Nausea%20-and-%20vomiting%20in%20pregnancy Signs and Symptoms
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