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hyperemesis gravidarum [keywords]
- Hyperemesis Gravidarum: A Holistic Overview and Approach to Clinical Assessment and Management. [JOURNAL ARTICLE]
- J Perinat Neonatal Nurs 2014 Dec 19.
Hyperemesis gravidarum (HG) is a rare and severe form of nausea and vomiting of pregnancy associated with significant costs and psychosocial impacts. The etiology of HG remains largely unknown, although maternal genetics and placental factors are suspected. Prompt recognition and treatment of HG are essential to minimize associated maternal and fetal morbidity. Diagnosis is made on the basis of typical presentation, with exclusion of other causes of severe nausea and vomiting of pregnancy. Validated clinical tools are available to assess severity of symptoms and guide plans of care. Evidence to guide management of HG is limited, but many nonpharmacologic and pharmacologic interventions are available with published guidelines to inform implementation. Care of the woman with HG requires compassion and acknowledgement of individual needs and responses to interventions.
- Cell-free fetal DNA and pregnancy-related complications (Review). [JOURNAL ARTICLE]
- Mol Med Rep 2014 Dec 19.
Cell‑free fetal DNA (cff‑DNA) is a novel promising biomarker that has been applied in various aspects of obstetrical research, notably in prenatal diagnosis and complicated pregnancies. It is easily detected by semi‑quantitative PCR for the SRY target gene. It is well recognized that the levels of circulating cff‑DNA play a role in various complications of pregnancy. In this review, we explore the implications of the detection of cff‑DNA in a range of pregnancy-related complications, such as preeclampsia, intrauterine growth restriction (IUGR), preterm labor, placenta previa and hyperemesis gravidarum. cff‑DNA is released due to apoptotic mechanisms occurring on trophoblastic cells, although recent in vivo studies support the existence of additional mechanisms. The increase in the levels of cff‑DNA can be used to predict pregnancy-related complications and has great value in the field of prenatal diagnosis and in common pregnancy-related complications, as it precedes the clinical symptoms of the disease. Gestational age is a factor that determines the elevation in cff‑DNA levels in response to pathological conditions. In conclusion, the detection of cff‑DNA levels has a number of valuable applications in prenatal screening; however, the detection of cff‑DNA levels has not yet been applied in clinical practice for the diagnosis of pregnancy-related disorders. Thus, studies are focusing on unraveling the etiology of alterations in its levels under pathological conditions during pregnancy, in order to determine the potenial predictive and diagnostic applications of this biomarker.
- [Hyperemesis gravidarum: A ten-year French retrospective study of 109 patients.] [JOURNAL ARTICLE]
- Presse Med 2014 Nov 18.
Hyperemesis gravidarum is the most severe form of nausea and vomiting of pregnancy. This condition has been rarely studied in France.To study the clinical and biological features of a French cohort of women with hyperemesis gravidarum.Retrospective data was searched in medical records for all the women admitted for hyperemesis gravidarum in the gynecologic units of the university center of Tours between January 2001 and December 2010. Data were available for 109 women.The prevalence of hyperemesis gravidarum was 3.9 per 1000 deliveries in our center. Half the women were not of French origin. The mean duration of the first hospitalization was 4.6±2.6 days (range: 1-17). Hyperemesis gravidarum was recurrent in 1/3 of the women. Routine liver function tests were found abnormal at admission or during hospitalization in 39.6% of cases with an increased ALT (>35IU/L) in 28.7% of patients. Women with elevated ALAT had more often a body mass index>25kg/m(2) (odds ratio [OR], 3.98; 95% confidence interval [CI], 1.29-12.59; P=0.01), a weight loss ≥6kg (OR, 4.52; CI, 1.53-13.77; P=0.002), and a hospital stay≥6 days (OR, 3.43; CI, 1.19-9.97; P=0.009). There was no difference in pregnancy outcomes between women with normal or increased ALT. Prothrombin time was decreased (<70%) in 25.6% of cases secondary to a vitamin K deficiency.This study shows that hyperemesis gravidarum in our center is frequently associated with a non-French origin, and that abnormal liver function tests and decreases of prothrombin time are common in this condition. Our results suggest that increased ALT is a factor of severity in hyperemesis gravidarum.
- Plasma serotonin levels are elevated in pregnant women with hyperemesis gravidarum. [JOURNAL ARTICLE]
- Arch Gynecol Obstet 2014 Dec 13.
