Hyperemesis Gravidarum (HG)

What is it?

It is a rare disorder characterized by severe and persistent nausea and vomiting during pregnancy that may necessitate in hospitalization. This is very unlikely to harm your baby, as long as your are treated for HG.

How is it different from morning sickness

As a result of the frequent nausea and vomiting the affected women will experience dehydration, vitamin and mineral deficiencies and a loss of greater than 5% of their original body weight and ketosis, although morning sickness is a common condition of pregnancy, HG represents the severe end of of the spectrum.

You are more likely to develop HG if your expecting twins or triplets, expecting a girl ( one of my clients had HG and she had a son, so not always the case), your sister or mother had HG or you have had motion sickness or migraines in the past.

When to seek treatment

As dehydration progresses it can cause tachycardia and hypotension, HG could also cause mild and transient hyperthyroidism, if HG persists past the 16-18 week mark it could seriously damage the liver. If you are experiencing any of these symptoms, call the doctor right away:

• nausea that persists throughout the day, making it impossible to eat or drink

• vomiting that occurs three to four times per day or an inability to keep anything in the stomach

• vomit that is a brownish color or has blood or streaks of blood in it

• weight loss

• fainting or dizziness

• decreased urination

• a rapid heart rate

• recurrent headaches

• unpleasant, fruity mouth or body odor

• extreme fatigue

• confusion

How may it be treated

Treatment usually consists of temporary suspension of oral intake followed by gradual resumption, fluids with thiamin, multivitamins and electrolytes as they are needed and antiemetics if they are needed.

At first the patients are given nothing by mouth and initial treatment is iv fluids resuscitation starting with 2liters of ringer's lactate to be infused over a 3 hour period to maintain an urine output of <100mL/h.

If dextrose is given then 100mg of thiamin should be given via iv first so as to prevent Wernicke encephalopathy, this does should be given daily for 3 days, subsequent fluid requirements vary with patient response but could be as much as 1liter every 4 hours or so for approximately 3 days. affected women are also treated for electrolyte deficiencies with potassium, magnesium and phosphorus as they are needed

Resources for support

some good local supports are other mothers who have had HG

https://www.hyperemesis.org/

http://www.bcwomens.ca/health-info/pregnancy-parenting/what-to-expect-in-pregnancy/coping-with-nausea-and-vomiting

https://www.facebook.com/Mission-Doula-102767834783574/?view_public_for=102767834783574