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A Mild Nausea and Vomiting of Pregnancy
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Reassurance and dietary advice are all that is required in most instances Because of possible teratogenicity, drugs used during the first half of pregnancy should be restricted to those of major importance to life and health Antiemetics, antihistamines, and antispasmodics are generally unnecessary to treat nausea of pregnancy Vitamin B6 (pyridoxine), 50 100 mg/d orally, is nontoxic and may be helpful in some patients
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B Hyperemesis Gravidarum
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Hospitalize the patient in a private room at bed rest Give nothing by mouth for 48 hours, and maintain hydration and electrolyte balance by giving appropriate parenteral fluids and vitamin supplements as indicated Rarely, total parenteral nutrition may become necessary As soon as possible, place the patient on a dry diet consisting of six small feedings daily plus clear liquids 1 hour after eating Prochlorperazine rectal suppositories may be useful After in-patient stabilization, the patient can be maintained at home even if she requires intravenous fluids in addition to her oral intake
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Bondok RS et al Pulsed steroid therapy is an effective treatment for intractable hyperemesis gravidarum Crit Care Med 2006 Nov;34(11):2781 3 [PMID: 16957638] Verberg MF et al Hyperemesis gravidarum, a literature review Hum Reprod Update 2005 Sep Oct;11(5):527 39 [PMID: 16006438]
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VOMITING OF PREGNANCY (MORNING SICKNESS) & HYPEREMESIS GRAVIDARUM (PERNICIOUS VOMITING OF PREGNANCY)
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ESSENTIALS OF DIAGNOSIS
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Morning or evening nausea and vomiting Persistent vomiting severe enough to result in weight loss, dehydration, starvation ketosis, hypochloremic alkalosis, hypokalemia May have transient elevation of liver enzymes Appears related to high or rising serum hCG More common with multiple gestation or hydatidiform mole
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SPONTANEOUS ABORTION
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ESSENTIALS OF DIAGNOSIS
Intrauterine pregnancy at less than 20 weeks Low or falling levels of hCG Bleeding, midline cramping pain Open cervical os Complete or partial expulsion of products of conception
General Considerations
Nausea and vomiting begin soon after the first missed period and cease by the fifth month of gestation Up to three-fourths
General Considerations
About three-fourths of spontaneous abortions occur before the 16th week; of these, three-fourths occur before
CMDT 2008
CHAPTER 18 B Laboratory Findings
Pregnancy tests show low or falling levels of hCG A complete blood count should be obtained if bleeding is heavy Determine Rh type, and give Rho(D) immune globulin if the type is Rh-negative All tissue recovered should be assessed by a pathologist and may be sent for genetic analysis in selected cases
the eighth week Almost 20% of all clinically recognized pregnancies terminate in spontaneous abortion More than 60% of spontaneous abortions result from chromosomal defects due to maternal or paternal factors; about 15% appear to be associated with maternal trauma, infections, dietary deficiencies, diabetes mellitus, hypothyroidism, the lupus anticoagulant-anticardiolipin-antiphospholipid antibody syndrome or anatomic malformations There is no reliable evidence that abortion may be induced by psychic stimuli such as severe fright, grief, anger, or anxiety In about one-fourth of cases, the cause of abortion cannot be determined There is no evidence that video display terminals or associated electromagnetic fields are related to an increased risk of spontaneous abortion It is important to distinguish women with a history of incompetent cervix from those with more typical early abortion and those with premature labor or rupture of the membranes Characteristically, incompetent cervix presents as silent cervical dilation (ie, with minimal uterine contractions) between 16 and 28 weeks of gestation Women with incompetent cervix often present with significant cervical dilation (2 cm or more) and minimal symptoms When the cervix reaches 4 cm or more, active uterine contractions or rupture of the membranes may occur secondary to the degree of cervical dilation This does not change the primary diagnosis Factors that predispose to incompetent cervix are a history of incompetent cervix with a previous pregnancy, cervical conization or surgery, cervical injury, diethylstilbestrol (DES) exposure, and anatomic abnormalities of the cervix Prior to pregnancy or during the first trimester, there are no methods for determining whether the cervix will eventually be incompetent After 14 16 weeks, ultrasound may be used to evaluate the internal anatomy of the lower uterine segment and cervix for the funneling and shortening abnormalities consistent with cervical incompetence
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