Toxicosis of pregnant women

Toxicosis of pregnant women occurs during pregnancy and, as a rule, ceases after its termination. There are numerous theories explaining their development (allergic, toxic, immunological, neuro-reflex, humoral, etc.). Conditionally toxicosis is divided into early and late. The most frequent clinical form of early toxicosis is vomiting of pregnant women. Less common are drooling, dermatosis, bronchial asthma, jaundice of pregnant women. Late toxicoses include dropsy of pregnant women, nephropathy, preeclampsia, eclampsia.

Vomiting of pregnant women is often observed against the backdrop of salivation, accompanied by nausea, a decrease in appetite, a change in taste sensations. The mild form is not negatively affected by the general condition of the pregnant woman. At a toxicosis of average severity weakness, weight loss, decrease diuresis, loss of appetite are noted. The most severe form of toxicosis is indomitable vomiting. Vomiting occurs up to 20 or more times a day, often regardless of food intake. Pregnant women lose weight sharply, blood pressure decreases, heart rate increases, body temperature rises, marked dehydration occurs, acetone is determined in urine. There is a danger to the life of the patient. In these cases, it is necessary to interrupt pregnancy.

Treatment. Light forms do not require hospitalization and special treatment. At a toxicosis of average severity and especially with indomitable vomiting hospitalization is obligatory. At night prescribed sleeping pills. An expressed antiemetic property possesses etaperazine (0.004-0.008 g 2-3 times a day after meals). Also apply splenin 1 ml 1-2 times a day for / m for 10 days, cocarboxylase in / m 50-100 mg 1-2 times a day, a complex of vitamins, novocaine IV daily for 10 ml 0.5 % Solution, diathermy of the solar plexus, hypnosis. Meals should be frequent (in 2-3 hours) and in small portions. If it is impossible to keep food in the stomach of the pregnant woman, nourishing enemas or parenteral administration of nutrient mixtures should be prescribed. It is necessary to inject large quantities of liquid daily (up to 3 l / day), glucose (30-40 ml of 40% IV solution), insulin (5 units per 100 ml of glucose). An exhausted patient shows fractional transfusions of 80-100 ml of Rh-compatible unicellular blood. If the treatment is ineffective and toxemia progresses (unceasing vomiting, persistent subfebrile condition, severe tachycardia, severe weight loss, proteinuria, acetonuria, jaundice), abortion is indicated.

A dropsy of pregnant women is characterized by edema, a negative diuretic, a rapid increase in the body weight of a pregnant woman (more than 300 g per week). In the urine, pathological elements are absent, blood pressure is not increased. Current is short-term or long-term. In some pregnant women the disease progresses and turns into nephropathy. The diagnosis is based on the detection in the second half of the pregnancy of edema, not associated with extragenital diseases. Hidden edema is detected when the pregnant woman is systematically weighed in a woman's consultation (once every 2 weeks).

Treatment. Limitation of fluid intake (up to 700-800 ml / day) and table salt (up to 3-5 g / day). Food is predominantly milk and vegetable with an increased content of vitamins. Pronounced edema is an indication for hospitalization. Assign bed rest, restriction of consumption of liquid and table salt, unloading days once a week (1 kg of apples or 400 g of cottage cheese), vitamins. Enter into / in glucose to 20-40 ml of 40% solution, give inside gipotiazid 25 mg 1-2 times a day, along with potassium chloride 1 g 3 times a day for 3-4 days.

Nephropathy often develops on the background of dropsy or previous extragenital diseases (hypertensive disease, nephritis), such forms of toxicosis are called combined. Characterized by a triad of symptoms: edema, hypertension, proteinuria. Often there are only two symptoms in any combination or one of them (monosymptomatic toxicosis). There may be cerebral symptoms. In severe cases, a transition to preeclampsia and eclampsia is possible. Nephropathy has an adverse effect on the fetus (hypotrophy, intrauterine death).

