Hyperemesis Gravidarum – Causes, Symptoms & Treatment

HYPEREMESIS GRAVIDARUM

Hyperemesis Gravidarum generally occurs during pregnancy, when the patient is constantly vomiting and has a severe case of nausea. This leads to dehydration and weight loss in some cases. To get a better understanding of the symptoms and causes, it helps to first understand the condition.

What Is Hyperemesis Gravidarum & When Does It Occur?

The fast-rising levels of the HCG hormone along with the progesterone levels during pregnancy can cause morning sickness. However, when these symptoms feel acute it could be a sign of pregnancy sickness. Hyperemesis gravidarum or pregnancy sickness occurs when there is excess and severe vomiting which is continuous. It is also more draining than morning sickness.

Hyperemesis gravidarum is not a common condition in pregnancy and affects only 3 percent of to-be-mothers. The condition is so severe that it does not let you gulp anything down including saliva.

Persistent nausea, excess weight loss, dehydration, an imbalance in electrolytes, malnutrition, acid-base imbalance and volume depletion can be caused because of pregnancy sickness.

The symptoms start to show between the fourth and the seventh week, which is the first trimester and tends to ease down between the 14th and the 16th week. It normally subsides around the 29th week. However, there have also been cases where hyperemesis gravidarum has lasted for the full pregnancy term.

Mild cases of hyperemesis gravidarum can be treated at home. But if the condition is severe, then it may need immediate hospitalisation which is required for the safety of the mother and the child.

It is important to treat the problem and start taking necessary care before the condition becomes critical. Since the symptoms of hyperemesis gravidarum are almost similar to that of morning sickness, it is first important to know how to differentiate between the two.

Is Hyperemesis Gravidarum A Pregnancy Sickness Or Morning Sickness?

Hyperemesis gravidarum is a pregnancy sickness. The condition causes difficulty in swallowing leading to vomiting. Large amounts of saliva get secreted in the mouth and trying to swallow the same only leads to vomiting.

The body tends to lose around 5 percent of its pre-pregnancy weight. The condition also leads to dehydration because of excessive vomiting several times a day. Difficulty in drinking and eating, followed by continuous vomiting are characteristic of the condition, leading to a constant state of fatigue and weakness.

You will know whether the symptoms are of morning sickness or pregnancy sickness if you show these indications.

  • Severe nausea that does not go away
  • Excessive vomiting
  • Inability to eat or drink anything
  • Lack of or reduction in appetite
  • Fainting spells
  • Dehydration
  • Excess loss of weight
  • Presence of blood in vomit

Although morning sickness has similar symptoms, the condition isn’t as severe because the body manages to retain food. But with hyperemesis gravidarum, taking even a bite of food will prove difficult.

Though a rare condition, hyperemesis gravidarum can affect any pregnant woman. There are a few women who are at a higher risk of having hyperemesis gravidarum during their pregnancy. If you feel that you are a likely candidate, then it’s important to be aware of the potential risks involved, as well as educate yourself on how to tackle pregnancy sickness.

Who Is Most At Risk In Hyperemesis Gravidarum?

Women who have a higher risk of complications in pregnancy because of hyperemesis gravidarum are:

  • First-time mothers
  • Young mothers
  • Obese women
  • Women carrying multiple foetuses
  • Women with prior history of hyperemesis gravidarum
  • Women who are under extreme emotional stress
  • Women with an endocrine imbalance
  • Women with a Vitamin B deficiency or H. pylori infection
  • Those prone to migraines or travel sickness
  • Those who have a pre-existing liver disease

There are high chances that if your mother has had a case of hyperemesis gravidarum you may have it too. Hyperemesis gravidarum affects a woman so much that she tends to feel weary the whole day. It may make, even the simplest of tasks, difficult to do.

Will hyperemesis gravidarum harm baby? If this worries you, then you would be glad to know that if hyperemesis gravidarum is treated on time, it is very unlikely to harm the baby. The baby will be born without any developmental or health issues.

The exact cause of hyperemesis gravidarum is still being researched and there is no evidence to pinpoint the reason for an occurrence.

Causes Of Hyperemesis Gravidarum

Vomiting in pregnancy is believed to occur because of the rising blood level of the human chorionic gonadotropin (HCG) hormone. This hormone is released by the placenta. Mild vomiting in the first three months of pregnancy is common, but severe vomiting is a reason for concern. Women who have a hydatidiform mole may also be at a higher risk of having hyperemesis gravidarum.

