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1.
Unlike severe nausea and vomiting of pregnancy (NVP), it is not known whether milder forms of NVP have been associated with psychosocial morbidity. We undertook the study to explore the prevalence of psychosocial morbidity by severity of NVP, and determine whether, after correction for severity of nausea/vomiting, there is a relationship between psychosocial morbidity and women's decisions to take anti-emetics as a reflection of their distress due to NVP. From 1996-97, an NVP Healthline was advertised. Callers underwent semi-structured interviews about both their NVP and associated psychosocial morbidity in a previous pregnancy. Most of the 3201 callers resided in Canada, worked outside the home, reported on planned pregnancy (a median of) 4 years before, and described severe (> 5 episodes/day of) nausea and vomiting. More severe nausea/vomiting was associated with more frequent feelings of depression, consideration of termination of pregnancy, adverse effects on women's relationships with their partners or their partners' everyday lives, and the perceived likelihood that NVP would harm their baby (p < 0.0001). However, all psychosocial factors were reported by a clinically important proportion of women with mild nausea/vomiting (0-1 episodes/day). The severity of vomiting was most closely related to women's decisions to take anti-emetics, but other psychosocial factors were also independently associated with anti-emetic therapy. We conclude that psychosocial morbidity is evident across the spectrum of severity of nausea and vomiting among women with NVP. The severity of nausea or vomiting does not appear adequately to reflect the distress caused by NVP, as reflected by women's decisions to take anti-emetic therapy.  相似文献   

2.
Unlike severe nausea and vomiting of pregnancy (NVP), it is not known whether milder forms of NVP have been associated with psychosocial morbidity. We undertook the study to explore the prevalence of psychosocial morbidity by severity of NVP, and determine whether, after correction for severity of nausea/ vomiting, there is a relationship between psychosocial morbidity and women's decisions to take anti-emetics as a reflection of their distress due to NVP. From 1996–97, an NVP Healthline was advertised. Callers underwent semi-structured interviews about both their NVP and associated psychosocial morbidity in a previous pregnancy. Most of the 3201 callers resided in Canada, worked outside the home, reported on planned pregnancy (a median of) 4 years before, and described severe (> 5 episodes/day of) nausea and vomiting. More severe nausea/vomiting was associated with more frequent feelings of depression, consideration of termination of pregnancy, adverse effects on women's relationships with their partners or their partners' everyday lives, and the perceived likelihood that NVP would harm their baby (p < 0.0001). However, all psychosocial factors were reported by a clinically important proportion of women with mild nausea/vomiting (0–1 episodes/day). The severity of vomiting was most closely related to women's decisions to take anti-emetics, but other psychosocial factors were also independently associated with anti-emetic therapy.

We conclude that psychosocial morbidity is evident across the spectrum of severity of nausea and vomiting among women with NVP. The severity of nausea or vomiting does not appear adequately to reflect the distress caused by NVP, as reflected by women's decisions to take anti-emetic therapy.  相似文献   

3.
Nausea and vomiting in pregnancy (NVP) is a widespread condition which may impact on the quality of life. Our objective was to understand the role of the placenta, which is mostly made up of fetal cells, in NVP. We examined the relationship between NVP and different partners in the same women. If a paternal contribution to placental function affects NVP, this could shed light on the genetics of the most common condition in pregnancy. We assessed nausea and vomiting in two groups of 100 women counselled by the Motherisk Program in Toronto, using a score from 1 (none) to 5 (severe with hyperemesis). The first group had >/=2 pregnancies with the same partner; the second had >/=2 pregnancies with >/=2 partners. Scores were averaged across pregnancies, partners and overall. Regression was used to separate numbers of pregnancies and partners. The 100 women having one partner reported an average score of 3.1 in their 261 pregnancies, which was similar to the score of 3.0 in 319 multi-partner pregnancies (p = 0.508). There was a positive (but weak) correlation between gravidity and NVP score (Spearman's rho = 0.21, p < 0.001) but not between partner and score. There was a linear increase in scores from 2.7 in the first pregnancy, to 4.0 in the tenth (rho = 0.948, p < 0.01). After controlling for number of pregnancies, number of partners was not associated with NVP scores (p = 0.302). NVP severity tends to increase with each successive pregnancy. Different partners have no impact on NVP severity.  相似文献   

