Toxicosis of pregnancy

Toxicosis pregnancy, complications of pregnancy, characterized by disorders of metabolism and symptoms of autointoxication. In toxicosis of pregnancy, there are phenomena of the total autointoxication organism of the patient with primary functional, and in severe cases - morphological damage of separate systems and organs. Toxicosis of pregnancy complicated by pregnancy, worsens the conditions of development of the fetus, often endanger a woman's life.
Toxicosis divided into two groups: early arising in the period from the 1st to the 10th-12th weeks of pregnancy, and late, developing normally from the 26th up to 40 weeks of pregnancy. Possible (although rare) cases of later origin or prolonged flow of early toxicosis of pregnancy (for example, 12-16 weeks). Often there are cases of late gestosis, occurring on 24-25-th week of pregnancy.
In each of these two major groups there are two subgroups: toxicosis of pregnancy net (primary) and combined (secondary). To blend include the toxicosis of pregnancy, occurring in pregnant women on the background of any predshestvovali diseases, mostly of hypertension, diabetes, diseases of liver, kidneys. When predshestvovali hypertension severe toxemia of pregnancy occurs 14 times more often than women, not burdened by this disease. Combined toxicosis of pregnancy are about half of all late toxicosis of pregnancy.
To the group of early toxicosis of pregnancy include the following forms: ptyalism (salivation), vomiting, excessive vomiting (uncontrollable vomiting), polyneuritis, bronchial asthma, dermatitis, horey, tetany, the disorder.
To the group of late toxicosis of pregnancy include dropsy pregnant (see), nephropathy (see Nephropathy pregnant), pre-eclampsia and eclampsia (see).
The etiology and pathogenesis. The occurrence of all forms of toxicosis of pregnancy should be considered as disrupting the normal flow of the restructuring of the woman's body, the violation of the process of adaptation to the new conditions which have arisen in connection with pregnancy. Some scientists explain the origin of early toxicosis of pregnancy, a violation of the processes of excitation and inhibition in the brain.
The pathogenesis of late toxicosis of pregnancy is not yet fully understood.
The clinic. Early toxicosis. Vomiting of pregnancy often joins previously incurred increased salivation (see Vomiting), although these forms of toxicosis of pregnancy can exist separately. Excessive salivation (ptyalism) is associated with the excitement of subcortical centers of the brain and irritation of the branches of the vagus nerve in the parotid salivary glands. The amount of saliva can reach 1 liters per day, not counting swallowed. When Troubleshooting, you must exclude food poisoning, appendicitis, cholecystitis.
Very rarely there are forms of early toxicosis of pregnancy, as polyneuritis, erased form osteomalacia (see), chorea, tetany, bronchial asthma, severe dermatitis.
The most common form of skin - itching pregnant (vulvar, sometimes the whole body). The differential diagnosis it is necessary to exclude diabetes, helminthic invasion, vulvovaginitis inflammatory Genesis, manifestations of Allergy. Treatment: a Dimedrol, suprastin, ultraviolet irradiation, vitamins B1, B6, estrogens, chloride calcium.
Rarely observed eczema, Herpes hyperemesis, or impetigo herpetiformis. Treatment: calcium, serum blood intramuscularly (10-20 ml)subcutaneously ingerowski solution (200 ml), digidrotahisterol (product irradiation of ergosterol).
Horey usually treated amidopirinom (0.2-0.3 g 6 times a day for 7 to 8 days), salicylates; tetany - calcium, paratireoidnam, vitamins D3, D2, digidrotahisterola; bronchial asthma drugs calcium, exposure of the skin of the body ultraviolet rays, vitamins (B1, D), sodium bromide with caffeine; as well, but with the addition of fish oils and progesterone, cure the disorder.

Late toxicosis often arise in nulliparous older than 30 years (especially undergoing early toxicosis of pregnancy when the pregnancy), and pregnant with chronic diseases of liver, bilious ways, kidneys, endocrine disorders, vitamin C, with mnogovodnee and prolificacy, recently underwent an acute infection. Late toxicosis of pregnancy are more likely to occur in women who have in the past been deleted one ovary, and more often as time has passed after the operation.
Crucial hypertension: during the I stage of her late toxicosis of pregnancy have 46,1 % of pregnant, and at stage II - from 72,4% . Therefore, in the second half of pregnancy should measure blood pressure, since the 32nd week every week. Threatening should be considered a rise in blood pressure compared to the baseline (before pregnancy) 30% or more.
Frequent and early signs of toxicosis of pregnancy is excessive accumulation of fluid in the body of the pregnant that finds expression in edema mainly of the lower limbs and fingers. One of the most important symptoms of late toxicosis of pregnancy - albuminuria (see Proteinuria).
For timely and effective treatment of late toxicosis of pregnancy they need early diagnosis. Treatment of late toxicosis of pregnancy at early stages of their development is at the same time, prevention is more severe toxicosis of pregnancy, in particular eclampsia.
The most important and decisive role in the early diagnosis of late toxicosis of pregnancy belongs to the women's consultations. You must take special account of pregnant predisposed to the development of late toxicosis of pregnancy.
In the treatment of toxicoses of pregnancy compulsory hospitalization, bed rest, calm, quiet, warm, with a sufficient supply of fresh air, reduced lighting of the premises; the absence of any emotional and painful stimuli. In cases of anxiety, increased excitability shown bromide sodium phenobarbital, andaxin, trioxazin; in more severe cases, the combined treatment of magnesium sulfate and chlorpromazine (see Nephropathy pregnant, Eclampsia). In preeclampsia and eclampsia necessary ether anaesthesia, then assign arfonad, chlorpromazine, issued a foreign, droperidol.
When arteriola and copilaroasa appoint antispasmodic: Dibazol, platifillin, papaverine, eufillin; in hypertension, reserpine, apressin, devinkan, pillen, Isobaric (ismelin).
In cases of hypoxia and hypoxia provide abundant supply of oxygen (by inhalation), constant access to fresh air, repeated intravenous administration of 40% glucose solution (100 ml) with ascorbic acid (300-500 mg), which improves urine flow, reduces swelling, the permeability of blood vessels, improves blood supply of the brain, increases the resistance of tissues (brain, kidneys) to hypoxia, improves the antitoxic function of a liver, a positive effect on the gas exchange. In violation of all types of metabolism (mainly protein and water-salt) designate a salt-free diet with adequate protein content, honey, methionine, vitamins; if there are significant swelling - gipotiazid (with simultaneous introduction of potassium salts), Favorit, ammonium chloride (one of these tools).
For a long period of toxicosis of pregnancy with no improvement, despite treatment, leads to irreversible changes in the placenta and fetal death. In such cases, in the interests of the viability of the fetus shows early delivery.
Prevention. Careful examination of the pregnant woman in the antenatal clinic: up to 20 weeks - 1 month, from 20 to 32 weeks - 2 times per month, with a 32-week - weekly; mandatory urinalysis, blood pressure measurement; weighing, measurement of volume feet on the level of the ankle, the volume of the fingers. If necessary, biochemical and endocrinology research; inspections therapist (special attention to the identified extragenital diseases and their treatment).