Hyperemesis gravidarum

Hypnosis maybe effective for severe NVP.11 Psychotherapy is another non-invasive treatment approach that is safe during pregnancy or in situations in which adverse treatment effects and drug interactions are a concern. One small study suggested that patients with hyperemesis gravidarum may benefit from the combination of psychotherapy and antiemetics. 

In rare instances (0.5% to 2% of pregnancies), NVP progresses to hyperemesis gravidarum.9 Treatment may require the use of enteral or parenteral nutrition if weight loss is present. A corticosteroid such as methylprednisolone may be considered. Methylprednisolone is associated with oral clefts in the fetus when used during the first trimester therefore, corticosteroids should be reserved as a last resort and should be avoided during the first 10 weeks of gestation.9,11... 

Hyperemesis gravidarum A rare disorder of severe and persistent nausea and vomiting during pregnancy that can result in dehydration, malnutrition, weight loss, and hospitalization. 

Key - Ineffective, + Effective, CD Crossover design, DB Double blind, GA General anesthesia (postoperative nausea), HG Hyperemesis gravidarum,... 

Fischer-Rasmussen W, Kjaer SK, Dahl C, Asping U. (1991). Ginger treatment of hyperemesis gravidarum. EurJ Obstet Gynecol Reprod Biol. 38(1) 19-24. 

Frigo P, Fang C, Reisenberger K, Kolbl H, Hirschl AM. (1998) Hyperemesis gravidarum associated with Helicobacter pylori seropositivity. Obstet Gynecol 91 615-617. 

Where patients are at risk of Wernicke s encephalopathy - for example, because of chronic alcohol abuse, hyperemesis gravidarum, or malnutrition - they should be given thiamine. In many countries no intravenous preparation of thiamine alone is available, and the compound preparations that are available are prone to cause anaphylactoid reactions, so they should be given by slow infusion, and with adequate facilities for resuscitation. A high potency preparation (Pabrinex ) that contains thiamine 250 mg in 10 ml with ascorbic acid, nicotinamide, pyridoxine and riboflavin, can be given by intravenous infusion over 10 min. 

Z0329 Fischer-Rasmussem, W., S. K. Kjaer, C. Dahl, and U. Asping. Ginger treatment of hyperemesis gravidarum. Eur J Obstet Gynecol Reprod Biol 1990 38 19-24. 

Van Waes, A. and Van de Velde, E. (1969) Safety evaluation of hal-operidol in the treatment of hyperemesis gravidarum. J Clin Pharmacol 9 224—237. 

It is indicated in wet beriberi, dry beriberi, Wernicke s encephalopathy, prophylaxis of thiamine deficiency, hyperemesis gravidarum, Korsakoff s syndrome, chronic alcoholics, multiple neuritis, toxic and confusional states, delirium tremens and anorexia nervosa. 

It is indicated to prevent and treat isoniazid, hydralazine, penicillamine and cycloserine induced neurological disturbances, mental symptoms in women on oral contraceptives, pyridoxine responsive anaemia and homocystinuria, morning sickness and hyperemesis gravidarum, convulsions in infants and children. 

Moran P, Taylor R. Management of hyperemesis gravidarum the importance of weight loss as a criterion for steroid therapy. QJM 2002 95(3) 153-8. 

Teratogenic activity has been attributed to doxylamine, a constituent of many combinations with vitamin B6 and antispasmodic agents, and used in the treatment of hyperemesis gravidarum. However, extensive studies and reviews have suggested that the incidence of malformations is not higher in children whose mothers have taken formulations containing antihistamines as a group, and in particular the combination of doxylamine/pyridoxine with or without dicycloverine (100-102). 

Cleft palate is seen more often in infants whose mothers have used antihistamines for the treatment of hyperemesis gravidarum (4.44 per 1000 births) than in infants of mothers without hyperemesis gravidarum and not treated with antihistamines (0.78 per 1000) (98). However, children of mothers suffering from hyperemesis gravidarum but not treated also showed a high incidence of cleft palate (3.14 per 1000). It is likely that cleft palate could be a consequence of the maternal condition rather than of drug teratogenicity. 

---