Toxicosis in adults: causes, symptoms, diagnosis, treatment

Local gynecologist

Lukyanova

Yana Sergeevna

Obstetrician-gynecologist, endosurgeon Member of the European Society of Gynaecological Endoscopy Member of the European Society of Human Reproduction and Embryology

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Pregnant women often suffer from a particularly form of poisoning of the body - toxicosis. The pathology is accompanied by nausea and vomiting. Pregnant women experience poisoning of the body with fetal products. This pathology manifests itself with a wide range of symptoms. Modern medicine can eliminate the disease.

Toxicosis in pregnant women: manifestation of the disease

Toxicosis is poisoning. The fetus secretes products inside the woman's body. The latter begins to perceive the work of the fetus as hostile. As a result, symptoms of poisoning appear.

Signs of toxicosis in pregnant women:

• constant nausea and strong morning gag reflex;
• increased drowsiness;
• constant weakness and low performance;
• constant mood swings of a drastic nature;
• dislike of strong odors.

The pathology manifests itself during the first trimester of pregnancy. But not all women observe it. Why this happens - there is still no exact answer. Over time, the phenomenon itself disappears. But some people experience toxicosis in the late stages of pregnancy. This is a more dangerous form of toxicosis as it can negatively affect the course of pregnancy. Observation by specialists in a hospital will be required.

Symptoms of the pathology appear gradually after conception. At the beginning, loss of appetite and increased irritability are observed. The disease is gradually getting worse. But for one woman only a few symptoms are characteristic, and not all at once. And so for everyone.

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used to treat nausea and vomiting in pregnant women

Various treatments for nausea and vomiting in pregnancy (non-pharmacological and pharmacological) are discussed. Among pharmacological ones, they are widely used, incl. for self-medication, we received herbal remedies (ginger, peppermint and raspberry leaves). Drugs used to treat these symptoms in pregnant women include pyridoxine, H1 blockers, dopamine and serotonin receptor antagonists, and glucocorticoids. However, despite the large selection of antiemetics, evidence on their effectiveness and safety when used as antiemetics in pregnant women is limited. Further research is needed into the effectiveness and safety of medications for treating nausea and vomiting in pregnant women.

Nausea and vomiting occur in 50–80% of pregnant women. Symptoms usually begin between 8 and 12 weeks of pregnancy and ease or disappear completely by 16 to 18 weeks. In approximately 5% of women, nausea and vomiting persist throughout pregnancy [1]. These symptoms do not have a negative impact on the course and outcome of gestation, but can significantly worsen the quality of life of pregnant women. The most severe manifestation of nausea and vomiting during gestation is hyperemesis gravidarum (uncontrollable vomiting of pregnant women), which occurs in 0.05–1.00% of cases and requires hospitalization.

Pharmacological and non-pharmacological methods are used in the treatment of nausea and vomiting in pregnant women. If possible, treatment should begin with non-pharmacological methods, including recommendations for changes in diet and daily routine. Since strong odors (cigarette smoke, perfume, cooking food) are often inducers of vomiting, it is advisable to avoid contact with them. It is recommended to take food and liquids separately from each other at short intervals and in small portions. Overeating, fatty or spicy foods should be avoided. Dry baked goods are not recommended in the morning, and protein-rich foods in the evening before bed. There is evidence of the effectiveness of acupuncture in some cases, as well as acupressure.

Among pharmacological agents, along with drugs, herbal products have become widespread, including for self-medication.

Herbal remedies

The most widely used herbal remedies for self-medication by pregnant women, according to a targeted study, include ginger, peppermint and raspberry leaves [3]. Among them, only ginger has been studied in clinical studies.

The effect of ginger on gastrointestinal motility is due to peripheral anticholinergic and antiserotonin actions. Its effectiveness and safety were studied in seven comparative studies with placebo and pyridoxine (vitamin B6). Based on the results of these studies, it can be assumed that in a daily dose of at least 1 g, divided into several doses, ginger can reduce the symptoms of nausea and vomiting in both outpatient and hospitalized pregnant women, and is at least as effective as vitamin B6 [1]. However, the results should be interpreted with caution because the ginger studies had methodological limitations, including small numbers of participants and heterogeneity. According to the findings of two meta-analyses, the current level of evidence for the effectiveness of ginger as an antiemetic in pregnant women is not sufficient to use it in widespread medical practice [4, 5]. It is recommended that ginger be further studied in randomized controlled trials.

The available evidence-based medicine data and long-term experience of using ginger in real practice allow us to consider it quite safe. Concerns about the potential effects of ginger on fetal sexual differentiation due to interaction with testosterone receptors are not supported by evidence [1]. There is also no evidence that, due to its inhibitory effect on thromboxane synthetase, ginger can contribute to the development of uterine bleeding and spontaneous abortion. Unlike most antiemetic drugs, it does not cause sedation or drowsiness. In general, ginger is well tolerated by pregnant women; its side effects (heartburn, diarrhea, irritation of the oral mucosa) are rare [6]. The drug interactions of ginger have been poorly studied, but caution is recommended when using it concomitantly with indirect anticoagulants, in particular warfarin. More definitive information about the effectiveness and safety of ginger for a variety of indications, including nausea and vomiting in pregnancy, will be available once a review of all available data, including ongoing studies, is completed by the National Center for Complementary and Alternative Medicine. for Complementary and Alternative Medicine USA) [7].

