The obstetrician's hand is a symptom of what disease. Acute hypoparathyroidism (hypocalcemic crisis). Spasmophilia in adults

OBSTETRIC TURN, an operation, with the help of a swarm you can change a given position of the fetus, for some reason unfavorable for the course of labor, to another, more advantageous one, and, of course, always only to a longitudinal position. (History of A. p. see Obstetrics ... ...

RUDOLFI- Karl (Rudolphi Karl Asmund, 1771 1832), founder of helminthology; graduated from philosophy and medical faculties in Greifswald, held the chair of anatomy and physiology in Berlin for 22 years. I became interested in helminthology during my student years... ... Great Medical Encyclopedia

Spasmophilia- SPASMOPHILIA is a disease of young children, characterized by a tendency to tonic and clonic-tonic convulsions due to hypocalcemia. Etiology and pathogenesis. The calcium content in the blood serum during rickets decreases in ... ... Wikipedia

Tetany- I Tetania (tetania; Greek tetanos tension, convulsion) is a pathological condition characterized by convulsive syndrome and increased neuromuscular excitability due to a decrease in the concentration of ionized calcium in the blood serum, as ... ... Medical encyclopedia

Smellie-Siegemundin reception- (W. Smellie, 1697 1763, English obstetrician; J. Siegemundin, 1648 1705, German midwife; synonym double manual technique) obstetric rotation of the fetus onto the leg, in which one hand of the obstetrician, inserted into the uterus, pushes the head up, and the other pulls the leg by... ... Large medical dictionary

Smelley - Siegemundin reception- (W. Smellie, 1697 1763, English obstetrician; J. Siegemundin, 1648 1705, German midwife; syn. double manual technique) obstetric rotation of the fetus onto the leg, in which one hand of the obstetrician, inserted into the uterus, pushes the head up, and the other pulls... ... Medical encyclopedia

Spasmophilia- I Spasmophilia (spasmophilia; Greek spasmos cramp, spasm + philia tendency; synonym: rickitogenic tetany, spasmophilic diathesis) is a pathological condition that occurs in children with rickets in the first 6-18 months. life; characterized by... ... Medical encyclopedia

Hypocalcemic crisis- Thetan attack... Wikipedia

Maine obstetrician- * main d accoucheur. honey. Hand deformity. Obstetrician's hand. BME 1934 411 … Historical Dictionary of Gallicisms of the Russian Language

Rigid person syndrome- Syn.: The “numb person” syndrome. Mersch-Woltmann syndrome. Progressive symmetrical muscle rigidity, usually manifesting in men aged 20–40 years. Muscle tension and painful muscle spasms increase over several... ...

Bullet phenomenon- spasm of the muscles of the hand (“obstetrician’s hand”) during passive extension of the arm (with spasmophilia, tetany) ... encyclopedic Dictionary in psychology and pedagogy

Hand in spasm is in a state of extension, the forearm is bent in semiflexion, and the shoulder is in a state of adduction (Trousseau's symptom - the obstetrician's hand).
On lower limbs There is increased extension of the thigh and lower leg with flexion of the foot and toes. In severe cases, cramps can involve all the muscles of the face, causing it to become distorted. The face takes on a characteristic expression, the forehead is wrinkled, the lips are contracted and protruded forward. The muscles of the eyes, tongue, larynx, and the diaphragm also take part in a spastic attack. With convulsions of the muscles of the larynx, which is more often observed in children, laryngospasms occur, with suffocation, cyanosis, and prolonged spasm severe asphyxia occurs with loss of consciousness, which can be fatal. Often, patients with chronic hypoparathyroidism experience trophic disorders: dry skin, brittle bones, hair loss, cataracts, significant weight loss. Patients often experience tachycardia, arrhythmia, and compressive pain in the heart area. The electrocardiogram shows an increase QT interval, which is caused by hypocalcemia.

Permanent symptom of hypoparathyroidism is a violation mineral metabolism- hypocalcemia up to 5-6 mg%, hyperphosphatemia up to 7-10 mg%, hypocalciuria and hypophosphaturia. Impaired function of the organ of vision is expressed in convergence disorders, eyelid spasms, diplopia, nystagmus and the development of cataracts. During an attack, you can observe a narrowing or dilatation of the pupils and a slow reaction. With spasm of the intercostal muscles, abdominal muscles and diaphragm, significant respiratory distress is observed.
Vegetative nervous system is in a state of increased excitability with a tendency to vasomotor phenomena.

Functional disorders gastrointestinal tract are expressed in increased peristalsis, constipation followed by diarrhea, and increased secretion of gastric juice. Gastric or duodenal ulcers may often develop.
By clinical course There are acute, chronic and latent forms of parathyroid tetany.

In acute tetany attacks often recur and continue long time, they may arise unexpectedly.
Development tetany in acute form after any injury and strumectomy, it indicates complete or almost complete shutdown of the function of the parathyroid glands. Acute form tetany may end in recovery or progress to chronic form depending on the nature of the disease, treatment, etc. This form has a less severe course, attacks are rare. In its origin, provoking moments, overheating or hypothermia, are important. exercise stress, mental trauma, pregnancy, acute infections.

Seasonal exacerbation, diseases in spring and autumn. Often, patients with chronic hypoparathyroidism exhibit trophic disorders: dry skin, brittle nails, hair loss and weight loss. Changes in the teeth are reduced to enamel defects; teeth break and crumble easily.

Recognition of idiopathic is hidden ongoing hypoparathyroidism presents known difficulties. This form is characterized by the absence of spontaneously occurring attacks, which can occur under the influence of various provoking factors. Idiopathic tetany more often occurs at a young age, men are more often affected. The presence of changes in calcium and phosphorus metabolism typical of hypoparathyroidism gives grounds to classify idiopathic tetany as a parathyroid form associated with congenital inferiority of the parathyroid glands.

Complaints patients with a latent form of tetany are usually associated with cardiac disorders: they complain of palpitations, chest pain, a feeling of tightness in the chest, fainting, and often complain of goosebumps crawling in their fingers. Physical and X-ray examinations internal organs no changes are detected. The simplest way is to identify Chvostek's symptom, based on increased excitability facial nerve with its mechanical irritation. In response to irritation, the upper lip twitches (Khvostek I), or the upper lip and nose (Khvostek II), or twitching of the corner of the mouth is added (Khvostek III).

Diagnosis and differential diagnosis. It is necessary to think about the possibility of hypoparathyroidism if patients, after partial removal of the thyroid gland, experience signs of topical seizures. When making a diagnosis, one should also differentiate tetany from hysteria and epilepsy. In patients with hysteria and epilepsy, calcium and phosphorus metabolism disorders are not found.
It should also be kept in mind hypoglycemic cramps, at which they are observed characteristic features, feeling of hunger, weakness, pale skin. The question is resolved by examining blood sugar and calcium levels.

Treatment of hypoparathyroidism. When treating an attack of tetany, it is necessary to administer 10 ml of 10% calcium chloride intravenously, 2-4 ml of parathyrsocrine intramuscularly.
Intravenous administration 10% calcium chloride solution or 10% calcium gluconate solution usually quickly stops an attack of convulsions during tetany, which is very important for laryngospasm, when this is the main measure during first aid.

