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Medline ® Abstracts for References 94,129,134-138

of 'Treatment and outcome of nausea and vomiting of pregnancy'

94
TI
Hyperemesis gravidarum complicated by Wernicke encephalopathy: background, case report, and review of the literature.
AU
Chiossi G, Neri I, Cavazzuti M, Basso G, Facchinetti F
SO
Obstet Gynecol Surv. 2006;61(4):255.
 
Wernicke encephalopathy (WE) is a rare but known complication of severe hyperemesis gravidarum caused by thiamine deficiency. This article presents an unusual case that occurred at our institution and reviews the 48 previously published cases of WE in pregnancy. Considering all the 49 cases, the mean (+/-standard deviation) patients' age was 26.7 +/- 4.9 years, the mean gestational age when WE manifested was 14.3 +/- 3.4 weeks, and the mean duration of vomiting and feeding difficulties was 7.7 +/- 2.8 weeks. Wernicke's classic triad (confusion, ocular abnormalities, and ataxia) manifested in only 46.9% (23 of 49) of the patients. Confusion affected 63.3% (31 of 49) of the patients, ocular signs 95.9% (47 of 49) and symptoms 57.1% (28 of 49), and ataxia 81.6% (40 of 49). Deterioration of consciousness affected 53.1% (26 of 49) of the subjects and memory impairment 61.2% (30 of 49). Complete remission of the disease occurred in only 14 of 49 cases. Symptom resolution required months and permanent impairments were common. The overall pregnancy loss rate, directly (spontaneous fetal loss) and indirectly (planned abortion) attributable to WE, was 47.9% (23 of 49). The diagnosis of WE is clinical and can be rapidly confirmed by magnetic resonance imaging. We emphasize the importance of thiamine supplementation to women with prolonged vomiting in pregnancy, especially before intravenous or parenteral nutrition. We also underline the necessity to promptly replace vitamin B1 when neurologic symptoms and/or signs develop in a patient with hyperemesis gravidarum.
AD
Obstetrics and Gynecology Residency Program, Modena Policlinico Hospital, University of Modena and Reggio Emilia, Modena, Italy.
PMID
129
TI
Morning sickness: a mechanism for protecting mother and embryo.
AU
Flaxman SM, Sherman PW
SO
Q Rev Biol. 2000;75(2):113.
 
Approximately two-thirds of women experience nausea or vomiting during the first trimester of pregnancy. These symptoms are commonly known as morning sickness. Hook (1976) and Profet (1988) hypothesized that morning sickness protects the embryo by causing pregnant women to physically expel and subsequently avoid foods that contain teratogenic and abortifacient chemicals, especially toxic chemicals in strong-tasting vegetables, caffeinated beverages and alcohol. We examined this hypothesis by comprehensively reviewing the relevant medical, psychological and anthropological literature. In its support, (i) symptoms peak when embryonic organogenesis is most susceptible to chemical disruption (weeks 6-18), (ii) women who experience morning sickness are significantly less likely to miscarry than women who do not (9 of 9 studies), (iii) women who vomit suffer fewer miscarriages than those who experience nausea alone, and (iv) many pregnant women have aversions to alcoholic and nonalcoholic (mostly caffeinated) beverages and strong-tasting vegetables, especially during the first trimester. Surprisingly, however, the greatest aversions are to meats, fish, poultry, and eggs. A cross-cultural analysis using the Human Relations Area Files revealed 20 traditional societies in which morning sickness has been observed and seven in which it has never been observed. The latter were significantly less likely to have animal products as dietary staples and significantly more likely to have only plants (primarily corn) as staples than the 20 societies in which morning sickness occurred. Animal products may be dangerous to pregnant women and their embryos because they often contain parasites and pathogens, especially when stored at room temperatures in warm climates. Avoiding foodborne microorganisms is particularly important to pregnant women because they are immunosuppressed, presumably to reduce the chances of rejecting tissues of their own offspring (Haig 1993). As a result, pregnant women are more vulnerable to serious, often deadly infections. We hypothesize that morning sickness causes women to avoid foods that might be dangerous to themselves or their embryos, especially foods that, prior to widespread refrigeration, were likely to be heavily laden with microorganisms and their toxins. The alternative hypotheses that morning sickness is (i) an epiphenomenon of mother-offspring genetic conflict or hormones associated with viable pregnancies, or (ii) an indicator to potential sexual partners and kin that the woman is pregnant, resulting in reduced sexual behavior and increased nepotistic aid, were not well supported. Available data are most consistent with the hypothesis that morning sickness serves an adaptive, prophylactic function.
AD
Department of Neurobiology and Behavior, Cornell University, Ithaca, New York 14853, USA. smf7@cornell.edu
PMID
134
TI
Review on hyperemesis gravidarum.
AU
Ismail SK, Kenny L
SO
Best Pract Res Clin Gastroenterol. 2007;21(5):755.
 
