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Nausea and Vomiting of Pregnancy

Nausea and Vomiting of Pregnancy. Adapted from: Quinlan JD, et al. Nausea and Vomiting of Pregnancy. Amer Fam Phys. July 1, 2003; 68 (1): 121-128. Nausea and Vomiting of Pregnancy. Affects 80% of women Several theories Exact cause remains unclear Elevated progesterone levels?

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Nausea and Vomiting of Pregnancy

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  1. Nausea and Vomiting of Pregnancy Adapted from: Quinlan JD, et al. Nausea and Vomiting of Pregnancy. Amer Fam Phys. July 1, 2003; 68 (1): 121-128.

  2. Nausea and Vomiting of Pregnancy • Affects 80% of women • Several theories • Exact cause remains unclear • Elevated progesterone levels? • HCG and estrogen? • Some studies have indicated H. pylori involvement…

  3. Benefits? • Women with uncomplicated “morning sickness” have been noted to have improved pregnancy outcomes • Fewer miscarriages • Fewer preterm deliveries • Fewer stillbirths • Fewer instances of low birth weight, growth retardation and mortality

  4. Hyperemesis gravidarum is linked to increased maternal adverse effects Splenic avulsion Esophageal rupture Mallory-Weiss tears Fetal Complications Increased fetal growth restriction Increased mortality Pneumothorax Neuropathy Preeclampsia Possible Complications?

  5. Management • Dietary measures • Emotional support • Acupressure • Ginger • Chiropractic

  6. Dietary Measures • Frequent small meals • Bland foods, high in CHO, low in fat • salty foods (eg. crackers) are usually well tolerated in the morning • sour & tart (eg. lemonade) are often better tolerated than water • Avoid smells and food textures that cause nausea

  7. Emotional Support • She may become depressed or exhibit other mood changes • Family support is critical! • Psych consult may be indicated if • she’s depressed • domestic violence is suspected • evidence of substance abuse

  8. Acupressure • Pericardium 6 or Neiguan point • located 3 fingerbreadths above the wrist on the volar surface • various commercial products for relieving motion sickness apply pressure to this area • Effectiveness is not clear but there are no side-effects…

  9. Ginger • Teas, preserves, capsule form • Fischer-Rasmussen (1991) demonstrated that 1g/day of ginger powder reduced symptoms of hyperemesis gravidarum The jury is still out…

  10. Chiropractic • Few studies but mothers report benefit • Evaluate the entire spine • especially mid-thoracic & upper cervical regions SOT - CMRT (liver) AK - stimulate liver, stomach, and pancreas neurolymphatics

  11. But what if...? • non-resolving or worsening symptoms OR • nausea began after 9 weeks of gestation Consider other causes…

  12. Non-”Morning Sickness” Causes of Vomiting • Gastrointestinal disorders • Genitourinary tract disorders • Metabolic disorders • Neurologic disorders • Pregnancy-related conditions • Drug toxicity or intolerance

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