Cannabinoid Hyperemesis Syndrome in the pregnant patient: clinical case and literature review

Cannabinoid Hyperemesis Syndrome in the pregnant patient: clinical case and literature review | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Help Center Sign In Submit a Preprint Cite Share Download PDF Case report Cannabinoid Hyperemesis Syndrome in the pregnant patient: clinical case and literature review Julien Flament, Nathan Scius, Henri Thonon This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-36159/v2 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 28 Oct, 2020 Read the published version in International Journal of Emergency Medicine → Version 2 posted 4 You are reading this latest preprint version Show more versions Abstract Background Cannabis use is on the rise. Several cases of cannabinoid hyperemesis syndrome, secondary to chronic cannabis intoxication, have been described worldwide, but few cases have described this entity in pregnant women. Case presentation We describe a 29-year-old pregnant patient that had consumed cannabis and experienced uncontrolled vomiting. The use of hot baths, the rapid improvement in symptoms, and results of complementary examinations suggested a diagnosis of cannabinoid hyperemesis syndrome. The patient could return home and she continued her pregnancy and childbirth without peculiarities. Conclusion Cannabinoid hyperemesis syndrome should be considered in the differential diagnosis of vomiting in pregnancy. Consumption of cannabis must be systematically included in the anamnesis. However, it seems to be somewhat unacceptable socially or medically. Consumption must be stopped to manage symptoms. Critical Care & Emergency Medicine Cannabinoid hyperemesis syndrome Pregnancy Cannabis Vomiting Cyclical vomiting syndrome 1. Background Cannabinoid hyperemesis syndrome is a recent clinical entity (1) involving nausea and vomiting in chronic cannabis users. The syndrome is also frequently associated with abdominal pain and compulsive showers or hot baths, which can attenuate the symptomatology (1,2). The diagnosis of cannabinoid hyperemesis syndrome is based on the exclusion of other causes and the disappearance of symptoms once cannabis consumption is terminated (2). The diagnosis and treatment of cannabinoid hyperemesis syndrome presents a challenge to the clinician. We describe a rare case of a pregnant woman that was likely to have cannabinoid syndrome. We will review the cases published to date and the current therapeutic options and discuss the peculiarity of pregnancy. Finally, we emphasize the notion that this syndrome should not be ignored, when assessing other causes of vomiting during pregnancy, such as hyperemesis gravidarum. 2. Case Presentation A 29-year-old patient in her first pregnancy, at 29 weeks and 1 day gestation, visited the emergency room for uncontrollable vomiting and epigastric pain. She reported no health problems, but she smoked tobacco and cannabis. She had consumed 2 grams per week for 6 years. She did not have any known allergies. She reported a decline in symptoms when taking a hot bath. The cardiopulmonary clinical examination was unremarkable. Abdominal palpation showed epigastric pain without guarding or rebound. The patient had a body temperature of 35.9°C, and displayed stable hemodynamics. Further examinations revealed normal CBC but leukocytosis with WBC of 14.7 with a left shift. An abdominal ultrasound showed no detectable pathology. Obstetrically, she had a normal ultrasound, normal cardio-fetal monitoring. She was treated with acetaminophen (1000 mg), tramadol (50 mg), metoclopramide (10 mg) and butylhyoscine bromide (10 mg). Based on the strong suspicion of cannabinoid hyperemesis syndrome and her clinical improvement in the emergency department, the details of this entity were explained to the patient, and she returned home. The pregnancy was uncomplicated, and she gave birth at 39 weeks 6/7 to a healthy 2650-g newborn. She was discharged home with her infant uneventfully on postpartum Day 3. 3. Discussion The classic clinical picture of cannabinoid hyperemesis syndrome is as follows: chronic, intensive use of cannabis, episodes of uncontrollable vomiting, and abdominal pain. A symptomatological and temporary improvement in symptoms is noted when taking a bath or hot shower. Finally, the syndrome ceases when the patient ceases cannabis use and resumes when they do not. Cannabis use is increasing worldwide (3). Accordingly, the number of published cases of cannabinoid hyperemesis syndrome has increased, and the pathology is of interest in various related specialties, including pediatrics (4) and forensic pathology (5). Although the cause of the syndrome is being discussed continually and remains to be formally clarified, a few known factors are notable. First, Δ-9-tetrahydrocannabinol (THC) is a CB1 receptor agonist, and it is assumed that deregulation of the receptor could cause nausea. More than half of pregnant women experience nausea and vomiting. Hyperemesis gravidarum, which affects only 0.3 to 1% of pregnant women, is defined as persistent vomiting, more than 5% weight loss, ketonuria, and electrolyte abnormalities (particularly hypokalemia). The physiopathology remains unclear, but it is linked to hormonal activity and the production of human chorionic gonadotropin (6,7). We conducted a literature search to identify clinical cases of cannabinoid hyperemesis syndrome in pregnant patients. We employed the search terms ‘Cannabinoid’ ‘Hyperemesis’ and ‘ Pregnancy ’ in PubMed and Google scholar . We identified five clinical cases (8-12) and extracted their characteristics (detailed in the appendix tables). Unlike studies in non-pregnant individuals (2), the low number of studies in pregnant patients makes it difficult to perform statistical analyses. On the other hand, there are similarities between non-pregnant and pregnant individuals. Most individuals with cannabinoid hyperemesis syndrome have consumed cannabis for years, mostly daily, and the symptoms tend to improve after taking a shower or hot bath. However, cannabinoid hyperemesis syndrome is particularly complex in pregnant women. Women that use cannabis during pregnancy are more likely to experience severe nausea than those that do not (13). Nevertheless, and paradoxically, antiemetic effects have been attributed to cannabis, in both the general population (14) and pregnant women (15). Some authors have recommended cannabis for treating hyperemesis gravidarum (16). One hypothesis suggested that endocannabinoids played a role in the latter pathology. However, that hypothesis was refuted in a prospective study that did not find any changes in plasma endocannabinoid levels in patients with gravidarum hyperemesis (17). Cannabis use is increasing among pregnant women (18). However, it seems to be somewhat unacceptable socially or medically. This stigma might lead them to hide it when taking of a comprehensive patient history. This possibility was reinforced by the absence of a link between symptomatology and cannabis use (8). The prevalence of cannabis use in parturition is likely to be generally underestimated (19). Some patients diagnosed with classical nausea and vomiting during pregnancy or even gravidarum hyperemesis might actually have cannabinoid hyperemesis syndrome. These entities might be differentiated clinically by the sensitivity of hyperemesis gravidarum to certain antiemetic drugs (20,21). Potentially beneficial therapies for treating common cannabinoid hyperemesis syndrome, such as lorazepam (22) and haloperidol (23), are contraindicated in parturient women (24). Capsaicin cream is not recommended in pregnant women. However, its usefulness could be discussed, in light of its supposed safety. Capsaicin treatment requires low dosages, and it doesn’t cross the placental barrier (25). Similarly, ondansetron (26) appears to have some efficacy. Although ondansetron is not recommended in the first trimester of pregnancy, its use might be permissible thereafter (24). Metoclopramide, which can be used throughout pregnancy, has been used to treat cannabinoid hyperemesis syndrome and showed some efficacy. This case study serves to remind physicians of the need to insist on recounting cannabis use when taking of the comprehensive patient history, particularly in parturient women with vomiting. Fortunately, the compulsive use of hot baths or showers seems specific to this clinical entity (2) and can help discriminate cannabinoid hyperemesis syndrome from other diseases. There is a need for prospective studies that aim to determine the proportion of this syndrome among a parturient sample with vomiting and characterize potential differences in this subpopulation. Randomized, controlled therapeutic trials should also be conducted to find a functional treatment for symptoms. On one hand, an effective treatment could obviate the potential consequences of drugs of equivocal safety. On the other hand, an effective treatment is needed to avoid serious consequences of uncontrollable vomiting, which range from pneumomediastinum (27) to death (5) and acute renal insufficiency (28). Abbreviations CBC: complete blood count WBC: white blood cell Declarations Ethics approval: not applicable Consent to participate: not applicable Consent for publication: The patient give his content for all part of the material referenced here. Availability of data and material: Please contact author for data requests. Competing interests: The authors declare that they have no competing interests. Funding: Not applicable Authors' contributions: JF write the manuscript. NS correct the manuscript. HT correct the manuscript. All authors read and approved the final manuscript Acknowledgements: Not applicable References Allen JH, de Moore GM, Heddle R, Twartz JC. Cannabinoid hyperemesis: cyclical hyperemesis in association with chronic cannabis abuse. Gut 2004; org/10.1136/gut.2003.036350 Simonetto DA, Oxentenko AS, Herman ML, Szostek JH. Cannabinoid hyperemesis: a case series of 98 patients. Mayo Clin Proc. 2012; org/10.1016/j.mayocp.2011.10.005 World drug report 2014, http://www.incb.org/documents/Publications/AnnualReports/AR2018/Annual_Report/Annual_Report_2018_F.pdf. Accessed April 1, 2020 Desjardins N, Stheneur C. Cannabinoid hyperemesis syndrome : A review of the literature. Arch Pediatr; org/10.1016/j.arcped.2016.01.016 Nourbakhsh M, Miller A, Gofton J, Jones G, Adeagbo B. CannabinoidHyperemesis Syndrome: Reports of Fatal Cases. J Forensic Sci. 2019; org/10.1111/1556-4029.13819. Goodwin TM. Hyperemesis gravidarum. Clin Obstet Gynecol1998;org/10.1097/00003081-199809000-00014 Niebyl JR. Nausea and vomiting in pregnancy. N Engl J Med 2010; org/10.1056/NEJMcp1003896 Schmid SM, Lapaire O, Huang DJ, Jürgens FE, Güth U. Cannabinoidhyperemesis syndrome: an underreported entity causing nausea and vomiting of pregnancy. Arch Gynecol Obstet. 