Hyperemesis gravidarum

From Wikipedia, the free encyclopedia

Hyperemesis gravidarum
Classification and external resources

Specialty

Gynecology

ICD-10

O21.1

ICD-9-CM

643.1

MedlinePlus

001499

Hyperemesis gravidarum (HG) is a complication of pregnancy that is characterized by

severe nausea and vomiting such thatweight loss and dehydration occurs.[1] Signs and symptoms
may include vomiting severe times a day and feeling faint. It is more severe than morning
sickness. Often symptoms get better after the 20th week of pregnancy but may last the entire
pregnancy.[2]
The exact cause of hyperemesis gravidarum is not known.[3] Risk factors include the first
pregnancy, multiple pregnancy, obesity, prior or family history of hyperemesis
gravidarum, trophoblastic disorder, and a history of a eating disorder.[3][4] The diagnosis is usually
made based on the signs and symptoms. It has been technically defined as more than three
episodes of vomiting per day such that weight loss of 5% or three kilograms has occurred
and ketones are present in the urine.[3] Other potential causes of the symptoms should be
excluded including urinary tract infection and high thyroid levels.[5]
Treatment includes drinking fluids and a bland diet. [2] Recommendations may include electrolytereplacement drinks, thiamine, and a higher protein diet.[3][6] Some women require intravenous
fluids.[2] With respect to medications pyridoxine or metoclopramide are preferred.
[5]
Prochlorperazine, dimenhydrinate, or ondansetron may be used if these are not effective.[3]
[5]
Hospitalization may be required. Psychotherapy may improve outcomes. Evidence
for acupressure is poor.[3]
While vomiting in pregnancy has been described as early as 2,000 BC, the first clear medically
description of hyperemesis gravidarum was in 1852 by Antoine Dubois.[7]Hyperemesis
gravidarum is estimated to affect 0.32.0% of pregnant women. [8] While previously a common
cause of death in pregnancy, with proper treatment this is now very rare. [9][10] Those affected have
a low risk of miscarriage but a higher risk of premature birth.[4] Some women opt to have
an abortion because of the symptoms.[6]
Contents

1Signs and symptoms

2Causes

3Pathophysiology

4Diagnosis

4.1Differential diagnosis

4.2Investigations

5Management
o

5.1Intravenous fluids

5.2Medications

5.3Nutritional support

5.4Alternative medicine

6Complications
o

6.1Pregnant woman

6.2Infant

7Epidemiology

8History
o

8.1Etymology

9Notable cases

10References

Signs and symptoms[edit]

When hyperemesis gravidarum is severe or inadequately treated, it may result in the following: [11]

Loss of 5% or more of pre-pregnancy body weight

Dehydration, causing ketosis,[12] and constipation

Nutritional disorders such as vitamin B1 (thiamine) deficiency, vitamin B6

deficiency or vitamin B12 deficiency

Metabolic imbalances such as metabolic ketoacidosis[11] or thyrotoxicosis[13]

Physical and emotional stress of pregnancy on the body

Difficulty with activities of daily living

Symptoms can be aggravated by hunger, fatigue, prenatal vitamins (especially those

containing iron), and diet.[14] Some women with hyperemesis gravidarum lose as much as 10% of
their body weight. Many people with HG are extremely sensitive to odors in their environment;
certain smells may exacerbate symptoms. This is known as hyperolfaction.Ptyalism, or
hypersalivation, is another symptom experienced by some women suffering from HG.

Hyperemesis gravidarum tends to occur in the first trimester of pregnancy[12] and lasts
significantly longer than morning sickness. While most women will experience near-complete
relief of morning sickness symptoms near the beginning of their second trimester, some sufferers
of HG will experience severe symptoms until they give birth to their baby, and sometimes even
after giving birth.[15]
A small percentage rarely vomit, but the nausea still causes most (if not all) of the same issues
that hyperemesis with vomiting does.[citation needed]

Causes[edit]
There are numerous theories regarding the cause of HG, but the cause remains controversial. It
is thought that HG is due to a combination of factors which may vary between women and
include genetics.[11] Women with family members who had Hyperemesis are more likely to
develop the disease.[16]
One factor is an adverse reaction to the hormonal changes of pregnancy, in particular, elevated
levels of beta human chorionic gonadotropin (hCG).[17][18] This theory would also explain why
hyperemesis gravidarum is most frequently encountered in the first trimester (often around 812
weeks of gestation), as hCG levels are highest at that time and decline afterward. Another
postulated cause of HG is an increase in maternal levels of estrogens (decreasing intestinal
motility and gastric emptying leading to nausea/vomiting). [11]