Lecture on toxicosis of pregnancy (morning sickness) in the first trimester of pregnancy

2021-01-30 12:00 AM

Pregnant women who have old lesions in the gastrointestinal tract such as appendicitis, biliary tract disease, peptic ulcer disease, during pregnancy can easily cause vomiting and vomiting reflex.

General perception

After menstruation, pregnant women often have increased salivation, nausea, vomiting, and notify the woman that she is pregnant. If the signs of morning sickness increase that affects the life of the pregnant woman, it is called vomiting. If the vomiting worsens and affects the health and life of the pregnant woman, it is called: severe vomiting. All of the above phenomena will go away on their own by the end of the third month of pregnancy (pregnancy - pregnancy) with or without any treatment.

Causes of disease

Currently, we do not know the cause of their pathogenesis. There should be many authors that:

May be due to eggs: Pregnancy, twins, multiple pregnancies. They have high levels of hCG, making pregnant women experience nausea and vomiting a lot.

Allergy theory: Pregnancy is a foreign protein to the mother's body, it can cause allergies, making pregnant women nausea and vomiting. Therefore, after miscarriage or fetal death, vomiting symptoms naturally go away.

Gastrointestinal theory: Pregnant women with old damage to the digestive tract such as appendicitis, biliary tract disease, peptic ulcer disease, during pregnancy can easily cause vomiting and vomiting.

Mild vomiting

 

Clinical symptoms

Initially: Pregnant woman has saliva, pale mouth, irritability, feeling like eating a certain kind of food. Taste changes such as: fear of rice, a craving for sour, or a craving for an unusual food. Saliva poured out more and more.

Then: nausea, vomiting. Vomiting food. Usually vomiting in the morning, vomiting whenever you smell food or thinking about the smell of food. Vomiting can lead to epigastric pain due to stomach irritation during vomiting.

Status of pregnant woman: increasingly thin, pale, anemic, weight loss, fatigue; due to vomiting many women cannot eat. This clinical condition is common in pregnant women.

Testing should be done to rule out: pregnancy, twins, multiple pregnancies, appendicitis, encephalitis, ...

Treatment

Nursing: Let pregnant women stay in the hospital, quiet, airy, clean, with no smell of food, enough light, warm in winter. A cold diet should be eaten less likely to induce vomiting.

Drug treatment:

Antiemetic drugs reduce secretion: Atropine, Metoclopramide (Primperan 10mg / tablet) or Mo ilium M 10mg / tablet, ... orally or inject and dose depending on the patient's situation.

Synthetic antihistamines: Prometazin sultat, ...

Vitamin B6, Magne-B6, ...

Often after treatment, vomiting symptoms of pregnant women gradually decrease and stop vomiting. If not treated, the disease will cure after the first 3 months of pregnancy.

Severe vomiting

In the past, severe vomiting was also called incontinence, because at that time there was no effective antiemetics, so this disease had a high maternal mortality rate, because it was not known how to treat abortion. Fortunately, this disease is very rare in our country, now we have good treatment experience.

Clinical symptoms

Clinically, since 1850 Paul Dubois has described the clinical symptom and divided it into three phases. In fact, these three phases have no clear boundaries in terms of timing or the manifestation of their symptoms.

Stage of vomiting and wasting:

Signs of vomiting: vomiting in the morning, related to meals, after vomiting all day, while sleeping, must also wake up to vomit.

Vomiting: Vomiting at first, vomiting in water with a sour smell of gastric juice, then vomiting green, yellow bile.

The more you vomit, the more painful your epigastric region is due to the contraction of your stomach.

Because of increasing vomiting, patients cannot eat or drink, their body becomes more and more emaciated, his face emaciated and dehydrated. The amount of urine is less and less, and leads to electrolyte disorders, acidosis disorders.

This phase can progress from 4 to 6 weeks.

In fact, severe vomiting often occurs at this stage, because the health network has expanded, matured, patients come to see and treat early. At this stage the latter is less common.

Rapid angiogenesis and metabolic disorders:

Symptoms: Vomiting more and more almost continuously, but the amount of vomit is less, since there is nothing left to vomit in the patient's body (stomach), so it is called vomiting.

The patient was emaciated, withered, concave eyes, hollow cheeks, dry mouth and tongue, sour breath, acetone smell, wrinkled skin, concave belly of the boat. Small rapid circuit ranges from 100 to over 120 times / minute.

