DOCSLIB.ORG

Nausea and Vomiting of Pregnancy JEFFREY D

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Nausea and Vomiting of Pregnancy JEFFREY D Nausea and Vomiting of Pregnancy JEFFREY D. QUINLAN, LCDR, MC, USN, Naval Hospital, Jacksonville, Florida D. ASHLEY HILL, M.D., Florida Hospital, Orlando, Florida Nausea and vomiting of pregnancy, commonly known as “morning sickness,” affects approximately 80 percent of pregnant women. Although several theories have been pro- posed, the exact cause remains unclear. Recent research has implicated Helicobacter pylori as one possible cause. Nausea and vomiting of pregnancy is generally a mild, self-limited condition that may be controlled with conservative measures. A small percentage of preg- nant women have a more profound course, with the most severe form being hyperemesis gravidarum. Unlike morning sickness, hyperemesis gravidarum may have negative impli- cations for maternal and fetal health. Physicians should carefully evaluate patients with nonresolving or worsening symptoms to rule out the most common pregnancy-related and nonpregnancy-related causes of severe vomiting. Once pathologic causes have been ruled out, treatment is individualized. Initial treatment should be conservative and should involve dietary changes, emotional support, and perhaps alternative therapy such as gin- ger or acupressure. Women with more complicated nausea and vomiting of pregnancy also may need pharmacologic therapy. Several medications, including pyridoxine and doxy- lamine, have been shown to be safe and effective treatments. Pregnant women who have severe vomiting may require hospitalization, orally or intravenously administered corti- costeroid therapy, and total parenteral nutrition. (Am Fam Physician 2003;68:121-8. Copy- right© 2003 American Academy of Family Physicians.) See page 18 for defi- ausea and vomiting of preg- and weight loss (more than 5 percent of body nitions of strength-of- nancy begins between the weight). Multiple gestation, gestational tropho- evidence levels. fourth and seventh week after blastic disease, triploidy, trisomy 21 syndrome the last menstrual period in (Down syndrome), and hydrops fetalis have 80 percent of pregnant women been associated with an increased incidence of Nand resolves by the 20th week of gestation in all hyperemesis gravidarum.5 but 10 percent of these women.1 The condition has been shown to be more common in urban Etiology and Pathophysiology women than in rural women.2 One study3 The etiology of nausea and vomiting of identified increased risk in housewives and pregnancy remains unknown, but a number decreased risk in “white collar” or professional of possible causes have been investigated. white women who consumed alcohol before Although many physicians were taught conception, and in women over 35 years of age that psychologic factors are responsible for with a history of infertility. nausea and vomiting of pregnancy and Hyperemesis gravidarum, a severe form of hyperemesis gravidarum, few data support nausea and vomiting, affects one in 200 preg- this theory. In one well-known study,4 the nant women.4 Although the definition of this Cornell Medical Index was administered condition has not been standardized, accepted to 44 pregnant women with hyperemesis and clinical features include persistent vomiting, 49 pregnant women without hyperemesis; the dehydration, ketosis, electrolyte disturbances, Minnesota Multiphasic Personality Inventory (MMPI) was administered only to the preg- nant women with hyperemesis. The MMPI Few data support the theory that psychologic factors are data suggested that women with hyperemesis have hysteria, excessive dependence on their responsible for nausea and vomiting of pregnancy. The roles of mothers, and infantile personalities. However, human chorionic gonadotropin and estrogen are controversial. the study findings were not conclusive because comparative testing was not performed. JULY 1, 2003 / VOLUME 68, NUMBER 1 www.aafp.org/afp AMERICAN FAMILY PHYSICIAN 121 Gastrointestinal tract dysfunction also has with hyperemesis have suppressed thyrotropin- been suggested as a cause of nausea and vom- stimulating hormone (TSH) levels. Work is iting of pregnancy. In one study6 in which ongoing to elucidate the interaction of hCG and progesterone was prescribed to nonpregnant TSH in pregnant women with hyperemesis.5 women, resultant nausea and vomiting sug- A recent study10 suggested that chronic gested that delayed gastric motility caused by infection with Helicobacter pylori may play a progesterone may be responsible for the condi- role in hyperemesis gravidarum. In this study, tion. Another study7 reviewed many potential 61.8 percent of pregnant women with hyper- gastrointestinal causes of nausea and vomiting emesis were found to be positive for the of pregnancy, including abnormalities