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Managing hyperemesis gravidarum: a multimodal challenge.

Jueckstock JK, Kaestner R, Mylonas I - BMC Med (2010)

Bottom Line: When prolonged or severe, this is known as hyperemesis gravidarum (HG), which can, in individual cases, be life threatening.Alternative methods, such as acupuncture, are not yet evidence based but sometimes have a therapeutic effect.In most cases, the condition is self limiting and subsides by around 20 weeks gestation.In addition, a psychosomatic approach is often helpful.In view of its potential complexity, general practitioners and obstetricians should be well informed about HG and therapy should be multimodal.

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Affiliation: First Department of Obstetrics and Gynaecology, Campus Innenstadt, Ludwig-Maximilians-University, Maistrasse 11, 80337 Munich, Germany.

ABSTRACT
Up to 90% of pregnant women experience nausea and vomiting. When prolonged or severe, this is known as hyperemesis gravidarum (HG), which can, in individual cases, be life threatening. In this article the aetiology, diagnosis and treatment strategies will be presented based on a selective literature review. Treatment strategies range from outpatient dietary advice and antiemetic drugs to hospitalization and intravenous (IV) fluid replacement in persistent or severe cases. Alternative methods, such as acupuncture, are not yet evidence based but sometimes have a therapeutic effect.In most cases, the condition is self limiting and subsides by around 20 weeks gestation. More severe forms require medical intervention once other organic causes of nausea and vomiting have been excluded. In addition, a psychosomatic approach is often helpful.In view of its potential complexity, general practitioners and obstetricians should be well informed about HG and therapy should be multimodal.

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Multimodal character of treatment strategies in hyperemesis gravidarum, adapted from reference [2].
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Figure 3: Multimodal character of treatment strategies in hyperemesis gravidarum, adapted from reference [2].

Mentions: Treatment strategies for HG should be based on the severity of symptoms and multimodal in nature (advice, hydration, medication, hospitalization and psychosomatic counselling when necessary; see Figure 3). The severity of the condition can be assessed by numerous questionnaires. Two of the most widely used questionnaires are the Pregnancy-Unique Quantification of Emesis and Nausea (PUQE) scoring index, which assesses nausea and vomiting over 12 h, and the PUQE-24, an extension of the original PUQE, which assesses symptoms over 24 h [52,53]. Another recently developed score is the Hyperemesis Impact of Symptoms Questionnaire (HIS) that brings into focus not only physical but also psychosocial factors in order to assess the impact of HG holistically [54].


Managing hyperemesis gravidarum: a multimodal challenge.

Jueckstock JK, Kaestner R, Mylonas I - BMC Med (2010)

Multimodal character of treatment strategies in hyperemesis gravidarum, adapted from reference [2].
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2913953&req=5

Figure 3: Multimodal character of treatment strategies in hyperemesis gravidarum, adapted from reference [2].
Mentions: Treatment strategies for HG should be based on the severity of symptoms and multimodal in nature (advice, hydration, medication, hospitalization and psychosomatic counselling when necessary; see Figure 3). The severity of the condition can be assessed by numerous questionnaires. Two of the most widely used questionnaires are the Pregnancy-Unique Quantification of Emesis and Nausea (PUQE) scoring index, which assesses nausea and vomiting over 12 h, and the PUQE-24, an extension of the original PUQE, which assesses symptoms over 24 h [52,53]. Another recently developed score is the Hyperemesis Impact of Symptoms Questionnaire (HIS) that brings into focus not only physical but also psychosocial factors in order to assess the impact of HG holistically [54].

Bottom Line: When prolonged or severe, this is known as hyperemesis gravidarum (HG), which can, in individual cases, be life threatening.Alternative methods, such as acupuncture, are not yet evidence based but sometimes have a therapeutic effect.In most cases, the condition is self limiting and subsides by around 20 weeks gestation.In addition, a psychosomatic approach is often helpful.In view of its potential complexity, general practitioners and obstetricians should be well informed about HG and therapy should be multimodal.

View Article: PubMed Central - HTML - PubMed

Affiliation: First Department of Obstetrics and Gynaecology, Campus Innenstadt, Ludwig-Maximilians-University, Maistrasse 11, 80337 Munich, Germany.

ABSTRACT
Up to 90% of pregnant women experience nausea and vomiting. When prolonged or severe, this is known as hyperemesis gravidarum (HG), which can, in individual cases, be life threatening. In this article the aetiology, diagnosis and treatment strategies will be presented based on a selective literature review. Treatment strategies range from outpatient dietary advice and antiemetic drugs to hospitalization and intravenous (IV) fluid replacement in persistent or severe cases. Alternative methods, such as acupuncture, are not yet evidence based but sometimes have a therapeutic effect.In most cases, the condition is self limiting and subsides by around 20 weeks gestation. More severe forms require medical intervention once other organic causes of nausea and vomiting have been excluded. In addition, a psychosomatic approach is often helpful.In view of its potential complexity, general practitioners and obstetricians should be well informed about HG and therapy should be multimodal.

Show MeSH
Related in: MedlinePlus