Morning sickness of pregnancy: more than meets the eye

2016 ◽  
Vol 30 (3) ◽  
Author(s):  
Noorazizah Arsad ◽  
Kah Teik Chew ◽  
Nur Azurah Abdul Ghani ◽  
Hui Jan Tan ◽  
Norasyikin A. Wahab ◽  
...  
Keyword(s):  
Gestational Age ◽  
Small For Gestational Age ◽  
Hyperemesis Gravidarum ◽  
Early Recognition ◽  
Wernicke’S Encephalopathy ◽  
Wernicke's Encephalopathy ◽  
Morning Sickness ◽  
Life Threatening ◽  
Life Threatening Complication ◽  
In Pregnancy

AbstractWernicke’s encephalopathy (WE) is a rare life-threatening complication following severe hyperemesis gravidarum. Early recognition of this condition and prompt thiamine administration is the key to preventing devastating sequelae. We report a successful delivery of a small-for-gestational-age (SGA) baby by a patient with WE and thyrotoxicosis in pregnancy.

Wernicke’s encephalopathy post hyperemesis gravidarum misdiagnosed as Guillain-Barre syndrome: lessons for the frontline

2021 ◽  
Vol 14 (3) ◽  
pp. e239977
Author(s):  
Kaushiki Kirty ◽  
Yashendu Sarda ◽  
Annu Jacob ◽  
Delanthabettu Venugopala
Keyword(s):  
Pregnant Woman ◽  
Hyperemesis Gravidarum ◽  
Early Recognition ◽  
Wernicke’S Encephalopathy ◽  
Guillain Barre Syndrome ◽  
Neurological Deficits ◽  
Wernicke's Encephalopathy ◽  
Motor Neuropathy ◽  
Guillain Barré Syndrome ◽  
Guillain Barré

We report a case of a 26-year-old pregnant woman, who presented with subacute limb weakness. This was initially suspected to be Guillain-Barre syndrome but subsequently found to be the motor neuropathy of dry beriberi (vitamin B1, thiamine deficiency) along with associated Wernicke’s encephalopathy (WE). The underlying cause was revealed as hyperemesis gravidarum (HG). HG complicates up to 3% of pregnancies and if severe, without nutritional supplements, may lead to electrolyte disturbances, calorie loss and vitamin deficiency. Although the association of HG and WE was first reported in 1939, it remains an under diagnosed condition with potential for serious and permanent neurological deficits, and some mortality, in both mother and baby. Early recognition of the problem, with timely and careful fluid, electrolyte, glucose and vitamin replacement is needed to avoid complications. We highlight current best practice in the treatment of WE. An open mind to the possibility of HG complications in any pregnant woman presenting with neurological symptoms is probably the most important lesson to learn from the front line.

Neurological disease in pregnancy

2010 ◽  
pp. 2144-2148
Author(s):  
G.G. Lennox ◽  
John D. Firth
Keyword(s):  
Thiamine Deficiency ◽  
Neurological Disease ◽  
Hyperemesis Gravidarum ◽  
Cauda Equina ◽  
Sensory Neuropathy ◽  
Wernicke’S Encephalopathy ◽  
Wernicke's Encephalopathy ◽  
Spine Metastases ◽  
Cauda Equina Compression ◽  
In Pregnancy

Thiamine deficiency—caused by the combination of the nutritional demands of pregnancy and hyperemesis gravidarum, presenting as a subacute sensory neuropathy or (less commonly) acute Wernicke’s encephalopathy. Chorea—all types are exacerbated in pregnancy, an effect termed chorea gravidarum. Malignancies—choriocarcinoma (see Chapter 14.17) can cause brain or spine metastases, the former giving rise to strokes through infarction or haemorrhage, and the latter to cord or cauda equina compression....

scholarly journals Complete recovery in Wernicke’s encephalopathy complicating hyperemesis gravidarum

2019 ◽  
Vol 12 (2) ◽  
pp. bcr-2018-227530
Author(s):  
Tripti Aneja ◽  
Latha Chaturvedula ◽  
Pradeep Pankajakshan Nair ◽  
Deepak Barathi ◽  
Anish Keepanasseril
Keyword(s):  
Maternal Morbidity ◽  
Index Case ◽  
Hyperemesis Gravidarum ◽  
Early Recognition ◽  
Neurological Complication ◽  
Complete Recovery ◽  
Wernicke’S Encephalopathy ◽  
Wernicke's Encephalopathy ◽  
Neurological Manifestations ◽  
Triplet Pregnancy

