TOXICOSES OF PREGNANT WOMEN (Greek toxikos the employee for greasing of arrows, i.e. poisonous) — the diseases which are arising in time and in connection with pregnancy and passing, as a rule, with its termination or in an early puerperal period.
It is accepted to distinguish early and late T. The toxicosis arising to 20 weeks of pregnancy call early, after 20 weeks — late. However this border is conditional. Basic distinction between early and late toxicoses is the main type of disturbances in an organism of the pregnant woman: for the majority of forms of early toxicosis disorders of functions of the alimentary system, are characteristic of late toxicosis — vascular disorders.
Separate forms T. were revealed in 19 century. So, in 1841 I. Korablev, and in 1874 I. P. Lazarevich considered an eclampsia as a specific disease of pregnant women; in 1886 E. Leyden offered the term «kidney of pregnant women», and a little later than Leleyn (M. to H. F. Lohiein) and behind it Kermauner entered the term of «a nephropathy of pregnant women» which remained and in modern obstetric literature. The term «toxicosis of pregnant women» was offered at the beginning of 20 century by W. A. Freund, to-ry considered T. as manifestations uniform patol. process. However the word «toxicosis» not quite precisely since still it was not succeeded to find the toxicants causing a disease. Therefore other terms «allergosis», «hypertensive syndrome of pregnant women», «neurosis of pregnant women» are offered; in foreign literature use the terms «ERN-gestoses» (from Edema, Proteinuria, Hypertonia s and «a toxaemia of pregnant women».
There are many various classifications of T., to-rykh the symptomatology of a disease is the cornerstone. For a long time obstetricians used Zeytts's classification including along with classical forms of toxicoses and other diseases which are found at pregnant women. Big disagreements are available concerning classification of separate forms of late toxicosis of pregnant women.
Etiol. the factor promoting developing of toxicoses is fetal egg and a placenta, however the contributing moments connected with a condition of an organism of the pregnant woman and influence of the environment on it are necessary for development of a disease.
Exists many theories of developing of early toxicosis of pregnant women: neurogenic, corticovisceral, hormonal, allergic, immune. In a crust, time early toxicosis is considered as a result of the disturbance of neuroendocrinal regulation and exchange connected with the diseases postponed earlier, features of the real pregnancy, influence on an organism of adverse environmental factors. The leading role belongs to a functional condition of c. N of page, to disturbances of reflex reactions of an organism of the pregnant woman in response to irritation of nerve terminations of a uterus the impulses going from fetal egg.
To a wedge, to forms of early toxicosis vomiting of pregnant women, hypersalivation (ptyalism), a dermatosis, a tetany, bronchial asthma, osteomalacy, jaundice of pregnant women, an acute yellow hepatatrophia belong.
Vomiting of pregnant women — one of frequent complications of pregnancy of early terms. It arises approximately at 50 — 60% of pregnant women, however only 8 — 10% from them need treatment (cm. Vomiting, vomiting of pregnant women ).
Hypersalivation often accompanies vomiting of pregnant women, arises as an independent form of toxicosis less often. At the expressed hypersalivation loss of saliva can exceed per day 1 l. Plentiful hypersalivation depresses mentality of the pregnant woman, leads to dehydration, a hypoproteinemia. Treatment of the expressed hypersalivation shall be carried out in the conditions of a hospital. Appoint rinsings infusion of a sage, a camomile, oak bark, atropine. At a considerable hypoproteinemia plasma transfusion is shown. The positive effect renders hypnosis.
Dermatosis. The most frequent form of a dermatosis of pregnant women is the itch, to-ry can have local character and be limited to area of a vulva or extend on all body. The itch sometimes happens painful, causes sleeplessness, irritability. The itch of pregnant women needs to be differentiated with other patol. the states which are followed by a skin itch: a diabetes mellitus (see a diabetes mellitus), fungus diseases of skin (see), a trichomoniasis (cm), allergic reaction (see the Allergy). Treatment comes down to purpose of the sedative, hyposensibilizing means, UF-radiations.
The tetania gravidarum is shown by myotonia of top and bottom extremities, persons. Diseases are the cornerstone of disturbance of exchange of calcium. It is also necessary to consider a possibility of manifestation in connection with pregnancy hypoparathyrosis (see). For treatment drugs of calcium are used.
