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Pregnancy, Hyperemesis Gravidarum - Follow-Up

Author Information and Disclosures

Follow-Up

Further Inpatient Care:
  • Admit patients with any of the following:
    • Persistently abnormal vital signs
    • Severe dehydration and inability to tolerate oral fluids
    • Severe electrolyte abnormality
    • Acidosis
    • Infection
    • Malnutrition
  • Weight loss
  • Patients who continue to lose weight may require supplemental nutrition. Several care reports demonstrate that enteral tube feedings may be well tolerated and are a reasonable first attempt in admitted patients. Rarely, some women require total parenteral nutrition.
Further Outpatient Care:
  • Reassurance
  • Frequent small meals with high-carbohydrate or high-protein content (Avoid offensive odors, fatty foods, spicy foods, iron supplements.)
  • Some patients may require pyridoxine, pyridoxine, and doxylamine, or other antiemetics.
  • For women infected with H pylori, case reports have suggested improvement in symptoms with eradication of the infection.
  • Some women may find benefit in counseling.
In/Out Patient Meds:
  • As an outpatient, trial of pyridoxine (vitamin B-6) with/without doxylamine
  • Oral or parenteral antiemetics if the patient's condition is unresponsive to fluids, dietary restrictions, and pyridoxine/doxylamine
Complications:
  • Complications of vomiting rarely occur; however, Mallory-Weiss tears and esophageal perforations have been reported.
  • Women with hyperemesis and poor weight gain have lower average birth weights and are more likely to have a small for gestational age infant and may be at higher risk for preterm birth.
  • In severe cases, without thiamine supplementation, Wernicke encephalopathy may occur (ie, diplopia, nystagmus, disorientation, confusion, coma).
  • If treatment is unsuccessful, complications of prolonged dehydration and starvation may occur.
Prognosis:
  • One study has demonstrated that adverse fetal outcomes are mostly limited to poor maternal weight gain. Women who gained less than 7 lb in pregnancy were more likely to have fetal complications, but those with hyperemesis and greater than 7-lb weight gain had no increased risk. This research indicates that treating hyperemesis gravidarum such that the patient is able to gain weight portends a better prognosis.
Patient Education:

Miscellaneous

Medical/Legal Pitfalls:
  • No drugs are approved by the FDA for the treatment of nausea and vomiting in pregnancy, and the expected benefits of treatment should outweigh the risks.
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Bibliography

