Hyperemesis gravidarum

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Vomiting in early pregnancy, often after wakening, is very common (70-80 per cent) and usually self-limiting. The etiology is unknown. Rarely (approximately 2 per 1000), the symptoms are very severe and protracted with complications that may include Wernicke's encephalopathy and death. A desire to avoid or delay antiemetic treatment during early pregnancy may cause severe dehydration and ketoacidosis. Past reports show associations between hyperemesis gravidarum and fetal growth retardation, congenital abnormalities, and prematurity. In recent reports no effect has been found on the outcome of pregnancy, perhaps because of improved patient management.

The antihistamine antiemetics (e.g. promethazine) have been widely used in pregnancy. They appear to be safe and reasonably effective. Nasogastric or nasojejunal feeding is used to maintain nutrition and hydration (va.n..,.d§.,.Ye.D 1997); only if these are unsuccessful should parenteral nutrition be used. Steroids have been used but are controversial.

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