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Morning Sickness
(Hyperemesis Gravidarum)
The term "morning sickness" is a misnomer as the nausea and vomiting characteristic of hyperemesis gravidarum can occur at any time during the day and may last all day. Most women experience at least some of the symptoms mentioned above during the first trimester of pregnancy. For most patients the problem is self-limiting, abating by the close of the first trimester and ending by 16 weeks' gestational age.
The etiology of hyperemesis is not clear, though most suspect that it has something to do with the hormonal changes related to early pregnancy. Patients with twins or triplets tend to have very severe nausea and vomiting, while patients with early miscarriages may have none at all. Most patients have the most severe problems during their first pregnancy, but some are affected during each of their successful pregnancies.
The proposed therapies for hyperemesis range from intravenous therapy to alternative medications and practices. When a patient complains of the nausea and vomiting of pregnancy, the first advice is to recommend eating small quantities of food frequently and to keep something in their stomach all of the time. Bland, salty and sour foods tend to help settle the nausea, giving rise to the old wives' tale regarding "pickles and ice cream." Vitamin B6, taken in oral doses of 25 mg tid or 30 mg daily, may be helpful.
Patients should contact their health-care provider if they are unable to hold down liquids for more than 48 hours. Certain sports drinks often will help restore electrolytes such as sodium and potassium lost during the course of excessive vomiting. This also serves as a source of glucose when other intake is impossible. Occasionally, intravenous therapy is necessary to rehydrate and to restore electrolyte imbalances.
Medications used to treat hyperemesis include antihistamines and antiemetics administered either orally, rectally, or intravenously—depending upon the severity of the vomiting. As a last resort, hospitalization and administration of an intravenous cocktail of droperidol and benadryl is one of the most effective ways to treat severe hyperemesis gravidarum.
As is often the case when traditional medicine fails to provide a cure, alternative therapies have been proposed to treat hyperemesis gravidarum. Acupuncture and accupressure have been found to be helpful in several controlled trials. Hypnosis and hypnotherapy have not been studied as carefully as acupuncture, so are not as widely accepted as possible sources of relief.
All in all, hyperemesis is usually a self-limiting
problem. Normally there is no effect on the growing fetus. For the majority
of women, the remainder of the pregnancy is enjoyable in anticipation of
the arrival of the newest member of the family.
