hyperemesis gravidarum


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Hyperemesis Gravidarum

 

Definition

Hyperemesis gravidarum means excessive vomiting during pregnancy.

Description

In pregnant women, nausea and vomiting (morning sickness) are common, affecting up to 80% of pregnancies. Hyperemesis, or extreme nausea and excessive vomiting, occur in about 1% of pregnancies. This condition causes uncontrollable vomiting, severe dehydration, and weight loss for the mother. However, hyperemesis gravidarum rarely causes problems for the unborn baby.

Causes and symptoms

The cause of nausea and vomiting during pregnancy is unknown but may be related to the level of certain hormones produced during pregnancy. Hyperemesis is seen more often in first pregnancies and multiple pregnancies (twins, triplets, etc.). The main symptom of hyperemesis is severe vomiting, which causes dehydration and weight loss.

Diagnosis

Although many women with morning sickness feel like they are vomiting everything they eat, they continue to gain weight and are not dehydrated; they do not have hyperemesis gravidarum. Women with this condition will start to show signs of starvation, including weight loss. Physical examination and laboratory tests of blood and urine samples will be used to help diagnose the condition. One of the most common tests used to help diagnosis and monitor hyperemesis gravidarum is a test for ketones in the urine. Excessive ketones in the urine (ketonuria) indicate that the body is not using carbohydrates from food as fuel and is inadequately trying to break down fat as fuel. Ketonuria is a sign that the body is beginning to operate in starvation mode.

Treatment

Hospitalization is often required. Intravenous fluids with substances that help the body conduct nerve signals (electrolytes) may be given to correct the dehydration and excessive acid in the blood (acidosis). Anti-nausea or sedative medications may be given by injection to stop the vomiting. In some cases, oral medication may be prescribed to control the nausea and vomiting while food is reintroduced. If food cannot be tolerated at all, intravenous nutritional supplements may be necessary. Injections of vitamin B6, in particular, may help overcome nutritional deficiencies that often occur.

Alternative treatment

The severe vomiting associated with hyperemesis gravidarum requires medical attention. Milder episodes of nausea or vomiting may be reduced with deep breathing and relaxation exercises. The use of herbal remedies should be done with extreme caution during pregnancy, especially in the first trimester. Natural remedies to reduce nausea include a teaspoon of cider vinegar in a cup of warm water, or tea made from anise (Pinpinella anisum), fennel seed (Foeniculum vulgare), red raspberry (Rubus idaeus), or ginger (Zingiber officinale). Wristbands can be positioned over acupressure points on both wrists. Aromatherapy with lavender, rose, or chamomile can be soothing, as can smelling ground ginger. Homeopathic remedies—which use extremely diluted solutions as treatments—can be safe and effective for controlling symptoms in some women.

Prognosis

In virtually all cases, the pregnancy can continue to the successful delivery of a healthy baby.

Prevention

Although there is no evidence that hyperemesis gravidarum can be prevented, vomiting during pregnancy sometimes may be lessened. Maintaining a healthy diet, getting adequate sleep, and controlling stress may contribute to prevention or improvement of symptoms. Several strategies may help lessen the nausea and vomiting. Eating dry foods and limiting fluid intake may also be helpful. Small meals should be eaten frequently throughout the day, with a protein snack at night. Eating soda crackers before rising from bed in the morning may help prevent early morning nausea. Iron supplements may cause nausea and can be eliminated until the nausea is controlled. Sitting upright for 45 minutes after meals may also help.

Resources

Other

Levy, B. T., and P. L. Brown. "Nausea and Vomiting in Pregnancy." The Virtual Hospital Page. University of Iowa. http://www.vh.org.
"Natural Remedies During Pregnancy: Frequently Asked Questions." Childbirth.Org. http://www.childbirth.org/articles/remedy.html.

Key terms

Ketonuria — The presence of large amount of ketones in the urine. These byproducts of inadequate breakdown of nutrients indicate that the body is in starvation.