The spirit of anxiety, fear, pessimism, fear for the baby in the womb, fear for his or her life, fear of not continuing to be pregnant and family happiness ...

Assay: Red blood cell count and hematocrit increase because of dehydration. Reduced alkali reserves. Metabolic acidosis and electrolyte disturbances are increasingly evident. Blood urea increased, but there was no sign of nephritis.

Progression time is about 2 to 3 weeks.

Stages with neurological events:

This is the period of consequence of dehydration, electrolyte disturbances, acid-base disorders, malnutrition and prolonged metabolic disturbances.

Gagging symptoms are almost gone. The patient fell into despair. Sometimes the patient's spirit is panic, delirious, sometimes lethargic, and then convulsive.

Shallow tachycardia about 40-50 times / minute, the pungent breath smells of acetone. Fast circuit can be over 120 times / minute. The amount of urine is less and then almost anuria. Patients can die in this depleted state.

Laboratory tests: Urine contains acetone, bile salts, bile pigmentation.

Blood: increased urea, decreased alkaline reserves, increased metabolic acidosis, disorder electrolytes.

Diagnose

Differential diagnosis:

With signs of vomiting should be distinguished from: Pregnancy and pregnancy accompanied by enteritis, intestinal obstruction, intussusception

With rapid pulse signs to distinguish from pregnancy accompanied by heart disease, Basedovv, infections, poisoning ...

With signs of coma to distinguish from pregnant women in a coma: due to liver, diabetes ...

Implementing the quadrants:

It is necessary to rely on clinical and laboratory findings: urine hCG quantification, ultrasound imaging, to determine if a pregnancy is normal or not.

Progression and prognosis

Progression: Severe vomiting can progress from mild to severe, if the patient is not treated promptly and appropriately.

Prognosis: Good if the disease is diagnosed early, properly treated, thanks to new drugs from the pharmaceutical industry, thanks to good abortion techniques. Currently, we have the ability to keep the pregnancy or avoid death for the mother.

Treatment

Conditions:

To stabilize the patient's spirit and ideology, to be assured of confidence in the current treatment capacity of medicine.

Practice feeding the patient while vomiting:

The first two days of intravenous feeding were prevented from dehydration and electrolytes.

For the next two days, feed the patient with continuous mouth-sucking ice cubes, if responding.

For the next two days, give the patient a sip of cold, condensed cold milk to enhance the nutritional value, if responding.

In the next two days, cold soup can be given to the patient.

In the process of feeding the patient, if the next day the patient cannot tolerate the new way of eating, we feed the patient again as the day before, then train the patient to eat as usual.

Patients should be isolated from loved ones that have the potential to aggravate the patient's illness; For example, if the mother-in-law of the patient should not be taken care of if the mother-in-law does not match.

Monitoring and evaluation: The changes in clinical signs, tests compared to before to evaluate the progression of severe vomiting so that management measures can be adjusted accordingly.

Symptomatic therapy:

Anti-dehydration, nutrition, electrolyte disorders, acid-base disorders: by intravenous infusion of all kinds of fluids such as 9% sodium chloride solution; 5% glucose solution and 10% moriamin S-2 solution, 5% amino plasma solution, 10%, 15%; 45% sodium bicarbonate solution to balance acidic alkali, nutrition and adequate replacement of fluids, electrolytes.

Antiemetic with antiemetic drugs such as: Primperan lOmg (metoclopramide HCL) orally 3-4 capsules / day, (1 tablet half an hour before meals) or Motilium - M 10mg orally 3 - 4 tablets/day, also take 1 tablet. half an hour before meals. Exudative drugs (atropine, belladonna ...).

Antihistamine anti-allergic drugs such as: Pipolphen, Allerlene ...

Other trace drugs such as calcium, vitamin B6, Mg - B6, ...

Sedation: Rotunda ...

Obstetrics: When the above symptomatic treatment does not work, it is advisable to have an abortion to protect the pregnant woman's life. Curettage should be done an anatomical test to determine for accuracy.

Prevention

The causes of these symptoms of early pregnancy poisoning are not known yet. Therefore, the prevention of diseases is mainly to early detect and promptly treat poisoning phenomena. On the other hand, one should cure the cause (risk) diseases before planning a pregnancy.