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Hyperemesis Gravidarum

What is Hyperemesis Gravidarum?
Background:Nausea and vomiting in pregnancy is extremely common. Studies estimate nausea occurs in 66-89% of pregnancies and vomiting in 38-57%. The nausea and vomiting associated with pregnancy almost always begins by 9-10 weeks of gestation, peaks at 11-13 weeks, and resolves (in 50% of cases) by 12-14 weeks. In 1-10% of pregnancies, symptoms may continue beyond 20-22 weeks. The most severe form of nausea and vomiting in pregnancy is called hyperemesis gravidarum (HEG). A continuous spectrum of the severity of nausea and vomiting ranges from the nausea and vomiting that occurs in most pregnancies to the severe disorder of HEG. HEG is characterized by persistent nausea and vomiting associated with ketosis and weight loss (5% of prepregnancy weight). HEG may cause volume depletion, altered electrolytes, and even death. Hospitalization is not infrequent.

Psychological abnormalities
Early work on the cause of both nausea and vomiting in pregnancy and HEG suggested that women with these symptoms were unable to accept pregnancy, had problems with their relationships with their mothers, or had personality disorders and/or hysteria.. Some cases of HEG may represent psychiatric illnesses, including Munchausen syndrome, conversion or somatization disorder, and major depression, or they may occur under situations of stress or ambivalence surrounding the pregnancy. However, HEG may occur in the absence of psychological illness or stress.

Causes
Risk factors for HEG may include the following:
  • Previous pregnancies with HEG
  • Greater body weight
  • Multiple gestations
  • Trophoblastic disease
  • Nulliparity


Symptoms
  • The defining symptoms of HEG are gastrointestinal in nature and include nausea and vomiting.
  • Other common symptoms include ptyalism (excessive salivation), fatigue, weakness, and dizziness.


    • Patients may experience the following:
  • Sleep disturbance
  • Hyperolfaction
  • Dysgeusia
  • Decreased gustatory discernment
  • Depression
  • Anxiety
  • Irritability
  • Mood changes
  • Decreased concentration

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