1
|
Admass BA, Tawye HY, Endalew NS, Mersha AT, Melesse DY, Workie MM, Gashaw M, Ferede YA. Assessment of post-operative nausea and vomiting prophylaxis usage for cesarean section, 2021: A cross sectional study. Ann Med Surg (Lond) 2022; 75:103399. [PMID: 35386765 PMCID: PMC8977925 DOI: 10.1016/j.amsu.2022.103399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/11/2022] [Accepted: 02/21/2022] [Indexed: 11/17/2022] Open
Abstract
Background Objective Methods Results Conclusions PONV is the most common morbidity after surgery and anesthesia. Untreated PONV is associated with complications. Appropriate anti emetic prophylactic agents can reduce PONV. Practice of PONV prophylactic usage is low.
Collapse
|
2
|
The incidence and factors associated with intraoperative nausea and vomiting during cesarean section under spinal anesthesia, July 2019. An institution based cross sectional study. INTERNATIONAL JOURNAL OF SURGERY OPEN 2020. [DOI: 10.1016/j.ijso.2020.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
3
|
Affiliation(s)
- Kerstin Austin
- Department of Gastroenterology and Hepatology; University of Wisconsin School of Medicine and Public Health; Madison Wisconsin USA
| | - Kelley Wilson
- Clinical Nutrition Services; University of Wisconsin Hospital and Clinics; Madison Wisconsin USA
| | - Sumona Saha
- Department of Gastroenterology and Hepatology; University of Wisconsin School of Medicine and Public Health; Madison Wisconsin USA
| |
Collapse
|
4
|
Chortatos A, Iversen PO, Haugen M, Eberhard-Gran M, Bjelland EK, Veierød MB. Nausea and vomiting in pregnancy - association with pelvic girdle pain during pregnancy and 4-6 months post-partum. BMC Pregnancy Childbirth 2018; 18:137. [PMID: 29739355 PMCID: PMC5941485 DOI: 10.1186/s12884-018-1764-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 04/23/2018] [Indexed: 11/10/2022] Open
Abstract
Background To better understand previous associations reported regarding nausea and vomiting in pregnancy (NVP) and pelvic girdle pain (PGP), an investigation into timing of symptom onset for NVP and PGP in pregnancy, as well as the association of NVP with PGP 4-6 months post-partum was performed. We hypothesised that women with NVP symptoms would be most susceptible to experiencing persistence of PGP post-partum. Methods Fifty two thousand six hundred seventy-eight pregnancies from the Norwegian Mother and Child Cohort Study were analysed regarding nausea, vomiting, pelvic girdle pain, and health outcome data collected from questionnaires answered between gestation weeks 15, 20, 30, and 6 months post-partum. Logistic regression was used. Results Women experiencing NVP and PGP together (6.9%) were heaviest in the sample, youngest at menarche and had highest proportion with education ≤12 years. The primiparous women in this group had the lowest timespan from menarche to pregnancy. Women with nausea alone (NP) and NVP had higher odds of PGP 4-6 months post-partum (adjusted odds ratio, aOR = 2.14, 95% CI 1.70–2.71, and aOR = 2.83, 95% CI 2.25–3.57, respectively), compared to symptom-free women. NP/NVP symptoms appeared early in the first trimester, while PGP symptoms appeared later in pregnancy. Women with longer durations of nausea and/or vomiting had a higher proportion of PGP compared to shorter duration women. Conclusions Women with NP and NVP had increased odds of PGP 4-6 months post-partum, and women with a long duration of nausea and/or vomiting had a higher proportion of PGP than women with shorter duration, both during pregnancy and 4-6 months post-partum. This finding suggests a synergistic relationship between NP/NVP and PGP. Electronic supplementary material The online version of this article (10.1186/s12884-018-1764-7) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Arthur Chortatos
- Oslo Centre for Biostatistics and Epidemiology, Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, PO Box 1122, Blindern, N-0317, Oslo, Norway. .,Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, PO Box 1046, Blindern, N-0317, Oslo, Norway.
