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At least 50% of women in their first trimester experience nausea and vomiting. We know this as "morning sickness". But for approximately 1 in 100 women, the nausea is consistent, lasts longer, and leads to effects such as dehydration and weight loss. This condition is called Hyperemesis Gravidarum and it is a severe medical condition that may lead to the pregnant women needing to be hospitalised for a period of time to be rehydrated and given anti-nausea medication.
What is Hyperemesis Gravidarum
Simply put, Hyperemesis Gravidarum means "Excessive Vomiting During Pregnancy". It begins between four and seven weeks into your gestation and usually lasts until around 20 weeks. However, for some women it continues right up until the day they give birth.
Hyperemesis Gravidarum is a serious and debilitating condition. If you are experiencing HG, chances are you will struggle to eat anything, keep any food (or even water) down, and living your daily routine will become a real struggle.
Symptoms of Hyperemesis Gravidarum
- Nausea and severe vomiting: i.e. vomiting that is persistent throughout the day and which makes it difficult to eat
- Food aversions
- Weight loss of 5% or more of pre-pregnancy weight
- An inability to swallow saliva; an excessive production of saliva
- Dehydration: loss of skin elasticity, furry tongue, breath that smells like nail polish or rotten apples (this is a big warning sign), reduced urination, or tachycardia (fast heartbeat)
- Muscle weakness/wasting
Could it be something else?
There are alternatives to Hyperemesis Gravidarum, especially if your symptoms start later in pregnancy (12 weeks or later), or are accompanied by fever or pain.
Alternatives to HG include:
- Urinary Tract Infection
- Peptic Ulcer
- A reflux disorder (such as Reflux Oesophogitis)
- Addison's Disease (an autoimmune disorder involving the adrenal gland)
How do I know I have Hyperemesis Gravidarum?
HG is diagnosed by a process of elimination.
Initial investigations will usually involve testing your weight (to see if you've lost weight); checking your temperature, pulse and blood pressure; and assessing for signs of dehydration (dry mucous membranes in the mouth, ketones in the urine, concentrated urine).
After that, you will probably have a series of urine-, blood-tests, and general examinations, including:
- Full blood count: - people with HG often have a raised Haematocrit (that is the volume percentage of red blood cells in your blood)
- Urine test: - testing for ketones; also looking for evidence of a Urinary Tract Infection that may be the alternate cause.
- Urea and Electrolyte Test (U&E):- in severe HG, raised serum levels, Hyponatraemia (low sodium in the blood) and Hypokalaemia (low potassium in the blood) are often found.
- Liver Function Test (LFT):- up to 50% of people with HG have moderately raised Transaminases (an enzyme that catalyses a reaction between amino acids and a-keto acids; high levels indicate liver damage). This usually reverses. New LFTs should be taken every two weeks.
- Calcium blood test: - Hypercalcaemia (high calcium in the blood) is a rare but treatable cause of symptoms that mimic HG and should be tested for.
- Pelvic ultrasound: - to rule out molar pregnancy (a potentially-malignant mass that mimics pregnancy)
Once you've had these tests, your doctor can be quite sure if you're suffering Hyperemesis Gravidarum.
Next, we look at causes, treatment, complications self-help, and what you can do now.