Morning Sickness vs Hyperemesis Gravidarum

hyperemesis gravidarum

severe morning sickness

• persistent, uncontrollable vomiting that begins in the first weeks of pregnancy & may continue throughout pregnancy

• temporary disabling condition

  • may require hospitalization & disrupts daily life

  • severe enough, some women wish to terminate

hyperemesis gravidarum diagnostic criteria

• hx of intractable vomiting in first ½ of pregnancy

• dehydration

• ketonuria

• weight loss > 5% of pre-pregnancy weight

• electrolyte imbalances: hypokalemia, increased BUN

• elevated HCT, urine specific gravity

• VS changes: hypotension, tachycardia

ketonuria

body breaks down fat for energy d/t vomiting so much

hyperemesis gravidarum etiology

unknown

theories:

• first pregnancies

• adolescents

• increased BMI

• family hx or hx of previous pregnancy with HG

• multifetal pregnancies (more placenta = more hCG)

• elevated levels of pregnancy hormones (hCG)

• heliobactorpylori (peptic ulcers)

hyperemesis gravidarum fetal risks

• fetal growth restriction (IUGR)

• abnormal development

• increased risk of fetal demise

hyperemesis gravidarum maternal manifestations

• weight loss

• muscle wasting

• nutritional deficiencies (bleeding gums, vit K)

• dehydration & hypovolemia

• acid-base balance, ketosis

• neurological sx: confusion, drowsiness

hyperemesis gravidarum management

• r/o other causes of n/v first

• home, in/outpatient options

• encourage small, frequent meals w/ simple carbs (dietary consult)

• carbonated sour beverages btwn meals

• eliminate environmental triggers: smells, heat, noise, etc

• pharmacological mgmt

  • vit B6 administered w/ antihistamine (first-line, OTC)

  • antiemetics: zofran, phenergan, reglan

• IVF (w/ glucose, electrolytes, vitamins), possible TPN

• inpatient: monitor VS, I&O, daily wt, cal count, dietary consult

• once able to tolerate PO, 6 small dry feedings followed by CL or 1oz water offered q1h, then CL & advance diet as tolerated

• complementary therapies: ginger, acupuncture/pressure, hypnosis