Review article: Management of hyperemesis gravidarum and nausea and vomiting in pregnancy

2021 ◽  
Author(s):  
Sandra A Lowe ◽  
Kate E Steinweg
Keyword(s):  
Hyperemesis Gravidarum ◽  
Review Article ◽  
Nausea And Vomiting ◽  
In Pregnancy

scholarly journals Gestational Thyrotoxicosis in a Patient With Hyperemesis Gravidarum

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A929-A929
Author(s):  
Hind Alameddine ◽  
Gurunanthan Palani ◽  
Kidmealem Zekarias
Keyword(s):  
Hyperemesis Gravidarum ◽  
Clinical Signs ◽  
Supportive Therapy ◽  
First Trimester ◽  
Nausea And Vomiting ◽  
Antithyroid Drugs ◽  
Significant Elevation ◽  
Free T4 ◽  
Overt Hyperthyroidism ◽  
In Pregnancy

Abstract Untreated or inadequately treated overt hyperthyroidism in pregnancy can have devastating consequences for both mother and fetus. At the same time antithyroid drugs (ATDs) are known for their teratogenic effect and should be avoid when possible; once the diagnosis of hyperthyroidism is made in a pregnant woman, attention should be focused on determining the etiology of the disorder and whether it warrants treatment. Here, we report a case of hyperemesis gravidarum patient presenting with significant elevation of thyroid hormones and a review on diagnosis and management of gestational transient thyrotoxicosis. A 33-year-old female, G4P3 at 8 weeks pregnant admitted for nausea and vomiting. Thyroid labs showed TSH < 0.01 (Reference: 0.4-4.0mU/L) and free T4 is 3.53 (Reference: 0.76-1.46ng/dl). Patient was discharged on antiemetics with a diagnosis of hyperemesis gravidarum. She was re-admitted at 9 weeks pregnant with ongoing nausea and vomiting. She had palpitations, fatigue and reported 15 pound weight loss in 2 weeks. Past medical history included thyroid hormone abnormality noted during pregnancies of 2011 and 2017. Physical exam was significant for tachycardia and diffusely enlarged thyroid gland. Repeat labs showed TSH <0.01, free T4 5.81, total T3 of 317 (Reference: 60-181ng/dl). Thyroid ultrasound showed multiple nodules. Considering significant elevation in free T4 and total T3; empiric therapy with propylthiouracil was recommended. Patient declined anti-thyroid therapy. TSI and TRH antibodies came back later as negative. Patient was treated with enteral feeding for hyperemesis gravidarum. Thyroid labs 3 weeks later improved; FT4 down to 1.63 and TT3 down to 250. Patient delivered healthy baby at 40 weeks of gestation. Although the differential diagnosis of thyrotoxicosis in pregnancy includes any cause that can be seen in a nonpregnant patient, the most likely causes for hyperthyroidism in pregnancy are gestational thyrotoxicosis (GTT) with or without hyperemesis gravidarum or Graves’ disease. GTT is described as an hCG-mediated hyperthyroidism that occurs in the first trimester of pregnancy; it is generally asymptomatic with mild biochemical hyperthyroidism. Distinguishing true overt hyperthyroidism from GTT in a setting of hyperemesis gravidarum is challenging. The absence of clinical signs of hyperthyroidism and negative thyroid antibodies supports the diagnosis of GTT. T3 tends to be disproportionately elevated more than T4 in patients with overt hyperthyroidism. HCG level has not been found to be useful in distinguishing between GTT and GD. Overt hyperthyroidism is treated using anti-thyroid drugs (ATD) whereas supportive therapy without ATD is the accepted standard of treatment of patients with hyperemesis gravidarum and GTT. More studies addressing the best management of these group of patients is needed.

SOMANZ position paper on the management of nausea and vomiting in pregnancy and hyperemesis gravidarum

2019 ◽  
Vol 60 (1) ◽  
pp. 34-43
Author(s):  
Sandra A. Lowe ◽  
Georgina Armstrong ◽  
Amanda Beech ◽  
Lucy Bowyer ◽  
Luke Grzeskowiak ◽  
...  
Keyword(s):  
Hyperemesis Gravidarum ◽  
Position Paper ◽  
Nausea And Vomiting ◽  
In Pregnancy

scholarly journals Approach to hyperemesis gravidarum

2021 ◽  
Vol 9 (01) ◽  
Author(s):  
Raksha Dubey
Keyword(s):  
Hyperemesis Gravidarum ◽  
Meat Products ◽  
Severe Form ◽  
Nausea And Vomiting ◽  
Nutritional Deficiencies ◽  
Protective Mechanism ◽  
Pathogenic Microorganisms ◽  
Acid Base ◽  
Volume Depletion ◽  
In Pregnancy

Nausea and vomiting commonly known as morning sickness in pregnancy is extremely common. During pregnancy normal nausea and vomiting may be evolutionary protective mechanism as it may protect the pregnant woman and her embryo from harmful substances in food such as pathogenic microorganisms in meat products and toxins in plants, these effects are maximal during embryogenesis the most vulnerable period of pregnancy. Studies suggest that women who had nausea and vomiting were less likely to have miscarriages and stillbirth. Hyperemesis gravidarum is rare but the most severe form of nausea and vomiting in pregnancy that may necessitate hospitalization. It is characterized by persistent nausea and vomiting associated with ketosis and weight loss (>5%) which may lead to volume depletion, electrolyte and acid base imbalances, nutritional deficiencies and even death.

