Hyperemesis gravidarum

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Classification according to ICD-10
O21.0 Slight hyperemesis gravidarum
O21.1 Hyperemesis gravidarum with metabolic disorder
ICD-10 online (WHO version 2019)

As hyperemesis gravidarum ( uncontrollable vomiting of pregnant women , nor uncontrollable vomiting during pregnancy ) is excessive and persistent, often throughout the day as well as nightly vomiting referred to with an empty stomach, especially in the first trimester of pregnancy ( trimester occurs) and about after the 14th Week of pregnancy subsides, but seldom lasts beyond the 20th week. Occasionally women also suffer from severe nausea and vomiting up to birth . About 0.5 to 1 percent of pregnant women show a threatening hyperemesis gravidarum, which, in contrast to the frequent vomiting of pregnancy (emesis gravidarum), can have serious consequences with an increased risk for mother and child. If hyperemesis gravidarum is treated improperly or not at all, the suffering of the pregnant woman can lead to a desired termination of the pregnancy , solely because of the unbearable nausea and vomiting. Taking the patient seriously in her condition and prompt therapeutic intervention are of the highest priority.

causes

The exact origin of hyperemesis gravidarum, first mentioned by Soranos in the 2nd century, as a symptom of an early gestosis is still unclear. Hormonal factors certainly play a role, since hyperemesis is more common in multiple pregnancies or a mole with its increased hCG level. The hCG stimulates the TSH receptor and leads to pseudo hyperthyroidism in pregnant women. Hyperemesis can often occur here.

However, it is still unclear whether the high hormone concentrations in themselves trigger the hyperemesis, or whether some people are simply more sensitive to the normal increase in hormones. However, the following hormones / mechanisms could play a role in hyperemesis:

A genetic aspect of excessive vomiting, also known as early toxicosis, has been discussed for some time (familial accumulation). In March 2018, a study was published in which it was shown that two genes (GDF15 and IGFBP7) are associated with hyperemesis gravidarum. Both GDF15 and IGFBP7 play an important role in early pregnancy (they promote implantation, minimize the risk of miscarriage). They are also associated with appetite regulation and tumor cachexia , a condition that is phenomenologically similar to hyperemesis gravidarum.

Symptoms and Diagnosis

Symptoms are severe, constant nausea and numerous vomiting, especially in the morning, but very often also spread over the whole day and at night. The lack of fluids leads to desiccosis (dehydration) with a weight loss of more than 5 percent of the initial value before pregnancy and a dry tongue, as well as poor circulation with tachycardia (rapid pulse) and hypotension (low blood pressure). Electrolyte imbalances with hypochloremia and foetor ex ore (acetone odor) as well as occurrence of ketone bodies and cylinders in the urine and protein, urobilinogen and porphyrinuria. In addition, there is a metabolic alkalosis .

In exceptional cases there is a deterioration in the general condition, fever, jaundice and cerebral symptoms (such as drowsiness and delirium ). Extreme complications such as loss of vitamins, impaired metabolism and electrolyte imbalances in hyperemesis gravidarum can also result in Wernicke encephalopathy , central pontine myelinolysis , vasospasm of the cerebral arteries , rhabdomyolysis , coagulopathy or peripheral neuropathy . The diagnosis of hyperemesis gravidarum is based on the clinical picture.

treatment

In most cases, it is sufficient to admit the patient as an inpatient and provide intravenous fluids, vitamins, and electrolytes to relieve symptoms and prevent more serious complications.

If this is not enough, antiemetic therapy must be started. Historical attempts at treatment have been made with cocaine , for example .

A drug used today is ondansetron ( e.g. in Zofran ), which was originally developed for the nausea of ​​cancer patients during chemotherapy and radiation therapy . In one study, an increased risk of developing an increased risk of cleft lip and palate was observed when ondansetron was administered in the first trimester of pregnancy . For this reason, the Federal Institute for Drugs and Medical Devices issued a warning against use in this situation ( Rote-Hand-Brief ). Drugs suitable for pregnant women are e.g. B. dimenhydrinate or doxylamine . Other possible measures are acupressure or the consumption of ginger (in various forms). Psychotherapy is only indicated if the person concerned expressly requests it as a treatment for the psychological stress caused by hyperemesis.

literature

Web links

Individual evidence

  1. ↑ a b c d M. FG Verberg, DJ Gillott, N. Al-Fardan, JG Grudzinskas: Hyperemesis gravidarum, a literature review. In: Human Reproduction Update . 2005, Vol. 11, No. 5, pp. 527-539.
  2. ↑ Horst Kremling : On the history of the gestosis. In: Würzburger medical history reports 17, 1998, pp. 261–274; here: p. 261 f.
  3. ^ Pschyrembel Clinical Dictionary. Founded by Willibald Pschyrembel. Edited by the publisher's dictionary editors, 255th edition. De Gruyter, Berlin 1986, p. 738.
  4. ^ Fritz Engelmann: Cocaine for insatiable vomiting in pregnant women. In: Centralblatt für Gynäkologie. Volume 10, No. 25, June 19, 1886, p. 396.
  5. ^ April Zambelli-Weiner, Christina Via, Matt Yuen, Daniel J. Weiner, Russell S. Kirby: First trimester ondansetron exposure and risk of structural birth defects . In: Reproductive Toxicology . tape 83 , January 1, 2019, ISSN  0890-6238 , p. 14–20 , doi : 10.1016 / j.reprotox.2018.10.010 ( sciencedirect.com [accessed October 1, 2019]).
  6. ↑ BfArM - Rote-Hand-Briefe and Informationsbriefe - Rote-Hand-Brief on Ondansetron: Increased risk of orofacial malformations when used in the first trimester of pregnancy. Retrieved October 1, 2019 .