HIPEREMESIS GRAVIDARUM

HIPEREMESIS GRAVIDARUMOleh : dr. H.B. Hafied & dr. H.M.M. Palisuri, Sp.OG.

Pengertian

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Hiperemesis gravidarum adalah muntah yang terjadi sampai umur kehamilan 20 minggu, muntah begitu hebat dimana segala apa yang dimakan dan diminum dimuntahkan sehingga mempengaruhi keadaan umum dan pekerjaan sehari-hari, berat badan menurun, dehidrasi, dan terdapat aseton dalam urin bukan karena penyakit seperti appendisitis, pielititis, dan sebagainya.(1)

Etiologi

________

Tidak jelas.(2)

Klasifikasi(2,3,4)

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Secara klinis, hiperemesis gravidarum dibedakan atas 3 tingkatan, yaitu :

1. Tingkat I

Muntah yang terus-menerus, timbul intoleransi terhadap makanan dan minuman,

berat-badan menurun, nyeri epigastrium, muntah pertama keluar makanan,

lendir dan sedikit empedu kemudian hanya lendir, cairan empedu dan terakhir

keluar darah. Nadi meningkat sampai 100 kali per menit dan tekanan darah

sistole menurun. Mata cekung dan lidah kering, turgor kulit berkurang dan urin

masih normal.

2. Tingkat II

Gejala lebih berat, segala yang dimakan dan diminum dimuntahkan, haus hebat,

subfebril, nadi cepat dan lebih 100-140 kali per menit, tekanan darah sistole

kurang 80 mmHg, apatis, kulit pucat, lidah kotor, kadang ikterus ada, aseton

ada, bilirubin ada dan berat-badan cepat menurun.

3. Tingkat III

Gangguan kesadaran (delirium-koma), muntah berkurang atau berhenti, ikterus,

sianosis, nistagmus, gangguan jantung, bilirubin ada, dan proteinuria.

Diagnosis(2,4)

_________

1. Amenore yang disertai muntah hebat (segala yang dimakan dan diminum akan

dimuntahkan), pekerjaan sehari-hari terganggu, dan haus hebat.

2. Fungsi vital : nadi meningkat 100 kali per menit, tekanan darah menurun pada

keadaan berat, subfebril dan gangguan kesadaran (apatis-koma).

3. Fisis : dehidrasi, keadaan berat, kulit pucat, ikterus, sianosis, berat badan

menurun, porsio lunak pada vaginal touche, uterus besar sesuai besarnya

kehamilan.

4. Laboratorium : kenaikan relatif hemoglobin dan hematokrit, shift to the left,

benda keton dan proteinuria.

Penatalaksanaan(2,3)

________________

1. Rawat di rumah sakit, batasi pengunjung.

2. Stop per oral 24-48 jam.

3. Infus glukosa 10% atau 5% : RL = 2 : 1, 40 tetes per menit.

4. Obat

- Vitamin B1, B2 dan B6 masing-masing 50-100 mg/hr/infus.

- Vitamin B12 200 mcg/hr/infus, vit. C 200/hr/infus.

- Phenobarbital 30 mg IM 2-3 kali per hari atau chlorpromazine 25-50 mg/hr IM

atau diazepam 5 mg 2-3 kali per hari IM.

- Antiemetik : prometazine (avopreg) 2-3 kali 25 mg per hari per oral atau

prochlorperazine (stimetil) 3 kali 3 mg per hari per oral atau mediamer B6 3

kali 1 per hari per oral.

- Antasida : acidrine 3 x 1 tab per hari per oral atau mylanta 3 x 1 tab per hari

per oral atau magnam 3 x 1 tab per hari per oral.

5. Diet

a. Diet hiperemesis I diberikan pada hiperemesis tingkat III. Makanan hanya

berupa roti kering dan buah-buahan. Cairan tidak diberikan bersama

makanan tetapi 1-2 jam sesudahnya. Makanan ini kurang dalam zat-zat gizi

kecuali vitamin C karena itu hanya diberikan selama beberapa hari.

b. Diet hiperemesis II diberikan bila rasa mual dan muntah berkurang. Secara

berangsur mulai diberikan bahan makanan yang bernilai gizi tinggi. Minuman

tidak diberikan bersama makanan. Makanan ini rendah dalam semua zat-zat

gizi kecuali vitamin A dan D.

c. Diet hiperemesis III diberikan kepada penderita dengan hiperemesis ringan.

