Vomiting in Pregnancy (Including Hyperemesis Gravidarum)

Introduction

Nausea and vomiting are common in early pregnancy, especially in the morning. That is why it is called morning sickness. It is caused by hormones released from the placenta of the baby called Human Chorionic Gonadotrophin (hCG) and Growth Differentiation Factor 15 (GDF15), and to some extent, estrogen. The more the placenta releases these hormones into the mother’s circulation, the more she experiences this problem. If there are minute amounts in the circulation the mother experiences only nausea, if there are significant amounts, the mother experiences occasional vomiting. If there are excessive amounts, the mother experiences excessive and frequent vomiting that may disrupt her physiology. This is what is called hyperemesis gravidarum.

Other Causes and Symptoms

Excessive and frequent vomiting in pregnancy or hyperemesis gravidarum is more common if the mother is carrying multiple babies, because the more babies she carries, the more placentae that release the hormones. But it can happen in singleton pregnancies (recall that Catherine, the Princess of Wales, had this terrible condition when she was pregnant with Prince George and with subsequent pregnancies). There is also a condition called hydatid mole where the pregnancy turns into malignant cells instead of a fetus. These cells also release the hormones and cause hyperemesis. A woman with a history of frequent heartburn or excessive gastric acid secretion or an infection with an organism that causes peptic ulcer called Helicobacter pylori before pregnancy is also highly likely to have hyperemesis because this acid is overproduced in pregnancy.

If you are pregnant and vomit excessively early in the morning and it continues throughout the day or after eating or drinking anything, and you feel weak, tired, and stressed out, you are likely to have hyperemesis gravidarum.

Management

Nausea and occasional vomiting can go on their own after a few more weeks into the pregnancy and do not need any medication. A woman having this can have a small sip of tea with ginger in the morning, which are natural anti-emetics. Some women found that some biscuits such as crackers, do suppress the nausea. You may benefit from some over-the-counter anti-emetics that do not harm the baby if the problem persists, but it is preferable to get advice from a midwife or your doctor before doing that.

Hyperemesis gravidarum however needs to be evaluated in the hospital because there is a health threat to mother and child if she continues to vomit whatever she eats or drinks and because there is a possibility of an abnormal pregnancy, the hydatid mole we mentioned earlier.

A pregnant woman with hyperemesis is admitted to the hospital and her blood and urine samples are collected to check for these hormones and other possible abnormalities associated with dehydration from the excessive vomiting. An intravenous fluid management with some anti-emetics is instituted and an abdominal ultrasound scan is done to rule out the mole and find out the condition of the baby. If a mole is found, it is evacuated using a suction machine, a procedure called manual vacuum aspiration (MVA). If there is no mole, the woman is kept for a few days for observation while undergoing this line of management until everything subsides.