Hospital admission for hyperemesis gravidarum in women at increased risk of spontaneous preterm birth (original) (raw)
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Frequency of Hyperemesis Gravidarum and associated risk factors among pregnant women
JPMA, 2020
Hyperemesis gravidarum (HG) is a severe complication of pregnancy characterised by severe nausea and vomiting. It occurs in 0.3-2% of all pregnancies. 1 It usually results in dehydration, starvation, loss of >5% of pre-pregnancy bodyweight and electrolyte imbalance. It is the commonest indication of hospitalisation in the first half of pregnancy, and is also a cause of pre-term delivery. Human chorionic gonadotropin (HCG) hormone is the most often stated likely cause of HG. The mechanism by which HCG causes HG remains unclear, but proposed mechanisms include a stimulating effect on the secretory processes in the upper gastrointestinal tract (GIT) or by stimulation of thyroid function because of its structural similarity to thyroid stimulating hormone (TSH). 2 Although most women with nausea and vomiting have symptoms limited to the first trimester, some patients have symptoms in their second trimester and a small percentage of women have prolonged course with symptoms extending until delivery. It is estimated that 70-80% of pregnant women experience nausea and vomiting. Nausea and vomiting in pregnancy (NVP) is more common in younger women with education level <12 years, non-smokers and obese women. 3 NVP has been associated with low income level and part-time employment status. 4 Due to HG, career problems, difficulties in taking sick leave and loss of job during hospitalisation have been frequently reported by working women. 5 Another cause of HG is high levels of thyroxin, oestrogen and progesterone. It is the most common cause of hospitalisation and is potentially lethal if not treated. States of high oestrogen concentration, such as low parity and high maternal body mass index (BMI), have been associated with higher incidence of HG. 3 It is a common pregnancy complication and is a multifactorial condition that has been associated with many risk factors, including multiple gestations, trophoblastic disease, HG with prior pregnancy, foetal abnormalities, such as triploidy, trisomy 21 and hydrops foetalis, and nulliparity. 6 More recently, it had been noted that mothers carrying foetuses with Down's Syndrome (DS), a condition associated with elevated HCG, are more likely to have NVP. Family history of HG is also a risk, with approximately 28% women reporting a history of HG in their mothers and 19% reporting their sisters had similar symptoms. 7 HG is common in patients with low socioeconomic status and is most common in women carrying a female foetus. 8 Studies on patients suffering from J Pak Med Assoc Abstract Objectives: To determine the frequency of hyperemesis gravidarum (HG) and associated factors among pregnant women. Method: The hospital-based cross-sectional study was conducted from October 2016 to March 2017 at Lady Reading Hospital (LRH), Peshawar, District Headquarter Hospital (DHQ), Mardan, and District Headquarter Hospital, Nowshera, Khyber Pakhtunkhwa, Pakistan, and comprised data of 146 pregnant women with hyperemesis gravidarum. Data was compiled using pre-designed proforma. Frequency data of HG was also collected from the two hospitals of Peshawar and Mardan presenting in 2015 and 2016. Blood samples of all patients were analysed for serum electrolytes and complete blood count. Data was analyzed using Microsoft Excel 2010. Results: Mean frequency of HG in LRH Peshawar and DHQ Mardan during 2015 and 2016 was 14.5% and 8.34% respectively. Of the 146 women, 103(70.5%) belonged to Nowshera, 24(16.4%) to Peshawar and 19(13%) to Mardan. The overall mean age was 27±4.9 years, and maximum number of patients 67(45.89%) were aged 26-30 years. Major risk factor was urinary tract infection in Nowshera 30(29%) and Mardan 5(26.3%), while no major factor was identified in Peshawar. Patients in the first trimester were 59(57.28%) in Nowshera, 19(100%) in Mardan and 19(83.3%) in Peshawar, and primigravidas were 19(18.4%), 6(25%) and 8(42%) respectively. Overall, 119(81.5%) patients had no history of abortion. Conclusion: The prevalence of hyperemesis gravidarum was high in Nowshera, Mardan and Peshawar, predominantly during the first trimester of pregnancy.
The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, 2015
Threatened preterm labor (tPTL) is a complication of pregnancy. Identification of women and clinical definition differs between countries. This study investigated differences in tPTL and effectiveness of vaginal progesterone to prevent preterm birth (PTB) between two countries. Secondary analysis of a RCT from Argentina and Switzerland comparing vaginal progesterone to placebo in women with tPTL (n=379). Cox proportional hazards analysis was performed to compare placebo groups of both countries and to compare progesterone to placebo within each country. We adjusted for baseline differences. Iatrogenic onset of labor or pregnancy beyond gestational age of interest was censored. Swiss and Argentinian women were different on baseline. Risks for delivery <14 days and PTB < 34 and < 37 weeks were increased in Argentina compared to Switzerland, HR 3.3 (95%CI 0.62 to 18), 54 (95%CI 5.1 to 569) and 3.1 (95%CI 1.1 to 8.4). In Switzerland, progesterone increased the risk for delivery...
