body. Proof of this is the fact that with multiple pregnancies and cystic drift, when a large amount of hCG is excreted, vomiting of pregnant women occurs especially often.

The factors predisposing to the development of toxicosis include chronic diseases of the gastrointestinal tract, liver, as well as asthenic syndrome.

PATHOGENESIS

In the pathogenesis of vomiting of pregnant women, the defining links are considered to be a violation of the neuroendocrine regulation of all types of metabolism, partial (or complete) starvation and dehydration. In the mother's body, with the progression of vomiting, water-salt (hypokalemia), carbohydrate, fat and protein metabolism is gradually disrupted against the background of increasing dehydration, exhaustion and weight loss. Fasting initially depletes glycogen stores in the liver and other tissues. Then catabolic reactions are activated (fat and protein metabolism increases). Against the background of suppression of the activity of the enzyme systems of tissue respiration, the energy needs of the mother's body are satisfied due to the anaerobic breakdown of glucose and amino acids. Under these conditions, β-oxidation of fatty acids is impossible, as a result of which the body accumulates under-oxidized metabolites of fat metabolism - ketone bodies (acetone, acetoacetic and β-hydroxybutyric acids), which are excreted in the urine.

In addition, ketosis is maintained through enhanced anaerobic breakdown of ketogenic amino acids. Against this background, ketonuria develops, arterial blood oxygenation decreases, and CBS shifts towards acidosis.

Changes in the organs of a pregnant woman initially have a functional character, and then, as dehydration increases, catabolic reactions intensify, and intoxication with under-oxidized products, they turn into dystrophic processes in the liver, kidneys and other organs. Initially, protein-synthetic, antitoxic, pigment and other functions of the liver, renal excretory function are disturbed; in the subsequent dystrophic changes are noted in the central nervous system, lungs, heart.

CLINICAL PICTURE

In 50-60% of cases, vomiting of pregnant women is regarded as a physiological sign of pregnancy, and in 8-10% - as a complication of pregnancy (toxicosis). In normal pregnancy, nausea and vomiting can be no more than 2-3 times a day in the morning, more often on an empty stomach, but this does not violate the general condition of the woman and, accordingly, does not require treatment. As a rule, at the end of the placentation process, nausea and vomiting stop by 12-13 weeks.

Vomiting, which occurs several times a day, regardless of food intake, is accompanied by a decrease in appetite, a change in taste and smell, a feeling of weakness, sometimes a decrease in body weight, is referred to as toxicosis. Distinguish between mild, moderate and excessive vomiting of pregnant women (Table 31-1).

Table 31-1. The severity of vomiting in pregnant women

Symptoms The severity of vomiting in pregnant women
Easy Average Severe (excessive)
Vomiting frequency per day 3-5 times 6-10 times 11-15 times or more (up to continuous)
Heart rate per minute 80–90 90–100 over 100
Systolic blood pressure 120-110 mm Hg 110-100 mm Hg below 100 mm Hg
Weight loss per week 1-3 kg (up to 5% of the original weight) 3-5 kg ​​(1-1.5 kg per week, 6-10% of original weight) over 5 kg (2-3 kg per week, over 10% of the original weight)
An increase in body temperature to subfebrile numbers Absent Rarely observed It is often observed (in 35-80% of patients)
Yellowness of the sclera and skin Absent In 5-7% of patients In 20-30% of patients
Hyperbilirubinemia Absent 21-40 μmol / l 21-60 μmol / l
Dry skin + ++ +++
Chair Daily Once every 2-3 days Stool retention
Diuresis 900-800 ml 800-700 ml Less than 700 ml
Ketonuria +, ++ +, ++, +++ (periodically in 20-50% of patients) +++, ++++ (in 70-100% of patients)

Note: +, ++, +++ - severity.

Mild vomiting occurs up to 4-5 times a day and is accompanied by an almost constant feeling of nausea.

Despite vomiting, part of the food is retained and pregnant women do not notice significant weight loss. The decrease in body weight is 1-3 kg per week (up to 5% of the initial weight). The general condition remains satisfactory, however, patients may note apathy and decreased performance. Hemodynamic parameters (pulse, blood pressure) in most pregnant women remain within normal limits. Sometimes they note moderate tachycardia (80–90 beats / min), hypotension. Diuresis does not change. Acetonuria is absent. There are no changes in the morphological composition of the blood. Light vomiting responds quickly to treatment or goes away on its own, so no special treatment is required. However, in 10-15% of pregnant women, it intensifies and can move to the next stage.

