The etiology of vomiting in a pregnant woman remains to this day the riddle of .The most common is the theory of neural-reflex mechanisms, which argues that great importance in the development of pathology belongs to violations of the regulation of the central nervous system by the work of internal organs. Also, an important role is played by the presence of excitation zones in the subcortical structures of the brain( reticular formation, regulatory centers in the medulla oblongata).In these areas, the location of the emetic center and the trigger zone with chemoreceptors that regulate the course of the emetic act is assumed. Not far from these structures are also the centers of respiration, salivation, the vasomotor regulator and the nucleus of the olfactory analyzer of the brain. Their close location with structures that regulate vomiting causes simultaneous nausea with the appearance of a number of concomitant disorders of the functions of various organs: increased saliva secretion, increased frequency and depth of breathing, increased heart rate, blanching of the skin as a result of spasmodic vessels located on the periphery.
The occurrence of excitation and its predominance among the subcortical structures of the brain, which leads to an increase in the activity of the autonomic nervous system( which causes to call for vomiting ) is associated with the presence of various pathological processes in the female genital organs( chronic foci of inflammatory diseases or transferred diseases).This causes a disruption in the functioning of the receptor apparatus of the uterus. It is also suggested that the receptors are damaged by a growing fetal egg, which can occur as a result of a violation of the normal, physiological relationships between the woman's organism and the embryo that forms in the early stages of pregnancy.
In addition to all of the above, a variety of disorders of autonomic nervous system functions in the initial stages of gestation can arise as a result of hormonal changes in the maternal organism( for example, an increase in the concentration of serum chorionic gonadotropin).In the case of the development of pathologies such as multiple pregnancy or bladder drift, in which the amount of this blood increases significantly, the likelihood of vomiting is significantly increased.
- 1 Factors that increase vomiting
- 2 Pathogenetic mechanism
- 3 Degrees and clinical signs of vomiting
- 4 Pregnancy termination
- 5 Treatment
Factors strengthening vomiting attacks
Various diseases of other organs contribute to the development of toxicosis and weighting of vomiting. Particularly strong effect will have the presence of:
- Chronic inflammatory processes in the gastrointestinal tract;
- Diseases of the liver;
- Asthenic syndrome.
Pathogenetic mechanism of
In the pathogenesis of this pathological condition, the main role is played by changes in the nervous and endocrine regulation of all metabolic variants, which leads to dehydration of the body and complete( or partial) cessation of nutrient intake of . Vomiting of pregnant , as it develops, causes a gradual disruption in the balance of water and salts, the exchange of proteins, fats and carbohydrates in the maternal body, taking place against the background of increased dehydration, weight loss and development of exhaustion. As a result of starvation, first of all, there is an expenditure of glycogen stores, which are contained in the liver and some other organs. Then, activation of catabolic reactions occurs, the activity of protein and fat cleavage increases. At the same time, the satisfaction of the energy requirements of the maternal organism occurs as a result of the anaerobic pathway of the decomposition of glucose and the components of the protein molecule( amino acids).
With this exchange mechanism, the oxidation of fatty acids to the end is impossible, and the result of the ongoing catabolic reactions will be the accumulation in the body of a woman under-oxidized fat metabolism products - ketone bodies( acetone, acetoacetic and beta-hydroxybutyric acids) that begin to excrete in the urine, which does not occurin normal conditions.
In addition, these substances will be formed in the process of enhanced anaerobic decomposition of amino acids.
Emerging changes in the body of a woman are initially functional, in the future, as the severity of the condition increases, the degree of dehydration, the severity of catabolic mechanisms, poisoning with under-oxidized metabolic products, dystrophic processes in the organs( liver, kidneys, etc.) increase. There is a violation of the liver( protein, pigments, secretion of toxins), excretory function of the kidneys, the work of the central nervous system, heart and lungs.
Degrees and Clinical Signs of Vomiting
In most women( about 50%), vomiting is a sign of a normal pregnancy, and only 10% of cases is excessive and becomes a complication of pregnancy, called toxicosis. In the case of the physiological course of the process, the presence of nausea and vomiting in the morning is normal no more than two to three times a day, usually on an empty stomach. This does not lead to a change in the state of health of a woman and does not require any treatment. More often, by the time of the end of the placentation period( 13 weeks), nausea and vomiting pass independently.
