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Rini Sulistyowati, Rr Catur Leni Wulandari (2021) Literature Review: The

Effect of Lemon Aromatherapy on Emesis Gravidarum. Journal Eduvest. 1(9):

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Eduvest – Journal of Universal Studies

Volume 1 Number 9, September 2021

p- ISSN 2775-3735 e-ISSN 2775-3727

LITERATURE REVIEW: THE EFFECT OF LEMON AROMATHERAPY

ON EMESIS GRAVIDARUM

Rini Sulistyowati, Rr Catur Leni Wulandari

Sultan Agung Islamic University

E-mail: [email protected], [email protected]

ARTICLE INFO ABSTRACT

Received:

August, 26

2021

Revised:

September, 12

2021

Approved:

September, 14

2021

Nausea and vomiting (Emesis Gravidarum) often occurs in 1st

trimester pregnant women. The cause is due to an increase in

the hormones estrogen and HCG in early pregnancy. One of

the effects is dehydration which causes the fetus to

experience problems, therefore therapy is needed one of the

therapies to deal with is the aroma therapy of lemon.

International literature searched by electronic means with key

words (emesis, lemon therapy, aromatherapy). 8 selection

articles on the effect of lemon aromatherapy on emesis

gravidarum. Result of this study is there were differences in

emesis gravidarum in aromatherapy with the same

treatment. One of the treatments for emesis gravidarum is a

non-pharmacological method, namely lemon aromatherapy.

Aromatherapy lemon therapy contains 66-80% limonene,

geranil acetate, nerol, linalyl acetate, 0.4-15% pinene, 1-4%

pinene, 6-14% terpinene and myrcen. Chemical compounds

such as geranil acetate, nerol are useful for antidepressants,

nantiseptics, anti spasmodics to relieve feelings of anxiety,

stress, and fatigue. Conclusion of this research that the use of

lemon aromatherapy is effective in reducing the occurrence of

emesis gravidarum.

KEYWORDS

Emesis, Lemon Therapy, Aromatherapy

This work is licensed under a Creative Commons

Attribution-ShareAlike 4.0 International

Rini Sulistyowati, Rr Catur Leni Wulandari

Literature Review: The Effect of Lemon Aromatherapy on Emesis Gravidarum 932

INTRODUCTION

Emesis Gravidarum often occurs in pregnant women in the 1st trimester. The cause

is an increase in the hormones estrogen and HCG in early pregnancy (Mariza &

Ayuningtias, 2019). One of the effects is dehydration that causes the fetus to experience

problems, therefore therapy is needed. One of the therapies to deal with is with the aroma

of lemon therapy (Oktaviani, 2020).

The results of the report showed that almost 50-90% of pregnant women vomiting

nausea occurs in the first trimester. This condition will improve at the gestational age of

12 - 16 weeks. This condition occurs in about 60 - 80% of primigravida and 40 - 60%

occurs in multigravida (Putri, 2020). A prospective study of 160 women found that 74%

reported nausea although only 1.8% experienced it as a symptom that only occurred in the

morning (Chahyani Agustia, 2019), In 80% of sufferers, nausea can last throughout the

day (Dewi, 2012), 51.4% of women experience nausea and 9.2% of women experience

vomiting (Kundarti, Rahayu, & Utami, 2017).

Nausea vomiting in pregnancy has a significant impact on the body where the

mother becomes very weak, the face is pale and the frequency of urination decreases

drastically so that body fluids are reduced and blood becomes thick (hemoconcentration)

(Vitrianingsih & Khadijah, 2019). This condition can slow down blood circulation so that

oxygen and food supply to the tissues is also reduced this can cause tissue damage that

endangers the health of the mother and fetus (Astuti & Ertiana, 2018). The principles of

emesis gravidarum management include prevention, reducing vomiting nausea, and

correction of fluid and electrolyte needs (Logo, 2020). Treatment of vomiting nausea can

be done by pharmacological or non-pharmacological means. Pharmacological treatment

is done by taking drugs such as anti-metik drugs or vitamin B6, but these drugs have side

effects that may be experienced by pregnant women such as; headache, diarrhea and

drowsiness. Other management that can be given is non-pharmacological or

complementary therapies that have cheaper advantages and do not have pharmacological

side effects, one of the therapies that are safe and can be given to pregnant women who

experience nausea vomiting by providing lemon aromatherapy.