of gas- H. pylori genome, compared with 27.6 percent tric electrical rhythm (gastric dysrhythmias). of pregnant women without hyperemesis. Many reports have suggested that hormones may cause nausea and vomiting of pregnancy Differential Diagnosis and Evaluation and hyperemesis gravidarum. In one compara- A thorough history and a complete physical tive study,8 women with nausea and vomiting of examination are important in the evaluation of pregnancy were found to have elevated levels of pregnant women who present with persistent human chorionic gonadotropin (hCG); how- vomiting. Nausea and vomiting in early preg- ever, another study9 did not support this find- nancy is usually a self-limited condition. When ing. Some studies have shown elevated estrogen the condition is more severe, potentially serious levels in women with this condition; others have causes need to be ruled out (Table 1).5 If nausea not.7 Hence, the roles of hCG and estrogen and vomiting begin after nine weeks of gesta- remain controversial. Many pregnant women tion, other causes should be investigated. If the findings of the history and physical examination suggest a specific cause, testing is TABLE 1 directed toward confirming that cause. For Differential Diagnosis of Persistent Vomiting in Pregnancy example, the findings may suggest pyelo- nephritis, a common condition in pregnancy. Gastrointestinal disorders Metabolic disorders Ultrasonography may be helpful in ruling out Gastroenteritis Diabetic ketoacidosis gallbladder, liver, and kidney disorders. In Biliary tract disease Porphyria addition to hyperemesis gravidarum, preg- Hepatitis Addison’s disease nancy-related causes of persistent vomiting Intestinal obstruction Hyperthyroidism include acute fatty liver and preeclampsia. Peptic ulcer disease Neurologic disorders Nonpregnancy-related causes include gas- Pancreatitis Pseudotumor cerebri trointestinal, genitourinary, metabolic, and Appendicitis Vestibular lesions neurologic disorders. Genitourinary tract disorders Migraine headaches Pyelonephritis Central nervous system tumors Maternal and Fetal Outcomes Uremia Pregnancy-related conditions Women with uncomplicated nausea and Degenerating uterine leiomyoma Nausea and vomiting of pregnancy* vomiting of pregnancy (“morning sickness”) Torsion Acute fatty liver of pregnancy have been noted to have improved pregnancy Kidney stones Preeclampsia outcomes, including fewer miscarriages, pre- Drug toxicity or intolerance term deliveries, and stillbirths, as well as fewer instances of fetal low birth weight, growth *—Including hyperemesis gravidarum. retardation, and mortality.11,12 In contrast, Adapted with permission from Goodwin TM. Hyperemesis gravidarum. Clin hyperemesis gravidarum has been associated Obstet Gynecol 1998;41:597-605. with increases in maternal adverse effects, including splenic avulsion, esophageal rup- 122 AMERICAN FAMILY PHYSICIAN www.aafp.org/afp VOLUME 68, NUMBER 1 / JULY 1, 2003 Nausea and Vomiting of Pregnancy ture, Mallory-Weiss tears, pneumothorax, peripheral neuropathy, and preeclampsia, as Nonpharmacologic measures for treating nausea and vomiting well as increases in fetal growth restriction and of pregnancy include dietary changes, emotional support, mortality.13-15 and acupressure. Treatment The management of nausea and vomiting of pregnancy depends on the severity of the domestic violence is suspected, or evidence of symptoms. Treatment measures range from substance abuse or psychiatric illness exists. dietary changes to more aggressive approaches Acupressure. Several studies17,18 have sug- involving antiemetic medications, hospitaliza- gested acupressure as a treatment for nausea. tion, or even total parenteral nutrition (TPN). The most common location for acupressure is We prefer to start with dietary changes and the pericardium 6 or Neiguan point, which then add medications as necessary. A Cochrane is located three fingerbreadths above the wrist review of various nonpharmacologic and phar- on the volar surface.Various commercial prod- macologic treatments for nausea and vomiting ucts for relieving motion sickness (e.g., Sea- of pregnancy and hyperemesis gravidarum was Band, ReliefBand) apply pressure to this area. recently published.16 [Evidence level B, system- One review19 of data from seven trials involv- atic review of variable-quality randomized ing Neiguan point acupressure indicated that controlled trials (RCTs)] these products are helpful for controlling morning sickness in early pregnancy; how- NONPHARMACOLOGIC THERAPY ever, a recent study20 demonstrated no benefit Dietary Measures. Initial treatment of for acupressure in pregnant women. women with mild nausea and vomiting of Further data are necessary to determine pregnancy (i.e., morning sickness) should whether acupressure is a viable treatment for include dietary changes.
