Hyperemesis gravidarum is a condition associated with vomiting of pregnant women leading to volume depletion and weight loss resulting in ketonemia. It is a disorder with signs of uncontrolled vomiting occasioned by severe dehydration, electrolyte imbalance, weight loss, muscle wasting and ketonuria. Majority of the cases require hospitalization. It affects close to 2.3 % of pregnancies and impacts the quality of life of the patient (Wegrzyniak, Repke, & Ural, 2012). It can also be challenging to treat the condition since there is no consensus of diagnostic criteria.
Etiology
The etiology of the condition is mostly unknown. However, various theories try to explain changes in the normal health conditions during pregnancy and the physical and biochemical functions of a patient. However, increased mass of the placenta following the pregnancy is associated with the disorder (Jennings & Krywko, 2020). Similarly, women with a history of vomiting and nausea even when they are not pregnant have a heightened chance of experiencing the same during pregnancy. Additionally, women from families with a history of hyperemesis are also likely to experience the same.
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Different studies have tried to understand the cause of hyperemesis, but they have not conclusively identified the same. The condition is not yet fully understood with some studies attributing it to gastrointestinal imbalance, hormones, autonomic nervous dysfunction, serotonin, nutritional deficiencies, thyrotoxicosis, hepatic abnormalities, asthma, allergies, helicobacter pylori and psychosomatic reasons (Wegrzyniak, Repke, & Ural, 2012). Babies born by mothers with the condition also have several obstacles to overcome since some are born prematurely; others have lower birth weights, are small for gestational age or can have 5-minute Appar score.
Signs and Symptoms
Nausea and uncontrolled vomiting are predominant signs of hyperemesis. Nausea does not subside, and the patient experiences severe dehydration caused by vomiting, which prevents one from keeping food or other drinks down. A patient also experiences food aversion, low blood pressure, decreased urination, headache, jaundice, fatigue and diminished skin elasticity. Others include weight loss, ketonuria, ptyalism (Wegrzyniak, Repke, & Ural, 2012). likewise, severe vomiting can lead to other conditions like confusion, fainting, rapid heart rate, secondary anxiety or depression.
The symptoms, in this case, can differ from one patient to another. According to the authors, the signs of hyperemesis peak after nine weeks after gestation and decline by the twentieth week. Similarly, 1%-5% of the patients must be hospitalized, and those who experience the condition in their first pregnancies have a higher chance of subsequent reoccurrence (Wegrzyniak, Repke, & Ural, 2012) . The disease has a different diagnosis and can cause severe adverse effects if it is not treated appropriately.
Treatment
Treatment of the disorder includes a range of alternatives like medication and different therapies. Some of the medicinal approaches for preventing and treating the disease include nutritional supplements and options like acupuncture and hypnosis. ACOG guidelines on nausea and vomiting should guide treatment hyperemesis. Initially, non-pharmacological interventions should be pursued (Jennings & Krywko, 2020). They include ginger supplements, folic acid supplements in place of prenatal vitamins and acupressure wristbands.
If the condition does not change, pharmacological therapy that includes vitamin B6 and doxylamine should be administered in three doses. If the symptoms persist, the second-line medication that contains dopamine and antihistamine are administered orally after every four to six hours. If the symptoms are unchanged and the patient is not dehydrated, they can be given ondansetron, metoclopramide or promethazine. However, if the patient is dehydrated, continuous infusion of intravenous fluid boluses should be administered (Jennings & Krywko, 2020). Similarly, altering the diet and one’s lifestyle can also help to contain the condition.
References
Jennings, L., & Krywko, D. (2020). Hyperemesis Gravidarum . Ncbi.nlm.nih.gov. Retrieved 22 April 2020, from https://www.ncbi.nlm.nih.gov/books/NBK532917/.
Wegrzyniak, L., Repke,, J., & Ural, S. (2012). Treatment of Hyperemesis Gravidarum . PubMed Central (PMC). Retrieved 22 April 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3410506/.