2011; org/10.1007/s00404-010-1811- 8 Alaniz VI, Liss J, Metz TD, Stickrath E. Cannabinoidhyperemesis syndrome: a cause of refractory nausea and vomiting in pregnancy. Obstet Gynecol. 2015; org/10.1097/AOG.0000000000000595 Andrews KH, Bracero LA. CannabinoidHyperemesis Syndrome During Pregnancy: A Case Report. J Reprod Med. 2015; 60(9-10): 430-2. Manning Meurer M, Chakrala K et al. A case of cannabinoidhyperemesis syndrome with Heliobacter pylori and preeclampsia during pregnancy. Subst Abus. 2018; org/10.1080/08897077.2017.1356790 Kim HG, Moon J, Dixon H et al. Recurrent Nausea and Vomiting in a PregnantWoman with Chronic Marijuana Use. Case Rep Obstet Gynecol. 2018; org/10.1155/2018/9746062 Roberson EK, Patrick WK, Hurwitz EL. Marijuana use and maternal experiences of severe nausea during pregnancy in Hawai'i. Hawaii J Med Public Health. 2014;73(9):283–287. Carlini EA . . The good and the bad effects of (-) trans-delta-9-tetrahydrocannabinol (Delta 9-THC) on humans. 2004; 44(4): 461-7. Westfall RE , Janssen PA , Lucas P et al. Survey of medicinal cannabis use among childbearing women: patterns of its use in pregnancy and retroactive self-assessment of its efficacy against 'morning sickness'. Complement Ther Clin Pract. 2006; 12(1): 27-33. Russo E. Cannabis Treatments in Obstetrics and Gynecology: A Historical Review,J Cannabis Therapeut;org/10.1300/J175v02v03_02 Gebeh AK , Willets JM , Marczylo TH , et Konje JC. Plasma anandamide and related n-acylethanolamide levels are not elevated in pregnancies complicated by hyperemesis gravidarum. J Matern Fetal Neonatal Med. 2014; org/10.3109/14767058.2013.847413 Keegan J , Parva M , Finnegan M et Gerson A et Belden M. Addiction in pregnancy. J Addict Dis. 2010; org/10.1080/10550881003684723 Jaques SC , Kingsbury A , Henshcke P , Chomchai C, Falconer J, Abdelatif ME et al. Cannabis, the pregnant woman and her child: weeding out the myths. J Perinatol. 2014; org/10.1038/jp.2013.180 Fejzo MS , Trovik J , Grooten IJ , Sridharan K, Roseboom TJ, Vikanes A et al. Nausea and vomiting of pregnancy and hyperemesis gravidarum. Nat Rev Dis Primers. 2019; org/10.1038/s41572-019-0110-3 O'Donnell A , McParlin C , Robson SC , Beyer F, Moloney E, Bryant A et al. Treatments for hyperemesis gravidarum and nausea and vomiting in pregnancy: a systematic review and economic assessment. Health Technol Assess. 2016; org/10.3310/hta20740 Sun S, Zimmermann AE. Cannabinoidhyperemesis syndrome. Hosp Pharm. 2013 ; org/10.1310/hpj4808-650 Hickey JL , Witsil JC , Mycyk MB . Haloperidol for treatment of cannabinoid hyperemesis syndrome. Am J Emerg Med. 2013; org/10.1016/j.ajem.2013.02.021 Reference Center for Teratogens, https//lecrat.fr. Accessed April 1, 2020 Dezieck L , Hafez Z , Conicella A , Blohm E, O’Connor MJ, Schwarz ES et al. Resolution of cannabis hyperemesis syndrome with topical capsaicin in the emergency department: a case series Clin Toxicol (Phila). 2017; org/10.1080/15563650.2017.1324166 Elkin K, Tai P, Winkel J, Kulkarni M, Sadler D, Truong N et al. 337 Cannabinoid Hyperemesis Syndrome: 3-Year Practice Patterns. Ann Emerg Med. 2019;org/10.1016/j.annemergmed.2019.08.296 Hernández-Ramos I , Parra-Esquivel P , López-Hernández Á , Burillo-Putze G. Spontaneuos pneumomediastinum secondary to cannabinoid hyperemesis syndrome. An Sist Sanit Navar. 2019; org/10.23938/ASSN.0635 Habboushe J, Sedor J. Cannabinoid hyperemesis acute renal failure: a common sequela of cannabinoid hyperemesis syndrome. Am J Emerg Med 2014; org/10.1016/j.ajem.2013.12.013 Tables Table 1 Published cases of cannabinoid hyperemesis syndrome in pregnant women Number Reference Age, y Obstetric Status Gestation period, weeks; days Nausea and vomiting + Cannabis use + Hot shower/bath Shower effect Usual consumption (how long/how many times per week) Antiemetic / Effect Other Examinations Delivery 1 Schmid SM et al, 2010 26 G2P0A1 10; ?/ ? All 3 Beneficial 13 years /daily Metoclopramide Chlorazine Dexamethasone Ondansetron Vitamin B6/ineffective Urinary and blood tests Uncomplicated 2 Alaniz VI et al, 2015 28 G5P3A1 30; 5/7 All 3 Beneficial 12 years /daily Unspecified molecule /ineffective Blood test + Cerebral and abdominal Magnetic Resonance imaging NICU for hypoxia. Hospital discharge on the second day in good condition 3 Andrews KH et al, 2015 24 G5P2A2 26; 2/7 All 3 Beneficial 8 years / several times per week Treatment incompletely specified. Metoclopramide effectiveness associated with stopping cannabis use and a prescription of hot showers Blood test Abdominal x-ray abdominal and pelvic CT scan 37 wks 2270 g APGAR 9/9; No complications described 4 Manning Meurer M et al, 2017 21 G1P0A0 6;?/ ? Shower/bath not described ? ? Treatment: unspecified molecule/no description of efficacy Blood test Digestive endoscopy Induced at 36 wks 6/7 for Pre-eclampsia. 2430 g Fetal deceleration Shoulder dystocia APGAR 1/5 19 days in NICU Baby intracranial hemorrhage and spontaneous resorption. At 10 months of life, normal baby evolution 5 Kim HG et al, 2018 20 G7P0A6 14; 3/7 All 3 Beneficial ? Ondansetron Famotidine Metoclopramide Ondansetron per os Promethazine IR All ineffective Blood test 40 wks 1/7 3190 g APGAR 8/9 No complications described 6 This Case 29 G1P0A0 29 All 3 Beneficial 6 years /daily Metoclopramide/ no effect Blood test Abdominal and pelvic ultrasound 39 wks 6/7 2650 g No complications. Hospital discharge on the third day in good condition ? indicates no data available. Abbreviations: NICU: neonatal intensive care unit; y: years; wks: weeks; g: grams Table 2 Demographic Characteristics Characteristic Average/median Age, years 24.6/25 Pregnancy at diagnosis, weeks 19.1/20 Time since first consumption, years 9.75/10 Consumption at least several times a week, n 4/4 Beneficial showers/hot baths, n 6/6 Need for neonatal intensive care, n 2/6 Cite Share Download PDF Status: Published Journal Publication published 28 Oct, 2020 Read the published version in International Journal of Emergency Medicine → Version 2 posted Editorial decision: Accept 30 Aug, 2020 Editor assigned by journal 31 Jul, 2020 Submission checks completed at journal 30 Jul, 2020 Editor invited by journal 30 Jul, 2020 You are reading this latest preprint version Show more versions Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-36159","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case report","associatedPublications":[],"authors":[{"id":1139674,"identity":"08d8e5ed-8d14-4f56-9ae6-70dafa8e250e","order_by":0,"name":"Julien Flament","email":"data:image/png;base64,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","orcid":"https://orcid.org/0000-0002-5001-7762","institution":"CHU UCL Namur","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Julien","middleName":"","lastName":"Flament","suffix":""},{"id":1139675,"identity":"26aeede1-fc50-446e-b349-387012154a0b","order_by":1,"name":"Nathan Scius","email":"","orcid":"","institution":"CHU UCL Namur","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Nathan","middleName":"","lastName":"Scius","suffix":""},{"id":1139676,"identity":"fa1fc203-c6f9-4064-9f2f-d62c21ebb900","order_by":2,"name":"Henri Thonon","email":"","orcid":"","institution":"CHU UCL Namur","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Henri","middleName":"","lastName":"Thonon","suffix":""}],"badges":[],"createdAt":"2020-06-16 21:34:24","currentVersionCode":2,"declarations":"","doi":"10.21203/rs.3.rs-36159/v2","doiUrl":"https://doi.org/10.21203/rs.3.rs-36159/v2","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12245-020-00311-y","type":"published","date":"2020-10-28T15:03:23+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":13569329,"identity":"bc14d79a-5ccc-4aa3-b638-455c2726e6d2","added_by":"auto","created_at":"2021-09-17 03:39:42","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":180321,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-36159/v2/e7d739e7-d92a-4331-bb38-8481ec8c9240.pdf"}],"financialInterests":"","formattedTitle":"Cannabinoid Hyperemesis Syndrome in the pregnant patient: clinical case and literature review","fulltext":[{"header":"1. Background","content":"\u003cp\u003eCannabinoid hyperemesis syndrome is a recent clinical entity (1) involving nausea and vomiting in chronic cannabis users. The syndrome is also frequently associated with abdominal pain and compulsive showers or hot baths, which can attenuate the symptomatology (1,2).