NAUSEA AND VOMITING OF PREGNANCY
Section snippets
Epidemiology
NVP is more common in Westernized countries, in predominantly urban compared with rural populations, and is rare in African, Native American, Eskimo, and some Asian populations except for the industrialized Japanese.86 Hypothesized demographic factors contributing to NVP include ethnicity,103 occupational status,103 and maternal age.46, 103 Certain reproductive history characteristics may also be influential, including nausea and vomiting in a prior pregnancy,61, 103 parity,46, 78 history of
HYPEREMESIS GRAVIDARUM
Hyperemesis gravidarum is the most severe manifestation of the spectrum of NVP. Historically known as “pernicious vomiting of pregnancy,”26 it is characterized by intractable nausea and vomiting, so severe as to cause dehydration, electrolyte and metabolic disturbances, and nutritional deficiency necessitating hospitalization.1, 26, 39 Although it shares much of the epidemiology, pathogenesis, and clinical features of NVP, it has important unique features.
THERAPY FOR NAUSEA AND VOMITING OF PREGNANCY AND HYPEREMESIS GRAVIDARUM
The management of NVP, depending on severity, ranges from conservative dietary modifications in the mildly symptomatic woman, to drug therapy and total parenteral nutrition for those with severe intractable symptoms (Table 1). Termination of pregnancy because of hyperemesis gravidarum was first reported in 1813, although the indications and the need for therapeutic abortions were discussed openly first in 1852.31 The performance of therapeutic abortions for hyperemesis gravidarum has decreased
SUMMARY
NVP is a spectrum of disorders ranging from the physiologically typical mild to moderate nausea and vomiting that is usually self-limited, to the pathologic, intractable symptoms of hyperemesis gravidarum that are associated with metabolic and electrolyte disturbances and weight loss. Up to 90% of pregnant women experience NVP. The pathogenesis remains poorly understood with multifactorial theories proposed combining both biologic and psychological factors. Diagnosing this syndrome is
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Assessment of post-operative nausea and vomiting prophylaxis usage for cesarean section, 2021: A cross sectional study
2022, Annals of Medicine and SurgeryCitation Excerpt :The predominant risk factor for nausea and vomiting after spinal anesthesia in cesarean section is arterial hypotension due to the blockade of the sympathetic nerve system [12]. PONV could be affected by hormonal and physiological changes of pregnancy, which alter the gastro-esophageal sphincter tone and the activity of the small bowel and esophagus, uterotonic agents, intra-operative manipulation of the uterus, and psychological distress aggravated by insufficient anesthesia [13,14]. Critical anesthetic events such as airway obstruction, aspiration pneumonitis, esophageal rupture, electrolyte imbalance, and wound dehiscence are rare, but mainly related to post-operative nausea and vomiting in general surgical patients [15].
A risk score for postoperative nausea and/or vomiting in women undergoing cesarean delivery with intrathecal morphine
2020, International Journal of Obstetric AnesthesiaSoluble urokinase-type plasminogen activator receptor (suPAR) and interleukin-6 levels in hyperemesis gravidarum
2018, Journal of the Chinese Medical AssociationCitation Excerpt :Hormonal changes, carbohydrate metabolism disorders, gastroenterological dismotility, genetic susceptibility, as well as immunological and inflammatory causes, are thought to be effective on the pathogenesis of HG.3 Multiple gestations, trophoblastic diseases and some fetal anomalies may also be associated with HG.3–5 However, no exact relationship has been proved between HG and any other single factor up till now.
Embryo quality: the missing link between pregnancy sickness and pregnancy outcome
2017, Evolution and Human BehaviorCitation Excerpt :Here hormone levels are not subject to normal controls: a minimum level is set by continued performance of the primary function (e.g., corpus luteum rescue); the maximum level is set when external costs emerge. Assuming that pregnancy sickness imposes costs, which it obviously does in the extreme case of hyperemesis gravidarum — e.g., increased maternal and fetal morbidity, fetal growth restriction, maternal and fetal death (Bailit, 2005; Broussard & Richter, 1998; Goodwin, 2008; Veenendaal, van Abeelen, Painter, van der Post, & Roseboom, 2011), then it arises from an antagonistic pleiotropy. The costs associated with the gene or genes that induce the deleterious effect of pregnancy sickness are counterbalanced by benefits elsewhere.
Nausea and vomiting of pregnancy - What's new?
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Address reprint requests to Joel E. Richter, MD, Department of Gastroenterology S-40, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195
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From the Department of Gastroenterology, The Cleveland Clinic Foundation, Cleveland, Ohio