Wernicke’s encephalopathy (WE) is an uncommon neurological complication in pregnancies complicated with hyperemesis due to thiamine deficiency. In women with hyperemesis, inadvertent glucose administration prior to thiamine supplementation triggers the development of neurological manifestations. Delay in the diagnosis can lead to maternal morbidity, and in one-third of cases may lead to persistence of some neurological deficit. With early recognition and thiamine supplementation, complete recovery is reported. We report a case of WE complicating a case of triplet pregnancy with hyperemesis gravidarum, which highlights the importance of early recognition and treatment, resulting in complete recovery as in the index case.

Wernicke’s encephalopathy in women with hyperemesis gravidarum – Case series and literature review

2021 ◽  
pp. 004947552110143
Author(s):  
Makarand Anil Rane ◽  
Hari Kishan Boorugu ◽  
Usha Ravishankar ◽  
S Tarakeswari ◽  
Hemamalini Vadlamani ◽  
...  
Keyword(s):  
Hyperemesis Gravidarum ◽  
Rare Complication ◽  
Case Series ◽  
Wernicke’S Encephalopathy ◽  
Wernicke's Encephalopathy ◽  
Chronic Alcohol Abuse ◽  
Delayed Treatment ◽  
Altered Mental State ◽  
Short And Long Term ◽  
Clinical Triad

Whilst nausea affects around 80% of pregnant women, hyperemesis gravidarum, an extreme form of the same, affects only 0.5% to 3%, but may lead to severe nutritional deficiency. Wernicke’s encephalopathy is an acute neuropsychiatric disorder which occurs due to thiamine deficiency and needs emergency treatment to prevent neurological morbidity and mortality. Wernicke’s encephalopathy is characterised by a clinical triad of oculomotor abnormalities, cerebellar dysfunction and altered mental state. Korsakoff’s psychosis is a chronic condition and consequence of Wernicke’s encephalopathy, resulting from its delayed treatment. Wernicke’s encephalopathy is a well-known complication of chronic alcohol abuse. Not many are aware of its association with hyperemesis gravidarum. Although it is a rare complication, if not diagnosed and treated promptly, it may result in permanent and irreversible neurological sequelae. The objective of our retrospective observational study was to analyse the clinical profile and outcome (short and long term) in a rare yet preventable complication of pregnancy.

scholarly journals Profound Hypokalaemia Resulting in Maternal Cardiac Arrest: A Catastrophic Complication of Hyperemesis Gravidarum?

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
Author(s):  
Anna Walch ◽  
Madeline Duke ◽  
Travis Auty ◽  
Audris Wong
Keyword(s):  
Cardiac Arrest ◽  
Hyperemesis Gravidarum ◽  
Extracellular Fluid ◽  
Nutritional Deficiencies ◽  
Normal Limits ◽  
Life Threatening ◽  
Total Body ◽  
Anuric Renal Failure ◽  
Hospital Cardiac Arrest ◽  
In Pregnancy

We present a case of a 39-year-old G8P6 Pacific Islander woman who at 15+5 weeks’ gestation had an out-of-hospital cardiac arrest secondary to profound hypokalaemia which was associated with severe hyperemesis gravidarum (HG). Her clinical course after arrest was complicated by a second 5-minute cardiac arrest in the Intensive Care Unit (ICU) (pre-arrest potassium 1.8), anuric renal failure requiring dialysis, ischaemic hepatitis, and encephalopathy and unfortunately fetal demise and a spontaneous miscarriage on day 2 of admission. Despite these complications, she was discharged home 4 weeks later with a full recovery. Following a plethora of inpatient and outpatient investigations, the cause of her cardiac arrest was determined to be profound hypokalaemia. The hypokalaemia was presumed second to a perfect storm of HG with subsequent nutritional deficiencies causing electrolyte wasting, extracellular fluid (ECF) volume reduction, and activation of the renin-angiotensin-aldosterone axis (RAAS). This combined with the physiological changes that promote potassium wasting in pregnancy including volume expansion, increased renal blood flow, increased glomerular filtration rate, and increase in cortisol contributed to the patient having a profoundly low total body potassium level. This diagnosis is further strengthened by the fact that her pre- and post-pregnancy potassium levels were within normal limits in the absence of supplementary potassium. This case highlights the potentially life-threatening electrolyte imbalances that can occur with HG and the importance of recognising the disease, comprehensive electrolyte monitoring, and aggressive management in pregnancy.