| | - Per Ole Iversen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, PO Box 1046, Blindern, N-0317, Oslo, Norway.,Department of Hematology, Oslo University Hospital, PO Box 4950, Nydalen, N-0424, Oslo, Norway
| | - Margaretha Haugen
- Domain for Infection Control and Environmental Health, Norwegian Institute of Public Health, PO Box 4404, Nydalen, N-0403, Oslo, Norway
| | - Malin Eberhard-Gran
- Domain for Mental and Physical Health, Norwegian Institute of Public Health, PO Box 4404, Nydalen, N-0403, Oslo, Norway.,Health Services Research Unit, Akershus University Hospital, PO Box 1000, N-1478, Lørenskog, Norway.,Institute of Clinical Medicine, Campus Ahus, University of Oslo, Lørenskog, Norway
| | - Elisabeth Krefting Bjelland
- Domain for Mental and Physical Health, Norwegian Institute of Public Health, PO Box 4404, Nydalen, N-0403, Oslo, Norway.,Department of Obstetrics and Gynecology, Akershus University Hospital, PO Box 1000, N-1478, Lørenskog, Norway
| | - Marit B Veierød
- Oslo Centre for Biostatistics and Epidemiology, Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, PO Box 1122, Blindern, N-0317, Oslo, Norway.,Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, PO Box 1046, Blindern, N-0317, Oslo, Norway
| |
Collapse
|
5
|
Hu R, Chen Y, Zhang Y, Qian Z, Liu Y, Vaughn MG, Xu S, Zheng T, Liu M, Zhang B. Association between vomiting in the first trimester and preterm birth: a retrospective birth cohort study in Wuhan, China. BMJ Open 2017; 7:e017309. [PMID: 28963301 PMCID: PMC5623485 DOI: 10.1136/bmjopen-2017-017309] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE Although vomiting in the first trimester has been reported to be associated with preterm birth (PTB), findings supporting this association remain inconsistent. Our aim was to assess the association between vomiting and PTB, as well as evaluate if the association is modified by pre-pregnancy body mass index (BMI). DESIGN A retrospective cohort study. SETTING Wuhan, a central city of China. PARTICIPANTS A total of 317 463 pregnant women who had a live, singleton newborn from 1 January 2010 to 23 May 2016 were enrolled in our study. MAIN OUTCOME MEASURE PTB was defined as gestational age <37 gestational weeks. Gestational age was calculated using reports from mothers based on the first day of their last menstrual period. An ultrasound was routinely used to determine gestational age before 12 gestational weeks. RESULTS Of the 317 463 pregnant women, 29.88% (94 857) experienced vomiting in the first trimester and 5.00% (15 889) experienced a PTB. Vomiting in the first trimester increased the risk for PTB and the multivariable adjusted OR was 1.05 (95% CI 1.02 to 1.09). In the stratified analyses, the association of vomiting in the first trimester was significant among underweight women (adjusted OR=1.08, 95% CI 1.04 to 1.17) and normal pre-pregnancy BMI women (adjusted OR=1.06, 95% CI 1.02 to 1.11), but not in overweight women (adjusted OR=1.01, 95% CI 0.90 to 1.14) and obese women (adjusted OR=0.93, 95% CI 0.73 to 1.19). CONCLUSIONS Our study indicates that vomiting in the first trimester was associated with PTB. Additionally, women with underweight and normal pre-pregnancy BMI who experienced vomiting are more likely to have a PTB.
Collapse
Affiliation(s)
- Ronghua Hu
- Health Surveillance Department, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yawen Chen
- Health Surveillance Department, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yiming Zhang
- Health Surveillance Department, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhengmin Qian
- Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri, USA
| | - Yan Liu
- Health Surveillance Department, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Michael G Vaughn
- Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri, USA
| | - Shunqing Xu
- Key Laboratory of Environment and Health Department, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tongzhang Zheng
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Mingzhu Liu
- Health Surveillance Department, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bin Zhang
- Health Surveillance Department, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| |
Collapse
|
6
|
Jelting Y, Klein C, Harlander T, Eberhart L, Roewer N, Kranke P. Preventing nausea and vomiting in women undergoing regional anesthesia for cesarean section: challenges and solutions. Local Reg Anesth 2017; 10:83-90. [PMID: 28860857 PMCID: PMC5558589 DOI: 10.2147/lra.s111459] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Intraoperative nausea and vomiting (IONV) or postoperative nausea and vomiting (PONV) affecting women undergoing regional anesthesia for cesarean section is an important clinical problem since these techniques are used widely. There are burdens of literature about IONV/PONV and several in parturient and cesarean. However, it needs more attention. The underlying mechanisms of IONV and PONV in the obstetrical setting mainly include hypotension due to sympathicolysis during neuraxial anesthesia, bradycardia owing to an increased vagal tone, the visceral stimulation via the surgical procedure and intravenously administered opioids. METHODS Given the high and even increasing rate of cesarean sections and the sparse information on the etiology, incidence and severity of nausea and vomiting and the impact of prophylactic measures on the incidence of PONV/IONV, this article aims to review the available information and provide pragmatic suggestions on how to prevent nausea and vomiting in this patient cohort. Current literature and guidelines were identified by electronic database searching (MEDLINE via PubMed and Cochrane database of systematic reviews) up to present, searching through reference lists of included literature and personal contact with experts. DISCUSSION AND CONCLUSION Taking into account the current guidelines and literature as well as everyday clinical experience, the first step for decreasing the incidence of IONV and PONV is a comprehensive management of circulatory parameters. This management includes liberal perioperative fluid administration and the application of vasopressors as the circumstances require. By using low-dose local anesthetics, an additional application of intrathecal or spinal opioids or hyperbaric solutions for a sufficient controllability of neuraxial distribution, maternal hypotension might be reduced. Performing a combined spinal-epidural anesthesia or epidural anesthesia may be considered as an alternative to spinal anesthesia. Antiemetic drugs may be administered restrainedly due to off-label use in pregnant women for IONV or PONV prophylaxis and may be reserved for treatment.
