“Therapeutic nihilism”, pathogenesis and outcomes of vomiting during pregnancy

Most women expecting a child experience toxicosis during pregnancy. This condition is very unpleasant not only because of the symptoms - nausea, aversion to smells and food, but also for other reasons. On the one hand, toxicosis is another indicator that a woman is pregnant, on the other hand, it may indicate that there are hidden health problems in the expectant mother’s body.

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Causes of toxicosis

The content of the article

Not all expectant mothers are given the opportunity to experience the symptoms of toxicosis. Young, healthy patients can avoid attacks of nausea and vomiting, since toxicosis occurs due to hormonal changes in the body, the age of the pregnant woman and the presence of chronic diseases.

If your mother suffered from toxicosis, then you may be susceptible to it, as it is inherited.

On the Internet you can find statements that nausea and vomiting in pregnant women are a sign of unpreparedness for motherhood. But these ideas are, of course, wrong, since many older women who have been dreaming of a baby for many years suffer from toxicosis in the same way as those who did not plan a child and became pregnant by accident.

Ways to overcome belching

It is better not to drink carbonated drinks during pregnancy.

There are several effective ways to help eliminate sour belching from your life. If you follow these tips constantly, then over time the number of these unpleasant moments will be significantly reduced, and perhaps they will disappear completely.

1. Firstly, it is better not to eat large portions; you should eat fractionally, in small portions and more often.
2. Secondly, it is better to avoid sour and fried foods altogether. Belching also occurs due to dishes that contain a lot of sugar or starch. This is especially true for potatoes and pasta. Any sweets made under industrial conditions are harmful for women expecting a baby. They often contain sorbitol, a sweetener that increases gas formation. Other chemical additives in these products affect bloating, belching, and heartburn. Therefore, it is better to completely exclude such tasty but dangerous products. If you want something sweet, take honey and dried fruits. They will not cause harm and will not cause belching.
3. Thirdly, foods that stimulate fermentation processes should be eaten in minimal quantities. After all, fermentation leads to the formation of gases in large quantities. This applies to white cabbage, cauliflower, broccoli, grains, legumes, and asparagus. But they cannot be completely ruled out. After all, they are all a source of various microelements, vitamins, minerals, which are so necessary for a little person growing in the body of a pregnant woman. They simply reduce the number of foods and eat them little by little.
4. Fourthly, try to formulate your diet from products with an alkaline reaction. These include dairy products, including cream, cottage cheese, and sour cream. Soft-boiled eggs, steamed omelettes, lean meat, butter (both vegetable and butter) will be useful. It is better to eat vegetables only boiled. If possible, fruits are baked.
5. Fifthly, you should never drink carbonated drinks. They cause belching even in people in good health. In addition, they contain chemicals that have a negative effect on a woman’s body.

To overcome belching, you need to eat slowly and chew food thoroughly. Do not talk while eating, this will prevent accidental swallowing of air. 30 minutes before meals you can drink water with mint. They drink it slowly, swallowing little by little. At lunch, you should try to eat soup to improve digestion and reduce the formation of gases.

A woman in an interesting position should strive for the correct position of her body; she should not bend over or turn sharply. You cannot be in a horizontal position after eating. In this case, you can provoke the flow of gastric juice into the esophagus, causing air to enter there. If you want to rest, it is better to do this by leaning your upper body on a pillow. The body should be in a sitting position. This is the most optimal position, preventing the passage of contents from the stomach into the esophagus.

We must remember that comfortable clothes largely determine how you feel. It should not tighten the body, especially the stomach. Compression of the abdomen leads to stagnation of gases in the stomach.

The doctor may also recommend special means that prevent the formation of gas in the gastrointestinal tract, for example, espumizan. Traditional medicine recommends using a baking soda solution. To do this, dissolve a pinch of soda in a glass of water and drink it. This remedy eliminates heartburn and sour belching. But you can use this remedy only if your gynecologist has nothing against it.

Signs of toxicosis

Most often, toxicosis begins to manifest itself from the 4th week of pregnancy. A woman may feel unreasonably tired and spontaneously vomit. Typically, toxicosis almost completely disappears by the 4th month of pregnancy, but in some cases it may appear later. Signs of toxicosis:

• Loss of appetite or deterioration.
• Headache, dizziness, constant desire to sleep.
• Change in taste preferences.
• Dislike of certain smells that you previously liked.
• Irritability.