The effectiveness and safety of other herbal remedies remain unknown. There are isolated reports of the use of mint leaves in pregnant women, but due to the potential to cause uterine bleeding, their use during pregnancy is not recommended [3].

Pyridoxine (vitamin B6)

Pyridoxine has been used to treat nausea and vomiting in pregnancy since the 1940s. The mechanism of its antiemetic action still remains unclear. The effectiveness and safety of pyridoxine alone and in combination with doxylamine have been studied in numerous clinical studies. Their results suggest that pyridoxine has an antiemetic effect only at high doses [8]. Specifically, two studies examined the efficacy and safety of pyridoxine as monotherapy when used at doses of 25 and 75 mg, respectively [8, 9]. The antiemetic effect was observed only in the second case [8]. It was also not possible to demonstrate the effectiveness of pyridoxine when added at a dose of 60 mg to intravenous rehydration agents, thiamine and metoclopramide in hospitalized women with hyperemesis gravidarum [10]. According to a recent meta-analysis, the level of evidence for the effectiveness of pyridoxine as an antiemetic in pregnant women is insufficient to recommend its routine use [5].

Pyridoxine, according to the FDA (Food and Drug Administration) classification, is one of the safest drugs during pregnancy - category A (safety proven in adequate clinical studies). However, these data were obtained for low doses of the drug recommended for pregnant women. At the same time, its antiemetic effect manifests itself in doses from 30 to 75 mg/day, which significantly exceeds that (1.9 mg) recommended for pregnant women [11]. Randomized, placebo-controlled trials did not show teratogenic effects with pyridoxine at doses up to 75 mg/day, but the number of women enrolled was insufficient to completely exclude such a risk. In addition, in high doses, pyridoxine can cause unwanted neurological effects, including seizures [12].

H1 blockers

Antihistamines that block H1 receptors are among the most widely used to treat nausea and vomiting in pregnancy. Various drugs in this group have been studied in more than 20 controlled studies. A meta-analysis of these studies showed that the risk of developing congenital anomalies of the fetus in the group of women receiving antihistamines was even slightly lower than in women who did not receive them [13]. However, H1-blockers significantly reduce vomiting (according to pooled data from 7 studies, relative risk [RR] = 0.34, 95% confidence interval [CI] – 0.27–0.43) [2]. Unfortunately, analysis of the results does not allow us to establish the optimal treatment regimen, since the studies examined different drugs in different doses. In addition, the side effects of antihistamines limit their use, in particular sedation, which causes many women to refuse to take them during the day [1]. There have been no studies examining non-sedating antihistamines (loratadine, cetirizine, fexofenadine) as antiemetics in pregnant women. In addition to sedation, first generation antihistamines can cause undesirable anticholinergic effects - dry mouth, accommodation paresis, constipation.

Doxylamine, diphenhydramine, dimenhydrinate, and meclizine are considered reasonably safe and are classified as Category B by the FDA. However, one case-control study found a weak correlation between diphenhydramine use and cleft palate in children [14]. Chills, diarrhea, respiratory depression and withdrawal symptoms have been described in neonates whose mothers took diphenhydramine during pregnancy. Concomitant use of diphenhydramine with benzodiazepines should be avoided, since the use of this combination during pregnancy is associated with a significant increase in perinatal mortality [15].

Dopamine receptor antagonists

Dopamine receptor antagonists (phenothiazines, benzamides, and butyrophenones) have also been used for many decades to treat nausea and vomiting in pregnancy. Phenothiazines (promethazine and prochlorperazine) are more effective than antihistamines in treating nausea and vomiting in pregnancy. Phenothiazines have been studied as antiemetics in women with severe vomiting in three randomized clinical trials (n = 400) and found to be significantly superior to placebo (RR = 0.31, 95% CI 0.24–0.42) [2].

From a safety point of view, the most well-studied phenothiazine derivative in pregnant women is chlorpromazine. In a case-control study of 315 prenatally exposed children and 11,099 controls, a small increase in the incidence of congenital anomalies was found in the chlorpromazine group (3.5 versus 1.6%) [16]. However, in another study that included 50 thousand children, including 142 children exposed to the drug in the first trimester and 284 throughout pregnancy, an increase in the incidence of malformations with the use of chlorpromazine could not be detected [17]. Similar data in this study were obtained for structurally similar drugs such as trifluoroperazine, perphenazine and prochlorperazine. In another study, use of prochlorperazine in early pregnancy was associated with a statistically significant increase in the risk of ventricular and atrial septal defects (odds ratio 1.52, 95% CI 1.05–2.19) [18]. Due to the fact that the teratogenic effect of phenothiazines was also observed in experiments on rodents, they are classified as category C in the FDA classification [19].

Two meta-analyses of pregnant women with schizophrenia taking dopamine receptor antagonists demonstrated an increased risk of preterm birth, perinatal death, and low birth weight. However, these complications could be due to risks associated with the maternal disease itself [20, 21]. Another meta-analysis examining the use of weak antipsychotics in pregnant women showed that their prenatal exposure may be associated with the development of one additional case of congenital anomalies for every 250 pregnancies [22].

