PREGNANCY INTOXICATIONS (GESTOSIS, PREGNANCY TOXAEMIAS, PREGNANCY TOXICOSES). – This designation is intended to group together all those morbid conditions whose principal characteristics are that they are closely linked to the pregnant state (almost as cause to effect) and that their intimate pathogenetic mechanism remains obscure.
The term p. i. in itself is improper, because it suggests a precise cause, namely identified toxins, 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 now been abandoned by the majority of scholars. It is now acknowledged, in fact, that pregnancy acts as a complex cause of a biological-hormonal order, affecting and at times compromising the pregnant woman’s entire organism; these morbid conditions often prove to be pathological and severe exaggerations of manifestations proper to pregnancy (such as slight fatty degeneration of the liver, mild albuminuria, occasional vomiting during the first three months, etc.) that are considered physiological, both because of their frequency and because they cause the pregnant woman no harm whatsoever.
The principal p. i. may be briefly indicated: 1) hyperemesis gravidarum, or uncontrollable vomiting in pregnant women, which prevents the woman from taking any solid or liquid food, even in minimal quantities, thereby first causing a progressive loss of body weight (up to 500–1000 grams per day) and then, in very severe cases, through the stage of cardiac adynamia, death. 2) Pregnancy nephropathies, in which there are extensive degenerative lesions of the kidney, with clinical consequences ranging from mild albuminuria without hypertension, to albuminuria with hypertension, oedema and oliguria, and ultimately renal insufficiency. 3) Eclampsia, a symptomatic complex that almost always follows severe nephropathy and is characterized by tonic-clonic convulsive seizures, subsequently followed by coma. Pregnancy nephropathies and eclampsia, however, almost always arise during the final months (the 7th–8th) of pregnancy; consequently, any therapeutic interruption of the pregnancy does not endanger the life of the foetus, which by then has attained sufficient development to enable it to live independently. 4) Jaundice and acute yellow atrophy of the liver, severe degenerative alterations which, often associated with the other forms of toxaemia, lead to the woman’s death through the clinical picture of severe hepatic insufficiency.
Other morbid conditions, of lesser importance and severity, may also be included among p. i. Pregnancy toxicoses all derive immediate benefit from termination of the pregnancy (abortion and induced premature delivery), which confirms their causal relationship with pregnancy; however, new developments in medical therapy make it possible, in the great majority of cases, to treat the morbid manifestations and allow the pregnancy to continue to term, without compromising the life of the mother or foetus.