Akathisia preceding an oculogyric crisis in a patient treated with prochlorperazine for hyperemesis gravidarum

2014 ◽  
Vol 3 (1) ◽  
Author(s):  
Patrick Williams ◽  
Haim Abenhaim
Keyword(s):  
Hyperemesis Gravidarum ◽  
Nausea And Vomiting ◽  
Class I ◽  
Dopaminergic Receptors ◽  
Severe Nausea ◽  
Behavioural Changes ◽  
Oculogyric Crisis ◽  
Threatening Condition ◽  
Life Threatening ◽  
In Pregnancy

AbstractProchlorperazine is a class I-A anti-emetic recommended for the treatment of severe nausea and vomiting in pregnancy. We present a case where a patient presented with hyperemesis gravidarum refractory to pyridoxine/doxylamine and dimenhydrinate and developed akathisia and dystonia after receiving prochlorperazine. Her condition resolved immediately following the administration of diphenhydramine. While procholorperazine is known to very rarely cause focal dystonias such as an oculogyric crisis, the influence of phenothiazines and neuroleptics on dopaminergic receptors can also trigger behavioural changes, which can rapidly evolve into a life-threatening condition.

scholarly journals Analysis of GDF15 and IGFBP7 in Hyperemesis Gravidarum Support Causality

2019 ◽  
Vol 79 (04) ◽  
pp. 382-388 ◽  
Author(s):  
Marlena Fejzo ◽  
Peter Fasching ◽  
Michael Schneider ◽  
Judith Schwitulla ◽  
Matthias Beckmann ◽  
...  
Keyword(s):  
Hyperemesis Gravidarum ◽  
Familial Aggregation ◽  
Twin Studies ◽  
Serum Levels ◽  
Nausea And Vomiting ◽  
Electrolyte Imbalance ◽  
Significant Weight Loss ◽  
Control Groups ◽  
Severe Nausea ◽  
In Pregnancy

Abstract Objective Hyperemesis gravidarum, severe nausea and vomiting in pregnancy, occurs in up to 2% of pregnancies and leads to significant weight loss, dehydration, electrolyte imbalance, and ketonuria. It is associated with both maternal and fetal morbidity. Familial aggregation studies and twin studies suggest a genetic component. In a recent GWAS, we showed that placentation, appetite, and cachexia genes GDF15 and IGFBP7 are linked to hyperemesis gravidarum (HG). The purpose of this study is to determine whether GDF15 and IGFBP7 are upregulated in HG patients. Methods We compared serum levels of GDF15 and IGFBP7 at 12 and 24 weeksʼ gestation in women hospitalized for HG, and two control groups, women with nausea and vomiting of pregnancy (NVP), and women with no NVP. Results We show GDF15 and IGFBP7 serum levels are significantly increased in women with HG at 12 weeksʼ gestation. Serum levels of hCG are not significantly different between cases and controls. At 24 weeks gestation, when symptoms have largely resolved, there is no difference in GDF15 and IGFBP7 serum levels between cases and controls. Conclusion This study supports GDF15 and IGFBP7 in the pathogenesis of HG and may be useful for prediction and diagnosis. The GDF15-GFRAL brainstem-activated pathway was recently identified and therapies to treat conditions of abnormal appetite are under intense investigation. Based on our findings, HG should be included.

scholarly journals Treatments for Hyperemesis Gravidarum and Nausea and Vomiting in Pregnancy

JAMA ◽  
2016 ◽  
Vol 316 (13) ◽  
pp. 1392 ◽  
Author(s):  
Catherine McParlin ◽  
Amy O’Donnell ◽  
Stephen C. Robson ◽  
Fiona Beyer ◽  
Eoin Moloney ◽  
...  
Keyword(s):  
Hyperemesis Gravidarum ◽  
Nausea And Vomiting ◽  
In Pregnancy

DIAGNOSIS AND MANAGEMENT OF NAUSEA AND VOMITING IN PREGNANCY

2006 ◽  
Vol 17 (1) ◽  
pp. 45-67 ◽  
Author(s):  
LAURA MAGEE ◽  
ALON SHRIM ◽  
GIDEON KOREN
Keyword(s):  
Weight Loss ◽  
Hyperemesis Gravidarum ◽  
Wide Spectrum ◽  
First Trimester ◽  
The Other ◽  
Nausea And Vomiting ◽  
Electrolyte Imbalance ◽  
The Common ◽  
Moderate Nausea ◽  
In Pregnancy

Nausea and vomiting of pregnancy (NVP) is a term used to describe a wide spectrum of symptoms. At one end of the spectrum is the common, mild to moderate nausea and vomiting that is usually limited to the first trimester. At the other end of the spectrum are the intractable, severe symptoms of hyperemesis gravidarum (HG) that is associated with weight loss, dehydration, electrolyte imbalance and hospitalisation.

Sign in / Sign up

Export Citation Format

Share Document