When mothers took high doses of chlorpromazine, their newborns developed respiratory distress syndrome [23]. Symptoms of extrapyramidal disorders (muscle rigidity, hypertension, tremor, dyskinesia, akathisia, weakness, feeding difficulties and insufficient motor maturity), which are considered a manifestation of withdrawal syndrome, have also been described [24]. These complications develop rarely and are usually transient in nature, although in some cases they can be observed for several months [25, 26]. A fairly common complication in children exposed during fetal development to typical antipsychotics, mostly weak ones, is incomplete formation of reflexes [27].

The benzamide derivative metoclopramide is widely used to relieve symptoms of nausea and vomiting as a second-line drug when phenothiazines and antihistamines are ineffective. Teratogenic effects with the use of metoclopramide have not been identified either in experimental animals or in humans (category B according to the FDA classification) [1]. The safety of its use in the first trimester of pregnancy was recently confirmed by the results of a large retrospective study in which 3458 children were exposed to the drug in utero [28]. Widespread use of metoclopramide limits the risk of developing extrapyramidal disorders in the mother, primarily tardive dyskinesia and acute dystonic reactions.

The butyrophenone derivative droperidol is used for severe nausea and vomiting. Its use has also not been associated with congenital abnormalities, but this drug has rarely been associated with prolongation of the QT interval on the maternal ECG, which can lead to fatal arrhythmias. Due to the risk of developing this complication, droperidol has been withdrawn from the pharmaceutical market in some countries, in particular the UK [29]. The American College of Obstetricians and Gynecologists recommends using this drug with caution [30]. In addition, when using droperidol, like other dopamine receptor antagonists, the development of extrapyramidal disorders is possible.

Several cases have been described in which an association was made between the use of haloperidol and limb shortening, but large series of observations did not confirm this association [31]. In a targeted cohort study, pregnancy outcomes in women taking butyrophenone antipsychotics (haloperidol - 188 and penfluridol - 27), with 78.2% of them in the first trimester, were compared with outcomes in 613 women taking non-teratogenic drugs. It was not possible to identify a significant increase in the risk of developing major congenital anomalies under the influence of butyrophenone derivatives [32]. However, two cases of congenital limb defects were reported in the butyrophenone group (one with haloperidol, one with penfluridol). Due to the relatively small number of participants, the study authors do not exclude a cause-and-effect relationship between butyrophenone antipsychotics and congenital limb anomalies. In addition, the use of butyrophenones was associated with significantly higher rates of spontaneous abortion and preterm birth, as well as lower birth weight of children.

Serotonin receptor antagonists

Serotonin receptor antagonists are not officially registered for the treatment of vomiting in pregnancy, but doctors prescribe ondansetron quite often for severe vomiting or hyperemesis gravidarum. When using ondansetron in the first trimester of pregnancy, no teratogenic effects were detected (category B according to the FDA classification). The clinical efficacy of ondansetron (10 mg every 8 hours intravenously) for hyperemesis gravidarum was studied in a small (n = 30), double-blind, randomized comparative study with promethazine (50 mg every 8 hours intravenously) [33]. There were no differences in length of hospital stay, reduction in nausea, or number of medications required to control vomiting between the groups. However, in the promethazine group, eight women reported symptoms of sedation, while no such effect was noted in the ondansetron group. The superiority of ondansetron in terms of efficacy compared to phenothiazines could not be demonstrated in this study, although there are reports in the literature of cases of its effectiveness in women with hyperemesis gravidarum in whom therapy with other drugs was unsuccessful.

In general, ondansetron is superior in safety to antihistamines and dopamine receptor antagonists [34]. Its most common side effects are headache, dizziness, sedation and gastrointestinal disturbances [35]. Serotonin receptor antagonists, including ondansetron, can cause a variety of changes in the ECG (PR, QRS, QT, QTc, JT intervals), but they are usually minor, reversible and in most cases have no clinical significance. Severe arrhythmias have not been described with their use [36].

Glucocorticoids

Glucocorticoids are prescribed to hospitalized women with hyperemesis gravidarum. Data from clinical studies on the effectiveness of glucocorticoids in pregnant women are controversial [1]. Drugs in this group quickly relieve symptoms, but their effectiveness with long-term use is questionable [1]. Corticosteroid use was associated with a small increased risk of cleft palate (RR = risk 3.4; 95% CI 1.97–5.69). Their use is not recommended before the 10th week of gestation.

Conclusion

Thus, despite the large selection of antiemetics, evidence on their effectiveness and safety when used as antiemetics in pregnant women is limited. This is supported by the results of a recently published Cochrane meta-analysis, which included 27 controlled randomized trials (4401 women) that evaluated various treatments for vomiting in pregnancy (acupuncture, acupressure, ginger, vitamin B6 and some antiemetics) [5]. Its authors were unable to formulate clear recommendations for the treatment of nausea and vomiting during gestation due to the methodological shortcomings of the studies, the heterogeneity of their participants, the interventions used, the comparison groups and the outcomes assessed. Further research is needed into the effectiveness and safety of medications for treating nausea and vomiting in pregnant women.