Depending on the duration and the frequency of attacks, calcium chloride and parathyroid injections are recommended to be carried out 2-3 times a day under the control of calcium levels in the blood.
In the inter-iristune period Calcium preparations are prescribed in the form of a 10% solution of calcium chloride, one tablespoon 3 times a day, or calcium gluconate in tablets, 3-4 tablets a day. At the same time prescribed orally alcohol solution vitamin D2 50,000-75,000 IU 2 times a day.

Acute hypoparathyroidism- an acute pathological condition that develops as a result of insufficient incretion of parathyroid hormone by the parathyroid glands, which leads to sharp decline level of calcium in the blood with subsequent attacks of tonic convulsions.

Tetany was first described by J. Clarke (1815). Tetany occurs at any age. It occurs not only with hypoparathyroidism, but also with a number of diseases and conditions without a decrease in the function of the parathyroid glands. The term “tetany”, in contrast to “acute hypoparathyroidism”, is a collective concept.

Etiology and pathogenesis of acute hypoparathyroidism

Acute hypoparathyroidism most often occurs due to accidental removal or trauma of the parathyroid glands during surgery. thyroid gland. The frequency of tetany after surgery on the thyroid gland ranges from 0.4 to 3.1% [Gurevich G. M., Mastbaum I. S., 1968]. According to other data, the frequency of tetany during resection of the thyroid gland is much higher and reaches 10% [Cherenko M.P., 1977] and even up to 20.5%.

A hypocalcemic crisis can develop when a hyperfunctioning parathyroid adenoma is removed as a result of atrophy of other parathyroid glands. The frequency of tetany after parathyroid adenectomy is 50-67% [Nikolaev O.V., Tarkaeva V.N., 1974]. In some cases, tetany that appears after removal of parathyroid adenoma is functional in nature and disappears with compensatory hyperplasia of the remaining parathyroid glands. Tetany can occur as a result of postoperative inflammation of the parathyroid glands or their autoimmune damage, as well as due to damage to the parathyroid glands by metastases of malignant neoplasms. Etiological factors tetany can also be tuberculosis, measles, influenza [Yules M., Hollo I., 1967], amyloidosis of the parathyroid glands, treatment radioactive iodine toxic goiter. In some cases, tetany is a consequence of idiopathic hypoparathyroidism, the cause of which has not been definitively established.

The cause of tetany may be congenital deficiency of the parathyroid glands. With hidden insufficiency of the parathyroid glands, it can be detected as a result of infection, intoxication (poisoning with lead, carbon monoxide, ergot), D-hypovitaminosis, alkalosis, pregnancy, lactation, and insufficient absorption of calcium in the intestine.

Due to parathyroid hormone deficiency, calcium intake from bone tissue into the blood and the reabsorption of phosphorus in the proximal renal tubules increases. This leads to hypocalcemia and hyperphosphatemia. A decrease in calcium levels in the blood leads to an imbalance between sodium and potassium ions, on the one hand, and calcium and magnesium, on the other. As a result, neuromuscular excitability sharply increases.

Tetany develops if the calcium level in the blood decreases to 1.25-1.75 mmol/l (5-7 mg%).

Clinic of acute hypoparathyroidism

Often an attack of tetany is preceded by precursors - coldness of the extremities, numbness, tingling and crawling, paresthesia and a feeling of spasms. Following the precursors, painful tonic spasms develop, which more often affect symmetrical muscle groups and are selective in nature.

Most often, cramps occur in the muscles upper limbs, less often - in the lower ones. The flexor muscles are mainly affected. As a result of a spasm of the facial muscles, a sardonic smile appears, the lips take on the appearance of a “fish mouth”. When the chewing muscles spasm, convulsive clenching of the jaws (trismus) occurs. Cramps in the muscles of the upper limbs lead to a characteristic position of the hand: the fingers are clenched and slightly brought towards the palm, the first finger is brought together, the hand is bent at the wrist joint (“obstetrician’s hand”). With spasm, the muscles of the lower extremities of the thighs and legs are extended, the feet rotate inward, and the torso is arched posteriorly (opisthotonus). Due to convulsive contractions of the intercostal muscles, abdominal muscles and diaphragm, breathing is sharply impaired.

Children often experience spasm of the laryngeal muscles, which leads to laryngospasm. With prolonged laryngospasm, asphyxia occurs and death occurs.

Changes in organs and systems during tetany depend on the predominance of the tone of the sympathetic or parasympathetic system. The predominance of the tone of the sympathetic system leads to tachycardia, increased blood pressure, pallor due to spasm of peripheral vessels, and parasympathetic - to vomiting, bradycardia, decreased blood pressure, diarrhea, polyuria. Spasms of smooth muscles of internal organs and blood vessels can simulate cardiovascular diseases(attacks of angina, endarteritis, migraine, etc.), respiratory diseases ( bronchial asthma etc.), gastrointestinal tract (cholecystitis, pancreatitis, appendicitis, stomach ulcer, etc.), genitourinary system(cystitis, nephritis, etc.). The ECG shows a prolongation of the Q-T interval, which is associated with hypocalcemia.

Attacks of compressive pain behind the sternum and in the heart area, such as angina pectoris, are identified as a kind of pseudoanginal form of tetany [Kyrge K. X., 1956; Quandt J., 1954, etc.]. The cardiac form of tetany can result in death as a result of convulsive contraction of the heart muscle or spasm of the coronary vessels. In some cases, a spasm of the spinal vessels occurs, as a result of which toxic-vascular myelopathy develops (girdling pain in the thoracic spine, a feeling of numbness in the legs, increasing weakness in them to the degree of paraparesis, etc.) [Martynov Yu. S. et al. , 1973].

Spasms of the digestive organs, occurring under the guise of cholecystitis, appendicitis, pancreatitis, etc., in some cases can lead to unnecessary surgical intervention. An attack of seizures can last from several minutes to several hours. Consciousness during a hypocalcemic crisis is usually preserved. In severe attacks of tetany, loss of consciousness is noted, which, in combination with convulsions, makes them similar to epileptic seizures. On the EEG in these patients, as in epilepsy, peak-wave complexes are observed (peaks, sharp waves, isolated or in combination with a subsequent slow wave). Under the influence of treatment, these changes may completely or partially disappear. Sometimes patients with tetany experience acute psychosis, cerebral edema, brainstem and extrapyramidal symptoms.

During an attack of tetany, diplopia may occur due to temporary strabismus or convergence disorder.

At mild form hypoparathyroidism, attacks of tetany are observed rarely (1-2 times a week), their duration does not exceed several minutes. In severe forms of hypoparathyroidism, attacks are frequent (sometimes several times a day), last several hours and easily occur under the influence of external stimuli (mental and physical trauma, hypothermia, overheating, etc.). The acute form of hypoparathyroidism has a severe course. Attacks of tonic convulsions are often repeated and protracted.

Laboratory data. For rapid diagnosis of hypocalcemic crisis, determination of the level of calcium in the blood is used. There is a decrease in the level of total calcium to 1.9 mmol/l (7.5 mg%) and below, and ionized calcium to 1.1 mmol/l (4.3 mg%) and below. The calcium level in the blood usually corresponds to the severity of tetany. In severe forms, the calcium content in the blood decreases to 1.5-1.2 mmol/l (6-5 mg%) and below. Hyperphosphatemia is characteristic. Hypocalciuria and hypophosphaturia are noted.

