Hyperemesis Gravidarum(Excessive Vomiting during Pregnancy)

What is hyperemesis gravidarum?

Nausea and vomiting occur frequently during pregnancy and more than half of all women suffer from ‘morning sickness’ at the beginning of their pregnancies.
Hyperemesis on the other hand is the severe form of ‘morning sickness’ that also occurs in the early weeks of pregnancy, when your sickness and vomiting persists all day and you are unable to keep your meals or drinks down. You may even start to lose weight.

It often makes you ill enough to require a check-up by your doctor and, in most cases, admission into hospital.

How common is this condition?

This severe form is not very common and affects only about one in 200 women. Untreated it could persist beyond your 16th week of pregnancy.

What are the symptoms?

• Vomiting excessively and feeling sick all of the time
• You may experience a dry mouth from dehydration
• You may feel unusually tired and light-headed
• Your urine may contain a high concentration of salts called ketones, which can change the appearance of your urine and give it an unpleasant smell
• All of these symptoms can be relieved quickly by giving you adequate fluids and anti-sickness medication

What causes the condition?

We do not know the exact cause of this. It is more common in first time mothers, in women carrying twins or in women who are very sensitive to hormones such as the oral contraceptive pills.
It is not unusual to have this problem if you are a younger mother under 20 or if you are older than 35 years old.
Stressful situations either at home or at work could worsen your condition.

Is this condition risky to my baby?

If treated, this condition has very little risk to your baby. It is a myth that excessive nausea or vomiting has to do with the sex of your baby, risk of miscarriages or abnormalities.

Is this condition risky to me?

There are very few risks to you if hyperemesis is diagnosed early and your doctor or the hospital treats you promptly. You may become malnourished and weak and in certain rare cases become drowsy or disorientated. However, with treatment, you are unlikely to get to this stage.

What tests do you do?

Rarely, symptoms are caused by health conditions other than your pregnancy such as a urinary tract infection, food poisoning or more serious conditions like appendicitis, thyroid, liver or kidney problems. We will look at your past health history and the effects of any regular medications you are on, and take some blood tests.

How do you treat this condition?

Your GP or your nurse may have started you on some treatment but referred you because you are becoming dehydrated and need to have fluids replaced. If you are to recover quickly, it is essential that we replace all the fluids you have lost already.

On admission to the ward you are likely to have a drip infusion of fluid with the essential nutrients that you need. We will encourage you to eat and drink little and often until the vomiting settles.

Occasionally we may need to refer you to our dietician, who can provide advice. Sometimes we may need to give you supplement drinks until you start to tolerate small meals and light snacks. It is often necessary to give you injections of anti-sickness medications to help your recovery.

We monitor your recovery and once your urine is clear of ketones, you can be discharged home.

Many women struggle with their domestic arrangements, work and childcare but cope better with the support they get from their partners, friends and families.

Are the drugs safe?

Yes. This is a critical time for your baby’s development and so we only use anti-sickness medications and vitamins that have been tested over years and that we know do not cause harm to you or your baby.

We will use minimal medications to reduce your symptoms and allow you to recover quickly to avoid a long stay in hospital. Feelings of nausea can sometimes be difficult to eliminate completely.

How long will I be in hospital?

We aim to treat you during the day time and allow you home in the evening, research shows that a good night’s sleep in your own bed can help your recovery.
Rarely, you will need to stay between one and two days, depending on how quickly you pick
up.

What do I need to do on leaving hospital?

There are a number of changes you may wish to make to your diet and lifestyle, which can reduce your symptoms:

• Make sure that you get plenty of rest because tiredness can make the nausea worse
• Avoid fizzy drinks and drink little and often rather than large amounts of fluids
• Choose what you eat carefully and only eat foods that you know you tolerate well
• Eat small, frequent meals and snacks throughout the day
• Choose starchy meals which are also low in fat e.g. pasta meals or baked potato which are easy to prepare. Avoid fried foods
• Pregnancy hormones heighten your sense of smell so avoid any food or smells that trigger your symptoms. Cold meals do not give up as many smells as hot, spicy foods and so may be better tolerated
• Stick to bland foods and avoid foods with tart sharp tastes or that are sweet. Most women find dry foods such as toast (without butter) or crackers are better tolerated.
• Avoid strong smells like perfumes and cigarette smoke at home

You can get additional advice and support from the Pregnancy Sickness Support group.