Toxicosis in pregnancy

Toxicosis in pregnancy is a pathological symptom complex that reflects the negative impact of pregnancy on the mother's body. According to the time of onset of toxicosis classified into the early, occurred in early pregnancy, and late, appearing in the second half. Most often, early toxicosis is diagnosed within the period from the 1st to the 10th to the 12th week, and the late ones on the 26th-40th week.

How long does the toxemia last for pregnancy? This question, which is often asked by a specialist, is unequivocally impossible to answer. Often, the early toxicosis lasts several days and disappears on its own, and sometimes it becomes protracted and lasts the entire first half of pregnancy.

Statistically more often( 60-65%) are diagnosed with early toxicosis, however only 10% of them require a serious correction.

Such a division of toxicosis into early and late is extremely important, since in different periods of pregnancy they have an ambiguous picture, differently affect the developing fetus and have different degrees of risk.

There is no single-valued theory on the origin of toxicosis in pregnancy, but at the present time negative factors( both external and internal) are known, which are likely to lead to the development of this pathology. It is believed that toxicoses of any genesis significantly complicate the course of pregnancy, create unfavorable conditions for the physiological development of the fetus, and in some situations become hazardous to the health and even life of the pregnant woman.

Any toxicosis, be it early or late, there is a single provoking factor - pregnancy. Developing fetus and hormonal dysfunction significantly change the functioning of the body. Obviously, toxicosis is associated with the problems of its adaptation to a new condition, and the degree of expression is determined by the ability to adapt to "life together."

The sex of a developing child does not affect toxicosis, and even more so it does not provoke. Among pregnant women there is a special myth connecting the sex of the unborn child and toxicosis, namely its form and duration. Changes in the maternal body during pregnancy do not depend on the sex of the unborn child, and therefore the toxicosis in pregnancy by a boy and the toxicosis during pregnancy by a girl are absolutely identical.

To early toxicosis mainly include disorders of the functioning of the gastrointestinal tract, 85-90% of this is vomiting. Less common are ptimalism( salivation) and rare forms: dermopathy, hepatosis and others.

Late toxicosis( also called gestosis) signals a deep pathological disorder of the vital systems: cardiovascular, excretory, circulatory, endocrine and others. It is accepted to allocate edemas of pregnant women, nephropathy of three degrees( from mild to severe), pre-eclampsia and eclampsia proper. All these forms can be considered as successive stages of a single pathological process.

Toxicoses, whether early or late, in initially healthy pregnant women are called "clean", or primary. If they are formed against the background of extragenital pathology, they are already considered to be combined( secondary).

Sometimes a pregnant woman can hear a verdict like "pretoxicosis".This concept is not a full-fledged diagnosis, but it has enormous clinical significance, since it indicates a high probability of being transformed into a true toxicosis of a late period. Pre-toxicity, in fact, is a preclinical form of gestosis, when its reliable signs are absent, but there are changes in the results of laboratory and instrumental studies: incorrect weekly weight gain, changes in blood and urine tests, unstable blood pressure, and others.

Diagnosis of toxicosis during pregnancy is based on the study of anamnestic, clinical and laboratory data, ultrasound scanning. The list of diagnostic procedures is determined according to the personal situation.

Treatment of toxicosis in pregnancy also depends on the specific situation, which includes the period of onset of the development of the disease, the severity of the symptoms and their effect on the fetus. Early toxicosis often occurs in mild or moderate form and does not require serious treatment. In contrast, late toxicoses always require more attention and mandatory correction, since they are considered as dangerous conditions.

Causes of Toxicosis in Pregnancy

As already mentioned, toxicosis of any duration and severity has a single reliable reason - a developing pregnancy. Early and late toxicosis manifest themselves in different ways, manifest in different stages of pregnancy, and also have unequal factors provoking to development.

Often, pregnant women with toxicosis indicate the presence of that in the mother, but contrary to popular belief, the presence of early toxicosis is not necessary, and its frequency is only 2-3%.More often, the causes of early toxicosis are completely harmless. Among the many theories explaining its appearance, the most reasonable are:

- Neuroreflex theory, it is the most popular one. According to this theory, the developing embryo affects the nerve endings( receptors) localized in the endometrium. There is a wave of excitement that rushes to the subcortical structures of the brain, where the olfactory and vomiting centers are located, as well as the zones responsible for the function of the digestive and autonomic systems.