\u003c/p\u003e\n\u003cp\u003eThe diagnosis of cannabinoid hyperemesis syndrome is based on the exclusion of other causes and the disappearance of symptoms once cannabis consumption is terminated (2). The diagnosis and treatment of cannabinoid hyperemesis syndrome presents a challenge to the clinician. We describe a rare case of a pregnant woman that was likely to have cannabinoid syndrome. We will review the cases published to date and the current therapeutic options and discuss the peculiarity of pregnancy. Finally, we emphasize the notion that this syndrome should not be ignored, when assessing other causes of vomiting during pregnancy, such as hyperemesis gravidarum.\u003c/p\u003e"},{"header":"2. Case Presentation","content":"\u003cp\u003eA 29-year-old patient in her first pregnancy, at 29 weeks and 1 day gestation, visited the emergency room for uncontrollable vomiting and epigastric pain. She reported no health problems, but she smoked tobacco and cannabis. She had consumed 2 grams per week for 6 years. She did not have any known allergies. She reported a decline in symptoms when taking a hot bath. The cardiopulmonary clinical examination was unremarkable. Abdominal palpation showed epigastric pain without guarding or rebound. The patient had a body temperature of 35.9\u0026deg;C, and displayed stable hemodynamics.\u003c/p\u003e\n\u003cp\u003eFurther examinations revealed normal CBC but leukocytosis with WBC of 14.7 with a left shift. An abdominal ultrasound showed no detectable pathology. Obstetrically, she had a normal ultrasound, normal cardio-fetal monitoring.\u003c/p\u003e\n\u003cp\u003eShe was treated with acetaminophen (1000 mg), tramadol (50 mg), metoclopramide (10 mg) and butylhyoscine bromide (10 mg). Based on the strong suspicion of cannabinoid hyperemesis syndrome and her clinical improvement in the emergency department, the details of this entity were explained to the patient, and she returned home.\u003c/p\u003e\n\u003cp\u003eThe pregnancy was uncomplicated, and she gave birth at 39 weeks 6/7 to a healthy \u0026nbsp;2650-g newborn. She was discharged home with her infant uneventfully on postpartum Day 3.\u003c/p\u003e"},{"header":"3. Discussion","content":"\u003cp\u003eThe classic clinical picture of cannabinoid hyperemesis syndrome is as follows: chronic, intensive use of cannabis, episodes of uncontrollable vomiting, and abdominal pain. \u0026nbsp;A symptomatological and temporary improvement in symptoms is noted when taking a bath or hot shower. Finally, the syndrome ceases when the patient ceases cannabis use and resumes when they do not.\u003c/p\u003e\n\u003cp\u003eCannabis use is increasing worldwide (3). Accordingly, the number of published cases of cannabinoid hyperemesis syndrome has increased, and the pathology is of interest in various related specialties, including pediatrics (4) and forensic pathology (5). Although the cause of the syndrome is being discussed continually and remains to be formally clarified, a few known factors are notable. First, \u0026Delta;-9-tetrahydrocannabinol (THC)\u0026nbsp; is a CB1 receptor agonist, and it is assumed that deregulation of the receptor could cause nausea.\u003c/p\u003e\n\u003cp\u003eMore than half of pregnant women experience nausea and vomiting. Hyperemesis gravidarum, which affects only 0.3 to 1% of pregnant women, is defined as persistent vomiting, more than 5% weight loss, ketonuria, and electrolyte abnormalities (particularly hypokalemia). The physiopathology remains unclear, but it is linked to hormonal activity and the production of human chorionic gonadotropin (6,7).\u003c/p\u003e\n\u003cp\u003eWe conducted a literature search to identify clinical cases of cannabinoid hyperemesis syndrome in pregnant patients. We employed \u003ca href=\"https://www.collinsdictionary.com/dictionary/english-french/the\"\u003ethe\u003c/a\u003e search \u003ca href=\"https://www.collinsdictionary.com/dictionary/english-french/term\"\u003eterms\u003c/a\u003e \u0026lsquo;Cannabinoid\u0026rsquo; \u0026lsquo;Hyperemesis\u0026rsquo; \u003ca href=\"https://www.collinsdictionary.com/dictionary/english-french/and_1\"\u003eand\u003c/a\u003e \u0026lsquo;\u003ca href=\"https://www.collinsdictionary.com/dictionary/english-french/pregnancy\"\u003ePregnancy\u003c/a\u003e\u0026rsquo; \u003ca href=\"https://www.collinsdictionary.com/dictionary/english-french/in_1\"\u003ein\u003c/a\u003e PubMed \u003ca href=\"https://www.collinsdictionary.com/dictionary/english-french/and_1\"\u003eand\u003c/a\u003e \u003ca href=\"https://www.collinsdictionary.com/dictionary/english-french/google\"\u003eGoogle\u003c/a\u003e \u003ca href=\"https://www.collinsdictionary.com/dictionary/english-french/scholar\"\u003escholar\u003c/a\u003e. We identified five clinical cases (8-12) and extracted their characteristics (detailed in the appendix tables).\u003c/p\u003e\n\u003cp\u003eUnlike studies in non-pregnant individuals (2), the low number of studies in pregnant patients makes it difficult to perform statistical analyses. On the other hand, there are similarities between non-pregnant and pregnant individuals. Most individuals with cannabinoid hyperemesis syndrome have consumed cannabis for years, mostly daily, and the symptoms tend to improve after taking a shower or hot bath. However, cannabinoid hyperemesis syndrome is particularly complex in pregnant women. Women that use cannabis during pregnancy are more likely to experience severe nausea than those that do not (13). Nevertheless, and paradoxically, antiemetic effects have been attributed to cannabis, in both the general population (14) and pregnant women (15). Some authors have recommended cannabis for treating hyperemesis gravidarum (16). One hypothesis suggested that endocannabinoids played a role in the latter pathology. However, that hypothesis was refuted in a prospective study that did not find any changes in plasma endocannabinoid\u0026nbsp; levels in patients with gravidarum hyperemesis (17).\u003cbr /\u003e Cannabis use is increasing among pregnant women (18). However, it seems to be somewhat unacceptable socially or medically. This stigma might lead them to hide it when taking of a comprehensive patient history. This possibility was reinforced by the absence of a link between symptomatology and cannabis use (8). The prevalence of cannabis use in parturition is likely to be generally underestimated (19). Some patients diagnosed with classical nausea and vomiting during pregnancy or even gravidarum hyperemesis might actually have cannabinoid hyperemesis syndrome. These entities might be differentiated clinically by the sensitivity of hyperemesis gravidarum to certain antiemetic drugs (20,21).\u003c/p\u003e\n\u003cp\u003ePotentially beneficial therapies for treating common cannabinoid hyperemesis syndrome, such as lorazepam (22) and haloperidol (23), are contraindicated in parturient women (24). Capsaicin cream is not recommended in pregnant women. However, its usefulness could be discussed, in light of its supposed safety. Capsaicin treatment requires low dosages, and it doesn\u0026rsquo;t cross the placental barrier (25). Similarly, ondansetron (26) appears to have some efficacy. Although ondansetron is not recommended in the first trimester of pregnancy, its use might be permissible thereafter (24). Metoclopramide, which can be used throughout pregnancy, has been used to treat cannabinoid hyperemesis syndrome and showed some efficacy.\u003c/p\u003e\n\u003cp\u003eThis case study serves to remind physicians of the need to insist on recounting cannabis use when taking of the comprehensive patient history, particularly in parturient women with vomiting. Fortunately, the compulsive use of hot baths or showers seems specific to this clinical entity (2) and can help discriminate cannabinoid hyperemesis syndrome from other diseases.\u003c/p\u003e\n\u003cp\u003eThere is a need for prospective studies that aim to determine the proportion of this syndrome among a parturient sample with vomiting and characterize potential differences in this subpopulation.\u003c/p\u003e\n\u003cp\u003eRandomized, controlled therapeutic trials should also be conducted to find a functional treatment for symptoms. On one hand, an effective treatment could obviate the potential consequences of drugs of equivocal safety. On the other hand, an effective treatment is needed to avoid serious consequences of uncontrollable vomiting, which range from pneumomediastinum (27) to death (5) and acute renal insufficiency (28).\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCBC: complete blood count\u003c/p\u003e\n\u003cp\u003eWBC: white blood cell\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval: not applicable\u003c/p\u003e\n\u003cp\u003eConsent to participate: not applicable\u003c/p\u003e\n\u003cp\u003eConsent for publication: The patient give his content for all part of the material referenced here.\u003c/p\u003e\n\u003cp\u003eAvailability of data and material: Please contact author for data requests.\u003c/p\u003e\n\u003cp\u003eCompeting interests: The authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003eFunding: Not applicable\u003c/p\u003e\n\u003cp\u003eAuthors' contributions: JF write the manuscript. NS correct the manuscript. HT correct the manuscript. All authors read and approved the final manuscript\u003c/p\u003e\n\u003cp\u003eAcknowledgements: Not applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAllen JH, de Moore GM, Heddle R, Twartz JC. Cannabinoid hyperemesis: cyclical hyperemesis in association with chronic cannabis abuse.