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hyperemesis gravidarum [keywords]
- Nausea and vomiting of pregnancy. [Journal Article]
- Am Fam Physician 2014 Jun 15; 89(12):965-70.
Nausea and vomiting of pregnancy affects nearly 75% of pregnant women. The exact cause is unknown. In most cases, it is a mild, self-limited condition that can be controlled with conservative measures and has no adverse fetal sequelae. About 1% of women develop hyperemesis gravidarum, which may result in adverse outcomes for the mother and fetus. Patients with nausea and vomiting of pregnancy should be evaluated for other causes, particularly if symptoms are unremitting or presentation is atypical. Initial treatment is conservative and includes dietary changes, emotional support, and vitamin B6 supplementation. Several safe and effective pharmacologic therapies are available for women who do not improve with initial treatment. Women with hyperemesis gravidarum may require more aggressive interventions, including hospitalization, rehydration therapy, and parenteral nutrition.
- A Case of Gestational Thyrotoxicosis Associated with Wernicke's Encephalopathy. [JOURNAL ARTICLE]
- Endocr Pract 2014 Aug 22.:1-10.
Objective: To present a case of gestational thyrotoxicosis and hyperemesis gravidarum associated with Wernicke's encephalopathy.Methods: We present a detailed case report with the clinical, imaging and laboratory findings of the patient and review the pertinent literature.Case presentation: A 36 year old woman, at 14 weeks of gestation, was admitted to the hospital for management of severe hyperemesis gravidarum (HG). While hospitalized, she developed low grade fever, tachycardia, hypotension and altered mentation. Laboratory tests were diagnostic of hyperthyroidism. Physical examination revealed a confused, lethargic woman with a normal sized thyroid and pendular nystagmus in primary and lateral gaze. She was treated empirically for thyroid storm with methimazole and other measures. A brain magnetic resonance imaging study (MRI) done later showed hyper-intense abnormal signals in bilateral thalamic regions consistent with Wernicke's encephalopathy (WE). She was immediately started on intravenous thiamine and her mental status improved considerably within 3-4 days. Within the two weeks, thyroid function tests normalized and methimazole was discontinued. The repeat brain MRI six months later showed marked reduction of signal intensity in both thalamic regions.Conclusion: This case demonstrates that gestational thyrotoxicosis in a patient with hyperemesis gravidarum can precipitate acute Wernicke's encephalopathy which may mimic thyroid storm and thus delay appropriate management of this neurological disorder. We conclude that prophylactic thiamine administration may be considered before caloric replacement in patients who present with hyperemesis gravidarum and acute neurological dysfunction.
- Weight loss in pregnancy and cardiometabolic profile in childhood: findings from a longitudinal birth cohort. [JOURNAL ARTICLE]
- BJOG 2014 Aug 22.
To investigate the consequences of weight loss in pregnancy on pregnancy outcomes and cardiometabolic profile in childhood.Prospective birth cohort (ABCD study).Between 2003 and 2004, all pregnant women in Amsterdam were approached for study participation.7818 pregnant women were included, of which 3165 consented to having their children examined at 5-6 years of age. In 1956 children fasting capillary blood samples were also taken.At antenatal booking, women answered questions about their pregnancy and whether they suffered from severe weight loss (SWL; >5 kg). Pregnancy details and outcomes were available through the obstetric caregiver.At birth main outcome measures were prematurity (<37 weeks) and birthweight. At follow-up, body mass index (BMI), blood pressure, glucose and lipids were assessed.SWL occurred in 6.8% of cases. Women with SWL had similar preterm birth rates compared with women without these complaints (adjusted OR 1.1, 95%CI 0.7, 1.7). Birthweight (adjusted difference - 31 g, 95%CI -76, 15) and BMI at 5-6 years of age (adjusted difference 0.2 kg/m(2) , 95%CI 0.0, 0.5) were similar in children born to mothers with SWL and without SWL, but blood pressure was increased. For diastolic blood pressure this association was independent of confounders (adjusted difference 1.4 mmHg, 95%CI 0.4, 2.4). Lipid and glucose levels were not significantly different between these groups.Early pregnancy weight loss, usually occurring as a manifestation of hyperemesis gravidarum, could have long-term consequences for offspring health.