- Hormonal dysfunction. After fertilization of the egg, the habitual rhythm of hormonal secretion changes, as a result, menstruation ceases, the yellow body of pregnancy appears in the ovaries, which synthesizes progesterone, responsible for maintaining the pregnancy that has come. A change in the hormonal status and the presence of an embryo provoke changes in the functioning of all body systems, so early toxicoses can be considered as an adaptive mechanism.

- Immunological theory. It is based on the representation of the relationship of the maternal organism and embryo on the principle of rejection reaction, when the embryo that appeared in the uterine cavity is considered a foreign element( antigen).

- Psychogenic Theory. It is based on data on the relationship between early toxicosis and its severity with the psychoemotional state of the pregnant woman.

- "Poisoning" of the mother with the products of the embryo's vital activity due to an incorrect exchange process.

Probably, each of the available theories of origin of early toxicosis is not isolated, since it is realized when interacting with the others.

It is known that the likelihood of developing toxicosis depends on the somatic health of the pregnant woman. Women with chronic pathologies suffer more often from symptoms of toxicosis, especially in the presence of heart disease, blood vessels, kidneys or endocrine diseases( diabetes mellitus in particular).So, the hypertensive illness in the anamnesis of the pregnant woman increases the chance of development of severe toxemia by 14 times.

Often among women you can hear that there is an early toxicosis in pregnancy when a girl. However, the sex of the child does not affect the appearance of toxicosis, therefore, toxicosis in pregnancy by a boy or girl is equivalent in frequency of occurrence.

But the number of babies born increases the likelihood of toxicoses of any duration. Too large amount of synthesized hCG( chorionic gonadotropin) in multiple pregnancies provokes an early toxicosis. Multiple pregnancy provokes late toxicosis, as the mother's body is significantly depleted by the second half of pregnancy and is often unable to compensate for the negative impact of the fruit.

Toxicosis with frozen pregnancy is possible only in its early form. After the fetus perishes, the symptoms of toxicosis suddenly stop.

Late toxicosis in the occurrence range from 3 to 22%, they are always associated with severe complications of physiological pregnancy. The basis of late toxicosis is always total vascular spasm, hypovolemia( reduction of circulating fluid), disturbance of microcirculation, changes in the coagulation system. Similar violations, in case of their untimely diagnosis and lack of proper correction, can provoke tissue necrosis. Unfortunately, late toxicosis still remains the so-called "disease of theories", since its true origin is unknown. In fact, the consequences of late gestosis are reduced to dystrophic changes in tissues of vital organs and systems.

However, no description of toxicoses of any period of pregnancy seems threatening, almost all of them are amenable to medical correction, if, of course, the pregnant woman follows the recommendations of specialists and in time passes the necessary examinations.

When toxemia begins in pregnancy

The onset of early toxicosis always occurs in the first 20 weeks of pregnancy, that is, in its first half.

The late toxicosis belongs to the second half of pregnancy, that is, it develops after 20 weeks. Often, those who have suffered severe toxicosis during early pregnancy after the end of the course begin to suffer from symptoms of late toxicosis. As a rule, this happens with those having a chronic genital or extra-genital pathology pregnant.

More often the symptoms of early toxicosis appear in the interval from the 1st to the 12th week, and the later - from the 26th to the 40th.

This division of toxicosis into terms is based on statistics, which determined the most frequent periods of occurrence of toxicosis. However, there are also rare cases when a toxicosis occurs after the specified periods or has a protracted course. Infrequently, early toxicosis happens on the 12th - 16th week, and the late on the 24th - the 25th. Therefore, it is not always easy to determine the exact onset of toxicosis and the time of its completion, especially if some pregnant women experience periodic deterioration of well-being and outside of toxicosis.

It should be noted that the presence of toxicosis of pregnancy can not always be determined. More often this happens in the early stages, when she experiences the "classic" symptoms of early toxicosis( nausea, vomiting, weakness, heartburn and the like).In the late term, toxicosis can begin with changes in the composition of blood, urine, fluctuations in blood pressure and other changes, which at first can only be noticed by a specialist. That is why it is so necessary to observe the schedule of visits and surveys, even if they do not seem necessary, and the pregnant woman feels well.

