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DOI: 10.1055/s-0030-1250769
© Georg Thieme Verlag KG Stuttgart · New York
Hyperemesis gravidarum
Hyperemesis GravidarumPublikationsverlauf
eingereicht 18.10.2010
revidiert 16.12.2010
akzeptiert 23.12.2010
Publikationsdatum:
15. Februar 2011 (online)
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Zusammenfassung
Circa 80 % aller Frauen leiden während der Schwangerschaft an Übelkeit und Erbrechen. In bis zu 20 % der Fälle können die Symptome über die gesamte Gravidität beobachtet werden. Die Ursache ist nach heutigem Kenntnisstand multifaktoriell und nicht endgültig geklärt. Die Betroffenen zeigen ein über den Tag hinweg übermäßig häufiges Erbrechen. Die weiteren Beschwerden sind häufig unspezifisch. Für die Diagnose richtungsweisend sind v. a. die Klinik der Patientin und die Ergebnisse der Laboruntersuchung (Elektrolytentgleisung, Hämatokriterhöhung, Ketonurie etc.). Die Behandlung ist symptomatisch. Neben der medikamentösen Therapie (Vitamin B6, Antihistaminika, Anticholinergika und andere niedrig dosierte Antiemetika sowie gastrointestinal wirksame Medikamente) haben auch naturheilkundliche Verfahren (Akupunktur, Akupressur, Ingwer etc.) ihren Stellenwert. Darüber hinaus sollte die Indikation zur psychosomatischen und ‐therapeutischen Begleitbehandlung großzügig gestellt werden, da davon auszugehen ist, dass psychologische Faktoren in der Pathogenese eine gewichtige Rolle spielen. Bei ausgeprägtem Verlauf (Hyperemesis Grad II) ist eine stationäre Behandlung indiziert.
Abstract
About 80 % of pregnant women suffer from nausea and vomiting and about 20 % will remain symptomatic throughout the whole course of pregnancy. The origin is not fully clarified and is believed to be multifactorial. The key symptoms that point towards the diagnosis of hyperemesis gravidarum consist of the clinical presentation and changes in the blood and urine analysis (increasing hematocrit, ketonuria, dysbalance of electrolytes, etc.). The treatment is symptomatic and consists of vitamin B6, antihistaminics, anticholinergics and other low dosed anti-emetics. Alternative approaches such as acupuncture, acupressure, ginger, etc. also play an important role. As psychological factors may often be of importance, psychosomatic treatment should always be considered. If the clinical symptoms are more pronounced (hyperemesis gravidarum level 2), an inpatient treatment should be considered.
Schlüsselwörter
Übelkeit - Erbrechen - Schwangerschaft - Hyperemesis gravidarum
Key words
nausea - vomiting - pregnancy - hyperemesis gravidarum
Literatur
- 1 Gadsby R, Barnie-Adshead A M, Jagger C. A prospective study of nausea and vomiting during pregnancy. Br J Gen Pract. 1993; 43 245-248
- 2 Sheehan P. Hyperemesis gravidarum – assessment and management. Aust Fam Physician. 2007; 36 698-701
- 3 Lacroix R, Eason E, Melzack R. Nausea and vomiting during pregnancy: A prospective study of its frequency, intensity, and patterns of change. Am J Obstet Gynecol. 2000; 182 931-937
- 4 Broussard C N, Richter J E. Nausea and vomiting of pregnancy. Gastroenterol Clin North Am. 1998; 27 123-151
- 5 Jordan V, MacDonald J, Crichton S et al. The incidence of hyperemesis gravidarum is increased among Pacific Islanders living in Wellington. N Z Med J. 1995; 108 342-344
- 6 Kallen B. Hyperemesis during pregnancy and delivery outcome: a registry study. Eur J Obstet Gynecol Reprod Biol. 1987; 26 291-302