Lemon aromatherapy is an essential oil produced from orange peel extract

(CitrusLemon) that is often used in aromatherapy (Silvia, 2018). Lemon aromatherapy is

a type of aromatherapy that is safe for pregnancy and childbirth (Martin et al., 2013).

Lemon aromatherapy contains content that can kill meningococcus bacteria, typhoid

bacteria, has a fungal effect and is effective to neutralize unpleasant odors, as well as

produce anti-anxiety, anti-depressant, anti-stress, and to lift and focus the mind (Saridewi,

Bahar, & Anisah, 2018). Lemon essential oil is the most widely used herbal oil and is

considered a good medicine in pregnancy. Lemon aromatherapy has been shown to have

beneficial effects on gravidarum emesis. Average score of emesis gravidarum decreases

over four days using lemon aromatherapy I (Kia, 2013). It is also in line with research

conducted by Erick et al by observing the use of non-pharmacological treatments in

women to eliminate emesis gravidarum (Cahyanto et al., 2020). The results showed that

40% of women use lemon aroma to relieve nausea vomiting, and more than half of those

who have used it say it is effective (al Cidadapi, 2016).

RESEARCH METHOD

In this research method, journal searches were carried out through Google

Scholar, PubMed, BioMed Central, NEJM. The purpose of this Literature Review is to

solve the problem regarding Emesis Gravidarum through the administration of Lemon

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Aromatherapy. The keyword used in this problem is “giving lemon aromatherapy to the

incidence of emesis gravidarum”. The method used in searching this article is to use the

relevant English and Indonesian languages. The articles obtained are reviewed to select

articles that meet the criteria. And the articles obtained amounted to 8 articles of which 5

international journals and 3 national articles, will then be reviewed.

A journal article conducted by Umu Fauzah entitled "The Effect of Giving Lemon

Inhalation Aromatherapy to Emesis Gravidarum in First Trimester Pregnant Women at

the Umbulharjo I Health Center Yogyakarta City" uses a method using a Quasi

Experiment type of research with the research design used is a pretest-posttest research

design with a control group (pretest posttest with control group). This design model uses

a comparison group (control). In this study, measurements were made in both groups

before and after being given the intervention/treatment, then a comparison was made

before and after the intervention was given. The population in this study amounted to 30

pregnant women who experienced emesis gravidarum with 15 control groups and 15

experimental groups. This study uses non-random sampling or also known as non-

probability sampling, namely the Accidental Sampling technique, where the sampling is

based on chance, that is, anyone who coincidentally / incidentally meets the researcher

can be used as a sample. In this study, the sample set was 30 people. Fifteen respondents

as the experimental group and 15 respondents as the control group. The data collection

tool used is a data collection sheet in the form of a questionnaire consisting of name, age,

gravida, gestational age, perceived complaints, diagnosis, therapy is given, nausea and

vomiting score. The data analysis used was a paired sample t-test parametric statistical

test with a significance limit of p-value <0.05 and an independent sample t-test

parametric statistical test with a p-value significance limit> 0.05.

The journal article conducted by Fitrianingsih and Siti Khatijah 2019 entitled

"Effectiveness of Lemon Aromatherapy for Treating Emesis Gravidarum" using the

research design method used, namely Quasi experiment with one group pre-post test

design. The research was conducted in April 2019 in the Berbah District of Sleman

Yogyakarta. The research population is pregnant women who experience emesis

gravidarum. The number of samples as many as 20 pregnant women were taken by

purposive sampling technique. Inclusion criteria in sampling are pregnant women in the

first trimester, pregnant women who experience nausea and vomiting, mothers who are

not allergic to Lemon essential oil and do not have diseases related to the gastrointestinal

tract. The exclusion criteria for this study were mothers who used other interventions to

reduce nausea and vomiting and mothers who did not use aromatherapy within 12

hours/fall. The material needed in the research is Lemon essential oil. The concentration

of lemon aromatherapy given is 10%, the concentration of lemon aromatherapy is based

on the research of Kaviani et al. (2014).

