Hyperemesis gravidarum
Hyperemesis gravidarum (HG) is a pregnancy complication that is characterized by severe nausea, vomiting, weight loss, and possibly dehydration.
[3] HG has been technically defined as more than three episodes of vomiting per day such that weight loss of 5% or three kilograms has occurred and ketones are present in the urine.
[3] While vomiting in pregnancy has been described as early as 2,000 BCE, the first clear medical description of HG was in 1852, by Paul Antoine Dubois.
[11] When vomiting is severe, it may result in the following:[16] Symptoms can be aggravated by hunger, fatigue, prenatal vitamins (especially those containing iron), and diet.
[citation needed] Hyperemesis gravidarum tends to occur in the first trimester of pregnancy[17] and lasts significantly longer than morning sickness.
[23] Women with severe hyperemesis who gain less than 7 kilograms (15 lb) during pregnancy tend have newborns with lower birth weight or are smaller for gestational age.
[26] One factor is an adverse reaction to the hormonal changes of pregnancy, in particular, elevated levels of beta human chorionic gonadotropin (β-hCG).
[27][28] This theory would also explain why hyperemesis gravidarum is most frequently encountered in the first trimester (often around 8–12 weeks of gestation), as β-hCG levels are highest at that time and decline afterward.
Another postulated cause of HG is an increase in maternal levels of estrogens (decreasing intestinal motility and gastric emptying leading to nausea/vomiting).
[29] Possible pathophysiological processes involved are summarized in the following table:[23] Hyperemesis gravidarum is considered a diagnosis of exclusion.
[34][35] Similar to the onset of standard bouts of morning sickness, the nausea and vomiting with hyperemesis typically starts between 5 and 6 weeks into pregnancy.
If conservative dietary measures fail, more extensive treatment such as the use of antiemetic medications and intravenous rehydration may be required.
[17] For women who require hospital admission, thromboembolic stockings or low-molecular-weight heparin may be used as measures to prevent the formation of a blood clot.
[23] Intravenous (IV) hydration often includes supplementation of electrolytes as persistent vomiting frequently leads to a deficiency.
[citation needed] After IV rehydration is completed, patients typically begin to tolerate frequent small liquid or bland meals.
[40] Home treatment is often less expensive and reduces the risk for a hospital-acquired infection compared with long-term or repeated hospitalizations.
She died in 1855 while four months pregnant, having been affected by intractable nausea and vomiting throughout her pregnancy, and was unable to tolerate food or even water.
[50] Catherine, Princess of Wales was hospitalised due to hyperemesis gravidarum during her first pregnancy, and was treated for the same condition during the subsequent two.
[54] These erroneous beliefs led to various abusive practices, such as isolating them from their friends and family, or leaving severely ill women to lie in the vomit when they were too weak to clean themselves, which have since been condemned by healthcare professionals and medical organizations such as the College of French Gynecologists and Obstetricians.
