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

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

94
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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
Hyperemesis gravidarum and fetal outcome.
AU
Paauw JD, Bierling S, Cook CR, Davis AT
SO
JPEN J Parenter Enteral Nutr. 2005;29(2):93.
 
BACKGROUND: Hyperemesis gravidarum (HG) is reported in 0.5-2% of all pregnancies. The purpose of this research was to evaluate the relationship of maternal HG, neonatal birth weight, and birth outcomes.
METHODS: This is a prospective cohort study of 45 patients diagnosed, by Fairweather's criteria, with HG compared with 306 non-HG control pregnant patients with singleton pregnancies. Sociodemographic and clinical data were obtained from the pregnant patients. Neonatal data were also collected, including indicators of neonatal wellness.
RESULTS: Significantly higher incidences of being nonwhite (33% vs 16%; p<.05) and of attaining post-high school education (60% vs 38%) were noted in the HG group, relative to controls. Mothers in the control group experienced greater gestational weight gain, 14.9 +/- 0.3 kg (mean +/- SEM) relative to mothers in the HG group (10.6 +/- 1.3 kg). Infants from HG pregnancies manifested significantly lower birth weight (3.23 +/- 0.09 kg vs 3.52 +/- 0.03 kg), younger gestational age (38.4 +/- 0.3 weeks vs 39.7 +/- 0.1 weeks), and a greater length of hospital stay (2.9 +/- 0.5 days vs 1.8 +/- 0.1 day), relative to infants from the control group. After undergoing multivariate analysis, HG was a significant predictor of decreased gestational age and increased hospital length of stay.
CONCLUSIONS: Infants born of women who had HG are more likely to experience decreased gestational age and increased length of hospital stay. Efficacy of early and aggressive treatment of HG, including nutrition support, in minimizing these outcomes needs to be studied.
AD
Spectrum Health Nutrition Support Service, Grand Rapids, MI 49503, USA.
PMID
134
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
135
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
136
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
137
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
138
TI
Maternal vitamin K deficient embryopathy: association with hyperemesis gravidarum and Crohn disease.
AU
Toriello HV, Erick M, Alessandri JL, Bailey D, Brunetti-Pierri N, Cox H, Fryer A, Marty D, McCurdy C, Mulliken JB, Murphy H, Omlor J, Pauli RM, Ranells JD, Sanchez-Valle A, Tobiasz A, Van Maldergem L, Lin AE
SO
Am J Med Genet A. 2013;161A(3):417. Epub 2013 Feb 12.
 
Chondrodysplasia punctata (CDP) is an etiologically heterogeneous disorder characterized by the radiographic finding of stippled epiphyses (punctate calcifications). It is often accompanied by a characteristic facial appearance, known as the Binder phenotype, which is attributed to hypoplasia of the nasal cartilages; abnormal distal phalanges (brachytelephalangy) are a common component manifestation as well. We report eight patients with a Binder phenotype with or without CDP who all shared a known or suspected maternal deficiency of vitamin K. We suspect that this phenotype is probably under recognized, and we hope to increase awareness about the maternal risk factors, especially hyperemesis gravidarum, which lead to nutritional deficiency.
AD
Genetic Services, Spectrum Health, Grand Rapids, Michigan, USA. toriello@msu.edu
PMID