Pregnancy is an exciting state for every woman, but early pregnancy can bring not only the joy of realizing a new life, but also unusual and unpleasant sensations, including toxicosis. This is a pathological condition that usually occurs within 4-7 weeks and is manifested by a number of symptoms: nausea, vomiting, hypersalivation (salivation), changes in food and olfactory preferences, changes in the emotional background towards increased mood lability.
Nausea and vomiting in pregnancy is a very common condition and does not always require treatment. According to statistics, manifestations of early toxicosis are present in approximately 60% of pregnant women. However, only 8 - 10% require any treatment.
The absence of nausea in the early stages is also absolutely normal and does not mean that the pregnancy is not progressing or is developing incorrectly.
Is nausea a sign of pregnancy?
Nausea is one of the doubtful signs of pregnancy. That is, nausea itself does not directly indicate pregnancy, but in combination with other signs (delayed menstruation, engorgement of the mammary glands, changes in the sense of smell and taste, dizziness, etc.) requires confirmation/exclusion of pregnancy.
If we consider nausea as one of the signs of pregnancy, then moderate manifestations of it can begin as early as a few days of missed period.
Causes of nausea and vomiting during pregnancy:
Hormonal causes of nausea and vomiting in a pregnant woman are, first of all, an increase in the level of human chorionic gonadotropin and progesterone in the blood. The maximum increase in hCG occurs at 6–7 weeks of pregnancy; it is during this period that most women experience manifestations of toxicosis of varying intensity. Also, in support of the hormonal causes of nausea and vomiting, we cite the fact that in multiple pregnancies, when the level of hCG is higher (see the article Analysis for human chorionic gonadotropin), the manifestations of toxicosis are more intense. Hormonal changes cause excitation in subcortical structures (reticular formation, regulatory centers of the medulla oblongata). In the medulla oblongata, the respiratory, olfactory and vomiting centers are located nearby, so all manifestations of toxicosis are interconnected. Also, an increase in progesterone in the blood leads to a decrease in the tone of smooth muscles throughout the body, this is good for the muscles of the uterus (no hypertonicity), but excessive relaxation of the muscles of the esophagus and stomach leads to the reflux of acidic contents, heartburn and vomiting.
The hormonal background of a woman during pregnancy changes noticeably, and is aimed at preserving and bearing the fetus, therefore, immune causes of nausea and vomiting arise from hormonal reasons. Natural immunosuppression occurs (decreased immunity), which serves to prevent the mother’s body from rejecting the fetus.
The psychological causes of nausea and vomiting in pregnant women cannot be clearly classified, however, there is evidence that early toxicosis is more common in women who are psychologically unprepared for motherhood, in pregnant women with an unfavorable family situation and in those who initially had manifestations of asthenia (psychological exhaustion, fatigue ).
Diseases associated with nausea:
1. Disease of the gastrointestinal tract (gastritis, peptic ulcer, cholecystitis, pancreatitis, hepatitis). In patients with gastrointestinal diseases, vomiting during pregnancy is much more common, begins earlier and is more severe.
2. Other diseases (anemia, allergic diseases and others) contribute to the general weakening of the body and can aggravate the condition of toxicosis.
3. Taking certain drugs (for example, chemotherapy for HIV infection, treatment of systemic diseases) can provoke nausea and increase the manifestations of toxicosis in the early stages.
How to relieve attacks of toxicosis?
In addition to a balanced diet, taking vitamins, herbal soothing teas and exercises, there are several methods that our great-grandmothers used to alleviate toxicosis during pregnancy - infusions and decoctions of natural medicinal herbs. Doctors note that such decoctions have a positive effect on the entire body as a whole, as it has anti-inflammatory and soothing properties.
To normalize the functioning of the gastrointestinal tract and eliminate the occurrence of nausea and vomiting, you can prepare the following decoction. To prepare it you will need wormwood – 8 parts, yarrow – 2 parts and St. John’s wort – 2 parts. It is necessary to grind the ingredients and mix together. One tablespoon of the resulting mixture is poured into a glass of boiling water and left in a sealed container for fifteen minutes. You need to take this decoction 3 times a day before meals, 1/3 cup.
