DIAGNOSIS AND MANAGEMENT OF NAUSEA AND VOMITING IN PREGNANCY

2006 ◽  
Vol 17 (1) ◽  
pp. 45-67 ◽  
Author(s):  
LAURA MAGEE ◽  
ALON SHRIM ◽  
GIDEON KOREN
Keyword(s):  
Weight Loss ◽  
Hyperemesis Gravidarum ◽  
Wide Spectrum ◽  
First Trimester ◽  
The Other ◽  
Nausea And Vomiting ◽  
Electrolyte Imbalance ◽  
The Common ◽  
Moderate Nausea ◽  
In Pregnancy

Nausea and vomiting of pregnancy (NVP) is a term used to describe a wide spectrum of symptoms. At one end of the spectrum is the common, mild to moderate nausea and vomiting that is usually limited to the first trimester. At the other end of the spectrum are the intractable, severe symptoms of hyperemesis gravidarum (HG) that is associated with weight loss, dehydration, electrolyte imbalance and hospitalisation.

scholarly journals Gestational Thyrotoxicosis in a Patient With Hyperemesis Gravidarum

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A929-A929
Author(s):  
Hind Alameddine ◽  
Gurunanthan Palani ◽  
Kidmealem Zekarias
Keyword(s):  
Hyperemesis Gravidarum ◽  
Clinical Signs ◽  
Supportive Therapy ◽  
First Trimester ◽  
Nausea And Vomiting ◽  
Antithyroid Drugs ◽  
Significant Elevation ◽  
Free T4 ◽  
Overt Hyperthyroidism ◽  
In Pregnancy

Abstract Untreated or inadequately treated overt hyperthyroidism in pregnancy can have devastating consequences for both mother and fetus. At the same time antithyroid drugs (ATDs) are known for their teratogenic effect and should be avoid when possible; once the diagnosis of hyperthyroidism is made in a pregnant woman, attention should be focused on determining the etiology of the disorder and whether it warrants treatment. Here, we report a case of hyperemesis gravidarum patient presenting with significant elevation of thyroid hormones and a review on diagnosis and management of gestational transient thyrotoxicosis. A 33-year-old female, G4P3 at 8 weeks pregnant admitted for nausea and vomiting. Thyroid labs showed TSH < 0.01 (Reference: 0.4-4.0mU/L) and free T4 is 3.53 (Reference: 0.76-1.46ng/dl). Patient was discharged on antiemetics with a diagnosis of hyperemesis gravidarum. She was re-admitted at 9 weeks pregnant with ongoing nausea and vomiting. She had palpitations, fatigue and reported 15 pound weight loss in 2 weeks. Past medical history included thyroid hormone abnormality noted during pregnancies of 2011 and 2017. Physical exam was significant for tachycardia and diffusely enlarged thyroid gland. Repeat labs showed TSH <0.01, free T4 5.81, total T3 of 317 (Reference: 60-181ng/dl). Thyroid ultrasound showed multiple nodules. Considering significant elevation in free T4 and total T3; empiric therapy with propylthiouracil was recommended. Patient declined anti-thyroid therapy. TSI and TRH antibodies came back later as negative. Patient was treated with enteral feeding for hyperemesis gravidarum. Thyroid labs 3 weeks later improved; FT4 down to 1.63 and TT3 down to 250. Patient delivered healthy baby at 40 weeks of gestation. Although the differential diagnosis of thyrotoxicosis in pregnancy includes any cause that can be seen in a nonpregnant patient, the most likely causes for hyperthyroidism in pregnancy are gestational thyrotoxicosis (GTT) with or without hyperemesis gravidarum or Graves’ disease. GTT is described as an hCG-mediated hyperthyroidism that occurs in the first trimester of pregnancy; it is generally asymptomatic with mild biochemical hyperthyroidism. Distinguishing true overt hyperthyroidism from GTT in a setting of hyperemesis gravidarum is challenging. The absence of clinical signs of hyperthyroidism and negative thyroid antibodies supports the diagnosis of GTT. T3 tends to be disproportionately elevated more than T4 in patients with overt hyperthyroidism. HCG level has not been found to be useful in distinguishing between GTT and GD. Overt hyperthyroidism is treated using anti-thyroid drugs (ATD) whereas supportive therapy without ATD is the accepted standard of treatment of patients with hyperemesis gravidarum and GTT. More studies addressing the best management of these group of patients is needed.