If these signs appear periodically in a pregnant woman, it can be judged that the pregnant woman has developed toxicosis.

“Therapeutic nihilism”, pathogenesis and outcomes of vomiting during pregnancy

Vomiting of pregnancy (VG) can occur at any stage and is observed in 80% of women. Severe RD, known as hyperemesis gravidarum, occurs infrequently (only in 0.2–3.6% of cases), but leads to “dehydration of the body, electrolyte, acid-base disturbances and is accompanied by a decrease in body weight of more than 5%” [1 ]. Epidemiology

As of 2012, treatment in the United States for one patient with RB is $47,351, and annual costs are about $2 billion, with about 60% being the cost of treatment (hospitalization, medications), and 40% being indirect economic losses ( days of incapacity, etc.) [2]. In the USA, the annual cost of treating such patients in a “hospital at home” setting is $200 million [3]. Taking into account other factors (the need for emergency hospitalization, treatment of potential complications of RB, difficulty performing work duties, etc.), economic losses may be significantly higher. Unfortunately, the wide occurrence of RB and in a number of cases the relatively successful course of pregnancy have formed not only among obstetricians and gynecologists, but also among therapists as doctors who most often treat these patients, a light attitude towards RB. Moreover, B.A. Rebrov et al. (2010) o [4]. This opinion of practicing physicians is supported by the Cochrane register of randomized controlled trials of pregnant women with this pathology, as well as a number of studies, including retrospective cohort studies, which did not reveal a significant difference in the incidence of perinatal mortality, perinatal outcomes and preterm birth in patients in Norway and France and other countries [5–8]. However, in some cases, this complication of pregnancy is accompanied by the threat of chorion and placental abruption, severe neurological complications, an increase in the percentage of premature births, fetal growth retardation, etc., and in the mother - rupture of the esophagus, pneumothorax, retinal hemorrhage, etc. and the number of such publications is constantly growing [9–12]. Population-based cohort study conducted by Swedish authors from 1997 to 2009. and included more than 1 million pregnant women, found that with the development of severe RP in the second trimester, the incidence of preeclampsia increases by 2 times, the risk of placental abruption increases by 3 times, and the risk of developing fetal growth restriction syndrome increases by 39% [13]. In 2011, in issue No. 1 of the journal “Bulletin of Obstetrician-Gynecologist,” we described a patient at 35 weeks. pregnancy with RB, leading to severe electrolyte and neurological disorders, metabolic alkalosis, symptoms of cholestasis, acute renal and liver failure. Symptomatic therapy and timely delivery saved the lives of the mother and child [14]. In 2014, we treated another patient with severe RB and similar metabolic and organ disorders at a period of 16 weeks. was effective, however, against the background of discontinuation of therapy for a period of 20 weeks. During pregnancy, antenatal fetal death was diagnosed in an outpatient setting [15]. In 2016, a patient admitted to MONIIAG with severe RB at 13 weeks of pregnancy. pregnancy, electrolyte disturbances, alkalosis and weight loss of about 17% before the start of intensive care, antenatal fetal death was also noted. Dehydration due to RB is thought to lead to severe electrolyte disturbances, primarily hypokalemia, and metabolic alkalosis due to the loss of significant volumes of gastric acid through vomiting. However, analysis of literature data and our own clinical observations indicate that the pathogenesis of RB can be much more complex. It should be noted that in the UK there are no national recommendations for the treatment of this pathology [16], and in the USA antihistamines, anticholinergics and pyridoxine (vitamin B6) are recommended for use (level of evidence B) [17].