Collapse
Affiliation(s)
- Yvonne Jelting
- Department of Anesthesia and Critical Care, University Hospitals of Wuerzburg, Wuerzburg
| | - Christian Klein
- Department of Anesthesia and Critical Care, University Hospitals of Wuerzburg, Wuerzburg
| | - Thomas Harlander
- Department of Anesthesia and Critical Care, University Hospitals of Wuerzburg, Wuerzburg
| | - Leopold Eberhart
- Department of Anesthesiology and Critical Care Medicine, Philipps-University Marburg, Marburg, Germany
| | - Norbert Roewer
- Department of Anesthesia and Critical Care, University Hospitals of Wuerzburg, Wuerzburg
| | - Peter Kranke
- Department of Anesthesia and Critical Care, University Hospitals of Wuerzburg, Wuerzburg
| |
Collapse
|
7
|
Koren G. Safety considerations surrounding use of treatment options for nausea and vomiting in pregnancy. Expert Opin Drug Saf 2017; 16:1227-1234. [DOI: 10.1080/14740338.2017.1361403] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Gideon Koren
- Western University Canada, Tel Aviv University Israel
| |
Collapse
|
8
|
Bustos M, Venkataramanan R, Caritis S. Nausea and vomiting of pregnancy - What's new? Auton Neurosci 2017; 202:62-72. [PMID: 27209471 PMCID: PMC5107351 DOI: 10.1016/j.autneu.2016.05.002] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 05/10/2016] [Accepted: 05/11/2016] [Indexed: 02/06/2023]
Abstract
Nausea and vomiting of pregnancy (NVP) is one of the most common disorders of pregnancy. The symptoms occur predominantly during the first trimester, although in a subgroup of patients they can continue throughout the entire pregnancy and can affect the woman's quality of life. A small percentage of women develop a severe form of NVP called hyperemesis gravidarum (HG) that if left untreated may lead to significant maternal morbidity and adverse birth outcomes. Overall, the morbidity in pregnant women with NVP is significant, although it tends to be underestimated. The pathogenesis of NVP remains unclear, but there is consensus that the disorder is multifactorial and that various genetic, endocrine and infectious factors may be involved. The treatment of NVP can be challenging as the optimal targets for therapy are not known. Currently, the therapy used depends on the severity of the disorder and it is focused on improving the symptoms while minimizing risks to mother and fetus. Therapies range from dietary changes, pharmacologic treatment or hospitalization with intravenous fluid replacement and nutrition therapy. The aims of this review are 1) to provide an overview of NVP, 2) to present possible links between the most important factors associated with the pathogenesis of NVP and 3) to discuss the effectiveness and safety of the pharmacologic and non-pharmacologic options available to treat this disorder.
Collapse
Affiliation(s)
- Martha Bustos
- School of Pharmacy, Department of Pharmaceutical Sciences, University of Pittsburgh, 716 Salk Hall, 3501 Terrace St, Pittsburgh, PA 15261, United States
| | - Raman Venkataramanan
- School of Pharmacy, Department of Pharmaceutical Sciences, University of Pittsburgh, 716 Salk Hall, 3501 Terrace St, Pittsburgh, PA 15261, United States; Department of Pathology, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15261, United States
| | - Steve Caritis
- Department of Obstetrics, Gynecology and Reproductive Sciences Magee Womens Hospital, 300 Halket St., Pittsburgh, PA 15213-3180, United States; School of Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, 300 Halket Street, Pittsburgh, PA 15213, United States.
| |
Collapse
|
9
|
Chortatos A, Haugen M, Iversen PO, Vikanes Å, Eberhard-Gran M, Bjelland EK, Magnus P, Veierød MB. Pregnancy complications and birth outcomes among women experiencing nausea only or nausea and vomiting during pregnancy in the Norwegian Mother and Child Cohort Study. BMC Pregnancy Childbirth 2015; 15:138. [PMID: 26100060 PMCID: PMC4477493 DOI: 10.1186/s12884-015-0580-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 06/17/2015] [Indexed: 12/27/2022] Open
Abstract
Background To compare pregnancy complications and birth outcomes for women experiencing nausea and vomiting in pregnancy, or nausea only, with symptom-free women. Methods Pregnancies from the Norwegian Mother and Child Cohort Study (n = 51 675), a population-based prospective cohort study, were examined. Data on nausea and/or vomiting during gestation and birth outcomes were collected from three questionnaires answered between gestation weeks 15 and 30, and linked with data from the Medical Birth Registry of Norway. Chi-squared tests, one way analysis of variance, multiple linear and logistic regression analyses were used. Results Women with nausea and vomiting (NVP) totalled 17 070 (33 %), while 20 371 (39 %) experienced nausea only (NP), and 14 234 (28 %) were symptom-free (SF). When compared to SF women, NVP and NP women had significantly increased odds for pelvic girdle pain (adjusted odds ratio, aOR, 2.26, 95 % confidence interval, 95 % CI, 2.09–2.43, and aOR 1.90, 95 % CI, 1.76–2.05, respectively) and proteinuria (aOR 1.50, 95 % CI 1.38–1.63, and 1.20, 95 % CI 1.10–1.31, respectively). Women with NVP also had significantly increased odds for high blood pressure (aOR 1.40, 95 % CI 1.17–1.67) and preeclampsia (aOR 1.13, 95 % CI 1.01–1.27). Conversely, the NVP and NP groups had significantly reduced odds for unfavourable birth outcomes such as low birth weight infants (aOR 0.72, 95 % CI 0.60–0.88, and aOR 0.73, 95 % CI 0.60–0.88, respectively) and small for gestational age infants (aOR 0.78, 95 % CI 0.73–0.84, and aOR 0.87, 95 % CI 0.81–0.93, respectively). Conclusions We found that women with NVP and NP are more likely to develop pregnancy complications, yet they display mostly favourable delivery and birth outcomes. Electronic supplementary material The online version of this article (doi:10.1186/s12884-015-0580-6) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Arthur Chortatos
- Oslo Centre for Biostatistics and Epidemiology, Institute of Basic Medical Sciences, University of Oslo, PO Box 1122, Blindern, N-0317, Oslo, Norway. .,Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, PO Box 1046, Blindern, N-0317, Oslo, Norway.