Load more

Recommended publications
  • “Morning Sickness”
    “Morning sickness” “Morning sickness”, which often occurs throughout the day, is a condition characterized by nausea, indigestion, and periodic vomiting during the first trimester of pregnancy. The condition varies from mild stomach upset to severe vomiting requiring hospitalization. Despite many years of study, the cause of these symptoms is unknown. Many women worry that failure to eat a full array of foods will somehow harm the fetus, but there is no cause for concern. In the era when intravenous nourishment was impossible, women with severe vomiting were treated with fluids only. Their babies were healthy and of normal birth weight. “Morning sickness” typically passes as the first trimester ends. In the meantime, the following suggestions can help: Separate solid food from liquids. Do not drink and eat simultaneously. Eat small amounts of food throughout the day. Bland foods such as bread or crackers work well. Wear acupressure bands at the pericardium 6 position of each wrist. This site is located three fingerbreadths above the wrist. Get plenty of rest and avoid stress. Avoid spicy and fatty foods. Try small dose of vitamin B6 (10-50mg three times a day). Add half a Unisom Nighttime Sleep Reliever to the B6 to concoct Benedectin, one the safest drugs for morning sickness ever developed. While the actual drug is not available in the US, experts on medications in pregnancy condone its use. If prenatal vitamins make you sick, take folic acid only (in a dose of 800 ug/day) until you feel better. Try antacids such as TUMS EX (which also contains calcium).
    [Show full text]
  • PLANNED OUT-OF-HOSPITAL BIRTH Approved 11/12/15
    HEALTH EVIDENCE REVIEW COMMISSION (HERC) COVERAGE GUIDANCE: PLANNED OUT-OF-HOSPITAL BIRTH Approved 11/12/15 HERC COVERAGE GUIDANCE Planned out-of-hospital (OOH) birth is recommended for coverage for women who do not have high- risk coverage exclusion criteria as outlined below (weak recommendation). This coverage recommendation is based on the performance of appropriate risk assessments1 and the OOH birth attendant’s compliance with the consultation and transfer criteria as outlined below. Planned OOH birth is not recommended for coverage for women who have high risk coverage exclusion criteria as outlined below, or when appropriate risk assessments are not performed, or where the attendant does not comply with the consultation and transfer criteria as outlined below (strong recommendation). High-risk coverage exclusion criteria: Complications in a previous pregnancy: Maternal surgical history Cesarean section or other hysterotomy Uterine rupture Retained placenta requiring surgical removal Fourth-degree laceration without satisfactory functional recovery Maternal medical history Pre-eclampsia requiring preterm birth Eclampsia HELLP syndrome Fetal Unexplained stillbirth/neonatal death or previous death related to intrapartum difficulty Baby with neonatal encephalopathy Placental abruption with adverse outcome Complications of current pregnancy: Maternal Induction of labor Prelabor rupture of membranes > 24 hours 1 Pre-existing chronic hypertension; Pregnancy-induced hypertension with diastolic blood pressure greater than
    [Show full text]
  • Module 2: Hypertensive Disorders of Pregnancy and Gestational Diabetes FINAL Description Text
