Hiperemezis gravidaruma güncel yaklaşımlar

Bulantı ve kusma (BK) gebeliklerin yaklaşık %75inde görülen yaygın bir semptomdur. Hiperemezis gravidarum (HEG) ise gebeliklerin %0,52sini etkileyen, 3 günden daha uzun süren aşırı bulantı kusma, dehidratasyon (ağızda kuruluk, deri turgorunda azalma), ketonüri, sıvı elektrolit bozukluğu, vücut ağırlığının %5inden fazla kilo kaybı ile karakterize nadiren hepatik ve renal yetmezliğe ilerleyebilen ve sıklıkla hastaneye yatış gerektiren daha ağır bir tablodur. HEG kişinin sosyal, aile ve iş hayatını etkileyerek psikolojik ve sosyal sorunlara, iş gücü kaybına neden olan, hastaneye tekrarlayan yatışlara sebep olarak sağlık maliyetlerini artıran bir durumdur. Dolayısıyla hastane kad ? n doğum servislerinde sık karşılaştığımız HEG hastalarında, risk faktörlerinin ve etyolojide rol alan mekanizmaların iyi anlaşılması , ayırıcı tanının yapı larak hastaneye yatışın değerlendirilmesi ve etkin tedavinin başlanması önemlidir. HEG tedavisinde ilk basamak yaşam tarzında ve diyette yapılan değişiklikler olmalıdır. Günümüzde medikal tedavi yanında alternatif tıp yöntemlerinin (hipnoz, akupunktur vs.) de uygulandığı HEG tedavisini tekrar değerlendirmek, tedavi basamaklarını ve etkinliklerini karşılaştırmak önemlidir. Gebe kadnı 3-4 ay veya daha uzun süre etkileyen bu tabloda kişiyi en kısa sürede aile ve iş hayatına geri kazandırmak sosyal ve maddi kayıpları en aza indirecektir. Bu yazıda bulantı kusma ve HEGin etyopatogenezi, tedavi yaklaşımları ile ilgili bilgiler son yıllara ait literatür verileri ışığında ele alınmış ve kliniğimizde de uyguladığmız basamaklı tedavi yaklaşımı sunulmuştur.

The contemporary approaches to hyperemesis gravidarum

Nausea and vomiting (BK), common symptoms of pregnancy, are seen in approximately 75% of pregnants. Hyperemesis gravidarum (HEG) is a more serious condition seen 0.5%-2% of pregnant women and is characterized with intractable recurring excessive nausea and vomiting that lasts longer than 3 days, dehydration (xerostomia, decreased skin turgor), ketonaemi, a fluid and electrolyte imbalance, weight loss more than 5% of pre-pregnancy weight, rarely can also progress to hepatic and renal failure and often requires hospitali- zation. HEG is a condition that causes psychological and social problems and loss of labor by affecting person's sociality, family, and labor loss, and often results in recurrent hospitalisation associated with increased health care costs. Therefore, in HEG patients frequently encountered in the Obstetrics and Gynecology services, risk factors and better understanding of the mechanisms involved in the etiology, and after performing a differential diagnostic procedure, evaluation of hospitalisation and initiation of effective treatment is important. The first step in the treatment of HEG involves dietary change and lifestyle modifications. Nowadays, it is important to reevaluate the HEG treat- ments using alternative medicine methods (hypnosis, acupuncture, etc.) besides medical therapy and to compare treatment steps and effectiveness. If the pregnant women, in condition which affects them 3-4 months or longer, are gained to family and work life as soon as possible, social and material losses is minimized. In this article, the contemporary information about etiopathogenesis and treatment approaches of nausea with associated vomiting and HEG were discussed in the light of the current literature and the stepped care in the treatment of HEG of our clinic was presented.

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