hiperemezis gravidarum tedavisnde güncel yaklaşımlar

Esra Tola

-

Yıl 2014, Cilt: 5 Sayı: 2, 72 - 76, 27.04.2014

Öz

Hyperemesis gravidarum, or pernicious vomiting of pregnancy, which can cause weight loss, electrolyte imbalance, kidney function disorders, is a complication of pregnancy that may have serious effects to the fetus. More than 80 % of pregnant women suffer from nausea and vomiting, however, hyperemesis gravidarum presents in only about 1 % to 3 %. It may have both maternal and fetal adverse effects. There are many treatment modalities such as, changing lifestyle, diet, non-pharmacologic agents, psychotherapy and antiemetics

Anahtar Kelimeler

Hyperemezis gravidarum, therapeutic agents

Kaynakça

Broussard CN, Richter JE. Nausea and vomiting of preg- nancy. Gastroenterol Clin North Am. 1998; 27(1): 123-151.
Abell TL, Riely CA. Hyperemesis gravidarum. Gastroen- terol Clin North Am. 1992; 21(4): 835-849.
Tan PC, Khine PP, Vallikkannu N, Omar SZ. Prometha- zine compared with metoclopramide for hyperemesis grav- idarum: a randomized controlled trial. Obstet Gynecol. 2010; 115(5): 975-981.
Jueckstock JK, Kaestner R, Mylonas I. Managing hyper- emesis gravidarum: a multimodal challenge. BMC Med. 2010; 8: 46.
Goodwin TM. Hyperemesis gravidarum. Clin Obstet Gy- necol. 1998; 41(3): 597-605.
Simon EP, Schwartz J. Medical hypnosis for hyperemesis gravidarum. Birth. 1999; 26(4): 248-254.
Sonkusare S. Hyperemesis gravidarum: a review. Med J Malaysia. 2008; 63(3): 272-6; quiz 7.
Tan PC, Jacob R, Quek KF, Omar SZ. Pregnancy outcome in hyperemesis gravidarum and the effect of laboratory clin- ical indicators of hyperemesis severity. J Obstet Gynaecol Res. 2007; 33(4): 457-464.
Carlsson CP, Axemo P, Bodin A, Carstensen H, Ehren- roth B, Madegard-Lind I, Navander C. Manual acupuncture reduces hyperemesis gravidarum: a placebo-controlled, randomized, single-blind, crossover study. J Pain Symptom Manage. 2000; 20(4): 273-279.
Borgeat A, Fathi M, Valiton A. Hyperemesis gravidarum: is serotonin implicated? Am J Obstet Gynecol. 1997; 176(2): 476-4
Taylor R. Successful management of hyperemesis grav- idarum using steroid therapy. QJM. 1996; 89(2): 103-107.
Fischer-Rasmussen W, Kjaer SK, Dahl C, Asping U. Gin- ger treatment of hyperemesis gravidarum. Eur J Obstet Gy- necol Reprod Biol. 1991; 38(1): 19-24.
Eliakim R, Abulafia O, Sherer DM. Hyperemesis grav- idarum: a current review. Am J Perinatol. 2000; 17(4): 207- 2
Chong W, Johnston C. Unsuspected thyrotoxicosis and hyperemesis gravidarum in Asian women. Postgrad Med J. 1997; 73(858): 234-236.
Kuscu NK, Koyuncu F. Hyperemesis gravidarum: current concepts and management. Postgrad Med J. 2002; 78(916): 76
Poursharif B, Korst LM, Macgibbon KW, Fejzo MS, Romero R, Goodwin TM. Elective pregnancy termination in a large cohort of women with hyperemesis gravidarum. Con- traception. 2007; 76(6): 451-455.
Bailit JL. Hyperemesis gravidarium: Epidemiologic find- ings from a large cohort. Am J Obstet Gynecol. 2005; 193(3 Pt 1): 811-814.
Dodds L, Fell DB, Joseph KS, Allen VM, Butler B. Out- comes of pregnancies complicated by hyperemesis grav- idarum. Obstet Gynecol. 2006; 107: 285-292.
Veenendaal MV, van Abeelen AF, Painter RC, van der Post JA, Roseboom TJ. Consequences of hyperemesis grav- idarum for offspring: a systematic review and meta-analysis. BJOG. 2011; 118(11): 1302-1313.
