Hyperemesis Gravidarum and the Sex of the Offspring

Studies have suggested that offspring of women hospitalized for hyperemesis gravidarum have a different sex ratio than those of women without this diagnosis, but little is known of the potential association between fetal gender and variables such as severity of hyperemesis, gestational trimester, and maternal age. Our findings provide evidence that pregnant women with a diagnosis of hyperemesis gravidarum in the first trimester give birth to a higher proportion of female newborns than do all mothers, regardless of whether they are hospitalized.     

妊娠剧吐与围产结局病例对照研究

目的:探讨妊娠剧吐对妊娠结局及妊娠期高血压疾病发生的影响。方法:收集2004年1月～2007年2月因妊娠剧吐在上海市第六人民医院住院并具有完整孕期资料的产妇40名,与随机抽取53名非妊娠剧吐者进行对比,比较两组间妊娠结局、剖宫产率及妊娠期高血压疾病发生率的差异。结果:对比与未合并妊娠剧吐的孕妇组,妊娠剧吐在一定程度上提高早产儿、女婴分娩率,但其间没见到明显的统计学意义。而在胎儿生长受限(低体重儿及小于孕龄儿)、妊娠期高血压疾病发生率及巨大儿、剖宫产率间有显著的统计学意义(P<0.05)。其妊娠剧吐组母体孕期增加的体重、新生儿出生体重、分娩孕周也明显低于对照组。结论:妊娠早期合并妊娠剧吐会影响到孕晚期母婴结局,故临床上我们要重视妊娠剧吐的发生和彻底治疗,并科学的指导这部分孕妇整个孕期的饮食健康管理,从根本上降低其引起的不良妊娠结局的发生。     

妊娠剧吐与胎儿生长受限的关联研究

目的探讨妊娠剧吐(HG)与胎儿生长受限(FGR)间的关联及其作用途径。方法问卷调查收集2 522名住院待产孕妇的人口统计学信息、孕期HG发生情况(HG组、轻度呕吐组、无呕吐组)、孕期饮食行为和心理状况,在分娩后记录新生儿出生结局。结果 HG组孕妇孕早期妊娠相关焦虑得分、孕晚期焦虑和抑郁得分均显著高于无呕吐组,孕期增重显著低于无呕吐组。多因素Logistic回归模型显示,早产(RR=1.94,95%CI 1.05～3.56)、女婴(RR=2.50,95%CI 1.67～3.76)、奶及奶制品摄入减少(RR=1.87,95%CI 1.10～3.18)、孕早期妊娠相关焦虑得分P75(RR=1.85,95%CI 1.05～3.25)、孕期增重相似文献   

Fetal salvage with maternal total parenteral nutrition: the pregnant mother as her own control

Hyperemesis gravidarum affects both maternal and fetal well-being by reducing maternal vascular volume (normally increased with pregnancy) and depleting maternal nutritional stores. Severe intractable hyperemesis may result in fetal demise. This report documents the ability to maintain maternal fluid and nutritional requirements during first trimester pregnancy in a female with intractable hyperemesis gravidarum. Additionally, this patient is unique in that her five prior pregnancies were complicated by hyperemesis with the last three resulting in fetal demise. Speculation regarding the relative importance of inadequate hydration and nutrition in first trimester fetal viability is given. When hyperemesis is unresponsive to conventional management, intravenous hydration should be instituted without delay to preserve maternal intravascular blood volume and thus placental blood flow. Consideration for total parenteral nutrition can then be given which, after adequate in-hospital instruction, may in most cases be continued in the home.     

孕早期妊娠呕吐相关危险因素回顾性队列研究

目的 调查分析武汉市孕早期妊娠剧烈呕吐的相关危险因素,指导孕期妇女的预防保健工作。方法 采用回顾性队列研究的方法,选择孕早期来院产检的孕妇,了解其早孕反应的情况,采用logistic回归分析对资料进行分析。结果 武汉市孕早期妊娠剧烈呕吐的相关危险因素有：孕周、噪音、睡眠不好、新近装修、咖啡和孕后食量减少,而孕后口味嗜酸辣、少吃蔬菜、TORCH至少有一项IGM阳性是HG的保护因素,并且孕前体重越大则HG的发生越少。结论 应重视孕早期剧烈呕吐问题,减少噪音等不良因素的暴露,创造良好妊娠条件,注意均衡饮食,保证睡眠,不提倡瘦身怀孕．以尽量减少HG的发生。     

肠内外营养在妊娠剧吐治疗中的应用

妊娠剧吐不利于母亲和胎儿的健康,提供足够的营养支持是治疗的主要措施。本文简要介绍近年肠内外营养在妊娠剧吐治疗中的应用情况,旨在为正确选择何种营养途径提供新的思路。     