To make an approximate judgment about the calcium content in the blood, the Sulkovich test is used (see section “Acute hyperparathyroidism”). Calcium is not detected in urine when its content in the blood is below 2-1.75 mmol/l (8-7 mg%).

To diagnose a hypocalcemic crisis that occurs with a predominance of symptoms autonomic dysfunction and viscerovascular pathology and latent tetany, use tests based on increased mechanical strength. thermal and electrical excitability of the neuromuscular system.

When tapping the facial nerve with a finger or a percussion hammer in front of the tragus of the auricle (at the exit point of the facial nerve), Chvostek's sign is revealed. This symptom may be I, II or III degree. Contraction of the muscles of the entire area innervated by the facial nerve is characteristic of overt tetany and is designated as “Tail-I”. With “Khvostek-P,” the muscles in the area of ​​the wing of the nose and the corner of the mouth contract, and with “Khvostek-III,” only the muscles of the corner of the mouth contract. "Khvostek-P and "Khvostek-Sh" are usually detected when latent tetany.

Trousseau's sign is detected by tightening the patient's shoulder with a rubber tourniquet or rubber cuff until the pulse disappears for 2-3 minutes. With hidden tetany, after a specified time, a convulsive reaction of the hand occurs in the constricted limb in the form of an “obstetrician’s hand.”

Schlesinger's sign is detected with rapid passive flexion in hip joint the patient's legs are straightened knee joint. With hidden tetany, a convulsive contraction of the extensor muscles of the thigh appears with a sharp supination of the foot. Contraction of the muscles of the limbs under the influence of a galvanic current of even small strength (0.7 mA) is called Erb's symptom.

Diagnosis and differential diagnosis of acute hypoparathyroidism

The diagnosis of acute hypoparathyroidism is established on the basis of anamnesis (the occurrence of attacks of tetany after surgery on the thyroid gland, removal of parathyroid adenoma, treatment of toxic goiter with radioactive iodine, etc.), characteristic clinical symptoms(local painful tonic spasms affecting symmetrical muscle groups - trismus, opisthotonus, etc., difficulty breathing, convulsive spasms of the whole body, etc.), laboratory data (hypocalcemia, hyperphosphatemia) and diagnostic tests (Chvostek's, Trousseau's symptoms , Erba). Of certain importance in the diagnosis of acute hypoparathyroidism are symptoms that indirectly indicate chronic hypoparathyroidism: dry skin, brittle and striated nails, defects in tooth enamel, caries, central or subcapsular cataracts, nested or total baldness, early graying of hair, symmetrical calcification of the choroid plexuses and other cerebral vessels, calcification of the basal ganglia, etc.

Seizure attacks in acute hypoparathyroidism are differentiated primarily from other hypocalcemic tetany not associated with primary pathology of the parathyroid glands. Tetany in these cases may occur as a result of impaired absorption of calcium in the intestine due to vitamin D deficiency (spasmophilia, rickets in adults). The cause of tetany may also be various diseases and conditions accompanied by impaired absorption of calcium in the intestine due to steatorrhea (sprue, chronic pancreatitis, diarrhea after resection of a large area small intestine, chronic enteritis, etc.). In some cases, such tetany develops due to an increased need for calcium and vitamin D during pregnancy and lactation. Hypocalcemic tetany can also occur after oxalate poisoning.

Unlike tetany in acute hypoparathyroidism, the above tetany is characterized not only by hypocalcemia, but also by hypophosphatemia. The only exception is tetany after oxalate poisoning, characterized by hypocalcemia and normal phosphorus levels in the blood. The cause of hypocalcemia in this case is calcium inactivation due to the formation of insoluble calcium oxalate compounds.

Hypocalcemic tetany, but with hyperphosphatemia, is observed in a congenital disease - Albright's disease, which, due to the insensitivity of the renal tubules to parathyroid hormone, is called pseudohypoparathyroidism. Patients with pseudohypoparathyroidism are characterized by short stature, short bone sizes, often pronounced mental retardation and the tendency of subcutaneous tissue to calcify and ossify.

Hypocalcemia with hyperphosphatemia, but usually without tetany, is observed in chronic renal failure. The absence of tetany in this form of hypocalcemia is due to acidosis due to hyperazotemia and hypermagnesemia, however, when the acid-base state shifts to the alkaline side, calcium ionization decreases and tetany may occur. Sometimes hypocalcemic tetany develops due to a deficiency of magnesium in the body. The latter helps to suppress the mobilization of calcium from bone tissue by parathyroid hormone. Hypomagnesemia can occur in severe nutritional disorders due to malabsorption in the intestine, after prolonged parenteral nutrition, in chronic alcoholism, etc.

Tetany with normal levels of calcium and phosphorus in the blood is observed with alkalosis (gastric and hyperventilation tetany) and citrate poisoning. Gastric tetany occurs after prolonged vomiting and loss of hydrochloric acid, as well as after taking large amounts of sodium bicarbonate, as a result of which the concentration of ionized calcium in the blood decreases. However, the total level of calcium in the blood remains within normal limits. Hyperventilation tetany is caused by increased release of CO 2, resulting in alkalosis. Hyperventilation tetany (after frequent and deep respiratory movements) is observed in hysteria and less often in patients with encephalitis.

Tetany in citrate poisoning is caused by calcium inactivation due to the formation of calcium citrate.

M. Yules and I. Hollo (1967) proposed the following scheme differential diagnosis tetany not associated with primary pathology of the parathyroid glands (Scheme 1).

Tetany can be of iatrogenic origin (administration of large doses of calcitonin, mithramycin, EDTA, glucagon, phosphorus salts, long-term use of phenobarbital, which disrupts the metabolism of vitamin D, etc.).

Attacks of convulsions in acute hypoparathyroidism, diffetania, caused by organic diseases Central nervous system (rheumatism, brain tumor, etc.), primary hyperaldosteronism, tetanus, rabies, strychnine poisoning.

In contrast to the hypocalcemic crisis in epilepsy, the symptoms of Chvostek, Trousseau, Erb are usually negative and phosphorus-calcium metabolism not violated. The hypoglycemic genesis of seizures is evidenced by anamnesis, a characteristic feeling of hunger, and normal calcium levels in the blood in the presence of hypoglycemia.

In tetany syndrome caused by organic diseases of the central nervous system, in contrast to tetany in acute hypoparathyroidism, there is no disturbance in phosphorus-calcium metabolism and changes in acid-base balance.

They talk about primary hyperaldosteronism characteristic symptoms diseases: attacks of severe muscle weakness, transient flaccid paralysis, arterial hypertension, polyuria, polydipsia, hypokalemia, etc. The calcium content in the blood is within normal limits.

We can talk about tetanus and hypocalcemic crisis based on the history (presence of injury and contamination of the wound with soil) and the widespread nature of the convulsions, usually starting from the masticatory muscles and involving the a certain sequence other muscles (facial muscles, muscles of the neck, torso, lower extremities). In contrast to the hypocalcemic crisis with tetanus, the calcium content in the blood is within normal limits.

