Vomiting of pregnancy

Vomiting of pregnancy - early toxicosis of pregnant women, the major clinical symptom of which is vomiting. In the process of development of the act of vomiting occur not only diarrhoea, motor, secretory, but sensitive, vascular and trophic disorders, in the aggregate complex clinical syndrome observed in 14,9% of pregnant women. Vomiting accompanied by salivation and nausea. Salivation is of a more permanent character and is observed more often than nausea, and the latter in turn is observed more often and is more permanent than vomiting.
Easy flowing vomiting pregnant called emesis hyperemesis seriously leaking - hyperemesis gravidarum. In mild vomiting occurs periodically (in the morning) and is caused by eating food or unpleasant odors, and in severe becomes more or less constant (uncontrollable), appearing even at night. There are disorders of taste, smell, and appetite, functional bowel disorders (constipation, flatulence, as an exception - diarrhea). Diarrhoeal disorders are the cause of the depletion of the body.
Notes lability of vasomotor and increased permeability of the walls of vessels, with hemorrhagic phenomena. Expressed hypotension with a tendency to decrease in pulse pressure. In mild cases observed bradycardia, in severe tachycardia, the propensity to syncopal States (type of vascular collapse).
Pronounced irritable reaction is quickly replaced by General weakness. Sometimes there are manic-depressive disorders, visual and auditory hallucinations, anxiety, "the flight into illness", "protest" against pregnancy, negative emotions.
Vomiting of pregnancy occurs as a result of violations of the relationship between the activity of the cerebral cortex, the functions of the autonomic nervous system and internal organs. Nowhere was the failure of the Central regulation of vegetative functions is in early pregnancy when need to adapt to new conditions and increased requirements for adaptive vegetative nervous mechanisms. In this regard, even physiological impulses that come from the side of the ovum, often undergo abnormal processing in the subcortical areas in the cortex. Especially large is the role of excessive force impulses on the part of the ovum caused by pathological state of interoreceptors of the uterus when it is underdevelopment and the inflammatory process.
Initially, patients prevails violation of cortical dynamics in reduced activity of the cortex and increase the excitability of the cortex, with emphasis on the irritation parasympathetic innervation of the authorities, without any disturbances of metabolism. Reduced power due to diarrhoeal disorders. These changes are functional and rational treatment can be solved. The disease occurs easily and is characterized as I severity, or phase of neurosis. In such cases, to induced abortion to resort does not follow, as the next pregnancy will also be accompanied by vomiting.
With the deterioration of the disease process goes in the II degree of gravity - phase toxicity. To the above symptoms joins a violation of both the consumer and regulatory phases of nutrition and metabolism. First upset of carbohydrate and fat metabolism, develop ketoacidosis, urine and blood appear acetone body. Deficiency of glycogen, encouraging the use of endogenous protein and fats.
Rational treatment allows in such cases to improve. However, in some cases, may experience spontaneous miscarriage, sometimes pregnancy has to interrupt. Indications for abortion: the progressive reduction of weight and excretion of urine, jaundice, tachycardia, increase in urine ketone bodies and bile pigments (urobilin, bilirubin).
In conclusion, the process can go in the III degree of gravity - phase dystrophy. The development of dystrophy vomiting pregnant should not be considered only from the point of view of starvation; it is the result of violations of the relationship between the endocrine and autonomic system and the exchange of vitamins in the presence of qualitative changes in the processes of nutrition and metabolism (protein, carbohydrate, fat, pigments, mineral water). Clinic vomiting pregnant at this stage includes a range of symptoms of malnutrition; the latter causes physical changes in various organs (atrophy, necrosis, hemorrhage, fatty degeneration, neuritis). Dystrophic process is reversible, but only to a certain stage. When expressed forms of malnutrition pregnancy should be terminated, otherwise the patient may die. As a result of holding the USSR of measures on protection of motherhood and childhood, providing prevention and early treatment of complications of pregnancy, such outcomes vomiting pregnant are extremely rare.