\u0026nbsp;Gut 2004; org/10.1136/gut.2003.036350\u003c/li\u003e\n\u003cli\u003eSimonetto DA, Oxentenko AS, Herman ML, Szostek JH. Cannabinoid hyperemesis: a case series of 98 patients.\u0026nbsp;Mayo Clin Proc. 2012; org/10.1016/j.mayocp.2011.10.005\u003c/li\u003e\n\u003cli\u003eWorld drug report 2014, http://www.incb.org/documents/Publications/AnnualReports/AR2018/Annual_Report/Annual_Report_2018_F.pdf. Accessed April 1, 2020\u003c/li\u003e\n\u003cli\u003eDesjardins N, Stheneur C. Cannabinoid hyperemesis syndrome\u0026nbsp;: A review of the literature. \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/27017363\"\u003eArch Pediatr; \u003c/a\u003eorg/10.1016/j.arcped.2016.01.016\u003c/li\u003e\n\u003cli\u003eNourbakhsh M,\u0026nbsp;Miller A,\u0026nbsp;Gofton J,\u0026nbsp;Jones G,\u0026nbsp;Adeagbo B. CannabinoidHyperemesis\u0026nbsp;Syndrome: Reports of Fatal Cases. \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/29768651\"\u003eJ Forensic Sci.\u003c/a\u003e\u0026nbsp;2019; org/10.1111/1556-4029.13819.\u003c/li\u003e\n\u003cli\u003eGoodwin TM. Hyperemesis gravidarum. Clin Obstet Gynecol1998;org/10.1097/00003081-199809000-00014\u003c/li\u003e\n\u003cli\u003eNiebyl JR. Nausea and vomiting in pregnancy. N Engl J Med 2010; org/10.1056/NEJMcp1003896\u003c/li\u003e\n\u003cli\u003eSchmid SM, Lapaire O, Huang DJ, J\u0026uuml;rgens FE, G\u0026uuml;th U. \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/21170540\"\u003eCannabinoidhyperemesis\u0026nbsp;syndrome: an underreported entity causing nausea and vomiting of pregnancy.\u003c/a\u003e Arch Gynecol Obstet. 2011; org/10.1007/s00404-010-1811-\u003cem\u003e8\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003eAlaniz VI, Liss J, Metz TD, Stickrath E. \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/25774930\"\u003eCannabinoidhyperemesis\u0026nbsp;syndrome: a cause of refractory nausea and vomiting in pregnancy.\u003c/a\u003e Obstet Gynecol. 2015; org/10.1097/AOG.0000000000000595\u003c/li\u003e\n\u003cli\u003eAndrews KH, Bracero LA. \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/26592070\"\u003eCannabinoidHyperemesis\u0026nbsp;Syndrome During Pregnancy: A Case Report.\u003c/a\u003e J Reprod Med. 2015; 60(9-10): 430-2.\u003c/li\u003e\n\u003cli\u003eManning Meurer M, Chakrala K et al. \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/28723278\"\u003eA case of\u0026nbsp;cannabinoidhyperemesis\u0026nbsp;syndrome with Heliobacter pylori and preeclampsia during\u0026nbsp;pregnancy.\u003c/a\u003e Subst Abus. 2018; org/10.1080/08897077.2017.1356790\u003c/li\u003e\n\u003cli\u003eKim HG, Moon J, Dixon H et al. Recurrent Nausea and Vomiting in a\u0026nbsp;PregnantWoman with Chronic Marijuana Use. Case Rep Obstet Gynecol. 2018; org/10.1155/2018/9746062\u003c/li\u003e\n\u003cli\u003eRoberson EK, Patrick WK, Hurwitz EL. Marijuana use and maternal experiences of severe nausea during pregnancy in Hawai'i.\u0026nbsp;Hawaii J Med Public Health. 2014;73(9):283\u0026ndash;287.\u003c/li\u003e\n\u003cli\u003e\u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/?term=Carlini%20EA%5BAuthor%5D\u0026amp;cauthor=true\u0026amp;cauthor_uid=15302527\"\u003eCarlini EA\u003c/a\u003e\u003csup\u003e.\u003c/sup\u003e. The good and the bad effects of (-) trans-delta-9-tetrahydrocannabinol (Delta 9-THC) on humans. 2004; 44(4): 461-7.\u003c/li\u003e\n\u003cli\u003e\u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/?term=Westfall%20RE%5BAuthor%5D\u0026amp;cauthor=true\u0026amp;cauthor_uid=16401527\"\u003eWestfall RE\u003c/a\u003e,\u0026nbsp;\u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/?term=Janssen%20PA%5BAuthor%5D\u0026amp;cauthor=true\u0026amp;cauthor_uid=16401527\"\u003eJanssen PA\u003c/a\u003e,\u0026nbsp;\u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/?term=Lucas%20P%5BAuthor%5D\u0026amp;cauthor=true\u0026amp;cauthor_uid=16401527\"\u003eLucas P\u003c/a\u003e et al. Survey of medicinal cannabis use among childbearing women: patterns of its use in pregnancy and retroactive self-assessment of its efficacy against 'morning sickness'. \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/16401527\"\u003eComplement Ther Clin Pract.\u003c/a\u003e2006; 12(1): 27-33.\u003c/li\u003e\n\u003cli\u003eRusso E. Cannabis Treatments in Obstetrics and Gynecology: A Historical Review,J Cannabis Therapeut;org/10.1300/J175v02v03_02\u003c/li\u003e\n\u003cli\u003e\u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/?term=Gebeh%20AK%5BAuthor%5D\u0026amp;cauthor=true\u0026amp;cauthor_uid=24117326\"\u003eGebeh AK\u003c/a\u003e,\u0026nbsp;\u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/?term=Willets%20JM%5BAuthor%5D\u0026amp;cauthor=true\u0026amp;cauthor_uid=24117326\"\u003eWillets JM\u003c/a\u003e,\u0026nbsp;\u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/?term=Marczylo%20TH%5BAuthor%5D\u0026amp;cauthor=true\u0026amp;cauthor_uid=24117326\"\u003eMarczylo TH\u003c/a\u003e, et Konje JC. Plasma anandamide and related n-acylethanolamide levels are not elevated in pregnancies complicated by\u0026nbsp;hyperemesis gravidarum. \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/24117326\"\u003eJ Matern Fetal Neonatal Med.\u003c/a\u003e2014; \u0026nbsp;org/10.3109/14767058.2013.847413\u003c/li\u003e\n\u003cli\u003e\u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/?term=Keegan%20J%5BAuthor%5D\u0026amp;cauthor=true\u0026amp;cauthor_uid=20407975\"\u003eKeegan J\u003c/a\u003e, \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/?term=Parva%20M%5BAuthor%5D\u0026amp;cauthor=true\u0026amp;cauthor_uid=20407975\"\u003eParva M\u003c/a\u003e, \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/?term=Finnegan%20M%5BAuthor%5D\u0026amp;cauthor=true\u0026amp;cauthor_uid=20407975\"\u003eFinnegan M\u003c/a\u003e et Gerson A et Belden M. Addiction in pregnancy. \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/20407975\"\u003eJ Addict Dis.\u003c/a\u003e 2010; org/10.1080/10550881003684723\u003c/li\u003e\n\u003cli\u003e\u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/?term=Jaques%20SC%5BAuthor%5D\u0026amp;cauthor=true\u0026amp;cauthor_uid=24457255\"\u003eJaques SC\u003c/a\u003e, \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/?term=Kingsbury%20A%5BAuthor%5D\u0026amp;cauthor=true\u0026amp;cauthor_uid=24457255\"\u003eKingsbury A\u003c/a\u003e, \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/?term=Henshcke%20P%5BAuthor%5D\u0026amp;cauthor=true\u0026amp;cauthor_uid=24457255\"\u003eHenshcke P\u003c/a\u003e, Chomchai C, Falconer J, Abdelatif ME et al. Cannabis, the pregnant woman and her child: weeding out the myths. \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/24457255\"\u003eJ Perinatol.\u003c/a\u003e 2014; org/10.1038/jp.2013.180\u003c/li\u003e\n\u003cli\u003e\u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/?term=Fejzo%20MS%5BAuthor%5D\u0026amp;cauthor=true\u0026amp;cauthor_uid=31515515\"\u003eFejzo MS\u003c/a\u003e, \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/?term=Trovik%20J%5BAuthor%5D\u0026amp;cauthor=true\u0026amp;cauthor_uid=31515515\"\u003eTrovik J\u003c/a\u003e, \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/?term=Grooten%20IJ%5BAuthor%5D\u0026amp;cauthor=true\u0026amp;cauthor_uid=31515515\"\u003eGrooten IJ\u003c/a\u003e, Sridharan K, Roseboom TJ, Vikanes A et al. Nausea and vomiting of pregnancy and hyperemesis gravidarum. \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/31515515\"\u003eNat Rev Dis Primers.\u003c/a\u003e 2019; org/10.1038/s41572-019-0110-3\u003c/li\u003e\n\u003cli\u003e\u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/?term=O'Donnell%20A%5BAuthor%5D\u0026amp;cauthor=true\u0026amp;cauthor_uid=27731292\"\u003eO'Donnell A\u003c/a\u003e, \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/?term=McParlin%20C%5BAuthor%5D\u0026amp;cauthor=true\u0026amp;cauthor_uid=27731292\"\u003eMcParlin C\u003c/a\u003e, \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/?term=Robson%20SC%5BAuthor%5D\u0026amp;cauthor=true\u0026amp;cauthor_uid=27731292\"\u003eRobson SC\u003c/a\u003e, Beyer F, Moloney E, Bryant A et al. Treatments for hyperemesis gravidarum and nausea and vomiting in pregnancy: a systematic review and economic assessment. \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/27731292\"\u003eHealth Technol Assess.\u003c/a\u003e 2016; org/10.3310/hta20740\u003c/li\u003e\n\u003cli\u003eSun S, Zimmermann AE. Cannabinoidhyperemesis\u0026nbsp;syndrome. \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/24421535\"\u003eHosp Pharm.\u003c/a\u003e\u0026nbsp;2013 ; org/10.1310/hpj4808-650\u003c/li\u003e\n\u003cli\u003e\u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/?term=Hickey%20JL%5BAuthor%5D\u0026amp;cauthor=true\u0026amp;cauthor_uid=23583118\"\u003eHickey JL\u003c/a\u003e, \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/?term=Witsil%20JC%5BAuthor%5D\u0026amp;cauthor=true\u0026amp;cauthor_uid=23583118\"\u003eWitsil JC\u003c/a\u003e, \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/?term=Mycyk%20MB%5BAuthor%5D\u0026amp;cauthor=true\u0026amp;cauthor_uid=23583118\"\u003eMycyk MB\u003c/a\u003e. Haloperidol for treatment of cannabinoid hyperemesis syndrome. \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/23583118\"\u003eAm J Emerg Med.