Chapter 11: Hyperemesis Gravidarum

Question 1

What is Hyperemesis Gravidarum?

Answer 1

extreme end of the nausea/vomiting spectrum in terms of severity

Question 2

Criteria for the Diagnosis of Hyperemesis Gravidarum

Answer 2

• persistent vomiting unrelated to other causes
• a measure of acute starvation (usually large ketonuria)
• and some discrete weight loss

Question 3

Etiology

Answer 3

unknown but, can be from

• elevated levels of estrogen and hCG
• elevated thyroid hormone during pregnancy
• relationship between hyperemesis and intrinsic hormones of the GI tract
• maybe genetic component

Question 4

Risk Factors

Answer 4

• increased placental mass associated with multiple gestation and molar pregnancy
• hx of hyperemesis gravidarum
• hx of motion sickness and migraine headaches
• pregnant with female child
• daughters and sisters of woman who have experienced hyperemesis gravidarum are also at risk

Question 5

Management

Answer 5

• women with a hx of nausea and vomiting in a previous pregnancy are advised to take multivitamins regularly before the next conception
• rest is encouraged
• avoid foods and sensory stimuli that provoke symptoms
• eat small frequent meals of dry, bland foods and include high-protein snacks in their diets
• avoid spicy foods
• eat crackers before arising
• ginger capsules may be of benefit
• If hospitalized, IV fluids containing dextrose and vitamins are given; placed on NPO; and treated with antiemetics; Parenteral or enteral feedings may be ordered if the patient is unable to take oral nourishment and if normal weight gain parameters for the gestation of pregnancy are not being met

Question 6

Management If Patient Needs to Be Hospitalized

Answer 6

• IV fluids containing dextrose and vitamins are given
• placed on NPO status
• treated with antiemetics
• parenteral or enteral feedings if patient is unable to take oral nourishment and if normal weight gain parameters for the gestation of pregnancy are not being met

Question 7

Things to Avoid With Hyperemesis Gravidarum

Answer 7

• foods and sensory stimuli that provoke symptoms (ex: become nausea when they smell certain foods being prepared)
• spicy foods

Question 8

Ginger

Answer 8

effective in treating nausea and vomiting

• antiemetic effect; increases GI motility
• tablet, capsule, or syrup

Question 9

Elasticized wristbands (e.g. Sea-Bands)

Answer 9

that use a firm object to place pressure on the Neiguan point (acupressure P6 point) are a nonpharmacological, noninvasive method that may lessen the frequency and severity of nausea and vomiting during pregnancy

Question 10

Common Medications For Nausea and Vomiting of Pregnancy

Answer 10

• Pyridoxine (Vitamin B6)
• Doxylamine succinate and pyridoxine hydrochloride (Diclegis) delayed release tablets (taken as a prescription, not a PRN)
• Promethazine (Phenergan)
• Dimenhydrinate (Dramamine)
• Metoclopramide (Reglan)