Hyperemesis gravidarum ( HG ) is a pregnancy complication characterized by severe nausea, vomiting, weight loss, and possibly dehydration. Signs and symptoms may also include vomiting several times a day and feel faint. Hyperemesis gravidarum is considered more severe than morning sickness. Often the symptoms get better after the 20th week of pregnancy but may last throughout the entire pregnancy.
The exact cause of hyperemesis gravidarum is unknown. Risk factors include first pregnancy, multiple pregnancy, obesity, previous family history or HG, trophoblastic disorders, and history of eating disorders. Diagnosis is usually made based on observed signs and symptoms. HG is technically defined as more than three episodes of vomiting per day such as weight loss of 5% or three kilograms has occurred and ketones present in the urine. Other potential causes of symptoms should be excluded including urinary tract infections and high thyroid levels.
Treatments include drinking fluids and a tasteless diet. Recommendations may include an electrolyte replacement drink, thiamine, and a higher protein diet. Some women need intravenous fluids. In connection with pyridoxine or metoclopramide drugs is preferred. Prochlorperazine, dimenhydrinate, or ondansetron can be used if this is not effective. Hospitalization may be required. Psychotherapy can improve results. Evidence for bad acupressure.
While vomiting in pregnancy was described as early as 2,000 BC, the first clear medical description of hyperemesis gravidarum was in 1852 by Antoine Dubois. Hyperemesis gravidarum is thought to affect 0.3-2.0% of pregnant women. Although previously known as a common cause of death in pregnancy, with proper care it is now very rare. Those affected have a lower risk of miscarriage but the risk of preterm delivery is higher. Some pregnant women choose to have an abortion because of the symptoms of HG.
Video Hyperemesis gravidarum
Signs and symptoms
When severe vomiting can cause the following things:
- Losing 5% or more of pre-pregnancy weight
- Dehydration, causing ketosis, and constipation
- Nutritional disorders such as vitamin B1 deficiency (thiamine), vitamin B6 deficiency or vitamin B12 deficiency
- Metabolic imbalances such as metabolic ketoacidosis or thyrotoxicosis
- Physical and emotional stress in pregnancy in the body
- Difficulty with daily life activities
Symptoms can be worsened by hunger, fatigue, prenatal vitamins (especially those containing iron), and diet. Many people with HG are very sensitive to odors in their environment; Certain odors can aggravate symptoms. Saliva excessive, also known as sialorrhea gravidarum, is another symptom experienced by some women.
Hyperemesis gravidarum tends to occur in the first trimester of pregnancy and lasts much longer than morning sickness. While most women will experience nearly perfect morning sickness symptoms near their early second trimester, some people with HG will experience severe symptoms until they give birth to their baby, and sometimes even after childbirth.
A small fraction rarely vomits, but nausea still causes most (if not all) of the same problems that hyperemesis with vomiting.
Maps Hyperemesis gravidarum
Cause
There are many theories about the cause of HG, but the cause is still controversial. It is thought that HG is due to a combination of factors that can vary between women and include genetics. Women with family members who have hyperemesis are more likely to develop the disease.
One factor is the adverse reaction to hormonal changes in pregnancy, in particular, an increase in human chorionic gonadotropin beta (hCG) levels. This theory will also explain why hyperemesis gravidarum is most common in the first trimester (often about 8-12 weeks gestation), because hCG levels are highest at that time and decrease thereafter. Other causes argued from HG are elevated levels of maternal estrogen (decreased intestinal motility and gastric emptying leading to nausea/vomiting).
Pathophysiology
Although the pathophysiology of HG is poorly understood, the most commonly accepted theory suggests that hCG levels are associated with it. Leptin may also play a role.
The possible pathophysiological processes involved are summarized in the following table:
Diagnosis
Hyperemesis gravidarum is considered a diagnosis of exclusion. HG can be associated with serious problems in the mother or infant, such as Wernicke's encephalopathy, coagulopathy, peripheral neuropathy.
Women with hyperemesis gravidarum are often dehydrated and lose weight despite trying to eat. The onset of nausea and vomiting in hyperemesis gravidarum is usually before the twenty-second week of pregnancy.
Differential diagnosis
Diagnoses to be ruled out include the following:
Investigation
General investigations include blood urea nitrogen (BUN) and electrolytes, liver function tests, urinalysis, and thyroid function tests. Hematologic examination includes hematocrit levels, which usually increase in HG. Ultrasound scans may be necessary to determine the status of pregnancy and to exclude molar or partial molar pregnancies.
Management
Dried bland food and oral rehydration are first-line treatments. Due to the potential for severe dehydration and other complications, HG is treated as an emergency. If conservative dietary measures fail, more extensive treatment such as the use of antiemetic drugs and intravenous rehydration may be necessary. If oral nutrition is inadequate, intravenous nutritional support may be necessary. For women who require hospitalization, thromboembolic stockings or low molecular weight heparin can be used as an action to prevent the formation of blood clots.
