1
|
Rath W, Maul H, Abele H, Pauluschke J. [Hyperemesis Gravidarum - an Interprofessional and Interdisciplinary Challenge - Evidence-Based Review]. Z Geburtshilfe Neonatol 2024; 228:218-231. [PMID: 38065551 DOI: 10.1055/a-2200-9686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
Hyperemesis gravidarum (HG) is a multifactorial disease characterized by severe and persisting nausea and vomiting, impairment of oral intake, weight loss of at least 5%, electrolyte abnormalities, and dehydration. The prevalence of HG ranges from 0.3 to 10% worldwide. The diagnosis is made by the patient's prehistory, clinical symptoms, physical examination, and the typical laboratory abnormalities. Therapeutic cornerstones are nutrition advice, consultation of life style, psychological/psychosocial support of the mother as well as the administration of antiemetics in a stepwise approach, depending on the severity of symptoms, and finally admission to hospital in severe cases. Treatment of patients requires close interprofessional and interdisciplinary cooperation.
Collapse
Affiliation(s)
- Werner Rath
- Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Holger Maul
- Geburtshilfe und Pränatalmedizin, Asklepios Kliniken Hamburg, Hamburg, Germany
| | - Harald Abele
- Frauenklinik, Universitätklinikum Tübingen, Tübingen, Germany
| | - Jan Pauluschke
- Frauenklinik, Universitätklinikum Tübingen, Tübingen, Germany
| |
Collapse
|
2
|
Fejzo MS. Hyperemesis gravidarum theories dispelled by recent research: a paradigm change for better care and outcomes. Trends Mol Med 2024; 30:530-540. [PMID: 38782680 DOI: 10.1016/j.molmed.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/27/2024] [Accepted: 04/10/2024] [Indexed: 05/25/2024]
Abstract
Nausea and vomiting (NVP) affect most pregnant women. At the severe end of the clinical spectrum, hyperemesis gravidarum (HG) can be life-threatening. The condition is fraught with misconceptions that have slowed progress and left women undertreated. Herein, recent scientific advances are presented that dispel common myths associated with HG related to maternal/offspring outcomes, etiology, and evolution. There is now strong evidence that (i) HG is associated with poor outcomes, (ii) a common cause of NVP and HG has been identified, and (iii) NVP is likely a protective evolutionary mechanism that occurs throughout the animal kingdom but is no longer necessary for human survival. Therefore, it is encouraging that we are finally on the cusp of testing treatments that may put an end to unnecessary suffering.
Collapse
Affiliation(s)
- Marlena Schoenberg Fejzo
- Center for Genetic Epidemiology, Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, CA 90033, USA.
| |
Collapse
|
3
|
Joshi A, Chadha G, Narayanan P. From Discomfort to Distress: A Critical Analysis of Hyperemesis Gravidarum in the Emergency Room. Cureus 2023; 15:e44004. [PMID: 37746494 PMCID: PMC10516742 DOI: 10.7759/cureus.44004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2023] [Indexed: 09/26/2023] Open
Abstract
Hyperemesis gravidarum (HG) is a severe and debilitating condition characterized by persistent and excessive nausea and vomiting during pregnancy (NVP), often leading to significant maternal and fetal morbidity. This literature review aims to provide a scientifically comprehensive overview of HG within the context of the emergency room (ER) setting. This review aims to enhance understanding and improve the management of HG cases presented to the ER by synthesizing current knowledge and evidence-based practices. This literature review encompasses a systematic analysis of relevant scientific literature, encompassing original research studies, review articles, and clinical guidelines. An extensive search of electronic databases was conducted, covering the period from January 2003 to January 2023. Keywords related to HG, pregnancy-related complications, emergency medicine, and ER management were employed to identify pertinent publications. Through the literature review, we found the incidence of HG-related ER admission to be 0.8%. Although the etiology of HG remains to be unknown, a strong association was found between developing HG in pregnant females and a history of gastrointestinal (GI) disorders, use of cannabis, and pregnancies conceived through artificial reproductive technology (ART). Furthermore, overweight females were more likely to develop HG. Maternal smoking was found to be protective against HG. The symptoms of HG mainly include intractable nausea and vomiting occurring usually between four and nine weeks of gestational age with a significant aversion to food and loss of weight. Diagnosis is done through a strong clinical suspicion, a history of HG in previous pregnancies, and a basic metabolic panel. Treatment includes intravenous (IV) fluids, antiemetic therapy, corticoids, thiamine supplements, and laxatives. In our review, we highlight a few complications that can be seen in HG through a synopsis of unique case reports found during our literature search. In conclusion, through this review, we wish to highlight HG as an obstetrical emergency. We aim to improve understanding, enhance early recognition, and promote evidence-based management strategies for HG in the emergency room. We hope that the findings presented herein will serve as a valuable resource for healthcare professionals, researchers, and policymakers involved in the care of pregnant females experiencing HG in the ER.