| | - Margaretha Haugen
- Division of Environmental Medicine, Norwegian Institute of Public Health, PO Box 4404, Nydalen, N-0403, Oslo, Norway.
| | - Per Ole Iversen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, PO Box 1046, Blindern, N-0317, Oslo, Norway. .,Department of Hematology, Oslo University Hospital, PO Box 4950, Nydalen, N-0424, Oslo, Norway.
| | - Åse Vikanes
- Division of Epidemiology, Norwegian Institute of Public Health, PO Box 4404, Nydalen, N-0403, Oslo, Norway.
| | - Malin Eberhard-Gran
- Department of Psychosomatics and Health Behaviour, Norwegian Institute of Public Health, PO Box 4404, Nydalen, N-0403, Oslo, Norway. .,Health Services Research Unit, Akershus University Hospital, PO Box 1000, N-1478, Lørenskog, Norway.
| | - Elisabeth Krefting Bjelland
- Department of Psychosomatics and Health Behaviour, Norwegian Institute of Public Health, PO Box 4404, Nydalen, N-0403, Oslo, Norway. .,Health Services Research Unit, Akershus University Hospital, PO Box 1000, N-1478, Lørenskog, Norway.
| | - Per Magnus
- Division of Epidemiology, Norwegian Institute of Public Health, PO Box 4404, Nydalen, N-0403, Oslo, Norway.
| | - Marit B Veierød
- Oslo Centre for Biostatistics and Epidemiology, Institute of Basic Medical Sciences, University of Oslo, PO Box 1122, Blindern, N-0317, Oslo, Norway. .,Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, PO Box 1046, Blindern, N-0317, Oslo, Norway.
| |
Collapse
|
10
|
Pregnancy sickness and parent-offspring conflict over thyroid function. J Theor Biol 2014; 355:61-7. [DOI: 10.1016/j.jtbi.2014.03.041] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 03/24/2014] [Accepted: 03/31/2014] [Indexed: 11/21/2022]
|
11
|
The delayed-release combination of doxylamine and pyridoxine (Diclegis®/Diclectin ®) for the treatment of nausea and vomiting of pregnancy. Paediatr Drugs 2014; 16:199-211. [PMID: 24574047 PMCID: PMC4030125 DOI: 10.1007/s40272-014-0065-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Nausea and vomiting of pregnancy (NVP) affects up to 85 % of all pregnancies. Effective treatment can greatly improve a woman's quality of life, reduce the risk for maternal and fetal complications, and reduce healthcare costs. Unfortunately, many women receive either no pharmacological treatment or are recommended therapies for which fetal safety and efficacy have not been established. First-line treatment of NVP, as recommended by several leading healthcare and professional organizations, is the combination of doxylamine and pyridoxine. This combination, formulated as a 10 mg/10 mg delayed-release tablet, was approved by the US Food and Drug Administration (FDA) for the treatment of NVP in April 2013 under the brand name Diclegis(®), and has been on the Canadian market since 1979, currently under the brand name Diclectin(®). The efficacy of Diclegis(®)/Diclectin(®) has been demonstrated in several clinical trials, and, more importantly, studies on more than 200,000 women exposed to doxylamine and pyridoxine in the first trimester of pregnancy have demonstrated no increased fetal risk for congenital malformations and other adverse pregnancy outcomes. The present review aims to present the scientific evidence on the effectiveness and fetal safety of Diclegis(®)/Diclectin(®) for the treatment of NVP to justify its use as first-line treatment for NVP.
Collapse
|
12
|
Voigt M, Fröhlich CW, Hüttel C, Kranke P, Mennen J, Boessneck O, Lenz C, Erbes T, Ernst J, Kerger H. Prophylaxis of intra- and postoperative nausea and vomiting in patients during cesarean section in spinal anesthesia. Med Sci Monit 2013; 19:993-1000. [PMID: 24226381 PMCID: PMC3852368 DOI: 10.12659/msm.889597] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background This paper describes a randomized prospective study conducted in 308 patients undergoing caesarean section in spinal anaesthesia at a single hospital between 2010 and 2012 to find a suitable anti-emetic strategy for these patients. Material/Methods Spinal anesthesia was performed in left prone position, at L3/L4 with hyperbaric 0.5% Bupivacaine according to a cc/cm body height ratio. There were no opioids given peri-operatively. The patients received either no prophylaxis (Group I) or tropisetron and metoclopramide (Group II) or dimenhydrinate and dexamethasone (Group III), or tropisetron as a single medication (Group IV). The primary outcome was nausea and/or vomiting (NV) in the intraoperative, early (0–2 h) or late (2–24 h) postoperative period. Multivariate statistical analysis was conducted with a regression analysis and a backward elimination of factors without significant correlation. Results All prophylactic agents significantly reduced NV incidence intraoperatively. Relative risk reduction for NV by prophylaxis was most effective (59.5%) in Group II (tropisetron and metoclopramide). In Group III (dimenhydrinate and dexamethasone), NV risk was reduced by 29.9% and by 28.7% in Group IV (tropisetron mono-therapy). The incidence of NV in the early (0–2 h) and the late (2–24 h) postoperative period was low all over (7.8%), but the relative risk reduction of NV in the early postoperative period was 54.1% (Group IV), 45.1% (Group III), and 34.8% (Group II), respectively. In the late postoperative period, there was no significant difference between the 4 groups. Conclusions We recommend a prophylactic medication with tropisetron 2 mg and metoclopramide 20 mg for patients during caesarean section. These agents are safe, reasonably priced, and highly efficient in preventing nausea and vomiting.
