Toxicosis of pregnant women. Early toxicosis during pregnancy: causes, diagnosis, treatment Forms of early toxicosis

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

Usually, the word "early toxicosis" is understood only as nausea, vomiting and salivation. The medical understanding of this word is somewhat different from the usual one: in textbooks on obstetrics, toxicosis is considered to be all pathological changes in a woman's body that may appear in the first trimester of pregnancy. These include not only nausea and vomiting, but also some other unpleasant phenomena that are much less common (dermatoses - skin lesions, tetany - muscle cramps, osteomalacia - softening of the bones, jaundice, bronchial asthma in pregnant women, etc.).

Causes

Despite numerous studies, it has not yet been possible to find the cause of toxicosis. But some hypotheses exist:

The most popular and most substantiated theory of the occurrence of toxicosis is the so-called neuro-reflex a theory according to which disturbances in the relationship between the central nervous system and internal organs play an important role in the development of the disease. Everyone knows that during pregnancy, many women become more capricious, irritable, whiny. This happens because during the bearing of a baby, the historically “older” subcortical structures of the brain begin to work more intensively than usual, while usually the cortex is more active in a person who is at the highest stage of evolution. But subcortical structures form the majority of protective reflexes, and wise nature, protecting pregnancy, makes this part of the future mother's brain work more efficiently. In the subcortical structures, there is a 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 saliva, pallor due to vasospasm.

immune theory. From the first days of intrauterine life, a baby is an organism different from its mother in its antigenic composition, to which antibodies are produced in a pregnant woman, allegedly causing toxicosis.

Hormonal theory. In the body of a pregnant woman, significant hormonal changes occur. In particular, a new hormone-producing organ 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 noted.

Psychogenic theory. It is believed that toxicosis may be the result of negative emotions: fear 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 of the gastrointestinal tract, liver, thyroid gland, as well as in women who have undergone artificial abortions, chronic inflammatory diseases of the genital organs. Predisposing factors are frequent nervous stress and malnutrition, asthenic type of constitution. In addition, pronounced forms of early toxicosis often occur in multiple pregnancies.

How is it manifested?

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

With a mild course of toxicosis, vomiting occurs no more than 5 times a day, may be accompanied by a prolonged or constant feeling of nausea. Vomiting happens 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). This condition is easily treatable at home.

In more severe cases, vomiting occurs up to 10-20 times a day and is accompanied by salivation, while the general condition of the woman worsens significantly, weakness and apathy occur. With vomit and saliva, a significant amount of fluid is lost, dehydration occurs, and metabolism is disturbed. The skin becomes dry, pale, blood pressure drops, the pulse quickens, constipation occurs, the amount of urine is reduced, and the temperature rises. The loss of body weight can be up to 8-10 kg or more (up to 10% of the initial body weight). With the progression of this form of toxicosis, a violation of the 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) may accompany vomiting of pregnant women, rarely occurs as an independent form of early toxicosis. With severe salivation per day, a pregnant woman can lose 1 liter of fluid. Excessive salivation leads to dehydration of the body, loss of proteins, and negatively affects the mental state of a woman.

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

Diagnosis and treatment of toxicosis

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

To eliminate discomfort, attention must be paid diet. With toxicosis, appetite is not always disturbed, sometimes it is even increased, but more often even the type of food does not cause positive emotions, sometimes you have to make considerable efforts to force yourself to swallow at least 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 often, 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 provoke vomiting more quickly. Products should be easily digestible, contain a sufficient amount of vitamins. It is better to drink mineral alkaline water, tea with mint.

If you note that significantly increased salivation, you will be helped by rinsing your mouth with tanning solutions that reduce this process, for example, infusions of sage, chamomile, mint. If you experience nausea and vomiting in the morning, right after waking up, try having breakfast in bed, putting a few crackers, lemon wedges, or mint gum next to your bed. It is 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, it affects nervous tension and fatigue. In this case, you can drink a soothing collection, motherwort or valerian.

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

Hospitalization

In the event that the doctor detects changes in the analyzes, the arrow of the scales stubbornly deviates to the left every day, and the state of health worsens, most likely, have to go to the hospital. The task of doctors in the first place will be to restore the lost fluid, protein, salts. You will be given a drip to ensure that nutrients and vitamins are delivered directly to your bloodstream. 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 the manifestation of toxicosis, then for your peace of mind a medical-protective regimen will be created in the hospital. In addition, you will be prescribed drugs that have a calming effect, and with increased salivation - drugs that inhibit the action of the salivary glands. Perhaps, non-drug methods will also be used: acupuncture, hypno- and psychotherapy, phyto-, aromatherapy. This will help reduce the number of drugs that can have an undesirable effect on the developing embryo.

When, as a result of treatment, weight gain becomes apparent, daily diuresis (the amount of urine separated), as well as pulse, blood pressure and temperature, normalize, vomiting will stop or become less frequent, it will be possible to return to the usual home environment. In rare cases, complex treatment for several days is completely ineffective, and then the pregnancy has to be interrupted.

These include diseases, the origin of which is associated with the development of a fetal egg in the body of a woman. Toxicosis occurs during pregnancy and usually disappear after it ends. After childbirth (or abortion), all manifestations of toxicosis usually completely disappear; long-term effects are observed after severe and long-term forms of these diseases

Etiology of gestosis

The theory of poisoning the body of a woman with toxic products turned out to be untenable, since it was not possible to isolate toxic substances from the body of pregnant women.

An immunological version has now been adopted explaining the occurrence of toxicosis by hypersensitivity to foreign proteins entering the body of a pregnant woman from a fetal egg. The changes in hormonal balance that occur during toxicosis are a consequence of toxicosis, and not their cause.

The occurrence of toxicosis of pregnant women is largely associated with the characteristics of the nervous system of a woman. During pregnancy, there are changes in the functions of almost all organs and systems, significant changes in metabolism. These changes are physiological, adaptive, they contribute to the successful course of pregnancy and the development of the fetus. All these changes arise and develop under the control of the nervous system. In the presence of changes in the nervous system of a woman, the development of physiological adaptive reactions is disturbed. Changes in the activity of a number of organs and systems acquire a pathological character; metabolism is disturbed, the reactions of the pregnant woman's body to irritations emanating from the external and internal environment change. All these disorders lead to the occurrence of toxicosis.

Changes in the functions of the nervous system, and therefore the occurrence of toxicosis contribute to:
1. Past severe illnesses
2. Wrong diet
3. Violation of the hygiene regime
4. Overwork and other factors that reduce immunity
5. Concomitant diseases: hypertension, heart disease, diseases of the kidneys, liver, endocrine glands (diabetes mellitus, thyrotoxicosis and others) and so on

Classification of toxicosis of pregnant women

1. Early toxicosis of pregnant women: vomiting, indomitable vomiting, hypersalivation
2. Late toxicosis of pregnant women: dropsy of pregnancy, nephropathy, preeclampsia and eclampsia
3. Rare forms of toxicosis of pregnant women: diseases of the skin, liver (jaundice of pregnancy), nervous, bone and other systems

Early toxicosis of pregnant women

Vomiting pregnant

In the first months of pregnancy, many women, especially primigravidas, experience nausea and vomiting in the morning. Vomiting does not happen every day and does not affect the woman's condition. Such vomiting is not toxicosis. Toxicosis includes vomiting of pregnant women, which is repeated several times a day, even after eating. Vomiting is accompanied by nausea, decreased appetite, weakness, irritability, drowsiness, sometimes insomnia, and a tendency to spicy and salty foods. The overall state is saved. It is observed in the first 2-3 months, is easily treatable or goes away on its own. Only in some, vomiting intensifies and acquires the character of the so-called indomitable vomiting.

Uncontrollable (excessive) vomiting of pregnant women

It is a serious illness. It repeats 20 or more times during the day, it happens day and night. Not only food is not retained, but also water. There is an aversion to food and, as a result, a decrease in body weight, subfebrile temperature, tachycardia, and a decrease in blood pressure. With a long course, severe weight loss, dry, flabby skin, acetone and protein appear in the urine, weakness, apathy. There may also be salivation. In a particularly severe course, a strong increase in body temperature, icterus, arrhythmias. The patient needs treatment, without treatment may die.

