Intended for healthcare professionals

Clinical Review

Obstetrician's perspective—therapeutic trial and error?

BMJ 2004; 328 doi: (Published 26 February 2004) Cite this as: BMJ 2004;328:504
  1. Ian A Greer, regius professor of obstetrics and gynaecology (
  1. 1University of Glasgow, Glasgow Royal Infirmary, Glasgow G31 2ER

    About 70% of pregnant women experience nausea and vomiting. This troublesome condition has been recognised in medical literature since the days of Hippocrates, who noted that it began soon after conception and continued until the end of the fourth month. Despite the longevity of our knowledge of this association, our understanding of the mechanism of this condition and its possible physiological protective role has advanced little. Indeed, sickness in pregnancy, like pre-eclampsia, remains a “disease of theories.” Many hypotheses have been advanced, ranging from psychological disturbance to nutritional deficiencies, disturbed thyroid function, and excessively high concentrations of chorionic gonadotropin.

    Our ability to treat nausea and vomiting in pregnancy is hampered by our lack of knowledge, and treatment has been empirical, focusing …

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