What is Hyperemesis Gravidarum?

About half of women will have early pregnancy reactions in the early stages of pregnancy, including dizziness, fatigue, lethargy, loss of appetite, partial eclipse, aversion to greasiness, nausea, and vomiting. The severity and duration of symptoms vary from person to person, most of them appear around 6 weeks of pregnancy, peak at 8 to 10 weeks, and disappear on their own at 12 weeks of pregnancy. A few pregnant women have severe early pregnancy reactions, frequent nausea and vomiting, can not eat, resulting in fluid imbalance and metabolic disorders, and even endanger the life of pregnant women.

Basic Information

English name

Hyperemesisgravidarum

Visiting department

Obstetrics and Gynecology

Multiple groups

Pregnant women with excessive stress, anxiety, anxiety, living environment, and poor financial status

Common symptoms

Vomit

Causes of pregnancy vomiting

The cause of early pregnancy response may be related to increased human chorionic gonadotropin (HCG), gastrointestinal dysfunction, decreased gastric acid secretion, and prolonged gastric emptying time. 0.3% to 1% of pregnant women will develop hyperemesis gravidarum, which is more common in young primiparas and is generally believed to be associated with a significant increase in HCG. The basis is that the time when the early pregnancy response appears and disappears is consistent with the time when the blood HCG value rises and falls. Hydatidiform moles and multiple pregnancy pregnant women have significantly increased blood HCG values and a high incidence of severe vomiting, indicating that hyperemesis may be related to elevated HCG levels. However, the degree of clinical manifestations is sometimes not necessarily proportional to blood HCG levels. Pregnant women with excessive mental stress, anxiety, anxiety, and poor living environment and economic conditions are prone to hyperemesis gravidarum, suggesting that the disease may be related to mental and social factors. Recent studies have found that hyperemesis gravidarum may also be related to H. pylori infection.

Clinical manifestations of pregnancy vomiting

Hyperemesis gravidarum occurs during the first trimester of pregnancy to 16 weeks of gestation, and is more common in young pregnant women. Early menstrual reactions usually occur about 40 days after menopause, and gradually worsen, until frequent vomiting, can not eat. There is bile or coffee-like substance in the vomit. Severe vomiting can cause dehydration and electrolyte disturbances, and use body fat to accumulate acetone, its intermediate product, causing metabolic acidosis. The patient's weight was significantly reduced, his complexion was pale, his skin was dry, his pulse was weak, and his urine output decreased. In severe cases, his blood pressure dropped, causing prerenal acute renal failure.

Hyperemesis gravidarum can cause two severe vitamin deficiencies:

1. Vitamin B ₁ deficiency

Can lead to Wernicke syndrome, clinical manifestations of central nervous system symptoms, namely nystagmus, visual impairment, ataxia, increased speech in the acute phase, and then gradually mental retardation, lethargy, isolated stiffness or coma. If left untreated, the mortality rate can reach 50%.

2. Vitamin K deficiency

Can lead to blood coagulation dysfunction, often accompanied by a decrease in plasma protein and fibrinogen, an increased tendency for pregnant women to bleed, nosebleeds, and even retinal bleeding.

Hyperemesis gravidarum should be distinguished from hydatidiform mole, hyperthyroidism, and diseases that may cause vomiting, such as hepatitis, gastroenteritis, pancreatitis, and biliary disease. Those with neurological symptoms should be distinguished from meningitis and brain tumors.

Pregnancy vomiting test

Urine test

Measure urine volume, urine specific gravity, ketone body, and pay attention to proteinuria and cast urine.

Blood test

Measure the number of red blood cells, the content of hemoglobin, the hematocrit, the whole blood, and the viscosity of the plasma to understand whether there is blood concentration. Arterial blood gas analysis measures blood pH, carbon dioxide binding power, etc. to understand the acid-base balance. Blood potassium, blood sodium, blood chlorine content, and liver and kidney function should also be measured.

3. Other

If necessary, fundus examination and neurological examination.

Differential diagnosis of pregnancy vomiting

Vomiting during pregnancy should be distinguished from hydatidiform mole, hyperthyroidism, and diseases that may cause vomiting, such as hepatitis, gastroenteritis, pancreatitis, and biliary disease. Those with neurological symptoms should be distinguished from meningitis and brain tumors.

Vomiting during pregnancy

Mild nausea and vomiting are common symptoms in early pregnancy. A small diet and frequent meals can often be relieved by taking vitamin B ₆ .

Patients with hyperemesis gravidarum should be hospitalized and fasted for 2 to 3 days. According to the test results, the amount of water loss and electrolyte disorders should be clarified, and water and electrolytes should be supplemented as appropriate. Glucose and Ringer's solution are dripped intravenously daily, and vitamin B ₆ , vitamin C, potassium chloride, etc. are added. Maintain daily urine output above 1000 ml. And given vitamin B ₁ intramuscularly. Those who are malnourished can be administered intravenously with fatty milk and amino acids. Generally, the condition can be improved after 2 to 3 days of the above treatment. Pregnant women can try a small amount of liquid diet after the vomiting stops and the symptoms are alleviated. If there are no adverse reactions, they can gradually increase their food intake and adjust the fluid replacement amount.

Most pregnant women with hyperemesis gravidarum improve after treatment and can continue to conceive. If conventional treatment is ineffective, persistent jaundice, persistent proteinuria, elevated body temperature, sustained above 38 ° C, tachycardia (120 beats per minute), and associated Wernicke syndrome are life-threatening pregnant women, and pregnancy termination should be considered.