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HYPEREMESIS GRAVIDARUM

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Definition

  1. intractable nausea and vomiting to extent of weight loss, dehydration and electrolyte imbalance, acid-base disturbance and if severe, hepatic and renal damage
  2. usually present in T1 then diminishes or persists throughout pregnancy
    in a minority

Etiology 

  1. presently thought to be multifactorial with hormonal, immunologic  and psychologic components
  2. high or rapidly rising beta-hCG or estrogen levels are implicated
Maternal Complications

  1. Mallory Weiss tears
  2. Wernicke's encephalopathy, if protracted course
  3. death

Fetal Complications 

  1. usually none 
  2. IUGR is 15x more common in women losing > 5% of prepregnant weight

Differential Diagnosis of Nausea and Vomiting

  1. hyperemesis is a diagnosis of exclusion
  2. GI inflammation/infection

    • appendicitis
    • cholecystitis
    • hepatitis
    • gastroenteritis
    • pancreatitis
    • PUD
    • fatty liver of pregnancy

  3. pyelonephritis 
  4. thyrotoxicosis 
  5. multiple gestation 
  6. GTN
  7. HELLP syndrome
Investigations

  1. labs (CBC, lytes, BUN and creatinine, urinalysis, LFTs)
  2. ultrasound (to R/O molar pregnancy, multiple pregnancy and to assess liver, pancreas, gallbladder, etc...)

Treatment

General
  1. early recognition is important
  2. if severe, admit to hospital
  3. NPO initially, then small frequent meals of appealing foods
  4. correct hypovolemia, electrolyte imbalance and ketosis
  5. thiamine, if indicated
  6. TPN if severe to reverse catabolic state
  7. consider emotional support, dietary and psychologic counselling

Pharmacological options
  1. dimenhydrinate (Gravol)
  2. vitamin B6 and doxylamine succinate (Diclectin)

Non-pharmacological options
  1. accupressure at inner aspect of the wrists, just proximal to the flexor crease has been shown to significantly reduce symptoms of nausea and vomiting
  2. avoid triggers (i.e. certain smells)

HYPEREMESIS GRAVIDARUM HYPEREMESIS GRAVIDARUM Reviewed by Radiology Madeeasy on September 09, 2010 Rating: 5
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