- Hyperemesis gravidarum: current perspectives. [Journal Article, Review]
- Int J Womens Health 2014.:719-25.
Hyperemesis gravidarum is a complex condition with a multifactorial etiology characterized by severe intractable nausea and vomiting. Despite a high prevalence, studies exploring underlying etiology and treatments are limited. We performed a literature review, focusing on articles published over the last 10 years, to examine current perspectives and recent developments in hyperemesis gravidarum.
- MR Imaging Findings in Alcoholic and Nonalcoholic Acute Wernicke's Encephalopathy: A Review. [REVIEW]
- Biomed Res Int 2014.:503596.
Wernicke's encephalopathy (WE) is a severe neurological syndrome caused by thiamine (vitamin B1) deficiency and clinically characterized by the sudden onset of mental status changes, ocular abnormalities, and ataxia. Apart from chronic alcoholism, the most common cause of WE, a lot of other conditions causing malnutrition and decreasing thiamine absorption such as gastrointestinal surgical procedures and hyperemesis gravidarum must be considered as predisposing factors. Due to its low prevalence and clinical heterogeneity, WE is often misdiagnosed, leading to persistent dysfunctions and, in some cases, to death. Nowadays, MR imaging of the brain, showing T2 and FLAIR hyperintensities in typical (thalami, mammillary bodies, tectal plate, and periaqueductal area) and atypical areas (cerebellum, cranial nerve nuclei, and cerebral cortex), is surely the most important and effective tool in the diagnostic assessment of WE. The aim of this paper is to propose a state of the art of the role of MR imaging in the early diagnosis of this complex disease.
- Hyperparathyroid crisis presenting with hyperemesis gravidarum. [JOURNAL ARTICLE]
- Arch Gynecol Obstet 2014 Jun 11.
Primary hyperparathyroidism during pregnancy is a rare condition, and the diagnosis may be confounded by pregnancy related conditions. Since the appropriate management reduces the maternal and fetal complications; differential diagnosis becomes quite crucial.Clinical course of a patient with hyperparathyroid crisis will be discussed with the review of the literature. A 22-year- old, (gravida 2, para 1) woman was presented with hyperparathyroid crisis at the 11th weeks' gestation. She was hospitalized twice due to hyperemesis gravidarum. When she was admitted to the hospital for the third time due to increased vomiting and weight-loss, serum biochemistry panel was performed and it revealed severe hypercalcemia that serum Ca was 17.59 mg/dl, and she was referred to our hospital as parathyroid crisis. Maternal hypercalcemia was resolved after urgent parathyroidectomy. She was diagnosed as preeclampsia at the 30 weeks' gestation and delivered a male infant weighing 1,090 g at 33 weeks' gestation with APGAR scores 6 at 1 min, and 7 at min 5, without evidence of neonatal hypocalcemia or tetany.Urgent parathyroidectomy is the definite treatment in symptomatic patients with hyperparathyroidism during pregnancy. Resolving maternal hypercalcemia prevents neonatal tetany and hypocalcemia.Hyperemesis may lead to hypercalcemic crisis in patients with hyperparathyroidism, so serum Ca level should be checked in patients with hyperemesis gravidarum especially who detoriate rapidly. Although they share some common pathogenetic mechanisms, there is not enough evidence for attributing preeclampsia to primary hyperparathyroidism.
- PMM.71 Vitamin K deficiency: An under-reported phenomenon in Hyperemesis Gravidarum? [Journal Article]
- Arch Dis Child Fetal Neonatal Ed 2014 Jun.:A145-6.
