UC Baby Blog OCT Severe Morning Sickness

Hyperemesis Gravidarum is severe nausea and vomiting during pregnancy.  More commonly experienced in the first half of the pregnancy. Symptoms get better in the second half. This condition is seen in 2% of pregnancies.

When women have Hyperemesis Gravidarum, the most critical health concern is dehydration and electrolyte imbalance. It brings risks to a mom’s health rather than the baby’s because babies don’t require many calories at the early stage of the pregnancy. Babies absorb and feed on whatever they need directly from the mom’s body.

Symptoms and Causes of Hyperemesis Gravidarum

Most women experience nausea or vomiting, known as “morning sickness,” especially during the first three months of pregnancy. The symptoms of morning sickness are caused by a rapidly rising blood level of pregnancy hormones, mainly estrogens and human chorionic gonadotropin (HCG).

The growing placenta produces HCG in the womb. The rising level of pregnancy hormones usually occurs in the morning (as so-called morning sickness), although it can happen any time of day. Women with morning sickness continue to gain weight and do not become dehydrated.

Mild morning sickness is common. On the other hand, Hyperemesis Gravidarium is a less common but much more severe form of nausea and vomiting. It can cause a weight loss of more than 5% of body weight.

Hyperemesis Gravidarium is seen more likely with:

  • Multiple babies (twins or more babies)
  • Hydatidiform mole
  • Hyperemesis Gravidarium with previous pregnancies
  • Being prone to motion sickness

Hyperemesis Gravidarium can lead to:

  • Weight loss (> 5% of weight)
  • Dehydration
  • Ketosis
  • Electrolyte imbalances
  • Thyroid and liver dysfunction
  • Confusion / headaches
  • Fainting due to hypotension
  • Jaundice
  • Extreme fatigue
  • Tachycardia (abnormally fast heart rate
  • Low amniotic fluid volume
  • Premature labour

What to watch out for

Symptoms typically start around nine weeks and tend to subside around the 20-week mark. Occasionally they last longer. Hyperemesis Gravidarum may cause transient hyperthyroidism.

If it persists after 20 weeks, it may seriously damage the liver, causing severe centrilobular necrosis or widespread fatty degeneration. The patient can have Wernicke encephalopathy due to brain damage or esophageal rupture from vomiting.

It is best to regularly consult the doctor if morning sickness has been going on for an extended period.

Treatment of Hyperemesis Gravidarum

Treatment starts with temporarily feeding the mother through the IV line. Fluids, multivitamins, minerals, and electrolytes are all provided to the body through IV. Nothing is given by mouth. When the symptoms decrease gradually, oral feeding starts. Sometimes anti-nausea medication is added to oral feeding.

There are also holistic alternatives to support the treatment. Bed rest can provide some comfort for weakness and fatigue. Acupressure and acupuncture to the inner wrist can reduce nausea for some moms. Some herbs such as ginger and peppermint can also be used to calm down stomach symptoms. Hypnosis is reported to provide relief in some cases.

 

REFERENCES:

Hyperemesis Gravidarum

The Management of Nausea and Vomiting during Pregnancy 

Hyperemesis gravidarum

Hyperemesis Gravidarum: Signs, Symptoms, and Treatment

 

Written by: Tina I Ureten MD, RDMS, RDCS

 

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