In pregnancy Hyperemesis Gravidarum may occur because of excessive -

Appeared in: UPPSC 2023

Explanation

Hyperemesis Gravidarum (HG) is a severe form of nausea and vomiting in pregnancy.
The hormone most strongly associated with HG is Human Chorionic Gonadotropin (hCG).
hCG levels rise rapidly in early pregnancy, peaking around 8-12 weeks, which directly correlates with the timing of the most severe HG symptoms.
Conditions that cause very high hCG levels, such as multiple pregnancies (twins) or molar pregnancies, are known to increase the risk and severity of HG.

Option A: While high progesterone levels can slow gastric emptying and contribute to general pregnancy nausea, it is not the primary hormone implicated in the extreme vomiting of Hyperemesis Gravidarum.
Option C: Estrogen levels also rise during pregnancy and can contribute to nausea, but the correlation with severe Hyperemesis Gravidarum is not as strong as the link with hCG.
Option D: Oxytocin's primary functions are related to uterine contractions during labor and milk let-down during breastfeeding. It is not associated with nausea and vomiting in early pregnancy.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Hormonal basis of Hyperemesis Gravidarum as background academic context rather than a clinical decision trigger.
Nurses must recognize that Hyperemesis Gravidarum is more severe than typical morning sickness and can lead to serious complications like dehydration, electrolyte imbalances (hypokalemia), and malnutrition.
Key nursing priorities include managing fluid and electrolyte balance with IV therapy, administering antiemetics, providing nutritional support, and offering psychological support.
What if? If a patient presents with HG symptoms and an unusually high hCG level for her gestational age, the nurse should be aware of the increased possibility of a multiple gestation or a molar pregnancy, and ensure appropriate follow-up diagnostics are considered.

How to Approach the Question

First, identify the key term in the question: 'Hyperemesis Gravidarum'. Recall that this is a severe form of morning sickness.
Next, consider the timing. HG typically occurs in the first trimester.
Think about the dominant hormonal changes of the first trimester. The most dramatic change is the rapid rise and peak of Human Chorionic Gonadotropin (hCG).
Evaluate the options based on their primary roles in pregnancy. Progesterone and Estrogen have roles but are not the primary cause of severe vomiting. Oxytocin is primarily active at the end of pregnancy and postpartum.
Conclude that the hormone with the strongest correlation to the timing and severity of HG is hCG.

Concept Tested & Keywords

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E6 Medicine Davidson Principles Practice 24e p. 1292-1294

E6 Obstetrics Williams p. 1-9

E6 Physiology Guyton 4SAE Part 3 p. 65-67

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