- 7 Tsang I S, Katz V L, Wells S D. Maternal and fetal outcomes in hyperemesis gravidarum. Int J Gynaecol Obstet. 1996; 55 231-235
- 8 Fairweather D V. Nausea and vomiting in pregnancy. Am J Obstet Gynecol. 1968; 102 135-175
- 9 Bennett T A, Kotelchuck M, Cox C E et al. Pregnancy-associated hospitalizations in the United States in 1991 and 1992: a comprehensive view of maternal morbidity. Am J Obstet Gynecol. 1998; 178 346-354
- 10 Miller F. Nausea and vomiting in pregnancy: the problem of perception – is it really a disease?. Am J Obstet Gynecol. 2002; 186 (5 Suppl. Understanding) S182-S183
- 11 Statistisches Bundesamt .Gesundheit – Diagnosedaten der Patienten und Patientinnen in Krankenhäusern (einschl. Sterbe- und Stundenfälle), in Fachreihe 12 – Reihe 6.2.1. 2009.. Wiesbaden: Statistisches Bundesamt; 2009
- 12 Mazzotta P, Maltepe C, Navioz Y et al. Attitudes, management and consequences of nausea and vomiting of pregnancy in the United States and Canada. Int J Gynaecol Obstet. 2000; 70 359-365
- 13 Dodds L, Fell D B, Joseph K S et al. Outcomes of pregnancies complicated by hyperemesis gravidarum. Obstet Gynecol. 2006; 107 (2 Pt 1) 285-292
- 14 Fukada Y, Ohta S, Mizuno K et al. Rhabdomyolysis secondary to hyperemesis gravidarum. Acta Obstet Gynecol Scand. 1999; 78 71
- 15 Kanayama N, Khatun S, Belayet H M et al. Vasospasms of cerebral arteries in hyperemesis gravidarum. Gynecol Obstet Invest. 1998; 46 139-141
- 16 Liang S G, Ooka F, Santo A et al. Pneumomediastinum following esophageal rupture associated with hyperemesis gravidarum. J Obstet Gynaecol Res. 2002; 28 172-175
- 17 Robinson J N, Banerjee R, Thiet M P. Coagulopathy secondary to vitamin K deficiency in hyperemesis gravidarum. Obstet Gynecol. 1998; 92 (4 Pt 2) 673-675
- 18 Peeters A, Van de Wyngaert F, Van Lierde M et al. Wernicke's encephalopathy and central pontine myelinolysis induced by hyperemesis gravidarum. Acta Neurol Belg. 1993; 93 276-282
- 19 Togay-Işikay C, Yiğit A, Mutluer N. Wernicke's encephalopathy due to hyperemesis gravidarum: an under-recognised condition. Aust N Z J Obstet Gynaecol. 2001; 41 453-456
- 20 Fell D B, Dodds L, Joseph K S et al. Risk factors for hyperemesis gravidarum requiring hospital admission during pregnancy. Obstet Gynecol. 2006; 107 (2 Pt 1) 277-284
- 21 Jarnfelt-Samsioe A, Samsioe G, Velinder G M. Nausea and vomiting in pregnancy – a contribution to its epidemiology. Gynecol Obstet Invest. 1983; 16 221-229
- 22 Klebanoff M A, Koslowe P A, Kaslow R et al. Epidemiology of vomiting in early pregnancy. Obstet Gynecol. 1985; 66 612-616
- 23 Vikanes A, Grjibovski A M, Vangen S et al. Maternal body composition, smoking, and hyperemesis gravidarum. Ann Epidemiol. 2010; 20 592-598
- 24 Zhang Y, Cantor R M, Macgibbon K et al. Familial aggregation of hyperemesis gravidarum. Am J Obstet Gynecol. 2010;
- 25 Vikanes A, Skjaerven R, Grjibovski A M et al. Recurrence of hyperemesis gravidarum across generations: population based cohort study. BMJ. 2010; 340 c2050
- 26 Tan P C, Jacob R, Quek K F et al. The fetal sex ratio and metabolic, biochemical, haematological and clinical indicators of severity of hyperemesis gravidarum. BJOG. 2006; 113 733-737
- 27 Goecke T W, Ekici A B, Niesler B et al. Two naturally occurring variants of the serotonin receptor gene HTR3C are associated with nausea in pregnancy. Acta Obstet Gynecol Scand. 2010; 89 7-14