Toxicosis of a pregnant woman is a condition in which urge to vomit appear independently of meals, with a decrease in appetite, weakness, loss of body weight, perversion of taste sensations. There are three degrees of toxicosis: mild, moderate and severe. The degree of severity is determined by the combination of emesis and disturbances in the body of the pregnant woman of the functions of organs and systems and the ongoing metabolic processes.
Mild vomiting differs from the physiological state of pregnancy only in the number of times during the day( up to 4-5), and also by the presence of a constant sensation of nausea. However, despite the vomiting, a certain amount of food is retained in the stomach and a significant loss of body weight in the pregnant does not occur. The percentage of weight loss is about 5%( on average not more than 3 kg).The general state of health of the pregnant does not suffer, however, lethargy and decreased activity are possible. The main indicators( heart rate and blood pressure) are kept within the normal range, in some pregnant women it is possible to increase the heart rate to 90 beats per minute. Urine such pregnant women also within the limits of the norm, ketone bodies in urine are not detected. Light vomiting is well treated, or it passes by itself, but in 10% of pregnant women it passes into a more severe stage.
Vomiting of moderate severity( or moderate) occurs 10 or more times a day. Characteristic deterioration of the general condition of women, metabolic disorders with the appearance of ketone bodies. Often, vomiting accompanies the excessive formation of saliva, which leads to an additional loss of fluid and nutrients, which is why the dehydration progresses. The loss of body weight is about 6% of the original. The woman has a pronounced weakness and lethargy, skin pale, tongue becomes covered with white coating, it becomes dryish. Subfebrile fever appears, the heart rate is increased to 100 beats per minute, blood pressure is reduced. Also, the amount of urine decreases, ketone bodies appear in it. Constipation is often typical. In clinical blood analysis, signs of mild anemia are revealed. At this stage, therapy is required, the prognosis is usually favorable.
Severe vomiting( excessive) is very rare and is accompanied by the development of severe poisoning by metabolic products, significant dehydration, dystrophic processes in vital organs and systems, which leads to a disruption of their functions. Vomiting occurs about 20 times during the day, accompanied by abundant saliva and constant nausea.
Typically, the deterioration of the general condition of women, the appearance of adynamia, headache, dizziness, rapid weight loss more than 10% of the original weight.
The subcutaneous fat layer disappears, the skin becomes dry and flabby, the tongue and lips dry out, there is a smell of acetone from the mouth, subfebrile fever. There is an increase in heart rate, lowering blood pressure and diuresis. In some cases, the forecast is unfavorable.
The course of severe toxicosis sometimes requires an emergency termination of pregnancy .Indications are:
- Strengthen weakness and lethargy;
- Appearance of obscuration of consciousness( euphoria or delirium);
- Increase in heart rate to 120 beats per minute, decrease in blood pressure to 80 mm.gt;p.
- Yellowing of the skin and mucous membranes, pain in the right upper quadrant, increased bilirubin up to 100 μmol / l in the blood;
- Decreased diuresis, an increase in the blood of nitrogen and urea, the appearance in the urine of protein and cylinders.
For successful treatment, the treatment-protective regime and the protection of the pregnant woman from the negative effects of are of great importance. Compliance with the diet is also important. Recommend digestible food, in small and small portions, take food preferably lying in bed. Drug therapy for complex vomiting, use the following groups of drugs:
- CNS and vomiting reflex blockers: atropine, tavegil, cerucal, motillium;
- Neuroleptics-haloperidol - to reduce the depressive syndrome;
- Infusion therapy for the purpose of replenishment of the lost volume of liquid, for elimination of toxins and delivery of nutrients( crystalloid solutions and means for intravenous nutrition - solutions of glucose and amino acids);
- Introduction of 5 or 10% albumin for replenishment of low protein in serum;
- Drugs affecting metabolism: riboflavin, ascorbic acid.
Complex treatment continues until the moment of stopping vomiting, improving the general condition, increasing body weight.