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Graviditetsillamående, emesis och hyperemesis gravidarum

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Definition:
Emesis är beteckningen på graviditetsillamående under första trimestern. Hyperemesis är ihållande illamående och kräkningar som fortsätter efter första trimestern samt ger nedsatt allmäntillsånd, elektrolytrubbningar med mera.
Förekomst:
Emesis upplevs av fler än 70 % av alla gravida kvinnor, medan endast 1 % drabbas av hyperemesis.
Symtom:
Illamående, ofta åtföljt av kräkningar och ökad salivsekretion, ofta under hela dagen.
Kliniska fynd:
Viktminskning är vanligt, möjligen. dehydrering och elektrolytstörningar
Diagnostik:
Vikt, elektrolyter, ketonuri i svåra fall. Kontrollera leverfunktionen.
Behandling:
Vid måttligt graviditetsillamående är läkemedel relevant. Vid hyperemesis kan sjukhusvård bli aktuellt för intravenös vätska.
  1. Trovik J, Nordeng H, Tellum JE, et al.. Emesis & Hyperemesis gravidarum. Norsk gynekologisk forening. Veileder i fødselshjelp (2020). ePub. ISBN 978-82-692382-0-4.
  2. Niebyl JR. Clinical practice. Nausea and vomiting in pregnancy. N Engl J Med 2010; 363:1544-50 PMID: 20942670 PubMed  
  3. Vikanes A, Skjaerven R, Grjibovski AM, Gunnes N, Vangen S, Magnus P. Recurrence of hyperemesis gravidarum across generations: population based cohort study. BMJ 2010; 340:c2050 PMID: 21030362 PubMed  
  4. Fejzi MS, Trovik J, Grooten IJ et al. Nausea and vomiting of pregnancy and hyperemesis gravidarum. Nat Rev Dis Primers 2019; 5: 62. pmid:31515515 PubMed  
  5. Sandven I, Abdelnoor M, Nesheim BI, Melby KK. Helicobacter pylori infection and hyperemesis gravidarum: a systematic review and meta-analysis of case-control studies. Acta obstetricia et gynecologica Scandinavica. 2009; 88): 1190-200. PMID: 19900137 PubMed  
  6. Fiaschi L, Nelson-Piercy C, Tata LJ. Hospital admission for hyperemesis gravidarum: a nationwide study of occurrence, reoccurrence and risk factors among 8.2 million pregnancies. Hum Reprod 2016; 31: 1675-84. pmid:27251205 PubMed  
  7. Birkeland E, Stokke G, Tangvik RJ, et al. Norwegian PUQE (Pregnancy-Unique Quantification of Emesis and nausea) identifies patients with hyperemesis gravidarum and poor nutritional intake: a prospective cohort validation study. PLoS One. 2015;10(4):e0119962. Published 2015 Apr 1. PMID: 25830549 PubMed  
  8. Fell, DB, Dodds, L, Joseph, KS, et al. Risk factors for hyperemesis gravidarum requiring hospital admission during pregnancy. Obstet Gynecol 2006; 107:277. PubMed  
  9. Abell, T, Riely, C. Hyperemesis gravidarum. Gastroenterol Clin North Am 1992; 21:835. PubMed  
  10. Stokke G, Gjelsvik BL, Flaatten KT, Birkeland E, Flaatten H, Trovik J. Hyperemesis gravidarum, nutritional treatment by nasogastric tube feeding: a 10-year retrospective cohort study. Acta obstetricia et gynecologica Scandinavica. 2015; 94: 359-67. PMID: 25581215 PubMed  
  11. Behandling av extremt graviditetsillamående (hyperemesis gravidarum). SBU, rapportnr:355, 2022. www.sbu.se  
  12. Tsakiridis I, Mamopoulos A, Athanasiadis A, Dagklis T. The Management of Nausea and Vomiting of Pregnancy: Synthesis of National Guidelines. Obstet Gynecol Surv. 2019 Mar;74(3):161-169. doi: 10.1097/OGX.0000000000000654. PMID: 31634919. PubMed  
  13. Matthews A, Haas DM, O'Mathúna DP, Dowswell T. Interventions for nausea and vomiting in early pregnancy. Cochrane Database of Systematic Reviews 2015, Issue 9. Art. No.: CD007575. DOI: 10.1002/14651858.CD007575.pub4 DOI  
  14. McParlin C, O'Donnell A, Robson SC, et al. Treatments for Hyperemesis Gravidarum and Nausea and Vomiting in Pregnancy: A Systematic Review. JAMA. 2016;316(13):1392-1401. doi:10.1001/jama.2016.14337 DOI  
  15. Boelig RC, Barton SJ, Saccone G, Kelly AJ, Edwards SJ, Berghella V. Interventions for treating hyperemesis gravidarum. Cochrane Database of Systematic Reviews 2016, Issue 5. Art. No.: CD010607 pmid: 27168518 PubMed  
  16. Quinlan JD, Hill DA. Nausea and vomiting of pregnancy. Am Fam Physician 2003; 68: 121-8. American Family Physician  
  17. Pasternak B, Svanström H, Mølgaard-Nielsen D, et al. Metoclopramide in pregnancy and risk of major congenital malformations and fetal death. JAMA 2013; 310: 1601-11. PMID: 24129464 PubMed  
  18. Janusmed. Region Stockholm. Fosterpåverkan. Metoklopramid (hämat 2022-09-19) janusmed.se  
  19. Vikanes Å, Trovik J, Tellum T, Lomsdal S, Stensløkken A, Nesheim B-I. Emesis og hyperemesis gravidarum. Norsk gynekologisk forening. Veileder i fødselshjelp 2014.
