Investigations[ edit ] Common investigations include blood urea nitrogen BUN and electrolytes, liver function tests , urinalysis ,  and thyroid function tests. Hematological investigations include hematocrit levels, which are usually raised in HG. If conservative dietary measures fail, more extensive treatment such as the use of antiemetic medications and intravenous rehydration may be required. If oral nutrition is insufficient, intravenous nutritional support may be needed. In addition, electrolyte levels should be monitored and supplemented; of particular concern are sodium and potassium.
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Open in a separate window Studies have focused on the reasons some pregnant mothers develop hyperemesis; however, the cause has not yet been clearly identified. The pathogenesis is not fully understood, but may be attributed to hormones, gastrointestinal GI dysfunction, thyrotoxicosis, serotonin, hepatic abnormalities, autonomic nervous dysfunction, nutritional deficiencies, asthma, 8 allergies, 12 Helicobacter pylori infection, 13 or psychosomatic causes. Babies born to mothers battling hyperemesis have a variety of different obstacles to overcome before becoming healthy.
Hyperemesis was also found to be associated with delivery before 37 weeks of gestation when compared with subjects without hyperemesis OR 1. When comparing infants born at an early gestational age to those who were not, there was no significant difference in Apgar scores, congenital anomalies, or perinatal death.
Hyperemesis has a tremendous detrimental effect on the weight of newborns, which is a focus of recent research. With minimal weight gain, adverse outcomes for the newborns have been noted. There are reports of congenital malformations such as undescended testicles, hip dysplasia, and Down syndrome. Researchers agree that the vomiting is most likely not teratogenic, but the untreated electrolyte disturbances, malnutrition, and maternal weight loss may be harmful.
The effects of hyperemesis gravidarum are quite widespread. In addition to feeling ill, women with this condition report other sources of distress, including time lost from work and decreased quality of life. They reported being limited not only due to the nausea and vomiting, but also from the psychological affliction that was caused by feeling ill for weeks to months. Hyperemesis can result in financial hardship for these patients, their places of employment, and the health care system, 6 showing that the effects of the disease are not limited to pregnant women alone.
Recent research now provides additional guidelines for protection against and relief from hyperemesis gravidarum. These treatment methods include a range of options, from routine changes to medications and various different therapies.
Alterations to maternal diet and lifestyle can have protective effects. Medicinal methods of prevention and treatment include nutritional supplements as well as alternative methods, such as hypnosis and acupuncture. Diet Modification of the amount and size of meals consumed throughout the day may help relieve symptoms.
Having smaller amounts of food and fluids more often can help prevent mild cases of nausea and vomiting from worsening. The meals should contain more carbohydrate than fat and acid. Lighter snacks, including nuts, dairy products, and beans, are often endorsed. Drinks that contain electrolytes and other supplements are advised.
If certain foods or food preparations trigger nausea, they should be avoided. Lifestyle Women who are affected by this illness should avoid stress and try to get as much rest as possible.
If emotional support is needed, the patient can see a psychologist to help address the debilitating symptoms. Supportive counseling or crisis intervention may be necessary. Rehydration along with replacement of electrolytes is very important in the treatment of hyperemesis. Normal saline or Hartmann solution are suitable solutions; potassium chloride can be added as needed. While replacing electrolytes, the physician must consider the risks of rapid infusion in order to prevent such conditions as central pontine myelinolysis.
Pregnant women should ingest a total of 1. If this cannot be taken orally, mg of thiamine may be diluted in mL of normal saline and infused for 30 minutes to 1 hour weekly.
They should not be used before 12 to 14 weeks of gestation due to possible detrimental effects to the developing fetus. A continuous infusion was then started at 1.
If the symptoms persisted, the amount was increased to 1. Droperidol is structurally related to haloperidol; it did not cause abnormal fetal or neonatal outcomes, and there were no maternal adverse outcomes, including hypotension. The primary location of action is in the CNS, but it also increases gastric emptying. It is very effective for patients who experience the emetic effects of chemotherapy.
A study on ondansetron found it to decrease vomiting after the first dose and decrease nausea subsequently. Steroids The mechanism of action of steroids is assumed to be a direct effect on the vomiting center of the brain. Because such high doses are required, it is improbable that there is a lack of pituitary adrenal reserve in this illness.
One study showed vomiting ceased in all patients within 3 hours after administration of the first dose of IV hydrocortisone. No women were readmitted to the hospital who were treated with methylprednisolone, but five patients from the promethazine group were readmitted to the hospital for hyperemesis within 2 weeks of discharge.
Neither drug displayed adverse effects. Ginger The GI symptoms of motion sickness and hyperemesis are similar; therefore, the root of ginger, Zingiber officinale, has been studied to treat hyperemesis.
The effectiveness of ginger is thought to be dependent on its aromatic, carminative, and absorbent characteristics. It is thought to act on the GI tract to increase motility, and its absorbent property may decrease stimuli to the chemoreceptor zone in the medulla that sends stimuli to the emetic center of the brain stem.