    Module 2: Hypertensive Disorders of Pregnancy and Gestational Diabetes FINAL Description Text Welcome to the module Hypertensive Disorders of Pregnancy and Gestational Diabetes. In this module, we will be discussing hypertensive Slide 1 disorders of pregnancy, including pregnancy induced hypertension and preeclampsia. We will also discuss Gestational Diabetes as well as nutrition solutions related to these issues Slide 2 We will begin by discussing hypertensive disorders in pregnancy. There are at least 5 distinct categories of hypertension and related disorders that occur during pregnancy. These categories are: preeclampsia/eclampsia, chronic hypertension, preeclampsia Slide 3 superimposed upon chronic hypertension, gestational hypertension and transient hypertension. Each of these will be discussed individually throughout the module, with recommendations based on best practices provided. Blood pressure is the force of blood on the walls of the arteries. Systolic blood pressure is measured when the ventricles are contracting while diastolic pressure is measured when the ventricles are relaxed. Normal Slide 4 blood pressure is typically 120/80 mm Hg.The general definition of high blood pressure in adults is a systolic BP > 140 mg HG or a diastolic blood pressure > 90 mm Hg. These criteria should be used for women throughout pregnancy. Chronic hypertension often exists prior to pregnancy and continues throughout pregnancy. It may not be noticed until the second trimester of pregnancy if prenatal care is delayed or if women have suffered from prolonged nausea and vomiting or morning sickness. If hypertension is Slide 5 diagnosed in early pregnancy and persists past 6 weeks postpartum, it would be considered to be a chronic health condition.
    [Show full text]
  • Pre-Pregnancy Risk Factors for Severe Hyperemesis Gravidarum: Korean Population Based Cohort Study
    life Article Pre-Pregnancy Risk Factors for Severe Hyperemesis Gravidarum: Korean Population Based Cohort Study Ho Yeon Kim 1, Geum Joon Cho 1,*, So Yeon Kim 1, Kyu-Min Lee 2, Ki Hoon Ahn 1 , Sung Won Han 2, Soon-Cheol Hong 1, Hyun Mee Ryu 3, Min-Jeong Oh 1, Hai-Joong Kim 1 and Seung Chul Kim 4,* 1 Department of Obstetrics and Gynecology, Korea University College of Medicine, 27 Inchonro, Seongbuk-gu, Seoul 02841, Korea; [email protected] (H.Y.K.); [email protected] (S.Y.K.); [email protected] (K.H.A.); [email protected] (S.-C.H.); [email protected] (M.-J.O.); [email protected] (H.-J.K.) 2 School of Industrial Management Engineering, Korea University, 145 Anam-ro, Anam-dong, Seongbuk-gu, Seoul 02841, Korea; [email protected] (K.-M.L.); [email protected] (S.W.H.) 3 Department of Obstetrics and Gynecology, CHA Bungdang Medical Center, CHA University School of Medicine, 59 Yatap-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 13496, Korea; [email protected] 4 Department of Obstetrics and Gynecology, Pusan National University School of Medicine, 2 Busandaehak-ro 63beon-gil, Jangjeon 2(i)-dong, Geumjeong-gu, Busan 46241, Korea * Correspondence: [email protected] (G.J.C.); [email protected] (S.C.K.) Abstract: Hyperemesis gravidarum is known to be associated with poor perinatal outcomes. This study aimed to identify pre-pregnancy risk factors for hospital admission in women with hyperemesis gravidarum. We enrolled women who had delivered between 1 January 2013 and 31 December 2015, and had undergone a national health screening examination through the National Health Insurance Corporation 1–2 years before their first delivery.