Collapse
Affiliation(s)
- Arushi Joshi
- Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - Garima Chadha
- Emergency Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - Palaniappan Narayanan
- Obstetrics and Gynecology, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| |
Collapse
|
4
|
Wu XK, Gao JS, Ma HL, Wang Y, Zhang B, Liu ZL, Li J, Cong J, Qin HC, Yang XM, Wu Q, Chen XY, Lu ZL, Feng YH, Qi X, Wang YX, Yu L, Cui YM, An CM, Zhou LL, Hu YH, Li L, Cao YJ, Yan Y, Liu L, Liu YX, Liu ZS, Painter RC, Ng EHY, Liu JP, Mol BWJ, Wang CC. Acupuncture and Doxylamine-Pyridoxine for Nausea and Vomiting in Pregnancy : A Randomized, Controlled, 2 × 2 Factorial Trial. Ann Intern Med 2023; 176:922-933. [PMID: 37335994 DOI: 10.7326/m22-2974] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND An effective and safe treatment for nausea and vomiting of pregnancy (NVP) is lacking. OBJECTIVE To assess the efficacy and safety of acupuncture, doxylamine-pyridoxine, and a combination of both in women with moderate to severe NVP. DESIGN Multicenter, randomized, double-blind, placebo-controlled, 2 × 2 factorial trial. (ClinicalTrials.gov: NCT04401384). SETTING 13 tertiary hospitals in mainland China from 21 June 2020 to 2 February 2022. PARTICIPANTS 352 women in early pregnancy with moderate to severe NVP. INTERVENTION Participants received daily active or sham acupuncture for 30 minutes and doxylamine-pyridoxine or placebo for 14 days. MEASUREMENTS The primary outcome was the reduction in Pregnancy-Unique Quantification of Emesis (PUQE) score at the end of the intervention at day 15 relative to baseline. Secondary outcomes included quality of life, adverse events, and maternal and perinatal complications. RESULTS No significant interaction was detected between the interventions (P = 0.69). Participants receiving acupuncture (mean difference [MD], -0.7 [95% CI, -1.3 to -0.1]), doxylamine-pyridoxine (MD, -1.0 [CI, -1.6 to -0.4]), and the combination of both (MD, -1.6 [CI, -2.2 to -0.9]) had a larger reduction in PUQE score over the treatment course than their respective control groups (sham acupuncture, placebo, and sham acupuncture plus placebo). Compared with placebo, a higher risk for births with children who were small for gestational age was observed with doxylamine-pyridoxine (odds ratio, 3.8 [CI, 1.0 to 14.1]). LIMITATION The placebo effects of the interventions and natural regression of the disease were not evaluated. CONCLUSION Both acupuncture and doxylamine-pyridoxine alone are efficacious for moderate and severe NVP. However, the clinical importance of this effect is uncertain because of its modest magnitude. The combination of acupuncture and doxylamine-pyridoxine may yield a potentially larger benefit than each treatment alone. PRIMARY FUNDING SOURCE The National Key R&D Program of China and the Project of Heilongjiang Province "TouYan" Innovation Team.
Collapse
Affiliation(s)
- Xiao-Ke Wu
- First Affiliated Hospital, Heilongjiang University of Chinese Medicine, and Heilongjiang Provincial Hospital, Harbin, China (X.-K.W.)
| | - Jing-Shu Gao
- First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, China, and College of Pharmacy, The Department of Medicine, Hangzhou Normal University, Hangzhou, China (J.-S.G.)
| | - Hong-Li Ma
- First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, China (H.-L.M., Y.W., J.C., X.-M.Y., L. Liu)
| | - Yu Wang
- First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, China (H.-L.M., Y.W., J.C., X.-M.Y., L. Liu)
| | - Bei Zhang
- Department of Obstetrics and Gynecology, Xuzhou Central Hospital, Xuzhou, China (B.Z.)