Collapse
|
13
|
Vt H, T M, T S, Nisha V A, A A. Dental considerations in pregnancy-a critical review on the oral care. J Clin Diagn Res 2013; 7:948-53. [PMID: 23814753 DOI: 10.7860/jcdr/2013/5405.2986] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Accepted: 03/03/2013] [Indexed: 11/24/2022]
Abstract
Pregnancy is a dynamic physiological state which is evidenced by several transient changes. These can develop as various physical signs and symptoms that can affect the patients health, perceptions and interactions with others in the environment. The patients may not always understand the relevance of the adaptations of their bodies to the health of their foetuses. A gestational woman requires various levels of support throughout this time, such as medical monitoring or intervention, preventive care and physical and emotional assistance. The dental management of pregnant patients requires special attention. Dentists, for example, may delay certain elective procedures so that they coincide with the periods of pregnancy which are devoted to maturation versus organogenesis. At other times, the dental care professionals need to alter their normal pharmacological armamentarium to address the patients' needs versus the foetal demands. Applying the basics of preventive dentistry at the primary level will broaden the scope of the prenatal care. Dentists should encourage all the patients of the childbearing ages to seek oral health counseling and examinations as soon as they learn that they are pregnant. This article has reviewed some of the physiologic changes and the oral pathologies which are associated with pregnancy, and how these alterations can affect the dental care of the patient.
Collapse
Affiliation(s)
- Hemalatha Vt
- Senior lecturer, Department of Oral Medicine & Radiology
| | | | | | | | | |
Collapse
|
14
|
Benson PW, Hooker JB, Koch KL, Weinberg RB. Bitter taster status predicts susceptibility to vection-induced motion sickness and nausea. Neurogastroenterol Motil 2012; 24:134-40, e86. [PMID: 22141371 DOI: 10.1111/j.1365-2982.2011.01842.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Sensitivity to bitter taste and susceptibility to nausea are both protective mechanisms that guard against toxin ingestion, and both these traits vary within and between populations. Thus, we postulated that they may have co-evolved, such that they are associated. METHODS Bitter taster status was determined in 40 subjects (13 men, 27 women) by measuring the differential perceived taste intensity between salt and n-propylthiouracil using a labeled magnitude scale; susceptibility to vection-induced motion sickness and nausea was assessed using an optokinetic drum, a validated multi-symptom scoring scale, and electrogastrography. KEY RESULTS Taster status distribution was 25% non-tasters (NT), 40% tasters (T), and 35% supertasters (ST). Gender had no impact on this distribution, but females had a higher mean maximum symptom score than males (12.4 ± 1.4 vs 7.3 ± 2.0). Non-tasters displayed a faster and larger increase in mean symptom scores, had a higher percentage of subjects with high maximum symptom scores, and had a higher mean maximum score than T or ST, (14.8 ± 2.6 vs 7.1 ± 1.8, vs 9.8 ± 2.0). Taster status did not affect the gastric myoelectric frequency response to vection. CONCLUSIONS & INFERENCES Non-tasters are more susceptible to vection-induced motion sickness and nausea than T or ST, suggesting these two traits may have co-evolved in a reciprocal manner: in environments where the NT trait conferred an evolutionary advantage by enabling intake of fruits and vegetables containing bitter, yet beneficial, phytonutrients, increased nausea susceptibility may have arisen to maintain protection against ingested toxins.
Collapse
Affiliation(s)
- P W Benson
- Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, NC 27157, USA
| | | | | | | |
Collapse
|
15
|
Abstract
Nausea and vomiting are common experiences in pregnancy, affecting 70% to 80% of all pregnant women. Various metabolic and neuromuscular factors have been implicated in the pathogenesis of nausea and vomiting of pregnancy (NVP) and hyperemesis gravidarum (HG), an entity distinct from NVP. However, their exact cause is unknown. Consequently, treatment of NVP and HG can be difficult, as neither the optimal targets for treatment nor the full effects of potential treatments on the developing fetus are known. This article reviews the epidemiology, pathology, diagnosis, outcomes, and treatment of NVP and HG.
Collapse
Affiliation(s)
- Noel M. Lee
- University of Wisconsin School of Medicine and Public Health, UW Medical Foundation Centennial Building, 1685 Highland Avenue, Madison, WI 53705, Phone: (608) 263-1995, Fax: (608) 265-5677
| | - Sumona Saha
- Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, UW Medical Foundation Centennial Building, 1685 Highland Avenue, Room 4224, Madison, WI 53705, Phone: (608) 263-1995, Fax: (608) 265-5677
| |
Collapse
|
16
|
Firoz T, Maltepe C, Einarson A. Nausea and vomiting in pregnancy is not always nausea and vomiting of pregnancy. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2011; 32:970-2. [PMID: 21176306 DOI: 10.1016/s1701-2163(16)34685-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The majority of pregnant women experience nausea and vomiting during pregnancy. However, nausea and vomiting in pregnancy is not always nausea and vomiting of pregnancy (NVP). The differential diagnosis of nausea and vomiting in pregnancy can be extensive and the underlying cause can sometimes be difficult to diagnose. However, the timing or onset of the symptoms is important in differentiating NVP from other causes. A thorough history and physical examination, with appropriate investigations, should be carried out in symptomatic women.
