University of Texas Medical Branch at Galveston, Galveston, Texas.
Obstet Gynecol. 2024 Jun 1;143(6):745-758. doi: 10.1097/AOG.0000000000005518. Epub 2024 Feb 1.
Hyperemesis gravidarum has a reported incidence of approximately 0.3-3% of pregnancies. Without treatment, refractory hyperemesis gravidarum can result in dehydration, electrolyte deficiencies, and severe nutritional deficiencies, resulting in significant maternal morbidity. The overall goals of inpatient management of refractory hyperemesis gravidarum are the resumption of oral intake to an adequate level to maintain hydration and nutrition, including the ability to tolerate oral pharmacotherapy. Patients initially are stabilized with rehydration and electrolyte repletion. There are numerous pharmacotherapeutics available that can be administered intravenously to control symptoms when oral intake is not an option. However, despite maximizing typical antiemetics, there will be cases refractory to these medications, and alternative pharmacotherapeutics and nutrition-support modalities must be considered. Mirtazapine, olanzapine, corticosteroids, and gabapentin are examples of alternative pharmacotherapeutics, and enteral and parenteral nutrition are alternative therapies that can be used when oral intake is not tolerated for prolonged time periods with ongoing weight loss. In refractory cases of hyperemesis gravidarum, the risks and benefits of these alternative forms of management must be considered, along with the risks of undertreated hyperemesis gravidarum and the overall effect of hyperemesis gravidarum on patients' quality of life.
妊娠剧吐的发病率约为 0.3-3%。未经治疗，难治性妊娠剧吐可导致脱水、电解质缺乏和严重营养缺乏，导致产妇发病率显著增加。住院治疗难治性妊娠剧吐的总体目标是恢复足够水平的口服摄入，以维持水合和营养，包括耐受口服药物治疗的能力。患者最初通过补液和电解质补充来稳定病情。有许多药物治疗方法可通过静脉给药来控制症状，当无法口服时使用。然而，尽管最大限度地使用了典型的止吐药，但仍会有一些患者对这些药物耐药，必须考虑替代药物治疗和营养支持方式。米氮平、奥氮平、皮质类固醇和加巴喷丁是替代药物治疗的例子，当不能耐受口服且持续体重减轻时，肠内和肠外营养是可替代的治疗方法。在难治性妊娠剧吐病例中，必须考虑这些替代管理形式的风险和益处，以及治疗不足的妊娠剧吐的风险以及妊娠剧吐对患者生活质量的总体影响。
