Early toxicosis of pregnant women. Clinic. Diagnostics. Indications for termination of pregnancy. How to relieve toxicosis with medication. Causes of early toxicosis
Details
1. Objective research pregnant or parturient begins with:
1) palpation of the abdomen
2) auscultation of the abdomen
3) measuring the circumference of the pelvis
4) objective examination by systems
2. The position of the fetus is:
1) the ratio of the back of the fetus to the sagittal plane
2) the ratio of the back of the fetus to the frontal plane
3) the ratio of the fetal axis to the longitudinal axis of the uterus
4) relationship various parts fetus
3. Articulation is correct when:
1) the head is unbent, the arms are crossed on the chest, the legs are bent at the knees and hip joints, body bent
2) the head is bent, the arms are crossed on the chest, the legs are bent at the knees and hip joints, the torso is bent
3) the head is bent, the spine is extended, the arms are crossed on the chest, the legs are bent at the knees and hip joints, the torso is bent
4) the head is bent, the arms are crossed on the chest, the legs are unbent at the hip and knee joints
4. The correct position of the fetus is:
1) longitudinal
2) oblique
3) transverse with the fetal head facing left
4) transverse with the fetal head facing to the right
5. The position of the fetus in the transverse position is determined by the location:
1) backrest
2) heads
3) small parts
4) pelvic end
6. Presentation of the fetus is the ratio:
1) fetal head to the entrance to the pelvis
2) the pelvic end of the fetus to the entrance to the small pelvis
3) the lowest part of the fetus to the entrance to the pelvis
4) fetal heads to the bottom of the uterus
7. The first reception of an external obstetric examination is determined by:
1) position of the fetus
2) type of fetus
3) the height of the fundus of the uterus
4) presenting part
8. The circumference of the abdomen in the 2nd half of pregnancy is measured:
1) in the middle of the distance between the navel and the xiphoid process
2) at the level of the navel
3) 3 transverse fingers below the navel
4) 2 transverse fingers above the navel
9. True conjugate is the distance between:
1) the middle of the upper edge of the pubic joint and the cape
2) the most protruding points of the symphysis and the cape
3) bottom edge symphysis and protruding point of the cape
4) iliac crests
10. When developing pregnancy not happening:
1) increase in the size of the uterus
2) softening it
3) changes in response to palpation
4) compaction of the uterus
5) changes in its shape
11. A reliable sign of pregnancy is:
1) lack of menstruation
2) an increase in the size of the uterus
3) dyspeptic disorders
4) the presence of a fetus in the uterus
5) belly enlargement
12. For pelvic presentation in external obstetric examination is not typical:
1) high location of the bottom of the uterus
2) balloting part in the bottom of the uterus
3) fetal heartbeat, better heard above the navel
4) balloting part above the entrance to the small pelvis
5) high location of the presenting part
13. characteristic feature complete dense attachment of the placenta is:
1) abdominal pain
2) bleeding
3) the height of the fundus of the uterus above the level of the navel after the birth of the fetus
4) no signs of separation of the placenta
14. Premature detachment of a normally located placenta is complicated by:
1) the formation of the uterus of Kuveler
2) intrapartum fetal death
3) the development of DIC syndrome
4) hemorrhagic shock
5) all of the above
15. In case of bleeding in the 3rd stage of labor and the presence of signs of separation of the placenta, it is necessary:
1) perform an external massage of the uterus
2) manual separation of the placenta
3) isolate the placenta by external methods
4) introduce means that reduce the uterus
5) put ice on the lower abdomen
16. Principles for managing hemorrhagic shock in obstetrics include:
1) local hemostasis
2) the fight against blood clotting disorders
3) infusion-transfusion therapy
4) prevention of kidney failure
5) all of the above
17. Methods for isolating an unseparated placenta from the uterus include:
1) Abuladze method
2) pulling on the umbilical cord
3) Krede-Lazarevich method
4) manual separation and allocation of the placenta
18. To assess the condition of the fetus, the following is used:
1) auscultation
2) cardiotocography
3) ultrasound examination
4) all of the above
19. The appearance of a clinically narrow pelvis is promoted by:
1) large fruit
2) delayed pregnancy
4) all of the above
20. The severity of toxicosis of the 1st half of pregnancy is characterized by:
1) weight loss
2) acetonuria
3) subfebrile condition
4) headache
5) pain in the lower abdomen
21. Ultrasound examination in obstetrics allows you to evaluate:
1) the location of the placenta, its size and structure
2) fetal anatomy
3) non-developing pregnancy
4) birth defects fetal development
5) all of the above
22. Postpartum endometritis does not occur:
1) subinvolution of the uterus
2) pain on palpation
3) sanious-purulent discharge
4) increase in the tone of the uterus
5) decrease in uterine tone
23. The most common form of postpartum infection is:
1) mastitis
2) thrombophlebitis
3) endometritis
4) septic shock
5) peritonitis
24. The development of gestational pyelonephritis is not affected by:
1) infection of the body
2) change in hormonal balance
3) pressure of the uterus and varicose veins on the ureter
4) vesicoureteral reflux
5) early toxicosis
25. When assessing the state of a newborn on the Apgar scale, the following is not taken into account:
1) heartbeat
2) breathing
3) the state of the pupils
4) muscle tone
5) skin color
26. The most formidable symptom of preeclampsia is:
1) albuminuria 1 g/l
2) significant weight gain
3) pain in the epigastric region
4) lethargy
5) increased excitability
27. The most typical sign of preeclampsia is:
1) swelling of the legs
2) albuminuria
3) complaints about headache, visual impairment
4) development in the second half of pregnancy
28. Classification of preeclampsia includes:
1) nephropathy
2) preeclampsia
3) eclampsia
4) dropsy of pregnancy
5) all of the above
29. Signs of eclampsia are:
1) hypertension
2) albuminuria and edema
3) diarrhea
4) convulsions and coma
31. The criterion for the severity of preeclampsia is not:
1) the duration of the disease
32. The most common cause of spontaneous abortion in the early stages:
1) Rh factor incompatibility
2) weight lifting, injury
3) chromosomal abnormalities embryo
4) infections
5) isthmic-cervical insufficiency
33. A sign of a developed labor activity is not:
1) outpouring of water
2) increasing pain in the abdomen
4) shortening and opening of the cervix
34. A hormone not produced by the placenta is:
1) estrogen
2) progesterone
3) HG
4) FSH
5) all of the above
35. The most common cause of fever on the 3rd-4th day after delivery:
1) urinary tract infection
2) endometritis
3) mastitis
4) thrombophlebitis
5) none of the above
36. The most common cause of death in premature newborns:
1) respiratory distress syndrome
2) hemorrhagic disease of the newborn
3) malformations
4) neonatal jaundice
5) infections
37. The reason for abortion can be:
1) infection
2) cervical insufficiency
3) trauma
4) ionizing radiation
5) all of the above
38. In a correctly built woman, the lumbar rhombus has the shape:
1) geometrically regular rhombus
2) triangle
3) irregular quadrilateral
4) a quadrangle elongated in the vertical direction
39. With the correct articulation of the fetus, the head is in the state:
1) maximum flexion
2) moderate flexion
3) moderate extension
4) maximum extension
40. In the 2nd stage of labor, the fetal heartbeat is controlled by:
1) after each attempt
2) every 15 minutes
3) every 10 minutes
4) every 5 minutes
41. The type of fetus is the ratio:
1) back of the fetus to the sagittal plane
2) the fetal head to the plane of entry into the small pelvis
3) the back of the fetus to the front and back walls uterus
4) axis of the fetus to the longitudinal axis of the uterus
42. head presentation fetus during physiological childbirth:
1) anterior head
2) occipital
3) frontal
4) facial
43. Diagonal conjugate is the distance between:
1) the lower edge of the symphysis and the cape
2) ischial tuberosities
3) iliac crests
4) large skewers of the femur
44. The true conjugate is normally equal (cm):
1) 11
2) 13
3) 9
4) 20
45. At the end of pregnancy, a nulliparous woman has a normal cervix:
1) shortened, softened
2) partially smoothed
3) smoothed out completely
4) saved
46. The placenta is impermeable to:
1) alcohol
