Hyperemesis gravidarum is protracted nausea and vomiting in the first trimester of pregnancy. It can lead to weight loss, electrolyte imbalance such as low potassium or sodium and dehydration. It affects about 3% of pregnant women. It is more than just morning sickness. It is caused by the pregnancy hormone hcg. The hormone rises in early pregnancy peaks at 9 weeks and then drop so the symptoms usually resolve by 12-14 weeks. However, there are a few unlucky women whose symptoms persist into the second and third trimester. (<10%).
So what can you do to treat hyperemesis?
- Lifestyle measures: avoiding cooking or certain smells that trigger your symptoms.
- Avoid getting too hungry; try eating small amounts regularly.
- Some people find jellies or fruit gums helpful for settling nausea.
- Stay hydrated.
Medication
- Cariban (doxylamine 10mg and Vitamin B6 10mg) has been used with great success. It is expensive though. You take one capsule in the morning, one in the afternoon and two at bedtime.
- Anti-sickness tablets: cyclizine, prochloperazine (stemetil), and promethazine (phenergen).
- Second line ant—sickness medications are metoclopramide (maxolon) and ondansteron (zofran).
- If you have heartburn a tablet called omeprazole can be used to reduced the acid in your stomach.
- Alternative therapy such as eating ginger and acupuncture can be effective.
- For resistant nausea and vomiting steroids may be used.
If you are dehydrated you will need intravenous fluids. Most hospitals offer this as an outpatient service but some women require admission to hospital.
See a dietititian.
Consider other common causes of vomiting in pregnancy such as urinary tract infection, gasteroenteritis (food poisoning) and stomach ulcers.
Assess your hyperemesis using the Modified 24-hour PUQE score:
1. On average in a day, for how long have you felt nauseated or sick to your stomach?
Symptom Score
Not at all 1
1 hour or less 2
2-3 hours 3
4-6 hours 4
> 6 hours 5
2. On average in a day, have you vomited or thrown up.
Symptom Score
Did not throw up 1
1-2 times 2
3-4 times 3
5-6 times 4
7+ times 5
3. On average in a day, how many times have you had retching or dry heaves without bringing anything up?
Symptom Score
Not at all 1
1 -2 2
3-4 3
5-6 4
7+ 5
Total Score
Mild ≤ 6
Moderate 7 – 12
Severe ≥ 13
