by Poon Chuen Wai. / Thesis (Ph.D.)--Chinese University of Hong Kong, 1996. / Includes bibliographical references (leaves 161-176). / Abstract --- p.i / Acknowledgements --- p.vi / Abbreviations --- p.viii / Introduction --- p.1 / Review of the literature --- p.2 / Incidence and historical background --- p.3 / Theories on etiology of emesis/hyperemesis gavidarum --- p.5 / Mechanism of vomiting --- p.7 / Temporal association between hCG and emesis/hyperemesis gravidarum --- p.9 / Thyroid function and emesis/hyperemesis gravidarum --- p.13 / Steroid hormone and emesis/hyperemesis gravidarum --- p.15 / Hyperemesis caused by corpus luteum in right ovary --- p.15 / "Formulation of a new hypothesis for emesis/hyperemesis gravidarum : “hCG stimulated electrolyte and fluid secretion in the UGIT, leading to pregnancy associated vomiting 226}0ح" --- p.16 / Is hCG a humoural secretory agent ？ --- p.18 / Can hCG stimulate the secretion of fluid and electrolytes from the GIT ？ --- p.18 / Are LH-CGR present in the GIT ？ --- p.20 / Can electrolyte and fluid secretion in the UGIT lead to vomiting during pregnancy ？ --- p.24 / HCG and regulation of electrolyte and fluid movement --- p.24 / Gut- gonad axis --- p.25 / Objectives --- p.27 / Section 1 hCG and in vitro secretion of anions from cells with functional LH-CGR - A cell model --- p.28 / Introduction --- p.28 / Materials and Methods / Materials --- p.30 / Methods / Chapter 1. --- Test for the presence of LH-CGR in human gastrointestinal cell lines --- p.31 / Chapter 2. --- Establishment of cells expressing functional receptor for hCG --- p.35 / Chapter 3. --- Effect of hCG on [125I] iodide efflux from COS-1 cells transiently expressing MC1+2 LH-CG/TSH chimera receptor --- p.38 / Chapter 4. --- Anion secretion from MLTC-1 cells with wild type LH-CGR --- p.38 / Chapter 5. --- Statistics --- p.41 / Results --- p.42 / Discussion --- p.55 / Section 2 Presence of LH-CGR in the upper gastrointestinal tract of rat --- p.61 / Introduction --- p.61 / Materials and Methods / Materials --- p.62 / Methods / Chapter 1. --- Screening for hCG binding sites along the rat GIT --- p.63 / Chapter 2. --- Detection of Triton X-100 soluble plasma membrane hCG binding protein along the rat GIT --- p.64 / Chapter 3. --- Measurement of affinity of the hCG binding proteins by Scatchard analysis --- p.66 / Chapter 4. --- Determination of the isoelectric points for the duodenal hCG binding protein and ovarian LH-CGR --- p.67 / Chapter 5. --- Developement of antibodies to LH-CGR --- p.69 / Chapter 6. --- Western blotting to determine the molecular weight of the LH-CGR --- p.78 / Chapter 7. --- Immunohistochemical localization of LH-CGR in the UGIT --- p.80 / Chapter 8. --- Statistics --- p.81 / Results --- p.82 / Discussion --- p.109 / Section 3 hCG and in vivo secretion of electrolytes from pancreas / duodenal region in rats --- p.119 / Introduction --- p.119 / Materials and Methods / Materials --- p.121 / Methods --- p.121 / Chapter 1. --- The effect of hCG on the secretion of electrolytes into bile and pancreatic/duodenal effluent --- p.121 / Chapter 2. --- Effect of ovariectomy on pancreatic content and electrolyte levels in blood --- p.125 / Chapter 3. --- Statistics --- p.128 / Results --- p.129 / Discussion --- p.151 / General discussion --- p.155 / Reference --- p.161 / Original data --- p.176

by Iris Frances Forster Benzie. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1989. / Bibliography: leaves 170-184.

