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Query: UMLS:C0027497 (nausea)
 23,468 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The presentation, nonradiologic diagnostic evaluation, and course (including complications and outcome) of gastrointestinal disorders in pregnancy are not substantially different than for the nonpregnant patient. The possible exception is the higher mortality for pancreatitis when it occurs during pregnancy. With the exception of nausea/vomiting and hyperemesis gravidarum, there does not appear to be a gastrointestinal tract disorder that is peculiar to the pregnant state. Hepatic disorders are somewhat different in that the excretory defect-pruritus gravidarum-cholestatic jaundice spectrum and perhaps part of what presents as acute hepatic failure are intimately associated with pregnancy and have an onset and course that are tied to the gestational period. Otherwise, hepatic diseases that occur during pregnancy share the characteristic of gastrointestinal diseases, that their manifestations are not clearly different from the nonpregnant state. As is true for the diagnostic approach to all medical diseases that occur during pregnancy, radiographic procedures are prohibited. Furthermore, therapy must be reconsidered with concern for its effect on the fetus. This leads to elimination of many or all measures used for purely symptomatic or nonspecific benefit. If no harm or potential harm will accrue for the fetus, therapy for hepatic and gastrointestinal disorders preceeds in pregnancy very much as it does in the nongravid individual.
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PMID:Hepatic and gastrointestinal disorders in pregnancy. 31 10

The definition, history, incidence, diagnosis, possible etiology and treatment of nausea and vomiting in early pregnancy, also called emesis gravidarum, are reviewed. The condition may involve nausea, retching and/or occasional vomiting in early pregnancy: severe vomiting is termed hyperemesis gravidarum. The condition was described as early as 2000 B.C. It occurs in 50-70% of pregnancies in Western societies, but is said to be rare in some primitive societies. A lower incidence of nausea and vomiting has been associated with spontaneous abortion before 20 weeks gestation. Among selected hormones measured in pregnant women, those with nausea and vomiting in early pregnancy had significantly lower cortisol and progesterone, but higher hCG, while those with vomiting in late pregnancy had significantly lower testosterone and hCG and higher dehydroepiandrosterone than unaffected women. Other factors proposed as causative agents include tissue polypeptide antigen, high LDLs and VLDLs, and low HDLs, gall bladder disease, and ovulation from the right ovary. Women who develop nausea while taking oral contraceptives also have a tendency to do so in pregnancy. Possibly the steroid load on the liver may explain the condition. In the absence of a theory to explain nausea in pregnancy, no specific treatment is known. Experimental use of S-adenosyl-L-methionine, a methyl donor active in estrogen conjugation, reverses some estrogen-induced liver changes, such as cholestasis, pruritus, and bile acid abnormalities in pregnancy.
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PMID:Nausea and vomiting in pregnancy: a review. 361 96

Serum concentrations of human chorionic gonadotrophin (hCG), schwangerschaftsprotein 1(SP1), progesterone and oestradiol were measured in 116 pregnant women experiencing varying degrees of nausea and vomiting or no nausea at all at between 9 and 16 weeks gestation. The patients were categorized into four groups, namely asymptomatic, nausea alone, nausea and vomiting and hyperemesis gravidarum. The distribution of levels for each group were examined in relation to the calculated normal ranges. Statistically higher hCG levels were found in out-patients with nausea alone or nausea and vomiting than in the asymptomatic women. No significant differences were found between the groups for any of the other measured variables, including the progesterone/oestradiol concentration ratio.
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PMID:Serum chorionic gonadotrophin (hCG), schwangerschaftsprotein 1 (SP1), progesterone and oestradiol levels in patients with nausea and vomiting in early pregnancy. 387 32

Hyperemesis gravidarum (HG) is a severe form of the more common nausea of early pregnancy. We report an unusual case of pneumomediastinum and bilatetral pneumothoraces presenting in the tenth week of pregnancy complicating HG.
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PMID:Pneumomediastinum and bilateral pneumothoraces in a patient with hyperemesis gravidarum. 798 26

Ondansetron is a 5-hydroxytryptamine receptor antagonist which is known to be a highly effective anti-emetic drug for chemotherapy-associated nausea and vomiting and for postoperative nausea. We report here a case where ondansetron was used in severe hyperemesis gravidarum to avoid parenteral nutrition. The drug was used intermittently in every trimester with no apparent adverse effects on mother or infant.
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PMID:Treatment of hyperemesis gravidarum with the 5-HT3 antagonist ondansetron (Zofran). 894 15

Nausea and vomiting are both common in early pregnancy. Most cases are mild and do not require treatment. However, persistent vomiting and severe nausea can progress to hyperemesis if the woman is unable to maintain adequate hydration, and fluid and electrolyte as well as nutritional status are jeopardised. Hyperemesis gravidarum is a diagnosis of exclusion, characterised by prolonged and severe nausea and vomiting, dehydration, ketosis and bodyweight loss. Investigation may show hyponatraemia, hypokalaemia, a low serum urea level, metabolic hypochloraemic alkalosis and ketonuria. The haematocrit is raised and the specific gravity of the urine is increased. There may be associated liver function test abnormalities and abnormal thyroid function tests, with biochemical thyrotoxicosis with raised free thyroxine levels and/or suppressed thyroid-stimulating hormone levels. The pathophysiology of hyperemesis is poorly understood. Various hormonal, mechanical and psychological factors have been implicated. Studies have demonstrated a direct relationship between the severity of hyperemesis, the degree of biochemical hyperthyroidism and the levels of human chorionic gonadotrophin (hCG). Management of hyperemesis should include hospitalisation, intravenous fluid and electrolyte replacement, thiamine (vitamin B1) supplementation, use of conventional antiemetics and psychological support. Most patients improve spontaneously with the help of the above measures without long term sequelae. Conventionally, antiemetics are not usually prescribed, especially before 12 weeks gestation, except for women with hyperemesis. This reluctance relates to fears which are often unfounded concerning the teratogenic effects of antiemetics. Severe hyperemesis, refractory to conventional management with intravenous fluids and antiemetics is a rare, miserable and disabling condition, associated with multiple hospital admissions, time away from work and the family, and psychological morbidity. If inadequately or inappropriately treated, it may cause Wernicke's encephalopathy, central pontine myelinolysis and death. In extreme cases, women may request, or their obstetricians recommend, termination of the pregnancy. There are uncontrolled data supporting a beneficial effect of corticosteroids in these women, and a randomised placebo-controlled trial is currently in progress.
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PMID:Treatment of nausea and vomiting in pregnancy. When should it be treated and what can be safely taken? 970 51

