Toxicosis during pregnancy is a pathological condition associated with pregnancy, complicating its course and ceasing after the end of gestation. According to the time of occurrence, early and late during pregnancy are distinguished. Early toxicosis during pregnancy is accompanied by hypersalivation (salivation), nausea, vomiting. Diagnosis of early toxicosis is based on complaints of a pregnant woman; the severity is determined based on a study of biochemical parameters of blood, urine. Treatment includes the appointment of a protective regime, diet, antiemetics and sedatives, infusion therapy, physiotherapy.
The concept of “toxicosis during pregnancy” 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 during pregnancy is associated with a violation of the adaptive processes of a woman’s body to pregnancy. Disease is expressed by various disorders of neurohumoral regulation: disorders of the functioning of the autonomic and central nervous system, endocrine and cardiovascular systems, metabolic processes and immune response.
The occurrence of early toxicosis during pregnancy is etiologically and pathogenetically caused by the processes of development of the fetal egg in the uterus. There are many theoretical justifications for this condition: there are toxic, neuroreflective, hormonal, psychogenic, immunological hypotheses that explain the development of early toxicosis during pregnancy. According to the toxic theory, the occurrence of pathological symptoms of toxicosis is caused by poisoning of the maternal organism with toxic products produced by the fetal egg or formed when metabolic processes are disrupted.
According to the supporters of the neuro-reflex theory, the development of early toxicosis during pregnancy is associated with irritation of the endometrial receptors by the growing fetus, which, in turn, is accompanied by an increase in the excitability of subcortical structures, where the emetic and olfactory centers are located, as well as zones regulating 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, pallor of the skin due to vascular spasm, 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.
Hormonal theory explains the occurrence of toxicosis during pregnancy by increased production of chorionic gonadotropin, which promotes the growth and strengthening of 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 psychogenic theory, the development of early pathology is more susceptible to emotional, impressionable women who have a disturbed ratio of inhibition and arousal processes. In these women, toxicosis can develop against the background of pregnancy-related experiences. The immunological theory is based on the views that the fetal egg for a pregnant woman is an organism alien in antigenic composition, in response to which antibodies are produced in a woman, which cause toxicosis. All these theories are legitimate to a certain extent and complement each other.
In addition, it is known that the most severe early toxicosis during pregnancy occurs in women with a burdened somatic status (nephritis, hypertension, gastritis, peptic ulcer, colitis, obesity), fatigue, neuropsychiatric injuries, irrational nutrition, bad habits. Toxicosis develops more often in pregnant women who have had abortions in the past, chronic inflammation of the genitals (endometritis, cervicitis, adnexitis). In these women, even before pregnancy, there is a violation of adaptation, which is aggravated with the onset of gestation. Women with pronounced antiperistalsis of the esophagus, violation of the swallowing reflex, increased activity of the vomiting center, are also predisposed to the development of early toxicosis during pregnancy.
Obstetrics and gynecology distinguish early toxicosis during pregnancy, late (gestosis), as well as rare forms of toxicosis. Early toxicosis during pregnancy is understood as gestational complications that develop in the first trimester (from the first days to 21-13 weeks of pregnancy); late toxicosis is disorders that occur in the third trimester (from 26-27 weeks before the end of gestation).
Forms of early toxicosis during pregnancy include vomiting (mild, moderate, excessive), ptialism (hypersalivation). Late toxicosis can occur in the form of dropsy of pregnant women, nephropathy, preeclampsia and eclampsia. Among the rare clinical forms of toxicosis are dermatoses of pregnant women, jaundice, bronchial asthma, tetany, osteomalacia, which can develop at any gestation period.
According to various data, early toxicosis occurs in 50-60% of pregnant women. The onset of manifestations often develops at 5-6 weeks of gestation. The most characteristic signs are nausea, vomiting, increased salivation, a sharp change in taste and olfactory perceptions, loss of appetite, lethargy, drowsiness. Objectively, with toxicosis during pregnancy, weight loss, hypotension, tachycardia, the appearance of acetone in the urine, an increase in azotemia in the blood, electrolyte disorders are determined. Taking into account the severity of vomiting, several degrees of early toxicosis during pregnancy are distinguished: mild, moderate and excessive.
Mild toxicosis during pregnancy (neurotic) is characterized by vomiting up to 5 times a day, satisfactory general condition. The severity of taste and olfactory perversions, intolerance of odors, including food, is noted. Women’s sleep and appetite usually do not suffer. There may be a weight loss of no more than 2 kg per week, slight tachycardia (up to 90 beats. in min.), hypotension (110-100/60 mmHg). Urine and blood tests remain within normal limits.