Tidigare forskning framhäver att hyperemesis gravidarum (HG) är ett tillstånd som innebärihållande och extremt illamående och kräkningar, vilket föranleder betydande hälsorelateradekonsekvenser för den gravida som drabbats. Trots detta råder det osäkerhet kring etiologin,effektiva behandlingar saknas och kunskapen om diagnosen är bristfällig.SyfteSyftet med intervjustudien var att undersöka upplevelsen av vitala mål bland kvinnor somdiagnosticerats med hyperemesis gravidarum (HG), samt deras förutsättningar att nå sina vitalamål.MetodStudien genomfördes med en kvalitativ metod med induktiv ansats och semi-struktureradeintervjuer. Data genomgick därefter innehållsanalys baserat på Lindgren, Lundman ochGraneheim (2020).ResultatInnehållsanalysen resulterade i två teman; Konsekvenserna av HG och Upplevelser ocherfarenheter av vården. Kvinnorna upplevde att deras behandling av illamåendet ochkräkningar och hälso- och sjukvårdens kunskap om diagnosen var otillräcklig. Kvinnornassymtom på HG gav konsekvenser för deras relationer, hälsa, familjebildning ochyrkesverksamma liv.KonklusionIntervjustudien beskrev ett multidimensionellt lidande som kvinnor som haft HG. Diagnosenkom att prägla flera aspekter av deras liv - även långsiktigt. Deras kräkningar och extremagraviditetsillamående upplevdes inte adekvat behandlat, vilket exempelvis relaterade tillineffektiva läkemedel, svåråtkomlig vård samt okunskap och oförståelse hos vårdpersonal.Detta påverkade kvinnornas relationer, arbete och utbildning, ekonomi, hälsa och vitala mål.Det behövs således mer forskning om HG och dess konsekvenser. Det behövs även nationellariktlinjer samt kompetensutveckling om HG inom svensk hälso- och sjukvård.

Pre-eclampsia is a major cause of maternal and perinatal morbidity and mortality worldwide. A predictor of pre-eclampsia would enable intervention, close surveillance and timely delivery, and thereby reduce the negative consequences of the disorder. The overall aim of this thesis was to study potential predictors of pre-eclampsia by biochemical and epidemiological methods. Angiopoietin-1 (Ang-1) and Angiopoietin-2 (Ang-2) are regulators of angiogenesis, which is important for placental development. In a prospective and longitudinal study of a low-risk population the Ang-1/Ang-2 ratio was evaluated. The Ang-1/Ang-2 ratio increased during pregnancy in all women but at gestational week 25 and 28 the ratios were significantly lower in women who later developed pre-eclampsia. The relevance of Histidine-rich glycoprotein (HRG), a protein with angiogenic properties, was furthermore evaluated. HRG levels decreased in all women, with significantly lower levels at gestational week 10, 25 and 28 in women who later developed pre-eclampsia. Thus both Ang-1/Ang-2 ratio and HRG may predict pre-eclampsia. To evaluate the predictive value of HRG in combination with uterine artery Doppler early in pregnancy a study was performed in a high-risk population. The results revealed that the combination was better able to predict preterm pre-eclampsia than each marker individually, with a sensitivity of 91% at a specificity of 62%.  A possible association between hyperemesis gravidarum and pre-eclampsia, as well as other placental dysfunctional disorders, was investigated. Hyperemesis gravidarum may be caused by high levels of human chorionic gonadotrophin (hCG) and increased levels of hCG in the second trimester is associated with later development of pre-eclampsia. A cohort of all pregnancies in the Swedish medical birth register between 1997 and 2009 was studied. After adjustment for confounding factors an association between hyperemesis gravidarum in the second trimester and preterm pre-eclampsia, placental abruption and infants born small for gestational age was demonstrated. In conclusion, the ratio of Ang-1/Ang-2 as well as HRG in plasma may be potential predictors of pre-eclampsia. Combination with uterine artery Doppler further increases the predictive value of HRG for preterm pre-eclampsia. Hyperemesis gravidarum in the second trimester may be considered as a clinical risk predictor of pre-eclampsia and other placental dysfunctional disorders.

