Two pregnant women with vomiting and fits

Two women with hyperemesis gravidarum were first seen with a short history of confusion diplopia, unsteadiness, and fits caused by Wernicke's encephalopathy. The neurologic presentation had been precipitated by a carbohydrate load inadvertently administered without vitamin supplementation. We stress the importance of prescribing thiamine supplements to all women with prolonged vomiting during pregnancy.(Am J Obstet Gynecol 1997;177:1539-40.)     

Understanding the Stigma of Hyperemesis Gravidarum: Qualitative Findings from an Action Research Study

Abstract: Background: Severe nausea and vomiting in pregnancy (hyperemesis gravidarum) can be a distressing and debilitating condition when it is uncontrolled. For all concerned, hyperemesis gravidarum can be difficult to treat satisfactorily, and women tend to be admitted to a hospital several times during early pregnancy. Our research objectives were to describe the experience of hyperemesis gravidarum from the perspective of affected women and to explore with health care professionals the barriers and facilitators to caring for women with the condition. Methods: A qualitative research design was used. A total of 18 women were interviewed, of whom 8 had two or more interviews. Seven focus groups were conducted with health care professionals. Thematic data analysis was undertaken. Results: The main themes emerging from the women’s data were the effect and burden of the symptoms of the condition and feeling unpopular with staff. From the practitioner data, the main themes were the validity (or invalidity) of hospitalization for women, skepticism of the severity of symptoms, the psychological and social dimensions of the condition, and inadequate primary care services. Conclusions: The main findings revealed that hyperemesis gravidarum is a debilitating condition and that the unhelpful attitudes of practitioners may affect whether women access timely and appropriate care. Many women appear to be unsupported by primary care services and are distressed when perceived either as “time wasters” or someone else’s responsibility. We propose that a tailored assessment and care plan for each woman is needed to help them control their symptoms, which ideally should be delivered in the community. (BIRTH 37:3 September 2010)     

Striae gravidarum: associated factors

BACKGROUND: Striae gravidarum (SG) is the most common change in connective tissue of pregnant women and may cause cosmetic concerns. OBJECTIVES: To determine the frequency of SG in Iranian pregnant women and its possible associations with the characteristics of themselves and their newborns. METHODS: One hundred and eighteen primigravid pregnant women were included in this prospective observational study at their first prenatal visit, among them 114 completed the study and gave birth. RESULTS: One hundred (87.7%) of 114 women developed SG with a mean Davey's score of 4.04 +/- 2.47. The mean gestational age at which SG first appeared was 27.57 +/- 5.38 weeks. Family history of SG in mother, baseline and delivery body mass index, greatest abdominal and hip girths, newborn weight, height and head circumference were significantly associated with the presence of SG. All of these factors were also correlated with Davey's score. CONCLUSION: Genetic and physical risk factors may be involved in the development of SG in primigravid women.     

维生素B6不同用药途径对妊娠剧吐疗效的对比

目的:比较维生素B6不同用药途径对妊娠剧吐的治疗效果。方法:将60例妊娠剧吐患者随机分为维生素B6穴位注射组和静脉给药组各30例,按相应的给药途径给药,比较不同用药途径的治疗效果。结果:穴位注射组的治疗总有效率明显大于静脉给药组,治疗时间明显小于静脉给药组,差异均有统计学意义(P<0.05)。结论:与静脉点滴给药途径比较,穴位注射维生素B6治疗妊娠剧吐效果更好,临床应用价值更高。     

Spontaneous globe subluxation in a patient with hyperemesis gravidarum: a case report and review of the literature

Globe subluxation, or anterior dislocation of the eyeball, is rarely encountered by emergency physicians. We report a case of subluxation of the globe secondary to severe vomiting followed by a discussion of globe subluxation, potential causes, procedure for reduction, and treatment for recurrent episodes. Early treatment by emergency physicians may prevent long-term complications and limit patient discomfort and anxiety.     