  20. Danielsson B, Wikner BN, Källén B. Use of ondansetron during pregnancy and congenital malformations in the infant. Reprod Toxicol 2014; 50: 134-7. PMID: 25450422 PubMed  
  21. Abas MN, Tan PC, Azmi N, Omar SZ. Ondansetron compared with metoclopramide for hyperemesis gravidarum: a randomized controlled trial. Obstetrics and gynecology. 2014; 123:1272-9. PMID: 24807340 PubMed  
  22. Huybrechts KF, Hernández-Días S, Straub L, et al. Intravenous Ondansetron in Pregnancy and Risk of Congenital Malformations. JAMA 2019. pmid: 31730152 PubMed  
  23. Matthews A, Dowswell T, Haas DM, Doyle M, O'Mathúna DP. Interventions for nausea and vomiting in early pregnancy. Cochrane Database of Systematic Reviews 2010; 9: CD007575. Cochrane (DOI)  
  24. Lindblad AJ, Koppula S. Ginger for nausea and vomiting of pregnancy. Can Fam Physician. 2016 Feb;62(2):145. PMID: 26884528; PMCID: PMC4755634.
  25. Norheim AJ, Pedersen EJ, Fonnebo V, Berge L. Acupressure treatment of morning sickness in pregnancy. A randomised, double-blind, placebo-controlled study. Scandinavian journal of primary health care. 2001; 19: 43-7. PMID: 11303547 PubMed  
  26. Haugen M, Vikanes A, Brantsaeter AL, Meltzer HM, Grjibovski AM, Magnus P. Diet before pregnancy and the risk of hyperemesis gravidarum. The British journal of nutrition. 2011; 106: 596-602. PMID: 21554820 PubMed  
  27. Maltepe C, Koren G. Preemptive treatment of nausea and vomiting of pregnancy: results of a randomized controlled trial. Obstetrics and gynecology international. 2013; 2013: 809787. PMID: 23476657.
  28. Chortatos A, Haugen M, Iversen P, Vikanes A, Magnus P, Veierod M. Nausea and vomiting in pregnancy: associations with maternal gestational diet and lifestyle factors in the Norwegian Mother and Child Cohort Study. BJOG 2013. PMID: 23962347 PubMed  
  29. Fell, DB, Dodds, L, Joseph, KS, et al. Risk factors for hyperemesis gravidarum requiring hospital admission during pregnancy. Obstet Gynecol 2006; 107:277-84. PMID: 16449112 PubMed  
  30. Chiossi, G, Neri, I, Cavazzuti, M, et al. Hyperemesis gravidarum complicated by wernicke encephalopathy: background, case report, and review of the literature. Obstet Gynecol Surv 2006; 61:255. PubMed  
  31. Eroglu, A, Kurkcuoglu, C, Karaoglanoglu, N, et al. Spontaneous esophageal rupture following severe vomiting in pregnancy. Dis Esophagus 2002; 15:242. PubMed  
  32. Paauw, JD, Bierling, S, Cook, CR, Davis, AT. Hyperemesis gravidarum and fetal outcome. JPEN J Parenter Enteral Nutr 2005; 29:93. PubMed  
  33. Heitmann K, Nordeng H, Havnen GC, Solheimsnes A, Holst L. The burden of nausea and vomiting during pregnancy: severe impacts on quality of life, daily life functioning and willingness to become pregnant again – results from a cross-sectional study. BMC Pregnancy Childbirth 2017; 17: 75. pmid:28241811 PubMed  
  34. Koren G, Madjunkova S, Maltepe C. The protective effects of nausea and vomiting of pregnancy against adverse fetal outcome - a systematic review. Reproductive toxicology. 2014; 47: 77-80. PMID: 24893173.
  35. Dodds, L, Fell, DB, Joseph, KS, et al. Outcomes of pregnancies complicated by hyperemesis gravidarum. Obstet Gynecol 2006; 107:285-92. PMID: 16449113 PubMed  
  36. Whitehead SA, Andrew PLR, Chamberlain GVP. Characterisation of nausea and vomiting in early pregnancy: a survey og 1000 women. J Obstet Gynaecol 1992; 12: 364-9. PubMed  
  37. Smith C, Crowther C, Beilby J, Dandeaux J. The impact of nausea and vomiting on women: a burden of early pregnancy. Australian & New Zealand Journal of Obstetrics & Gynaecology 2000; 40: 397-401.
  38. Dodds, L, Fell, DB, Joseph, KS, et al. Outcomes of pregnancies complicated by hyperemesis gravidarum. Obstet Gynecol 2006; 107:285. PubMed  
  39. Trogstad, LI, Stoltenberg, C, Magnus, P, et al. Recurrence risk in hyperemesis gravidarum. BJOG 2005; 112:1641. PubMed  
  • Athena Adeli, legitimerad läkare, Karolinska Institutet