Nelson-Piercy C, Fayers P, de Swiet M. Randomised, double-blind, placebo-controlled trial of corticosteroids for the treatment of hyperemesis gravidarum. BJOG. 2001; 108(1): 9-15.
Tsang IS, Katz VL, Wells SD. Maternal and fetal out- comes in hyperemesis gravidarum. Int J Gynaecol Obstet. 1996; 55(3): 231-235.
Ebrahimi N, Maltepe C, Bournissen FG, Koren G. Nausea and vomiting of pregnancy: using the 24-hour Pregnancy- Unique Quantification of Emesis (PUQE-24) scale. J Obstet Gynaecol Can. 2009; 31(9): 803-807.
Power Z, Campbell M, Kilcoyne P, Kitchener H, Waterman H. The Hyperemesis Impact of Symptoms Questionnaire: development and validation of a clinical tool. Int J Nurs Stud. 2010; 47(1): 67-77.
Lacasse A, Rey E, Ferreira E, Morin C, Berard A. Validity of a modified Pregnancy-Unique Quantification of Emesis and Nausea (PUQE) scoring index to assess severity of nausea and vomiting of pregnancy. Am J Obstet Gynecol. 2008; 198(1): 71-77.
Ismail SK, Kenny L. Review on hyperemesis gravidarum. Best Pract Res Clin Gastroenterol. 2007; 21(5): 755-769.
Ozerkan K, Küçükkömürcü Ş, Özdil M, Arslan E, Saraydaroğlu Ö. Hiperemezis Gravidarum ve Mide Kanseri. Turkiye Klinikleri J Gynecol Obst . 2007; 17(3): 224-227.
Aslan E, Şimşek E, Kılıçdağ E, Bolat F, Nursal TZ, Haydardedeoğlu B. Hiperemezis gravidarum ayırıcı tanısında mide kanseri: Olgu sunumu. J Turk Soc Obstet Gynecol. 2008; 5(1): 36-39.
Jednak MA, Shadigian EM, Kim MS, Woods ML, Hooper FG, Owyang C, asler WL. Protein meals reduce nausea and gastric slow wave dysrhythmic activity in first trimester pregnancy. Am J Physiol. 1999; 277: 855-861.
Nelson-Piercy C. Treatment of nausea and vomiting in pregnancy. When should it be treated and what can be safely taken? Drug Saf. 1998; 19(2): 155-164.
Shrim A, Boskovic R, Maltepe C, Navios Y, Garcia- Bournissen F, Koren G. Pregnancy outcome following use of large doses of vitamin B6 in the first trimester. J Obstet Gynaecol. 2006; 26(8): 749-751.
Einarson A, Maltepe C, Boskovic R, Koren G. Treatment of nausea and vomiting in pregnancy: an updated algorithm. Can Fam Physician. 2007; 53(12): 2109-2111.
Hornby PJ. Central neurocircuitry associated with emesis. Am J Med. 2001; 111 Suppl 8A: 106S-112S.
Sheean PM, Braunschweig CA. Exploring the clinical characteristics of parenteral nutrition recipients admitted for initial hematopoietic stem cell transplantation. J Am Diet Assoc. 2007; 107(8): 1398-1403.
World MJ. Ondansetron and hyperemesis gravidarum. Lancet. 1993 16; 341(8838): 185.
Sullivan CA, Johnson CA, Roach H, Martin RW, Stewart DK, Morrison JC. A pilot study of intravenous ondansetron for hyperemesis gravidarum. Am J Obstet Gynecol. 1996; 174(5): 1565-1568.
Festin M. Nausea and vomiting in early pregnancy. Clin Evid (Online). 2009; 2009.
Mazzotta P, Magee LA. A risk-benefit assessment of pharmacological and nonpharmacological treatments for nausea and vomiting of pregnancy. Drugs. 2000; 59(4): 781- 800.
Tan PC, Omar SZ. Contemporary approaches to hyperemesis during pregnancy. Curr Opin Obstet Gynecol. 2011; 23(2): 87-93.
Ferreira E, Gillet M, Lelievre J, Bussieres JF. Ondansetron use during pregnancy: a case series. J Popul Ther Clin Pharmacol. 2012; 19(1): 1-10.
