Overview
Hyperemesis gravidarum (HG) begins between the fourth and
sixth week of pregnancy. Symptoms usually improve somewhat
by the 15th to 20th week of gestation, although some women
continue to have frequent relapses throughout pregnancy.
Most affected women have numerous episodes of vomiting throughout
the day with few if any symptom-free periods, especially
during the first three months. This leads to rapid and
significant weight loss, dehydration, electrolyte disturbances,
ketosis and acetonuria often requiring hospitalization.
If these derangements are not treated promptly or adequately,
they can lead to irreversible renal, neurologic, and hepatic
damage.
Other complications include Mallory-Weiss tears (linear
mucosal tears at the cardio-esophageal junction with hematemesis),
acid aspiration, and metabolic alkalosis. These women present
to their physicians with weight loss of 5 to 20+ pounds (2.25
to 9+ kgs.); however, since some are overweight to begin
with, they may not appear malnourished on visual inspection.
This is especially true as the pregnancy progresses. Early,
aggressive medical care often decreases the severity of a
woman's symptoms and leads to quicker recovery.
Recognition of the signs that a woman is transitioning from
morning sickness to hyperemesis gravidarum is critical. The
initial signs include:
- Rapid weight loss (1.5+ lbs [or .68+ kgs.] per
week)
- Recurrent ketosis
- Frequent and/or severe nausea/vomiting
If these are seen early in pregnancy, hydration with
vitamins, antiemetics, and close monitoring is imperative.
For more on management, see our Suggested
Protocol.
Updated on:
Aug. 09, 2006 |
