Hyperemesis Gravidarum

Did you know that about 0.3% – 2.0% of all pregnant women experience hyperemesis gravidarum? Hyperemesis gravidarum (HG) is an intense and prolonged version of morning sickness that causes severe nausea and vomiting.

This pregnancy complication is characterized by constantly vomiting in ample amounts, particularly 3 – 4 episodes of vomiting a day. With that being said, the first clear medical description of HG was finalized in 1852 by Antoine Dubois.

The word hyperemesis gravidarum comes from the Greek word hyper which means excessive, emesis which means vomiting. Then gravidarum comes from the Latin word which means the feminine noun of pregnant [woman].

Hyperemesis gravidarum generally occurs between 4 – 6 weeks of pregnancy, worsens around 9 – 13 weeks, and usually subsides by the 20th week.  Although about 20% of women suffer from HG all throughout the journey.

Risk factors of hyperemesis gravidarum

Some factors that increase the risk of having a hyperemesis gravidarum are as follows:

Pregnancy week by week
  • Prior or having a history record of hyperemesis gravidarum
  • Having a history record of an eating disorder
  • Pregnant with multiples (twins, triplets, and the like)
  • Obese women
  • Hyper olfaction – certain odors that triggers HG
  • First – time mothers
  • Young and teenaged mothers
  • Women with Vitamin B deficiency
  • Women who suffer from helicobacter pylori infection (H. pylori infection)– germs and bacteria in the digestive tract
  • Women who suffer from extreme emotional stress
  • Expectant mothers who suffer from Trophoblastic disease (a disease which occur when atypical cells are present inside the uterus

Signs and symptoms of hyperemesis gravidarum

  • Weight loss for more than 3 kilograms / 10 pounds or 5% of the body weight
  • Food aversions
  • Hyper salivation
  • Vomiting with blood
  • Decreased urine output
  • Dehydration which is accompanied by infrequent urination, dark yellow and ketones present in the urine (ketosis)
  • Pregnancy – induced headache
  • Misperception
  • Lightheadedness and fainting
  • Jaundice
  • Atypical hypotension (widely called as low blood pressure)
  • Tachycardia – tachycardia is when the heart beats faster or has irregular patterns
  • Secondary anxiety
  • Depression
  • Loss of skin firmness and elasticity
  • Over – fatigue
  • Gastrointestinal complications

Hyperemesis gravidarum versus morning sickness

Hyperemesis gravidarum and morning sickness are different pregnancy disorders. They have different signs, symptoms and side effects. To be able to know which is which, below are the following characteristics to distinguish if it is HG or not:

  • Hyperemesis gravidarum is accompanied by severe vomiting while morning sickness is milder
  • Hyperemesis gravidarum usually begins within the first 6 weeks of pregnancy and does not subside while morning sickness usually begins during the 1st month of pregnancy and goes away during the 3rd – 4th month
  • Hyperemesis gravidarum causes a complete loss of appetite while morning sickness only cause a slight loss
  • Hyperemesis gravidarum is constant while morning sickness subsides by week 12 – 14 of pregnancy
  • Hyperemesis gravidarum leads to severe dehydration while morning sickness does not
  • Hyperemesis is accompanied by vomiting that cannot keep any food and/or fluids down the stomach while morning sickness keeps some food and/or fluids down

Causes of hyperemesis gravidarum

Until now, doctors still do not know what causes the hyperemesis gravidarum to trigger. However, they believe that it is related to the following causes enlisted below:

Congenital cause

Women whose family members and relatives suffered from HG are likely to be affected.

High levels of human chorionic gonadotrophin (hCG) and progesterone hormone

High levels of human chorionic gonadotrophin (hCG) and progesterone hormone relaxes the muscles (especially the digestive tract).

Increased in maternal estrogen level

An increase in maternal estrogen level disrupts the digestive movement.

Complications caused by hyperemesis gravidarum

Hyperemesis gravidarum can cause numerous complications on both the expectant mother and the unborn baby. If HG is left unmanaged and untreated, it will result to the following complications enlisted below:

On the expectant mother

Kidney malfunction

Kidneys will not function well unlike pre – pregnancy which will cause decreased urine output.

Mineral deficiency

Due to constant vomiting, the levels of minerals (particularly electrolytes which consist of sodium and potassium) abruptly drop. Mineral deficiency will lead to energy loss.

Vitamin deficiency

With loss of appetite leads to loss of Vitamins B1 (thiamine), B6, and B12 supplementation which will lead to hypotension.

Electrolyte disturbance

Electrolyte disturbance refers to the imbalance or lack of minerals in the body.

Weakening of the muscles

An expectant mother’s muscles weaken due to the rapid increase in hCG and progesterone.

Excessive saliva

Spit and avoid swallowing the excess saliva (also called as hyper salivation) since it will worsen hyperemesis gravidarum.

Anemia

Women who suffer from HG are likely to be attacked with anemia due low levels of blood.

Hyponatremia

Hyponatremia is a condition where the blood concentrates too little amount of sodium.

Wernicke’s encephalopathy

Wernicke’s encephalopathy is a neurological condition which is caused by lack of Thiamine (Vitamin B1) due to constant vomiting.

Central pontine myelinolysis

Central pontine myelinolysis (CPM) is a neurological disorder where the myelin sheath and brain cells are damaged. CPM is induced by HG during gestation.

