Behavioral Treatment of Hyperemesis Gravidarum

Hyperemesis gravidarum, while no longer a serious threat to maternal mortality, is a serious disorder endangering pregnancy. While recognition of psychological factors in the etiology of the disorder has been considerable, prior writing has been speculative and often the methodology used in research has been unsound. This paper presents a technique for the assessment of the idiosyncratic factors triggering nausea and vomiting in the individual patient and a methodology to develop short-term therapy around that information. Four case studies are presented to illustrate the procedures. While further research is clearly needed, these results suggest that the presumption of a singular underlying dynamic as the controlling cause of hyperemesis gravidarum is probably not useful.     

Haemodialysis in Acute Renal Failure Following Hyperemesis Gravidarum

Summary: Acute renal failure due to hyperemesis gravidarum in a 27-year-old woman is described. Prompt haemodialysis led eventually to full recovery of the mother and vaginal delivery of a viable infant. Immediate intensive care with haemodialysis is mandatory if pregnancy is complicated by acute renal failure, in order to protect the fetus from the uraemic environment.     

A Case of Peutz-Jeghers' Syndrome in Early Pregnancy Mimicking Hyperemesis Gravidarum

Summary: An initial misdiagnosis of hyperemesis gravidarum was made in a patient with Peutz-Jeghers' syndrome, the patient presenting with vomiting due to jejunal intussusception.     

Total Parenteral Nutrition (TPN) and Steroid Usage in the Management of Hyperemesis Gravidarum

EDITORIAL COMMENT: We accepted this case report for publication to remind readers that the usual nausea and vomiting of early pregnancy can become persistent and severe. In a series of 92,838 consecutive antenatal patients at the Mercy Hospital for Women, 1.1% had vomiting of sufficient severity to warrant admission to hospital. Most admissions were of 2–6 days' duration and more than 70% required only 1 admission. However, the condition was refractory in about 10% of these women who required repeated admissions to hospital. As in the case reported here the condition can be recurrent in subsequent pregnancies. In the series quoted above, 75% of the women were admitted in the first 14 weeks of pregnancy, and the positive association with multiple pregnancy (21 cases), hydatidiform mole (7 cases) and urinary tract infection (31 cases) was less than expected. Nonetheless these conditions should always be excluded. When the editor was a medical officer at The Royal Women's Hospital, Melbourne, 1957–1960, he saw 2 cases of hyperemesis gravidarum where the vomiting of black fluid was suggestive of acute dilatation of the stomach. Both women were moribund. The first woman had a hydatidiform mole and hysterotomy was performed successfully. The second woman, who had required prolonged hospitalization in her only other pregnancy, was treated successfully by hypnosis by our Indian resident medical officer. The vomiting ceased, but the hypnosis was reinforced daily and the woman remained in hospital for several weeks. In the series quoted, there was a history of past psychiatric disease in 6.3% and many of the remaining women had an underlying problem of anxiety, depression or psychosocial disturbance. Since these women have dehydration and even starvation when admitted to hospital they should receive vitamins as well as intravenous fluids, calories and antinausea preparations as in the case presented here.     

Understanding the Stigma of Hyperemesis Gravidarum: Qualitative Findings from an Action Research Study

Abstract: Background: Severe nausea and vomiting in pregnancy (hyperemesis gravidarum) can be a distressing and debilitating condition when it is uncontrolled. For all concerned, hyperemesis gravidarum can be difficult to treat satisfactorily, and women tend to be admitted to a hospital several times during early pregnancy. Our research objectives were to describe the experience of hyperemesis gravidarum from the perspective of affected women and to explore with health care professionals the barriers and facilitators to caring for women with the condition. Methods: A qualitative research design was used. A total of 18 women were interviewed, of whom 8 had two or more interviews. Seven focus groups were conducted with health care professionals. Thematic data analysis was undertaken. Results: The main themes emerging from the women’s data were the effect and burden of the symptoms of the condition and feeling unpopular with staff. From the practitioner data, the main themes were the validity (or invalidity) of hospitalization for women, skepticism of the severity of symptoms, the psychological and social dimensions of the condition, and inadequate primary care services. Conclusions: The main findings revealed that hyperemesis gravidarum is a debilitating condition and that the unhelpful attitudes of practitioners may affect whether women access timely and appropriate care. Many women appear to be unsupported by primary care services and are distressed when perceived either as “time wasters” or someone else’s responsibility. We propose that a tailored assessment and care plan for each woman is needed to help them control their symptoms, which ideally should be delivered in the community. (BIRTH 37:3 September 2010)     

