Severe nausea and vomiting in pregnancy - Hiperemezis gravidarium - Treatment

Initial therapy should be conservative and may include dietary recommendations and food support. Strategies include a soft diet and nutrition before lifting in the morning.
Medical therapy:If pharmacologic therapy is necessary treatment is initiated with the administration of vitamin B 6, doxilamina 3 times per day. Ginger capsules 4 times per day may be added if the patient vomits. Ginger has proven useful in numerous studies in this condition. Antiemetics: metoclopramide, promethazine, ondasetron, low-dose methylprednisolone if vomiting persists. If hypokalemia is severe potassium is administered parenterally.
Pyridoxine is helpful in reducing severe vomiting but less effective in the moderate. In combination with doxilamina, the active ingredient in many pills have been shown in numerous studies to reduce nausea and vomiting by 70%.Ondasetronul became the most widely used orally and parenteral antiemetic in pregnancy. It is useful for patients who do not tolerate the drug orally. It is a serotonin antagonist. It can use other emetics such as promethazine and prochlorperazine.Anticholinergics are supported by some studies. Dimenhidrinatul meclizine and are more useful than placebo in emesis of pregnancy. Metoclopramide, servant promotilitate was shown to be more effective than placebo in treating hiperemezei, but is associated with increased birth defects.Corticosteroids may be beneficial in the treatment hiperemezei gravidarium. I think the last option in patients requiring parenteral or enteral nutrition due to weight loss. The system is used with methylprednisolone for 3 days. Patients who do not respond within this period do not adhere to treatment. Recent studies show the association between oral cleft and methylprednisolone used in the first quarter. Recommendation of corticosteroids is used with caution and avoided before 10 weeks' gestation.Ginger capsules are an herbal remedy commonly used in hiperemeza. They come four times a day and are effective against emesis comparable, with placebo, without evidence of significant adverse effects.
Diet:Suggestions for modifications in patients with hiperemeza food include the following:-Consumption of food at the request of whatever body of meals- Frequent consumption of small meals-Avoiding fat and spices, fresh and dried food consumed increaseEliminating pills with iron--Protein meals are usefulBeverage consumption-growth cabogazoase-Consumption of ginger, mint, bread without butter, jelly-Consumption of prenatal vitamins may decrease emesis associated with pregnancy.
Prognosis:Hiperemeza gravidarium self-limiting and in most cases not improve until the first quarter. However symptoms can persist up to 20-22 week of gestation, or in some cases up to birth. The condition is still associated with significant morbidity, but it is a rare cause of maternal death. Gravidarium hiperemezis Women who lost weight are at increased risk of low birth weight babies. The disease is severe and inadequately treated can cause weight loss, dehydration, nutritional deficiencies, emotional stress, metabolic disturbances, difficulty in daily physical activity, hallucinations. Some women lose weight up to 20%. Many suffer from extreme sensitivity to odors in the environment-hiperolfactie. Ptialismul or salivation is another symptom experienced by some women who suffer from hiperemeza.
In moderate vomiting, the patient and the fetus does not experience morbidity or mortality. Before the invention of intravenous hydration, hiperemeza was a major cause of maternal death. Today death is extremely rare, but morbidity meterne Wernicke encephalopathy comprehensive vitamin B deficiency, sindromu Mallory-Weiss esophageal rupture, pneumothorax, acute tubular necrosis. Hiperemeza is the second leading cause of hospitalization in pregnancy and premature birth.