4.
The symptomatology of nausea and vomiting of pregnancy (NVP) ranges from mild to very severe. The most advanced method to measure the burden of NVP, the Rhode's scores, incorporates physical signs (length and number of episodes of nausea, number and volume of vomits, and number of retching) with measures of distress caused by these symptoms. However, this system has been validated only for symptoms that occurred in the past 12 h, thus obviating its wide clinical use, and particularly its retrospective use. OBJECTIVE: To examine whether the severity of the physical symptoms of NVP correlate with the degree of stress caused by them, and to develop simple scores that can be used clinically. METHODS AND RESULTS: We prospectively scored 283 women with NVP using the Rhode's system. There was excellent and highly significant correlation between the physical symptoms and their degrees of distress. Subsequently, we examined two simple scoring systems, one with three and one with five physical symptoms. Both yielded distribution of severity of NVP not different from the one found with the use of the full Rhode's score. CONCLUSION: A scoring system based on all five physical symptoms, or only on three (length of nausea, number of episodes of nausea and number of vomits) yielded accurate estimates of severity and changes in severity of NVP. Unlike the Rhode's score, this simple method can be used clinically to evaluate the severity and changes in NVP.  相似文献   

5.
The Pregnancy-Unique Quantification of Emesis (PUQE) is a scoring system to quantify the severity of nausea and vomiting of pregnancy (NVP). Based on quantification of the 3 physical symptoms of NVP (nausea, vomiting and retching), PUQE closely correlates with the validated but much more complex Rhodes' score. We examined the ability of PUQE to predict four independent aspects of NVP: (a) pregnant women's ability to take multivitamins. (b) rates of emergency room visits and hospitalisation for NVP. (c) health cost of NVP. (d) women's self scores of well-being in NVP. Using large prospective cohorts of women for each end point, severity of NVP measured by PUQE had significant predictive value for all 4 aspects sought. PUQE has been validated through 4 independent clinical outcomes of direct importance and relevance for NVP. The simplicity of PUQE and the ease of its execution make it a practical tool for both clinical follow-up and research.  相似文献   

6.
With up to 80% of pregnant women experiencing nausea and vomiting of pregnancy (NVP), it is critical to have a graded scale of its severity as a guide for appropriate treatment. In 2002 we introduced the Pregnancy-Unique Quantification of Emesis (PUQE) scoring system, which assessed the severity of nausea and vomiting in pregnancy (NVP) based on three physical symptoms: nausea, vomiting, and retching over the previous 12 hours. We present here validation of an extension of the original PUQE, by assessing NVP over 24 hours. This extension is deemed more clinically relevant, because assessment of symptoms over only 12 hours may encompass sleeping hours and hence may not adequately capture the length and severity of the symptoms. In this study we assessed the external validity of the new PUQE-24 by examining its ability to evaluate several characteristics associated with NVP: (a) ability to take multivitamin supplements; (b) rates of hospitalization and emergency room visits for severe symptoms; (c) sleep patterns; (d) liquid intake; and (e) the woman’s self-rated well-being scores. Data collected prospectively from 315 women counselled via the Motherisk NVP line were used for the validation. PUQE-24 showed strong correlation with all parameters examined except for sleep patterns and hydration status. The well-being score, however, correlated significantly with hydration status. Capturing 24 hours rather than 12 hours of symptoms may better direct management of NVP and predict its outcome.  相似文献   

7.
Ensiyeh J  Sakineh MA 《Midwifery》2009,25(6):649-653

Objective

to compare the effectiveness of ginger and vitamin B6 for the treatment of nausea and vomiting in early pregnancy.

Methods

double-blind randomised controlled trial. Pregnant women with nausea, who first attended the antenatal clinic at or before 17 weeks gestation, were invited to participate in the study. Over a 3-month period, 70 women were randomised to receive either ginger 1 g/day or vitamin B6 40 mg/day for 4 days. Subjects graded the severity of their nausea using a visual analogue scale, and recorded the number of vomiting episodes in the 24 hours before treatment and during 4 consecutive days while taking treatment. At 7-day follow-up, women reported any changes in the severity of their symptoms.

Results

compared with baseline, the decrease in the visual analogue scores of post-therapy nausea in the ginger group was significantly greater than that for the vitamin B6 group (p=0.024). The number of vomiting episodes decreased in both groups, and there was no significant difference between the groups. In the ginger group, 29/35 women reported an improvement in nausea symptoms, compared with 23/34 women in the vitamin B6 group (p=0.52).

