Hyperemesis gravidarum

Hyperemesis gravidarum (HG) is a severe form of morning sickness, with "unrelenting, excessive pregnancyrelated nausea and/or vomiting that prevents adequate intake of food and fluids." Hyperemesis is considered a rare complication of pregnancy but, because nausea andvomiting during pregnancy exist on a continuum, there is often not a good diagnosis between common morning sickness and hyperemesis. Estimates of the percentage of pregnant women afflicted range from 0.3% to 2.0%.

Etymology
Hyperemesis gravidarum is from the Greek hyper-, meaning excessive, and emesis, meaning vomiting, as well as the Latin gravida, meaning pregnant. Therefore, hyperemesis gravidarum means "excessive vomiting in

pregnancy."

Causes
The cause of HG is unknown. The leading theories state that it is an adverse reaction to the hormonal changes of pregnancy. In particular, Hyperemesis may be due to raised levels of beta HCG (human chorionic gonadotrophin) as it is more common in multiple pregnancies and in gestational trophoblastic disease. This theory would also explain why hyperemesis gravidarum is most frequently encountered in first trimester (often around 8 12 weeks of gestation), as HCG levels are highest at that time and decline afterward. It is thought that estrogen produces nausea and regurgitation of stomach acids in some women. There is also evidence that leptin may play a role in HG. A recent study gives "preliminary evidence" that there may be a genetic component. Symptoms of morning sickness, and HG, can be aggravated by the following factors: hunger, fatigue, prenatal vitamins (especially those containing iron), odors, and diet.

Symptoms
When HG is severe and/or inadequately treated, it may result in:              Loss of 5% or more of pre-pregnancy body weight Dehydration, causing ketosis, and constipation Nutritional deficiencies Metabolic imbalances Altered sense of taste Sensitivity of the brain to motion Food leaving the stomach more slowly Rapidly changing hormone levels during pregnancy Stomach contents moving back up from the stomach Physical and emotional stress of pregnancy on the body Subconjunctival hemorrhage (broken blood vessels in the eyes) Difficulty with daily activities Hallucinations

Some women with HG lose as much as 30% of their body weight. Many sufferers of HG are extremely sensitive to odors in their environment; certain smells may exacerbate symptoms. This is known as hyperolfaction. Ptyalism, or hypersalivation, is another symptom experienced by some women suffering from HG. As compared to morning sickness, HG tends to begin somewhat earlier in the pregnancy and last significantly longer. While most women will experience near-complete relief of morning sickness symptoms near the beginning of their second trimester, some sufferers of HG will experience severe symptoms until they give birth to their baby, and sometimes even after giving birth.

Complications
For the pregnant woman If inadequately treated, HG can cause renal failure, central pontine myelinolysis, coagulopathy, atrophy, Mallory-Weiss syndrome,hypoglycemia, jaundice, malnutrition, Wernicke's encephalopathy, pneumomediastinum, rhabdomyolysis, deconditioning, splenic avulsion, and vasospasms of cerebral arteries. Depression is a common secondary complication of HG. On rare occasions a woman can die from hyperemesis; Charlotte Bront is a presumed victim of the disease For the fetus Infants of women with severe hyperemesis that gain less than 7 kg (15.4 lb) during pregnancy tend to be of lower birth weight, small for gestational age, and born before 37 weeks gestation. In contrast, infants of women with hyperemesis that have a pregnancy weight gain of more than 7 kg appear similar as infants from uncomplicated pregnancies.[9] No long-term follow-up studies have been conducted on children of hyperemetic women. Studies show that 38% or so of children whose mothers were exposed to HG end up with a higher chance of having anxiety, being bipolar, and acquiring other behavioral as they get older.

Diagnosis
Women experiencing hyperemesis gravidarum often are dehydrated and lose weight despite efforts to eat. The nausea and vomiting begins in the first or second month of pregnancy. It is extreme and is not helped by normal measures. Fever, abdominal pain, or late onset of nausea and vomiting usually indicate another condition, such as appendicitis, gallbladder disorders,gastritis, hepatitis, or infection.

Treatment
Small, frequent meals and eating dry foods such as crackers may help relieve uncomplicated nausea. You should drink plenty of fluids. Increase fluids during the times of the day when you feel the least nauseated. Seltzer, ginger ale, or other sparkling waters may be helpful. Vitamin B6 (no more than 100 mg daily) has been shown to decrease the nausea in early pregnancy. Medication to prevent nausea is reserved for cases where vomiting is persistent and severe enough to present potential risks to you and your unborn baby. In severe cases, you may be admitted to the hospital, where fluids will be given to you through an IV.