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Morning Sickness and Hyperemesis Gravidarum

Nausea and vomiting in pregnancy is extremely common. It is commonly referred to as morning sickness, however the nausea and vomiting can occur at any time of day. Studies estimate that nausea and vomiting occurs in 50–90% of pregnancies. For the majority of cases morning sickness is not a serious condition and it doesn’t place the mother or baby at risk.

The most severe form of nausea and vomiting in pregnancy is called Hyperemesis Gravidarum. This condition can place the mother and baby at risk because the nausea and vomiting prevent the mother from retaining and utilising food and fluid. Hyperemesis occurs in approximately 1% of pregnant women. It can start between four to six weeks of pregnancy. Symptoms usually improve from about 15–20 weeks but occasionally last the entire pregnancy.

Distinguishing between morning sickness and Hyperemesis Gravidarum

Morning Sickness Hyperemesis Gravidarum

Nausea sometimes accompanied by vomiting.

Nausea accompanied by severe vomiting.

Nausea that subsides at 12 weeks or soon after.

Nausea that does not subside.

Vomiting that does not cause sever dehydration.

Vomiting that causes severe dehydration—decrease in urine output.

Vomiting that allows you to keep some food down.

Vomiting that does not allow you to keep any food down causing electrolyte imbalance.

Weight loss of 5% or more of prepregnancy weight

Headaches, confusion, fainting, jaundice

Reference: http://americanpregnancy.org/pregnancycomplications/hyperemesisgravidarum.html 31/10/2007

If you are diagnosed with Hyperemesis, a plan of care to promote a healthy outcome for you and your baby can be developed. It is important to receive treatment early to prevent complications.

Every woman and her pregnancy are different and therefore every treatment is different. Mild cases of Hyperemesis can be simply controlled by a change of diet, rest and antacids.

The more severe cases often require hospitalisation where there is close monitoring of food/liquid intake and output. Careful rehydration is provided through an intravenous drip.

Do not take any medications to solve this problem without first consulting your health care provider.

Tips for relieving symptoms

Dietary Modification Suggestions

  • Eat frequent, small meals every two to three hours.
  • Speak to your healthcare provider about your symptoms and how they affect you. They may recommend a safe and effective medication to treat your nausea and/or vomiting and to prevent the progression of the condition.
  • Speak to a dietitian about ensuring the nutritional adequacy of your diet during pregnancy and strategies to mitigate nausea and vomiting symptoms.
  • Eat dry crackers 15 minutes before getting out of bed in the morning.
  • Do not skip meals needlessly.
  • Drink fluidshalf an hour before a meal or half an hour after a meal. Avoid drinking during your meal to avoid becoming overfull.
  • Drink about eight glasses of liquid during the day to avoid dehydration.
  • Try to eat cold food rather than hot food (cold foods have less odour).
  • Avoid spicy foods.
  • Avoid foods high in fat.
  • Protein-containing snacks are helpful (e.g. yoghurt and fruit; wholegrain crackers with sliced cheese)
  • Sugar free mineral waters or soda waters can assist in settling nausea.
  • Include herbal teas containing peppermint or ginger or other ginger-containing beverages.
  • If odours bother you while cooking, try to improve ventilation in the kitchen area.
  • If it is possible, get assistance in the preparation of your meal.

Activity

  • Limit noise, light, odours and stimulation from others.
  • Nausea and vomiting may worsen when you get overtired. Try to increase resting periods and take more naps during the day.

Alternative treatments

While the severe vomiting associated with hyperemesis requires medical attention, milder conditions of nausea or vomiting may be reduced with deep breathing and relaxation exercise.

If you are considering natural therapies you should always consult a qualified natural therapies practitioner. Some women have found natural therapies helpful.

Vitamin B6 and ginger products (crystallised ginger, ginger lollies, ginger ale, tea or raw ginger) are the non-drug products of choice. Talk to your pharmacist about the correct dose of Vitamin B6.

Wristbands can be used on the acupressure points on the wrists (two finger breadths down from the 'pulse point' on the outside of the wrists). These can usually be purchased from a chemist as a treatment for motion sickness.

Some aromatherapy oils can be used as long as they are also prescribed by a qualified practitioner.

Some people have also found regular acupuncture treatments reduce nausea and vomiting. However it is essential that you ensure that the practitioner is qualified and experienced in the area of maternity.

If you are taking other medications, please talk to your pharmacist or doctor or call the
National Prescribing Service Medicines Line on 1300 633 424 before taking any new medications.

Contact your doctor if you have any of the following

  • abdominal pain, bleeding or cramping
  • visual changes
  • difficulty walking or talking
  • extreme tiredness and very low energy
  • shortness of breath
  • dizziness and/or fainting
  • moderate or severe headache and/or fever
  • muscular weakness or severe cramping in legs
  • a dry mouth
  • repeated dry retching and vomiting
  • severe nausea that keeps you from eating and drinking
  • passing urine in small amounts and less often than usual
  • urine is dark yellow and smelly
  • vomit is blood stained or yellow/green with bile
  • weight loss of one kilogram or more in a week.

If you require any further information or advice, please contact your obstetrician or Mater Private Emergency Care on 07 3163 1000

References:
www.sosmorningsickness.org/faq
www.emedicine.com/med/topic1075
www.hyperemesis.org/hyperemesis-gravidarum
Milliman Care Guildlines 11th Edition 2007

Mater Private Emergency Care Centre

Mater Private Hospital Brisbane
301 Vulture Street, South Brisbane Qld 4101
Telephone: 07 3163 1000

www.mater.org.au

© 2010 Mater Misericordiae Ltd. ACN 096 708 922.

Mater acknowledges consumer consultation in the development of this patient information.
Mater Doc Num: HOSP-005-01379
Last modified 19/11/2015.
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