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Hyperemesis Gravidarum: More Than Morning Sickness

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About 50 percent of all pregnant women experience morning sickness, usually beginning during the sixth week of pregnancy. Typically, a woman has a nauseous feeling that can, but not always, be accompanied with vomiting. For most women, morning sickness stops around the twelfth week of pregnancy. However, symptoms of severe nausea and vomiting during pregnancy that leads to dehydration indicates hyperemesis gravidarum. The incidence of occurrence is about one percent of all pregnancies.

Schiff’s “Diseases of the Liver” refers to hyperemesis gravidarum as a liver disorder unique to pregnancy and the “the severe end of the spectrum of morning sickness.” Liver involvement is common and documented in half of all cases. Blood testing reveals elevated liver enzymes which are indicative of liver injury, and a slight increase in bilirubin. The highest elevations are seen in women with more severe or prolonged vomiting.

This condition presents early in pregnancy, during the 4th to 10th week of gestation and generally resolve by the 20th week. Symptoms of hyperemesis gravidarum include nausea that does not subside and is accompanied by severe vomiting, serious dehydration, and weight loss of five percent or more of pre-pregnancy weight.

Pregnant women who experience these symptoms need to call their health care provider. Drinking plenty of fluids and increasing fluid intake during the times of feeling the least nauseated will prevent dehydration. Treatment includes temporarily stopping solid food to allow the GI tract to rest followed by gradually resuming a regular diet. Antiemetic medications used to control vomiting are prescribed with caution. In very serious cases, hospitalization is required. A woman can be hydrated with intravenous fluids and receive nourishment by parenteral feedings.

Sources: American Pregnancy Association: www.americanpregnancy.org
Schiff’s Diseases of the Liver by Eugene R. Schiff eighth edition volume 2
The Merck Manuals: www.merck.com

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