Extreme Nausea & Vomiting in Pregnancy - Causes And Treatment of Hyperemesis Gravidarum

Extreme Nausea & Vomiting in Pregnancy - Causes And Treatment of Hyperemesis Gravidarum

Does your morning sickness not seem to be easing off? Do every smell and taste worsen your nausea? Does it feel like spending most of the time in the washroom? If this is the case, then you are going through extreme nausea and vomiting phase of your pregnancy.

Hyperemesis Gravidarum (HEG)

Most of the pregnant women experience nausea or morning sickness during pregnancy. While morning sickness is quite uncomfortable, it is generally harmless and goes away within 12 weeks. 

But when this morning sickness takes extreme form, it causes severe nausea and vomiting, a condition known as Hyperemesis Gravidarum.

How can we differentiate between morning sickness and Hyperemesis Gravidarum?

It’s very important to distinguish between both the conditions as they are two different things with different side effects. When you are suffering from Hyperemesis Gravidarum, you tend to vomit a lot, sometimes it is constant. 

This causes severe dehydration and leads to weight loss. Hyperemesis Gravidarum strikes between the 4-6th week of pregnancy and might get worse in the 9-13th week. It does not go away easily and usually lasts longer.

On the other hand, this is not the case with morning sickness. It does include nausea but vomiting is not constant. These symptoms typically wither away within 12-14 weeks or end of the first trimester. Morning sickness does not even cause severe dehydration.

How common is Hyperemesis Gravidarum?

Extreme nausea and vomiting in pregnancy occur in 1 in 300 cases. The numbers are expected to be much higher than this since many of the pregnant women are treated at home or receive outpatient treatment.

The estimates are generally determined via weight loss. If the weight loss is over 5 percent of the total body weight accompanied by other complications such as uncontrollable vomiting and disturbed nutrition, then it falls in the hyperemesis gravidarum category. 

Less than half percent of pregnant women with this condition might experience symptoms throughout pregnancy.

What causes Hyperemesis Gravidarum?

Almost every pregnant woman experience some form of morning sickness. Expert doesn’t know what exactly causes hyperemesis gravidarum, but the following reasons are often associated with increased morning sickness:

Relation with hCG hormone

It is believed that hyperemesis gravidarum has some connection with Human Chorionic Gonadotropin (hCG) hormone. The hormone is created by placenta during pregnancy, presence of which can also determine whether you are pregnant or not. 

In pregnancy, this hormone is typically released in large amount and at a rapid rate, especially in the first trimester. And as hyperemesis gravidarum is most frequently experienced in the first trimester, increased level of hCG might be the reason behind it.

Increase in Estrogen

Some experts assume that increase in the estrogen levels during pregnancy is the reason behind hyperemesis gravidarum. This could be because intestinal motility and gastric emptying capability decreases during pregnancy, which might lead to increase in nausea and vomiting.

Family history

Another theory is that this condition is genetic. Women with family members who had experienced hyperemesis gravidarum are likely to develop this condition.

Helicobacter Pylori

According to a study, over 90 percent cases of pregnant women with hyperemesis gravidarum are also infected with this bacterium.

Thyroid Imbalance

According to HER Foundation, 70 percent of women with hyperemesis gravidarum have changes in blood thyroxine level.

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Nutritional Deficiency

Deficiency in pyridoxine (B vitamin) and zinc can cause hyperemesis gravidarum

Others

Other causes include liver abnormalities, stress, and abnormalities of fat in the blood

What are the symptoms of Hyperemesis Gravidarum?

The onset of hyperemesis gravidarum typically occurs in the first trimester. Some of the most common symptoms are:

  • Dehydration
  • Headache
  • Feeling of constant nausea
  • Vomiting 3-4 times a day
  • Loss of appetite
  • Dizziness or light-headedness
  • Jaundice
  • Loss of skin elasticity

Complications associated with Hyperemesis Gravidarum

The vomiting can be so terrible that most of the pregnant women are unable to perform their day to day activities. The complications include:

  • Losing over 5 percent of the total body weight
  • Decrease in urine output
  • Loss of essential electrolytes such as sodium and potassium
  • Changes in blood pressure
  • Weakening of muscles due to electrolyte imbalance and malnutrition
  • Too much making of saliva

Known risk factors

Some factors that could increase the chances of extreme nausea and vomiting are:

  • Being overweight
  • History of hyperemesis gravidarum
  • First time pregnancy
  • Multiple pregnancy
  • Abnormal growth of cells inside the uterus (trophoblastic disease)

When to call the doctor?

You must call the doctor if you experience severe nausea and vomiting accompanied by following signs:

  • Abdominal pain
  • Unable to tolerate fluids
  • Blood in vomit
  • Rapid heart rate

How to diagnose HEG?

The doctor would be asking your medical history followed by physical examination. He will also look at the common symptoms such as blood pressure changes and fast pulse rate to diagnose the condition. Further, he may order tests such as:

  • Blood and urine tests for checking symptoms of depression
  • Tests for checking gastrointestinal problems
  • Liver and thyroid function tests
  • Ultrasound to check for gestational status and traces of abnormal cells growing in the uterus

Treatment

The treatment will depend on the severity of the symptoms and how it is affecting the health. It is estimated that about 5 percent of women require checking in the hospital. The doctor might recommend following things:

Changes in lifestyle

You would be advised to eat smaller and frequent meals. The same advice would be for drinking as well that should be done through a straw.

  • Having cold foods rather than hot could make you feel comfortable
  • Sports drink or some nutritional supplements would balance lost electrolytes in the body
  • Getting enough sleep to ward off stress

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Intravenous fluids

Pregnant women who are unable to take in food or drink due to the constant tendency of nausea will need to get them intravenously. In extreme cases, you would get fluids via a tube attached to your stomach or intestine.

Ginger

The doctor would advise ginger which can be taken in the form of tea. Taking 1 to 1.5 gram of several doses of ginger daily might help some women. Low dose ginger supplements are also available.

Medications

To prevent you from throwing up less, the doctor might prescribe you most commonly used anti-nausea drugs. These include promethazine, droperidol, and meclizine. If you are unable to take them orally, these medicines might be administered intravenously or via injection.

Other

The doctor might also recommend pressure wristband and vitamin B6 might help prevent nausea.

Once you start taking food and not vomiting anymore, your doctor might tell you to stop the treatment. Women with prolonged hyperemesis gravidarum might face severe complications such as preterm labor and preeclampsia. So, the sooner you talk to your gynecologist and start the treatment, the more you will feel better and prevent complications.