Symptoms and signs of toxemia in pregnancy

Early onset of toxicosis is more often manifested by nausea( especially morning sickness), heartburn, general weakness, emotional lability.

Early toxicosis combines several conditions( or forms):

- Vomiting of pregnant women. This form of early toxicosis should be differentiated from usual, physiological, vomiting of pregnant women, which is observed in 50-60%.

- Ptimalism( drooling).An excessive amount of saliva appears when the hormonal adjustment is negatively affected by the salivary glands.

- Jaundice of pregnant women. It is the result of cholestasis or fatty hepatosis.

Early toxicosis can be manifested by one of the listed conditions or a combination of them.

Late toxicosis is more difficult. It also has several forms that are combined etiologically and consistently developing phases of a single pathological process, namely:

- Edema( dropsy) of pregnant women. The earliest and not always obvious symptom of late toxicosis. The expression of edema is of great value for the diagnosis of the severity of gestosis.

- Nephropathy. Violation of normal kidney function also has several degrees of severity. The presence of renal dysfunction can always be determined by the appearance of protein in the urine. Severe toxicosis during pregnancy in the form of nephropathy often increases the number of blood pressure.

- Pre-eclampsia. We can say that it is a natural outcome of severe nephropathy( if it is not treated in a timely manner).Violation of blood circulation in the structures of the brain threatens serious complications for the mother and fetus.

- Eclampsia. Severe terminal phase of gestosis, capable of killing both the mother and, accordingly, the fetus. Is manifested convulsive seizures, brain edema, retinal detachment and even coma.

Attention should be paid to early toxicosis in the case of a frozen pregnancy. It is his features that serve as the first clinical sign of trouble. Since at first the pregnancy develops, and the fetus grows, the first signs of toxicosis do not differ from those of pregnancy during physiological pregnancy. When, due to serious pathological causes, the fetus dies, the pregnancy "freezes", that is, it actually stops. Termination of pregnancy provokes and stop early toxicosis, which is clinically manifested in a sudden( almost 1 day) disappearance of all its symptoms. Sometimes toxicosis with a frozen pregnancy can be confused with the symptoms of intoxication, provoked by the death of the fetus. The tissues of the deceased fetus, decomposing, produce toxins that poison the mother's body, so the patient's well-being worsens: dizziness, nausea, vomiting and other symptoms similar to the symptoms of toxicosis appear. Late toxicosis with a frozen pregnancy can not be, because such a pregnancy simply does not last so long.

More details about the symptoms of toxicosis of the early and late periods of pregnancy are described in the chapters devoted to each type of toxicosis separately.

Timing of pregnancy toxicity

How long does it last? It is impossible to find a unanimous answer to this frequently asked question. It is known that in somatically healthy pregnant women the early toxicosis either does not develop or proceeds without serious disturbances of well-being, and also lasts very briefly, and late toxicosis is more often absent.

Early toxicosis is almost always due to the period of adaptation, when the developing fetus and the mother's body learn to adapt to coexistence. The better the woman's health outside of pregnancy, the higher the chances of short duration and the low symptomateness of this period. In any case, early toxicosis ends after the end of the first half( week 20) ​​of pregnancy.

Late toxicosis occurs when the adaptation of the educated system "mother-child" is already passed( second half of pregnancy), therefore it always has a pathological basis, more often - diseases of the pregnant woman. The heavier the toxemia is in later periods, the longer it lasts. As a rule, late toxicosis happens more often in those pregnant women who had it in the early periods.

Early toxicosis in pregnancy

The onset of pregnancy often manifests itself with all known unpleasant clinical signs, for example, changes in perception of flavors and smells, nausea, or heartburn. They can appear already in the first weeks after the delay of another menstruation, when the presence of pregnancy can be established only with the help of rapid testing or laboratory( level of hCG in urine and blood).Such symptoms can not always be considered toxicosis.

As noted above, the most frequent forms of early toxicosis are identified and less frequent.

The early forms include:

- Vomiting. Appears in almost every second( about 60%) pregnant. There is a direct relationship between the period of vomiting and its severity: the earlier vomiting begins, the heavier its symptoms will be in the future.

According to the severity of the course of vomiting, pregnant women are classified into three classes: light( first), middle( second) and heavy( third).

