Hyperemesis gravidarum is a condition in which pregnant women experience severe vomiting and weight loss. Treatment can require hospitalization. This condition affects about 2% of pregnancies. This is a potentially serious problem that requires care from your doctor.
Causes
Several factors may contribute to hyperemesis gravidarum, including:
-
High or rapidly rising serum levels of hormones such as hCG (human chorionic gonadotropin)secreted by the fetus
-
Increased estrogen levels
-
Pressure on the stomach and intestines
-
A multiple pregnancy (ie, twins or more)
-
Hydatidiform mole (abnormal tissue growth, not a true pregnancy)
Risk Factors
The following factors increase your chance of developing hyperemesis gravidarum. If you have any of these risk factors, tell your doctor:
-
First birth
-
Hyperemesis gravidarum in prior pregnancies
-
Mother or sister with hyperemesis gravidarum
-
Being pregnant with more than one fetus
-
Living in the Western Hemisphere
-
Emotional problems
-
History of an eating disorder
-
Infection with the bacterium Helicobacter pylori
-
Carrying a fetus with Down syndrome
-
History of motion sickness
-
History of migraines
-
Carrying a fetus that is female
Symptoms
The following list of symptoms are general and may be caused by other, less serious health conditions. However, if you experience any one of them, call your physician to discuss your condition. Symptoms may include:
-
Severe and lasting vomiting—not being able to keep liquids down
-
Weight loss
-
Dehydration, which may show the following signs:
-
-
-
-
-
Yellow skin
-
Racing heart
-
Dizziness
-
Feeling faint
Diagnosis
Your doctor will ask about your symptoms and medical history, and perform a physical exam.
Tests may include the following:
-
Weight measurement – to determine if you have lost weight
-
Blood electrolytes – to identify disturbances in salts and other minerals in the blood due to extreme vomiting
-
BHCG – An extremely high level could indicate more than one fetus or a molar pregnancy (an abnormal growth that mimics pregnancy).
-
-
-
-
-
-
-
-
-
-
Treatment
Talk with your doctor about the best treatment plan for you. Treatment options include the following:
IV Hydration and Anti-nausea Medicines
Many times, hyperemesis can be managed by a short treatment with fluids in the vein and medicines to stop the nausea immediately. This is followed by daily use of antinausea medicines to keep the nausea at bay and allow eating and drinking. Some women require IV fluids throughout the pregnancy. This can sometimes be done without the need for hospitalization.
Medicines for hyperemesis may include:
-
Promethazine
-
Meclizine
-
Ondansetron
-
Droperidol
-
Metoclopramide
Nutrition by Vein
If a woman is unable to tolerate food by mouth, even with daily use of antinausea medicines, she may need to receive nutrition by vein. This is called parenteral nutrition. A special kind of catheter is placed in a large vein and liquid nutrition is given. This can sometimes be done without hospitalization.
Stress Reduction Techniques
Hypnosis and psychotherapy can be useful in reducing symptoms once the patient undergoes any treatment that her doctor deems necessary to stabilize her condition.
Vitamin and Other Complementary Therapies
Once a patient’s condition has been medically treated, some doctors suggest the use of Vitamin B6 supplements. Studies have shown that B-6 supplements taken daily can reduce nausea. Doctors may also suggest acupressure treatment, or that the patient consume ginger to lessen the nausea.
Termination of Pregnancy
In extreme cases, your doctor may discuss the option of terminating the pregnancy if a specific type of eye problem called hemorrhagic retinitis occurs.
Prevention
Many of the conditions that lead to hyperemesis are not preventable and it is unknown why some women without those conditions develop hyperemesis. You can try to reduce your nausea during pregnancy by:
-
Avoiding smells, foods, or other things that stimulate nausea
-
Eating frequent small meals
-
Not allowing yourself to get too hungry or too full
RESOURCES:
The American College of Obstetricians and Gynecologists
http://www.acog.org
The Cleveland Clinic
http://www.clevelandclinic.org
Dartmouth-Hitchcock Medical Center
http://www.dhmc.org/webpage.cfm
Familydoctor.org
http://familydoctor.org
University of Virginia
http://www.healthsystem.virginia.edu/toplevel/home/home.cfm
CANADIAN RESOURCES
The Canadian Women's Health Network
http://www.cwhn.ca/indexeng.html
The Society of Obstetricians and Gynaecologists of Canada (SOGC)
http://www.sogc.org/index_e.asp
References:
ACOG issues guidance on the treatment of morning sickness during pregnancy. American College of Obstetrics and Gynecology website. Available at: http://www.acog.org/from_home/publications/press_releases/nr03-29-04-1.cfm. Accessed August 11, 2005.
Beers MH, Berkow R, eds-in-chief. The Merck Manual of Diagnosis and Therapy. 17th ed. Whitehouse Station, NJ: Merck Research Laboratories; 1999.
Burrow GN, Duffy TP, eds. Medical Complications During Pregnancy. 5th ed. Philadelphia, PA: W.B. Saunders Company; 1999.
Cunningham FG, Gilstrap LC, Gant NF, Hauth JC, Leveno KJ, Wenstrom KD, eds. Williams Obstetrics. 21st ed. New York, NY: McGraw-Hill; 2001.
Gabbe SG, Niebyl JR, Simpson JL. Obstetrics: Normal and Problem Pregnancies. 4th ed. United Kingdom: Churchill Livingstone; 2003.
Gastroenterology Clinics of North America. Philadelphia, PA: WB Saunders.
Hyperemesis gravidarum. US National Library of Medicine and the National Institutes of Health website. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/001499.htm. Accessed August 6, 2005.
Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL, eds. Harrison’s Principles of Internal Medicine. 16th ed. New York, NY: McGraw-Hill Companies, Inc; 2005.
Mahan LK, Escott-Stump S, eds. Krause’s Food, Nutrition and Diet Therapy. 10th ed. Philadelphia, PA: W.B. Saunders Company; 2000.
Quinlan JD, Hill DA. Nausea and vomiting of pregnancy. Am Fam Physician. 2003;68:121-128. American Family Physician website. Available at: http://www.aafp.org/afp/20030701/121.html. Accessed August 12, 2005.
Sadock BJ, Sadock VA, eds. Kaplan and Sadock’s Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry. 9th ed. Philadelphia, PA: Lippincott, Williams and Wilkins; 2003.
Wise MG, Rundell JR, eds. The American Psychiatric Publishing Textbook of Consultation-Liaison Psychiatry: Psychiatry in the Medically Ill. 2nd ed. Washington, DC: American Psychiatric Publishing, Inc.; 2002.