Einarson A, Maltepe C, Navioz Y, Kennedy D, Tan MP, Koren G. The safety of ondansetron for nausea and vomiting of pregnancy: a prospective comparative study. BJOG. 2004; 111(9): 940-943.
Asker C, Norstedt Wikner B, Kallen B. Use of antiemetic drugs during pregnancy in Sweden. Eur J Clin Pharmacol. 2005; 61(12): 899-906.
Tan PC, Yow CM, Omar SZ. A placebo-controlled trial of oral pyridoxine in hyperemesis gravidarum. Gynecol Obstet Invest. 2009; 67(3): 151-157.
Nageotte MP, Briggs GG, Towers CV, Asrat T. Droperidol and diphenhydramine in the management of hyperemesis gravidarum. Am J Obstet Gynecol. 1996; 174(6): 1801-1805; discussion 5-6.
Lacasse A, Lagoutte A, Ferreira E, Berard A. Metoclopramide and diphenhydramine in the treatment of hyperemesis gravidarum: effectiveness and predictors of rehospitalisation. Eur J Obstet Gynecol Reprod Biol. 2009; 143(1): 43-49.
Ditto A, Morgante G, la Marca A, De Leo V. Evaluation of treatment of hyperemesis gravidarum using parenteral fluid with or without diazepam. A randomized study. Gynecol Obstet Invest. 1999; 48(4): 232-236.
Reichmann JP, Kirkbride MS. Nausea and vomiting of pregnancy: cost effective pharmacologic treatments. Manag Care. 2008; 17(12): 41-45.
Tasci Y, Demir B, Dilbaz S, Haberal A. Use of diazepam for hyperemesis gravidarum. J Matern Fetal Neonatal Med. 2009; 22(4): 353-356.
Park-Wyllie L, Mazzotta P, Pastuszak A, Moretti ME, Beique L, Hunnisett L, Friesen MH, Jacobson S, Kasapi- novic S, Chang D, Diav-Citrin O, Chitayat D, Nulman I, Ein- arson TR, Koren G. Birth defects after maternal exposure to corticosteroids: prospective cohort study and meta-analysis of epidemiological studies. Teratology. 2000; 62(6): 385-392.
Dolovich LR, Addis A, Vaillancourt JM, Power JD, Ko- ren G, Einarson TR. Benzodiazepine use in pregnancy and major malformations or oral cleft: meta-analysis of cohort and case-control studies. BMJ. 1998; 317(7162): 839-843.
Schwarzer V, Heep A, Gembruch U, Rohde A. Treatment resistant hyperemesis gravidarum in a patient with type 1 diabetes mellitus: neonatal withdrawal symptoms after suc- cessful antiemetic therapy with mirtazapine. Arch Gynecol Obstet. 2008; 277(1): 67-69.
Safari HR, Fassett MJ, Souter IC, Alsulyman OM, Good- win TM. The efficacy of methylprednisolone in the treatment of hyperemesis gravidarum: a randomized, double-blind, controlled study. Am J Obstet Gynecol. 1998; 179(4): 921- 9
Vutyavanich T, Kraisarin T, Ruangsri R. Ginger for nau- sea and vomiting in pregnancy: randomized, double-masked, placebo-controlled trial. Obstet Gynecol. 2001; 97(4): 577- 5
Hsu JJ, Clark-Glena R, Nelson DK, Kim CH. Nasogas- tric enteral feeding in the management of hyperemesis grav- idarum. Obstet Gynecol. 1996; 88(3): 343-346.
Levine MG, Esser D. Total parenteral nutrition for the treatment of severe hyperemesis gravidarum: maternal nutri- tional effects and fetal outcome. Obstet Gynecol. 1988; 72(1): 102
Rayburn W, Wolk R, Mercer N, Roberts J. Parenteral nu- trition in obstetrics and gynecology. Obstet Gynecol Surv. 1986; 41(4): 200-214.
Rosen T, de Veciana M, Miller HS, Stewart L, Rebarber A, Slotnick RN. A randomized controlled trial of nerve stim- ulation for relief of nausea and vomiting in pregnancy. Obstet Gynecol. 2003; 102(1): 129-135.
Koch KL, Stern RM, Vasey M, Botti JJ, Creasy GW, Dw- yer A. Gastric dysrhythmias and nausea of pregnancy. Dig Dis Sci. 1990; 35(8): 961-968.

