HYPEREMESIS GRAVIDARUM

It is the most severe form of NVP.

What is hyperemesis gravidarum (HG) in relation to nausea and vomiting of pregnancy (NVP)?

9–10 weeks of gestation.

When does hyperemesis gravidarum typically begin (gestational age)?

11–13 weeks.

When does hyperemesis gravidarum typically peak (gestational age)?

12-14 weeks

When does hyperemesis gravidarum typically resolve (gestational age)?

Persistent N/V associated with ketosis and weight loss.

What key feature characterizes hyperemesis gravidarum compared to typical NVP?

Volume depletion;' electrolytes and acid-base imbalances; nutritional deficiencies; death.

What are the consequences/complications associated with HG (list all in the card)?

1) Hormonal changes 2) Gastrointestinal dysfunction 3) Hepatic dysfunction 4) Lipid alterations 5) Infection 6) Vestibular and olfaction 7) Genetic

What are the 7 broad categories listed under “HG Pathophysiology” (enumerate)?

Higher levels of triglycerides, total cholesterol, and phospholipids.

In HG, what lipid changes are noted (name all the “higher levels of” items)?

Abnormalities in hepatic function (in pregnant women).

The lipid alterations in HG may be related to abnormalities in what body function?

Helicobacter pylori.

Which bacterium is mentioned under “Infection” as being found in the stomach and possibly aggravating N/V in pregnancy?

Active peptic ulcer.

What stomach condition is listed as being caused by H. pylori infection?

Hyperacuity of the olfactory system.

Under “Vestibular and Olfaction,” what olfactory feature is described?

The smell of cooking food, particularly meats.

What specific smell trigger is mentioned under vestibular/olfaction that can trigger nausea?

3% risk of having hyperemesis in their own pregnancy.

In the genetic study, what was the risk of HG in daughters born from a pregnancy complicated by hyperemesis?

1.1% risk.

n the genetic study, what was the risk of HG in women born after an unaffected pregnancy?

Nausea and vomiting 2) Ptyalism 3) Fatigue, weakness, dizziness

Symptoms of HG

Timing, onset, severity, pattern, and alleviating and exacerbating factors.

What history elements should be asked related to the symptoms (timing-pattern type details)?

Past medical conditions, surgeries, medications, allergies, adverse drug reactions, family history, social history (including support system), employment, habits, and diet.

What past-history areas should be asked for HG assessment (list all categories mentioned)?

Gynecologic history of symptoms.

What gynecologic history item is specifically mentioned to ask?

High hCG levels.

In HG “Hormonal Changes,” high levels of what hormone are highlighted?

Transient hyperthyroidism.

High hCG levels in HG can cause what thyroid-related condition?

hCG can stimulate the thyroid gland’s thyroid-stimulating hormone (TSH) receptor

How can hCG physiologically affect the thyroid (what receptor/hormone is mentioned)?

In the first trimester.

When do hCG levels peak according to the HG hormonal changes section?

By the middle of the 2nd trimester.

: In HG-related transient hyperthyroidism, by when does thyroid function normalize?

No—it normalizes without antithyroid treatment.

Does HG-related transient hyperthyroidism require antithyroid treatment

The stomach pacemaker.

In “Gastrointestinal Dysfunction,” what is said to cause rhythmic peristaltic contractions of the stomach?

Abnormal myoelectric activity.

What abnormal activity is said to cause a variety of gastric dysrhythmias?

Tachygastrias and bradygastrias.

types of gastric dysrhythmias

MORNING SICKNESS / NAUSEA.

Under GI dysfunction, what symptom label is emphasized alongside dysrhythmias?

Elevated estrogen or progesterone levels
Thyroid disorders
Abnormalities in vagal and sympathetic tone
Vasopressin secretion in response to intravascular volume perturbation

What mechanisms that cause gastric dysrhythmias

Liver disease with mild serum transaminase elevation.

Under “Hepatic Dysfunction,” what liver disease note is given

Impairment of mitochondrial fatty acid oxidation.

Under hepatic dysfunction, what metabolic impairment is mentioned?

Accumulation of fatty acids in the placenta, leading to generation of reactive oxygen species.

what accumulation leads to reactive oxygen species?

Previous pregnancies with hyperemesis gravidarum

Greater body weight

Multiple gestations

Trophoblastic disease

Nulliparity

Risk Factors for HG

Reassurance; dietary recommendations; support;

• Alternative therapies: acupressure, hypnosis.

What are the “Medical Care” items listed for HG

Acupressure on your wrist.

Mild nausea can be relieved by what specific method and location (as noted)?

10–25 mg, 3–4×/day.

What is the Vitamin B-6 dosing listed (dose + frequency)?

12.5 mg, 3–4 times daily (only FDA-approved drug).

What is the dosing for doxylamine

250 mg, 4 times daily.

What is the dosing for ginger capsules?

5–10 mg O.R q8 h (orally; widely used).

What is the dosing for metoclopramide (dose + route + frequency note)?

Promethazine 12.5 mg orally or rectally q4h
OR dimenhydrinate 50–100 mg orally q4–6h.

What is the dosing for promethazine (and the alternative medication + dosing)?

4–8 mg, orally or IV, q8h.

What is the dosing for ondansetron (dose + routes + frequency)?

Parenteral or enteral route

Under nutritional supplementation, what routes are listed?

Total parenteral nutrition (TPN).

Under nutritional supplementation, what is stated as the standard method for HG?

Eat when hungry, regardless of normal meal times.

Diet advice in HG: what should you do about timing of eating?

Eat frequent small meals.

Diet advice in HG: what meal pattern is recommended?

Avoid fatty and spicy foods and emetogenic foods or smells.

Diet advice in HG: what foods/odors should be avoided?

Increase intake of bland or dry foods.

Diet advice in HG: what type of foods should be increased?

Eliminate pills with iron.

Diet advice in HG: what should be eliminated (specific supplement form)?

High-protein snacks.

Diet advice in HG: what kind of snacks are helpful?

Crackers in the morning.

What specific morning food suggestion is listed for HG?

Carbonated beverages.

What beverage type is suggested to increase intake of?

Herbal teas containing peppermint or ginger; other ginger-containing beverages.

What herbal teas are mentioned (include examples listed)?

Broth, crackers, unbuttered toast, gelatin, or frozen desserts.

What comfort foods/drinks are listed in the herbal tea/broth line (list all)?

Preconception use of prenatal vitamins.

What preconception practice is said to possibly decrease N/V associated with pregnancy?

Decreased activity; increased rest; fresh outdoor air.

What activity recommendations are listed for HG (enumerate all)?