Serum concentrations of MMP-1, MMP-2, and TIMP-1 in Chinese women: age-related changes, and the relationships with bone biochemical markers, bone mineral density

BACKGROUND: Osteoblast-derived matrix metalloproteinse-1 (MMP-1), MMP-2 and tissue inhibitor of metalloproteinase-1 (TIMP-1) play a role in bone metabolism by degrading bone matrix. METHODS: We measured MMP-1, MMMP-2, TIMP-1 and associated results with age and bone metabolism in 591 Chinese women aged 20-80 y. RESULTS: Serum MMP-1, MMP-2, and TIMP-1 concentrations exhibited positive correlation with age. Serum concentrations of MMP-1 were higher in 40-69 y old women. The concentrations of MMP-2 were significantly increased in the 50-69 y olds. Serum TIMP-1 concentrations were significantly lower in women aged 30-59 y, and then these were followed by an increase at >60 y olds. We found a significant negative weaker correlation between MMP-2 and BMD. But multiple linear stepwise regression analysis showed that MMP-2 was not a determinant factor for BMD. There were significant positive correlations between MMP-2 and bone alkaline phosphatase (BAP), osteocalcin (OC), and cross-linked N-telopeptides of type I collagen (NTX). CONCLUSIONS: The serum concentrations of MMP-1, MMP-2, and TIMP-1 exhibit age-related changes, and circulating MMP-2 and bone turnover are related.     

The impact of severe hyperemesis gravidarum on the triple test screening results

Objective: we aimed to determine the influence of severe hyperemesis gravidarum on the interpretation of the triple test screen results. Methods: A retrospective, case control study. The study group included 73 women who were hospitalized due to severe hyperemesis gravidarum and data regarding triple screening test was available. Data was compared with a control group consisting of low-risk patients without hyperemesis gravidarum, who underwent the triple screening test in the same laboratory and matched to the study group by maternal age and gestational age at the time of screening in a 2:1 ratio. Results: Overall, 219 gravid patients were included in the study, of whom 73 were diagnosed with severe hyperemesis gravidarum. Patients in the control group were characterized by higher weight at the time of triple test screen (53.7?±?10.9 vs. 59.7?±?14.3 years, p?=?0.043). No difference was found in the level of Alpha-fetoprotein or unconjugated estriol (uE3) between the groups; however the level of hCG was significantly increased in women with severe hyperemesis gravidarum (1.2977?±?0.82 vs. 1.0662?±?0.53 MoM, p?=?0.013). Conclusion: Increase in the level of hCG in women with severe hyperemesis gravidarum alter the results of triple test screen. This data should be incorporated when counseling patients regarding overall risk for chromosomal abnormalities.     

Mirtazapine: treatment of depression, anxiety, and hyperemesis gravidarum in the pregnant patient. A report of 7 cases

Summary Objective: Though selective serotonin re-uptake inhibitors have been studied in pregnancy (Gupta, 1998), there is little information on the efficacy and safety of mirtazapine (Remeron^?), a central alpha-2 blocker for treatment of depression and anxiety in pregnancy. Since mirtazapine blocks the 5HT-3 receptor postsynaptically, like ondansetron (Zofran^?) but unlike any other antidepressant, there is reason to believe that mirtazapine may be of great use in treating not only depression and anxiety in pregnancy but also nausea and the more severe condition, hyperemesis gravidarum. Method: Seven cases are reviewed in which mirtazapine was given in pregnancy for hyperemesis and depression. Five patients were treated as outpatients. Two patients were begun on mirtazapine as inpatients already on transparenteral nutrition, one having had a negative reaction to ondansetron and metoclopramide. Results: All patients demonstrated improvement of depressed mood, and reduced nausea and vomiting. All seven babies were born at term, each with APGAR scores of 7 or 8 at one minute, 9 at five minutes. Conclusions: Mirtazapine may prove a valuable treatment in pregnancy for depression, anxiety and/or hyperemesis, based on its dual action (serotonin and norepinephrine), efficacy in treating depression, and antagonism of 5HT-3. Further studies of its potential therapeutic use in pregnancy are warranted.     

中西药治疗妊娠剧吐400例观察

目的：探讨中西药结合斑娠别吐的价值。方法：对400例妊娠剧吐回顾总结。结果：中西药结合治疗妊娠剧吐较单纯的西药治疗有明显优势。结论：中西药结合治疗妊娠剧吐较单纯的西药治疗妊娠剧吐疗效更好。