Treatment:
- Stationary
- Good care, long sleep
- Light, well-digestible food
- Intravenous glucose, vitamins B, C
- Antiemetics: cerucal, chlorpromazine

Salivation

The amount of saliva secreted can reach 1 liter per day. It does not cause severe disorders in the body and does not require termination of pregnancy.
Treatment: same as for vomiting of pregnant women, atropine 2 times a day subcutaneously
Late toxicosis of pregnant women

Dropsy, nephropathy, preeclampsia and eclampsia are different stages in the development of a single pathological process.

The initial stage of toxicosis and dropsy, under appropriate conditions, passes into a more severe form - nephropathy, nephropathy into preeclampsia and then into eclampsia.

1. Dropsy of pregnancy

A small and quickly disappearing pastosity in the area of ​​​​the feet and legs in late pregnancy is often observed. This pastiness is not toxicosis.

Dropsy of pregnancy is a persistent swelling. Appears in the second half of pregnancy, closer to childbirth. At first, pastosity, then swelling of the feet and legs, then the hips and external genitalia swell. In a severe course of the disease, edema spreads to the entire torso and face. Since there is fluid retention, therefore, body weight increases dramatically (normally, in the 2nd half of pregnancy, weight gain is 250-300 grams per week, here 500-700 grams or more). Sometimes there are hidden edema, which are detected only by systematic weighing of the pregnant woman. The fluid accumulates in the subcutaneous tissue, the accumulation of fluid in the serous cavities (abdominal, pleural and others) usually does not occur.

The accumulation of fluid depends on the violation of water-salt metabolism and the increase in capillary permeability with the release of fluid from the vessels into the tissues. There are no changes in the heart, liver, kidneys and other organs. The patient's condition is not disturbed, only with severe edema fatigue appears.

The course is protracted, the edema either decreases or increases again. Decrease with bed rest and diet and reappear with the transition to a normal lifestyle. In most women, dropsy disappears without a trace after childbirth.

Prevention: compliance with the diet, daily weighing is necessary for timely diagnosis.

Treatment: fluid and salt restriction. Mostly carbohydrates, can be diuretics. If the regimen of the pregnant woman is incorrect, dropsy can go into the next more severe stage of toxicosis - nephropathy of pregnant women.

2. Nephropathy of pregnancy

A triad of symptoms is characteristic: edema, proteinuria, hypertension. In severe cases, there are also violations of not only water-salt, but also protein and fat metabolism. They are more common during the first pregnancy, usually occurs in the last month of pregnancy, closer to childbirth. The course of nephropathy is protracted, often continuing until childbirth. The development of the fetus lags behind, the stillbirth rate is quite high. For timely diagnosis, each pregnant woman regularly examines urine for protein, measures blood pressure, and controls body weight by weighing.
Treatment: stationary (department of pathology of pregnant women), bed rest, diet with strict restriction of water and salt. In severe cases, protein is limited, carbohydrates are predominantly given. Daily diuresis is measured, blood pressure is monitored daily, urine is examined after 2-3 days. Drug treatment: magnesium sulfate 25%, antihypertensive, diuretic.

3. Preeclampsia

In the absence of the correct regimen and treatment, nephropathy can turn into preeclampsia.
Clinic:
1. Triad of symptoms: hypertension, edema, albuminuria
2. Visual disturbances (veil before the eyes, flickering flies), changes in the retina (edema, hemorrhage, detachment)
3. Possible hemorrhages in vital organs (without transition to eclampsia)
4. Possible premature detachment of the placenta, asphyxia of the fetus and its death before birth or during childbirth

Treatment:
- Immediate hospitalization
- A strict diet with a sharp decrease in fluid and salt intake
- Hypotensive
- Diuretic

4. Eclampsia

The highest stage of development of late toxicosis. The activity of all important systems and organs is disrupted. Occurs more often during childbirth, less often during pregnancy. Sometimes seizures of eclampsia occur after childbirth. This disease is more common in primigravida.
Clinic
1. Convulsive seizure lasting 1-2 minutes. Convulsions are tonic-clonic. After convulsions, the patient goes to sleep, when she wakes up she does not remember convulsions. Convulsions as in epilepsy. The number of seizures varies from 1-2 to 10 or more.
2. With eclampsia, the function of the central nervous system is disturbed: ET excitability sharply increases, in connection with this, all irritants (pain, noise, bright light, and so on) can cause a new attack of eclampsia.
3. Dystrophic processes occur in the liver, kidneys and other organs, the functions of these organs are disturbed. Little urine, it has a lot of protein and cylinders.
4. In the placenta, hemorrhages and other changes may occur leading to oxygen starvation of the fetus. The patient can die from an attack of eclampsia (even the first one) and after attacks. The main causes of death are cerebral hemorrhages, asphyxia, pulmonary edema, and cardiac dysfunction.

With eclampsia, intrauterine fetal death can occur. The stillbirth rate is quite high.

Prevention
It is the main measure to combat eclampsia. It includes strict adherence to the diet, early diagnosis and treatment of dropsy of pregnancy, nephropathy, preeclampsia.

Treatment of eclampsia
1. Strict rest with the absence of pain, tactile, visual and other stimuli.
2. Magnesium sulfate 25% (calms the central nervous system, lowers blood pressure, increases diuresis)
3. Intravenous glucose 40% 30-50 ml, ascorbic acid 2-3 times a day. Glucose reduces intracranial pressure, increases diuresis.
4. Diuretics (hypothiazide, furosemide, mannitol)
5. In case of eclampsia during childbirth, one should strive for accelerated radiological resolution using gentle methods.

Women who have undergone eclampsia need special attention: daily monitoring of blood pressure, 2-3 days later urine analysis, monitoring of cardiac activity and respiration.

Toxicosis of pregnant women- this is a pathological condition that occurs only during pregnancy, complicates its course and, as a rule, disappears with its interruption or on its own during treatment.

Causes of toxicosis

To date cause of toxicity not studied enough. There is no exact data on the origin of this pathological condition. The International Association of Obstetricians and Gynecologists have identified the most likely causes of the development of toxicosis:

1. Hormonal changes. From the first days after conception, a woman's body undergoes great changes associated with a change in the amount of hormones released. Against this background, the well-being of a pregnant woman may worsen;
2. The presence of chronic diseases. It is noted that toxicosis occurs more often in women with weakened immunity and diseases of various organs (especially diseases of the digestive, respiratory and endocrine systems). Therefore, women planning a pregnancy are advised to undergo a complete medical examination in advance;
3. The psycho-emotional state of a woman. , lack of sleep, high mental stress contribute to the development of toxicosis and aggravate the severity of their manifestation;
4. : , the use of narcotic substances;
5. Woman's age. It was noted that early pregnancy (mother's age up to 20 years) and late pregnancy (more than 35 years) often occur with various forms of toxicosis;
6. Heredity. Genetic predisposition plays a significant role here: if a woman's mother, aunt or grandmother suffered from toxicosis, then this woman is also likely to develop preeclampsia.

There are three forms of toxicosis:

1. Early (develop in the first trimester of pregnancy);
2. Late (occur in the second and third trimester, more often in the last two or three months);
3. Rare (more often begin in the first trimester, but can occur at any stage of pregnancy).

Early toxicosis: types, timing of occurrence, treatment

Early toxicosis occur at the beginning of pregnancy and end by the end of the first trimester. Most often, symptoms begin at 5-6 weeks of pregnancy, less often at an earlier date (some women feel a deterioration in well-being almost immediately after conception, even before the onset of a delay in menstruation). Allocate two forms early gestosis:

Vomiting pregnant

• Light;
• moderate;
• Excessive.

Salivation (salivation).

Vomiting pregnant- the most common form of early toxicosis. In the first weeks of pregnancy, many women have nausea and vomiting that occur in the morning, not every day and do not affect the condition of the pregnant woman. Such vomiting does not apply to toxicosis and does not require treatment.