Menurut kesanggupan penderita minuman boleh diberikan bersama makanan.

Makanan ini cukup dalam semua zat gizi kecuali kalsium.

Daftar Pustaka

______________

1. Fairwether. Nausea and Vomity in Pregnancy, Am J Obst. & gynec. 1968. vol. 102;

135-171.

2. Mannor SM. Hyperemesis Gravidarum. In : Iffty L, Kaminetzky HA eds. Principles

and Practise of Obstetric and Perinatology. Vol. 12. Toronto : A Wiley Medical

Publication. 1981. 1155-1164.

3. Greenhill. Obstetrics 12 th. ed. Philadelphia : WB. Saunders Company. 1961. 375-

377.

4. Belscher NA, Macky. Obstetric and the Newborn and Illustrated Textbook 2nd. ed.

Sydney : WB. Saunders Company 1986. 305.

Update : 15 Februari 2006

Sumber :

Pedoman Diagnosis dan Terapi Obstetri dan Ginekologi, dr. I.M.S. Murah Manoe, Sp.OG., dr. Syahrul Rauf, Sp.OG., dr. Hendrie Usmany, Sp.OG. (editors). Bagian / SMF Obstetri dan Ginekologi Fakultas Kedokteran Universitas Hasanuddin, Rumah Sakit Umum Pusat, dr. Wahidin Sudirohusodo, Makassar, 1999.

/www.geocities.com/klinikobgin/kelainan-kehamilan/hiperemesis-gravidarum.htm

Hyperemesis Gravidarum This Report is free of charge.Full report version is displayed.

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Copyright 1999, 2002, 2003, 2006

NORD is grateful to Dr. Gideon Koren, Director of the Motherisk Program at The Hospital for Sick Children of Toronto, and Caroline Maltepe, nausea and vomiting of pregnancy counselor, for assistance in the preparation of this report.

Synonyms of Hyperemesis Gravidarum No synonyms found Disorder Subdivisions

No synonyms found

General DiscussionHyperemesis gravidarum (HG) is a rare disorder characterized by severe and persistent nausea and vomiting during pregnancy that may necessitate hospitalization. As a result of frequent nausea and vomiting, affected women experience dehydration, vitamin and mineral deficit, and the loss of greater than five percent of their original body weight.

Nausea and vomiting of pregnancy (NVP), more widely known as morning sickness, is a common condition of pregnancy. Many researchers believe that NVP should be regarded as a continuum of symptoms that may impact an affected woman's physical, mental and social well-being to varying degrees. Hyperemesis gravidarum represents the severe end of the continuum. No specific line exists that separates hyperemesis gravidarum from NVP; in most cases, affected individuals progress from mild or moderate nausea and vomiting to hyperemesis gravidarum. The exact cause of hyperemesis gravidarum is not known.

SymptomsHyperemesis gravidarum may develop rapidly within a few weeks or gradually over a few months. Individuals with hyperemesis gravidarum experience severe and persistent nausea and vomiting that occur before the 20th week of pregnancy (gestation) and are severe enough to result in progressive weight loss of greater than five percent of their original body weight. In addition, frequent vomiting may also lead to dehydration and vitamin and mineral deficit. Hyperemesis gravidarum often leads to hospitalization to restore lost fluids and nutrients to affected women.

Additional symptoms associated with hyperemesis gravidarum may include rising pulse rate, excessive salivation (ptyalism), and a rapid heartbeat (tachycardia). In some cases, affected individuals may have a distinct odor to their breath (ketonic odor). Symptoms associated with the disorder may subside and recur ("wax and wane") resulting in affected individuals being hospitalized more than once during their pregnancy.

Quality of life is also affected. Individuals are often unable to work, complete daily household tasks and routines, care for young children and, in some cases, may elect to skip social activities and functions. Persistent and severe nausea and vomiting associated with hyperemesis gravidarum may put a strain on various family relationships as well.

Significant debate exists in the medical literature as to the effect hyperemesis gravidarum may have on the fetus. Most studies fail to demonstrate any difference between infants of women who experience hyperemesis gravidarum during pregnancy, and women who do not. However, some researchers have reported that infants of women who experienced hyperemesis gravidarum often exhibit a lower birth weight than infants of women who did not have the disorder. In addition, some research has shown that low birth weight was more common in infants of women who were repeatedly hospitalized for hyperemesis gravidarum than infants of women who were hospitalized only once.