Conclusion

ginger is more effective than vitamin B6 for relieving the severity of nausea, and is equally effective for decreasing the number of vomiting episodes in early pregnancy.  相似文献   

8.
Study ObjectiveTo determine the relationship between severity of nausea and vomiting during pregnancy (NVP) and depressive symptoms in pregnant adolescents.DesignProspective cross-sectional study.SettingA maternity research hospital outpatient clinic, Ankara, Turkey.ParticipantsA total of 200 pregnant adolescents.Interventions and Main Outcome MeasuresDemographic features and obstetric histories of the participants were assessed. The Rhodes test was performed to determine nausea and vomiting severity in a face-to-face interview, and the self-reported Edinburgh Postnatal Depression Scale was administered with supervision.ResultsThe Rhodes test results showed that 52/200 patients (26%) were classified with none, 83/200 patients (41.5%) with mild, 48/200 patients (24.0%) with moderate, and 17/200 patients (8.5%) with severe symptoms. The mean depression score in the severe vomiting group was significantly higher than that in the no NVP and mild NVP groups (P = .028 and .041, respectively). No differences were found between the other groups.ConclusionSevere nausea and vomiting was associated with greater depressive symptom severity in pregnant adolescents.  相似文献   

9.
The majority of pregnant women experience nausea and vomiting during pregnancy. However, nausea and vomiting in pregnancy is not always nausea and vomiting of pregnancy (NVP). The differential diagnosis of nausea and vomiting in pregnancy can be extensive and the underlying cause can sometimes be difficult to diagnose. However, the timing or onset of the symptoms is important in differentiating NVP from other causes. A thorough history and physical examination, with appropriate investigations, should be carried out in symptomatic women.  相似文献   

10.
Our objective was (1) to evaluate total oxidant status (TOS) and total antioxidant status (TAS) in women with nausea and vomiting of pregnancy (NVP) compared with healthy pregnant controls, and (2) to explore any possible relationship between oxidative stress and clinical severity of the disease. Fifty-three women with NVP and 35 healthy pregnant women were enrolled in the study. Of these 53 women, 25 women were classified as mild and 28 women were classified with moderate/severe NVP. The severity of the disease was assessed by Rhodes' index. Plasma levels of TOS and TAS were determined by using automated methods. TOS was significantly higher and TAS was significantly lower in women with NVP ( P < 0.0001, for both). The moderate/severe NVP group had higher levels of TOS and lower levels of TAS than the women with mild NVP ( P < 0.0001, for both). Moreover, Rhodes' index showed positive correlation with TOS (r = 0.563; P < 0.0001) and negative correlation with TAS (r = -0.595; P < 0.0001). These findings indicate that oxidative stress is increased in NVP. There was a strong relationship between oxidative stress and the clinical severity of the disease. Therefore, we suggest that the levels of TOS and TAS can be used as additional markers in the diagnosis and clinical severity of NVP.  相似文献   

11.
Objectives: (1) To quantify rates of suboptimal use of pyridoxine hydrochloride-doxylamine (Diclectin); and (2) to study responses to optimal doses of Diclectin in women previously taking a suboptimal dose.Methods: Women who called the Motherisk NVP helpline, and were taking only Diclectin (vitamin B6 10 mg and doxylamine 10 mg), were enrolled in the study and assessed for the severity of nausea and vomiting of pregnancy (NVP) with the Motherisk-PUQE (pregnancy-unique quantification of emesis and nausea) scoring system. Their Diclectin doses were subsequently increased according to body weight and individual symptoms. A follow-up phone call occurred within I to 3 weeks after the intervention, at which time the overall PUQE score was repeated, along with individual scoring of symptoms of nausea, vomiting, and retching.Results: Sixty-eight women were enrolled and completed the study. Despite moderate to severe NVP, defined by the validated PUQE scoring system, most women (50/68) were receiving 2 tablets a day of Diclectin instead of the recommended dose of 4 tablets a day. Following a mean doubling of the dose to 4 tablets a day, there was a significant decrease in length of nausea (from 4 to 3 hours, P < 0.001), frequency of vomiting (from mean 1.6 to 1.3 a day, P = 0.02), and overall PUQE score (from mean 7.5 to 6.1, P < 0.001).Conclusion: Women suffering from NVP are often given subtherapeutic doses of Diclectin. Women should receive a dosage according to their body weight and severity of their symptoms.  相似文献   

12.
Introduction: Nausea and vomiting of pregnancy (NVP) are one of the most common complains of the early pregnancy period and are bothersome for pregnant women. Some prefer to use herbal medicine instead of chemical agents.