    [Show full text]
  • What You Need to Know About Morning Sickness What Is Morning Sickness? Morning Sickness Is Nausea And/Or Vomiting That Many Pregnant Women Experience
    What You Need to Know About Morning Sickness What is morning sickness? Morning sickness is nausea and/or vomiting that many pregnant women experience. The term “morning sickness” is common, but it’s not correct, because many women have nausea and vomiting all day. The most important thing to know about nausea you may experience during your pregnancy is it’s normal. According to the American Pregnancy Association, more than 50% of pregnant women have nausea and/or vomiting. Although it’s most common during the first trimester, it’s possible to feel sick throughout the entire nine months of your pregnancy. For some women, feeling nauseous and/or throwing up are among the first symptoms of pregnancy. Most women start having nausea and/or vomiting around the sixth week of their first trimester. And some women notice their symptoms disappear around the 12th week of pregnancy or their second trimester. In general, nausea when pregnant isn’t harmful to you or the baby. However, if you can’t keep water or food down for long periods, then it can be dangerous, and you should talk to your provider about it. Common symptoms • Nausea • Vomiting • Feeling sick • Not being able to handle specific odors or foods Extreme morning sickness: Hyperemesis gravidarum Estimates are that 3% of pregnant women have hyperemesis gravidarum. This extreme nausea, vomiting and weight loss during pregnancy can be harmful to you and the baby, so you should talk to your doctor right away. If you’re not able to keep food or water down, then you could become malnourished and dehydrated.
    [Show full text]
  • Guide to Learning in Maternal-Fetal Medicine
    GUIDE TO LEARNING IN MATERNAL-FETAL MEDICINE First in Women’s Health The Division of Maternal-Fetal Medicine of The American Board of Obstetrics and Gynecology, Inc. 2915 Vine Street Dallas, TX 75204 Direct questions to: ABOG Fellowship Department 214.871.1619 (Main Line) 214.721.7526 (Fellowship Line) 214.871.1943 (Fax) [email protected] www.abog.org Revised 4/2018 1 TABLE OF CONTENTS I. INTRODUCTION ........................................................................................................................ 3 II. DEFINITION OF A MATERNAL-FETAL MEDICINE SUBSPECIALIST .................................... 3 III. OBJECTIVES ............................................................................................................................ 3 IV. GENERAL CONSIDERATIONS ................................................................................................ 3 V. ENDOCRINOLOGY OF PREGNANCY ..................................................................................... 4 VI. PHYSIOLOGY ........................................................................................................................... 6 VII. BIOCHEMISTRY ........................................................................................................................ 9 VIII. PHARMACOLOGY .................................................................................................................... 9 IX. PATHOLOGY .........................................................................................................................
    [Show full text]
  • Correlation of Estradiol and Estriol Serum
    2019 Skin Diseases & Skin Care Extended Abstract Vol.4 No.3 Correlation of Estradiol and Estriol Serum Levels to Melasma Severity in Pregnant Women Aunur Rofiq* , SHW Tantari, A Widiatmoko and Dyah Ayu Savitri Dermatology and Venereology, Faculty of Medicine, Brawijaya University, RSUD Dr Saiful Anwar Malang, Indonesia Email: [email protected] ABSTRACT Melasma is also known as chloasma or mask of potency of estriol; therefore, estradiol is said to be pregnancy because it shows during pregnancy as a the main estrogen . A study by Gopichandani et al. symmetrical hyperpigmented lesion Melasma supported the hypothesis that the main patients in Indonesia was estimated to be 0.2–4% pathogenesis of melasma was estradiol. НLs was of all dermatology patients . In Saiful Anwar proven by the high estradiol level in pregnant General Hospital Malang, East Java, Indonesia, women with melasma compared to those without melasma was found in 338 of 9736 dermatology melasma. Нe other forms of estrogen such as patients per year (3.4%) in 2014, and is the seventh estriol and estrone also Defected the cytoplasm and most common diagnosis in dermatology clinic. In the main estrogen receptor known to be expressed 2015, melasma incidence was declined to 226 of in the melanocyte . Especially in the third 8310 patients per year and not included in the top trimester, the high level of estriol and estradiol was ten most common dermatology diagnoses. Нe related to the high level of MSH, which caused current data from Saiful Anwar General Hospital tyrosinase and dopachrome tautomerase dermatology clinic in 2016 stated that melasma production; this sequence led to melanogenesis and patient was 185 of 7945 patients per year (2.3%).