Hyperemesis gravidarum with metabolic disturbance is a rare case in pregnant women and its exact cause is not entirely known. Hormonal changes are thought to be the reason for hyperemesis gravidarum.

Signs & Symptoms Of Hyperemesis Gravidarum

Awareness of the symptoms leads to early detection and enables one to seek timely medical attention before the condition progresses causing further discomfort.

Symptoms of severe hyperemesis gravidarum should not be ignored. If you display the following symptoms, it is best to consult your doctor at the earliest:

  • Difficulty in taking fluids
  • Little or no urination for eight hours or passing dark urine
  • Abdominal pain
  • Fever
  • Bleeding
  • Headache
  • Visual disturbance
  • Dizziness
  • Blood or bile in the vomit
  • Persistent and severe nausea
  • Salivating abnormally
  • Weight loss due to Hyperemesis gravidarum
  • Light-headedness or fainting
  • Constipation
  • Jaundice

Other symptoms to look out for are:

  • Disturbance in sleep
  • Dysgeusia
  • Decrease in gustatory discernment
  • Hyperolfaction
  • Anxiety
  • Depression
  • Mood change
  • Decrease in concentration
  • Feeling irritated

The doctor will check for metabolic disturbance and will recommend a blood and urine test to know the cause of the sickness. The tests focus on signs of malnutrition, dehydration and presence of ketones (toxic acid chemicals), in the urine.

As soon as you detect any of the symptoms of hyperemesis gravidarum you can start to make necessary diet and lifestyle changes that will help lessen the uneasiness.

What Can Be Done To Ease Hyperemesis Gravidarum?

The remedies suggested to relieve hyperemesis gravidarum depend on the severity of the case. Here are ways to ease discomfort:

1. Mild cases

If your condition is not very severe and you are able to have some food and fluids then you could try the following home remedies for hyperemesis gravidarum:

  • Ginger is known to ease nausea. Ginger tea, ginger cookies and ginger candies can be consumed frequently.
  • Avoid spicy and fatty food that tend to cause nausea.
  • Avoid tastes and smells that make you feel nauseated.
  • Avoid large meals. Break it down into six to eight meals in a day. The meals should be rich in carbohydrates and proteins. This makes it easier to digest the food and prevents the acids from corroding the stomach lining which tends to make one feel like vomiting.
  • Increase fluid intake and pay attention to the colour of your urine. Dark and scant urine is an indication that you need more fluids in your diet.
  • Acupuncture for hyperemesis gravidarum and even acupressure help to an extent.
  • Hypnosis.
  • Lots of rest.

If home remedies fail to give any relief, then your doctor may prescribe medication. Vitamin B6 helps to relieve stress and nausea and you may also be prescribed Unisom sleep tablets.

2. Severe cases

In case your condition is severe and you are vomiting continuously and losing a lot of weight, then you may need intravenous fluids and could be hospitalised. You may also be given an anti-nausea drug. Once you are able to have small amounts of fluids and food, you can start following the practices that are recommended for mild cases of hyperemesis gravidarum. Proper treatment will keep the baby safe and unaffected.

It is however recommended that you talk to your health practitioner early and not wait till the condition worsens to do so.

You should also avoid some triggers that may make you feel uneasy. These may include:

  • Noise and sounds
  • Bright lights
  • Toothpaste
  • Perfume and bathing product smells
  • Pressure on the stomach
  • Motion sickness because of riding in a car

Hyperemesis gravidarum can make you feel very sick and tired. Take plenty of rest and do not strain yourself on account of household chores. Also, eat whatever your body accepts even if the food is not necessarily very nutritious. Get the sickness diagnosed early so that the required precautionary steps can be taken to avoid any health complications.

Hyperemesis Gravidarum Diagnosis

It may not be possible to diagnose hyperemesis gravidarum in women only through a physical examination. Bleeding and abdominal pains or any other unusual complaint can help detect the sickness.