24G留置针在妊娠剧吐输液中的应用

目的探讨在妊娠剧吐输液治疗中应用24G留置针的作用。方法将200例妊娠剧吐输液患者随机分为两组,观察组使用24G留置针,对照组按常规使用7号钢针,调查两组患者静脉穿刺时疼痛程度、1 d内重新穿刺率、输液速度等情况。结果观察组患者1 d内重新穿刺率好于对照组,差异有统计学意义(P<0.01)。两组患者静脉穿刺时疼痛程度、输液速度差异无统计学意义。结论应用24 G留置针为妊娠剧吐孕妇进行输液治疗能降低重新穿刺率,减轻患者痛苦,减少护理工作量,保证护理安全。     

孕妇夫妻双方参与健康教育效果观察

目的:探讨孕妇夫妻双方参与治疗妊娠剧吐健康教育对改善临床症状的效果。方法:随机将120例妊娠剧吐孕妇分为实验组和对照组,实验组孕妇夫妻双方参与妊娠剧吐的健康教育;对照组仅对孕妇本人进行健康教育,观察两组孕妇的疗效情况。结果:实验组病情恢复显著优于对照组,有临床意义(P<0.05)。结论:夫妻双方参与妊娠剧吐的健康教育能有效地改善患者的临床症状,缩短病程,是促进妊娠剧吐孕妇积极配合治疗及保证临床疗效的重要环节。     

Diet before pregnancy and the risk of hyperemesis gravidarum

Hyperemesis gravidarum (hyperemesis), characterised by severe nausea and vomiting in early pregnancy, has an unknown aetiology. The aim of the present study was to investigate food and nutrient intake before pregnancy and the risk of developing hyperemesis in women participating in the Norwegian Mother and Child Cohort Study. From 1999 to 2002, a total of 7710 pregnant women answered a FFQ about their diet during the 12 months before becoming pregnant and a questionnaire about illnesses during pregnancy, including hyperemesis. Only women who were hospitalised for hyperemesis were included as cases. Nutrient intakes during the year before pregnancy did not differ between the ninety-nine women who developed hyperemesis and the 7611 who did not. However, the intake of seafood, allium vegetables and water was significantly lower among women who developed hyperemesis than among women in the non-hyperemesis group. Relative risks of hyperemesis were approximated as OR, and confounder control was performed with multiple logistic regression. Women in the upper tertile of seafood consumption had a lower risk of developing hyperemesis than those in the lower tertile (OR 0·56, 95 % CI 0·32, 0·98), and women in the second tertile of water intake had a lower risk of developing hyperemesis than those in the first tertile (OR 0·43, 95 % CI 0·25, 0·73). The findings suggest that a moderate intake of water and adherence to a healthy diet that includes vegetables and fish are associated with a lower risk of developing hyperemesis.     

妊娠早期剧烈呕吐相关危险因素及其对妊娠结局的影响

目的:探讨妊娠早期剧烈呕吐的相关危险因素,分析妊娠剧烈呕吐与妊娠结局的关系,指导孕期妇女的预防保健工作。方法:采用队列研究的方法,分析孕早期妇女妊娠剧烈呕吐状况,追踪其妊娠结局,主要分析方法为卡方检验和Logistic回归分析。结果:妊娠早期剧烈呕吐的相关危险因素有孕周、噪音、睡眠不好、新近装修、咖啡和孕后食量减少,而孕后口味嗜酸辣、少吃蔬菜是剧烈呕吐的保护因素。孕早期剧烈呕吐不是不良妊娠结局的高危因素,对妊娠结局影响不大。结论:妊娠早期剧烈呕吐与妊娠结局关系不大,但应重视孕早期剧烈呕吐,减少噪音等不良因素的暴露,创造良好妊娠条件,注意均衡饮食,保证睡眠,以尽量减少高危妊娠的发生。     

Enteral nutrition in hyperemesis gravidarum: a new development.

Hyperemesis gravidarum occurs in up to 2% of pregnancies. Hospitalization is commonly required to treat dehydration and electrolyte and metabolic imbalances. Severe forms of hyperemesis gravidarum involving weight loss greater than 5% of prepregnancy weight have been associated with poor fetal growth and outcome. Hyperemesis gravidarum is a high-risk condition from a nutritional perspective. Traditional approaches to nutrition management focus on the cautious introduction of fluids and low-fat solids following resolution of acute nausea and vomiting. When trials of oral feeding fail to be tolerated, consideration should be given to the enteral route as the means of nutritional rehabilitation. A carefully designed delivery regimen combined with antiemetic therapy can prevent abdominal or sensory episodes that might precipitate further vomiting. Two case studies of the successful use of enteral nutrition in hyperemesis gravidarum are presented. Although clinical experience is limited and further research is needed, early results suggest that enteral nutrition in hyperemesis gravidarum is an effective and safe technique.     