scholarly journals EFEKTIVITAS PEMBERIAN PISANG AMBON DAN VITAMIN B UNTUK MENURUNKAN HIPEREMESIS GRAVIDARUM DI BPM ENDAH BEKTI

2018 ◽  
Vol 7 (1) ◽  
pp. 17-21
Author(s):  
Elvika Fit Ari Shanti ◽  
Liberty Barokah ◽  
Budi Rahayu
Keyword(s):  
Pregnant Women ◽  
Vitamin B6 ◽  
Hyperemesis Gravidarum ◽  
Post Partum ◽  
Endocrine System ◽  
First Trimester ◽  
The Other ◽  
Vitamin B ◽  
Difference Test ◽  
In Pregnancy

Background: Endocrine system changes during pregnancy are important to keep the pregnancy, fetal growth and post partum recovery. Around 50-90% of pregnant women experience vomit and nausea. To solve those problems, ‘pisang ambon’ (Musa paradisiacal) consumption is one of choices because of its flavonoid and vitamin B6 which can overcome vomit and nausea in pregnancy. Objective: The aim of this research was to identify the effectiveness between pisang ambon (Musa paradisiacal) consumption and vitamin B6 to reduce hyperemesis gravidarum in BPM Endah Bekti. Methods: A quasy experimental design with two-group posttest only was assigned to 20 pregnant women on their first trimester. First ten sample was given vitamin B6 and the other ten sample were given vitamin B6 plus pisang ambon. Data were then analyzed using two independent mean difference test. Results: The result shows that in vitamin B6 consumption for hyperemesis gravidarum in 10% pregnant women were in the effective category. While in the pisang ambon consumption shows 100% of pregnant women are in the effective category. Conclusion: There is difference in effectiveness between vitamin B6 and pisang ambon consumption to overcome hyperemesis gravidarum (p=0,003<α).   Keywords: Hiperemesis gravidarum, vitamin B6, Pisang ambon

scholarly journals Implementing standardised rhodes index to measure the efficacy of ginger extract (Zingiber officinale) in pregnancy induced nausea and vomiting

2017 ◽  
Vol 6 (8) ◽  
pp. 1932
Author(s):  
Asha P. Dass ◽  
Priyadarshini Deodurg ◽  
Sandhiya Rajappan
Keyword(s):  
Zingiber Officinale ◽  
First Trimester ◽  
Nausea And Vomiting ◽  
Ginger Extract ◽  
Natural Signs ◽  
End Of Treatment ◽  
First Trimester Of Pregnancy ◽  
Baseline Values ◽  
Moderate Nausea ◽  
In Pregnancy

Background: Although nausea and vomiting are natural signs of pregnancy affecting about half the pregnant women during their first trimester of pregnancy, it is unpleasant and difficult symptom to deal with. Considering the fact that medication during pregnancy is not advised, we decided to study the efficacy of a natural product to control nausea and vomiting during early pregnancy. Our study was directed to estimate the efficacy of ginger extract (Zingiber officinale) in pregnancy induced nausea and vomiting.Methods: A total of 30 women with pregnancy of 4-16 weeks, suffering from nausea and vomiting were included in this study (n=30). Subjects were given ginger extract 250mg, to be taken 3 times a day half an hour before food for 1 week. Severity of vomiting was assessed by Rhodes Index of Nausea and Vomiting by the patients. Baseline scores were compared with the score at the end of 7 day. The findings were analysed statistically.Results: Effect with the ginger extract in pregnancy induced nausea and vomiting was assessed at the end of treatment (day 7) and compared with the baseline values. Four patients reported symptoms of heartburn. Otherwise, there were no other reports of any adverse effects. The results showed significance (p <0.005).Conclusions: Ginger extract (Zingiber officinale) helps in reducing severity and frequency of pregnancy induced nausea and vomiting. Therefore, we conclude that ginger extract can be used for mild to moderate nausea and vomiting induced by pregnancy during first trimester.

scholarly journals Analysis of GDF15 and IGFBP7 in Hyperemesis Gravidarum Support Causality

2019 ◽  
Vol 79 (04) ◽  
pp. 382-388 ◽  
Author(s):  
Marlena Fejzo ◽  
Peter Fasching ◽  
Michael Schneider ◽  
Judith Schwitulla ◽  
Matthias Beckmann ◽  
...  
Keyword(s):  
Hyperemesis Gravidarum ◽  
Familial Aggregation ◽  
Twin Studies ◽  
Serum Levels ◽  
Nausea And Vomiting ◽  
Electrolyte Imbalance ◽  
Significant Weight Loss ◽  
Control Groups ◽  
Severe Nausea ◽  
In Pregnancy

