Nausea and vomiting of pregnant women: pathogenesis-based management

Abstract

Background. According to WHO, 70-80 % of women experience symptoms of toxicosis during the first 16 weeks of pregnancy. 10-15 % of them need inpatient treatment. Vomiting occurs in 50-80 % of pregnant women, in 2 % there is hyperemesis gravidarum. Objective. To describe the features of pathogenesis of nausea and vomiting in pregnant women (NVPW) and the management of women with these conditions. Materials and methods. Analysis of literature sources on this issue. Results and discussion. Risk factors for NVPW are the history of migraine and sea sickness, a family history of hyperemesis gravidarum, multiple pregnancy. Metabolic and hormonal factors, motility disorders of the digestive system, psychosocial factors and evolutionary protection of the fetus during embryogenesis are involved in the pathogenesis of NVPW. In NVPW there is a lack of energy, which leads to lipolysis with the formation of ketone bodies. Progression of hyperemesis gravidarum leads to the disruptions of water, carbohydrates, proteins and lipids metabolism, to ketoacidosis, and to vitamin and mineral deficiency. Laboratory tests show an increase in hematocrit, leukocytosis, increased urea and bilirubin, decreased total protein and albumin, proteinuria, cylindruria, erythrocyturia, and a positive acetone reaction of urine. Complications of this condition for the mother include exhaustion, micronutrient deficiencies, neurological disorders, multiple organ dysfunction and even coma, and for the child – the risk of miscarriage and premature birth. The goals of NVPW treatment include the elimination of the symptoms and reduction of the risks to the mother and fetus. The aggressiveness of treatment is determined by the severity of symptoms and the degree of weight loss. In mild cases, drinking a lot of fluids, diet, rest, acupressure, and ginger extract are recommended, in moderate cases it is advisable to add pyridoxine, antihistamines, and dopamine antagonists. If vomiting does not disappear after such treatment, it is advisable to prescribe infusions of 0.9 % NaCl and Xylate (“Yuria-Pharm”), parenteral nutrition, ondansetron. In the absence of effect, methylprednisolone (intravenously) is prescribed. Reo water for medical purposes (“Yuria-Pharm”), which quickly eliminates the deficiency of fluid and electrolytes, contains an alkalizing component, and has detoxifying properties, can be prescribed as in addition. The purpose of infusion therapy for vomiting in pregnant women is to restore the volume of circulating blood, to stop ketogenesis, to restore fluid and electrolyte and acid-base balance, and detoxification. For this purpose, it is advisable to use Xylate, as far as glucose exacerbates acidosis and is poorly absorbed under stress. Xylate has an extremely powerful antiketogenic effect. Abortion in hyperemesis gravidarum is indicated in case of continuous vomiting for 3 days in the intensive care unit, reduction of diuresis to 300 ml per day, progressive acetonuria for 3-4 days, progressive weight loss, severe tachycardia (100-120 beats/min), dysfunction of the central nervous system, jaundice of skin and sclerae, hyperbilirubinemia (80-100 μmol/L). Conclusions. 1. NVPW is a common pathological condition among pregnant women. 2. In NVPW there is a lack of energy, which leads to lipolysis with the formation of ketone bodies. 3. Complications of this condition include exhaustion, micronutrient deficiencies, neurological disorders, multiple organ dysfunction, coma, risk of miscarriage and premature birth. 4. In the absence of the effect of conservative measures, it is advisable to prescribe infusions of 0.9 % NaCl and Xylate, parenteral nutrition, ondansetron, methylprednisolone. 5. The purpose of infusion therapy for vomiting of pregnant women is to restore the volume of circulating blood, to stop ketogenesis, to restore fluid and electrolyte and acid-base balance, and to detoxify. For this purpose, it is advisable to use Xylate.