To relieve irritability and nausea, as well as improve overall well-being and normalize sleep, this medicinal mixture is suitable. It is necessary to take chamomile flowers, valerian root, fennel and caraway fruits and mint leaves in equal proportions, chop all this and mix thoroughly. A tablespoon of the mixture already obtained is poured with one glass of boiling water and left for about 20-30 minutes. You need to drink this decoction at night before going to bed, ½ cup.
To prevent morning sickness, it is recommended to use peppermint essential oil. A few drops of oil can be placed directly on your pillow before going to bed or on a handkerchief that you leave at your head.
Norm and pathology at different periods.
Periodic moderate nausea in the early stages (up to 11 - 12 weeks), which does not lead to weight loss, complete refusal of food, does not cause changes in blood and urine tests, is a very conditional pathological condition and cannot be treated.
All pregnant women are examined in accordance with Order of the Ministry of Health of Russia dated November 12, 2012 No. 572n, and if the results of the examination do not reveal pathological changes or concomitant diseases, and the fetus develops normally, then such a pregnancy is considered to be proceeding normally and is subject to routine monitoring in the antenatal clinic.
Nausea and vomiting during pregnancy can continue until 22 completed weeks of pregnancy. There are also separate forms of vomiting (vomiting that began after 22 weeks of pregnancy and other forms of vomiting), which are rare.
The presence of vomiting classifies the current pregnancy as complicated; management and observation tactics depend on the severity of the condition.
Mechanism of development of vomiting
In the brain there is a so-called vomiting center: a collection of numerous nerve nuclei that receive impulses from the cardiovascular system, stomach, esophagus and intestines, as well as the limbic system - structures responsible for memory, emotions, sleep and wakefulness. The vomiting center is washed by cerebrospinal fluid, into which chemicals from the blood penetrate, so vomiting (emetic syndrome) often accompanies various poisonings. It is affected by intracranial pressure, so an increase or decrease in the latter also causes vomiting.
Emetic syndrome is a protective reflex. It is necessary to cleanse the stomach of toxic contents that have entered it and avoid intoxication of the body. Also, the syndrome is a signal for a person to find and eliminate the existing problem.
During pregnancy, emetic syndrome occurs due to the following reasons:
- diseases of the stomach and intestines;
- pathologies of the liver, pancreas and bile bladder;
- excessive stress;
- adrenal insufficiency;
- food or chemical poisoning;
- intracranial hypertension or, less commonly, hypotension;
- heart diseases (including myocardial infarction, for example, its painless form);
- diseases of the vestibular apparatus;
- diseases accompanied by intoxication: tonsillitis, sinusitis, pneumonia.
But in the early stages of pregnancy, vomiting can be an almost “normal” phenomenon that occurs in response to an increase in human chorionic gonadotropin hormone in the blood. And the more of this hormone (for example, with multiple pregnancies), the more pronounced the emetic syndrome is.
Classification of vomiting during pregnancy:
1) mild nausea and vomiting in pregnancy:
- vomiting is repeated no more than 5 times a day - general condition is satisfactory - body weight loss up to 2 - 3 kg - no tachycardia - blood and urine tests are within normal limits - stool and urination are normal
2) vomiting of a pregnant woman of moderate severity:
- vomiting 6 - 10 times a day - complaints of weakness - dizziness - loss of appetite - tachycardia up to 100 beats per minute - weight loss of about 3 kg in 7 - 10 days - low-grade fever (up to 37.2°C) - pale skin and mucous membranes, yellowness of the skin and mucous membranes in 5 - 7% - in a general urine test - a positive reaction to acetone - urination is normal - stool once every 2 - 3 days
3) severe or excessive vomiting of a pregnant woman:
- vomiting more than 10 times (can reach 20 - 25 times a day) - salivation - weight loss to 8 - 10 kg or more - blood pressure is reduced (90/60 mmHg or less) - tachycardia (heart rate more than 100 per minute) - severe weakness, dizziness, fainting, disturbed sleep - increased body temperature to 37.5 - 38 ° C - dry and pale skin and mucous membranes, yellowness of the skin and sclera in 20 - 30% - smell of acetone from the mouth - in the general analysis urine increase in protein and a sharply positive reaction to acetone (+++ or ++++, or more than 0.03) - in a general blood test, blood thickening and anemia are observed, in a biochemical analysis, creatinine, urea, bilirubin, ALT, AST are increased - diuresis is reduced , stool with delays of up to 5 days or more.