Information about the authors: Elena Andreevna Ushkalova – Doctor of Medical Sciences, Department of General and Clinical Pharmacology of RUDN University. Email; Romanova Olga Leonidovna – postgraduate student of the Department of General and Clinical Pharmacology of the RUDN University. Email; Illarionova Tatyana Semenovna – Candidate of Biological Sciences, Associate Professor of the Department of General and Clinical Pharmacology of the RUDN University.

Source

Origins of the development of pathology

During pregnancy, hormonal changes occur in the female body. This is a natural process.

Modern science is not able to give an exact answer about the development of toxicosis. Each woman develops this disease individually. It all depends on the immunity and physiological characteristics of the pregnant woman’s body. High-quality therapy requires an individual approach.

The emerging fetus produces waste products and produces toxins. The disease is not terrible and you should not be afraid of it. The task of the expectant mother is to alleviate her situation in the possible ways.

Additional reasons for the development of toxicosis:

• growth of the placenta;
• protecting the body from the effects of an actively growing fetus;
• presence of chronic diseases;
• unstable psychological state of the pregnant woman;
• genetic predisposition;
• pregnancy with multiple fetuses;
• great age of the pregnant woman.

The development of toxicosis is accompanied by a considerable number of factors. It is difficult to independently try to determine the source of the problem and how to influence it. Specialists of JSC “Medicine” (clinic of academician Roitberg) will help a woman get rid of feelings of discomfort and turn the initial stage of pregnancy into pleasure.

Causes of defecation delay

Constipation is a condition characterized by a decrease in the number of bowel movements, difficult bowel movements, and hard stools. The disorder is often accompanied by a decrease in the volume and consistency of stool.

Constipation during pregnancy occurs for several reasons:

1. Violation of the motor-evacuation and rhythmic function of the intestines, caused by compression from the growing uterus.
2. Relaxation of intestinal smooth muscles, impaired peristalsis due to increased progesterone levels.
3. Unbalanced diet, insufficient water intake.
4. Drug therapy, the presence of chronic gastrointestinal diseases.

Also, gestational constipation is often associated with a lack of physical activity, taking certain vitamins and minerals, and emotional stress. In the early stages, problems with stool occur due to toxicosis. General malaise, nausea, loss of appetite - all this affects digestion and causes dehydration and a decrease in the volume of feces.

The most common cause of colonic stasis in pregnant women is a decrease in the production of substances that activate intestinal motility. A decrease in the amount of these compounds is normal. This is a kind of protective reaction of the body that prevents the threat of miscarriage.

Physical inactivity can be the main mechanism for the development of constipation during pregnancy and an aggravating factor. Insufficient physical activity is usually associated with a woman’s unsatisfactory well-being, the risk of miscarriage, and a doctor-recommended reduction in activity. And during a multiple pregnancy, even simple exercises can be difficult for a woman due to the increased load on the musculoskeletal system.

The food preferences of the expectant mother also change. Often, the diet is completely revised some time after conception. The digestive system may need some time to get used to increased amounts of food and changes in the daily menu.

Risks of toxicosis

Despite the natural origin of the disease, it carries risks. They are associated with the course of pregnancy and the quality of gestation. The disease can also negatively affect the general condition of a woman.

Risk factors for toxicosis in pregnant women:

• lack of quality sleep;
• constant overwork;
• lack of a power supply system.

The fetus requires additional resources from the female body for development. But the body does not rest and does not receive quality nutrition for the growth of the fetus.

There are several degrees of early toxicosis in pregnant women:

• mild degree. Vomiting no more than 5 times a day. Loss of body weight no more than 3 kg;
• average degree. Vomiting up to 10 times a day. In 2 weeks, a woman can lose up to 10 kg of weight. Unsatisfactory general condition;
• severe degree. Vomiting more than 25 times a day. Loss of body weight more than 10 kg. Development of liver and kidney failure, general degradation of the body.

Observation of a general deterioration in well-being and active manifestation of symptoms is a reason to consult a specialist. Vomiting and not eating deprive the fetus of important nutrients.

Contraindications

Even though Enterosgel does not penetrate the systemic bloodstream and does not stick to the walls of the digestive canal, it has a number of contraindications:

• peptic ulcer of the duodenum or stomach in the acute stage;
• morphophysiological disorders in the gastrointestinal tract of various types (intestinal atony, acute gastric dilatation syndrome, etc.);
• hypersensitivity to Enterosgel components;
• bleeding from the gastrointestinal tract.

Side effects

Enterosgel is well tolerated, but this does not eliminate the possible occurrence of adverse reactions. Thus, taking the drug can cause nausea, periodic vomiting, and in the first days there is a possibility of developing constipation. In case of functional renal or liver failure, a feeling of aversion to the drug may occur.

Risks of complications

The effect of toxicosis on a pregnant woman’s body depends on the degree of development of the disease. The first degree is harmless to the woman’s body and occurs naturally. In some cases, the second degree does not pose a threat. In a normal course, by 14 weeks the symptoms disappear.