CausesThe exact cause of hyperemesis gravidarum is not known. Most researchers believe that biological, psychological and sociological factors may all play a role. Some theories concerning the cause of hyperemesis gravidarum include vitamin B deficiency; hyperthyroidism; endocrine imbalances; gastroesophageal reflux occurring in association with abnormalities in the electrical properties of muscles affecting the stomach (gastric dysrhythmias); Helicobacter Pylori infections; psychological factors; and disturbances in carbohydrate metabolism. Despite several clinical studies, researchers have been unable to definitively determine why hyperemesis gravidarum occurs.

Some researchers have reported that certain factors may be associated with an increased risk of developing hyperemesis gravidarum including younger maternal age, high body weight (obesity), no previous completed pregnancies (nulliparity), carrying twins, a first-time pregnancy, and/or a history of hyperemesis gravidarum in previous pregnancies.

Affected PopulationsHyperemesis gravidarum is estimated to occur in .5 percent to two percent of pregnant women. Approximately 4,000 Canadian women a year experience hyperemesis gravidarum, according to estimates from the Society of Obstetricians and Gynecologists of Canada based upon American data. Nausea and vomiting of pregnancy in general is estimated to occur in 50 percent to 90 percent of all pregnancies.

Hyperemesis gravidarum, like nausea and vomiting of pregnancy, usually occurs before the 20th week of pregnancy often between the fourth and tenth week. In many cases, as with mild or moderate nausea and vomiting of pregnancy, symptoms resolve before 20 weeks. However, cases have been reported in which symptoms persisted after 20 weeks. Hyperemesis gravidarum often occurs during first pregnancies and usually recurs in subsequent pregnancies.

Related DisordersSymptoms of the following disorders can be similar to those of hyperemesis gravidarum. Comparisons may be useful for a differential diagnosis:

Many disorders and conditions affecting the digestive tract (gastrointestinal disorders) are associated with nausea and vomiting. Such disorders and conditions include acute inflammation of the appendix (appendicitis), inflammation of the pancreas (pancreatitis), bowel obstruction, peptic disorders and a flu-like illness that is characterized by nausea, vomiting, fever, and diarrhea and is caused by a virus (viral gastroenteritis) (For more information on these disorders, choose the specific disorder name as your search term in the Rare Disease Database.)

Many disorders and conditions affecting the reproductive and urinary systems (genitourinary tract) may also be associated with nausea and vomiting. Such disorders or conditions include inflammation of the kidneys and pelvis (pyelonephritis), degeneration of abnormal growths of fibrous tissue (fibroid degeneration), and a twisted ovarian cyst (ovarian torsion). (For more information on these disorders, choose the specific disorder as your search term in the Rare Disease Database.)

Hepatitis is an inflammation of the liver that, in some cases, may cause temporary or permanent damage. At least six forms of hepatitis have been identified (i.e., hepatitis types A, B, C, D, E, and G). Common symptoms associated with hepatitis include fatigue, mild fever and gastrointestinal problems such as nausea and vomiting and a general feeling of discomfort in the stomach. Hepatitis is usually caused by viruses. However, other causes have been identified, including bacteria, certain chemicals, alcoholism, and other medical disorders. (For more information on this disorder, choose "hepatitis" as your search term in the Rare Disease Database.)

Additional disorders and conditions associated with nausea and vomiting include diabetes, lesions of the central nervous system, thyroid dysfunction, toxic effects of certain drugs (drug toxicity) and disorders affecting the ear and/or ear canal (vestibular disorders). Certain conditions associated with pregnancy may also cause nausea and vomiting, including carrying twins, high blood pressure caused by pregnancy (pregnancy-induced hypertension), excess amniotic fluid (hydramnios) and hydatidiform mole (a condition in which a mass of cysts develops in the fertilized egg). (For more information on these disorders, choose the specific disorder as your search term in the Rare Disease Database.)

