Hyperemesis gravidarum is a severe form of morning sickness. Women who suffer from hyperemesis gravidarum endure considerable nausea and vomiting.
While morning sickness is a common complaint of pregnancy, hyperemesis gravidarum is a critical condition making it impossible to eat or drink. Normal remedies for morning sickness do not work, and it is usually treated in hospital with bed rest and intravenous feeding.
Hyperemesis gravidarum is usually diagnosed when other explanations for persistent nausea and vomiting have been excluded. Your doctor will look for signs of weight loss (greater than five percent of your pre-pregnancy weight), dehydration, nutritional deficiency, metabolic imbalance and the presence of ketones in the urine.
The condition is most likely to occur between week eight and week twelve, and it usually resolves by week twenty one. For less than half of all women who suffer from it, hyperemesis gravidarum can last the entire pregnancy. While there is no bright side to this debilitating condition, women who suffer from nausea during pregnancy have a lower incidence of miscarriage.
Experts are unsure about the cause of hyperemesis gravidarum. Many possible links and risk factors have been identified, but the condition is still not fully understood. The condition has been linked with hyperthyroidism and vitamin B6 (pyridoxine) deficiency, and there are possible associations with helicobacter pylori seropositivity, but so far no evidence has proven conclusive. An association between hyperemesis gravidarum and hydatidiform mole, a rare obstetrical complication, has been made, but the incidence of hyperemesis is greater than that of hydatidiform mole, occurring in about two percent (2 in 100) pregnancies and no direct link can be confirmed. It is also thought that the increased levels of estrogenOne of a group of female hormonal steroids that promote secondary sex characteristics.
Created in the ovaries, adrenal cortices, and fetoplacental unit, estrogen is used to prepare the genital tract for fertilization, implantation and nutrition of the embryo.
Estrogen is a key ingredient in oral contraceptives. Estrogens include conjugated estrogen, esterified estrogen, estradiol, estriol and estrone.
Visit our comprehensive glossary for more pregnancy terms and definitions. and human chorionic gonadotropinHuman chorionic gonadotropin is a hormone released into the maternal bloodstream by the developing placenta from about six days after the last period was due (about 22 days after the last menstrual period). Its presence can be detected in the urine by a home pregancy test and a positive result indicates pregnancy. Gonadotropins are used to treat infertility, hypogonadism and nonobstructive cryptorchidism. Often abbreviated to HCG.
Visit our comprehensive glossary for more pregnancy terms and definitions., hCG, may exacerbate extreme nausea and vomiting in pregnancy.
Psychological factors such as the inability to cope with daily life, feeling trapped by people or circumstances, (such as worries about perceived social stigmas including giving birth as an unwed mother) have also been proposed. Psychologists point out that a simple change of people and surroundings, or the support and reassurance offered by the hospital play a large part in the treatment of hyperemesis gravidarum, and suggest that immature or hysterical personalities are more susceptible to the condition since it is a symptom of disturbed relationships.
The incidence of hyperemesis gravidarum is between one and three percent (1 - 3 in 100), although the incidence is higher in cases of molar and multiple pregnancies.
Women who suffer from hyperemesis gravidarum are unable to eat or drink. The nausea and vomiting is responsible for a loss of nutrients and fluids resulting in malnutrition and dehydration. If you are experiencing hyperemesis gravidarum you are at risk of dietary deficiencies, which if improperly treated can lead to intrauterine growth retardation and premature labor in the baby.
Before the development of intravenous feeding mortality was a possible complication of hyperemesis gravidarum. Fortunately with early detection and hospital treatment, complications are no longer life threatening.
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Frequent vomiting may cause esophageal perforations and Mallory-Weiss tears. Longer term complications of vomiting may include gastric ulcers, esophageal bleeding and ongoing nausea. If the condition is severe and not treated with thiamine supplementation, there may be signs of Wernicke encephalopathy such as confusion, disorientation, diplopia and nystagmus. Ketonuria is a common complication of hyperemesis gravidarum. In extreme cases there may be kidney and liver damage as a result of weight loss and dehydration, and metabolic imbalances.
