Early pregnancy reaction

Introduction to early pregnancy response In early pregnancy (about six weeks after menopause), the amount of chorionic gonadotropin (HCG) in pregnant women increases, gastric acid secretion decreases and gastric emptying time prolongs, leading to dizziness, fatigue, loss of appetite, acid food or disgusting greasy, nausea, morning A series of reactions, such as vomiting, are collectively referred to as early pregnancy reactions. These symptoms generally do not require special treatment. After 12 weeks of gestation, as the level of HCG in the body decreases, the symptoms disappear naturally and the appetite returns to normal. But to remind pregnant women that not all vomiting is an early pregnancy reaction. The cause of hyperemesis in pregnancy has not been known so far, and may be mainly related to the imbalance of hormonal mechanism and mental state in the body. Mild pregnancy vomiting: generally do not require special treatment. Only need to understand whether the patient has any ideological concerns about pregnancy, pay attention to his mental state, give more spiritual encouragement, and according to the patient's preference, give digestible food, eat in divided doses, and avoid high-fat foods. Patients with severe vomiting or associated with dehydration or ketonuria require hospitalization. basic knowledge The proportion of illness: 5-10% Susceptible population: pregnant women Mode of infection: non-infectious Complications: abortion anemia

Early pregnancy response

Cause

The etiology of hyperemesis in pregnancy has not been known so far, and may be mainly related to the imbalance of the mechanism of action of hormones and mental state in the body. The role of hormones refers to the highest level of hCG in the body when pregnancy is most severe in gestation; twin pregnancy or blister The concentration of hCG in the blood of patients with fetal blocks was significantly increased, and the incidence of hyperactivity was also significantly increased, suggesting that the disease is closely related to hCG. In addition, if the adrenal cortical function is low, the secretion of corticosteroids is insufficient, thus making the body water and sugar. Metabolic disorders, nausea and vomiting and other gastrointestinal symptoms, and the use of ACTH or corticosteroids, the symptoms can be significantly improved, it is also considered that the decline in adrenal function is also related to pregnancy vomiting, it is believed that vitamin B6 deficiency may also be One of the causes of the disease, in any case, the mental factors have a greater relationship with the occurrence of hyperemesis in pregnancy, especially pregnant women have fear of pregnancy itself, or bored, and influenced by folk feudal superstitions, etc. can cause vomiting Intensified, there is a history of severe dysmenorrhea, an increase in pregnancy vomiting.

The body is severely dehydrated, the blood is concentrated, the vascular permeability is increased, the plasma protein is filtered out and the proteinuria and tube type are formed, and the urine volume is reduced. In addition, due to continuous vomiting, the sodium salt is lost, the urine volume is further reduced, and the urine specific gravity can be Lowering is the manifestation of low-salt syndrome, which in turn leads to secondary damage to the kidney: degeneration of the renal tubules, and partial necrosis of the cells. The normal excretion function of the renal tubules disappears or decreases, eventually leading to plasma The concentration of protein nitrogen, uric acid and creatinine increased rapidly. With the impaired renal function, acidosis appeared, and the potassium ions in the cells were transferred to the outside of the cell. Hyperkalemia appeared, which was weak, affectionate, and the limbs were cold. The ECG shows that the T wave is high and the base is low, the P wave disappears and the QRS wave is abnormal and widened. In severe cases, the heartbeat can be stopped.

Patients with severe pregnancy vomiting often have a disease duration of more than a few weeks, resulting in severe nutritional deficiencies, vitamin C deficiency, increased vascular fragility, and even retinal hemorrhage.

Early pregnancy response prevention

For this serious morning sickness, if the situation is critical, the doctor will temporarily use the drug to control the symptoms. In the long process of pregnancy, the expectant mother should be scientific and reasonable to reduce morning sickness. It should start from the following three aspects:

First, to maintain a relaxed and happy mood, morning sickness is only an instinctive reaction of the body's self-protection. If properly handled, it can be reduced as much as possible without adversely affecting the fetus.

Second, a reasonable diet, pregnant women's diet should be rich in nutrition, light and delicious, easy to digest as a principle, in terms of taste, not too taboo, can take care of pregnant women's eating habits and hobbies as much as possible, alcohol should be absolutely prohibited.

