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What is Hyperemesis Gravidarum (HG)?

Hyperemesis Gravidarum (HG) is the most severe form of nausea and vomiting during pregnancy. HG causes malnutrition, electrolyte imbalance, and dehydration which, if left untreated, can be life-threatening for mother and her unborn child(ren).

In order to ensure survival, the pregnant woman requires a significant amount of support and care. Each case should not be compared to another HG pregnancy as each pregnancy is different.

Symptoms of Hyperemesis Gravidarum:
  • Fatigue
  • Jaundice
  • Fainting
  • Weight loss
  • Confusion
  • Palpitations
  • Headaches
  • Sensitivity to environmental odors
  • Frequent urination
  • Nutritional deficiencies
  • Metabolic imbalances
  • Altered sense of taste
  • Difficulty with daily activities
  • Severe dehydration, causing ketosis and constipation
  • Nausea accompanied with vomiting
  • Food aversions, which means the food doesn’t seem to be tasty
  • Subconjunctival hemorrhage (broken blood vessels in the eyes) 
While normal morning sickness starts around 9 to 10 weeks gestation, HG symptoms can appear as early as conception. These symptoms can occur at any time throughout the day.

While HG sometimes subsides after 14 weeks of pregnancy, it may stay throughout the entire pregnancy. This is more common in young pregnant women and/or women who have had multiple pregnancies in a short period of time.

Hyperemesis Gravidarum is diagnosed by persistent nausea and vomiting related with ketosis and weight loss (>5% of pre-pregnancy weight). Also, it may cause volume depletion, nutritional deficiencies, electrolytes and acid-base imbalances, and even death. One in fifty pregnant women are reported to suffer from HG.


Causes of Hyperemesis Gravidarum

At this time, the exact cause of HG is unknown.

Theories regarding the cause of HG:

  • Digestive tract dysmotility (i.e. food does not move smoothly along the digestive tract)
  • Deficiency of nutrientst
  • Hormonal changes such as increased levels of progesterone, estrogen and beta HCG (Human Chorionic Gonadotrophin)
  • A bacteria called Helicobacter pylori may also play a role in causing HG)
  • HG may be a genetic. Pregnant women with a family history of HG are at higher risk.
Prevention of HG is not yet possible, but early detection can help in providing required treatment and care.

Complications of Hyperemesis Gravidarum

These complications are experienced due to dehydration and starvation with resulting ketoacidosis:

  • Too much vomiting is harmful as it leads to dehydration and poor weight gain during pregnancy.
  • Wernicke’s encephalopathy
  • Peripheral Neuritis
  • Korsakoff’s psychosis
  • Stress ulcers in stomach
  • Jaundice

Diagnosis of Hyperemesis Gravidarum

A physical examination will be performed by the doctor. Blood pressure may be low and pulse may be high. The following laboratory tests will be done to check for signs of dehydration:

  • Urine ketones
  • Hematocrit

To rule out liver and gastrointestinal problems, your doctor may need to run tests. If you are carrying twins or more, a pregnancy ultrasound will be done to see and to check for a hydatidiform mole.

Treatments for Hyperemesis Gravidarum

Always consult your health care professional before attempting and/or seeking any of these treatment options.

          Increase Fluid Intake
  • Drink plenty of fluids throughout the day whenever you feel the least nauseated. (Examples: Seltzer water, sparkling carbonated water, ice, fruit juice, sport drinks)
  • Some women are unable to tolerate anything by mouth. In this case, fluids are given through IV and administered by medical professionals.
  • Normal intake of diet should be looked upon after the process of re-hydration is complete.

Bed Rest

Many health care professionals advise HG patients go on complete or modified bed rest based on the severity of the disorder.

Adjust Diet
  • Eat small, frequent, bland meals rather than consuming three larger meals daily. (Examples: dried toast, crackers, chicken broth, ginger-based foods, lean meats, gelatin, popsicles, rice, baked or mashed potatoes)
  • Avoid fried, fatty and spicy foods as well as smells that trigger nausea and vomiting.
  • Many HG suffers are unable to consume anything by mouth their entire pregnancy, not even their own saliva. A health care professional should be consulted about options that will provide mother and child(ren) with proper nutrition and hydration to ensure their health, safety and survival.
  • Forcing a HG sufferer to eat or drink can make the condition worse and the recovery more difficult.
Medication
  • Reserved for cases where vomiting is continual and severe enough to present potential risks to mother and unborn child(ren).
  • Antiemetics: Ondansetron (Zofran); Metclopramide (Reglan); Dronabinol (Marinol); Pyridoxine/doxylamine (Bendectin)
  • Antihistamines: Promethazine (Phenergan); Diphenhydramine (Benedryl)
  • Corticosteroids: Hydrocortisone; Prednisolone.
  • Some women have reported greater relief when their health care professional prescribed two or more medications, alternating them at different times throughout the day.
Supplements and Acupressure
  • Vitamin B6 (no more than 100mg daily) has been shown to reduce the nausea in early pregnancy.
  • Supplementation of thiamine, vitamin A and B, sodium and potassium is also shown to improve some symptoms, however, as mentioned before, many HG sufferers are unable to take in anything by mouth, not even prenatal vitamins.
  • Acupressure may also help by pressing the finger or thumb against the inside of the wrist. 







 




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