Hyperemesis gravidarum (HG) is a severe form of nausea and vomiting seen in women during pregnancy and often results in hospital admission.A 33 year old Caucasian woman in her first pregnancy, presented at 13 weeks gestation with a 6 weeks history of significant vomiting and weight loss of 6 kgs. She was admitted as she had not responded to oral antiemetics. During her admission she was managed with parenteral antiemetics, steroids and anti-thrombotics. She was found have a deranged clotting profile but a normal platelet count and liver function tests with no signs or symptoms of bleeding diatheses. The clotting profile was rapidly corrected after parenteral treatment with Vitamin K suggesting a Vitamin K deficiency consequent to hyperemesis.Hyperemesis gravidarum is a serious condition that can result in electrolyte, fluid and nutritional deficiencies. In particular, liver dysfunction has been associated with the condition; however it is not well understood. It should be noted that clotting profile can also be affected by this condition, as seen in this case. Management of HG focuses mainly on rehydration, but it is important to consider and correct nutritional deficiencies and any electrolyte imbalances that may result.Although, there are very few reports of Vitamin K deficiency, it should be taken into consideration, particularly in cases of intractable HG. The severity of nutritional deficiency and weight loss seen in these patients may warrant prophylactic administration of vitamin K to prevent coagulopathy or bleeding diathesis.
- PMM.07 The Hyperemesis Gravidarum Protocol: A retrospective audit of management in a DGH. [Journal Article]
- Arch Dis Child Fetal Neonatal Ed 2014 Jun.:A126.
Hyperemesis gravidarum occurs in less than 1% of pregnancies(1) but causes significant morbidity and burdens inpatient gynaecology services. Best-practice advice is based on expert opinion as no national guidelines on management exist. This audit examined the management of women admitted with hyperemesis against hospital guidelines based on best-evidence expert advice.Women admitted with a diagnosis of 'hyperemesis' over a retrospective 6 month period were identified. Hospital guidelines on hyperemesis management were examined and 62 auditable data points identified. The medical records, discharge summaries, drug charts, and investigations of each admission were studied accordingly.108 admissions over six months were identified, accounting for 291 bed days. Average duration of admission was two days. A significant number of women were re-admitted more than once. Correct admission investigations (15-65%) were often missed. Ward-based monitoring (10-57%) and the provision of advice to patients (2-9%) was poor. Recommended medications were often omitted (12%) or misprescribed (8-43%).Multiple areas of weakness in management were identified. A route-cause analysis was performed and extensive changes to the guidelines were made, patient information leaflets were written and education of the MDT was undertaken as a result. A re-audit was planned to assess the impact of these interventions.Jarvis S, Nelson-Piercy C. Management of nausea and vomiting in pregnancy. BMJ. 2011 Jun 17;342:d3606. doi: 10.1136/bmj.d3606.
- Marked changes in olfactory perception during early pregnancy: a prospective case-control study. [JOURNAL ARTICLE]
- Eur Arch Otorhinolaryngol 2014 Jun 28.
Pregnancy seems to be related with a significant change in olfaction. Here, we investigate this theory by testing the odor identification abilities of uncomplicated pregnant women and compare the results with non-pregnant controls. The study included 31 healthy pregnant women in the first trimester (Group 1), 30 in the second trimester (Group 2), 31 in the third trimester, and 30 non-pregnant healthy controls (Group 4). In order to measure odor identification abilities, each subject completed the 12-item Brief Smell Identification Test (BSIT). Next, the demographic characteristics and BSIT scores of the groups were compared. The total BSIT scores of the subjects in Group 1 were found to be significantly lower than those of the other groups (p < 0.001). This reduction in odor identification abilities was particularly noticeable for leather, pine, and soot. Pregnant women in the second and third trimesters had similar odor identification abilities to the healthy controls (p > 0.05). Early pregnancy might be related to significant changes in olfactory performance. The distortion of odor identification in the first trimester might be a causative factor for the development of pregnancy-specific conditions, such as morning sickness and hyperemesis gravidarum, which are both common complaints during the early phase of parturition.
- Hyperemesis Gravidarum is a Syndrome of Metabolic and Endocrine Disturbances: A Case Description. [Journal Article]
- Indian J Clin Biochem 2014 Jul; 29(3):390-2.
Hyperemesis gravidarum is a clinical syndrome characterized by excess vomiting, dehydration and weight loss associated high human chorionic gonadotropin levels, usually occurring in the first trimester of gestation. It often presents with severe electrolyte imbalance, mental confusion and may be associated with thyroid dysfunction. We are describing the management of one such case riddled with multiple metabolic events.