Because of the malnutrition associated with hyperemesis gravidarum, the baby is at risk of premature birth, low birth weight and low Apgar scoresA general test given 1 minute and 5 minutes after the birth of a child to determine its wellbeing. it uses the rating of five factors to judge the baby's ability to adjust to life outside of the uterus.
The test consists of measuring the baby's heart rate, respiratory effor, muscle tone, reflex action and color and is scored from a low value of 0 to a high value of 2 which ar then added. A score of 9/10 would indicate a score of 9 at 1 minute and 10 at 5 minutes.
Visit our comprehensive glossary for more pregnancy terms and definitions.. In extreme cases there is a slight risk of some skin and central nervous systemAn intricate network of structures that runs extensively throughout the body and activates, coordinates and controls all functions of the body.
The nervous system consists of two parts, the central nervous system and the peripheral nervous system. The central nervous system is composed of the brain and the spinal cord. The peripheral nervous system includes the cranial nerves and spinal nerves.
Afferent fibers carry sensory impulses to the central nervous system. Efferent fibers carry motor impulses in the form of electrical energy from the central nervous system to the muscles and other organs.
Somatic fibers are those associated with the bones, muscles and the skin. Visceral fibers are those associated with the internal organs, blood vessels and mucus membrane. All of the functions are coordinated by a network of tiny structures including neurons, axons, dendrites and ganglia.
Visit our comprehensive glossary for more pregnancy terms and definitions. abnormalities. There is evidence to suggest that boys born of mothers experiencing hyperemesis gravidarum during pregnancy have a slightly increased risk of testicular cancer.
If you are experiencing morning sickness and nausea during the early stages of your pregnancy your doctor will try to ensure that the complaint does not develop into hyperemesis gravidarum. Following the recommendations of the American College of Obstetrics and Gynecology, treatment of vomiting and nausea in a primigravidaA term used to describe a mother who is pregnant for the first time. Sometimes called gravida I.
Visit our comprehensive glossary for more pregnancy terms and definitions. patient should begin with the administration of vitamin B6 (pyridoxine) supplementation, possibly with doxylamine. If the condition continues or worsens, antiemetic medication may be required.
If the nausea and vomiting does not improve and hyperemesis is suspected, the condition will be confirmed with a series of tests.
If the tests confirm the presence of hyperemesis gravidarum, treatment will consist mostly of supportive care. Emotional support and reassurance from your family, friends and healthcare providers is an essential part of the treatment.
Intravenous infusion consisting of fluid to combat dehydration comprising water, chloride, glucose, lactate or bicarbonate, potassium and sodium to correct metabolic imbalances will be administered. A low dosage of antiemetic medication, such as Phenergan, may be added to the infusion to prevent vomiting. If it is possible to swallow vitamins, they will be recommended as part of the treatment.
After about forty eight hours, symptoms should disappear and a carefully controlled diet consisting of neutral fluids and dry carbohydrate foods may begin. Small portions will be provided at regular intervals to minimize the recurrence of symptoms as a result of unpleasant odors or other triggers. Psychological counseling may also be recommended at this stage of treatment.
Refractory hyperemesis gravidarum is sometimes treated with a steroid burst, and your doctor will decide whether this treatment, which is similar to that used to treat acute asthma is appropriate for you.
If the condition develops in severity so that emergency room care is required the following actions may be performed:
After you return home, treatment will continue with the use of oral medications. An effective and safe treatment for morning sickness consisting of vitamin B6 and doxylamine succinate used to be recommended for hyperemesis until it was withdrawn for legal reasons. If your doctor approves, the medication can be reproduced by taking 25mg of vitamin B6 (half tablet) and 25mg of Unisom Nighttime Sleep Aid (half tablet) three times daily. Do not use Maximum Strength Unisom Sleepgels, since these contain diphenhydramine hydrochloride. Alternatively your doctor may recommend Compazine, Phenergan, Inapsine and Tigan. No medications should be taken without the express recommendation of your healthcare provider.
With prompt and decisive diagnosis, hyperemesis gravidarum may be effectively treated and complications avoided. Your doctor will want to ensure that any nutritional deficiencies resulting from the condition are corrected to ensure that your baby is healthy for the remainder of your pregnancy.
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