History Of Hyperemesis Gravidarum Research Articles

From Discomfort to Distress: A Critical Analysis of Hyperemesis Gravidarum in the Emergency Room.

Hyperemesis gravidarum (HG) is a severe and debilitating condition characterized by persistent and excessive nausea and vomiting during pregnancy (NVP), often leading to significant maternal and fetal morbidity. This literature review aims to provide a scientifically comprehensive overview of HG within the context of the emergency room (ER) setting. This review aims to enhance understanding and improve the management of HG cases presented to the ER by synthesizing current knowledge and evidence-based practices. This literature review encompasses a systematic analysis of relevant scientific literature, encompassing original research studies, review articles, and clinical guidelines. An extensive search of electronic databases was conducted, covering the period from January 2003 to January 2023.Keywords related to HG, pregnancy-related complications, emergency medicine, and ER management were employed to identify pertinent publications. Through the literature review, we found the incidence of HG-related ER admission to be 0.8%. Although the etiology of HG remains to be unknown, a strong association was found between developing HG in pregnant females and a history of gastrointestinal (GI) disorders, use of cannabis, and pregnancies conceived through artificial reproductive technology (ART). Furthermore, overweight females were more likely to develop HG. Maternal smoking was found to be protective against HG. The symptoms of HG mainly include intractable nausea and vomiting occurring usually between four and nine weeks of gestational age with a significant aversion to food and loss of weight. Diagnosis is done through a strong clinical suspicion, a history of HG in previous pregnancies, and a basic metabolic panel. Treatment includes intravenous (IV) fluids, antiemetic therapy, corticoids, thiamine supplements, and laxatives. In our review, we highlight a few complications that can be seen in HG through a synopsis of unique case reports found during our literature search. In conclusion, through this review, we wish to highlight HG as an obstetrical emergency. We aimto improve understanding, enhance early recognition, and promote evidence-based management strategies for HG in the emergency room. We hope that the findings presented herein will serve as a valuable resource for healthcare professionals, researchers, and policymakers involved in the care of pregnant females experiencing HG in the ER.

Risk of Cardiovascular Disease in Women With a History of Hyperemesis Gravidarum, With and Without Preeclampsia.

Background Hyperemesis gravidarum is associated with preeclampsia, but it is unclear whether hyperemesis gravidarum is a risk factor for cardiovascular disease. We assessed the long-term risk of cardiovascular disease in women who experienced hyperemesis gravidarum with or without preeclampsia. Methods and Results We analyzed a longitudinal cohort of 1 413 166 pregnant women in Quebec between 1989 and 2021. Women were followed from their first pregnancy up to 3 decades later. We computed hazard ratios (HRs) and 95% CIs for the association of hyperemesis gravidarum, preeclampsia, or both conditions with subsequent risk of cardiovascular hospitalization using Cox regression models adjusted for baseline characteristics. Among 1 413 166 women, 16 288 (1.2%) had hyperemesis gravidarum only, 69 645 (4.9%) preeclampsia only, and 1103 (0.08%) had both conditions. After 32 years of follow-up, cardiovascular disease incidence was 17.7 per 100 women with hyperemesis gravidarum only, 28.2 per 100 women with preeclampsia only, 30.9 per 100 women with both exposures, and 14.0 per 100 women with neither exposure. Compared with no exposure, women with both hyperemesis and preeclampsia had the greatest risk of cardiovascular hospitalization (HR, 3.54 [95% CI, 3.03-4.14]), followed by women with preeclampsia only (HR, 2.58 [95% CI, 2.51-2.64]) and hyperemesis only (HR, 1.46 [95% CI, 1.38-1.54]). Having both hyperemesis gravidarum and preeclampsia was strongly associated with valve disease (HR, 3.38 [95% CI, 1.69-6.75]), heart failure (HR, 3.43 [95% CI, 1.79-6.59]), and cardiomyopathy (HR, 4.17 [95% CI, 1.99-8.76]). Conclusions Hyperemesis gravidarum is associated with the development of cardiovascular disease, whether preeclampsia is present or not.