The following disorder may be associated with hyperemesis gravidarum as a secondary characteristic. It is not necessary for a differential diagnosis:

Wernicke's encephalopathy is a neurological disorder characterized by confusion, an impaired ability to coordinate voluntary movements (ataxia), and paralysis of certain eye muscles (ophthalmoplegia). Additional symptoms may include drowsiness, lack of emotions (apathy) and rapid, involuntary eye movements (nystagmus). Wernicke's encephalopathy is caused by a deficiency of vitamin B1 (thiamine). (For more information on this disorder, choose "Wernicke " as your search term in the Rare Disease Database.)

Standard TherapiesThe diagnosis of hyperemesis gravidarum may be confirmed by a thorough clinical evaluation, detailed patient history, and the identification of characteristic symptoms (e.g., persistent and severe nausea and vomiting, dehydration, and weight loss). The diagnosis is one of exclusion as other causes of nausea and vomiting during pregnancy must be ruled out. Physicians should determine the frequency of nausea and vomiting and the extent to which they affect an affected individual's daily life.

Treatment The diagnosis of hyperemesis gravidarum should lead to immediate hospitalization of an affected individual in order to restore fluids and replace electrolytes by infusing medications and fluids through veins (intravenously). Food should not be given through the mouth (orally) until vomiting stops and dehydration has been corrected. Instead, food may be supplied by way of the intestines (enteral feeding) or by injection through some other route (parenteral feeding).

Vitamin supplementation (particularly vitamins B6, C and thiamine) may also be recommended. Thiamine supplementation is specifically recommended to prevent the development of Wernicke's encephalopathy.

With these treatments, in many cases, vomiting may stop. If vomiting continues, antiemetic drug therapy may be recommended. (For more information on antiemetic drugs, see the Investigational Therapies section of this report.)

After vomiting stops, affected individuals should receive enteral nutritional supplementation as needed to calm nausea. Physicians should then slowly and carefully reintroduce fluids and small, frequent meals into an affected individual's diet. Meals should consist of foods that are high in carbohydrates and low in fat.

In some cases, counseling may be recommended for women to help deal with the complications of hyperemesis gravidarum. In addition, treatments for mild or moderate nausea and vomiting in pregnancy may also be of benefit. These common treatments include plenty of bed rest, avoiding odors that may trigger an episode of nausea or vomiting, and dietary changes (i.e., avoiding foods that worsen nausea and vomiting). However, no clinical data exist to prove the effectiveness of these treatments.

Investigational TherapiesIn some persistent cases of hyperemesis gravidarum, drugs that prevent or lessen nausea and vomiting may be prescribed (antiemetic drug therapy). In Canada, the drug diclectin, which contains an antihistamine (doxylamine succinate) and vitamin B6 (pyridoxine), is approved for treatment of nausea and vomiting of pregnancy. Diclectin is the only drug in Canada labeled as safe and effective to treat nausea and vomiting of pregnancy. It is not currently available in the United States, but papers presented at a May 2002 conference on Understanding and Treating Nausea and Vomiting of Pregnancy, sponsored by the National Institute of Child Health and Human Development and The Office of Rare Diseases, National Institutes of Health, proposed that its possible use in the U.S. be studied.

The ingredients of diclectin are the same as those of bendectin, a drug used to treat nausea and vomiting in pregnancy in the United States from 1956 to 1983. After numerous lawsuits were filed claiming bendectin caused various birth defects, the drugs manufacturer voluntarily withdrew it from the market, citing rising legal costs and negative publicity. However, despite bendectins becoming the most studied drug in regard to pregnancy, no research has ever demonstrated an increased incidence of birth defects in association with the use of bendectin. In fact, the Food and Drug Administration (FDA) has determined that bendectin was not withdrawn from the market for reasons of safety or effectiveness.

Other antihistamines have been used to treat nausea and vomiting in pregnancy, sometimes in conjunction with diclectin. These include dimenhydrinate (Gravol), hydroxyzine (Atarax), and promethazine (Phenergan). However, these drugs have not been studied thoroughly in pregnant women, and their FDA approval labeling cautions that they are not approved for pregnant or nursing women. These drugs have been studied in pregnant women and have not been shown to increase the risk of congenital anomalies.

http://www.rarediseases.org/search/rdbdetail_abstract.html?disname=Hyperemesis+Gravidarum+

Hiperemesis GravidarumEmesis Gravidarum

Kriteria: Mual dan mutah selama kehamilan muda (6-16 minggu)

Masih dapat melakukan aktivitas sehari-hari

Sering timbul pada pagi hari (morning sickness).

