Hyperemesis Gravidarum

What is hyperemesis gravidarum?

Hyperemesis (heye-per-EM-e-sis) gravidarum (gra-vi-DA-rum) is a severe form of nausea and vomiting that happens during pregnancy. Hyperemesis is worse than morning sickness. It may cause a woman to have nausea or vomiting all day for many days. It may keep a woman from eating and drinking enough food and liquids. Hyperemesis may lead to problems such as weight loss, dehydration, and malnutrition. Malnutrition occurs when you do not get enough calories or nutrients to keep you healthy. Women who have hyperemesis may have trouble doing their regular daily activities.

What causes hyperemesis gravidarum?

The cause of hyperemesis is not known. Hyperemesis is more common in certain women. Women who are pregnant for the first time or are pregnant with twins may be more likely to have hyperemesis. Hyperemesis is also more common in women who have had hyperemesis during an earlier pregnancy.

What are the signs and symptoms of hyperemesis gravidarum?

Signs and symptoms usually begin in the first trimester (first 3 months) of pregnancy. Hyperemesis often goes away toward the end of second trimester (4th to 6th month) of pregnancy. However, sometime hyperemesis continues through an entire pregnancy. Common signs and symptoms of hyperemesis gravidarum are:

• Severe (very bad) nausea and vomiting. You may also have dry retching (vomiting motion, but nothing comes out of your mouth).
  
  
• Easily irritated by smells, motion, noise, and light.
  
  
• Heart rate that is faster than usual or blood pressure that is lower than usual.
  
  
• Loss of too much body fluid (dehydration). This may include:
  
  
  • Dark yellow urine.
    
    
  • Dry mouth and lips.
    
    
  • Dry skin.
    
    
  • Urinating less than usual.
  
  
• Very tired, sad or anxious.
  
  
• Weight loss.

How is hyperemesis gravidarum diagnosed?

Your caregiver may first do tests to find out if your vomiting is being caused by other health problems. Your caregiver will do a medical exam and check your weight. Your caregiver may ask you questions about your health and the medicines that you are taking. Your caregiver may do blood and urine tests. Your caregiver may use these tests to find out if your hyperemesis is causing more problems. For example, hyperemesis may cause you to become dehydrated.

How is hyperemesis gravidarum treated?

Your treatment will depend on how bad your hyperemesis is. Always work closely with your caregiver to find the treatment that is right for you. You may need to receive more treatment in the hospital if you cannot control your hyperemesis at home. Some of the treatments for hyperemesis may include:

• Diet:
  
  
  • Avoid foods that make you feel sick to your stomach. Foods that have strong odors may cause nausea for some women.
    
    
  • Avoid having an empty stomach. Eat small meals often throughout the day.
    
    
  • Eat low fat, high protein foods. Examples of these foods are lean meat, beans, and turkey or chicken without the skin.
    
    
  • Eat bland foods such as dry toast, dry cereal, noodles, and bread. Other bland foods are bananas, apples, rice, and popcorn without butter. Avoid spicy and greasy or fried foods.
    
    
  • Eat crackers or dry toast before you get up from bed in the morning. Get out of bed slowly. You may also try eating a snack before you go to bed at night. Keep crackers or dry toast at your bedside to eat during the night if you wake up hungry.
    
    
  • If drinking liquids with meals makes you sick to your stomach, drink liquids between meals instead. Wait at least 30 minutes after eating before drinking liquids. Drink small amounts of liquids often.
    
    
  • On days when you feel better, eat a variety of foods from all the food groups.
  
  
• Medicines and nutrition supplements: You may need one or more of the following.
  
  
  • Vitamin B6: This vitamin may be given to help decrease nausea and vomiting.
    
    
  • Antihistamine: An antihistamine (an-ti-HIS-tah-meen) may be given along with Vitamin B6 to help decrease nausea and vomiting.
    
    
  • Antiemetic medicine: An antiemetic (an-teye-e-MET-ik) medicine may be given to calm your stomach and help control vomiting.
    
    
  • Vitamin and mineral supplements: These supplements help increase the level of vitamins and minerals in your body. Take only the vitamin or mineral supplement that your caregiver tell you to.
  
  
• Counseling: Some women who have hyperemesis may feel depressed (sad), guilty or anxious because they have hyperemesis. They may also feel depressed because they cannot do their regular daily activities. Tell your caregiver if you are feeling sad, guilty or anxious. Your caregiver may tell you to go to a specially trained caregiver to talk about how you are feeling.
  
  
• Other types of treatment: Ginger may help to decrease nausea and vomiting for some women. Ask your caregiver if it is OK for you to use ginger. Other treatments such as wrist acupressure bands may also help to decrease nausea and vomiting. Always ask your caregiver before trying these and other types of treatment.

Risks:

Hyperemesis may cause you to lose too much weight. Vomiting caused by hyperemesis may damage or tear the tissue in your esophagus. It may cause you to lose too much water and electrolytes (salts) from your body. If this happens, you may need to go to the hospital to get IV fluids. Hyperemesis may cause other chemicals in your body to be unbalanced. Very bad hyperemesis may cause your baby to have a low birth weight (weigh less than he should at birth). Without treatment, hyperemesis gravidarum can lead to malnutrition and damage to body organs such as the kidney and liver. It can even cause death. Always work closely with your caregiver to treat your hyperemesis.

Where can I go to get support?

Coping with hyperemesis can be very hard. You and those close to you may feel angry, sad, or frightened. These feelings are normal. Talk to your caregivers, family, or friends about your feelings. Let them help you. Encourage those close to you to talk to your caregiver about how things are at home. Your caregiver can help your family better understand how to support a person with hyperemesis. You can contact the following national organization for more information:

• Hyperemesis Education and Research Foundation
  932 Edwards Ferry Rd, #23
  Leesburg , VA 20176
  Web Address: www.hyperemesis.org
  

Call your caregiver if:

• You are losing weight.
  
  
• Your nausea and vomiting are getting worse. Call if you are not able to keep any food down.
  
  
• You have a fever.
  
  
• You have questions or concerns about hyperemesis or your treatment.

Seek care immediately if:

• You have signs of dehydration (water loss). These may include a dry mouth or feeling thirsty. Your skin may also become wrinkled if you are dehydrated. Other signs may be passing little or no urine, dizziness, or feeling like you are going to faint.
  
  
• You have bad abdominal (belly) pain.
  
  
• You feel too weak or dizzy to stand up.
  
  
• You see blood in your vomit or bowel movements.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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