Treatment stationary. A salt-free diet, a liquid restriction, unloading days, vitamin therapy, glucose preparations, iv magnesium sulfate 20 ml of a 25% solution 4-5 times a day (not more than 25 g of pure substance per day), oxygen therapy, dibazol, papaverine, reserpine , Diuretics, rutin, glucose 50 ml of 40% IV solution. Pregnant with severe forms of nephropathy is led by an obstetrician together with an anesthesiologist (intensive therapy). In such cases, appoint droperidol for 10-15 mg (4-5 ml of 0.25% solution) in / m or IV (slowly injected!), Seduxen 10 mg (2 ml 0.5% solution) iv . These drugs are prescribed to reduce the excitability of the centers of the brain and stabilize blood pressure. To eliminate vascular spasm, I / v injected 10 ml of a 2.4% solution of euphyllin, 1 ml of a 0.25% solution of racedil, 4-5 ml of a 2% solution of no-shpa. Dehydration is carried out by administration of mannitol (30-60 g of a 20% w / w solution), lasix (2-4 ml of 1% solution). To remove intoxication appoint gemodez (200-400 ml) and glucose caffeine mixture (200 ml of 20% glucose solution, 200 ml of 0.5% solution of novocaine, 15 units of insulin) IV. Correction of hypoproteinemia and hypovolemia is carried out by administration of albumin (100-200 ml) or dry plasma (150 ml). To normalize the microcirculation, use rheopolyglucin (400 ml IV). All listed medical measures are carried out in the intensive care unit or intensive care unit. Treatment continues 2-5 days before the persistent disappearance of cerebral symptoms, stabilization of blood pressure and restoration of normal diuresis. Then the patients are transferred to the pathology ward of pregnant women. For the prevention of intrauterine hypoxia of the fetus, 20 ml of a 40% glucose solution in the IV, oxygen inhalation, cordyamine 2 ml IM, cocarboxylase 50 mg IM and 2 ml 1% solution sygethin IM.

Pre-eclampsia is characterized by the appearance on the background of previous nephropathy of complaints of severe headache, visual disturbance, pain in the epigastric region. Treatment is similar to the treatment of severe nephropathy.

Eclampsia is characterized by seizures with loss of consciousness. Most often occurs against a background of severe nephropathy or pre-eclampsia. The fit of seizures develops in a certain sequence: Stage I - small fibrillar contractions of the facial muscles appear, passing to the upper limbs; Stage II - tonic spasms of the muscles of all skeletal muscles; The patient loses consciousness, there is no breath, the pupils are dilated, cyanosis of the skin and mucous membranes; Stage III - clonic convulsions of the muscles of the trunk, then upper and lower extremities; There is irregular breathing, foam is released from the mouth; Stage IV - a coma. Currently, eclampsia is characterized by a small number of seizures that occur against the background of a relatively mild form of nephropathy or preeclampsia. Complications of eclampsia: a decrease in cardiac activity, cerebral hemorrhage, pulmonary edema; Intrauterine fetal hypoxia, intrauterine fetal death.

The treatment is based on the principles developed by V. V. Stroganov: creation of a treatment-and-protective regime; Carrying out of the actions directed on normalization of the major functions of an organism; Use of medicines to eliminate the main manifestations of eclampsia; Fast and gentle delivery. The treatment is performed by an obstetrician in conjunction with an anesthesiologist in the intensive care unit or in a specially equipped ward. All manipulations (obstetric studies, measurement of blood pressure, injections, catheterization, etc.) are performed under anesthesia. When an attack occurs, seizures are caused by ether-oxygen anesthesia or resort to neuroleptanalgesia (droperidol - 4-5 ml of 0.25% solution of IV, seduxen - 2 ml of 0.5% solution of IV). During the II and III stages of anesthesia, anesthesia is temporarily stopped. After stopping the attack to prevent a new attack, seizures are again given a short-term anesthesia. Removable dentures are removed, a rotor-expander is inserted between the jaws. The patient is given oxygen after each attack. Carry out the same drug therapy as with a severe form of nephropathy. Eclampsia in labor requires accelerated delivery (early opening of the bladder, the imposition of obstetric forceps). Caesarean section is performed according to strict indications:
Incessant attacks of eclampsia; A prolonged coma; Hemorrhage into the fundus, retinal detachment; Pronounced oliguria or anuria; pulmonary edema; Premature detachment of the normally located placenta.

Prevention of late toxicosis is carried out in women's clinics (training in hygiene of pregnant women, phi-psychopsychophysical preparation, etc.). An important role belongs to the early detection of toxicosis of pregnant women.