30/07/2023
Pregnancy Sickness
Nausea and vomiting affects upto 80% of women during pregnancy and is the leading cause of hospital admission which lasts for around 3-4 days.
The terms used for this nausea and vomiting can be the following
NVP: Nausea and vomiting of pregnancy without any other cause for the vomiting
Hyperemesis Gravidarum: Severe form of NVP which leads to Weight loss of 5% as compared to pre-pregnancy body weight, abnormal electrolytes and dehydration.
What causes the nausea and vomiting?
A rising trend in the pregnancy hormone beta HCG is associated with the nausea and vomiting of pregnancy.
This is sometimes considered as a sign of healthy pregnancy. However it is not mandatory for everyone to have a NVP during pregnancy nor is it considered healthy when it starts affecting the daily activities of women.
The proposed theory to explain the cause are
Feto-protective
Immunological
Biochemical
Biosocial
To ensure that the pregnancy progresses smoothly without causing undue discomfort, It is important to address this issue as it has been observed that almost 1 in 10 women having Hyperemesis gravidarum will opt to terminate the pregnancy because of the distress it causes.
How to know that the vomiting in pregnancy is severe?
A scoring system has been developed to make the soring quantitative. It is known as the PUQE (Pregnancy unique quantification of Emesis) score. As per the score , the vomiting is termed as mild , moderate or severe.
What can be the other causes of vomiting?
Gastritis
Cholecystitis
Infection : Kidney, gut , lower Urinary tract,
pancreatitis
Hepatitis
metabolic: Diabetes and complications
Abnormal pregnancy like molar or twins
Neurological causes
Drug or food induced
What to expect when visiting a doctor?
If the vomiting prevents you from having a discussion, then you will be offered fluid and treatment initially and then assessed for associated abnormalities which can trigger/cause vomiting.
Blood tests will be offered to check for the functions of Kidney, liver and urine test is done to search for "KETONES" which is a measure of the severity of dehydration.
Certain pre-existing diseases like diabetes can present as vomiting so it is wiser to do a thorough assessment.
If you are suggested an admission, blood thinners will be given through an injection to reduce the chances of development of clots in your legs and lungs. These will be discontinued upon discharge.
To assess the growing fetus, a scan will be offered.
Is there any way to avoid Nausea in pregnancy?
Simple dietary measure during early pregnancy which includes
Addition of carbohydrates during snacking , switching over to bland food and frequently eating small meals in a ratio of 3 meals and 3 snacks might avoid the onset of NVP
Ginger: In the form of juice or ginger tea can be helpful in suppressing nausea.
Avoidance of triggers and smell that provokes vomiting
Massaging Neiguan point: acupressure point which relieves nausea.
What is the impact of NVP on the fetus?
NVP is a common condition and doesnt have a sustainable impact on the fetus.
In cases of hypermesis gravidarum, almost 10% women wish not to continue the pregnancy as they are unable to carry on with the disability.
What medicines are given for this condition?
Simple anti-vomiting medicines are the first line to be used.
cyclizine, prochlorperazine, promethazine and chlorpromazine are safe to consume but caution needs to be taken regarding a rare but bothersome condition known as Extrapyramidal side effects.
If the first line does not act, second line anti-vomiting medicines are
Metoclopramide, domperidone and Ondansetron.
Third line medications consist of Steroids which needs to be given in a hospital set up through the veins.
Severe nausea and vomiting of pregnancy is a disabling condition which needs to be dealt with compassion and acknowledgement of the symptoms of the pregnant woman.
This condition might recur in the same pregnancy and there is a high likelihood of reappearing during subsequent pregnancies. This is one of the reasons why the management of this condition should take into account addressing the issue with empathy.
If managed properly, the pregnancy outcome is good with a healthy mother and a baby. It is important to try the non-medical methods of tackling this condition moving over to first line followed by second line medications.
For your healthcare needs, please visit me at Wellkins medical Centre.