Abstract Objective Hyperemesis gravidarum, severe nausea and vomiting in pregnancy, occurs in up to 2% of pregnancies and leads to significant weight loss, dehydration, electrolyte imbalance, and ketonuria. It is associated with both maternal and fetal morbidity. Familial aggregation studies and twin studies suggest a genetic component. In a recent GWAS, we showed that placentation, appetite, and cachexia genes GDF15 and IGFBP7 are linked to hyperemesis gravidarum (HG). The purpose of this study is to determine whether GDF15 and IGFBP7 are upregulated in HG patients. Methods We compared serum levels of GDF15 and IGFBP7 at 12 and 24 weeksʼ gestation in women hospitalized for HG, and two control groups, women with nausea and vomiting of pregnancy (NVP), and women with no NVP. Results We show GDF15 and IGFBP7 serum levels are significantly increased in women with HG at 12 weeksʼ gestation. Serum levels of hCG are not significantly different between cases and controls. At 24 weeks gestation, when symptoms have largely resolved, there is no difference in GDF15 and IGFBP7 serum levels between cases and controls. Conclusion This study supports GDF15 and IGFBP7 in the pathogenesis of HG and may be useful for prediction and diagnosis. The GDF15-GFRAL brainstem-activated pathway was recently identified and therapies to treat conditions of abnormal appetite are under intense investigation. Based on our findings, HG should be included.

scholarly journals EFEKTIVITAS PEMBERIAN PISANG AMBON DAN VITAMIN B UNTUK MENURUNKAN HIPEREMESIS GRAVIDARUM DI BPM ENDAH BEKTI

2019 ◽  
Vol 7 (1) ◽  
pp. 17-21
Author(s):  
Elvika Fit Ari Shanti ◽  
Liberty Barokah ◽  
Budi Rahayu
Keyword(s):  
Pregnant Women ◽  
Vitamin B6 ◽  
Hyperemesis Gravidarum ◽  
Post Partum ◽  
Endocrine System ◽  
First Trimester ◽  
The Other ◽  
Vitamin B ◽  
Difference Test ◽  
In Pregnancy

Background: Endocrine system changes during pregnancy are important to keep the pregnancy, fetal growth and post partum recovery. Around 50-90% of pregnant women experience vomit and nausea. To solve those problems, ‘pisang ambon’ (Musa paradisiacal) consumption is one of choices because of its flavonoid and vitamin B6 which can overcome vomit and nausea in pregnancy. Objective: The aim of this research was to identify the effectiveness between pisang ambon (Musa paradisiacal) consumption and vitamin B6 to reduce hyperemesis gravidarum in BPM Endah Bekti. Methods: A quasy experimental design with two-group posttest only was assigned to 20 pregnant women on their first trimester. First ten sample was given vitamin B6 and the other ten sample were given vitamin B6 plus pisang ambon. Data were then analyzed using two independent mean difference test. Results: The result shows that in vitamin B6 consumption for hyperemesis gravidarum in 10% pregnant women were in the effective category. While in the pisang ambon consumption shows 100% of pregnant women are in the effective category. Conclusion: There is difference in effectiveness between vitamin B6 and pisang ambon consumption to overcome hyperemesis gravidarum (p=0,003<α). Keywords: Hiperemesis gravidarum, vitamin B6, Pisang ambon

scholarly journals EFEKTIFITAS PEMBERIAN PERMEN JAHE TERHADAP MUAL MUNTAH PADA IBU HAMIL DI KLINIK KHAIRUNIDA SUNGGAL TAHUN 2018

2019 ◽  
Vol 1 (1) ◽  
pp. 36-44
Author(s):  
Ani Nurdiana ◽  
Betty Mangkuji ◽  
Rismahara Lubis
Keyword(s):  
Pregnant Women ◽  
Hyperemesis Gravidarum ◽  
Sampling Technique ◽  
First Trimester ◽  
Statistical Test ◽  
Nausea And Vomiting ◽  
P Value ◽  
Nutritional Disorder ◽  
Average Decrease ◽  
Pharmacy Department

