hyperemesis gravidarum

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.

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hyperemesis /hy·per·em·e·sis/ (-em´ĕ-sis) excessive vomiting.hyperemet´ic

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hyperemesis gravida´rum  the pernicious vomiting of pregnancy.

hyperemesis lacten´tium  excessive vomiting in nursing babies.

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hyperemesis grav·i·dar·um (grv-dârm)

n.

Severe, intractable vomiting during pregnancy, usually in the first trimester.

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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 immunologic 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.

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hyperemesis gravidarum

Obstetrics A condition that respects no race, parity status or social class, characterized by vomiting in the 1^st 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