Here are a few exams and tests used to detect hyperemesis gravidarum:

  • Measuring blood pressure and pulse in the standing and lying down position
  • Checking the volume status like mucous membrane, neck veins, skin turgor or mental status
  • General physical appearance
  • Evaluating thyroid
  • Evaluating the abdomen
  • Evaluating the cardiac condition
  • Evaluating any neurological disorder

In addition there are some laboratory tests which can help evaluate the condition of a woman who suffers from hyperemesis gravidarum. These are:

  • Urine analysis to look for specific gravity and ketones
  • The serum levels of electrolytes and ketones
  • Bilirubin and liver enzyme level
  • Lipase and amylase levels
  • Thyroxin level
  • Checking urine culture
  • Checking the calcium and hematocrit level
  • Hepatitis panel

Diagnosis can also be done with some imaging studies too. These include:

  • Obstetric ultrasonography is done to evaluate multiple gestations or any trophoblastic disease.
  • Upper abdominal ultrasonography is done to check the pancreas and the biliary tree.
  • Abdominal computed tomography scanning or magnetic resonance imaging is done to check to see if there are any concerns with the appendicitis to be the cause ofvomiting and nausea.

If your sickness is causing a lot of discomfort, then the doctor may advise you some treatment. The treatment could be moderate if your case isn’t severe or in rare cases, the doctor may even suggest surgery.

Treatment of Hyperemesis Gravidarum

The initial treatment in women who suffer from hyperemesis gravidarum is very moderate. These could include some home remedies or a hyperemesis gravidarum diet.

In case the patient does not feel better even after following the natural remedies, then certain drugs may be suggested. Doxylamine or pyridoxine is an approved drug by the FDA and is given to ease nausea and vomiting.

The following medication is given to treat hyperemesis gravidarum:

  • Vitamins like pyridoxine
  • Herbal medicines like ginger
  • Antiemetics like promethazine, metoclopramide etc
  • Corticosteroids like methylprednisolone
  • Antihistamines like diphenhydramine

METOCLOPRAMIDE

Medication is offered in case the situation is severe or persistent. All the medication should be taken only after consulting a doctor.

The doctor may admit you in case the medication doesn’t work, if you continue to face difficulty in eating and drinking, if you are dehydrated or have developed a medical issue.

The treatment given to patients suffering from pregnancy sickness could be some or all of these:

  • Intravenous fluid(IV) – This is done to restore hydration, nutrients, vitamins and electrolytes in the body.
  • Tube feeding – The doctor may either use Nasogastric, where a tube is passed through the nose to the stomach to restore the lost nutrients in the body. The other method called percutaneous endoscopic gastrostomy is where the nutrients are restored by a tube that passes through the abdomen into the stomach. Percutaneous endoscopic gastrostomy is a surgical method.

In the hospital, you may be given fluids to replace the loss of fluids in your body. You will also be supplemented with minerals and vitamins especially vitamin B1.

Only in some severe refractory cases where the survival of the mother is in danger will a doctor suggest a surgery. Surgery may also be the only option if the sickness is causing a lot of psychological and physical burden. The operation, however, will lead to the termination of the pregnancy.

It is important that you monitor and manage the sickness early to avoid treatment. But if the condition is severe and the doctor suggests a treatment, it is recommended to get yourself treated for hyperemesis gravidarum because pregnancy sickness can also cause a lot of complications.

Complications With Hyperemesis Gravidarum

You may not develop any complications with hyperemesis gravidarum if it gets treated on time. However, if the sickness is very severe then you may develop a blood clot in one of the veins. This is called deep vein thrombosis (DVT). This is caused if you have become dehydrated or have not been moving around a lot. You would be given a drug called heparin to reduce the risk of developing a clot and the nurse may also give you special compression stockings to wear.

If you have a deficiency of vitamin B6 then you may feel pain and a pricking sensation in your hands and feet.

There may however also be rare cases where a woman will develop serious problems and bleeding in her oesophagus because of constant vomiting. Consult a doctor for advice to get Hyperemesis Gravidarum treated before the condition worsens.

When Is The Right Time To Visit Doctor?

As soon as you find any symptoms of hyperemesis gravidarum, consult your doctor immediately. Not being able to take fluids can lead to dehydration which can cause a lot of complications.

Hyperemesis gravidarum is not a common pregnancy condition and seeing a doctor in the early stages of the condition will help avoid any further problems.

Talk to your relatives and friends to know about their experiences and how they fought the sickness. You may also involve your partner to help you with the emotional stress that is caused because of hyperemesis gravidarum.

Also read: Heartburn During Pregnancy