Management of pregnant women with various forms of toxicosis. Early toxicosis of pregnant women

Early toxicosis during pregnancy is a woman’s health disorder associated with the adaptation of her body to bearing a fetus.

6 out of 10 women experience toxicosis in the early stages, but gynecologists do not always consider this condition a disease that necessarily requires treatment. Early toxicosis of pregnancy still has no clearly established causes, and there are no ways to prevent it. The absence of early toxicosis also does not indicate any pathology; some women do not experience it at all.

Causes of early toxicosis

The causes of early toxicosis during pregnancy have not yet been fully studied; several theories are trying to explain it, but all researchers agree on only one thing: it is the presence of the fetus in the uterus that causes the symptoms of early pregnancy. Removal ovum leads to immediate cessation of complaints.

Most likely, the causes of early toxicosis in pregnant women are caused by neuro-reflex shifts at the level of the diencephalic region of the brain, discoordination of the processes of excitation and inhibition in which occurs due to a violation of neuro-reflex impulses due to the embryo developing in the uterus and the rapidly progressing ingrowth of chorionic villi into the endometrium.

It is known that after the formation of the placenta is completed by 11-13 weeks unpleasant firsts symptoms during pregnancy subside, and the pregnant woman’s condition returns to normal.

Signs of early toxicosis

Toxicosis in early pregnancy, the treatment of which requires drug intervention, should pose a threat to the woman’s health.

Signs of pregnancy in the early stages due to gastroenterological discomfort must be distinguished from true early toxicosis of pregnancy, which is a serious functional disorder nervous system, which occurs in response to the presence of a fertilized egg.

How does early toxicosis manifest?

Early toxicosis in pregnant women can have a wide variety of symptoms, but nausea and heartburn are the leading manifestations in the vast majority of women. In the early stages, vomiting, dizziness and nausea during pregnancy are the most common forms of toxicosis, drooling is quite common, and other rare signs of early toxicosis, for example, dermatosis, are much less common. itchy skin, osteomalacia or bronchial asthma.

Vomiting during pregnancy affects 6 out of 10 women, but only 10% of them are treated. Doctors consider heartburn and nausea only as natural symptoms during pregnancy, and the pregnant woman is given only recommendations on diet and nutrition.

Vomiting is graded according to severity; there are three in total. The timing of when nausea during pregnancy, vomiting, and other signs of early toxicosis appears is important; the earlier, the more severe the course of vomiting becomes.

1 degree of severity
Vomiting and nausea occur after eating, up to 5 times a day; a pregnant woman can lose up to 3 kg of body weight. Despite general poor health and loss of appetite, her condition remains relatively satisfactory. Skin remains moist, pulse and arterial pressure within normal limits. How to deal with early toxicosis during pregnancy with such manifestations - of course, without drugs. Obstetricians do not treat this; you need to try to survive the troubles of the first trimester using only folk remedies from early toxicosis.

2nd degree of severity
Severe nausea during pregnancy occurs already in the first days and quickly develops into vomiting, which occurs regardless of food intake, up to 10 times a day. There may be a slight fever, acetone is found in the urine of half of the pregnant women, the pressure decreases, the pulse accelerates to 100 per minute, the general condition of the woman is severely disturbed, many have thoughts of terminating the pregnancy, it is so difficult to bear. Starting from the second degree of severity, toxicosis in the early stages of pregnancy is subject to drug treatment.

3 degree of severity
This is already a life-threatening condition for a pregnant woman, excessive vomiting. It repeats up to 25 times a day, and can even be triggered by movement. The pregnant woman does not want to move, lies down all the time, cannot sleep, food and water cannot be retained, vomiting occurs immediately, and loss of up to 10 kg of body weight is possible. The skin and tongue become dry, the temperature rises, the pulse reaches 120 per minute, and the blood pressure is low. Acetone is found in the urine of all women, there is often protein, hemoglobin is increased, and there are changes in the biochemical blood test.

When does early toxicosis begin and end?

Early toxicosis begins in most cases already from 5-6 weeks of pregnancy, some not so much happy women may feel the first symptoms even before the delay of menstruation. This earliest toxicosis is associated with a woman’s high sensitivity to pregnancy hormones and subsequently proceeds very hard.

The timing when early toxicosis ends depends on the severity of its course and the type of pregnancy you have, singleton or multiple. In a singleton pregnancy, early toxicosis lasts up to 11-12 weeks, and in a multiple pregnancy it goes away by 14-16 weeks of pregnancy.

Treatment of early toxicosis

At mild degree Nausea and vomiting, treatment of early toxicosis of pregnancy is carried out on an outpatient basis; with moderate and even more severe degrees, hospitalization may be required. It often happens that the very fact of excluding a pregnant woman from a stressful environment at home and at work already leads to an improvement in her condition.

Nutrition in the treatment of early toxicosis in pregnant women is of great importance; proper consumption of food in itself can reduce nausea during pregnancy. You need to eat in small portions, every 2 hours, lying down, food should be chilled, mineral water, alkaline and non-carbonated, is indicated.

Toxicosis in the early stages, treatment

The first trimester of pregnancy is characterized by the fact that the fetus is vulnerable, and many drugs can negatively affect its development, this limits the range of drugs used. Of course, you cannot prescribe anything to yourself without consulting a doctor; how to alleviate early toxicosis should be decided only with his help.

The most frequently prescribed drugs:

Cerucal (metoclopromide) refers to an anemetic, it is prescribed in extreme cases, with uncontrollable vomiting of pregnant women due to its ability to increase the tone of the uterus and thereby provoke miscarriages. In general, this drug is prohibited in the first trimester, and only in exceptional cases can it be prescribed to you.

Torekan, has a similar effect to cerucal and is also prescribed for health reasons.

Hofitol, This herbal remedy, which is an artichoke extract. The drug has an antioxidant effect and improves liver function, which can significantly eliminate nausea during pregnancy.

B vitamins. During pregnancy, the need for B vitamins increases by 40%, they active participant many metabolic processes in the mother's body and are needed developing fetus. If they are deficient, nausea in the early stages of pregnancy is more pronounced, and their administration reduces the unpleasant symptoms of toxicosis. However, the use of injectable forms increases the risk of developing an allergy to these drugs.

Droperidol, a drug that acts directly on the mother’s nervous system, can only be used when absolutely necessary. Although no teratogenic effect on the fetus has been identified, this medicine is still classified as one that is prescribed only when the benefit to the mother is higher than the risks to the fetus.