Third, moderate exercise can also help to alleviate morning sickness. Pregnant women should not stay in bed all day because of nausea and vomiting.

Early pregnancy reaction complications Complications, anemia, anemia

1. Hypokalemia or hyperkalemia: It is caused by severe vomiting and imbalance of electrolyte balance. If the clinician fails to diagnose it in time, it may endanger the patient's life.

Second, esophageal mucosal laceration or esophageal hemorrhage: due to persistent severe vomiting, damage to the esophageal mucosa and laceration, bleeding, can occur in the stomach, esophageal junction distal, named Mengle-Weiss syndrome (Ma11ory-Weiss Syndrome), even the perforation of the esophagus, manifested as chest pain, spit, hematemesis, and urgent surgery.

Early pregnancy reaction symptoms Common symptoms Nausea and vomiting Nausea anorexia Loss of appetite, fatigue, stomach pain, dizziness, weight loss

According to the medical history and clinical manifestations, it is first clear whether pregnancy, if it is definitely a pregnancy, it is also necessary to exclude vomiting caused by the digestive system or other diseases of the nervous system. There was a case that had been pregnant in April, but continued to spit, extremely thin, spirit Wilt, accompanied by hypokalemia, after gastrointestinal angiography and gastroscopy confirmed the pyloric obstruction caused by gastric cancer, improved after surgery, so critically ill patients who can not be explained by hyperemesis must be carefully identified with internal surgery, occasionally There may be vomiting caused by meningitis, brain tumor or uremia.

Generally divided into three according to the severity of vomiting.

First, morning sickness: It is the most common condition in early pregnancy. In the early morning, there may be nausea and hooliganism or mild vomiting, but it does not affect daily life.

Second, moderate hyperemesis (moderate hyperemesis): for nausea and vomiting, and not limited to the morning, but after drug symptomatic treatment and dietary guidance, such as eating liquid or semi-liquid and low-fat diet, rest, the symptoms are more ease.

Third, pernicious vomiting (pernicious vomiting): for persistent nausea and vomiting, leading to acidosis and electrolyte imbalance, or abnormal liver function, but hospitalization to control metabolic disorders, but the type of incidence is not high, about 1:250 ~ 1:350, hospitalization is required.

Increased vomiting can lead to dehydration, insufficient blood volume, blood concentration, decreased extracellular fluid, imbalance of electrolyte balance, weight loss, insufficient caloric intake, negative nitrogen balance, elevated plasma urea nitrogen and uric acid, and severe vomiting. Loss of hydrogen, sodium, potassium, hypokalemia, hypochloremia, metabolic alkalosis, but also due to prolonged vomiting, the intestinal alkaline fluid is lost, resulting in metabolic acidosis, due to fat Oxidation is incomplete, the body's acetaminophen acetate and -hydroxybutyric acid increase, and is excreted by the kidneys.

Due to dehydration, hypoxia, liver function can be affected to make SGPT, SGOT value increased, severe cases may appear jaundice, suggesting a poor prognosis, in hypokalemia, ECG can show PR and QT interval extension and T wave inversion, such as Cardiac conduction stops can cause cardiac arrest.

Early pregnancy response check

After the diagnosis of pregnancy vomiting, it is necessary to determine the severity according to clinical manifestations. For severe cases, the following tests are required:

First, blood

Check blood routine and hematocrit to help understand the presence or absence of blood concentration. Conditional blood viscosity and plasma viscosity check, carbon dioxide binding or blood gas analysis to understand blood pH, alkali reserve and acid and acid balance, also need Serum serum bilirubin, liver and kidney function.

Second, urine

Calculate urine volume daily, measure urine specific gravity, ketone body, and test for urine tricholemia.

Third, ECG examination

This test is particularly important and can be used to help detect the presence or absence of hypokalemia or hyperkalemia and myocardium.

Diagnosis of early pregnancy response

diagnosis

According to the history, clinical manifestations and gynecological examination for diagnosis, hCG measurement, can be diagnosed early pregnancy, severe symptoms, test urinary ketone body, you can be diagnosed as pregnancy vomiting.

Differential diagnosis

Pay attention to the identification of digestive diseases combined with pregnancy.

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