The third degree is dangerous for the health of the woman and the fetus. The body becomes dehydrated and exhausted. Women are at risk of developing complications:

• heart and kidney failure;
• pulmonary edema;
• falling into a coma due to exhaustion;
• placental insufficiency in late stages of pregnancy;
• delay in fetal development;
• risk of premature birth.

Toxicosis in pregnant women is not always mild. The health of the fetus is in the hands of the mother and father. As symptoms of the disease develop, the risk of complications increases proportionally.

Features of treatment and laxatives

Treatment of constipation during pregnancy requires an integrated approach. The doctor’s first recommendation will be to adjust your lifestyle and diet. In case of ineffectiveness or poor effectiveness of such measures, symptomatic therapy is prescribed. The doctor will not wait for results from the diet if constipation causes severe discomfort, there is a risk of complications, and urgent help is required.

When choosing a laxative, it is important to pay attention to the safety of the drug for both the expectant mother and the baby. There are several groups of laxatives:

• Osmotic (macrogol, lactulose). Products based on macrogol (polyethylene glycol) help soften stool and increase its volume. As a result, the walls of the colon are stretched, which stimulates their contraction and bowel movements. Lactulose preparations are laxatives with prebiotic action. They also increase the volume of intestinal contents, increase osmotic pressure, dilute stool and stimulate peristalsis. In addition, lactulose stimulates the growth of lactobacilli and inhibits the growth of ammoniogenic microorganisms and salmonella.
• Softening. Such products are represented by oils and glycerin, they promote the penetration of water into the stool. These drugs can only be recommended for the treatment of occasional constipation, since vegetable oils interfere with the absorption of fat-soluble vitamins (A, ED, K). They are prescribed to pregnant women with great caution to avoid complications such as hypovitaminosis.
• Bulk laxatives: vegetable - bran, plantain seeds, flax, etc.; synthetic - preparations based on cellulose. Promotes fluid retention in the intestines, increases the volume of feces, and gently stimulates peristalsis. Suitable for continuous use for constipation with normal transit time.
• Anthraquinone derivatives, stimulant laxatives. Preparations based on buckthorn, rhubarb, and senna are absolutely contraindicated during pregnancy. They have a teratogenic effect and can cause severe pathologies in fetal development. In addition, such laxatives are addictive and are fraught with irreversible consequences for a woman’s digestive system.

The doctor may prescribe other groups of drugs to relieve constipation. If means for regulating intestinal motility are in most cases contraindicated for the expectant mother, then pre- and probiotics can be recommended to restore the intestinal microflora. This is especially true in cases where stool retention has been observed for a long time and there is a possibility of an imbalance in the microflora.

The range of medications approved for use in pregnant women is very limited.

For expectant mothers, medications that irritate the intestinal epithelium, increase peristalsis and have a softening effect are contraindicated. During this period, doctors recommend using laxatives that do not harm the health of the mother and fetus and do not affect the course of pregnancy. For example, agents of the osmotic, isoosmotic group. These drugs do not penetrate the fetoplacental barrier, are not absorbed into the gastrointestinal tract, and do not change the tone of the inner layer of the uterus (myometrium).

Such products include “Fitomucil Norm”. The drug does not contain senna or components with teratogenic effects. The product contains natural sources of soluble fiber: the shell of plantain seeds, as well as the pulp of homemade plum fruits. “Fitomucil Norm” gently restores the rhythm of the intestines, normalizes stool, and facilitates the process of defecation. In addition, “Fitomucil Norm” is an English drug with guaranteed quality of raw materials, high efficiency and safety.

Prebiotics and probiotics provide indirect help for constipation. They help normalize the ratio of bacteria, promote the production of vitamins, normal and regular bowel function. Probiotics provide a favorable environment for the proliferation of your own beneficial flora. Prebiotics, in turn, are a complex of living bifidobacteria and lactobacilli that populate the intestines and help eliminate the manifestations of dysbiosis. Such drugs are approved for use in pregnant women according to indications.

Decoctions of prunes or rolled oats, as well as a mixture of dried apricots, raisins and honey, are good for constipation. Dried apricots contain a lot of fiber and are a kind of natural bulk laxative. Regular consumption of kiwi also helps normalize stool in pregnant women. Fresh vegetables and fruits containing large amounts of dietary fiber have a similar effect. But it is important to remember that not all common products and folk remedies can be used during pregnancy.

At the first symptoms of constipation, it is advisable to inform your doctor about this and discuss with him the optimal way to combat constipation.

Contact a specialist

You should not rely on your own strength to overcome toxicosis in the early stages and its consequences. Specialists from JSC “Medicine” (academician Roitberg’s clinic) believe that pregnancy should be comfortable. Despite the absence of a threat from a mild form of the disease, you should still see a doctor.

Factors that determine an urgent visit to a doctor in the center of Moscow in case of toxicosis in pregnant women:

• vomiting more than 5 times per day. Due to regurgitation of nutrients, the body develops exhaustion and dehydration;
• the number of urinations decreased and the urine became darker in color. During vigorous activity, dizziness is observed;
• abdominal pain;
• vomiting when eating food and lack of food for more than 12 hours;
• weight loss exceeds 2.5 kg per week.

