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Hyperemsis gravidarum – severe form of morning sickness

Small percentage of women have a more profound course of nausea and vomiting  in pregnancy .Severe form called as hyperemisis gravidarum (HG) 

HG more commonly seen in Indian,Pakistan,Asian,New Zealand women  than other country’s

0.3-2% of all pregnancies effects from HG


buy Lyrica from canada WOMEN WITH HG – HOW THEY PRESENT :
  • They present with persistent vomiting,dehydration,ketosis,electrolyte disturbances ,acid base imbalance and weight loss ( more than 5% body weight or more than 3 kg )
  • Other effects are : dry mucous membranes,poor skin turgor,postural hypotension,muscle wasting ,mental status changes , nutritional  deficiencies
enter Alterations in the lab values like :
  • Increased serum BUN ,increased serum creatinine ,increased haematocrit ,ketonuria, increased specific gravity of urine ,hypochloric metabolic alkalosis or acidosis with severe volume contraction ,decreased pre albumin levels ,vitamin B1 ,iron calcium and folate deficiencies ,increased bilirubin levels ,increased alkaline phosphate levels ,increased transaminase (AST ) levels more than 2-3 times the upper range ,serum amylase and lipase levels may be elevated , decrease in TSH levels

Below said situations are mostly associated with increased incidence of hyperemisis gravidarum ( HG )

  • Multiple gestation
  • Gestational  trophoblastic disease
  • Triploids ,trisomy 21 ( Down’s syndrome)
  • Hydrops foetalis
  • Hyperemisisgravidarum in prior pregnancy
  • Family history of HG
  • Age more than 30 years
  • Obesity
  • Low body mass index
  • Female gender foetus in uterus ,those women more associated with the HG
  • Women with HG is having negative effects on mother and foetus
  • Increased foetal growth restriction ( IUGR )
  • Low birthweight babies
  • Premature deliveries
  • Increased mortality of foetus
  • Women may suffer from splenic avulsion ,esophageal rupture,Mallory -Weiss tears ,pneumothorax ,peripheral neuropathy,pre eclampsia  etc
  • As earlier discussed dietary measures ,emotional support ,antiemetics like ondansetron are useful in HG as well .Apart from all these ,below said medication are useful in HG
  • MOTILITY DRUGS : metoclopramide acts by increasing pressure at the lower esophageal sphincter ,as well as speeding transit through stomach
  • CORTICOSTEROIDS : oral methyl prednisone gives good results in recurrent vomiting of hyperemisis gravidarum .Usage of this drug is doubt of benefit in some individuals
  • ENTERAL OR PARENTERAL NUTRITION : enteral tube feeding and total parenteral nutrition is a last resort treatments in women with continuous vomitings and weight loss .
  • 8 French dobbhoff nasogastic tube and infusion rates up to 100 ml per hour is indicated.
  • Total parenteral nutrition administered through a central venous catheter .Content caliculated by daily caloric requirement and electrolyte abnormalities

Severe form of nausea and vomiting of pregnancy , so called Hyperemisis gravidarum – should be tackled carefully to avoid detrimental effects on mother and baby 




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