Vomissements incoercibles de la grossesse : mise au point

Spontaneous pneumomediastinum: an unusual complication of hyperemesis gravidarum

A 21-year-old first trimester primagravida woman with hyperemesis gravidarum was noted to have incidental subcutaneous emphysema during thyroid ultrasound. Follow-up radiograph demonstrated supraclavicular subcutaneous emphysema, left apical pneumothorax and pneumomediastinum. The patient was transferred to the intensive care unit and evaluated for esophageal rupture. Because no defects were seen on swallow studies/endoscopy and the patient was stable, she was treated conservatively with antibiotics and monitored. The patient's condition improved, and she was discharged on hospital day 6. Subcutaneous emphysema secondary to hyperemesis gravidarum is a rare but potentially life-threatening condition in which the source of the mediastinal leak needs to be immediately determined. After the more serious sources of mediastinal air have been excluded, conservative management is suitable.

French family physician experience concerning the outpatient care for women suffering from nausea and vomiting in pregnancy

OBJECTIVE

To explore thoughts and attitudes among French family physicians on the outpatient care for women suffering from nausea and vomiting in pregnancy (NVP).

DESIGN AND SETTING

A retrospective study was conducted among family physicians who had taken care of pregnant women who gave birth in our hospital in 1 year.

PATIENTS AND METHODS

Fifty-nine French family physicians responded to a questionnaire assessing their experience about outpatient care for women suffering from NVP. Analysis were done according to the physicians' age, as the annual demographics data analysis from the French Medical Council.

RESULTS

More than 89% of family physicians asked systematically the question concerning NVP (53/59), which were estimated as a frequent symptom (n=44, 74.6%). The intensity of NVP was assessed as mild in 28.8% (n=17), moderate in 62.7% (n=37), severe in 6.8% (n=4) and unbearable in 1.7% (n=1). Physicians younger than 40 years questionned less frequently about NVP compared to those older than 40 or older than 60 years (66.7% vs. 90.5% vs. 95.5%, respectively; P=0.04). Severe and unbearable NVP were significantly estimated more frequent among younger physicians (33.3% vs. 6.8%; P=0.03). Treatments (sick leave, diet, drugs, homeopathy, acupuncture or psychotherapy) did not differ between groups.

DISCUSSION AND CONCLUSION

Outpatient care for women suffering from NVP may vary according to the physician. French family physicians played a key role in NVP. Younger family physician considered NVP as a frequent symptom which needed active management in severe forms.