Currently, severe vomiting is quite rare, this is due to greater coverage of pregnant women with medical supervision than before.
Conditions that cause anxiety
For mild illness, when nausea does not progress to vomiting, there are no other symptoms, no special treatment is required. It is enough to rest a little for the discomfort to go away. If nausea ends with moderate vomiting up to 2-3 times a day, you should consult a doctor who will conduct an examination and give general recommendations on the pregnant woman’s lifestyle.
Vomiting more than 3 times a day is already a pathological condition. It threatens with dehydration, general malaise and requires hospital treatment. The following symptoms accompanying nausea should also pay attention to:
- sudden weight loss;
- decreased or increased blood pressure;
- stomach ache;
- temperature increase;
- bowel disorder.
These conditions indicate severe intoxication of the body and can be both manifestations of toxicosis and a consequence of poisoning. In any case, if you have these symptoms, you should immediately consult a doctor, as the consequences for the health of the mother and fetus can be quite serious.
The causes of nausea during pregnancy, as we see, depend on the period and general condition of the woman. You shouldn’t figure them out on your own; you should only trust a specialist to identify the causes and prescribe treatment.
When the first vomiting occurs during pregnancy, the woman is happy because she receives confirmation that she has conceived, but in the future, daily nausea can be so exhausting that there is no time for joy. Why does expectant mothers vomit and how can they alleviate their suffering? Are nausea and vomiting during pregnancy always normal, or can such symptoms be dangerous?
Nausea and vomiting is one of the symptoms of pregnancy
When should you not worry?
— If you suspect the possibility of pregnancy, and you feel nauseous, then the first thing you should do is a pregnancy test (how and when to perform the test correctly, read the article “Pregnancy Test”). If the test result is positive, immediately make an appointment with your obstetrician/gynecologist. If the result is negative, but there are several questionable signs of pregnancy, the test should be repeated after 48 hours.
- If you know about your pregnancy, and you begin to experience signs of early toxicosis, then you should monitor your condition.
If nausea does not cause a significant limitation in daily activity, you can carry out your usual work, the amount of food consumed has decreased slightly, there are no fainting or severe dizziness (slight weakness and dizziness may occur), then there is no need to worry, but routine monitoring with a antenatal clinic doctor is necessary.
Many people are perplexed why pregnant women undergo a general urine test so often. In fact, the diagnostic significance of OAM is difficult to overestimate at any stage of pregnancy. With toxicosis, pathological changes first appear in the urine (specific gravity changes, ketone bodies/acetone, protein appear).
If you are bothered by vomiting food up to 5 times a day, but your general condition suffers slightly (weakness, slight dizziness, changes in taste preferences, aversion to certain foods), then you should report your condition to your doctor. If there are no changes in blood and urine tests, or the presence of a fetal heartbeat on ultrasound, this condition is subject to home correction (below we will talk about diet and other techniques that alleviate the course of toxicosis).
When should you see a doctor?
— If vomiting, according to clinical manifestations, is of moderate severity (approximately, this is vomiting 6–10 times a day and 2 or more accompanying symptoms), then treatment is indicated in the day hospital of the antenatal clinic or gynecological department (depending on the equipment of the medical institution) or in 24-hour hospital.
If you have recently had an appointment and have been recommended home treatment, but the severity of your condition is progressing, you should make an unscheduled visit to your obstetrician-gynecologist. Never hesitate to worry about your health. Lack of normal nutrition and dehydration causes biochemical changes in body fluids (primarily in the blood), and this cannot but affect the unborn baby.
— Severe vomiting must be treated strictly in a 24-hour hospital. All types of treatment are carried out, the fetal heartbeat is monitored and, depending on the dynamics of the condition, the question of the possibility of carrying a pregnancy is decided. Severe vomiting over a long period of time and without treatment effect threatens the life of the mother and is therefore an indication for termination of pregnancy.
