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Why are Women Still Dying from Nausea and Vomiting of Pregnancy?

Until the 1950’s, maternal deaths were commonly associated with hyperemesis gravidarum (HG). Although maternal mortality secondary to HG has since decreased, there have been 6 deaths reported recently in the literature. In addition, reports of Wernicke’s encephalopathy (WE) secondary to HG are on the rise. Herein we review the documented mortalities and provide our analysis of the critical issues that must be urgently addressed to put an end to HG-related deaths. In short, we recommend the following for patients with HG: 1) mandatory reporting and documentation on death certificates of HG-related deaths, 2) inclusion of appropriate thiamin dose in all prenatal vitamin formulations, 3) daily electrolyte and nutrition monitoring in patients presenting with HG with special attention to and hospitalization for signs of thiamin deficiency and hypokalemia, 4) thyroid screening and subsequent treatment for all patients presenting with HG, 5) provider education on the importance of communication with the patient/family as language barriers and provider bias can result in misdiagnosing symptoms of WE when depression and/or inability to communicate is present. Prompt testing and treatment followed by frequent follow-up with the patient until symptoms subside may help to prevent HG-related deaths in the future.


Marlena S Fejzo, Kimber MacGibbon and Patrick M Mullin

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