Hyperemesis Gravidarum Disease

BASICS

DESCRIPTION

Persistent vomiting in a pregnant woman that interferes with fluid and electrolyte balance, as well as nutrition. Usually associated with the first 8 to 20 weeks of pregnancy. Believed to have biomedical and behavioral aspects. Associated with high estrogen levels. Symptoms usually begin about 2 weeks after first missed period.

System(s) affected: Gastrointestinal, Reproductive, Endocrine/Metabolic
Genetics: Unknown
Incidence/Prevalence in USA:
- 2% of pregnancies have electrolyte disturbances
- 50% of pregnancies have at least some gastrointestinal disturbance
Predominant age: 21-31
Predominant sex: Female only

SIGNS AND SYMPTOMS

Hypersensitivity to smell
Alteration in taste
Nausea
Vomiting with retching
Acidosis
Decreased urine output
Volume depletion
Fatigue
Starvation

CAUSES

Unknown
May be psychological factors
Hyperthyroidism
Hyperparathyroidism
Gestational hormones
Liver dysfunction
Autonomic nervous system dysfunction

RISK FACTORS

Trophoblastic activity
Gonadotropin production stimulated
Altered gastrointestinal function
Various odors
Taste or sight of food
Hyperthyroidism
Hyperparathyroidism
Obesity
Multiple gestations
Nulliparity
Liver dysfunction

DIAGNOSIS

LABORATORY

Electrolytes decreased
Urinalysis - glucosuria, albuminuria, granular casts and hematuria (rare)
Increased uric acid
Reduced protein

Drugs that may alter lab results: None likely
Disorders that may alter lab results: N/A

PATHOLOGICAL FINDINGS

Fatty degeneration of the liver; renal tubular damage; heart damage; petechial brain hemorrhages

SPECIAL TESTS

None indicated for the diagnosis of hyperemesis gravidarum

IMAGING

No imaging is indicated for the diagnosis of hyperemesis gravidarum

DIAGNOSTIC PROCEDURES

Only indicated if it is necessary to rule out other diagnoses

TREATMENT

APPROPRIATE HEALTH CARE

Outpatient therapy
In some severe cases, inpatient parenteral or enteral volume and nutrition repletion may be indicated

GENERAL MEASURES

Patient reassurance
Bedrest
If dehydrated, IV fluids. Repeat if there is a recurrence of symptoms following initial improvement.

SURGICAL MEASURES

N/A

ACTIVITY

As tolerated after improvement

DIET

Nothing by mouth for first 24 hours if patient is ill enough to require hospitalization
For outpatient: A diet rich in carbohydrates and protein, such as fruit, cheese, cottage cheese, eggs, beef, poultry, vegetables, toast, crackers, rice. Limit intake of butter. Patients should avoid spicy meals and high fat foods.

PATIENT EDUCATION

Attention should be given to psychosocial issues such as possible ambivalence about the pregnancy
Patients should be instructed to take small amounts of fluid frequently to avoid volume depletion

FOLLOW UP

PREVENTION/AVOIDANCE

Anticipatory guidance in first and second trimester regarding dietary habits in hopes of avoiding volume and nutritional depletion

POSSIBLE COMPLICATIONS

Patients with greater than a 5% weight loss are associated with intrauterine growth retardation and fetal anomalies
Hemorrhagic retinitis
Liver damage
CNS deterioration, sometimes to coma

EXPECTED COURSE AND PROGNOSIS

Self-limited illness with good prognosis if patient's weight is maintained at greater than 95% of the pre-pregnancy weight
With complication of hemorrhagic retinitis, mortality rate is 50%

MISCELLANEOUS

ASSOCIATED CONDITIONS

Hyperthyroidism

AGE-RELATED FACTORS

N/A

Pediatric: N/A
Geriatric: N/A
Others: N/A

PREGNANCY

Problem is confined to early pregnancy

OTHER NOTES

N/A

ABBREVIATIONS

N/A

Clinical Investigations

ROLE OF HOMOEOPATHY

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