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

• Nausea and 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 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
• The pregnant woman’s sense of well-being and her daily activities are greatly affected by NVP; the physical and emotional impact often leads to anxiety and worry about the effect of the symptoms on the fetus and reduced job efficiency

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

• 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
• 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

• Represents the most severe form of NVP
• Most common reason for hospital admission during the 1st part of pregnancy 
• A diagnosis of exclusion based on typical signs and symptoms in the absence of other causes that may explain the clinical presentation 
• Criteria for diagnosis are as follows: 
  • Persistent vomiting not related to other causes
  • Evidence of weight loss, usually ≥5% of prepregnancy weight
  • Evidence of starvation, ie ketonuria
  • Abnormalities of electrolyte levels, thyroid and liver may also be present
• May lead to significant complications including the following:
  • Rupture of the esophagus 
  • Acute tubular necrosis 
  • Wernicke’s encephalopathy secondary to Thiamine deficiency 
  • Hyperthyroxinemia with low thyroid-stimulating hormone (TSH) levels
  • Depression

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 NVP

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