| | - Zhao-Lan Liu
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China (Z.-L. Liu)
| | - Jian Li
- Department of Obstetrics & Gynaecology, Affiliated Hospital, Guizhou Medical University, Guiyang, China; First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, China; and Department of Obstetrics & Gynecology, The Chinese University of Hong Kong, Hong Kong, China (J.L.)
| | - Jing Cong
- First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, China (H.-L.M., Y.W., J.C., X.-M.Y., L. Liu)
| | - Hui-Chao Qin
- Heilongjiang Provincial Hospital, Harbin Institute of Technology, Harbin, China (H.-C.Q., L.-L.Z.)
| | - Xin-Ming Yang
- First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, China (H.-L.M., Y.W., J.C., X.-M.Y., L. Liu)
| | - Qi Wu
- Heilongjiang Province "TouYan" Innovation Team, Heilongjiang University of Chinese Medicine, Harbin, China, and Department of Obstetrics & Gynaecology, The Chinese University of Hong Kong, Hong Kong, China (Q.W.)
| | - Xiao-Yong Chen
- Jiangxi Maternal and Child Health Hospital, Nanchang, China (X.-Y.C.)
| | - Zong-Lin Lu
- Luoyang Hospital of Chinese Medicine, Luoyang, China (Z.-L. Lu)
| | - Ya-Hong Feng
- Ningxia Hui Autonomous Region Hospital of Chinese Medicine, Yinchuan, China (Y.-H.F.)
| | - Xue Qi
- Jixi Maternal and Child Health Hospital, Jixi, China (X.Q.)
| | - Yan-Xiang Wang
- Jiamusi Maternal and Child Health Hospital, Jiamusi, China (Y.-X.W.)
| | - Lan Yu
- Hegang Maternal and Child Health Hospital, Hegang, China (L.Y.)
| | - Ying-Mei Cui
- Mudanjiang Maternal and Child Health Hospital, Mudanjiang, China (Y.-M.C.)
| | - Chun-Mei An
- Shuangyashan Maternal and Child Health Hospital, Shuangyashan, China (C.-M.A.)
| | - Li-Li Zhou
- Heilongjiang Provincial Hospital, Harbin Institute of Technology, Harbin, China (H.-C.Q., L.-L.Z.)
| | - Yu-Hong Hu
- First Affiliated Hospital of Jiamusi University, Jiamusi, China (Y.-H.H.)
| | - Lu Li
- Pharmaceutical Informatics Institute, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China, and Department of Obstetrics & Gynaecology, The Chinese University of Hong Kong, Hong Kong, China (L. Li)
| | - Yi-Juan Cao
- Centre of Reproductive Medicine, Xuzhou Central Hospital, Xuzhou, China (Y.-J.C.)
| | - Ying Yan
- Department of Gynecology, First Affiliated Hospital, Tianjin University of Chinese Medicine, Tianjin, China (Y.Y.)
| | - Li Liu
- First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, China (H.-L.M., Y.W., J.C., X.-M.Y., L. Liu)
| | - Yu-Xiu Liu
- Data and Statistics Division, Department of Critical Care Medicine, Jinling Hospital, and Department of Biostatistics, Public Health School, Nanjing Medical University, Nanjing, China (Y.-X.L.)
| | - Zhi-Shun Liu
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China (Z.-S.L.)
| | - Rebecca C Painter
- Amsterdam University Medical Center, Reproduction and Development, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (R.C.P.)
| | - Ernest H Y Ng
- Department of Obstetrics & Gynaecology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China (E.H.Y.N.)
| | - Jian-Ping Liu
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China, and National Research Center in Complementary and Alternative Medicine (NAFKAM), Department of Community Medicine, Faculty of Health Science, UiT The Arctic University of Norway, Tromsø, Norway (J.-P.L.)
| | - Ben Willem J Mol
- Monash Medical Centre, Monash University, Melbourne, Victoria, Australia (B.W.J.M.)
| | - Chi Chiu Wang
- Department of Obstetrics & Gynaecology, Li Ka Shing Institute of Health Sciences; School of Biomedical Sciences; and The Chinese University of Hong Kong-Sichuan University Joint Laboratory in Reproductive Medicine, The Chinese University of Hong Kong, Hong Kong, China (C.C.W.)