Diphenhydramine, pipolfen. These medications are usually prescribed for allergic reactions, however, due to their sedative, calming effect and normalization of work immune system they help when you feel sick during pregnancy. It must be warned that these drugs should also not be prescribed to everyone, and are indicated in the first trimester only if the obvious benefit to the mother outweighs the risk to the fetus.

Herbal infusions and herbal infusions. Herbs for early toxicosis help to safely relieve nausea during pregnancy, and can be used independently by the expectant mother, even if she is simply worried about nausea and heartburn during pregnancy. However, what to do in case of early toxicosis, specifically what herbs to drink, also needs to be agreed with your doctor, since many of them are dangerous during pregnancy, we wrote about this.

Splenin, is a drug that is made from the spleens of cattle. Nausea during pregnancy when treated with splenin is reduced by normalizing nitrogen metabolism and improving liver function.

Polyphepan, is an adsorbent that collects toxins in the stomach and intestines. Everything would be fine, but at the same time, necessary, useful substances are removed.

As you can see, any drug treatment, all pills for nausea during pregnancy, injections have negative side and carry some risk. This means you need to try to do without them. Only herbs are relatively safe and help fight early toxicosis without risk.

Often, all treatment in a hospital is limited to infusions of glucose and ascorbic acid, and this is correct, although it does not completely eliminate early toxicosis.

And most importantly, don’t forget that early nausea during pregnancy is more likely an indicator that everything is fine and going according to plan. Your pregnancy is progressing and you will soon become a mother. By 11-13 weeks you will be enjoying your condition, and you just need to try to survive what is happening now.

But it is precisely this period of pregnancy that is often complicated by early toxicosis. According to statistics, every second expectant mother suffers from this disease. Many people mistakenly consider it the norm, but this is not so: toxicosis is a pathology.

Usually the word “early toxicosis” refers only to nausea, vomiting and drooling. The medical understanding of this word is somewhat different from the everyday one: in obstetrics textbooks, everyone is considered toxicosis pathological changes in a woman’s body, which can appear in the first trimester of pregnancy. These include not only nausea and vomiting, but also some others unpleasant phenomena, occurring much less frequently (dermatoses - skin lesions, tetany - muscle cramps, osteomalacia - softening of bones, jaundice, bronchial asthma of pregnant women, etc.).

Causes

Despite numerous studies, the cause of toxicosis has not yet been found. But some hypotheses exist:

The most popular and most substantiated theory of the occurrence of toxicosis is the so-called neuro-reflex theory according to which important role disturbances in the relationships between the central nervous system and internal organs. Everyone knows that during pregnancy many women become more capricious, irritable, and whiny. This happens because during pregnancy, the historically “older” subcortical structures of the brain begin to work more intensively than usual, whereas usually a person at the highest stage of evolution has a more active cortex. But subcortical structures form the majority of protective reflexes, and wise nature, protecting pregnancy, forces this part of the brain expectant mother work more efficiently. The subcortical structures contain the vomiting center, as well as olfactory zones and cells that “control” internal organs, including the stomach, heart, blood vessels, lungs, and salivary glands. Therefore, nausea and vomiting may be preceded by such phenomena as deepening of breathing, increased heart rate, increased amount of saliva, and pallor caused by vasospasm.

Immune theory. From the first days of intrauterine life, the baby is an organism different from the mother in its antigenic composition, to which the pregnant woman produces antibodies that supposedly cause toxicosis.

Hormonal theory. Significant changes occur in the pregnant woman's body hormonal changes. In particular, a new organ that produces hormones appears - the placenta. The appearance of a new “leader” is not always liked by the nervous system and internal organs of a pregnant woman, and they react to this with symptoms of toxicosis. With vomiting of pregnant women, there is a temporary coincidence of the onset of vomiting with a peak in the content of hCG (placental hormone), and a decrease in corticosteroids in the adrenal cortex is often observed.

Psychogenic theory. It is believed that toxicosis can be the result of negative emotions: fears for the baby, fear of childbirth.

Risk factors

Although no one is immune from toxicosis, it has been noted that most often it occurs in expectant mothers suffering from chronic diseases gastrointestinal tract, liver, thyroid gland, as well as in women who have undergone induced abortions, chronic inflammatory diseases of the genital organs. Predisposing factors are frequent nervous stress and poor nutrition, asthenic type of constitution. In addition, severe forms of early toxicosis more often occur during multiple pregnancies.

How does it manifest?

The most common manifestation of toxicosis is vomit, which can occur with varying frequency, depending on the severity of toxicosis.

In mild cases of toxicosis, vomiting occurs no more than 5 times a day, and may be accompanied by a prolonged or constant feeling of nausea. Vomiting occurs on an empty stomach, can be caused by eating or unpleasant odors. In this case, the loss of body weight is either absent or small - 1-3 kg (up to 5% of body weight before pregnancy). Similar condition easy to treat at home.

In more severe cases, vomiting occurs up to 10-20 times a day and is accompanied by drooling, while the woman’s general condition significantly worsens, weakness and apathy occur. A significant amount of fluid is lost through vomit and saliva, dehydration occurs, and metabolism is disrupted. The skin becomes dry, pale, blood pressure decreases, the pulse quickens, constipation occurs, the amount of urine discharge decreases, and the temperature rises. Loss of body weight can be up to 8-10 kg or more (up to 10% of initial body weight). With the progression of this form of toxicosis, a violation of water-salt, protein, carbohydrate and fat metabolism, acid-base and vitamin balance, and the functions of the endocrine glands gradually develops. In such a situation, the supply of nutrients to the fetus is sharply disrupted, and it is during this period that the laying and formation of all the main organs and systems of the baby takes place.

Salivation(ptyalism) can accompany vomiting of pregnant women, less often it occurs as an independent form of early toxicosis. With severe drooling, a pregnant woman can lose 1 liter of fluid per day. Excessive drooling leads to dehydration of the body, loss of proteins, negatively affects mental condition women.

By 12 weeks of pregnancy, as a rule, the symptoms of early toxicosis disappear.

Diagnosis and treatment of toxicosis

Even with mild manifestations of toxicosis, the doctor will refer you for tests. You will need to take a urine test for acetone and ketone bodies, biochemical and general tests blood. In case of severe disease, the patient will be admitted to a hospital. For mild, the most common degree of toxicosis, you will be treated at home under the supervision of a antenatal clinic doctor.

