For Kate and all expectant mothers: Acute morning sickness

Gynaecologist Dr Darshana Apte gives readers the lowdown on hyperemesis gravidarum, the acute form of morning sickness that saw the pregnant Duchess of Cambridge admitted to hospital two days ago.

What is hyperemesis gravidarum?

In simple words, hyperemesis gravidarum is an extreme form of morning sickness. Morning sickness is most common in pregnant women; it is usually temporary and a minor nuisance. However, in hyperemesis gravidarum the vomiting and nausea become chronic and continue through the day.

Practicing gynaecologist Dr Darshana Apte explains that in HG, sickness can occur at any time of the day and may continue throughout the course of the pregnancy; the vomiting is so severe that no food or liquid can be kept down. Unlike regular morning sickness, hyperemesis gravidarum usually persists past the first three months of pregnancy, she adds.

HG is more common in young women, especially those who are in their first pregnancy

Symptoms

Women with hyperemesis gravidarum often lose weight during pregnancy, and feel tired and dizzy. They may also pass less urine, which is thick and yellowish, she adds. As they keep throwing up, these expectant mothers may suffer from dehydration and hence develop symptoms of dizziness, headaches, palpitations etc.

Dr Apte adds that a woman must see her doctor if the following symptoms are consistent:

• The nausea persists
• You are unable to keep your food down
• You have a racing or pounding heart
• You're vomiting blood
• You have a pain in your upper abdomen, or behind your breast bone, which does not go away

Says Dr Apte, "Although we cannot pinpoint a particular cause, there could be a number of reasons for hyperemesis gravidarum. These include the effect of changes in hormones, emotional changes that occur during pregnancy, nutritional deficiency, feelings of loneliness or other gastrointestinal complexities."

As for treatment, she advises that you may first want to try a few diet and lifestyle changes. If these changes do not relieve your symptoms or if your nausea and vomiting are severe, you may need additional treatment and you need to let your health care provider know about it.

Like treatment of nausea and vomiting in pregnancy, hyperemesis treatment begins begins with prevention. The woman's perception of the severity of her symptoms and her desire for treatment are influential in clinical decision making, Dr Apte adds.

Here are some ways of getting over hyperemesis:

• Get plenty of rest.
• Avoid smells that bother you.
• Eat five or six small meals each day instead of three large meals.
• Eat a few crackers before you get out of bed in the morning to help settle your stomach.
• Eat small snacks high in protein (such as a glass of milk or a cup of yoghurt) throughout the day.
• Try spending time with people you enjoy.
• Distract yourself by taking up something you like, such as a hobby.
• Avoid spicy and fatty foods.
• Chew on small pieces of ginger, foods containing ginger such as ginger biscuits and crystallised ginger, or drink ginger herbal tea.

When symptoms are severe, admission to hospital may be needed for observation and to treat dehydration with intravenous fluids. However, this is usually just for a day or two, she states.

Hyperemesis gravidarum rarely shows harmful effects in milder cases. But in more severe cases, which are very rare, there is a risk of complications for both mother and baby, especially if the problem isn't recognised and treated early. These include premature labour.

Dr Apte adds that depression and anxiety are secondary psychological challenges which may result and complicate the management of hyperemesis.

For most young women, depression occurs as a natural outcome of being confined to home or bed, and being unable to carry out their everyday activities. It's the frustration that creeps in when it's difficult to step out and carry out daily chores or even get to the workplace.

Furthermore, anxiety often results from the worry of retching and vomiting, accompanied by strong nausea.

"It should be remembered that individuals respond to medication in various ways," Dr Apte advises. There is no single remedy or 'cure' for nausea and vomiting that is guaranteed to work for all women.

The state of mind of the expectant mother and family support are also a very important aspect of treating HG.