Thyroid Disease I: Hyperthyroidism in Pregnancy

2020 ◽  
Author(s):  
Robert B. Martin ◽  
Brian Casey
Keyword(s):  
Hyperemesis Gravidarum ◽  
Beta Blockers ◽  
Thyroid Stimulating Hormone ◽  
Thyroid Storm ◽  
Care Level ◽  
Hypermetabolic State ◽  
Life Threatening ◽  
Overt Hyperthyroidism ◽  
In Pregnancy ◽  
Stimulating Hormone

Thyroid physiologic adaptations in pregnancy may be confused with pathologic changes. Human chorionic gonadotropin rises early in pregnancy, stimulating thyrotropin secretion and suppressing thyroid stimulating hormone. These chemical changes are often seen in hyperemesis gravidarum and gestational transient thyrotoxicosis. Therefore, mild thyrotoxicosis may be difficult to differentiate from early pregnancy thyroxine stimulation.  However, overt hyperthyroidism usually includes classic symptoms seen outside of pregnancy in addition to suppressed TSH and T4 levels. Treatment includes thionamides propylthiouracil and methimazole.  Thyroid ablation is contraindicated in pregnancy. Often, in affected women, the fetus is euthyroid, but neonates can develop hyper or hypothyroidism with or without a goiter. Lastly, thyroid storm, though rare, is life threatening. Often presenting as a hypermetabolic state with cardiomyopathy and pulmonary hypertension, it generally results from decompensation from preeclampsia, anemia, sepsis, or surgery.  Treatment requires intensive care level management, with initiation of thionamides, iodine, and beta blockers.   This review contains 2 figures, 4 tables and 38 references. Keywords: Thyroid-releasing hormong, thyroid-stimulating hormone, thyromegaly, thyroid-stimulating immunoglobulins, thryotoxicosis, thionamides, thyroid storm

scholarly journals Comparison of neonatal outcomes of small for gestational age and appropriate for gestational age preterm infants born at 28–36 weeks of gestation: a multicentre study in Ethiopia

2020 ◽  
Vol 4 (1) ◽  
pp. e000740
Author(s):  
Netsanet Workneh Gidi ◽  
Robert L Goldenberg ◽  
Assaye K Nigussie ◽  
Elizabeth McClure ◽  
Amha Mekasha ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Late Onset ◽  
Early Recognition ◽  
Neonatal Outcomes ◽  
P Value ◽  
Prolonged Hospitalisation ◽  
Increased Risk ◽  
Appropriate For Gestational Age

PurposeThe aim of this study was to assess morbidity and mortality pattern of small for gestational age (SGA) preterm infants in comparison to appropriate for gestational age (AGA) preterm infants of similar gestational age.MethodWe compared neonatal outcomes of 1336, 1:1 matched, singleton SGA and AGA preterm infants based on their gestational age using data from the study ‘Causes of Illness and Death of Preterm Infants in Ethiopia (SIP)’. Data were analysed using SPSS V.23. ORs and 95% CIs and χ2 tests were done, p value of <0.05 was considered statistically significant.ResultThe majority of the infants (1194, 89%) were moderate to late preterm (32–36 weeks of gestation), 763 (57%) were females. Male preterm infants had higher risk of being SGA than female infants (p<0.001). SGA infants had increased risk of hypoglycaemic (OR and 95% CI 1.6 (1.2 to 2.0), necrotising enterocolitis (NEC) 2.3 (1.2 to 4.1), polycythaemia 3.0 (1.6 to 5.4), late-onset neonatal sepsis (LOS) 3.6 (1.1 to 10.9)) and prolonged hospitalisation 2.9 (2.0 to 4.2). The rates of respiratory distress syndrome (RDS), apnoea and mortality were similar in the SGA and AGA groups.ConclusionNeonatal complications such as hypoglycaemic, NEC, LOS, polycythaemia and prolonged hospitalisation are more common in SGA infants, while rates of RDS and mortality are similar in SGA and AGA groups. Early recognition of SGA status, high index of suspicion and screening for complications associated and timely intervention to prevent complications need due consideration.

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