  1. ACOG (American College of Obstetrics and Gynecology): Practice Bulletin: nausea and vomiting of pregnancy. Obstet Gynecol 2004 Apr; 103(4): 803-14[Medline].
  2. Aikins Murphy P: Alternative therapies for nausea and vomiting of pregnancy. Obstet Gynecol 1998 Jan; 91(1): 149-55[Medline].
  3. Bailit JL: Hyperemesis gravidarium: Epidemiologic findings from a large cohort. Am J Obstet Gynecol 2005 Sep; 193(3 Pt 1): 811-4[Medline].
  4. Bashiri A, Neumann L, Maymon E: Hyperemesis gravidarum: epidemiologic features, complications and outcome. Eur J Obstet Gynecol Reprod Biol 1995 Dec; 63(2): 135-8[Medline].
  5. Boone SA, Shields KM: Treating pregnancy-related nausea and vomiting with ginger. Ann Pharmacother 2005 Oct; 39(10): 1710-3[Medline].
  6. Borrelli F, Capasso R, Aviello G: Effectiveness and safety of ginger in the treatment of pregnancy-induced nausea and vomiting. Obstet Gynecol 2005 Apr; 105(4): 849-56[Medline].
  7. Carmichael SL, Shaw GM: Maternal corticosteroid use and risk of selected congenital anomalies. Am J Med Genet 1999 Sep 17; 86(3): 242-4[Medline].
  8. Chan NN: Thyroid function in hyperemesis gravidarum. Lancet 1999 Jun 26; 353(9171): 2243[Medline].
  9. Child TJ: Management of hyperemesis in pregnant women. Lancet 1999 Jan 23; 353(9149): 325[Medline].
  10. Chiossi G, Neri I, Cavazzuti M: Hyperemesis gravidarum complicated by wernicke encephalopathy: background, case report, and review of the literature. Obstet Gynecol Surv 2006 Apr; 61(4): 255-68[Medline].
  11. Czeizel AE, Dudas I, Fritz G: The effect of periconceptional multivitamin-mineral supplementation on vertigo, nausea and vomiting in the first trimester of pregnancy. Arch Gynecol Obstet 1992; 251(4): 181-5[Medline].
  12. Czeizel AE, Vargha P: A case-control study of congenital abnormality and dimenhydrinate usage during pregnancy. Arch Gynecol Obstet 2005 Feb; 271(2): 113-8[Medline].
  13. Davis M: Nausea and vomiting of pregnancy: an evidence-based review. J Perinat Neonatal Nurs 2004 Oct-Dec; 18(4): 312-28[Medline].
  14. Dickson MJ: Management of hyperemesis in pregnant women. Lancet 1999 Jan 23; 353(9149): 325[Medline].
  15. Dodds L, Fell DB, Joseph KS: Outcomes of pregnancies complicated by hyperemesis gravidarum. Obstet Gynecol 2006 Feb; 107(2 Pt 1): 285-92[Medline].
  16. Fell DB, Dodds L, Joseph KS: Risk factors for hyperemesis gravidarum requiring hospital admission during pregnancy. Obstet Gynecol 2006 Feb; 107(2 Pt 1): 277-84[Medline].
  17. Fischer-Rasmussen W, Kjaer SK, Dahl C: Ginger treatment of hyperemesis gravidarum. Eur J Obstet Gynecol Reprod Biol 1991 Jan 4; 38(1): 19-24[Medline].
  18. Frigo P, Lang C, Reisenberger K: Hyperemesis gravidarum associated with Helicobacter pylori seropositivity. Obstet Gynecol 1998 Apr; 91(4): 615-7[Medline].
  19. Fukada Y, Ohta S, Mizuno K: Rhabdomyolysis secondary to hyperemesis gravidarum. Acta Obstet Gynecol Scand 1999 Jan; 78(1): 71[Medline].
  20. Hod M, Orvieto R, Kaplan B: Hyperemesis gravidarum. A review. J Reprod Med 1994 Aug; 39(8): 605-12[Medline].
  21. Hoo JJ: Acupressure for hyperemesis gravidarum. Am J Obstet Gynecol 1997 Jun; 176(6): 1395-7[Medline].
  22. Jacoby EB, Porter KB: Helicobacter pylori infection and persistent hyperemesis gravidarum. Am J Perinatol 1999; 16: 85-8[Medline].
  23. Jewell D, Young G: Interventions for nausea and vomiting in early pregnancy. Cochrane Database Syst Rev 2003; CD000145[Medline].
  24. Kocak I, Akcan Y, Ustun C, et al: Helicobacter pylori seropositivity in patients with hyperemesis gravidarum. Int J Gynaecol Obstet 1999 Sep; 66(3): 251-4[Medline].
  25. Kousen M: Treatment of nausea and vomiting in pregnancy. Am Fam Physician 1993 Nov 15; 48(7): 1279-84[Medline].
  26. Lee RH, Pan VL, Wing DA: The prevalence of Helicobacter pylori in the Hispanic population affected by hyperemesis gravidarum. Am J Obstet Gynecol 2005 Sep; 193(3 Pt 2): 1024-7[Medline].
  27. Meighan M, Wood AF: The impact of hyperemesis gravidarum on maternal role assumption. J Obstet Gynecol Neonatal Nurs 2005 Mar-Apr; 34(2): 172-9[Medline].
  28. Nageotte MP, Briggs GG, Towers CV: Droperidol and diphenhydramine in the management of hyperemesis gravidarum. Am J Obstet Gynecol 1996 Jun; 174(6): 1801-5; discussion 1805-6[Medline].
  29. Nelson-Piercy C: Treatment of nausea and vomiting in pregnancy. When should it be treated and what can be safely taken? Drug Saf 1998 Aug; 19(2): 155-64[Medline].
  30. Newman V, Fullerton JT, Anderson PO: Clinical advances in the management of severe nausea and vomiting during pregnancy. J Obstet Gynecol Neonatal Nurs 1993 Nov-Dec; 22(6): 483-90[Medline].
  31. Park-Wyllie L, Mazzotta P, Pastuszak A, et al: Birth defects after maternal exposure to corticosteroids: prospective cohort study and meta-analysis of epidemiological studies. Teratology 2000 Dec; 62(6): 385-92[Medline].
  32. Petik D, Puho E, Czeizel AE: Evaluation of maternal infusion therapy during pregnancy for fetal development. Int J Med Sci 2005 Oct; 2(4): 137-42[Medline].
  33. Quinlan JD, Hill DA: Nausea and vomiting of pregnancy. Am Fam Physician 2003 Jul; 68 (1): 121-8[Medline].
  34. Robinson JN, Banerjee R, Thiet MP: Coagulopathy secondary to vitamin K deficiency in hyperemesis gravidarum. Obstet Gynecol 1998 Oct; 92(4 Pt 2): 673-5[Medline].
  35. Rodriguez-Pinilla E, Martinez-Frias ML: Corticosteroids during pregnancy and oral clefts: a case-control study. Teratology 1998 Jul; 58(1): 2-5[Medline].
  36. Russo-Stieglitz KE, Levine AB, Wagner BA: Pregnancy outcome in patients requiring parenteral nutrition. J Matern Fetal Med 1999 Jul-Aug; 8(4): 164-7[Medline].
  37. Safari HR, Fassett MJ, Souter IC: The efficacy of methylprednisolone in the treatment of hyperemesis gravidarum: a randomized, double-blind, controlled study. Am J Obstet Gynecol 1998 Oct; 179(4): 921-4[Medline].
  38. Safari HR, Alsulyman OM, Gherman RB: Experience with oral methylprednisolone in the treatment of refractory hyperemesis gravidarum. Am J Obstet Gynecol 1998 May; 178(5): 1054-8[Medline].
  39. Sahakian V, Rouse D, Sipes S, et al: Vitamin B6 is effective therapy for nausea and vomiting of pregnancy: a randomized, double-blind placebo-controlled study. Obstet Gynecol 1991 Jul; 78(1): 33-6[Medline].
  40. Selitsky T, Chandra P, Schiavello HJ: Wernicke's encephalopathy with hyperemesis and ketoacidosis. Obstet Gynecol 2006 Feb; 107(2 Pt 2): 486-90[Medline].
  41. Serrano P, Velloso A, Garcia-Luna PP: Enteral nutrition by percutaneous endoscopic gastrojejunostomy in severe hyperemesis gravidarum: a report of two cases. Clin Nutr 1998 Jun; 17(3): 135-9[Medline].
  42. Sullivan CA, Johnson CA, Roach H: A pilot study of intravenous ondansetron for hyperemesis gravidarum. Am J Obstet Gynecol 1996 May; 174(5): 1565-8[Medline].
  43. Verberg MF, Gillott DJ, Al-Fardan N: Hyperemesis gravidarum, a literature review. Hum Reprod Update 2005 Sep-Oct; 11(5):527-39:[Medline].
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Synonyms And Related Keywords

