and weight loss (more than 5 percent of body weight).Multiple gestation,gestational tropho-blastic dia,triploidy,trisomy 21 syndrome (Down syndrome),and hydrops fetalis have been associated with an incread incidence of hyperemesis gravidarum.5
Etiology and Pathophysiology
The etiology of naua and vomiting of pregnancy remains unknown,but a number of possible caus have been investigated.Although many physicians were taught that psychologic factors are responsible for naua and vomiting of pregnancy and hyperemesis gravidarum,few data support this theory.In one well-known study,4the Cornell Medical Index was administered to 44 pregnant women with hyperemesis and 49 pregnant women without hyperemesis;the Minnesota Multiphasic Personality Inventory (MMPI) was administered only to the preg-nant women with hyperemesis.The MMPI data suggested that women with hyperemesis have hysteria,excessive dependence on their mothers,and infantile personalities.However,the study findings were not conclusive becau comparative testing was not performed.
N
aua and vomiting of preg-nancy begins between the fourth and venth week after the last menstrua
l period in 80 percent of pregnant women
and resolves by the 20th week of gestation in all but 10 percent of the women.1The condition has been shown to be more common in urban women than in rural women.2One study 3identified incread risk in houwives and decread risk in “white collar”or professional white women who consumed alcohol before conception,and in women over 35 years of age with a history of infertility.明朝建立时间
Hyperemesis gravidarum,a vere form of naua and vomiting,affects one in 200 preg-nant women.4Although the definition of this condition has not been standardized,accepted clinical features include persistent vomiting,dehydration,ketosis,electrolyte disturbances,
Naua and vomiting of pregnancy, commonly known as “morning sickness,” affects approximately 80 percent of pregnant women. Although veral theories have been pro-pod, the exact cau remains unclear. Recent rearch has implicated Helicobacter pylori as one possible cau. Naua and vomiting of pregnancy is generally a mild, lf-limited condition that may be controlled with conrvative measures. A small percentage of preg-nant women have a more profound cour, with the most vere form being hyperemesis gravidarum. Unlike morning sickness, hyperemesis gravidarum may have negative impli-cations for maternal and fetal health. Physicians should carefull中科协
y evaluate patients with nonresolving or worning symptoms to rule out the most common pregnancy-related and nonpregnancy-related caus of vere vomiting. Once pathologic caus have been ruled out, treatment is individualized. Initial treatment should be conrvative and should involve dietary changes, emotional support, and perhaps alternative therapy such as gin-ger or acupressure. Women with more complicated naua 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 vere 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.)
Few data support the theory that psychologic factors are
responsible for naua and vomiting of pregnancy . The roles of human chorionic gonadotropin and estrogen are controversial.
Naua and V omiting of Pregnancy
JEFFREY D.QUINLAN,LCDR,MC,USN,Naval Hospital,Jacksonville,Florida D.ASHLEY HILL,M.D.,Fl
orida Hospital,Orlando,Florida
See page 18 for defi-nitions of strength-of-evidence levels.励志名人
ture,Mallory-Weiss tears,pneumothorax, peripheral neuropathy,and preeclampsia,as well as increas in fetal growth restriction and mortality.13-15
Treatment
The management of naua and vomiting of
pregnancy depends on the verity of the symptoms.T reatment measures range from dietary changes to more aggressive approaches involving antiemetic medications,hospitaliza-tion,or even total parenteral nutrition (TPN). W e prefer to start with dietary changes and then add medications as necessary.A Cochrane review of various nonpharmacologic and phar-macologic treatments for naua and vomiting of pregnancy and hyperemesis gravidarum was recently published.16[Evidence level B,system-atic review of variable-quality randomized controlled trials (RCTs)] NONPHARMACOLOGIC THERAPY
Dietary Measures.Initial treatment of women with mild naua and vomiting of pregnancy (i.e.,morning sickness) should include dietary changes.Affected pregnant women should be instructed to eat frequent, small meals and to avoid smells and food tex-tures that cau naua.Solid foods should be bland tasting,high in carbohydrates,and low in fat.Salty foods (e.g.,salt
ed crackers,potato chips) usually can be tolerated early in the morning,and sour and tart liquids (e.g., lemonade) often are tolerated better than water.Family members should be informed that pregnant women with naua and vomit-ing of pregnancy may need to alter mealtimes and other home routines.
Emotional Support.Although naua and vomiting of pregnancy and hyperemesis gravidarum are not strongly associated with psychologic illness,some women may become depresd or exhibit other affective changes. It is important that the women receive appropriate support from family members and medical and nursing staff.Consultation is indicated if a pregnant woman is depresd,domestic violence is suspected,or evidence of
substance abu or psychiatric illness exists.
Acupressure.Several studies17,18have sug-
gested acupressure as a treatment for naua.
The most common location for acupressure is
the pericardium 6 or N eiguan point,which
is located three fingerbreadths above the wrist
on the volar surface.Various commercial prod-
ucts for relieving motion sickness (e.g.,Sea-住院医师职责
Band,ReliefBand) apply pressure to this area.
One review19of data from ven trials involv-
ing Neiguan point acupressure indicated that
the products are helpful for controlling
morning sickness in early pregnancy;how-
ever,a recent study20demonstrated no benefit
for acupressure in pregnant women.
Further data are necessary to determine
whether acupressure is a viable treatment for
naua and vomiting of pregnancy.However,
acupressure is a nonpharmacologic interven-
tion without known adver side effects.Some
physicians may wish to offer it to their patients.
Ginger.A popular alternative treatment for
morning sickness,ginger has been ud in
teas,prerves,ginger ale,and capsule form.
One European study21demonstrated that gin-
ger powder (1 g per day) was more effective
than placebo in reducing the symptoms of
hyperemesis gravidarum.
There have been no published reports of
fetal anomalies associated with the u of gin-
ger.However,one investigator22warned that
ginger root contains thromboxane syntheta
inhibitor,which may interfere with testos-
terone receptor binding in the fetus.Other
investigators23noted that although safety data
are lacking,people in many cultures u gin-
礼物作文300字ger as a spice;the amounts ud are similar to
tho commonly prescribed for the treatment
爱是什么of naua and vomiting of pregnancy.
Naua and Vomiting of Pregnancy
技术联盟Nonpharmacologic measures for treating naua and vomiting
of pregnancy include dietary changes, emotional support,佛珠手链
and acupressure.
Naua and Vomiting of Pregnancy
