Nausea and Vomiting of Pregnancy and Hyperemesis Gravidarum
Nausea and vomiting to affects about 70% to 85% of pregnant women. Symptoms of nausea and vomiting of pregnancy (NVP) are most common during the first trimester; however, some women have persistent nausea for their entire pregnancy.
Hyperemesis often occurs in association with high levels of human chorionic gonadotropin (hCG), such as with multiple pregnancies, trophoblastic disease, and fetal anomalies such as triploidy.
The following are the conditions that Predispose to Excessive Nausea and Vomiting :
Treatment of nausea and vomiting of pregnancy
- Viral gastroenteritis
- Gestational trophoblastic disease
- Urinary tract infection
- Multifetal gestation
- Gallbladder disease
Patients should avoid odors or foods that seem to be aggravating the nausea. Useful dietary modifications include avoiding fatty or spicy foods, and stopping iron supplements. Frequent small meals also may improve symptoms. Recommendations
include bland and dry foods, high-protein snacks, and crackers at the bedside to be taken first thing in the morning.
Cholecystitis, peptic ulcer disease, or hepatitis can cause nausea and vomiting and should be excluded.
Gastroenteritis, appendicitis, pyelonephritis, and pancreatitis also should be excluded. Obstetric explanations for nausea and vomiting may include multiple pregnancies or a hydatidiform mole.
Pyridoxine is effective as first-line therapy and is recommended up to 25 mg three times daily. Pyridoxine serum levels do not appear to correlate with the prevalence or degree of nausea and vomiting. Multivitamins also are effective for
prevention of NVP.
Hyperemesis gravidarum occurs in the extreme 0.5% to 1% of patients who have intractable vomiting.
Patients with hyperemesis have abnormal electrolytes, dehydration with high urine-specific gravity, ketosis and acetonuria, and untreated have weight loss >5% of body weight. Intravenous hydration is the first line of therapy for patients with severe nausea and vomiting. Administration of vitamin B1 supplements may be necessary.