Pregnancy causes a lot of change in the mother’s body, so there are various kinds of physiological discomfort in the mother such as nause and vomiting, usually mild and controlable. This condition sometimes stops in the first trimester, but its effect may lead to nutritional disorder, dehydration, weakness, weight loss, and electrolyte imbalances. If not treated, it will worsen into Hyperemesis Gravidarum This study aimed to determine the effectiveness og ginger candy in reducing the frecuency of nause and vomiting in first trimester pregnant women in the Khairunida clinik with experimental Quasy design and tested by One Group Pretest Postest. About 15 samples were obtained through purposive sampling technique and the data were taken using the T-dependent test. Through the study, it was found that the frequency of nausea and vomiting before being given intervation was 10,93 and after being given intervation was 3,33 with an average decrease by 7,60. Through the statistical test, it was obtained the p value <(0.05) so that this study concluded that administration of ginger candy was effective in reduring nausea and vomiting in first trimester pregnant women. Further researchers are expected toreduce the use of non-pharmacological drugs to overcome nausea and vomiting in first trimester pregnant women and collaborate with the pharmacy department to facilitate the process of making good qualityy ginger candy.

PSVI-7 Effect of substrates of agroindustrial wastes fermented with LAB and yeasts on productive, reproductive and health indicators in primiparous guinea pigs

2021 ◽  
Vol 99 (Supplement_3) ◽  
pp. 396-397
Author(s):  
Juan Taboada ◽  
Wilfido Briñez ◽  
José E Miranda ◽  
Alfredo Marin
Keyword(s):  
Weight Loss ◽  
Weight Gain ◽  
Beneficial Effect ◽  
Guinea Pigs ◽  
Health Indicators ◽  
Blood Parameters ◽  
The Other ◽  
Kluyveromyces Fragilis ◽  
Agroindustrial Wastes ◽  
In Pregnancy

Abstract El objetivo de este estudio fue evaluar el posible efecto probiótico del sustrato de residuos agroindustriales fermentado con BAL y levaduras sobre los indicadores productivos, reproductivos y de salud de cobayas primíparas y su descendencia. Se utilizaron 80 cuyes nulíparas distribuidas en 4 grupos de 20 hembras nulíparas cada uno, de 120 ± 5 días de edad, 1450 ± 25 g de peso vivo, todas sometidas al mismo sistema de manejo y alimentación actual de la granja. Se aplicaron con una dosis de 1 mL del bioaditivo / animal. Los tratamientos suministrados fueron las siguientes variantes: T1. control. T2, Sustrato (residuos agroindustriales) fermentado con L. acidophilus ATCC® 4356 ™. T3, sustrato más Kluyveromyces fragilis L4 (UCLV). T4, sustrato fermentado con microorganismos T2 y T3.En el experimento se utilizó un diseño completamente al azar, donde se evaluaron los indicadores reproductivos, productivos y de salud. Weight gain in pregnancy was greater (P &lt; 0.05) in T4 in this same group, weight loss was less (P &lt; 0.05) in lactation; the age at first conception and at delivery decreased (P &lt; 0.05) in T4; fertility, the number of live-born animals and the weight at birth and at weaning were higher (P &lt; 0.05) in T4 compared to the other groups; Likewise, blood parameters notably improved in the animals of treatment 4. The treaties with bioaditive were the ones whit the best behavior as reflected in table 1. In the experiment, the beneficial effect as a probiotic was confirmed by the treatments (T2, T3 and T4) of these with the best performance was T4. The inclusion of substrates fermented with LAB and yeasts significantly improves the productive, reproductive and health indicators of primiparous guinea pigs and their offspring.

The liver in pregnancy

2013 ◽  
pp. 309-318
Author(s):  
Daniel Marks ◽  
Marcus Harbord
Keyword(s):  
Liver Disease ◽  
Hyperemesis Gravidarum ◽  
Gallstone Disease ◽  
Liver Function Tests ◽  
The Other ◽  
Liver Disorders ◽  
Hepatic Rupture ◽  
Chiari Syndrome ◽  
Acute Fatty Liver ◽  
In Pregnancy

