Excessive vomiting of pregnancy (EVP) occurs in 3-10 cases per 1000 pregnancies. Predominant among the urban population.
Content
Main features
Excessive vomiting is a complication of pregnancy, manifested by uncontrollable nausea and vomiting, which develops in early pregnancy and leads to fluid and electrolyte imbalances and weight loss.
Unlike nausea and vomiting during pregnancy , which only bothers women in the morning, CRP appears not only in the morning, but throughout the day. At its core, this is severe toxicosis, and therefore requires serious attention.
Symptoms
This complication is first diagnosed at the beginning of the first trimester, from the 4th to the 10th week. Symptoms may persist up to 18-20 weeks.
The main symptoms are:
- uncontrollable vomiting;
- reduction in body weight by 5% or more from the initial weight;
- hypersalivation (increased salivation).
In this case, it is possible that
- hypovitaminosis,
- abdominal pain,
- weight loss,
- acid-base imbalance,
- increased levels of liver enzymes,
- increased blood pressure.
Reasons for the development of CRB
Factors have been identified that increase the likelihood of developing this complication:
- first pregnancy;
- multiple births;
- obesity;
- pregnancy diabetes;
- older primigravidas (over 30 years old);
- young primiparas;
- nausea and vomiting during a previous pregnancy;
- chronic diseases accompanied by poor nutrition.
Additional risk factors also include pre-pregnancy diseases:
- dental diseases;
- bronchial asthma;
- thyroid diseases;
- psychological disorders;
- smoking during pregnancy.
What complications can it lead to without treatment?
Untimely or inadequate treatment of excessive vomiting during pregnancy can lead to complications such as:
- blindness, brain damage;
- liver diseases;
- rupture and perforation of the esophagus;
- loss of consciousness, coma, death;
- renal failure;
- pancreatitis;
- deep venous thrombosis;
- sepsis (including fungal), local infections;
- venous thrombosis;
- pulmonary thromboembolism;
- splenic rupture;
- fatty infiltration of the placenta.
Diagnostics
To determine the reasons that caused CRB, the following studies are carried out:
- Ultrasound of the abdominal cavity;
- urine test for ketones;
- blood test for electrolytes, ketones, creatinine, acid-base balance, transminases;
- blood test for amylase/lipase;
- thyroid-stimulating hormone of the pituitary gland, free triiodothyronine and thyroxine in the blood;
- urine culture;
- hematocrit
If excessive vomiting in pregnant women continues after the 20-22nd week of pregnancy, then in order to carry out differential diagnosis, magnetic resonance imaging (preferably) and computed tomography of the abdominal organs are performed according to strict indications.
Increased levels of ALT and AST occur in 50% of cases with CRP; they quickly decrease with treatment. Typically, the increase in transaminase levels is minor and does not exceed 30% of the upper limit of normal. However, if they increase, it is necessary to exclude hepatitis.
Amylase increases in 10% of pregnant women with CRP and requires excluding the diagnosis of pancreatitis.
In 50-60% of cases, FRB is associated with temporary hyperthyroidism and suppression of thyroid-stimulating hormone. However, it is nevertheless necessary to examine the thyroid gland for possible diseases.
The presence of urinary tract infections and even asymptomatic bacteruria contribute to the prolongation of the period of CRP and the intensification of symptoms.
Treatment
Be sure to follow the diet recommended for mild to moderate nausea and vomiting during pregnancy. It is described in this article .
Carry out rehydration - replenishing fluid loss, correcting disturbances in electrolyte metabolism and acid-base balance.
For vomiting lasting 3 weeks or more, drug treatment begins with the administration of balanced vitamin-mineral complexes, then pyridoxine (vitamin B6) and thiamine (vitamin B1) are added.
Antiemetic (antiemic) drugs should be prescribed strictly in the specified sequence. Each subsequent drug can be prescribed only if the previous drug is ineffective.
Antiemetic (antiemic) drugs of group 1
These drugs are considered safe for mother and fetus:
pyridoxine (vitamin B1), 5% solution, taken 0.25-0.5 ml 2-3 times a day;
avioplant (ginger rhizome powder) - 250 mg 4 times a day;
mint tablets - 2.5 mg 4 times a day.
It is possible to combine drugs from the first group with each other.
Antiemetic (antiemic) drugs of group 2
These drugs belong to safety group B - there is no evidence of a health risk.
Prokinetic agents:
- metoclopramide (cerucal, raglan) in the form of a solution is used 2.0 ml (10 mg) intramuscularly or intravenously 2-3 times a day, then 1 tablet (10 mg) 3-4 times a day 30 minutes before meals at bedtime up to 4 weeks
Antiemetic drugs, which are often positioned as antihistamines (antiallergic) agents:
- dimenhydrinate (aviomarin, Daedalone, Dramamine) 50 mg 4-6 times a day up to 400 mg/day;
- diphenhydramine (diphenhydramine) 1% 1 ml intramuscularly, intravenously 1.0-5.0 ml, then in tablets 0.05 g 3-4 times a day up to 300 mg per day.
Antiemetic (antiemic) drugs of group 3
These drugs belong to safety group C - use caution when using them, and are approved for use in pregnant women under strict indications. There is some information about the danger to the fetus. They act on all body systems and penetrate the placenta. Can only be used from the second trimester of pregnancy:
- hyoscine butyl bromide (buscopan) solution 2.0 ml (20 mg) subcutaneously, intramuscularly, intravenously 2-3 times a day, then in tablets of 10 mg 3 times a day;
- promethazine (pipolfen) solution 2.5% 2.0 ml (50 mg) intramuscularly, intravenously 2-3 times a day, then in tablets 2-12.5 mg 4-6 times a day (up to 150 mg);
- chlorine promazine (aminazine) solution 2.5% 1.0-2.0 ml (25-50 mg) intramuscularly, intravenously 2-3 times a day (no more than 3 times), then in tablets 50 mg 3 times a day day (up to 150 mg);
- ogdansetron (domegan, eofetron, eofran) solution 0.2% 2.0 ml (4 mg) or 0.2% 4.0 ml (8 mg) intravenously slowly drip into 100 ml saline 1-2 times a day, then in tablets of 4-8 mg 2 times a day (up to 150 mg/day).
Other drugs
Drugs from other groups, with more serious contraindications, are used only when absolutely necessary. These include
- methylprenisolone (metypred),
- aprepitant (emend).
Pregnant women should be prescribed the minimum effective dose of the drug and periodically try to discontinue it or switch to using safer drugs.
If natural nutrition is not possible, enteral or parenteral nutrition .
If all treatment methods are ineffective and there are severe water and electrolyte disorders, termination of pregnancy is indicated.
The prognosis for the mother and fetus after reversing CRF is favorable.
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