Objective: The purpose of the present study was to compare the effects of ginger, pyridoxine (vitamin B6), and placebo for the treatment of NVP.

Method: The study was performed as a triple blind clinical trial on pregnant women suffering mild to moderate NVP between 6 and 16 weeks of pregnancy. In these women ginger, 500?mg twice daily, vitamin B6 40?mg twice daily and placebo twice daily were administered for 4?d. Rhodes questionnaire was used for evaluation of the severity of symptoms. The severity of NVP was evaluated 24?h before entering the study and up to 4 d after using medications and results were compared among the three groups.

Results: Seventy-seven women finished the study (28 in the Ginger group, 26 in the B6 group, and 23 in the placebo group). The women of the three groups did not have significant differences according to age, gestational age, parity, and severity of each symptom before treatment and educational status. Total score of Rhodes questionnaire for nausea was decreased significantly in three groups after treatment. (p?p?=?.012, and p?=?.03 for ginger, vitamin B6, and placebo, respectively.) Also total score of Rhodes questionnaire for vomiting was decreased in three groups (p?=?.03 for ginger, p?=?.02 for B6, and p?=?.04 for placebo). Ginger and vitamin B6 could reduce the severity of all items of Rhodes questionnaire significantly; however, placebo was significantly effective only on the frequency of nausea, intensity of vomiting and frequency of retching. Ginger and vitamin B6 were more effective than placebo (p?=?.039 and p?=?.007, respectively); however, total score of Rhodes did not show significant difference between ginger and vitamin B6 (p?=?.128). Ginger was more effective for nausea (intensity and distress) and distress of vomit.

Conclusion: Ginger is more effective than placebo for the treatment of mild to moderate NVP and is comparable with vitamin B6.

Trial registration number and registry website: IRCT2015020320923N1  相似文献   

13.
Case reports have associated severe nausea and vomiting of pregnancy (NVP) with elective termination of pregnancy. Therefore, our objective was to explore the determinants of consideration of termination and actual termination of pregnancy among women with NVP. From 1996 to 1997, callers to an advertised NVP Healthline underwent a semi-structured interview. From callers who retrospectively reported on NVP in a previous pregnancy, a nested unmatched case-control study was performed. Callers were divided into three groups: those who reported having electively terminated their pregnancy due to NVP, those who considered termination due to NVP and those who never considered termination. The severity of nausea and vomiting, and frequency of psychosocial morbidity, were compared between cases and controls, and multivariate logistic regression analysis was used to determine factors independently associated with termination and/or consideration of termination of pregnancy due to NVP. Of 3201 callers with NVP, 413 women reported having considered termination of pregnancy for NVP, 108 reported termination due to NVP and 2609 reported never having considered termination for NVP. The following factors were independently associated with a woman's consideration of termination of pregnancy due to NVP: unplanned pregnancy (p = 0.002), multiparity (p = 0.0001), more severe vomiting (p = 0.003), feelings of depression (p < 0.0001) and reported adverse effects of NVP on both her partner's daily life (p = 0.04) and her relationship with her partner (p = 0.0003). The following factors were independently associated with actual termination of pregnancy due to NVP: unplanned pregnancy (p < 0.0001), multiparity (p = 0.03) and feelings of depression (p = 0.001). There were no significant interactions between factors. Consideration of termination, or actual termination of pregnancy, due to NVP are associated with psychosocial circumstances, which should be taken into consideration when managing these women.  相似文献   

14.
BACKGROUND: Health care providers and popular press articles frequently advise women that nausea and vomiting of early pregnancy (NVP) portends a favorable fetal outcome. AIM: To investigate the claim that NVP protects against adverse fetal outcomes and improves placental and fetal growth. METHODS: Data were collected on a prospective cohort of 849 Ecuadorian prenatal patients beginning in early gestation until postpartum. A questionnaire collected information on NVP and other maternal characteristics. Fetal outcomes and placental characteristics were examined using anthropometry and physical examination. Multivariate statistical methods controlled for potential confounders. RESULTS: Women with nausea only (AOR = 0.45; 95% CI = 0.22-0.94) or nausea with vomiting (AOR = 0.66; 95% CI = 0.46-0.99) had significantly decreased miscarriage risk although the strength of the protection appeared less than that reported for other populations. NVP was not associated with low birth weight, preterm delivery, congenital anomaly, or other outcomes excepting slightly increased mean infant thigh skinfold (P = 0.024), mid-upper arm circumference (P = 0.049), and placental weight (P = 0.034). CONCLUSIONS: The data did not support the common belief that NVP protects against multiple adverse outcomes. Placental weight was slightly increased in women with NVP but this difference was not reflected in higher birth weights or other types of fetal growth except of marginally increased limb fat.  相似文献   

15.
16.