History (bite, salivation of an infected animal) and characteristic clinical picture(hydrophobia, aerophobia, excitement, sometimes violent attacks, followed by paralysis of the muscles of the limbs, tongue, increased salivation etc.) indicate the presence of rabies and the absence of a hypocalcemic crisis.

In case of strychnine poisoning, in contrast to a hypocalcemic crisis, Chvostek's and Trousseau's symptoms are negative, the calcium level in the blood is normal.

Prognosis of acute hypoparathyroidism

With timely and correct replacement therapy The prognosis for life is usually favorable. With laryngospasm and cardiac tetany, the prognosis is serious (death can occur due to asphyxia, convulsive contraction of the heart muscle or spasm of the coronary vessels).

Prevention. Prevention of acute hypoparathyroidism involves maximally sparing the parathyroid glands during operations on the thyroid gland, as well as preventing complications (adhesions, infiltrates, etc.) that impair their blood supply after surgery.

Early detection of neuromuscular excitability in patients after surgery on the thyroid gland is necessary, followed by immediate rational specific therapy. Preventive actions should be aimed at preventing infections and intoxications that damage the parathyroid glands, as well as factors that provoke the development of acute hypocalcemic crisis in patients with chronic hypoparathyroidism. To prevent tetany, patients with hypoparathyroidism are prescribed a diet rich in calcium and poor in phosphorus.

Treatment of acute hypoparathyroidism

1. To relieve an acute attack of tetany, depending on the severity of the attack, 10-50 ml of a 10% solution of calcium chloride or calcium gluconate is administered intravenously. The effect of the drug appears already at the end of the injection. If necessary, intravenous administration of calcium preparations is repeated 3-4 times a day.

2. After the administration of calcium supplements, 40-100 units of parathyroidin are administered subcutaneously or intramuscularly to prevent attacks of tetany. Parathyroidin - an extract of the parathyroid glands of cattle - contains 20 units of the active principle in 1 ml. The therapeutic effect after its administration occurs within 2-3 hours and lasts 20-24 hours. The maximum increase in calcium levels in the blood after administration of the drug occurs after 18 hours.

3. After eliminating the seizures, instead of parathyroidin or simultaneously with it, dihydrotachysterol (AT-10) is prescribed at a dose of 2 mg orally after 6 hours. Subsequently, every 2 days, the dose is reduced by 2 mg. The maintenance dose is usually 2 mg. Dihydrotachysterol not only promotes the absorption of calcium by the intestine, but also, like parathyroid hormone, promotes the mobilization of calcium from the bones and the excretion of phosphorus in the urine. Treatment with dihydrotachysterol, like parathyroidin, is carried out under systematic monitoring of calcium levels in the blood and its excretion in the urine. The duration of action of the drug after its discontinuation is 10 days. For better absorption of calcium by the intestine, ergocal-ciferol (vitamin D2) can be used instead of dihydrotachysterol. To eliminate attacks of tetany, vitamin D2 (alcohol solution) is prescribed at 200,000-400,000 IU per day, followed by a gradual reduction in the dose after the attacks stop to 25,000-50,000 IU per day. Treatment with vitamin D2 is carried out under systematic monitoring (1-2 times a month) of calcium levels in the blood.

4. Prescribe sedatives and antispasmodics (bromides, luminal, chloral hydrate orally or in an enema, papaverine, etc.).

5. To eliminate alkalosis, use ammonium chloride 3-7 g per day.

6. With increasing laryngospasm, intubation or tracheotomy is indicated.

Potemkin V.V. Emergency conditions in the clinic of endocrine diseases, 1984

With a disorder of calcium-phosphorus metabolism, which accompanies moderate or severe rickets, 4% of children develop spasmophilia, which is also called infantile tetany. This pathology is accompanied by a spastic state of the muscles of the limbs, face, larynx, as well as the occurrence of general clonic and tonic convulsions. It is usually detected between the ages of three months and two years. One of the most striking manifestations of the developing disease are the symptoms of Chvostek, Trousseau and Lyust, which help to determine the severity of the ongoing disease. We will talk about how these symptoms are determined and how they are treated later in the article.

How are spasmophilic symptoms checked?

To check for the presence of Chvostek's sign, also called the facial nerve phenomenon, the child is placed on a bed without a pillow. The legs should be straightened and the arms should lie along the body.

The symptom is checked by lightly tapping with a percussion hammer or fingers at the exit site trigeminal nerve(above the zygomatic arch). If the patient experiences involuntary twitching of the eyelid and corner of the upper lip, then the mentioned symptom is considered positive. By the way, it is checked on both cheekbones.

Chvostek's symptoms have 3 degrees of manifestation:

1. Muscle contraction throughout the area of ​​innervation of the facial nerve.
2. Contraction of the muscles in the corner of the mouth and at the wing of the nose.
3. Muscle contraction only in the corner of the mouth.

In the presence of obvious tetany, the child exhibits the first degree of symptom even from a light touch in the area of ​​the facial nerve.

Additional ways to check for antispasmodic symptoms

No less indicative in terms of determining the severity of the baby’s condition are the symptoms of Trousseau and Lust.

• Trousseau's sign is detected by compression of the middle of the child's shoulder. In this case, the doctor should try to capture as much of the soft tissue of his hand as possible. If, as a result of this (about 2-3 minutes after compression), the patient’s fingers take a forced position, called “obstetrician’s hands” (that is, the thumb is brought to the palm, the index and middle fingers are extended, and the ring and little fingers are bent), then the symptom is considered positive. To check for its presence in older children or adults, you can use a blood pressure cuff, pumping air into it until the pulse stops.
• The Lust sign is checked using a hammer, which is tapped behind the head of the minor or by squeezing the gastrocnemius muscle in the area of ​​the Achilles tendon. If the patient experiences involuntary abduction of the foot (“ballerina’s foot”), then the symptom can be considered positive. It is tested on both limbs.

The symptoms of Chvostek, Trousseau, and Lyust are considered spasmophilic. They become positive if a sick child has a change in the amount of calcium in the blood that is responsible for muscle contractions. This can be caused not only by the presence of rickets, but also by other diseases.

What is tetany

Chvostek's and Trousseau's symptoms are signs of spasmophilia (tetany). This disease is characterized by increased nervous excitability, manifested in the limbs or larynx. More often this pathology observed in boys in the first six months of life.

And the biological basis of this disease is low level ionized calcium in the child's blood.

Why is Chvostek's sign dangerous in children?

Photos of children with tetany allow us to understand what the signs of the disease are. The main one is laryngospasm, which is expressed by difficulty breathing, pale face, sweating, and sometimes loss of consciousness. Periodic cramps of the feet and hands (carpopedal spasm), sometimes lasting several hours, are also characteristic. Spasms of other muscle groups are also possible - respiratory, chewing, eye, etc.

But the most severe sign of the disease is considered to be an attack of eclampsia - clonic-tonic convulsions, starting from the face and turning into cramps of the limbs and laryngospasm. In this case, the child most often loses consciousness, foam appears on the lips, and involuntary urination is observed. Eclampsia is dangerous due to the possibility of respiratory or cardiac arrest.

Who might get tetany?

In the first days of life convulsive states and hypocalcemia most often occur in babies born prematurely, in twins, as well as in those who have had jaundice or an infectious disease.