Etiology and pathogenesis

The pathogenesis of the disease is associated with an increase in the production of human chorionic gonadotropin in the first trimester (hCG) [18], which, in turn, causes an increase in the content of thyroid hormones and estradiol. One of the hCG subunits is characterized by structural similarity with the thyroid-stimulating hormone (TSH) glycoprotein, and at high concentrations of the former, TSH receptors can be activated. It is believed that gestational hyperthyroidism is a temporary phenomenon and disappears when hCG levels decrease in the second trimester [19, 20]. However, this theory does not explain the persistence of RB in the second and especially in the third trimester. High levels of hCG in the second trimester may cause abdominal placentation. Thus, a number of authors have discovered functional placental disorders that may be associated with RB [21]. Helicobacter pylori plays a certain role in the pathogenesis, and eradication can be effective in reducing the symptoms of RB, but the significance of this factor greatly depends on the population examined and the country [22, 23]. Thus, the “trigger” factor for severe disease appears to be high estrogen levels. During a normal pregnancy, this concentration of estrogen causes a moderate activation of the renin-aldosterone system, the main manifestation of which is fluid retention, necessary to maintain an increase in circulating blood volume. Among the risk factors for RB are young age, first pregnancy, low socioeconomic status, diabetes mellitus, arterial hypertension, smoking, alcohol consumption, IVF, female sex of the fetus and multiple pregnancy, mental state of the woman, etc. [24]. The multiplicity of risk factors also indicates that the pathogenesis of suffering is unclear. Severe RD, described by us and other authors, leads not only to pronounced loss of body weight, but also to hepatic-renal failure, metabolic alkalosis, life-threatening hypokalemia and hypomagnesemia, as well as a decrease in vitamin B1 levels [10, 12]. Similar changes occur not only in the fetus, but also in the newborn, which was observed in our observation [14]. Apparently, they are the cause of antenatal death [25]. The meta-analysis presented by MV Veenendaal et al. (2011) [26], as well as isolated studies, revealed worsening perinatal outcomes in women with RB [11]. In 1% of pregnant women with this pathology, adverse outcomes are observed not only for the fetus, but also for the mother [27]. With severe RB, the death of women is caused by organ damage, manifested by oliguria and decreased liver function [28]. In the observations we noted and in modern literature, metabolic alkalosis was significant and long-lasting, persisting in the absence of vomiting and against the background of normalization of potassium levels in the blood serum. On this basis, in our opinion, a reasonable opinion has been expressed about the formation in pregnant women with severe vomiting of phenomena similar to those in Barter syndrome (hereditary or acquired high-renin aldosteronism with hypokalemic alkalosis) [25, 29]. Metabolic alkalosis, as well as magnesium ion deficiency, cause a number of neurological symptoms, psychoemotional disorders and psychiatric disorders (depression, hallucinations, rapid mood changes, etc.), which were also encountered in our observations [30–35]. Thus, fears and depression in severe cases of the disease are observed in 47% and 48% of cases, respectively [36]. Magnesium deficiency leads to destabilization of the cell membrane, primarily nerve fibers and myocardial cells. Clinical symptoms associated with magnesium deficiency include: anxiety, sleep disturbances, depression, hearing loss, tinnitus, dizziness, neuromuscular disorders, spasmophilia, muscle cramps, migraine. M. A. Berdai et al. (2016) described a patient with severe RB who was admitted to the hospital at 17 weeks. pregnancy in a coma. The patient was diagnosed with Wernicke encephalopathy as a typical manifestation of severe vitamin B1 deficiency [10]. G. Chiossi et al. (2006) reported that of 49 such patients, complete recovery occurred in only 14, and neurological symptoms slowly regressed over several months. Spontaneous termination of pregnancy was noted in 37%, and termination of pregnancy at the request of the woman – in 10% of cases [37]. Without active treatment, Wernicke encephalopathy leads to temporary neurological disorders, Korsakoff's syndrome and demyelination of the central parts of the brain, which are fatal in 10–20% of cases; Fetal pathologies include miscarriages, premature birth and growth retardation [38, 39]. In the case of treatment started in the first 24 hours from the development of symptoms, the prognosis of this complication of RB is quite favorable [40, 41].

