Hyperemesis Gravidarum Awareness Day was Sunday May 15.
However, it should be EVERY day!
In 1979, a young twenty-three year old was expecting
her first child. During her first
trimester, she experienced the typical morning sickness. At the cusp between second and third
trimester, this young woman developed severe nausea and vomiting. The severity was overwhelming to the point
that she had to bring a “barf bag” with her wherever she went. When she (a med-surg nurse) brought it to her
obstetrician’s attention, he turned a blind eye, said hyperemesis gravidarum
didn’t really exist, it was all in her head and handed her “water pills” to
relieve the pitting edema in her calves, ankles and feet. Fortunately, this young woman gave birth
vaginally and had a healthy baby girl.
However, on the day of discharge from the hospital, her obstetrician
told her that she would not be able to breastfeed because the water pills had
dried up all of her milk.
According
to Medscape, hyperemesis gravidarum (HG) is the most severe form of nausea and
vomiting in pregnancy, characterized by persistent nausea and vomiting
associated with ketosis, dehydration and weight loss (>5% of prepregnancy
weight). This condition may cause volume depletion, electrolytes and acid-base
imbalances, nutritional deficiencies, and even death. Severe hyperemesis
requiring hospital admission occurs in 0.3-2% of pregnancies.
The
HER Foundation (Hyperemesis Education & Research Foundation:
www.helpher.org) is a non-profit organization that has been dedicated to HG
support, education, research and advocacy since 2003. The HER Foundation says there is no clear
etiology for HG and it could even be due to multiple causes. When first
recognized several centuries ago, HG was thought to be caused by toxins,
ulcerations or an infection. In the 20th
century it was decided that HG was a psychological condition. Today, lab tests can be done to confirm
hyperemesis gravidarum. These tests
include urinalysis for ketones and specific gravity, serum levels of electrolytes
and ketones, TSH and free T, and hematocrit levels to name a few.
The
only FDA approved drug for treating nausea and vomiting in pregnancy is
pyridoxine or Vitamin B6. Herbals such
as ginger may also be helpful, but not in all cases. In severe cases, antiemetics, corticosteroids
or antihistamines may also be used. Nutritional
supplementations either by IV or directly into the GI system may help with
nutritional deficiencies.
There
are several handouts available from the HER Foundation and the University of
Southern California:
Remember
that young nurse from 1979? She went on
to become a childbirth educator so that other mothers could be aware of
HG. She also successfully breastfed her
first baby, thanks to the local La Leche League. That young woman was me.
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