Nausea and vomiting in pregnancy: causes, consequences and treatment

Abstract

Uvod: Slabost in bruhanje sta v nosečnosti zelo pogosta pojava, izražata pa se z različno intenziteto, najhujša oblika se kaže kot nosečniška hiperemeza. Simptomi običajno izzvenijo po 22. tednu gestacije, v posameznih primerih pa vztrajajo skozi celotno nosečnost. Vzroki do danes še niso čisto pojasnjeni, obstajajo pa številni dejavniki tveganja, ki dokazano vplivajo na razvoj simptomatike. Slabost in bruhanje lahko tako pri materi kot pri otroku pustita resne posledice. Zdravljenje je usmerjeno na omiljevanje simptomov, pri hudih oblikah pa je včasih potrebna tudi hospitalizacija. Namen: Namen diplomskega dela je raziskati vzroke za nastanek slabosti in bruhanja, preučitev posledic in ugotoviti, kako poteka zdravljenje. Metode dela: Za iskanje literature smo uporabili različne tuje podatkovne baze, kot so Wiley, PubMed, CINAHL in Cochrane. Iskanje literature je potekalo s pomočjo naslednjih ključnih besed v slovenskem in angleškem jeziku: »pregnancy, nausea, vomiting, cause, consequence, treatment« in »nosečnost, slabost, bruhanje, vzrok, posledica in zdravljenje«. Za vključitev literature v analizo smo upoštevali članke v slovenščini in angleščini, ki so bili dostopni v polni obliki z relevantno vsebino in objavljeni med leti 2010-2021. Izbrane članke smo kritično ocenili s pomočjo CASP orodja. Rezultati: V končno analizo je bilo uvrščenih 14 člankov. K nastanku slabosti in bruhanja pripomore prisotnost različnih oblik slabosti in glavobolov pred nosečnostjo. Dejavniki tveganja so pozitivna družinska anamneza, nižja izobrazba, zgodovina depresije, okužba s helicobacter pylori, telesna neaktivnost in povišan indeks telesne mase. Pri nosečnici, ki se srečuje s slabostjo in bruhanjem, je povišano tveganje za razvoj hipertenzije, proteinurije, preeklampsije, bolečin v medeničnem obroču in porast simptomov depresije ter razvoj posttravmatske stresne motnje. Pri plodu glede posledic strokovnjaki niso enotni. Kasneje v otroštvu je večje tveganje za psihosomatske motnje v razvoju. Uporaba nefarmakoloških načinov učinkovito lajša simptome. Razprava in zaključek: Ugotovili smo, da je potrebno informirati zdravstvene delavce o kakovostni in holistični obravnavi nosečnic, ki doživljajo slabost in bruhanje, o primernem pristopu in svetovanju glede možne samopomoči pri lajšanju simptomov ter o pravočasnem ukrepanju ob zapletih.Introduction: Nausea and vomiting in pregnancy are very common but the appearance of intensity can differ, the most serious form is pregnancy hyperemesis. Symptoms usually fade out after 22. week of gestation, in some cases they persist through the whole pregnancy. Causes are still quite unknown, but there are multiple risk factors, that are proven to impact the development of symptoms. Nausea and vomiting can have serious consequences on both mother and fetus. Treatment is focused on relieving the symptoms, but sometimes in severe forms the hospilatization is needed. Purpose: The purpose of the diploma work is to research the causes of nausea and vomiting in pregnancy, to examine the consequences and treatment. Methods: To search for literature we used various foreign databases, such as Wiley, PubMed, CINAHL in Cochrane. The literature was searched using the following keywords in English and Slovene: »pregnancy, nausea, vomiting, cause, consequence and treatment/nosečnost, slabost, bruhanje, vzrok, posledica in zdravljenje«. In analysis we included literature that was written in Slovene or English, had relevant content and open access and was published between the years of 2010-2021. We critically appraised the chosen articles with the help of CASP tool. Results: There was 14 articles that were listed to final analysis. Presence of different forms of nausea and headache before pregnancy is proven to influence the development of nausea and vomiting. There are many risk factors, such as positive family anamnesis, lower education, history of depression, infection with helicobacter pylori, physical inactivity and increased body mass index. There is an increased chance in pregnant women with nausea and vomiting for development of hypertensia, proteinuria, preeclampsia, pelvic girdle pain, increased symptoms of depression and development of posttraumatic stress disorder. Experts are not united regarding consequences in fetus. Later in childhood there is higher risk for development of psychosomatic disorders. The use of non pharmacological methods is effective in relieving symptoms. Discussion and conclusion: There is a need to educate health professionals about quality and holistic care of women with nausea and vomiting in pregnancy, also to educate about appropriate counseling and informing about how they can relieve the symptoms themselves and to take measures in time in case of complications

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