To eliminate discomfort, you need to pay attention diet. With toxicosis, appetite is not always impaired, sometimes it is even increased, but more often than not even the sight of food does not evoke positive emotions, and sometimes you have to make significant efforts to force yourself to swallow even a piece. Therefore, you can satisfy your culinary whims by introducing coveted pickles, sweet buns or exotic fruits into your diet. Food should be taken frequently, 5-6 times a day, but the portions should be small and the menu varied.

It should be borne in mind that very hot or very cold food will more quickly provoke vomiting. Products should be easily digestible and contain sufficient amounts of vitamins. It is better to drink mineral alkaline water and mint tea.

If you note that it is significantly increased salivation, you will be helped by rinsing your mouth with tanning solutions that reduce this process, for example, infusions of sage, chamomile, and mint. If nausea and vomiting occur in the morning, immediately after waking up, try having breakfast in bed, placing a few crackers, lemon slices or mint gum next to the bed. It’s especially nice if in this situation the future dad shows himself to be a gentleman and serves you a light and healthy breakfast.

If nausea starts in the afternoon, then most likely this is due to nervous tension and fatigue. In this case, you can drink a soothing tea, motherwort or valerian.

If these measures do not help, be sure to inform your obstetrician-gynecologist.

Hospitalization

If the doctor discovers changes in the tests, the scale arrow stubbornly deviates to the left every day, and your health worsens, most likely will have to go to hospital. The doctors' first task will be to restore lost fluid, protein, and salts. You will be given an IV to ensure that nutrients and vitamins go directly into your blood. To suppress vomiting and nausea, drugs that block the gag reflex are used. Since, as already mentioned, the state of the nervous system has a significant impact on the severity of toxicosis, a protective treatment regime will be created in the hospital for your peace of mind. In addition, you will be prescribed medications that have a calming effect, and if there is increased salivation, medications that inhibit the action of the salivary glands. It is possible that non-drug methods will also be used: acupuncture, hypnotherapy and psychotherapy, herbal and aromatherapy. This will help reduce the number of drugs that can have undesirable effects on the developing embryo.

When, as a result of treatment, weight gain becomes obvious, daily diuresis (the amount of urine excreted), as well as pulse, blood pressure and temperature are normalized, vomiting stops or becomes less frequent, and you can return to your usual home environment. IN in rare cases complex treatment over several days turns out to be completely ineffective, and then the pregnancy has to be terminated.

Toxicosis of pregnant women is a concept that unites a group of gestational complications associated with the development of the fertilized egg and disappearing after childbirth or termination of pregnancy. Doctors associate the development of toxicosis in pregnant women with a disruption of adaptive processes in a woman’s body for pregnancy. Toxicoses are expressed by disturbances in the functioning of various systems and organs.

In medicine, early toxicosis, late toxicosis (preeclampsia) and rare forms of the complications under consideration are distinguished.

Table of contents:

Early toxicosis of pregnant women

This concept refers to gestational complications that develop in the first trimester (up to 12-13 weeks). It is early toxicosis that is most often diagnosed in pregnant women, but, as a rule, all discomfort/unpleasant sensations with such a complication disappear without a trace and do not pose a threat to the fetus or the woman herself.

Reasons for the development of early toxicosis

In the course of research into the complication in question, it was concluded that several factors could be the reasons for its development:

Every pregnant woman may have all these factors, and which one will play a role? main role doesn't matter. Doctors have noted that early toxicosis is severe in women with a burdened somatic status, that is, they have a history of nephritis and duodenal ulcers. With almost 100% confidence, doctors predict the appearance of early toxicosis in pregnant women who have had abortions and have a history of chronic diseases of the female reproductive system (,).

Symptoms of early toxicosis in pregnant women

The most characteristic signs of early toxicosis, which appear at 5-6 weeks of pregnancy, are considered to be a sudden change in taste and olfactory perceptions, drowsiness, lethargy and loss of appetite. The doctor can objectively determine weight loss, lowering blood pressure, increasing azotemia in the blood, the appearance of acetone in the urine and electrolyte disturbances . Depending on how severe the vomiting is, doctors distinguish several degrees of early toxicosis:

Note:severe early toxicosis leads to hemorrhages in the conjunctiva, increased heart rate up to 120 beats per minute, and hypotension, the general condition of the pregnant woman worsens. In this case, the gynecologist will insist on hospitalization of the pregnant woman.

Diagnosis of early toxicosis in pregnant women

The type of gestational complication in pregnant women in question is identified by analyzing the woman’s complaints, based on objective data and the results of additional examinations. A gynecologist examines a woman in a chair and performs a test, which helps to ensure the presence of a fertilized egg in the uterus, determine the duration of pregnancy and make sure normal development fetus

If a pregnant woman has complaints characteristic of early toxicosis, then she must undergo treatment, and.

Treatment of early toxicosis in pregnant women

A mild degree of early toxicosis in pregnant women does not require hospitalization, but the woman still needs to apply some methods to improve her well-being. Usually everything is limited to taking (or motherwort infusion), vitamins and antiemetics (cerucal). If the type of gestational complication in question is accompanied by excessive salivation, then the doctor may recommend rinsing the mouth with infusions of chamomile (these plants have tanning properties). To reduce the intensity of nausea and vomiting, it is necessary to correct the pregnant woman’s diet - it should be fractional, the food should be easily digestible, and the food should be taken in small portions.

Note: any medications and infusions of sedative herbs are prescribed to a pregnant woman only by a gynecologist. Independent choice treatment of early toxicosis is fraught with pregnancy complications.

With a moderate degree of early toxicosis, the pregnant woman is treated in an inpatient setting, where she is prescribed infusion therapy - intravenous administration Disol/Acesol/Trisol ( saline solutions), glucose, hepatoprotectors, vitamins and protein preparations. To stop attacks of vomiting, a woman is advised to use antipsychotic drugs; an excellent effect is also observed during physiotherapy - for example, electrophoresis, electrosleep, acupuncture.

Severe early toxicosis in pregnant women is a critical condition, so such patients are treated in intensive care units under constant monitoring of hemodynamic and laboratory parameters. Treatment comes down to infusions of solutions in a volume of at least three liters, the introduction of neuroleptics, hepatoprotectors, and antiemetics.

Note:a severe degree of early toxicosis can result in coma and death of the woman, so most often in this case, doctors perform an artificial termination of pregnancy for medical reasons. It often happens spontaneous interruption pregnancy.

