Hyperemesis gravidarum in Chinese women

The Hyperemesis Beliefs Scale (HBS): a new instrument for assessing beliefs about severe nausea and vomiting in pregnancy

OBJECTIVE

The purpose of this research was to validate the Hyperemesis Beliefs Scale (HBS), a new instrument for assessing patient perception factors of hyperemesis gravidarum (HG) that influence reported patient satisfaction with medical care.

METHODS

Patients' beliefs and their perception of their physicians' beliefs about the causal explanations of HG, seriousness of the illness, and the impact of the illness upon patients' daily lives were determined using a newly developed hyperemesis beliefs scale (HBS) in a sample of 96 women. Exploratory factor analyses of the patient and physician versions of the HBS were performed separately using principal factor analysis extraction and oblique rotation in SPSS.

RESULTS

Exploratory factor analyses of patient and physician versions of the HBS demonstrated broad support for the hypothesized factor structure. However, two key differences appeared in the two versions of the HBS. First, the patient items exhibited two causal factors (general and personal), whereas the physician items showed only a single causal factor. Second, in the patient version, items assessing the impact of HG on the babies' health loaded separately from the rest of the items in the HBS, whereas the analyses of the corresponding physician items indicated that the baby items loaded well on the degree of seriousness factor.

CONCLUSION

This scale may be of value in facilitating further research on HG illness representations, patient-physician relationship and patient satisfaction. Specifically, the HBS design provides data to show whether patient-physician agreement on particular measures is associated with better patient satisfaction outcomes.

Chicken or the egg? The biological-psychological controversy surrounding hyperemesis gravidarum

Women's somatic complaints are more likely to be labeled by physicians and other health care professionals as psychologically based when the condition has an obscure etiology. Perhaps because of this, there are a number of medical conditions which have been under investigated and where erroneous assumptions about them exist. Hyperemesis gravidarum (HG)--severe nausea and vomiting during pregnancy--is an example of such an illness. HG remains a puzzling condition for both physicians and patients because there is no known cause or cure. By its very nature, HG has a clearly established biological cause--pregnancy. Yet, because the exact causal pathophysiological mechanism is unknown, the organicity of the pregnant state is either minimized or ignored. This paper examines how HG is characterized in the literature and the empirical basis for psychogenesis. Analysis of the literature reveals a tension in the discourse such that both biologic and psychologic approaches to HG have existed in parallel tracks throughout history. Still, results support that sociocultural factors rather than scientific evidence have shaped the overarching and predominant illness paradigm of psychogenesis. Implications for women's health care and HG, in particular, are presented.

Human chorionic gonadotropin: a secretory hormone

There are several physiological and pathophysiological situations where there is an apparent fluid flux across plasma membranes at the time when human chorionic gonadotropin (hCG) levels are high. These fluxes may take the form of a fluid loss from gastrointestinal tract (e.g. emesis/hyperemesis gravidarum) or accumulations in enclosures (e.g. amniotic fluid or hydatidiform mole). What is not obvious though is whether hCG is the cause of these fluid fluxes. Although glycoprotein hormones like hCG are mainly hormonogenic, their action in the latter process involves the efflux or conductance of halide ions. Since the basis of fluid secretion is an active efflux of ions such as chloride stimulated by a humoral agent, accompanied by a passive diffusion of water across a cell wall, I hypothesize that hCG is also a secretory hormone and responsible for fluid fluxes in the above and other clinical situations.

Clinical experience with patients suffering from hyperemesis gravidarum (severe nausea and vomiting during pregnancy): thoughts about subtyping of patients, treatment and counseling models

The medical and psychological treatment of hyperemesis gravidarum (HG) is generally acknowledged as being difficult. It is also recognized that the somatic changes during pregnancy play a role in the process of HG and that psychosocial factors are of particular importance. The following issues have been studied: psychosocial stressors; personality disorders; coping mechanisms and stress tolerance. The reviewed studies mention many different causes of HG. Some produce symptoms in certain women and some will not. As a result of clinical experience and observation during several years treating women with HG from a broad social, cultural and ethnic background in a large inner-city general hospital, we have been able to identify several subgroups of HG patients according to personality pathology, psychiatric symptoms and psychosocial stress factors. Accurate assessment is necessary in order to be able to tailor the interventions to the characteristics and needs of the individual patient. For the various subgroups different treatment strategies are recommended.

The role of serotonin as a mediator of emesis induced by different stimuli

The aim of this work was to evaluate the impact of changes in serotonin metabolism on the pathophysiology of different types of emesis: pregnancy-induced emesis, emesis associated with inner-ear dysfunction, and cisplatin-induced emesis. The urinary excretion of 5-hydroxyindoleacetic acid (5-HIAA), the main metabolite of serotonin, was measured in 13 women with pregnancy-induced emesis, 12 patients who had nausea and vomiting following inner-ear dysfunctions, 27 patients with cisplatin-induced emesis and a control group of 21 women. 5-HIAA was measured with a fluorescence polarization immunoassay (Abbott) and corrected for varying urine concentrations. Both patients with emesis associated with inner-ear dysfunction and patients with pregnancy-associated emesis showed a similar 5-HIAA excretion pattern compared with the control group. No correlation between intensity of nausea or vomiting and changes in 5-HIAA excretion could be detected. In patients receiving cisplatin, the 5-HIAA excretion increased rapidly within the 12 h following cisplatin administration and returned to baseline levels after 24 h. There was a parallel increase of 5-HIAA excretion and numbers of emetic episodes in the first 12 h, but delayed emesis was not associated with elevated 5-HIAA excretion. Our results provide evidence that serotonin is involved in the pathophysiology of cisplatin-induced acute emesis. Cisplatin-induced delayed emesis, pregnancy-associated emesis, and emesis due to inner-ear dysfunction are not associated with elevated levels of 5-HIAA excretion. The serotonin pathway probably represents only one of many different afferent mechanisms capable of initiating the emesis cascade.

Antenatal complications and perinatal outcome in patients with nausea and vomiting-complicated pregnancy

The incidence of nausea and vomiting-complicated pregnancy was determined in a district hospital in Hong Kong. Nausea was present in 11.4% and vomiting in 63.5% of pregnant women. Patients with vomiting complicating early pregnancy have a statistically significant higher incidence of antepartum haemorrhage of indeterminate origin. The incidences of medical diseases complicating pregnancy, other major antenatal complications, and the neonatal outcome were not different between vomiting and non-vomiting patients.

Low birth weight and hyperemesis gravidarum

A group of patients suffering from severe hyperemesis gravidarum is defined. In contrast to what is reported in the literature, these women gave birth to babies with lower birth weight when compared to the hospital population and also to women who had a milder degree of hyperemesis gravidarum. This indicates that the metabolic disturbance created by hyperemesis may have an adverse effect on the growth potential of the fetus.