GENETIC AND MATERNAL FACTORS IN HYPEREMESIS GRAVIDARUM: A SYSTEMATIC REVIEW

Hyperemesis gravidarum (HG) is the severe form of nausea and vomiting during pregnancy, which can extremely lead to dehydration, significant weight loss, electrolyte and metabolic imbalances. Importantly, early identification of HG symptoms can help to reduce the severity and prevent complications. Although HG is associated with many adverse maternal and fetal outcomes, there is limited understanding about the risk factors. This review provides current data of genetic and maternal factors that are linked to HG. All observational studies published in English that investigated the genetic or maternal factors associated with HG from 2011 until 2021 were systematically searched using PubMed, Scopus, and ProQuest electronic databases. A total of 1462 citation titles was identified, of which 47 potentially relevant abstracts were screened. Of those, 15 studies met the inclusion and exclusion criteria. The genetic variants in ryanodine receptor 2 gene (RYR2), growth differentiation factor-15 gene (GDF15), and protein coding insulin-like growth factor-binding protein 7 (IGFBP7) were found to be associated with HG. On the other hand, several potential maternal factors contributing to the onset of HG were age, Helicobacter pylori infection, body mass index status, a history of HG in a previous pregnancy, high serotonin levels, and reproductive factors. In view of the lack of strength of overall evidence for risk factors related to HG, it is first imperative to establish a precise definition for HG in a diverse study population. Nevertheless, to conclude, this review was able to provide current data of genetic and maternal factors that are associated with HG.

An Unusual Cause of Nausea and Vomiting in Pregnancy

PA Aline Snietka: Today's case is a 24-year-old G4P2012 female at 9 weeks gestation who presented to our emergency department (ED) complaining of persistent, gradually worsening nausea with non-bloody, non-bilious vomiting over the course of 2 weeks. The patient had been evaluated in the ED several times for her symptoms during this pregnancy, with a history of hyperemesis gravidarum during previous pregnancies. She endorsed vomiting more than five times per day and that she was unable to tolerate any oral solids or liquids.

Serotonin Syndrome After Treatment of Nausea and Vomiting in Pregnancy.

Nausea and vomiting in pregnancy often require pharmacotherapy for symptom management. Serotonin syndrome is a rare clinical entity that can be precipitated by the medications used to treat nausea and vomiting in pregnancy. A 35-year-old pregnant individual with a history of hyperemesis gravidarum in an earlier pregnancy requiring prolonged hospitalization presented with nausea and vomiting at 7 weeks of gestation. She was incidentally found to have severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection when she was universally screened at the time of admission. She required pharmacotherapy, including prochlorperazine and ondansetron for treatment of nausea as well as sumatriptan for migraine. She developed acute spasticity, autonomic dysfunction, and temperature rise, precipitated by antiemetic therapy, consistent with serotonin syndrome. The syndrome resolved with supportive care and benzodiazepines. Serotonin syndrome is a serious clinical entity that can be provoked by the pharmacotherapy given to treat nausea and vomiting in pregnancy. This medical emergency requires early recognition and prompt management.

Attention Deficit Hyperactivity Disorder following Hypothalamic Hamartoma Surgery : An unusual manifestation

IntroductionPsychiatric symptoms are a common comorbid feature of hypothalamic hamartoma(HH) with epilepsy. They are a significant challenge for patient and their families. Most common psychiatric symptoms are externalizing behaviors such as aggression and defiance.ObjectivesTo outline an atypical presentation of HH in form of development of ADHD post-surgery.MethodsA 6-year old child born out of non-consanguinous marriage, with history of hyperemesis gravidarum and depression in mother in ante-natal period, delivered by NVD at term(did not cry at birth and was hospitalized for 3 days) with birth weight of 2.25 kg, currently presented to Neurology with global developemental delay and history of gelastic seizures since 3 years of age. Patient was diagnosed with pituitary hamartoma(through MRI) and precocious puberty that time and was operated for it after which he started having behavioural issues like irritability, aggression, hyperactivity and lack of appropriate social behaviour with peers along with defiance towards parents. Child was then refered to Psychiatry. On MSE patient did not interact with interviewer and was noticed to shout loudly when confronted for using mobile phone. MRI brain(2 months back) showed post-op changes with cystic lesion in suprasellar region. IQ assessment showed borderline intelligence.ResultsPatient was started on Risperidone(upto 1.5 mg) which lead to some improvement. However antiepileptics are being rationalized to prevent behavioural issues secondary to epilepsyConclusionsPatients of HH with epilepsy, present with varied psychiatric symptoms which usually improve after surgery. However we came across a child with worsening of psychiatric symptoms after he was operated for above lesion.DisclosureNo significant relationships.