An increase in vomiting up to 10 times a day or more, a deterioration in the general condition and metabolism with the development of ketoacidosis indicates moderate severity. Vomiting is often accompanied by salivation, as a result of which there is an additional significant loss of fluid and nutrients. As a result, dehydration and weight loss progress to 3-5 kg ​​per week (6% of the initial weight) until exhaustion. The general condition of pregnant women worsens, there is significant weakness and apathy. The skin is pale, dry, the tongue is coated with a whitish coating, dryish. Body temperature can be subfebrile (no higher than 37.5 ° C), tachycardia (up to 100 beats / min) and arterial hypotension are characteristic. Diuresis is reduced. In urine, acetone is determined in 20-50% of pregnant women. In the study of blood, mild anemia can be detected, in the analysis of CBS, metabolic acidosis. Often, patients note constipation. The prognosis with timely treatment is usually favorable.

Excessive vomiting (severe), which is rarely observed, is characterized by dysfunction of vital organs and systems, up to the development of dystrophic changes in them due to severe intoxication and dehydration. Vomiting is noted up to 20 times a day; it is accompanied by profuse salivation and constant nausea. Food and liquid are not retained. At the same time, the general condition is grave. Patients complain of headaches, dizziness. Adynamia is noted; body weight decreases rapidly (up to 2-3 kg per week, ie over 10% of the original body weight). The subcutaneous fat layer disappears, the skin becomes dry and flabby, the tongue and lips are dry, the smell of acetone is felt from the mouth; body temperature is subfebrile, but can rise to 38 ° C; severe tachycardia, hypotension occur. Diuresis sharply decreases.

With excessive vomiting in the blood, the levels of residual nitrogen, urea, and bilirubin increase. An increase in Ht and the number of leukocytes is characteristic. At the same time, the content of albumin, cholesterol, potassium, chloride decreases. In urine, protein and casts, urobilin, bile pigments, erythrocytes and leukocytes are determined. The reaction of urine to acetone is sharply positive.

With excessive vomiting, the prognosis is not always favorable. Signs of a threatening condition that determine the indications for an emergency termination of pregnancy are an increase in weakness, adynamia, euphoria or delirium, tachycardia (up to 110–120 beats / min), hypotension (up to 90–80 mm Hg), yellowness of the skin and sclera, pain in the right hypochondrium, decreased urine output (up to 300-400 ml per day), hyperbilirubinemia (within 100 μmol / l), increased levels of residual nitrogen, urea, proteinuria, cylindruria.

DIAGNOSTICS

Diagnosis of vomiting during pregnancy is not difficult. To determine the severity of vomiting, a clinical examination of the patient is necessary: ​​a study of a general analysis of blood and urine; determination in the dynamics of Ht, blood levels of bilirubin, residual nitrogen and urea, electrolytes (potassium, sodium, chlorides), total protein and protein fractions, transaminases, indicators of CBS, glucose. In the urine, the level of acetone, urobilin, bile pigments, and protein is determined. With significant dehydration in the blood thickening, there may be false-normal indicators of the content of Hb, erythrocytes, protein. The degree of dehydration is determined by the Ht level. Its value above 40% indicates severe dehydration.

DIFFERENTIAL DIAGNOSTICS

The manifestations of early toxicosis in pregnant women must be differentiated from a number of diseases, which are also characterized by vomiting (foodborne toxicity, gastritis, pancreatitis, cholelithiasis, stomach cancer, thyrotoxicosis, neuroinfection and other pathological conditions).

TREATMENT OF VOMITING DURING PREGNANCY

OBJECTIVES OF TREATMENT

The goal of the treatment is to restore water-salt metabolism, metabolism, and functions of vital organs.

INDICATIONS FOR HOSPITALIZATION

With mild vomiting, treatment can be carried out on an outpatient basis, with moderate and severe vomiting - in a hospital.

NON-MEDICINAL VOMITING TREATMENT

Great importance must be attached to diet. In connection with a decrease in appetite, a variety of foods are recommended in accordance with the woman's desire. Food should be easily digestible, contain a large amount of vitamins.