\u003c/a\u003e 2013; org/10.1016/j.ajem.2013.02.021\u003c/li\u003e\n\u003cli\u003eReference Center for Teratogens, https//lecrat.fr. Accessed April 1, 2020\u003c/li\u003e\n\u003cli\u003e\u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/?term=Dezieck%20L%5BAuthor%5D\u0026amp;cauthor=true\u0026amp;cauthor_uid=28494183\"\u003eDezieck L\u003c/a\u003e, \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/?term=Hafez%20Z%5BAuthor%5D\u0026amp;cauthor=true\u0026amp;cauthor_uid=28494183\"\u003eHafez Z\u003c/a\u003e, \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/?term=Conicella%20A%5BAuthor%5D\u0026amp;cauthor=true\u0026amp;cauthor_uid=28494183\"\u003eConicella A\u003c/a\u003e, Blohm E, O\u0026rsquo;Connor MJ, Schwarz ES et al. Resolution of cannabis hyperemesis syndrome with topical capsaicin in the emergency department: a case series \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/?term=Case+series+of+patients+treated+for+cannabinoid+hyperemesis+syndrome+with+capsaicin+cream.\"\u003eClin Toxicol (Phila).\u003c/a\u003e 2017; org/10.1080/15563650.2017.1324166\u003c/li\u003e\n\u003cli\u003eElkin K, Tai P, Winkel J, Kulkarni M, Sadler D, Truong N et al. 337 Cannabinoid Hyperemesis Syndrome: 3-Year Practice Patterns. \u003ca href=\"https://www.sciencedirect.com/science/journal/01960644\"\u003eAnn\u003c/a\u003e Emerg Med. 2019;org/10.1016/j.annemergmed.2019.08.296\u003c/li\u003e\n\u003cli\u003e\u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/?term=Hern%C3%A1ndez-Ramos%20I%5BAuthor%5D\u0026amp;cauthor=true\u0026amp;cauthor_uid=31133765\"\u003eHern\u0026aacute;ndez-Ramos I\u003c/a\u003e, \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/?term=Parra-Esquivel%20P%5BAuthor%5D\u0026amp;cauthor=true\u0026amp;cauthor_uid=31133765\"\u003eParra-Esquivel P\u003c/a\u003e, \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/?term=L%C3%B3pez-Hern%C3%A1ndez%20%C3%81%5BAuthor%5D\u0026amp;cauthor=true\u0026amp;cauthor_uid=31133765\"\u003eL\u0026oacute;pez-Hern\u0026aacute;ndez \u0026Aacute;\u003c/a\u003e, Burillo-Putze G. Spontaneuos pneumomediastinum secondary to cannabinoid hyperemesis syndrome. \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/31133765\"\u003eAn Sist Sanit Navar.\u003c/a\u003e 2019; org/10.23938/ASSN.0635\u003c/li\u003e\n\u003cli\u003eHabboushe J, Sedor J. Cannabinoid hyperemesis acute renal failure: a common sequela of cannabinoid hyperemesis syndrome. Am J Emerg Med 2014; org/10.1016/j.ajem.2013.12.013\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp style=\"margin: 0in 0in 10pt;line-height: 16.866666793823242px;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px; font-family: Verdana, Geneva, sans-serif; color: rgb(0, 0, 0);\"\u003eTable 1 Published cases of cannabinoid hyperemesis syndrome in pregnant women\u003c/span\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" style=\"border-collapse: collapse;\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 46.25px;border-top-width: 1pt;border-bottom-width: 1pt;border-left-width: 1pt;border-style: solid none solid solid;border-top-color: windowtext;border-bottom-color: windowtext;border-left-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"6.451612903225806%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eNumber\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59.984375px;border-top-width: 1pt;border-style: solid none;border-top-color: windowtext;border-bottom-width: 1pt;border-bottom-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"7.526881720430108%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eReference\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.75px;border-top-width: 1pt;border-style: solid none;border-top-color: windowtext;border-bottom-width: 1pt;border-bottom-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"4.301075268817204%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eAge, y\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52.015625px;border-top-width: 1pt;border-style: solid none;border-top-color: windowtext;border-bottom-width: 1pt;border-bottom-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"7.526881720430108%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eObstetric Status\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55.65625px;border-top-width: 1pt;border-style: solid none;border-top-color: windowtext;border-bottom-width: 1pt;border-bottom-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"11.827956989247312%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eGestation period, weeks; days\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;border-top-width: 1pt;border-style: solid none;border-top-color: windowtext;border-bottom-width: 1pt;border-bottom-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"9.67741935483871%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eNausea and vomiting\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003e+\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eCannabis use +\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eHot shower/bath\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56.375px;border-top-width: 1pt;border-style: solid none;border-top-color: windowtext;border-bottom-width: 1pt;border-bottom-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"7.526881720430108%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eShower effect\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73.71875px;border-top-width: 1pt;border-style: solid none;border-top-color: windowtext;border-bottom-width: 1pt;border-bottom-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"8.602150537634408%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eUsual consumption (how long/how many times per week)\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96.109375px;border-top-width: 1pt;border-style: solid none;border-top-color: windowtext;border-bottom-width: 1pt;border-bottom-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"15.053763440860216%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eAntiemetic / Effect\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78.046875px;border-top-width: 1pt;border-style: solid none;border-top-color: windowtext;border-bottom-width: 1pt;border-bottom-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"10.75268817204301%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eOther Examinations\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;border-top-width: 1pt;border-right-width: 1pt;border-bottom-width: 1pt;border-style: solid solid solid none;border-top-color: windowtext;border-right-color: windowtext;border-bottom-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"10.75268817204301%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eDelivery\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 46.25px;border-style: none none solid solid;border-left-width: 1pt;border-left-color: windowtext;border-bottom-width: 1pt;border-bottom-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"6.451612903225806%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003e1\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59.984375px;border-style: none none solid;border-bottom-width: 1pt;border-bottom-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"7.526881720430108%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eSchmid SM et al, 2010\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.75px;border-style: none none solid;border-bottom-width: 1pt;border-bottom-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"4.301075268817204%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003e26\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52.015625px;border-style: none none solid;border-bottom-width: 1pt;border-bottom-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"7.526881720430108%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eG2P0A1\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55.65625px;border-style: none none solid;border-bottom-width: 1pt;border-bottom-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"11.827956989247312%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003e10; ?/ ?