Many women are familiar with nausea during pregnancy, but a small percentage suffer from a particularly severe form, known as hyperemesis gravidarum. Constant vomiting can make pregnancy an extreme feat. How dangerous the disease is and what helps with severe vomiting in pregnancy.
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Around 25 percent of all women suffer from nausea (Nausea) during early pregnancy, about 50 percent more Vomit (Emesis gravidarum). In most cases, the symptoms subside towards the end of the first third of pregnancy (trimester). In 0.2 to 2 percent of pregnancies, however, vomiting is excessively pronounced – this is hyperemesis gravidarum.
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What is hyperemesis gravidarum?
Experts understand hyperemesis gravidarum to be a pregnancy complication characterized by particularly severe nausea and frequent vomiting (more than five times a day). Other criteria of the disease are:
- weight loss more than five percent of body weight,
- Disorders in metabolism as well
- dehydration (Dehydration).
The extreme nausea usually starts in the 4th to 9th week of pregnancy. In about half of the patients, the symptoms improve again from the 14th week of pregnancy (GW). Only in exceptional cases does the uncontrollable pregnancy vomiting last beyond the 20th week. Due to the poor general condition, a hospital stay is necessary in many cases.
Degrees of severity of hyperemesis gravidarum
Experts distinguish two degrees of severity:
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Hyperemesis gravidarum Grad 1 Nausea, vomiting and a pronounced feeling of illness occur. The metabolic values are in the normal range.
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Hyperemesis gravidarum Grad 2 In addition to the symptoms of grade 1, pregnant women suffer from a disturbed metabolism, water and mineral balance.
Symptoms: hyperemesis gravidarum or normal morning sickness?
Nausea during pregnancy is not uncommon and usually places a heavy burden on those affected. In most cases, however, it is a normal side effect of pregnancy and not a serious illness.
Hyperemesis gravidarum, on the other hand, is an extreme form of morning sickness. Typical signs include:
- Persistent nausea and vomiting (at least five times in 24 hours)
- Food and liquid cannot be retained in the body
- Weight loss (more than five percent of body weight)
- Dehydration (dry mucous membranes and tongue, standing skin folds, sunken eyes, reduced urge to urinate and feeling thirsty)
- circulatory weakness (dizzinesspulse too fast)
- High temperature
- Sweet breath odor (indicative of ketosis)
Other symptoms are possible with continued dehydration. Frequent consequences are nutrient deficiencies and disturbances in the water balance such as electrolyte imbalances.
If the disease persists beyond the 16th to 18th week of pregnancy, serious damage to the liver can occur, which is manifested, for example, by a jaundice makes noticeable. In the case of severe liver damage or lack of fluids, clouding of consciousness up to and including delirium may occur. Likewise, blood coagulation disorders as well as nerve and Muscle aches possible.
How dangerous is hyperemesis gravidarum?
The constant vomiting not only represents a strong psychological burden for pregnant women, it also often leads to physical weakness and deficiency states, which increase the risk of further complications such as a Preeclampsia (high blood pressure in pregnancy with kidney disorders) or damage to the esophagus.
Left untreated, hyperemesis gravidarum can affect the metabolism of pregnant women. Vitamin B deficiency damage to the brain (Wernicke encephalopathy) or nerve damage can occur. However, such complications are rare.
For the unborn child there is a risk of being born prematurely (i.e. before the 37th week of pregnancy). The baby can at the birth have a reduced weight (less than 2.5 kilograms).
Causes: how does hyperemesis gravidarum occur?
The exact causes of the disease are not yet clear. It was long thought to be purely psychological and stemmed from stress during pregnancy. This assumption is now considered outdated and has not been scientifically proven. Instead, experts suspect that several different factors play a role.
These include hormonal changes. Especially the pregnancy hormone hCG (human chorionic gonadotropin) seems to play a role as nausea and vomiting are triggered by high levels of hCG. In addition, the disease occurs more frequently in multiple pregnancies, in which the hCG level is generally higher. But also other hormones like Estrogenprogesterone and thyroid hormones appear to be involved.