2) morphine, barbiturates
3) penicillin, streptomycin
4) thiouracil, ether
5) heparin
47. External obstetric examination in the 2nd half of pregnancy does not imply:
1) determining the position, position, size of the fetus
2) anatomical assessment of the pelvis
3) determining the duration of pregnancy
4) functional assessment of the pelvis
5) assessment of the frequency and rhythm of the fetal heartbeat
48. Diagnosis of small terms of pregnancy involves:
1) change in basal temperature
2) level detection chorionic gonadotropin in the urine
3) Ultrasound examination
4) dynamic observation
5) all of the above
49. An objective sign developed regular labor activity is:
1) outpouring of water
2) increasing pain in the abdomen
3) increasing frequency of contractions
4) shortening and opening of the cervix
5) pain in the suprapubic and lumbar regions
50. Placenta previa can be assumed in the case of:
1) prenatal discharge of water
2) if the presenting part of the fetus is not clear on palpation
3) inconsistencies in the height of the fundus of the uterus to the gestational age
4) blood discharge from the genital tract
5) acute pain in a stomach
51. The most common cause of premature detachment of a normally located placenta is:
1) preeclampsia
2) abdominal trauma
3) prolongation of pregnancy
4) polyhydramnios, multiple pregnancy
5) short umbilical cord
52. Pathological blood loss in early postpartum period requires first of all:
1) press on the aorta
2) introduce uterine contracting agents
3) terminal parameters
4) perform a manual examination of the uterus
5) examine the birth canal
53. Bleeding in placenta previa is characterized by:
1) suddenness of occurrence
2) repeatability
3) painlessness
4) different intensity
5) all of the above
54. The most common cause of placenta previa is:
1) anomalies in the development of the uterus
2) inflammatory processes of the genitals
3) uterine fibroids
4) endometriosis
5) abortions
56. The effectiveness of labor activity is objectively assessed:
1) by the frequency and duration of contractions
2) according to the duration of labor
3) according to the dynamics of smoothing and opening of the cervix
4) according to the state of the fetus
5) by the time of the outflow of amniotic fluid
57. An abortion that has begun is characterized by:
1) pain in the lower abdomen
2) bloody discharge from the genital tract
3) signs of softening and shortening of the cervix
4) discharge of the elements of the fetal egg
5) change in the size of the uterus
58. Discoordinated labor activity is characterized by:
1) irregular contractions
2) contractions of varying intensity
3) painful contractions
4) poor dynamics of cervical dilatation
5) all of the above
59. Mature cervix is characterized by:
1) its location along the wire axis of the pelvis
2) softening all over
3) patency of the cervical canal for 1–1.5 fingers
4) shortening of the neck up to 1–1.5 cm
5) all of the above
60. Most serious complication in childbirth with breech presentation is:
1) untimely discharge of water
2) weakness of labor activity
3) traumatic injuries of the fetus
4) prolapse of the umbilical cord
5) leg prolapse
61. Lactostasis is characterized by:
4) free separation of milk
62. A sign of a clinical discrepancy between the fetal head and the mother's pelvis is:
1) a positive sign of Vasten
2) urinary retention
3) swelling of the cervix and external genitalia
4) lack of translational movement of the head with good labor activity
5) all of the above
63. Primary weakness of labor activity is characterized by:
1) the presence of regular contractions
2) painful contractions
3) insufficient advancement of the presenting part
4) insufficient dynamics of cervical dilatation
5) belated rupture of amniotic fluid
64. In the treatment of postpartum endometritis, the following are not used:
1) antibiotics
2) aspiration of the contents of the uterine cavity
3) infusion therapy
4) estrogen-gestagen preparations
65. The most common cause of jaundice in newborns on the 2nd or 3rd day:
1) incompatibility of blood groups
2) physiological jaundice
3) septicemia
4) syphilis
5) drugs
66. An indication for emergency delivery in severe forms of preeclampsia is:
1) long course and ineffectiveness of therapy
2) oliguria
3) fetal growth retardation syndrome
4) polyuria
5) headache
67. The criterion for the severity of preeclampsia is not:
1) the duration of the disease
2) the presence of concomitant somatic diseases
3) the amount of amniotic fluid
4) ineffectiveness of the therapy
5) fetal growth retardation syndrome
68. Factors predisposing to preeclampsia are:
1) kidney disease
2) multiple pregnancy
4) endocrine pathology
4) hypertension
5) all of the above
69. Differential diagnosis in eclampsia is carried out:
1) with epilepsy
2) with hysteria
3) with hypertensive crisis
4) with meningitis
5) with all of the above
70. The fourth method of external obstetric examination is determined by:
1) presenting part
2) articulation of the fetus
3) position of the fetus
4) the ratio of the presenting part of the fetus to the entrance to the pelvis
71. The method of instrumental research used during pregnancy and childbirth is:
1) probing the uterus
2) examination of the cervix using mirrors
3) biopsy
4) hysterography
72. Reliable signs of pregnancy include:
1) fetal movement
2) enlargement of the uterus
3) cyanosis of the vagina
4) palpation of parts of the fetus
5) increase in rectal temperature
73. Formation of a clinically narrow pelvis is promoted by:
1) large fruit
2) delayed pregnancy
3) Wrong head insertion
4) all of the above
74. The management of the third stage of labor depends on:
1) degree of blood loss
2) the duration of labor
3) the presence of signs of separation of the placenta
4) the state of the newborn
5) the duration of the waterless period
75. Best of all, the fetal heartbeat is heard in the 1st position, anterior occipital presentation:
1) right below the navel
2) on the left below the navel
3) on the left above the navel
4) on the left at the level of the navel
76. When an abortion has begun, it is indicated:
1) hospitalization
2) instrumental removal of the fetal egg
3) the use of antibiotics
4) outpatient treatment
5) the use of reducing funds
77. The development of fetoplacental insufficiency is more often caused by:
1) preeclampsia
2) kidney disease
3) hypertension
4) anemia of pregnant women
5) obesity
78. The clinical picture of premature detachment of a normally located placenta is characterized by:
1) abdominal pain
2) hemorrhagic shock
3) change in fetal heartbeat
4) change in the shape of the uterus
5) all of the above
79. The most common method of caesarean section (CS) is:
1) corporal CS
2) extraperitoneal CS
3) isthmic-corporal (longitudinal section) CS
4) CS in the lower uterine segment (transverse section)
5) vaginal CS
80. Lactostasis is characterized by:
1) significant uniform engorgement of the mammary glands
2) moderate breast engorgement
3) body temperature 40C, chills
4) free separation of milk
5) increased blood pressure
81. Postpartum mastitis is not typical for:
1) fever with chills
2) breast engorgement
3) painful limited infiltrate in the mammary gland
4) free separation of milk
5) breast hyperemia
82. The optimal delivery option for severe preeclampsia is:
1) the imposition of obstetric forceps
2) self-delivery
3) cesarean section operation
4) vacuum extraction of the fetus
5) fruit-destroying operation
83. Factors predisposing to preeclampsia are:
1) kidney disease
2) multiple pregnancy
3) endocrine pathology
4) hypertension
5) all of the above
84. Infusion therapy for severe forms of preeclampsia involves:
1) reduction of hypovolemia
2) improvement of the rheological properties of blood
3) normalization of microcirculation in vital organs
4) treatment of fetal hypoxia
5) all of the above
About Rh, Uterine ruptures, Uterine scar, Narrow pelvises
85. Clinical signs overstretching of the lower uterine segment is fundamental for the diagnosis:
1) placental abruption
2) acute fetal hypoxia
3) threatening uterine rupture
4) the onset of uterine rupture
5) completed uterine rupture
86. Clinical symptoms of a threatening mechanical uterine rupture are:
1) overextension of the lower segment
2) bleeding from the genital tract
3) uterine hypertonicity (does not relax between contractions)
4) fetal hypoxia
5) hemorrhagic shock
87. What are the indications for caesarean section in the presence of a scar on the uterus:
1) the age of the pregnant woman is over 30 years old
2) failure of the scar on the uterus after cesarean section according to ultrasound