Objective

To evaluate the efficacy of administering a low dose of propofol at the end of surgery in preventing postoperative nausea/vomiting in women undergoing gynecologic laparoscopic surgery.

Method

In a randomized, double-blind, placebo-controlled study, 90 patients received intravenous injections of a placebo or propofol at 2 different low doses, 0.25 mg/kg or 0.5 mg/kg. All episodes of nausea, retching, or vomiting were then recorded for 24 hours.

Results

The percentages of patients experiencing nausea, retching, or vomiting were 67% in the placebo group, 60% in the propofol 0.25 mg/kg group (P = 0.39), and 33% in the propofol 0.5 mg/kg group (P = 0.009). A significant difference in the rates of nausea/vomiting was found between the 2 propofol groups (P = 0.03). No adverse events attributed to the study drug were observed.

Conclusion

Prophylactic therapy with 0.5 mg/kg of propofol was found to be effective in preventing nausea/vomiting in patients undergoing gynecologic laparoscopic surgery.  相似文献   

17.
The objectives of this study were (1) to determine aversive stimuli that are related to nausea and vomiting in pregnancy (NVP); (2) to determine food and fluid intake in early pregnancy; and (3) to explore relationships between aversive stimuli and health measures. A total of 273 women in an antenatal setting completed a questionnaire survey, incorporating the Nausea and Vomiting in Pregnancy Instrument (NVPI); the General Health Questionnaire (GHQ); measures of perceived mood and illness; food and fluid intake; and open-ended questions relating to perceived aversive and helpful stimuli. Data was subjected to quantitative and qualitative analysis. A total of 57% of women reported aversive stimuli. Of these, the primary sense implicated was olfaction, with 72% reporting food smells. A number of women were affected by the odours of drinks (26%) and other products (31%). Women who were adversely affected by odours had higher severities of NVP, perceived illness and psychopathology scores on the GHQ. In conclusion, odour appears to be an important stimulus related to NVP, with perceived aversive smells related to the severity of nausea. Women severely affected by NVP demonstrated worse health. The role of olfaction in pregnancy and specifically in sufferers of severe NVP should be evaluated further.  相似文献   

18.
OBJECTIVE: To investigate the association between either depression or anxiety early in pregnancy, and nausea and vomiting, in a clinical sample. METHODS: Anxiety and depression scores of 230 women were investigated by using the Hospital Anxiety and Depression Scale. Nausea and vomiting of pregnancy (NVP) were scored by using the Rhode's system. These scores and demographic data were compared and P < 0.05 was considered significant. RESULTS: A significant correlation between Rhode's score and both anxiety (r=0.388, P < 0.001) and depression score, (r=0.351, P < 0.001) was found. Gestational age showed and inverse correlation with anxiety scores (P=0.019). There was no significant correlation between demographic data and anxiety/depression scores, or Rhode's scores. CONCLUSION: There is an association between anxiety and depression early in pregnancyand severity of NVP.  相似文献   

19.
20.
《Seminars in perinatology》2014,38(8):496-502
With 50–90% of pregnant women experiencing nausea and vomiting of pregnancy (NVP), the burden of illness can become quite significant if symptoms are under-treated and/or under-diagnosed, thus allowing for progression of the disease. The majority of these women will necessitate at least one visit with a provider to specifically address NVP, and up to 10% or greater will require pharmacotherapy after failure of conservative measures to adequately control symptoms. As a result, initiation of prompt and effective treatment in the outpatient setting is ideal. Once NVP is diagnosed and treatment is started, it is crucial to track symptoms in order to assess for a decrease in or resolution of symptoms as well as an escalation in symptoms requiring additional therapy. Of note, co-existing gastroesophageal reflux disease (GERD), Helicobacter pylori infection, and psychosocial factors may have a negative impact on the management of NVP. Ultimately, every woman has her own perception of disease severity and desire for treatment. It is critical that both the provider and patient be proactive in the diagnosis and management of NVP.  相似文献   

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