Early gestosis as a cause of severe neurological disorders in pregnant women: literature review and clinical case
DOI:
https://doi.org/10.37800/RM.3.2022.87-95Keywords:
pregnancy, early preeclampsia, vomiting in pregnancy, complications, Wernicke’s encephalopathy, treatment, vitamin B1 (thiamine)Abstract
Relevance: Despite the significant advances in modern medical science, some practical cases are still difficult to diagnose and treat since they require awareness in various fields of medicine. Such conditions include vomiting in pregnancy, ICD-10 code O21 (lat. hyperemesis gravidarum) - an early gestosis-related pathological condition of the first half of pregnancy. This complication is a common symptom in pregnancy; however, some cases require inpatient care. Generally, an earlier onset of vomiting in pregnancy predetermines its more severe course. Wernicke’s encephalopathy (WE), a rare neurological syndrome with a severe course, can be a complication of excessive vomiting in pregnancy. An inattentive and unprofessional attitude to these symptoms at the PHC level can have tragic consequences for the woman and the child.
The study aimed to increase the clinical awareness of the medical community regarding Wernicke’s encephalopathy, its diagnosis criteria, and treatment direction.
Methods: The study included the analysis of special literature on WE pathogenesis, diagnosis, and treatment and the analysis of medical documentation on a clinical case of severe early gestosis complicated by WE.
Results: WE is manifested by a triad of symptoms: ophthalmoplegia, ataxia, and Korsakov’s syndrome. We can result in significant complications, including fetal pathologies, namely congenital malformations. WE prognosis depends on timely diagnosis and initiation of treatment. High morbidity (80%) and mortality in pregnant women (10-20%) and fetus (50%) prompts a detailed study of this pathology. Parenteral administration of vitamins (thiamine) in the early stages of the disease contributes to an almost complete recovery of the gravida. Long-term administration of thiamine in large doses is efficient as monotherapy during intensive therapy.
Conclusion: Timely administration of thiamine in combination with other means of intensive therapy can safely prevent damage to the subcortical structures of the brain and the disability of mothers and their children.
References
Запорожан В.М., Чайка В.К., Маркін Л.Б. та ін Акушерство та гінекологія: Національний підручник Т. 1: Акушерство – К.: ВСВ «Медицина», 2013. – 1032 с. [Zaporozhan V.M., Chaika V.K., Markin L.B. ta in Akusherstvo ta hinekolohiia: Natsionalnyi pidruchnyk T. 1: Akusherstvo – K.: VSV «Medytsyna», 2013. – 1032 s.].
WHO recommendations on antenatal care for a positive pregnancy experience. Женева: ВООЗ; 2017 р. https://www.who.int/publications-detail-redirect/9789241549912].
Drossman D.A., Hasler W.L. Rome IV. Functional GI disorders: disorders of gut-brain interaction. Gastro- enterology., 2016; 150(6): 1257–61. https://doi.org/10.1053/j.gastro.2016.03.035.
Flynn А, Macaluso M, D’Empaire I, Troutman MM. Wernicke’s encephalopathy: Increasing clinician awareness of this serious, enigmatic, yet treatable disease. Prim Care Companion CNS Disord. 2015;17(3). DOI: 10.4088/PCC.14r01738.
Матвієнко Ю. Енцефалопатія Верніке. 2011. Медицина світу. Український медичний портал. [Matviienko Yu. Entsefalopatiia Vernike. 2011. Medytsyna svitu. Ukrainskyi medychnyi portal]. http://msvitu.com/archive/2011/october/article-3.php
Борисенко О.А. ,. Зайцева Т.А,. Шапошникова А.В, Кудинова С.Г. Энцефалопатия Вернике у беременной. Психоневрологія та нейропсихіатрія., 2018; 6 (98): 50-53. [Borysenko O.A. ,. Zaitseva T.A,. Shaposhnykova A.V, Kudynova S.H. Эntsefalopatyia Vernyke u beremennoi. Psykhonevrolohiia ta neiropsykhiatriia., 2018; 6 (98): 50-53]. https://neuronews.com.ua/ru/archive/2018/6%2898%29/pages-50-52/encefalopatiya-vernike-u-beremennoy-#gsc.tab=0.
