etiology of early pregnancy reaction, what are the reasons for early pregnancy reaction
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The main causes of early pregnancy reaction were the increase of chorionic gonadotropin (HCG), the decrease of gastric acid secretion and the prolongation of gastric emptying time
Etiology of early pregnancy reaction
So far, the etiology of hyperemesis gravidarum is unknown, which may be mainly related to the imbalance of hormone mechanism and mental state in vivo. The role of hormones means that in the first trimester of pregnancy, when vomiting is the most serious, the hCG level in the body is the highest; The concentration of HCG in the blood of the patients with twin pregnancy or vesicular mole mass was significantly increased, and the hyperemesis was also significantly increased, which suggested that the disease was closely related to HCG. In addition, if the adrenocortical function is low, its corticosteroid secretion is insufficient, which leads to disorder of water and sugar metabolism in the body, and digestive tract symptoms such as nausea and vomiting appear. Moreover, when ACTH or corticosteroid is used, the symptoms can be obviously improved, so it is also considered that the decrease of adrenocortical function is also related to hyperemesis gravidarum. Some people think that vitamin B6 deficiency may also be one of the causes of the disease. In any case, mental factors have a great relationship with the occurrence of hyperemesis gravidarum. In particular, pregnant women have fear of pregnancy itself, or are bored, and are influenced by folk feudal superstitions, etc., which can cause vomiting to intensify. There is a history of severe dysmenorrhea, hyperemesis gravidarum increased.
Generally, it is divided into three types according to the severity of vomiting.
1. Morning sickness
It is the most common condition in the first trimester of pregnancy. Nausea, salivation or mild vomiting may occur in the early morning, but it does not affect daily life.
2. Moderate hyperemesis
(Moderate hyperemesis) is the aggravation of nausea and vomiting, which is not limited to the morning. However, with symptomatic treatment of drugs and dietary guidance, such as eating liquid or semi-liquid and low-fat diet and proper rest, the symptoms can be relieved.
3. Malignant vomiting
(Pernicious vomiting) is persistent nausea and vomiting, resulting in acidosis and electrolyte imbalance, or abnormal liver function, which requires hospitalization to control metabolic disorders. However, the incidence of this type is not high, about 1: 250 ~ 1: 350, and it needs hospitalization.
1) Due to the aggravation of vomiting,
It can lead to dehydration, insufficient blood volume, blood concentration, decreased extracellular fluid, imbalance of electrolyte balance and weight loss. Insufficient calorie intake leads to negative nitrogen balance, increase of plasma urea nitrogen and uric acid, and loss of hydrogen, sodium and potassium plasma due to severe vomiting, resulting in hypokalemia, hypochloremia and metabolic alkalosis, but also loss of intestinal alkaline fluid due to long-term vomiting, resulting in metabolic acidosis. Due to incomplete oxidation of fat, acetate, ketone, acetic acid and β-hydroxybutyric acid in the body increase and are excreted through the kidney.
2) Due to dehydration and lack of oxygen,
Liver function may be involved, which may increase SGPT and SGOT values. In severe cases, aundice may appear, suggesting poor prognosis. In hypokalemia, ECG can show prolonged P-R and QT intervals and T wave inversion, such as cardiac conduction arrest can cause cardiac arrest.
4. The body is severely dehydrated,
Blood concentration, vascular permeability increases, plasma protein is filtered out, resulting in proteinuria and tubular type, and urine volume decreases accordingly. In addition, due to continuous vomiting, loss of sodium salt, reduction of urine volume and reduction of urine specific gravity, which is the manifestation of low salt syndrome, and then leads to secondary damage of kidney: degeneration of renal tubules, and extensive cell necrosis in some parts, then the normal excretion function of renal tubules disappears or decreases, and finally the concentration of non-protein nitrogen, uric acid and creatinine in plasma increases rapidly. With the damage of renal function and acidosis, the potassium ions in cells are transferred to the outside of cells, and hyperkalemia occurs, which is characterized by weakness, apathy, wet and cold limbs. ECG shows that T wave is high and the base is low and narrow, P wave disappears, QRS wave is abnormal and widened, and in severe cases, it can cause cardiac arrest.
5. Patients with severe hyperemesis gravidarum,
Often due to the course of disease as long as several weeks or more, resulting in severe nutritional deficiency, vitamin C deficiency, increased vascular fragility and even retinal hemorrhage.
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