First, mild, the degree of vomiting does not disturb the state of health of a pregnant woman, as it happens not more often than five times a day. More often, vomiting provokes a meal, and on an empty stomach it happens less often. Pregnant tries to eat less often, starts to get nervous, loses appetite. Reducing the amount of food and loss of fluid with vomit provoke a slight loss of weight, usually no more than 3 kg.

Episodes of vomiting with a moderate degree of severity are repeated more often - from 6 to 10 times a day. They are no longer associated with the fact of food intake and are accompanied by greater loss of fluid and, correspondingly, body weight. Moderate vomiting takes up to 3 kg in a pregnant woman for 1.5-2 weeks. The first accompanying negative symptoms appear: subfebrile, tachycardia 90-100 beats / min, a slight decrease in blood pressure. An alarming symptom is the appearance of acetone in the urine of some( 20% - 50%) of pregnant women.

Excessive( severe) vomiting occurs 20-25 times a day, significantly worsening the pregnancy and leads to serious consequences: dangerous weight loss( sometimes up to 10 kg), dryness of mucous membranes and skin, temperature rise, tachycardia up to 110-120bpm, drop in blood pressure. Water and food do not stay in the body, so the pregnant woman experiences all the negative manifestations of severe dehydration, up to the violation of all parts of the metabolism.

- Salivation( birdism).Excessive separation of saliva sometimes reaches 1 liter per day, so, in fact, the level of fluid loss in the body is comparable( and sometimes exceeds) with severe vomiting. Ptimalism can be combined with vomiting or exist in isolation, but always provokes severe symptoms of dehydration.

- Jaundice of pregnant women. Provoked by cholestasis - the cessation or reduction of bile flow into the small intestine. It is mainly associated with a change in the metabolism of estrogens, which distort the process of bile formation and bile secretion. It is manifested by heartburn, itchy skin, light jaundice of the skin. It should be noted that mild manifestations of cholestasis are found in almost all pregnant women, but not always they are transformed into a full-fledged picture of toxicosis.

To rare forms of early toxicosis include:

- Dermatosis( dermopathy), more often it is an itch of pregnant women, less often - eczema. Apparently, the appearance of itching provokes hormonal dysfunction, namely the change in the concentration of estrogens. Itching is more often localized on the mucous and skin of the genitals, less often - on any part of the body.

Dermatosis in pregnancy should be differentiated from other pathologies that provoke itching - candidiasis, allergies, diabetes mellitus and others.

Constant itching provokes neurotic disorders: sleep disorders, irritability and even depression.

- Hepatosis. It also causes jaundice and itching of pregnant women, but it is associated with more terrible causes - with atrophy of the hepatic tissue.

- Osteomalacia - a change in the structure of bone tissue due to a distortion of calcium and phosphorus metabolism. Bones loosen, become brittle, which is fraught with fractures.

- Cramps of the muscles of the hands or feet, as well as faces - tetany.

- Bronchial asthma, which appears exclusively during pregnancy. It is rare. Symptomatically, it resembles "normal" asthma, but it is more severe, with elements of severe respiratory failure.

Late toxicosis in pregnancy

Late toxicosis is more often diagnosed in overcoming the 30-year-old line of primiparous women, as well as in multiple pregnancies.

Late toxicosis, in contrast to its early forms, is always a pathological condition that complicates the course of pregnancy. Highlight the classic triad of symptoms of toxicosis of late pregnancy: increased blood pressure, proteinuria( excretion of protein in the urine) and swelling. This triad served as the birth of a new term - OPH( OPH) - gestosis, where O-edema, P-proteinuria, and D-hypertension. These symptoms can be both isolated and present all at once. It should be noted that the symptoms of late toxicosis may appear for the first time at an earlier time, but to appear slightly and impermanently.

According to the generally accepted classification, several forms of late toxicosis are distinguished: edema of the pregnant( dropsy);Nephropathy of varying severity;Preeclampsia and eclampsia. They are its stages.

Depending on the background on which the toxicosis appears, it can be "clean", that is, appear in a somatically healthy patient, and "combined", which is always based on extragenital pathology. Practically in 80% of pregnant women, the toxicosis of the second half is combined.

