HYPEREMESIS GRAVIDARUM

General Information

DEFINITION--Severe nausea and vomiting in a pregnant woman, causing dehydration and drastic changes in body chemistry. This is different and much more serious than morning sickness during pregnancy.

BODY PARTS INVOLVED--Gastrointestinal tract; vomiting center in the brain.

SEX OR AGE MOST AFFECTED--Pregnant females.

SIGNS & SYMPTOMS

• Severe nausea.
• Vomiting, first of mucus, then of bile and finally of blood.
• Dehydration.
• Failure to gain weight, or weight loss to less than prepregnancy weight.
• Pale, waxy, dry and sometimes yellow skin.
• Rapid heartbeat.
• Headache, confusion or lethargy.

CAUSES--

Unknown. The most common theories include:

• Multiple pregnancy (more than one fetus), producing high levels of a hormone, human chorionic gonadotrophin.
• Inflammation of the pancreas.
• Bile-duct disease.
• Psychological factors, such as depression or a poor response to stress.

RISK INCREASES WITH

• Taste or sight of food.
• Various odors.
• Use of a drug that may interfere with normal pregnancy.

HOW TO PREVENT

• Don't use any drugs, including non-prescription drugs or alcohol, during pregnancy without consulting your doctor.
• Maintain an adequate diet during all stages of pregnancy.

What To Expect

DIAGNOSTIC MEASURES--

• Your own observation of symptoms.
• Medical history and physical exam by a doctor.
• Diagnostic tests may be conducted to rule out other disorders of the liver, kidney, pancreas, intestine and gastrointestinal tract.

APPROPRIATE HEALTH CARE

• Self-care after diagnosis.
• Doctor's treatment.
• Hospitalization to replace fluid and electrolytes intravenously, if needed.
• Repeated eye exams are necessary to prevent possible hemorrhagic retinitis.

POSSIBLE COMPLICATIONS

• Severe dehydration.
• Liver disease.
• Hemorrhage into the retina of the eye.
• Coma.
• Miscarriage or damage to the fetus.
• Death of the mother.

PROBABLE OUTCOME--Usually curable with treatment.

How To Treat

GENERAL MEASURES--

• Reduce stress whenever possible (see How to Cope with Stress in Appendix).
• Weigh daily and report any unusual changes to the doctor.

MEDICATION--

• Your doctor may prescribe: Intravenous fluid and electrolyte replacement if your condition is serious. Therapeutic trial of vitamin B-6.
• If other drugs are prescribed for you, carefully follow instructions on the label.
• Don't use any medicine, including non-prescription medicine to prevent vomiting, without telling your doctor.

ACTIVITY--

• Stay in bed until symptoms disappear.
• After recovery, stay as active as your strength allows. Work and exercise moderately. Rest often.

DIET--If the condition has not reached the point to warrant hospitalization for intravenous fluids, follow these instructions:

• If you feel nauseated in the morning, eat dry toast or saltine crackers before you get out of bed.
• Eat small, frequent meals.
• Don't eat fried foods; they increase nausea.
• Sit upright for 45 minutes after eating.
• Obtain additional dietary instructions from your doctor or nutritionist. If intravenous fluids are necessary, you will probably progress from them to a clear liquid diet, full liquid diet and then regular diet with small, frequent meals.

Call Your Doctor If

• You have symptoms of hyperemesis gravidarum.
• Nausea, vomiting or continued weight loss despite treatment.