Hyperemesis Gravidarum: Excessive Vomiting in Pregnancy
What is Hyperemesis Gravidarum (HG)
70-80% of women experience morning sickness but hyperemesis gravidarum is found in only 1% of pregnancies. HG is s condition characterized by severe and excessive nausea and vomiting, electrolyte imbalances and weight loss. Symptoms usually begin between the 4th and the 6th week of pregnancy and usually improve between the 15th and 20th week.
Women suffering with HG have many episodes of vomiting in one day and constant nausea. Many women with HG tend to experience symptoms or have relapses throughout the entire pregnancy.
What Sets Apart HG from Morning Sickness?
Nausea and vomiting
Nausea with SEVERE vomiting
Nausea that goes away after 12 weeks or a little after
Nausea that does not go away
Vomiting without dehydration
Vomiting with severe dehydration
Able to keep some food down
Not able to keep any food down
The Nature of HG symptoms
The symptoms of HG usually begin between the 4th and 6th week with the climax between the 9th and 13th weeks. Some women even begin sensing early symptoms (i.e. taste and smell changes, nausea, vomiting and fatigue) a few days after conception. Between approximately the 14th and 20th weeks, there's usually an improvement in symptoms but at least 10-20% of HG patients continue to be nauseous and to vomit. Those 10-20% of women may even vomit up until the delivery of the fetus.
- Nausea and vomiting at the sight, smell or thought of food
- Motion sickness
- Food intolerance and avoidance (can lead to anorexia)
- Oversensitive gag reflex
- Dizziness / fainting
- Inability to maintain an upright position
- Pale, waxy, dry (and sometimes jaundice [yellow]) skin
- Hemorrhages in the retina
- Lethargy and extreme fatigue
- Excessive salivation
- Sleep disturbance (i.e. insomnia)
- Excessive thirst
The Progression of vomiting: first of mucus, then bile and then blood.
You know when normal morning sickness is transitioning to hyperemesis gravidarum when there is rapid wright loss (5% or more of pre-pregnancy weight) and frequent, severe nausea and vomiting.
Bear in mind that these are not causes of HG. The exact cause of HG is unknown. These are just statistical risk factors:
- More common in first pregnancies
- More common in women with a pre-pregnancy weight of 170 lbs
- Those with multiple pregnancies (e.g. twin pregnancies)
- Those less than 20 years old. Risk may decrease after the age of 35.
- Often occurs in subsequent pregnancies
- Those with a history of miscarriages
- Those with untreated asthma
- Excessive stress (makes the condition worse)
- Those with PTSD
- Those with epilepsy
Hospitalization and Treatment
Women with HG are usually hospitalized at least once over the course of their pregnancy. Sometimes nausea and vomiting is so severe it must be treated with anti-emetic medications. The first line treatment for HG is making sure the affected woman gets plenty of rest and strictly managing small meals (avoiding spicy or fatty foods). It is recommended that women with HG increase their intake of high-protein foods.
At the hospital, HG patients receive intravenous replacement fluids to hydrate the patient and get their electrolytes, vitamin and nutrients back in balance. Some patients require tube feeding until they are able to tolerate eating food and keeping the food down. HG patients must be constantly monitored.
What about the Fetus
Studies have shown no profound effect on the fetus from the mother having HG. However, some medications used to manage HG can affect the fetus. Maternal stress and complications of HG can also affect the fetus, but if the condition is handled well, fetuses are born just as healthy as they would in a normal pregnancy.
Sometimes medical abortion is recommended for patients with HG, but that's only in extremely severe cases. Some mothers who are unable to handle the torment of HG my choose to abort the fetus.
Psychological Component of HG
Depression and anxiety is a secondary symptom of hyperemesis gravidarum. HG doesn't just take a toll on the mother's body but on her emotions, even more so than in normal pregnancies.
At times, hypnosis and psychotherapy is required to "train" the woman with HG not to vomit at the thought of food. Cognition (thought process) is an important factor in the severe nausea and vomiting experienced in HG.
A woman with HG needs a lot of support from her friends and family. Some women require counseling and psychological assistance to cope with HG. I've read stories about women who were so plagued by the constant vomiting and nausea of HG that they developed cued panic attacks when thinking about food. I've even heard stories of women suffering from Post Traumatic Stress Disorder (PTSD) following the pregnancy.
Tips for those with HG
- Get plenty of rest: will lower your level of stress
- Separate foods and drinks: increases the chances of you keeping your food down
- Make ginger your friend: ginger may help ease nausea and vomiting
- Drink Gatorade (or another similar drink): to keep your electrolytes up
- Tea party: drinking herbal teas such as ginger and peppermint may help ease nausea
- Crackers: keep crackers at the side of the bed to prevent worsening of nausea in the morning
- Small, frequent meals
- Drink milkshakes and smoothies: if you're still having trouble keeping solid foods down
For More information, check out these sites:
- Help HER - Hyperemesis Education Research
- Pregnancy, Hyperemesis Gravidarum: eMedicine Emergency Medicine
Overview: Nausea and vomiting are common in pregnancy, occurring in 70-85% of all gravid women.
- Hyperemesis Gravidarum : American Pregnancy Association
Hyperemesis gravidarum is a condition that occurs during pregnancy and is a severe form of morning sickness.
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