Nausea and Vomiting of Pregnancy

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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.

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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

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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

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Possible Complications?

• 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

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Management

• Dietary measures
• Emotional support
• Acupressure
• Ginger
• Chiropractic

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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

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Emotional Support

• She may become depressed or exhibit other mood
  changes
• Family support is critical!
• Psych consult may be indicated if
• shes depressed
• domestic violence is suspected
• evidence of substance abuse

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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

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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

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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

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But what if...?

• non-resolving or worsening symptoms
• OR
• nausea began after 9 weeks of gestation
• Consider other causes

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Non-Morning Sickness Causes of Vomiting

• Gastrointestinal disorders
• Genitourinary tract disorders
• Metabolic disorders
• Neurologic disorders
• Pregnancy-related conditions
• Drug toxicity or intolerance