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Hyperemesis Gravidarum
(Severe Morning Sickness, Persistent Vomiting of Pregnancy, HG)

Hyperemesis gravidarum is a condition in which pregnant women experience severe vomiting and weight loss. Treatment can require hospitalization. This condition affects about two percent of pregnancies. This is a potentially serious problem that requires care from your doctor.

Several factors may contribute to hyperemesis gravidarum, including:
  • High or rapidly rising serum levels of hormones such as hCG (human chorionic gonadotropin)secreted by the fetus.
  • Increased estrogen levels
  • Pressure on the stomach and intestines
  • a multiple pregnancy (i.e., twins or more)
  • hydatidiform mole (abnormal tissue growth, not a true pregnancy)
Risk Factors:
The following factors increase your chances of developing hyperemesis gravidarum. If you have any of these risk factors, tell your doctor:
  • First birth
  • Hyperemesis gravidarum in prior pregnancies
  • Mother or sister with hyperemesis gravidarum
  • Being pregnant with more than one fetus
  • Living in the Western Hemisphere
  • Emotional problems
  • History of an eating disorder
  • Infection with the bacterium Helicobacter pylori
  • Carrying a fetus with Down Syndrome
  • History of motion sickness
  • History of migraines
  • Carrying a fetus that is female
The following list of symptoms are general and may be caused by other, less serious health conditions. However, if you experience any one of them, call your physician to discuss your condition. Symptoms may include:
  • Severe and lasting vomiting—not being able to keep liquids down
  • Weight loss
  • Dehydration; signs of dehydration may include:
    • Ketones in urine
    • Increased hematocrit
    • Increased pulse rate
    • Decreased blood pressure
  • Yellow skin
  • Racing heart
  • Dizziness
  • Feeling faint
Your doctor will ask about your symptoms and medical history, and perform a physical exam.

Tests may include the following:

  • Weight measurement- to determine if you have lost weight
  • Blood electrolytes- this test identifies disturbances in salts and other minerals in the blood due to extreme vomiting
  • BHCG- an extremely high level could indicate more than one fetus or a molar pregnancy (an abnormal growth that mimics pregnancy)
    • Blood pressure- high blood pressure can indicate a condition called preeclampsia that can also cause nausea and vomiting.
    • Urine dip: looks for ketones. When there is not enough sugar in the blood because of vomiting, the body produces ketones
    • Tests to look for problems with the following organs:
    • Liver
    • Stomach
    • Kidneys
    • Pancreas
    • Intestines
    • Thyroid
    • Nervous system and brain
Talk with your doctor about the best treatment plan for you. Treatment options include the following:

IV Hydration and Anti-nausea Medicines
Many times hyperemesis can be managed by a short treatment with fluids in the vein and medicines to stop the nausea immediately. This is followed by daily use of anti-nausea medicines to keep the nausea at bay and allow eating and drinking. Some women require IV fluids throughout the pregnancy. This can sometimes be done without the need for hospitalization.

Medicines for hyperemesis may include:

  • Promethazine
  • Meclizine
  • Ondansetron
  • Droperidol
  • Metoclopramide
Nutrition by Vein
If a woman is unable to tolerate food by mouth even with daily use of anti-nausea medicines, she may need to receive nutrition by vein. This is called parenteral nutrition. A special kind of catheter is placed in a large vein and liquid nutrition is given. This can sometimes be done without hospitalization.

Stress Reduction Techniques
Hypnosis and psychotherapy can be useful in reducing symptoms once the patient undergoes any treatment that her doctor deems necessary to stabilize her condition.

Vitamin & Other Complementary Therapies
Once a patient’s condition has been medically treated, some doctors suggest the use of Vitamin B-6 supplements. Studies have shown that B-6 supplements taken daily can reduce nausea. Doctors may also suggest acupressure treatment, or that the patient consume ginger to lessen the nausea.

Termination of Pregnancy
In extreme cases, your doctor may discuss the option of terminating the pregnancy if a specific type of eye problem called hemorrhagic retinitis occurs.

Many of the conditions that lead to hyperemesis are not preventable and it is unknown why some women without those conditions develop hyperemesis. You can try to reduce your nausea during pregnancy by:
  • Avoiding smells, foods or other things that stimulate nausea
  • Eat frequent small meals
  • Do not allow yourself to get too hungry or too full
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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