Hyperemesis gravidarum (HG) refers to severe and persistent nausea and vomiting during the first trimester of pregnancy, resulting in dehydration, ketosis, and even acidosis, requiring hospitalization.
The incidence of hyperemesis gravidarum is about 0.3-3%, but late or incomplete treatment will lead to serious complications, and even endanger the safety of the mother’s life.
Management of patients with hyperemesis gravidarum depends on the severity of symptoms, their impact on health and quality of life, and the safety of treatment for the mother and fetus. It generally includes non-drug treatment, drug treatment, nutritional treatment after hospitalization, etc.
Hyperemesis gravidarum is usually developed from nausea and vomiting during pregnancy, and the control of mild to moderate nausea and vomiting is the key to prevent its further development. Once the disease worsens, control becomes more difficult.
(1) Prevention: starting vitamin supplementation 1 month before pregnancy can effectively reduce the incidence and severity of nausea and vomiting during pregnancy;
(2) Change habits: rest and avoid the odor and other stimuli that can aggravate symptoms, which can often be identified by pregnant women in daily contact; Avoid fasting in the morning, eat little meals, eat slowly, avoid stomach distension; Eat a light, high-protein diet and avoid spicy and greasy foods.
③ Adjuvant treatment: studies have shown that ginger can relieve nausea symptoms, but can not relieve vomiting; Taking ginger preparations (tea, food, drink, sugar, etc.) during pregnancy is a great way to relieve nausea. Avoid taking iron, which can irritate the stomach and induce nausea and vomiting.
After diagnosis and evaluation, mild to moderate pregnancy nausea and vomiting can be alleviated outside the hospital with drug therapy and non-drug therapy; When the disease is further aggravated, and even develops to hyperemesis gravidarum, it is necessary to be hospitalized, mainly with multi-line drug therapy.
Vitamin B6 or vitamin B6 in combination with doxiiramine or vitamin B6/ doxiiramine combination is approved by the FDA and recommended as first-line medication. Antihistamines such as diphenhydramine or tea phenhydramine should be considered if they are not effective in alleviating symptoms of hyperemesis gravis.
When the disease is not under control but there is no dehydration, metoclopramide, Ondansetron, promethazine and so on can be combined as appropriate.
When the disease is not under control and dehydration has occurred, diphenhydramine, methoclopramide, ondansetron, or promethazine can be used in addition to the previous treatment for antiemetic treatment, but active fluid rehydration should be used in conjunction with antiemetic treatment.
The daily volume of intravenous fluid was 3000ml, vitamin B1, B6, and C were supplemented, and continuous fluid supplementation was maintained for at least 3 days, and the daily urine volume was maintained at ≥1000ml.
Note: ① Vitamin B1 should be added before glucose infusion to prevent Wernicke’s encephalopathy;
② The polarized solution was composed of glucose 50g, insulin 10U and 10% potassium chloride 1.0g to supplement energy;
③ Potassium supplementation: 3-4G /d (6-8g/d in severe cases), 1g potassium /500ml urine is safe;
④ Monitor electrolyte;
Studies have shown that glucocorticoid can effectively relieve the symptoms of hyperemesis gravidarum. However, considering that the use of glucocorticoid in early pregnancy may lead to the occurrence of fetal cleft lip and palate, it must be applied only when the treatment has no obvious effect.
ACOG recommends that the use of first-line drugs should be avoided before 10 weeks of gestation, but should be stopped immediately if symptoms do not improve within 3 days, and be gradually reduced within 2 weeks for effective patients, and the duration of use should be controlled within 6 weeks.
The treatment of hyperemesis gravidarum is more dependent on the control of medication, and the delay of illness is often due to the safety of medication. Among them, ondansetron and glucocorticoid have been shown to be associated with the risk of fetal malformation, and the rest of the drugs during pregnancy are relatively safe.
However, phenothiazines and metoclopramide may cause extrapyramidal adverse reactions and should be carefully considered before use.
Prevention or early intervention of hyperemesis gravidarum can often effectively control the condition of hyperemesis gravidarum, but when it develops to a certain extent, serious physical complications will follow. The pregnancy should be terminated immediately if all treatments have been tried and the condition has not been relieved or if the patient has the following conditions:
(1) The body temperature was continuously higher than 38℃;
② Heart rate in bed > 120 beats/min;
Persistent jaundice or proteinuria;
④ Signs of polyneuritis;
⑤ Intracranial or fundus hemorrhage does not improve after treatment;
(6) Wernicke’s encephalopathy (blindness, convulsions, coma);
Although death from hyperemesis gravidarum is rare, the complications caused by hyperemesis gravidarum can be overwhelming for pregnant women.
In light cases, low birth weight infants, small for gestational age infants are caused; in severe cases, venecke encephalopathy, splenic rupture, esophageal rupture, pneumothorax and renal tubular necrosis are caused, which directly threaten the life safety of pregnant women. In addition, women with hyperemesis gravidarum have a higher risk of mental illness. Therefore, it is necessary to correctly grasp the key points of processing and escort the safety of mothers and children.