Information Preeclampsia includes vomiting, which is repeated several times during the day, accompanied by severe nausea, a sharp decrease or lack of appetite, a change in taste preferences and olfactory sensations.

According to the severity are distinguished:

1. Light form. Vomiting is repeated up to 5 times a day, more often after meals, slightly worsens the woman's well-being, is easily treatable or resolves on its own by 10-12 weeks of pregnancy;
2. Moderate form. Vomiting occurs up to 10 times a day, is not associated with food intake, is accompanied by a significant deterioration in the woman's condition, general weakness. With proper treatment, this form of toxicosis gradually stops. In the future, pregnancy develops normally.
3. Excessive form. Vomiting occurs up to 20 times or more per day and contributes to the development of a serious condition of a woman. Starvation and dehydration lead to a decrease in body weight, exhaustion, an increase in temperature and pulse. Requires emergency treatment, in the absence of which a fatal outcome is possible.

salivation (ptyalism)) is increased salivation and loss of more fluid (up to 1 liter or more per day). Ptyalism can occur as an independent form of toxicosis or accompany vomiting of pregnant women. With severe salivation, the woman's well-being worsens, sleep is disturbed, weight loss and dehydration of the body due to fluid loss are possible. Due to the constant secretion of saliva, maceration of the skin and mucous membranes occurs.

Treatment ptyalism and mild vomiting are carried out on an outpatient basis. If there is no effect, the woman must be hospitalized and further examination and treatment is carried out in a hospital. With vomiting of moderate and excessive forms, hospitalization should be immediate.

Special treatment of early toxicosis consists in the following activities:

1. Ensuring complete physical and emotional rest;
2. The correct diet (reception of high-calorie food in fractional portions every 2-3 hours);
3. Taking sedatives (,);
4. antiemetic therapy;
5. Vitamin therapy;
6. Hepatoprotectors;
7. Intravenous drip infusions of solutions to combat dehydration.

Important If the treatment does not give the desired effect and the condition of the pregnant woman worsens, then an emergency termination of pregnancy is indicated.

Late toxicosis: types, timing of occurrence, treatment

Late toxicosis develops most often after 30 weeks of pregnancy. In rare cases, it manifests itself already in the second trimester and then proceeds more malignantly, and is less treatable. There are the following forms of preeclampsia:

1. dropsy pregnant(fluid retention in the body and the appearance of persistent edema);
2. Nephropathy(clinically manifested by three symptoms: edema, high blood pressure);
3. Preeclampsia(transitional stage from nephropathy, characterized by dysfunction of the nervous system);
4. Eclampsia(the final stage of late preeclampsia with the onset of convulsions and loss of consciousness).

dropsy pregnant occurs when fluid is retained in the tissues. Its main clinical manifestation is edema, which progresses with the development of the disease. Allocate three degrees of severity of dropsy:

1. First degree. Edema appears on the legs, with pressure on the tissues in the region of the tibia, visible impressions remain;
2. Second degree. Edema spreads further to the trunk, but water does not stagnate in the abdominal cavity. Impressions remain with pressure on the abdomen;
3. Third degree. Edema appears on the trunk and face. The general condition of the pregnant woman worsens: fatigue, shortness of breath, palpitations appear.

Treatment this stage of toxicosis includes:

1. Restriction of liquid (no more than 1 liter per day) and table salt when cooking;
2. Exclusion from the diet of all foods that can retain water in the body: smoked, fatty, spicy, salty;
3. (furosemide, hypothiazide, etc.).

In most cases, the treatment is effective and takes no more than 6-8 days for mild and moderate and 10-12 days for severe toxicosis.

Nephropathy most often develops against the background of unrecognized in a timely manner or incorrectly treated dropsy of pregnant women. This form of late toxicosis is characterized by triad of symptoms:

1. swelling;
2. Hypertension (increased blood pressure);
3. Proteinuria (increased protein in the urine).

Nephropathy can be monosymptomatic (only one symptom is observed - hypertension or albuminuria) or polysymptomatic (two or three signs appear at the same time).

Treatment nephropathy should be carried out only in a hospital setting. Therapy consists of the following activities:

1. Complete bed rest, a state of physical and emotional rest;
2. Nutrition normalization. A pregnant woman is prescribed a predominantly milk-vegetarian diet, a strict restriction of fluid intake, salt and fats. Once a week they spend fasting days (fruit or);
3. Normalization of sleep by taking sedatives;
4. Taking diuretics to reduce swelling;
5. Consultation with a therapist and taking antihypertensive drugs to lower blood pressure.

With unsuccessful treatment, it is necessary to carry out early delivery, because. further prolongation of pregnancy can threaten the health and life of a woman.

The final stages of development of gestosis are preeclampsia And eclampsia. At preeclampsia headaches, blurred vision, drowsiness, increased fatigue appear. Some patients experience abdominal pain, nausea, vomiting,. These symptoms are associated with profound changes in cerebral circulation and increased intracranial pressure.

Treatment preeclampsia is the same as with nephropathy, but all injections, intravenous infusions should be carried out only under anesthesia (inhalation of nitrous oxide and oxygen), so as not to provoke an attack of eclampsia.

Eclampsia manifested by a sharp onset of convulsions and a complete loss of consciousness. A seizure occurs in three stages:

1. First step. There are small contractions of the muscles of the face, which pass to the muscles of the upper limbs. This period lasts 20-30 seconds;
2. Second phase. There are strong convulsions of all muscles, breathing is disturbed up to its complete stop, the woman loses consciousness. The stage lasts no more than 25 seconds.
3. Third stage. Convulsions stop, the pregnant woman falls into a coma. Upon returning to consciousness, the patient does not remember anything, complains of severe fatigue, muscle pain. The duration of the third stage is up to 1.5 minutes.

Therapeutic measures in case of eclampsia, they should be urgent and take place with the obligatory presence of resuscitators. Therapy includes:

1. Relief of seizures by inhalation of oxygen, nitrous oxide and ether;
2. Lowering blood pressure by intravenous administration of antihypertensive drugs (the woman must be under anesthesia at this time);
3. Sleeping pills (the pregnant woman is put into a state of medical sleep for 1-2 days).

Intensive care in the intensive care unit should be carried out for about 10 days. If the seizures resume during treatment, the woman is prescribed an emergency delivery.

Rare forms of toxicosis: types, timing of occurrence, treatment

Rare forms of toxicosis often begin in the first trimester, but can occur at any stage of pregnancy. This type of toxicosis includes:

1. Dermatoses (various skin diseases);
2. Jaundice of pregnancy (icteric coloration of the skin and visible mucous membranes);
3. Yellow liver atrophy (acute liver disease with degeneration of liver cells);
4. (a disease of the respiratory tract, manifested by shortness of breath, shortness of breath and periodic attacks of suffocation);
5. Tetany (convulsive seizures caused by a violation of calcium metabolism in the body);
6. Osteomalacia (a disease characterized by softening and deformation of the skeletal system due to a violation of phosphorus-calcium metabolism in the body).

Dermatoses pregnant women include a group of skin diseases that occur only during pregnancy. The most common itching of pregnancy, which can spread throughout the body. A woman's general well-being worsens, irritability appears, sleep is disturbed. Less common are eczema (an inflammatory skin disease that manifests itself as a profuse rash, itching and burning). Treatment is carried out in a hospital. A pregnant woman is recommended a sparing diet with the exception of spicy, smoked dishes. To reduce itching and burning, vitamin therapy, calcium preparations are prescribed. Lotions with a solution of potassium permanganate are applied locally to the affected areas.

Jaundice pregnant women is rare. Its main clinical manifestations are liver damage, icteric coloration of the skin, itching. When a diagnosis is made, a pregnant woman is urgently hospitalized and the pregnancy is terminated at any time.

Yellow dystrophy of the liver- an extremely dangerous form of rare toxicosis. It is very difficult and often leads to death. There is liver damage, an increase in jaundice, a sharp onset of convulsions and a coma. An immediate termination of pregnancy is indicated, which can help save a woman's life.