Cohort experience of second messenger RNA vaccine dose tolerance after an initial-dose reaction

Cohort experience of second messenger RNA vaccine dose tolerance after an initial-dose reaction

Predictors of adverse pregnancy outcome at Hospitals in South Gondar Zone, North-central Ethiopia: A multicenter facility-based unmatched case-control study

BackgroundAdverse pregnancy outcomes are the most significant public health problem which leads to serious short and long-term health consequences to the mother and the newborn baby. Adverse pregnancy outcomes, especially prematurity and low birth weights are the major cause of neonatal morbidity and mortality in Ethiopia, particularly in the study area. Therefore, this study was aimed to determine predictors of adverse pregnancy outcome among mothers who gave birth at Hospitals in South Gondar zone, North-central Ethiopia. MethodsHospital-based unmatched case-control study was conducted. A total of 441 study participants with 147 cases and 294 controls were included. The study participants were selected by multi-stage sampling technique. A combination of chart review and interview were used. Data entry and analysis were done by using Epi data version 3.1 and SPSS version 23 respectively. Descriptive & analytical statistics were computed. In the binary logistic regression, both bivariable and multivariable analysis was computed. Statistical significance was considered at P < 0.05 and the strength of association were assessed by using the adjusted odds ratio with their 95%confidence interval. ResultA total of 147 cases and 294 controls were included. The mean age (±SD) of study participants was 26.8 ± 5.5 years. History of adverse birth outcome (AOR = 6.39, 95%CI = 2.55, 15.99), did not receive dietary counseling during pregnancy (AOR = 5.17, 95%CI = 2.09, 12.84), pregnancy induced hypertension (AOR = 3.74, 95%CI = 1.20, 11.62), history of hyperemesis gravidarum in the recent pregnancy (AOR = 4.01, 95%CI = 1.58, 10.21) and inter-pregnancy interval less than 24 months (AOR = 2.02, 95%CI = 1.04, 3.91) were significantly associated with adverse pregnancy outcome. ConclusionThis study showed that history of adverse pregnancy outcome, pregnancy induced hypertension, did not receive dietary counseling, history of hyperemesis gravidarum, and inter-pregnancy interval less than 24 months were significantly associated with adverse pregnancy outcome. This study implies the need to improve dietary counseling for pregnant mothers during antenatal care visits. Beside to this, counseling on birth spacing should be given to improve inter-pregnancy intervals.

Eating habits and history of hyperemesis gravidarum as a risk factor of preeclampsia

ObjectiveThis study aimed to determine the relationship between eating habits and hyperemesis gravidarum with preeclampsia incidence. MethodThis study used a cross-sectional design. The total sample was 48 pregnant women with normal and preeclamptic pregnancies who had a gestational age above 20 weeks, collecting data using a questionnaire and data analysis using the chi-square test and odds ratio (OR). ResultsThe habit of eating irregular fruit during pregnancy was significantly associated with the incidence of preeclampsia, with an OR value of 8.57. Mothers who had hyperemesis gravidarum increased their risk 3.86 times for developing preeclampsia. ConclusionEating habits and history of hyperemesis gravidarum is a risk factor of preeclampsia. Nutritional intervention is needed through nutrition education for pre-pregnant women so that their nutritional adequacy during pregnancy can be fulfilled, especially during the 1st trimester, namely the implantation phase and socialization of the community movement program for healthy living, especially the consumption of vegetables and fruits for women of childbearing age, women during pre-pregnancy, pregnant and breastfeeding.

