Hyperemesis gravidarum

B. Böer; M. Hoopmann; M. Hübner; B. Yazdi; K. O. Kagan; H. Abele

doi:10.1055/s-0030-1250769

Geburtshilfe und Frauenheilkunde, Inhaltsverzeichnis

Geburtshilfe Frauenheilkd 2011; 71(1): 26-37
DOI: 10.1055/s-0030-1250769

Übersicht

Hyperemesis gravidarum

Hyperemesis GravidarumB. Böer¹ , M. Hoopmann¹ , M. Hübner¹ , B. Yazdi¹ , K. O. Kagan¹ , H. Abele¹

¹Perinatalzentrum Universitätsklinikum Tübingen, Tübingen

Abstract

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

Volltext

Referenzen

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