Early toxicosis of pregnant women. Late gestosis
Gestoses (toxicosis) of pregnant women are called diseases that arise in connection with the development of the fetal egg in violation of the processes of adaptation of the woman's organism to pregnancy.
The cause of their occurrence is the pregnancy itself, with the interruption of the last (after childbirth or abortion) signs of gestosis disappear.
By the time of occurrence and clinical manifestations, it is customary to distinguish the following forms of gestosis of pregnant women:
1. Early toxicosis: vomiting, excessive vomiting, drooling.
2. Toxicosis, rarely found: dermatosis of pregnant women, chorea of pregnant women, jaundice of pregnant women, acute fatty hepatosis, etc.
3. Late gestosis: hypertension, swelling, proteinuria, pre-eclampsia mild, moderate and severe, eclampsia.
Early toxicosis (gestosis) of pregnant women
The pathogenesis of early toxicosis is the inadequate response of the pregnant woman's body to mandatory changes that result from the development of the gestational process. These changes are compensatory and controlled by the central nervous system. Migrated to pregnancy severe diseases (inflammatory processes of the genitals, sexual infantilism, brain trauma), the presence of chronic foci of infection, malnutrition, nervous exhaustion, stress, fatigue and other unfavorable factors lead to disruption of normal relationships between the processes of excitation and inhibition in the cortex of the brain the brain. In such conditions, the compensatory changes that accompany pregnancy become pathological in nature and cause metabolic disorders, vascular disorders, hormonal imbalance and associated electrolyte shifts.
Vomiting of the pregnant (emesis gravidarum) - the most common form is gestosis of the first half of pregnancy . Usually vomiting, many women accompany the first months of pregnancy, this form of early gestosis is different in that vomiting is not only in the morning, but it is repeated several times a day, even after eating. By severity, light, moderate and excessive vomiting is distinguished. Vomiting of pregnant mild degree is repeated several times (from 3 to 5) per day and does not affect the general condition of the patient. As a rule, vomiting occurs after eating, accompanied by nausea, a decrease in appetite, the appearance of a tendency to spicy and salty dishes. A moderate degree of toxicosis is characterized by more frequent vomiting (10-12 times a day), occurs regardless of food intake.
The patient can not keep food, salivation occurs. There is a moderate tachycardia, subfebrile temperature is noted, arterial hypotension develops. The patient complains of weakness, drowsiness, and sometimes insomnia. Diuresis is reduced. Such a condition can occur independently or under the influence of ongoing treatment. But in some women vomiting increases and acquires the character of excessive, repeating 20 times or more per day, arising both day and night. In the stomach, not only food, but also water is not delayed. As a result of dehydration, carbohydrate, fatty, water-salt metabolism is disrupted, signs of intoxication increase. Patients are apathetic, dynamically, complain of epigastric pain, right hypochondrium, above the heart. Women quickly lose body weight (from 2 to 5 kg per week), the subcutaneous fat layer disappears. The carcase becomes dry, the symptom of the "dust trail" (a strip of exfoliating epidermis scales, while holding a finger over the skin) is noted during examination, the turgor is reduced. Appears icteric sclera, the smell of acetone from the mouth. Body temperature rises to 38 ° C or higher, tachycardia develops more than 120 beats per minute. Pulse of weak filling. The heart sounds are muffled. Arterial pressure is reduced to 80 mm Hg. Progressively decreases diuresis, which is accompanied by an increase in the blood urea, bilirubin, residual nitrogen. Increases hematocrit, leukocytosis, reduces the level of albumins, cholesterol, potassium. In the urine appears protein, the blood elements, the reaction to acetone is sharply positive. In the body, severe changes can occur that lead to the death of a woman. Treatment of vomiting of pregnant women should be comprehensive and focused mainly on the normalization of the central nervous system and the state of water-salt metabolism. It is carried out in a hospital, where conditions for complete physical and mental rest are created. Psychotherapy is an indispensable component of treatment. Patients are prescribed light food, which is well absorbed (crackers, mashed potatoes, tea, cocoa, coffee, lean meat, fish, eggs, butter, etc.). It should be taken lying down, often in small portions, preferably in a hunting form. If the food is not digested, 40% glucose solution is prescribed for 30-40 ml intravenously along with vitamins B and C.
If necessary, prescribe medication for gestosis, which includes:
1. Influence on the functions of the central nervous system, as the main pathogenetic factor for the purpose of suppressing the excitability of the vomiting center: etaperazin 0002 g - 3-4 times a day 10-12 days, the torekan 1.0 ml intramuscularly, or 6.5 mg in as a dragee, or rectal suppositories 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 (50ml 4% solution of sodium bromide once a day) administration of sodium bromide in combination with caffeine by N.V.Obozevoy (within 10-15 days, sodium bromide 10% - 10.0 ml daily and subcutaneously 10 % caffeine solution, 1.0 ml twice daily).
2. Desensitizing agents (diphenhydramine 1% - 2.0 ml, diprazine 2.5% - 1.0 ml 2-3 times per day intramuscularly).
3. In order to eliminate hypoproteinemia and dehydration, intravenous drip administration of protein preparations, glucose solution with insulin, Ringer-Locke solution is expedient. To combat metabolic acidosis - 5% solution of sodium hydrocorbanate under the control of acid-base blood. In severe forms of the disease shows the use of haemodesis, rheopolyglucin, repeat blood transfusions in small doses (100-150 ml) are also useful. During the day the patient should receive at least 2.0-2.5 liters of fluid.
4. Parenteral administration of vitamins: C - 100-200 mg, Vee - 50 mg, B2 and B650 mg, in turn every other day, cocarboxylases of 100 mg.
5. Endonasal electrophoresis with novocaine or dimedrol, inductothermy on the solar plexus site. Daily monitoring of body weight, amount of fluid taken and diuresis. With unsuccessful treatment, sometimes you have to resort to abortion.
Salivation (ptyalismus). Hypersalivation is observed with vomiting, and sometimes it is also an independent manifestation of toxicosis, histosis. The amount of saliva released can reach 1.0 liters per day. Salivation does not cause serious disorders in the body, but it suppresses the psyche of patients, causes maceration of the skin and mucous membranes of the lips. When salivation is carried out a similar treatment, as with vomiting. Sometimes, in order to reduce the secretion of the salivary glands, intramuscular administration of atropine is prescribed for 1.0 ml of a 0.1% solution. It is advisable to rinse the mouth with sage infusion, chamomile and other agents that have astringent properties. Termination of pregnancy, this pathology does not need.