3) a scar after laparoscopic removal of an interstitially located myomatous node
4) correct answers 2.3
5) scar after laparoscopic removal of the myoma node on the leg
88. What are the signs of threatening uterine rupture along the scar during pregnancy:
1) bleeding from the genital tract
2) fetal hypoxia
3) hyperthermia, chills
4) nausea, epigastric pain
5) all answers are correct
89. Specify characteristic ultrasonic signs hemolytic disease fetus:
1) oligohydramnios
2) premature "aging" of the placenta
3) thickening of the placenta
4) hepatomegaly
5) correct answers 3.4
90. Specify the most accurate method for diagnosing fetal hemolytic disease (HFD) and its severity:
1) determination of antibody titer
2) Ultrasound examination
3) amniocentesis
4) cordocentesis
5) cardiotocography
91. What obstetric complications often cause intrauterine fetal death?
1) premature detachment placenta
2) premature effusion amniotic fluid
3) completed uterine rupture
4) polyhydramnios
5) correct answers 1.3
92. What is the main cause of a clinically narrow pelvis:
1) breech presentation fetus
2) the transverse position of the fetus
3) premature outpouring of water
4) anatomically narrow pelvis
5) prolapse of umbilical cord loops
93. Which of the following methods is pathogenetically substantiated in the treatment of fetal hemolytic disease:
1) plasmapheresis
2) hemosorption
3) transplantation of a skin flap from the husband
4) intrauterine blood transfusion to the fetus
5) amniocentesis
94. What are the indications for caesarean section in breech presentation of the fetus:
1) foot presentation
2) estimated fetal weight over 3600 g
3) anatomically narrow pelvis
4) early rupture of amniotic fluid
5) correct answers 1,2,3
95. Childbirth through the birth canal with normal size of the pelvis and the average size of the fetus is not possible:
1) with facial presentation
2) with breech presentation
3) with frontal presentation
4) with occipital presentation
5) with anterior head presentation
96. Absence of dynamics of cervical dilatation in the presence of clinically expressed labor activity is typical for:
1) primary weakness of labor activity
2) secondary weakness of labor activity
3) pathological preliminary period
4) discoordination of labor activity
5) excessive labor activity
97. Fetal hypoxia during pregnancy according to cardiotocographic study is evidenced by:
1) basal rate 120-160 beats per minute
2) the presence of sporadic accelerations
3) the presence of late decelerations
4) 1.2 is correct.
98. The beginning of the second stage of labor is:
1) full dilation of the cervix
2) outpouring of amniotic fluid
3) the appearance of regular contractions
4) expulsion of the fetus
5) true 1.2
99. Signs of an anatomically narrow pelvis are:
1) lack of advancement of the head with good labor activity
2) a decrease in at least one of the dimensions of the pelvis by 2 cm or more compared to normal
3) Wrong head insertion
4) positive symptom of Vasten
5) true 1.4
100. The wire point in the anterior occipital presentation is:
1) small fontanel
2) large fontanel
3) chin
4) the border of the scalp
5) glabella
101. Signs of preeclampsia do not include:
1) proteinuria
2) swelling
3) headache
4) increased blood pressure
5) true 2.3
102. The introduction of anti-Rh immunoglobulin to prevent Rh sensitization is not indicated for:
1) the presence of Rh antibodies
2) the birth of a Rh-positive child
3) the birth of a Rh-negative child
4) with ectopic pregnancy
5) true 1.3
Pregnancy is an amazing journey of 9 months. To become the owner of the most valuable reward in the world, the expectant mother must solve difficult tasks. The first serious endurance test for almost every pregnant woman is early toxicosis.
Toxicosis during pregnancy, or early gestosis, is nothing more than an adaptive behavior of the female body to the birth of a new life in it. Poor health at the beginning of pregnancy is noted in 6 out of 10 expectant mothers, but doctors are in no hurry to add toxicosis to the list of diseases requiring immediate treatment. True reasons This condition has not yet been found, so there is no specific therapy for its correction. By the way, some pregnant women do not have to deal with early toxicosis at all, but this does not mean that there are any problems in the development of the baby.
Why a woman is overcome by toxicosis
Confidently voice the factors that provoke the appearance of gestosis at the dawn of pregnancy, experts are not able to: it is only known for certain that this phenomenon is due to the presence of an embryo in the uterus. If the fetal egg is removed, the unpleasant symptoms characteristic of toxicosis immediately disappear and the woman's well-being quickly returns to normal.
Scientists are inclined to the following: early toxicosis appears on the basis of unconscious changes that occur in the diencephalic region of the cerebral cortex. Due to the appearance of a new "element" in the body, as well as due to the rapid implantation of the villi of the embryo into the thickness of the uterus, the neuroreflex impulse changes, as a result of which a violation of the processes of excitation and inhibition is possible in this area of the brain. As a rule, toxicosis disappears when the placenta surrounding the fetus is finally formed. This happens by 11 - 13 weeks of an "interesting" position.
In addition, experts call a number of factors that indirectly affect the intensity and timing of toxicosis in the first weeks after conception:
Signs of early toxicosis
Toxicosis can visit a pregnant woman in any guise, but there are a number of symptoms that almost always accompany this phenomenon. So, general weakness, heartburn, dizziness, vomiting, increased salivation and nausea during pregnancy are a common and very common picture. There are other manifestations of toxicosis that are much less common in pregnant women: various dermatoses, osteomalacia, or breathing problems, such as bronchial asthma.
Before answering the pregnant woman’s question “I have toxicosis, what should I do?”, The doctor will carefully ask the woman about her well-being. If heartburn and nausea can be perceived as quite tolerable natural manifestations of a special situation and corrected by proper nutrition and regimen, then vomiting can significantly complicate the course of pregnancy.
There are 3 degrees of severity of vomiting. The earlier signs of early toxicosis appear in a pregnant woman, the more serious the course takes vomiting attacks:
- 1 degree. Discomfort in the form of nausea torments a woman mainly after eating, and vomiting can occur up to 6 times a day, as a result of which the expectant mother loses up to 3 kg in weight. But even despite the general weakness and lack of appetite, the woman’s condition does not cause concern: her skin remains moist, and her pulse and arterial pressure within the normal range. The doctor will only recommend to be patient and wait out this difficult period of pregnancy. With his permission, you can use various folk remedies to get rid of nausea.
- 2 degree. A woman is very sick from the first days of an “interesting” situation, and vomiting torments very often - up to 10 times a day, which depends on the number of meals. At the same time, the body temperature rises slightly, the pressure drops, and the pulse quickens to 100 beats per minute. Analyzes of 50% of expectant mothers indicate that acetone is present in their urine. Some of the women are so hard to endure such "charms" of their situation that they seriously begin to think about terminating the pregnancy. By the way, such a violent reaction of the body in the first weeks of pregnancy can sometimes indicate that a woman is expecting twins or triplets. This stage of toxicosis can be corrected by medication.
- 3 degree. Abundant and frequent vomiting(up to 20 - 25 times a day) poses a threat to the life of a pregnant woman. Vomiting can occur from any careless movement, so a woman often lies, afraid to move, she loses sleep and appetite. But even if she tries to eat or drink something through force, nothing stays in the stomach due to severe nausea and vomiting. As a result, the unfortunate woman can lose more than 10 kg. There is a rapid depletion and dehydration of the body: the skin and mucous membranes oral cavity become dry, high temperature rises, pressure drops, and the pulse "frequents" up to 120 beats per minute. The results of the tests do not console either: the urine of a pregnant woman contains acetone and protein. Needless to say, a woman needs immediate hospitalization? Severe toxicosis can cause a forced termination of pregnancy.
How long does early toxicosis last
Some "lucky women" are faced with the first manifestations of toxicosis even before they find out the happy news, that is, before the delay in menstruation. Toxicosis gradually increases, and the woman's condition worsens every week. Fortunately, these cases are not common. For the vast majority of pregnant women, the first timid thoughts about how to get rid of toxicosis arise from 5 to 6 weeks of an “interesting” situation.
Early toxicosis ends closer to 11-12 weeks if a woman is expecting one baby, and by 14-16 weeks if the pregnancy is multiple. Also, the timing of the end of gestosis depends on the degree of its severity.
How is early toxicosis determined?
The moment when toxicosis begins is difficult to miss - its signs are very eloquent. The doctor makes a diagnosis, taking into account the complaints of a pregnant patient. To accurately determine the severity of preeclampsia, a woman gives urine for general analysis and blood for clinical and biochemical research. Based on their results, the gynecologist will prescribe effective ways to deal with malaise.
A slight, mild degree of toxicosis does not affect the test data - all important indicators do not exceed the norm.
Early preeclampsia, moderate in intensity, makes some adjustments to the research indications. In the blood, for example, the concentration of substances such as hemoglobin, hematocrit and leukocytes increases to a small extent. In the body, the water-electrolyte balance is disturbed and, as a result, the concentration of potassium in the blood plasma increases sharply (more than 5 mmol / l) and the number of sodium ions decreases (less than 135 mmol / l). The density of urine increases, acetone is found in its composition.