    [Show full text]
  • Pregnancy: Morning Sickness
    Managing Morning Sickness: After Your Visit Your Kaiser Permanente Care Instructions For many women, the toughest part of early pregnancy is morning sickness. Morning sickness can range from mild nausea to severe nausea with bouts of vomiting. Symptoms may be worse in the morning, although they can strike at any time of the day or night. If you have nausea, vomiting, or both, look for safe measures that can bring you relief. You can take simple steps at home to manage morning sickness. These steps include changing what and when you eat and avoiding certain foods and smells. Some women find that acupuncture and acupressure wristbands also help. Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take. How can you care for yourself at home? • Keep food in your stomach, but not too much at once. Your nausea may be worse if your stomach is empty. Eat five or six small meals a day instead of three large meals. • For morning nausea, eat a small snack, such as a couple of crackers or dry biscuits, before rising. Allow a few minutes for your stomach to settle before you get out of bed slowly. • Drink plenty of fluids, enough so that your urine is light yellow or clear like water. If you have kidney, heart, or liver disease and have to limit fluids, talk with your doctor before you increase the amount of fluids you drink.
    [Show full text]
  • Morning Sickness”
    WHAT TO DO ABOUT “MORNING SICKNESS” For many pregnant women, “morning sickness” doesn’t just happen in the morning but comes and goes all day long. For most women this passes after the first trimester, but for 10-20% of pregnant women this unpleasantness lasts the whole nine months. Nausea and some vomiting are normal and are the body’s reaction to the surge of hormones that go with a healthy pregnancy. Although you can feel terrible, these symptoms are associated with a positive pregnancy outcome. One study found that women who threw up during their pregnancy were less likely to suffer miscarriages or stillbirths than women who didn’t. How To Best Manage Nausea and Vomiting Get plenty of fresh air! One theory is that high hormonal levels enhance your sense of smell making background odors you hardly noticed before more potent, making you feel queasy. It is often certain smells (a co-worker’s perfume, stale coffee, the fast- food restaurant you drive by) more than foods you eat that turn your stomach. Pay attention to odors that set you off and avoid them. Keep windows open as much as possible in your house. Get plenty of rest! Drink fluids between meals. Take your prenatal vitamins. Many women don’t eat well balanced meals in their first trimester which makes the nutrition supplement very important at this time. Be sure to take your vitamins with some food - you’ll be able to tolerate them better - and vitamins need food to do their jobs. Eat what you want when you want it.
    [Show full text]
  • Managing Morning Sickness | Nutrition Education Materials Online (NEMO)
    My Nutrition Managing morning sickness About morning sickness • Nausea and vomiting is very common during pregnancy. For most people, it starts in the first 12 weeks of pregnancy and eases by 20 weeks. • Morning sickness may affect you at any time of the day, not only in the morning. This can make it hard to follow a balanced diet. • There are some medications that can help manage morning sickness and allow you to eat well. These include vitamin supplements (vitamin B6) and ginger tablets. It is important to discuss these with your doctor, especially if morning sickness is making it difficult to eat or drink. Tips to manage morning sickness • Eat small, frequent meals – skipping meals can make nausea worse. • It is important to stay hydrated by sippingMy fluids between meals. Drinking fluids with NutritionMy meals may fill you up and make it difficult to eat. Nutrition • Avoid drinks that are too cold. Caffeine-containing drinks like tea, coffee, softdrinks and energy drinks should also be avoided. • Choose a time when you feel well to eat. This may be 20 to 30 minutes after taking anti-nausea medication. • Choose room temperature or cold foods without strong smells. Remember to avoid foods that are high risk of Listeria in pregnancy. These include deli meats, smoked seafood, soft cheeses and leftovers that are cold or more than 24 hours old. • Iron supplements or iron in your pregnancy multivitamin may upset your stomach. Speak with your Doctor or Dietitian about this before changing your supplement. • Avoid smoking. This can make nausea worse and is harmful for you and your baby’s health.