Bronchial asthma as a manifestation of toxicosis occurs in isolated cases. It responds well to treatment, and pregnancy can be maintained. A pregnant woman is prescribed vitamin therapy, sedatives and calcium preparations.

Tetany of pregnant women occurs when the parathyroid glands malfunction, which leads to a significant disruption of calcium metabolism in the body. Clinically, the disease manifests itself in the form of spasms of the muscles of the upper and lower extremities, less often the muscles of the face and trunk. For treatment, take parathyroidin (a hormone produced by the parathyroid glands), calcium preparations. In most cases, treatment is successful and the pregnancy persists.

Osteomalacia occurs as a result of a violation in the body of the exchange of phosphorus and calcium. It is clinically manifested by decalcification and softening of the bones (often the spine and pelvis), which leads to severe pain and skeletal deformity. Treatment includes vitamins D and E, physiotherapy (ultraviolet radiation). In the absence of the effect of therapy, termination of pregnancy is indicated.

Toxicosis is a fairly common condition of pregnant women, accompanied by nausea and vomiting. It occurs due to poisoning with toxins and other harmful substances that are formed in a pregnant woman during the development of the fetus.

It can also lead to the manifestation of many symptoms, the most permanent being disorders of the central nervous system, cardiovascular system and metabolism. How long toxicosis lasts during pregnancy, so much the manifestation of symptoms continues.

There are several degrees of toxicosis:

• The first - the urge to vomit is observed infrequently, up to 5 times. Weight loss is negligible up to 3 kg.
• The second is vomiting up to 10 times and weight loss can be 3-4 kg over a two-week period, which can lead to a decrease in blood pressure.
• The third is prolonged and frequent bouts of vomiting, reaching up to 25 times a day, there is a significant weight loss - more than 10 kg, the temperature rises and the pulse quickens.

When does toxicosis begin in pregnant women?

Many women try to determine the absence or, conversely, the presence of pregnancy and begin to listen to their body, to its every change. Not every woman knows exactly when toxicosis can begin during pregnancy. Doctors set the following time frames:

• Early toxicosis can begin in the first days of delay or at 5-6 weeks of pregnancy. And toxicosis ends early by 13-14 weeks, but everything can end earlier, each case is individual.
• Manifestations of late toxicosis begin in the very last trimester of pregnancy, and sometimes in the middle of the second trimester, which is much more dangerous for the fetus and mother.

Signs of toxicosis in pregnant women

As soon as a child is conceived, the body of the future mother begins to adjust the rhythm of work for two: the mother herself and the baby. From which, at first, a woman begins to experience discomfort called toxicosis. How to deal with it, you can find out on the forum, where every mom shares her secret.

First of all, a woman manifests irritability, increased salivation, loss of appetite, nausea, weakness, drowsiness, changes in taste buds, vomiting, and weight loss. Very rarely, with early toxicosis, one can observe the development of dermatosis, asthma, osteomalacia - softening of the bone substance, tetany - spasmodic manifestations of skeletal muscles. Signs of severe toxicosis appear regardless of who mommy is waiting for: a boy or a girl. Symptoms of toxicosis can also be observed during a frozen pregnancy, which can be distinguished by the absence of fetal movement and heartbeat.

The most dangerous and unpleasant signs of toxicosis, both in the first trimester and in the third.

Gag reflex in pregnancy

Vomiting is one of the most striking manifestations of toxicosis in late and early pregnancy. Most often, vomiting is active for 20 weeks, and the earlier it starts, the more severe it is. There are several degrees of severity of the gag reflex in a pregnant woman:

1. Mild nausea and a small amount of vomiting, which occurs no more than 5 times a day, usually after meals. The woman's condition is unchanged, weight loss is about 3 kg, but no more.
2. Gagging increases up to 10 times a day, regardless of food intake, and weight loss in 2 weeks can already reach 3 kg or more. The well-being of a pregnant woman worsens significantly: weakness occurs, the pulse rate increases, and blood pressure decreases.
3. There is excessive vomiting, which can reach up to 25 times a day. Such a transient process leads to dehydration of the body and a sharp weight loss (more than 10 kg.). The temperature rises, bad breath appears, the pulse quickens, blood pressure drops and the woman becomes inhibited. In some cases, there may be a violation of the kidneys and with prolonged vomiting, which is already becoming life-threatening for the mother, doctors recommend artificial termination of pregnancy.

Dermatous rashes

This is the most unpleasant manifestation of toxicosis at the 13th week of pregnancy, in the form of scattered itching of the skin, it can reach the genitals. This leads to irritability, sleep disturbance and depression.

Dangerous development of tetany and osteomalacia

Progressive development occurs due to the violations of the exchange of phosphorus and calcium in the body of the expectant mother. Osteomalacia causes softening of the bone tissue, which threatens with bone fractures. Tetany is dangerous with cramps in the muscles of the upper extremities, very rarely observed in the lower extremities and on the face.

Why is there no toxicosis

Women are so accustomed to the idea that toxicosis is a normal course of pregnancy that its absence began to evoke fear and apprehension. Do not worry, such suspicions are completely unfounded and not dangerous. On the contrary, it means that the expectant mother is absolutely healthy. If there is no toxicosis, this is normal. The body easily adapted to the new rhythm of work, coping well with the loads, it adapted to the new state without the manifestation of nausea, vomiting and violations of its general systems.

The advantageous aspects of "non-toxic" pregnancy are obvious:

• there is no threat of miscarriage, subsequently severe toxicosis;
• timely replenishment of vitamins developing the fetus, which improves its development, without any pathologies;
• excellent mood and well-being, allows you to enjoy the unique state of the body.

Types of toxicosis

During pregnancy, there are several types of toxicosis:

• Staphylococcal toxicosis - is activated by enterotoxigenic strains, which, during reproduction, can release heat-resistant exotoxin into food products. An urgent consultation with a doctor, examination and further treatment is necessary.
• Evening toxicosis - after an exhausting and stressful day and without taking enough food, the body becomes exhausted and succumbs to the attack of toxicosis. Toxicosis in the evenings makes it difficult to fall asleep and rest in peace. Evening walks, freshly prepared juice or fruit drink from fresh sour berries have a beneficial effect on the body.
• Toxicosis in the first half of pregnancy - This is approximately the period from 1 to 14 weeks of pregnancy. Doctors recommend calmly experiencing the symptoms of toxicosis in the first trimester. In the event that the signs intensify, then specialists can prescribe safe soft herbal remedies, which will greatly alleviate the condition of the pregnant woman and reduce intoxication. But it is worth noting that while mommy uses prescribed drugs, she feels great, but when you stop taking these drugs, the signs of toxicosis immediately resume. To reduce toxicosis during pregnancy, you can resort to folk remedies, which will be safer for the baby.
• Late toxicosis - with the normal development of pregnancy, the re-emergence of toxicosis in the second trimester is excluded. But there are times when late toxicosis causes bouts of vomiting and nausea, if the symptoms increase, then a complication occurs called preeclampsia. It is manifested by swelling, the presence of protein in the urine, high blood pressure and weight gain up to 400 grams per week. The more toxicosis progresses in late pregnancy, the more difficult and dangerous it is for the health of a pregnant woman. But mom, who regularly visits the doctor, will be notified of preeclampsia in time, and hospitalized in time. Treatment is prescribed individually, it all depends on the specific situation and the degree of symptoms.
• Toxicosis before delay - Did you feel nausea immediately after conception? This is not a sign that you are already pregnant. Toxicosis can begin 7-10 days after the development of the fetal egg. But nausea and vomiting may not always occur, on the contrary, many women begin to experience a brutal appetite.

Causes of toxicosis during pregnancy

Why toxicosis occurs during pregnancy is still a mystery and an unexplored phenomenon. In absolute accuracy, it is impossible to say what causes the symptoms of toxicosis in the early and late stages.