A severe form of toxicosis in a short time is expressed in the fact that all indicators of laboratory tests strongly deviate from normal data. First of all, we are talking about total protein, glucose and ESR, the concentrations of which are sharply reduced. At the same time, the level of substances such as urea, creatinine, ALT and AST in the blood increases. Another alarm signal– urine tests for acetone, ketone bodies and protein are positive.
How to relieve toxicosis with medication
If nausea and vomiting do not drastically affect the quality of life of a pregnant woman, treatment is carried out on an outpatient basis. Moderate and severe early preeclampsia is a convincing reason for hospitalization.
In the first trimester of pregnancy future baby still so weak and unprotected that even the most harmless, at first glance, drugs can harm him. Naturally, the range of medicines that are prescribed to pregnant women is extremely limited. All medicines can be taken only with the permission of your doctor! Consider the most well-known drugs, which are often prescribed for severe toxicosis.
Cerucal (the domestic analogue of Metoclopromide) has the first trimester of pregnancy on the list of contraindications, as it can provoke an increase in the tone of the uterus and, as a result, a miscarriage. However, this effective antiemetic can greatly improve the condition of a woman if doses are selected with extreme caution and only in exceptional cases.
Hofitol is a plant-based drug. It contains artichoke extract. With the help of this antioxidant, you can improve the condition of the liver and reduce the intensity of nausea attacks.
B vitamins. Vitamins B1, B6 and B12 are taken Active participation in the metabolic processes in the body of the expectant mother. Moreover, they are indispensable building material for a growing baby. It is noted that the deficiency of B vitamins in a pregnant woman increases early toxicosis. However, the decision to use the drug in the form of a solution for injection should be balanced - the drug can cause an allergic reaction.
Droperidol. Influencing the nervous system of a pregnant woman, the drug has an anti-shock and antiemetic effect. And although it has not been proven that the remedy can adversely affect the embryo, it is prescribed only in hopeless situations.
Antihistamines Diphenhydramine and Pipolfen are prescribed not only to eliminate the symptoms of allergies, but also to suppress the manifestations of early preeclampsia. These drugs have a calming effect on the central nervous system of a woman and stabilize her activity. immune system. Beforehand, the doctor evaluates the possible risk for the child and the obvious benefit for the pregnant woman.
Splenin. The active ingredient of the drug is a substance that is contained in the spleen of cattle. The medicine normalizes the work of the liver, on the state of which the strength of the manifestation of toxicosis in the first weeks of pregnancy depends.
Polyphepan is an adsorbent drug that helps the liver and intestines cope with the elimination of toxic substances. The drug, like the rest, is prescribed only in last resort- together with harmful substances the body of a pregnant woman also loses some of the beneficial vitamins and minerals.
Whether we like it or not, taking medication always comes with health risks. This is especially true for a future mother who dreams of a strong toddler. This means that no matter what week of pregnancy toxicosis appears, you need to try to endure this unpleasant condition without pills and injections. However, for advice on issues that concern her, a pregnant woman should contact her doctor in any case. Remember that bearing an heir must be treated very responsibly: a strong early preeclampsia, which began to be treated late, can result in late toxicosis and placental abruption at the final stage of pregnancy.
How to get rid of toxicosis in early pregnancy without the use of drugs
The sooner the expectant mother realizes that her lifestyle is now subordinated to the miracle that grows in her, the more likely it is that severe toxicosis bypass her!
Dietary nutrition and daily routine for early gestosis
Most best mode nutrition for a pregnant woman - modest portions up to 6 times a day. It is good if the food is warm, extremes in the form of too cold or hot dishes expectant mother Not needed. The diet should be cleared of spicy, fried, smoked, acidic foods and carbonated drinks. This applies to all pregnant women without exception. Food is best consumed in liquid and semi-liquid form.
If nausea and vomiting increase every day, the so-called dry diet will help the expectant mother: hard-boiled eggs, baked potatoes, bread and butter will help reduce the intensity of attacks. The most useful food for a woman in position is considered dairy products, vegetables, fruits, fish and steamed meat. These food groups are a complete building material that the child's body needs for development and the mother's body to maintain a healthy tone and energy.
Basically, on early stage pregnancy, you can not deny yourself anything and gradually try everything your soul desires. The main thing is that the food is easily digestible and contains a maximum of vitamins and minerals.
Some expectant mothers experience nausea immediately after waking up. You can outwit toxicosis if you leisurely eat a banana, a handful of nuts or a rye cracker before getting out of bed. You need to chew food very slowly - so nausea will recede faster. Drink alkaline water throughout the day mineral water, having previously agreed on the maximum daily volume of fluid with the doctor. After eating, active actions and haste are contraindicated for the expectant mother. Allow yourself 15-20 minutes to relax and unwind.
Slow walking will help to ease the manifestations of toxicosis, so you should try to provide yourself with a daily walk and portion fresh air. If vitamins for pregnant women, who usually drink in the morning, cause a woman to feel disgust and nausea, then the situation can usually be corrected by postponing the intake of vitamins in the evening or taking a pill at night.
The sudden onset of nausea for many pregnant women is helped by suppressing mints or mints, and with copious excretion chamomile, sage and mint in the form of infusions for rinsing the mouth do well.
In matters of nutrition for a pregnant woman, everything is so individual that sometimes a future mother should listen to her body: what exactly do you want most often? Perhaps sauerkraut or a crust of black bread sprinkled with salt will be a real salvation from nausea and poor health.
Physiotherapy against early toxicosis
Physiotherapy procedures in most cases are absolutely harmless for women in position. They can also be used to correct toxicosis: during the period of the greatest manifestation of unpleasant symptoms and at a time when they are already on the decline. The use of endonasal electrophoresis with B vitamins and galvanization of the brain is considered especially effective. The optimal course of treatment is 8-10 sessions.
Non-traditional methods of treatment of early toxicosis
Unfortunately, future mothers tend to distrust non-traditional therapy: the cautious subconscious that protects the baby reacts this way to everything new and unusual. Meanwhile, pregnant women who have decided to try something “something like that” for themselves notice a positive effect after acupuncture procedures and acupressure. The result of irritation is vital important points on the skin, the tip of the needle becomes an increase in the elasticity of the uterus and quick, painless childbirth. If you trust an experienced master, good mood and well-being guaranteed!
Acupuncture can also be used as a prophylaxis, since the cervix becomes more elastic as a result of a course of acupuncture, and childbirth proceeds faster and more painlessly.
For women who feel bad from one type of needles, a more gentle and pleasant method in the fight against toxicosis in the first weeks of pregnancy is suitable. This is aromatherapy. In search of an answer to the question of what helps with toxicosis, expectant mothers must certainly surround themselves with healing fragrances essential oils. It can be jasmine, rose, orange, lemon, neroli, anise oil. There are plenty to choose from!
The first aroma session should not exceed 15 minutes, every day the duration of the procedure should be increased by a quarter of an hour until it is 3 hours.
Alternative methods of treatment of toxicosis
A mild degree of early gestosis is quickly corrected with the help of the gifts of nature - we are talking about O medicinal herbs. The experience of centuries shows that the most effective remedy for combating nausea, irritability and general weakness are infusions of chamomile flowers, mint leaves and lemon balm.
It is not difficult to prepare a healing drink: 2 tbsp. l. flowers chamomile you need to pour boiling water (0.5 l) and insist in a thermos until the next morning. Strained infusion drink 3 times a day for half an hour before meals. The drink can be sweetened with a spoonful of honey. Healthy mint and lemon balm teas are prepared in the same way. In the summer, a pregnant woman can carry a few leaves of mint or lemon balm with her everywhere: chewing them, she will get rid of sudden nausea.
Doctors warn: get involved in herbs long time it is forbidden! This is not safe for blood pressure, which can suddenly drop as a result of prolonged herbal treatment.
Prevention of early toxicosis during pregnancy
In order not to suffer from excruciating nausea, dizziness and bad mood while expecting a baby, a woman needs to seriously take care of her health even before pregnancy. The list of preventive measures includes:
- no history of abortion;
- timely and thorough treatment of chronic diseases;
- indispensable physical activity;
- healthy lifestyle;
- conscious moral and physical training for future motherhood.
Nausea and vomiting do not add future mother enthusiasm about her current situation: severe toxicosis inevitably gives rise to questions “who is to blame?” and “what to do?”. Psychologists advise not to dwell on the problem, but to try to push it into the background with more pleasant experiences. A pregnant woman should communicate more often with the baby, who will certainly hear her, and always think only about the good. positive attitude will help you survive any trials on the way to your cherished goal!