This study aimed to determine the association between serotonin and hyperemesis gravidarum.Plasma samples of 87 women in their first trimester pregnancies with HG (n = 28), morning sickness of pregnancy (n = 30) and control (n = 29) groups were obtained. Plasma levels of serotonin were compared between the groups, and the correlations with severity of symptoms using modified PUQE (Pregnancy Unique Quantification of Emesis) scoring, BMI, E2, hCG and TSH were calculated.When the groups were compared with respect to serotonin levels, the group with hyperemesis gravidarum was found to have significantly higher serotonin levels (p = 0.001). A significant positive correlation was found between the serotonin level and the PUQE score in all study subjects (r = 0.578, p = 0.0001). A serotonin threshold of >277.58 ng/mL had a sensitivity of 75 %, specificity of 86.4 %, positive predictive value of 72.4 %, negative predictive value of 87.9 %, and a likelihood ratio of 5.53 (p = 0.0001).Our findings support the possible role of serotonin in the pathogenesis of hyperemesis gravidarum.
- Intestinal obstruction in pregnancy by ondansetron. [Journal Article]
- Reprod Toxicol 2014 Dec.:152-3.
Ondansetron use for nausea and vomiting during pregnancy has increased in the last years, although its maternal and fetal safety is not conclusive.We describe a case of intestinal obstruction in a pregnant woman with severe nausea and vomiting of pregnancy treated with ondansetron, which is known to slow gut motility.The spontaneous reporting system of WHO confirms that this potentially life threatening complication is more common than what the peer review literature may suggest and needs to be looked into carefully, especially in view of the wide spread off-label use for NVP.
- Helicobacter pylori infection amongst Arab Israeli women with hyperemesis gravidarum-a prospective, controlled study. [Journal Article]
- Int J Infect Dis 2014 Dec.:292-5.
Helicobacter pylori has been associated with hyperemesis gravidarum in some geographical regions. The prevalence of H. pylori in Arab Israeli women in the Upper Galilee and its association with hyperemesis gravidarum has not been studied previously. We aimed to examine if hyperemesis gravidarum is associated with H. pylori in this population.Subjects with hyperemesis gravidarum carrying a singleton fetus were recruited prospectively. Women with an uncomplicated pregnancy served as controls. All patients underwent (13)C-urea breath testing to assess for H. pylori infection.A total of 72 subjects, including 24 patients with hyperemesis gravidarum and 48 controls, aged 28.8±5.3 years, were included. H. pylori infection was identified in 75.0% (18/24) of cases and 60.4% (29/48) of controls (p=not significant). H. pylori infection did not correlate with age, fetal sex, or the number of previous pregnancies (p=not significant).H. pylori does not seem to increase the likelihood of hyperemesis gravidarum in Arab Israeli women. However, given the high background prevalence of H. pylori in this population, a larger study is required to corroborate these findings. (MOH20110066).
- Protective effects of the active fraction from the tuber of Scirpus yagara in mouse endotoxin shock model. [JOURNAL ARTICLE]
- J Ethnopharmacol 2014 Oct 31.:331-337.
Scirpus yagara Ohwi is a perennial, aquatic plant, whose dry tubers have long used as Traditional Chinese Medicine (TCM) "Sanleng" for the treatment of postpartum abdominal pain, hyperemesis gravidarum, amenorrhea, dyspepsia and several inflammatory related diseases. Although it is known to have anti-inflammatory activities, its mechanism of action on lipopolysaccharide (LPS)-induced inflammation has not yet been identified in detail.This study was designed to investigate the anti-inflammatory activity of the active fraction (AF) from the tuber of S. yagara both in vitro and in vivo.RAW264.7 macrophage were incubated for 16h with 1µg /ml of LPS in absence or presence of AF (0, 10, 50 and 100µg /ml) and the secretions of tumor necrosis-alpha (TNF-α) and interleukin-6 (IL-6) in the medium were determined by using an enzyme-linked immunosorbent assay (ELISA). In the in vivo study, mice were orally administrated with AF (50 and 300mg/kg) for three days consecutively. 1h after the last AF administration, the mice were intraperitoneally injected with LPS (15mg/kg), and the lifespan of LPS-challenged mice were determined. Furthermore, the levels of pro-inflammatory cytokines TNF-α and IL-6 in the serum, lung and liver were measured using ELISA kit, and histological change in lungs was examined by light microscopy. Additionally, the components of AF were analyzed by high performance liquid chromatography (HPLC) using a C18 column.AF significantly decreased TNF-α and IL-6 production induced by LPS in RAW264.7 macrophage. In LPS-induced mouse endotoxin shock model, AF pre-treatment significantly improved the survival rate of mice. And LPS-induced increases of pro-inflammatory cytokines TNF-α and IL-6 in the serum, lung and liver were markedly suppressed by AF. Moreover, the histopathological examination indicated that AF could significantly attenuate lung tissues injury in endotoxemic mice. In addition, eight compounds (protocatechuic acid, vanillic acid, p-coumaric acid, ferulic acid, methyl-3,6-dihydroxy-2-[2-(2-hydroxyphenyl)-ethynyl] benzoate, sciryagarol I, sparstolonin B, SanLeng diphenyllactone) of AF were quantified by HPLC analysis.These results suggested that AF protected mice against LPS-induced lethality by inhibiting the production of multiple cytokines and organ dysfunction. Thus AF may prove beneficial in the prevention and treatment of endotoxin shock.
