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hyperemesis gravidarum [keywords]
- [Two Cases of Wernicke´s Encephalopathy That Developed during Total Parenteral Nutrition in Colon Cancer Patients Treated with 5-Fluorouracil-based Chemotherapy]. [English Abstract, Journal Article]
- Korean J Gastroenterol 2014 Sep 25; 64(3):158-63.
Wernicke's encephalopathy (WE) caused by thiamine deficiency is an acute neurological disorder. Clinically, the classic triad of WE consists of ophthalmoplegia, ataxia, and mental status changes. Thiamine deficiency is known to occur commonly in chronic alcoholic patients. Sometimes, it can occur in patients after gastrointestinal surgery and in those with malabsorption. In addition, patients undergoing renal dialysis, suffering from hyperemesis gravidarum, receiving total parenteral nutrition (TPN), and being treated with chemotherapeutic agents are also prone to develop thiamine deficiency. Herein, we report two cases of WE that developed following simultaneous 5-fluorouracil (5-FU) chemotherapy and TPN in colon cancer patients which was successfully treated with thiamine administration.
- Relation of inflammatory markers with both presence and severity of hyperemesis gravidarum. [Journal Article]
- Ginekol Pol 2014 Aug; 85(8):589-93.
The aim of our study is to determine the newly introduced systemic inflammation marker, neutrophil lymphocyte ratio (NLR) in hyperemesis gravidarum (HG) patients and to investigate the association between severity of the disease and NLR.The study population consisted of 55 pregnant patients with HG and 50 pregnant women without complaints matched for gestational age as a control group. The HG patients were grouped as mild (n = 16), moderate (n = 19) and severe (n = 20) according to Modified Pregnancy- Unique Quantification of Emesis and Nausea Scoring Index Questionnaire. Furthermore, hsCRP, neutrophils, lymphocytes, and NLR were evaluated with complete blood count.The HG group had significantly higher NLR values compared to the control group (2.69 +/- 1.81 vs 1.97 +/- 1.34, p = 0.004). HsCRP levels were significantly higher among HG patients compared to the control group (1.95 +/- 2.2 vs 0.56 +/- 0.30, p < 0.001). The subgroup analysis revealed statistically significant increases in NLR and hsCRP values with increased HG severity (p < 0.001, p = 0.002). The correlation analysis demonstrated a strong correlation between NLR and hsCRP levels (r: 0.703, p < 0.001).Our study results showed that NLR and hsCRP levels are increased in HG disease compared to gestational age matched control group subjects. Furthermore, NLR and hsCRP values are correlated with severity of disease. NLR could be used as a marker for both presence and severity of hyperemesis gravidarum.
- Potential maternal symptomatic benefit of gabapentin and review of its safety in pregnancy. [REVIEW]
- Eur J Obstet Gynecol Reprod Biol 2014 Aug 17.:280-283.
Restless legs syndrome (RLS) and nausea and vomiting of pregnancy (NVP) are both common maternal conditions affecting quality of life. Gabapentin is currently FDA-approved for treating RLS and preliminary results have shown it may be effective for treating the most severe form of NVP, hyperemesis gravidarum (HG). Because NVP and HG symptoms peak early in pregnancy, the potential teratogenicity of gabapentin needs to be considered. We reviewed published pregnancy registries and cohorts for pregnancy outcomes associated with maternal gabapentin use. Gabapentin exposures from 5 pregnancy registries, 1 HG pilot study and 2 additional cases were reviewed. Among 294 first trimester gabapentin-monotherapy exposures, there were 5 major congenital malformations (MCMs) reported (1.7%), which favorably compares to the MCM rate in the general population (1.6-2.2%). Two of the registries reported maternal gabapentin use among 261 singleton pregnancies to be associated with roughly equivalent rates of premature birth, birth weight after correction for gestational age at delivery and maternal hypertension/eclampsia as those that have been reported in the general population. These data support the safety of gabapentin use in pregnancy; however, the number of exposures to date is still small. If future pregnancy registry data confirm this positive safety profile, gabapentin therapy would likely be a safe and effective treatment for RLS during pregnancy. Controlled, clinical trials are needed to assess gabapentin's effectiveness for HG.
- Elderly primigravidae versus young primigravidae: a review of pregnancy outcome in a low resource setting. [Journal Article]
- Niger J Med 2014 Jul-Sep; 23(3):220-9.
