About Hyperemesis Gravidarum

When nausea and vomiting become more than a nuisance and more like an all day, every day event -- what can be done? Family Physician Jane Forester has some information about some treatment options.
Jane Forester

Your question
My wife is just over three months pregnant and is suffering from severe nausea and vomiting. What can be done to help her? At what point might she need to be hospitalized? - Jack in Detroit, Michigan

The expert answers
About 60 to 70 percent of pregnant women complain of nausea and vomiting during the first 8 to 12 weeks of gestation. In general, the symptoms are mild and are normally gone during the beginning phase of the second trimester.

In a small amount of women, the severity of the symptoms will result in the necessity to hospitalize in order to control the symptoms. In severe cases of nausea and vomiting that do not respond to simple lifestyle changes, the medical term is referred to as Hyperemesis Gravidarum.

Hyperemesis gravidarum is reserved for the intractable nausea and vomiting that occurs in about one percent of all pregnant women. Differences are noticed in its occurrence between cultures and races. It is found more commonly in the White population and less so among African Americans, Eskimos and some African tribes. It appears more frequently with first pregnancies, but tends to recur in subsequent pregnancies of these same women. In general, pregnancy outcome is usually the same as in the general population, with no harm done to the mother, fetus or infant.

Hyperemesis gravidarum is diagnosed based on a history of intractable (nonstop) vomiting and the inability to retain fluids or solids. Weight loss occurs and often electrolyte imbalances occur. Bloodwork is done to check for electrolyte imbalances and urine is checked for ketones in the urine (a sign of severe dehydration). Normally even this condition is self-limiting and hospitalization is seldom needed since it can be treated on an outpatient basis.

Treatments offered include psychological support, dietary alterations, and reassurance. Patients are asked to take small, frequent meals and to eat solid foods. Antiemetics (antinausea) drugs such as Phenergan, Compazine, Dramamine and a drug used for nausea in patients undergoing cancer treatment (Zofran) are often used with good results, when all conservative treatments have failed. There is always a risk associated with any drug taken during pregnancy. Please don't take any drug without being well-informed as to the potential risks to your baby.

If electrolyte disturbances are found and outpatient treatment fails, then patients will be admitted to the hospital for a more thorough work-up and treatment. Intravenous hydration, correction of the imbalance, and supportive psychological treatment are instituted. In almost every case this type of hospitalization cures any serious continuation of the nausea and vomiting as long as it is related only to the pregnancy. Occassionally, an underlying pathology is found in the gastrointestinal system, which can be uncovered and treated during a hospitalization. Much preventative education occurs during a hospitalization to help assure that the patient can feel well after discharge from the hospital and take all means to prevent a recurrence.

I wish your wife the best throughout her pregnancy and that the second trimester not only ends the sickness, but also brings on joys that were not experienced in the first trimester. I also appreciate your loving concern on behalf of your wife.

Jane Forester
Family Physician
Glencoe, IllinoisPregnancyAndBaby.com

Tags: vomiting

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