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Hyperemesis gravidarum (HG) is a severe form of morning sickness, with "unrelenting,

excessive pregnancy-related nausea and/or vomiting that prevents adequate intake of food
and fluids."[1]Hyperemesis is considered a rare complication of pregnancy but,
because nausea and vomiting during pregnancy exist on a continuum, there is often not a
good diagnosis between commonmorning sickness and hyperemesis. Estimates of the
percentage of pregnant women afflicted range from 0.3% to 2.0%.[2]

Contents

[hide]

• 1 Etymology
• 2 Cause
• 3 Symptoms
• 4 Complications
o 4.1 For the
pregnant woman
o 4.2 For the
fetus
• 5 Diagnosis
• 6 Treatment
o 6.1 IV
hydration
o 6.2 Medications
o 6.3 Nutritional
support
o 6.4 Support

• 7 References

[edit]Etymology

Hyperemesis gravidarum is from the Greek hyper-, meaning excessive, and emesis,
meaning vomiting, as well as the Latin gravida, meaning pregnant. Therefore, hyperemesis
gravidarum means "excessive vomiting in pregnancy."

[edit]Cause

The cause of HG is unknown. The leading theories speculate that it is an adverse reaction to
the hormonal changes of pregnancy. In particular Hyperemesis may be due to raised levels
of beta HCG (human chorionic gonadotrophin)[3] as it is more common in multiple
pregnancies and in gestational trophoblastic disease. This theory would also explain why
hyperemesis gravidarum is most frequently encountered in first trimester (often around 8 –
12 weeks of gestation), as HCG levels are highest at that time and decline afterwards.
Additional theories point to high levels of estrogen and progesterone[citation needed], which may
also be to blame for hypersalivation; decreased gastric motility (slowed emptying of the
stomach and intestines); immune response to fragments of chorionic villi that enter the
maternal bloodstream; or immune response to the "foreign" fetus.[citation needed] There is also
evidence that leptin may play a role in HG.[4] Historically, HG was blamed upon a
psychological condition of the pregnant women. Medical professionals believed it was a
reaction to an unwanted pregnancy or some other emotional or psychological problem.[citation
needed]
This theory has been disproved, but unfortunately some medical professionals espouse
this view and fail to give patients the care they need.[citation needed] A recent study gives
"preliminary evidence" that there may be a genetic component.[5]

[edit]Symptoms

When HG is severe and/or inadequately treated, it may result in:

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


 Dehydration, causing ketosis and constipation
 Nutritional deficiencies
 Metabolic imbalances
 Altered sense of taste
 Sensitivity of the brain to motion
 Food leaving the stomach more slowly
 Rapidly changing hormone levels during pregnancy
 Stomach contents moving back up from the stomach
 Physical and emotional stress of pregnancy on the body
 Subconjunctival hemorrhage (broken blood vessels in the eyes)
 Difficulty with daily activities
 Hallucinations

Some women with HG lose as much as 20% of their body weight. Many sufferers of 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.

As compared to morning sickness, HG tends to begin somewhat earlier in the pregnancy


and last significantly longer. 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. An overview of the significant differences between morning sickness and
HG can be found atHyperemesis or Morning Sickness: Overview.

[edit]Complications

[edit]For the pregnant woman


If inadequately treated, HG can cause renal failure, central pontine
myelinolysis, coagulopathy, atrophy, Mallory-Weiss
syndrome, hypoglycemia, jaundice, malnutrition, Wernicke's
encephalopathy, pneumomediastinum, rhabdomyolysis,deconditioning, splenic avulsion, and
vasospasms of cerebral arteries. Depression is a common secondary complication of HG.
On rare occasions a woman can die from hyperemesis; Charlotte Bronté is a presumed
victim of the disease.[6]

[edit]For the fetus


Infants of women with severe hyperemesis who gain less than 7 kg (15.4 lb) during
pregnancy tend to be of lower birth weight, small for gestational age, and born before 37
weeks gestation, in contrast, infants of women with hyperemesis who have a pregnancy
weight gain of more than 7 kg appear similar as infants from uncomplicated pregnancies.
[7]
No long-term follow-up studies have been conducted on children of hyperemetic women.

[edit]Diagnosis

Women who are experiencing hyperemesis gravidarum often are dehydrated and losing
weight despite efforts to eat. The nausea and vomiting begins in the first or second month of
pregnancy. It is extreme and is not helped by normal measures.[8]

Fever, abdominal pain, or late onset of nausea and vomiting usually indicate another
condition, such as appendicitis, gallbladder disorders, gastritis, hepatitis, or infection.[8]

[edit]Treatment

Because of the potential for severe dehydration and other complications, HG is generally
treated as a medical emergency. Treatment of HG may include antiemetic medications and
intravenous rehydration. If medication and IV hydration are insufficient, nutritional support
may be required.

Management of HG can be complicated because not all women respond to treatment.