Early toxicosis, in most cases, is considered normal occurrence, if it occurs in mild to moderate severity. Most often, the unpleasant symptoms of the phenomenon in question disappear after 12-13 weeks of pregnancy, and if this does not happen, the gynecologist will conduct a full examination of the patient to exclude hepatitis, pancreatitis, hepatosis and hydatidiform mole.

Late toxicosis of pregnant women (gestosis)

Late toxicosis, or gestosis, in pregnant women is a complication of pregnancy in the third trimester, which is characterized by the development of deep disorders in vital organs and systems. Late toxicosis begins to develop after 18-20 weeks of pregnancy, but it is diagnosed only at 26-28 weeks of pregnancy.

Causes of late toxicosis

Modern gynecology has several theories about the reasons for the development of this type of gestational pregnancy complication, which is why this condition is often called the “disease of theories.” Let's highlight the most popular opinions:

1. Hormonal disorders. There is a disruption in the regulation of vital functions, which leads to an immunological conflict between the fetus and the mother.
2. Corticovisceral theory. During pregnancy, disruptions may occur in the relationship between the cortex and subcortical structures of the brain, and this provokes reflex changes in the blood vessels and circulatory system.
3. Generalized vasospasm. This leads to disruption of the blood supply to organs and tissues, blood pressure increases, and the total volume of blood that circulates in the vascular bed decreases.
4. Damage to the inner lining of blood vessels. This violation leads to oxygen starvation cells of the brain, kidneys and liver.

Symptoms of gestosis (late toxicosis)

The very first manifestation of this type of gestational complication is dropsy, which is characterized by fluid retention in the body and the appearance of persistent edema. At first they may be hidden and can be detected only after studying the graph of the pregnant woman’s weight gain, but after the swelling becomes obvious and pronounced, the doctor classifies the stages of dropsy:

• Stage 1– swelling spreads only to the lower extremities, and specifically, covers the legs and feet;
• Stage 2– swelling is present both in the lower extremities and on the anterior abdominal wall of the abdomen;
• Stage 3 dropsy– swelling is present on the lower and upper extremities, face and abdomen;
• 4 stud ia - edema acquires a universal, generalized character.

Note:with dropsy general health pregnant women, as a rule, are not disturbed. But if the swelling is severe, the patient will complain of increased fatigue, thirst and a feeling of heaviness in the legs.

After a pregnant woman has developed nephropathy, which will be characterized by a combination of three symptoms - edema, hypertension and proteinuria (the appearance of protein in the urine). Even if only two of these symptoms are present, the doctor will diagnose pregnancy nephropathy. It is worth noting that for pregnant women in the third trimester it will not be stable, but wave-like. To track these jumps, you need to compare pressure indicators in the first months of pregnancy and the current period of gestation.

Note:development dangerous complications with gestosis (for example, premature detachment placenta, bleeding or fetal death) is often provoked not by high blood pressure, but by its fluctuations.

Pregnancy prognosis with nephropathy is very variable. Combined forms significantly worsen the prognosis late toxicosis- for example, if a woman has developed nephropathy against the background of previously diagnosed nephritis. A long course of nephropathy can progress to the next stage of development of late toxicosis - preeclampsia.

Preeclampsia characterized by a circulatory disorder of the central nervous system. Symptoms of preeclampsia will include not only manifestations of nephropathy, but also nausea and vomiting. Memory impairment, lethargy, indifference to the outside world and loved ones, visual disturbances, and pain in the epigastric region are noted.

There are a number of indicators that will indicate the development of preeclampsia and late toxicosis of pregnancy:

• blood pressure – 160/110 and above;
• diuresis – less than 400 ml;
• nausea and vomiting;
• amount of protein in urine – 5 grams or more per day;
• disorders of brain activity;
• visual disturbances;
• decrease in platelets in the blood;
• liver dysfunction;
• decreased blood clotting rates.

The development of a seizure in eclampsia can be triggered by any external stimulus - for example, sharp pain, bright light, stress or loud sound. The duration of an attack of convulsions is 1-2 minutes, it begins with twitching of the muscles of the eyelids, face, and then spreads to the muscles of the upper/lower limbs and the whole body. During a convulsive seizure, a pregnant woman’s gaze freezes, her pupils roll back, the corners of her mouth droop, and her fingers clench into fists.

30 seconds after the onset of an attack of eclamptic convulsions, a woman begins to have tonic convulsions - the pregnant woman’s body tenses and stretches, the spine arches, the head falls back, the jaw clenches tightly, and the skin acquires a bluish tint. Since during an attack the respiratory organs are involved, a disruption of this activity and loss of consciousness occurs.

Note:just at the moment of loss of consciousness in a pregnant woman who is in a convulsive seizure against the background of eclampsia, hemorrhage in the brain and rapid death can occur.

10-20 seconds after tonic convulsions, clonic convulsions begin to develop - the woman literally convulses, continuously moving her arms and legs, as if bouncing in bed. Such convulsions last a maximum of one and a half minutes, and then hoarse breathing appears, with foam coming from the mouth.

Important:after the end of the convulsive attack, the pregnant woman remembers nothing about it, feels severe weakness and headache. Any irritant, including injections medicines, can provoke the onset of a new attack.

Nonconvulsive eclampsia is considered a very dangerous condition - a comatose state develops suddenly against the background of high blood pressure. This type of eclampsia is characterized by extensive hemorrhage in the brain and death of the woman.

Diagnostic measures

When diagnosing the type of gestational complication in question, the gynecologist takes into account the woman’s complaints, pays attention to her appearance (swelling can be detected) and is guided by the results of the examinations. To determine the degree of late toxicosis, a pregnant woman is sent for blood and urine tests, and she is also examined by an ophthalmologist.

If there is a suspicion of the development of gestosis (late toxicosis), then ultrasound and Doppler sonography are required - this will help assess the condition of the fetus and placental blood flow.

Treatment of late toxicosis (preeclampsia)

Treatment of gestosis in the conditions of outpatient management of a pregnant woman is allowed only if it is mild; in all other cases, the woman is hospitalized in institutions where there is an intensive care unit and everything necessary for urgent delivery.

The goal of treating gestosis is to normalize the functioning of the central nervous system, stabilize metabolic processes, and normalize blood pressure. The duration of therapy for late toxicosis depends only on the intensity of its manifestation.