Nausea and vomiting of pregnant women: pathogenesis-based management

Background. According to WHO, 70-80 % of women experience symptoms of toxicosis during the first 16 weeks of pregnancy. 10-15 % of them need inpatient treatment. Vomiting occurs in 50-80 % of pregnant women, in 2 % there is hyperemesis gravidarum.&#x0D; Objective. To describe the features of pathogenesis of nausea and vomiting in pregnant women (NVPW) and the management of women with these conditions.&#x0D; Materials and methods. Analysis of literature sources on this issue.&#x0D; Results and discussion. Risk factors for NVPW are the history of migraine and sea sickness, a family history of hyperemesis gravidarum, multiple pregnancy. Metabolic and hormonal factors, motility disorders of the digestive system, psychosocial factors and evolutionary protection of the fetus during embryogenesis are involved in the pathogenesis of NVPW. In NVPW there is a lack of energy, which leads to lipolysis with the formation of ketone bodies. Progression of hyperemesis gravidarum leads to the disruptions of water, carbohydrates, proteins and lipids metabolism, to ketoacidosis, and to vitamin and mineral deficiency. Laboratory tests show an increase in hematocrit, leukocytosis, increased urea and bilirubin, decreased total protein and albumin, proteinuria, cylindruria, erythrocyturia, and a positive acetone reaction of urine. Complications of this condition for the mother include exhaustion, micronutrient deficiencies, neurological disorders, multiple organ dysfunction and even coma, and for the child – the risk of miscarriage and premature birth. The goals of NVPW treatment include the elimination of the symptoms and reduction of the risks to the mother and fetus. The aggressiveness of treatment is determined by the severity of symptoms and the degree of weight loss. In mild cases, drinking a lot of fluids, diet, rest, acupressure, and ginger extract are recommended, in moderate cases it is advisable to add pyridoxine, antihistamines, and dopamine antagonists. If vomiting does not disappear after such treatment, it is advisable to prescribe infusions of 0.9 % NaCl and Xylate (“Yuria-Pharm”), parenteral nutrition, ondansetron. In the absence of effect, methylprednisolone (intravenously) is prescribed. Reo water for medical purposes (“Yuria-Pharm”), which quickly eliminates the deficiency of fluid and electrolytes, contains an alkalizing component, and has detoxifying properties, can be prescribed as in addition. The purpose of infusion therapy for vomiting in pregnant women is to restore the volume of circulating blood, to stop ketogenesis, to restore fluid and electrolyte and acid-base balance, and detoxification. For this purpose, it is advisable to use Xylate, as far as glucose exacerbates acidosis and is poorly absorbed under stress. Xylate has an extremely powerful antiketogenic effect. Abortion in hyperemesis gravidarum is indicated in case of continuous vomiting for 3 days in the intensive care unit, reduction of diuresis to 300 ml per day, progressive acetonuria for 3-4 days, progressive weight loss, severe tachycardia (100-120 beats/min), dysfunction of the central nervous system, jaundice of skin and sclerae, hyperbilirubinemia (80-100 μmol/L).&#x0D; Conclusions. 1. NVPW is a common pathological condition among pregnant women. 2. In NVPW there is a lack of energy, which leads to lipolysis with the formation of ketone bodies. 3. Complications of this condition include exhaustion, micronutrient deficiencies, neurological disorders, multiple organ dysfunction, coma, risk of miscarriage and premature birth. 4. In the absence of the effect of conservative measures, it is advisable to prescribe infusions of 0.9 % NaCl and Xylate, parenteral nutrition, ondansetron, methylprednisolone. 5. The purpose of infusion therapy for vomiting of pregnant women is to restore the volume of circulating blood, to stop ketogenesis, to restore fluid and electrolyte and acid-base balance, and to detoxify. For this purpose, it is advisable to use Xylate.

Fetal Head Growth during Early to Mid-Gestation Associated with Weight Gain in Mothers with Hyperemesis Gravidarum: A Retrospective Cohort Study.

