-IBIS-1.5.0-
tx
endocrine system
nausea of pregnancy
diagnoses
definition and etiology
definition: Nausea and vomiting associated with the first trimester of pregnancy. If it progresses to the point where the woman suffers from dehydration, acidosis, and starvation it is termed "Hyperemesis gravidarum".
etiology: Normal nausea during pregnancy results from production of human chorionic gonadotrophin (HCG) and estrogen, which the syncytial cells in the placenta secrete in growing amounts 10 days after fertilization occurs. Persistent hyperemesis gravidarum can be associated with serious liver disease, pancreatitis, kidney disease, GI tract lesions, intestinal obstruction, and intracranial lesions.
There is a suggested connection with low B6, folic acid and/or progesterones.
signs and symptoms
normal nausea of pregnancy:
Nausea and vomiting in the morning, and when preparing or smelling food.
Signs of pregnancy: Chadwick's, Goodell's, etc. Otherwise the PE will be normal.
Normal weight gain occurs and the woman is not dehydrated.
Usually the worst of the nausea and vomiting is over by the sixth week of pregnancy.
hyperemesis gravidarum:
The normal signs of pregnancy but may be losing weight rather than gaining it.
Dehydration.
Vomiting is frequent and intense.
If the woman has hemorrhagic retinitis the condition is very severe: therefore, frequent ophthalmoscopic examinations should be performed.
lab findings: Investigate the underlying process when excessive vomiting is occurring.
CBC
dehydration, electrolyte imbalance with acidosis
liver enzymes may be abnormal
course and prognosis
Normal nausea of pregnancy usually passes without complication, although the patient may suffer uncomfortably until it fades. In hyperemesis gravidarum the prognosis is guarded and hospitalization is usually required to reverse acidosis and treat dehydration, as well as giving anti-emetics/IV vitamins/sedatives as necessary. If hemorrhagic retinitis appears the situation is very serious, as the mortality rate in such cases is 50%.
differential diagnosis
Determine the cause in a pregnant patient.
Other causes of nausea in the non-pregnant patient
footnotes