Hyperemesis gravidarum (HG)

Hyperemesis gravidarum is protracted nausea and vomiting in the first trimester of pregnancy. It can lead to weight loss, electrolyte imbalance such as low potassium or sodium and dehydration. It affects about 3% of pregnant women. It is more than just morning sickness. It is caused by the pregnancy hormone hcg. The hormone rises in early pregnancy peaks at 9 weeks and then drop so the symptoms usually resolve by 12-14 weeks. However, there are a few unlucky women whose symptoms persist into the second and third trimester. (<10%).

So what can you do to treat hyperemesis? Lifestyle measures such as avoiding cooking or certain smells that trigger your symptoms. Avoid getting too hungry; try eating small amounts regularly. Some people find jellies or fruit gums helpful for settling nausea. The most important thing is to stay hydrated. In recent years Cariban (doxylamine 10mg and Vitamin B6 10mg) has been used with great success. It is expensive though. You take one capsule in the morning, one in the afternoon and two at bedtime. In terms of medication there are a number of anti-sickness tablets that are used in pregnancy. These include cyclizine, prochloperazine (stemetil), and promethazine (phenergen). Second line ant—sickness medications are metoclopramide (maxolon) and ondansteron (zofran). If you have heartburn a tablet called ranitidine (zantac) can be used to reduced the acid in your stomach. Alternative therapy such as eating ginger and acupuncture can be effective. For resistant nausea and vomiting steroids have been used successfully.

If you are dehydrated you will need intravenous fluids. Most hospitals offer this as an outpatient service but some women require admission to hospital. If you are losing weight the hospital will usually organise for a dietitian to see you.

Remember to consider other common causes of vomiting in pregnancy such as urinary tract infection, gasteroenteritis (food poisoning) and stomach ulcers.

For further advice speak to your doctor or midwife.