But still, doctors identify several causes of toxicosis in pregnant women:

1. Changes in the hormonal system. From the first hours of fertilization of an egg in the uterine cavity, cardinal hormonal changes occur in a woman. The composition of hormones changes dramatically, which is reflected in the behavior and health and well-being of a pregnant woman. Against the background of these changes, she becomes irritable, touchy and whiny, nausea is provoked, and her sense of smell is aggravated. In the first months, the fetus for the mother's body is considered a foreign body, which he would like to get rid of, which also affects the well-being of the future mother. But when does toxicosis in pregnant women end? After some time, the level of hormones stabilizes, and the mother's body calmly accepts the embryo, and the fight against toxicosis will stop by the second trimester.
2. Development of the placenta. The likelihood of this theory is quite logical. It was found that toxicosis exhausts the female body in the first trimester, up to about 13-14 weeks. The sharp disappearance of toxicosis is associated with the fact that the placenta is already completing its formation. And now the performance of many functions passes into her duties, this number includes the retention of toxic substances. In the meantime, the process of placental development is not completed, the body of a pregnant woman itself protects itself from possible intoxication by vomiting.
3. Defensive reaction. The refusal of the expectant mother from many products and late toxicosis during pregnancy is nothing more than a natural act of protection. Mommy develops nausea primarily on cigarette smoke, coffee-containing drinks, on fish, meat and eggs. They can be hazardous to health due to the pathogens they contain. The gag reflex and nausea protect the fetus and the mother's body from the ingress of substances harmful and dangerous to them, in which case toxicosis in pregnant women is biologically necessary. In addition to the toxins and poison contained in the food consumed, the development and growth of the embryo is negatively affected by insulin produced after each meal.
4. Chronic infections and diseases. Infections and illnesses that have not been fully cured lead to a weakening of the immune system of a pregnant mother. This can provoke toxicosis in the first trimester, and then what to do? It is necessary to connect the full complex of vitamins at the planning stage, as well as contact a specialist and undergo a full examination. Then undergo a course of treatment, especially for infections.
5. Psychological changes. Severe toxicosis in the 3rd trimester may begin due to the psychological and emotional state of the mother. Nervous experiences, stress, lack of sleep, emotional upheaval and irritability are the causes of severe toxicosis, leading to nausea and vomiting. According to doctors, late toxicosis develops in women who become pregnant unexpectedly and unplanned. Moreover, many women set themselves up in advance for the fact that all pregnant women have severe toxicosis in the first trimester or in the later stages. And the principle of self-hypnosis is known to all. According to scientists, with the onset of pregnancy, the nervous system undergoes great changes, and the centers of the brain that are responsible for the functioning of the sense of smell and the gastrointestinal tract are currently activated.
6. Age Criteria. Pregnancy that occurs after 30-35 years is considered dangerous, especially if this is the first conception or there have been multiple abortions before. The development of toxicosis can manifest itself much stronger and more risky. Experts say that the younger the future mother, the easier it is to tolerate the possible symptoms of toxicosis. But this is not in all cases, there are exceptions.
7. Genetic background. The occurrence of toxicosis in the second trimester due to heredity has a greater chance of developing it. In the event that someone from the previous generation suffered from toxicosis at week 16 or any other period, there is a 70% chance that this problem will not bypass you either. The risk of an increase in symptoms increases if a woman had toxicosis in a previous pregnancy.
8. Multiple pregnancy. There is certainly more joy from such news, but there will also be more difficulties in bearing. For example, toxicosis in the second half of pregnancy in a mother with twins manifests itself much more often and more progressively than in a woman with a singleton pregnancy. But for pregnant women who have undergone early toxicosis, the threat of miscarriage is practically not threatened, which is important.

It can also be said with confidence that a healthy woman is less susceptible to the manifestation of toxicosis during pregnancy than a mother with chronic diseases, infections and leading an unhealthy lifestyle.

What week does toxicosis go away?

All cases associated with toxicosis of the first half of pregnancy and subsequent trimesters are individual, therefore, to accurately answer the question: “When will toxicosis end?”, No one can answer absolutely exactly. Some mothers experience a slight sign of nausea, while others are forced to spend weeks in the hospital in order to overcome toxicosis. The same factor applies to the duration, because in pregnant women, toxicosis is observed in different trimesters, but in most cases, toxicosis at week 14 goes away on its own.

Signs of toxicosis can continue until the placenta is formed, and this process ends at about 12 or 14 weeks. After that, the calm course of pregnancy of the second trimester begins. Toxicosis in the third trimester can resume again, then it already has a completely different term - preeclampsia.

There are times when a future mother's toxicosis begins in the last trimester, which is much more dangerous than toxicosis in the early stages of pregnancy. With signs of late toxicosis, you should immediately contact a specialist.

How to reduce toxicosis during pregnancy?

What exactly helps with toxicosis and how to alleviate its symptoms can only be determined by the pregnant woman herself, each has its own method of dealing with toxicosis. The main symptoms of toxicosis during pregnancy appear in the morning, because the level of glucose in the blood is lowered during this period of time. If you follow the tips below, then the activity of toxicosis may subside.

How to avoid toxicosis during pregnancy:

• Before you get out of bed, you should eat a small piece of bread, biscuits, or preferably dried fruit. Make mint tea, add a slice of lemon and a small amount of sugar to it, which normalizes blood glucose levels. All of these methods will help relieve the symptoms of toxicosis in the early period or in the last trimester, there is no difference.
• You can dissolve a slice of lemon or orange, sour fruits usually smooth out the manifestations of nausea. But for many, on the contrary, toxicosis increases, so you need to listen to your body and check all methods gradually.
• You need to drink only those drinks and juices that are right for you: herbal tea, iced drinks, plain water, vegetable broth.
• Instead of drinks containing a large amount of dyes, you can eat fruits with a high liquid content - melon, watermelon, grapes and ginger, with toxicosis will be the best option. Sometimes you can treat yourself to a serving of ice cream.
• Heavy, spicy and fried foods should be replaced with steamed dishes. Also, light foods in the form of dairy foods, fruits and raw vegetables are less taxing on the stomach and are much healthier.
• It is necessary to divide the meal into several servings and eat smaller amounts of food, but more often. During the day, you can connect crackers, a banana or an apple so that the stomach is not empty. The fight against toxicosis will not be in vain if you do not allow vomiting and nausea to become a habitual manifestation of your body.
• It is not recommended to go to bed immediately after eating. It is worth waiting a few hours before falling asleep or just lying down.
• A proven grandmother's recipe for toxicosis during pregnancy is a spoonful of honey at the beginning of the first symptoms of toxicosis.

Nutrition for toxicosis of pregnant women

So how to make up the diet of the expectant mother, with toxicosis in the early stages of pregnancy? The erroneous opinion of many is to limit oneself in food, the less we eat, the less nausea and vomiting. First, it is in the initial months that the embryo needs various trace elements and vitamins. Secondly, even the shortest diet, which is aimed at eating only one product, can soon cause an allergic reaction, both in mommy and in the fetus.

Therefore, it is important to make a balanced diet during this period:

• From the very beginning of toxicosis, it is necessary to exclude exactly those products that cause nausea. These are mostly dairy products.
• And what foods are needed, despite the progression of nausea and vomiting? To replenish minerals - sodium and chlorine - table salt is recommended, but in moderation. Therefore, salted fish and cucumbers will even be useful during this period, but do not forget about the measure, especially for women with chronic kidney diseases.
• The menu for toxicosis in late pregnancy is significantly different. First of all, it is important to remember the enemy of the last trimester of pregnancy - salt. Therefore, refrain from taking herring and cucumbers, this can provoke fluid retention in the body. And less salt in all dishes.

The best prevention for late toxicosis is moderate food intake. The most unloved products for the body in this period are smoked meats, pickles and marinades. Therefore, it is very important to follow a healthy and healthy diet before late toxicosis begins.

Protein plays an important role in late toxicosis, and the lack of protein leads to its decrease in the blood. In this connection, it is recommended to add boiled fish, cottage cheese and boiled lean meat to the healthy diet.

Treatment of toxicosis

There are many remedies for toxemia, and some only reduce the symptoms, while others fight it. But it is worth taking into account that not all drugs for toxicosis are safe and effective.

