- Home
- Informtion
- Doctors inform
- Gynecologist informs
- Early gestosis (toxicosis) of pregnant women
- Home
- Informtion
- Doctors inform
- Gynecologist informs
- Early gestosis (toxicosis) of pregnant women
Early gestosis (toxicosis) of pregnant women
25.06.2024
Early gestosis (toxicosis) of pregnant women
03/28/2024
Pregnancy is a special, important period in the life of every woman. Unfortunately, the joyful anticipation of a baby is often overshadowed by the appearance of gestosis. Many people regard early gestosis (we are more familiar with the word toxicosis) as the norm during pregnancy and do not seek medical help or complain to their doctor. In fact, this is a failure in the adaptation processes of the mother’s body, which requires attention from doctors.
In what cases can gestosis be considered a minor trouble that mars pregnancy, and in what cases will medical attention be needed?
Gestosis in pregnant women is a condition that develops in response to the implantation of the fertilized egg into the endometrium (the mucous membrane of the uterine wall). Manifestations of early gestosis are present before the placenta ruptures, i.e. in the first trimester of pregnancy and the first weeks of the second trimester.
The most common manifestations:
- Nausea;
- Vomit;
- Dermatoses of pregnant women;
- Neuropsychopathy.
Why does early gestosis (toxicosis) occur during pregnancy?
Numerous studies do not bring us any closer to establishing the exact cause of gestosis. But there are several confirmed hypotheses that deserve attention.
Hormonal changes. Already from the moment the fertilized egg begins to implant into the endometrium, certain hormonal changes begin. A new compound appears in the blood, which is absent in non-pregnant women - human chorionic gonadotropin. HCG concentration in the first trimester it increases at a rapid pace, which can provoke a response of varying intensity.
Immune theory (influence of fetal antigens) . Each new life in the mother’s body, oddly enough, is perceived as foreign, because it has its own special set of antigens, different from the mother’s. In response to fetal antigens, the mother produces antibodies, and processes are launched aimed at getting rid of the “stranger.”
Reflex theory. In fact, the simplest of theories. Irritation of uterine receptors by the growing fetus. Signals from these receptors are transmitted to the brain, where the vomiting center and the center of smell are located. Also in the immediate vicinity there are zones that regulate blood circulation, digestion, and the functioning of the glands. It is possible that it is the excessive stimulation of all these centers that leads to the appearance of symptoms of early gestosis.
Psychogenic theory. Formation of pregnancy dominant in the brain. This special center (dominant) is responsible for the behavior of the expectant mother. The level of anxiety increases, emotional instability appears (tearfulness, touchiness, irritability). All these factors subsequently lead to weakness, nausea, and dizziness.
You also need to understand that extragenital diseases of the expectant mother (diseases of the endocrine, cardiovascular, digestive systems, etc.) negatively affect the general condition and can increase the manifestations of gestosis.
When do symptoms of gestosis appear?
The first manifestations may appear already in the first days of the delay. They reach their maximum peak towards the end of the first trimester and then go away on their own.
At this point, the placenta is almost formed, the level of hCG decreases, and the manifestations of gestosis go away.
Taking into account the complaints of a pregnant woman, general condition, and the severity of symptoms, early gestosis is divided according to the degree of severity into: mild, moderate, severe.
Manifestations of early gestosis.
Nausea. This is the most common symptom of early gestosis and occurs in most pregnant women. Nausea can occur at any time: in the morning on an empty stomach, or in response to smells or food intake.
Vomiting (from 1-2 times to indomitable, requiring medical attention). Vomiting is dangerous due to dehydration, which significantly increases the risk of blood clots and increases the load on the cardiovascular system. With frequent vomiting, the absorption of food and liquid is disrupted, the water-electrolyte balance is disrupted, which negatively affects the condition of the pregnant woman.
Perversion (change) of taste and smell. Previously familiar and even favorite smells cause discomfort, irritate the vomiting center, cause nausea and vomiting.
Increased salivation (ptialism). It may be the only manifestation of early gestosis, and be combined with other symptoms. With excessive salivation, fluid loss can reach up to 1 liter, and with it, as with vomiting, proteins and electrolytes.
Weight loss due to fluid loss and loss of appetite. Weight change is an indicator of the severity of gestosis and the effectiveness of treatment.
Fluctuations in blood pressure as a consequence of dehydration and in turn lead to drowsiness, lethargy, apathy, decreased attention and concentration.
Manifestations of early gestosis also include: skin lesions (dermatoses that occur during pregnancy), changes in liver function, manifested by hepatosis, as well as pathological processes that can affect the respiratory system (bronchial asthma of pregnant women develops). Fortunately, these are infrequent manifestations of gestosis (toxicosis).