The data collection method begins by asking a questionnaire to measure the degree

of nausea and vomiting before being given treatment and filling in the respondents'

answers on the questionnaire sheet. The measuring instrument in this study is the

RHODES Index based on the scores obtained on the respondents' answers about the

incidence of nausea and vomiting experienced. Furthermore, the researchers gave lemon

aromatherapy to pregnant women to try to smell and explain how to intervene, namely by

inhaling a cotton swab that had been given lemon essential oil when experiencing nausea

and or vomiting for 5 minutes with a distance of about 2 cm from the nose, after 48 hours

then continued with asked again the degree of nausea and vomiting after the intervention.

Data were analyzed using Paired t-test.

The results of Lacasse's research (2014, in Tiran, 2014) in Canada from 367

pregnant women, 78, 47% of nausea and vomiting occurred in the first trimester with the

Rini Sulistyowati, Rr Catur Leni Wulandari

Literature Review: The Effect of Lemon Aromatherapy on Emesis Gravidarum 932

degree of nausea and vomiting that was 52.2% mild nausea and vomiting, 45.3 moderate

and 2.5%

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Literature Review: The Effect of Lemon Aromatherapy on Emesis Gravidarum 934

heavy. In the second trimester, 40.1% of women still had nausea and vomiting with

details of 63.3% and 0.8% severe nausea and vomiting. In accordance with evidence-

based practice. Midwives are the health workers who provide obstetric services, one of

which is by providing examination services for pregnant women to determine the

condition of the mother and fetus. In carrying out Antenatal Care (ANC) services, they

should always provide explanations and motivations regarding how pregnant women feel,

including nausea and vomiting

Researcher's journal article This study was carried out by Siti Cholifah and Titin

Eka Nuriyanah entitled "Lemon Aromatherapy Reduces Nausea and Vomiting in First

Trimester Pregnant Women". nausea and vomiting, sampling with consecutive sampling

were 36 mothers in 2 BPM in Sidoarjo Regency who met the inclusion criteria willing to

be studied, normal pregnancy <12 weeks of gestation and exclusion criteria for grande

multigravida. From December 16, 2017 to January 16, 2018. Nausea and vomiting were

measured before and after giving lemon aromatherapy with the Rhodes Index. The

concentration of lemon aromatherapy was given by mixing 0.1 ml of lemon essential oil

into 1 ml of water, the concentration of lemon aromatherapy was based on the research of

Kaviani et al. (2014) then the mother inhales lemon aromatherapy placed in a cotton swab

at a distance of approximately 2 cm from the nose while breathing deeply for + 5 minutes

and can be repeated if she still feels nauseated and vomiting. Then evaluated after 12

hours.

Research journal articles by Parisa Yavari kia ; Farzaneh Safajou ; Mahnaz

Shahnazi ; Hossein Nazemiyeh with the title “The Effect of Lemon Inhalation

Aromatherapy on Nausea and Vomiting of Pregnancy: A Double-Blinded, Randomized,

Controlled Clinical Trial” in 2014 This was a randomized clinical trial in which 100

pregnant women with nausea and vomiting who had eligibility criteria were randomly

divided into intervention and control groups based on four- and six-random block

sampling method. Lemon essential oil and placebo were given to the intervention and

control groups, respectively, to inhale it as soon as they felt nausea. The nausea,

vomiting, and retch intensity were investigated 24 hours before and during the four days

of treatment employing PUQE-24

Results: There was a statistically significant difference between the two groups in

the mean scores of nausea and vomiting on the second and fourth days (P = 0.017 and P =

0.039, respectively). The means of nausea and vomiting intensity in the second and fourth

days in the intervention group were significantly lower than the control group. In

addition, in intragroup comparison with ANOVA with repeated measures, nausea and

vomiting mean in the five intervals, showed a statistically significant difference in each

group.

