Hyperemesis gravidarum (HG) is not the same as the morning sickness and vomiting experienced by most, approximately 80 percent, women in the early stages of pregnancy. Hyperemesis gravidarum is distinguished by the fact that they should start before the 16th week of pregnancy, are very severe and are associated with the presence of ketone bodies in the urine (ketonuria). What are the causes of uncontrolled vomiting in pregnancy and how is it treated?
Incompetent vomiting of pregnant women( hyperemesis gravidarum , HG) is a problem that affects up to 3 percent of women. Most of them require hospitalization for the welfare of themselves and the developing fetuses. Often, in the course of the above-mentioned disorder, nutritional deficiencies, including vitamin deficiencies, occur. The most common ones include decreased levels of thiamine, riboflavin, vitamin A and vitamin B6. It happens that long-term deficiency of B vitamins leads to the development of Wernicki's encephalopathy, which may be associated with symptoms from the central nervous system. It is believed that if the weight loss in the case of vomiting is less than 5%, and the vomiting itself does not significantly affect the electrolyte balance, the development of the fetus should not be disturbed and no abnormalities should be expected, although this is an individual matter.
Incompetent vomiting of pregnant women: risk factors
Which women are at risk of uncontrolled vomiting during pregnancy? The most common risk factors for uncontrolled vomiting in pregnancy include:
- multiple pregnancy
- hormonal disorders of the thyroid or parathyroid glands in the form of hyperthyroidism. In medical terminology, there is even a separate disease entity, which is a combination of hyperthyroidism and incontinent vomiting of pregnancy, with endocrinopathy itself without typical clinical symptoms, but with the presence of anti-thyroid antibodies only. This is a temporary situation and usually does not occur after resolution.
- metabolic disorders, e.g. obesity
- trophoblast pathologies, including excessive production of chorionic gonadotropin by trophoblast cells. An example of a trophoblast disorder running with incontinentpregnant women are pregnant.
- history of incontinent vomiting of pregnant women
Despite the established risk factors for maternal irresistible vomiting, the search for new ones is ongoing. Recently, the possible importance of the infectionHelicobacter pylorihas been emphasized, although these are the conditions that require confirmation for the time being. Serotonin, which is important in the case of vomiting in people without comorbid pregnancy, seems not to be so much involved in this situation.
Diagnosis of maternal incontinence
Incompetent vomiting of pregnant women can be diagnosed in women under 16 weeks of pregnancy, most often the first symptoms appear around 4-10 weeks. Complete recovery usually takes place around week 20.
An inherent element of diagnostics is an ultrasound examination: first of all, determining whether we are dealing with a live intrauterine pregnancy, and also whether the pregnancy is single or multiple.
Besides, routine laboratory tests are performed, i.e .:
- blood count
- ionogram, i.e. the assessment of the level of basic electrolytes (sodium, potassium, chlorides)
- liver enzymes (transaminases)
- amylaza
- thyroid hormone (TSH, fT3, fT4)
- concentration of chorionic gonadotropin
- urea
- creatinine
- general urine test to look for ketonuria and assess its severity.
Differentiation of maternal incontinence includes exclusion of such pathologies as: cholecystitis, acute pancreatitis, hyperparathyroidism or thyroid gland, inflammation of the gastric mucosa, etc.
Treatment of incontinent vomiting in pregnant women
Treatment of maternal incontinence is primarily symptomatic and mainly consists in modifying the diet and diet. For the sake of the child, this should not be a zero diet, as deprivation of nutrients may translate into abnormal development of the fetus. The diet should therefore be light, meals eaten more frequently but smaller portions. It is recommended to separate solid and liquid foods, with a break between them of about 2 hours.
Avoiding unpleasant odors can further reduce the severity of vomiting.
Due to water and electrolyte disturbances, it is necessary to correct it. The same recommendations apply to acid-base management. Due to the lack of confirmation of the safety of generally available antiemetics, their use should be precededmedical consultation. Do not take any preparations on your own. Usually, treatment of pregnant women suffering from incontinent vomiting is carried out in a hospital setting.