Chvostek's symptom in children in the first months of life can be provoked by both a decrease in the intake of calcium into the child's body and an increase in the secretion of calcitonin. Doctors associate this condition with a disruption in the supply of phosphorus and calcium when the baby is suddenly transferred to breastfeeding. cow's milk, and also (in rare cases) with a lack of vitamin D and calcium in the maternal body.

As a rule, in children, hypocalcemia is manifested by neuromuscular irritability, convulsions, vomiting, tachycardia and respiratory symptoms.

Treatment of tetany

Attacks of eclampsia require urgent assistance to the child, and in case of respiratory or cardiac arrest, resuscitation measures.

For any manifestations of tetany, the child is prescribed anticonvulsants(“Sibazon” intramuscularly or intravenously, “Sodium oxybarbutyrate” intramuscularly, “Phenobarbital” rectally in suppositories or orally, etc.). Intravenous administration of 10% calcium gluconate solution or intramuscular 25% magnesium sulfate solution is also indicated.

Spasmophilia, causing symptoms Chvostek and Trousseau, as a rule, has a favorable prognosis in most cases. The only danger is prolonged laryngospasm, which threatens respiratory arrest.

When the child reaches the age of 2-3 years, the pathological condition is eliminated as a result of stabilization of calcium and phosphorus levels in the blood.

Hypoparathyroidism is a disease that is accompanied by Chvostek's symptom

This is also a clear sign of a pathological condition called hypoparathyroidism, in which there is a decrease in function. Most often, this problem arises as a result of surgery for a disease of the thyroid gland or the presence of inflammatory process. And sometimes dysfunction can be caused by infectious processes, such as measles or influenza.

In newborns, hypoparathyroidism develops in the case of a congenital absence of the parathyroid glands or when their functioning is suppressed by increased release of parathyroid hormone in the mother's body during pregnancy.

In this case, the patient, as a rule, exhibits a decrease in the calcium content in the blood in parallel with an increase in the concentration of phosphorus. And outwardly this is manifested by the already described tetany, intestinal phenomena, abnormalities in the growth of teeth, nails and hair, as well as skin changes.

In such cases, the symptoms of Chvostek and Trousseau, along with laboratory tests, help to accurately identify the developed tetanic condition and diagnose the patient.

Treatment of hypoparathyroidism

To treat this disease, it is important to take into account the reasons that caused its appearance, as well as the severity of the symptoms. At acute course illness with symptoms of tetany, urgent administration of 10% calcium chloride or calcium gluconate intravenously is recommended. This is done slowly, taking into account the fact that the first mentioned solution contains 27% of the substance of the same name, and the second contains only 9%.

As a rule, in order to eliminate Chvostek's symptoms, treatment with calcium supplements is required for at least 10 days. Taking calcium orally has a good effect, and doctors advise doing this by dissolving the drug in milk to prevent the development of gastritis.

The chronic condition of hypoparathyroidism requires taking vitamin D, starting with a loading dose (200-300 thousand units per day), with mandatory monitoring of phosphorus and calcium levels in the blood, and after normalizing their levels, the dose is reduced to 50 thousand units. per day in children under one year old or up to 125 thousand units. - in patients after a year.

What other diseases cause Trousseau and Chvostek symptoms?

In addition to diseases caused only by a decrease in calcium in the blood plasma for any reason, the symptoms of Chvostek, Trousseau and Lust can also be found in other ailments. These include:

• Neurasthenia with an anxious and suspicious state, manifested in the form of The patient experiences periodic disturbances in the rhythm of breathing, simulating suffocation, with a feeling of a lump in the throat, lack of air, and sometimes with loss of consciousness and convulsions.
• Dyscirculatory processes combined with asthenic or astheno-neurotic syndrome, characterized by the condition constant fatigue and nervous exhaustion, as well as headaches, sleep disturbances and dizziness.
• Hysteria, epilepsy and other diseases.

Prevention of calcium imbalance in a child

As you have probably already seen, for diseases that accompany Chvostek’s symptom in children, treatment comes down to the inevitable restoration of blood levels normal level calcium and phosphorus. Therefore, the prevention of these pathologies also requires, first of all, monitoring the concentration of the mentioned substances, which is carried out by local pediatricians.

It is important to create optimal conditions for the development of the fetus in a pregnant woman. To do this, if the expectant mother lives in unsatisfactory social and living conditions or belongs to a risk group (if diabetes mellitus, nephropathy, hypertension and rheumatism), she is prescribed vitamin D in the last 2 months of pregnancy. In a normal pregnancy, following a diet and physical activity is sufficient.

And for a newborn to grow strong and healthy, it is important to have breastfeeding, timely introduction of complementary foods, daily exposure to fresh air, free swaddling, massage, gymnastics and light-air baths.

Trousseau) - 1) (syn. Trousseau phenomenon) - a tonic spasm of the hand that occurs in response to pressure in the area of ​​the neurovascular bundle on the shoulder; a sign of spasmophilia or tetany; 2) development acute thrombophlebitis large veins for cancer of internal organs.

“Obstetrician’s hands”? This is when fingers 1, 4, 5 are bent and you cannot move them normally. When the nerves of the hand are damaged.

or carpal tunnel syndrome. What is it?

This is completely called the Wernicke-Mann pose. Occurs with hemiparesis (paresis of one half of the body), characteristic of damage to the central motor neuron.

Trousseau syndrome

This syndrome is named after the person who first established the relationship between the combination of thrombophlebitis and cancer of internal organs - the French doctor Andre Trousseau. A typical symptom of spasmophilia - “obstetrician’s hand” - is named after him. Trousseau syndrome refers to paraneoplastic processes, and links together spontaneous migratory thrombophlebitis and advanced cancer of the esophagus or other internal organs (usually the stomach, liver).

Paraneoplastic processes are processes occurring in the body of elderly and old people (they are much less common in young people), which develop when oncological diseases, but are in no way connected directly with the tumor itself - that is, neither with its metastases, nor with its growth. Such nonspecific reactions occur in response to those changes that arise due to the presence of an altered, neoplastic, essentially foreign process for the body.

Causes

There are several causes of Trousseau syndrome. One of them lies in the excessive formation of thrombus-forming factors. Almost any tumor, starting from a small size, produces fibrinopeptide A, which, when detected, can be a marker of a tumor of internal organs - this is due to the fact that quantitative indicators fibrinopeptide A and tumor size are associated with fairly high degree accuracy.

The second reason is a change in hemostasis in cancer patients according to the type of external coagulation mechanism - that is, after substances that are not part of its composition (in this case, tumor cells) enter the blood. Tumors are a constant source of tissue thromboplastin, as well as a special “cancer procoagulant” that converts coagulation factors VII and X into serine proteinase.

More often this symptom appears with tumors of the gastrointestinal tract.

Symptoms

As often happens in medicine, the discovery of this syndrome associated with the death of the author himself. Andre Trousseau had been studying neoplastic pathology for a long time, and had already noticed signs of spontaneous thrombosis. Since the relationship between thrombosis and tumors was obvious to Trousseau, he assumed that he himself had stomach cancer, especially since there were not too obvious, but nevertheless alarming symptoms. And so it turned out - Andre died of stomach cancer.