Hyperemesis gravidarum is severe, intractable nausea and vomiting affecting 0.3-2% of pregnancies. It has a complex multifactorial aetiology. This review explores the current literature relating to the clinical manifestations, differential diagnosis, epidemiology, possible aetiology, maternal and fetal complications, and evidence-based management of hyperemesis.
AD
Cork University Maternity Hospital, Wilton, Cork, Ireland. sitikhadijahismail@yahoo.co.uk
PMID
135
TI
Wernicke's encephalopathy due to hyperemesis gravidarum: an under-recognised condition.
AU
Togay-Işikay C, Yiğit A, Mutluer N
SO
Aust N Z J Obstet Gynaecol. 2001;41(4):453.
 
We present a case of a 25-year-old woman with drowsiness, nystagmus, severe ataxia and areflexia, which developed six weeks after admission to an obstetric clinic for hyperemesis gravidarum. She had been treated with intravenous dextrose and electrolyte solutions and antiemetics. Magnetic resonance imaging (MRI) performed on the fifth day of her neurologic symptoms showed increased intensity in both thalami, periaqueductal grey matter, the floor of the fourth ventricle and superior cerebellar vermis in T2 weighted and FLAIR images. Clinical signs and MRI findings were consistent with the diagnosis of Wernicke's encephalopathy. On the third day of thiamine replacement, neurologic signs improved dramatically In addition to our case, we review 29 previously reported cases of Wernicke's encephalopathy associated with hyperemesis gravidarum, and emphasize the importance of thiamine supplementation to women with prolonged vomiting in pregnancy especially if they are given intravenous or parenteral nutrition.
AD
Department of Neurology, Faculty of Medicine, University of Ankara, Turkey.
PMID
136
TI
Hyperemesis gravidarum complicated by Wernicke's encephalopathy.
AU
Spruill SC, Kuller JA
SO
Obstet Gynecol. 2002;99(5 Pt 2):875.
 
BACKGROUND: Wernicke's encephalopathy is usually associated with alcohol abuse, but can also occur with hyperemesis gravidarum. The effect of delay in thiamine replacement on fetal outcomes is unknown. We present a case of this complication.
CASE: A primipara with hyperemesis was admitted for mental status changes in her 14th week of pregnancy. Physical examination revealed a lethargic patient with ophthalmoplegia, ataxia, and hyporeflexia. Parenteral thiamine therapy was started. The patient improved rapidly although the ataxia persisted. A spontaneous abortion occurred 2 weeks later.
CONCLUSION: Wernicke's encephalopathy can complicate hyperemesis gravidarum. Early thiamine replacement may decrease the chances of spontaneous abortion.
AD
Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
PMID
137
TI
Spontaneous esophageal rupture following severe vomiting in pregnancy.
AU
Eroğlu A, Kürkçüoğlu C, Karaoğlanoğlu N, TekinbaşC, Cesur M
SO
Dis Esophagus. 2002;15(3):242.
 
Spontaneous esophageal perforation is an uncommon finding requiring prompt diagnosis and immediate surgery because of its high mortality rate. Esophageal rupture secondary to severe vomiting in pregnancy is extremely rare and only four cases have been published in the literature. We report the case of a 20-year-old female in whom severe vomiting in early pregnancy resulted in esophageal perforation with subcutaneous emphysema. The diagnosis was made 48 h later. The patient had undergone surgical treatment and the postoperative period was uneventful. The unusual cause and the interesting clinical course of esophageal rupture are described.
AD
Department of Thoracic Surgery, School of Medicine, Atatürk University, Erzurum, Turkey. atilaeroglu@hotmail.com
PMID
138
TI
The nutritional status and treatment of patients with hyperemesis gravidarum.
AU
van Stuijvenberg ME, Schabort I, Labadarios D, Nel JT
SO
Am J Obstet Gynecol. 1995;172(5):1585.
 
OBJECTIVE: The objective of this study was to evaluate the nutritional status of patients with hyperemesis gravidarum and the effect of a treatment regimen administered during hospitalization.
STUDY DESIGN: This was a descriptive, controlled study of 20 patients with hyperemesis gravidarum whose nutritional status was assessed and compared with that of 20 pregnant, nonvomiting matched controls. Blood nutrient status was reassessed after 10 days of treatment with an intravenous saline solution containing a multivitamin preparation and again at day 20.
RESULTS: Mean dietary intake of most nutrients fell below 50% of the recommended dietary allowances and differed significantly (p<0.01) from that of controls. More than 60% of the patients had suboptimal biochemical status of thiamine, riboflavin, vitamin B6, vitamin A, and retinol-binding protein. Vitamin C, calcium, albumin, hematocrit, and hemoglobin values were significantly higher in those patients where the duration of vomiting had been longer, suggesting the presence of dehydration. Treatment was associated with cessation of vomiting and improvement in blood nutrient status. Pregnancy outcome was favorable in all patients.
CONCLUSION: The hyperemetic pregnant patient is at nutritional risk; prompt initiation of corrective therapy is recommended.
AD
Department of Human Nutrition, University of Stellenbosch, South Africa.
PMID