The elderly primigravida is defined as a woman who goes into pregnancy for the first time at the age of 35 years or older. Progressively, this has become more common in our contemporary society and traditionally such pregnancy is regarded as high risk.This was to determine and compare the pregnancy outcomes in elderly primigravidae aged 35 years and above with those of young primigravidae aged 20-25 yearsThe pregnancy outcomes of 82 elderly primigravidae (study group) with a singleton gestation, who delivered in the Teaching Hospital from 1st July, 2005 to 30th June, 2010 were compared with those of 131 young primigravidae (control group) who delivered during the same period in the same hospital.During the study period, there were 3,189 deliveries, given an incidence of elderly primigravidity as 2.6% or 1 in 39 deliveries. The mean age of the study group and control group were 36.4 +/- 0.9 years and 23.1 +/- 1.6 years respectively. The incidence of anaemia, antepartum haemorrhage, hyperemesis gravidarum, malpresentation, intrauterine growth restriction, diabetes mellitus and fibroid were statistically higher in the elderly primigravidae than in the control (p < 0.05). Cephalopelvic disproportion, prolonged second stage, fetal distress and primary post partum haemorrhage were also statistically higher (p < 0.05) including the caesarean section (53.7%) and episiotomy rates (94.6%).Elderly primigravida remains a high risk pregnancy and the incidence is high. They were significantly associated with adverse pregnancy outcomes and operative obstetric interventions. Early booking and more obstetric vigilance shall improve their pregnancy outcomes.
- Nausea and vomiting of pregnancy. [Journal Article]
- Am Fam Physician 2014 Jun 15; 89(12):965-70.
Nausea and vomiting of pregnancy affects nearly 75% of pregnant women. The exact cause is unknown. In most cases, it is a mild, self-limited condition that can be controlled with conservative measures and has no adverse fetal sequelae. About 1% of women develop hyperemesis gravidarum, which may result in adverse outcomes for the mother and fetus. Patients with nausea and vomiting of pregnancy should be evaluated for other causes, particularly if symptoms are unremitting or presentation is atypical. Initial treatment is conservative and includes dietary changes, emotional support, and vitamin B6 supplementation. Several safe and effective pharmacologic therapies are available for women who do not improve with initial treatment. Women with hyperemesis gravidarum may require more aggressive interventions, including hospitalization, rehydration therapy, and parenteral nutrition.
- A Case of Gestational Thyrotoxicosis Associated with Wernicke's Encephalopathy. [JOURNAL ARTICLE]
- Endocr Pract 2014 Aug 22.:1-10.
Objective: To present a case of gestational thyrotoxicosis and hyperemesis gravidarum associated with Wernicke's encephalopathy.Methods: We present a detailed case report with the clinical, imaging and laboratory findings of the patient and review the pertinent literature.Case presentation: A 36 year old woman, at 14 weeks of gestation, was admitted to the hospital for management of severe hyperemesis gravidarum (HG). While hospitalized, she developed low grade fever, tachycardia, hypotension and altered mentation. Laboratory tests were diagnostic of hyperthyroidism. Physical examination revealed a confused, lethargic woman with a normal sized thyroid and pendular nystagmus in primary and lateral gaze. She was treated empirically for thyroid storm with methimazole and other measures. A brain magnetic resonance imaging study (MRI) done later showed hyper-intense abnormal signals in bilateral thalamic regions consistent with Wernicke's encephalopathy (WE). She was immediately started on intravenous thiamine and her mental status improved considerably within 3-4 days. Within the two weeks, thyroid function tests normalized and methimazole was discontinued. The repeat brain MRI six months later showed marked reduction of signal intensity in both thalamic regions.Conclusion: This case demonstrates that gestational thyrotoxicosis in a patient with hyperemesis gravidarum can precipitate acute Wernicke's encephalopathy which may mimic thyroid storm and thus delay appropriate management of this neurological disorder. We conclude that prophylactic thiamine administration may be considered before caloric replacement in patients who present with hyperemesis gravidarum and acute neurological dysfunction.
- Weight loss in pregnancy and cardiometabolic profile in childhood: findings from a longitudinal birth cohort. [JOURNAL ARTICLE]
- BJOG 2014 Aug 22.
