A hyperemesis gravidarum (hyperemesis gravidarum) is sustained, strong pregnancy-induced vomiting, which causes a marked dehydration, often accompanied by electrolyte imbalance, ketosis and weight loss.
Nausea and vomiting occurs in up to 80% of pregnant women. The symptoms are during the first trimester most common and most. In common parlance says morning sickness that nausea and / or vomiting may occur in general at any time of the day. Symptoms vary from mild to severe (hyperemesis gravidarum). A hyperemesis gravidarum (hyperemesis gravidarum) is sustained, strong pregnancy-induced vomiting, which causes a marked dehydration, often accompanied by electrolyte imbalance, ketosis and weight loss. Pathophysiology The pathophysiology of nausea and vomiting in early pregnancy is unknown, although probably metabolic, endocrine, gastrointestinal and psychological factors play a role. Estrogen may be involved because the estrogen levels are increased in patients with hyperemesis gravidarum. Etiology The most common causes of uncomplicated nausea and vomiting in early pregnancy (see Table: Causes of nausea and vomiting in early pregnancy) are Morning sickness (most common) hyperemesis gravidarum gastroenteritis occasionally cause ferrous Pregnancy vitamin supplements nausea. More rarely a threatening persistent vomiting is triggered by a molar pregnancy. Vomiting can also be caused by a number of pregnancy-independent disease. Common causes of an acute abdomen (z. B. appendicitis, cholecystitis) may occur during pregnancy and be accompanied by vomiting, but the main complaint is pain and vomiting not usually. Likewise, some CNS disorders (eg., Migraine, CNS hemorrhage, increased intracranial pressure) may be accompanied by vomiting, but headaches or other neurological symptoms are usually the dominant complaints. Causes of nausea and vomiting in early pregnancy cause Suspicion Results Diagnostic procedure pregnancy Depending Morning sickness (uncomplicated nausea and vomiting) Light, intermittent symptoms at different times of day, especially during the first trimester normal vital signs and physical examination diagnosis of exclusion hyperemesis gravidarum Frequent, persistent Ov to take elkeit and vomiting with the inability orally a sufficient amount of liquid and / or food to be Usually signs of dehydration (z. As tachycardia, dry mouth, thirst), weight loss ketone bodies in urine, serum electrolytes, magnesium, blood urea nitrogen, creatinine case of prolonged state, if necessary, liver function tests, pelvic ultrasonography hydatidiform uterus greater than expected, lack of fetal heart sounds and movements Occasionally, elevated blood pressure, vaginal bleeding, grapes-like tissue from the cervix blood pressure measurement, quantitative hCG, pelvic ultrasound, biopsy pregnancy Regardless acute gastroenteritis, non-chronic; often diarrhea accompanied Normal (benign) abdomen (soft, not painful, not distended) Clinical examination intestinal obstruction acute, often in patients with surgery on the abdomen Colicky pain with constipation and distended, tympanischem abdomen can be caused by appendicitis or in patients with appendicitis Abdomenübersichtsaufnahmen occur in the lying and standing, ultrasound and possibly CT (for unclear X-ray and ultrasound findings) urinary tract infection or pyelonephritis Frequent urination, urinary urgency or urinary retention, with or without flank pain and fever Urinalysis and urine culture hCG = human chorionic gonadotropin. Clarification Severe or life-threatening causes of nausea and vomiting have to be digested. Morning sickness (uncomplicated nausea and vomiting) and hyperemesis gravidarum are diagnosis of exclusion. History In the history of the current disease should be especially take into account: the beginning and duration of vomiting Triggering and relieving factors type (eg bloody, watery, bilious.) And quantity of vomiting Common (intermittent or persistent) Important associated symptoms include diarrhea, constipation and abdominal pain. When occurring pain of location, presence and severity should be requested. It should also be asked what social impacts the symptoms of the patient and her family had (z. B. if she is able to work or to care for their children). The review of Organysteme should symptoms pregnancy independent causes of nausea and vomiting include, including fever or chills, especially when associated with flank pain or voiding symptoms (urinary tract infection or pyelonephritis), and neurological symptoms such as headache, weakness, focal deficits and confusion (migraine or CNS bleeding ). During the history of questions about morning sickness or hyperemesis be asked in previous pregnancies. Regarding past surgical procedures especially abdominal procedures are