Toxicosis of pregnancy is complications of pregnancy, characterized by a metabolic disorder and auto-toxicity phenomena. At toxicosis of pregnancy, there are phenomena of general autointoxication of the organism of the patient with a predominantly functional, and in severe cases, morphological damage to individual systems and organs. Toxicosis of pregnancy complicates the course of pregnancy, worsens the development of the fetus, often endangers the life of a woman.
Toxicosis is divided into two groups: early, occurring in the period from the 1 st to 10-12th week of pregnancy, and late, usually developing from the 26th to the 40th week of pregnancy. Possible (though rare) cases of later occurrence or protracted course of early toxicosis of pregnancy (for example, 12-16 weeks). Often there are cases of late toxicosis that occur during the 24-25th week of pregnancy.
In each of the two main groups, two more subgroups are distinguished: pregnancy toxicity is pure (primary) and combined (secondary). The combination of toxicosis pregnancy, arising in pregnant women on the background of any pre-existing disease, most often hypertension, diabetes, liver disease, kidney. With pre-existing hypertensive disease, severe toxicity of pregnancy occurs 14 times more often than in women not burdened with this disease. Combined toxemia of pregnancy make up about half of all late toxicosis of pregnancy.
To the group of early toxicosis of pregnancy carry the following forms: ptyalism (drooling), vomiting, excessive vomiting (indomitable vomiting ), polyneuritis , bronchial asthma, dermatoses , chorea, tetany, osteomalacia.The
The group of late toxicosis of pregnancy includes dropsy of pregnant women (see), nephropathy (see Nephropathy of pregnant women), preeclampsia and eclampsia (see).
Etiology and pathogenesis. The emergence of all forms of toxicosis of pregnancy should be considered as a violation of the normal course of the restructuring of the woman's body, a violation of the process of adaptation to the new conditions that have arisen in connection with pregnancy. Some scientists explain the origin of early toxicosis of pregnancy by violating the processes of excitation and inhibition in the brain.
The pathogenesis of late toxicosis of pregnancy has not yet been fully explored.
Clinic. Early toxicosis . Vomiting of pregnant women is often associated with the earlier increased salivation (see Vomiting), although these forms of pregnancy toxicity may exist separately. Excessive salivation (ptyalism) is associated with overexcitation of subcortical centers of the brain and irritation of the branches of the vagus nerve in salivary parotid glands . The amount of saliva released can reach 1 liter per day, not counting the swallowed. When diagnosing it is necessary to exclude food poisoning, appendicitis, cholecystitis .
The most common form of dermatosis is the itching of the pregnant (the vulva, sometimes the entire body). In differential diagnosis, it is necessary to exclude diabetes mellitus , helminthic invasion, vulvovaginitis of inflammatory genesis, manifestations of allergy . Treatment: dimedrol, suprastin, irradiation with ultraviolet rays, vitamins B1 , B6 , estrogens , calcium chloride.
Less commonly observed is eczema , Herpes gravidarum, or impetigo herpetiformis. Treatment: calcium preparations, blood serum intramuscularly (10-20 ml), subcutaneously Ringer's solution (200 ml), dihydrotachysterol (product of ergosterol irradiation).
Chorea is usually treated with amidopyrine (0.2-0.3 g 6 times a day for 7-8 days), salicylates; tetany - calcium preparations, parathyreocrine, vitamins D3, D2, dihydrotachysterol; bronchial asthma - calcium preparations, irradiation of the skin of the body with ultraviolet rays, vitamins (B1, D), sodium bromide with caffeine; Similarly, but with the addition of fish oil and progesterone , osteomalacia is treated.
Late toxicosis often occurs in primiparas over the age of 30 (especially those who have undergone early toxicosis of pregnancy in this pregnancy), as well as pregnant women with chronic liver, biliary tract, kidney, endocrine disorders, hypovitaminosis C, with a lot of water and many pregnancies recently infected with acute infections. Later toxicosis of pregnancy is more likely to occur in women who have had one ovary removed in the past, and the more often, the more time passed after the operation.
Of exceptional importance is hypertension : at stage I its late toxicosis of pregnancy occurs in 46.1% of pregnant women, and at stage II - in 72.4%. Therefore, in the second half of pregnancy, it is necessary to measure blood pressure, starting from the 32nd week on a weekly basis. Threatening should be regarded as an increase in blood pressure compared with the baseline (before pregnancy) by 30% or more.
A frequent and early sign of toxicosis of pregnancy is the excessive accumulation of fluid in the body of a pregnant woman, which finds expression in edema mainly of the lower extremities, as well as fingers. One of the most important symptoms of late toxicosis of pregnancy is albuminuria (see Proteinuria ).
For the timely effective treatment of late toxicosis of pregnancy, their early diagnosis is necessary. Treatment of late toxicosis of pregnancy at the earliest stages of their development is at the same time the prevention of more severe forms of toxicosis of pregnancy, in particular eclampsia.
The main and decisive role in the timely diagnosis of late toxicosis of pregnancy belongs to women's consultations. It is necessary to take pregnant women who are predisposed to the development of late toxicosis of pregnancy.
In the treatment of pregnancy toxicosis are mandatory: hospitalization, bed rest, peace, silence, heat with sufficient fresh air, reduced lighting of the room; absence of any emotional and painful stimuli. In cases of anxiety, increased excitability shows sodium bromide, phenobarbital , andaxin, trioxazine; in more severe cases - combined treatment with magnesium sulfate and aminazine (see Nephropathy of pregnant women, Eclampsia ). With pre-eclampsia and eclampsia, an ether anesthesia is required, followed by administration of arfonad, aminazine, viadryl, droperidol.
With arteriolo- and capillarospasm, antispasmodics are prescribed: dibazol, platyphylline , papaverine , and euphyllin ; with hypertension - reserpine , apressin, devinkan, pyrilene , isobarine (ismelin).
In cases of hypoxemia and hypoxia, abundant supply of oxygen (by inhalation) is provided, constant access of fresh air, repeated intravenous injection of 40% glucose solution (100 ml) with ascorbic acid (300-500 mg), which increases diuresis, reduces edema, vascular permeability , improves brain nutrition, increases the endurance of tissues (brain, kidneys) to hypoxia, improves the antitoxic function of the liver, favorably affects gas exchange . In violation of all types of metabolism (mainly protein and water-salt), prescribe a salt-free diet with sufficient protein, honey, methionine, vitamins; in the presence of significant edema - hypothiazide (with the simultaneous introduction of potassium salts), fonurite, ammonium chloride (one of these drugs).
Prolonged toxicity of pregnancy without noticeable improvement, despite treatment, leads to irreversible changes in the placenta and the death of the fetus. In such cases, early vaginal delivery is indicated in the interest of viability of the fetus.
Prevention . A thorough examination of the pregnant woman in the women's consultation is necessary: before the 20th week - once a month, from the 20th to the 32nd week - 2 times a month, from the 32nd week - weekly; obligatory examination of urine, measurement of blood pressure; weighing, measuring the volume of legs at the level of the ankles, the volume of the fingers. If necessary, biochemical and endocrinological studies; examinations of the therapist (special attention to the revealed extragenital diseases and compulsory their treatment).