Collapse
Affiliation(s)
- Tabassum Firoz
- Department of Medicine, University of Toronto, Toronto ON
| | | | | |
Collapse
|
17
|
Baggley A, Navioz Y, Maltepe C, Koren G, Einarson A. Determinants of Women's Decision Making on Whether to Treat Nausea and Vomiting of Pregnancy Pharmacologically. J Midwifery Womens Health 2010; 49:350-4. [PMID: 15236716 DOI: 10.1016/j.jmwh.2004.03.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Nausea and vomiting of pregnancy (NVP) affects up to 80% of all women to some degree during their pregnancies. Diclectin (doxylamine and pyridoxine [vitamin B6]) has been on the Canadian market for many years and is indicated as the drug of choice for the treatment of NVP. However, some women choose not to treat NVP with pharmacologic measures, perhaps due to a persistent fear of teratogenic risk. The objective of this study was to determine the factors that influence a woman's decision not to treat NVP with pharmacologic measures. Fifty-nine women recruited from the Motherisk Nausea and Vomiting Helpline completed a questionnaire. All were informed that Diclectin was considered safe for use during pregnancy. At a follow-up telephone call, 34% were not using any pharmacologic treatment, and of those who were taking the drug, 26% were using less than the recommended dose. Reasons cited for not using the medication were insufficient safety data, preference for non-pharmacologic methods, and being made to feel uncomfortable by the physician. Of the women who did use Diclectin, the most convincing reassuring information that it was safe to use came from friends and family. Many other factors play a large role in a women's decision making.
Collapse
Affiliation(s)
- Anne Baggley
- The Motherisk Program, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | | | | |
Collapse
|
18
|
Abstract
Nausea and vomiting of pregnancy (NVP) is a common medical condition in pregnancy with significant physical and psychological morbidity. Up to 90% of women will suffer from NVP symptoms in the first trimester of pregnancy with up to 2% developing hyperemesis gravidarum which is NVP at its worst, leading to hospitalization and even death in extreme cases. Optimal management of NVP begins with nonpharmacological approaches, use of ginger, acupressure, vitamin B6, and dietary adjustments. The positive impact of these noninvasive, inexpensive and safe methods has been demonstrated. Pharmacological treatments are available with varying effectiveness; however, the only drug marketed specifically for the treatment of NVP in pregnancy is Diclectin® (vitamin B6 and doxylamine). In addition, the Motherisk algorithm provides a guideline for use of safe and effective drugs for the treatment of NVP. Optimal medical management of symptoms will ensure the mental and physical wellbeing of expecting mothers and their developing babies during this often stressful and difficult time period. Dismissing NVP as an inconsequential part of pregnancy can have serious ramifications for both mother and baby.
Collapse
Affiliation(s)
- Neda Ebrahimi
- Pharmaceutical Sciences, University of Toronto, Toronto, Ontario, Canada.
| | | | | |
Collapse
|
19
|
Jueckstock JK, Kaestner R, Mylonas I. Managing hyperemesis gravidarum: a multimodal challenge. BMC Med 2010; 8:46. [PMID: 20633258 PMCID: PMC2913953 DOI: 10.1186/1741-7015-8-46] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2010] [Accepted: 07/15/2010] [Indexed: 12/18/2022] Open
Abstract
Up to 90% of pregnant women experience nausea and vomiting. When prolonged or severe, this is known as hyperemesis gravidarum (HG), which can, in individual cases, be life threatening. In this article the aetiology, diagnosis and treatment strategies will be presented based on a selective literature review. Treatment strategies range from outpatient dietary advice and antiemetic drugs to hospitalization and intravenous (IV) fluid replacement in persistent or severe cases. Alternative methods, such as acupuncture, are not yet evidence based but sometimes have a therapeutic effect.In most cases, the condition is self limiting and subsides by around 20 weeks gestation. More severe forms require medical intervention once other organic causes of nausea and vomiting have been excluded. In addition, a psychosomatic approach is often helpful.In view of its potential complexity, general practitioners and obstetricians should be well informed about HG and therapy should be multimodal.
Collapse
Affiliation(s)
- J K Jueckstock
- First Department of Obstetrics and Gynaecology, Campus Innenstadt, Ludwig-Maximilians-University, Maistrasse 11, 80337 Munich, Germany
| | | | | |
Collapse
|
20
|
Khatun M, Clavarino AM, Callaway L, Alati R, Najman JM, Williams G, Al Mamun A. Common symptoms during pregnancy to predict depression and health status 14 years post partum. Int J Gynaecol Obstet 2008; 104:214-7. [PMID: 19036371 DOI: 10.1016/j.ijgo.2008.10.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2008] [Revised: 10/13/2008] [Accepted: 10/20/2008] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To examine the prospective association between symptoms commonly experienced during pregnancy and the mental and general health status of women 14 years post partum. METHODS Data used were from the Mater-University of Queensland Study of Pregnancy, a community-based prospective birth cohort study begun in Brisbane, Australia, in 1981. Logistic regression analyses were conducted. RESULTS Data were available for 5118 women. Women who experienced a higher burden of symptoms during pregnancy were at greater risk of becoming depressed and reporting poorer health status 14 years post partum. Women who experienced major problems during pregnancy were 4 times more likely to be depressed and nearly 8 times more likely to report poorer health status 14 years after the index pregnancy compared with women who experienced few problems. CONCLUSIONS Findings suggest that pregnant women who experience common symptoms during pregnancy are likely to experience poorer mental and self-reported general health 14 years after the pregnancy.
