Severe pregnancy vomiting – Hyperemesis gravidarum
Nausea and vomiting are some of the most recognisable signs of pregnancy. Around seven in every ten pregnant women will experience some level of morning sickness – although it can happen at any time of the day – with symptoms typically subsiding around the 12 to 14 week mark.
Hyperemesis gravidarum (HG) – severe nausea and vomiting in pregnancy – happens in around one in every 100 pregnancies and can be extremely serious, often requiring hospital treatment.
The Royal College of Obstetricians and Gynaecologists (RCOG) state that “HG is characterised by severe, protracted nausea and vomiting associated with weight loss of more than 5% of pre-pregnancy weight, dehydration and electrolyte imbalances.”
What causes hyperemesis gravidarum?
Why some women experience HG is not completely understood, but it is thought that the hormonal changes which happen in pregnancy are the cause and the rapid rise of the hormone human chorionic gonadotropin, released by the placenta, is believed to be the main culprit in cases of hyperemesis gravidarum.
Who is most at risk of HG?
There are some key factors that make one expectant mother’s chances of developing HG greater than another’s. You are more prone to developing HG if:
- this is your first pregnancy
- you’re expecting a girl, twins, or triplets
- a close relative has suffered from it or you’ve suffered from it in a previous pregnancy
- you suffer from migraines or travel sickness
- you are overweight
- you’re young
What are the signs of hyperemesis gravidarum?
At around week 14 the typical feelings of sickness associated with pregnancy should reduce considerably or disappear completely (although for some women the period of sickness may last longer). The nausea and vomiting associated with HG, on the other hand, is prolonged and severe and happens very frequently, and it may even last for the entirety of the pregnancy.
With HG, you may struggle to keep anything down at all, which leads to weight loss and dehydration. This can lead to dizziness, fatigue, and decreased urination.
If your sickness is lasting a long time or is particularly severe to the point that you’re experiencing the above symptoms, contact your midwife or doctor.
Could I be suffering from something else?
Some symptoms of HG are similar to those of other conditions.
For instance, if your symptoms include a high temperature, then it’s possible you’re suffering from a gastric upset or urinary tract infection.
Talk to your doctor or midwife as soon as you feel your symptoms are becoming difficult to manage so that you can be sure about what condition you have and what the best method of treatment is.
What can trigger HG?
When suffering from HG, you are likely to become extremely sensitive to certain triggers, which may be smells and even sights.
Your heightened senses may make you extremely sensitive to cooking smells, and nausea may even be triggered by the mere sight of food. When others are cooking meals (hopefully your partner will take over some chores for you), ask them to leave windows open in the kitchen, and they may need to eat their food away from you for a while.
Any strong smell or taste can trigger a vomiting attack – washing powder, toothpaste, deodorant, cigarette smoke. Ask partners friends and family to consider your HG and maybe refrain from wearing strong perfume around you. If you find a fragrance that you can tolerate, why not carry a small amount of it with you, so that if you are bombarded with the odour that is your particular trigger, you have a ready-made nose protector.
What can I do to ease the symptoms of HG?
Excessive vomiting causes water loss, so it’s crucial that you try to stay hydrated. If you are having trouble keeping liquids down, take only small sips or try sucking on ice cubes. Some women find bottled water more pleasant to drink than tap water and keeping it in the fridge can also make a positive difference.
Resting is the only way to combat the exhaustion. Get as much rest as you can because tiredness will only make the nausea worse. If you start to feel better after a period of rest, try to pace yourself when starting to be active again – too much too soon could trigger a relapse.
If this isn’t your first baby and you already have children, it would be very helpful to arrange childcare for them. Again, your family will need to support you and take over any household chores that usually fall on your shoulders, if they can.
How will the condition be treated?
Talk to your doctor and midwife early on to manage the symptoms before they become health threatening. The faster you intervene the better, as although healthcare professionals may be reluctant to treat you immediately, they will be able to monitor your overall health.
Some of the medical guidance given for general morning sickness can also be applied to HG, although the effectiveness may be limited because the symptoms are generally much more severe.
The RCOG suggest that “a holistic approach to assessment and treatment should be adopted” and this may include nutritionists, pharmacists, endocrinologists (someone who studies how hormones affect health), while “emotional support and psychological or psychiatric care may be required”.
If the HG is threatening your health, perhaps you are experiencing low blood pressure or ketosis (a build up of chemicals known as ketones in the blood and urine which occurs when your body begins to turn fat into energy rather than the glucose contained in food) you may be offered an anti-sickness, or anti-emetic, medication for your HG.
There are several different types of anti-emetic medication, and you might be required to try out a few of them before you find the one that is the most effective for you. The drugs will likely be used in conjunction with vitamins (B6 and B12) and steroids. Information about medicines used in pregnancy can be found on the bumps website, the UK Teratology Information Services (UKTIS).
Will my baby be okay?
The good news is that with the right care and treatment, it is very unlikely that HG will cause any harm to your developing baby. Any anti-sickness medication prescribed by your GP is very safe and shouldn’t cause any issues for the developing foetus. If you don’t seek treatment, however, and lose a lot of weight, then there is the danger that your baby will be born with a low birth weight.
Are there any complications?
If not properly treated, HG can become serious and lead to weight loss and dehydration. Even with medication, you may find that you still suffer from severe symptoms or that your body simply keeps bringing the medication back up. In this case, you may need to be hospitalised.
Prolonged, violent vomiting can cause your oesophagus to tear. If you experience bad chest pain, difficulty in breathing, or blood in your vomit, you should seek urgent medical attention.
In rare cases, dehydration and a lack of mobility can lead to blood clots, or deep vein thrombosis (DVT). You may have to be hospitalised if you develop DVT, but it can be prevented with simple leg exercises and by drinking plenty of water.
How can I cope with the mental stress of HG?
Due to the intense nature of the condition, it’s possible that HG won’t just affect you physically – your emotional health may also be at risk.
The exhaustion and depression that’s likely to come with HG can be tough to deal with. The constant feeling of sickness may lead to you become very isolated, reluctant to go out because of the fear of being sick in public. Further anxiety may be caused by the idea of how you’re going to cope with the rest of your pregnancy.
These mental symptoms are serious and bottling the feelings up will only make them worse. Talk about how you feel with your midwife or doctor, and they will help you receive the support you need. If you haven’t already, you should also open up to your family about how you’re feeling and what you’re going through so that they can do their best to support you. Explain to them that what you are experiencing is more than ‘morning sickness’ and show them this article. HG is serious and your family need to take it seriously as well.
While HG may not be the most common condition experienced by pregnant women, you are certainly not alone if you are suffering. Many others have been through this and will understand how difficult it is. Why not join our forum and see how others are coping or read our parent’s blog about coping with hyperemesis gravidarum.