American journal of obstetrics and gynecology
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Am. J. Obstet. Gynecol. · May 2002
ReviewEvidence-based view of safety and effectiveness of pharmacologic therapy for nausea and vomiting of pregnancy (NVP).
Our goal was to review the safety and effectiveness of available antiemetics for treatment of nausea and vomiting of pregnancy. ⋯ Many medications, particularly H(1)-antagonists and phenothiazines, are safe and effective for treatment of varying degrees of NVP.
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Am. J. Obstet. Gynecol. · May 2002
ReviewEpidural analgesia side effects, co-interventions, and care of women during childbirth: a systematic review.
The purpose of this article is to profile research findings targeting the intrapartum care implications of the most common side effects and co-interventions that go along with the use of epidural analgesia during labor. Randomized, controlled trials published in English from 1990 to 2000 that addressed each of the targeted side effects and 3 specified co-interventions were evaluated for inclusion in this report. Side effects such as pruritus, nausea, and hypotension during labor are common, but they are usually mild and necessitate treatment infrequently. ⋯ The use of "delayed" pushing may be an effective way to minimize the risk for difficult deliveries. Upright positioning even when confined to bed may be advantageous and desirable to women; however, additional research to determine actual outcome benefits with epidurals is needed. Implications for further research linked to epidural analgesia also include informed consent, modification of caregiving procedures, and staffing/cost issues.
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Am. J. Obstet. Gynecol. · May 2002
ReviewUnintended effects of epidural analgesia during labor: a systematic review.
Epidural analgesia is used by more than half of laboring women, yet there is no consensus about what unintended effects it causes. To evaluate the state of our knowledge, we performed a systematic review of the literature examining the unintended maternal, fetal, and neonatal effects of epidural analgesia used for pain relief in labor by low-risk women. Our review included randomized and observational studies appearing in peer review journals since 1980. ⋯ Women should be informed of unintended effects of epidural clearly supported by the evidence, especially since epidural use is almost always an elective procedure. Further research is needed to advance our understanding of the unintended effects of epidural. Improved information would permit women to make truly informed decisions about the use of pain relief during labor.
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The objective of this review is to outline gastrointestinal factors that may be relevant to nausea and vomiting of pregnancy. Gastric neuromuscular dysfunctions of the stomach include abnormalities in gastric myoelectrical activity, gastric tone, and contractility, all of which may result in gastroparesis. ⋯ In pregnant women with abdominal pain, nausea, and vomiting, standard gastrointestinal diseases such as gastroesophageal reflux, peptic ulcers, and cholecystitis must be considered. A diagnostic approach and therapeutic options for treating nausea and vomiting of pregnancy based on understanding of gastric neuromuscular dysfunction is outlined.
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Am. J. Obstet. Gynecol. · May 2002
Linking olfaction with nausea and vomiting of pregnancy, recurrent abortion, hyperemesis gravidarum, and migraine headache.
The experience of women was sought about nausea and vomiting, its relation to olfaction, its occurrence among pregnant women with anosmia, and the potential association of hyperemesis gravidarum and migraine headache. ⋯ The frequency of nausea and vomiting, caused most often by nonpregnancy-related triggers, is high among women. In a small sample of women with congenital anosmia, nausea and vomiting of pregnancy occurred in only 1 pregnancy, suggesting that olfaction is a highly selected trigger for nausea and vomiting of pregnancy. The shared nausea and vomiting experience of hyperemesis gravidarum and migraine headache among women suggests a common mechanism, possibly based on allelic variations within the DRD2 (dopaminergic receptor) gene. Because olfactory receptors, odor types, and MHC antigens are closely integrated, and because olfactory stimuli often incite episodes of pregnancy, nausea, and vomiting, hyperemesis gravidarum, and migraine headache, these genes and their products invite further scrutiny. The pregnancy-conserving effect of PNV and the MHC antigen overlap in couples with recurrent abortion are important clues possibly relating olfaction, MHC antigens, and reproductive success or failure.