clarified, which would increase the risk of a mechanical bowel obstruction. Drugs that are taken by the patient to be examined to see whether they could play a role (eg. As iron-containing compounds, hormone therapy), and whether it begins Examination safe in pregnancy sind.Körperliche examination to test vital signs for fever , tachycardia, and abnormal blood pressure (too low or too high). While the general assessment is paid to signs of intoxication (eg. As lethargy, confusion, agitation). A complete physical examination, including a pelvic exam is performed to detect symptoms of serious or potentially life-threatening causes of nausea and vomiting ( see table: relevant physical examination findings in a pregnant patient with vomiting). Relevant physical examination findings in a pregnant patient with vomiting organ system findings General lethargy, restlessness HEENT dry mucous membranes, sclera icteric neck stiffness in passive flexion (neck stiffness) Gastrointestinal distention with bloat Missing or high-sounding bowel sounds focal e sensitivity Peritonealzeichen (Defense voltage hardened abdominal wall, rebound tenderness) Urogenital flank pain at knock uterus larger than expected lack of fetal heart sounds grape-like tissue from the uterus Neurological confusion, photophobia, focal weakness, nystagmus HEENT = head, eyes, ears, nose and throat (head, eyes, ears, nose, and throat). Warning The following findings are particularly important: abdominal pain signs of dehydration (eg, orthostatic hypotension, tachycardia.) Fever Bloody or bilious vomiting No Child movement or fetal heart tones Abnormal neurological findings Persistent or worsening symptoms interpretation of the findings, the distinction between schwangerschaftsabhängigem vomiting and vomiting due to other causes is important. The clinical manifestation is helpful (see p. Causes of nausea and vomiting in early pregnancy). If the vomiting starts after the first trimester, or is accompanied by abdominal pain and / or diarrhea, it is less likely due to the pregnancy. Abdominal tenderness could indicate an acute abdomen. Meningism and / or neurologic abnormalities indicate a neurological cause. Vomiting is more justified when it starts during the first trimester, it lasts for several days or weeks to returns, missing abdominal pain and there are no signs or symptoms of involvement of other organ systems in pregnancy. If the vomiting seems to be pregnancy related and severe runs (that is frequent, prolonged, accompanied by dehydration), hyperemesis should gravidarum and hydatid considered werden.Tests In patients with significant vomiting and / or signs of dehydration tests are usually required , If suspicion of hyperemesis gravidarum is that ketone bodies are determined in urine. If the symptoms are particularly severe or persistent, the serum electrolytes should be checked. If fetal heart tones are not detectable audibly or by fetal Doppler examination, a molar pregnancy should be ruled out with a pelvic sonography. Based on clinical suspicion diagnoses pregnancy independent diseases are more investigations initiated (see Fig. Causes of nausea and vomiting in early pregnancy). Treatment of pregnancy-induced vomiting can by frequent drinking or eating (5-6 small meals / day) be alleviated, but it should only bland foods (eg. As biscuits, soft drinks, BRAT diet [bananas, rice, applesauce, dry toast] ) will be included. to eat before getting up can be helpful. In cases of suspected Exsikkose (z. B. on the bottom of a hyperemesis gravidarum), 1-2 l of 0.9% NaCl or Ringer-lactate solution i.v. administered and detected electrolyte disturbances are compensated. Certain medicines (see Table: Recommended drugs for nausea and vomiting in early pregnancy) that have no evidence of adverse effects in the fetus can be given for the relief of nausea and vomiting during the first trimester. Recommended drugs for nausea and vomiting in early pregnancy drug dosage vitamin B6 (pyridoxine) 25 mg po 3 times daily doxylamine 25 mg p.o. p.o. before bedtime Promethazine 12.5-25 mg, i.m. or rectally every 6 h as required metoclopramide 5-10 mg every 8 h p.o. or i.m. Ondansetron 8 mg p.o. or i.m. every 12 h as necessary vitamin B6 is used as monotherapy; the symptoms improve not other drugs are given. Ginger (z. B. ginger capsules 250 mg po three times or two times a day, Ginger Candies) acupuncture, patches for motion sickness and hypnosis can, as well as a change from pregnancy vitamins to children’s Vitaminkaubonbons with folic acid, be helpful. Summary vomiting during pregnancy improves usually by itself and is responsive to change in diet. Hyperemesis gravidarum is rare, but severe, leading to dehydration, ketosis, and weight loss. Independent pregnancy causes should be considered.