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5-HT3 receptor antagonists, such as dolasetron, granisetron (Kytril), ondansetron (Zofran), and palonosetron (Axoli), are crucial in managing chemotherapy-induced nausea and vomiting (CINV) and postoperative nausea. These drugs selectively block 5-HT3 receptors in the visceral vagal and spinal afferent nerves, chemoreceptor trigger zone, and the vomiting center. They have a rapid onset of action and can be given as a single dose before chemotherapy. Ondansetron and granisetron, in particular,...
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Management Considerations for Recalcitrant Hyperemesis.

Daniel Spinosa1, Annalisa Post2, Jeffrey A Kuller3

  • 1Resident, Department of Obstetrics and Gynecology, Duke University, Durham, NC.

Obstetrical & Gynecological Survey
|January 31, 2020
PubMed
Summary
This summary is machine-generated.

Hyperemesis gravidarum (HEG) management requires specialized therapies beyond typical nausea and vomiting treatments. Corticosteroids and H. pylori treatment show promise, with enteral nutrition preferred for supplementation.

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Area of Science:

  • Obstetrics and Gynecology
  • Maternal-Fetal Medicine
  • Gastroenterology

Background:

  • Hyperemesis gravidarum (HEG) affects 0.3%-3% of pregnancies, necessitating advanced treatments beyond standard nausea and vomiting of pregnancy (NVP) care.
  • Distinguishing between NVP and HEG is crucial but challenging for obstetricians.
  • Limited literature exists for HEG management compared to NVP.

Purpose of the Study:

  • To review the etiology of NVP/HEG, highlighting diagnostic considerations for HEG versus NVP.
  • To explore management options for refractory HEG, focusing on maternal and fetal outcomes.
  • To identify therapies with favorable risk-reward profiles for severe cases.

Main Methods:

  • A comprehensive literature review was conducted.
  • Primary databases utilized included PubMed and Google Scholar.

Main Results:

  • Short-course corticosteroids and *Helicobacter pylori* treatment demonstrated the best risk-reward profiles among evaluated pharmacologic options.
  • Enteral nutrition is preferred over parenteral nutrition for nutritional supplementation.
  • Postpyloric feeding and surgically placed feeding tubes may offer advantages in specific refractory cases.

Conclusions:

  • HEG is a diagnosis for refractory NVP, presenting significant treatment challenges.
  • Management decisions for HEG should be individualized, considering patient-specific factors and the risks and benefits of available therapies.
  • While algorithmic management is difficult for HEG, available data can guide patient-provider discussions on treatment options.