Clinical and Experimental Obstetrics & Gynecology
Background: Hyperemesis gravidarum (HG) is a disease that occurs during pregnancy. It is relatively rare (0.3-3.6%), but with great potential for complications. Its diagnostic criteria still lack consensus, and most studies only establish the presence of uncontrollable vomiting, requiring hospitalization. The present study aimed to investigate its epidemiological profile and maternal and neonatal outcomes in a series of cases with more restrictive diagnostic criteria. Methods: A retrospective analysis of all cases admitted with a diagnosis of HG, according to more restrictive service criteria, was performed with a review of medical records and laboratory tests in a Brazilian university hospital. Results: HG was confirmed in 85 cases (0.39% incidence). The most frequent early symptoms included a weight loss ≥5% (94.4%) or ≥10% (63.9%), dehydration (76.5%), hyponatremia (49.4%), hypokalemia (40.5%), increased liver enzymes (46.4%), and transient hyperthyroidism (38.6%). Enteral nutrition was used in 7.1% of the patients, and parenteral nutrition in 1.2%. A large majority of patients was provided with a prescription of more than one drug, and the most used drugs were dimenhydrinate (87.1%), metoclopramide (85.9%), and ondansetron (38.8%). The average length of hospital stay was 15 days (1-145 days). Childbirth data were obtained from 40 patients, with 60% of births being cesarean deliveries, 35.3% premature births, 32% with low birth weight, and 7.5% stillbirths, with 12.5% of cases having postpartum complications. The overall rate for clinical complications was 30.5%. Conclusions: With well-defined and more restrictive criteria, we observed a high rate of obstetric and neonatal complications compared to international data. Thus, a correct diagnosis is essential for identifying this serious condition and to allow earlier treatment, reducing clinical, obstetric, and neonatal complications.
Hyperemesis Gravidarum and Obstetric Outcome
Nepal Journal of Obstetrics and Gynaecology, 2012
Aims: This study was conducted to evaluate maternal characteristics and obstetric outcomes among women with hyperemesis gravidarum during pregnancy. Methods: A prospective hospital based study was conducted at Nepal medical college and teaching hospital over the period of two years where all the women admitted with history of hyperemesis gravidarum were evaluated. Hyperemesis gravidarum was defined as intractable nausea/vomiting in pregnancy that leads to dehydration, nutritional deficiency, electrolyte and metabolic disturbances and considerable ketonuria that may require hospitalization. The age of women, parity, gestational age, method of treatment and duration of hospital stay were analysed.The fetal outcome evaluated were incidence of preterm birth, apgar score <7 at 5 mins of birth, low birth weight, perinatal deaths and congenital anomalies in baby. Results: There were 52 women admitted with hyperemesis gravidarum among all obstetric admission (N= 2080). The incidence of h...
IOSR Journals , 2019
Introduction: Nausea and vomiting are among the commonest experiences by women during pregnancy. It may affect 70-80% of all pregnant women. 1 Majority of the pregnant women experiences nausea and vomiting mostly during the first trimester. Very limited number of limited women have a prolonged course with symptoms extending until delivery. 2 Etiological factor is taken in to consideration more than 35 (29.16%) were ediophothic. 15% were multiple pregnancy, 6.66% were due to vesicular mole. Ectopic pregnancy attributed to 5%. History of hyperemesis in previous pregnancy noted in 18.33% of women. Psycholgical stress was noticed in 11.66% of individuals, Pre-eclampsia was 8.33%, Acute fatty liver of pregnancy was 5.83%-Table IV. Conclusion: The majority of pregnant women experience some type of morning sickness (70-80%). Recent studies show that cases of extreme morning sickness called hyperemesis Gravidarum (HG) are reported by those who treated in a hospital but the numbers are expected to be much higher than this since many women are treated at home or by outpatient care with their health care provider. If not recognized and treated appropriately in time may result in complications leading to morbididity and mortality. In our study there is no mortality.
Outcomes of pregnancies complicated by hyperemesis gravidarum
Archives of Gynecology and Obstetrics, 2011
Objectives To evaluate maternal and fetal outcomes among women with hyperemesis gravidarum (HG). Methods In a university hospital and a research and training hospital, a retrospective cohort study was conducted among women with singleton deliveries between 2003 and 2011. Maternal outcomes evaluated included gestational diabetes, pregnancy-induced hypertension, cesarean delivery. Neonatal outcomes also determined were 5-min Apgar score of less than 7, low birth weight, small for gestational age (SGA), preterm delivery, fetal sex, and stillbirth. Results There were no statistical diVerences in the mean of age, parity, the number of artiWcial pregnancy, and smoking between two groups. Infants from HG pregnancies manifested similar birth weight (3,121.5 § 595.4 vs. 3,164 § 664.5 g) and gestational age (38.1 § 2.3 vs. 38.1 § 2.6 weeks), relative to infants from the control group (p = 0.67 and 0.91, respectively). In addition, no statistical signiWcant diVerences were found in the rates of SGA birth, preterm birth, gestational diabetes, pregnancy-induced hypertension, and adverse fetal outcome between two groups (p > 0.05). Cesarean delivery rates were similar in two groups (31.9% in hyperemesis group vs. 27% in control group, p = 0.49). Comparing the gender of the newborn baby and Apgar scores less than 7 at 5 min, there were no statistically signiWcant diVerences between two groups (p = 0.16 and 0.42, respectively). Conclusion Hyperemesis gravidarum is not associated with adverse pregnancy outcomes.