hyperemesis gravidarum, nausea and vomiting in pregnancy, pernicious vomiting in pregnancy, uncontrollable vomiting in pregnancy, severe nausea and vomiting in pregnancy, morning sickness, miscarriage

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Author Information and Disclosures

Author: Susan Renee Wilcox, MD, Resident, Department of Emergency Medicine, Harvard Medical School

Coauthor(s): Alison Edelman, MD, Assistant Professor, Department of Obstetrics and Gynecology, Oregon Health Sciences University; Judith R Logan, MD, MS, Assistant Professor, Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University

Susan Renee Wilcox, MD, is a member of the following medical societies: Phi Beta Kappa

Editor Information

Editor(s): Assaad J Sayah, MD, Chief, Department of Emergency Medicine, Cambridge Health Alliance; Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine; Mark Zwanger, MD, MBA, Assistant Professor, Department of Emergency Medicine, Thomas Jefferson University; John Halamka, MD, Chief Information Officer, CareGroup Healthcare System, Assistant Professor of Medicine, Department of Emergency Medicine, Beth Israel Deaconess Medical Center; Assistant Professor of Medicine, Harvard Medical School; and Pamela Dyne, MD, Program Director, Associate Professor, Department of Medicine, Division of Emergency Medicine, University of California at Los Angeles School of Medicine

 
 
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