hiperemezis gravidarum tedavisnde güncel yaklaşımlar

Yıl 2014, Cilt: 5 Sayı: 2, 72 - 76, 27.04.2014

Esra Tola

Öz

Hiperemezis gravidarum, diğer adıyla gebeliğin inatçı bulantı kusması, kilo kaybı, elektrolit düzensizliği ve böbrek fonksiyon bozukluğu ile seyredebilen fetusa ciddi etkileri olabilen bir gebelik komplikasyonudur. Gebeliklerin %80’den fazlasında bulantı kusma görülmesine rağmen hiperemezis gravidarum gebeliklerin % 0,3-2’ni komplike eder. Hiperemezis gravidarumun hem maternal hem fetal olumsuz etkileri olabilir. Tedavisinde yaşam şekli değişikliği, diyet, non farmakolojik ajanlar, psikoterapi ve anti-emetikler, gibi pek çok modalite uygulanmaktadır

Anahtar Kelimeler

Hiperemezis gravidarum, terapötik ajanlar, güncel yaklaşımlar

Kaynakça

Broussard CN, Richter JE. Nausea and vomiting of preg- nancy. Gastroenterol Clin North Am. 1998; 27(1): 123-151.
Abell TL, Riely CA. Hyperemesis gravidarum. Gastroen- terol Clin North Am. 1992; 21(4): 835-849.
Tan PC, Khine PP, Vallikkannu N, Omar SZ. Prometha- zine compared with metoclopramide for hyperemesis grav- idarum: a randomized controlled trial. Obstet Gynecol. 2010; 115(5): 975-981.
Jueckstock JK, Kaestner R, Mylonas I. Managing hyper- emesis gravidarum: a multimodal challenge. BMC Med. 2010; 8: 46.
Goodwin TM. Hyperemesis gravidarum. Clin Obstet Gy- necol. 1998; 41(3): 597-605.
Simon EP, Schwartz J. Medical hypnosis for hyperemesis gravidarum. Birth. 1999; 26(4): 248-254.
Sonkusare S. Hyperemesis gravidarum: a review. Med J Malaysia. 2008; 63(3): 272-6; quiz 7.
Tan PC, Jacob R, Quek KF, Omar SZ. Pregnancy outcome in hyperemesis gravidarum and the effect of laboratory clin- ical indicators of hyperemesis severity. J Obstet Gynaecol Res. 2007; 33(4): 457-464.
Carlsson CP, Axemo P, Bodin A, Carstensen H, Ehren- roth B, Madegard-Lind I, Navander C. Manual acupuncture reduces hyperemesis gravidarum: a placebo-controlled, randomized, single-blind, crossover study. J Pain Symptom Manage. 2000; 20(4): 273-279.
Borgeat A, Fathi M, Valiton A. Hyperemesis gravidarum: is serotonin implicated? Am J Obstet Gynecol. 1997; 176(2): 476-4
Taylor R. Successful management of hyperemesis grav- idarum using steroid therapy. QJM. 1996; 89(2): 103-107.
Fischer-Rasmussen W, Kjaer SK, Dahl C, Asping U. Gin- ger treatment of hyperemesis gravidarum. Eur J Obstet Gy- necol Reprod Biol. 1991; 38(1): 19-24.
Eliakim R, Abulafia O, Sherer DM. Hyperemesis grav- idarum: a current review. Am J Perinatol. 2000; 17(4): 207- 2
Chong W, Johnston C. Unsuspected thyrotoxicosis and hyperemesis gravidarum in Asian women. Postgrad Med J. 1997; 73(858): 234-236.
Kuscu NK, Koyuncu F. Hyperemesis gravidarum: current concepts and management. Postgrad Med J. 2002; 78(916): 76