Coping strategies for uncomplicated morning sickness, which may include eating a bland
diet and eating before rising in the morning, may be of some assistance but are unlikely to
resolve the disorder on their own. There is evidence that ginger may be effective in treating
pregnancy-related nausea; however, this is generally ineffective in cases of HG.
[edit]IV hydration
IV hydration often includes supplementation of electrolytes as persistent vomiting frequently
leads to a deficiency. Likewise supplementation for lost thiamine (Vitamin B1) must be
considered to reduce the risk of Wernicke's encephalopathy.[9] A and B vitamins are depleted
within two weeks, so extended malnutrition indicates a need for evaluation and
supplementation. Additionally, mineral levels should be monitored and supplemented; of
particular concern aresodium and potassium.

After IV rehydration is completed, patients generally progress to frequent small liquid or


bland meals. After rehydration, treatment focuses on managing symptoms to allow normal
intake of food. However, cycles of hydration and dehydration can occur, making continuing
care necessary. Home care is available in the form of a PICC line for hydration and nutrition
(called total parenteral nutrition). Home treatment is often less expensive than long-term
and/or repeated hospital stays.
[edit]Medications

While no medication is considered completely risk-free for use during pregnancy, there are
several which are commonly used to treat HG and are believed to be safe.

The standard treatment in most of the world is Benedictin (also sold under the trademark
name Diclectin), a combination of doxylamine succinate and vitamin B6. However, due to a
series of birth-defect lawsuits in the United States against its maker, Merrill Dow, Benedictin
is not currently on the market in the U.S. (None of the lawsuits were successful, and
numerous independent studies and the Food and Drug Administration (FDA) have
concluded that Benedictin does not cause birth defects.) Its component ingredients are
available over-the-counter (doxylamine succinate is the active ingredient in many sleep
medications), and some doctors will recommend this treatment to their patients.

Antiemetic drugs, especially ondansetron (Zofran), are effective in many women. The major
drawback of ondansetron has been its cost. In severe cases of HG, the Zofran pump may be
more effective than tablets. Zofran is also available in ODT (oral disintegrating tablet) which
can be easier for women who have trouble swallowing due to the nausea. Promethazine
(Phenergan) has been shown to be safe, at least in rats and may be used during pregnancy
with minimal/no side effects. Metoclopramide is sometimes used in conjunction with
antiemetic drugs; however, it has a somewhat higher incidence of side effects. Other
medications less commonly used to treat HG
include Marinol, corticosteroids andantihistamines.

There is a lot of anecdotal evidence around the use of marijuana of the pharamaceitical
extract Marinol to relieve the symptoms of HG, in a similar way to treating nausea in people
with Cancer and AIDS. However, due to the criminalisation of cannabis, there have been no
clinical trials into its effectivess or risks to the foetus.[10]

[edit]Nutritional support
Women who do not respond to IV rehydration and medication may require nutritional
support. Patients might receive parenteral nutrition (intravenous feeding via a PICC line) or
enteral nutrition (via a nasogastric tube or a nasojejunum tube).

[edit]Support

It is important that women get early and aggressive care during pregnancy. This can help
limit the complications of HG. Also, because depression can be a secondary condition of
HG, emotional support, and sometimes even counseling, can be of benefit. It is important,
however, that women not be stigmatized by the suggestion that the disease is being caused
by psychological issues.

Hyperemesis Risks

If left untreated, hyperemesis can be life threatening for both a pregnant women and the
unborn foetus.

Some health risks for a pregnant woman include:

• nutritional deficiencies
• high blood pressure
• liver disease
• kidney disease

Hyperemesis gravidarum pregnancy complications include:

• early delivery
• low birth weight
• large for age baby
• congenital heart disease

Miscarriage is very rare.

Treat Hyperemesis
1
Call your doctor if you haven't been able to keep down any fluids for more than
12 hours, have a fever, cracked lips or any other signs of dehydration. For
reasons unknown to doctors, some women experience a severe form of morning
sickness, known as hyperemesis, in which they can't stop vomiting. Hyperemesis
requires medical attention.
 2
Stay hydrated by going to your doctor's office or to the emergency department
to receive IV fluids. In most cases your doctor will make the arrangements.
Sometimes the cycle of hyperemesis can be broken by a round of IV fluids
because once a woman is rehydrated she may be able to begin keeping down
small amounts of liquid.
 3
Take prescription anti-emetics if your doctor feels it's necessary. Though no
pregnant woman wants to take medications during pregnancy, continuous
vomiting and severe dehydration that doesn't respond to IV fluids can put you at
risk for miscarriage or threaten the growth of your baby.
 4
Gather a support system. Hyperemesis is often misunderstood. Other people
don't see the severity of the situation or understand the depression, guilt and
despair that comes with being so sick during pregnancy that you are
incapacitated. Having family and friends around to support you can help you
through this rough time.

Read more: How to Treat Pregnancy Nausea |


eHow.com http://www.ehow.com/how_2139068_treat-pregnancy-
nausea.html#ixzz14j8aK1gX

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