Penatalaksaan: Pendekatan psikologis>> terangkan bahwa itu merupakan gejala kehamilan muda, akan hilang sendiri setelah kehamilan 16 minggu

Perbanyak istirahat

Kurangi beban kerja sehari-hari dan beban psikologis

Medikamentosa : pasang infus RL / D10% , jika KU jelek atau pre-shock>> Antivomitus (Primperan inj. +/ oral) tranguliser.

Hiperemesis GravidarumKreteria: Mual dan mutah semakin hebat

Tidak dapat lagi melakukan aktivitas sehari-hari.

Penatalaksaan: Rawat inap

Stop makan / minum dalam 24 jam pertama

Obat-obat diberikan parenteral

Infus D10% (2000 ml) + RD5% (2000 ml) / hari tiap botol tambahan: Antiemetik (metoklopramid hidrochlorid) 1 amp (10 mg), Vit. B Komplek 2 ml, Vit.C 1 amp, Kalau perlu Diazepam 10 mg im

Psikoterapi

Dalam 24 jam pertama>> evaluasi

Bila membaik : boleh makan / minum bertahap

Bila tetap : Stop makan minum ? lanjutka R/ di atas untuk 24 jam kedua

Bila dalam 24 jam kedua tidak membaik>> pertimbangan rujukan

Infus dilepas setelah 24 jam bebas mual dan mutah

Kriteria pulang: Mual dan mutah tidak ada lagi

Keluhan subyektif tidak ada

Tanda-tanda vital baik

http://cakmoki.blogsome.com/2006/09/22/hiperemesis-gravidarum/OverviewHyperemesis gravidarum (HG) is a severe form of nausea and vomiting in pregnancy. It is generally described as unrelenting, excessive pregnancy-related nausea and/or vomiting that prevents adequate intake of food and fluids. If severe and/or inadequately treated, it is typically associated with:

loss of greater than 5% of pre-pregnancy body weight (usually over 10%)

dehydration and production of ketones

nutritional deficiencies

metabolic imbalances

difficulty with daily activities

HG usually extends beyond the first trimester and may resolve by 21 weeks; however, it can last the entire pregnancy in less than half of these women. Complications of vomiting (e.g. gastric ulcers, esophageal bleeding, malnutrition, etc.) may also contribute to and worsen ongoing nausea.

There are numerous theories regarding the etiology of hyperemesis gravidarum. Unfortunately, HG is not fully understood and conclusive research on its potential cause is rare. New theories and findings emerge every year, substantiating that it is a complex physiological disease likely caused by multiple factors.

Diagnosis is usually made by measuring weight loss, checking for ketones, and assessing the overall condition of the mother. If she meets the standard criteria and is having difficulty performing her daily activities, medications and/or other treatments are typically offered.

Treating HG is very challenging and early intervention is critical. HG is a multifaceted disease that should be approached with a broad view of possible etiologies and complications. When treating mothers with HG, preventing and correcting nutritional deficiencies is a high priority to promote a healthy outcome for mother and child.

Most studies examining the risks and outcomes for a pregnant woman with nausea and vomiting in pregnancy find no detrimental effects long-term for milder cases. Those with more severe symptoms that lead to complications, severe weight loss, and/or prolonged nausea and vomiting are at greatest risk of adverse outcomes for both mother and child. The risk increases if medical intervention is inadequate or delayed.

The list of potential complications due to repeated vomiting or severe nausea is extensive, all of which may worsen symptoms. Common complications from nausea and vomiting include debilitating fatigue, gastric irritation, ketosis, and malnutrition. Aggressive care early in pregnancy is very important to prevent these and more life-threatening complications such as central pontine myolinolysis or Wernicke's encephalopathy. After pregnancy and in preparation of future ones, it is important to address any resulting physical and psychological complications.

Hyperemesis Gravidarum impacts societies, families and individuals. Recent, conservative estimations suggest HG costs nearly $200 million annually just for inpatient hospitalization. Considering many women are treated outside the hospital to save costs, the actual cost is likely many times greater. Beyond financial impact, many family relationships dissolve and future family plans are almost always limited. Women often lose their employment because of HG, and women are frequently undertreated and left feeling stigmatized by a disease erroneously presumed to be psychological.