- 28 Verberg M F, Gillott D J, Al-Fardan N et al. Hyperemesis gravidarum, a literature review. Hum Reprod Update. 2005; 11 527-539
- 29 Cole L A. Biological functions of hCG and hCG-related molecules. Reprod Biol Endocrinol. 2010; 8 102
- 30 Askling J, Erlandsson G, Kaijser M et al. Sickness in pregnancy and sex of child. Lancet. 1999; 354 2053
- 31 Basso O, Olsen J. Sex ratio and twinning in women with hyperemesis or pre-eclampsia. Epidemiology. 2001; 12 747-749
- 32 Goodwin T M, Montoro M, Mestman J H et al. The role of chorionic gonadotropin in transient hyperthyroidism of hyperemesis gravidarum. J Clin Endocrinol Metab. 1992; 75 1333-1337
- 33 Tojo S, Ashitaka Y, Nishimura R. HCG: Biology and Chemistry.. In: Grudzinskas J G, Teisner B, Seppala M, eds. Pregnancy Proteins, Biology, Chemistry and clinical Application.. Sydney: Academic Press; 1982: 29
- 34 Power Z, Thomson A M, Waterman H. Understanding the stigma of hyperemesis gravidarum: qualitative findings from an action research study. Birth. 2010; 37 237-244
- 35 Tempfer C. Physiologie und Therapie der Hyperemesis gravidarum. Gynäkologe. 2001; 34 833-840
- 36 Panesar N S, Li C Y, Rogers M S. Are thyroid hormones or hCG responsible for hyperemesis gravidarum? A matched paired study in pregnant Chinese women. Acta Obstet Gynecol Scand. 2001; 80 519-524
- 37 Fonseca E B, Celik E, Parra M et al. Progesterone and the risk of preterm birth among women with a short cervix. N Engl J Med. 2007; 357 462-469
- 38 Böer B, Kagan K O, Hoopmann M et al. Kann Progesteron in der Schwangerschaft die Frühgeburtsrate senken?. Geburtsh Frauenheilk. 2010; 70 672-674
- 39 Walsh J W, Hasler W L, Nugent C E et al. Progesterone and estrogen are potential mediators of gastric slow-wave dysrhythmias in nausea of pregnancy. Am J Physiol. 1996; 270 (3 Pt 1) G506-G514
- 40 Depue R H, Bernstein L, Ross R K et al. Hyperemesis gravidarum in relation to estradiol levels, pregnancy outcome, and other maternal factors: a seroepidemiologic study. Am J Obstet Gynecol. 1987; 156 1137-1141
- 41 Jordan V, Grebe S K, Cooke R R et al. Acidic isoforms of chorionic gonadotrophin in European and Samoan women are associated with hyperemesis gravidarum and may be thyrotrophic. Clin Endocrinol (Oxf). 1999; 50 619-627
- 42 Yoneyama Y, Suzuki S, Sawa R et al. The T-helper 1/T-helper 2 balance in peripheral blood of women with hyperemesis gravidarum. Am J Obstet Gynecol. 2002; 187 1631-1635
- 43 James W H. The associated offspring sex ratios and cause(s) of hyperemesis gravidarum. Acta Obstet Gynecol Scand. 2001; 80 378-379
- 44 Schiff M A, Reed S D, Daling J R. The sex ratio of pregnancies complicated by hospitalisation for hyperemesis gravidarum. BJOG. 2004; 111 27-30
- 45 Tan P C, Tan N C, Omar S Z. Effect of high levels of human chorionic gonadotropin and estradiol on the severity of hyperemesis gravidarum. Clin Chem Lab Med. 2009; 47 165-171
- 46 Golberg D, Szilagyi A, Graves L. Hyperemesis gravidarum and Helicobacter pylori infection: a systematic review. Obstet Gynecol. 2007; 110 695-703
- 47 Mansour G M, Nashaat E H. Role of Helicobacter pylori in the pathogenesis of hyperemesis gravidarum. Arch Gynecol Obstet. 2010; [Epub ahead of print]