Tumors of internal organs do not always make themselves felt with typical symptoms. And people often tend to reduce the significance of what they consider to be terrible complaints and symptoms. The tumor grows, its external influence on the body increases, and pareneoplastic processes are provoked. If phlebothrombosis is formed in different places, are difficult to treat, or even not treatable at all, if there are thromboses of large arteries not associated with any diseases known to the patient, a cancerous tumor should be assumed.

Diagnosis and treatment

Diagnosis must be thorough. Increased thrombotic processes, constant changes in blood parameters, indicating changes in coagulation factors. It is necessary to conduct a blood test for the presence of fibrinopeptide A and other coagulation factors, and also pay attention to all nonspecific complaints that the patient has. A thorough diagnosis will also be required to determine the location of the tumor.

There is no specific treatment for Trousseau's syndrome (as well as other paraneoplastic processes). They can only clinically weaken or regress with successful treatment (even palliative treatment).

Forecast

Entirely depends on the prognosis of the tumor and the possibilities of its radical treatment.

7 reasons why you can't quit smoking.

Convulsive syndrome

In this article we will talk about cramps. First of all, about what pathological conditions they are characteristic.

Cramps themselves are not a disease, but a symptom, and therefore they are not treated. What do they do with them, you ask? The answer is: they stop, or, to put it in simple language, are removed.

What should you do if a child has seizures? First of all, call an ambulance. Doctors will administer anticonvulsants and take the child to the hospital or leave him at home under the supervision of a local pediatrician.

Remember that it is PROHIBITED to transport a person with seizures. This is fraught with complications. Therefore, do not demand immediate hospitalization from emergency doctors and do not allow them to take the child away until the condition stabilizes. If the convulsions were so short-lived that you did not even have time to get scared, much less call for help, do not forget about them. Be sure to see your doctor as soon as possible. We hope our article will help you navigate a difficult situation.

So, cramps are involuntary muscle contractions caused by irritation of certain brain structures, controlling movements. Seizures are divided into epileptic and non-epileptic. This division is important because these two groups have a completely different approach to treatment.

There are also tonic - more persistent and slow convulsions and clonic - fast, fragmentary. They can also have a mixed character - tonic-clonic. Although these names are not easy, in reality these 2 types of seizures are clearly distinguishable. Anyone who has seen both at least once in his life will never confuse them.

Most often, convulsions are a reflection of epileptic seizures. In this case, they can be generalized (general) or focal (local). Partial seizures involve seizures in one limb or on one side of the body. They indicate an area of ​​the brain that is affected by arousal. During generalized seizures, the entire cerebral cortex, which is responsible for movement, is irritated, so all the muscles of the body are seized with convulsions. We will talk about epilepsy in more detail in future articles.

Now let's return to non-epileptic causes of seizures.

Febrile seizures. The most common seizures in children are febrile, i.e. caused by a rise in body temperature above 38 C. As the temperature rises, the metabolism in the brain cells and its blood supply change. The consequence of this is an increase in convulsive readiness. Typically, convulsions occur on the first day of fever when infectious diseases: flu, sore throat, etc. They look like twitching of the limbs against the background of loss of consciousness and increased overall body tone. The attack lasts 3-5 minutes and most often occurs once. The risk group is all children aged 9 to 20 months. What should you do in such a situation?

1. Call an ambulance.

2. Turn the child on his side, expose him as much as possible and keep him calm. Don't scream trying to bring him to consciousness.

3. Remove all hazardous items to prevent injury. The child must be in a safe place (corners of the bed, etc., in this case there is danger).

4. Provide access to fresh air.

The examinations that you will undergo after such an episode include a visit to a neurologist and EEG recording. Don't get scared ahead of time. Availability febrile seizures most often it does not indicate any nervous disease at all. It is necessary to get checked, since 20% of such children are subsequently diagnosed with epilepsy.

Tetany. Tetany is caused by a decrease in calcium levels in the blood. Lack of calcium leads to increased excitability nerve tissue, as a result of which a series of discharges occur in it. Tetany is easy to recognize. Spasms of the hands and feet are characteristic. The spasm of the hand looks like an “obstetrician’s hand” - flexion in the metacarpophalangeal joints and extension in the interphalangeal joints, flexion in the radial and elbow joints. If the spasm affects the leg, then the foot and toes bend towards the sole with an inward turn. The danger of tetany is that laryngospasm may develop (spasm glottis), making it difficult to breathe. If your seizures resemble tetany, tell your doctor. To begin with, he will conduct several functional tests, and then send you to analyze your hormone levels. Most common reason tetany – insufficiency of the parathyroid glands. However, it can occur with hyperventilation ( deep breathing) in patients with neuroses and renal failure. It may also be associated with decreased magnesium levels or fluctuations in blood potassium levels. This applies mainly to sudden changes in concentrations, e.g. intravenous administration medications containing these electrolytes.

Multifocal myoclonus – jerky, irregular convulsive movements. They often appear in the context of confusion or daze. Such myoclonus may be accompanied by tremors and twitching. Usually occurs as a consequence of metabolic or toxic encephalopathy. In children it appears mainly as a consequence of apnea at birth.

In junior childhood epileptic seizures are easily confused with affective-respiratory attacks. Affective-respiratory attacks occur as a consequence of intense screaming in an offended or frightened child. They are characterized by holding the breath while inhaling, followed by blueness, loss of consciousness, decreased muscle tone, or generalized tonic muscle tension. Sometimes against this background short-term clonic twitching occurs. After a few seconds, breathing, and with it the screaming, resumes. Confusion persists for a minute, after which the child returns to the interrupted activity. Seizures are observed mainly in children from 6 months of age. up to 4 years and then disappear without a trace. The main therapy is psychological correction of the behavior of mother and child.

Often the “convulsions” are demonstrative – hysterical. In this case, they are bizarre, without a clear change in the tonic and clonic phases with arching of the body, kicking, moaning, screaming. It is characteristic that all this happens with unchanged consciousness. Help - remove the audience for whom the concert is given.

Brief clonic convulsions may occur during fainting. This happens when a fainting person does not get the opportunity to fall (sitting in a chair, on public transport). In this case, the fainting prolongs and, as a result, short-term convulsions occur. Their duration in this case does not exceed several seconds.

It is necessary to distinguish convulsions from hyperkinesis. These are involuntary violent movements associated with the defeat of the system responsible for the smoothness, economy and emotional coloring of movements. There are several types of hyperkinesis: tremor (shaking), dystonia, chorea, athetosis, ballism, tics, etc. We will describe the most common ones. Surely you have seen such patients on the street. Don't be afraid of them - basically, they have adequate mental and mental development, they themselves suffer from their defect. So, dystonia is involuntary slow repetitive movements, rotation, flexion or extension of various parts of the body with the formation of pathological postures. Chorea is a continuous stream of fast, nonrhythmic, chaotic jerks. Athetosis – slow worm-like movements in the arms and body. Sometimes athetosis looks like a corkscrew twist.

Read about the epileptic nature of seizures in the next article.

Obstetrician syndrome

IN medical literature Trousseau's symptom refers to two conditions:

Recurrent thrombophlebitis in cancer of internal organs (it is, however, more often called Trousseau's syndrome). Thrombophlebitis affects both superficial and deep veins, often changes location (thrombophlebitis migrans) and manifests itself as chains of painful nodules along the affected veins. Veins are affected haphazardly, simultaneously or sequentially. Trousseau syndrome develops due to changes in malignant neoplasm prothrombin level.