| |
Collapse
|
5
|
Love JE, McCarthy J, Datta M, Wong R, Huang LL. Wernicke encephalopathy in pregnancy. Intern Med J 2023; 53:651-653. [PMID: 37186361 DOI: 10.1111/imj.16065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 12/19/2022] [Indexed: 05/17/2023]
Affiliation(s)
- Jane E Love
- Department of Obstetric Medicine and Nephrology, Eastern Health, Melbourne, Victoria, Australia
| | - Josphine McCarthy
- Department of Endocrinology, Eastern Health, Melbourne, Victoria, Australia
| | - Mineesh Datta
- Department of Radiology, Eastern Health, Melbourne, Victoria, Australia
- Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Rosemary Wong
- Department of Endocrinology, Eastern Health, Melbourne, Victoria, Australia
- Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Louis L Huang
- Department of Obstetric Medicine and Nephrology, Eastern Health, Melbourne, Victoria, Australia
- Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
6
|
Cao X, Sun M, Yang Q, Wang Q, Hou L, Wang J, Wu Y, Ge L. Risk of abnormal pregnancy outcomes after using ondansetron during pregnancy: A systematic review and meta-analysis. Front Pharmacol 2022; 13:951072. [PMID: 36120333 PMCID: PMC9480102 DOI: 10.3389/fphar.2022.951072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/28/2022] [Indexed: 12/05/2022] Open
Abstract
Background: Hyperemesis gravidarum is a serious pregnancy complication that affects approximately 1% of pregnancies worldwide. Objective: To determine whether the use of ondansetron during pregnancy is associated with abnormal pregnancy outcomes. Search strategy: PubMed, Cochrane Library, CINAHL, Embase, CNKI, CBM, WANFANG, and ClinicalTrials.gov were searched for citations published in any language from inception to 15 December 2021. Selection criteria: Eligible studies included any observational study. Data collection and analysis: Odds ratio (OR) and 95% confidence interval (CI) were used as indicators to examine the association between ondansetron and abnormal pregnancy outcomes. Main results: Twenty articles from 1,558 citations were included. Our preliminary analysis showed that compared with the unexposed group, the use of ondansetron during pregnancy may be associated with an increased incidence of cardiac defects (OR = 1.06, 95% CI: 1.01–1.10), neural tube defects (OR = 1.12, 95% CI: 1.05–1.18), and chest cleft (OR = 1.21, 95% CI: 1.07–1.37). Further sensitivity analysis showed no significant association between ondansetron and cardiac defects (OR = 1.15,95% CI: 0.94–1.40) or neural tube defects (OR = 0.87,95% CI: 0.46–1.66). When controversial studies were eliminated, the results for the chest defects disappeared. Simultaneously, we found that the use of ondansetron was associated with a reduced incidence of miscarriage (OR = 0.53, 95% CI: 0.31–0.89). Ondansetron was not associated with orofacial clefts (OR = 1.09,95% CI: 0.95–1.25), spinal limb defects (OR = 1.14,95% CI: 0.89–1.46), urinary tract deformities (OR = 1.06,95% CI: 0.97–1.15), any congenital malformations (OR = 1.03,95% CI: 0.98–1.09), stillbirth (OR = 0.97,95% CI: 0.83–1.15), preterm birth (OR = 1.22,95% CI: 0.80–1.85), neonatal asphyxia (OR = 1.05,95% CI: 0.72–1.54), or neonatal development (OR = 1.18,95% CI: 0.96–1.44) in our primary analysis. Conclusion: In our analysis, using ondansetron during pregnancy was not associated with abnormal pregnancy outcomes. Although our study did not find sufficient evidence of ondansetron and adverse pregnancy outcomes, future studies including the exposure period and dose of ondansetron, as well as controlling for disease status, may be useful to truly elucidate the potential risks and benefits of ondansetron.