The first evidence of late toxicosis is hydrocephalus. It provokes fluid retention in the body. First, edemas are of a hidden nature, so they are poorly visualized. Their presence can be assumed by an incorrect change in body weight( over 300 grams weekly).As soon as the edema becomes visible, they are classified into four stages( or degrees):

• 1st stage - edema is localized exclusively on the lower extremities, and only on the legs and feet,

• 2nd stage - not only the legs swell, But also the anterior abdominal wall,

• Stage 3 "adds" swelling of the hands( especially the brushes) and face,

• The 4th, the heaviest, the dropsy stage is characterized by generalized swelling.

As a rule, a dropsy does not provoke a deterioration in the state of health of a pregnant woman. Sometimes, along with swelling, there is thirst, heaviness in the legs( especially at the end of the day) and fatigue.

Regular weighing, careful external examination and measurement of the amount of excreted fluid( diuresis) helps to diagnose dropsy. With significant swelling fluid retention in the body, and not excreted in the urine, so the amount of fluid is always more than the selected( negative diuresis).

Swelling during pregnancy indicates that the kidneys are working at the limit of possibilities. If timely hydrops are not corrected, the next stage of late toxicosis - nephropathy - may develop. In addition to continuing edema, lability arterial pressure appears. If it is equal to or exceeds 135/85 mmHg, it is regarded as a manifestation of nephropathy, unless out of pregnancy such pressure was for a particular woman "worker".Arterial hypertension threatens with interruption of pregnancy and fetal death, moreover, the most dangerous is not the increase in pressure itself, but its uncontrolled fluctuations.

Nephropathy has another "classic" clinical sign - proteinuria, or the appearance of a protein in the urine. In healthy women, regardless of the presence of pregnancy, the urine does not contain protein. The protein appears when the normal function of the kidneys is disturbed, and its concentration serves as an indicator of the degree of this disorder.

Simultaneously, diuresis changes in the background of the triad of symptoms. The daily amount of excreted urine decreases, and the lower this amount, the heavier the toxemia.

Diagnosis of nephropathy also does not imply serious and costly manipulation. Timely detection of edema, detection of protein in the urine, measurement of diuresis and dynamic control of blood pressure will establish a reliable diagnosis and prevent the emergence of the next stages of the development of toxicosis.

Very unfavorable is the situation when nephropathy passes into eclampsia - a terminal, life-threatening, stage of late toxicosis. An intermediate state between nephropathy and eclampsia is preeclampsia. Its basis is a severe form of nephropathy. The main pathological mechanism is a circulatory disorder in the central nervous system. At this stage, there are headaches, a sensation of a heavy occiput, nausea and / or vomiting, pain in the projection of the liver. The pregnant woman experiences constant fatigue, drowsiness, lethargy, irritability. Infringements of blood supply in the brain can provoke retinal damage, then there are disorders from the viewpoint: a veil or fog before the eyes, flashing "flies".

The following diagnostic criteria help diagnose pre-eclampsia:

- increased to 160/110 mmHg.arterial pressure;

- daily loss of protein with urine up to 5 g or more;

- diuresis, not exceeding 400 ml;

- nausea and / or vomiting, not associated with digestion;

- hepatic dysfunction;

- changes in the parameters of blood coagulation.

The terminal stage of all processes occurring in late toxicosis is eclampsia. She has convulsive seizures and a subsequent coma.

Late toxicosis of any form is also reflected in the fetus, so diagnosis always involves monitoring its condition. An ultrasound scan is performed, blood flow in the placental vessels is measured, and cardiac activity is studied. Even in the absence of severe suffering of the mother from the symptoms of gestosis, deterioration of the child's well-being may become an occasion for an emergency termination of pregnancy.

When toxemia in pregnancy ends

Pregnancy, even if it is physiological, is associated with significant inconveniences and problems. The woman gets tired faster, she must give up the usual rhythm of life, change the diet, visit a doctor and so on. Toxicosis often exhausts the pregnant, so the question " How to get rid of toxemia in pregnancy? "sounds in the specialist's office quite often. An unequivocal answer to such questions gynecologists do not give.

