임임 임 임임임 임임 , 임임임 임 임임임 ? June Seek Choi M.D., PhD., Associate Professor The Korean Motherisk Program, Division of Maternal-Fetal Medicine, Dept. of OB & GYN., Cheil General Hospital & Women's Healthcare Center, College of Medicine, Kwandong University, Seoul, Korea
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Transcript
임신 중 입덧의 관리 , 어떻게 할 것인가 ?
June Seek Choi M.D., PhD., Associate ProfessorThe Korean Motherisk Program,
Division of Maternal-Fetal Medicine, Dept. of OB & GYN.,
Cheil General Hospital & Women's Healthcare Center, College of Medicine, Kwandong University, Seoul, Korea
Contents
• Introduction
• Physiology of NVP (nausea and vomiting of pregnancy)
• Management of Hyperemesis Gravidarum
– Non-pharmacologic Treatment
– Pharmacologic Treatment
– Experience of Cheil General Hospital & Women’s
Healthcare Center (doxylamine+pyridoxine)
Introduction(1)
Psychologic condition manifestingthe rejection of the pregnancy by themother
Normal symptom of pregnancy, a potentially life threatening disease process and a physiologic protective mechanism to optimize pregnancy outcomes.
Introduction(2)
Nausea and vomiting of pregnancy
Hyperemesis Gravidarun: weight loss, usually more than 5% of prepregnancy weight
•Young age•History of motion sickness•History of migraines•Female gender of fetus•Disorder of fatty acid oxidation•Genetic predisposition
•Nausea beginning after 9 weeks’ gestation•Nausea and vomiting antedating the pregnancy•Abdominal pain•Fever•Headache•Goiter•Abnormal neurologic examination•Elevated white blood cell count, anemia, or thrombocytopenia
Physiology of NVP
VestiVestibular bular
& & CNS CNS nausenause
aa
Visceral Visceral & &
chemorechemoreceptor ceptor trigger trigger zone zone
Chlorpromazine: 10-25mg q4-6h po or IM, 50-100mg q4-6h pr
Perphenazine
Prochlorperazine: 5-10mg q6-8h IM or po
Promethazine: 12.5-25mg q4-6h IM or po
Trifluoperazine
Trimethobenzamide
Domperidone: 10-20mg po q6-8h
Droperidol: 0.5-1.0mg/h IV infusion
Metoclopromide: 5-10mg q6h IV or po
May be sedating or rarely cause extrapyramidal effects
Pharmacologic Treatment(5) Others
Nausea and vomiting of pregnancy:treatment algorithm
Dimenhydrinate, 50 mg IV (in 50 mL saline, over20 minutes), every 4 to 6 hoursorMetoclopramide, 5 to 10 mg IV every 8 hoursorPromethazine, 12.5 to 25 mg IV every 4 hoursorProchlorperazine, 5 to 10 mg IV every 4 hours (maximum dose, 40 mg/d)
For patients not tolerating oral intake
Goodwin, 2008
Ondansetron( 온단트 , 조프란 ), 4 to 8 mg orally or IV every 8 hoursorMethylprednisolone, 16 mg orally or IV every8 hours for 3 days. Taper over 2 weeks to lowest effective dose. If beneficial, limit total duration of use to 6 weeks.
For persistent vomiting substitute
Experience of Cheil General Hospital & Women’s Healthcare Center (doxylamine+pyridoxine) (1)
2006.01-2010.05
Experience of Cheil General Hospital & Women’s Healthcare Center (doxylamine+pyridoxine) (2)
2006.01-2010.05
Experience of Cheil General Hospital & Women’s Healthcare Center (doxylamine+pyridoxine) (3)