The value of the psyche pregnant in the development of early toxemia

Most studies are devoted to the study of the clinical aspect of pregnancy, and the personal characteristics of women during this period are studied as concomitant. Such a one-sided research approach cannot provide the necessary reduction in the pathology of pregnancy, since the peculiarities of the course of pregnancy should be considered not as violations, but as a normal type of response of a woman to the load experienced during pregnancy.

Early toxicosis is one of the most common and urgent problems of modern obstetrics. This pathology occurs in 50-90% of pregnant women, the frequency of severe forms ranges from 0.1 to 1.8%. The need for hospitalization occurs in 1419% of cases. Toxicosis refers to the conditions of pregnant women that arise in connection with the development of the entire fetal egg or its individual elements, characterized by a multiplicity of symptoms, of which the most permanent and pronounced are disorders of the central nervous system, vascular disorders and metabolic disorders. There are several classifications of vomiting of pregnant women. One of the first was developed by A. A. Lebedev in 1957:

I degree - phase of neurosis;

• II    degree - phase of toxicosis;

• III    degree - phase of dystrophy.

The changes occurring during the neurosis phase are considered by him as functional, since they are manifested by a decrease in the activity of the cerebral cortex and an increase in the activity of the subcortex, with an emphasis on the irritability of parasympathetic innervation of organs, without special metabolic disorders.

Early toxicosis is a complex symptom complex that develops in the first trimester of pregnancy and is characterized by a number of dyspeptic disorders: nausea, vomiting, hypersalivation, decreased appetite, impaired taste and olfactory sensations. Depending on the severity of these symptoms, body weight decreases, disorders occur in all types of metabolism, which leads to deterioration of the functions of a number of organs and systems of the pregnant woman.

In most cases, nausea and vomiting do not affect the course of pregnancy and are considered as a physiological condition. Some foreign authors consider the absence of these symptoms as an increased risk of miscarriage. Nevertheless, even mild nausea and vomiting significantly worsen a woman's quality of life.

There were many theories trying to explain the mechanism of early toxicosis: reflex, neurogenic, hormonal, allergic, immune, cortico-visceral. In the pathogenesis of early toxicosis, a leading role is played by a violation of the functional state of the central nervous system. In the early stages of pregnancy, the symptoms of early toxicosis (neurosis) are manifested by a disorder of the gastrointestinal tract. Food reflexes are associated with the vegetative centers of the diencephalic region. Afferent signals coming here from the periphery may have a perverted character (either due to changes in the uterine receptors or in the pathways), changes may also occur in the centers of the diencephalic region themselves, which may change the nature of the response efferent impulses. With impaired sensitivity of the system, a change in reflex reactions quickly occurs, a violation of nutritional functions: loss of appetite, nausea, hypersalivation, vomiting. Neuroendocrine and metabolic disorders play a huge role in the occurrence of early toxicosis, in this regard, with the progression of the disease, changes in water-salt, carbohydrate and fat, and then protein metabolism gradually develop against the background of increasing exhaustion and weight loss. However, psychological studies have not confirmed a higher prevalence in patients with functional dyspepsia of life events that can cause stress, compared with those in healthy people. It was also found that the psychological profile compiled on the basis of the results of the MMR1 test does not differ significantly in patients with functional dyspepsia and in patients with other gastroenterological diseases. Along with this, patients with functional dyspepsia revealed a higher level of anxiety, depression, neurotic and hypochondriac reactions. It is the comorbidity of symptoms of dyspepsia and mental disorders that determines the development of functional somatic syndromes, which, in fact, are somatic mental disorders. The interdisciplinary approach makes it possible not only to diagnose in a timely manner, but also to successfully treat mental disorders that mimic somatic diseases in a somatic hospital.