Treatment

To date, there are no agreed recommendations on the need for inpatient treatment of these patients. F. P. McCarthy et al. (2014) showed that treatment in a day hospital can reduce the need for inpatient treatment without deteriorating the well-being of pregnant women [42]. With the development of dehydration, hospitalization is required, and RD is the most common reason for hospital treatment of pregnant women in the first half of gestation [12, 27, 43, 44]. Before starting treatment, differential diagnosis is carried out with diseases of the gastrointestinal tract (hepatitis, pancreatitis, biliary tract diseases), pyelonephritis and metabolic disorders (diabetic ketoacidosis, porphyria, Addison's disease). According to meta-analysis and systemic reviews, the level of ketonuria may indicate the severity of RB (in 65% this complication is accompanied by ketonuria) [45], although this statement is not supported by all authors [46]. Correction of the diet using ginger, chamomile, lemon oil, mint oil and a number of antiemic drugs (metoclopramide), recommended for use from the second trimester of pregnancy, may have some effect [47, 48]. It is possible to use the serotonergic drug ondasetron, which does not have a teratogenic effect, which was proven in a retrospective cohort study, the results of which were published in 2016. The authors found that pregnant women receiving this drug had fewer miscarriages and terminations of pregnancy, and also increased the number of live births [49]. The basis for the effectiveness of therapy is the correction of electrolyte disorders, alkalosis, dehydration, as well as the prevention of neurological complications. V. Jaspers et al. (1990) in a randomized double study showed that the addition of a drug containing 15 mmol of magnesium aspartate to therapy reduces the incidence of preterm birth and leads to higher estriol levels from 33 to 36 weeks. pregnancy [50]. If oral administration of drugs is possible, a high daily requirement for magnesium ion is achieved by prescribing Magnerot in a dosage of 2 tablets 3 times a day in the first week, then 1 tablet 3 times a day. It should be noted that Magnerot contains orotic acid, which promotes the penetration of magnesium into the cell. Daily monitoring of the patient's condition is necessary, assessing the content of electrolytes in the blood and acid-base balance. When the condition and basic indicators of metabolism are stabilized, outpatient observation or treatment in a “one-day hospital” is possible, subject to a quick change of tactics in case of deterioration of objective indicators. Severe RB requires massive infusion therapy of up to 6 liters of saline solution, potassium preparations and 3 liters of Ringer's solution in the first 12 hours. With stabilization of the condition and a tendency towards normalization of key metabolic parameters, the volume of injected solutions can be reduced to 2 liters/day [12]. PC Tan et al. (2013) believe that additional intravenous long-term use of 5% glucose compared with saline does not provide advantages in terms of reducing ketonuria, severity of vomiting, electrolyte disorders and length of hospitalization [51]. The use of thiamine before glucose administration is recommended to reduce maternal morbidity and fetal loss [10]. Apparently, the use of drugs that inhibit the production of aldosterone and retain potassium in the body, primarily amiloride, which is widely used in pregnant women with Barter syndrome [52], as well as indomethacin, which indirectly inhibits the formation of renin and aldosterone [53, 54], may be promising.

Conclusion

Thus, the pathogenesis of RB appears to be complex and multi-stage. If in the first trimester one can assume the development of hCG-stimulated hyperthyroidism, then in the future, continued vomiting and hypokalemia form a state of hyperaldosteronism and metabolic alkalosis, closing a vicious circle of suffering. Severe RB with the pathogenesis described above is a complication that causes unfavorable perinatal outcomes, antenatal death and high maternal morbidity. Treatment of severe forms of RB must necessarily be carried out in a hospital and include massive infusions, therapy with electrolyte solutions, correction of alkalosis, as well as replacement therapy using magnesium preparations [27]. When relative remission is achieved, patients should be transferred to oral medications (in particular, Magnerot). When relative remission is achieved and oral administration of drugs is possible, patients are transferred to taking the drug Magnerot. It must be borne in mind that long-term parenteral therapy is not absolutely safe. A retrospective analysis of the condition of 166 patients with RB, who received parenteral therapy in 16.3% of cases, revealed a significant increase in the number of serious complications (sepsis, infective endocarditis, thrombophlebitis, etc.) [55].

When toxicosis is dangerous

Toxicosis manifests itself differently in pregnant women. Minor bouts of vomiting and nausea will not cause any harm to either the mother or the child. It is generally accepted that nausea has a beneficial effect on the body of a pregnant woman, as it prevents a woman from eating foods that are not suitable for her.

Scientists believe that mild morning sickness and headaches are caused by a protective mechanism that protects the fetus from toxins contained in fish, meat and poultry. This is why toxicosis is a common occurrence in the early stages of pregnancy, when the fetus is especially vulnerable.

Moreover, in women suffering from toxicosis, early miscarriages occur much less frequently. Therefore, do not panic if toxicosis still overtakes you. Some mothers rejoice at it, since it is this condition that gives them the feeling of pregnancy in the early stages, when other signs are not yet noticeable.

But if toxicosis is expressed in the form of constant vomiting, and the pregnant woman herself loses weight because she cannot eat anything, then she will have to be treated. To give birth to a healthy child, you should obey your gynecologist in everything.

Many mothers refuse treatment, believing that toxicosis will go away on its own over time, and the fact that weight decreases when vomiting is even better, because later you won’t have to fight with extra pounds. This opinion is wrong - the result of stubbornness will be late gestosis.

Miscarriage between 12 and 22 weeks

Such a miscarriage is considered late. Its causes coincide with the causes of early miscarriages (anatomical, immune, infectious, endocrine).