- 48 Fischbach W, Malfertheiner P, Hoffmann J C et al. S3-Guideline “Helicobacter pylori and gastroduodenal ulcer disease” of the German Society for Digestive and Metabolic Diseases (DGVS) in cooperation with the German Society for Hygiene and Microbiology, Society for Pediatric Gastroenterology and Nutrition e. V., German Society for Rheumatology, AWMF-Registration-no. 021/001. Z Gastroenterol. 2009; 47 1230-1263
- 49 Schäfer C, Spielmann H, Vetter K. Arzneiverordnungen in der Schwangerschaft und Stillzeit.. 7. Aufl. München, Jena: Urban & Fischer; 2006
- 50 Chan N N. Thyroid function in hyperemesis gravidarum. Lancet. 1999; 353 2243
- 51 Tan J Y, Loh K C, Yeo G S et al. Transient hyperthyroidism of hyperemesis gravidarum. BJOG. 2002; 109 683-688
- 52 Soares C N, Zitek B. Reproductive hormone sensitivity and risk for depression across the female life cycle: a continuum of vulnerability?. J Psychiatry Neurosci. 2008; 33 331-343
- 53 Munch S. Chicken or the egg? The biological-psychological controversy surrounding hyperemesis gravidarum. Soc Sci Med. 2002; 55 1267-1278
- 54 Fairweather D V. Nausea and vomiting during pregnancy. Obstet Gynecol Annu. 1978; 7 91-105
- 55 Bailit J L. Hyperemesis gravidarium: Epidemiologic findings from a large cohort. Am J Obstet Gynecol. 2005; 193 (3 Pt 1) 811-814
- 56 Paauw J D, Bierling S, Cook C R et al. Hyperemesis gravidarum and fetal outcome. JPEN J Parenter Enteral Nutr. 2005; 29 93-96
- 57 Czeizel A E, Sarkozi A, Wyszynski D F. Protective effect of hyperemesis gravidarum for nonsyndromic oral clefts. Obstet Gynecol. 2003; 101 737-744
- 58 Mylonas I, Gingelmaier A, Kainer F. Erbrechen in der Schwangerschaft, Übersichtsarbeit. Deutsches Ärzteblatt. 2007; 25 1821-1826
- 59 Kirk E, Papageorghiou A T, Condous G et al. Hyperemesis gravidarum: is an ultrasound scan necessary?. Hum Reprod. 2006; 21 2440-2442
- 60 Mylonas I. Hyperemesis gravidarum.. In: Kainer F, Hrsg. Facharzt Geburtsmedizin.. München, Jena: Urban & Fischer Verlag; 2006
- 61 Goodwin T M. Hyperemesis gravidarum. Clin Obstet Gynecol. 1998; 41 597-605
- 62 Quinlan J D, Hill D A. Nausea and vomiting of pregnancy. Am Fam Physician. 2003; 68 121-128
- 63 Schwentner L, Wulff C, Kreienberg R et al. Exacerbation of a maternal hiatus hernia in early pregnancy presenting with symptoms of hyperemesis gravidarum: case report and review of the literature. Arch Gynecol Obstet. 2010; [Epub ahead of print]
- 64 Lewandowski K, Hincz P, Grzesiak M et al. New onset Addison's disease presenting as prolonged hyperemesis in early pregnancy. Ginekol Pol. 2010; 81 537-540
- 65 Pachydakis A, Koutroumanis P, Geyushi B et al. Primary hyperparathyroidism in pregnancy presenting as intractable hyperemesis complicating psychogenic anorexia: a case report. J Reprod Med. 2008; 53 714-716
- 66 Matthews A, Dowswell T, Haas D M et al. Interventions for nausea and vomiting in early pregnancy. Cochrane Database Syst Rev. 2010; CD007575
- 67 Kim D R, Connolly K R, Cristancho P et al. Psychiatric consultation of patients with hyperemesis gravidarum. Arch Womens Ment Health. 2009; 12 61-67
- 68 Pirimoglu Z M, Guzelmeric K, Alpay B et al. Psychological factors of hyperemesis gravidarum by using the SCL-90-R questionnaire. Clin Exp Obstet Gynecol. 2010; 37 56-59
- 69 Bühling K J, Bohnet H G. Ursachen und Therapie der Schwangerschaftsübelkeit. Frauenarzt. 2006; 47 1110-1113
- 70 Fischer-Rasmussen W, Kjaer S K, Dahl C et al. Ginger treatment of hyperemesis gravidarum. Eur J Obstet Gynecol Reprod Biol. 1991; 38 19-24
- 71 Ismail S K, Kenny L. Review on hyperemesis gravidarum. Best Pract Res Clin Gastroenterol. 2007; 21 755-769
