ABSTRACT
Vomiting of pregnancy is a physiological symptom of the first trimester and is a frequent reason for consultation as well as hospitalization in the severe forms (hyperemesis gravidarum), which complicate 0.3 to 4% of the pregnancies and represent the first cause of hospitalization in the first trimester. Hyperemesis gravidarum may be responsible for a loss of weight with dehydration and/or hypokalemia. The use of scores such as PUQE-modified or NVPQOL may allow an objective and accurate assessment of symptoms and impairment of quality of life. Organic disease should be always eliminated and hospitalization may be necessary to effectively treat vomiting and correct any electrolyte disorders.
Subject(s)
Hyperemesis Gravidarum/classification , Cross-Sectional Studies , Dehydration/etiology , Female , Hospitalization , Humans , Hyperemesis Gravidarum/diagnosis , Hyperemesis Gravidarum/epidemiology , Hyperemesis Gravidarum/therapy , Hypokalemia/etiology , Pregnancy , Quality of Life , Risk Factors , Weight LossABSTRACT
In a retrospective analysis of 192 cases of presumed hyperemesis gravidarum, there were no biochemical markers that predicted hospital readmission. There was, however, statistically significant negative predictive value in abnormal liver function tests. This could represent acute self-limited illness with a component of hepatitis as the cause for the clinical presentation, rather than hyperemesis.
Subject(s)
Hyperemesis Gravidarum/classification , Liver Function Tests , Patient Readmission/statistics & numerical data , Adult , Analysis of Variance , Aspartate Aminotransferases/blood , Biomarkers/blood , Female , Humans , Hyperemesis Gravidarum/blood , Hyperemesis Gravidarum/epidemiology , Length of Stay , Leukocyte Count , Liver/enzymology , Pregnancy , Retrospective Studies , Severity of Illness IndexABSTRACT
The medical and psychological treatment of hyperemesis gravidarum (HG) is generally acknowledged as being difficult. It is also recognized that the somatic changes during pregnancy play a role in the process of HG and that psychosocial factors are of particular importance. The following issues have been studied: psychosocial stressors; personality disorders; coping mechanisms and stress tolerance. The reviewed studies mention many different causes of HG. Some produce symptoms in certain women and some will not. As a result of clinical experience and observation during several years treating women with HG from a broad social, cultural and ethnic background in a large inner-city general hospital, we have been able to identify several subgroups of HG patients according to personality pathology, psychiatric symptoms and psychosocial stress factors. Accurate assessment is necessary in order to be able to tailor the interventions to the characteristics and needs of the individual patient. For the various subgroups different treatment strategies are recommended.
Subject(s)
Counseling , Hyperemesis Gravidarum/classification , Hyperemesis Gravidarum/psychology , Adaptation, Psychological , Adult , Female , Humans , Hyperemesis Gravidarum/therapy , Personality , Pregnancy , Risk Factors , Stress, Psychological/psychologyABSTRACT
Psychosocial factors have long been believed to be important in the pathogenesis of emesis gravidarum (morning sickness) and hyperemesis gravidarum (HG). Although this has been confirmed during extensive studies over the last 30 years, HG has never been described as a conversion reaction. We describe two women presenting with hyperemesis who clearly fulfill diagnostic criteria for conversion. We suggest that strong psychodynamic conflicts are expressed by this potentially dangerous symptom in a subset of individuals and that dynamic interventions have a role in treating certain patients with HG.