The listed factors of toxicosis reflect serious problems with the body. Delaying time will lead to even bigger problems.

Symptoms of toxicosis in late pregnancy

Late toxicosis is a serious complication of pregnancy. Women with late toxicosis need constant medical supervision, since there is a threat not only to the health of the pregnant woman, but also to the baby. Due to metabolic disorders, the placenta, which is the connecting link between mother and child, suffers. Its blood supply deteriorates, so the fetus does not receive the nutrients and oxygen it needs.

Excess water in the mother’s body creates a large load on the kidneys, which can lead to their failure, and in severe cases, to hemorrhage and swelling of the brain. With a mild degree, you can do without a hospital, the main thing is to regularly see a doctor. In severe cases, hospitalization is mandatory.

The main symptoms of late toxicosis:

• swelling;
• increased blood pressure;
• the appearance of protein in the urine;
• convulsions.

Slight swelling is observed in the later stages in most pregnant women, but widespread swelling throughout the body, including the face, indicates the appearance of dropsy - late toxicosis of the initial stage. In more severe cases, blood pressure increases and there is a risk of developing a convulsive syndrome. A pregnant woman with such symptoms must be admitted to a hospital under medical supervision.

Visit or doctor's visit: preparatory activities

Poor health, constant low blood pressure and vomiting require preparation before visiting the medical center on your own. You should relax before going to the hospital.

Loved ones need:

• make an appointment for the pregnant woman in advance;
• organize delivery in the most comfortable conditions by car or taxi in the shortest possible time;
• promptly pick up the pregnant woman from the clinic.

If acute problems arise, you should wait until the doctor comes to your home. Ambulance is an effective measure in the fight against toxicosis, since the patient may be unable to move independently.

Diagnostic measures of toxicosis

Obvious symptoms do not give the right to independently diagnose toxicosis during pregnancy. The patient should be examined by a specialist. Doctors from various fields of our multidisciplinary medical center in the center of Moscow treat diseases. This depends on the strength of the disease and the presence of additional pathologies.

• Gynecologist. Qualified specialists will tell you how to deal with toxicosis using medications and other means. The pregnant woman will be explained the causes of toxicosis and how long toxicosis lasts. The doctor will listen to the symptoms of toxicosis of the pregnant woman and accurately outline the clinical picture. Toxicosis of the first pregnancy should not cause fear to patients either - the gynecologist’s task is to give confidence to future mothers. There is also the opportunity to ask a specialist about the timing - when toxicosis ends.
• Severe toxicosis and the presence of complications require an in-depth study of the patient’s condition by other specialists. Our clinic offers the opportunity to undergo examinations by a physiotherapist. The doctor will tell you how to alleviate toxicosis and reduce its effect on other organs.
• Personal problems will be resolved by a psychologist. A specialist will help resolve family problems until toxicosis ends. The psychologist will tell you how to combat toxicosis.

The family and the pregnant woman themselves should prepare in advance for the period when toxicosis begins. This is done at the stage of pregnancy so as not to unnecessarily irritate the woman. JSC "Medicine" (clinic of academician Roitberg) provides a full range of medical services for pregnant women in the Central District.

How to deal with toxicosis using folk remedies?

Let us immediately make a reservation that it is possible to fight toxicosis with folk remedies only in mild cases. If symptoms are severe and severe, medical attention is required. The following tips will help alleviate toxicosis in early pregnancy:

• When you wake up, do not jump out of bed immediately. Lie down for a while, and only then get up, slowly without sudden movements.
• Sour or salty foods sometimes help with nausea. You can suck a slice of lemon or eat a lightly salted cucumber.
• One of the popular methods to combat nausea is water with honey and apple cider vinegar. Add one teaspoon of food to a glass of water and place it next to your bed before going to bed. When you wake up, drink a drink. Please note that this recipe has limitations. It is contraindicated in women with diabetes, excess weight, liver and gallbladder diseases.
• Mint also helps to cope with early toxicosis. To quickly relieve an attack of nausea, carry mint candies with you in your purse, and brew tea at home with the addition of mint leaves.

In case of late toxicosis, to reduce swelling, it is recommended to reduce salt intake and control the amount of fluid. Two liters per day will be enough.

If none of the tips helps cope with toxicosis, you should visit a doctor.

Treatment methods

Severe manifestations of the disease require specialized medications. Self-medication can be harmful, so you should definitely consult with specialists from JSC “Medicine” (clinic of academician Roitberg). This way there will be no risk of harm to the fetus.

Treatment principles:

• mild form does not require treatment. It all comes down to observation;
• elimination of vomiting;
• choleretic drugs relieve symptoms and improve liver function;
• other prescribed medications will help get rid of muscle spasms, eliminate abdominal pain, lower blood pressure and overcome general weakness.

Medications are prescribed by qualified doctors based on test results. Conclusions and treatment based on them that are not supported by research are dangerous to health.

Symptoms of constipation during pregnancy

The main signs of constipation during pregnancy include:

• lack of stool for more than three days in a row;
• incomplete bowel movement;
• discomfort and feeling of fullness during bowel movements;
• increased stool density;
• reduction in the number of acts of defecation.