Intravenous fluid
Intravenous (IV) hydration often includes electrolyte supplementation because persistent vomiting often causes deficiency. Likewise, supplements for thiamine loss (Vitamin B 1 ) should be considered to reduce the risk of Wernicke's encephalopathy. Vitamins A and B will be discharged within two weeks, so extended malnutrition indicates the need for evaluation and supplementation. In addition, electrolyte levels should be monitored and supplemented; Particular attention is sodium and potassium.
After IV rehydration is complete, the patient in general progress becomes a small liquid or soft food. After rehydration, the treatment focuses on managing symptoms to allow normal food intake. However, hydration and dehydration cycles may occur, making continuous care necessary. Home care is available in the form of a PICC line for hydration and nutrition (called total parenteral nutrition). Home care is often less expensive than long-term or recurrent hospitalization.
Drugs
A number of effective and safe antiemetics in pregnancy include: pyridoxine/doxylamine, antihistamines (such as diphenhydramine), and phenothiazines (such as promethazine). Due to its effectiveness, it is unknown whether anyone is superior to others to relieve nausea or vomiting. Limited evidence of published clinical trials suggests the use of drugs to treat hyperemesis gravidarum.
While pyridoxine/doxylamine, a combination of vitamin B 6 and doxylamine, is effective in pregnancy nausea and vomiting, some question its effectiveness in HG. Ondansetron may be beneficial, however, there are some concerns about the relationship with the gap ceiling, and there is little high-quality data. Metoclopramide is also used and is relatively well tolerated. Evidence for weak corticosteroid use; there is some evidence that the use of corticosteroids in pregnant women may slightly increase the risk of facial mouth opening in infants and may suppress fetal adrenal activity. However, hydrocortisone and prednisolone are not active in the placenta and may be used in the treatment of hyperemesis gravidarum after 12 weeks.
Nutritional support
Women who do not respond to IV rehydration and medication may require nutritional support. Patients may receive parenteral nutrition (intravenous administration via PICC) or enteral nutrition (via nasogastric tube or nasojejunal tube). There is only limited evidence from trials to support the use of vitamin B6 to improve yield. Hiperalimentation may be necessary in certain cases to help maintain volume requirements and allow weight gain. A doctor may also prescribe Vitamin B1 (to prevent Wernicke's encephalopathy) and folic acid supplementation.
Alternative medicine
Acupuncture (both with P6 and traditional methods) has been found to be ineffective. The use of ginger products may be helpful, but evidence of its effectiveness is limited and inconsistent, although three recent studies support ginger against placebo.
Complications
Pregnant women
If HG is not adequately treated, anemia, hyponatremia, Wernicke's encephalopathy, renal failure, central pontine mielinolysis, coagulopathy, atrophy, Mallory-Weiss tears, hypoglycemia, jaundice, malnutrition, pneumomediastinum, rhabdomyolysis, deconditions, deep venous thrombosis, pulmonary embolism, avulsion spleen. , or cerebral artery vasospasm is a possible consequence. Depression and PTSD are common secondary complications of HG and emotional support can be beneficial.
Baby
The effects of HG on the fetus are mainly due to the electrolyte imbalance caused by HG in the mother. Infants of women with severe hyperemesis who received less than 7 kg (15.4 pounds) during pregnancy tended to be low birth weight, small for gestational age, and were born before 37 weeks of pregnancy. In contrast, infant women with hyperemesis who had a gestational weight greater than 7 kg looked similar to infants from uncomplicated pregnancies. There was no significant difference in neonatal mortality rates in infants born to mothers with HG compared to babies born to mothers without HG. Children born to mothers with severe hyperemesis have a fourfold increase in neurobehavioral diagnosis.
Epidemiology
Vomiting is a common condition affecting about 50% of pregnant women, with another 25% experiencing nausea. However, the incidence of HG is only 0.3-1.5%. After preterm labor, hyperemesis gravidarum is the second most common reason for hospital admission during the first half of pregnancy. Factors such as infection with Helicobacter pylori, increased production of thyroid hormone, low age, low body mass index before pregnancy, multiple pregnancies, molar pregnancy, and a history of hyperemesis gravidarum have been linked to HG development.
History
Thalidomide is prescribed for the treatment of HG in Europe until it is recognized that thalidomide is teratogenic and is a cause of phocomelia in neonates.
Etymology
Hyperemesis gravidarum comes from the Greek hyper - , which means excessive, and , which means vomiting, and Latin gravidarum , the feminine genital plural form of the adjective, here used as a noun, which means "pregnant [woman]". Therefore, hyperemesis gravidarum means "excessive vomiting in pregnant women".
Famous cases
The writer Charlotte BrontÃÆ'Â sering is often considered to suffer from hyperemesis gravidarum. He died in 1855 at four months pregnant, suffered from abdominal pain and vomiting throughout his pregnancy, and could not tolerate food or even water.
The Duchess of Cambridge was hospitalized for hyperemesis gravidarum during her first pregnancy, and was treated for the same condition for the next two.
References
External links
Source of the article : Wikipedia
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