Hyperemesis gravidarumHyperemesis gravidarum Classification and external resources ICD-10 MedlinePlus O21.1 001499 Hyperemesis gravidarum (HG) is a complication of pregnancy characterized by intractable nausea, vomiting, and dehydration and is estimated to affect 0.5-2.0% of pregnant women.[1][2]Malnutrition and other serious complications, such as fluid or electrolyte imbalances, may result. Hyperemesis is considered a rare complication of pregnancy but, because nausea and vomiting during pregnancy exist on a spectrum, it is often difficult to distinguish this condition from the more common form of nausea and vomiting experienced during pregnancy known as morning sickness. Signs and symptoms When hyperemesis gravidarum is severe and/or inadequately treated, it may result in:[1] Loss of 5% or more of pre-pregnancy body weight Dehydration, causing ketosis, and constipation Nutritional disorders such as Vitamin B1 (thiamine) deficiency, Vitamin B6 deficiency or Vitamin B12 deficiency Metabolic imbalances such as metabolic ketoacidosis[1] or thyrotoxicosis[3] 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.[4] Some women with hyperemesis gravidarum lose as much as 10% of their body weight. [5] 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. Another postulated cause of HG is an increase in maternal levels of estrogens (decreasing intestinal motility and gastric emptying leading to nausea/vomiting). It is thought that HG is due to a combination of factors which may vary between women and include: genetics.[1] Pathophysiology Morning sickness Although the pathophysiology of HG is poorly understood. elevated levels of beta human chorionic gonadotropin.Hyperemesis gravidarum tends to begin somewhat earlier in the pregnancy and last significantly longer than morning sickness. and sometimes even after giving birth.[11] Possible pathophysiological processes involved are summarized in the .[8][9] This theory would also explain why hyperemesis gravidarum is most frequently encountered in the first trimester (often around 8 – 12 weeks of gestation).[10]Leptin may also play a role.[6] Causes While there are numerous theories regarding the cause of HG. While most women will experience near-complete relief of morning sickness symptoms near the beginning of their second trimester. the cause remains controversial. the most commonly accepted theory suggests that levels of hCG are associated with it. in particular.[7] One factor is an adverse reaction to the hormonal changes of pregnancy. as hCG levels are highest at that time and decline afterward. and overall health. some sufferers of HG will experience severe symptoms until they give birth to their baby.[1] body chemistry. and even maternal and fetal death.[1] HG can be associated with serious maternal and fetal morbidity. coagulopathy.[1] Di�erential diagnosis Diagnoses to be ruled out include:[12] . peripheral neuropathy.[16][17] The onset of the nausea and vomiting in hyperemesis gravidarum is typically before the twentysecond week of pregnancy. such as Wernicke's encephalopathy.following table:[12] Source Placenta Etiology Pathophysiology hCG Corpus luteum Distention of gastrointestinal tract Crossover with TSH. causing gestational thyrotoxicosis[10] Placenta Estrogen Decreased gut mobility Progesterone Elevated liver enzymes Decreased lower esophageal sphincter pressure Increased levels of sex steroids in hepatic portal system[13] Gastrointestinal tract Helicobacter pylori Increased steroid levels in – Psychological Possible effect of culture and circulation[14] environment[15] Diagnosis Hyperemesis gravidarum is considered an exclusion. Women experiencing hyperemesis gravidarum often are dehydrated and lose weight despite efforts to eat.[10]fetal growth restriction. [18] Management Because of the potential for severe dehydration and other complications. urinalysis. nutritional support may be required. If insufficient.[17] and thyroid function tests. liver function tests. HG is treated as an emergency.