It is observed, as a rule, with adenocarcinomas of the pancreas or lung, as well as the stomach, breast or prostate gland. Trousseau described it in 1861, and in 1867 he discovered it as one of the manifestations of pancreatic cancer, which ultimately killed him.

Carpal spasm (hand spasm during tetany). It is often associated with foot flexor spasm (carpopedal spasm), extension posture, and opisthotonus.

During carpal spasm, the wrist flexors and finger extensors contract. Thumb turns out to be bent and brought to the palm, the rest are bent at the metacarpophalangeal joints, but straightened at the interphalangeal joints. The hand assumes a position similar to that given to it by the doctor performing a vaginal examination, which is why Trousseau called carpal spasm “the hand of the obstetrician” (in French, main d’accoucheur).

Under what conditions is the “obstetrician’s hand” symptom observed?

For any predisposing to tetany: alkalosis, hypocalcemia, hypomagnesemia, hypophosphatemia.

How to provoke carpal spasm to reveal hidden tetany?

Press the shoulder with the sphygmomanometer cuff until the pulse disappears in the radial artery for 5 minutes. For hypocalcemia, the sensitivity of this test is 66%, but in 4% of cases the result is false positive, so it does not replace the determination of serum calcium levels.

Instead of provoking carpal spasm, you can determine Chvostek's symptom, indicating increased excitability - twitching of the facial muscles when tapping on the temporal bone before auricle at the exit point of the facial (VII cranial) nerve.

The sensitivity of Chvostek's sign for latent tetany is low (27%), and the false-positive rate is very high (19-74% in children and 4-29% in adults).

Who is Trousseau?

Armand Trousseau () - one of the greatest figures in Parisian medicine of the 19th century. He was the first in France to perform tracheostomy, introduce thoracentesis, and coin the term “aphasia.” He was an excellent clinician and teacher, renowned as a lecturer who presented clinical observations with the grace of a novelist, and as an ardent advocate of bedside clinical teaching.

It was Trousseau who introduced into widespread use such eponyms as Addison's disease, Graves' disease and Hodgkin's disease. He was deeply respected and loved by students and colleagues. His students include Potin, Lasegue, Brown-Séquard and da Costa. In addition, Trousseau was involved in political activities. He was a participant in the revolution of 1848, one of the creators of its legislative body.

His advice to students remains relevant 150 years after his death: “Watch the practice of many doctors; Do not unconditionally assume that your teacher is always right, that he is the best. Don't be shy about admitting your own ignorance. In fact, recognition of it is on the tip of every doctor’s tongue. Do not exaggerate your medical merits by mastering scientific facts. They are only a condition for future professional achievements, allowing you to take the next step to the heights of mastery.”

Who is Khvostek?

Frantisek Chvostek () - an Austrian surgeon originally from the Czech Republic, in 1867 he described the symptom named after him. In addition to surgery, he studied and treated diseases of the nervous system, including experimental research in the field of electrotherapy.

Obstetrician syndrome

During spasm, the arm is in a state of extension, the forearm is bent in semiflexion, and the shoulder is in a state of adduction (Trousseau's symptom - the obstetrician's hand).

On the lower extremities there is increased extension of the thigh and lower leg with flexion of the foot and toes. In severe cases, cramps can involve all the muscles of the face, causing it to become distorted. The face takes on a characteristic expression, the forehead is wrinkled, the lips are contracted and protruded forward. The muscles of the eyes, tongue, larynx, and the diaphragm also take part in a spastic attack. With spasms of the muscles of the larynx, which is more often observed in children, laryngospasms occur, with suffocation, cyanosis; with prolonged spasm, severe asphyxia appears with loss of consciousness, which can be fatal. Often, patients with chronic hypoparathyroidism experience trophic disorders: dry skin, brittle bones, hair loss, cataracts, significant weight loss. Patients often experience tachycardia, arrhythmia, and compressive pain in the heart area. An electrocardiogram reveals an increase in the QT interval, which is caused by hypocalcemia.

A constant symptom of hypoparathyroidism is a violation of mineral metabolism - hypocalcemia up to 5-6 mg%, hyperphosphatemia up to 7-10 mg%, hypocalciuria and hypophosphaturia. Impaired function of the organ of vision is expressed in convergence disorders, eyelid spasms, diplopia, nystagmus and the development of cataracts. During an attack, you can observe a narrowing or dilatation of the pupils and a slow reaction. With spasm of the intercostal muscles, abdominal muscles and diaphragm, significant respiratory distress is observed.

The autonomic nervous system is in a state of increased excitability with a tendency to vasomotor phenomena.

Dysfunction of the gastrointestinal tract is expressed in increased peristalsis, constipation followed by diarrhea, and increased secretion of gastric juice. Gastric or duodenal ulcers may often develop.

According to the clinical course, acute, chronic and latent forms of parathyroid tetany are distinguished.

In the acute form of tetany, attacks are often repeated, last a long time, and can occur unexpectedly.

The development of tetany in acute form after any trauma and strumectomy indicates complete or almost complete shutdown of the function of the parathyroid glands. The acute form of tetany can end in recovery or become chronic, depending on the nature of the disease, treatment, etc. This form has a less severe course, attacks are rare. In its origin, provoking moments, overheating or hypothermia, physical activity, mental trauma, pregnancy, and acute infections are important.

Seasonal exacerbations and diseases occur in spring and autumn. Often, patients with chronic hypoparathyroidism exhibit trophic disorders: dry skin, brittle nails, hair loss and weight loss. Changes in the teeth are reduced to enamel defects; teeth break and crumble easily.

Recognition of idiopathic latent hypoparathyroidism presents certain difficulties. This form is characterized by the absence of spontaneously occurring attacks, which can occur under the influence of various provoking factors. Idiopathic tetany more often occurs at a young age, men are more often affected. The presence of changes in calcium and phosphorus metabolism typical of hypoparathyroidism gives grounds to classify idiopathic tetany as a parathyroid form associated with congenital inferiority of the parathyroid glands.

Complaints from patients with a latent form of tetany are usually associated with disturbances in cardiac activity: they complain of palpitations, chest pain, a feeling of tightness in the chest, headaches, fainting, and often complain of goosebumps crawling in their fingers. Physical and x-ray examinations of internal organs reveal no changes. The simplest way is to identify Chvostek's symptom, which is based on increased excitability of the facial nerve when it is mechanically irritated. In response to irritation, the upper lip twitches (Khvostek I), or the upper lip and nose (Khvostek II), or twitching of the corner of the mouth is added (Khvostek III).

Diagnosis and differential diagnosis. It is necessary to think about the possibility of hypoparathyroidism if patients, after partial removal of the thyroid gland, experience signs of topical seizures. When making a diagnosis, one should also differentiate tetany from hysteria and epilepsy. In patients with hysteria and epilepsy, calcium and phosphorus metabolism disorders are not found.

One should also keep in mind hypoglycemic convulsions, in which characteristic symptoms are observed: a feeling of hunger, weakness, and pale skin. The question is resolved by examining blood sugar and calcium levels.