Collapse
Affiliation(s)
- Xiao Cao
- Evidence-Based Nursing Centre, School of Nursing, Lanzhou University, Lanzhou, China
| | - Mingyao Sun
- Evidence-Based Nursing Centre, School of Nursing, Lanzhou University, Lanzhou, China
| | - QiuYu Yang
- Evidence-Based Nursing Centre, School of Nursing, Lanzhou University, Lanzhou, China
| | - Qi Wang
- Department of Social Medicine and Health Management, and Evidence Based Social Science Research Centre, School of Public Health, Lanzhou University, Lanzhou, China
| | - Liangying Hou
- Department of Social Medicine and Health Management, and Evidence Based Social Science Research Centre, School of Public Health, Lanzhou University, Lanzhou, China
| | - Jing Wang
- Department of Obstetrics and Gynecology, The First Hospital of Lanzhou University, Key Laboratory of Gynecologic Oncology of Gansu Province, Lanzhou, Gansu, China
| | - Yu Wu
- Department of Obstetrics and Gynecology, The First Hospital of Lanzhou University, Key Laboratory of Gynecologic Oncology of Gansu Province, Lanzhou, Gansu, China
- *Correspondence: Yu Wu, ; Long Ge,
| | - Long Ge
- Department of Social Medicine and Health Management, and Evidence Based Social Science Research Centre, School of Public Health, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
- *Correspondence: Yu Wu, ; Long Ge,
| |
Collapse
|
7
|
Terrault NA, Williamson C. Pregnancy-Associated Liver Diseases. Gastroenterology 2022; 163:97-117.e1. [PMID: 35276220 DOI: 10.1053/j.gastro.2022.01.060] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 01/21/2022] [Accepted: 01/26/2022] [Indexed: 12/14/2022]
Abstract
The liver disorders unique to pregnancy include hyperemesis gravidarum, intrahepatic cholestasis of pregnancy, acute fatty liver of pregnancy, and preeclampsia-associated hepatic impairment, specifically hemolysis, elevated liver enzymes, and low platelet count syndrome (HELLP). Their importance lies in the significant maternal and fetal/neonatal morbidity and mortality. Expeditious diagnosis and clinical evaluation is critical to ensure timely, appropriate care and minimize risks to the pregnant woman and her fetus/baby. A multidisciplinary approach is essential, including midwives, maternal-fetal-medicine specialists, anesthetists, neonatologists, and hepatologists.
Collapse
Affiliation(s)
- Norah A Terrault
- Gastrointestinal and Liver Disease Division, University of Southern California, Los Angeles, California, USA.
| | | |
Collapse
|
8
|
Yue SW, Huang YY, Huang CR, Huang WP, Ouyang YQ. Effect of auriculotherapy on nausea and vomiting during pregnancy: A systematic review. Eur J Integr Med 2022. [DOI: 10.1016/j.eujim.2022.102130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
9
|
Blake Gornall A, Hutchinson AM, Redley B. Clinician perspectives of pregnant women's participation in antiemetic decision-making: A qualitative study. Nurs Health Sci 2022; 24:54-64. [PMID: 35174947 DOI: 10.1111/nhs.12930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 01/30/2022] [Accepted: 02/07/2022] [Indexed: 11/30/2022]
Abstract
This study explored clinician perceptions of women's participation in decision-making about antiemetic treatments during pregnancy, and the suitability of the five Choosing Wisely questions to increase women's involvement. The qualitative interpretive descriptive design used semi-structured interviews to capture data. Participants were six obstetricians and six midwives experienced in providing care for pregnant women seeking support for nausea and vomiting at a single private, obstetrician-led maternity health service in Australia. Thematic analysis revealed four themes that captured clinician perspectives about women's participation in decision-making about antiemetic treatments: (i) information gathering; (ii) developing an understanding; (iii) using knowledge; and (iv) making decisions. Clinician attitudes and perspectives, as well as their self-reported styles of communication and negotiation, influenced how they engaged with women during decision-making. While unfamiliar with the five Choosing Wisely questions, almost all participants considered them potentially useful, but for other clinicians. Strategies to actively involve women in decision-making about antiemetics were inconsistently used. The five Choosing Wisely questions may provide a useful tool for clinicians, but further research is needed to better understand women's perspectives and clinician-related barriers to shared decision-making.