For the treatment of vomiting pregnant, there is no single method or one of any tools. Therapeutic measures can be divided into three groups: 1) aimed at restoration of normal cortical dynamics, along with the normal kortiko-subcortical relations; 2) aimed at restoring the normal state of the peripheral nervous system, eliminate it irritative process; 3) aimed at eliminating the consequences of the violation of the Central regulation of vegetative functions (eating disorders, metabolic and degenerative changes in the body).
The first group includes treatment for sleep (protective inhibition), psychotherapy, and brankovina therapy in modification N. C. Kobozeva (1951): daily administration 10-20 ml of 10% solution of sodium bromide intravenous and 1 ml of 10% solution of caffeine-benzoate sodium subcutaneously 2 times a day; course of treatment is 10-12 days. Applied also 2.5% solution of chlorpromazine on 1-2 ml in 250 to 500 ml of 5% glucose solution or izotoniceski solution of sodium chloride intravenous drip method daily for 7-8 days. The therapeutic effect is achieved by intramuscular injection of 1 ml of 2.5% solution of chlorpromazine with 5 ml of 0.25% solution novokaina (HP Persianinov, 1960). Active antiemetics funds, exceeding on the effects of chlorpromazine, is a domestic product etaperazin, devoid of hypotensive and toxic action. N. Century Gorbacheva, who suggested this drug (1964, 1965), recommends to apply it inside 0,004 g or 0.008 g 3 times a day within 30 minutes after a meal within 10-12 days independently (in the lungs cases) or in the integrated therapy (in more severe cases).
The second group includes physiotherapy activities: diathermy solar plexus; ultraviolet irradiation of skin hyperuricemia doses (3, 4, 5, 6 biodoses) by type "panties" respectively ThVIII-IX - LI-II; lumbar-bronchoscopy novokaolinoviy; cervico-facial inegalitarian; the nasal inegalitarian with novocaine or vitamin B1. This group includes the parametric novocaine blockade.
The third group includes intravenous injection of 50 ml of 40% glucose solution and 20 ml of 20% or 10% solution of sodium chloride daily for 10-12 days. This also should include polivitaminnami. First of all it is necessary to introduce intramuscularly daily for 10 - 12 days ascorbic acid (500 mg), vitamin B1 (20 mg) and B6 (20 mg). Need artificial nutrition - solution Tired (sodium chloride 8 g; calcium chloride 0.2 g; potassium chloride 0.2 g; sodium bicarbonate 1 g; magnesium chloride 0.1 g; sodium phosphate 0.05 g; distilled water up to 1000 ml). In this part you can enable and above the dose of glucose and vitamins. The nutrient solution should be imposed through duodenal probe, slowly drip method, daily for 10-12 days (after the preliminary suction through a tube of duodenal contents). It is not recommended to enter the nutrient solution through the rectum, mucous membrane which sucks badly due to secondary polyhipe - or vitamin deficiency.
Recommended subcutaneous (slow) drip sterile mixture, consisting of 450 ml of ringer-Locke, 450 ml of 5% glucose solution, 100 ml 0.25% novokaina solution, 1 ml of 1% solution mezatona, 1 ml of 1% solution of Dimedrol, 200-300 mg of ascorbic acid, 20 mg of vitamins B1 and B6, 100-200 mcg vitamin B12 (N. N. Kozhevnikov, 1964).
In complex therapy vomiting pregnant, you can include hormones [1 ml of 0.5% solution of progesterone, 5 UNITS ACTH and cortisone (A. S. Lesakova, 1962)], insulin (up to 20 UNITS) in combination with glucose, and splenin (C. P. Komissarenko, 1959). Enter splenin intramuscularly or under the skin. When I severity enter 1 ml daily for 8 to 10 days; II severity - 2 ml daily (once, or 1 ml, 2 times a day) for 10 to 15 days, in resistant cases - 2 ml, 2 times a day. When relapse treatment repeat. At III severity splenin impose on 2 ml, 2 times a day for 10-15 days.
To prevent recurrence of the disease in the following pregnancies predisposed women should be treated outside of pregnancy. Cm. also Toxicosis of pregnancy.