Broussard C N, Richter J E
Department of Gastroenterology, Cleveland Clinic Foundation, Ohio, USA.
Gastroenterol Clin North Am. 1998 Mar;27(1):123-51. doi: 10.1016/s0889-8553(05)70350-2.
NVP is a spectrum of disorders ranging from the physiologically typical mild to moderate nausea and vomiting that is usually self-limited, to the pathologic, intractable symptoms of hyperemesis gravidarum that are associated with metabolic and electrolyte disturbances and weight loss. Up to 90% of pregnant women experience NVP. The pathogenesis remains poorly understood with multifactorial theories proposed combining both biologic and psychological factors. Diagnosing this syndrome is straightforward, but other organic sources should be excluded when symptoms are severe or prolonged. The overall prognosis is excellent for typical NVP, but whether hyperemesis gravidarum increases the risk to the fetus is controversial. Initial management should be conservative, including reassurance of the transient nature of the symptoms and the good prognosis, in addition to dietary modifications. Pharmacologic therapy is reserved for patients with persistent symptoms and is appropriate after discussion of the risks and benefits with informed consent. Alternative treatments, including psychotherapy and other nonpharmacologic modalities, are less proven but potentially safe and effective, thus providing additional therapeutic options. In refractory cases, nutritional supplementation becomes life-saving for both the mother and the fetus. Therapeutic abortion is a rare and last resort, to be used only when maternal life is threatened.
妊娠剧吐（NVP）是一系列病症，范围从生理上典型的轻度至中度恶心和呕吐（通常为自限性），到妊娠剧吐的病理性、难治性症状（与代谢和电解质紊乱及体重减轻相关）。高达90%的孕妇会经历妊娠剧吐。其发病机制仍知之甚少，提出了结合生物和心理因素的多因素理论。诊断该综合征很简单，但当症状严重或持续时，应排除其他器质性病因。典型妊娠剧吐的总体预后良好，但妊娠剧吐是否会增加胎儿风险存在争议。初始管理应保守，除饮食调整外，还包括让患者放心症状的短暂性及良好预后。药物治疗适用于症状持续的患者，在与患者充分讨论风险和益处并获得知情同意后使用。替代治疗，包括心理治疗和其他非药物方法，虽证据较少，但可能安全有效，从而提供了额外的治疗选择。在难治性病例中，营养补充对母亲和胎儿都至关重要。治疗性流产是一种罕见的最后手段，仅在母亲生命受到威胁时使用。