Note:independent childbirth in case of severe toxicosis of pregnant women is allowed only if the condition of the mother in labor is satisfactory, the therapy was effective, and there are no disturbances in the intrauterine development of the fetus. Even slight negative dynamics are an indication for surgical delivery.

Rare toxicoses of pregnant women

If we talk about rare forms of toxicosis in pregnant women, it is worth highlighting several of the most pronounced.

Dermatoses of pregnant women

They arise against the background of hormonal disorders, “failures” of metabolic processes and an imbalance between the cortex and subcortical structures of the brain. Such toxicoses appear almost immediately after conception and disappear after childbirth.

Dermatoses of pregnant women are manifested by erythema and herpetic rashes. They do not pose any danger to the life of the mother and fetus, but treatment is necessary, as this will alleviate the woman’s condition.

As part of measures aimed at getting rid of this form of rare gestational complication, a diet with limited proteins and fats is prescribed. Of the medications, those that can normalize metabolism will be effective.

Jaundice of pregnancy

Most often it occurs in the third trimester of pregnancy, but can also accompany early toxicosis, which is severe. When it appears in pregnant women, the doctor must necessarily conduct an examination of the woman in order to differentiate the condition in question from pathological damage to the liver and/or biliary tract.

Treatment of jaundice in pregnant women consists of prescribing a balanced diet and using certain medications - for example, cholestyramine or Nerabol. It is allowed to use antihistamines and phenobarbital in the treatment of jaundice in pregnant women, and if the clinical manifestations of the form of gestational complication in question increase, and are even accompanied by a severe course of early or late toxicosis, then the woman will be advised to terminate the pregnancy.

Acute fatty hepatosis of pregnant women

Extremely dangerous condition, which develops at 33-40 weeks of pregnancy. It always begins acutely, and in almost all cases ends in the death of the fetus or the woman herself.

Treatment of acute fatty hepatosis in pregnant women involves immediate termination of pregnancy, detoxification therapy and the introduction of protein/lipotropic agents.

Chorea of ​​pregnancy

This form is associated with a disturbance in calcium metabolism, which occurs due to hypofunction of the parathyroid glands. Chorea of ​​pregnancy manifests itself as convulsive twitching of the muscles of the upper/lower extremities. Most often, this form of rare toxicosis occurs in women with a history of rheumatism.

Treatment of chorea in pregnant women is carried out in a hospital; the woman is prescribed sedatives and drugs that can normalize calcium metabolism (vitamins D, E and calcium gluconate).

Osteomalacia

This is an extremely rare form of toxicosis in pregnant women, its development is due to decalcification of bones and their softening. Most often the pelvic bones and spine are affected, this process is accompanied by severe pain and deformation of the affected bones.

Treatment of osteomalacia in pregnant women involves therapy aimed at normalizing phosphorus-calcium metabolism.

Toxicoses in pregnant women are disorders in the body that are associated with the onset of conception. Doctors pursue the goal not only to alleviate the woman’s condition, but also to maintain normal intrauterine development fetus Regardless of what type of toxicosis develops in a pregnant woman and to what degree of severity it occurs, the woman should be under the supervision of a gynecologist, and in most cases, undergo hospital treatment.

Tsygankova Yana Aleksandrovna, medical observer, therapist of the highest qualification category

Toxicoses(gestosis) are conditions of pregnant women that arise in connection with the development of the entire fetal egg or its individual elements, characterized by a multiplicity of symptoms, of which the most constant and pronounced are dysfunction of the central nervous system, vascular disorders and metabolic disorders. When the fertilized egg or its elements are removed, the disease usually stops. These states Pregnant women are classified according to the date of occurrence. There are early toxicoses and late gestosis. They differ in their clinical course. Early toxicosis is usually observed in the first trimester, and it resolves at the beginning of the second trimester of pregnancy. Preeclampsia occurs in the second or third trimesters of pregnancy.

PATHOGENESIS

There were many theories trying to explain the mechanism of development of early toxicosis: reflex, neurogenic, hormonal, allergic, immune, corticovisceral. In the pathogenesis of early toxicosis, the leading role is played by disruption of the functional state of the central nervous system. IN early dates During pregnancy, symptoms of early toxicosis (neurosis) are manifested by dysfunction of the gastrointestinal tract. Food reflexes are associated with the vegetative centers of the diencephalic region. Afferent signals arriving here from the periphery may be perverted in nature (either due to changes in the uterine receptors or in the pathways); changes are also possible in the centers of the diencephalic region themselves, which can change the nature of the response efferent impulses. If the sensitivity of the system is impaired, a change in reflex reactions and disturbances in nutritional functions quickly occur: loss of appetite, nausea, salivation (salivation), vomiting. Neuroendocrine and metabolic disorders play a huge role in the occurrence of early toxicosis; therefore, as the disease progresses, changes in water-salt, carbohydrate and fat metabolism gradually develop against the background of increasing exhaustion and loss of body weight. Hormonal imbalance can cause pathological reflex reactions. When vomiting in pregnant women, a temporary coincidence of the onset of vomiting with the peak of human chorionic gonadotropin levels is noted, and a decrease in corticosteroid function of the adrenal glands is often noted.

CLINICAL COURSE

There are common (vomiting of pregnant women, salivation) and rare forms of early toxicosis (dermatoses of pregnancy, tetany, osteomalacia, acute yellow atrophy of the liver, bronchial asthma of pregnant women).

Vomiting of pregnancy(emesis gravidarum) occurs in approximately 50-60% of pregnant women, but no more than 8-10% of them require treatment. The earlier vomiting during pregnancy occurs, the more severe it is. Depending on the severity of vomiting, there are three degrees of severity: mild, moderate and severe.

For mild (grade I) vomiting of pregnancy the general condition of the patient remains satisfactory. Vomiting occurs 5 times a day, often after meals, sometimes on an empty stomach. This reduces appetite and depresses the mood of a pregnant woman. The patient loses no more than 3 kg in weight, body temperature remains within normal limits. Humidity skin and mucous membranes remains normal, the pulse rate does not exceed 80 beats/min. Blood pressure does not change. Clinical tests urine and blood without pathological changes.

