Women with hyperemesis gravidarum, unlike women with ordinary morning sickness, lose weight and become dehydrated.
Doctors diagnosis hyperemesis gravidarum based on symptoms and do tests to check for dehydration and other possible causes of the vomiting.
Treatment involves nothing by mouth at first, fluids containing electrolytes and vitamins given by vein, and drugs to relieve the nausea.
(See also Nausea and Vomiting During Early Pregnancy Nausea and Vomiting During Early Pregnancy Up to 80% of pregnant women have nausea and vomiting to some extent. Nausea and vomiting are most common and most severe during the 1st trimester. Although commonly called morning sickness,... read more .)
Pregnancy complications, such as hyperemesis gravidarum, are problems that occur only during pregnancy. They may affect the woman, the fetus, or both and may occur at different times during the pregnancy. However, most pregnancy complications can be effectively treated.
Pregnancy frequently causes nausea and vomiting. It usually occurs in the morning (as so-called morning sickness Nausea and Vomiting During Early Pregnancy Up to 80% of pregnant women have nausea and vomiting to some extent. Nausea and vomiting are most common and most severe during the 1st trimester. Although commonly called morning sickness,... read more ), although it can occur any time of day.
Hyperemesis gravidarum differs from ordinary morning sickness. If women vomit often and have nausea to such an extent that they lose weight and become dehydrated, they have hyperemesis gravidarum. If women vomit occasionally but gain weight and are not dehydrated, they do not have hyperemesis gravidarum.
The cause of hyperemesis gravidarum is unknown.
Symptoms of Hyperemesis Gravidarum
Women with hyperemesis gravidarum may not consume enough food to provide their body with energy. Then the body breaks down fats, resulting in a buildup of waste products (ketones) called ketosis. Ketosis can cause fatigue, bad breath, dizziness, and other symptoms.
Women with hyperemesis gravidarum often become so dehydrated that the balance of electrolytes Overview of Electrolytes Well over half of the body's weight is made up of water. Doctors think about the body's water as being restricted to various spaces, called fluid compartments. The three main compartments are... read more , needed to keep the body functioning normally, is upset. Dehydration can also cause other problems such as a rapid heart rate and, rarely, abnormal heart rhythms.
Hyperemesis gravidarum may cause the thyroid gland to become slightly and temporarily overactive (called hyperthyroidism Hyperthyroidism Hyperthyroidism is overactivity of the thyroid gland that leads to high levels of thyroid hormones and speeding up of vital body functions. Graves disease is the most common cause of hyperthyroidism... read more ).
Rarely, hyperemesis gravidarum continues after 16 to 18 weeks of pregnancy. If it does, it may severely damage the liver, causing jaundice and degeneration of liver tissue. If hyperemesis gravidarum severely damages the liver or causes severe dehydration, women can become confused.
Diagnosis of Hyperemesis Gravidarum
A doctor's evaluation
Blood and urine tests
Doctors ask women about the vomiting:
When it started
How long it lasts
How many times a day it occurs
Whether anything relieves or makes it worse
What the vomit looks like
How much vomit there is
If doctors suspect hyperemesis gravidarum based on symptoms, they do blood and urine tests to determine whether dehydration is present and to check for electrolyte abnormalities, which may result from dehydration.
Ultrasonography is usually done to determine whether women have a hydatidiform mole Hydatidiform Mole A hydatidiform mole is growth of an abnormal fertilized egg or an overgrowth of tissue from the placenta. Women appear to be pregnant, but the uterus enlarges much more rapidly than in a normal... read more (a disorder that initially resembles pregnancy) or more than one fetus ( multiple births Multiple Births The term multiple births refers to the presence of more than one fetus in the uterus. The number of twin, triplet, and other multiple births has been increasing during the last two decades.... read more ). Either condition may make vomiting more likely.
Other tests may be done to rule out other possible causes of vomiting.
Treatment of Hyperemesis Gravidarum
Nothing by mouth at first
Fluids given intravenously
Drugs to relieve nausea
If hyperemesis gravidarum is confirmed, the woman is given nothing by mouth at first. Instead, she is given fluids intravenously. The fluids usually contain sugar (glucose) and include electrolytes and vitamins as needed. If vomiting is severe and persists, the woman is hospitalized and continues to be given fluids containing any needed supplements. She is also given drugs to relieve nausea (antiemetics) by mouth, injection, or suppository.
After the woman is rehydrated and vomiting has subsided, she is given fluids to drink. If she can tolerate fluids, she can begin eating frequent, small portions of bland foods. The size of the portions is increased as she can tolerate more food.
If symptoms recur, the treatment is repeated.
Rarely, if weight loss continues and symptoms persist despite treatment, corticosteroids (such as methylprednisolone) may be used for a short time. However, they are rarely used during the 1st trimester because they can cause birth defects.
In very severe cases, the woman can be fed intravenously or via a tube passed through the nose and down the throat to the small intestine for as long as necessary, but this treatment is avoided as much as possible.
If vomiting continues despite treatment and causes continuing weight loss, jaundice, and abnormal heart rhythms in the mother, the mother's life may be in danger. In such cases, ending the pregnancy may be an option. Women can discuss this option with their doctor.