Hyperemesis Gravidarum

Published on 30/05/2015 by admin

Filed under Obstetrics & Gynecology

Last modified 30/05/2015

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Chapter 212 Hyperemesis Gravidarum

INTRODUCTION

Description: Hyperemesis gravidarum is exaggerated nausea and vomiting of early pregnancy sufficient to produce dehydration, metabolic disturbances, and weight loss. Alkalosis (from HCl loss) and hypokalemia are common.
Prevalence: Seventy percent to 85% of women experience nausea; 50% have emesis in the first trimester; hyperemesis occurs in 0.5% to 2% of pregnancies.
Predominant age: Reproductive.
Genetics: No genetic pattern.

ETIOLOGY AND PATHOGENESIS

Causes: Unknown.
Risk Factors: Multiple gestation, hydatidiform mole, ambivalence about pregnancy (debated).

CLINICAL CHARACTERISTICS

Signs and Symptoms

• Nausea and vomiting leading to weight loss, dehydration, ketone formation, and electrolyte disturbances
• Symptoms generally begin between the fourth and eighth week, lasting until 16 weeks or longer

DIAGNOSTIC APPROACH

Differential Diagnosis

• Abnormality of pregnancy (trophoblastic disease, multiple gestation)
• Psychological overlay
• Gastroenteritis
• Cholecystitis
• Pancreatitis
• Hepatitis
• Peptic ulcer disease
• Fatty liver of pregnancy
• Pyelonephritis

Associated Conditions: Intrauterine growth restriction.

Workup and Evaluation

Laboratory: Evaluation of liver and metabolic function (serum enzymes and urinary ketones).
Imaging:

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