Early toxicosis during pregnancy. Video
TOXICOSIS OF PREGNANT WOMEN
Toxicosis of pregnant women are diseases that occur in connection with the development of the fetal egg and are characterized by very diverse symptoms, of which the most permanent and pronounced are dysfunction of the central nervous system, vascular disorders, metabolic disorders. By the time of occurrence and clinical manifestations, it is customary to subdivide toxicosis into 2 groups: early (vomiting of pregnant women, hypersalivation, dermatosis, hepatopathy, neuro- and psychopathy, etc.) and late - gestosis (dropsy of pregnant women, nephropathy, preeclampsia, eclampsia). In a special group are rare forms toxicosis - hepatopathy (toxic jaundice), acute liver dystrophy, tetany of pregnant women, chorea of pregnant women, osteomalacia, arthropathy. Early toxicosis is usually characterized by dehydration of the body. late toxicosis (OPG gestosis) - excessive accumulation of fluid in the tissues. The problem of toxicosis remains an urgent problem due to the fact that the frequency of this complication does not decrease, but even increases due to a decrease in the health indices of the current generation of girls and women and a significant incidence of immaturity reproductive system they have. And, in addition, the clinical course of toxicosis has changed somewhat, when, against the background of a long course, an explosive acceleration of clinical manifestations occurs with the development of irreversible shock manifestations in systems and organs that ensure the correct course of pregnancy (placenta, kidneys, liver, lungs, heart, brain). The features of the clinical course of toxicosis include polysystemic, multi-organ damage with a pronounced damaging effect on the fetus.
MANAGEMENT OF PREGNANT WOMEN WITH TOXICOSIS
The first meeting between a doctor and a pregnant woman takes place, as a rule, in antenatal clinic. During the first visit, it is important to find out if the woman is at risk for the development of toxicosis.
Risk factors for the development of toxicosis:
extragenital diseases before pregnancy vascular system, kidney, endocrine and immunological disorders
general and genital infantilism
complications of previous pregnancies, childbirth and the postpartum period
chronic inflammatory processes in the endometrium
chronic intoxication with nicotine and alcohol
the presence of late toxicosis in the mother and sisters
early (before 18 years) or late (after 27 years) age of first pregnancy
unfavorable time of conception 15.04 - 15.08 and 15.11 - 10.08.
pregnancy when staying in the north for less than 5 years
early complications of pregnancy: toxicosis, threat of miscarriage, arterial hypotension, vegetative-vascular dystonia.
latent iron deficiency (hemoglobin content less than 118 gl in the first trimester)
detection of extragenital pathology during pregnancy
hemoconcentration (an increase in hemoglobin over 5 gl at 28-32 weeks, leukopenia, thrombocytopenia
All women who are likely to develop preeclampsia are registered in the antenatal clinic and carefully examined. Women who are not included in the risk group are also regularly monitored. It is important to identify the onset of toxicosis as early as possible (at the stage of pretoxicosis) and treat it.
PRETOXICOSIS.
It is characterized by the condition of a pregnant woman preceding gestosis, although pretoxicosis does not necessarily develop into toxicosis. It is important to identify pretoxicosis as early as possible before it becomes more severe.
Signs of pretoxicosis:
pathological weight gain after the 20th week of pregnancy in the absence of visible edema.
Increase in diastolic pressure over 90 mm Hg
decrease in pulse pressure to 30 or less.
Asymmetry of blood pressure on two arms (it is always necessary to measure on two arms) more than 10 mm Hg.
functional tests for measuring blood pressure: a test with a turn - turn the woman on the left side, on the right, and if after that the change in blood pressure is more than 20 mm Hg, then this woman will be at risk.
Decreased daily diuresis to 900 ml/day or less. In this case, a decrease in the specific gravity of urine is determined.
Slight proteinuria.
Higher mean BP. The norm of average blood pressure is 90-100 mm Hg, if more than 105, then this is a pathology.
Laboratory indicators (hemoglobin, hematocrit, etc.).
1. Diet with restriction of sodium salts and moderate fluid restriction (1000 - 1200 ml per day). Currently fasting days are not assigned.
2. Mode. Physical activity must be regulated and good dream. Required to take sedatives.
3. Psychoprophylactic preparation. Pregnancy and childbirth are always stressful, so conversations with a pregnant woman, exercise, swimming, reflexology are shown).
4. Taking antiplatelet agents to improve uteroplacental circulation (trental tablets 0.1 each, chimes tablets 0.025 each, complamin).
5. Oxygen therapy with electroanalgesia for the regulation of cortical neurodynamics, vascular tone.
6. Vitamins to improve tissue metabolism: gindevit, vitamin E, methionine, glutamic acid, vitamin C, riboflavin, nicotinic acid.
7. To reduce the permeability of the vascular wall - ascorutin, galascorbin, calcium gluconate.
8. With pathological weight gain: diuretic teas, potassium orotate, antispasmodics (dibazole, papaverine), antihistamines.
9. Aspirin preparations 60 mg / day starting from the 13th week of pregnancy in women at risk for the development of preeclampsia. The use of such a dose is based on the fact that aspirin promotes the release of prostacyclin (a natural vasodilator and antiaggregant). The prevalence of prostacyclin over thromboxanes is the prevention of vasospasm.
10. Calcium preparations. In women with arterial hypertension, there is an increase in the content of calcium in the cells, which leads to vasoconstriction, and in the plasma the concentration of calcium decreases. Therefore, taking 2 g of calcium salt per day from 20 weeks of gestation is widely used in the United States. You can use fish oil that contains a large amount of vitamins and calcium
EARLY TOXICOSIS OF PREGNANT WOMEN.
They occur in 60-50% of all pregnant women, but require correction in only 10%. Early toxicosis of pregnant women is manifested by dyspeptic disorders in the form of vomiting, salivation; rare forms - dermatosis of pregnant women, bronchial asthma of pregnant women, hepatosis of pregnant women (up to fatty hepatosis of pregnant women). The most common form of hypertension is vomiting, and depending on the frequency of vomiting, the degree of deterioration and laboratory parameters, there are:
1. light degree
2. moderate degree
3. severe vomiting
In order to determine the severity of vomiting of pregnant women, it is necessary to conduct the following studies:
1. Clinical blood test (increase in hematocrit, hemoglobin, erythrocytes, increase in ESR).
2. Biochemical blood test (total protein content and protein fractions, fibrinogen, platelet counts, liver enzymes).
3. Urinalysis (increase in specific gravity, daily urine output, urea, creatinine in order to identify the degree of involvement of the kidneys in the process).
4. With all the mechanisms of pathogenesis, the development of early toxicosis of pregnant women violates the ECG, which also shows the degree of electrolyte imbalance, EEG.
5. Strict calculation of the frequency of vomiting per day compared with daily diuresis.
6. Assessment of the general condition: complaints, pulse, dry skin, etc.
Treatment mild degree vomiting may not be performed. Treatment requires severe and moderate vomiting in women at risk of developing into a severe degree. Treatment is carried out only in a hospital.
1. Regulation of the central nervous system: droperidol is a neuroleptic with a pronounced antiemetic effect (intravenously, intramuscularly, 1 ml of a 0.25% solution of Droperidol). With intravenous administration, the effect is very fast, with intramuscular administration, the effect occurs after 3-4 hours. Aminazine is now used less frequently, as it has a negative effect on the liver. Herbal infusions, Relanium tablets (40-50 mg, or Relanium 0.5% 2 ml), Nozepam (10 mg).
2. Fight against dehydration. In severe vomiting, infusion therapy of at least 1.5-3 liters compared with diuresis: saline solutions (crystalloids), proteins and plasma preparations, 10-20% glucose, vitamins B and C. In severe vomiting, prednisolone (hydrocortisone), estrogens.
3. Antihistamines: dimedrol (Sol. Dimedroli 1% 1ml), pipolfen (0.025 tablets), suprastin (2% 1 ml, in tablets of 0.025), diprazine (2.5% 1 ml in ampoules).
4. In the presence of metabolic acidosis - sodium bicarbonate 200 ml. Can be used - acesol, orthosol, chlosol, potassium, sodium asparginate. Bromine preparations are very rarely used. Polyglucin is used less often, reopoliglyukin - hyperoncotic drugs with high hematocrit numbers are not recommended.
Severe vomiting requires emergency care. Indications for termination of pregnancy will be:
severe general condition
failure of treatment in the next 6-12 hours
development of acute yellow liver dystrophy
development of OPN
Since early toxicosis of pregnancy most often develops at 6-12 weeks of gestation, the method of terminating a pregnancy is artificial abortion.