Nasojejunal feeding in hyperemesis gravidarum--a preliminary study

Hyperemesis gravidarum is a severe form of nausea and vomiting during the first trimester of pregnancy. Our objective was to assess the feasibility of nasojejunal feeding in our patients. Eleven pregnant women aged 23-46 years with hyperemesis gravidarum, persisting in spite of an in-hospital treatment of 2-15 days by intravenous fluids and antiemetic drugs and accompanied by weight loss, consented to have a nasojejunal feeding tube inserted endoscopically. Mean in-hospital weight loss prior to tube insertion was 2.2+/-1.1 kg (range 0.9-5.1 kg). A clear reduction in the extent of vomiting was already apparent within the first 48 h after tube insertion, but vomiting ceased completely after a mean of 5+/-4 days (range 1-13 days). Weight gain was recorded in six patients who stayed on tube feeding for more than 4 days. Patients were encouraged to start drinking and eating along tube feeding after 3-4 days. Ceasing vomiting and a concomitant sufficient oral intake of at least 1000 kcal/day resulted in the decision to remove the tube after 4-21 days. In three cases, however, the tube was expelled by recurrent vomiting after 1-4 days, or was blocked as in one case. The tube was not reintroduced and patients did not resume vomiting. There were no complications associated with this feeding approach in this population. Only one patient was readmitted. None of the rest resumed vomiting after tube withdrawal.The above suggests that nasojejunal enteral feeding can be an effective option in hyperemesis gravidarum persisting despite intravenous fluids and antiemetic drugs.     

Thiamine deficiency and beriberi features in a patient with hyperemesis gravidarum

Wernicke's encephalopathy has been sporadically reported in patients with severe hyperemesis gravidarum. We report a new case of Wernicke's encephalopathy in a patient who had hyperemesis gravidarum associated with signs and symptoms of dry and wet beriberi. The case was managed with very large doses of thiamine. The conclusion was that, in long-lasting hyperemesis gravidarum, recognizing signs of beriberi may help prevent the onset of Wernicke's encephalopathy, thanks to timely therapy with thiamine supplements. A thiamine therapy similar to the one reported in this article could prove useful in long-lasting hyperemesis gravidarum complicated by Wernicke's encephalopathy.     

孕产妇幽门螺旋杆菌感染及其与病理妊娠的关系

目的:探讨孕产妇幽门螺旋杆菌感染情况及其与病理妊娠的关系。方法:随机选取门诊和住院的孕产妇,用胶体金层析法幽门螺旋杆菌抗原检测试剂盒检测孕产妇粪便中幽门螺旋杆菌抗原(HpSA),对孕产妇归类分组,并计算出幽门螺旋杆菌感染率。结果:共对3620例孕产妇进行了粪便幽门螺旋杆菌抗原检测。正常妊娠孕产妇2 578例中HpSA+106例,幽门螺旋杆菌感染率为4.11%,病理性妊娠孕产妇1 042例中HpSA+50例,感染率为4.80%,略高于正常孕产妇,但统计学上无显著差异(P>0.05)。其中,妊娠剧吐、流产、死胎等早中期病理妊娠孕产妇幽门螺旋杆菌的HpSA+率为8.52%,显著高于正常孕产妇组和晚期病理妊娠组(P<0.01);在所有病理妊娠中,又以胎儿生长受限和妊娠剧吐孕产妇感染率最高,HpSA+率分别为27.3%和17.2%,显著高于正常孕产妇组和其他病理妊娠组(P<0.01)。结论:幽门螺旋杆菌感染与早中期病理妊娠,尤其是妊娠剧吐和胎儿生长受限有一定的关系,可能是诱发早中期病理妊娠和胎儿生长受限的因素之一。     

Feeding Jejunostomy for the Treatment of Severe Hyperemesis Gravidarum: A Case Series