• Treatment of toxicosis with the help of a drug method. In the fight against toxicosis, among a wide range of drugs used, only valerian, nosh-pa and trace elements are among the harmless means. But in some situations, the use of more serious drugs is simply necessary for the health of the mother and child, if inactive, a miscarriage may occur. Drug treatment of early and late toxicosis should be comprehensive and include various drugs: enterosgel, Essentiale, cerucal and many others.
• Immunocytotherapy is a modern invasive method of treatment. The principle of its action is as follows: the husband's lymphocytes are injected into the skin of the forearm of a pregnant woman. Relief of symptoms of toxicosis occurs after 24 hours. This method of treatment requires a thorough examination of the father for infections. It is important to know that immunocytotherapy can be dangerous, as it increases the risk of contracting hepatitis and other infections.
• Homeopathic method of treatment. This type of fight against toxicosis is considered the safest and most effective. Homeopathy allows you to select individual preparations that can treat not only the female body, but also the children. Side effects and overdose are excluded, and addiction does not occur from the drugs used.
• aromatherapy has been used since ancient times and has a beneficial effect on the well-being of a pregnant woman. So, for example, during the morning exacerbation of toxicosis, you can drop a couple of drops of peppermint essential oil on a handkerchief and put it next to you. If you do this procedure for several nights in a row, the result will not be long in coming.

You can carry ginger oil with you and at the moment when the attack of nausea worsens, you need to drop ginger oil on your palms, rub it well and bring your palms to your nose, and take a deep breath. You can also carry out steam inhalation, they reduce the urge to vomit.

For preventive purposes, every morning it is necessary to rub the oil solution into the umbilical region: one drop of ginger is added to a dessert spoon of vegetable oil.

In addition to the above methods of treating toxicosis, phytotherapy is also used, and someone prefers unusual methods: acupuncture, hypnosis, electrosleep, and others.

You should not set yourself up for the fact that the manifestations of toxicosis during pregnancy will not let you through. Tell yourself more often: “Everything will be fine, both with me and with the child!”

Checking the article: Lada Sergeeva,
practicing gynecologist

Useful video about toxicosis during pregnancy

Answers

Almost 2/3 of pregnant women face toxicosis of varying severity. It can significantly worsen a woman's well-being and even cause her to be hospitalized. Fortunately, in most cases, toxicosis of pregnant women does not lead to disability, although this condition imposes certain restrictions on the regimen and nutrition.

What is considered toxicosis during pregnancy

Pregnancy without toxicosis is the absolute norm. But in the modern world this is not common, and the absence of any uncomfortable symptoms already in the first days after a delay in menstruation is often perceived by a woman as an alarming sign. So what is toxicosis?

This term refers to a group of pathological conditions that occur only during pregnancy, lead to a deterioration in the woman's well-being and are manifested by extragenital symptoms. They can appear even before registering a missed period and receiving a positive pregnancy test. So many women consider this condition to be the very first and quite reliable sign of a successful conception.

In fact, toxicosis refers to the dubious signs of pregnancy. After all, its symptoms are nonspecific, sometimes it is difficult to distinguish them from the signs of various somatic diseases. In addition, some complaints that appear in a pregnant woman may be of a psychogenic nature, that is, they do not have a physiological connection with the development of an embryo in the uterus. And sometimes a condition that mimics toxicosis even occurs outside of pregnancy. This is possible if a woman is very much looking forward to its onset and has a tendency to somatize her emotions due to individual psychological characteristics.

The term "toxicosis" was introduced into use at the beginning of the last century. Moreover, initially they designated pathological extragenital conditions that occur at any gestational age. Currently, toxicosis is diagnosed only in the 1st trimester. And at a later date, the term "gestosis" is used. And this is already a much more severe and potentially life-threatening condition for the fetus and woman. But even now it is sometimes called late toxicosis, which is not a completely correct term.

Main clinical forms

According to the modern classification, toxicosis includes:

• Vomiting of pregnant women is the most common form, accounting for up to 85% of cases. It is she who is most often called.
• Salivation.
• Dermatoses or "pruritus of pregnant women."
• Chorea of ​​pregnancy.
• Bronchospasm and bronchial asthma.
• Hepatosis, acute yellow liver atrophy.
• Osteomalacia.

In terms of severity, toxicosis can have 3 degrees of severity: mild, moderate, severe. This is decisive when deciding on the hospitalization of a pregnant woman, even if she does not show signs of a threat of interruption and deviations in the development of pregnancy.

Why does he appear

For quite a long time, the development of toxicosis was associated with the poisoning of the woman's body by metabolic products (toxins) formed during the development of the embryo. Currently, this theory is recognized as untenable, as it does not explain the disappearance of the main symptoms as the pregnancy progresses. Subsequently, many other assumptions were made, and some of them are reflected in the modern understanding of the pathogenesis of toxicosis of pregnancy. The study of this condition is still underway, because the final mechanisms for the development of key symptoms have not yet been established.

To date, it is believed that the main causes of toxicosis during pregnancy lie in the developing hormonal imbalance in the woman's body and in the change in the functional state of her central nervous system (especially the diencephalic region and the parasympathetic part). Subsequently, secondary dysmetabolic disorders occur. This aggravates the condition and may contribute to the formation of not functional, but structural changes in some internal organs with the appearance of new symptoms. In severe toxicosis, dystrophic changes develop.

For example, vomiting leads to dehydration and electrolyte imbalance. This can already secondarily provoke a violation of the digestive tract, convulsions, a violation of the functioning of the central nervous system and the heart. Starvation or low absorption of essential nutrients associated with toxicosis contribute to hypoproteinemia and the accumulation of ketone bodies. In an unfavorable scenario, this can cause severe progressive hyperlipemia with subsequent fatty infiltration of the liver.

In some cases, signs of toxicosis can be explained by the allergization of the body of a pregnant woman by trophoblast proteins.

Clinically significant hormonal changes

Pathogenetically important dyshormonal disorders of early pregnancy:

• Relative estrogen deficiency. By itself, this does not lead to toxicosis, but in combination with other disorders it becomes clinically significant and contributes to the development of autonomic reactions.
• An increase in the concentration of progesterone in the blood. This hormone is produced by the corpus luteum of the ovary, which remains in place and continues to function after the implantation of the embryo. Its main task is to prolong pregnancy, prevent spontaneous abortions and ensure adequate growth of uterine tissues. But the effects of progesterone are not limited to the reproductive system. It acts on smooth muscle fibers in the walls of the digestive tract, relaxing them. This can lead to an imbalance in the functioning of the stomach and various parts of the intestine, which causes unpleasant symptoms in toxicosis.
• Progressively increasing production of chorionic gonadotropin in the first weeks of pregnancy. There is evidence that the peak values ​​of this substance often act as a provoking factor for the development of vomiting. This may explain the prevalence of complaints of nausea in the morning, when the concentration of hCG is usually highest.
• Decreased secretion of glucocorticosteroids by the adrenal cortex. This leads to a decrease in the reaction of blood vessels to vasoconstrictor substances, contributes to the accumulation of fluid in the intercellular spaces.

Currently dishormonal changes are considered key in the pathogenesis of toxicosis.

What affects the likelihood of developing toxicosis

Not all pregnant women develop toxicosis. Even for the same woman, the period of bearing the first and subsequent children may differ. And if she has already experienced toxicosis earlier, during the second pregnancy, his symptoms may not bother. And it is impossible to predict its appearance.

There is also an opinion that there is a relationship between the likelihood of toxicosis and the sex of the conceived child. But it has no scientific evidence. In the earliest stages of pregnancy, when toxicosis usually appears, all embryos develop in the same way. They do not yet have a differentiation of the reproductive system, this will only happen from the 8th week of gestation. Therefore, the sex of the child cannot affect the development of early toxicosis.