- 72 Niebyl J R, Goodwin T M. Overview of nausea and vomiting of pregnancy with an emphasis on vitamins and ginger. Am J Obstet Gynecol. 2002; 186 (5 Suppl. Understanding) S253-S255
- 73 Vutyavanich T, Kraisarin T, Ruangsri R. Ginger for nausea and vomiting in pregnancy: randomized, double-masked, placebo-controlled trial. Obstet Gynecol. 2001; 97 577-582
- 74 Jewell D. Nausea and vomiting in early pregnancy. Clin Evid. 2003; 1561-1570
- 75 Jewell D, Young G. Interventions for nausea and vomiting in early pregnancy. Cochrane Database Syst Rev. 2003; CD000145
- 76 de Aloysio D, Penacchioni P. Morning sickness control in early pregnancy by Neiguan point acupressure. Obstet Gynecol. 1992; 80 852-854
- 77 Roscoe J A, Matteson S E. Acupressure and acustimulation bands for control of nausea: a brief review. Am J Obstet Gynecol. 2002; 186 (5 Suppl. Understanding) S244-S247
- 78 Shin H S, Song Y A, Seo S. Effect of Nei-Guan point (P6) acupressure on ketonuria levels, nausea and vomiting in women with hyperemesis gravidarum. J Adv Nurs. 2007; 59 510-519
- 79 Römer A. Akupunktur für Hebammen, Geburtshelfer und Gynäkologen.. 3. Aufl. Stuttgart: Hippokrates Verlag; 2002
- 80 Sahakian V, Rouse D, Sipes S et al. Vitamin B6 is effective therapy for nausea and vomiting of pregnancy: a randomized, double-blind placebo-controlled study. Obstet Gynecol. 1991; 78 33-36
- 81 Vutyavanich T, Wongtra-ngan S, Ruangsri R. Pyridoxine for nausea and vomiting of pregnancy: a randomized, double-blind, placebo-controlled trial. Am J Obstet Gynecol. 1995; 173 (3 Pt 1) 881-884
- 82 Chiossi G, Neri I, Cavazzuti M et al. Hyperemesis gravidarum complicated by Wernicke encephalopathy: background, case report, and review of the literature. Obstet Gynecol Surv. 2006; 61 255-268
- 83 Kallen B, Lundberg G, Aberg A. Relationship between vitamin use, smoking, and nausea and vomiting of pregnancy. Acta Obstet Gynecol Scand. 2003; 82 916-920
- 84 Bühling K J. Nausea and Hyperemesis gravidarum. Gynäkol Geburtsmed Gynakol Endokrinol. 2008; 4 36-48
- 85 Mazzotta P, Magee L A. A risk-benefit assessment of pharmacological and nonpharmacological treatments for nausea and vomiting of pregnancy. Drugs. 2000; 59 781-800
- 86 Leathem A M. Safety and efficacy of antiemetics used to treat nausea and vomiting in pregnancy. Clin Pharm. 1986; 5 660-668
- 87 Koren G, Levichek Z. The teratogenicity of drugs for nausea and vomiting of pregnancy: perceived versus true risk. Am J Obstet Gynecol. 2002; 186 (5 Suppl. Understanding) S248-S252
- 88 Magee L A, Mazzotta P, Koren G. Evidence-based view of safety and effectiveness of pharmacologic therapy for nausea and vomiting of pregnancy (NVP). Am J Obstet Gynecol. 2002; 186 (5 Suppl. Understanding) S256-S261
- 89 Rohde A, Dembinski J, Dorn C. Mirtazapine (Remergil) for treatment resistant hyperemesis gravidarum: rescue of a twin pregnancy. Arch Gynecol Obstet. 2003; 268 219-221
- 90 Lacasse A, Lagoutte A, Ferreira E et al. Metoclopramide and diphenhydramine in the treatment of hyperemesis gravidarum: effectiveness and predictors of rehospitalisation. Eur J Obstet Gynecol Reprod Biol. 2009; 143 43-49
- 91 Yoon C K, Chang M H, Lee D C. Wernicke-Korsakoff syndrome associated with hyperemesis gravidarum. Korean J Ophthalmol. 2005; 19 239-242
- 92 Arsenault M Y, Lane C A, MacKinnon C J et al. The management of nausea and vomiting of pregnancy. J Obstet Gynaecol Can. 2002; 24 817-831 quiz 832-833