We conducted a case-control study to investigate the effect of prepregnancy diet, particularly dietary fats, on the risk of severe hyperemesis gravidarum. Cases were 44 women previously hospitalized at Brigham and Women's Hospital, Boston, MA, for severe hyperemesis gravidarum who delivered a singleton liveborn between January 1, 1993, and December 31, 1995. Controls were 87 women who delivered a singleton liveborn at Brigham and Women's Hospital during the same period and who experienced less than 20 hours of nausea and fewer than three episodes of vomiting over the duration of their pregnancies. Odds ratios were derived from unconditional logistic regression models using data collected via self-administered food frequency questionnaires. Our results indicate that prepregnancy, high daily intake of total fat increases the risk of severe hyperemesis gravidarum (odds ratio = 2.9 for each 25 gm per day increase; 95% confidence interval = 1.4-6.0). This association is driven primarily by saturated fat intake [odds ratio = 5.4 for each 15 gm per day increase (equivalent to one quarter-pound cheeseburger); 95% confidence interval = 2.0-14.8]. We observed no independent effect of total energy intake.
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PMID:Saturated fat intake and the risk of severe hyperemesis gravidarum. 979 74

Several serotonin (5-HT) receptor subtypes have been defined by pharmacological responses to selective agonists and antagonists and by pathways of receptor-effector coupling. Using molecular techniques, additional receptor subtypes have been described. 5-HT receptors are prevalent in the central nervous system and gut and participate in induction of emesis. 5-HT3 antagonists are used to prevent emesis from cancer chemotherapy and also demonstrate efficacy in radiation-induced nausea, postoperative nausea, hyperemesis gravidarum, and nausea and vomiting with the acquired immunodeficiency syndrome. 5-HT4 agonists exhibit prokinetic properties in nauseated patients with gastroparesis and functional dyspepsia. Conversely, 5-HT4 antagonists have antiemetic activity in some experimental models. The 5-HT1D receptor agonist sumatriptan reduces emesis with migraine headaches and in cyclic vomiting syndrome, most likely via action on central nervous system sites. In other models, 5-HT1A and 5-HT2A/5-HT2C agonists exhibit antiemetic properties. The utility of 5-HT receptor ligands in treating emesis is the subject of active investigation.
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PMID:Serotonin receptor physiology: relation to emesis. 1049 49

Hyperemesis gravidarum, severe vomiting, develops in about 1-2% of all pregnancies. Acupuncture on the point PC6 above the wrist on the palmar side has been found to prevent some types of nausea and vomiting. The purpose of the present study was to see if acupuncture, in addition to standard treatment, could hasten the improvement of hyperemesis gravidarum. Thirty-three women with hyperemesis were evaluated in a randomized, single-blind, crossover comparison of two methods of acupuncture, active (deep) PC6 acupuncture or placebo (superficial) acupuncture. The women estimated their degree of nausea on a visual analogue scale (VAS). The daily number of emesis episodes were documented. Crossover analyses showed that there was a significantly faster reduction of nausea VAS and more women who stopped vomiting after active acupuncture than after placebo acupuncture. This study suggests that active PC6 acupuncture, in combination with standard treatment, could make women with hyperemesis gravidarum better faster than placebo acupuncture.
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PMID:Manual acupuncture reduces hyperemesis gravidarum: a placebo-controlled, randomized, single-blind, crossover study. 1102 9

Our objective was to survey obstetrician/gynecologists concerning their management of nausea and vomiting in pregnancy. We mailed a survey on nutrition during pregnancy to the 230 ACOG Fellows who are members of the Collaborative Ambulatory Research Network and to a control sample of 800 non-Network Fellows. Results presented here are for the questions concerning prevalence and management of pregnancy-induced nausea. A total of 488 surveys (47.4% response rate) were analyzed. Respondents reported that on average, 51.4% of patients complain of nausea during pregnancy, and 9.2% complain of severe or prolonged nausea with vomiting. Respondents reported that on average, 2.4% of patients require hospitalization because of hyperemesis gravidarum. Treatments recommended by a majority of respondents for moderate nausea were eating frequent small meals (95.5%), snacking on soda crackers (88.5%), avoiding strong odors (75.6%), taking a prescribed antiemetic (71.3%), taking ginger (51.8%), and eliminating iron supplements (50%). Women physicians were more likely to recommend ginger and less likely to prescribe an antiemetic. For severe and sustained nausea with vomiting, with additional symptoms such as dehydration or weight loss, intravenous hydration (88.7%) and antiemetics (74.0%) were the most common treatment options. Almost half (48.8%) of respondents would hospitalize such patients. We conclude that obstetrician/gynecologists appear to be knowledgeable concerning current opinion on managing nausea and vomiting of pregnancy. Improvements in the management of nausea during pregnancy are more likely to come from further research, not education of physicians.
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PMID:A survey on the management of nausea and vomiting in pregnancy by obstetrician/gynecologists. 1124 31


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