Hyperemesis,gastrointestinal and liver disorders in pregnancy

Pregnant women may be affected by diseases of the gastrointestinal tract or liver. These disorders can be related or unrelated to pregnancy. Conditions unrelated to pregnancy can be pre-existing or co-incident. These diseases have varying effects on obstetric outcome. Severe liver disease in pregnancy is rare. We present some common gastrointestinal and liver disorders focussing on the diagnosis, management and effects on pregnancy outcomes.     

Hyperemesis gravidarum,gastrointestinal and liver disease in pregnancy

Women of childbearing age may be affected by diseases of the gastrointestinal tract or liver; some have no effect on obstetric outcome, some are improved in pregnancy and some deteriorate. Gastrointestinal or liver disease may be caused by pregnancy and resolve following delivery e.g. hyperemesis gravidarum, pre-eclampsia, acute fatty liver of pregnancy, HELLP syndrome and obstetric cholestasis, or may present for the first time in pregnancy e.g. inflammatory bowel disease, cholelithiasis and hepatitis. These examples and other common gastrointestinal and liver disorders will be discussed giving details of diagnosis, management and effects on pregnancy outcome and also background information on normal liver physiology in pregnancy.     

Hyperemesis gravidarum,gastrointestinal and liver disease in pregnancy

Up to 80% of pregnant women experience discomfort due to symptoms originating from the gastrointestinal tract; ∼5% of them have more severe disease that can adversely affect maternal and fetal outcome. This review presents options of symptomatic relief for the common complaints of the gastrointestinal tract. It also discusses the management of the commonest or most serious conditions of the gastrointestinal tract and liver that can coexist or appear for the first time in pregnancy.     

Randomized, Placebo-Controlled Trial of Granisetron for Control of Nausea and Vomiting During Cesarean Delivery Under Spinal Anesthesia

Objective(s)

The objective of this study was to evaluate the efficacy and safety of granisetron (5HT₃ receptor antagonist) on the incidence of nausea and vomiting in cesarean deliveries under spinal anesthesia.

Method(s)

In the randomized, double-blind study, 80 parturients received granisetron 40 μg/kg or placebo (n = 40 each) intravenously, immediately after clamping of the fetal umbilical cord. Nausea, vomiting, and adverse events were then observed for 24 h after administration of spinal anesthesia.

Results

A complete response (defined as no postoperative nausea and vomiting) during 0–4 h after administration of spinal anesthesia was achieved in 80 % of patients with granisetron and in 45 % of patients with placebo. The corresponding incidences during (4–24 h) were 82.5 and 55 % (P value <0.05). No difference in adverse events was observed in any of the groups.

Conclusion(s)

Prophylactic use of granisetron is effective for preventing emetic episodes during spinal anesthesia for cesarean delivery.     

Control of Carboplatin-Induced Emesis with a Fixed Low Dose of Granisetron (0.5 mg) plus Dexamethasone

In an effort to develop a cost-effective antiemetic regimen for carboplatin-based chemotherapy, we examined a fixed (0.5 mg) low dose of granisetron (a new 5-HT₃(serotonin) antagonist) plus dexamethasone (20 mg) in 23 patients with gynecologic malignancies receiving this antineoplastic drug. Nineteen (83%) patients experienced complete control of acute emesis (nausea and vomiting) while 22 (96%) individuals demonstrated complete or major control (≤2 episodes of vomiting, ≤5 episodes of retching, minimal interference with eating) of emetic events. We conclude that this fixed low-dose granisetron plus dexamethasone regimen is a safe, convenient, and cost-effective antiemetic program for individuals receiving carboplatin-based chemotherapy.