hyperemesis gravidarum
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Epidemiology
- 15% chance of recurrence with subsequent pregnancy[2]
- 3 times more common in daughters of affected mothers[4]
Pathology
- generally self-limited
- fetal production of GDF15, & maternal sensitivity to GDF15, contribute risk of hyperemesis gravidarum[5]
- increased circulating levels of chorionic gonadotropin
- liver disorder
Clinical manifestations
- severe vomiting
Laboratory
- serum transaminases < 500 IU/L (50%)[1]
- serum bilirubin < 4 mg/dL
- basic metabolic panel: electrolyte abnormalities[1]
- increased serum total T4
- low serum TSH
- blunted TSH response to TRH
Management
- clinical hydration
- intravenous fluids as needed[1]
- antiemetics[1], metoclopramide
- pyridoxine (vit B6) 10-25 mg TID-QID
- add doxylamine 12.5 mg with each dose of pyridoxine as needed
- accupressure[3]
More general terms
Additional terms
References
- ↑ Jump up to: 1.0 1.1 1.2 1.3 1.4 Medical Knowledge Self Assessment Program (MKSAP) 11, 16. American College of Physicians, Philadelphia 1998, 2012
- ↑ Jump up to: 2.0 2.1 Trogstad LI, Stoltenberg C, Magnus P, Skjaerven R, Irgens LM. Recurrence risk in hyperemesis gravidarum. BJOG. 2005 Dec;112(12):1641-5. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16305568
- ↑ Jump up to: 3.0 3.1 Prescriber's Letter 13(12): 2006 Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=221210&pb=PRL Gastrointestinal drug use during pregnancy (subscription needed) http://www.prescribersletter.com
- ↑ Jump up to: 4.0 4.1 Vikanes A et al Recurrence of hyperemesis gravidarum across generations: population based cohort study BMJ 2010;340:c2050 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/21030362 <Internet> http://www.bmj.com/cgi/content/full/340/apr29_1/c2050
Nelson-Piercy C (Editorial) Recurrence of hyperemesis across generations BMJ 2010;340:c2178 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/21030363 <Internet> http://www.bmj.com/cgi/content/extract/340/apr29_1/c2178 - ↑ Jump up to: 5.0 5.1 Fejo M, Rocha N, Cimino I et al GDF15 linked to maternal risk of nausea and vomiting during pregnancy. Nature. 2-23. Dec 13. PMID: https://www.ncbi.nlm.nih.gov/pubmed/38092039 https://www.nature.com/articles/s41586-023-06921-9