- Assessment of body composition with bioelectrical impedance analysis in pregnant women with hyperemesis gravidarum before and after treatment. [JOURNAL ARTICLE]
- J Obstet Gynaecol 2014 Nov 19.:1-4.
More than half of pregnant women suffer from nausea and vomiting, in 0.5-1% of the pregnant women, if nausea and vomiting are severe and persistent, condition can progress to hyperemesis. We evaluated the fluid volume parameters in pregnant women with hyperemesis gravidarum, before and after treatment using the bioelectrical impedance vectors. A total of 70 pregnant women who had weight loss exceeding 5% of pre-pregnancy body weight were recruited for the study in the first trimester. The measurement of multi-frequency bioelectrical impedance analysis parameters was performed on the day of hospitalisation before any treatment and after treatment at 24 h and 72 h with the same procedure. Total body water, extracellular water, intracellular water, and fat-free mass index increased after treatment at 24 h (P < 0.01). Also, the mean pregnancy-unique quantification of emesis and nausea score was significantly lower after treatment (11.3 ± 2.1 at enrolment, 5.1 ± 1.4 at 24 h and 4.3 ± 1.1 at 72 h) (P < 0.01), which correlated with the patients' clinical improvement and changes in hydration. In pregnant women with moderate-to-severe hyperemesis gravidarum, significant body composition changes occur and fluid replacement therapy performed during a short period of time, such as 24 h, provides improvement in body composition.
- Evaluation of the relationship between Helicobacter Pylori infection and Hyperemesis Gravidarum. [Journal Article]
- Med J Islam Repub Iran 2014.:72.
Hyperemesis gravidarum (HEG) is one of the many problems during pregnancy; its etiology has not been clearly understood. Inflammatory factors like helicobacter pylori infection has been considered as a risk factor in some studies. The purpose of the present study is to find a relationship between Helicobacter Pylori (H.P) infection and hyperemesis gravidarum (HEG).A case control study was performed on two groups of pregnant women who were in the first trimester of their pregnancies. Case group were pregnant women with hyperemesis gravidarum and control group were pregnant women with the same gestational age but without hyperemesis gravidarum. In both groups, IgG for H.P was measured and compared between the 2 groups.Totally, 175 pregnant women were evaluated; 78 women with HEG and 97 without. Both groups had no statistically significant difference according to age, gestational age, gravidity, and body mass index (BMI). 51 women out of 78 (65.4%) in HEG group and 43 women (44.3%) in the control group were IgG positive for HP, which showed a significant difference (p=0.005); OR= 2.37, CI 95%= 1.28-4.38. Also, mean serum level of IgG was higher in the HEG group (42.1 ± 3.75 VS 32.6 ± 3.65, p= 0.05). Between the different variables of age, gestational age, gravidity and HP infection, only HP infection was found as a risk factor for HEG using logistic regression model (p=0.011); OR= 2.522, CI 95%= 1.23-5.14.HP infection is higher in HEG cases and may be considered as its risk factor.
- A novel study on transdermal clonidine treatment of hyperemesis gravidarum. [Comment, Journal Article]
- BJOG 2014 Nov; 121(12):1563.