How to get rid of nausea at home?
First of all, you should accept the fact that nausea (if we are talking about a non-dangerous condition, see above) will accompany your pregnancy for some time. Psychological self-preparation plays a certain role in the home treatment of toxicosis. Ask close relatives (mother, grandmother, sisters) about the course of their pregnancies; the intensity and duration of toxicosis may be hereditary.
Diet for nausea and moderate vomiting during pregnancy.
Food is taken fractionally, in small portions. If this means that you will eat several spoons 10 times a day, then for this period this is your diet. Large portions of food can cause vomiting reflexively, simply due to the stretching of the stomach walls by volume.
The food should be cool, try dishes that you were previously used to eating hot, eat at room temperature or even cool (for example, buckwheat porridge is not hot and with sauce, but cool with milk and sugar/honey, and so on).
Food should be of a gentle consistency (save fried and rough foods for later), easily digestible, contain a large amount of vitamins and meet the woman’s desires. Milk and dairy products, oddly enough, provoke nausea, and in the early stages they should be limited or completely eliminated, and calcium should be obtained from broccoli, green beans and sesame seeds.
Spicy and richly spiced dishes can dull the feeling of nausea, but they stimulate severe salivation and can provoke epigastric pain (an irritating effect), so their consumption should be limited.
You should not take dry food and liquid at the same time. That is, if you have eaten porridge or pasta, you should not wash it down with tea. It is better to separate liquid and solid food for 1.5 - 2 hours.
For some women, a “dry” diet helps muffle the feeling of nausea: baked potatoes, baked pumpkin (pumpkin has an antiemetic effect), cereals, bread and crackers.
You should also consume a sufficient amount of salt, since when vomiting, the expectant mother constantly loses it, which affects the basic metabolism and water-salt metabolism.
Most women experience bouts of morning sickness, and if left untreated, the feeling of unwellness can last all day. Prepare a light breakfast in the evening (a handful of nuts, a vitamin mixture of chopped raisins, dried apricots and prunes with honey, an orange, cool tea with lemon balm or lemon), eat in small portions, without getting out of bed. After you have a snack, do not rush to get up; it is better to remain in a reclining position for another 20 - 30 minutes.
Mint candies and mint tea will help cope with attacks of nausea in public places and in transport.
In general, in terms of food composition, a pregnant woman’s diet does not have significant restrictions; all recommendations fit into the basics of rational nutrition.
But there are foods that should be strictly excluded: carbonated drinks (especially sweet ones), canned foods, alcohol.
Replenishing lost fluid
Replenishing (rehydrating) lost fluid is even more important than eating. In most cases, restricting food for a short time does not cause damage to the body, but you cannot go a day without water. Water is a natural solvent and substrate for all chemical reactions in the body. Mostly water and minerals are lost through vomit, so you must take a responsible approach to regulating your drinking regime. If there are no problems with high blood pressure, then the volume of fluid per day should be at least 2 liters. This includes: still mineral water, natural juices diluted 1:1 with water (juices from packages have no nutritional value, but the sugar content is too high), weak tea, fruit and dried fruit compotes and a decoction of lemon balm, rose hips and ginger.
Rehydration and detoxification medicated
The drug Regidron is used: one packet of powder is dissolved in 1 liter of water, the solution is taken orally in very small portions, chilled. If you are not sure that the water is suitable for drinking, it should be boiled and cooled before preparing the solution, the solution should be stored in a cool place and used within 24 hours. The dose of the drug is calculated based on the approximate loss of fluid (loss of 500 ml, which means you should drink 1 liter and so on).
Enterosorbents
In addition to the diet of a pregnant woman suffering from toxicosis, you can independently use enterosorbents (enterosgel, polyphepan, polysorb) to reduce intoxication, but you should not get carried away with them too much, since the sorbent also absorbs useful substances, removing them from the body.
Folic acid
Also, all pregnant women are recommended to use folic acid at the stage of preconceptional preparation and further up to 12 weeks. There is evidence that pregnant women who took folic acid or folate complex vitamins (Femibion Natalcare I) were less likely to suffer from nausea and vomiting during pregnancy. The dose of folic acid for pregnant women is 400 mcg per day, if you bought folic acid with a dosage of 1 mg (the most common option), then take 1 tablet every other day.
