HYPEREMESIS GRAVIDARUM

This is the excessive vomiting of pregnancy, commonly during early months, which causes the deterioration of the health of the woman. Fortunately enough, incidence of this condition is less at present partly due to better antiemetic drugs and partly because of seeking advice earlier by the patient. The condition traditionally classified as a “toxaemia of pregnancy” is no longer tenable because of the better understanding of its underlying morbid changes.

Aetiology: Definitely this is not known. The following theories have been held to be responsible for this:

1. Neurosis theory - certain amount of neurotic element is present especially in mild to moderate cases, as vomiting suddenly ceases when patient is removed from her environment particularly to the hospital.

2. Endocrine theories - excess of chorionic gonadotrophins has been suspected to be the cause of excessive vomiting. However on hormonal assay, this could not be confirmed. Excess of oestrogens from growing trophoblast is also suspected to set up vomiting.

The “trigger mechanism” to initiate vomiting in pregnancy is obscure. It is perhaps initiated by the early trophoblast being aggravated by neurosis. In a fully developed case of hyperemesis gravidarum, manifestations are mainly those for effects of vomiting and starvation. These effects are those of carbohydrate starvation leading to acidosis and ketosis, vitamin deficiencies, and water, electrolytes depletion.