Hyperemesis gravidarum

Hyperemesis gravidarum: Excerpt from Professional Guide to Diseases (Eighth Edition)

Unlike the transient nausea and vomiting normally experienced between the 6th and 12th weeks of pregnancy, hyperemesis gravidarum is severe and unremitting nausea and vomiting that persists after the first trimester. If untreated, it produces substantial weight loss; starvation; dehydration, with subsequent fluid and electrolyte imbalance (hypokalemia); and acid-base disturbances (acidosis and alkalosis). This syndrome occurs in approximately 1 in 200 pregnancies. The prognosis is good with appropriate treatment.

Causes and incidence

Although its cause is unknown, hyperemesis gravidarum often affects pregnant females with conditions that produce high levels of human chorionic gonadotropin, such as hydatidiform mole or multiple pregnancies. Its other possible causes include pancreatitis (elevated serum amylase levels are common), biliary tract disease, drug toxicity, inflammatory obstructive bowel disease, and vitamin deficiency (especially of B₆). In some patients, it may be related to psychological factors such as ambivalence toward pregnancy.

This disorder occurs in 0.5 to 10 of every 1,000 pregnancies. The incidence increases in molar and multiple pregnancies.

Signs and symptoms

The cardinal symptoms of hyperemesis gravidarum are unremitting nausea and vomiting. The vomitus initially contains undigested food and mucus as well as small amounts of bile; later, only bile and mucus; and finally, blood and material that resembles coffee grounds. Persistent vomiting causes substantial weight loss and eventual emaciation. Associated effects may include pale, dry, waxy, and possibly jaundiced skin; subnormal or elevated temperature; rapid pulse; a fetid, fruity breath odor from acidosis; and central nervous system symptoms, such as confusion, delirium, headache, lassitude, stupor and, possibly, coma.

Diagnosis

Diagnosis depends on a history of uncontrolled nausea and vomiting that persists beyond the first trimester, evidence of substantial weight loss, and other characteristic clinical features. Serum analysis shows decreased protein, chloride, sodium, and potassium levels, and increased blood urea nitrogen levels. Other laboratory tests reveal ketonuria, slight proteinuria, and elevated hemoglobin and white blood cell levels. Diagnosis must rule out other conditions with similar clinical effects.

Treatment

Hyperemesis gravidarum may necessitate hospitalization to correct electrolyte imbalance and prevent starvation. I.V. infusions maintain nutrition until the patient can tolerate oral feedings. She progresses slowly to a clear liquid diet, then a full liquid diet and, finally, small, frequent meals of high-protein solid foods. A midnight snack helps stabilize blood glucose levels; vitamin B supplements help correct vitamin deficiency.

When vomiting stops and electrolyte balance has been restored, the pregnancy usually continues without recurrence of hyperemesis gravidarum. Most patients feel better as they begin to regain normal weight, but some continue to vomit throughout the pregnancy, requiring extended treatment. If appropriate, some patients may benefit from consultations with clinical nurse specialists, psychologists, or psychiatrists.

Special considerations

❑ Encourage the patient to eat. Suggest dry foods and decreased liquid intake during meals.

❑ Instruct the patient to remain upright for 45 minutes after eating to decrease reflux.

❑ Provide reassurance and a calm, restful atmosphere. Encourage the patient to discuss her feelings regarding her pregnancy.

❑ Before discharge, provide good nutritional counseling.

Book Source Details

• Book Title: Professional Guide to Diseases (Eighth Edition)
• Author(s): Springhouse
• Year of Publication: 2005
• Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 Lippincott Williams & Wilkins.

More About Hyperemesis Gravidarum

• Back to disease: Hyperemesis Gravidarum: Introduction
• Next Book Extract About Hyperemesis Gravidarum: Nausea (Professional Guide to Signs & Symptoms (Fifth Edition))
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: Professional Guide to Diseases (Eighth Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2005 ISBN: 1-58255-370-X

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