Collapse
|
21
|
Abstract
This article describes clinical approaches for the perioperative management of the pregnant oral and maxillofacial surgical patient. The following topics are discussed: ethical principles of treatment during pregnancy, physiologic changes and their treatment considerations, fetal and maternal risks of various medications, medical problems occurring during pregnancy, and common minimally invasive approaches that the surgeon can apply to minimize the risk to the mother and unborn child. The strategies discussed provide successful treatment outcomes during this important time in the female surgical patient's life.
Collapse
|
22
|
Gilinsky NH, Muthunayagam N. Gastrointestinal endoscopy in pregnant and lactating women: emerging standard of care to guide decision-making. Obstet Gynecol Surv 2007; 61:791-9. [PMID: 17107628 DOI: 10.1097/01.ogx.0000248745.10232.bb] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Endoscopic procedures generally are considered to be low-risk modalities, being performed on an on-demand basis in many ambulatory endoscopy centers and hospitals. However, the safety and efficacy of gastrointestinal endoscopy in pregnancy has not been well studied. In pregnancy, the risks to the fetus and mother are numerous and the magnitude of this risk will differ depending on trimester, the disease process being addressed, the underlying health and status of the maternofetal unit, and the nature of the endoscopic intervention being contemplated. Given the difficulties in performing prospective studies in the pregnant patient, these risks have not been well-quantified. Decision-making in practice is at times highly individualized. The obstetrician and endoscopist may therefore need to rely on prudent practice based on personal experience in conjunction with recognized underlying basic principles and consensus guidelines, rather than hard scientific data, to guide decision-making and advising patients. The purpose of this review is to make those caring for pregnant patients aware of the clinical considerations necessary to ensure a successful outcome and to provide guidance with respect to what is now considered to be the standard of care when managing pregnant and lactating patients in whom an endoscopic procedure is being contemplated.
Collapse
Affiliation(s)
- Norman H Gilinsky
- Department of Internal Medicine, Division of Digestive Diseases, University of Cincinnati College of Medicine, Cincinnati, Ohio 45267, USA.
| | | |
Collapse
|
23
|
Agren A, Berg M. Tactile massage and severe nausea and vomiting during pregnancy - women's experiences. Scand J Caring Sci 2006; 20:169-76. [PMID: 16756522 DOI: 10.1111/j.1471-6712.2006.00394.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Nausea and vomiting during pregnancy is a condition with an obscure aetiology. The treatment is symptomatic but there is a lack of alternative treatments. Tactile massage is known to give relaxation and increased well-being in connection with different illnesses, but has never been studied on women with severe nausea and vomiting during pregnancy (SNVP). The aim of this study was to describe hospitalized women's experiences of SNVP and of tactile massage. A phenomenological method was used. Ten hospitalized women with SNVP were included. Each woman was given tactile massage on three separate occasions. After the final massage an open interview was used covering both the experience of severe nausea and vomiting, and of tactile massage. The findings revealed an essential meaning summarizing the experience: to obtain a relieving moment of rest and access to the whole body when nausea rules life. When nausea is experienced as controlling a woman's life, tactile massage is experienced as promoting relaxation and gives her an opportunity to regain access to her body. The findings suggest that tactile massage is a good alternative and complement to traditional treatment of SNVP.
Collapse
Affiliation(s)
- Annelie Agren
- Department of Obstetrics and Gynaecology, Hospital of Skövde, Sweden.
| | | |
Collapse
|
24
|
Thukral C, Wolf JL. Therapy Insight: drugs for gastrointestinal disorders in pregnant women. ACTA ACUST UNITED AC 2006; 3:256-66. [PMID: 16673005 DOI: 10.1038/ncpgasthep0452] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2005] [Accepted: 02/01/2006] [Indexed: 12/20/2022]
Abstract
The management and treatment of gastrointestinal ailments in pregnant women requires special attention and expertise, since the safety of the mother, fetus and neonate remains the primary focus. Nausea and vomiting during pregnancy is common, as is symptomatic gastroesophageal reflux disease. Peptic ulcer disease occurs less frequently and with fewer complications. Gastroenterologists and obstetricians should be familiar with safe treatment options for these conditions, because they can profoundly impair the quality of life of pregnant women. During pregnancy, constipation can develop de novo, or chronic constipation can increase in severity. Given the array of therapies for constipation, physicians must apprise themselves of drugs that are safe for both mother and fetus. Management of acute, self-limited diarrhea should focus on supportive therapy, dietary changes and maintenance of hydration. Treatment of chronic diarrhea should be considered in the context of therapy for the underlying disorder. Inflammatory bowel disease and irritable bowel syndrome present a unique therapeutic challenge--to control the disease while minimizing toxicity to the fetus and mother. Initiation and alteration of medical therapy for gastrointestinal disorders during pregnancy must be undertaken after discussion with the patient's obstetrician.