LATE TOXICOSIS OF PREGNANT WOMEN (OPG-gestoses).
OPG-gestoses include water management, nephropathy, preeclampsia and eclampsia. Incorrect adaptation of the body to the development of the ovum is most often characterized by spasm of blood vessels. violation of their permeability. the development of edema, thickening of the blood, a violation of the state of the liver and nervous system. Clinical forms of gestosis often represent certain stages in the development of a single pathological process. Nephropathy occurs in 2.1-27%, eclampsia - in 0.05-0.1% of pregnant women and women in childbirth.
To assess the severity of preeclampsia, various scales have been proposed: based on the Zantgemeister triad, where each symptom is scored. Some include daily diuresis, subjective complaints, fetal malnutrition in indicators. The index of toxicosis is determined. The most common is the Peller scale: the severity of edema, weight gain, proteinuria, blood pressure, daily diuresis, subjective complaints. Points are counted. Repin scale: the same + condition of the fundus. With mild preeclampsia - angiopathy with dilated veins and narrowed arteries. Severe preeclampsia - narrowing of the arteries and veins, preeclamptic condition - swelling of the retina. Weight gain is not more than 12 kg, but depending on the type of physique: with a normal physique, an increase of 9-10 kg, for hyposthenics - 11-12 kg, for hypersthenics no more than 8-9 kg. Thus, the diagnosis of toxicosis is based on the Zantgemeister triad and laboratory data (decreased diuresis, the presence of protein and a cylinder in the urine, an increase in creatinine and urea, changes in liver tests; impaired uteroplacental circulation, ultrasound data - malnutrition, platelet count - as a prognostic criterion ).
Risk groups for the development of OPG-preeclampsia:
Women with kidney disease.
Women with diseases of the cardiovascular system - hypertension, vegetovascular dystonia, heart defects.
Women with endocrinopathies and especially obesity and diabetes.
An examination that every woman must undergo to clarify the severity of preeclampsia:
Clinical blood test: pay attention to hemoglobin, hematocrit, ESR, the number of red blood cells, platelets.
Determination of kidney function: daily diuresis, with severe preeclampsia - determination of hourly diuresis, Zimnitsky, Nechiporenko test. Pay attention to the specific gravity, the amount of protein, the presence of hyaline cylinders.
Liver function test based on biochemical analysis blood: coagulogram, amount of protein, liver enzymes.
Determination of the state of the cardiovascular system - numbers of blood pressure, pulse, ECG (signs of myocardiopathy).
Examination of the fundus (to establish the degree of retinal angiopathy).
Dopplerography, ultrasound (determination of the thickness of the placenta, the degree of maturity (with preeclampsia, the gestation period is exceeded), small-point hemorrhages in the placenta, determination of the degree of fetal malnutrition.
The diagnosis is made on the basis of laboratory data, clinical manifestations, and the severity of preeclampsia is judged according to these criteria. Treatment of gestosis is carried out only in a hospital due to the possibility of a rapid transition to more severe forms.
Principles of treatment:
Therapeutic and protective regime: reduced doses of neuroleptics (droperidol), ataractics (seduxen, diazepam), antihistamines (diphenhydramine, pipolfen), analgesics with physiotherapy (IRT, electroanalgesia).
Hypotensive: better ganglion blockers (pentamine, benzohexonium, hygronium), taking into account the duration of their action, 8% magnesia sulfate IV drip.
Detoxification: correction of KOS, electrolytes, rheological properties of blood - hemodez, rheopolyglucin, rheoglunam, crystalloids.
Diuretics against the background of adequate infusion therapy with control of water and electrolyte balance, since unreasonable use of diuretics reduces BCC and increases the risk of DIC.
Treatment of preeclampsia is always carried out under the control of: * AD numbers. * Daily diuresis, hourly diuresis in severe cases. * Biochemical parameters, especially platelets.
The ineffectiveness of the treatment of late toxicosis is determined by: 1) negative diuresis; 2) sharp fluctuations in blood pressure throughout the day (falling to normal numbers); 3) high mean blood pressure; 4) tachycardia; 5) continued suffering of the fetus.
The main thing is to decide on the time and speed of delivery. In 15% of pregnant women with preeclampsia, therapy is ineffective. That is, the need for early delivery:
with prolonged sluggish toxicosis, not amenable to therapy
severe preeclampsia, not amenable to therapy during the day.
violation of the vital activity of the fetus (intrauterine hypoxia)
If there is a mature birth canal and if there is preeclampsia, then it is necessary to carry out labor induction with early amniotomy: an amniotomy is performed, the woman is transferred to the maternity ward and a management plan is outlined. If the birth canal is immature, the course of gestosis is sluggish or, on the contrary, bright - delivery by caesarean section. Cesarean section is indicated for: Abdominal delivery in PTB reaches 5-25% and is shown:
intractable eclampsia (more than a day)
prolonged (more than 24 hours) coma after eclampsia;
aneurosis, retinal detachment and hemorrhage in the fundus;
cerebral hemorrhage and its threat;
critical uncontrolled hypertension;
disorder cerebral circulation with the failure of therapy within 2-3 hours;
oliguria and anuria due to SNP and AKI for more than 24 hours;
combination with obstetric pathology (age of the woman, wrong positions fetus and insertion of the head, scar on the uterus, narrow pelvis, placenta previa and premature detachment, breech presentation, severe fetal hypoxia with a neck unprepared for childbirth);
eclampsia in the first stage of labor in the absence of conditions for rapid delivery;
lack of effect from labor induction (opening less than 4 cm in 6 hours);
combination with combined heart disease with a predominance of stenosis, coarctation of the aorta II-III degree;
intractable acute SSN; intractable acute respiratory failure
Features of conducting labor through the natural birth canal: the presence of painful contractions always leads to an exacerbation of preeclampsia in childbirth, so the following tactics must be applied: FIRST PERIOD. 1. Pain relief (promedol, fentanyl), epidural anesthesia - hypotensive effect, relaxes the cervix, improves uteroplacental circulation. 2. Antihypertensive therapy intravenously - dibazol, papaverine, fractional intramuscular pentamine, clonidine (sedation, hypotensive, analgesic effect), sublingual nitroglycerin.
SECOND PERIOD. Greatest chance of seizures and other complications. Ganglioblockers are administered intravenously by drip-controlled normotonia (imechin, pentamine). Depending on the condition of the fetus and mother, the second period should be shortened by perineotomy or by the imposition of exit or cavitary obstetric forceps.
THIRD PERIOD. With careful prevention of bleeding. Since there is already a chronic stage of DIC. Intravenously drip oxytocin, methylergometrine, at the time of head eruption.
REGRESSION OF LATE TOXICOSIS
The reverse development of the main clinical manifestations of PTB lasts up to 3 weeks, pathogenetic disorders are especially persistent during the 1st week, therefore, convulsive readiness and the possibility of eclampsia remain. However, the residual effects of PTB, especially severe and complicated forms, increase sharply after 1-2 years. These are kidney diseases up to 30%, hypertension up to 25%, diencephalic syndrome up to 20%. Only 30% of women who have had severe forms of PTB remain healthy. The rest have disorders of the immune and endocrine systems, cardiovascular diseases, and kidney diseases. This requires a phased rehabilitation under the supervision of a local obstetrician-gynecologist, internist, neuropathologist, endocrinologist, nephrologist. As for reproduction, it is possible not earlier than 2 years and not later than 5 years after PTB, and only after a thorough systematic examination in a hospital setting.
PREVENTION MEASURES FOR TOXICOSIS
Firstly, this is the rehabilitation of girls, girls, women of reproductive age by a therapist with extragenital pathology.
Secondly, early diagnosis and the treatment of delayed physical and sexual development is the task of the pediatrician.
Thirdly, the obligatory function of an obstetrician-gynecologist is the early detection and treatment of sexual infantilism, the fight against unwanted pregnancy, the active detection and treatment of chronic endometritis and cervicitis.