Bronchial asthma of pregnant women is observed extremely seldom. Assume that it disturbance of calcic exchange owing to hypofunction of paraboards of pdny glands is the reason. Bronchial asthma of pregnant women should be differentiated with the exacerbation of earlier arisen bronchial asthma which is often observed during pregnancy (see). At treatment of this form of toxicosis use drugs of calcium, sedatives, vitamins.
Osteomalacy of pregnant women is caused by disturbance of phosphorus-calcium exchange, decalcification and a softening of bones of a skeleton. Its reasons are a little studied. In the expressed form osteomalacy of pregnant women meets extremely seldom; pregnancy in this case is absolutely contraindicated. The symphyseopathy is more often observed (see. Pubic symphysis ), to-ruyu a number of researchers carries to the erased form osteomalacy (see).
Jaundice of pregnant women is observed at excessive vomiting of pregnant women, at the renal and hepatic syndrome of pregnant women arising at an eclampsia (see). N. A. Farber allocated a special form of jaundice of pregnant women, to-ruyu called holestaticheskpm a hepatosis. It arises at the beginning of the second trimester of pregnancy more often, has the progressing character, stops with abortion, can repeat at each pregnancy and is the indication to abortion. Jaundice of pregnant women is followed by a skin itch, increase in level of cholesterol and an alkaline phosphatase in blood at the normal content of alaninaminotranspherase. At this form of toxicosis not incubation of pregnancy (see), Bleeding in labor is possible (see), at children anomalies of development are observed. Jaundice of pregnant women should be differentiated with the jaundice which arose at the pregnant woman owing to a disease of a viral hepatitis (see a viral hepatitis), and also as a result of cholelithiasis (see) or hemolitic anemia (see). Treatment is same, as at hepatitis (see). Appoint vitamins, glucose, proteinaceous drugs, etc. Sometimes resort to abortion.
The acute yellow hepatatrophia is observed extremely seldom as an outcome of excessive vomiting of pregnant women or a severe form of jaundice of pregnant women (see. Toxic dystrophy of a liver ).
the Pathogeny of late toxicosis is difficult. In a crust, time it is considered as result of disturbance of mechanisms of adaptation of the organism of the woman connected with changes of reactivity of c. N of page (corticovisceral theory). Also immune and vascular theories are recognized. The vascular frustration which are characterized by disturbance of a hemodynamics, microcirculation, vascular permeability, leading to increase in the ABP and sharp disturbance of peripheric circulation are the cornerstone of a pathogeny of late toxicosis. Circulator disturbances in various vascular pools lead to a hypoxia of bodies and fabrics, development of a metabolic acidosis. Frustration of cerebral circulation cause the subsequent disturbances of the central regulation of the vital functions of an organism — a vascular tone and breath. Considerable changes develop in kidneys: the spasm of the bringing arterioles promotes decrease in a renal blood-groove, reduction of glomerular filtering, a delay of sodium and excess liquid in an organism. The hypoxia leads to decrease in disintoxication, belkovoobrazovatelny and mochevinoobrazovatelny function of a liver. Late toxicosis is followed by the circulator disturbances in system of uteroplacental blood circulation leading to the intravascular disseminated blood coagulation, thrombosis of intervillous spaces and spiral arteries of a myometrium, partial or full switching off from a hemodynamics of certain sites of a placenta. At the same time insufficiency of a placenta develops, it is broken its transport, endocrine, barrier functions, immunotolerance between an organism of a .matera and a fruit decreases. These disturbances lead to development of a hypoxia and a small-for-date fetus. Frequency of late toxicosis of pregnant women reaches 17,6% of total number of pregnancies. It is shown various a wedge, forms — hydrops gravidarum (see), a nephropathy of pregnant women (see), a preeclampsia and an eclampsia (see. Eclampsia ). Nek-ry scientists allocate a hypertension of pregnant women. Foreign researchers distinguish two a wedge, forms of late toxicosis: preeclampsia and eclampsia. Late toxicosis is subdivided on «pure», arisen at almost healthy woman, and «combined», developed against the background of any hron. diseases. Late toxicosis of pregnant women can be followed by various obstetric complications: prezhdveremenny childbirth (see), weakness of patrimonial forces (see. Childbirth ), premature placental detachment (see), bleedings. It exerts adverse impact on a condition of a fruit. Depending on severity of toxicosis perinatal mortality (see) from 38 to 90%0 fluctuates; a hypoxia (see Asphyxia of a fruit and the newborn), hypotrophy (see), anomalies of fetation meet more often than at uncomplicated pregnancy.