A research journal article conducted by Ismail BIYIK, Fatih KESKIN entitled “The

Lollipop with Lemon Aroma May Be Promising in Nausea and Vomiting in Pregnancy”

uses a prospective case-control study design conducted in two centers; Bursa Karacabey

and Mustafakemalpasa State Hospitals between June 2016 and August 2018 and was

approved by the Ethics Committee of the Bursa High Specialization Research and

Training Hospital and informed written consent was obtained from each participant. The

study was conducted following the required Declaration of Helsinki. Power 81%,

Pregnancy -Unique Quantification of Emesis and Nausea (PUQE) study and control

group scores at baseline and the first day were 1.23, significance level (alpha) 0.05,

coefficient of variation on original scale 0.3 and sample size 33 +33 was calculated by the

PASS 11 program. The group to be included in the first patient meeting the inclusion

criteria was determined by a simple randomized method. Therefore, control group 1

Rini Sulistyowati, Rr Catur Leni Wulandari

Literature Review: The Effect of Lemon Aromatherapy on Emesis Gravidarum 936

patient and patient 2 were included in the study group. Patients with odd numbers were

included in the control group and patients with even numbers were included in the study

group. The study involved women aged 18-45 years with singleton pregnancies between

6-14 weeks. The week of pregnancy is determined by the date of the last menstrual

period. If there is a difference of more than 1 week between the date of the last menstrual

period and the ultrasound measurement, then the ultrasound measurement is accepted in

determining the week of gestation. The diagnosis of NVP is a diagnosis of exclusion such

as Patients with multiple pregnancies, molar pregnancies, or systemic diseases

(pancreatitis, hepatitis, cholecystitis, etc.) women with hyperemesis gravidarum were

excluded from the study. Pregnant with weight loss of >5%, findings of dehydration,

ketosis, and electrolyte abnormalities are accepted as hyperemesis.

Research journal articles researched by Dr. Arshi Anjum, Dr. Kouser Fathima

Firdose, Dr. Wajeeha Begum with the title "Effect of Sikanjabeen Lemooni in Qay'al-

Haml: An Open Observational Study" using the type of research study. An open

observation study was conducted from January 2017 to December 2017 at the Dept. OBG

National Institute of Unani Medicine hospital, Bengalurus. The sample size is calculated

using the formula, n = 2 [(Zα- Zβ) × ] 2 / (μ1 - 2) 15 around the difference in the mean

PUQE of the two estimates. The mean and SD of PUQE were taken from previous

studies. n = number of samples required, 1 = mean score before treatment, 2 = mean score

after treatment, 1-μ2 = clinically significant difference, = standard deviation. The

calculated sample size is 27.08; considering 10% dropouts, the total sample size was 30.

Pregnant women with c/o nausea and vomiting with a single intrauterine pregnancy at 7

to 14 weeks gestation were included in the study. Women with hyperemesis gravidarum,

treated with other antiemetics, with pregnancy-related medical conditions such as severe

anemia, hypertension and diabetes mellitus and with a history of other non-obstetrical

causes of vomiting such as cholecystitis and appendicitis were excluded from the study

by performing Hb%, RBS, CUE, Ultrasound-obstetrics. A total of 68 patients were

screened; 3 patients were ineligible because of HG. Of the 65 eligible patients; 22 refused

to participate and 13 were excluded; 1 patient was aborted before treatment was started, 1

had multiple pregnancies, in 2 patients each gestational age >14 weeks and Hb% <11; 3

had hypothyroidism and 4 patients had UTI. 30 patients were included in this study.

This research journal article was researched by Masoumeh Namazi; Seddigheh

Amir Ali Akbari; Faraz Mojab ; Atefe Talebi ; Hamid Alavi Majd; Sharareh Jannesari

with the title “Aromatherapy With Citrus Aurantium Oil and Anxiety During the First

Stage of Labor”. This study used the method. This randomized clinical trial was

conducted on two groups of pregnant women, who were referred to Vali-Asr Hospital

(Tuyserkan, Iran) between June and September 2013. It was registered with the Iranian

Clinical Trials Registry (IRCT ID: N6 201301306807). Considering similar studies, 95%

confidence interval, and 5% probability of error, the sample size was calculated as 63

subjects in each group. Women were first briefed on the aims and methods of the study

and then asked to provide written informed consent if they were willing to participate.