Ginger may also block the GI responses and consequent nausea feedback. In a double-blind, randomized, crossover trial, 1 g of ginger was administered daily for 4 days. The preference among the patients to receive ginger versus placebo was significant. Also, after 4 days of treatment, there was a significant decrease in vomiting in the ginger-treated group versus the placebo-treated group.
The mean hospitalization after feedings began was 4. On discharge, one woman did not require enteral feedings, and the other six continued feedings in the outpatient setting. The average duration of feedings was 43 days, ranging from 5 to days.
One patient was content with the enteral feedings and continued them for days; however, the second longest duration was only 49 days. In order to minimize the possibility of aspiration, the feeding tube was placed past the pylorus. This technique, however, exposes the patient to radiation to check the position of the tube. Despite its expense, it is considerably cheaper compared with total parenteral nutrition TPN. This type of feeding is most useful in patients whose nausea and vomiting are associated with the consumption of food.
TPN has been used in other conditions to sustain pregnancies, such as jejunoileal bypass, diabetes, and Crohn disease. This source of calories prevents ketosis, which develops from fatty acid metabolism and may have adverse effects on the fetus. In order to study the nutritional effects of hyperemesis, the basal metabolic expenditure and adjusted metabolic expenditure were defined by indirect calorimetry, and the appropriate number of calories was calculated for each patient.
The group of hyperemesis patients compared with the two control groups of healthy pregnant women and healthy women who were not pregnant had significantly different substrate utilization. The hyperemesis patients used fat, consistent with a catabolic state. The pre- and posttreatment mean respiratory quotients of the hyperemesis group were significantly different.
The birth weights of the infants surpassed the average birth weights for their respective gestational ages. The consequences are similar to a woman with diabetes during pregnancy. Hyperglycemia may cause fetal anomalies and complications. Placental infarctions and placental fat deposits are also a risk with fat emulsion infusions, possibly resulting in placental insufficiency. In a placebo-controlled, randomized, single-blind, crossover study, acupuncture treatments were given for 30 minutes three times a day because, in previous studies, an 8-hour treatment effect had been shown.
Women in the active acupuncture group versus the placebo group had a significantly quicker decrease in the amount of nausea they experienced. The active acupuncture group had significantly fewer patients vomiting. There was no significant difference in food intake between the two groups, and no side effects were observed.
There are a few possible mechanisms of action for the reduction of hyperemesis from acupuncture. It seems to inhibit nociceptive transmission and autonomic reflexes. It also seems to decrease pain in the system from the periaqueductal gray, which partially works through endorphinergic mechanisms. Because one potential cause of hyperemesis is reduced gastric emptying, and acupuncture has an effect on the GI tract, another possible mechanism of action is through somatovisceral reflexes.
Hypnotized patients have, however, been able to control sympathetic tone, vasoconstriction, and vasodilation, heart rate, and muscle tone. Biofeedback uses an external method of feedback whereas hypnosis uses an internal control from the patient.
An example of this is the unnoticed hum of a computer motor. The first component is a deep relaxation that acts to decrease sympathetic nervous system arousal.
The second component is the response to hypnotic suggestion of symptom removal. This response to suggestion is independent of the sympathetic or parasympathetic systems and is often independent of their conscious awareness or memory of the suggestion. No teratogenic effects were noted. Conclusions Nausea and vomiting are positive predictors of a favorable pregnancy outcome, but excessive vomiting may have negative effects on the mother and baby, including low birth weight, antepartum hemorrhage, preterm delivery, and failure of infant testes to descend.
In order to alleviate this nausea and vomiting, the simplest changes are to eat more frequent, smaller meals and avoid foods or odors that trigger vomiting.
Another lifestyle alteration is to decrease stress and get more rest throughout the day. Thiamine should be supplemented at 1. When these methods do not help, IV fluids should be administered to replace the lost fluid and electrolytes.
The medications found to improve hyperemesis gravidarum symptoms without causing detrimental effects to the fetus are listed in Table 2. Metoclopramide, when compared with promethazine, proved to cause less drowsiness, dizziness, and dystonia. Steroids were found to relieve symptoms better than promethazine, but are only to be used if all other causes of vomiting have been excluded. Ginger was found to significantly improve the nausea and vomiting of hyperemesis. With severe hyperemesis, more invasive measures have been shown to improve symptoms.
Nasogastric feedings relieved symptoms and decreased length of hospital stay. TPN shifted the patients from a catabolic state to an anabolic state and improved their nutritional status.
This method, however, does have risks. Table 2.
Conseils : Hyperemesis gravidarum
Where can I get help and support for hyperemesis gravidarum? What is hyperemesis gravidarum? Hyperemesis gravidarum HG means excessive vomiting in pregnancy. HG is more common than you may think. It affects about one in 60 mums-to-be so severely that they need hospital treatment Fiaschi et al It tends to peak at eight weeks Fiaschi et al , before easing off from about 15 weeks HER Foundation
Hyperemesis gravidarum (severe pregnancy sickness)
Hiperemezis Gravidarum Nasıl Önlenir?