Department of Obstetric Medicine, Royal Hospital for Women, Sydney, New South Wales, Australia.
School of Women's and Children's Health, The University of New South Wales, Sydney, New South Wales, Australia.
Emerg Med Australas. 2022 Feb;34(1):9-15. doi: 10.1111/1742-6723.13909. Epub 2021 Dec 6.
Nausea and vomiting in pregnancy (NVP) are common in early pregnancy but there is a wide spectrum of severity in terms of the duration and acuity of symptoms throughout gestation. Adverse maternal and fetal outcomes have been seen in women who experience severe symptoms, also known as hyperemesis gravidarum (HG). Evidence-based, assessment and management can reduce symptom severity, avoid physical and psychological deterioration and minimise the impact on quality of life and function. A pathway for assessment and management of NVP and HG in the emergency room is presented based on the Society of Obstetric Medicine of Australia and New Zealand Guideline for the Management of Nausea and Vomiting in Pregnancy and Hyperemesis Gravidarum. Assessment requires an objective evaluation using a validated scoring system such as the PUQE-24 score, as well as calculation of hydration and nutritional status. Ketonuria is not associated with either the diagnosis or severity of HG. Further investigation including biochemistry is only required in severe cases. Many women will have tried a range of therapies and an important aspect of treatment is to recognise the validity of their symptoms. Treatment may require a combination of intravenous fluids, anti-emetics, acid suppression and laxatives. Outpatient management is optimal but admission may be required for refractory symptoms, organ dysfunction or concurrent significant co-morbidities. Emergency management of NVP and HG requires an appropriate pathway of care to support women until the natural resolution of their condition. Both underuse of safe therapies and overuse of ineffective medication must be avoided.
妊娠恶心呕吐（NVP）在妊娠早期很常见，但在整个孕期症状的持续时间和严重程度方面存在广泛的差异。经历严重症状的妇女（也称为妊娠剧吐）会出现不良的母婴结局。基于澳大利亚和新西兰妇产科医学学会的《妊娠恶心呕吐管理指南》，本文提出了一种在急诊室评估和管理 NVP 和 HG 的方法。评估需要使用经过验证的评分系统（如 PUQE-24 评分）进行客观评估，并计算水合状态和营养状况。酮尿与 HG 的诊断或严重程度无关。只有在严重的情况下才需要进一步进行包括生化检查在内的调查。许多女性已经尝试了多种治疗方法，治疗的一个重要方面是认识到她们症状的合理性。治疗可能需要静脉补液、止吐药、抑酸剂和泻药的联合治疗。门诊管理是最佳选择，但对于难治性症状、器官功能障碍或同时存在严重合并症的患者，可能需要入院治疗。NVP 和 HG 的急诊管理需要一个适当的护理途径，以支持女性直到其自然缓解。必须避免安全疗法的使用不足和无效药物的过度使用。
