Hyperemesis gravidarum

 ICD9        = 643.0, 643.1|

}} Hyperemesis gravidarum (from the Latin for "extreme vomiting of the pregnant woman") is a severe form of morning sickness. According to the Hyperemesis Education and Research Foundation, hyperemesis gravidarum (HG) is described as ?unrelenting, excessive pregnancy-related nausea and/or vomiting that prevents adequate intake of food and fluids.? It is considered a rare complication of pregnancy. The exact number of sufferers is difficult to pinpoint because symptoms of nauseaand vomitingduring pregnancy exist on a continuum, and there is no clear boundary between common morning sicknessand hyperemesis. Estimates of the percentage of pregnant women afflicted range from 0.3% to 2%.

Symptoms

When HG is severe and/or inadequately treated, it may result in:

• • loss of 5% or more of pre-pregnancy body weight
  • dehydrationand ketosis
  • nutritional deficiencies
  • metabolic imbalances
  • difficulty with daily activities

Some women with HG lose as much as 20% of their body weight. Many sufferers of HG are extremely sensitive to odors in their environment; certain smells may exacerbate symptoms. This is known as hyper olfaction. Ptyalism, or hypersalvation, is another symptom experienced by some, but not all, women suffering from HG.

As compared to morning sickness, HG tends to begin somewhat earlier in the pregnancy and last significantly longer. While most women will experience near-complete relief of morning sickness symptoms near the beginning of their second trimester, some sufferers of HG will experience severe symptoms until delivery. A chart comparing morning sickness to HG can be found at: http://www.helpher.org/mothers/hyperemesis-or-morning-sickness/index.php.

Complications

For the pregnant woman

If inadequately treated, HG can cause renal failure, central pontine myelinolysis, coagulopathy, atrophy , Mallory-Weiss syndrome, hypoglycemia, jaundice, malnutrition, Wernicke's encephalopathy, pneumomediastinum, rhabdomyolysis, deconditioning, splenic avulsion and vasospasms of cerebral arteries. Depressionis a common secondary complication of HG.

Charlotte Bronteis believed to have died from HG.

The serious, and sometimes fatal complications of HG are almost always avoided with aggressive treatment.

For the fetus

No long-term follow-up studies have been conducted on children of hyperemetic women. Children born to hyperemetic women appear to have no greater risk of complications or birth defects than the general population. However, recent research in fetal programming indicates that prolonged stress, dehydration and malnutrition during pregnancy can put the fetus at risk for chronic disease, such as diabetes or heart disease, later in life. This underscores the importance of aggressive treatment of the condition.

Treatment

Because of the potential for severe dehydration and other complications, HG is generally treated as a medical emergency. Treatment of HG may include antiemeticmedications and intravenous rehydration. If medication and IV hydration are insufficient nutritional support may be required.

Management of HG can be complicated because not all women respond to treatment. Coping strategies for uncomplicated morning sickness -- which may include eating a bland diet and eating before rising in the morning -- may be of some assistance but are unlikely to resolve the disorder on their own. There is evidence that gingermay be effective in treating pregnancy-related nausea, however this is generally ineffective in cases of HG.

IV hydration

IV hydration often includes supplementation of electrolytes or B vitamins, as persistent vomiting frequently leads to a deficiency. After IV rehydration is completed, patients generally progress to frequent small liquid or bland meals. After rehydration, treatment focuses on managing symptoms to allow normal intake of food. Management of HG can be complicated because not all women respond to treatment. Coping strategies for uncomplicated morning sickness -- which may include eating a bland diet and eating before rising in the morning -- may be of some assistance but are unlikely to resolve the disorder on their own. There is evidence that gingermay be effective in treating pregnancy-related nausea, however this is generally ineffective in cases of HG.

Medications

While no medication is considered completely risk-free for use during pregnancy, there are several which are commonly used to treat HG and are believed to be safe.

The standard treatment in most of the world is Benedictin, a combination of doxylaminesuccinate and vitamin B-6. However, due to a series of birth-defect lawsuits in the United States against its maker, Merrill Dow, Benedictin is not currently on the market in the U.S. (None of the lawsuits were successful, and numerous independent studies and the FDAhave concluded that Benedictin does not cause birth defects.) Its component ingredients are available over-the-counter (doxylamine succinate is the active ingredient in many sleep medications), and some doctors will recommend this treatment to their patients.

Antiemeticdrugs, especially ondansetron(Zofran), are effective in many women. The major drawback of ondansetron is its extremely high cost. In severe cases of HG, the Zofran pump may be more effective than tablets. Metaclopramideis sometimes used in conjunction with antiemetic drugs; however, it has a somewhat higher incidence of side effects. Other medications less commonly used to treat HG include corticosteroidsand antihistamines.

Nutritional Support

Women who do not respond to IV rehydration and medication may require nutritional support. Patients might receive parenteral nutrition(intravenous feeding via a PICC line) or enteral nutrition (via a nasogastric tubeor a nasojejunum tube).

Complementary and Alternative Medicine

Some women with HG find relief with complementary or alternative medicine, including chiropractic, homeopathy, acupunctureand NAET

Cause

The cause of HG is unknown. The leading theories speculate that it is an adverse reaction to the hormonal changes of pregnancy.

Historically, HG has been blamed upon a psychological condition of the pregnant women. Medical professionals believed it was a reaction to an unwanted pregnancy or some other problem emotional or psychological problem. This theory has been disproved, but unfortunately some medical professionals espouse this view and fail to give patients the care they need.

External links

• Hyperemesis Education & Research Foundation
• Pregnancy @ about.com
• University of Maryland Medical Center Hyperemesis site

This article is licensed under the GNU Free Documentation License.
It uses material from the Wikipedia article Hyperemesis gravidarum.