Nausea is common in the early stages of pregnancy (often from the 6th week of pregnancy). These nausea can be accompanied by vomiting, anorexia, weight loss and extreme sensitivity to certain odors. Since nausea and vomiting are usually more severe in the morning, this condition is called morning sickness. In case of nausea and vomiting during pregnancy throughout the day, not responding to outpatient medication, preventing the mother’s normal diet, daily activities, disrupting her general condition or causing weight loss, ‘hyperemesis gravidarum’ is in question. Hyperemesis gravidarum is a condition that requires further examination and treatment. While nausea and vomiting are relatively frequent during pregnancy, nausea and vomiting with such an unusual course are encountered only in 4 out of a thousand people. Hyperemesis gravidarum is generally more common in those who had their first pregnancy at a young age. It is relatively more common in those who are overweight, those with multiple pregnancies, and those with a high sociocultural level.
Causes of Hyperemesis Gravidarum
The causes of hyperemesis gravidarum are generally caused by increases in hormones. The increase in physiological estradiol and HCG hormones that occur due to pregnancy is higher than normal or high levels of individual sensitivity although the levels are within the normal limits, cause some other symptoms such as disgust from the odors and odors. In cases such as mole pregnancy and multiple pregnancy, the problem of hyperemesis gravidarum is common since HCG is produced much more than normal.
Differential Diagnosis of Hyperemesis Gravidarum
It is not correct to connect every nausea and vomiting to pregnancy. Nausea and vomiting that are particularly severe and respond poorly to treatment, other diseases that may lead to the same symptoms in nausea and vomiting that continue at the end of the first trimester or are just beginning in the second trimester are also sought. The most important of these are mole pregnancy, hepatitis (inflammation of the liver), pancreatitis (inflammation of the pancreas), cholelithiasis (gallstones), cholecystitis (inflammation of the gallbladder), peptic ulcer (stomach and duodenal ulcer) and pneumonia. In addition, hyperthyroidism (overwork of the thyroid gland), ovarian cyst torsion (choking of the ovarian cyst), digestive tract obstruction, IDDM (insulin dependent diabetes disease) and brain tumors also play a role. These diseases are rarely seen in expectant mothers because they are rare even in non-pregnant women.
Effects of Hyperemesis Gravidarum on Pregnancy and Fetus
It is a frequently observed condition that pregnants with excessive nausea and vomiting during early pregnancy have a healthier pregnancy and a low rate of miscarriage, but the cause of which cannot be scientifically clarified. However, this situation may be reversed in hyperemesis gravidarum, prospective mothers who develop and undergo treatment or do not respond to treatment. In case of weight loss, electrolyte imbalances, insufficient intake of nutrients and vitamins, developmental retardation may develop in the baby. It is not possible for the expectant mother who develops Hyperemesis gravidarum to have to go to the hospital and receive treatment, as long as she receives the appropriate treatment, and does not affect the later stages of her pregnancy.
Hyperemesis Gravidarum Treatment
Pregnancy week is determined by ultrasound examination after general system examination of each mother candidate who applies with severe nausea and vomiting. Factors such as multiple pregnancy or mole pregnancy can be easily detected on ultrasound. In case of pregnancy, the treatment takes a different direction. The duration of fasting can be indirectly demonstrated in the full urine test. As the duration of fasting increases, ketone substances, especially acetone, increase in urine. The higher the ketone is in the urine, the heavier the hyperemesis gravidarum. The urine density measured in the full urine test and the observed color of the urine also give information about the general fluid state of the body. Normal urine density is 1020, normal urine color is light yellow. Since the urine production of the kidneys decreases when the body is dehydrated, the color of the urine becomes darker and the density is higher. Urinary tract infection can also be detected in full urine analysis.
Blood electrolytes also give detailed information about the body’s water status. When the body is dehydrated, the amount of sodium and potassium in the blood increases, since the blood is concentrated. The increased electrolytes indicate that hyperemesis is very severe and is a condition that requires urgent treatment. Cases of hyperemesis gravidarum, which are severe enough to cause electrolyte imbalance, are very rare.
One of three different treatment approaches is applied in the treatment of Hyperemesis gravidarum:
- Outpatient drug-free treatment
- Outpatient medication
- Inpatient serum and drug treatment
If the mother’s candidates have mild complaints, outpatient treatment can be tried. The purpose of outpatient treatment is to ensure that the expectant mother copes with nausea.
- Have food items like crackers or biscuits ready at the edge of your bed. Get up from bed after eating them in the morning.
- Get your daily meal by dividing it into five or six, not three.
- Take liquids between meals. Do not drink too much liquid during meals.
- Stay away from foods that touch your stomach and intestines
- If your complaints do not go away with these measures, contact your doctor again.
If the mother’s complaints hinder her daily activities and she does not respond to drug-free treatment, outpatient treatment is tried. Medicines in the form of tablets or suppositories that are given to the expectant mother as a nausea reliever are used for years and are known to have no negative effects on the baby. In addition, a vitamin treatment is started, where B vitamins are in the foreground. When an outpatient medication is decided, the expectant mother should comply with the precautions mentioned above while using her medicines.
If the mother’s complaints do not respond to outpatient medication treatment, her general condition is impaired, there is weight loss, if the tests show that the body has not taken any nutrients for a long time (if ketone bodies are found high in the urine) or if there are signs that the body is dehydrated (urine density is increased, the color is found dark, blood is electrolytes are imbalanced) hospitalized and serum treatment is started. The purpose of serum therapy is to return the fluid, electrolyte and nutrients lost to the prospective mother by intravenous (intravenously). Anti-nausea medications and vitamins are also given from the hip or serum.
With serum treatment, the expectant mothers usually recover within a week. In rare cases, it may be necessary to stay in the hospital for more than a week. While discharged, the mother is given medicines for home use. Hyperemesis gravidarum usually subsides parallel to the growth of the gestational week and ends at the end of the first trimester or at the beginning of the second trimester (14th week). Hyperemesis gravidarum, which does not respond to any treatment and is severe enough to require termination of pregnancy, is very rare.