II degree – vomiting medium degree gravity .The woman’s general condition is noticeably disturbed: vomiting is observed from 6 to 10 times a day and is no longer associated with food intake, body weight loss is from 2 to 3 kg in 1.5-2 weeks. Possible low-grade fever. The moisture content of the skin and mucous membranes remains normal. 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 woman's general condition deteriorates sharply. Vomiting occurs up to 20-25 times a day, sometimes with any movement of the patient. Disturbed sleep, weakness. Loss of body weight up to 8-10 kg. The skin and mucous membranes become dry, the tongue is coated. Body temperature rises (37.2-37.5° ). Tachycardia up to 110-120 beats/min, blood pressure decreases. Pregnant women do not retain food or water, which leads to dehydration and metabolic disorders. All types of metabolism are disrupted. Daily diuresis is reduced, acetonuria, often protein and casts in the urine. Sometimes the hemoglobin content in the blood increases, associated with dehydration. Blood tests show hypo- and dysproteinemia, hyperbilirubinemia, increased creatinine. Shift in acid-base balance towards acidosis. When examining electrolytes, a decrease in potassium, sodium and calcium is found.

SCHEME FOR ESTABLISHING THE SEVERITY OF VOMITING IN PREGNANCY

Symptoms	Severity of vomiting during pregnancy
	Lightweight	Average	Heavy
Appetite	Moderately reduced	Significantly reduced	Absent
Nausea	Moderate	Significant	Constant, painful
Salivation	Moderate	Expressed	Thick viscous
Frequency of vomiting (per day)	3-5 times	6-10 times	11-15 times and more often (up to continuous)
Pulse rate	80-90	90-100	Over 100
Systolic blood pressure	120-110 mm Hg.	110-100 mm Hg.	Less than 100 mm Hg.
Food retention	Mainly held	Partially held	Don't hold
Weight loss	1-3 kg (up to 5% of the original weight)	3-5 kg ​​(1 kg per week, 6-10% of initial weight)	More than 5 kg (2-3 kg per week, more than 10% of the initial weight)
Dizziness	Rarely	In 30-40% of patients (moderately expressed)	In 50-60% of patients (significantly expressed)
Low-grade fever	ѕ	Rarely observed	In 35-80% of patients
Yellowness of the sclera and skin	ѕ	In 5-7% of patients	In 20-30% of patients
Hyperbilirubinemia	ѕ	21-40 µmol/l	21-60 µmol/l
Dry skin	- +	++	+++
Chair		Once every 2-3 days	Retention of stool
Diuresis	900-800 ml	800-700 ml	Less than 700ml
Acetonuria	ѕ	Periodically in 20-50%	In 70-100%

Manifestations of early toxicosis in pregnant women must be differentiated from a number of diseases in which vomiting is also observed (foodborne toxic infection, gastritis, pancreatitis, cholelithiasis, stomach cancer, neuroinfection, etc.).

TREATMENT

Treatment of patients with vomiting of pregnancy should be complex and differentiated with simultaneous multilateral impact on various aspects of the pathogenesis of the disease.

Complex therapy for vomiting during pregnancy includes drugs that affect the central nervous system, normalize endocrine and metabolic disorders (in particular, water and electrolyte balance), antihistamines, and vitamins. During treatment, it is necessary to observe a therapeutic and protective regime. You cannot place two similar patients in a ward, since a recovering woman may experience a relapse of the disease under the influence of a patient with ongoing vomiting.

To normalize the function of the central nervous system, electrosleep or electroanalgesia is used. The duration of exposure is 60-90 minutes. The course of treatment consists of 6-8 sessions. Hypnosuggestive therapy can be used to influence the central nervous system. Gives a good effect various options reflexology.

To combat dehydration of the body, to detoxify and restore the CBS, infusion therapy is used in an 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 (at the rate of 1 unit of insulin per 4.0 g of dry matter glucose). To correct hypoproteinemia, albumin (10.0 or 20.0% solution in an amount of 100-150 ml) and plasma are used. If CBS is violated, 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 quickly improves.

To suppress the excitability of the vomiting center, you can use cerucal, torekan, droperidol, etc. The basic rule is drug therapy for severe and moderate vomiting, the parenteral method of administration is used for 5-7 days (until a lasting effect is achieved).

Complex therapy for vomiting during pregnancy includes intramuscular injections vitamins (B

1, V 6, V 12 , C) and coenzymes (cocarboxylase). They use diprazine (pipolfen), which has a sedative effect on the central nervous system and helps reduce vomiting. The drug has prolonged antihistamine activity. The complex of drug therapy also includes other antihistamines - suprastin, diazolin, tavegil, etc.

The criteria for the sufficiency of infusion therapy are a decrease in dehydration and an increase in skin turgor, normalization of the hematocrit value, an increase in diuresis, and an improvement in well-being. Complex therapy is continued until vomiting stops and normalization occurs. general condition, gradual increase in body weight. Discharge 5–7 days after cessation of vomiting.

The ineffectiveness of the therapy is an indication for termination of pregnancy.

Indications for termination of pregnancy are:

Continuous vomiting;

Increasing dehydration of the body;

Progressive loss of body weight;

Progressive acetonuria for 3-4 days;

Severe tachycardia;

Dysfunction of the nervous system (adynamia, apathy, delirium, euphoria);

Bilirubinemia (up to 40-80 µmol/l), and hyperbilirubinemia 100 µmol/l is critical;

Jaundice staining of the sclera and skin.

The basis for the prevention of early toxicosis is the identification and elimination of psychogenic factors and the improvement of the health of women with chronic diseases of the liver, gastrointestinal tract, etc. before pregnancy.

Salivation(ptyalismus) can accompany vomiting of pregnant women, less often it occurs as an independent form of early toxicosis. With severe drooling, a pregnant woman can lose 1 liter of fluid per day. Excessive salivation leads to dehydration of the body, hypoproteinemia, maceration of the facial skin, negatively affects the psyche, and body weight decreases.

Severe drooling should be treated in a hospital. Prescribe rinsing the mouth with an infusion of sage, chamomile, oak bark, menthol solution and agents that reduce salivation (cerucal, droperidol). If there is a large loss of fluid, Ringer-Locke solutions and 5.0% glucose are prescribed intravenously. With significant hypoproteinemia, infusion of albumin and plasma solutions is indicated. A good effect is achieved through hypnosis and acupuncture. To prevent and eliminate maceration of facial skin with saliva, lubricate it with zinc paste, Lassar paste or Vaseline.

Dermatoses of pregnant women– rare forms of early toxicosis. This is a group of different skin diseases, which occur during pregnancy and disappear after its end. Dermatoses appear in the form of itching, urticaria, and herpetic rashes.