Manifestations of mild toxicosis - the general condition of the pregnant woman does not suffer, there are no changes in the tests or they are insignificant. Vomiting up to 5 times a day, food and liquid are digested, sleep is not disturbed, performance is the same.
Moderate severity is characterized by :
- constant nausea, which does not disappear even after bouts of vomiting, bouts of vomiting up to 10 times a day;
- general condition suffers, performance decreases, sleep is disturbed;
- weight loss due to impaired digestion of food (a pregnant woman can lose up to 5 kg per week);
- In general clinical tests, significant changes are noted: an increase in red blood cells and hematocrit in the blood; acetone appears in significant quantities in the urine.
Severe early gestosis is, fortunately, extremely rare. This is a life-threatening condition for the mother and fetus that requires mandatory medical care. Manifested by uncontrollable vomiting, severe dehydration, significant loss of body weight, changes in the cardiovascular and nervous systems. Laboratory diagnostic methods allow you to confirm the diagnosis: – blood pH, water-electrolyte balance, and blood clotting processes are disturbed. A urine sample for acetone is strongly positive.
When will it get easier?
Each woman’s reaction to pregnancy is individual, and it is impossible to answer when the symptoms of early gestosis go away. For some, gestosis does not manifest itself at all, for others it goes away by 11-12 weeks, and for others, they feel all the delights up to 15-16 weeks.
What about pregnancy without gestosis?
According to various authors, up to 40% of pregnant women carry a pregnancy to term without manifestations of early gestosis. You should not expect unpleasant symptoms in advance, especially since for most the symptoms go away by the end of the first trimester.
When should you see a doctor?
A pregnant woman should tell the doctor even about mild manifestations of gestosis. After which, a medical history will be carefully collected and tests will be prescribed to exclude serious diseases that may be “hiding” behind the manifestations of gestosis, and to assess the general condition of the patient. General clinical blood and urine tests, as well as an ultrasound of the abdominal organs and kidneys, will be prescribed.
In case of severe manifestations of gestosis, a pregnant woman is sent to hospital for a full examination and treatment under the supervision of medical personnel.
How to treat?
The approach to the treatment of gestosis is individual and depends on the specific case, the severity of the course and the presence of concomitant diseases in the woman.
If the pregnant woman’s condition does not suffer, she undergoes treatment on an outpatient basis. Adequate weight gain and no changes in test results are a sure sign of effective treatment.
How can a pregnant woman help herself?
No matter how trivial it may seem, the daily routine is important. Sleep at least 8 hours a day, ideally rest during the day. Adequate physical activity, walks in the fresh air, refusal of heavy physical work. Minimizing stress. You can’t give up hobbies and hobbies; they help distract you from your painful condition.
Nutrition
It is recommended to eat food 5-6 times a day in small portions. You should not allow yourself to feel a distinct feeling of hunger. The diet should be selected so that it contains enough fresh vegetables and fruits familiar to a woman (without exotic ones). Eating home-cooked, well-cooked food with a minimum content of spices and fats is encouraged (it is strongly recommended to avoid fast food restaurants during pregnancy). It is recommended to completely eliminate foods that irritate the mucous membrane of the gastrointestinal tract (salted, smoked, hot, spicy, as well as strong tea, coffee, highly carbonated drinks, alcohol, smoking).
Drinking regime is important. You need to drink clean warm water in small sips, up to one and a half to two liters per day. You can drink alkaline mineral water, weak tea with mint, ginger. But you should refuse freshly squeezed juices, because... they also have an aggressive effect on the gastrointestinal mucosa.
Drug treatment.
Medicines are prescribed strictly according to indications and only in cases where symptoms persist after following all recommendations. Typically, pregnant women with mild gestosis do not need medication.
To the hospital.
Pregnant women with moderate and severe degrees of gestosis require hospital treatment. They are under constant supervision of medical personnel and receive drug therapy.
Danger of gestosis.
Manifestations of early gestosis, leading to dehydration, weight loss, are dangerous due to disruption of all types of metabolism (water-electrolyte, acid-base, protein, etc.), disruption of the functioning of organs and systems. Violation of the supply of nutrients to the fetus affects the formation of its organs. In severe cases, there is a risk of pregnancy loss, so a pregnant woman with manifestations of gestosis must strictly follow all the recommendations of the treating doctor.
Author: obstetrician-gynecologist of the first qualification category (head of department) of the obstetric department of pathology of pregnancy Savenok I.A.