Herbal preparations with choleretic and hepatoprotective effects
You can also independently use herbal preparations (chophytol, 2 tablets 3 times a day for 2 - 3 weeks), which facilitate the functioning of the liver and thereby reduce the manifestations of toxicosis.
Non-drug treatments for nausea during pregnancy
Among non-drug treatment methods, it is advisable to use:
1) Aromatherapy (peppermint oil relieves attacks of morning sickness and nausea in transport, citrus oils also help relieve the urge to vomit; moisten a piece of cotton wool or cloth with the oil and place it near the bed, or use essential oil inhalation at the time of an attack of nausea)
2) long walks in the fresh air
3) exclusion of stressful situations, home regime.
If there is no relief from treatment at home and the severity of the condition progresses, then continued treatment in a hospital setting is indicated.
How to alleviate the condition?
And even though the causes of toxicosis have not yet been sufficiently studied, every woman is interested in how to stop vomiting during pregnancy? The condition can often be alleviated by making slight changes to your daily habits. Start from the moment you wake up. For many pregnant women, the morning is the hardest thing to get through. If you vomit a lot in the morning, learn to calm your stomach before getting out of bed. This could be dry cookies or crackers and a few sips of water - prepare them in the evening to have a snack in the morning without getting out of bed. Get up only after some time has passed so that everything has settled down. It is better to lie in a semi-sitting position, raising your upper body.
In general, when vomiting during pregnancy, it is extremely important not to starve and drink enough fluids. But there are often problems with drinking water and food: everything immediately comes back. Doctors urge pregnant women in such cases to eat only the desired dishes, but certainly in fractions: literally a little at a time, but quite often. It is better to exclude all fried, spicy, smoked and other aggressive foods (although, most likely, they already disgust you) and choose something light as a snack: vegetables, fruits, fermented milk drinks. Protein (an egg or a piece of boiled lean meat) is good for breakfast. Try to include B vitamins in your diet, especially vitamin B6 (or pyridoxine) - it can eliminate nausea and prevent vomiting. Pyridoxine is found in whole grains, buckwheat, sprouted wheat, potatoes, carrots, cabbage, bananas, hazelnuts, peanuts, walnuts, sunflower seeds, chicken, and fish. Vitamin B6 is also sold in the form of a medicine in the pharmacy. However, before using it, be sure to consult your doctor (the recommended dose for pregnant women is no more than 25 mg 3-4 times a day).
For toxicosis, first courses are useful - light soups and broths. Liquid warm food is usually gratefully accepted by the stomach.
Treatment of nausea and vomiting in a pregnant woman in a day hospital
1. infusion therapy
Infusion therapy is the intravenous administration of crystalloid solutions (saline solution (sodium chloride 0.9%), Ringer's solution, glucose solution 5%, less often combined solutions Trisol, Acesol, etc.) in order to replenish the volume of circulating plasma.
The volumes of injected solutions are calculated based on the severity of the condition and body weight, but usually do not exceed 1200 ml. By introducing solutions, dehydration and blood thickening are eliminated, and tissue metabolic processes are normalized.
2. B vitamins.
With toxicosis, the need for water-soluble vitamins increases by 40%; it is impossible to create a depot for them in the body, so the deficiency is replenished with medication. Injectable single preparations (vitamin B1, vitamin B6) and tablet complex preparations (Magnelis, Magne-B6 forte) are used.
The duration of use and mode of administration are determined by the doctor. Thoughtless use of even seemingly safe vitamins during pregnancy can lead to unpredictable consequences.
3. vitamin C.
Vitamin C is also a water-soluble vitamin and is easily lost through vomiting. Performs an antioxidant function in the body. Intravenous drip administration of ascorbic acid in saline solution is used; the dosage and duration of administration is determined by the attending physician.
4. prokinetics
Cerucal (metoclopramide), Motilium (domperidone) are injected for indomitable vomiting. They are administered strictly according to indications, since in case of overdose they provoke uterine hypertonicity.
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