Merck's Hyperemesis Gravidarum - may lead to abortion

Hyperemesis Gravidarum

Uncontrollable nausea and vomiting during pregnancy that results in dehydration and acidosis.

http://www.merck.com/mrkshared/mmanual/section18/chapter252/252c.jsp

Hyperemesis gravidarum is distinct from ordinary morning sickness with nausea and vomiting. Many pregnant women with morning sickness feel as though they are vomiting everything they ingest, but if they continue to gain weight and are not dehydrated, they do not have hyperemesis gravidarum. Weight loss, dehydration, and ketosis confirm extensive vomiting. Psychologic factors are prominent in hyperemesis gravidarum but do not lessen the danger.

Persistent hyperemesis gravidarum is uncommon but may be associated with serious liver damage. Autopsies in such cases usually show severe centrilobar necrosis or widespread fatty degeneration similar to that seen in starvation.

Patients should be evaluated for unsuspected liver disease, kidney infection, pancreatitis, intestinal obstruction, GI tract lesions, and intracranial lesions, all of which can cause vomiting.

Treatment

Acidosis and dehydration are corrected with IV infusion of water, glucose, and electrolytes. The patient should be kept in bed in a hospital and given nothing by mouth for 24 h. Antiemetics and sedatives should be used as necessary. Occasionally, IV vitamin therapy is required. After dehydration and acute vomiting are corrected, small, bland oral feedings at frequent intervals may be started and increased as tolerated. Usually vomiting ceases within a few days, but sometimes the regimen of fasting, IV fluids, and small meals has to be repeated once or twice.

Repeated ophthalmoscopic examinations are imperative, and if hemorrhagic retinitis appears, the pregnancy should be terminated at once. Even if retinitis does not develop, termination of the pregnancy should be considered in the rare cases that do not respond to therapy (as evidenced by continued weight loss, jaundice, and increasing pulse rate).