With a moderate (toxic) degree of toxicosis during pregnancy, constant nausea is observed, the frequency of vomiting per day is up to 10 times, liquid and food are retained slightly. General well-being worsens, appetite decreases, sleep is disturbed. A pregnant woman can lose from 3 to 5 kg in weight per week. Objectively revealed subfebrility, tachycardia (90-100 beats. in min.), hypotension (100-90 / 60-50 mmHg), the presence of acetone in the urine.
With the most severe form of toxicosis during pregnancy – excessive, indomitable vomiting (dystrophic stage), severe multiple organ disorders develop. It is characterized by painful vomiting up to 20 or more times a day, lack of appetite, inability to retain fluid and food in the stomach, sleep disturbance. The woman’s condition is apathetic, myalgia may bother. The loss of body weight progresses, reaching 7-15 kg.
Objectively, signs of dehydration are revealed: dry skin with jaundice, decreased tissue turgor. Often there are petechiae on the skin, hemorrhages in the conjunctiva due to clotting disorders and constant tension. An increase in the pulse rate to 120 beats is determined . per minute, arrhythmia, hypotension (up to 80/40 mmHg). In the urine – ketonuria, albuminuria, cylindruria; oliguria or anuria develops. In the peripheral blood, the concentration of bilirubin, creatinine, urea increases, violations of water-salt and protein metabolism, CSF are detected.
Ptialism (salivation) can be an independent form of toxicosis during pregnancy or be observed together with vomiting. With a pronounced degree of salivation, a pregnant woman can lose up to 1 liter of fluid per day, which leads to dehydration of the body, hypoproteinemia, psychological discomfort.
Dermatoses are considered to be rare forms of early toxicosis during pregnancy, which more often occur by the type of skin itching. Itching during pregnancy can be local (in the vulva area) or spread to the whole body. Pronounced and constant itching of the skin is accompanied by insomnia, irritability. To exclude other causes of itching, the patient should be examined for diabetes mellitus, fungal diseases, trichomoniasis, allergic diseases, worm infestation. Rarely dermatoses during pregnancy manifest themselves in the form of herpes, eczema, herpetiform impetigo.
Tetany with this disease 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 by a gynecologist during pregnancy, since they often develop gestosis later.
The diagnosis is established taking into account complaints, objective data, and the results of additional studies. Conducting an examination on a chair and ultrasound allows you to verify the presence of a fetal egg in the uterus, determine the gestation period, and trace the development of the fetus.
In pregnant women with signs of toxicosis, a study of clinical blood analysis, biochemical parameters (total protein and fractions, fibrinogen, liver enzymes, electrolytes, CBS), general urine analysis is performed. The measurement of daily diuresis, monitoring of pulse, ECG and blood pressure, counting the frequency of vomiting is shown.
A mild form 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, taking 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, mouthwash with herbal solutions with tanning properties (infusions of chamomile, mint, sage) is useful.
With moderate toxicosis of pregnant women, infusion therapy is carried out in the hospital – 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 physiotherapy procedures (electroson, endonasal electrophoresis, galvanization, phytotherapy, aromatherapy), acupuncture.
Treatment of severe toxicosis of pregnant women is carried out in intensive care wards under the control of laboratory and hemodynamic parameters. Therapy includes infusion of solutions in a volume of up to 3 liters, the introduction of neuroleptics, hepatoprotectors, antiemetics, the formulation of nutritional enemas. Severe toxicosis of pregnant women is dangerous for the woman and fetus. If the treatment is untimely or ineffective, coma and death of the patient may occur. Therefore, with a malignant form of early toxicosis, termination of pregnancy is indicated.
Prognosis and prevention
Against the background of early toxicosis during pregnancy, severe dehydration, multiple organ failure with impaired liver, heart and kidney functions may occur. A deadly complication can be the development of yellow liver atrophy. In patients with severe toxicosis, spontaneous termination of pregnancy often occurs. In most cases, the manifestations of early toxicosis of pregnant women subside by 12-13 weeks of gestation. With a prolonged course of early toxicosis, it is necessary to exclude combined (hepatitis, pancreatitis) and obstetric pathology (cystic drift, hepatosis).
The prevention of toxicosis is facilitated by responsible preparation of a woman for pregnancy, including timely therapy of chronic pathology, maintaining a healthy lifestyle, refusing abortions, etc.