Hyperemesis Gravidarum

Signs, Symptoms, and Treatment

Hyperemesis gravidarum is a condition characterized by severe nausea, vomiting, weight loss, and electrolyte disturbance. Mild cases are treated with dietary changes, rest, and antacids. More severe cases often require a stay in the hospital so that the mother can receive fluid and nutrition through an intravenous line (IV). DO NOT take any medications to solve this problem without first consulting your health care provider.

What causes such severe nausea?

The majority of pregnant women experience some type of morning sickness (70 – 80%). Recent studies show that at least 60,000 cases of extreme morning sickness called hyperemesis gravidarum (HG) are reported by those who treated in a hospital but the numbers are expected to be much higher than this since many women are treated at home or by outpatient care with their health care provider.
It is believed that this severe nausea is caused by a rise in hormone levels; however, the absolute cause is still unknown. The symptoms of HG usually appear between 4-6 weeks of pregnancy and may peak between 9-13 weeks. Most women receive some relief between weeks 14-20, although up to 20% of women may require care for hyperemesis throughout the rest of their pregnancy. There is no known prevention of Hyperemesis gravidarum but you can take comfort in knowing that there are ways to manage it.

Distinguishing between morning sickness and hyperemesis gravidarum:

Signs and symptoms of hyperemesis gravidarum:

• Severe nausea and vomiting
• Food aversions
• Weight loss of 5% or more of pre-pregnancy weight
• Decrease in urination
• Dehydration
• Headaches
• Confusion
• Fainting
• Jaundice
• Extreme fatigue
• Low blood pressure
• Rapid heart rate
• Loss of skin elasticity
• Secondary anxiety/depression

What are the treatments for hyperemesis gravidarum?

In some cases, hyperemesis gravidarum is so severe that hospitalization may be required.
Hospital treatment may include some or all of the following:

• Intravenous fluids (IV) – to restore hydration, electrolytes, vitamins, and nutrients
• Tube feeding:
  • Nasogastric – restores nutrients through a tube passing through the nose and into the stomach
  • Percutaneous endoscopic gastrostomy – restores nutrients through a tube passing through the abdomen and into the stomach; requires a surgical procedure
• Medications – metoclopramide, antihistamines, and antireflux medications*

Other treatments may include:

• Bed Rest –This may provide comfort, but be cautious and aware of the effects of muscle and weight loss due to too much bed rest.
• Acupressure – The pressure point to reduce nausea is located at the middle of the inner wrist, three-finger lengths away from the crease of the wrist, and between the two tendons. Locate and press firmly, one wrist at a time for three minutes. Sea bands also help with acupressure and can be found at your local drug store.
• Herbs – ginger or peppermint
• Homeopathic remedies are a non-toxic system of medicines. Do not try to self-medicate with homeopathic methods; have a doctor prescribe the proper remedy and dose.
• Hypnosis

* When it comes to medications, it is very important that you weigh the risks and the benefits. Some drugs may have adverse effects on you or the development of your baby. Discuss the risks and side effects of each drug with your health care provider.

Where can I get more help?

To get more information on hyperemesis gravidarum you can go to the HER (Hyperemesis Education & Research) Foundation.
Check out this book on morning sickness for helpful hints to combat those queasy and sick feelings.

The Morning Sickness Companion – Elizabeth Kaledin

Your purchase supports the APA.

Want to Know More?

• Morning Sickness Relief
• 7 Common Discomforts of Pregnancy

Compiled using information from the following sources:
Williams Obstetrics Twenty-Second Ed. Cunningham, F. Gary, et al, Ch. 49.
HER Foundation, www.hyperemesis.org