The epigenetic impact of malnutrition in mothers with hyperemesis gravidarum (HG) on their offspring has not been fully elucidated. Recently, several reports have demonstrated that children born to mothers with HG were small for gestational age and had low birth weight, reduced insulin sensitivity, and neurodevelopmental delays during childhood. Therefore, we examined the relationship between fetal growth and changes in the maternal body weight in HG cases. A total of 34 patients with HG were hospitalized and delivered at term between 2009 and 2012. The records of 69 cases of pregnant women without a history of HG were extracted after matching their maternal age, parity, pregestational body mass index (BMI), gestational age, and fetal sex ratio with those of the HG group for comparison. The maternal weight gain at term was less in the HG than in the control group. There was no statistical difference in birth weight, placental weight, and ultrasonic fetometric parameters expressed in standard deviation (SD) scores, including biparietal diameter, abdominal circumference, and femur length, between the HG and the control group. Whereas fetal head growth in the HG group was positively associated with maternal weight gain at 20 weeks of gestation only, this association was not observed in the control group. We herein demonstrate that maternal weight gain from the nadir is associated with fetal head growth at mid-gestation. Thus, maternal undernutrition in the first trimester of pregnancy could affect fetal brain growth and development, leading to an increased risk of neurodevelopmental delays in later life.

Hyperemesis gravidarum

Nausea and vomiting in pregnancy (NVP), or morning sickness, is the most common symptom experienced by pregnant women and affects 80% of pregnancies. NVP occurs across a spectrum, ranging from mild to severe, with hyperemesis gravidarum (HG) representing the most extreme form. HG is a complication of pregnancy affecting 1% of pregnancies, and if left untreated can cause maternal and fetal morbidity and mortality. Early treatment of NVP in primary care can prevent progression to HG. This article aims to help GP trainees understand the natural history of HG and provides a framework for its assessment and management.

Pneumotoraks spontan primer berulang pada wanita hamil dengan hiperemesis gravidarum: laporan kasus

Background: Spontaneous pneumothorax is a rare case during pregnancy. However, the condition of Hyperemesis Gravidarum during pregnancy is one of the risk factors for recurrent primary spontaneous pneumothorax.Case Description: A 28-year-old woman with G5P3013 gestational age 12-13 weeks with Hyperemesis Gravidarum had complaints of tightness and recurrent acute pleuritic chest pain. After a clinical and supporting examination using ultrasound, patients were diagnosed with recurrent primary spontaneous pneumothorax, and observational and symptomatic treatments were performed. The rupture of the bleb or the subpleura bulla is thought to be a pathological mechanism. Patients given birth vaginally without complications and complete resolution of the pneumothorax occurred.Conclusion: Recurrent pneumothorax in pregnant women with a history of hyperemesis gravidarum is rare. Observational and symptomatic treatment is the initial treatment that can be done.

Burden of Helicobacter pylori Infections and Associated Risk Factors among Women of Child Bearing Age in Addis Ababa, Ethiopia.

Background Early detection and treatment of Helicobacter pylori (H. pylori) infection in women of child bearing ages may reduce the risk of maternal health disorder. This study was conducted to determine the burden of H. pylori infections and associated risk factors among women of child bearing ages in Kolfe Keranio Subcity Woreda 9 Health Centers, Addis Ababa, Ethiopia. Methods Facility based cross sectional study design was conducted from April to October 2015. The study recruited 195 pregnant and 137 nonpregnant women with age range of 16-40 years. Sociodemographic data of study participants were collected by structured questionnaire. Venous blood was analyzed to determine hemoglobin, H. pylori stool antigen test kit was used to assess H. pylori infection, and fresh fecal (stool) was used to examine intestinal parasites among study subjects. Data was entered and analyzed using SPSS version 19. Bivariate and multivariate logistic regression model using odds ratio (OR) at 95% confidence interval (CI) were calculated. P-value less than 0.05 was taken as statistically significant. Results The overall burden of H. pylori infection among study participants was 29% (96/332). H. pylori infection was statistically significantly associated with pregnancy status (AOR: 1.825, CI (1.42-2.15), P=0.020), history of hyperemesis gravidarum (AOR=7.028, C.I (2.47-19.99), P=0.018), and low hemoglobin value (AOR=0.177, CI (0.083–0.379), p=0.003). There was no statistically significant association between H. pylori infection and sociodemographic characteristics and some expected risk factors like smoking, Khat chewing, alcohol drinking habit, and presence of intestinal parasites. Conclusion In this study, H. pylori infection was still a public health problem in the study area. H. pylori infected women also had high rate of anemia compared to women who had not H. pylori infected. Hence clinician and other responsible bodies should give a special attention for women who had been infected with H. pylori. Further large case control studies are warranted to understand more the role of H. pylori, HG, and other associated risk factors.

