The Tired Pregnant Woman

Introduction

Many pregnant women develop hyperemesis gravidarum. There are numerous gastrointestinal, genitourinary, neurologic, and metabolic causes to consider in this patient population.

Case Presentation

This clinicopathological case presentation details the initial assessment and management of an 18-year-old pregnant patient who presented to the emergency department with a complaint of nausea, vomiting, fatigue, and intermittent bleeding.

Discussion

This case takes the reader through the differential diagnosis and evaluation of the patient and the signs and symptoms, including her agitation and tachycardia, that led us to the correct diagnosis.

Transient non-autoimmune hyperthyroidism of early pregnancy

It is characterized by chemical and sometimes clinical hyperthyroidism, without evidence of thyroid autoimmunity that resolves spontaneously by 16 weeks gestation without significant obstetrical complications.

Effect of high levels of human chorionic gonadotropin and estradiol on the severity of hyperemesis gravidarum

BACKGROUND

Serum human chorionic gonadotropin (hCG) and estradiol levels are higher in women with hyperemesis gravidarum (HG) than in unaffected pregnant controls. We postulated that higher levels of these hormones may be associated with clinically more severe HG. The aim of this study was to evaluate the effect of maternal hCG and estradiol levels on the severity of HG.

METHODS

A prospective study was performed on 167 first trimester women hospitalized for HG. Venous blood was taken for hCG and estradiol levels. Scattergrams were plotted for hCG or estradiol levels vs. gestational age. A curve of best fit was drawn. Women were categorized into two groups according to their position above or below the curve. Prolonged hospital stay (> or =4 days) was used as a marker for HG severity. Multivariable logistic regression analysis was used to control for differences in characteristics, laboratory results on admission, and treatment received.

RESULTS

After adjustment, high hCG level adjusted odds ratio (AOR) (2.2, 95% CI 1.0-4.9, p=0.04) and hyponatremia AOR (2.8, 95% CI 1.2-6.6, p=0.02) were independently associated with prolonged hospital stay. With bivariate analysis, high estradiol level was not associated with prolonged stay.

CONCLUSIONS

High hCG but not estradiol is associated with more severe HG.

Maternal reproductive and demographic characteristics as risk factors for hypospadias

This study examined the association of hypospadias risk with several maternal reproductive and demographic characteristics: age, parity, body mass index (BMI), nausea and vomiting of pregnancy (NVP), multiple pregnancy, fertility treatments and procedures, education and race-ethnicity. The study included data on deliveries with estimated due dates from October 1997 to December 2000 that were part of the National Birth Defects Prevention Study, a multi-state case-control study of many birth defects. The analysis included 502 cases with second or third degree hypospadias (i.e. the urethra opened at the penile shaft, scrotum or perineum) and 1286 male, liveborn, non-malformed controls. Risks were estimated from a multivariable logistic regression model that included all exposures of interest. Results indicated particularly elevated risks among births to women who were primiparae, aged >or=35 years and had a BMI of >26, compared with women who were multiparae, aged <30 years and had a BMI of <or=26 [adjusted OR 12.5, 95% CI 5.1, 30.8]. NVP at least once per day during the second or third month of pregnancy vs. no NVP was associated with slightly reduced risk [OR 0.8, 95% CI 0.6, 1.1]. Multiple birth, fertility treatments and college education were associated with increased risks, and Hispanic race-ethnicity was associated with reduced risk. Although the potential contribution of underlying maternal endocrine parameters to the current findings are unknown, the results do provide clues regarding hypospadias aetiology that merit further investigation.