Latest Treatment of Pregnancy Sickness
Hyperemesis gravidarum occurs in the extreme 0.5 to 1 of patients who have intractable vomiting. Patients with hyperemesis have abnormal electrolytes, dehydration with high urine-specific gravity, ketosis and acetonuria, and untreated have weight loss 5 of body weight. Intravenous hydration is the first line of therapy for patients with severe nausea and vomiting. Administration of vitamin B1 supplements may be necessary to prevent Wernicke's encephalopathy.
Patients should avoid odors or foods that seem to be aggravating the nausea. Useful dietary modifications include avoiding fatty or spicy foods, and stopping iron supplements. Frequent small meals also may improve symptoms. Recommendations include bland and dry foods, high-protein snacks, and crackers at the bedside to be taken first thing in the morning. B. Cholecystitis, peptic ulcer disease, or hepatitis can cause nausea and vomiting and should be excluded. Gastroenteritis, appendicitis, pyelonephritis, and pancreatitis also should be excluded. Obstetric explanations for nausea and vomiting may include multiple pregnancies or a hydatidiform mole. D. Vitamin therapy. Pyridoxine is effective as first-line therapy and is recommended up to 25 mg three times daily. Pyridoxine serum levels do not appear to correlate with the prevalence or degree of nausea and vomiting. Multivitamins also are effective for prevention of NVP. Premesis Rx is a prescription tablet with controlled-release...
(a) Hyperemesis gravidarum is common and around 5 of cases require hospital admission because of dehydration and ketosis. Thyroid function should be checked in these patients a correlation has been established between the severity of the hyperemesis and thyroid function with an elevated FT4 and FT3
First-trimester morning sickness may be relieved by eating frequent, small meals, getting out of bed slowly after eating a few crackers, and by avoiding spicy or greasy foods. Promethazine (Phenergan) 12.5-50 mg PO q4-6h prn or diphenhydramine (Benadryl) 25-50 mg tid-qid is useful.
Mallory-Weiss syndrome, first described in people with alcohol dependence, is now recognized across the life span but is most common in men over the age of 40. In women, hyperemesis gravidarum, which in the first trimester of pregnancy causes persistent nausea and vomiting. There are no known ethnic or racial considerations.
Transient gestational hyperthyroidism (associated with hyperemesis gravidarum) causes such as hyperemesis gravidarum, toxic multinodular goitre, toxic adenoma and subacute thyroiditis may occur. It should be noted that most women with nausea and vomiting in pregnancy do not have hyperthyroidism. Rarer causes include struma ovarii, hydatidiform mole and one reported case of a TSH receptor mutation activated only during pregnancy 27 (table 3). The clinical suspicion of hyperthyroidism may not be obvious as symptoms of tachycardia, sweating, dyspnoea and nervousness are seen in normal pregnancy as are cardiac systolic flow murmurs. The diagnosis should always be confirmed by estimation of circulating thyroid hormone concentrations. It should be noted that serum thyroxine (both total and free) varies during normal gestation. Recent national and internationally agreed guidelines suggest that laboratories should be encouraged to develop normal ranges for total but more particularly free T4...
Sherman and Flaxman (2001) stress that, even in those countries using spices heavily and regularly, pre-adolescent children and women in their first trimester typically avoid highly spiced foods. Morning sickness may reduce maternal intake of foods containing teratogens during the early embryogenesis, when delicate fetal tissues are most susceptible to chemical disruption. Women who experience morning sickness are less likely to miscarry than women who do not. A possible negative corollary to the Sherman and Flaxman hypothesis might tend to discourage the use of ginger to avoid hyperemesis gravidarum during the first trimester. See ginger for its role in avoiding morning sickness.
Signs of pregnancy amenorrhea, morning sickness, Ilegar's sign (softening and compressibility of die lower uterine segment), Chadwick's sign (dark discoloration of the vulva and vaginal walls), linea nigra, chloasma, auscultation of fetal heart tones, visibility of gestational, sac and or fetus on ultrasound, uterine contractions, weight gain, and palpation ballottemetiL of fetus. Normal pregnancy changes nausea and vomiting (morning sickness), amenorrhea, heavy (possibly even painful) feeling of the breasts, increased pigmentation of the nipples and areolae (and Montgomery tubercles), backache, linea nigra, chloasma, striae gravidarum, mild ankle edema, heartburn, and increased frequency of urination.
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