PREGNANCY TOXICOSES (Gestosis, Pregnancy Toxemias, Pregnancy Toxicoses). - Under this designation it is intended to group together all those morbid states whose principal characteristics are that they are closely bound to the pregnant state (almost as cause to effect) and that they have an intimate pathogenetic mechanism that is still obscure.
The term pregnancy t. is in itself improper, because it suggests a precise cause, that is, identified toxic substances, which does not correspond to the truth, both because such hypothetical toxic substances have never been identified and, above all, because this very theory of morbid causation has today been abandoned by the majority of scholars. It is now admitted, in fact, that pregnancy acts as a complex cause of a biological-hormonal order that invests and, at times, compromises the entire organism of the pregnant woman; such morbid states often prove to be pathological and serious exaggerations of those manifestations proper to pregnancy (such as the slight fatty degeneration of the liver, the slight albuminuria, the occasional vomiting of the first three months, etc.) that are considered physiological, both because of their frequency and because they do not harm the pregnant woman in any way.
The principal pregnancy t. are briefly indicated: 1) gravid hyperemesis or incoercible vomiting of pregnant women, which prevents in the woman any intake of solid or liquid food even in the smallest quantity, thereby causing first a progressive loss of body weight (up to 500-1000 grams per day) and then, in very serious cases, through the stage of cardiac adynamia, death. 2) Gravid nephropathies, in which there are imposing degenerative lesions of the kidney, with clinical consequences ranging from mild albuminuria without hypertension, to that with hypertension, edemas, oliguria, up to renal insufficiency. 3) Eclampsia, a symptomatic complex that almost always follows a serious nephropathy, and which is characterized by tonic-clonic convulsive crises, subsequently followed by coma. Gravid nephropathies and eclampsia, however, almost always arise in the last months (7th-8th) of pregnancy, therefore the possible therapeutic interruption of the pregnancy does not jeopardize the life of the fetus, which by then has reached a development such as to permit it an autonomous life. 4) Jaundice and acute yellow atrophy of the liver, serious degenerative alterations that, often associated with the other forms of toxemia, bring the woman to death through the picture of major hepatic insufficiency.
Other morbid states, of lesser importance and gravity, can be included among the pregnancy t. The gravid toxicoses all find immediate benefit in the interruption of pregnancy (induced abortion and premature delivery), which confirms their causal relationship with pregnancy; however, the new acquisitions of medical therapy allow, in the great majority of cases, to treat the morbid manifestations and to allow the pregnancy to continue to term, without compromising the life of the mother and the fetus.
Bibliography3 works
Emanuele Lauricella