Hyperemesis gravidarum: signs and treatment

Hyperemesis gravidarum is relentless vomiting during pregnancy resulting in dehydration, weight loss, and ketosis.

Hyperemesis gravidarum is a medical condition characterized by, 

  • uncontrolled vomiting requiring hospitalization,
  • dehydration,
  • Muscular atrophy: a disorder that causes motor difficulties.
  • electrolyte imbalance: that is, when electrolytes (usually, sodium or potassium) are unable to do their job well.
  • ketonuria: presence in the urine of acetacetic acid, beta-hydroxybutyric acid and acetone.
  • weight loss greater than 5% of body weight. 
  • Excessive salivation is also a typical symptom of this disorder. 

Most women with hyperemesis gravidarum also have,

  • hyponatremia, i.e. a serum sodium concentration below 135 mmol/L;
  • hypokalemia (or hypokalemia), i.e. a lack of potassium in the blood,
  • and a low serum urea level.

Symptoms of hyperemesis gravidarum usually peak at week 9 and subside after about 20 weeks of gestation. 

About 1% to 5% of women with hyperemesis gravidarum must be hospitalized. 

Women who developed hyperemesis during their first pregnancy have a high risk of recurrence.

Morning sickness, or hyperemesis gravidarum ( Hyperemesis Gravidarum, HG )?

Most pregnant women (70-85%) experience some type of morning sickness at some point in their pregnancy.

Recent studies show that there are at least 0.3 -2.3% of women hospitalized for extreme morning sickness, with nausea due to hyperemesis gravidarum. 

But the real numbers for this condition are thought to be much higher, given that many women are treated at home or away from hospital, by their doctor or a trusted professional.

This severe nausea is believed to be caused by an increase in hormone levels; however, its actual cause still remains unknown.

The symptoms of hyperemesis gravidarum (HG) described above usually appear between the 4th and 6th week of pregnancy, with a peak towards the ninth. 

Most women have some relief around the 20th week, although 20% of women still need assistance during the remainder of their pregnancy.

No prevention strategy is known to combat hyperemesis gravidarum. However, it can be comforting to know that there are many ways to manage it.

However, it is always important to know how to distinguish between morning sickness and hyperemesis gravidarum.

Here is a table with some symptoms that distinguish them.

in morning sickness in hyperemesis gravidarum
Nausea, sometimes accompanied by vomiting. Nausea accompanied by severe vomiting.
Nausea that subsides at 12 weeks or shortly thereafter. Nausea that never subsides.
Vomiting that does not cause severe dehydration. Vomiting causing severe dehydration.
Vomiting that allows you to swallow food. Vomiting that prevents you from swallowing food.

Its most common symptoms

The most signs and symptoms of hyperemesis gravidarum are,

  • severe nausea and vomiting,
  • food aversions,
  • a loss of 5% or more of pre-pregnancy weight,
  • a decrease in urination,
  • dehydration,
  • the headache ,
  • the confusion,
  • fainting.
  • jaundice,
  • extreme fatigue,
  • a low blood pressure,
  • a rapid heartbeat,
  • loss of skin elasticity,
  • secondary anxiety/depression.

The medical treatments

Most treatments are aimed at improving your symptoms. 

In some cases, hyperemesis gravidarum is so severe that it requires hospitalization. In the hospital, this condition can be treated with one of the following “strategies”:  

  • with an intravenous supply of fluids in order to restore hydration, electrolytes, vitamins and nutrients;
  • with a nasogastric diet: nutrients are restored with the insertion of a tube that passes through the nose up to the stomach;
  • with a percutaneous endoscopic gastrostomy feeding: it is a surgical procedure that is put in place to restore nutrients through a tube that passes through the abdomen into the stomach;
  • with the intake of certain drugs: metoclopramide, antihistamines, ‘ondansetron, corticosteroids, antireflux, mirtazapine, pyridoxine-doxylamine, promethazine  

Other possible remedies in cases of hyperemesis gravidarum

Other remedies may consist,

  • from bed rest : Rest can provide relief, but you should always be aware of the effects that bed rest has on muscle mass and weight loss.
  • acupressure , which is a technique based on the pressure of the fingers on the body: there is a pressure point to reduce nausea which is located in the center of the inner wrist, three fingers away from the wrist crease, between the two tendons; after identifying it, you must press firmly on one wrist at a time for three minutes.
  • from the use of bracelets Nausea cuffs:  Sea nausea cuffs are available and can be bought in pharmacies.
  • from taking certain herbs: ginger or peppermint.
  • from hypnosis . 
  • from acupuncture . 

Katherine Johnson, M.D., is a board-certified obstetrician-gynecologist with clinical expertise in general obstetrics and gynecology, family planning, women’s health, and gynecology.

She is affiliated with the Obstetrics and Gynecology division at an undisclosed healthcare institution and the online platform, Maternicity.com.

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