In modern conditions the course of late toxicosis has nek-ry features: it is shown early, in the second trimester of pregnancy, quite often observed at arterial hypotension, eclamptic attacks arise at rather low hypertensia and a stertost of symptoms of the previous nephropathy. Seasonality of late toxicosis is accurately traced: in the winter and in the spring it is observed more often. The heaviest current has the combined toxicosis, especially at a disease of kidneys, cardiovascular system, endocrine system.
Philosophy of treatment of late toxicosis consist in obligatory hospitalization of the pregnant woman in department or chamber of pathology of pregnant women of a maternity home, creation of the medical and guarding mode, performing hypotensive therapy, correction of water and electrolytic exchange and acid-base equilibrium. In recent years at treatment of late toxicosis widely use infusional therapy for the purpose of elimination of disturbances of a hemodynamics, disorders of microcirculation and normalization of rheological properties of blood, and also an action for fight against a hypoxia and a small-for-date fetus.
Obstetric tactics at late toxicosis is defined by degree hundred weights and assumes the choice of term and a way of delivery. At absence or insufficient effect of the carried-out therapy of a severe form of late toxicosis reasonablly whenever possible early abortion, especially at patients with the combined toxicosis. In a crust. time in connection with development of obstetric anesthesiology indications to operation a dog and r ev and sechen and I extend (see).
Nowadays obstetricians allocate a preclinical stage of late toxicosis — protoxygoats, characterized by specific general and local changes and reflecting initial disturbances of adaptable mechanisms at pregnant women. To a wedge, to manifestations of a pretoksikoz refer the increased hydrophily of fabrics, increase in the ABP on 10 mm of mercury. after the dosed exercise stress (in the absence of decrease to initial level at rest), changes of a number of indicators of blood (the increased aggregation of erythrocytes and coagulability of blood), traces of protein in urine. Pretoksikoz develops at pregnant women of group of high risk on development of late toxicosis more often (pregnant women with various extragenital diseases, women with the first pregnancy are more senior than 30 years, and also the women having late toxicosis in the anamnesis).
The forecast after the postponed late toxicosis depends on quality of treatment-and-reabilitation actions in an early puerperal period since at these women renal failures, and further development of an idiopathic hypertensia are often observed (see).
Prevention of late toxicosis consists in systematic overseeing by all pregnant women, beginning from early durations of gestation, in holding recreational actions (observance of the guarding mode, a balanced diet of the pregnant woman, vitamin therapy), early identification and systematic treatment of a pretoksikoz and diseases contributing to its development. The women who transferred severe forms of late toxicosis need dispensary observation. The prevention of the next pregnancy within two years is desirable.
Bibliography: Barkhatova T. P. and Kadiyev V. A. Vomiting of pregnant women, Akush. and ginek. M 12, page 48, 1980; B e to-to e r S. M. Patologiya of pregnancy, L., 1975; In and x l I e in and E. M. Volemiche-skiye of disturbance in obstetric and gynecologic clinic and their correction, M., 1977; r and shch e N to V. I. Late toxicosis of pregnant women, Kiev, 1968; Nicol and-e in A. P. Late toxicoses of pregnant women, M., 1972; P e the t r about in - M and with l and - to about in M. A. and With about t of N is also new L. G. Late toxicosis of pregnant women, L., 1971; With and in e l e in and G. M. Infusional therapy in obstetrics and gynecology, M., 1976; F and r e r N. A. Jaundices and pregnancy, Akush. and ginek., No. 12, page 52, 1982; Burrow G. N. a. Ferris T. F. Medical complications during pregnancy, p. 60, Philadelphia a. o., 1975; Erkrankungen wahrend der Schwanger-schaft, hrsg. v. H. Kyank u. M. Giilzow, S. 229, Lpz., 1979; Rippmann E. T. EPH-Gestose, B. — N. Y., 1972.
T. P. Barkhatova.