The most common form of dermatosis is pregnancy itch (pruritus gravidarum). Itching may appear in the first months and at the end of pregnancy, limited to the external genital area or spread throughout the body. The itching is often painful and causes insomnia, irritability or depressed mood. Itching during pregnancy must be differentiated from diseases that are accompanied

itching: diabetes, fungal diseases skin, trichomoniasis, allergic reactions.

Treatment consists of prescribing sedatives, desensitizing agents (diphenhydramine, pipolfen), B vitamins

1 and B 6 , general ultraviolet irradiation.

Tetany of pregnant women(tetania gravidarum) is manifested by muscle spasms of the upper extremities ("obstetrician's hand"), less often the lower extremities ("ballerina's leg"), and the face ("fish mouth"). The basis of the disease is a decrease or loss of function of the parathyroid glands and, as a consequence, a violation of calcium metabolism. In case of severe disease or exacerbation of latent tetany during pregnancy, the pregnancy should be terminated. Parathyroidin, calcium, dihydrotachysterol, and vitamin D are used for treatment.

Osteomalacia in pregnancy (oste omalacia gravidarum) in expressed form is extremely rare. Pregnancy in these cases is absolutely contraindicated. An erased form of osteomalacia - symphysiopathy - is more often observed. The disease is associated with impaired phosphorus-calcium metabolism, decalcification and softening of skeletal bones. The main manifestations of symphysiopathy are pain in the legs, pelvic bones, and muscles. General weakness, fatigue, paresthesia appear; the gait changes ("duck-like"), tendon reflexes increase. Palpation of the pubic joint is painful. Radiographs of the pelvis sometimes reveal discrepancy in the bones of the pubic joint, however, unlike true osteomalacia, there are no destructive changes in the bones. The erased form of osteomalacia is a manifestation of hypovitaminosis D.

Treatment of the disease. The use of vitamin D has a good effect, fish oil, general ultraviolet irradiation, general and local, progesterone.

Acute yellow atrophy of the liver.(atrophia heratis blava acuta) is extremely rare and can be the result of excessive vomiting of pregnancy or occur independently of it. As a result of fatty and protein degeneration of liver cells, the size of the liver decreases, necrosis and liver atrophy occur. The disease is extremely severe (intense jaundice, itching

,vomiting, seizures, coma), usually leads to the death of the patient.

Treatment is immediate termination of pregnancy, although termination of pregnancy rarely improves the prognosis.

Bronchial asthma in pregnant women(asthma bronchiale gravidarum) is observed very rarely. The cause of bronchial asthma is hypofunction of the parathyroid glands and calcium metabolism disorders.

Treatment: Calcium preparations, B vitamins, sedatives usually give a positive result.

Bronchial asthma in pregnant women must be differentiated from exacerbation of bronchial asthma that existed before pregnancy.

Prevention of early toxicosis is timely treatment chronic diseases, elimination of mental stress, adverse effects of the external environment.

Early diagnosis and treatment of the initial (mild) manifestations of toxicosis are of great importance, and, consequently, preventing the development of severe forms of the disease.

Toxicosis, or gestosis, is a painful condition that develops during pregnancy, the occurrence of which is associated with the formation of the fertilized egg and its individual elements. In this case, the symptoms can be quite varied, but the most pronounced and frequent signs are:

• disruption of the normal functioning of the central nervous system;
• disorders of the vascular system;
• metabolic disorders.

Termination of pregnancy leads to the disappearance of the clinical picture.

Timing of occurrence

In accordance with the period of development, toxicosis is divided into early and late. They have significant differences in the clinical course. The early form of toxicosis appears in the first trimester and goes away by the beginning of the second.

Late gestosis develops in the next two trimesters.

- a phenomenon so common that its symptoms are considered a classic picture of pregnancy. This approach is erroneous, since gestosis is a consequence of a violation of the mechanism of regulation of behavioral reactions and metabolic processes, i.e. is a pathological condition, while pregnancy is a normal, albeit special, state of the female body.

Causes

The exact cause of toxicosis has not yet been found. Scientists offer several basic theories.

Nervous-reflex theory of toxicosis

According to this theory, the development of the disease is caused by a disruption in communication between the central nervous system and internal organs. It is known that pregnancy makes women more irritable and moody. Experts explain this by activation of subcortical structures, while in the normal state core is the cerebral cortex. The subcortex is responsible for the formation of protective reflexes, and through its stimulation, Nature protects pregnancy. It is in this area that the olfactory and vomiting centers are located, the zone of control of internal organs: salivary glands, blood vessels, heart, lungs. For this reason, increased salivation, tachycardia, deep breathing, and vascular spasm often occur to the point of nausea, leading to noticeable pallor of the skin.

Immune theory

From the very moment of conception, the fetus differs from the maternal body in its antigenic composition, resulting in the production of antibodies to it. Some experts believe that toxicosis is the result of their synthesis.

Hormonal theory

The onset of pregnancy is associated with major changes hormonal levels. The appearance of a placenta that produces its own hormone (hCG) leads to a reaction from the nervous system and internal organs, manifested in the form of toxicosis. The time of vomiting coincides with the moment of increase in the level of human chorionic gonadotropin. The production of corticosteroids in the adrenal cortex is often simultaneously reduced.

Psychogenic theory of toxicosis

According to adherents of this theory, the cause of toxicosis in pregnant women is a feeling of anxiety for the unborn child and fear of the upcoming birth.

Risk factors

Toxicosis can develop in any woman, but the following factors create especially favorable conditions for it:

• diseases of the gastrointestinal tract;
• liver problems;
• pathology endocrine system(in particular, the thyroid gland);
• previous inflammation of the genital organs;
• abortions;
• stress;
• asthenic physique;
• poor nutrition;
• multiple pregnancy.

General symptoms

In early toxicosis the following are observed:

• deterioration of condition;
• weakness;
• irritability;
• drowsiness;
• depression;
• poor appetite;
• weight loss;
• nausea;
• vomit;
• change in taste sensations.

Types of early toxicosis

The most common forms of manifestation of this condition are:

• vomit;
• salivation.

Much less common:

• dermatoses of pregnant women;
• tetany;
• osteomalacia;
• bronchial asthma of pregnant women;
• acute yellow liver atrophy.

Vomiting of pregnancy

Vomiting is one of the most common symptoms of toxicosis. Occurs in more than 60% of cases. As a rule, when early occurrence it is particularly difficult. According to the severity, three degrees of vomiting are distinguished.

1. Lightweight , in which it occurs up to 5 times a day, mainly after meals. It does not affect the general condition of the woman. Weight loss – up to 3 kg.

