Definition of Hyperemesis gravidarum
Hyperemesis gravidarum is nausea and vomiting that occurs excessively during pregnancy. Nausea and vomiting (morning sickness) in the early trimester of pregnancy are actually normal. However, in hyperemesis gravidarum, nausea and vomiting can occur throughout the day and there is a risk of causing dehydration. Not only dehydration, hyperemesis gravidarum can cause pregnant women to experience electrolyte disorders and weight loss. This condition needs to be treated immediately to prevent health problems for pregnant women and their fetuses.
Causes of Hyperemesis Gravidarum
The cause of hyperemesis gravidarum is not known for certain, but this condition is often associated with high levels of the hormone human chorionic gonadotropin (HCG) in the blood. This hormone is produced by the placenta since the first trimester of pregnancy and levels continue to increase throughout pregnancy.
There are several conditions that put pregnant women at greater risk of experiencing hyperemesis gravidarum, namely:
- Just pregnant for the first time.
- Pregnant with twins.
- Suffering from obesity.
- Having a family member who has experienced hyperemesis gravidarum.
- Had hyperemesis gravidarum in a previous pregnancy.
- Experiencing molar pregnancy.
Symptoms of Hyperemesis Gravidarum
The main symptoms of hyperemesis gravidarum are nausea and vomiting during pregnancy, which can occur more than 3-4 times a day. This condition can result in loss of appetite and weight loss. Excessive vomiting can also cause pregnant women to experience dizziness, weakness and dehydration.
Apart from excessive nausea and vomiting, hyperemesis gravidarum sufferers can also experience additional symptoms in the form of:
- Headache.
- Constipation (a condition characterized by difficulty defecating or defecating less frequently than usual).
- Very sensitive to smells.
- Urinary incontinence (a condition when a person has difficulty holding in urination and thus wets the bed).
- Excessive saliva production.
- Heart beat.
Symptoms of hyperemesis gravidarum usually appear at 4-6 weeks of gestation and begin to subside at 14-20 weeks of gestation.
Pregnant women are advised to undergo regular pregnancy checks from an obstetrician from the start of pregnancy. That way, the condition of the mother and fetus can always be monitored. The recommended pregnancy check-up schedule is:
- Gestational age 4–28 weeks: 1 time every 1 month.
- Gestational age 28–36 weeks: 1 time every 2 weeks.
- Gestational age 36-40 weeks: 1 time every 1 week.
In addition to carrying out routine checks, pregnant women need to immediately see a doctor if nausea and vomiting get worse or are accompanied by:
- Dizzy.
- Doesn’t want to eat or drink for 12 hours.
- Stomach ache.
- Symptoms of dehydration, such as weakness, infrequent urination, dry skin, and palpitations.
- Vomiting blood.
- Weight loss drastically.
Treatment of Hyperemesis Gravidarum
In diagnosing hyperemesis gravidarum, the doctor will ask about symptoms and examine the medical history of the pregnant woman and her family. A physical examination is also carried out to see the effects of hyperemesis gravidarum, such as low blood pressure and fast heart rate. From a physical examination, the doctor can determine whether the vomiting experienced by a pregnant woman is normal or excessive (hyperemesis gravidarum). To see in more detail the consequences of hyperemesis gravidarum, the doctor will carry out further examinations.
Further examination can be done with blood and urine tests. The goal is to check for signs of electrolyte disturbances and dehydration. Pregnancy ultrasound is also performed to monitor the condition of the fetus and detect abnormalities in the womb. Apart from that, to ensure that the symptoms of nausea and vomiting experienced by pregnant women are not caused by an illness, such as liver disease, the doctor will carry out further tests, for example liver function tests.
In contrast to morning sickness, which can be treated at home, hyperemesis gravidarum sufferers need to undergo treatment in hospital. The treatment given is determined based on the severity of the symptoms and the overall health condition of the pregnant woman. Treatment aims to stop nausea and vomiting, replace fluids and electrolytes lost due to excessive vomiting, meet nutritional needs, and restore appetite.
Some drugs that can be given by doctors are:
- Anti-nausea medication, such as promethazine.
- Vitamin B1 or thiamine.
- Pyridoxine or vitamin B6.
- Vitamin and nutritional supplements.
If hyperemesis gravidarum causes a pregnant woman to be unable to swallow fluids or food at all, the doctor will administer medication and nutrition through an IV. Apart from infusion, pregnant women can also receive food intake through a feeding tube.
Complications of Hyperemesis Gravidarum
Hyperemesis gravidarum can endanger the condition of pregnant women and the fetus. Excessive nausea and vomiting will cause the body to lose a lot of fluids, thereby risking triggering dehydration and electrolyte disorders. If left untreated, these two conditions can cause deep vein thrombosis in pregnant women.
Some other complications that can occur are:
- Malnutrition.
- Impaired liver and kidney function.
- Mallory-Weiss syndrome, which is a tear in the inner wall of the esophagus.
- Vomiting blood, caused by bleeding from a tear in the esophagus.
- Anxiety and depression.
If not treated immediately, hyperemesis gravidarum can cause the pregnant woman’s organs to fail and the baby to be born prematurely.
Prevention of Hyperemesis Gravidarum
It is not yet known how to prevent hyperemesis gravidarum. Even so, there are several efforts that can be made to relieve morning sickness so that it does not develop into hyperemesis gravidarum, namely:
- Drink more water to prevent dehydration.
- Drink drinks containing ginger to relieve nausea and warm the body.
- Get enough rest time to relieve stress and relieve fatigue.
- Consume foods high in protein, low in fat, and with a smooth texture so they are easy to swallow and digest.
- Eat small portions of food frequently, and avoid oily, spicy or strong-smelling foods, which can trigger nausea.
- Take pregnancy supplements to meet your vitamin and iron needs during pregnancy.
- Using aromatherapy to reduce morning sickness.
Maintaining a healthy pregnancy during the first trimester is also important to prevent hyperemesis gravidarum, one of which is by undergoing regular pregnancy checks. Pregnancy checks are generally carried out from 4 weeks of gestation, to monitor fetal development and detect early any abnormalities that may occur in the fetus.
