Severe nausea and vomiting in pregnancy - Hiperemezis gravidarium

The pregnant emetic disease is a severe form of morning vomiting of pregnancy occurring with adequate food and fluid intake. Hiperemeza is considered a rare complication of pregnancy but, as pregnancy and vomiting coexist there a correct diagnosis between morning and hiperemeza emesis. Women who suffer from this pathological condition varies from 0. 3-2. 0%.
The cause of the disorder is unknown. Theories speculate an adverse reaction to the hormonal changes of pregnancy. In particular hiperemeza may be due to high levels of the hormone beta HCG and is more common in multiple pregnancies and gestational trophoblastic disease. This theory would explain why hiperemeza gravidaruim is frequently encountered in the first trimester, when hormone levels are at its peak.Additional theories aim high levels of estrogen and progesterone can cause hypersalivation and decreased gastric motility. His theory postulated immune response to chorionic Vili fragments entering the maternal circulation and the immune response to foreign fetus.
In the past disturbance was attributed to a pregnant woman's psychological condition.Doctors thought it was a reaction to unwanted pregnancy or other psychological or emotional problems. This theory was disproved.
When disease is severe and inadequately treated may result in loss Gruta, dehydration, nutritional deficiencies, emotional stress, metabolic disturbances, difficulty in daily physical activity, hallucinations. Some women lose weight up to 20%. Many suffer from extreme sensitivity to odors in the environment-hiperolfactie. Ptialismul or salivation is another symptom experienced by some women who suffer from hiperemeza.
Compared with morning sickness emetics, hiperemeza tends to begin early in pregnancy and persist longer. While most women experience symptoms emetics release second quarter early morning, accusing those who suffer from symptoms until hiperemeza child at birth and even after birth.
Due to severe dehydration and other potential complications, the disease is generally treated as a medical emergency. Treatment includes administration of antiemetics and intravenous rehydration, with nutritional support. Disease control can be complicated because not all women respond to treatment. Strategies include a soft diet and nutrition before lifting in the morning.
PathogenesisNausea and vomiting can be a normal pregnancy-protective evolutionary process may protect the woman and fetus from harmful substances in food such as meat products of pathogenic microorganisms and toxins in plants, the effect being highest during embryogenesis. This study is supported by the fact that women who have experienced these symptoms do not have abortions.Women with this disease shows high levels of HCG which cause transient hyperthyroidism. Some studies show a relationship between estrogen and increased severity of vomiting during pregnancy. Previous intolerance to the pill is associated with nausea and vomiting of pregnancy. Progesterone is also up in the first quarter and decreased smooth muscle activity, though studies have failed to prove cause-effect relationships between them.
Gastrointestinal dysfunction:Peacemaker rhythmic peristaltic contractions trigger stomach. Mioelectrica abnormal activity can cause a variety of gastric dysrhythmia, including tahigastrii and bradigastrii.Gastric dysrhythmia have been associated with morning sickness. This dysrhythmia was associated with nausea while mioelectrica normal activity was present in the absence of emesis. The mechanisms that cause gastric dysrhythmia contain estrogen or progesterone high, thyroid disorders, abnormalities of vagal and sympathetic tone and vasopressin secretion in response to intravascular volume perturbations. Many of these factors are present in pregnancy. The pathophysiological factors are considered to be more severe gastrointestinal tract more sensitive to changes in those who develop neural hiperemeza gravidarium.
Liver dysfunction:Liver disease with moderate rise in transaminases occurs in about 50% of patients with hiperemezis gravidarium. Impaired fatty acid oxidation by mitochondria has been considered to play a role in maternal liver disease pathogenesis. Malnutrition is likely to lead to peripheral lipolysis and increased fatty acid load in metarno-fetal circulation, combined with reduced mitochondrial capacity to oxidize fatty.
Altered lipid levels:They found high levels of triglycerides, total cholesterol and phospholipids in women with comparable gravidarium hiperemeza pregnant women who do not have vomiting. This phenomenon may be associated with abnormalities in liver function in pregnant women.
Infection:Helicobacter pylori is a bacterium found in stomach can aggravate nausea and vomiting in pregnancy. Studies show role of bacteria in pregnant emesis caused by infection with peptic ulcer.
Vestibular and smell:Hiperacuitatea olfactory system may be one factor causing the nausea and vomiting of pregnancy. Many pregnant women report the smell of cooked food, especially meat that triggers vomiting.
Psychological Problems:Some cases may represent hiperemeza gravidarium mental disorders, including Munchausen syndrome, somatization illness or major depression. They may occur in situations of stress. It seems that psychological responses can intercationa or exacerbate nausea and vomiting of pregnancy.Causes and risk factors:-Ethnicity, fetal abnormalities, high body massAbove-vomiting of pregnancy than between tasks intervelulPrevious intolerance to contraception,Emesis, earlier pregnancyMultiple-gestation, trophoblastic disease-Nuliparitatea.Smoking is associated with decreased risk of emesis gravidarium.
Signs and symptomsNausea and vomiting in pregnancy are extremely common. Hiperemezis gravidarium is the most severe form of this phenomenon. Studies show that the condition affects between 50-90% of pregnancies. Debuts at 9-10 weeks of pregnancy, with maximum expression at 11-13 weeks and usually resolves in most cases at 12-14 weeks. 1-105 of the symptoms may continue pregnancies over 22 weeks. Uncomplicated Nausea and vomiting are usually associated with a low rate of abortions, but hiperemezis gravidarium can affect health and wellbeing of the fetus and mother.The symptoms are gastrointestinal in nature condition and include nausea and vomiting.Ptialismul Other common symptoms include fatigue, weakness and dizziness.
Patients may experience the following:-Sleep disturbances, hiperolfactie, dysgeusia-Decreased sensitivity gustatoriiFor depression, anxiety, irritability-Changes in behavior, loss of concentration.
Complications of pregnant women:-Kidney failure, central pontine mielimoliza, coagulopathy-Atrophy, Mallory-Weiss sidnrom, hypoglycemia-Jaundice, malnutrition, Wernicke encephalopathy, Pneumomediastinum, randomioliza, avulsion spelnica-Cerebral artery vasospasm, depression.
Fetal Complications:There are no long term studies on the effects on children of mothers with hiperemeza.Children born to these mothers do not appear to pose a high risk of complications or birth defects from the general population. However, current research indicates that prolonged stress, dehydration and malnutrition during pregnancy may put the fetus at risk of chronic diseases such as diabetes or heart disease, late in their evolution neurobehavioral defects or problems.
Disease progression:Hiperemeza gravidarium was a significant cause of maternal death before 1940. Today the condition is still associated with significant morbidity, but it is a rare cause of maternal death. Gravidarium hiperemezis Women who lost weight are at increased risk of low birth weight babies.