\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;border-style: none none solid;border-bottom-width: 1pt;border-bottom-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"9.67741935483871%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eAll 3\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56.375px;border-style: none none solid;border-bottom-width: 1pt;border-bottom-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"7.526881720430108%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eBeneficial\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73.71875px;border-style: none none solid;border-bottom-width: 1pt;border-bottom-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"8.602150537634408%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003e13 years /daily\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96.109375px;border-style: none none solid;border-bottom-width: 1pt;border-bottom-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"15.053763440860216%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eMetoclopramide\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eChlorazine\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eDexamethasone\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eOndansetron\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eVitamin B6/ineffective\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78.046875px;border-style: none none solid;border-bottom-width: 1pt;border-bottom-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"10.75268817204301%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eUrinary \u0026nbsp;and blood tests\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;border-style: none solid solid none;border-bottom-width: 1pt;border-bottom-color: windowtext;border-right-width: 1pt;border-right-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"10.75268817204301%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eUncomplicated\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 46.25px;border-style: none none solid solid;border-left-width: 1pt;border-left-color: windowtext;border-bottom-width: 1pt;border-bottom-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"6.451612903225806%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003e2\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59.984375px;border-style: none none solid;border-bottom-width: 1pt;border-bottom-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"7.526881720430108%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eAlaniz VI et al, 2015\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.75px;border-style: none none solid;border-bottom-width: 1pt;border-bottom-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"4.301075268817204%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003e28\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52.015625px;border-style: none none solid;border-bottom-width: 1pt;border-bottom-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"7.526881720430108%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eG5P3A1\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55.65625px;border-style: none none solid;border-bottom-width: 1pt;border-bottom-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"11.827956989247312%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003e30; 5/7\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;border-style: none none solid;border-bottom-width: 1pt;border-bottom-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"9.67741935483871%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eAll 3\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56.375px;border-style: none none solid;border-bottom-width: 1pt;border-bottom-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"7.526881720430108%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eBeneficial\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73.71875px;border-style: none none solid;border-bottom-width: 1pt;border-bottom-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"8.602150537634408%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003e12 years /daily\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96.109375px;border-style: none none solid;border-bottom-width: 1pt;border-bottom-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"15.053763440860216%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eUnspecified molecule /ineffective\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78.046875px;border-style: none none solid;border-bottom-width: 1pt;border-bottom-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"10.75268817204301%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eBlood test\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003e+\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eCerebral and abdominal Magnetic Resonance imaging\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;border-style: none solid solid none;border-bottom-width: 1pt;border-bottom-color: windowtext;border-right-width: 1pt;border-right-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"10.75268817204301%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eNICU for hypoxia.\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eHospital discharge on the second day in good condition\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 46.25px;border-style: none none solid solid;border-left-width: 1pt;border-left-color: windowtext;border-bottom-width: 1pt;border-bottom-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"6.451612903225806%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003e3\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59.984375px;border-style: none none solid;border-bottom-width: 1pt;border-bottom-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"7.526881720430108%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eAndrews KH et al, 2015\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.75px;border-style: none none solid;border-bottom-width: 1pt;border-bottom-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"4.301075268817204%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003e24\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52.015625px;border-style: none none solid;border-bottom-width: 1pt;border-bottom-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"7.526881720430108%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eG5P2A2\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55.65625px;border-style: none none solid;border-bottom-width: 1pt;border-bottom-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"11.827956989247312%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003e26; 2/7\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;border-style: none none solid;border-bottom-width: 1pt;border-bottom-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"9.67741935483871%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eAll 3\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56.375px;border-style: none none solid;border-bottom-width: 1pt;border-bottom-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"7.526881720430108%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eBeneficial\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73.71875px;border-style: none none solid;border-bottom-width: 1pt;border-bottom-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"8.602150537634408%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003e8 years / several times per week\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96.109375px;border-style: none none solid;border-bottom-width: 1pt;border-bottom-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"15.053763440860216%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eTreatment incompletely specified. \u0026nbsp;Metoclopramide effectiveness associated with stopping cannabis use and a prescription of hot showers\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78.046875px;border-style: none none solid;border-bottom-width: 1pt;border-bottom-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"10.75268817204301%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eBlood test Abdominal x-ray\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eabdominal and pelvic CT scan\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;border-style: none solid solid none;border-bottom-width: 1pt;border-bottom-color: windowtext;border-right-width: 1pt;border-right-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"10.75268817204301%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003e37 wks\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003e2270 g\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eAPGAR 9/9; No complications described\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 46.25px;border-style: none none solid solid;border-left-width: 1pt;border-left-color: windowtext;border-bottom-width: 1pt;border-bottom-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"6.451612903225806%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003e4\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59.984375px;border-style: none none solid;border-bottom-width: 1pt;border-bottom-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"7.526881720430108%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eManning Meurer M et al, 2017\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.75px;border-style: none none solid;border-bottom-width: 1pt;border-bottom-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"4.301075268817204%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003e21\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52.015625px;border-style: none none solid;border-bottom-width: 1pt;border-bottom-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"7.526881720430108%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eG1P0A0\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55.65625px;border-style: none none solid;border-bottom-width: 1pt;border-bottom-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"11.827956989247312%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003e6;?/ ?\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;border-style: none none solid;border-bottom-width: 1pt;border-bottom-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"9.67741935483871%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eShower/bath not described\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56.375px;border-style: none none solid;border-bottom-width: 1pt;border-bottom-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"7.526881720430108%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003e?\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73.71875px;border-style: none none solid;border-bottom-width: 1pt;border-bottom-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"8.602150537634408%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003e?