La présente recherche explore l'expérience des femmes enceintes atteintes d'un trouble rare de la grossesse du nom d'hyperémésis gravidarum dont les principaux symptômes sont des nausées et des vomissements sévères que la médecine parvient difficilement à contrôler et à traiter efficacement. Cette recherche s'inscrit dans une visée exploratoire et pour cette raison utilise un devis de recherche qualitative dont la théorie de base est la théorie psychodynamique. Cette recherche a été entreprise suite au constat du peu d'intérêt porté aux aspects psychologiques dans le développement de cette affection, les principaux écrits étant de nature médicale et par conséquent s'intéressant davantage aux différents aspects physiologiques de ce trouble. Une question s'est alors imposée : que peut-on comprendre de cette affection de la grossesse sur le plan psychologique? Au plan théorique, la recherche s'est principalement inspirée des écrits de Monique Bydlowski sur la grossesse comme crise maturative et les transformations psychiques résultantes. D'autres auteurs dont S. Freud, F. Ferraro et A. Nunziante-Cesaro, C. Revault d'Allonnes, L. Roegiers, J-M. Delassus et C. Lechartier-Atlan ont également enrichi le contexte théorique sur les différents enjeux, à la fois conscients et inconscients, entourant cet événement que représente la grossesse. Deux recherches portant spécifiquement sur ce trouble, soient celle de Cohen et al (2007) et de Karpel et de Gmeline (2004) ont, par ailleurs, servi de référence à cette étude. Des entrevues individuelles semi-dirigées ont été menées à deux reprises auprès de trois femmes enceintes souffrant d'hyperémésis gravidarum et un inventaire de personnalité, le MMPI-II a également été utilisé afin de diversifier le matériel recueilli. L'analyse des données a été effectuée à partir du discours de ces femmes. Celle-ci s'est inspirée de la méthode d'analyse thématique de Paillée et Mucchielli (2003). Cette analyse a donné naissance à un arbre thématique composé de quatorze thèmes descriptifs et cinq rubriques : l'univers relationnel, la maladie, la grossesse, les représentations des rôles parentaux et la culpabilité. À chacune de ses rubriques sont rattachés les thèmes descriptifs. Par la suite une analyse dynamique des thèmes a permis d'ouvrir sur la discussion clinique et sur l'essai d'interprétation clinique, celle-ci étant inspirée des différents concepts psychanalytiques évoqués dans la section théorique. La discussion a permis de mettre en lumière différentes hypothèses, dont celles d'éventuels manques au niveau du holding de ces femmes par leurs mères, ainsi que la possibilité de recourir à la grossesse marquée de l'hyperémésis gravidarum comme une tentative de recréer ce lien pourtant décevant avec la mère. ______________________________________________________________________________ MOTS-CLÉS DE L’AUTEUR : hyperémésis gravidarum, grossesse, conflit psychique, relation à la mère, ambivalence.

Diss. (sammanfattning) Stockholm : Karol. inst., 2003. / Härtill 5 uppsatser.

Introduction: Hyperemesis gravidarum (HG) in pregnancy can cause severe and persistent vomiting, nausea, dehydration, vitamin and mineral deficiencies. The symptoms can have varying degrees of impact on women's physical, emotional, social, and marital lives and affect their quality of life. Some women voluntarily terminate their pregnancies due to HG. Despite the severe consequences, the etiology of this disorder remains unknown. HG is thought to be caused by a mixture of hormonal variables and genetics. Various therapies have been documented with varying degrees of efficacy. Nevertheless, there is a lack of research on the actual causes of the disease and effective medications, as well as a lack of research on patients' experiences with HG, its treatments, and its consequences. Aim: This thesis aims to examine women's own experiences of HG, with the following research questions: How do women experience HG in their daily lives? What kind of support do they have in coping? What kind of approach do they receive from the health care system? What medical interventions were offered to them? and how effective were they perceived? Method: The thesis adopts a qualitative approach. Some prominent women's groups on Facebook were used to spread the information about the study, and 20 women in Sweden who had suffered from HG during pregnancy and had given birth no more than four years ago were interviewed individually online via Zoom. The data was analyzed using the thematic analysis method by creating sub-themes and themes through coding. Findings: The analysis revealed two themes: 'Trapped in my own body' and 'Longing for optimal HG care'. The first theme described the women's daily lives, which were significantly affected by HG. Due to severe vomiting and nausea, many of them were bedridden for long periods and unable to take care of their children or do household chores. They had significant problems with eating food, drinking water, odors, and oral hygiene. Many were unable to work, and most were on long-term sick leave. Women relied on their partners and families to cope with HG. The disease was compounded by mental health problems such as isolation, loneliness, sadness, and even depression. The second theme revealed that medications and their perceived effects were experienced differently. No drug could completely cure the disease in every case, and HG treatments were not considered optimal by any woman. Medical facilities often lacked knowledge about the disease and the drugs available, and there were no functioning care plans. Lack of knowledge meant that most women in the early stages of pregnancy were not taken seriously by the health system, and it took a long time for many of them to receive appropriate treatment. Conclusion: HG was perceived by women as a severe disease that caused significant physical and psychological obstacles in life and made women feel imprisoned in their bodies. Their most considerable support in coping with this illness was their partners and family. Despite these severe problems, most received inadequate care at health facilities mainly due to ignorance of the disease. This study has highlighted a great need for clear organizational structures, a working care plan, and more knowledge of HG in all health departments. Evidence-based national and local guidelines are needed to improve the availability and quality of health care. Based on the women’s experiences, the findings of this study may provide essential insights for implementing such guidelines in clinical practice.