Causes of severe vomiting in pregnancy

Emobileclinic Trending Topic: Hyperemesis Gravidarum (HG)

A number of pregnant women experience some degree of nausea or vomiting during pregnancy. These women experience morning sickness during pregnancy. While morning sickness can be quite uncomfortable, it typically goes away within 12 weeks, in some cases the sickness is severe and continues beyond the 14-16 week mark or acute pregnancy sickness. It is however a generally harmless condition. 

Hyperemesis gravidarum is the most severe form of nausea and vomiting in pregnancy, characterized by persistent nausea and vomiting associated with ketosis and weight loss. This condition may cause volume depletion, electrolytes and acid-base imbalances, nutritional deficiencies, and even death. 

HG can have serious consequences if it goes beyond 16 week of pregnancy, so it is important to get treatment as soon as possible if one has the condition. Most morning sickness eases as a woman’s pregnancy progresses. It affects about 1 in 200 women, although estimates vary depending on how the condition is defined.

Reasons to seek treatment

The inability to keep any fluids down will make one become severely dehydrated which in turn lead to loss of weight and other health risks like:

Ketosis – a serious condition that is caused by a raised number of ketones in the blood (ketones are poisonous acidic chemicals)

Deep Vein Thrombosis (DVT)- there is an increased risk of deep vein thrombosis, a blood clot in one of the veins in the body. DVT can be fatal if left untreated. The risk to your baby is low, but if HG affects your weight your baby is at higher risk of being born with a low birth weight.

Symptoms of Hyperemesis Gravidarum

Dehydration

Dizziness

Weight loss occasioned by vomiting

 Nausea

Sleep disturbance

Hyperolfaction

Dysgeusia

Decreased gustatory discernment

Depression

Anxiety

Irritability

Mood changes

Decreased concentration

Causes of Hyperemesis Gravidarum

Virtually all women do have morning sickness during their pregnancy. Morning sickness is nausea and vomiting during pregnancy. The name does not suggest that the sickness must always occur in the morning.

Morning sickness and HG seem to have a connection to human chorionic gonadotropin (hCG). This is a hormone created during pregnancy by the placenta. The body produces a large amount of this hormone at a rapid rate early in pregnancy. The American Pregnancy Association states that hCG levels typically double every 48 to 72 hours. These levels can continue to rise throughout the pregnancy.

Who Is at Risk for Hyperemesis Gravidarum?

Someone with history of HG 

being pregnant with more than one baby

Overweight

A first-time mother

Diagnosis

It can be diagnosed following the documentation of your medical history by the medical doctor through any of these means:

Physical examination in women with suspected hyperemesis gravidarum is usually unremarkable. Findings may be more helpful if the patient has unusual complaints suggestive of other disorders (eg, bleeding, abdominal pain).

Examination includes the following: 

Vital signs, including standing and lying blood pressure and pulse

Volume status (eg, mucous membrane condition, skin turgor, neck veins, mental status)

General appearance (eg, nutrition, weight)

Thyroid evaluation

Abdominal evaluation

Cardiac evaluation

Neurologic evaluation

Laboratory tests

Initial laboratory studies used in the evaluation of women with hyperemesis gravidarum should include the following:

Urinalysis for ketones and specific gravity

Serum levels of electrolytes and ketones

Liver enzymes and bilirubin levels

Amylase/lipase levels

Thyroid stimulating hormone, free thyroxine levels

Urine culture

Calcium level

Hematocrit level

Hepatitis panel

Imaging studies

The following imaging studies may be used to assess women with hyperemesis gravidarum:

Obstetric ultrasonography: to evaluate for multiple gestations or trophoblastic disease

Upper abdominal ultrasonography: to evaluate the pancreas and/or biliary tree

Abdominal computed tomography scanning or magnetic resonance imaging: if appendicitis is suspected as a cause of nausea and vomiting in pregnancy

Additional imaging studies may be warranted if the patient’s clinical presentation is atypical (eg, nausea and/or vomiting beginning after 9-10 wk of gestation, nausea and/or vomiting persisting after 20-22 wk, acute severe exacerbation) or if another disorder is suggested based on the history or physical examination findings.

Treatment

Treatment will be determined by the nature of symptoms:

Natural nausea prevention methods such as vitamin B-6 or ginger, eating smaller, more frequent meals and dry foods such as crackers as well as excessive intake of fluids (water) to stay hydrated may be recommended by the medical doctor.

Bed Rest –this may provide comfort, but be cautious and aware of the effects of muscle and weight loss due to too much bed rest.

Pregnant who are highly dehydrated may require admission in hospital.

Medication (promethazine and meclizine) may be administered through IV when vomiting becomes threatened to the mother or child. Although, taking medication while pregnant can cause potential health problems for the baby, but in severe cases of HG, maternal dehydration is a more concerning problem. 

Surgery: in some refractory severe cases of hyperemesis gravidarum, if maternal survival is threatened, or if hyperemesis gravidarum is causing severe physical and psychological burden, termination of the pregnancy should be considered.