[12] In those who require admission to the hospital. thromboprophylaxis such as thromboembolic stockings or low-molecular-weight heparin may be recommended. termination of pregnancy may be necessary to preserve health of the woman.Type Infections (usually accompanied by fever Differential diagnoses Urinary tract infection Hepatitis and/or associated neurological Meningitis symptoms) Gastroenteritis Gastrointestinal disorders (usually accompanied by abdominal pain) Appendicitis Cholecystitis Pancreatitis Fatty liver Peptic ulcer Small bowel obstruction Metabolic Thyrotoxicosis (common in Asian subcontinent)[10] Addison's disease Diabetic ketoacidosis Hyperparathyroidism Drugs Antibiotics Iron supplements Investigations Common investigations include blood urea nitrogen (BUN) and electrolytes.[17] An ultrasound scan may be needed to know gestational status and to exclude molar or partial molar pregnancy. In case of failure of all modalities of treatment. Treatment may include antiemetics and intravenous rehydration.[12] Intravenous �uids . which are usually raised in HG. Hematological investigations include hematocrit levels. and phenothiazines (such as promethazine).IV hydration often includes supplementation of electrolytes as persistent vomiting frequently leads to a deficiency.[25] Evidence for the use of corticosteroids is weak. there are some concerns regarding an association with cleft palate. is effective in nausea and vomiting of pregnancy.[22] some have questioned its effectiveness in HG. making continuing care necessary. hydrocortisone and prednisolone are inactivated in the placenta and may be used in the treatment of hyperemesis gravidarum. treatment focuses on managing symptoms to allow normal intake of food.[19] A and B vitamins are depleted within two weeks. However. so extended malnutrition indicates a need for evaluation and supplementation. After rehydration. a combination of vitamin B6 and doxylamine.[1][26] However. there is some evidence that corticosteroid use in pregnant women may slightly increase the risk of oral facial clefts in the infant and may suppress fetal adrenal activity. After IV rehydration is completed. Likewise.[21] With respect to effectiveness.[23] Ondansetron may be beneficial. Medications A number of antiemetics are effective and safe in pregnancy including: pyridoxine/doxylamine. In addition.[20] Home treatment is often less expensive than long-term and/or repeated hospital stays. Patients might receive parenteral nutrition .[21]Metoclopramide is also used and relatively well tolerated.[1] Nutritional support Women not responding to IV rehydration and medication may require nutritional support. patients in general progress to frequent small liquid or bland meals. supplementation for lost thiamine (Vitamin B1) must be considered to reduce the risk of Wernicke's encephalopathy. mineral levels should be monitored and supplemented. antihistamines (such as diphenhydramine).[21] While pyridoxine/doxylamine. it is unknown if one is superior to another. cycles of hydration and dehydration can occur. however.[24] and there is little high quality data. Home care is available in the form of a PICC line for hydration and nutrition (called total parenteral nutrition). of particular concern are sodium and potassium. Mallory-Weiss tears.4 lb) during pregnancy tend to be of lower birth weight.[27] Evidence supporting the use of ginger to provide symptomatic relief of HG is currently inconclusive due to a lack of study.[12] Alternative medicine Acupuncture has been found to be ineffective.[1]hypoglycemia. pneumomediastinum. deep vein thrombosis. splenic avulsion. Depression is a common secondary complication of HG and emotional support can be of benefit.[29] There is no significant difference in the neonatal death rate in infants born to mothers with HG compared to infants born to mothers who do not have HG. rhabdomyolysis. and vasospasms of cerebral arteries are possible consequences. jaundice.[27]Hyperalimentation may be necessary in certain cases to help maintain volume requirements and allow weight gain. Vitamin B6 has been shown to improve outcome.(intravenous feeding via a PICC line) or enteral nutrition (via a nasogastric tube or a nasojejunum tube). In contrast. malnutrition. central pontine myelinolysis.[1]renal failure. small for gestational age.[1]hyponatremia. infants of women with hyperemesis who have a pregnancy weight gain of more than 7 kg appear similar to infants from uncomplicated pregnancies.[1] Infant The effects of HG on the fetus are mainly due to electrolyte imbalances caused by HG in mother. and born before 37 weeks gestation.