Collapse
Affiliation(s)
| | - Alison M Hutchinson
- School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia.,Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Burwood, Victoria, Australia.,Monash Health, Clayton, Victoria, Australia
| | - Bernice Redley
- School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia.,Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Burwood, Victoria, Australia.,Monash Health, Clayton, Victoria, Australia
| |
Collapse
|
10
|
Hsiao HF, Grzeskowiak LE, Thomas A. Response to Letter to the Editor 'Answering medication safety concerns in pregnancy - The difficulty for community pharmacists'. Aust N Z J Obstet Gynaecol 2021; 61:E29. [PMID: 34874552 DOI: 10.1111/ajo.13442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 09/14/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Han-Fang Hsiao
- SA Pharmacy, Flinders Medical Centre, SA Health, Adelaide, SA, Australia
| | - Luke E Grzeskowiak
- SA Pharmacy, Flinders Medical Centre, SA Health, Adelaide, SA, Australia.,College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia.,Adelaide Medical School, Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia.,South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Alicia Thomas
- SA Pharmacy, Flinders Medical Centre, SA Health, Adelaide, SA, Australia
| |
Collapse
|
11
|
Lowe SA, Steinweg KE. Review article: Management of hyperemesis gravidarum and nausea and vomiting in pregnancy. Emerg Med Australas 2021; 34:9-15. [PMID: 34872159 DOI: 10.1111/1742-6723.13909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 11/01/2021] [Accepted: 11/11/2021] [Indexed: 01/16/2023]
Abstract
Nausea and vomiting in pregnancy (NVP) are common in early pregnancy but there is a wide spectrum of severity in terms of the duration and acuity of symptoms throughout gestation. Adverse maternal and fetal outcomes have been seen in women who experience severe symptoms, also known as hyperemesis gravidarum (HG). Evidence-based, assessment and management can reduce symptom severity, avoid physical and psychological deterioration and minimise the impact on quality of life and function. A pathway for assessment and management of NVP and HG in the emergency room is presented based on the Society of Obstetric Medicine of Australia and New Zealand Guideline for the Management of Nausea and Vomiting in Pregnancy and Hyperemesis Gravidarum. Assessment requires an objective evaluation using a validated scoring system such as the PUQE-24 score, as well as calculation of hydration and nutritional status. Ketonuria is not associated with either the diagnosis or severity of HG. Further investigation including biochemistry is only required in severe cases. Many women will have tried a range of therapies and an important aspect of treatment is to recognise the validity of their symptoms. Treatment may require a combination of intravenous fluids, anti-emetics, acid suppression and laxatives. Outpatient management is optimal but admission may be required for refractory symptoms, organ dysfunction or concurrent significant co-morbidities. Emergency management of NVP and HG requires an appropriate pathway of care to support women until the natural resolution of their condition. Both underuse of safe therapies and overuse of ineffective medication must be avoided.
Collapse
Affiliation(s)
- Sandra A Lowe
- Department of Obstetric Medicine, Royal Hospital for Women, Sydney, New South Wales, Australia.,School of Women's and Children's Health, The University of New South Wales, Sydney, New South Wales, Australia
| | - Kate E Steinweg
- Royal Darwin Hospital, Darwin, Northern Territory, Australia
| |
Collapse
|
12
|
Eis D. Übelkeit und Erbrechen als Symptome in der Notfallmedizin. Notf Rett Med 2021. [DOI: 10.1007/s10049-020-00820-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
13
|
Hsiao HF, Thomas A, Kay-Smith C, Grzeskowiak LE. Pregnant women report being denied medications to treat severe nausea and vomiting of pregnancy or hyperemesis gravidarum - findings from an Australian online survey. THE AUSTRALIAN & NEW ZEALAND JOURNAL OF OBSTETRICS & GYNAECOLOGY 2021; 61:616-620. [PMID: 33984156 DOI: 10.1111/ajo.13359] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 02/28/2021] [Accepted: 03/17/2021] [Indexed: 11/29/2022]
Abstract
We conducted an online survey of 249 Australian women who currently or previously experienced severe nausea and vomiting of pregnancy (NVP) or hyperemesis gravidarum (HG) and examined their experiences in being denied medications during pregnancy. One in four women reported being denied medications for NVP/HG, which most commonly involved doxylamine and encounters with community pharmacists. Women's experiences reflected that lack of awareness of guidelines and unfavourable risk-benefit assessments appeared to be key barriers to facilitating medication access. Approaches towards identifying and effectively addressing barriers to the provision of effective treatments for severe NVP and HG are urgently needed.