\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96.109375px;border-style: none none solid;border-bottom-width: 1pt;border-bottom-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"15.053763440860216%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eTreatment: unspecified molecule/no description of efficacy\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78.046875px;border-style: none none solid;border-bottom-width: 1pt;border-bottom-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"10.75268817204301%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eBlood test Digestive endoscopy\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;border-style: none solid solid none;border-bottom-width: 1pt;border-bottom-color: windowtext;border-right-width: 1pt;border-right-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"10.75268817204301%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eInduced at 36 wks 6/7 for\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003ePre-eclampsia.\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003e2430 g\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eFetal deceleration\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eShoulder dystocia\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eAPGAR 1/5\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003e19 days in NICU\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eBaby intracranial hemorrhage and spontaneous resorption.\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eAt 10 months of life, normal baby evolution\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 46.25px;border-style: none none solid solid;border-left-width: 1pt;border-left-color: windowtext;border-bottom-width: 1pt;border-bottom-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"6.451612903225806%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003e5\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59.984375px;border-style: none none solid;border-bottom-width: 1pt;border-bottom-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"7.526881720430108%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eKim HG et al, 2018\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.75px;border-style: none none solid;border-bottom-width: 1pt;border-bottom-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"4.301075268817204%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003e20\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52.015625px;border-style: none none solid;border-bottom-width: 1pt;border-bottom-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"7.526881720430108%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eG7P0A6\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55.65625px;border-style: none none solid;border-bottom-width: 1pt;border-bottom-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"11.827956989247312%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003e14; 3/7\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;border-style: none none solid;border-bottom-width: 1pt;border-bottom-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"9.67741935483871%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eAll 3\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56.375px;border-style: none none solid;border-bottom-width: 1pt;border-bottom-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"7.526881720430108%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eBeneficial\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73.71875px;border-style: none none solid;border-bottom-width: 1pt;border-bottom-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"8.602150537634408%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003e?\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96.109375px;border-style: none none solid;border-bottom-width: 1pt;border-bottom-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"15.053763440860216%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eOndansetron\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eFamotidine\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eMetoclopramide\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eOndansetron per os\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003ePromethazine IR\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eAll ineffective\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78.046875px;border-style: none none solid;border-bottom-width: 1pt;border-bottom-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"10.75268817204301%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eBlood test\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;border-style: none solid solid none;border-bottom-width: 1pt;border-bottom-color: windowtext;border-right-width: 1pt;border-right-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"10.75268817204301%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003e40 wks 1/7\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003e3190 g\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eAPGAR 8/9\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eNo complications described\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 46.25px;border-style: none none solid solid;border-left-width: 1pt;border-left-color: windowtext;border-bottom-width: 1pt;border-bottom-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"6.451612903225806%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003e6\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59.984375px;border-style: none none solid;border-bottom-width: 1pt;border-bottom-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"7.526881720430108%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eThis Case\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.75px;border-style: none none solid;border-bottom-width: 1pt;border-bottom-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"4.301075268817204%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003e29\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52.015625px;border-style: none none solid;border-bottom-width: 1pt;border-bottom-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"7.526881720430108%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eG1P0A0\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55.65625px;border-style: none none solid;border-bottom-width: 1pt;border-bottom-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"11.827956989247312%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003e29\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;border-style: none none solid;border-bottom-width: 1pt;border-bottom-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"9.67741935483871%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eAll 3\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56.375px;border-style: none none solid;border-bottom-width: 1pt;border-bottom-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"7.526881720430108%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eBeneficial\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73.71875px;border-style: none none solid;border-bottom-width: 1pt;border-bottom-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"8.602150537634408%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003e6 years /daily\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96.109375px;border-style: none none solid;border-bottom-width: 1pt;border-bottom-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"15.053763440860216%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eMetoclopramide/ no effect\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78.046875px;border-style: none none solid;border-bottom-width: 1pt;border-bottom-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"10.75268817204301%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eBlood test\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eAbdominal and pelvic ultrasound\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;border-style: none solid solid none;border-bottom-width: 1pt;border-bottom-color: windowtext;border-right-width: 1pt;border-right-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"10.75268817204301%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003e39 wks 6/7\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003e2650 g\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eNo complications. Hospital discharge on the third day in good condition\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp style=\"margin: 0in 0in 10pt;line-height: 16.866666793823242px;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003e\u003cspan style=\"line-height: 18.399999618530273px;\"\u003e? indicates no data available. Abbreviations: NICU: neonatal intensive care unit; y: years; wks: weeks; g: grams\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp style=\"margin: 0in 0in 10pt;line-height: 16.866666793823242px;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003e\u003cspan style=\"line-height: 18.399999618530273px;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp style=\"margin: 0in 0in 10pt;line-height: 16.866666793823242px;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp style=\"margin: 0in 0in 10pt;line-height: 16.866666793823242px;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eTable 2 Demographic Characteristics\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" style=\"border-collapse: collapse;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 