The American College of Obstetricians and Gynecologists. Practice bulletin summary N 153. Nausea and vomiting of pregnancy. Obstet. Gynecol., 2015; 126(3): 687–68. DOI: 10.1097/01.AOG.0000471177.80067.19.
Жабченко І.А.. Олешко В.Ф. Роль гормонального та обмінного дисбалансу в розвитку порушень обтураційної функції шийки матки та способи його корекції. Медичні аспекти здоров’я жінки., 2017; 2(107): 1-11. [Zhabchenko I.A.. Oleshko V.F. Rol hormonalnoho ta obminnoho dysbalansu v rozvytku porushen obturatsiinoi funktsii shyiky matky ta sposoby yoho korektsii. Medychni aspekty zdorovia zhinky., 2017; 2(107): 1-11].
Жабченко І.А. Магній в акушерській практиці: відомі факти та нові можливості. Медичні аспекти здоров’я жінки., 2019; 1-2(122-123): 32-8. [Zhabchenko I.A. Mahnii v akusherskii praktytsi: vidomi fakty ta novi mozhlyvosti. Medychni aspekty zdorovia zhinky., 2019; 1-2(122-123): 32-8]. https://mazg.com.ua/ua/archive/2019/1-2%28122-123%29/pages-32-38/magniy-v-akusherskiy-praktici-vidomi-fakti-ta-novi-mozhlivosti-
Жабченко І.А., Олешко В.Ф., Магомедов О.М. Роль сполучної тканини та деяких мікроелементів у розвитку істміко-цервікальної недостатності. Збірник наукових праць Асоціації акушерів-гінекологів України. – К.: Полиграф плюс. 2016; 2 (38):188 – 193 [Zhabchenko I.A., Oleshko V.F., Mahomedov O.M. Rol spoluchnoi tkanyny ta deiakykh mikroelementiv u rozvytku istmiko-tservikalnoi nedostatnosti. Zbirnyk naukovykh prats Asotsiatsii akusheriv-hinekolohiv Ukrainy. – K.: Polyhraf plius. 2016; 2 (38):188 - 193]. https://repo.odmu.edu.ua/xmlui/bitstream/handle/123456789/8714/ZAKHARENKO.pdf?sequence=1&isAllowed=y
Жабченко І.А., Корнієць Н.Г., Тертична-Телюк С.В. Вплив мікронутрієнтного статусу на перебіг вагітності у жінок-переміщених осіб. Здоровье женщины., 2018. 10(136): 56-60. [Zhabchenko I.A., Korniiets N.H., Tertychna-Teliuk S.V. Vplyv mikronutriientnoho statusu na perebih vahitnosti u zhinok-peremishchenykh osib. Zdorove zhenshchynы., 2018. 10(136): 56-60]. doi 10.15574/HW.2018.136.56.
Schabelman E, Kuo D. Glucose before thiamine for Wernicke encephalopathy: a literature review. J Emerg Med. 2012; 42:488-494. https://doi.org/10.1016/j.jemermed.2011.05.076 .
Zhang SQ, Guan YT. Acute bilateral deafness as the first symptom of Wernicke encephalopathy. AJNR Am J Neuroradiol. 2012; 33: E44-Е45. https://doi.org/10.3174/ajnr.A3040.
Kattah JC. The Spectrum of vestibular and ocular motor abnormalities in thiamine deficiency. Curr Neurol Neurosci Rep. 2017; 17:40. https://doi.org/10.1007/s11910-017-0747-9.
Herrell HE. Nausea and vomiting of pregnancy. Am Fam Physician. 2014; 89:965-970. https://www.aafp.org/afp/2014/0615/p965.html.
Galvin R, Bråthen G, Ivashynka A, Hillbom M, Tanasescu R, Leone MA. EFNS guidelines for diagnosis, therapy and prevention of Wernicke encephalopathy. Europ J of Neurol. 2012; 17:1408-1418. https://doi.org/10.1111/j.14681331.2010.03153.x.
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