Toxemia of Pregnancy

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toxemia of pregnancy

[täk′sē·mē·ə əv ′preg·nən·sē]
(medicine)

Toxemia of Pregnancy

 

a group of pathological conditions occurring in pregnancy that take the form of neuroendocrine and metabolic disturbances and disappear with the discontinuation of pregnancy. Predisposing factors include high blood pressure (hypertension), chronic nephritis, diseases of the liver and secretory glands, and neurogenic and psychic shock. According to the generally accepted neural reflex theory, toxemias of pregnancy are caused by pathological impulses that emanate from the fertilized egg and enter the patient’s central nervous system.

Toxemias of pregnancy differ in the first and second halves of pregnancy. Early toxemias are marked by hypersalivation, morning sickness, and uncontrolled vomiting, and late toxemias, by edema, kidney diseases, preeclampsia, and eclampsia. A period of morning sickness lasting six to ten weeks often accompanies the early onset of hypersalivation. Morning sickness usually does not require hospitalization or special treatment. Uncontrolled vomiting, which occurs 20 or more times a day, leads to increasing exhaustion, dehydration, and toxicosis. The disorder lowers the blood pressure, raises body temperature, and accelerates the pulse. In some cases it becomes necessary to terminate the pregnancy.

Late toxemias of pregnancy are generally manifested by edema, first in the legs and then throughout the entire body. Kidney diseases associated with pregnancy are marked by edema, high blood pressure, and the presence of albumin in the urine (proteinuria). The transition of kidney disease into the next stage of toxemia—preeclampsia—is marked by symptoms of circulatory disturbance. These include headache, the appearance of spots before the eyes, and pain in the epigastric region. The affected person becomes agitated or depressed, and the pulse is slow and strained. Eclampsia is manifested by seizures and coma, during which death may occur from pulmonary edema or cerebral hemorrhage. In the most severe nonspasmodic form of eclampsia —deep coma—death occurs from brain edema and irreversible changes in the liver.

The treatment of toxemias of pregnancy depends on the form of the disease and on its severity and duration. Uncontrolled vomiting necessitates hospitalization, a therapeutic and preventive regimen, and the administration of food in small portions. Bromine and chlorpromazine hydrochloride preparations are prescribed, as well as intravenous injections of glucose, physiological solutions, and vitamins. Edema is treated by restricting the intake of fluids and salt and by administering diuretics. The kidney diseases associated with pregnancy are treated in a hospital with diuretics and such antihypertensives as magnesium sulfate, chlorpromazine hydrochloride, reserpine, hydrochlorothiazide, and Lasix.

If preeclampsia develops, the patient should be hospitalized immediately in an intensive care unit under constant observation by obstetricians and resuscitation specialists. Preeclampsia and eclampsia are treated by providing a therapeutic and preventive regimen, by normalizing the functioning of the vital organs, and by eliminating the primary symptoms with narcotics, antihypertensives, and diuretics, as well as by careful delivery of the child as soon as possible.

Toxemias of pregnancy are prevented by following a proper regimen of work, rest, and diet during pregnancy. The pregnant woman should have regular gynecological examinations, which can detect and prescribe early treatment for diseases that may develop into toxemias of pregnancy. Early diagnosis and treatment of incipient manifestations of toxemias are essential.

REFERENCES

Petrov-Maslakov, M. A., and L. G. Sotnikova. Pozdnii toksikoz beremennykh. Leningrad, 1971.
Nikolaev, A. P. Pozdnie toksikozy beremennykh. Moscow, 1972.
Persianinov, L. S. Akusherskii seminar, 2nd ed., vol. 2. Tashkent, 1973.

A. P. KIRIUSHCHENKOV

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