hyperemesis gravidarum /hī′pərem″isis/ [Gk, hyper + emesis, vomiting; L, gravida, pregnant] , an abnormal condition of pregnancy characterized by protracted vomiting, weight loss, and fluid and electrolyte imbalance. If the condition is severe and intractable, brain damage, liver and kidney failure, and death may result. The cause of the condition is not known; an increase in levels of chorionic gonadotropins or other hormones, an immunological sensitivity to products of conception, or aggravation of preexisting emotional conflicts has been suggested, but a causal relationship has not been proved. It occurs in approximately 3 of every 1000 pregnancies. Its incidence has diminished in recent years. ▪ OBSERVATIONS: Dry mucous membranes are a sign of dehydration. Other signs include decreased skin elasticity, a rapid pulse, and falling blood pressure. The specific gravity of the urine rises, and the volume of urine excreted falls. The hematocrit is elevated because of hemoconcentration. Loss of electrolytes in vomitus leads to metabolic acidosis with hypokalemia, hypochloremia, and hyponatremia. Severe potassium deficit alters myocardial function; the electrocardiogram may show prolonged P-R and Q-T intervals and inverted T waves. In addition to weight loss, undernourishment causes fever, ketosis, and acetonuria. Severe vitamin B deficiency may result in encephalopathy manifested by confusion and eventually coma. Laboratory analyses of blood indicate increased concentrations of metabolic products normally cleared by the liver and kidneys. Forceful vomiting may cause retinal hemorrhages that impair vision and gastroesophageal tears that bleed, causing hematemesis or melena. ▪ INTERVENTIONS: Effective therapy arrests vomiting and achieves rehydration, adequate nutrition, and emotional stabilization. Bed rest is instituted. Antiemetics safe for the fetus are sometimes administered. Fluids, electrolytes, nutrients, and vitamins are given parenterally if the woman is unable to retain fluids by mouth. The fetal heart rate is measured frequently. Psychiatric consultation and therapy are sometimes beneficial. Termination of pregnancy is curative but almost never required. ▪ PATIENT CARE CONSIDERATIONS: Women are often frightened of and uncomfortable about their illness at a time when they worry about the health of their unborn child as well as their own health. Visitors are encouraged; isolation, formerly recommended, is not desirable. Sympathetic listening and supportive, nonjudgmental care are provided. The woman and her family are told often that the prognosis is excellent for both mother and baby. The woman is weighed regularly, and her weight is accurately recorded, for the best evidence of recovery is steady weight gain.
