«Therapeutic nihilism», pathogenesis and outcome of vomiting in pregnant women
Mravyan S.R., Petruhin V.A.

Moscow Regional Research Institute of Obstetrics and Gynecology

The paper addresses the common complication of pregnancy – vomiting during pregnancy  (VP), occurring most often in the first third of gestation period and lasting in some cases up to last period. VP is accompanied by threat of chorion and placenta detachment, severe neurological complications, increased risk of preterm birth, fetal growth retardation, etc., as well as esophagus rupture, pneumothorax, retinal hemorrhage et al. The number of such publications is growing all the time.
The most important component of VP pathogenesis is vegetative status, gestation hyperthyroidism during first trimester, Helicobacter pylori infection, etc. No single theory explains all cases of VP. Authors conclude that VP pathogenesis has a multifactorial nature. VP in late pregnancy is characterized by “a vicious circle” formation: severe electrolyte, neurological disorders and alkalosis with hyperaldosteronism. Vitamin B1 deficiency  and hypomagnesemia form the neurological status of patients (combination of peripheral neurological and psychiatric disorders, demyelination of central parts of the brain with  development of Wernicke's encephalopathy in severe cases). Current literature doesn’t contain evidence based treatment guidelines of severe VP. Diet correction, sedative and antiemetic drugs do not provide clear and consistent effect. Treatment of severe VP must necessarily be carried out in hospital and include massive infusion, electrolyte solutions,  alkalosis correction, as well as replacement therapy with high doses of vitamin B1 and magnesium products. Patients can take Magnerot in case of relative remission and possibility of oral administration of medicines.
  
Key words: vomiting in pregnant women,  pregnancy, complications, aldosteronism, electrolytes.

For citation: Mravyan S.R., Petruhin V.A. «Therapeutic nihilism», pathogenesis and outcome of vomiting in pregnant women // RMJ. 2016. № 15. P. 966–970.