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N USE ND VOMITING IN PREGN NCY

UNIVERSITY of TARUMANAGARA

PERIOD 3 NOVEMBER - 22 NOVEMBER 2014

IRWAN DEPUTRA HAMDANI - 406138103 1

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EPIDEMIOLOGY

About 50% of women have nausea and

vomiting in early pregnancy

Additional 25% have nausea alone

Also called morning sickness

The symptoms lead to dehydration and

weight loss

http://www.nejm.org/doi/full/10.1056/NEJMcp1003896

http://www.nejm.org/doi/full/10.1056/NEJMcp1003896http://www.nejm.org/doi/full/10.1056/NEJMcp1003896http://www.nejm.org/doi/full/10.1056/NEJMcp1003896

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ETIOLOGY

Still unclear

Stimulus is produced by the placenta

Correlates closely with the level of humanchorionic gonadotropin (hCG)estrogen

nausea and vomiting

Vitamin B deficiencyB1, B6, B12

http://www.nejm.org/doi/full/10.1056/NEJMcp1003896

http://www.nejm.org/doi/full/10.1056/NEJMcp1003896http://www.nejm.org/doi/full/10.1056/NEJMcp1003896http://www.nejm.org/doi/full/10.1056/NEJMcp1003896

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MANAGEMENT

Pharmacology

Antihistamines:

Meclizine25 mg every 4-6 hours

Dimenhydrinateorally or rectally 50-100 mg every 4-6

hours Diphenhydramine25-50 mg orally every 4-6 hours /

10-50 mg intravenously / intramuscularly every 4-6 hours

Metoclopramid:

5HT antagonis

Ondansetron 4-8 mg orally every 8 hours

http://www.nejm.org/doi/full/10.1056/NEJMoa1211035#t=articleMethods http://www.nejm.org/doi/full/10.1056/NEJMoa0807154#t=articleDiscussion

http://www.medscape.com/viewarticle/545629_3

http://www.nejm.org/doi/full/10.1056/NEJMoa1211035http://www.nejm.org/doi/full/10.1056/NEJMoa0807154http://www.medscape.com/viewarticle/545629_3http://www.medscape.com/viewarticle/545629_3http://www.medscape.com/viewarticle/545629_3http://www.nejm.org/doi/full/10.1056/NEJMoa0807154http://www.nejm.org/doi/full/10.1056/NEJMoa0807154http://www.nejm.org/doi/full/10.1056/NEJMoa1211035http://www.nejm.org/doi/full/10.1056/NEJMoa1211035

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MANAGEMENT

Pharmacology

Dopamine antagonists:

Metoclopramide5-10 mg orally or intravenously

every 6 hours

Prochlorperazine 5-10 mg orally or 10-25 mg

rectally every 6 hours

promethazine 12.5-25 mg every 4-6 hours orally orrectally

http://www.nejm.org/doi/full/10.1056/NEJMoa1211035#t=articleMethods http://www.nejm.org/doi/full/10.1056/NEJMoa0807154#t=articleDiscussion

http://www.medscape.com/viewarticle/545629_3

http://www.nejm.org/doi/full/10.1056/NEJMoa1211035http://www.nejm.org/doi/full/10.1056/NEJMoa0807154http://www.medscape.com/viewarticle/545629_3http://www.medscape.com/viewarticle/545629_3http://www.medscape.com/viewarticle/545629_3http://www.nejm.org/doi/full/10.1056/NEJMoa0807154http://www.nejm.org/doi/full/10.1056/NEJMoa0807154http://www.nejm.org/doi/full/10.1056/NEJMoa1211035http://www.nejm.org/doi/full/10.1056/NEJMoa1211035

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Corticosteroids

Methylprednisolone 48 mg/day in 3 divideddoses for 2-3 days

SupplementVit B:

B11025 mg po / day

B620 -50mg po / day B1250100 ug / day