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Chapter-14 Hyperemesis Gravidarum

BOOK TITLE: Essentials of Obstetrics

Author
1. Patel Sukhpreet
2. Shah Duru
ISBN
9788180613623
DOI
10.5005/jp/books/10288_14
Edition
1/e
Publishing Year
2004
Pages
7
Author Affiliations
1. Gynaecworld, Bombay Hospital and Medical Research Centre Gynaecworld, Mumbai, St. Elizabeth Nursing Home, Mumbai, 922, Tulsiani Chambers, Free Press Journal Road, Nariman Point, Mumbai 400021, Mumbai, St Elizabeth Nursing Home, Ruxmani Lying-in Hospital, Smt Motiben B Dalvi Hospital, Mumbai, Maharashtra, India, Mumbai, Maharashtra, India, Ruxmani Lying in Hospital, Bombay Hospital, Mumbai, India, St. Elizabeth Nursing Home, Ruxmani Lying in Hospital, Smt. Motiben Dalvi Hospital, 922, Tulsiani Chambers, Free Press Journal Road, Nariman Point, Mumbai, India, Mumbai, India, St.Elizabeth Nursing Home, Ruxmani Lying In Hospital, Smt Motiben Dalvi Hospital, 922, Tulsiani Chambers, Free Press Journal Road, Nariman Point, Mumbai, India, E-mail: patelsukhpreet@yahoo.co.in, Breach Candy Hospital and St. Elizabeth, Mumbai, India, Bombay Hospital and Medical Research Centre, Mumbai
2. Breach Candy Hospital, Jaslok Hospital and Sir Hurkisondas Hospital, Mumbai, Maharashtra, India, Gynaecworld—the Center for Women's, Health and Fertility, Mumbai, Maharashtra, India, Gynaecworld, Mumbai, Maharashtra, India, Mumbai, Breach Candy Hospital/Jaslok Hospital/Sir HN Hospital, Mumbai, Maharashtra, India, Gynaecworld – the Center for Women’s Health and Fertility; Breach Candy Hospital and Research Centre, and Jaslok Hospital and Research Centre, Mumbai, Maharashtra, India, Gynaecworld, The Center for Women’s Health and Fertility; Royal College of Obstetrics and Gynecology, UK, Gynaecworld-The Center for Women’s Health and Fertility; The PCOS Society (India), Mumbai, Maharashtra, India, Jaslok Hospital and Research Centre Mumbai, Kwality House, Above Chinese Room Restaurant, Kemps Corner, Mumbai 400026, Gynaecworld Fertility Center, Kemps, Corner, Mumbai, Maharashtra, India, Gynaecworld–the Center for Women’s Health and Fertility; Indian Society of Assisted Reproduction (ISAR), The PCOS S
Chapter keywords
gastrointestinal tract, Nausea and vomiting during pregnancy (NVP), hyperemesis gravidarum, esophageal, gastric and small bowel motility, smooth muscle relaxation, female sex hormones, dehydration, ketosis, electrolyte and acid-base disturbances, sunken eyes, loss of skin elasticity, dry tongue, ketotic odor of breath, tachycardia, hypotension, peptic ulcer disease, gastroenteritis, appendicitis, gastroesophageal reflux, urine specific gravity, ketonuria, increased serum blood urea nitrogen, creatinine, hematocrit levels, jaundice, hepatic dysfunction, stress ulcers, vomiting, pancreatitis, and renal failure, iron tablets, hypovolemia, electrolyte disturbances, intravenous fluids, alternative nonpharmacologic treatments, conventional treatments, pharmacotherapy, powdered root of ginger, medical hypnosis, therapeutic abortion

Abstract

The gastrointestinal tract is commonly affected by the physiologic changes that occur during pregnancy. Nausea and vomiting during pregnancy (NVP) is a common experience, affecting 50 to 90 percent of all women. Hyperemesis gravidarum is the most severe manifestation of the spectrum of NVP. This chapter describes the epidemiology, pathogenesis, diagnosis, clinical features, and management of hyperemesis gravidarum. During pregnancy esophageal, gastric and small bowel motility are impaired as a result of smooth muscle relaxation fostered by increased levels of female sex hormones. NVP occurs within weeks of missing the period, symptoms usually peak between 10 and 16 weeks of gestation and definitely disappear by week 20. Patients usually present with signs of dehydration, ketosis, and electrolyte and acid-base disturbances. These include sunken eyes, loss of skin elasticity, dry tongue with ketotic odor of breath, tachycardia, hypotension. The differential diagnosis for NVP includes peptic ulcer disease, gastroenteritis, appendicitis, and severe gastroesophageal reflux. Laboratory findings usually show evidence of dehydration with increased urine specific gravity and ketonuria and increased serum blood urea nitrogen, creatinine, and hematocrit levels. Complications include jaundice due to hepatic dysfunction, stress ulcers due to excessive vomiting, pancreatitis, and renal failure. Iron tablets, if taken should be withheld, since it may contribute to nausea and vomiting. The mainstay of therapy for hyperemesis gravidarum includes correction of hypovolemia and electrolyte disturbances with intravenous fluids. Alternative nonpharmacologic treatments should be considered if conventional treatments fail or if the patient does not wish to incur the risks associated with pharmacotherapy. Powdered root of ginger in the dose of 1gm daily has been found to reduce symptoms in women with hyperemesis gravidarum. It has been suggested that medical hypnosis should be considered as an adjunctive treatment option for women with hyperemesis gravidarum. Therapeutic abortion is a rare and last resort, to be used only when maternal life is threatened.

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