HYPEREMESIS GRAVIDARUM IN A TERTIARY CARE CENTRE IN EASTERN NEPAL: A PROSPECTIVE OBSERVATIONAL STUDY
AbstractBackground: Hyperemesis gravidarum (HG) is the most severe form of nausea and vomiting of pregnancy which can have potentially dangerous complications if untreated. Its treatment is basically supportive as the condition itself is self-limiting. The aim of our study was to evaluate maternal characteristics in patients with HG including risk factors and treatment outcome with respect to improvement in Pregnancy Unique Quantification of Emesis (PUQE) scores, number of doses of antiemetics used, weight gain during treatment and duration of intravenous fluid therapy Methods: A cross-sectional study where all women admitted to B.P. Koirala Institute of Health Sciences with a diagnosis of HG during a period of one year were studied for different maternal characteristics. The severity of disease was quantified using Modified PUQE score and the various treatment outcomes considered. Results: The admission for hyperemesis gravidarum (n=81, including 13 readmissions) was 10.64% of total early pregnancy admissions (n=735).The condition was more common in nulliparous patients (56%) at a mean period of gestation of 8.93±2.33wks. Most patients suffered from moderate to severe disease at presentation, mean PUQE scores being 12.29±1.59.The median number of doses of intravenous antiemetics used was three (IQR 3-6), median weight gain was one kg (IQR 0-1kg), median duration of intravenous fluid therapy was 24hrs (IQR 24-48hrs) and mean length of hospital stay was 3.2±1.48 days. Conclusions: Hyperemesis is one of the common causes of hospitalization in early pregnancy. Treatment has favourable outcome with early recovery.
Ismail SK, Kenny L. Review on hyperemesis gravidarum. Best Pract Res ClinGastroenterol2007;21(5):755–69.
Koren G, Boskovic R, Hard M, Maltepe C, Navioz Y, Einarson A.Motherisk-PUQE (pregnancy-unique quantiﬁcation of emesis and nausea) scoring system for nausea and vomiting of pregnancy. Am J ObstetGynecol 2002;186(5):S228–31.
Koren G, Piwko C, Ahn E, Boskovic R, Maltepe C, Einarson A, et al. Validation studies of the Pregnancy Unique-Quantiﬁcation of Emesis (PUQE) scores. J ObstetGynaecol 2005;25(3):241–4.
Attard CL, Kohli MA, Coleman S, Bradley C, Hux M, Atanackovic G, et al. The burden of illness of severe nausea vomiting of pregnancy in United States. Am J ObstetGynecol2002;186(5):S220–7.
Bashiri A, Neumann L, Maymon E, Katz M. Hyperemesis gravidarum: epidemiologic features, complications and outcome. Eur JObstetGynecolReprodBiol 1995;63(2):135–8.
Bailit JL. Hyperemesis gravidarum: epidemiologic ﬁndings from a large cohort. Am J ObstetGynecol 2005;193(3 Pt 1):811–4.
Tsang IS, Katz VL, Wells SD. Maternal and fetal outcomes in hyperemesis gravidarum. Int J GynaecolObstet 1996;55(3):231–5.
Gazmararian JA, Petersen R, Jamieson DJ,Schild L, Adams MM, Deshpande AD, et al. Hospitalizations during pregnancy among managed care enrollees. ObstetGynecol 2002;100(1):94–100.
Giri A, Tuladhar A, Tuladhar H. Hyperemesis gravidarum and obstetric outcome. Nepal JObstetGynaeocol 2011;6(2):24–6.
Dodds L, Fell DB, Joseph KS,Allen VM, Butler B. Outcomes of pregnancies complicated by hyperemesis gravidarum. ObstetGynecol 2006;107(2 Pt 1):285–92.
Klebanoff MA, Koslowe PA, Kaslow R, Rhodes GG. Epidemiology of vomiting in early pregnancy. ObstetGynecol 1985;66(5):612–6.
Price A, Davies R, Heller SR, Milford-Ward A, Weetman AP. Asian women are at risk of gestational thyrotoxicosis. J ClinEndocrinolMetab 1996;81(3):1160–3.
Fejzo MS, Ingles SA, Wilson M, Wang W, MacGibbon K, Romero R, et al. High prevalence of severe nausea and vomiting of pregnancy and hyperemesis gravidarum among relatives of affected individuals .Eur J ObstetGynecolReprodBiol2008;141(1):13–7.
Sullivan CA, Johnson CA, Roach H, Martin RW, Stewart DK, Morrison JC. A pilot study of intravenous ondansetron for hyperemesis gravidarum. Am J ObstetGynecol 1996;174(5):1565–8.
Fell DB, Dodds L, Joseph KS,Allen VM,Butler B. Risk factors for hyperemesis gravidarum requiring hospital admission during pregnancy.ObstetGynecol 2006;107(2 Pt 1):277–84.
Trogstad LI, Stoltenberg C, Magnus P, Magnus P, Skjaerven R, Irgens LM. Recurrence risk in hyperemesis gravidarum. BJOG 2005;112(12):1641–5.
Poursharif B, Korst LM, Macgibbon KW, Fejzo MS, Romero R, Goodwin TM. Elective pregnancy termination in a large cohort of women with hyperemesis gravidarum. Contraception 2007;76(6):451–5.