Clinical Signs & Symptoms
Laboratory findings may include:
- Signs of dehydration and starvation such as increased ketones, increased urine specific gravity, increased blood urea nitrogen
- Electrolyte imbalances such as abnormal levels of phosphate, magnesium, sodium and potassium
- Vitamin deficiencies such as vitamin K, D and thiamin
- Increases in liver enzymes, such as in aspartate aminotransferase, alanine aminotransferase or bilirubin activity
- Abnormal thyroid and parathyroid levels
- Increased hematocrit, indicating a reduced blood volume
Electrolyte changes include decreased sodium, potassium, phosphate, chloride and magnesium levels. However, in some women, lab levels such as electrolytes may appear normal or falsely concentrated due to dehydration. Treatment for these women is advisable to replace marginally normal levels of electrolytes and nutrients.
Baseline laboratory tests should be done prior to onset of severe symptoms. Regular assessment with the HELP Score allows objective trending of symptom severity.
Fortunately, most women with less severe HG or those who are treated aggressively early in pregnancy, will not have life-threatening complications or a prolonged recovery.
Dehydration and Malnutrition
Most women with HG will have marginal hydration if they are not dehydrated. Turgor testing, weight trending, and general assessment of dry skin, lips, and mucous membranes indicate hydration.
Recurrent dehydration worsens nausea and vomiting and make symptoms more refractory to treatment as well as reduce medication effectiveness.
TIP: Always give IV nutrients (e.g. MVI, thiamin, vit K, folic acid) with IV fluids. Intramuscular vitamins are not advised due to muscle atrophy and low pain tolerance.
If the woman has been unable to eat sufficiently for a few weeks and has also been vomiting, she is at high-risk for nutritional deficiencies and refeeding syndrome. Being pregnant, she is also in a state of accelerated starvation, meaning the adverse effects of starvation will occur more quickly. Significant malnutrition can occur as many nutrients are depleted in a relatively short time frame, especially water-soluble vitamins, such as thiamin.
Thiamin deficiency has been well-documented in hyperemetic women and may lead to Wernicke's encephalopathy (encephalopathy that progresses to life-threatening neurological damage and cardiorespiratory arrest). The prognosis is then poor as irreversible organ damage and death may occur.
Comparison of Morning Sickness and HG
|Area Impacted:||Morning Sickness:||Hyperemesis Gravidarum:|
|Employment||May lose up to a month of employment, work part-time and/or use sick time. Job performance may be reduced.||Often are unable to work for weeks or months and may lose their job or be forced to resign.|
|Daily Activities||Can perform most necessary responsibilities at some point during the day or week when symptoms are less intense.||May be unable to perform even simple household chores or care for themselves (shower, drive, etc.) when symptoms are severe.|
|Energy Level||Fatigue is mild to moderate and decreases workload. Rest is needed to alleviate symptoms.||Fatigue may be severe for weeks or months. Bed rest is often a necessity. Prolonged fatigue is very common.|
|Relationships & Socialization||Relationships may be stressed but social functioning is only temporarily reduced.||Relationships are often greatly strained and may dissolve. Isolation is common and may lead to depression. Abuse and neglect of the mother may occur.|
|Finances||Financial loss due to medical care, loss of work, and use of sick time is significant, but usually manageable.||Financial loss due to medical care, loss of income, and additional paid services (child care) can be devastating.|
|Stress Level||Psychological stress is mild to moderate and may result in depression during/after pregnancy that may resolve without treatment.||Psychological stress is typically moderate to severe and often results in anxiety, depression and trauma that may be prolonged. May require treatment.|
|Recovery||Postpartum recovery is typical and usually takes a few months.||Postpartum recovery is prolonged, averaging 6 months to 2 years.|