2. Moderate . The frequency of manifestation is up to 10 times, both after meals and on an empty stomach. A noticeable violation of the general condition is recorded. In 10-15 days, a woman can lose up to 3 kg of weight. The degree of moisture of the skin and mucous membranes remains within normal limits. There may be a slight decrease in blood pressure and tachycardia, the presence of acetone bodies in the urine.

3. Heavy . Characterized by a sharp deterioration in the woman’s condition. Vomiting occurs with the slightest movements, up to 25 times a day. Weight loss is 8-10 kg. Dry skin and mucous membranes and a coated tongue are observed. Sleep is disturbed. Blood pressure drops sharply, tachycardia is recorded. The inability to retain food and water leads to dehydration, metabolic disorders, and increased hemoglobin levels. Diuresis decreases, protein and casts are found in the urine. The study of electrolytes reveals a decrease in the level of sodium, potassium, and calcium.

Treatment

Vomiting is treated comprehensively. Therapy includes:

1. Use of drugs to eliminate metabolic and endocrine disorders.

2. The function of the central nervous system is regulated with the help of electroanalgesia, electrosleep, hypnosuggestive therapy, and reflexology.

3. Infusion therapy is used to detoxify and eliminate signs of dehydration. Hypoproteinemia is eliminated by administering albumin.

4. To suppress the excitability of the vomiting center, cerucal, droperidol or torekan are prescribed.

5. Injections of vitamins C, group B, cocarboxylase.

6. Antihistamines: diazolin, tavegil, suprastin. It is possible to use diprazine: the drug suppresses or reduces vomiting due to its sedative effect on the central nervous system.

7. Methionine – prevents and treats toxic lesions of liver tissue. Splenin can be used, which significantly increases the detoxification function of the liver and improves immunity.

Salivation

Drooling usually accompanies vomiting, but can also occur independently. With significant severity of this form of toxicosis, a loss of up to 1 liter of fluid per day is possible, which leads to dehydration, maceration of the facial skin, and hypoproteinemia. This condition has a very negative effect on the psyche.

Treatment

In case of severe drooling, inpatient treatment is carried out.

1. Rinse with infusion of chamomile, oak bark, sage, and menthol.

2. If there is significant loss of fluid, a 5% glucose solution, Ringer-Locke solution, is injected intravenously.

3. Severe hypoproteinemia is an indication for infusion of plasma solution, albumin.

4. Atropine is prescribed (subcutaneously or orally).

5. Hypnosis also proves effective.

6. Maceration of the skin with saliva can be eliminated or prevented by applying Lassara paste or zinc paste.

Dermatosis of pregnant women

Dermatoses include a group of skin diseases that develop during pregnancy and disappear after its end.

1. The most common form is pregnancy itch. It may appear only in the vulva area or spread to the entire body. When severe, it leads to increased irritability and sleep disturbances. When itching occurs, it is necessary to differentiate from other pathologies accompanied by this symptom:

• diabetes mellitus;
• trichomoniasis;
• fungal skin diseases;
• allergic reactions.

2. A rarer manifestation of dermatoses is eczema, the causative agents of which are herpetic viruses.

3. The most dangerous is impetigo herpetiformis, which often leads to death. Its appearance is caused by endocrine disorders - in particular, disruption of the parathyroid glands. Main symptoms:

• pustular rash;
• chills;
• septic fever (can be long-lasting or intermittent);
• vomit;
• diarrhea;
• convulsions;
• rave.

Treatment

1. Itching is treated with sedatives: pipolfen, diphenhydramine. B1 and B6 are also assigned. Ultraviolet irradiation gives good results.

2. When treating eczema, the following is prescribed:

• calcium preparations;
• dihydrotachysterol;
• glucocorticoids;
• warm baths with a solution of potassium permanganate;
• disinfectant ointments;
• opening of pustules.

If there is no result, the pregnancy must be terminated.

Bronchial asthma in pregnant women

This form of toxicosis is characterized by a severe course. It occurs extremely rarely. The main symptoms are:

• attacks of suffocation;
• dry cough of a chronic nature.

There is an assumption that the development of asthma is associated with decreased function of the parathyroid glands, accompanied by disturbances in calcium metabolism. The condition must be differentiated from the acute period of asthma that existed before pregnancy.

Treatment

Are used:

• calcium preparations;
• vitamin D;
• sedatives.

Osteomalacia

Pathology occurs against the background of a disturbance in phosphorus-calcium metabolism, leading to decalcification and softening of bones. Main symptoms:

• pain in the muscles, pelvic bones, lower extremities;
• pain of the pubic joint on palpation;
• general weakness;
• increased fatigue;
• paresthesia;
• change in gait (the so-called “duck walk”);
• increased tendon reflexes.

Sometimes x-rays reveal bone discrepancies in pubic joint. The difference from true osteomalacia is the absence of destructive changes. A manifestation of the erased form of the disease is hypovitaminosis D.

Tetany

The cause of the disease is loss or decreased function of the parathyroid glands, which results in a disturbance of calcium metabolism. Main manifestations:

• muscle cramps in the arms – “obstetrician’s hand”;
• leg muscle cramps - “ballerina’s leg”;
• spasms of the facial muscles - “fish mouth”.

In case of exacerbation or severe course, the pregnancy is terminated.

Treatment

Prescribed:

• parathyroidin;
• calcium;
• dihydrotachysterol;
• vitamin D

Acute yellow atrophy of the liver in pregnant women

The disease develops as a result of severe vomiting of pregnant women or independently:

• the liver decreases in size as a result of protein or fatty degeneration;
• jaundice occurs;
• severe nervous disorders appear;
• Coma ensues, leading to the death of the patient.

The duration of the entire process is 14-20 days. Liver atrophy is a direct indication for immediate termination of pregnancy, although such a measure does not always lead to recovery.

Diagnostics

When symptoms of toxicosis appear, the following studies are prescribed:

• general blood analysis;
• determination of biochemical parameters: fibrinogen, total protein and fractions, liver enzymes, CBS, electrolytes;
• Analysis of urine;
• determination of daily diuresis;
• measurement of pulse and blood pressure;
• control the frequency of vomiting.

Prevention

Main preventive measures are:

• early treatment of chronic diseases;
• psychophysical preparation for pregnancy;
• elimination of adverse environmental factors;
• elimination of stress and correction of emotional background;
• balanced diet.

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