Toxicosis does not have a clear deadline, as it always depends solely on the specific situation. It is believed that the period of adaptation of the pregnant body is completed by the 14th week, which means that toxemia usually disappears at the same time. Sometimes unpleasant symptoms disappear earlier, and in a small part of pregnant women, the early toxicosis can last for the entire first half of pregnancy. The modern huge arsenal of remedies against the symptoms of early toxicosis helps to shorten its duration.

Often pregnant women confuse pregnancy symptoms( nausea, vomiting, faintness in the morning and the like) and signs of toxicosis due to their similarity, so it seems to them that the toxicosis they have been going on for too long. To properly determine and choose the right therapy( if it is needed), a specialist is needed. It is unacceptable to try to prescribe yourself a cure yourself.

Late toxicosis often appears shortly before delivery and therefore does not last long. For this form of toxicosis, it is extremely important not its duration, but clinical and laboratory manifestations. Late toxicosis will never pass independently, and a high risk of negative consequences requires emergency medical measures.

How to deal with toxemia in pregnancy

How to get rid of toxemia during pregnancy? Perhaps, every pregnant woman wants to get an answer to such a question.

Therapeutic methods of eliminating the symptoms of toxicosis are determined by several factors. It is especially important which toxicosis must be treated.

Late toxicosis always requires serious therapy, which can only be prescribed by a qualified specialist. But early toxicosis does not always require complex treatment.

In vomiting of a slight degree of severity, it is sufficient to change the diet and the rhythm of food intake to eliminate it. Food should be varied, contain enough vitamins. It is believed that food does not need to be strongly heated, it is necessary to take it in a cooled form. The amount of food eaten at one time should be small, but it is worth every two or three hours, preferably - reclining. Since along with vomiting the pregnant woman loses fluid, it must be replenished. Drinking should also not be hot, contain gas and be excessively plentiful at one time. The amount of liquid recommended by the doctor( at least 2 liters) should be divided into 5-6 receptions.

The first half of pregnancy is characterized by intensive growth of the fetus and the formation of its main systems, so the drug effect on the developing child should either be ruled out, or, if necessary, be minimal and adequate. To eliminate mild vomiting, homeopathic remedies, physiotherapy, and psychotherapy are used.

Medium and severe vomiting is treated with limited drug therapy under hospital conditions.

To reduce, and sometimes eliminate, swelling, you need to pay attention to the amount of daily drunk liquid and eaten salt. Sometimes to eliminate edema of mild degree of expression, it is sufficient to use less liquid and to exclude salted foods, to rest more.

Food should include raw and baked vegetables and fruits, honey.

It should be especially emphasized that a normal physiological pregnancy can occur accompanied by light swelling, nausea, or vomiting with a frequency no more than 2 times a day. This condition is not a toxicosis, passes by itself and does not require treatment. To eliminate unpleasant symptoms, it is sufficient to reduce the amount of food taken at a time, eat more often and exclude from the diet hard-to-digest food.

Tablets and detoxification products for pregnancy

It is not recommended to take medicines for pregnant women on their own. Any, even quite harmless for non-pregnant medicine, is not always allowed to recommend for eliminating manifestations of toxicosis, especially in the "decisive" time when the developing fetus is too vulnerable.

Among the folk remedies against early toxicosis, the most popular are:

- lobules or diluted lemon juice in the morning( immediately as it woke up);

- decoctions and infusions of mint and chemist's chamomile;

- crackers from "black"( type of "Borodino") bread, they need to dissolve if you feel worse;

- ginger, it is quite possible to eat raw, as a seasoning for any dish, add to tea.

There are no universal prescriptions for relieving the symptoms of toxicosis, every pregnant woman "invents" her method.

If you do not manage without medications, after all, you can not, and the toxicosis continues, the doctor recommends the treatment. Vomiting therapy is complex.

Usually, to combat nausea and / or mild vomiting, the following are recommended: Motilium, Cerucal, Essentiale forte, Regidron and the like. If the source of the symptoms of early toxicosis is psychoemotional tension, soothing agents, including those of plant origin, help.

Unfortunately, sometimes a severe early tokos can not tell the pregnancy. Pregnancy is interrupted in those situations when the general condition is too heavy, and the therapy did not have the expected effect within 6 to 12 hours. If signs of severe damage to liver tissue and / or kidneys appear, pregnancy is eliminated immediately. Since more often such complications of early toxicosis occur before the 12-week period, pregnancy is interrupted by artificial abortion.