To investigate the consequences of weight loss in pregnancy on pregnancy outcomes and cardiometabolic profile in childhood.Prospective birth cohort (ABCD study).Between 2003 and 2004, all pregnant women in Amsterdam were approached for study participation.7818 pregnant women were included, of which 3165 consented to having their children examined at 5-6 years of age. In 1956 children fasting capillary blood samples were also taken.At antenatal booking, women answered questions about their pregnancy and whether they suffered from severe weight loss (SWL; >5 kg). Pregnancy details and outcomes were available through the obstetric caregiver.At birth main outcome measures were prematurity (<37 weeks) and birthweight. At follow-up, body mass index (BMI), blood pressure, glucose and lipids were assessed.SWL occurred in 6.8% of cases. Women with SWL had similar preterm birth rates compared with women without these complaints (adjusted OR 1.1, 95%CI 0.7, 1.7). Birthweight (adjusted difference - 31 g, 95%CI -76, 15) and BMI at 5-6 years of age (adjusted difference 0.2 kg/m(2) , 95%CI 0.0, 0.5) were similar in children born to mothers with SWL and without SWL, but blood pressure was increased. For diastolic blood pressure this association was independent of confounders (adjusted difference 1.4 mmHg, 95%CI 0.4, 2.4). Lipid and glucose levels were not significantly different between these groups.Early pregnancy weight loss, usually occurring as a manifestation of hyperemesis gravidarum, could have long-term consequences for offspring health.
- Hyperemesis gravidarum: current perspectives. [Journal Article, Review]
- Int J Womens Health 2014.:719-25.
Hyperemesis gravidarum is a complex condition with a multifactorial etiology characterized by severe intractable nausea and vomiting. Despite a high prevalence, studies exploring underlying etiology and treatments are limited. We performed a literature review, focusing on articles published over the last 10 years, to examine current perspectives and recent developments in hyperemesis gravidarum.
- MR Imaging Findings in Alcoholic and Nonalcoholic Acute Wernicke's Encephalopathy: A Review. [REVIEW]
- Biomed Res Int 2014.:503596.
Wernicke's encephalopathy (WE) is a severe neurological syndrome caused by thiamine (vitamin B1) deficiency and clinically characterized by the sudden onset of mental status changes, ocular abnormalities, and ataxia. Apart from chronic alcoholism, the most common cause of WE, a lot of other conditions causing malnutrition and decreasing thiamine absorption such as gastrointestinal surgical procedures and hyperemesis gravidarum must be considered as predisposing factors. Due to its low prevalence and clinical heterogeneity, WE is often misdiagnosed, leading to persistent dysfunctions and, in some cases, to death. Nowadays, MR imaging of the brain, showing T2 and FLAIR hyperintensities in typical (thalami, mammillary bodies, tectal plate, and periaqueductal area) and atypical areas (cerebellum, cranial nerve nuclei, and cerebral cortex), is surely the most important and effective tool in the diagnostic assessment of WE. The aim of this paper is to propose a state of the art of the role of MR imaging in the early diagnosis of this complex disease.
- Hyperparathyroid crisis presenting with hyperemesis gravidarum. [JOURNAL ARTICLE]
- Arch Gynecol Obstet 2014 Jun 11.
Primary hyperparathyroidism during pregnancy is a rare condition, and the diagnosis may be confounded by pregnancy related conditions. Since the appropriate management reduces the maternal and fetal complications; differential diagnosis becomes quite crucial.Clinical course of a patient with hyperparathyroid crisis will be discussed with the review of the literature. A 22-year- old, (gravida 2, para 1) woman was presented with hyperparathyroid crisis at the 11th weeks' gestation. She was hospitalized twice due to hyperemesis gravidarum. When she was admitted to the hospital for the third time due to increased vomiting and weight-loss, serum biochemistry panel was performed and it revealed severe hypercalcemia that serum Ca was 17.59 mg/dl, and she was referred to our hospital as parathyroid crisis. Maternal hypercalcemia was resolved after urgent parathyroidectomy. She was diagnosed as preeclampsia at the 30 weeks' gestation and delivered a male infant weighing 1,090 g at 33 weeks' gestation with APGAR scores 6 at 1 min, and 7 at min 5, without evidence of neonatal hypocalcemia or tetany.Urgent parathyroidectomy is the definite treatment in symptomatic patients with hyperparathyroidism during pregnancy. Resolving maternal hypercalcemia prevents neonatal tetany and hypocalcemia.Hyperemesis may lead to hypercalcemic crisis in patients with hyperparathyroidism, so serum Ca level should be checked in patients with hyperemesis gravidarum especially who detoriate rapidly. Although they share some common pathogenetic mechanisms, there is not enough evidence for attributing preeclampsia to primary hyperparathyroidism.