INTRODUCTION

Nausea and vomiting are common phenomena in pregnancy. Between 50% and 85%
of all pregnancy women experience nausea and vomiting 1. Hyperemesis represents more
severe nausea and vomiting in early pregnancy and

is the most common reason for

hospitalization. However Hyperemesis gravidarum is rare, occurring in about 0,1% to 2%

affect of all pregnancy. It reported by different authors. Although nausea and vomiting is
common and hyperemesis gravidarum is rare, the two condition have often studied as part of
the some continum. In the USA more than 50.000 women are hospitalized annually for
hyperemesis gravidarum2. In great Britain mortality from hyperemesis gravidarum was 159
deaths per million births ( Michelini,2002). The cause of these condition remains unknown.
Nausea and vomiting are considered a presumptive sign of pregnancy. Hyperemesis
gravidarum like nausea and vomiting, in most cases, the ocset of symptoms is beginning at
about 4th week and ending about 12th week of gestation, peak at 9 weeks to 10 weeks (need
hospitalization), abate by 16 to 18 weeks. However small percentage of patients continue to
have symptoms until delivery with resolution by 20 weeks of gestation. 3 Nausea and
vomiting that develop beyond 10 weeks of gestation are generally thought to be due to
another cause. Hyperemesis gravidarum is unassociated with other medical conditions, such
as cholestasis, hepatitis, preeclampsia, vital syndrome, menieres disease or influenza.
Hyperemesis gravidarum said to be higher in multiple pregnancy, hydatidiform mole and
other condition associated with higher pregnancy hormone level.
1 CME resource, November 29, 2010. Lippincott Williams and wilkins,2004, nausea and vomiting
of pregnancy vol 18,
Human reproduction update advance access published july 8,2005,
hyperemesis gravidarum, a literature review page1.

2 CME resource, November 29, 2010.

3 CME resource, November 29, 2010. Lippincott Williams and wilkins,2004, nausea and vomiting
of pregnancy vol 18,
Human reproduction update advance access published july 8,2005, hyperemesis gravidarum, a
literature review page1.
Lippincott Williams and wilkins, 2005, Greenbergs text-atlas of emergency medicine,page:381.
Lippincott Williams and wilkins ,Harwood-Nuss clinical practice of emergency medicine,11 sept
2011
Ase Vidgis Vikanes, 2010,cause of HG (thesis), university of oslo Norwegian institute

There is some variation definition of hyperemesis gravidarum from some literature. The most
commonly great definition is thar Hyperemesis gravidarum is a syndrome characterized by
severe condition from nausea and vomiting during pregnancy with weight loss over 5% of
pregnancy, leading fluid, electrolyte and acid-base imbalance, nutrition deficiency,
hypokalemia, ketosis, acetonuria, ptyalism. They are relatively commonly seen complication
in patients with severe hyperemesis gravidarum. 4 Women with hyperemesis gravidarum have
lower risk for foetal loss and non syndrome oral clefts. Although the pathogenesis (caused) of
hyperemesis gravidarum remains unknown, many theories release into hormonal, neurologis,
metabolic, toxic, and psychogenic factors5. Several hormones have been implicated, they are
human chorionic godadoptrin (hCG), estradiol, 17-hydroxyprogesterone and thyroid
hormone. Human chorionic godadoptrin (hCG) serum levels are likely causative factors, peak
in the 1st trimester.
Many treatment can be accepted to pregnant women with hyperemesis gravidarum. A women
with hyperemesis gravidarum must take home away from work. There are some therapy for
pregnant women with hyperemesis gravidarum, such as fluid therapy, vitamin
supplementation and electrolyte acid-base imbalance correction, and thiamine supplements.
When patients fail to respond, antimetic therapy is also administered. 6 The other methods of
treatment in hyperemesis gravidarum patients were identified, including oral ginger root
extract, oral or injected corticosteroids or injected adrenocorticotropic hormone (ACTH) and
acupuncture. (jewell and young, 2003)

4 CME resource, November 29, 2010 Lippincott Williams and wilkins, 2005, Greenbergs text-atlas

of emergency medicine,page:381.
Human reproduction update advance access published july 8,2005, hyperemesis gravidarum, a
literature review page1
Lippincott Williams and wilkins ,Harwood-Nuss clinical practice of emergency medicine,11 sept
2011

5 Lippincott Williams and wilkins ,Harwood-Nuss clinical practice of emergency medicine,11 sept
2011

6 CME resource, November 29, 2010 Lippincott Williams and wilkins, 2005, Greenbergs text-atlas

of emergency medicine,page:381.
Human reproduction update advance access published july 8,2005, hyperemesis gravidarum, a
literature review page1