Contemporary approaches to hyperemesis during pregnancy.
ABSTRACT Nausea and vomiting of pregnancy (NVP) affects 90% of pregnant women and its impact is often underappreciated. Hyperemesis gravidarum, the most severe end of the spectrum, affects 0.5-2% of pregnancies. The pathogenesis of this condition remains obscure and its management has largely been empirical. This review aims to provide an update on advances in pregnancy hyperemesis focusing on papers published within the past 2 years.
The cause of hyperemesis is continuing to be elaborated. Recent data attest to the effectiveness of the oral doxylamine-pyridoxine in NVP. Follow-up data of children exposed in early pregnancy to doxylamine-pyridoxine for NVP are reassuring. Evidence is increasing for ginger as an effective herbal remedy for NVP. Metoclopramide is effective in NVP and hyperemesis gravidarum, with a good balance of efficacy and tolerability. A recent large-scale study on first trimester exposure to metoclopramide is reassuring of its safety. Evidence is emerging for the treatment of acid reflux to ameliorate NVP. The role of corticosteroids for hyperemesis gravidarum remains controversial. Transpyloric feeding may be warranted for persistent weight loss, despite optimal antiemetic therapy.
Women with significant NVP should be identified so that they can be safely and effectively treated.
Article: Notfallmedikamente bei Schwangeren[Show abstract] [Hide abstract]
ABSTRACT: Die Notfallversorgung einer schwangeren Patientin stellt eine große Herausforderung dar. Zu der Behandlung des eigentlichen medizinischen Notfalls der Mutter kommt die psychische Belastung durch das Wissen um die Schwangerschaft und mögliche Auswirkungen auf das ungeborene Kind. Aus Mangel an Erfahrung besteht zudem eine Unsicherheit bei der Auswahl und Dosierung von Medikamenten. Der folgende Beitrag beleuchtet neben physiologischen Grundlagen der Schwangerschaft und allgemeinen Überlegungen zur Pharmakotherapie bei Schwangeren, typische Szenarien in der Notfallversorgung mit den entsprechenden Empfehlungen zur jeweiligen Therapie einer schwangeren Patientin.01/2012; 107(2). DOI:10.1007/s00063-011-0037-2
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ABSTRACT: To compare the effects of promethazine with those of metoclopramide for hyperemesis gravidarum. Women at their first hospitalization for hyperemesis gravidarum were approached when intravenous antiemetic therapy was needed. They were randomly assigned to receive 25 mg promethazine or 10 mg metoclopramide every 8 hours for 24 hours in a double-blind study. Primary outcomes were vomiting episodes by diary and well-being visual numerical rating scale score (10-point scale) in the 24-hour main study period. Participants also filled out an adverse-effects questionnaire at 24 hours and a nausea visual numerical rating scale score at recruitment and at 8, 16, and 24 hours. A total of 73 and 76 women, randomized to metoclopramide and promethazine, respectively, were analyzed. Median vomiting episodes were one (range 0-26) compared with two (range 0-26) (P=.81), and well-being visual numerical rating scale scores were 8 (range 1-10) compared with 7 (range 2-10) (P=.24) for metoclopramide and promethazine, respectively. Repeat-measures analysis of variance of the nausea visual numerical rating scale scores showed no significant difference between study drugs (F score=0.842, P=.47). Reported drowsiness (58.6% compared with 83.6%, P=.001, number needed to treat to benefit [NNTb] 5), dizziness (34.3% compared with 71.2%, P<.001, NNTb 3), dystonia (5.7% compared with 19.2%, P=.02, NNTb 8), and therapy curtailment owing to adverse events (0 of 73 [0%] compared with 7 of 76 [9.2%], P=.014) were encountered less frequently with metoclopramide. Promethazine and metoclopramide have similar therapeutic effects in patients who are hospitalized for hyperemesis gravidarum. The adverse effects profile was better with metoclopramide.Obstetrics and Gynecology 05/2010; 115(5):975-81. DOI:10.1097/AOG.0b013e3181d99290 · 4.37 Impact Factor
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ABSTRACT: Medical emergencies in pregnant patients pose a great challenge. Due to a lack of experience many emergency care providers are uncertain about which drugs can be used and the dosage. The following article reviews the physiological changes during pregnancy, general considerations about pharmacotherapy in pregnant patients and highlights typical emergency scenarios with the corresponding recommendations for which drugs to use in pregnant patients.02/2012; 107(2):123-7.