Pregnancy is a whole complicated phase, sometimes when I think about what women go through during pregnancy, fear grips my heart, my Mum has always been a community mother, sometimes she would go out and return with a child who is homeless or a pregnant woman who has been abandoned, this is regardless of the fact that we do not have so much at home also, but she couldn't just bear it that another human would go through intense hunger and starvation when she would have been able to do something. So she came home with this pregnant woman whose husband had abandoned her, the pregnancy was a lot for the woman to handle, she was throwing up heavily and there was even a particular night she started bleeding, it took a lot of medical attention and money to ensure both mother and baby were alright. The topic I will be writing about today with you my friends is, Hyperemesis gravidarum which is intractable vomiting during pregnancy, while it has become almost normal for women to vomit during pregnancy, especially the first trimester, it is different in this case because the vomiting is highly severe that it leads to weight loss and volume depletion, creating ketonuria or/and ketonemia.
There are several theories associated with hyperemesis gravidarum, but the etiology is largely unknown, but there are certain risk factors associated with the development of hyperemesis during pregnancy. Women who experience nausea and vomiting while they are not pregnant usually as a result of the consumption of medications that contain estrogen, or exposure to motions, or they have a history of migraines stand a higher chance of experiencing vomiting and nausea while pregnant. Studies have shown as well that hyperemesis is possible in women who have a first-degree relative who has previously experienced hyperemesis gravidarum. Protective measures have to do with the use of multivitamins six weeks before the age of gestation and maternal smoking.
Having established the fact that, hyperemesis gravidarum has no clear cause, there are several theories that would become what people hold to become a major cause of this disease.
- Hormonal changes: Human chorionic gonadotropin (hCG) has different levels of implications, that gets to its peak in the first trimester, which corresponds to the onset of hyperemesis symptoms and there are serious studies that show a correlation between a higher concentration of hCG and hyperemesis, but the report of this data has not been consistent.
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Estrogen also contributes seriously to nausea and vomiting during pregnancy. The level of Estradiol increases at an early pregnancy stage and decreases later on, as it mirrors the typical course of nausea and vomiting during pregnancy. In addition, vomiting and nausea are side effects of medications that contain estrogen, as the level of estrogen increases, so does the occurrence of vomiting happen also.
Changes in Gastrointestinal system: The lower esophageal sphincter has a habit of relaxing during pregnancy as a result of the elevations in progesterone and estrogen, which has resulted in an increased incidence of gastroesophageal reflux disease GERD symptoms in pregnancy, and GERD symptoms in nausea.
Hyperemesis gravidarum has been associated with several risk factors, women with hyperemesis gravidarum are often younger, a person of color, primiparous and not likely to consume alcohol, and other factors like socioeconomic status, smoking, body mass index, does not show any difference between women who have hyperemesis gravidarum and those who do not. Parental factors do not play any role in hyperemesis gravidarum. The high prevalence of hyperemesis gravidarum through the immigrant population certainly provides a degree of complexity to the issue on the ground, therefore creating a piece of conflicting evidence about immigrant women who are good with physical health stands a chance of developing mental health issues during their perinatal phase.
The treatment for hyperemesis gravidarum should be provided based on the guideline made available by the "American College of Obstetrics and Gynecology (ACOG) Nausea and vomiting in pregnancy guidelines". At the initial stage, treatment should begin with non-pharmacological interventions, like the switching of the patient's prenatal vitamins to the supplementation of folic acid with the use of ginger as supplementation. If after this, the patient still continues to experience serious significant symptoms, then pharmacological therapy which includes a combination of Vitamin B6 (pyridoxine) and doxylamine.
Second-line medications consist of antihistamines and dopamine antagonists administered every 25-50 mg for 4 to 6 hours orally, at this point, if the patient keeps experiencing significant symptoms without any sign of dehydration, then metoclopramide, promethazine, or ondansetron will be administered orally, in a case of dehydration on the other hand, intravenous fluid boluses or persistent infusions of regular saline must be administered in addition to intravenous ondansetron, metoclopramide or promethazine.
References.
https://www.ncbi.nlm.nih.gov/books/NBK532917/
https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-022-04922-6
https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-019-2344-1
https://karger.com/pha/article/100/3-4/161/267137/Hyperemesis-Gravidarum-A-Review-of-Recent
Hi, I am Tobi a writer, speaker, relationship blogger, and lover of good music. I love making friends and learning from people. Want to hear me speak on relationships and general life issues, you can find my youtube channel where you can listen and watch any episode for free, please, If do not forget to subscribe, friends. I sincerely appreciate every love I get from here, kindly do well to keep them coming.