Obstetrics and gynecology. Toxicoses of pregnant women (the most important)

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Obstetrics and gynecology. Toxicoses of pregnant women (the most important)

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29. Toxicosis of pregnant women

Toxicosis of pregnant women (gestosis) - 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.

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 of the development of early toxicosis, the theory of disruption of neuroendocrine regulation and metabolism, which develops as a result of previous diseases, characteristics of pregnancy, and the influence of unfavorable environmental factors on the body, is currently adhered to. Early toxicosis of pregnancy is most often accompanied by vomiting and drooling (ptyalism).

The appearance of vomiting is associated with a hormonal imbalance. 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 three degrees of severity of vomiting during pregnancy:

1) a mild degree is characterized by vomiting up to 5 times a day, while the condition of the pregnant woman is not disturbed;

2) moderate severity is accompanied by vomiting up to 10-12 times a day, symptoms of intoxication, weakness, weight loss and diuresis decrease;

3) severe degree (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 impaired function of vital organs. Severe vomiting is characterized by severe weakness, agitation or apathy, low-grade fever, tachycardia, a decrease in 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, 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.

Author: Ivanov A.I.

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