Hyperemesis Gravidarum

 

Hyperemesis gravidarum is nausea and vomiting severe enough to cause physiological and biochemical effects.

It usually occurs during the first trimester of ~1% of all pregnancies and then decreases, but is present throughout pregnancy in a few women.

In contrast, morning sickness affects at least half of pregnancies, occurring most commonly in the first and second trimesters.

 

 

Causes and Risk Factors

 

Hyperemesis is multifactorial, as described below.

Rapidly rising beta-hCG and estrogen levels may play a role in this condition.

 

 

 

 

 

Signs, Symptoms, and Diagnosis

Hyperemesis is diagnosed by excluding other potential causes, including:

 

  • history and physical exam
  • lab investigations
  • diagnostic imaging

History and Physical Exam

Effects of hyperemesis include:

  • weight loss
  • dehydration

Lab Investigations

Important screens include:

  • CBC
  • electrolytes
  • BUN, creatinine
  • liver enzymes
  • urinalysis

Lab findings include:

  • ketonuria
  • electrolyte imbalances
  • acid-base disturbances
  • hepatic and renal damage

Diagnostic Imaging

 

 

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Pathophysiology

Hyperemesis is multifactorial, with hormonal, immunologic, and psychological contributors.

 

 

 

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Treatments

Medications

Diclectin, or (doxylamine succinate with vitamin B6) can be used, with gravol as a safe adjunct

 

Non-medications

rest

avoid triggers (ie smells, foods)

if severe, admit to hospital to correct hypovolemia, electrolyte imbalance, and ketosis

TPN if catabolic state persists

 

 

 

 

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Consequences and Course

 

Maternal consequences include:

Fetal consequences are rare, but include IUGR.

 

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Resources and References