    [Show full text]
  • Screening for Gestational Diabetes Mellitus: a Systematic Review to Update the 2014 U.S
    Evidence Synthesis Number 204 Screening for Gestational Diabetes Mellitus: A Systematic Review to Update the 2014 U.S. Preventive Services Task Force Recommendation Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services 5600 Fishers Lane Rockville, MD 20857 www.ahrq.gov Contract No. HHSA-290-2015-00009-I Prepared by: Pacific Northwest Evidence-Based Practice Center Oregon Health & Science University Mail Code: BICC 3181 SW Sam Jackson Park Road Portland, OR 97239 www.ohsu.edu/epc University of Alberta Evidence-Based Practice Center 4-474 Edmonton Clinic Health Academy 11405 – 87 Avenue Edmonton, Alberta, Canada T6G 1C9 Investigators: Jennifer Pillay, MSc Lois Donovan, MD Samantha Guitard, MSc Bernadette Zakher, MD Christina Korownyk, MD Michelle Gates, PhD Allison Gates, PhD Ben Vandermeer, MSc Christina Bougatsos, MPH Roger Chou, MD Lisa Hartling, PhD AHRQ Publication No. 21-05273-EF-1 February 2021 This report is based on research conducted by the Pacific Northwest Evidence-based Practice Center (EPC) and the University of Alberta EPC under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. HHSA-290-2015-00009-I). The findings and conclusions in this document are those of the authors, who are responsible for its contents, and do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services. The information in this report is intended to help health care decisionmakers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of health care services.
    [Show full text]
  • The Effect of Hyperemesis Gravidarum on Pregnancy Outcomes Hiperemezis Gravidarumun Gebelik Sonuçlarına Etkisi
    JOURNAL OF Journal of Contemporary CONTEMPORARY MEDICINE Medicine DOI: 10.16899/jcm.870631 J Contemp Med 2021;11(4):428-432 Orjinal Araştırma / Original Article The Effect of Hyperemesis Gravidarum on Pregnancy Outcomes Hiperemezis Gravidarumun Gebelik Sonuçlarına Etkisi Zekiye Soykan Sert1 1Department of Gynecology and Obstetrics, Aksaray University Education and Research Hospital, Aksaray, Turkey Abstract Öz Objective: We evaluated the clinical characteristics of the patients Amaç: Hiperemezis gravidarum (HG) tanısı ile takip edilen hastaların followed with the diagnosis of hyperemesis gravidarum (HG). We klinik özelliklerini değerlendirdik. Bu hastalarda HG'nin gebelik aimed to determine the effects of HG on pregnancy outcomes in sonuçları üzerindeki etkilerini belirlemeyi amaçladık. this study. Material and Method: This retrospective study was conducted in Gereç ve Yöntem: Bu retrospektif çalışma 2018-2020 yılları arasında the department of obstetrics and gynecology between January hastanemiz kadın hastalıkları bölümünde gerçekleştirildi. Çalışma 2018–2020. The study group consisted of pregnant women who grubu, 20. gebelik haftasından önce HG tanısı alan ve hastanemizde were diagnosed with HG before the 20th gestational week and tedavi edilerek doğum yapılan gebelerden oluşturuldu. Hastalar HG were treated and delivered at our hospital. The patients were varlığına göre iki gruba ayrıldı. Her iki grup plasental disfonksiyon divided into two groups based on the presence of HG. Both groups were compared in terms of placental dysfunction and ve yenidoğan sonuçları açısından karşılaştırıldı. HG'nin şiddeti newborn outcomes. The severity of the HG was assessed and değerlendirildi ve sınıflandırıldı. Hafif ve ağır vakaları karşılaştıran HG classified. A sub-analysis of the HG group comparing mild and grubunun bir alt analizi yapıldı.
    [Show full text]