384. Wernicke’s encephalopathy: An uncommon complication from Hyperemesis Gravidarum

Hyperemesis Gravidarum (HG) is a complication of pregnancy associated with severe nausea and vomiting that can lead to fluid-electrolyte imbalances and nutritional deficiencies. HG is distinguished from the benign nausea and vomiting of pregnancy by the presence of ketonuria and weight loss. Wernicke’s Encephalopathy is a neurologic manifestation of acute thiamine (Vitamin B1) deficiency. We describe a case of Hyperemesis Gravidarum presenting with gait ataxia and nystagmus which led to Wernicke’s encephalopathy. An 18-year-old Prima Gravida at 18 weeks gestation with a history of HG presented to our hospital with a 5-day history of vertigo. She was diagnosed with dehydration secondary to HG and was admitted for further workup of her vertigo. On neurologic examination, bilateral horizontal and vertical nystagmus were present. A magnetic resonance imaging (MRI) of the brain demonstrated an area of restricted diffusion in the medial thalamic nuclei. This abnormality paired with the patient’s history of malnutrition secondary to HG supported a diagnosis of Wernicke’s Encephalopathy. The patient was administered IV thiamine 200 mg and then subsequently transitioned to oral thiamine 100 mg daily. The patient was discharged home on hospital day 5 with out-patient follow up. Hyperemesis Gravidarum is defined as persistent vomiting with a weight loss exceeding 5% of pre-pregnancy weight, in addition to ketonuria unexplained by other causes. Wernicke’s Encephalopathy presents with a classic triad of gait ataxia, ophthalmoplegia, and confusion. Wernicke’s Encephalopathy is most commonly caused by chronic alcoholism, but it can also occur rarely as a complication of HG. In conclusion, vertigo during pregnancy should be carefully evaluated and physicians should maintain a broad differential diagnosis, including Wernicke’s Encephalopathy. When treating Hyperemesis Gravidarum, clinicians should have a high level of suspicion for Wernicke’s encephalopathy if neurologic complaints occur, as failure to provide timely treatment could lead to fatal maternal and fetal consequences.

Moderate iodine deficiency among pregnant women in Hong Kong: revisit the problem after two decades.

A survey conducted during 2005 to 2007 by the Centre for Food Safety in Hong Kong suggested that only 5% of the local population had a sufficient dietary intake of iodine. The study, however, was limited as biochemical data (ie urinary iodine concentration) were lacking. Pregnant women are vulnerable to iodine deficiency because of their increased requirement. Recent studies have shown that iodine deficiency in early pregnancy is associated with poorer cognitive development in early childhood. This study reports the iodine status of women during early gestation at an obstetric unit in Hong Kong. Healthy pregnant women with no history of hyperemesis gravidarum were enrolled into a study when they first made a booking in an antenatal clinic of a public hospital to investigate their iodine status during early pregnancy. All subjects were asked to collect their morning urine for measurement of iodine and creatinine levels. Daily dietary intake of iodine was assessed in a subgroup of participants by structured interview using a standard food frequency questionnaire. A total of 600 pregnant women were enrolled at a median of 7.0 weeks of gestation. The median urinary iodine concentration and urinary iodine-to-creatinine ratio were 100 μg/L and 98 μg/g, respectively; 429 (71.5%) participants had iodine insufficiency according to the World Health Organization classification. Daily dietary intake of iodine was assessed in 146 participants. The median daily intake of iodine was 69.5 μg and 122 (83.6%) participants had an intake below the 250 μg recommended during pregnancy by the World Health Organization. Local pregnant women continue to have an inadequate dietary intake of iodine and remain iodine-deficient.

