HORMONAL, BIOCHEMICAL AND ELECTROLYTES CHANGES IN NORMAL PREGNANT WOMEN, MILD EMESIS AND HYPEREMESIS GRAVIDARUM AND THEIR PREGNANCY OUTCOME
Thanaa Hamed and Mohamed Baghdady*
Department of Medical Biochemistry, Benha Faculty of Medicine and *El-Galaa Maternity Teaching hospital*
Objective: To show the hormonal, biochemical and electrolyte changes in hyperemetic patient in relation to normal and mild emetic patient, also to evaluate pregnancy outcome in different groups.
Design: A prospective observational study setting: El Galaa Maternity Teaching Hospital and Medical Biochemistry Department Benha faculty of Medicine.
Subjects and Methods: This study was conducted on 60 pregnant women each has (singleton living fetus). They were divided into 3 groups: Group 1: Consisted of 20 normal pregnant women, their mean age, parity and gestational age was 26.3±4.41 and 2.1±1.02 and 10.8±2.09, respectively. Group II: consisted of 20 mild emetic patients, their mean age, parity and gestational age was 27.6±4.02 and 2.55±0.89 and 10±1.94, respectively. Group III: Consisted of 20 hyperemetic patients, their mean age, parity and gestational age was 22.45±2.48, 1.2±0.95 and 10.7±2.54, respectively. All cases, examined clinically and transvaginal U/S done, urine sample and, 5cc of venous blood was obtained; serum was used for hormonal assay (Free TSH, T3 & T4), liver and renal function tests serum electrolytes and ketone bodies in urine. The data were analyzed statistically.
Results: The results showed significant increase in free T3, free T4 in hyperemesis group than normal and mild emesis group (p < 0.001). However there was decrease in albumin in hyperemesis group than normal and mild emesis group (p < 0.001). There was significant increase in serum urea and creatinine in hyperemesis group than normal and mild emesis group (p < 0.001). There was significant decrease in blood level of sodium and postassium in hyperemesis group than normal and mild emesis group (p < 0.001). Contrary to that urinary ketone bodies significantly increased in hyperemesis group than normal and mild emesis group (p < 0.001). In 20% of hyperemesis group, medical abortion was induced by vaginal misprostol because of marked deterioration in liver, renal function, marked electrolyte disturbance and marked ketonuria, however the remaining 80% vomiting stopped completely by 20 weeks gestation and pregnancy continued normally up to term, 75% of them had normal vaginal delivery, while 25% were terminated by LSCS. In group I and II, pregnancy continued normally up to term and normal vaginal delivery occurred in 80% and 85% while LSCS was done in 20% and 15% respectively.
Conclusion: In hyperemesis gravidarum there was progressive increase in thyroid activity (hyperthyroidism), deterioration of liver and renal function, electrolyte disturbance and ketonuria.