OverviewThere are numerous theories regarding the etiology of HG; however, none are, as of yet, conclusive. A cause is very difficult to determine and is most likely not due to only one factor. It may vary between women depending on biological make-up (genetics), body chemistry, and overall health. However, as is common in poorly understood disorders, a psychological cause is named when a physiological one is not known.

This is especially true when so many of the symptoms like nausea are not objectively measurable. Thus it is easy to dismiss a woman's symptoms as being psychological, exaggerated, or imaginary, when in fact they are very real and may in fact be very severe. However, accurately determining severity is difficult, especially if there is not obvious "proof" of how sick a woman is. Proof, such as severe weight loss or dehydration, often comes after she is very sick for some time, and it is then more difficult to manage her symptoms.

Early Research & Perspectives

Hyperemesis gravidarum became a recognized disorder several centuries ago, but the first research appears to have been published in the 18th century. Incidence in the United States is reported to be about 60,000 cases annually; however, that number only reflects those treated as inpatients, not those treated at home or in outpatient/urgent care facilities. With the focus on cost reduction in health care, the majority of women are not admitted to the hospital. Thus the incidence of HG is likely several times greater than suggested. It is not actually a rare disorder. If it is not treated, a mother can suffer greatly and may even have acute or chronic anxiety and/or depression from the trauma of incessant nausea and vomiting.

HG was first thought to be related to a physiological cause such as toxins, ulcerations, or infection in a related organ. A physical cause such as abnormalities of the female reproductive system was also suggested. Early in the 20th century, a psychological cause was proposed by those subscribing to psychoanalytic theories. Unfortunately, despite the lack of evidence in these biased studies, their assumptions have persisted to this day. Every type of medical professional from pharmacist to nurse and allopathic to naturopathic physician is typically taught that HG is a psychological disorder. Many textbooks and published medical research still erroneously suggest that HG is psychosomatic, as well. It is no surprise that women suffering from HG are often left untreated or not taken seriously. This belief has been passed from generation to generation of health professional despite the multitude of evidence showing many contributing factors unrelated to psychological conflicts.

Currently, many theories are being tested, and new ones emerge every year. Most center around known pregnancy-related factors like hormonal changes (e.g. estrogen increase) and physical changes (e.g. relaxed esophageal sphincter) since the onset is related to pregnancy and ends before or at delivery. Research is limited and minimal funding is granted for hyperemesis research, so high-quality studies with decisive results are uncommon.

Human Chorionic Gonadotropin (hCG) & Estrogen HormonesMost theories center around the increase in hCG & estrogen hormones like progesterone in early pregancy.

Psychological CausesSome mistakenly state psychological causes, but most if not all women experience psychological effects (e.g.: frustration, feelings of helplessness, isolation, depression, etc.) secondary to HG.

Thyroxine LevelsIncrease in serum thyroxine levels have been documented in 70% of pregancies complicated by HG.

Gastric Neuromuscular DysfunctionsA recent theory cites a dysfunction that results in regurgitation of duodenal content back into the stomach and subsequent nausea and vomiting.

Deficiencies of NutrientsAnother theory attributes HG to deficiencies of pyridoxine and zinc, though results are not conclusive.

Other Theories & Resource LinksLinks & abstracts to various other physiological and immunological theories.

HormonesHormonal changes are the most studied theory but fail to show consistency among all women with HG. Most studies focus on the changes in hCG and steroid hormones like cortisol, estrogen, and progesterone in early pregnancy because onset and peak of symptoms correlate with elevations in these hormones.Offsite Research:

Human Chorionic Gonadotropin and Hyperemesis GravidarumT. Murphy Goodwin, MD

There are a number of reasons for considering the association of human chorionic gonadotropin (hCG) with hyperemesis gravidarum. The temporal relationship between peak hCG levels and the most common time of nausea and vomiting has long been noted. More recently, the relationship of hCG to transient hyperthyroidism of hyperemesis gravidarum (THHG) has been described. Several experiments of nature have suggested that hCG plays a role. We will consider these interrelated lines of evidence.