At this time, miscarriage also occurs due to isthmic-cervical insufficiency - the weak cervix cannot hold the fetus and dilates. For this reason, miscarriage can occur in the 2-3 trimester. Isthmic-cervical insufficiency is observed in 15.0-42.7% of women suffering from miscarriage. Careful monitoring of the pregnant woman allows you to identify the problem in time and perform surgical correction of the cervix before the onset of labor.

For isthmic-cervical insufficiency, there is only one treatment method - mechanical narrowing of the cervical canal. To do this, the neck is either sewn up or a special ring is put on it. However, the latter method is less effective, because the ring can easily slide off the neck, then it will no longer hinder the process of its opening.

After suturing, if necessary, it is possible to use antibiotics and drugs that normalize the vaginal microflora. Treatment of the vagina and monitoring of the condition of the sutures is carried out daily for 5 days. Sutures are removed at 37-38 weeks and in case of premature onset of labor.

Isthmic-cervical insufficiency can be primary (for no apparent reason), or can be a consequence of abortion or hormonal disorders (increased levels of androgens - male sex hormones or their precursors).

Miscarriage after 22 weeks

Such a loss is difficult to forget. Obstetricians talk about premature birth after the 28th week of pregnancy. Traditionally, a child born after this period is considered viable. But medicine knows of many cases where it was possible to save the lives of earlier children.

We recommend that you be thoroughly examined for miscarriage, check the above factors. In addition to them, the cause of miscarriage can be antiphospholipid syndrome, while the woman’s body perceives the child as something foreign and rejects it. This disease, like the others listed, can be corrected, i.e. You have a very real chance of bearing a child.

Miscarriages due to hemostasis disorders

All of the above reasons account for only 30-40%. Up to 70% of miscarriages are caused by disorders in the blood clotting system (hemostasis).

Disorders of the blood coagulation system that lead to pregnancy loss can be divided into thrombophilic (increased coagulation) and hemorrhagic (tendency to bleeding). Both of these extremes are dangerous for the fetus. Various disorders leading to the formation of small blood clots lead to the fact that the fetus loses sufficient blood supply, development is disrupted and the fetus is rejected.

Major hemorrhagic changes can appear in childhood in the form of increased bleeding during cuts, tooth extraction, and the onset of menstruation. But sometimes they manifest themselves only during pregnancy and cause miscarriage. Early bleeding and chorionic detachment are difficult to stop.

You may not realize it, but strange headaches, weakness, fatigue, and a temporary decrease in sense of smell or hearing may be symptoms of disorders in the blood coagulation system.

When planning a pregnancy, you need to undergo a genetic examination and, if necessary, begin treatment.

It is advisable to be examined for hidden hemostasis defects even for those who consider themselves healthy. This will make it possible to predict the occurrence of complications and prevent loss. Early therapy can prevent miscarriage in 98% of cases. If hemostasis defects are discovered already during pregnancy, it can be difficult to maintain it.

What to do after a miscarriage?

Find out the reason! The ideal option is for future parents to be examined: it is much wiser to postpone conception and spend two to three months identifying the reasons than to risk getting pregnant again, spend two months waiting, and then lose everything again and still go to the doctors.

Until you understand the reason, it will not evaporate. In most cases, the answers lie on the surface. Take care of your health and your future baby.

Make an appointment with an obstetrician-gynecologist by calling +7(495)150-60-01

Tyan Oksana Aleksandrovna Head of department, obstetrician-gynecologist Doctor of the highest category Work experience: 25 years

Maksimova Tamara Anatolyevna Obstetrician-gynecologist Work experience: 6 years

Zabolotnova Olga Valentinovna Obstetrician-gynecologist Doctor of the first category Work experience: 25 years

Moiseeva Alla Vitalievna Obstetrician-gynecologist, ultrasound diagnostics doctor First category doctor Work experience: 36 years

Volkova Polina Dmitrievna Obstetrician-gynecologist, ultrasound diagnostics doctor Doctor of the highest category Work experience: 34 years

Postnikova Nadezhda Anatolyevna Obstetrician-gynecologist, ultrasound diagnostics doctor Work experience: 34 years

Shchelokova Elena Nikolaevna Obstetrician-gynecologist Doctor of the highest category Work experience: 37 years

How toxicosis can end

Early toxicosis is considered less dangerous than late toxicosis, since it appears and disappears unnoticed. Late gestosis is dangerous because the pregnant woman constantly vomits, her sense of smell becomes more acute, mood swings occur, and the woman becomes irritable. All this affects the child. The causes of late toxicosis are stress, poor sleep, a short interval between births, and hormonal imbalance.

