Hyperemesis gravidarum (pregnancy vomiting) occurs when ketoacidosis and 5% weight loss are added to the pregnant woman's complaints of excessive nausea and vomiting. In this situation, fluid loss, electrolyte imbalance, deterioration in acid-base balance and subsequent severe nutritional deficiency occur. It has even been reported that patients who were neglected or not treated appropriately died.
Severe hyperemsis that requires hospitalization is seen in 0.3-2% of pregnant women.
Symptoms
The disease The defining complaint is extreme unprovoked nausea and aggressive vomiting. Other accompanying findings are ptyalism (excessive salivation), weakness, and fatigue.
Patients also experience sleep disturbance, hypersensitivity of the sense of smell, anxiety, difficulty swallowing, decreased attention, They may experience mood disorders.
Diagnosis
There are no special physical examination findings. It is necessary to distinguish the patient's urinary tract infection from other diseases of the digestive system.
Things to Do During the First Examination
Vital signs, blood pressure and pulse count,
Weight monitoring,
Determination of fluid balance
Thyroid examination,
Laboratory tests,
Neurological examination and cardiological examination can be performed when necessary.
Initial Urinalysis
Complete urine test.
Serum electrolyte levels and ketone research
Liver enzymes
TSH and freeT3 levels
Hematoctrit level
Calcium level
Hepatitis panel
The following imaging methods are applied.
Obstetric Ultrasound: It is necessary to rule out the presence of multiple pregnancy or trophoblastic disease.
Upper abdominal ultrasound: If there is clinical suspicion, it is necessary to image the pancreas and bile ducts.
Abdominal MRI/CT: It is applied if an acute emergency disease of the digestive system such as appendicitis is clinically suspected. Abdominal MRI/CT should be applied if the patient's clinical appearance is sudden and noisy and if the examination findings suggest a condition other than hyperemesis in the patient's history.
Upper gastrointestinal system endoscopy is a method that can be safely applied if upper gastrointestinal system bleeding is considered during pregnancy.
Treatment
Initial treatment is conservative and minimally invasive. Adjusting the diet, maintaining fluid balance, and suppressing nausea are the basic treatments.
Medication
The only drug approved by the FDA for the treatment of pregnancy nausea is doxylamine/pyridoxin. Antihistamines, phenothiazine group antiemetics and motility regulators Metoclopramide (metpamid tablet) are used. In stubborn cases, onusetron (zofran tablet) and steroids (deltacortil tablet) are used.
Among herbal products, there are cases where ginger is beneficial.
Termination of pregnancy is also a possible option in cases of severe resistant hyperemesis that threatens the life of the pregnant woman.
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