Trimester of Pregnancy

Unlike the nausea and vomiting of the first trimester of pregnancy which is seen in up to half of all pregnant women, hyperemesis gravidarum is a rare complication in which the nausea and vomiting are severe and continue past the first trimester. Hyperemesis gravidarum can lead to weight loss, dehydration, and imbalances in the body’s necessary chemicals called an electrolyte imbalance. It can lead to serious changes in the pH of the blood-how acid or alkaline it is. These effects can be life threatening if not treated. Hyperemesis gravidarum can cause changes in liver function and result in jaundice (yellowing of the skin).

Hyperemesis gravidarum is treatable. All its associated problems can be corrected. However, the condition can be serious enough to warrant hospitalization and special intravenous feeding, although sometimes it can be managed with intravenous fluid replacement without hospitalization.

The cause of hyperemesis gravidarum is not known. For many years, it was believed to be due to ambivalence about the pregnancy, but that belief has been discarded. There is some evidence that hormone levels are unusually high in hyperemesis but the reason for nausea and vomiting with high hormone levels is not clear. Because sometimes a woman’s vomiting subsides when she is in the hospital only to recur when she is discharged, there is speculation that social problems at home playa role in causing hyperemesis gravidarum. Again, this is not proven. However, social services and psychological counseling can be beneficial if you have hyperemesis.

Hyperemesis gravidarum can subside and recur throughout pregnancy, requiring repeated hospitalizations. The physician should look for other pathologic causes of the vomiting such as gastroenteritis, hepatitis, ulcer, or disorders of the gall bladder, kidney, or pancreas. For some women, the condition returns in subsequent pregnancies. At the least, it makes pregnancy less than an enjoyable experience.

If you have severe nausea and vomiting for a short period of time, try to sip fluids throughout the day. If at any time in pregnancy you are unable to hold down any food for 24 hours, you must contact your physician or midwife. The treatment may be as simple as getting some fluids via an intravenous line in the care provider’s office or as extensive as prolonged hospitalization. Treatment depends on the extent of symptoms and the results of urine and blood tests to determine your electrolyte balance.

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