# Hyperemesis Gravidarum --- **hyperemesis gravidarum** up to 3% of pregnancies second most common reason to be hospitilized antepartum intractable vomiting during pregnancy, leading to weight loss and volume depletion, resulting in ketonuria and/or ketonemia normal "morning sickness" goes away. you shouldn't be loosing weight, you should be some nausea during pregnancy, especially the first trimester, is normal. But most of the time there are ways to mitigate the nausea and it's not a big problem. - small, infrequent meals - having some plain crackers before getting out of bed - antiemetics are [[teratogen|teratogenic]] so unfortunately they can't have those • Nausea and vomiting complicate 50% to 80% of all pregnancies • Typically begins 4-10 weeks and resolves by 20 weeks • Cause unknown but common theories are: • Increasing levels of estrogen, progesterone, and human chorionic gonadotropin (hCG) • Gastric changes Thyroid changes • Nausea and vomiting excessive enough to cause weight loss, electrolyte imbalance, nutritional deficiencies, and ketonuria • Occurs in approximately 0.3% to 3% of pregnancies • 2nd most common reason for hospitalization during pregnancy in the U.S. • Usually begins during the first trimester, about 10% continue to have symptoms throughout the pregnancy ## Risk Factors • Age < 18 • Nulliparity, • BMI less than 18.5 or greater than 25 • Low socioeconomic status • Asthma • Migraines • Preexisting diabetes • Psychiatric illness • Hyperthyroid disorders • Gastrointestinal disorders • History of hyperemesis • Multifetal gestation • Gestational trophoblastic disease • Family history of hyperemesis Potential complications: • Severe but rare for the birthing person: esophageal rupture, pneumomediastinum, and deficiencies of vitamin K and thiamine with resulting Wernicke encephalopathy (CNS involvement) • Neonatal: small for gestational age, low birthweight, or preterm birth • Clinical manifestations: • Significant weight loss • Dehydration • Dry mucous membranes • Decreased BP • Increased pulse rate • Poor skin turgor • Unable to keep down even clear liquids taken by mouth • Electrolyte imbalances assessment History • Frequency, severity, and duration of episodes of nausea and vomiting, • Precipitating and alleviating factors • Any pharmacologic or nonpharmacologic treatment measures used Physical • Complete physical examination with special attention to fluid and electrolyte balance, nutritional status, and gastric, liver, thyroid, heart, and lung function • Pre-pregnancy weight and gain or loss during pregnancy Labs • Urinalysis • Complete blood cell count, electrolytes, liver enzymes, and bilirubin levels • Thyroid hormones Psychosocial assessment: • Fear and anxiety • Concerns related to their own health and the effects on pregnancy outcome and fetus • Family support Client Problems: • Dehydration related to excessive vomiting • Inadequate weight gain or weight loss • Anxiety ## Interventions • IV therapy for correction of fluid and electrolyte imbalances • Medications to control nausea and vomiting • Start small frequent feedings once the vomiting has stopped • Start with limited amounts of oral fluids and bland foods (crackers, toast, baked chicken) • Progress slowly as tolerated until able to consume a nutritionally sound diet • Psychosocial Care Maintain calm, compassionate, and sympathetic care • Recognize that the manifestations can be physically and • emotionally debilitating to them and stressful their family Irritability, tearfulness, and mood changes are often consistent • with this disorder Fetal well-being is a primary concern of the person • Provide an environment conducive to discussion of concerns • Help them to identify and mobilize sources of support • Include the family in the plan of care whenever possible • • Their participation may help alleviate some of the emotional stress associated with this disorder ___