Treatment of hypoparathyroidism. When treating an attack of tetany, it is necessary to administer 10 ml of 10% calcium chloride intravenously, 2-4 ml of parathyrsocrine intramuscularly.

Intravenous administration of a 10% solution of calcium chloride or a 10% solution of calcium gluconate usually quickly stops an attack of convulsions during tetany, which is very important for laryngospasm, when this is the main measure during first aid.

Depending on the duration and frequency of attacks, injections of calcium chloride and parathyroid hormone are recommended 2-3 times a day under the control of calcium levels in the blood.

In the inter-iristune period, calcium supplements are prescribed in the form of a 10% solution of calcium chloride, one tablespoon 3 times a day, or calcium gluconate in tablets, 3-4 tablets a day. At the same time, an alcohol solution of vitamin D2 in ME is prescribed orally 2 times a day.

The diet of patients should contain a large number of calcium, which is why dairy products are recommended.

DIC syndrome in obstetrics

Pregnant women are considered one of the most vulnerable categories of patients, who are susceptible not only to infectious and respiratory diseases, but also various violations in the functioning of internal organs. Pregnant women may experience complications from the nervous, vascular and digestive systems, and endocrine disorders, developing against the background of changes hormonal levels. Negative changes can also occur in the hematopoietic system, as well as hemostasis - a biological system that ensures the vital functions of the body, maintains the liquid state of the blood and promotes the rapid restoration of the skin and mucous membranes after damage.

DIC syndrome in obstetrics

A fairly common pathology of hemostasis during pregnancy is DIC syndrome. This is the process of active leaching of thromboplastin (an external stimulator of the coagulation process) from tissues and organs, which leads to impaired blood clotting. IN medical practice This condition is called “disseminated intravascular coagulation.” The syndrome is dangerous due to its asymptomatic course and the rapid development of systemic coagulopathy, therefore all pregnant women should be observed by a gynecologist or obstetrician-gynecologist at their place of residence throughout the entire pregnancy.

Why do hemostasis disorders occur during pregnancy?

Minor disorders of hemostasis, accompanying signs of disseminated intravascular coagulation, can be explained by physiological processes occurring in a woman’s body during pregnancy, but in the vast majority of cases (more than 94%), such symptoms are the result of certain pathologies.

Fetal death

One of the causes of acute DIC at any stage of gestation is intrauterine fetal death and pregnancy loss. This can happen for a number of reasons, but the most common ones are:

• maternal intake of toxic drugs and potent drugs;
• amniotic fluid embolism (amniotic fluid entering the pulmonary arteries and their branches);
• placenta previa or abruption;
• acute alcohol or drug intoxication of the fetus;
• tumors of the outer cellular layer of the placenta (trophoblast).

One of the causes of pathology is fetal death

Miscarriage of pregnancy can occur at any stage, but disseminated intravascular coagulation syndrome appears only 4-6 weeks after antenatal fetal death. The pathology becomes more complicated acute intoxication And high risk entry of toxic products into the systemic bloodstream, which can lead to the development of sepsis and inflammation of the bone marrow.

Determine frozen pregnancy early is possible only with the help ultrasound examination, as well as a blood test for the level of human chorionic gonadotropin, which will be significantly lower than the gestational norm. After weeks, fetal death can be suspected by the absence of movements and heartbeat.

Important! DIC syndrome of the 4th degree can lead to the death of a woman, therefore, if there are any signs indicating a possible termination of pregnancy, you must immediately contact the pregnancy pathology department at the regional maternity hospital.

Preeclampsia and initial signs of preeclampsia

Preeclampsia (“late toxicosis”) is the most common pathology of pregnant women, encountered by almost 60% of women. Preeclampsia has three main signs that allow diagnosing the pathology at an early stage:

• a stable increase in blood pressure with a weak response to drug correction;
• detection of protein or traces thereof in urine;
• swelling on the face and limbs, most often having a generalized form.

High blood pressure during pregnancy

Women diagnosed with gestosis should be under constant supervision of specialists, since progressive forms of pathology can cause the development of preeclampsia - a disorder cerebral circulation against the background of late toxicosis of the second half of pregnancy. Another danger of gestosis is damage to endothelial cells (single-layer flat cells covering the surface of the cardiac cavity, lymphatic and blood vessels). If the integrity of the endothelium is compromised, disseminated intravascular coagulation syndrome may develop, requiring close monitoring and timely emergency care.

Symptoms of gestosis during pregnancy

Other reasons

The causes of DIC syndrome may be of infectious origin. Infection of amniotic fluid, prolonged bacterial infections internal organs in the mother, increasing the risk of bacteria and their toxins entering the bloodstream - all this can cause coagulation disorders and systemic coagulopathy, so it is important to treat any diseases in a timely manner infectious nature and follow all doctor's orders. Some women refuse to take antibiotics, believing that they may harm the unborn child, but it has long been proven that the consequences of using antimicrobial drugs are much milder compared to possible complications if the infection reaches the fetus.

90% of children have no symptoms after birth due to intrauterine infection

Other causes of acute disseminated intravascular coagulation may include:

• surgical operations performed during pregnancy with blood or plasma transfusion (the risk increases if blood incompatible with the group or Rh factors was used for the transfusion);
• damage to red blood cells or platelets;
• long-term uterine bleeding leading to the development of hemorrhagic shock;
• uterine rupture;
• atony of the uterine muscles (decreased muscle tone);
• medical massage of the uterus.

Infectious diseases, burns, injuries skin, states of shock pathologies of the placenta of various origins can also cause coagulopathy, so it is important for a pregnant woman to undergo the examinations prescribed by the doctor on time and take the necessary tests.

Symptoms: when should you see a doctor?

The danger of DIC syndrome lies in its practically asymptomatic course. In most cases, pathology can be determined only after laboratory diagnostics, which can determine hematological disorders (changes in blood chemical parameters). With grade 3 and 4 disseminated intravascular coagulation syndrome, a woman may experience specific symptoms, the main of which is a hemorrhagic rash. It looks like a small pink or light red spot, is localized on the surface of the epidermis and appears as a result of rupture of small blood vessels and hemorrhage under the skin.

Coagulation of blood flowing from the uterine cavity

Other signs that may indicate the need to seek help medical care, relate:

• frequent nosebleeds in the absence of injuries or other damage;
• bleeding gums (provided that the woman does not suffer inflammatory diseases periodontal and periodontal disease, as well as gingivitis);
• bruises that form on various parts of the body without exposure to any damaging factors;
• uterine bleeding and spotting;
• poor wound healing;
• bleeding at injection sites.

Nosebleed

A woman can also feel constant weakness, her performance is impaired, and increased drowsiness appears. With frequent bleeding, constant headaches, dizziness, and a feeling of pressure in the temporal and occipital areas are noted. All these signs are a reason to carry out diagnostic measures, therefore, if they occur, you should immediately consult a doctor managing your pregnancy.

Target organs in DIC syndrome

Symptoms of pathology depending on the stage

In total, there are 4 stages of DIC syndrome, each of which has its own clinical features. For a more accurate diagnosis and determination of the pathogenesis of existing disorders, the doctor needs to collect a complete anamnesis and conduct laboratory diagnostics.

Table. Stages of disseminated intravascular coagulation syndrome and their symptoms.