Poursharif B, Korst LM, Macgibbon KW, Fejzo MS, Romero R, Goodwin TM. Elective pregnancy termination in a large cohort of women with hyperemesis gravidarum. Con- traception. 2007; 76(6): 451-455.
Bailit JL. Hyperemesis gravidarium: Epidemiologic find- ings from a large cohort. Am J Obstet Gynecol. 2005; 193(3 Pt 1): 811-814.
Dodds L, Fell DB, Joseph KS, Allen VM, Butler B. Out- comes of pregnancies complicated by hyperemesis grav- idarum. Obstet Gynecol. 2006; 107: 285-292.
Veenendaal MV, van Abeelen AF, Painter RC, van der Post JA, Roseboom TJ. Consequences of hyperemesis grav- idarum for offspring: a systematic review and meta-analysis. BJOG. 2011; 118(11): 1302-1313.
Nelson-Piercy C, Fayers P, de Swiet M. Randomised, double-blind, placebo-controlled trial of corticosteroids for the treatment of hyperemesis gravidarum. BJOG. 2001; 108(1): 9-15.
Tsang IS, Katz VL, Wells SD. Maternal and fetal out- comes in hyperemesis gravidarum. Int J Gynaecol Obstet. 1996; 55(3): 231-235.
Ebrahimi N, Maltepe C, Bournissen FG, Koren G. Nausea and vomiting of pregnancy: using the 24-hour Pregnancy- Unique Quantification of Emesis (PUQE-24) scale. J Obstet Gynaecol Can. 2009; 31(9): 803-807.
Power Z, Campbell M, Kilcoyne P, Kitchener H, Waterman H. The Hyperemesis Impact of Symptoms Questionnaire: development and validation of a clinical tool. Int J Nurs Stud. 2010; 47(1): 67-77.
Lacasse A, Rey E, Ferreira E, Morin C, Berard A. Validity of a modified Pregnancy-Unique Quantification of Emesis and Nausea (PUQE) scoring index to assess severity of nausea and vomiting of pregnancy. Am J Obstet Gynecol. 2008; 198(1): 71-77.
Ismail SK, Kenny L. Review on hyperemesis gravidarum. Best Pract Res Clin Gastroenterol. 2007; 21(5): 755-769.
Ozerkan K, Küçükkömürcü Ş, Özdil M, Arslan E, Saraydaroğlu Ö. Hiperemezis Gravidarum ve Mide Kanseri. Turkiye Klinikleri J Gynecol Obst . 2007; 17(3): 224-227.
Aslan E, Şimşek E, Kılıçdağ E, Bolat F, Nursal TZ, Haydardedeoğlu B. Hiperemezis gravidarum ayırıcı tanısında mide kanseri: Olgu sunumu. J Turk Soc Obstet Gynecol. 2008; 5(1): 36-39.
Jednak MA, Shadigian EM, Kim MS, Woods ML, Hooper FG, Owyang C, asler WL. Protein meals reduce nausea and gastric slow wave dysrhythmic activity in first trimester pregnancy. Am J Physiol. 1999; 277: 855-861.
Nelson-Piercy C. Treatment of nausea and vomiting in pregnancy. When should it be treated and what can be safely taken? Drug Saf. 1998; 19(2): 155-164.
Shrim A, Boskovic R, Maltepe C, Navios Y, Garcia- Bournissen F, Koren G. Pregnancy outcome following use of large doses of vitamin B6 in the first trimester. J Obstet Gynaecol. 2006; 26(8): 749-751.
