What is Hyperemesis gravidarum?Hyperemesis gravidarum literally means ""excessive vomiting."" Hyperemesis begins in early pregnancy and usually softens before the 14th week of pregnancy, sometimes it may last longer, occasionally even throughout the entire pregnancy, and fortunately this is unusual, especially if you are treated early (Tiran 2004).
Hyperemesis is not uncommon, occurring in about 0.5 to 2 percent of pregnancies and is one of the most common reasons for hospitalization during early pregnancy (CKS 2005, ACOG 2004
Is it a pregnancy sickness or hyperemesis?Hyperemesis is the most likely explanation if you vomit several times a day and can not eat or drink without vomiting and if you lose weight Treatments do not help and you are tormented with your normal life (Motherisk 2002) But there is no standard definition for hyperemesis. Some doctors diagnose if you lose more than 3 kg or 5 to 10 percent of your pre-pregnancy weight (Tiran 2004), or if you are dehydrated.
Even if you are not losing weight or your doctor is not worried about your weight loss, it should be possible that tests are being done and you are being treated for your pregnancy sickness. Early treatment can prevent or mitigate hyperemesis.
If your nausea starts after the ninth week of pregnancy, or if you have a fever or pain, there may be another reason for it, such as an upset stomach, an ulcer, a urinary tract infection, a thyroid disorder or diabetes (CKS 2005, ACOG 2004).
The Effects of Hyperemesis
Hyperemesis determines your life. You are exhausted, depressed and unable to enjoy your pregnancy. Relationships are severely strained - they may feel isolated, retreat, and make your partner feel marginalized (Tiran 2004).For weeks and months, taking care of yourself and your family can be difficult - even simple tasks such as showering, driving or shopping are sometimes impossible.
The influence of hyperemesis can last for a long time. For a long time you may not even be able to think about a second baby.
What causes them and am I in danger?
The reason for hyperemesis is still not fully understood. As with morning sickness, quite a few factors are likely to be involved. This includes hormone changes.But unlike the morning sickness that affects a majority of pregnant women, we know that some women are more likely to suffer from hyperemesis than others.The risk of hyperemesis is greater for you if you:
expect twins or a multiple birth
- are the daughter or sister of a woman who had hyperemesis
- had hyperemesis in a previous pregnancy
- have a history of motion sickness or migraine
- have pre-existing liver disease
- have thyroid abnormalities (ACOG 2004, CKS 2005)
- What can I do to help myself?
Seek professional help early. Explain how bad you feel and say if you want a treatment.
- Ask your partner, family, and friends for help and support - in cooking, shopping, child care, and the home.
- Accept your cravings for certain foods. Avoid the sights and smells that cause you nausea.
- Stay hydrated. Drink everything you can and if you can, or suck ice cubes.
- Eat everything you can. The ""good"" diet will help you catch up later.Your baby gets its food from the reserves of your body.
- Try using natural remedies such as Vitamin B 6, ginger or acupressure (""Sea Sand"") along with a medical treatment ( Motherisk 2002, ACOG 2004).
- Rest as much as possible and do not feel guilty about it - you are sick!
- Talk to others in our community who know how you feel.
- When should I see my doctor or midwife?
Talk to your doctor or midwife as soon as the symptoms affect your life or if you are worried about your or your baby's health.For example, a urine test can be used to determine if it contains ketones. This is an indication of inadequate food intake (CKS 2005). Blood and urine tests can also find other reasons that cause your nausea. An ultrasound scan can tell if you have more than one baby or if you have an anomaly of the placenta (ACOG 2004, CKS 2005).
If you can not keep liquids, you should be aware of signs of dehydration. This also includes little or very dark yellow urine. If you pinch the back of your hand and then the skin fold stops and does not go down fast, you should consult your doctor (CKS 2005).
Other signs that should never be ignored are pain or bleeding in the abdomen, blurred vision, headache, dizziness, disorientation, and blood or bile in your vomit.
In cases of confusion, vision and gait disorders, the very rare complication of Wernicke's encephalopathy must be considered.This very rare disease of the brain caused by malnutrition is preventable and can be treated with vitamin B 1 (thiamine) (Tiran, 2004, CKS 2005).
What treatment requires hyperemesis?
You should be offered medication for severe and persistent pregnancy sickness (CKS 2005) (Motherisk 2002). There are safe and effective medicines for nausea. (Tiran 2004).If you can not keep your food and fluids with you, it may be difficult to swallow tablets. Some anti-nausea medicines are available as suppositories (introduced rectally), in buccal form (the tablet does not go to sleep, but dissolves in the cheek pouch) or they can be injected (Tiran 2004).
You may have to try out which remedy will help you. Antihistamines are usually given first, as they are considered to be the safest in pregnancy. If they do not help, you may be offered Vomex A or Atosil (CKS 2005). Steroids (such as methylprednisolone) are rarely used in hyperemesis (ACOG 2004, Tiran 2004).
You can be hospitalized for rehydration therapy and / or tube feeding if you can not drink and eat and continue to lose weight. But hospital treatment is not mandatory with hyperemesis (Tiran 2004).
What happens in the hospital?
If you do not respond to medication at home, or if you are dehydrated and malnourished, you may be hospitalized (Tiran 2004, ACOG 2004).If you're in the hospital, you'll probably be given infusion therapy (IV) to replace the lost fluids, vitamins and minerals (CKS 2005). Nausea medications may be added to the infusion or given as an injection.
Some women need to be hospitalized several times during their pregnancy. But monitoring and early treatment at home can help prevent this (Tiran 2004).
Is vomiting or treatment harmful to my baby?
The choking and vomiting effort does no harm to your baby. In fact, the risk of miscarriage is lower if you have morning sickness (Tiran 2004). Your baby may be smaller at birth - but it will catch up soon (CKS 2005).All medicines should be used with great care during pregnancy. But the medicines mentioned for nausea are considered safe and there is no indication that they are harming your baby (CKS 2005).
Where can I find help and support?
Women with hyperemesis often struggle to be taken seriously. Many are still often confronted with the outdated attitude that everything happens only ""in the head"" (ACOG 2004).Women who suffer from it often say that the best treatment is to be believed (Tiran 2005).You can find consolation at the thought that you are not alone, and that other women have also suffered from hyperemesis. There are websites that offer information about hyperemesis by experts or talk to mothers in our community.
If you used to have hyperemesis, there are things you can do to be prepared for it the next time.
www. hyperemesis. de - Private Website with Affected Forumwww. hyperemesis. org - HER Foundation. Hyperemesis Education and Research
www. embryotox. DE - Information on the Compatibility of Medicines during Pregnancy and Breastfeeding
ACOG. 2004. Nausea and Vomiting of Pregnancy. ACOG Practice Bulletin 52, 803-810.
Clinical Knowledge Summaries (CKS). 2005. Nausea and vomiting in pregnancy. National library for health. cks. library. nhs. uk [as of January 2008]
Motherisk. 2007. Treatment of nausea and vomiting in pregnancy - updated algorithm www. Motherisk. org [pdf file, January 2008]
Tiran, D. 2004. Nausea and Vomiting in Pregnancy: an integrated approach to care. London: Churchill Livingstone.
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