Question

What is the difference between morning sickness and hyperemesis gravidarum?

What signs and symptoms will this patient possibly have?

What kind of labs need to be looked at with this patient, and why are those important?

What would be necessary for you to educate your patient on? Describe your teaching method for this patient?

Answer 1

What is the difference between morning sickness and hyperemesis gravidarum?

Morning sickness or emesis gravidarum is the complaint of nausea and occasional vomiting experienced in the early morning on rising by women during early pregnancy. It is experienced by nearly 50% of pregnant women and does not have any deleterious effect on the health of pregnant women or restricts her day to day activities. It is considered as a normal symptom of early pregnancy and is caused by high levels of human chorionic gonadotrophin (HCG) hormone. It generally does not require any treatment and resolves on its own towards the end of the first trimester.

On the other hand, hyperemesis gravidarum is severe type of vomiting which has an adverse effect on the health of pregnant women (dehydration and starvation) and incapacitates her day to day functioning. It is a pathological condition requiring appropriate evaluation and management.

What signs and symptoms will this patient possibly have?

A pregnant woman with hyperemesis gravidarum will present with increased frequency of vomiting with retching. Due to this and self-restriction from fear of vomiting, her oral intake is reduced resulting in dehydration, constipation and oliguria. Women may present with features of dehydration like dry coated tongue, sunken eyes, the fruity smell in the breath (ketoacidosis from starvation), tachycardia, hypotension, and increased temperature.

What kind of labs need to be looked at with this patient, and why are those important?

A patient with hyperemesis gravidarum needs to be investigated for the examination of urine, the biochemical examination of blood and assessment for signs of complications.

Urine should be evaluated for-

· Quantity - small quantity indicates dehydration and decreased renal blood flow

· Colour- dark colour (concentrated urine)

· Presence of acetone - indicates ketoacidosis resulting from starvation

Serum electrolytes to assess the impact of dehydration on serum electrolytes

ECG- to assess the effect of abnormal serum potassium on heart

Ultrasonography to assess foetal wellbeing and rule out possible causes of excessive vomiting like obstetric causes (hydatidiform mole, multiple pregnancy), gynaecological (e.g. ovarian cyst, uterine fibroid), medical-surgical (e.g. pyloric stenosis, appendicitis) etc.

What would be necessary for you to educate your patient on? Describe your teaching method for this patient?

· Patient with hyperemesis gravidarum need the following care-

· Sympathetic handling, listening and understanding the patient.

· Maintain hyperemesis chart by recording vitals (temperature, pulse, and blood pressure), oral and parenteral intake, weight, urine output and urine examination for ketones and proteins and results of serum electrolytes.

· Hospitalization, if required. Withhold all oral intake for at least 24 hours after cessation of vomiting and nutritional support with intravenous fluids.

· Antiemetic drugs like Promethazine or Prochlorperazine

· Other symptomatic management like treatment of hypotension, supplementation of vitamins etc.

· Resumption of oral feeding, begin with small frequent meals and gradually progress to full diet.

Teaching method for patient:

· Individualized health education using appropriate audio visual aids planned on the basis of her educational status, economic condition and cultural norms etc.

· Instructional pamphlet or written instruction about self-care including diet and symptoms to notice and report.

· Demonstration of how to maintain hyperemesis chart at home.