产科常见的问题-cgmhorgtw.ppt

Evaluation gastrointestinal conditions (e.g., appendicitis, hepatitis, pancreatitis, or biliary tract disease), pyelonephritis, and metabolic disorders such as diabetic ketoacidosis, porphyria, or Addison’s disease. An onset of nausea and vomiting more than 8 weeks after the last menstrual period is rare in pregnancy. The presence of fever, abdominal pain, or headache is atypical in women with hyperemesis and suggests another cause. Nausea and Vomiting in Pregnancy Is Not Always Nausea and Vomiting of Pregnancy While causes of nausea and vomiting unrelated to pregnancy can occur at any time, preeclampsia, HELLP syndrome and acute fatty liver of pregnancy typically occur in the third trimester. Signs changes in blood pressure and heart rate. fever meningismus tenderness, guarding, rigidity, peritoneal signs; right upper quadrant jaundice. Lab urinary ketones, blood urea nitrogen, creatinine, alanine aminotransferase, aspartate aminotransferase, electrolytes, amylase Ultrasonographic testing should be performed to detect multiple gestation or hydatidiform mole. Management Pharmacologic Therapies 10% of women with nausea and vomiting in pregnancy require medication Management of Refractory Cases Intravenous hydration and nutritional supplementation. Enteral tube feeding Total parenteral nutrition substantial risk of line sepsis (25%); steatohepatitis reserved for clinically significant weight loss (5% of body weight) and no response to antiemetic regimens or cannot be managed with enteral feedings. Areas of Uncertainty The cause or causes remain unclear. The mechanism of action of vitamin B6 is unknown. data are lacking to identify factors predicting the response to therapies. Vitamin B6 levels do not predict the response to therapy with vitamin B6. Conclusions and Recommendations Consider other causes of nausea and vomiting in early pregnancy Dietary advice vitamin B6 [pyridoxine], 10 to 25 mg every 8 hours, and doxylamine, 25 mg at bedtime and 12.5 mg