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NAUSEA & VOMITING IN PREGNANCY
Nausea & vomiting in pregnancy (NVP), commonly known as "morning sickness", affects 50-90% of pregnant women.
In most women, the condition manifests between the 4th-7th week after last menstrual period and resolves by the 16th week of gestation.
It manifests in a spectrum of severity from mild nausea to very rare life-threatening symptoms.
The etiology is multifactorial.
The pregnant woman's sense of well-being and her daily activities are greatly affected by nausea and vomiting; the physical and emotional impact often leads to anxiety and worry about the effect of the symptoms on the fetus and reduced job efficiency.

Introduction

  • Nausea and vomiting in pregnancy (NVP), commonly known as “morning sickness”, affects 50-90% of pregnant women
  • In most women (60%), the condition manifests between the 4th-7th week after the last menstrual period and resolves by the 16th-20th week of gestation
    • About 9% of women have symptoms that last after the 16th week 

Definition

Hyperemesis Gravidarum

  • The most severe form of nausea and vomiting in pregnancy (NVP) affecting 0.3%-2% of all pregnant women
  • Persistent vomiting (>3x daily) may lead to dehydration and electrolyte disturbances, ketosis, acetone in the blood, and weight loss >5% of prepregnancy weight
  • In severe cases, liver function tests (LFTs) may be deranged, urinalysis may show ketonuria, and imbalance is noted on serum creatinine and electrolyte measurements

Etiology

  • Etiology is multifactorial
    • Other possible causes include genetic, vestibulo-ocular reflex abnormality, H pylori infection, psychological,hormonal [progesterone, estrogen, human chorionic gonadotropin (hCG), thyroxin, ghrelin, leptin, nesfatin-1, PYY-3]

Signs and Symptoms

  • Symptoms can occur at any time of the day; therefore, the term “morning sickness” is incorrect
    • 95% of patients have symptoms before and after midday and 4% experience symptoms only in the morning
  • Nausea and vomiting in pregnancy (NVP) manifests in a spectrum of severity from mild nausea to very rare life-threatening symptoms
    • Generally a mild, self-limited condition that may be controlled with conservative treatment
    • Only a small percentage of patients have a profound course

Risk Factors

Maternal factors and fetal conditions associated with increased risk of hyperemesis gravidarum:

  • Nulliparity
  • Obesity
  • Young maternal age
  • Increased placental mass (multiple gestation, gestational trophoblastic disease)
  • Triploidy
  • Fetal down syndrome
  • Hydrops fetalis

Other predisposing factors for nausea and vomiting in pregnancy (NVP):

  • Family history or a history of hyperemesis gravidarum in previous pregnancy
  • Increased levels of human chorionic gonadotropin (hCG) and estrogen
  • Medical conditions like migraine and history of motion sickness
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