Einarson A, Maltepe C, Boskovic R, Koren G. Treatment of nausea and vomiting in pregnancy: an updated algorithm. Can Fam Physician. 2007; 53(12): 2109-2111.
Hornby PJ. Central neurocircuitry associated with emesis. Am J Med. 2001; 111 Suppl 8A: 106S-112S.
Sheean PM, Braunschweig CA. Exploring the clinical characteristics of parenteral nutrition recipients admitted for initial hematopoietic stem cell transplantation. J Am Diet Assoc. 2007; 107(8): 1398-1403.
World MJ. Ondansetron and hyperemesis gravidarum. Lancet. 1993 16; 341(8838): 185.
Sullivan CA, Johnson CA, Roach H, Martin RW, Stewart DK, Morrison JC. A pilot study of intravenous ondansetron for hyperemesis gravidarum. Am J Obstet Gynecol. 1996; 174(5): 1565-1568.
Festin M. Nausea and vomiting in early pregnancy. Clin Evid (Online). 2009; 2009.
Mazzotta P, Magee LA. A risk-benefit assessment of pharmacological and nonpharmacological treatments for nausea and vomiting of pregnancy. Drugs. 2000; 59(4): 781- 800.
Tan PC, Omar SZ. Contemporary approaches to hyperemesis during pregnancy. Curr Opin Obstet Gynecol. 2011; 23(2): 87-93.
Ferreira E, Gillet M, Lelievre J, Bussieres JF. Ondansetron use during pregnancy: a case series. J Popul Ther Clin Pharmacol. 2012; 19(1): 1-10.
Einarson A, Maltepe C, Navioz Y, Kennedy D, Tan MP, Koren G. The safety of ondansetron for nausea and vomiting of pregnancy: a prospective comparative study. BJOG. 2004; 111(9): 940-943.
Asker C, Norstedt Wikner B, Kallen B. Use of antiemetic drugs during pregnancy in Sweden. Eur J Clin Pharmacol. 2005; 61(12): 899-906.
Tan PC, Yow CM, Omar SZ. A placebo-controlled trial of oral pyridoxine in hyperemesis gravidarum. Gynecol Obstet Invest. 2009; 67(3): 151-157.
Nageotte MP, Briggs GG, Towers CV, Asrat T. Droperidol and diphenhydramine in the management of hyperemesis gravidarum. Am J Obstet Gynecol. 1996; 174(6): 1801-1805; discussion 5-6.
Lacasse A, Lagoutte A, Ferreira E, Berard A. Metoclopramide and diphenhydramine in the treatment of hyperemesis gravidarum: effectiveness and predictors of rehospitalisation. Eur J Obstet Gynecol Reprod Biol. 2009; 143(1): 43-49.
Ditto A, Morgante G, la Marca A, De Leo V. Evaluation of treatment of hyperemesis gravidarum using parenteral fluid with or without diazepam. A randomized study. Gynecol Obstet Invest. 1999; 48(4): 232-236.
Reichmann JP, Kirkbride MS. Nausea and vomiting of pregnancy: cost effective pharmacologic treatments. Manag Care. 2008; 17(12): 41-45.
Tasci Y, Demir B, Dilbaz S, Haberal A. Use of diazepam for hyperemesis gravidarum. J Matern Fetal Neonatal Med. 2009; 22(4): 353-356.
