gynecology and obstetrics
Hyperemesis Gravidarum
Introduction
Hyperemesis gravidarum is severe nausea and vomiting during pregnancy that results in dehydration, weight loss, and ketosis. Diagnosis is clinical and by measurement of urine ketones, serum electrolytes, and renal function. Treatment is with temporary suspension of oral intake and with IV fluids, antiemetics if needed, and vitamin and electrolyte repletion. (See also Nausea and Vomiting During Early Pregnancy .) Pregnancy frequently causes nausea and vomiting; the cause appears to be rapidly increasing levels ofestrogensor the beta subunit ofhuman chorionic gonadotropin(beta-hCG). Vomiting usually develops at about 5 weeks gestation, peaks at about 9 weeks, and disappears by about 16 or 18 weeks. It is often called morning sickness, but it can occur any time of day. Women with normal nausea and vomiting during pregnancy usually continue to gain weight and do not become dehydrated. Hyperemesis gravidarum is an extreme form of normal nausea and vomiting during pregnancy. It can be distinguished because it causes the following: Weight loss (>5% of weight) Dehydration Ketosis Electrolyte abnormalities (in many women) As dehydration progresses, it can cause tachycardia and hypotension. Hyperemesis gravidarum may cause mild, transient Hyperthyroidism . Hyperemesis gravidarum that persists past 16 to 18 weeks is uncommon but may seriously damage the liver, causing severe centrilobular necrosis or widespread fatty degeneration, and may cause 