The Treatment of Nausea and Vomiting In Pregnancy: A Shakespearean Approach

Vomiting or Nauseated when pregnant? It's disturbing to patients because of how they feel, and even more disturbing if they worry about the treatments. We have several effective therapies! But maybe your doc has forgotten them!

Juliet bemoaning the ire the last name of her beloved Romeo would inspire in her family cried out in some of the most oft recited lines of Shakespeare:
     What's in a name? that which we call a rose
      By any other name would smell as sweet;
      So Romeo would, were he not Romeo call'd,
      Retain that dear perfection which he owes
      Without that title. Romeo, doff thy name,
      And for that name which is no part of thee
      Take all myself.
And so too is the treatment of nausea and vomiting of pregnancy. There is a medication that was once one of the most popular medications prescribed to anyone. It was called Bendectin. It's use has mostly passed on. The widely prescribed Bendectin long went off the market in 1983, yet this "rose" has only lost it's name and the American Congress of Obstetricians and Gynecologist practice guidelines continue to recommend giving as a first line doxylamine and vitamin B6 as fist line therapy. Bendectin itself was pulled by the ill fated Merrell-Dow company, already long stung by it's mess with the drug thalidomide, which when used for nausea in pregnancy caused the horrific birth defects of phocomelia. It took the birth defects of over 10,000 babies in dozens of countries before the obstetrical community listed to an Australian obstetrician Dr.William McBride who recognized the link. Dr. McBride had fallen from grace however as some of his dog research was found to have been flawed or falsified. The Although true for thalidomide, it was teratogenic, and remains avoided, the obstetricians, recognized the junk science for what it was, and the case against Bendecin was just pure junk science, led by the flamboyant and horrifying to this gyno: Melvin Beli. Bendectin was pulled from the shelves in 1983, and pregnant women all over the country were hospitalized in almost double the numbers they had ever been according to recent reviews of the medical care of the time. Although the Bendectin case in legal circles was revolutionary at the time, with the Supreme Court even formulating a principal, the Daubert principal, that was supposed to be 'against the use of junk science' in these types of cases it has remained a travesty in the medical world and even some legal scholars have been quoted, This is as might be expected, for the Bendectin litigation can be seen, as Professor Green asserts, as "the taj mahal of horror stories about the tort system: ...

So we look at the roses, and regardless of naming them, choose to continue the scientific quest. The Scientific Quest continues in this story. 75% of moms will experience nausea or vomiting in pregnancy, and many will need treatment. The most mild and safest treatment is what each gyno wants for her patients. So Canadian gynos published a study of an improved formulation of this "rose", bendectin by the drug name of Diclectin in Canada. There were 256 women, that were treated with this drug v placebo for about two weeks each. Brave women, given the ferocity of Beli's words which probably still echo over his Montgomery Street pirate flag, the women both did well and had no serious adverse events. What do you think of when you see a rose?

Passing Your Uterine Lining, Menstrual Period Norms

Decidual Cast Periods can be fairly easy, passing some tissue at a time, or off can come the whole lining in one piece called a decidual cast. Generally the lining of the uterus is only 6-8 mm thick at the time of the menstrual period, and it is shed gradually, a few cells at a time. The decidual cast is when the entire lining passes spontaneously. It's not uncommon, but it usually both uncomfortable, and alarming to some. But us women are designed to have some sort of periods Or Not? We have to pass tissue each month. Or Not? Are they good for us? Or Not? Do we want them? Or Not? Is this something that is individual? Or Not? It's a complex topic that I will be discussing a lot over my time in this blog. So lets start with basics: How much do we bleed and what are we loosing, and just what was this that the patient passed? And another basic: track your periods, and the Women's Health Practice site http://www.womenshealthpractice.com/media/pdf/menstrual_chart.pdf you

Endocervial polyps

2 cm Endometrial Polyp After Removal Polyps in the cervix are almost never cancerous, but can bleed or get infected and should be removed. The are not directly related to an endometrial or uterine polyp (which is a precancerous condition), but your gyno may want to make sure these two conditions do not co-exist.

Irregular Periods can Be the Sign of Other Medical Conditions

Heavy menstrual Bleeding Menstrual Period Norms The menstrual period's normal physiologic function to shed the lining and then prepare the lining for a pregnancy. Thus a sample of the lining under the microsope looks like it has glands within tissue. It’s hard to know if this is a heavy period, or one that is really so heavy that you need treatment without really checking completely with your gyno! Experts have used a number of definitions to determine if the period you are having is too heavy. Your perception is important. The actual amount of blood lost is important, but that can be determined by collecting each pad and weighing them before and after blood collection. So gynos have struggled with how to determine the formal definition of heavy bleeding. A basic check up, and a basic blood count, is not going to really make your version of heavy periods fit the typical “FDA” approved definition because that is defined by the exact amount of blood lost, which is los

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