Hyperemesis gravidarum

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admin | May 03, 2010 | 0 comments
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Nausea and vomiting (morning sickness) is common symptoms in any pregnancy. When these symptoms are severe which hampers the daily life and requiring hospital admission is called hyperemesis gravidarum. Hyperemesis gravidarum, also called HEG, is severe nausea and vomiting during pregnancy. Its results in dehydration, weight loss, unable to eat, and a disturbance in the acid-base balance in the body.

The exact cause of HEG is unknown but some studies shows that ,there may be a link between high level of estrogen or human chrionic gonadotrion , a hormone that helps the unborn bady to developed which is produced by placenta .

The risk of HEB seems less in elder women than the younger one .first pregnancy, twin , triplets pregnancy, previous HEG, overweight and trophoblastic disease of the womb are some risks factor for hyperemesis gravidarum

Symptoms or HEG are at peak at 8 to 12 weeks of pregnancy (high level of human chrionic gonadotrion in 8-12 weeks) and usually resolve by the 16^th to 17^th week. Commonly patients present with the long-lasting vomiting but some patients also have the symptoms like excess of saliva, weight loss, fatigue, headache, fainting, syncope, and weakness, loss of appetite, decreased concentration, irritability, mood changes, and impaired sense of taste.

Hyperemesis gravidarum is diagnosed by taking complete history, Lab tests (Complete blood count, serum electrolytes liver enzymes and bilirubin, and urinalysis for ketone and specific gravity, ketone are a sign or starvation) and ultrasound to exclude and trophoblastic disease of the womb.

When patient is diagnosed as HEG admission is needed for further management. Patient is managed with giving nothing from mouth and giving IV fluid with adding vitamins and antiemetics drugs likes promethzine, hydroxyzine, prochlorperazine (2 -3 times a day ). In some refractory severe cases of hyperemesis gravidarum, if maternal survival is threatened, or if hyperemesis gravidarum is causing severe physical and psychological burden, termination of the pregnancy should be considered.When urine ketone is nil stop IV fluid and allows small meals per mouth and discharged with giving oral antiemetics drugs.

Hyperemesis gravidarum is self-limited and improves by the end of the first trimester but in some case symptoms may persist through 20-22 week of pregnancy, in rare cases, until delivery.

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