Park-Wyllie L, Mazzotta P, Pastuszak A, Moretti ME, Beique L, Hunnisett L, Friesen MH, Jacobson S, Kasapi- novic S, Chang D, Diav-Citrin O, Chitayat D, Nulman I, Ein- arson TR, Koren G. Birth defects after maternal exposure to corticosteroids: prospective cohort study and meta-analysis of epidemiological studies. Teratology. 2000; 62(6): 385-392.
Dolovich LR, Addis A, Vaillancourt JM, Power JD, Ko- ren G, Einarson TR. Benzodiazepine use in pregnancy and major malformations or oral cleft: meta-analysis of cohort and case-control studies. BMJ. 1998; 317(7162): 839-843.
Schwarzer V, Heep A, Gembruch U, Rohde A. Treatment resistant hyperemesis gravidarum in a patient with type 1 diabetes mellitus: neonatal withdrawal symptoms after suc- cessful antiemetic therapy with mirtazapine. Arch Gynecol Obstet. 2008; 277(1): 67-69.
Safari HR, Fassett MJ, Souter IC, Alsulyman OM, Good- win TM. The efficacy of methylprednisolone in the treatment of hyperemesis gravidarum: a randomized, double-blind, controlled study. Am J Obstet Gynecol. 1998; 179(4): 921- 9
Vutyavanich T, Kraisarin T, Ruangsri R. Ginger for nau- sea and vomiting in pregnancy: randomized, double-masked, placebo-controlled trial. Obstet Gynecol. 2001; 97(4): 577- 5
Hsu JJ, Clark-Glena R, Nelson DK, Kim CH. Nasogas- tric enteral feeding in the management of hyperemesis grav- idarum. Obstet Gynecol. 1996; 88(3): 343-346.
Levine MG, Esser D. Total parenteral nutrition for the treatment of severe hyperemesis gravidarum: maternal nutri- tional effects and fetal outcome. Obstet Gynecol. 1988; 72(1): 102
Rayburn W, Wolk R, Mercer N, Roberts J. Parenteral nu- trition in obstetrics and gynecology. Obstet Gynecol Surv. 1986; 41(4): 200-214.
Rosen T, de Veciana M, Miller HS, Stewart L, Rebarber A, Slotnick RN. A randomized controlled trial of nerve stim- ulation for relief of nausea and vomiting in pregnancy. Obstet Gynecol. 2003; 102(1): 129-135.
Koch KL, Stern RM, Vasey M, Botti JJ, Creasy GW, Dw- yer A. Gastric dysrhythmias and nausea of pregnancy. Dig Dis Sci. 1990; 35(8): 961-968.

Toplam 57 adet kaynakça vardır.

Ayrıntılar

Birincil Dil	Türkçe
Bölüm	Derlemeler
Yazarlar	Esra Tola
Yayımlanma Tarihi	27 Nisan 2014
Gönderilme Tarihi	12 Aralık 2012
Yayımlandığı Sayı	Yıl 2014 Cilt: 5 Sayı: 2

Kaynak Göster

Vancouver	Tola E. hiperemezis gravidarum tedavisnde güncel yaklaşımlar. Süleyman Demirel Üniversitesi Sağlık Bilimleri Dergisi. 2014;5(2):72-6.

Kapak Resmi İndir

Makale Dosyaları

Tam Metin

SDÜ Sağlık Bilimleri Dergisi, makalenin gönderilmesi ve yayınlanması dahil olmak üzere hiçbir aşamada herhangi bir ücret talep etmemektedir. Dergimiz, bilimsel araştırmaları okuyucuya ücretsiz sunmanın bilginin küresel paylaşımını artıracağı ilkesini benimseyerek, içeriğine anında açık erişim sağlamaktadır.