- 93 Ditto A, Morgante G, la Marca A et al. Evaluation of treatment of hyperemesis gravidarum using parenteral fluid with or without diazepam. A randomized study. Gynecol Obstet Invest. 1999; 48 232-236
- 94 Tasci Y, Demir B, Dilbaz S et al. Use of diazepam for hyperemesis gravidarum. J Matern Fetal Neonatal Med. 2009; 22 353-356
- 95 Lagiou P, Tamimi R, Mucci L A et al. Nausea and vomiting in pregnancy in relation to prolactin, estrogens, and progesterone: a prospective study. Obstet Gynecol. 2003; 101 639-644
- 96 Park-Wyllie L, Mazzotta P, Pastuszak A et al. Birth defects after maternal exposure to corticosteroids: prospective cohort study and meta-analysis of epidemiological studies. Teratology. 2000; 62 385-392
- 97 Bondok R S, El Sharnoubi N M, Eid H E et al. Pulsed steroid therapy is an effective treatment for intractable hyperemesis gravidarum. Crit Care Med. 2006; 34 2781-2783
- 98 Vaisman N, Kaidar R, Levin I et al. Nasojejunal feeding in hyperemesis gravidarum – a preliminary study. Clin Nutr. 2004; 23 53-57
- 99 Ghani R. The use of total parenteral nutrition in protracted hyperemesis gravidarum. J Obstet Gynaecol. 2003; 23 199-201
- 100 Stanga Z, Brunner A, Leuenberger M et al. Nutrition in clinical practice – the refeeding syndrome: illustrative cases and guidelines for prevention and treatment. Eur J Clin Nutr. 2008; 62 687-694
- 101 Biesalski H K, Bischoff S C, Böhles H-J et al. Wasser, Elektrolyte, Vitamine und Spurenelemente. Aktuel Ernahrungsmed. 2007; 32 30-34
- 102 Hytten F E. Nutrition.. In: Hytten F E, Chamberlain G, eds. Clinical Physiology in Obstetrics.. London: Blackwell; 1991: 153
- 103 Bung P. Schwangerschaft und Ernährung.. In: Schneider H, Husslein P, Schneider K TM, Hrsg. Die Geburtshilfe.. Berlin: Springer; 2006: 219-234
- 104 Kreymann G, Adolph M, Müller M J. Energieumsatz und Energiezufuhr. Aktuel Ernahrungsmed. 2007; 32 8-12
- 105 National Collaborating Centre for Acute Care .NICE – Nutrition support in adults. Oral nutrition support, enteral tube feeding and parenteral nutrition.. London: National Collaborating Centre for Acute Care at The Royal College of Surgeons of England; 2006
- 106 Mazzotta P, Stewart D E, Koren G et al. Factors associated with elective termination of pregnancy among Canadian and American women with nausea and vomiting of pregnancy. J Psychosom Obstet Gynaecol. 2001; 22 7-12
- 107 Poursharif B, Korst L M, Macgibbon K W et al. Elective pregnancy termination in a large cohort of women with hyperemesis gravidarum. Contraception. 2007; 76 451-455
- 108 Poursharif B, Korst L M, Fejzo M S et al. The psychosocial burden of hyperemesis gravidarum. J Perinatol. 2008; 28 176-181
- 109 Munch S, Schmitz M F. The Hyperemesis Beliefs Scale (HBS): a new instrument for assessing beliefs about severe nausea and vomiting in pregnancy. J Psychosom Obstet Gynaecol. 2007; 28 219-229
- 110 Power Z, Campbell M, Kilcoyne P et al. The Hyperemesis Impact of Symptoms Questionnaire: development and validation of a clinical tool. Int J Nurs Stud. 2010; 47 67-77
- 111 Goodwin T M. Nausea and vomiting of pregnancy: an obstetric syndrome. Am J Obstet Gynecol. 2002; 186 (5 Suppl. Understanding) S184-S189
Dr. Harald Abele
Perinatalzentrum Universitätsklinikum Tübingen
Universitäts-Frauenklinik
Calwer Straße 7
72076 Tübingen
eMail: harald.abele@med.uni-tuebingen.de