he Relation between Hyperemesis Gravidarum and H.PYlor

2. The Relation Between Helicobacter Pylori Seropositivity
and Hyperemesis Gravidarum in Pregnant Women
During First Trimester
By
Mohammed Hemdan Aboulfotoh Ibrahim Hemdan
(M.B.B.CH)
Registrar of obstetrics and gynecology
El-Galaa Teaching Hospital

5.  About 50% - 90% of all pregnancies are
accompanied by nausea and vomiting.
(Jueckstock et al., 2010).
 Nausea and vomiting of pregnancy is best
thought of as a spectrum disorder with
varying degrees of symptoms in different
women. Symptoms can range from mild
nausea to unbearable bouts of nausea and
vomiting throughout the day (Mazzotta et
al., 2000).
Introduction

6.  Hyperemesis gravidarum (HG), the most severe form of
pregnancy-associated nausea and vomiting, is leading to
weight loss, nutritional deficiencies, and metabolic
disturbance, for example, dehydration, acidosis from
starvation, hypokalemia, and transient hepatic
dysfunction, often requiring hospitalization and medical
treatment to avoid life-threatening complications (Ismail et
al., 2007).
 The typical onset is between 4 and 8 weeks of gestation,
continuing until 14–16 weeks, HG complicates 0.3–2% of
all pregnancies and is a multifactorial disease; however,
little is known about the etiology of HG. But a variety of
mechanisms may play a role in this disease, such as
endocrine factors like human chorionic gonadotropin
(HCG), estradiol, and progesterone and immunologic
factors. (Verberg and M.F.G, 2006).
Introduction

7.  Recently, several studies suggest that there is a
strong associaton between H.pylori infection
and Hyperemesis gravidarum (Shaban et al.,
2014).
 H.pylori, as a gram-negative flagellated spiral
bacterium, colonizes stomach and creates the basis
of pathogenesis of gastric pathologies, including
chronic gastritis, duodenal and gastric ulcers,
gastric adenocarcinoma, and mucosa-associated
lymphoid tissue lymphoma (Wang et al., 2013).
Introduction

8.  H pylori is one of the most common infectious diseases on
earth. Its prevalence varies among different populations.
More prevalent rates are found in developing countries,
with lower prevalence rates in developed countries
(Nguyen et al., 2015).
 H.pylori is thought to spread between persons through the
feco-oral or oral-oral route. Contaminated water is a
possible environmental reservoir (Deborah et al., 2007).
Introduction

9. Microscopic picture of H. pylori
&
Scanning electron micrograph of H. pylori

11. Aim of the Study
The aim of the study is to
evaluate any possible association between
H.pylori infection and hyperemesis gravidarum
for better evaluating the condition and improving
the cure rate especially in resistant cases of
hyperemesis gravidarum.

13. Patients & Methods
Study Title:
 Detection of Anti-H.pylori serum IgG in
hyperemesis gravidarum pregnant ladies
during first trimester in comparion to
asymptomatic pregnant women.
Study Design:
 Case control study.

14. Patients & Methods
Study Setting:
 El-Galaa Teaching Hospital.
Study timing:
 From Augest 2015 to April 2016.
Study Population:
 90 pregnant women who were divided into two
groups: group A (case group) composed of 45
cases of hyperemesis gravidarum and group B
(control group) made up of 45 healthy pregnant
according to the following inclusion and
exclusion criteria:

15. Patients & Methods
Inclusion criteria:
 Age: 18 – 40 years old.
 Gestational age: less than 13 weeks confirmed by
U/S.
 Diagnosis of hyperemesis gravidarum is based on:
 Excessive pregnancy-related nausea and/or vomiting
that prevents adequate intake of food and fluids.
 Measuring weight loss (>5% of pre-pregnancy
weight).
 Signs of dehydration: Ketonuria (+1 or more) in
urine analysis.
 Elevation of temperature.

16. Patients & Methods
Exclusion criteria:
 Multiple gestation pregnancy
 Pregnant is more than 13 week of gestational age
 Hydaditiform molar pregnancy
 Other causes of vomiting:
 Gastroenteritis
 Cholecystitis
 Pyelonephritis
 Liver dysfunction
 Urinary tract infection
 Hyperthrodism, psychosocial or any other maternal
disorder
 Trophoblastic neoplasia

17. Patients & Methods
Procedures:
All women were subjected to:
Full history taking,
 It included present history, obstetric history, full
menstrual history, past history of medical disorders,
or surgical and gynecological operations.
 Gestational age was determined by first day of last
menstrual period
Clinical examination
 General examination including: vital signs (blood
pressure, pulse, respiratory rate and temperature),
Weight, gait, height, head, chest, heart, breast, back
and lower limbs.
 Abdominal examination.

18. Patients & Methods
Investigations:
 Fetal assessment: Transabdominal or transvaginal
ultrasound for assessment of gestational age and
fetal viability.
 Maternal assessment:
 Complete blood count.
 Complete urine analysis for ketonuria and to exclude
UTI
 Liver function tests including alanine aminotransferase
(ALT), aspartate aminotransferase (AST).
 Renal functions tests including blood urea nitrogen
(BUN) and serum creatinine.
 Serum electrolytes (sodium, potassium,)
 Fasting and postprandial blood sugar.
 Abdominal ultrasound.

19. Patients & Methods
HP infection assessment
 A venous sample was collected to test
the maternal serum for Anti- HP IgG
by enzyme linked immunoassay ELISA.

21. Comparison between patients and control
according LFT.
Results

22. Positive correlation and significant between
freq. of vomiting/d and AST.
Results

23. Positive correlation and significant between
freq. of vomiting/d and ALT.
Results

24. Comparison between patients and control
according Na.
Results

25. Negative correlation and significant
between freq. of vomiting/d and Na.
Results

26. Comparison between patients and control
according K.
Results

27. Negative correlation and significant
between freq. of vomiting/d and K.
Results

28. Positive correlation and significant between
freq. of vomiting/d and Pulse.
Results

29. Positive correlation and significant between
freq. of vomiting/d and Temp.
Results

30. Relation between ketonurea and Freq. of
vomiting.
Results

31. Anti-H pylori
IgG by ELISA
negative and
positive
distribution of
the patients
group
Results
This fig. shows that 86.67% of patiants
group are positive for Anti-H pylori IgG

32. Results
Anti-H pylori
IgG by ELISA
negative and
positive
distribution of
the control group.
This fig. shows that 33.33 % of control group are
positive for Anti-H pylori IgG
Results suggest that there is a strong associaton
between H.pylori and Hyperemesis gravidarum

33.  The results of this study present a powerful association
between H pylori and hyperemesis gravidarum, matching the
results of many previous studies.
 We recommend that the H pylori diagnostic test be a part of
hyperemesis gravidarum investigation, when patients are
resistant to conventional therapy as well as in women who
desire to become pregnant in the near future.

34.  Resistant cases of hyperemesis gravidarum should receive anti
H. pylori antibiotics. The regimen most commonly
recommended for first line treatment of H. pylori is triple
therapy with a PPI (omeprazole20 mg twice daily), amoxicillin
(1 g twice daily), and clarithromycin (500 mg twice daily) for 7
to 14 days. ( Fallone et al., 2016).
 The treatment of H.Pylori infection may reduce the risk of
hyperemesis gravidarum and its complications.