Pathophysiology of the gastrointestinal tract during pregnancySinger AJ, Brandt LJ.Department of Medicine, Montefiore Hospital and Medical Center, Albert Einstein College of Medicine, Bronx, New York. Am J Gastroenterol 1991 Dec;86(12):1695-712Pregnancy is associated with a wide variety of physiologic changes in virtually all the organ systems of the body. Some of these changes, such as the hyperventilation of pregnancy with its resulting respiratory alkalosis, are clinically silent, whereas others, such as heart-burn and hemorrhoids, cause significant distress. The effects of pregnancy on the hepatobiliary system have been the subject of much scrutiny and many publications, whereas disturbances of the hollow viscera have been infrequently reviewed. In this report, we will discuss the major pathophysiologic changes that occur along the length of the hollow viscera of the gastrointestinal tract during pregnancy.

Serum chorionic gonadotrophin (hCG), schwangerschaftsprotein 1 (SP1), progesterone and oestradiol levels in patients with nausea and vomiting in early pregnancy.Masson GM, Anthony F, Chau E. British Journal of Obstetrics Gynaecology. 1985 Mar;92(3):211-5Serum concentrations of human chorionic gonadotrophin (hCG), schwangerschaftsprotein 1(SP1), progesterone and oestradiol were measured in 116 pregnant women experiencing varying degrees of nausea and vomiting or no nausea at all at between 9 and 16 weeks gestation. The patients were categorized into four groups, namely asymptomatic, nausea alone, nausea and vomiting and hyperemesis gravidarum. The distribution of levels for each group were examined in relation to the calculated normal ranges. Statistically higher hCG levels were found in out-patients with nausea alone or nausea and vomiting than in the asymptomatic women. No significant differences were found between the groups for any of the other measured variables, including the progesterone/oestradiol concentration ratio.

Psychological

Some mistakenly suggest psychological causes, but most if not all women experience secondary psychological effects (e.g.: frustration, feelings of helplessness, isolation, depression, etc.) due to the misery and stress of HG. These emotions are well-documented in women on bed rest for non-hyperemesis causes. Unfortunately, studies of this nature have been cited for many decades, despite the poor study quality and lack of conclusive results. HG is a poorly understood disorder and as a result is often blamed on psychological causes because a physiological cause is still unknown.

Offsite Research:

Chicken or the egg? The biological-psychological controversy surrounding hyperemesis gravidarum.Munch S.School of Social Work, Rutgers, The State University of New Jersey, New Brunswick 08901, USA. (e-mail: smunch@rci.rutgers.edu) Social Science & Medicine 2002 Oct;55(7):1267-78Women's somatic complaints are more likely to be labeled by physicians and other health care professionals as psychologically based when the condition has an obscure etiology. Perhaps because of this, there are a number of medical conditions which have been under investigated and where erroneous assumptions about them exist. Hyperemesis gravidarum (HG)--severe nausea and vomiting during pregnancy--is an example of such an illness. HG remains a puzzling condition for both physicians and patients because there is no known cause or cure. By its very nature, HG has a clearly established biological cause--pregnancy. Yet, because the exact causal pathophysiological mechanism is unknown, the organicity of the pregnant state is either minimized or ignored. This paper examines how HG is characterized in the literature and the empirical basis for psychogenesis. Analysis of the literature reveals a tension in the discourse such that both biologic and psychologic approaches to HG have existed in parallel tracks throughout history. Still, results support that sociocultural factors rather than scientific evidence have shaped the overarching and predominant illness paradigm of psychogenesis. Implications for women's health care and HG, in particular, are presented.

Psychological factors and hyperemesis gravidarum.Simpson SW, Goodwin TM, Robins SB, Rizzo AA, Howes RA, Buckwalter DK, Buckwalter JG.Graduate School of Psychology at Fuller Theological Seminary, Pasadena, California, USA. Journal of Womens Health and Gender Based Medicine 2001 Jun;10(5):471-7Hyperemesis gravidarum (HG) is a condition of severe, intractable nausea and vomiting during pregnancy. It has long been held that HG is a psychosomatic illness reflective of a long-term psychological trait, that is, conversion disorder. We investigated this possibility by conducting a two-phase study: (1) a comparison of women with (n = 9) and without (n = 10) HG during pregnancy and (2) a comparison of nonpregnant women who did (n = 10) and did not (n = 12) have HG during their most recent pregnancies. The pattern of findings differed between experiments 1 and 2. During pregnancy, women with HG scored significantly higher on three scales associated with conversion disorder (all p values