An additional disadvantage is that gestosis appears in the later stages, while a woman needs to tune in to a positive wave in order for the birth to be easier, she has to cope with her own body, which rejects food. The irritability of the expectant mother can lead to tone (tension) of the uterus and early labor. In the later stages, along with gestosis, edema may appear, protein in the urine, and the woman will constantly suffer from changes in blood pressure. Treatment of gestosis should be carried out under the supervision of a gynecologist, who selects a special diet for the woman, adjusting her lifestyle.

In what cases during pregnancy does a gynecologist require special attention?

• Physiological pregnancy of a healthy woman
  . Involves monthly consultations with the obstetrician-gynecologist leading the patient, passing mandatory tests for diseases, and preparation for childbirth. If toxicosis is present, the gynecologist will prescribe additional tests - you will need to take a biochemical blood test and a general urine test.
• Pregnancy after IVF.
  Requires careful screening in any case. In case of toxicosis, additional examination is necessary. In case of severe toxicosis, you will have to be treated in a hospital.
• Multiple pregnancy
  , due to the significant burden on the body and possible premature birth, is accompanied by enhanced obstetric control.
• Pregnancy in the presence of chronic diseases
  . Women with endocrine and cardiovascular diseases, disorders of the kidneys and digestive organs, and joint diseases will have to visit the gynecological clinic especially often, especially in the later stages.
• Pregnancy with pathological disorders
  . The presence of any pathological disorders (extragenital pathologies in a woman in labor, abnormal position of the fetus, immunological or genetic disorders identified in it) require regular monitoring and consultation with specialized specialists - an endocrinologist, geneticist, etc. In case of severe toxicosis, inpatient treatment is recommended.

Prevention of toxicosis during pregnancy

To prevent toxicosis you should:

• Give up bad habits and alcohol, start eating right.
• If you notice that you have become irritable due to a certain smell, you should eliminate the cause of that smell. At the first manifestations of toxicosis, the smells that the woman previously liked now become unbearable.
• Try not to get overtired. Sleep at least 8 hours a day, spend time outdoors more often. If you get motion sickness on public transport, try to use it less.
• Small meals can reduce toxicosis. Another advantage of frequent meals is the reduction of heartburn, since a small portion of food is digested faster. By eating frequently, you can avoid the risk of gaining excess weight.
• Mint leaves help relieve nausea. You can drink mint tea, but mint-flavored gum should be avoided as it can increase nausea.
• Take vitamins that will help strengthen your immune system, protect your body from various diseases, and also enrich you with microelements that are necessary not only for you, but also for your baby.

How can a gynecologist help you at the Diana Clinic?

In our clinic, highly qualified specialists in various specialized fields are waiting for you. We have a laboratory with the ability to conduct research and tests of any complexity and an ultrasound diagnostic room, where a new 3.4 D ultrasound machine is installed.

We offer:

• Development of an individual pregnancy management program for each patient with the appointment of a personal physician.
• Trimester screening examination with various programs, depending on the condition of the fetus and the pregnant woman.
• Additional studies (genetics, ultrasound) in any trimester to assess possible disorders in the fetus.
• An individual examination program and unscheduled urgent diagnostic procedures prescribed by the gynecologist leading the patient in connection with the manifestations of negative symptoms.
• Organization of specialized consultations with expert level specialists for women with complicated pregnancies, suspected fetal pathology and exacerbations of chronic diseases.
• Selection of gentle treatment for chronic and infectious diseases with minimal impact on the fetus and creation of opportunities for postpartum rehabilitation.
• Specialized preparation of patients with pathologies for childbirth and postpartum recovery.

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Belching, features of the condition

Sometimes belching may indicate diseases of the gastrointestinal tract

Pregnancy affects the functioning of all organs and systems of the body. There is a restructuring at all levels, starting with the hormonal level. Now the main goal of the body is to bear the baby.

The restructuring affects all internal organs, including the gastrointestinal tract. The increasing size of the uterus has an impact on the abdominal organs. Therefore, the occurrence of heartburn and belching is a very common occurrence for this condition. There is often a feeling of overeating.

Belching is the release of gas through the mouth from the esophagus or stomach. Very often the belching is acidic. This is due to the entry of gastric juice into the lower sector of the esophagus. Gastric juice irritates this area and provokes belching.