hyperemesis

 [hi″per-em´ĕ-sis]
excessive vomiting. adj., adj hyperemet´ic.
hyperemesis gravida´rum excessive and pernicious vomiting during pregnancy, usually in the first trimester, a more serious condition than the simple morning sickness that is common during the first trimester. The exact cause is not known; however, it is thought to be related to trophoblastic activity and production of chorionic gonadotropin and may be aggravated by psychologic factors. It is more common in association with hydatidiform mole and multiple gestation, both of which are associated with elevated levels of chorionic gonadotropin.
Symptoms. The patient complains of uncontrollable nausea, persistent retching and vomiting, inability to take any food by mouth, and exhaustion due to restlessness and lack of sleep. As the condition persists the patient becomes severely dehydrated, develops a fever, and may show signs of peripheral nerve involvement and jaundice. The urine may contain blood, bile, albumin, and ketone bodies as starvation develops. Although hyperemesis gravidarum is rarely fatal, these latter symptoms indicate a grave illness that demands prompt treatment.
Treatment. The physical symptoms of the patient are relieved by intravenous administration of fluids and nutrients and mild sedation to promote rest and relaxation. There is some controversy as to the value of psychotherapy; however, it is generally agreed that the patient will need help in overcoming emotional problems and situational tension if they contribute to the occurrence of the disorder. Dietary treatment may include limiting the intake of liquids, eating a snack of crackers or dry toast before arising, and avoiding excessive fat in the diet.
Patient Care. The hospitalized patient should be placed in a quiet, well-ventilated room that is free from odors or sights that may cause nausea. Fluid intake and output are monitored and mouth care is given frequently. Food and liquids are resumed on a prescribed schedule that gradually progresses to a regular diet. The patient should be encouraged to talk about her feelings if she indicates a desire to do so. The caregivers should be alert to signs of depression or fears of pregnancy, labor, or the responsibilities of motherhood. Recovery is much more likely if the patient is able to vocalize her fears and seek aid in solving any situational or emotional conflicts that may contribute to her illness. Those who care for her should be sympathetic, optimistic, and reassuring in discussing her condition with her.
hyperemesis lacten´tium vomiting by nursing babies.

hy·per·em·e·sis grav·i·da'r·um

pernicious vomiting in pregnancy.

hyperemesis gravidarum

(hī′pər-ĕm′ĭ-sĭs grăv′ĭ-dâr′əm)
n.
Severe, intractable vomiting during pregnancy, usually in the first trimester.

hyperemesis gravidarum

[hī′pərem′isis]
Etymology: Gk, hyper + emesis, vomiting; L, gravida, pregnant
an abnormal condition of pregnancy characterized by protracted vomiting, weight loss, and fluid and electrolyte imbalance. If the condition is severe and intractable, brain damage, liver and kidney failure, and death may result. The cause of the condition is not known; an increase in levels of chorionic gonadotropins or other hormones, an immunological sensitivity to products of conception, or aggravation of preexisting emotional conflicts has been suggested, but a causal relationship has not been proved. It occurs in approximately 3 of every 1000 pregnancies. Its incidence has diminished in recent years.
observations Women are frightened of and uncomfortable and embarrassed about their illness. Dry mucous membranes are a sign of dehydration. Other signs include decreased skin elasticity, a rapid pulse, and falling blood pressure. The specific gravity of the urine rises, and the volume of urine excreted falls. The hematocrit is elevated because of hemoconcentration. Loss of electrolytes in vomitus leads to metabolic acidosis with hypokalemia, hypochloremia, and hyponatremia. Severe potassium deficit alters myocardial function; the electrocardiogram may show prolonged P-R and Q-T intervals and inverted T waves. In addition to weight loss, undernourishment causes fever, ketosis, and acetonuria. Severe vitamin B deficiency may result in encephalopathy manifested by confusion and eventually coma. Laboratory analyses of blood indicate increased concentrations of metabolic products normally cleared by the liver and kidneys. Forceful vomiting may cause retinal hemorrhages that impair vision and gastroesophageal tears that bleed, causing hematemesis or melena.
interventions Effective therapy arrests vomiting and achieves rehydration, adequate nutrition, and emotional stabilization. Bed rest is instituted. Antiemetics safe for the fetus are administered. Fluids, electrolytes, nutrients, and vitamins are given parenterally if the woman is unable to retain fluids by mouth. The fetal heart rate is measured frequently. Psychiatric consultation and therapy are sometimes beneficial. Termination of pregnancy is curative but almost never required.
nursing considerations Visitors are encouraged; isolation, formerly recommended, is not desirable. Sympathetic listening and supportive, nonjudgmental care are provided. The woman and her family are told often that the prognosis is excellent for both mother and baby. The woman is weighed regularly, and her weight is accurately recorded, for the best evidence of recovery is steady weight gain.

hyperemesis gravidarum

Obstetrics A condition that respects no race, parity status or social class, characterized by vomiting in the 1st trimester–3.5/1000 pregnancies, of a severity that may induce renal failure and require hospitalization; if Pt stabilizes, there is no risk of toxemia during later gestation, nor ↑ risk of spontaneous abortion or deformities

hy·per·em·e·sis grav·i·darum

(hī'pĕr-em'ĕ-sis grav-ē'dā-rŭm)
Nausea and vomiting during pregnancy severe enough to result in dehydration, acidosis, and weight loss. May require hospitalization; if untreated, can be fatal.

hyperemesis gravidarum

A condition of excessively severe and protracted sickness and vomiting occurring as one of the complications of pregnancy. Hyperemesis can be dangerous, but admission to hospital, without treatment, is often sufficient to relieve it.
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