■恶心和呕吐发生在70%以上的孕妇身上,1和只有2%的女性发展为妊娠剧吐(HG)。2HG是妊娠第22周之前持续和过度的呕吐。HG患者可发生危及生命的电解质紊乱或血栓栓塞。肺栓塞(PE)是一种血栓栓塞,可阻断并阻止血液流向肺部动脉。HG和PE都会增加妊娠患者的发病率和死亡率。在文献中仅报道了两名具有致命结局的HG患者发生PE。我们报告了一例住院HG患者的PE,结果更好。
一名26岁以前健康的3级和2级孕妇患者在妊娠10周时接受了女性健康和研究中心的HG治疗。她在妊娠6周时出现恶心和呕吐,并在急诊科接受治疗,在那里她开始使用静脉内(IV)液体进行水合,止吐药,和deltaparin用于预防深静脉血栓形成(DVT),因为她怀孕脱水了.她正在接受低钾血症的钾替代疗法。病人正在好转;仍然呕吐,但不那么频繁。第3天,入院后,病人突然出现咯血,胸痛,还有心悸.她是心动过速(120bpm)和呼吸急促(每分钟30次呼吸)。她感到头晕,血氧饱和度(SpO2)约为95%。检查时她的胸部很干净。计算机断层扫描肺动脉造影显示双侧PE。她被接纳为高依存度单位。该患者为快速呼吸和心动过速,需要无创通气。开始治疗剂量的依诺肝素(1mg/kg),并补充芬太尼加对乙酰氨基酚用于镇痛,持续的静脉输液,还有异丙嗪.她的呼吸道症状和心动过速在第6天得到改善,她从那里转移到病房,并在第10天出院,服用依诺肝素治疗剂量(1mg/kg),门诊随访没有问题,她过得很好.
HG是一种严重的妊娠临床疾病,患者有顽固性恶心和呕吐,发病率甚至死亡率增加。这些患者经常出现酮尿症,脱水,电解质异常,和7%的体重减轻。很少,这些患者存在严重的维生素缺乏症,导致神经急症Wernicke脑病.DVT的发生是由于这些患者的妊娠血栓形成和脱水的主要危险因素之一。在死后的两个HG病例中报告了PE的发生。我们的患者出现了双侧PE,由于不动而导致的医疗紧急情况,脱水,和妊娠期间血栓前的优势。PE被早期检测和管理,带来更好的结果。
■HG应早期诊断,随后患者入院。我们的HG患者因合并妊娠而并发罕见的双侧PE,脱水,和不动,尽管DVT的预防与良好的结果。在这些脱水的孕妇中,临床医生应该怀疑DVT和PE。高度怀疑,早期诊断,多学科团队的管理是我们HG患者更好的PE结局的关键.
UNASSIGNED: Nausea and vomiting occur in more than 70% of pregnant women,1 and only 2% of these females progress into hyperemesis gravidarum (HG).2 HG is the persistent and excessive vomiting before the 22nd week of gestation. HG patients can develop life-threatening electrolyte disturbances or thromboembolism. Pulmonary embolism (PE) is a thromboembolism that blocks and stops blood flow to an artery in the lung. Both HG and PE increase morbidity and mortality in pregnant patients. HG patients developing PE are reported only in two patients with fatal outcomes in the literature. We report a case of PE in a hospitalized HG patient with a better outcome.
UNASSIGNED: A 26-year-old previously healthy gravida 3 and para 2 patient was admitted to the Women Wellness and Research Center with HG at 10 weeks of gestation. She developed nausea and vomiting at 6 weeks of gestation and was treated in the emergency department, where she was started on intravenous (IV) fluids for hydration, an antiemetic, and deltaparin for prevention of deep venous thrombosis (DVT), as she was pregnant and dehydrated. She was on potassium replacement therapy for hypokalemia. The patient was improving; still had vomiting, but less frequent. On day 3, following admission, the patient suddenly developed hemoptysis, chest pain, and palpitation. She was tachycardic (120 bpm) and tachypneic (30 breaths per minute). She was feeling dizzy, and her oxygen saturation (Spo2) was around 95%. Her chest was clear on examination. Computerized tomographic pulmonary angiography showed bilateral PE. She was admitted to the highdependency unit. The patient was tachypneic and tachycardic and required non-invasive ventilation. A therapeutic dose of enoxaparin (1 mg/kg) was started and supplemented with fentanyl plus paracetamol for analgesia, continued IV fluids, and promethazine.Her respiratory symptoms and tachycardia improved by day 6, she was transferred to the ward from there and discharged home by day 10, on enoxaparin therapeutic dose (1 mg/kg), and follow up in outpatient clinics showed no issues, and she is doing fine.
UNASSIGNED: HG is a severe clinical disease in pregnancy where patients have intractable nausea and vomiting with increased morbidity and even mortality. These patients frequently present with ketonuria, dehydration, electrolyte abnormalities, and a weight loss of 7%. Rarely, these patients\' present with severe vitamin deficiency, causing a neurological emergency called Wernicke\'s encephalopathy. The occurrence of DVT is one of the main risk factors due to prothrombotic conditions in pregnancy in combination with dehydration in these patients. The occurrence of PE is reported in two cases of HG in the post-mortem. Our patient developed bilateral PE, a medical emergency due to immobility, dehydration, and prothrombotic predominance during pregnancy. PE was detected early and managed, leading to a better outcome.
UNASSIGNED: HG should be diagnosed early, followed by admission of the patient to the hospital. Our patient with HG was complicated by a rare bilateral PE due to a combination of pregnancy, dehydration, and immobility, despite DVT prophylaxis with a favorable outcome. Clinicians should have an index of suspicion for DVT and PE in these dehydrated pregnant patients. A high index of suspicion, early diagnosis, and management by a multidisciplinary team are key for better outcomes of PE in our HG patient.