Stagnation of intestinal contents is often accompanied by flatulence, a feeling of bitterness in the mouth, nausea, and increased gas formation. Experts distinguish between chronic and acute constipation. The acute form is temporary and most often occurs under the influence of provoking factors. For example, severe stress or changes in diet.

Constipation in a pregnant woman can manifest itself not only as stool retention. Thus, constipation is considered to be daily bowel movements if dense, fragmented stool is observed in a small volume, and the woman notes a feeling of incomplete bowel movement.

However, most often constipation is the absence of stool for 2-3 days. Normally, bowel movements should occur daily, in rare cases it is permissible up to once every 2 days, if the expectant mother notes good health and the absence of unpleasant symptoms.

In addition to rare bowel movements, the following signs may indicate constipation:

• abdominal pain due to the accumulation of feces and gases;
• false urge to defecate, in which a visit to the toilet ends without result;
• the need for strong straining to empty the bowel;
• dense, dry feces

Companions of constipation are hemorrhoids, anal fissures and other proctological diseases. The likelihood of developing hemorrhoids during pregnancy increases, and if stool retention also occurs, the risk of such a pathology increases several times.

Severe constipation during pregnancy is sometimes accompanied by symptoms of general intoxication: dizziness, excessive sweating, weakness, headaches, fatigue and sleep disturbances. This is due to the developing intoxication of the body due to stagnation of feces. In case of prolonged constipation lasting 3 days or more, a slight rise in temperature, nausea and even vomiting may be observed. Such symptoms cause difficulties in diagnosing toxicosis, anemia and other diseases that may accompany pregnancy.

Home measures to combat toxicosis

Folk remedies can alleviate mild forms of the disease. The pregnant woman and her relatives should take care to follow proven methods.

Home methods for treating toxicosis:

• good sleep;
• regular long walks;
• eating small portions, but often;
• refusal of fatty and salty foods;
• remove all foreign and unpleasant odors in the home that cause irritation;
• favorable psychological environment.

Don't give in to stress and overwork. Controlling your emotions will help you achieve a happy meeting with your newborn. Folk remedies will help you easily tolerate a simple form of toxicosis.

What can pregnant women eat and drink if they are constipated?

A pregnant woman experiencing constipation needs to carefully monitor her diet. It is important to understand what you can eat if you have problems with bowel movements, and what foods you should avoid. If you have a bowel movement disorder, you should follow some rules:

1. Drink at least 1.5–2 liters of clean water daily. You should drink water in small sips. In this case, the liquid should not be too cold. In addition, it is useful to drink herbal teas, natural yoghurts, and kefir. In the third trimester of pregnancy (after 20 weeks), it is necessary to reduce the amount of fluid you drink to 1–1.5 liters per day.
2. Cook dishes by steaming or in the oven. Eliminate fatty and fried foods from the menu.
3. Make sure that meals are fractional. You need to eat often, in small portions. The interval between meals is no more than 4 hours.

To normalize stool, it is important to form a correct nutritional system. Your daily menu should include fresh vegetables and fruits that are high in fiber. A large amount of healthy dietary fiber is found in apples, sauerkraut, green salad, apricots, artichokes, raspberries, and black currants.

You can eat wheat bran, almonds, hazelnuts, and green peas. Dried fruits, stewed vegetables, as well as buckwheat and oatmeal facilitate bowel movements. It is better to choose coarse bread, it has more benefits for digestion.

Fermented milk products are important. They are rich in beneficial bacteria and help improve microflora and eliminate constipation. It is better to choose kefir, yogurt, and yogurt. So, one of the proven folk remedies for constipation is a glass of yogurt + 20 pieces of dried apricots at night. If you have this problem, it is better to avoid whole milk. It stimulates increased gas formation and can cause increased abdominal pain.

Of the juices, it is better to give preference to apricot, pumpkin, plum, carrot, peach, and you should give up apple and grape for a while.

The list of prohibited products includes:

• chocolate, baked goods;
• cocoa, black tea and coffee;
• rice, pasta;
• radishes, garlic, onions, mushrooms;
• fatty meats, spicy dishes;
• canned food, smoked meats.

The consumption of dairy products with a high percentage of fat should be greatly limited - it is better to eat cream, full-fat sour cream, and ice cream less often. You will also have to temporarily give up hard-boiled eggs. Rusks, rice water, strong black tea, berry jelly, astringent fruits, pomegranates and infusions of pomegranate peels, unripe pears, black grape varieties have a strengthening effect.

For constipation, it is advisable to exclude from the diet foods that cause fermentation and flatulence. It is better to completely remove white and brown sugar, store-bought juices and carbonated drinks from the menu. Legumes and vegetables with a lot of essential oils also stimulate increased gas formation, so limit their consumption or eliminate them from your diet altogether.

A review of the usual diet is the first thing an expectant mother who is experiencing constipation needs to do. In addition, pregnant women should not eat salty dishes and foods, as they retain fluid in the body and can cause swelling.

The diet and fluid intake, as well as the daily diet, must be selected individually. It is best to do this together with the doctor monitoring the pregnancy.