Hospital admission for hyperemesis gravidarum: a nationwide study of occurrence, reoccurrence and risk factors among 8.2 million pregnancies.

What are the maternal risk factors for hyperemesis gravidarum (HG) hospital admission, readmission and reoccurrence in a following pregnancy? Young age, less socioeconomic deprivation, nulliparity, Asian or Black ethnicity, female fetus, multiple pregnancy, history of HG in a previous pregnancy, thyroid and parathyroid dysfunction, hypercholesterolemia and Type 1 diabetes are all risk factors for HG. Women with Black or Asian ethnicity, of young age, carrying multiple babies or singleton females, with Type 1 diabetes or with a history of HG were previously reported to be at higher risk of developing HG; however, most evidence is from small studies. Little is known about associations with other comorbidities and there is controversy over other risk factors such as parity. Estimates of HG prevalence vary and there is a little understanding of the risks of HG readmission in a current pregnancy and reoccurrence rates in subsequent pregnancies, all of which are needed for planning measures to reduce onset or worsening of the condition. We performed a population-based cohort study of pregnancies ending in live births and stillbirths using prospectively recorded secondary care records (Hospital Episode Statistics) from England. We analysed those computerized and anonymized clinical records from over 5.3 million women who had one or more pregnancies between 1997 and 2012. We obtained 8 215 538 pregnancies from 5 329 101 women of reproductive age, with a total of 186 800 HG admissions occurring during 121 885 pregnancies. Multivariate logistic regression with generalized estimating equations was employed to estimate odds ratios (aOR) to assess sociodemographic, pregnancy and comorbidity risk factors for HG onset, HG readmission within a pregnancy and reoccurrence in a subsequent pregnancy. Being younger, from a less socioeconomically deprived status, of Asian or Black ethnicity, carrying a female fetus or having a multiple pregnancy all significantly increased HG and readmission risk but only ethnicity increased reoccurrence. Comorbidities most strongly associated with HG were parathyroid dysfunction (aOR = 3.83, 95% confidence interval 2.28-6.44), hypercholesterolemia (aOR = 2.54, 1.88-3.44), Type 1 diabetes (aOR = 1.95, 1.82-2.09), and thyroid dysfunction (aOR = 1.85, 1.74-1.96). History of HG was the strongest independent risk factor (aOR = 4.74, 4.46-5.05). Women with higher parity had a lower risk of HG compared with nulliparous women (aOR = 0.90, 0.89-0.91), which was not explained by women with HG curtailing further pregnancies. Although this represents the largest population-based study worldwide on the topic, the results could have been biased by residual and unmeasured confounding considering that some potential important risk factors such as smoking, BMI or prenatal care could not be measured with these data. Underestimation of non-routinely screened comorbidities such as hypercholesterolemia or thyroid dysfunction could also be a cause of selection bias. The estimated prevalence of 1.5% from our study was similar to the average prevalence reported in the literature and the representativeness of our data has been validated by comparison to national statistics. Also the prevalence of comorbidities was mostly similar to other studies estimating these in the UK and other developed countries. Women with Black or Asian ethnicity, of young age, carrying multiple babies or singleton females, with Type 1 diabetes or with history of HG were confirmed to be at higher risk of HG with an unprecedented higher statistical power. We showed for the first time that socioeconomic status interacts with maternal age, that hypercholesterolemia is a potential risk factor for HG and that carrying multiple females increases risk of hyperemesis compared with multiple males. We also provided robust evidence for the association of parity with HG. Earlier recognition and management of symptoms via gynaecology day-case units or general practitioner services can inform prevention and control of consequent hospital admissions. The work was founded by The Rosetrees Trust and the Stoneygate Trust. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. C.N.-P. reports personal fees from Sanofi Aventis, Warner Chilcott, Leo Pharma, UCB and Falk, outside the submitted work and she is one of the co-developers of the RCOG Green Top Guideline on HG; all other authors did not report any potential conflicts of interest. Not applicable.

