Why am I still vomiting even now that I am in my second trimester? Can my unborn baby be at risk?

Why am I still vomiting even now that I am in my second trimester? Can my unborn baby be at risk?

 Nausea and vomiting in pregnancy are extremely common; 70-80% of women experience these symptoms early in their pregnancy and approximately 35% of all pregnant patients are absent from work on at least one occasion through nausea and vomiting.

Although the symptoms are often most pronounced in the first trimester, they by no means are confined to it. Similarly, despite common usage of the term ‘morning sickness’, in only a minority of cases are the symptoms solely confined to the morning. Nausea and vomiting in pregnancy tends to be mild and self-limited and is not associated with adverse pregnancy outcome.
 



Hyperemesis gravidarum is a severe intractable form of nausea and vomiting that affects 0.3-2.0% of pregnancies. It causes imbalances of fluid and electrolytes, disturbs nutritional intakes and metabolism, causes physical and psychological debilitation and is associated with adverse pregnancy outcome, including an increased risk of preterm birth and low birth-weight babies. The cause is unknown and various hypothesis have been proposed including an association with high levels of serum human chorionic gonadotrophin (hCG), oestrogen and thyroxine. The likely cause is multifactorial. Severe cases of hyperemesis gravidarum cause malnutrition and vitamin deficiencies, including Wernicke’s encephalopathy, and intractable retching predisposes to trauma to the oesophagus and Mallory Weiss tears. Treatment includes fluid replacement and thiamine supplementation. Antiemetics such as phenothiazines are safe and are commonly prescribed. Other proposed treatments including the administration of corticosteroids have not yet been adequately proven and remain empirical.


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Emobileclinic Consultant, obstetrician and gynecologist



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