Collapse
Affiliation(s)
- Han-Fang Hsiao
- SA Pharmacy, Flinders Medical Centre, SA Health, Adelaide, South Australia, Australia
| | - Alicia Thomas
- SA Pharmacy, Flinders Medical Centre, SA Health, Adelaide, South Australia, Australia
| | | | - Luke E Grzeskowiak
- SA Pharmacy, Flinders Medical Centre, SA Health, Adelaide, South Australia, Australia.,College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia.,Adelaide Medical School, Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia.,South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| |
Collapse
|
14
|
Pan X, Chu R, Meng J, Wang Q, Zhang Y, Song K, Yang X, Kong B. Hyperemesis gravidarum induced refeeding syndrome causes blood cell destruction: a case report and literature review. BMC Pregnancy Childbirth 2021; 21:366. [PMID: 33966630 PMCID: PMC8108454 DOI: 10.1186/s12884-021-03821-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 04/21/2021] [Indexed: 11/24/2022] Open
Abstract
Background Hyperemesis gravidarum (HG) is a common complication during pregnancy, however, HG associated simultaneous onset of blood cell destruction due to electrolyte abnormalities is rare. In this case, a woman with refeeding syndrome (RFS) secondary to electrolyte abnormalities caused by severe HG was diagnosed and managed in our hospital. Case presentation A 29-year old woman was sent to the local hospitals because of severe HG with appetite loss, weight reduction, general fatigue, and she was identified to have severe electrolyte abnormalities. However, the electrolyte abnormalities were not corrected promptly, and then she had the symptoms of stillbirth, altered mental status, visual hallucination, hemolytic anemia and thrombocytopenia. After transferred to our hospital, we continued to correct the electrolyte abnormalities and the labor induction was performed as soon as possible. The symptoms of blood cell destruction were relieved obviously, and the patient discharged four days later. The electrolyte disturbances and physio-metabolic abnormalities caused by HG helped us diagnose this case as RFS. Conclusions This case emphasizes that patients with RFS should be diagnosed appropriately and intervened promptly in order to prevent electrolyte imbalance induced blood cell destruction.
Collapse
Affiliation(s)
- Xiyu Pan
- Department of Obstetrics Gynecology, Cheeloo College of Medicine, Qilu Hospital, Shandong University, Shandong, 250012, Jinan, China
| | - Ran Chu
- Department of Obstetrics Gynecology, Cheeloo College of Medicine, Qilu Hospital, Shandong University, Shandong, 250012, Jinan, China
| | - Jinyu Meng
- Department of Obstetrics Gynecology, Cheeloo College of Medicine, Qilu Hospital, Shandong University, Shandong, 250012, Jinan, China
| | - Qiannan Wang
- Department of Obstetrics Gynecology, Cheeloo College of Medicine, Qilu Hospital, Shandong University, Shandong, 250012, Jinan, China
| | - Yue Zhang
- Department of Obstetrics Gynecology, Cheeloo College of Medicine, Qilu Hospital, Shandong University, Shandong, 250012, Jinan, China
| | - Kun Song
- Department of Obstetrics Gynecology, Cheeloo College of Medicine, Qilu Hospital, Shandong University, Shandong, 250012, Jinan, China.
| | - Xingsheng Yang
- Department of Obstetrics Gynecology, Cheeloo College of Medicine, Qilu Hospital, Shandong University, Shandong, 250012, Jinan, China
| | - Beihua Kong
- Department of Obstetrics Gynecology, Cheeloo College of Medicine, Qilu Hospital, Shandong University, Shandong, 250012, Jinan, China
| |
Collapse
|
15
|
Kennedy DS, Batagol RP. Confusion about doxylamine safety in pregnancy. Med J Aust 2021; 214:286-286.e1. [PMID: 33629372 DOI: 10.5694/mja2.50969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/10/2020] [Accepted: 11/24/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Debra S Kennedy
- MotherSafe, Royal Hospital for Women, Sydney, NSW.,University of New South Wales, Sydney, NSW
| | | |
Collapse
|
16
|
Shand A, Austin K, Nassar N, Kidson‐Gerber G. Pharmacological management of anaemia in pregnancy: a review. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2020. [DOI: 10.1002/jppr.1648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Antonia Shand
- Child Population and Translational Health Research Children's Hospital at Westmead Clinical School The University of Sydney Sydney Australia
- Royal Hospital for Women Randwick Australia
| | - Kathryn Austin
- Royal Hospital for Women Randwick Australia
- Royal North Shore Hospital St Leonards Australia
| | - Natasha Nassar
- Child Population and Translational Health Research Children's Hospital at Westmead Clinical School The University of Sydney Sydney Australia
| | - Giselle Kidson‐Gerber
- Royal Hospital for Women Randwick Australia
- Department of Haematology Prince of Wales Hospital Sydney Australia
- University of New South Wales Kensington Australia
| |
Collapse
|