Summary about Disease
Hyperemesis Gravidarum (HG) is a severe form of morning sickness in pregnancy. It's characterized by persistent, excessive nausea and vomiting that can lead to dehydration, weight loss, electrolyte imbalances, and nutritional deficiencies. Unlike typical morning sickness, HG often requires medical intervention.
Symptoms
Persistent and severe nausea
Intractable vomiting (frequent and difficult to control)
Dehydration (decreased urination, dark urine, dizziness)
Weight loss (more than 5% of pre-pregnancy weight)
Electrolyte imbalances (e.g., low potassium, sodium, chloride)
Nutritional deficiencies
Headaches
Confusion
Fatigue
Causes
The exact cause of HG is not fully understood, but several factors are believed to contribute:
Hormonal changes: Elevated levels of hormones such as human chorionic gonadotropin (hCG) and estrogen are implicated.
Genetics: There appears to be a genetic predisposition, with a higher risk if a close female relative experienced HG.
Evolutionary adaptation: Proposed theory that it is due to the natural rejection of toxins.
Gastric dysrhythmia: Slowed gastric emptying may play a role.
Helicobacter pylori: Presence of H. pylori in the digestive tract is linked to a greater risk.
Medicine Used
Treatment focuses on symptom relief and correcting complications. Common medications include:
Antiemetics:
Pyridoxine (Vitamin B6)
Doxylamine
Promethazine
Ondansetron
Metoclopramide
Intravenous (IV) fluids: To treat dehydration.
Electrolyte replacement: To correct imbalances (e.g., potassium chloride).
Vitamin supplementation: Especially thiamine (vitamin B1) to prevent Wernicke's encephalopathy.
Corticosteroids: In severe cases, after other treatments have failed.
Is Communicable
No, hyperemesis gravidarum is not a communicable disease. It is a pregnancy-related condition, not caused by an infectious agent.
Precautions
Early recognition and reporting of symptoms to a healthcare provider.
Dietary modifications (small, frequent meals; bland foods).
Avoidance of triggers (strong odors, certain foods).
Rest and stress reduction.
Close monitoring of hydration and weight.
Adherence to prescribed medications.
How long does an outbreak last?
HG typically begins in the early weeks of pregnancy (often around week 4-6) and can persist throughout the first trimester. In some cases, symptoms may improve around week 14-20, but in others, they can last throughout the entire pregnancy.
How is it diagnosed?
Diagnosis is based on:
Clinical evaluation: Assessment of symptoms (severe nausea and vomiting).
Physical examination: Signs of dehydration, weight loss.
Laboratory tests:
Urine ketones (indicating dehydration).
Electrolyte levels (to assess imbalances).
Liver function tests (to rule out other causes).
Thyroid function tests (to rule out hyperthyroidism).
Differential diagnosis: Ruling out other conditions with similar symptoms.
Timeline of Symptoms
Week 4-6: Onset of severe nausea and vomiting, often worse than typical morning sickness.
Week 6-12: Peak severity of symptoms, with significant impact on daily life.
Week 14-20: Symptoms may begin to improve for some women, but others continue to experience severe nausea and vomiting.
Remainder of pregnancy: Symptoms may persist throughout the pregnancy in some cases, requiring ongoing management.
Important Considerations
HG can have significant physical and psychological impacts on the pregnant woman.
Early diagnosis and treatment are crucial to prevent complications.
Hospitalization may be necessary for severe cases.
Thiamine deficiency, leading to Wernicke's encephalopathy, is a serious risk and requires prompt treatment.
Mental health support is important, as HG can contribute to anxiety and depression.
Long-term complications for the baby are possible if the mother's nutritional needs are not met.