Women were only included if they were Iranian, primiparous, and aged 18-35 years, had

full-term, singleton pregnancy, cephalic presentation, spontaneous contractions, cervical

dilation 3-4 cm at delivery, good hip condition and intact amniotic sac. , had not used

analgesic drugs in the past eight hours, and had no liver, gallbladder, or respiratory

disease on their records. People with impaired smell, allergy to herbal medicines, or

complications of pregnancy (eg, preeclampsia, chorioamnionitis, placental abruption, and

abnormal fetal heart rate at the time of the study) were excluded. Data were collected

using obstetric and demographic questionnaires, examination and observation checklists

including vital signs, vaginal examination, uterine contractions, and fetal heart rate, and

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the Spielberger state anxiety questionnaire. The suitability of the first two tools was tested

through content validity. In addition, the reliability of the checklist was agreed using the

parallel form reliability (r = 0.85). After completing the first two instruments, the severity

of anxiety was assessed with 20 items of the mentioned anxiety questions. As each item

was assigned a score of 1-4, the total anxiety score ranged between 20 and 80 (20-40,

mild anxiety; 41-60, moderate anxiety; 61-80, severe anxiety). This questionnaire is

widely used to measure trait-state anxiety in clinical studies (11, 22–24) and has a

correlation coefficient of 0.85–0.91 (25).

Exclusion criteria were allergy or intolerance, pregnancy complications such as

vaginal bleeding during the study, and emergency cesarean delivery before study

completion. The random number table was used to randomly allocate women who were

eligible for aromatherapy and the control group (n = 63 each). The concentration of the

purchased distillate (Iran-Gereban Co., Iran) was determined by the gravimetric method

at the School of Pharmacy, Shahid Beheshti University of Medical Sciences (Teheran,

Iran). Each 100 mL of the distillate contains 8 mL of essential oil. Gauze cloth

impregnated with 4 mL of normal saline and distillate was attached to the collars of

participants in the aromatherapy and control groups. The gauze is changed every 30

minutes. Anxiety intensity in both groups was measured at baseline and after intervention

at 3-4 and 6-8 cm openings. Data analysis was performed with SPSS for Windows

version 22.0 (SPSS Inc., Chicago, IL, USA). Descriptive statistics including central

tendency, dispersion, and frequency distribution were used to describe the two groups.

Chi-square and Fisher's exact test was applied to compare qualitative variables between

groups. Quantitative variables were compared using an independent t-test. Comparison of

the two groups in terms of qualitative variables with non-normal distribution and ordinal

variables were performed using the nonparametric Mann-Whitney test. Finally, the

Kolmogorov-Smirnov test was performed to check the normal distribution of the subjects.

Journal article conducted by Narges Joulaeerad, Giti Ozgoli, and Fatemeh

Salehimoghaddam entitled “Effect of Aromatherapy with Peppermint Oil on the Severity

of Nausea and Vomiting in Pregnancy: A Single-blind, Randomized, Placebo-controlled

trial in 2015. A single-blind randomized placebo-controlled clinical trial was conducted

on 56 pregnant women with complaints of NVP, who were referred to the selected health

center of Shahid Beheshti University of Medical Sciences in Tehran from December 2014

to the end of May 2015. .

Inclusion criteria were age 18 to 35 years, Iranian and at least educated, literate,

basic level of NVP mild to moderate (scores 3 to 12) based on scores obtained from the

PUQE questionnaire before the intervention, 6 to 20 weeks gestation based on the first

day of the period. last menstrual period (LMP) or first-trimester ultrasound, have at least

one ultrasound report to determine the number and health of the fetus, desired pregnancy

according to individual, deficiency Olfactory problems according to individual, singleton

pregnancy normal in all respects and no history of obstetric complications in current

pregnancy (no symptoms of threatened abortion, less molar pregnancy), pregnant women

who are healthy in all respects and no known history of the disease. based on information

from maternal health profile records, non-smoking and alcohol consumption, individual

insensitivity to herbal medicine, did not consume chemical and herbal antiemetic drugs in

the 24 hours before the study began, did not experience mental health problems and bad

luck in the six months before the study started.

In addition, participants were excluded from the study if severe nausea and

vomiting occurred during pregnancy (score 13 or higher on the PUQE questionnaire),

sensitivity to peppermint essential oil or intolerance to peppermint aroma, taking

antiemetic drugs or herbal remedies during pregnancy. the study period, the

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Literature Review: The Effect of Lemon Aromatherapy on Emesis Gravidarum 936

implementation of aromatherapy less than three times a day, the occurrence of symptoms

of threatened abortion during the study period, and the reluctance to continue to

participate in the study.