It should be taken chilled, in small portions every 2-3 hours, while lying in bed. Shown is mineral alkaline water without gas in small volumes (5-6 times a day). A chilled decoction of ginger or lemon balm is also prescribed in small portions of at least 1 liter per day.

With vomiting of moderate severity, mixtures for enteral nutrition are prescribed.

Given the short gestation period, in order to exclude the negative effect of drugs on the ovum, it is advisable to carry out non-drug treatment. To normalize the functional state of the cerebral cortex and eliminate autonomic dysfunction, central electroanalgesia, acupuncture, psychotherapy and hypnotherapy are indicated. The use of homeopathic medicines is effective. These methods of treatment may be sufficient in the treatment of patients with mild vomiting of pregnant women, and in moderate and severe cases, they can limit the amount of drug therapy.

VOMITING MEDICINAL TREATMENT

When vomiting pregnant women, drug treatment should be comprehensive:

Drugs that regulate the function of the central nervous system and block the gag reflex;
infusion agents for rehydration, detoxification and parenteral nutrition;
drugs designed to normalize metabolism.

The main rule of drug therapy for severe and moderate severity of vomiting is the parenteral method of administering drugs until a stable effect is achieved.

A properly organized therapeutic and protective regime and the elimination of negative emotions play an important role in normalizing the function of the central nervous system. When hospitalized, it is advisable to place the patient in a separate ward in order to exclude reflex vomiting.

Prescribe drugs that directly block the gag reflex: drugs that affect various neurotransmitter systems of the medulla oblongata: M-antagonists (atropine), dopamine receptor blockers (antipsychotics - haloperidol, droperidol, phenothiazine derivatives - thiethylperazine), as well as direct antagonists of dophamidine centrally acting drugs that block serotonin receptors (ondansetron).

An important link in treatment is considered to be infusion therapy, which includes the use of crystalloids and parenteral nutrition agents. Crystalloids are designed to rehydrate. Of crystalloids, complex solutions are used, such as Ringer-Locke's solution, trisol, chlorosalt. For parenteral nutrition, solutions of glucose, amino acids and fat emulsions are used with a total energy value of up to 1500 kcal per day. In order to better assimilate glucose, insulin is administered. With a decrease in the total volume of blood protein to 5 g / l, colloidal solutions are indicated (for example, 5-10% albumin solution up to 200-400 ml).

The volume of infusion therapy is 1-3 liters, depending on the severity of toxicosis and the patient's body weight.

The criteria for the sufficiency of infusion therapy are considered to be a decrease in dehydration and an increase in skin turgor, normalization of Ht and diuresis.

Along with infusion therapy, drugs are prescribed that normalize metabolism. Taking into account vomiting, it is advisable to prescribe them parenterally: riboflavin (1 ml of a 1% solution intramuscularly), ascorbic acid (up to 5 ml of a 5% solution intravenously, intramuscularly), Actovegin (5 ml intravenously), essential phospholipids (5 ml intravenously).

The therapy is continued until vomiting is permanently stopped, the general condition is normalized, and the body weight gradually increases. Treatment of mild to moderate vomiting in pregnant women is almost always effective.

Excessive vomiting of pregnant women in the absence of the effect of complex therapy for 3 days is an indication for termination of pregnancy.

TERMS AND METHODS OF DELIVERY

An increase in ketonuria and proteinuria, the appearance of an icteric color of the skin and sclera, an increase in body temperature to subfebrile values ​​are considered prognostically unfavorable signs indicating the ineffectiveness of the therapy.

The ineffectiveness of the therapy is an indication for termination of pregnancy. So, the indications for termination of pregnancy are:

Lack of effect from complex therapy within three days;
incessant vomiting;
increasing dehydration of the body;
progressive weight loss;
progressive ketonuria within 3-4 days;
severe tachycardia;
dysfunction of the nervous system (weakness, apathy, delirium, euphoria);
bilirubinemia (up to 40–80 µmol / L), hyperbilirubinemia of 100 µmol / L is critical;
icteric staining of the sclera and skin.

PATIENT INFORMATION

A pregnant woman should know that a normal pregnancy can be physiologically accompanied by nausea and vomiting with a frequency of 2-3 times a day. Deterioration is transient and does not require treatment. In addition to following a diet, it is worth taking easily digestible food in small portions.