Hyperemesis Gravidarum

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Hyperemesis Gravidarum

The Hyperemesis Gravidarum:

Hyperemesis gravidarum

Definition

Hyperemesis gravidarum (HG) is a pregnancy complication that is characterized by severe nausea, vomiting, weight loss, and possibly dehydration. [1]

Overview

Risk factors include the first pregnancy, multiple pregnancy, obesity, prior or family history of HG, trophoblastic disorder, also a history of eating disorders.[1]

Causes

There are numerous theories regarding the cause of HG, but the cause remains controversial. It is thought that HG is due to a combination of factors which may vary between women and include genetics. Women with family members who had HG are more likely to develop the disease.
One factor is an adverse reaction to the hormonal changes of pregnancy, in particular, elevated levels of beta human chorionic gonadotropin (β-hCG).
More recently, another cause of HG was discovered: "Evidence suggests abnormal levels of the hormone GDF15 are associated with HG. [1]

Although the pathophysiology of HG is poorly understood, the most commonly accepted theory suggests that levels of β-hCG are associated with it. Leptin, a hormone that inhibits hunger, may also play a role.

Possible pathophysiological processes involved are summarized in the following table:

Source	Cause	Pathophysiology
Placenta	β-hCG	Distention of the gastrointestinal tract Crossover with TSH, causing gestational thyrotoxicosis
Placenta Corpus luteum	Estrogen Progesterone	Decreased gut mobility Elevated liver enzymes Decreased lower esophageal sphincter pressure Increased levels of sex steroids in hepatic portal system
Gastrointestinal tract	Helicobacter pylori	Increased steroid levels in circulation

[1]

Sign & Symptoms

When vomiting is severe, it may result in the following i.e.:

Loss of 5% or more of pre-pregnancy body weight
Dehydration, causing ketosis, also constipation
Nutritional disorders, such as vitamin B₁(in other words, thiamine) deficiency, vitamin B₆ (in other words, pyridoxine) deficiency or vitamin B₁₂ (cobalamin) deficiency
Metabolic imbalances such as metabolic ketoacidosis or thyrotoxicosis
Physical and emotional stress
Difficulty with activities of daily living
Symptoms can aggravate especially by hunger, fatigue, prenatal vitamins and diet.

Other symptoms

Many women with HG are extremely sensitive to odors in their environment; certain smells may exacerbate symptoms.
Excessive salivation, also known as sialorrhea gravidarum, is another symptom experienced by some women.
Hyperemesis gravidarum tends to occur in the first trimester of pregnancy and lasts significantly longer than morning sickness. 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
A small percentage rarely vomit, but the nausea still causes most of the same issues that hyperemesis with vomiting does.[1]

Diagnosis

Hyperemesis gravidarum considered a diagnosis of exclusion. HG can associated with serious problems in the mother or baby, such as Wernicke’s encephalopathy, coagulopathy and peripheral neuropathy.
Women experiencing hyperemesis gravidarum often dehydrated and lose weight despite efforts to eat. The onset of the nausea and vomiting in hyperemesis gravidarum is typically before the 20th week of pregnancy.[1]

Investigation

Common investigations include blood urea nitrogen(BUN) and electrolytes, liver function tests, urinalysis, and thyroid function tests.
Hematological investigations include hematocrit levels, which are usually raised in HG.
An ultrasound scan may be needed to know gestational status and to exclude molar or partial molar pregnancy.[1]

Treatment

Hyperemesis gravidarum (HG) a severe and prolonged form of nausea and/or vomiting during pregnancy.
HG affects 0.3-2% of pregnancies and define by dehydration, ketonuria, and more than 5% body weight loss. Initial pharmacologic treatment for HG includes a combination of doxylamine and pyridoxine.
Additional interventions include ondansetron or dopamine antagonists such as metoclopramide or promethazine. The options are limited for women who are not adequately treat with these medications. [1]

Homoeopathic Treatment

Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines are selected after a full individualizing examination and case-analysis, which includes the medical history of the patient, physical and mental constitution, family history, presenting symptoms, underlying pathology, possible causative factors etc. A miasmatic tendency (predisposition/susceptibility) is also often taken into account for the treatment of chronic conditions.

What Homeopathic Doctors do?

A homeopathy doctor tries to treat more than just the presenting symptoms. The focus is usually on what caused the disease condition? Why ‘this patient’ is sick ‘this way’. The disease diagnosis is important but in homeopathy, the cause of disease is not just probed to the level of bacteria and viruses. Other factors like mental, emotional and physical stress that could predispose a person to illness are also looked for.

No a days, even modern medicine also considers a large number of diseases as psychosomatic. The correct homeopathy remedy tries to correct this disease predisposition. The focus is not on curing the disease but to cure the person who is sick, to restore the health. If a disease pathology is not very advanced, homeopathy remedies do give a hope for cure but even in incurable cases, the quality of life can be greatly improved with homeopathic medicines.

The homeopathic remedies

The homeopathic remedies (medicines) given below indicate the therapeutic affinity but this is not a complete and definite guide to the homeopathy treatment of this condition. The symptoms listed against each homeopathic remedy may not be directly related to this disease because in homeopathy general symptoms and constitutional indications are also taken into account for selecting a remedy.

Medicine of Hyperemesis gravidarum:

ARSENICUM ALBUM:

Persistent, deathly nausea during pregnancy. Moreover, The entire inner part of the stomach seems raw.
Constrictive pain when the stomach is empty. Additionally, Nausea 11 a.m. and 3 p.m. and in forenoon, obliging her to lie down.
Violent vomiting excited by taking any substance taken into the stomach. In detail, Vomiting brings no relief. Loathes food. Constant thirst for cold water, the smallest part of which cannot be retained.
Patient thinks she will die. Severe prostration.
Worse – cold drinks, after midnight, right side. On the other hand Better – heat, warm drinks.

KREOSOTUM:

The nausea also vomiting are frequently associated with soreness at the pit of the stomach.
Nausea with burning in mouth. Furthermore, Urging to vomit, but only saliva appears. Retching. Fasts in the morning. Besides this, Fretful in morning to the point of weeping.
Face is pale also puffy.
Worse – open air, cold, rest, lying. whereas Better – motion, warmth, warm food.

NUX VOMICA:

General, Vomiting and nausea every morning. Aversion to food. Needs to lie down.
Nausea to the odours of food. Additionally, Nausea in morning with chilliness.
Worse – especially after eating a little, walking.

TABACUM:

Persistent nausea also vomiting of pregnancy, with deathly nausea, pale face, coldness in stomach.
Nausea in morning on rising, on motion. Violent vomiting, bitter, sour, even before breakfast.
Faint and weakness after vomiting. Pale face, covered specifically with cold sweat.

IPECACUANHA:

In brief, Vomiting with mucus and sometimes blood, bile, and green gelatinous mucus. Often caused by nervous irritability.
Nausea with empty eructations and salivation, distressing, with compulsive but ineffectual retching.
Lastly, Nausea with clean moist tongue.

LACTIC ACID:

Nausea, vomiting, morning sickness especially in pale anemic women.
Hot, acrid eructations. Nausea, better eating.

LOBELIA:

Basically, Faintness and sinking in pit of stomach with nausea and vomiting.
Worse – afternoon, slightest motion, cold. On the other hand Better – warmth, rapid walking, water.

ASARUM:

Nausea, eructations and vomiting during pregnancy. Nausea with loathing and shuddering.
Violent, empty retching which < all symptoms. Melancholy, tearful, peevish.
Worse – penetrating sounds, cold, dry weather. Whereas Better – washing, in damp cold weather.[2]