353.6pt;border-top-width: 1pt;border-bottom-width: 1pt;border-left-width: 1pt;border-style: solid none solid solid;border-top-color: windowtext;border-bottom-color: windowtext;border-left-color: windowtext;padding: 0in 5.4pt;height: 20.55pt;vertical-align: top;\" valign=\"top\" width=\"50%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eCharacteristic\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 353.6pt;border-top-width: 1pt;border-right-width: 1pt;border-bottom-width: 1pt;border-style: solid solid solid none;border-top-color: windowtext;border-right-color: windowtext;border-bottom-color: windowtext;padding: 0in 5.4pt;height: 20.55pt;vertical-align: top;\" valign=\"top\" width=\"50%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eAverage/median\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 353.6pt;border-style: none none solid solid;border-left-width: 1pt;border-left-color: windowtext;border-bottom-width: 1pt;border-bottom-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"50%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eAge, years\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 353.6pt;border-style: none solid solid none;border-bottom-width: 1pt;border-bottom-color: windowtext;border-right-width: 1pt;border-right-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"50%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003e24.6/25\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 353.6pt;border-style: none none solid solid;border-left-width: 1pt;border-left-color: windowtext;border-bottom-width: 1pt;border-bottom-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"50%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003ePregnancy at diagnosis, weeks\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 353.6pt;border-style: none solid solid none;border-bottom-width: 1pt;border-bottom-color: windowtext;border-right-width: 1pt;border-right-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"50%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003e19.1/20\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 353.6pt;border-style: none none solid solid;border-left-width: 1pt;border-left-color: windowtext;border-bottom-width: 1pt;border-bottom-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"50%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eTime since first consumption, years\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 353.6pt;border-style: none solid solid none;border-bottom-width: 1pt;border-bottom-color: windowtext;border-right-width: 1pt;border-right-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"50%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003e9.75/10\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 353.6pt;border-style: none none solid solid;border-left-width: 1pt;border-left-color: windowtext;border-bottom-width: 1pt;border-bottom-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"50%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eConsumption at least several times a week, n\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 353.6pt;border-style: none solid solid none;border-bottom-width: 1pt;border-bottom-color: windowtext;border-right-width: 1pt;border-right-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"50%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003e4/4\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 353.6pt;border-style: none none solid solid;border-left-width: 1pt;border-left-color: windowtext;border-bottom-width: 1pt;border-bottom-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"50%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eBeneficial showers/hot baths, n\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 353.6pt;border-style: none solid solid none;border-bottom-width: 1pt;border-bottom-color: windowtext;border-right-width: 1pt;border-right-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"50%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003e6/6\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 353.6pt;border-style: none none solid solid;border-left-width: 1pt;border-left-color: windowtext;border-bottom-width: 1pt;border-bottom-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"50%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family: Verdana, Geneva, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px;\"\u003eNeed for neonatal intensive care, n\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 353.6pt;border-style: none solid solid none;border-bottom-width: 1pt;border-bottom-color: windowtext;border-right-width: 1pt;border-right-color: windowtext;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"50%\"\u003e\n \u003cp style=\"margin: 0in;line-height: normal;font-size:15px;font-family: Calibri, sans-serif;\"\u003e\u003cspan style=\"font-size: 10px; font-family: Verdana, Geneva, sans-serif; color: rgb(0, 0, 0);\"\u003e2/6\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"international-journal-of-emergency-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ijem","sideBox":"Learn more about [International Journal of Emergency Medicine](https://intjem.biomedcentral.com/)","snPcode":"12245","submissionUrl":"https://submission.nature.com/new-submission/12245/3","title":"International Journal of Emergency Medicine","twitterHandle":"@IntJEmergMed","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Cannabinoid hyperemesis syndrome, Pregnancy, Cannabis, Vomiting, Cyclical vomiting syndrome","lastPublishedDoi":"10.21203/rs.3.rs-36159/v2","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-36159/v2","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"Background\n\nCannabis use is on the rise. Several cases of cannabinoid hyperemesis syndrome, secondary to chronic cannabis intoxication, have been described worldwide, but few cases have described this entity in pregnant women.\n\nCase presentation\n\nWe describe a 29-year-old pregnant patient that had consumed cannabis and experienced uncontrolled vomiting. The use of hot baths, the rapid improvement in symptoms, and results of complementary examinations suggested a diagnosis of cannabinoid hyperemesis syndrome. The patient could return home and she continued her pregnancy and childbirth without peculiarities.\n\nConclusion\n\nCannabinoid hyperemesis syndrome should be considered in the differential diagnosis of vomiting in pregnancy. Consumption of cannabis must be systematically included in the anamnesis. However, it seems to be somewhat unacceptable socially or medically. Consumption must be stopped to manage symptoms.","manuscriptTitle":"Cannabinoid Hyperemesis Syndrome in the pregnant patient: clinical case and literature review","msid":"","msnumber":"","nonDraftVersions":[{"code":2,"date":"2020-08-06 20:31:25","doi":"10.21203/rs.3.rs-36159/v2","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Accept","date":"2020-08-30T12:00:00+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2020-07-31T12:00:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2020-07-30T12:00:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2020-07-30T12:00:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"international-journal-of-emergency-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ijem","sideBox":"Learn more about [International Journal of Emergency Medicine](https://intjem.biomedcentral.com/)","snPcode":"12245","submissionUrl":"https://submission.nature.com/new-submission/12245/3","title":"International Journal of Emergency Medicine","twitterHandle":"@IntJEmergMed","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}},{"code":1,"date":"2020-06-19 14:48:02","doi":"10.21203/rs.3.rs-36159/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Minor revision","date":"2020-07-09T12:00:00+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2020-06-17T12:00:00+00:00","index":"","fulltext":""},{"type":"submitted","content":"","date":"2020-06-16T12:00:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2020-06-16T12:00:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2020-06-16T12:00:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"international-journal-of-emergency-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ijem","sideBox":"Learn more about [International Journal of Emergency Medicine](https://intjem.biomedcentral.com/)","snPcode":"12245","submissionUrl":"https://submission.nature.com/new-submission/12245/3","title":"International Journal of Emergency Medicine","twitterHandle":"@IntJEmergMed","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"eefe6685-3ec2-4e9f-979d-04203e3478ee","owner":[],"postedDate":"August 6th, 2020","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":125348,"name":"Critical Care \u0026 Emergency Medicine"}],"tags":[],"updatedAt":"2020-11-01T15:04:15+00:00","versionOfRecord":{"articleIdentity":"rs-36159","link":"https://doi.org/10.1186/s12245-020-00311-y","journal":{"identity":"international-journal-of-emergency-medicine","isVorOnly":false,"title":"International Journal of Emergency Medicine"},"publishedOn":"2020-10-28 15:03:23","publishedOnDateReadable":"October 28th, 2020"},"versionCreatedAt":"2020-08-06 20:31:25","video":"","vorDoi":"10.1186/s12245-020-00311-y","vorDoiUrl":"https://doi.org/10.1186/s12245-020-00311-y","workflowStages":[]},"version":"v2","identity":"rs-36159","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-36159","identity":"rs-36159","version":["v2"]},"buildId":"re_ckhLnmML6MCF96OHNJ","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}