Obstetrics and Gynecology · MU Sofia

21. Hyperemesis gravidarum. Hypertensive disorders of pregnancy - preeclampsia, HELLP syndrome, eclampsia

Covers hyperemesis gravidarum, its causes, associated findings and treatment, then moves to hypertensive disorders of pregnancy. A classification table sets out chronic, gestational, preeclampsia and superimposed types. The note also explains the placental pathogenesis, severe features including HELLP syndrome and eclampsia, aspirin prevention, and a management table covering antihypertensives, magnesium sulphate, monitoring and timing of delivery.

Inside: 2 sections · 2 tables · 16 flashcards · 3 min

Topic 21 of 61 in the MU Sofia syllabus for Obstetrics and Gynecology (Medicine, Year 5). The free AceMed note covers it in 2 sections, about 293 words (3 min of reading), with 16 flashcards.

In this note

  1. Hyperemesis gravidarum
  2. Hypertensive disorders of pregnancy

Hyperemesis gravidarum

Nausea and vomiting affect up to 80% of pregnancies, peak at 9–12 weeks and usually settle by 16–20 weeks. Hyperemesis gravidarum (≈ 1%) is severe, persistent vomiting with weight loss > 5%, dehydration, ketonuria and electrolyte imbalance.

  • Associated with high hCG: multiple pregnancy, molar pregnancy. Exclude urinary infection, gastroenteritis, thyroid disease, hepatitis.
  • Findings: ketonuria, hypokalaemia, hyponatraemia, raised haematocrit; transient biochemical hyperthyroidism (from hCG).
  • Treatment: IV fluids (normal saline with potassium), thiamine before dextrose (prevents Wernicke encephalopathy), antiemetics (antihistamines such as promethazine or cyclizine, metoclopramide, ondansetron), thromboprophylaxis, and steroids in refractory cases.

Hypertensive disorders of pregnancy

Hypertension is BP ≥ 140/90 mmHg on two occasions at least 4 hours apart; ≥ 160/110 is severe. These disorders complicate about 5–10% of pregnancies and are a leading cause of maternal death.

Pathogenesis

Poor trophoblast invasion leaves the spiral arteries narrow, so the placenta is underperfused. It releases anti-angiogenic factors (sFlt-1, soluble endoglin; low PlGF) that cause widespread endothelial damage: vasoconstriction, leaky capillaries, platelet activation.

Severe features

  • BP ≥ 160/110; platelets < 100 × 10⁹/L; liver transaminases twice normal or right upper quadrant/epigastric pain; creatinine > 1.1 mg/dl (97 µmol/L) or doubled; pulmonary oedema; new headache or visual disturbance.
  • HELLP syndrome: Haemolysis, Elevated Liver enzymes, Low Platelets; can occur with mild hypertension.
  • Eclampsia: generalised seizures in a woman with preeclampsia, with no other cause.

Prevention

Aspirin 75–150 mg at night from 12 weeks to 36 weeks for women at high risk (previous preeclampsia, chronic hypertension, kidney disease, diabetes, autoimmune disease, multiple pregnancy, or several moderate risks).

Management

In an eclamptic fit: call for help, left lateral position, airway and oxygen, magnesium sulphate, control BP, then deliver once the mother is stable.

Delivery of the placenta is the only cure of preeclampsia; magnesium sulphate prevents fits but does not lower blood pressure.

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