Extreme vomiting during pregnancy

Extreme vomiting during pregnancy

What is Hypermesis Gravidarum?

According to ACOG, Hyperemesis gravidarum is the most severe form of nausea and vomiting of pregnancy. It occurs in up to 3% of pregnancies. This condition may be diagnosed when a woman has lost 5% of her pre-pregnancy weight and has other problems related to dehydration (loss of body fluids). Women with hyperemesis gravidarum need treatment to stop their vomiting and restore body fluids.

What is it caused by and when does it occur?

It’s thought to be caused by a rise in hormone levels but this is still being researched. Typically Hyperemesis Gravidarum appears between weeks 4-6 and may also come back during weeks 9-13. Most women do find relief between 14-20 weeks, though 20% of women will likely need required care for the remainder of their pregnancy. 

How is it diagnosed?

Diagnosis can be made when a woman has dropped 5% of her pre-pregnancy weight with simultaneous dehydration or loss of body fluids. Your doctor will run tests to measure your levels of urine ketones, serum electrolytes, and renal function. 

Morning Sickness vs. Hyperemesis Gravidarum

Morning Sickness: Hyperemesis Gravidarum:
Nausea sometimes accompanied by vomiting Nausea accompanied by severe vomiting
Nausea that subsides at 12 weeks or soon after Nausea that does not subside
Vomiting that does not cause severe dehydration Vomiting that causes severe dehydration
Vomiting that allows you to keep some food down Vomiting that does not allow you to keep any food down

Signs and Symptoms

  • Severe nausea and vomiting
  • Food Aversions
  • Weight loss 5% of more or pre-pregnancy weight
  • Decrease in urination
  • Dehydration
  • Headaches
  • Fainting
  • Confusion
  • Jaundice
  • Extreme fatigue
  • Low blood pressure
  • Rapid heart rate
  • Loss of skin elasticity
  • Secondary anxiety
  • Depression

Treatment Options

Some cases may require hospitalization, depending on the severity. 

GYN Emergent Care Center can help with the following:

  • IV to restore hydration, vitamins, nutrients, and electrolytes.
  • Percutaneous Endoscopic Gastrostomy restores nutrients through a tube through the abdomen into the stomach. 
  • Nasogastric restores nutrients with a tube through the nose.

Other treatment:

  • Acupressure
  • Ginger and/or peppermint herbs
  • Rest
  • In some cases, hypnosis.

What′s new?

According to the HER Foundation, 

FINALLY A BREAKTHROUGH FOR women suffering from the severe pregnancy illness, hyperemesis gravidarum (HG). Many people remember Princess Kate Middleton being hospitalized during her first pregnancy due to the severity of the disorder. However, other women affected by the pregnancy illness have limited family size, quit their jobs or sadly felt so desperate due to the debilitating illness that they terminated wanted pregnancies. Many HG women describe the illness as something no one can truly understand unless they have endured it themselves. Instead of the joy every pregnancy should bring, HG women spend most of the 9 months suffering in silence unable to eat or simply keep water down.

The HER Foundation, researchers at UCLA and USC, and 23andMe, Inc. conducted the first genome-wide analysis of Hyperemesis Gravidarum (HG) and identified two genes associated with HG, which was published this week in Nature Communications. (https://www.nature.com/articles/s41467-018-03258-0).

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