Prevention of toxicosis immediately before the onset of pregnancy and during it are:
intensive dispensary monitoring of pregnant women at risk for PTB - 1 time in 2 weeks in the first half and once a week in the second;
rational mode of work and rest with walks 2 times a day in the fresh air;
exercise therapy, physiopsychoprophylactic preparation;
rationally constructed diet: wide use of vegetables, fruits, vegetable oil, boiled meat and fish, cottage cheese, replacing salt with sonasol, fasting days under weight and diuresis control, magnesium diet;
vitamin preparations: C, retinol, PP, haloscorbin, glutamic acid, calcium gluconate, gendevit;
central electroanalgesia, massage or galvanization of the collar zone, electrosleep to regulate cortical neurodynamics and vascular tone, ultrasound or microwave therapy on the kidney area to normalize general and regional hemodynamics, endonasal galvanization, ultraviolet irradiation;
improvement of uteroplacental circulation: electrorelaxation of the uterus according to Khasin, magnesium iontophoresis, xanthinol nicotinate, sigetin with fenoterol, eufilin in suppositories, oxygen therapy;
herbal medicine: motherwort, valerian root, rose hips, mint, immortelle, chamomile, cudweed, St. John's wort, bearberry, lingonberry leaves;
if pretoxicosis is detected, hospitalization in a day hospital with an in-depth examination, treatment with preformed physical factors(central electroanalgesia, electrosleep, galvanization of the cervicofacial, collar zones, endonasal, ultrasound or microwave therapy on the kidney area). Complex vitamin therapy: biotin 3-5 mg, pyridoxine 10 mg, calcium pantothenate 100 mg, calcium panganate 100 mg, E 0.5 mg, riboflavin 5 mg, B12 10 mcg, nicotinic acid 20 mg, C 200 mg 2 times a day, fasting diet. If there is no effect, hospitalization in an obstetric hospital is necessary, since this is already PTB.
The main condition for the prevention of PTB is the continuity in the work of the w / c and obstetric hospital, early diagnosis and treatment of initial forms of PTB with mandatory correction of the feto-placental and utero-placental complex.
REHABILITATION
3 weeks daily: blood pressure, diuresis, urine and blood tests; samples of Zemnitsky, Nechiporenko, Reberg, determination of urea and blood proteins; therapy that improves the functional state of the central nervous system, water-electrolyte and protein balance, elimination of hypovolemia.
In the clinic up to 1 year: a therapist once a month, blood pressure, urine and blood tests. Symptomatic treatment of the central nervous system, blood pressure, kidneys, in case of pathology - treatment.
With an increase in blood pressure and proteinuria within 6 months after birth - hospitalization in a specialized department, and then
1 year after the hospital - examination and observation by a specialist in the field.
Toxicosis- a pathological condition that occurs during pregnancy and passes with its resolution. etiological factor yavl fertilized egg. Early toxicosis is usually observed in the 1st trimester and disappears by the 2nd trimester.
Pathogenesis: Food reflexes are associated with the vegetative centers of the diencephalic region. The afferent signals coming here from the periphery can be perverse (either due to changes in the uterus receptors or in the pathways), changes are possible in the centers of the diencephalic region themselves, which can change the nature of the response efferent impulses. When the sensitivity of the system is disturbed, a change in reflex reactions quickly occurs, a violation of nutritional functions: loss of appetite, nausea, salivation (salivation), vomiting. neuroendocrine and metabolic disorders, in connection with this, with the progression of the disease, changes in water-salt, carbohydrate and fat, and then protein metabolism gradually develop against the background of increasing exhaustion and weight loss. Violation of the hormonal state can cause pathological reflex reactions. With vomiting of pregnant women, a temporary coincidence of the onset of vomiting with a peak in the content of chorionic gonadotropin is noted, and a decrease in corticosteroid function of the adrenal glands is often noted.
(violation of the reaction of the maternal organism to impulses from the fetal egg, increased excitability of the vomiting center and salivary center.
hormonal changes)
Risk groups: chronic diseases of the gastrointestinal tract, a history of abortion, stressful conditions, negative attitude to pregnancy
Clinic
Common (vomiting of pregnant women, salivation) and rare forms of early toxicosis (dermatoses of pregnant women, tetany, osteomalacia, acute yellow liver atrophy, bronchial asthma of pregnant women) are distinguished.
Vomiting pregnant(emesis gravidarum) occurs in 50-60% of pregnant women. The earlier vomiting occurs during pregnancy, the more severe it is. Depending on the severity of vomiting, three degrees of severity are distinguished: mild, moderate and severe.
With a mild degree (I degree) vomiting of pregnant women the general condition is satisfactory. Vomiting is observed 5 times a day more often after meals, sometimes on an empty stomach. The patient loses no more than 3 kg in weight, the pulse rate does not exceed 80 beats / min. Arterial pressure does not change. Clinical analyzes of urine and blood without pathological changes.
II degree - vomiting of moderate severity. The general condition is disturbed: vomiting is observed from 6 to 10 times a day and is no longer associated with food intake, weight loss is from 2 to 3 kg in 1.5-2 weeks. Subfebrile temperature is possible. Tachycardia up to 90-100 beats / min. Blood pressure may be slightly reduced. Acetonuria in 20-50% of patients.
III degree - severe (excessive) vomiting of pregnant women. The general condition is deteriorating sharply. Vomiting occurs up to 20-25 times a day, sometimes with any movement of the patient. Sleep disturbance, adynamia. Loss of body weight up to 8-10 kg. Skin and the mucous membranes become dry, the tongue coated. The body temperature rises (37.2-37.5 °). Tachycardia up to 110-120 beats / min, blood pressure decreases. Pregnant women retain neither food nor water, which leads to dehydration and metabolic disorders. All types of metabolism are disturbed. Daily diuresis is reduced, acetonuria, often protein and casts in the urine. Sometimes the content of hemoglobin in the blood increases, associated with dehydration. In blood tests, hypo- and dysproteinemia, hyperbilirubinemia, increased creatinine. Shift of acid-base balance towards acidosis. In the study of electrolytes, a decrease in potassium, sodium and calcium is found.
Treatment
Complex therapy vomiting of pregnant women includes drugs that affect the central nervous system, normalize endocrine and metabolic disorders (in particular, water and electrolyte balance), antihistamines, vitamins. During treatment, it is necessary to observe the medical-protective regimen.
To normalize the function of the central nervous system, electrosleep or electroanalgesia are used. The duration of exposure is 60-90 minutes. The course of treatment consists of 6-8 sessions
To combat dehydration of the body, to detoxify and restore KOS, infusion therapy is used in the amount of 2.0-2.5 liters per day. Ringer-Locke solution (1000-1500 ml), 5.0% glucose solution (500-1000 ml) with ascorbic acid (5.0% solution 3-5 ml) and insulin (based on 1 unit of insulin per 4.0 g of dry matter glucose). To correct hypoproteinemia, albumin (10.0 or 20.0% solution in the amount of 100-150 ml), plasma is used. In violation of CBS, intravenous administration of sodium bicarbonate (5.0% solution) or lactosol, etc. is recommended. As a result of the elimination of dehydration and loss of salts, as well as albumin deficiency, the condition of patients improves rapidly.
Cerucal, torekan, droperidol, etc. can be used to suppress the excitability of the vomiting center.
Intramuscular injections vitamins (B1, B6, B12, C) and coenzymes (cocarboxylase). Diprazine (pipolphen) is used, which has a sedative effect on the central nervous system, which helps to reduce vomiting. The drug has a prolonged antihistamine activity. To the complex drug therapy include other antihistamines - suprastin, diazolin, tavegil, etc.
The criteria for the adequacy of infusion therapy are a decrease in dehydration and an increase in skin turgor, normalization of hematocrit, an increase in diuresis, and improvement in well-being.
The ineffectiveness of the therapy is an indication for termination of pregnancy.
Salivation(ptyalismus) may accompany vomiting of pregnant women, rarely occurs as an independent form of early toxicosis. With severe salivation per day, a pregnant woman can lose 1 liter of fluid. Abundant salivation leads to dehydration of the body, hypoproteinemia, maceration of the skin of the face, negatively affects the psyche, body weight decreases.
Treatment of severe salivation should be carried out in a hospital. Assign rinsing of the mouth with infusion of sage, chamomile, oak bark, menthol solution and agents that reduce salivation (cerucal, droperidol). With a large loss of fluid, Ringer-Locke solutions, 5.0% glucose are prescribed intravenously. With significant hypoproteinemia, an infusion of albumin and plasma solutions is indicated. To prevent and eliminate maceration of facial skin with saliva, lubrication with zinc paste, Lassar paste or petroleum jelly is used.
Dermatoses of pregnant women- rare forms of early toxicosis. This is a group of various skin diseases that occur during pregnancy and disappear after it ends. Dermatoses appear in the form of itching, urticaria, herpetic eruptions.
