Hyperemesis Gravidarum
Article Sections
Introduction
Physiologic nausea and vomiting of pregnancy (NVP) affects most pregnancies but is usually mild, limited to the first trimester, and associated with normal vital signs and laboratory findings. Hyperemesis gravidarum is a severe form of NVP characterized by persistent nausea and vomiting and usually associated with ketonuria and weight loss >5% of prepregnancy body weight.
Pathophysiology and risk factors
The exact pathogenesis of hyperemesis gravidarum is unclear but may involve hormonal changes, particularly elevations in human chorionic gonadotropin (hCG). Therefore, risk factors include hyperemesis gravidarum in a prior pregnancy, multiple gestation (likely due to greater placental mass and hCG production), molar pregnancy (eg, gestational trophoblastic disease), and history of acid reflux.
Clinical presentation
Symptoms of hyperemesis gravidarum typically begin at 5-6 weeks gestation. Patients have severe and persistent nausea associated with nonbilious vomiting that can occur at any time of day. Patients can develop acute dehydration due to inability to tolerate oral intake.
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