Collapse
Affiliation(s)
- Chandrashekhar Thukral
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, MA 02215, USA
| | | |
Collapse
|
25
|
Levine ME. Sickness and satiety: physiological mechanisms underlying perceptions of nausea and stomach fullness. Curr Gastroenterol Rep 2005; 7:280-8. [PMID: 16042911 DOI: 10.1007/s11894-005-0020-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The pathophysiology of nausea and the physiological mechanisms underlying perceptions of stomach emptiness and fullness are not clearly understood, but several potentially important factors have been identified. Gastric dysrhythmias are believed to contribute to the subjective experience of nausea and may also be involved with perceptions of stomach emptiness, hunger, and even dyspepsia symptoms like bloating and early satiety. Normal gastric neuromuscular function is more evident in the absence of nausea and is also thought to be related to feelings of satiety or comfortable stomach fullness. Autonomic and endocrine influences may also play a critical role in the pathophysiology of nausea and abnormal perceptions of stomach emptiness or fullness. Achieving a better understanding of the gastric neuromuscular and neurohormonal influences on perceptions arising from the viscera may prove invaluable in the development of novel treatments for such conditions as unexplained nausea, functional dyspepsia, and obesity.
Collapse
Affiliation(s)
- Max E Levine
- Department of Internal Medicine, Section of Gastroenterology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
| |
Collapse
|
26
|
Balki M, Carvalho JCA. Intraoperative nausea and vomiting during cesarean section under regional anesthesia. Int J Obstet Anesth 2005; 14:230-41. [PMID: 15935649 DOI: 10.1016/j.ijoa.2004.12.004] [Citation(s) in RCA: 115] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2004] [Revised: 12/01/2004] [Accepted: 12/01/2004] [Indexed: 11/23/2022]
Abstract
Nausea and vomiting during regional anesthesia for cesarean section are very common and unpleasant events. They cause significant distress to the patient and also interfere with the surgical procedure. They have multiple etiologies, which include hypotension, vagal hyperactivity, visceral pain, i.v. opioid supplementation, uterotonic agents and motion. The obstetric anesthesia literature has addressed these causative factors for nausea and vomiting individually, making it difficult for the anesthesiologists to have a comprehensive understanding of these important complications. This review highlights the anesthetic and non-anesthetic causes of intraoperative nausea and vomiting during regional anesthesia for cesarean section and the appropriate prophylactic and therapeutic management. Intraoperative nausea and vomiting can be best prevented by controlling hypotension, optimizing the use of neuraxial and i.v. opioids, improving the quality of block, minimizing surgical stimuli and judicious administration of uterotonic agents. Although prophylactic antiemetics have been advocated during cesarean sections, strict adherence to these practices can effectively lower the incidence of intraoperative nausea and vomiting without the requirement of antiemetic agents. Antiemetics, therefore, should be reserved for the prevention of intraoperative nausea and vomiting in high-risk patients and for the treatment of nausea and vomiting not responding to routine measures.
Collapse
Affiliation(s)
- M Balki
- Department of Anesthesia, Mount Sinai Hospital, University of Toronto, Canada.
| | | |
Collapse
|
27
|
Glatter KA, Tuteja D, Chiamvimonvat N, Hamdan M, Park JK. Pregnancy in Postural Orthostatic Tachycardia Syndrome. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2005; 28:591-3. [PMID: 15955196 DOI: 10.1111/j.1540-8159.2005.50026.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Postural orthostatic tachycardia syndrome (POTS) is a rare disease characterized by syncope, sinus tachycardia, and orthostasis due to autonomic dysfunction. METHODS AND RESULTS Two women aged 26 and 24 years with severe POTS became pregnant. Both women experienced hyperemesis gravidarum with subsequent marked improvement in their POTS symptoms until 6 months gestation, when their syncope and sinus tachycardia caused clinical decompensation. Both patients delivered healthy babies at 37 weeks by elective cesarean section. CONCLUSION In long-term follow-up, both women reported improvement in their prepartum symptoms. We describe the first report, to our knowledge, of two successful pregnancy outcomes in severe POTS, including the first report of midodrine use in pregnant women.
Collapse
Affiliation(s)
- Kathryn A Glatter
- Department of Adult Cardiology, University of California-Davis, 4860 Y Street, Suite 2820, Sacramento, CA 95817, USA.
| | | | | | | | | |
Collapse
|
28
|
|
29
|
Trujillo K, Harvey-Banchik L. Hyperemesis gravidarum: feed the mother, feed the child. JPEN J Parenter Enteral Nutr 2005; 29:134-5. [PMID: 15772393 DOI: 10.1177/0148607105029002134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
30
|
Abstract
Pregnancy results in physiologic changes in almost all organ systems in the body mediated mainly by female sex hormones. Physiologic changes of pregnancy influence the dental management of women during pregnancy. Understanding these normal changes is essential for providing quality care for pregnant women. This review article briefly discusses the cardiovascular, respiratory, gastrointestinal, urogenital, endocrine, and oral physiologic changes that occur during normal gestation. A summary of current scientific knowledge of ionizing radiation is presented. Information about the compatibility, complications, and excretion of the common drugs during pregnancy is provided. Drugs and their usage during breast-feeding are also discussed. Guidelines for the management of a pregnant patient in the dental office are summarized.
Collapse
Affiliation(s)
- Lakshmanan Suresh
- Department of Oral Diagnostic Sciences, School of Dental Medicine, State University of New York at Buffalo, 14214, USA
| | | |
Collapse
|
31
|
Arsenault MY, Lane C. In Response. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2003. [DOI: 10.1016/s1701-2163(16)30104-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|