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The tools used in this study included three questionnaires: (1) a demographic and

obstetrics questionnaire; (2) PUQE questionnaire; and (3) the final questionnaire. The

demographic and obstetrics questionnaire consisted of two parts, namely background

information and obstetric history, which the researcher filled out for each woman. A

PUQE questionnaire containing three questions about duration of nausea, amount of

vomiting and frequency of vomiting (22, 23). This was used to determine the baseline

level of NVP and its severity during the study period.

The final questionnaire was used to evaluate patient satisfaction with treatment,

adherence to health and nutrition recommendations, and evaluation of changes in general

symptoms from the pregnant woman's point of view.

The content validity of the final questionnaire was evaluated. In addition, the

reliability of the PUQE questionnaire with a correlation coefficient of 0.9 was determined

using the retest-test method.

A research journal article conducted by Rahajeng Siti Nur Rahmawati, Indah

Rahmaningtyas, Trinanda Qonitah with the title "Lemon Aromatherapy To Reduce

Emesis Gravidarum". In this method, this type of research is a quantitative study with a

comparative design, where 2 groups receive a different intervention, namely the provision

of hot ginger drinks and lime drinks. Before the intervention is given, a pretest will be

given and after the intervention will be given a posttest. The research design is to

distinguish groups against work procedures. Provision of hot ginger with the

composition: ginger emprit (Zingiber officinale, the smallest and hottest type of ginger in

Indonesia) sliced 2 grams, 1 tablespoon sugar, and 250 ml of warm water with a

temperature of 60-700C, given 2x1 a day for 4 days. Giving lime with the composition: 1

lime (Citrus limon) with a diameter of 1.5 - 2.5 cm, 1 tablespoon sugar and 250 ml of

warm water with a temperature of 60-700C, given 2x1 a day for 4 days.

RESULT AND DISCUSSION

A. Review Result

1. A journal article conducted by Umu Fauzah entitled "The Effect of Lemon

Inhalation Aromatherapy on Emesis Gravidarum in First Trimester Pregnant

Women at Umbulharjo I Health Center Yogyakarta City. moderate vomiting

as many as 9 people (60.0%). The results showed that based on table 3 it can

be seen that before being given lemon inhalation aromatherapy, most research

respondents were in moderate nausea and vomiting category, namely 9 people

(60.0%) and table 4.5 after being given lemon inhalation aromatherapy, most

research respondents were in the no category. nausea and vomiting as many as

13 people (86.67). Based on table 3, p value = 0.000 <0.05, it can be

concluded that there is a significant difference in respondents before and after

giving lemon inhalation aromatherapy in the experimental group where the

average value of the intensity of nausea and vomiting before being given is

12.80 and after being given the average value of nausea and vomiting.

decreased by 3.07. It can be seen that the difference in the average value

between before and after is 9,733 with a standard deviation of 4,061.

2. Journal article conducted by Fitrianingsih and Siti Khatijah 2019 entitled

"Effectiveness of Lemon Aromatherapy for Treating Emesis Gravidarum"

Based on table 3 p value = 0.000 < 0.05, it can be concluded that there are

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Literature Review: The Effect of Lemon Aromatherapy on Emesis Gravidarum 938

significant differences in respondents before and after giving lemon inhalation

aromatherapy. in the experimental group where the average value of the

intensity of nausea and vomiting before being given was 12.80 and after being

given the average value of nausea and vomiting decreased, namely 3.07. It can

be seen that the difference in the average value between before and after is

9,733 with a standard deviation of 4,061. Various studies are in line with the

results of this study, among other studies conducted by Rofi'ah (2019) that

there is a difference in the degree of emesis gravidarum in pregnant women

between before and after being given lemon aromatherapy, where the level of

emesis gravidarum before being given lemon aromatherapy is in the score

range of 3 – 23. and the level of emesis gravidarum after being given lemon

aromatherapy on a score range of 0-19. In this study also compared the use of

aromatherapy with various doses of 0.1 ml; 0.2ml; and 0.3ml. Based on the

results of this study, there was no difference in the effectiveness of lemon

aromatherapy between the three doses in overcoming emesis gravidarum, but

if analyzed in each group, the results showed that lemon aromatherapy doses

of 0.2 and 0.3 were effective in overcoming emesis gravidarum. Thus, health

workers, lecturers or educators as service providers and transfer agents of

knowledge can use references from various research results on the benefits of

lemon aromatherapy in overcoming emesis gravidarum.