[1] Epidemiology .[12] Infants of women with severe hyperemesis who gain less than 7 kg (15. deconditioning. anemia. atrophy. coagulopathy.[1]Wernicke's encephalopathy. [18] A physician might also prescribe Vitamin B1 (to prevent Wernicke's encephalopathy) and folic acid supplementation. pulmonary embolism.[28] Complications Pregnant woman If HG is treated inadequately. Notable cases Author Charlotte Brontë is often thought to have suffered from hyperemesis gravidarum. multiple pregnancies. She died in 1855 while four months pregnant. hyperemesis gravidarum means "excessive vomiting of pregnant women".[1] History Thalidomide was prescribed for treatment of HG in Europe until it was recognized that thalidomide is teratogenic and is a cause of phocomelia in neonates. the feminine genitive plural form of an adjective. with another 25% suffering from nausea. was hospitalized with the condition. meaning vomiting. and emesis. meaning excessive. and a past history of hyperemesis gravidarum have been associated with the development of HG. A (July 2012). having been afflicted by intractable nausea and vomiting throughout her pregnancy. low age.[30] However. meaning "pregnant [woman]". and the Latin gravidarum.[34][35] References 1. used marijuana to treat the worst symptoms associated with her pregnancies. Duchess of Cambridge. Catherine. here used as a noun. Therefore.[32] In December 2012.[33] Queen Victoria of the United Kingdom of Great Britain.[1] Factors such as infection with Helicobacter pylori. hyperemesis gravidarum is the second most common reason for hospital admission during the first half of pregnancy. a rise in thyroid hormone production. who is known by many as the first medical marijuana pharmacologist. molar pregnancies.3—1. low body mass index prior to pregnancy.Vomiting is a common condition affecting about 50% of pregnant women.5%. "Emergency . ^ a b c d e f g h i j k l m n o p q Summers.[10] After preterm labor. and was unable to tolerate food or even water.[31] Etymology Hyperemesis gravidarum is from the Greek hyper-. the incidence of HG is only 0. Kiliç D. Retrieved 26 July 2012. Res. "Endoscopy in hyperemesis gravidarum and . 10. PMID 17885701 . Tarim. 2. PhD (2004). PMID 16006438 .1016/j. Best Pract. LA (August 2010). Gumurdulu. 12. viii. "Hyperemesis gravidarum. ES. ^ Cole. Retrieved 25 December 2012." . 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A. childbirth and the puerperium (O. proteinuria and hypertensive disorders Gestational diabetes · Gestational hypertension (Pre-eclampsia · Eclampsia · HELLP syndrome) · Digestive system Acute fatty liver of pregnancy · Hepatitis E · Hyperemesis gravidarum · Intrahepatic cholestasis of pregnancy · Integumentary Gestational pemphigoid · Impetigo system / herpetiformis · Intrahepatic dermatoses of cholestasis of pregnancy · Linea pregnancy nigra · Prurigo gestationis · Pruritic folliculitis of pregnancy · Pruritic urticarial papules and plaques of pregnancy (PUPPP) · Striae gravidarum · Nervous system Chorea gravidarum · Blood Gestational thrombocytopenia · Pregnancy-induced hypercoagulability · Other.V· T· E· Pathology of pregnancy. 630–679) Pregnancy with Ectopic pregnancy abortive (Abdominal pregnancy · Cervical pregnancy · outcome Interstitial pregnancy · Ovarian pregnancy) · Molar pregnancy · Miscarriage · Oedema. predominantly related to pregnancy Maternal care amniotic fluid related to the (Oligohydramnios · Polyhydramnios) · Braxton Hicks fetus and contractions · chorion / amnion amniotic cavity (Amniotic band syndrome · Chorioamnionitis · Chorionic hematoma · Monoamniotic twins · Premature rupture of membranes) · Obstetrical hemorrhage (Antepartum) · placenta (Circumvallate placenta · Monochorionic twins · Placenta praevia · Placental abruption · Twin-to-twin Pregnancy Labor transfusion syndrome) · Amniotic fluid embolism · Cephalopelvic disproportion · Dystocia (Shoulder dystocia) · Fetal distress · Obstetrical hemorrhage . 0 Terms of Use Desktop . additional terms may apply.Read in another language This page is available in 9 languages اﻟﻌﺮﺑﯿﺔ Deutsch Español ﻓﺎرﺳﯽ Nederlands Polski Русский Slovenčina Svenska Last modified 5 days ago Mobile Text is available under CC BY-SA 3. 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