Women whose mothers also had the condition are about three to four times more at risk. Therefore, experts assume that the predisposition also has an influence. In addition, sluggishness of the esophagus and stomach could be causing the constant nausea. Studies have also found that the stomach germ Helicobacter pylori is much more common in pregnant women with hyperemesis gravidarum. However, it has not been proven whether this is the cause or consequence of the disease.
Risk factors that favor hyperemesis gravidarum:
- Young age
- overweight
- Metabolic diseases (e.g Diabetes mellitus)
- Mehrlingsschwangerschaften
- African or Asian descent
How is hyperemesis gravidarum diagnosed?
Pregnant women who are constantly nauseous and who vomit frequently should definitely seek medical help. As a rule, the first point of contact is the gynecological practice. There, those affected are first asked about the frequency of vomiting and other symptoms. This is followed by a physical examination, during which a possible weight reduction and general condition are checked. Attention is also paid to signs of dehydration or a metabolic disorder.
This is followed by a laboratory diagnostic test. That blood count is used on inflammatory, electrolyte, liver, kidney and thyroid levels checked. A urine sample provides information on possible ketone bodies in the urine. The substances are formed during the breakdown of fatty acids in the body and are an important indication of a possible metabolic imbalance. The diagnosis also includes a ultrasound examination (sonography) to check the development of the unborn child.
Under certain circumstances, further examinations are used to detect diseases such as a Abdominal influenza or one inflammation of the pancreas rule out. In addition, other diseases can occur at the same time as hyperemesis gravidarum, such as:
- Preeclampsia
- Pregnancy obese liver
- Inflammation in the digestive tract or urogenital area
- neurological diseases
- metabolic diseases
A poor general condition (signs of dehydration or severe weight loss) requires admission to a hospital.
Therapy: How is hyperemesis gravidarum treated?
The aim of treatment for hyperemesis gravidarum is to stop the urge to vomit and to replenish fluid, vitamin and electrolyte stores. Depending on the severity of the symptoms, different treatments are possible:
Diet and conservative measures
In milder cases, one can often diet change and measures that are recommended for normal morning sickness help. These include, among others:
- Avoiding triggers (e.g. certain smells)
- Low-fat and high-carbohydrate diet
- Lots of small meals
- Drink enough (especially chamomile or herbal teas are good for the stomach and intestines)
- Lots of rest and enough sleep
Also can Ginger, Acupuncture, Acupressure on the wrist and supplementation with vitamin B relieve the nausea. However, the measures cannot reduce vomiting.
medication
Various medications can help with hyperemesis gravidarum. become frequent Antihistamines, anticholinergics and antiemetics are prescribed to relieve nausea. The drug of choice is the antihistamine meclozine, which in Germany is only available from pharmacies abroad. Alternatively, doctors often prescribe a combination of doxylamine and pyridoxine (Vitamin B6) that reduce nausea.
In severe cases, the administration of metoclopramide (from the group of antiemetics), cortisone medications or ondansetron possible. The latter is usually used in bouts of nausea during a cancer therapy used, but has also shown success in extreme morning sickness. When prescribing medication during pregnancy, the benefits and risks must be carefully weighed.
Inpatient treatment
In severe cases of vomiting during pregnancy, an inpatient stay is necessary. Pregnant women receive electrolyte solutions and medication for nausea and vomiting here. In the case of malnutrition, vitamin intake (especially Thiamin) to be displayed. In the hospital, the condition of those affected and the baby can be better monitored.
Duration and prognosis of hyperemesis gravidarum
Severe complications and life-threatening conditions are rare in hyperemesis gravidarum. The symptoms usually subside from the 14th week of pregnancy, but they persist in around 15 to 20 percent of those affected in the third trimester, and in around 5 percent even until birth.
Severe vomiting during pregnancy is very exhausting and stressful. Private and professional activities are affected and pregnant women can pregnancy depression develop. Medical, family and, under certain circumstances, psychological care is therefore very important.
Can hyperemesis gravidarum be prevented?
So far, hyperemesis gravidarum cannot be prevented. The risk that women will develop hyperemesis gravidarum if they become pregnant again is 15 to 20 percent.
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