How do you define the pregnancy induced nausea and vomiting?
Vomiting: to eject the contents of the stomach and upper part of small intestine through the mouth after the contraction of diaphragmatic and abdominal muscles.
Emesis: It is the expression of nausea and vomiting in a single word. It is reflexive.
The pregnancy induced nausea and vomiting is called Hyperemesis Gravidarum.
Is it seen in all the pregnant women?
An 85% of all pregnancies has nausea and vomiting. As a result of persistent of pregnancy induced nausea and vomiting, the picture is created with weight loss plus dehydration, that’s the loss of water.
What is the cause of pregnancy induced nausea and vomiting?
The “Chemoreceptor Trigger Zone” as a sensorial area having a chemoreceptor structure within a special region in the brain can be considered as a nausea and vomiting center. When this area is exposed to some hormonal changes as with the various medicines or in pregnancy, there will be nausea and vomiting. In other words, the hormonal change in pregnancy will trigger the mechanisms that start this case.
Whom is it seen more frequently?
It is more frequently seen in cases of early age pregnancy, first pregnancies, in those who have heavier body weight, and within industrial societies. It is most frequently seen in 6th to 16th pregnancy weeks.
Could nausea and vomiting have an underlying psychological cause?
Yes, in some psychological and social cases, this disease can be triggered:
- Extreme desire to have a baby
- Fear of being a mother and labor
- Excited and labile personality
- The nausea and vomiting complaints will be more frequently seen in those pregnant women who have a risk of losing her job and domestic problems.
What kinds of changes will the pregnant women who have nausea and vomiting complaints have on their bodies?
There will be 3 significant changes depending of the severity of the disease.
- Dehydration (Loss of water)
- Running out of backup source of energy
- Disordered electrolyte metabolism
These changes are the basic elements that determine the severity of the picture and method of treatment.
What is done for the treatment?
For mild cases, our suggestions include the followings:
- Eating little but frequently
- A diet rich in carbon hydrate and poor in fat
- Getting out of bed 1-2 hours later in the morning
- Avoiding stinky environments and food. IF IT IS INSUFFICIENT, the physician can include anti-nausea medicines.
For severe cases;
The patient is hospitalized for the purpose of treatment of the dehydration and salt deficit. The patient is drip-fed with solutions containing glucose to relieve the feel of hunger. B1, B6 and C vitamins will be added to these solutions. The treatment is continued until the fluid-electrolyte balance of the patient and the blood sugar levels have been taken under control. Usually the patients are discharged from hospital at the end of 1-2 day process.
When does the pregnancy induced nausea discontinue? If not, what should one do?
The nausea and vomiting complaints cause to call the early pregnancy as the most unpleasant period during the whole pregnancy period. The increase in Beta HCG hormone triggers the center of nausea in the brain. The nausea that usually begins after the 6th week is accompanied by sensitivity to odors, lack of appetite and vomiting. Usually seen in the morning, the complaint of nausea and vomiting will end between 12th and 14th week, if there is not any other underlying disease. Excessive vomiting is seen in a few pregnant women. This is called “hyperemesis gravidarum”, which means the excessive pregnancy induced nausea.
A majority of the pregnant women who have a complaint of vomiting describes that it is seen once ot twice a day and most frequently in the morning. In some other, the vomiting is so severe that they say that they cannot even drink water. As the picture is so big, the types of examination and treatment have differences. The mild cases are usually followed up as unmedicated outpatient. Several recommendations are provided and if these recommendations are followed, they will be usually helpful:
- When you wake up in the morning, eat one or two crackers and do not promptly get out of bed because sudden movements will trigger the nausea.
- Change your dietary habits. Try to eat little but often.
- Get abundance of water but drink water between the meals but not during the meal. Overstress of the stomach will increase the nausea.
- Avoid eating spicy and fatty dishes. Gaseous drinks may cause overstress.
- Keep dry food such as saltine crackers, melba toasts, and hardtacks along with you.
- Do not worry about that you could not eat healthily and something will happen to your baby, if you do not have excessive vomiting. Your baby will not be affected by this.
- In case of fatigue, excessive vomiting, dehydration and loss of weight, consult with your physician.
If the pregnant vomits too much, there will be loss of water and electrolyte. In the urine test, there will be seen increase in the ketone substance that shows the water deficit of the urine. Therefore, the pregnant woman needs to be hospitalized and the water and electrolyte lost are required to be substituted. The case will be recovered usually within 1-2 days with drip-fed solutions and medicines transfused. B vitamin combinations are used for the treatment and B6 vitamin will be helpful during the outpatient follow-up period.
There may be another underlying cause for the treatment-resistant cases. Many special cases independently from the pregnancy such as intra- and extra-hepatic bile ducts, pancreatic diseases, gastrointestinal obstructions and thyroid gland problems should be examined other than multiple pregnancy and mola pregnancy. These cases are rarely observed diseases where severe vomiting can be seen. They can be detected and treated during pregnancy.