Liver disease in pregnancy Liver function tests in pregnancy Hyperemesis gravidarum Obstetric cholestasis Acute fatty liver of pregnancy Pre-eclampsia HELLP syndrome Spontaneous hepatic rupture Gallstone disease Pancreatitis Budd–Chiari syndrome Viral hepatitis Pre-existing cirrhotic liver disease A number of liver disorders are unique to, or more likely to occur in, pregnancy. These should be considered alongside the other causes of liver disease that occur in non-pregnant patients. Transient mild derangements of LFT are common and rarely require further assessment beyond repeat monitoring to ensure normalization. However, liver disorders in pregnancy often present non-specifically and, therefore. all patients merit formal clinical assessment....

scholarly journals Study of serum lipase level in pregnant woman presenting with nausea and vomiting

2019 ◽  
Vol 9 (1) ◽  
pp. 1480-1484
Author(s):  
Arun Dhungana ◽  
Pratigyan Gautam ◽  
Rosina Manandhar ◽  
Chanda Karki
Keyword(s):  
Serum Amylase ◽  
Hyperemesis Gravidarum ◽  
Serum Glucose ◽  
Nausea And Vomiting ◽  
Electrolyte Imbalance ◽  
Normal Range ◽  
Serum Lipase ◽  
Biochemical Basis ◽  
Glucose Levels ◽  
Serum Amylase Activity

Background: Hyperemesis gravidarum is a complex condition characterized by excessive nausea and vomiting during pregnancy. It presents with various symptoms which include disturbed nutrition, electrolyte imbalance, ketosis and extreme weight loss. The objective of this study is to compare serum lipase, amylase and glucose in Hyperemesis gravidarum with non-pregnant women. Materials and methods: A total of 100 subjects among which 50 were nonpregnant women as controls and 50 were women with hyperemesis gravidarum as cases were enrolled in the study. Serum lipase, amylase and glucose levels were estimated in all the subjects. Results: The levels of mean serum lipase were lesser in cases (23.55 ± 4.91U/L) compared to that in controls (25.45 ± 5.97U/L) with p=0.086. However, the levels of mean serum amylase were higher in cases (76.40 ± 33.86 U/L) compared to that in controls (69.66 ± 16.45U/L) with p= 0.210. Serum amylase activity was raised in 8% of the patients whereas the activity of pancreatic lipase was within normal range. Serum glucose levels were lower in cases (84.72 ± 11.28 mg/dl) than that in controls (87.04 ± 10.65 mg/dl) with p=0.293. Conclusions: From this study we conclude that lipase activity was statistically insignificant in hyperemesis gravidarum. Therefore, pancreatic activities were less affected by hyperemesis gravidarum. So, this condition needs further exploration regarding biochemical basis to minimize the risk associated with it. 

scholarly journals Effectiveness of Ginger in Treating Nausea and Vomiting of Pregnancy

2021 ◽  
Vol 3 (1) ◽  
pp. 120-124
Author(s):  
Ahmad Ramadhanu
Keyword(s):  
Lifestyle Modification ◽  
First Trimester ◽  
Nausea And Vomiting ◽  
Main Complaint ◽  
Significant Burden ◽  
First Trimester Of Pregnancy ◽  
Cns Side Effects ◽  
Possible Cause ◽  
In Pregnancy

Nausea and vomiting in pregnancy (NVP) is one of the common main complaint in pregnancy. NVP can be a significant burden to the patient, make a decrease in quality of life, pregnancy threatening or even worse can lead to nutritional loss and death. NVP diagnosed when in first trimester of pregnancy and the other possible cause of NVP is excluded. Management of NVP is included maintaining hydration, nutrition, and lifestyle modification. Also avoiding the smells, food, or activity that can cause nause are necessary. There are some methods to treat NVP including pharmalogical or non-pharmalogical. The non-pharmalogical approach is change nutritional habits, lifestyle and medications. Several pharmalogical agents that can be used to relief the symptoms of NVP are pyridoxine, anti- histamines, metoclopramide, pyridoxine/doxylamine, promethazine and metoclopramide. Some patients also want to try more “natural” medications for NVP like ginger. The pharmacological activity is thought to stand in the pungent principles (gingerols and shogaols) and volatile oils (sesquiterpenes and monoterpenes). The true mechanism of action of ginger is probable to be a gastric effect, to increase tone and peristaltic due to anticholinergic and antiserotonin act. Ginger acts straight to the digestive tract and avoids the CNS side effects common to centrally acting antiemetics. Ginger is available in capsule or syrup form or in candy, cookies, beer, tinctures, teas, sodas, and jam. Nowadays, true dosing is available only if one uses standardized extracts; however, women may choose to use another form of ginger.

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