Pregnancy itching(pruritus gravidarum) may appear in the first months and at the end of pregnancy, be limited to the vulva or spread throughout the body. Itching is often excruciating, causing insomnia, irritability, or depressed mood.
Treatment consists in the appointment of sedatives, desensitizing (diphenhydramine, pipolfen), vitamins B1 and B6, general ultraviolet irradiation.
Tetany of pregnant women(tetania gravidarum) is manifested by muscle spasms of the upper extremities ("obstetrician's hand"), less often of the lower extremities ("ballerina's leg"), face ("fish mouth"). The basis of the disease is a decrease or loss of the function of the parathyroid glands and, as a result, a violation of calcium metabolism. In case of a severe course of the disease or an exacerbation of latent tetany during pregnancy, the pregnancy should be terminated. Parathyroidin, calcium, dihydrotachysterol, vitamin D are used for treatment.
Osteomalacia in pregnancy(osteomalacia gravidarum) in a pronounced form is extremely rare. Pregnancy in these cases is absolutely contraindicated. More often, an erased form of osteomalacia is observed - symphysiopathy. The disease is associated with a violation of phosphorus-calcium metabolism, decalcification and softening of the bones of the skeleton. An erased form of osteomalacia is a manifestation of hypovitaminosis D.
Treatment of the disease. good effect provides the use of vitamin D, fish oil, general ultraviolet irradiation, general and local, progesterone.
Acute yellow atrophy of the liver.(atrophia heratis blava acuta) is extremely rare and may be the result of excessive vomiting during pregnancy or occur independently. As a result of fatty and protein degeneration of liver cells, a decrease in the size of the liver occurs, the occurrence of necrosis and atrophy of the liver.
Treatment consists of immediate termination of pregnancy, although termination of pregnancy rarely improves the prognosis.
Bronchial asthma in pregnancy(asthma bronchiale gravidarum) is very rare. The cause of bronchial asthma is hypofunction of the parathyroid glands and impaired calcium metabolism.
Treatment: calcium supplements, B vitamins, sedatives usually give a positive result.
Prevention early toxicosis is the timely treatment of chronic diseases, the elimination of mental stress, adverse environmental influences. Of great importance is the early diagnosis and treatment of initial (mild) manifestations of toxicosis, and, consequently, the prevention of the development of severe forms of the disease.
Indications for termination of pregnancy are:
incessant vomiting;
increasing dehydration of the body;
progressive weight loss;
progressive acetonuria within 3-4 days;
severe tachycardia;
dysfunction of the nervous system (adynamia, apathy, delirium, euphoria);
bilirubinemia (up to 40-80 µmol/l), and hyperbilirubinemia of 100 µmol/l is critical;
icteric coloration of the sclera and skin.
– pathological conditions associated with pregnancy, complicating its course and stopping after the end of gestation. According to the time of occurrence, early and late toxicosis pregnant. Early toxicosis of pregnant women is accompanied by hypersalivation (salivation), nausea, and vomiting. Diagnosis of early toxicosis is based on complaints of a pregnant woman; the severity is established on the basis of a study of biochemical parameters of blood, urine. Treatment of early toxicosis of pregnant women includes the appointment of a protective regimen, diet, antiemetics and sedatives, infusion therapy, physiotherapy.
General information
The concept of "toxicosis of pregnant women" includes an extensive group of gestational complications associated with the development of the fetal egg and disappearing after termination of pregnancy or childbirth. The development of toxicosis of pregnant women is associated with a violation of the adaptive processes of the woman's body to pregnancy. Toxicosis of pregnant women is expressed by various disorders of neurohumoral regulation: impaired functioning of the autonomic and central nervous systems, endocrine and cardiovascular systems, metabolic processes and immune response.
Causes
The occurrence of early toxicosis of pregnant women is etiologically and pathogenetically due to the development of the fetal egg in the uterus. There are many theoretical justifications for this condition: there are toxic, neuroreflex, hormonal, psychogenic, immunological hypotheses that explain the development of early toxicosis in pregnant women. According to the toxic theory, the occurrence pathological symptoms toxicosis is caused by poisoning of the mother's body with toxic products produced by the fetal egg or formed in violation of metabolic processes.
According to supporters of the neuroreflex theory, the development of early toxicosis of pregnant women is associated with irritation by the growing fetus of endometrial receptors, which, in turn, is accompanied by an increase in the excitability of the subcortical structures, where the vomiting and olfactory centers are located, as well as the zones that regulate the activity of digestion, blood circulation, respiration, secretion etc. In response to this irritation, a whole cascade of various vegetative reactions of the body occurs - nausea, vomiting, tachycardia, salivation, pale skin due to vasospasm, etc. By the end of the first trimester, the pregnant woman's body adapts to such irritations, as a result of which the manifestations of early toxicosis disappear.
The hormonal theory explains the occurrence of toxicosis of pregnant women by increased production of chorionic gonadotropin, which contributes to the growth and strengthening of the chorionic villi, the development of the corpus luteum of pregnancy in the ovaries. After 12-13 weeks of gestation, the concentration of hCG in the peripheral blood begins to decrease.
From the point of view of the psychogenic theory, emotional, impressionable women are more prone to the development of early toxicosis of pregnant women, in whom the ratio of inhibition and excitation processes is disturbed. In these women, toxicosis may develop against the background of experiences associated with pregnancy. The immunological theory is based on the views that a fetal egg for a pregnant woman is an organism that is alien in antigenic composition, in response to which a woman produces antibodies that cause toxicosis. All these theories are valid to a certain extent and complement each other.
In addition, it is known that the most severe early toxicosis of pregnant women occurs in women with aggravated somatic status (nephritis, hypertension, gastritis, peptic ulcer, colitis, obesity), overwork, neuropsychic injuries, poor nutrition, bad habits. Toxicosis often develops in pregnant women who have had abortions in the past, chronic inflammation of the genitals (endometritis, cervicitis, adnexitis). Even before pregnancy, these women have a violation of adaptation, which is aggravated with the onset of gestation. Women with severe antiperistalsis of the esophagus, impaired swallowing reflex, increased activity of the vomiting center, are also predisposed to the development of early toxicosis of pregnant women.
Classification
Tetany in toxicosis of pregnant women develops against the background of a violation of calcium metabolism. Tetany is manifested by muscle cramps and often occurs against the background of hypoparathyroidism. Patients with early toxicosis need increased control gynecologist during pregnancy, because subsequently they often develop preeclampsia.
Diagnostics
The diagnosis of early toxicosis of pregnant women is established taking into account complaints, objective data, and the results of additional studies. Carrying out an examination on a chair and ultrasound allows you to verify the presence of a fetal egg in the uterus, determine the gestational age, and track the development of the fetus.
In pregnant women with signs of toxicosis, a study is performed clinical analysis blood, biochemical parameters (total protein and fractions, fibrinogen, liver enzymes, electrolytes, CBS), urinalysis. Measurement of daily diuresis, pulse control, ECG and blood pressure, counting the frequency of vomiting are shown.
Treatment of early toxicosis of pregnant women
A mild form of toxicosis of pregnant women does not require hospitalization; with moderate and excessive vomiting, treatment in a hospital is necessary. In mild cases, a pregnant woman is recommended to observe psychological and physical rest, take sedatives (valerian, motherwort), vitamins, antiemetics (cerucal). The nutrition of a pregnant woman with toxicosis should be fractional, easily digestible, in small portions. With increased salivation, it is useful to rinse the mouth with herbal solutions with tanning properties (infusions of chamomile, mint, sage).
With moderate toxicosis of pregnant women in the hospital, infusion therapy is carried out - parenteral administration of saline solutions, glucose, protein preparations, hepatoprotectors, vitamins. In order to stop vomiting, neuroleptic drugs (chlorpromazine, droperidol) are prescribed according to indications. A good effect is observed from physiotherapeutic procedures (electrosleep, endonasal electrophoresis, galvanization, herbal medicine, aromatherapy), acupuncture.
Treatment of severe toxicosis of pregnant women is carried out in intensive care units under the control of laboratory and hemodynamic parameters. Therapy includes the infusion of solutions in a volume of up to 3 liters, the introduction of neuroleptics, hepatoprotectors, antiemetics, and nutritional enemas. A severe degree of toxicosis of pregnant women is a danger to the woman and the fetus. With untimely or ineffective treatment, coma may occur) and obstetric pathology (cystic drift, hepatosis).
The prevention of toxicosis is facilitated by the responsible preparation of a woman for pregnancy, including timely therapy. chronic pathology, maintaining a healthy lifestyle, refusing abortion, etc.