3. This research journal article was conducted by Siti Cholifah and Titin Eka

Nuriyanah entitled "Lemon Aromatherapy Reduces Nausea and Vomiting in

First Trimester Pregnant Women". after being given lemon aromatherapy

Mean+ SD 13.67 + 4.071 Rhodes index score from the category of moderate

nausea and vomiting to mild, the results of the Wilcoxon Sign Rank Test

analysis showed a significant decrease in the Rhodes index score for nausea

and vomiting after pregnant women inhaled lemon aromatherapy with P value

= 0.0001 < = 0.05. The results of this study are supported by the research of

Safajau, et al (2014) with the results of p = 0.0001 lemon inhalation

aromatherapy can effectively reduce nausea and vomiting in pregnant women.

In addition, Santi's (2013) study showed that p = Aromatherapy, a non-

pharmacological therapy, is currently being widely used in the UK and

Europe, with availability reported in 76% in German obstetrics departments,

aromatherapy has recently been introduced to US hospitals and clinic (Seol et

al., 2010; Horowitz, 2011; Conrad, 2010 in Smith V 2012). Lemon

aromatherapy derived from the extraction of lemon peel (Citrus Lemon) is one

type of aromatherapy that is safe for pregnancy and childbirth (Medforth,

2013). In this study, all respondents liked the smell of lemon aromatherapy.

Lemon essential oil contains 66-80% limonene, geranyl acetate, nerol, linalyl

acetate, -pinene 0.4–15%, -pinene 1-4%, terpinene 6-14% and myrcen

(Young, 2011). Chemical compounds such as geranil acetate, nerol, linalyl

acetate, have antidepressant, antiseptic, antispasmodic, sexual arousal and

mild sedative effects (Namazi, et al, 2014)

4. A research journal article conducted by Ismail BIYIK, Fatih KESKIN entitled

“The Lollipop with Lemon Aroma May Be Promising in Nausea and

Vomiting

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5. in Pregnancy.” Among vegetable oils and non-pharmacological alternative

aromatherapy, ginger, peppermint, and lemon essential oils are used to prevent

NVP (10-12). The anti-emetic effect of lemon is known for a long time and so

far no harm has been reported during pregnancy (13,14). Lemon in the form of

essential oil (lemon orange) prepared for dispersal in bedroom air has been

shown to lower NVP (15). The smell of lemon is reported to reduce symptoms

of nausea and vomiting by as much as 40% (16). Smith et al. reported that

fresh lemon odor was effective in reducing NVP symptoms (17). Yavari Kia

et al. suggested that inhaling lemon for 4 days was effective in reducing NVP

symptoms when compared to controls (8).

6. Although it is not known that the mechanism of chemotherapy-induced nausea

and vomiting is the same as that of NVP, it has been reported that Citrus

aurantium oral capsule reduces chemotherapy-induced nausea in patients with

ovarian cancer (18). In addition, Ozdemir et al. reported that administering

strawberry-scented lollipops to patients receiving cryopreserved peripheral

blood stem cell (PBSC) infusions during bone marrow transplantation reduced

treatment-related nausea and vomiting (9). Dimethyl sulfoxide, an ingredient

of cryopreserved autoligous peripheral stem cells (PBSC) is thought to reach

mucosal surfaces such as the oral cavity and cause nausea and vomiting that

smells like garlic. The gustatory branches of the olfactory and fascial nerves,

the glossopharyngeal nerve and the vagus nerve are thought to transmit these

signals to the hypothalamus and limbic system. Perhaps the same mechanism

applies to lemon lollipops. It is known that ketones produced during long-term

starvation are excreted through exhalation and urination in the form of acetone

halitosis and ketonuria. Excretion of ketones through respiration and

ketonemia itself causes bad breath, bad breath, and vomiting which in turn

causes hunger and ketone production returns in a vicious cycle. Inhalation of

aromas or aromatic tastes can be used to suppress bad breath and break this

cycle. Inhalation of lemon is thought to produce this effect by the olfactory

center via olfactory receptors and induce a state of physical and mental well-

being (8). The same effect may apply to the lemon-scented puffs in the form

of lollipops. Although there are reports that inhaling lemon lowers NVP, there

are no studies on the effects of oral administration of lemon-flavored lollipops.

