Hyperemesis Gravidarum : definition, clinical feature, complication, management

“ It is a severe type of vomiting of pregnancy which has got deleterious effect on the health of mother and/or incapacitate her in day to day activities “

There has been marked fall in the incidence during the last 30 years . It is now rare in hospital practice (less than 1 in 1000 pregnancy ). The reason are……

• Better application of family planning knowledge which reduces the number of unplanned pregnancies
• Early visit to antenatal clinic
• potent antihistaminic and antiemetic drug .

Etiology /high risk factor :

• It is mostly limited to the first trimester and resolve by 20 weeks (90% )
• It is common in first pregnancy, with a tendency to recure again in subsequent pregnancies (15%)
• Younger age pregnancy
• Low body mass
• History of motion sickness or migraine
• It has got a family history – mother and sister also suffer from the same manifestation
• Women suffered nausea and vomiting while on COCs. it is more prevalent in hydatidiform mole and multiple pregnancy.
• it is more common in unplanned pregnancy

Clinical feature :

Symptoms : Vomiting is increased in frequency with retching

1. Oliguria : urine quality is diminished
2. Epigastric pain
3. Constipation

complication may appear if not treated

1. Dehydration
2. Ketoacidosis (dry coated tongue )
3. Sunken eyes
4. Tachycardia
5. Hypotension
6. rise in temperature may be noted
7. Jaundice late feature

Investigation : 

• Urine analysis : Dark color , high specific gravity with acid reaction , diminished or even absence of chlorine .
• Biochemical and circulatory changes : LFTs are abnormal in many patient (40%)with rise in level of serum transaminases and bilirubin . Jaundice may be present .
• Serum TSH , T3 and free T4 : Women (60%)may suffer from transient phase of thyroid dysfunction.
• Opthalmoscopic examination ; it is require if the patient is seriously ill . Rental hemorrhage and detachment of the retina are most unfavorable sign.
• ECG : When there is abnormal serum potassium level .

Complication :

The majority of the clinical manifestation are due to the effect of dehydration and starvation with resultant ketoacidosis.

1. Neurological complication
2. Wernickes encephalopathy
3. Beri beri due to thiamine deficiency
4. Pontine myelinolysis
5. peripheral neuritis
6. Korsakoffs psychosis
7. Stress ulcer in stomach
8. Esophageal tear (mallory-weiss syndrome)
9. Jaundice
10. Hepatic failure
11. Convulsion and comma
12. Hypoprothrombinemia due to vitamin k deficiency
13. Renal failure

Effect on fetus : Fetus usually remains unaffected once the problem is resolve. fetal risk may be due to low birth weight and preterm birth

Early causes with nausea vomiting in pregnancy are managed at home with oral antiemetics.

1. Maintenance of hydration
2. To control vomiting
3. To correct the fluids and electrolyte imbalance
4. To correct metabolic disturbances
5. To Prevent the serious complications of severe vomiting
6. To correct vitamin deficiencies
7. Care of pregnancy

Fluids : oral feeding is withheld for at least 24 hour after the cessation of vomiting

During this period , fluid is given through intravenous drip method

Enteral nutrition through nasogastric tube may also be given

Prevention : The only prevention is to impart effective management to correct simple vomiting of pregnancy

1. To take small amount and at frequent intervals
2. To drink fluids in between meals and not after the meals
3. Not to lie down immediately after meal
4. To avoid food that causes gastric irritation
5. To avoid food (high fat) and odor that trigger nausea vomiting.