Background: Hyperemesis gravidarum is severe nausea and vomiting during pregnancy leading to dehydration, nutrition deficiency, and fetal morbidity and mortality. Treatment must maintain fluid and electrolyte balance and caloric intake. Parenteral nutrition is often attempted; however, complication rates are high. Nutrition via nasoenteric and percutaneous endoscopic gastrostomy tubes is limited by poor patient tolerance, tube dislodgement, and altered anatomy in pregnancy. Methods: Women with hyperemesis gravidarum who failed standard therapy were offered jejunostomy. All patients underwent surgical jejunostomy in the second trimester. Isotonic tube feeds were administered to a goal caloric factor calculated by the Harris‐Benedict equation with a correction added for pregnancy. Patients were monitored until delivery. Results: Five women underwent jejunostomy placement at our institution between 1998 and 2005. One patient underwent jejunostomy placement twice for consecutive pregnancies. The mean body weight loss from prepregnancy was 7.9% (range, 4.0%–15.9%). Patients underwent jejunostomy placement between 12 and 26 weeks of gestation (median 14 weeks). Twelve to 16 Fr catheters were placed in the proximal jejunum. Maternal weight gain occured in 5 of 6 pregnancies. The mean duration of tube placement was 19 weeks (range, 8–28 weeks). All pregnancies ended with term deliveries (range, 36–40 weeks of gestation). The mean infant birth weight was 2885 g (range, 2270–4000 g). Tube‐related complications were limited to dislodgement in 2 patients in the third trimester. No cases of infection, bleeding, or preterm labor occured. Conclusions: Feeding via jejunostomy is a potentially safe, effective, and well‐tolerated mode of nutrition support therapy in hyperemesis gravidarum.     

Hyperemesis, hyperthyroidism, or both?

Nausea and vomiting are common during pregnancy and, when severe enough to require intervention, may develop into the syndrome known as hyperemesis gravidarum. When the diagnosis of hyperemesis is considered, a careful search for secondary causes is necessary. The list of secondary causes includes hyperthyroidism, a relatively uncommon condition during pregnancy. Because many of the signs and symptoms of hyperthyroidism are common, and thyroid function tests are more difficult to interpret during normal pregnancy, making the diagnosis of hyperemesis gravidarum is a challenge. The decision to treat or to await spontaneous resolution depends on the severity of the illness and the likelihood of the presence of true Graves' disease. The case summarized here demonstrates these issues, and includes treatment options for hyperemesis-associated hyperthyroidism.     

Hyperemesis gravidarum: an approach to the nutritional aspects of care

There has been little documentation on how to care for the patient with hyperemesis gravidarum. This article presents one method for managing patients with severe hyperemesis gravidarum in the hospital. At MacDonald House of University Hospitals of Cleveland, this method has been used quite successfully for the last five years. The combination of team support, individualized care, supplements created by the dietitian on the basis of patient preferences, and an adapted documented approach for patients with eating aberrations are important aspects of effective management of hyperemesis gravidarum.     

Transient hyperthyroidism of hyperemesis gravidarum: a sheep in wolf's clothing

BACKGROUND: Transient hyperthyroidism of hyperemesis gravidarum (THHG) is a self-limiting hyperthyroidism occurring in the context of hyperemesis gravidarum. METHODS: A literature search of MEDLINE was undertaken, and a case report of a woman with THHG in pregnancy is described. RESULTS AND CONCLUSIONS: Because thyroid function tests cannot distinguish Graves disease from THHG, the diagnosis of THHG rests largely on the concurrent development of hyperemesis and hyperthyroidism and the absence of signs and symptoms of hyperthyroidism before and during pregnancy. THHG might be responsible for 40% to 70% of thyroid function abnormalities in pregnancy. Both the thyroid function abnormalities and hyperemesis are related to elevated levels of human chorionic gonadotropin. THHG resolves by 18 weeks of pregnancy without sequelae. No treatment is required. Diagnosis of THHG by the primary care provider can prevent unnecessary treatment or referral for specialty care.     

心理护理对妊娠剧吐患者的治疗效果

目的分析心理护理在妊娠剧吐患者中所起的作用。方法对妊娠剧吐患者进行分组观察,对于观察组患者采取科学有效的心理护理方法。结果观察组治愈17例(85%),3例治疗好转出院,总有效率达100%;对照组治愈6例(31%),好转11例,无效3例,总有效率为86%。两组疗效比较差异有统计学意义(P<0.05)。结论在妊娠剧吐患者中,应用心理护理者明显优于单纯药物治疗者,临床观察疗效可靠,不容忽视。     

Hyperemesis gravidarum and thyrotoxicosis--a diagnostic and therapeutic problem

We report a case of hyperemesis gravidarum complicated by thyrotoxicosis which was managed conservatively during pregnancy. Problems of diagnosing mild thyrotoxicosis in pregnancy are discussed. Although no specific antithyroid therapy was given, the patient had an uneventful pregnancy after the first trimester. Neither she nor her baby exhibited any subsequent features of thyroid dysfunction. This suggests that treatment of thyrotoxicosis in early pregnancy is not always required because of the spontaneous improvement which is likely to occur as pregnancy progresses.