It is important to understand that some dishes and products cause individual reactions in us, and the effect of their consumption largely depends on the characteristics of the gastrointestinal tract. For example, semolina porridge can have a fixing effect in your case and not affect the functioning of the digestive system of another person.

It may be useful to keep a food diary, where you record your observations, which will allow you to identify certain patterns: how certain foods affect your stool. This will help develop the most effective diet, taking into account the needs of the body and personal characteristics.

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Toxicosis during pregnancy: myths and misconceptions

There are established opinions regarding the manifestation of toxicosis. Not all of them are true. You should not listen to public opinion.

• If you feel nauseous, it will be a girl. Vomiting is a symptom of intoxication due to fetal development. It doesn’t matter what gender he will be.
• In a strong organism, the manifestations of toxicosis are more powerful. Here it’s rather the opposite – a strong body is able to cope with the problems that arise.
• Toxicosis cannot be cured. The phenomenon cannot be completely cured, but the pregnant woman’s condition can be significantly alleviated.

Only specialists can give accurate answers to questions.

Preventive measures

Prevention measures are aimed at preventing the occurrence of side effects of toxicosis. It is important for a young mother to control herself throughout the day.

Useful tricks:

• absence of sudden movements, especially in the morning;
• split meals with lots of snacks;
• cumin or regular chewing gum prevents vomiting;
• high intake of vitamin B6 contributes to the absence of vomiting4
• only light food in the diet;
• drinking large volumes of liquid per day in small portions;
• drinking mint decoctions.

Prevention will improve your well-being. The phenomena of toxicosis, if the daily routine is followed, will practically not disturb the young mother.

How to take Enterosgel

Enterosgel in any dosage form is taken orally 2 hours before meals or medications, or 2 hours after.

Enterosgel paste is completely ready for use. It should be taken with enough water. But an aqueous suspension is made from Enterosgel in gel form before taking it. To do this, the required amount of gel is ground in a quarter glass of water, then taken with water.

Enterosgel paste is washed down with water.

Therapeutic course:

On average, the duration of the therapeutic course is 7-14 days. To prevent chronic intoxication, it is necessary to take 22.5 g (1 packet) 2 times a day for 7-10 days monthly. If the intoxication is pronounced, then the doctor may decide to double the dose in the first 3 days of therapy. After stabilization of the condition, they switch to the average therapeutic dosage. After the symptoms of acute intoxication or intestinal infection disappear, the drug is used for several more days.

For obstructive jaundice and liver cirrhosis, it may be prescribed for a longer period of time (2 months or more).

Repeating the course of treatment is permissible only after the recommendation of the attending physician.

Thus, the instructions for use of Enterosgel give the following dosages:

The daily dose (45 g for adults and 30 g for children) is divided into 3 doses. The duration of treatment is determined individually and depends on the severity of the disease and the age of the patient.

• single dosage – 1 tablespoon (15 g) – for adults;
• children under 3 years old – 1 teaspoon (5 g) 2 times a day (daily dose – 10 g);
• children 3-5 years old – 1 teaspoon 3 times a day (daily dose – 15 g);
• children 5-14 years old - 1 dessert spoon (10 g) 3 times a day (daily dose - 30 g).

Prevention:

For preventive purposes, adult patients are prescribed the following dosage regimen:

• prevention of ischemic heart disease and atherosclerosis - 1-1.5 months three times a day, 1 packet;
• prevention of chronic poisoning of the body - 7-10 days, twice a day, 1 packet;
• body cleansing - 10-14 days, three times a day, 1 packet (the cleansing course is repeated 3 to 6 times during the year).

For diarrhea:

You should immediately take 2 standard single doses of Enterosgel. In the future, the drug is taken 1 standard dose after each bowel movement. After the stool returns to normal, the drug is taken in an age-appropriate dosage for another 5 days.

It is important to remember that diarrhea cannot be treated with sorbent alone. It is necessary to find out the source of the disease and begin comprehensive drug treatment. After all, diarrhea can be infectious or non-infectious. A doctor can determine the cause of diarrhea.

When vomiting:

Enterosgel is taken when vomiting, as it usually indicates intoxication of the body. In case of acute poisoning, the dose of Enterosgel can be doubled for the first three days. After this, you should take the standard therapeutic dosage - 1 packet or 1.5 tbsp. spoons 3 times/day. On average, in case of poisoning, the therapeutic course lasts 10 days. The drug must be taken immediately after vomiting has stopped. If there is a series of attacks, then in the interval between them. It is worth noting that Enterosgel is contraindicated if the cause of poisoning is caustic substances (acids or alkalis), some solvents (for example, ethylene glycol or methanol), or cyanides.

Important! For diseases that are accompanied by fluid loss (vomiting, diarrhea), the use of Enterosgel should be supplemented with rehydration solutions that replenish the deficiency of electrolytes. This is necessary to avoid dehydration and subsequent complications. To replenish the volume of lost fluid and electrolytes, you should purchase specialized drugs at the pharmacy: Regidron, Trisol, Gidrovit, Reosolan, Gastrolit, Humana Electrolyte, etc.

Your doctor will help you choose the required dosage and frequency of administration.