Obstetrics and Gynecology - A. M. Gromova 2000

Early pregnancy toxicosis. Late gestosis
Early pregnancy toxicosis

Gestosis (toxicosis) of pregnant women refers to conditions that arise due to The Development of the fertilized ovum amidst impaired adaptation processes of the maternal Organism to Pregnancy.

Pregnancy itself is the underlying cause of these disorders; with the termination of pregnancy (following childbirth or abortion), the symptoms of gestosis disappear. Depending on the time of onset and clinical manifestations, the following forms of gestosis in pregnant women are distinguished:

1. Early toxicosis: vomiting, excessive vomiting, ptyalism (salivation).

2. Rare forms of toxicosis: dermatosis of pregnancy, chorea gravidarum, obstetric jaundice, acute fatty Liver of pregnancy, etc.

3. Late gestosis: Hypertension, edema, proteinuria, mild, moderate, and severe Preeclampsia, Eclampsia.

The Pathogenesis of early toxicosis stems from an inadequate reaction of the pregnant woman's body to the mandatory physiological changes triggered by the gestational process. These changes are compensatory in nature and are regulated by the Central Nervous system. Severe pre-existing conditions (Inflammatory Diseases of the reproductive Organs, genital infantilism, TRAUMATIC Brain INJURIES), chronic infection foci, poor Nutrition, nervous exhaustion, stress, overwork, and other adverse factors disrupt the normal balance between Excitation and Inhibition processes in the Cerebral Cortex. Under such conditions, the compensatory changes accompanying pregnancy acquire a pathological character, causing Metabolic Disorders, vascular disturbances, hormonal imbalances, and associated electrolyte shifts.

Vomiting of pregnancy (emesis gravidarum) is the most frequent form of toxicosis During the first half of pregnancy. This form of early gestosis differs from the common morning sickness experienced by many women in the early months of pregnancy in that the vomiting occurs not only in the morning but repeats multiple times a day, even after meals. Depending on the severity, mild, moderate, and excessive (intractable) vomiting are distinguished. Mild vomiting of pregnancy recurs several times (3 to 5) a day and does not affect the patient's general condition. As a rule, vomiting occurs after meals, accompanied by nausea, loss of appetite, and a craving for sour and salty foods. Moderate toxicosis is characterized by more frequent vomiting (10–12 times a day) occurring independently of food intake. The patient cannot retain food and develops ptyalism. Moderate tachycardia, subfebrile Temperature, and hypotension develop. The patient complains of lethargy, drowsiness, and occasionally insomnia. Diuresis decreases. Such a condition may resolve spontaneously or under METABOLISM/18.html">The Influence of Treatment. However, in some women, vomiting intensifies and becomes excessive, recurring up to 20 times or more per day, both day and night. Neither food nor Water is retained in The Stomach. As a result of dehydration, carbohydrate, lipid, and Water-Salt Metabolism are disrupted, and signs of intoxication progress. Patients are apathetic and adynamic, complaining of pain in the epigastrium, right hypochondrium, and suprapubic region. Women rapidly lose body weight (2 to 5 kg per week), and the subcutaneous fat layer disappears. The Skin becomes dry; examination reveals the 'dust trail' sign (a streak of exfoliated epidermal scales when running a finger across the skin), and turgor is reduced. Scleral icterus and an acetone odor from the Mouth appear. Body temperature rises to 38°C or higher, and tachycardia develops exceeding 120 beats per min. The pulse is of low volume. Heart sounds are muffled. Blood pressure drops to 80 mmHg. Diuresis progressively decreases, accompanied by elevated blood levels of urea, bilirubin, and residual nitrogen. Hematocrit and leukocytosis increase, while albumin, Cholesterol, and potassium levels decline. Urine shows the presence of protein and Blood Cells, and the acetone reaction is strongly positive. Severe changes may occur in the body, leading to the patient's death. Treatment for vomiting of pregnancy must be comprehensive and aimed primarily at normalizing central nervous system function and water-salt balance. It is carried out in a hospital Setting where complete physical and mental rest is ensured. Psychotherapy is an essential component of treatment. Patients are prescribed easily digestible light foods (rusks, mashed potatoes, tea, cocoa, coffee, lean meat, fish, eggs, butter, etc.). Food should be consumed in a recumbent position, frequently and in small portions, preferably chilled. If food is not retained, a 40% glucose solution (30–40 ml intravenously along with Vitamins B and C) is administered. When necessary, medical treatment is prescribed, including:

1. Intervention targeting central nervous system Functions as the primary pathogenetic factor to suppress the excitability of the vomiting center: etaperazine 0.002 g 3–4 times a day for 10–12 days; torekal 1.0 ml intramuscularly, or 6.5 mg in dragee or suppository form 2–3 times a day; droperidol 0.5–1.0 ml intramuscularly 1–3 times a day; cerucal 10 mg intramuscularly or per os; bromides in the form of microclysters (50 ml of a 4% sodium bromide solution once a day); administration of sodium bromide combined with caffeine according to N.V. Obozeva's method (for 10–15 days, intravenous administration of 10% sodium bromide - 10.0 ml daily and subcutaneous administration of 10% caffeine solution - 1.0 ml twice a day).

2. Desensitizing agents (diphenhydramine 1% - 2.0 ml, diprasine 2.5% - 1.0 ml 2–3 times a day intramuscularly).

3. To eliminate hypoproteinemia and dehydration, intravenous drip infusion of protein preparations, glucose solution with Insulin, and Ringer-Locke solution is advisable. To combat metabolic acidosis, a 5% sodium bicarbonate solution under the control of the blood acid-base balance. In severe forms of the disease, The Use of hemodez and rheopolyglucukin is indicated; repeated small-dose blood transfusions (100–150 ml) are also beneficial. The patient should receive at least 2.0–2.5 liters of fluid per day.

4. Parenteral administration of vitamins: C - 100–200 mg, B₁ - 50 mg, B₂ and B₆ - 50 mg each, alternately every other day, and cocarboxylase - 100 mg.

5. Endonasal Electrophoresis with novocaine or diphenhydramine, inductothermy applied to the solar plexus area. Body weight, fluid intake, and diuresis are monitored daily. If treatment is unsuccessful, pregnancy termination sometimes becomes necessary.

Salivation (ptyalismus). Hypersalivation is observed during vomiting and occasionally occurs as an independent manifestation of toxicosis. The amount of saliva produced can reach 1.0 liter per day. Ptyalism does not cause severe bodily harm, but it depresses the patient's psyche and causes maceration of the skin and labial mucosa. Treatment for ptyalism is similar to that for vomiting. Sometimes, to reduce salivary gland secretion, intramuscular administration of atropine (1.0 ml of a 0.1% solution) is prescribed. Rinsing the Oral Cavity with sage or chamomile infusion and other astringent agents is recommended. This pathology does not require the termination of pregnancy.