Ondansetron in pregnancy and risk of adverse fetal outcomes in the United States.

This is an analysis of fetal outcome in pregnancies exposed to ondansetron to treat Hyperemesis Gravidarum (HG). In this retrospective cohort study, U.S. data on outcome were collected on 1070 pregnancies exposed to ondansetron and compared to outcomes in two control groups: 771 pregnancies in women with a history of HG with no ondansetron exposure and 1555 pregnancies with neither a history of HG nor ondansetron exposure. Ventricular septal defects were reported in 2/952 of infants in the HG/Ondansetron-exposure group and 4/1286 in the No HG/No Ondansetron-exposure group. Cleft palate was reported in 1/952 live births in the HG/Ondansetron and 2/1286 in the No HG/No Ondansetron-exposure groups. Women with a history of HG who took ondansetron reported less miscarriages and terminations, and higher live birth rates. The overall results do not support evidence of teratogenicity of ondansetron.

Hyperemesis Gravidarum: An Out of the Box Presentation, a Rare Case Report and Literature Review

Infratentorial ependymoma presenting as hyperemesis gravidarum during pregnancy is not reported in the literature. The management of these rare infratentorial tumors during pregnancy poses a great challenge to the obstetrician, since the physiological and hormonal changes of pregnancy can exacerbate the symptoms of the tumor and pose varying risks to both the mother and the fetus. We report a case of an infratentorial ependymoma presenting as hyperemesis gravidarum at 24 weeks of gestation. A 36-year-old diabetic woman was admitted with persistent vomiting at 24 weeks of gestation with a provisional diagnosis of hyperemesis gravidarum. She had history of hyperemesis gravidarum throughout the antenatal period and was on regular follow-up by obstetrician and physician. She developed features of intracranial hypertension and bilateral abducent nerve palsy during hospital stay. An MRI scan of the brain revealed a tumor of the fourth ventricle causing obstructive hydrocephalus. An emergency ventriculoperitoneal shunt was done to relieve the intracranial pressure. Subsequently, she underwent a suboccipital craniotomy with complete removal of the tumor. Histopathology was consistent with ependymoma. During the postoperative period, she developed stridor and dyspnoea and was ventilated. Intrauterine death of the fetus was confirmed by ultrasonology as there was cessation of the fetal heart sound. A hysterotomy was done to remove the fetus as an induction of labor failed. She subsequently developed ventilator associated pneumonia and adult respiratory distress syndrome followed by septicemia and expired on the 12th postoperative day despite appropriate antibiotics and other supportive measures. To our knowledge, this is the first reported case of infratentorial ependymoma presenting during pregnancy. Intracranial tumors, especially infratentorial tumors during pregnancy, are associated with high maternal and fetal morbidity and mortality as they behave differently from supratentorial tumors. A definite protocol for the management of pregnant patients with infratentorial tumors is lacking as there are only few reported cases. Early detection and treatment plays an important role in the management of these tumors. J Clin Gynecol Obstet. 2014;3(4):143-146 doi: http://dx.doi.org/10.14740/jcgo287w

Helping women prepare for hyperemesis gravidarum

Hyperemesis gravidarum is a serious complication of pregnancy presenting as prolonged and severe nausea and vomiting causing dehydration, malnutrition and significant morbidity. Women with a history of hyperemesis gravidarum have around an 80% chance of suffering in subsequent pregnancies. Careful and thorough planning in advance of future pregnancy can significantly reduce the overall severity of symptoms and improve the psychosocial welfare of the women as well as pregnancy outcomes. This article explores the various aspects of a thorough prophylactic care plan to optimise the outcomes of future pregnancies and reduce the morbidity associated with hyperemesis gravidarum. The evidence-base for the following aspects are discussed to ensure a holistic care plan can be developed: physical preparation, prophylactic medication, criteria to assess deterioration, further treatment options if required, and psychosocial management