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Hyperemesis Gravidarum

(Severe Morning Sickness; Persistent Vomiting of Pregnancy; HG)

Definition

Hyperemesis gravidarum (HG) is an uncommon condition characterized by frequent, persistent, and severe vomiting and nausea during pregnancy. As a result, you may be unable to take in a sufficient amount of food and fluids. It can cause a weight loss of more than 5% of your pre-pregnancy body weight. This can also cause dehydration and vitamin and mineral deficiencies. Treatment may require hospitalization.
HG is a more severe form of nausea and vomiting of pregnancy (NVP), also called morning sickness. Morning sickness affects anywhere between 70% to 80% of pregnant women. HG is estimated to occur in up to 2% of pregnancies.

Causes

There are many theories about the causes of HG, but none have been confirmed. HG is a complex disease that is likely caused by many factors. Some of these include:
The Brain May Be Cause of Nausea
Brainstem and brain
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Risk Factors

Factors that may increase your chance of HG include:

Symptoms

HG may cause:

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done. Tests may include the following:

Treatment

Treating HG symptoms early in pregnancy can make you less sick in the long run and can decrease recovery time. Because HG is caused by many factors that vary among women, it is difficult to find a treatment that works for everyone. Talk with your doctor about the best treatment plan for you. Treatment options include the following:

Diet

Try to eat frequent, small meals, bland or dry foods, high-protein choices.

Anti-nausea Medications

Reducing nausea, and thus allowing eating and drinking, will hasten recovery. Due to the risk of stating that a drug is safe for use during pregnancy, very few pharmaceutical manufacturers will say that their drugs are intended for a pregnancy condition like HG. However, doctors often recommend that women with HG take certain anti-nausea medications, balancing the potential benefits and risks. Talk to your doctor about the right medications for you.
A common and safe remedy is to take supplemental vitamin B6 (pyridoxine). The American Congress of Obstetricians and Gynecologists recommends that first-line treatment of nausea and vomiting of pregnancy should start with pyridoxine with or without doxylamine. Pyridoxine has been found to be effective in significantly reducing severe vomiting.

IV Hydration and Anti-nausea Medications

In urgent visit situations, HG can be managed by IV fluids and vitamins. This can sometimes be done without hospitalization. Very rarely, some people require IV fluids throughout the entire pregnancy.

Nutrition by Vein

If you are unable to tolerate food by mouth, you may need to receive nutrition by vein. This is called parenteral nutrition. A special kind of catheter is placed in a large vein and liquid nutrition is given. This can sometimes be done without hospitalization.

Alternative Therapy

Acupressure may help to reduce nausea. Acupressure is when pressure is applied to acupuncture points.

Termination of Pregnancy

In extreme cases, induced abortion may be considered.

Prevention

Many of the conditions that lead to HG are not preventable. To help reduce your chance of nausea during pregnancy take these steps:

RESOURCES

The American Congress of Obstetricians and Gynecologists http://www.acog.org

Hyperemesis Education and Research Foundation http://www.helpher.org

CANADIAN RESOURCES

The Canadian Women's Health Network http://www.cwhn.ca

The Society of Obstetricians and Gynaecologists of Canada (SOGC) http://www.sogc.org

References

About hyperemesis. Hyperemesis Education and Research Foundation website. Available at: http://www.helpher.org/hyperemesis-gravidarum. Updated April 18, 2013. Accessed August 6, 2013.

Acupuncture. EBSCO Natural and Alternative Treatments website. Available at: http://www.ebscohost.com/biomedical-libraries/natural-alternative-treatments. Updated May 29, 2013. Accessed August 6, 2013.

American Congress of Obstetrics and Gynecology. ACOG (American Congress of Obstetrics and Gynecology) Practice Bulletin: Nausea and vomiting of pregnancy. Obstet Gynecol. 2004;103(4):803-8014. Reaffirmed 2011.

Herrell HE. Nausea and vomiting of pregnancy. Am Fam Physician. 2014;89(12):965-970.

Morning sickness. American Congress of Obstetricians and Gynecologists website. Available at: http://www.acog.org/~/media/For%20Patients/faq126.pdf?dmc=1&ts=20130806T1444487894. Accessed August 6, 2013.

Nausea and vomiting in pregnancy. EBSCO DynaMed website. Available at: http://www.ebscohost.com. Updated Updated April 10, 2013. Accessed August 6, 2013.

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