Predisposing factors include:

• . The hormonal "surge" in a pregnant woman is usually higher than when conceived with a single embryo.
• Tendency to neurosis-like and somatoform reactions, migraines. Indeed, in these cases, even before pregnancy, there is a change in the interaction between the brain, the autonomic part of the nervous system and target organs.
• Transferred shortly before conception infectious diseases and surgical interventions, especially on the reproductive organs.
• The presence of chronic diseases of internal organs. The onset and prolongation of pregnancy can become a factor that disrupts the existing balance and leads to decompensation of the existing pathology. This is especially true for diseases of the digestive tract.
• hereditary predisposition.
• Age. Pregnant women over 35-40 years old are more likely to develop toxicosis. This is due to a decrease in their general compensatory capabilities of the body, a decrease in the functional activity of the endocrine and reproductive systems, and the accumulation of chronic and not always diagnosed pathology of internal organs.

It is important to understand that the presence of predisposing conditions only increases the likelihood of developing toxicosis. And their absence does not guarantee good health in the first months of pregnancy. Absolutely healthy and quite emotionally balanced women often face toxicosis. This is no exception to the rule and only speaks of the development of their reaction to the changes occurring during pregnancy.

When does toxicity begin?

How long after conception does toxicosis occur?

The timing of the development of this condition is quite individual, but in any case, it appears only after the implantation of the fetal egg into the functional layer of the endometrium of the uterus. And this process occurs no earlier than 5 days after the fusion of the egg and sperm, most often on the 9th day after ovulation.

But in a number of women, for various reasons, the timing of implantation shifts and can be either 7-8 or 11-14 days. At the same time, a long time interval between fertilization and the introduction of the fetal egg is fraught with non-preservation of pregnancy, the woman's body simply does not have time to adequately respond and prevent the onset of menstruation.

What explains such a period?

Fertilization of the egg most often occurs in the lumen of the fallopian tube. Therefore, for proper implantation, the resulting fetal egg must reach the endometrium. It also needs to go through certain successive stages of development and be transformed into a blastocyst in the process of active cell division. Therefore, even if fertilization occurs in the uterine cavity, implantation is still possible only after a strictly defined number of days.

Only after the introduction and fixation of the fetal egg in the endometrium, the woman's body receives a signal about the onset of pregnancy and begins to produce hormones for its prolongation. And a pronounced increase in the level of progesterone and a progressive increase in the synthesis of hCG are just capable of provoking the onset of toxicosis. But this usually does not happen immediately after implantation, but only after reaching a certain concentration of hormones and a secondary change in the functional state of the nervous system. In addition, each pregnant woman has her own sensitivity to the processes taking place in her body.

So what week does toxicosis begin?

The majority of women begin to experience its symptoms within about 1.5 weeks after a missed period. Most often, they are preceded by other signs of an increase in progesterone levels: breast engorgement, increased nipple sensitivity, and others. But in some pregnant women, they appear almost simultaneously with nausea, already a week and a half before the expected date of menstruation.

The pregnancy that came after can also proceed with toxicosis. In this case, it is necessary to take into account the later implantation of the fetal egg due to the technical features and timing of the procedure for transferring embryos into the uterine cavity. Therefore, the symptoms of toxicosis usually occur after confirmation of the fact of pregnancy using a laboratory test for hCG and ultrasound.

It is important to understand that toxicosis is not excluded and with. After all, the place of implantation does not affect the functioning of the corpus luteum, the synthesis of hormones is supported by the signals coming from the developing fetal egg. Therefore, it is impossible to assume an ectopic pregnancy only by the severity of toxicosis; other symptoms indicate this pathology.

Main manifestations

The most common form of toxicosis is nausea and vomiting of pregnant women. They are usually combined with increased salivation, increased sensitivity to odors (both food and household), the appearance of taste preferences, and a change in appetite.

Nausea is an uncomfortable, but not at all dangerous symptom for a woman’s health and for the development of an embryo. It can be almost constant, disturb with influxes in response to external taste and aromatic stimuli, or appear mainly in the first hours after waking up in the morning. But evening toxicosis is also possible, which is not a gross pathology. The deterioration of the state at the end of the day is explained by the fatigue of the pregnant woman with the depletion of the functional reserves of the nervous system.

Vomiting most often accompanies nausea and develops at its peak. In the first half of pregnancy, morning urges usually occur on an empty stomach. But vomiting can also appear after eating. Its frequency and abundance depend on the severity of toxicosis and the presence of concomitant chronic diseases of the gastrointestinal tract. The diet of a pregnant woman is also of some importance. Abundant, irritating, fatty foods usually aggravate the situation and provoke vomiting more often.

In addition, gastric emptying may not be spontaneous. Wanting to alleviate the condition, reduce the severity of nausea and feelings of heaviness and fullness in the abdomen, some pregnant women deliberately induce vomiting. This is fraught with the appearance of traumatic linear tears of the mucous membrane of the esophagus at the place of its transition to the stomach, which causes some discomfort and can even cause the appearance of individual streaks of fresh blood in the vomit.

Early toxicosis can also be accompanied by heartburn - a burning sensation behind the sternum with a sour taste in the mouth, and sometimes with a feeling of irritation in the throat. The appearance of this symptom is explained by the relaxation of the cardiac sphincter between the esophagus and stomach with the reflux of acidic contents into the upper sections and even into the oral cavity. The likelihood of heartburn increases with intentional provocation of vomiting. But in general, heartburn usually appears at more pronounced gestational ages.

The change in the general condition, the nature and severity of metabolic changes in toxicosis of the first half of pregnancy depend on the severity of its course. With repeated, debilitating vomiting, other symptoms appear and increase. They are associated with dehydration, electrolyte imbalance, protein deficiency and deterioration in the functioning of internal organs. Severe toxicosis is actually multiple organ failure.

Basic severity criteria

There are 3 degrees of severity of vomiting of pregnant women:

1. Light. Vomiting occurs 2-4 times a day, while the discharge is not abundant and without pathological impurities. The pregnant woman does not have weight loss, there are no deviations in the biochemical and general blood tests. Her general condition is assessed as satisfactory.
2. Medium. The frequency of vomiting is 10 or more times a day. The pregnant woman loses weight, she has obvious autonomic disorders and signs of dehydration (dry skin, decreased urine output with acetonuria, severe asthenia, tachycardia and a tendency to lower blood pressure). But there are no critical changes in the general and biochemical analysis of blood yet, the existing hypochloremia and mild anemia can be corrected. The temperature is usually subfebrile. With inadequate treatment, the condition progresses, disorders of carbohydrate and fat metabolism develop.
3. Heavy. Indomitable vomiting (more than 20 times a day) is one of the many polymorphic symptoms caused by multiple organ failure. Body temperature may be subfebrile or febrile. There is a progressive decrease in body weight with signs of dystrophy of internal organs and tissues. The functioning of the kidneys is disturbed, persistent oliguria, proteinuria, acetonemia and acetonuria develop. Liver damage causes jaundice due to bilirubinemia. The balance of minerals is grossly disturbed, there are obvious violations of all types of metabolism. With an increase in symptoms, the level of consciousness is disturbed, subsequently a coma develops.

Fortunately, intractable vomiting of pregnant women with progressive deterioration of the condition is now rarely diagnosed. After all, such a severe form of toxicosis develops by gradually worsening the symptoms, so that there is the possibility of timely correction of emerging disorders.

When to Worry

Most pregnant women experience a mild form of toxicosis, manifested by nausea and mild morning vomiting. This condition is not dangerous and does not even require special treatment. However, symptoms may develop that require immediate medical attention.

These include:

• vomiting more than 10 times a day;
• severe adynamia and asthenia, significantly disrupting the daily functioning of a pregnant woman;
• violation of the depth of consciousness (in the form of stunning and even stupor), the main symptom of this condition is motor and mental retardation with a violation of the level of contact with the outside world;
• weight loss;
• dryness and decrease in skin turgor;
• the appearance of the smell of acetone in the exhaled air;
• a clear decrease in the amount of urine excreted per day;
• the appearance of yellowness of the sclera, visible mucous membranes and skin;
• sudden disappearance of complaints, which may be a sign of a progressive drop in hCG levels due to.

Strengthening of existing symptoms, the appearance of new disorders - all this also requires a consultation with a doctor.