2021
Background: Globally, it has proven that preterm birth is associated with perinatal mortality to the extent of >75%, and >50% of perinatal and long term morbidity. Oral progesterone are easy to take but are less effective because of first pass hepatic metabolism leading to variable plasma levels while intramuscular progesterone carries the risk of swelling and bruising at injection site. The aim was to find out frequency of preterm birth in patients treated with oral versus intramuscular progesterone. Methods: Randomized controlled trial conducted in the department of obstetrics and gynecology, Sir Ganga Ram hospital Lahore, Pakistan conducted from 5 October 2017 to 4 April 2018. This study involved 530 pregnant women with history of at least 1 previous preterm delivery presenting in antenatal clinic between 16-20 weeks of gestation. Group I received oral progesterone 10 mg tablet duphaston BD from 20 weeks till 37 weeks. Group II received intramuscular progesterone injection ...
Does Progesterone Treatment Influence Risk Factors for Recurrent Preterm Delivery?
Obstetrics & Gynecology, 2005
Objective: To examine how demographic and pregnancy characteristics can affect the risk of recurrent preterm delivery and the how the effectiveness of progesterone treatment for prevention alters these relationships. Methods: This was a secondary analysis of a randomized trial of 17␣-hydroxyprogesterone caproate to prevent recurrent preterm delivery in women at risk. Associations of risk factors for preterm delivery (less than 37 completed weeks of gestation) were examined separately for the women in the 17␣-hydroxyprogesterone caproate (n ϭ 310) and placebo (n ϭ 153) groups. Results: Univariate analysis found that the number of previous preterm deliveries and whether the penultimate delivery was preterm were significant risk factors for preterm delivery in both the placebo and progesterone groups. High body mass index was protective of preterm birth in the placebo group. Multivariate analysis found progesterone treatment to cancel the risk of more than 1 previous preterm delivery, but not the risk associated with the penultimate pregnancy delivered preterm. Obesity was associated with lower risk for preterm delivery in the placebo group but not in the women treated with progesterone.
BMC Pregnancy and Childbirth
Background: Progesterone is a critical hormone in early pregnancy. A low level of serum progesterone is associated with threatened miscarriage. We aim to establish the distribution of maternal serum progesterone in normal pregnancies compared to pregnancies complicated by threatened miscarriage from 5 to 13 weeks gestation. Methods: This is a single centre, prospective cohort study of 929 patients. Women from the Normal Pregnancy [NP] cohort were recruited from antenatal clinics, and those in the Threatened Miscarriage [TM] cohort were recruited from emergency walk-in clinics. Women with multiple gestations, missed, incomplete or inevitable miscarriage were excluded from the study. Quantile regression was used to characterize serum progesterone levels in the NP and TM cohorts by estimating the 10th, 50th and 90th percentiles from 5 to 13 weeks gestation. Pregnancy outcome was determined at 16 weeks of gestation. Subgroup analysis within the TM group compared progesterone levels of women who subsequently miscarried with those who had ongoing pregnancies at 16 weeks of gestation. Results: Median serum progesterone concentration demonstrated a linearly increasing trend from 57.5 nmol/L to 80.8 nmol/L from 5 to 13 weeks gestation in the NP cohort. In the TM cohort, median serum progesterone concentration increased from 41.7 nmol/L to 78.1 nmol/L. However, median progesterone levels were uniformly lower in the TM cohort by approximately 10 nmol/L at every gestation week. In the subgroup analysis, median serum progesterone concentration in women with ongoing pregnancy at 16 weeks gestation demonstrated a linearly increasing trend from 5 to 13 weeks gestation. There was a marginal and non-significant increase in serum progesterone from 19.0 to 30.3 nmol/L from 5 to 13 weeks gestation in women who eventually had a spontaneous miscarriage. Conclusions: Serum progesterone concentration increased linearly with gestational age from 5 to 13 weeks in women with normal pregnancies. Women with spontaneous miscarriage showed a marginal and non-significant increase in serum progesterone. This study highlights the pivotal role of progesterone in supporting an early pregnancy, with lower serum progesterone associated with threatened miscarriage and a subsequent complete miscarriage at 16 weeks gestation.