Lollipops are readily available and are much cheaper and acceptable than

lemon flavored oil. Therefore, we investigated the effect of lemon-flavored

lollipops (round candy with sticks) on NVP cases in this study. Decreased

PQUE scores in the study group compared to the control

7. Research journal articles conducted by Parisa Yavari; Farzaneh Safajou;

Mahnaz Shahnazi; Hossein Nazemiyeh entitled “The Effect of Lemon

Inhalation Aromatherapy on Nausea and Vomiting of Pregnancy: A Double-

Blinded, Randomized, Controlled Clinical Trial.” According to the findings of

this study, the mean value of NVP decreased during four days of using inhaled

lemon aromatherapy; however, this reduction in scores was statistically

significant only on the second and fourth days of follow-up in the two groups.

The use of complementary and alternative medicine (CAM) in Iran has a long

Rini Sulistyowati, Rr Catur Leni Wulandari

Literature Review: The Effect of Lemon Aromatherapy on Emesis Gravidarum 940

history and midwives and doctors are keen to use it. Aromatherapy is a

method that in addition to having a physical effect, has a psychological effect

(such as relaxation or stimulation) that can be repeated very quickly. Smell at

the lowest basic level, can stimulate the body to respond physically and

psychologically. When aromatic substances such as herbal oils give off odor

molecules, receptor cells in the nose send impulses directly to the olfactory

areas of the brain. This region is closely linked to other systems that control

memory, emotions, hormones, sex, and heart rate. The pulse acts immediately

and the hormones released are capable of stimulating, calming, calming, or

exhilarating the person, leading to the creation of physical and mental changes

(10). Lemon aromatherapy can have a beneficial effect on NVP (17). The

results of the Pretest-Posttest study in Indonesia, in 12 pregnant women with

NVP showed that lemon aromatherapy reduced NVP (18), this is in line with

the results of this study. Erick et al. investigated the use of non-

pharmacological treatments by women for the relief of NVP. The results of his

study showed that 40% of women used lemon scent to relieve NVP, and

26.5% of those who used it said it was effective (11).

8. The results of the study by Pasha et al. who used peppermint inhaled

aromatherapy to relieve NVP in 60 pregnant women tried to report that

recovery was improved to the delight of researchers, but that was not true. the

likelihood of this type of bias may be higher in trials where placebo is used

only as a treatment. The significant decrease in nausea and vomiting scores

only on the second and fourth days between the groups may be due to

different responses by individuals to aromatherapy. In other words, this

treatment may be pleasant for some and maybe uncomfortable for others. In

aromatherapy, patients need to inhale certain odors based on their

psychosocial state, and each individual will react to certain odors differently

(19). Therefore, it can be considered as one of the limitations of this study.

Another limitation to this study was the inability to control psychological

factors during the intervention. One of the strengths of this study is the use of

the PUQE-24 questionnaire specifically designed for NVP. We have not found

any clinical trials that have tested the therapeutic effect of Lemon aroma on

NVP. Therefore, due to limited research in the field of aromatherapy on NVP,

further research is needed in this area. Inhaled aromatherapy with Lemon

essential oil has shown that this method can reduce NVP. In contrast to

chemical treatments, aromatherapy has beneficial effects on physical and

psychological health and may be useful as an alternative approach in the

treatment of NVP.

The results of the review, which have described the level of giving lemon

aromatherapy to the incidence of emesis gravidarum. According to (Winkjosatro,

2010), that pregnancy at a young age is one of the factors causing emesis

gravidarum in a healthy reproductive period that the age for pregnancy and

childbirth is 20-30 years, maternal mortality in pregnant women and giving birth

at the age of under 20 years turns out to be 2 – 3 times higher than deaths that

occur at the age of 20-35 years, maternal mortality increases again after the age of

35 years, this is due to the decline in the function of the female reproductive

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941 http://eduvest.greenvest.co.id

organs.

CONCLUSSION

Conclusions based on the analysis that has been done by the author, it is

concluded that the use of lemon aromatherapy reduces the incidence of emesis

gravidarum. Suggestions that can be given for the implementation of the next literature

review is that it is better to use more databases so that you can get more and better articles

and the limitation of the year for searching articles with the specified keywords is the last

five years.

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