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Hyperemesis gravidarum
From Wikipedia, the free encyclopedia
Hyperemesis gravidarum (from Greek hyper and emesis and Latin gravida; meaning
"excessive vomiting of pregnant women") is a severe form of morning sickness, with
unrelenting, excessive pregnancy-related nausea and/or vomiting that prevents adequate
intake of food and fluids.[1] Hyperemesis is considered a rare complication of pregnancy
but, because nausea and vomiting during pregnancy exist on a continuum, there is often
not a good diagnosis between common morning sickness and hyperemesis. Estimates of
the percentage of pregnant women afflicted range from 0.3% to 2%.[2]
Contents
[hide]
• 1 Cause
• 2 Symptoms
• 3 Complications
o 3.1 For the pregnant woman
o 3.2 For the fetus
• 4 Diagnosis
• 5 Treatment
o 5.1 IV hydration
o 5.2 Medications
o 5.3 Practice in United Kingdom
o 5.4 Nutritional support
o 5.5 Complementary and alternative medicine
o 5.6 Support
• 6 Impact
• 7 Footnotes
• 8 External links
[edit] Cause
The cause of HG is unknown. The leading theories speculate that it is an adverse reaction
to the hormonal changes of pregnancy. In particular Hyperemesis may be due to raised
levels of beta HCG (Human Chorionic Gonadotrophin) as it is more common in multiple
pregnancies and in gestational trophoblastic disease.
Additional theories point to high levels of estrogen and progesterone,[citation needed] which
may also be to blame for hypersalivation; decreased gastric motility (slowed emptying of
the stomach and intestines); immune response to fragments of chorionic villi that enter
the maternal bloodstream; or immune response to the "foreign" fetus.[citation needed]
A recent study gives "preliminary evidence" that there may be a genetic component.[4]
[edit] Symptoms
When HG is severe and/or inadequately treated, it may result in:
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 hyperolfaction. Ptyalism, or hypersalivation, is another
symptom experienced by some, but not all, women suffering from HG.
[edit] Complications
[edit] For the pregnant woman
[edit] Diagnosis
Women who are experiencing hyperemesis gravidarum often are dehydrated and losing
weight despite efforts to eat. The nausea and vomiting begins in the first or second month
of pregnancy. It is extreme and is not helped by normal measures.[5]
Fever, abdominal pain, or a late onset of nausea and vomiting usually indicate another
condition, such as appendicitis, gall bladder problems, gastritis, hepatitis, or infection.[5]
Because a self-report of this condition can be used to conceal an eating disorder, the
presence of conditions such as bulimia nervosa and purging disorder must be
appropriately evaluated.[6] One way to do this is to ask the pregnant woman to eat in a
closely observed environment.
[edit] Treatment
Because of the potential for severe dehydration and other complications, HG is generally
treated as a medical emergency. Treatment of HG may include antiemetic medications
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 ginger may be effective in
treating pregnancy-related nausea, however this is generally ineffective in cases of HG.
[edit] IV hydration
When continuing care is necessary,[citation needed] home care is available in the form of a
PICC line. Home treatment is often less expensive than long-term hospital admission.
[edit] 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 (also sold under the trademark
name Diclectin), a combination of doxylamine succinate and vitamin B6. 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 Food and Drug Administration
(FDA) have 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.
Antiemetic drugs, especially ondansetron (Zofran), are effective in many women. The
major drawback of ondansetron has been its cost. In severe cases of HG, the Zofran pump
may be more effective than tablets. Metoclopramide is 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 Marinol, corticosteroids and
antihistamines.
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 tube or a nasojejunum tube).
[edit] Support
It is important that women get early and aggressive care during pregnancy. This can help
limit the complications of HG. Also, because depression can be a secondary condition of
HG, emotional support, and sometimes even counseling, can be of benefit. It is important,
however, that women not be stigmatized by the suggestion that the disease is being
caused by psychological issues.
[edit] Impact
According to the Hyperemesis Education and Research Foundation (HER),
hospitalization in the United States for HG may cost more than $3,300 per incident, with
1–3% of all pregnant women being hospitalized at least once for this condition. [9] HG
may also interfere with daily activities, employment and important relationships, with
some women divorcing or limiting their family size through pregnancy prevention and
even abortion. [9]