What is included in the survey

Examination of pregnant women with complaints of the presence of symptoms of toxicosis is aimed at assessing their somatic condition and excluding diseases that can lead to similar complaints.

Diagnostics includes laboratory and instrumental studies:

• a general blood test to detect anemia and signs of an inflammatory process;
• a biochemical blood test with a mandatory assessment of the functional state of the kidneys and liver, indicators of total protein and protein fractions, the ratio of key ions;
• urinalysis, determination of daily diuresis and daily loss of protein in the urine;
• Ultrasound of the organs of the hepatobiliary system, pancreas and kidneys, which allows not only to identify existing chronic diseases, but also pregnancy-related hepatosis;
• consultation with a neurologist (if a neuroinfection is suspected, with the development of impaired consciousness);
• according to indications - smears and, if necessary, a serological examination to exclude food poisoning.

Pregnant women with toxicosis must regularly monitor the level of blood pressure. After all, nausea and weakness can be due to its significant fluctuations both upward and towards a clear decrease.

Pregnant women with a sudden disappearance or a sharp weakening of the main symptoms require special attention. They are shown an unscheduled ultrasound to confirm the viability of the embryo. The fact is that during a frozen pregnancy, toxicosis often decreases rapidly due to the cessation of the synthesis of supporting hormones.

How to deal with toxicosis during pregnancy

Treatment of mild toxicosis is usually not carried out. Only with the development of neurosis-like reactions and a decrease in working capacity can a woman be offered therapy in a day or round-the-clock hospital. Moderate forms of toxicosis are the basis for resolving the issue of the advisability of hospitalization. And severely expressed options require the speedy placement of a pregnant woman in a hospital or even in an intensive care unit.

It is important to understand that all prescribed remedies are not able to completely eliminate the main symptoms, since it is impossible to get rid of toxicosis while maintaining its only cause (pregnancy). The drugs used help to stop potentially life-threatening complications, alleviate some of the manifestations and thereby alleviate the woman's condition. Moreover, each prescribed remedy for toxicosis has its own point of application and certain indications. Therefore, only a doctor should select the optimal therapeutic regimen.

Possible directions of therapeutic effects in toxicosis:

• Elimination of existing dehydration, the choice of technique depends on the severity of dehydration and the patient's condition. Drinking is practiced using special saline solutions, infusion therapy based on rheopolyglucin, Ringer-Lock and others.
• Correction of electrolyte disturbances and metabolic acidosis. In severe vomiting of pregnant women, the administration of a glucose-insulin-potassium mixture, sodium bicarbonate is often required. The selection of solutions to compensate for the deficiency of electrolytes is based on a dynamic assessment of their level in the blood plasma.
• Replenishment of a clear nutrient deficiency. In severe cases, special nutrient mixtures are prescribed, plasma, albumin, serotransfusin can be administered intravenously.
• Reduction of endogenous intoxication caused by multiple organ failure. Intravenous administration of gemodez is shown, sometimes extracorporeal blood purification procedures are performed.
• Maintaining the function of the hepatobiliary system. In mild and moderate cases, with a hepatoprotective purpose and to improve the functioning of the biliary system, Hofitol, Essentiale are often prescribed. With severe disorders, treatment regimens for non-infectious hepatitis are used.
• Fight against kidney failure.
• Fight against vomiting. For this, Cerucal is most often used. Pyridoxine (vitamin B6) preparations, such as Navidoxin, also have an antiemetic effect. For the relief of severe emetic attacks, injections of neuroleptic and antihistamines can be used.
• Stabilization of the neurovegetative background, regulation of the activity of the central nervous system. With indomitable vomiting in the first days of treatment, potent substances (tranquilizers, some antipsychotics, anesthetics) can be used to quickly reduce the excitability of the main structures of the brain. Subsequently, it is recommended to take herbal preparations, magnesium. The very fact of hospitalization often has a stabilizing effect, which makes it possible for a pregnant woman to create a protective regimen. Psychotherapeutic and some physiotherapeutic techniques are actively used (electrosleep, color and light therapy, aromatherapy, acupuncture, massage of the cervical-collar zone and hands, darsonvalization, etc.).

In severe toxicosis with the development of life-threatening conditions that cannot be at least partially corrected during the day, the issue of abortion for medical reasons is decided. This measure is also necessary in the development of acute yellow atrophy of the liver.

How to relieve toxicosis without drugs

Drug therapy for toxicosis is by no means an everyday measure. For mild (and sometimes moderate) vomiting of pregnant women, non-drug measures are sufficient. These include diet, work and rest regimen, a variety of folk remedies for toxicosis. Some women during this period resort to the help of homeopaths.

Herbal infusions based on mint, chamomile, lemon balm, valerian, sage, rosehip, oregano, ginger are widely used. Some of them have a slight sedative effect, others help reduce the severity of the gag reflex. But do not forget that herbal medicine is potentially allergenic. In addition, without the consent of a doctor, plants that can affect blood clotting should be avoided.

Helps with toxicosis during pregnancy and aromatherapy, despite the woman's increased sensitivity to smells. You can reduce the severity of nausea by inhaling a small amount of essential oils of peppermint, lemon, anise, ginger oil. They are usually used not in a pure (concentrated) form, but in a mixture with a neutral base oil. For such inhalations, you can use aroma lamps, aroma pendants, or simply apply a few fragrant drops on a handkerchief.

How to eat

Nutrition for toxicosis is a very important aspect. Food should be taken fractionally, which will avoid overeating and long "hungry" intervals. Many women manage morning sickness with a light snack right after waking up, right in bed. Such a meal will increase the level of glucose in the blood, because the natural morning subhypoglycemia for a pregnant woman can become a factor provoking vomiting.

During the day, to reduce the symptoms of toxicosis, you can use crackers, a slice of lemon, a teaspoon of honey, a small amount of sunflower seeds, cranberry juice. The composition of such a snack is selected individually, empirically.

Food during the period of toxicosis should be easily digestible, appetizing looking, freshly prepared, with a minimum of artificial flavoring and preservative additives. At the same time, it should provide the supply of essential nutrients and have adequate calorie content. It is advisable to abandon frying and deep-frying, the use of fatty sauces, smoked meats and factory-made sausages. Preference should be given to baked, boiled and stewed dishes, as well as fresh vegetables and fruits. Marinades and pickles can be used to a limited extent, if there are appropriate taste preferences.

It is recommended to include in the menu products with a high content of well-digestible protein, vitamin B6, polyunsaturated fatty acids. But freshly baked bread, products made from yeast dough and premium flour, legumes should be discarded - they can increase gas formation in the intestines, which will negatively affect the well-being of a pregnant woman.

When to expect relief

How long does toxicosis last in pregnant women and at what gestational age should its symptoms disappear? This question is one of the most common at the reception of an obstetrician-gynecologist. After all, nausea and other symptoms are very uncomfortable and can even disrupt the social life of a pregnant woman.

Toxicosis is typical for the first trimester of pregnancy, in most cases it begins to fade at 12-14 weeks of gestation. But sometimes his symptoms persist for some time (up to about 20 weeks), which is quite acceptable. Therefore, to refer to this condition, it is more correct to use the term "toxicosis of the first half of pregnancy."

The disappearance of symptoms is explained by physiological changes that occur starting from the 12th week of gestation. We are talking about the formation of the placenta. It not only forms a semi-permeable selective barrier between the blood of the mother and the fetus, but also performs an endocrine function. At the beginning of the first trimester, she begins to actively synthesize hCG and other hormones that were previously produced by the corpus luteum in the ovary. And at 14-16 weeks, this function completely passes to the placenta. At the same time, the concentration of hCG in the woman’s blood gradually decreases, which explains the improvement in her well-being.

Therefore, at the beginning of the second trimester, toxicosis usually passes. Of course, this happens gradually, with a gradual depletion of symptoms and an improvement in the general well-being and activity of the pregnant woman.

Morning toxicosis is a fairly common occurrence in early gestation. And in many cases, this does not require the use of any drugs. As the pregnancy progresses, its symptoms disappear, which usually allows a woman to fully enjoy the period of bearing a child.