Coagulopathy

Coagulopathy is a bleeding disorder where the blood’s inability to clot is weakened due to blood deficiency.

Atrophy

Atrophy refers to the impartial or partial wasting of a body part due to intense vomiting.

Mallory – Weiss tears

Mallory – Weiss tears syndrome (also called as gastro – esophageal laceration syndrome) is the tearing at the lining of the stomach and esophagus which is caused by severe and constant vomiting.

Hypoglycemia

Hypoglycemia refers to low blood sugar or glucose level caused by loss of appetite.

Malnutrition

Malnutrition refers to the lack of nutrients in the body which is caused by loss of appetite.

Pneumomediastinum

Pneumomediastinum (also called as mediastinal emphysema) is the atypical presence of air and other gas in the mediastinum.

Rhabdomyolysis

Rhabdomyolysis is the rapid breakdown of the skeletal striated muscles. This is because the muscles weaken when HG occurs.

Deep venous thrombosis

Deep venous thrombosis is when the blood clot forms deep within a vein.

Pulmonary embolism

Pulmonary embolism is the blocking of arteries in the lungs due to the intense pull of constant vomiting.

On the soon – to – be baby

The effects of HG on expectant mothers affects their soon – to – be babies, below are the following complications which is due to the domino effect of the symptom:

Low birth weight

Since the baby’s mother suffered from weight loss, so does the newborn.

Small size for his current gestational age

Since the baby’s mother lack of nutrients, vitamins and minerals while carrying him. The baby will likely have a small size for his current gestational age.

Secondary complications of hyperemesis gravidarum

  • Depression
  • Post – traumatic stress disorder (PTSD)

Management and diagnosis for hyperemesis gravidarum

Up till now, there is no proven way to cure or prevent hyperemesis gravidarum. However, there are available ways to manage and diagnose the symptom.

For mild cases

Mild cases of hyperemesis gravidarum can be treated by using the natural home treatments and applying the following tips below:

Acupressure

Acupressure (either the traditional method or with Pericardium 6 pressure point) treats HG by pressuring the points which reduces nausea.

The pressure point for HG can be found at the middle of the inner wrist, 3 finger lengths away from the folds of the wrist and in between 2 tendons.

Sea band wristband

Sea band wristband (acupressure wristband) is a cheaper alternative of acupressure which provides natural relief for nausea – related motion. Wear sea – bands to maintain or continue the effect that is brought by acupressure.

Eating small and frequent meals daily

Make it a habit to small and frequent meals to prevent ample amounts of vomiting throughout the day. Eat foods that are high in carbohydrates and protein which prevents the acids from staying in the stomach lining.

Eat dry and bland foods

Whenever hyperemesis gravidarum strikes, eat dry and bland foods such as plain biscuits.

Stay well – hydrated

Always stay well – hydrated by drinking small amounts of water frequently (preferably with a straw) to avoid dehydration.

Oral rehydration solution

Oral rehydration therapy (ORS) replaces fluid by means of drinking water with a moderate amount of sugar and salt.

Natural herbs intake

Take natural herbs such as ginger (at least 1 – 1.5 grams per day in small and several doses) and peppermint since it relaxes the digestive tract. However, researches show that ginger has poor effectivity in curing HG.

Thiamine intake

Take Thiamine (Vitamin B1) for at least 1.5 milligrams per day to increase the healthy levels of blood pressure and decrease the chances of vomiting.

Bed rest

Take a bed rest to comfort the body. But take note to avoid lying on the bed for too long as it may lead to weak muscles and weight loss.

Hypnosis

Believe it or not, hypnosis is also said to be a way to treat HG as it maneuvers the patient’s attention away from the symptom.

For severe cases

Hyperemesis gravidarum is so severe that the patient may require staying in the hospital and getting some treatment there. In fact, about 60,000 cases of HG are reported to receive treatment in the hospital. Such hospital treatment options are as follows:

Intravenous fluids (IV rehydration)

Intravenous fluids restore hydration; supplies minerals (particularly electrolytes), vitamins (particularly thiamine which lessens the risk of Wernicke’s encephalopathy) and nutrients in the body.

PICC Line

PICC (peripherally inserted central cathether) Line is a homecare treatment alternative to restore hydration and supply nutrition (also called as parenteral nutrition).

Tube feeding

If HG reached the point of being unable to get some food and fluids down, the doctor may recommend tube feeding.

  • Nasogastric feeding tube – supplies nutrients from a tube that passes through the nose and down the stomach
  • Nasojejunal tube – supplies nutrients from a tube that is connected to the abdomen bypassing the stomach (particularly the small intestine) via a surgical procedure
  • Percutaneous endoscopic gastrostomy (also called as PEG tube)

Intravenous feeding (IV feeding)

Intravenous feeding is a total parenteral nutrition which bypasses stomach completely.

Antimietic medication

Antimietic is a drug that is specifically designed to cure nausea and vomiting. Such Antimietic medications are enlisted below:

  • Metoclopramide
  • Antihistamine (preferably diphenhydramine)
  • Phenothiazine (preferably promethazine)
  • Ondansetron
  • Hydrocortisone and prednisolone
  • Antireflux
  • Pyridoxine / doxylamine

If the symptoms and complications of HG begin to subside, she is now allowed to stop the abovementioned treatments.